DR MOUIN ABBOUD

pr of anatomy

Faculity of medicin

Damascus and sham

universiies

نواحي الرأس والعنق

SCALP

• The scalp is the part of the head that extends from the superciliary

arches anteriorly to the external occipital protuberance and superior

nuchal lines posteriorly. Laterally it continues inferiorly to the

zygomatic arch.

• The scalp is a multilayered structure with layers that can be defined

by the word itself:

• S-skin;

• C-connective tissue (dense);

• A-aponeurotic layer;

• L-loose connective tissue;

• P-pericranium

Innervation

• Sensory innervation of the scalp is from

two major sources:

• cranial nerves

• or cervical nerves

• Motor innervation : The occipitofrontalis

muscle is innervated by branches of the

facial nerve [VII].

Branches of the trigeminal

nerve• Branches of the trigeminal nerve [V]

supply the scalp anterior to the ears and

the vertex of the head

• These branches are”

❖ the supratrochlear

❖ supra-orbital,

❖ zygomaticotemporal,

❖ and auriculotemporal nerves

cervical nerves• Posterior to the ears and vertex,

sensory innervation of the scalp is by

cervical nerves, specifically branches from

spinal cord levels C2 and

• These branches are:

❖ the great auricular,

❖ the lesser occipital,

❖ the greater occipital,

❖ and the third occipital nerves.

Arteries

• Arteries supplying the scalp are branches

of either :

❖ the external carotid artery

❖or the ophthalmic artery, which is a branch

of the internal carotid artery.

Branches from the ophthalmic

artery• The supratrochlear

• and supra-orbital arteries supply the

anterior and superior aspects of the scalp.

Branches from the external

carotid artery• Three branches of the external carotid

artery supply the largest part of the scalp-

❖the superficial temporal,

❖posterior auricular,

❖ and occipital arteries

• supply the lateral and posterior aspects of

the scalp

Veins• the supratrochlear and supra-orbital participate in

the formation of the angular vein, which is the upper

tributary to the facial vein;

• the superficial temporal vein drains the entire lateral

area of the scalp before passing inferiorly to join in the

formation of the retromandibular vein;

• the posterior auricular vein drains the area of the scalp

posterior to the ear and eventually empties into a

tributary of the retromandibular vein;

• the occipital vein drains the posterior aspect of the

scalp it passes through the musculature in the posterior

neck to join in the formation of the plexus of veins in the

suboccipital triangle.

Lymphatic drainage• The lymphatics in the occipital region initially drain to occipital

nodes

• Further along the pathway occipital nodes drain into upper deep

cervical nodes.

• There is also some direct drainage to upper deep cervical nodes

from this part of the scalp.

• Lymphatics from the upper part of the scalp drain in two directions:

• posterior to the vertex of the head they drain to mastoid nodes

(retro-auricular/posterior auricular nodes)

• anterior to the vertex of the head they drain to pre-auricular and

parotid nodes anterior to the ear on the surface of the parotid

gland.

• there may be some lymphatic drainage from the forehead to the

submandibular nodes through efferent vessels that follow the

facial artery.

The muscles of the face

• The muscles of the face develop from the second pharyngeal

arch and are innervated by branches of the facial nerve [VII].

• They are in the superficial fascia, with origins from either bone

or fascia, and insertions into the skin.

• Because these muscles control expressions of the face they

are sometimes referred to as muscles of 'facial expression'.

• They also act as sphincters and dilators of the orifices of

the face (i.e. the orbits, nose, and mouth).

• This organizational arrangement into functional groups

provides a logical approach to understanding these muscles

innervationface

• During development a cranial nerve becomes

associated with each of the pharyngeal arches.

Because the face is primarily derived from the

first and second pharyngeal arches,

innervation of neighboring facial structures

varies as follows:

• the trigeminal nerve [V] innervates facial

structures derived from the first arch;

• the facial nerve [VII] innervates facial structures

derived from the second arch.

Sensory innervation

• As the face is derived developmentally

from a number of structures originating

from the first pharyngeal arch, therefore

cutaneous innervation of the face is by

branches of the trigeminal nerve [V].

