1 Department of Anatomy REGIONAL ANATOMY OF THE HEAD MUDr. Marek Joukal, Ph.D. Borders aginst neck Superficial: protub. occipit. ext. linea nuchae sup. porus acusticus ext. mandible Deep: basis cranii ext. Border: glabela - protub. occip. ext. Cranial region Superficial regions: regio frontalis regio parietalis regio occipitalis regio temporalis Deep regions: basis cranii int. basis cranii ext. Layers: 1. skin (+ hairs) 2. Subcutaneous tissue 3. galea aponeurotica 4. Loose subgaleal tissue 5. periosteum 5. bone (lamina ext., diploe, lamina int.) 6. dura mater encephali Scalp and calvaria 2 Regiones frontoparietooccipitales a., v. et n. supraorbitalis a supratrochlearis a., v., n., zygomaticotemporalis a. et v. temporalis superficialis, n. auriculotemporalis, n. auricularis magnus a. et v. auricularis post. a. et. v. occipitalis, n. occipitalis major et minor Regio temporalis n. auriculotemporalis fascia temporalis m. temporalis a.,v., n. temporalis prof. Borders: linea temporalis sup., arcus zygomaticus skin n. auricularis magnus m. temporoparietalis (n.VII.) a., v. temporalis spf. (v. retromandibularis) Fossa cranii anterior Fossa cranii media Fossa cranii posterior BASIS CRANII INTERNA BASIS CRANII INTERNA – Fossa cranii anterior os frontale: partes orbitales - sinus frontalis pars nasalis crista frontalis - falx cerebri + sinus durae matris os ethmoidale: lamina cribrosa - nn. olfactorii, a. meningea ant. n. ethmoidalis ant. (rr. nasales) crista galli os sphenoidale: allae minores – canalis opticus (n. opticus, a. ophthalmica) sulcus praechiasmaticus - chiasma opticum 3 BASIS CRANII INTERNA – Fossa cranii media os sphenoidale: facies cerebralis allae majores sella turcica os temporale facies ant. pyramidis squama ossis temporalis fossa hypophysialis: hypophysis sulcus caroticus: sinus cavernosus sulcus sinus petrosi superioris sinus petrosus superior impressio trigemini ganglion trigeminale Fossa cranii media - structures III. IV. V/1 V/2 VI. Sinus cavernosus - structures Fossa cranii media - openings fissura orbitalis superior n. III., IV., VI. n. ophthalmicus (+branches) vena ophthalmica sup. apertura int. canalis carotici a. carotis int. hiatus canalis n. petrosi majoris n. petrosus major hiatus canalis n. petrosi minoris n. petrosus minor 4 Fossa cranii media - openings foramen rotundum n. maxillaris foramen ovale n. mandibularis, veins foramen spinosum a. meningea media, r. meningeus n. mandibularis BASIS CRANII INTERNA – Fossa cranii posterior os sphenoidale clivus (synchondrosis sphenooccipitalis) os temporale facies post. pyramidis os occipitale Structures related to dura mater enceph. protuberantia occipitalis interna eminentia cruciformis Structures related to dural sinuses sulcus sinus sagittalis superioris sulcus sinus transversi sulcus sinus sigmoidei sulcus sinus petrosi superioris sulcus sinus petrosi inferioris Fossa cranii posterior Fossa cranii posterior – openings porus acusticus internus canalis n. facialis (VII.), n. VIII. apertura externa aqueductus vestibuli ductus endolymphaticus apertura externa canaliculi cochlae Perilymph drainage 5 Fossa cranii posterior – openings foramen jugulare nn. IX., X., XI., vena jugularis interna canalis hypoglossi n. XII canalis condylaris emissarium foramen magnum spinal cord, a. vertebralis, n. XI., veins BASIS CRANII EXTERNA Fossa cranii anterior Fossa cranii media Fossa cranii posterior BASIS CRANII EXTERNA – fossa cranii anterior Palatum durum processus palatini maxillarum laminae horizontales ossis palatini choanae maxilla BASIS CRANII EXTERNA – fossa cranii anterior Palatum durum: foramen palatinum majus – nervus palatinus major, arteria palatina major foramina palatina minora – nervi palatini minores, arteriae palatinae minores foramen incisivum – nervus nasopalatinus, small spetal arteries from a. maxillaris Choanae – cavitas nasi 6 BASIS CRANII EXTERNA – fossa cranii media Os sphenoidale: corpus – crista et vomer (choanae) allae majores foramen ovale – n. mandibularis foramen spinosum – a. meningea media, r. meningeus processus pterygoideus canalis pterygoideus – n. canalis pteryg. (n. petrosus prof. + n. petrosus major) BASIS CRANII EXTERNA – fossa cranii media (os temporale) synchondrosis sphenopetrosa (n. petrosus major et minor) apertura externa canalis carotici (a. carotis int., plexus caroticus) canalis musculotubarius (m. tensor tympani, tuba auditiva) apertura externa canaliculi tympanici (n. tympanicus) apertura externa canaliculi cochlae (perilympha) fossa jugularis (v. jugularis int.) canaliculus mastoid. (n. auricularis) foramen jugulare (nn. IX., X., XI.) foramen stylomastoideum (n. VII.) processus mastoideus (m. sternocleidomastoideus) incisura mastoidea (m. digastricus) sulcus arteriae occipitalis (a. occipitalis) fossa mandibularis et tuberculum articulare (art. temporomandibularis) os tympanicum – sulcus (membrana tympani) fissura petrotympanica (chorda tympani) fissura tympanomastoidea (n. auricularis n. X.) BASIS CRANII EXTERNA – fossa cranii media (os temporale) BASIS CRANII EXTERNA – fossa cranii posterior (os occipitale) foramen magnum medulla spinalis, a. vertebralis a. spinalis ant. + aa. spinales post. plexus venosi vertebrales int. + basilaris radix spinalis n. XI. condyli occipitales – art. atlantooccipitalis canalis n. hypoglossi – n. XII. canalis condylaris – emmisarium protuberantia occip. ext. + crista occipit. lig. nuchae lineae nuchae 7 FACIAL REGION Superficial regions regio orbitalis regio nasalis regio labialis regio mentalis regio infraorbitalis regio zygomatica regio buccalis regio parotideomasset. Regio parotideomasseterica Borders: Superior - arcus zygomaticus Ventral - m. masseter Caudal - mandible Posterior – line through tragus Regio parotideomasseterica - content glandula parotis fascia parotideomasseterica ductus parotideus plexus parotideus n. VII. pars spf. et prof. gl. parotis a. temporalis spf. a. transversa faciei v. temporalis spf., v. retromandibularis n. auriculotemporalis NERVUS VII. - plexus parotideus rr. temporales rr. zygomatici rr. buccales r. marginalis mandibulae r. coli (ansa cervicalis spf.) 8 n.VII. r. stylohyoideus (m. stylohyoideus) r. digastricus (venter post. m. digastrici) n. auricularis post. a. auricularis post. (a. carotis ext.) Retromandibular region Other facial regions Regiones: orbitalis, nasalis, infraorbitalis, buccalis, zygomatica mentalis Layers: Skin and subscutaneous tissue innervation - n. V. mm. of facial expression innervation - n. VII. Blood supply a. et v. facialis (branches of a. maxillaris et ophthalmica) Mocosa and submocusa gll. labiales, buccales, nasales Skin innervation Around eye m. orbicularis oculi m. procerus m. corrugator supercilii Around nose m. nasalis Muscles of the facial expression 9 Around mouth m. levator labii sup. m. levator labii sup. al. nasi, m. levator anguli oris m. zygomaticus major et minor m. buccinator m. risorius m. orbicularis oris m. depressor anguli oris m. depressor labii inf. m. mentalis Muscles of the facial expression Blood supply of the face a. facialis a. labialis sup. et inf. (circulus arteriosus oris) a. alaris nasi a. angularis a. maxillaris a. mentalis a. infraorbitalis a. ophthalmica a. supraorbitalis a. supratrochlearis et infratrochlearis a. temporalis spf. a. transversa faciei v. facialis vena profunda faciei (connected with plexus pterygoideus) plexus pterygoideus (v. maxilaris) v. mentalis v. infraorbitalis v. ophthalmica sup. et. Inf. v. supraorbitalis v. palpebralis med. et lat. v. supratrochlearis et infratroch. Blood drainage of the face Superior wall crista infratemporalis alae majoris ossis sphenoidalis Medial wall lamina lateralis processus pterygoidei Lateral side of the pharynx Ventral wall facies infratemporalis corporis maxillae Lateral wall ramus mandibulae Dorsal wall Styloid septum Regio infratemporalis 10 Regio infratemporalis musculus pterygoideus med. et lat. n. mandibularis Brancehs for masticatory muscles, m. tensor tympani a veli palatini, n. buccalis, n. auriculotemporalis, n. lingualis, n. alveolaris inf. a. maxillaris (pars mandibularis et pterygoidea) plexus pterygoideus Regio infratemporalis Canalis mandibulae: a. et n. alveolaris