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Cervical Fascia Dr. Sherif Fahmy

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Superficial Fascia (Page 2) It is a thin layer of fascia that contains: 1- Platysma muscle. 2- Superficial veins. 3- Cutaneous nerves. 4- Superficial lymph nodes. Dr. Sherif Fahmy

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Platysma Muscle Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Platysma m. Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Superficial Veins Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Cutaneous Nerves Dr. Sherif Fahmy

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Great auricular n. Lesser occipital n. Transverse cutaneous n. of neck Supra-clavicular n. Cutaneous Nerves Dr. Sherif Fahmy

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Superficial Cervical Lymph Nodes Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Deep Cervical Fascia (Page 4) Dr. Sherif Fahmy

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1- Investing Layer of Deep Fascia Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Platysma m. Deep investing fascia Dr. Sherif Fahmy

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Attachments of Investing Deep Fascia 1-Upper: To symphesis menti, lower border of mandible, mastoid process, Superior nuchal line and external occipital protuberance. It splits around parotid and submandibular glands. 2-Lower: Superasternal notch, clavicle, acromion and spine. It splits above suprasternal notch which contains lower parts of anterior jugular veins, jugular arch, sternal head of sternomastoid muscle and some lymph nodes. 3-Posterior: Ligamentum nuchae and spine of C7. 4-Anterior: Symphesis menti, Body of hyoid and suprasternal notch. Dr. Sherif Fahmy

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It forms the roof of Anterior & Posterior Triangles of the Neck Dr. Sherif Fahmy

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Structures That pierce the deep investing fascia 1- External jugular vein (one inch above the clavicle). 2- Supraclavicular nerves )just above the clavicle). Dr. Sherif Fahmy

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External jugular vein Supra- clavicular n. Deep investing fascia of neck Dr. Sherif Fahmy Dr. Sherif Fahmy

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Structures which are embedded in deep investing fascaia 1- Spinal accessory nerve. 2- Inferior belly of omohyoid muscle. Dr. Sherif Fahmy

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Spinal accessory n. Inferior belly of omohyoid m. Superior belly of omohyoid m. Hyoid bone Deep investing fascia of neck Dr. Sherif Fahmy Dr. Sherif Fahmy

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Other Deep Fascia 2- Prevertebral fascia. 3- Pretracheal fascia (will be described with thyroid gland). 4- Carotid sheath. (will be described with carotid arteries). 5- Buccopharyngeal and pharyngeobasilar fasciae with pharynx. Dr. Sherif Fahmy

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Prevertebral Muscles & Fascia Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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POSTERIOR TRIANGLE OF NECK (Page 9) Dr. Sherif Fahmy Dr. Sherif Fahmy

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Boundaries Dr. Sherif Fahmy Dr. Sherif Fahmy

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Sternomastoid m. Trapezius m. Superior nuchal line Clavicle Dr. Sherif Fahmy Dr. Sherif Fahmy

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Roof Dr. Sherif Fahmy

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Platysma m. Deep investing fascia Dr. Sherif Fahmy Dr. Sherif Fahmy

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Spinal accessory n. External jugular vein Supra- clavicular n. Inferior belly of omohyoid m. Superior belly of omohyoid m. Hyoid bone Deep investing fascia of neck Dr. Sherif Fahmy Dr. Sherif Fahmy

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Floor Dr. Sherif Fahmy

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Scalenus medius m. Levator scapulae m. Semispinalis capitis m. Splenius capitis m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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Sterno-mastoid m. (cut) Scalenus medius m. Levator scapulae m. Splenius m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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Contents Dr. Sherif Fahmy

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A- Muscle •Inferior belly of omohyoid muscle. Dr. Sherif Fahmy

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Sterno-mastoid m. (cut) Inferior belly of omo- hyoid m. Hyoid bone Superior belly of omohyoid m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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Inferior belly of omohyoid m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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B- Nerves • 1- Spinal accessory nerve. • 2- Branches of cervical plexus. • 3- Trunks of brachial plexus. Dr. Sherif Fahmy

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Spinal accessory n. Great auricular n. Lesser occipital n. Transverse cutaneous n. of neck Supra-clavicular n. Trunks of brachial plexus Dr. Sherif Fahmy Dr. Sherif Fahmy

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Spinal accessory n. Great auricular n. Lesser occipital n. Transverse cutaneous n. of neck Supra-clavicular n. Dr. Sherif Fahmy Dr. Sherif Fahmy

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C- Arteries • 1- Occipital artery. • 2- Third part of subclavian artery. • 3- Suprascapular artery. • 4- Transverse cervical artery. Dr. Sherif Fahmy Dr. Sherif Fahmy

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Occipital art. Transverse cervical art. Suprascapular art. 3rd part of subclavian art. Dr. Sherif Fahmy Dr. Sherif Fahmy

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1st part of subclavian art. Thyrocervical trunk 3rd part of subclavian art. Supr- ascapular art. Transverse cervical art. Scalenus anterior m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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D- Veins •1- External jugular vein. •2- Anterior jugular vein. •3- Transverse cervical vein. •4- Suprascpular vein. •5- Subclavian vein. Dr. Sherif Fahmy

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External jugular vein Anterior jugular vein Transverse cervical vein Suprascapular vein Subclavian vein Dr. Sherif Fahmy

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E- Lymph nodes • 1- On posterior border of sterno- mastoid m. • 2- On anterior border of trapezius m. • 3- Along spinal accessory n. • 4- Along transverse cervical vessels. Dr. Sherif Fahmy

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Transverse cervical art. Deep lymph nodes Dr. Sherif Fahmy Dr. Sherif Fahmy

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Applied Anatomy •1- Injury of external jugular may lead to air embolism. •2- Injury of spinal accessory leads to shoulder drop. Dr. Sherif Fahmy

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External Jugular Vein (Page 14) Dr. Sherif Fahmy

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External jugular vein Anterior jugular vein Transverse cervical vein Suprascapular vein Subclavian vein Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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ANTERIOR TRIANGLE OF NECK (Page 36) Dr. Sherif Fahmy

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Anterior triangle is divided into: •1- Carotid triangle. •2- Digastric triangle. •3- Submental triangle. •4- Muscular triangle. Dr. Sherif Fahmy

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Sterno- mastoid m. Superior belly of omohyoid m. Digastric m. Lower border of body of mandible Midline of neck Carotid triangle Muscular triangle Digastric triangle Submental triangle Dr. Sherif Fahmy Dr. Sherif Fahmy

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CAROTID TRIANGLE (Page 38) Dr. Sherif Fahmy

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Boundaries of Carotid Triangle Dr. Sherif Fahmy

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Sterno- mastoid m. Superior belly of omohyoid m. Posterior belly of digastric m. Carotid triangle Dr. Sherif Fahmy Dr. Sherif Fahmy

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Posterior surface Floor

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Floor of Carotid Triangle Dr. Sherif Fahmy

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Superior belly of omohyoid m. Posterior belly of digastric m. Sterno- mastoid m. Hyoid bone Thyro-hyoid m. Hyo-glossus m. Middle constrictor m. Inferior constrictor m. Dr. Sherif Fahmy Dr. Sherif Fahmy

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Contents of Carotid Triangle Dr. Sherif Fahmy

