The Head - Speaker Deck

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Scalp (Page 58) Dr.Sherif Fahmy

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Supra-orbital notch Super-ciliary arch Supero-medial angle (supratrochlear notch) Supra- orbital foramen Dr.Sherif Fahmy

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Superior temporal line Super- ciliary arch Superior nuchal line Dr.Sherif Fahmy

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Superior nuchal line Dr.Sherif Fahmy Highest nuchal line

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Sup. Nuchal line Superior temporal line Superciliary arch Extensions of scalp Dr.Sherif Fahmy

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Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium Layers of scalp Dr.Sherif Fahmy

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Subcutaneous vessels Emissary vein Intracranial vein Dangerous layer Dr.Sherif Fahmy 1- Skin 2- Connective tissue 3- Aponeurosis of occipito- frontalis m. 4- Loose areolar layer 5-Pericarnium Subcutaneous nerve Fat Fibrous septum

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3rd Layer of Scalp (Occipito-frontalis Muscle)

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Frontal belly Occipitl belly Aponeurosis Lateral 2/3 of Sup. Nuchal line Posterior auricular br. Of facial n. Temporal br. Of facial n. Parotid gland Superior temporal line Skin at eyebrow Facial nerve

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Nerve Supply of Scalp (Page 60)

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Sensory (Cutaneous)

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Ophthalmic n. Maxillary n. Mandibular n. Ventral primary rami of upper cervical nerves Dr. Sherif Fahm Trigeminal nerve Dorsal primary rami of upper cervical nerves

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Trigeminal ganglion Ophthalmic n. Maxillary n Mandibular n. Dr.Sherif Fahmy

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Supra- trochlear n. Supra- orbital n. Zigomatico- temporal n. Auriculo- temporal n. Greater occipital n. Third occipital n. Lesser occipital n. Great auricular n. Auricle

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Dr.Sherif Fahmy Supra-trochlear n. Supra-orbital n. Zygomatico- temporal n. Auriculo- temporal n. Greater occipital n. Lesser occipital n. Third occipital n. Great auricular n.

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Motor

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Facial nerve Posterior auricular n. Temporal brs.

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Blood Supply of Scalp (Page 62)

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Supra- trochlear a. Supra-orbital a. Superficial temporal a. Occipital a. Posterior auricular a. External carotid artery

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Supra- trochlear vein Supra- orbital vein Facial vein Deep facial vein Superficial temporal vein Occipital venous network Occipital vein Sub- occipital venous plexus Retro- mandibular vein Common facial vein Posterior auricular vein E.J.V.

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Lymph Drainage 1- Anterior part: to Submandibular lymph nodes. 2- Middle (lateral) part: to parotid lymph nodes. 3- Posterior part: to mastoid and occipital lymph nodes.

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FACE (Page 65) Dr. Sherif

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Dr. Sherif Fahmy

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Muscles of the Face ➢1- Orbicularis oculi ➢2- Buccinator ➢3- Orbicularis oris Dr. Sherif Fahm

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Orbicularis oculi m. Orbicularis oris m. Buccinator m. Dr. Sherif Fahmy

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Orbicularis Oculi Dr. Sherif Fahmy

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Dr. Sherif Fahm

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Superior tarsus Inferior tarsus Medial palpebral ligament Lateral palpebral ligament Dr. Sherif Fahmy

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Medial palpebral lig. Orbital part Palpebral part Dr. Sherif Fahmy

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Medial palpebral lig. Dr. Sherif Fahmy

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Lacrimal sac Dr. Sherif Fahmy

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Posterior lacrimal crest Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Orbicularis Oris & Buccinator (Page 66) Dr. Sherif Fahmy

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Masseter m. (cut) Buccinator m. Orbicularis oris m. Temoralis m. Dr. Sherif Fahmy

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Upper fibers Lower fibers Middle fibers Dr. Sherif Fahmy

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Outer surface of alveolar margin of maxilla Outer surface of alveolar margin of mandible Pterygo- mandibular lig. Upper fibers Lower fibers Middle fibers Dr. Sherif Fahmy

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Skin Buccinator m. Buccal nerves Facial vessels Buccal lymph nodes Buccal pad of fat Bucco-pharyngeal fascia Buccal mucus membrane Parotid duct Dr. Sherif Fahmy

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Nerve Supply of Face (Page 68) A- Motor Nerve Supply Dr. Sherif Fahmy

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Parotid gland Facial nerve Posterior auricular br. Temporal branch Zygomatic branches Buccal nerves Mandibular br. Cervical branch Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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B- Sensory (cutaneous) Nerve Supply of Face (Page 69)

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Ophthalmic n. Maxillary n. Mandibular n. Great auricular n. (cervical plexus) Dr. Sherif Fahmy

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Supraorbital n. Supratrochlear n. Palpebral br. From lacrimal Infra-trochlear n. External nasal n. Ophthalmic Division Maxillary Division Infra-orbital n. Zygomatico-facial n. Mandibular Division Mental n. Buccal n. Auriculo-temporal n Great auricular n. Dr. Sherif Fahmy

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Blood Supply of Face A- Arterial Supply Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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B- Venous Drainage

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Dr. Sherif Fahmy

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Other Arteries Of The Face From ophthalmic artery: Supra-trochlear, supraorbital, dorsal nasal & palpebral arteries. From maxillary artery: infraorbital, buccal & mental arteries. From Superficial temporal artery: Transverse facial and zygomatico- orbital. Dr.Sherif Fahmy

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Facial art Supraorbital art. Supratrochlear art Infraorbital art Mental art Zygomatico- orbital art. Superficial temporal art Transverse facial art. Other arteries in the face Dorsal nasal Medial palpebral Lateral palpebral Zygomatic arch Dr.Sherif Fahmy

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B- Venous Drainage Dr.Sherif Fahmy

