Skull

  • from the front

  • 1

    Anterior nasal spine

  • 2

    Body of mandible

  • 3

    Frontal bone

  • 4

    Frontal notch

  • 5

    Frontal process of maxilla

  • 6

    Glabella

  • 7

    Greater wing of sphenoid bone

  • 8

    Infra-orbital foramen

  • 9

    Infra-orbital margin

  • 10

    Inferior nasal concha

  • 11

    Inferior orbital fissure

  • 12

    Lacrimal bone

  • 13

    Lesser wing of sphenoid bone

  • 14

    Maxilla

  • 15

    Mental foramen

  • 16

    Mental protuberance

  • 17

    Middle nasal concha

  • 18

    Nasal bone

  • 19

    Nasal septum

  • 20

    Nasion

  • 21

    Orbit (orbital cavity)

  • 22

    Ramus of mandible

  • 23

    Superior orbital fissure

  • 24

    Supra-orbital foramen

  • 25

    Supra-orbital margin

  • 26

    Zygomatic bone

The term ‘skull’ includes the mandible, and ‘cranium’ refers to the skull without the mandible.

The calvarium is the vault of the skull (cranial vault or skull-cap) and is the upper part of the cranium that encloses the brain.

The front part of the skull forms the facial skeleton.

The supra-orbital, infra-orbital and mental foramina (24, 8 and 15) lie in approximately the same vertical plane.

Details of individual skull bones are given on pages 18–27 , of the bones of the orbit and nose on page 12 , and of the teeth on pages 13 and 16–19 .

Tripod fracture

Skull

  • muscle attachments, from the front

  • 1

    Buccinator

  • 2

    Corrugator supercilii

  • 3

    Depressor anguli oris

  • 4

    Depressor labii inferioris

  • 5

    Levator anguli oris

  • 6

    Levator labii superioris

  • 7

    Levator labii superioris alaeque nasi

  • 8

    Masseter

  • 9

    Mentalis

  • 10

    Nasalis

  • 11

    Orbicularis oculi

  • 12

    Platysma

  • 13

    Procerus

  • 14

    Temporalis

  • 15

    Zygomaticus major

  • 16

    Zygomaticus minor

Skull

  • radiograph, occipitofrontal 15° projection

  • 1

    Basi-occiput

  • 2

    Body of sphenoid

  • 3

    Crista galli

  • 4

    Ethmoidal air cells

  • 5

    Floor of maxillary sinus (antrum)

  • 6

    Foramen rotundum

  • 7

    Frontal sinus

  • 8

    Greater wing of sphenoid

  • 9

    Internal acoustic meatus

  • 10

    Lambdoid suture

  • 11

    Lateral mass of atlas (first cervical vertebra)

  • 12

    Lesser wing of sphenoid

  • 13

    Mastoid process

  • 14

    Nasal septum

Skull

  • from the right

  • 1

    Anterior lacrimal crest

  • 2

    Anterior nasal spine with tympanic ring

  • 3

    Body of mandible

  • 4

    Condylar process of the mandible

  • 5

    Coronal suture

  • 6

    Coronoid process of mandible

  • 7

    External acoustic meatus of temporal bone

  • 8

    External occipital protuberance (inion)

  • 9

    Fossa for lacrimal sac

  • 10

    Frontal bone

  • 11

    Frontal process of maxilla

  • 12

    Frontozygomatic suture

  • 13

    Glabella

  • 14

    Greater wing of sphenoid bone

  • 15

    Inferior temporal line

  • 16

    Lacrimal bone

  • 17

    Lambdoid suture

  • 18

    Mastoid process of temporal bone

  • 19

    Maxilla

  • 20

    Mental foramen

  • 21

    Mental protuberance

  • 22

    Nasal bone

  • 23

    Nasion

  • 24

    Occipital bone

  • 25

    Orbital plate of ethmoid bone

  • 26

    Parietal bone

  • 27

    Pituitary fossa (sella turcica) (see Figure A on page 5 )

  • 28

    Posterior lacrimal crest

  • 29

    Pterion (encircled)

  • 30

    Ramus of mandible

  • 31

    Squamous part of temporal bone

  • 32

    Styloid process of temporal bone

  • 33

    Superior temporal line

  • 34

    Tympanic part of temporal bone

  • 35

    Zygomatic arch

  • 36

    Zygomatic bone

  • 37

    Zygomatic process of temporal bone

Pterion (29) is not a single point but an area where the frontal (10), parietal (26), squamous part of the temporal (31) and greater wing of the sphenoid bone (14) adjoin one another.

It is an important landmark for the anterior branch of the middle meningeal artery, which underlies this area on the inside of the skull ( page 17 ).

Extradural haemorrhage

Skull

  • A

    radiograph, lateral projection

  • B

    coloured bones

  • 1

    Aponeurosis of occipitofrontalis

  • 2

    Dura mater

  • 3

    Frontalis muscle (covered by loose areolar tissue)

  • 4

    Loose areolar tissue

  • 5

    Middle meningeal artery impression on dura mater

  • 6

    Parietal branch of the superficial temporal artery

  • 7

    Periosteum

  • 8

    Skin

  • 9

    Subcutaneous tissue

  • 10

    Temporal bone

  • 11

    Temporal fascia

  • 12

    Temporalis muscle

  • C

    scalp dissection

Scalp layers

S, skin; C, connective tissue; A, aponeurosis of occipitofrontalis; L, loose areolar tissue; P, periosteum.

See label list on page 4 for A and B labels

Skull

  • muscle attachments, from the right

  • 1

    Buccinator

  • 2

    Corrugator supercilii

  • 3

    Depressor anguli oris

  • 4

    Depressor labii inferioris

  • 5

    Levator anguli oris

  • 6

    Levator labii superioris

  • 7

    Levator labii superioris alaeque nasi

  • 8

    Masseter

  • 9

    Nasalis

  • 10

    Occipital part of occipitofrontalis

  • 11

    Orbicularis oculi

  • 12

    Platysma

  • 13

    Procerus

  • 14

    Sternocleidomastoid

  • 15

    Temporalis

  • 16

    Temporomandibular joint

  • 17

    Zygomaticus major

  • 18

    Zygomaticus minor

The bony attachments of the buccinator muscle (1) are to the upper and lower jaws (maxilla and mandible) opposite the three molar teeth. (The teeth are identified on page 13 .)

The upper attachment of temporalis (upper 15) occupies the temporal fossa (the narrow space above the zygomatic arch at the side of the skull). The lower attachment of temporalis (lower 15) extends from the lowest part of the mandibular notch of the mandible, over the coronoid process and down the front of the ramus almost as far as the last molar tooth.

Masseter (8) extends from the zygomatic arch to the lateral side of the ramus of the mandible.

Temporomandibular joint (TMJ) dislocation

Skull

  • from behind

  • 1

    External occipital protuberance (inion)

  • 2

    Highest nuchal line

  • 3

    Inferior nuchal line

  • 4

    Lambda

  • 5

    Lambdoid suture

  • 6

    Occipital bone

  • 7

    Parietal bone

  • 8

    Parietal foramina

  • 9

    Sagittal suture

  • 10

    Superior nuchal line

See label list below for C and D.

Skull

  • right infratemporal region, obliquely from below

  • 1

    Articular tubercle

  • 2

    External acoustic meatus

  • 3

    Horizontal plate of palatine bone

  • 4

    Inferior orbital fissure

  • 5

    Infratemporal crest

  • 6

    Infratemporal (posterior) surface of maxilla

  • 7

    Infratemporal surface of greater wing of sphenoid bone

  • 8

    Lateral pterygoid plate

  • 9

    Mandibular fossa

  • 10

    Mastoid notch

  • 11

    Mastoid process

  • 12

    Medial pterygoid plate

  • 13

    Occipital condyle

  • 14

    Occipital groove

  • 15

    Pterygoid hamulus

  • 16

    Pterygomaxillary fissure and pterygopalatine fossa

  • 17

    Pyramidal process of palatine bone

  • 18

    Spine of sphenoid bone

  • 19

    Styloid process

  • 20

    Third maxillary molar tooth

  • 21

    Tuberosity of maxilla

  • 22

    Vomer

  • 23

    Zygomatic arch

Skull

  • from above

  • 1

    Bregma

  • 2

    Coronal suture

  • 3

    Frontal bone

  • 4

    Lambda

  • 5

    Lambdoid suture

  • 6

    Occipital bone

  • 7

    Parietal bone

  • 8

    Parietal eminence

  • 9

    Parietal foramen

  • 10

    Sagittal suture

In this skull, the parietal eminences are prominent (A8).