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A- Arteries Dr. Sherif Fahmy

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Common carotid artery Internal carotid art. External carotid art. Superior thyroid art. Lingual art. Facial art. Occipital art. Dr. Sherif Fahmy

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B- Nerves & Veins Dr. Sherif Fahmy

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Spinal accessory n. Vagus nerve Hypoglossal n. Descendens hypoglossi Nerve to thyrohyoid m. Internal jugular vein Ansa cervicalis Descendens cervicalis Dr. Sherif Fahmy

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Vagus nerve Superior laryngeal nerve Internal laryngeal nerve External laryngeal nerve Dr. Sherif Fahmy Dr. Sherif Fahmy

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Applied Anatomy Dr. Sherif Fahmy

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Common carotid art. Internal carotid art. Carotid sinus Carotid body Glossopharyngeal nerve Dr. Sherif Fahmy Dr. Sherif Fahmy

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SUBMANDIBULAR REGION (Page 70) Dr.Sherif Fahmy

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Sterno- mastoid m. Superior belly of omohyoid m. Digastric m. Lower border of body of mandible Midline of neck

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Muscles of Submandibular (Suprahyoid) Region 1- Digastric muscle. 2- Stylohyoid muscle. 3- Myelohyoid muscle. 4- Hyoglossus muscle. 5- Geniohyoid muscle. 6- Genioglossus muscle.

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Superficial part of submandibular gland Anterior belly of digastric m. Dr. Sherif Fahmy Posterior belly of digastric m.

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Anterior belly of digastric m. Myelohyoid nerve Submental artery Myelohyoid m. Dr. Sherif Fahmy Posterior belly of digastric m. Stylohyoid m. Hyoglossus m. Dr.Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular ganglion Deep part of submandibular gland Hypoglossal nerve Posterior belly of digastric m. Submandibular duct Dr. Sherif Fahmy Myelohyoid n Submental vs Anterior belly of digastric m Hyoglossus m.

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Geniohyoid m. Hyoglossus m. Genio-glossus m. Stylo-glossus m. Lingual nerve Hypoglossal nerve Deep part of submandibular gland Submandibular duct Myelohyoid m. (cut) Dr. Sherif Fahmy

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Styloid process Stylohyoid ligamnent Glossopharyngeal n. Middle constrictor m. First part of lingual artery 3rd part of lingual artery Geniohyoid m. Genioglossus m. Sublingual gl. Dr. Sherif Fahmy

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Digastric Muscle (Page 70) Dr.Sherif Fahmy

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Mastoid process Styloid process Posterior belly of digastric m. Stylohyoid m. Anterior belly of digastric m. Hyoid bone Fibrous loop Digastric fossa Mandible Intermediet tendon

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Relations of Digastric Muscle Dr.Sherif Fahmy

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A- Anterior Belly Dr.Sherif Fahmy

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Superficial part of submandibular gland Anterior belly of digastric m. Superficial Relations of Anterior belly Digastric muscle Dr. Sherif Fahmy Dr.Sherif Fahmy

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Anterior belly of digastric m. Myelohyoid nerve Submental artery Myelohyoid m. Deep Relations of Anterior belly Digastric Muscle Dr. Sherif Fahmy Dr.Sherif Fahmy

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B- Posterior Belly Dr.Sherif Fahmy

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Superficial part of submandibular gland Posterior belly of digastric m. Parotid gland Superficial Relations of Posterior Belly Digastric muscle Mastoid process Angle of mandible Dr. Sherif Fahmy Dr.Sherif Fahmy

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Posterior belly of digastric m. Internal carotid art. External carotid art. Facial art. Occipital art. I.J.V. Hypoglossal n. Vagus n. Spinal accessory n. Deep relations of posterior belly of digastric m. Dr. Sherif Fahmy Dr.Sherif Fahmy

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Relations to Borders of Posterior Belly of Digastric m. Dr.Sherif Fahmy

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Stylohyoid m Dr. Sherif Fahmy Dr.Sherif Fahmy

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Posterior belly of digastric m. Posterior auricular art. Occipital art. Dr.Sherif Fahmy

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Myelohyoid Muscle (Diaphragma Oris) (Page 74) Dr.Sherif Fahmy

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Myelohyoid muscle Myelohyoid line Median raphe Body of hyoid bone Dr. Sherif Fahmy

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Relations of Myelohyoid M. Dr.Sherif Fahmy

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Anterior belly of digastric m. Myelohyoid m. myelohyoid nerve Submental artery Beginning of anterior jugular vein Superficial Submental lymph nodes Dr. Sherif Fahmy Dr.Sherif Fahmy

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Superficial part of submandibular gland Dr. Sherif Fahmy

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Geniohyoid m. Hyoglossus m. Genio-glossus m. Stylo-glossus m. Lingual nerve Hypoglossal nerve Deep part of submandibular gland Submandibular duct Myelohyoid m. (cut) Deep Dr. Sherif Fahmy

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Submental Triangle (Page 40) Dr.Sherif Fahmy

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Anterior belly of digastric m. Myelohyoid m. Submental artery Beginning of anterior jugular vein Body of hyoid bone Submental lymph nodes Dr. Sherif Fahmy

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Hyoglossus Muscle (Page 78) Dr.Sherif Fahmy

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Greater horn of hyoid m. tongue Hyoglossus m. Dr. Sherif Fahmy

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Relations of Hyoglossus M. Dr.Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular ganglion Deep part of submandibular gland Hypoglossal nerve Posterior belly of digastric m. Superficial Relations of Hyoglossus Muscle Submandibular duct Dr. Sherif Fahmy

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Styloid process Styloglossus m. Lingual nerve Submandibular ganglion Deep part of submandibular gland Hypoglossal n. Dr. Sherif Fahmy

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Styloid process Stylohyoid ligamnent Glossopharyngeal n. Middle constrictor m. First part of lingual artery 3rd part of lingual artery Geniohyoid m. Genioglossus m. Deep, anterior and posterior relations Sublingual gl. Dr. Sherif Fahmy

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Stylohyoid Muscle (Page 76) Dr.Sherif Fahmy

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Dr. Sherif Fahmy

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Geniohyoid Muscle (Page 70) Dr.Sherif Fahmy

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Geniohyoid m. Genial tubercles Body of hyoid bone Dr. Sherif Fahmy

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Genioglossus Muscle (Page 78) Dr.Sherif Fahmy

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Hypoglossal nerve Genioglossus m. Dr. Sherif Fahmy

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Submandibular Salivary Gland Page 82 Dr.Sherif Fahmy

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Parts, site and extensions • Parts: superficial & deep to myelohyoid muscle. • Site: Upper part is deep to mandible (submandibular fossa) while the lower part in digastric triangle. • Extensions: Anterior: mental foramen. Posterior: Angle of mandible. Superior: myelohyoid line. Inferior: intermediate tendon of digastric muscle. Dr.Sherif Fahmy

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Superficial part of submandibular gland Posterior belly of digastric m. Anterior belly of digastric m. Parotid gland Dr. Sherif Fahmy

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Relations of the superficial part Dr.Sherif Fahmy