inf. (nervus mylohyoideus), n. buccalis, n. lingualis Spatium praestyloideum et retrostyloideum Styloid septum m. sternocleidomastoideus venter posterior m. digastrici m. stylohyoideus m. stylopharyngeus m. styloglossus Spatium praestyloideum a. carotis ext. v. retromandibularis Spatium retrostyloideum a.carotis int. v. jugularis int. nn. IX., X., XI., XII. tr. sympathicus a. carotis int. a. pharyngea asc. v. jugularis int. plexus venosus pharyngeus n. IX. (m. stylopharyngeus) n. X. (vagina carotica - dors.) n. XI. (m. sternocleidomast.) n. XII. (arcus n. hypoglossi) tr. sympathicus (praevertebral fascia) Spatium parapharyngeum 11 Superior wall facies maxillaris alae majoris ossis sphenoidalis foramen rotundum (fossa cranii media) fissura orbitalis inferior (orbita) Medial wall lamina perpendicularis ossis palatini foramen sphenopalatinum (cavum nasi osseum) Ventral wall tuber maxillae (foramina alveolaria) Dorsal wall processus pterygoideus ossis sphenoidalis canalis pterygoideus (basis cranii externa) Inferiorly canalis palatinus major (cavum oris) Fossa pterygopalatina Fossa pterygopalatina - content a. maxillaris (pars pterygopal.) a. infraorbitalis a. alveolaris sup. post. a. palatina descendens a. canalis pterygoidei a. sphenopalatina n. maxillaris n. infraorbitalis n. zygomaticus nn. pterygopalatini ggl. pterygopalatinum nn. palatini (major et minores) n. canalis pterygoidei (n. petrosus maj.,prof.) nn. nasales post.., rr. orbitales Eylid morphology skin Subcutaneous tissue m. orbicularis oculi septum orbitale + tarsus sup. et inf. (gl. tarsales - Meibomi) m. tarsalis sup. et inf., m. levator palpebrae sup. tunica conjunctiva palpebrarum Regio orbitalis + orbit Aditus orbitae margo supraorbitalis, infraorb. Superior wall pars orbitalis ossis frontalis ala minor ossis sphenoidalis Orbit – bony part Medial wall processus frontalis maxillae os lacrimale lamina orbitalis ossis ethmoidalis ala minor ossis sphenoidalis Lateral wall facies orbitalis ossis zygomatici facies orbitalis alae majoris ossis sphenoid. fissura orbitalis superior et inferior Inferior wall facies orbitalis corporis maxillae facies orbitalis ossis zygomatici processus orbitalis ossis palatini 12 Orbit – content periorbit fissura orbitalis sup. et inf. (m. orbitalis) vagina bulbi Extraocular muscles and their fascia mm. recti (sup., inf. med., lat.) mm. obliqui (sup., inf.) m. levator palpebrae sup. spatium episclerale Loose connective tissue corpus adiposum orbitae bulbus oculi Retrobulbar space – upper part borders: periorbita m. levator palpebrae sup. n. lacrimalis r. comm. cum n. zygomatico n. frontalis n. supraorbitalis (med., lat.) n. supratrochlearis n. trochlearis m. obliquus bulbi sup. Retrobulbar space – middle part n. abducens m. rectus lat. ramus sup. n. oculomotorii m. levator palpebrae sup m. rectus sup. et med. ramus inferior n. oculomotorii ggl. ciliare nn. ciliares breves n. nasociliaris n. ethmoidalis ant., post., n. infratrochlearis a. ophthalmica a. ethmoidalis ant., post., a. infratrochlearis v. ophthalmica sup. borders: m. levator palpebrae sup. + plane through n. opticus Retrobulbar space – inferior part borders: plane through n. opticus + floor of the orbit ramus inf. n. oculomotorii m. rectus inf. m. obliquus bulbi inf. a. + n. infraorbitalis canalis infraorbitalis a. + n. zygomaticus foramen zygomaticoorbitale v. ophthalmica inf. 13 Regio sublingualis borders: kran.: mucosa of the floor of oral cavity (plica subligualis, caruncula sublingualis) kaud.: diaphragma oris (m. mylohyoideus, m. geniohyoideus, m. digastricus, m. stylohyoideus) lat.: mandible med.: tongue Regio sublingualis gl. submandibularis + ductus submandibularis (crossing with n. lingualis) gl. subligualis + ductus sublinguales major et minores a., n. lingualis n. hypoglossus v. commitans n. hypoglossi References Čihák, R.: Anatomie 3. Praha, Grada, 2001, 2004 Sobotta, J.: Atlas of Human Anatomy Vol 1–2 Munich, Urban und Schwarzenberg, 1993 Wiliams, P. & Warvick, R.: Gray´s Anatomy, 37 ed, Churhill Livingstone, 1996 Netter, F.: Atlas of Human Anatomy, 4th ed., Elsevier, USA, 2006