Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
THE THORAX
Week #1
Day 1
Surface Anatomy—N 181
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Clavicle
o Sternoclavicular joint
o Acromioclavicular joint
Acromion of scapula
Jugular notch (suprasternal notch)
Manubrium
Sternal angle
Body of sternum
Xiphisternal junction
Xiphoid process
Seventh costal cartilage
Costal margin
Anterior axillary fold (lateral border of the pectoralis major muscle)
Skeleton of the Thorax
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Thoracic vertebrae
Rib
o Head
o Neck
o Tubercle
o Costal margin
o Shaft (body)
o Costal groove
o First rib
 Highest, shortest, broadest, and most sharply curved rib
Costal cartilage
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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True ribs (1-7)
False ribs (8-10)--3
Floating ribs (11-12)--2
Sternum N186
o Jugular notch (suprasternal notch)
o Manubrium
o Sternal angle
o Body
o Xiphoid process
Scapula N185
o Acromion
o Coracoid process
Intercostal space and muscle
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Intercostal space (dissect—space between 4 and 5 ribs)
o External intercostal muscle N426
 Elevates ribs below it
 Fibers are diagonal toward anterior midline as they
Descend
o Internal intercostal muscle
 Depresses rib above
 Fiber direction is perpendicular to fibers of external inter costal m.
o Innermost intercostal m.—N192
 Same fiber direction and attachment and action
As the internal intercostal m.
Serratus anterior
Intercostal nerve
Posterior intercostal artery and vein
o Intercostal nerves and vessels between internal intercostal muscle and innermost intercostal m.
o Intercostal nerves and vessels supply the intercostal m., skin of thoracic wall, and parietal pleura
o Order: veinartery nerve
Anterior intercostal branches of internal thoracic artery N189
o Supply anterior end of intercostal space
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Removal of the anterior thoracic wall
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Costal parietal pleura
o Attaches to thoracic wall
Right and left internal thoracic vessels
Transversus thoracic m. N191
o Inferior attachment: on sternum
o Superior attachment: costal cartilages 2 to 6
o Depresses ribs
Internal thoracic artery and veins
o Between the transversus thoracis m. and costal cartilages
Follow the internal thoracic artery inferiorly and find one:
o Anterior intercostal branches
Posterior to the sixth or seventh costal cartilage, the internal thoracic artery divides into:
o Superior epigastric artery
o Musculophrenic artery
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Day 2
Lungs
Lungs in the thorax—N198
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Three surfaces of lung
o Costal
o Mediastinal
o Diaphragmatic
Oblique fissure(major fissure)—located on both lungs
o Separate lobes of lung
Right lung
o Horizontal fissure (minor/transverse fissure)
 Defines middle lobe
o Three lobes
 Superior lobe
 Lies anteriorly
 Middle lobe
 Inferior lobe
 Lies posteriorly
Left lung
o Two lobes
 Superior lobe
 Inferior lobe
Apex (on each lung)
o Arise as high as the neck of first rib
Pericardium
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Contains the heart
Root of the lung
o May be filled with clotted blood and pulmonary vessels
Phrenic nerve
Pericardiacophrenic vessels
Vagus nerve—N230, 231
Removal of the lungs
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When comparing two lungs note the following:
o Right lung is shorter
o Right lung has greater volume than left lung
Borders of the lung
o Anterior
o Posterior
o Inferior
Cardiac notch
o On superior lobe of left lung, anterior to heart
Lingula on left lung
o Inferior, medial portion of the superior lobe of the left lung
Contact impressions on mediastinal surface (right lung)—N 199
o Cardiac impression
o Esophagus impression
o Arch of the azygos vein impression
o Superior vena cava impression
Contact impression on mediastinal surface (left lung)—N 199
o Cardiac impression
o Aortic arch impression
o Thoracic aorta impression
Hilum of the lung—N208, 209
o Main bronchus
o Pulmonary artery
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Pulmonary veins
In left lung—N203
o Superior lobar (secondary) bronchi
o Inferior lobar (secondary bronchi
o Segmental bronchi (9)
In right lung—
o Superior lobar bronchi (eparterial bronchus)
o Middle lobar bronchi
o Inferior lobar bronchi
o Segmental bronchi (10)
Bronchopulmonary segment
Bronchial artery
Mediastinum
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Mediastinum: region between two pleural cavities
Boundaries of mediastinum:
o Superior boundary: superior thoracic aperture
o Inferior boundary: diaphragm
o Anterior boundary: sternum
o Posterior boundary: bodies of vertebrae T1 to T12
o Lateral boundaries: mediastinal parietal pleurae (left and right)
Sternal angle
Plane of sternal angle-- marks level of:
o Superior border of pericardium
o Bifurcation of trachea
o End of ascending aorta
o Beginning and end of arch of aorta
o Beginning of thoracic aorta
Superior mediastinum
Inferior mediastinum—divided by pericardium into 3 parts
o Anterior mediastinum: between sternum and pericardium—may find thymus in children
o Middle mediastinum: contains pericardium, heart, and roots of great vessels
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Posterior mediastinum: posterior to pericardium and anterior to bodies of T5 to T12; contains structures that pass between neck,
thorax, and abdomen
Four parts of mediastinum
Mediastinal pleura—N230, 231
Pericardium
Root of the lung
Esophagus (right side)
Thoracic aorta (left side)
Costal pleura (on side of vertebral body)
Endothoracic fascia
o Separates costal pleura from thoracic wall
Phrenic nerves
o Innervate diaphragm
Left and right pericardiacophrenic vessels
o Supply diaphragm
Middle mediastinum
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Middle mediastinum
Pericardium
o Sac enclosing the heart
o Attached to central tendon of diaphragm
Heart
Roots of great vessels
Heart in the thorax—N212
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Superior vena cava
Ascending aorta
Arch of the aorta
Pulmonary trunk
Ligamentum arteriosum
o Connects the left pulmonary artery to the arch of the aorta
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Left vagus nerve
o Crosses left side of aortic arch
Left recurrent laryngeal nerve
Right atrium
Right ventricle
Left ventricle
Borders of the heart
o Right border: formed by right atrium
o Inferior border: formed by right ventricle and small part of left ventricle
o Left border: formed by left ventricle
o Superior border: formed by right and left atria and auricles
Apex of the heart
o Part of left ventricle
o Located deep to 5th intercostal space
Base of heart
Parietal layer of serous pericardium
o Smooth shiny surface that lines inner pericardium
Visceral layer of serous pericardium (epicardium)—N212
Pericardial cavity
o Potential space between parietal and visceral layers of serous pericardium
o Contains serous fluid that lubricates serous surfaces and allows free movement of heart while in pericardium
Oblique pericardial sinus—N215
Transverse pericardial sinus
Day 3
Removal of the heart
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ascending aorta
pulmonary trunk
superior vena cava
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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inferior vena cava
four pulmonary veins
o form boundary of oblique pericardial sinus
External features of the heart
Surface features—N214
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External surfaces of heart—N214
o Coronary (atrioventricular) sulcus: runs around heart, separates atria from ventricles
o Anterior interventricular sulcus/posterior interventricular sulcus: indicate location of interventricular septum; join the
coronary sulcus at a right angle
o Sternocostal (anterior) surface: formed by right ventricle
o Diaphragmatic (interior) surface: formed by left ventricle and small part of right ventricle
o Pulmonary (left) surface: formed by left ventricle; in contact with cardiac impression of left lung
o Chambers of the heart
 right atrium and right auricle
 right ventricle
 left ventricle
 left atrium and let auricle
 Superior view
 aorta and aortic valve
 pulmonary trunk and pulmonary valve
 superior vena cava
 Diaphragmatic surface
 Inferior vena cava
 Posterior interventricular sulcus
Cardiac veins—N216
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Cardiac veins
o Superficial to coronary arteries