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Lateral surface Inferolateral surface Medial pterygoid m. Facial artery Facial vein Cervical branch of facial nerve Submandibular lymph nodes Body of mandible Lateral & inferolateral relations Dr. Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular ganglion Deep part of submandibular gland Hypoglossal n. Posterior belly of digastric m. Dr. Sherif Fahmy

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Relations of deep part and course of the duct Dr.Sherif Fahmy

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Hyoglossus m. Myelohyoid m. Lingual n. Hypoglossal n. Submandibular duct Deep part of submandibular gland Styloglossus m. Sublingual gland Dr. Sherif Fahmy

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Frenulum of tongue Sublingual fold Opening of submandibular duct Dr.Sherif Fahmy

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Nerve supply: 1- Sensory 2- Sympathetic. 3- Parasympathetic. Blood supply. By facial vessels. Dr.Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular ganglion Dr. Sherif Fahmy

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Applied Anatomy • Formation of a stone in its duct is common because its secretion is muco-serous and more viscid. • In this case the gland swell during chewing. Dr.Sherif Fahmy

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DIGASTRIC TRIANGLE (Page 36) Dr.Sherif Fahmy

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Boundaries Dr.Sherif Fahmy

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Digastric m. Lower border of body of mandible Dr. Sherif Fahmy

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Posterior belly of digastric m. Stylohyoid m. Anterior belly of digastric m. Mandible Dr. Sherif Fahmy

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Floor of Digastric Triangle Dr.Sherif Fahmy

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Myelohyoid m. Hyoglossus m. Dr. Sherif Fahmy

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Contents Dr.Sherif Fahmy

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Lateral surface Inferolateral surface Medial pterygoid m. Facial artery Facial vein Cervical branch of facial nerve Submandibular lymph nodes Body of mandible Lateral & inferolateral relations Dr. Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular ganglion Deep part of submandibular gland Hypoglossal n. Posterior belly of digastric m. Dr. Sherif Fahmy

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Sublingual Salivary Gland Dr.Sherif Fahmy

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Sublingual salivary gland Submandibular salivary gland Parotid gland Dr.Sherif Fahmy

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Myelohyoid m. Lingual n. Submandibular duct Deep part of submandibular gland Sublingual gland Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Submandibular Ganglion (Page 88) Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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COMMON CAROTID ARTERY (Page 54) Dr.Sherif Fahmy

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Arch of aorta Rt. Common carotid a. Left common carotid a. Thyroid cartilage External carotid a. Internal carotid a. Brachio-cephalic art. Course Dr.Sherif Fahmy

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Relations Dr.Sherif Fahmy

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Common carotid a. Ext. carotid art. Int. carotid art. Dr.Sherif Fahmy

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Lobe of thyroid gland Common carotid a. Internal jugular vein Omohyoiod m. Sternothyroid m. Sternohyoid m. Sternomastoid m. Vagus n. Superficial, medial and lateral realtions Dr.Sherif Fahmy

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-Deep relations of CCA, ICA, IJV & carotid sheath -Relations of sympathetic chain and cervical plexus Dr.Sherif Fahmy

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Longus coli m. Scalenus anterior m. 1st part of subclavian art. Vertebral artery Thyro-cervical trunk Internal carotid a. Longus capitis m. Superior laryngeal n. Superior sympathetic ganglion Phrenic n. Internal jugular vein Rectus capitis lateralis m. Cervical plexus Inferior thyroid a. Scalenus medius m. Levator scapulae m. Dr.Sherif Fahmy

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Longus coli m. 1st part of subclavian art. Vertebral artery Inferior thyroid a. Deep relations of common carotid artery Lower part of sympathetic chain Dr.Sherif Fahmy

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Vagus n. Rt recussent laryngeal n. Rt common carotid a. Lt common carotid a. Thoracic duct Dr.Sherif Fahmy

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Internal Carotid Artery (page 64) Dr.Sherif Fahmy

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Course & Relations Dr.Sherif Fahmy

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Common carotid a. Internal carotid a. External carotid a. Cervical part (1st) Dr.Sherif Fahmy

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Brachio-cephalic art. Common carotid a. External carotid a.(cut) Internal carotid a. Vertebral artery Dr.Sherif Fahmy

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Relations of First Part (Cervical) Dr.Sherif Fahmy

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Internal carotid a. Hypoglossal n. Common facial vein Lingual vein Posterior belly of digastric m. Ext. carotid art. Int. jugular vein Vagus n. Descendens hypoglossi Dr.Sherif Fahmy

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Common carotid a. External carotid a. Internal carotid a. Styloglossus m. Styloid process Stylopharyngeus m. Glossopharyngeal n. Pharyngeal br. Of vagus n. Dr.Sherif Fahmy

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Internal carotid a. Longus capitis m. Superior laryngeal n. Superior sympathetic ganglion Deep Relations Dr.Sherif Fahmy

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

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

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Branches Dr.Sherif Fahmy

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

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Anterior cerebral a. Middle cerebral a. Posterior communicating a. Anterior choroidal a Int. carotid art (cut) Dr.Sherif Fahmy

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External Carotid Artery (Page 56) Dr.Sherif Fahmy

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Rt. Common carotid a. Thyroid cartilage External carotid a. Internal carotid a. Dr.Sherif Fahmy

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Common carotid a. External carotid a. Parotid gland Internal carotid a. Superficial temporal a. Dr.Sherif Fahmy

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Common carotid a. Internal carotid a. External carotid a. Superficial temporal a. Maxillary a. Dr.Sherif Fahmy

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Relations Dr.Sherif Fahmy

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Hypoglossal n. Common facial vein Lingual vein Posterior belly of digastric m. Ext. carotid art. Parotid gl. Facial nerve Retro-mandibular vein Superficial Relations Dr.Sherif Fahmy

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External carotid a. Internal carotid a. Styloglossus m. Styloid process Stylopharyngeus m. Glossopharyngeal n. Pharyngeal br. Of vagus n. Deep Relations Dr.Sherif Fahmy

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Branches Dr.Sherif Fahmy

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1-Superior thyroid a. Superior laryngeal a. Infrahyoid a. 2-Lingual a. 3-Facial a. 6-Ascending pharyngeal a. 4-Occipital a. 5-Posterior auricular a. 7-Maxillary a 8-Superficial temporal a. Dr.Sherif Fahmy

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1- Superior Thyroid Artery Dr.Sherif Fahmy

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Superior thyroid a. Superior laryngeal a. Infrahyoid a. Anterior & posterior glandular brs. To sternomastoid m. To cricothyroid m. Superior thyroid A. Dr.Sherif Fahmy

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2- Lingual Artery Dr.Sherif Fahmy

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1st part of lingual a. 3rd part of lingual a. Hyoglossus m. Sublingual br. E.C.A. Lingual artery 2nd part deep to hyoglossus m. Dr.Sherif Fahmy

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3- Facial Artery Dr.Sherif Fahmy

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Facial artery Dr.Sherif Fahmy

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Ext. carotid art. Facial art. Ascending palatine art. Tonsillar br. Glandular br. Submental br. Facial artery in neck Superior constrictor Dr.Sherif Fahmy

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Dr. Sherif Fahmy Dr.Sherif Fahmy

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4- Occipital Artery Dr.Sherif Fahmy

