Kenhub Atlas of Human Anatomy 2023

PELVIS AND
BASICS UPPER LIMB LOWER LIMB SPINE AND BACK THORAX ABDOMEN PERINEUM HEAD AND NECK NEU ROAN ATOMY
Atlas of
Human
Anatomy
Copyright © 2023 by Kenhub GmbH
Originally published in Germany by Kenhub
All rights reserved. No part of this book may be reproduced or utilized in any
form or by any means, electronic or mechanical, including photocopying or
recording by any information storage and retrieval system, without written
permission from the copyright owner.
To request permissions, contact the copyright owner at [email protected].
Note to the reader: This book is intended as an informational guide. The text,
graphics, images and other materials in this book are for informational purposes
only. No material in this book is intended to substitute professional medical
advice, diagnosis or care. It should not be used to treat a serious ailment with
out prior consultation with a qualified health care professional.
ISBN 978-3-96298-318-5 (print)

ISBN 978-3-96298-319-2 (ebook pdf)
ISBN 978-3-96298-320-8 (ebook epub)
Printed and bound in India by Replika Press Pvt. Ltd.
10 9 8 7 6 5 4 3 2 1
Illustrations Paul Kim, Irina Munstermann, Liene Znotina, Begona Rodriguez,

Samantha Zimmerman, Esther Gollan, Hannah Ely, Mao Miyamoto, Rebecca
Betts, and Yousun Koh
Editor Mike Pascoe PhD
Contributors Abdulmalek Albakkar MD, Alexandru Andrusca MD PhD, Claudia
Bednarek MD, Declan Tempany BSc (Hons), Dimitrios Mytilinaios MD PhD, Edwin
Ocran MBChB MSc, Egle Pirie BSc (Hons), Elisabeth Friesen, Gordana Sendic
MD, Jana Vaskovic MD, Juliana Walek MD, Kevin Kuschel MD, Marcell Laguna,
Marta Krzanowski BMedSc, Milena Vujovic MD, Muhammed Albakkar DDS, Nicola
McLaren MSc, Nila Nikro, Rafael Lourenô do Carmo MD, Rafaela Linhares MD,
Roberto Grujicic MD, Sara Ferreira MD, Sophie Stewart MSc
Text design and layout Medlar Publishing Solutions Pvt. Ltd., India
To send correspondence to the authors of this book, contact us directly at

[email protected].
EVOLVING DIVERSITY
AND INCLUSION
Diversity is all around us—in nature, culture, art, and in our very being as humans.
Society has oftentimes failed to depict the diversity that colors our world, so it’s
up to everyone as individuals to do their part and contribute towards a diverse
and more inclusive culture. We’ve all seen that this is changing for the better in
modern times, since we have come to understand how diversity and inclusion
are able to enrich human learning and experience.
Kenhub is a company that greatly values diversity, defined as a broad spectrum

of human characteristics and experiences. We foster a culture of inclusion
which is reflected in our community of teammates, partners, consumers and
customers from all around the world. Our ongoing mission is to create a safe
environment for everyone, focusing on cultivating equity, as well as celebrating
individual uniqueness and identity.
Representation matters. It is our vision to diversify our content so that every

one feels seen, included, comfortable and respected. We believe that, by rep
resenting our differences, we help future healthcare professionals develop and
learn new ways of thinking, behaving and caring for their patients. A multicul
tural exchange of ideas and experiences bolsters new generations, leading to
innovation and increased creativity. This is especially pertinent in an educational
setting such as Kenhub.
We take pride in making a step towards our vision by diversifying our anatom
ical models and by shifting away from only featuring the standard white male
model of the human body. As many as there are anatomical variations in vessels
and nerves of the human body, there can be many different varieties of peo
ple, and we’re embracing those differences. We understand that we are not
exact carbon copies of each other. Thankfully we are all sprinkled with our own
unique traits and features and we believe that these individual features should
be reflected and celebrated in anatomical education.
In addition, we recognize that the lexicon of anatomy is littered with epony
mous terms that primarily represent contributions of white, male scientists.
The use of these terms further minimizes the contributions of non-white and
non-male scientists and adds cognitive burden required to translate these
names into structures. For this reason, we have chosen to use toponyms
offered by the Terminologia Anatomica (2nd edition, 2019) as primary terms
whenever possible.
There are still big steps to be made, both on our platform and in society, but
we’re moving in the right direction—one step at a time, actively working on
changes that we believe will make our audience at Kenhub feel seen and heard.
TABLE OF CONTENTS
Preface....................................................................................................... xiii
How to use this atlas ...................................................................................xvi
1 BASICS................................................................................................. 1
Terminology .................................................................................................. 2
Directional terms and body planes .............................................................. 2
Regions of the body ....................................................................................3
Body surface anatomy................................................................................ 4
Cavities of the body ................................................................................... 6
2 UPPER LIMB....................................................................................... 9
Overview ..................................................................................................... 10
Regions of the upper limb ......................................................................... 10
Shoulder and arm ........................................................................................ 12

Clavicle..................................................................................................... 12
Humerus and scapula ................................................................................13
Glenohumeral (shoulder) joint ................................................................... 17
Muscles of the arm and shoulder ............................................................... 19
Elbow and forearm ..................................................................................... 22

Radius and ulna........................................................................................ 22
Elbow joint............................................................................................... 25
Forearm muscles: Anterior compartment ................................................. 27
Forearm muscles: Posterior compartment ............................................... 29
Wrist and hand ............................................................................................ 31

Bones of the wrist and hand...................................................................... 31
Ligaments of the wrist and hand............................................................... 33
Muscles of the hand ................................................................................. 38
Nerves and vessels ...................................................................................... 42

Brachial plexus......................................................................................... 42
Table of contents v
Neurovasculature of the arm and shoulder ............................................... 44
Neurovasculature of the elbow and forearm............................................ 50
Neurovasculature of the hand .................................................................. 56
3 LOWER LIMB ..................................................................................... 61
Overview .................................................................................................... 62
Regions of the lower limb ........................................................................ 62
Hip and thigh .............................................................................................. 63

Hip bone ..................................................................................................63
Femur ...................................................................................................... 66
Hip joint ...................................................................................................68
Muscles of the hip and thigh..................................................................... 69
Knee and leg ................................................................................................ 74

Tibia and fibula ..........................................................................................74
Knee joint ................................................................................................. 77
Muscles of the leg.................................................................................... 82
Ankle and foot ............................................................................................ 86

Bones of the foot ..................................................................................... 86
Talus........................................................................................................ 88
Calcaneus ................................................................................................ 90
Ankle joint ............................................................................................... 92
Joints and ligaments of the foot............................................................... 94
Muscles of the foot 98
Nerves and vessels .................................................................................... 103

Neurovasculature of the hip and thigh.................................................... 103
Muscular innervation ........................................................................ 105
Cutaneous innervation..................................................................... 105
Femoral artery and its branches.............................................................. 106
Sciatic nerve and its branches.................................................................. 107
Neurovasculature of the leg and knee..................................................... 108
Muscular innervation ........................................................................ 110
Cutaneous innervation...................................................................... 110
Arteries and nerves of the foot ................................................................110
Muscular innervation 112
Cutaneous innervation 112
4 SPINE AND BACK ............................................................................. 113
Overview 114
Regions of the back and buttocks............................................................ 114
Vertebral column 115
vi Kenhub Atlas of Human Anatomy

Spine .......................................................................................................... 119
Cervical spine .......................................................................................... 119
Thoracic spine ........................................................................................ 124
Lumbar spine.......................................................................................... 126
Sacrum and coccyx ................................................................................ 128
Arteries of the vertebral column............................................................. 130
Veins of the vertebral column.................................................................. 132
Back .......................................................................................................... 134

Muscles of the back................................................................................ 134
Superficial muscles of the back ........................................................ 134
Deep muscles of the back ................................................................. 137
Neurovasculature of the back................................................................. 144
5 THORAX ........................................................................................... 147
Thoracic wall ............................................................................................. 148

Sternum................................................................................................. 148
Ribs........................................................................................................ 150
Costovertebral joints.............................................................................. 154
Muscles of the thoracic wall.................................................................... 156
Thoracic surface of the diaphragm.......................................................... 160
Neurovasculature of the thoracic wall ..................................................... 161
Neurovasculature of the intercostal space.............................................. 165
Female breast ........................................................................................... 168

Structure of the female breast................................................................168
Blood vessels of the female breast ......................................................... 169
Lymphatics of the female breast ............................................................. 171
Mediastinum .............................................................................................. 173

Borders, divisions and contents of the mediastinum................................ 173
Neurovasculature of the posterior mediastinum ..................................... 176
Esophagus.............................................................................................. 180
Lymphatics of the mediastinum...............................................................181
Lungs ........................................................................................................ 184

Trachea .................................................................................................. 184
Bronchial tree and alveoli ........................................................................ 185
Overview of the lungs ............................................................................ 189
Lungs in situ ............................................................................................192
Lymphatics of the lungs.......................................................................... 194
Heart ........................................................................................................ 196

Heart in situ ............................................................................................196
Surface anatomy of the heart ................................................................. 199
Table of contents vii

Right atrium and ventricle ...................................................................... 202
Left atrium and ventricle........................................................................ 206
Heart valves........................................................................................... 208
Coronary arteries and cardiac veins ......................................................... 212
Nerves of the heart ................................................................................ 214
Lymphatics of the heart...........................................................................217
6 ABDOMEN....................................................................................... 219
Abdominal wall .......................................................................................... 221

Regions of the abdomen.......................................................................... 221
Muscles of the abdominal wall................................................................ 223
Abdominal surface of the diaphragm....................................................... 226
Inguinal canal.......................................................................................... 228
Neurovasculature of the abdominal wall................................................. 230
Peritoneum ............................................................................................... 234

Peritoneal relations................................................................................ 234
Mesentery .............................................................................................. 236
Greater omentum................................................................................... 237
Omental bursa ........................................................................................239
Retroperitoneum.................................................................................... 241
Stomach ....................................................................................................243
Stomach in situ .......................................................................................243
Structure of the stomach........................................................................244
Spleen ....................................................................................................... 246

Structure of the spleen...........................................................................246
Liver .......................................................................................................... 248

Overview of the liver .............................................................................. 248
Surfaces of the liver ................................................................................250
Gallbladder............................................................................................. 253
Pancreas ....................................................................................................254
Pancreas in situ .......................................................................................254
Pancreatic duct system .......................................................................... 256
Small intestine .......................................................................................... 257

Duodenum ............................................................................................. 257
Jejunum and ileum................................................................................. 259
Arteries and veins of the small intestine.................................................. 261
Innervation of the small intestine............................................................263
Lymphatics of the small intestine ............................................................265
Large intestine .......................................................................................... 267

Large intestine........................................................................................ 267
Rectum and anal canal............................................................................ 269
viii Kenhub Atlas of Human Anatomy

Arteries of the large intestine ................................................................. 270
Innervation of the large intestine ............................................................ 272
Neurovasculature of the rectum and anal canal....................................... 275
Kidneys and ureters ................................................................................... 277

Kidneys................................................................................................... 277
Renal arteries 279
Ureters 280
Nerves, vessels and lymphatics of the abdomen ........................................ 283

Lumbar plexus ........................................................................................283
Arteries of the stomach, liver and gallbladder ......................................... 285
Arteries of the pancreas, duodenum and spleen...................................... 287
Hepatic portal system ............................................................................ 289
Lymphatics of the pancreas, duodenum and spleen ................................ 290
Lymphatics of the stomach, liver and gallbladder.................................... 292
Lymphatics of the posterior abdominal and pelvic wall ............................295
7 PELVIS AND PERINEUM .................................................................. 299
Pelvic girdle and floor ............................................................................... 300

Bony pelvis ............................................................................................ 300
Ligaments of the pelvis .......................................................................... 304
Muscles of the pelvic floor and perineum ................................................307
Female pelvis and reproductive organs..................................................... 309

Introduction to the female pelvic cavity................................................. 309
Uterus, uterine tubes and ovaries............................................................ 313
Cervix, vagina and vulva 316
Fetus in utero 319
Male pelvis and reproductive organs........................................................... 321

Introduction to the male pelvic cavity...................................................... 321
Testis and epididymis 323
Scrotum and spermatic cord...................................................................324
Urinary bladder and urethra 327

Male urinary bladder and urethra ............................................................ 329
Female urinary bladder and urethra......................................................... 331
Perineum 333
Penis 333
Female perineum....................................................................................336
Neurovasculature of the female perineum.............................................. 339
Nerves, vessels and lymphatics of the pelvis .............................................. 342

Sacral plexus...........................................................................................342
Nerves of the male pelvis ....................................................................... 344
Nerves of the female pelvis .................................................................... 345
Table of contents ix
Blood supply of the male pelvis............................................................... 347
Blood supply of the female pelvis ............................................................349
Lymphatics of the urinary organs ............................................................350
Lymphatics of the male genitalia ............................................................ 352
Lymphatics of the female genitalia ......................................................... 354
8 HEAD AND NECK ............................................................................. 357
Overview ................................................................................................... 359

Regions of the head and face .................................................................. 359
Skull ......................................................................................................... 360

Anterior view of the skull ....................................................................... 360
Lateral and posterior views of the skull ................................................... 361
Calvaria .................................................................................................. 363
Inferior view of the cranium ................................................................... 364
Cranial fossae......................................................................................... 367
Midsagittal skull...................................................................................... 370
Ethmoid bone ........................................................................................ 372
Sphenoid bone ........................................................................................ 374
Temporal bone........................................................................................ 377
Mandible ................................................................................................ 380
Face and scalp ............................................................................................383

Muscles of facial expression ....................................................................383
Blood vessels of the face and scalp ......................................................... 386
Nerves of the face and scalp....................................................................393
Arteries of the head: Lateral view ............................................................396
Infratemporal region and pterygopalatine fossa ........................................399

Muscles of mastication ...........................................................................399
Temporomandibular joint........................................................................ 401
Pterygopalatine fossa ............................................................................ 403
Orbit and contents .................................................................................... 408

Bones of the orbit .................................................................................. 408
Muscles of the orbit ................................................................................ 410
Neurovasculature of the orbit ................................................................ 412
Superior and inferior orbital fissures ........................................................417
Anatomy of the eyeball ........................................................................... 419
Blood vessels of the eyeball.................................................................... 422
Eyelids and lacrimal apparatus................................................................ 423
Nasal region............................................................................................... 425

Nasal cavity............................................................................................ 425
Neurovasculature of the nasal cavity ...................................................... 427
x Kenhub Atlas of Human Anatomy

Ear ........................................................................................................... 430
External ear ........................................................................................... 430
Middle ear...............................................................................................432
Internal ear............................................................................................. 435
Oral cavity ................................................................................................. 439

Overview of the oral cavity ..................................................................... 439
Surface of the tongue ............................................................................ 440
Muscles of the tongue............................................................................ 442
Neurovasculature of the tongue............................................................. 445
Salivary glands ....................................................................................... 446
Teeth........................................................................................................ 448
Types of teeth ........................................................................................ 448
Anatomy of the tooth............................................................................ 450
Pharynx .................................................................................................... 453

Pharyngeal mucosa................................................................................ 453
Muscles of the pharynx ...........................................................................454
Blood vessels of the pharynx...................................................................456
Nerves of the pharynx ............................................................................ 457
Neck .......................................................................................................... 459

Hyoid bone............................................................................................. 459
Muscles of the anterior neck .................................................................. 460
Larynx................................................................................................... 464
Thyroid and parathyroid glands ................................................................471
Neurovasculature of the neck................................................................. 474
Cervical plexus........................................................................................ 479
Lymphatics of the head and neck............................................................ 480
Triangles of the neck...............................................................................483
Compartments of the neck .................................................................... 486
9 NEUROANATOMY ........................................................................... 491
Introduction to the brain ........................................................................... 493
Cerebrum .................................................................................................. 495

Cerebral cortex.......................................................................................495
Motor and sensory cortical homunculus ................................................ 499
White matter......................................................................................... 500
Basal nuclei ............................................................................................ 501
Diencephalon ......................................................................................... 502
Brainstem and cerebellum ........................................................................ 505

Brainstem...............................................................................................505
Cerebellum ........................................................................................... 508
Table of contents xi
Meninges and ventricles of the brain .......................................................... 511
Cranial meninges..................................................................................... 511
Ventricles of the brain ............................................................................. 512
Blood supply of the brain ............................................................................515

Arteries of the brain ................................................................................ 515
Veins of the brain .................................................................................... 519
Dural venous sinuses .............................................................................. 522
Spinal cord ................................................................................................ 524

Topography and morphology of the spinal cord....................................... 524
Spinal meninges and nerve roots ............................................................ 526
Spinal nerves 527
Blood vessels of the spinal cord .............................................................. 529
Cranial nerves 532

Cranial nerve overview............................................................................532
Olfactory nerve (CN I) ............................................................................. 536
Optic nerve (CN II) ...................................................................................538
Oculomotor, trochlear and abducens nerves (CN III, IV & VI) ..................... 540
Trigeminal nerve (CN V) ...........................................................................543
Ophthalmic nerve (CN V1) 543
Maxillary nerve (CN V2) 545
Mandibular nerve (CN V3) 547
Facial nerve (CN VII) ................................................................................ 550
Vestibulocochlear nerve (CN VIII) ............................................................ 553
Glossopharyngeal nerve (CN IX)............................................................... 556
Vagus nerve (CN X).................................................................................. 559
Accessory nerve (CN XI)...........................................................................563
Hypoglossal nerve (CN XII).......................................................................564
Taste pathway........................................................................................ 566
Index ......................................................................................................... 567
xii Kenhub Atlas of Human Anatomy

PREFACE
As of summer 2023, Kenhub.com has helped more than 4 million registered

users worldwide to deepen their understanding of the structure and organiza
tion of the human body (and pass their exams too). Since launching Kenhub.com
in 2012, we’ve had over 110 million visitors on our website, with this number
growing everyday.
Further to this, universities such as Charite—Universitatsmedizin Berlin and the

University of Colorado use our learning materials to teach their students, in
parallel with textbooks and practical lab teaching.
Kenhub offers you and your university the most accurate and reliable digi
tal anatomy educational tools. Based on regular feedback from our users, it
became clear that physical anatomy atlases are still highly valued by students.
That is why we have decided to print a top quality anatomy atlas based on years
of experience, constant refinement and user feedback.
OUR QUALITY COMMITMENT
At Kenhub, we are passionate about providing the most accurate and relia
ble resources for healthcare professionals that are either learning or teaching
anatomy and histology. We work hard to ensure that our content rises to the
highest academic standards.
We use multiple academic resources as a reference point, with particular

emphasis on those which are familiar to the majority of students and instruc
tors alike. Thus for anatomy related content, our main references are two of the
most widely respected anatomy textbooks:
• Gray’s Anatomy, The Anatomical Basis of Clinical Practice, 42nd Ed. (Editor in
chief: Susan Standring)
• Clinically Oriented Anatomy (by Keith L. Moore, Arthur F. Dalley II, and Anne
M. R. Agur)
Preface xiii
In addition to accuracy, our articles and illustrations on Kenhub.com are con
tinuously updated with the latest findings and discoveries in anatomy and his
tology. Towards this, our writing and review process involves the appraisal of
peer-reviewed scientific literature related to each topic.
Understanding that not everybody enjoys reading dense academic content,

we strive to make our articles as light and as easy to read as possible, without
scrimping on the details.
Both our atlas of anatomy illustrations and textbook-style articles are availa
ble for free upon registration on Kenhub.com. For a faster and more engaging
learning experience, we offer hundreds of videos and quizzes as part of our paid
Premium product.
REVIEWED BY EXPERTS
In enlisting our content creation team, we follow the highest educational and
scientific standards. The authors of our articles are medical students, junior
doctors, or postgrads who are passionate about anatomy, histology and med
ical education. Our talented authors love teaching their younger fellows and
have a great ability to simplify complex topics into easy-to-digest articles. The
manuscripts are then reviewed by a group of experts in the medical education
field. We collaborate with university professors, senior doctors and Ph.D. can
didates from around the world who are experts in anatomy, histology and med
ical education.
xiv Kenhub Atlas of Human Anatomy

We are also proud to collaborate with some of the world’s top medical illus
trators, including the Netter award winner Paul Kim, and others like Begona
Rodriguez, Esther Gollan, Hannah Ely, Irina Munstermann, Liene Znotina, Mao
Miyamoto, Rebecca Betts, Samantha Zimmerman, and Yousun Koh. Referenc
ing Netter’s Atlas of Human Anatomy and Sobotta Atlas of Human Anatomy (to
name a few), our illustrators create original anatomical or histological illustra
tions. The original illustrations we create are then subject to a rigorous review
process (sometimes it takes more than 6 months for an illustration to be pub
lished due to the multiple reviewing steps!).
Atlas content reviewer
For this atlas specifically, we are proud to work together with Dr. Mike Pascoe.
Mike is an Associate Professor of Anatomy at the University of Colorado
Anschutz Medical Campus.
Dr. Pascoe studied the neurophysiology of movement at the University of

Colorado Boulder and defended his doctoral dissertation in 2010. He then joined
the faculty at Anschutz in 2011 where he develops and delivers gross anatomy
curricula to physical therapy, physician assistant, and medical doctor students.
His primary research interest is the investigation of constructivist approaches

in technology-enabled learning environments (e.g., wiki usage, interactive
modules, Snapchat, etc) to improve learning outcomes and student satisfac
tion. Of secondary interest is the determination of “need-to-know” anatomy
content for physical therapy students.
Dr. Pascoe’s service commitments include mentoring students, organizing

anatomy laboratory refresher courses for practicing clinicians, community out
reach, and service as a peer-reviewer for many anatomy education journals.
This atlas hasn’t been possible without the help of the Kenhub team. It consists
of diverse, talented individuals which create Kenhub’s unique, interdisciplinary
perspective on anatomy education. We are a fully remote company meaning
that our team is spread out all around the world.
You can find more information about the team here:
Learn more about the

Kenhub Team
Kenhub is grounded on academic literature and research, validated by experts,

and trusted by more than 80 million readers worldwide.
Preface xv
HOW TO USE THIS ATLAS
Mike Pascoe PhD
BUILT FOR LEARNERS
This atlas represents a collection of clear, comprehensible and didactically val

uable images from Kenhub.com, intuitively organized to aid you in your mastery
of the organization of the human body. The features of this modern print atlas
were formulated by direct input from students of anatomy and experienced
educators. This print atlas was designed by the preferences of anatomy stu
dents to assist in the challenges of identifying structures in the anatomy labo
ratory and to assist in studying for written exams.
xvi Kenhub Atlas of Human Anatomy

The ease of navigation is the most important feature of an anatomy atlas!
Therefore, this atlas has been organized by region (e.g., upper limb), with various
body systems presented therein. A color coding system is used throughout the
atlas, as this has been recognized as the most efficient way to find a structure
quickly in a print atlas. This atlas provides a series of regional overview images
that will assist you in identifying structures in and out of the laboratory based
on adjacent key anatomical relations. This is how expert anatomists navigate
the body, so don’t underestimate the power of having a good understanding
of neighboring anatomical structures! Additionally, each overview image is
accompanied by text captions in order to convey and describe presented struc
tures in a clear and concise manner.
The small size of the atlas enables you to transport it and use it across many dif
ferent settings beyond your home, such as the anatomy lab and in the lecture
hall on campus.
How to use this atlas xvii

DIGITALLY ENHANCED LEARNING
This atlas can be used in traditional ways, as mentioned above, and in ways you
may not have considered before. A big strength of the atlas is the ability to
extend its content into the rich resources on the Kenhub website.
The reader can use their smartphone to access any structure on Kenhub
through their atlas and view any additional related images, as well as related
articles, videos and quizzes. The atlas can also be used as a reference (i.e., “sec
ond screen”) when reviewing lectures at home or on the go.
This is enabled by the Quick Response (QR) codes, which have been included in
the atlas as a quick way to connect you to the extensive online resources on the
Kenhub platform. To do this, open the camera app on your smartphone, ensur
ing the rear-facing camera is selected. Point your camera at the QR code and
center the box over the code to scan it. Tap on the URL popup banner at the top
of the screen, and you’ll be connected directly to the supplemental information
on Kenhub.com.
Here we see a learner scanning a QR code in the atlas in order to review further details found on Kenhub.
com.
xviii Kenhub Atlas of Human Anatomy

BASICS 1
Terminology............................... 2
Directional terms and body planes 2
Regions of the body..................... 3
Body surface anatomy................. 4
Cavities of the body..................... 6
TERMINOLOGY
DIRECTIONAL TERMS AND BODY PLANES
Anatomists use specific terms to help clearly communicate the location of

structures within the human body. These are directional terms, regional terms
and body planes. To avoid confusion and miscommunication, a standard refer
ence point for these terms is always used, this reference point is the anatom
ical position. The anatomical position is when the body is standing erect, with
the face looking forwards, the feet parallel, the arms hanging at the sides, the
palms facing forwards and the thumbs pointing away from the body.
Directional terms and body planes allow us to describe the relationship between
anatomical structures. For example, the wrist is distal to the elbow, the ears are
lateral to the eyes, the nose is located in the midsagittal plane.
FIGURE 1.1. Directional terms and body planes.
Key points about directional terms and body planes
Body planes Coronal, sagittal, median, transverse
Superior (cranial), inferior (caudal), anterior (ventral), posterior (dorsal), medial,

Directional
lateral, proximal, distal, left, right, superficial, deep, central, peripheral, ulnar, radial,
terms
rostral, caudal, palmar, plantar
Directional terms and Basic anatomy and

body planes terminology
2 Kenhub Atlas of Human Anatomy

TERMINOLOGY
REGIONS OF THE BODY
The human body can be studied under the umbrella of two primary regions.
These are the axial region, which encompasses the head, neck and trunk, and
the appendicular region which describes the upper and lower limbs.
Each of these regions can in turn be broadly divided into a number of smaller
sub-regions or parts.
- Head -
— Neck —
Shoulder
- Thorax
Back -
Elbow
Forearm
Abdomen
Wrist
Hand
Gluteal region
Hip region
Pelvis
Thigh
Knee
Leg
Ankle
Foot
FIGURE 1.2. Regions of the body.
Key points about the regions of the body
Head
Axial regions Neck
Trunk (thorax, abdomen, pelvis, back)
Appendicular Upper limb (shoulder, arm, elbow, forearm, wrist, hand)

regions Lower limb (hip, gluteal region, thigh, knee, leg, ankle, foot)
Body regions: Learn

Basic anatomy and
with quizzes and
terminology
labeled diagrams
Basics 3
TERMINOLOGY
BODY SURFACE ANATOMY

Surface anatomy teaches about the main anatomical features visible on the
surface of the human body. This knowledge helps to identify inner anatomical
structures according to their visible features.
A good understanding of surface anatomy is key to interpreting normal and

abnormal anatomy in clinical settings, such as medical imaging procedures and
physical examination. Many aspects of surface anatomy between the sexes are
similar but there are a few differences which mainly relate to sexual differenti
ation during development.
Sternocleidomastoid muscle Jugular notch of

sternum
Clavicle Supraclavicular fossa
Biceps brachii muscle Deltoid muscle
Breast Mammillary line
Cubital fossa Areola
Nipple Costal margin
Anterior superior iliac

Mons pubis
spine
Umbilicus
FIGURE 1.3. Female body surface anatomy (anterior view).

TERMINOLOGY
FIGURE 1.4. Female body surface anatomy (posterior view).
Surface
Anterior surface Posterior surface
landmarks
Larynx, sternocleidomastoid muscle,

supraclavicular fossa, clavicle, External occipital protuberance,
pectoralis major muscle, jugular notch vertebra C7 trapezius muscle, spine
of sternum, sternum, sternal angle, of scapula, medial border of scapula,
Head, neck xiphoid process, breast, areola, nipple, inferior angle of scapula, latissimus
and trunk costal margin, rectus abdominis dorsi muscle, lumbar triangle (of Petit),
muscle, linea alba, linea semilunaris, iliac crest, posterior superior iliac spine,
umbilicus, mons pubis, anterior sacral triangle, sacroiliac joint, anal
superior iliac spine, inguinal ligament, region
scrotum, penis, glans penis, vulva
Acromion, deltoid muscle, biceps

brachii muscle, cubital fossa, radial
Upper limb Triceps brachii muscle, olecranon
foveola (anatomical snuffbox), thenar
eminence, hypothenar eminence
Femoral triangle, quadriceps femoris Gluteal region, intergluteal cleft,

muscle, patella, tibial tuberosity, tibialis gluteal sulcus, iliotibial tract, hamstring
Lower limb
anterior muscle, lateral malleolus, muscles, popliteal fossa, triceps surae
medial malleolus muscle, calcaneal (Achilles) tendon
Basics 5
TERMINOLOGY
CAVITIES OF THE BODY

The main body cavities are classified into two groups according to their loca
tion: Dorsal cavity and ventral cavity. The dorsal cavity consists of the cranial
cavity, which houses the brain; and the vertebral canal, which houses the spinal
cord. The ventral cavity is composed of the thoracic cavity and abdominopel-
vic cavity. The thoracic cavity contains several smaller spaces that house the
trachea, lungs, esophagus and heart. The abdominopelvic cavity can be subdi
vided into the abdominal and the pelvic cavities, which contain the abdominal
and pelvic organs, respectively.
Cranial cavity
Vertebral canal
Superior mediastinum
Anterior mediastinum
Middle mediastinum
Posterior mediastinum —
Peritoneal cavity
Abdominal cavity
Pelvic cavity
o'
FIGURE 1.5. Cavities of the body (lateral view).

TERMINOLOGY
Pleural cavity
Pericardial cavity
Abdominal cavity
Pelvic cavity
FIGURE 1.6. Cavities of the body (anterior view).
Key points about the body cavities
Main cavities of Dorsal cavity: cranial cavity, vertebral canal

the body Ventral cavity: thoracic cavity, abdominopelvic cavity
Cranial cavity: brain
Vertebral canal: spinal cord

Thoracic cavity:
Mediastinum contents: heart, trachea, esophagus

Main contents
Mediastinum divisions: superior, inferior (subdivisions: anterior, middle posterior)
of body cavities
Pleural cavity: lungs
Abdominopelvic cavity:
Abdominal cavity: gastrointestinal system
Pelvic cavity: reproductive organs, urinary bladder, sigmoid colon and rectum
Basic medical
Basic anatomy and
terminology 101:
terminology
Learn with quizzes
Basics 7
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UPPER LIMB 2
Overview................................................................................... 10
Regions of the upper limb.............................................................. 10
Shoulder and arm...................................................................... 12

Clavicle...........................................................................................12
Humerus and scapula..................................................................... 13
Glenohumeral (shoulder) joint........................................................ 17
Muscles of the arm and shoulder.................................................... 19
Elbow and forearm................................................................... 22

Radius and ulna.............................................................................. 22
Elbow joint.....................................................................................25
Forearm muscles: Anterior compartment.......................................27
Forearm muscles: Posterior compartment.....................................29
Wrist and hand.......................................................................... 31

Bones of the wrist and hand............................................................31
Ligaments of the wrist and hand.....................................................33
Muscles of the hand....................................................................... 38
Nerves and vessels.................................................................... 42

Brachial plexus...............................................................................42
Neurovasculature of the arm and shoulder.................................... 44
Neurovasculature of the elbow and forearm.................................. 50
Neurovasculature of the hand........................................................56
OVERVIEW
REGIONS OF THE UPPER LIMB
Every medical professional needs to know the descriptive terms used for the
regions of the whole body in order to localize and diagnose different injuries
and diseases, as well as communicate them to other physicians. The same goes
for the upper limb, which is divided into several regions on its anterior and pos
terior aspects. Many of these regions contain various neurovascular structures,
which makes them important surgical landmarks.
Deltoid region Posterior region

of arm
Axillary region
Posterior region
Shouldei
Anterior region of elbow
of arm
Posterior region
Lateral bicipital of forearm
Arm
groove
Medial border
Elbow of forearm
groove
Lateral border
Anterior region Forearm of forearm
of elbow
Radial foveola
Anterior region
Wrist
of forearm Posterior region
of wrist
Anterior region ■] Hand |-
of wrist
Dorsum of hand
Palm of hand
Dorsal surfaces
of fingers
Palmar surfaces
of fingers
Thenar eminence Hypothenar eminence
Metacarpal region
Thumb
Index finger Little finger
Middle finger Ring finger
FIGURE 2.1. Regions of the upper limb. The upper limb is divided into 4 main parts—shoulder, arm, forearm
and hand. The shoulder contains two important regions: The deltoid region and the axillary (armpit) region.
The arm and forearm contain two regions each that correspond to their anterior and posterior surfaces.
Found between the arm and forearm are the anterior and posterior cubital regions. Below the forearm
is the carpal region, which connects the forearm with the hand. Lastly, the hand consists of the palm
anteriorly, and dorsum of hand posteriorly. The hand can be subdivided into the metacarpal region and the
digits. The digits are numbered 1-5 from from the thumb to the little finger.

OVERVIEW
Important terms about the regions of the upper limb
Shoulder region Deltoid region (subregion, but in some sources used as synonym)
Axillary region Axilla, axillary fossa
Arm Anterior/posterior brachial regions
Cubital region
Elbow region • Anterior cubital region (cubital fossa)
• Posterior cubital region (olecranon region)
Antebrachial region
• Anterior antebrachial region

Forearm • Posterior antebrachial region
• Medial border ^ ulnar border
• Lateral border ^ radial border
Carpal region
Wrist region • Anterior carpal region
• Posterior carpal region
Radial foveola (anatomical snuffbox)
Digits:
• Thumb: 1st digit

Hand • Index finger: 2nd digit
• Middle finger: 3rd digit
• Ring finger: 4th digit
• Little finger: 5th digit
Regions of the upper

limb
Upper Limb 11
SHOULDER AND ARM
CLAVICLE
FIGURE 2.2. Clavicle. The clavicle is an S-shaped long bone that connects the upper limb to the trunk
resting horizontally between the sternum and the acromion of the scapula. It consists of three main parts:
The shaft, sternal end, and acromial end. The sternal end hosts the sternal articular surface (facet) that
articulates with the manubrium of sternum, forming the sternoclavicular joint. The acromial end features
the acromial articular surface (facet), which forms the acromioclavicular joint together with the acromion
of the scapula. The superior surface of the clavicle is generally smooth and lies just deep to the skin.
In contrast, its inferior surface is rough due to several important bony landmarks (namely attachments).
From lateral to medial, the following can be observed: Trapezoid line (attachment for the trapezoid
ligament), the conoid tubercle (attachment for the conoid ligament), subclavian groove (attachment for
the subclavius muscle), and impression for costoclavicular ligament (attachment for the ligament that
binds the clavicle to the first rib).
Key points about the clavicle
Parts Sternal (medial) end, shaft, acromial (lateral) end
Trapezoid line, conoid tubercle, groove for subclavius muscle, impression for
Bony landmarks
costoclavicular ligament
Sternoclavicular joint - between sternal end of clavicle and manubrium of sternum

Joints
Acromioclavicular joint - between acromial end of clavicle and acromion of scapula
Attachment of upper limb to trunk as part of ‘shoulder girdle’
Function Protection of underlying neurovascular structures supplying upper limb

Force transmission from upper limb to axial skeleton
Clavicle

SHOULDER AND ARM
HUMERUS AND SCAPULA
The humerus is a long bone that comprises the bony framework of the arm,
while the scapula is a flat bone of the pectoral girdle. The humerus and scapula
articulate with each other to form the glenohumeral (shoulder) joint, which is
the most mobile joint of the body. Both bones are held together via several lig
aments and muscle tendons.
Greater tubercle Anatomical neck
Head
Crest of greater tubercle
Intertubercular sulcus
Anterior border
Lesser tubercle
Anterolateral surface Surgical neck
Crest of lesser tubercle

Deltoid tuberosity
Anteromedial surface
Body
Medial border
Lateral supracondylar
Medial supracondylar ridge
ridge
Coronoid fossa
Radial fossa
Medial epicondyle
Lateral epicondyle
as m Condyle
Capitulum I3B3HB Trochlea
FIGURE 2.3. Humerus (anterior view). The proximal end of the humerus is composed of a large rounded
head, an anatomical neck and a surgical neck. Located towards the lateral portion of the proximal
humerus is a bony protrusion known as the greater tubercle. The greater tubercle has an anterior and
posterior surface. The lesser tubercle is much smaller than its greater counterpart and is situated more
medially. These prominences act as an important attachment site for the muscles of the shoulder. Both
the greater and lesser tubercles extend distally into crests and demarcate a prominent groove called the
intertubercular sulcus. This sulcus consists of a lateral and medial lip, which function as insertion sites for
the latissimus dorsi and pectoralis major muscles. The intertubercular sulcus also acts as a conduit for the
tendon of the long head of the biceps brachii muscle and is therefore also known as the bicipital groove.
The anterior shaft of the humerus is marked by the deltoid tuberosity, which provides an attachment
point for the deltoid muscle. From this anterior perspective, two borders (anterior and medial) and two
surfaces (anteromedial and anterolateral) of the humerus can be identified.
The distal end of the humeral shaft widens to form the medial and lateral supracondylar ridges, which end
distally as the medial and epicondyles of the humerus. The medial and lateral condyles act as important
attachment sites for muscles of the forearm.
The distal end of the humerus is marked by a series of fossae and processes. The condyle of the humerus
is made up of the articulating trochlea and capitulum and non-articulating olecranon (see next image),
coronoid, and radial fossae. The condyle of the humerus plays a key role in the formation of the elbow joint
as it articulates with the radius and ulna.
Upper Limb 13
SHOULDER AND ARM
FIGURE 2.4. Humerus (posterior view). Due to its lateral positioning, the greater tubercle of the humerus
can also be identified from this posterior view.
Posteriorly, the shaft of the humerus is marked by the oblique radial groove, which allows for the passage
of the radial nerve and deep brachial artery. In addition, the lateral border and posterior surface of the
humerus can be appreciated from the posterior view.
The distal end of the posterior humerus presents with a large fossa known as the olecranon fossa. In elbow
extension, the tip of the ulnar olecranon process lodges into this fossa.
The medial epicondyle of the humerus contains a shallow ridge on its posterior surface, known as the
groove for ulnar nerve. As its name suggests, the groove transmits the ulnar nerve.
Key points about the humerus
Head, anatomical neck, surgical neck, greater tubercle

Proximal end Lesser tubercle
Intertubercular sulcus (crest of greater tubercle, crest of lesser tubercle)
Surfaces: anteromedial, anterolateral, posterior

Borders: anterior, lateral, posterior
Body
Landmarks: lateral supracondylar ridge, medial supracondylar ridge, radial groove,
supracondylar process
Lateral epicondyle
Medial epicondyle (groove for ulnar nerve)
Distal end
Condyle of humerus: capitulum, trochlea, olecranon fossa, coronoid fossa,
radial fossa

SHOULDER AND ARM
FIGURE 2.5. Scapula (anterior view). The scapula is a triangular bone with three borders (superior, lateral
and medial) and three angles (superior, inferior and lateral).
The anterior surface of the scapula leans against the 2nd-7th ribs on the posterolateral aspect of the
thorax, and is therefore also known as the costal surface of the scapula. The majority of the concave
anterior surface of the scapula is occupied by the large subscapular fossa, which provides an attachment
point for the subscapularis muscle.
The superior border of the scapula is marked by a bony indentation known as the scapular notch. The scap
ular notch allows for the passage of the suprascapular nerve and therefore may also be referred to as the
suprascapular notch. Protruding from the superior border of the scapula is the hook-like projection known
as the coracoid process. This structure allows for the attachment of various muscles and ligaments.
The lateral surface of the scapula contains the neck of scapula, which extends to form the glenoid fossa.
The shallow glenoid fossa articulates with the humeral head to form the highly dynamic but resultantly
unstable glenohumeral joint. Superior and inferior to the glenoid fossa are the supra- and infraglenoid
tubercles, respectively. These act as important attachment points for the long head of the biceps and
triceps brachii muscles.
Key points about the scapula
Costal surface: subscapular fossa

Surfaces Posterior surface: spine of scapula, deltoid tubercle, spinoglenoid notch,
supraspinous fossa, infraspinous fossa, acromion
Medial border
Borders Lateral border
Superior border: scapular notch, coracoid process
Superior angle
Inferior angle
Angles
Lateral angle: glenoid fossa, supraglenoid tubercle, infraglenoid tubercle, neck
of scapula
Upper Limb 15
SHOULDER AND ARM
Supraspinous fossa Scapular notch
Acromion
Root of spine
of scapula
Spinoglenoid
notch
Spine of scapula
Medial border
Deltoid tubercle
Inferior angle Infraspinous fossa
FIGURE 2.6. Scapula (posterior view). The posterior surface of the scapula is convex and marked by
a protruding ridge of bone known as the spine of scapula. This ridge unevenly separates the posterior
surface of the scapula into two divisions: The supraspinous fossa and the much bigger, infraspinous fossa.
The supraspinatus muscle sits within the supraspinous fossa, while the infraspinous fossa is occupied by
the infraspinatus and teres minor muscles of the rotator cuff complex.
The spine of the scapula begins at the root of the spine and extends and widens to form the acromion
process of the scapula. The acromion articulates with the clavicle to form the acromioclavicular joint.
The spine and acromion of the scapula serve as important attachment points for muscles of the back and
shoulder and function as levers for these muscles, particularly the trapezius muscle.
Connecting the supraspinous and infraspinous fossa together is the spinoglenoid notch. The suprascapu
lar artery and nerve travel through this notch to supply structures of the scapular region.
Humerus Scapula

SHOULDER AND ARM
GLENOHUMERAL (SHOULDER) JOINT

The glenohumeral joint, also known as the shoulder joint, is a ball-and-socket
type of synovial joint, in which the head of the humerus (ball) articulates with
the glenoid fossa of the scapula (socket). The surface of the humeral head is
much larger than the surface of glenoid fossa, which allows for the greatest
range of motion seen in any joint. This mobility comes at the cost of joint sta
bility, with the shoulder joint being one of the most frequently dislocated joints
of the body.
Superior glenohumeral Coracoacromial ligament

ligament
Subdeltoid & subacromial

Coracohumeral bursae
ligament
Subscapularis muscle
Middle glenohumeral
ligament
Inferior glenohumeral
ligament Supraspinatus
muscle
Teres minor
muscle
Infraspinatus
muscle
Teres major
muscle
FIGURE 2.7. Shoulder joint (anterior/posterior views). Three glenohumeral ligaments (superior, middle,
inferior) form as a thickening of the articular capsule and connect the humeral head to the glenoid fossa of
the scapula. The coracohumeral ligament connects the coracoid process of the scapula with the greater
tubercle of the humerus and reinforces the superior portion of the glenohumeral articular capsule.
The transverse humeral ligament extends between the lesser and greater tubercles and stabilizes the
tendon of the long head of the biceps brachii muscle. Lastly, the joint is also stabilized by four muscles
(supraspinatus, infraspinatus, teres minor and subscapularis muscles [faded]) collectively known as the
rotator cuff which form a musculotendinous sleeve around the joint.
Upper Limb 17
SHOULDER AND ARM
Supraspinatus muscle Coracoacromial ligament
Subdeltoid & subacromial

bursae Coracohumeral ligament
Glenoid fossa of scapula

Tendon of long head of
biceps brachii muscle
Articular capsule of
glenohumeral joint
Subtendinous bursa of
subscapularis muscle
Infraspinatus muscle
Superior glenohumeral
Inferior glenohumeral ligament
ligament
Middle glenohumeral ligament

Teres minor muscle
Long head of triceps Glenoid labrum of scapula

brachii muscle
Teres major muscle Subscapularis muscle
FIGURE 2.8. Shoulder joint (lateral view).
Key points about shoulder joint
Joint type Synovial ball-and-socket joint
Articular
Glenoid fossa of scapula, head of humerus
surfaces
Superior glenohumeral, middle glenohumeral, inferior glenohumeral,

Ligaments
coracohumeral, transverse humeral
Important
Rotator cuff muscles: supraspinatus, infraspinatus, teres minor, subscapularis
muscles
Flexion, extension, abduction, adduction, external rotation, internal rotation and

Functions
circumduction
Glenohumeral joint

SHOULDER AND ARM
MUSCLES OF THE ARM AND SHOULDER
The muscles of the arm and shoulder act on the shoulder and elbow joints,
ensuring the mobility of the upper limb relative to the trunk. They are divided
into the following groups:
• The muscles of the shoulder, specifically the scapulohumeral muscles, con

sist of the deltoid, teres major, and muscles of the rotator cuff (supraspina-
tus, infraspinatus, teres minor, and subscapularis). All these muscles support
movement and stabilization of the shoulder joint.
• The muscles of the arm are divided into anterior and posterior compart
ments. Depending on their bony attachments and line of pull, the muscles
will serve either as flexors (anterior group) or extensors (posterior group) of
the arm and/or forearm.
Supraspinatus Deltoid
muscle muscle
Infraspinatus
muscle Subscapularis
muscle
Teres minor
muscle
Coracobrachialis
muscle
Teres major
muscle
Biceps brachii
Triceps brachii muscle
muscle
Anconeus Brachialis
muscle muscle
FIGURE 2.9. Muscles of the arm and shoulder.
Arm muscles
Upper Limb 19
SHOULDER AND ARM
Arm muscles Origin Insertion Innervation Function
Shoulder joint:
Clavicular part:
arm flexion, arm
lateral third of
internal rotation
clavicle
(clavicular part),
Deltoid
Acromial part: Axillary nerve arm abduction
Deltoid tuberosity of
acromion of (C5-C6) (acromial part),
humerus
scapula arm extension,
arm lateral
Spinal part: spine
rotation (spinal
of scapula
part)
Crest of lesser
Shoulder joint:
Inferior angle tubercle of
Lower subscapular arm internal
and lower part of humerus (a.k.a.
Teres major or thoracodorsal rotation, arm
lateral border of Medial lip of
nerves (C5-C7) extension, arm
scapula intertubercular
adduction
sulcus)
Anteromedial Shoulder joint:

Coracoid process
Coracobrachialis surface of arm flexion, arm
of scapula
humeral shaft adduction
Long head:
supraglenoid Musculocutaneous Elbow joint:
tubercle of Radial nerve (C5-C6) forearm flexion
Biceps brachii scapula tuberosity of and supination;
Short head: radius Shoulder joint:

coracoid process weak arm flexion
of scapula
Distal half of Ulnar tuberosity, Musculocutaneous Elbow joint:

Brachialis anterior surface of Coronoid nerve, Radial nerve forearm flexion (in
humerus process of ulna (C5-C7) all positions)
Long head:
infraglenoid
tubercle of
scapula
Lateral head: Shoulder joint:
posterior surface arm extension and
Olecranon of adduction (long
of humerus Radial nerve
Triceps brachii ulna and fascia head);
(superior to radial (C6-C8)
of forearm
groove) Elbow joint:
Medial head: forearm extension
posterior surface
of humerus
(inferior to radial
groove)
Elbow joint:
assists in forearm
Lateral epicondyle Lateral surface Radial nerve
Anconeus extension;
of humerus of olecranon (C7, C8)
stabilization of
elbow joint

SHOULDER AND ARM
Rotator cuff
Origin Insertion Innervation Function
muscles
Shoulder joint:
Upper and lower arm internal
Subscapular fossa Lesser tubercle
Subscapularis subscapular nerves rotation; stabilizes
of scapula of humerus
(C5-C6) humeral head in
glenoid cavity
Shoulder joint:
arm external
rotation, arm
Lateral border of Axillary nerve
Teres minor adduction;
scapula (C5, C6)
stabilizes humeral
head in glenoid
cavity
Shoulder joint:
Greater tubercle
arm abduction;
Supraspinous of humerus
Supraspinatus stabilizes humeral
fossa of scapula
head in glenoid
Suprascapular cavity
nerve (C5, C6) Shoulder joint:
arm external
Infraspinous fossa
Infraspinatus rotation; stabilizes
of scapula
humeral head in
glenoid cavity
Upper Limb 21
ELBOW AND FOREARM
RADIUS AND ULNA
The radius and ulna are the two bones of the forearm. They articulate proxi
mally with the humerus at the elbow, and distally with the carpal bones at the
wrist. In the anatomical position, the radius is positioned on the lateral aspect
of the forearm, while the ulna is found medially.
The radius and ulna articulate with each other at the proximal and distal radi
oulnar joints, while their bodies are connected by an interosseous membrane.
These two joints allow the radius to move around the ulna, allowing for a palm
facing up (supinated) or palm facing down (pronated) positioning of the forearm.
Articular circumference Coronoid process of

of head of radius ulna
Head of radius
Tuberosity of ulna
Neck of radius
Radial tuberosity
Anterior border of ulna
Anterior border
of radius
Styloid process
Styloid process of ulna
of radius
FIGURE 2.10. Radius and ulna (anterior view). The radius is the shorter of the two bones of the forearm
and consists of a proximal extremity, shaft and a distal extremity. The proximal end of radius consists of
a head and neck. The discoid head of the radius articulates superiorly with the capitulum of the humerus,
contributing to the formation of the elbow joint. At the same time, the head of the radius also articulates
with the ulna forming the proximal radioulnar joint. In this joint, the circumference of the head of the
radius is situated on the radial notch of ulna. The neck of radius is a narrowing of the radius that lies just
distal to the head. Distal to the medial aspect of the neck is an oval bony protrusion known as the radial
tuberosity, onto which the biceps brachii inserts. The shaft of the radius acts as an important attachment
point for muscles of the forearm, some of which include the supinator and pronator teres muscles. From
this anterior view, the anterior border of the shaft of the radius can be appreciated.
The distal extremity of the radius widens to form three smooth, concave surfaces. The medial aspect of
the distal radius forms a concavity known as the ulnar notch, which articulates with the distal ulna. The
lateral aspect of the distal radius forms a ridge and terminates distally as the radial styloid process.

ELBOW AND FOREARM
The ulna is similarly composed of a proximal end, shaft and distal end. The proximal end of the ulna is par
ticularly wide to accommodate the trochlea of humerus. Projecting anteriorly from the proximal portion
of the ulna is the coronoid process. The coronoid process aids in stabilizing the elbow joint and preventing
hyperflexion of the forearm. Inferior to the coronoid process is the tuberosity of ulna, which functions
as an attachment point for the brachialis muscle. The distal end of the ulna tapers to form the disc-like
head of the ulna. The head of the ulna does not articulate with the carpal bones and is therefore not a
component of the wrist joint. Projecting from the head of the ulna is a small bony protrusion known as
the styloid process of ulna.
FIGURE 2.11. Radius and ulna (posterior view). Posteriorly, the posterior and interosseous borders of
radius can be identified. The interosseous border of the radius forms the radial attachment point for the
interosseous membrane of the forearm, that spans the space between the radius and ulna. The dorsal
tubercle protrudes on the posterior aspect of the head of the radius and is seated between the grooves
for the tendons of the extensor carpi radialis longus and brevis, as well as the tendon of the extensor
pollicis longus. The styloid process of radius can also be identified from this posterior view.
From a posterior aspect, the ulna is rounded and smooth and can be palpated subcutaneously along the
entire length of the medial antebrachial region. The proximal end of the posterior ulna presents a hook
shaped process known as the olecranon. This bony protrusion serves as a short lever for extension of the
elbow. The posterior and interosseous borders of ulna can also be appreciated from this view.
Upper Limb 23
ELBOW AND FOREARM
Key points about the radius
Head: articular facet of head of radius (for capitulum of humerus), articular

Proximal end circumference of head of radius (for radial notch of ulna)
Neck
Surfaces: anterior, lateral, superior
Body Borders: anterior, interosseous, posterior
Landmarks: radial tuberosity, pronator tuberosity, suprastyloid crest
Distal end Radial styloid process, dorsal radial tubercle, ulnar notch, carpal articular surface
Key points about the ulna
Olecranon, coronoid process (tuberosity of ulna, radial notch), trochlear notch,

Proximal end
sublime tubercle
Surfaces: anterior, posterior, medial
Body Borders: anterior, interosseous, posterior

Landmarks: supinator crest
Head of ulna (articular circumference for ulnar notch of radius, ulnar styloid
Distal end
process)
Ligaments between the radius and ulna
Interosseous membrane of forearm
Oblique cord
Anular ligament of radius
Ligaments Radial collateral ligament of elbow joint

Ulnar collateral ligament of elbow joint
Dorsal radioulnar ligament

Palmar radioulnar ligament
Radius and ulna

ELBOW AND FOREARM
ELBOW JOINT
Articular capsule
Anular ligament of elbow joint
of radius
Distal tendon Medial epicondyle

of biceps of humerus
brachii muscle
Interosseous Ulnar collateral

membrane ligament
of forearm
Olecranon of ulna
Oblique cord
FIGURE 2.12. Elbow joint (medial/lateral views). The elbow joint is made up of three joints including the
humeroulnar, humeroradial and proximal radioulnar joints. The humeroulnar joint is between the trochlea
on the medial aspect of the distal end of the humerus and the trochlear notch on the proximal ulna. The
humeroradial joint is formed between the capitulum on the lateral aspect of the distal end of the humerus
with the head of the radius. The proximal ends of the radius and ulna articulate with each other at the
proximal radioulnar joint. There are three main ligaments that support the elbow joint: The ulnar collateral
ligament, radial collateral ligament and anular ligament. The ulnar and radial collateral ligaments are each
made up of three component parts:
• Ulnar collateral ligament: Anterior bundle, posterior bundle, and transverse bundle (Cooper’s ligament).
• Radial collateral ligament: Annular ligament, radial collateral ligament (proper), and lateral ulnar col
lateral ligament.
Upper Limb 25
ELBOW AND FOREARM
Brachialis muscle Trochlea of humerus
Humerus Synovial membrane of

elbow joint
Triceps brach
muscle
Articular cartilage
of trochlea
Fat pad of
elbow joint
Coronoid process
Subtendinous bursa of ulna
of triceps brachii
muscle
Articular cavity
Articular cartilage of elbow joint
of trochlear notch
Olecranon of ulna Ulna
Olecranon bursa Trochlear notch of ulna
FIGURE 2.13. Elbow joint (sagittal section through trochlea). The elbow joint is enveloped in an articular
capsule composed of an outer fibrous layer and lined internally by a synovial membrane. During movement
(flexion and extension), the fat pads are pulled away by the tendinous attachments of the brachialis and
triceps brachii muscles to allow space for bony processes. Extension of the elbow is facilitated by the
olecranon bursa which serves as a lubricating component between the olecranon of the ulna and the
overlying skin.
Key points about the elbow joint
Bones Humerus, radius, ulna
Joints Humeroulnar joint, humeroradial joint, proximal radioulnar joint
Ligaments Ulnar collateral ligament, radial collateral ligament, anular ligament
Movements Flexion, extension, supination, pronation
Elbow joint

ELBOW AND FOREARM
FOREARM MUSCLES: ANTERIOR COMPARTMENT
The forearm is divided into anterior and posterior compartments. The muscles
of the anterior compartment, also known as the flexor-pronator muscles, are
divided into two groups:
• Superficial group: Pronator teres, flexor carpi radialis, flexor carpi ulnaris,
palmaris longus and flexor digitorum superficialis muscles.
• Deep group: Flexor digitorum profundus, flexor pollicis longus and pronator
quadratus muscles.
These muscles act on different joints of the upper limb, enabling movements of
the forearm, hand and fingers. Most of the anterior muscles are innervated by
the branches of the median nerve. The exceptions are the flexor carpi ulnaris,
which is supplied by the ulnar nerve, and the flexor digitorum profundus, which
is innervated by branches of both the median and the ulnar nerves.
Although the brachioradialis muscle is present in the following image, it does

not belong to the anterior forearm muscles. Functionally it is a flexor of the
elbow joint, however, based on its location, it belongs to the superficial group
of posterior compartment muscles.
Superficial layer Deep layer
Brachioradialis muscle Flexor carpi ulnaris

muscle
Pronator teres
muscle
Flexor digitorum
profundus muscle
Palmaris longus
muscle
Flexor pollicis
longus muscle
Flexor carpi radialis
muscle
Flexor digitorum Pronator quadratus

superficialis muscle muscle
FIGURE 2.14.
Upper Limb 27
ELBOW AND FOREARM
Muscles of the anterior

compartment of the Origin Insertion Innervation Function
forearm
Humeral
head: medial Elbow joint: forearm
supracondylar Lateral
flexion;
Pronator ridge of humerus surface of
Proximal radioulnar
teres radius (distal Median
Ulnar head: joint: forearm
to supinator) nerve
coronoid process pronation
(C6, C7)
of ulna
Medial Bases of Wrist joint: wrist

Flexor carpi
epicondyle of metacarpal flexion, wrist
radialis
humerus bones 2-3 abduction
Medial Pisiform
epicondyle bone,
Wrist joint: wrist
Flexor carpi of humerus, Hamate Ulnar nerve
flexion, wrist
ulnaris Olecranon and bone, Base of (C7-T1)
adduction
Superficial posterior border metacarpal
group of ulna bone 5
Flexor
Medial Median Wrist joint: wrist
Palmaris retinaculum,
epicondyle of nerve flexion; tenses
longus Palmar
humerus (C7, C8) palmar aponeurosis
aponeurosis
Humeroulnar
head: medial
epicondyle
of humerus, Metacarpophalangeal
Sides of
Flexor Coronoid Median and proximal
middle
digitorum process of ulna nerve interphalangeal
phalanges of
superficialis (C8, T1) joints 2-5: finger
Radial head: digits 2-5
flexion
proximal half of
anterior border
of radius
Digits 2-3:
median
Proximal half Palmar
nerve Metacarpophalangeal
Flexor of anterior surfaces
(anterior and interphalangeal
digitorum surface of ulna, of distal
interosseous joints 2-5: finger
profundus Interosseous phalanges of
nerve); Digits flexion
membrane digits 2-5
4-5: ulnar
nerve (C8, T1)
Deep
Palmar
group Anterior surface
Flexor surface Metacarpophalangeal
of radius and Median
pollicis of distal and interphalangeal
interosseous nerve
longus phalanx of joint 1: thumb flexion
membrane (anterior
thumb
interosseous
Distal nerve)
Pronator Distal anterior anterior (C7, C8) Radioulnar joints:
quadratus surface of ulna surface of forearm pronation
radius
1® Superficial anterior Deep anterior

forearm muscles forearm muscles

ELBOW AND FOREARM
FOREARM MUSCLES: POSTERIOR COMPARTMENT
The muscles of the posterior compartment, also known as the extensor

supinator muscles, are divided into two groups:
• Superficial group: Brachioradialis, extensor carpi radialis longus, extensor

carpi radialis brevis, extensor digitorum, extensor digiti minimi and extensor
carpi ulnaris muscles.
• Deep group: Supinator, abductor pollicis longus, extensor pollicis brevis,
extensor pollicis longus and extensor indicis muscles.
Most of the muscles in the superficial layer have a common origin on the lat
eral epicondyle of the humerus, while the muscles of the deep layer typically
originate from the distal part of the ulna. All are innervated by branches of the
radial nerve.
Superficial layer
Extensor carpi radialis Brachioradialis

longus muscle muscle
Extensor carpi Extensor carpi radialis

ulnaris muscle brevis muscle
Extensor digitorum Extensor digiti

muscle minimi muscle
Deep layer
Abductor pollicis
Supinator muscle longus muscle
Extensor pollicis
brevis muscle
Extensor pollicis
longus muscle
Extensor indicis
muscle
FIGURE 2.15 .
Superficial posterior Deep posterior

forearm muscles forearm muscles
Upper Limb 29
UPPER LIMB
ELBO W AND FOREARM

Posterior compartment muscles Origin Insertion Innervation Function
Kenhub Atlas o f Hum an A natom y
(Proximalto) Styloid process Elbow joint: forearm flexion (when semi

Brachioradialis Lateral supracondylar ridge of of radius pronated)
humerus, Lateral intermuscular
Extensor carpi radialis septum of arm Posterior aspect of base of Radial Nerve
longus metacarpal bone 2 (C5-C8) Wrist joints: hand extension, Hand
Extensor carpi radialis Posterior aspect of base of abduction (radialdeviation)
Superficial brevis metacarpal bone 3

group Lateral epicondyle of humerus Extensor expansions of Metacarpophalangeal/lnterphalangeal
Extensor digitorum
(common extensortendon) digits 2-5 joints 2-5: finger extension
Metacarpophalangeal joint 5: finger

Extensor digiti minimi Extensor expansion of digit 5
extension
Lateral epicondyle of humerus, Wrist joint: hand extension and

Extensor carpi ulnaris Base of metacarpal bone 5
Posterior border of the ulna adduction
Lateral epicondyle of humerus, Lateral, posterior, and

Proximal radioulnar joint: forearm
Supinator Radial collateral Ligament, Anular anterior surfaces of proximal
supination
Ligament, Supinator crest of ulna third of radius
Posterior surface of proximal Radiocarpal joint: hand abduction (radial

Base of metacarpal bone 1,
Abductor pollicis longus half of radius, ulna and Posterior deviation); Carpometacarpal joint of
(Trapezium Bone)
interosseous membrane interosseous thumb: thumb abduction and extension
nerve (C7, C8)
Wrist joint: weak hand extension
Posterior surface of middle
Posterior aspect of base of Metacarpophalangeal and
Extensor pollicis longus third of ulna and interosseous
Deep group distal phalanx of thumb interphalangeal joint of thumb: thumb
membrane
extension
Posterior surface of distalthird Carpometacarpal and

Posterior aspect of base of
Extensor pollicis brevis of radius and interosseous Metacarpophalangeal joint 1: thumb
proximal phalanx of thumb
membrane extension
Wrist joint: weak hand extension

Posterior surface of distal
Extensor expansion of index Metacarpophalangeal and
Extensor indicis third of ulna and interosseous
finger interphalangeal joints of index finger:
membrane
finger extension
WRIST AND HAND
BONES OF THE WRIST AND HAND

The wrist and hand are the most distal parts of the upper limb. They consist
of several groups of bones connected via numerous articulations that facilitate
fine movements of the hand, such as writing or drawing. From proximal to dis
tal, these bones are divided into three groups:
• Carpal bones: Eight short bones arranged into proximal and distal rows
(4 each). Metacarpal bones: Five long bones, each form the root of the cor
responding digit. Phalanges: Fourteen long bones subdivided into three
sets: Proximal, middle and distal. (Note that the thumb is devoid of a middle
phalanx)
Scaphoid bone Midcarpal joint
Lunate bone
Trapezium bone
Capitate bone
Trapezoid bone
Triquetrum bone
Pisiform bone
Carpometacarpal joints
Hamate bone
Intermetacarpal joints
Hook of hamate bone
Base of metacarpal bone

Metacarpal bone
Body of metacarpal bone

Metacarpophalangeal
joints
Head of metacarpal bone
Base of phalanx of hand

Proximal phalanx of hand
Body of phalanx of hand
Middle phalanx of hand

Head of phalanx of hand
Distal phalanx of hand Interphalangeal joints of hand
FIGURE 2.16 .
Upper Limb 31
WRIST AND HAND
Key points about the bones of the wrist and hand
8 short bones that comprise the root of the hand
Proximal row: scaphoid, lunate, triquetrum, pisiform

Carpal bones
Distal row: trapezium, trapezoid, capitate, hamate
Joints: radiocarpal, intercarpal, midcarpal, carpometacarpal
5 long bones of the hand

Metacarpal
Parts: metacarpal base, body, head
bones
Joints: carpometacarpal, intermetacarpal, metacarpophalangeal
14 long bones of the fingers (5 proximal, 4 middle, 5 distal)
Phalanges Parts: base, body, head

Joints: metacarpophalangeal, interphalangeal
Carpal bones Metacarpal bones
Phalanges of the
hand

WRIST AND HAND
LIGAMENTS OF THE WRIST AND HAND
The ligaments participate in the stabilization of joints, but can also limit cer
tain movements based on their position around the joint. The wrist and hand
feature several joints. Proximal to distal, the first one is the radiocarpal (wrist)
joint which connects the forearm and the hand. The rest of the joints are in
the hand, connecting groups of bones to each other (e.g. carpal and metacar
pal), as well as individual bones amongst themselves (e.g. scaphoid and lunate).
Namely, these joints are: Intercarpal, carpometacarpal, intermetacarpal, meta
carpophalangeal and interphalangeal joints.
The proper function of the ligaments is crucial for the normal mobility and
function of the wrist and hand.

Short radiolunate
ligament
Long radiolunate Ulnocapitate ligament -----

ligament
Radioscapholunate Ulnolunate ligament

ligament
Radioscaphocapitate Ulnotriquetral ligament

ligament
Ulnopisiform ligament
Palmar scaphotriquetral
Ligament
Pisohamate ligament
Triquetrocapitate ligament
PaLmar capitohamate
Ligament
Trapezocapitate ligament
Palmar
trapezoideocapitate
ligament
FIGURE 2.17. Ligaments of the wrist and hand (palmar view). The radiocarpal joint (wrist joint) is stabilized
by a number of ligaments, namely the palmar and dorsal radiocarpal ligaments, the palmar ulnocarpal
ligament and the radial and ulnar collateral ligaments. These ligaments extend from the distal portion of
either the radius or ulna, respectively, to insert onto the carpal bones of the hand.
The intercarpal joints formed between the carpal bones are stabilized by numerous sets of ligaments.
The palmar intercarpal ligaments stretch between adjacent carpal bones and are made up of the radiate
carpal ligament, the palmar scaphotriquetral and pisohamate ligaments as well as a few others which are
not visible from this view. The radiate carpal ligament is formed by a set of five ligaments: The scaphocap-
itate (not seen), triquetrocapitate, palmar capitohamate, palmar trapezoideocapitate and trapezocapitate
ligaments.
Upper Limb 33
WRIST AND HAND
Palmar
carpometacarpal
Ligaments
Palmar
metacarpal
ligaments
Palmar
metacarpophalangeaL Deep transverse
ligaments metacarpal
Ligament
CollateraL
metacarpophalangeaL Palmar
ligaments _ interphalangeal
ligaments
Cruciform ligaments
of fingers Phalangoglenoid
Ligaments
Anular ligaments
of fingers
FIGURE 2.18. Ligaments of the metacarpals and phalanges (palmar view). The distal row of the palmar
surface of carpal bones and metacarpal bones are bridged by the palmar carpometacarpal ligaments.
The palmar carpometacarpal ligaments are comprised of a series of ligamentous bands. There are 2 bands
associated with the 2nd metacarpal, one of which is connected to the trapezoid and one to the trapezium
bone. The 4th metacarpal is connected to the capitate and the hamate, while the 5th metacarpal only has
one band anchoring it to the hamate bone. In contrast, the 3rd metacarpal has three associated ligaments
which anchor it to the trapezoid, capitate and hamate bones on the palmar surface of the hand.
The four palmar metacarpal ligaments attach to the palmar surfaces of the bases of adjacent metacarpal
bones, connecting the 5 metacarpal bones to each other.
Located on the palmar aspect of the metacarpophalangeal (MCP) joints are the palmar metacarpophalan
geal ligaments, which are dense fibrocartilaginous thickenings of the metacarpophalangeal joint capsule.
The anular ligaments of the phalanges form small hoops on the palmar surface of the digits, through
which the tendons of flexor digitorum muscle pass. There are 2-3 annular ligaments associated with the
phalanges of the thumb and 5 annular ligaments in each of the four fingers.
The cruciform ligaments consist of two obliquely crossed bands and there are 3 sets associated with each
digit. The annular and cruciform ligaments of the phalanges work together to prevent bowstringing of
the flexor tendons.

WRIST AND HAND
Tendon of extensor carpi ulnaris Dorsal radioulnar ligament

muscle
Tendon sheath of extensor

carpi ulnaris muscle Dorsal radiocarpal ligament
Ulnomeniscal homologue
Scapholunate interosseous
ligament
Ulnar collateral ligament
of wrist joint
- Dorsal intercarpal ligaments
Lunotriquetral interosseous
ligament
Trapeziotrapezoidal
Dorsal triquetrohamate interosseous ligament
ligament
Capitohamate interosseous Trapezoideocapitate

ligament nterosseous ligament
Dorsal carpometacarpal
ligaments
Dorsal metacarpal
ligaments
Interosseous metacarpal
ligaments
Accessory collateral
ligaments
Proper collateral |
ligaments '■
FIGURE 2.19. Ligaments of the wrist and hand (dorsal view). The interosseous intercarpal ligaments
are visible. These ligaments lie within the joint capsule and provide stability to the intercarpal joints.
The interosseous intercarpal ligaments include the scapholunate, lunotriquetral, trapeziotrapezoidal,
trapezoideocapitate and the capitohamate interosseous ligaments.
Located between the dorsal and palmar metacarpal ligaments are the interosseous metacarpal ligaments.
These ligaments stretch between adjacent metacarpal bones aiding in stabilizing movement.
The dorsal carpometacarpal ligaments of metacarpals 2-4 are composed of two ligaments each of which
attach to the base of the metacarpals. Similar to its palmar counterpart, the 5th metacarpal has only one
dorsal carpometacarpal ligament.
Upper Limb 35
WRIST AND HAND
Vinculum longum
FIGURE 2.20. Ligaments of the metacarpals and phalanges (lateral view). Contributing to the stabilization
of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are the proper and accessory collateral
ligaments of the MCP and IP joints. These ligaments are located on the radial and ulnar aspects of each
joint and help to prevent excessive adduction-abduction movements of associated joints.

WRIST AND HAND
Key points about the ligaments and supporting structures of the wrist and hand

Distal radioulnar joint
Dorsal radioulnar ligament
Palmar radiocarpal ligament (radioscaphocapitate ligament, short and long

radiolunate ligaments, radioscapholunate ligament)
Palmar ulnocarpal ligament (ulnocapitate, ulnolunate, ulnotriquetral,

ulnopisiform ligaments)
Radiocarpal (wrist)
Dorsal radiocarpal ligament
joint
Triangular fibrocartilage complex (palmar ulnocarpal ligaments, palmar
radioulnar ligament, articular disc, ulnomeniscal homologue, tendon sheath
of extensor carpi ulnaris muscle)
Collateral ligaments of wrist (radial/ulnar collateral ligaments of wrist joint)
Fascial bands:
Flexor retinaculum of wrist
Extensor retinaculum of wrist
Palmar ligaments:
Palmar intercarpal ligaments: radiate carpal ligament (scaphocapitate,

triquetrocapitate, palmar capitohamate, palmar trapezoideocapitate,
trapezocapitate ligaments), palmar scaphotriquetral, palmar lunotriquetral,
Intercarpal joints palmar triquetrohamate, pisotriquetral and pisohamate ligaments
Dorsal ligaments:
Dorsal intercarpal ligaments
Interosseous ligaments:
Intercarpal interosseous ligaments: scapholunate interosseous ligament,

lunotriquetral interosseous ligament, trapeziotrapezoidal interosseous
ligament, trapezoideocapitate interosseous ligament, capitohamate
interosseous ligament
Carpometacarpal Dorsal carpometacarpal ligaments

joints Palmar carpometacarpal ligaments
Palmar metacarpal ligaments

Intermetacarpal
Dorsal metacarpal ligaments
joints
Interosseous metacarpal ligaments
Proper collateral metacarpophalangeal ligaments
Accessory collateral metacarpophalangeal ligaments

Metacarpophalangeal
Phalangoglenoid ligaments
joints
Palmar metacarpophalangeal ligaments
Deep transverse ligament
Palmar interphalangeal ligaments
Proper collateral interphalangeal ligaments

Interphalangeal
Accessory collateral interphalangeal ligaments
joints
Annular ligaments
Cruciform ligaments
Joints and ligaments MRI of the wrist

of the upper limb normal anatomy
Upper Limb 37
WRIST AND HAND
MUSCLES OF THE HAND
The muscles of the hand are organized into five compartments: The thenar,
adductor, hypothenar, central, and interosseous compartments.
Thenar compartment
• Adductor pollicis brevis
• Flexor pollicis brevis
• Opponens pollicis
Adductor compartment
• Adductor pollicis
Hypothenar compartment
• Abductor digiti minimi
• Flexor digiti minimi
• Opponens digiti minimi
Central compartment
• Lumbricals (4)
Interosseous compartments
• Dorsal interossei (4)
• Palmar interossei (3)
FIGURE 2.21. Muscular compartments of the hand. The thenar compartment contains the short muscles
of the thumb and includes the abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis
muscles. The adductor compartment contains the adductor pollicis muscle. The hypothenar muscles
move the little finger and include the abductor digiti minimi, flexor digiti minimi and opponens digiti
minimi muscles. The palmaris brevis is sometimes considered with the hypothenar muscles, however is
functionally not related to movement of the little finger. The central compartment contains the lumbrical
muscles (4), which are found between the metacarpals and attach proximally to the tendons of flexor
digitorum profundus muscle. The interosseous compartments contain either the dorsal interossei (4),
which are small muscles found between the metacarpal bones on the dorsal surface of the hand, or the
palmar interossei (3), which represent their palmar counterparts.

WRIST AND HAND
Abductor pollicis Abductor digiti minimi

brevis muscle muscle of hand
Flexor pollicis Flexor digiti minimi

brevis muscle brevis muscle of hand .
o
3 o
<5 ro
---------- Adductor pollicis Lumbrical muscles --------
E muscle of hand g 3
re
D
Opponens digiti minimi -----------
muscle of hand
Dorsal interossei
muscles
- Opponens
pollicis muscle
Palmar interossei ______

muscles
FIGURE 2.22. Muscles of the hand. The majority of the muscles of the hand lie superficially in the palm
and are depicted on the upper image. The lower image shows four muscles that lie deep within the hand:
The opponens pollicis (of the thenar compartment), palmar and dorsal interossei (of the interosseous
compartment) and opponens digiti minimi (of the hypothenar group). The attachments, innervation and
functions of each muscle are in the tables following.
Upper Limb 39
WRIST AND HAND
Thenar
muscles
Tubercle of
Carpometacarpal
Opponens trapezium Radial border of
joint 1: thumb
pollicis bone, Flexor metacarpal bone 1
opposition
retinaculum
Recurrent branch of
Tubercles of median nerve (C8, T1)
Abductor scaphoid and Carpometacarpal
pollicis trapezium joint 1: thumb
brevis bones, Flexor abduction
retinaculum
Lateral aspect of
Superficial
base of proximal
head: flexor Superficial head:
phalanx 1 (via radial
retinaculum, recurrent branch of
Flexor sesamoid bone) Carpometacarpal and
Tubercle of median nerve
pollicis trapezium bone metacarpophalangeal
brevis Deep head: deep joint 1: thumb flexion
Deep head: branch of ulnar
trapezoid and nerve (C8, T1)
capitate bones
Hypothenar
muscles
Metacarpophalangeal
Pisiform bone joint 5: finger
Ulnar side of base
Abductor (Pisohamate abduction
of proximal phalanx
digiti ligament, and flexion;
of digit 5, Extensor
minimi Tendon of flexor Interphalangeal
expansion of digit 5
carpi ulnaris) joints: finger
extension
Deep branch of
Metacarpophalangeal
Flexor digiti Base of proximal ulnar nerve (C8, T1) joint 5: finger flexion
minimi phalanx of digit 5 (+ Finger lateral
Hook of hamate, rotation/opposition)
Flexor
retinaculum Carpometacarpal
Opponens
Ulnar aspect of joint 5: finger
digiti
metacarpal bone 5 flexion, finger lateral
minimi
rotation/opposition
Palmar
Superficial branch Tightens palmar
(Palmaris aponeurosis, Dermis of skin of
of ulnar nerve aponeurosis, Tightens
brevis) Flexor hypothenar region
(C8, T1) grip
retinaculum

WRIST AND HAND
Central,
interosseous
and Origin Insertion Innervation Function
adductor
muscles
1 & 2: radial
aspects of
tendons 1 & 2 of Metacarpophalangeal
flexor digitorum Radial aspect 1 & 2: median nerve joints 2-5:
Lumbricals profundus; of extensor (C8, T1) finger flexion;
(4) 3 & 4: opposing expansion of digits 3 & 4: deep branch of Interphalangeal
aspects of 2-5 ulnar nerve (C8-T1) joints 2-5: finger
tendons 2-4 of extension
flexor digitorum
profundus
1 & 2: radial bases

of proximal
phalanges/
extensor Metacarpophalangeal
expansions of joints 2-4: finger
Adjacent sides digits 2 & 3 abduction,
Dorsal
of metacarpal finger flexion;
interossei (4) 3 & 4: ulnar bases
bones 1-5 Interphalangeal
of proximal joints 2-4: finger
phalanges/ extension
extensor
expansions of
digits 3 and 4 Deep branch of ulnar
nerve (C8-T1)
1: ulnar base
of proximal
phalanx/extensor Metacarpophalangeal
Ulnar side of expansion of joints 2, 4 & 5:
metacarpal bone digit 2 finger adduction,
Palmar
2, Radial side 2 & 3: radial base finger flexion;
interossei (3)
of metacarpal of proximal Interphalangeal
bones 4 and 5 phalanges/ joints 2, 4 & 5: finger
extensor extension
expansions of
digits 4 and 5
Transverse head:
palmar base
of metacarpal
bone 3 Medial base of
Carpometacarpal
Adductor proximal phalanx 1 Deep branch of ulnar
Oblique head: joint 1: thumb
pollicis (via ulnar sesamoid nerve (C8, T1)
capitate bone, adduction
bone)
Palmar bases
of metacarpal
bones 2 & 3
Thenar muscles Hypothenar muscles
E^S^
Upper Limb 41
NERVES AND VESSELS
BRACHIAL PLEXUS
The brachial plexus is a network of nerves originating in the neck region, pass
ing between the anterior and middle scalene muscles. It passes through the
axilla where many peripheral nerves arise that course through the upper limb
to innervate the muscles, joints and skin. It can be divided into two main parts:
Supraclavicular and infraclavicular. The supraclavicular part (roots and trunks
with their branches) of the brachial plexus is located in the posterior triangle of
the neck, while its infraclavicular part (cords and their branches) is in the axilla.
The brachial plexus gives off lateral branches (anterior and posterior) and five
major terminal branches.
Posterior rami of spinal nerves
Roots of brachial plexus
Anterior divisions of brachial plexus
Posterior divisions of brachial plexus
FIGURE 2.23. Brachial plexus: Overview. The brachial plexus is formed by five anterior rami that originate
from the spinal nerves C5-T1 (roots of the brachial plexus). These roots merge to form three trunks:
Superior (C5-6), middle (C7) and inferior (C8-T1). Each trunk then divides into an anterior and posterior
division, therefore forming six divisions altogether. The six divisions then reform, resulting in three cords:
Posterior, lateral and medial.
Clinical case: Brachial

Brachial plexus
plexus injury

NERVES AND VESSELS
Ansa pectoralis Dorsal scapular nerve
Muscular branches of
Superior subscapular brachial plexus (longus
nerve colli and scalene muscles)
Thoracodorsal Suprascapular nerve

nerve
Lateral pectoral Subclavian nerve

nerve
Inferior Long thoracic nerve

subscapular nerve
Musculocutaneous 1st intercostal nerve

nerve
Axillary nerve 2nd intercostal nerve
Radial nerve Medial pectoral nerve
Median nerve Medial brachial cutaneous

nerve
Ulnar nerve Medial antebrachial

cutaneous nerve
FIGURE 2.24. Brachial plexus: Branches. With respect to their position relative to the clavicle, the branches
of the brachial plexus can be divided into supraclavicular and infraclavicular groups. The supraclavicular
branches include the dorsal scapular nerve, suprascapular nerve, long thoracic nerve and subclavian nerve.
The infrascapular branches can be further divided into preterminal and terminal branches. The preterminal
infraclavicular branches emerge from the lateral, medial and posterior cords of the brachial plexus. The
lateral cord gives rise to the lateral pectoral nerve while the medial cord gives rise to the medial pectoral
nerve and medial brachial/antebrachial cutaneous nerves forearm. The posterior cord of the brachial
plexus gives off the upper subscapular nerve, thoracodorsal nerve and lower subscapular nerve. Finally,
the five main terminal branches include the musculocutaneous, axillary, radial, median and ulnar nerves.
Key points about the brachial plexus
Roots C5, C6, C7, C8, T1
Trunks: superior, middle, inferior

Structural
Divisions: three anterior and three posterior
organization
Cords: posterior, lateral and medial
Supraclavicular
Dorsal scapular nerve, suprascapular nerve, long thoracic nerve and subclavian
preterminal
nerve
branches
Infraclavicular Lateral pectoral nerve, medial pectoral nerve, medial cutaneous nerve of arm,
preterminal medial cutaneous nerve of forearm, upper subscapular nerve, thoracodorsal nerve,
branches lower subscapular nerve.
Terminal
Musculocutaneous nerve, axillary nerve, median nerve, radial nerve, ulnar nerve
branches
Function Complete sensory and motor innervation of the upper limb
Upper Limb 43
NERVES AND VESSELS
NEUROVASCULATURE OF THE ARM AND SHOULDER
Acromial branch of thoracoacromial artery

Thyrocervical trunk
Deltoid branch of thoracoacromial artery
Costocervical trunk
2nd part of axillary artery
Subclavian artery
3rd part of axillary artery

Suprascapular artery
Posterior circumflex
humeral artery
Clavicular branch of
thoracoacromial artery
Anterior circumflex
humeral artery
Superior thoracic artery
Subscapular artery
1st part of axillary artery |
Brachial artery
Pectoral branch of thoracoacromial
artery
Deep brachial artery

Thoracoacromial artery
Nutrient artery of humerus

Lateral thoracic artery
Radial collateral artery

Superior ulnar collateral artery
Inferior ulnar collateral artery
FIGURE 2.25. Arteries of the arm and shoulder (anterior view). The subclavian artery conveys oxygenated
blood to the upper limb, axilla and lateral aspect of the thorax. It exits the thorax at the lateral border
of the first rib where it becomes the axillary artery which can be divided into three parts relative to the
pectoralis minor muscle. The first part is proximal to the pectoralis minor and has one branch: The superior
thoracic artery, which supplies the pectoralis minor and major muscles. The second part lies posterior
to the pectoralis minor and has two main branches: The thoracoacromial artery, which further divides
into four terminal branches (acromial, clavicular, deltoid and pectoral) and the lateral thoracic artery
supplying the pectoralis and serratus anterior muscles. The third part has three branches: The subscapular
artery, the anterior circumflex humeral artery and posterior circumflex humeral artery. The axillary
artery terminates at the inferior border of the teres major muscle where it becomes the brachial artery.
Branches of the brachial artery in the arm include the deep brachial artery, the nutrient artery of humerus
as well as the superior and inferior ulnar collateral arteries.
Neurovasculature
Axillary artery
of the upper limb

NERVES AND VESSELS
Thyrocervical trunk Axillary artery
Costocervical trunk Subscapular artery
Subclavian artery Anterior circumflex

humeral artery
humeral artery
Dorsal scapular artery

Brachial artery
Circumflex scapular
artery
Thoracodorsal artery
Superior ulnar collateral

artery
Middle collateral
artery
Radial collateral
artery
FIGURE 2.26. Arteries of the arm and shoulder (posterior view). Oxygenated blood is supplied to the
proximal upper limb (pectoral girdle region) by arterial branches originating from the subclavian artery.
The thyrocervical trunk, a short and wide vessel arising from the first segment of the subclavian artery,
vascularizes the deep cervical and shoulder muscles as well as the skin of the neck and shoulders. A branch
of the thyrocervical trunk, the suprascapular artery, courses inferolaterally towards the superior border
of the scapula to supply muscles in the shoulder and scapular region, including skin of the upper thoracic
cage and shoulder. The dorsal scapular artery, an independent branch of the subclavian artery, supplies
two superficial muscles of the back, the levator scapulae and rhomboid muscles. It anastomoses with the
suprascapular artery in the posterior scapular region. Together with the subscapular artery and its branch,
the circumflex scapular artery, they form the scapular anastomosis. The thoracodorsal artery, a branch
of the subscapular artery, descends with the thoracodorsal nerve to supply muscles of the back and skin
in the axillary region. The largest branch of the brachial artery is the deep brachial artery which supplies
the posterior arm muscles. It divides into two branches, the middle collateral and the radial collateral
arteries which contribute to the arterial anastomosis of the elbow. Specifically, the radial collateral artery
supplies the radial nerve, the brachioradialis and brachialis muscles.
Key points about the arteries of the arm and shoulder
Axillary artery
Subscapular artery
Anterior/posterior circumflex humeral arteries
Brachial artery

Superior ulnar collateral artery
Brachial artery Inferior ulnar collateral artery

Radial artery
Ulnar artery
Upper Limb 45
NERVES AND VESSELS
Subclavian vein
Suprascapular vein
Thoracoacromial vein
Axillary vein
Cephalic vein
Anterior circumflex
humeral vein
humeral vein
Subscapular vein
Basilic vein
Brachial veins
Lateral thoracic vein
FIGURE 2.27. Veins of the arm and shoulder (anterior view). Deoxygenated blood from the hand, forearm
and arm is drained via the superficial and deep veins of the arm. The main superficial veins of the upper
limb are the cephalic and basilic veins which are continuations of the same veins in the forearm. Deep veins
of the upper limb, such as the brachial, axillary and subclavian veins, and their tributaries accompanying
their arterial counterparts (i.e. venae comitantes). At the inferior border of the teres major muscle, the
basilic vein unites with the brachial vein(s) to form the axillary vein. At the lateral border of the first rib, it
continues as the subclavian vein transporting deoxygenated blood to the brachiocephalic vein. Venous
blood is returned to the heart via the superior vena cava.
Axillary vein

NERVES AND VESSELS
FIGURE 2.28. Veins of the arm and shoulder (posterior view). Deep veins of the upper limb, such as the
brachial, axillary and subclavian veins, transport deoxygenated blood to the superior vena cava. The paired
brachial veins along with their tributaries, the veins of the forearm, empty into the axillary vein which
in turn conveys the majority of blood from the arm and shoulder. The anterior and posterior circumflex
humeral veins accompany their arterial counterparts, passing anterior to the surgical neck of the humerus
to enter the axillary vein. In the scapular region, accompanying veins of the arteries contributing to the
scapular anastomosis equally form a rich venous plexus to drain the scapular and shoulder region.
Key points about the veins of the arm and shoulder
Formed by: basilic vein, brachial veins
Tributaries: thoracoacromial, subscapular, anterior circumflex humeral and

Axillary vein
posterior circumflex humeral veins, cephalic vein
Drains into: subclavian vein
Upper Limb 47
NERVES AND VESSELS
Subclavian nerve
Lateral supraclavicular nerve
Intermediate Medial
upraclavicular nerve supraclavicular
nerve
Ansa pectoralis
Suprascapular nerve
Lateral pectoral nerve
Lateral cord
Superior lateral brachial
cutaneous nerve
Axillary nerve Medial cord
Radial nerve
Posterior cord
Median nerve
Long thoracic nerve
Musculocutaneous
nerve
Medial pectoral nerve
Ulnar nerve
Inferior lateral brachial Medial brachial cutaneous nerve

cutaneous nerve
Medial antebrachial cutaneous nerve
FIGURE 2.29. Nerves of the arm and shoulder (anterior view). A major component of the axilla are the
cords and branches of the brachial plexus, a major network of nerves supplying the upper limb. The lateral
pectoral nerve arises from the lateral cord of brachial plexus and primarily innervates the pectoralis major
muscle (fibers may also pass to the medial pectoral nerve via the ansa pectoralis, when present). The
musculocutaneous nerve is a terminal branch of the lateral cord which provides motor innervation to the
muscles of the anterior arm (namely the biceps brachii, coracobrachialis and brachialis muscles) as well
as sensory innervation of the lateral forearm. The median nerve arises from medial and lateral roots; it is
branchless within the arm. Branches of the medial cord of the brachial plexus include the medial pectoral
nerve (which provides motor innervation to the pectoralis minor and sternocostal head of the pectoralis
major muscle), medial brachial cutaneous nerve (provides sensory innervation to the skin of the medial
aspect of the arm) and medial antebrachial cutaneous nerve providing sensory innervation to the skin of
the arm overlying the biceps brachii and medial forearm.
Axillary nerve

NERVES AND VESSELS
Medial supraclavicular
nerve Axillary nerve
Lateral supraclavicular Ulnar nerve

nerve
Musculocutaneous nerve
Suprascapular
nerve
Superior lateral brachial
cutaneous nerve
Dorsal scapular nerve
Radial nerve
Long thoracic nerve

— Median nerve
_ Posterior brachial
Medial brachial cutaneous nerve cutaneous nerve
Posterior antebrachial
cutaneous nerve
Thoracodorsal nerve
Inferior lateral
■— brachial cutaneous
nerve
FIGURE 2.30. Nerves of the arm and shoulder (posterior view). In relation to the humerus, many nerves of
the brachial plexus arise and course posterior to it. The ulnar nerve is a terminal branch of the medial cord
of the brachial plexus; it is branchless within the arm. The posterior cord of the brachial plexus gives rise
to the subscapular (not depicted here), thoracodorsal and axillary nerves innervating the subscapularis
and teres major muscles, the latissimus dorsi and deltoid muscles, respectively. The radial nerve, a larger
terminal branch of the posterior cord, supplies all muscles of the posterior compartment of the arm and
forearm. It equally provides sensory innervation to the skin of the posterior and inferolateral arm and
forearm (posterior/inferior lateral brachial cutaneous nerves). In the clavicular and shoulder region, the
supraclavicular nerves arising from the cervical plexus provide sensation over the clavicle, anteromedial
shoulder and medial chest. The suprascapular nerve arises from the superior trunk of the brachial plexus
and passes through the scapular notch to innervate the supraspinatus and infraspinatus muscles, as well
as the glenohumeral joint along its course. The long thoracic nerve originates from the posterior aspect
of anterior rami of spinal nerves C5, C6 and C7 and supplies the serratus anterior muscle. Arising from the
anterior ramus of spinal nerve C5, the dorsal scapular nerve descends deep to the levator scapulae and
rhomboid muscles to supply them.
Key points about the nerves of the arm and shoulder
Cervical plexus Supraclavicular nerves
Dorsal scapular nerve

Supraclavicular/
preterminal Long thoracic nerve
branches of Suprascapular nerve
brachial plexus
Subclavian nerve
Lateral pectoral nerve

Lateral cord of
Musculocutaneous nerve
brachial plexus
(Lateral root of) Median nerve
Upper Limb 49
NERVES AND VESSELS
Key points about the nerves of the arm and shoulder
Subscapular nerves
Thoracodorsal nerve
Radial nerve
Posterior cord
of brachial • Posterior brachial cutaneous nerve
plexus
• Inferior lateral cutaneous brachial nerve
Axillary nerve
• Superior lateral brachial cutaneous nerve
Medial pectoral nerve
Medial brachial cutaneous nerve (anastomoses with intercostobrachial nerve)

Medial cord of
brachial plexus
Ulnar nerve
(Medial root of) Median nerve
NEUROVASCULATURE OF THE ELBOW

AND FOREARM
Radial recurrent artery Anterior ulnar recurrent

artery
Cubital anastomosis
Nutrient artery of radius
Posterior ulnar
recurrent artery
Radial artery
Common
interosseous
artery
Anterior interosseous
artery
Nutrient artery
of ulna
radial artery Ulnar artery
Median artery Muscular branches of

ulnar artery
FIGURE 2.31. Arteries of the forearm (anterior view). Oxygenated blood reaches the elbow and forearm
via the brachial artery, and its largest branch, the deep brachial artery. Upon entering the cubital fossa
the brachial artery immediately divides into the two major arteries of the forearm: The ulnar and radial
arteries. Branches from the brachial, ulnar and radial arteries anastomose to form the cubital anastomosis.
Shortly after its origin, the ulnar artery gives off the common interosseous artery which further bifurcates
into anterior and posterior interosseous arteries. The anterior interosseous artery extends along the
interosseous membrane of the forearm. The ulnar and radial arteries then descend through the forearm,
giving off several muscular branches along their lengths, before terminating in the arterial arches of the
hand.

NERVES AND VESSELS
Radial artery Ulnar artery
Superior ulnar Radial collateral artery

collateral artery
Inferior ulnar Recurrent interosseous

collateral artery artery
Middle collateral Anterior interosseous

artery artery
Ulnar artery Radial artery
Posterior interosseous Dorsal carpal arch

artery
FIGURE 2.32. Arteries of the forearm (posterior view). The anastomotic network encompassing the elbow
joint is formed by branches of the brachial, radial and ulnar arteries. Component vessels of the cubital
anastomosis include: The radial, middle, superior ulnar and inferior ulnar collateral arteries of the arm
which anastomose with the radial, interosseous, anterior ulnar and posterior ulnar recurrent arteries
of the forearm, respectively. These arteries provide arterial supply to structures of the elbow joint. The
posterior interosseous artery arises from the common interosseous artery and passes dorsally across
the proximal border of the interosseous membrane to reach the posterior compartment of the forearm.
It continues distally between the deep and superficial muscles of the posterior forearm and gives off
several muscular and cutaneous branches. Near the wrist it anastomoses with the anterior interosseous
artery and contributes to the formation of the dorsal carpal arch of the hand.
Key points about the arteries of the elbow and forearm
Radial recurrent artery

Radial artery
Muscular branches of radial artery
Anterior ulnar recurrent artery
Posterior ulnar recurrent artery

Muscular branches of ulnar artery
Ulnar artery Nutrient artery of ulna
Common interosseous artery

Anterior interosseous artery ( -> nutrient artery of radius, median artery)
Posterior interosseous artery ( -> recurrent interosseous artery)
Upper Limb 51
NERVES AND VESSELS
Cephalic vein Brachial veins
Basilic vein
Accessory cephalic
vein
Median cubital vein
Anterior interosseous
veins Median antebrachial
vein
Radial veins Ulnar veins
FIGURE 2.33. Veins of the forearm (anterior view). The upper limb is drained by both deep and superficial
venous systems. The main superficial veins include the cephalic and basilic veins, both of which arise
from the dorsal venous network of the hand. The cephalic vein communicates with the basilic vein via the
median cubital vein and drains superficial regions of the hand, wrist and forearm. The median antebrachial
vein drains the anterior forearm, usually emptying into the median cubital/basilic vein in the region of the
cubital fossa. The deep venous system arises from the venous palmar arches and comprises the paired
radial, ulnar and anterior interosseous veins which empty into the brachial veins of the arm. The deep veins
of the forearm communicate with the superficial veins via perforating veins.
Key points about the veins of the elbow and forearm
Tributaries: dorsal venous network, Accessory cephalic vein

Cephalic vein
Drains into: axillary vein
Tributaries: median cubital vein (median antebrachial vein)

Basilic vein
Tributaries: anterior interosseous veins, posterior interosseous veins, ulnar veins,

Brachial veins radial veins, deep brachial veins
Radial veins Ulnar veins

NERVES AND VESSELS
FIGURE 2.34. Veins of the forearm (posterior view). The cephalic and basilic veins of the forearm originate
from the dorsal venous network of the hand. Also arising from the medial aspect of the dorsal venous
network is the accessory cephalic vein. It courses in a superolateral direction to unite with the cephalic
vein variably around the level of the elbow joint, when present. The deep veins of the forearm seen from
this posterior view include the posterior interosseous veins, which arise from the dorsal venous network
and drain to a collateral vein at the elbow joint.
Upper Limb 53
NERVES AND VESSELS
Radial nerve Muscular branches of

median nerve
Muscular branches
of radial nerve Posterior branch of medial
antebrachial cutaneous nerve
Deep branch of
radial nerve
Muscular branches
of ulnar nerve
Lateral antebrachial
cutaneous nerve
Anterior branch of medial

antebrachial cutaneous
Anterior branch of lateral nerve
Median nerve
Posterior branch of lateral
Communicating branch of
Superficial branch median nerve with ulnar nerve
of radial nerve
Anterior interosseous nerve Ulnar nerve
FIGURE 2.35. Nerves of the forearm (anterior view). The median nerve is the principal nerve of the anterior
compartment of the forearm. It gives rise to the anterior interosseous nerve as well as several muscular
branches. The ulnar nerve travels through the forearm, supplying only the flexor carpi ulnaris and part of
flexor digitorum profundus muscles as it travels to supply structures of the hand. The radial nerve divides
into its superficial and deep branches just before it enters the forearm. Cutaneous innervation of the
anterior forearm is supplied by the medial and lateral antebrachial cutaneous nerves and their associated
branches. The medial antebrachial cutaneous nerve arises from the medial cord of the brachial plexus
while the lateral antebrachial cutaneous nerve is a continuation of the musculocutaneous nerve.
Key points about the nerves of the elbow and forearm
Posterior antebrachial cutaneous nerve

Muscular branches of radial nerve
Radial nerve
Deep branch of radial nerve (Posterior interosseous nerve)
Superficial branch of radial nerve
Lateral
antebrachial Anterior branch of lateral antebrachial cutaneous nerve
cutaneous Posterior branch of lateral antebrachial cutaneous nerve
nerve
Muscular branches of median nerve
Median nerve Anterior interosseous nerve

Communicating branch of median nerve and ulnar nerve
Ulnar nerve Muscular branches of ulnar nerve
Medial
antebrachial Anterior branch of medial antebrachial cutaneous nerve
cutaneous Posterior branch of medial antebrachial cutaneous nerve
nerve

NERVES AND VESSELS
Ulnar nerve Radial nerve
Deep branch of radial

nerve
Posterior antebrachial
cutaneous nerve
Posterior branch of
Lateral antebrachial
cutaneous nerve
Posterior branch of
medial antebrachial
cutaneous nerve
Posterior interosseous
nerve
Dorsal branch of Superficial branch

ulnar nerve of radial nerve
FIGURE 2.36. Nerves of the forearm (posterior view). The radial nerve divides into superficial and
deep branches just anterior to the lateral epicondyle of the humerus. The superficial branch descends
along the anterior forearm curving around the radius between the brachioradialis and pronator teres
muscles to enter the posterior distal third of the forearm. The deep branch of the radial nerve enters the
posterior forearm by passing between the humeral and ulnar heads of the supinator muscle, at which
point it becomes known as the posterior interosseous nerve. This nerve provides motor innervation to
muscles of the posterior forearm. The posterior antebrachial cutaneous nerve arises from radial nerve
in the posterior compartment of the arm and descends distally to provide cutaneous innervation to the
skin of the posterolateral forearm. Posterior branches of the medial and lateral antebrachial nerves also
contribute to the cutaneous innervation of the posterior forearm. The ulnar nerve can be seen passing
posterior to the medial epicondyle of the distal humerus where it is prone to compression.
Median nerve Ulnar nerve
Upper Limb 55
NERVES AND VESSELS
NEUROVASCULATURE OF THE HAND
Palmar carpal branch Palmar carpal branch of

of radial artery ulnar artery
Superficial palmar Recurrent branches of

branch of radial artery deep palmar arch
Princeps pollicis artery Deep palmar branch

of ulnar artery
Palmar radial Deep palmar arch

digital artery of thumb
Perforating branches of
Superficial palmar arch
palmar metacarpal
arteries
Palmar ulnar Palmar metacarpal arteries

digital artery of thumb
Common palmar Palmar digital artery of

digital arteries Little finger
Radialis indicis artery Proper palmar digital arteries
FIGURE 2.37. Arteries of the hand (palmar view). The arterial supply of the hand is provided by the ulnar
and radial arteries, whose terminal branches contribute to the formation of superficial and deep palmar
arches. The superficial palmar arch is formed by the terminal branch of the ulnar artery and the superficial
branch of the radial artery. The superficial palmar arch gives rise to the common palmar digital arteries
which travel distally between fingers 2-4. It also gives rise to the palmar digital artery of little finger. At
the level of the metacarpophalangeal joints, the common palmar digital arteries bifurcate to form proper
palmar digital arteries. The deep palmar arch is formed by the terminal branch of the radial artery and the
deep branch of the ulnar artery. The deep palmar arch gives off three palmar arteries which join with the
common palmar digital arteries to supply the fingers. At the base of the palmar metacarpal arteries are
the perforating branches of the palmar metacarpal arteries which anastomose with the dorsal metacarpal
arteries. The palmar aspect of the thumb receives its arterial supply from a branch of the radial artery
known as the princeps pollicis artery.

NERVES AND VESSELS
Dorsal radiocarpal Dorsal carpal arch

anastomosis
Dorsal carpal branch

of radial artery
Dorsal carpal branch
of ulnar artery
Dorsal metacarpal
arteries
Basal metacarpal
arch
Dorsal radial
digital artery
of thumb
Dorsal digital Dorsal ulnar digital

arteries of hand artery of thumb
FIGURE 2.38. Arteries of the hand (dorsal view). There are three main arterial networks on the dorsum of
the hand: The dorsal radiocarpal anastomosis, the dorsal carpal arch and the basal metacarpal arch. The
dorsal radiocarpal anastomosis is formed by contributions from the radial, ulnar and anterior/posterior
interosseous arteries. The dorsal carpal arch is formed by the dorsal carpal branches of the radial and ulnar
arteries as well as contributions from the dorsal radiocarpal anastomosis. Arising from the dorsal carpal
arch are the 2nd-4th dorsal metacarpal arteries, which are often linked via anastomosing vessels at the
bases of the metacarpal bones, forming a basal metacarpal arch. The dorsal metacarpal arteries extend
distally along the metacarpal bones and bifurcate to form the dorsal digital arteries of the hand. The dorsal
surface of the thumb receives its arterial supply from the dorsal radial and ulnar digital arteries, which
arise from the radial artery and 1st dorsal metacarpal artery, respectively.
Hand: arteries Palmar branches Dorsal branches
Palmar carpal branch of radial artery
Superficial palmar branch of radial Dorsal carpal branch of radial artery

artery
1st dorsal metacarpal artery (Dorsal
Radial artery
Princeps pollicis artery ( -> radialis ulnar digital artery of thumb)
indicis artery, palmar ulnar digital
Dorsal radial digital artery of thumb
artery of thumb, palmar radial digital
artery of thumb)
Palmar carpal branch of ulnar artery Dorsal carpal branch of ulnar artery
Ulnar artery
Deep palmar branch of ulnar artery ( -> dorsal digital artery of little finger)
Palmar arches
Superficial palmar arch ( -> common

palmar digital arteries, proper palmar Dorsal radiocarpal anastomosis
digital arteries, palmar digital artery of
Dorsal carpal arch ( -> dorsal metacarpal
Arterial arches little finger)
arteries, dorsal digital arteries)
Deep palmar arch ( -> palmar
Basal metacarpal arch
metacarpal arteries, perforating
branches of palmar metacarpal
arteries)
Upper Limb 57
NERVES AND VESSELS
FIGURE 2.39. Veins of the hand (palmar view). Palmar digital veins drain the palmar aspect of the fingers
and empty into either the superficial venous palmar arch or the dorsal venous network via communicating
intercapitular veins. Palmar metacarpal veins drain into the deep venous palmar arch. The superficial and
deep venous palmar networks follow their arterial counterparts draining blood into the ulnar and radial
veins.
Cephalic vein
Basilic vein
Dorsal venous network of hand
Dorsal metacarpal veins
Intercapitular veins of hand
Dorsal digital veins of hand
FIGURE 2.40. Veins of the hand (dorsal view). The dorsal digital veins travel along the sides of the fingers
and are joined by the oblique intercapitular veins which collect blood from the palmar digital veins. The
dorsal digital veins empty into the dorsal metacarpal veins which ultimately drain to the dorsal venous
network of the hand. The dorsal venous network gives rise to the superficial veins of the forearm which
include the cephalic and basilic veins.

NERVES AND VESSELS
Hand: veins
Cephalic vein Dorsal venous network, lateral dorsal metacarpal veins, dorsal digital veins
Basilic vein Dorsal venous network, medial dorsal metacarpal veins, dorsal digital veins
Radial veins Deep venous palmar arch, palmar metacarpal veins
Ulnar veins Superficial venous palmar arch, palmar digital veins
Recurrent branch of median nerve Palmar branch of median nerve
Palmar branch of
ulnar nerve
Common palmar digital

branches of median nerve
Superficial branch of
ulnar nerve
Common palmar digital

branch of ulnar nerve
Deep branch
of ulnar nerve
Palmar digital branch

of ulnar nerve of little
finger
Proper palmar
Proper palmar digital
digital branches
branches of ulnar nerve
of median nerve
FIGURE 2.41. Nerves of the hand (palmar view). Motor innervation to the hand is supplied by the median
and ulnar nerves. The radial nerve only contributes to its cutaneous innervation. The ulnar nerve gives off a
palmar branch in the distal forearm before bifurcating into superficial and deep branches when it reaches
the hand. The superficial branch of the ulnar nerve gives off a common palmar digital branch and a palmar
digital branch to the [ulnar side of the] little finger. The common palmar digital branch further bifurcates to
form two proper palmar digital branches of the ulnar nerve which supply the adjoining sides of the ring and
little fingers. Therefore, the ulnar nerve provides sensory innervation to the medial one third of the palm
of the hand and palmar surfaces of medial one and a half digits. As the median nerve enters the hand it
divides into palmar, recurrent and common palmar digital branches. The common palmar digital branches
divide into proper palmar digital branches to supply the thumb through middle fingers as well as the radial
aspect of the ring finger. The median nerve provides sensory innervation to the lateral two thirds of the
palm of the hand and the palmar surface and dorsal distal one third of the lateral three and a half digits.
Upper Limb 59
NERVES AND VESSELS
Hand: main nerves Branches Innervation field
Motor: thenar muscles and lumbrical

Palmar branch, recurrent branch, muscles (1st & 2nd)
Median nerve common palmar digital branches Sensory: lateral % of palm; palmar
( -> proper palmar digital branches) surface and dorsal distal / of lateral
3 / digits
Dorsal branch, dorsal digital Motor: hypothenar, interossei muscles

branches, palmar branch, superficial and lumbricals (3rd & 4th)
branch ( -> common palmar digital Sensory: medial / of palm; palmar
Ulnar nerve
nerves surfaces of medial 1 / digits, Medial /
-> proper palmar digital nerves), of dorsum of hand; dorsal surfaces of
deep branch medial 2 / digits
Motor: none
Superficial branch ( -> dorsal digital
Radial nerve Sensory: lateral % of dorsum of hand;
branches)
dorsal proximal % of lateral 3 / digits
Superficial branch of radial nerve
Dorsal branch of ulnar nerve
Dorsal digital branches of radial nerve
Dorsal digital branches of ulnar nerve
FIGURE 2.42. Nerves of the hand (dorsal view). Cutaneous innervation on the dorsum of the hand is
mainly supplied by the ulnar and radial nerves. The dorsal branch of the ulnar nerve arises from the ulnar
nerve approximately 5cm proximal to the wrist joint. It extends dorsally and divides into several dorsal
digital branches. The dorsal digital branches of the ulnar nerve provide cutaneous innervation to the skin
of the medial half of the dorsum of the hand and the skin on the dorsal aspect of the medial two and a
half fingers. The superficial branch of the radial nerve extends dorsally and gives off several dorsal digital
branches. The dorsal digital branches of the radial nerve provide cutaneous innervation to the lateral two
thirds of the dorsum of the hand and dorsal proximal two thirds of the lateral two and a half digits The 5th
dorsal digital branch of radial nerve usually communicates with adjacent ulnar r. digitalis dorsalis which
supplies the adjoining sides of the middle and ring fingers. The terminal parts of the dorsal aspect of the
lateral three and a half digits are supplied by branches of the median nerve.
Hand anatomy

LOWER LIMB 3
Overview................................................................................... 62
Regions of the lower limb.............................................................. 62
Hip and thigh............................................................................ 63

Hip bone........................................................................................63
Femur........................................................................................... 66
Hip joint........................................................................................ 68
Muscles of the hip and thigh...........................................................69
Knee and leg.............................................................................. 74

Tibia and fibula............................................................................... 74
Knee joint.......................................................................................77
Muscles of the leg.......................................................................... 82
Ankle and foot.......................................................................... 86

Bones of the foot...........................................................................86
Talus.............................................................................................. 88
Calcaneus......................................................................................90
Ankle joint..................................................................................... 92
Joints and ligaments of the foot.................................................... 94
Muscles of the foot........................................................................98
Nerves and vessels.................................................................. 103

Neurovasculature of the hip and thigh.......................................... 103
Muscular innervation................................................................ 105
Cutaneous innervation.............................................................. 105
Femoral artery and its branches....................................................106
Sciatic nerve and its branches....................................................... 107
Neurovasculature of the leg and knee........................................... 108
Muscular innervation................................................................. 110
Cutaneous innervation...............................................................110
Arteries and nerves of the foot..................................................... 110
Muscular innervation................................................................. 112
Cutaneous innervation...............................................................112
OVERVIEW
REGIONS OF THE LOWER LIMB
Like the rest of the body, the lower limb is divided into many smaller regions
that help clinicians describe, diagnose and treat pathologic conditions of the
lower limb. The lower limb has an anterior and a posterior surface. Each sur
face consists of different regions that have their own boundaries and clinically
important contents, such as muscles, bones and neurovascular structures.
Hip region Intergluteal cleft
Gluteal region
Femoral triangle
Gluteal sulcus
Anterior region
of thigh Posterior region
---------- Thigh---------- of thigh
Anterior region
of knee Popliteal fossa
Posterior region
Anterior region
of leg
of knee
---------- Knee ----------
Posterior region
Anterior region
of leg
of ankle
Posterior region
Medial border of ankle
of foot Medial retromalleolar
region
Metatarsal region
Lateral retromalleolar
--------- Ankle---------- region
Lateral border
of foot ---------- Foot --------- Sole of foot
Hallucial eminence Heel region
Dorsum of foot Proximal transverse arch of foot
Distal transverse arch of foot Interdigital spaces of foot
Great toe Little toe
2nd toe 4th toe

3rd toe I
Digits of foot
FIGURE 3.1. Regions of the lower limb. The lower limb is divided into 7 main regions: The gluteal, hip,
femoral (thigh), knee, leg, talocrural (ankle) and foot regions. Some of these regions are divided in
accordance to their anterior and posterior surfaces, while others have specific subregions through which
clinically significant neurovascular structures pass. e.g., femoral triangle, which contains the femoral
nerve, artery and vein.
Regions of the lower Human anatomy

limb terminology

HIP AND THIGH
HIP BONE
The hip bone is the large flat bone forming the left and right aspects of the pel
vis. It is made from three primary bones: The ilium, ischium and pubis. These
primary bones fuse into a single hip bone during the adolescent stage of devel
opment. Sometimes called the pelvic bone, each hip bone articulates anteriorly
with its contralateral counterpart at the pubic symphysis and posteriorly with
the sacrum. On its inferolateral surface is the acetabulum, a concave socket
that articulates with the femur to form the hip joint. The hip bone has a num
ber of important bony landmarks and provides attachment for many muscles,
including muscles of the abdomen, back, buttocks, hip and thigh. It transfers
body weight between the lower limbs and axial skeleton and thus has an impor
tant role to play in locomotion.
FIGURE 3.2. Hip bone. Three primary bones fuse together to form the hip bone, the ilium, ischium and pubis.
All three bones meet at the acetabulum. The ilium is the largest of the three hip bone components and is
located superior to both the ischium and pubis. The body of the ilium forms its inferior portion, fusing with
the ischium and pubis at the acetabulum. Its upper part forms the wing, or ala, of the ilium. The pubis is the
smallest of the three bones. It is positioned on the anterior aspect of the pelvic girdle and articulates with
its fellow at the pubic symphysis. The pubis consists of a body from which two projections extend: The
superior and inferior pubic rami. The ischium, sometimes called the “sitting bone”, is the inferoposterior
component of the hip bone. Superiorly, the body of the ischium meets the body of the ilium and superior
ramus of the pubis, while inferiorly the ramus arches anteriorly to meet the inferior pubic ramus forming
the ischiopubic ramus. This arch forms the inferior boundary of the obturator foramen.
Lower Limb 63
HIP AND THIGH
| Medial ]
Iliac fossa Iliac tuberosity
Anterior superior Auricular surface

iliac spine of ilium
Posterior superior
Anterior inferior iliac spine
iliac spine
Posterior inferior
co
Z Iliopubic eminence iliac spine
_i
o'
LU
Greater sciatic notch
O Obturator groove
Arcuate line of ilium

Pecten pubis
Ischial spine
Pubic tubercle
Lesser sciatic notch
Symphyseal surface
of pubis Ischial tuberosity
FIGURE 3.3. Medial surface. The internal surface of the iliac ala/wing features the large, concave iliac
fossa which provides attachment for the iliacus muscle. It is limited inferiorly by the arcuate line, which
contributes to the pelvic inlet/superior pelvic aperture. Also visible is the medially facing sacropelvic
surface of ilium, which bears the iliac tuberosity as well as an ear-shaped auricular surface for articulation
with the sacrum at the sacroiliac joint. The greater sciatic notch is found along the posterior border of the
ilium and ischium. Moving inferiorly, the lesser sciatic notch can be identified between the ischial spine
and tuberosity. The pubis is located anteriorly; its superior ramus extends laterally to meet the ilium at
the iliopubic eminence. The medial, oval-shaped symphyseal surface of the pubis is separated from its
contralateral fellow by an interpubic disc, forming the pubic symphysis.
Key points about the hip bone
Ilium, Ischium, Pubis

Bones
(Shared landmarks: acetabulum, greater sciatic notch, obturator foramen)
Body: supraacetabular groove

Ala: iliac fossa, iliac crest, anterior superior iliac spine, anterior inferior iliac spine,
Ilium posterior superior iliac spine, posterior inferior iliac spine
Sacropelvic surface: iliac tubercle, auricular surface of ilium

Gluteal surface: anterior gluteal line, posterior gluteal line, inferior gluteal line
Body: ischial spine, lesser sciatic notch

Ischium
Ramus: ischial tuberosity
Body: pubic tubercle, pubic crest, symphyseal surface
Superior ramus: iliopubic eminence, pecten pubis, obturator crest, obturator

Pubis
groove, anterior/posterior obturator tubercles
Inferior ramus: contributes to ischiopubic ramus

HIP AND THIGH
Lateral]
Iliac tubercle Inner lip
Posterior gluteal line Intermediate

zone
Anterior gluteal line
Outer lip
Posterior superior
iliac spine Anterior superior
iliac spine
Posterior inferior
iliac spine Anterior inferior
iliac spine
Greater sciatic
notch
Margin
Inferior gluteal line
Lunate
Ischial spine surface
Pubic tubercle
Lesser sciatic notch
Ischial tuberosity Obturator crest
Obturator foramen Acetabular notch
FIGURE 3.4. Lateral surface. The superior part of this lateral view of the hip bone shows the external or
gluteal surface of the ilium. It is marked by three elevations (the anterior, posterior and inferior gluteal
lines) which mark the boundaries between attachment sites for the gluteal muscles. The most superior
aspect of the ilium forms a well defined rim called the iliac crest, which extends between the anterior and
posterior superior iliac spines (ASIS/PSIS). The anterior superior iliac spine provides the lateral attachment
for the inguinal ligament. Just inferior to these spines we can find their inferior counterparts, the anterior
and posterior inferior iliac spines. The lateral view also presents a cup-shaped cavity known as the
acetabulum, in which the hip bone articulates with the femur at the hip joint. Four main elements of the
acetabulum can be identified: The margin, fossa, lunate surface and acetabular notch. Also seen is a large
bony aperture known as the obturator foramen; this is closed by the obturator membrane, except for
a small opening (canal) giving passage to the obturator artery, veins and nerve from the pelvis into the
medial compartment of the thigh.
Hip bone
Lower Limb 65
HIP AND THIGH
FEMUR
The femur is the longest and strongest bone of the human body. It forms the
skeletal framework of the thigh and contributes to two major body joints:
The hip and knee. The majority of the muscles of the hip and thigh attach to
the femur in order to produce the movements on these joints.
Fovea for ligament of head of femur
co
Z Head
_i
o'
LU
O Neck
Greater trochanter
Lesser trochanter
Intertrochanteric line
Lateral epicondyle
Lateral condyle
Patellar surface
Medial epicondyle
Medial condyle
FIGURE 3.5. Femur (anterior view). The anterior view of the femur features several important landmarks.
The most proximal portion of the head of the femur features a small dimple, known as the fovea for the
ligament of head of femur. Below the neck of the femur are the greater and lesser trochanters, with the
intertrochanteric line spanning between them. These bony prominences act as important attachment
sites for the muscles of the hip and thigh. The distal end of the femur contains the medial and lateral
condyles that articulate with the tibia, as well as the medial and lateral epicondyles above them. Between
the medial and lateral condyle is the patellar surface of the femur, which as its name suggests, articulates
with the patella, contributing to the formation of the knee joint. Notice how some of these landmarks are
better seen on the posterior view (2nd image), such as the lesser trochanter, and the medial and lateral
condyles.
B Femur
iOS
Sa&g Jwgt
Hip joint

HIP AND THIGH
Head
Greater trochanter
Trochanteric fossa
Neck
Intertrochanteric crest
Lesser trochanter
Pectineal line
Spiral line
Gluteal tuberosity
Linea aspera
Lateral supracondylar line
Medial supracondylar line
Popliteal surface
Lateral epicondyle
Medial epicondyle
Intercondylar fossa
Lateral condyle
Medial condyle
FIGURE 3.6. Femur (posterior view). The lesser trochanter is clearly seen on the posterior view,
separated from the greater trochanter by the intertrochanteric crest. The intertrochanteric crest and
intertrochanteric line (anterior view) mark the transition between the neck of the femur and the shaft
of the femur. Found on the medial surface of the greater trochanter is the crescent-shaped depression
known as the trochanteric fossa. Seen below the lesser trochanter are the 3 small bony ridges called
pectineal line, spiral line and gluteal tuberosity. These 3 ridges converge inferiorly to form the linea
aspera that runs along the entire shaft of the femur. Near the distal end of the femur, the linea aspera
diverges into 2 ridges: The medial and lateral supracondylar lines. The posterior surface of the distal end
of the femur provides a better visual of the medial and lateral condyles, which in this view are separated
by the intercondylar fossa.
Key points about the femur
Head of femur, fovea for ligament of head of femur, neck of femur, greater
Proximal end trochanter, trochanteric fossa, lesser trochanter, intertrochanteric line,
intertrochanteric crest
Spiral line, pectineal line, gluteal tuberosity, linea aspera (with medial and lateral
Shaft
lips, medial supracondylar line, lateral supracondylar line, popliteal surface
Medial condyle: medial epicondyle, adductor tubercle

Lateral condyle: lateral epicondyle, groove for popliteus muscle
Distal end Intercondylar fossa
Intercondylar line
Patellar surface
Joints Hip joint, knee joint
Lower Limb 67
HIP AND THIGH
HIP JOINT
The hip joint is a large articulation between the head of the femur and acetab
ulum of the hip bone. It is the most proximal joint of the free lower limb and is
classified as a ball-and-socket type of synovial joint capable of a wide range of
movements. Compared to the shoulder joint, the hip joint sacrifices a part of its
mobility for stability, since it needs to bear the entire weight of the upper body
while standing. Hence, the hip joint is the most stable joint in the body.
Acetabular
co
Z labrum
_i
o'
LU
O
Head of femur
Ligament of
head of femur
Transverse
acetabular
ligament
Synovial
membrane
Zona orbicularis
ligament
FIGURE 3.7. Overview of the hip joint. The hip joint has several ligaments that play an important role in
stabilizing the joint during various movements. The ligaments of the hip joint are divided into two groups:
Capsular and intracapsular. The capsular ligaments reinforce the joint capsule and include the iliofemoral,
pubofemoral and ischiofemoral ligaments. The intracapsular ligaments are situated inside of the joint
capsule and include the transverse ligament of the acetabulum and ligament of the head of the femur.
Key points about the hip joint
Joint type Synovial ball-and-socket joint
Articulating
Head of femur, lunate surface of acetabulum
surfaces
Capsular: iliofemoral, pubofemoral, ischiofemoral ligaments

Ligaments
Intracapsular: transverse ligament of acetabulum, ligament of head of femur
Flexion, extension, abduction, adduction, external rotation, internal rotation and

Movements
circumduction

HIP AND THIGH
MUSCLES OF THE HIP AND THIGH
The muscles of the hip and thigh are divided into three major groups:
• Iliopsoas muscle
• Gluteal muscles, comprised of superficial and deep groups
• Thigh muscles, subdivided into the anterior, medial and posterior groups.
Iliacus muscte Psoas minor muscle
Iliopsoas muscle
Psoas major muscle
Pectineus muscle
Gracilis muscle
Adductor brevis
muscle
Adductor magnus
muscle
Adductor longus
muscle
Rectus femoris Sartorius muscle

muscle
Vastus lateralis
Vastus medialis muscle
muscle
FIGURE 3.8. Anterior view. From this anterior perspective the iliopsoas muscle as well as the muscles
of the anterior and medial compartments can be identified. The iliopsoas muscle group consists of the
iliacus, psoas major, and psoas minor muscles which function to flex the trunk and thigh at the hip joint.
The quadriceps femoris muscle forms the great anterior muscle of the thigh. It consists of four parts: The
vastus lateralis, vastus intermedius, vastus medialis, and rectus femoris muscles. The quadriceps femoris
muscle is a powerful extensor of the knee. The rectus femoris muscle of this group also works together
with the sartorius muscle of the anterior thigh to produce flexion of the thigh at the hip joint. The medial
thigh muscles mainly function to adduct the thigh at the hip joint. Muscles of this region include the
gracilis, pectineus, adductor longus, adductor brevis, and adductor magnus. This group of muscles may
also be known as the adductor muscle group. The obturator externus muscle is also classified as a member
of the medial compartment of the thigh due to its innervation by the obturator nerve, however, is often
grouped with the other lateral rotators of the hip joint (deep gluteal muscles) due to its shared function
with these muscles.
Lower Limb 69
HIP AND THIGH
Gluteus medius
muscle
Gluteus minimus
muscle
Piriformis muscle
Superior gemellus
muscle
Quadratus femoris
muscle
Inferior gemellus muscle
Obturator internus muscle
Tensor fasciae latae muscle
Gluteus maximus muscle
Biceps femoris muscle
Semitendinosus muscle
Semimembranosus muscle
FIGURE 3.9. Posterior view. The muscles of the gluteal region are divided into superficial and deep groups.
The superficial gluteal muscles include the large gluteus maximus muscle as well as the gluteus medius
and minimus muscles; the tensor fascia latae muscle which is positioned laterally. The superficial gluteal
muscles collectively contribute to extension, internal and external rotation and abduction and adduction
of the thigh at the hip joint. The deep gluteal muscles are located beneath the superficial gluteal muscles
and include the piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus,
and quadratus femoris muscles. The deep gluteal muscles function to externally rotate and abduct the
thigh at the hip joint whilst also contributing to stabilization of the head of the femur with the acetabulum.
The posterior muscles of the thigh are also known as the ischiocrural, or more commonly, the hamstring
muscles. They include: The biceps femoris, semimembranosus and semitendinosus muscles. The ischi-
ocrural muscles work together to extend the thigh, flex the knee joint and stabilize the hip joint.
Iliopsoas muscles Origin Insertion Innervation Function
Femoral nerve
Iliacus Iliac fossa
(L2-L4)
Hip joint: thigh/
Vertebral bodies trunk flexion,
ofT12-L4, Lesser trochanter
thigh external
Intervertebral discs of femur
Anterior rami rotation; trunk
Psoas major
between T12-L4, of spinal nerves lateral flexion
Costal processes of L1-L3
L1-L5 vertebrae
(Psoas minor: L1
Iliopubic only)
Vertebral bodies of Weak trunk
Psoas minor eminence, Pecten
T12 & L1 vertebrae flexion
pubis

HIP AND THIGH
Gluteal muscles Origin Insertion Innervation Function
Lateroposterior
surface of sacrum Hip joint: thigh
and coccyx, Gluteal extension,
surface of ilium Iliotibial thigh external
Inferior
Gluteus (behind posterior tract, Gluteal rotation, thigh
gluteal nerve
maximus gluteal line), tuberosity of abduction
(L5-S2)
Thoracolumbar femur (superior part),
fascia, thigh adduction
Sacrotuberous (inferior part)
ligament
Gluteal surface
Lateral aspect
of ilium (between
Gluteus of greater Hip joint: thigh
anterior and
medius trochanter of abduction,
posterior gluteal
femur thigh internal
lines)
Superficial rotation
group Gluteal surface (anterior part);
Anterior aspect
of ilium (between pelvis
Gluteus of greater
anterior and stabilization
minimus trochanter of
inferior gluteal
femur
lines) Superior
gluteal nerve
Hip joint:
(L4-S1)
thigh internal
rotation, (weak
abduction);
Anterior superior
Tensor Knee joint:
iliac spine (ASIS),
fasciae Iliotibial tract leg external
Outer lip of iliac
latae rotation, (weak
crest
leg flexion/
extension);
stabilizes hip &
knee joints
Anterior surface
of sacrum
(between the S2
and S4), Gluteal Apex of greater Nerve to
Piriformis surface of ilium trochanter of piriformis
(near posterior femur (S1-S2)
inferior iliac spine),
(Sacrotuberous
ligament)
Nerve to
Medial surface Hip joint:
Superior obturator
Ischial spine of greater thigh external
gemellus internus
trochanter rotation, thigh
(L5, S1)
of femur, abduction (from
(via tendon Nerve to flexed hip);
Inferior of obturator quadratus stabilizes head
Ischial tuberosity
Deep gemellus internus) femoris of femur in
group (L4-S1) acetabulum
Ischiopubic ramus, Medial surface Nerve to

Obturator Posterior surface of greater obturator
internus of obturator trochanter of internus
membrane femur (L5, S1)
Anterior surface
of obturator
Obturator Trochanteric Obturator
membrane, Bony
externus fossa of femur nerve (L3, L4)
boundaries of
obturator foramen
Hip joint:
Nerve to thigh external
Quadratus Intertrochanteric quadratus rotation;
Ischial tuberosity
femoris crest of femur femoris stabilizes head
(L4-S1) of femur in
acetabulum
Lower Limb 71
HIP AND THIGH
Anterior thigh
muscles
Hip joint: thigh

Proximal end of flexion, thigh
tibia below medial abduction, thigh
Anterior superior
Sartorius condyle external rotation;
iliac spine (ASIS)
Knee joint: leg
(via pes anserinus) flexion, leg
internal rotation
Anterior inferior Hip joint:

iliac spine, Tibial tuberosity thigh flexion;
Rectus femoris (via patellar
Supracetabluar Knee joint: leg
groove ligament), Patella extension
(Lateral condyle Femoral nerve
Vastus Anterior surface of tibia) (L2-L4)
intermedius of femoral shaft
(Sartorius L2-L3
Intertrochanteric only)
Tibial tuberosity
line, Gluteal
(via patellar
tuberosity,
Vastus lateralis ligament), Patella,
Greater
(Lateral condyle
trochanter, Linea Knee joint: leg
of tibia)
aspera of femur extension
Intertrochanteric Tibial tuberosity

line, spiral line (via patellar
and linea ligament), Patella,
Vastus medialis
aspera, medial
supracondylar line (Medial condyle
of femur of tibia)
Medial thigh
muscles
Femoral nerve Hip joint: thigh flexion,

Superior pubic Pectineal line thigh adduction, thigh
(L2, L3)
Pectineus ramus (Pectineal of femur, Linea external rotation, thigh
line of pubis) aspera of femur (Obturator nerve internal rotation; pelvis
(L2, L3) stabilization
Adductor
part: gluteal
Adductor part: tuberosity, Linea Adductor part: Hip joint: thigh flexion,
inferior pubic aspera (medial obturator nerve thigh adduction, thigh
ramus, Ischial lip), Medial external rotation
(L2-L4);
Adductor ramus supracondylar (adductor part), thigh
magnus Ischiocondylar extension, thigh
line;
Ischiocondylar part: tibial internal rotation
part: ischial Ischiocondylar division of sciatic (ischiocondylar part);
tuberosity part: adductor nerve (L4) pelvis stabilization
tubercle of
femur

HIP AND THIGH
Medial thigh
muscles
Gluteal Hip joint: thigh

Adductor Inferior public
tuberosity of adduction, thigh
minimus ramus
femur external rotation
Hip joint: thigh flexion,

Anterior body of thigh adduction, thigh
Adductor longus
pubis external rotation;
Obturator nerve
pelvis stabilization
(L2-L4)
Linea aspera of
femur (medial
lip)
Hip joint: thigh flexion,
Anterior body of
thigh adduction, thigh
Adductor brevis pubis, Inferior
external rotation;
pubic ramus
pelvis stabilization
Anterior body of Medial surface Hip joint: thigh flexion,

pubis, Inferior of proximal Obturator nerve thigh adduction;
Gracilis
pubic ramus, tibia (via pes (L2-L3) Knee joint: leg flexion,
Ischial ramus anserinus) leg internal rotation
Posterior thigh
muscles
(Superolateral Hip joint: thigh

Medial condyle
Semimembranosus impression of) extension, thigh
of tibia
Ischial tuberosity Tibial division internal rotation;
Proximal end of of sciatic Knee joint: leg
(Posteromedial nerve (L5-S2) flexion, leg
tibia below medial
Semitendinosus impression of) internal rotation;
condyle (via pes
Ischial tuberosity stabilizes pelvis
anserinus)
Long head:
(Inferomedial Long head:
impression of) tibial division Hip joint: thigh
Ischial tuberosity, of sciatic extension, thigh
Sacrotuberous nerve (L5-S2); external rotation;
(Lateral aspect of)
Biceps femoris ligament; Knee joint: leg
Short head:
Head of fibula flexion, leg
Short head: linea common
aspera of femur fibular division external rotation;
(lateral lip), Lateral of sciatic stabilizes pelvis
supracondylar line nerve (L5-S2)
of femur
Hip and thigh The quadriceps

muscles femoris muscle
olio
Lower Limb 73
KNEEAND LEG
TIBIA AND FIBULA
The tibia and fibula are the two long bones of the leg, positioned parallel to each
other. The tibia is the second largest bone in the body (after the femur) and the
primary weight-bearing bone of the leg. The fibula is the more slender of the
two bones, located lateral to the tibia. These two bones articulate with each
other, making the three following joints:
1. Superior tibiofibular joint: Plane synovial joint

2. Middle tibiofibular joint: Fibrous joint, attached by the interosseous
membrane
co 3. Inferior tibiofibular joint: Syndesmosis
Z
_i
o'
LU The tibia and fibula articulate with the talus to form the ankle joint, while only
O the tibia articulates with the femur and participates in the formation of the
knee joint.
Anterior] Posterior^
Intercondylar eminence
Tibial plateau
Medial condyle
Tubercle of iliotibial tract
Lateral condyle-
Tibial tuberosity
Soleal line
Anterior border
Medial border
Medial surface
Posterior surface
Interosseous border
Fibular notch
Malleolar groove
Medial malleolus
Articular facet of
medial malleolus
FIGURE 3.10. Tibia. The tibia articulates proximally at the knee joint with the distal end of the femur which
rests upon the tibial plateau, formed by the medial and lateral tibial condyles. The tibial tuberosity is a
large roughened prominence on the anterior proximal tibia which serves as the attachment point for the
patellar ligament (and indirectly for the tendon of the quadriceps femoris muscle). The body, or shaft, of
the tibia has three surfaces (medial, lateral and posterior), which are separated by three borders (anterior,
interosseous and medial). The posterior surface of the tibia bears a ridge known as the soleal line which

KNEE AND LEG
gives attachment to the soleus muscle. The distal end of the tibia bears a projection known as the medial
malleolus which articulates with the body of the talus; its medial surface can be palpated as the medial
‘knob’ of the ankle.
Anterio^l Posterior^
Apex of head—
of fibula
-Articular facet of
head of fibula
------- Head--------
------- Neck--------
—Anterior border z
03
— Medial border—
Posterior border-
interosseous crest
— Lateral surface
Posterior surface -
— Medial surface
-Articular facet of
lateral malleolus
-Lateral malleolus-
FIGURE 3.11. Fibula. The head forms the enlarged proximal end of the fibula. It bears two main landmarks:
An apex (a.k.a., styloid process) which projects proximally from its posterior surface, and a small, medially
oriented articular surface for the lateral condyle of the tibia, which contributes to the superior tibiofibular
joint. The body of the fibula forms a long thin shaft, with three surfaces (medial, lateral and posterior)
separated by three ill-defined borders (anterior, posterior and medial). The medial surface of the fibula
is marked by an interosseous crest, which is connected to the interosseous border of the tibia via the
interosseous membrane of the leg to form the middle tibiofibular joint. The distal end of the fibula
articulates once again with the tibia to form the inferior tibiofibular joint, before expanding to form the
lateral malleolus which constitutes the lateral ‘knob’ of the ankle. Like its medial counterpart, the lateral
malleolus articulates with the body of the talus to collectively form the talocrural joint.
Key points about the tibia
Lateral condyle, medial condyle, tibial plateau, anterior and posterior intercondylar
Proximal end
areas, tubercle of iliotibial tract, tibial tuberosity
Three borders (anterior, medial, interosseous); three surfaces (posterior, medial,

Shaft
lateral), soleal line (posterior surface)
Distal end Medial malleolus, fibular notch
Lower Limb 75
KNEE AND LEG
Key points about the fibula
Apex (styloid process), head of fibula, (with articular facet for lateral condyle of
Proximal end
tibia), neck
Three borders (anterior, medial, posterior); three surfaces (medial, lateral,

Shaft
posterior)
Distal end Lateral malleolus
Intracrural joints
Superior/proximal tibiofibular joint Proximal tibia ^ proximal fibula
Middle tibiofibular joint Shaft of tibia ^ shaft of fibula (via interosseous membrane)
Inferior/distal tibiofibular joint Distal tibia ^ distal fibula
Tibia
||R| Fibula

KNEE AND LEG
KNEE JOINT
The knee joint is a complex synovial joint that connects three bones (the femur,
tibia and patella) which together form a pair of articulations:
1. The tibiofemoral joint, formed between the tibia and the femur.
2. The patellofemoral joint, formed between the patella and the femur.
The knee joint is the largest joint of the body, responsible for bearing a consid
erable amount of biomechanical stress every time we stand or walk. Its integ
rity is supported by many extracapsular and intracapsular ligaments, menisci,
as well as surrounding muscles that provide the knee joint with the stability
needed to bear the weight of the whole body.
Lateral patellar Medial patellar

retinaculum retinaculum
Fibular collateral
Tibial collateral
ligament
ligament
of knee joint
of knee joint
Inferior
subtendinous
bursa of biceps Patellar
femoris muscle ligament
Subtendinous bursa Anserine bursa

of iliotibial tract
FIGURE 3.12. Bursae and extracapsular ligaments (anterior view). Knee bursae are small fluid-filled sacs
whose function is to reduce friction and accommodate gliding of muscles or tendons as they cross over
bony prominences of the knee joint. Two groups of bursae are associated with the knee joint: Bursae
around the patella (anterior/patellar ligaments) and bursae located elsewhere. The nonpatellar group
consists of a group of superficial bursae, most notable being the inferior subtendinous bursa of biceps
femoris muscle and anserine bursa. The former is located on the lateral side of the joint, between the
tendon of biceps femoris and fibular collateral ligament. The anserine bursa is found on the medial side,
cushioning the space between the tibial collateral ligament and combined tendinous expansions of the
sartorius, gracilis and semitendinosus muscles (pes anserinus).
As many as fourteen bursae may be present, including the subtendinous bursa of iliotibial tract found
between tibia and the distal part of iliotibial tract.
The extracapsular ligaments of the knee are located outside the joint capsule. They are the patellar liga
ment, fibular and tibial collateral ligaments, and oblique and arcuate popliteal ligaments (depicted on the
posterior view).
Lower Limb 77
KNEE AND LEG
Articular capsule of knee joint
Tibial collateral ligament

of knee joint
co
Oblique popliteal ligament
Z
_i
o'
LU
O
Arcuate popliteal ligament
Fibular collateral ligament

of knee joint
Popliteus muscle
FIGURE 3.13. Extracapsular ligaments and popliteus muscle (posterior view). Right knee, capsule in situ.
The articular capsule extends posteriorly between the intercondylar line of the femur to the posterior
border of the tibial plateau. It strengthened posteriorly by the arcuate and oblique popliteal ligaments,
medially by the tibial collateral ligament and laterally by the fibular collateral ligament. The popliteus
muscle provides additional stabilization to the knee joint as it ascends superolaterally across its posterior
aspect. Its tendon enters the lateral part of the articular capsule, deep to the arcuate popliteal ligament,
therefore making it an intracapsular structure.