Coronary arteries
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Coronary sinus
o On diaphragmatic surface
o Located in coronary sulcus
Great cardiac vein
o On sternocostal surface of heart
Middle cardiac vein
o In posterior interventricular sulcus
Small cardiac vein
o Courses along inferior border of heart
Anterior cardiac veins
o Bridge atrioventricular sulcus between right atrium and right ventricle
o Drain anterior wall of right ventricle directly into right atrium
Coronary arteries—N216
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Aortic valve
Right semilunar cusps
Left semilunar cusps
Posterior semilunar cusps
Aortic sinus (right, left, posterior)
Left aortic sinus
o Opening of the left coronary artery
 anterior interventricular branch (left anterior descending LAD artery)
 follows great cardiac vein
 Circumflex branch
o Right coronary artery
 Opening at right aortic sinus
 Anterior right atrial branch
 Sinuatrial nodal branch
o Supplies sinuatrial node
 Marginal branch
 Follows cardiac vein along inferior border of heart
 Posterior interventricular branch
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Anastomoses with anterior interventricular branch of left coronary artery
Artery to the atrioventricular node
Internal features of the heart
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blood passes through the heart in the following order:
o right atrium—N220
 anterior wall of right atrium (interior of heart)
 pectinate muscles: horizontal ridges of muscle
 crista terminalis: vertical ridge of muscle that connects pectinate muscles
 posterior wall of right atrium
 opening of superior vena cava
 opening and valve of inferior vena cava
 opening and valve of coronary sinus
 fossa ovalis
o derived from foramen ovale
 in fetus, blood from placenta is delivered to heart via IVC; oxygen rich blood and nutrients is
directed toward foramen ovale that allows passage to left atrium and out to the body without
going to the lung
 limbus fossa ovalis
 Conduction system of the heart: on walls of atria
 Sinuatrial node (SA node)
 Atrioventricular node (AV node)
 Right atrioventricular valve
o right ventricle—N220
 pulmonary valve
 anterior wall of right ventricle
 interventricular septum
 chordae tendineae
 opening of the right atrioventricular valve (tricuspid valve)
 three cups:
o anterior
o septal
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o posterior
papillary muscles
 anterior
o largest
 septal
o very small and may be multiple
 posterior
 Trabeculae carneae
 Septomarginal trabecula (moderator band)
 Opening of the pulmonary trunk
 Conus arteriosus (infundibulum)
 Cone-shaped portion of right ventricle
 Inner wall is smooth
 Pulmonary valve
 Three semilunar cusps (anterior, right, left)—N222
 One fibrous nodule
o Help seal valve cusps and prevent backflow of blood during diastole
 Two lunules
o Help seal valve cusps and prevent backflow of blood during diastole
left atrium—N221
 four pulmonary veins
 arranged in pairs—two from right lung and two from left lung
 valve of the foramen ovale
 on interatrial septum
 opening into left auricle
 opening of left atrioventricular valve
left ventricle—N221
 aortic valve
 three semilunar valve cusps—N222
 right
 left
 posterior
 left atrioventricular valve (bicuspid valve, mitral valve)
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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anterior cusp
posterior cusp
anterior papillary muscle
posterior papillary muscle
chordae tendineae
trabeculae carneae
aortic valve
right, left and posterior semilunar cusps
 one nodule and two lunules
muscular part of the interventricular septum
membranous part of the interventricular septum
coronary arteries
aortic sinuses
noncoronary cusp
conducting system of the heart—N225
 AV node
 AV bundle: two divisions
o Right bundle
 Stimulates ventricles to contract
 Carries impulses to anterior papillary muscle through septomarginal trabecula
o Leff bundle
 Stimulate ventricles to contract
 Septomarginal trabecula
Week 2
Day 1
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Boundaries of the superior mediastinum
o Superior: superior thoracic aperture
o Posterior: bodies of vertebrae T1 to T4
o Anterior: manubrium of sternum
o Lateral: mediastinal pleurae (left and right)
o Inferior: plane of sternal angle
Thymus: fatty remnant posterior to the manubrium of sternum –N 212
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Left brachiocephalic vein
Right brachiocephalic vein
Superior vena cava—where brachiocephalic veins meet—N230
Azygos vein: on right side of mediastinum
Arch of azygos vein: passes superior to root of right lung and drains into posterior surface of superior vena cava
Right and left phrenic nerves
o Pass posterior to brachiocephalic veins
o Run with pericardiacophrenic vessels
o Enter superior surface of diaphragm
arch of the aorta—N231
o begins and ends at level of sternal angle
o three arteries branch from arch of aorta
 brachiocephalic trunk
 left common carotid artery
 left subclavian artery
ligamentum arteriosum
o connects arch of aorta to left pulmonary artery
left vagus nerve
left recurrent laryngeal nerve
right vagus nerve
right recurrent laryngeal nerve
o loops around right subclavian artery
trachea
o esophagus is posterior to trachea
bifurcation of the trachea
o bifurcation occurs at the plane of the sternal angle to form the
 right and left main bronchus
 right main bronchus has a larger diameter, is shorter and is more vertical
tracheobronchial lymph nodes
o located around trachea near bifurcation
tracheal rings
carina
o special piece of tracheal cartilage
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Posterior Mediastinum—N232
-structures are between the thorax and the abdomen; is posterior to pericardium
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boundaries of posterior mediastinum
o superior: plane of sternal angle
o posterior: bodies of vertebrae T5 to T12
o anterior: pericardium
o lateral: mediastinal pleura (left and right)
o inferior: diaphragm
area of the oblique pericardial sinus
esophagus
thoracic aorta
esophageal plexus of nerves
o innervates the inferior portion of the esophagus
right vagus nerve
left vagus nerve
anterior and posterior vagal trunk
o found on inferior part of esophagus before it passes through diaphragm
o innervate gastrointestinal tract
azygos vein
posterior intercostal veins –N238
thoracic duct
o between azygos vein and the thoracic aorta
o to the left of azygos vein and is posterior to esophagus—N316
right posterior intercostal arteries
hemiazygos vein
o where posterior intercostal veins drain into
accessory hemiazygos vein
o where posterior intercostal veins drain into
thoracic aorta
esophageal arteries
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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left bronchial arteries
posterior intercostal arteries
intercostal nerve—innermost intercostal muscle
sympathetic trunk—N240
o has one sympathetic ganglion for each thoracic vertebral level
rami communicantes (2) (white ramus communicans, gray ramus communicans)
o connect each intercostal nerve with its corresponding thoracic sympathetic ganglion
o white ramus communicans is more lateral
greater splanchnic nerve (on left and right)
lesser splanchnic nerve
least splanchnic nerve
THE HEAD AND NECK
Neck
Surface of the neck—N17
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Atlas (C1)
o Anterior arch and tubercle
o Transverse process with transverse foramen
o Groove for vertebral artery
o Posterior arch and tubercle
o Superior articular surface for occipital condyle
Axis (C2)
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o Dens
o Body
o Transverse process with transverse foramen
o Lamina
o Spinous process
o Superior articular facet for atlas
Vertebrae C3 to C7
Body
Transverse process with transverse foramen
Groove for spinal nerve
Lamina
Spinous process
Vertebral prominens
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Posterior triangle of the neck
--N35
 Pharynx and esophagus
o Superior part of digestive tract
 Larynx and trachea
o Superior parts of respiratory tract
 Thyroid gland and parathyroid glands
 Visceral part of neck boundaries
o Posterior: cervical vertebrae
o Posterolateral: the scalene muscles
o Lateral: the sternocleidomastoid m.
o Anterior: the infrahyoid mm
 Carotid artery (internal carotid artery)
 Internal jugular vein
 Vagus nerve
 Carotid sheath
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Posterior triangle of the neck—N26
 Boundaries of posterior triangle:
 Anterior: posterior border of sternocleidomastoid m.