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Posterior belly of digastric m. Sterno- mastoid m. Internal carotid art. Facial art. Occipital art. Dr.Sherif Fahmy

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Occipital art. Transverse cervical art. Suprascapular art. 3rd part of subclavian art. Dr.Sherif Fahmy

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Supra- trochlear a. Supra-orbital a. Superficial temporal a. Occipital a. Posterior auricular a. Dr.Sherif Fahmy

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5- Posterior Auricular Artery Dr.Sherif Fahmy

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1-Superior thyroid a. Superior laryngeal a. Infrahyoid a. 2-Lingual a. 3-Facial a. 6-Ascending pharyngeal a. 4-Occipital a. 5-Posterior auricular a. 7-Maxillary a 8-Superficial temporal a. Dr.Sherif Fahmy

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6- Ascending Pharyngeal Artery Dr.Sherif Fahmy

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1-Superior thyroid a. Superior laryngeal a. Infrahyoid a. 2-Lingual a. 3-Facial a. 6-Ascending pharyngeal a. 4-Occipital a. 5-Posterior auricular a. 7-Maxillary a 8-Superficial temporal a. Dr.Sherif Fahmy

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JUGULAR VEINS Dr.Sherif Fahmy

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Anterior & External Jugular Veins (page 14) Dr.Sherif Fahmy

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Anterior facial vein Posterior division of retromandibular vein Posterior auricular vein External jugular vein Dr.Sherif Fahmy

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External jugular vein Anterior jugular vein Transverse cervical vein Suprascapular vein Subclavian vein Dr.Sherif Fahmy

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Internal Jugular Vein (page 66) Dr.Sherif Fahmy

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Course & Relations Dr.Sherif Fahmy

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Beginning of internal jugular vein Dr.Sherif Fahmy Sigmoid sinus Dr.Sherif Fahmy

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Superior bulb Inferior bulb Dr.Sherif Fahmy

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Internal jugular vein Subclavian vein Brachiocephalic vein Dr.Sherif Fahmy

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Relations Dr.Sherif Fahmy

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Posterior belly of digastric m. Sternomastoid m. Spinal accessory n. Descendens cervicalis Upper deep cervical Omohyoid m. Lower deep cervical l.n. Sternothyroid m. Sternohyoid m Sternomastoid Superficial Relations Dr.Sherif Fahmy

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Scalenus anterior m. 1st part of subclavian art. Thyro-cervical trunk Phrenic n. Internal jugular vein Rectus capitis lateralis m. Cervical plexus Levator scapulae m. Scalenus medius m. Deep Relations Transverse pr C1 Dr.Sherif Fahmy

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Tributaries Dr.Sherif Fahmy

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Inferior petrosal sinus Common facial vein Lingual vein Superior thyroid vein Middle thyroid vein Pharyngeal vein Internal jugular vein Dr.Sherif Fahmy

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Carotid Sheath (Page 6) A tube of deep fascia that surrounds big vessels and nerves in the neck. Attachments: Above: To tympanic plate and petrous bone. Below: To fibrous pericardium. Anterior: to pretracheal fascia. Posterior: Prevertebral fascia. Dr.Sherif Fahmy

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Contents: • Common and internal carotid arteries. • Internal jugular vein. • Vagus nerve. In the upper part lower 4 cranial nerves are present in the upper part of sheath. Structures embeded: -Ansa cervicalis in anterior wall. -Sympathetic chain in posterior wall. Dr.Sherif Fahmy

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Relations: 1- Anterior (superficial). 2- Posterior (deep). 3- Medial. Dr.Sherif Fahmy

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Posterior belly of digastric m. Sternomastoid m. Spinal accessory n. Descendens cervicalis Upper deep cervical Omohyoid m. Lower deep cervical l.n. Sternothyroid m. Sternohyoid m Sternomastoid m Superficial Relations Dr.Sherif Fahmy

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Longus coli m. Scalenus anterior m. 1st part of subclavian art. Vertebral artery Thyro-cervical trunk Phrenic n. Internal jugular vein Rectus capitis lateralis m. Cervical plexus Levator scapulae m. Scalenus medius m. Deep Relations Dr.Sherif Fahmy

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Cervical Plexus (Page 36) Dr.Sherif Fahmy

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Cervical plexus Levator scapulae m. Scalenus medius m. Internal jugular vein Phrenic nerve Cervical Plexus Dr.Sherif Fahmy

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Great auricular n. Lesser occipital n. Transverse cutaneous n. of neck Supra-clavicular n. Dr.Sherif Fahmy

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Cervical Part of Sympathetic Trunk (Page 100) Dr.Sherif Fahmy

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Internal carotid a. Longus capitis m. Superior sympathetic ganglion Middle sympathetic ganglion Inferior sympathetic ganglion Longus coli m. Common carotid artery (cut) Dr.Sherif Fahmy

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Branches C7 C8 Dr.Sherif Fahmy

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Facial Nerve (Page 89) Dr.Sherif Fahmy

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

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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. Dr.Sherif Fahmy

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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. Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Handle of malleus Chorda tympani n. Dr.Sherif Fahmy

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

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LAST 4 CRANIAL NERVES (Page 92)

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Deep Origin (Nuclei) of Last 4 cranial nerves 9th C.N. 10th C.N. 11th C.N. 12th C.N. Motor -Nucleus Ambiguus Hypo- glossal nucleus Sensory Spinal nucleus of trigeminal nerve No No Taste Nucleus solitarius No No Para- sympathetic Inf. Salivary (9th) & dorsal nucleus (10th) No No -Upper 5 cervical segments

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Medulla oblongata Pons Midbrain Inferior view of the Brain

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9th & 10th CN 11th CN 12th CN Medulla oblongata

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Parotid gland Carotid sheath Lower 4 cranial ns Styloid process

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Stylopharyngeus m. Glossopharyngeal nerve

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Glossopharyngeal n. Hyoglossus m.

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Superior belly of omohyoid m. Posterior belly of digastric m. Sterno- mastoid m. Spinal accessory n. Vagus nerve Hypoglossal n. Descendens hypoglossi Nerve to thyrohyoid m. Internal jugular vein Ansa cervicalis

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Spinal accessory n.

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Glosso-pharyngeal nerve (9th C.N.) (Page 92)

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Medulla Glosso- pharyngeal n. Jugular foramen Superior ganglion Inferior ganglion Int. jugular vein Int. carotid art. Carotid sinus Ext. carotid art. Middle constrictor m. Hyoglossus m. Post 1/3 of tongue Palatine tonsil Soft palate Course Styloid process Stylopharyngeus m.

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Glosso- pharyngeal n. Jugular foramen Inferior ganglion Carotid sinus 5- sensory to post. 1/3 of tongue 6- to palatine tonsil 7- to soft palate Branches 1-Tympanic br. Lesser superficial petrosal n. Stylo- phayngeus m. 2-N.to stylo- pharyngeus m. 3- Carotid n. 4- Pharyngeal br. To pharyngeal plexus

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Vagus Nerve (10th CN) (Page 94)

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Medulla Vagus Sup. ganglion Inf. ganglion Carotid sheath Styloid pr. Post. Belly of digastric m. subclavian art. Int. carotid art. Int. jugular vein Course

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Branches 1- Meningeal br. 2- Auricular br. 3- Pharyngeal br. 4- Superior laryngeal br. Internal laryngeal br. External laryngeal br. 5- Superior cardiac 6-Inferior cardiac 7- Recurrent laryngeal n.