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Retro-mandibular (Posterior facial) vein Retro- mandibular vein Superficial temporal vein Maxillary vein Anterior division of retromandibular vein Posterior division of retromandibular vein Facial vein Posterior auricular vein External jugular vein Parotid gland Common facial vein Dr.Sherif Fahmy

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Facial vein Dr.Sherif Fahmy

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Supra-trochlear vein Supra-orbital vein Facial (anterior facial) vein Facial (Anterior Facial)vein Deep facial vein Anterior division of retro-mandibular vein Common facial vein Masseter m. Dr.Sherif Fahmy

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Communications Between Facial Vein and Cavernous Sinus Dr.Sherif Fahmy

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Facial vein Cavernous sinus Ophthalmic veins Deep facial vein Pterygoid venous plexus Emissary vein Dr.Sherif Fahmy

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Parotid Gland (Page 75) Dr.Sherif Fahmy

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Position, Extent & Capsule Dr.Sherif Fahmy

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Mastoid process Styloid process Ramus of mandible External auditory meatus Dr.Sherif Fahmy

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Extensions External auditory meatus 2 cm below and behind angle of mandible Mastoid process Masseter muscle Dr.Sherif Fahmy

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Parts of Parotid Gland 1- Main superficial part. 2- Small accessory part. 3- Deep part. Dr.Sherif Fahmy

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Main superficial part (Pyramidal in shape) Accessory part Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Relations of Parotid Gland Parotid gland has: -Two ends: upper & lower. -Two borders: Anterior & posterior. -Three surfaces: Lateral (superficial), Deep or medial (Anteromedial & posteromedial) Dr.Sherif Fahmy

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Ends of Parotid Gland Dr.Sherif Fahmy

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Upper concave end Lower pointed end Temporo-mandibular joint External auditory meatus Dr.Sherif Fahmy

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Posterior belly of digastric m. Auriculo- temporal nerve Superficial temporal vessels Cervical branch of facial nerve Divisions of retromandibular vein

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Borders of Parotid Gland Dr.Sherif Fahmy

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Sternomastoid m. Masseter m. Temporal br. Zygomatic br. Transverse facial artery Upper buccal br. Parotid duct Accessory part of gland Lower buccal br Mandibular br. Posterior border Dr.Sherif Fahmy

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Surfaces of Parotid Gland 1- Lateral (superficial or Subcutaneous). 2- Deep or medial: is divided by deep part into: A- Anteromedial surface. B- Posteromedila surface. Dr.Sherif Fahmy

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Lateral Surface Anterior division of great auricular nerve Superficial parotid lymph nodes Dr.Sherif Fahmy

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Deep or Medial surface Anterior border Posterior border Border of deep part Antero-medial surface Postero- medial surface Dr.Sherif Fahmy

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Ramus of mandible Medial pterygoid m. Masseter m. Mastoid process Styloid process Facial nerve Carotid sheath Internal carotid art. Lower 4 cranial nerves Internal jugular vein Dr.Sherif Fahmy

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Structures Within (Embeded) Parotid Gland (Page 80) Dr.Sherif Fahmy

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Facial nerve Retro-mandibular vein External carotid artery Deep parotid lymph nodes Dr.Sherif Fahmy

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Surface Anatomy of Parotid Gland (page 78) Dr.Sherif Fahmy

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Anterior border Lower end Posterior border Upper end Dr. Sherif Fahmy Dr.Sherif Fahmy

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Parotid Duct (Page 78) Dr.Sherif Fahmy

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Parotid duct Accessory part Transverse facial artery Buccinator muscle Masseter m. Dr.Sherif Fahmy

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Opening of parotid duct Dr.Sherif Fahmy

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Nerve Supply of Parotid Gland A- Sensory: Great auricular and auriculo-temporal nerves. B- Sympathetic: Plexus around external carotid and middle meningeal arteries. C- Parasympathetic Dr.Sherif Fahmy

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Medulla Inferior salivary nucleus Glosso- pharyngeal n. (9th CN) Jugular foramen Tympanic br. Tympanic canaliculus Tympanic cavity Tympanic plexus Lesser superficial petrosal n. Foramen ovale Otic ganglion Auriculo- temporal n. Parotid gland Post-ganglionic fibers Parasympathetic nerve supply Dr. Sherif Fahmy

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Facial Nerve (Page 89)

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Pons Motor nucleus Sup. Salivary n. N.Solitarius Internal auditory meatus Facial nerve Vestibulo- cochlear nerve Motor root Nervus intermedius

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Pons Medulla Facial nerve Petrous bone Internal auditory meatus Vestibule of internal ear Geniculate ganglion Medial wall Posterior wall Stylo- mastoid fr. Styloid process Parotid gland Course of facial N.

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Facial nerve Posterior auricular n. Temporal brs. Zygomatic brs. Buccal brs. Mandibular br. Cervical br.

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Pons Facial nerve Geniculate ganglion Stylo- mastoid fr. 1- Greater superficial petrosal n. F.Lacerum Pterygoid canal Spheno- palatine ganglion 2-N. To stapedius m. 3-Chorda tympani n. 4- Posterior auricular n. 5- N. to posterior belly of digastric & stylohyoid ms. Lingual n. Submandibular ganglion Branches of facial n.

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Facial nerve Posterior auricular n. Temporal brs. Zygomatic brs. Buccal brs. Mandibular br. Cervical br.

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CRANIAL CAVITY Dr. Sherif Fahmy

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Layers of Dura Mater A- Outer layer: It is the layer which is adherent to the inner surface of skull, which is actually the endosteum of bones. B- Inner layer: It is nearer to brain and is considered as the meningeal layer. Dr. Sherif Fahmy

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Folds of Dura Mater Folds are formed from inner layer of dura mater to separate between different parts of the brain. A- Vertical Folds: Falx cerebri & Falx cerebelli. B- Horizontal folds: Tentorium cerebelli & Diaphragma sellae.