 Posterior: anterior border of trapezius m.
 Inferior: middle one-third of clavicle
 Superficial (roof): superficial layer of the deep cervical fascia
 Deep (floor): muscles of neck covered by prevertebral fascia
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Platysma m.
o Superficial fascia
o Covers lower part of posterior triangle
o Attachments
 Inferior: deltoid and pectoral region
 Superior: mandible, skin of cheek, angle of mouth, orbicularis oris m.
o Innervation facial nerve
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External jugular vein—N31
o Deep to platysma m.
o Drain into the subclavian vein
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Cervical plexus
o Great auricular nerve
 Crosses over superficial surface of sternocleidomastoid m. parallel to external jugular vein
 Innervates skin of lower part of ear and skin extending from the angle of the mandible to mastoid process
o Lesser occipital nerve
 Pass superiorly along border of sternocleidomastoid m.
 Supplies part of scalp immediately behind ear
o Transverse cervical n.
 Passes transversely across sternocleidomastoid m. and neck
 Supplies skin of anterior angle of neck
 May be removed with platysma m.
o Supraclavicular nerves
 Pass inferiorly to innervate skin of shoulder
 Medial, intermediate, and lateral branches
 Accessory nerve (XI)
o Attach
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Superiorly to midpoint of posterior border of sternocleidomastoid m.
 Inferiorly to trapezius m.
C3 and C4 branches join CN XI in posterior triangle and branches provide proprioceptive sensory innervation
Innervates: the sternocleidomastoid m and trapezius m.
Anterior triangle of the neck N28
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Boundaries of anterior triangle of the neck
o Anterior: median line of the neck
o Posterior: anterior border of sternocleidomastoid m.
o Superior: the inferior border of mandible
o Superficial (roof): superficial layer of deep cervical fascia
o Deep(floor): larynx and pharynx
 Triangle divided into smaller triangles
 Muscular, carotid, submandibular, and submental
Bones and cartilage—N29
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Hyoid bone: at angle between the floor and mouth and superior end of the neck
Thyrohyoid membrane: stretching between the thyroid cartilage and hyoid bone
Thyroid cartilage: anterior midline of neck
Superficial fascia—N31
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External jugular vein
Retromandibular vein
Posterior auricular vein
Anterior jugular vein
Muscular triangle—N29
 Muscular triangle
o Infrahyoid muscles, thyroid gland, parathyroid glands
o Boundaries of muscular triangle
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Superolateral: superior belly of omohyoid m.
 Inferolateral: anterior border of sternocleidomastoid m.
 Medial: median plane of neck
Sternohyoid m.
o Inferior attachment: sternum
o Superior attachment: body of hyoid bone
o Function: depresses hyoid bone
Superior belly of the omohyoid m.
o Inferior: inferior border of hyoid bone
o Superior: scapula near suprascapular notch
o Depresses hyoid bone
Sternothyroid m.
o Inferior: sternum
o Superior: oblique line of thyroid cartilage
o Depresses larynx
Thyrohyoid m.
o Inferior: oblique line of the thyroid cartilage
o Superior: hyoid bone
o Elevates larynx
Ansa cervicis
o Innervates four infrahyoid m.
N31
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Laryngeal prominence
Cricothyroid ligament
Cricoid cartilage
First trachea ring
Isthmus of the thyroid gland
Submandibular triangle—N32
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Submandibular triangle:
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Submandibular gland, facial artery, facial vein, stylohyoid m. , part of hypoglossal nerve (XII), lymph nodes
Boundaries of submandibular triangle
 Superior: inferior border of mandible
 Anteroinferior: anterior belly of the digastric m.
 Posteroinferior: posterior belly of digastric m.
 Superficial (roof): superficial layer of deep cervical fascia
 Deep (floor): mylohyoid and hyoglossus m.
Mastoid process
Styloid process
Inner aspect of mandible—N15
o Digastric fossa
o Mylohyoid line
o Submandibular fossa
o Mylohyoid groove
Anterior and posterior bellies of the digastric m.
Intermediate tendon
Tendon of the stylohyoid muscle
o Attaches to the body of the hyoid bone
o Innervated by facial nerve and elevates hyoid bone
Hypoglossal nerve (XII)
o Passes deep to the posterior belly of digastric m.
Mylohyoid m.
Submental triangle—N31
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Submental triangle
o Submental lymph nodes
o Boundaries of submental triangle
 Right and left: anterior bellies of the right and left digastric mm.
 Inferior: hyoid bone
 Superficial(roof): superficial layer of deep cervical fascia
 Deep (floor): mylohyoid m.
Carotid triangle—N32
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Carotid triangle
o Carotid arteries (common, internal, external), branches of the external carotid artery, part of hypoglossal n., branches of
vagus n.
o Boundaries of carotid triangle
 Inferomedial: superior belly of the omohyoid m.
 Inferolateral: anterior border of the sternocleidomastoid m.
 Superior: posterior belly of the digastric muscle
Tip of the greater horn of the hyoid bone
Nerve to the thyrohyoid m. –N32
Hypoglossal n.
Superior root of the ansa cervicalis
Inferior root of the ansa cervicalis
Thyrohyoid membrane
Internal branch of the superior laryngeal n.
External branch of the superior laryngeal n.
Superior laryngeal n.
Cricothyroid m.
Carotid sheath
Internal jugular vein
Common facial vein
Superior thyroid vein
Middle thyroid vein
External carotid artery (6 branches)—N34
o Superior thyroid artery
 Superior laryngeal artery
o Lingual artery
o Facial artery
o Occipital artery
o Posterior auricular artery
Bifurcation of the common carotid artery
Carotid sinus
Carotid body
22
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Internal carotid artery
Ascending pharyngeal artery
Vagus nerve (X)
THYOID AND PARATHYROID GLANDS
N74, 76

Cervical viscera contain the following structures:
o Pharynx
o Esophagus
o Larynx
o Trachea
o Thyroid gland
o Parathyroid glands

Thyroid gland
o Located between C5 to T1
o Touches near carotid sheath laterally
o Right and left lobes
 Connected by isthmus (crosses anterior surface of tracheal rings 2 and 3)
o Pyramidal lobe
 Extends superiorly from isthmus
 Remnant of embryonic development
Superior thyroid artery
o Supplies thyroid gland
o Branch of external carotid artery
Superior and middle thyroid veins
o Tributary to internal jugular vein
Right and left inferior thyroid veins
o Descend into thorax on anterior surface of trachea
o Drain into right and left brachiocephalic vein (right thyroid vein drains into right brachiocephalic vein and visa versa)
Thyroidea ima artery (lowest)
o Rare to find 2-12% found in population
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o If present, enters thyroid gland inferiorly near midline
Recurrent laryngeal nerve
Parathyroid glands
o Regulate calcium metabolism
ROOT OF THE NECK
N33
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Root (base) or the neck
o Junction between the thorax and neck
o Superior to the superior thoracic aperture
Omohyoid muscle
o Inferior and superior belly are joined by an intermediate tendon
External jugular vein
o Only tributary of the subclavian vein
Subclavian vein
Internal jugular vein
Brachiocephalic vein
Subclavian artery—N33
o Branch of the brachiocephalic trunk
o Left subclavian artery is a branch of the aortic trunk
o Has 3 parts—reference point—anterior scalene muscle
o First part: from its origin to the medial border of the anterior scalene m.