KNEE AND LEG
Posterior cruciate Tibial collateral

ligament ligament
Fibular collateral Medial

ligament meniscofemoral
ligament
Anterior Medial
cruciate meniscotibial
ligament ligament
Lateral Medial meniscus

meniscus
Transverse ligament Anterior meniscotibial

ligament
FIGURE 3.14. Intracapsular ligaments and menisci (anterior view). Right knee, flexed position with
capsule removed. The intracapsular ligaments of the knee joint are located within the joint capsule,
with the most notable being the anterior and posterior cruciate ligaments (discussed in next image). The
menisci are paired, crescent-shaped fibrocartilaginous structures located between the articular surfaces
of tibia and femur. They are supported by several accessory ligaments which include anterior and medial
meniscotibial ligaments, medial meniscofemoral and posterior meniscofemoral (depicted on posterior
view) and transverse ligament of knee.
Lower Limb 79
KNEE AND LEG
Anterior cruciate ligament
Posterior meniscofemoral
ligament
co
Z
_i
o' Posterior cruciate ligament
LU
Lateral meniscus
Medial meniscus
FIGURE 3.15. Intracapsular ligaments and menisci (posterior view). Right knee, capsule removed. The
cruciate ligaments of the knee extend between the intercondylar fossa of the femur and intercondylar
areas of the tibia, crossing each other to form an ‘X’ shape (cross: Latin = crux). The posterior cruciate
ligament is the shorter, thicker and stronger of the pair. They function to stabilize the knee joint by resisting
translation of the femur on the tibia and preventing hyperflexion/hyperextension.
Key points about the knee joint
Tibiofemoral joint: synovial hinge joint

Type
Patellofemoral joint: plane joint
Articular Tibiofemoral joint: lateral and medial condyles of femur, tibial plateau
surfaces Patellofemoral joint: patellar surface of femur, articular surface of patella
Extracapsular ligaments: patellar ligament, medial and lateral patellar retinacula,

tibial (medial) collateral ligament, medial meniscofemoral ligament, medial
meniscotibial ligament, fibular (lateral) collateral ligament, oblique popliteal
Ligaments and ligament, arcuate popliteal ligament, anterolateral ligament
menisci
Intracapsular ligaments/menisci: anterior cruciate ligament (ACL), posterior
cruciate ligament (PCL), medial meniscus, lateral meniscus, transverse ligament of
the knee, anterior meniscotibial ligament, posterior meniscofemoral ligament
Movements Extension, flexion, internal/external rotation

KNEE AND LEG
Synovial membrane Tendon of quadriceps

femoris muscle
Anterior suprapatellar
(quadriceps) fat pad
Posterior suprapatellar
(prefemoral) fat pad
Suprapatellar bursa
Lateral subtendinous Patellofemoral joint

bursa of gastrocnemius
muscle
Prepatellar bursa
Infrapatellar fat pad

Articular capsule
Deep infrapatellar
bursa
Articular cartilage
Subcutaneous
infrapatellar bursa
Lateral meniscus Patellar ligament
FIGURE 3.16. Sagittal view of the knee joint (mid patella). Sagittal view of the knee joint, with articulating
surfaces clearly visible. The lateral and medial condyles of the femur articulate with the tibial plateau
inferiorly forming the tibiofemoral joint. Anteriorly, the patellar surface of the femur articulates with
the articular surface of patella forming the patellofemoral joint. This view of the knee joint is best for
examining the structure of the articular capsule and its two parts, the outer fibrous layer and inner
synovial membrane which encloses the articular cavity.
The articular capsule forms several pouches called bursae, that cushion and reduce friction between
muscle tendons and bones of the knee. Additional important structures are the menisci situated between
the lateral and medial condyles of the femur and tibial plateau, increasing congruency between these
articulating surfaces. A large, intracapsular infrapatellar fat pad can be identified between the patellar
ligament and synovial membrane. It works to reduce friction between surrounding adjacent structures i.e.
patella bone, patellar ligament and underlying bones.
Kneejoint Patella
Lower Limb 81
KNEE AND LEG
MUSCLES OF THE LEG
The muscles of the leg are divided into three compartments based on their
location and primary functions.
The anterior (dorsiflexor) compartment, which consists of the tibialis ante

rior, extensor digitorum longus, fibularis tertius and extensor hallucis longus
muscles. Crossing the ankle from the anterior aspect, these muscles primar
ily cause dorsiflexion of the foot.
The lateral (fibular) compartment, which houses the fibularis longus and fib-
ularis brevis muscles. The major function of this compartment is to evert the
co foot.
Z
_i The posterior (plantar flexor) compartment, which is divided into the super
o'
LU ficial and deep parts. The former contains the triceps surae (gastrocnemius
O and soleus) and plantaris muscles, while the latter consists of the popliteus,
tibialis posterior, flexor digitorum longus and flexor hallucis longus muscles.
The main function of this compartment is plantar flexion of the foot at the
ankle joint.
FIGURE 3.17. Muscles of the leg (anterior view). The four muscles of the anterior compartment of the leg
include the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius (not
shown/illustrated) muscles. These muscles pass anterior to the ankle joint to insert at the foot, therefore
eliciting dorsiflexion at the ankle joint on contraction. The extensor digitorum longus and extensor hallucis
longus extend distally to insert onto the dorsal surface of the phalanges and therefore also function in
extension of the digits at the metatarsophalangeal and interphalangeal joints.

KNEE AND LEG
The fibularis longus and brevis muscles form the lateral compartment of the leg. The fibularis longus
muscle travels along the lateral portion of the leg, crossing onto the plantar aspect of the foot, before
inserting onto the first metatarsal and medial cuneiform bones. The fibularis brevis muscle inserts onto
the tuberosity of the fifth metatarsal bone. The fibularis longus and brevis muscles are both evertors of
the foot (occurring at the subtalar joint), therefore functioning to elevate the lateral border of the foot on
contraction.
Gastrocnemius
muscle Triceps surae
muscle
Soleus muscle
Plantaris muscle
Popliteus muscle
Tibialis posterior muscle
Fibularis longus muscle
Flexor digitorum longus

muscle
Flexor hallucis longus

muscle
FIGURE 3.18. Muscles of the leg (posterior view). The posterior compartment of the leg can be divided
into superficial and deep parts by the transverse intermuscular septum. The superficial muscles of
the posterior leg include the gastrocnemius, soleus and plantaris. The large gastrocnemius and soleus
collectively form the triceps surae muscle which is a powerful plantar flexor of the foot at the ankle joint.
A large shared common tendon, the calcaneal tendon (a.k.a. Achilles tendon), extends from the muscle
bellies of the triceps surae muscle to insert onto the posterior aspect of the calcaneus. The plantaris
muscle has a short belly and a long tendon which extends along the posterior leg to also insert onto the
posterior calcaneus. This muscle contributes to proprioception during plantarflexion of the ankle joint.
The deep muscles of the posterior leg comprise four muscles: The popliteus, flexor digitorum longus,
flexor hallucis longus, and tibialis posterior. The short popliteus muscle acts on the knee joint, while the
rest of the deep muscles of the posterior leg contribute to plantarflexion of the foot at the ankle joint, in
addition to other individual functions. The flexor digitorum longus and flexor hallucis longus muscles also
contribute to flexion of the toes at the metatarsophalangeal and interphalangeal joints.
Lower Limb 83
KNEE AND LEG
Anterior leg
muscles
Lateral tibial Talocrural Joint: foot

condyle, proximal dorsiflexion; Subtalar
Medial cuneiform
half of lateral Deep fibular joint: foot inversion;
Tibialis anterior bone, Base of
surface of tibia, nerve (L4, L5) supports medial
metatarsal bone 1
Interosseous longitudinal arch of
membrane foot
(Middle third Metatarsophalangeal

of) Medial Base of distal and interphalangeal
Extensor
surface of fibula, phalanx of great joint 1: toe extension;
hallucis longus
Interosseous toe Talocrural joint: foot
membrane dorsiflexion
Metatarsophalangeal
co
Z (Proximal half of) and interphalangeal
_i Medial surface joints 2-5: toe
o' Extensor Distal and middle
LU
of fibula, Lateral Deep fibular extension;
digitorum phalanges of
tibial condyle, nerve (L5, S1) Talocrural joint: foot
O longus digits 2-5
Interosseous dorsiflexion;
membrane Subtalar joint: foot
eversion
(Distal third of)

Talocrural joint: foot
Medial surface of Dorsal surface of
dorsiflexion;
Fibularis tertius fibula, Anterior base of metatarsal
Subtalar joint: foot
intermuscular bone 5
eversion
septum
Lateral leg
muscles
Talocrural
Head of fibula, joint: foot
Proximal 2/3 of plantar flexion;
lateral surface of Medial cuneiform Subtalar joint:
Fibularis longus fibula, Anterior bone, Metatarsal foot eversion;
and posterior bone 1 supports
intermuscular Superficial fibular longitudinal and
septa nerve (L5, S1) transverse arches
of foot
Distal 2/3 of Talocrural joint:

lateral surface of foot plantar
Tuberosity of
Fibularis brevis fibula, Anterior flexion;
metatarsal bone 5
intermuscular Subtalar joint:
septum foot eversion

KNEE AND LEG
Posterior leg
muscles
Lateral head:
posterolateral surface
of lateral femoral
condyle; Talocrural joint: foot
plantar flexion;
Gastrocnemius Medial head: posterior Knee joint: leg
surface of medial flexion
femoral condyle,
Popliteal surface of Posterior surface
femoral shaft of calcaneus Tibial nerve
(via calcaneal (S1, S2)
Soleal line, Medial Talocrural joint:
tendon)
border of tibia, Head foot plantar flexion;
Soleus
of fibula, Posterior Subtalar joint: foot
border of fibula eversion
Lateral supracondylar Talocrural joint: foot

line of femur, Oblique plantar flexion;
Plantaris
popliteal ligament of Knee joint: knee
knee flexion
Lateral condyle of
Unlocks knee
femur, Posterior horn Posterior surface Tibial nerve
Popliteus joint; Knee joint
of lateral meniscus of of proximal tibia (L4-S1)
stabilization
knee joint
Tuberosity of Talocrural joint:

Posterior surface
navicular bone, foot plantar flexion;
of tibia, Posterior
Tibialis All cuneiform Tibial nerve Subtalar joint: foot
surface of fibula,
posterior bones, bases of (L4, L5) inversion; supports
Interosseous
metatarsal bones medial longitudinal
membrane
2-4 (Cuboid bone) arch of foot
Metatarsophalangeal
and interphalangeal
joints 2-5: toe
Flexor Posterior surface of Bases of distal
Tibial nerve flexion;
digitorum tibia, (inferior to soleal phalanges of
(L5-S2) Talocrural joint:
longus line) digits 2-5
foot plantar flexion;
inversion
(Distal 2/3 of)

Metatarsophalangeal
Posterior surface of
and interphalangeal
fibula, Interosseous
Base of distal joint 1: toe flexion;
Flexor hallucis membrane, Posterior Tibial nerve
phalanx of great Talocrural joint:
longus intermuscular (S2, S3)
toe foot plantar flexion;
septum, Fascia of
tibialis posterior
inversion
muscle
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Lower Limb 85
ANKLE AND FOOT
BONES OF THE FOOT
The human foot contains 26 bones that are divided into 3 groups. The most
proximal are the tarsal bones, which consist of seven irregularly shaped short
bones, homologous to the carpal bones of the hand. Next are the five long met
atarsal bones which are equivalent to the metacarpals of the hand. Finally, the
phalanges of the foot form the toes in an identical manner to which the pha
langes of the hand form the fingers. The lateral four toes are made up of three
phalanges (proximal, middle and distal), while the great toe consists of only two
phalanges (proximal and distal).
co The foot can also be divided into 3 regions; the hindfoot, midfoot and forefoot.
Z
_i The tarsal bones are contained in the hindfoot and midfoot, while the metatar
o'
LU sals and phalanges lie in the forefoot.
O
Navicular bone —
Head of talus
Intermediate
cuneiform
Neck of talus
bone
Lateral
o Talus cuneiform
o
bone
— Calcaneus Cuboid
bone
Tuberosity of 5th Metatarsal
metatarsal bone bones
Calcaneal Phalanges
tuberosity of foot
FIGURE 3.19. Overview of the bones of the foot. The hindfoot is the most proximal group and includes
only two bones: The talus and calcaneus. The talus forms the ankle joint superiorly with the tibia and fibula,
while the calcaneus forms the heel. Anterior to the talus and calcaneus are the next set of tarsal bones,
which belong to the midfoot: The navicular, cuboid and three cuneiform bones (lateral, intermediate and
medial). The last group of bones make up the forefoot and include the metatarsal bones and phalanges.
There are three consecutive sets of phalanges for each toe (proximal, middle and distal), except for the
great toe that contains two phalanges (proximal and distal).

ANKLE AND FOOT
Key points about the bones of the foot
Tarsal bones: talus, calcaneus, navicular, medial cuneiform, intermediate

cuneiform, lateral cuneiform, cuboid
Bones Metatarsal bones 1-5
Phalanges of foot: proximal, middle and distal phalanx (toes 2-5); proximal and
distal phalanx (great toe)
Talocrural joint: talus ^ tibia/fibula (a.k.a. ankle joint)
Subtalar joint: talus ^ calcaneus

Calcaneocuboid joint: calcaneus ^ cuboid
Talonavicular joint: talus ^ navicular bone

Joints Tarsometatarsal joints: medial, intermediate and lateral cuneiform, cuboid bones
^ metatarsal bones
Metatarsophalangeal joints: metatarsal bones ^ proximal phalanges
Proximal interphalangeal joints: proximal phalanges ^ middle phalanges
Distal interphalangeal joints: middle phalanges ^ distal phalanges
Bgeajgftflia
Ankle and foot
Talus
anatomy
Calcaneus Navicular bone
Cuboid
Lower Limb 87
ANKLE AND FOOT
TALUS
The talus is the most proximal bone of the foot that belongs to the group of
bones collectively known as the tarsus. It articulates with four bones: The tibia,
fibula, calcaneus and navicular. In articulating with the tibia and fibula superi
orly, the talus forms the ankle/talocrural joint and thereby establishes a link
between the leg and the foot. Inferiorly, the talus articulates with the calcaneus
forming the subtalar/talocalcaneal joint, while anteriorly it articulates with the
navicular bone where it forms the talonavicular joint. In these articulations, the
talus represents the cornerstone of the longitudinal arch formed by the tarsal
and metatarsal bones, that transmits the entire weight of the body evenly to
co the heel and forefoot when standing.
Z
_i
o'
LU
Navicular articular surface
Medial malleolar facet
Lateral malleolar facet
Superior facet
Lateral tubercle of posterior

process
Groove for tendon of flexor

hallucis longus muscle of talus
Anterior facet for calcaneus
Middle facet for calcaneus
Talar sulcus
Posterior calcaneal articular facet
Medial tubercle of posterior

process
Posterior process of talus
FIGURE 3.20. Talus (superior and inferior views). The talus consists of three main parts: Head, neck
and body. The head of the talus is the most distal part and presents the navicular articular surface. The
inferior aspect of the head of the talus features the anterior and middle facets, which articulate with
corresponding facets on the calcaneus.
Proximal to the head is the neck of the talus. The superior surface of the neck of talus is unremarkable
while the inferior surface of the neck of talus contains a deep trough known as the talar sulcus.
The most proximal and largest part of the talus is the body. The most prominent feature on the superior
surface of the body of talus is the trochlea of talus which contains the saddle-shaped superior facet. The
superior facet articulates with the inferior articular surface of the tibia contributing to the formation of
the ankle joint. The posterior aspect of the body contains the posterior process bearing the medial and
lateral tubercles which are separated by the groove for the tendon of flexor hallucis longus muscle.

ANKLE AND FOOT
| Medial | Superior facet
Medial malleolar facet
"O
Lateral tubercle of— <n
posterior process
o'
"O
o
Medial tubercle of --- o
posterior process $
Navicular articular surface

[Lateral |
Lateral malleolar facet
Talar sulcus
Posterior calcaneal
articular facet
FIGURE 3.21. Talus (medial and lateral views). The navicular articular surface of the head of talus is best
appreciated from the medial aspect of the talus. As its name suggests, it articulates with the articular
surface of the navicular bone to form the talonavicular joint.
On the lateral view, the talar sulcus of the neck is clearly seen, which forms the tarsal sinus when joined
with the calcaneal sulcus of the calcaneus.
On the medial and lateral sides of the body, the talus bears a medial and lateral malleolar facet that serve
as articular surfaces for the medial and lateral malleoli, respectively. The lateral malleolar facet is a con
cave, triangular area that encloses the trochlea laterally. The medial malleolar facet is a smooth crescent
shaped area that encloses the trochlea medially. The medial and lateral tubercles of the posterior process
of the body of the talus provide attachment sites for the medial and posterior talocalcaneal ligaments and
the posterior talofibular ligament.
Key points about the talus
Surfaces Superior, inferior, medial, lateral, posterior
Head of talus: navicular articular surface
Bony landmarks Neck of talus: talar sulcus, tarsal sinus

and articular
Body of talus: trochlea of talus, posterior process of talus, medial tubercle, lateral
surfaces
tubercle, groove for tendon of flexor hallucis longus muscle of talus, medial
malleolar surface, lateral malleolar surface
Ankle/talocrural joint: talus ^ tibia, fibula
Articulations Subtalar joint: talus ^ calcaneus
Talonavicular joint: talus ^ navicular bone
Ankle joint: lateral malleolar surface of talus, medial malleolar surface of talus
Articular
Subtalar joint: anterior, middle and posterior facets for calcaneus
surfaces
Talonavicuar joint: navicular articular surface
Lower Limb 89
ANKLE AND FOOT
CALCANEUS
The calcaneus, also known as the heel bone, is the largest of the foot bones
that sits just below the talus. It articulates with two bones, the talus and cuboid
bone, forming the subtalar and calcaneonavicular joints, respectively.
I Superior I Articular surface for cuboid
Anterior talar articular surface
Middle talar articular surface
- Calcaneal sulcus
Fibular trochlea
Posterior talar articular surface
Body of calcaneus
| Posterior |
Calcaneal tuberosity
Sustentaculum tali
Groove for tendon of flexor hallucis

longus muscle
Medial process of calcaneal tuberosity
Lateral process of calcaneal tuberosity
FIGURE 3.22. Calcaneus (superior and posterior views). The superior view of the calcaneus presents
with a number of articular surfaces which participate in the formation of the joints of the foot and ankle.
One of them is the posterior talar articular surface, located along the dorsal surface of the calcaneus.
It represents one of the three surfaces on the calcaneus that articulate with the talus, with the other two
being the anterior and middle talar articular surfaces, which can be observed anteromedially.
The large calcaneal tuberosity forms the heel of the foot and is the attachment site for the long calcaneal
tendon. The inferior aspect of the calcaneal tuberosity presents with a medial and lateral process, which
are important attachment points for the muscles of the foot. From the posterior view, the sustentaculum
tali can also be observed. This is a large shelf-like projection found along the posteromedial aspect of the
calcaneus. It supports the head of the talus and contains the groove for the flexor hallucis longus muscle
on its inferior surface.

ANKLE AND FOOT
| Medial | Posterior talar articular surface
Anterior talar articular surface
Middle talar articular surface
Sustentaculum tali
Calcaneal tuberosity
| Lateral | Medial process of calcaneal

tuberosity
Articular surface for cuboid
Fibular trochlea
----Lateral process of calcaneal

tuberosity
FIGURE 3.23. Calcaneus (medial and lateral views). On the medial view, the anterior process of the
calcaneus features the cuboid articular surface, which articulates with the cuboid bone to form the
calcaneocuboid joint. The anterior and middle talar articular surfaces articulate with their calcaneal
counterparts and contribute to the formation of the talocalcaneonavicular joint of the tarsus. Posterior to
the anterior talar articular surface is the aforementioned sustentaculum tali.
Along the lateral surface of the calcaneus is a small prominence known as the fibular trochlea. It is typi
cally located between the tendons of the fibularis longus and brevis muscles and serves as a second pulley
for the fibularis tendons.
Key points about the calcaneus
Surfaces Superior, medial, lateral, inferior
Calcaneal sulcus, sustentaculum tali, groove for the tendon of flexor hallucis
Bony landmarks longus, fibular trochlea, calcaneal tuberosity, medial and lateral process of
calcaneal tuberosity, anterior process of calcaneus
Subtalar joint: talus ^ calcaneus

Articulations
Calcaneocuboid joint: calcaneus ^ cuboid bone
Articular
Anterior/middle/posterior articular surface, articular surface for cuboid
surfaces
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Lower Limb 91
ANKLE AND FOOT
ANKLE JOINT
The ankle joint (a.k.a. talocrural joint) is formed by the articular surfaces of the
distal parts (malleoli) of the tibia and fibula and the body of the talus and is clas
sified as a type of synovial hinge joint. It is supported by a complex set of strong
ligaments providing it with stabilization to manage the entire body weight
against the ground forces below.
Medial collateral ligament

of ankle joint
FIGURE 3.24. Ankle joint (medial view). Considering its role in bearing the entire weight of the body,
it is not surprising that the ankle joint has quite a few ligaments that stabilize it during movement.
The ligaments are divided into two groups: The medial (tibial) and lateral (fibular) collateral ligaments.
The medial collateral ligament, also known as the deltoid ligament, is a strong band that reinforces
the medial aspect of the joint and prevents dislocations of the ankle joint. The ligament has a proximal
attachment on the medial malleolus of the tibia, and fans out from there to insert onto the navicular bone,
calcaneus, and talus. Consequently, the medial collateral ligament consists of 4 parts: The tibionavicular
ligament, extending from the tibia to the navicular bone, the tibiocalcaneal ligament stretching from the
tibia to the calcaneus, and anterior and posterior tibiotalar ligaments, extending from the tibia to the
talus.
Joints and ligaments

The ankle joint
of the foot

ANKLE AND FOOT
FIGURE 3.25. Ankle joint (lateral view). Similarly to the medial collateral ligament, the lateral collateral
ligament is a strong compound ligament that reinforces the lateral aspect of the ankle joint. The ligament
has a proximal attachment on the fibula and a distal attachment on the talus and calcaneus. The lateral
collateral ligament is comprised of three distinct bands: The anterior talofibular and posterior talofibular
ligaments, that extend between the fibula and talus, as well as the calcaneofibular ligament, that extends
between the fibula and calcaneus.
Key points about the ankle joint
Joint type Synovial hinge joint; uniaxial
Articulating Articular facet of medial malleolus (tibia); articular facet of lateral malleolus
surfaces (fibula); trochlea, medial/lateral malleolar facets (talus)
Medial collateral (deltoid): tibionavicular, tibiocalcaneal, anterior tibiotalar,

posterior tibiotalar ligaments
Ligaments
Lateral collateral: anterior talofibular, posterior talofibular, calcaneofibular
ligaments
Movements Dorsiflexion, plantar flexion
Lower Limb 93
ANKLE AND FOOT
JOINTS AND LIGAMENTS OF THE FOOT
The foot has a complex structure with many bones and joints which require
its numerous ligaments and supporting structures to help stabilize and ena
ble optimal movement of the foot. The ligaments of the foot are categorized
according to their associated joints, with each joint of the foot containing two
or more ligaments. Conveniently, most ligaments are named according to their
position relative to the joint they support e.g., dorsal, plantar and interosseous
cuboideonavicular ligaments.
FIGURE 3.26. Joints of the foot (right foot, lateral view). The anatomical subtalar joint (a.k.a. talocalcaneal
joint) is formed between the inferior surface of the body of the talus and posterior articular surface of
the calcaneus. The transverse tarsal joint (a.k.a. midtarsal joint) is an S-shaped joint which connects the
hindfoot and midfoot. It is a compound joint composed of two smaller joints, the talocalcaneonavicular
and calcaneocuboid joints.
Distally, there are a number of smaller intertarsal joints between the cuboid, navicular and cuneiform
bones, namely the cuboideonavicular, cuneocuboid, cuneonavicular and intercuneiform joints.
There are three tarsometatarsal joints: A medial joint involving the medial cuneiform and first metatar
sal bones, a middle joint formed by intermediate and lateral cuneiform bones with the second and third
metatarsal bones, and a lateral joint between the cuboid and fourth and fifth metatarsal bones. The joints
between the heads of the metatarsal bones and bases of the proximal phalanges of the toes are known as
metatarsophalangeal joints, while those found between contiguous phalanges are termed interphalan-
geal joints.

ANKLE AND FOOT
Talonavicular ligament
Calcaneonavicular ligament
Dorsal cuneonavicular
Anterior tibiofibular ligament ligaments
Dorsal intercuneiform
Anterior talofibular ligament ligament
Dorsal
Posterior talofibular cuneocuboid
ligament ligament
Calcaneofibular
ligament
Lateral talocalcaneal
ligament
Long plantar ligament
Talocalcaneal interosseous
ligament
Dorsal metatarsal
Dorsal calcaneocuboid ligament ligaments
Dorsal tarsometatarsal
Calcaneocuboid ligament ligaments
Dorsal cuboideonavicular ligament
FIGURE 3.27. Ligaments of the foot (lateral view). The joints of the foot are supported by several plantar,
dorsal and interosseous ligaments.
From this lateral perspective, several notable ligaments can be identified:
The lateral, anterior and interosseous talocalcaneal ligaments provide support to the subtalar joint, while
dorsally, the transverse tarsal joint is supported by the calcaneonavicular and calcaneocuboid ligaments
(which collectively are referred as the bifurcate ligament) as well as the talonavicular and dorsal calcane
ocuboid ligaments. Several additional ligaments can be seen supporting the dorsal aspect of the joints of
the midfoot and tarsometatarsal joints.
Ankle and foot Joints and ligaments

anatomy of the foot
Lower Limb 95
ANKLE AND FOOT
FIGURE 3.28. Ligaments of the foot (medial view). From this medial perspective, the plantar calca
neonavicular ligament (a.k.a. spring ligament) is of particular interest. It extends between the
sustentaculum tali and medioplantar margin of the posterior surface of the navicular bone, filling a
wedge-shaped gap between these structures. It functions to stabilize the medial longitudinal arch of the
foot and supports the head of the talus within the talocalcaneonavicular joint.
Also visible is the long plantar ligament which extends from the plantar surface of the calcaneus to the
cuboid and second-fourth/fifth metatarsal bones. It supports the transverse tarsal joint and longitudinal
arches of the foot.
Key points about the joints and ligaments the foot
Talocalcaneal joint Medial, lateral, posterior, interosseous and anterior talocalcaneal ligaments
Talocalcaneo
[Dorsal] talonavicular ligament, plantar calcaneonavicular ligament
navicular joint
Calcaneocuboid, dorsal calcaneocuboid, plantar calcaneocuboid, long plantar

Calcaneocuboid joint
ligaments
Cuboideonavicular Dorsal cuboideonavicular, plantar cuboideonavicular, interosseous

joint cuboideonavicular ligaments
Dorsal cuneonavicular (3), plantar cuneonavicular (3), medial cuneonavicular

Cuneonavicular joint
ligaments
Dorsal cuneocuboid, plantar cuneocuboid, interosseous cuneocuboid

Cuneocuboid joints
ligaments
Intercuneiform
Dorsal (2), interosseous (2) and plantar intercuneiform ligaments (1 or 2)
joints

ANKLE AND FOOT
Plantar
calcaneonavicular
ligament
Plantar calcaneocuboid
ligament
Plantar cuboideonavicular
ligament
Plantar cuneonavicular
Plantar tarsometatarsal
ligaments
ligaments
Plantar intercuneiform
ligaments
Plantar metatarsal
ligaments
Plantar cuneocuboid
ligament
Plantar
metatarsophalangeal
ligaments
Deep transverse
metatarsal ligament
Collateral ligaments of
interphalangeal joints
of foot
FIGURE 3.29. Ligaments of the foot (plantar view). Right foot with long plantar ligament removed. The
major plantar ligaments are the plantar calcaneonavicular ligament, the long plantar ligament and plantar
calcaneocuboid ligament (a.k.a short plantar ligament). The latter of these extends between the anterior
part of the plantar surface of the calcaneus to the plantar surface of the cuboid bone. It functions to
stabilize the calcaneocuboid part of the transverse tarsal joint and supports the lateral longitudinal arch
of the foot. Several smaller plantar intertarsal ligaments can be seen between the cuboid, navicular and
cuneiform bones. Plantar tarsometatarsal ligaments stabilize the articulations between the cuneiform
and cuboid bones with the bases of the metatarsal bones. The metatarsophalangeal and interphalangeal
joints are strengthened by tight collateral ligaments, which prevent excessive range of movement in
these joints.
Key points about the joints and ligaments the foot
Tarsometatarsal
Dorsal and plantar tarsometatarsal, cuneometatarsal interosseous ligaments
joint
Intermetatarsal
Dorsal, plantar and interosseous metatarsal ligaments
joints
Metatarsophalangeal Plantar and collateral metatarsophalangeal, deep transverse metatarsal

joints ligaments
Interphalangeal
Plantar and collateral interphalangeal ligaments
joints of foot
Lower Limb 97
ANKLE AND FOOT
MUSCLES OF THE FOOT
Extensor digitorum brevis muscle
Extensor hallucis brevis muscle
Dorsal interossei muscles of foot
FIGURE 3.30. Dorsal muscles of the foot. The dorsal muscles of the foot are composed of two muscles:
The extensor hallucis brevis and extensor digitorum brevis. Both muscles originate from the superolateral
surface of the calcaneus and extend distally across the dorsum of the foot, lateral to the tendons of their
‘longus’ counterparts.
The dorsal interossei are part of the fourth layer of plantar muscles of the foot, but are best viewed from
this dorsal perspective. They are located between the metatarsal bones and consist of four bipennate
muscles which arise from opposing surfaces of adjacent bones. The first (most medial) dorsal interosse
ous muscle inserts into the medial aspect of the base of the proximal phalanx of the second toe, while the
lateral three muscles insert into the lateral aspect of the bases of the proximal phalanges of the toes 2-4.
Dorsal muscles Origin Insertion Innervation Function
Superolateral
surface of
calcaneus bone, Extensor Distal
Extensor interosseous digitorum longus interphalangeal
digitorum brevis talocalcaneal tendons of toes joints 2-4: toe
ligament; Stem of 2-4 Deep fibular extension
inferior extensor nerve (L5,S1)
retinaculum
Superolateral
Extensor hallucis Proximal phalanx Metatarsophalangeal
surface of
brevis of great toe joint 1: toe extension
calcaneus bone

ANKLE AND FOOT
Abductor digiti minimi

muscle of foot
Flexor digitorum
brevis muscle
Abductor hallucis
muscle
Quadratus plantae
muscle
Lumbrical muscles
of foot
FIGURE 3.31. 1st and 2nd plantar layers of the foot. The medial, lateral and central plantar muscles can be
alternatively classified according to four muscular layers. The first (left) and second (right) layers can be
identified in this image. The first layer is composed of three muscles: The abductor hallucis (medial), flexor
digitorum brevis (central) and abductor digiti minimi (lateral). All three extend distally from the calcaneal
tuberosity to the toes and contribute to the maintenance of the concavity of the foot.
The second layer of plantar muscles consist of the quadratus plantae muscle and four lumbrical muscles,
both of which belong to the central muscle group of the foot. Tendons of the flexor hallucis longus and
flexor digitorum longus muscles run within the same plane as these muscles. The quadratus plantae mus
cle arises by a medial and lateral head from the calcaneus and inserts onto the lateral aspect of the tendon
of the flexor digitorum longus muscle as it passes through this region.
The four lumbrical muscles arise from the tendons of the flexor digitorum longus muscle at their angles of
separation, and insert onto the medial aspect of the extensor expansions of toes 2-5.
Dorsal muscles of the Central muscles of

foot the sole of the foot
Lateral muscles of Medial muscles of the

the sole of the foot sole of the foot
Lower Limb 99
ANKLE AND FOOT
Flexor hallucis brevis muscle
Oblique head -----

Adductor
- hallucis
muscle
Transverse head J
Flexor digiti minimi brevis

muscle of foot
Plantar interossei muscles
FIGURE 3.32. 3rd and 4th plantar layers of the foot. The third layer is composed of the flexor hallucis
brevis, adductor hallucis and flexor digiti minimi brevis muscles. The flexor hallucis brevis muscle arises
from the cuboid via its lateral head and from the tendon of the tibialis posterior muscle and medial
intermuscular septum via its medial head. Both heads run anteromedially towards the great toe, inserting
onto each side of the base of the proximal phalanx of the hallux. The adductor hallucis muscle similarly
arises by way of two heads: An oblique and transverse head. It’s oblique head originates from the bases
of metatarsal bones 2-4, cuboid, lateral cuneiform bones and the tendon of fibularis longus, while it’s
transverse head extends from the plantar metatarsophalangeal ligaments of toes 3-5 and deep transverse
metatarsal ligaments to reach and attach onto the base of the proximal phalanx of the great toe. The
flexor digiti minimi brevis muscle is part of the lateral muscle group and acts on the fifth toe. It originates
from the base of metatarsal 5 and extends to insert onto the proximal phalanx of the little toe.
The fourth layer of plantar muscles consist of the plantar and dorsal interossei which are located in the
central compartment of the foot. The dorsal interossei are best viewed from a dorsal perspective of the
foot (see previous image).
The plantar interossei are three muscles which arise from the medial plantar aspect of the metatarsals
3-5, respectively and insert onto the medial bases of the proximal phalanges and extensor expansion of
toes 3-5.

ANKLE AND FOOT
Medial plantar
muscles
Medial process
of calcaneal Metatarsophalangeal
tuberosity, Base of proximal Medial plantar joint 1: toe abduction,
Abductor nerve
Flexor phalanx of great toe flexion; support
hallucis
retinaculum, toe (S1-S3) of longitudinal arch
Plantar of foot
aponeurosis
Tendon of tibialis
Lateral and Metatarsophalangeal
posterior, Medial
medial aspects joint 1: toe flexion;
Flexor hallucis cuneiform Medial plantar
of base of support of
brevis bone, Lateral nerve (S1,S2)
proximal phalanx longitudinal arch of
cuneiform bone,
of great toe foot
Cuboid bone
€
Central plantar
muscles
Oblique head: bases

metatarsal bones
2-4, Cuboid bone,
Lateral cuneiform
Metatarsophalangeal
bone, Tendon of
Lateral aspect of joint 1: toe adduction,
fibularis longus Lateral
Adductor base of proximal toe flexion; support
muscle; plantar nerve
hallucis phalanx of great of longitudinal and
Transverse (S2,S3)
toe transverse arches
head: plantar
of foot
metatarsophalangeal
& deep transverse
metatarsal ligaments
of toes 3-5
Metatarsophalangeal
Flexor Medial process of Middle
Medial plantar joints 2-5: toe flexion;
digitorum calcaneal tuberosity, phalanges of
nerve (S1-S3) supports longitudinal
brevis Plantar aponeurosis digits 2-5
arch of foot
Medial surface of
Lateral
Quadratus calcaneus bone, Tendon of flexor Metatarsophalangeal
plantar nerve
plantae Lateral process of digitorum longus joints 2-5: toe flexion
(S1-S3)
calcaneal tuberosity
Lumbrical 1:
Medial bases medial
Metatarsophalangeal
of proximal plantar
joints 2-5: toe flexion,
Tendons of flexor phalanges nerve (S2,S3);
Lumbricals (4) toes adduction;
digitorum longus and extensor lumbricals
Interphalangeal joints
expansion of 2-4: lateral
2-5: toes extension
digits 2-5 plantar nerve
(S2-S3)
Medial bases
Metatarsophalangeal
of proximal
joints 3-5: toe flexion,
Plantar Medial aspects of phalanges
toes adduction;
interossei (3) metatarsal bones 3-5 and extensor
Interphalangeal joints
expansion of
3-5: toes extension
digits 3-5
1: medial base of Lateral

proximal phalanx plantar nerve
of digit 2 (S2-S3) Metatarsophalangeal
2-4: lateral bases joints 2-4: toe flexion,
Dorsal Opposing sides of
of proximal toe abduction;
interossei (4) metatarsal bones 1-5
phalanges Interphalangeal joints
and extensor 2-4: toe extension
expansion of
digits 2-4
Lower Limb 101

ANKLE AND FOOT
Lateral plantar
muscles
Metatarsophalangeal
Calcaneal Base of proximal
joint 5: toe abduction,
Abductor digiti tuberosity, phalanx of digit Lateral plantar
toe flexion; supports
minimi Plantar 5, Metatarsal nerve (S1-S3)
longitudinal arch of
aponeurosis bone 5
foot
Base of
Flexor digiti metatarsal bone Base of proximal Lateral plantar Metatarsophalangeal
minimi brevis 5, Long plantar phalanx of digit 5 nerve (S2-S3) joint 5: toe flexion
ligament
Long plantar
ligament, Base of
Lateral border Metatarsophalangeal
Opponens digiti metatarsal bone Lateral plantar
of metatarsal joint 5: toe abduction,
minimi 5, Tendon sheath nerve (S2-S3)
bone 5 toe flexion
of fibularis
longus
The plantar muscles of the foot can also be organized into four layers:
Plantar muscles: layers
Abductor hallucis
First layer Flexor digitorum brevis
Abductor digiti minimi
Quadratus plantae
Second layer
Lumbricals
Flexor hallucis brevis
Third layer Adductor hallucis
Flexor digiti minimi brevis
Fourth layer Plantar and dorsal interossei

NERVES AND VESSELS
NEUROVASCULATURE OF THE HIP AND THIGH
The blood supply for the hip and thigh mainly arises from the internal iliac and
femoral arteries. The internal iliac artery gives rise to the superior gluteal, infe
rior gluteal and obturator arteries. They mainly supply the gluteal region, but
some of their branches also supply the thigh area. The femoral artery is a con
tinuation of the external iliac artery after it enters the femoral triangle and is
the main supplier of the structures of the thigh. The region is drained mainly
by the femoral vein with its two main tributaries: The deep femoral and great
saphenous veins. Both muscular and cutaneous innervation of the hip and thigh
comes from the nerves of the lumbar (L1-L4) and sacral (L4-S4) plexuses.
Lateral femoral Femoral vein

cutaneous nerve
Femoral nerve
Muscular branches
of femoral nerve
Femoral artery
Saphenous nerve
Lateral circumflex
femoral artery
Deep femoral artery Descending genicular

artery
FIGURE 3.33. Anterior view. The main supplier of arterial blood to the thigh and leg is the femoral artery.
This artery starts at the level of the inguinal ligament, descending through the femoral triangle and along
the anteromedial thigh. Once reaching the distal thigh it passes through the adductor canal and then
passes through the adductor hiatus to take a posterior position in the popliteal fossa, where it becomes
the popliteal artery. A major branch of the femoral artery is the deep femoral artery, also sometimes
termed the deep artery of thigh or profundus femoris artery. It descends alongside the femoral artery,
giving off many smaller branches which supply the hip region (circumflex arteries) and muscles of the
posterior and medial thigh (perforating femoral arteries).
Traveling alongside the femoral artery is the femoral vein, which drains blood received from the popliteal
vein, great saphenous vein, deep femoral vein and their respective tributaries throughout the thigh. Also
traveling alongside the femoral artery is the femoral nerve which provides muscular and cutaneous inner
vation to the hip and anterior thigh. The medial thigh is predominantly supplied by the obturator nerve.
Lower Limb 103

NERVES AND VESSELS
Superior cluneal nerves
Middle cluneal nerves
Superior gluteal artery
Superior gluteal nerve
Inferior gluteal nerve
Pudendal nerve
Inferior gluteal artery
Internal pudendal artery
Inferior cluneal nerves
Posterior femoral
cutaneous nerve
Sciatic nerve
FIGURE 3.34. Posterior view. Arterial supply to the lower limb starts in the pelvis with the common
iliac artery. This quickly splits into two divisions, the external iliac artery and the internal iliac artery.
The internal iliac artery provides branches to the pelvic and gluteal regions, as seen here with the superior
and inferior gluteal arteries, while the external iliac artery continues to descend into the thigh as the
femoral artery. The hip itself is supplied by a periarticular anastomosis, formed by branches of the femoral
artery (the medial and lateral circumflex femoral arteries), and branches of the internal iliac artery (the
obturator, superior gluteal and inferior gluteal arteries). The posterior thigh is supplied by branches of the
femoral artery, specifically by perforating arteries, which branch from the deep femoral artery.
Innervation to the posterior hip and thigh regions is supplied either by direct branches from the sacral
plexus (such as the posterior femoral cutaneous nerve and the gluteal nerves) or by muscular branches
of the sciatic nerve, which arise before its bifurcation into the common fibular nerve and tibial nerve. The
sciatic nerve does not provide any cutaneous innervation to the posterior thigh;, instead this is provided
solely by cutaneous nerves, the posterior femoral cutaneous nerve (sacral plexus) and by the anterior and
lateral femoral cutaneous nerves (lumbar plexus).
Key points about neurovasculature of the hip and thigh
External iliac artery: deep circumflex iliac artery, femoral artery, superficial
epigastric artery, superficial circumflex iliac artery, deep femoral artery, medial
Arteries circumflex femoral artery, lateral circumflex femoral artery, descending genicular
artery
Internal iliac artery: obturator artery, superior gluteal artery, inferior gluteal artery
Veins Superficial: great saphenous vein, accessory saphenous vein

(tributaries) Deep: femoral vein, deep femoral vein, medial/lateral circumflex femoral veins

NERVES AND VESSELS
Key points about neurovasculature of the hip and thigh
Lumbar plexus: lateral femoral cutaneous nerve, accessory obturator nerve,

obturator nerve, femoral nerve (saphenous nerve), superior cluneal nerves
Nerves Sacral plexus: superior gluteal nerve, inferior gluteal nerve, posterior femoral
cutaneous nerve (inferior cluneal nerves), sciatic nerve (tibial nerve, common
fibular nerve), medial cluneal nerves
Muscular innervation
Femoral nerve Quadriceps femoris, pectineus, sartorius
Biceps femoris, semimembranosus, semitendinosus and ischiocondylar

Sciatic nerve
part of adductor magnus
Adductor brevis, adductor longus, gracilis, obturator externus, adductor

Obturator nerve
part of adductor magnus
Superior gluteal nerve Tensor fasciae latae, gluteus minimus, gluteus medius
Inferior gluteal nerve Gluteus maximus
Cutaneous innervation
Femoral nerve Anterior and medial thigh (anterior cutaneous branches)
Area over course of saphenous vein; articular branches to hip and knee
Saphenous nerve
joints
Lateral femoral
Lateral thigh
cutaneous nerve
Posterior femoral
Lower border of gluteus maximus, posterior and medial thigh
cutaneous nerve
Obturator nerve Proximal part of medial thigh
Superior cluneal nerves Superolateral buttocks
Medial cluneal nerves Medial buttocks
Inferior cluneal nerves Inferior buttocks
Lower extremities Hip and thigh

arteries and nerves anatomy
Lower Limb 105

NERVES AND VESSELS
FEMORAL ARTERY AND ITS BRANCHES
Superficial circumflex Deep circumflex

iliac artery iliac artery
Medial circumflex
femoral artery Inferior epigastric
artery
Lateral circumflex
femoral artery Superficial epigastric
artery
Ascending branch of
lateral circumflex
femoral artery
Superficial external
pudendal artery
Descending branch of
lateral circumflex
femoral artery
Deep external
First femoral pudendal artery
perforating artery
Second femoral Deep femoral artery

perforating artery
Transverse branch
Femoral artery
of lateral circumflex
femoral artery
FIGURE 3.35. Femoral artery and its branches (anterior view). The femoral artery continues from the
external iliac artery after it passes the inguinal ligament. It gives off several branches, including the
superficial epigastric, superficial circumflex iliac, superficial external pudendal, deep external pudendal,
deep femoral and the descending genicular artery. The deep femoral artery in turn gives off the lateral
and medial circumflex femoral arteries as well as the perforating femoral arteries. The femoral artery
continues into the leg as the popliteal artery.
Key points about the femoral artery
Origin: continuation of the external iliac artery after inguinal ligament

Pathway of the
Pathway: descends the anterior thigh
femoral artery
Termination: popliteal artery
Main branches Superficial epigastric, superficial circumflex iliac, superficial external pudendal,
of the femoral deep external pudendal, deep femoral, lateral circumflex artery of the thigh, medial
artery circumflex artery of the thigh, descending genicular artery
Femoral artery Sciatic nerve

NERVES AND VESSELS
SCIATIC NERVE AND ITS BRANCHES
Lumbosacral trunk
Sciatic nerve
Pudendal nerve
Coccygeal nerve
Posterior femoral cutaneous nerve
Common fibular nerve
Tibial nerve
Superficial fibular nerve
Sural nerve
Medial plantar nerve
Medial calcaneal branches of tibial nerve
Lateral calcaneal branches of sural nerve
Lateral dorsal cutaneous nerve of foot
Lateral plantar nerve
FIGURE 3.36. Overview of the sciatic nerve. The sciatic nerve is formed within the pelvis from the anterior
rami of spinal nerves L4-S3. It enters the lower limb by traveling through the greater sciatic foramen of
the posterior pelvis and inferior to, or occasionally through, the piriformis muscle. After passing into the
free lower limb, the sciatic nerve passes down the posterior thigh supplying innervation to the hip joint,
hamstring muscles and ischiocondylar part of the adductor magnus muscle. Just above the level of the
knee, the sciatic nerve divides into its two terminal branches: The tibial nerve and the common fibular/
peroneal nerve.
The tibial nerve supplies motor and sensory innervation to the posterior leg and foot. The major branches
of the tibial nerve are the sural nerve and the medial and lateral plantar nerves. The common fibular nerve
quickly divides into the deep fibular nerve and the superficial fibular nerve; these nerves provide motor
and sensory supply to the anterolateral aspects of the leg and the dorsum of the foot.
Key points about the sciatic nerve
Origin: spinal nerves L4-S3
Pathway of the Pathway: enters thigh between ischial tuberosity and greater trochanter of femur,
sciatic nerve descends through posterior compartment of thigh
Termination: tibial nerve, common fibular nerve
Main branches Common fibular nerve: superficial fibular nerve, deep fibular nerve
of the sciatic Tibial nerve: sural nerve, medial calcaneal branches, lateral calcaneal branches
nerve (of sural nerve), medial and lateral plantar nerves
Lower Limb 107

NERVES AND VESSELS
NEUROVASCULATURE OF THE LEG AND KNEE

The neurovasculature of the knee and leg can be organized around three main
structures:
The popliteal artery is the major contributor to arterial supply of this region
giving off several branches to the leg (e.g. anterior tibial artery, posterior tib
ial artery, sural arteries) and genicular arteries around the region of the knee
joint.
The popliteal vein drains this region as far as up as the adductor canal. It
receives the anterior and posterior tibial veins and other vessels such as the
small saphenous vein that carries blood from the lateral surface of the leg.
The great saphenous vein drains the medial surface of the leg.
The tibial and common fibular nerves (terminal branches of the sciatic nerve)
and their branches provide most of the motor and sensory supply to the leg.
(Additional cutaneous innervation is also provided by the saphenous nerve, a
terminal branch of the femoral nerve).
Superior lateral genicular artery
Superior medial genicular artery

Genicular
anastomosis
Inferior medial genicular artery
Inferior lateral genicular artery
Saphenous nerve
Anterior tibial artery
Superficial fibular nerve
Deep fibular nerve
Anterior medial malleolar artery
Anterior lateral malleolar artery
FIGURE 3.37. The anterior tibial artery and its branches supply arterial blood to the anterior aspect of
the leg. Arising from the popliteal artery, it passes from the posteriorly located popliteal fossa to the

NERVES AND VESSELS
anterior leg via an oval aperture in the proximal part of the interosseous membrane, medial to the head
of the fibula. The anterior tibial artery continues along the anterior aspect of the interosseous membrane
between the tibia and fibula. In the region of the ankle joint, it gives off anterior medial and anterior lateral
malleolar branches for supply of the ankle joint, terminating in the foot as the dorsalis pedis artery. The
knee is supplied by a network of interlacing branches of the femoral and popliteal arteries, collectively this
network is called the genicular anastomosis.
Venous drainage occurs via the dual action of deep and superficial venous systems, with the anterior tibial
veins draining deep structures of the anterior leg and the great and short saphenous veins draining super
ficial structures. All lower limb veins eventually empty into the femoral vein.
The common fibular nerve along with its two branches, the superficial and deep fibular nerves, provides
innervation to the lateral and anterior compartments of the leg, respectively. The common fibular is the
smaller terminal branch of the sciatic nerve, the larger terminal branch being the tibial nerve.
Popliteal vein
Common fibular nerve
Superior lateral genicular artery
Superior medial genicular artery
Tibial nerve
Sural arteries
Popliteal artery
Inferior lateral genicular artery
Inferior medial genicular artery
Tibiofibular trunk
Fibular artery
Posterior tibial artery
FIGURE 3.38. Posterior leg and popliteal fossa, with the popliteal artery and genicular anastomosis
supplying the knee joint and related structures. Arterial blood to the posterior leg is provided by the
posterior tibial artery, a continuation of the popliteal artery which gives off the fibular artery as it
descends. It enters the foot by passing posterior to the medial malleolus, after which it terminates as the
medial and lateral plantar arteries.
Accompanying the posterior tibial artery is the tibial nerve. This large terminal branch of the sciatic nerve
descends the popliteal fossa and passes into the posterior leg to sit deep to the gastrocnemius and soleus
muscles, supplying all the muscles in the posterior compartment of the leg. The tibial nerve then trav
els just posterior to the medial malleolus to terminate in the foot as plantar nerves. The great and small
saphenous veins ascend the posteromedial and lateral aspects, respectively, these work alongside the
deep and centrally located posterior tibial veins to drain venous blood from the leg.
Lower Limb 109

NERVES AND VESSELS
Key points about ineurovasculature of the knee and leg
Genicular anastomosis (knee): five genicular branches of popliteal artery (superior

and inferior medial, superior and inferior lateral, middle genicular arteries), anterior
Arteries and posterior tibial recurrent arteries, descending branches of femoral and lateral
circumflex arteries, circumflex fibular branch of posterior tibial artery
Leg: popliteal artery, anterior tibial artery, posterior tibial artery, fibular artery
Popliteal vein, anterior tibial veins, posterior tibial veins, fibular veins, small
Veins
saphenous vein, great saphenous vein
Femoral nerve: saphenous nerve

Nerves Sciatic nerve: tibial nerve, common fibular nerve (superficial and deep fibular
nerves, lateral sural cutaneous nerve), sural nerve (medial sural cutaneous nerve)
co
Z
_i
o' Superficial fibular nerve Fibularis longus, fibularis brevis muscle
LU
O Tibialis anterior, extensor digitorum longus, fibularis tertius, extensor

Deep fibular nerve
hallucis longus
Gastrocnemius, popliteus, soleus, plantaris, tibialis posterior, flexor

Tibial nerve
digitorum longus, flexor hallucis longus
Saphenous nerve Anteromedial aspect of knee, medial aspect of leg
Lateral sural cutaneous

Proximal posterolateral aspect of leg
nerve
Superficial fibular nerve Distal lateral aspect of leg
Sural nerve Posterior aspect of leg
Arteries of the leg Veins of the lower

and foot limb
ARTERIES AND NERVES OF THE FOOT

The arterial supply to the foot can be divided into a dorsal and plantar compo
nent, that are connected through the pedal arches:
• The anterior tibial artery gives off a number of branches to supply the dor
sum of the foot.
• The posterior tibial artery, provides the branches for the plantar portion of
the foot.
Five major nerves provide innervation to the foot; these are the tibial, sural,
deep fibular, superficial fibular and saphenous nerves.

NERVES AND VESSELS
Lateral tarsal
artery
Medial tarsal
arteries
Arcuate
artery
Dorsal
metatarsal
arteries
Dorsalis pedis
artery metatarsal
arteries
FIGURE 3.39. Arteries of the foot. This image demonstrates the arterial network of the foot (dorsum
of the foot on the left, sole of the foot on the right), formed by the branches of the two main arteries:
Dorsalis pedis artery (branch of the anterior tibial artery) and medial and lateral plantar arteries (branches
of the posterior tibial artery). Notice the anastomoses and arterial arches that these vessels form in order
to supply the foot.
Lateral dorsal
cutaneous
nerve of foot
Dorsal digital
nerves of foot
proper plantar
digital nerves
FIGURE 3.40. Nerves of the foot. At first glance, the trajectory of the neural network seems similar to
the arterial one. The difference is that all these branches come from as many as 5 nerves. Notice how
the dorsum of the foot (image on the left) is supplied mainly by the branches of the superficial and deep
fibular, tibial and sural nerves. The cutaneous innervation of this area is supplied by the saphenous nerve.
Lower Limb 111

NERVES AND VESSELS
Finally, the sole of the foot (image on the right) is mainly innervated by the branches of the tibial nerve
(medial and lateral plantar nerves).
Key points about arteries and nerves of the foot
Dorsalis pedis artery: lateral and medial tarsal artery, arcuate artery,
deep plantar artery
Posterior tibial artery: medial plantar artery, lateral plantar artery

Arteries
Deep plantar arch: lateral plantar artery, deep plantar artery
Superficial plantar arch: lateral plantar artery, superficial branch of medial plantar
artery
Superficial fibular nerve: medial dorsal cutaneous nerve of foot, intermediate

dorsal cutaneous nerve of foot
co
Nerves
Deep fibular nerve: dorsal digital branches
Z
_i Tibial nerve: sural, medial calcaneal and medial and lateral plantar nerves
o'
LU
O
Tibial nerve Flexor digitorum longus and flexor hallucis longus muscles
Flexor hallucis brevis, flexor digitorum brevis, abductor hallucis and

Medial plantar nerve
lumbrical muscles
Flexor digiti minimi brevis, quadratus plantae, abductor digiti minimi,

Lateral plantar nerve dorsal and plantar interossei muscles, adductor hallucis and lumbrical
muscles
Extensor digitorum longus, extensor hallucis longus and extensor

Deep fibular nerve
digitorum brevis muscles
Dorsum of foot Saphenous, superficial fibular, sural, deep fibular and lateral plantar nerves
Sole of foot Saphenous, medial plantar, lateral plantar, sural and tibial nerves
Lower extremities Arteries of the leg

arteries and nerves and foot
Arterial anastomoses
of the lower
extremity

SPINE AND 4
BACK
Overview..................................................................................114
Regions of the back and buttocks.................................................. 114
Vertebral column.......................................................................... 115
Spine......................................................................................... 119
Cervical spine............................................................................... 119
Thoracic spine.............................................................................. 124
Lumbar spine................................................................................126
Sacrum and coccyx...................................................................... 128
Arteries of the vertebral column................................................... 130
Veins of the vertebral column....................................................... 132
Back......................................................................................... 134
Muscles of the back...................................................................... 134
Superficial muscles of the back................................................. 134
Deep muscles of the back.......................................................... 137
Neurovasculature of the back....................................................... 144
OVERVIEW
REGIONS OF THE BACK AND BUTTOCKS
The back and the buttocks comprise the posterior aspect of the trunk. Like the
rest of the body, the back and the buttocks are divided into several regions,
which help clinicians localize, describe and communicate various diseases and
injuries clearly and accurately.
Deltoid region Suprascapular region
Triangle of
auscultation Interscapular
region
Infrascapular
region
u Scapular region
<
co
a Vertebral
z
< region
id
Z
a Lateral region of
(/)
thorax
Lumbar region
Sacral region
Gluteal region
Coccygeal region Anal region
FIGURE 4.1. Regions of the back and buttocks. The back and buttocks present several distinct topographical
regions named according to their relations with underlying structures. The nine regions of the back are the
deltoid, suprascapular, scapular, interscapular, infrascapular, vertebral, lumbar and sacral regions and the
triangle of auscultation. The buttocks can be similarly classified into gluteal, anal and coccygeal regions.
Body regions learn

Anatomy of the back with quizzes and
labeled diagrams

OVERVIEW
VERTEBRAL COLUMN
The vertebral column (spine) is composed of 33-35 vertebrae, 24 of which are

separated by intervertebral discs; the remaining vertebrae are usually fused to
compose two respective bones, the sacrum and coccyx. The vertebral column
is divided into five regions: (from superior to inferior) the cervical, thoracic, lum
bar, sacral and coccygeal regions. The vertebrae articulate with each other by
connecting their bodies and their arches via intervertebral joints. These joints
are present throughout the whole spine, while some regions have region
specific joints (e.g., the thoracic spine with the ribs).
When observed from the lateral aspect, the vertebral column presents four
curvatures: Two concavities and two convexities. The curvatures that are
concave anteriorly are called the thoracic and sacral kyphoses. The curvatures
that are convex anteriorly are known as the cervical and lumbar lordoses.
Atlas (C1)
Axis (C2)
C3
C4
C5
C6
C7
Thoracic
spine
L1
L2
L3
L4
L5
Sacrum
FIGURE 4.2. Vertebral column (anterior and lateral views).
Spine and back 115

OVERVIEW
u
<
co
a
z
<
id FIGURE 4.3. Anatomy of a typical vertebra. The vertebrae of each region have common anatomical features
Z which help in distincting them one from another. Nevertheless, all vertebrae share a number of common/
a
(/) general features. The large cylindrical part located anteriorly is the vertebral body; it is separated above
and below from adjacent vertebral bodies by fibrocartilaginous structures known as intervertebral discs.
The posterior part of the vertebra is the vertebral arch, which is formed by two pedicles (one on either
side) and two laminae that complete the arch posteriorly. The body and arch of each vertebra enclose a
space called the vertebral foramen. Several projections, or processes, extend from the arch. Each vertebra
has a spinous process extending posteriorly on the midline, two transverse processes extending laterally,
as well as two superior and two inferior articular processes. Each articular process bears an articular facet
for articulation with a contiguous vertebra.
Key points about the vertebral column
Cervical spine (7)

Thoracic spine (12)
Main regions Lumbar spine (5)

Sacrum (5)
Coccyx (3-5)
Cervical lordosis (C2-T2)

Thoracic kyphosis (T2-T12)
Curvatures
Lumbar lordosis (T12—sacrovertebral angle)
Sacral kyphosis (sacrovertebral articulation—coccyx)
Movements Flexion, extension, lateral flexion, rotation (torsion)
Functions Movement, stabilization and support of the trunk; protection of the spinal cord
Key points about the structure of a typical vertebra
Vertebral body
Main
Vertebral arch
components
Vertebral foramen
Pedicles
Bony landmarks Laminae

of vertebral
Vertebral processes: spinous process, transverse processes, superior articular
arch
processes (with superior articular facets) and inferior articular processes
(with inferior articular facets)

OVERVIEW
-Vertebral body
Posterior longitudinal
ligament
Ligamenta flava
Transverse process_
of vertebra
Spinous process_
of vertebra
Intertransverse
ligament
_ Articular capsule _
of zygapophyseal joint
Interspinous
ligament
Supraspinous_
ligament
_ Inferior articular
process of vertebra
Superior articular
process of vertebra
Intervertebral disc
Anterior longitudinal ligament
FIGURE 4.4. Joints of the vertebral bodies and arches. Intervertebral joints are articulations between
adjacent vertebrae of the spine.
An intervertebral symphysis is the articulation of two contiguous vertebral bodies and the intervening
intervertebral disc. It is classified as a secondary cartilaginous joint or symphysis (fibrocartilage compo
sition). Vertebral bodies in the cervical region also articulate at uncovertebral joints (of Luschka). These
comprise four pairs of plane synovial joints present between the vertebrae C3-C7, along the lateral bor
ders of their vertebral bodies. A zygapophyseal joint (facet joint) is a synovial joint formed by the articular
processes of neighboring vertebrae. Both intervertebral disc and zygapophyseal joints extend between
the levels of the axis (C2) and sacrum (S1). The intervertebral joints are reinforced and supported by numer
ous ligaments.
The anterior and posterior longitudinal ligaments extend along the anterior and posterior surfaces of the
vertebral bodies and interposed intervertebral discs, respectively. The ligamenta flava can be seen on the
posterior surface of the vertebral canal, extending between adjacent laminae. The inferior articular pro
cesses of each vertebra articulates with the superior articular processes of its neighbor below, forming
two zygapophyseal (facet) joints at each vertebral level; each is surrounded by an articular capsule. Other
ligaments extend between different bony processes of the adjacent vertebrae, namely the intertrans-
verse ligament (between transverse processes) and interspinous and supraspinous ligaments (between
spinous processes).
Spine and back 117

OVERVIEW
Key points about the joints of the vertebral bodies and arches
Intervertebral symphysis: inferior vertebral plateau of superior vertebral body and

superior vertebral plateau of inferior vertebral body
Zygapophyseal joints: superior articular facets of inferior vertebra and inferior

Joints
articular facets of superior vertebra
Uncovertebral joints: uncinate processes of inferior vertebra and inferolateral

surfaces of superior vertebral body
Main ligaments
Anterior longitudinal ligament: anterior aspect of vertebral bodies and

intervertebral discs
Posterior longitudinal ligament: posterior aspect of vertebral bodies and
intervertebral discs
Accessory ligaments
Ligaments
Ligamenta flava: posterior surface of vertebral canal, along adjacent laminae
Interspinous ligaments: adjacent spinous processes
Supraspinous ligament: extremities of spinous processes
Intertransverse ligaments: adjacent transverse processes
Nuchal ligament: external occipital protuberance to spinous process of C7
Movements Flexion, extension, lateral flexion, rotation
Curvature and
Vertebral column movements of the
vertebral column

SPINE
CERVICAL SPINE
The cervical spine consists of seven vertebrae named sequentially in a supero-
inferior direction, C1-C7.
There are three atypical vertebrae in the cervical spine. The first (C1) and second
(C2) cervical vertebrae are known as the atlas and axis, while the seventh ver
tebra (C7) is named the vertebra prominens, due its elongated spinous process.
The rest of the cervical vertebrae, C3-C6, all have a similar anatomical structure
and are therefore classified as typical vertebrae.
Anterior tubercle
Groove for spinal nerve

<n
2
z
m
>
z
Posterior tubercle □
tn
>
n
7s
Transverse foramen
Superior articular
process
Pedicle of vertebral arch
Lamina of vertebral arch
Spinous process
FIGURE 4.5. A typical cervical vertebrae (C3-C6) consists of a body and arch. The vertebral body is smaller
than that of its thoracic and lumbar counterparts due to the fact that it supports less weight. The
vertebral arch projects from the posterior side of the body, initially as paired pedicles which represent
the root of the arch. The pedicles are connected by a pair of laminae which enclose the vertebral foramen.
The spinous process may be bifid, something only seen in cervical vertebrae.
Spine and back 119

SPINE
u
<
co
a
z
<
id
Z
a
(/)
FIGURE 4.6. Superior view of atlas (C1), posterior view of axis (C2). The atlas (C1) is a ring-shaped vertebra,
devoid of vertebral body and spinous process. It consists of the anterior and posterior arches which are
connected via a lateral mass on each side, together enclosing the vertebral canal through which the spinal
cord passes. Each lateral mass features articular facets on its superior and inferior surface and a single
transverse process that projects laterally.
The anterior and posterior arches feature several bony landmarks that provide the attachment points for
the ligaments of the cervical spine. Moreover, the anterior arch contains an articular surface that partic
ipates in formation of the median atlantoaxial joint, a joint between atlas and axis. The superior and infe
rior articular facets of the lateral masses participate in the atlantooccipital and lateral atlantoaxial joints,
respectively. The former is a joint between the atlas and the occipital bone, while the latter is a three-part
joint between the atlas and axis. The transverse processes that stem from the lateral masses feature a
small foramen called foramen transversarium. This foramen exists in vertebrae C1-C6 and it is traversed
by the vertebral artery.
The axis (C2) primarily differs from a typical vertebra by its prominent bony projection known as the dens
(odontoid process). As a whole, the axis consists of anterior and posterior parts. The anterior part is formed
by the body and dens, while the posterior part consists of two pedicles, two transverse processes, two
laminae and a spinous process. The body of the axis is small and inferiorly elongated so that it overlaps
the vertebra C3. It serves as an attachment point to several muscles and ligaments of the neck. The dens
of axis projects from the superior surface of the body. It features an anterior articular facet which articu
lates with atlas at the median atlantoaxial joint and a posterior articular facet over which runs the trans
verse ligament of atlas. Either side of the dens, the body of the axis features superior and inferior articular
facets which are located on its superior and inferior surfaces, respectively. The former participate in the
lateral atlantoaxial joints, while the latter articulate with vertebra C3 via specialized zygapophyseal joints,
which are sometimes collectively referred to as the vertebroaxial joint.

SPINE
FIGURE 4.7. Atlantooccipital and atlantoaxial joints. The atlas articulates with the occipital bone at the
atlantooccipital joint, which presents the primary connection of the head with the trunk. This is a synovial
joint formed by the occipital condyles and superior articular facets of the atlas. The joint is secured by the
anterior and posterior atlantooccipital membranes and allows for flexion and extension of the head, as
well as a limited degree of lateral flexion.
The atlas and axis articulate via a complex atlantoaxial joint. This joint consists of three synovial com
ponents: A single median atlantoaxial joint and paired lateral atlantoaxial joints. The main movement of
this complex joint is the axial rotation of the head, but it also allows limited flexion, extension and lateral
flexion.
The median atlantoaxial joint (a.k.a. atlantodental joint) is formed by the dens of axis, anterior arch of the
atlas and transverse ligament of the atlas. It is composed of two elements: An articulation between the
anterior articular facet of the dens axis and facet for dens located on the internal surface of the anterior
arch of the atlas, as well as a second articulation between the posterior articular facet of the dens axis and
the anterior surface of the transverse ligament of atlas. The joint is primarily reinforced by the cruciform
ligament complex, which consists of the transverse ligament of atlas, superior and inferior longitudinal
bands of cruciform ligament. The additional support is provided by the tectorial membrane, alar ligaments,
apical ligament of dens, anterior and posterior atlantoaxial membranes.
The left and right lateral atlantoaxial joints are formed by the inferior articular surfaces of the lateral
masses of the atlas with the superior articular surfaces of the axis. They are reinforced by several liga
ments e.g. the accessory atlantoaxial ligament, anterior/posterior atlantoaxial membranes, tectorial
membrane etc.
Spine and back 121

SPINE
Posterior
Tectorial membrane of
atlantooccipital
cervical vertebral column
membrane
Apical ligament of dens Posterior

atlantoaxial
membrane
Basilar part of
occipital bone External occipital
protuberance
Anterior
atlantooccipitaL
membrane Posterior arch
of atLas
Anterior
atlantooccipitaL
ligament
Nuchal ligament
Anterior arch
of atlas
Interspinous ligament
Anterior atlantoaxial
id
o membrane
<
co
a Ligamenta flava
z Transverse ligament
<
id of atlas
Z
<n Articular capsule of
Anterior longitudinal
zygapophyseal joint
ligament
Longitudinal bands of Posterior longitudinal

cruciform ligament ligament
FIGURE 4.8. Craniovertebral ligaments (midsagittal view). Midsagittal section through the base of the
skull and cervical vertebrae. The dynamic craniovertebral joints are stabilized by a number of ligaments
which can be identified in this image. The anterior and posterior atlantooccipital membranes prevent
excessive movement at the atlantooccipital joint, and are further stabilized by the anterior and lateral
atlantooccipital ligaments. The anterior atlantooccipital ligament is a median thickening of the anterior
atlantooccipital membrane while the lateral atlantooccipital ligaments (not shown) develop as a thickening
of the articular capsule of the joint. Connecting the axis to the base of the cranium are the apical ligament
of dens, the transverse occipital ligament (not shown), the alar ligaments and the tectorial membrane.
The median atlantoaxial joint is stabilized by a series of ligaments known as the anterior atlantoaxial
membrane, the anterior atlantodental ligament (not shown) and the cruciform ligament.
Key points about the cervical spine
Seven cervical vertebrae
Structure Typical: C3-C6
Atypical: C1, C2, C7
Body, arch (pedicles and laminae), spinous process, transverse processes, superior
Typical vertebra
and inferior articular processes and their articular facets
Atlas (C1): anterior arch, posterior arch, lateral mass, transverse process, vertebral
canal
Atypical Axis (C2): vertebral body, dens axis, pedicle (x2), transverse process (x2), lamina (x2),
vertebra spinous process
Vertebra prominens (C7): all features as in typical vertebra, except that the spinous
process is longer and not bifid and the body is larger

SPINE
Key points about the cervical spine
Atlantooccipital joint: atlas (C1) and occipital bone
Atlantoaxial joints: atlas (C1) and axis (C2)

Intervertebral symphyses: bodies of contiguous vertebrae
Joints
Zygaopophyseal joints: superior and inferior articular processes of contiguous
vertebrae
Uncovertebral joints: uncinate processes of the superior surface of vertebral body
with inferior surface of vertebral body above
Key points about the atlantooccipital joint
Type Synovial ellipsoid joint; biaxial
Articular
Occipital condyles, superior articular facets of atlas
surfaces
Ligaments Posterior atlantooccipital ligament, anterior atlantooccipital ligament
Principal movement; Flexion - extension

Movements
Limited lateral flexion
Key points about the atlantoaxial joint
Type Atlantoaxial joint complex: synovial joint; biaxial
Median atlantoaxial joint: dens of axis (C2), osteoligamentous ring (anterior arch of
Articular atlas [C1], transverse ligament of atlas)
surfaces Lateral atlantoaxial joints: inferior articular surface of lateral mass for atlas,
superior articular facet of axis
Cruciform ligament (transverse ligament of atlas, superior and inferior longitudinal

Ligaments
bands), tectorial membrane, alar ligaments, apical ligament of dens
Principal movement; axial rotation,

Movements
Limited flexion, extension, lateral flexion
Vertebral column
191 Cervical spine
Atlantooccipital joint Atlantoaxial joint
Spine and back 123

SPINE
THORACIC SPINE
The thoracic spine consists of 12 vertebrae, designated T1-T12 from superior

to inferior. Eight thoracic vertebrae, T2-T9 are the typical vertebrae, while the
remaining four are atypical. The exclusive feature of the thoracic vertebrae is
that each of them articulates with a pair of ribs, and therefore contain compo
nents to accommodate that.
Costal facet of transverse process
Inferior costal facet
Inferior articular process
u
<
co Inferior articular facet
a
z
<
id
Z
a
(/)
Superior costal facet
Vertebral foramen
Pedicle of vertebral arch
Superior articular facet
Transverse process
Lamina of vertebral arch
Spinous process
FIGURE 4.9. Typical thoracic vertebra. A typical thoracic vertebra consists of a body, arch, spinous,
transverse and superior and inferior articular processes. The body (typically heart-shaped) is larger than
those seen in the cervical spine, but smaller than those of lumbar vertebrae. Specific features of thoracic
vertebrae are:
• Costal facets: Vertebrae T2-T9 bear superior and inferior ‘demifacets’ which are located on the superior
and inferior margins of the lateral sides of each vertebral body (therefore, articulation with the head of
one rib is shared between adjacent vertebrae. Vertebra T1 features a demifacet along its inferolateral
margins, and a whole facet on its superolateral surfaces. Vertebrae T10-T12 features a single whole
costal facet on each side of their body.
• Vertebral arch: More circular and smaller than that in cervical vertebrae.
• Spinous process: Elongated, the angle between the spinous process and the body becomes more acute
in lower levels.
• Transverse processes: Feature costal facets for articulation with the tubercle of the ipsilateral numeri
cally equivalent rib (exception: Vertebrae T11/T12).
• Superior and inferior articular processes: Superior processes face backward (and slightly lateral/
upwards), inferior process are oriented forward (and slightly medial/downward)

SPINE
Key points about the thoracic spine
12 thoracic vertebrae
Structure Typical: T2-T9

Atypical: T1, T10-T12
Body, arch, costal facets, spinous process, transverse processes, superior and
Typical vertebra
inferior articular processes
T1: features one demifacet and one full facet on each side
Atypical
T10: single costal facets on each side
vertebra
T11, T12: single costal facets on each side, no costotransverse joints
Intervertebral symphyses: between bodies of contiguous vertebrae

Zygapophyseal joints: between articular processes of contiguous vertebrae
Joints Costocorporeal joints: between costal facets/demifacets of vertebral bodies and

head of ribs
Costotransverse joints: between costal facets on transverse processes and
tubercles of ribs
Key points about costovertebral joints
Costocorporeal joint: costal demifacets on vertebrae T1-T9, full costal facets on

Articular vertebrae T1, T10, T11, T12; heads of ribs 1-12
surfaces Costotransverse joint: tubercle of ribs 1-10, transverse costal facets on transverse
processes of numerically equivalent vertebrae
Costocorporeal joint: fibrous capsule, radiate, intraarticular ligaments (only joints

2-9)
Ligaments
Costotransverse joint: fibrous capsule, costotransverse, superior costotransverse,
lateral costotransverse, accessory ligament (sometimes absent)
Costocorporeal joints: internal rotation and elevation of head of rib
Movements Costotransverse joints 1-6: internal rotation of neck of rib

Costotransverse joints 7-10: posteromedial translation of neck of rib
Thoracic vertebrae Thoracic cage
Learn anatomy of the

spine diagrams and
interactive vertebrae
quizzes
Spine and back 125

SPINE
LUMBAR SPINE
The lumbar spine consists of five lumbar vertebrae, designated L1-L5. They are
the largest and sturdiest examples of all vertebrae due to their role in support
ing the weight of the upper body. Like their cervical and thoracic counterparts,
the lumbar vertebrae articulate with each other via the intervertebral symphy
ses and zygapophyseal joints. The inferiormost lumbar vertebra, L5, articulates
with the sacrum via the lumbosacral joint, which is morphologically similar to
the more superior intervertebral joints.
Nucleus pulposus (D
(D
(D
Anulus fibrosis
Vertebral foramen
Pedicle of vertebral
arch
Transverse process
Superior articular
process
--- Superior articular facet
Mammillary process of
Lumbar vertebra
Spinous process of vertebra
FIGURE 4.10. Typical lumbar vertebra. A typical lumbar vertebra bears a large and ellipsoid vertebral
body which increases in size from L1 to L5. The lumbar vertebral arches are noticeably smaller, therefore
enclosing a relatively narrow vertebral canal. The spinous process is thick and short and nearly horizontally
oriented. The transverse processes are more slender than those in the upper segments of the spine and
are devoid of any articular surfaces. The superior processes are concave and face medially, whereas
the inferior processes are convex and are laterally oriented towards the superior processes of the next
vertebra.
The distinguishing components of the lumbar vertebrae are the accessory and mammillary processes,
which serve as the attachment sites for the deep muscles of the back; the accessory processes projects
from the roots of the transverse processes (not shown), while the mammillary processes project from the
posterior surfaces of the superior articular processes.

SPINE
Key points about the lumbar spine
Structure Five lumbar vertebrae (L1-L5)
Vertebral body, vertebral arch, spinous process, transverse processes, accessory

Typical vertebra
process, mammillary processes
Intervertebral symphyseal joints: between the bodies of the contiguous vertebrae

Joints
Lumbosacral joint: intervertebral and zygapophyseal joints between L5 and sacrum
Key points about the lumbosacral joint
Anterior intervertebral joint: symphysis

Type
Facet joints: synovial plane joints
Anterior intervertebral joint: inferior surface of L5 vertebral body, superior surface

Articular of S1 vertebral body
surfaces
Facet joints: superior articular processes of the S1, inferior articular processes of L5
Ligaments Iliolumbar ligament, lateral lumbosacral ligament
Movements Flexion, extension, lateral flexion
W.H
Lumbar vertebrae
enKS!
Spine and back 127

SPINE
SACRUM AND COCCYX
The sacrum is a triangular bone comprising five fused sacral vertebrae, S1-S5.
It articulates with the iliac components of the hip bones via the sacroiliac joint,
therefore contributing to the pelvic girdle and playing an important role in sta
bilization of the pelvis. Superiorly, it articulates with the inferiormost lumbar
vertebra (L5) to form the lumbosacral joint. Inferiorly, it articulates with the
coccyx to form the sacrococcygeal joint.
The coccyx is the most inferior part of the spine and consists of three to five
fused rudimentary coccygeal vertebrae.
FIGURE 4.11. Overview of sacrum and coccyx (anterior and posterior views). The sacrum consists of
a base, paired lateral parts and apex. It is convex anteriorly and features dorsal and pelvic surfaces. The
dorsal surface is vertically ridged due to the presence of the following crests: A single median sacral crest
(fusion of spinous processes), as well as bilateral/paired intermediate and lateral sacral crests (fusion of
articular and transverse processes, respectively). The intermediate crests terminate inferiorly as the sacral
horns. Between the intermediate and lateral ridges are four posterior sacral foramina. The pelvic surface
is relatively smooth, except for four transverse ridges located between the bodies of vertebrae S1-S5.
Four anterior sacral foramina are also present, as well as a large anterior projection of the base, known
as the sacral promontory. The lateral parts of sacrum represent the fused expansions of the transverse
processes as well as vestiges of the sacral ribs. The lateral aspects of the sacrum each feature a rough
articular surface, known as the auricular surface, at which the sacrum articulates with ilium forming the

SPINE
sacroiliac joints.The apex of the sacrum articulates with the base of coccyx, forming at the sacrococcygeal
joint. The vertebral foramina of fused sacral vertebrae together form a vertebral canal that passes through
the sacrum, transmitting the distal parts of the cauda equina and the filum terminale.
The coccyx is the most inferior/caudal part of the spine and consists of three to five fused coccygeal ver
tebrae (Co1-5). It consists of three parts: A base, a pair of horns and an apex. The base of coccyx articulates
with the sacrum, while the apex faces inferiorly and represents the termination of the vertebral column.
The coccygeal horns project superiorly from the posterior margin of the base to articulate with the sacral
horns.
Key points about the sacrum
Structure Five fused sacral vertebrae (S1-S5)
Dorsal surface: median crest, intermediate crests, lateral crests, four pairs of
posterior sacral foramina, sacral horns
Pelvic surface: transverse ridges, sacral promontory, four pairs of anterior sacral
foramina
Parts
Lateral (auricular) surface: articulates with ilium
Base: articulates with L5
Apex: articulates with coccyx
Lumbosacral joint: between the superior auricular process of sacrum and inferior
articular facets of L5
Joints
Sacrococcygeal joint: between the apex of the sacrum and the base of the coccyx
Sacroiliac joint: between lateral sacral surface and iliac articulation surface
Key points about the coccyx
Structure 3-5 fused coccygeal vertebrae
Parts Apex, base, coccygeal horns
Joints Sacrococcygeal joint: between the apex of the sacrum and the base of the coccyx
Sacrum
Spine and back 129

SPINE
ARTERIES OF THE VERTEBRAL COLUMN
Each vertebra is supplied by a number of spinal, periosteal, pre/postcentral and

pre/postlaminar l vessels which arise from larger parent arteries. The vertebrae
of the cervical region primarily receive their arterial supply from the vertebral
and ascending cervical arteries. The posterior intercostal and subcostal arteries
supply vertebrae of the thoracic region, the lumbar arteries supply vertebrae of
the lumbar region, while the vertebrae of the sacral region receive their blood
supply from the iliolumbar and lateral and medial sacral arteries.
Posterior radicular artery
Anterior radicular artery
Prelaminar branch
Dorsal branch of
posterior intercostal artery
Postcentral branch
Spinal branch of
Precentral branch
Thoracic aorta
Periosteal arteries
Posterior intercostal artery
FIGURE 4.12. Blood supply of thoracic vertebrae. The thoracic aorta descends along the anterior surface
of the vertebral bodies giving off multiple paired posterior intercostal arteries. Small precentral and
periosteal branches arise directly from the posterior intercostal arteries along the anterolateral aspect of
the vertebral bodies. The spinal arterial branches arise either directly from the posterior intercostal artery
or from one of its major branches, the dorsal branch of the posterior intercostal artery. The segmental
spinal branch travels with the spinal nerve in the intervertebral foramen towards the vertebral foramen,
where it branches into postcentral (anterior), prelaminar (posterior) and radicular arteries. The postcentral
and prelaminar arteries give off branches to supply the vertebral body and the lamina respectively, and
anastomose with arteries of adjacent vertebral levels. The radicular arteries supply the spinal nerves and
meninges of the spinal cord.

SPINE
Abdominal aorta Common iliac artery
External iliac
artery
Median sacraL
artery
Internal iliac
artery
Iliolumbar-
artery
Anterior division of
internal iliac artery
Lateral sacral artery Posterior division of

internal iliac artery
FIGURE 4.13. Arteries of the sacrum and coccyx (anterior view). The abdominal aorta terminates by
bifurcating into the left and right common iliac arteries anterior to the body of L4, each of which in turn
divide into internal and external iliac arteries. Arising from the posterior division of the internal iliac artery
is the iliolumbar artery, a small vessel which runs superolaterally along the anterior surface of the ala of
the sacrum supplying structures within this region. Also arising from the posterior division of the internal
iliac artery are the lateral sacral arteries. The paired lateral sacral arteries descend anterior to the anterior
sacral foramina and anterior rami of the sacral spinal nerves and give off several spinal branches which
travel through the sacral foramina to supply structures of the spinal cord. Arising from the posterior
aspect of the abdominal aorta, just proximal to the bifurcation is the median sacral artery. This is an
unpaired artery which runs along the anterior surface of the last two lumbar vertebrae and the length
of the sacrum and coccyx. As this artery passes over the sacral promontory it gives off small transverse
branches which anastomose with the right and left lateral sacral arteries.
Key points about the arteries of the vertebral column
Cervical: vertebral and ascending cervical arteries
Thoracic: posterior intercostal arteries

Parent arteries
by region Lumbar: L1-L4: subcostal and lumbar arteries L5: iliolumbar and median sacral
arteries
Sacrum: iliolumbar and lateral and median sacral arteries
Arteries
Periosteal branches, equatorial branches, nutrient branches, segmental spinal
of isolated
branches, prelaminar arterial branch, postcentral arterial branch, radicular arteries
vertebra
Lumbar arteries
Spine and back 131

SPINE
VEINS OF THE VERTEBRAL COLUMN
The vertebral column is drained by four venous plexuses: The anterior exter
nal, anterior internal, posterior internal and posterior external vertebral venous
plexuses. These plexuses communicate with each other through the interver
tebral foramina and drain the external and internal regions of each vertebra.
Intervertebral veins drain the vertebral venous plexuses and travel through the
intervertebral foramina to empty into the vertebral veins (cervical), the poste
rior intercostal veins (thoracic), the lumbar veins and the sacral veins.
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FIGURE 4.14. Veins of the lumbar vertebrae (sagittal and left superolateral views). Spinal veins form
internal and external vertebral venous plexuses along the vertebral column. Each of these plexuses can be
further divided into an anterior and a posterior plexus. Within the trabecular bone of the vertebral body are
the basivertebral veins. These veins emerge on the posterior aspect of each vertebral body and drain into
the anterior external and anterior internal venous plexuses. The intervertebral veins are located on the
superior surface of the pedicle of each vertebra and drain regions of the spinal cord and vertebral plexuses.
The intervertebral veins travel through the intervertebral foramina of the vertebral column to drain into
the vertebral veins of the neck and segmental veins of the trunk.

SPINE
Key points about the veins of the vertebral column
Cervical: vertebral veins
Collecting veins Thoracic: intercostal veins

by region Lumbar: lumbar veins -> Ascending lumbar veins
Sacrum: sacral veins
Veins of
Anterior and posterior external vertebral venous plexuses, anterior and posterior
isolated
internal vertebral venous plexuses, basivertebral veins, intervertebral veins
vertebra
Veins of the vertebral

column
Spine and back 133

BACK
MUSCLES OF THE BACK
The back muscles are divided into two large groups:
• The superficial (extrinsic) back muscles, which lie most superficially on the
back. These muscles are also called immigrant muscles, since they actually
represent muscles of the upper limb that have migrated to the back during
fetal development. These muscles are divided into superficial and interme
diate layers.
• The deep (intrinsic) back muscles, which are also called true back muscles.
They are located deep to the extrinsic muscles, from which they are separated
by the thoracolumbar fascia. Their primary function is to produce movements
of the vertebral column. These muscles are divided into superficial, deep, and
deepest layers.
Superficial muscles of the back
The superficial muscles are located beneath the skin and superficial fascia of
the back and extend between the vertebral column and bones of the pectoral
girdle and arm. Their principal function is to support and move the upper limb
through movement of the scapula and humerus.
They are divided into two different groups consisting of a:
• Superficial layer: Trapezius, latissimus dorsi, levator scapulae, rhomboid major

and minor muscles
• Intermediate layer: Serratus posterior superior and serratus posterior inferior
muscles
Overview of back
muscles

BACK
Obliquus capitis Rectus capitis

superior muscle posterior
major muscle
Rectus capitis
posterior minor
muscle Obliquus capitis
interior muscle
Trapezius
muscle
Levator
scapulae
muscle
Rhomboid major
muscle
Serratus posterior
Latissimus dorsi superior muscle
muscle
Serratus posterior Rhomboid minor

inferior muscle muscle
FIGURE 4.15. Overview of the superficial muscles of the back. Overview of the superficial muscles of
the back showing their attachment points on the bones of the trunk and upper limb. The trapezius and
latissimus dorsi muscles are the largest members of this group and cover most of the back with the
exception of the scapular region. Deep to them are the smaller members of the superficial layer (levator
scapulae, rhomboid major and minor muscles). The serratus posterior superior and inferior muscles
belong to the intermediate layer. In addition, a few of the suboccipital muscles can also be observed along
the occipitocervical junction.
Spine and back 135

BACK
Superficial layer Origin Insertion Innervation Function
Descending Descending part: Descending part:

part: medial lateral third of scapulothoracic
third of superior clavicle joint: draws
nuchal line, scapula
External occipital superomedially;
protuberance, atlantooccipital
Spinous processes joint/upper
of cervical cervical
vertebrae/Nuchal vertebrae:
ligament extension of
head and neck,
lateral flexion of
head and neck
Motor: accessory
(ipsilateral);
nerve (CN XI)
altantoaxial joint:
rotation of head
Trapezius (contralateral)
Sensory: anterior
rami of spinal
Transverse Transverse part: nerves C3-C4 (via Transverse part:
part: broad medial aspect cervical plexus) scapulothoracic
aponeurosis at of acromion, joint: draws
spinous processes Superior crest of scapula medially
of vertebrae T1-T4 spine of scapula
(or C7-T3)
Ascending part: Ascending part: Ascending part:

spinous processes medial end of scapulothoracic
of vertebrae spine of scapula joint: draws
T5-T12 (or T2-T12) scapula
inferomedially
(All parts support
scapula)
Scapulothoracic
joint: draws
Medial border Anterior rami scapula
Transverse of scapula (from of spinal nerves superomedially,
Levator scapulae processes of superior angle to C3-C4, Dorsal rotates glenoid
vertebrae C1-C4 root of spine of scapular nerve cavity inferiorly;
scapula) (C5) Cervical joints:
lateral flexion of
neck (ipsilateral)
Medial border Scapulothoracic

Spinous process of scapula (from joint: draws
Rhomboid major of vertebrae inferior angle to scapula
Dorsal scapular
T2-T5 root of spine of superomedially,
nerve
scapula) rotates glenoid
(C5) cavity inferiorly;
Nuchal ligament, Root (medial end)
Rhomboid minor Spinous processes of spine of supports position
of vertebrae C7-T1 scapula of scapula
Vertebral
part: spinous
processes of
vertebrae T7-T12,
Thoracolumbar
Shoulder joint:
fascia
arm internal
Iliac part: Intertubercular Thoracodorsal rotation, arm
Latissimus dorsi posterior third of sulcus of humerus nerve (C6-C8) adduction, arm
crest of ilium extension; assists
Costal part: ribs in respiration
9-12
Scapular part:
inferior angle of
scapula

BACK
Intermediate
layer
Nuchal ligament,
Serratus
spinous processes Superior borders 2nd-5th
posterior Elevates ribs
of vertebrae of ribs 2-5 Intercostal nerves
superior
C7-T3
Anterior rami
of spinal nerves
Serratus Spinous processes Depresses ribs/
Inferior borders of T9-T12 (a.k.a.
posterior of vertebrae Draws ribs
ribs 9-12 9th-11th
inferior T11-L2 inferoposteriorly
intercostal nerves
+ subcostal nerve)
Deep muscles of the back
The deep (intrinsic) muscles of the back extend along the length of either side
of the vertebral column, deep to the thoracolumbar fascia. Their main functions
include maintaining the body posture as well as facilitating the movements of
the vertebral column.
They can be subdivided into four groups, or layers:
• Superficial layer: Splenii muscles

• Intermediate layer: Erector spinae muscles
• Deep layer: Transversospinal muscles
• Deepest layer: Segmental muscles
The majority of the deep back muscles are innervated by the segmental branches
of the posterior rami of spinal nerves. The blood supply comes from branches
of the occipital, deep and transverse cervical, vertebral, posterior intercostal,
subcostal, lumbar and lateral sacral arteries.
Spine and back 137

BACK
Splenius capitis Semispinalis

muscle capitis muscle
Iliocostalis
cervicis muscle Longissimus
capitis muscle
Iliocostalis
thoracis muscle
Longissimus
cervicis muscle
Spinalis
thoracis muscle
Semispinalis
Longissimus thoracic muscle
thoracis muscle
Iliocostalis Multifidus
lumborum muscle muscle
FIGURE 4.16. Superficial and intermediate deep back muscles. The superficial layer of deep back muscles
consists of the two splenii muscles: Splenius capitis and cervicis (not labeled). The intermediate layer
consists of the erector spinae muscle group which is composed of three muscle columns: The iliocostalis,
longissimus and spinalis muscles. They are regionally divided into lumbar, thoracic, cervical, and capital
components.

BACK
Interspinales
Intertransversarii
cervicis
colli muscles
muscles
Spinalis Semispinalis
cervicis cervicis
muscle muscle
Rotatores
Interspinales
breves
thoracis
and longi
muscles
muscles
Intertransversarii Interspinales
lumborum lumborum
muscles muscles
FIGURE 4.17. Deep and deepest deep back muscles. The deep and deepest layers of the deep back muscles
consist of several smaller muscle groups. Broken down simply, the deep layer consists of a muscle group
called transversospinal muscles, subdivided into the semispinalis, multifidus and rotatores muscles. These
subgroups are further broken down into regional components, with the exception of the rotatores that
are divided based on their length into the short and long rotatores breves and longi.
The deepest layer consists of three muscle groups: Levatores costarum, interspinales and intertransver-
sarii muscles. They are often referred to as the segmental or minor back muscles given their small size and
limited role in the back movements.
Spine and back 139

BACK
Suboccipital
muscles
Medial part of Atlantooccipital

Rectus capitis Posterior tubercle
inferior nuchal joint: head
posterior minor of atlas (C1)
line extension
Bilateral
contraction—
Atlantooccipital
joint: head
extension
Lateral part of
Rectus capitis Spinous process
inferior nuchal
posterior major of axis (C2)
line
Unilateral
contraction—
Atlantoaxial joint:
Posterior ramus head rotation
of spinal nerve (ipsilateral)
C1 (suboccipital
Obliquus capitis Spinous process Transverse nerve)
inferior of axis (C2) process of atlas
Bilateral
contraction—
Atlantooccipital
joint: head
Occipital bone extension
Transverse
Obliquus capitis (between superior
process of atlas
superior and inferior
(C1) Unilateral
nuchal lines)
contraction—
Atlantoaxial
joint: head lateral
flexion (ipsilateral)
Bilateral
contraction—
Lateral superior Extends head/

Spinous processes Lateral branches neck
nuchal line of
of vertebrae of posterior rami
Splenius capitis occipital bone, Unilateral
C7-T3, nuchal of spinal nerves
Mastoid process contraction—
ligament C2-C3
of temporal bone
Lateral flexion
and rotation of
head (ipsilateral)
Bilateral
contraction—
Lateral branches Extends neck

Spinous processes Transverse
of posterior rami Unilateral
Splenius cervicis of vertebrae processes of
of lower cervical contraction—
T3-T6 vertebrae C1-C3
spinal nerves
Lateral flexion
and rotation of
neck (ipsilateral)

BACK
Iliocostalis
cervicis:
transverse
processes of
Iliocostalis
vertebrae C4-C6
cervicis: angle of
ribs 3-6
Iliocostalis Bilateral
thoracis: angles contraction—
Iliocostalis
of ribs 1-6,
thoracis: angle of Extension of spine
Transverse
ribs 7-12 Lateral branches
process of
Iliocostalis of posterior rami
vertebra C7
of spinal nerves Unilateral
Iliocostalis contraction—
lumborum:
Iliocostalis Lateral flexion of
lateral crest of
lumborum: spine (ipsilateral)
sacrum, medial
angle of ribs
end of iliac crest,
5-12, Transverse
thoracolumbar
processes of
fascia
vertebrae L1-L4
(+ Adjacent
thoracolumbar
fascia)
Longissimus
capitis: transverse
processes of
vertebrae C4-T5
Longissimus Longissimus
cervicis: capitis: mastoid Entire muscle:
transverse process of Bilateral
processes of temporal bone contraction—
vertebrae T1-T5
Extension of spine
Longissimus Unilateral
Longissimus cervicis: contraction—
thoracis: transverse
Lateral flexion of
processes of
Lumbar part: spine (ipsilateral)
vertebrae C2-C6
lumbar
intermuscular
Longissimus aponeurosis, Longissimus
Longissimus
medial part capitis only:
thoracis: lumbar
of sacropelvic part: accessory Bilateral
surface of and transverse contraction—
ilium, posterior processes of Extension of head
sacroiliac vertebrae L1-L5 and neck
ligament
Unilateral
Thoracic part: contraction—
Thoracic part: transverse Lateral flexion
spinous and process of and rotation of
transverse vertebrae T1-T12, head (ipsilateral)
processes of Angles of ribs 7-12
vertebrae L1-L5,
median sacral
crest, posterior
surface of
sacrum, posterior
iliac crest
Spine and back 141

BACK
Deep layer
(transversospinales)
Semispinalis
capitis: articular
Semispinalis Bilateral
processes of Semispinalis
capitis: between contraction —
vertebrae C4-C7, capitis:
superior and
Transverse descending Extension of
inferior nuchal
processes of branches head, cervical and
lines of occipital
vertebrae T1-T6 of greater thoracic spine
bone
occipital nerve
(C2) and spinal
Semispinalis nerve C3 Unilateral
Semispinalis
Semispinalis cervicis: contraction —
cervicis: spinous
transverse Lateral flexion
processes of
processes of Semispinalis
vertebrae C2-C5 of head, cervical
vertebrae T1-T6 cervicis/
and thoracic
thoracis:
spine (ipsilateral),
medial
Semispinalis rotation of head,
Semispinalis branches of
thoracis: spinous cervical and
thoracis: posterior rami
processes of thoracic spine
transverse of spinal nerves
vertebrae C6-T4 (contralateral)
processes of
vertebrae T6-T10
Multifidus
cervicis: superior
articular
processes of
vertebrae
C4-C7
Multifidus Bilateral
thoracis: contraction —
transverse
Extension of spine
process of Lateral aspect and
thoracic tips of spinous Medial
vertebrae processes of branches of
Multifidus Unilateral
vertebrae 2-5 posterior rami
contraction —
levels above of spinal nerves
Multifidus origin Lateral flexion of
lumborum: spine (ipsilateral),
mammillary rotation of spine
processes of (contralateral)
lumbar vertebrae,
posterior aspect
of sacrum,
posterior superior
iliac spine (PSIS)
of ilium, posterior
sacroiliac
ligament
Rotatores breves:
laminae/Spinous
Bilateral
Rotatores breves: process of
contraction —
transverse vertebra
processes of Extension of
(1 level above
vertebrae T2-T12 thoracic spine
origin)
Rotatores breves
and longi
Rotatores longi: Unilateral
Rotatores longi:
transverse contraction —
laminae/Spinous
processes
process of Rotation of
of thoracic
vertebra thoracic spine
vertebrae
(contralateral)
(2 levels above
origin)

BACK
Deepest layer Origin Insertion Innervation Function
Interspinales
cervicis: inferior
Interspinales aspect of spinous
cervicis: superior processes of
aspect of spinous vertebrae C2-C7
processes of
vertebrae C3-T1
Interspinales
Interspinales thoracis: inferior
thoracis: superior aspect of spinous
aspect of spinous processes of Extension of
Posterior rami of
Interspinales process of vertebrae T1, cervical and
spinal nerves
vertebrae T2, T11 & T10 & T11 lumbar spine
T12 (variable)
Interspinales
lumborum:
superior aspects
of spinous Interspinales
processes of lumborum:
vertebrae L2-L5 inferior aspects of
spinous processes
of vertebrae L1-L4
Anterior/
Anterior/ posterior cervical
posterior cervical intertransversarii:
intertransversarii: inferior border Anterior/
superior border of transverse posterior cervical
of transverse process of intertransversarii:
processes of superior adjacent anterior and
vertebrae C2-T1 cervical vertebra posterior rami
of cervical spinal
nerves
Medial lumbar Medial lumbar
Assists in lateral
intertransversarii: intertransversarii:
Intertransversarii flexion of spine;
accessory mammillary
stabilizes spine
processes of process of
vertebrae L1-L4 succeeding
vertebra
Lumbar
Lateral lumbar intertransversarii:
intertransversarii: Lateral lumbar anterior rami of
transverse intertransversarii: lumbar spinal
and accessory transverse nerves
processes of process of
vertebrae L1-L4 succeeding
vertebra
Superior border/
Transverse Posterior rami Elevation of
Levatores external surface
process of of spinal nerves ribs; rotation of
costarum of rib (one level
vertebrae C7-T11 T1-T12 thoracic spine
below origin)
Intrinsic back Overview of back

muscles muscles
Spine and back 143

BACK
NEUROVASCULATURE OF THE BACK
The arterial supply of the back is primarily derived via the posterior intercos
tal and lumbar arteries, which arise directly from the aorta. Additional supply is
delivered by cutaneous branches of arteries supplying the superficial (extrinsic)
muscles of the back (e.g. transverse cervical artery) as well as those forming the
scapular anastomosis. Venous drainage is achieved via similar patterns however
these vessels empty into the brachiocephalic veins, azygos venous system and
inferior vena cava.The skin of the back is primarily innervated by the posterior
rami of most of spinal nerves, specifically the medial branches of these rami
in the cervical and thoracic regions (C2-C5, T2-T12) and the lateral branches of
the posterior rami in the lumbar region (L1-L3). The superficial back muscles are
mainly innervated by branches of the cervical and brachial plexuses, and inter
costal nerves. Most of the deep muscles of the back are innervated by the pos
terior rami of cervical, thoracic and lumbar spinal nerves.
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id
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Posterior
auricular
Lesser occipital artery
nerve
Occipital artery
Great auricular- Vertebral artery

nerve
Deep cervical
vein
Suboccipital
nerve
Deep cervical
artery
Third occipital nerve Common carotid

artery
FIGURE 4.18. Neurovasculature of the dorsal neck.

BACK
Supraclavicular nerves
Transverse cervical artery
Lateral cutaneous branch

of intercostal nerve
Posterior intercostal
artery
vein
Subcostal vein
Subcostal artery
Intercostal nerve
Lumbar veins
Lumbar arteries
FIGURE 4.19. Neurovasculature of the back. The arterial supply of the back is primarily derived via the
posterior intercostal and lumbar arteries which arise directly from the aorta. Additional supply is delivered
by cutaneous branches of arteries supplying the superficial (extrinsic) muscles of the back (e.g. transverse
cervical artery) as well as those forming the scapular anastomosis. Venous drainage is achieved via similar
patterns however these vessels empty into the brachiocephalic veins, azygos venous system and inferior
vena cava. The skin of the back is primarily innervated by the posterior rami of most of spinal nerves,
specifically the medial branches of these rami in the cervical and thoracic regions (C2-C5, T2-T12) and
the lateral branches of the posterior rami in the lumbar region (L1-L3). The superficial back muscles are
mainly innervated by branches of the cervical and brachial plexus, and intercostal nerves. Most of the deep
muscles of the back are innervated by the posterior rami of cervical, thoracic and lumbar spinal nerves.
Arteries of the back and dorsal neck
Occipital artery Back of scalp, sternocleidomastoid muscle, deep muscles of back and neck
Deep cervical artery Deep muscles of neck
Transverse cervical
Trapezius muscle, sternocleidomastoid muscle
artery
Muscles and skin of the thoracic region
arteries
Subcostal artery Subcostal region
Lumbar arteries Muscles and skin in lumbar region, contents of vertebral canal, abdominal wall
Spine and back 145

BACK
Motor innervation of the back and dorsal neck
Superficial (extrinsic) All muscles innervated by branches of cervical/brachial plexus or intercostal

muscles of back nerves except for the trapezius muscle (accessory nerve [CN XI])
Deep (intrinsic) Almost all muscles innervated by posterior rami of cervical/thoracic/lumbar

muscles of back spinal nerves
Suboccipital muscles Suboccipital nerve (C1)
Cutaneous innervation of the back and dorsal neck
Posterior rami of spinal nerves C2-C4/5, greater/lesser/third occipital nerves

Cervical region
(C2-C3)
Posterior rami of spinal nerves T2-T12, lateral cutaneous branches of 2nd-11th

Thoracic region
intercostal nerves/subcostal nerve
Lumbar region Posterior rami of spinal nerves L1-L2/3
Muscles of the neck: Overview of back

An overview muscles
Anatomy of the back:

Intrinsic back
Spine and back
muscles
muscles

THORAX 5
Thoracic wall........................................................................... 148
Sternum.......................................................................................148
Ribs.............................................................................................. 150
Costovertebral joints....................................................................154
Muscles of the thoracic wall......................................................... 156
Thoracic surface of the diaphragm................................................160
Neurovasculature of the thoracic wall...........................................161
Neurovasculature of the intercostal space.................................... 165
Female breast..........................................................................168
Structure of the female breast..................................................... 168
Blood vessels of the female breast............................................... 169
Lymphatics of the female breast................................................... 171
Mediastinum....................................................... .................... 173

Borders, divisions and contents of the mediastinum ...................... 173
Neurovasculature of the posterior mediastinum.... ...................... 176
Esophagus............................................................. ..................... 180
Lymphatics of the mediastinum............................. ...................... 181
Lungs....................................................................................... 184
Trachea........................................................................................184
Bronchial tree and alveoli............................................................. 185
Overview of the lungs.................................................................. 189
Lungs in situ................................................................................. 192
Lymphatics of the lungs................................................................194
Heart....................................................................................... 196
Heart in situ................................................................................. 196
Surface anatomy of the heart....................................................... 199
Right atrium and ventricle........................................................... 202
Left atrium and ventricle..............................................................206
Heart valves.................................................................................208
Coronary arteries and cardiac veins...............................................212
Nerves of the heart...................................................................... 214
Lymphatics of the heart................................................................ 217
THORACIC WALL
STERNUM
The sternum is a flat, elongated bone located centrally in the anterior thoracic
wall. It’s made up of three main parts: The manubrium, body and xiphoid pro
cess. It articulates with the clavicles at the sternoclavicular joints and with
the cartilages of the first seven pairs of ribs through the sternochondral/ster-
nocostal joints. The sternum anchors the right and left ribs to stabilize the rib
cage, and has various functions including the protection of the heart and lungs
from mechanical damage.
Jugular notch
Clavicular notch
Manubrium
of sternum
Manubriosternal
joint
Body of sternum
Costal notches
Xiphisternal joint
Xiphoid process
FIGURE 5.1. Anterior and lateral perspectives of the sternum. The manubrium articulates with the body
of the sternum at the manubriosternal joint, and the body of the sternum with the xiphoid process at the
xiphisternal joint. On the manubrium, the jugular/suprasternal notch is located centrally along its superior
border and is flanked either side by the clavicular notches which accommodate the sternal end of each
clavicle.
Directly below the clavicular notch and along the length of the manubrium and body of the sternum are
seven paired costal notches which receive the cartilages of the true ribs. It’s important to note that the
sternum articulates with the costal cartilages and not directly with the ribs, through the sternochondral
joints. These joints allow slight movement of the thoracic cavity and expansion when breathing.

THORACIC WALL
Key points about sternum
Parts Manubrium, body of sternum, xiphoid process
Manubrium: jugular notch, clavicular notch, 1st costal notch, 2nd costal notch
Bony landmarks Body of sternum: 2nd-7th costal notches

Xiphoid process
Sternoclavicular joint: articulation between manubrium and clavicle

Sternochondral joints: articulation between sternum and costal cartilages of
Joints 1st-7th ribs
Manubriosternal joint: articulation between manubrium and body of sternum

Xiphisternal joint: articulation between body of sternum and xiphoid process
Provides an anchoring point for the costal cartilages;

Function
Protection of heart and lungs from mechanical damage.
Sternum
Thorax 149
THORACIC WALL
RIBS
The ribs are arc-shaped, flat bones that form the majority of the thoracic cage.
There are 12 pairs of ribs, articulating posteriorly with the thoracic vertebrae.
They serve to protect the thoracic organs such as the heart and lungs, and pro
vide attachment points to muscles of the back, chest and proximal upper limb.
In addition, ribs have an important role in breathing where they move during
chest expansion to enable lung inflation.
FIGURE 5.2. Ribs (lateral-left view). The ribs can be divided into groups based on which structure they
articulate with anteriorly. The first seven pairs of ribs articulate directly with the sternum through their
costal cartilages and are known as the true ribs or vertebrosternal ribs. The joints between the ribs and
their cartilages are called costochondral joints, while the joints between the cartilages and sternum are
called the sternochondral joints.
The 8th-10th ribs unite anteriorly via their costal cartilages and articulate indirectly with the sternum via
the 7th rib; they are known as false ribs or vertebrocostal ribs. The 11th and 12th ribs are known as floating
ribs as they do not attach to the sternum in any manner and are particularly short and have no necks nor
tubercles.