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A- Vertical Folds:

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B- Horizontal Folds

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1- Falx Cerebri

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2- Tentorium Cerebelli (Page 112) Dr.Sherif Fahmy

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Cerebral hemisphere Cerebellar hemisphere Tentorium cerebelli Sagittal Section Dr.Sherif Fahmy

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Falx cerebri Tentorium cerebelli Dr.Sherif Fahmy

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Anterior Clinoid process Posterior clinoid process Superior petrosal sulcus Transverse sulcus Internal occipital protuberance Dr.Sherif Fahmy Apex of petrous bone

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Anterior clinoid process Free border Posterior clinoid process Superior petrosal sulcus Transverse sulcus Internal occipital protuberance Site of attachment of falx cerebri Oculomotor n. Trochlear n. Trigeminal n. Attached border Dr.Sherif Fahmy

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Attached border Free border Site of crossing between 2 borders Dr.Sherif Fahmy

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Tentorium cerebelli Superior petrosal sinus Transverse sinus Straight sinus Venous Sinuses Related Dr.Sherif Fahmy

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3- Falx Cerebelli (Page114) Dr.Sherif Fahmy

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Falx cerebri Tentorium cerebelli (cut) Falx cerebelli Foramen magnum Occipital sinus Dr.Sherif Fahmy

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4- Diaphragma Sellae Dr.Sherif Fahmy

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Falx cerebri Tentorium cerebelli Diaphragma sellae Pituitary stalk Dr.Sherif Fahmy

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Diaphragma Sellae Anterior clinoid process Posterior clinoid process Pituitary stalk Dr.Sherif Fahmy

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Blood & Nerve Supply of Meninges Cranial Fossae Blood supply Nerve Supply Anterior Anterior & posterior ethmoidal from ophthalmic Anterior ethmoidal from ophthalmic Middle Middle & accessory meningeal from maxillary. Meningeal br. of maxillary n. & nervus spinosus of mandibular Posterior Vertebral, occipital and ascending pharyngeal arteries Meningeal branches from vagus and hypoglosal nerves. Dorsal rami of upper 3 cervical nerves.

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Dural Venous Sinuses (page 116) Dr.Sherif Fahmy

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DURAL VENOUS SINUSES They are intracranial veins that run between 2 dural layers or in a dural fold. Dural sinuses are characterized by being thin walled, valveless, connected with extracranial veins by emissary veins. They drain skull bones, meninges, brain, orbit, inner ear and pituitary gland.

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Single Sinuses: 1- Superior sagittal. 2- Inferior sagittal. 3- Straight. 4- Occipital. 5- Basilar plexus of veins. 6- Intercavernous sinuses.

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Superior Sagittal Sinus Dr.Sherif Fahmy

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Anterior Clinoid process Posterior clinoid process Superior petrosal sulcus Transverse sulcus Internal occipital protuberance Dr.Sherif Fahmy Apex of petrous bone Foramen caecum

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Superior sagittal sinus Inferior sagittal sinus Straight sinus Great cerebral vein Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Superior sagittal sinus Arachnoid granulations Emissary vein Dr.Sherif Fahmy

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Arachnoid granulations Anterior trunk of middle meningeal vein Posterior trunk of middle meningeal vein Superior sagittal sinus (opened) Dr.Sherif Fahmy

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Superior sagittal sinus (opened) Side lacuna (opened) Side lacunae of superior sagittal sinus Arachnoid granulations Dr.Sherif Fahmy

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Inferior Sagittal and Straight Sinuses Dr.Sherif Fahmy

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Superior sagittal sinus Inferior sagittal sinus Straight sinus Great cerebral vein Dr.Sherif Fahmy

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Single & Paired Sinuses Dr.Sherif Fahmy

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Central retinal vein Spheno- parietal sinus Ophthalmic vein Intercavernous sinuses Superficial middle cerebral vein Middle meningeal vein Superior petrosal sinus Inferior petrosal sinus Basilar plexus of veins Occipital sinus Transverse sinus Sigmoid sinus Cavernous sinus Dr.Sherif Fahmy

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Cavernous Sinus (Page 118) Dr.Sherif Fahmy

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Site, Shape, Size of Cavernous Sinus Dr.Sherif Fahmy

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Dr.Sherif Fahmy Apex of petrous bone Apex of orbit Side of body of sphenoid (site of cavernous sinus)

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Cavernous sinus Body of sphenoid Dr.Sherif Fahmy

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Cavernous sinus Dr.Sherif Fahmy Body of sphenoid Anterior superior intercavernous sinus

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Relations of Cavernous Sinus Dr.Sherif Fahmy

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Cavernous sinus Body of sphenoid Apex of petrous bone Apex of orbit Dr.Sherif Fahmy

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Pituitary gland Body of sphenoid Sphenoidal air sinus Occulomotor n. Trochlear n. Ophthalmic n. Maxillary n. Internal carotid art. Abducent n. Dr.Sherif Fahmy Cavernous sinus

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Pituitary gland Body of sphenoid Int. Carotid art. Sphenoidal air sinus Uncus of temporal lobe Occulomotor n. Trochlear n. Abducent n. Ophthamic n. Maxillary n. Dr.Sherif Fahmy

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Communications Dr.Sherif Fahmy

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Central retinal vein Spheno- parietal sinus Ophthalmic vein Intercavernous sinuses Superficial middle cerebral vein Middle meningeal vein Superior petrosal sinus Inferior petrosal sinus

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Cavernous sinus Anterior facial vein Superior ophthalmic vein Deep facial vein Pterygoid venous plexus Pharyngeal plexus Internal jugular vein

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EMISSARY VEINS (Page 120)

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Superior sagittal sinus Nasal veins Foramen caecum Cavernous sinus Sigmoid sinus Anterior facial vein Ophthalmic vein Deep facial vein Pterygoid venous plexus Pharyngeal plexus Int. jugular vein Occipital veins Suboccipital venous plexus Parietal emmissary veins