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Accessory Nerve (11th CN) (Page 96)

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Posterior belly of digastric m. Sterno- mastoid m. Spinal accessory n. Internal jugular vein

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Spinal accessory n.

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Cranial root Spinal root Vagus nerve Accessory nerve Carotid sheath Styloid process Posterior belly of digastric m. Sterno- mastoid m. Trapezius m. Spinal accessory n. Course & Branches Jugular foramen

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Spinal accessory n. Sternomastoid m. Trapezius m.

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Hypoglossal Nerve (12th CN) (Page 98)

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Superior belly of omohyoid m. Posterior belly of digastric m. Sterno- mastoid m. Hypoglossal n. Descendens hypoglossi Nerve to thyrohyoid m. Internal jugular vein Ansa cervicalis

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Hypoglossal n. Br. From C1 Nerve Hypoglossal canal Carotid sheath Styloid process Posterior belly of digastric m Int. jugular vein Descendens cervicalis Ansa cervicalis Descendens hypoglossi N. To thyro- hyoid m. N. To genio- hyoid m. To all muscles of tongue except palato-glossus Course & Branches ICA Medulla

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Oral (Mouth) Cavity (Page 102)

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Parts of Oral Cavity 1- Vestibule: between lips and teeth. 2- Mouth cavity proper: Inner to teeth.

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Vestibule Mouth cavity proper

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Boundaries of Mouth Cavity Proper 1- Infront & sides: Teeth 2- Roof: Palate (hard & soft) 3- Floor: A- Upper surface of anterior 2/3 of tongue. B- Lower surface of tongue. C- Below tongue. D- Myelohyoid muscle and its relations.

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Vestibule Frenulum of tongue Deep lingual vein Pilca fimberiata

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Anterior belly of digastric m. Myelohyoid m. myelohyoid nerve Submental artery Beginning of anterior jugular vein Superficial

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Geniohyoid m. Hyoglossus m. Genio-glossus m. Stylo-glossus m. Lingual nerve Hypoglossal nerve Deep part of submandibular gland Submandibular duct Myelohyoid m. (cut) Deep

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TONGUE (Page 106)

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External Features

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Oral part Pharyngeal part Upper Surface

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Sulcus terminalis Foramen cecum Lingual tonsil Circumvallate papillae Filiform papillae Fungiform papillae

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Frenulum of tongue Deep lingual vein Plica fimberiata Sublingual fold Sublingual papilla

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Frenulum of tongue Sublingual fold Sublingual papilla receiving opening of submandibular duct

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Muscles of the Tongue Intrinsic 1- Transverse. 2- Vertical 3- Superior longitudinal. 4- Inferior longitudinal Extrinsic 1- Styloglossus 2- Hyoglossus. 3- Genioglossus. 4- Palato-glossus.

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A- Extrinsic Muscles

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Palato- glossus m. Stylo-glossus m. Hyo-glossus m. Genio-glossus m.

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B- Intrinsic Muscles

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Vertical muscle Transverse muscle Superior longitudinal m. Inferior longitudinal m. Intrinsic muscles T.S L.S.

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Blood Supply of Tongue

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Arterial Supply

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Ext. carotid art. Lingual art. Dorsal lingual arteries Deep artery of tongue

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Venous Drainage

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Deep lingual vein Dorsal lingual veins Hypoglossal nerve Common lingual vein

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Lymph Drainage

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Submental nodes Submandibular nodes Jugulo- digastric nodes Jugulo-omohyoid nodes

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Submental nodes Submandibular nodes Jugulo-digastric node Jugulo-omohyoid node Post. Belly of digastric m. I.J.V Omo-hyoid m.

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Nerve Supply • Motor: Hypoglossal nerve except palato-glossus muscle. • Sensory: Anterior 2/3: lingual & Chorda tympani. Posterior 1/3: Glossopharyngeal nerve

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SOFT PALATE (Page 114)

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Uvula (median part of soft palate) Hard palate Palato-glossal fold Palato- pharyngeal fold

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Naso- pharynx Soft palate Palato-glossus m. Sagittal Section

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Importance of Soft Palate - Closses nasopharynx during swallowing and blowing.

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Site of soft palate

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Hard palate Soft palate Naso-pharynx Oro-phrynx

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Parts of Soft Palate

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Uvula (median part of soft palate) Palato-glossal fold Palato- pharyngeal fold Palatine tonsil Parts of Soft Palate

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Hard palate Uvula (median part of soft palate) Palatine tonsils Palato- glossal fold

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Muscles of Soft Palate A- Extrinsic Muscles: • 1- Tensor palati. • 2- Levator palati. • 3- Palato-glossus. • 4- Palato-pharyngeus. B- Intrinsic Muscle: • - Musculus uvulae.

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Sulcus for auditory tube Scaphoid fossa Petrous bone

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Scaphoid fossa Auditory tube Lateral pterygoid plate 1-Tensor palatine m. Pterygoid hamulus Palato- glossus m. Palatine aponeurosis Palato- pharyngeus m. 2-Levator palati m Maxilla Mandible (Cut) Thyroid cartilage

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Palatine aponeurosis Posterior nasal spine Musculus uvulae m. Intrinsic Muscle

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Nerve Supply 1- Motor: Cranial accessory through vagus n. except tensor palati from mandibular n. 2- Sensory: - Glossopharyngeal n. - Lesser palatine n.

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Blood Supply 1- Lesser palatine art. from greater palatine from maxillary. 2- Ascending palatine art. from facial art. 3- Ascending pharyngeal art. from ext. carotid art.

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PHARYNX (Page 117) Dr.Sherif Fahmy

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Shape & Extensions Shape: Funnle-shaped. Extensions: - Above: base of skull. - Below: Esophagus at level of C6 vertebra. Length: 5 inches Diameter: 3.5 cm at upper end & 1.5 cm at lower end. Dr.Sherif Fahmy

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Parts of Pharynx •1- Naso-pharynx •2- Oro-pharynx •3- Laryngo-pharynx Dr.Sherif Fahmy

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Naso- pharynx oro- pharynx Laryng- pharynx Soft palate Epiglottis Larynx Sagittal Section Dr.Sherif Fahmy

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Relations of pharynx Dr.Sherif Fahmy

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Larynx Nasal cavity Oral cavity Dorsum of tongue Upper 6 cervical vertebrae Anterior & Posterior Relations Dr.Sherif Fahmy

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Lobe of thyroid gland Common carotid art. Styloid apparatus Lateral Relations Dr.Sherif Fahmy

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Layers of Wall of pharynx 1- Mucosa. 2- Submucosa. 3- Pharyngo-basilar fascia. 4- Muscle layer. 5- Buccopharyngeal fascia. Dr.Sherif Fahmy

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Muscles of Pharynx A- Constrictor muscles B- Longitudinal muscles Dr.Sherif Fahmy

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Constrictor Muscles (Page 119) Dr.Sherif Fahmy