Motor innervation

• The muscles of the face, as well as those

associated with the ear and the scalp, are

derived from the second pharyngeal arch.

The cranial nerve associated with this arch

is the facial nerve [VII] and therefore

branches of the facial nerve [VII] innervate

all these muscles.

Arteries

• Facial artery: Branches of the facial artery include the

superior and inferior labial branches and the lateral

nasal branch

• the superficial temporal artery: Another contributor to the

vascular supply of the face is the transverse facial artery

• The maxillary artery: the infra-orbital artery - the

buccal artery - the mental artery

• Branches of the ophthalmic artery : the supraorbital and

supratrochlear arteries- the zygomaticofacial artery - the

dorsal nasal artery

Veins• Facial vein : Its point of origin is near the medial corner of the orbit

as the supratrochlear and supra-orbital veins come together to

form the angular vein.

• The transverse facial vein is a small vein that accompanies the

transverse facial artery in its journey across the face . It empties

into the superficial temporal vein within the substance of the

parotid gland.

Intracranial venous

connections• :near the medial corner of the orbit, it

communicates with ophthalmic veins;

• in the area of the cheek it communicates

with veins passing into the infra-orbital

foramen;

• it communicates with veins passing into

deeper regions of the face (i.e. the deep

facial vein connecting with the pterygoid

plexus of veins).

Lymphatic drainage

• Lymphatic drainage from the face primarily moves towards three

groups of lymph nodes

• submental nodes inferior and posterior to the chin, which drain

lymphatics from the medial part of the lower lip and chin

bilaterally;

• submandibular nodes superficial to the submandibular gland

and inferior to the body of the mandible, which drain the

lymphatics from the medial corner of the orbit, most of the

external nose, medial part of the cheek, the upper lip and the

lateral part of the lower lip that follow the course of the facial

artery;

• pre-auricular and parotid nodes anterior to the ear, which drain

lymphatics from most of the eyelids, a part of the external nose,

and the lateral part of the cheek.

The Anteriorالمثلث الأمامي للعنق

Triangle:

فلي وما هو المسافة المتواجدة تحت الحافة السفلية للفك الس•

.العضلتين القصيتين الخشائيتينبين

,بالخط الناصف الأمامي للعنقتتحدد بالأمام •

, الحافة الأمامية للعضلة القصية الخشائيةبالخلف •

سفليالحافة السفلية للفك الذات توضع علوي وهي القاعدة•

,يزاوية الفك السفلي حتى الناتيء الخشائمن وخط ممتد

القص بالأسفل على ذروته •

Anterior triangle of the neck

• The anterior triangle of the neck is outlined

by :

❖the anterior border of the

sternocleidomastoid muscle laterally,

❖ the inferior border of the mandible

superiorly,

❖and the midline of the neck medially

• It is further subdivided into several smaller

triangles

Subdivisions

❑ the anterior triangle subdivides into four

triangles :

❖Carotid triangle

❖Submental Triangle

❖Submandibular Triangle

❖Muscular Triangle

المثلثات القسمية للمثلث الامامي

:يمكن أن يقسم هذا المثلث إلى المثلثات التالية•

:The Muscular Triangleالمثلث العضلي •

:The Carotid Triangleالمثلث السباتي •

:The Digastric Triangleمثلث ذات البطنين •

Submental Triangleالمثلث تحت الذقن •

Submental Triangle

Submental Triangleالمثلث تحت الذقن

.بالبطن الأمامي لذات البطنينيتحدد بكل جانب •

, الفك السفليقمته تتوضع على •

لة وسقفه هو العضجسم العظم اللاميتتشكل قاعدته من •

.الضرسية اللامية

المثلث تحت الذقن

وبعض عقدتين لمفيتينيحتوي المثلث تحت الذقن عقدة أو •

.الأوردة المتحدة لتشكيل الوريد الوداجي الأمامي

Submental Triangle

❑ The main content is :

• the submental lymph nodes, which filter

lymph draining from the floor of the mouth

• and parts of the tongue.