The point where the sagittal suture (A10) meets the coronal suture (A2) is the bregma (A1). At birth, the unossified parts of the frontal and parietal bones in this region form the membranous anterior fontanelle ( page 14 , D1).

The point where the sagittal suture (A10) meets the lambdoid suture (A5) is the lambda (A4). At birth, the unossified parts of the parietal and occipital bones in this region form the membranous posterior fontanelle ( page 14 , C13).

The label A3 in the centre of the frontal bone indicates the line of the frontal suture in the fetal skull ( page 14 , A5). The suture may persist in the adult skull and is sometimes known as the metopic suture.

The arachnoid granulations ( page 62 , B1), through which cerebrospinal fluid drains into the superior sagittal sinus, cause the irregular depressions (B2) on the parts of the frontal and parietal bones (B3 and 7) that overlie the sinus.

Skull

  • internal surface of the cranial vault, central part

  • 1

    Coronal suture

  • 2

    Depressions for arachnoid granulations

  • 3

    Frontal bone

  • 4

    Frontal crest

  • 5

    Groove for superior sagittal sinus

  • 6

    Grooves for middle meningeal vessels

  • 7

    Parietal bone

  • 8

    Parietal foramina

  • 9

    Sagittal suture

Pepperpot skull

Skull

  • external surface of the base

  • 1

    Apex of petrous part of temporal bone

  • 2

    Articular tubercle

  • 3

    Carotid canal

  • 4

    Condylar canal (posterior)

  • 5

    Edge of tegmen tympani

  • 6

    External acoustic meatus

  • 7

    External occipital crest

  • 8

    External occipital protuberance

  • 9

    Foramen lacerum

  • 10

    Foramen magnum

  • 11

    Foramen ovale

  • 12

    Foramen spinosum

  • 13

    Greater palatine foramen

  • 14

    Horizontal plate of palatine bone

  • 15

    Hypoglossal canal (proximal & distal openings)

  • 16

    Incisive fossa

  • 17

    Inferior nuchal line

  • 18

    Inferior orbital fissure

  • 19

    Infratemporal crest of greater wing of sphenoid bone

  • 20

    Jugular foramen

  • 21

    Lateral pterygoid plate

  • 22

    Lesser palatine foramina

  • 23

    Mandibular fossa

  • 24

    Mastoid foramen

  • 25

    Mastoid notch

  • 26

    Mastoid process

  • 27

    Medial pterygoid plate

  • 28

    Median palatine (intermaxillary) suture

  • 29

    Occipital condyle

  • 30

    Occipital groove

  • 31

    Palatine grooves and spines

  • 32

    Palatine process of maxilla

  • 33

    Pharyngeal canal

  • 34

    Petrosquamous fissure

  • 35

    Petrotympanic fissure

  • 36

    Pharyngeal tubercle

  • 37

    Posterior border of vomer

  • 38

    Posterior nasal aperture (choana)

  • 39

    Posterior nasal spine

  • 40

    Pterygoid hamulus

  • 41

    Pyramidal process of palatine bone

  • 42

    Scaphoid fossa

  • 43

    Spine of sphenoid bone

  • 44

    Squamotympanic fissure

  • 45

    Squamous part of temporal bone

  • 46

    Styloid process

  • 47

    Stylomastoid foramen

  • 48

    Superior nuchal line

  • 49

    Transverse palatine (palatomaxillary) suture

  • 50

    Tuberosity of maxilla

  • 51

    Tympanic part of temporal bone

  • 52

    Vomerovaginal canal

  • 53

    Zygomatic arch

The palatine processes of the maxilla (32) and the horizontal plate of the palatine bone (14) form the hard palate (roof of the mouth and floor of the nasal cavity).

The carotid canal (3), recognized by its round shape on the inferior surface of the petrous part of the temporal bone, does not pass straight upwards to open into the inside of the skull but takes a right-angled turn forwards and medially within the petrous temporal to open into the back of the foramen lacerum (9).

Intracranial spread of infection – face

Intracranial spread of infection – scalp

Skull

  • muscle attachments, external surface of the base

Green line = capsule attachments of atlanto-occipital and temporomandibular joints

  • 1

    Capsule attachment of atlanto-occipital joint

  • 2

    Capsule attachment of temporomandibular joint

  • 3

    Deep head of medial pterygoid

  • 4

    Levator veli palatini

  • 5

    Longissimus capitis

  • 6

    Longus capitis

  • 7

    Masseter

  • 8

    Musculus uvulae

  • 9

    Occipital part of occipitofrontalis

  • 10

    Palatopharyngeus

  • 11

    Pharyngeal raphe

  • 12

    Posterior belly of digastric

  • 13

    Rectus capitis anterior

  • 14

    Rectus capitis lateralis

  • 15

    Rectus capitis posterior major

  • 16

    Rectus capitis posterior minor

  • 17

    Semispinalis capitis

  • 18

    Splenius capitis

  • 19

    Sternocleidomastoid

  • 20

    Styloglossus

  • 21

    Stylohyoid

  • 22

    Stylopharyngeus

  • 23

    Superficial head of medial pterygoid

  • 24

    Superior constrictor

  • 25

    Superior oblique capitis

  • 26

    Tensor tympani

  • 27

    Tensor veli palatini

  • 28

    Trapezius

  • 29

    Upper head of lateral pterygoid

The medial pterygoid plate has no pterygoid muscles attached to it. It passes straight backwards, giving origin at its lower end to part of the superior constrictor of the pharynx (24).

The lateral pterygoid plate has both pterygoid muscles attached to it: medial and lateral muscles from the medial and lateral surfaces, respectively (3 and 29). The plate becomes twisted slightly laterally because of the constant pull of these muscles which pass backwards and laterally to their attachments to the mandible ( pages 18–19 ).

Skull fracture

Skull

  • internal surface of the base (cranial fossae)

  • 1

    Anterior clinoid process

  • 2

    Arcuate eminence

  • 3

    Carotid groove

  • 4

    Clivus

  • 5

    Cribriform plate of ethmoid bone

  • 6

    Crista galli

  • 7

    Diploë

  • 8

    Dorsum sellae

  • 9

    Foramen caecum

  • 10

    Foramen lacerum

  • 11

    Foramen magnum

  • 12

    Foramen ovale

  • 13

    Foramen rotundum

  • 14

    Foramen spinosum

  • 15

    Frontal crest

  • 16

    Frontal sinus

  • 17

    Greater wing of sphenoid bone

  • 18

    Groove for anterior ethmoidal nerve and vessels

  • 19

    Groove for inferior petrosal sinus

  • 20

    Groove for sigmoid sinus

  • 21

    Groove for superior petrosal sinus

  • 22

    Groove for superior sagittal sinus

  • 23

    Groove for transverse sinus

  • 24

    Grooves for middle meningeal vessels

  • 25

    Hiatus and groove for greater petrosal nerve

  • 26

    Hiatus and groove for lesser petrosal nerve

  • 27

    Hypoglossal canal

  • 28

    Internal acoustic meatus

  • 29

    Internal occipital protuberance (position of confluence of sinuses)

  • 30

    Jugular foramen

  • 31

    Jugum of sphenoid bone

  • 32

    Lesser wing of sphenoid bone

  • 33

    Occipital bone (cerebellar fossa)

  • 34

    Optic canal

  • 35

    Orbital part of frontal bone

  • 36

    Parietal bone (postero-inferior angle only)

  • 37

    Petrous part of temporal bone

  • 38

    Pituitary fossa (sella turcica)

  • 39

    Posterior clinoid process

  • 40

    Prechiasmatic groove

  • 41

    Squamous part of temporal bone

  • 42

    Superior orbital fissure

  • 43

    Tegmen tympani

  • 44

    Trigeminal impression

  • 45

    Tuberculum sellae

  • 46

    Venous (emissary) foramen

The anterior cranial fossa (ACF) is limited posteriorly on each side by the free margin of the lesser wing of the sphenoid (32) with its anterior clinoid process (1), and centrally by the anterior margin of the prechiasmatic groove (40).

The middle cranial fossa (MCF) is butterfly-shaped and consists of a central or median part and right and left lateral parts. The central part includes the pituitary fossa (38) on the upper surface of the body of the sphenoid, with the prechiasmatic groove (40) in front and the dorsum sellae (8) with its posterior clinoid processes (39) behind. Each lateral part extends from the posterior border of the lesser wing of the sphenoid (32) to the groove for the superior petrosal sinus (21) on the upper edge of the petrous part of the temporal bone.

The posterior cranial fossa (PCF), whose most obvious feature is the foramen magnum (11), is behind the dorsum sellae (8) and the grooves for the superior petrosal sinuses (21).