 has three branches:
 (1) Vertebral artery: goes superiorly between anterior scalene m. and longus colli m.; passes into
transverse foramen of vertebra C6
 (2) internal thoracic artery: arises from anteroinferior surface of subclavian a. and passes inferiorly to
supply anterior thoracic wall
 (3) thyrocervical trunk: arises from anterosuperior surface of subclavian a.; has 3 branches
o (1) Transverse cervical a.: crosses root of neck superior to clavicle and deep to omohyoid m.;
supplies trapezius m.
24
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
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(2) Suprascapular a.: passes laterally and posteriorly to suprascapular notch; passes superior to
the transverse scapular ligament; supplies supraspinatus and infraspinatus m.
o (3) inferior thyroid a.: passes medially toward thyroid gland; passes posterior to the cervical
sympathetic trunk
 Ascending cervical a.: is a branch of the inferior thyroid artery
o Second part: posterior to the anterior scalene m.: has one branch
 Costocervical trunk: arises from the posterior surface of the subclavian a.; divides into 2 branches
 (1) Deep cervical a.
 (2) supreme intercostal a.: gives rise to posterior intercostal arteries 1 and 2
o Third part: between the lateral border of the anterior scalene m. and the lateral border of the first rib; has one branch
 Dorsal scapular a.
 Passes between superior and middle trunks of brachial plexus; supplies muscles in the scapula; may arise
from the transverse cervical artery instead of the subclavian a.
Thoracic duct: ascends from thorax into the neck; posterior to esophagus; joins the left subclavian vein and the left internal
jugular v.—N206
Right lymphatic duct
o Drains into the junction of the right subclavian and right internal jugular veins
Vagus nerve:--N32
o In carotid sheath; goes into thorax; passes posterior to the root of the lung
Right laryngeal n.: given off by the right vagus n.
Left laryngeal n.: given off by the left vagus n.
Phrenic n.: crosses anteriorly to the anterior scalene m.
Sympathetic trunk: (cervical portion; continuous with the thoracic sympathetic trunk)
Muscles of the floor of the posterior cervical triangle:--N33
o Splenius capitis m.
o Levator scapulae m.
o Anterior, middle and posterior scalene mm.
 Anterior and middle scalene mm. attach to the first rib
Interscalene triangle: formed by the first rib and adjacent borders of the anterior and middle scalene mm.
o Components of triangle:
 Subclavian artery
 Roots of brachial plexus
 At level of interscalene triangle
25
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Includes supraclavicular portion: roots, trunks, divisions
Subclavian vein
Transverse cervical a.
Suprascapular s.
Phrenic n.
HEAD
Skull
N2
Anterior view
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Frontal bone
o Glabella
o Superciliary notch
o Supraorbital notch (foramen)
Nasal bone
Zygomatic bone
Maxilla
o Frontal process
o Infraorbital foramen
o Anterior nasal spine
o Alveolar process
Nasal septum
Mandible
o Alveolar process
o Mental foramen
o Mental protuberance
Nasion
o Junction between the frontal and nasal bones
Orbital margin
26
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Formed by 3 bones (frontal, maxillary, an zygomatic)
Anterior nasal aperture
o Bounded by nasal bones and maxillae
Lateral view of Skull—N4
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Parietal bone
o Superior temporal line
o Inferior temporal line
Frontal bone
Sphenoid bone
o Greater wing
Zygomatic bone
o Frontal process
o Temporal process
Temporal bone
o Squamous part
o External acoustic meatus
o Mastoid process
o Zygomatic process
Occipital bone
o External occipital protuberance
Sutures
o Lambdoid
o Squamosal
o Coronal
Pterion
o Junction of the frontal bone, parietal bone, greater wing of sphenoid bone, and squamous part of temporal bone
Mandible—N15
o Ramus
 Cornoid process
 Mandibular notch
 Condylar process
27
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Head (condyle)
 Neck
Angle
Body
Mental foramen
Inferior border
Superior view of the skull—N7
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Calvaria
o Skull cap formed by parts of the frontal, parietal, and occipital bones
 Frontal (metopic) suture: between the ossification centers of the frontal bone
 Coronal suture: between frontal bone and two parietal bones
 Sagittal suture: between two parietal bones
 Bregma: point were sagittal and coronal sutures meet
 Lambdoid suture: between occipital bone and 2 parietal bones
 Lambda: point where sagittal and lambdoid sutures meet
FACE
Surface Anatomy
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Vertex
Supraorbital margin
Nasal bones
Alveolar process of maxilla
Mental protuberance of the mandible
Zygomatic arch
Zygomatic bone
Angle of the mandible
**The skin and face receives sensory innervation from three divisions/branches of trigeminal nerve (V); two cervical spinal nerves also provide
sensory innervation
28
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Ophthalmic division (V1): skin of the forehead, upper eyelids, and nose
Maxillary division (V2): skin of lower eyelid, cheek, and upper lip
Mandibular division (V3): skin of the lower face and part of the side of the head
Cervical spinal nerves 2 & 3: skin of the back of the head and area around the ear
**All muscles of facial expression receive motor innervation from facial nerve (VII)—N24
Superficial fascia of the face—N23
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Platysma m.
Masseter m.
o Used for mastication
Parotid duct
o Drains into oral cavity
Facial nerve—N25
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Parotid gland
Facial nerve branches
o Temporal branch: crosses zygomatic arch
o Zygomatic branch: crosses zygomatic bone
o Buccal branches: crosses the superficial surface of masseter m.
o Mandibular branch: parallels the inferior margin of the mandible
o Cervical branch: crosses the angle of the mandible to enter the neck
Parotid plexus
Masseter m.
Buccal fat pad
Buccinator m.
o Parotid duct pierces buccinator m.
o Buccal branch of facial n.: crosses superficial surface of masseter m.; gives motor innervation to buccinator m.
o Buccal n.: branch of mandibular division of trigeminal n. (V3)—from deep to masseter m.; gives sensory innervation to mucosa
and skin of cheek; provides no motor innervation
29
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
Facial artery and vein—N23
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Facial artery
Inferior labial and superior labial aa.
Angular a.
Facial vein
Muscles around the orbital opening—N26
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Orbicularis oculi m.
o Innervated by the temporal and zygomatic branches of the facial n.