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Crico- pharyngeus m Thyro- pharyngeus m 3- Inferior Constrictor m Cricoid Thyroid Hyoid Stylohyoid lig. 2- Middle constrictor m Pterygoid hamulus Pterygo- mandibular lig. 1- Superior constrictor m Pharyngeal tubercle Pharyngeal raphe Dr.Sherif Fahmy

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Gaps Between Constrictor Muscles Dr.Sherif Fahmy

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Cricoid Thyroid Hyoid Tensor palati m. Auditory tube Tensor palati m. Stylopharyngeus m. Glossopharyngeal nerve Superior laryngeal art. Internal laryngeal nerve Thyro-hyoid membrane Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Longitudinal Muscles of Pharynx • 1- Stylo-pharyngeus muscle • 2- Palato-pharyngeus muscle • 3- Slapingo-phryngeus muscle Dr.Sherif Fahmy

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Auditory tube Salpingo- pharyngeus m. Soft palate Palato- pharyngeus m Stylo- pharyngeus m Thyroid cartilage Wall of pharynx Styloid process Dr.Sherif Fahmy

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Cavity of Pharynx Dr.Sherif Fahmy

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Naso- pharynx oro- pharynx Laryng- pharynx Soft palate Epiglottis Larynx Sagittal Section Dr.Sherif Fahmy

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A- Naso-pharynx 1- Boundaries. 2- Communications. 3- Internal features. Dr.Sherif Fahmy

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Naso-pharyngeal tonsil Opening of auditory tube Tubal elevation Salpingo- pharyngeal fold Pharyngeal recess Dr.Sherif Fahmy

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B- Oro-pharynx 1- Boundaries. 2- Communications. 3- Internal features. Dr.Sherif Fahmy

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Palatine tonsil Dr.Sherif Fahmy

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Palatine tonsils Palato- glossal fold Palato- pharyngeus fold Dr.Sherif Fahmy

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Uvula (median part of soft palate) Palato-glossal fold Palato- pharyngeal fold Palatine tonsil Dr.Sherif Fahmy

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Palatine Tonsil (Page 124) Dr.Sherif Fahmy

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Palatine tonsil Dr.Sherif Fahmy

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Relations of Palatine Tonsil Dr.Sherif Fahmy

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Palatine tonsil Dr.Sherif Fahmy

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Palato-glossal fold Palato- pharyngeal fold Palatine tonsil Dr.Sherif Fahmy

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Intra-tonsillar cleft Tonsillar crypts capsule Superior constrictor m. Paratonsillar vein Facial art. Ascending palatine art. I.C.A. Medial Dr.Sherif Fahmy

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Arterial supply of palatine tonsil: 1- Tonsillar branch of facial artery. 2- Ascending pharyngeal artery. 3- Ascending palatine artery. 4- Lesser palatine artery. 5- Dorsal lingual arteries from lingual artery. Nerve supply: 1- Glossopharyngeal nerve. 2- Lesser palatine nerve. Lymph drainage: 1- Jugulo-digastric nodes. Surface anatomy: - Oval area on ramus of mandible, above and infront angle of mandible. Dr.Sherif Fahmy

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C- Laryngo-pharynx 1- Boundaries. 2- Communications. 3- Internal features. Dr.Sherif Fahmy

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Posterior view Posterior wall of pharynx (Cut) Piriform recess Inlet of larynx Pathway of food during swallowing Dr.Sherif Fahmy

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Waldeyer’s Ring of Lymphoid Tissue • 1- Nasopharyngeal tonsil • 2- Palatine tonsils • 3- Lingual tonsil • 4- Tubal tonsils Dr.Sherif Fahmy

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Palatine tonsil Naso- pharyngeal tonsil Tubal tonsil Lingual tonsil Dr.Sherif Fahmy

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Arterial Supply of Pharynx • 1- Ascending pharyngeal artery. • 2- Ascending palatine artery. • 3- Pharyngeal branch from maxillary artery. • Pharyngeal plexus: • 1- Pharyngeal branch of glosso-pharyngeal nerve (sensory). • 2- Pharyngeal branch of vagus (Motor). • 3- Pharyngeal branch from superior cervical sympathetic ganglion (sympathetic) Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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LYMPH DRAINAGE OF HEAD & NECK Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Superficial Lymph Nodes • A- Circular Group: • 1- Buccal nodes. • 2- Parotid nodes. • 3- Mastoid nodes. • 4- Occipital nodes. • 5- Submental nodes. • 6- Submandibular nodes. • B- Vertical Group: • 1- Anterior cervical nodes. • 2-superficial cervical nodes. Dr.Sherif Fahmy

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Submental nodes Submandibular nodes Parotid nodes Mastoid nodes Occipital nodes Ext. jugular vein with superficial cervical nodes Anterior cervical nodes Buccal nodes Superficial nodes in H&N Dr.Sherif Fahmy

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Deep Lymph nodes 1- Median group: -Retropharyngeal, infrahyoid, prelaryngeal, pretracheal and paratracheal. 2- At side of neck along I.J.V.: - Upper & lower deep cervical nodes. Dr.Sherif Fahmy

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Fate of lymph drainage of head & neck Dr.Sherif Fahmy

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Nose (Page 130) Dr.Sherif Fahmy

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Bony skeleton of nose Nasal bones Frontal process of maxilla Nasal process of frontal bone Dr.Sherif Fahmy

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NASAL CAVITY (Page 130) Dr.Sherif Fahmy

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Roof & Floor Dr.Sherif Fahmy

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Nasal bone Frontal bone Cribriform plate of ethmoid Body of sphenoid Hard palate Soft palate Dr.Sherif Fahmy

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Nasal Septum (medial wall) Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Lateral Wall of Nasal Cavity Dr.Sherif Fahmy

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Cartilage Medial surface of ethmoidol labyrinth Superior concha Middle concha Maxilla Inferior concha Perpendicular plate of palatine bone Spheno- palatine foramen Dr.Sherif Fahmy

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Superior concha Middle concha Inferior concha Dr.Sherif Fahmy

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Spheno-ethmoidal recess Sup. Concha (cut) Superior meatus Middle concha (cut) Middle meatus Inferior concha (cut) Inferior meatus Vestibule Atrium Dr.Sherif Fahmy

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Spheno-ethmoidal recess Superior meatus Inferior meatus Sphenoidal air sinus Opening of post. Ethmoidal sinus Bulla ethmoidalis Hiatus semilunaris Lower end of naso-lacrimal duct Frontal sinus Dr.Sherif Fahmy

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Lining of Nasal Cavity Skin: at vestibule. Olfactory mucosa: at upper 1 cm of nasal septum, spheno-ethmoidal recess and superior concha. Respiratory mucosa: lines the rest of the cavity. Dr.Sherif Fahmy

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Blood & Nerve Supply of Nasal Cavity Dr.Sherif Fahmy

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Anterior ethmoidal a. Post. Ethmoidal a. Spheno- palatine art. Greater palatine a. Anterior superior alveolar Dr.Sherif Fahmy

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Area of Epistaxis (Little’ Area) Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Anterior ethmoidal nerve Olfactory nerves Medial nasal Lateral nasal Greater palatine n. Anterior superior alveolar n. Dr.Sherif Fahmy