For cranial dural attachments and reflections, see pages 59–62 .

Anosmia

Skull base fracture

Skull

  • bones of the left orbit

  • 1

    Anterior ethmoidal foramen

  • 2

    Anterior lacrimal crest

  • 3

    Body of sphenoid bone, forming medial wall

  • 4

    Fossa for lacrimal sac

  • 5

    Frontal notch

  • 6

    Frontal process of maxilla, forming medial wall

  • 7

    Greater wing of sphenoid bone, forming lateral wall

  • 8

    Inferior orbital fissure

  • 9

    Infra-orbital foramen

  • 10

    Infra-orbital groove

  • 11

    Lacrimal bone, forming medial wall

  • 12

    Lesser wing of sphenoid bone, forming roof

  • 13

    Marginal tubercle

  • 14

    Maxilla, forming floor

  • 15

    Nasolacrimal canal

  • 16

    Optic canal

  • 17

    Orbital border of zygomatic bone, forming floor

  • 18

    Orbital part of frontal bone, forming roof

  • 19

    Orbital plate of ethmoid bone, forming medial wall

  • 20

    Orbital process of palatine bone, forming floor

  • 21

    Posterior ethmoidal foramen

  • 22

    Posterior lacrimal crest

  • 23

    Superior orbital fissure

  • 24

    Supra-orbital foramen

  • 25

    Zygomatic bone forming lateral wall

  • 26

    Zygomatico-orbital foramen

Nasal cavity

  • lateral wall

In this midline sagittal section of the skull, with the nasal septum removed, the superior and middle nasal conchae have been dissected away to reveal the air cells of the ethmoidal sinus, in particular the ethmoidal bulla (5).

  • 1

    Air cells of ethmoidal sinus

  • 2

    Clivus

  • 3

    Cribriform plate of ethmoid bone

  • 4

    Dorsum sellae

  • 5

    Ethmoidal bulla

  • 6

    Frontal sinus

  • 7

    Horizontal plate of palatine bone

  • 8

    Incisive canal

  • 9

    Inferior meatus

  • 10

    Inferior nasal concha

  • 11

    Lateral pterygoid plate

  • 12

    Left sphenoidal sinus

  • 13

    Medial pterygoid plate

  • 14

    Nasal bone

  • 15

    Nasal spine of frontal bone

  • 16

    Opening of maxillary sinus (maxillary antrum)

  • 17

    Palatine process of maxilla

  • 18

    Perpendicular plate of palatine bone

  • 19

    Pituitary fossa (sella turcica)

  • 20

    Pterygoid hamulus

  • 21

    Right sphenoidal sinus

  • 22

    Semilunar hiatus

  • 23

    Sphenopalatine foramen

  • 24

    Uncinate process of ethmoid bone

The roof of the nasal cavity consists mainly of the cribriform plate of the ethmoid bone (B3) with the body of the sphenoid containing the sphenoidal sinuses (B21 and 12) behind, and the nasal bone (B14) and the nasal spine of the frontal bone (B15) at the front.

The floor of the cavity consists of the palatine process of the maxilla (B17) and the horizontal plate of the palatine bone (B7).

The medial wall is the nasal septum which is formed mainly by two bones – the perpendicular plate of the ethmoid and the vomer – and the septal cartilage.

The lateral wall consists of the medial surface of the maxilla with its large opening (B16), overlapped from above by parts of the ethmoid (B1, 5 and 24) and lacrimal bones, from behind by the perpendicular plate of the palatine (B18), and below by the inferior concha (B10).

Skull

  • Left orbit, individual bones

  • 1

    Ethmoid

  • 2

    Frontal

  • 3

    Lacrimal

  • 4

    Mandible

  • 5

    Maxilla

  • 6

    Nasal

  • 7

    Palatine

  • 8

    Sphenoid

  • 9

    Temporal

  • 10

    Zygomatic

Sinus pathology

Permanent teeth

  • from the left and in front

  • 1

    First (central) incisor

  • 2

    Second (lateral) incisor

  • 3

    Canine

  • 4

    First premolar

  • 5

    Second premolar

  • 6

    First molar

  • 7

    Second molar

  • 8

    Third molar (wisdom tooth)

The corresponding teeth of the upper and lower jaws have similar names. In clinical dentistry, the teeth are usually identified by the numbers 1–8 (as listed here) rather than by name.

The third molar is sometimes called the wisdom tooth.

Upper and lower jaws

  • from the left and in front

    • E

      orthopantomogram in a 6-year-old child

    • F

      in a 4-year-old child with erupted deciduous teeth and unerupted permanent teeth

  • 1

    First (central) incisor of deciduous dentition

  • 2

    Second (lateral) incisor of deciduous dentition

  • 3

    Canine of deciduous dentition

  • 4

    First molar of deciduous dentition

  • 5

    Second molar of deciduous dentition

  • 6

    First (central) incisor of permanent dentition

  • 7

    Second (lateral) incisor of permanent dentition

  • 8

    Canine of permanent dentition

  • 9

    First premolar of permanent dentition

  • 10

    Second premolar of permanent dentition

  • 11

    First molar of permanent dentition

  • 12

    Second molar of permanent dentition

The deciduous molars occupy the positions of the premolars of the permanent dentition.

Edentulous mandible

  • in old age, from the left

  • 1

    Angle

  • 2

    Body

  • 3

    Mental foramen

  • 4

    Ramus

With the loss of teeth, the alveolar bone becomes resorbed, so that the mental foramen (3) and mandibular canal lie near the upper margin of the bone.

The angle (1) between the ramus (4) and body (2) becomes more obtuse, resembling the infantile angle (as in E and F, above).

Skull of a full-term fetus

  • A

    from the front

  • B

    from the left and slightly below

  • C

    from behind

  • D

    from above

  • 1

    Anterior fontanelle

  • 2

    Coronal suture

  • 3

    Elevations over deciduous teeth in body of mandible

  • 4

    External acoustic meatus

  • 5

    Frontal suture (metopic suture)

  • 6

    Frontal tuberosity

  • 7

    Half of frontal bone

  • 8

    Lambdoid suture

  • 9

    Mastoid fontanelle

  • 10

    Maxilla

  • 11

    Occipital bone

  • 12

    Parietal tuberosity

  • 13

    Posterior fontanelle

  • 14

    Ramus of mandible

  • 15

    Sagittal suture

  • 16

    Sella turcica

  • 17

    Semicircular canals, superior

  • 18

    Sphenoidal fontanelle

  • 19

    Stylomastoid foramen

  • 20

    Symphysis menti

  • 21

    Tympanic ring

Cleft lip and palate

Fetal skull radiographs

  • E

    frontal projection

  • F

    lateral projection

The face at birth forms a relatively smaller proportion of the cranium than in the adult (about one-eighth compared with one-half) because of the small size of the nasal cavity and maxillary sinuses and the lack of erupted teeth.

The posterior fontanelle (C13, E13) closes about 2 months after birth, the anterior fontanelle (A1, D1, F1) in the second year.

Owing to the lack of the mastoid process (which does not develop until the second year), the stylomastoid foramen (B19) and the emerging facial nerve are relatively near the surface and unprotected.

Resin cast of head and neck arteries

  • full-term fetus, from the left

In this cast of fetal arteries, note in the front of the neck the dense arterial pattern indicating the thyroid gland (G), and above and in front of it the fine vessels outlining the tongue (T).

Hydrocephalus

Scalp wounds

Skull

  • A

    coloured left half of the skull in sagittal section

  • A

    Superior nasal concha

  • B

    Middle nasal concha

  • C

    Inferior nasal concha

  • D

    Palatine bone

See page 17 for additional label numbers.

NB: The perpendicular plate of the ethmoid has been removed to expose the conchae.

  • B

    cleared specimen from the front, illuminated from behind

  • C

    radiograph of facial bones, occipitofrontal view

Compare with the skull on [CR] .

  • 1

    Body of mandible

  • 2

    Crista galli

  • 3

    Ethmoidal air cells

  • 4

    Frontal crest

  • 5

    Frontal sinus

  • 6

    Greater wing of sphenoid bone

  • 7

    Inferior nasal concha

  • 8

    Infra-orbital margin

  • 9

    Lesser wing of sphenoid bone

  • 10

    Mastoid process

  • 11

    Maxillary sinus

  • 12

    Mental foramen

  • 13

    Nasal septum

  • 14

    Ramus of mandible

  • 15

    Root of lower lateral incisor

  • 16

    Root of upper central incisor

  • 17

    Superior orbital fissure

  • 18

    Supra-orbital margin

  • 19

    Zygomatic arch

Blow-out fractures of the orbit

Mastoiditis

Skull

  • left half of the skull in sagittal section

The inside of the left half of the skull is seen from the right, with the bony part of the nasal septum (36 and 45) preserved.

