dr mouin abboud pr of anatomy faculity of medicin damascus …ªشريح 2... · sensory...
TRANSCRIPT
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DR MOUIN ABBOUD
pr of anatomy
Faculity of medicin
Damascus and sham
universiies
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نواحي الرأس والعنق
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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
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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].
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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
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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.
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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.
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Branches from the ophthalmic
artery• The supratrochlear
• and supra-orbital arteries supply the
anterior and superior aspects of the scalp.
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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
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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.
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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.
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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
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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.
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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].
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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.
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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
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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.
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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).
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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.
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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 •
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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
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Subdivisions
❑ the anterior triangle subdivides into four
triangles :
❖Carotid triangle
❖Submental Triangle
❖Submandibular Triangle
❖Muscular Triangle
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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 •
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Submental Triangle
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Submental Triangleالمثلث تحت الذقن
.بالبطن الأمامي لذات البطنينيتحدد بكل جانب •
, الفك السفليقمته تتوضع على •
لة وسقفه هو العضجسم العظم اللاميتتشكل قاعدته من •
.الضرسية اللامية
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المثلث تحت الذقن
وبعض عقدتين لمفيتينيحتوي المثلث تحت الذقن عقدة أو •
.الأوردة المتحدة لتشكيل الوريد الوداجي الأمامي
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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.
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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•
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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
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Submandibular Triangle
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Submandibular Triangle
❑ The Submandibular Triangle : contains
❖ the submandibular gland (salivary),
❖and lymph nodes.
❖The facial artery and vein also pass
through this area.
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CONTENTS OF DIGASTRIC
TRIANGLE
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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•
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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•
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Muscular Triangle
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• 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.
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:The Carotid Triangleالمثلث السباتي
القصية الخشائيةبالعضلة بالخلفيتحدد •
ميةبالبطن العلوي للعضلة الكتفية اللابالأمام والأسفل•
ات بالعضلة الإبرية اللامية والبطن الخلفي لذبالأعلى•
.البطنين
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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
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❑ 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.
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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.
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: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
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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.
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• 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
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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.
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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.
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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.
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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.
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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
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: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
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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.
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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
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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.
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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
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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.
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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
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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
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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.
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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.
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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.
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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.
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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)
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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.
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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.
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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.
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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.
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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.