THORACIC WALL
FIGURE 5.3. Typical rib (superior view). The seventh rib is shown as a representative of all typical ribs
(3rd-9th). The typical ribs all present a head, neck, tubercle and body. From a superior perspective, the
crest of the neck, angle and external surface are visible. Each typical rib has a head with two articular
facets, separated crest of the head (not labeled): For articulation with the superior costal facet of its
corresponding vertebral body, and the other for articulation with the inferior costal facet of the superior
vertebra.
Inferiorly, the internal surface is shown medial to where the costal groove is located; this groove contains
the intercostal artery, vein and nerve. The distal end of a typical rib is continuous with a costal cartilage
which articulates directly, or indirectly, with the sternum.
Key points about ribs
True ribs: 1st-7th (vertebrosternal ribs)
False ribs: 8th-12th
Classifications (vertebrocostal ribs: 8th-10th, floating ribs: 11th-12th)

Typical ribs: 3rd-9th
Atypical ribs: 1st, 2nd, 10th-12th
Head: facet divided into two by crest of head of rib

Neck: crest of neck of rib
Parts & Body: tubercle, costal groove, angle
landmarks
(typical ribs) External and internal surfaces
Round superior border, sharp inferior border
Proximal (vertebral) and distal (sternal) ends
Provide attachment points to muscles of the back, thorax and proximal upper limb
Function
Protect thoracic organs such as heart and lungs
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THORACIC WALL
Articular facet of head of rib
Head of rib
Neck of rib
Tubercle of rib
Body of rib
Costal groove
Muscle attachments
Innermost intercostal muscles
Internal intercostal muscles
External intercostal muscles
FIGURE 5.4. Typical rib (inferior view). The 5th rib is shown from an inferior view. This perspective allows
the appreciation of the costal groove which is traversed by the intercostal vessels and intercostal nerve.
The order of these structures from superior to inferior is vein, artery, nerve.
The inferior surface of the rib provides the attachment sites for the intercostal muscles. The external and
internal intercostal muscles attach to the anterior margin of the groove, while the innermost intercostal
muscles attach to the posterior margin.
Ribs Thoracic cage

THORACIC WALL
1st rib
Groove for subclavius muscle
Groove for subclavian vein
Scalene tubercle
Tubercle of rib
Groove for subclavian artery
2nd rib
Tuberosity for serratus

anterior muscle
11th rib
FIGURE 5.5. Atypical ribs (superior view). The ribs 1, 2 and 11 are shown as representatives of atypical
ribs. The atypical ribs (1st, 2nd, 10th-12th) also have a head, neck and body, however, they differ in their
morphology and/or unique landmarks. For example, the 1st rib features attachment points for subclavius/
scalene muscles and grooves for subclavian vessels, while the 2nd rib contains the tuberosity for serratus
anterior muscle. The 11th and 12th ribs are more slender than the other ribs and lack several of the typical
landmarks seen on typical ribs. For example, these ribs don’t have a neck or tubercule, while only having
one facet on their heads, and as such articulating with only one vertebra.
Key points about ribs
Rib 1: shortest true rib, single facet on head; lacks angle and costal groove, has two
grooves for subclavian vessels, scalene tubercle
Rib 2: tuberosity for serratus anterior muscle

Atypical ribs
Rib 10: single facet on head
Rib 11: single facet on head; short neck, lacks tubercle, has a slight costal groove
Rib 12: single facet on head; lacks tubercle, angle, costal groove
Thorax 153
THORACIC WALL
COSTOVERTEBRAL JOINTS
The costovertebral joints refer to the articulations between the proximal ends
of the ribs and their corresponding vertebrae. A costovertebral joint comprises
two groups of synovial plane joints:
• Joint of head of rib (also sometimes referred to as costocorporeal joint)

• Costotransverse joint
In most cases, each rib articulates with its numerically equivalent vertebra and
the vertebra immediately superior to it. Exceptions to this are the costoverte
bral joints related to the 1st rib and the ribs 10-12, which only articulate with
one vertebra.
Intervertebral disc Vertebral foramen
Radiate ligament of Pedicle of vertebral

head of rib arch
Joint of head of rib Neck of rib
Lateral Tubercle of rib

costotransverse
ligament
Costotransverse
joint
Superior
costotransverse Costotransverse
ligament ligament
Superior articular Spinous process

facet of vertebra of vertebra
FIGURE 5.6. Costotransverse joints (superior view). The costotransverse joints are articulations between
the articular facets of the tubercles of the ribs and the costal facets on the transverse processes of the
corresponding vertebrae. These joints have a small synovial cavity that is surrounded by a weak articular
capsule. The capsule is reinforced and strengthened by the costotransverse, lateral costotransverse and
superior costotransverse ligaments. These joints are only present in the ribs 1-10.

THORACIC WALL
Transverse process of vertebra
Lateral costotransverse ligament
Intertransverse ligament
Inferior costal facet of vertebra
Costal facet of transverse

process
Superior costal facet of vertebra
Head of rib
Intraarticular ligament of head

of rib
Superior costotransverse
ligament
Radiate ligament of head of rib
Neck of rib
Intervertebral disc
Vertebral body
FIGURE 5.7. Joint of head of rib (lateral view). The joint of head of rib (costocorporeal joint), connects the
head of a rib to the body/bodies of adjacent thoracic vertebrae. The articulating surfaces of the 2nd to
9th ribs consist of a superior and an inferior costal facet, that articulate with the bodies of two adjacent
vertebrae: The vertebra of the same number and the vertebra above. An intervertebral disc is positioned
between these facets.
A short horizontally oriented intraarticular ligament extends from the anterior surface of the head of the
rib to the intervertebral disc, which helps to delineate an upper and a lower joint cavity. These cavities are
covered by a single articular capsule, which becomes thickened anteriorly to form the radiate ligament.
The heads of the 1st, 10th, 11th and 12th ribs each articulate with only one vertebra; thus, these joints only
have a single cavity.
Thorax 155
THORACIC WALL
MUSCLES OF THE THORACIC WALL
The muscles of the thoracic wall are defined as muscles attached to the bony
framework of the thoracic cage. They maintain the stability of the thoracic
wall, and play a role in respiration. The muscles of the thoracic wall are divided
into two groups: Intrinsic and extrinsic.
The intrinsic muscles of the thoracic wall originate and insert onto the tho
racic cage and contribute to its structure. This group of muscles generally work
together to facilitate breathing movements through the elevation and depres
sion of the lateral shaft of each rib and are therefore also known as the mus
cles of respiration. Intrinsic muscles of the thoracic wall include the: Serratus
posterior, levatores costarum, intercostal, subcostal and transversus thoracis
muscles, as well as the variably present sternalis muscle.
The extrinsic muscles of the thoracic wall usually have one attachment to the
thoracic cage and are functionally related to the neck, abdomen, back and/or
upper limbs. Although these muscles can be classified as thoracic muscles and
are involved in movement of the rib cage for respiration, their primary functions
relate to movement of the pectoral girdle and/or the arm and are therefore also
known as the anterior axioappendicular muscles. As a secondary function these
muscles contribute to movements during breathing and include the subclavius,
pectoralis major and minor muscles as well as the inferior portion of the serra-
tus anterior muscle.
Extrinsic
muscles
Anteroinferior surface Sternoclavicular

Costal cartilage, Subclavian
Subclavius of middle third of joint: anchors and
Sternal end of rib 1 nerve (C5-C6)
clavicle depresses clavicle
Clavicular head: Clavicular head:

anterior surface of lateral pectoral
clavicle nerve (C5-C7)
Shoulder joint: arm
(medial half) Sternocostal adduction, arm
Sternocostal head: Crest of greater head: medial internal rotation,
Pectoralis
anterior surface tubercle of humerus pectoral nerve arm flexion
major
of sternum, Costal (all heads) (C8-T1) (clavicular head),
cartilages of ribs 1-6 arm extension
Abdominal
(sternocostal head);
Abdominal (rectus) (rectus) head:
head: anterior layer medial pectoral
of rectus sheath nerve (C8-T1)
Scapulothoracic
Anterior surface, Lateral and joint: draws scapula
Pectoralis Coracoid process of
Costal cartilages of medial pectoral anteroinferiorly,
minor scapula
ribs 3-5 nerves (C5-T1) stabilizes scapula
on thoracic wall
Superior part: anterior

Superior part: ribs
surface of superior Scapulothoracic
1-2, Intercostal
angle of scapula joint: draws scapula
fascia
anterolaterally,
Middle part: anterior
Serratus Middle part: Long thoracic Suspends scapula
surface of medial
anterior ribs-3-6 nerve (C5-C7) on thoracic wall,
border of scapula
rotates scapula
Inferior part: ribs
Inferior part: anterior (draws inferiorly
7-8/9/10 (+ external
surface of inferior angle laterally)
oblique muscle)
angle of scapula

THORACIC WALL
intercostal thoracis
muscles muscle
FIGURE 5.8. Muscles of thoracic wall (anterior view). Intrinsic muscles evident from this anterior view
include the intercostal, subcostal and transversus thoracis muscles. Lying beneath the large extrinsic
muscles of the thoracic wall are the intercostal muscles (external, internal and innermost intercostal
muscles). These muscles are located within the intercostal spaces and function to elevate, stabilize or
depress the thoracic cage and therefore facilitate breathing movements. The subcostal muscles are
bands of muscle located on the internal surface of the lower ribs, sharing a plane with the innermost
intercostals. They support the intercostal spaces and thoracic cage, and depress the ribs during forced
expiration. Also located along the internal aspect of the thoracic cage is the transversus thoracis muscle.
This is a weak muscle of the rib cage which assists in expiration.
The extrinsic muscles of the thoracic wall include the subclavius, pectoralis major and minor and serratus
anterior muscles. The short, triangular subclavius muscle is located beneath the clavicle and mainly func
tions in anchoring and depressing the bone. The large pectoralis major muscle arises from three heads
(clavicular, sternocostal and abdominal) which unite before inserting into the intertubercular sulcus of
the humerus. Deep to the pectoralis major muscle, is the smaller pectoralis minor muscle. The pectoralis
major primarily flexes, adducts and internally rotates the arm at the shoulder joint on contraction, while
the pectoralis minor muscle stabilizes and draws the scapula anteroinferiorly.
Located along the anterolateral aspect of the thoracic wall is the large fan shaped serratus anterior mus
cle. This muscle primarily functions to rotate and draw the scapula anterolaterally. All of the extrinsic mus
cles of the thoracic wall participate in elevation of the rib cage during forced inspiration as a secondary
function.
Thorax 157
THORACIC WALL
Serratus posterior superior

muscle
Levatores costarum muscles
Serratus posterior inferior

muscle
External intercostal
muscles
Internal intercostal
muscles
Innermost intercostal
muscles
FIGURE 5.9. Muscles of thoracic wall (posterior view). The intrinsic muscles of the posterior thoracic
wall can be better appreciated from this view. The serratus posterior superior and inferior muscles are
two paired muscles located in the upper and lower back. Their main function is to facilitate the act of
respiration; the serratus posterior superior muscle elevates the ribs, while the serratus posterior inferior
muscle depresses the ribs. The levatores costarum consists of 12 small triangular bilateral muscles that
connect the thoracic vertebrae with the adjacent ribs. This group of muscles function in elevating the ribs
to facilitate forced inspiration and produce rotation and lateral flexion of the thoracic vertebrae.
The external, internal and innermost intercostal muscles can also be appreciated from a posterolateral
view of the thoracic cage. The external intercostal muscles are the most superficial intercostal muscles;
their fibers are oriented in an inferomedial direction. The internal intercostal muscles form the middle
layer of the intercostal musculature; their fibers course inferolaterally. The innermost intercostals are the
deepest intercostal muscles and course in the same manner as the internal intercostal muscles. All three
intercostal muscles are accessory respiratory muscles that participate in the process of forced breathing.

THORACIC WALL
Intrinsic muscles Origin Insertion Innervation Function
Serratus Nuchal ligament, Superior 2nd-5th

posterior spinous processes of borders of ribs Intercostal Elevates ribs
superior vertebrae C7-T3 2-5 nerves
Anterior rami
of spinal nerves
Serratus Depresses ribs/
Spinous processes of Inferior borders T9-T12 (9th-11th
posterior Draws ribs
vertebrae T11-L2 of ribs 9-12 Intercostal
inferior inferoposteriorly
nerves +
subcostal nerve)
Elevate ribs during

forced inspiration;
External
Inferior border of ribs Supports
intercostals
intercostal spaces
Superior border
and thoracic cage
of immediate rib
Internal below
intercostals
Costal groove of ribs Depresses ribs
Innermost during forced
intercostals expiration;
Intercostal
Supports
Internal surface nerves
intercostal spaces
Subcostal Internal surface of of rib
and thoracic cage
muscles ribs (near angle of rib) (2-3 levels
below origin)
Sternal ends of costal

cartilages of ribs Internal surface
Transversus 4-7, Inferoposterior of costal Depresses costal
thoracis surface of body of cartilages of ribs cartilages
sternum and xiphoid 2-6
process
Thorax Muscles of the trunk
Intercostal muscles
Thorax 159
THORACIC WALL
THORACIC SURFACE OF THE DIAPHRAGM
The diaphragm is a large, dome-shaped, musculotendinous structure that sep

arates the thoracic cavity from the abdominal cavity. Contraction of this large
muscle is vital for respiration, as it flattens the dome-like structure of the dia
phragm and thus expands the thoracic cavity, allowing air to flow into the lungs.
The diaphragm is innervated by the left and right phrenic nerves, which arise
from spinal nerves C3 to C5. There are a number of apertures, or openings,
which allow structures to pass through the diaphragm and enter or leave the
thoracic cavity. The three major openings are named after the structures that
pass through them: The aortic hiatus, esophageal hiatus and caval foramen.
Right sympathetic trunk
Left sympathetic trunk
Azygos vein
Hemiazygos vein
Thoracic aorta
Esophagus
Central tendon of diaphragm
Inferior vena cava
Pericardium
Diaphragmatic part of parietal

pleura
Mediastinal part of parietal pleura
Left costomediastinal recess
Costal part of parietal pleura
Right costomediastinal recess
Sternum
FIGURE 5.10. Thoracic surface of the diaphragm (superior view). The diaphragm is the large muscular
structure, which separates the thoracic cavity from the abdominal cavity and allows for the passage of
several important structures, including the aorta, inferior vena cava and esophagus. Directly covering the
diaphragm is a layer of the parietal pleura of the lungs called the diaphragmatic part of the parietal pleura.
In this illustration, the parietal pleura is partially removed on both sides, to reveal the left and right central
tendons of the diaphragm beneath.
The pericardium also lies directly on the diaphragm and encloses the heart. The muscle fibers of the dia
phragm radiate outwards from the central tendons and attach peripherally to the circumference of the
inferior thoracic aperture (vertebra T12, 11th and 12th ribs, costal cartilages of 7th-10th ribs and xiphoid
process of the sternum). The domed shape of the diaphragm accommodates several pleural recesses
along its border - the left and right costomediastinal recesses, located between the thoracic surface of
the diaphragm and the anterior wall of the rib cage, as well as the costodiaphragmatic recesses, located
between the diaphragm and lateral wall of the rib cage.

THORACIC WALL
Key points about the thoracic surface of the diaphragm
Parts Skeletal muscle (sternal, costal and lumbar parts), central tendon
Main muscle responsible for respiration; increases abdominal pressure to expel

Function
feces, vomit and urine; applies pressure on the esophagus to prevent acid reflux
Relations Parietal pleura, pericardium
Aortic hiatus: aorta, azygos vein, thoracic duct
Openings Esophageal hiatus: esophagus, branches of the left gastric artery and vein, anterior
(apertures) and posterior vagal trunks
Caval foramen: inferior vena cava, branches of the right phrenic nerve
Innervation Left and right phrenic nerves (C3-C5)
Diaphragm Anatomy of breathing
NEUROVASCULATURE OF THE THORACIC WALL
The thoracic wall has a rich arterial supply via branches that arise from three
main sources: The subclavian artery, axillary artery and the thoracic aorta.
The veins of the thoracic wall initially follow a similar course to that of their
arterial counterparts, however, most of them terminate by draining into the
azygos venous system. Lastly, the nervous supply to the thoracic wall mainly
stems from the anterior rami of the spinal nerves T1-T12 (intercostal/subcos-
tal nerves). Additional nervous supply to the thoracic wall stems from a small
number of preterminal branches of the brachial plexus (e.g., medial and lateral
pectoral nerves, long thoracic nerve).
Thorax 161
THORACIC WALL
Intercostal nerve
Anterior intercostal vein
Anterior intercostal artery
Internal thoracic vein
Internal thoracic artery
Azygos vein
Hemiazygos vein
Subcostal artery
Subcostal nerve
FIGURE 5.11. Arteries, veins and nerves of the thoracic wall. The main arteries of the thoracic wall are the
internal thoracic, anterior intercostal, posterior intercostal and subcostal arteries. The internal thoracic
artery arises from the subclavian artery, and distally terminates by splitting into the musculophrenic and
superior epigastric arteries.
The anterior intercostal arteries are a set of nine arteries that supply the anterior part of intercostal
spaces of the ribs 1-10. The upper six anterior intercostal arteries arise from the internal thoracic artery,
while the rest are branches of the musculophrenic artery. The posterior intercostal arteries are a set of
eleven arteries that supply the posterior intercostal spaces. The first and second arise from the supreme
intercostal artery, while the rest arise from the thoracic aorta. Finally, the subcostal artery arises from the
thoracic aorta and supplies the subcostal region below the 12th rib.
The venous drainage of the thoracic wall is accommodated by intercostal veins that accompany the inter
costal arteries. Most of the posterior intercostal veins (4th-11th) drain directly into the azygos venous
system. The 1st posterior intercostal vein, called the supreme intercostal vein drains directly into the
ipsilateral brachiocephalic vein. Additionally, the 2nd and 3rd posterior intercostal veins merge to form a
superior intercostal vein on each side. The left superior intercostal vein goes on to drain into the left bra
chiocephalic vein, while the right one drains into the azygos vein.
The anterior rami of spinal nerves T1-T11 (1st-11th thoracic nerves) form the intercostal nerves that course
within the intercostal spaces. The anterior ramus of spinal nerve T12 (12th thoracic nerve) forms the sub
costal nerve that runs below the rib cage. The pectoral muscles of the thoracic wall also receive inner
vation from the medial and lateral pectoral nerves, which arise from the medial and lateral cords of the
brachial plexus, respectively.

THORACIC WALL
Pectoral branches of
thoracoacromial artery
internal thoracic artery

of posterior intercostal
artery
FIGURE 5.12. Top image: Arteries of the thoracic wall. This image depicts the cutaneous and perforating
branches of the main thoracic vessels supplying the skin and muscles of the thoracic wall. Bottom image:
Veins of the thoracic wall. This image depicts the cutaneous and muscular tributaries to the veins of the
thoracic wall.
Thorax 163
THORACIC WALL
Supraclavicular nerves___ Brachial plexus
---- Long thoracic nerve
Pectoralis major muscle —
Lateral pectoral
nerve
Lateral Pectoralis
cutaneous minor muscle
branch of
intercostal
nerve
Medial pectoral
nerve
Anterior Rectus abdominis

cutaneous branch of muscle
intercostal nerve
External intercostal
muscles
Serratus anterior
muscle
Internal intercostal
muscles
External abdominal Internal abdominal

oblique muscle oblique muscle
FIGURE 5.13. Nerves of the thoracic wall. This image depicts the cutaneous and muscular branches
supplying the skin and musculature of the thoracic wall.
Key points about the neurovasculature of the thoracic wall
Internal thoracic artery (origin: subclavian artery)

Superior thoracic artery (origin: axillary artery)
Lateral thoracic artery (origin: axillary artery)
Arteries Anterior intercostal arteries (origin: internal thoracic artery (upper 6),
musculophrenic artery (lower 3))
Posterior intercostal arteries (origin: supreme intercostal artery (upper 2), thoracic
aorta (lower 10))
Subcostal artery (origin: thoracic aorta)
Anterior intercostal veins (drain into: internal thoracic vein)

Posterior intercostal veins:
• Supreme intercostal vein drains into: brachiocephalic vein

• Superior intercostal vein drains into: azygos vein (right), left brachiocephalic vein
Veins (left)
• Right 4th-11th drain into: azygos vein
• Left 4th-7th drain into: accessory hemiazygos vein

• Left 8th-11th drain into: hemiazygos vein
• Subcostal vein drains into: azygos vein (right), hemiazygos vein (left)

THORACIC WALL
Key points about the neurovasculature of the thoracic wall
Thoracic nerves:
Anterior rami of spinal nerves T1-T11 = intercostal nerves

Anterior ramus of spinal nerve T12 = subcostal nerve
Nerves Brachial plexus:
Long thoracic nerve (C5, C6, C7)

Lateral pectoral nerve (C5, C6, C7)
Medial pectoral nerve (C8, T1)
Intercostal arteries
IB®? Intercostal spaces
and veins
NEUROVASCULATURE OF THE INTERCOSTAL SPACE

Intercostal spaces are anatomical spaces which lie between adjacent ribs. They
are occupied by three layers of intercostal muscles as well as neurovascular
bundles of intercostal vessels and nerves. Each neurovascular bundle lies within
the costal groove, along the inferior margin of the superior rib, and passes in the
plane between the inner and innermost layers of muscles. From superior to infe
rior, they are arranged as vein, artery and then nerve. Smaller collateral branches
of each nerve, artery and vein run along the superior aspect of the lower rib.
Key points about the neurovasculature of the intercostal space
Anterior intercostal arteries

Origin: internal thoracic artery (upper six intercostal spaces), musculophrenic artery
(lower three intercostal spaces)
Branches: collateral branch

Arteries
Posterior intercostal arteries
Origin: supreme intercostal artery (upper two), descending thoracic aorta (lower
nine)
Branches: dorsal branch, collateral branch, lateral cutaneous branch
Anterior intercostal veins
Drain into: internal thoracic vein
Posterior intercostal veins
Supreme intercostal vein (1st) -> drains into brachiocephalic vein
Right 2nd-3rd (form right superior intercostal vein) -> drains into azygos vein
Veins
Left 2nd-3rd (form left superior intercostal vein) -> drains into left brachiocephalic
vein
Right 4th-11th -> drain into azygos vein
Left 4th-8th -> drain into accessory hemiazygos vein

Left 9th-11th -> drain into hemiazygos vein
Anterior rami of spinal nerves T1-T11 = Intercostal nerves

Nerves Branches: collateral branch, lateral cutaneous branch, anterior cutaneous branch
(muscular branches)
Thorax 165
THORACIC WALL
Collateral branch of posterior intercostal artery
Spinal branch of posterior intercostal artery
Dorsal branch of posterior intercostal artery
Accessory hemiazygos vein
Anterior intercostal artery
Collateral branch of
anterior intercostal artery
internal thoracic vein
Sternal branches of
Sternal branches of
internal thoracic vein
Dorsal branch of
posterior intercostal vein
Medial dorsal cutaneous
branch of posterior
intercostal artery
Lateral cutaneous branch of
Posterior intercostal vein
Lateral cutaneous branch of
Collateral branch of
Lateral dorsal cutaneous branch
of posterior intercostal artery
FIGURE 5.14. Vessels of the intercostal space (superolateral view). The anterior and posterior intercostal
arteries pass around the thoracic wall forming a basket-like pattern of vascular supply around it. These
arteries mostly originate from the thoracic aorta and internal thoracic artery, respectively. Venous
drainage generally parallels the pattern of arterial supply. The anterior intercostal veins drain into the
internal thoracic vein, adjacent to the internal thoracic artery. Most of the posterior intercostal veins drain
into the azygos venous system which is represented by the accessory hemiazygos vein at this level and left
lateral perspective of the thoracic cavity. Collateral vessels are given off towards the lower edge of each
intercostal space (superior border of lower rib).

THORACIC WALL

Spinal ganglion
Anterior cutaneous branch

Posterior ramus
of spinal nerve
Sympathetic trunk
White and
grey rami
communicantes
of spinal nerve
Intercostal
nerve
Medial branch of
posterior ramus
of spinal nerve
Collateral branch
Lateral branch of
posterior ramus of spinal nerve
FIGURE 5.15. Nerves of the intercostal space. Intercostal nerves originate as the anterior rami of spinal
nerves T1 to T11. Each gives rise to a lateral cutaneous branch and terminates anteriorly as anterior
cutaneous branches. In addition to these major branches, small collateral branches can be found in the
intercostal space running along the superior border of the lower rib.
Intercostal arteries
Intercostal spaces
and veins
Intercostal nerves
Thorax 167
FEMALE BREAST
STRUCTURE OF THE FEMALE BREAST

The female breasts are glandular organs that contain mammary glands used in
the production of milk for nursing newborns. They are located on the antero
lateral walls of the thoracic cage, extending vertically between the 2nd and 6th
ribs and horizontally between the lateral border of the sternum and midaxillary
line. A small axillary process may extend towards the axillary fossa.
Between each breast and underlying pectoral fascia is a retromammary space

containing fat and loose connective tissue which allows a degree of movement
on the thoracic wall.
Breast size and shape is highly dependent on various genetic, ethnic and dietary
factors as well as age, menstrual status and parity. They are frequently asym
metric, variably pendulous and usually conoid or piriform in appearance.
Lobe of mammary gland

Suspensory ligaments of breast
Serratus anterior muscle
Areola
Adipose tissue
Nipple
Lactiferous duct
External abdominal
oblique muscle
Intercostal muscles
Lateral mammary branches
of lateral thoracic artery
Pectoral fascia
Retromammary space
Pectoralis major muscle
Pectoralis minor muscle

Lateral mammary branches of
Ribs
FIGURE 5.16. Structure of the female breast (anterior and sagittal views). Each breast comprises
15-20 secretory lobes which are separated by fibrous suspensory ligaments which extend between
the clavipectoral fascia and dermis of the overlying skin. The secretory lobes contain numerous lobules
composed of the tubuloalveolar glands, which are drained by lactiferous ducts which converge and open
at the nipple. The nipples are surrounded by a pigmented circular region of skin called the areola, which

FEMALE BREAST
becomes more pigmented and prominent during pregnancy. The areola shows small punctual elevations
on its surface, which are formed by areolar glands. These are mostly sweat and sebaceous glands which
produce an antimicrobial secretion that protects the surface of areola.
gR|
Breast cancer
development
Breast after prophylactic
subcutaneous
mastectomy
BLOOD VESSELS OF THE FEMALE BREAST
Left internal jugular vein
Left subclavian artery
Left subclavian vein
Left brachiocephalic vein
Cephalic vein
Axillary artery
Axillary vein
Brachial veins
Basilic vein
Lateral mammary branches

of lateral thoracic artery
Medial mammary branches

of internal thoracic artery
FIGURE 5.17. Blood vessels of the female breast. The image shows the left pectoral region of a female,
with the skin removed to reveal the breast tissue. The pectoralis major and minor muscles are also partially
removed to better expose the blood vessels and lymphatics beneath them.
The arterial supply of the female breast is given by branches of three arteries:
• Internal thoracic artery (supply to the medial part of the breast)
• Main branches to the breast: Medial mammary branches [of perforating arteries] and anterior inter
costal arteries
• Axillary artery (supply to the superolateral part of the breast)
• Main branches to the breast: Lateral mammary branches of lateral thoracic artery, superior thoracic
artery, pectoral branch of thoracoacromial artery
Thorax 169
FEMALE BREAST
• Posterior intercostal artery (supply to the lateral part of the breast)
• Main branches to the breast: Lateral mammary branches of lateral cutaneous branches
The venous drainage of the female breast mostly mimics the arteries. The blood drains mainly into the
axillary vein, but there is some drainage into the internal thoracic vein.
Key points about the blood vessels of the female breast
Internal thoracic artery (supply to the medial part of the breast)
-> medial mammary branches [of perforating arteries] and anterior intercostal
arteries
Arteries of the Axillary artery (supply to the superolateral part of the breast)
female breast -> lateral mammary branches of lateral thoracic artery, superior thoracic artery,
pectoral branch of thoracoacromial artery
Posterior intercostal artery (supply to the lateral part of the breast)
-> lateral mammary branches of lateral cutaneous branches
Axillary vein: receives blood from superolateral breast, drains into subclavian vein
Posterior intercostal vein: receives blood from lateral breast, drains into azygos
Veins of the
venous system
female breast
Internal thoracic vein: receives blood from medial breast, drains into
brachiocephalic vein
Breast

FEMALE BREAST
LYMPHATICS OF THE FEMALE BREAST
In the context of mammary carcinoma/breast cancer, a knowledge of the anat

omy of the lymphatics of the female breast is of utmost importance in the stag
ing and treatment of this disease.
Apical axillary
I lymph nodes
Central axillary
lymph nodes
Interpectoral
lymph nodes
Lateral axillary
lymph nodes
Subscapular axillary
lymph nodes
Anterior axillary
I lymph nodes
Paramammary
» lymph nodes
Parasternal
lymph nodes
Submammary
I lymph nodes
FIGURE 5.18. Lymphatics of the female breast. Lymph from the breast tissue and adjacent structures
usually take three main routes of drainage:
• Most of the lymph from the nipple, areola and breast lobules (especially those from the lateral quad
rants) are drained into a lateral route by the subareolar lymphatic plexus. From there, the lymph is car
ried to the axillary lymph nodes. Those are subdivided into five groups: Anterior (pectoral), posterior
(subscapular), lateral (brachial or humeral), central and apical. Lymphatic vessels draining these large
node groups converge to form the subclavian lymph trunk(s). The left and right subclavian lymph
trunks usually open independently into the ipsilateral venous angle (junction of subclavian and internal
jugular veins), but can also join the ipsilateral jugular and/or bronchomediastinal lymph trunk - forming
a right lymphatic duct on the right side, or joining the thoracic duct on the left. This route drains over
75% of the lymph from the breast tissue.
• A medial pathway is composed mainly of parasternal lymph nodes that drain lymph mostly from the
medial quadrants of the breast tissue and enter the bronchomediastinal lymph trunks, which usually
independently drain into ipsilateral venous angle.
A deep pathway drains the deeper portions of the breast tissue to the subclavicular lymphatic plexus.
Thorax 171
FEMALE BREAST
Key points about the lymphatics of the female breast
• Dominant pathway of female breast (nipple, areola, majority of glandular tissue)
• Axillary lymph nodes: anterior (pectoral), posterior (subscapular), lateral (brachial

Lateral pathway or humeral) -> central -> apical
• Drains to the ipsilateral venous angle (sometimes via right lymphatic or thoracic
duct)
• Drain medial quadrants of the breast
Medial pathway • Parasternal lymph nodes
• Drains to bronchomediastinal lymph trunks
Deep pathway • Drain deep portions of breast directly to subclavicular lymphatic plexus
Lymphatic drainage
Axillary lymph nodes
of the breast

MEDIASTINUM
BORDERS, DIVISIONS AND CONTENTS

OF THE MEDIASTINUM
The mediastinum is a compartment of the thorax located in the midline of

the body, that contains most of the thoracic viscera, apart from the lungs. It
extends vertically from the superior thoracic aperture to the diaphragm and is
bounded laterally by the medial surfaces of the pleura.
The thoracic plane (of Ludwig), is an imaginary line extending from the ster
nal angle, anteriorly, to the T4-T5 intervertebral space, posteriorly. This plane
divides the mediastinum into superior (above the thoracic plane) and inferior
(below the thoracic plane) mediastinal divisions.
The inferior division is further subdivided into anterior, middle and posterior
compartments by the pericardial sac. Structures located anterior to the pericar
dial sac belong to the anterior mediastinum, whereas those located posterior
to pericardial sac are said to be structures of the posterior mediastinum. Those
located in and around the pericardial sac belong to the middle mediastinum.
These structures course longitudinally through the superior and inferior medi
astinum: Esophagus, azygos vein and vagus and phrenic nerves.
1st rib Clavicle
Brachial plexus
Intercostal muscles
Esophagus
Intercostal nerve
Trachea
Posterior Superior vena cava

intercostal vein
Right phrenic nerve

Azygos vein
Right pulmonary
artery
Greater thoracic
splanchnic nerve
Right main
bronchus
Pericardiacophrenic
vein Right pulmonary
veins
Diaphragm Parietal pleura
FIGURE 5.19. Overview of the mediastinum (right lateral view). The esophagus courses longitudinally
throughout the mediastinum, posterior to the trachea and main bronchi and anteromedial to the
Thorax 173
MEDIASTINUM
azygos vein. The pericardial sac can be seen anteriorly, with its contents and adjacent structures forming
the middle compartment of the inferior mediastinum. Pericardiophrenic arteries and veins are also seen
abutting the pericardial sac.
Left subclavian vein Left subclavian artery
Aortic arch Left superior

intercostal vein
Thymus Posterior intercostal

artery
Left pulmonary Accessory

artery hemiazygos vein
Left pulmonary Vagus nerve

veins
Pericardiacophrenic Sympathetic trunk

artery
Left phrenic nerve Left main bronchus
Pericardium Thoracic aorta
FIGURE 5.20. Overview of the mediastinum (left lateral view). The main structures seen in this image are
the thoracic aorta (situated anterolateral to the thoracic vertebral bodies and posterior to the pulmonary
artery and veins), the left main bronchus as well as the pericardial sac and its contents. The phrenic and
vagus nerves are also shown.

MEDIASTINUM
Right common carotid artery Left internal jugular vein
Right internal jugular vein Left recurrent laryngeal nerve
Right vagus nerve Left subclavian artery
Right subclavian artery Left common carotid artery
Right subclavian vein Left subclavian vein
Internal thoracic artery Pericardiacophrenic artery
Phrenic nerve Pericardiacophrenic vein
Thymus Pericardium
Brachiocephalic trunk Left brachiocephalic vein
Right brachiocephalic Left vagus nerve

vein
Aortic arch
Superior vena cava
Pulmonary trunk
Ligamentum arteriosum -
Left auricle of heart
Mediastinal part of
parietal pleura Anterior interventricular
" artery
Right auricle of heart
— Conus arteriosus
Right coronary artery _ Anterior interventricular

sulcus
Right ventricle of heart - Left ventricle of heart
Diaphragm Apex of heart
FIGURE 5.21. Overview of the mediastinum (anterior view). The thymus can be seen as the anteriormost
structure of the superior mediastinum; posterior to this structure it is possible to partially see the main
supraaortic vessels (brachiocephalic trunk, left common carotid artery and left subclavian artery), as well
as the main venous structures of the superior mediastinum (internal jugular, subclavian, brachiocephalic
veins and superior vena cava). The pericardial sac is also shown, with its relation to the adjacent pleural
sacs.
Key points about the mediastinum
Superior: superior thoracic aperture (delineated by the manubrium of the sternum,

superior border of the first rib and T1 vertebral body)
Inferior: diaphragm
Borders
Anterior: sternum and costal cartilages of 1st-5th ribs
Posterior: vertebral bodies of superior thoracic vertebrae
Lateral: parietal pleura of each lung
Thoracic plane: extends from sternal angle to vertebrae T4/5 intervertebral space
Superior mediastinum: above thoracic plane
Divisions
Inferior mediastinum: below thoracic plane, further subdivided into anterior,
middle and posterior compartments, according to relations with pericardial sac
Thorax 175
MEDIASTINUM
Key points about the mediastinum
Superior mediastinum: thymus, trachea, superior part of superior vena cava, aortic
arch and its branches (brachiocephalic trunk, left common carotid artery and left
subclavian artery, esophagus)
Anterior mediastinum: thymus

Contents Middle mediastinum: pericardial sac and heart; roots of superior and inferior
vena cava; pulmonary trunk, arteries and veins; root of aorta; main bronchi;
pericardiacophrenic arteries and veins
Posterior mediastinum: descending thoracic aorta and its branches; azygos veins,
esophagus
Mediastinum
NEUROVASCULATURE OF THE POSTERIOR

MEDIASTINUM
Major vessels in the posterior mediastinum include the thoracic aorta and its
branches, as well as the azygos venous system. The main nerves of the poste
rior mediastinum include the right and left vagus nerves, the esophageal nerve
plexus and the anterior and posterior vagal trunks. The sympathetic trunks and
the thoracic splanchnic nerves, commonly described as part of the posterior
mediastinum, are actually located a bit more laterally, on each side of the tho
racic vertebral column.

MEDIASTINUM
Esophageal branches of
inferior thyroid artery
Right common carotid artery
Thyrocervical trunk
Left common carotid artery
Right subclavian artery
Brachiocephalic trunk
Aortic arch
Esophageal branches of aorta
Thoracic aorta
Inferior phrenic artery
Esophageal branches of
left gastric artery
Left gastric artery
Common hepatic artery
Splenic artery
Abdominal aorta
FIGURE 5.22. Arteries of the posterior mediastinum. The main arteries that supply blood to the posterior
mediastinum originate from the thoracic aorta. In this image, the esophageal branches and the posterior
intercostal arteries are visible. Along its course through the posterior mediastinum the thoracic aorta
also gives off branches to the pericardium, the bronchi, the mediastinum, and the superior surface of the
diaphragm.
Thorax 177
MEDIASTINUM
Right brachiocephalic vein
Inferior thyroid vein
Superior vena cava
Esophageal veins
Accessory hemiazygos vein
Azygos vein
Hemiazygos vein
Inferior vena cava
Left gastric vein
FIGURE 5.23. Veins of the posterior mediastinum. The venous drainage of the posterior mediastinum is
facilitated by the azygos venous system. This includes the azygos vein situated on the right aspect of the
thoracic cavity, as well as the hemiazygos and accessory hemiazygos veins on the left. These veins receive
blood from the esophagus through the esophageal veins and blood from the intercostal spaces drained by
the posterior intercostal veins.

MEDIASTINUM
Left vagus nerve
Right recurrent laryngeal

nerve
Left recurrent laryngeal

nerve
Right vagus nerve
Intercostal nerve
Anterior vagal trunk
Esophageal plexus
Greater thoracic
splanchnic nerve
Anterior gastric plexus
FIGURE 5.24. Nerves of the posterior mediastinum. The posterior mediastinum houses different nervous
structures from the autonomic nervous system. The right and left sympathetic trunks and their associated
ganglia are found on each side of the thoracic vertebral column. The thoracic splanchnic nerves, also
known as greater, lesser, and least splanchnic nerves, arise from these trunks. Surrounding the esophagus
we find the esophageal plexus, a wide-meshed autonomic network of nerves mainly derived from the
right and left vagus nerves. The fibers of this plexus converge to form the anterior and posterior vagal
trunks. The anterior trunk is constituted mainly from the left vagus nerve and the posterior mainly from
the right vagus nerve.
Key points about the neurovasculature of the posterior mediastinum
Thoracic aorta and its branches (pericardial branches, bronchial branches,

Arteries esophageal branches, mediastinal branches, posterior intercostal arteries, superior
phrenic artery, subcostal artery)
Azygos system of veins (azygos vein, hemiazygos vein, accessory hemiazygos vein),
Veins
posterior intercostal veins, esophageal veins
Sympathetic trunks and thoracic splanchnic nerves, right and left vagi nerves,
Nerves
esophageal plexus, anterior and posterior vagal trunks
Neurovascular
supply and lymphatic
Mediastinum
drainage of the
esophagus
Thorax 179
MEDIASTINUM
ESOPHAGUS
The esophagus is a muscular hollow organ that propels food from the pharynx
to the stomach through peristaltic movements. Two muscular rings, the upper
and lower esophageal sphincters, regulate the passage of food and liquids. The
esophagus is located mainly in the mediastinum and is closely related to sev
eral surrounding structures. Based on its position, the esophagus can be divided
into three parts: Cervical, thoracic and abdominal.
The vascular supply of the esophagus mainly stems from the inferior thyroid
artery, direct branches from the thoracic aorta, as well as the left gastric
artery. Venous drainage is provided by esophageal veins, which are largely
received by the azygos venous system. The esophageal plexus provides nervous
supply to the esophagus via parasympathetic and sympathetic fibers. Lymph is
drained to the deep cervical lymph nodes, regional lymph nodes (juxtaoesoph-
ageal lymph nodes), paratracheal, superior and inferior tracheobronchial lymph
nodes, left gastric and coeliac lymph nodes.
Cervical part of esophagus
Trachea
Right vagus nerve

nerve
Left vagus nerve
Aortic arch
Tracheal bifurcation
Left main bronchus
Right main bronchus
Thoracic part of esophagus
Thoracic aorta
Pericardium
Diaphragm
Abdominal part of
esophagus
Stomach
FIGURE 5.25. Esophagus in situ. The esophagus is located posterior to the trachea and anterior to the
vertebral column. On its course, it is closely associated with several structures, such as the thoracic
aorta, the left main bronchus, and the left atrium of the heart (not visible here). The cervical portion of

MEDIASTINUM
the esophagus begins at the pharyngoesophageal junction and ends at the entry into the upper thoracic
aperture. The thoracic portion travels through the superior and posterior mediastinum. It ends at the
esophageal hiatus where the esophagus passes through the diaphragm. The abdominal portion lies
intraperitoneally. It starts where the esophagus passes through the diaphragm and terminates at the
cardial orifice of the stomach (esophagogastric junction).
Key points about the esophagus
Esophagus is a muscular, tubular part of the gastrointestinal tract, connecting the

Definition
pharynx to the stomach
Cervical part: between pharyngoesophageal junction and upper thoracic aperture
Parts Thoracic part: between upper thoracic aperture and esophageal hiatus
Abdominal part: between esophageal hiatus and gastroesophageal junction
Function Propel food from pharynx to stomach through peristaltic movements
Arterial supply: esophageal branches of inferior thyroid artery, thoracic aorta and
left gastric artery
Venous drainage: esophageal veins drain into inferior thyroid vein, azygos venous
system, left gastric vein
Innervation: via esophageal plexus. Parasympathetic innervation from vagus nerve
Neurovascular (CN X), recurrent laryngeal nerve; sympathetic supply from cervical and thoracic
supply sympathetic trunk and thoracic spinal nerves T5-T12
Myenteric plexus (of Auerbach) and submucosal plexus (of Meissner) embedded in
esophageal wall play role in regulating peristalsis
Lymphatics: deep cervical lymph nodes, juxtaoesophageal lymph nodes,

paratracheal, superior and inferior tracheobronchial lymph nodes, left gastric and
coeliac lymph nodes
Posterior: vertebral column, distal part of descending thoracic aorta
Relations Anterior: trachea, left main bronchus, left atrium of heart
Lateral: proximal part of descending thoracic aorta
EHW®gSW.E Neurovascular
supply and lymphatic
Esophagus
drainage of the
esophagus
LYMPHATICS OF THE MEDIASTINUM
The mediastinum contains several aggregations of lymph nodes which can be

broadly categorized into three groups: Anterior mediastinal, intermediate (tra
cheobronchial) and posterior. As with all lymph nodes in the body, these node
groups are ultimately drained into large thoracic lymphatic vessels (thoracic
duct/right lymphatic duct) which terminate at the junction of the subclavian
and internal jugular veins.
Given their close proximity and common drainage pathways, the lymph nodes
of the thoracic wall (a.k.a. parietal thoracic lymph nodes) will also be evaluated
in this section.
Thorax 181
MEDIASTINUM
Supraclavicular lymph
nodes
Brachiocephalic (anterior
mediastinal) lymph nodes
Paratracheal lymph
nodes
Intercostal lymph
nodes
Juxtavertebral lymph
nodes
Tracheobronchial
lymph nodes
Juxtaesophageal
lymph nodes
Juxtaaortic lymph
nodes
Prepericardiac
lymph nodes
Superior diaphragmatic
lymph nodes
Interaorticoesophageal
lymph node
Lateral pericardiac
lymph nodes
FIGURE 5.26. Lymphatics of the mediastinum (anterolateral view, heart displaced). Several groups of
visceral lymph nodes are visible. The brachiocephalic/anterior mediastinal lymph nodes are located in
the superior mediastinum in relation to the great vessels. The tracheobronchial/intermediate mediastinal
lymph nodes surround the bifurcation of the trachea, as well as the superior and inferior aspects of the
main bronchi.
The juxtaesophageal, interaorticoesophageal and juxtaaortic lymph nodes are commonly grouped as
posterior mediastinal lymph nodes. They drain adjacent organs, vessels and tissues of the posterior medi
astinum and send efferents to the paratracheal lymph nodes and right lymphatic/thoracic ducts.
Parietal thoracic lymph nodes visible in this illustration include the intercostal, juxtavertebral and superior
diaphragmatic lymph nodes. They collect the lymph from the deep back and intercostal muscles, parietal
pleura and vertebral column. Lymph drained from the upper intercostal nodes (approx. levels 1-7) drains
into a common intercostal trunk destined for the supraclavicular nodes while the lower intercostal nodes
often drain below the diaphragm to the gastric or celiac lymph nodes/cisterna chyli before ultimately
reaching the thoracic duct. Efferent vessels of the juxtavertebral nodes may follow a similar drainage
pattern and/or alternatively pass via the posterior mediastinal lymph nodes. The superior diaphragmatic
lymph nodes drain the diaphragm, diaphragmatic portion of the pericardium and diaphragmatic pleura.
They usually drain to the parasternal (not shown) or posterior mediastinal lymph nodes.

MEDIASTINUM
Below is the summary of the lymphatic drainage of the main lymphatic vessels
in the thorax.
Drains most of the mediastinal organs via left bronchomediastinal lymphatic

Thoracic duct trunk (as well as the majority of the body, except for regions received by right
lymphatic duct listed below)
Drains left side of the heart, right lung, lower lobe of left lung, right side of
Right lymphatic duct the thorax via right bronchomediastinal lymphatic trunk (as well as right side
of the head and neck and right upper limb)
Lymphatic system of
Lymph nodes of the
the thoracic cavity
thorax and abdomen
and mediastinum
Thorax 183
LUNGS
TRACHEA
The trachea (windpipe) is a long fibrocartilaginous respiratory tube that con

nects the larynx to the main bronchi. As it is located below the larynx, it is
considered part of the lower respiratory tract. The main function of this carti
laginous tube is to conduct air from the larynx to the bronchi and vice versa. The
trachea also protects the lungs from potentially harmful external agents with
its immune cells and from particles physically entering the lungs through its
specialized epithelial cells.
Cricoid cartilage Thyroid cartilage
Median cricothyroid
Anular ligaments ligament
of trachea
Tracheal bifurcation
Right main bronchus
Carina of trachea
Right superior-
lobar bronchus
Left main bronchus
Middle lobar-
bronchus Left superior
lobar bronchus
Right inferior Left inferior

lobar bronchus lobar bronchus
FIGURE 5.27. Trachea (anterior view). The trachea is continuous with the larynx at the inferior border
of the cricoid cartilage. Its tubular structure is maintained by 16-20 incomplete/C-shaped cartilaginous
rings which comprise its anterolateral wall. These cartilages are interconnected by anular ligaments
located between adjacent cartilage rings. The posterior wall of the trachea is occupied by the trachealis
muscle (not visible from this perspective). The trachea normally terminates at the level of vertebra T5 in a
bifurcation giving off two main bronchi.

LUNGS
Key points about the trachea
Definition Fibrocartilaginous tube that transports air from the upper respiratory tract to the
lungs and vice versa
Anterolateral wall: 16-20 tracheal cartilages connected by anular ligaments

Structure
Posterior wall: fibromuscular wall (trachealis muscle)
Function Air conduction, immune and mechanical protection
Anatomy of breathing
BRONCHIAL TREE AND ALVEOLI
The bronchial tree is a branching tubular structure which conducts air between
the trachea and lungs. It comprises the bronchi and their subsequent branches
(bronchioles), which open into terminal alveolar ducts. There are four types of
bronchi including main (primary) bronchi, lobar (secondary) bronchi, segmental
(tertiary) and intrasegmental bronchi. All bronchi have an outer layer containing
variable amounts of irregularly placed cartilaginous plates.
The airway divisions after the intrasegmental bronchi are called bronchioles,
which lack cartilage. The last divisions of the bronchial tree are known as res
piratory bronchioles, which end in small sacs containing alveoli. This is the site
of gaseous exchange between the blood and the lungs. The main function of
the bronchial tree is to provide a passageway for air to move into and out of
each lung. In addition, the mucous membrane of these airways protects the
lungs by capturing debris and pathogens.
Thorax 185
LUNGS
Right main bronchus
Right lobar bronchi
Bronchial artery
Pulmonary artery
Pulmonary veins
Terminal bronchiole
Bronchial veins
Alveolus
Alveolar sac
Bronchiole
Bronchial nerve
Pulmonary arteriole
Pulmonary capillary
Pulmonary venule
Alveolar pores (of Kohn)
FIGURE 5.28. Overview of the bronchioles and alveoli. On the right, a macroscopic view shows
the branching of the bronchial tree. On the left, the respiratory bronchioles, alveoli and associated
neurovasculature are shown. Bronchioles arise from the intrasegmental bronchi, lack cartilage and may
divide up to 20-25 times. The last divisions of a bronchiole that does not contain alveoli (i.e. one whose
sole function is gas conduction) are known as terminal bronchioles. They subdivide into respiratory
bronchioles which open into small alveolar sacs containing alveoli via small alveolar ducts.
Each alveolus opens up internally in the alveolar sac, while externally it is surrounded by a nest of blood
capillaries supplied by small branches of the pulmonary and bronchial arteries.
Key points about the bronchial tree and alveoli
Bronchial tree is a term used to describe the multiple bronchi that conduct air
Definition
from the trachea to alveoli
Bronchial tree:
• Main (primary) bronchi
• Lobar (secondary) bronchi

• Segmental (tertiary) bronchi
Branching • Intrasegmental bronchi

• Bronchioles
• Terminal bronchioles
• Respiratory bronchioles
• Alveolar duct ^ alveolar sac ^ alveolus
Function Airway conduction, protection against pathogens and debris

LUNGS
| Left lung~[
Inferior
Anterior
lingular -
segment
segment
Superior
<D Anterior
lingular
O segment
segment (D
O_
-o’
o Apico- ■ Apico- o
posterior — posterior cr
(D
segment L segment
Inferior Superior
lingular lingular
segment 61 segment
Superior
4 Superior
segment segment
5
10
Posterior Posterior
10
basal- • basal
o segment segment (D
o- -O’
<D Lateral Lateral o

basal basal
segment segment
Antero
Anterior
medial
basal
basal
segment
segment
FIGURE 5.29. Bronchopulmonary segments (left lung). The left lung is composed of 8-10 bron
chopulmonary segments (depending on classification) which can be identified from both medial and
lateral views. Each bronchopulmonary segment has its own tertiary bronchus and segmental branch of
the pulmonary artery (of the same name).
The superior lobe of the left lung is formed by four main bronchopulmonary segments: The apicoposterior
(1, 2), anterior (3), superior lingular (4) and inferior lingular segments (5) which are situated at the lingula
of the left lung. The inferior lobe is composed of superior (6) and basal segments. The latter are further
divided into the anteromedial basal (7, 8), lateral basal (9) and posterior basal (10) segments.
Key points about the bronchial tree and alveoli
Left lung:
• Superior lobe (Apicoposterior segment (1,2), anterior segment (3), superior

lingular segment (4), inferior lingular segment (5))
• Inferior lobe (Superior segment (6), anteromedial basal segment (7,8), lateral
Segmental
basal segment (9), posterior basal segment (10))
bronchi/
bronchopulmonary Right lung:
segments
• Superior lobe (Apical segment (1), posterior segment (2), anterior segment (3))
• Middle lobe (Lateral segment (4), medial segment (5))

• Inferior lobe (Superior segment (6), medial basal segment (7), anterior basal
segment (8), lateral basal segment (9), posterior basal segment (10))
Thorax 187
LUNGS
Posterior Posterior
segment segment
Apical Apical
segment segment
Anterior Anterior
segment segment
CD
o
Medial Lateral
^segment segment! s
■O CL
-CD
£
Superior Medial g.
segment segment °
Medial
Superior
CD basal
segment
O segment
O- Anterior
Anterior □
basal basal
segment segment -o'
Lateral Lateral §-
basal basal °
segment segment
Posterior Posterior
L basal basal -
segment segment
FIGURE 5.30. Bronchopulmonary segments (right lung). The right lung consists of 10 bronchopulmonary
segments. Just like in the left lung, each bronchopulmonary segment of the right lung also has its own
tertiary bronchus and segmental branch of the pulmonary artery (of the same name).
The superior lobe of the right lung has three bronchopulmonary segments: Apical (1), posterior (2) and
anterior (3). The middle lobe of the right lung is formed of the lateral (4) and medial (5) segments, while the
inferior lobe of the right lung is composed of superior (6), medial basal (7), anterior basal (8), lateral basal
(9) and posterior basal (10) segments.
Alveoli Bronchi

LUNGS
OVERVIEW OF THE LUNGS
The lungs are paired organs located in the thoracic cavity. They are considered
to be central organs of the respiratory system since they are in charge of gase
ous exchange between the inspired air and blood.
Due to the differences in space in the two sides of the thoracic cavity, the lungs
are asymmetrical (the left lung is smaller in size). Each lung has three borders
(anterior, posterior, and inferior) that marginate three surfaces (costal, medial
and diaphragmatic).
Apex
Costal surface
Anterior border
Superior lobe
....... Oblique fissure
Horizontal fissure
— of right lung
Cardiac notch of left lung
Lingula of left lung
Middle lobe of right lung
Inferior lobe
Inferior border
FIGURE 5.31. Lateral views of the lungs. This perspective clearly shows the anterior and inferior borders
of the lungs as well as their costal surfaces. The costal surface faces the ribs and is covered by visceral
pleura. Due to the ‘spongy’ nature of the lung parenchyma, the ribs leave defined marks known as costal
impressions along the entire costal surface.
The lungs are divided into lobes by double folds of pleura which form fissures. From the lateral view the
fissures are seen as thick lines that extend across the costal surface. The left lung has only one fissure
(oblique fissure of left lung) which divides it into superior and inferior lobes, while the right lung has two
fissures (oblique and horizontal fissures of right lung) that divide it into superior, middle, and inferior lobes.
Thorax 189
LUNGS
Superior lobe Apex of lung
Superior lobar-
bronchus Oblique fissure
Right pulmonary
artery Bronchial artery
Right superior-
pulmonary vein
Intermediate
bronchus
Horizontal fissure
Hilum of lung
Cardiac impression
Right inferior
Middle lobe pulmonary vein
Diaphragmatic Inferior lobe

surface
Right lung
FIGURE 5.32. Medial view of the right lung. The superior most, pointed portion of each lung is known as
the apex. Inferior to it on the mediastinal surface is a wedge shaped depression known as the the hilum of
the lung; the most prominent feature seen from this medial perspective.
Many structures enter or exit the lung via the hilum such as the pulmonary artery and veins and bronchial
arteries, the lobar bronchi, lymphatic vessels and bronchopulmonary lymph nodes. Impressions seen on
the right lung include the smaller cardiac impression and grooves for trachea, esophagus, brachiocephalic
and azygos veins, as well as the superior and inferior vena cava.

LUNGS
Apex of lung Superior lobe
Oblique fissure Mediastinal surface
Left pulmonary Left superior

artery pulmonary vein
Lobar bronchi Anterior border
Vertebral surface Bronchopulmonary

Lymph nodes
Left inferior-
pulmonary vein Cardiac impression
Inferior lobe
Cardiac notch
Diaphragmatic
surface Lingula
Inferior border Pulmonary

ligament
Left lung
FIGURE 5.33. Medial view of the left lung. Due to the presence of other organs in the thoracic cavity, on
the surfaces of the lungs there are marks or impressions by those adjacent organs. The most prominent
impression seen on the medial surface of the left lung is the cardiac impression, while the smaller
impressions include the grooves for the aorta, subclavian artery, 1st rib, trachea and esophagus.
Key points about the medial and lateral views of the lungs
Right lung: apex, costal impressions, oblique fissure, horizontal fissure, superior
Lateral view lobe, medial lobe, inferior lobe
Left lung: apex, cardiac notch, lingula, superior lobe, inferior lobe
Right lung: horizontal and oblique fissures, smaller cardiac impression, grooves for
trachea, esophagus, brachiocephalic vein, azygos vein, superior vena cava, inferior
Medial view vena cava
Left lung: oblique fissure, cardiac impression, grooves for aorta, subclavian artery,
1st rib, trachea, esophagus
Main bronchus, lobar bronchi (superior, intermediate, inferior), one pulmonary

Hilum contents artery, two pulmonary veins, bronchial arteries and veins, pulmonary nervous
plexus, lymphatics, bronchopulmonary lymph nodes, areolar tissue
Bronchopulmonary
The lung
segments
Thorax 191
LUNGS
LUNGS IN SITU
The lungs are located either side of the mediastinum, surrounded by the tho
racic cage and superior to the diaphragm. Hence, each lung has a mediastinal,
costal and diaphragmatic surface. Both lungs are enveloped by visceral and
parietal pleura, between which is a potential space known as the pleural cavity.
Inferior and anterior to the lungs are two potential spaces called pleural
recesses to which the pulmonary tissue does not extend (or extends only dur
ing a forced inspiration), called the costodiaphragmatic and costomediastinal
recesses, respectively.
Each lung has an apex and a base, as well as anterior, posterior and inferior bor
ders. The apices of the lungs project into the superior thoracic aperture, about
2.5 cm above the medial third of the clavicle. The base of each lung rests upon
the ipsilateral hemidiaphragms; the inferior border is located around the level
of the 6th rib at the midclavicular line, 8th rib at the midaxillary line, and 10th rib
posteriorly at the scapular line. The anterior border of right lung is located deep
to the right margin of the sternum, extending between the second and sixth
costal cartilages; the anterior border of the left lung begins deep to the ster
num at the level of the second intercostal space before running inferolaterally
to the sixth intercostal space, about 3 cm from the left margin of the sternum.
Brachiocephalic trunk Trachea
Cervical part of parietal

Right brachiocephalic pleura
vein
Left brachiocephalic
Superior vena cava
vein
Apex of lung
Superior lobe of
right lung
Aortic arch
Right pulmonary
artery
Mediastinal part of
parietal pleura
Pulmonary veins
Superior lobe of
Left lung
Horizontal fissure
of right lung
Left main bronchus
Middle lobe of
right lung Left pulmonary
artery
Inferior lobe of
right lung Inferior lobe of
left lung
Oblique fissure
Costodiaphragmatic
of lung
recess
Diaphragmatic part of
parietal pleura Ligamentum
arteriosum
Diaphragm Pulmonary trunk
FIGURE 5.34. Lungs and heart in situ (anterior view). In this image, both the right and the left lungs
are slightly retracted so the relations of the lungs with the heart and other mediastinal structures can

LUNGS
be seen. The right lung lies closely to the superior and inferior venae cavae as well as the azygos vein
(not seen), while the left lung relates to the ascending and thoracic aorta. Both lungs conform around
the shape of the heart. Each lung is suspended from the mediastinum by its root: A pedicle formed by
structures entering and exiting the lungs via the hilum (e.g., bronchi, pulmonary/bronchial vasculature,
lymphatics and nerves).
Notice the two potential spaces (out of four in total) between the lungs and the parietal pleura, also known
as the pleural recesses. The costodiaphragmatic recess is located at the inferior most part of the pleural
cavity whereas the costomediastinal recess lies anteriorly, between the costal and mediastinal layers of
parietal pleura. Those recesses are usually empty, so dull percussion sound in those areas as well as posi
tive chest radiograph can indicate a pathological condition.
Surface projections
Apex of lung ~2.5 cm above the clavicle
Inferior border of lung 6th rib, 8th rib, and 10th rib
Inferior border of pleura 8th rib, 10th rib, and 12th rib
Anterior margin of lung 2nd-6th intercostal spaces (laterally displaced by ~3cm on left side)
The lung The pleural cavity
Normal chest x-ray
Thorax 193
LUNGS
LYMPHATICS OF THE LUNGS
The lymphatics of the lung consist of several lymph node groups and lym
phatic vessels that drain the superficial and deep regions of both lungs into the
tracheobronchial nodes surrounding the bifurcation of the trachea and main
bronchi. These in turn empty into the right and left bronchomediastinal trunks
via paratracheal lymph nodes and ultimately into venous circulation.
The superficial (or subpleural) lymphatics of the lung drain lymph from the vis
ceral pleura and peripheral lung tissue to the bronchopulmonary lymph nodes
at the hilar region of each lung. The deep (or central) lymphatics of the lung
drain the bronchi and peribronchial parenchyma of the lung via intrapulmonary
lymph nodes after which lymph is also ultimately received by the bronchopul
monary lymph nodes. From here, lymph from both the superficial and deep
lymphatics of the lungs is passed to the tracheobronchial nodes.
A good understanding of the lymphatic drainage of the lungs is important clini

cally, particularly in the staging and treatment of lung cancer.
Deep cervical lymph nodes
Paratracheal lymph nodes
Bronchomediastinal
lymph trunk
Lymph node of
ligamentum arteriosum
Superior tracheobronchial
lymph nodes
Intrapulmonary
lymph nodes
Inferior tracheobronchial
lymph nodes
Bronchopulmonary
lymph nodes
FIGURE 5.35. Overview of the lymphatics of the lung (anterior view). Anterior view of the lungs and
tracheobronchial tree, showing the thoracic aorta and brachiocephalic veins. Lymph drained from the

LUNGS
right superior and inferior tracheobronchial nodes, as well as the left inferior tracheobronchial nodes, is
received by the right bronchomediastinal trunk. From here, lymph is carried via paratracheal nodes and
returned to venous circulation around the right venous angle.
The left superior tracheobronchial nodes drain to the left bronchomediastinal trunk (also via paratracheal
nodes) which empties into the left venous angle, sometimes via the thoracic duct.
Key points about the lymphatic drainage of the lungs
Superficial
Drains visceral pleura and superficial lung parenchyma (tissue) -> drains initially into
(subpleural)
the bronchopulmonary nodes
pathway
Deep (central) Drains bronchi and peribronchial parenchyma -> drains initially into the
pathway intrapulmonary nodes
Intrapulmonary nodes -> bronchopulmonary nodes -> right inferior tracheobronchial

Right lung nodes -> right superior tracheobronchial nodes -> right paratracheal nodes -> right
bronchomediastinal lymph trunk -> right venous angle -> venous circulation
Superior lobe: intrapulmonary nodes -> bronchopulmonary nodes -> left inferior
tracheobronchial nodes -> left superior tracheobronchial nodes -> left paratracheal
nodes -> left bronchomediastinal lymph trunk -> left venous angle (or thoracic duct)
venous circulation
Left lung
Inferior lobe: intrapulmonary nodes -> bronchopulmonary nodes -> left inferior
tracheobronchial nodes -> right superior tracheobronchial nodes -> right
paratracheal nodes -> right bronchomediastinal lymph trunk -> right venous angle ->
venous circulation
The lymphatic system

The lung of the thoracic cavity
and mediastinum
Thorax 195
HEART
HEART IN SITU
Exploring the anatomical relations of the heart in situ will allow you to better
understand its function. The heart is located in the middle mediastinum, mostly
to the left of the midsagittal plane. The main relations of the hearts are with the
thymus and sternum (anteriorly), the lungs (laterally), the diaphragm (inferiorly),
and the great vessels (posterosuperiorly).
Usually, the heart has the size of a fist and is positioned roughly along an axis
extending from the right shoulder to the left hypochondrium. Its position has
often been described as “a pyramid which has fallen over” where the apex is
located on the left midclavicular line, pointing in an anteroinferior direction.
Its inferior surface, also known as the diaphragmatic surface, sits on the dia
phragm and can be located at the level of the 5th-6th intercostal space. The
superior border lies at the level of the second costal space, while the posterior
part is located at the level of the third costal cartilage.
It’s important to know where the heart is located and its orientation in clin
ical practice when listening for heart sounds with a stethoscope (ausculta
tion) or while performing cardiopulmonary reanimation (CPR) in the case of an
emergency.
Right internal jugular vein
Left internal jugular vein
Right vagus nerve
Right common carotid artery

nerve
Left subclavian vein
Left common carotid artery
Right subclavian artery
Right subclavian vein
Thymus
Phrenic nerve
Pericardiacophrenic artery
Pericardiacophrenic vein
Pericardium
FIGURE 5.36 . Heart in situ (anterior view). The heart is separated from other structures of the mediastinum
by a double layered fibroserous sac called the pericardium. On its surface are important vessels which

HEART
supply and drain the pericardium and diaphragm, known as the pericardiacophrenic artery and vein.
The right and left phrenic nerves, which innervate the diaphragm, course laterally on either side of the
heart. These are clinically important since they can be damaged during surgical interventions to the heart.
Right brachiocephalic vein
Aortic arch
Left vagus nerve
Ligamentum arteriosum
Superior vena cava
Pulmonary trunk
Mediastinal part of
parietal pleura
Anterior interventricular
artery
Conus arteriosus
Right coronary artery
Left ventricle of heart
Right atrium of heart
Apex of heart
Right ventricle of heart
FIGURE 5.37 . Heart in situ (anterior pericardium removed). Removing the pericardium allows the
appreciation of the relations of the heart with the great vessels. The great vessels (venae cavae, aorta
and pulmonary trunk) attach to the posterosuperior aspect of the heart, known as the base of the heart.
The apex of the heart is its sharpest point, located at its bottom left portion and angled anteroinferiorly.
Thorax 197
HEART
Azygos vein
Hemiazygos vein
Thoracic aorta
Esophagus
Inferior vena cava
Pericardium
Diaphragmatic part of parietal

pleura
Mediastinal part of parietal pleura
Left costomediastinal recess
Costal part of parietal pleura
Right costomediastinal recess
Sternum
FIGURE 5.38 . Diaphragmatic relations of the heart (superior view). Cross section showing the thoracic
surface of the diaphragm. The heart is located anterior to the esophagus, thoracic aorta and thoracic
vertebrae. Each lung has a base resting on the diaphragm; the deviation of the apex to the left is clearly
visible as an indentation of the left lung known as the cardiac notch.
Key points about the anatomical relations of the heart
Location: middle mediastinum, mostly to the left of the midsagittal plane

Position Orientation: positioned in a direction of a plane extending from the right shoulder
to left hypochondrium, with the apex leaned towards the left
Pericardium (sac surrounding the heart)

Thymus (anterior)
Visceral
Lungs (lateral)
relationships
Diaphragm (inferior)
Esophagus (posterior)
Arteries: aortic arch, brachiocephalic trunk, left and right common

carotid arteries, left and right subclavian arteries, internal thoracic artery,
pericardiacophrenic artery, pulmonary trunk
Surrounding
neurovasculature Veins: left and right internal jugular veins, left and right subclavian veins, left and
right brachiocephalic veins, superior vena cava, pericardiacophrenic veins
Nerves: left and right vagus nerves (CN X), left and right phrenic nerves
Blood supply Left and right phrenic arteries (branches of the abdominal aorta)
Nerves Left and right phrenic nerves (C3-C5)

HEART
Heart
H ______ ___
SURFACE ANATOMY OF THE HEART
The heart has five surfaces:
• Anterior (sternocostal) surface, which lies adjacent to the body of sternum,

sternocostal muscles and the third to sixth costal cartilages.
• Inferior (diaphragmatic) surface, which sits mainly on the central tendon of
the diaphragm.
• Left and right (pulmonary) surfaces, which face the left and right lungs,
respectively. The left surface involves the lateral portion of the left ventri
cle as well as a small part of the left atrium/auricle, while the right surface is
found between the superior vena cava and the intrathoracic part of the infe
rior vena cava.
• Posterior surface (base), which lies anterior to the principal bronchi and
esophagus.
The heart also presents four borders:
• The right border is a line that runs mainly over the right atrium, extending
between the superior and inferior vena cava, and over a small portion of the
right ventricle.
• The left (obtuse) border separates the left and anterior surfaces, mainly
formed by the left ventricle and part of the left auricle.
• The superior border is a line that goes over the roots of the aorta and pulmo
nary trunk and a small portion of the left and right auricle.
• The inferior (acute) border extends along the right ventricle and part of the
left ventricle at its apex.
Thorax 199
HEART
Left common carotid artery Left subclavian artery
Pulmonary trunk
Aortic arch
Left pulmonary artery
Ascending aorta
Left pulmonary veins
Superior vena cava
Left auricle
Right auricle
Anterior
interventricular
Coronary sulcus sulcus
Left ventricle
Inferior vena cava
Right ventricle Apex of heart
FIGURE 5.39. Anterior view of the heart. The anterior surface of the heart faces anterosuperiorly and
bears a profound right convexity compared to the left. The right ventricle occupies about two-thirds of
its extent, while the left ventricle makes up the remaining one-third. The left atrium is mainly obscured by
the roots of the aorta and pulmonary trunk, with only a small part of the left auricle of the heart projecting.
The atria and ventricles are separated by a deep groove called the coronary (atrioventricular) sulcus that
contains the largest of the cardiac vessels; it is interrupted anteriorly by the root of the pulmonary trunk.
The anterior surface is marked by another groove, called the anterior interventricular sulcus, that sepa
rates the left and right ventricles and contains the anterior interventricular artery and vein. In this image
one can also visualize the outline of the right (pulmonary) surface of the heart, which is longer and more
protuberant than the left surface, and is formed by the right atrium superiorly and right ventricle inferiorly.

HEART
Left subclavian artery Left common carotid artery
Aortic arch

Superior vena cava

Right pulmonary
artery
Left atrium of heart
Right pulmonary veins

Great cardiac vein
Right atrium of heart

Inferior vein of
left ventricle
Inferior vena cava

Coronary sinus
Right ventricle of heart

Left ventricle of heart
Apex of heart Inferior interventricular

sulcus
FIGURE 5.40. Posteroinferior view of the heart. The inferior surface is mostly made up of the left ventricle
and part of the right ventricle and gently slopes anteroinferiorly from the base of the heart towards the
apex. It is separated from the anatomical base (posterior surface) of the heart by the posterior part of
the coronary sulcus. The inferior surface is also marked by the inferior (posterior) interventricular sulcus,
which separates the ventricles and contains the inferior (posterior) interventricular artery and middle
cardiac vein. The posterior surface is largely formed by the left atrium which is pierced by four pulmonary
veins, as well a small portion of the right atrium which receives the superior and inferior venae cavae.
The atria are separated by a shallow interatrial sulcus, which together with the coronary and inferior
interventricular sulci, form the crux of the heart.
Key points about the surfaces of the heart
Components: right atrium, % right ventricle, % left ventricle
Landmarks: right auricle of heart, coronary sulcus, anterior interventricular sulcus,

Anterior cardiac apex
(sternocostal)
surface Vessels: right coronary artery, anterior interventricular artery/vein, anterior veins
of right ventricle
Relations: sternum, sternocostal muscles, third to sixth costal cartilages
Components: left ventricle, right ventricle

Landmarks: inferior (posterior) interventricular groove, atrioventricular groove,
Inferior cardiac apex
(diaphragmatic) Vessels: inferior (posterior) interventricular artery, middle cardiac vein, coronary
surface sinus, inferior vein of right ventricle
Relations: sits mainly the central tendon of diaphragm, and a small portion of left
muscular part of diaphragm
Components: left ventricle, small part of left atrium and left auricle of heart
Left Landmarks: atrioventricular groove
(pulmonary)
surface Vessels: circumflex artery, great cardiac vein, left marginal vein
Relations: left pericardiacophrenic neurovascular bundle, left pleura/lung
Thorax 201
HEART
Key points about the surfaces of the heart
Components: right atrium

Right
Landmarks: sulcus terminalis
(pulmonary)
surface Relations: intrathoracic part of inferior vena cava, superior vena cava, right pleura/
lung
Components: right atrium, left atrium

Posterior
Vessels: coronary sinus, left and right pulmonary veins, vena cavae
surface (base)
Relations: principal bronchi, esophagus
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RIGHT ATRIUM AND VENTRICLE

The right atrium occupies the upper right side of the heart. It is the first cham
ber of the heart to receive the deoxygenated blood from the body via 3 main
sources: The superior vena cava, which drains blood from the upper parts of the
body, the inferior vena cava, which collects blood from the lower parts, and the
coronary sinus, which drains blood from the heart itself. One of the main fea
tures of the right atrium is the sinoatrial (SA) node that is placed within the wall
of this chamber adjacent to the entrance of the superior vena cava. It is known
as “the human pacemaker” that spontaneously generates electrical impulses
and determines the normal heart rhythm.
The right ventricle takes up the majority of the anterior surface of the heart. It
receives blood from the right atrium and pumps it via the pulmonary trunk into
the lungs for blood oxygenation. The blood flow between these heart cham
bers is regulated by the right atrioventricular (tricuspid) valve, allowing only
unidirectional flow from the right atrium to the right ventricle. Similarly, the
pulmonary valve permits the blood to flow from the right ventricle to the pul
monary trunk without regurgitation.

HEART
Crista terminalis
Superior vena cava
Pectinate muscles
Interatrial septum
Right pulmonary artery
Limbus of fossa ovalis
Right pulmonary veins
Right atrioventricular
orifice
Fossa ovalis of right atrium
Right atrioventricular valve
Orifice of coronary sinus
Valve of inferior vena cava
Valve of coronary sinus
Inferior vena cava
FIGURE 5.41. Overview of the right atrium. Interior of the right atrium with its anterior wall is reflected.
The internal surface of the anterior wall has a roughened appearance due to the presence of the
pectinate muscles. These are folds of muscle arranged in a comb-like fashion around the region of the
right auricle which function to act as a volume reservoir, increasing the capacity of the right atrium during
times of dilatation. The remaining walls of the right atrium are smooth and offer the appreciation of
several anatomical landmarks: The fossa ovalis, valves of the inferior vena cava and coronary sinus, as well
as the right atrioventricular orifice.
Thorax 203
HEART
Ascending aorta Pulmonary valve
Conus arteriosus
Supraventricular
crest
Septal papillary
muscle
Coronary sulcus
Right ventricle
Right
atrioventricular
valve Septomarginal
trabecula
Tendinous cords
Inferior papillary
muscle
Anterior papillary muscle Trabeculae

carneae
FIGURE 5.42. Overview of the right ventricle. Right ventricle, anterolateral wall removed. The structure
of the right atrioventricular (tricuspid) valve with its three papillary muscles (anterior, inferior
(a.k.a.posterior) and septal) and their tendinous cords (chordae tendineae) can be seen. The structure of
the pulmonary valve is also illustrated as well, immediately superior to the conus arteriosus.
Key points about the right atrium
Receives deoxygenated blood from systemic circulation via the superior vena cava,
inferior vena cava and coronary sinus
Characteristics: thin wall; contains the sinoatrial and atrioventricular nodes; three
Features internal surfaces (venous, vestibular, auricular)
Landmarks: right auricle
Function: reservoir for blood and an active pump that helps fill the ventricle
Right auricle of
Cone-shaped pouch which extends from the superoanterior part of right atrium
heart
Pectinate
Array of parallel muscular columns on the internal anterior wall of right atrium
muscles
Crista Crescent-shaped muscular ridge on the internal aspect of right atrium that
terminalis externally corresponds with the terminal sulcus
Sinus of venae
Portion of right atrium that receives the superior and inferior venae cavae
cavae
Vestibule
of right
Fibrous rings that support the leaflets of the right atrioventricular valve
atrioventricular
valve
Fossa ovalis Oval depression on the interatrial septum (remnant of foramen ovale)

HEART
Key points about the right atrium
Sinoatrial (SA)
node Collection of specialized nodal tissue that produces electrical impulses that travel
(natural through the electrical conduction system
pacemaker)
Atrioventricular Part of electrical conduction system found near coronary sinus on the interatrial
(AV) node septum
Key points about the right ventricle
Receives deoxygenated blood from right atrium and pumps it to the lungs for
oxygenation
Features Characteristics: septomarginal trabecula (moderator band)

Landmarks: three prominent papillary muscles
Function: pumps blood into the pulmonary circulation
Supraventricular Round accentuation of the internal muscular wall that separates the conus
crest arteriosus from the rest of the ventricular cavity
Conus arteriosus Conical pouch where the pulmonary trunk arises
Trabeculae
Muscular elevations that course along mainly apical parts of ventricular wall
carneae
Papillary (Anterior/inferior/septal papillary muscles)

muscles, chordae Muscular projections attached to cusps of right atrioventricular valve via
tendineae tendinous cords (chordae tendineae) preventing prolapse
Septomarginal A muscular tissue that transmits the right branch of atrioventricular bundle from
trabecula the interventricular septum to the anterior papillary muscle
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Ventricles of the
Atria of the heart
heart
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Heart
Thorax 205
HEART
LEFT ATRIUM AND VENTRICLE
The left atrium occupies the base (posterior part) of the heart. It receives oxy
genated blood from the lungs via four pulmonary veins and pumps it into the
left ventricle via the left atrioventricular orifice. This orifice features the left
atrioventricular (mitral/bicuspid) valve which functions to seal the atrioven
tricular opening during the ventricular contraction (systole). This prevents
regurgitation of blood into the left atrium and redirects blood flow through the
aortic orifice during ventricular systole.
The left ventricle is the largest of all heart chambers, mainly due to the thick
ness of its muscular walls. It occupies most of the left pulmonary and inferior
surfaces of the heart, including its apex. Once filled with blood, the left ventri
cle contracts and strongly ejects most of its contents into the aorta. The left
ventricle and aorta are separated by the aortic orifice, which features the aortic
(left semilunar) valve. This valve is closed during ventricular diastole, prevent
ing backflow of blood in the left ventricle, and open during systole to allow the
blood to enter systemic circulation.
Aortic arch
Pulmonary trunk
Left atrioventricular valve
Tendinous cords of left

atrioventricular valve
Coronary sinus
Superior papillary
muscle of left
ventricle
Interventricular
septum
Inferior papillary muscle
of left ventricle
Apex of heart
FIGURE 5.43. Interior of the left ventricle. The left ventricle has noticeably thicker muscular walls which
facilitate the generation of sufficient force to overcome the higher blood systemic pressure of the aorta.

HEART
Similar to its right counterpart, the internal structure of the ventricle features notable muscular ridges,
known as the trabeculae carneae.
The left atrioventricular (mitral) valve has two leaflets, anterior and posterior. Each of these are con
nected to a corresponding superior (or anterior) and inferior (posterior) papillary muscle via tendinous
cords, also known as chordae tendineae. A small conical projection of the left atrium, known as the left
auricle (or atrial appendage) can be seen adjacent to the root of the pulmonary trunk. The posterior wall
of the left atrium is also pierced by four pulmonary veins which carry oxygenated blood from the lungs.
Key points about the left atrium
Receives oxygenated blood from the lungs via the pulmonary veins (4 ostia)
Characteristics: cuboidal chamber, thicker walls (compared to right atrium); has a
Features small muscular pouch -> left auricle of heart (contains pectinate muscles)
Landmarks: T5 - T8 (supine), T6 - T9 (erect)

Function: reservoir for blood and active pumps that help fill the ventricles
Sinus of
pulmonary Portion of posterior wall of left atrium that receives pulmonary veins
veins
Vestibule of left
atrioventricular Contains fibrous ring that supports the leaflets of left AV valve
valve
Key points about the left ventricle
Receives oxygenated blood from left atrium
Characteristics: long conical shape, thicker walls (compared to right ventricle),

Features
smooth inflow/outflow tracts
Function: pumps blood into systemic circulation
Area immediately below aortic orifice, has fibrous walls that support leaflets of
Aortic vestibule
aortic valve
Trabeculae
Muscular elevations that course along mainly apical parts of ventricular wall
carneae
Papillary (Superior/inferior papillary muscles)

muscles,
chordae Muscular projections attached to cusps of left atrioventricular valve via tendinous
tendineae cords (chordae tendineae) preventing prolapse
Rounded anteroinferior extremity of heart formed by left ventricle;

Apex of heart Located at left 5th intercostal space approximately 9 cm from median plane where
apex beat (sounds of left AV valve closure) is maximal.
Ventricles of the
Atria of the heart
heart
Thorax 207
HEART
HEART VALVES
There are four valves in the heart which can be divided into two groups: The
atrioventricular valves and semilunar valves. The atrioventricular valves are
located between the atria and ventricles; the right atrioventricular valve (tri
cuspid valve) is positioned between the right atrium and the right ventricle,
while the left atrioventricular valve (mitral or bicuspid valve) lies between the
left atrium and the left ventricle. On the other hand, the semilunar valves are
the pulmonary valve, located between the right ventricle and the pulmonary
trunk, and the aortic valve, between the left ventricle and aorta.
All the valves comprise a fibrous core covered by endocardial lining facing the
chambers of the heart, and they promote unidirectional flow of blood through
the heart.
Right semilunar leaflet
Anterior semilunar leaflet
Left semilunar leaflet
Right coronary leaflet
Left coronary leaflet
Noncoronary leaflet
Left fibrous trigone
Right fibrous trigone
Anterior leaflet
Posterior leaflet
Fibrous ring
Superior leaflet
Septal leaflet
Inferior leaflet
Fibrous ring
FIGURE 5.44. Overview of the valves of the heart (posterosuperior view). Posterosuperior view of the
heart, with the atria removed to expose the heart valves and surrounding structures. All four heart valves
have 3 cusps or leaflets each, except for the left atrioventricular (mitral valve), which only has 2 cusps
(there may be small accessory cusps between the two major cusps of this valve).
The right, left and posterior semilunar cusps of the aortic valve are commonly referred to as the right cor
onary, left coronary and noncoronary leaflets in clinical practice. Other terminological variations include

HEART
the anterior/posterior leaflets of the right atrioventricular valve which can more accurately be referred to
as the superior/inferior leaflets, respectively. The heart valves are anchored by the fibrous skeleton of the
heart, which can be seen as the fibrous rings of left and right atrioventricular valves (mitral and tricuspid
valves).
Ascending aorta Pulmonary valve
Conus arteriosus
Supraventricular-
crest
Septal papillary
muscle
Coronary sulcus
Right ventricle
Right
atrioventricular
va lve Septomarginal
trabecula
Tendinous cords |
Inferior papillary
muscle
Anterior papillary muscle Trabeculae

carneae
FIGURE 5.45. Right atrioventricular and semilunar valves. Overview of the right ventricle showing the
valve apparatus which supports the right atrioventricular valve, a.k.a. tricuspid valve. This valve is attached
to 3 sets of papillary muscles (anterior, medial (or septal), and inferior) via tendinous cords (chordae
tendineae). These anchor the cusps and prevent them from prolapsing when closed and pressure inside
the right ventricle increases. The pulmonary valve can also be seen, and together with the aortic valve
they comprise the semilunar valves. These valves are smaller than the AV valves and do not have tendinous
cords or papillary muscles supporting them.
Thorax 209
HEART
Aortic arch
Pulmonary trunk
Left atrioventricular valve
Tendinous cords of left

atrioventricular valve
Coronary sinus
Superior papillary
muscle of left
ventricle
Interventricular"
septum
Inferior papillary muscle
of left ventricle
Apex of heart
FIGURE 5.46. Left atrioventricular valve. Left view of the heart with a section of the left ventricular wall
removed to reveal the interior of this chamber. The left atrioventricular valve (mitral or bicuspid valve) can
be seen separating the left atrium and ventricle. The free edge of each leaflet receives multiple tendinous
cords from both papillary muscles (superior/anterolateral and inferior/posterior).
The papillary muscles of the left ventricle are much larger than their right counterparts, most likely
related to the fact that they must resist greater pressure in order to keep the left AV valve closed during
ventricular systole. From the left ventricle blood flows to the root of the aorta via the aortic valve, not
seen in this image.
Key points about the heart valves
Leaflets (cusps): 3 - superior (anterior), inferior (posterior) and septal

Right Papillary muscles: anterior, septal (medial) and inferior (posterior)
atrioventricular
valve (tricuspid) Position: between right atrium and right ventricle
Function: prevents backflow from right ventricle into right atrium
Leaflets (cusps): 2 - anterior (aortic) and posterior (mural)

Left Papillary muscles: inferior (posterior) and superior (anterolateral)
atrioventricular
valve (mitral) Position: between left atrium and left ventricle
Function: prevents backflow from left ventricle into left atrium
Leaflets (cusps): 3 - anterior (non-adjacent), right (right adjacent), and left (left
adjacent)
Pulmonary (No associated papillary muscles)
valve
Position: between right ventricle and root of pulmonary trunk
Function: prevents backflow from pulmonary circulation into right ventricle

HEART
Key points about the heart valves
Leaflets (cusps): 3 - right coronary (right semilunar), left coronary (left semilunar),
and non-coronary (posterior semilunar)
Aortic valve (No associated papillary muscles)
Position: between left ventricle and root of aorta
Function: prevents backflow from systemic circulation into left ventricle
Heart valves Heart
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Valvular heart disease
Thorax 211
HEART
CORONARY ARTERIES AND CARDIAC VEINS

Coronary arteries and cardiac veins comprise the coronary circulation that is
responsible for the blood supply and drainage of the heart muscle (myocar
dium). The two main coronary arteries are the left and right coronary arter
ies. The former is usually of a larger caliber and typically gives off two main
branches that supply a larger area of the heart including most of the left atrium,
the left ventricle and the interventricular septum. The smaller, right coronary
artery supplies the right atrium, right ventricle, interatrial and interventricular
septa, atrioventricular (AV) and sinuatrial (SA) nodes.
The coronary veins can be organized into two groups of veins: The greater and
smaller cardiac venous system. The greater cardiac venous system comprises
the coronary sinus and its tributaries, as well as the anterior cardiac veins, atrial
veins, and the veins of the ventricular septum. The smaller cardiac venous sys
tem is composed of the ‘smallest cardiac veins’ (Thebesian veins) that drain
blood directly into the heart chambers.
Ascending aorta
Left coronary artery
Right coronary artery

Sinuatrial nodal branch of
right coronary artery
Conal branch of
Left marginal branch of
circumflex artery of heart
Anterior interventricular artery
Great cardiac vein
Atrial branch of
Anterior veins of right ventricle
Right marginal vein of heart

Right marginal branch of
Left marginal vein of heart
Oblique vein of left atrium
Inferior vein of left ventricle
Coronary sinus
Small cardiac vein
Inferior interventricular artery
Middle cardiac vein
FIGURE 5.47. Overview of the coronary arteries and cardiac veins. The coronary arterial system starts
with two main arteries which originate from the aortic sinuses of the root of the aorta. The right coronary
artery wraps around the right side of the heart running in the coronary/atrioventricular sulcus. It gives rise

HEART
to three groups of branches (anterior, marginal and inferior (formerly known as the posterior branch)) that
vascularize the majority of structures located in the right aspect of the heart.
The left coronary artery courses towards the anterior interventricular groove where it bifurcates into its
two terminal branches: The anterior interventricular artery and circumflex artery of the heart.
The largest vein of the heart is the coronary sinus. It runs in the coronary sulcus on the inferior aspect of
the heart and drains blood from the majority of the heart into the right atrium. The coronary sinus has
many tributaries including the great, middle and small cardiac veins, inferior vein of the left ventricle and
the oblique vein of left atrium. The largest vein on the anterior aspect of the heart is the great cardiac
vein. This vein receives blood from many venules of the ventricles and left atrium, left marginal vein and
anterior interventricular vein.
Key points about the coronary arteries and cardiac veins
Left coronary artery: anterior interventricular artery, circumflex artery of heart

Coronary
arteries and Right coronary artery: sinuatrial nodal branch, conal branch, atrial branches,
their branches ventricular branches, right marginal branch, inferior(/posterior) interventricular
artery, atrioventricular nodal branch, right inferolateral branch
Coronary sinus and its tributaries (great cardiac vein, middle cardiac vein, small
Main cardiac
cardiac vein, inferior vein of left ventricle); anterior cardiac veins, atrial and
veins
ventricular smallest cardiac veins (Thebesian veins)
■ Blood supply of the Long ectopic left
lltil heart main coronary artery
Thorax 213
HEART
NERVES OF THE HEART

The heart receives intrinsic and extrinsic innervation, which allows it to con
tinue to beat independently, even if its nerve supply is disrupted. The intrinsic
conducting system initiates and controls the contractions of the heart. The
contractions are regulated by an extrinsic regulatory system which consists of
autonomic nerve fibers that originate from a network of nerves also known as
the cardiac plexus.
The cardiac plexus is formed of both sympathetic and parasympathetic nerve

fibers as well as visceral afferent fibers conveying reflexive and nociceptive
fibers from the heart. It is located on the anterior surface of the trachea and
along the posterior surface of the ascending aorta and pulmonary trunk. The
sympathetic innervation to the heart comes from the sympathetic trunk, while
the parasympathetic innervation originates from the vagus nerve (CN X). The
cardiac plexus is responsible for influencing heart rate, cardiac output, and con
traction force of the heart.
Right vagus nerve Superior cervical ganglion
Middle cervical ganglion

Vertebral ganglion
Cervicothoracic
Right recurrent ganglion
laryngeal nerve
Left recurrent
laryngeal nerve
2nd thoracic
ganglion
Thoracic aortic
plexus
3rd thoracic
ganglion
Left sympathetic
trunk
Right sympathetic
trunk Left vagus nerve
Right phrenic
Left phrenic
nerve
nerve
Cardiac plexus Intercostal nerve
FIGURE 5.48. Overview of the innervation of the heart (anterior view). The heart is supplied mainly by
the cardiac plexus, comprising fibers from both sympathetic and parasympathetic nervous systems. The
sympathetic supply comes primarily from the presynaptic fibers that originate from the intermediolateral
cell columns of the first four or five thoracic segments of the spinal cord. These fibers synapse in the

HEART
superior thoracic paravertebral sympathetic ganglia and cervical ganglia of the sympathetic trunks.
Postganglionic fibers from these ganglia unite to form sympathetic cardiac nerves.
The parasympathetic supply comes from presynaptic fibers that arise from neurons either in the poste
rior nucleus of the vagus nerve or near the nucleus ambiguus, and run in cardiac branches of the vagus
nerves. Postsynaptic parasympathetic cell bodies (intrinsic ganglia) are located in the atrial wall and inter
atrial septum near the SA and AV nodes and along the coronary arteries.
FIGURE 5.49. Conduction system of the heart. The conduction system of the heart is formed by the
specialized cardiac muscle fibers that are responsible for the initiation and conduction of the cardiac
impulse. The conduction system is composed of five components: The sinuatrial (SA) node, atrioventricular
(AV) node, AV bundle, right and left branches of the atrioventricular bundles (of His) and the subendocardiac
fibers (Purkinje fibers). The SA node is the pacemaker of the heart and is located superior to the sulcus
terminalis of the right atrium. The AV node is also located in the right atrium. It picks up and propagates
action potentials produced by the sinuatrial node, however is also capable of producing its own action
potentials. The atrioventricular bundle (of His) is made up of specialized cardiac muscle fibers that extend
through the interatrial septum as far as the apex of the heart. These fibers then divide into subendocardiac
(Purkinje) fibers that extend into the myocardium of the ventricles.
Key points about the nerves of the heart
Cervical and thoracic cardiac branches of vagus nerves

Parasympathetic
efferent fibers Function: decrease heart rate, decrease force of contraction of myocardium,
vasoconstriction of coronary arteries
Cardiac nerves from superior, middle and inferior cervical and upper thoracic
Sympathetic ganglia
efferent fibers Function: increase heart rate, increasing force of contraction of myocardium,
increasing blood flow in coronary vessels
Thorax 215
HEART
Key points about the nerves of the heart
Afferent Cervical and thoracic cardiac branches of vagus nerves

parasympathetic Function: feedback on blood pressure
Afferent Afferents to middle and inferior cervical and upper thoracic ganglia
sympathetic
fibers Function: feedback on blood pressure, pain sensation
Sinuatrial (SA) node
Atrioventricular (AV) node

Conduction
system of the AV bundle
heart
Right and left branches of atrioventricular bundles
Subendocardial (Purkinje) fibers
Innervation of the iSasE: Conducting system of

heart the heart
fiisSnis

HEART
LYMPHATICS OF THE HEART
Like the other organs in our body, the heart also needs to have interstitial fluid
drained from its tissues. Small lymphatic vessels of the heart form three plex
uses: The subendocardiac plexus, the myocardiac plexus and the subepicardiac
plexus. The subendocardiac and myocardiac plexus drain into the subepicardiac
plexus, which in turn gives rise to the right and left coronary lymphatic trunks
(or cardiac collecting trunks) which drain the right and left sides of the heart,
respectively.
Brachiocephalic
Lymph nodes
Inferior tracheobronchial
Lymph nodes
Bronchopulmonary
Lymph nodes
Left coronary
Lymphatic trunk
Right coronary
lymphatic trunk
FIGURE 5.50. Overview of the lymphatics of the heart. The right coronary lymphatic trunk travels within
the coronary sulcus, courses anterior to the ascending aorta and ends in the brachiocephalic (anterior
mediastinal) lymph nodes, usually on the left. Lymph drained from here is usually received by the thoracic
duct.
The left coronary trunk travels superiorly within the anterior interventricular groove, passing between
the pulmonary artery and left atrium before draining into the inferior tracheobronchial lymph nodes.
Lymph is then drained to the right lymphatic duct.
Thorax 217
HEART
Key points about the lymphatics of the heart
Subendocardiac plexus: drains into subepicardial plexus

Lymphatic
plexuses of the Myocardiac plexus: drains into subepicardial plexus
heart
Subepicardiac plexus: efferents form the right and left coronary trunks
Drains: right atrium, right border of heart and inferior (diaphragmatic) surface of
Right coronary right ventricle
trunk
Empties into: brachiocephalic lymph nodes (usually on the left) -> thoracic duct
Drains: regions of right and left ventricles around anterior interventricular groove,
Left coronary as well as inferior (diaphragmatic) surface of left ventricle
trunk
Empties into: inferior tracheobronchial lymph nodes -> right lymphatic duct
Lymphatic system of
Heart the thoracic cavity
and mediastinum

ABDOMEN 6
Abdominal wall........................................................................ 221
Regions of the abdomen............................................................... 221
Muscles of the abdominal wall...................................................... 223
Abdominal surface of the diaphragm............................................ 226
Inguinal canal............................................................................... 228
Neurovasculature of the abdominal wall.......................................230
Peritoneum............................................................................. 234
Peritoneal relations...................................................................... 234
Mesentery................................................................................... 236
Greater omentum.........................................................................237
Omental bursa............................................................................. 239
Retroperitoneum......................................................................... 241
Stomach.................................................................................. 243
Stomach in situ............................................................................ 243
Structure of the stomach............................................................. 244
Spleen..................................................................................... 246
Structure of the spleen................................................................ 246
Liver......................................................................................... 248
Overview of the liver................................................................... 248
Surfaces of the liver..................................................................... 250
Gallbladder...................................................................................253
Pancreas.................................................................................. 254
Pancreas in situ............................................................................ 254
Pancreatic duct system............................................................... 256
Small intestine........................................................................ 257

Duodenum................................................................................... 257
Jejunum and ileum.......................................................................259
Arteries and veins of the small intestine........................................ 261
Innervation of the small intestine................................................. 263
Lymphatics of the small intestine................................................. 265
Large intestine........................................................................ 267
Large intestine............................................................................. 267
Rectum and anal canal..................................................................269
Arteries of the large intestine....................................................... 270
Innervation of the large intestine................................................. 272
Neurovasculature of the rectum and anal canal............................. 275
Kidneys and ureters................................................................. 277

Kidneys.........................................................................................277
Renal arteries...............................................................................279
Ureters........................................................................................ 280
Nerves, vessels and lymphatics of the abdomen................... 283

Lumbar plexus............................................................................. 283
Arteries of the stomach, liver and gallbladder............................... 285
Arteries of the pancreas, duodenum and spleen............................ 287
Hepatic portal system..................................................................289
Lymphatics of the pancreas, duodenum and spleen......................290
Lymphatics of the stomach, liver and gallbladder.......................... 292
Lymphatics of the posterior abdominal and pelvic wall................. 295
ABDOMINAL WALL
REGIONS OF THE ABDOMEN
The abdomen is divided into several regions that allow precise communication
about the location of anatomical structures within it, as well as any pathologies.
There are two ways to map the abdomen: By nine regions or by four quadrants.
Hypochondriac
region
Right upper
Midclavicular quadrant
line
Epigastric
region
Anterior
median line
Subcostal Left upper

plane quadrant
Umbilical
region
Transumbilical
Inter plane
tubercular
plane
Left lower
quadrant
Hypogastric
region
Right lower
-------- Inguinal------------ quadrant
region
Lateral
region
FIGURE 6.1. Regions of the abdomen. Two vertical and two horizontal planes divide the abdomen into
9 regions: Right and left hypochondriac regions, epigastric region, umbilical region, right and left lateral
regions of abdomen, hypogastric region, and right and left inguinal regions. The vertical planes are the left
and right midclavicular lines. The first horizontal plane is the subcostal plane which runs at the level of the
lower edge of the 10th costal cartilage. The second horizontal plane is the intertubercular plane, which
passes through the tubercles of the iliac crest and the body of the fifth lumbar vertebra.
Another way to divide the abdomen is into four quadrants with one vertical and one horizontal line. The
vertical line runs along the midline of the abdomen and the horizontal line along the abdomen at the level
of the umbilicus. These divide the abdomen into the right upper quadrant, the left upper quadrant, the
right lower quadrant and the left lower quadrant.
Key points about the regions of the abdomen
Nine-region Right and left hypochondriac regions, epigastric region, umbilical region, right and
scheme left lateral regions, hypogastric region, right and left inguinal regions.
Four-quadrant Right upper quadrant, left upper quadrant, right lower quadrant, left lower
scheme quadrant.
Abdomen 221
ABDOMINAL WALL
Contents of the abdominal regions
Left hypochondriac Left kidney, spleen, tail of pancreas; parts of stomach, left lobe of liver,
region small intestines, transverse colon, descending colon
Right hypochondriac Right lobe of liver, gallbladder, right colic flexure, upper half of right
region kidney and part of duodenum
Abdominal part of esophagus, pylorus of stomach, spleen, pancreas,

Epigastric region right and left suprarenal glands; parts of duodenum, liver, right and left
kidneys, ureters
Part of stomach, pancreas, lower part of duodenum, part of jejunum and

Umbilical region
ileum, cisterna chyli, transverse colon, part of kidneys, ureters
Left lateral region of

Lower part of left kidney, descending colon, parts of jejunum and ileum
abdomen
Right lateral region of Part of right lobe of liver, gallbladder, ascending colon, lower part of right
abdomen kidney, parts of duodenum
Hypogastric region Ileum, sigmoid colon, rectum, ureters, urinary bladder
Body regions learn

Regions of the
with quizzes and
abdomen
labeled diagrams
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ABDOMINAL WALL
MUSCLES OF THE ABDOMINAL WALL
The abdominal muscles are divided into the anterolateral and posterior groups.
• The anterolateral abdominal muscles compose the anterolateral abdomi

nal wall. There are five muscles in this group (superficial to deep): Pyramida-
lis, external abdominal oblique, internal abdominal oblique and transversus
abdominis muscles.
• The posterior abdominal muscles contribute to the posterior abdominal wall.
This group consists of one true posterior wall muscle, the quadratus lum-
borum, as well as the iliopsoas muscle group which continues into the lower
limb.
These muscles also support the abdominal viscera and participate in the for
mation of important anatomical passageways that allow structures from the
abdomen and pelvis to reach the perineum and lower limb (e.g., inguinal canal)
Rectus abdominis muscle
Linea alba
Quadratus lumborum
muscle
Transversus abdominis
muscle
Internal abdominal oblique

muscle
Inguinal ligament
Pyramidalis muscle
Cremaster muscle
FIGURE 6.2 . Muscles of the anterior abdominal wall. The external abdominal oblique muscle is removed
to allow the appreciation of the internal abdominal oblique on the left side of the image. The right side
of the image shows the muscles that lie deep to the internal oblique, namely the rectus abdominis,
Abdomen 223
ABDOMINAL WALL
pyramidalis and transversus abdominis muscle. The quadratus lumborum muscle is visible contributing to
the posterior abdominal wall.
Muscles of
abdominal wall
Bilateral
contraction -
Trunk flexion,
Compresses
Intercostal nerves abdominal viscera,
External Linea alba, Pubic (T7-T11), Subcostal Expiration
External surfaces
abdominal tubercle, Anterior nerve (T12), Unilateral
of ribs 5-12
oblique half of iliac crest Iliohypogastric contraction -
nerve (L1)
Trunk lateral
flexion
(ipsilateral),
Trunk rotation
(contralateral)
Bilateral
contraction -
Trunk flexion,
Intercostal nerves Compresses
Anterior abdominal viscera,
Inferior borders of (T7-T11), Subcostal
two-thirds Expiration
Internal ribs 10-12, Linea nerve (T12),
of iliac crest,
abdominal alba, Pubic crest, Iliohypogastric Unilateral
Iliopectineal arch,
oblique Pecten pubis (via nerve (L1), contraction -
Thoracolumbar
conjoint tendon) Ilioinguinal nerve
fascia Trunk lateral
(L1)
flexion
(ipsilateral),
Trunk rotation
(ipsilateral)
Lateral part: lower

edge of internal
abdominal oblique
and transversus
Genital branch
abdominis
Tunica vaginalis of of genitofemoral Retraction of
Cremaster muscles, Middle
testis nerve testis
of inguinal
ligament (L1, L2)
Medial part: pubic

tubercle, Lateral
part of pubic crest
Bilateral
Internal
contraction -
surfaces of Linea alba, Intercostal nerves
costal cartilages Aponeurosis (T7-T11), Subcostal Compresses
of ribs 7-12, of internal nerve (T12), abdominal viscera,
Transversus Expiration
Thoracolumbar abdominal oblique Iliohypogastric
abdominis
fascia, Anterior muscle; Pubic nerve (L1), Unilateral
two thirds of iliac crest, Pectineal Ilioinguinal nerve contraction -
crest, Iliopectineal line of pubis (L1)
Trunk rotation
arch
(ipsilateral)

ABDOMINAL WALL
Muscles of
abdominal wall
Trunk flexion,
Xiphoid process, Intercostal nerves
Pubic symphysis, Compresses
Rectus abdominis Costal cartilages (T7-T11), Subcostal
Pubic crest abdominal viscera,
of ribs 5-7 nerve (T12)
Expiration
Pubic crest, Pubic Subcostal nerve

Pyramidalis Linea alba Tenses linea alba
symphysis (T12)
Bilateral
contraction -
Fixes Ribs 12
Inferior border of Subcostal nerve during inspiration,
Iliac crest,
Quadratus rib 12, Transverse (T12), Anterior Trunk extension
Iliolumbar
lumborum processes of rami of spinal
ligament Unilateral
vertebrae L1-L4 nerves L1-L4
contraction -
Lateral flexion of
trunk (ipsilateral)
Anterior abdominal
wall
lllll Anterior abdominal
muscles
Lateral abdominal
muscles
Abdomen 225
ABDOMINAL WALL
ABDOMINAL SURFACE OF THE DIAPHRAGM
Two main arteries branch off the abdominal aorta and travel along the abdom
inal surface of the diaphragm, providing its arterial blood supply: The left and
right inferior phrenic arteries. Another branch arising from the abdominal aorta
is the celiac trunk, which in turn gives rise to three arteries that travel directly
beneath the abdominal surface of the diaphragm: The common hepatic, left
gastric and splenic arteries.
The diaphragm is closely related to components of the axial skeleton, including

the ribs, sternum and lumbar vertebrae, as well as several muscles, such as the
psoas major and quadratus lumborum muscles.
Sternum
Caval foramen
Esophageal hiatus
Median arcuate ligament
Phrenic nerve
Inferior phrenic artery
Superior suprarenal artery
Left gastric artery
Splenic artery
Celiac trunk
11th rib
Thoracic splanchnic nerves
Abdominal aorta
Left crus of diaphragm
12th rib
Lateral arcuate ligament
Right crus of diaphragm
Quadratus lumborum muscle
Psoas major muscle
Vertebra L1
Medial arcuate ligament
FIGURE 6.3 . Abdominal surface of the diaphragm. This inferior view (abdominal surface) of the diaphragm
shows the muscular and tendinous components, as well as the three main openings of the diaphragm:
The aortic hiatus (aorta, vena azygos and thoracic duct), esophageal hiatus (esophagus, branches of left
gastric artery and vein and anterior vagal trunk) and caval foramen (inferior vena cava and branches of right
phrenic nerve). These are formed with the help of tendinous structures, including the right and left crus of
the diaphragm as well as the median arcuate ligament.
Two further ligaments, the medial and lateral arcuate ligaments, form openings posterior to the dia
phragm, through which the psoas major and quadratus lumborum muscles pass. Also visible in this inferior
view of the diaphragm are components of the axial skeleton, such as the ribs, sternum and the first three
lumbar vertebrae. The major vessels supplying the diaphragm are also seen traveling along its abdominal
surface: The phrenic nerves and inferior phrenic arteries.

ABDOMINAL WALL
Key points about the abdominal surface of the diaphragm
Parts Skeletal muscle (sternal, costal and lumbar parts), central tendon
Main muscle responsible for respiration; increases abdominal pressure to expel

Function
feces, vomit and urine; applies pressure on the esophagus to prevent acid reflux
Aortic hiatus: aorta, azygos vein, thoracic duct
Openings Esophageal hiatus: esophagus, branches of the left gastric artery and vein,
(apertures) anterior and posterior vagal trunks
Caval foramen: inferior vena cava, branches of the right phrenic nerve
Blood supply Left and right phrenic arteries (branches of the abdominal aorta)
Innervation Left and right phrenic nerves (C3-C5)
Musculotendinous Right and left crus of the diaphragm; median, medial and lateral arcuate
structures ligaments
EMSSaM^B
Diaphragm Hiatal hernia
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Abdomen 227
ABDOMINAL WALL
INGUINAL CANAL
The inguinal canal is an oblique tubular passage that connects the pelvis and
perineum. It originates superolaterally at the deep inguinal ring, traverses the
abdominal wall and terminates at the superficial inguinal ring near the pubic
tubercle.
During fetal life, the inguinal canal in males allows for the physiological
descension of the testes into the scrotum. In adult life, the inguinal canal serves
as a conduit for the spermatic cord and ilioinguinal nerve in males. In females,
the inguinal canal is less prominent due to the absence of the spermatic cord,
however, it does provide the passage for the round ligament of uterus and
ilioinguinal nerve.
The inguinal canal is the weakest point of the trunk wall and as such, an often
site for herniations (inguinal hernia), especially so in males due to the descent
of the testis.
External abdominal
oblique muscle
Transversus abdominis
muscle
Pampiniform plexus
Testicular artery
Internal abdominal
oblique muscle
Inferior epigastric artery
Ductus deferens
Inferior epigastric vein
Deep inguinal ring
Transversalis fascia
Internal spermatic fascia
Inguinal ligament
Rectus abdominis muscle
Pyramidalis muscle
Femoral vein
Femoral artery
Superficial inguinal ring
External spermatic fascia
Spermatic cord
FIGURE 6.4 . Inguinal canal (male). The inguinal canal is shown originating at the deep inguinal ring, located
at the midpoint between the anterior superior iliac spine and pubic tubercle. It continues between the
anterior abdominal muscles and terminates at the superficial inguinal ring.

ABDOMINAL WALL
FIGURE 6.4. (continued)
The canal is bounded from four aspects:
The roof is formed by the internal oblique and transversus abdominis muscles. The anterior wall is derived
from the aponeuroses of the internal and external abdominal oblique muscles. The floor is formed by the
inguinal and lacunar ligaments (not shown). The posterior wall is formed by the transversalis fascia and
conjoint tendon of the abdominal internal abdominal oblique muscles.
The image depicts the spermatic cord traversing the inguinal canal. The cord is enveloped by three fascial
layers, derived from the musculofascial structures of the abdominal wall. From superficial to deep, they
are: External spermatic fascia (derived from the aponeurosis of external abdominal oblique). Cremasteric
muscle (derived from the internal abdominal oblique and its fascia). Internal spermatic fascia (derived from
the transversalis fascia).
The cord itself transmits several structures to and from the testes: Testicular, cremasteric and artery
of ductus deferens. Pampiniform venous plexus. Ilioinguinal nerve and genital branch of genitofemoral
nerve. Ductus deferens.
Inguinal canal
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z
m
z
Abdomen 229
ABDOMINAL WALL
NEUROVASCULATURE OF THE ABDOMINAL WALL
As the anterolateral abdominal wall is a particularly large region, formed by

multiple layers of skin, connective tissue and muscles, it requires an abundant
nervous and blood supply.
Superior Lateral thoracic

epigastric artery
artery
Anterior branches
of lateral cutaneous
branches of
Anterior intercostal arteries
intercostal
artery Cutaneous
branches of
superior epigastric
artery
Subcostal
artery Cutaneous
branches of
inferior epigastric
artery
Lumbar
arteries Superficial
epigastric artery
Inferior
epigastric Femoral artery
artery
FIGURE 6.5. Arteries of the anterolateral abdominal wall. Intercostal arteries 10-11, along with the
subcostal artery, provide the anterior and lateral cutaneous branches that supply the skin and muscles
of the upper lateral portion of the abdominal wall. The lower lateral portion is mainly supplied by the
lumbar arteries, while the medial part is supplied by the branches of the superior, inferior and superficial
epigastric arteries.

ABDOMINAL WALL
Superior epigastric Thoracoepigastric vein

vein
Cutaneous tributaries
vein
of superior epigastric
vein
Subcostal vein
Cutaneous tributaries
of inferior epigastric
Lumbar veins vein
Inferior epigastric Superficial epigastric

vein vein
FIGURE 6.6. Veins of the anterolateral abdominal wall. The venous drainage of the anterolateral >
tn
abdominal wall mainly mirrors the arterial supply. The posterior intercostal veins 10-11, as well as the □
O
subcostal vein, are tributaries of the hemiazygos vein. The superior epigastric vein drains into the internal Z
thoracic vein, while the inferior epigastric vein drains into the external iliac vein. The lumbar veins drain m
z
directly into the inferior vena cava, while the superficial epigastric vein drains into the femoral vein.
Key points about the neurovasculature of the anterolateral abdominal wall
Internal thoracic artery and its branches (musculophrenic artery, superior

epigastric artery), 10th and 11th posterior intercostal arteries, subcostal artery,
Arteries
inferior epigastric artery, deep circumflex iliac artery, superficial circumflex iliac
artery, superficial epigastric artery
Superficial epigastric vein, superior epigastric vein, inferior epigastric vein,

Veins
thoracoepigastric vein, subcostal vein
Thoracoabdominal nerves, lateral cutaneous branches of intercostal nerves 7-11,

Nerves
subcostal nerve, iliohypogastric nerve, ilioinguinal nerve
Abdomen 231
ABDOMINAL WALL
Intercostal nerve Anterior cutaneous

branch of intercostal
nerve
Anterior branch of
lateral cutaneous
Subcostal nerve branch of intercostal
nerve
Lateral cutaneous
branch of subcostal
Iliohypogastric nerve
nerve
Anterior cutaneous
branch of subcostal
nerve
Ilioinguinal nerve Cutaneous branch

of iliohypogastric
nerve
FIGURE 6.7. Nerves of the anterolateral abdominal wall. The anterolateral abdominal wall is innervated
by four main sources:
• Intercostal nerves 7-11 (the anterior rami of spinal nerves T7-T11)
• Subcostal nerve (anterior ramus of spinal nerve T12)
• Iliohypogastric and ilioinguinal nerves (branches of anterior ramus of spinal nerve L1)
The intercostal nerves 7-11 (sometimes referred to as thoracoabdominal nerves) and the subcostal nerve
pass between the internal oblique and transversus abdominis muscles, giving off two cutaneous branches:
Anterior and lateral. They supply the skin and muscles of the anterolateral abdominal wall.
The iliohypogastric and ilioinguinal nerves supply the skin and muscles of the inguinal and hypogastric
regions.
Key points about the neurovasculature of the posterior abdominal wall
Abdominal aorta and its branches (subcostal artery, inferior phrenic artery, lumbar
Arteries
arteries, median sacral artery)
Inferior vena cava and its tributaries (inferior phrenic veins, lumbar veins, and
Veins
common iliac veins)
Nerves Aortic and periarterial nervous plexuses

ABDOMINAL WALL
Musculophrenic artery
Subcostal vein
Subcostal artery

Anterior intercostal
artery
Superior epigastric artery
Superior epigastric vein
Ascending lumbar vein
Abdominal aorta
Inferior vena cava
Lumbar arteries
External iliac artery
External iliac vein
FIGURE 6.8. Arteries and veins of the posterior abdominal wall (lateral view). The arteries that supply the
posterior abdominal wall primarily stem from the abdominal aorta, often being referred to as the parietal
branches of the aorta. The paired parietal branches are the subcostal, inferior phrenic and lumbar arteries.
They respectively supply the regions at the levels of L2, T12 and L1-L4.
The veins of the posterior abdominal wall are predominantly the tributaries of the inferior vena cava.
Namely, these are the inferior epigastric, lumbar and common iliac veins.
Anterior abdominal
wall
Lumbar plexus
Abdomen 233
PERITONEUM
PERITONEAL RELATIONS
The peritoneum is a double-layered serous membrane that envelopes the

abdominal organs and lines the walls of the abdominal cavity. The two layers
are the visceral and parietal peritoneum.
According to their position in relation to the peritoneum, the organs of the

abdominopelvic region can be classified as:
• Intraperitoneal organs
• Extraperitoneal organs (retroperitoneal and infraperitoneal)
FIGURE 6.9. Retroperitoneal vs. intraperitoneal organ. Organs which are completely surrounded by
visceral peritoneum and connected by mesentery are called intraperitoneal organs. Most intraperitoneal
structures are associated with the gastrointestinal tract as this organization allows for both support and
movement.
In contrast, organs located behind the parietal peritoneum are referred to as the retroperitoneal organs.
If they develop and remain outside the peritoneum, they are referred to as the primary retroperitoneal
organs. Secondary retroperitoneal organs initially develop within the peritoneum and become retroper
itoneal when their mesentery fuses with the posterior abdominal wall during embryonic development.
Infraperitoneal organs are organs that lie inferior to the peritoneal cavity.

PERITONEUM
| | Peritoneum |
Intraperitoneal Retroperitoneal
organs organs
Liver- Aorta
Hepatic portal vein
Celiac trunk
Stomach
Splenic artery
Splenic vein
Transverse
colon Pancreas
Superior mesenteric
artery
Small intestine Middle colic artery
Horizontal part of
duodenum
Rectum
FIGURE 6.10. Peritoneal relations. Intraperitoneal organs are completely wrapped by visceral peritoneum.
These organs are the liver, spleen, stomach, superior part of the duodenum, jejunum, ileum, transverse
colon, sigmoid colon and superior part of the rectum. Retroperitoneal organs are found posterior to the
peritoneum in the retroperitoneal space with only their anterior wall covered by the parietal peritoneum.
If they develop and remain outside the peritoneum, they are primarily retroperitoneal organs: Kidney,
adrenal glands and ureter. Other retroperitoneal organs develop inside the peritoneum, but then move
posterior to it and fuse with the abdominal wall: Pancreas, distal duodenum, ascending and descending
colons. Great blood vessels are also retroperitoneal.
Key points about the peritoneal relations
Stomach, superior part of the duodenum, jejunum, ileum, cecum/appendix,

Intraperitoneal
transverse colon, sigmoid colon, liver, gallbladder, spleen, pancreas (tail), female
structures
reproductive organs (ovaries, uterus and uterine tubes)
Primary
Esophagus, anal canal, kidneys, suprarenal (adrenal) glands, ureters, aorta, inferior
retroperitoneal
vena cava
organs
Secondary
Pancreas (head, neck and body), distal duodenum, ascending colon, descending
retroperitoneal
colon, proximal one-third of rectum
organs
Infraperitoneal
Inferior two thirds of rectum, urinary bladder
organs
Recesses Duodenal recesses, caecal recesses, intersigmoid recess
Recesses of the
The peritoneum
peritoneal cavity
Abdomen 235
PERITONEUM
MESENTERY
The mesentery is an abdominal organ comprised of both layers of the perito

neum: Visceral and parietal. The main function of the mesentery is to attach/
suspend the intraperitoneal organs (mainly the intestines) to the posterior
abdominal wall and provide neurovascular communication between those
organs and vessels/nerves of the posterior abdominal wall. Mesenteries include
the:
• Small intestine mesentery (mesentery proper): Suspends the jejunum and the
ileum
• Mesoappendix: Suspends the vermiform appendix and the cecum
• Transverse mesocolon: Suspends the transverse colon
• Sigmoid mesocolon: Suspends the sigmoid colon
Greater omentum
Transverse colon
Teniae coli
Transverse mesocolon
Right colic flexure
Jejunum
Left colic flexure
Mesentery
Ascending colon
Descending colon
Sigmoid mesocolon
Sigmoid colon
Parietal peritoneum
Cecum
Rectum
Ileum
Lateral umbilical fold
Medial umbilical fold
Median umbilical fold
FIGURE 6.11. Overview of the mesentery. The mesentery proper is the largest mesentery that wraps
around the jejunum and ileum, attaching them to the posterior abdominal wall. The transverse mesocolon
supports the transverse colon, attaching it to the posterior abdominal wall. The sigmoid mesocolon
provides support for the sigmoid colon. The mesoappendix is the mesentery of the appendix and the
cecum.