Palpebral fissure (opening of eyelid)
o Orbital part: surrounds orbital margin and closes eyelids tight
o Palpebral part: thinner portion; within eyelids; blinks the eyelid
Muscles around the oral opening—N26
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Levator labii superioris m.
o Superior attachment: maxilla
o Inferior attachment: upper lip
o Action: elevates upper lip
o Innervation: zygomatic, buccal, mandibular branches of facial nn.
Zygomaticus major m.
o Lateral attachment: zygomatic bone
o Medial attachment: angle of mouth
o Action: draws angle of mouth superiorly and posteriorly
o Innervation: zygomatic, buccal, mandibular branches of facial nn.
Orbicularis oris m.
o Medial attachment: maxilla, mandible, and skin in median plane
o Lateral attachment: angle of the mouth
o Is the sphincter of the mouth
o Innervation: zygomatic, buccal, mandibular branches of facial nn.
Buccinator m.
o proximal attachment: pterygomandibular raphe and lateral surfaces of alveolar processes of maxilla and mandible
30
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole

o distal attachment: angle of mouth
o action: compresses cheek against molar teeth, keeping food on occlusal surface during chewing
o Innervation: zygomatic, buccal, mandibular branches of facial nn.
Depressor anguli oris m.
o Inferior attachment: mandible
o Superior attachment: angle of mouth
o Action: depresses corner of mouth
o Innervation: zygomatic, buccal, mandibular branches of facial nn.
Sensory nerves of the face—N24
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Sensory Nerves
o Supraorbital n.: branch of ophthalmic division of the trigeminal n. (V1) that passes through the supraorbital notch (foramen)
o Infraorbital n.: branch of maxillary division of trigeminal n. (V2) that passes through infraorbital foramen
 Innervates inferior eyelid, side of nose, upper lip
o Mental n.: branch of mandibular division of trigeminal n. (V3) that passes through the mental foramen
 Innervates lower lip and chin
Mental foramen
Mental n., artery, and vein
o Come from mental foramen
Skeleton of the parotid region
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Temporal bone –N4
o Mandibular fossa
o External acoustic meatus
o Styloid process
o Stylomastoid foramen
o Mastoid process
Mandible-N15
o Head
o Neck
o Angle
o Ramus
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole

Boundaries of parotid bed—N34
o Posterior: mastoid process and posterior belly of digastric m.
o Anterior: medial pterygoid m., ramus of mandible, and masseter m.
o Medial: styloid process and associated m. (stylopharyngeus, styloglossus, stylohyoid)
o Posterosuperior: floor of external acoustic meatus
N25
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Parotid sheath
o Contains parotid gland
Facial nerve
Stylomastoid foramen
Parotid duct
Auriculotemporal n.
o Branch of mandibular division of trigeminal n. (V3)
o Innervates skin of anterior side of ear and temporal region
o Delivers postganglionic parasympathetic nerve fibers from otic ganglion
External jugular vein
Maxillary vein
Superficial temporal vein
Superficial temporal vein
External carotid artery—N34
o Maxillary artery
o Superficial temporal artery
Superficial temporal artery
o Supplies lateral part of scalp
Posterior belly of digastric m.
Stylohyoid m.
TEMPORAL REGION
**Temporal region has two fossae
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Temporal fossa: superior to zygomatic arch; contains temporalis m.
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole

Infratemporal fossa: inferior to zygomatic arch; deep to ramus of mandible; contains medial and lateral pterygoid mm, branches of
mandibular division of trigeminal n. (V3), and maxillary vessels and their branches
Skeleton of temporal region—N4
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Superior and inferior temporal lines: on parietal bone
Temporal fossa: formed by parts of 4 cranial bones: parietal, frontal, squamous part of temporal, and greater wing of sphenoid
Zygomatic arch: formed by zygomatic process of zygomatic bone
Mandibular fossa and articular tubercle: on temporal bone
Lateral view of mandible—N15
o Head
o Neck
o Mandibular notch
o Coronoid process
o Ramus angle
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Internal surface of mandible
o Lingula: attaches sphenomandibular ligament
o Mandibular foramen: for inferior alveolar nn and vessels
o Mylohyoid groove: for mylohyoid n. and vessels
Lateral view of infratemporal fossa—N4
o Pterygomaxillary fissure
 Between lateral plate of pterygoid process and maxilla
o Inferior orbital fissure
 Between greater wing of sphenoid bone and maxilla
o Infratemporal surface of maxilla
o Greater wing of sphenoid bone
 Contains the foramen ovale and the foramen spinosum
o Lateral plate of pterygoid process of sphenoid bone
o Pterygopalatine fossa: at superior end of pterygomaxillary fissure
o Sphenopalatine foramen: opening in medial wall of pterygopalatine fossa that enters nasal cavity
Boundaries of infratemporal fossa
o Lateral: ramus of mandible
o Anterior: infratemporal surface of maxilla
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33
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
o
Medial: lateral plate of pterygoid process
Roof: greater wing of sphenoid bone
Masseter muscle and removal of the zygomatic arch

Masseter m.
o Superior attachment: inferior border of zygomatic arch
o Inferior attachment: lateral surface of ramus of mandible
o Elevates mandible (closes jaw) and protrudes mandible
o Innervation: masseteric branch of mandibular division of trigeminal nerve (V3)—N54
Temporal region—N54
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Boundaries of temporal fossa
o Superior and posterior: superior temporal line
o Anterior: frontal and zygomatic bones
o Inferior: zygomatic arch superficially and infratemporal crest of sphenoid bone deeply
o Superficial: temporal fascia
Temporalis (temporal) m.
o Attached to deep surface of temporal fascia
o Inferior attachment: coronoid process of mandible
o Muscle fibers of anterior portion are vertical (elevate mandible)
o Muscle fibers of posterior portion are horizontal (retract mandible)
Infratemporal fossa—N40
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Boundaries of intratemporal fossa
o Superior: zygomatic arch superficially, infratemporal crest of sphenoid bone deeply
o Anterior: alveolar border of maxilla
o Lateral: ramus of mandible
o Medial: lateral plate of pterygoid process
Inferior alveolar nerve and vessels
o Nerve innervates mandibular teeth
Mandibular canal
34
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Mental nerve
o Branch of inferior alveolar n.
o Innervates chin and lower lip
lingual n.
o innervates mucosa of anterior 2/3 of tongue and floor of oral cavity
maxillary artery—N40 has 15 branches—know 5 of 15 for now
o middle meningeal artery: passes through foramen spinosum; enters middle cranial fossa; supplies dura mater
o deep temporal arteries (anterior and posterior)
o masseteric artery
o inferior alveolar a.
o buccal a.: supply cheek
lateral pterygoid m.—N55
o has 2 heads
o anterior attachment of superior head: infratemporal surface of greater wing of sphenoid bone
o anterior attachment of inferior head: lateral surface of lateral plate of pterygoid process
o posterior attachment: articular disc in capsule of temporomandibular joint and neck of mandible
o action: depress mandible (opens jaw)
medial pterygoid m.
o proximal attach: maxilla and medial surface of lateral plate of pterygoid process
o distal attach: inner surface of ramus of mandible
o elevates mandible (closes jaw)
inferior alveolar n.
lingual n.
chorda tympani
pterygopalatine fossa
posterior superior alveolar a.