  • 1

    Alveolar process of maxilla

  • 2

    Angle of mandible

  • 3

    Body of mandible

  • 4

    Clivus

  • 5

    Coronal suture

  • 6

    Crista galli of ethmoid bone

  • 7

    Dorsum sellae

  • 8

    External occipital protuberance

  • 9

    Frontal sinus

  • 10

    Groove for mylohyoid nerve

  • 11

    Groove for sigmoid sinus

  • 12

    Groove for superior petrosal sinus

  • 13

    Groove for transverse sinus

  • 14

    Grooves for middle meningeal vessels (anterior division)

  • 15

    Horizontal plate of palatine bone

  • 16

    Hypoglossal canal

  • 17

    Incisive canal

  • 18

    Internal acoustic meatus in petrous part of temporal bone

  • 19

    Internal occipital protuberance

  • 20

    Lambdoid suture

  • 21

    Lateral pterygoid plate

  • 22

    Left sphenoidal sinus

  • 23

    Lingula

  • 24

    Mandibular foramen

  • 25

    Margin of foramen magnum

  • 26

    Mastoid (posterior inferior) angle of parietal bone

  • 27

    Medial pterygoid plate

  • 28

    Mental protuberance

  • 29

    Mylohyoid line

  • 30

    Nasal bone

  • 31

    Occipital bone

  • 32

    Occipital condyle

  • 33

    Orbital part of frontal bone

  • 34

    Palatine process of maxilla

  • 35

    Parietal bone

  • 36

    Perpendicular plate of ethmoid bone

  • 37

    Pituitary fossa (sella turcica)

  • 38

    Posterior nasal aperture (choana)

  • 39

    Pterion (encircled)

  • 40

    Pterygoid hamulus of medial pterygoid plate

  • 41

    Ramus of mandible

  • 42

    Right sphenoidal sinus

  • 43

    Squamous part of frontal bone

  • 44

    Squamous part of temporal bone

  • 45

    Vomer

The bony part of the nasal septum consists of the vomer (45) and the perpendicular plate of the ethmoid bone (36). The anterior part of the septum consists of the septal cartilage ( pages 60 and 61 ).

In this skull, the sphenoidal sinuses (42 and 22) are large, and the right one (42) has extended to the left of the midline. The pituitary fossa (37) projects down into the left sinus (22).

The grooves for the middle meningeal vessels (14) pass upwards and backwards. The circle (39) marks the region of the pterion, and corresponds to the position shown on the outside of the skull on page 4 .

Extradural haemorrhage

Pituitary tumour

Mandible

  • A

    from the front

  • B

    from behind

  • C

    from the left and front

  • D

    internal view from the left

  • 1

    Alveolar part

  • 2

    Angle

  • 3

    Anterior border of ramus

  • 4

    Base

  • 5

    Body

  • 6

    Coronoid process

  • 7

    Digastric fossa

  • 8

    Head

  • 9

    Inferior border of ramus

  • 10

    Lingula

  • 11

    Mandibular foramen

  • 12

    Mandibular notch

  • 13

    Mental foramen

  • 14

    Mental protuberance

  • 15

    Mental tubercle

  • 16

    Mylohyoid groove

  • 17

    Mylohyoid line

  • 18

    Neck

  • 19

    Oblique line

  • 20

    Posterior border of ramus

  • 21

    Pterygoid fovea

  • 22

    Ramus

  • 23

    Sublingual fossa

  • 24

    Submandibular fossa

  • 25

    Superior and inferior mental spines (genial tubercles)

The head (8) and the neck (18, including the pterygoid fovea, 21) constitute the condyle.

The alveolar part (1) contains the sockets for the roots of the teeth.

The base (4) is the inferior border of the body (5), and becomes continuous with the inferior border (9) of the ramus (22).

Impacted wisdom tooth

Mastoiditis

Orthopantomogram

Mandible

  • muscle attachments

  • A

    from the front

  • B

    from behind

  • C

    from the left and front

  • D

    internal view from the left

Green line = capsular attachment of temporomandibular joint; blue line = limit of attachment of the oral mucous membrane; pale green line = ligament attachment

  • 1

    Anterior belly of digastric

  • 2

    Buccinator

  • 3

    Depressor anguli oris

  • 4

    Depressor labii inferioris

  • 5

    Genioglossus

  • 6

    Geniohyoid

  • 7

    Lateral pterygoid

  • 8

    Masseter

  • 9

    Medial pterygoid

  • 10

    Mentalis

  • 11

    Mylohyoid

  • 12

    Platysma

  • 13

    Pterygomandibular raphe and superior constrictor

  • 14

    Sphenomandibular ligament

  • 15

    Stylomandibular ligament

  • 16

    Temporalis

The lateral pterygoid (A7) is attached to the pterygoid fovea on the neck of the mandible (and also to the capsule of the temporomandibular joint and the articular disc – see page 42 , A27, A28).

The medial pterygoid (B9, C9) is attached to the medial surface of the angle of the mandible, below the groove for the mylohyoid nerve.

Masseter (C8) is attached to the lateral surface of the ramus.

Temporalis (C16) is attached over the coronoid process, extending back as far as the deepest part of the mandibular notch and downwards over the front of the ramus almost as far as the last molar tooth.

Buccinator (C2) is attached opposite the three molar teeth, at the back reaching the pterygomandibular raphe (C13).

Genioglossus (B5) is attached to the superior mental spine and geniohyoid (B6) to the inferior mental spine.

Mylohyoid (11) is attached to the mylohyoid line.

The attachment of the lateral temporomandibular ligament to the lateral aspect of the neck of the condyle is not shown.

Fractured maxilla

Frontal bone

  • A

    external surface from the front

  • B

    external surface from the left

  • C

    from below

  • D

    internal surface from above and behind (right half not shown; ethmoidal notch is inferior)

  • 1

    Anterior ethmoidal canal (position of groove)

  • 2

    Ethmoidal notch

  • 3

    Foramen caecum

  • 4

    Fossa for lacrimal gland

  • 5

    Frontal crest

  • 6

    Frontal sinus

  • 7

    Frontal tuberosity

  • 8

    Glabella

  • 9

    Inferior temporal line

  • 10

    Nasal spine

  • 11

    Orbital part

  • 12

    Position of frontal notch or foramen

  • 13

    Posterior ethmoidal canal (position of groove)

  • 14

    Roof of ethmoidal air cells

  • 15

    Sagittal crest

  • 16

    Superciliary arch

  • 17

    Superior temporal line

  • 18

    Supra-orbital margin

  • 19

    Supra-orbital notch or foramen

  • 20

    Trochlear fovea (or tubercle)

  • 21

    Zygomatic process

Right maxilla

  • A

    from the front

  • B

    from the lateral side

  • C

    from the medial side

  • D

    from below

  • E

    from above

  • F

    from behind

  • 1

    Alveolar process

  • 2

    Anterior lacrimal crest

  • 3

    Anterior nasal spine

  • 4

    Anterior surface

  • 5

    Canine eminence

  • 6

    Canine fossa

  • 7

    Conchal crest

  • 8

    Ethmoidal crest

  • 9

    Frontal process

  • 10

    Greater palatine canal (position of groove)