PERITONEUM
Key points about the mesentery
The mesentery is a peritoneal organ, composed of two layers of peritoneum, that

Definition
wraps around the intestines and connects them to the posterior abdominal wall
Structure Mesentery proper, transverse mesocolon, sigmoid mesocolon, mesoappendix
Attaches intestines to the abdominal wall, supports digestion, stores fat,

Function participates in immune functions, provides a pathway for the neurovascular
structures that supply the intestines
Mesentery
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GREATER OMENTUM
The omenta are fused peritoneal folds that connect the intraperitoneal organs
to each other. The greater omentum is the largest, apron-like peritoneal fold
which extends from the greater curvature of the stomach and duodenum to
the posterior abdominal wall. The greater omentum is a site of fat deposition
and functions to protect the abdominal organs by cushioning them and activat
ing the immune response, as well as contributing to reparative processes.
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Abdomen 237
PERITONEUM
Falciform
ligament
of liver
Round ligament
of liver
Right lobe of liver
Gallbladder
Ascending colon
Parietal
peritoneum
Middle colic artery Middle colic vein
Jejunum
FIGURE 6.12. Greater omentum. The greater omentum is a four-layered peritoneal fold that hangs like
an apron covering the abdominal organs. From left to right, the upper margin of the greater omentum is
continuous with the gastrosplenic ligament, greater curvature of the stomach and the proximal part of
the duodenum. It descends inferiorly over the transverse colon, jejunum and ileum. The omentum then
turns posteriorly, passing anterior to the transverse colon and transverse mesocolon to attach to the
posterior abdominal wall.
The right margin of the greater omentum is usually attached to the hepatic flexure and upper portion
of the ascending colon. Its left margin is sometimes attached to the anterior surface of the descending
colon. The greater omentum is vascularized by the gastroomental arteries, and the blood is drained by
gastroomental veins, which run between its layers.
Key points about the greater omentum
Definition The greater omentum is the largest peritoneal fold located in the abdominal cavity.
Blood supply Right gastroomental artery, left gastroomental artery
Venous
Right gastroomental vein, left gastroomental vein
drainage
Related organs Stomach, duodenum, colon, jejunum, ileum
Function Site of fat deposition, protection, reparation
Greater and lesser

omentum
||LJO The peritoneum

PERITONEUM
OMENTAL BURSA
The omental bursa is a large peritoneal recess located in the abdomen formed
by a double-layered fold of visceral peritoneum. It is situated posterior to
the stomach and the lesser omentum, inferior to the liver and anterior to the
pancreas. The omental bursa is also known as the lesser sac, in contrast to
the larger part of the peritoneal cavity which is referred to as the greater sac.
These two cavities are connected by the epiploic foramen (of Winslow). The size
of the omental bursa varies greatly, mainly due to the volume of the organs that
make up its walls.
Posterior wall of stomach

Omental foramen
Left gastric artery
Proper hepatic artery
Celiac trunk
Left suprarenal gland
Left kidney
Splenic artery
Gastrosplenic ligament
Gastroduodenal artery
Right gastroomental artery
Pancreas
Middle colic vein

Middle colic artery
Anterior superior
pancreaticoduodenal
artery
Gastrocolic ligament
Transverse colon
Greater omentum
FIGURE 6.13. Structure of the omental bursa. The omental bursa is found posterior to the stomach,
inferior to the liver and anterior to the pancreas and duodenum. It has an irregular shape with one superior
and one inferior recess. The superior recess is bordered by the diaphragm and the coronary ligament of the
liver, while the inferior recess is found between the folding layers of the greater omentum.
The omental bursa communicates with the greater sac via the epiploic foramen (omental foramen) found
posterior to the free edge of the lesser omentum. This foramen has clear borders:
• Anterior - hepatoduodenal ligament
• Posterior - inferior vena cava and the right crus of the diaphragm
• Superior - caudate lobe of the liver
• Inferior - superior part of the duodenum
Abdomen 239
PERITONEUM
Liver
Gallbladder
Spleen
Hepatoduodenal
ligament
Descending part
of duodenum
Right kidney
Left colic flexure
Right colic flexure
Descending colon
Ascending colon
FIGURE 6.14. Posterior relations of the omental bursa. The omental bursa is a potential space whose
function is to provide space for unhindered movements of the stomach. It is filled with peritoneal fluid
and provides a cushion between the posterior surface of the stomach and several other structures: Celiac
trunk and its branches, pancreas, left kidney and left suprarenal glands. The omental bursa allows normal
peristalsis of the stomach without friction against the above mentioned structures.
Key points about the omental bursa
Omental bursa (lesser sac) is a hollow space formed by the greater and lesser
Definition
omentum and its adjacent organs.
Anterior: hepatogastric ligament, posterior surface of stomach, posterior layers of

the lesser and greater omenta
Walls
Posterior: transverse colon, transverse mesocolon, pancreas, left adrenal gland,
and the upper end of the left kidney, abdominal aorta, coeliac trunk, diaphragm
Superior: extends between esophagus and ligamentum venosum
Inferior: from gastrosplenic ligament to duodenum

Borders
Left: gastrosplenic ligament, spleen, phrenicosplenic ligament
Right: epiploic foramen, lesser omentum, greater sac
Superior omental recess

Recesses Inferior omental recess
Splenic recess
Omental bursa

PERITONEUM
RETROPERITONEUM
The retroperitoneum is a potential anatomical space located posterior to the

peritoneal cavity and anterior to the posterior abdominal wall. It contains sev
eral organs which, due to their location behind the parietal peritoneum, are
referred to as the retroperitoneal organs. The retroperitoneum is divided into
three individual spaces:
• Anterior pararenal space

• Posterior pararenal space
• Perirenal space
Hepatic veins Abdominal part of

esophagus
Diaphragmatic
Left suprarenal gland
surface of liver
Splenic artery
Right suprarenal
gland
Pancreas
Hepatoduodenal Ascending part of

ligament duodenum
Right kidney Left kidney
Left colic artery

Descending part
of duodenum
Abdominal aorta
Horizontal part Inferior mesenteric

of duodenum artery
Root of mesentery Left common iliac

artery
Inferior vena cava
Sigmoid mesocolon
Right common Left external iliac

iliac artery artery
Parietal peritoneum Medial umbilical fold
Left ureter
Right external
iliac artery Median umbilical fold
Right ureter Rectum
FIGURE 6.15. Retroperitoneal organs. Retroperitoneal organs are found posterior to the peritoneal
cavity in the retroperitoneal space with only their anterior wall covered by the parietal peritoneum. If
they develop and remain outside the peritoneum, they are referred to as the primary retroperitoneal
organs. These are the kidneys, suprarenal glands, ureters, aorta/inferior vena cava and rectum. Secondary
retroperitoneal organs initially develop within the peritoneum, however, they become retroperitoneal as
they lose their mesentery during embryonic development. These include the pancreas, distal duodenum,
ascending and descending colons.
Abdomen 241
PERITONEUM
Key points about the retroperitoneum
The retroperitoneum is a potential anatomical space located posterior to the

Definition
parietal peritoneum.
Primary
retroperitoneal Kidneys, suprarenal (adrenal) glands, ureter, aorta/inferior vena cava
organs
Secondary
retroperitoneal Pancreas, distal duodenum, ascending colon, descending colon
organs
Spaces Anterior pararenal space, posterior pararenal space, perirenal space
Recesses of the
The peritoneum
peritoneal cavity
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STOMACH
STOMACH IN SITU
The stomach is a hollow muscular organ and the most dilated portion of the
gastrointestinal tract. It is located on the left upper quadrant of the abdomen
between the esophagus and duodenum. The stomach consists of four main
parts: The cardia, fundus, body, and pyloric part.
Falciform ligament of liver Left lobe of liver
Round ligament of liver Fundus of stomach
Gallbladder
Esophagus
Right lobe
Parietal
of liver
peritoneum
OmentaL
foramen
Diaphragm
Lesser
curvature
of stomach Cardia of
stomach
Duodenum
Spleen
Right kidney
Lesser
Transverse omentum
colon
Body of
Pylorus
stomach
Ascending colon Greater curvature of

stomach
Pyloric part of stomach Greater omentum
FIGURE 6.16. Stomach in situ. The stomach has a characteristic ‘J-shape’ created by two unequal
curvatures: The longer, convex greater curvature (located on the left side) and the shorter, concave lesser
curvature (on the right). Between the curvatures,the four main parts of the stomach are visible: Cardia,
fundus, body and the pyloric part. Anterior relations of the stomach are not fully visible in the illustration
however they include the diaphragm, left lobe of the liver (retracted), and the anterior abdominal wall.
Key points about the stomach and its relations
The stomach is a hollow muscular organ of the digestive system, specialized in the
Definition
mechanical and chemical digestion of food.
Main parts Cardia, fundus, body, pyloric part
Anterior: diaphragm, left lobe of liver, and anterior abdominal wall
Posterior: omental bursa (lesser sac), pancreas, left kidney and adrenal gland,
Relations splenic artery and spleen
Superior: esophagus and diaphragm

Inferior: transverse colon/mesocolon, greater omentum
Mechanical and chemical digestion (of proteins and fats especially), absorption,
Functions
hormone secretion
Abdomen 243
STOMACH
STRUCTURE OF THE STOMACH
The wall of the stomach consists of four histological layers: Mucosa, sub
mucosa, muscular coat (muscularis externa) and serosa. The muscular coat is
further divided into three separate layers: The oblique, circular and longitudi
nalmuscle fibers. The main function of the stomach involves the mechanical
and chemical digestion of ingested food.
Fundus of stomach
Esophagus
Body of stomach
Oblique fibers of muscular

coat of stomach
Cardia of stomach
Circular layer of muscular

coat of stomach
Pyloric canal
Pyloric antrum
Longitudinal layer of muscular

coat of duodenum
Longitudinal layer of muscular

coat of stomach
Gastric canal
Pyloric orifice
Superior part of duodenum
Gastric folds
Pyloric sphincter
FIGURE 6.17. Musculature and mucosa of the stomach. Outer and inner surfaces of the stomach.
The upper image shows the external features of the stomach and its three muscular layers. The outermost
layer is the longitudinal muscle layer. Its fibers are mostly situated on the greater and lesser curvatures.
The middle layer is the circular muscle layer composed of circular muscle fibers. This layer comprises
the pyloric sphincter which serves to regulate the passage of digested food into the duodenum. When
these two layers are removed, the innermost layer, the oblique muscle fibers become visible. This layer is
responsible for the peristaltic movement that churns and breaks down food in the stomach.
In the lower image, the anterior wall of the stomach has been removed to reveal its internal features.
The most prominent features seen on the mucosa of the stomach are the gastric folds (gastric rugae).
The gastric canal runs along the lesser curvature of the stomach and is formed by the longitudinal muscle
fibers of the stomach. The pylorus represents the terminal part of the stomach. It is divided into two parts,
the pyloric antrum, which connects to the body of the stomach, and the pyloric canal, which connects to
the duodenum by the pyloric orifice.

STOMACH
Key points about the structure of the stomach
The stomach is a hollow muscular organ of the digestive system, specialized in the
Definition
accumulation and digestion of food.
Main parts Cardia, fundus, body, pyloric part
Layers of the
Mucosa, submucosa, muscular layer, serosa
gastric wall
Muscular layers Longitudinal layer, circular layer, oblique fibers
Function Mechanical and chemical digestion, absorption, hormone secretion
The stomach Stomach histology
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Abdomen 245
SPLEEN
STRUCTURE OF THE SPLEEN

The spleen is a soft, delicate, fist-sized, intraperitoneal organ covered by a
fibroelastic capsule. It is located in the left upper quadrant of the abdomen
(left hypochondrium), at the level of the ninth to eleventh ribs, posterior to
the stomach and anterior to the left hemidiaphragm and costodiaphragmatic
recess. It plays an important role in the immune system, by participating both in
the humoral and the cell-mediated responses.
Visceral surface
Posterior extremity Superior border
Gastrosplenic
ligament Gastric impression
Renal
impression
Colic impression
Splenic artery
Splenorenal
Inferior border Ligament
Splenic vein Anterior

extremity
Posterior extremity
Inferior border
FIGURE 6.18. Surfaces of the spleen. The spleen has two surfaces: Visceral and diaphragmatic. The convex
diaphragmatic surface faces the diaphragm and is shown on the lower half of the image, while the upper
image on represents the visceral surface of the spleen.
The hilum is located centrally on the visceral surface with the splenic vessels (splenic artery and vein) sur
rounded by the gastrosplenic and splenorenal ligaments. The visceral surface also bears three impressions,
named by the structures directly in contact with them: These are the gastric, colic and renal impressions.

SPLEEN
Fibrous capsule
Splenic pulp
Trabecular artery
Splenic trabeculae
Trabecular vein
FIGURE 6.19. Transverse section of the spleen. Transverse section through the hilum shows the
parenchyma/splenic pulp being divided into small sections by numerous septa called trabeculae.
Key points about the spleen
Intraperitoneal lymphatic organ found on the left side of the abdomen, inferior to
Definition
the diaphragm
Superolateral: diaphragm
Relations of Anteromedial: stomach

spleen Posteroinferior: left kidney (and superior pole of the left suprarenal gland)
Inferior pole: left flexure of the colon
Arterial supply: splenic artery
Neurovascular Venous drainage: splenic vein

supply Lymphatic drainage: celiac node
Innervation: celiac plexus
Spleen
Splenic artery
rupture
Abdomen 247
LIVER
OVERVIEW OF THE LIVER

The liver is a large accessory organ of the gastrointestinal tract with metabolic,
endocrine and exocrine functions. It is located mainly in the right hypochondrium
and epigastrium, with a small portion extending into the left hypochondrium.
The liver is divided into the right, left, quadrate and caudate lobes. It is covered
in visceral peritoneum, except for the bare area, where it is in contact with the
diaphragm and therefore has diaphragmatic and visceral surfaces. Its location
gives it numerous relations to other organs and structures of the body:
• Superior: diaphragm
• Anterior: ribs (7-11th), anterior abdominal wall
• Posteroinferior: esophagus, right kidney and adrenal gland, right colic flexure,
lesser omentum, duodenum, gallbladder, stomach
The position of the liver is secured with the following ligaments: Coronary,
left and right triangular, falciform, round ligaments, ligamentum venosum and
lesser omentum.
Round ligament of liver Left lobe of liver
Right lobe of liver Abdominal part

of esophagus
Gallbladder
Gastrosplenic
Omental ligament
foramen
Hepatogastric
Hepatoduodenal ligament
ligament
Spleen
Superior part
of duodenum
Body of
pancreas
Pyloric part
of stomach
Left colic
flexure
Right colic
flexure Root of
transverse
Greater mesocolon
omentum
Duodenojejunal
Transverse colon flexure
Horizontal part Mesentery

of duodenum proper
FIGURE 6.20. Relations of the liver. Anterior view of the abdomen with the liver retracted and the
stomach removed to expose the underlying structures. Right and left lobes of the liver can be seen, with
the gallbladder on the posterior surface of the right lobe and with the blood vessels and the bile duct
enclosed in the hepatoduodenal ligament (part of the lesser omentum).
The rest of the lesser omentum is formed by the hepatogastric ligament. It extends between the liver and
the stomach, but only a small part of it is visible around the cardiac orifice of the esophagus. The falciform
ligament is located between the right and left lobes and is continuous inferiorly with the round ligament

LIVER
of the liver, which is exposed due to the reflected liver. The round ligament extends posteroinferiorly
to join the ligamentum venosum. A section of the greater omentum, the superior part of the duodenum
and the transverse colon are all shown and form the posteroinferior anatomical relations of the liver. Not
shown in the image are the posterior relations of the liver to the right kidney and the adrenal gland.
Key points about the liver
Location Right hypochondriac and epigastric regions
Lobes: right, left, caudate, quadrate

Surfaces: diaphragmatic, visceral
Anatomy Fissures: main portal fissure, right portal fissure, left portal fissure, umbilical
fissure (fissure for ligamentum teres, fissure for ligamentum venosum)
Ligaments: coronary, left triangular, right triangular, falciform, round, ligamentum
venosum, hepatogastric, hepatoduodenal
Metabolic, endocrine and exocrine functions (xenobiotic biotransformation,

Function
protein synthesis, nutrient storage, bile production)
Superior: diaphragm
Anterior: ribs 7-11, anterior abdominal wall

Relations
Posteroinferior: esophagus, stomach, gallbladder, duodenum, right kidney, right
adrenal gland, right colic flexure, lesser omentum
Functional division of
Liver
the liver
E®iS
Liver ligaments
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Abdomen 249
LIVER
SURFACES OF THE LIVER
The liver has two surfaces which are separated by a narrow inferior border:
• The diaphragmatic surface, lying just below the diaphragm

• The visceral surface, which faces the abdominal organs
Diaphragm
Left triangular
Ligament
Fibrous appendix
Bare area
Left lobe of liver
Anterior part of coronary

ligament
Falciform ligament
Inferior border
Umbilical vein
Round ligament
Right triangular ligament
Right lobe
Gallbladder
FIGURE 6.21. Anterior view of the liver. Observing the liver from an anterior perspective allows the
appreciation of its superior, anterior and right surfaces, which are collectively dome-shaped due to
their contact with the overlying diaphragm. All are covered mainly with peritoneum which is reflected
superiorly as the anterior part of the coronary ligament, forming the bare area of the liver posterior to it.
The peritoneum covering the anterior surface meets its posterior counterpart at the upper right and left
corners of the liver, forming the right and left triangular ligaments. The left and right lobes of the liver are
separated by the falciform ligament, whose inferior margin encloses the round ligament.

LIVER
Inferior vena cava Inferior vena cava

Ligament
Hepatic veins
Bare area
Caudate lobe
Fibrous appendix Caudate process
Hepatic portal
Right hepatic artery
vein
Left hepatic Posterior part of

artery coronary ligament
Left lobe
Right hepatic duct
Left hepatic duct
Right lobe
Common hepatic
duct
Porta hepatis
Proper hepatic
artery
Cystic artery
Bile duct
Cystic duct
Quadrate lobe
Round ligament Gallbladder
FIGURE 6.22. Inferior view of the liver. Several vascular and ligamentous structures, together with the
gallbladder, form the shape of the letter “H” on the posteroinferior aspect of the liver. The horizontal limb
is represented by the hilum of the liver (porta hepatis), which gives passage to the hepatic portal vein,
proper hepatic artery and biliary ducts. The right limb of the H is formed by the groove for inferior vena
cava and gallbladder below it. The left limb, which separates the left lobe from the caudate and quadrate
lobes, is defined by the fissures for ligamentum venosum and round ligament.
Between the porta hepatis and inferior vena cava is the posterior part of the coronary ligament that
extends to the right, marking the inferior boundary of the bare area of the liver. Below it on the right
lobe are impressions of the suprarenal gland, kidney and hepatic flexure of the colon. The posteroinferior
aspect of the left lobe presents a well defined impression of the stomach, while the quadrate lobe is adja
cent to the first part of the duodenum.
Abdomen 251
LIVER
Fibrous Anterior part of

appendix coronary ligament
Left triangular-
ligament Right hepatic vein
Left and intermediate Bare area

hepatic veins
Posterior part of
Groove for inferior
coronary ligament
vena cava
Caudate lobe Right triangular

ligament
Quadrate lobe Visceral surface

of right lobe
Common hepatic duct Caudate process
Hepatic portal vein

Cystic duct
Left hepatic artery
Cystic artery
Round ligament
Gallbladder
Proper hepatic artery Bile duct
FIGURE 6.23. Posterior view of the liver. The posterior surface of the liver is attached to the diaphragm
at the bare area. This area is bounded by the anterior and posterior parts of the coronary ligament which
merge to the left and right as the triangular ligaments of the liver. In the center of the bare area are the
right, middle and left hepatic veins.
The caudate lobe is limited by the posterior part of coronary ligament, fissure for ligamentum venosum
and porta hepatis. The left lobe carries an impression of the stomach, while to the right of the gallbladder
are additional impressions of the suprarenal gland and kidney.
Key points about the surfaces of the liver
Right lobe: largest lobe of the liver
Lobes ofthe Left lobe: separated anteriorly from right lobe by falciform ligament
liver Quadrate lobe: visceral surface, between gallbladder and left lobe
Caudate lobe: visceral surface, between inferior vena cava and left lobe
Surfaces: superior, anterior, right, posterior

Diaphragmatic
surface Landmarks: cardiac impression, bare area, groove for inferior vena cava, hepatic
veins
Also known as inferior surface;
Landmarks: porta hepatis, fossa for gallbladder, omental tuberosity,

Visceral surface Fissures: main portal fissure, right portal fissure, left portal fissure, umbilical
fissure (fissure for ligamentum teres, fissure for ligamentum venosum)
Impressions: esophageal, gastric, duodenal, colic, renal, suprarenal
Ligaments of Coronary (anterior and posterior parts), left triangular, right triangular, falciform,
liver round, ligamentum venosum, hepatogastric, hepatoduodenal

LIVER
GALLBLADDER
The gallbladder is a small intraperitoneal organ, located below the liver, to

which it is functionally connected through the extrahepatic duct system. While
the liver produces bile, the gallbladder’s main function is to store bile that it
receives from the liver and concentrate it by removing water and electrolytes.
FIGURE 6.24. Overview of the gallbladder. The gallbladder is a small pear-shaped sac, which is divided into
four anatomical parts: Fundus, body, infundibulum and neck. It is located on the inferior aspect of the right
lobe of the liver. The gallbladder empties its contents via the cystic duct, which joins with the common
hepatic duct from the liver to form the bile duct. The bile duct extends into the pancreas, where it joins
the main pancreatic duct to form the hepatopancreatic ampulla (ampulla of Vater). This short duct then
empties into the duodenum via the major duodenal papilla.
Key points about the gallbladder
Gastrointestinal, intraperitoneal sac-like organ, located on the inferior aspect of

Definition
the liver
Parts Fundus, body, infundibulum, neck
Function Storage, concentration and release of bile
Extrahepatic Left and right hepatic ducts, common hepatic duct, cystic duct, bile duct,
duct system pancreatic duct, hepatopancreatic ampulla, major duodenal papilla
Arterial supply: cystic artery
Neurovascular Venous drainage: small tributaries of the segmental portal veins

supply Lymph: intrahepatic lymph vessels, cystic node
Innervation: hepatic plexus
Abdomen 253
PANCREAS
PANCREAS IN SITU
The pancreas is an accessory retroperitoneal organ of the digestive system
that has both exocrine and endocrine functions. It helps digestion by producing
pancreatic juices which are secreted into the duodenum. These juices consist of
enzymes that break down sugars, lipids, and starches. The pancreas also pro
duces important hormones (insulin, glucagon, and somatostatin) that regulate
blood glucose levels.
Hepatic veins
Inferior vena cava
Right suprarenal gland
Hepatic duct
Hepatic portal vein
Hepatoduodenal
Ligament
Splenic artery
Pancreas
Superior part of
duodenum
Left colic flexure
Jejunum
Transverse colon
Descending part of
duodenum
Descending colon
Ascending part of
duodenum
Horizontal part of
duodenum
Root of mesentery
FIGURE 6.25. Pancreas in situ. The pancreas is an elongated organ which lies mainly retroperitoneally
across the posterior abdominal wall. It is divided into five anatomical parts: Head, neck, body, tail and
uncinate process. The descending and horizontal parts of the C-shaped duodenum wrap around the
pancreatic head. The aorta, superior mesenteric artery, left renal vessels, left kidney, and left suprarenal
gland are situated posterior to the pancreatic body. The tail is the last part of the pancreas and lies
intraperitoneally. It is situated in close proximity to the hilum of the spleen and runs with the splenic
vessels in the splenorenal ligament.

PANCREAS
Key points about the pancreas
Definition Accessory gland of the digestive system with endocrine and exocrine functions
Location Retroperitoneal, behind the stomach
Anterior: stomach, transverse mesocolon
Posterior: common bile duct, aorta, inferior vena cava, hepatic portal vein, left
kidney, left suprarenal gland
Relations
Superior: splenic artery
Lateral-right: duodenum
Lateral-left: spleen
Parts Head, uncinate process, neck, body, tail
Exocrine: secretes enzymatic fluids that break down nutrients

Function Endocrine: secretes hormones that regulate metabolism (insulin, glucagon,
somatostatin)
Arterial supply: superior and inferior pancreaticoduodenal arteries
splenic artery, gastroduodenal artery, superior mesenteric artery

Neurovascular Venous drainage: pancreaticoduodenal veins, superior mesenteric vein, hepatic
supply portal vein, pancreatic veins, splenic vein
Innervation: vagus nerve (parasympathetic), greater and lesser splanchnic nerves

(sympathetic)
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Pancreas Pancreas histology
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Abdomen 255
PANCREAS
PANCREATIC DUCT SYSTEM
The pancreatic duct system is a system of excretory ducts within the pancre
atic tissue which convey the pancreatic digestive enzymes (pancreatic juices)
and bile into the duodenum.
Superior duodenal flexure

Pyloric sphincter
Body of pancreas
Pyloric orifice
Pyloric canal
Minor duodenal papilla

Accessory pancreatic duct
Duodenojejunal flexure
Uncinate process of pancreas
Bile duct
Jejunum
Ascending part of duodenum
Head of pancreas
Pancreatic duct
Hepatopancreatic ampulla
Horizontal part of duodenum
Major duodenal papilla
Inferior duodenal flexure
Descending part of duodenum
FIGURE 6.26. Pancreatic duct system. The pancreatic duct (of Wirsung) originates in the pancreatic
tail and courses through the entire length of the body of pancreas, from which it receives the contents
of the smaller interlobular ducts. At the head of the pancreas, it converges with the bile duct to form
the hepatopancreatic ampulla (of Vater). The bile and pancreatic juices are then passed into the
duodenum through the major duodenal papilla. The hepatopancreatic sphincter (of Oddi) surrounds
the hepatopancreatic ampulla to allow for a controlled flow of pancreatic juices and bile. The smaller
accessory pancreatic duct, when present, drains the head of the pancreas and empties into the duodenum
at the minor duodenal papilla.
Key points about the pancreatic duct system
Extends from tail to head of pancreas

Main pancreatic
duct (of Joins bile duct to form hepatopancreatic ampulla
Wirsung)
Drains into duodenum at major duodenal papilla
Arises at head of pancreas

Accessory
pancreatic duct Communicates with main pancreatic duct
(of Santorini)
Empties into duodenum at minor duodenal papilla
Drains pancreatic digestive enzymes and bile into the duodenum where further
Function
digestion of food takes place

SMALL INTESTINE
DUODENUM
The duodenum is the first segment of the small intestine, extending from the
pyloric sphincter of the stomach to the jejunum. It is divided into the superior,
descending, horizontal and ascending parts. Only the proximal section of the
superior part is intraperitoneal, and thus the most mobile, while the rest of the
duodenum is retroperitoneal.
Its functions are to dilute and neutralize digestive juices, digest and process
chyme passed on from the stomach, receive pancreatic enzymes and bile, as
well as absorb various nutrients.
The wall of the duodenum consists of three main layers: An inner mucosa with
defined circular folds (of Kerckring), an underlying submucosa and a double lay
ered muscular coat.
Abdominal aorta
Hepatic portal vein
Superior duodenal flexure
Pyloric sphincter
Duodenojejunal flexure
Bile duct
Minor duodenal papilla
Accessory pancreatic duct
Circular folds (of Kerckring)
Descending part of duodenum
Pancreatic duct
Major duodenal papilla
Superior mesenteric artery
Head of pancreas
Inferior duodenal flexure
Superior mesenteric vein
Longitudinal layer of
muscular coat of duodenum
Circular layer of muscular coat
of duodenum
Ascending part of duodenum
Submucosa
Horizontal part of duodenum
Jejunum
FIGURE 6.27. Overview of the duodenum with related structures. The anterior wall of the superior and
descending parts of the duodenum is removed to reveal its internal structure. Circular folds (of Kerckring)
define the mucosa from the descending part onwards. Two small openings are seen amongst them in
the descending part of the duodenum. The major duodenal papilla allows pancreatic enzymes and bile to
enter the duodenum from the union of the pancreatic duct and bile duct, known as the hepatopancreatic
ampulla. The minor duodenal papilla is an opening for pancreatic enzymes from the accessory pancreatic
duct.
Abdomen 257
SMALL INTESTINE
The different layers of the duodenum are exposed on its horizontal part. The head of the pancreas sits
within the curve of the duodenum. The abdominal aorta, hepatic portal vein (pictured) inferior vena
cava, pancreaticoduodenal arteries, bile duct, right kidney, ureter and psoas major, gonadal vessels and
L3 vertebra (not pictured) are located posterior to the duodenum. The superior mesenteric artery and vein
(pictured), right lobe of the liver and the gallbladder (not pictured) extend over the anterior surface of the
duodenum.
Key points about the duodenum
Superior: from pyloric sphincter to superior duodenal flexure

Descending: from superior duodenal flexure to inferior duodenal flexure
Parts
Horizontal: from inferior duodenal flexure to ascending part
Ascending: from horizontal part to the duodenojejunal flexure
Mucosa (with circular folds [of Kerckring])

Internal
Submucosa
structure
Muscular coat (outer longitudinal, inner circular layers)
Major duodenal papilla: from hepatopancreatic ampulla

Openings
Minor duodenal papilla: from accessory pancreatic duct
Hepatoduodenal ligament (part of lesser omentum)

Ligaments
Suspensory muscle of duodenum (ligament of Treitz)
In curve of duodenum - head of pancreas
Posterior - abdominal aorta, hepatic portal vein, inferior vena cava, gastroduodenal
Relations artery, bile duct, right kidney, ureter and psoas major, L3 vertebra, right gonadal
vessels
Anterior - superior mesenteric artery/vein, gallbladder, right lobe of liver
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Duodenum Small intestine
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SMALL INTESTINE
JEJUNUM AND ILEUM
The jejunum and ileum are the middle and terminal parts of the small intestine,
extending from the duodenojejunal flexure to the ileocecal junction. Together,
they measure around five meters on average, with the jejunum comprising the
proximal two-fifths and the ileum the distal three-fifths. They occupy much
of the mid-to-lower abdominal cavity where they are largely enclosed by the
large intestine. In the supine position, the jejunum is generally situated within
the left lateral and umbilical regions of the abdomen, while the ileum is charac
teristically found within the hypogastric and right inguinal/iliac regions.
The main function of the jejunum and ileum is to absorb nutrients from food
(chyme). The jejunum absorbs most of the sugars, fatty and amino acids as well
as other nutrients. The ileum absorbs remaining nutrients after passage through
the jejunum and is specifically responsible for the absorption of vitamin B12 and
reabsorption of conjugated bile salts.
FIGURE 6.28. Jejunum and ileum reflected (anterior view). The jejunum begins at the duodenojejunal
flexure, an abrupt bend after which the small intestine becomes intraperitoneal again. From this point,
both the jejunum and ileum are suspended from the posterior abdominal wall by the mesentery proper,
which gives them a great degree of mobility within the abdominal cavity. The walls of both the jejunum and
ileum are enveloped by visceral peritoneum except along their mesenteric borders where the peritoneum
is reflected onto the mesentery behind.
There is no clear demarcation between the jejunum and ileum, but rather a gradual transition in their inter
nal morphology from one part to the next. At a gross level, the jejunum has a somewhat ‘redder’ appear
ance due its more profuse blood supply compared with the ileum. The distal 30cm of the ileum is referred
to as the terminal ileum (due to specialized morphology and functions of this part). It terminates at the
ileocecal junction, featuring the ileal papilla, through which the contents of the small intestine pass from
the ileum to the cecum of the large intestine.
Abdomen 259
SMALL INTESTINE
Key points about the jejunum and ileum
Jejunum Ileum
Terminal part of small intestine, located

Definition/ Middle part of small intestine, located in
in hypogastric and right inguinal/iliac
location umbilical and left lateral regions
regions
Proximal 2/5 of small intestine (after

Length Distal 3/5 of small intestine
duodenojejunal flexure)
• Mucosa (with circular folds [of Kerckring])
• Submucosa
Structure
• Muscular coat (outer longitudinal, inner circular layers)
• Visceral peritoneum
Thinner walls with fewer, less defined

Thicker wall with more numerous and
Internal circular folds, contains high amounts
pronounced circular folds, more profuse
anatomy of MALT (mucosa associated lymphoid
blood supply
tissue)
Absorbs remaining nutrients after

Absorbs digested sugars, amino and jejunum, (specifically responsible for
Functions
fatty acids, nutrients etc. absorption vitamin B and conjugated
bile salts)
Jejunum
IK Ileum
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SMALL INTESTINE
ARTERIES AND VEINS OF THE SMALL INTESTINE
The small intestine comprises three separate segments: The duodenum,

jejunum and ileum, each of which with different vasculature. The proximal half
of the duodenum, which is part of the foregut, is mainly supplied by branches
of the gastroduodenal artery (a terminal branch of the common hepatic artery).
Tributaries draining this part of the duodenum mostly empty directly into the
portal vein.
The rest of the small intestine, which belongs to the midgut, receives its arterial
supply and venous drainage from the main vessels associated with the midgut:
The superior mesenteric artery (SMA) and vein. It is important to note that
both the arterial supply and the venous drainage of the small intestine is highly
variable.
Left gastric artery

Splenic artery
Left renal artery
Right gastroomental
artery
Middle colic artery
Anterior superior
pancreaticoduodenal
artery
Inferior
pancreaticoduodenal
artery
Superior mesenteric
artery
Right colic artery
Jejunal arteries
Ileocolic artery
Ileal arteries
Colic branch of
ileocolic artery
Ileal branch of
ileocolic artery
Posterior cecal artery
Anterior cecal artery
Straight arteries
of small intestine
FIGURE 6.29. Arteries of the small intestine. Overview of the abdomen with the liver reflected, and
parts of the stomach, pancreas and large intestine removed. The proximal part of the duodenum (as
far as the major duodenal papilla), is primarily supplied by superior pancreaticoduodenal branches of
the gastroduodenal artery (which also provides supply via the supraduodenal, retroduodenal and right
gastroomental arteries). There are also small contributions to the duodenum from the right gastric
artery, a branch of the proper hepatic artery. The superior mesenteric artery supplies the remainder of
the duodenum via the inferior pancreaticoduodenal and first jejunal arteries.
Abdomen 261
SMALL INTESTINE
The jejunal and ileal branches of the superior mesenteric artery form loops known as arterial arcades. They
give off branches known as straight arteries or vasa recta which supply the jejunum and the ileum. The
terminal part of the ileum receives its supply from branches of the ileocolic artery.
Left gastric vein
Hepatic portal vein
Splenic vein
Inferior mesenteric
vein
Middle colic vein
Superior mesenteric
vein
Right colic vein
Jejunal veins
Inferior vena cava
Ileocolic vein
Ileal veins
Cecal veins
FIGURE 6.30. Veins of the small intestine. Overview of the abdomen with the liver reflected and parts
of the stomach, pancreas and large intestine removed. The venous drainage of the small intestine is
more variable, but tends to generally follow the same pattern as the arteries. The superior mesenteric
vein, however, drains into the hepatic portal vein rather than the inferior vena cava. The blood then goes
through the portal venous system to the liver, where nutrients and toxins are removed, before being
emptied into the inferior vena cava.
Key points about the vascular supply of the small intestine
Main arteries: anterior superior pancreaticoduodenal artery, posterior superior

Duodenum
pancreaticoduodenal artery (from gastroduodenal artery)
arterial supply
Minor contributions: right gastric (from proper hepatic artery), supraduodenal,
(proximal part)
retroduodenal and right gastroomental arteries (from gastroduodenal artery)
Duodenum Main arteries: anterior inferior pancreaticoduodenal artery, posterior inferior

arterial supply pancreaticoduodenal artery (from SMA)
(distal part) Minor contributions: first jejunal artery (from SMA)
Duodenum Proximal part: superior pancreaticoduodenal vein (drains into right gastroepiploic
venous vein and hepatic portal vein)
drainage Distal part: inferior pancreaticoduodenal vein (drains into superior mesenteric vein)

SMALL INTESTINE
Key points about the vascular supply of the small intestine
Jejunum Arteries: jejunal arteries (arterial arcades) to straight arteries (from SMA)
vascular supply Veins: jejunal veins (drain to superior mesenteric vein)
Arteries: ileal arteries (arterial arcades) to straight arteries, Ileal branch of ileocolic
Ileum vascular artery (from SMA)
supply
Veins: ileal veins, Ileocolic vein (drain to superior mesenteric vein)
Blood supply and

Superior mesenteric
innervation of the
artery
small intestine
INNERVATION OF THE SMALL INTESTINE
The small intestine has an extrinsic and intrinsic innervation. The extrinsic
innervation is provided by the sympathetic and parasympathetic divisions of
the autonomic nervous system, while the intrinsic innervation comes from the
enteric nervous system.
Preganglionic sympathetic fibers from the thoracolumbar spinal cord travel as

the greater and lesser thoracic splanchnic nerves to the celiac, aorticorenal and
superior mesenteric ganglia. From there, postganglionic fibers are distributed
via the celiac/superior mesenteric plexus to the duodenum, jejunum and ileum
to inhibit digestion. Both the anterior and posterior vagal trunks of the vagus
nerve send parasympathetic contributions via the celiac ganglia which then fol
low the same pathway as the sympathetic fibers to stimulate digestion. Post
ganglionic parasympathetic fibers are located in the target organ wall.
The enteric nervous system regulates muscle tone and contractions, nutrient
absorption and enzyme secretion via the myenteric plexus (plexus of Auerbach)
and the submucosal plexus (Meissner’s plexus).
Abdomen 263
SMALL INTESTINE
Hepatic branch of
anterior vagal trunk
Hepatic plexus
Celiac branch of
Celiac branches of
posterior vagal trunk
Pyloric branch of
Right greater thoracic

splanchnic nerve
Left greater thoracic

splanchnic nerve
Celiac ganglia
Left lesser thoracic

splanchnic nerve
Aorticorenal ganglia
Superior mesenteric
ganglion
Pancreatic plexus
Superior mesenteric
plexus
Periarterial plexus
FIGURE 6.31. Nerves of the small intestine. Overview of the abdomen with the liver reflected, and
parts of the stomach, pancreas and large intestine removed. The greater and lesser splanchnic nerves
transmit sympathetic innervation from the thoracolumbar spinal cord to the celiac, aorticorenal and
superior mesenteric ganglia on both sides of the celiac trunk. Parasympathetic information is provided
by the anterior and posterior vagal trunks, following the same periarterial pathways and passing through
the sympathetic ganglia. From here, sympathetic and parasympathetic nerve fibers are distributed via
periarterial plexuses to the duodenum, jejunum and ileum.
Key points about the innervation of the small intestine
Preganglionic: greater and lesser splanchnic nerves from thoracolumbar spinal

cord to celiac, aorticorenal and superior mesenteric ganglia
Sympathetic
Postganglionic: fibers from celiac and superior mesenteric ganglia to small
Innervation
intestine
Function: inhibits digestion
Preganglionic: anterior and posterior vagal trunks to celiac and superior

mesenteric plexus
Parasympathetic
Postganglionic: fibers from celiac and superior mesenteric ganglia to small
innervation
intestine
Function: stimulates digestion
Myenteric plexus (of Auerbach): regulates smooth muscle tone and contractions
Intrinsic
innervation Submucosal plexus (Meissner’s Plexus): regulates intestinal enzyme secretion,
food absorption and (sub)mucosal muscle movement

SMALL INTESTINE
Blood supply and

innervation of the Celiac plexus
small intestine
LYMPHATICS OF THE SMALL INTESTINE
The lymph nodes of the duodenum include the superior and inferior pancre
aticoduodenal lymph nodes, superior mesenteric lymph nodes, celiac lymph
nodes and again drain into the cisterna chyli.
The distal part of the ileum is drained by the ileocolic lymph nodes. Lymph
drained from the proximal ileum and the jejunum is carried to the juxtaintes-
tinal lymph nodes which are located within the mesentery in close proximity
to the small intestine. From here, lymph continues to the superior mesenteric
lymph nodes via the intermediate mesenteric lymph nodes, ultimately reaching
the cisterna chyli via the intestinal lymph trunk.
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Abdomen 265
SMALL INTESTINE
Celiac lymph nodes
Thoracic duct
Cisterna chyli
Superior mesenteric
lymph nodes
Right colic lymph

nodes
Intermediate
mesenteric
lymph nodes
Ileocolic lymph nodes
Juxtaintestinal lymph
nodes
z FIGURE 6.32. Lymph nodes of the small intestine. Overview of the abdomen with the liver reflected
id
z and the stomach, pancreas and parts of the large intestine removed. The lymph nodes of the small
o intestine compose one the largest groups in the body, consisting of 100-150 nodes dispersed throughout
a
co the mesentery. The juxtaintestinal lymph nodes are located peripherally close to the ileal and jejunal
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wall. From here, lymph is transported towards the superior mesenteric lymph nodes via intermediate
mesenteric nodes located alongside the jejunal and ileal arteries. Pancreaticoduodenal lymph nodes drain
most of the duodenum. Lymph is then transported to the celiac and superior mesenteric nodes before
reaching the cisterna chyli and continuing into the thoracic duct.
Key points about the lymph nodes of the small intestine
Distal: ileocolic lymph nodes

Ileum Proximal: juxtaintestinal lymph nodes ^ superior mesenteric lymph nodes via
intermediate mesenteric lymph nodes
Juxtaintestinal lymph nodes ^ superior mesenteric lymph nodes via intermediate

Jejunum
mesenteric lymph nodes
Mainly drained by superior and inferior pancreaticoduodenal lymph nodes (in

Duodenum addition to pyloric and inferior pancreatic nodes) ^ celiac & superior mesenteric
lymph nodes
Lymphatics of
Lymphatic system
abdomen and pelvis

LARGE INTESTINE
LARGE INTESTINE
The large intestine is the penultimate part of the gastrointestinal tract. It is
responsible for the absorption of water and electrolytes and converting indi
gestible matter to feces, which is stored temporarily until defecation. The large
intestine begins at the ileocaecal junction and it consists of the cecum, vermi
form appendix, colon, rectum and anal canal. The colon is the longest part of the
large intestine, subdivided into four main segments: The ascending, transverse,
descending and sigmoid colon. All parts of the large intestine are located retro-
peritoneally, with the exception of the transverse and sigmoid colon, which are
intraperitoneal organs.
Transverse colon Transverse mesocolon
Mesentery Greater omentum
Omental
Haustra of colon
appendices
Ascending colon Free tenia
Omental tenia Mesocolic tenia
Ileal papilla Semilunar folds

of colon
Terminal part Descending colon

of ileum
Cecum Sigmoid mesocolon
Mesoappendix Sigmoid colon
Vermiform appendix Rectum
FIGURE 6.33. Anterior view of the large intestine (greater omentum removed). The large intestine begins
at the cecum, which continues on from the terminal part of the ileum. Protruding from the cecum is the
vermiform appendix, which usually lies intraperitoneally and is held in position by its mesentery, the
mesoappendix.
Continuing on from the cecum is the colon, divided into ascending, transverse, descending and sigmoid
colon. Of these, the transverse and sigmoid colon are located intraperitoneally and suspended by the
transverse and sigmoid mesocolon, respectively. The large intestine ends with the rectum and anal canal.
Important features unique to the large intestine are the epiploic appendages, which are small pouches of
the peritoneum filled with adipose tissue, the longitudinal bands of smooth muscle called taenia coli, as
well as the pouch-like sacculations called haustra coli.
Abdomen 267
LARGE INTESTINE
Key points
about Lymphatic
Location Blood supply Innervation Mesentery
the large drainage
intestine
Superior
Ileocolic
Cecum Intraperitoneal mesenteric /
artery
plexus
Superior Ileocolic
Intraperitoneal mesenteric plexus lymph nodes
Vermiform Appendicular
(or in the pelvic (sympathetic), Mesoappendix
appendix arteries
cavity) vagus nerve
(parasympathetic)
Ileocolic and Superior Epicolic and

Ascending
Retroperitoneal right colic mesenteric paracolic /
colon
arteries plexus lymph nodes
Superior
Right, middle
Transverse and inferior Middle colic Transverse
Intraperitoneal and left colic
colon mesenteric lymph nodes mesocolon
arteries
plexuses
Descending Superior
Retroperitoneal /
colon hypogastric
Left colic
plexus Paracolic
and superior
(sympathetic), and epicolic
Sigmoid sigmoid Sigmoid
Intraperitoneal pelvic splanchnic lymph nodes
colon arteries mesocolon
nerves
(parasympathetic)
Intraperitoneal
(superior
segment), Superior
Rectum Pararectal
retroperitoneal [Ano]rectal and inferior
(inferior and epirectal /
arteries hypogastric
segment) lymph nodes
plexuses
Pelvic cavity
Anal canal
(extraperitoneal)
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of the large intestine

LARGE INTESTINE
RECTUM AND ANAL CANAL
The rectum and anal canal are located in the pelvic cavity and are the terminal
structures of the gastrointestinal tract. The rectum is a direct continuation of
the sigmoid colon and is followed by the anal canal, which opens itself to the
external environment through the anus. The main functions of these structures
is to absorb water and electrolytes, and store feces prior to defecation.
The rectum and anal canal lie posteriorly against the sacrum and coccyx, the
anococcygeal ligament and the median sacral vessels. In males, the urinary
bladder, distal parts of the ureters, ductus deferens, seminal glands, and pros
tate are found anterior to the rectum and anal canal, whereas in females the
vagina occupies this position.
Sigmoid colon
Rectosigmoid junction
External iliac vein
Rectum
Transverse folds of rectum
Paraproctium
Rectal ampulla
Levator ani muscle
Anorectal junction
Pudendal nerve
Internal pudendal vein
Perineal nerve
Anal columns
Ischioanal fossa
External anal sphincter

Anal valves
Internal anal sphincter
Internal rectal venous plexus

Anal sinuses
Pectinate line
Anal pecten
External rectal
venous plexus Anocutaneous line
FIGURE 6.34. Rectum and anal canal (coronal view). The rectum extends from the rectosigmoid junction
superiorly to the anorectal junction inferiorly. Four transverse folds create the three lateral flexures of the
rectum (superior, intermediate, and inferior). The anal canal houses the anal columns, which are connected
to each other distally end by folds known as anal valves. Found between the anal columns are anal sinuses,
into which the excretory ducts of the anal glands open. The anal valves form an irregular line called the
pectinate line, which is an important anatomic landmark.
The anal canal extends down to the anocutaneous line, which represents its transition into the anus and
perianal skin. The region between the pectinate line and anocutaneous line is termed as the anal pecten.
The internal anal sphincter can be seen surrounding the upper two thirds of the anal canal, whereas the
external anal sphincter is observed external to the lower two thirds of the anal canal. The levator ani
Abdomen 269
LARGE INTESTINE
muscle can be seen extending inferiorly, where its puboanalis part (puboanalis, a.k.a. puborectalis mus
cle) slings around the anorectal junction. The region constituted by adipose tissue that is interposed in
between the anal canal and the ischium is termed ischioanal fossa.
Key points about the rectum and anal canal
Superior third of rectum: intraperitoneal

Location Middle third of rectum: retroperitoneal
Inferior third of rectum and anal canal: infraperitoneal
Rectum: absorption of water and electrolytes and feces storage

Function
Anal canal: absorption of water and electrolytes and defecation
Major Vertical flexures: sacral flexure (dorsal bend) and anorectal flexures (ventral bend)
landmarks of Lateral flexures: superior flexure (convexes to the right), intermediate flexure
rectum (convexes to the left) and inferior lateral flexure (convexes to the right)
Columnar zone: contains anal columns, valves and sinuses

Major
Intermediate zone: separated from the columnar zone by the pectinate (dentate)
landmarks of
line
anal canal
Cutaneous zone: made of perianal skin and progresses to the anus
Rectum Anal canal

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ARTERIES OF THE LARGE INTESTINE

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LU The blood supply of the large intestine complies with the pattern of its embry
X
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• The midgut derived part, from ileocecal junction to the proximal two-thirds
of the transverse colon, is supplied by the branches of the superior mesen
teric artery.
• The hindgut derived part, from the final third of transverse colon to the ter
mination of anal canal, is supplied by the branches of the inferior mesenteric
artery and internal iliac artery.
These terminal branches of the superior and inferior mesenteric arteries anas
tomose to form the marginal artery of colon (of Drummond), which contrib
utes to the supply of the entire large intestine.

LARGE INTESTINE
Left branch of middle colic artery
Right branch of middle colic artery

Middle colic artery
Ascending branch of right
colic artery
Ascending branch of left
colic artery
Right colic artery
Descending branch of right

colic artery
Descending branch of left
colic artery
Left colic artery
Inferior mesenteric artery

Straight arteries of colon
Sigmoid arteries
Intestinal arteries
Marginal artery of colon
Ileocolic artery
Sigmoid mesocolon
Internal iliac artery
Superior anorectal artery
Anterior cecal artery
Colic branch of ileocolic artery

Ileal branch of ileocolic artery
Posterior cecal artery
FIGURE 6.35. Arteries of the large intestine. The large intestine is supplied mainly by branches of the
superior mesenteric, inferior mesenteric and internal iliac arteries. The superior mesenteric artery supplies
the cecum, ascending colon and a part of the transverse colon. The inferior mesenteric artery supplies the
terminal part of the transverse colon, the descending colon and the proximal part of the rectum. Finally,
the internal iliac artery supplies the distal part of rectum. The branches of these arteries anastomose
close to the large intestine, forming the marginal artery of colon.
Key points about the arteries of the large intestine
Supplies the derivatives of the midgut:
Cecum: anterior cecal artery, posterior cecal artery (branches of ileocolic artery)
Superior
mesenteric Appendix: appendicular artery (branch of ileocolic artery)
artery
Ascending colon: colic branch (of ileocolic artery), right colic artery
Proximal % of transverse colon: middle colic artery
Supplies a part of the hindgut derivatives:
Distal % of transverse colon: left colic artery

Inferior
mesenteric Descending colon: left colic artery
artery
Sigmoid colon: sigmoid arteries
Superior part of rectum: superior anorectal artery
Supplies the rest of the hindgut derivatives:

Internal iliac
artery Middle and inferior parts of rectum: middle anorectal artery, inferior anorectal
artery
Abdomen 271
LARGE INTESTINE
INNERVATION OF THE LARGE INTESTINE
Similar to the small intestine, the large intestine receives both intrinsic and
extrinsic innervation. Intrinsic innervation is facilitated by the enteric nerv
ous system (ENS). The myenteric and submucosal plexuses are constituents
of the ENS and are responsible for regulating peristaltic contractions of the
large intestine as well as mucosal secretions and blood flow. Although the ENS
is capable of autonomously driving various motor patterns in the large intes
tine, its functions are modulated by sympathetic, parasympathetic and visceral
afferent pathways.
Extrinsic innervation is largely dependent on the embryological origin of the

large intestine:
• Midgut-derived structures (i.e. cecum ^ proximal two-thirds of transverse

colon) receive parasympathetic fibers from the vagus nerve/vagal trunks
(i.e. cranial origin), and sympathetic fibers which originate from the thoracic
splanchnic nerves (T5-T12).
• Hindgut-derived structures (distal third of transverse colon ^ rectum) receive
their parasympathetic innervation from the pelvic splanchnic nerves (S2-S4)
(i.e. sacral origin), and sympathetic innervation via the lumbar splanchnic
nerves (L1-L2)
Functionally, parasympathetic fibers are responsible for increasing secretomo-

tor activity along this segment of the digestive tract, while sympathetic fibers
play an inhibitory role in the activity of the large intestine.
Besides the regulation of secretomotor activity via efferent innervation, the

large intestine equally sends visceral afferent signals to the brainstem and thal
amus. Pain sensation is carried via sympathetic fibers to the thoracolumbar spi
nal sensory ganglia, while reflex information reaches the vagal sensory ganglia
through parasympathetic pathways.

LARGE INTESTINE
Transverse colon
Middle and right colic

arteries (with autonomic
plexus)
Intermesenteric plexus
Superior mesenteric plexus
Descending colon
Inferior mesenteric plexus
Inferior mesenteric ganglion
Left colic artery (with

autonomic plexus)
Sigmoid arteries (with

autonomic plexus)
Superior hypogastric plexus
Branches of inferior
hypogastric plexus to
descending and
sigmoid colon
Ileocolic artery (with

autonomic plexus)
Left inferior hypogastric

plexus
Right hypogastric nerve

(with autonomic plexus)
Ascending colon
FIGURE 6.36 . Nerves of the large intestine. Overview of the abdomen and peritoneal cavity with the
greater and lesser omenta reflected and small intestine removed. The colon can be seen along with its
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Preganglionic parasympathetic fibers from the anterior and posterior vagal trunks, destined to supply O
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the derivatives of the midgut (i.e. cecum ^ proximal two-thirds of transverse colon), pass through the m
superior mesenteric plexus (without synapsing) and continue their course to synapse with cell bodies z
of postganglionic neurons in the enteric plexuses. The hindgut receives its parasympathetic innerva
tion via preganglionic parasympathetic fibers (pelvic splanchnic nerves (S2-4)) which enter the inferior
hypogastric plexus, in which some synapse. From here, most fibers ascend via retroperitoneal tissues,
independent of the periarterial plexuses, to supply this part of the colon (some fibers may ascend via the
hypogastric nerve/superior hypogastric plexus to pass through the inferior mesenteric plexus to reach
the hindgut). Most preganglionic parasympathetic fibers synapse in intramural plexuses.
Preganglionic sympathetic fibers to the midgut originate from spinal nerves T5-T12 which form the
greater and lesser thoracic splanchnic nerves. These course via the superior mesenteric plexuses, where
they synapse. Postganglionic fibers reach the midgut via periarterial plexuses found along the superior
mesenteric artery and its branches. Sympathetic innervation to the hindgut originates from spinal nerves
L1-L2 (lumbar splanchnic nerves). Preganglionic fibers synapse in the aortic and inferior mesenteric plex
uses and emerge as postganglionic sympathetic neurons to supply the hindgut via periarterial plexuses of
the inferior mesenteric artery and its branches.
Abdomen 273
LARGE INTESTINE
Key points about the innervation of the small intestine
Midgut-derived structures
• Preganglionic: greater and lesser thoracic splanchnic nerves (T5-T12) ^ superior

mesenteric plexuses
• Postganglionic: fibers from celiac and superior mesenteric ganglia ^ large

intestine via periarterial plexuses along superior mesenteric artery and
branches
Sympathetic
innervation Hindgut-derived structures
• Preganglionic: lumbar splanchnic nerves (L1-L2) to aortic, inferior mesenteric

plexuses
• Postganglionic: fibers from aortic, inferior mesenteric, hypogastric plexuses to

large intestine (hindgut-derived structures)
Function: inhibits digestion
Midgut-derived structures
• Preganglionic: anterior and posterior vagal trunks ^ celiac and superior

mesenteric plexuses (no synapse) ^ synapse in myenteric and submucosal
plexuses
• Postganglionic: fibers extend from enteric plexuses to innervate glands

(secreto-motor) and muscle (motor) of the large intestine.
Parasympathetic
innervation Hindgut-derived structures
• Preganglionic: pelvic splanchnic nerves (S2-S4) ^ inferior hypogastric plexus

(some synapse here) ^ most synapse in myenteric and submucosal plexuses
• Postganglionic: fibers from inferior hypogastric plexus to parasympathetic

ganglia of large intestine (hindgut-derived structures)
Function: stimulates digestion
Myenteric plexus (Auerbach’s plexus): regulates smooth muscle tone and

Intrinsic contractions
innervation Submucosal plexus (Meissner’s plexus): regulates intestinal enzyme secretion,
food absorption and (sub)mucosal muscle movement
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LARGE INTESTINE
NEUROVASCULATURE OF THE RECTUM

AND ANAL CANAL
Abdominal aorta
Left colic artery
Marginal artery of colon
Median sacral artery
Common iliac artery
Superior gluteal artery
Middle anorectal artery
Inferior gluteal artery
Obturator artery
Inferior anorectal artery
FIGURE 6.37 . Arteries of the rectum and anal canal (posterior view, sacrum removed). The rectum and
anal canal are supplied by the three anorectal arteries: Superior, middle and inferior, previously known as
the ‘rectal’ arteries. From superior to inferior, these arteries branch from the inferior mesenteric, internal
iliac and internal pudendal arteries, respectively.
Key points about the blood vessels of the rectum and anal canal
Superior Origin: inferior mesenteric artery

anorectal artery Supply: upper two thirds of the rectum
Middle Origin: internal iliac artery

anorectal artery Supply: middle and lower parts of the rectum
Inferior Origin: internal pudendal artery (branch of the internal iliac artery)
anorectal artery Supply: anal canal, internal and external anal sphincter, perianal skin
Superior anorectal veins ^ Superior mesenteric vein

Anorectal veins Middle anorectal veins ^ Internal iliac vein
Inferior anorectal veins ^ Internal pudendal vein (drains into the internal iliac vein)
Abdomen 275
LARGE INTESTINE
Inferior mesenteric vein
Inferior vena cava
Sigmoid veins
Common iliac vein
Superior anorectal vein
Internal iliac vein
Superior gluteal vein
External iliac vein
Middle anorectal veins
Inferior gluteal vein
Obturator vein
Inferior anorectal veins
FIGURE 6.38 . Veins of the rectum and anal canal (posterior view sacrum removed). The three anorectal
veins follow the same path as arteries, draining into the corresponding vessels: Inferior mesenteric,
internal iliac and internal pudendal veins. The anorectal veins form a hemorrhoidal venous plexus which
has a special clinical significance, as it can swell and present as different types of hemorrhoids.
Key points about the innervation of the rectum and anal canal
Enteric nervous system

Intrinsic
innervation of • Submucosal plexus (of Meissner)
rectum and anal • Enteric plexus (of Auerbach)
canal
Control peristaltic contractions and mucous secretions.
Extrinsic
Autonomic nervous system
innervation
of rectum • Sympathetic input: sacral splanchnic nerves
and upper • Parasympathetic input: pelvic splanchnic nerves
half of anal
Splanchnic nerves synapse within the superior and inferior hypogastric plexuses
canal (above
and give the superior anal (rectal) nerves.
pectinate line)
Extrinsic
innervation Somatic nervous system
of lower
• Pudendal nerve: inferior anal (rectal) nerve
half of anal
canal (below • Provides voluntary control over external anal sphincter and defecation
pectinate line)

KIDNEYS AND URETERS
KIDNEYS
The kidneys are a pair of bilateral, retroperitoneal abdominal organs of the uri
nary system which are located on either side of the vertebral column. They are
surrounded by a fibrous capsule and adipose tissue that protect them from
injury. Functionally, the main parts of the kidney are the cortex, medulla and
hilum. The main function of the kidneys is to regulate the amount of fluid and
electrolytes in the body. They also excrete metabolic waste products and pro
duce hormones that facilitate several metabolic processes.
Suprarenal gland Superior suprarenal

arteries
Inferior suprarenal Middle suprarenal

artery artery
Adipose capsule Suprarenal vein

of kidney
Renal capsule Medial border

of kidney
Renal cortex Right renal artery
Lateral border Right renal vein

of kidney
Hilum of kidney Renal pelvis
Inferior pole of kidney Right ureter
FIGURE 6.39. Gross anatomy of kidney (anterior view). The kidneys are positioned in the retroperitoneal
space at the level of vertebrae T12-L3. They are bean-shaped and feature two poles (superior and inferior)
and two borders (medial and lateral).
Located at the superior pole is the suprarenal gland. The medial border of the kidney is defined by the
hilum of the kidney, which is the entry and exit point for the neurovascular structures of the kidney (renal
artery and vein, renal plexus) and the ureter. The most superior vessel is the renal vein which exits the
kidney, just below which is the renal artery that enters in, with the ureter located most inferiorly of the
three. The anterior to posterior orientation follows the same pattern: Renal vein, renal artery and ureter.
Abdomen 277
KIDNEYS AND URETERS
Renal column
Base of renal pyramid
Renal capsule
Renal papilla
Renal cortex
Minor renal calyx
Renal pelvis
Left ureter
Major renal calyx
Renal medulla
FIGURE 6.40. Internal anatomy of kidney (coronal view). The internal structure (parenchyma) of the kidney
consists of the outer renal cortex and inner renal medulla which is characterized by renal pyramids. The
pyramids are separated by extensions of the cortex known as renal columns. The apices of the pyramids
project medially toward the renal sinus where they each open into a minor calyx that unite to form a major
calyx. Usually, there are two to three major calyces in the kidney (superior, middle, and inferior), which
further unite to form the renal pelvis. The renal pelvis gives off a single ureter that leaves the kidney via
the hilum.
Key points about the kidneys
Definition Paired retroperitoneal organs of the urinary system.
2 poles (superior and inferior)

Main external
2 borders (lateral and medial)
features
Fibrous capsule, hilum
Main internal
Renal cortex, renal medulla, renal pelvis
features
Renal artery (branch of the abdominal aorta)
Neurovascular Renal vein (drains to the inferior vena cava)

structures
Renal plexus (derived from celiac plexus, intermesenteric plexus, aorticorenal
ganglia and lumbar splanchnic nerves)
Elimination of toxic metabolites through urine, regulation of blood homeostasis

Functions
and blood pressure, production of some hormones
Coronal section of the

Kidneys
kidney

KIDNEYS AND URETERS
RENAL ARTERIES
The renal arteries arise from the abdominal aorta just inferior to the superior
mesenteric artery in the retroperitoneum. Each courses posterior to the ipsi
lateral renal vein and nerves towards the renal hilum, through which they enter
their respective kidney. The right renal artery originates slightly inferior to its
left counterpart and is also longer, traveling posterior to the inferior vena cava.
The renal arteries supply oxygenated blood to the kidney parenchyma and
simultaneously deliver the blood to be filtered by the kidneys.
Arcuate artery of kidney Interlobular

arteries of kidney
Superior Inferior suprarenal

segmental artery artery
of kidney
Anterior superior
Anterior branch
segmental artery
of renal artery
Posterior
segmental artery Right renal artery
of kidney
Posterior branch Ureteric branch

of renal artery of renal artery
Anterior inferior Pelvic branches

segmental artery of renal artery
of kidney
Inferior
Interlobar arteries
of kidney segmental artery
of kidney
FIGURE 6.41. Renal arteries (coronal section of the kidney). Overview of a coronal section of the right
kidney, exposing the right renal artery and its branches. Upon traversing the renal hilum, the renal artery
divides into an anterior branch and a posterior branch. The anterior branch further divides into four
segmental arteries: The superior or apical, anterior superior, anterior inferior and inferior segmental
arteries. The posterior branch divides into the posterior segmental arteries to supply the posterior
segment of the kidney.
The segmental arteries of both branches then divide into the interlobar arteries which are located in
between the renal lobes. At the base of the medullary pyramids of the lobe these arteries receive the
name of arcuate arteries, and they give origin to the interlobular arteries. These then enter the nephrons
as afferent glomerular arterioles to bring blood to the glomerulus to be filtered. The inferior suprarenal
artery is a branch to the renal pelvis. The ureteric branch of the renal artery supplies the suprarenal gland,
renal pelvis and ureter, respectively.
Abdomen 279
KIDNEYS AND URETERS
Key points about the renal arteries
Abdominal aorta, at the level of the IV disc between the L1 and L2 vertebrae, inferior
Origin
to the origin of the superior mesenteric artery
Anterior branch: superior (apical), anterior superior, anterior inferior and inferior
segmental arteries
Posterior branch: posterior segmental arteries
Branches
Inferior suprarenal artery
Branch to renal pelvis
Ureteric branch
Supply kidney parenchyma with oxygenated blood

Functions
Deliver blood to be filtered by the kidney
Supply Kidneys, suprarenal glands, ureters
Neurovascular supply
Renal artery
of the kidney
URETERS
The ureters are a pair of muscular, tubular structures that are responsible for
transporting urine from the kidneys to the urinary bladder by peristalsis for
temporary storage, until urination. Each ureter arises as a continuation of the
funnel-shaped renal pelvis at the hilum of the kidney in the posterior abdomen
z
LU and runs distally into the pelvic cavity to enter the base of the urinary blad
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o der. The ureters are closely related to several structures along their course,
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the abdominopelvic cavity, ductus deferens in males and the uterine cervix in
females.
The blood supply of the ureters comes from the abdominal aorta through mul
tiple direct and indirect branches along its length. The ureters receive both
sympathetic and parasympathetic innervation through several plexuses in the
abdomen and pelvis.

KIDNEYS AND URETERS
Kidney
Renal artery
Renal vein
Abdominal aorta
Abdominal part of ureter
Ovarian vein
Common iliac artery
Ovarian artery
Pelvic part of ureter
Internal iliac vein
Ovary
Uterus
Urinary bladder
FIGURE 6.42. Ureters in situ. The ureters leave the kidneys posterior to the renal vessels and course
distally on the anterior surface of the psoas major muscle, posterior to the ovarian vessels (or testicular
vessels in males). They cross the bifurcation of the common iliac arteries at the pelvic brim to enter
the pelvic cavity, where they run below the ductus deferens in males and below the uterine arteries in
females, to enter the base of the urinary bladder.
Key points about the ureters
Parts Abdominal, pelvic
Function Transport of urine from the kidneys to urinary bladder
Right ureter: psoas major muscle, genitofemoral nerve, duodenum (descending

part), branches of the superior mesenteric vessels, gonadal vessels, common iliac
Major relations artery, uterine artery, urinary bladder
Left ureter: psoas major, genitofemoral nerve, branches of the inferior mesenteric
vessels, gonadal vessels, common iliac artery, uterine artery urinary bladder
Ureteric branches of renal artery, ovarian/testicular artery, ureteric branches of

Blood supply the abdominal aorta and common iliac arteries, ureteric branches of the superior
and inferior vesical and uterine arteries
Renal plexus and ganglia, aortic plexus, ureteric branches of intermesenteric

Innervation
plexus, pelvic splanchnic nerves, superior and inferior hypogastric plexuses
Lymphatic
Internal iliac, external iliac nodes, common iliac, and lumbar lymph nodes
drainage
Abdomen 281
KIDNEYS AND URETERS
Ureters Urinary system
Kidneys ureters and

suprarenal glands
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NERVES, VESSELS AND LYMPHATICS
OFTHEABDOMEN
LUMBAR PLEXUS
The lumbar plexus is a collection of spinal nerves located deep in the lumbopel-
vic region, close to the psoas major muscle. Formed from the anterior rami of
spinal nerves L1-L4, the plexus provides innervation to the muscles, joints and
skin of the anterolateral aspects of the pelvis and thigh.
The lumbar plexus has six major terminal branches. According to their anatom
ical position, the branches are grouped into anterior and posterior divisions.
The anterior division innervates the pelvis, while the posterior division supplies
branches to the thigh. Fibers from spinal nerve L4 join with fibers from L5 to
form the lumbosacral trunk. This large nerve links the lumbar plexus with the
sacral plexus, thus these nerve complexes are often given the combined name
of lumbosacral plexus. Together these two plexuses supply all innervation to
the pelvis and lower limb.
| | Anterior rami of spinal nerves L1-L5 |
Subcostal nerve
White and grey

rami communicantes
of spinal nerve
Branch of spinal nerve T12

for iliohypogastric
and ilioinguinal nerves
Ilioinguinal nerve
Genitofemoral nerve
Lateral femoral
cutaneous nerve
Obturator nerve
Accessory obturator nerve
Gray ramus communicans

of spinal nerve
Lumbosacral trunk
Femoral nerve
FIGURE 6.43. Lumbar plexus. The lumbar plexus is formed by the anterior rami of spinal nerves
L1-L4. These six terminal branches arise from the plexus: The iliohypogastric nerve, ilioinguinal nerve
genitofemoral nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. Occasionally,
in approximately 29% of the people, an accessory obturator nerve can be present. The iliohypogastric and
ilioinguinal nerves arise from the anterior ramus of spinal nerve L1. Genitofemoral (L2-L3) and obturator
nerves (L2-L4) are anterior divisions of anterior rami of spinal nerves and they supply the anterolateral
hip region. The lateral femoral cutaneous (L2-L3) and femoral nerves (L2-L4) are posterior divisions of
anterior rami of spinal nerves and they supply innervation to the anterolateral thigh.
Abdomen 283
NERVES, VESSELS AND LYMPHATICS OF THE ABDOMEN
Key points about the lumbar plexus
Roots L1, L2, L3, L4
Branches from spinal nerve L1

Structural
Branches from anterior division of spinal nerves L2-L4
organization
Branches from posterior division of spinal nerves L2-L4
Terminal Iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve, obturator nerve,

branches lateral femoral cutaneous nerve and femoral nerve.
Sensory and motor innervation of the lower abdomen, pelvis, anterolateral hip and
Function
thigh regions
Lumbar plexus Femoral nerve
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ARTERIES OF THE STOMACH, LIVER

AND GALLBLADDER
The stomach, liver and gallbladder (foregut derivatives) are supplied by the
three branches of the celiac trunk: Left gastric, common hepatic and splenic
arteries.
Cystic artery
Left hepatic artery
Left inferior phrenic

artery
Esophageal branches
of left gastric artery
Right inferior phrenic

artery
Abdominal aorta
Short gastric arteries
Hepatic portal vein
------Left gastric artery
------ Inferior vena cava
Splenic artery
Supraduodenal artery
Right gastric artery
Left gastroomental
artery
Anterior superior
pancreaticoduodenal artery
Right gastroomental artery
FIGURE 6.44. Arteries of the stomach, liver and gallbladder. Arterial supply of the stomach, liver and
gallbladder with the liver retracted.
The blood supply of the stomach originates from the celiac trunk and is provided from two anastomotic
systems along the curvatures and several direct branches. The anastomosis along the lesser curvature is
created by the union of the right and left gastric arteries which originate from the common hepatic artery
and celiac trunk, respectively. The greater curvature anastomosis is formed by the union of the right and
left gastroomental arteries (gastroepiploic), which originate from the gastroduodenal and splenic arter
ies, respectively. Short and posterior gastric arteries, which arise from the splenic artery supply the fun
dus and posterior wall.
The liver is supplied by the proper hepatic artery which is a continuation of the common hepatic artery and
courses alongside the hepatic portal vein and common bile duct (porta hepatis). The right hepatic artery
gives off the cystic artery which supplies the gallbladder.
Abdomen 285
Key points about the arteries of the stomach
Right gastric Arises from proper hepatic artery, forms anastomosis with left gastric artery;
artery supplies lesser curvature, anterior and posterior sides of the stomach
Left gastric Arises from common hepatic artery, forms anastomosis with right gastric artery;
artery supplies lesser curvature, cardia, right upper and posterior walls
Right
gastroomental Arises from gastroduodenal artery; forms anastomosis with left gastroomental
(gastroepiploic) artery and supplies inferior part of greater curvature
artery
Left
gastroomental Arises from splenic artery; forms anastomosis with right gastroomental artery and
(gastroepiploic) supplies superior part of greater curvature
artery
Short and
posterior Arise from splenic artery; supply fundus and posterior wall of stomach
gastric arteries
Gastroduodenal
Arises from common hepatic artery; supplies pyloric part
artery
Key points about the arteries of the liver
Common Originates from the celiac trunk, supplies liver (via proper hepatic artery ^ right/
hepatic artery left hepatic arteries)
Key points about the arteries of the gallbladder
Arises from right hepatic artery, supplies the gallbladder, common hepatic duct,
Cystic artery
cystic duct and the proximal part of the common bile duct
Blood vessels of
Celiac trunk
abdomen and pelvis

ARTERIES OF THE PANCREAS, DUODENUM

AND SPLEEN
The pancreas, duodenum and spleen are supplied with oxygenated blood by
arteries that stem from the celiac trunk and superior mesenteric artery, both
of which originate from the abdominal aorta.
Cystic artery
Hepatic portal vein
Supraduodenal artery
Left gastric artery
Celiac trunk
Short gastric arteries
Posterior gastric artery
Splenic artery
Splenic vein
Left gastroomental artery
Inferior vena cava
Artery of tail of pancreas
Pancreatic branches of
splenic artery
Right gastric artery
Inferior pancreatic artery
Dorsal pancreatic artery
Posterior superior
pancreaticoduodenal artery
Anterior superior pancreaticoduodenal
artery
Anastamosis between superior mesenteric
artery and inferior pancreatic artery
Duodenal branches of pancreaticoduodenal
arteries
Posterior inferior pancreaticoduodenal artery
Anterior inferior pancreaticoduodenal artery
Superior mesenteric vein
FIGURE 6.45. Arterial supply of the pancreas, duodenum and spleen. Anterior view with the liver
retracted and stomach removed. The posterior superior pancreaticoduodenal artery arises as a proximal
branch of the gastroduodenal artery, while its anterior counterpart arises as the smaller terminal branch
of the same vessel. The anterior and posterior inferior pancreaticoduodenal arteries arise from a common
branch of the superior mesenteric artery. The pancreaticoduodenal arteries project around the pancreatic
neck where they form arterial arcades to supply the head, neck and uncinate process of the pancreas.
The duodenum is also supplied by these arteries, and additionally by the supraduodenal artery. The splenic
artery is the longest branch of the celiac trunk and runs horizontally towards the spleen. It courses along
the superior border of the pancreas and supplies its body and tail with numerous branches (dorsal pancre
atic artery, great pancreatic artery, artery of tail of pancreas). Upon reaching the splenic hilum, it divides
into 2-3 terminal branches supplying the spleen.
Abdomen 287
Key points about the arteries of the pancreas
Superior Branches of gastroduodenal artery, form pancreaticoduodenal arcades which

pancreaticoduodenal run anteriorly and posteriorly with inferior pancreaticoduodenal arteries;
arteries supply head and neck of pancreas
Inferior Branches of superior mesenteric artery, form pancreaticoduodenal arcades

pancreaticoduodenal which run anteriorly and posteriorly with superior pancreaticoduodenal
arteries arteries; supply head and uncinate process of pancreas
Direct branch of celiac trunk; supplies body and tail of pancreas (via dorsal and
Splenic artery
great pancreatic arteries and artery of tail of pancreas)
Key points about the arteries of the duodenum
Superior Branches of gastroduodenal artery; form pancreaticoduodenal arcades with

pancreaticoduodenal inferior pancreaticoduodenal arteries, supply superior and descending part of
arteries duodenum
Inferior Branches of the superior mesenteric artery, form pancreaticoduodenal

pancreaticoduodenal arcades with superior pancreaticoduodenal arteries; supply horizontal and
arteries ascending part of duodenum
Supraduodenal
Branches of gastroduodenal artery (or common hepatic artery); mainly
and retroduodenal
supplies superior/posterior part of duodenum
arteries
Key points about the arteries of the spleen
Splenic artery Direct branch of celiac trunk; divides into 2 or 3 splenic branches
M
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Blood vessels of
Celiac trunk
abdomen and pelvis
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HEPATIC PORTAL SYSTEM
The hepatic portal system is a venous system that drains the spleen, pancreas,
gallbladder and upper parts of the gastrointestinal tract.
Gastric arteries Gastric veins
Proper hepatic
artery Celiac trunk
Hepatic portal
vein
Splenic artery
Common
hepatic artery
Splenic vein
Gastroduodenal
artery
Gastroomental
Anterior veins
pancreatico
duodenal veins
Gastroomental
Superior mesenteric arteries
artery
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Superior mesenteric vein Inferior mesenteric Z
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vein z
FIGURE 6.46. Tributaries and branches of the hepatic portal vein. An overview of the upper portion of
the abdomen with the liver reflected and parts of the stomach, pancreas and small intestine removed.
The hepatic portal vein is formed by the union of the superior mesenteric and splenic veins just posterior
to the neck of the pancreas. The superior mesenteric vein receives venous blood from the small intestine,
cecum, ascending colon and transverse colon through its tributaries. The splenic vein can be found along
the posterior length of the pancreas and receives several tributaries which drain the spleen, parts of the
stomach and pancreas. The hepatic portal vein ascends obliquely alongside the proper hepatic artery
within the hepatoduodenal ligament to reach the liver before bifurcating into left and right branches.
Key points about hepatic portal system
Branches: anterior and posterior right branches of hepatic portal vein,

transverse and umbilical parts of left branch of hepatic portal vein
Hepatic portal
vein Tributaries: superior mesenteric, splenic, posterior superior pancreaticoduodenal,
cystic, paraumbilical and gastric veins
Course: hepatoduodenal ligament ^ porta hepatis
Superior Tributaries: jejunal, ileal, ileocolic, right and middle colic, right gastro-omental, and
mesenteric vein pancreaticoduodenal veins
Tributaries: short gastric, left gastro-omental, inferior mesenteric and pancreatic

Splenic vein
veins
Abdomen 289
LYMPHATICS OF THE PANCREAS, DUODENUM

AND SPLEEN
The lymphatic drainage of the pancreas, duodenum and spleen is closely related
to their venous drainage. For example, as in the case of the arterial supply of the
pancreas, the lymphatic drainage of the head of the pancreas is different than
of the body and tail. Similarly, the lymphatic drainage of the superior part of the
duodenum is different from its inferior part.
Lymphatic capillaries within the pancreas, duodenum and spleen collect lymph
from these tissues and transport it into adjacent lymph nodes. The lymph is
then passed along a series of lymph nodes to reach the terminal lymph nodes,
which in this case, are known as the preaortic lymph nodes. The preaortic
lymph nodes consist of three groups of nodes: The celiac, superior mesenteric
and inferior mesenteric lymph nodes out of which the former two drain the
pancreas, duodenum and spleen.
Cystic lymph node
Hepatic lymph nodes
Left gastric lymph

nodes
Celiac lymph nodes
Splenic lymph nodes
Right gastric lymph

nodes
Superior pancreatic
lymph nodes
Superior pancreaticoduodenal
lymph nodes
Superior mesenteric lymph nodes
Inferior pancreaticoduodenal lymph nodes
FIGURE 6.47. Lymphatic drainage of the pancreas, duodenum and spleen. An overview of the upper
portion of the abdomen with the liver retracted and the stomach removed to provide a clear view
of the pancreas, duodenum and spleen. The body and tail of the pancreas are drained by the superior
and inferior pancreatic lymph nodes. The head of the pancreas is drained by the superior and inferior
pancreaticoduodenal lymph nodes, which also drain the majority of the duodenum. The exception is the

superior part of the duodenum, which is drained by the pyloric lymph nodes and the ascending part of the
duodenum, drained by the inferior pancreatic and superior mesenteric lymph nodes.
The spleen is drained by the splenic lymph nodes, which may also drain the tail of the pancreas and there
fore can also be known as the pancreaticosplenic lymph nodes. The majority of these lymph nodes even
tually drain into the celiac lymph nodes, which ultimately drain into the cisterna chyli.
Key points about the lymphatics of the pancreas
Superior pancreaticoduodenal lymph nodes ^ hepatic lymph nodes ^ celiac lymph

nodes ^ cisterna chyli
Head
Inferior pancreaticoduodenal lymph nodes ^ superior mesenteric lymph nodes ^
celiac lymph nodes ^ cisterna chyli
Body Superior and inferior pancreatic lymph nodes ^ celiac lymph nodes ^ cisterna chyli
Superior and inferior pancreatic lymph nodes ^ celiac lymph nodes ^ cisterna chyli
Tail
Splenic lymph nodes ^ celiac lymph nodes ^ cisterna chyli
Key points about the lymphatics of the duodenum
Superior part Pyloric lymph nodes ^ hepatic lymph nodes ^ celiac lymph nodes ^ cisterna chyli
Inferior pancreatic lymph nodes ^ celiac lymph nodes ^ cisterna chyli

Ascending part
Superior mesenteric lymph nodes ^ cisterna chyli
Superior pancreaticoduodenal lymph nodes ^ hepatic lymph nodes ^ celiac lymph

Descending nodes ^ cisterna chyli
and horizontal
parts Inferior pancreaticoduodenal lymph nodes ^ superior mesenteric lymph nodes ^
celiac lymph nodes ^ cisterna chyli
Key points about the lymphatics of the spleen
Spleen Splenic nodes ^ celiac lymph nodes ^ cisterna chyli
Lymphatics of the Lymphatics of

retroperitoneal space abdomen and pelvis
Abdomen 291
LYMPHATICS OF THE STOMACH, LIVER

AND GALLBLADDER
The lymphatic drainage of the stomach is somewhat variable between individ

uals however several major lymph nodes are generally involved. These are the:
• Juxtacardial nodes, located in the region of the cardia of the stomach,

• Right/left gastric nodes, short gastric nodes, right/left gastroomental (a.k.a.
gastroepiploic) nodes (all of which are related to the arteries of the same
names),
• Pyloric nodes (made up of the supra-, sub- and retropyloric groups), related
to the pylorus of the stomach.
The lymphatic drainage of the liver is elaborate and can generally be split into
superficial and deep pathways:
• The superficial pathway transports lymph via channels in the subserosal are
olar tissue which envelopes the liver. The anterior and inferior surfaces largely
drain to hepatic nodes, while lymph from other surfaces is mainly received by
various node groups of the inferior mediastinum or the celiac/superior mes
enteric nodes.
• The deep pathway consists of hepatic lymph vessels which follow branches
of the hepatic arteries and portal vein and flow towards the hepatic nodes at
the hilum of the liver. Other lymphatic vessels course along the hepatic veins
which exit via the bare area of the liver; these are received by the right lumbar
(a.k.a. caval) nodes or inferior diaphragmatic nodes.
Lymph drained from the gallbladder is mainly received either directly by hepatic
nodes or first via a cystic lymph node.

Juxtacardial lymph nodes
Hepatic lymph nodes
Left gastric lymph

nodes
Celiac lymph
nodes
Left gastroomental
lymph nodes
Pancreatic lymph
nodes
Suprapyloric lymph
nodes
Right gastroomental
lymph nodes
Subpyloric lymph nodes
FIGURE 6.48. Lymphatics of the stomach, liver and gallbladder (anterior view). Anterior view with the
liver retracted showing a section of the lymphatic system of the upper abdomen. The nodes draining
the stomach are labeled. The right and left gastric nodes follow the arteries of the same name along the
lesser curvature of the stomach while the right and left gastroomental nodes follow their homonymous
arteries on the greater curvature of the stomach. Lymph drained from these nodes is largely received by
the celiac nodes which in turn drain into the cisterna chyli via the left lumbar nodes (paraaortic nodes) or
intestinal lymphatic trunk.
Abdomen 293
Cystic lymph node
Hepatic lymph nodes
Left gastric lymph

nodes
Celiac lymph nodes
Splenic lymph nodes
Right gastric lymph

nodes
Superior pancreatic
lymph nodes
Superior pancreaticoduodenal
lymph nodes
Superior mesenteric lymph nodes
Inferior pancreaticoduodenal lymph nodes
FIGURE 6.49. Lymphatics of the stomach, liver and gallbladder (retrogastric view). Anterior view of
abdomen with the stomach removed to show the lymphatic pathways of the upper abdomen. The hepatic
lymph nodes can be identified around the porta hepatis, as well as a cystic lymph node which drains the
gallbladder. The hepatic nodes largely drain to the celiac nodes via lymphatic vessels which course along
z the common and proper hepatic arteries. The right and left gastric nodes can also be clearly observed
id along their related arteries.
E
o
a
CO
< Key points about the lymphatics of the stomach
Cardia Juxtacardial nodes
Fundus Short gastric nodes
Lesser
Right/left gastric nodes
curvature
Greater
Right/left gastroomental nodes
curvature
Pyloric part Pyloric nodes (suprapyloric, retropyloric, subpyloric nodes)
Drainage path Celiac nodes ^ intestinal lymphatic trunk ^ cisterna chyli ^ thoracic duct
Key points about the lymphatics of the liver
Anterior surface Hepatic nodes
Inferior surface Hepatic nodes (or directly to lumbar nodes)

Superficial
pathway Superior surface Hepatic nodes/parasternal/pericardiac nodes
Celiac/superior mesenteric or posterior

Posterior surface
mediastinal nodes

Key points about the lymphatics of the liver
Hepatic nodes ^ celiac nodes

Deep pathway
Posterior mediastinal/ right lumbar nodes
Key points about the lymphatics of the gallbladder
Superior aspect Cystic node or directly to hepatic nodes
Inferior aspect Cystic node, posterior pancreaticoduodenal nodes or preaortic nodes
Lymphatics of Lymphatics of the

abdomen and pelvis retroperitoneal space
LYMPHATICS OF THE POSTERIOR ABDOMINAL

AND PELVIC WALL
There are several groups of lymph nodes present in the posterior abdominal
and pelvic walls. Most of those groups are named according to their anatomical
relation to the aorta/inferior vena cava and their branches/tributaries.
The main lymph node groups of this region are the lumbar lymph nodes, com
posed of the right lumbar (caval), intermediate lumbar and left lumbar (aortic)
>
nodes. They receive lymph from abdominal organs and also from the common, 03
□
internal and external iliac lymph nodes, which drain the pelvic organs. o
z
m
z
The lymph is then drained by lymph trunks:
• Left lumbar lymph trunk: Drains left lumbar lymph nodes

• Right lumbar lymph trunk: Drains right lumbar and intermediate lumbar
lymph nodes.
• Intestinal lymph trunk: Drains celiac, superior mesenteric and phrenic lymph
nodes.
• Cisterna chyli: Receives the lymph from the trunks mentioned above (directly
or indirectly) and ultimately drains all the lymph from the posterior abdomen
and pelvis.
Abdomen 295
Inferior Celiac lymph

diaphragmatic nodes
lymph nodes
Superior
mesenteric Intestinal
lymph nodes lymphatic trunk
Cisterna chyli
Left lumbar
Right lumbar lymphatic trunk
lymphatic trunk
Retrocaval lymph
Inferior mesenteric
nodes
lymph nodes
Retroaortic lymph
nodes
Lateral aortic
lymph nodes
Intermediate
lumbar lymph
nodes
Common iliac
Lateral caval
lymph nodes
lymph nodes
Promontorial
lymph nodes Internal iliac
lymph nodes
Sacral lymph
nodes
External iliac
Intermediate lymph nodes
lacunar lymph
node
Deep inguinal Superficial inguinal
lymph nodes lymph nodes
FIGURE 6.50. Lymphatics of the posterior abdominal and pelvic wall. Illustration of the posterior
abdominal wall and pelvic cavity, with the organs and other structures removed to reveal the lymph nodes
and neighboring vessels. In the center of the figure, adjacent to the abdominal aorta, is the cisterna chyli,
z the main drainage pathway of the posterior abdominal wall. Two trunks converge to form the cisterna
id chyli: The right lumbar lymph trunk and left lumbar lymph trunk (which usually receives the intestinal
E
o lymph trunk). These structures receive the lymph mainly from the lumbar lymph nodes (which are
a composed of the left lumbar nodes, also known as aortic lymph nodes and the right lumbar nodes, also
CO
< called caval lymph nodes) as well as the celiac and superior/inferior mesenteric nodes which drain the
gastrointestinal tract.
Pelvic organs drain to the common, internal and external iliac lymph nodes, which in turn drain to lumbar
lymph nodes.
Key points about the lymphatics of the posterior abdominal wall
Cisterna chyli: ultimately drains most of the lymph from the posterior abdominal
wall, pelvis and lower limbs
Intestinal lymph trunk: drains phrenic, celiac, superior mesenteric, and some
Main trunks inferior mesenteric lymph nodes
Left lumbar lymph trunk: drains left lumbar lymph nodes (may receive intestinal
lymph trunk)
Right lumbar lymph trunk: drains right lumbar and intermediate lymph nodes

Key points about the lymphatics of the posterior abdominal wall
Phrenic nodes: drain inferior surface of diaphragm, abdominal part of esophagus,

and suprarenal glands
Celiac nodes: drain stomach, duodenum, pancreas, liver, spleen, and greater
omentum
Main abdominal
lymph node Superior mesenteric nodes: drain jejunum, ileum, cecum, vermiform appendix,
groups ascending, and transverse colons
Inferior mesenteric nodes: drain regions irrigated by the inferior mesenteric artery
Left/right lumbar nodes: directly drain kidneys, superior abdominal part of ureters,
gonads, also receives efferents from GIT
Main pelvic
Common, internal and external iliac lymph nodes: drain the pelvis and the lower
lymph node
limbs
groups
Lymphatics of Lymphatics of the

abdomen and pelvis retroperitoneal space
>
03
□
o
z
m
z
Abdomen 297
PELVIS AND
PERINEUM
7
Pelvic girdle and floor............................................................ 300
Bony pelvis.................................................................................. 300
Ligaments of the pelvis................................................................ 304
Muscles of the pelvic floor and perineum..................................... 307
Female pelvis and reproductive organs................................. 309

Introduction to the female pelvic cavity....................................... 309
Uterus, uterine tubes and ovaries..................................................313
Cervix, vagina and vulva................................................................ 316
Fetus in utero............................................................................... 319
Male pelvis and reproductive organs......................................321

Introduction to the male pelvic cavity........................................... 321
Testis and epididymis....................................................................323
Scrotum and spermatic cord........................................................ 324
Urinary bladder and urethra................................................... 327

Male urinary bladder and urethra.................................................. 329
Female urinary bladder and urethra...............................................331
Perineum................................................................................. 333
Penis........................................................................................... 333
Female perineum ............................336
Neurovasculature of the female perineum....... ............................339
Nerves, vessels and lymphatics of the pelvis ......................... 342

Sacral plexus.................................................... ............................342
Nerves of the male pelvis................................ ........................... 344
Nerves of the female pelvis............................. ............................345
Blood supply of the male pelvis........................ ............................ 347
Blood supply of the female pelvis.................... ........................... 349
Lymphatics of the urinary organs.................... ........................... 350
Lymphatics of the male genitalia..................... ............................352
Lymphatics of the female genitalia.................. ............................354
PELVIC GIRDLE AND FLOOR
BONY PELVIS
The bony pelvis is a complex, basin-shaped structure that comprises the skel
etal framework of the pelvic region and houses the pelvic organs. It consists of
the right and left hip bones and the sacrum, which are connected via the sac
roiliac joints.
Sacroiliac joint
Iliac fossa
Arcuate line of ilium
Iliac crest
Pelvic inlet
Pecten pubis
Iliac tubercle
Anterior superior iliac spine
Anterior inferior iliac spine
Acetabulum of hip bone
Obturator crest of pubis
Pubic crest
Obturator foramen of hip bone
Pubic symphysis
Pubic tubercle
P E LV IS AND
Subpubic angle
FIGURE 7.1a. Bony pelvis (anterior and posterior views). The bilateral ischiopubic rami form the pubic
arch, the vertex of which is known as the subpubic angle. In fig 7.1a of a female pelvis, the subpubic angle
measures around 90° (approximating to the angle between the widely extended thumb and index finger);
in a male pelvis (fig 7.1b), it measures closer to 60° (approximate angle between abducted index and middle
fingers).

Gluteal surface of ilium
Iliac crest
Posterior gluteal line of ilium
Anterior gluteal line of ilium
Inferior gluteal line of ilium
Posterior superior iliac spine
Posterior inferior iliac spine
Greater sciatic notch
Ischial spine
Obturator foramen of hip bone
Ischial tuberosity
Lesser sciatic notch of hip bone
FIGURE 7.1b. Bony pelvis (anterior and posterior views). (Continued)
TJ
P E LV IS AND
m
2
z
m
c
z
Pelvis and perineum 301

Superior articular process of sacrum
Median sacral crest
Sacral canal
Iliac tuberosity
Sacroiliac joint
Iliac crest
Ala of sacrum
Base of sacrum
Iliac fossa
Sacral promontory
Ischial spine
Anterior superior
iliac spine
Anterior inferior
iliac spine
Arcuate line
Iliopubic eminence
Pecten pubis
Pubic tubercle
Pubic symphysis
FIGURE 7.2 . Bony pelvis (superior view). The bony pelvis is divided into the greater and lesser pelvis by the
pelvic inlet (superior pelvic aperture). Posteriorly, the pelvic inlet is bounded by the sacral promontory
and alae of the sacrum. The anterolateral borders are defined by a right and left linea terminalis, which are
formed by the arcuate line of the ilium and pectin pubis/pubic crest of the pubis.
The greater (a.k.a false) pelvis is found superior to the pelvic inlet and contains the inferior parts of the
abdominal organs. The lesser (a.k.a. true) pelvis is located between the pelvic inlet and pelvic outlet, and it
includes the intrapelvic urinary organs, internal reproductive organs and the perineum.
P E LV IS AND
Z
□
id
Z
a
id
a

| | Pelvic outletj Pubic symphysis
Ischiopubic ramus
Ischial tuberosity
Sacrotuberous
ligament
- Sacrum
Coccyx
Posterior superior
iliac spine
FIGURE 7.3 . Bony pelvis (inferior view). The pelvic outlet (a.k.a. inferior pelvic aperture) is the inferior
opening of the true pelvis. It is formed anteriorly by the pubic arch, ischiopubic rami and ischial tuberosities,
and posteriorly by inferior borders of the sacrotuberous ligaments and apex of the coccyx. Since the latter
structures are both slightly yielding, this results in a less rigid posterior half of the pelvic outlet.
Key points about the bony pelvis
Hip bone: ilium, ischium, pubis
Bones Sacrum
Coccyx
Acetabulum, ischiopubic ramus, obturator foramen, greater sciatic notch, greater

P E LV IS A N D
Hip bone
sciatic foramen
Ilium Body of ilium, ala, gluteal surface, sacropelvic surface
Body of ischium, ramus of ischium, ischial spine, lesser sciatic notch, lesser sciatic
Ischium
foramen, ischial tuberosity
Pubis Body of pubis, superior pubic ramus, inferior pubic ramus
Sacrum Base of sacrum, apex of sacrum, lateral part, pelvic surface, dorsal surface
Coccyx Base of coccyx, coccygeal horn, apex of coccyx
Sacroiliac joint, pubic symphysis, lumbosacral joint, sacrococcygeal symphysis, hip

Joints
joint
The pelvis
gw Sacrum

LIGAMENTS OF THE PELVIS
The robust structure of the pelvic girdle is held together by important mechan
ical stabilizers, the ligaments of the pelvis, which provide structural support in
and around the pelvis. Pelvic ligaments can be categorized according to their
associated joints and are therefore divided into the ligaments of the: Lumbosa
cral, sacroiliac, sacrococcygeal, and pubic symphyseal joints of the pelvis.
Psoas minor muscle
Psoas major muscle

liopsoas
_T muscle
lliacus muscle
Iliopectineal arch
Iliolumbar ligament
Lateral lumbosacral ligament
Anterior sacroiliac ligament
Anterior sacrococcygeal
ligament
Sacrospinous ligament
Inguinal ligament
Superior pubic
ligament
Sacrotuberous
ligament
Anterior pubic
ligament
Inferior pubic
ligament
P E LV IS AND
FIGURE 7.4 . Ligaments of the pelvis (Anterior view). The anterior longitudinal ligament travels along
the entire length of the vertebral column. It extends from the basilar part of the occipital bone to the
anterior surface of the sacrum, passing over the lumbosacral joint in doing so. It functions to prevent
hyperextension of the vertebral column and reinforces the anterior aspect of the sacrum.
Ligaments of the lumbosacral joint limit the range of movement at this junction and include the iliolumbar
and lateral lumbosacral ligaments. The former is made up of two bands (superior and inferior) originat
ing from the transverse processes of vertebra L5. The superior band extends over the sacroiliac joint and
across the iliac crest to blend with the thoracolumbar fascia, while the inferior band crosses the anterior
sacroiliac ligament to insert in the posterior region of the iliac fossa. Continuous with the lower border
of the iliolumbar ligament is the lateral lumbosacral ligament which arises from the lower margin of the
transverse process of L5 vertebra and passes inferolaterally to attach to the ala of the sacrum.
The sacroiliac joint is strengthened by three ligaments, of which only the anterior sacroiliac ligament is
seen in this view. It comprises the anteroinferior thickening of the joint capsule and connects the preau-
ricular surface of the ilium to the third sacral segment.
On the anterior aspect of the bony pelvis, the pubic symphysis is strengthened by the superior, anterior
and inferior pubic ligaments. Two ligaments crossing the pubic bone can equally be seen: The iliopec-
tineal arch, a thickened band of iliopsoas fascia, running from the anterior superior iliac spine (ASIS) to the

iliopectineal eminence of the pubic bone as well as the inguinal ligament extending from the ASIS to the
pubic tubercle. Anterior stabilization of the sacrococcygeal joint is achieved by the anterior sacrococcy
geal ligament, which is a continuation of the anterior longitudinal ligament.
Posterior sacroiliac ligament
Iliolumbar ligament
Interosseous sacroiliac
ligament
Sacrotuberous ligament
Superficial posterior
sacrococcygeal ligament
Lateral sacrococcygeal
ligament
Deep posterior
sacrococcygeal
ligament
Sacrospinous
ligament
Posterior pubic
ligament
FIGURE 7.5. Ligaments of the pelvis (Posterior view). The sacroiliac joint is strengthened by three
ligaments, namely the anterior (see previous image), interosseous and posterior sacroiliac ligaments.
The interosseous sacroiliac ligament constitutes the major bond between the ilium and sacrum, filling
the gaps between these two bones at the posterosuperior aspect of the joint. The posterior sacroiliac
P E LV IS AND
ligament lies superficial to the interosseous sacroiliac ligament and consists of several fibers connecting
the posterior superior iliac spine (PSIS), iliac crest as well as the lateral and intermediate sacral crests. The
two bones of the pelvic spine (sacrum and coccyx) are strengthened by the anterior (see previous image)
and posterior sacrococcygeal ligaments.
The superficial posterior sacrococcygeal ligament arises from the margin of the sacral hiatus and attaches
to the dorsum of the coccyx. The deep posterior sacrococcygeal ligament extends from the dorsal sur
face of the fifth sacral vertebral body to the dorsal surface of the coccyx. Bilaterally, the lateral posterior
sacrococcygeal ligament spans from the inferolateral angles of the sacrum to the transverse processes of
the coccyx. Two major ligaments situated on the posterior aspect of the bony pelvis are the sacrospinous
and sacrotuberous ligaments. These transform the lesser and greater sciatic notches into the lesser and
greater sciatic foramina. The former extends from the margins of the coccyx and sacrum to the spine
of the ischium, while the latter has several attachments to the posterior superior iliac spine, the poste
rior sacroiliac ligaments, lateral sacral crest as well as the lateral margins of the lower sacrum and upper
coccyx.
Lastly, the posterior pubic ligament, blending with the periosteum of both pubic bodies posteriorly, can
be seen in this view.

Key points about the ligaments of the pelvis
Lumbosacral
Iliolumbar ligament, lateral lumbosacral ligament
joint
Anterior sacroiliac ligament, interosseous sacroiliac ligament, posterior sacroiliac

Sacroiliac joint
ligament
Sacrococcygeal Anterior sacrococcygeal ligament, superficial posterior sacrococcygeal ligament,

joint deep posterior sacrococcygeal ligament, lateral sacrococcygeal ligament
Pubic Superior pubic ligament, anterior pubic ligament, inferior pubic ligament, posterior
symphysis pubic ligament
Nonarticular Anterior longitudinal ligament, sacrospinous ligament, sacrotuberous ligament,

ligaments iliopectineal arch, inguinal ligament
Function Mechanical stabilizers of the pelvic girdle

P E L V IS A N D

MUSCLES OF THE PELVIC FLOOR AND PERINEUM

The pelvic floor is formed by the bowl- or funnel-shaped pelvic diaphragm,
consisting of the levator ani and coccygeus muscles and their investing fascia.
Structurally, the pelvic floor separates the pelvic cavity from the perineum.
Functionally, these pelvic floor muscles support the pelvic organs, keeping
them in place and preventing prolapse upon straining. It also aids in maintaining
both urinary and fecal continence until one can conveniently void.
Piriformis muscle
Coccygeus muscle
Pubococcygeus muscle
Iliococcygeus muscle
Puborectalis muscle
External anal sphincter
Superficial transverse
perineal muscle
Deep transverse
perineal muscle
Bulbospongiosus muscle
Ischiocavernosus muscle
P E LV IS AND
External urethral sphincter
FIGURE 7.6. Muscles of the pelvic floor and perineum. The upper image shows the superior view of the
pelvic floor, while the lower image demonstrates the inferior view. From the superior view, the levator
ani muscle and its three components are visible: The puborectalis (puboanalis), pubococcygeus and
iliococcygeus muscles. Extending between the ischial spines and coccyx is the coccygeus muscle. Moving
posterosuperiorly, the piriformis muscle forms the posterolateral wall of the pelvic cavity, while the
obturator internus muscle forms part of the anterolateral wall of the pelvic cavity.
From the inferior view, the muscles of the perineum can be identified. Beginning in the deep perineal
space/pouch, there is the deep transverse perineal muscle and external urethral sphincter. Moving inferi
orly to the superficial perineal space/pouch, the superficial transverse perineal muscle, bulbospongiosus,
and paired ischiocavernosus muscles are found. Finally, heading posteriorly to the anal triangle of the per
ineum, the external anal sphincter is depicted.

Pelvic diaphragm Origin Insertion Innervation Function
Posterior None (forms

surface of ‘puborectal
Puborectalis
bodies of pubic sling’ posterior
Nerve to levator
bones to rectum) Supports
ani (S4)
pelvic viscera,
Anococcygeal (pubococcygeus
Posterior Increases
ligament, also receives
surface of intraabdominal
Coccyx, Perineal branches
Levator ani Pubococcygeus bodies of pubic pressure,
body and via inferior
bones (lateral to Assists
musculature of rectal/perineal
puborectalis) with fecal
prostate/vagina branches of and urinary
pudendal nerve continence
Tendinous
Anococcygeal (S2-S4))
arch of interal
Iliococcygeus ligament,
obturator fascia,
Coccyx
Ischial spine
Anterior rami of Supports pelvic

Inferior end of
Coccygeus Ischial spine spinal nerves S4 viscera, Flexes
sacrum, Coccyx
& S5 coccyx
Ischiopubic
ramus, Posterior Greater Nerve to
Obturator
surface of trochanter of obturator
internus
obturator femur internus (L5-S2) Hip joint:
membrane thigh external
Anterior surface rotation, thigh
ofS2-S4 abduction
segments (from flexed
of sacrum, Greater Nerve to hip); stabilizes
Piriformis Superior margin trochanter of piriformis head of femur
of greater femur in acetabulum
(S1, S2)
sciatic notch,
Sacrotuberous
ligament
Muscles of the pelvic

Perineal region
floor
P E L V IS A N D

FEMALE PELVIS AND REPRODUCTIVE ORGANS
INTRODUCTION TO THE FEMALE PELVIC CAVITY
The female pelvic cavity contains several organs from the digestive, reproduc
tive and urinary systems, some of which pass into the perineum. These include
the:
• Terminal part of the sigmoid colon, which continues distally as the rectum
• Ovaries, uterine tubes and uterus
• Pelvic part of the ureters and urinary bladder
The female pelvic organs are surrounded by pelvic visceral fascia. Addition
ally, the parietal peritoneum of the abdominal cavity reflects onto the superior
surfaces of some of these organs, forming pouches/spaces between adjacent
organs. The pelvic floor is formed by a musculofascial pelvic diaphragm com
posed of the levator ani and coccygeus muscles, that separates the pelvic cavity
above from the perineum below.
The female pelvic cavity is supplied by various branches of the internal iliac
artery, the superior [ano]rectal artery and the median sacral artery, with the
ovary receiving the ovarian artery from the abdominal aorta. Various visceral
plexuses carry both sympathetic and parasympathetic fibers that provide
innervation to the organs as well as visceral afferent fibers which mostly carry
pain sensation to the central nervous system.
P E LV IS AND

Right common iliac vein Uterine tube
Right common iliac Teniae coli

artery
Peritoneum
Vertebra L5
Round ligament
Sigmoid mesocolon
of uterus
Sigmoid colon Vesicouterine

pouch
Uterus
Pelvic visceral
fascia
Rectouterine
pouch
Urinary bladder
Proper ovarian
ligament Superior pubic
ramus
Rectum Inferior pubic

ramus
Right ureter
Levator ani muscle
Vagina Ischiocavernosus
muscle
External anaL
sphincter Labium minus of vulva
Perineal body Labium majus of vulva
FIGURE 7.7. Female pelvis and perineum (parasagittal section). Parasagittal section of the female pelvis
and perineum (right view) with parts of the right pelvic wall, fascia, ovary and other structures removed to
show the relations of the female pelvic organs. The urinary bladder (full of urine) is located anteriorly, just
posterior to the pubic bone, with the distal part of the right pelvic ureter at its base.
The uterus sits between the urinary bladder and the rectum and shows pieces of the right proper ovarian
ligament, uterine tube and round ligament of the uterus. The vagina extends inferiorly from the cervical
region of the uterus and opens into the perineum at the vaginal orifice (opening). The terminal part of the
sigmoid colon continues distally as the rectum, both of which are located in the posterior aspect of the
pelvic cavity, anterior to the sacrum and coccyx.
P E LV IS A N D
Key points about the female pelvic cavity
Bones: hip bone (Ilium, ischium, pubis), sacrum, coccyx

Walls and floors Ligaments: sacroiliac, sacrospinous, and sacrotuberous
Muscles: levator ani, coccygeus, piriformis, obturator internus
Organs: sigmoid colon, rectum

Digestive
organs Functions: absorption of minerals, vitamins, water and electrolytes, temporary
storage of fecal matter and elimination during defecation
Organs: ovary, uterine tube, uterus, vagina

Reproductive
organs Functions: formation and development of ova, production of estrogen and
progesterone, implantation of embryo, fetal development
Organs: pelvic part of ureter, urinary bladder

Urinary organs
Functions: transport and elimination of urine from from the body

Rectus abdominis Pubic symphysis

muscle
Deep dorsal vein
of clitoris
Urinary bladder
Inferior epigastric
Psoas major muscle artery
External iliac vein

External iliac
artery Deep circumflex
iliac artery
Iliacus muscle Deep circumflex

iliac vein
Obturator canal
Ovarian artery
Superior vesical
artery
Internal iliac
artery Umbilical artery
Obturator artery
Internal iliac vein
Middle anorectal
artery
Cervix of uterus
Uterine artery
Rectum Median sacral artery
FIGURE 7.8. Organs and vessels (superior view). The urinary bladder (opened and retracted) is situated
posterior the anterior pelvic wall. Immediately posterior to it is the uterus (body removed, with only the
cervix remaining). Finally, in the posterior part of the pelvic cavity is the rectum.
This superior view also allows the appreciation of the distribution of the vessels in the pelvic cavity. The
arteries of this area stem mainly from the internal and external iliac arteries, which are shown bifurcating
from the common iliac artery. The internal iliac artery supplies the pelvic walls and organs, as well as the
gluteal and medial thigh regions of the lower limb. The external iliac artery provides arterial supply to
the lower abdominal wall (via the inferior epigastric and deep circumflex iliac arteries); it passes beneath
the inguinal ligament, where it becomes the femoral artery (main artery of the lower limb).
P E L V IS AND
Key points about the female pelvic cavity
Vesicouterine pouch (between urinary bladder and uterus)

Peritoneal
pouches/ Rectouterine pouch (between uterus and rectum)
depressions
Pararectal fossae (lateral to the recum)
Internal iliac artery: superior vesical arteries, inferior vesical artery, internal
pudendal artery, middle [ano]rectal artery
Blood supply Superior [ano]rectal artery (from inferior mesenteric artery)

Median sacral artery (from aortic bifurcation)
Ovarian artery (from abdominal aorta)
Sympathetic: lumbar splanchnic nerves, hypogastric and pelvic plexuses

Innervation Parasympathetic: pelvic splanchnic nerves, left and right inferior hypogastric
plexuses, and rectal (pelvic) plexus

Umbilical fascia Rectus sheath
Median umbilical Retropubic space

ligament
Deep inguinal ring Transverse perineal

ligament
Transversalis fascia
Medial pubovesical
Iliopubic tract ligament
Round ligament Iliac fascia

of uterus
Obturator fascia
Medial umbilical
ligament
Tendinous arch of
Suspensory levator ani muscle
ligament of ovary
Tendinous arch of
Lateral ligament of pelvic fascia
urinary bladder
Vesicouterine pouch
Pararectal fossa
Cardinal ligament
Presacral space
Rectouterine pouch Presacral fascia
Anterior sacrococcygeal Rectal fascia

ligament
FIGURE 7.9. Fasciae/ligaments and anatomical spaces (superior view). The peritoneum covers the pelvic
wall as well as parts of the viscera. Consequently, a number of spaces and pouches are created. The most
significant ones are the vesicouterine pouch, rectouterine pouch (of Douglas, lowest part of the female
peritoneal cavity), pararectal fossae and presacral space.
Female reproductive Anatomical spaces of

P E LV IS AND
organs the pelvic cavity

UTERUS, UTERINE TUBES AND OVARIES
The vagina, uterus, uterine tubes and ovaries represent the internal organs of
the female reproductive system (female internal genitalia).
The uterus, commonly known as the womb, is a pear-shaped muscular organ

situated in the pelvis anterior to the rectum and posterior to the urinary blad
der. It is about 8 cm long and is divided into 4 parts: The cervix, isthmus, corpus,
and fundus. The uterus has many functions, such as providing vaginal and uter
ine secretions, hosting the fetus during pregnancy, and allowing sperm to pass
to the uterine tubes in order to fertilize an egg (ovum). During childbirth, the
uterus contracts to move the fetus through the pelvis/birth canal.
The ovaries are paired disc-shaped endocrine glands, responsible for the pro
duction of eggs (ova) and the secretion of the hormones progesterone and
estrogen. An ovum is released every 3 to 4 weeks into the uterine tube, which is
a paired, 10 cm long muscular tube. The uterine tube extends laterally from each
side of the uterus, serving as a passageway between the ovaries and the uterus.
Fundus of uterus
Ampulla of uterine tube
Epoophoron
Infundibulum
of uterine tube
Vesicular appendage
of epoophoron
Isthmus of
uterine tube
Mesosalpinx
Ovary
Broad ligament of uterus

P E LV IS AND
Proper ovarian ligament
Mesometrium
Body of uterus
Uterosacral ligament
Myometrium
Cervix of uterus
Vagina
FIGURE 7.10. Internal female reproductive organs (posterior view). Each uterine tube is made up of
4 parts: The infundibulum, ampulla (where eggs are usually fertilized), isthmus and the intramural part.
The uterus has 3 layers: The endometrium, myometrium, and the perimetrium. The uterus, uterine tubes

and ovaries are supported by various ligaments, including the uterosacral ligament inferiorly, the ovarian
ligament laterally, the suspensory ligament and the broad ligament of uterus. The most prominent of them
is the broad ligament of uterus, which is subdivided into 3 components: The mesometrium, mesosalpinx
and mesovarium.
Uterine part of
uterine tube
Ovarian vein
Uterine tube
Ovarian artery
Suspensory
ligament of
ovary
Fimbriae of
uterine tube
Tertiary ovarian
follicle
Corpus luteum
Corpus albicans
Mesovarium
Uterine ostium of
uterine tube
Ureter
Endometrium
Isthmus of uterus
Internal os of uterus
Vaginal fornix
External os of uterus
FIGURE 7.11. Internal female reproductive organs (frontal section). A frontal-section of the ovary, with
the ovarian follicles in different stages of maturation. When a follicle has matured, it undergoes ovulation
and releases an egg (ovum) into the peritoneal cavity and ultimately into the uterine tube.
P E LV IS AND
Key points about the uterus
Definition Pear-shaped muscular organ, 8 cm long
Parts Cervix, isthmus, corpus, and fundus
Endometrium (innermost mucous membrane layer)

Layers Myometrium (smooth muscle layer)
Perimetrium (serosa or outer serosal layer)
Uterosacral ligament, broad ligament of uterus (mesometrium, mesosalpinx,

Ligaments
mesovarium)
Vagina (inferior), urinary bladder (anterior), rectum (posterior), uterine tubes (left
Relations
and right), ovaries (left and right)
Provide vaginal and uterine secretions, host the fetus during pregnancy, allow
sperm to pass through the uterine tubes in order to fertilize an egg, provide
Function
mechanical protection, nutritional support to the fetus, and remove waste from
inside the uterus

Key points about the uterine tube
Definition 10 cm long muscular tubes extending bilaterally from the uterus
Parts Infundibulum, ampulla, isthmus and intramural part
Ligaments Broad ligament (specifically the mesosalpinx)
Relations Ovaries, uterus, appendix (right), sigmoid colon (left), common iliac vessels
Function Passageway between the ovaries and the uterus
Key points about the ovary
Definition Bilateral disc-shaped organs and endocrine glands
Ligaments Suspensory ligament of ovary, proper ovarian ligament, broad ligament
Relations Uterine tubes, uterus, appendix (right), sigmoid colon (left)
Function Production of eggs, secretion of estrogen and progesterone
Uterus The female gonads
Uterine tubes
P E LV IS AND

CERVIX, VAGINA AND VULVA
The cervix is a narrow canal about 2.5 cm long that connects the body of the
uterus to the vagina. It is divided into a supravaginal part (endocervix) found
superior to the vagina, and a vaginal part (ectocervix) which projects into the
vagina. The cervix has many functions, such as facilitating passage of sperm,
providing a physical barrier from pathogens and foreign objects, and main
taining physical integrity as the uterus enlarges during pregnancy. The cervix
directly communicates with the vagina, which is the most distal part of the
internal female genitalia.
The vagina is a flexible muscular canal that has a variety of functions, including
menstruation, childbirth, and sexual intercourse. It is situated in the lesser pel
vis, lying between the urinary bladder anteriorly, and the rectum posteriorly. It
measures about 8 to 10 cm long, extending from the cervix of the uterus to the
external genitalia.
The vulva is a collection of structures that represents the external part of the
female reproductive system (external genitalia) surrounding the vaginal orifice.
It consists of the mons pubis, labia majora, labia minora, clitoris, external ori
fice of the urethra, vestibule of vagina, vestibular bulb, hymen and vestibular
(Bartholin) glands. The vulva plays a role in stimulation and arousal during sexual
intercourse, while also protecting the internal organs of the female reproduc
tive system.
P E L V IS A N D


Ureter
External iliac vein
Rectum
Ovary
Fundus of uterus
Iliacus muscle
Uterine tube
Ilium
Round ligament of
uterus
Cervix of uterus
Cardinal ligament
Paracolpium
Vagina
Levator ani muscle
- Inferior pubic ramus
Deep transverse perineal muscle
Ischiocavernosus muscle
Perineal artery
Bulb of vestibule
Bulbospongiosus muscle
Vestibule of vagina
Crus of clitoris
Perineal fascia
FIGURE 7.12. Uterus and vagina. The image above shows a coronal section of the female perineum. The
inferior end of the cervix is seen projecting into the vagina, known as the vaginal part of the cervix. This
protrusion forms a dome-shaped recess in the vaginal wall around the cervix called the vaginal fornix.
The walls of the vagina are covered by many transverse folds called vaginal rugae, which contribute to
the elasticity and resilience of the vagina during sexual intercourse. The vagina opens into the vestibule of
vagina, a part of the vulva lying between the labia minora. The vagina is closely related to many organs and
structures of the pelvic region. In this coronal section, one can observe its lateral relations with the para-
colpium, left and right ureter and levator ani muscle. A part of the levator ani muscle, called the pubovag-
inalis muscle, provides a U-shaped muscular sling that wraps around the vagina.
P E LV IS A N D

Key points about the cervix and vagina
Classification Internal female genitalia
Cervix: lowermost portion of the uterus approximately 2.5 cm long, connecting

the body of uterus to the vagina.
Definition
Vagina: very flexible fibrocartilaginous tube approximately 8-10 cm long,
connecting the cervix of the uterus to the external genitalia (vulva)
Parts Cervix: supravaginal and vaginal part
Superior: body of uterus
Anterior: urinary bladder, urethra

Relations Posterior: rectum
Lateral: deep transverse perineal muscle, levator ani muscle, paracolpium, ureter,
cardinal ligament.
Cervix: facilitates passage of sperm, maintains sterility of uterus, maintains

physical integrity as the uterus enlarges during pregnancy and expands during
Functions labor.
Vagina: menstruation, childbirth, sexual intercourse
Key points about the vulva
Classification External female genitalia
Mons pubis, labia majora, labia minora, clitoris

Components
Vaginal opening: external orifice of the vagina and urethra
Bulb of vestibule, artery of bulb of vestibule, bulbospongiosus muscle, perineal

Relations
fascia
Sexual function: arousal and stimulation

Functions
Protection of the internal female genitalia
Female reproductive
Vagina
organs
P E L V IS A N D

FETUS IN UTERO
The fetus is a term that describes an unborn baby from the 8th week after fer
tilization until birth. In the uterus (i.e., in utero) the fetus is surrounded by an
amniotic sac, a membranous sac which provides protection to the fetus.
The placenta is a temporary organ for gas, nutrient and substance exchange
between mother and fetus. This exchange is mediated by the umbilical cord, a
structure developed from the fetal tissue. It contains one vein and two arteries,
which carry oxygen and nutrients to the fetus and waste products away from it.
Placenta Basal decidua
Myometrium Amnion
Chorion
Parietal decidua
Amniotic sac
Umbilical cord
Uterine cavity
Fetus
Mucus plug
Rectus abdominis
muscle
Sacrum
Urinary bladder
Rectum
Internal anal Pubic symphysis

sphincter
Anus Urethra
P E LV IS AND
Vagina Vaginal orifice
FIGURE 7.13. Fetus in utero. While in the uterus, the fetus is surrounded by a thin double layered membrane
called the amniotic sac. The inner layer (closer to the fetus) is also known as the amnion, while the outer
layer (closer to the uterus) is also known as the chorion. The amniotic sac is filled with amniotic fluid that
surrounds and bathes the fetus during development.
The fetus is connected to the placenta via the umbilical cord. The umbilical cord has two umbilical arteries
that carry the deoxygenated blood from the fetus. In contrast, a single umbilical vein carries oxygenated
blood, rich in nutrients from the mother to the fetus.

Myometrium Spiral artery of uterus
Maternal
circulation
Maternal vein
Basal decidua
Parietal
Intervillous decidua
spaces
Placental
Chorion —
septum
frondosum
Chorion laeve
Umbilical —
artery
Amnion
o
'c L Chorionic plate Umbilical vein -
FIGURE 7.14. Cross-section of the placenta. At the beginning of the fetal period, the placenta has two
components: A fetal portion, formed by the chorion frondosum, and a maternal portion, formed by the
decidua basalis. On the fetal side, the placenta is bordered by the chorionic plate. On its maternal side, it is
bordered by the basal decidua.
The placenta is the meeting point of two circulatory systems: Fetal circulation and maternal circulation.
The maternal component of the placenta contains maternal arteries and veins that feed into the intervil
lous spaces. On the opposite side, the umbilical arteries and veins form a tree-like structure within the
intervillous space. Here, the fetal and maternal blood comes into close contact separated only by a thin
membrane, called the placental membrane.
Key points about the placenta
The placenta is a highly specialized, temporary organ that develops as a conduit

Definition
between maternal and fetal tissues.
P E LV IS AND
Fetal portion: chorion frondosum

Portions
Maternal portion: basal decidua
Exchange of metabolic and gaseous products between maternal and fetal

Functions
bloodstreams, production of hormones.
Anatomical changes Embryology 1st week

during gestation of development

MALE PELVIS AND REPRODUCTIVE ORGANS
INTRODUCTION TO THE MALE PELVIC CAVITY

The male pelvic cavity is a basin-shaped space formed by bony and musculoliga-
mentous pelvic walls and floor. It contains several organs from the digestive, repro
ductive and urinary systems, some of which pass into the perineum. These include:
• Terminal part of the sigmoid colon, which continues distally as the rectum
• A pair of seminal vesicles, ductus deferens and the prostate
• Pelvic part of the ureters and urinary bladder
The organs are surrounded by pelvic visceral fascia and have the parietal perito
neum of the abdominal cavity reflecting onto their superior surfaces, forming
pouches in between adjacent organs. The pelvic floor is formed by the levator
ani and coccygeus muscles (collectively known as the pelvic diaphragm) which
separate the pelvic cavity above from the perineum below.
The male pelvic cavity is supplied by various branches of the internal iliac arter
ies, the superior [ano]rectal artery and the median sacral artery. The organs
within the pelvic cavity are innervated by various visceral plexuses that carry
both sympathetic and parasympathetic fibers as well as visceral afferent fibers
which generally carry pain sensation to the central nervous system.
Right common Sigmoid mesocolon

iliac artery
Right common
iliac vein
Sigmoid colon
Vertebra L5
Teniae coli Rectus

abdominis
Rectovesical muscle
pouch
Right ductus
deferens Peritoneum
P E LV IS AND
Right ureter
Pelvic visceral
Rectum fascia
Right seminal
gland
Urinary bladder
Levator ani muscle
External anal
sphincter Inferior pubic
ramus
Prostate
Perineal body Pampiniform plexus
FIGURE 7.15. Male pelvis and perineum (parasagittal section). Parasagittal section of the male pelvis
and perineum (right view) with parts of the right pelvic wall and fascia removed to show the relations

of the male pelvic organs. The urinary bladder (depicted as full of urine) is located anteriorly within the
pelvic cavity, posterior to the pubic bone. The prostate sits immediately inferior to the urinary bladder.
The terminal part of the sigmoid colon continues distally as the rectum, both of which are located in the
posterior aspect of the pelvic cavity, anterior to the sacrum and coccyx. The pelvic part of the ureter,
ductus deferens and seminal vesicle are centrally located in the image, between the urinary bladder and
the rectum.
Key points about the male pelvic cavity
Bones: hip bone (ilium, ischium, pubis), sacrum, coccyx

Walls and floors Ligaments: sacroiliac, sacrospinous, and sacrotuberous
Muscles: levator ani, coccygeus, piriformis, obturator internus
Organs: sigmoid colon, rectum

Digestive
organs Functions: absorption of minerals, vitamins, water and electrolytes, temporary
storage of fecal matter and elimination during defecation
Organs: prostate, seminal vesicles, ductus deferens

Reproductive
organs Functions: secretion of protein and nutrient rich fluid that contributes to volume
of semen, transport of semen
Organs: pelvic part of ureter, urinary bladder

Urinary organs
Functions: transport and elimination of urine from from the body
Peritoneal
Rectovesical pouch (between the rectum and urinary bladder)
pouches
Internal iliac artery: superior vesical arteries, inferior vesical artery, internal
pudendal artery, middle [ano]rectal artery
Blood supply
Superior [ano]rectal artery (from inferior mesenteric artery)
Median sacral artery (from aortic bifurcation)
Sympathetic: lumbar splanchnic nerves, hypogastric and pelvic plexuses

Innervation Parasympathetic: pelvic splanchnic nerves, left and right inferior hypogastric
plexuses, and rectal (pelvic) plexus
Male reproductive
Pelvis and perineum
organs
P E L V IS A N D

TESTIS AND EPIDIDYMIS

The testes (sing. testis) are the male gonads which are composed of lobules
containing convoluted seminiferous tubules, where sperm production (sper
matogenesis) occurs. Supporting cells within the testes secrete hormones,
primarily androgens such as testosterone. The testes reside within connective
tissue layers known as the tunica albuginea and tunica vaginalis which are fur
ther enveloped by the layers of the spermatic cord.
Efferent ductules from the testis join to form the epididymis (pl. epididymides).
These ductules unite within the head and body of the epididymis to form a sin
gle duct in the tail of the epididymis before becoming the ductus (or vas) defe
rens. Within the lumens of the ductules in the epididymis, sperm maturation is
completed, although they remain immotile.
Head of epididymis Cavity of tunica vaginalis
Efferent ductules Parietal layer

of testis
Body of epididymis
Visceral layer
Epididymis
Rete testis
Testicular artery
Convoluted
seminiferous
tubule
Ductus deferens
P E L V IS AND
Straight
seminiferous
Tunica albuginea tubule
of testis
Tail of epididymis Septa of testis
FIGURE 7.16. Lateral view of testis, epididymis and ductus deferens (removed from scrotum). A section
of the testis and surrounding connective tissue layers has been removed in order to visualize the internal
structure of the testis.
The convoluted seminiferous tubules form the bulk of the testis and converge to become the straight
seminiferous tubules as they approach the hilum, where they form the rete testis. The efferent ductules
arise from the rete testis and converge to form the head and body of the epididymis.
The ductules continue to unite within the epididymis, forming a single duct, known as the tail of the
epididymis, which continues as the ductus deferens. The testis is enveloped by the tunica vaginalis and
the tunica albuginea. The tunica vaginalis has two layers: A visceral layer and parietal layer between which
is a potential space known as the cavity of the tunica vaginalis. The tunica albuginea envelopes only the
testis while the tunica vaginalis envelops the testes and much of the epididymis.

Key points about testis and epididymis
Contents: lobules, septa, mediastinum of testis, seminiferous tubules (convoluted/

straight), rete testis, efferent ductules.
Testis Coverings: tunica vaginalis (composed of parietal and visceral layers), tunica
albuginea, tunica vasculosa.
Functions: production of sperm, hormone production and secretion.
Location: overlies superoposterior aspect of testis.
Structure: formed by efferent ductules from testis ^ join together in head and
Epididymis
body ^ become single duct in tail ^ continues as ductus deferens.
Function: maturation of sperm.
Epididymis
Neurovascular supply
Ductus defererns
of the testes
SCROTUM AND SPERMATIC CORD
The scrotum is a cutaneous fibromuscular sac composed of thin, pigmented

skin and multiple layers of fascia and smooth muscle. The structures contained
in the scrotal sac are the testes, epididymis, and lower parts of the spermatic
cord. The function of the scrotum is to facilitate the positioning of the testes
external to the pelvis. This is fundamental for maintaining the optimal tem
perature for spermatogenesis, which is several degrees below normal body
P E L V IS A N D
temperature.
The testis is suspended in the scrotum by the spermatic cord. The spermatic
cord is a collection of vessels, nerves, and ducts surrounded by muscle and fas
cia, that run to and from the testis. Its component layers arise from the deep
inguinal ring and inguinal canal, ultimately exiting at the superficial inguinal ring
to terminate in the scrotum, at the posterior aspect of the testis. The fascial
coverings of the spermatic cord are derived from the anterior abdominal wall,
which is explained as the testes ‘dragging’ the layers of the abdominal wall dur
ing their descent into the scrotum during fetal life. Each testis resides in its own
compartment, which are separated by a vertical fibrous scrotal septum.