The Digastricمثلث ذات البطنين

Triangle:

لفك بقاعدة الفك السفلي وبخط من زاوية ابالأعلى يتحدد •

.السفلي حتى الناتيء الخشائي

ينبالبطن الخلفي للعضلة ذات البطنبالأسفل والخلف•

, والإبرية اللامية

.بالبطن الأمامي لذات البطنينبالأسفل والأمام•

مثلث ذات البطنين

الغدة تحتيحتوي مثلث ذات البطنين في قسمه الأمامي •

ى المتوضع إلالوريد الوجهيوعلى سطحها الفك السفلي

. الشريان الوجهيالعمق من

فلي من بينما يتواجد في القسم الخلفي من المثلث الجزء الس•

.الغدة النكفية

Submandibular Triangle

Submandibular Triangle

❑ The Submandibular Triangle : contains

❖ the submandibular gland (salivary),

❖and lymph nodes.

❖The facial artery and vein also pass

through this area.

CONTENTS OF DIGASTRIC

TRIANGLE

The Muscularالمثلث العضلي

Triangle:

والممتد من العظم بالأمام بالخط الناصف للعنقيتحدد •

,اللامي حتى القص

الحافة الأمامية للعضلة القصية وبالأسفل والخلف •

,الخشائية

.اللامية–بالبطن العلوي للكتفية وبالأعلى والخلف•

المثلث العضلي

يقة يتواجد تحت الطبقة المغلفة من اللفافة الرقبية العم•

ممتدة من الفك السفلي حتى مجموعة عضلات طولانية

:عظم القص وهذه العضلات هي

مي تحت العظم اللا, العضلة الضرسية اللامية:فوق اللامي•

(.قصية–درقية , لامية–درقية ):تحت اللامي •

اضافة للاوردة الوداجية الامامية•

Muscular Triangle

• The muscular triangle is also unique in

containing no vessels of note.

• It does however contain some muscles

and organs –

• the infrahyoid muscles,

• the pharynx,

• and the thyroid, parathyroid glands.

:The Carotid Triangleالمثلث السباتي

القصية الخشائيةبالعضلة بالخلفيتحدد •

ميةبالبطن العلوي للعضلة الكتفية اللابالأمام والأسفل•

ات بالعضلة الإبرية اللامية والبطن الخلفي لذبالأعلى•

.البطنين

المثلث السباتي

ب العص, الوريد الوداجي الباطن:المثلث السباتينجد في •

ظاهر الشريان السباتي الأصلي وتفرعه إلى سباتي, المبهم

,وباطن

العروة الرقبيةنجد •

انتحت اللسنجد العصب . تفرعات السباتي الظاهرونجد •

لى ماراً من أمام الشرايين السباتية الباطن والظاهر ونجد ع

العصب الجانب الأنسي من الشريان السباتي الظاهر

.اهرالعصب الحنجري الظوإلى الأسفل منه الحنجري الباطن

❑ The main contents of the carotid triangle

are :

• the common carotid artery (which

bifurcates within the carotid triangle into

the external and internal carotid arteries),

• the internal jugular vein,

• and the hypoglossal and vagus nerves.

محتويات المثلث الامامي

❑ The anterior triangle of the neck contains muscles, nerves, arteries, veins

and lymph nodes.

❖ The muscles in this part of the neck are :

▪ four suprahyoid muscles (stylohyoid, digastric, mylohyoid, and geniohyoid)

▪ and four infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, and

sternothyroid)

❑ The vessels are :

❖ common carotid artery

❖ internal jugular vein .

❑ The nerves :

❖ Numerous cranial nerves are located in the anterior triangle . The cranial

nerves in the anterior triangle are :

▪ the facial [VII], glossopharyngeal [IX], vagus [X],accessory [XI], and

hypoglossal [XII] nerves.