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Paranasal Sinuses (Page 138) Dr.Sherif Fahmy

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Frontal sinuses Ethmoidal sinuses Maxillary sinuses Dr.Sherif Fahmy

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Frontal sinus Ethmoidal sinuses Sphenoidal sinus Maxillary sinus Dr.Sherif Fahmy

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Maxillary Sinus (Page 138) Dr.Sherif Fahmy

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Opening of maxillary sinus Dr.Sherif Fahmy

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Spheno- palatine art Posterior superior alveolar art. Infra- orbital art. Anterior superior alveolar art. Middle superior alveolar art Dr.Sherif Fahmy Dr.Sherif Fahmy

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Joints of Atlas and Axis (Page 162) Dr.Sherif Fahmy

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ATLANTO-OCCIPITAL AND ATLANTO-AXIAL JOINTS Dr.Sherif Fahmy

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Atlanto-occipital J. Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Superior aspect of atlas Facet for dens of axis Superior articular process Transverse ligament of atlas Dr.Sherif Fahmy

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Anterior arch of atlas Anterior longitudinal ligament Anterior atlanto- occipital membrane Occipital bone of skull Dr.Sherif Fahmy

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External occipital protuberance Posterior atlanto- occipital membrane Posterior aspect Dr.Sherif Fahmy

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Atlanto-axial J. Dr.Sherif Fahmy

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Superior aspect of atlas Facet for dens of axis Superior articular process Transverse ligament of atlas Dr.Sherif Fahmy

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Transverse ligament of atlas Dens of axis Superior aspect of median atlanto-axial joint Anterior arch of atlas Dr.Sherif Fahmy

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Transverse ligament of atlas Alar ligament Lateral atlanto- axial joint Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Posterior longitudinal lig. Membrana tectoria Transverse lig. Inf. Longitudinal lig. Sup. Longitudinal lig. Cuciform ligament Alar ligaments Anterior aspect with removed anterior parts of vertebrae Basilar part of occipital bone Dr.Sherif Fahmy

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Membrana tectoria (cut) Membrana tectoria (cut) Superior longitudinal lig. (cut) Apical ligament Alar ligament Accessory atlanto- axial ligament Transverse ligament Clivus Dr.Sherif Fahmy

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Posterior longitudinal lig. Membrana tectoria Transverse lig. Inf. Longitudinal lig. Sup. Longitudinal lig. Cuciform ligament Alar ligaments Anterior aspect with removed anterior parts of vertebrae Basilar part of occipital bone Dr.Sherif Fahmy

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Membrana tectoria (cut) Membrana tectoria (cut) Superior longitudinal lig. (cut) Apical ligament Alar ligament Accessory atlanto- axial ligament Transverse ligament Clivus Dr.Sherif Fahmy

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Transverse ligament of atlas Dens of axis Superior aspect of median atlanto-axial joint Anterior arch of atlas Dr.Sherif Fahmy

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Transverse ligament of atlas Alar ligament Lateral atlanto- axial joint Dr.Sherif Fahmy

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THE EAR (Page 154) Dr.Sherif Fahmy

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A- External Ear Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Auricle Lobule External auditory meatus Ear drum Dr.Sherif Fahmy

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Auricle Lobule of ear External auditory meatus Ear drum Dr.Sherif Fahmy

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Tympanic memebrane (Ear drum) Dr.Sherif Fahmy

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Tympanic membrane External auditory meatus Malleus Middle ear Dr.Sherif Fahmy

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Pars tensa Pars flaccida Cone of light Handle of malleus Dr.Sherif Fahmy

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Tympanic membrane Malleus Middle ear Umbo Handle of malleus Dr.Sherif Fahmy

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Blood & Nerve Supply of Tympanic Membrane • 1- Nerve Supply: • A- Outer surface: is supplied by auriculo- temporal and auricular branch of vagus. • B- Inner surface: tympanic plexus. • 2- Blood Supply: • 1- Outer surface: deep auricular artery. • 2- Inner surface: from anterior tympanic artery. Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Outer aspect of tymoanic membrane Handle of malleus Cone of light Dr.Sherif Fahmy

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Otitis media Dr.Sherif Fahmy

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B- Middle Ear (Page 156) Dr.Sherif Fahmy

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Epitympanic recess Tympanic cavity Parts of middle ear cavity Dr.Sherif Fahmy

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Roof Floor Anterior wall Posterior wall Medial wall Walls of middle ear Dr.Sherif Fahmy

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Tegmen tympani Dr.Sherif Fahmy

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Roof Tegman tympani Floor Int. jugular vein Tympanic br. Of Glosso- pharyngeal n. Roof & Floor Dr.Sherif Fahmy

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Anterior wall Posterior wall Promontory Tympanic plexus Oval windowe Round window Br. From sympathetic plexus around I.C.A. Tympanic br. Of 9th CN Canal for facial N. Medial wall Dr.Sherif Fahmy

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Roof Floor Anterior wall Posterior wall Tensor tympani m. Auditory tube Internal carotid art. Sympathetic plexus Anterior wall Dr.Sherif Fahmy

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Aditus ad antrum Pyramid Facial canal Chorda tympani Posterior wall Dr.Sherif Fahmy

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External auditory meatus Ear drum Lateral wall Dr.Sherif Fahmy

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Contents of middle ear 1- Ossicles: Malleus, incus and stapes. 2- Muscles: Tensor tympani & Stapedius. 3- Nerves: Tympanic plexus and chorda tympani. 4- Blood vessels: Tympanic arteries. Dr.Sherif Fahmy

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Malleus Middle ear Incus Stapes Ossicles Dr.Sherif Fahmy

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Malleus Incus Stapes Ossicles Head Handle Body Long process Head Neck Limbs Foot plate Short process Anterior process Dr.Sherif Fahmy

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Pharyngo-tympanic tube Dr.Sherif Fahmy

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Middle ear Lateral wall of naso- pharynx Pharyngo- tympanic tube Dr.Sherif Fahmy

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Dr.Sherif Fahmy

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Opening of pharyngeotympanic tube Dr.Sherif Fahmy

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Inner Ear (Page 160) Dr.Sherif Fahmy

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Internal acoustic meatus Dr.Sherif Fahmy

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Petrous Semicircular canals Vestibule Cochlea Bony labyrinith Dr.Sherif Fahmy

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saccule Utricle Cochlear duct Semicircular ducts Endolymphatic duct Membranous labrynith Dr.Sherif Fahmy

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Vestibulo-cochlear Nerve (Page 160) Dr.Sherif Fahmy

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Vestibular nerve Cochlear nerve Internal auditory meatus Vestibulo- cochlear nerve Dr.Sherif Fahmy

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Vestibular ganglia Vestibular nerve Spiral ganglia Cochlear nerve Vestibulo- cochlear nerve Internal auditory meatus Ponto- cerebellar angle Dr.Sherif Fahmy

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Transmission of sound Tympanic membrane Malleus Incus Stapes Oval window Round window closed with 2dry tympanic membrane Dr.Sherif Fahmy

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Spiral gangliom Dr.Sherif Fahmy

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Applied Anatomy 1- Otitis media. 2- Intracranial injury of facial n. -At internal auditory meatus. -At medial wall of middle ear. 3- High tone deafness. Dr.Sherif Fahmy