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PITUITARY GLAND

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Optic groove for optic chiasma Sella turcica Dorsum sellae Site for cavernous sinus

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Pituitary gl. Pituitary stalk Tuber cinereum (hypothala mus) Optic chiasma

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Optic chiasma Pituitary gl. Sphenoida air sinus Dorsum sellae Sagittal Section

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Pars tuberalis Pars anterior Pars intermedia Anterior lobe Pars posterior (posterior lobe) Stalk Infundibulum Parts of Pituitary Gland Tuber cinereum (hypothalamus)

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Superior hypophyseal art. Inferior hypophyseal art. Hypothalamo- hypophyseal portal vein Vein to cavernous sinus Blood Supply of Pituitary Gland

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Intra-cranial Course of Internal Carotid Artery

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Relations of Lateral Pterygoid Muscle (Page 87) Dr.Sherif Fahmy

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N. To masseter m. Deep temporal nerves. Lingual n. Inferior alveolar n. Maxillary artery Buccal br. Of mandibular n. Upper border Lower border Between 2 heads Ramus (cut) Superficial head of med. Pterygoid m. Dr.Sherif Fahmy

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Lateral pterygoid m. (cut) Accessory meningeal art. Middle meningeal art. Sphenoman dibular lig. Chorda tympani n. Tensor tympani m. Mandibular n. Deep Relations Dr.Sherif Fahmy Lateral pterygoid plate

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Mandibular n. Middle meningeal a. Sphenomandibular lig. Lateral pterygoid m. (cut) Dr.Sherif Fahmy Lateral pterygoid plate Chorda tympani

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Parasympathetic Nerve Supply (Page 80) Dr.Sherif Fahmy

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Applied Anatomy: 1- Inflammation of parotid Gl.: Causes: viral or bacterial which reach the gland through blood or duct of the gland. Leads to: - Pain in the gland. - Pain in TMJ. - Everted ear lobule. 2- Parotid tumor: benign or malignant.

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Dr.Sherif Fahmy

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THE ORBIT (Page 123) Dr.Sherif Fahmy

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BONY ORBIT Dr.Sherif Fahmy

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Roof & Lateral Wall Dr.Sherif Fahmy

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Orbital plate of frontal bone Lesser wing of sphenoid Optic foramen Greater wing of sphenoid Zygomatic bone Superior orbital fissure Dr.Sherif Fahmy

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Medial Wall Dr.Sherif Fahmy

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Frontal process of maxilla Lacrimal bone Orbital plate of ethmoid Body of sphenoid Lacrimal fossa Dr.Sherif Fahmy

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Posterior ethmoidal foramen Anterior ethmoidal foramen Ethmoidal Foramena Dr.Sherif Fahmy

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Floor Dr.Sherif Fahmy

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Orbital surface of maxilla Infra-orbital groove Orbital surface of zygomatic bone Infra-orbital foramen Dr.Sherif Fahmy

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Orbital Fissures Dr.Sherif Fahmy

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Superior orbital fissure Inferior orbital fissure Dr.Sherif Fahmy

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CONTENTS OF ORBIT ➢ 1- The eyeball. ➢ 2- Extraocular muscles. ➢ 3- Nerves: optic nerve, branches of ophthalmic nerve, divisions of oculomotor, trochlear, abducent, sympathetic fibers and ciliary ganglion. ➢ 4- Vessels: ophthalmic artery and vein. ➢ 5- Lacrimal apparatus. ➢ 6- Fat Dr.Sherif Fahmy

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EXTRAOCULAR MUSCLES ➢6 muscles are inserted to the eyeball: 4 recti (lateral, medial, superior and inferior), 2 oblique (superior and inferior). ➢One muscle is inserted to upper eye lid (levator palpebrae superioris). Dr.Sherif Fahmy

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Superior rectus muscle Inferior oblique m. Inferior rectus m. Lateral rectus muscle Medial rectus muscle Dr.Sherif Fahmy

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Levator palpebrae superioris Superior rectus Lateral rectus Lacrimal gland Medial rectus Superior oblique m. Dr.Sherif Fahmy

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Levator palpebrae superioris muscle (cut) Superior rectus (cut) Medial rectus muscle Lateral rectus m. Optic nerve Inferior rectus muscle Dr.Sherif Fahmy

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Origin of Extraocular Muscles: -4 recti: arises from common tendinous ring around optic foramen and medial end of superior orbital fissure. - Superior oblique & levator palpebrae superioris: from posterior part of roof. - Inferior oblique: from anterior part of floor just lateral to lacrimal groove. Dr.Sherif Fahmy

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RECTI MUSCLES 1- Medial Rectus. 2- Lateral Rectus. 3- Superior Rectus. 4- Inferior Rectus Dr.Sherif Fahmy

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Medial rectus m. Lateral rectus m. Inferior rectus m. Superior rectus m. Tendinous ring Lateral Medial Optic foramen Superior orbital fissure Dr.Sherif Fahmy

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Superior rectus muscle Inferior oblique m. Inferior rectus m. Lateral rectus muscle Medial rectus muscle Dr.Sherif Fahmy

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Superior rectus Lateral rectus Lacrimal gland Medial rectus muscle Inferior rectus m. Dr.Sherif Fahmy

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Superior rectus m Medial rectus m Inferior rectus m Lateral rectus m 5.5 6.5 7 7.5 Dr.Sherif Fahmy

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OBLIQUE MUSCLES 1- Superior Oblique. 2- Inferior Oblique. Dr.Sherif Fahmy

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1- Superior Oblique Muscle Dr.Sherif Fahmy

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Lacrimal fossa Origin of inferior oblique muscle Origin of superior oblique Origin of levator palpebrae superioris Dr.Sherif Fahmy

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Superior oblique m. Trochlea Superior oblique m. Dr.Sherif Fahmy

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2- Inferior oblique Muscle Dr.Sherif Fahmy