  • 11

    Incisive canal

  • 12

    Incisive fossa

  • 13

    Inferior meatus

  • 14

    Infra-orbital canal

  • 15

    Infra-orbital foramen

  • 16

    Infra-orbital groove

  • 17

    Infra-orbital margin

  • 18

    Infratemporal surface

  • 19

    Lacrimal groove

  • 20

    Maxillary hiatus and sinus

  • 21

    Middle meatus

  • 22

    Nasal crest

  • 23

    Nasal notch

  • 24

    Orbital surface

  • 25

    Palatine process

  • 26

    Tuberosity

  • 27

    Unerupted third molar tooth

  • 28

    Zygomatic process

Right lacrimal bone

  • G

    from the lateral (orbital) side

  • H

    from the medial (nasal) side

    • 29

      Lacrimal groove

    • 30

      Lacrimal hamulus

    • 31

      Nasal surface

    • 32

      Orbital surface

    • 33

      Posterior lacrimal crest

Right nasal bone

  • J

    from the lateral side

  • K

    from the medial side

    • 34

      Internal surface and groove for anterior ethmoidal nerve

    • 35

      Lateral surface

Right palatine bone

  • A

    from the medial side

  • B

    from the lateral side

  • C

    from the front

  • D

    from behind

  • E

    from above

  • F

    from below

  • 1

    Conchal crest

  • 2

    Ethmoidal crest

  • 3

    Greater palatine groove

  • 4

    Horizontal plate

  • 5

    Lesser palatine canals

  • 6

    Maxillary process

  • 7

    Nasal crest

  • 8

    Orbital process

  • 9

    Perpendicular plate

  • 10

    Posterior nasal spine

  • 11

    Pyramidal process

  • 12

    Sphenoidal process

  • 13

    Sphenopalatine notch

  • G

    Articulation of the right maxilla and the palatine bone, from the medial side

  • 1

    Horizontal plate of palatine

  • 2

    Maxillary process of palatine

  • 3

    Palatine process of maxilla

Right temporal bone

  • A

    external aspect

  • B

    internal aspect

  • C

    from above

  • D

    from below

  • E

    from the front

  • 1

    Aqueduct of vestibule

  • 2

    Arcuate eminence

  • 3

    Articular tubercle

  • 4

    Auditory (eustachian) tube

  • 5

    Canal for tensor tympani

  • 6

    Canaliculus for tympanic branch of glossopharyngeal nerve

  • 7

    Carotid canal

  • 8

    Cochlear canaliculus

  • 9

    Edge of tegmen tympani

  • 10

    External acoustic meatus

  • 11

    Groove for middle temporal artery

  • 12

    Groove for sigmoid sinus

  • 13

    Groove for superior petrosal sinus

  • 14

    Grooves for branches of middle meningeal vessels

  • 15

    Hiatus and groove for greater petrosal nerve

  • 16

    Hiatus and groove for lesser petrosal nerve

  • 17

    Internal acoustic meatus

  • 18

    Jugular fossa

  • 19

    Jugular surface

  • 20

    Mandibular fossa

  • 21

    Mastoid canaliculus for auricular branch of vagus nerve

  • 22

    Mastoid notch

  • 23

    Mastoid process

  • 24

    Occipital groove

  • 25

    Parietal notch

  • 26

    Petrosquamous fissure (from above)

  • 27

    Petrosquamous fissure (from below)

  • 28

    Petrotympanic fissure

  • 29

    Petrous part

  • 30

    Postglenoid tubercle

  • 31

    Sheath of styloid process

  • 32

    Squamotympanic fissure

  • 33

    Squamous part

  • 34

    Styloid process

  • 35

    Stylomastoid foramen

  • 36

    Subarcuate fossa

  • 37

    Suprameatal triangle

  • 38

    Tegmen tympani

  • 39

    Trigeminal impression on apex of petrous part

  • 40

    Tympanic part

  • 41

    Zygomatic process

Right parietal bone

  • A

    external surface

  • B

    internal surface

  • 1

    Frontal (anterior) border

  • 2

    Frontal (antero-superior) angle

  • 3

    Furrows for frontal branch of middle meningeal vessels (anterior division)

  • 4

    Furrows for parietal branch of middle meningeal vessels (posterior division)

  • 5

    Groove for sigmoid sinus at mastoid angle

  • 6

    Inferior temporal line

  • 7

    Mastoid (postero-inferior) angle

  • 8

    Occipital (posterior) border

  • 9

    Occipital (postero-superior) angle

  • 10

    Parietal foramen

  • 11

    Parietal tuberosity

  • 12

    Sagittal (superior) border

  • 13

    Sphenoidal (antero-inferior) angle

  • 14

    Squamosal (inferior) border

  • 15

    Superior temporal line

Right zygomatic bone

  • C

    lateral surface

  • D

    from the medial side

  • E

    from behind

  • 1

    Frontal process

  • 2

    Marginal tubercle

  • 3

    Maxillary border

  • 4

    Orbital border

  • 5

    Orbital surface

  • 6

    Temporal border

  • 7

    Temporal process

  • 8

    Temporal surface

  • 9

    Zygomatico-orbital foramen

  • 10

    Zygomaticofacial foramen

  • 11

    Zygomaticotemporal foramen

The zygomatic process of the temporal bone ( page 4 ) and the temporal process of the zygomatic bone (C7, D7) form the zygomatic arch ( page 4 , 38).

Sphenoid bone

  • A

    from the front

  • B

    from behind

  • C

    from above and behind

  • D

    from below

  • E

    from the left

Vomer

  • F

    from the right

  • G

    from behind

  • 1

    Ala of vomer

  • 2

    Anterior clinoid process

  • 3

    Body with openings of sphenoidal sinuses

  • 4

    Carotid groove

  • 5

    Cerebral surface of greater wing

  • 6

    Dorsum sellae

  • 7

    Ethmoidal spine

  • 8

    Foramen ovale

  • 9

    Foramen rotundum

  • 10

    Foramen spinosum

  • 11

    Groove for nasopalatine nerve and vessels

  • 12

    Infratemporal crest of greater wing

  • 13

    Infratemporal surface of greater wing

  • 14

    Jugum

  • 15

    Lateral pterygoid plate

  • 16

    Lesser wing

  • 17

    Medial pterygoid plate

  • 18

    Optic canal

  • 19

    Orbital surface of greater wing

  • 20

    Posterior border of vomer

  • 21

    Posterior clinoid process

  • 22

    Prechiasmatic groove

  • 23

    Pterygoid canal

  • 24

    Pterygoid hamulus

  • 25

    Pterygoid notch

  • 26

    Pterygoid process

  • 27

    Rostrum

  • 28

    Scaphoid fossa

  • 29

    Sella turcica (pituitary fossa)

  • 30

    Spine

  • 31

    Superior orbital fissure

  • 32

    Temporal surface of greater wing

  • 33

    Tuberculum sellae

  • 34

    Vaginal process

Ethmoid bone

  • A

    from above

  • B

    from the left

  • C

    from the front

  • D

    from the left, below and behind

  • 1

    Ala of crista galli

  • 2

    Anterior ethmoidal groove

  • 3

    Cribriform plate

  • 4

    Crista galli

  • 5

    Ethmoidal bulla

  • 6

    Ethmoidal labyrinth (containing ethmoidal air cells)

  • 7

    Middle nasal concha

  • 8

    Orbital plate

  • 9

    Perpendicular plate

  • 10

    Posterior ethmoidal groove

  • 11

    Superior nasal concha (meatus)

  • 12

    Uncinate process

Right inferior nasal concha

  • E

    from the lateral side

  • F

    from the medial side

  • G

    from behind

  • 1

    Anterior end

  • 2

    Ethmoidal process

  • 3

    Lacrimal process

  • 4

    Maxillary process

  • 5

    Medial surface

  • 6

    Posterior end

Maxilla

  • H

    Articulation of right maxilla, palatine bone and inferior nasal concha, from the medial side

  • 1

    Anterior end of inferior nasal concha

  • 2

    Ethmoidal process of inferior nasal concha

  • 3

    Frontal process of maxilla

  • 4

    Horizontal plate of palatine

  • 5

    Lacrimal process of inferior nasal concha

  • 6

    Palatine process of maxilla

  • 7

    Perpendicular plate of palatine

  • 8

    Posterior end of inferior nasal concha

Occipital bone

  • A

    external surface from below

  • B

    internal surface

  • C

    external surface from the right and below

  • D

    bones of the base of the skull

orange, occipital; red, temporal; blue, sphenoid

  • 1

    Basilar part

  • 2

    Cerebellar fossa

  • 3

    Cerebral fossa

  • 4

    Condylar fossa (and condylar canal in B and C)

  • 5

    Condyle

  • 6

    External occipital crest

  • 7

    External occipital protuberance

  • 8

    Foramen magnum

  • 9

    Groove for inferior petrosal sinus

  • 10

    Groove for sigmoid sinus

  • 11

    Groove for superior sagittal sinus

  • 12

    Groove for transverse sinus

  • 13

    Highest nuchal line

  • 14

    Hypoglossal canal

  • 15

    Inferior nuchal line

  • 16

    Internal occipital crest

  • 17

    Internal occipital protuberance

  • 18

    Jugular notch

  • 19

    Jugular process

  • 20

    Jugular tubercle

  • 21

    Lambdoid margin

  • 22

    Lateral angle

  • 23

    Lateral part

  • 24

    Mastoid margin

  • 25

    Pharyngeal tubercle

  • 26

    Squamous part

  • 27

    Superior angle

  • 28

    Superior nuchal line

Neck

  • surface markings of the front and right side

  • 1

    Accessory nerve emerging from sternocleidomastoid

  • 2

    Accessory nerve passing under anterior border of trapezius

  • 3

    Angle of mandible

  • 4

    Anterior border of masseter and facial artery

  • 5

    Anterior jugular vein

  • 6

    Arch of cricoid cartilage

  • 7

    Body of hyoid bone

  • 8

    Clavicle

  • 9

    Clavicular head of sternocleidomastoid

  • 10

    Deltoid

  • 11

    External jugular vein

  • 12

    Hypoglossal nerve

  • 13

    Inferior belly of omohyoid

  • 14

    Infraclavicular fossa and cephalic vein

  • 15

    Internal laryngeal nerve

  • 16

    Isthmus of thyroid gland

  • 17

    Jugular notch and trachea

  • 18

    Laryngeal prominence (Adam's apple)