:The Posterior Triangleالمثلث الخلفي

لمنحرفةالعضلة القصية الخشائية والعضلة شبه اياحة متواجدة بين •

الخط القفوي بالأعلى خلف الجمجمة على ذروة المثلثتتوضع •وتحتوي , فتتوضع بالأمام على جذر العنقالقاعدة أما , العلوي

القصية شبه المنحرفة و)الجزء من الترقوة المتوضع بين العضلتين(. الخشائية

. العميقةالطبقة المغلفة من اللفافة الرقبيةمن سقف المثلثيتشكل •اللفافة أمام الفقارفتتشكل من أرضية المثلثأما

–رافعة الكتف–الطحالية )العضلات أمام الفقار المتواجد تحتها •فة وتغطي اللفا(. أخمعية أمامية–أخمعية وسطى –أخمعية خلفية

للضفيرة الجذوع الثلاثة, أيضاً باتجاه الأسفل الشريان تحت الترقوةوكذلك عرى الضفيرة الرقبية, العضدية

The posterior triangle of the

neck

• Borders : Its boundaries

are as follows:

• Anterior: Posterior

border of the SCM.

• Posterior: Anterior

border of the trapezius

muscle.

• Inferior: Middle 1/3 of the

clavicle.

• The posterior triangle of the neck is

covered by the investing layer of fascia,

and the floor is formed by the

prevertebral fascia

• The Contents are :

❖Muscles

❖Vessels

❖Nerves

Muscles

❑ The posterior triangle of the neck contains many muscles

❖ The muscles that form the borders :

▪ Anterior border is the posterior border of the SCM.

▪ Posterior border is : anterior border of the trapezius muscle.

❖ The muscles that form the floor of the posterior triangle:

• Splenius capitis

• Levator scapulae

• Anterior, Middle and Posterior scalene

❖ A significant muscle in the posterior triangle region in

the omohyoid muscle.

The vessels

❑ The vessels are :

❖ The external jugular vein is one of the major veins of

the neck region .Within the posterior triangle, the

external jugular vein pierces the investing layer of fascia

and empties into the subclavian vein.

❖ The transverse cervical and suprascapular veins also

lie in the posterior triangle

❖ The subclavian, transverse cervical and suprascapular

veins are accompanied by their respective arteries in the

posterior triangle.

Nerves

• The accessory nerve (CN XI) exits the cranial cavity, descends

down the neck, innervates sternocleidomastoid and enters the

posterior triangle. It crosses the posterior triangle in an oblique,

inferoposterior direction, within the investing layer of fascia.

• The cervical plexus forms within the muscles of the floor of the

posterior triangle. A major branch of this plexus is the phrenic

nerve, which arises from the anterior divisions of spinal nerves C3-

C5. It descends down the neck, within the prevertebral fascia, to

innervate the diaphragm.

• Other branches of the cervical plexus innervate the vertebral

muscles, and provide cutaneous innervation to parts of the neck and

scalp.

• The trunks of the brachial plexus also cross the floor of the

posterior triangle.

Subdivisions

• The omohyoid muscle splits the posterior

triangle of the neck into two:

• The larger, superior part is termed

the occipital triangle.

• The inferior triangle is known as the

subclavian triangle and contains the

distal portion of the subclavian artery.

المثلثات القسمية للمثلث الخلفي

:ويوصف ضمن المثلث الخلفي للعنق مثلثين هما•

:The Occipital Triangleالمثلث القذالي •

م وهو محدد بالأما, هو الانقسام العلوي والأكبر من المثلث الخلفي•

أما , بالخلف العضلة شبه المنحرفة, بالعضلة القصية الخشائية

.فالبطن السفلي للعضلة الكتفية اللاميةبالأسفل

The Supraclavicularالمثلث فوق الترقوة • Triangle:

لى يتحدد بالأع. هو الانقسام السفلي والأصغر من المثلث الخلفي•

أما قاعدته , وةبالأسفل بالترق, بالبطن السفلي للعضلة الكتفية اللامية

.الحافة الخلفية للعضلة القصية الخشائيةفهي

:أهم محتويات المثلث الخلفي

.ب اللاحقوالعص, يتوضع بين الأرضية والسقف العقد اللمفية للمثلث الخلفي-•

لخلفي لتثقب تمر الفروع الجلدية للضفيرة الرقبية بشكل مستقيم عبر المثلث ا-•.اللفافة العميقة على الحافة الخلفية للقصية الخشائية