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Larynx (Page 142) Dr.Sherif Fahmy

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Skeleton of larynx A- Cartilages: 1- Single: Thyroid, cricoid and epiglottis. 2- Paired: Arytenoid, corniculate and cuneiform. B- Membranes: Thyrohyoid, cricothyroid, cricotracheal and quadrangular. Dr.Sherif Fahmy

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Thyroid cartilage Dr.Sherif Fahmy

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Thyroid cartilage Cricoid cartilage Quadrilateral lamina Laryngeal prominence (Adam’s apple) Hyoid bone Dr.Sherif Fahmy

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Laryngeal prominence Thyroid notch Superior horn Inferior horn Oblique line Thyoid cartilage Quadrilateral plate of cartilage Dr.Sherif Fahmy

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Cricoid Cartilage Dr.Sherif Fahmy

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Cricoid cartilage Anterior arch Posterior quadrate lamina Articulation with inferior horn of thyroid cartilage Site for arytenoid Crico-tracheal ligament Dr.Sherif Fahmy

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Epiglottis Dr.Sherif Fahmy

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Epiglottis Stalk Right thyroid lamina Thyroepiglottic lig. Dr.Sherif Fahmy

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Epiglottis Thyroid cartilage Arytenoid cartilage Posterior quadrate cricoid cartilage Thyro- epiglottic lig. Posterior concave smooth surface Posterior aspect Dr.Sherif Fahmy

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Arytenoid cartilage Thyroid cartilage (cut) Quadrangular membrane Epiglottis Thyro-epiglottic lig. Upper border Lower border Cricoid cartilage Crico-thyroid membrane Dr.Sherif Fahmy

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Thyroid cartilage (cut) Thyro-epiglottic lig. Hyoid bone Hyo-epiglottic lig. Vestibular fold Arytenoid cartilage Ary-epiglottic fold Epiglottis Quadrangular membrane Dr.Sherif Fahmy

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Oral part Pharyngeal part Median glosso- epiglottic lig. Lateral glosso- epiglottic folds Epiglottis Dr.Sherif Fahmy

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Arytenoid Cartilages Dr.Sherif Fahmy

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Arytenoid cartilage Apex Base Vocal process Muscular process Cricoid cartilage Muscular process Dr.Sherif Fahmy

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Cricoid cartilage Arytenoid cartilage Vocal process Vocal cord Posterior quadrate lamina Muscular processes Dr.Sherif Fahmy

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Corniculate & Cuneiform Cartilages Dr.Sherif Fahmy

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Cricoid cartilage (cut) Arytenoid cartilage Thyroid cartilage (cut) Quadrangular membrane Corniculate cartilage Cuneiform cartilage Epiglottis Dr.Sherif Fahmy

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Ligaments, Membranes & Folds Dr.Sherif Fahmy

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1- Thyro-hyoid Memrane Dr.Sherif Fahmy

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Thyroid cartilage Hyoid bone Median thyrohyoid lig. Lateral thin part Perforation for passage of int. laryngeal n. and sup. Laryngeal art. Lateral thyrohyoid lig. Dr.Sherif Fahmy

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2- Ligaments & folds attached to epiglottis Dr.Sherif Fahmy

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Arytenoid cartilage Thyroid cartilage (cut) Quadrangular membrane Epiglottis Thyro-epiglottic lig. Upper border Lower border Dr.Sherif Fahmy

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Thyroid cartilage (cut) Thyro-epiglottic lig. Epiglottis Hyoid bone Hyo-epiglottic lig. Vestibular fold Arytenoid cartilage Ary-epiglottic fold Quadrangular membrane covered with mucus membrane Dr.Sherif Fahmy

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Pharyngeal part Median glosso- epiglottic lig. Lateral glosso- epiglottic folds Epiglottis Dr.Sherif Fahmy

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3- Ligaments attached to Cricoid cartilage Dr.Sherif Fahmy

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Ligaments attached to Cricoid cartilage Crico-tracheal ligament 1st tracheal ring Cricoid cartilage Dr.Sherif Fahmy

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Crico-thyroid lig. Crico-vocal lig. Cricoid cartilage Thyroid cartilage Dr.Sherif Fahmy

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Cricoid cartilage (cut) Vocal process Crico-vocal lig. Cricothyroid lig. Thyroid cartilage (cut) Arytenoid cartilage Vocal cord Sagittal section of skeleton of larynx Dr.Sherif Fahmy

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Cavity of Larynx (Page 148) Dr.Sherif Fahmy

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Vestibular fold Arytenoid cartilage Ary-epiglottic fold Vestibule Sinus Infraglottic part Cavity of larynx Vocal fold Epiglottis Sagittal section Dr.Sherif Fahmy

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Vestibule Infra-glottic part Sinus Cavity of Larynx Epiglottis Ary-epiglottic fold Vestibular fold Vocal fold Coronal section Saccule Dr.Sherif Fahmy

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Inlet of Larynx Dr.Sherif Fahmy

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Posterior view Posterior wall of pharynx (Cut) Piriform recess Inlet of larynx Pathway of food during swallowing Dr.Sherif Fahmy

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Upper border of epiglottis Ary-epiglottic fold Inter-arytenoid fold Cuneiform cartilage Corniculate cartilage Inlet of larynx Dr.Sherif Fahmy

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Ary-epiglottic fold Vestibular fold Vocal fold Sinus of larynx Thyroid cartilage (cut) Dr.Sherif Fahmy

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Muscles of Larynx Dr.Sherif Fahmy

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Crico-thyroid m. Dr.Sherif Fahmy

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Epiglottis Thyroid cartilage Arytenoid cartilage Posterior aspect Transverse arytenoid Oblique arytenoid m. Ary-epiglottic m. Posterior crico- arytenoid m. Cricoid cartilage Dr.Sherif Fahmy

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Cricoid cartilage Arytenoid cartilage Vocal cord Muscular processes Lateral crico- arytenoid m. Vocalis m. Dr.Sherif Fahmy

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Posterior crico- arytenoid m. Lateral crico- arytenoid Transverse arytenoid Oblique arytenoid Vocalis m. Arytenoid cartilage Cricoid cartilage Thyroid cartilage Dr.Sherif Fahmy

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Lateral crico-arytenoid m. Posterior crico- arytenoid m. Thyro-arytenoid m. Thyro-epiglottic m. Ary-epiglottic m. Dr.Sherif Fahmy

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Superior view Arytenoid Vocal lig Vocalis m. Thyro- arytenoid m. Dr.Sherif Fahmy

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Quiet respiration Deep inspiration Dr.Sherif Fahmy

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Abduction of vocal cord Adduction of vocal cords Closure of rima glottidis Dr.Sherif Fahmy

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Nerve Supply 1- Superior laryngeal Nerve. 2- Recurrent laryngeal Nerve. Dr.Sherif Fahmy

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Blood Supply 1- Superior laryngeal artery. 2- Inferior laryngeal artery. Dr.Sherif Fahmy

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Applied Anatomy Tracheostomy: A hole which is done in trachea or crico-thyroid membrane in case of laryngeal obstruction. Dr.Sherif Fahmy