  • 19

    Lowest part of parotid gland

  • 20

    Mastoid process

  • 21

    Pectoralis major

  • 22

    Site for palpation of common carotid artery

  • 23

    Sternal head of sternocleidomastoid

  • 24

    Sternoclavicular joint and union of internal jugular and subclavian veins to form brachiocephalic vein

  • 25

    Sternocleidomastoid

  • 26

    Submandibular gland

  • 27

    Tip of greater horn of hyoid bone

  • 28

    Tip of transverse process of atlas

  • 29

    Upper trunk of brachial plexus

  • 30

    Vocal cord position

The pulsation of the common carotid artery (22, opposite page, 8) can be felt by backward pressure in the angle between the lower anterior border of sternocleidomastoid and the side of the larynx and trachea.

The cricoid cartilage (6) is about 5 cm (2 in) above the jugular notch of the manubrium of the sternum (17).

The lower end of the internal jugular vein lies behind the interval between the sternal (23) and clavicular (9) heads of sternocleidomastoid (when viewed from the front), just above the point where it joins the subclavian vein to form the brachiocephalic vein (24).

The trunks of the brachial plexus (29) can be felt as a cord-like structure in the lower part of the posterior triangle.

Torticollis

Varicella-zoster virus infection – head and neck

Side of the neck

  • right side, deep dissection

The lingual nerve (27) lies superficial to hyoglossus (17) and at this level is a flattened band rather than a typical round nerve, with the deep part of the submandibular gland (10) below it. The nerve crosses underneath the submandibular duct (51), lying first lateral to the duct and then medial to it.

The thyrohyoid membrane (60) is pierced by the internal laryngeal nerve (23) and the superior laryngeal artery (55).

Apart from supplying muscles of the tongue, the hypoglossal nerve (19) gives branches to geniohyoid (14) and thyrohyoid (59) and forms the upper root of the ansa cervicalis (62). These three branches consist of the fibres from the first cervical nerve that have joined the hypoglossal nerve higher in the neck; they are not derived from the hypoglossal nucleus. The C1 fibres in the upper root of the ansa contribute to the supply of sternohyoid (45) and omohyoid (21, 54).

  • 1

    Accessory nerve

  • 2

    Anterior belly of digastric and nerve

  • 3

    Ascending palatine artery

  • 4

    Auriculotemporal nerve

  • 5

    Buccinator

  • 6

    Capsule of temporomandibular joint

  • 7

    Cervical nerves to trapezius

  • 8

    Common carotid artery

  • 9

    Deep lingual artery

  • 10

    Deep part of submandibular gland

  • 11

    External carotid artery

  • 12

    External laryngeal nerve

  • 13

    Facial artery

  • 14

    Geniohyoid

  • 15

    Glossopharyngeal nerve

  • 16

    Great auricular nerve

  • 17

    Hyoglossus

  • 18

    Hyoid bone

  • 19

    Hypoglossal nerve

  • 20

    Inferior alveolar nerve

  • 21

    Inferior belly of omohyoid

  • 22

    Internal jugular vein

  • 23

    Internal laryngeal nerve

  • 24

    Lateral lobe of thyroid gland

  • 25

    Lesser occipital nerve

  • 26

    Levator scapulae

  • 27

    Lingual nerve

  • 28

    Linguofacial trunk

  • 29

    Lower root of ansa cervicalis

  • 30

    Middle thyroid vein

  • 31

    Molar salivary glands

  • 32

    Mylohyoid and nerve

  • 33

    Nerve to mylohyoid

  • 34

    Occipital artery

  • 35

    Parotid duct

  • 36

    Posterior auricular artery

  • 37

    Posterior belly of digastric

  • 38

    Ramus of mandible

  • 39

    Roots of phrenic nerve

  • 40

    Scalenus anterior

  • 41

    Scalenus medius

  • 42

    Splenius capitis

  • 43

    Sternocleidomastoid (cut)

  • 44

    Sternocleidomastoid branch of occipital artery

  • 45

    Sternohyoid

  • 46

    Sternothyroid

  • 47

    Styloglossus

  • 48

    Stylohyoid

  • 49

    Stylohyoid ligament

  • 50

    Sublingual gland

  • 51

    Submandibular duct

  • 52

    Superficial (transverse) cervical artery

  • 53

    Superficial temporal artery

  • 54

    Superior belly of omohyoid

  • 55

    Superior laryngeal artery

  • 56

    Superior thyroid artery

  • 57

    Superior thyroid vein

  • 58

    Temporalis

  • 59

    Thyrohyoid and nerve

  • 60

    Thyrohyoid membrane

  • 61

    Trapezius

  • 62

    Upper root of ansa cervicalis

  • 63

    Vagus nerve

  • 64

    Ventral ramus of fifth cervical nerve

  • 65

    Zygomatic arch

Front of the neck

  • deeper dissection

    Axial CT neck

  • 1

    Accessory nerve

  • 2

    Brachial plexus (roots)

  • 3

    Cervical nerves to trapezius

  • 4

    Clavicle

  • 5

    Common carotid artery

  • 6

    Cricothyroid

  • 7

    Digastric, anterior belly

  • 8

    External carotid artery

  • 9

    Facial artery

  • 10

    Facial vein

  • 11

    Great auricular nerve

  • 12

    Hyoid bone, body

  • 13

    Inferior thyroid vein

  • 14

    Internal jugular vein

  • 15

    Laryngeal prominence

  • 16

    Mandible

  • 17

    Mylohyoid, anomalous fibres

  • 18

    Omohyoid, inferior belly (cut)

  • 19

    Omohyoid, superior belly (cut)

  • 20

    Parotid gland

  • 21

    Pectoralis major

  • 22

    Phrenic nerve

  • 23

    Platysma

  • 24

    Right brachiocephalic vein

  • 25

    Right subclavian vein

  • 26

    Scalenus anterior

  • 27

    Scalenus medius

  • 28

    Sternocleidomastoid, clavicular head

  • 29

    Sternocleidomastoid, sternal head

  • 30

    Sternohyoid (cut)

  • 31

    Subclavian artery

  • 32

    Subclavius

  • 33

    Submandibular gland

  • 34

    Superior laryngeal artery

  • 35

    Superior thyroid artery

  • 36

    Superior thyroid vein

  • 37

    Supraclavicular nerve

  • 38

    Suprascapular artery

  • 39

    Suprascapular vein

  • 40

    Tendon of scalenus anterior

  • 41

    Thyrohyoid

  • 42

    Thyroid gland, lateral lobe

  • 43

    Trapezius

  • 44

    Vagus nerve

On the right hand side, the clavicle (4) has been cut and reflected inferiorly to reveal the underlying subclavius (32). Dotted line is the level of axial CT (shown on the right).

Accessory nerve palsy

Goitre

Submandibular tumour

Right side of the neck

  • 1

    Accessory nerve

  • 2

    Ansa cervicalis

  • 3

    Common carotid artery

  • 4

    Dorsal scapular nerve

  • 5

    External carotid artery

  • 6

    External laryngeal nerve

  • 7

    Facial artery

  • 8

    Facial vein

  • 9

    Fourth cervical nerve ventral rami

  • 10

    Great auricular nerve

  • 11

    Greater horn of hyoid bone

  • 12

    Hyoid bone

  • 13

    Hypoglossal nerve

  • 14

    Inferior belly of omohyoid

  • 15

    Inferior constrictor of pharynx

  • 16

    Inferior root of ansa cervicalis

  • 17

    Inferior thyroid artery

  • 18

    Internal carotid artery

  • 19

    Internal jugular vein (double at upper end)

  • 20

    Internal laryngeal nerve penetrating thyrohyoid membrane

  • 21

    Lesser occipital nerve

  • 22

    Levator scapulae

  • 23

    Lingual artery

  • 24

    Lingual vein

  • 25

    Marginal mandibular branch of facial nerve

  • 26

    Omohyoid tendon

  • 27

    Phrenic nerve

  • 28

    Posterior belly of digastric

  • 29

    Scalenus anterior

  • 30

    Scalenus medius

  • 31

    Second cervical nerve ventral rami

  • 32

    Sternocleidomastoid (cut)

  • 33

    Sternohyoid

  • 34

    Sternothyroid

  • 35

    Stylohyoid

  • 36

    Subclavian vein

  • 37

    Submental artery

  • 38

    Transverse cervical artery (superficial)

  • 39

    Superior belly of omohyoid

  • 40

    Superior laryngeal artery

  • 41

    Superior root of ansa cervicalis

  • 42

    Superior thyroid artery

  • 43

    Suprahyoid artery on hyoglossus

  • 44

    Suprascapular artery

  • 45

    Suprascapular nerve

  • 46

    Third cervical nerve ventral rami

  • 47

    The right lymphatic duct

  • 48

    Thyrocervical trunk

  • 49

    Thyrohyoid muscle and nerve to thyrohyoid

  • 50

    Upper trunk of brachial plexus

  • 51

    Vena comitans of hypoglossal nerve

Branchial cysts

Carotid artery stenosis

Left side of the neck

  • from the left and front

Platysma and the deep cervical fascia have been removed.