Anterior scrotal
branch of Testicular artery
ilioinguinal nerve
Superficial
Body of penis
inguinal ring
Spermatic cord
Appendix of
epididymis
Cremasteric
artery
Appendix of testis
Genital branch
of genitofemoral
nerve Tunica vaginalis
Cremasteric vein of testis
Lymphatic vessels Tunica albuginea

in spermatic cord of testis
Autonomic
testicular plexus Glans penis
Pampiniform plexus Internal

spermatic
fascia
Ductus deferens
Cremaster muscle
Artery of ductus
deferens
External spermatic
Epididymis
fascia
Scrotal Dartos fascia of

skin scrotum
FIGURE 7.17. Scrotum and spermatic cord. The scrotum consists of several layers: Skin, dartos fascia
(with dartos muscle), external spermatic fascia, cremasteric fascia (with cremaster muscle) and internal
spermatic fascia. The internal spermatic fascia is loosely attached to the parietal layer of tunica vaginalis
of the testis.
Structures in the spermatic cord include the ductus deferens, artery to ductus deferens, testicular artery,
pampiniform plexus, cremasteric artery and vein, genital branch of the genitofemoral nerve, autonomic
testicular plexus and lymphatic vessels. The fascial coverings of the spermatic cord are the internal sper
matic fascia, cremasteric fascia (with cremaster muscle), and external spermatic fascia.
Key points about the scrotum

P E LV IS AND
Contents Testes, epididymis, lower parts of spermatic cords
Skin, dartos fascia (dartos muscle), external spermatic fascia, cremasteric fascia
Layers
(cremaster muscle) and internal spermatic fascia
Function Maintains optimal temperature for spermatogenesis
Key points about the spermatic cord
Ductus deferens, artery to ductus deferens, testicular artery, pampiniform plexus

Contents (testicular veins), cremasteric artery and vein, genital branch of the genitofemoral
nerve, autonomic testicular plexus, and lymphatic vessels
Internal spermatic fascia, cremasteric fascia (cremaster muscle), external

Coverings
spermatic fascia
Contains structures running to and from the testis; suspends the testis in the
Function
scrotum

Enasj^saEi
^!®igKKSS&
Male reproductive
Scrotum
organs
P E L V IS A N D

URINARY BLADDER AND URETHRA
The urinary bladder is a hollow distensible muscular organ which functions

to temporarily store urine. When empty, the urinary bladder is shaped like a
pyramid and lies entirely within the lesser pelvis. As the bladder begins to fill,
it becomes ovoid and expands in an upward direction to occupy a part of the
greater pelvis.
Both male and female urinary bladders consist of four parts (apex, body, fundus
and neck) and three surfaces (superior surface and two inferolateral surfaces).
Extending from the neck of the bladder in both sexes is the urethra. The differ
ences between the male and female bladders are within their respective rela
tions with other pelvic organs. The urethrae, however, have major structural
differences.
P E LV IS AND
FIGURE 7.18. Urinary bladder (lateral view). Urinary bladder shown full of urine, within the female pelvis.
Three out of four main parts of the bladder are shown: The apex, body and fundus. The fourth part, the
neck of bladder, is not visible on this image as it extends from the undersurface of the bladder. The bladder
is held in place by the median umbilical ligament.

Right ureteric
orifice
Muscular layer
Left ureteric orifice
Interureteric crest
Trigone
Internal urethral
sphincter
Internal urethral
orifice
FIGURE 7.19. Urinary bladder (coronal section). This section displays several main internal features of the
urinary bladder, such as the trigone, left and right ureteric orifices and interureteric crest. The trigone is
a triangular area of the bladder between the left and right ureteric orifices and internal urethral orifice.
This region is particularly sensitive to the increase of pressure resulting from the urine accumulation and
retention. Urine is delivered to the kidneys via the ureters which empty into the organ via the ureteric
orifices. A slightly curved ridge called the interureteric crest connects the two orifices, at the same time
defining the upper margin of the trigone of the bladder.
P E LV IS AND

MALE URINARY BLADDER AND URETHRA

The male urinary bladder is located just inferior to the peritoneum and lies
anterior to the rectum, anterosuperior to the prostate and posterior to the
pubic symphysis.
The male urethra is a roughly 20 cm long tube and extends from the internal
urethral orifice at the neck of the bladder to the external urethral orifice of the
glans penis. From proximal to distal, it is divided into intramural/preprostatic,
prostatic, membranous and spongy parts and features openings for prostatic
fluid, semen from the testes and excretions of the bulbourethral glands.
Trigone of urinary bladder

Uvula of urinary bladder
Internal urethral sphincter
Urethral crest
Prostate
Prostatic ductules
Prostatic utricle
Opening of ejaculatory duct
Seminal colliculus
Prostatic part of urethra
Male external urethral sphincter
Bulbourethral gland
Membranous part of urethra
Crus of penis
Bulb of penis
Ampulla of urethra
Spongy part of urethra
Corpus cavernosum of penis
Deep artery of penis
Corpus spongiosum of penis
P E LV IS AND
Urethral lacunae
Tunica albuginea of corpus cavernosum
Glans penis
Navicular fossa of urethra
External orifice of urethra
FIGURE 7.20. Penis and male urethra. Longitudinal section through the male urogenital tract showing
the structural components of the penis and the male urethra. Urine enters the intramural/preprostatic
part of the male urethra through the internal urethral sphincter and is transported towards the external
urethral orifice at the end of the glans penis. Prostatic fluid enters the prostatic part of the urethra via
the prostatic ductules and semen from the testes via the opening of the ejaculatory duct. Bulbourethral
glands secrete lubricating mucus into the spongy part of the urethra just proximal to the ampulla and
navicular fossa of the urethra.

Key points about the male urinary bladder
Surfaces Superior, left inferolateral and right inferolateral
Parts Apex, body, fundus and neck
Peritoneum (superior surface only), pelvic visceral fascia

Lining/wall Bladder wall: serosa (reflection of peritoneum), detrusor vesicae muscle, subserosa
and mucosa
Internal Right ureteral orifice, left ureteral orifice, interureteric crest, trigone, uvula of
features bladder, internal urethral orifice
Arterial: superior vesical artery, inferior vesical artery

Neurovascular
Venous: vesical venous plexus (vesical veins)
supply
Nerve: vesical plexus, inferior hypogastric plexus
Superior: pelvic visceral fascia, peritoneal membrane, sigmoid colon

Surrounding Anterior: retropubic space, pubic symphysis
structures and
spaces Posterior: seminal gland, rectoprostatic fascia, rectovesical pouch, rectum
Inferior: prostate, levator ani muscle
Key points about the male urethra
Begins Internal urethral orifice (of urinary bladder)
Ends External urethral orifice (glans penis)
Preprostatic/intramural part, prostatic part (crest of urethra, prostatic ducts,

Parts seminal colliculus, opening of ejaculatory ducts), membranous part and spongy
part (bulbourethral glands, ampulla of urethra, navicular fossa)
Arterial: inferior vesical artery, artery of bulb of penis

Neurovascular
Venous: prostatic venous plexus
supply
Nerve: prostatic plexus, pudendal nerve
Surrounding Prostate, external urethral sphincter, corpus spongiosum, bulbospongiosus

structures muscle, corpus cavernosum
Urinary bladder and Development of the

urethra urinary system
P E L V IS A N D

FEMALE URINARY BLADDER AND URETHRA
The female urinary bladder is located posterior to the pubic symphysis in the
retropubic space and lies just anterior to the vagina. Similar to its male counter
part, the female urinary bladder has three surfaces: A superior surface and two
inferolateral surfaces. It consists of four distinct parts: Apex, body, fundus and
neck of the urinary bladder.
The female urethra, which is much shorter than that found in males, extends
from the neck of the urinary bladder at the internal urethral orifice and meas
ures approximately 5 cm in length.
Interureteric crest Trigone of urinary bladder
Body of urinary bladder Left ureteric orifice
Peritoneum Detrusor vesicae muscle
Fundus of urinary
Right ureteric orifice
bladder
ExtraperitoneaL Hip bone

space
Vesical venous Urethra

plexus
Obturator
Neck of urinary
internus muscle
bladder
Tendinous arch of
Pelvic visceral fascia
pelvic fascia
Levator ani muscle — External urethral

sphincter
Perineal membrane
Inferior pubic ramus
Ischiocavernosus Crus of clitoris

muscle
Round ligament of
Deep perineal fascia
uterus
TJ
P E L V IS AND
Superficial perineal fascia Bulb of vestibule

m
2
z
m
Vagina Bulbospongiosus muscle c
z
FIGURE 7.21. Female urinary bladder. A coronal section of the female urinary bladder and urethra. This
section displays the body, fundus and neck of the bladder as well as the main internal features of the
urinary bladder: The trigone, left and right ureteric orifices and interureteric crest of the urinary bladder.
The female urethra begins as a continuation of the neck of the bladder at the internal urethral orifice and
terminates as the external orifice of the female urethra. The urethra is located just anterior to the vagina
and is surrounded by the external urethral sphincter along its proximal two-thirds. Distally, it is encircled
by a muscular sling formed by the compressor urethrae muscle as well as the urethrovaginal sphincter
(not shown).

Key points about the female urinary bladder
Surfaces Superior, left inferolateral and right inferolateral
Parts Apex, body, fundus and neck
Peritoneum (superior surface only), pelvic visceral fascia

Lining/wall Bladder wall: serosa (reflection of peritoneum), detrusor vesicae muscle and
mucosa
Internal Right ureteric orifice, left ureteric orifice, interureteric crest, trigone and internal
features urethral orifice
Arterial: superior vesical artery, vaginal artery

Neurovascular
supply
Nerve: vesical plexus, inferior hypogastric plexus
Superior: pelvic visceral fascia, peritoneal membrane and sigmoid colon

Surrounding Anterior: retropubic space and pubic symphysis
structures and
spaces Posterior: vesicouterine pouch and vagina
Inferior: pelvic diaphragm
Key points about the female urethra
Begins Internal urethral orifice of urinary bladder
Ends External urethral orifice [vestibule of vagina]
Arterial: internal pudendal artery, vaginal artery

Neurovascular
supply
Nerve: vesical plexus, pudendal nerve
Surrounding Pelvic diaphragm, external urethral sphincter, compressor urethrae, sphincter

structures urethrovaginalis, perineal membrane, and urethral glands
Development of the
Urethral sphincters
urinary system
P E L V IS A N D

PERINEUM
PENIS
The penis is a male external genital organ which functions as part of the repro
ductive and urinary systems. It becomes erect to facilitate sexual intercourse,
acts as a conduit for the passage of semen and facilitates the transport of urine
from the urinary bladder to the external environment.
From proximal to distal, the penis consists of a root, body and glans which are
composed of 3 erectile bodies: Two bilateral corpora cavernosa and one median
corpus spongiosum.
• The root of the penis is made up of the bulb of the penis (proximal expanded
part of the corpus spongiosum), the crura (sing.: Crus, proximal tapering
parts of the corpora cavernosa which are fixed to the ischiopubic rami) which
are surrounded by the bulbospongiosus and ischiocavernosus muscles,
respectively.
• The body of the penis consists of the free portions of the corpus spongiosum
(which contains the urethra), located ventrally, and corpora cavernosa found
on the dorsolateral aspect of the penis.
• The glans penis is formed by the bulbous extension of the corpus spongiosum
distally.
P E LV IS AND

PERINEUM
Intercavernous septum of Glans penis

deep fascia of penis
Corpus cavernosum Corpus spongiosum
Crus of penis Bulb of penis
Deep fascia of penis External orifice of urethra
Inferior pubic ramus Prepuce of penis
Perineal membrane Subcutaneous tissue
Superficial transverse Ischiocavernosus muscle

perineal muscle
Anus External anal sphincter
Levator ani muscle Gluteus maximus muscle
FIGURE 7.22. Penis (inferior view). The root forms the fixed or anchored portion of the penis, while the
body and glans forms the free, pendulous part. The bulb of the penis, which consists of the proximal
portion of the corpus spongiosum, lies firmly anchored to the perineal membrane/body, while the crura
of the penis are fixed to the ischiopubic rami of the pelvic girdle.
The penis is further stabilized by the suspensory and fundiform ligaments (not seen in this image). Envel
oping the bulb and crura of the penis are the bulbospongiosus (removed) and ischiocavernosus muscles.
These muscles aid in emptying the urethra and stabilizing the erect penis. Surrounding the structure of
the penis and erectile tissues is the deep and superficial fascia/subcutaneous tissue of the penis. The deep
fascia lies just superficial to the tunica albuginea of the penis and surrounds all three erectile tissues. As its
name suggests, the superficial fascia is located most superficially and is continuous with the superficial
P E LV IS A N D
fascia/subcutaneous tissue of the perineum (Colles’ fascia).
Key points about the penis
Root: bulb of penis, crura, ischiocavernosus muscles, bulbospongiosus muscle

Parts Body: distal parts of corpora cavernosa and corpus spongiosum
Glans: neck and corona of glans
Erectile bodies Corpora cavernosa (x2), corpus spongiosum (x1)
Tunica albuginea, deep fascia of penis (Buck’s fascia) and superficial fascia/
Fasciae
subcutaneous tissue of penis (Colles’ fascia)
Ligaments Suspensory and fundiform ligaments
Reproductive: becomes erect to facilitate sexual intercourse

Functions
Urinary: passage of urine from urinary bladder to external environment

PERINEUM
Prostate
Prostatic ductules
Opening of ejaculatory duct
Seminal colliculus
Male external urethral sphincter
Bulbourethral gland
Crus of penis
Bulb of penis
Urethra
Corpus cavernosum of penis
Deep artery of penis
Corpus spongiosum of penis
Tunica albuginea of corpus cavernosum
Glans penis
Navicular fossa of urethra
FIGURE 7.23. Penis. Longitudinal cross-section of the male urogenital tract showing the structural
components of the penis and male urethra. The spongy part of the male urethra is surrounded in its
entirety by corpus spongiosum. The distal portions of the corpus spongiosum and corpora cavernosa form
the body of the penis. The head of the penis, known as the glans penis is formed by the distal expansion of
the corpus spongiosum as it wraps around the ends of the corpora cavernosa.
The base of the glans projects posteriorly, forming a rounded margin known as the corona of the glans
which overhangs a groove known as the neck of the glans. This forms the boundary between the body
and glans penis. Located at the tip of the glans is the opening for the spongy urethra, the external urethral
orifice.
P E L V IS AND
1
1
Male reproductive
The male urethra
organs

PERINEUM
FEMALE PERINEUM
The perineum is a diamond shaped compartment which sits just inferior to the
pelvic cavity, forming the lowest portion of the trunk in the human body.
The female perineum is bounded superiorly (internally) by the pelvic dia

phragm and inferiorly (externally) by the perineal skin and fascia. It is occupied
by muscles, erectile and cavernous tissues which facilitate excretion, egestion
and reproduction. A transverse line, known as the interischial line, stretches
between the two ischial tuberosities dividing the perineum into two regions:
• The urogenital triangle, which is located anteriorly, is further subdivided by

the perineal membrane into superficial and deep perineal spaces. The female
urogenital triangle contains muscles, fasciae, erectile tissues and spaces
associated with the female urogenital system. It also functions as an anchor
ing point for the external female genitalia.
• The anal triangle, located posteriorly, houses the anal canal and the internal
and external anal sphincters. These are all surrounded by a fat-filled space
known as the ischioanal fossa.
P E LV IS AND
FIGURE 7.24. Female perineum (inferior view). The image demonstrates the boundaries of the perineum
represented by imaginary lines that connect the pubic symphysis, ischial tuberosities and coccyx. A
transverse line that extends between the two ischial tuberosities divides the perineum into the urogenital
(anterior) and anal (posterior) triangles.

PERINEUM
Anterior labial commissure
Pubic symphysis
Prepuce of clitoris
Glans of clitoris
Labia minora

Opening of paraurethral
gland
Ischiopubic ramus of
hip bone
Vestibule of vagina
Vaginal orifice
Labium majus of vulva
Opening of greater
vestibular gland
Ischial tuberosity
Labium minus of vulva
Frenulum of labia minora
Ischial spine
Posterior labial commissure
Perineal raphe
Sacrum
Coccyx
Posterior superior iliac spine
FIGURE 7.25. Surface anatomy of the female perineum. An overview of the borders and external features
of the female perineum in the lithotomy position. The female perineum is bordered by the pubic symphysis
anteriorly, the ischiopubic rami anterolaterally, the sacrotuberous ligaments posterolaterally and the
sacrum and coccyx posteriorly.
Visible in this illustration is the surface anatomy of the female urogenital triangle that is defined by the
vulva. The vulva represents the external female genitalia that include the mons pubis, labia majora, labia
minora, clitoris, vestibule of the vagina, vaginal orifice and external orifice of the urethra. Posterior to the
urogenital triangle is the anal triangle, containing the anal aperture. Not visible in this illustration are the
internal structures of the female perineum which include the female urethra, vaginal canal, anal canal,
P E L V IS AND
perineal muscles and fascia.
Key points about the female perineum
Internal (roof): pelvic diaphragm (levator ani and coccygeus muscles)

External (floor): fascia and skin
Anterior: pubic symphysis

Borders
Posterior: sacrum and coccyx
Anterolateral: ischiopubic rami
Posterolateral: sacrotuberous ligaments
1. Urogenital triangle (deep perineal space and superficial perineal space)
2. Anal triangle
Divisions
Divided by: interischial line
Structures between triangles: perineal body and perineal raphe

PERINEUM
Key points about the urogenital triangle
Superiorly: pelvic diaphragm (levator ani and coccygeus muscles)
Inferiorly: fascia and skin

Boundaries Anteriorly: pubic symphysis
Posteriorly: interischial line
Laterally: ischiopubic rami and ischial tuberosities
Divisions Deep perineal space and superficial perineal space
From deep to superficial:
1. Inferior fascia of pelvic diaphragm
2. Deep perineal space: deep transverse perineal muscle, compressor urethrae

muscle, sphincter urethrovaginalis muscle, external urethral sphincter, parts of
Layers and urethra and vagina and anterior recess of the ischioanal fossa
contents
3. Perineal membrane
4. Superficial perineal space: crus of clitoris, ischiocavernosus muscle, bulb of

vestibule, bulbospongiosus muscle
5. Fascia: perineal fascia and subcutaneous tissue of perineum
Mons pubis, labium majus of vulva, anterior labial commissure, posterior labial
Surface
commissure, cleft of vulva, labium minus of vulva, glans of clitoris, vestibule of
anatomy
vagina (external urethral orifice, opening of paraurethral glands and vaginal orifice)
Key points about the anal triangle
Superiorly: pelvic diaphragm (levator ani and coccygeus muscles)
Inferiorly: fascia and skin
Boundaries Anteriorly: interischial line

Posteriorly: coccyx and sacrum
Laterally: sacrotuberous ligament and ischial tuberosities
External anal sphincter, internal anal sphincter, anal canal, anal aperture,
Contents
anococcygeal ligament and ischioanal fossa
External female Female reproductive

genitalia organs
P E L V IS A N D

PERINEUM
NEUROVASCULATURE OF THE FEMALE PERINEUM
The main neurovascular structures of the female perineum emerge from the
pudendal canal and include the internal pudendal artery and vein, and the
pudendal nerve.
Deep artery of clitoris
Artery of bulb of
vestibule
Perineal artery
Inferior anorectal artery
FIGURE 7.26. Arteries of the female perineum (inferior view). The internal pudendal artery is the main
artery supplying the structures of the female perineum. It gives off four branches: The inferior [ano]rectal
and perineal artery, the artery of vestibular bulb and the deep artery of clitoris.
Key points about the arteries of the female perineum

P E L V IS AND
Main artery Internal pudendal artery
Inferior [ano]rectal artery, perineal artery, artery of vestibular bulb,

Branches
deep artery of clitoris
Inferior [ano]rectal artery: anal canal, internal and external anal sphincter, perianal
skin
Perineal artery: transverse perineal muscles, perineal body and posterior part of
Supply area the labia
Artery of vestibular bulb: vestibular bulb, erectile tissue of the vagina
Deep artery of clitoris: corpus cavernosum of the clitoris

PERINEUM
Vein of bulb of vestibule
— Deep veins of clitoris
Perineal veins
Inferior anorectal veins
FIGURE 7.27. Veins of the female perineum (inferior view). The internal pudendal vein is the main vein
draining the venous blood from the female perineum. The venous return is similar to the arterial homolog,
as the internal pudendal vein receives the blood of all four sets of veins of the female perineum: The deep
veins of clitoris, veins of vestibular bulb, perineal veins and the inferior [ano]rectal veins.
Key points about the veins of the female perineum
Main vein Internal pudendal vein
Deep veins of clitoris, veins of vestibular bulb, perineal veins, inferior [ano]rectal
Branches
veins
Deep veins of clitoris: corpora cavernosa of the clitoris

Veins of vestibular bulb: vestibular bulb, erectile tissue of vagina
Drainage area
P E LV IS AND
Perineal veins: transverse perineal muscles, perineal body, posterior part of the
labia
Inferior [ano]rectal veins: inferior part of the rectum

PERINEUM
Dorsal nerve of clitoris
Posterior labial nerves
Perineal nerve
Inferior anal nerve
Pudendal nerve
Anococcygeal nerve
FIGURE 7.28. Nerves of the female perineum (inferior view). The pudendal nerve is the main nerve of the
female perineum, providing sensory as well as motor innervation. It gives off the inferior anal nerve, dorsal
nerve of clitoris and the perineal nerve.
Key points about the nerves of the female perineum
Main nerve Pudendal nerve
Inferior anal nerve, dorsal nerve of clitoris, perineal nerve (giving off posterior labial
Branches
nerves)
Inferior anal nerve: motor innervation to the external anal sphincter, sensory
innervation to the skin of the anal canal inferior to the pectinate line
Dorsal nerve of clitoris: sensory innervation to the corpus cavernosum of clitoris
Supply area
Perineal nerve: motor innervation to the superficial and deep perineal muscles
P E LV IS AND
(muscular branches), sensory innervation to the skin of the labia majora (posterior
labial nerves)
Perineal region Pelvis and perineum

NERVES, VESSELS AND LYMPHATICS OF THE PELVIS
SACRAL PLEXUS
The sacral plexus is a nerve network composed of the anterior rami of the spinal
nerves L4-L5 (lumbosacral trunk) and spinal nerves S1-S4 which exit the verte
bral column either through the lowest two intervertebral foramina or anterior
sacral foramina. The plexus is located posterior to the internal iliac artery and
vein and anterior to the piriformis muscle.
The numerous branches of the plexus can be divided into posterior branches,
arising from the posterior divisions of the anterior rami, anterior branches,
from the anterior division, and one terminal branch. The main function of the
plexus is to innervate the majority of muscles of the hip and gluteal region,
lower limbs, pelvis and perineum. Additionally, the sacral plexus provides sen
sory innervation to the lower limb except for the anterior, medial and lateral
parts of the thigh. Due to its connection via the lumbosacral trunk, the sacral
plexus is often described together with the lumbar plexus under a combined
name lumbosacral plexus.
Lumbosacral trunk
Perineal branch of
spinal nerve S4
L4
Nerve to quadratus
femoris muscle
Nerve to obturator
internus muscle S1
S2
Nerve to levator ani muscle
Nerve to piriformis muscle S3
Posterior femoral
S4
cutaneous nerve
P E LV IS AND
Common fibular division S5

of sciatic nerve
Co
Tibial division of sciatic nerve
Perforating cutaneous nerve
Sciatic nerve
Pudendal nerve
FIGURE 7.29. Sacral plexus. The spinal nerves L4—S5 are shown on the right hand side, each giving an
anterior and a posterior ramus. The plexus is formed by the anterior rami of the L4—S4 spinal nerves, while
the S5 root joins the coccygeal (Co) root to form the coccygeal plexus.
The anterior rami of spinal nerves further split into anterior and posterior divisions and numerous
branches arise from each division. They then join together to form the nerves of the sacral plexus, which
can be divided into anterior and posterior branches. The anterior branches are the nerve to quadratus
femoris, nerve to obturator internus, pudendal nerve, nerves to levator ani and coccygeus. The posterior

branches are the nerve to piriformis, superior gluteal nerve, inferior gluteal nerve, posterior femoral cuta
neous nerve, perforating cutaneous nerve and pelvic splanchnic nerves. Continuations of spinal nerves
L4—S3 converge together to form a single terminal branch, known as the sciatic nerve. It splits into the
tibial and common fibular nerves to supply structures of the thigh, leg and foot.
Key points about the sacral plexus
Origin L4, L5, S1, S2, S3, S4
Anterior branches: nerve to quadratus femoris, nerve to obturator internus,

pudendal nerve, nerves to levator ani and coccygeus
Posterior branches: nerve to piriformis, superior gluteal nerve, inferior gluteal

Branches
nerve, posterior femoral cutaneous nerve, perforating cutaneous nerve, pelvic
splanchnic nerves
Terminal branch: sciatic nerve (divides into tibial and common fibular nerves)
Motor and sensory innervation to the posterior thigh, leg, foot and part of the
Function
pelvis
Mnemonic for Superior gluteal nerve, inferior gluteal nerve, posterior cutaneous nerve of thigh,
main branches pudendal nerve, sciatic nerve (SIPPS)
Sacral plexus The sciatic nerve
P E LV IS AND

NERVES OF THE MALE PELVIS
The nervous supply to the male pelvis includes both somatic innervation (motor
and sensory) of the skin and skeletal muscles, and autonomic (visceral) innerva
tion of the pelvic organs and glands.
Somatic innervation to the male pelvis stems from the lumbar, sacral and
coccygeal plexuses. The nerves that arise from these plexuses, including the
pudendal nerve, scrotal nerves, and dorsal penis nerve, provide innervation to
the muscles of the pelvis and skin of the penis and scrotum.
Autonomic innervation is provided by both sympathetic and parasympathetic

fibers. Sympathetic innervation stems from the lumbar and sacral splanchnic
nerves, while the parasympathetic supply comes from the pelvic splanchnic
nerves. These nerves and their branches form the superior and inferior hypo
gastric plexuses, which then divide into several smaller plexuses. Fibers from
these plexuses innervate the blood vessels, glands and organs of the male pel
vis including the rectum, urinary bladder, urethra, testis, epididymis, prostate,
seminal and bulbourethral glands.
Lumbar ganglion Lumbar splanchnic nerve

of sympathetic trunk
Gray ramus Superior hypogastric

communicans plexus
of spinal nerve
Lumbosacral trunk Left hypogastric

nerve
Right hypogastric Iliac plexus

nerve
Obturator
Pelvic splanchnic nerve
nerves
Deferential
Pudendal nerve plexus
P E LV IS AND
Middle anorectal Vesical plexus

plexus
Cavernous
Inferior anorectal nerves of
plexus penis
Inferior anal nerve Prostatic plexus
Posterior scrotal nerves Dorsal nerve

of penis
FIGURE 7.30. Nerves of the male pelvis (sagittal view). The lumbar, sacral and coccygeal plexuses give off
several pelvic branches such as the obturator nerve, pudendal nerve, rectal nerves, scrotal nerves, and
dorsal penis nerve. These nerves provide motor and sensory innervation to the muscles and skin of the
pelvis.

Lumbar and sacral splanchnic nerves provide the pelvis with autonomic innervation via the superior
hypogastric plexus. This plexus gives off the left and right hypogastric nerves that merge with the pelvic
splanchnic nerves to form the inferior hypogastric plexus. The superior and inferior hypogastric plexus
further divide into smaller plexuses, forming the[ano]rectal plexuses, vesical plexus, deferential plexus,
and prostate plexus. These subplexuses provide autonomic innervation to the male pelvic viscera and
glands including the rectum, urinary bladder, testis, epididymis, prostate and seminal glands.
Key points about innervation of the male pelvis
Plexus: lumbar plexus, sacral plexus, coccygeal plexus.

Nerves: obturator nerve, pudendal nerve, rectal nerves, scrotal nerves, dorsal nerve
Somatic
of penis.
innervation
Function: sensory innervation of penis, scrotum, perineum; motoric innervation of
muscles of the pelvis.
Plexus: superior hypogastric plexus, inferior hypogastric plexus, rectal plexus,

vesical plexus, deferential plexus, prostate plexus.
Nerves: lumbar splanchnic nerves, sacral splanchnic nerves, hypogastric nerves,

Autonomic
pelvic splanchnic nerves
innervation
Function: sympathetic and parasympathetic innervation of rectum, urinary
bladder, urethra, testis, epididymis, deferent duct, prostate, seminal and
bulbourethral glands, corpora cavernosa of penis
Neurovascular supply Male reproductive

of the pelvis organs
NERVES OF THE FEMALE PELVIS
The nervous supply to the female pelvis involves both somatic innervation
(motor and sensory) of the skin and skeletal muscle, and autonomic (visceral)
innervation of the pelvic organs and glands.
Somatic innervation to the female pelvis stems from the lumbar, sacral and
P E LV IS AND
coccygeal plexus. The nerves arising from them provide sensory as well as
motor innervation to the skin and muscles of the pelvis.
Autonomic innervation is provided by both sympathetic and parasympathetic

nervous systems. Sympathetic innervation is carried by the lumbar and sacral
splanchnic nerves, which go on to form the superior hypogastric plexus. Par
asympathetic innervation is carried by the pelvic splanchnic nerves, which
merge with a branch of the superior hypogastric plexus to form the inferior
hypogastric plexus. These in turn divide into several smaller plexuses that are
close to the target organs, collectively known as pelvic plexuses. Fibers from
these plexuses innervate the blood vessels, glands and organs of the female
pelvis.

Lumbar ganglion of Lumbar splanchnic

sympathetic trunk nerves
Gray ramus
Superior hypogastric
communicans
plexus
of spinal nerve
Anterior rami of Left hypogastric

lumbar nerves nerve
Right hypogastric
Obturator nerve
nerve
Left inferior
Sacral plexus
hypogastric plexus
Pelvic splanchnic Vesical plexus

nerves
Left middle anorectal Uterovaginal plexus

plexus
FIGURE 7.31. Nerves of the female pelvis (sagittal view). The lumbar, sacral and coccygeal plexus give
off several pelvic branches such as the obturator nerve, pudendal nerve and anococcygeal nerves. These
nerves provide motor and sensory innervation to the muscles of the pelvic floor and perineum.
Lumbar and sacral splanchnic nerves provide the pelvis with autonomic innervation via the superior
hypogastric plexus. This plexus gives off the left and right hypogastric nerves that merge with the pelvic
splanchnic nerves to form the inferior hypogastric plexus. The superior and inferior hypogastric plexus
further divide into smaller plexuses, forming the vesical plexus, uterovaginal plexus and [ano]rectal plex-
uses.These subplexuses provide autonomic innervation to the female pelvic viscera, glands and blood ves
sels, including the rectum, urinary bladder, urethra, uterus, ovaries and vagina.
Key points about innervation of the female pelvis
Plexus: lumbar plexus, sacral plexus, coccygeal plexus.

P E LV IS AND
Somatic Nerves: obturator nerve, pudendal nerve, anococcygeal nerves.

innervation
Function: sensory innervation of vulva and perineum, motoric innervation of
muscles of the pelvic floor.
Plexus: superior hypogastric plexus, inferior hypogastric plexus, vesical plexus,

uterovaginal plexus, rectal plexus.
Autonomic Nerves: lumbar splanchnic nerves, sacral splanchnic nerves, hypogastric nerves,
innervation pelvic splanchnic nerves.
Function: sympathetic and parasympathetic innervation of rectum, vesica urinaria,

urethra, uterus, ovaries, vagina.
Neurovascular supply Female reproductive

of the pelvis organs

BLOOD SUPPLY OF THE MALE PELVIS
The arterial blood supply of the male pelvis stems mainly from the internal and
external iliac arteries which originate from the abdominal aorta via the com
mon iliac artery.
The external iliac artery travels anteriorly, inferiorly and laterally in the pelvis
giving off two branches before continuing its course to the thigh as the femo
ral artery: The inferior epigastric and deep circumflex iliac arteries. The internal
iliac artery is the main artery of the pelvis and with its branches supplies the
walls and viscera of the pelvis, reproductive organs, buttocks and the thigh. A
notable exception are the testes (which are supplied by the testicular artery
that arises directly from the abdominal aorta), and the rectum which is largely
supplied by the superior [ano]rectal branch of the inferior mesenteric artery.
Venous drainage of the male pelvis generally follows a course similar to its
arterial counterparts.
Left iliolumbar artery Abdominal aorta
Inferior mesenteric
Left superior gluteal artery artery
Left lateral sacral vein Left umbilical artery
Left superior
Left internal iliac
gluteal vein
artery
Median sacral artery Left obturator vein
Left external iliac

Superior anorectal
vein
artery
Left external iliac
Left middle
artery
anorectal veins
Superior Left obturator
anorectal vein artery
Left middle Left inferior

anorectal artery vesical artery
Right middle Left inferior

anorectal artery vesical vein
P E LV IS AND
Right inferior Right superior

vesical artery vesical veins
Right middle Dorsal artery
anorectal veins of penis
Right inferior Deep dorsal vein
anorectal veins of penis
Right inferior Right superior

anorectal artery vesical artery
Internal pudendal Right inferior
artery vesical vein
Posterior scrotal vein Posterior scrotal

arteries
FIGURE 7.32 . Blood supply of the male pelvis (sagittal view). At the level of the sacroiliac joint, the bilateral
common iliac artery bifurcates into the external and internal iliac arteries. The external iliac artery courses
towards the thigh to continue as the femoral artery, whereas the internal iliac artery courses towards the
greater sciatic foramen and gives off multiple branches to supply the pelvic wall and organs. These can be
divided into an anterior and a posterior division.

Branches of the posterior division are the iliolumbar, superior gluteal and lateral sacral arteries. The ante
rior division gives off the obturator, umbilical, superior and inferior vesical, internal pudendal, middle
[ano]rectal and inferior gluteal arteries.
The veins of the male pelvis collect blood from the urogenital organs and the rectum and drain into the
internal iliac vein (or inferior mesenteric vein in the case of the superior [ano]rectal vein). From the internal
iliac vein, the blood is transported to the common iliac vein and from there into the inferior vena cava.
The right and left testicular veins drain directly to the inferior vena cava and left renal vein, respectively.
Key points about the arteries and veins of the male pelvis
Supply area: pelvic wall and organs, gluteal region and medial compartment of
thigh (except for superior part of rectum - supplied via superior [ano]rectal branch
of inferior mesenteric artery)
Internal iliac
artery Branches:
• Posterior division: iliolumbar, superior gluteal, lateral sacral arteries
• Anterior division: obturator, umbilical, superior and inferior vesical, internal

pudendal, middle [ano]rectal and inferior gluteal arteries
External iliac Supply area: lower limb, muscles and skin of the lower abdominal wall
artery Branches: inferior epigastric, deep circumflex iliac arteries
Superior [ano]rectal artery (from inferior mesenteric artery);

Other arteries
Testicular artery (from abdominal aorta)
Most veins drain to internal iliac vein ^ inferior vena cava

Exceptions:
Veins
• Superior [ano]rectal vein ^ inferior mesenteric vein
• Right/left testicular veins ^ inferior vena cava/left renal vein
Male reproductive
|||||| Pelvis and perineum
organs
P E L V IS A N D

BLOOD SUPPLY OF THE FEMALE PELVIS
The female pelvis receives the majority of its arterial supply from the external
and internal iliac arteries, both of which originate from the common iliac artery.
A notable exception are the ovaries (as well as parts of the uterine tube/uterus)
which are supplied by the ovarian artery that arises directly from the abdom
inal aorta and the rectum which is largely supplied by the superior [ano]rectal
branch of the inferior mesenteric artery.
For the most part, venous drainage of the female pelvis follows a course similar
to that of its arterial counterparts.
Left common iliac vein Left common iliac artery
Left iliolumbar artery Left external iliac artery
Median sacral artery Left umbilical artery
Left internal iliac vein Left obturator vein

Left internal iliac
artery Left uterine vein
Superior anorectal Left obturator artery

vein
Left external iliac
Left vaginal artery vein
Superior anorectal Left superior vesical

artery artery
Left middle Left uterine artery

anorectal veins
Left inferior vesical
Left middle artery
anorectal artery
Left inferior vesical
Right uterine artery vein
Right uterine vein Uterine venous

plexus
Right middle
anorectal artery Right superior vesical
artery
Right middle
anorectal veins Right vesical veins
Right inferior Right inferior vesical

P E LV IS AND
anorectal veins artery

Right inferior Right internal pudendal
anorectal artery vein
Vaginal venous plexus Internal pudendal artery
FIGURE 7.33 . Blood supply of the female pelvis (sagittal view). At the level of the sacroiliac joint, the
bilateral common iliac artery bifurcates into the external and internal iliac arteries. The external iliac
artery courses towards the thigh to continue as the femoral artery, whereas the internal iliac artery gives
off multiple branches to supply the pelvic wall and viscera. It can be divided into anterior and posterior
divisions.
The branches of the posterior division are the iliolumbar, superior gluteal and lateral sacral arteries. The
anterior division gives off the uterine, obturator, umbilical, vaginal, superior vesical, internal pudendal,
middle [ano]rectal and inferior gluteal arteries.
The veins of the female pelvis collect blood from the urogenital organs and the rectum and drain into the
internal iliac vein (or inferior mesenteric vein in the case of the superior [ano]rectal vein. From the internal
iliac vein, the blood is transported to the common iliac vein and from there to the inferior vena cava. The
right and left ovarian veins directly drain directly to the inferior vena cava and left renal vein, respectively.

Key points about the arteries and veins of the male pelvis
Supply area: pelvic wall and organs, gluteal region and medial compartment of
thigh (except for superior part of rectum - supplied via superior [ano]rectal branch
of inferior mesenteric artery
Internal iliac Branches:
artery
• Posterior division: iliolumbar, superior gluteal, lateral sacral arteries
• Anterior division: uterine, obturator, umbilical, vaginal, superior vesical, internal
pudendal, middle [ano]rectal and inferior gluteal arteries
External iliac Supply area: lower limb, muscles and skin of the lower abdominal wall
artery Branches: inferior epigastric, deep circumflex iliac arteries
Superior [ano]rectal artery (from inferior mesenteric artery);

Other arteries
Ovarian artery (from abdominal aorta)
Most veins drain to internal iliac vein ^ inferior vena cava
Exceptions:
Veins
• Superior [ano]rectal vein ^ inferior mesenteric vein
• Right/left ovarian veins ^ inferior vena cava/left renal vein
Arterial supply of the

Iliac artery
pelvis
LYMPHATICS OF THE URINARY ORGANS
Lymphatic drainage of the urinary system, as occurs with many other systems,
is carried out to regional lymph nodes found around its organs, which then
drain into larger lymphatic vessels and more central lymph node groups.
The main lymphatic drainage routes of the urinary system are centered around
the common, internal and external iliac lymph nodes, as well as the lumbar (aor
P E L V IS A N D
tic and caval) lymph nodes. These in turn drain into the left and right lumbar
lymph trunks, which join together to form the cisterna chyli, which continues
as the thoracic duct. In the case of the urinary bladder, lymph collected from
this organ is drained to paravesical lymph nodes which feed into the larger
groups mentioned above.

Inferior diaphragmatic
lymph nodes
Lateral caval lymph nodes
Retrocaval lymph nodes
Right lumbar lymphatic

trunk
Lateral aortic lymph nodes
Precaval lymph nodes
Common iliac lymph nodes
Promontorial lymph nodes
Internal iliac lymph nodes
External iliac lymph nodes
Lateral vesical lymph nodes
Prevesical lymph nodes
FIGURE 7.34 . Lymph nodes of the urinary organs. Retroperitoneal compartment exposed, showing the
urinary system (kidneys, ureters and urinary bladder), and the major abdominal and pelvic vessels. The main
groups of pelvic lymph nodes of the pelvis and posterior abdominal wall can be seen. Lymph from the
paravesical, common, internal and external lymph nodes ultimately converge to the lumbar lymph nodes.
Those in turn drain to the left and right lumbar lymph trunks, which along with the intestinal lymph trunk
converge to form the cisterna chyli.
P E LV IS AND
Key points about the lymphatics of the urinary organs
Three plexuses of lymphatic vessels: parenchymal, subcapsular, perirenal fat;

Kidney
All three drain to lumbar (caval and aortic) lymph nodes.
Superior abdominal part: lumbar lymph nodes

Ureters Inferior abdominal part: common iliac lymph nodes
Pelvic part: external iliac lymph nodes
Lymph drains into paravesical (prevesical, lateral vesical and retrovesical) lymph
nodes
Bladder
Superolateral part: common iliac lymph nodes
Fundus: external and internal iliac lymph nodes
Lymph drains to common, internal and external lymph nodes

Urethra Males: the spongy part of urethra drains to prepubic lymph node and superomedial
superficial inguinal lymph nodes before draining to external iliac lymph nodes

Lymphatic vessels
Lymphatics of
and nodes of the
abdomen and pelvis
pelvis
LYMPHATICS OF THE MALE GENITALIA
There are five main groups of lymph nodes that lymph from the external and
internal male genitalia drain to:
• The skin of the scrotal sac, perineum, skin of the penis, cavernous bodies of
the penis, glans penis, and distal spongy urethra drain into the superficial and
deep inguinal lymph nodes.
• The ductus deferens, ejaculatory ducts, bulbourethral glands, seminal glands,
membranous and proximal spongy urethra, as well as the prostate drain into
the external iliac and internal iliac lymph nodes. The external iliac lymph
nodes also receive lymph drained via the inguinal nodes. Lymph then travels
to the common iliac lymph nodes.
• Finally, the last major group draining the male genitalia of lymph are the lum
bar lymph nodes (a.k.a. aorticocaval nodes). They drain lymph directly from
the testes, epididymis, and proximal portion of the ductus deferentes while
also receiving afferent vessels from the common iliac lymph nodes. Lymph
then travels to the cisterna chyli.
P E L V IS A N D

Lateral caval Lateral aortic

3
Precaval lymph Preaortic
nodes lymph nodes
Intermediate lumbar
lymph nodes Common iliac
lymph nodes
Medial lacunar
lymph node
Lateral sacral
lymph nodes
Superolateral
superficial inguinal
lymph nodes
External iliac
lymph nodes
Deep inguinal
lymph nodes
Promontorial
Superomedial
lymph nodes
superficial
inguinal lymph
nodes
Internal iliac
Prepubic lymph nodes
lymph node
Inferior superficial inguinal Median sacral

FIGURE 7.35. Lymph nodes of the male genitalia. The external male genitalia (skin of scrotum, penis) are
primarily drained by the superficial and deep inguinal lymph nodes. Lymph from the inguinal nodes is then
drained to the external iliac nodes, which in addition to the internal iliac nodes, also drain the internal male
genitalia (prostate, seminal glands etc...)
The exceptions of this are the testes, epididymides and proximal ductus deferens which drain directly to
the lumbar lymph nodes, via vessels along the testicular arteries.
Key points about the lymphatics of the male genitalia
Superficial and Receive from: skin of scrotal sac, perineum, skin of penis, cavernous bodies of penis,
glans penis, distal spongy urethra.
P E LV IS AND
deep inguinal
lymph nodes Drain to: external iliac lymph nodes
External and Receive from: ductus deferens, ejaculatory ducts, bulbourethral glands, seminal
internal iliac glands, membranous urethra, proximal spongy urethra, prostate.
lymph nodes Drain to: common iliac lymph nodes
Lumbar lymph Receive from: testes, epididymis, ductus deferens, common iliac lymph nodes.
nodes Drain to: cisterna chyli
Lymphatics of
Lymphatic system
abdomen and pelvis

LYMPHATICS OF THE FEMALE GENITALIA
The lymphatic drainage of the female reproductive organs is carried by the

three major groups of lymph nodes:
• Superficial and deep inguinal lymph nodes drain the clitoris, skin of the vulva
and vestibule of the vagina.
• Internal and external iliac nodes drain the remainder of vagina and part of the
uterus. The external iliac nodes also receive lymph from the inguinal nodes.
The common iliac lymph nodes, in turn, receive lymph from the internal and
external iliac nodes.
• Lumbar (aorticocaval) lymph nodes directly receive lymph drained from much
of the uterus and uterine tubes as well as the ovaries. They also drain lymph
from the common iliac lymph nodes. Finally, lymph drained by the lumbar
nodes is then carried to the cisterna chyli via the left and right lumbar lym
phatic trunks.
Cisterna chyli Left lumbar

lymphatic trunk
Right lumbar
lymphatic trunk
Lateral aortic
Retroaortic
lymph nodes
lymph nodes
Retrocaval
lymph nodes
Common iliac
Intermediate lymph nodes
lumbar
lymph nodes
Lateral caval
lymph nodes
Internal iliac
lymph nodes
Promontorial
P E LV IS AND
lymph nodes
Sacral lymph
nodes External iliac
lymph nodes
Intermediate
lacunar
lymph node
Superficial
Deep inguinal
inguinal
lymph nodes
lymph nodes
FIGURE 7.36. Lymph nodes of the female genitalia. Lymph drained from the ovaries, as well as much of
the uterine tube and body of the uterus is drained by a number of collecting vessels which bypass the
pelvic lymph nodes to empty directly into the ipsilateral lumbar lymph nodes (via a collateral pathway of
the ovarian arteries).

Lymph from the cervix is largely drained to the external iliac lymph nodes, however collecting vessels
from the lateral and posterior aspects of the cervix may drain to the internal iliac and/or sacral lymph
nodes.
The upper half of the vagina is largely drained by the external iliac lymph nodes, while lymph drained from
the lower half of the vagina (except the vestibule) is received by the internal iliac nodes. The vestibule
of the vagina, as well as skin of the vulva is drained by collecting vessels which terminate in the superficial
inguinal lymph nodes, while those of the clitoris are largely received by the deep inguinal lymph nodes.
From here the general pathway is as follows: Inguinal lymph nodes ^ iliac lymph nodes ^ lumbar lymph
nodes ^ cisterna chyli.
Key points about the lymphatics of the female genitalia
Superficial and Receive from: clitoris, skin of the vulva and vestibule of vagina
deep inguinal
lymph nodes Drain to: external iliac lymph nodes
External and Receive from: vagina, uterus (partly), external iliac lymph nodes
internal iliac
lymph nodes Drain to: common iliac lymph nodes
Lumbar lymph Receive from: ovaries, uterine tubes, uterus common iliac lymph nodes
nodes Drain to: cisterna chyli
Lymphatics of
abdomen and pelvis
P E LV IS AND

HEAD AND
NECK
8
Overview................................................................................. 359
Regions of the head and face....................................................... 359
Skull......................................................................................... 360
Anterior view of the skull.............................................................360
Lateral and posterior views of the skull......................................... 361
Calvaria....................................................................................... 363
Inferior view of the cranium......................................................... 364
Cranial fossae...............................................................................367
Midsagittal skull............................................................................370
Ethmoid bone.............................................................................. 372
Sphenoid bone............................................................................. 374
Temporal bone..............................................................................377
Mandible..................................................................................... 380
Face and scalp......................................................................... 383

Muscles of facial expression......................................................... 383
Blood vessels of the face and scalp...............................................386
Nerves of the face and scalp......................................................... 393
Arteries of the head: Lateral view................................................. 396
Infratemporal region and pterygopalatine fossa ...................399

Muscles of mastication........................................... .................... 399
Temporomandibular joint........................................ .................... 401
Pterygopalatine fossa............................................ .................... 403
Orbit and contents................................................................. 408

Bones of the orbit........................................................................408
Muscles of the orbit..................................................................... 410
Neurovasculature of the orbit...................................................... 412
Superior and inferior orbital fissures............................................. 417
Anatomy of the eyeball................................................................ 419
Blood vessels of the eyeball..........................................................422
Eyelids and lacrimal apparatus......................................................423
Nasal region............................................................................ 425
Nasal cavity..................................................................................425
Neurovasculature of the nasal cavity............................................427
Ear........................................................................................... 430
External ear.................................................................................430
Middle ear.................................................................................... 432
Internal ear.................................................................................. 435
Oral cavity............................................................................... 439

Overview of the oral cavity.......................................................... 439
Surface of the tongue................................................................. 440
Muscles of the tongue..................................................................442
Neurovasculature of the tongue.................................................. 445
Salivary glands............................................................................ 446
Teeth....................................................................................... 448
Types of teeth............................................................................. 448
Anatomy of the tooth.................................................................. 450
Pharynx................................................................................... 453
Pharyngeal mucosa......................................................................453
Muscles of the pharynx................................................................ 454
Blood vessels of the pharynx........................................................ 456
Nerves of the pharynx.................................................................. 457
Neck........................................................................................ 459
Hyoid bone.................................................................................. 459
Muscles of the anterior neck........................................................460
Larynx......................................................................................... 464
Thyroid and parathyroid glands..................................................... 471
Neurovasculature of the neck....................................................... 474
Cervical plexus............................................................................. 479
Lymphatics of the head and neck................................................. 480
Triangles of the neck.................................................................... 483
Compartments of the neck......................................................... 486
OVERVIEW
REGIONS OF THE HEAD AND FACE
Temporal region Frontal region
Parietal region Orbital region
Zygomatic Infraorbital region

region
Occipital region Nasal region
Auricular region Oral region
Mastoid region Mental region
Parotideomasseteric region Buccal region
FIGURE 8.1 . Regions of the head and face. Most of the regions in the neurocranial portion correspond to
underlying bones/landmarks of the same name. The exception to this is the auricular region, that contains
the external ear/auricle. The regions of the viscerocranium are named according to bony or soft tissue
structures of the face. The orbital region contains the organs, bones and soft tissue of the orbit. Inferior to
this is the infraorbital region, overlying the maxilla, and the zygomatic region, named after the zygomatic
bone (commonly referred to as the cheek bone). The nasal region contains the bone, cartilage and other
tissues of the nose, while the oral region below contains the structures of the oral cavity. The buccal
region is named after the latin term ‘bucca’, which refers to the cheek (largely comprised by the buccinator
muscle), while parotidomasseteric region is named after the underlying parotid gland and masseter
muscle. The inferior-most region of the face is the mental region, demarcating the chin (Latin = mentus).
Human anatomy Regions of the head

terminology and neck
Head and neck 359

SKULL
The human skull consists of 22 bones which are mostly connected together
by ossified joints, called sutures. The skull is divided into the braincase (neuro
cranium) and the facial skeleton (viscerocranium). Neurocranium provides the
protection of the most important organ in the human body: The brain, while
viscerocranium supports all of the facial structures.
ANTERIOR VIEW OF THE SKULL
Glabella of frontal bone Frontal bone
Supraorbital foramen Nasal bone

of frontal bone
Orbital plate of
Orbital surface ethmoid bone
of frontal bone
Coronal suture
Lesser wing of
sphenoid bone Parietal bone
Temporal bone
Frontal process of
zygomatic bone
Frontal process
of maxilla Greater wing of
sphenoid bone
Sphenoid bone
Orbital surface of
Temporal process zygomatic bone
of zygomatic bone
Orbital surface
Zygomatic bone of maxilla
Zygomatic process
Ethmoid bone of maxilla
Ramus of mandible Infraorbital foramen

of maxilla
Anterior nasal
Mental foramen
spine of maxilla
of mandible
Alveolar process of maxilla Body of mandible
FIGURE 8.2 . Anterior view of the skull. Two temporal bones, two parietal bones, the sphenoid, ethmoid
and the frontal bone can be observed from this perspective. These are all bones of the neurocranium.
Most bones of the viscerocranium are visible: The vomer, two inferior nasal conchae, two nasal bones, two
maxillae, mandible, two zygomatic bones, and two lacrimal bones. The skull bones form two anatomical
spaces, the bony orbit which houses the eyeballs and the nasal cavity.
Key points about the anterior view of the skull
Frontal bone, nasal bones (2), maxillae (2), lacrimal bones (2), ethmoid bone,
Bones zygomatic bones (2), sphenoid bone, parietal bones (2), temporal bones (2),
mandible
Frontonasal suture: joins frontal and nasal bones

Frontozygomatic suture: joins frontal and zygomatic bone
Sutures
Zygomaticomaxillary suture: joins zygoma and maxilla
Intermaxillary suture: joins the two maxillae

SKULL
Anterior and lateral

Viscerocranium
views of the skull
LATERAL AND POSTERIOR VIEWS OF THE SKULL
Inferior temporal line Superior temporal line
Sphenoparietal
suture Squamous suture
Temporal fossa
External
acoustic
meatus
Squamous part
of temporal
bone
Petrous part of
temporal bone
Zygomatic
process of
temporal bone
Occipital bone
Zygomatic arch
Styloid process of Mastoid process of

temporal bone temporal bone
FIGURE 8.3 . Skull (lateral view). The frontal bone articulates with the zygomatic bone (frontozygomatic
suture), the greater wing of the sphenoid bone (sphenofrontal suture) and the parietal bones (coronal
suture).
i
From this lateral perspective, the squamous and petrous part of the temporal bone are visible and are m
separated from each other by the zygomatic process. This zygomatic process unites with the temporal
>
□
process of the zygomatic bone to form the zygomatic arch. The squamous part of the temporal bone >
z
articulates with the parietal bone superiorly (squamous suture) and with the greater wing of the sphenoid □
bone anteriorly (sphenosquamosal suture). The squamous part of the temporal bone and the greater wing z
m
of the sphenoid bone together form the majority of the temporal fossa. The external acoustic meatus n
is part of the tympanic portion of the temporal bone with the styloid process situated inferior, and the
7s
mastoid process posterior to it. The pterion is a point of intersection of frontal, sphenoid, parietal, and
temporal bones.
On this view, the occipital bone is seen articulating with the parietal bone superiorly and the petrous part
of the temporal bone inferiorly.
Head and neck 361

SKULL
Lambdoid suture Sagittal suture
External Supreme nuchal

occipital Line of occipital
protuberance bone
Superior nuchal
Line of occipital
Occipital bone
condyle
Inferior nuchal
Line of occipital
bone
Mastoid
foramen Pterygoid process
of sphenoid bone
Mandibular-
foramen Palatine bone
Incisive foramen Palatine process

of maxilla
FIGURE 8.4. Skull (posterior view). The posterior view is mostly occupied by the squamous part of the
occipital bone and the posterior aspect of the parietal bones. The two parietal bones meet in the midline
and form the sagittal suture. Each parietal bone also articulates with the occipital bone to form the
lambdoid suture. The main features of the occipital bone are visible on this view, primarily the supreme,
superior and inferior nuchal lines, the external occipital protuberance and the occipital condyles. The rest
of the posterior skull is occupied by the posterior aspects of the maxillae and mandible, and parts of the
palatine and sphenoid bones.
Key points Lateral view Posterior view
Nasal bone, lacrimal bone, frontal bone, Occipital bone, parietal bones, palatine
Bones maxilla, mandible, zygomatic, sphenoid, bone, sphenoid bone, temporal bone,
temporal, parietal and occipital bone maxilla, mandible
Squamous suture: joins the parietal and

the temporal bones
Sphenofrontal suture: joints frontal and

the sphenoid bones Sagittal suture: joins the two parietal bones
Sphenoparietal suture: joins sphenoid and Lambdoid suture: joins parietal and occipital
Sutures the parietal bones bones
Occipitomastoid suture: joins occipital The sagittal and lambdoid sutures converge
bone and the mastoid process of the into a lambda
temporal bone
Temporozygomatic suture: joins temporal

and the zygomatic bones

SKULL
CALVARIA
Coronal suture
Sagittal suture
Occipital bone Lambdoid suture
Frontal crest
Groove for superior

sagittal sinus
Granular foveolae
Arterial grooves
Diploe
FIGURE 8.5. Superior and inferior views of the calvaria. The superior surface features the sutures that
connect the bones of the calvaria: The sagittal, coronal and lambdoid sutures. Each parietal bone contains
a parietal foramen that forms a channel for the emissary vein. The most prominent feature on the inferior
view of the calvaria called the groove for superior sagittal sinus can be seen right in the middle. Anteriorly,
the edges of this groove unite to form a bony ridge called the frontal crest. On either side of the groove for
superior sagittal sinus there are several round pits called the granular foveolae, which house the arachnoid
granulations. Moving further laterally, there are many branching grooves, called arterial grooves, in which
the meningeal arteries course.
Key points about the calvaria
Bones Frontal bone, parietal bone (2), occipital bone
Sagittal suture: parietal bones Coronal suture: frontal bone and parietal bones
Sutures
Lambdoid suture: parietal bones and occipital bone
Superior view: cranial sutures, parietal foramina

Bony features Inferior view: frontal crest, groove for superior sagittal sinus, granular foveolae,
arterial grooves, diploe
Calvaria Cranial sutures
Head and neck 363

SKULL
INFERIOR VIEW OF THE CRANIUM
| [Maxilla
Zygomatic bone
Palatine bone
Sphenoid bone
Temporal bone
Occipital bone
Vomer
Frontal bone
Parietal bone
FIGURE 8.6 . Base of the cranium (inferior view). The temporal bones articulate with the zygomatic bones
anteriorly, forming the zygomatic arches. Posterior to them is the occipital bone which occupies most
of the posterior aspect on the inferior side of the cranium. The sphenoid bone can be identified centrally
articulating with the maxillae and palatine bones anterior to it; these form the hard palate while the
former also houses the maxillary/upper dentition.

SKULL
Palatine process Median palatine suture

of maxilla
Alveolar process
Transverse palatine
of maxilla
suture
Posterior nasal spine Horizontal plate

of palatine bone of palatine bone
Pterygoid hamulus Pyramidal process

of sphenoid bone of palatine bone
Temporal surface
Temporal process
of greater wing
of zygomatic bone
of sphenoid
Infratemporal crest Zygomatic process

of sphenoid bone of temporal bone
Infratemporal surface
Articular tubercle
of greater wing
of temporal bone
of sphenoid bone
Mastoid process Vaginal process

of temporal bone of sphenoid bone
Styloid process Occipitomastoid

of temporal bone suture
Pharyngeal tubercle
Occipital condyle
of occipital bone
Superior nuchal line Inferior nuchal line

of occipital bone of occipital bone
External occipital crest External occipital

protuberance
FIGURE 8.7 . Prominent landmarks. The external surface of the occipital bone is defined by several well
defined ridges and crests, namely the external occipital crest as well as the superior and inferior occipital
lines. Also visible are the occipital condyles, which articulate with the atlas (vertebra C1). The temporal
bone presents more prominent landmarks compared to its posterior neighbor, the largest of which being
the mastoid, styloid and zygomatic processes. Important landmarks of the sphenoid bone from this
perspective include pterygoid process (located centrally); this is formed of medial and lateral plates, the
former of which bears a hooked shaped extremity known as the pterygoid hamulus. The horizontal plates
of the palatine bones along with the palatine processes of the maxillae form the hard palate.
Head and neck 365

SKULL
Palatovaginal canal Incisive foramen
Lesser palatine
Choana
foramen
Greater palatine
Inferior orbital foramen
fissure
Vomerovaginal
Scaphoid fossa canal
of sphenoid bone
Pterygoid fossa
of sphenoid bone
Pterygoid canal
Foramen ovale
Foramen
spinosum
Foramen lacerum
Petrotympanic
fissure Mandibular fossa
of temporal bone
Stylomastoid
foramen Carotid canal
Mastoid foramen Mastoid notch

of temporal bone
Hypoglossal canal Jugular foramen
Foramen magnum Condylar fossa

of occipital bone
FIGURE 8.8 . Foramina and fissures. The most prominent feature from this perspective is foramen
magnum of the occipital bone, which gives passage to the spinal cord from the brainstem. Notable
foramina which give passage to cranial nerves include the foramen rotundum (maxillary nerve (CN V2)),
foramen ovale (mandibular nerve (CN V3), jugular foramen (glossopharyngeal, vagus and accessory nerves
(CN IX-XI), internal jugular vein) and the hypoglossal canal (hypoglossal nerve (CN XII).
Anterior to the jugular foramen, the carotid canal which gives passage to the internal carotid artery can
be seen. The foramen spinosum transmits the middle meningeal artery and vein, while the inferior orbital
fissure gives passage to several structures including the infraorbital nerve and artery, zygomatic nerve
and a branch of the inferior ophthalmic vein.
Foramina, fissures, canals and contents
Incisive foramen Nasopalatine nerve, sphenopalatine artery
Greater palatine foramen Greater palatine nerves, arteries and veins
Lesser palatine foramen Lesser palatine nerves, arteries and veins
Mandibular nerve (CN V3), accessory meningeal artery, lesser petrosal

Foramen ovale
nerve, emissary veins
Middle meningeal artery and vein, meningeal branch of mandibular nerve

Foramen spinosum
(CN V3)
Internal jugular vein, inferior petrosal sinus, posterior meningeal artery,
Jugular foramen
glossopharyngeal nerve, vagus nerve, accessory nerve (CN IX, X, XI)
Stylomastoid foramen Stylomastoid artery, facial nerve (CN VII)
Foramen magnum Medulla oblongata, vertebral arteries
Infraorbital nerve, zygomatic nerve, artery and vein, inferior branch of

Inferior orbital fissure
inferior ophthalmic vein
Petrotympanic fissure Chorda tympani, anterior tympanic artery
Carotid canal Internal carotid artery, internal carotid nerve plexus
Condylar canal Emissary veins, meningeal branch of occipital artery

SKULL
Inferior view of the

base of the skull
IB Skull
eL_ J-
CRANIAL FOSSAE
The base of the skull, or the cranial floor, is the inferior wall of the cranial cavity.
It comprises parts of the frontal, sphenoid, temporal, and occipital bones. These
bones form the three cranial fossae: Anterior, middle and posterior.
The base of the skull features many openings that are traversed by nerves,
arteries and veins traveling between the brain and the neck.
| Frontal bone
| Ethmoid bone
Sphenoid bone
Parietal bone
Temporal bone
Occipital bone
FIGURE 8.9. Superior view of the base of the skull. The bones that comprise the base of the skull are the
frontal, ethmoid, sphenoid, temporal and occipital bones. The frontal and sphenoid bone, as well as a small
part of ethmoid bone, join to form the anterior cranial fossa; the sphenoid and temporal bones together
form the middle cranial fossa, while the temporal and occipital bones form the posterior cranial fossa.
Head and neck 367

SKULL
| Anterior cranial fossa
| Middle cranial fossa
| Posterior cranial fossa
FIGURE 8.10. Cranial fossae. The anterior cranial fossa is the anteriormost area of the cranial floor,
formed by the orbital surface of the frontal bone, cribriform plate of the ethmoid bone, and part of the
lesser wing of the sphenoid bone. The middle cranial fossa is composed of the body and greater wings
of sphenoid bone, as well as the squama and anterior surface of the petrous part of temporal bone. The
posterior cranial fossa is formed by the posterior surface of the petrous part of temporal bone and the
occipital bone.
IK The skull Cranial fossae
L J
Learn skull anatomy

with skull bones
quizzes and diagrams

SKULL
Foramen cecum Frontal crest
Superior surface of orbital plate Crista galli of ethmoid bone
Body of sphenoid bone Cribriform plate of ethmoid bone
Chiasmatic sulcus
Optic canaL Lesser wing of sphenoid

bone
Greater wing of
Anterior clinoid process
sphenoid bone
Foramen rotundum Tuberculum sellae
Hypophyseal fossa Carotid sulcus
Foramen spinosum Foramen ovale
Trigeminal Posterior clinoid

impression process
Dorsum sellae Carotid canal
Arcuate eminence Foramen lacerum
Internal acoustic
Sella turcica
meatus
Clivus of occipital bone Groove for sigmoid sinus
Hypoglossal canaL 'Jugular foramen
Cerebellar fossa Foramen magnum
Internal occipital protuberance Internal occipital crest
FIGURE 8.11. Landmarks of the base of the skull (superior view). There are many foramina, canals, sulci
and other structures seen on the superior view of the base of the skull. The anterior cranial fossa features
several landmarks, such as the cribriform foramina, foramen cecum, sphenoidal yoke and frontal crest.
The middle cranial fossa contains a higher number of landmarks compared to the anterior cranial fossa
e.g. clinoid processes, sella turcica, carotid sulcus, foramen ovale and trigeminal impression. The posterior
cranial fossa features structures such as the clivus, foramen magnum, internal acoustic meatus, jugular
foramen and hypoglossal canal.
Key points Anterior cranial fossa Middle cranial fossa Posterior cranial fossa
Body and greater wings of

Orbital surface of frontal Posterior surface of
sphenoid bone, squama and
Bones bone, lesser wing of petrous part of temporal
anterior surface of petrous
sphenoid bone bone, occipital bone
part of temporal bone
Chiasmatic sulcus,
tuberculum sellae, anterior
clinoid process, sella
Anterior ethmoidal turcica, middle clinoid
Clivus, foramen magnum,
foramen, cribriform process, carotid sulcus,
internal acoustic
Landmarks foramina, sphenoidal yoke, foramen lacerum, foramen
meatus, jugular foramen,
foramen caecum, frontal spinosum, superior orbital
hypoglossal canal
crest fissure, foramen rotundum,
foramen ovale, trigeminal
impression, internal
opening of carotid canal
Frontal lobe of cerebrum,

Temporal lobe of cerebrum,
Contents olfactory bulb, olfactory Brainstem, cerebellum
pituitary gland
tract
Head and neck 369

SKULL
MIDSAGITTAL SKULL
The midsagittal section of the skull enables us to understand the structure of

the two main parts of the skull:
• Neurocranium, or the brain case, which houses the brain

• Viscerocranium, which houses the structures of the face, oral, nasal and
orbital cavities
The bones of the skull not only form and enclose these spaces, but they also
feature numerous passageways for neurovascular structures to pass in and out
of the cranial cavity.
Frontal bone Anterior clinoid process

of sphenoid bone
Crista galli of
Optic canal
ethmoid bone
Squamous part of
Frontal sinus
temporal bone
Ethmoid bone Sella turcica
Sphenoid bone
Perpendicular
plate of ethmoid
bone Basilar part of
occipital bone
Vomer-
Anterior Lateral plate of

nasal spine pterygoid process
of maxilla of sphenoid bone
Medial plate of
Incisive canaL pterygoid process
of sphenoid bone
Alveolar process Palatine bone

of maxilla
FIGURE 8.12. Midsagittal skull (with nasal septum). This section allows the appreciation of the structure of
the bony nasal septum, which is composed of the perpendicular plate of ethmoid bone and vomer joining
the maxilla and palatine bones. The latter two bones are seen comprising the floor of the nasal cavity,
separating it from the oral cavity. At the roof of the nasal cavity there is the ethmoid bone which encloses
it towards the anterior cranial fossa. Below, there is a hollow cavity which represents the sphenoidal sinus.

SKULL
Superior nasal concha Lesser wing of sphenoid

of ethmoid bone bone
Cribriform plate
of ethmoid bone Greater wing of
sphenoid bone
Nasal bone
Sphenoidal sinus
Lacrimal bone
Middle nasal concha

of ethmoid bone
Nasal surface
of maxilla
Palatine bone
Inferior nasal
concha
Maxilla Palatine process of

maxilla
FIGURE 8.13. Midsagittal skull (septum removed). With nasal septum removed, a better view on the
lateral wall of the nasal cavity is possible. The wall shows three bony projections called the superior,
middle and inferior nasal conchae (turbinates). The superior and middle conchae are parts of the ethmoid
bone, while the inferior nasal concha is an individual bone that attaches to the ethmoid, maxilla, lacrimal
and palatine bones.
Key points about the midsagittal skull
Neurocranium: frontal bone, ethmoid bone, sphenoid bone, parietal bone, temporal
bone, occipital bone
Viscerocranium: nasal bone, inferior nasal concha, lacrimal bone, maxilla, palatine
Bones
bone, vomer
Sutures: coronal suture, lambdoid suture, squamous suture, occipitomastoid
suture, sphenofrontal suture
Frontal bone Frontal sinus
Crista galli, cribriform plate, perpendicular plate, superior nasal concha, middle
Ethmoid bone
nasal concha
Greater wing, lesser wing, anterior clinoid process, optic canal, sella turcica,
Sphenoid bone
sphenoidal sinus, medial pterygoid plate, lateral pterygoid plate, pterygoid hamulus
Maxilla Anterior nasal spine, incisive canal, palatine process, alveolar process
Palatine bone Perpendicular plate, horizontal plate
Parietal bone Groove for middle meningeal artery
Squamous part, petrous part, internal acoustic meatus, groove for superior
Temporal bone
petrosal sinus, external opening of vestibular aqueduct, groove for sigmoid sinus
Basilar part, groove for transverse sinus, external occipital protuberance (inion),
Occipital bone jugular foramen, groove for inferior petrosal sinus, hypoglossal canal, foramen
magnum, occipital condyle
Head and neck 371

SKULL
ETHMOID BONE
The ethmoid is a small fragile bone located in the midline of the anterior skull.
It sits in the anterior cranial fossa, medial to the orbits and slightly superopos-
terior to the nasal cavity. Due to its position, it contributes to forming the
medial orbital walls, the nasal septum, as well as the roof and lateral walls of
the nasal cavity.
The ethmoid bone is a pneumatized bone, meaning that it is full of air cells
(spaces), and has been compared to an ice cube, in size, shape and weight. It is a
complex shaped bone with a number of named parts.
FIGURE 8.14. Ethmoid bone (anterior and posterior views). The ethmoid is an unpaired bone situated in
the midline of the skull. It consists of a centrally positioned crista galli, which is continued inferiorly by
the perpendicular plate.
On each side of the midline there is a spongy lateral mass, often referred to as the ethmoidal labyrinth.
Each mass consists of numerous air-filled ethmoidal cells. Thus, each mass is known as the ethmoidal
paranasal sinus. The lateral wall of the sinus presents a saccular extension called the ethmoid bulla, one of
the largest of ethmoidal cells. Ethmoidal masses feature a hook-like projection pointing inferiorly called
the uncinate process. This process forms a part of the wall of the maxillary sinus and is often confused as
a part of the maxilla rather than of ethmoid.

SKULL
The lateral surface of ethmoidal masses faces the orbit, forming a part of its medial wall. The medial sur
face of each mass faces the perpendicular plate. From an anterior view, it is visible how a separate bony
lamina called the middle nasal concha extends inferiorly from the root of each mass. The posterior view
allows the appreciation of the superior nasal concha as well. The conchae project into the nasal cavity
increasing its surface. Between the conchae is the middle nasal meatus, which drains the ethmoidal
sinuses into the nasal cavity.
| Superior] Perpendicular plate
Crista galli
Orbital plate
Cribriform plate
Ethmoidal cells
Crista galli
Ethmoidal cells
Orbital plate
Middle nasal concha
Perpendicular plate
FIGURE 8.15. Ethmoid bone (superior and lateral views). The superior view allows the appreciation of one
of the most unique landmarks of the ethmoid bone: The cribriform plate. The cribriform plate is split into
left and right halves by the crista galli. The plate shows multiple openings through which the fibers of the
olfactory nerve (CN I) pass. The fibers converge into the olfactory bulbs, each resting on the respective
surfaces of the cribriform plate.
The lateral view provides a better visualization of the perpendicular plate. It forms a part of the nasal sep
tum and articulates with the vomer.
Key points about the ethmoid bone
Anterior cranial fossa, medial to the orbits and slightly superoposterior to the nasal
Location
cavity.
Crista galli, ala of crista galli, cribriform plate of ethmoid bone, perpendicular
plate of ethmoid bone, ethmoidal labyrinth, cells of ethmoid bone, orbital plate of
Landmarks
ethmoid bone, ethmoid bulla, uncinate process of ethmoid bone, supreme nasal
concha, superior nasal concha, middle nasal concha, ethmoidal infundibulum
Articulating Frontal, sphenoid, nasals (2), maxillae (2), lacrimals (2), palatines (2), inferior nasal
bones conchae (2) and the vomer.
Head and neck 373

SKULL
||| Ethmoid bone
SPHENOID BONE
The sphenoid bone is one of the most complex bones of the skull. It comprises
most of the middle part of the base of the skull, contributes to the floor of the
middle cranial fossa of the skull, and forms a small portion of the bony orbit.
Anterior
J Greater wing
J Body
J Lesser wing
Posterior I I Pterygoid process
FIGURE 8.16. Parts of the sphenoid bone. The sphenoid bone consists of a centrally positioned body from
which the two pairs of wings arise: Greater wings and lesser wings. The bifid pterygoid process arises
from each greater wing and points inferiorly.

SKULL
Sphenoidal crest
Sphenoidal sinus
Orbital surface of
greater wing
Zygomatic margin of
greater wing
Sphenoidal concha
Temporal surface
of greater wing
Foramen rotundum
Infratemporal crest
Pterygoid canal
Maxillary surface of
greater wing
Spine of sphenoid bone
Pterygoid notch
Lateral plate of
pterygoid process
Medial plate of
pterygoid process
Pterygoid hamulus
FIGURE 8.17. Sphenoid bone (anterior view). The anterior surface of the sphenoid body features the
sphenoidal crest in the midline via which it articulates with the perpendicular plate of the ethmoid bone,
contributing to the formation of the nasal septum. On each side of the crest is the sphenoidal concha
which partially encloses the sphenoidal sinus. The superolateral part of the sinus remains open and
communicates with the nasal cavity.
The root of the greater wing features two openings: The foramen rotundum and pterygoid canal. The
foramen rotundum is traversed by the maxillary branch of trigeminal nerve (CN V2), while the pterygoid
(Vidian) canal transmits the artery and nerve of pterygoid canal. From an anterior perspective the orbital,
temporal and maxillary surfaces of the greater wing are visible. The orbital surface contributes to the lat
eral part of the orbit. The temporal surface faces laterally and is divided by the infratemporal crest into
superior and inferior portions. The superior portion contributes to the wall of the temporal fossa, while
the inferior portion forms a part of the infratemporal fossa. The maxillary surface faces the maxilla.
The spine of sphenoid bone points inferiorly from the lower margin of the temporal surface, providing the
attachment site for the sphenomandibular ligament.
The pterygoid process extends inferiorly from the root of the greater wing. It bifurcates into the lateral
and medial plates, between which is a space called the pterygoid notch. The very tip of the medial plate is
called the pterygoid hamulus.
Sphenoid bone
Head and neck 375

SKULL
Dorsum sellae
Anterior clinoid process
Parietal margin of
greater wing
Posterior clinoid
process
Cerebral surface
Carotid sulcus
Squamosal margin of
greater wing
Sulcus of auditory tube
Scaphoid fossa
Sphenoidal rostrum
Pterygoid fossa
FIGURE 8.18. Sphenoid bone (posterior view). The posterior surface of the sphenoid body is rough,
featuring a prominent landmark: Dorsum sellae. The dorsum sellae articulates with the occipital bone
and forms the clivus. The inferolateral angles of the dorsum present small posterior clinoid processes,
which forms one of the attachment points for the tentorium cerebelli. In the midline, the body presents a
triangular process called the sphenoidal rostrum which points towards the ala of vomer.
The posterior view allows a better appreciation of the root of the lesser wing. This bony process spirals
from the sphenoid body, forming the anterior clinoid process, after which it continues laterally and fuses
with the greater wing.
The irregular appearance of the root of the greater wing is also noticeable from this perspective. This area
features the sulcus of auditory tube which houses the cartilaginous auditory tube. The cerebral surface of
greater wing contributes to the middle cranial fossa, lodging a part of the temporal lobe of the brain. The
ridged parietal and squamosal margins of the greater wings are visible, which serve for the articulations
with the parietal and temporal bones respectively.
From this aspect, the plates of the pterygoid process present as concave. At their origin there is a shallow
scaphoid fossa which serves as the attachment site for the tensor veli palatini muscle. The very concavity
of the lateral plate comprises an obtuse-angled pterygoid fossa which provides the attachment site for
the medial pterygoid muscle.
Key points about the sphenoid bone
Body (median portion)

Greater wing (lateral portion)
Parts
Lesser wings (anterior portion)
Pterygoid processes (directed inferiorly)
Sphenofrontal suture with frontal bone
Sphenoparietal suture with parietal bone

Sutures Sphenosquamosal suture with temporal bone
Spheno-occipital suture with occipital bone (disappears by age 25 as bones

fuse together)

SKULL
TEMPORAL BONE
The temporal bone is a complex cranial bone that constitutes a large portion of
the lateral wall and base of the skull. There are a number of openings and canals
in the temporal bone through which structures enter and exit the cranial cavity.
The temporal bone also houses the structures forming the middle and inner ear.
Occipital margin
Groove for middle temporal artery
Parietal margin
Squamous part
Petrous part
Sphenoidal margin
Tympanosquamous
fissure
Zygomatic process
Petrotympanic fissure
Bony external
acoustic opening
Tympanic part of
temporal bone
Tympanomastoid fissure
Styloid process
Mastoid process
Mastoid notch
FIGURE 8.19. Temporal bone (lateral view). The temporal bone is a bone located bilaterally on either
side of the skull. The image above shows the temporal bone from a lateral perspective, which allows
the appreciation of the main parts of the temporal bone: The petrous part, squamous part and tympanic
part. These are demarcated by several fissures, such as the petrosquamous fissure, which separates the
squamous and petrous part; the tympanosquamous fissure, separating the tympanic and squamous parts,
and others. Some notable features of the temporal bone are seen from this perspective, such as the i
m
mastoid process, zygomatic process and groove for the middle temporal artery. >
□
>
z
□
z
m
n
7s
Head and neck 377

SKULL
Occipital margin
Parietal margin
Groove for middle

meningeal artery
Squamous part
Petrosquamous fissure
Sphenoidal margin
Arcuate eminence
Zygomatic process
Subarcuate fossa
Bony external acoustic opening
Apex of petrous part
Styloid process
Petrous part of temporal bone
Groove for sigmoid sinus
FIGURE 8.20. Temporal bone (medial view). The medial view of the temporal bone provides a visual of its
internal features. Some of these are formed by the imprinting of the passing intracranial structures, such
as the groove for middle meningeal artery and groove for sigmoid sinus. The tympanic part houses the
structures of the middle and inner ear. The temporal bone has three margins, which denote the bones it
articulates with: Sphenoidal, parietal and occipital margins.
Temporal bone Mastoid process

SKULL
Apex of petrous part
Sphenoidal margin
Zygomatic process
Petrous part
Articular tubercle
Carotid canal
Mandibular fossa
Styloid process
Bony external acoustic opening
Tympanic part
Mastoid process
Stylomastoid foramen
Mastoid notch
Jugular fossa
Occipital margin
Mastoid foramen
FIGURE 8.21. Temporal bone (inferior view). On the inferior side, the temporal bone provides a clear visual
of the several landmarks not seen on other views. These are the styloid process, mandibular fossa and
articular tubercle of the temporal bone. This view also gives the best visual of several openings (foramina)
in the temporal bone through which structures enter and exit the cranial cavity. These include the carotid
canal, for the passage of the internal carotid artery, the stylomastoid foramen transmitting the facial
nerve (CN VII) and stylomastoid artery, and the mastoid foramen for the passage of the emissary veins.
Key points about the temporal bone
Petrous part
Main parts Tympanic part
Squamous part
Articulations Occipital bone, parietal bone, sphenoid bone, zygomatic bone and mandible
Petrotympanic fissure
Petrosquamous fissure
Fissures
Tympanosquamous fissure
Petrous part: occipital margin, mastoid process, mastoid notch, mastoid foramen,
apex of petrous part, carotid canal, tegmen tympani, arcuate eminence, bony
labyrinth, internal acoustic meatus, subarcuate fossa, jugular fossa, styloid process,
stylomastoid foramen, groove for sigmoid sinus, tympanic cavity
Bony features
Tympanic part: bony external acoustic opening, bony external acoustic meatus
Squamous part: sphenoidal margin, parietal margin, parietal notch, groove for
middle temporal artery, zygomatic process, mandibular fossa, articular tubercle,
groove for middle meningeal artery
Head and neck 379

SKULL
MANDIBLE
The mandible is the largest bone of the human head. It is the only mobile bone
of the skull (not including the auditory ossicles). The mandible is technically not
part of the viscerocranium, however is sometimes still considered as such by
some texts. It connects to the maxilla (part of the viscerocranium) via the teeth
when the jaw is closed, and with the temporal bone (part of the neurocranium)
via the temporomandibular joint. Due to its mobility, the prime function of the
mandible is to assist in mastication.
FIGURE 8.22. Parts of the mandible. The mandible is composed of two main parts: The body and ramus.
The point at which the ramus and body of the mandible unite is known as the angle of mandible.
The body is the horizontal portion of the mandible that creates the jawline. It is subdivided into the base
and alveolar part. The base forms the lower portion of the mandible and provides the structural integrity
of the jaw, while the alveolar part holds the mandibular teeth.
u
id
Z The rami are the two vertical processes that are connected to the body at the mandibular angle. The
a superior portion of each is composed of two bony processes (coronoid and condylar processes) sepa
z
< rated by the mandibular notch. The condylar process consists of the head (also known as the mandibu
a lar condyle) and neck of the mandible. The rounded head of the mandible articulates with the temporal
<
id bone on each side to create the temporomandibular joint which provides mobility to the mandible and
I
allows mastication.

SKULL
FIGURE 8.23. Mandible (anterolateral view). The mental protuberance presents at the midline of the
base of the external surface of the mandible and is continuous laterally on either side with the mental
tubercles. Collectively these structures form the prominence of the chin.
Inferior to the mandibular premolar teeth, along the external surface of the base of the mandible is a
small, round opening known as the mental foramen, which allows for the passage of the mental branch
of inferior alveolar artery, mental vein and mental nerve. The oblique lines of the body of the mandible
are continuous superiorly with the anterior border of the ramus of the mandible and extend anteroinferi-
orly towards the mental tubercles. They form the lateral boundary of the retromolar fossa and provide an
origin site for the depressor anguli oris muscle.
The external surface of the angle of mandible presents with a roughening for the attachment of the mas
seter muscle known as the masseteric tuberosity.
Along the anterior aspect of each neck of mandible are two small, shallow depressions known as the
pterygoid foveae, which provide an insertion site for the lateral pterygoid muscle on each side. The internal
surface of the ramus of the mandible presents with the mandibular foramen (also known as the inferior
alveolar foramen) which houses the inferior alveolar artery, vein and nerve. The opening has a prominent
ridge in its front known as the lingula of mandible for the attachment of the sphenomandibular ligament.
The mylohyoid groove runs in an anteroinferior direction from this point and contains the mylohyoid nerve.
Head and neck 381

SKULL
Pterygoid tuberosity
Sublingual fossa
Submandibular fossa
Mental spines
Digastric fossa
FIGURE 8.24. Mandible (posterior view). The internal surface of the body, angle and ramus of the
mandible can be seen from this posterior view. The midline of the internal surface of the body of the
mandible presents with two bony indentenations known as the sublingual and submandibular fossae.
These structures house the sublingual and submandibular salivary glands, respectively. The mental spines
(superior and inferior) are small midline processes on the body of the mandible which act as an attachment
site for the genioglossus muscle.
Along the base of the mandible are two rough, shallow depressions known as the digastric fossae which
serve as an origin site for the anterior belly of the digastric muscle.
The internal surface of the angle of the mandible presents with a roughening for the attachment of the
medial pterygoid muscle, known as the pterygoid tuberosity.
Key points about the mandible
Main parts Body, ramus
Articulations Maxilla (via teeth), temporal bone (via temporomandibular joint)
Body: mental protuberance, mental tubercle, mental foramen, oblique line of

mandible, sublingual fossa, mylohyoid line, submandibular fossa, mental spines,
digastric fossa, alveolar part, interalveolar septa
Bony features
Ramus: coronoid process, mandibular notch, condylar process, head of mandible,
neck of mandible, pterygoid fovea, pterygoid tuberosity, masseteric tuberosity,
angle of mandible, mandibular foramen, lingula, mylohyoid groove
Temporomandibular
Mandible
joint

FACE AND SCALP
MUSCLES OF FACIAL EXPRESSION

The muscles of the facial expression are a group of approximately 20 superfi
cial skeletal muscles of the face and scalp which originate from the bony and
fibrous structures of the skull and insert into the skin. These attachments give
them an important role in showing emotions through facial expressions.
Procerus muscle Frontalis muscle &

epicranial aponeurosis
Orbicularis oculi muscle Corrugator supercilii

muscle
Levator labii superioris Auricularis superior

alaeque nasi muscle muscle
Zygomaticus minor Auricularis anterior

muscle muscle
Zygomaticus major
Nasalis muscle
muscle
Risorius muscle Levator labii

superioris muscle
Depressor anguli
Buccinator muscle
oris muscle
Depressor labii inferioris

muscle Orbicularis oris muscle
Platysma muscle Mentalis muscle
FIGURE 8.25. Muscles of facial expression. The largest group consisting of 11 muscles is the buccolabial
group. The majority of the mouth muscles are connected by a fibromuscular hub (modiolus) at each angle
of the mouth into which these muscles insert. This group is in charge of the shape and movements of
the mouth and lips. The next group is the nasal group that consists of two muscles (nasalis and procerus
muscles). Next, the orbital group consists of three muscles (orbicularis oculi, corrugator supercilii,
depressor supercilii muscles) that are responsible for opening and closing the eyes and moving the
eyebrows. The auricular group is a group of three fan-shaped muscles (auricularis anterior, auricularis
posterior and auricularis superior muscles) that move the ear lobe/auricle to a small extent. The last group
is the epicranial group (scalp and neck group) which includes two wide and flat muscles (occipitofrontalis
and platysma muscles). The occipitofrontalis muscle consists of two bellies (occipital and frontal) and acts
mainly on the forehead, while the platysma mainly acts on the neck and lower lip.
Head and neck 383

FACE AND SCALP
Buccolabial group Origin Insertion Innervation Function
Medial aspects
of maxilla and Closes mouth,
Skin and mucous
Orbicularis oris mandible, Perioral Compresses and
membrane of lips
skin and muscles, protrudes lips
Modiolus
Buccal branch
(External lateral of facial nerve
surface of) Alveolar (CN VII)
process of maxilla, Compresses
Buccinator Buccinator ridge cheek against
of mandible, Modiolus, Blends molar teeth
Pterygomandibular with muscles of
raphe upper lip
(Posterior part of) Elevates and

Zygomaticus
Lateral aspect of everts angle of
major
zygomatic bone mouth
Blends with
(Anterior part of) muscles of upper Elevates upper lip,
Zygomaticus
Lateral aspect of lip (medial to Zygomatic and Exposes maxillary
minor
zygomatic bone zygomaticus buccal branches teeth
major muscle) of facial nerve
Zygomatic process (CN VII) Elevates and
Blends with
Levator labii of maxilla, Maxillary everts upper lip,
muscles of
superioris process of Exposes maxillary
upper lip
zygomatic bone teeth
Levator anguli Canine fossa of Elevates angle of

oris maxilla mouth
Parotid fascia,
Buccal branch
Buccal skin, Extends angle of
Risorius of facial nerve
Zygomatic bone mouth laterally
(CN VII)
(variable) Modiolus
Mental tubercle Buccal and

and oblique line mandibular
Depressor anguli Depresses angle
of mandible branches of
oris of mouth
(continuous with facial nerve
platysma muscle) (CN VII)
Oblique line
Skin and
Depressor labii of mandible Depresses lower
submucosa of
inferioris (continuous with lip inferolaterally
lower lip Mandibular
platysma muscle)
branch of facial
nerve (CN VII) Elevates, everts
Skin of chin
Incisive fossa of and protudes
Mentalis (Mentolabial
mandible lower lip, Wrinkles
sulcus)
skin of chin
Lateral crus
of major alar
cartilage, Blends Zygomatic and
Levator labii Elevates and
Frontal process of with fibres of buccal branches
superioris alaeque everts upper lip
maxilla levator labii of facial nerve
nasi and nasal ala
superioris and (CN VII)
orbicularis oris
muscles

FACE AND SCALP
Nasal group Origin Insertion Innervation Function
Skin of glabella, Temporal, lower

Nasal bone, Depresses medial
Fibres of zygomatic or
(Superior part end of eyebrow,
Procerus frontal belly of buccal branches
of) Lateral nasal Wrinkles skin of
occipitofrontalis of facial nerve
cartilage glabella
muscle (CN VII)
Alar part: frontal

Alar part:
process of maxilla Alar part: skin
depresses ala
(superior to lateral of ala;
Buccal branch laterally, dilates
incisor)
Nasalis Transverse part: of facial nerve nostrils
Transverse merges with (CN VII) Transverse part:
part: maxilla counterpart at
wrinkles skin of
(superolateral to dorsum of nose
dorsum of nose
incisive fossa)
Orbital group Origin Insertion Innervation Function
Orbital part:
closes eyelids
Nasal part of tightly
Skin of orbital Temporal and
frontal bone,
region, Lateral zygomatic Palpebral part:
Frontal process
Orbicularis oculi palpebral branches of closes eyelids
of maxilla, Medial
ligament, Superior facial nerve gently
palpebral ligament,
and inferior tarsi (CN VII)
Lacrimal bone Lacrimal part:
compresses
lacrimal sac
Medial end of
superciliary Skin above middle Creates vertical
Corrugator
arches, Fibers of of supraorbital wrinkles over
supercilii
orbicularis oculi margin glabella
Temporal
muscle
branches of
facial nerve
(CN VII) Depresses
Skin of medial end
Depressor Medial angle of medial portion of
of eyebrow and
supercilii orbit eyebrow, Moves
glabella
skin of glabella
Epicranial group Origin Insertion Innervation Function
Frontal belly:
Frontal belly
temporal
(frontalis): skin of Frontal belly:
branches of
eyebrow, Muscles elevates
facial nerve
of forehead eyebrows,
(CN VII)
Occipitofrontalis wrinkles skin of
Occipital belly
Occipital belly: forehead
(occipitalis):
posterior
(Lateral 2/3 of) Epicranial Occipital belly:
auricular nerve
Superior nuchal aponeurosis retracts scalp
(branch of facial
line
nerve (CN VII))
Tenses fascia of
Temporal
temporal region,
branches of
Temporoparietalis Auricular muscles assists with
facial nerve
movement of
(CN VII)
auricle
Head and neck 385

FACE AND SCALP
Auricular group Origin Insertion Innervation Function
Temporal fascia/
Auricularis Temporal Draws auricle
Epicranial Spine of helix
anterior branches of anteriorly
aponeurosis
facial nerve
Auricularis Epicranial Superior surface (CN VII) Draws auricle
superior aponeurosis of auricle superiorly
Posterior
Auricularis Mastoid process of Ponticulus of auricular nerve Draws auricle
posterior temporal bone conchal eminence (branch of facial posteriorly
nerve (CN VII))
Facial muscles The human face
BLOOD VESSELS OF THE FACE AND SCALP

The arterial supply of the face and scalp originates almost exclusively from
the external carotid artery. The vast majority of the supply to the skin and
muscles of the face originates from the facial artery. Additional supply to the
face stems from the maxillary artery, which is a branch of the external carotid
artery. Other branches of the external carotid artery mostly supply the scalp,
and include the posterior auricular, occipital and superficial temporal arteries.
While most of the face is supplied by the branches of the external carotid, a
major contributor to the arterial supply is the ophthalmic artery, a branch of
the internal carotid artery.
The venous drainage of the face and the scalp is mostly analogue to the arterial
supply. The most notable vein is the facial vein, that runs a similar course to its
arterial counterpart, receives many tributaries along its course, and ultimately
drains into the internal jugular vein.

FACE AND SCALP
Frontal branch of superficial

temporal artery
Superficial temporal artery
Middle temporal artery
Zygomaticoorbital artery
Transverse facial artery
Facial artery
Superior labial artery
Mental branch of inferior

alveolar artery
Submental artery
FIGURE 8.26. Arteries of face and scalp (anterior view: Superficial). The facial artery arises from the
external carotid artery within the neck and continues along the inner surface of the mandible. It then
crosses over the inferior aspect of the mandible and continues its course superiorly across the face.
The branches of the facial artery which supply the superficial face and scalp are the submental artery,
supplying the submental area (alongside the mental branch of the inferior alveolar artery), the superior
and inferior labial arteries (see next image), which supply the upper and lower lip, the lateral nasal artery,
which supplies the skin of the nose and its terminal branch, the angular artery (see next image).
Supplying the superficial aspect of the face and scalp is one of the terminal branches of the external
carotid artery, the superficial temporal artery. The superficial temporal artery extends through the tem
poral region and gives rise to its two main branches: The transverse facial and middle temporal arteries.
The zygomaticoorbital artery is an occasional branch of the middle temporal artery that runs along the
upper border of the zygomatic arch. It may also arise from the superficial temporal artery.
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Head and neck 387

FACE AND SCALP
Supratrochlear artery
Supraorbital artery
Ophthalmic artery
Angular artery
Infraorbital artery
Buccal artery
Inferior labial artery
External carotid artery
FIGURE 8.27. Arteries of face and scalp (anterior view: Deep). The ophthalmic artery arises within the skull
and extends anteriorly to enter the orbit with the optic nerve via the optic foramen. It continues along
the medial wall of the orbit where it gives off several branches. Branches of the ophthalmic artery which
supply deep structures of the face include the supraorbital, supratrochlear and dorsal nasal arteries. The
supraorbital and supratrochlear arteries extend superiorly to supply the forehead and scalp while the
dorsal nasal artery extends inferomedially to anastomose with the angular artery (terminal branch of
facial artery).
The buccal artery arises from the 2nd part of the maxillary artery, while the infraorbital artery originates
from the 3rd part of the maxillary artery within the pterygopalatine fossa. The buccal artery passes for
wards to reach and supply the buccinator muscle and overlying skin. The infraorbital artery ascends to the
orbit of the eye via the inferior orbital fissure and emerges onto the face through the infraorbital foramen.
It supplies the skin of the inferior eyelid, cheek and nose as well as the maxillary teeth via its terminal
branches.
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FACE AND SCALP
Parietal branch of superficial

temporal artery
Frontal branch of superficial
temporal artery
Anterior deep temporal artery
Ophthalmic artery
Medial palpebral artery
Dorsal nasal artery
Posterior deep
temporal artery
Lateral nasal branch
of facial artery
Maxillary artery
Masseteric artery
Buccal artery
Posterior auricular-
artery
Occipital artery
Internal carotid artery
FIGURE 8.28. Arteries of face and scalp (lateral view). The maxillary artery gives off the infraorbital artery,
that supplies the area between the eye and upper lip, the buccal artery, supplying the buccinator muscle
and skin of the cheek, as well as the inferior alveolar artery, which gives off the mental artery to supply the
chin. The scalp receives its vascular supply through branches of the external carotid artery: The posterior
auricular, superficial temporal and occipital arteries.
1 Supply
Artery Branches
Submental artery Muscles and skin of the submental area
Inferior labial artery Lower lip

Facial artery
Superior labial artery Upper lip, nasal septum, and ala of the nose
Angular artery Orbicularis oris muscle and the lacrimal sac
Infraorbital artery Area between the lower eyelid and upper lip
Buccal artery Buccinator muscle and surrounding structures

Maxillary artery
Mental branch of the inferior
Chin
alveolar artery
Auricle of the ear and scalp posterior and

Posterior auricular artery
superior to the auricle
Other branches Occipital artery Posterior scalp

of external
Superficial temporal artery Temporal region of the face and scalp
carotid artery
Transverse facial artery Parotid gland and surrounding structures
Middle temporal artery Temporal region of the face and scalp
Ophthalmic Supratrochlear artery Forehead, scalp and superior conjunctiva

artery Supraorbital artery Forehead, scalp and superior conjunctiva
Head and neck 389

FACE AND SCALP
Superficial temporal vein
Deep facial vein
Facial vein
Inferior labial vein
Internal jugular vein
FIGURE 8.29. Veins of face and scalp (anterior view: Superficial). Superficial venous drainage of the face
is mainly achieved through tributaries from the retromandibular and facial veins. The superficial temporal
veins pass laterally from the temporal region over the zygomatic arch and enter the parotid gland. Within
the parotid gland, the superficial temporal veins join with the maxillary veins to form the retromandibular
vein. The superficial temporal veins drain the muscles and skin of the temporal region.
The deep facial vein drains the rostral aspect of the pterygoid plexus to the facial vein, while the inferior
labial veins courses laterally along the lower lip, draining structures of this region into the facial vein. The
retromandibular and facial veins extend inferiorly and drain to the internal jugular vein.

FACE AND SCALP
Supraorbital vein
Supratrochlear vein
Angular vein
Transverse facial vein
Superior labial vein
FIGURE 8.30. Veins of face and scalp (anterior view: Deep). The main vein draining the deep structures
of the face is the facial vein, which receives various tributaries that run a similar course to their arterial
counterparts and are therefore identically named. The facial vein originates at the lower margin of the
orbit as a continuation of the angular vein, which is formed by the junction of the supratrochlear and
supraorbital veins. The facial vein courses inferolaterally, directly posterior to the facial artery. It receives
the superior labial, inferior labial and deep facial vein (previous image) as tributaries, and terminates by
draining into the internal jugular vein.
Head and neck 391

FACE AND SCALP
Middle temporal vein
Retromandibular vein
Nasofrontal vein
Pterygoid venous plexus
Posterior auricular vein
External nasal veins
Parotid veins
Deep facial vein
Posterior division of
retromandibular vein
Buccal vein
External jugular vein
Masseteric vein
Submental vein
Mental vein
Common facial vein
FIGURE 8.31. Veins of face and scalp (lateral view). The veins of the scalp are named by their arterial
counterparts; the posterior auricular, superficial temporal and middle temporal veins. These drain into the
retromandibular vein, which courses just posterior to the mandible and anastomoses with the facial vein
prior to draining into the internal jugular vein.
Region Veins Drainage area
Supratrochlear and supraorbital veins Forehead and anterior scalp
Anterior scalp, forehead, eyelids and

Angular vein
conjunctiva
Face Anterior scalp, forehead, eyelids, external
Inferior labial, superior labial and
nose, anterior cheek, lips, chin and
facial veins
submandibular gland
Deep facial vein Structures of the infratemporal fossa
Superficial temporal vein Temporal scalp, temporal muscle and ear
Scalp Middle temporal vein Temporal scalp

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Superficial arteries
and veins of the face Facial artery
and scalp

FACE AND SCALP
NERVES OF THE FACE AND SCALP
The nerves responsible for the motor innervation of the face and scalp
originate mainly from the facial nerve (CN VII). The sensory innervation occurs
mainly through branches of the trigeminal nerve (CN V). This large cranial
nerve divides into three branches, the ophthalmic (CN V1), maxillary (CN V2) and
mandibular (CN V3) nerves. These are responsible for the sensory innervation
of three distinct dermatomes on the face, with the mandibular nerve (CN V3)
also carrying additional motor fibers to the muscles of mastication. The skin of
the scalp anterior to the ears is innervated by branches of the trigeminal nerve,
while the posterior scalp is supplied by branches arising from the upper cervical
spinal nerves.
Temporal branches
of facial nerve
External nasal branch of

anterior ethmoidal nerve
Facial nerve
Buccal branches
of facial nerve
Marginal mandibular
branch of facial nerve
Cervical branch of
facial nerve
FIGURE 8.32. Nerves of face and scalp (anterior view: Superficial). The facial nerve (CN VII) provides
motor innervation to the muscles of the face via the temporal, zygomatic, buccal, mandibular and
cervical branches. More specifically, these branches supply the stapedius, posterior belly of digastric, the
stylohyoid muscle and all the muscles of facial expression. The facial nerve also conveys preganglionic
parasympathetic fibers to the geniculate ganglion to innervate all the major glands of the face, except the
parotid gland.
Head and neck 393

FACE AND SCALP
Supraorbital nerve
Supratrochlear nerve
Auriculotemporal nerve
Infratrochlear nerve
Zygomaticofacial nerve
Infraorbital nerve
Buccal nerve
Mental nerve
FIGURE 8.33. Nerves of face and scalp (anterior view: Deep). The sensory innervation to the face and scalp
arises from the trigeminal nerve (CN V) (not visible). The trigeminal nerve divides to give off three branches
(ophthalmic (V1), maxillary (VII) and mandibular (VIII)) which supply sensory innervation to corresponding
regions of the face and scalp. The ophthalmic nerve (CN V1) gives off the supraorbital, supratrochlear,
external nasal branch of anterior ethmoidal nerve (see previous image) and infratrochlear nerve to
innervate the area from the anterior scalp down to the upper eyelid. The maxillary nerve (CN V2) gives
off the infraorbital, zygomaticofacial and zygomaticotemporal nerve to supply the area from the lower
eyelid to the upper lip. The mandibular nerve (CN V3) gives off the auriculotemporal nerve, buccal nerve
and mental nerve to innervate the lower lip, chin and jaw.
Nerve Branches Supply
Posterior auricular nerve, temporal

branches, zygomatic branches,
Facial nerve (CN VII) Muscles of facial expression
buccal branches, marginal
mandibular branch, cervical branch
Muscles of mastication, mylohyoid

Mandibular nerve (V3) Motor branches muscle, anterior belly of digastric
muscle
Supraorbital nerve, supratrochlear

nerve, external nasal branch Anterior scalp, forehead, upper
Ophthalmic nerve (V1)
of anterior ethmoidal nerve, eyelid, conjunctiva and nose
infratrochlear nerve, lacrimal nerve
Area over the zygomatic bone,

Infraorbital nerve, zygomaticofacial
Maxillary nerve (V2) anterior temple, lower eyelid, side of
nerve, zygomaticotemporal nerve
the nose and upper lip

FACE AND SCALP
Supraorbital nerve
Zygomaticotemporal
nerve
Temporal branches
of facial nerve
Zygomaticofacial nerve

Infraorbital nerve
Posterior auricular nerve
Greater occipital nerve
Facial nerve
Lesser occipital nerve
Buccal nerve
Buccal branches
of facial nerve
Mental nerve
Marginal mandibular
branch of facial nerve
Cervical branch
of facial nerve
Great auricular nerve
FIGURE 8.34. Nerves of face and scalp (lateral view). The nerves providing sensory innervation to the
area of the scalp posterior to the ear are the great auricular and lesser occipital nerves (via the cervical
plexus/anterior rami of spinal nerves C2/C3), as well as the greater and third occipital nerves (which arise
from posterior ramus of spinal nerve C2). The area of the scalp anterior to the ears is innervated by the
zygomaticotemporal nerve, a branch of the maxillary nerve (CN V2) and the auriculotemporal nerve, which
is a branch of the mandibular nerve (CN V3). As discussed in the last image, the anterior scalp is innervated
by the supratrochlear and supraorbital nerves, which are branches of the ophthalmic nerve (CN V1).
Nerve Branches Supply
Temple, external acoustic meatus,

Auriculotemporal nerve, buccal
Mandibular nerve (V3) tympanic membrane, buccinator
nerve, mental nerve
muscle, lower lip and chin
Great auricular nerve (C2-C3), lesser

occipital nerve (C2) (via cervical
Spinal nerves C2/C3 plexus); greater occipital nerve, third Skin of the posterior scalp
occipital nerve (posterior ramus
spinal nerve C3)
Superficial nerves of
Facial nerve
the face and scalp
Head and neck 395

FACE AND SCALP
ARTERIES OF THE HEAD: LATERAL VIEW
The arteries of the head can be divided didactically according to the branches of
three main arteries:
• External carotid artery

• Internal carotid artery
• Vertebral artery
The external carotid artery supplies most of the structures located outside the
cranial vault, i.e. muscles, viscera and skin of the scalp, face and neck. The inter
nal carotid artery is the most important artery for the anterolateral aspects of
the brain, while the vertebral artery supplies most of the posterior structures
of the brain, as well as some muscles and skin of the posterior neck.
Anterior deep Sphenopalatine artery

temporal artery
Buccal artery
Infraorbital artery
Masseteric artery
Posterior deep Artery of pterygoid
temporal artery canal
Pterygoid
branches Pharyngeal branch
of maxillary artery
Anterior tympanic
artery
Posterior superior
Deep auricular
alveolar artery
artery
Middle meningeal
Descending palatine
artery
artery
Accessory
meningeal artery
Inferior alveolar
— artery Angular artery
Superficial temporal Maxillary artery

artery
Posterior meningeal
artery Lateral nasal branch of
facial artery
Posterior auricular
artery Superior labial artery
Ascending pharyngeal
artery
External carotid Inferior labial artery
artery
Occipital artery Mental branch of inferior
alveolar artery
Lingual artery
Submental artery
Carotid body
Facial artery
Carotid bifurcation
Superior laryngeal artery
Superior thyroid artery
Common carotid artery 'Brachiocephalic trunk
FIGURE 8.35. External carotid artery and its branches. After bifurcating from the common carotid artery,
the external carotid artery courses superiorly along the neck, giving branches to supply the muscles,
viscera and skin of the head, neck and face. There are eight major branches emerging directly from the
external carotid artery: The superior thyroid, ascending pharyngeal, lingual, facial, occipital and posterior
auricular arteries, as well as two terminal branches, the maxillary and superficial temporal arteries. The
image shows the three parts of the maxillary artery and its branches, which supply many structures of the
face, ear, skull, meninges, oral cavity and oropharynx.

FACE AND SCALP
Anterior cerebral artery
Anterior choroidal artery —
Superior hypophyseal artery-----
Posterior communicating —
artery
Inferior hypophyseal artery __
Communicating
part (C7)
Ophthalmic
part (C6)
Clinoid part (C5) —
Cavernous part (C4) —
Lacerum part (C3) —
Petrous part (C2) —
Cervical part (C1) —
Carotid sinus —
FIGURE 8.36. Internal carotid artery and its branches. All seven segments of the internal carotid artery
can be seen in this image. From proximal to distal these are the cervical (C1), petrous (C2), lacerum (C3),
cavernous (C4), clinoid (C5), ophthalmic (C6) and communicating (C7) parts. Except for C7, the odd numbered
parts usually do not give off any branches. The most important branches can be seen originating from
the cavernous segment (meningohypophyseal and inferolateral trunks), ophthalmic segment (ophthalmic
and superior hypophyseal arteries) and communicating segment (posterior communicating and anterior
choroidal arteries). The termination of the internal carotid artery can also be observed where it bifurcates
into the anterior and middle cerebral arteries.
B
External carotid
Internal carotid
artery and its
artery
branches
Head and neck 397

FACE AND SCALP
Basilar artery Posterior

communicating
artery
Labyrinthine artery
Posterior
cerebral
artery
Meningeal branches
of vertebral artery
Superior
cerebellar
“Intracranial artery
part (V4)
Pontine
arteries
Atlantic
part (V3)
Anterior inferior
cerebellar artery
Cervical
part (V2)
Posterior inferior
Prevertebral cerebellar artery
- part (V1)
Inferior thyroid
Deep cervical artery
artery
Supreme Thyrocervical
intercostal trunk
artery
Costocervical Subclavian
trunk artery
FIGURE 8.37. Vertebral artery and its branches. The vertebral artery can be seen in its totality with
four parts: Prevertebral (V1), cervical (V2), atlantic (V3) and intracranial (V4). The most important branches
originate in the intracranial segment: Meningeal branches (that supply the meninges of the posterior
fossa), posterior inferior cerebellar artery (a.k.a. PICA). The vertebral artery terminates by merging with
the contralateral vertebral artery to form the basilar artery. Some branches of the basilar artery should
also be recognized: The labyrinthine and pontine arteries can be noted, as well as the anterior inferior
cerebellar arteries (a.k.a. AICA), the superior cerebellar arteries and the posterior cerebral arteries, which
are its terminal branches.
Artery Branches Supply
Superior thyroid, ascending pharyngeal, lingual,

External carotid Muscles, viscera and skin
facial, occipital, posterior auricular, maxillary and
artery of the scalp, face and neck
superficial temporal arteries
Meningohypophyseal trunk, ophthalmic,

Internal carotid superior hypophyseal, posterior communicating, Anterolateral aspect of
artery anterior choroidal, anterior cerebral, anterior the brain
communicating and middle cerebral arteries
Muscular, spinal, meningeal branches; Posterior

Posterior parts of the
inferior cerebellar, basilar, anterior inferior
Vertebral artery brain, muscles and skin of
cerebellar, superior cerebellar, pontine, posterior
the posterior neck
cerebral arteries
Vertebral artery

INFRATEMPORAL REGION AND
PTERYGOPALATINE FOSSA
MUSCLES OF MASTICATION
The muscles of mastication are the temporalis, masseter, medial pterygoid and
lateral pterygoid. These muscles produce movements of the mandible, or lower
jaw, at the temporomandibular joints, thus enabling functions such as chewing
and grinding.
Superior head of lateral

pterygoid muscle
Inferior head of lateral

pterygoid muscle
Superficial head of medial

pterygoid muscle
Deep head of medial

pterygoid muscle
FIGURE 8.38. Overview of the muscles of mastication. The muscles of mastication originate from
different bones of the skull and insert into the mandible. Temporalis muscle is located in the temporal
fossa. Masseter muscle can be found on the face, superficial to the lateral surface of the ramus of the
mandible. This muscle has a superficial and a deep layer. The medial and lateral pterygoids are found in the
infratemporal fossa. Each muscle consists of two heads. The medial pterygoid has a deep and a superficial
head, while the lateral pterygoid has a superior and an inferior head.
Head and neck 399

INFRATEMPORAL REGION AND PTERYGOPALATINE FOSSA
Muscles of
mastication
Temporal fossa Deep temporal Anterior part:

Apex and medial elevates mandible
Temporalis (up to inferior branches (of
surface of coronoid
muscle temporal line), mandibular Posterior part:
process of mandible
Temporal fascia nerve [CN V3]) retracts mandible
Superficial part:
maxillary process
of zygomatic bone,
Inferior border of Masseteric
zygomatic arch Lateral surface of
nerve (of Elevates and
Masseter muscle (anterior 2/3’s) ramus and angle of
mandibular protrudes mandible
mandible
Deep part: deep/ nerve [CN V3])
inferior surface
of zygomatic arch
(posterior 1/3)
Bilateral
contraction -
Superior head:
Superior head: Protrudes and
infratemporal crest
joint capsule of depresses
of greater wing of Lateral
temporomandibular mandible, Stabilizes
Lateral sphenoid bone pterygoid
joint condylar head
pterygoid Inferior head: nerve (of during closure;
muscle Inferior head: mandibular
lateral surface of
pterygoid fovea on nerve [CN V3]) Unilateral
lateral pterygoid
neck of condyloid contraction -
plate of sphenoid
process of mandible Medial movement
bone
(rotation) of
mandible
Superficial part: Bilateral

tuberosity of contraction -
maxilla, Pyramidal Medial Elevates and
process of palatine Medial surface of pterygoid protrudes mandible
Medial pterygoid bone; ramus and angle of nerve (of Unilateral
muscle
Deep part: medial mandible mandibular contraction -
surface of lateral nerve [CN V3]) Medial movement
pterygoid plate of (rotation) of
sphenoid bone mandible
BC^^^MB
Muscles of Temporomandibular
mastication joint

TEMPOROMANDIBULAR JOINT
The temporomandibular joint (TMJ) connects the skull to the mandible. It is

located between the mandibular fossa and articular tubercle of the temporal
bone and the condylar process of the mandible. It is classified as a synovial-type
joint, however, is atypical in that its articular surfaces are lined by fibrocarti-
lage rather than hyaline cartilage and that it contains a fibrocartilaginous disc.
The TMJs facilitate a range of movements of the lower jaw namely depression/
elevation, lateral deviation (left or right), and protraction/retraction.
Temporal bone
Articular capsule of
temporomandibular joint
2 O-2j ------ Superior head

a; ----
j^'E Inferior head
Q.
External acoustic meatus
Lateral temporomandibular
ligament
■g
ra'o-^
CD <_ D
ZjEjE
_r ।--------- Deep head
1— Superficial head
Q.
Styloid process of
temporal bone
Sphenomandibular ligament
Stylomandibular ligament
Mandible
Mastoid process
of temporal bone
FIGURE 8.39. Overview of temporomandibular joint. Part of the ramus of the mandible and zygomatic
arch have been removed to expose the infratemporal fossa, where two muscles of mastication are
located: The medial and lateral pterygoid muscles. Three major ligaments are associated with this joint.
The lateral temporomandibular ligament is a thickening of the joint capsule and strengthens it laterally.
The sphenomandibular ligament is located medial to the joint, running from the spine of the sphenoid
bone to the lingula on the medial side of the ramus of the mandible. The stylomandibular ligament passes
from the styloid process of the temporal bone to the posterior margin and angle of the mandible.
Head and neck 401

Articular tubercle of
temporal bone
Superior cavity
Anterior band
Intermediate zone
Posterior band
Synovial membrane
Retrodiscal tissue
Inferior cavity
Articular surface of
condyle of mandible
Articular surface of
mandibular fossa
Posterior articular capsule
Anterior articular capsule
Condylar process of mandible
FIGURE 8.40. Capsule of temporomandibular joint. Magnification of the TMJ with the capsule opened.
In this sagittal view, details of the anatomy of the joint are illustrated. The joint cavity is divided into two
cavities (superior and inferior) by an articular disc. In the sagittal section, the disc has a thin intermediate
zone which is bounded by thickened anterior and posterior bands. The disc stabilizes the condyle of the
mandible within the joint, reduces frictional forces between the articular surfaces and may aid lubrication
of the joint.
Key points about the temporomandibular joint
Articular Temporal bone: mandibular fossa and articular tubercle

surfaces Mandible: condylar process
Joint capsule
Components Synovial membrane
Articular disc (anterior/posterior bands, intermediate zone)
J
Superior (discotemporal) cavity (translational movement)

H EA D A N D N EC K
Cavities
Inferior (discomandibular) cavity (rotational movement)
Major: lateral temporomandibular ligament (thickened lateral portion of capsule,

Ligaments strengthens TMJ laterally)
Minor: stylomandibular ligament, sphenomandibular ligament

Key points about the movements of mandible at the TMJ
Rotational Elevation: temporalis, masseter and medial pterygoid muscles

movements Depression: lateral pterygoid, digastric, geniohyoid and mylohyoid muscles
Protrusion: lateral pterygoid and medial pterygoid muscles

Retraction: posterior fibers of temporalis, deep part of masseter, geniohyoid and
Translational digastric muscles
movements
Lateral deviation (left or right): posterior fibers of temporalis, digastric, mylohyoid
and geniohyoid muscles (ipsilateral movement); lateral and medial pterygoid
muscles (contralateral movement)
Temporomandibular
joint
gl Mandible
PTERYGOPALATINE FOSSA
The pterygopalatine fossa is a small cone-shaped space located between the
pterygoid process of the sphenoid posteriorly, the posterior aspect of the max
illa anteriorly and the lateral surface of the palatine bone medially. Despite its
small size, this region is anatomically strategic because of its communications
with different intra and extracranial spaces: The middle cranial fossa, pharyn
geal vault, infratemporal fossa, lateral nasal cavity, floor of the orbit and tissues
of soft and hard palates.
The main contents of the pterygopalatine fossa are the maxillary nerve
(CN V2) and its branches as well as the pterygopalatine ganglion, formed
by preganglionic fibers of the nerve of the pterygoid canal. Additionally, it
contains the pterygopalatine part of the maxillary artery, its branches and
accompanying veins.
Head and neck 403

fossa fissure
FIGURE 8.41. Structure of pterygopalatine fossa. Left lateral view of the cranium with the zygomatic
arch removed to expose the pterygopalatine fossa located between the maxilla, sphenoid and palatine
bones. Posteriorly the pterygopalatine fossa communicates with the middle cranial fossa via the foramen
rotundum and pterygoid canal as well as with the nasopharynx, via the palatovaginal canal (pharyngeal
canal). Medially the inferior orbital fissure can be seen, communicating with the floor of the orbit, while
laterally the pterygomaxillary fissure connects the pterygopalatine fossa with the infratemporal fossa.
The sphenopalatine foramen found on the medial wall of the pterygopalatine fossa opens into the lateral
mucosa of the nasal cavity.

Nasopalatine Zygomatic nerve

nerve
Zygomaticotemporal Branches of
nerve maxillary nerve
to pterygopalatine
ganglion
Zygomaticofacial
nerve Nerve of pterygoid
canal
Orbital branches of
pterygopalatine
ganglion Pharyngeal nerve
Infraorbital nerve
Maxillary nerve
Middle superior
alveolar nerve
Pterygopalatine
Anterior superior-
ganglion
alveolar nerve
Posterior superior Palatine nerves

alveolar nerve
FIGURE 8.42. Nerves of pterygopalatine fossa. The maxillary nerve (CN V2) is seen entering the
pterygopalatine fossa posteriorly through the foramen rotundum, before it gives off the zygomatic and
the posterior superior alveolar nerves. Both the maxillary and zygomatic nerves continue anteriorly to
enter the inferior orbital fissure.
Some ganglionic branches also emerge from the maxillary nerve in the pterygopalatine fossa, where they
join the pterygopalatine ganglion, a parasympathetic ganglion which also receives preganglionic fibers
via the nerve of pterygoid canal (from facial nerve [CN VII]). Apart from the pharyngeal nerve that exits the
fossa via the palatovaginal canal, the main nerves branching from the pterygopalatine ganglion are the
nasopalatine nerve (courses medially through the sphenopalatine foramen), orbital branches of maxillary
nerve, posterior superior lateral nasal branches (not shown) and greater and lesser palatine nerves (which
course inferiorly to the greater and lesser palatine foramina, respectively).
Key points about pterygopalatine fossa
Anterior Posterior surface of maxilla
Posterior Pterygoid process of sphenoid bone
Superior Greater wing of sphenoid bone

Borders
Inferomedial Palatine bone
Opening into infratemporal fossa via pterygomaxillary

Lateral
fissure
Foramen rotundum and

^ middle cranial fossa
pterygoid canal
Palatovaginal canal ^ mucosa of pharyngeal vault

Pterygomaxillary fissure ^ infratemporal fossa
Gateways
Sphenopalatine foramen ^ mucosa of lateral nasal cavity
Inferior orbital fissure ^ floor of the orbit
Lesser palatine canal ^ mucosa of the soft palate
Greater palatine canal ^ mucosa of the hard palate
Head and neck 405

artery of maxillary artery
FIGURE 8.43. Arteries of pterygopalatine fossa. The main artery to be found in the pterygopalatine fossa
is the third (pterygopalatine) part of the maxillary artery. There is a lot of anatomical variation concerning
the branches of this part of the maxillary artery. Usually it gives off the greater palatine and posterior
superior alveolar arteries inside the pterygopalatine fossa, before it bifurcates in the infraorbital and
sphenopalatine arteries.
The infraorbital artery enters the inferior orbital fissure anteriorly, while the sphenopalatine artery
courses medially to enter the sphenopalatine foramen. Two other arteries are worth mentioning here: The
pharyngeal artery and the artery of pterygoid canal, both of which course posteriorly to enter respectively
the palatovaginal canal and the pterygoid canal.
Key points about pterygopalatine fossa
Maxillary nerve (CN V2) and its branches: zygomatic nerve

and branches to the pterygopalatine ganglion
Pterygopalatine ganglion afferent nerves: branches from

maxillary nerve, nerve of pterygoid canal
Nerves
Pterygopalatine ganglion efferent nerves: pharyngeal
nerve, greater and lesser palatine nerves, orbital
branches, posterior superior lateral nasal branches,
Contents nasopalatine nerve
Pterygopalatine part (3rd part) of maxillary artery and its

branches: greater palatine, posterior superior alveolar,
Arteries
infraorbital, sphenopalatine and pharyngeal arteries and
artery of pterygoid canal
Pterygoid venous plexus, greater palatine vein,

Veins infraorbital vein, deep facial vein ^ all draining to
cavernous sinus, maxillary, or facial veins

FIGURE 8.44. Veins of pterygopalatine fossa. The main venous structure seen in the pterygopalatine fossa
is the pterygoid venous plexus. This plexus drains to multiple different venous structures: Posteriorly to
the greater palatine vein, that accompanies the course of the maxillary artery; anteroinferiorly to the
facial and deep facial veins; and medially to the cavernous sinus, which is an intracranial venous structure
located adjacent to the sella turcica.
Anatomy of the Pterygopalatine

pterygopalatine fossa ganglion
Head and neck 407

ORBIT AND CONTENTS
BONES OF THE ORBIT
The orbits are two bony sockets that hold and protect the eyeballs and their
associated structures. These structures include the optic nerve, extraocular
muscles, the lacrimal apparatus, fascia and neurovasculature that supply them,
as well as orbital fat within which these structures are embedded.
Supraorbital foramen Frontal bone

of frontal bone
Zygomatic process Orbital surface of

of frontal bone frontal bone
Lesser wing of Anterior and
sphenoid bone posterior ethmoidal
Greater wing of foramina
sphenoid bone Optic canal
Superior
orbital fissure
Nasal bone
Orbital process
of palatine bone Frontal process
Orbital surface of maxilla
of zygomatic
bone
Lacrimal bone
Inferior orbital
fissure
Orbital plate of
Zygomatic bone ethmoid bone
Orbital surface
Infraorbital groove
of maxilla
Infraorbital foramen
Maxilla
of maxilla
FIGURE 8.45. Bones of the orbit: Overview. Anterior view of the right orbit showing its bony walls and
associated fissures and foramina. The superior wall of the orbital cavity is formed mainly by the orbital
surface of the frontal bone. The medial wall consists of the orbital plate of ethmoid bone, the frontal
process of maxilla, the lacrimal and the sphenoid bones. The inferior wall of the orbit is formed by the
orbital surface of maxilla, orbital process of palatine bone and zygomatic bone, while the lateral wall
consists of the frontal process of zygomatic bone and the greater wing of sphenoid bone.
Key points about the bony orbit
Bones Maxilla, frontal, zygomatic, ethmoid, lacrimal, sphenoid and palatine bones
Roof (superior): orbital surface of frontal bone, lesser wing of sphenoid bone
Medial: orbital plate of ethmoid bone, frontal process of maxilla, lacrimal bone,
lesser wing of sphenoid bone
Walls
Floor (inferior): orbital surface of maxilla, orbital process of palatine bone,
zygomatic bone
Lateral: frontal process of zygomatic bone, greater wing of sphenoid bone
Supraorbital foramen, infraorbital groove, infraorbital foramen, anterior and

Fissures and
posterior ethmoidal foramina, optic canal, superior orbital fissure, inferior
foramina
orbital fissure

ORBIT AND CONTENTS
gm Bones of the orbit Viscerocranium
Foramina and fissures

of the skull
Iwlttiwii
Head and neck 409

ORBIT AND CONTENTS
MUSCLES OF THE ORBIT

The muscles of the orbit, also referred to as extraocular muscles, or extrin
sic muscles of the eyeball, consist of seven skeletal muscles that are located
within the orbital cavity, external to the eyeball. Of the seven muscles, the leva
tor palpebrae superioris muscle elevates the upper eyelid. The remaining six are
responsible for moving the eyeball in various directions and consist of four recti
muscles (superior, inferior, medial and lateral rectus muscles) and two oblique
muscles (superior and inferior oblique muscles).
FIGURE 8.46. Muscles of the orbit. Lateral view of the left orbit (left image) and anterior view of the right
u orbit (right image) showing the positions of muscles of the orbit. The most superior muscle is the levator
id
Z palpebrae superioris, originating from the lesser wing of the sphenoid bone and inserting on the superior
a tarsus and skin of the superior eyelid. Four straplike recti muscles (superior, inferior, medial and lateral
z
< rectus muscles) all originate from the common tendinous ring and run straight within the orbit to insert
a on the anterior half of the eyeball. The superior oblique muscle arises from the body of sphenoid bone
<
id and passes superomedially within the orbit, with its tendon running through the trochlea of the superior
I
oblique, prior to inserting on the superior surface of the eyeball. The inferior oblique muscle is seen
crossing the floor of the orbit below the inferior rectus muscle after arising from the maxillary bone, to
insert on the inferior surface of the eyeball below the lateral rectus muscle.