Temporomandibular joint—N16
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temporomandibular joint
temporomandibular ligament
superior synovial cavity
inferior synovial cavity
35
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
CRANIAL FOSSAE
Skeleton of the cranial base—N9
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Skull find
o Ethmoid bone
 Crista galli
 Cribriform plate
o Frontal bone
 Orbital part
o Sphenoid bone
 Lesser wing
 Sphenoidal crest
 Superior orbital fissure
 Anterior clinoid process
 Sphenoidal limbus
 Optic canal
 Hypophyseal fossa
 Posterior clinoid process
 Greater wing
 Foramen rotundum
 Foramen ovale
 Foramen spinosum
o Temporal bone
 Squamous part
 Petrous part
 Superior border (petrous ridge)
 Groove for sigmoid sinus
 Internal acoustic meatus
o Occipital bone
 Clivus
 Jugular foramen
 Hypoglossal canal
36
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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 Groove for the sigmoid sinus
 Foramen magnum
 Groove for the transverse sinus
 Internal occipital protuberance
Foramen lacerum
Anterior cranial fossa
Middle cranial fossa
Posterior cranial fossa
Anterior Crania fossa—N104
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Anterior cranial fossa: 3 bones
o Sphenoid bone
o Ethmoid bone
o Orbital part of frontal bone
Olfactory nerve (I)
Middle cranial fossa—N104
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Middle cranial fossa: contains
o temporal lobe of brain
middle meningeal artery
foramen spinosum
superior petrosal sinus
optic nerve (II): passes through optic canal to enter orbit
optic canal
superior orbital fissure: where 4 cranial nerves pass through
o oculomotor nerve (III):
o trochlear nerve (IV)
o ophthalmic division of the trigeminal n. (V1)
o abducent nerve (VI)
trigeminal nerve (V)
o largest cranial n.
37
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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trigeminal ganglion
maxillary division of trigeminal nerve (V2)
foramen rotundum
mandibular division of trigeminal verve (V3)
internal carotid artery
carotid canal
hypophyseal fossa
sellar diaphragm (diaphragm sellae)
anterior and posterior intercavernous sinuses—N104
Posterior cranial fossa—N104
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facial nerve (VII)
vestibulocochlear nerve (VIII)
glossopharyngeal nerve (IX)
vagus nerve (X)
accessory nerve (XI)
cervical root of accessory nerve
hypoglossal nerve (XII)
hypoglossal canal
pp. 220- 221—Forgot to do **
DURAL INFOLDINGS AND DURAL VENOUS SINUS
**The dural venous sinus collect venous drainage from brain and conduct it out of cranial cavity
Dural Infoldings—N103
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cerebral falx (falx cerebri)
o lies between the cerebral hemispheres
o attached to crista galli, calvaria on both sides of groove for superior sagittal sinus, and cerebellar tentorium
cerebellar tentorium
38
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
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attached to clinoid process of sphenoid bone, superior border of petrous portion of temporal bone, and occipital bone on both sides
of groove for transverse sinus
tentorial notch
o opening in cerebellar tentorium
o brainstem passes through it
o between cerebral hemispheres and cerebellum
cerebellar falx
o inferior to cerebellar tentorium in the midline
o attaches to occipital bone
o between cerebellar hemispheres
Dural venous Sinuses—N104
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superior sagittal sinus
o begins near crista galli
o ends near cerebellar tentorium
o drains into confluence of sinuses
inferior sagittal sinus
o inferior margin of cerebral falx
o from cerebellar tentorium and drains into straight sinus
o smaller diameter than superior sagittal sinus
straight sinus
o near line of junction of cerebral falx and cerebellar tentorium
o receives inferior sagittal sinus and great cerebral vein
o drains into confluence of sinus
transverse sinuses
o carries venous blood from confluence of sinuses to sigmoid sinus
sigmoid sinus
o begins at lateral end of transverse sinus and ends at jugular foramen
internal jugular vein
o formed by external surface of jugular foramen
From Atlas—N104
o Sphenoparietal sinus
o Cavernous sinus
39
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
o
o
Superior petrosal sinus
Inferior petrosal sinus
Basilar plexus
PHARYNX
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Pharyngeal wall—has 3 layers (from outside inward)
o Buccopharyngeal fascia: adventia of pharynx that is continuous with connective tissue that covers buccinator m.
o Muscular layer: has outer circular part and inner longitudinal part
o Mucous membrane:
Muscles of the Pharyngeal Wall—N67
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Inferior pharyngeal constrictor muscle
o Anterior attachment: oblique line of thyroid cartilage and lateral surface of cricoid cartilage
o Posterior attachment: is the pharyngeal raphe
Middle pharyngeal constrictor m.
o Anterior attachment: greater horn of hyoid bone and inferior portion of stylohyoid ligament
o Posterior attachment: pharyngeal raphe
o Inferior part is deep to inferior pharyngeal constrictor m.
40
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Superior pharyngeal constrictor m.
o Superior to middle pharyngeal constrictor m.
o Anterior attachment: pterygomandibular raphe
o Posterior attachment: pharyngeal raphe and pharyngeal tubercle of occipital bone
o Inferior part is deep to middle pharyngeal constrictor m.
Pharyngobasilar fascia
o Dense connective tissue membrane that attaches the superior edge of superior constrictor to base of the skull
Stylopharyngeus m.
o Superior attachment: medial surface of styloid process
o Inferior attachment: inner aspect of pharyngeal wall
o Enters pharyngeal wall by passing between superior and middle pharyngeal constrictor m.
o Innervated by glossopharyngeal n. (IX)—N71
Pharyngeal plexus of nerves
o On posterolateral aspect of pharynx
o Receives branches from
 Glossopharyngeal n.—sensory to pharyngeal mucosa
 Vagus n.—motor to pharyngeal constrictor mm.
 Superior cervical sympathetic ganglion—vasomotor
Contents of carotid sheath
Glossopharyngeal n. (IX)
o Passes between internal & external carotid aa as it approaches stylopharyngeus m.
Vagus n. (X)
o Posterior to internal carotid a. and internal jugular vein in carotid sheath
o Superior laryngeal n.
o Pharyngeal branch of vagus n.
Hypoglossal n. (XII)
o In submandibular triangle
o Passes lateral to internal and external carotid aa.
Superior cervical sympathetic ganglion
Sympathetic trunk
Bisection of the head
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On skull find
41
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o
o
o
o
o
Nasal bone, frontal bone
Cribriform plate
Body of sphenoid bone
Hard plate
Basilar part of occipital bone—foramen magnum
Internal Aspect of phaynx—N63
Parts of pharynx

Nasopharynx
o Posterior to nose and superior to soft palate
o Posterior nasal aperture (chonona)
 Transition between nasal cavity and nasopharynx
 Two choanae are separated by nasal septum—N64
 Opening of the pharyngotympanic tube (auditory tube, eustachian tube)
 On lateral wall of nasopharynx
o Torus tubaris
 Cartilage of pharyngotympanic tube covered by mucosa
o Salpingopharyngeal fold
 Extends from torus tubarius
o Pharyngeal recess
 Superior to torus tubaris
o Pharyngeal tonsil (adenoid)
 In mucous membrane above pharyngeal recess
**Adenoids: enlarged pharyngeal tonsils; obstruct flow of air from nose through nasopharynx, making mouth breathing necessary—Clinical
correlation
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Oropharynx
o Posterior to oral cavity
o Palatoglossal fold: dividing line separating oral cavity and oropharynx
o Fauces: transitional region between right and left palatoglossal folds
o Palatopharyngeal fold
 Posterior to palatoglossal fold
o Palatine tonsil: between palatoglossal tongue and palatopharyngeal fold
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Laryngopharynx—N66
o Posterior to larynx
o Extends from hyoid bone to lower border of cricoid cartilage
o Epiglottis—midline of laryngopharynx
o Inlet (aditus) of the larynx—midline of laryngopharynx
o Piriform recess: lateral to midline
 Borders:
 Medial: larynx
 Lateral: thyroid cartilage
 Posterior: inferior pharyngeal constrictor m.