In 20% of faces, as in this specimen, the marginal mandibular branch of the facial nerve (30) arches downwards off the face for part of its course and overlies the submandibular gland (46).

  • 1

    Accessory nerve

  • 2

    Anterior belly of digastric

  • 3

    Anterior jugular vein

  • 4

    Body of hyoid bone

  • 5

    Body of mandible

  • 6

    Buccal fat pad

  • 7

    Cervical branch of facial nerve

  • 8

    Cervical nerves to trapezius

  • 9

    Clavicular head of sternocleidomastoid

  • 10

    Common carotid artery

  • 11

    Dorsal scapular nerve

  • 12

    External carotid artery

  • 13

    External jugular vein

  • 14

    External laryngeal nerve

  • 15

    Facial artery

  • 16

    Facial vein

  • 17

    Great auricular nerve

  • 18

    Greater horn of hyoid bone (underlying 25)

  • 19

    Hyoglossus

  • 20

    Hypoglossal nerve

  • 21

    Inferior belly of omohyoid

  • 22

    Inferior constrictor of pharynx

  • 23

    Inferior thyroid vein

  • 24

    Internal carotid artery and superior root of ansa cervicalis

  • 25

    Internal laryngeal nerve

  • 26

    Jugulodigastric lymph nodes

  • 27

    Lesser occipital nerve

  • 28

    Lingual artery

  • 29

    Lingual vein

  • 30

    Marginal mandibular branch of facial nerve

  • 31

    Masseter

  • 32

    Mylohyoid

  • 33

    Nerve to thyrohyoid

  • 34

    Parotid gland

  • 35

    Phrenic nerve (on scalenus anterior)

  • 36

    Posterior auricular vein

  • 37

    Posterior belly of digastric

  • 38

    Posterior branch of retromandibular vein

  • 39

    Scalenus anterior

  • 40

    Scalenus medius

  • 41

    Sternal head of sternocleidomastoid

  • 42

    Sternocleidomastoid

  • 43

    Sternohyoid

  • 44

    Sternothyroid

  • 45

    Stylohyoid

  • 46

    Submandibular gland

  • 47

    Submental artery and vein

  • 48

    Superficial (transverse) cervical artery

  • 49

    Superficial (transverse) cervical vein

  • 50

    Superior belly of omohyoid

  • 51

    Superior laryngeal artery

  • 52

    Superior thyroid artery

  • 53

    Supraclavicular nerve (cut upper edge)

  • 54

    Suprahyoid artery

  • 55

    Suprascapular artery

  • 56

    Suprascapular nerve

  • 57

    Thyrohyoid

  • 58

    Thyrohyoid membrane

  • 59

    Thyroid gland (left lobe)

  • 60

    Trapezius

  • 61

    Upper trunk of brachial plexus

Carotid artery bruits

Carotid artery variants

Cervical lymph node enlargement

Right lower face and upper neck

  • A

    parotid and upper cervical regions

  • B

    submandibular region

  • 1

    Ansa cervicalis, inferior branch

  • 2

    Ansa cervicalis, superior branch

  • 3

    Anterior belly of digastric

  • 4

    Anterior jugular vein

  • 5

    Brachial plexus (roots)

  • 6

    Buccinator

  • 7

    Common carotid artery

  • 8

    Depressor anguli oris

  • 9

    External carotid artery

  • 10

    External jugular vein

  • 11

    Facial artery

  • 12

    Facial vein

  • 13

    Great auricular nerve

  • 14

    Greater horn of hyoid bone

  • 15

    Hyoid bone

  • 16

    Hypoglossal nerve

  • 17

    Internal jugular vein

  • 18

    Internal laryngeal nerve

  • 19

    Lesser occipital nerve

  • 20

    Levator scapulae

  • 21

    Mandible

  • 22

    Masseter

  • 23

    Mylohyoid

  • 24

    Oblique line of the thyroid cartilage

  • 25

    Parotid gland and facial nerve branches at anterior border

  • 26

    Platysma

  • 27

    Posterior belly of digastric

  • 28

    Retromandibular vein

  • 29

    Scalenus anterior

  • 30

    Sternocleidomastoid

  • 31

    Sternohyoid

  • 32

    Sternothyroid

  • 33

    Submandibular gland

  • 34

    Superior belly of omohyoid (bifid-variation)

  • 35

    Superior laryngeal artery

  • 36

    Superior thyroid artery

  • 37

    Suprascapular artery

  • 38

    Thyrohyoid

  • 39

    Thyrohyoid membrane

  • 40

    Thyroid gland (right lobe)

  • 41

    Trapezius

Mumps

Parotidectomy

Parotid tumours

Left lower face and upper neck

Digital subtraction angiography, external carotid artery
  • 1

    Ascending pharyngeal artery

  • 2

    Branches of cervical plexus

  • 3

    C1 (descendens hypoglossi)

  • 4

    Common carotid artery

  • 5

    Cricothyroid artery

  • 6

    Digastric muscle (anterior belly)

  • 7

    External carotid artery

  • 8

    Facial nerve, marginal mandibular branch

  • 9

    Facial artery

  • 10

    Greater horn of the hyoid bone

  • 11

    Hypoglossal nerve

  • 12

    Internal carotid artery

  • 13

    Internal laryngeal nerve

  • 14

    Lingual artery

  • 15

    Masseter muscle

  • 16

    Mylohyoid muscle

  • 17

    Occipital artery

  • 18

    Omohyoid muscle (reflected)

  • 19

    Parotid gland (reflected)

  • 20

    Scalenus medius muscle

  • 21

    Scalenus posterior muscle

  • 22

    Sinus nerve to carotid sinus and body

  • 23

    Sternohyoid muscle

  • 24

    Sternocleidomastoid muscle (reflected)

  • 25

    Sternothyroid muscle (cut)

  • 26

    Stylohyoid muscle

  • 27

    Submental artery

  • 28

    Superior laryngeal artery

  • 29

    Superior thyroid artery

  • 30

    Thyroid gland (lateral lobe)

  • 31

    Trapezius muscle

  • 32

    Vagus nerve

Carotid endarterectomy

Right side of the neck

  • deep dissection

  • 1

    Accessory nerve (cut)

  • 2

    Anterior belly of digastric

  • 3

    Ascending palatine artery

  • 4

    Ascending pharyngeal artery

  • 5

    Carotid sinus

  • 6

    Common carotid artery (cut)

  • 7

    External carotid artery (cut)

  • 8

    External laryngeal nerve

  • 9

    Facial artery

  • 10

    Glossopharyngeal nerve

  • 11

    Great auricular nerve

  • 12

    Hyoglossus

  • 13

    Hypoglossal nerve (cut)

  • 14

    Inferior constrictor

  • 15

    Inferior thyroid artery

  • 16

    Internal carotid artery

  • 17

    Internal jugular vein

  • 18

    Internal laryngeal nerve

  • 19

    Lateral lobe of thyroid gland

  • 20

    Lingual artery

  • 21

    Lingual nerve

  • 22

    Middle cervical sympathetic ganglion

  • 23

    Mylohyoid

  • 24

    Occipital artery (cut)

  • 25

    Phrenic nerve

  • 26

    Posterior belly of digastric (cut)

  • 27

    Recurrent laryngeal nerve

  • 28

    Scalenus anterior

  • 29

    Sternocleidomastoid (cut)

  • 30

    Sternohyoid (cut)

  • 31

    Sternothyroid (cut)

  • 32

    Styloglossus

  • 33

    Stylohyoid (cut end displaced medially)

  • 34

    Stylohyoid ligament

  • 35

    Stylopharyngeus

  • 36

    Sublingual gland

  • 37

    Submandibular duct

  • 38

    Submandibular ganglion

  • 39

    Superior belly of omohyoid (cut)

  • 40

    Superior laryngeal artery

  • 41

    Superior thyroid artery

  • 42

    Thyrohyoid and nerve

  • 43

    Upper root of ansa cervicalis

  • 44

    Vagus nerve

The hypoglossal nerve (13) passes downwards, curling around the occipital artery (24) and lying superficial to the external carotid (7) and lingual (20) arteries.