ORBIT AND CONTENTS
Extraocular
muscles
Levator
Lesser wing of Oculomotor nerve Elevates superior
palpebrae Superior tarsal plate
sphenoid bone (CN III) eyelid
superioris
Lateral Abducens nerve

Abducts eyeball
rectus (CN VI)
Medial rectus Adducts eyeball

Anterior half of
Common Elevates, adducts,
Superior eyeball (posterior
tendinous ring internally rotates
rectus to corneoscleral
(Anulus of Zinn) eyeball
junction)
Oculomotor nerve Depresses, adducts,
Inferior (CN III) externally rotates
rectus
eyeball
Inferolateral aspect Abducts, elevates,

Inferior Orbital surface
of eyeball (deep to externally rotates
oblique of maxilla
lateral rectus muscle) eyeball
Superolateral aspect
Abducts, depresses,
Superior Body of sphenoid of eyeball (deep to Trochlear nerve
internally rotates
oblique bone rectus superior, via (CN IV)
eyeball
trochlea orbitae)
Muscles of the orbit Nerves of the orbit
Head and neck 411

ORBIT AND CONTENTS
NEUROVASCULATURE OF THE ORBIT
The ophthalmic artery provides the main arterial supply to the orbit with minor
contributions from the external carotid artery. The principal drainage system of
the orbit is by the ophthalmic veins.
Facilitating vision, movements of the eye, tear production and general sensa
tion are the nerves of the orbit which include the optic nerve (CN II), oculomo
tor nerve (CN III), trochlear nerve (CN IV), abducens nerve (CN VI) and autonomic
nerves. The ophthalmic (V1) and maxillary branches (V2) of the trigeminal nerve
(CN V) also supply branches which innervate structures of the orbit.
Supratrochlear artery
ophthalmic artery
Dorsal nasal artery
Lacrimal artery
Ophthalmic artery
Superior ophthalmic
vein
Cavernous sinus
Vorticose veins
Inferior ophthalmic
vein
Infraorbital artery
Infraorbital vein
Pterygoid venous
plexus
Maxillary artery
FIGURE 8.47. Arteries and veins of orbit (lateral view). The main artery of this region is the ophthalmic
artery (arising from the internal carotid artery), which gives off 10 branches to supply all of the structures
of the orbit, in addition to some surrounding structures. The lacrimal artery arises from the ophthalmic
artery just lateral to the optic nerve and courses anteriorly to supply the lacrimal gland. The muscular
branches of the ophthalmic artery supply the intrinsic muscles of the eyeball and give off a small branch,
the anterior ciliary artery which supplies the anterior eye.
The supratrochlear and dorsal nasal arteries travel through and exit the orbit to supply regions of the
nose, eyelids, forehead and scalp. Other branches of the ophthalmic artery (central retinal, posterior cili
ary, medial palpebral, supraorbital and the anterior and posterior ethmoidal arteries) can be observed from
a superior view of the orbit (see next image). Aside from the ophthalmic artery, this region is also supplied
by the maxillary artery (arising from the external carotid artery), which gives off an infraorbital branch to
supply the floor of the orbit.
Venous drainage of the orbit is mainly facilitated by the superior and inferior ophthalmic veins, central
retinal vein, vorticose veins and infraorbital vein which drain into the cavernous sinus of the cranial cavity
and pterygoid plexus of veins within the infratemporal fossa.

ORBIT AND CONTENTS
FIGURE 8.48. Arteries and veins of orbit (superior view). The central retinal artery arises from the
ophthalmic artery and courses alongside the optic nerve within the dural sheath, to supply the inner layers
of the retina of the eyeball. The long and short posterior ciliary arteries extend anteriorly and supply the
choroid, ciliary body and iris of the eyeball. The supraorbital artery arises from the ophthalmic artery as
it passes medially and crosses the optic nerve in the orbital cavity. It supplies some of the muscles of the
eye as well as the skin and muscles of the forehead via superficial and deep branches. The anterior and
posterior ethmoidal arteries arise from the ophthalmic artery within the orbital cavity and pass medially
to enter the ethmoidal canal. They supply the nasal cavity and septum.
Venous drainage of the superior orbital region is mainly carried out by the superior ophthalmic vein and its
associated tributaries. It accompanies the ophthalmic artery along its course, passing through the supe
rior orbital fissure to reach the cavernous sinus.
Key points about the blood vessels of the orbit
Ophthalmic artery: lacrimal artery, long and short posterior ciliary arteries,
muscular branches of ophthalmic artery (anterior ciliary arteries), central retinal
Arteries artery, supraorbital artery, anterior and posterior ethmoidal arteries, medial
palpebral arteries, supratrochlear artery, dorsal nasal artery
Maxillary artery: infraorbital artery
Superior ophthalmic vein: tributaries ^ nasofrontal vein, anterior and posterior

ethmoidal veins, lacrimal vein, vorticose veins, ciliary veins, central retinal vein,
episcleral veins; drains into cavernous sinus
Inferior ophthalmic vein: drains into superior ophthalmic vein/cavernous sinus/

Veins pterygoid plexus of veins
Central retinal vein: drains into cavernous sinus but may join superior ophthalmic vein
Vorticose veins: drain into ophthalmic veins
Infraorbital vein: drains into pterygoid venous plexus
Head and neck 413

ORBIT AND CONTENTS
Frontal nerve
Oculomotor nerve
Supraorbital nerve
Supratrochlear
nerve
Superior branch of
oculomotor nerve
Lacrimal nerve
Short ciliary nerves
Ciliary ganglion
Branch of nasociliary
nerve to ciliary
ganglion
Inferior branch of
oculomotor nerve
Communicating
branch of zygomatic
nerve to lacrimal
nerve
Infraorbital nerve
Ophthalmic nerve
Zygomatic nerve
Maxillary nerve
Trigeminal nerve
FIGURE 8.49. Nerves of orbit (lateral view: Eyeball in situ). The superior and inferior branches of the
oculomotor nerve (CN III) enter the orbit through the superior orbital fissure to supply the extraocular
muscles of the eye. The ophthalmic nerve (CN V1) passes through the cavernous sinus and divides into
three branches: The lacrimal, frontal and nasociliary nerves (not visible) before passing through the
superior orbital fissure to enter the orbit. The lacrimal nerve carries sensory and autonomic nerve fibers
to supply the lacrimal gland, eyelids and conjunctiva. The frontal nerve divides into supratrochlear and
supraorbital branches and conveys general sensation from the forehead, glabella, frontal sinus, skin of the
upper eyelid and conjunctiva.
The orbit also receives partial innervation from the zygomatic and infraorbital branches of the maxillary
nerve (CN V2). Located towards the posterior region of the orbit is the parasympathetic ciliary ganglion.
The ciliary ganglion relays parasympathetic impulses and transports sympathetic and sensory impulses to
structures of the orbit.

ORBIT AND CONTENTS
Anterior ethmoidal
nerve
Posterior ethmoidal
nerve
Nasociliary nerve
FIGURE 8.50. Nerves of orbit (lateral view: Eyeball removed). The nasociliary nerve arises from the
ophthalmic branch (CN V1) of the trigeminal nerve and runs obliquely forward through the orbit. Along the
way it gives off the long ciliary (not shown), posterior and anterior ethmoidal and infratrochlear nerves,
which supply regions of the orbit. The nasociliary nerve conveys sensation from the skin of the dorsum of
the nose, eyelids, medial conjunctiva, membranes of the ethmoidal air cell, sphenoid sinus and portions of
the nasal cavity. It also transmits sympathetic fibers which supply sensory fibers to the sclera, cornea, iris
and ciliary body through the ciliary ganglion.
Key points about the nerves of the orbit
Superior branch of oculomotor nerve

Oculomotor
Inferior branch of oculomotor nerve
nerve (CN III)
(Branch of oculomotor nerve to ciliary ganglion)
Frontal nerve
Supraorbital nerve
Nasociliary nerve
Ophthalmic Posterior ethmoidal nerve
nerve (V1) Anterior ethmoidal nerve
Long ciliary nerves
Branch of nasociliary nerve to ciliary ganglion
Lacrimal nerve
Zygomatic nerve
Maxillary nerve Zygomaticotemporal nerve (Communicating branch of zygomaticotemporal nerve
to lacrimal nerve)
(V2)
Infraorbital nerve
Head and neck 415

ORBIT AND CONTENTS
Key points about the nerves of the orbit
Parasympathetic ganglion in the orbit; receives preganglionic fibers from the

oculomotor nerve, gives off postganglionic branches (short ciliary nerves) to ciliary
Ciliary ganglion muscle and sphincter pupillae.
(Postganglionic sympathetic fibers from internal carotid plexus as well as sensory/
afferent fibers also pass through this ganglion)
Nasociliary nerve
Ciliary ganglion
Lacrimal nerve
Frontal nerve
Abducens nerve
nerve to ciliary
ganglion
Optic nerve
Ophthalmic nerve
Maxillary nerve
Oculomotor nerve
Trochlear nerve
FIGURE 8.51. Nerves of orbit (superior view). The optic nerve (CN II) is purely sensory and transmits visual
impulses from the eyeball to the brain. The trochlear nerve (CN IV) and abducens nerve (CN VI) enter the
orbit through the superior orbital fissure to supply the extraocular muscles of the eye.
The ciliary ganglion is one of the four parasympathetic ganglia of the head and receives preganglionic
parasympathetic fibers from the Edinger-Westphal nucleus via the oculomotor nerve (CN III). It supplies
structures of the eye (ciliary and sphincter pupillae muscles) via the short ciliary nerves with parasympa
thetic, sensory and sympathetic fibers, which also pass through the ganglion.
Blood vessels and

nerves of the eye

ORBIT AND CONTENTS
SUPERIOR AND INFERIOR ORBITAL FISSURES
The superior and inferior orbital fissures are clefts inside the bony orbit. They
are located between the lesser and greater wings of the sphenoid bone, and the
sphenoid bone and the maxilla, respectively.
The orbit and the middle cranial fossa communicate via the superior orbital fis
sure, while the inferior orbital fissure connects the pterygopalatine fossa to the
bony orbit. Several important neurovascular structures pass through the supe
rior and inferior orbital fissures.
Lacrimal nerve
Frontal nerve
Superior ophthalmic
vein
Trochlear nerve
Superior branch of
Inferior branch of
Orbital branches of
pterygopalatine ganglion
— Infraorbital nerve
Infraorbital artery
Infraorbital vein
Zygomatic nerve
FIGURE 8.52. Superior and inferior orbital fissures: Neurovasculature. The superior orbital fissure
is located superolateral to the optic canal and positioned between the lesser and greater wings of the
i
m
sphenoid bone. The common tendinous ring is situated along the anteroinferior aspect of the superior >
□
orbital fissure. Several nerves and veins pass through the superior orbital fissure with some also extending >
within the common tendinous ring. From superior to inferior, the contents of the superior orbital fissure
z
□
include the lacrimal nerve, frontal nerve, superior ophthalmic vein, trochlear nerve (CN IV), the superior z
branch of the oculomotor nerve (CN III), nasociliary nerve, abducens nerve (CN VI), the inferior branch of
m
n
the oculomotor nerve (CN III) and the superior branch of the inferior ophthalmic vein.
7s
The inferior orbital fissure is located between the sphenoid bone and maxilla and lies inferolateral to the
optic canal and inferior to the superior orbital fissure. It opens into the posterolateral aspect of the orbital
floor and allows the passage of several neurovascular structures. Contents of the inferior orbital fissure
include the infraorbital nerve, zygomatic nerve, inferior branch of the inferior ophthalmic vein, infraorbital
artery and the orbital branches of the pterygopalatine ganglion.
Head and neck 417

ORBIT AND CONTENTS
Levator palpebrae
superioris muscle
Superior rectus muscle
Superior oblique muscle
- Sheath of optic nerve
Optic nerve
Lateral rectus muscle
Ophthalmic artery
Medial rectus muscle
Common tendinous
ring (of Zinn)
Superior branch of
oculomotor nerve
Nasociliary nerve
Inferior branch of
oculomotor nerve
Abducens nerve
Inferior rectus muscle
FIGURE 8.53. Common tendinous ring: Structure and neurovasculature. The common tendinous ring
of Zinn is a fibrous tissue that serves as a common origin for the four rectus muscles. It encircles the
inferolateral part of the superior orbital fissure and surrounds the superior branch of the oculomotor
nerve (CN III), nasociliary nerve, abducens nerve (VI) and the inferior branch of the oculomotor nerve (CN III)
as they pass through the superior orbital fissure.
Contents of the superior and inferior orbital fissures
Lacrimal and frontal nerve (branches of CN V1), trochlear nerve, superior

ophthalmic vein, inferior and superior branches of oculomotor nerve,
Superior orbital fissure
nasociliary nerve (branch of CN V1), abducens nerve, and superior branch
of inferior ophthalmic vein
Inferior branch of inferior ophthalmic vein, orbital branches of

Inferior orbital fissure pterygopalatine ganglion, infraorbital nerve (branch of CN V2),
infraorbital artery and vein, and zygomatic nerve (branch of CN V2)
Arteries and veins

Nerves of the orbit
of the orbit

ORBIT AND CONTENTS
ANATOMY OF THE EYEBALL
The globe shaped eyeball sits within the anterior aspect of the orbit of the skull
and contains the optical structures responsible for vision.
The outer fibrous layer (external tunic) is formed by the sclera and the protrud
ing translucent cornea. The middle vascular layer (middle tunic), also known as
the uvea, consists of three connecting layers: The choroid, ciliary body and iris.
The inner layer (internal tunic) is formed solely by the retina.
Between the cornea and lens are two chambers (anterior and posterior) which
are separated by the iris. The anterior and posterior chambers communicate
with each other via the pupil and are filled with a nutrient rich fluid known as
aqueous humor. A third, postremal chamber is located posterior to the lens
which houses the vitreous body of the eye.
FIGURE 8.54. Eyeball (transverse section). The choroid of the eye is located between the sclera and retina
and is filled with numerous vascular bundles which supply the outer portion of the retina. Posterior to the
iris and anterior portion of the sclera is a thickening of muscular and connective tissue known as the ciliary
body. The final component of the vascular layer is the pigmented iris which contains a central aperture
known as the pupil.
The retina forms the inner layer of the eye and is composed of non-visual and optic parts. Located poste
rior to the lens and enveloped by the retina is a compartment known as the postremal/vitreous chamber
which is occupied by a semi-solid/jelly-like structure known as the vitreous body. Embedded within the
meshes of the vitreous body is a fluid-like substance known as vitreous humor. Together these structures
allow for the passage of light to the retina and provide structural support to the lens anteriorly.
Head and neck 419

ORBIT AND CONTENTS
Capsule of lens Cornea
Iris
Sphincter pupillae muscle
PupiL
Anterior chamber Dilator pupillae muscle
Iridocorneal angle
Venous sinus of sclera

Corneoscleral
junction
Ciliary body
Bulbar conjunctiva
Zonular fibers
Posterior chamber
Lens
FIGURE 8.55. Anterior part of eyeball (transverse section). The opaque sclera lies just behind the
translucent bulbar conjunctiva and provides an attachment site for the extrinsic and intrinsic muscles of
the eye. Located on the inner portion of the anterior sclera at the iridocorneal angle is the venous sinus of
sclera (canal of Schlemm), which collects aqueous humor from the anterior chamber of the eye, delivering
it through a trabecular meshwork into the bloodstream. Forming the transparent part of the fibrous layer
is the convex cornea. The junction at which the cornea and sclera meet is known as the corneoscleral
junction.
Key points about the anatomy of the eyeball
Connective Anterior: bulbar conjunctiva

tissue layer Posterior: fascial sheath of eyeball
Fibrous layer Cornea: bordered by corneoscleral junction
(External tunic) Sclera: features venous sinus of sclera, sulcus sclerae, scleral spur
Iris: surrounds pupil, contains sphincter pupillae/dilator pupillae muscles

Vascular layer Ciliary body: corona ciliaris/pars plicata (with ciliary processes and folds), orbiculus
(Middle tunic) ciliaris/pars plana, ciliary muscle, zonular fibres
Choroid
Inner layer Retina: nonvisual retina (iridal and ciliary parts), ora serrata, optic part of retina
(Internal tunic) Intraocular part of optic nerve: optic disc
Anterior chamber
Chambers Posterior chamber
Postremal chamber: vitreous body (with vitreous humor/membrane, hyaloid canal)
Cornea
Refractive Aqueous humor

media Lens
Vitreous body (and vitreous humor)

ORBIT AND CONTENTS
FIGURE 8.56. Lens and ciliary body (posterior view). At the center of this image is the lens, located
posterior to the iris and anterior to the postremal/vitreous chamber of the eye. The capsule of the lens
is anchored to adjacent ciliary processes of the ciliary body by zonular fibers which collectively form the
suspensory ligament of the lens/ciliary zonule.
The anterior portion of the ciliary body is known as the corona ciliaris/pars plicata and is marked by ciliary
processes (separated by ciliary folds) which function to produce aqueous humor within the posterior
chamber providing nutrients for the cornea and lens. The orbiculus ciliaris/pars plana forms the posterior
portion of the ciliary body and terminates along the ora serrata. The optic part of the retina is continuous
with the choroid and sclera before terminating anteriorly at the ora serrata while the non-visual part of
the retina extends over the ciliary body and iris.
Structure of the
Visual pathway
eyeball
Blood vessels and Arteries and veins of

nerves of the eye the orbit
Head and neck 421

ORBIT AND CONTENTS
BLOOD VESSELS OF THE EYEBALL
The eyeball receives its main arterial supply via the ophthalmic artery that
gives off several branches. The venous drainage occurs via the central retinal,
superior ophthalmic, inferior ophthalmic, and middle ophthalmic veins. The
veins drain an intricate venous network located between the different layers
of the eyeball.
Minor arterial
circle of iris
Major arterial
circle of iris
Muscular branches
of ophthalmic artery
Anterior ciliary
arteries
Long posterior
ciliary arteries
Short posterior
ciliary arteries
Vorticose veins
Bulb of vorticose
vein
Central retinal
artery
Ophthalmic artery
FIGURE 8.57. Blood vessels of the eyeball: Overview. The main arterial supply arises from the ophthalmic
artery, a branch of the internal carotid artery. It gives rise to several ocular branches, such as the central
retinal artery, muscular branches (which give rise to the anterior ciliary arteries), as well as the long and
short posterior ciliary arteries. The central retinal artery supplies the optic nerve and the innermost layers
of the retina. The ciliary arteries supply the choroid and the outermost layers of the retina. The anterior
ciliary arteries and the posterior ciliary arteries anastomose to form the minor and major arterial circle of
the iris. Venous drainage occurs via the vorticose veins and the central retinal vein into the superior and
inferior ophthalmic veins.
Key points about the blood vessels of the eyeball
Branches of ophthalmic artery: central retinal, anterior ciliary, short and long
Arterial supply
posterior ciliary, episcleral artery, muscular branches
Venous Central retinal vein, vorticose veins, anterior ciliary veins, episcleral and muscular
drainage veins drain into superior and inferior ophthalmic veins.

ORBIT AND CONTENTS
EYELIDS AND LACRIMAL APPARATUS
The accessory structures of the eye are the eyelids and lacrimal apparatus,
whose function is to protect and lubricate the eye.
Superior conjunctival
fornix
Superior tarsal
/ muscle
Iris
Cornea
^^n^ Lens
Anterior
—-—- chamber
t ; Ciliary and
----- —---- — sebaceous
glands
Posterior
chamber
Ciliary body
Inferior conjunctival
\ fornix
Inferior tarsal muscle
FIGURE 8.58. Eyelids and conjunctiva (sagittal section). Directly adjacent to the cornea is the bulbar
conjunctiva, a mucous membrane which lines the anterior surface of the eyeball and continues along the
inner surface of the eyelids as the palpebral conjunctiva.
Also depicted in the image are the numerous layers composing the eyelid: Outermost the skin and eye
lashes (cilia), followed by a layer of subcutaneous tissue, skeletal muscle, tarsal plate and innermost, the
palpebral conjunctiva. The skeletal muscle within the eyelid is mainly fibers of the palpebral portion of the
orbicularis oculi muscle, which surrounds the eye and acts as a type of sphincter, as it closes the eyes upon
contraction. The tarsal plate is a plate of dense connective tissue, responsible for the crescent-shaped
form of the eyelid, conforming to the convex anterior surface of the eyeball.
Head and neck 423

ORBIT AND CONTENTS
Frontal bone
Lacrimal sac
Lacrimal gland
Inferior nasal
concha
Lacrimal papilla
Nasolacrimal
duct
Lacrimal
caruncle
Middle nasal
Lacrimal concha of
canaliculus ethmoid bone
Opening of Inferior nasal

nasolacrimal duct meatus
FIGURE 8.59. Lacrimal apparatus. The lacrimal gland is located within a small fossa on the orbital surface
of the frontal bone and is separated into a superior orbital part and an inferior palpebral part by the
aponeurosis of the levator palpebrae superioris muscle. It produces lacrimal fluid, which is the aqueous
component of the tear film and reaches the eye through 6-12 excretory ducts that open up into the
superolateral aspect of the conjunctival sac between the eyelids and eyeball. The fluid then moves from
lateral to medial across the eyeball, facilitated by the blinking of the eyelids, and collects in the lacrimal
lake in the medial angle of the eye. This accumulation of fluid is drained by the lacrimal papillae, which
conduct the fluid through the lacrimal canaliculi into the lacrimal sac, which continues inferiorly as the
nasolacrimal duct opening on the lateral wall of the inferior nasal meatus.
Key points about the eyelids
Shield eyes from dust and other foreign particles; protect eyes from injury and
Function
excessive light; maintain a moist surface on the cornea
From superficial to deep: skin and eyelashes (cilia), subcutaneous tissue, skeletal
Layers muscle (orbicularis oculi muscle/levator palpebrae superioris), tarsal plate,
palpebral conjunctiva
Ciliary glands (of Moll): secrete a lipid-based compound, prevents evaporation of

tear film
Secretions of
Sebaceous glands (of Zeis): secrete sebum for hair follicles of the eyelashes (cilia)
the eyelid
Tarsal glands (Meibomian glands): secrete a sebaceous substance (meibum), for an
oily layer across the anterior eyeball to prevent evaporation of tear film
u
id
Z
a
z Key points about the lacrimal apparatus
<
a Function Production, movement and drainage of lacrimal fluid
<
id
I Production of lacrimal fluid: lacrimal gland
e Excretion: 6-12 excretory ducts of lacrimal gland

Components
Drainage: through lacrimal caruncle, lacrimal papilla, lacrimal canaliculus, lacrimal
sac, nasolacrimal duct ^ inferior nasal meatus

NASAL REGION
NASAL CAVITY
The nasal cavities are spaces within the anterior aspect of the skull, located
directly behind the external nose. The left and right cavities are separated in
the midline by a central nasal septum (medial wall) and both chambers are also
bounded by a roof, floor and lateral wall.
Each cavity has three regions: Vestibule region, respiratory region and the
olfactory region. The vestibule is located within the nares. It is lined by skin and
houses hair follicles. The olfactory region is the most superior part of the nasal
cavity, it is lined by olfactory epithelium and contains olfactory receptors. The
remaining nasal cavity forms the large respiratory region. This area is lined by
respiratory epithelium with ciliated and mucous cells and contains the nasal
conchae and meatuses.
Ethmoid bone Frontal bone
Frontal sinus Superior nasal meatus
Sphenoethmoidal
Agger nasi recess
Sphenoidal sinus
Nasal bone
Sphenopalatine
Lateral nasaL foramen
cartilage
Sphenoid bone
Nasal surface of
maxilla
Middle nasal concha
of ethmoid bone
Major alar
cartilage Medial plate of
pterygoid process of
Minor alar sphenoid bone
cartilages
Palatine bone
Lacrimal bone
Middle nasal meatus i
m
>
□
>
Inferior nasal meatus Inferior nasal concha z
□
z
m
FIGURE 8.60. Lateral wall of the nasal cavity. The anterior apertures to the nasal cavity are the nostrils n
7s
(nares), while posteriorly the nasal cavity opens into the nasopharynx via the choanae. The roof houses
the cribriform plate, which allows the passage of olfactory fibers conveying the sense of smell. The
hard palate is the floor, separating the nasal from the oral cavity. The medial wall is formed anteriorly by
cartilage and posteriorly by the very thin vomer bone and the perpendicular plate of the ethmoid bone.
Both are covered by a thin, mucosal lining.
The lateral wall of each nasal cavity exhibits three curved bony shelves. These are the superior, middle
and inferior conchae. The conchae project medially into the nasal cavity forming four air channels through
Head and neck 425

NASAL REGION
which inhaled air can flow, increasing the surface area between the lateral wall and the passing air. From
inferior to superior the four air channels are the inferior nasal meatus, middle nasal meatus, superior nasal
meatus and the sphenoethmoidal recess.
Posterior process of
Cribriform plate of cartilage of nasal
ethmoid bone septum
Perpendicular plate Vomer

of ethmoid bone
Posterior nasal
Cartilage of nasaL spine of palatine
septum bone
Palatine process Horizontal plate

of maxilla of palatine bone
Nasal septum Pharyngeal tonsil
Choana
Torus tubarius
Hard palate
Pharyngeal opening
Soft palate
of auditory tube
FIGURE 8.61. Medial wall of the nasal cavity. The nasal septum divides the nasal cavity into the right and
left chambers. This septum has both bony and cartilaginous parts, composed mainly by the perpendicular
plate of the ethmoid, the vomer and the septal cartilage. The septum is smooth and mostly featureless,
and like the rest of the nasal cavity, it is covered with nasal mucosa.
Key points about the nasal cavity
Skeletal Ethmoid bone, sphenoid bone, frontal bone, vomer, nasal bone (2), maxilla (2),
framework palatine bone (2), lacrimal bone (2) and inferior nasal concha bone (2)
Roof - cribriform plate

Floor - hard palate
Boundaries
Medial wall - nasal septum
Lateral wall - houses the conchae and meatuses
Anterior - nostrils
Posterior - nasopharynx (choana)
Apertures Superior - cribriform plate

Inferior - Incisive canal
Posterosuperior - sphenopalatine foramen

NASAL REGION
NEUROVASCULATURE OF THE NASAL CAVITY

The nasal cavity has a rich neurovascular supply, provided by the nasal arteries,
veins and nerves. Nasal arteries warm and humidify inhaled air, preparing the air
to travel down into our lungs. Nasal veins drain the deoxygenated blood. Nasal
nerves carry olfactory information and general sensation, as well as parasym
pathetic (secretomotor) signals to and from the brain allowing for the sense of
smell and taste.
Nasal septal branch of

superior labial artery
Posterior septal branches of

sphenopalatine artery
Septal branches of posterior

ethmoidal artery
Anterior septal branches of

anterior ethmoidal artery
Posterior ethmoidal artery
Anterior ethmoidal artery
Anterior lateral nasal branches

of anterior ethmoidal artery
External nasal branches of

anterior ethmoidal artery
Lateral nasal branches of

posterior ethmoidal artery
Sphenopalatine artery
Posterior lateral nasal branches

of sphenopalatine artery
Superficial temporal artery

of facial artery
Maxillary artery
Greater palatine artery
FIGURE 8.62. Arteries of the nasal cavity. The lateral wall and nasal septum of the nasal cavity receive
arterial supply from five main arteries: The anterior and posterior ethmoidal arteries (ophthalmic artery),
the sphenopalatine and greater palatine arteries (maxillary artery) and the septal branch of the superior
labial artery (facial artery). The anterior and posterior ethmoidal and sphenopalatine arteries divide into
lateral and septal branches as they enter the nasal cavity, while the greater palatine artery enters the
nasal cavity via the incisive canal of the hard palate. The septal branch of the superior labial artery does
not give off any named branches and terminates by anastomosing with the anterior septal branches of the
anterior ethmoidal artery. These arteries collectively supply the ethmoidal and frontal sinuses, the roof
of the nasal cavity as well as the mucosa of the nasal conchae, the nasal meatuses and the nasal septum.
All 5 arteries anastomose in an arterial plexus located in the anterior nasal septum termed the Kiesselbach
area. This region is a common site for nose bleeds (epistaxis).
Head and neck 427

NASAL REGION
Posterior septal branches

of sphenopalatine vein
Septal branches of
posterior ethmoidal vein
Posterior ethmoidal vein
Anterior septal branches of

anterior ethmoidal vein
Anterior ethmoidal vein
Lateral nasal branch of

posterior ethmoidal vein
Anterior lateral nasaL

branches of anterior
ethmoidal vein
Sphenopalatine vein
Posterior lateral nasaL

branches of
sphenopalatine vein

of facial vein
Greater palatine vein
FIGURE 8.63. Veins of the nasal cavity. The nasal veins (sphenopalatine, facial, and ophthalmic veins)
follow the pathways of the arteries forming a rich venous plexus within the mucosa of the nasal cavity,
particularly at the posterior end of the inferior nasal meatus (Woodruff’s plexus). Veins of the nasal cavity
have three main drainage points: The facial vein, cavernous sinus and pterygoid venous plexus. The
sphenopalatine vein and its associated tributaries generally travel through the sphenopalatine foramen
to drain into the pterygoid venous plexus. The greater palatine vein drains the hard palate and gingiva and
enters the infratemporal fossa to also drain into the pterygoid venous plexus. The ethmoidal veins drain
the roof and upper septal and lateral walls of the nasal cavity, ethmoidal air sinuses, dorsum of the nose
and dura mater. The posterior ethmoidal vein and its associated tributaries empty into the cavernous sinus
while the anterior ethmoidal vein and its tributaries drain to the facial or superior ophthalmic vein.

NASAL REGION
Nasopalatine nerve
Medial nasal branches of

Olfactory nerve
Anterior ethmoidal nerve

Lateral nasal branches of

Pterygopalatine ganglion
Lateral superior posterior

nasal branches of
Inferior
posterior nasal branches of
Greater palatine nerve
Lesser palatine nerve
FIGURE 8.64. Nerves of the nasal cavity. The nasal cavity is innervated by 3 nerves
1. Cranial nerve I - Olfactory nerve
2. Cranial nerve V - Trigeminal nerve
3. Cranial nerve VII - Facial nerve
The olfactory nerve carries information of smell to the brain. The trigeminal nerve supplies the nasal cavity
with sensation, where CN V1 (ophthalmic nerve) innervates the anterior nasal cavity and CN V2 (maxillary
nerve) the posterior cavity. The facial nerve carries parasympathetic supply to nasal mucous glands.
Lateral wall of the Medial wall of the

nasal cavity nasal cavity
Kiesselbachs plexus Olfactory pathway
Head and neck 429

EAR
EXTERNAL EAR
The external ear consists of the auricle and the external acoustic meatus. It is
separated from the middle ear by the tympanic membrane (eardrum).
Tympanic membrane
Helix
Antihelix
External
acoustic
meatus
Concha
Antitragus
Posterior-
auricular
groove
Lobule
FIGURE 8.65. External ear (coronal section). The auricle is an irregularly shaped cartilaginous structure
covered by a thin layer of skin. It is continuous with the external acoustic meatus, a tubular component
of the external ear. The lateral one-third of the meatus is cartilaginous, while its medial two-thirds
are osseous (temporal bone). The external acoustic meatus terminates with the tympanic membrane
(eardrum) which is connected to the ossicles of the middle ear.

EAR
Anterior crus Triangular fossa of antihelix
Crura of
antihelix Crus
Lposterior crus
— Helix
Tail
Antihelix
Supratragic
notch
Scaphoid fossa Supratragic

tubercle
Tragus
--- Cymba
Concha — Intertragic
incisure
Cavity
Antitragus
Posterior auricular groove Lobule
FIGURE 8.66. Auricle (lateral view). The auricle has several depressions and elevations that comprise its
unique shape. The tragus is one of several cartilaginous flaps in the external ear and provides a lateral
border to the distal end of the external acoustic meatus. The antitragus is located posteroinferior to the
tragus, from which it is separated by the intertragic incisure. The helix forms the outer concave border
of the ear and may present a small congenital protuberance called the auricular tubercle (of Darwin (not
shown)). Internal to the helix is another raised cartilaginous structure called the antihelix which presents
paired, fork-like crura at its superior extremity. It is separated from the helix by the scaphoid fossa. Finally,
the inferior most structure of the auricle is the soft, fibrofatty structure known as the lobule.
Key points about the external ear
Parts Auricle, external acoustic meatus, tympanic membrane
Extrinsic: auricularis superior, auricularis anterior, auricularis posterior

Muscles Intrinsic: tragicus, antitragicus, obliquus auriculae, transversus auriculae, helicis
major, helicis minor
Posterior auricular artery;

Anterior auricular branches of superficial temporal artery;
Blood supply
Small branches of occipital artery, deep auricular artery (of maxillary artery), and
inferior tympanic artery (of ascending pharyngeal artery)
Great auricular nerve;

Innervation
Auriculotemporal nerve (branch of mandibular nerve [CN V3])
I
Function Conduction of sound waves to the middle ear m
>
□
>
z
□
||||||| z
m
n
7s
(Egg jjMgt
Outer ear The ear
Head and neck 431

EAR
MIDDLE EAR
The middle ear consists of an air-filled chamber within the temporal bone
known as the tympanic cavity, located between the external and internal parts
of the ear. It is often divided into two main parts: The inferior tympanic cavity
proper (atrium) and the superior epitympanic recess (attic).
The middle ear is bounded laterally by the tympanic membrane and medially
by the lateral wall of the internal ear. The roof of the cavity is formed by a thin
plate of bone, the tegmen tympani, while the floor is similarly thin, overlying
the internal jugular vein.
The tympanic cavity is directly connected to neighboring anatomical structures

and spaces. Anteromedially, it is directly connected with the auditory tube (Eus
tachian tube) which facilitates equalization of air pressure within the tympanic
cavity with ambient pressure. Posteriorly, the tympanic cavity communicates
with the mastoid cell of the temporal bone via the mastoid antrum. The result
of these direct connections is a continuous mucous membrane between the
tympanic cavity, auditory tube, mastoid cells and antrum.
Tegmental wall of tympanic cavity Epitympanic recess
Mastoid wall of tympanic cavity Tympanic cavity proper
Jugular wall of tympanic cavity
FIGURE 8.67. Parts and walls of tympanic cavity (medial view). The tympanic cavity has two main parts:
The tympanic cavity proper and the epitympanic recess. The tympanic cavity proper is located medially to
the tympanic membrane, while the epitympanic recess lies above the level of the tympanic membrane,
next to the mastoid air cells.

EAR
The tympanic cavity is shaped like a cube, containing 6 walls: Membranous, tegmental, jugular, mastoid,
labyrinthine and carotid wall, with the latter 2 not shown in this section. The membranous (lateral) wall is
formed by the tympanic membrane and the squamous part of temporal bone. The labyrinthine (medial)
wall separates the tympanic cavity from the labyrinth. The tegmental wall (roof) is a thin plate of bone
that separates the tympanic cavity from the cranial cavity, while the jugular wall (floor) separates it from
the jugular vein and the carotid artery below. The carotid (anterior) wall corresponds to the carotid canal
and contains the tympanic opening of the auditory tube, while the mastoid (posterior) wall partly sepa
rates the tympanic cavity from the mastoid antrum.
Facial nerve Anterior semicircular canal
Tegmen tympani
Bony ampullae of
of temporal bone
semicircular canals
Epitympanic recess
Vestibular nerve
Malleus
Vestibulocochlear
nerve
Incus
Cochlear nerve
Base of stapes
Helicotrema
Limbs of stapes
Vestibule of
Stapes internal ear
Tympanic membrane Cochlea
Tympanic cavity Cochlear window
FIGURE 8.68. Middle ear (coronal section). The tympanic cavity is a narrow space located in the petrous
part of the temporal bone. It contains three auditory ossicles (malleus, incus and stapes) which are
suspended via small ossicular ligaments and regulate the transmission of sound from the external
environment to the internal ear. The jugular wall/floor of the tympanic cavity features the pharyngeal
opening of the auditory tube, a part osseous-part cartilaginous conduit which links the tympanic cavity
with the nasopharynx.
Key points about the middle ear
Parts Tympanic cavity (proper), epitympanic recess
Tegmental wall (roof)

Jugular wall (floor)
Membranous (lateral) wall (tympanic membrane)
Walls
Labyrinthine (medial) wall
Mastoid (posterior) wall
Carotid (anterior) wall
Auditory
Malleus, incus, stapes
ossicles
Muscles Tensor tympani muscle, stapedius muscle
Anterior tympanic artery (of maxillary artery), deep auricular artery (of maxillary
Arterial supply
artery), stylomastoid artery (of occipital artery)
Head and neck 433

EAR
Superior ligament —
Body
Short limb _
□
n
c
Posterior ligament
Long limb
Lenticular process..
Head
Limbs
Base
Chorda tympani
Stapedius muscle
Cochleariform process
Tympanic membrane
Tensor tympani muscle
Auditory tube
FIGURE 8.69. Middle ear (sagittal section). This sagittal section (medial view) of the middle ear provides a
better view of the three auditory ossicles, their parts and their ligaments. The malleus consists of a head,
neck, anterior and lateral processes and handle. It is suspended via three ligaments: The superior, anterior
and lateral ligaments of malleus (the former of which is not seen on this view).
The incus consists of a body, short and long limbs, and lenticular process. It is suspended by two ligaments:
The superior and posterior ligaments of incus.
The stapes consists of a head, anterior and posterior limbs, and base; it is suspended via the anular liga
ment of stapes (not shown). In addition, the tensor tympani muscle is clearly seen on this view, running
through the semicanal for the tensor tympani muscle of the temporal bone across the cochleariform pro
cess which acts as a pulley for this muscle. This view also provides a visual of the stapedius muscle, which
attaches on the neck of the stapes.
Key points about the middle ear
Tympanic plexus (glossopharyngeal nerve [CN IX]), nerve to stapedius (facial nerve
Innervation [CN VII]), nerve to tensor tympani (of mandibular nerve [CN V3]), caroticotympanic
nerves
Function Conduction of sound waves to the inner ear
Auditory ossicles Middle ear

EAR
INTERNAL EAR
The internal ear is located in the petrous part of the temporal bone, between
the tympanic cavity (middle ear) laterally and the internal acoustic meatus
medially. It is formed by a number of bony cavities (bony labyrinth), which con
tain several membranous ducts and sacs (membranous labyrinth).
The cavities forming the bony labyrinth are the vestibule, cochlea, and three
semicircular canals. These cavities are filled with a clear fluid, called perilymph.
The membranous labyrinth lies suspended within the bony labyrinth, and is also
filled with a fluid, the endolymph. It consists of three semicircular ducts (one
inside each semicircular canal), the cochlear duct (inside the cochlea) and two
sacs found in the vestibule, the saccule and the utricle.
The internal ear has two main functions, acting as a transducer transforming
the mechanical energy of sound waves into neuronal impulses (cochlear part
of the internal ear), and also playing an important role in the maintenance of
balance (vestibular part of the internal ear and semicircular canals).
Common bony Anterior semicircular canal

limb
Simple Vestibule
bony limb
Vestibular
Posterior window
semicircular
canaL
Cochlea
Lateral
semicircular
canal
Helicotrema
Anterior bony
ampulla
Scala vestibuli
Lateral bony
ampulla Cochlear window
Posterior bony ampulla Scala tympani
FIGURE 8.70 . Bony labyrinth. The bony labyrinth is located within the petrous part of the temporal bone.
It consists of three continuous parts: Vestibule, cochlea and semicircular canals.
The vestibule is a central bony cavity which communicates with the middle ear through the vestibular
window on its lateral wall.
Head and neck 435

EAR
Posterosuperiorly, the vestibule is continued by the three semicircular bony canals, each placed in a spe
cific anatomical plane. The anterior canal lies in the sagittal plane, the posterior is in the lateral plane, while
the lateral canal lies in the transverse plane. The canals arise from the vestibule via bony ampullae (ante
rior, posterior, lateral). They curve through their respective planes, diving back into the bony vestibule.
The lateral canal does so directly via the simple bony limb, while the anterior and posterior canals merge
forming the common bony limb which then joins the vestibule.
The cochlea is a snail-like structure that spirals from the anterior part of the vestibule. The cochlea is
essentially a bony canal that spirals around its axis two and a half times. The central portion of the cochlea,
i.e. the axis, around which it spirals, is called the modiolus. Along the entire length of the cochlea is a thin
bony lamina which divides the cochlea into two parts: Scala vestibuli and scala tympani. These sub-canals
are entirely separate except at the apex of the cochlea, where they communicate through a narrow slit
called the helicotrema.
The whole bony labyrinth is filled with perilymph.
Anterior semicircular Anterior ampullary nerve

duct
Common
membranous Utricular nerve
limb
Anterior Superior part of
membranous vestibular ganglion
ampulla
Posterior Vestibular nerve

semicircular
duct
Facial nerve
Lateral
semicircular
duct
Cochlear nerve
Lateral ampullary
nerve Inferior part of
vestibular
Lateral ganglion
membranous
ampulla Saccular nerve
Posterior
membranous Posterior ampullary
ampulla nerve
Utricle of vestibular-
labyrinth Cochlear duct
Saccule of vestibular Ductus reuniens (of Hensen)

labyrinth
FIGURE 8.71 . Membranous labyrinth. The membranous labyrinth is suspended within the perilymph of
the bony labyrinth thus mirroring its overall structure. The central part of the membranous labyrinth
is located within the bony vestibule. It consists of two sacs: Utricle and saccule, which communicate
via a small duct called the ductus reuniens. The utricle lies in the posterior part of the vestibule, while
the saccule lies anteriorly. The three membranous semicircular ducts branch from the utricle and pass
through the semicircular canals. Similar to their bony counterparts, the canals originate with membranous
ampullae (anterior, posterior, lateral). The anterior and posterior duct unite as well, forming the common
membranous limb.
The bony cochlea houses the membranous cochlear duct which follows its spiral course.
The whole membranous labyrinth is filled with endolymph. Movement of endolymph stimulates the
receptor cells within the walls of the labyrinth, producing neuronal stimuli related to balance and hearing.
These stimuli are conveyed via the vestibulocochlear nerve, whose components can be seen innervating
different parts of the labyrinth. Essentially, the vestibular nerve innervates the utricle, saccule and semi
circular ducts, via its branches, conveying the information about balance. Branches of the cochlear nerve
innervate the spiral organ of Corti that is located in the cochlea, providing information about hearing.

EAR
Scala vestibuli Vestibular membrane
Interdental cells Cochlear duct
Spiral limbus Spiral prominence
Osseous Stria vascularis

spiral lamina
Peripheral Outer spiral sulcus

fibers of
cochlear nerve
Cochlear- Spiral ligament

ganglion
Cochlear nerve Supporting cells
Modiolus Spiral organ
Habenula perforata Scala tympani
FIGURE 8.72 . Cochlea (cross section). The cochlea is the structure of the internal ear responsible for
hearing. Its structure resembles a snail shell situated in the bony labyrinth of the temporal bone. The ‘shell’
of the cochlea is wrapped two and a half times around its axis, known as the modiolus. The cross section of
the cochlea reveals its internal structure which is characterized by the cavity of the cochlea (spiral canal)
and a triangular membranous duct, called the cochlear duct (also known as the scala media).
The scala media is filled with endolymph. In addition to the scala media, there are two more canals that
run parallel to one another, the scala vestibuli and scala tympani. In contrast to the scala media, the scala
vestibuli and scala tympani are filled with perilymph. Sound vibrations transmitted from the middle ear
through the vestibular window result in mechanical movements of the fluids inside the cochlea which
moves the basilar membrane. Movements of the basilar membrane in turn cause movements of the struc
tures within the cochlear duct. These movements are converted to electrical impulses in the receptor part
of the cochlea known as the spiral organ (of Corti).
Key points about the internal ear
Bony labyrinth: vestibule, semicircular canals, cochlea

Parts
Membranous labyrinth: utricle, saccule, semicircular ducts, cochlear duct
Utricle and saccule: information about the position of the head (via vestibular
nerve)
Functions Semicircular ducts: information about movements of the head (via vestibular
nerve)
Cochlear duct: hearing information (via cochlear nerve)
Head and neck 437

EAR
Intermediate tunnel Tectorial membrane
Inner tunnel Outer hair cells
Hensen’s stripe Outer phalangeal

epithelial cells
Outer border cells

Inner hair cell
(Hensen’s cells)
Basal external
Inner border cell glandular cells
(Boettcher cells)
| Cuboid external
Inner spiral sulcus supporting cells
(Claudius cells)
Inner sulcus cells Basilar membrane
Inner phalangeal External pillar

epithelial cell epithelial cell
Internal pillar Vas spirale

epithelial cell
FIGURE 8.73. Cochlear duct/spiral organ (cross section). The spiral organ (of Corti) is the receptor organ
for hearing that produces electrical impulses in response to auditory stimuli. It is located in the cochlear
duct of the cochlear canal sitting on top of the basilar membrane.
The spiral organ (of Corti) contains a number of receptor cells known as hair cells. More specifically, it
contains three rows of outer hair cells and one row of inner hair cells. Hair cells are so named because
they contain hair-like projections on the apical part of their cell membrane, known as stereocilia, which
are embedded in a gel-like structure called the tectorial membrane. As perilymph moves in response to
sound waves, it shifts the basilar membrane respectively to the tectorial membrane. These shifts between
the tectorial and basilar membranes bend the stereocilia, causing the hair cells to depolarize and release
neurotransmitters (glutamate) that transmits the sound information to the cochlear nerve.
Inner ear ilFlil Vestibular system
Auditory pathway

ORAL CAVITY
OVERVIEW OF THE ORAL CAVITY
The oral cavity is the initial part of the digestive system that contains the struc
tures necessary for mastication and speech; teeth, tongue and salivary glands.
It allows food to be tasted and broken down to form the food bolus, which is
pushed back into the pharynx to initiate the process of deglutition (swallowing).
Moreover, the oral cavity also has a role in the process of articulation, which is
the modification of sounds to facilitate communication; it can also be an alter
native route for the inhalation of air into the respiratory system.
The oral cavity is divided in two regions: Oral vestibule and oral cavity proper.
Frenulum of upper lip Gingiva
Hard palate Uvula of palate
Soft palate Palatopharyngeal

arch
Palatoglossal arch Isthmus of fauces
Posterior wall of
Palatine tonsil
pharynx
Oral cavity proper Body of tongue
Oral vestibule Frenulum of lower lip
FIGURE 8.74. Overview of the oral cavity. The oral vestibule contains the lingual/buccal gingiva which are
firmly attached to the maxilla and mandible, as well as the median mucosal folds known as the superior
and inferior labial frenula. The space enclosed by the teeth is the oral cavity proper, whose roof is formed
by the hard and soft palates. The uvula can be seen hanging from the posterior part of the soft palate.
The floor of that cavity is composed of the geniohyoid and mylohyoid muscles (not shown). Its lateral
walls are formed by the dental arches. Posteriorly, the oral cavity proper opens into the isthmus of fauces
(oropharyngeal isthmus), a transitional space located between the oral cavity and oropharynx, bounded
anteriorly by the palatoglossal arches and posteriorly by the palatopharyngeal arches. The space between
these arches is called tonsillar fossa (sinus) and contains the palatine tonsils.
Oral cavity Tongue
Head and neck 439

ORAL CAVITY
SURFACE OF THE TONGUE

The tongue consists of a body, apex and root containing the lingual papillae
and tonsils.
Epiglottis Median glossoepiglottic fold
Lateral
glossoepiglottic fold Palatopharyngeal
arch
Root oftongue
Epiglottic
vallecula
Palatine tonsil
Lingual tonsil
Foliate papillae
Terminal sulcus
Vallate papillae of tongue
Foramen cecum
Median sulcus of tongue
oftongue
Apex of tongue Body of tongue
FIGURE 8.75. Superior view of the surface of the tongue. The apex of the tongue lies most anteriorly.
The body of the tongue is divided into two hemispheres by the median sulcus of the tongue and contains
numerous lingual papillae. It has a rough dorsal (superior) and a smooth ventral (inferior) surface. The root
of the tongue with the lingual tonsils is located posteriorly. Just anterior to it lies the foramen cecum, an
embryological remnant of the thyroglossal duct. The epiglottis is located posteriorly to the root of the
tongue and the palatine tonsils laterally.
The lingual papillae are located on the presulcal part of the tongue, just anterior to the terminal sulcus.
The vallate papillae run parallel to the terminal sulcus, whereas the foliate papillae are located on the
posterolateral end of the body of the tongue on each side. The filiform papillae are the most numerous
lingual papillae and cover most of the presulcal area of the dorsum of the tongue. Their main function is to
increase the friction between the food and the tongue. The fungiform papillae are larger than the filiform
papillae and rounder in shape. They are mostly found at the tip and side of the tongue and contain taste
buds on their upper surface.
The taste sensation is transmitted to the brainstem via three nerves: The facial nerve (chorda tympani)
innervating the anterior % of tongue and soft palate, the glossopharyngeal nerve innervating the posterior
/ of the tongue and the vagus nerve innervating the epiglottis.

ORAL CAVITY
Lingual tonsil
Filiform papillae
Lymphoid nodule
Vallate papillae
Crypt of
lingual tonsil
Fungiform papilla
Taste buds
Sulcus of papilla
Posterior lingual
gland
Gustatory glands
FIGURE 8.76. Overview of the lingual papillae. The distinct shapes of the four types of lingual papillae can
be seen. The vallate papillae are separated from their walls by the sulcus of papilla. In addition to this, the
gustatory glands, also known as von Ebner’s glands, are located deep to the vallate papillae. The posterior
lingual glands are located at the root of the tongue. Above the posterior lingual glands, the lingual tonsil
is illustrated.
Key points of the lingual papillae
Stretched, conical, gray-white papillae
Filiform Covered with keratinized squamous epithelium

papillae Provide friction to allow movement of the food bolus during chewing
Do not possess taste buds
Highly vascular, mushroom-shaped papillae

Fungiform
Scattered across the entire dorsal surface of the tongue
papillae
Contain few taste buds on the apical aspect
Bilaterally paired, parallel, “leaf-like” ridges of mucosa
On the posterolateral margin of the tongue, near the terminal sulcus

Foliate papillae
Non-keratinized mucosa
Contain numerous taste buds
Usually between 8-12 cylindrical papillae

Vallate papillae
Anterior and parallel to the terminal sulcus of the tongue
ElHKa&lsl
Anatomy of taste
Head and neck 441

ORAL CAVITY
MUSCLES OF THE TONGUE
The tongue consists of two major muscle groups: Extrinsic and intrinsic.
The extrinsic muscles originate outside of the tongue and mainly function to
move the tongue as a whole (i.e. gross movement). They are the genioglossus,
hyoglossus, styloglossus and palatoglossus. The intrinsic muscles are contained
within the tongue itself and alter its size and shape to produce fine movements
for talking and swallowing. They are the superior and inferior longitudinal mus
cles, vertical and transverse muscles of the tongue.
All of the lingual muscles innervated by the hypoglossal nerve (CN XII), except
for the palatoglossus muscle, which receives its innervation from the vagus
nerve (CN X) via the pharyngeal plexus.
Superior longitudinal Muscosa of tongue

muscle of tongue
Vertical muscle
Transverse of tongue
muscle of
tongue
Palatoglossus
muscle
Inferior
longitudinal
muscle
of tongue Styloglossus
muscle
Genioglossus muscle Hyoglossus muscle
FIGURE 8.77. Muscles of the tongue (coronal section). The tongue is composed of 8 paired muscles, which
are separated left from right by a median lingual septum. The intrinsic muscles (superior longitudinal
muscle, inferior longitudinal muscle, vertical muscle and transverse muscle) are confined within the core
of the tongue. They are flanked on either side by the styloglossus, hyoglossus and palatoglossus muscles
which enter the side of the tongue, decussating with each other as well as the inferior longitudinal muscle.
The genioglossus muscle is located medially on either side of the lingual septum. The hypoglossal nerve
(CN XII), which innervates most of the muscles of the tongue, is also shown in this image.

ORAL CAVITY
Palatoglossus muscle
Superior longitudinal
muscle of tongue
Styloglossus muscle
Vertical muscle of tongue
Transverse muscle
of tongue
Inferior longitudinal
muscle of tongue
Hyoglossus muscle
Genioglossus muscle
FIGURE 8.78. Muscles of the tongue (sagittal section). The attachment points of the extrinsic muscles are
visible in this image. The genioglossus muscle originates from the superior mental spine of the mandible;
its triangular shape inserts along the entire length of the tongue as well as the body of the hyoid bone.
The styloglossus muscle originates from the styloid process of the temporal bone; its longitudinal fibers
blend with the inferior longitudinal muscle while its oblique fibers decussate with those of the hyoglossus
muscle which extends from body and greater horn of the hyoid bone. Finally, the palatoglossus muscle
can be identified arising from tissues of the soft palate extending towards the tongue, forming the wall
of the palatoglossal arch.
Extrinsic
tongue Origin Insertion Innervation Function
muscles
Bilateral
contraction -
Entire length Depresses and
of dorsum of protrudes tongue;
Superior mental
Genioglossus tongue/Lingual
spine of mandible Unilateral
aponeurosis, Body
of hyoid bone contraction -
Deviates tongue
contralaterally
Inferior/Ventral
Body and greater Hypoglossal Depresses and
Hyoglossus parts of lateral
horn of hyoid bone nerve (CN XII) retracts tongue
tongue
Longitudinal
Anterolateral part: blends
aspect of styloid with inferior
longitudinal Retracts and
process (of
Styloglossus muscle elevates lateral
temporal bone),
aspects of tongue
Stylomandibular Oblique part:
ligament blends with
hyoglossus muscle
Lateral margins Vagus nerve (CN

Palatine Elevates root of
of tongue, Blends X) (via branches
Palatoglossus aponeurosis of soft tongue, Constricts
with intrinsic of pharyngeal
palate isthmus of fauces
muscles of tongue plexus)
Head and neck 443

ORAL CAVITY
Intrinsic
tongue Origin Insertion Innervation Function
muscles
Retracts and
Superior Submucosa of
Apex/Anterolateral broadens tongue,
longitudinal posterior tongue,
margins of tongue Elevates apex of
muscle Lingual septum
tongue
Retracts and
Inferior
Root of tongue, broadens tongue,
longitudinal Apex oftongue Hypoglossal
Body of hyoid bone Lowers apex of
muscle nerve (CN XII) tongue
Transverse Lateral margin Narrows and

Lingual septum
muscle of tongue elongates tongue
Root of tongue,
Vertical Lingual Broadens and
Genioglossus
muscle aponeurosis elongates tongue
muscle
Muscles and taste

sensation of the
tongue

ORAL CAVITY
NEUROVASCULATURE OF THE TONGUE
Dorsal lingual artery Lingual nerve
Submandibular- Dorsal lingual vein

ganglion
Deep lingual vein Hypoglossal

nerve
Deep lingual Lingual artery

artery
Sublingual artery Retromandibular

vein
Vena comitans of Left internal

hypoglossal nerve jugular vein
Facial vein External carotid

artery
FIGURE 8.79. Nervous and vascular supply of the tongue. Sagittal section of the lower face showing
the tongue and its neurovascular supply. The image shows the lingual nerve, a branch of the mandibular
nerve (CN V3), and the submandibular ganglion, a parasympathetic ganglion associated with the chorda
tympani. Chorda tympani is a branch of the facial nerve (CN VII) that carries special sensory innervation to
the tongue and parasympathetic innervation to the submandibular and sublingual glands. The hypoglossal
nerve (CN XII) carries motor innervation to all the intrinsic muscles of the tongue. The lingual artery
originates from the external carotid artery and gives off 3 main branches: The dorsal lingual, deep lingual
and sublingual arteries, which supply the root of the tongue, the body of tongue and the floor of the oral
cavity and sublingual glands, respectively. Lastly, the veins that drain the tongue into the internal jugular
vein are visible.
Key points about the neurovasculature of the tongue
Motor innervation: hypoglossal nerve (CN XII) innervates all except palatoglossus
muscle (pharyngeal plexus from vagus nerve, CN X)
Sensory and parasympathetic innervation:
Innervation
• Anterior %: lingual nerve for general sensory (branch of mandibular nerve V3) and
chorda tympani nerve for special sensory (branch of facial nerve, CN VII)
• Posterior / and vallate papillae: glossopharyngeal nerve (CN IX)
Lingual artery and its branches:
• Dorsal lingual artery: supplies the root of tongue

Arterial supply
• Deep lingual artery: supplies the body of tongue
• Sublingual artery: supplies the floor of the oral cavity and sublingual glands
Dorsal lingual vein: drains the root of tongue ^ lingual vein ^ internal jugular vein (IJV)
Venous Deep lingual vein: drains the body of tongue ^ lingual vein ^ IJV
drainage
Sublingual veins: drain the floor of oral cavity and sublingual glands to vena
comitans of hypoglossal nerve ^ lingual vein ^ IJV
Head and neck 445

ORAL CAVITY
Nerve and blood

supply of the tongue
SALIVARY GLANDS
The salivary glands are exocrine tubuloacinar structures whose excretory ducts
open into the oral cavity. The main function of these glands is to secrete saliva,
a seromucous liquid that has several major functions within the oral cavity
including lubrication, digestion, physicochemical/immune defense and taste
transmission. The total daily output of saliva in an adult is about 1.5 liters. The
major salivary glands are the paired parotid, submandibular and sublingual
glands. Additionally, there are as many as 600 minor salivary glands scattered
throughout the oral cavity.
Transverse facial artery Parotid duct
Temporal branches of Buccinator muscle

facial nerve
Facial nerve Facial artery
Superficial temporal
Tongue
vein
Superficial temporal Sublingual fold

artery
Buccal branches Lingual frenulum

of facial nerve
Parotid gland Submandibular duct
Masseter muscle Sublingual caruncle
Posterior auricular vein Sublingual gland
Posterior division of Sublingual artery

External jugular vein Sublingual vein
Anterior division of Mylohyoid muscle

Common facial vein Submandibular gland
External carotid artery Facial vein
FIGURE 8.80. Salivary glands (overview). The parotid gland is the largest of the major salivary glands,
located superficially in the front of the ear (preauricular region). It is shaped like an inverted pyramid and

ORAL CAVITY
enclosed in a fibrous capsule. A number of important neurovascular structures traverse the parotid gland
including the external carotid artery, retromandibular vein and facial nerve. The secreted content of the
parotid gland gets released through the parotid duct (Stensen’s duct) whose orifice can be seen on the
buccal wall at the level of the maxillary second molar.
The submandibular gland is the second largest salivary gland, located inferior and deep to the ramus of
the mandible in the submandibular triangle of the neck (a.k.a. digastric triangle). This gland produces the
largest amount of saliva that gets excreted through the submandibular duct (of Wharton) which opens at
the sublingual papilla under the tongue.
The sublingual gland is an almond-shaped gland and is the smallest of the major salivary glands. It lies on
the mylohyoid muscle and is covered by the mucosa of the floor of the mouth, which is raised as a sub
lingual fold. It has several ductal openings that run along the sublingual folds: A major sublingual duct (of
Bartholin) and as many as 20 minor sublingual ducts (of Rivinius).
Type 1
Salivary glands Location Excretory duct Blood supply Innervation
Superficial
Auriculotemporal
temporal
nerve (V3 ),
artery,
Preauricular Serous Parotid duct glossopharyngeal
Parotid maxillary
region gland (of Stensen) nerve (CN IX),
artery,
external carotid
transverse
plexus
facial artery
Sublingual
Submandibular
Submandibular artery, Chorda tympani
Submandibular Mixed gland duct (of
triangle submental (CN VII)
Wharton)
artery
Major
sublingual duct
Sublingual
(of Bartholin),
Beneath the Mucous artery, Chorda tympani
Sublingual minor
sublingual fold gland submental (CN VII)
sublingual
artery
ducts (of
Rivinius)
Submandibular gland
Bi K£il Parotid gland
BfeE Ml
Sublingual gland
Head and neck 447

TEETH
TYPES OF TEETH
The teeth are organized in two arches, a maxillary or superior arch and a man
dibular or inferior arch, each of which is divided into two quadrants.
Each quadrant on the permanent dentition is made up of eight teeth (one cen
tral incisor, one lateral incisor, one canine, two premolars and three molars).
The morphology and anatomical characteristics of each of these are specific to
each tooth since they have different functions.
Maxillary right Maxillary left central

central incisor tooth incisor tooth
Maxillary right
lateral incisor tooth incisor tooth
Maxillary right Maxillary left
canine tooth canine tooth
Maxillary right Maxillary left first
first premolar tooth premolar tooth
Maxillary right second Maxillary left second
premolar tooth premolar tooth
Maxillary right first Maxillary left
molar tooth first molar tooth
Maxillary right second Maxillary left
molar tooth second molar tooth
Maxillary right third Maxillary left
molar tooth third molar tooth
Mandibular right
Mandibular left
third molar tooth
central incisor tooth
Mandibular right Mandibular left
second molar tooth Lateral incisor tooth
first molar tooth canine tooth
Mandibular right second Mandibular left
premolar tooth third molar tooth
Mandibular right first Mandibular left
premolar tooth second molar tooth
canine tooth first molar tooth
Mandibular right lateral Mandibular left

incisor tooth second premolar tooth
Mandibular right central Mandibular left first

incisor tooth premolar tooth
FIGURE 8.81. Teeth in situ. Overview of the permanent dentition with all 32 teeth: 16 maxillary/superior
u teeth and 16 mandibular/inferior teeth.
id
Z
a
z
<
a
<
id
I

TEETH
Molar teeth Premolar teeth Incisor tooth
FIGURE 8.82. Anatomy of each tooth. Dentition of maxillary left quadrant in isolation with crowns and
roots visible. Each tooth has a clinical crown, which is the portion of the tooth seen in the oral cavity. Cusps
are prominent landmarks on the crown presenting as eminences or projections that help teeth with their
functions. Canine teeth only have a single predominant cusp, while premolars have 2 cusps except for the
mandibular second premolar which generally has 3 cusps. The mandibular first molar has 5 cusps whereas
the maxillary first molar has 4 cusps with a small accessory cusp (of Carabelli) sometimes described as a
fifth cusp. Both the maxillary and mandibular second molars have 4 cusps.
The number of roots for each tooth is similarly variable; the central and lateral incisors, canines and
premolars all have a single root with the exception of the maxillary first premolar which generally has
2 roots. The maxillary first and second molars have 3 roots and the mandibular first and second molars
have 2 roots. Regarding third molars or wisdom teeth, the number of cusps and roots is subject to a deal
of interindividual variation, however generally varies between 3-4 cusps in the maxillary third molars
and 4-5 cusps in the mandibular third molars. Regarding roots the maxillary third molar varies between
1-3 roots while the mandibular third molar can vary between 1-2 roots.
Teeth Number Function Roots Cusps
Incisor 8 Cut and bite 1 None
Canine 4 Tear 1 1
Premolar 8 Tear and grind 1 2
First: 4
Maxillary 3 Second: 4
Third: variable
Molar 6 Crush and grind
First: 5
Mandibular 2 Second: 4
Third: variable
Head and neck 449

TEETH
Ace your exam

with these teeth
Teeth
diagrams and tooth
identification quizzes
ANATOMY OF THE TOOTH

Each tooth is made up of a crown and root(s). The crown can be defined either
as a clinical crown, which is the portion exposed to the oral cavity, or as an ana
tomical crown, going from the cementoenamel junction to the cusps or the
incisal edge of the tooth. Below it, the part of the tooth attached to the sur
rounding alveolar bone of the maxilla or mandible, is known as the root. The
alveolar processes of the maxilla and mandible contain sockets known as den
tal alveoli. Each dental alveolus houses a tooth, and is bound to it by a specific
fibrous joint known as gomphosis or dentoalveolar syndesmosis (a.k.a. peg and
socket joint). The root of the tooth is held in place by the peridodontium, which
is composed of the periodontal ligament, cementum and gingiva (gum).
Each tooth is composed of a variety of tissues. Enamel is a hard calcareous sub

stance which covers the anatomical crown of the tooth; it is the hardest tis
sue in the human body. Dentin is covered by the enamel in the crown and the
cementum in the roots. Dental pulp is the innermost portion of the tooth, con
taining nerves, blood vessels and connective tissue. It’s found in the pulp cavity
of the crown as well as within the root canal(s).

TEETH
FIGURE 8.83. Tooth: Parts and landmarks. Section of a molar tooth. The enamel consists of a highly
mineralized and resistant layer which functions as a hard chewing surface and as a barrier which protects
the tooth from possible physical, thermal and chemical damage. Dentin provides support to the enamel,
while the dental pulp is responsible for nourishing surrounding tissue and perceiving pain or discomfort
in cases of drastic temperature changes, pressure, trauma and possible infections. Important landmarks
found in every tooth are the cementoenamel junction ‘CEJ’ (the point at the neck of the tooth where the
cementum and the enamel border each other), and the dentinoenamel junction ‘DEJ’ (point where the
enamel and dentin meet).
Head and neck 451

TEETH
Marginal gingiva
Alveolar gingiva
Lamina propria
of gingiva
Gingival papilla
Periodontal ligament
Cementum
Gingiva
FIGURE 8.84. Tooth: Supporting structures. Teeth are held in place by the periodontium composed
of a variety of supporting structures such as the gum or gingiva, periodontal ligament, cementum and
alveolar bone. Integrity of these structures is important since without them, teeth can become loose and
eventually detach completely. The gingiva is the external portion of the periodontium surrounding each
tooth. It is divided into an alveolar/fixed gingiva (going from the mucogingival junction until the level of the
cementoenamel junction ‘CEJ’ or more specifically, the free gingival groove) and a marginal/free gingiva
(from the free gingival groove until the gingival margin surrounding the tooth).
Anatomy of the tooth Gingiva

PHARYNX
PHARYNGEAL MUCOSA
The pharynx, commonly known as the throat, is a muscular tube extending

from the nasal and oral cavities until the larynx and the esophagus: A place of
passage for air, food and liquids.
Based on its anterior relations, the pharynx is divided into three mains sections:
The nasopharynx, posterior to the nasal cavity; the oropharynx, posterior to
the oral cavity; and the laryngopharynx posterior to the larynx. The pharyngeal
wall is formed essentially by muscles and fascia and is covered internally by a
mucous membrane.
Pharyngeal tonsil Middle nasal concha

of ethmoid bone
Torus tubarius Choana
Nasal septum Inferior nasal concha
Torus levatorius Pharyngeal recess
Salpingopharyngeal
Soft palate
fold
Uvula of palate Nasopharynx
Oropharynx Palatine tonsil
Palatopharyngeal arch Root of tongue
Epiglottis Laryngeal inlet
Aryepiglottic fold Fold of superior

laryngeal nerve
Piriform recess Cuneiform tubercle
Interarytenoid notch Laryngopharynx
Esophagus Corniculate tubercle
FIGURE 8.85. Pharyngeal mucosa (posterior view). The nasopharynx is located behind the posterior
aperture of the nasal cavity (choanae), above the level of the soft palate and below the base of the skull.
It is continuous inferiorly with the oropharynx which is located between the level of the soft palate
and upper margin of the epiglottis. The oropharynx communicates anteriorly with the oral cavity and is
continuous inferiorly with the laryngopharynx, which is the inferior most part of the pharynx. It extends
from the superior margin of the epiglottis to the top of the esophagus. The laryngopharynx communicates
anteriorly with the larynx through the laryngeal inlet.
|F|| The pharynx
Head and neck 453

PHARYNX
MUSCLES OF THE PHARYNX
The functions of the pharynx are accomplished by several muscles, divided into
two groups based on the orientation of their fibers. The constrictor muscles are
formed by a series of overlapping circularly oriented fibers while the longitudi-
nal/elevator muscles have fibers that are oriented vertically.
Cartilaginous part Pharyngobasilar

of auditory tube fascia
Salpingopharyngeus Superior pharyngeal

muscle constrictor muscle
Middle pharyngeal Stylopharyngeus

constrictor muscle muscle
Greater horn of
Pharyngeal raphe
hyoid bone
Thyropharyngeal part
Palatopharyngeus
of inferior pharyngeal
muscle
constrictor muscle
Cricopharyngeal part
Thyroid cartilage of inferior pharyngeal
constrictor muscle
Inferior pharyngeal
Esophagus
constrictor muscle
FIGURE 8.86. Pharyngeal muscles (posterior view). The constrictor muscles on either side of the
pharynx form the main components of the pharyngeal wall and are named according to their position:
Superior, middle, and inferior. The inferior constrictor muscle is further divided into thyropharyngeal and
cricopharyngeal parts. Posteriorly, these muscles come together in the midline at the pharyngeal raphe.
The muscular sleeve formed by these muscles has a strong internal lining known as the pharyngobasilar
fascia which is particularly evident superior to the level of the superior constrictor; here the pharyngeal
wall is formed almost completely of fascia.
The longitudinal/elevator muscles of the pharynx are located deep to their circular counterparts and
include the stylopharyngeus, salpingopharyngeus and palatopharyngeus muscles, which originate from
the styloid process of temporal bone, auditory tube and soft palate, respectively.

PHARYNX
Pharyngeal
constrictors
Pterygoid hamulus,
Superior Pterygomandibular Pharyngeal tubercle on
pharyngeal raphe, Posterior basilar part of occipital
constrictor end of mylohyoid bone
line of mandible Branches of
pharyngeal plexus
Median pharyngeal (CN X)
Stylohyoid
Middle raphe, Blends
ligament, Greater
pharyngeal with superior and
and lesser horn of
constrictor inferior pharyngeal
hyoid bone Constricts
constrictors
wall of
Thyropharyngeal Thyropharyngeal part: Both parts: pharynx
part: oblique line of median pharyngeal branches of during
thyroid cartilage raphe pharyngeal plexus swallowing
(CN X)
Inferior
Cricopharyngeal Cricopharyngeal part: Cricopharyngeal
pharyngeal
part: cricoid blends inferiorly with part: also receives
constrictor
cartilage circular esophageal branches of
fibres external and/or
recurrent laryngeal
branches ofvagus
nerve (CN X)
Longitudinal
pharyngeal muscles
Blends with
pharyngeal
constrictors,
Medial base of Elevates
Lateral Glossopharyngeal
Stylopharyngeus styloid process pharynx and
glossoepiglottic nerve (CN IX)
of temporal bone larynx
fold, Posterior
border of thyroid
cartilage
Elevates
Inferior/
Blends with pharynx,
cartilaginous
Salpingopharyngeus palatopharyngeus Opens auditory
part of auditory
muscle tube during
(Eustachian) tube
swallowing
Branches of
pharyngeal Elevates
Posterior border
plexus (CN X) pharynx
Posterior of thyroid
superiorly,
border of hard cartilage, Blends
Palatopharyngeus anteriorly
palate, Palatine with contralateral
and medially
aponeurosis palatopharyngeus
(shortening it to
muscle
swallow)
Muscles and walls

Pharynx
of the pharynx
Head and neck 455

PHARYNX
BLOOD VESSELS OF THE PHARYNX
The pharynx has a very rich blood supply. Its upper parts are supplied by branches
of the external carotid artery, while the lower parts are supplied by branches
from the subclavian artery. The venous drainage of this region is done through
a network of pharyngeal veins that form a venous plexus.
Ascending pharyngeal Superior bulb of internal

artery jugular vein
Occipital artery External carotid

artery
Internal carotid Internal jugular vein

artery
Pharyngeal veins Superior laryngeal

vein
Superior thyroid Superior laryngeal

artery artery
Common carotid Thyrocervical trunk

artery
Inferior thyroid artery Brachiocephalic trunk
FIGURE 8.87. Overview of the blood vessels of the pharynx. In this posterior perspective, important blood
vessels of the head and neck can be seen on either side of the pharynx. The external carotid artery gives
off several branches, some of them responsible for supplying the upper part of the pharynx. The ascending
pharyngeal artery arises from the external carotid artery close to the carotid bifurcation and ascends
superiorly along the pharynx, giving off branches that supply various structures located in the upper part
of the pharynx.
The lower part of the pharynx is supplied by pharyngeal branches of the inferior thyroid artery, which
originates from the thyrocervical trunk of the subclavian artery. The pharyngeal veins form a venous
plexus which drains inferiorly into the internal jugular veins.
Key points about the blood vessels of the pharynx
Supplied by branches of external carotid artery:
• Ascending pharyngeal artery

Upper pharynx • Ascending palatine and tonsillar branches of the facial artery
• Branches of lingual artery

• Branches of maxillary artery
Supplied by branches of subclavian artery:

Lower pharynx
• Pharyngeal branches of inferior thyroid artery (from thyrocervical trunk)

PHARYNX
NERVES OF THE PHARYNX
Nearly all of the innervation of the pharynx, either motor or sensory, is derived
from the pharyngeal plexus, located in the outer fascia of the pharyngeal wall.
This plexus is formed mainly through the branches of the vagus (CN X) and glos
sopharyngeal (CN IX) nerves with contributions from the superior cervical sym
pathetic ganglion.
Other important nerves located in the parapharyngeal space are the accessory
(CN XI) and the hypoglossal (CN XII) nerve, as well as all nerves of the cervical
sympathetic trunk. These nervous structures are not directly involved in the
nerve supply of the pharynx but are closely related to this organ.
Inferior ganglion Glossopharyngeal

of vagus nerve nerve
Superior cervical _ Hypoglossal nerve

ganglion
Superior Accessory nerve

laryngeal nerve
External branch Internal branch of

of superior superior laryngeal
laryngeal nerve nerve
Vagus nerve Sympathetic trunk
Middle cervical Cervicothoracic

ganglion ganglion
Left recurrent Right recurrent

laryngeal nerve laryngeal nerve
FIGURE 8.88. Overview of the nerves of the pharynx. In this posterior view we can see the nerves that
supply the pharynx and other important nervous structures of the parapharyngeal space. The pharyngeal i
m
plexus is mainly composed of pharyngeal branches of the glossopharyngeal and vagus nerves and lies on >
the external surface of the pharynx.
□
>
z
On the right side of the image, superiorly, the glossopharyngeal nerve (CN IX) is seen after leaving the skull □
through the jugular foramen. The vagus nerve (CN X) also leaves the skull through this foramen and has z
m
two sensory ganglia in this location (in this image the inferior ganglion is visible). The superior laryngeal n
7s
nerve arises from the inferior ganglion of the vagus nerve and descends against the lateral wall of the
pharynx. It divides into the external and internal branches. The recurrent laryngeal nerve is also a branch
of the vagus nerve that supplies the larynx. The right and left nerves are not symmetrical, with the left
nerve looping under the aortic arch, and the right nerve looping under the right subclavian artery then
traveling upwards.
The accessory nerve (CN XI) also passes through the jugular foramen and courses through the neck; it
pierces the sternocleidomastoid muscle which it innervates. The hypoglossal nerve (CN XII) leaves the
Head and neck 457

PHARYNX
skull, travels down the neck and ends at the base and underside of the tongue, being responsible for its
nerve supply. The cervical sympathetic trunk lies behind the carotid sheath (a condensation of deep fascia
of the neck in which is embedded the common and internal carotid arteries, internal jugular vein, and the
vagus nerve). This trunk contains three interconnected ganglia: The superior, middle and inferior (stellate
or cervicothoracic).
Key points about the nerves of the pharynx
1. Pharyngeal branches of the glossopharyngeal nerve (CN IX)
Pharyngeal 2. Pharyngeal branch of the vagus nerve (CN X)

plexus 3. Branches from the external laryngeal nerve from the superior laryngeal branch
(composition) of the vagus nerve (CN X)
4. Contributions from the superior cervical sympathetic ganglion
Nasopharynx: pharyngeal branch of the maxillary nerve (CN V2)
Sensory Oropharynx: glossopharyngeal nerve (CN IX) via the pharyngeal plexus
innervation
Laryngopharynx: vagus nerve (CN X) via the internal branch of the superior
laryngeal nerve
All pharyngeal muscles: pharyngeal branch of the vagus nerve (CN X) (except for the
Motor
stylopharyngeus muscle which is innervated by a branch of the glossopharyngeal
innervation
nerve)

NECK
HYOID BONE
The hyoid bone is a small U-shaped bone located in the anterior neck between
the epiglottis and the thyroid cartilage. It does not articulate directly with other
bones but instead is connected to adjacent bones via muscles and ligaments.
The hyoid bone serves as an attachment site for the muscles of the floor of the
mouth, tongue, larynx, epiglottis, and pharynx.
Together with these muscles, the hyoid bone assists in movements, such as
opening the jaw, articulating, swallowing, and coughing.
FIGURE 8.89. Hyoid bone. Anterior view of the neck region with the larynx and the trachea visible. The
magnified illustration depicts the structure and bony landmarks of the hyoid bone. It consists of three
parts: A rectangular body with two lesser and two greater horns protruding from it. The illustration below
shows the in situ position of the hyoid bone, anterior to the epiglottis and superior to the thyroid cartilage
of the larynx. The hyoid bone is connected to the thyroid cartilage via the thyrohyoid membrane. The
i
m
stylohyoid ligament and stylohyoid muscle (not depicted) connect the hyoid bone to the styloid process >
□
of the temporal bone (not shown). >
z
□
z
m
n
*
Hyoid bone
Head and neck 459

NECK
MUSCLES OF THE ANTERIOR NECK
Geniohyoid muscle Digastric muscle
Longus capitis Mylohyoid muscle

muscle
Longus colli Stylohyoid

muscle muscle
Scalenus
anterior Thyrohyoid
muscle muscle
Omohyoid Sternocleido
muscle mastoid
muscle
Scalenus
posterior Sternothyroid
muscle muscle
Sternohyoid
Scalenus medius
muscle
muscle
Platysma muscle
FIGURE 8.90. Muscles of the anterior neck (anterior view). The lower image shows the platysma. This
sheet-like muscle lies most superficially within the subcutaneous tissue and covers all of the anterior
aspect of the neck. The upper image shows all other anterior neck muscles that are situated deep to the
platysma.
The sternocleidomastoid is a two-headed muscle and can be prominently seen and palpated along
the lateral sides of the neck creating a ‘V-shape’. The suprahyoid (digastric, mylohyoid, geniohyoid and
stylohyoid) and infrahyoid (sternohyoid, omohyoid, sternothyroid and thyrohyoid muscle) muscles position
the hyoid bone, thus playing an active role in swallowing and the movement of the larynx. The scalene
muscles (scalenus anterior, middle and posterior) attach to the upper two ribs, making them accessory
muscles of respiration. The prevertebral muscles (rectus capitis anterior, rectus capitis lateralis, longus
capitis and longus colli) are located along the length of the anterior cervical spine and are surrounded by
the prevertebral fascia of the neck. These muscles help with flexion of the head to varying degrees.

Anterior neck muscles Origin Insertion Innervation Function |||||||||
Lower border of mandibLe,

_ . , Depresses mandibLe and angLe of
Skin/Fascia of infra- and Skin of buccaL/cheek CervicaLbranch of , __ , .
Platysma r ___ _ , mouth, Tenses skin of Lower face
supracLavicuLar regions region, Lower Lip, ModioLus, faciaLnerve CNVII) ,
and anterior neck
OrbicuLaris oris muscLe
Bilateral contraction -
AtLantooccipitaLjoint/Superior
cervicaLspine: head/Neck
Sternal head: superoanterior
Superficial muscles extension; inferior cervicaL
surface of manubrium of LateraL surface of mastoid Motor: accessory vertebrae: neck flexion;
sternum process of temporaL bone,
Sternocleidomastoid nerve (CN XI), Sensory: sternoclavicular joint: elevation
Clavicular head: superior LateraL haLf of superior anterior ram, of spinal of cLavicLe and manubrium of
surface of mediaL third of nuchaL Line of occipitaL bone nerves C2-C3 sternum
cLavicLe
Unilateral contraction - CervicaL
spine: neck ipsiLateraLfLexion, neck
contra LateraL rotation
Bilateral contraction - Neck

ScaLene tubercLe and fLexion
AnteriortubercLe of
superior border of rib 1 Anterior rami of spinaL Unilateral contraction - Neck
Scalenus anterior transverse processes of
(anteriorto subcLavian nerves C4-C6 LateraLfLexion (ipsiLateraL), Neck
vertebrae C3-C6
groove) rotation (contraLateraL), ELevates
rib 1
Scalene muscles Transverse processes
Superior border of rib 1
of C1/C2 -» C7 (posterior Anterior rami of spinaL ., , , , „
Scalenus medius (posteriorto subcLavian Neck LateraLfLexion, ELevates rib 1
tubercLes of transverse proc, nerves C3-C8
groove)
in C3-C7)
Posterior tubercLes of
Anterior rami of spinaL ., , , , ~
Head and neck
Scalenus posterior transverse processes of ExternaL surface of rib 2 _ ___ Neck LateraLfLexion, ELevates rib 2
nerves C6-C8
vertebrae C4-C6/C5-C7
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Anterior neck muscles Origin Insertion Innervation Function
Anterior belly: nerve to

Anterior belly: digastric fossa mylohyoid (of inferior
Kenhub Atlas o f Hum an A n ato m y
of mandible alveolar nerve) (CN V3) Depresses mandible, Elevates

Intermediate digastric
Digastric hyoid bone during swallowing and
Posterior belly: mastoid tendon (Body of hyoid bone) Posterior belly: speaking
notch of temporal bone digastric branch of
facial nerve (CN VII)
Nerve to mylohyoid (of Forms floor of oral cavity, Elevates

Mylohyoid raphe, Body of
Suprahyoid muscles Mylohyoid Mylohyoid Line of mandible inferioralveolar nerve hyoid bone and floor of mouth,
hyoid bone
(CNV3) Depresses mandible
Anterior ramus of
Inferior mentalspine (Inferior spinal nerve Cl (via Elevates and draws hyoid bone
Geniohyoid
genialtubercle) hypoglossal nerve anteriorly
Body of hyoid bone [CN XII])
Styloid process of temporal Stylohyoid branch of Elevates and draws hyoid bone
Stylohyoid
bone facial nerve (CN VII) posteriorly
Posterior surface of
Oblique Line of thyroid
Sternothyroid manubrium of sternum, Depresses Larynx
cartilage
Costal cartilage of rib 1
Manubrium of sternum, Inferior border of body of Depresses hyoid bone (from

Sternohyoid Anterior rami of spinal
Medial end of clavicle hyoid bone elevated position)
nerves C1-C3 (via ansa
Inferior belly: superior cervicalis)
Inferior belly: intermediate
border of scapula (near
Infrahyoid muscles tendon of omohyoid muscle Depresses and draws hyoid bone
Omohyoid suprascapular notch)
Superior belly: body of posteriorly
Superior belly: intermediate
hyoid bone
tendon of omohyoid muscle
Anterior ramus of
Oblique Line of thyroid Inferior border of body and spinal nerve Cl (via Depresses hyoid bone, Elevates
Thyrohyoid
cartilage greater horn of hyoid bone hypoglossal nerve La rynx
[CN XII])
Anterior surface of Lateral
Inferior surface of basilar
Rectus capitis anterior mass and transverse process Atlantooccipital joint: head flexion
part of occipital bone
of atlas Anterior rami of spinal
nerves C1, C2
Unilateral contraction -
Superior surface of Inferior surface of jugular
Rectus capitis Lateralis Atlantooccipital joint: head Lateral
transverse process of atlas process of occipital bone
flexion (ipsilateral), stabilizes joint
Bilateral contraction - Head

Anteriortubercles of flexion
Anterior rami of spinal
Longus capitis transverse processes of Basilar part of occipital bone
Prevertebral nerves C1-C3 Ipsilateral contraction - Head
C3-C6
muscles rotation (ipsilateral)
Superior part: anterior Superior part: anterior

tubercles of transverse tubercle of vertebra C1
processes of vertebrae Intermediate part: anterior Bilateral contraction - Neck
C3-C5 flexion, Neck Lateral flexion
surface of bodies of
Anterior rami of spinal (ipsilateral)
Longus colli Intermediate part: anterior vertebrae C2-C4
nerves C2-C6
surface of bodies of Unilateral contraction - Neck
Inferior part: anterior
vertebrae C5-T3 contralateral rotation
tubercles of transverse
Inferior part: anterior surface processes of vertebrae
of bodies of vertebrae T1-T3 C5-C6
Muscles of the neck

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LARYNX
The larynx houses and protects the vocal cords, as well as the entrance to the
trachea, preventing food particles or fluids from entering the lungs during
swallowing.
The larynx lies anterior to the esophagus at the level of the third to the sixth
cervical vertebrae and is continuous with the laryngopharynx above and tra
chea below. It consists of a complex cartilaginous skeleton connected by
membranes, ligaments and associated muscles. The muscles are grouped into
extrinsic muscles, suspending the larynx to its neighboring structures and
moving it as a whole, and intrinsic muscles, which move the vocal cords in order
to produce speech sounds (phonation).
FIGURE 8.91. Larynx in situ: Anterior view. The thyroid cartilage is the largest of the laryngeal cartilages
and presents broad flat right and left halves of hyaline cartilage which fuse anteriorly in the midline to
form the laryngeal prominence, commonly called the “Adam’s apple”. The thyroid cartilage is attached
superiorly to the hyoid bone via the thyrohyoid membrane. Directly below the thyroid cartilage lies the
cricoid cartilage, a ring-shaped hyaline cartilage which is connected to the trachea inferiorly.

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Hyoid bone Epiglottis
Aperture of Laryngeal saccule

thyrohyoid membrane
Triticeal cartilage Thyrohyoid membrane
Aryepiglottic fold Quadrangular membrane
Vestibular fold Vestibular ligament
Superior horn
of thyroid cartilage Rima glottidis
Cuneiform tubercle
Vocal process of
arytenoid cartilage
Corniculate tubercle
Conus elasticus
Vocal fold
Arytenoid cartilage
Interarytenoid notch
Inferior horn of Capsule of cricoarytenoid

thyroid cartilage joint
Muscular process of Thyroid articular surface

arytenoid cartilage of cricoid cartilage
Vertical ridge of lamina Cricoid cartilage

of cricoid cartilage
Trachea Tracheal cartilages
FIGURE 8.92. Structure of the larynx (posterolateral view). The epiglottis is a leaf-shaped piece of elastic
cartilage attached to the internal surface of the thyroid cartilage. When oral contents are swallowed, it
folds over the laryngeal inlet preventing food/fluids from entering the trachea.
A thin layer of connective tissue, the quadrangular membrane extends between the lateral borders of the
epiglottis and the arytenoid cartilages. Its free lower edge is thickened and forms the vestibular ligament.
This ligament is enclosed by a fold of mucous membrane to form the vestibular fold (false vocal cord)
which extends from the thyroid cartilage to the arytenoid cartilage. The (true) vocal cords consist of the
vocal ligament which is the medial free edge of the conus elasticus or lateral cricothyroid ligament, as well
as the vocalis muscle which comes from the medial fibers of the thyroarytenoid muscle and the overlying
mucosa which covers it.
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Epiglottic cartilage Stalk of epiglottis
Median thyrohyoid
Aryepiglottic muscle ligament
Thyroepiglottic
Lateral thyrohyoid
ligament
ligament
Vocal ligament
Thyroepiglottic muscle
Thyroarytenoid muscle
Vocalis muscle
Median cricothyroid
Corniculate cartilage ligament
Corniculate articular
Oblique arytenoid muscle surface of arytenoid
cartilage
Transverse arytenoid
muscle Arch of cricoid cartilage
Capsule of cricothyroid
Cricothyroid muscle
joint
Posterior cricoarytenoid Lateral cricoarytenoid

muscle muscle
Cricotracheal ligament Lamina of cricoid cartilage
FIGURE 8.93. Muscles of the larynx (posterolateral view). The intrinsic muscles of the larynx alter both
the length and the tension placed upon the vocal cords. They are functionally divided into adductors
(lateral cricoarytenoid, oblique arytenoid, transverse arytenoid), abductors (posterior cricoarytenoid),
sphincters (transverse arytenoid, aryepiglottic), tensors (cricothyroid), and relaxors (thyroarytenoid,
vocalis). The space between the vocal cords is called rima glottidis.
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FIGURE 8.94. Action of vocalis and thyroarytenoid muscles (superior view). The thyroarytenoid muscle
is a wide, paired muscle arising from the inner surface of thyroid cartilage, near the midline, as well
as the cricothyroid ligament. Its fibers pass posterolaterally to insert into the anterolateral surface
of the arytenoid cartilage. The vocalis muscle is a small, paired strand-like muscle which sits parallel to
the vocal ligament. It originates at the lateral surface of the vocal process of arytenoid cartilage, runs
anteromedially across the laryngeal inlet and attaches to the anterior part of the ipsilateral vocal ligament
near the thyroid cartilage.
The thyroarytenoid and vocalis muscles both draw the arytenoid cartilages anteriorly allowing the vocal
ligaments to shorten, thicken and relax. This means they play a crucial part in controlling and changing the
tonal quality of the voice. Concurrently, both muscles rotate the arytenoid cartilages medially which helps
in closing the rima glottidis. The narrow/wedge-shaped appearance of the rima glottidis in this image
represents that seen during normal respirations (‘resting’ position).
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FIGURE 8.95. Action of transverse and oblique arytenoid muscles (superior view). The transverse
arytenoid muscle is the only unpaired intrinsic muscle of the larynx and runs horizontally between the
arytenoid cartilages. The oblique arytenoid muscle is a paired muscle and originates from the muscular
process of the arytenoid cartilage. It extends obliquely towards its superiorly located insertion on the
contralateral arytenoid cartilage. Along its path, the oblique arytenoid muscle crosses its counterpart
from the opposite side, forming the letter “X”.
Upon contraction, the transverse and oblique arytenoid muscles adduct the vocal folds, closing the poste
rior portion of the rima glottidis and narrowing the aditus laryngis. The closed/slit-like appearance of the
rima glottidis in this image represents that seen during phonation (production of speech sounds).

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FIGURE 8.96. Action of lateral cricoarytenoid muscles (superior view). The lateral cricoarytenoid is a
bilateral muscle attaching between the cricoid and arytenoid cartilages. When these muscles contract,
they rotate the arytenoid cartilages medially which brings the tips of the vocal processes together. This
results in adduction of the vocal folds and closure of the anterior part of the rima glottidis. The relaxed
arytenoid muscles still allow air to pass via the posterior (intercartilaginous) part of the rima glottidis,
therefore allowing a toneless sound to be produced i.e., a whisper.
Vocal ligament Thyroid cartilage
Cricoid cartilage
Arytenoid
cartilage
Rima glottidis
Muscular process of Posterior cricoarytenoid

arytenoid cartilage muscle
FIGURE 8.97. Action of posterior cricoarytenoid muscles (superior view). The proximal attachment of
posterior cricoarytenoid muscle is on the posterior surface of the cricoid cartilage and its corresponding
insertion point is on the muscular process of the arytenoid cartilage. Contraction of the posterior
cricoarytenoid muscle rotates the arytenoid cartilages laterally and pulls them posterolaterally.
Therefore, it is the only muscle of the larynx that abducts the vocal cords and opens the rima glottidis.
This action makes the posterior cricoarytenoid muscle the most important muscle in the larynx in the act
of respiration. The open appearance of the rima glottidis in this image represents that seen during forced
respiration.
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Key points about the larynx
Spaces Three parts: vestibule, ventricle, infraglottic cavity
Unpaired: epiglottis, cricoid cartilage, thyroid cartilage
Paired: arytenoid cartilages, corniculate cartilages, cuneiform cartilages, (triticeal

cartilages ^ variable)
Cartilages
Hyaline: cricoid cartilage, thyroid cartilage
Elastic: epiglottis, arytenoid cartilages (only vocal process), corniculate cartilages,

cuneiform cartilages, (triticeal cartilages)
Extrinsic: thyrohyoid membrane, cricotracheal ligament, hyoepiglottic ligament

Ligaments and
membranes Intrinsic: quadrangular membrane, vestibular fold, thyroepiglottic ligament,
median/anterior cricothyroid ligament, conus elasticus, vocal ligaments
Depressors: infrahyoid muscles (sternohyoid muscle, sternothyroid muscle,

Extrinsic omohyoid muscle; except thyrohyoid muscle)
muscles Elevators: thyrohyoid muscle, suprahyoid muscles (digastric muscle, stylohyoid
muscle, geniohyoid muscle, mylohyoid muscle, stylopharyngeus muscle)
Adductors: transverse arytenoid muscle, oblique arytenoid muscle, lateral

cricoarytenoid muscle
Abductors: posterior cricoarytenoid muscle

Intrinsic
muscles Sphincters: transverse arytenoid muscle, aryepiglottic muscle
Tensors: cricothyroid muscle
Relaxor: thyroarytenoid muscle, vocalis muscle (fine adjustment)
Superior laryngeal nerve: external branch (external laryngeal nerve) ^ motor

innervation to cricothyroid muscle; internal branch (internal laryngeal nerve) ^
sensory/secretomotor innervation to laryngeal cavity above vocal cords
Innervation Recurrent laryngeal nerve: anterior laryngeal branch (inferior laryngeal nerve) ^
motor innervation to all intrinsic muscles (except cricothryoid muscle); posterior
laryngeal branch ^ sensory/secretomotor innervation to laryngeal cavity below
vocal cords
Function Air conduction, airway protection, sound production
Cartilages of the
Larynx
larynx
Muscles of the larynx

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THYROID AND PARATHYROID GLANDS
The thyroid and parathyroid glands are endocrine organs, located in the neck,
anterior and lateral to the trachea and larynx.
The thyroid gland is responsible for producing thyroid hormones regulat

ing metabolism. It consists of two lobes, an isthmus and pyramidal lobe, all of
which are supplied by the superior and inferior thyroid arteries. Venous drain
age occurs via the superior, middle, and inferior thyroid veins. The thyroid gland
receives sympathetic and parasympathetic innervation from the three cervical
sympathetic ganglia and branches of the vagus nerve, respectively.
The parathyroid glands, located on the back of the thyroid gland, participate in
regulating blood calcium levels. Their neurovascular supply is similar to that of
the thyroid gland.
| Anterior"!
Thyroid cartilage
Cricothyroid ligament
Cricoid cartilage
Cricotracheal ligament
Pyramidal lobe of thyroid gland
Left lobe of thyroid gland
Right lobe of thyroid gland
Isthmus of thyroid gland
Trachea
FIGURE 8.98. Thyroid and parathyroid glands (overview). Top image: Anterior view of the thyroid gland
with thyroid cartilage and the cervical part of the trachea exposed. The butterfly-shaped thyroid gland
consists of left and right conical shaped lobes which are connected by a central isthmus. A third pyramidal
lobe may be present occasionally. The thyroid gland is located anterior to the trachea and inferior to the
thyroid cartilage.
Bottom image: Posterior view of the thyroid gland with the four parathyroid glands exposed. Two pairs of
lentil-shaped parathyroid glands are positioned on the back of each lobe of the thyroid gland. According to
their location, they are called superior and inferior parathyroid glands.
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Internal carotid Vertebral artery

artery
External carotid Superior thyroid

artery artery
Common carotid Inferior thyroid

artery artery
Transverse cervical Thyrocervical

artery trunk
Subclavian Suprascapular
artery artery
FIGURE 8.99. Arterial supply of the thyroid and parathyroid gland. Anterior view of the neck region
with the thyroid gland and its arterial supply. The hyoid bone, thyrohyoid membrane, larynx, and trachea
are depicted. The superior thyroid artery, a branch of the external carotid artery, supplies the superior
portion of the thyroid gland. The inferior portion of the thyroid gland is supplied by the inferior thyroid
artery, arising from the thyrocervical trunk, a proximal branch of the subclavian artery. The arterial supply
of the four parathyroid glands (not depicted) occur via the inferior thyroid artery. In some individuals, an
anatomical variant, the thyroid ima artery, may be present and contribute to the arterial supply of the
thyroid and parathyroid gland.

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FIGURE 8.100. Venous drainage of the thyroid and parathyroid gland. Anterior view of the neck region
with the thyroid gland and its venous supply. The hyoid bone, thyrohyoid membrane, larynx and trachea
are depicted. Venous drainage of the superior aspect of the thyroid gland occurs via the thyroid venous
plexus and the superior and middle thyroid vein that empty into the internal jugular vein. The inferior
thyroid vein drains the inferior aspect of the thyroid gland and empties into the brachiocephalic vein.
Venous drainage of the parathyroid glands occurs via the thyroid venous plexus and the thyroid veins.
Venous
Parts Arterial supply Innervation Functions
drainage
Superior thyroid
Three cervical
artery (from
sympathetic
external carotid
Superior, ganglia, Produces
Left and right artery) and
middle and external thyroid
lobes, isthmus, inferior thyroid
Thyroid inferior thyroid branch of hormones
pyramidal artery (from
gland veins which superior and
lobe (variably thyrocervical
form thyroid laryngeal nerve regulates
present) trunk), thyroid
plexus and recurrent metabolism
ima artery may
laryngeal
be present
nerve
occasionally
Four lentil
Participate
shaped glands
Three cervical in regulating
Parathyroid located on Inferior thyroid
Thyroid plexus sympathetic blood
gland back of each artery
ganglia calcium
lobe of thyroid
levels
gland
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Superior thyroid
Thyroid gland
artery
NEUROVASCULATURE OF THE NECK
The neck is a complex thoroughfare for a large number of vessels and nerves
which serve to supply, drain and innervate the head, neck, trunk and upper limb.
The main arterial structures of the neck are the carotid and vertebral arteries.
The common carotid artery ascends through the neck bifurcating into the
internal and external carotid arteries. The internal carotid artery ascends to
provide anterior supply to structures of the cranial cavity while the external
carotid artery branches to supply structures of the neck and face. Arising from
the subclavian arteries at the root of the neck are the paired vertebral arteries
which ascend through the transverse foramina of the upper six cervical verte
brae, to provide posterior supply to the cranial cavity.
The primary venous channels of the neck are the internal, external and anterior
jugular veins. Tributaries of these collecting veins largely follow a similar pat
tern to their fellow arteries.
Numerous cranial and peripheral nerves pass through and supply structures of
the neck. The cervical plexus, located at the superior portion of the neck, gives
off several branches to supply cutaneous and muscular innervation to many
structures of the neck as well as parts of the face, shoulder region and thorax.
The trunks of brachial plexus also can be seen passing between the anterior and
middle scalene muscles on their way to the axilla and upper limb. Cranial nerves
of the neck include the glossopharyngeal (CN IX), vagus (CN X), accessory (CN XI)
and hypoglossal (CN XII) nerves.

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Facial artery
Lingual artery
Submental artery
Vertebral artery
Common carotid artery
Ascending cervical artery
Inferior thyroid artery
Thyrocervical trunk
Subclavian artery
FIGURE 8.101. Arteries of the neck (anterior view). Located at the root of the neck are the subclavian and
common carotid arteries which arise from the brachiocephalic trunk on the right and from the arch of the
aorta on the left. The thyrocervical trunk arises from the first part of the subclavian artery and gives off
the inferior thyroid, ascending cervical, transverse cervical and suprascapular arteries. Also arising from
the posterosuperior aspect of this part is the vertebral artery. Branching from the second part of the
subclavian artery is the costocervical trunk which gives off a branch, the deep cervical artery at the root
of the neck. The external carotid artery arises at the level of the hyoid bone, from the bifurcation of the
common carotid artery and gives off several branches which include the superior thyroid, lingual artery,
ascending pharyngeal, occipital and posterior auricular arteries (not shown).
The rest of the branches of the external carotid artery are located superior to the neck. The internal carotid
artery does not give off any cervical branches.
Arteries Branches/tributaries
Brachiocephalic
Subclavian arteries, common carotid arteries, thyroid ima artery
trunk/arch of aorta
Subclavian artery Vertebral artery, thyrocervical trunk, costocervical trunk
External carotid Superior thyroid artery, ascending pharyngeal artery, lingual artery, facial
artery artery, occipital artery, posterior auricular artery
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Common facial vein
Superior thyroid vein
Facial vein
Vertebral vein
Middle thyroid vein
Inferior thyroid vein
Subclavian vein
FIGURE 8.102. Veins of the neck (anterior view). The main veins of the neck are the external, internal
and anterior jugular veins. The external jugular vein is usually formed by the posterior auricular and
posterior division of the retromandibular veins (not shown) and drains into the subclavian vein at the
root of the neck. Tributaries of the external jugular vein include the anterior jugular, transverse cervical,
suprascapular and posterior external jugular veins (not shown). The internal jugular vein descends through
the neck, joining with the subclavian vein to form the left/right brachiocephalic veins. Unlike its arterial
counterpart (the internal carotid artery), the internal jugular vein receives numerous tributaries within the
neck, most notably the common facial vein which is received around the level of, or inferior to, the hyoid
bone. The superior and middle thyroid veins drain regions of the thyroid gland and larynx, emptying into
the internal jugular vein, while the inferior thyroid vein drains directly into the left brachiocephalic vein.
The vertebral vein descends within the transverse foramina of the cervical vertebrae and also drains into
the brachiocephalic vein.
Veins Branches/tributaries
Posterior division of retromandibular vein, posterior auricular vein, anterior

jugular vein, suprascapular vein, transverse cervical veins
Common facial vein, superior and inferior bulb of internal jugular vein,
Internal jugular vein pharyngeal venous plexus, superior thyroid vein, lingual vein, middle thyroid
vein, sternocleidomastoid vein
Vertebral vein Occipital vein, anterior vertebral vein, accessory vertebral vein
Subclavian vein External jugular vein
Subclavian vein, internal jugular vein, vertebral vein, deep cervical vein,
Brachiocephalic vein
inferior thyroid vein

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Hypoglossal nerve
Ansa cervicalis
Transverse cervical nerve
Cervical plexus
Anterior rami of
spinal nerves C5-C8
Phrenic nerve
Vagus nerve
Recurrent laryngeal
nerve
Brachial plexus
FIGURE 8.103. Nerves of the neck (anterior view). The cervical plexus is located at the superior portion of
the neck and is formed by the anterior rami of spinal nerves C1-C4. The cervical plexus gives off a number
of deep and superficial branches. The deep branches include the ansa cervicalis, muscular branches of the
cervical plexus and the phrenic nerve, while examples of superficial branches include the lesser occipital,
great auricular, transverse cervical and supraclavicular nerves (not pictured).
The glossopharyngeal nerve (CN IX) descends between the internal carotid artery and internal jugular vein
to innervate internal structures of the head and neck, while the vagus nerve (CN X) descends towards the
thorax, giving off the superior and recurrent laryngeal nerves while doing so. The accessory nerve (CN XI;
in addition to contributions from spinal nerves C3-4), descends through the posterior aspect of the neck
to reach the trapezius muscle of the back. Finally, the hypoglossal nerve (CN XII) does not give off any
branches within the neck and travels to supply muscles of the tongue.
Nerves Branches/tributaries
Superficial branches: lesser occipital nerve, great auricular nerve, transverse

Cervical plexus cervical nerve, supraclavicular nerves
Deep branches: ansa cervicalis, phrenic nerve
Brachial plexus Dorsal scapular nerve, long thoracic nerve, suprascapular nerve, subclavian
(supraclavicular part) nerve
Glossopharyngeal nerve (CN IX), vagus nerve (CN X), accessory nerve (CN XI),
Cranial nerves
hypoglossal nerve (CN XII)
Autonomic nerves Sympathetic trunk, superior, middle, inferior cervical ganglia
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Right internal carotid

artery
Carotid sinus
Accessory nerve
Right vagus nerve
Ansa cervicalis
Phrenic nerve
Thyrocervical trunk
Subclavian artery
Brachial plexus
Subclavian vein
FIGURE 8.104. Neurovasculature of the neck (lateral view). The anatomical relations between several
neurovascular structures of the neck can be appreciated from this lateral perspective. The carotid arteries
ascend through the neck, just deep to the internal jugular veins. Traveling medial to the internal jugular
vein is the vagus nerve (CN X). The accessory nerve (CN XI) descends posterolaterally, emerging from
behind the posterior border of the sternocleidomastoid muscle, where it receives sensory contributions
from spinal nerves C3-4.
Branches of the cervical plexus, ansa cervicalis and phrenic nerve are also located deep to the sterno
cleidomastoid muscle. Passing beneath the intermediate tendon of the omohyoid muscle is the trans
verse cervical artery which branches from the thyrocervical trunk to supply muscles of the neck and back.
The suprascapular artery also branches from the thyrocervical trunk within the supraclavicular fossa and
extends laterally to supply structures of the pectoral girdle. Also located within this region is the supr
aclavicular part of the brachial plexus which passes between the anterior and middle scalene muscles
(interscalene space).
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CERVICAL PLEXUS
| | Anterior rami of spinal nerves C1-C4

Muscular branches of cervical plexus
(longus capitis colli muscles)
O Posterior rami of spinal nerves C1-C4
Muscular branches (rectus capitis

lateralis, longus capitis, and rectus
capitis anterior muscles)
Lesser occipital nerve
Hypoglossal nerve
Thyrohyoid branch of hypoglossal nerve
Geniohyoid branch of hypoglossal nerve
Transverse cervical nerve

Superior omohyoid branch
of ansa cervicalis
Sternocleidomastoid branch
of cervical plexus
Ansa cervicalis
Sternothyroid branch of ansa cervicalis
Sternohyoid branch of ansa cervicalis
Inferior omohyoid branch

of ansa cervicalis
Trapezius branch
Muscular branches
(scalene and levator scapulae muscles)
Supraclavicular nerves
Phrenic nerve
FIGURE 8.105. Overview of the cervical plexus. The cervical plexus can be seen as a cluster of nerves
originating from the anterior rami of spinal nerves C1-C4. A nerve loop known as the ansa cervicalis is
formed by branches of spinal nerves C1-C3 can be seen in the superior aspect of the illustration. The
ansa cervicalis provides motor innervation to all infrahyoid muscles except the thyrohyoid muscle. The
phrenic nerve originates from C3-C5. It travels into the thoracic cavity and provides motor innervation
to the diaphragm and sensory supply to the pericardium and diaphragm. The cervical plexus also provides
contributions to the accessory nerve, innervating the trapezius muscle. The superficial/cutaneous
branches of the cervical plexus (lesser occipital, great auricular, transverse cervical and supraclavicular
nerves) innervate the skin of the neck, scalp and shoulder.
Key points about the cervical plexus
Definition Nervous plexus formed by the anterior rami of the spinal nerves C1-C4.
Superior root of ansa cervicalis (C1): thyrohyoid muscle
Inferior root of ansa cervicalis (C2-C3): most of the infrahyoid muscles (omohyoid,
sternohyoid and sternothyroid muscles)
Deep/muscular
branches Phrenic nerve (C3-C5): diaphragm (+ sensory innervation of the central tendon of
the diaphragm and pericardium)
Segmental branches: rectus capitis anterior, rectus capitis lateralis, longus colli,
longus capitis muscles
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Key points about the cervical plexus
Lesser occipital nerve (C2): skin of the neck and scalp posterior to the auricle
of the ear
Superficial/ Great auricular nerve (C2-C3): skin over the parotid gland, posterior to the auricle
cutaneous and the mastoid area
branches
Transverse cervical nerve (C2-C3): anterior and lateral parts of the neck
Supraclavicular nerves (C3-C4): shoulder and clavicular regions
Cervical plexus
the face and scalp
LYMPHATICS OF THE HEAD AND NECK
Malar lymph node
Nasolabial lymph nodes
Buccinator lymph nodes
Mandibular lymph nodes
Submandibular lymph
nodes
Lingual lymph nodes
Submental lymph nodes
FIGURE 8.106. Lymph nodes of the head (lateral view). Lymph nodes of the head are generally divided
into three separate groups: The lingual lymph nodes, facial lymph nodes and a group of five lymph nodes

NECK
which make up the pericervical lymphatic circle (visible in next image). The lingual lymph nodes are located
in the intermuscular spaces of the floor of the mouth and function to drain lymph from the tongue.
Its efferent vessels drain to either the superior deep lateral cervical nodes of the neck, submandibular
and/or submental lymph nodes. The facial lymph nodes are located along the facial vein and consist of
the buccinator, nasolabial, malar and mandibular lymph nodes. This group of lymph nodes drain the
corresponding regions of the face into the submandibular lymph nodes.
Mastoid lymph nodes
Superficial parotid
lymph nodes
Occipital lymph
nodes
Deep parotid lymph

nodes
Jugulodigastric
lymph node
Superficial lateral
cervical lymph nodes
Deep lateral cervical

lymph nodes
Juguloomohyoid
lymph node
FIGURE 8.107 . Lymph nodes of the neck (lateral view). At the junction between the head and neck are five
groups of lymph nodes which form the pericervical lymphatic circle. These are the occipital, mastoid,
superficial and deep parotid, submandibular and submental lymph nodes. These nodes receive lymph
from regions of the nose, cheeks, ear, scalp and chin and drain to either the superficial or deep lymph
nodes of the neck.
Lymphatics of the neck can generally be divided into superficial and deep anterior lymph nodes, and
i
superficial and deep lateral lymph nodes. From this lateral perspective, the proximal portions of the m
superficial and deep lateral cervical lymph nodes can be observed. The superficial lateral cervical
>
□
lymph nodes are situated adjacent to the external jugular vein and receive lymphatic drainage from the >
pericervical lymphatic circle. This group of lymph nodes extend along the external jugular vein and empty
z
□
into the supraclavicular lymph nodes at the root of the neck. z
m
n
The deep lateral cervical lymph nodes are located along the course of the internal jugular vein. These are *
further divided into superior and inferior groups by the superior belly of the omohyoid muscle. The larg
est node of the superior deep lateral cervical nodes is the jugulodigastric node, while the largest node of
the inferior group of deep lateral cervical nodes is the juguloomohyoid node. This group of lateral nodes
receive the majority of lymph from the head and neck region and drain to the jugular trunk at the base of
the neck.
Head and neck 481

NECK
Submandibular Submental lymph

lymph nodes nodes
Superficial lateral
cervical lymph nodes Jugulodigastric
lymph node
Superior deep lateral

cervical lymph nodes Prelaryngeal
lymph nodes
Superficial anterior
cervical lymph nodes
Paratracheal
lymph nodes
Juguloomohyoid
lymph node
Thyroid lymph
nodes
Accessory
lymph nodes
Pretracheal _
Inferior deep lymph nodes
lateral cervical
lymph nodes
Supraclavicular
Jugular
lymph nodes
lymphatic trunk
Right lymphatic duct Thoracic duct
FIGURE 8.108 . Lymphatics of the head and neck (Anterior view). Located along the anterior jugular vein
are the superficial anterior cervical lymph nodes, which drain to the deep lateral cervical lymph nodes or
directly to the supraclavicular lymph nodes via efferent vessels. The deep anterior cervical lymph nodes
are subdivided into the prelaryngeal, thyroid, paratracheal and pretracheal lymph nodes depending on
their location. These nodes usually drain directly to the deep lateral cervical lymph nodes but in some
cases can also drain to the superficial anterior cervical lymph nodes.
The superficial lateral cervical lymph nodes are located along the length of the external jugular vein and
as a result are also known as the external jugular nodes. These nodes usually drain to the supraclavicular
lymph nodes at the root of the neck.
The deep lateral cervical lymph nodes are located along the length of the internal jugular vein and are
therefore also known as the internal jugular nodes. They are divided into a superior and inferior group. The
superior deep lateral cervical lymph nodes are located above the superior belly of the omohyoid muscle.
One of the largest nodes in this region is known as the jugulodigastric lymph node. The inferior deep lat
eral cervical nodes are located along the length of the internal jugular vein below the superior belly of the
omohyoid muscle. The large juguloomohyoid lymph node can be found along the middle portion of the
internal jugular vein. Efferent vessels from the deep lateral cervical lymph nodes join to form the jugular
trunks which drain into the right lymphatic and thoracic ducts, or directly into the subclavian vein.
u
id
Z
a Key points about the lymphatics of the head and neck
z
< Facial lymph
a Buccinator, nasolabial, malar and mandibular lymph nodes
< nodes
id
I Pericervical Occipital, mastoid, parotid (superficial and deep), submandibular and submental
lymphatic circle lymph nodes
Anterior
Superficial anterior cervical lymph nodes, deep anterior cervical lymph nodes
cervical lymph
(prelaryngeal, thyroid, pretracheal and paratracheal lymph nodes)
nodes

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Key points about the lymphatics of the head and neck
Superficial lateral cervical lymph nodes, deep lateral cervical lymph nodes
Lateral cervical
(superior and inferior deep lateral cervical lymph nodes), accessory lymph nodes,
lymph nodes
supraclavicular lymph nodes
Pharyngeal
Pharyngeal lymphoid ring (pharyngeal, lingual, palatine and tubal tonsils),
lymphoid ring
retropharyngeal lymph nodes
and nodes
Lymphatic
Jugular trunk, right lymphatic duct, thoracic duct
trunk and ducts
Lymphatic drainage
Lymph nodes of the
of the oral and nasal
head neck and arm
cavities
TRIANGLES OF THE NECK
| | Anterior triangle of neck | | | Posterior triangle of neck|

Carotid triangle | | Occipital triangle
| | Submandibular triangle | | Omoclavicular triangle
| | Submental triangle
| | Muscular triangle
Stylohyoid muscle
Digastric muscle
Splenius capitis muscle
Hyoglossus muscle
Mylohyoid muscle
Thyrohyoid muscle
Trapezius muscle
Omohyoid muscle
Sternocleidomastoid muscle
Sternohyoid muscle
Levator scapulae muscle
Scalenus medius muscle

Scalenus posterior muscle
Scalenus anterior muscle
FIGURE 8.109 . Triangles of the neck (overview). The midline of the neck divides the anterolateral neck
region into two symmetrical halves. On each side there is an anterior and a posterior triangle, separated by
the sternocleidomastoid muscle. The anterior triangle stretches from the midline of the neck anteriorly
Head and neck 483

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to the sternocleidomastoid muscle posteriorly and its superior border is the body of the mandible. It is
further subdivided into four smaller triangles: The submandibular, submental, carotid and muscular
triangles. The posterior triangle is bordered by the sternocleidomastoid muscle anteriorly, the trapezius
muscle posteriorly and the clavicle inferiorly. The inferior belly of the omohyoid muscle passes through
and further divides it into a smaller omoclavicular (a.k.a. subclavian) and a larger occipital triangle.
Right internal carotid

artery
Carotid sinus
Accessory nerve
Right vagus nerve
Ansa cervicalis
Phrenic nerve
Thyrocervical trunk
Subclavian artery
Brachial plexus
Subclavian vein
FIGURE 8.110 . Triangles of the neck: Neurovasculature. Lateral view of the major arteries, veins and nerves
located within the triangles of the neck, with the sternocleidomastoid muscle faded out to reveal the
vessels beneath. The common carotid artery courses upwards along the sternocleidomastoid muscle into
the carotid triangle, where it bifurcates within the carotid sheath into the internal and external carotid
arteries. Also located within the sheath are the internal jugular vein and vagus nerve.
Numerous branches of the external carotid artery arise within the carotid triangle, including the superior
and inferior thyroid arteries and veins, which travel through the muscular triangle and ultimately supply
the thyroid and parathyroid glands; as well as the facial artery, which courses through the submandibular
triangle together with the facial vein to supply superficial structures of the face.
Several important nerves are also seen in this image, such as the vagus nerve and ansa cervicalis, both
located anteriorly in the neck, within the carotid triangle. The accessory nerve (CN XI) enters the neck in
the carotid triangle and courses beneath the sternocleidomastoid muscle to reach the occipital triangle
within the posterior neck. Also located posteriorly are the brachial plexus and phrenic nerve, which pass
through the omoclavicular and occipital triangles, as well as branches of the cervical plexus which course
through the occipital triangle.

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Triangles of the
Borders Contents
neck: anterior
Superior: mandible Submandibular glands and lymph

Anterior: anterior belly of digastric muscle nodes, facial artery and vein,
Submandibular submental artery and vein, mylohyoid
triangle Posterior: posterior belly of the digastric nerve, geniohyoid muscle, hyoglossus
muscle muscle, lingual artery, deep lingual
Floor: mylohyoid and hyoglossus muscles vein
Lateral: anterior belly of the digastric

muscle
Submental Inferior (base): hyoid bone Submental veins, submental lymph
triangle nodes
Superior (apex): mandibular symphysis
Floor: mylohyoid muscle
Superior: hyoid bone
Superolateral: superior belly of omohyoid Infrahyoid muscles (thyrohyoid,

muscle sternothyroid, sternohyoid), thyroid
Muscular
gland, parathyroid gland, superior
(omotracheal) Inferolateral: sternocleidomastoid muscle
thyroid artery and vein, inferior
triangle
Base: median line of the neck thyroid artery and vein, anterior
Apex: junction of the sternocleidomastoid jugular vein
and superior belly of the omohyoid muscle
Anterior: superior belly of the omohyoid

Carotid sheath containing the
muscle
common carotid artery, internal
Superior: posterior belly of digastric jugular vein, vagus nerve (CN X),
muscle deep cervical lymph nodes; superior
Carotid triangle Posterior: anterior border of the thyroid artery, lingual artery, facial
sternocleidomastoid muscle artery, ascending pharyngeal artery,
occipital artery; hypoglossal nerve
Floor: thyrohyoid, hyoglossus, middle
(CN XII), accessory nerve (CN XI), ansa
and inferior constrictors of the pharynx
cervicalis
muscle
Triangles of the
Borders Contents
neck: posterior
Superior: inferior belly of omohyoid

muscle Subclavian artery, transverse cervical
Omoclavicular Anterior: sternocleidomastoid muscle artery, dorsal scapular artery,
(supraclavicular) external jugular vein, brachial plexus,
triangle Inferior: clavicle phrenic nerve, supraclavicular lymph
Floor: anterior and middle scalene nodes
muscles
Anterior: posterior border of

sternocleidomastoid muscle
Occipital artery, transverse cervical
Occipital Posterior: trapezius muscle artery, accessory nerve (CN XI),
triangle Inferior: inferior belly of omohyoid muscle brachial plexus, cervical plexus,
phrenic nerve, cervical lymph nodes
Floor: splenius capitis, levator scapulae
and middle scalene muscles
Head and neck 485

NECK
COMPARTMENTS OF THE NECK
Fasciae of the neck (cervical fascia) are multilayered sheaths of connective

tissue that wrap the structures of the neck and can be divided into two layers: A
superficial layer (superficial cervical fascia) and a deep layer (deep cervical fascia).
The cervical fasciae provide longitudinal organization by separating the tissues
of the neck and therefore largely limit the spread of infection in response to
pathology or trauma. The superficial cervical fascia (i.e. subcutaneous tissue or
tela subcutanea) lies deep to the skin and does not contribute to the forma
tion of the neck compartments. However, the deep cervical fascia typically has
three separate layers that contribute to the formation of the spaces and com
partments of the neck. These layers include:
• The superficial layer (investing layer, external layer, parotidomasseteric fascia)

• The middle layer (pretracheal layer, buccopharyngeal fascia)
• The deep layer (deep investing layer, prevertebral layer)
A compartment is a section of the body bounded by fascia. The internal struc

tures of the neck are divided into four main compartments: The visceral com
partment, vertebral compartment and two vascular compartments. Each
compartment is contained within unique layers of deep cervical fascia.
The fasciae of the neck also contribute to the formation of three fascial spaces:
The pretracheal space, the retropharyngeal space and the danger space (of
Grodinsky). These spaces extend from the base of the skull to the mediastinum
and in doing so may provide a conduit for the passage of infection from the neck
to the thoracic cavity.