NOSE AND NASAL CAVITY
Skeleton of nasal cavity—N2
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Nasal bone
Lacrimal bone
Maxilla
o Frontal process
o Anterior nasal aperture
o Anterior nasal spine
Nasal septum—bony part
Middle nasal concha—part of ethmoid bone
Inferior nasal concha
N38
Ethmoid bone
o Cribriform plate
o Superior nasal concha
o Middle nasal concha
Lacrimal bone
Inferior nasal concha
Maxilla
o Palatine process
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Incisive canal
Sphenoid bone
o Opening of sphenoidal sinus
o Sphenoidal sinus
o Body
o Medial plate of pterygoid process
o Lateral plate of pterygoid process
Palatine bone
o Perpendicular plate
o Horizontal plate
Sphenopalatine foramen
External nose—N36
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Lateral nasal cartilage—gives shape to bridge of nose
Septal cartilage—separates right and left nasal cavities and forms anterior part of nasal septum
Ala cartilage—lateral to septal cartilage; gives shape to nostril
Nasal Cavity
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Boundaries of nasal cavity:
o Roof: bound by nasal septum and 3 bones: nasal bone, cribriform plate of ethmoid bone, and sphenoid bone
o Floor: palatine process of maxilla and horizontal plate of palatine bone
o Medial wall: nasal septum
o Lateral wall: maxilla, lacrimal bone, ethmoid bone, inferior nasal concha, perpendicular plate of palatine bone
Nasal Septum—N39
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Nasal septum
Perpendicular plate of ethmoid bone
Vomer
Septal cartilage
In mucosa of nasal septum
44
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Nasopalatine nerve
 Pass via sphenopalatine foramen to incisive canal
 Innervate nasal septum
 Oral mucosa of hard palate
Sphenopalatine a.
 Pass via sphenopalatine foramen to incisive canal
 Innervate nasal septum
 Oral mucosa of hard palate
Olfactory area
 Mucosa near cribriform plate
 Extends down lateral wall of nasal cavity
Lateral wall of nasal cavity—N37
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Lateral wall of nasal cavity
o Sphenoethmoidal recess
 Above superior concha
 Opening of sphenoidal sinus
o Superior concha
o Superior meatus
 Inferior to superior concha
 Opening of the posterior ethmoidal cells
o Middle concha
 Semilunar hiatus (hiatus semilunaris)
 Ethmoidal bulla (bulla ethmoidalis)
o Opening of middle ethmoidal cells
 Opening of frontal sinus
 Opening of anterior ethmoidal cells
 Opening of maxillary sinus
o Middle meatus
 Inferior to middle concha
o Inferior concha
 Nasolacrimal duct
o Inferior meatus
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
 Inferior to inferior concha
Vestibule
 Superior to nostril and anterior to inferior meatus
o Atrium
 Superior to vestibule and anterior to middle meatus
Sphenoidal sinus—N48
o Inferior to hypophyseal fossa and pituitary gland
o Clinical correlation: can perform surgeries to pituitary gland via the sphenoid sinus
Ethmoidal cells
o Between nasal cavity and orbit
Maxillary sinus
o 3 sided pyramid
o Can hold up to 15 mL
 Roof of maxillary sinus is floor of orbit and infraorbital n. innervates mucosa of sinus
 Floor of maxillary sinus is alveolar process of maxilla
 Opening of maxillary sinus is near roof
 Roots of maxillary teeth may project into maxillary sinus
o Clinical correlation
 Maxillary cannot drain with head upright, so if infection occurs, an opening can be created surgically via inferior meatus
near floor of maxillary sinus to promote drainage
 Roots of teeth project into maxillary sinus and are covered by mucosa; extraction of teeth (maxillary molar or pre molar
teeth) results in mucosa superior to root being torn and fistula may form between oral cavity and maxillary sinus
o
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HARD PALATE AND SOFT PALATE
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Hard palate—forms anterior 2/3
Soft palate—forms posterior 1/3
Skeleton of Palate—N8
Skull—Inferior view
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Maxilla
o Incisive foramen
o Alveolar process
o Palatine process
46
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Palatine bone
o Horizontal plate
o Greater palatine foramen
o Lesser palatine foramen
o Posterior nasal spine
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Sphenoid bone
o Halamus of medial plate of pterygoid process
o Medial plate of pterygoid process
o Lateral plate of pterygoid process
o Scaphoid fossa
o Pterygoid canal
Infratemporal fossa—N4
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Inferior orbital fissure
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Sphenopalatine foramen
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Pterygopalatine fossa
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Pterygomaxillary fissure
Soft palate—N64
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Mucosal features of inner pharynx
o Torus tubarius
o Opening of pharyngotympanic tube
o Salpingopalatine fold
o Torus Levatorius
o Salpingopharyngeal fold
o Palatoglossal fold
o Palatopharyngeal fold
Soft palate
o Thickness due to palatine glands
o Strength due to palatine aponeurosis
o Mobility due to muscles that attach to posterior 2/3
Palatopharyngeus
o Superior attachment: hard palate and palatine aponeurosis
o Inferior attachment: thyroid cartilage and pharyngeal wall
47
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Function: elevate larynx during swallowing
o Inner longitudinal muscle layer of pharynx
Salpingopharyngeus m.
o Superior attachment: cartilage of pharyngotympanic tube
o Distal attachment: thyroid cartilage and pharyngeal wall
o Function: elevate larynx during swallowing
o Blends with palatopharyngeus m.
o Inner longitudinal muscle layer of pharynx
Stylopharyngeus muscle
o Enter pharynx between superior and middle pharyngeal constrictor mm
o Lies anterior and parallel to the palatopharyngeus and salpingopharyngeus mm; all three blend near inferior ends
Pharyngobasilar fascia
o encloses gap between the superior border of the superior pharyngeal constrictor m. and base of skull; following structures pass through
gap:
 pharyngotympanic tube (auditory tube)
 connects nasopharynx to tympanic cavity
 part closest to pharynx is cartilaginous
 part closest to middle ear passes through temporal bone
 levator veli palatine m.
torus levatorius
o levator veli palatini m.
 superior attachment: cartilage of pharyngotympanic tube and adjacent part of temporal bone
 distal attachment: palatine aponeurosis
 function: elevate soft palate
medial plate of the pterygoid process
o tensor veli palatini m.
 lies lateral to medial plate
 superior attachment: scaphoid fossa
 belly of muscle is between medial and lateral plates of pterygoid process
 tendon runs medially around hamulus of medial pterygoid process and forms palatine aponeurosis
 function: tenses soft palate
The five muscles of soft palate and pharynx are innervated by vagus nerve (X) vis pharyngeal plexus **
o Salpingopharyngeus m.
o Levator veli palatini
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
o Palatoglossus m.
o Palatopharyngeus m.
o Musculus uvulae
The tensor veli palatini m. is innervated by mandibular n. CNV3
N52
Greater palatine n. and vessels
o Come from greater palatine foramen
Nasopalatine n
o Supplies mucosa over the anterior part of hard palate
Lesser palatine n.
o Posterior to greater palatine n.