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Lacrimal fossa Origin of inferior oblique muscle Dr.Sherif Fahmy

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Inferior oblique m. Inferior rectus m. Superior oblique m. Trochlea Dr.Sherif Fahmy

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LEVATOR PALPEBRAE SUPERIORIS Dr.Sherif Fahmy

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Levator palpebrae superioris m. Superior rectus muscle Dr.Sherif Fahmy

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Levator palpebrae superioris Dr.Sherif Fahmy

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Nerves of the Orbit 1- Motor Nerves: - Oculomotor n. (3rd CN) - Trochlear n. (4th CN) - Abducent n. (6th CN) 2- Sensory Nerves: - 3 branches of ophthalmic nerve (5th CN) (lacrimal, frontal and naso-ciliary) - Optic nerve. (2nd CN) Dr.Sherif Fahmy

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Anatomy of a Cranial Nerve - Deep origin (nuclei). - Type of fibers inside the nerve. - Superficial attachment. - Course. - Branches. - Applied anatomy. Dr.Sherif Fahmy

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Oculomotor nerve Trochlear nerve Trigeminal nerve Abducent nerve Dr.Sherif Fahmy

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Crossing between 2 borders Oculomotor (3rd CN) Trochlear (4th CN) Trigeminal (5th CN) Dr.Sherif Fahmy

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Cavernous sinus Dr.Sherif Fahmy

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Body of sphenoid Occulomotor n. Trochlear n. Ophthalmic n. Maxillary n. Internal carotid art. Abducent n. Cavernous sinus Dr.Sherif Fahmy

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Anterior clinoid process Optic foramen Superior orbital fissure Dr.Sherif Fahmy

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Tendinous ring Lacrimal n. Frontal n. Trochlear n. Superior division of oculomotor Inferior division of oculomotor Nasociliary n. Abducent n. Optic nerve Ophthalmic art. Dr.Sherif Fahmy

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Motor Nerve Supply (Page 135) 1- Oculomotor nerve. 2- Trochlear nerve. 3- Abducent nerve. Dr.Sherif Fahmy

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1- Oculomotor Nerve Dr.Sherif Fahmy

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Midbrain Oculomotor n. Superior orbital fissure Superior division Lev. Palp. superioris Superior rectus Inferior division Med. rectus Inf. rectus Inferior oblique Ciliary gang. Dr.Sherif Fahmy

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Injury of Oculomotor N. 1- Ptosis. 2- Lateral squint. 3- Dilatation of pupil. 4- Loss of accomodation. Dr.Sherif Fahmy

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Ciliary Ganglion Dr.Sherif Fahmy

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Ciliary ganglion Short ciliary nerves Dr.Sherif Fahmy

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2- Trochlear Nerve (Page 137) Dr.Sherif Fahmy

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Inferior colliculus Trochlear nerve Dr.Sherif Fahmy

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Basillar artery Posterior cerebral artery Trochlear nerve Suerior cerebellar artery Dr.Sherif Fahmy

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Crossing between 2 borders Trochlear (4th CN) Dr.Sherif Fahmy

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Trochlear nerve Superior orbital fissure Superior oblique m Dr.Sherif Fahmy

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3- Abducent Nerve Dr.Sherif Fahmy

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Abducent nerve Cavernous sinus Dr.Sherif Fahmy

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Body of sphenoid Internal carotid art. Abducent n. Dr.Sherif Fahmy Cavernous sinus Dr.Sherif Fahmy

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Pons Medulla Abducent n. Superior orbital fissure Lateral rectus m Dr.Sherif Fahmy

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Sensory Nerves - Ophthalmic nerve. - Optic nerve. Dr.Sherif Fahmy

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Ophthalmic Nerve (Page 133) Dr.Sherif Fahmy

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Supraorbital n. Supratrochlear n. Palpebral br. From lacrimal Infra-trochlear n. External nasal n. Ophthalmic Division Dr.Sherif Fahmy

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Body of sphenoid Occulomotor n. Trochlear n. Ophthalmic n. Maxillary n. Dr.Sherif Fahmy Cavernous sinus Dr.Sherif Fahmy

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Superior orbital fissure Dr.Sherif Fahmy

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Tendinous ring Lacrimal n. Frontal n. Trochlear n. Superior division of oculomotor Inferior division of oculomotor Nasociliary n. Abducent n. Dr.Sherif Fahmy

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Course & Branches Dr.Sherif Fahmy

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Ophthalmic nerve Trigeminal ganglion Lacrimal br. Frontal br. Naso-ciliary br. Dr.Sherif Fahmy

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Branches of Ophthalmic Nerve 1- Lacrimal. 2- Frontal. 3- Naso-ciliary. Dr.Sherif Fahmy

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Supraorbital n. Supratrochlear n. Palpebral br. From lacrimal Infra-trochlear n. External nasal n. Ophthalmic Division Dr.Sherif Fahmy

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1- Lacrimal Nerve Dr.Sherif Fahmy

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Ophthalmic nerve Lacrimal br. Dr.Sherif Fahmy

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2- Ganglionic brs 4- Zygomatic br. Z-F Z-T Lacrimal n. Spheno-palatine ganglion Dr.Sherif Fahmy

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2- Frontal Nerve Dr.Sherif Fahmy

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Ophthalmic nerve Frontal nerve Supra-trochlear nerve Supra-orbital n. Dr.Sherif Fahmy

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3- Naso-ciliary Nerve Dr.Sherif Fahmy

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Naso-ciliary n Optic nerve Ophthalmic n. Trochlea Dr.Sherif Fahmy

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Branches of Naso- ciliary nerve Dr.Sherif Fahmy

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Naso-ciliary n 1-Ganglionic Ophthalmic n. 3-Posterior ethmoidal 4-Anterior ethmoidal 2-Long ciliary nerve Ciliary ganglion Dr.Sherif Fahmy