NECK
Pretracheal fascia
(D
(D
Buccopharyngeal
fascia
Infrahyoid fascia
Carotid sheath
Alar fascia
Deep layer of deep

cervical fascia
Superficial layer of deep

cervical fascia
Cervical subcutaneous tissue
FIGURE 8.111 . Cervical fascia (cross section). The superficial layer of deep cervical fascia is located deep to
the superficial cervical fascia and encircles the neck, surrounding the trapezius and sternocleidomastoid
muscles. This layer of fascia forms one large compartment which contains the other three smaller
compartments of the neck.
The middle layer of deep cervical fascia is typically divided into muscular (infrahyoid) and visceral fas
ciae. The muscular or infrahyoid fascia surrounds the infrahyoid (strap) muscles while the visceral fascia
is divided into two parts: A pretracheal layer and a buccopharyngeal layer. The deep layer of deep cervical
fascia also known as prevertebral fascia is a cylindrical layer of fascia which surrounds the cervical verte
bra. Prevertebral fascia passes between the attachment points on the transverse processes of the cervical
vertebrae and splits into two layers forming another sheet of fascia known as alar fascia. Alar fascia forms
the anterior layer of the prevertebral fascia and delimits the posterior margin of the retropharyngeal
space and the anterior margin of the danger space.
Formed by contributions from all three layers of deep cervical fascia is the carotid sheath. The carotid
sheath extends from the base of the skull caudally to the first rib. It surrounds the major vascular struc
tures of the neck thereby forming the vascular compartment.
Head and neck 487

NECK
Visceral compartment
Pretracheal space
Vascular compartment
Retropharyngeal space
Danger space
(of Grodinsky)
Vertebral compartment
FIGURE 8.112 . Compartments and spaces of the neck. The visceral compartment of the neck is surrounded
by the visceral cervical fascia, specifically the pretracheal fascia anterolaterally and buccopharyngeal fascia
posteriorly. It extends from the superior part of the hyoid bone superiorly to the superior mediastinum
inferiorly. It is the most anteriorly located compartment of the neck.
Posterior to the visceral compartment is the large vertebral compartment of the neck. This compartment
is surrounded posterolaterally by prevertebral fascia and anteriorly by alar fascia. It is attached superiorly
as a continuous circle from the base of the skull and extends to the superior mediastinum inferiorly.
The paired vascular compartments (a.k.a. carotid spaces), formed by the carotid sheaths, house the large
vascular channels of the neck (common carotid artery, internal jugular vein). Each vascular compartment
extends from the base of the skull to the aortic arch within the thoracic cavity.
Between the investing layer of cervical fascia and pretracheal fascia is the most anteriorly located fascial
space, the pretracheal space. It extends from the thyroid cartilage superiorly to reach the superior medi
astinum inferiorly.
The buccopharyngeal fascia together with the carotid sheath and alar fascia of the deep layer of deep
cervical fascia form a fat filled space known as the retropharyngeal space. The danger space which lies
between the alar and prevertebral fascia is located just anterior to the cervical vertebral bodies and spans
from the base of the skull to the posterior mediastinum where the prevertebral layers of deep cervical
fascia fuse. The danger space is so called as its loose areolar tissue provides a route of passage for the rapid
down spread of infection from the neck to the thoracic region. The retropharyngeal and danger spaces
extend from the base of the skull superiorly to the posterior mediastinum inferiorly.

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Esophagus Sternohyoid muscle
Spinal cord Platysma muscle
Longus colli muscle

Trachea
Omohyoid muscle
Sternothyroid muscle
Vagus nerve
Thyroid gland
Internal jugular
vein Sternocleidomastoid
muscle
Phrenic nerve
Recurrent laryngeal
nerve
Spinal nerve
Common carotid
artery
Scalenus medius
muscle
Scalenus anterior
Splenius cervicis muscle
muscle
Sympathetic trunk
Multifidus muscle
Scalenus posterior
Semispinalis muscle
cervicis muscle
Levator scapulae
Skin muscle
Trapezius muscle Deep cervical muscles
Semispinalis capitis muscle Splenius capitis muscle
Nuchal ligament Cervical vertebra

Q| Visceral compartment
Q| Vascular compartment
Q Vertebral compartment
FIGURE 8.113 . Compartments of the neck: The visceral compartment, which is enclosed by pretracheal and
buccopharyngeal fascia, contains the thyroid and gland, parathyroid glands, larynx, trachea, hypopharynx,
recurrent laryngeal nerve and esophagus.
The vertebral compartment contains the cervical vertebrae and deep muscles associated with them,
which include the longus colli muscle, the scalenus anterior, medius and posterior muscles, the deep
cervical muscles (splenius cervicis, splenius capitis, semispinalis cervicis, semispinalis capitis, multifidus
muscle) and the levator scapulae muscle.
The vascular compartment of the neck is so called according to its contents. It contains the major vascular
structures of the neck which include the common carotid arteries and internal jugular veins. It also con
tains the vagus nerve, part of the recurrent laryngeal nerve and the deep cervical lymph nodes.
The three spaces of the neck mainly contain a combination of subcutaneous fat, loose connective tissue
and lymph nodes.
Cervical fascias Carotid sheath
Head and neck 489

NEUROANATOMY 9
Introduction to the brain....................................................... 493
Cerebrum................................................................................ 495
Cerebral cortex............................................................................ 495
Motor and sensory cortical homunculus...................................... 499
White matter............................................................................... 500
Basal nuclei.................................................................................. 501
Diencephalon.............................................................................. 502
Brainstem and cerebellum..................................................... 505

Brainstem.................................................................................... 505
Cerebellum..................................................................................508
Meninges and ventricles of the brain...................................... 511

Cranial meninges........................................................................... 511
Ventricles of the brain.................................................................. 512
Blood supply of the brain........................................................ 515

Arteries of the brain......................................................................515
Veins of the brain......................................................................... 519
Dural venous sinuses....................................................................522
Spinal cord.................................................... ...........................524

Topography and morphology of the spinal cord ............................ 524
Spinal meninges and nerve roots.................... ............................ 526
Spinal nerves.................................................. ............................. 527
Blood vessels of the spinal cord...................... ............................ 529
Cranial nerves............................................... ......... 532

Cranial nerve overview.................................... .......... 532
Olfactory nerve (CN I)..................................... .......... 536
Optic nerve (CN II)........................................... .......... 538
Oculomotor, trochlear and abducens nerves (CN III, IV & VI) .......... 540
Trigeminal nerve (CN V).................................................... .......... 543
Ophthalmic nerve (CN V1)............................................... .......... 543
Maxillary nerve (CN V2)................................................... .......... 545
Mandibular nerve (CN V3)................................................ .......... 547
Facial nerve (CN VII).......................................................... .......... 550
Vestibulocochlear nerve (CN VIII).................................................. 553
Glossopharyngeal nerve (CN IX).................................................... 556
Vagus nerve (CN X)....................................................................... 559
Accessory nerve (CN XI)................................................................ 563
Hypoglossal nerve (CN XII)............................................................ 564
Taste pathway..............................................................................566
INTRODUCTION TO THE BRAIN
The brain is an integral part of the central nervous system. It contains three
main parts:
• The cerebrum is the largest part of the brain. It is responsible for higher-order
bodily functions such as vision, hearing, cognition, emotions, learning and
fine control of movement.
• The cerebellum sits below the cerebrum. It regulates motor functions such
as balance, coordination and speech.
• The brainstem connects the brain with the spinal cord. It controls the most
lower-order bodily functions such as breathing and heart rate.
Frontal lobe Corpus callosum
Central sulcus
Thalamus
Parietal lobe
Occipital lobe Pituitary gland
Lateral sulcus
Midbrain —
Cerebellum
Temporal lobe Superior Pons
Rostral Dorsal
Medulla
Anterior Posterior oblongata
Ventral
D Dorsal
Caudal
Longitudinal axis
of the forebrain
Cerebellum
Longitudinal axis of the / Inferior
brainstem and spinal cord Caudal
FIGURE 9.1. Overview of the brain. The brain consists of three main parts:
• The cerebrum is organized into two hemispheres that are connected by a large bundle of white matter
tissue called the corpus callosum. The outer surface of the cerebrum exhibits many elevated ridges of
tissue called gyri, that are separated by grooves called sulci. The gyri and sulci increase the surface area
of the cerebrum, providing it with its characteristic convoluted appearance.
Each hemisphere of the cerebrum contains six lobes: Frontal, temporal, parietal, occipital, insular and
limbic. The insular lobe is located internal to the lateral sulcus and is therefore not visible superficially.
It is covered by portions of the parietal, temporal and frontal lobes which are collectively referred to as
the operculum (lit. ‘a covering’).
• The cerebellum is found inferior to the occipital lobe of the cerebrum. It also has two hemispheres that
are connected by the vermis.
• The brainstem is the most caudal part of the brain. It is made up of the midbrain, pons, and medulla
oblongata, each of which have their own structural and functional organization.
Neuroanatomy 493
INTRODUCTION TO THE BRAIN
Key points about the brain
Part Structure Functions
• Frontal, temporal, • Gray matter: process/integrate sensory input, control

parietal, occipital, voluntary/skilled movement, higher mental functions
Cerebrum insular and limbic lobes (cognition, emotions, learning)
• Basal nuclei • Modulate voluntary movements
• Vermis and hemispheres • Processes motor/proprioceptive, visual/vestibular

Cerebellum (anterior, posterior, input, motor functions (balance/equilibrium,
flocculonodular lobes) coordination, speech)
• Midbrain • Visual/auditory reflexes, nuclei of cranial nerves III/IV
• Pons • Relays cerebral input to cerebellum, nuclei of cranial

nerves V-VII
• Medulla oblongata
Brainstem • Relays sensory input to cerebellum, controls heart/
breathing rate, nuclei of cranial nerves VIII-XII
(all parts of the brainstem carry information between

upper and lower parts of the CNS)
Central nervous Cerebellum and

system brainstem

CEREBRUM
CEREBRAL CORTEX
Each hemisphere of the cerebrum contains six lobes: Frontal, temporal,
parietal, occipital, insular and limbic. The insular lobe is located internal to the
lateral sulcus and is therefore not visible superficially. It is covered by portions
of the parietal, temporal and frontal lobes which are collectively referred to as
the operculum (lit. ‘a covering’).
□ Frontal lobe
Superior frontal gyrus
□ Parietal lobe
□ Temporal lobe
□ Occipital lobe Middle frontal gyrus
□ Insula
□ Limbic lobe
Precentral sulcus
Postcentral sulcus
Central sulcus
Angular gyrus
Postcentral gyrus
Precentral gyrus
Superior temporal
gyrus
Inferior frontal gyrus
Middle temporal gyrus
Inferior temporal gyrus
FIGURE 9.2. Lobes of the cerebrum. Color-coded representation of the cerebral lobes as well as major
gyri and sulci identifiable from a lateral perspective.
Neuroanatomy 495
CEREBRUM
Lobes of the cerebrum
Anatomy Functions
Anterior to central sulcus, superior to

lateral sulcus Control of voluntary movement, involved
Frontal lobe in attention, short term memory tasks,
Major gyri: precentral gyrus, superior, motivation, planning, speech
middle, inferior frontal gyri
Processing of somatosensory input

Posterior to the central sulcus (touch, pain, pressure and temperature),
Major gyri/areas: postcentral gyrus, integration of other sensory input (taste,
Parietal lobe
superior parietal lobule, inferior parietal hearing, sight, and smell), visuospatial
lobule (angular gyrus) mapping and attention, processing
language and numerical relationships
Lateral surface of cerebrum, inferior to Decoding sensory input (visual and

lateral sulcus auditory) into derived meanings for
Temporal lobe
Main gyri: superior, middle, inferior retention of visual memory and language
temporal gyri comprehension
Posterior to parietal/temporal lobes

Occipital lobe Center for visual processing
Main gyri: occipital gyri
Deep to temporal/parietal/frontal lobes Processing and integration of taste

Insula sensation, visceral and pain sensation
Main gyri: long/short gyri of insula and vestibular functions
Medial surface of each hemisphere,

surrounding corpus callosum Modulation of emotions, modulation
Limbic lobe of visceral and autonomic functions,
Main gyri: paraterminal, cingulate, learning, memory
parahippocampal gyri
The cerebral cortex forms the surface of each hemisphere; it is composed of

gray matter and is the most complex part of the cerebrum. Functionally, it can
be divided into three general areas:
• Primary motor cortex, which is involved in the planning and execution of

movement
• Primary sensory cortices, which receive and process sensory input
• Association areas, which serve to integrate information from several
structures/areas.
Association areas can be unimodal, which integrate information from a single

source (typically an adjacent primary motor/sensory area) or higher-order/
multimodal, which receive information from multiple sources in order to carry
out higher cognitive functions. All neurons in the cerebral cortex are interneu
rons as they synapse with other neurons.

CEREBRUM
Primary motor Primary somatosensory

area area
Premotor/ Somatosensory
supplementary assocation area
motor area
Parietooccipito-
Frontal temporal
eye field association area
Prefrontal
Wernicke’s
association
area
area
Primary
Broca’s area
visual area
Limbic association Visual association

area area
Primary auditory Auditory association

area area
Primary motor area | | Unimodal association areas
Primary sensory areas Higher order (multimodal) association areas
FIGURE 9.3. Motor, sensory and association cortices. Left lateral view of the cerebrum. A map depicting
the major functional areas of the cerebrum according to the three main groups.
Motor, sensory and association cortices
Area Location Function
Motor
Primary motor area Precentral gyrus (frontal lobe) Planning and execution of movement
Sensory
Primary
Postcentral gyrus (parietal lobe) Processing of somatic sensory input
somatosensory area
Primary visual area Occipital lobe Processing of visual input
Primary auditory area Superior parietal lobule Processing of auditory input
Olfactory area Limbic/medial temporal lobes Processing of olfactory input
Gustatory area Insular/parietal lobes Processing of taste stimuli
Vestibular areas Parietal/temporal lobes Equilibrium and balance
Association areas
Premotor area Anterior to primary motor cortex Complex movement
Somatosensory Posterior to primary somatosensory Integration of somatic sensory

association area cortex information
Anterior part of occipital lobe, Spatial orientation, perception of

Visual association
posterior parts of parietal/temporal depth, location, movement and
area
lobes velocity of objects in space
Neuroanatomy 497
CEREBRUM
Motor, sensory and association cortices
Area Location Function
Interpretation of signals from

surrounding somatosensory, visual
Parietalocciptio-
Posterior parts of parietal/occipital/ and auditory areas (e.g. visuospatial
temporal association
temporal lobes awareness, visual language (reading),
area
naming of objects), learning of fine
motor skills
Posterolateral part temporal lobe

Wernike’s area Language (comprehension)
(usually left hemisphere)
Temporal association Processes of recognition/association,

Anterior pole of temporal lobe
area behavior, emotions, and motivation
Higher mental functions, behavior,

Prefrontal area Anterior frontal lobe
personality
Frontal eye fields Anterior to premotor cortex Eye movements
Inferolateral frontal lobe (usually left Language (production/word

Broca’s area
hemisphere) formation)
Anterior pole of temporal lobe,

Limbic association Processes of recognition/association,
ventral part of frontal lobe,
area behavior, emotions, and motivation
cingulate gyrus
Cerebral cortex

CEREBRUM
MOTOR AND SENSORY CORTICAL HOMUNCULUS

The primary motor cortex is somatotopically arranged such that different parts
of this gyrus are associated with the motor control of the different parts of
the contralateral side of the human body. To reflect this, a spatial map of the
body along the primary motor cortex, referred to as the motor homunculus,
has been developed. Similar to the primary motor cortex, the neurons in the
primary somatosensory cortex are somatotopically arranged; a sensory map of
the body along the postcentral gyrus is known as the sensory homunculus.
FIGURE 9.4. Motor and sensory cortical homunculi. This image shows coronal sections of the brain
through the precentral and postcentral gyri. The motor homunculus (upper right image) represents a
topographic map of the motor innervation of the body. Note that the body parts of the homunculus are
not proportional to the real body parts. This is because the amount of cortex dedicated to each body part
is proportional to the intricacy and complexity of the motor function of each body part.
The sensory homunculus (lower left image) is a topographic distribution of the somatosensory innerva
tion of different body parts. Again, the area of the cortex that is responsible for the innervation of the
body parts, is not proportional to the dimensions of the body part. The amount of cortex per body part is
proportional to the complexity of sensations received from that organ.
Neuroanatomy 499
CEREBRUM
WHITE MATTER
Deep to the cerebral cortex (i.e. gray matter containing neuronal cell bodies)
is the cerebral white matter which is composed of axons of neurons reaching
between different areas of the brain. Most of these nerve fibers are surrounded
by a type of fatty sheath/envelope called myelin which gives the white mat
ter its color. While the gray matter facilitates information processing, the white
matter serves the important role of function of enabling information transfer.
FIGURE 9.5. Cerebral white matter. Deep to the cerebral cortex (i.e. gray matter) is the cerebral white
matter, which is composed of tracts carrying signals to, from or within each cerebral hemisphere. The
largest of these is the corpus callosum, a dense plate composed of commissural fibers which connect
the cerebral hemispheres. Projection fibers, on the other hand, connect different cortical regions within
lower regions of the brain or spinal cord, while association fibers are those which interconnect different
regions of the cerebral cortex within the same hemisphere.

CEREBRUM
BASAL NUCLEI
The basal nuclei, commonly known as the basal ganglia, are a group of gray mat
ter masses found deep within the white matter of each cerebral hemisphere.
The components of basal nuclei are the caudate nucleus, putamen, and globus
pallidus. The subthalamic nucleus and substantia nigra are not anatomically part
of the basal nuclei but are functionally connected and related to this system.
The basal nuclei play a crucial role in the modulation of voluntary movements.
Dysfunction of these structures can lead to several neurologic conditions
broadly known as movement disorders.
FIGURE 9.6. Overview of the basal nuclei. Left lateral perspective of the brain, with the left-sided
instances of the different nuclei of the basal nuclei presented. The caudate nucleus is an elongated,
C-shaped structure that consists of a head, body and tail. The tail extends as far anteriorly/rostrally as far
as the amygdaloid body, which is not part of the caudate nucleus. Located close to the head of the caudate
nucleus is the nucleus accumbens, a structure involved in the perception of pleasure that is considered
to be a part of the limbic system. Continuous with the head of the caudate nucleus is the putamen, a
rounded nucleus which is the most lateral of the basal nuclei. The globus pallidus is situated medial to the
putamen and is divided into lateral (or external) and medial (or internal) segments. Also represented in the
image are two important structures functionally related to the basal nuclei: The subthalamic nucleus and
the substantia nigra, located in the subthalamus and midbrain, respectively. Central in this image and lying
medially to the basal nuclei is the thalamus. The thalamus has important connections with the basal nuclei.
Neuroanatomy 501
CEREBRUM
Key points about the basal nuclei
Definition Group of subcortical nuclei that fine-tune the voluntary movement
Caudate nucleus
Putamen
Globus pallidus
Components
Functionally related structures:
Subthalamic nucleus
Substantia nigra
Planning and modulation of movement, memory, eye movements, reward

Function
processing, motivation
Direct and indirect

Basal ganglia pathways of the basal
ganglia
DIENCEPHALON
The forebrain can be further divided into two parts: The telencephalon (com
posed of cerebral cortex, white matter and basal nuclei) and the diencephalon
that occupies the central region of the brain (around the third ventricle).
The diencephalon is divided into several distinct parts, most notably the:
Thalamus: Central portion of the diencephalon (many other parts of the dien
cephalon take their names based on their relevant position compared to the
thalamus. It is an ovoid, bilateral gray matter structure, found in the center of
the brain, just superior to the brainstem. The thalamus has many important
functions, but in general is considered to be the central relay station of the
brain, that relays limbic, sensory and motor information between the cere
bral cortex and the rest of the nervous system.
Epithalamus: Small dorsal part of the diencephalon that participates in the
formation of the roof of the third ventricle. The structures that make up the
epithalamus are the pineal gland and habenular nuclei.
Subthalamus: Lies inferior to the posterior part of the thalamus, just pos
terior and lateral to the hypothalamus. The largest division of the subthala
mus is the subthalamic nucleus. This nucleus plays a fundamental role in the
circuitry of the basal nuclei (i.e. movement regulation).
Hypothalamus: Inferior most part of the diencephalon, located anteroinfe
rior to the thalamus. It can be divided into several regions each of which is
responsible for certain functions. In general, it forms connections with dif
ferent body systems (endocrine, autonomic and limbic) through which it
controls some vital functions of the human body (e.g., homeostasis, energy
consumption, hunger, awareness, etc.)

CEREBRUM
FIGURE 9.7. Overview of the diencephalon. A sagittal section of the brain showing the diencephalon and
surrounding structures. The diencephalon is the central portion of the brain located around the third
ventricle, superior to the brainstem (medulla, pons and midbrain), and inferior to the corpus callosum and
cerebral cortex.
Four notable parts of the diencephalon include the epithalamus, thalamus, subthalamus, and hypothal
amus. The largest and most significant part of the diencephalon is the thalamus, which is an ovoid gray
matter structure that relays information from the cortex to the rest of the nervous system and vice versa.
The epithalamus is a small portion of the diencephalon located dorsal and caudal to the thalamus. The
subthalamus and hypothalamus are both located ventral to the thalamus. The subthalamus is involved in
movement regulation, while the hypothalamus controls vital functions such as hunger and thirst.
Key points about the four main parts of the diencephalon
Part Location Function
Regulation of circadian rhythms responsible for regular

Caudal part of
Epithalamus sleep and wake cycles, regulates motivational states and
diencephalon
cognition
Superior to brainstem,
Relays limbic, sensory and motor information between
Thalamus either side of third
the cerebral cortex and the rest of the nervous system
ventricle
Inferior to posterior
part of the thalamus;
Subthalamus Regulation of movement
posterior and lateral to
hypothalamus
Vital functions of the body (e.g., homeostasis, energy

consumption, hunger, awareness, body temperature),
Anteroinferior to
Hypothalamus regulates hormonal output of the adenohypophysis
thalamus
(anterior pituitary gland), acts as endocrine gland
(produces antidiuretic hormone/oxytocin)
Neuroanatomy 503
CEREBRUM
it®
■ Diencephalon Hypothalamus
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Thalamus

BRAINSTEM AND CEREBELLUM
BRAINSTEM
The brainstem is a stalk-like projection which extends caudally from the base of
the diencephalon, connecting it with the spinal cord. It is the oldest part of the
brain and is composed of three parts: The midbrain, pons and medulla oblongata.
Vertical division: Horizontal division:

■ Tectum ® Midbrain
□ Tegmentum E3 Pons
□ Basilar part ES Medulla oblongata
Inferior colliculus-----------
Cerebral aqueduct--------
Crus cerebri-----
Superior medullary velum —
Fourth ventricle
Pyramid of medulla oblongata
Inferior medullary velum
FIGURE 9.8. Parts of the brainstem (sagittal view). The midbrain is the shortest segment of the brainstem.
It extends caudally from the base of the diencephalon) to the pons. Its functions are associated with motor
coordination (in particular eye movements), visual and auditory processing, arousal/consciousness as well
as behavioral responses to fear and danger.
The pons is located between the midbrain and medulla oblongata and forms the largest component of the
brainstem. It houses the nuclei of cranial nerves V-VIII, as well as the pontine nuclei which facilitate corti-
copontocerebellar communication. It also participates in the regulation of sleep and breathing.
The medulla oblongata is the narrowest and most caudal part of the brainstem. It has a tapered appear
ance that extends from the pons to the spinal cord. It houses the nuclei of cranial nerves IX-X, and XII and
is involved in controlling respiratory function, the cardiovascular system, as well as gastrointestinal and
digestive activities.
The brainstem can also be divided vertically into tectum, tegmentum and basilar parts. The tectum (L. roof)
and tegmentum (L. covering) are used in relation to the developing central cavity of the neural tube. The
tectum is the roof of the cavity while the tegmentum forms the ventral covering. The central cavity of the
neural tube becomes the aqueduct of Sylvius, the fourth ventricle, and the central canal of the spinal cord.
Therefore, the tectum is the area dorsal to the cerebral aqueduct, while the tegmentum is ventral to these
structures at the respective levels. The basilar part is ventral to tegmentum and it spans all three vertical
parts of the brainstem.
Neuroanatomy 505
Cerebral peduncle
Trigeminal nerve
Oculomotor nerve
Basilar sulcus
Trochlear nerve
Pons
Abducens nerve
Facial nerve
Vestibulocochlear nerve
Glossopharyngeal nerve
Vagus nerve
Hypoglossal nerve
Accessory nerve
Pyramid of medulla
oblongata
Olivary nuclei
Preolivary groove
Retroolivary groove
Decussation of pyramids
FIGURE 9.9. Brainstem (anterior/ventral view). Along its ventral surface, the midbrain is characterized
by two prominences known as the cerebral peduncles which connect the cerebral hemispheres to the
brainstem. Between each cerebral peduncle is a shallow depression, the interpeduncular fossa; the
posterior perforated substance forms the floor of this fossa, while its contents include the oculomotor
nerves (CN III) and mammillary bodies.
When viewed from the ventral aspect, the pons resembles a dome-like structure with numerous hori
zontal striations across its surface. A shallow depression runs along its vertical axis known as the basilar
groove, which houses the basilar artery.
An anterior median fissure divides the ventral medulla oblongata into symmetrical halves and is bordered
on either side by the medullary pyramids. Lateral to each pyramid is another prominent bulge, the olive,
which corresponds to the location of the olivary nuclei. At its caudal/inferior end, the anterior median
fissure is interrupted by criss-crossing fibers known as the decussation of pyramids, which mark the ter
mination of the medulla oblongata.

Thalamus
Superior colliculus
Inferior colliculus
Trochlear nerve
Superior medullary
velum
Medial eminence of
rhomboid fossa
Medullary striae of
fourth ventricle
Vestibular area of
fourth ventricle
Rhomboid fossa
Cuneate tubercle
Gracile tubercle
Cuneate fasciculus
Gracile fasciculus
FIGURE 9.10. Brainstem (posterior/dorsal view). The posterior part (tectum) of the midbrain has two pairs
of raised, round protrusions that are collectively known as the quadrigeminal plate. This complex consists
of the superior and inferior colliculi.
The dorsal aspect of the pons and upper medulla oblongata forms the floor of the fourth ventricle, form
ing a large landmark known as the rhomboid fossa. T The cranial/superior limit of the pons is formed by a
structure which contributes to the formation of the roof of the fourth ventricle, the superior medullary
velum, while the inferior boundary of the pons is formed by the medullary striae of the fourth ventricle.
The dorsal/posterior surface of the medulla oblongata is divided into an open/superior part, which con
tains the caudal half of the fourth ventricle, and a closed/inferior part, which contains the central canal
that continues into the spinal cord. The dorsal aspect of the inferior part of the medulla oblongata is
marked by the gracile and cuneate tubercles which are continuations of the gracile and cuneate fasciculi
of the spinal cord.
Key points about the brainstem
Anatomy Functions
Major landmarks: cerebral peduncles, Processes and directs visual/auditory

interpeduncular fossa (mamillary body) information to thalamus, monitors
Midbrain
quadrigeminal plate (inferior colliculus, movement with basal nuclei, contains
superior colliculus) nuclei of cranial nerves III/IV
Major landmarks: upper rhomboid fossa

(median sulcus, sulcus limitans, medial Relays cerebral input to cerebellum,
Pons eminence, upper part of vestibular area) contains nuclei of cranial nerves V-VII
intermediate rhomboid fossa (medullary Regulates breathing, sleep-wake cycle
striae of fourth ventricle)
Neuroanatomy 507
Key points about the brainstem
Anatomy Functions
Relays sensory input to cerebellum,

Parts: superior/open (caudal part of fourth regulates several homeostatic functions
ventricle), inferior/closed (contains central (e.g. heart/breathing rate), contains nuclei
Medulla n
canal) of cranial nerves VIII-XII
oblongata
Major landmarks: pyramids, decussation of (all parts of the brainstem carry
pyramids, olives, gracile/cuneate tubercles information (via white matter tracts)
between upper and lower parts of the CNS)
The brainstem
CEREBELLUM
The cerebellum is the part of the brain which lies posterior (dorsal) to the pons
and medulla. It sits in the posterior cranial fossa beneath the occipital lobe of
the cerebrum, from which it is separated by the tentorium cerebelli. It is con
nected to the brainstem by three sets of large bilateral nerve fiber bundles
known as cerebellar peduncles.
At a gross level, the cerebrum is built around a central vermis which is flanked
on either side by a cerebellar hemisphere. It has three surfaces: Superior (tento
rial), anterior (petrosal) and inferior (suboccipital). All are highly convoluted and
bear deep fissures that divide the cerebellum into lobes that are further subdi
vided into lobules. The surface of the cerebellum is much more tightly folded
compared to the cerebral cortex and is marked with fine gyri known as folia.
The cerebellum receives input from peripheral receptors and motor centers in
the spinal cord, visual and vestibular apparatus as well as cerebrum and brain
stem; it is responsible for integrating these inputs to ensure coordination of
movement, balance and posture, as well as motor learning.

Anterior notch Anterior quadrangular

of cerebellum lobule
Primary fissure
Central lobule
Posterior
quadrangular
Culmen lobule
Horizontal
fissure
Declive
/fl Superior
posterior
fissure
— Folium Superior
semilunar
lobule
Horizontal
Posterior notch fissure
of cerebellum
Inferior semilunar
lobule
| | Anterior lobe
| | Posterior lobe
FIGURE 9.11. Cerebellum (superior view). Isolated view of the cerebellum after it has been removed from
the posterior cranial fossa and detached from the brainstem.
The superior surface of the cerebellum is generally rounded and broad, except for pronounced anterior
and posterior cerebellar notches located between the expanded cerebellar hemispheres. The anterior
cerebellar notch contains the inferior colliculi of the midbrain in situ, while the posterior cerebellar notch
contains the falx cerebelli. The primary fissure of the cerebellum separates the anterior and posterior
lobes. The largest and deepest fissure of the cerebellum, the horizontal fissure, extends posterolaterally
along each hemisphere separating the superior and inferior semilunar lobules.
Neuroanatomy 509
Vermis Cerebellar hemisphere
Superior cerebellar peduncle
Middle cerebellar
peduncle
Horizontal fissure
Inferior cerebellar
peduncle
Flocculus
Nodule
Tonsil
Posterior notch
of cerebellum
| | Anterior lobe
| | Posterior lobe
| | Flocculonodular lobe
FIGURE 9.12. Cerebellum (anterior view, left side). This view of the cerebellum is once again characterized
by a central vermis which connects the cerebellar hemispheres. Also visible are three pairs of prominent
fiber bundles, the superior, middle, and inferior cerebellar peduncles that connect the cerebellum to the
midbrain, pons, and medulla oblongata, respectively. The superior and inferior medullary vela are thin
sheets of white matter which form the roof of the fourth ventricle. This is the only perspective in which
the three lobes of the cerebellum (anterior, posterior and flocculonodular) are collectively visible.
The anterior (petrosal) surface of the cerebellum bears the tonsils of the cerebellum which protrude
inferomedially between the tuber and uvula of the vermis. The largest and deepest fissure of the cere
bellum, the horizontal fissure. It extends posterolaterally along each hemisphere dividing the cerebellum
into upper and lower parts.
Afferent and efferent

Cerebellum gross
pathways of the
anatomy
cerebellum

MENINGES AND VENTRICLES OF THE BRAIN
CRANIAL MENINGES
Separating the brain and spinal cord from their surrounding bony enclosures
are three membranes known as the meninges. The outermost layer is the dura
mater (also known as pachymeninx) which consists of a double layer of thick,
dense irregular connective tissue. The middle layer is the arachnoid mater,
so-called for its spider web-like appearance, while the innermost layer is the
thin and delicate pia mater. The arachnoid and pia mater can also be collectively
referred to as the leptomeninges due to their common embryological and cel
lular structure.
These layers delimitate three clinically important spaces: The epidural (or
extradural), subdural, and subarachnoid spaces. The epidural space is located
between the bones of the cranium and outer (periosteal) layer of the dura mater,
while the subdural space lies between the inner (meningeal) layer of the dura
mater and arachnoid mater. Both of these are potential spaces, meaning that
under normal circumstances they are closed. The subarachnoid space, located
between the arachnoid and pia mater, is a fluid-filled space that contains CSF,
as well as cerebral arteries and veins. Finally, separating the pia mater from the
surface of the brain is a thin space known as the subpial space.
Periosteum Diploic veins
Emissary Superior sagittal

veins sinus
Skull Periosteal layer

of dura mater
Cerebral Subdural space

cortex
Arachnoid Subarachnoid
granulations space
Meningeal layer of Pia mater

cranial dura mater
Arachnoid mater Subpial space
FIGURE 9.13. Meninges of the brain (coronal section). Coronal section through a portion of the skull,
meninges and cerebral cortex. The cranial dura mater is composed of two layers: The outer periosteal layer
Neuroanatomy 511
(which adheres tightly to the skull, also known as the endocranium) and inner meningeal layer. The two dural
layers are usually directly apposed to one another, except in places where they separate to form the dural
venous sinuses, which is represented in this image by the superior sagittal sinus. Deeper to the dura mater
is the arachnoid mater with its small protrusions known as arachnoid granulations, that pierce the inner
layer of the dura projecting into the lumen of the superior sagittal sinus. The pia mater is a thin membrane
composed of a single cell layer which, unlike the dura and arachnoid mater, closely follows all contours (i.e.,
gyri and sulci) of the brain. Thin projections of connective tissue called arachnoid trabeculae extend from
the inner surface of the arachnoid mater, traverse the subarachnoid space and attach to the outer surface
of the pia mater.
Key points about the cranial meninges
Definition Three membranous layers that envelop the brain
Dura mater
Meninges Arachnoid mater

Pia mater
Epidural space
Meningeal Subdural space

spaces Subarachnoid space
Subpial space
Mechanical protection of brain

Function Support of cerebral blood vessels
Accommodation and circulation of CSF (subarachnoid space)
Related Dural venous sinuses (venous drainage of the brain)

structures Arachnoid granulations (return of CSF to venous circulation)
Meninges ventricles
Meninges of the brain
and brain blood
and spinal cord
supply
VENTRICLES OF THE BRAIN
The ventricles of the brain are an interconnected network of cavities filled with
cerebrospinal fluid (CSF) located within the brain parenchyma. The ventricu
lar system consists of the two lateral ventricles, the third ventricle, and the
fourth ventricle. The choroid plexuses, located within each ventricle, produce
CSF which fills the ventricles and subarachnoid space. This fluid cushions the
brain and spinal cord from injury and also serves as a nutrient delivery and waste
removal system for the brain.

Central part of lateral

Left lateral ventricle
ventricle
Suprapineal recess
Interventricular foramen
Pineal recess of third

Frontal horn of lateral ventricle
ventricle
Atrium of lateral
ventricle
Right lateral ventricle
Occipital horn of
lateral ventricle
Third ventricle
Cerebral aqueduct
Supraoptic recess
Fourth ventricle
Infundibular recess of
Lateral recess of fourth
third ventricle ventricle
Temporal horn of lateral

Central canal of spinal cord
ventricle
FIGURE 9.14. Ventricles of the brain. The lateral ventricles are two C-shaped cavities, one in each cerebral
hemisphere. Each lateral ventricle has a central part, or body (located in the region of the parietal lobe),
an atrium and three horns projecting into the lobes for which they are named: The frontal (or anterior)
horn, the occipital (or posterior) horn, and the temporal (or inferior) horn. The interventricular foramen
(of Monro) is a Y-shaped channel that connects the paired lateral ventricles with the third ventricle. The
third ventricle is a narrow vertical cavity within the diencephalon which bears several outpocketings: The
supraoptic, infundibular, suprapineal, and pineal recesses. It is drained by the cerebral aqueduct (of Sylvius)
that conveys CSF into the fourth ventricle. The fourth ventricle is a diamond-shaped cavity located in the
brainstem. It has two lateral apertures (openings of the lateral recesses) and a single median aperture,
both of which empty into the subarachnoid space surrounding the brainstem. This ventricle is the most
inferior and is continuous with the central canal of the spinal cord.
Key points about the ventricles of the brain
Definition Interconnected cavities within the brain that produce and contain CSF
Protect the brain from injury

Function
Nutrition of the brain and waste removal
Lateral ventricles (2)
Composition Third ventricle

Fourth ventricle
Related Interventricular foramen (of Monro): lateral ventricles ^ third ventricle

structures Cerebral aqueduct (of Sylvius): third ventricle ^ fourth ventricle
Neuroanatomy 513
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jgjragsJsSfe
Ventricular system
Choroid plexus
of the brain

BLOOD SUPPLY OF THE BRAIN
ARTERIES OF THE BRAIN
The arterial supply of the brain is derived from two primary sources: The internal
carotid and vertebral arteries. The internal carotid arteries and their branches
supply blood to the majority of the forebrain giving them the classification of
the anterior cerebral circulation or the internal carotid system. The vertebral
arteries and their major branches supply blood to the spinal cord, brainstem and
cerebellum, and a significant part of the posterior cerebral hemispheres (usu
ally the occipital and inferior temporal lobes). The vertebral arteries and their
branches are commonly referred to as the vertebrobasilar system or the poste
rior cerebral circulation.
The cerebral arterial circle (of Willis) is an anatomical structure that provides
an anastomotic connection between the anterior and posterior circulations,
providing collateral flow to affected brain regions in the event of arterial
incompetency.
Anterior choroidal artery Anterior cerebral artery
Superior hypophyseal artery

Anterior communicating
artery
Posterior communicating
artery
Ophthalmic artery
Basilar artery
Inferior hypophyseal artery Middle cerebral artery
---------- Communicating
part (C7)
Ophthalmic
part (C6)
Clinoid part (C5)
Cavernous part (C4)
Lacerum part (C3)
Petrous part (C2)
--------- Cervical part (C1)
Vertebral artery
Carotid sinus
FIGURE 9.15. Arteries of the head (lateral view). The internal carotid artery (ICA) originates from the
common carotid artery. It is usually divided into seven distinct parts based on its course and anatomical
relations. Segments C6/C7 provide several branches which supply the anterior circulation of the brain, as
well as the orbit: The ophthalmic artery, superior hypophyseal artery, posterior communicating artery,
anterior choroidal artery, anterior cerebral artery and middle cerebral artery. The vertebral artery provides
blood supply for brainstem, cerebellum, and posterior part of the brain.
Neuroanatomy 515
Anterior communicating artery Internal carotid artery
Anterior cerebral artery

Posterior communicating
artery
Lateral orbitofrontal
artery
Middle cerebral artery
Artery of prefrontal
sulcus
Anterior choroidal
artery
Superior
cerebellar
artery
Pontine arteries
Basilar artery
Labyrinthine artery
Posterior cerebral
artery
Anterior inferior cerebellar

Vertebral artery artery
Anterior spinal artery Posterior inferior cerebellar artery
FIGURE 9.16. Arteries of the head (inferior view). The main artery of the anterior circulation of the brain is
the internal carotid artery (ICA), which terminates as the anterior and middle cerebral arteries.
The main artery of the posterior circulation is the vertebral artery. It enters the cranial cavity via the fora
men magnum and gives off several branches to the spinal cord, meninges and part of the cerebellum. The
two vertebral arteries then converge to form the basilar artery which courses vertically across the pons
and posterior cranial fossa where it gives off several branches to the rest of the cerebellum, pons, mid
brain and internal ear. The basilar artery terminates as a bifurcation which gives off the paired posterior
cerebral arteries that contribute to the cerebral arterial circle (of Willis).
The cerebral arterial circle (of Willis) is an anastomotic loop/ring formed between four paired arteries and
one unpaired artery which facilitates collateral blood between the anterior and posterior cerebral circu
lations as well as the right and left blood supply. Several small perforating (central) arteries emerge from
the cerebral arterial circle (of Willis), many of which pass into the brain directly and supply the cortex and
subcortical structures.

Cingular branches Paracentral branches of

callosomarginal artery
Callosomarginal artery Precuneal branches of

pericallosal artery
Frontal branches of
callosomarginal
artery Dorsal branch to
corpus callosum of
medial occipital artery
Pericallosal artery
Parietooccipital
branch of medial
occipital artery
Frontopolar
artery
Calcarine branch
of medial
Medial occipital artery
orbitofrontal
artery Medial occipital
artery
Anterior
cerebral artery
Posterior inferior
Anterior temporal artery
communicating artery
Posterior cerebral artery

Right internal
carotid artery
Posterior communicating artery Anterior inferior temporal artery
FIGURE 9.17. Arteries of the brain (medial view). Right cerebral hemisphere (without the brainstem and
cerebellum) with arteries exposed. The anterior cerebral artery (ACA) gives off several branches including
the anterior communicating artery and cortical branches to the frontal and medial surfaces of the cerebral
cortex (frontal, parietal and limbic lobes) and part of the corpus callosum.
The posterior cerebral artery (PCA) gives off several branches to the occipital lobe, the inferolateral sur
face of the temporal lobe, midbrain, thalamus, choroid plexus (third and lateral ventricle) and cerebral
peduncles.
Neuroanatomy 517
Artery of central sulcus Artery of precentral sulcus
middle cerebral artery
FIGURE 9.18. Arteries of the brain (lateral view). Lateral view of the brain with its arterial vessels; the
lateral sulcus has been opened to expose the arteries within.
The prominent vessel seen from this view is the middle cerebral artery (MCA), a terminal branch of the
internal carotid artery. It provides a large number of small central branches (which supply the thalamus,
basal nuclei and internal capsule) as well as several larger cortical branches to the frontal, parietal, insular
and temporal lobes.
Key points about the arteries of the brain
Main arteries: internal carotid artery, anterior cerebral artery, anterior

Anterior communicating artery and middle cerebral artery
circulation
Supply: forebrain
Main arteries: vertebral artery, basilar artery, posterior cerebral artery and
Posterior posterior communicating artery
circulation Supply: posterior cerebral cortex (occipital lobe and partly temporal lobe), midbrain,
brainstem
From anterior to posterior

Anterior communicating artery (from the anterior cerebral artery)
Cerebral Anterior cerebral arteries (from the internal carotid artery)
arterial circle
(of Willis) Internal carotid arteries (from the common carotid artery)
Posterior communicating arteries (from the posterior cerebral artery)

Posterior cerebral arteries (branch of the basilar artery)
Anterior cerebral artery: frontal, parietal and cingulate cortex; corpus callosum,
region of the brain primarily responsible for motor and sensory of the lower limbs
Middle cerebral artery: most of the lateral surface of the frontal, parietal and
Supply temporal lobes (except for the superior border of the former two and inferior
border of the latter), basal nuclei and internal capsule
Posterior cerebral artery: occipital lobe, inferolateral surface of the temporal lobe,
midbrain, thalamus, choroid plexus (third and lateral ventricle), cerebral peduncles

Cerebral arterial
Arteries of the brain
circle (of Willis)
Hgftffigsas
Internal carotid
Vertebral artery
artery
VEINS OF THE BRAIN
The brain is an especially well-vascularised organ, receiving approximately

twenty percent of cardiac output. The veins of the brain drain the blood from
the entire brain as well as the surrounding structures (meninges, eyeballs etc).
The drained blood is then first returned to the dural venous sinuses and then
the internal jugular vein. Structurally, the veins of the brain lack a muscular layer
(tunica media), which allows them to expand and collapse substantially. There
are two types of venous systems that drain the blood from the brain. These are
the superficial (external) venous system and the deep (internal) venous system.
• The superficial cerebral veins are found in the subarachnoid space

(i.e. between the arachnoid and pia mater) on the external surface of the cer
ebrum. They are divided into groups in relation to the part of the brain that
they drain: The superior, middle and inferior cerebral veins.
• The deep venous system of the cerebrum is composed of a series of venous
sinuses and deep cerebral veins. Numerous medullary veins extend through
out the white matter of the cerebrum, and drain into subependymal veins
along the inner surface of the lateral ventricles leading to the formation of
larger cerebral veins mainly internal cerebral veins, basal vein (of Rosenthal)
and great cerebral vein (of Galen). The subependymal veins and subsequent
deep medullary veins drain into the dural sinuses before emptying into the
internal jugular vein.
Venous drainage of the cerebellum is achieved by the superior and inferior cere
bellar veins which drain into the great cerebral vein (of Galen), the straight sinus,
the superior petrosal sinus, or the sigmoid sinus.
Veins of the brainstem form an intricate plexus deep to the arteries of the brain
stem and drain to the veins of the spinal cord, basal vein, great cerebral vein (of
Galen), cerebellar veins and/or the dural venous sinuses. to
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Neuroanatomy 519
Superior sagittal sinus Superior anastomotic vein
Inferior
Superior cerebral veins
anastomotic vein
Superficial middle
Transverse sinus
cerebral vein
Confluence of
Inferior cerebral veins
sinuses
Superior petrosal
Occipital sinus
sinus
Inferior petrosal sinus Sigmoid sinus
Left internal jugular vein Petrosal vein
FIGURE 9.19. Superficial veins of the brain (lateral view). There are approximately eight to twelve superior
cerebral veins that drain the superolateral and upper medial surfaces of each cerebral hemisphere. They
are small in caliber, and they usually follow the cerebral sulci towards the superomedial margin of the
cerebral hemisphere and drain into the superior sagittal sinus.
The superficial middle cerebral vein courses along the lateral cerebral fissure. It drains blood from most
of the lateral surface of the cerebral hemisphere and conveys it to the cavernous sinus, following a course
along the lateral sulcus.
The inferior cerebral veins are variable and numerous; they drain the inferior portion of the cerebral
hemisphere.

FIGURE 9.20. Deep cerebral veins (medial view). Located between the periosteal and meningeal layers of
dura mater are the dural venous sinuses. Generally venous blood from deeper structures of the cerebrum
drain into deep cerebral veins (see previous image) which extend and empty into three dural venous
sinuses: The transverse, straight and sigmoid sinuses.
The straight sinus receives the inferior sagittal sinus and the great cerebral vein (of Galen). It runs in a
posteroinferior direction towards the internal occipital protuberance and contributes to the formation of
the confluence of sinuses. Emerging from this confluence are the paired transverse sinuses which travel
within the lateral border of the tentorium cerebelli. The transverse sinuses terminate as they extend to
form the sigmoid sinuses at the point where the tentorium cerebelli ends. The sigmoid sinuses course
along the floor of the posterior cranial fossa and empty into the internal jugular veins as they leave the
cranium via the jugular foramina.
Key points about the veins of the brain
• Superior cerebral veins

Superficial
• Superficial middle cerebral vein (of Sylvius)
cerebral veins
• Inferior cerebral veins
Deep cerebral • Great cerebral vein (of Galen):

veins Main tributaries: internal cerebral vein, basal vein, inferior sagittal sinus
Veins of • Superior cerebellar veins

cerebellum • Inferior cerebellar veins
• Midbrain: veins of midbrain ^ great cerebral vein (of Galen) or basal vein
• Pons: pontine veins ^ basal vein, cerebellar veins, petrosal sinuses or transverse
Veins of
sinus
brainstem
• Medulla oblongata: medullary veins ^ inferior petrosal, occipital sinuses, internal
jugular vein or radicular veins of spinal cord
Neuroanatomy 521
Veins of the brain
DURAL VENOUS SINUSES

The dural venous sinuses are major vascular channels contained between the
meningeal and periosteal layers of the dura mater. Most of the major dural
venous sinuses are found adjacent to the falx cerebri and tentorium cerebelli.
Major dural venous sinuses include the superior sagittal sinus, inferior sagittal
sinus, straight sinus, transverse sinus, sigmoid sinus and superior petrosal sinus
(see previous images).
The main function of the dural venous sinuses is to drain all venous blood within
the cranial cavity with the ultimate point of drainage being the internal jugular
vein. In addition, the dural sinuses also drain cerebrospinal fluid (CSF) via arach
noid granulations.
Internal carotid artery Optic chiasm
Superficial middle Superior ophthalmic

cerebral vein vein
Sphenoparietal sinus Pituitary gland
Cavernous sinus Trigeminal nerve
Posterior
Basilar venous plexus
intercavernous sinus
Superior Inferior petrosal sinus

petrosal sinus
Sigmoid sinus Great cerebral vein
Inferior cerebral veins Straight sinus
Transverse sinus Confluence of sinuses
Inferior sagittal sinus Superior sagittal sinus
FIGURE 9.21. Dural venous sinuses (calvaria removed). The cavernous sinus is a large venous plexus
situated on either side of the sella turcica of the sphenoid bone. It drains blood from the superior and

inferior ophthalmic veins, superficial middle cerebral veins and sphenoparietal sinus. It is then drained by
the superior and inferior petrosal sinuses that convey blood to the transverse sinuses and subsequent
internal jugular vein.
Key points about the dural venous sinuses
A collection of sinuses or blood channels that drains all venous blood from the
Definition
cranial cavity and returns it towards the heart
Location Situated between periosteal and meningeal layers of dura mater
Paired venous Transverse sinus, cavernous sinus, superior petrosal sinus, inferior petrosal sinus,
sinuses sphenoparietal sinus, sigmoid sinus, basilar sinus
Unpaired Superior sagittal sinus, inferior sagittal sinus, straight sinus, occipital sinus,
venous sinuses intercavernous sinus
Dural sinuses
Neuroanatomy 523
SPINAL CORD
TOPOGRAPHY AND MORPHOLOGY

OF THE SPINAL CORD
The spinal cord is a component of the central nervous system (CNS) that arises
as a continuation of the medulla oblongata of the brainstem. It is a cylindrical
structure enclosed within, and occupying, two-thirds of the length of the ver
tebral canal.
It extends from the foramen magnum of the skull to vertebra L1/L2, where it
terminates as the medullary cone. The spinal cord functions as a conduit for
information between the brain and the periphery. It also serves to generate
reflexes which ensure the smooth running of daily activities.
FIGURE 9.22. Spinal cord (sagittal view). The spinal cord extends from the brainstem at the foramen
magnum and terminates at the level of vertebrae L1/L2. Similar to the vertebral column, the spinal cord
is divided into five regions, each providing their sets of spinal nerves: Cervical (C1-C8, red), thoracic
(T1-T12, orange), lumbar (L1-L5, green), sacral (S1-S5, blue), and coccygeal (Co1, purple). The coccygeal nerve
originates from the terminal portion of the spinal cord, the medullary cone, and is the last and smallest
spinal nerve. Extending from the apex of the medullary cone is the filum terminale, a thin connective
tissue structure formed as an extension of pia mater. The filum terminale attaches on the sacrum and
functions to anchor and stabilize the distal portion of the spinal cord.
Throughout its length, the spinal cord presents two well defined enlargements to accommodate for
innervation of the upper and lower limbs: The cervical (C3-T2) and lumbosacral enlargement (L1-S3). As
the spinal cord is shorter than the vertebral column, the roots of spinal nerves L2 and onwards descend
for varying distances around and beyond the cord resulting in the formation of a nerve root bundle known
as the cauda equina.

SPINAL CORD
Posterior median sulcus Posterior intermediate

sulcus
Posterolateral
sulcus
White matter
Posterior root of
spinal nerve
Anterolateral
sulcus
Anterior root of
spinal nerve Rootlets of
spinal nerve
Anterior median fissure Gray matter
FIGURE 9.23. Spinal cord (cross section). Internally, the spinal cord is made of gray and white matter
just like other parts of the central nervous system. Externally, it contains left and right anterolateral and
posterolateral surfaces, which feature a number of grooves known as fissures and sulci.
The anterior median fissure is a deep groove along the anterior length of the spinal cord that incompletely
divides it into symmetrical halves. Lateral to the anterior median fissure is a bilateral shallow groove
known as the anterolateral sulcus where the anterior rootlets of the spinal nerves emerge.
The posterior median sulcus extends along the posterior midline of the spinal cord. On either side of
the posterior median sulcus are the posterolateral sulci, from which the posterior rootlets of the spinal
nerves emerge on either side.
Key points about the topography and morphology of the spinal cord
Within the vertebral canal of the vertebral column
Location Beginning: medulla oblongata of brainstem at foramen magnum

Termination: medullary cone at vertebral level L1/L2
Cervical, thoracic, lumbar, sacral, coccygeal
Parts Cervical enlargement ^ supplies upper limbs
Lumbosacral enlargement ^ supplies lower limbs
Anterolateral ^ Anterior median fissure, anterolateral sulcus

Surfaces Posterolateral ^ Posterior median sulcus, posterior intermediate sulcus (cervical
and upper thoracic levels), posterolateral sulcus
Function Conducts impulses from the brain to the body and generates reflexes
Ascending tracts Descending tracts

of the spinal cord of the spinal cord
Neuroanatomy 525
SPINAL CORD
SPINAL MENINGES AND NERVE ROOTS

The spinal cord is enveloped by the three meningeal coverings which, from
superficial to deep, are known as the dura mater, arachnoid mater and pia mater.
They are continuous with their counterparts surrounding the brain at the fora
men magnum and function to suspend and protect the spinal cord within the
vertebral canal. They also house blood vessels that supply the spinal cord and
form a continuous cerebrospinal fluid (CSF) filled cavity which surrounds the
spinal cord.
Also enveloped (partially or fully) by the outer two meningeal layers are the
anterior/posterior rootlets of each spinal nerve.
White matter Posterior horn

of spinal cord
Gray matter Lateral horn of

spinal cord
Anterior spinal
artery Anterior horn
of spinal cord
Posterior root
of spinal nerve Rootlets of
posterior root
Spinal nerve
Gray ramus
communicans
Rootlets of of spinal nerve
anterior root
Spinal ganglion
Posterior ramus
of spinal nerve
Anterior ramus
White ramus
communicans of spinal nerve
of spinal nerve
Vascular plexus
Anterior root of
of pia mater
spinal nerve
Arachnoid mater Dura mater
FIGURE 9.24. Spinal meninges and nerve roots. The pia mater is the innermost layer of the three meningeal
layers which surround the spinal cord. It is highly vascular and closely follows the contours of the spinal
cord. The second meninx is the arachnoid mater, which is separated from the pia mater by a cerebrospinal
fluid filled space known as the subarachnoid space. The thickest and most superficial meninx is the dura
mater, which lies in close proximity to the arachnoid mater (but is separated from by a potential space
known as the subdural space). The space between the vertebral canal and dura mater is known as the
epidural space which contains adipose tissue that helps to absorb shock and protect the spinal cord.
The arachnoid and dura mater form a ‘sleeve’ over the spinal nerve rootlets and roots, whereas the pia
mater reflects onto the root complex and blends with their epineurium. The dura, arachnoid and pia mater
extend along the spinal cord, beyond the conus medullaris to terminate at the lower border of the second
sacral vertebra.

SPINAL CORD
The anterior rootlets/root of spinal nerve contain motor/autonomic nerve fibers which carry impulses
away from the central nervous system (CNS) towards the periphery. The cell bodies of the anterior root
neurons are located in the anterior and lateral horns of the spinal cord.
The posterior rootlets/root of spinal nerve contain the central processes of sensory neurons, whose cell
bodies are located in the spinal ganglion of the posterior root of each spinal nerve. They carry signals from
the periphery to the CNS. Typically, the anterior and posterior roots unite to form a single spinal nerve car
rying mixed motor and sensory fibers and exit the vertebral column through the intervertebral foramina.
Key points about the spinal meninges and nerve roots
Dura mater: surrounds filum terminale and terminates at S2 vertebral level

Spinal meninges Arachnoid mater: fuses with dura mater and terminates at S2 vertebral level
Pia mater: extends as a coating of the filum terminale which reaches S2 vertebra
Spaces Epidural space, subdural space, subarachnoid space
Posterior rootlets/roots
Origin: posterolateral sulcus of spinal cord
Posterior rootlets ^ posterior roots (spinal ganglion): sensory fibers

Nerve rootlets/
Anterior rootlets/roots
roots
Origin: anterolateral sulcus of spinal cord
Anterior rootlets ^ anterior roots: motor/autonomic fibers

Anterior roots + posterior roots ^ mixed spinal nerve
Meninges of the brain

Spinal nerves
and spinal cord
SPINAL NERVES
The spinal nerves are a collection of thirty-one pairs of mixed nerves which
arise from the spinal cord. They form the largest component of the peripheral
nervous system (PNS), transmitting afferent (sensory) and efferent (motor/
autonomic) information between much of the periphery and central nervous
system. Neurons within each spinal nerve can be functionally categorized as
somatic (related pertaining to skin, skeletal muscle, tendons and joints), or vis
ceral (pertaining to internal organs/smooth muscle, cardiac muscle and glands).
Thus, neurons within a typical spinal nerve can be classed as belonging to one of
four functional modalities:
• Somatic afferent/efferent, or
• Visceral afferent/efferent
The spinal nerves can be subdivided as follows: Eight pairs of cervical nerves,
twelve thoracic, five lumbar, five sacral and one coccygeal. to
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The spinal nerves exit the vertebral canal through the intervertebral foramen, or >
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via the sacral foramina in the sacral region, and give off two primary branches: A z
Neuroanatomy 527
SPINAL CORD
small posterior ramus and a larger anterior ramus. These branches supply cuta
neous, motor and autonomic innervation to muscles and skin of the neck, trunk
and limbs.
Vertebral body Pia mater of spinal cord
Subarachnoid space
Ganglion of
sympathetic trunk
Lateral horn
of spinal cord White ramus
communicans
of spinal nerve
Anterior root
of spinal nerve Gray ramus
communicans of
Recurrent spinal nerve
meningeal branches
of spinal nerve Anterior ramus of
spinal nerve
Posterior ramus of
spinal nerve
Spinal ganglion
Lateral branch of
posterior ramus
of spinal nerve
Dura mater
Posterior root
of spinal nerve
Arachnoid mater Spinal cord

of spinal cord
Medial branch of posterior Epidural space

ramus of spinal nerve
FIGURE 9.25. Spinal cord and spinal nerves (superior view). On exiting the intervertebral foramen, each
spinal nerve divides into anterior and posterior rami. The posterior ramus extends in a posterior direction
and further divides into medial and lateral branches, which provide innervation to the deep back muscles
(epaxial muscles) as well as an associated narrow strip of overlying skin. The anterior ramus provides motor
innervation (somatic or visceral) to the rest of the body related to that segmental level, often intermingling
with other spinal nerves leading to the formation of the major somatic plexuses (cervical, brachial, lumbar
and sacral). Just before the bifurcation into anterior and posterior rami, the spinal nerve also gives rise
to one or more recurrent /meningeal branches which re-enter the intervertebral foramen to supply the
meninges and other structures of the vertebral canal.
Communicating with the anterior ramus of the spinal nerves are the white and gray rami communicantes
which convey sympathetic nerve fibers. The anterior rami of spinal nerves T1-L2 give off the white rami
communicantes which carries preganglionic sympathetic fibers from the lateral horn of the spinal cord to
an adjacent sympathetic ganglion. Here they can either synapse with a postganglionic sympathetic neu
ron at the same or a superior/inferior level via the sympathetic trunk, or pass through the sympathetic
ganglion (without synapsing) continuing as a preganglionic nerve fiber; in all cases nerve fibers of the sym
pathetic trunk reenter the spinal nerves via a gray ramus communicans.

SPINAL CORD
Key points about the spinal nerves
Formation Anterior root (efferent) + posterior root (afferent) ^ Spinal nerve (mixed)
Posterior ramus: lateral and medial branches
Anterior ramus: recurrent meningeal branch, white ramus communicans

Branches
(T1-L2 spinal nerves)
Receives: gray ramus communicans (sympathetic input)
Posterior ramus: efferent innervation to the deep back muscles and overlying skin
Supply area Anterior ramus: afferent and autonomic innervation to the rest of the skeletal
muscles of the body, including those of the limbs and trunk, and most remaining
areas of the skin, except for certain regions of the head
E
Spinal nerves Spinal cord
BLOOD VESSELS OF THE SPINAL CORD

The spinal cord receives its main arterial supply from the vertebral arteries. The
vertebral artery arises from the subclavian artery and gives off three branches
for the spinal cord: A single anterior spinal and two posterior spinal arteries.
These branches pass longitudinally along the anterior and posterior aspect of
the spinal cord, respectively, and are thus deemed as longitudinal vessels.
The spinal cord receives additional arterial supply from segmental spinal arter
ies that arise in a craniocaudal sequence from the spinal branches of vertebral,
deep cervical, posterior intercostal and lumbar arteries. These branches pass
through the intervertebral foramina and split into anterior and posterior radic
ular branches that pass along the anterior and posterior roots, respectively. At
some levels of the spinal cord, some radicular arteries give rise to segmental
medullary arteries that anastomose with the longitudinal vessels.
Venous blood from the spinal cord is largely drained via a single anterior spinal
vein and a single posterior spinal vein, which, in turn, drain into the internal ver
tebral plexus found in the epidural space. The blood from the internal vertebral
plexus continues to drain into the external vertebral plexus, and finally empties
into systemic veins of the caval and azygos systems, depending on the location.
Neuroanatomy 529
SPINAL CORD
Right posterior spinal artery
Left posterior spinal artery
Posterior radicular artery
Anterior segmental
medullary artery
Sulcal arteries
Anterior radicular artery
Arterial vasocorona
Anterior spinal artery
Spinal cord
Spinal branch of posterior

intercostal artery
Dorsal branch of posterior

intercostal artery
Descending thoracic aorta
FIGURE 9.26. Arteries of the spinal cord. Top image: The anterior and posterior spinal arteries form
pial anastomoses called the ‘arterial vasocorona’, which encircles the spinal cord and supplies its lateral
surface and the spinal meninges.
Lower image: Each segment of the spinal cord receives additional supply from spinal branches of various
arteries depending on the region, in this case the posterior intercostal arteries. A spinal branch of the dor
sal branch of each posterior intercostal artery passes through the intervertebral foramina into the verte
bral canal, where they split into the anterior and posterior radicular branches and pass along the anterior
and posterior roots. Most of the radicular branches are small and terminate along the spinal nerve roots.
However, some larger radicular branches continue as segmental medullary arteries that anastomose the
anterior and posterior spinal arteries and provide additional arterial supply to the spinal cord.

SPINAL CORD
Posterior spinal vein
Anterior spinal vein
Sulcal veins
Posterior radicular vein
Coronal venous plexus
Anterior radicular vein
Inferior vena cava
Anterior external vertebral

venous plexus
Basivertebral veins
Anterior internal vertebral

venous plexus
Intervertebral vein
Spinal cord
Posterior internal
vertebral venous plexus
Posterior external
vertebral venous plexus
FIGURE 9.27. Veins of the spinal cord. Venous blood from the spinal cord is largely drained via a single
anterior spinal vein and a single posterior spinal vein, which, in turn, drain into the internal vertebral
plexus found in the epidural space. The blood from the internal vertebral plexus continues to drain into
the external vertebral plexus, and finally empties into systemic veins of the caval and azygos systems,
depending on the location.
Main blood vessels of the spinal cord
Longitudinal arteries (arise from vertebral artery):
Anterior spinal artery

Posterior spinal artery (2x)
Arteries Segmental arteries (arise from vertebral, deep cervical, posterior intercostal and lumbar
arteries):
Spinal branches ^ Anterior and posterior radicular arteries ^ Segmental medullary arteries
Arterial vasocorona:
Anastomosis between the anterior posterior spinal arteries
Intramedullary venous plexus ^ coronal plexus (longitudinal veins) anterior and posterior
Veins radicular veins (segmental veins) ^ anterior and posterior internal vertebral plexus ^
intervertebral veins ^ anterior and posterior external vertebral plexus ^ systemic veins
Blood supply of the Veins of the vertebral

spinal cord column
Neuroanatomy 531
CRANIAL NERVES
CRANIAL NERVE OVERVIEW
The cranial nerves are a group of 12 nerves that originate directly from the brain
and reach the periphery via openings of the skull (i.e. cranium). Each cranial
nerve can be denoted by a name (e.g. olfactory nerve) or a number (i.e. Roman
numerals: I-XII). The number of each nerve is based on its origin, when the
brain and brainstem are observed from rostral to caudal. All 12 nerves are bilat
eral and collectively function to relay information to/from various parts of the
body and brain.
According to the type of nuclei and subsequently the type of nervous fibers
that constitute the nerve, we can classify them into seven modalities.
Key points about cranial nerve modalities
Efferent (motor)
Carries information from the brain to the periphery
Afferent (sensory)
Carries information from the periphery to the brain
Mixed
Carries information both ways
Special
Nerve fiber
terminology Carries information from/to the special senses (vision, smell, taste, hearing and
balance)
General
Carries information from/to any other part of the body, except the special senses
Somatic
Carries information to/from the skin or skeletal muscles
Visceral
Carries information to/from internal organs
General somatic afferent (GSA)
Conveys general sensation from skin
(a.k.a. [general] somatic sensory)
General visceral afferent (GVA)
Conveys general sensation from viscera
(a.k.a. [general] visceral sensory)

Special somatic afferent (SSA)
Conveys senses derived from ectoderm (e.g. sight, sound, balance)
(a.k.a. special somatic sensory)
Special visceral sensory (SVA)

Nerve fiber
types/ Conveys senses derived from endoderm (e.g. taste, smell)
modalities
(a.k.a. special visceral sensory)
General somatic efferent (GSE)
Conveys motor innervation for skeletal muscles
(a.k.a. [general] somatic motor)
General visceral efferent (GVE)
Conveys motor innervation for smooth muscle, cardiac muscle and glands
(a.k.a. [general] visceral motor)

Special visceral efferent (SVE)
Conveys motor innervation for muscles derived from pharyngeal arches
(a.k.a. special visceral motor, branchial motor)

CRANIAL NERVES
FIGURE 9.28. 12 cranial nerves: Anatomy. Inferior view of the brain and brainstem, summarizing the
anatomy of each cranial nerve. The first two cranial nerves, the olfactory nerve (CN I) and optic nerve (CN II)
are the only two cranial nerves that originate from the cerebrum. More specifically, the olfactory nerve
(CN I) can be generally used as an umbrella term to describe components extending from the olfactory
part of the nasal mucosa to the olfactory cortex (via the cribriform plate of ethmoid bone). The optic nerve
(CN II) extends from the retina of the eye to the primary visual cortex (striate area) via the optic canal.
All other cranial nerves originate from the brainstem. The oculomotor (CN III) and trochlear (CN IV) nerves
originate from the midbrain. The abducens nerve (CN VI) originates from the pontomedullary region.
Since these three nerves act on eye muscles, they extend from the brainstem and exit via the superior
orbital fissure. The trigeminal nerve (CN V) originates from the pons and gives rise to three nerve divi
sions: Ophthalmic (V1), maxillary (V2), and mandibular (V3) which exit the cranium via the superior orbital
fissure, foramen rotundum and foramen ovale, respectively. The facial nerve (CN VII) originates from the
pontomedullary junction by two roots: Motor and sensory. The vestibulocochlear nerve (CN VIII) also orig
inates from the pontomedullary junction and consists of the vestibular and cochlear components. Both
CN VII and VIII exit via the internal acoustic meatus. The glossopharyngeal nerve (CN IX) originates from
the superior/rostral portion of the medulla oblongata while the vagus nerve (CN X) also originates from
the medulla oblongata, just caudal to CN IX. The accessory nerve (CN XI) has traditionally been described as
having both spinal and cranial roots. As seen in the illustration, its cranial root emerges from the medulla
oblongata, while the spinal root arises from the upper five or six cervical segments of the spinal cord. CN
IX-XI all exit the skull via the jugular foramen. Finally, the hypoglossal nerve (CN XII) also originates from
the medulla oblongata. Its dozen roots pass laterally across the posterior cranial fossa before merging into
a single trunk which exits via the hypoglossal canal.
Neuroanatomy 533
CRANIAL NERVES
Olfactory (I) Oculomotor (III)

Sensory fibers Sensory: Nose Motor: All eye muscles Trochlear (IV)
Motor fibers except thosesupplied Motor: superior
Optic (II)
dhjk y an oblique muscle
Sensory: Eye
Abducens (VI)
Motor: Lateral
rectus muscle
Intermediate nerve
Motor: Submandibular
and sublingual glands
Sensory: Anterior part Trigeminal (V)

of tongue and soft ■, Sensory: Face,
palate sinuses, teeth, etc.
Motor: Muscles of
mastication
Facial (VII)
Motor: Muscles
of the face Vestibulocochlear
(VIII)
Sensory: Inner ear
Vagus (X) '

Motor: Heart, lungs,
bronchi, gastrointestinal
tract
Sensory: Heart, lungs,
bronchi, trachea,
larynx, pharynx, J Glossopharyngeal (IX)
gastrointestinal tract,
Motor: Pharyngeal
external ear :t
musculature
Sensory: Posterior part of
tongue, tonsil, pharynx
Hypoglossal (XII) Accessory (XI)

Motor: Muscles of Motor: sternocleidomastoid
the tongue and trapezius muscles
FIGURE 9.29. 12 cranial nerves: Overview of functions. The olfactory nerve (CN I) is solely sensory and
conveys impulses that provide the sense of smell (olfaction). The optic nerve (CN II) is also a sensory
nerve, responsible for vision. The oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves can be
observed as a group due to their similar functions: All are motor nerves that innervate the eye muscles and
thus play a key role in eye movement/accommodation. The trigeminal nerve (CN V) is the first mixed nerve
(i.e. has both sensory and motor fibers). This nerve provides the sensation for the face and controls the
muscles of mastication. The facial nerve (CN VII) is also a mixed nerve. The function of the sensory portion
of this nerve is to provide a taste for the anterior portion of the tongue, while its motor component plays
part in the modulation of facial expressions, salivation, and lacrimation. The vestibulocochlear nerve (CN
VIII) is a sensory nerve in charge of maintaining balance and hearing. The glossopharyngeal nerve (CN IX) is
a mixed nerve that provides sensation to the tongue and pharynx, as well as the control of muscles that
facilitate the act of swallowing. The vagus nerve (CN X) is the longest mixed cranial nerve. Its sensory role
is to convey sensory information from the external ear, pharynx, larynx, thorax, and abdomen. In contrast,
its motor component plays part in acts of swallowing, speech, coughing, and various parasympathetic
functions. The accessory nerve (XI) is solely a motor nerve. It controls two muscles involved in head and
shoulder movements (sternocleidomastoid and trapezius muscles). The hypoglossal nerve (CN XII) is also a
motor nerve that controls muscles that facilitate the movements of the tongue.

CRANIAL NERVES
Key points about the cranial nerves
A set of 12 peripheral nerves emerging from the brain that innervate the structures
Definition
of the head, neck, thorax and abdomen
Olfactory nerve (CN I): afferent/sensory (SVA)
Optic nerve (CN II): afferent/sensory (SSA)
Oculomotor nerve (CN III): efferent/motor (GSE & GVE)
Trochlear nerve (CN IV): efferent/motor (GSE)

Trigeminal nerve (CN V): mixed
Ophthalmic nerve (V1): afferent/sensory (GSA)
Maxillary nerve (V2): afferent/sensory (GSA)

12 cranial
Mandibular nerve (V3): afferent/sensory (GSA & SVE)
nerves
Abducens nerve (CN VI): efferent/motor (GSE)
Facial nerve (CN VII): mixed (GSA, SVA, SVE, GVE)

Vestibulocochlear nerve (CN VIII): afferent/sensory (SSA)
Glossopharyngeal nerve (CN IX): mixed (GSA, GVA, SVA, SVE, GVE)
Vagus nerve (CN X): mixed (GSA, GVA, SVA, SVE, GVE)
Accessory nerve (CN XI): efferent/Motor (GSE & SVE)
Hypoglossal nerve (CN XII): efferent/Motor (GSE)
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12 cranial nerves Cranial nerve nuclei
Neuroanatomy 535
CRANIAL NERVES
OLFACTORY NERVE (CN I)
The olfactory nerve (CN I) is a special sensory (special visceral afferent [SVA])
nerve that carries the sensation of smell (olfaction) via a series of nervous
structures which make up the olfactory pathway to the brain. This allows us
to detect various odors. Each olfactory nerve proper is actually one of 15-20
olfactory fiber bundles, which consist of bipolar olfactory sensory neurons
located in the olfactory mucosa of the roof of the nasal cavity. These fiber bun
dles course through small tiny foramina in the cribriform plate of the ethmoid
bone to enter the cranial cavity, where they join the olfactory bulb.
In the olfactory bulb, the olfactory nerve fibers synapse with primary dendrites
of projection neurons (known as mitral and tufted cells) to form an olfactory
glomerulus. Axons from these neurons project posteriorly as the olfactory tract.
As it courses posteriorly, each olfactory tract bifurcates at the olfactory trigone
into the medial and lateral olfactory striae. The olfactory striae project into
areas of the olfactory cortex, allowing perception of smell. The olfactory bulb
also receives efferent fibers which synapse on granular cells and subsequently
interact with mitral and tufted cells to modulate the sensation of smell.
Paraterminal Anterior
gyrus commissure
Subcallosal area
Medial olfactory
Olfactory bulb stria
Dura mater
Anterior perforated
substance
Frontal sinus
Cribriform plate Uncus

of ethmoid bone
Olfactory tract
Amygdaloid body
Olfactory trigone
Ambient gyrus Parahippocampal

gyrus
FIGURE 9.30. Olfactory pathway. Midsagittal section of the cerebrum and roof of the nasal cavity showing
the olfactory structures. The olfactory nerve (CN I) arises from multiple olfactory sensory neurons in the
olfactory mucosa whose central processes (axons) combine to form olfactory fiber bundles. These fiber
bundles pass through foramina in the cribriform plate (of ethmoid bone), terminating in the olfactory bulb.
The olfactory bulb extends caudally/posteriorly as the olfactory tract. This divides at the olfactory trigone
into the medial/lateral olfactory striae which form the borders of the anterior perforated substance, and
carry sensory information to regions of the olfactory cortex.

CRANIAL NERVES
Afferent fibers of Efferent fibers of

olfactory tract olfactory tract
Periglomerular cell Granular cell
Olfactory glomerulu Projection neurons
propria Olfactory gland

(of Bowman)
Olfactory epitheli Olfactory part of

nasal mucosa
Olfactory cilia Basal cells
FIGURE 9.31. Olfactory organ and bulb. Section of nasal mucosa and cribriform plate, with a microscopic
view of the olfactory organ (olfactory part of nasal mucosa) and neural pathways of the olfactory bulb.
The olfactory epithelium contains olfactory sensory neurons (olfactory receptor cells) that are wedged
between supporting and basal epithelial cells. The peripheral processes (dendrites) of each neuron bears
dendritic bulbs (sometimes known as olfactory vesicles), with cilia protruding above the epithelial surface
which react to odiferous stimuli dissolved with the nasal mucus. The central processes(axons) of each
olfactory neuron collect into olfactory fiber bundles (a.k.a. olfactory nerves proper) that pass through
the cribriform plate and project into the olfactory bulb. Underlying the olfactory epithelium is the lamina
propria which contains olfactory glands (of Bowman) that span the olfactory epithelium and secrete
mucus. The olfactory bulb contains about 2000 olfactory glomeruli formed by synapses between terminal
ends of the olfactory fiber bundles and the primary dendrites of projection neurons (mitral and tufted
cells) as well as periglomerular cells, which are involved in odor discrimination. The projection neurons in
turn project their axons (afferent fibers) posteriorly/caudally to form the olfactory tract. Additionally, the
olfactory bulb contains [amacrine] granular cells which receive efferent fibers from central brain areas (as
well as other mitral/tufted cells) and modulates the afferent signals from mitral/tufted cells.
Key points about the olfactory nerve and pathway
(Olfactory part of nasal mucosa)

Epithelium: olfactory sensory/receptor neurons (contain olfactory cilia), supporting
Olfactory organ
cells, and basal (stem) cells
Lamina propria: olfactory glands (Bowman’s glands)
Cranial nerve I (CN I): collective term for 15-20 olfactory fiber bundles which cross
Olfactory nerve
the cribriform plate on each side
Contains olfactory glomeruli, cell bodies of projection neurons (mitral and tufted
Olfactory bulb cells), granule cells, periglomerular cells; serves as a relay station of the olfactory
pathway
Axons of projection neurons (afferent fibers of olfactory bulb)

Olfactory tract Anterior olfactory nucleus
Efferent (centrifugal) fibers of olfactory bulb
Olfactory striae Medial and lateral divisions of olfactory tract
Medial olfactory stria: subcollosal area, paraterminal gyrus, anterior commissure

Olfactory
cortex Lateral olfactory stria: olfactory tubercle, piriform cortex, anterior cortical
amygdaloid nucleus, periamygdaloid cortex, and lateral entorhinal cortex
Function/type Smell/olfaction
of fibers Special sensory/special visceral afferent
Neuroanatomy 537
CRANIAL NERVES
The olfactory
The 12 cranial nerves
pathway
OPTIC NERVE (CN II)
The optic nerve (CN II) is a special somatic afferent (SSA) nerve which carries the
sensation of sight (vision) from the retina of the eye to the brain. The optic nerve
is a part of the visual pathway, which is a route by which light that falls on the
retina is transmitted to the occipital lobe of the brain, where it is interpreted
as visual information. More specifically, the visual pathway refers to a series of
synapses that start in the retina, where light stimuli are converted into action
potentials, and transmitted across several nervous structures to reach the pri
mary visual cortex.
The structures of the visual pathway include the retinal neurons (photore
ceptors, bipolar cells, ganglion cells) which pass visual stimuli through the optic
nerve, optic chiasm, and optic tract to the lateral geniculate nucleus. Axons
from the lateral geniculate nucleus then project via the optic radiation to the
primary visual cortex of the occipital lobe.
The optic nerve is formed when the axons of retinal ganglion cells pierce the
scleral layer of the eyeball. The nerve runs posteromedially within the orbit and
through the optic canal to enter the cranial cavity, where together with its con
tralateral counterpart, forms the optic chiasm.

CRANIAL NERVES
FIGURE 9.32. The components of the visual pathway. The visual pathway begins with light entering the
ocular bulb from the visual fields and being processed by the retina. Visual information is then passed
on from the retina by the optic nerve (CN II) through the optic canal (not shown) to the optic chiasm in
the middle cranial fossa. From the optic chiasm, the axons of the optic nerve continue posteriorly as the
optic tract, which then synapse at the lateral geniculate nucleus of the thalamus. Axons from the lateral
geniculate nucleus travel via the optic radiation to finally reach the primary visual cortex. It is important to
note that about 90% of the retinal axons synapse directly at the lateral geniculate nucleus. The remaining
10% project to other subcortical nuclei, mainly the superior colliculus. The superior colliculus is involved
in visual reflexes, such as saccadic eye movements or tracking of objects in the visual field. The superior
colliculus projects onto the pulvinar of thalamus, which in turn projects onto the secondary visual cortex.
Key points about the visual pathway
Retina ^ optic nerve (CN II) ^ optic chiasm ^ optic tract ^ lateral geniculate
nucleus (90%) ^ optic radiation ^ primary visual cortex
Components
Retina ^ optic nerve (CN II) ^ optic chiasm ^ optic tract ^ superior colliculus (10%)
^ pulvinar of thalamus ^ secondary visual cortex
Sensory neural layer of the eyeball
Retina Neurons: photoreceptors (rod cells and cone cells), bipolar cells, ganglion cells,
horizontal cells, and amacrine cells
Optic nerve
Formed by axons of ganglion cells coming together at the optic disc
(CN II)
Point of decussation of the optic nerves: nasal fibers of retina cross over to the
Optic chiasm
contralateral optic tract, while temporal fibers stay on the same side (ipsilateral)
Left: carries left temporal and right nasal fibers of retina

Optic tracts
Right: carries right temporal and left nasal fibers of retina
Neuroanatomy 539
CRANIAL NERVES
Key points about the visual pathway
Lateral Receives 90% of the retinal fibers

geniculate Represents a relay center of the thalamus that projects to the primary visual cortex
nucleus via the optic radiation
Receives 10% of the retinal fibers

Superior
colliculus Integrates visual, auditory, and somatosensory spatial information and controls
reflex movements of the eye
Large bilateral bundle of fibers each containing two divisions that receive visual
Optic radiation
input from upper and lower quadrants of the contralateral hemifields
Primary visual Brodmann area 17: region of the occipital lobe that receives and processes visual
cortex information from contralateral visual field
The visual pathway The optic nerve
OCULOMOTOR, TROCHLEAR AND ABDUCENS

NERVES (CN III, IV & VI)
Movements of the eyeball affecting the direction of gaze are controlled by

three cranial nerves: The oculomotor (CN III), trochlear (CN IV) and abducens
(CN VI) nerves.
To be more specific, these nerves provide motor supply to the extraocular

muscles:
• Oculomotor nerve: Superior, medial and inferior recti muscles, as well as the
inferior oblique muscle.
• Trochlear nerve: Superior oblique muscle (‘trochlear’ referring to the pulley
like anatomy of this muscle (Latin: Trochlea = pulley).
• Abducens nerve: Lateral rectus (‘abducens’ refers to abduction of the eye
which is achieved by this muscle).
In addition, the oculomotor nerve also provides motor innervation to the leva
tor palpebrae superioris muscle, as well as parasympathetic innervation to the
sphincter pupillae and ciliary muscles. Therefore, it also has a role in elevation of
the upper eyelid, pupillary constriction and accommodation of the lens.
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CRANIAL NERVES
Accessory nucleus of
oculomotor nerve
Nucleus of oculomotor nerve
Levator palpebrae
superioris muscle
Superior rectus muscle
Oculomotor nerve
Superior branch of
oculomotor nerve
Medial rectus muscle
Ciliary ganglion
Inferior oblique
muscle
Branch of
oculomotor nerve
to ciliary ganglion
Inferior rectus muscle
Inferior branch of
oculomotor nerve
FIGURE 9.33. Oculomotor nerve (left orbital view). The oculomotor nerve (CN III) arises from the
oculomotor complex located in the midbrain, ventral to the periaqueductal gray substance, at the level
of the superior colliculus. It is comprised of two nuclei: The nucleus of oculomotor nerve (contains cell
bodies of general somatic efferent (GSE, motor) neurons), and the accessory nucleus of oculomotor nerve
(Edinger-Westphal, contains cell bodies of general visceral efferent (GVE, parasympathetic) neurons).
Efferent fibers emerge from the midbrain into the interpeduncular fossa/cistern as the oculomotor nerve,
which continues through the lateral wall of the cavernous sinus. From here, it enters the orbit the superior
orbital fissure (internal to the common tendinous ring) as two branches which innervate the majority of
the extraocular muscles:
• Superior branch: Superior rectus and levator palpebrae superioris muscles
• Inferior branch: Medial rectus, inferior rectus and inferior oblique muscles
The inferior branch also carries preganglionic parasympathetic fibers which synapse with postganglionic
neurons in the ciliary ganglion; these fibers provide parasympathetic innervation to the ciliary and sphinc
ter pupillae muscles responsible for accommodation and pupillary constriction, via the short ciliary nerves
(branch of CN V1).
Neuroanatomy 541
CRANIAL NERVES
Nucleus of
trochlear nerve
Superior oblique
muscle
Trochlear nerve
Abducens nerve
Lateral rectus
muscle
Nucleus of
abducens nerve
FIGURE 9.34. Trochlear and abducens nerves. The trochlear nerve (CN IV) arises from the nucleus of
trochlear nerve (containing general somatic efferent (GSE) neurons), which is located in the tegmentum of
the caudal midbrain. Fibers from this nucleus decussate posteriorly and emerge from the dorsal midbrain,
just below the inferior colliculus. From here, the trochlear nerve curves around the midbrain, passing
through the lateral wall of the cavernous sinus, superior and lateral to the oculomotor nerve. It continues
into the orbit via the superior orbital fissure, external to the common tendinous ring, before terminating
in the superior oblique muscle.
The abducens nerve (CN VI) arises from the nucleus of abducens nerve, which also contains general somatic
efferent (GSE) neurons and is located near the rhomboid fossa/floor of the fourth ventricle. Fibers from
this nucleus exit the brainstem at the medullopontine sulcus (pontomedullary junction) as the abducens
nerve, which courses through the cavernous sinus (along the internal carotid artery). It then enters the
orbit via the superior orbital fissure, internal to the common tendinous ring. The abducens nerve then pen
etrates the medial surface of the lateral rectus muscle, which functions as an abductor of the eyeball.
Key points about the cranial nerves III, IV and VI
Fiber types: general somatic efferent fibers (GSE), general visceral efferent fibers
(GVE)
Origin: ventral midbrain (interpeduncular fossa)
Exits skull: superior orbital fissure
Nuclei: nucleus of oculomotor nerve (GSE); accessory nucleus of oculomotor nerve
Oculomotor (Edinger-Westphal) (GVE)
nerve (CN III) Branches: superior and inferior branch, branch of oculomotor nerve to ciliary
ganglion (parasympathetic root of ciliary ganglion)
Function: superior branch ^ Motor innervation to superior rectus, levator

palpebrae superioris muscles
Inferior branch ^ medial rectus, inferior rectus, inferior oblique muscles (GSE);
branch to ciliary ganglion ^ parasympathetic innervation to ciliary and sphincter
pupillae muscles (GVE)

CRANIAL NERVES
Key points about the cranial nerves III, IV and VI
Fiber type: general somatic efferent (GSE)
Origin: dorsal midbrain

Trochlear nerve
(CN IV)
Nucleus: nucleus of trochlear nerve
Function: motor innervation to superior oblique muscle
Fiber type: general somatic efferent fibers (GSE)
Origin: medullopontine sulcus (pontomedullary junction)

Abducens nerve
(CN VI)
Nucleus: nucleus of abducens nerve
Function: motor innervation to lateral rectus muscle
Trochlear nerve and

Oculomotor nerve
the abducent nerve
TRIGEMINAL NERVE (CN V)
The trigeminal nerve, otherwise known as the 5th cranial nerve (CN V), is a mixed
nerve meaning that it is made up of both sensory and motor components. It
is formed by three sensory nuclei (mesencephalic/principal sensory/spinal
nucleus of trigeminal nerve) and one motor nucleus (motor nucleus of trigem
inal nerve). At the level of the pons, efferents of the sensory nuclei merge to
form a large sensory root, while those from the motor nucleus continue as a
smaller motor root. These roots course anteriorly out of the posterior cranial
fossa and travel along the anterior surface of the petrous part of the tempo
ral bone where the sensory root expands to form the trigeminal ganglion, from
which arises the three divisions of the trigeminal nerve: The ophthalmic (V1),
maxillary (V2) and mandibular nerves (V3).
Ophthalmic nerve (CN V1)
The ophthalmic nerve is the most superior branch of the trigeminal ganglion,
and provides general somatic afferent (GSA) innervation to structures of the
upper portion of the face, nasal cavity and mucosa of paranasal sinuses. It
extends from the trigeminal ganglion through the lateral wall of the cavernous
sinus where it divides into three main branches (the lacrimal, frontal and naso
ciliary nerves) all of which pass through the superior orbital fissure.
Neuroanatomy 543
CRANIAL NERVES
Frontal nerve Lacrimal nerve
Anterior ethmoidal nerve to ciliary ganglion
nerve
Nasociliary nerve
Supraorbital nerve
Internal carotid
artery
Supratrochlear
nerve
Tentorial branch
of ophthalmic
nerve
Trigeminal nerve
Posterior
ethmoidal
nerve Trigeminal ganglion
Long ciliary nerves

Ophthalmic nerve

Optic nerve
Communicating branch Ciliary ganglion

of zygomatic nerve
to lacrimal nerve
FIGURE 9.35. Ophthalmic nerve (left lateral view). The ophthalmic nerve extends in an anterosuperior
direction from the trigeminal ganglion and gives rise to a small branch known as the tentorial branch of
ophthalmic nerve which provides innervation to the tentorium cerebelli. The frontal nerve is the largest
branch of the ophthalmic nerve. It enters the orbit via the superior orbital fissure external to the common
tendinous ring and divides into two terminal branches: The supraorbital and supratrochlear nerves. The
lacrimal nerve also enters the orbit external to the common tendinous ring and extends across the roof
of the orbit towards the lacrimal gland. Before reaching the gland, it expands into several branches,
which either terminate in the lacrimal gland or extend through the gland, terminating in the skin of the
upper eyelid. Just behind the lacrimal gland, the lacrimal nerve is joined by the communicating branch of
zygomaticotemporal nerve (from V2) to lacrimal nerve, which provides parasympathetic innervation to the
lacrimal gland. The nasociliary nerve enters the superior orbital fissure within the common tendinous ring
and then crosses over to the medial orbital wall. It gives off several branches which include the long ciliary,
posterior ethmoidal, anterior ethmoidal and infratrochlear nerves as well as the branch of nasociliary
nerve to ciliary ganglion (sensory root of ciliary ganglion).
Key points about the ophthalmic nerve
Fibers: general somatic afferent (GSA)
Origin: trigeminal ganglion
Structure and Exits skull: superior orbital fissure

features
Associated nuclei: sensory nuclei (mesencephalic, principal sensory, spinal nuclei of
trigeminal nerve) and motor nucleus of trigeminal nerve
Associated ganglia: trigeminal ganglion, ciliary ganglion
Frontal nerve (supraorbital and supratrochlear nerves)

Lacrimal nerve
Branches
Nasociliary nerve (branch of nasociliary nerve to ciliary ganglion, long ciliary nerves,
posterior ethmoidal nerve, anterior ethmoidal nerve, infratrochlear nerve)
Function Provides Innervation to forehead, scalp, eyelids, eye, conjunctiva and nasal cavity

CRANIAL NERVES
Ophthalmic branch of
Trigeminal nerve
the trigeminal nerve
Maxillary nerve (CN V2)
The maxillary nerve emerges from the anterior portion of the trigeminal gan
glion and like its origin, is exclusively composed of general somatic afferent
(sensory) fibers. It passes through the lateral wall of the cavernous sinus and
foramen rotundum to enter the pterygopalatine fossa. Here, it gives rise to the
majority of its branches before extending through the inferior orbital fissure
where it gives rise to its terminal branch, the infraorbital nerve. Through its
intricate pathway the maxillary nerve provides the major sensory innervation to
the skin of the lower eyelid, the prominence of the cheek, part of the temporal
region, alar part of the nose, and upper lip.
Communicating Maxillary nerve

branch of zygomatic
nerve to lacrimal nerve
Zygomatic nerve Trigeminal ganglion
Infraorbital nerve Trigeminal nerve
Anterior superior Mandibular nerve

alveolar nerve
Superior Meningeal branch

dental plexus of maxillary nerve
Dental branches Pterygopalatine

of superior ganglion
alveolar nerves
Middle superior Pharyngeal nerve

alveolar nerve
Branches Palatine nerves

of maxillary nerve to
Posterior superior alveolar Nasopalatine nerve

nerve
FIGURE 9.36. Maxillary nerve (left lateral view). Just before the maxillary nerve exits the middle
cranial fossa, via the foramen rotundum, it gives off a small meningeal branch which carries sensory
impulses from the dura mater of this region. Within the pterygopalatine fossa, the maxillary nerve gives
off a number of branches that can be divided into those which arise directly from the nerve and those
Neuroanatomy 545
CRANIAL NERVES
associated with the pterygopalatine ganglion which is located on the posterior wall of the pterygopalatine
fossa (see next image). The maxillary nerve leaves the pterygopalatine fossa by coursing anterior through
the pterygomaxillary fissure to enter the infratemporal fossa, where it gives off the posterior superior
alveolar nerve. It then turns medially to enter the orbit via the inferior orbital fissure, where it continues
as the terminal branch of the maxillary nerve, the infraorbital nerve. The infraorbital nerve proceeds
anteriorly across the floor of the orbit in the infraorbital groove, giving off the middle superior alveolar
nerve, before continuing through the infraorbital canal. Here, the anterior superior alveolar nerve arises
before the infraorbital nerve continues onto the face via the infraorbital foramen and terminates as
groups of palpebral, nasal and superior labial branches.
Nasopalatine nerve Zygomatic nerve
Zygomaticotemporal Branches of maxillary

nerve nerve to
pterygopalatine
ganglion
Zygomaticofacial
nerve
Nerve of pterygoid
Orbital branches of
canal
pterygopalatine
ganglion
Pharyngeal nerve
Infraorbital nerve
Middle superior Maxillary nerve

alveolar nerve
Anterior superior Pterygopalatine ganglion

alveolar nerve
Posterior superior Palatine nerves

alveolar nerve
FIGURE 9.37. Maxillary nerve (pterygopalatine fossa, left lateral view). Within the pterygopalatine fossa,
branches arise directly from the maxillary nerve including the branches to pterygopalatine ganglion (of
which there are usually two) and the zygomatic nerve. Branches associated with the pterygopalatine
ganglion include the nasopalatine, posterior superior nasal, greater palatine, lesser palatine and pharyngeal
nerves, as well as 2-3 small orbital branches. Parasympathetic and sympathetic fibers are delivered to
the pterygopalatine ganglion via the nerve of pterygoid canal (derived from the greater petrosal (facial
nerve, CN VII) and deep petrosal nerve (internal carotid plexus), respectively. Postganglionic fibers are
then distributed within the aforementioned ganglionic branches of the maxillary nerve to regulate
secretomotor and vascular responses in the lacrimal gland as well as mucous membranes of the nasal
cavity, naso/oropharynx, and upper oral cavity. While the naso-, greater and lesser palatine nerves mainly
convey sensory impulses, they also carry special visceral afferent (taste) fibers from the palate to the
pterygopalatine ganglion; these fibers continue to the facial nerve via the nerve of pterygoid canal.
Key points about the maxillary nerve
Fibers: general somatic afferent (GSA)

Structure and Exits skull: foramen rotundum
features
Associated ganglia: trigeminal ganglion, pterygopalatine ganglion

CRANIAL NERVES
Key points about the maxillary nerve
Directly from maxillary nerve:

Meningeal branch, branches of the maxillary nerve to pterygopalatine ganglion,
zygomatic nerve, posterior superior alveolar nerve, infraorbital nerve
Branches
Associated with pterygopalatine ganglion:
Orbital branches, posterior superior nasal branches, nasopalatine nerve, pharyngeal
nerve, greater palatine nerve, lesser palatine nerves
Sensory innervation of skin of lower eyelid, prominence of the cheek, part of the
Function
temporal region, alar part of the nose and upper lip
Maxillary branch of
Mandibular nerve (CN V3)
The mandibular nerve, accompanied by the motor root of the trigeminal nerve,
leaves the skull through the foramen ovale, after which both unite within the
infratemporal fossa. The mandibular nerve is therefore the only division of
the trigeminal nerve to convey both afferent (sensory) and efferent (motor)
nerve fibers. It supplies:
• General somatic afferent (GSA, sensory) innervation to the skin over the man
dible, cheek and temporal region, mucosa of the oral cavity and tongue, the
mandibular teeth, parts of the external ear, as well as the temporomandibular
joint
• Special visceral efferent (SVE) innervation is provided to eight muscles: Mus
cles of mastication (4), mylohyoid, anterior belly of digastric, tensor veli palat
ini, and tensor tympani muscles
• Other fiber types (special visceral afferent (SVA), general visceral efferent
(GVE)) are also carried by the mandibular nerve via anastomoses with branches
of other cranial nerves
Neuroanatomy 547
CRANIAL NERVES
Anterior deep temporal nerve
Masseteric nerve
Posterior deep temporal nerve
Nerve to medial
pterygoid muscle
mandibular nerve
Posterior division of
mandibular nerve
Meningeal branch of
mandibular nerve
Middle meningeal
artery
Auriculotemporal
Inferior dental plexus nerve
Nerve to lateral Chorda tympani

pterygoid muscle
FIGURE 9.38. Infratemporal branches and anterior division. The mandibular nerve arises from the anterior
portion of the trigeminal ganglion. Accompanied by the motor root of the trigeminal nerve, it exits the
skull through the foramen ovale and enters the infratemporal fossa. At this point, the motor root unites
with the mandibular nerve, making it a mixed nerve. Within the infratemporal fossa the mandibular trunk
immediately gives off two branches: A meningeal branch which ascends through the foramen spinosum to
supply dura of the middle cranial fossa and a nerve to medial pterygoid muscle which passes through the
otic ganglion (not shown) to supply the medial pterygoid, tensor veli palatini, and tensor tympani muscles.
The mandibular nerve then splits into anterior and posterior divisions. The anterior division passes efferent
(motor) fibers to the masseteric nerve, deep temporal nerves and nerve to lateral pterygoid and receives
afferent (sensory) fibers from the buccal nerve which supplies the skin over the cheek.

CRANIAL NERVES
Posterior deep Ophthalmic nerve

temporal nerve
Anterior deep Maxillary nerve

temporal nerve
Masseteric nerve Trigeminal ganglion
Anterior division of Sensory root of

mandibular nerve trigeminal nerve
Nerve to lateral Motor root of

pterygoid muscle trigeminal nerve
Buccal nerve Mandibular nerve
Lingual nerve Nerve to medial

pterygoid muscle
Anterior/posterior
branch of lingual nerve Meningeal branch of
to submandibular mandibular nerve
ganglion
Lingual branches Posterior division of
of lingual nerve mandibular nerve
Sublingual nerve Middle meningeal artery
Mental nerve Auriculotemporal nerve
Submandibular Inferior alveolar nerve

ganglion
Submandibular Nerve to mylohyoid muscle

nerves
FIGURE 9.39. Posterior division. The posterior division of the mandibular nerve is mainly sensory and is
larger than the anterior division. The auriculotemporal nerve arises posterior to the temporomandibular
joint (usually as two roots which encircle the middle meningeal artery) and supplies parts of the auricle/
external acoustic meatus and posterior half of the temporal region. Sympathetic/parasympathetic fibers
to the parotid gland (derived from the plexus of the middle meningeal artery and otic ganglion, respectively)
are also carried within this nerve. The lingual nerve arises from the terminal bifurcation of the posterior
division, and carries general somatic afferent/sensory fibers from the anterior two-thirds of the tongue,
floor of the oral cavity and lower lingual gingiva. It is joined by the chorda tympani (of facial nerve) which
delivers general visceral efferent/parasympathetic fibers to the submandibular and sublingual glands
via homonymous/same-named branches of the lingual nerve. Special visceral afferent/taste fibers from
the anterior two-thirds of the tongue are carried by the lingual nerve to the chorda tympani. The inferior
alveolar nerve is a mixed nerve, carrying sensory fibers from the mandibular teeth via the inferior dental
plexus (see first image) and lower lip/labial gingiva (via mental nerve), as well as general somatic afferent/
motor fibers to the mylohyoid and anterior belly of digastric muscles.
Key points about the mandibular nerve
Fibers: general somatic afferent (GSA, sensory), special visceral efferent (SVE,
branchiomotor) (special visceral afferent/taste (SVA), general visceral efferent/
parasympathetic (GVE) fibers also carried to/from other cranial nerves)

Structure and
Exits skull: foramen ovale
features
Associated ganglia: trigeminal ganglion, otic ganglion, submandibular/sublingual
ganglion
Neuroanatomy 549
CRANIAL NERVES
Key points about the mandibular nerve
Meningeal branch of mandibular nerve
Nerve to medial pterygoid

Branches Anterior division: masseteric nerve, anterior and posterior deep temporal nerves,
nerve to lateral pterygoid, buccal nerve
Posterior division: auriculotemporal nerve, lingual nerve, inferior alveolar nerve
General somatic afferent: skin and mucosa of the lower face, oral cavity, ear and
mandibular teeth
General somatic efferent: muscles of mastication, mylohyoid muscle, anterior belly

Function of digastric, tensor veli palatini muscle, tensor tympani muscle
(Special visceral afferent: taste from anterior % of tongue
General visceral efferent: secretomotor to submandibular/sublingual glands)
Mandibular branch of
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FACIAL NERVE (CN VII)
The facial nerve is a mixed nerve carrying several different types of nerve fibers
which allow it to participate in a wide range of functions. These include:
• General somatic afferent (sensory) innervation of the skin around the exter
nal acoustic meatus, parts of the auricle and retroauricular/mastoid region
• Special visceral afferent (taste) sensation from the anterior two-thirds of the
tongue
• General visceral efferent (parasympathetic, or secretomotor) innervation to
the lacrimal, submandibular and sublingual glands as well as mucous mem
branes of the nasal cavity, hard and soft palates
• Special visceral efferent (branchiomotor) innervation of the muscles of facial
expression and scalp, as well as the stapedius, stylohyoid and posterior belly
of the digastric muscles
The facial nerve arises at the cerebellopontine angle as two separate roots. Its
motor root is associated with neurons originating in the large motor nucleus of
facial nerve, located in the pons. The sensory root contains somatic sensory and
visceral sensory (taste) fibers, the cell bodies of which are located in the genic
ulate ganglion. The central processes of these fibers terminate at the sensory
nucleus of trigeminal nerve and nucleus of solitary tract, respectively. Efferent
parasympathetic roots (from the superior salivatory nucleus) are also carried
within the sensory root, therefore it is not actually completely sensory in com
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CRANIAL NERVES
Along its pathway, the facial nerve can be divided into three different segments:
An intracranial (cisternal) part, intratemporal part (enclosed within the tempo
ral bone) and an extracranial part that describes the facial nerve after it emerges
from the temporal bone.
FIGURE 9.40. Intracranial/temporal parts of facial nerve. The larger and more medial motor root as
well as the smaller, more lateral, sensory root (intermediate nerve) arise at the cerebellopontine angle
and traverse the posterior cranial fossa, forming the branchless, intracranial part of the facial nerve. The
roots then enter the temporal bone via the internal acoustic meatus together with the vestibulocochlear
nerve, as well as the labyrinthine artery and vein. The sensory and motor components usually merge at,
or within the internal acoustic meatus, and then continue into the facial canal located along the medial
wall of the tympanic cavity. Here, the facial nerve expands into the geniculate ganglion, which contains
the cell bodies of the sensory neurons related to the nerve. The greater petrosal nerve arises directly
from the geniculate ganglion and carries general visceral efferent (parasympathetic) fibers destined for
the lacrimal, nasal and palatine glands, as well as special visceral afferent (taste) fibers from the palate
(both via the pterygopalatine ganglion). The facial nerve then gives off two further intratemporal branches
(nerve to stapedius muscle and the chorda tympani) which arise before the facial nerve exits the temporal
bone via the stylomastoid foramen. The chorda tympani carries both parasympathetic fibers destined for
the submandibular/sublingual glands as well as special visceral afferent (taste) fibers from the anterior
two-thirds of the tongue via the lingual nerve (see next image).
Neuroanatomy 551
CRANIAL NERVES
Temporal branches Greater petrosal nerve

of facial nerve
Facial nerve
Pterygopalatine
ganglion
Auricular branch of
posterior auricular
nerve
Zygomatic branches
of facial nerve
Occipital branch of
posterior auricular
nerve
Buccal branches
of facial nerve
Posterior auricular
nerve
Mandibular nerve
Digastric branch
of facial nerve
Submandibular
ganglion Stylohyoid branch
of facial nerve
Marginal mandibular Cervical branch

branch of facial nerve of facial nerve
FIGURE 9.41. Extracranial part of facial nerve. After it emerges from the stylomastoid foramen, the facial
nerve gives off the posterior auricular nerve (which provides motor innervation to the occipital part of
occipitofrontalis muscle and auricular muscles, as well as sensory innervation to the variable amounts of
the auricle and retroauricular region), as well as other motor branches to the digastric (posterior belly) and
stylohyoid muscles. It then enters the parotid gland and bifurcates into two trunks, which give off five
terminal branches collectively known as the parotid plexus. These are the temporal, zygomatic, buccal,
marginal mandibular, and cervical branches, all of which innervate the muscles of facial expression but do
not innervate the parotid gland itself.
Key points about the facial nerve
Fibers: general somatic afferent (GSA), special visceral afferent (SVA), general
visceral efferent (GVE), special visceral efferent (SVE, branchiomotor)
Origin: cerebellopontine angle (Motor and sensory (intermediate nerve) roots)
Structure and Exits skull: stylomastoid foramen

features
Associated nuclei: motor nucleus of facial nerve, superior salivatory nucleus,
nucleus of solitary tract
Associated ganglia: geniculate ganglion (pterygopalatine ganglion, otic ganglion,
submandibular ganglion)

CRANIAL NERVES
Key points about the facial nerve
Intracranial: origin ^ internal acoustic meatus
(no branches)
Intratemporal: internal acoustic meatus ^ stylomastoid foramen
Parts & Greater petrosal nerve, nerve to stapedius, chorda tympani

branches
Extracranial: after stylomastoid foramen
Posterior auricular nerve, digastric branch, stylohyoid branch

Parotid plexus: temporal branch, zygomatic branch, buccal branch, marginal
mandibular branch, cervical branch
Main: motor innervation to muscles of facial expression (SVE)
Functions Others: taste innervation of anterior two-thirds of tongue and palate (SVA),
parasympathetic innervation of lacrimal, nasal, palatine and salivary glands (except
parotid) (GVE), sensation to parts of auricle and retroauricular region (GSA)
Facial nerve
the face and scalp
VESTIBULOCOCHLEAR NERVE (CN VIII)
The vestibulocochlear nerve, also known as the 8th cranial nerve (CN VIII) is a
sensory nerve that consists of two divisions: The vestibular and cochlear nerves.
The function of the vestibulocochlear nerve is to provide special somatic affer
ent (SSA) innervation of the internal ear, with each division serving a specific
role:
• The vestibular nerve conveys information from the vestibular apparatus of

the internal ear to the vestibular nuclei in the pons and brainstem in order to
maintain balance, spatial orientation and coordination
• The cochlear nerve is part of the auditory pathway, conveying auditory infor
mation from the cochlea of the internal ear to the cochlear nuclei in the
brainstem in order to enable the sense of hearing
Neuroanatomy 553
CRANIAL NERVES
Cochlear nerve Vestibular nerve
Cochlear ganglion
Facial nerve
Chorda tympani
Vestibulocochlear
nerve
Anterior ampullary
nerve
Superior vestibular
nucleus
Lateral ampullary
nerve
Medial vestibular
nucleus
Superior part of
vestibular ganglion
Lateral vestibular
Utricular nerve nucleus
Inferior vestibular
Posterior ampullary nucleus
nerve
Saccular nerve Posterior cochlear

nucleus
Inferior part of
vestibular ganglion Anterior cochlear
nucleus
FIGURE 9.42. Vestibulocochlear nerve. The vestibulocochlear nerve (CN VIII) arises from the brainstem at
the pontomedullary junction/cerebellopontine angle. It exits the cranium via the internal acoustic meatus
of the temporal bone, where it divides into the vestibular and cochlear nerves.
The vestibular nerve contains the axons of neurons whose cell bodies are found in the vestibular gan
glion, found at the lateral end/fundus of the internal acoustic meatus. The vestibular ganglion consists
of superior and inferior parts, from which the superior and inferior branches of vestibular nerve arise and
proceed to innervate the vestibular apparatus (utricle, saccule and semicircular ducts). The anterior amp
ullary, lateral ampullary and utricular nerves arise from the superior branch, while the posterior ampullary
and saccular nerves are given off from the inferior component. These nerves collect information related
to motion and position of the head and transmit it to the vestibular nuclei (the superior, inferior, medial
and lateral vestibular nuclei) in the lower pons/upper medulla oblongata in order to maintain balance and
equilibrium.
The cochlear nerve contains the axons of neurons whose cell bodies are located in the cochlear/spiral
ganglion that lies in the spiral canal of the modiolus of the cochlea. Peripheral processes of these neu
rons send terminal endings to receptors in the spiral organ (of Corti), that collect auditory information
and transmit it via the cochlear nerve to the cochlear nuclei (anterior and posterior cochlear nuclei) in the
brainstem, and ultimately to the primary auditory cortex of the temporal lobe.

CRANIAL NERVES
Key points about the vestibulocochlear nerve (CN VIII)
Fibers: special sensory afferent nerve (SSA)
Origin: pontomedullary junction/cerebellopontine angle

Enters skull: internal acoustic meatus
Associated nuclei:
Vestibular nerve: superior vestibular nucleus (of Bechterew), lateral vestibular
Structure and nucleus (of Deiters), inferior vestibular nucleus (of Roller), medial vestibular nucleus
features (of Schwalbe)
Cochlear nerve: anterior and posterior cochlear nuclei

Associated ganglia:
Vestibular nerve: vestibular ganglion (receives the inputs from the utricular,
saccular, lateral, anterior and posterior ampullary nerves)
Cochlear nerve: spiral ganglion (receives the inputs from the spiral organ (of Corti))
Vestibular nerve: transmits information about motion and position of the head to
Function maintain balance and equilibrium
Cochlear nerve: transmits auditory information/enables the sense of hearing
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Auditory pathway Vestibular system
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Neuroanatomy 555
CRANIAL NERVES
GLOSSOPHARYNGEAL NERVE (CN IX)
The glossopharyngeal nerve (CN IX) is a mixed cranial nerve that carries both
motor and sensory fibers. Its functions include:
• general somatic afferent (GSA) innervation of the tongue and throat

• special visceral afferent (SVA) sensation of taste to the posterior third of the
tongue
• general visceral afferent (GVA) sensation from specific structures of the com
mon carotid artery (carotid sinus and carotid body)
• general somatic efferent (GSE) innervation is also provided to the stylo-
pharyngeus muscle
• general visceral efferent (GVE) secretomotor (parasympathetic) innervation
to the parotid gland
Pons
Superior salivatory nucleus
Inferior salivatory nucleus
Solitary nucleus and tract
Nucleus ambiguus
Spinal nucleus and tract

of trigeminal nerve
Superior ganglion of
glossopharyngeal nerve
Jugular foramen
Stylomastoid foramen
Inferior ganglion of
Carotid canal
Communicating branch of facial

nerve with glossopharyngeal nerve
Communicating branch of
glossopharyngeal nerve with
auricular branch of vagus nerve
Medulla oblongata
| Glossopharyngeal nerve
FIGURE 9.43. Glossopharyngeal nerve (origin and proximal branches). The glossopharyngeal nerve (CN IX)
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o (general somatic efferent fibers), and sensory fibers from the spinal trigeminal nucleus (general somatic
afferent) and solitary nucleus (general visceral sensory).
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CRANIAL NERVES
The glossopharyngeal nerve emerges from the lateral aspect of the rostral medulla and leaves the skull
via the anterior part of the jugular foramen. Here, it bears its associated sensory ganglia: The superior and
inferior ganglia.
Tympanic plexus
Lesser petrosal nerve
Tubal branch of tympanic plexus
Auditory tube
Parotid gland
Stylopharyngeal branch
Palatine tonsil
Tonsillar branches
Lingual branches
Pharyngeal branches
Tongue
Pharyngeal constrictor muscle
Carotid sinus nerve
Carotid sinus
Carotid body
FIGURE 9.44. Glossopharyngeal nerve (distal branches). After exiting the jugular foramen, the
glossopharyngeal nerve gives off the tympanic nerve, which joins the tympanic plexus in providing
general sensory innervation to the mucosa of the middle ear, auditory tube, and mastoid air cells. The
tympanic plexus gives rise to the lesser petrosal nerve, which carries the parasympathetic component
of the glossopharyngeal nerve and supplies it to the otic ganglion to innervate the parotid gland via the
auriculotemporal nerve (CN V3). CN IX then descends into the anterior triangle of the neck, where it gives
rise to several branches.
The stylopharyngeal branch provides somatic motor innervation to the stylopharyngeus muscle. The
carotid branch carries general visceral afferent fibers from the carotid sinus and carotid body. Pharyn
geal and tonsillar branches provide general sensory supply to the mucosa of the pharynx and the palatine
tonsil region, respectively. The lingual branch provides general sensory supply to the base of the tongue
and special visceral afferent (taste) innervation to the posterior one-third of the tongue. Finally, the glos
sopharyngeal nerve gives off communicating branches that form connections with the sympathetic
trunk, vagus (CN X) and facial nerves (CN VII).
Neuroanatomy 557
CRANIAL NERVES
Key points about the glossopharyngeal nerve (CN IX)
Fiber types: general somatic efferent (GSE), special visceral afferent (SVA), general
somatic afferent (GSA), general visceral afferent (GVA), general visceral efferent
(GVE)
Origin: medulla oblongata
Exists skull: jugular foramen

Structure Associated nuclei:
Motor: nucleus ambiguus (SVE) and inferior salivatory nucleus (GVE)
Sensory: nucleus of trigeminal nerve (GSA) and nuclei of solitary tract (SVA)
Associated ganglia:
Sensory: superior and inferior ganglia of glossopharyngeal nerve
Parasympathetic: otic ganglion
Tympanic nerve
Carotid branch
Pharyngeal branches
Branches
Stylopharyngeal branch
Tonsillar branches
Lingual branch
Motor innervation: stylopharyngeus muscle
Taste innervation: posterior third of tongue
General sensation: tympanic cavity, eustachian tube, fauces, tonsils, nasopharynx,

Function
uvula and posterior third of tongue
Visceral sensation: carotid body and sinus
Parasympathetic innervation: parotid gland
Glossopharyngeal
Anatomy of taste
nerve

CRANIAL NERVES
VAGUS NERVE (CN X)
The vagus nerve is the longest cranial nerve, and as its name suggests (Latin =
wandering nerve). It has an extensive course and wide distribution in the body,
traversing the neck, thorax and abdomen. It is a mixed nerve, whose functions
include:
• general somatic afferent (GSA, sensory) innervation of the laryngopharynx,

larynx and root of the tongue
• special visceral afferent (SVA, taste) innervation of the root of the tongue and
epiglottal taste buds
• general visceral afferent (GVA, sensory) innervation of thoracic and abdominal
organs
• general visceral efferent (GVE, parasympathetic) innervation to thoracoab
dominal organs and mucosa of the palate, pharynx, larynx and trachea
• special visceral efferent (SVE, branchiomotor) innervation to the palatoglos
sus muscle of the tongue and several muscles of the soft palate, pharynx and
larynx
The vagus nerve arises from the lateral aspect of the medulla oblongata and
exits the cranial cavity through the jugular foramen. From here, each vagus
nerve descends through the neck, providing innervation to the palate, pharynx,
and larynx along the way, before continuing into the thorax to innervate the
heart, bronchi, and lungs. The right and left vagus nerves intermingle around
the esophagus before going on to form the posterior and anterior vagal trunks
which subsequently pass into the abdomen to supply abdominal viscera of the
foregut and midgut (i.e. stomach as far as the left colic flexure of large intes
tine) and other abdominal organs (liver, spleen, pancreas etc.).
Neuroanatomy 559
CRANIAL NERVES
Jugular foramen
Superior ganglion
Nucleus of solitary tract
Posterior nucleus
Nucleus ambiguus
Spinal nucleus of
trigeminal nerve
Accessory nerve
Inferior ganglion
Auricular branch
Pharyngeal branch
Superior laryngeal nerve
FIGURE 9.45. Vagus nerve: Intracranial and upper cervical parts. The vagus nerve carries special visceral
efferent/branchiomotor fibers from the nucleus ambiguus and general visceral efferent/parasympathetic
fibers from the posterior (dorsal) nucleus of vagus nerve. General somatic afferent/sensory fibers are
carried to the spinal nucleus of trigeminal nerve, while both general and special visceral afferent fibers
arrive at the nucleus of solitary tract.
The vagus nerve emerges from the lateral surface of the medulla as a group of rootlets that merge before
exiting the skull via the jugular foramen between the glossopharyngeal (CN IX) and accessory (CN XI)
nerves. In this region, the vagus nerve bears the superior (jugular) ganglion that contains the cell bodies
of GSA fibers and has connections to the glossopharyngeal nerve, cervical sympathetic trunk and cranial
root of accessory nerve (which is nowadays considered as a functional component of the vagus nerve). The
superior ganglion gives off a meningeal branch (not shown) as well as an auricular branch, which supplies
parts of the auricle and tympanic membrane. Below the superior ganglion is the inferior (nodose) ganglion
which contains cell bodies of visceral and special sensory fibers of the vagus nerve and has connections
with the hypoglossal nerve (CN XII).
After exiting the jugular foramen, the vagus nerve gives off a pharyngeal branch which supplies motor
function to pharyngeal constrictor and palatine muscles, as well as receiving some GVA/sensory fibers
from the pharyngeal plexus also. It also communicates with the carotid branch (of CN IX). The final upper
cervical branch seen here is the superior laryngeal nerve.