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Tonsillar bed—N64
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Palatine tonsil
o Located in tonsillar bed
 Boundaries
 Anterior—palatoglossal fold
 Posterior—palatopharyngeal fold
 Lateral—superior pharyngeal constrictor m.
Crypts
Palatoglossus m.
o Superior attachment: palatine aponeurosis
o Inferior attachment: lateral side of tongue
o Function: elevates tongue; depresses soft palate
Glossopharyngeal nerve (IX)
o Passes between superior and middle pharyngeal constrictor mm to enter tonsillar bed
o Innervates mucosa of posterior 1/3 of tongue and posterior wall of pharynx
Sphenopalatine foramen and pterygopalatine fossa—N42
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Sphenopalatine artery—N41
o Posterior lateral nasal artery: lateral to nasal wall
49
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Posterior septal branch: to nasal septum
Sphenopalatine foramen
Greater palatine n.—greater palatine canal
Lesser palatine n.—greater palatine canal
Descending palatine artery—greater palatine canal
o One of the terminal branches of the maxillary artery
o Divides to give rise to the
 Greater palatine a.
 Lesser palatine a.
Pterygopalatine ganglion
o Location for synapse of preganglionic axons of facial n. that course first to greater petrosal n. and then to pterygoid canal
o Postganglionic fibers go with branches of maxillary division of trigeminal n.
o Stimulates secretion from mucosa of nasal cavity, paranasal sinuses, nasopharynx, roof of mouth, and soft palate, lacrimal gland
Nerve of the pterygoid canal
o Enters pterygopalatine fossa posteriorly
o Passes anterior toward pterygopalatine ganglion
o Has preganglionic parasympathetic axons from greater petrosal n. and postganglionic sympathetic axons from deep petrosal n.
Infratemporal fossa—N69
o Maxillary a.—passes deeply toward pterygomaxillary fissure to give rise to:
 Sphenopalatine a.—passes through pterygopalatine fossa and then through sphenopalatine foramen to enter nasal cavity
 Descending palatine a.—enters greater palatine canal
 Infraorbital a.—passes through inferior orbital fissure to enter infraorbital canal and emerge on face at infraorbital
foramen
o Maxillary division of trigeminal n.—courses from foramen rotundum to inferior orbital fissure; passes through pterygopalatine
fossa and gives off pterygopalatine branches that form greater and lesser palatine nerves
ORAL REGION
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Oral region
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Oral vestibule: bounded externally by lips and cheeks and internally by teeth and gums
Oral cavity proper: area between alveolar arches and teeth; largest content of oral cavity proper is the tongue
Surface anatomy of the oral vestibule—N51
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Maxilla
o Alveolar process
o Anterior surface (above the alveolar process)
o Infratemporal surface
Mandible
o Alveolar process
o Coronoid process and the tendon of the temporalis m.
Masseter m.
o Can be palpated when the teeth are clenched
Communication between the oral vestibule and the oral cavity proper
o Posterior to the third molar tooth
Frenulum
Opening of the parotid duct
o Located lateral to the second maxillary molar tooth
Surface anatomy of the oral cavity proper
Borders of your oral cavity
 Lateral and anterior: teeth and gums
 Superior: the hard palate
 Inferior: mucosa covering tongue and sublingual area
 Posterior: palatoglossal folds (right and left)
In your oral cavity
 Tongue
o Body
o Apex
51
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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o Median sulcus
Sublingual area
o Frenulum of the tongue (sublingual frenulum)
o Sublingual fold (pica sublingualis)
o Sublingual caruncle
o Opening of the submandibular duct: on the sublingual caruncle
o Deep lingual veins: on either side of frenulum of tongue
Tongue—N58
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Tongue
o Root—posterior 1/3
o Body—anterior 2/3
o Apex
o Dorsum
 Terminal sulcus (sulcus terminalis)—divides anterior 2/3 of tongue from posterior 1/3
 Lingual tonsil—posterior to terminal sulcus
 Foramen cecum—in midline at point o terminal sulcus
 Lingual papillae—four types: vallate, filiform, fungiform, and foliate
Body of the tongue
o Lies horizontal in the oral cavity
Root of the tongue
o Is more vertical
o Lower part of anterior boundary of the oropharynx
o Structures include:
 Median glossoepiglottic fold: midline fold of mucosa between the dorsum of the tongue and the epiglottis
 Lateral glossoepiglottic fold: between the dorsum of the tongue and the lateral border of the epiglottis
 Epiglottic vallecula: depression between median and lateral glossoepiglottic folds
Bisection of the mandible and floor of the mouth
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Mylohyoid mm.
Geniohyoid m.
o Deep to mylohyoid
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Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Anterior attachment: inferior mental spine of the mandible
Posterior attachment: body of hyoid bone
Function: pulls hyoid bone anteriorly
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Sublingual region—N51
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Genioglossus m.
o Anterior attachment: superior mental spine of the mandible
o Posterior attachment: hyoid bone and the tongue
o Function: protrudes the tongue
o Innervate: hypoglossal nerve (XII)
o Clinical correlation
 Lack of function of the genioglossus m is a result of hypoglossal n. dysfunction; the tongue cannot protrude in the
midline; the functional side of the tongue protrudes normally and the side with the dysfunctional nerve protrudes less or
not at all; when testing for hypoglossal n. lesions, the protruded tongue deviates toward the side of the nerve lesion
Frenulum of the tongue
Sublingual fold
Sublingual caruncle
Opening of the submandibular duct
Sublingual gland
o Deep to mucosa
o Rests on mylohyoid m.
o Has about 12 short ducts that drain along the summit of the sublingual fold
Submandibular duct
o Opens at the sublingual caruncle
Deep part of the submandibular gland
o On deep side of mylohyoid m.
Lingual n.
o Passes lateral, inferior, and medial to the submandibular duct
o Has several branches that supply the mucosa of the anterior 2/3 of the tongue with general sensation and taste fibers—N61
Submandibular ganglion
o Near the third mandibular molar tooth
o Below the lingual n.
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53
Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)
Melissa McDole
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Hypoglossal n. (XII)
o Passes between the submandibular gland and the hypoglossal m.
o Both the hypoglossal n. and the lingual n. pass between the hypoglossus m and the mylohyoid m. to enter the sublingual region
o Hypoglossal n. passes inferior to the lingual n.
Hypoglossus m.
o Deep to the mylohyoid
o Inferior attachment: body and greater horn of the hyoid bone
o Superior attachment: lateral side of the tongue
o Function: depresses and retracts tongue
Styloglossus m.—N59
o Proximal attachment: styloid process
o Distal attachment: lateral side of the tongue
o Function: draws tongue superiorly
Intrinsic mm of the tongue—N60
o Vertical
o Transverse
o Superior longitudinal
o Inferior longitudinal groups of fibers
Lingual artery—from external carotid artery
o Passes medial to the hypoglossal m.—name becomes deep lingual artery
The intrinsic mm of the tongue and three extrinsic mm of the tongue (styloglossus, genioglossus, and hypoglossus) are innervated by
the hypoglossal n. (XII)
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