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Optic Nerve Dr.Sherif Fahmy

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Superior rectus Lateral rectus Lacrimal gland Medial rectus muscle Inferior rectus m. Levator palpebrae superioris m. Superior oblique Dr.Sherif Fahmy

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Naso-ciliary n Optic nerve Ophthalmic n. Dr.Sherif Fahmy

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Ophthalmic artery Dr.Sherif Fahmy

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OPHTHALMIC ARTERY

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Ophthalmic artery Lacrimal branch Posterior ciliary branches Supraorbital branch Posterior ethmoidal Anterior ethmoidal Medial palpebral art. Dorsal nasal artery Supratrochlear artery

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Ophthalmic Veins

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Eyelid

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LACRIMAL APPARATUS

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The Eyeball

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Orbital Fascia

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Maxillary Nerve & Sphenopalatine Ganglion

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Related Skull Features

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Superior orbital fissure Foramen rotandum Foramen spinosum Foramen ovale Trigeminal impression Dr. Sherif Fahmy

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Pterygopalatine fossa Remove mandible Dr. Sherif Fahmy

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Infraorbital groove Inferior orbital fissure Infraorbital foramen Infraorbital canal Dr. Sherif Fahmy

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Incisive fossa Greater palatine foramen Lesser palatine foramen Dr. Sherif Fahmy Dr. Sherif Fahmy

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Trigeminal Nerve (Page 85)

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Pons Trigeminal ganglion Mandibular n. Maxillary n. Ophthalmic n. Motor root of Trigeminal n. Dr. Sherif Fahmy Sensory root of trigeminal n. Roots of Trigeminal n. Medulla

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Trigeminal ganglion Maxillary n. Cavernous sinus Dr. Sherif Fahmy Medulla (cut) Sensory root of trigeminal ganglion Mandibular nerve Ophthalmic nerve

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MAXILLARY NERVE (Page 87)

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Revision of Branches of Maxillary Nerve to Face & Scalp

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Zygomatico-temporal n. Zygomatico-facial n. Infra-orbital n. Dr. Sherif Fahmy

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Course of Maxillary Nerve

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Trigeminal ganglion Maxillary n. Dr. Sherif Fahmy

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Pons Sensory root of trigeminal nerve Motor root of trigeminal n. Trigeminal ganglion Lateral wall of cavernous sinus Maxillary n. Foramen rotundum Pterygo-palatine fossa Spheno-palatine ganglion Inferior orbital fissure Infra-orbital groove Infra-orbital canal Infra-orbital n. Palpebral Labial Nasal Back of maxilla Infra-orbital foramen Dr. Sherif Fahmy

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Branches of Maxillary Nerve

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1-Meningeal br 2- Ganglionic brs 3- Posterior superior alveolar br. 4- Zygomatic br. Z- F Z-T Lacrimal n. Infra-orbital n. 5-Middle superior alveolar br. 6- Anterior superior alveolar br. Descends with sinuous course in canalis sinosus 7- P 8- N 9- L Maxillary sinus Dr. Sherif Fahmy

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Maxillary nerve Infra-orbital n. Spheno-palatine gangliom Zygomatic nerve Lacrimal n. Lacrimal n. Zygomatico- temporal n. Posterior superior alveolar n. Maxillar y Sinus Dr. Sherif Fahmy Zygomatico -facial nerve

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Spheno-palatine (Pterygo- palatine) Ganglion (Page 91)

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Maxillary nerve Spheno-palatine gangliom

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PTERYGO- PALATINE FOSSA

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Pterygopalatine fossa

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Communications

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Spheno-palatine foramen Foramen rotundum Pterygoid canal Palatine canal Foramen for posterior superior alveolar vessels and nerve Inferior orbital fissure

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Facial nerve Geniculate ganglion Greater superficial petrosal n. (parasympathetic root) Deep petrosal n. (Sympathetic root) Sensory root (br. From maxillary n. Sepheno- palatine ganglion) Branches of the ganglion Dr. Sherif Fahmy

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Branches of Spheno-Palatine Ganglion

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Spheno-palatine ganglion 1- Orbital br 2-Pharyngeal br 4- Medial nasal (Long spheno- palatine) br. 3- Lateral nasal (Short spheno-palatine) br. 5- Greater palatine br. 6- Lesser palatine br.

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Lesser palatine nerves Greater palatine foramen Greater palatine n. Incisive fossa Long spheno-palatine n. (Naso-palatine br.) Hard Palate

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Mandibular Nerve Dr.Sherif Fahmy

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Mandibular Division Mental n. Buccal n. Auriculo-temporal n Dr. Sherif Fahm

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Posterior Division of Mandibular Nerve (Page 98) It gives the following branches: 1- Auriculo-temporal nerve. 2- Inferior alveolar nerve. 3- Lingual nerve. Dr.Sherif Fahmy

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Pons Trigeminal ganglion Mandibular n. Maxillary n. Ophthalmic n. Motor root of Trigeminal n. Dr.Sherif Fahmy

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Trigeminal ganglion Mandibular n. Maxillary n. Ophthalmic n. Cavernous sinus Dr.Sherif Fahmy

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Foramen ovale Lateral pterygoid m (cut) Tensor palati m. Trunk of mandibular nerve Posterior division of mandibular n. Lingual nerve Chorda tympani n. Inferior alveolar n. Auriculo-temporal n. Anterior division of mandibular n. Dr.Sherif Fahmy

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1- Inferior Alveolar Nerve Dr.Sherif Fahmy

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Inner view Outer view Inferior alveolar nerve Myelohyoid nerve Mental br. Incisive br. Dr.Sherif Fahmy

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2- Auriculo- temporal Nerve (Page 98) Dr.Sherif Fahmy

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Lateral pterygoid m (cut) Trunk of mandibular nerve Posterior division of mandibular n. Auriculo-temporal n. Middle meningeal art. Neck of mandible Dr.Sherif Fahmy