الكتف يمر عبر القسم السفلي من المثلث الشريانان العنقي المعترض وفوق-•.مع أوردتهما وذلك إلى الأعلى تماماً من الترقوة

مفية فوق تكون العقد في المستوى فوق الترقوة متعددة وتعرف باسم العقد الل-•.الترقوة إضافة لبعض العقد الانتقالية الإبطية القمية

ى العقد يتواجد في قمة المثلث ثلاث أو أربع عقد بلغمية تحت جلدية وهي تسم-•.القذالية

ينما ب, (جزء ثالث)يمر فوق مستوى الترقوة تماماً الشريان تحت الترقوة -•.يتوضع الوريد تحت الترقوة خلف الترقوة

يان تحت تتوضع عناصر الضفيرة العضدية جزئياً فوق وجزئياً خلف الشر-•.الترقوة

لظاهر يمر خلف الحافة الخلفية للعضلة القصية الخشائية الوريد الوداجي ا-•.حتى انتهائه بالوريد تحت الترقوة

The infratemporal fossa

• The infratemporal fossa is a complex area

located at the base of the skull, deep to

the masseter muscle.

• It is closely associated with both the

temporal and pterygopalatine fossae and

acts as a conduit for neurovascular

structures entering and leaving the cranial

cavity.

The boundaries

• The boundaries of this complex structure consists of

both bone and muscle:

• Lateral – condylar process and ramus of the mandible

bone

• Medial – lateral pterygoid plate; tensor veli palatine,

levator veli palatine and superior constrictor muscles

• Anterior – posterior border of the maxillary sinus

• Posterior – carotid sheath

• Roof – greater wing of the sphenoid bone

• Floor – Medial pterygoid muscle

Contents

• Muscles

• The infratemporal fossa is associated with

the muscles of mastication.

• The medial and lateral pterygoids are

located within the fossa itself, whilst the

masseter and temporalis muscles insert

and originate into the borders of the fossa.

Nerves

• The infratemporal fossa forms an important passage for a number of

nerves originating in the cranial cavity

• Mandibular nerve – a branch of the trigeminal nerve (CN V). It

enters the fossa via the foramen ovale, giving rise to motor and

sensory branches. The sensory branches continue inferiorly to

provide innervation to some of the cutaneous structures of the face.

• )Auriculotemporal, buccal, lingual and inferior alveolar nerves (

• Chorda tympani – a branch of the facial nerve (CN VII). It follows

the anatomical course of the lingual nerve and provides taste

innervation to the anterior 2/3 of the tongue.

• Otic ganglion – a parasympathetic collection of neurone cell

bodies. Nerve fibres leaving this ganglion ‘hitchhike’ along the

auriculotemporal nerve to reach the parotid gland

Vasculature

• The maxillary artery, the terminal branch of the external

carotid artery, travels through the infratemporal fossa.

Within the fossa, it gives rise to the middle meningeal

artery, which passes through the superior border via the

foramen spinosum.

• The pterygoid venous plexus is directly connected to

the cavernous sinus and drains the eye. Infections of the

skin and eye socket are able to track back into this

plexus within the fossa and up into the cavernous sinus,

making meningitis is a substantial risk. Other veins in the

fossa include the maxillary vein and middle meningeal

vein.

The pterygopalatine fossa

• The pterygopalatine fossa is a bilateral,

cone-shaped depression extending deep

from the infratemporal fossa all the way to

the nasal cavity via the sphenopalatine

foramen.

• It is located between the maxilla, sphenoid

and palatine bones, and communicates

with other regions of the skull and facial

skeleton via several canals and foramina

Borders• The borders of the pterygopalatine fossa are

formed by the palatine, maxilla and sphenoid

bones:

• Anterior: Posterior wall of the maxillary sinus.

• Posterior: Pterygoid process of the sphenoid

bone.

• Inferior: Palatine bone and palatine canals.

• Superior: Inferior orbital fissure of the eye.

• Medial: Perpendicular plate of the palatine bone

• Lateral: Pterygomaxillary fissure

Contents

• The Pterygopalatine Fossa contains many

important neurovascular structures.

