Skin and Soft Tissues Skin Dorsal skin versus palmar skin The dorsal skin is thin, mobile and frequently hirsute over the proximal phalanges and the ulnar aspect of the dorsum of the hand. The skin of the palm and the palmar surface of the digits is thick and hairless, with a well-defined stratum lucidum and a higher density of nerve endings and eccrine sweat glands, but…

Skin and Soft Tissues Skin Cutaneous vascular supply The skin of the elbow and forearm receives its blood supply from muscle perforators, fasciocutaneous networks and direct cutaneous vessels. The skin of the anterolateral cubital fossa is supplied by muscle perforators arising from the radial collateral and radial recurrent arteries. The skin of the medial cubital fossa receives branches from an anastomosis between the inferior ulnar collateral…

The upper limb is differentiated to achieve the complex patterns of stereotactic, non-stereotactic and gestural movements (each with a distinct neurological basis) that enable hand function. The combined movements of the shoulder and elbow bring objects in the hand into the visual field, while the great range of the shoulder and pectoral girdle enable a wide reach. Oculospinal afferents appear to be the most important modulators…

The upper limb is, in mechanical terms, a series of powered, articulated segments which enable the hand to be positioned accurately in space so that it can sense and manipulate its surrounding environment. It is attached to the bony thorax at the sternoclavicular joint, and to the chest wall by a series of powerful flat muscles which stabilize the scapula, allowing it to act as a…

The gross anatomy of the structures that lie within the vertebral canal and their extensions through the intervertebral foramina, the spinal nerve or radicular (‘root’) canals, is described in this chapter. The internal organization of the spinal cord is described in Chapter 27 . The spinal cord and its blood vessels and nerve roots lie within a meningeal sheath, the theca, which occupies the central zone…

Most clinical disorders of the back present as low back pain with or without associated lower limb pain, weakness or numbness, and so, historically, most attention has been paid to the anatomy of the lower (lumbosacral) back. In this Section, the term ‘back’ will include the whole of the posterior aspect of the trunk and of the neck. The whole of this region has great clinical…

The outer surface of the eye is composed of parts of two spheres with different radii. The anterior segment, part of the smaller sphere, is formed by the transparent cornea and accounts for approximately 7% of the ocular surface. The posterior segment of the eyeball is part of the larger sphere formed externally by the opaque sclera ( Fig. 45.1 ). Open full size image Fig.…

Bony Orbit The bony orbits are skeletal cavities located on either side of the root of the nose that serve as sockets for the eyes and associated tissues. The walls of each orbit protect the eye from injury, provide points of attachment for six extraocular muscles that allow the accurate positioning of the visual axis, and determine the spatial relationship between the two eyes, which is…

The inner ear contains the organ of hearing and the organs of balance. All are located within the labyrinth, a series of interlinked cavities in the petrous temporal bone containing interconnected membranous sacs and ducts. All spaces within the labyrinth are filled with fluid. The different sacs contain sensory epithelia consisting of supporting cells and mechanosensory cells, the hair cells that underlie acoustico-lateralis sensory systems in…

By convention, the ear is subdivided into three parts: the external, middle and inner ear. It is largely, but not entirely, contained within the temporal bone. The ears not only receive, modulate, conduct, amplify and discriminately analyse the complex pressure waves that are sound, but also contain the end organs of balance. Temporal Bone Each temporal bone consists of four components: the squamous, petromastoid and tympanic…

The larynx is an air passage, a sphincter and an organ of phonation, and extends from the tongue to the trachea. It projects ventrally between the great vessels of the neck and is covered anteriorly by skin, fasciae and the infrahyoid strap muscles that lower the hyoid bone and the larynx. Above, it opens into the laryngopharynx and forms its anterior wall; below, it continues into…

The pharynx is a 12–14 cm long musculomembranous tube shaped like an inverted cone. It extends from the cranial base to the lower border of the cricoid cartilage (the level of the sixth or seventh cervical vertebrae), where it becomes continuous with the oesophagus. The width of the pharynx varies constantly because it is dependent on muscle tone, especially of the constrictors. At rest, the pharyngo-oesophageal…

Box 39.1 and Table 39.1 set out the different anatomical and clinical terms that are applied to some of the structures described in this chapter. Box 39.1 A note on terminology ‘The advent of endoscopic sinus surgery led to a resurgence of interest in the detailed anatomy of the internal nose and paranasal sinuses. However, the official Terminologia Anatomica used by basic anatomists omits many of…

Infratemporal Fossa The infratemporal fossa lies deep to the ramus of the mandible. It communicates with the temporal fossa superiorly deep to the zygomatic arch; the orbit anteriorly through the inferior orbital fissure; the pterygopalatine fossa medially through the pterygomaxillary fissure; the middle fossa through the foramina ovale and spinosum. It contains lateral and medial pterygoid, the mandibular division of the trigeminal nerve, the chorda tympani…

The mouth extends from the lips and cheeks externally to the anterior pillars of the fauces internally, where it continues into the oropharynx. The mouth can be subdivided into the vestibule external to the teeth and the oral cavity proper internal to the teeth ( Fig. 37.1 ). The palate forms the roof of the mouth and separates the oral and nasal cavities. The floor of…

Skin The scalp and buccolabial tissues are described here. The structure of the eyelids is discussed in Chapter 44 . Scalp The scalp extends from the top of the forehead anteriorly to the superior nuchal line posteriorly. Laterally, it projects down to the zygomatic arch and external acoustic meatus. It consists of five layers: skin, subcutaneous tissue, occipitofrontalis (epicranius) and its aponeurosis, subaponeurotic loose areolar tissue…

The neck extends from the base of the cranium and the inferior border of the mandible to the thoracic inlet. Skin The skin in the neck is normally under tension. Lines of greatest tension have been termed ‘relaxed skin tension lines’; surgical incisions made along these lines are said to heal better with minimal postoperative scarring. Cutaneous vascular supply and lymphatic drainage The blood vessels supplying…

The skull is the bony skeleton of the head. It houses the brain, the organs of special sense, and the upper parts of the respiratory and digestive systems and provides attachments for many of the muscles of the head and neck. Movement is restricted and is found only in relation to the mandible at the temporomandibular joint and at the atlanto-occipital joint for movement of the…