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Auriculo- temporal nerve Superficial temporal vessels Upper end of parotid gland Auricle Zygomatic arch

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Otic ganglion Auriculo- temporal n. Parotid gland Post-ganglionic fibers Parasympathetic nerve supply of parotid gland Dr. Sherif Fahmy

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3- Lingual nerve (Page 99) Dr.Sherif Fahmy

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Lateral pterygoid m (cut) Posterior division of mandibular n. Lingual nerve Chorda tympani n.(Taste & Parasympathetic) Inferior alveolar n. Medial pterygoid m. Dr.Sherif Fahmy

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Lower head of lateral pterygoid m. Dr.Sherif Fahmy Lingual n. Inferior alveolar n. Dr.Sherif Fahmy

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Lateral petrygoid m. Chorda tympani n. Inferior alveolar n. Lingual n. Ramus of mandible Last molar Styloglossus m. Hyoglossus m. Submandibular ganglion Submandibular duct Genio- glossus m. Sublingual gland

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Parasympathetic Ganglia 1- Otic ganglion. 2- Spheno-palatine (pterygopalatine ganglion). 3- Ciliary ganglion. 4- Submandibular ganglion. Dr.Sherif Fahmy

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Otic Ganglion (Page 105) Dr.Sherif Fahmy

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Site, Size & Relations Dr.Sherif Fahmy

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Foramen ovale Mandibular nerve (main trunk) Tensor palati m. Lateral pterygoid m. (cut) Otic ganglion (deep to mandibular n.) Dr.Sherif Fahmy

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Roots & Branches Dr.Sherif Fahmy

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Foramen ovale Mandibular nerve Parasympathetic root (lesser superficial petrosal nerve) Sympathetic root (from plexus around middle meningeal artery) Medial pterygoid m. Motor root (from n. to medial pterygoid m.) Otic Ganglion Auriculo- temporal n. Parotid gland Post-ganglionic fibers T.P. T.T. Dr.Sherif Fahmy Sensory root

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MAXILLARY NERVE (Page 92) Dr.Sherif Fahmy

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Maxillary Division of Trigeminal ganglion Infra-orbital n. Zygomatico-facial n. Dr. Sherif Fahm Zygomatico-temporal n.

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Pons Trigeminal ganglion Mandibular n. Maxillary n. Ophthalmic n. Dr.Sherif Fahmy

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Trigeminal ganglion Mandibular n. Maxillary n. Ophthalmic n. Cavernous sinus Dr.Sherif Fahmy

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Course & Relations of Maxillary Nerve Dr.Sherif Fahmy

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Pons Sensory root Motor root of trigeminal n. Trigeminal ganglion Lateral wall of cavernous sinus Maxillary n. Foramen rotundum Pterygo-palatine fossa Spheno-palatine ganglion Inferior orbital fissure Infra-orbital groove Infra-orbital canal Infra-orbital n. P L N Back of maxilla

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Branches of Maxillary Nerve Dr.Sherif Fahmy

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1-Meningeal br 2- Ganglionic brs 3- Posterior superior alveolar br. 4- Zygomatic br. Z-F Z-T Lacrimal n. Infra-orbital n. 5-Middle superior alveolar br. 6- Anterior superior alveolar br. 7- P 8-N 9-L Maxillary sinus

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Maxillary nerve Infra-orbital n. Spheno-palatine gangliom Zygomatic nerve Lacrimal n. Lacrimal n. Zygomatico- temporal n. Posterior superior alveolar n. Maxillary Sinus Dr.Sherif Fahmy

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PTERYGO- PALATINE FOSSA (Page 100) Dr.Sherif Fahmy

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Walls of Pterygo- palatine Fossa Dr.Sherif Fahmy

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Pterygoid process Back of maxilla Perpendicular plate of palatine bone Dr.Sherif Fahmy

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Back of maxilla Lateral pterygoid plate Perpendicular plate of palatine bone Pterygo-maxillary fissure Dr.Sherif Fahmy

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Communications Dr.Sherif Fahmy

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Spheno-palatine foramen Palato-vaginal acnal Foramen rotundum Pterygoid canal Palatine canal Foramen for posterior superior alveolar vessels and nerve Inferior orbital fissure Dr.Sherif Fahmy

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Foramen Rotundum Foramen lacerum Dr.Sherif Fahmy

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Palato-vaginal canal Foramen lacerum Greater palatine foramen Dr.Sherif Fahmy

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SPHENO-PALATINE (PTERYGO- PALATINE) GANGLION (Page 101) Dr.Sherif Fahmy

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Trigeminal ganglion Mandibular nerve Ophthalmic n. Maxillary nerve Foramen rotandum Infra-orbital n. Spheno-palatine gangliom Dr.Sherif Fahmy

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Branches of Spheno-Palatine Ganglion Dr.Sherif Fahmy

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Spheno-palatine ganglion 1- Orbital br 2-Pharyngeal br 4- Long spheno- palatine br. 3- Short spheno- palatine br. 5- Greater palatine br. 6- Lesser palatine br.

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Lesser palatine nerves Greater palatine foramen Greater palatine n. Incisive fossa Long spheno-palatine n. Hard Palate Dr.Sherif Fahmy

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Spheno-palatine Ganglion

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Branches of Spheno-Palatine Ganglion

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Spheno-palatine foramen Foramen rotundum Pterygoid canal Palatine canal Inferior orbital fissure

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Spheno-palatine ganglion 1- Orbital br 2-Pharyngeal br 4- Medial nasal (Long spheno- palatine) br. 3- Lateral nasal (Short spheno-palatine) br. 5- Greater palatine br. 6- Lesser palatine br.