• the maxillary nerve and its branches

• , the pterygopalatine ganglion

• and the maxillary artery and its branches.

The pterygopalatine ganglion

• The pterygopalatine ganglion sits deep within the

pterygopalatine fossa near the sphenopalatine foramen.

• It is the largest parasympathetic ganglion related to branches

of the maxillary nerve (via pterygopalatine branches) and is

predominantly innervated by the greater petrosal branch of

the facial nerve (CNVII).

• Postsynaptic parasympathetic fibres leave the ganglion and

distribute with branches of the maxillary nerve (CNV2). These

fibres are secretomotor in function, and provide

parasympathetic innervation to the lacrimal gland, and

muscosal glands of the oral cavity, nose and pharynx.

The maxillary artery

• The maxillary artery is a terminal branch of the external carotid

artery. The terminal portion of the maxillary artery lies within the

pterygopalatine fossa. Here, it separates into several branches

which travel through other openings within the fossa to reach the

regions they supply.

• These branches include, but are not limited to:

• Sphenopalatine artery (to the nasal cavity).

• Descending palatine artery – branches into greater and lesser

palatine arteries (hard and soft palates).

• Infraorbital artery (lacrimal gland, and some muscles of the eye).

• Posterior superior alveolar artery (to the teeth and gingiva).

• At their terminal ends, the sphenopalatine and greater palatine

arteries anastomose at the nasal septum.

openings

• there are seven openings (also known as

foramina) that connect the pterygopalatine

fossa with the orbit, nasal and oral

cavities, middle cranial fossa and

infratemporal fossa. The openings

transmit blood vessels and

nerves between these regions.

Sphenopalatine Foramen

• Sphenopalatine Foramen

• This foramen is the only opening in the medial

boundary. It connects the pterygopalatine fossa

to the nasal cavity

• The sphenopalatine foramen transmits the

sphenopalatine artery and vein, as well as the

nasopalatine nerve (a large branch of the

pterygopalatine ganglion – CNV2)

Pterygoid and Pharyngeal

Canals• Pterygoid and Pharyngeal Canals

• These two canals, along with the foramen rotundum, are

the three openings in the posterior wall of the

pterygopalatine fossa:

• Pterygoid canal – runs from the middle cranial fossa

and through the medial pterygoid plate. It carries the

nerve, artery and vein of the pterygoid canal.

• Pharyngeal canal – communicates with the

nasopharynx. It carries the pharyngeal branches of the

maxillary nerve and artery.

Inferior Orbital Fissure

• Inferior Orbital Fissure

• The inferior orbital fissure forms the

superior boundary of the pterygopalatine

fossa and communicates with the orbit.

It is a space between the sphenoid and

maxilla bones.

• The zygomatic branch of the maxillary

nerve and the infraorbital artery and

vein pass through the inferior orbital

fissure.

Pterygomaxillary Fissure

• Pterygomaxillary Fissure

• The pterygomaxillary fissure connects the infratemporal

fossa with the pterygopalatine fossa It transmits two

neurovascular structures:

• Posterior superior alveolar nerve – a branch of the

maxillary nerve. It exits through the fissure into the

infratemporal fossa, where it goes on to supply the

maxillary molars.

• Terminal part of the maxillary artery – enters the

pterygopalatine fossa via the fissure.

Foramen Rotundum

• Foramen Rotundum

• The foramen rotundum connects the

pterygopalatine fossa to the middle

cranial fossa. It is one of three openings

in the posterior boundary of the

pterygopalatine fossa. It conducts a single

structure, the maxillary nerve.

Greater Palatine Canal

• Greater Palatine Canal

• The greater palatine canal lies in the inferior boundary of

the pterygopalatine fossa, and communicates with the oral

cavity.

• The canal is formed by a vertical groove in the palatine

bone which is closed off by an articulation with the maxilla.

Branching from the greater palatine canal are the

accessory lesser palatine canals.

• The greater palatine canal transmits the descending

palatine artery and vein, the greater palatine nerve and

the lesser palatine nerve.