The glossopharyngeal nerve (10) passes downwards and forwards, curling round the lateral side of stylopharyngeus (35).

The removal of parts of the sternohyoid (30), omohyoid (39) and sternothyroid (31) displays the lateral lobe of the thyroid gland (19). Note the inferior thyroid artery (15) behind the lower part of the lobe, with the recurrent laryngeal nerve (27) passing deep to this looping vessel to enter the pharynx beneath the inferior constrictor (14).

Root of the neck

MR angiogram, neck

Thyroid ultrasound, transverse image (* longus colli deep to lateral lobe of thyroid gland).
  • 1

    Accessory phrenic nerve

  • 2

    Ansa subclavia

  • 3

    Arch of cricoid cartilage

  • 4

    Ascending cervical artery

  • 5

    Brachial plexus

  • 6

    Brachiocephalic artery

  • 7

    Capsule of sternoclavicular joint

  • 8

    Common carotid artery

  • 9

    Cricothyroid muscle

  • 10

    External carotid artery

  • 11

    External laryngeal nerve

  • 12

    First rib (sectioned)

  • 13

    Hypoglossal nerve

  • 14

    Inferior thyroid artery

  • 15

    Inferior thyroid veins

  • 16

    Internal carotid artery

  • 17

    Internal jugular vein

  • 18

    Internal thoracic artery

  • 19

    Internal thoracic vein

  • 20

    Isthmus of thyroid gland

  • 21

    Jugular lymphatic trunk

  • 22

    Lateral lobe of thyroid gland

  • 23

    Left brachiocephalic vein

  • 24

    Lung apex

  • 25

    Manubrium of sternum

  • 26

    Middle thyroid vein

  • 27

    Phrenic nerve

  • 28

    Right brachiocephalic vein

  • 29

    Scalenus anterior

  • 30

    Scalenus medius

  • 31

    Subclavian artery

  • 32

    Subclavian vein

  • 33

    Submandibular gland

  • 34

    Superficial (transverse) cervical artery

  • 35

    Superior thyroid artery and vein

  • 36

    Suprascapular artery

  • 37

    Thyrocervical trunk

  • 38

    Sternohyoid (cut)

  • 39

    Trachea

  • 40

    Vagus nerve

  • 41

    Ventral ramus of fifth cervical nerve

  • 42

    Vertebral vein

Internal jugular vein catheterisation

Subclavian vein catheterisation

Prevertebral region

  • 1

    Accessory nerve (spinal root)

  • 2

    Anterior longitudinal ligament

  • 3

    Ascending cervical artery and vein

  • 4

    Ascending pharyngeal artery

  • 5

    Brachiocephalic artery

  • 6

    Dorsal scapular artery

  • 7

    Glossopharyngeal nerve

  • 8

    Inferior cervical ganglion

  • 9

    Inferior thyroid artery

  • 10

    Inferior vagal ganglion

  • 11

    Internal carotid artery

  • 12

    Internal carotid nerve

  • 13

    Internal jugular vein, upper end

  • 14

    Internal jugular vein, lower end

  • 15

    Internal thoracic artery

  • 16

    Jugular lymphatic trunk

  • 17

    Left brachiocephalic vein

  • 18

    Left common carotid artery

  • 19

    Left subclavian artery

  • 20

    Levator scapulae

  • 21

    Longus capitis

  • 22

    Longus colli

  • 23

    Mastoid process

  • 24

    Mediastinal lymphatic trunk

  • 25

    Meningeal branch of ascending pharyngeal artery

  • 26

    Middle cervical ganglion

  • 27

    Occipital artery

  • 28

    Oesophageal branch of inferior thyroid artery

  • 29

    Oesophagus

  • 30

    Phrenic nerve

  • 31

    Posterior belly of digastric

  • 32

    Rectus capitis lateralis

  • 33

    Recurrent laryngeal nerve

  • 34

    Right brachiocephalic vein

  • 35

    Right common carotid artery

  • 36

    Right lymphatic duct

  • 37

    Right subclavian artery

  • 38

    Scalenus anterior

  • 39

    Scalenus medius

  • 40

    Spine of sphenoid bone

  • 41

    Sternocleidomastoid

  • 42

    Subclavian vein

  • 43

    Superficial cervical artery

  • 44

    Superior cervical ganglion

  • 45

    Suprascapular artery

  • 46

    Sympathetic trunk

  • 47

    Thoracic duct

  • 48

    Thyrocervical trunk

  • 49

    Trachea

  • 50

    Transverse process of atlas

  • 51

    Tympanic part of temporal bone

  • 52

    Upper trunk of brachial plexus

  • 53

    Vagus nerve, on left

  • 54

    Vagus nerve, on right

  • 55

    Ventral ramus of third cervical nerve

  • 56

    Vertebral artery

  • 57

    Vertebral vein

Horner's syndrome

Face

  • surface markings on the front and right side

The pulsation of the superficial temporal artery (6) is palpable in front of the tragus of the ear (26).

The parotid duct (20 and 21) lies under the middle-third of a line drawn from the tragus of the ear (26) to the midpoint of the philtrum (22).

The pulsation of the facial artery (4) is palpable where the vessel crosses the lower border of the mandible at the anterior margin of the masseter muscle, about 2.5 cm (1 in) in front of the angle of the mandible (3).

  • 1

    Ala

  • 2

    Alar groove (nasolabial groove)

  • 3

    Angle of mandible

  • 4

    Anterior border of masseter and facial vessels

  • 5

    Apex of external nose

  • 6

    Auriculotemporal nerve and superficial temporal vessels

  • 7

    Dorsum of nose

  • 8

    External aperture (anterior naris)

  • 9

    Frontal notch and supratrochlear nerve and vessels

  • 10

    Glabella of nose

  • 11

    Head of mandible

  • 12

    Infra-orbital foramen, nerve and vessels

  • 13

    Infra-orbital margin

  • 14

    Lateral angle of mouth

  • 15

    Lateral part of supra-orbital margin

  • 16

    Lower border of body of mandible

  • 17

    Lower border of ramus of mandible

  • 18

    Medial palpebral ligament anterior to lacrimal sac

  • 19

    Mental foramen, nerve and vessels

  • 20

    Parotid duct emerging from gland

  • 21

    Parotid duct turning medially at anterior border of masseter

  • 22

    Philtrum

  • 23

    Root of nose

  • 24

    Septum of nose (nasal columella)

  • 25

    Supra-orbital notch (or foramen), nerve and vessels

  • 26

    Tragus

  • 27

    Zygomatic arch

Ophthalmic herpes zoster

Face

  • superficial dissection from the front and the right

  • 1

    Accessory parotid gland overlying parotid duct

  • 2

    Anterior branch of superficial temporal artery

  • 3

    Auriculotemporal nerve and superficial temporal vessels

  • 4

    Body of mandible

  • 5

    Buccinator and buccal branches of facial nerve

  • 6

    Depressor anguli oris

  • 7

    Depressor labii inferioris

  • 8

    Facial artery

  • 9

    Facial vein

  • 10

    Frontalis part of occipitofrontalis

  • 11

    Great auricular nerve

  • 12

    Levator anguli oris

  • 13

    Levator labii superioris

  • 14

    Levator labii superioris alaeque nasi

  • 15

    Marginal mandibular branch of facial nerve

  • 16

    Masseter

  • 17

    Nasalis

  • 18

    Orbicularis oculi

  • 19

    Orbicularis oris

  • 20

    Parotid gland

  • 21

    Procerus

  • 22

    Sternocleidomastoid

  • 23

    Supra-orbital nerve

  • 24

    Supratrochlear nerve

  • 25

    Temporal branch of facial nerve

  • 26

    Temporalis underlying temporal fascia

  • 27

    Zygomatic branch of facial nerve

  • 28

    Zygomaticus major

  • 29

    Zygomaticus minor

Facial nerve (Bell's) palsy

Intracranial spread of infection – face

Intracranial spread of infection – scalp

Surgical flaps of scalp

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here