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Lesser palatine nerves Greater palatine foramen Greater palatine n. Incisive fossa Long spheno-palatine n. (Naso-palatine br.) Hard Palate

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Mandibular Nerve (page 95)

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Course of Mandibular Nerve

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Pon s Sensory root of trigeminal n. Motor root of trigeminal n. Trigeminal ganglion Mandibular n. Foramen ovale Main trunk Posterior division Anterior division Dr. Sherif Fahmy

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Relations of Main Trunk of Mandibular Nerve A- Superficial B- Deep

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Foramen ovale Lateral pterygoid m (cut) Tensor palati m. Trunk of mandibular nerve Dr. Sherif Fahmy

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Revision of Branches of Mandibular Nerve in Face & Scalp

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Mental nerve Buccal nerve Auriculo-temporal nerve Dr. Sherif Fahmy

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Upper head of lat. pterygoid Lower head of lateral pterygoid m. Lateral Pterygoid M. Dr.Sherif Fahmy Deep temporal nerves Nerve to masseter Lingual n. Inferior alveolar n. Buccal nerve

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Branches of Mandibular Nerve (Main trunk & Anterior Division)

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Nervous spinosus N. To medial pterygoid m. Otic ganglion Tensor palati Tensor tympani To mastication muscles except medial pterygoid Buccal nerve Foramen spinosum Dr. Sherif Fahmy

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Posterior Division of Mandibular Nerve

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Branches of Posterior Division of Mandibular Nerve It gives the following branches: 1- Auriculo-temporal nerve. 2- Inferior alveolar nerve. 3- Lingual nerve. Dr. Sherif Fahmy

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Some Features of the Mandible

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Mental foramen Dr. Sherif Fahmy Ramus of mandible Neck Body

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Mandibular foramen Myelohyoid groove Inner surface of the Ramus Dr. Sherif Fahmy

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Course Similarities Between 3 Branches of Posterior Division of Mandibular Nerve

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Trunk of mandibular nerve Posterior division of mandibular n. Lingual nerve Chorda tympani n. Inferior alveolar n. Auriculo-temporal n. Anterior division of mandibular n. Dr. Sherif Fahmy Middle meningeal artery

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Lateral petrygoid m. Chorda tympani n. Inferior alveolar n. Lingual n. Ramus of mandible Last molar Sublingual gland Dr. Sherif Fahmy Medial pterygoid muscle

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1- Auriculo-temporal Nerve

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Lateral pterygoid m (cut) Posterior division of mandibular n. Auriculo-temporal n. Middle meningeal art. Neck of mandible Dr. Sherif Fahmy 2 roots of auriculo-temporal nerve

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Auriculo- temporal nerve Superficial temporal vessels Upper end of parotid gland Auricle Zygomatic arch Dr. Sherif Fahmy

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Otic ganglion Auriculo- temporal n. Parotid gland Post-ganglionic fibers Parasympathetic nerve supply of parotid gland Dr. Sherif Fahmy Dr. Sherif Fahmy

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2- Inferior Alveolar Nerve

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Lateral pterygoid m (cut) Posterior division of mandibular n. Inferior alveolar nerve Dr. Sherif Fahmy

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Lateral petrygoid m. Inferior alveolar n. Lingual n. Ramus of mandible Dr. Sherif Fahmy

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Inner view Outer view Inferior alveolar nerve Myelohyoid nerve Mental br. Incisive br. Dr. Sherif Fahmy

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3- Lingual nerve

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Lateral pterygoid m (cut) Posterior division of mandibular n. Lingual nerve Chorda tympani n.(Taste & Parasympathetic) Medial pterygoid m. Dr. Sherif Fahmy

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Otic Ganglion (Page 101) Dr.Sherif Fahmy

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Site, Size & Relations Dr.Sherif Fahmy

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Foramen ovale Mandibular nerve (main trunk) Tensor palati m. Lateral pterygoid m. (cut) Otic ganglion (deep to mandibular n.) Dr.Sherif Fahmy

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Roots & Branches Dr.Sherif Fahmy

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Foramen ovale Mandibular nerve Parasympatheti c root (lesser superficial petrosal nerve) Sympathetic root (from plexus around middle meningeal artery) Medial pterygoid m. Motor root (from n. to medial pterygoid m.) Otic Ganglio n Auriculo- temporal n. Parotid gland Post-ganglionic fibers T.P. T.T . Dr.Sherif Fahmy Sensory root

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Walls of Pterygo- palatine Fossa

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Pterygoid process Back of maxilla Perpendicular plate of palatine bone

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Back of maxilla Lateral pterygoid plate Perpendicular plate of palatine bone Pterygo-maxillary fissure

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Communications

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Spheno-palatine foramen Palato-vaginal canal Foramen rotundum Pterygoid canal Palatine canal Foramen for posterior superior alveolar vessels and nerve Inferior orbital fissure

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Foramen Rotundum Foramen lacerum

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Palato-vaginal canal Foramen lacerum Greater palatine foramen

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SPHENO-PALATINE (PTERYGO- PALATINE) GANGLION (Page 101)

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Trigeminal ganglion Mandibular nerve Ophthalmic n. Maxillary nerve Foramen rotandum Infra-orbital n. Spheno-palatine gangliom

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Greater Superficial Petrosal

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Pons Sup. Salivary n. Internal auditory meatus Facial nerve Vestibulo- cochlear nerve Facial nerve

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Pons Facial nerve Geniculate ganglion 1- Greater superficial petrosal n. F.Lacerum Pterygoid canal Spheno- palatine ganglion Petrous bone

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Petrous bone Carotid canal Internal carotid a. Cartilage closing the lower aspect of foramen lacerum Cavernous sinus Intra-cranial course

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Branches of Spheno-Palatine Ganglion

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Spheno-palatine ganglion 1- Orbital br 2-Pharyngeal br 4- Long spheno- palatine br. 3- Short spheno- palatine br. 5- Greater palatine br. 6- Lesser palatine br.

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Lesser palatine nerves Greater palatine foramen Greater palatine n. Incisive fossa Long spheno-palatine n. (Naso-palatine br.) Hard Palate

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