CRANIAL NERVES
Internal branch of Superior cervical cardiac

superior laryngeal nerve branch
External branch of Inferior cervical cardiac

superior laryngeal nerve branch
Right recurrent Anterior vagal trunk

aryngeal nerve
Left recurrent Celiac branches of

laryngeal nerve posterior vagal trunk
Cardiac plexus Anterior gastric branches of

Esophageal plexus Splenic plexus
Hepatic branch of Superior mesenteric

anterior vagal trunk ganglion
Hepatic plexus Intermesenteric plexus
Pancreatic plexus Intestinal branch
FIGURE 9.46. Vagus nerve: Cervical and thoracoabdominal branches. The superior laryngeal nerve
terminates via an internal branch (which carries sensory information from the supraglottic part of the
larynx and epiglottis), and an external branch (which innervates the cricothyroid muscle). The vagus nerve
then descends through the anterior triangle of the neck in the carotid sheath, traveling posterior to the
internal jugular vein and common carotid artery, where superior and inferior cervical cardiac branches are
given off carrying GVE (parasympathetic) to and GVA (reflex) fibers from the cardiac plexus.
At the root of the neck, the vagus nerve passes anterior to each subclavian artery to enter the thorax,
after which the right and left vagus nerves follow asymmetric courses. On the right side, the recurrent
laryngeal nerve loops under the subclavian artery, while its counterpart on the left courses under the
aortic arch before ascending through the neck. Both nerves innervate the intrinsic muscles of the larynx
(except cricothyroid) as well as the mucosa of the infraglottic part of the larynx and trachea. In the thorax,
the vagus nerve also gives rise to thoracic cardiac branches, bronchial and esophageal branches which
together with branches of the sympathetic trunk, form the cardiac, pulmonary (not shown) and esopha
geal plexuses, respectively.
The right and left vagus nerves, after contributing to the esophageal plexus, re-form and continue into
the abdomen as the posterior and anterior vagal trunks, respectively. The posterior vagal trunk gives rise
to the posterior gastric branch, most of the fibers of the celiac, pancreatic, splenic, renal, suprarenal (not
shown) and intermesenteric plexuses, as well as the intestinal branches of the vagus nerve. The anterior
vagal trunk gives off the anterior gastric branch and the hepatic branch which contributes to the hepatic
plexus, but not the superior mesenteric ganglion which contains sympathetic fibers.
Neuroanatomy 561
CRANIAL NERVES
Key points about the vagus nerve (CN X)
Fiber types: general somatic afferent (GSA), special visceral afferent (SVA), general
visceral afferent (GVA), general somatic efferent (GSE), general visceral efferent
(GVE)
Origin: medulla oblongata

Structure
Motor nuclei: nucleus ambiguus (SVE), dorsal vagal nucleus (GVE)
Sensory nuclei: spinal nucleus of trigeminal nerve (GSA), nucleus of solitary tract
(GVA/SVA)
Associated ganglia: superior and inferior ganglia of CN X
Jugular fossa: meningeal, auricular branches
Neck: pharyngeal, superior laryngeal, recurrent laryngeal nerve (right only);

superior/inferior cervical cardiac branches
Branches Thorax: recurrent laryngeal nerve (left only), thoracic cardiac branches, bronchial
branches, esophageal branches
Abdomen: posterior vagal trunk (posterior gastric, celiac, renal branches), anterior
vagal trunk (anterior gastric branches, hepatic, pyloric branches), intestinal
branches (up to left colic flexure)
General somatic afferent (GSA): larynx, laryngopharynx, part of the external

acoustic meatus, and dura mater of posterior cranial fossa
General visceral afferent (GVA): aortic body chemoreceptors/aortic arch

baroreceptors, esophagus, bronchi, lungs, heart, and abdominal viscera of foregut
and midgut
Special visceral afferent (SVA): taste from root of tongue and epiglottis
Function
General somatic efferent (GSE): palatoglossus muscle, muscles of soft palate
(except tensor veli palatini), muscles of pharynx (except stylopharyngeus) and
muscles of larynx
General visceral efferent (GVE): parasympathetic/secretomotor fibers to smooth

muscle and glands of the pharynx and larynx, parasympathetic innervation of
thoracic viscera, and abdominal viscera of the foregut and midgut
Vagus nerve

CRANIAL NERVES
ACCESSORY NERVE (CN XI)
The accessory nerve is primarily a motor nerve meaning that it supplies effer
ent motor function to muscles. Traditionally, it has been considered to have
two parts, a cranial root and a spinal root. The classification of the cranial root
is somewhat controversial however, with many anatomists nowadays consid
ering these fibers to be part of the vagus nerve. Therefore, when clinicians and
textbooks refer to the accessory nerve, they usually are specifically referring to
the spinal part only (making the accessory nerve the only cranial nerve not to
originate within the cranium). Consequently, many no longer technically con
sider the accessory nerve to be a cranial nerve but continue to include it as one,
so as not to defy traditional convention.
When considering the spinal part only, the function of the accessory nerve is to
supply motor innervation to two muscles, the sternocleidomastoid and trape
zius. The type of innervation carried by the accessory nerve to these muscles
is disputed however. Some references describe it as carrying special visceral
efferent (SVE, branchiomotor) fibers (due to a close relationship between the
nucleus of accessory nerve with the nucleus ambiguous), while others describe
it as carrying general somatic efferent (GVE) fibers (due to the unknown/dis-
puted embryological origins of the sternocleidomastoid and trapezius muscles).
Superior ganglion of
Vagus nerve
vagus nerve
Cranial root of
accessory nerve Jugular foramen
Nucleus ambiguus
vagus nerve
Spinal root of
accessory nerve
Spinal nerve C1
Spinal nerve C2
Sternocleidomastoid
muscle
Spinal nerve C3
Accessory nerve
Spinal nerve C4
Spinal nerve C5 Trapezius muscle
FIGURE 9.47. Pathway of the accessory nerve. The spinal root of the accessory nerve originates from the
cell bodies of motor neurons located in the upper five or six cervical segments of the spinal cord which
collectively form the nucleus of accessory nerve. Multiple rootlets exit the spinal cord between the
anterior and posterior spinal nerve roots and combine to form the nerve trunk, which ascends the spinal
cord and passes through the foramen magnum to enter the cranium. The cranial root arises from motor
Neuroanatomy 563
CRANIAL NERVES
neurons originating in the nucleus ambiguus of the medulla oblongata. Rootlets from this nucleus exit
from the dorsolateral medulla oblongata and temporarily join with the fibers of the spinal root. Together,
they then exit the skull via the jugular foramen.
The nerve then divides into two again: The internal branch (cranial root) joins with the vagus nerve to
innervate the muscles of soft palate/larynx while the external branch (spinal root) descends into the lat
eral cervical region of the neck, passing superficially through its posterior triangle. Here the accessory
nerve passes deep to the sternocleidomastoid muscle, which it innervates via a muscular branch. It con
tinues to descend in a posterolateral direction, before terminating as a trapezius branch which spans out
across the trapezius muscle, supplying it with motor function.
Supplementary innervation of the sternocleidomastoid and trapezius muscles is also delivered via
homonymous branches of the cervical plexus. These branches contain afferent/sensory neurons, whose
cells bodies are located in the spinal ganglia of spinal nerves C2-C4. Some motor fibers are also believed
to be delivered to the muscles via this pathway.
Key points about the accessory nerve
Fibers: special visceral efferent (SVE) (or general somatic efferent (GSE))
Origin: rootlets along upper cervical spinal cord (spinal root), dorsolateral medulla
Structure and oblongata (cranial root)
features Exits skull: jugular foramen
Associated nuclei: nucleus ambiguus (cranial root); Nucleus of accessory nerve

(spinal root)
Internal branch ^ joins vagus nerve

Branches
External branch ^ sternocleidomastoid and trapezius branches
Spinal root: motor innervation to sternocleidomastoid and trapezius muscles

Function
Cranial root: motor innervation to muscles of soft palate and larynx
Accessory nerve Motor cranial nerves
HYPOGLOSSAL NERVE (CN XII)
The hypoglossal nerve is primarily a motor nerve which arises as a series of

rootlets from the lateral surface of the medulla oblongata, between the pyr
amid and olive.
It supplies motor innervation (GSE) to the extrinsic muscles of the tongue with
the exception of palatoglossus (i.e. genioglossus, hyoglossus and styloglossus
muscles) as well as all of the intrinsic muscles of the tongue (superior longitudi
nal muscle of tongue, inferior longitudinal muscle of tongue, transverse muscle
of tongue and vertical muscle of tongue).

CRANIAL NERVES
Tongue Nucleus of hypoglossal

nerve
Styloglossus muscle Hypoglossal nerve
Genioglossus muscle Anterior rami of

spinal nerves C1-C3
Hyoglossus muscle Superior root of

ansa cervicalis
Thyrohyoid muscle Inferior root of

ansa cervicalis
Sternohyoid muscle Ansa cervicalis
Omohyoid muscle Sternothyroid muscle
FIGURE 9.48. Hypoglossal nerve: Overview. The hypoglossal nerve (CN XII) arises as a series of rootlets
from the hypoglossal nucleus of the medulla oblongata. The rootlets combine to form the nerve proper,
which then exits the cranium via the hypoglossal canal.
During its course, the hypoglossal nerve receives the fibers from spinal nerve C1 (and/or C2) which ‘piggy
back’ the nerve, but do not mix with it. They leave the hypoglossal nerve as a series of branches: Meningeal
branch, superior root of ansa cervicalis, thyrohyoid branch and geniohyoid branch.
The only ‘true’ branches of the hypoglossal nerve are the terminal lingual branches that innervate the
muscles of the tongue. These branches supply all extrinsic and intrinsic muscles of the tongue, with the
exception of the palatoglossus muscle, which is supplied by the vagus nerve.
Key points about the hypoglossal nerve (CN XII)
Fibers: general somatic efferent (GSE)
Structure and Origin: medulla oblongata (between pyramid and olive)

features Exits skull: hypoglossal canal
Associated nuclei: nucleus of hypoglossal nerve
Lingual branches of hypoglossal nerve
Note that whilst the following branches are given off by the hypoglossal nerve,
their fibers originate from the cervical plexus (C1-2):
Branches Meningeal branch
Superior root of ansa cervicalis
Thyrohyoid branch
Geniohyoid branch
Motor innervation:
Extrinsic muscles of the tongue: genioglossus, hyoglossus and styloglossus
Function
Intrinsic muscles of the tongue: superior longitudinal lingual, inferior longitudinal
lingual, transversus linguae and verticalis linguae muscle
The hypoglossal
nerve
Neuroanatomy 565
CRANIAL NERVES
TASTE PATHWAY
After reviewing the anatomy of the facial, glossopharyngeal and vagus nerves,
the various pathways of taste sensation will now be summarized.
Ventral posteromedial nucleus

Lateral hypothalamic area
Amygdaloid body
Taste sensory cortex
Pons
Trigeminal nerve
Trigeminal ganglion
Facial nerve
Sensory root of facial nerve
Geniculate ganglion
Maxillary nerve
Greater petrosal nerve
Pterygopalatine ganglion
Fungiform papilla
Mandibular nerve
Otic ganglion
Foliate papillae
Lingual nerve
Vallate papillae
Chorda tympani
Rostral solitary nucleus
Epiglottis
Inferior ganglion of vagus nerve
Superior laryngeal nerve
Vagus nerve
FIGURE 9.49. Taste pathway: Overview. Taste sensation from taste buds of the anterior two-thirds of the
tongue (fungiform and foliate papillae), travels via the chorda tympani of the facial nerve. Additionally, the
greater petrosal branch of the facial nerve supplies the taste buds of the soft palate. Cell bodies of these
neurons are located in the geniculate ganglion; their central processes continue towards the brainstem as
the sensory root of facial nerve, also known as the intermediate nerve.
Taste sensation from the posterior third of the tongue is carried by the lingual branch of the glossopharyn
geal nerve; the cell bodies of these neurons are located in the inferior ganglion of glossopharyngeal nerve.
Taste sensation from the laryngeal surface of the epiglottis is carried by the superior laryngeal branch of
the vagus nerve; cell bodies of these neurons are located in the inferior ganglion of vagus nerve.
Upon entering the brainstem, central processes of the gustatory elements: Afferents of the facial, glos
sopharyngeal and vagus nerve fibers form the solitary tract and synapse in the rostral third of the nucleus
of solitary tract of the medulla oblongata. Second-order fibers then ascend via three pathways. The
majority of the fibers go on to synapse in the ventral posteromedial nucleus of the thalamus, which syn
apse with third-order fibers destined for the insular cortex for interpretation of taste. Other fibers travel
to the lateral hypothalamic area, involved in appetite and satiety mechanisms. The rest of the fibers pass
to the amygdala, which is involved in emotions and memory formation in relation to food.

INDEX
A Accessory process of lumbar vertebrae, 127

Abdomen Accessory saphenous vein, 104
planes of, 221, fig 6.1 Acetabular fossa, 68, fig 3.7
regions, 221, fig 6.1 Acetabular labrum, 68, fig 3.7
Abdominal aorta, 131, fig 4.13, 226-227, fig 6.3, Acetabular margin, 68, fig 3.7
232-233, fig 6.8, 241, fig 6.15, 257, Acetabular notch of hip bone, 65, fig 3.4
fig 6.27, 275, fig 6.37, 280, 285, fig 6.44 Acetabulum, 64-65, fig 3.4, 68, fig 3.7
in male, 347, fig 7.32 bony pelvis, 300, 303, fig 7.1a
Abdominal lymph node groups, 297 Acoustic meatus
Abdominal regions external, 361, fig 8.3, 430-431, fig 8.65-8.66
contents, 222 internal, 551, fig 9.40
Abdominal surface of diaphragm, 227 Acromioclavicular joint, 12
Abdominal wall Acromion of scapula, 15, fig 2.5
arteries of, 230, fig 6.5 Adductor brevis muscle, 69, fig 3.8, 73, 105
muscles of, 223-225, fig 6.2 Adductor compartment, 38-39, fig 2.21-2.22
nerves of, 232, fig 6.7 Adductor longus muscle, 69, fig 3.8, 73
Abdominopelvic cavity, 6-7, fig 1.5-1.6 Adductor magnus muscle, 69, fig 3.8, 72, 107
Abducens nerve (CN VI), 416, fig 8.51, 412, fig 8.47, Adductor pollicis muscle, 38-39, fig 2.21-2.22
533-535, fig 9.28-9.29, 540, 542-543, Adductor tubercle
fig 9.34 on medial epicondyle of femur, 67
brainstem, 506, fig 9.9 Adipose capsule of kidney, 277, fig 6.39
common tendinous ring of Zinn, 418, fig 8.53 Adrenal glands see suprarenal (adrenal) glands
function of, 540, 543 Agger nasi, 425, fig 8.60
nerves of orbit, 416, fig 8.51 Ala
nucleus of, 542, fig 9.34 of ilium, 63-65, fig 3.2-3.4
Abductor digiti minimi muscle, 38-39, of sacrum, 128, fig 4.11
fig 2.21-2.22 Alar cartilage(s)
Abductor pollicis brevis muscle, 38-39, major, 425, fig 8.60
fig 2.21-2.22 minor, 425, fig 8.60
Abductor pollicis longus muscle, 29-30, fig 2.15 Alar fascia, 487, fig 8.111
Accessory lymph nodes, 482, fig 8.108 Alar ligament(s), 120-121, fig 4.6-4.7
Accessory nerve (CN-XI), 506, fig 9.9, 533, fig 9.28, Alveolar artery
533-535, 560, fig 9.45, 563-564, inferior, 396, fig 8.35
fig 9.47, 563, fig 9.47 mental branch of, 387, fig 8.26, 396,
branches of, 564 fig 8.35
cranial root of, 563, fig 9.47 superior
foramina of the skull, 366 posterior, 396, fig 8.35, 406, fig 8.43
functions of, 563-564 Alveolar nerve
nerves of pharynx (CN XI), 457-458, fig 8.88 inferior, 549, fig 9.39
neurovasculature of the neck, 478, fig 8.104 superior
pathway of, 563, fig 9.47 anterior, 405, fig 8.42, 545-546, fig 9.36-9.37
spinal root of, 563, fig 9.47 dental branches of, 545, fig 9.36
structure and features of, 564 middle, 405, fig 8.42, 545-546, fig 9.36-9.37
triangles of the neck, 484, fig 8.110 posterior, 405, fig 8.42, 545-546,
Accessory nucleus of oculomotor nerve, 541, fig 9.36-9.37
fig 9.33 Alveolar process of maxilla, 360, fig 8.2, 365,
Accessory obturator nerve, 105 fig 8.7, 370, fig 8.12
Accessory pancreatic duct (of Santorini), 256-258, Ambient gyrus, 536, fig 9.30
fig 6.26-6.27 Amniochorion, 320, fig 7.14
Index 567
Amnion, 319-320, fig 7.13-7.14 Anorectal venous plexus
Amniotic sac, 319, fig 7.13 inferior of male, 344-345, fig 7.30
Ampulla middle
of urethra, 329, fig 720 of female, 346, fig 7.31
of uterine tube, 313, fig 7.10 of male, 344-345, fig 7.30
Ampulla of Vater see Hepatopancreatic ampulla Ansa cervicalis, 462, 477-478, fig 8.103-8.104,
(ampulla of Vater) 479, fig 8.105, 484-485, fig 8.110, 565,
Ampullary nerve fig 9.48
anterior, 436, fig 8.71, 554, fig 9.42 omohyoid branch of
lateral, 436, fig 8.71, 554, fig 9.42 inferior, 479, fig 8.105
posterior, 436, fig 8.71, 554, fig 9.42 superior, 479, fig 8.105
Amygdaloid body, 501, fig 9.6, 536, fig 9.30, 566, sternocleidomastoid branch of, 479, fig 8.105
fig 9.49 sternothyroid branch of, 479, fig 8.105
Anal aperture, 338 Ansa pectoralis, 43, fig 2.24, 48, fig 2.29
Anal canal, 235, 268, 269-270, fig 6.34 Anserine bursa of the knee, 77, fig 3.12
blood vessels of, 275-276, fig 6.37-6.38 Antebrachial cutaneous nerve(s)
function of, 270 lateral, 54, fig 2.35
innervation of, 276, fig 6.38 anterior branch of, 54, fig 2.35
landmarks of, 270 posterior branch of, 54-55, fig 2.35-2.36
Anal nerve medial, 43, fig 2.24, 48-50, fig 2.29-2.30
inferior anterior branch of, 54, fig 2.35
of female, 341, fig 7.28 posterior branch of, 54-55, fig 2.35-2.36
of male, 344-345, fig 7.30 posterior, 49, fig 2.30, 55, fig 2.36
Anal pecten, 269, fig 6.34 Antebrachial region
Anal region, 114, fig 4.1 anterior, 10-11, fig 2.1
Anal sphincter posterior, 10-11, fig 2.1
external, 269, fig 6.34, 307, fig 7.6 Antebrachial vein, 52, fig 2.33
of female, 310, fig 7.7 Anterior arch of atlas (C1), 120-121, fig 4.6-4.8
of male, 334, fig 7.22 Anterior atlantooccipital ligament, 122-123,
internal, 269, fig 6.34 fig 4.8
Anal triangle, 336, fig 7.24 Anterior branch of renal arteries, 279-280,
Anastomotic network elbow joint, 51, fig 2.32 fig 6.41
Anastomotic vein Anterior cardiac vein, 212-213, fig 5.47
inferior, 520, fig 9.19 Anterior cerebral vein, 521, fig 9.20
superior, 520, fig 9.19 Anterior cervical lymph nodes
Anatomical neck of humerus, 13-14, fig 2.3 superficial, 482, fig 8.108
Anatomical position, 2 Anterior chamber of eyeball, 420, fig 8.55
Anatomical relations of heart, 198, fig 5.38 Anterior ciliary arteries, 422, fig 8.57
Anatomical snuffbox see radial roveola Anterior clinoid process, 369, fig 8.11
Anconeus muscle, 19-21, fig 2.9 of sphenoid bone, 369, fig 8.11, 376, fig 8.18
Angle of mandible, 380, fig 8.22 Anterior crus of ear, 431, fig 8.66
Angular artery, 388, fig 8.27, 396, fig 8.35 Anterior extremity of spleen, 246, fig 6.18
Angular gyrus(i), 495-496, fig 9.2 Anterior interventricular artery, 197, fig 5.37, 212,
artery to, 518, fig 9.18 213, fig 5.47
Angular vein, 391, fig 8.30 Anterior lateral malleolar artery, 108, fig 3.37
Ankle joint, 89, fig 3.21, 92-93, fig 3.24-3.25 Anterior longitudinal ligament, 117-118, fig 4.4,
articulating surfaces of, 93 122, fig 4.8, 304, 306, fig 7.4-7.5
ligaments of, 93 Anterior medial malleolar artery, 108, fig 3.37
movements of, 93 Anterior median fissure of spinal cord, 525,
synovial hinge joint, 92-93 fig 9.23
Ankle joint see also talocrural joint Anterior nasal spine of maxilla, 360, fig 8.2, 370,
Anococcygeal ligament, 338 fig 8.12
Anococcygeal nerve, 341, fig 7.28 Anterior rami of spinal nerves C1-C3, 565, fig 9.48
Anocutaneous line, 269, fig 6.34 Anterior rami of spinal nerves C1-C4, 479,
Anorectal artery fig 8.105, 528
inferior, 275, fig 6.37, 339, fig 7.26 Anterior semicircular duct of membranous
female, 349, fig 7.33 labyrinth, 436, fig 8.71
male, 347-348, fig 7.32 Anterior talofibular ligament, 93, fig 3.25
superior of male, 347, fig 7.32 Anterior tibial artery, 108, 110, fig 3.37-3.38
Anorectal junction, 269 Anterior tibiotalar ligament, 93, fig 3.25
Anorectal vein(s), 275 Anterior tubercle of atlas, 120, fig 4.6
inferior, 276, fig 6.38 Anterior vagal trunk, 264, fig 6.31, 561-562,
female, 349-350, fig 7.33 fig 9.46
middle, 276, fig 6.38 celiac branches of, 264, fig 6.31
female, 349-350, fig 7.33 gastric branches of, 561-562, fig 9.46
male, 347-348, fig 7.32 hepatic branch of, 264, fig 6.31, 561, fig 9.46
superior, 276, fig 6.38 pyloric branch, 264, fig 6.31, 561, fig 9.46
female, 349-350, fig 7.33 Antihelix of ear, 430-431, fig 8.65-8.66
male, 347-348, fig 7.32 crura of, 430-431, fig 8.65-8.66

Antitragus, 430-431, fig 865-866 Arm and shoulder
Anular ligaments (continued)
of fingers, 34, fig 2.18, 37 muscles of, 19-21, fig 2.9
of radius, 24-26, fig 2.12 neurovasculature of, 44-49, fig 2.25-2.30
Anulus fibrosis, 126, fig 4.10 Arm as region, 10-11, fig 2.1
Anus Arterial grooves, 363, fig 8.5
of female, 319, fig 7.13 Arterial supply of duodenum, 262, 287-288,
of male, 334, fig 7.22 fig 6.45
Aorta, 235, fig6.10 Arterial supply of eyeball, 422, fig 8.57
abdominal, 131, fig 4.13, 226-227, fig 6.3, Arterial supply of parathyroid glands, 472, fig 8.99
232-233, fig 6.8, 241, fig6.15, 257, Arterial supply of thyroid, 472, fig 8.99
fig6.27, 275, fig 6.37, 280, 285, fig 6.44 Arterial supply of tongue, 445, fig 8.79
in male, 347, fig 7.32 Arterial vasocorona, 530, fig 9.26
ureteric branches of, 281, fig 6.42 Arteries of brain, 515-518, fig 9.15-9.18
ascending, 200, fig 5.39, 204, fig 5.42, 209, Arteries of duodenum, 287-288, fig6.45
fig 5.45, 212, fig 5.47 Arteries of gallbladder, 285-286, fig6.44
brachiocephalic trunk/arch of, 475, fig 8.101, Arteries of hand, 56-57, fig 2.38
478, fig 8.104 Arteries of liver, 285-286, fig6.44
thoracic, 130, fig 4.12, 198, fig 5.38 Arteries of neck, 475, fig 8.101
descending, 530, fig 9.26 Arteries of pancreas, 287-288, fig 6.45
Aortic arch, 192, fig 5.34, 197, fig 5.37, 200-201, Arteries of spinal cord, 530-531, fig 9.27
fig 5.39-5.40, 206, fig 5.43, 210, Arteries of spleen, 287-288, fig6.45
fig 5.46 Arteries of stomach, 285-286, fig6.44
Aortic hiatus, 226-227, fig6.3 Arteries see also individual arteries
Aortic (left semilunar) valve see aortic valve Artery of bulb of vestibule, 339, fig 7.26
Aortic lymph nodes Artery of central sulcus, 518, fig 9.18
lateral, 296, fig 6.50, 351, fig 7.34 Artery of ductus deferens, 325, fig 7.17
female, 354, fig 7.36 Artery of precentral sulcus, 518, fig 9.18
male, 353, fig 7.35 Artery of tail of pancreas, 287, fig6.45
Aortic nervous plexus, 232, 281 Artery to angular gyrus, 518, fig 9.18
Aorticorenal ganglia, 264, fig 6.31 Articular capsule of elbow joint, 25, fig 2.12
Aortic valve, 206, 208, fig 5.44 Articular cartilage of knee, 81, fig 3.16
coronary leaflet(s) Articular cartilage of temporomandibular joint,
left, 208, fig 5.44 402, fig 8.40
right, 208, fig 5.44 Articular disk of temporomandibular joint, 402,
noncoronary leaflet, 208, fig 5.44 fig 8.40
Aortic vestibule, 207 Articular facet
Apex of heart, 197, fig 5.37, 200-201, fig 5.39-5.40, of head of fibula, 75, fig 3.11
206, fig 5.43, 210, fig 5.46 of lateral malleolus, 75, fig 3.11
Apex of lung, 190-192, fig 5.32-5.34 of medial malleolus, 74, fig 3.10
Apex of sacrum, 128, fig 4.11 superior of lumbar vertebra, 126, fig 4.10
Apex of tongue, 440, fig 8.76 Articular process of lumbar spine
Apex of urinary bladder of female, 332 superior, 126
Apical foramen of tooth, 451, fig 8.83 Articular process of sacrum
Apical ligament of dens, 122, fig 4.8, 123 superior, 128, fig 4.11
Appendicular regions, 3, fig 1.2 Articular process of vertebra
Appendix, 235 inferior, 117, fig 4.4
of epididymis, 325, fig 7.17 superior, 117, fig 4.4, 119
of testis, 325, fig 7.17 Articular surface for cuboid, 90-91, fig 3.22-3.23
Arachnoid granulations, 511, fig 9.13 Articular surfaces of atlantoaxial joint, 121, fig 4.7,
Arachnoid mater of cranial meninges, 511, fig 9.13, 123
526, fig 9.24 Articular surfaces of atlantooccipital joint, 121,
Arachnoid mater of spinal cord, 528, fig 9.25 fig 4.7, 123
Arch of atlas Articular tubercle of temporal bone, 365, fig 8.7,
anterior, 120-121, fig 4.6 402, fig 8.40
posterior, 122, fig 4.8 Articulating surfaces of hip joint, 68, fig 3.7
Arcuate artery, 111, fig 3.39 head of femur, 68, fig 3.7
of kidney, 279-280, fig 6.41 lunate surface of acetabulum, 68, fig 3.7
Arcuate eminence of skull, 369, fig 8.11 Aryepiglottic fold, 453, fig 8.85, 465, fig 8.92
Arcuate eminence of temporal bone, 378, fig 8.20 Aryepiglottic muscle, 466, fig 8.93
Arcuate ligament Arytenoid cartilage, 465, fig 8.92, 467-469,
ateral, 226-227, fig 6.3 fig 8.94-8.97
medial, 226-227, fig 6.3 corniculate articular surface, 466, fig 8.93
median, 226-227, fig 6.3 muscular process of, 465, fig 8.92, 467,
Arcuate line of ilium, 64, fig 3.3, 300, 303, fig 7.1a-7.3 fig 8.94, 469, fig 8.96-8.97
Areolar tissue, 191 vocal process of, 465, fig 8.92, 467, fig 8.94
Arm and shoulder, 12-21, fig 2.2-2.9 Arytenoid muscle
bones of, 12-16, fig 2.2-2.6 oblique, 466, fig 8.93, 468, fig 8.95
joint of, 17-18, fig 2.7-2.8 transverse, 466, fig 8.93, 468, fig 8.95
Index 569
Ascending aorta, 200, fig 5.39, 204, fig 5.42, 209, Atrium
fig 5.45, 212, fig 5.47 (continued)
Ascending cervical artery, 131, 475, fig 8.101 fossa ovalis, 203-204, fig 5.41
Ascending colon, 235-236, fig 6.10-6.11, 238, left, 201-202, fig 5.40, 206, fig 5.43, 210, fig 5.46
fig 6.12, 240, fig 6.14, 242, 243, fig 6.16, oblique vein of, 212-213, fig 5.47
267-268, fig 6.33 Auditory tube (Eustachian tube), 432-434,
Ascending lumbar vein, 132-133, fig 4.14, 233, fig 8.67-8.69, 557, fig 9.44
fig 6.8 cartilaginous part of, 454, fig 8.86
Ascending part of duodenum, 241, fig 6.15, pharyngeal opening of, 426, fig 8.61
254-258, fig 6.25-6.27, 291 sulcus of, 376, fig 8.18
Ascending pharyngeal artery, 396, fig 8.35, 456, Auricle of ear, 430-431, fig 8.65-8.66
fig 8.87, 475, 485 Auricle of heart
inferior tympanic artery of, 431, fig 8.66 left, 175, fig 5.21, 197, fig 5.37, 199-200, fig 5.39,
Association cortex, 497, fig 9.3 206, fig 5.43, 210, fig 5.46
Association fibers, 500, fig 9.5 right, 175, fig 5.21, 197, fig 5.37, 199-200,
Atlantoaxial joint, 121, fig 4.7, 123 fig 5.39, 203, fig 5.41, 204
articular surfaces of, 121, 123, fig 4.7 Auricular artery
joints of, 121, 123 deep, 396, fig 8.35, 431, 433
joint type of, 121, 123, fig 4.7, 123 posterior, 144, fig 4.18, 389, fig 8.28, 396,
ligaments of, 123, fig 4.7 fig 8.35, 431, 475
movements of, 121, 123, fig 4.7, 123 Auricular branch of vagus nerve, 560, fig 9.45
Atlantoaxial joint complex, 123 Auricular groove
Atlantoaxial membranes posterior, 430-431, fig 8.65-8.66
anterior, 121, 122, fig 4.8 Auricularis anterior muscle, 383, fig 8.25, 386, 431
posterior, 121 Auricularis posterior muscle, 383, fig 8.25
Atlantodental joint see median atlantoaxial joint Auricularis superior muscle, 383, fig 8.25
Atlantooccipital joint, 120-121, fig 4.7, 123 Auricular nerve
articular surfaces of, 121, fig 4.7, 123 great, 144, fig 4.18, 395, fig 8.34, 431, 477,
joint type of, 121, fig 4.7, 123 fig 8.103, 479-480, fig 8.105
ligaments of, 121, fig 4.7, 123 posterior, 386, 394-395, 552-553, fig 9.41
movements of, 121, fig 4.7, 123 auricular branch of, 552, fig 9.41
Atlantooccipital ligaments, 122-123, fig 4.8 occipital branch of, 385, 552, fig 9.41
anterior, 122-123, fig 4.8 Auricular surface of ilium, 64, fig 3.3
lateral, 122, fig 4.8 Auricular vein
posterior, 122-123, fig 4.8 dens of axis, 120-121, fig 4.6-4.7
Atlantooccipital membranes inferior articular facet of, 120, fig 4.6
anterior, 122, fig 4.8 posterior, 392, fig 8.31, 446, fig 8.80, 476, 392,
posterior, 122, fig 4.8 fig 8.31
Atlas (C1), 120-121, fig 4.6 posterior articular facet of dens axis, 120, fig 4.6
alar ligaments of, 120-121, fig 4.6-4.7 spinous process of, 120, fig 4.6
anterior arch of, 120-122, fig 4.6-4.8 superior articular process of, 120, fig 4.6
anterior tubercle of, 120, fig 4.6 transverse process of, 120, fig 4.6
lateral mass of, 120, fig 4.6 Auriculotemporal nerve, 394-395, fig 8.33-8.34,
posterior arch of, 120-122, fig 4.6-4.8 447, 548-549, fig 9.38-9.39, 557,
transverse foramen of, 120, fig 4.6 fig 9.44
transverse ligament of, 120-122, fig 4.6-4.8 Auscultation of heart, 196, fig 5.36
transverse process of, 120, fig 4.6 Autonomic nervous system, 179, fig 5.24, 263
Atrial branches of right coronary artery, 212-213, Axial regions, 3, fig 1.2
fig 5.47 Axilla, 10-11
Atrial veins, 212-213 Axillary artery, 44-45, fig 2.25-2.26
Atrioventricular bundles (of His), 215-216, fig 5.49 Axillary fossa, 11
left, 215-216, fig 5.49 Axillary nerve, 20-21, 43, fig 2.24, 48-50,
right, 215-216, fig 5.49 fig 2.29-2.31
subendocardial branches of, 215, fig 5.49 Axillary region, 10-11, fig 2.1
Atrioventricular nodal branch of right coronary Axillary vein, 46-47, fig 2.27-2.28, 163, fig 5.12,
artery, 213 169-170, fig 5.17
Atrioventricular node, 205, 215-216, fig 5.49 Axis (C2), 115, fig 4.2, 119-123, fig 4.5-4.7
Atrioventricular orifice Azygos vein, 160, fig 5.10, 162, fig 5.11, 173-174,
right, 203, fig 5.41 fig 5.19, 178-179, fig 5.23, 191, 193, 198,
Atrioventricular valve, 208, fig 5.44 fig 5.38, 227
left atrioventricular (mitral/bicuspid), 206,
fig 5.43, 207-208, fig 5.44, 210, fig 5.46 B
tendinous chords of, 206-207, fig 5.43, 210, Basal decidua of placenta, 319-320, fig 7.13-7.14
fig 5.46 Basal ganglia see basal nuclei
right (tricuspid), 202-204, fig 5.41-5.42, Basal metacarpal arch, 57, fig 2.38
208-210, fig 5.41, fig 5.44-5.46 Basal nuclei, 494, 501-502, fig 9.6, 507, 518
vestibule of, 204, 207 components of, 502
Atrium definition of, 502
right, 197, fig 5.37, 201-202, fig 5.40 function of, 502

Basal vein (of Rosenthal), 519, 521, fig 9.20 Borders of spleen
Base of sacrum, 128, fig 4.11 inferior border of, 246, fig 6.18
Base surface of heart see posterior surface superior border of, 246, fig 6.18
of heart (base) Brachial artery, 44-45, fig 2.25-2.26, 50
Basilar artery, 398, fig 8.37, 506, 515-516, Brachial cutaneous nerve(s)
fig 9.15-9.16, 518 inferior lateral, 48-49, fig 2.29-2.30
Basilar membrane, 437-438, fig 8.73 medial, 43, fig 2.24, 48-50, fig 2.29-2.30
Basilar part of brainstem, 505, fig 9.8 posterior, 49-50, fig 2.30
Basilar part of occipital bone, 121-122, fig 4.7-4.8, superior lateral, 48-50, fig 2.29-2.30
370, fig 8.12, 455, 463 Brachialis muscle, 19, fig 2.9, 26, fig 2.13
Basilar sulcus, 506, fig 9.9 Brachial plexus, 42-43, fig 2.23-2.24, 145-146,
Basilar venous plexus, 522, fig 9.21 161-162, 164-165, fig 5.13, 474, 477-478,
Basilic vein, 46-47, fig 2.27-2.28, 52-53, fig 8.103-8.104, 484-485, fig 8.110
fig 2.33-2.34, 58-59, fig 2.40, 169, fig 5.17 branches of, 43, fig 2.24
Basivertebral veins, 132-133, fig 4.14, 531, fig 9.27 lateral cord of, 48, fig 2.29
Biaxial joint, 123 medial cord of, 48, fig 2.29
Biceps brachii muscle, 4-5, fig 1.3, 13, 17, 19-20, posterior cord of, 48, fig 2.29
fig 2.9, 22, 25, 48 Brachial veins, 46-47, fig 2.27-2.28, 52, fig 2.33,
distal tendon of, 25, fig 2.12 169, fig 5.17
Biceps femoris muscle, 70, 73, fig 3.9 Brachiocephalic lymph nodes, 217, fig 5.50
Bicuspid valve see left atrioventricular Brachiocephalic trunk, 175-176, fig 5.21-5.22,
(mitral/bicuspid) valve 192, fig 5.34, 197, fig 5.37, 200-201,
Bile duct, 248, fig 6.20, 251-253, fig 6.22-6.23, fig 5.39-5.40, 396, fig 8.35, 456,
255, 256-258, fig 6.26-6.27 fig 8.87, 475, fig 8.101, 478, fig 8.104,
Bladder see urinary bladder 484, fig 8.110
Blood vessels of the spinal cord, 529-531, Brachiocephalic trunk/arch of aorta, 475
fig 9.26-9.27 Brachiocephalic vein(s), 46, 169, fig 5.17, 175,
Body cavities 6-7, fig 1.5-1.6 fig 5.21, 178, fig 5.23, 190-192, fig 5.32,
contents of, 6-7 fig 5.34, 197, fig 5.37, 473, 476
dorsal, 6-7, fig 1.5, fig 1.6 left, 169-170, fig 5.17, 175, fig 5.21, 178, fig 5.23,
ventral, 6-7, fig 1.5, fig 1.6 191-192, fig 5.34, 194, fig 5.35, 197-198,
Body of calcaneus, 90, fig 3.22 fig 5.37
Body of ilium right, 175, fig 5.21, 178, fig 5.23, 191-192, fig 5.34,
supraacetabular groove, 64 194, fig 5.35, 197-198, fig 5.37
Body of mandible, 360, fig 8.2, 380, fig 8.22 Brachioradialis muscle, 29-30, fig 2.15
alveolar part, 380, fig 8.22 Brain, 493, fig 9.1, 533, fig 9.28
base part, 380, fig 8.22 blood supply of
Body of tongue, 440, fig 8.76 arteries of, 515-518, fig 9.15-9.18
Body of urinary bladder veins of, 519-521, fig 9.19-9.20
of female, 331-332, fig 7.21 cerebellum, 493, fig 9.1
Body of uterus see corpus of uterus cerebrum, 493, fig 9.1
Body planes, terms, and relationship of, 2 directional terms of, 493, fig 9.1
Body regions, 3, fig 1.2 functions of, 493-494, fig 9.1
appendicular, 3, fig 1.2 structure of, 493, fig 9.1
axial, 3, fig 1.2 Brainstem, 493, fig 9.1, 505-508, fig 9.8-9.10,
Boettcher cells see basal external glandular cells 533, 553
(Boettcher cells) veins of, 521, fig 9.28
Bones Branches of antebrachial cutaneous nerve
of ankle joint, 92-93, fig 3.24-3.25 anterior branch of, 54, fig 2.35
of arm and shoulder, 12-16, fig 2.2-2.6 medial branch of
of elbow joint, 25-26, fig 2.12-2.13 anterior branch of, 54, fig 2.35
of foot, 86-91, fig 3.19-3.23 posterior branch of, 55, fig 2.36
of hand and wrist, 31-32, fig 2.16 posterior branch of, 54-55, fig 2.35-2.36
of hip, 63-65, fig 3.2-3.4 Branches of internal carotid artery
of knee and leg, 74-76, fig 3.10-3.11 cavernous part of (C4), 397, fig 8.36, 515,
of pelvis, 300-303, fig 7.1a-7.3 fig 9.15
of thigh, 66-67, fig 3.5-3.6 cervical part of (C1), 397, fig 8.36, 515, fig 9.15
Bones see also individual bones clinoid part of (C5), 397, fig 8.36, 515, fig 9.15
Bony ampulla of bony labyrinth communicating part of (C7), 397, fig 8.36, 515,
anterior, 435, fig 8.70 fig 9.15
lateral, 435, fig 8.70 lacerum part of (C3), 397, fig 8.36, 515, fig 9.15
posterior, 435, fig 8.70 ophthalmic part of (C6), 397, fig 8.36, 515,
Bony external acoustic opening of temporal bone, fig 9.15
377-379, fig 8.19-8.21 petrous part of (C2), 397, fig 8.36, 515, fig 9.15
Bony pelvis, 300-303, fig 7.1a-7.3 Branches of popliteal artery, 108, fig 3.37
Borders of heart, 199 anterior tibial artery, 108, fig 3.37
Borders of kidney posterior tibial artery, 108, fig 3.37
lateral, 277-278, fig 6.39-6.40 sural arteries, 108, fig 3.37
medial, 277-278, fig 6.39-6.40 Broca’s area of cerebrum, 497-498, fig 9.3
Index 571
Bronchial arteries and veins, 190-191, fig 5.32-5.33 Calcaneus
Bronchomediastinal lymph trunk, 194-195, (continued)
fig 5.35 subtalar joint, 91
Bronchopulmonary lymph nodes, 190-191, sustentaculum tali, 90-91, fig 3.22-3.23
fig 5.32-5.33, 194, fig 5.35, 217, fig 5.50 talar articular surface, 90, fig 3.22
Buccal artery, 388-389, fig 8.27-8.28, 396, fig 8.35 anterior, 90-91, fig 3.22-3.23
Buccal nerve, 394-395, fig 8.33-8.34, 548-550, middle, 90-91, fig 3.22-3.23
fig 9.39 posterior, 90-91, fig 3.22-3.23
Buccal region, 359, fig 8.1 Callosomarginal artery, 517, fig 9.17
Buccal vein, 392, fig 8.31 frontal branches of, 517, fig 9.17
Buccinator lymph nodes, 480, fig 8.106 paracentral branches of, 517, fig 9.17
Buccinator muscle, 359, 383-384, fig 8.25, Calvaria, 363, fig 8.5
388-389, 395, 446, fig 8.80 Canine teeth, 448-449, fig 8.81-8.82
Buccopharyngeal fascia, 486-489, fig 8.111 Capitate bone, 31-32, fig 2.16, 34, 40-41
Buck’s fascia see Deep fascia of penis Capitohamate interosseous ligament, 35, fig 2.3, 37
(Buck’s fascia) palmar, 37
Bulbar conjunctiva, 420, fig 8.55, 424, fig 8.58 Capitulum, 13-14, fig 2.3, 22, 24-25
Bulb of penis, 329-330, fig 7.20, 334-335, Capsular ligaments, 68, fig 3.7
fig 7.22-7.23 Capsule of cricoarytenoid joint, 465, fig 8.92
Bulb of vestibule, 317-318, fig 7.12, 331, fig 7.21, 338 Capsule(s) of cerebral cortex
artery of, 339, fig 7.26 external, 500, fig 9.5
vein of, 340, fig 7.27 internal, 500, fig 9.5
Bulb of vorticose vein, 422, fig 8.57 Cardiac impression of left lung, 190-191,
Bulbospongiosus muscle, 307-308, fig 7.6, fig 5.32-5.33
317-318, fig 7.12, 330-331, fig 7.21, Cardiac notch of lung, 190-191, fig 5.32-5.33
333-334, 338 Cardiac plexus, 214, fig 5.48, 561, fig 9.46
Bulbourethral gland, 329-330, fig 7.20, 335-335, Cardiac veins, 212-213, fig 5.47
fig 7.23, 352-353 anterior, 212-213, fig 5.47
Bundle branch atrial, 212
left, 215, fig 5.49 coronary sinus, 201-206, fig 5.40-5.41, fig 5.43,
right, 215, fig 5.49 210, fig 5.46, 212-213, fig 5.47
Bursa(e) of the knee, 77, fig 3.12 orifice of, 203, fig 5.41
anserine, 77, fig 3.12 valve of, 203, fig 5.41
deep infrapatellar, 81, fig 3.16 great, 201, fig 5.40, 212-213, fig 5.47
prepatellar, 81, fig 3.16 inferior of left ventricle, 213
subcutaneous infrapatellar, 81, fig 3.16 marginal of heart
subtendinous left, 212, fig 5.47
of biceps femoris right, 212, fig 5.47
inferior, 77, fig 3.12 middle, 212-213, fig 5.47
subtendinous oblique of left atrium, 212, fig 5.47
of gastrocnemius muscle small, 212-213, fig 5.47
lateral, 81, fig 3.16 smallest
subtendinous atrial, 212-213
of iliotibial tract, 77, fig 3.12 ventricular smallest (thebesian veins)
suprapatellar, 81, fig 3.16 212-213
Cardia of stomach, 243-244, fig 6.16-6.17
C Cardinal ligament, 312, fig 7.9, 316-318, fig 7.12
Caecal recesses, 235 Caroticotympanic nerves, 434
Calcaneal sulcus, 90, fig 3.22 Carotid artery
Calcaneal tuberosity, 90-91, fig 3.22-3.23 branches of, 389
lateral process, 90-91, fig 3.22-3.23 common, 144, fig 4.18, 396, fig 8.35, 456,
medial process, 90-91, fig 3.22-3.23 fig 8.87, 472, fig 8.99, 474-475,
Calcaneocuboid joint, 91 fig 8.101, 478, fig 8.104, 484-485,
Calcaneofibular ligament, 93, fig 3.25, 95 fig 8.110, 488, 489, fig 8.113, 561
Calcaneus, 83, 85-89, fig 3.19-3.20, 90-91, left, 175-177, fig 5.21-5.22, 196, fig 5.36,
fig 3.22-3.23, 92-94, fig 3.24-3.25, 200-201, fig 5.39-5.40
97-99, 101 right, 175-177, fig 5.21-5.22, 196, fig 5.36,
articular surface for cuboid, 90-91, 200-201, fig 5.39-5.40
fig 3.22-3.23 external, 386-389, fig 8.27-8.28, 396, fig 8.35,
body of calcaneus, 90, fig 3.22 398, 422, fig 8.57, 427, fig 8.62,
calcaneal sulcus, 90, fig 3.22 445-447, fig 8.79-8.80, 456, fig 8.87,
calcaneal tuberosity, 90-91, fig 3.22-3.23 472-473, fig 8.99, 474-475, fig 8.101,
lateral process, 90-91, fig 3.22-3.23 478, fig 8.104, 484, fig 8.110
medial process, 90-91, fig 3.22-3.23 internal, 366, 386, 389, fig 8.28, 396-398,
calcaneocuboid joint, 91 fig 8.35-8.36, 412, fig 8.47, 456, fig 8.87,
fibular trochlea, 90-91, fig 3.22-3.23 472, fig 8.99, 474-476, fig 8.101, 478,
groove for flexor hallucis longus tendon, fig 8.104, 515-516, fig 9.15-9.16, 518,
90-91, fig 3.22-3.23 522, fig 9.21, 544, fig 9.35, 556, fig 9.43

Carotid artery Cecum, 235-236, fig 6.10-6.11, 259-260, fig 6.28,
(continued) 267-268, fig 6.33, 271-273
branches of Celiac ganglia, 263-264, fig 6.31
cavernous part of (C4), 397, fig 8.36, 515, Celiac lymph nodes, 182, 247, 265-266, fig 6.32,
fig 9.15 290-297, fig 6.47-6.50
cervical part of (C1), 397, fig 8.36, 515, Celiac node of spleen, 247, fig 6.19
fig 9.15 Celiac plexus of spleen, 247, fig 6.19
clinoid part of (C5), 397, fig 8.36, 515, Celiac trunk, 226-227, fig 6.3, 235, fig 6.10,
fig 9.15 239-240, fig 6.13, 264, 285, 287-288,
communicating part of (C7), 397, fig 8.36, fig 6.45
515, fig 9.15 Cementum of teeth, 452, fig 8.84
lacerum part of (C3), 397, fig 8.36, 515, Central compartment of hand, 38, fig 2.21-2.22
fig 9.15 Central retinal artery, 422, fig 8.57
ophthalmic part of (C6), 397, fig 8.36, 515, Central sulcus of brain, 493, fig 9.1, 518, fig 9.18
fig 9.15 Central tendon of diaphragm, 198, fig 5.38, 226,
petrous part of (C2), 397, fig 8.36, 515, fig 6.3
fig 9.15 Cephalic vein, 46-47, fig 2.27-2.28, 52-53,
right, 397, fig 8.36, 478, fig 8.104, 484, fig 2.33-2.34, 58-59, fig 2.39, 163-164,
fig 8.110, 517, fig 9.17 fig 5.12, 169, fig 5.17
Carotid bifurcation, 396, fig 8.35, 456 accessory, 52-53, fig 2.33-2.34
Carotid body, 396, fig 8.35, 556-557, fig 9.44 Cerebellar artery
Carotid canal, 366, fig 8.8, 369, 379, fig 8.21, 433, anterior
556, fig 9.43 inferior, 398, fig 8.37, 398, fig 8.37, 516, fig 9.16
Carotid sheath, 487, fig 8.111, 485, 487-488, posterior
fig 8.111, 561 inferior, 398, fig 8.37, 398, fig 8.37, 516, fig 9.16
Carotid sinus, 397, fig 8.36, 478, fig 8.104, 484, superior, 398, fig 8.37, 398, fig 8.37, 516, fig 9.16
fig 8.110, 515, fig 9.15, 556-557, Cerebellar fissures
fig 9.43-9.44 horizontal, 509-510, fig 9.11-9.12
Carotid sinus nerve, 557, fig 9.44 primary, 509, fig 9.11
Carotid sulcus, 369, fig 8.11, 376, fig 8.18 superior posterior, 509, fig 9.11
Carotid triangle of neck, 483-485, fig 8.109-8.110 Cerebellar fossa, 369, fig 8.11
Carotid wall, 433 Cerebellar lobes
Carpal arch anterior, 494, 510, fig 9.12
dorsal, 51, fig 2.32, 57, fig 2.38 flocculonodular, 494, 510, fig 9.12
Carpal articular surface, 24 posterior, 494, 510, fig 9.12
Carpal bones, 31-32, fig 2.16 Cerebellar lobules
Carpal region, 10-11, fig 2.1 quadrangular lobule
Carpometacarpal joints, 31-32, fig 2.16 anterior, 509, fig 9.11
dorsal, 37 posterior, 509, fig 9.11
Carpometacarpal ligaments semilunar
dorsal, 35, fig 2.19, 37 inferior, 509, fig 9.11
palmar, 34, fig 2.18, 37 superior, 509, fig 9.11
Cartilages of larynx, 470 Cerebellar surfaces
Caudal as term of relationship, 2, fig 1.1 anterior (petrosal), 508, 510
Caudate lobe of liver, 239, 248, 251-252, inferior (suboccipital), 508
fig 6.22-6.23 superior (tentorial), 508
Caudate nucleus, 500-502, fig 9.5-9.6 Cerebellar vein
body of, 501, fig 9.6 inferior, 521
head of, 501, fig 9.6 superior, 521, fig 9.20
tail of, 501, fig 9.6 Cerebellum, 493, fig 9.1, 508-510, fig 9.11-9.12
Caval foramen, 160-161, 226-227, fig 6.3 fissures of
Caval lymph nodes horizontal, 509-510, fig 9.11-9.12
lateral, 295-296, fig 6.50, 350-351, fig 7.34 primary, 509, fig 9.11
female, 354-355, fig 7.36 superior posterior, 509, fig 9.11
male, 353, fig 7.35 flocculus of, 510, fig 9.12
Cavernous nerves of penis, 344, fig 7.30 folia of, 508
Cavernous part (C4) of internal carotid artery, hemisphere(s) of, 494, 510, fig 9.12
397, fig 8.36 lobes of
Cavernous sinus, 406-407, fig 8.44, 412-413, anterior, 494, 510, fig 9.12
fig 8.47, 428, fig 8.63, 520, 522-523, flocculonodular, 494, 510, fig 9.12
fig 9.21 posterior, 494, 510, fig 9.12
Cavities of temporomandibular joint lobules of
inferior, 402, fig 8.40 quadrangular lobule
superior, 402, fig 8.40 anterior, 509, fig 9.11
Cavity of ear, 431, fig 8.66 posterior, 509, fig 9.11
Cecal artery semilunar
anterior, 261, fig 6.29, 271, fig 6.35 inferior, 509, fig 9.11
posterior, 261, fig 6.29, 271, fig 6.35 superior, 509, fig 9.11
Index 573
Cerebellum Cervical part (V2) of vertebral artery, 398, fig 8.37
(continued) Cervical plexus, 477, fig 8.103, 479-480, fig 8.105,
nodule of, 510, fig 9.12 485
notch of ansa cervicalis, 462, 477-478, fig 8.103-8.104,
anterior, 509, fig 9.11 479, fig 8.105, 484-485, fig 8.110, 565,
posterior, 509-510, fig 9.11-9.12 fig 9.48
peduncle of omohyoid branch of
inferior, 510, fig 9.12 inferior, 479, fig 8.105
middle, 510, fig 9.12 superior, 479, fig 8.105
superior, 510, fig 9.12 sternocleidomastoid branch of, 479, fig 8.105
surfaces of, 508 sternothyroid branch of, 479, fig 8.105
anterior (petrosal), 508, 510 anterior rami of spinal nerves C1-C3, 565,
inferior (suboccipital), 508 fig 9.48
superior (tentorial), 508 anterior rami of spinal nerves C1-C4, 479,
tonsil of, 510, fig 9.12 fig 8.105, 528
vermis of, 494, 508-510, fig 9.11-9.12 deep/muscular branches of, 479, fig 8.105
central lobule of, 509, fig 9.11 definition of, 479, fig 8.105
culmen of, 509, fig 9.11 great auricular nerve, 144, fig 4.18, 395, 431,
declive of, 509, fig 9.11 477, 479-480, fig 8.105
folium of, 509, fig 9.11 hypoglossal nerve (CN XII), 479, fig 8.105, 485,
Cerebral aqueduct, 505, fig 9.8, 513, fig 9.14 506, fig 9.9, 533, fig 9.28, 533-535,
Cerebral arterial circle (of Willis), 516, 518 560, 564-565
Cerebral artery(ies) geniohyoid branch of, 479, fig 8.105, 565
anterior, 398, fig 8.37, 515-518, fig 9.15-9.17 thyrohyoid branch of, 479, fig 8.105, 565
middle, 397-398, fig 8.36-8.37, 515-518, lesser occipital nerve, 479, fig 8.105
fig 9.15-9.17 muscular branches of, 479, fig 8.105
posterior, 398, fig 8.37, 517-518, fig 9.17 phrenic nerve, 479, fig 8.105
Cerebral cortex, 495-498, fig 9.2-9.3, 500-503, superficial/cutaneous branches, 479-480,
fig 9.5-9.7, 511, fig 9.13 fig 8.105
Cerebral peduncle, 506-507, fig 9.9 supraclavicular nerve, 479, fig 8.105
Cerebral surface, 376, fig 8.18 transverse cervical nerve, 479, fig 8.105
Cerebral vein(s), 519-521, fig 9.19-9.20 trapezius branch, 479, fig 8.105
anterior, 521, fig 9.20 Cervical spine (C1-C7), 115-116, fig 4.2
great (of Galen), 521-522, fig 9.20-9.21 joints, 123
inferior, 520-522, fig 9.19, fig 9.21 structure, 122
superficial middle (of Sylvius), 520, fig 9.19, 522, vertebrae
fig 9.21 atypical (C1-2) (C7), 119, 122
superior, 520, fig 9.19 typical (C3-C6), 119, fig 4.5, 122
Cerebrum, 369, 493-494, fig 9.1, 495-496, fig 9.2, Cervical subcutaneous tissue, 487, fig 8.111
536, fig 9.30 Cervical vertebra(e), 489, fig 8.113
map of functional areas of, 497, fig 9.3 atypical, C1-2, C7, 119, 122
motor, sensory and association cortices, 497, typical C3-C6, 119, fig 4.5, 122
fig 9.3 Cervicothoracic ganglion, 214, fig 5.48, 457,
Cervical artery(ies) fig 8.88
ascending, 131, 475, fig 8.101 Cervix of uterus, 311-312, fig 7.8, 313-318,
deep, 144-145, fig 4.18, 398, fig 8.37 fig 7.10-7.12
transverse, 145, fig 4.19, 472, fig 8.99, 475, definition of, 318
fig 8.101, 478, fig 8.104, 484-485, functions of, 318
fig 8.110 Chamber(s) of eyeball, 420, fig 8.55
vertebral, 131 anterior, 420, 423, fig 8.58
Cervical fascia, 486-488, fig 8.111-8.112 posterior, 420, fig 8.55, 423, fig 8.58
deep, 486 Chiasmatic sulcus, 369, fig 8.11
deep layer of, 486-488, fig 8.111-8.112 Choana, 366, fig 8.8, 426, fig 8.61, 453, fig 8.85
middle layer of, 486-487, fig 8.111 Chordae tendineae see tendinous chords
superficial layer of, 486-487, fig 8.111 Chorda tympani, 366, 434, fig 8.69, 548-549,
superficial, 486 fig 9.38, 551, fig 9.40, 553-554, fig 9.42,
Cervical ganglion 566, fig 9.49
middle, 214, fig 5.48, 457, fig 8.88 Chorion, 319-320, fig 7.13-7.14
superior, 214, fig 5.48, 457, fig 8.88 Chorion frondosum, 320, fig 7.14
Cervical lordosis, 115, fig 4.2 Chorionic plate, 320, fig 7.14
Cervical lymph nodes of head and neck Chorion laeve, 320, fig 7.14
anterior, 482, fig 8.108 Choroid, 413, 419-422, fig 8.54, fig 8.56-8.57
lateral, 483 Choroidal artery
Cervical muscles anterior, 397, fig 8.36, 515-516, fig 9.15-9.16
deep, 489, fig 8.113 Ciliary arteries
Cervical nerve anterior, 412, 422, fig 8.57
transverse, 477, fig 8.103, 479-480, fig 8.105 posterior, 413, fig 8.48
Cervical part (C1) of internal carotid artery, 397, long, 413, 422, fig 8.57
fig 8.36 short, 413, 422, fig 8.57

Ciliary body, 419-421, fig 8.55, 423, fig 858 Coccygeus muscles, 307-309, fig 7.6, 321, 337-338
Ciliary ganglion, 414-416, fig 8.49, fig 8.51, Coccyx, Co1-5, 115-116, fig 4.2,128-129, fig 4.11,
541-542, fig 9.33, 544, fig 9.35 131, fig 4.13, 303, fig 7.3, 305, 307, 322,
Ciliary glands (of Moll), 423-424, fig 8.58 336-338, fig 7.24-7.35
Ciliary nerves joints of, 129
long, 544, fig 9.35 parts of, 129
short, 414-416, fig 8.49, fig 8.51, 541, fig 9.33, structure of, 129
544, fig 9.35 Cochlea, 433, fig 8.68, 435-437, fig 8.70, fig 8.72
Ciliary processes, 420-421, fig 8.56 Cochlear duct, 436-437, fig 8.71-8.72
Cingular branches, 517, fig 9.17 basal external glandular cells (Boettcher cells)
Cingulate gyrus, 498 of, 438, fig 8.73
Circular folds (of Kerckring), 257-258, fig 6.27 basilar membrane of, 437-438, fig 8.73
Circumflex arteries of heart, 213 cuboid external supporting cells (Claudius cells)
left marginal branch of, 212, fig 5.47 of, 438, fig 8.73
Circumflex arteries of hip and thigh, 103, fig 3.33 external pillar epithelial cell, 438, fig 8.73
deep circumflex iliac artery, 103-104, fig 3.33, inner border cell of, 438, fig 8.73
106, fig 3.35 inner hair cell of, 438, fig 8.73
lateral circumflex femoral artery, 103, fig 3.33, inner phalangeal epithelial cell of, 438,
106, fig 3.35 fig 8.73
medial circumflex femoral artery, 103, fig 3.33, inner spiral sulcus of, 438, fig 8.73
106, fig 3.35 inner sulcus cells of, 438, fig 8.73
superficial circumflex iliac artery, 103, fig 3.33, inner tunnel of, 438, fig 8.73
106, fig 3.35 intermediate tunnel of, 438, fig 8.73
Circumflex femoral veins internal pillar epithelial cell of, 438, fig 8.73
deep, 104 outer border cells (Hensen’s cells) of, 438,
medial, 104 fig 8.73
lateral, 104 outer hair cells of, 438, fig 8.73
Circumflex iliac artery outer phalangeal epithelial cells of, 438,
deep, 104, 106, fig 3.35, 231, 311, fig 7.8 fig 8.73
superficial, 104, 106, fig 3.35, 231 tectorial membrane of, 438, fig 8.73
Circumflex iliac vein vas spirale of, 438, fig 8.73
deep, 311, fig 7.8 Cochlear ganglion, 437, fig 8.72, 554, fig 9.42
Circumflex scapular artery, 45, fig 2.26 Cochleariform process, 434, fig 8.69
Cisterna chyli, 222, 265-266, fig 6.32, 291, Cochlear nerve(s), 433, fig 8.68, 436-438,
293-296, fig 6.50, 350-355, fig 7.36 fig 8.71-8.72, 553-554, fig 9.42
female, 354-355, fig 7.36 peripheral fibers of, 437, fig 8.72
male, 353 Cochlear nucleus
Claudius cells see Cuboid external supporting cells anterior, 554, fig 9.42
Clavicle, 4-5, fig 1.3, 12, fig 2.2, 49, 149 posterior, 554, fig 9.42
acromial end of, 12, fig 2.2 Cochlear window, 433, fig 8.68, 435, fig 8.70
acromioclavicular joint, 12 Colic flexure
body of, 12, fig 2.2 left, 236, fig 6.11, 238, fig 6.12, 240, fig 6.14, 248,
conoid tubercle of, 12, fig 2.2 fig 6.20, fig 6.25, 559
function of, 12, fig 2.2 related liver, 248, fig 6.20
shaft of, 12, fig 2.2 right, 222, 236, fig 6.11, 240, fig 6.14, 248-249,
sternal articular surface of, 12, fig 2.2 fig 6.20, 254, fig 6.25
sternal end of, 12, fig 2.2 related liver, 248, fig 6.20
trapezoid line of, 12, fig 2.2 Colic impression of spleen, 246, fig 6.18
Clinoid process Colic lymph nodes, 266, fig 6.32
anterior, 369-371, fig 8.11, 376, fig 8.18 Collateral artery of arm and shoulder
posterior, 369, fig 8.11, 376, fig 8.18 inferior ulnar collateral artery, 44, fig 2.25, 51,
Clitoris, 316, 318 fig 2.32
crus of, 317, fig 7.12, 331, fig 7.21, 338 middle, 45, fig 2.26, 51, fig 2.32, 51, fig 2.32
deep artery of, 339, fig 7.26 radial, 44-45, fig 2.25-2.26, 51, fig 2.32
deep veins of, 340, fig 7.27 superior ulnar collateral artery, 44-45,
dorsal, 311, fig 7.8, 341, fig 7.28 fig 2.25-2.26, 51, fig 2.32
glans of, 337-338, fig 7.25 Collateral interphalangeal ligaments, 36, fig 2.20
prepuce of, 337-338, fig 7.25 Collateral ligament(s)
Clivus of occipital bone, 369, fig 8.11 of ankle joint
Cluneal nerve(s) 103, fig 3.33 lateral, 92-93, fig 3.24-3.25
inferior, 104-105, fig 3.34 medial, 92, fig 3.24-3.25
medial, 104-105, fig 3.34 of elbow
superior, 104-105, fig 3.34 radial, 24-25
Coccygeal horns, 129 ulnar, 24-25
Coccygeal nerve, 107, fig 3.36, 524, fig 9.22 of wrist and hand, 33-37, fig 2.18-2.20
Coccygeal region, 114, fig 4.1 ulnar, 35
Coccygeal venous plexus Collateral metacarpophalangeal ligaments, 34,
of female pelvis, 345-346, fig 7.31 fig 2.18, 36, fig 2.20
of male pelvis, 344-345 accessory, 36-37, fig 2.20
Index 575
Collateral metacarpophalangeal ligaments Condyle(s)
(continued) (continued)
ascending, 235-236, fig 6.10-6.11, 238, fig 6.12, of fibula
240, fig 6.14, 242, 243, fig 6.16, lateral, 75, fig 3.11
267-268, fig 6.33 medial, 75, fig 3.11
descending, 235-236, fig 6.10-6.11, 240, of humerus, 13-14, fig 2.3-2.4
fig 6.14, 242, 267-268, fig 6.33 of tibia
haustra of, 267-268, fig 6.33 lateral, 74-75, fig 3.10
semilunar folds of, 267-278, fig 6.33 medial, 74-75, fig 3.10
sigmoid, 235-236, fig 6.11, 267-269, Confluence of sinuses, 520, fig 9.19, 521-522, fig 9.21
fig 6.33-6.34 Conjunctival fornix
transverse, 235-236, fig 6.10-6.11, 238-239, inferior, 423, fig 8.58
fig 6.12-6.13, 240, 243, fig 6.16, 248, superior, 423, fig 8.58
fig 6.20, 267-268, fig 6.33 Connective tissue layer of eyeball, 420, fig 8.55
related liver, 248, fig 6.20 Conoid tubercle of clavicle, 12, fig 2.2
Colliculus Conus arteriosus, 175, fig 5.21, 197, fig 5.37,
inferior of brainstem, 505, fig 9.8, 507, fig 9.10, 204-205, fig 5.42, 209, fig 5.45
539-540, fig 9.32 Conus elasticus, 465, fig 8.92, 470
seminal, 329-330, fig 7.20, 335, fig 7.23 Coracoacromial ligament, 17-18, fig 2.7-2.8
superior of brainstem, 507, fig 9.10, 539-540, Coracobrachialis muscle, 19-20, fig 2.9
fig 9.32 Coracohumeral ligament, 17-18, fig 2.7-2.8
Colon, 267-268, fig 6.33 Coracoid process of scapula, 15, fig 2.5
Commissural fibers, 500, fig 9.5 Cornea, 419-421, fig 8.54-8.55, 423-424, fig 8.58
Common bile duct see porta hepatis Corneoscleral junction, 420, fig 8.55
Common bony limb of bony labyrinth, 435, Corniculate articular surface of arytenoid
fig 8.70 cartilage, 466, fig 8.93
Common carotid artery, 144, fig 4.18 Corniculate cartilage, 466, fig 8.93
Common digital arteries Corniculate tubercle, 453, fig 8.85, 465, fig 8.92
palmar, 56, fig 2.37 Corona ciliaris, 420-421, fig 8.56
Common facial vein, 446, fig 8.80 Corona of glans, 334-335
Common fibular division of sciatic nerve, Coronal plane, 2, fig 1.1
342-343, fig 7.29 Coronal suture, 360-361, fig 8.3, 363, fig 8.5
Common fibular nerve, 105, 107, 109-110, fig 3.38 Coronal venous plexus, 531, fig 9.27
Common hepatic artery, 177, fig 5.22, 226, Coronary arteries, 212-213, fig 5.47, 215
fig 6.3, 239, fig 6.13, 257-258, fig 6.27, left, 212-213, fig 5.47
285-289, fig 6.44-6.46, 285-287, anterior interventricular, 197, fig 5.37, 212,
fig 6.44-6.45, 289, fig 6.46 213, fig 5.47
Common iliac artery, 131, fig 4.13, 275, fig 6.37 circumflex artery of heart, 213
left, 241, fig 6.15 marginal branch, 212, fig 5.47
right, 241, fig 6.15 right, 197, fig 5.37, 212, fig 5.47
Common membranous limb of membranous atrial branches of, 212-213, fig 5.47
labyrinth, 436, fig 8.71 atrioventricular nodal branch, 213
Common tendinous ring (of Zinn), 418, fig 8.53 conal branch of, 212-213, fig 5.47
Communicating artery(ies) interventricular
anterior, 397-398, fig 8.36-8.37, 515-518, inferior/posterior, 213, fig 5.47
fig 9.15-9.17 right marginal branch of, 213, fig 5.47
posterior, 397-398, fig 8.36-8.37, 515-518, right inferolateral branch of, 213
fig 9.15-9.17 sinuatrial nodal branch of, 212-213, fig 5.47
Complex synovial joint of knee, 77-81, fig 3.12-3.16 ventricular branches of, 213
Components of basal nuclei, 502 Coronary circulation, 212, fig 5.47
Compressor urethrae muscle, 338 Coronary ligament of liver, 239, 249-250
Conal branch of right coronary artery, 212-213, anterior part of, 250-252, fig 6.21, fig 6.23
fig 5.47 posterior part of, 251-252, fig 6.22-6.23
Concha of ear, 430-431, fig 8.65-8.66 Coronary sinus, 201-206, fig 5.40-5.41, fig 5.43,
Conduction system of heart, 215, fig 5.49 210, fig 5.46, 212-213, fig 5.47
atrioventricular bundles (of His), 215-216, fig 5.49 orifice of, 203, fig 5.41
left, 215-216, fig 5.49 valve of, 203, fig 5.41
right, 215-216, fig 5.49 Coronary sulcus, 200-201, fig 5.39, 204, fig 5.42,
atrioventricular (AV) node, 215-216, fig 5.49 209, fig 5.45, 217
sinuatrial (SA) node, 215-216, fig 5.49 Coronoid fossa of humerus, 13-14, fig 2.3
subendocardiac (Purkinje) fibers, 215-216, Coronoid process of mandible, 380, fig 8.22
fig 5.49 Coronoid process of ulna, 23, fig 2.10, 26, fig 2.13
Condylar fossa of occipital bone, 366, fig 8.8 Corpus albicans, 314, fig 7.11
Condylar process of mandible, 380, fig 8.22, 402, Corpus callosum, 493, fig 9.1, 496, 500, fig 9.5,
fig 8.40 503, fig 9.7, 517-518, fig 9.17
Condyle(s) Corpus cavernosum
of femur of clitoris, 339
lateral, 66-67, fig 3.5-3.6, 80 of penis, 329-330, fig 7.20, 334-335,
medial, 66-67, fig 3.5-3.6, 80 fig 7.22-7.23

Corpus cavernosum Cranial nerve(s)
tunica albuginea of, 329, fig 7.20, 335, fig 7.23 CN V1 - ophthalmic, 412, fig 8.47, 414, fig 8.49,
of testis, 323-325, fig 7.16-7.17 416, fig 8.51, 533-535, fig 9.28-9.29,
Corpus luteum, 314, fig 7.11 543-544, fig 9.35, 549, fig 9.39
Corpus of uterus, 313-315, fig 7.10-7.11 branches of, 394, fig 8.33, 544
Corpus spongiosum of penis, 329-330, fig 7.20, function of, 544
333-335, fig 7.22-7.23 structure and features, 544
Corrugator supercilii muscle, 383, fig 8.25, 385 tentorial branch of, 544, fig 9.35
Cortex of kidney see renal cortex, 277-278, CN V2 - maxillary, 393, 405, fig 8.42, 412,
fig 6.39-6.40 fig 8.47, 414-416, fig 8.49, fig 8.51,
Costal facets 533-535, fig 9.28-9.29, 545, fig 9.36,
of thoracic vertebrae 549, fig 9.39, 551, fig 9.40, 566, fig 9.49
inferior, 124, fig 4.9, 151, 155, fig 5.7 branches of, 547
superior, 124, fig 4.9, 151, 155, fig 5.7 branches to pterygopalatine ganglion, 545,
Costal impressions fig 9.36
on right lung, 189-191, fig 5.32-5.33 function of, 547
Costocervical trunk, 44-45, fig 2.24-2.26, 398, meningeal branch of, 545, fig 9.36
fig 8.37, 475 structure and features, 546
Costocorporeal joints of thoracic spine, 125, 154 CN V3 - mandibular Mandibular nerve (CN V3),
Costodiaphragmatic recess, 160, 192-193, fig 5.34 393, 533-535, fig 9.28-9.29, 545,
Costomediastinal recess, 192-193 fig 9.36, 547-550, fig 9.38-9.39, 552,
left, 160, 198, fig 5.38 fig 9.41, 566, fig 9.49
right, 160, 198, fig 5.38 anterior division of, 548-549, fig 9.38-9.39
Costotransverse joint, 154 auriculotemporal nerve branch of, 431,
Cranial as term of relationship, 2, fig 1.1 fig 8.66
Cranial cavity, 6-7, fig 1.5-1.6 branches of, 550
Cranial dura mater, 511, fig 9.13 function of, 550
meningeal layer of, 511, fig 9.13 meningeal branch of, 366, 548-549,
Cranial fossa(e), 367-368, fig 8.10 fig 9.38-9.39
anterior, 368, fig 8.10 motor branches of, 394, fig 8.33
middle, 368, fig 8.10 posterior division of, 548-549, fig 9.38-9.39
posterior, 368, fig 8.10 structure and features, 549
Cranial meninges, 511-512, fig 9.13 tensor tympani of, 434
arachnoid mater, 511-512, fig 9.13 CN VI - abducens, 416, fig 8.51, 412, fig 8.47,
definition of, 512 533-535, fig 9.28-9.29, 540, 542-543,
dura mater, 511-512, fig 9.13 fig 9.34
function of, 512 brainstem, 506, fig 9.9
pia mater, 511-512, fig 9.13 common tendinous ring of Zinn, 418, fig 8.53
Cranial nerve(s) function of, 540, 543
CN I - olfactory, 429, fig 8.64, 429, fig 8.64, nerves of orbit, 416, fig 8.51
533-535, fig 9.28-9.29, 536-537, nucleus of, 542, fig 9.34
fig 9.30-9.31 CN VII - facial, 393, fig 8.32, 395, fig 8.34,
function of, 537 429, fig 8.64, 433-434, fig 8.68, 436,
olfactory pathway, 536, fig 9.30 fig 8.71, 446, fig 8.80, 506, fig 9.9, 531,
CN II - optic nerve, 412, fig 8.47, 416, fig 8.51, fig 9.27-9.29, 533-535, fig 9.28-9.29,
418-420, fig 8.53-8.54, 422, 533-535, 550-553, fig 9.40-9.41, 552,
fig 9.28-9.29, 538-540, fig 9.32, 544, fig 9.41-9.42, 554, 566, fig 9.49
fig 9.35 buccal branches of, 393, fig 8.32, 395,
sheath of, 418, fig 8.53 fig 8.34, 446, fig 8.80, 552, fig 9.41
CN III - oculomotor, 412, fig 8.47, 414-416, cervical branch of, 393, fig 8.32, 395, fig 8.34,
fig 8.49-8.51, 533-535, fig 9.28-9.29, 552, fig 9.41
540-541, fig 9.33 communicating branch with
branch to ciliary ganglion, 541, fig 9.33 glossopharyngeal nerve, 556, fig 9.43
function of, 540, 542 digastric branch of, 552, fig 9.41
inferior branch of, 414, fig 8.49, 418, fig 8.53, functions of, 550, 552, fig 9.41
541, fig 9.33 marginal mandibular branch of, 393, fig 8.32,
superior branch of, 414, fig 8.49, 418, 395, fig 8.34, 552, fig 9.41
fig 8.53, 541, fig 9.33 motor root of, 551, fig 9.40
CN IV - trochlear, 412, fig 8.47, 416, fig 8.51, 507, parts and branches, 552, fig 9.41
fig 9.10, 533-535, fig 9.28-9.29, 540, posterior auricular nerve branch of, 394,
542-543, fig 9.34 fig 8.33
function of, 540 sensory root of, 551, fig 9.40, 566, fig 9.49
nucleus of, 542, fig 9.34 structures and features, 552, fig 9.41
CN V - trigeminal, 393, 412, fig 8.47, 414, stylohyoid branch of, 552, fig 9.41
fig 8.49, 429, fig 8.64, 506, fig 9.9, 522, temporal branches of, 393, fig 8.32, 395,
fig 9.21, 533-535, fig 9.28, 543-545, fig 8.34, 446, fig 8.80, 552, fig 9.41
fig 9.35-9.36, 566, fig 9.49 zygomatic branches of, 394, fig 8.33, 552,
spinal nucleus of, 560, fig 9.45 fig 9.41
Index 577
Cranial nerve(s) Craniovertebral ligaments
(continued) midsagittal view, 122, fig 4.8
CN VIII - vestibulocochlear, 433, fig 8.68, 533, Cremasteric fascia, 325, fig 7.17
fig 9.28-9.29, 533-535, fig 9.28-9.29, Cremaster muscle, 224, 229
553-555, fig 9.42, 554, fig 9.42 Crest of pubis, 300-303, fig 7.1a-7.3
cochlear nerve(s), 552, fig 9.41, 554, fig 9.42 Crests of sacrum
function of, 552, fig 9.41, 555 intermediate, 128-129
structure and features, 555 lateral, 128-129
vestibular nerve(s), 552, fig 9.41, 554, fig 9.42 median, 128-129
CN IX - glossopharyngeal, 434, 457-458, Cribriform plate of ethmoid bone, 368-369,
fig 8.88, 474, 477, fig 8.103, 506, fig 9.9, fig 8.11, 371, fig 8.13, 373, fig 8.15
533-535, 556-558, fig 9.43-9.44, 560, Cricoarytenoid joint
fig 9.45, 566, fig 9.49 capsule of, 465, fig 8.92
branches of, 556, fig 9.43 Cricoarytenoid muscle
communicating branch with auricular lateral, 466, fig 8.93, 469-470, fig 8.96
branch of vagus nerve, 556, fig 9.43 posterior, 466, fig 8.93
functions of, 556, fig 9.43 Cricoid cartilage, 464-465, fig 8.91-8.92,
inferior ganglion of, 556, fig 9.43, 566, fig 9.49 466-471, fig 8.93-8.97, 184, 455
of tongue, 556-557, fig 9.43-9.44 arch of, 466, fig 8.93
structure of, 556, fig 9.43 lamina of, 466-467, fig 8.93, 469, fig 8.96
superior ganglion of, 556, fig 9.43 thyroid articular surface of, 465, fig 8.92
CN X - vagus, 442, 457-458, fig 8.88, 474, Cricopharyngeal part of inferior pharyngeal
477, fig 8.103, 489, fig 8.113, 506, constrictor muscle, 454, fig 8.86
fig 9.9, 531, fig 9.27-9.28, 533-535, Cricothyroid joint
fig 9.28-9.29, 559-562, fig 9.45-9.46, capsule of, 466, fig 8.93
563, fig 9.47, 566, fig 9.49 Cricothyroid ligament, 471, fig 8.98
branches of, 561, fig 9.46 median, 184, fig 5.27, 464-467, fig 8.91, fig 8.93,
functions of, 559, 561, fig 9.46 470, 561
inferior ganglion of, 457-458, fig 8.88, 563, Cricothyroid muscle, 464, fig 8.91, 466, fig 8.93, 470
fig 9.47, 566, fig 9.49 Cricotracheal ligament, 466, fig 8.93, 471, fig 8.98
left, 197, fig 5.37, 214, fig 5.48 Crista galli of ethmoid bone, 369-370,
right, 196, fig 5.36, 214, fig 5.48, 478, fig 8.11-8.12, 372-373, fig 8.14-8.15
fig 8.104, 484, fig 8.110 Crista terminalis, 203-204, fig 5.41
structure of, 561, fig 9.46 Crown of tooth, 451, fig 8.83
superior ganglion of, 563, fig 9.47 Cruciform ligaments
CN XI - accessory, 474, 506, fig 9.9, 533, longitudinal bands of, 122, fig 4.8
fig 9.28, 533-535, 560, fig 9.45, of atlantoaxial joint, 121, 123
563-564, fig 9.47, 563, fig 9.47 of fingers, 34, fig 2.18, 37
branches of, 564 Crus (crura)
cranial root of, 563, fig 9.47 cerebri, 505, fig 9.8
foramina of the skull, 366 of antihelix of ear
functions of, 563-564 anterior, 431, fig 8.66
nerves of pharynx (CN XI), 457-458, fig 8.88 posterior, 431, fig 8.66
neurovasculature of the neck, 478, fig 8.104 of clitoris, 317, fig 7.12, 331, fig 7.21, 338
pathway of, 563, fig 9.47 of diaphragm
spinal root of, 563, fig 9.47 left, 226-227, fig 6.3
structure and features of, 564 right, 226-227, fig 6.3, 239
triangles of the neck, 484, fig 8.110 of penis, 329, fig 7.20, 333-335, fig 7.22-7.23
CN XII - hypoglossal, 442, 445, fig 8.79, Crypt of lingual tonsil, 441, fig 8.76
457-458, fig 8.88, 474, 477, fig 8.103, Cubital anastomosis, 50-51, fig 2.31
479, fig 8.105, 485, 506, fig 9.9, 533, Cubital fossa, 4-5, 11, fig 2.1, 52
fig 9.28-9.29, 533-535, 560, 564-565, Cubital region
fig 9.48 anterior, 11
branches of, 565 posterior, 11
function of, 564-565 Cubital vein
geniohyoid branch of, 479, fig 8.105, 565 median, 52, fig 2.33
nucleus of, 565, fig 9.48 Cuboid external supporting cells (Claudius cells),
of tongue, 565, fig 9.48 438, fig 8.73
structure and features of, 565, fig 9.48 Cuneate fasciculus, 507, fig 9.10
thyrohyoid branch of, 479, fig 8.105, 565 Cuneate tubercle, 507, fig 9.10
Cranial nerves, 532-534, fig 9.28-9.29, 537 Cuneiform tubercle, 453, fig 8.85, 465, fig 8.92
definition of, 533, fig 9.28 Cutaneous nerve
functions of, 534, fig 9.29 antebrachial
nerve fiber terminology, 532 lateral, 54, fig 2.35
nerve fiber types/modalities, 532 anterior branch of, 54, fig 2.35
Cranial nerves of neck posterior branch of, 54-55, fig 2.35-2.36
accessory (CN XI), 474 medial, 43, fig 2.24, 48-50, fig 2.29-2.30
glossopharyngeal (CN IX), 474 anterior branch of, 54, fig 2.35
hypoglossal (CN XII), 474 posterior branch of, 54-55, fig 2.35-2.36
vagus (CN X), 474 posterior, 49, fig 2.30, 55, fig 2.36

Cutaneous nerve Deltoid tubercle of scapula, 16, fig 2.6
(continued) Dens of axis, 120-121, fig 4.6, 123
brachial Dental arteries, 451, fig 8.83
inferior lateral, 48-49, fig 2.29-2.30 Dental nerves, 451, fig 8.83
medial, 43, fig 2.24, 48-50, fig 2.29-2.30 Dental plexus
posterior, 49-50, fig 2.30 inferior, 548, fig 9.38, 549
superior lateral, 48-50, fig 2.29-2.30 superior, 545, fig 9.36
femoral Dental veins, 451, fig 8.83
lateral, 103, fig 3.33, 105, 283-284, fig 6.43 Dentin of teeth, 451, fig 8.83
posterior, 104-105, fig 3.34, 107, fig 3.36, Depressor anguli oris muscle, 381, 383-384,
342-343, fig 7.29 fig 8.25
of arm Depressor labii inferioris muscle, 383-384, fig 8.25
medial, 43 Depressor supercilii muscle, 383, 385
of foot Descending colon, 235-236, fig 6.10-6.11, 240,
intermediate dorsal, 112 fig 6.14, 242, 267-268, fig 6.33
lateral dorsal, 107, fig 3.36, 111, fig 3.40 Descending genicular artery, 103-104, fig 3.33,
medial dorsal, 112 106
of forearm Descending part of duodenum, 240-241,
medial, 43 fig 6.14-6.15, 254-258, fig 6.25-6.27,
perforating, 342-343, fig 7.29 291
sural Detrusor vesicae muscle, 330-331, fig 7.21
lateral, 110 Diaphragm, 173-175, fig 5.19-5.21, 180-181,
medial, 110 fig 5.25,192, fig 5.34, 226-227, fig 6.3
Cutaneous nerve of foot abdominal surface of, 227
intermediate dorsal, 112 blood supply of, 226-227, fig 6.3
lateral dorsal, 107, fig 3.36, 111, fig 3.40 central tendon of, 198, fig 5.38, 226, fig 6.3
medial dorsal, 112 crus of
Cymba of ear, 431, fig 8.66 left, 226-227, fig 6.3
Cystic artery, 251-253, fig 6.22-6.23, 285-286, right, 226-227, fig 6.3, 239
fig 6.44 function of, 227
Cystic duct, 251-252, fig 6.22, 286 innervation of, 160, 479
Cystic lymph node, 290, fig 6.47, 292, 294, fig 6.49 lymphatics of, 182, fig 5.26
musculotendinous structures of, 226-227,
D fig 6.3
Danger space (of Grodinsky), 486, 488, fig 8.112 openings of, 227
Dartos fascia parts of, 227
of scrotum, 325, fig 7.17 pelvic, 308-309, 321, 332, 336-338
Decussation of pyramids, 506, fig 9.9, 508 related heart, 198, fig 5.38
Deep artery of clitoris, 339, fig 7.26 related liver, 250, fig 6.21
Deep artery of penis, 329, fig 7.20, 335, fig 7.23 thoracic surface of, 160-161, fig 5.10
Deep brachial artery, 14, 44-45, fig 2.25-2.26, 50 Diaphragmatic lymph nodes
Deep cervical artery, 144, fig 4.18, 398, fig 8.37 inferior, 296-297, fig 6.50, 351, fig 7.34
Deep cervical lymph nodes, 194, fig 5.3 superior, 182, fig 5.26
Deep cervical vein, 144, fig 4.18, 476 Diaphragmatic part of parietal pleura, 160,
Deep circumflex iliac artery, 103-104, fig 3.33 fig 5.10, 192, fig 5.34
Deep facial vein, 390-392, fig 8.29, fig 8.31, Diaphragmatic surface of heart see inferior
406-407, fig 8.44 (diaphragmatic) surface of heart
Deep fascia of penis (Buck’s fascia), 334-335, Diaphragmatic surface of liver, 241, fig 6.15
fig 7.22-7.23 Diaphragmatic surface of spleen, 246, fig 6.18
intercavernous septum of, 334, fig 7.22 anterior extremity, 246, fig 6.18
Deep femoral artery, 103-104, fig 3.33, 106, inferior border, 246, fig 6.18
fig 3.35 posterior extremity, 246, fig 6.18
Deep fibular nerve, 84, 107-108, fig 3.37, 110, 112 superior border, 246, fig 6.18
Deep head of medial pterygoid muscle, 399, Diencephalon, 502-503, fig 9.7
fig 8.38 epithalamus, 502-503, fig 9.7
Deep infrapatellar bursa of the knee, 81, fig 3.16 hypothalamus, 502-503, fig 9.7
Deep lingual artery, 445, fig 8.79 subthalamus, 502-503, fig 9.7
Deep lingual vein, 445, fig 8.79 thalamus, 493, fig 9.1, 502-503, fig 9.7, 507, 518,
Deep palmar arch, 56, fig 2.37 539-540, 566
recurrent branches of, 56, fig 2.37 Digastric fossa of mandible, 382, fig 8.24, 462
Deep parotid lymph nodes, 481, fig 8.107 Digastric muscle, 382, 394, 460, fig 8.90, 460,
Deep part of masseter muscle, 399, fig 8.38 fig 8.80, 470, 483, fig 8.109, 485
Deep plantar artery, 112 Digital artery(ies) of hand
Deep transverse ligament, 37 dorsal, 57, fig 2.38
Deep veins of clitoris, 340, fig 7.27 palmar
dorsal, 311, fig 7.8, 341, fig 7.28 radial, 56, fig 2.37
Deferential plexus ulnar, 56, fig 2.37
of male, 344-345, fig 7.30 Digital nerve(s) of foot
Deltoid muscle, 4-5, fig 1.3, 13, 19-20, fig 2.9 dorsal, 111, fig 3.40
Deltoid region, 10, fig 2.1, 114, fig 4.1 proper plantar, 111, fig 3.40
Index 579
Digital vein(s) of hand Duodenum
dorsal, 58, fig 2.40 (continued)
palmar, 58, fig 2.40 recesses of, 235
Dilator pupillae muscle, 420, fig 8.55 related gallbladder, 253, fig 6.24
Diploe, 363, fig 8.5 related liver, 248-249, fig 6.20
Diploic veins, 511, fig 9.13 related pancreas, 254-255, fig 6.25
Directional terms of the brain, 493, fig 9.1 superior part of, 235, 244, fig 6.17, 248, fig 6.20,
Distal as term of relationship, 2, fig 1.1 254-256, fig 6.26, 257-258, fig 6.27
Distal end of femur, 67, fig 3.6 venous drainage of, 262
intercondylar fossa, 67, fig 3.6 wall of, 257
intercondylar line, 67 Dural venous sinuses, 512, 519, 521, 522-523,
patellar surface, 66, fig 3.5 fig 9.21
Distal end of ulna, 22-24, fig 2.10-2.11 paired venous sinuses, 523
Distal part of duodenum, 235 unpaired venous sinuses, 523
Distal phalanx of hand, 31, fig 2.16 Dura mater of cranial meninges, 511-512, fig 9.13
Dorsal artery of penis, 347, fig 7.32 Dura mater of spinal meninges, 526, fig 9.24, 528,
Dorsal as term of relationship, 2, fig 1.1 fig 9.25, 536, fig 9.30
Dorsal cutaneous nerve of foot, 112
intermediate, 112 E
lateral, 107, fig 3.36, 111, fig 3.40 Ear
medial, 112 anterior crus of, 431, fig 8.66
Dorsal digital branches, 112 antihelix of, 430-431, fig 8.65-8.66
Dorsal digital nerves of foot, 111, fig 3.40 crura of, 431, fig 8.66
Dorsalis pedis artery, 109, 111-112, fig 3.39 external ear, 430-431, fig 8.65-8.66
Dorsal metatarsal arteries, 111, fig 3.39 internal ear, 435-438, fig 8.70-8.73
Dorsal nerve of clitoris, 341, fig 7.28 middle ear, 432-434, fig 8.67-8.69
Dorsal nerve of penis, 344-345, fig 7.30 Efferent ductules of testis, 323, fig 7.16
Dorsal radial tubercle of radius, 23-24, fig 2.11 Ejaculatory duct opening, 329, fig 7.20, 335,
Dorsal scapular artery, 45, fig 2.26 fig 7.23
Dorsal vein Elbow and forearm, 3, 10, fig 2.1, 20, 22-30,
deep fig 2.10-2.15
of clitoris, 311, fig 7.8 bones of, 22-24, fig 2.10-2.11
of penis, 347, fig 7.32 elbow joint, 25-26, fig 2.12-2.13
Dorsum sellae, 369, fig 8.11, 376, fig 8.18 muscles of, 27-30, fig 2.14-2.15
Duct of Santorini see Accessory pancreatic duct neurovasculature of, 44-49, fig 2.25-2.30
(of Santorini) Elbow as region, 10, fig 2.1
Duct of Wirsung see Pancreatic duct (of Wirsung) Elbow joint, 25-26, fig 2.12-2.13
Ductus deferens, 228-229, fig 6.4, 321-325, articular capsule of, 25, fig 2.12
fig 7.15-7.17 bones of, 25-26, fig 2.12-2.13
artery of, 325, fig 7.17 joint of, 25-26, fig 2.12-2.13
right, 321, fig 7.15 ligaments of, 25-26, fig 2.12
Ductus reuniens (of Hensen), 436, fig 8.71 movements of, 26, fig 2.13
Duodenal flexure Emissary veins, 366, 379, 511, fig 9.13
inferior, 256-258, fig 6.26-6.27 Enamel of teeth, 451, fig 8.83
superior, 256-258, fig 6.26-6.27 Endocrine system
Duodenal papilla pancreas, 254-255, fig 6.25
major, 253, fig 6.24, 256-258, fig 6.26-6.27 Endolymph, 435-437
minor, 256-258, fig 6.26-6.27 Endometrium, 313-315, fig 7.11
Duodenal recesses, 235 Enteric nervous system, 263-264, fig 6.31, 272
Duodenojejunal flexure, 248, fig 6.20, 256-260, of anal canal, 276
fig 6.26-6.28 of rectum, 276
related liver, 248, fig 6.20 Enteric plexus (of Auerbach)
Duodenum, 222, 243, fig 6.16, 248, fig 6.20, of anal canal, 276
257-258, fig 6.27, 259, fig 6.28, 261-262 of rectum, 276
arterial supply of, 262, 287-288, fig 6.45 Epicondyle(s)
ascending part of, 241, fig 6.15, 254-258, of femur
fig 6.25-6.27 lateral, 66-67, fig 3.5-3.6
descending part of, 240-241, fig 6.14-6.15, medial, 66-67, fig 3.5-3.6
254-258, fig 6.25-6.27 of humerus
distal part of, 235 lateral, 13-14, fig 2.3, 20, 25, fig 2.12, 28-30
horizontal part of, 235, fig 6.10, 241, fig 6.15, medial, 13-14, fig 2.3, 25, fig 2.12, 28-30
248, fig 6.20, 254-258, fig 6.25-6.27 Epicranial aponeurosis, 383, fig 8.25, 385-386
related liver, 248, fig 6.20 Epididymis, 323-324, fig 7.16
lymphatics of, 266, fig 6.32, 290-291, fig 6.47, body of, 323-324, fig 7.16
297 function of, 324
muscular coat of head of, 323-324, fig 7.16
circular layer of, 257, fig 6.27 tail of, 323-324, fig 7.16
longitudinal layer of, 244, fig 6.17 Epidural space, 511-512, 526-529, fig 9.25, 531

Epigastric artery Ethmoidal cells, 372-373, fig 8.14-8.15
inferior, 106, fig 3.35, 228-229, fig 6.4, 230-231, Ethmoidal foramina
fig 6.5-6.6, 233, fig 6.8, 236, fig 6.11, anterior, 408, fig 8.45
311-312, fig 7.8 posterior, 408, fig 8.45
cutaneous branches of, 230, fig 6.5 Ethmoidal nerve
superficial, 104, 106, fig 3.35, 230-231, fig 6.5 anterior, 415, fig 8.50, 429, fig 8.64, 544,
superior, 230-231, fig 6.5-6.6, 233, fig 6.8 fig 9.35
cutaneous branches of, 230, fig 6.5 external nasal branch of, 393, fig 8.32, 395,
Epigastric region, 221-222, fig 6.1 fig 8.34, 429, fig 8.64
Epigastric vein lateral nasal branches of, 429, fig 8.64
inferior, 228, fig 6.4, 231, fig 6.6, 233, fig 6.8, medial nasal branches of, 429, fig 8.64
236, fig 6.11, 311, fig 7.8 posterior, 415, fig 8.50, 544, fig 9.35
cutaneous tributaries of, 231, fig 6.6 Ethmoidal vein
superficial, 231, fig 6.6 anterior, 413, 428, fig 8.63
superior, 231, fig 6.6, 233, fig 6.8 anterior septal branches of, 428, fig 8.63
cutaneous tributaries of, 231, fig 6.6 anterior lateral nasal branches of, 428,
thoracoepigastric vein, 231, fig 6.6 fig 8.63
Epiglottic cartilage, 466, fig 8.93 posterior, 413, 428, fig 8.63
Epiglottic vallecula, 440, fig 8.75 lateral nasal branch of, 428, fig 8.63
Epiglottis, 440, fig 8.75, 453, fig 8.85, 459, septal branches of, 428, fig 8.63
fig 8.89, 464, fig 8.91, 465, fig 9.92, 470 Eustachian tube see auditory tube
stalk of, 466, fig 8.93 (Eustachian tube)
Epiploic foramen (of Winslow), 239 Exocrine system
Epithalamus, 502-503, fig 9.7 pancreas, 255
function of, 503, fig 9.7 Extensor carpi radialis brevis muscle, 29, fig 2.15
location of, 503, fig 9.7 Extensor carpi radialis longus muscle, 29, fig 2.15
Epitympanic recess, 432-433, fig 8.67-8.68 Extensor digiti minimi muscle, 29-30, fig 2.15
Epoophoron, 313, fig 7.10 Extensor digitorum longus muscle, 82, fig 3.17
vesicular appendage of, 313, fig 7.10 Extensor digitorum muscle, 29-30, fig 2.15
Equatorial branches, 131 Extensor hallucis longus muscle, 82, fig 3.17
Erector spinae muscles, 137 Extensor indicis muscle, 29-30, fig 2.15
Esophageal hiatus, 160-161, 181, 226-227, fig 6.3 Extensor pollicis brevis muscle, 29-30, fig 2.15
Esophageal plexus, 179-181, 561, fig 9.46 Extensor pollicis longus muscle, 29-30, fig 2.15
Esophagus, 179-181, fig 5.25, 198, fig 5.38, 222, Extensor retinaculum of wrist, 37
226-227, 235, fig 6.10, 243-244, External acoustic meatus, 361, fig 8.3, 379, 395,
fig 6.16-6.17, 453, fig 8.85, 454, 401, fig 8.40
fig 8.86, 489, fig 8.113 External capsule of cerebral cortex, 500, fig 9.5
abdominal, 241, fig 6.15 External ear, 430, fig 8.65
Ethmoidal artery auricle, 430, fig 8.65
anterior, 413, fig 8.48, 427, fig 8.62 blood supply of, 431, fig 8.66
anterior lateral nasal branches, 427, fig 8.62 external acoustic meatus, 430, fig 8.65
anterior septal branches of, 427, fig 8.62 function of, 431, fig 8.66
external nasal branches of, 427, fig 8.62 innervation of, 431, fig 8.66
posterior, 413, fig 8.48, 427, fig 8.62 muscles of, 431, fig 8.66
lateral nasal branches of, 427, fig 8.62 parts of, 431, fig 8.66
septal branches of, 427, fig 8.62 External iliac artery, 103, 104, 106, 131, fig 4.13,
Ethmoid bone, 360, fig 8.2, 367, fig 8.9, 370-371, 233, fig 6.8, 269, fig 6.34, 275, fig 6.37,
372-373, fig 8.12-8.13, fig 8.14-8.15, 281, fig 6.42, 311, fig 7.8
425-426, fig 8.60 female, 317, fig 7.12
articulating bones of, 373, fig 8.15 left, 241, fig 6.15
bones of orbit, 408, fig 8.45 male, 347-350, fig 7.32-7.33
cribriform plate of, 369, fig 8.11, 371, fig 8.13, External iliac vein, 231, 269, fig 6.34, 276, fig 6.38,
426, fig 8.61, 536, fig 9.30 311, fig 7.8
crista galli of, 369-370, fig 8.11-8.12, 372-373, female, 316, fig 7.12
fig 8.14-8.15 male, 347, fig 7.32
landmarks of, 373, fig 8.15 External occipital crest, 365, fig 8.7
location of, 373, fig 8.15 External occipital protuberance, 5, 118, 122,
nasal bones, 425-426, fig 8.60-8.61 fig 4.8, 365, fig 8.7, 362, fig 8.4, 371
nasal concha of ethmoid bone External orifice of urethra
inferior, 453, fig 8.85 female, 337, fig 7.25
middle, 371-373, fig 8.13-8.15, 424-425, male, 329, fig 7.20, 334-335, fig 7.22-7.23
fig 8.59-8.60, 453, fig 8.85 External pillar epithelial cell, 438, fig 8.73
superior, 371-373, fig 8.13-8.15 Extrahepatic duct system, 253, fig 6.24
orbital plate of, 360, fig 8.2, 373, fig 8.15, 408, Extraocular muscles see muscles of orbit
fig 8.45 Extraperitoneal organs
perpendicular plate of, 370, fig 8.12, 373, infraperitoneal, 234
fig 8.15, 426, fig 8.61 retroperitoneal, 234
Ethmoid bulla, 372-373, fig 8.14 Extraperitoneal space, 331, fig 7.21
Index 581
Extremities of spleen Facial vein(s)
anterior extremity of, 246, fig 6.18 (continued)
posterior extremity of, 246, fig 6.18 deep, 390, fig 8.29, 392, fig 8.31, 407, fig 8.44
Eyeball, 419-421, fig 8.54-8.56 lateral nasal branch of, 428, fig 8.63
accessory structures of, 423, fig 8.85 transverse, 391, fig 8.30
anterior chamber of, 420, fig 8.55 Falciform ligament of liver, 238, fig 6.12, 243,
arterial supply, 412-413, fig 8.47, 422, fig 8.57 fig 6.16, 249
blood vessels of, 422, fig 8.57 Fascia(e) of neck
chambers of, 420, fig 8.55 danger space (of Grodinsky), 486, 488,
connective tissue layer of, 420, fig 8.55 fig 8.112
fibrous layer (external tunic) of, 420, fig 8.55 pretracheal space, 486-488, fig 8.111
inner layer (internal tunic) of, 420, fig 8.55 retropharyngeal space, 486, 488
muscles of, 410-411, fig 8.46 Fascial bands, 37
nerves of, 414-416, fig 8.49-8.51 Fascial sheath of eyeball, 420, fig 8.55
refractive media of, 420, fig 8.55 Fat pad of elbow joint, 26, fig 2.13
vascular layer (middle tunic), 420, fig 8.55 Fat pads of the knee
venous drainage of, 412-413, fig 8.47, 422, fig 8.57 infrapatellar fat pad, 81, fig 3.16
Eyelids, 423, fig 8.58 suprapatellar (quadriceps) fat pad
function, 424, fig 8.59 anterior, 81, fig 3.16
layers of, 424, fig 8.59 suprapatellar (prefemoral) fat pad
secretions of, 424, fig 8.59 posterior, 81, fig 3.16
Female internal genitalia, 313-315, fig 7.10-7.11
F Female pelvic cavity
Face blood supply of, 311, fig 7.8
as a region, 359, fig 8.1 bones of, 310, fig 7.7
Facial artery(ies), 386-389, fig 8.26-8.27, 391, 396, digestive organs of, 310, fig 7.7
fig 8.35, 446, fig 8.80, 475, fig 8.101 innervation of, 311, 345-346, fig 7.31
branches of, 389 ligaments of, 310
lateral nasal branch of, 389, fig 8.28, 396, muscles of, 310, fig 7.7
fig 8.35, 427, fig 8.62 nerves of, 345-346, fig 7.31
transverse, 387, fig 8.26, 389, 446-447, fig 8.80 reproductive organs of, 310, fig 7.7
Facial expression urinary organs of, 310, fig 7.7
muscles of, 383-386, fig 8.25 Female pelvis, 309-320, fig 7.7-7.14
Facial lymph nodes of head and neck, 480, autonomic innervation of, 345-346, fig 7.31
fig 8.106, 482, fig 8.108 blood supply of, 311
anterior, 482, fig 8.108 digestive organs of, 310
lateral, 483 innervation of
Facial nerve (CN VII), 393, fig 8.32, 395, fig 8.34, parasympathetic, 311
429, fig 8.64, 433-434, fig 8.68, 436, sympathetic, 311
fig 8.71, 446, fig 8.80, 506, fig 9.9, 531, peritoneal pouches of, 311
fig 9.27-9.29, 533-535, fig 9.28-9.29, reproductive organs of, 310
550-553, fig 9.40-9.41, 552, somatic innervation of, 345-346, fig 7.31
fig 9.41-9.42, 554, 566, fig 9.49 urinary organs of, 310
buccal branches of, 393, fig 8.32, 395, fig 8.34, walls and floors of, 310
446, fig 8.80, 552, fig 9.41 Female pelvis see also individual female
cervical branch of, 393, fig 8.32, 395, fig 8.34, reproductive organs
552, fig 9.41 Female reproductive organs, 313-320,
communicating branch with glossopharyngeal fig 7.11-7.14
nerve, 556, fig 9.43 Female reproductive organs see also individual
digastric branch of, 552, fig 9.41 female reproductive organs
functions of, 550, 552, fig 9.41 Female urinary bladder, 331-332, fig 7.21
marginal mandibular branch of, 393, fig 8.32, Femoral artery, 103-104, fig 3.33-3.34, 106,
395, fig 8.34, 552, fig 9.41 fig 3.35, 228-230, fig 6.4-6.5, 347, 349
motor root of, 551, fig 9.40 branches of, 106, fig 3.35
parts and branches of, 552, fig 9.41 pathway of, 106, fig 3.35
posterior auricular nerve branch of, 394, perforating arteries, 106, fig 3.35
fig 8.33 Femoral cutaneous nerve
sensory root of, 551, fig 9.40, 566, fig 9.49 lateral, 103, fig 3.33, 105, 283-284, fig 6.43
structures and features, 552, fig 9.41 posterior, 104-105, fig 3.34, 107, fig 3.36,
stylohyoid branch of, 552, fig 9.41 342-343, fig 7.29
temporal branches of, 393, fig 8.32, 395, Femoral nerve, 62, 70, 72, 103, fig 3.33, 105, 110,
fig 8.34, 446, fig 8.80, 552, fig 9.41 283-284, fig 6.43
zygomatic branches of, 394, fig 8.33, 552, Femoral region, 62, fig 3.10
fig 9.41 Femoral triangle, 62, fig 3.10
Facial vein(s), 390, fig 8.29, 392, fig 8.31, 407, Femoral vein, 103-104, 109, fig 3.38, 228, fig 6.4
fig 8.44, 428, fig 8.63, 445-446, tributaries, 103, fig 3.33
fig 8.79-8.80, 473, fig 8.100, 476, Femur, 66-67, fig 3.5-3.6
fig 8.102 adductor tubercle of, 67, fig 3.6
common, 392, fig 8.31, 473, fig 8.100 condyles of, 66-67, fig 3.5-3.6

Femur Fibula
lateral tibiofibular joint types
medial, 66-67, fig 3.5-3.6 fibrous joint, 74
distal end of, 67, fig 3.6 plane synovial, 74
epicondyle(s) of syndesmosis, 74
lateral, 66-67, fig 3.5-3.6 Fibular artery, 109-110, fig 3.38
medial, 66-67, fig 3.5-3.6 Fibular nerves, 108-110, fig 3.37-3.38
fovea of, 66-67, fig 3.5-3.6 deep, 109-110, fig 3.37- 3.38, 112
gluteal tuberosity of, 67, fig 3.6 common, 109, fig 3.38
groove for popliteal muscle, 67 superficial, 109-110, fig 3.37-3.38, 112
head of, 66, fig 3.5 Fibular trochlea, 90-91, fig 3.22-3.23
intercondylar fossa of, 67, fig 3.6 Filiform papillae, 441, fig 8.76
intercondylar line of, 67 Filum terminale, 524, fig 9.22
intertrochanteric crest of, 67 Fimbriae of uterine tube, 314, fig 7.11
intertrochanteric line of, 67 Fissures of cerebellum
joints of, 67, fig 3.6 horizontal, 509-510, fig 9.11-9.12
linea aspera of, 67, fig 3.6 primary, 509, fig 9.11
neck of, 66-67, fig 3.5-3.6 superior posterior, 509, fig 9.11
patellar surface of, 66-67, fig 3.5, 80-81 Fissure(s) of lung
pectineal line of, 67, fig 3.6 horizontal, 192, fig 5.34
popliteal surface of, 67, fig 3.6 oblique, 192, fig 5.34
proximal end of, 67, fig 3.6 Fissures of right lung
shaft of, 67, fig 3.6 horizontal, 190-192, fig 5.32-5.34
spiral line of, 67, fig 3.6 oblique fissures, 190-192, fig 5.32-5.34
supracondylar lines of Flexor carpi radialis muscle, 27-28, fig 2.14
lateral, 67, fig 3.6 Flexor carpi ulnaris muscle, 27-28, fig 2.14
medial, 67, fig 3.6 Flexor digiti minimi brevis muscle, 38-39, fig 2.21,
trochanteric fossa of, 67 fig 2.22
trochanters of, 66, fig 3.5 Flexor digitorum profundus muscle, 27-28,
greater, 66-67, fig 3.5-3.6 fig 2.14
lesser, 66-67, fig 3.5-3.6 Flexor digitorum superficialis muscle, 27-28,
Fetal circulation, 320, fig 7.14 fig 2.14
Fetus Flexor pollicis brevis muscle, 38-39, fig 2.21,
in utero, 319-320, fig 7.13-7.14 fig 2.22
Fibrous appendix of liver, 250, fig 6.21 Flexor pollicis longus muscle, 27-28, fig 2.14
Fibrous capsule of spleen, 247, fig 6.19 Flexor-pronator muscles, 27
Fibrous layer (external tunic) of eyeball, 420 Flocculus of cerebellum, 510, fig 9.12
Fibrous trigone Floculonodular lobes, 494
left, 208, fig 5.44 Folia of cerebellum, 508
right, 208, fig 5.44 Foliate papillae, 440, fig 8.76, 566, fig 9.49
Fibula, 75-76, fig 3.11 Foot
apex of head of, 75-76, fig 3.11 bones of, 86-91, fig 3.19-3.23
articular facet(s) joints of, 87, 94, fig 3.26
of head of, 75, fig 3.11 ligaments of, 95, fig 3.27
of lateral malleolus, 75-76, fig 3.11 muscles of, 98-102, fig 3.30-3.32
of medial malleolus, 74, fig 3.10 Foot bones
border(s) of calcaneal tuberosity of, 86, fig 3.19
anterior, 75-76, fig 3.11 calcaneus of, 86, fig 3.19
medial, 75-76, fig 3.11 cuboid bone of, 6, fig 3.19
posterior, 75, fig 3.11 cuneiform bones of
fibular notch of, 75 intermediate, 86, fig 3.19
head of, 75-76, fig 3.11 lateral, 86, fig 3.19
interosseous crest of, 75, fig 3.11 ligaments of, 95, fig 3.27
malleolus(i) medial cuneiform bone, 86, fig 3.19
lateral malleolus, 5, fig 1.4, 75, fig 3.11 metatarsal bones of, 86, fig 3.19
medial malleolus, 75, fig 3.11 navicular of, 86, fig 3.19
neck of, 75-76, fig 3.11 phalanges of foot
posterior border of, 75, fig 3.11 distal, 86, fig 3.19
styloid process of, 75-76, fig 3.11 distal phalanx, 86, fig 3.19
surfaces of middle phalanx, 86, fig 3.19
lateral, 75-76, fig 3.11 neck of, 86, fig 3.19
medial, 75-76, fig 3.11 proximal, 86, fig 3.19
posterior, 75-76, fig 3.11 proximal phalanx, 86, fig 3.19
talocrural joint, 75, fig 3.11 talus, 86, fig 3.19
tibiofibular joint talus, 86, fig 3.19
inferior, 75-76 tarsal bones of, 86, fig 3.19
middle, 75-76 tuberosity of 5th metatarsal bone of, 86,
superior, 75-76 fig 3.19
Index 583
Foot joints, 87, 94, fig 3.26 Foot muscles
calcaneocuboid, 87 (continued)
cuboideonavicular, 96, fig 3.28 flexor hallucis brevis, 100-101, fig 3.32
cuneiform, 87 interossei
intermediate, 87 dorsal, 98, fig 3.30, 101-102
lateral, 87 plantar, 100-102, fig 3.32
medial, 87 lumbrical, 99, fig 3.31, 101-102
cuneocuboid, 94, fig 3.26, 96, fig 3.28 oblique head, 100, fig 3.32
distal interphalangeal, 87 opponens digiti minimi, 102
intercuneiform, 96, fig 3.28, 94, fig 3.26 quadratus plantae, 99, fig 3.31, 101-102
intermetatarsal, 97 Foot region, 62, fig 3.10
interphalangeal, 94, fig 3.26, 97 Foramen (of Winslow) see epiploic foramen
metatarsophalangeal, 94, fig 3.26, 97 (of Winslow)
proximal interphalangeal, 87 Foramen cecum, 369, fig 8.11
subtalar, 87, 94-96, fig 3.26-3.28 Foramen cecum of tongue, 440, fig 8.75
talocalcaneal joint, 94, fig 3.26 Foramen lacerum, 366, fig 8.8
talocalcaneonavicular joint, 96, fig 3.28 Foramen magnum, 366, fig 8.8, 369, fig 8.11
talocrural, 86-87, fig 3.19 Foramen ovale, 366, fig 8.8, 369, fig 8.11
talonavicular, 87 Foramen rotundum, 369, fig 8.11, 375-376,
tarsometatarsal, 87, 94, fig 3.26, 97 fig 8.17-8.18, 404, fig 8.41
transverse tarsal, 94, fig 3.26 Foramen spinosum, 366, fig 8.8, 369, fig 8.11
Foot ligaments Foramina and fissures of the skull, 366, fig 8.8
anterior tibiofibular, 95, fig 3.27 Forearm
bifurcate, 95, fig 3.27 as region, 10-11, fig 2.1
calcaneocuboid, 95, fig 3.27 bones of, 22-24, fig 2.10-2.11
calcaneofibular, 95, fig 3.27 joints of
calcaneonavicular, 95, fig 3.27 elbow, 25-26, fig 2.12-2.13
plantar, 96, fig 3.28 muscles of
collateral ligaments of interphalangeal joints anterior compartment, 27-28, fig 2.14
of foot, 97, fig 3.29 posterior compartment, 29-30, fig 2.15
deep transverse metatarsal, 97, fig 3.29 neurovasculature of, 50-55, fig 2.31-2.36
dorsal calcaneocuboid, 95, fig 3.27 Forearm as a region, 10-11, fig 2.1
dorsal cuboideonavicular, 95, fig 3.27 Fornix of cerebral cortex, 500, fig 9.5
dorsal cuneocuboid, 95, fig 3.27 Fossa ovalis
dorsal cuneonavicular, 95-96, fig 3.27-3.28 of right atrium, 203-204, fig 5.41
dorsal intercuneiform, 95-96, fig 3.27-3.28 Fourth ventricle of brainstem, 505, fig 9.8
dorsal tarsometatarsal, 95-96, fig 3.27-3.28 medullary striae of, 507, fig 9.10
lateral talocalcaneal, 95, fig 3.27 vestibular area of, 507, fig 9.10
long plantar, 95-96, fig 3.27-3.28 Fovea centralis, 418, fig 8.53
metatarsal Fovea of femur, 66-67, fig 3.5-3.6
dorsal, 95, fig 3.27 Frenulum of
plantar, 97, fig 3.29 labia minora, 337, fig 7.25
plantar calcaneocuboid, 97, fig 3.29 lower lip, 439, fig 8.74
plantar calcaneonavicular, 97, fig 3.29 upper lip, 439, fig 8.74
plantar cuboideonavicular, 97, fig 3.29 Frontal bone, 360-364, fig 8.2-8.6, 367, fig 8.9,
plantar cuneocuboid, 97, fig 3.29 369-371, fig 8.11-8.12, 408, fig 8.45,
plantar cuneonavicular, 97, fig 3.29 424-425, fig 8.59-8.60
plantar intercuneiform, 97, fig 3.29 orbital surface of, 360, fig 8.2, 369, 408,
plantar metatarsophalangeal, 97, fig 3.29 fig 8.45
plantar tarsometatarsal, 97, fig 3.29 supraorbital foramen of, 360, fig 8.2, 408,
talocalcaneal interosseous, 95, fig 3.27 fig 8.45
medial, 96, fig 3.28 zygomatic process of, 408, fig 8.45
talofibular Frontal branches of callosomarginal artery, 517,
anterior, 95, fig 3.27 fig 9.17
posterior, 95, fig 3.27 Frontal crest, 363, fig 8.5, 369, fig 8.11
talonavicular, 95, fig 3.27 Frontal gyrus(i)
Foot muscles inferior, 495-496, fig 9.2
abductor digiti minimi muscle of, 100, fig 3.31, middle, 495-496, fig 9.2
102 superior, 495-496, fig 9.2
abductor hallucis, 99, fig 3.31, 101-102 Frontalis muscle, 383, fig 8.25
adductor hallucis, 100-102, fig 3.32 Frontal lobe of cerebrum, 493-496, fig 9.1-9.2
oblique head of, 100, fig 3.32 Frontal nerve, 414-418, fig 8.49, fig 8.51-8.53,
transverse head of, 100, fig 3.32 544, fig 9.35
extensor digitorum brevis, 98, fig 3.30 Frontal region, 359, fig 8.1
extensor hallucis brevis, 98, fig 3.30 Frontal sinus, 370-371, fig 8.12, 414, 425, fig 8.60,
flexor digiti minimi brevis muscle of, 100, 536, fig 9.30
fig 3.32, 102 Frontonasal suture of skull, 360, fig 8.2
flexor digitorum brevis, 99, fig 3.31, 101-102 Frontopolar artery, 517, fig 9.17

Frontozygomatic suture of skull, 361, fig 8.3 Genicular anastomosis
Fundus of (continued)
gallbladder, 253, fig 6.24 superior lateral genicular artery, 108-110,
stomach, 243-244, fig 6.16-6.17 fig 3.37-3.38
urinary bladder superior medial genicular artery, 108-110,
of female, 331, fig 7.21 fig 3.37-3.38
uterus, 313, fig 7.10 Geniculate body
Fungiform papilla, 441, fig 8.76, 566, fig 9.49 lateral, 539, fig 9.32
medial, 539, fig 9.32
G Geniculate ganglion, 393, 550-551, fig 9.40, 552,
Gallbladder, 238, fig 6.12, 240, fig 6.14, 243, 566, fig 9.49
fig 6.16, 253, fig 6.24 Genioglossus muscle, 442-443, fig 8.77-8.78, 565,
arteries of, 285-286, fig 6.44 fig 9.48
body of, 253, fig 6.24 Geniohyoid muscle, 460, fig 8.90, 462
definition of, 253 Genitofemoral nerve, 228-229, 281, 283,
extrahepatic duct system, 253 fig 6.43
function of, 253 Gingiva, 439, fig 8.74, 450, 452, fig 8.84, 549,
lymphatics of, 292-295, fig 6.48-6.49 fig 9.39
inferior aspect, 295 alveolar, 452, fig 8.84
superior aspect, 295 lamina propria of, 452, fig 8.84
neck of, 253, fig 6.24 marginal, 452, fig 8.84
neurovascular, 253 Gingival papilla, 452, fig 8.84
related liver, 248, fig 6.20 Glabella of frontal bone, 360, fig 8.2
Gastric artery(ies), 285, 286, fig 6.44, 289, fig 6.46 Glans of clitoris, 337-338, fig 7.24-7.25
esophageal branches, 285, fig 6.44 Glans penis, 325, fig 7.17, 329, fig 7.20, 333-335,
left, 285 fig 7.22-7.23, 335, fig 7.23
of hepatic portal system, 289, fig 6.46 corona of, 335, fig 7.23
posterior, 285-286, fig 6.45 neck of, 334-335, fig 7.22-7.23
right, 285 Glenohumeral (shoulder) joint, 13, 15, 17-18,
short, 285-287, fig 6.44-6.45 fig 2.7, fig 2.8
Gastric canal, 244, fig 6.17 bones of, 17-18, fig 2.7-2.8
Gastric folds, 244, fig 6.17 functions of, 17-18, fig 2.7-2.8
Gastric impression, 246, fig 6.18 ligaments of, 17-18, fig 2.7-2.8
Gastric lymph nodes muscles of, 17-18, fig 2.7-2.8
left, 290, fig 6.47, 293-294, fig 6.48-6.49 rotator cuff muscles, 17-18, fig 2.7-2.8
right, 290, fig 6.47, 293-294, fig 6.48-6.49 Glenoid fossa, 15, 17-18, fig 2.8
short, 292 Glenoid labrum of scapula, 18, fig 2.8
Gastric veins, 289, fig 6.46 Globus pallidus, 500, fig 9.5
Gastrocolic ligament, 239, fig 6.13 lateral segment of, 501-502, fig 9.6
Gastroduodenal artery, 239, fig 6.13, 261, fig 6.29, medial segment of, 501-502, fig 9.6
285, fig 6.44, 289, fig 6.46 Glossoepiglottic fold
of pancreas, 255 lateral, 440, fig 8.75
of stomach, 286 median, 440, fig 8.75
Gastroepiploic artery see gastroomental artery Glossopharyngeal nerve (CN IX), 434, 457-458,
Gastrointestinal tract fig 8.88, 477, fig 8.103, 506, fig 9.9,
esophagus, 181 533-535, 556-558, fig 9.43-9.44, 560,
large intestine, 267, fig 6.33 fig 9.45, 566, fig 9.49
liver, 248, fig 6.20 branches of, 556, fig 9.43
rectum and anal canal, 269, fig 6.34 communicating branch with auricular branch
stomach, 243, fig 6.16 of vagus nerve, 556, fig 9.43
Gastroomental arteries, 238, fig 6.12, 289, functions of, 556, fig 9.43
fig 6.46 inferior ganglion of, 556, fig 9.43, 566, fig 9.49
left, 285-286, fig 6.44-6.45 of tongue, 556-557, fig 9.43-9.44
right, 239, fig 6.13, 261-262, 285-286, structure of, 556, fig 9.43
fig 6.44-6.45 superior ganglion of, 556, fig 9.43
Gastroomental lymph nodes, 292-295, Gluteal artery
fig 6.48-6.49 inferior, 104, fig 3.34, 275, fig 6.37
left, 293-295, fig 6.48-6.49 superior, 104, fig 3.34, 275, fig 6.37
right, 293-295, fig 6.48-6.49 left
Gastroomental veins, 238, fig 6.12, 289, fig 6.46 of male pelvis, 347-348, fig 7.32
Gastrosplenic ligament, 238-239, fig 6.12-6.13, Gluteal lines
246, fig 6.18 anterior, 64-65, fig 3.4
related liver, 248, fig 6.20 inferior, 64-65, fig 3.4
Genicular anastomosis, 108-110, fig 3.37-3.38 posterior, 64-65, fig 3.4
inferior lateral genicular artery, 108-110, Gluteal muscles, 69-73, fig 3.8-3.9
fig 3.37-3.38 gluteus maximus muscle, 69-73, fig 3.8-3.9
inferior medial genicular artery, 108-110, gluteus medius muscle, 69-73, fig 3.8-3.9
fig 3.37-3.38 gluteus minimus muscle, 69-73, fig 3.8-3.9
Index 585
Gluteal nerve, 104-105, fig 3.34, 107, fig 3.36 H
inferior, 71, 104-105, fig 3.34, 107, fig 3.36, Habenula perforata, 437, fig 8.72
342-343, fig 7.29 Hallucial eminence, 62, fig 3.10
superior, 71, 104-105, fig 3.34, 107, fig 3.36, Hamate bone, 31, fig 2.16, 34
342-343, fig 7.29 hook of, 31, fig 2.16
Gluteal region, 3, fig 1.2, 5, 62, fig 3.10, 103-104, Hand and wrist, 31-41, fig 2.16-2.22
114, fig 4.1, 342, 348, 350 bones of, 31-32, fig 2.16
Gluteal sulcus, 5, 62, fig 3.10 joints of, 31-32, fig 2.16
Gluteal surface of ilium, 71, 301, fig 7.1b ligaments of, 33-37, fig 2.17-2.20
Gluteal vein muscles of, 38-41, fig 2.21-2.22
inferior, 276, fig 6.38 neurovasculature, 42-43, fig 2.23-2.24
superior, 276, fig 6.38 venous network of
of male pelvis, 347-348, fig 7.32 dorsal, 58, fig 2.39
Gluteus maximus muscle, 70, fig 3.9, 334, Haustra of colon, 267-268, fig 6.33
fig 7.22-7.23 Head
Gracile fasciculus, 507, fig 9.10 as a region, 359, fig 8.1
Gracile tubercle, 507, fig 9.10 Head and neck
Gracilis muscle, 69, fig 3.8 lymphatics of, 480-483, fig 8.106-8.108
Granular foveolae, 363, fig 8.5 cervical lymph nodes
Gray matter, 494-496, 500-503, fig 9.5-9.7, anterior, 482, fig 8.108
525-526, fig 9.23-9.24 lateral, 483
Gray ramus communicans of spinal nerve, 283, facial lymph nodes, 480, fig 8.106, 482,
fig 6.43, 344-346, fig 7.30-7.31, 526, fig 8.108
fig 9.24, 528, fig 9.25 lingual lymph nodes, 480, fig 8.106
of female pelvis, 346, fig 7.31 lymphatic trunk and ducts, 480, fig 8.106
of male pelvis, 344, fig 7.30 pericervical lymph nodes, 480-482,
Great auricular nerve (C2-3), 144, fig 4.18, 395, fig 8.106-8.108
431, 477, 479-480, fig 8.105 pharyngeal lymphoid ring and nodes, 482,
Great cardiac vein, 201, fig 5.40, 212-213, fig 5.47 fig 8.108
Great cerebral vein (of Galen), 521-522, Head of femur, 66, fig 3.5, 68, fig 3.7
fig 9.20-9.21 Head of fibula, 75-76, fig 3.11
Great saphenous vein, 103-104, 108, 110 Head of ulna, 24
Greater occipital nerve, 142, 144, fig 4.18, 395, Heart, 196-218, fig 5.36-5.50
fig 8.34 anatomical relations of, 198, fig 5.38
Greater palatine nerve, 366, 429, fig 8.64, 547 apex of, 197, fig 5.37, 200-201, fig 5.39-5.40,
Greater palatine vein, 406-407, fig 8.44, 428, 206, fig 5.43, 210, fig 5.46
fig 8.63 arteries and veins of, 212-23, fig 5.47
Greater sciatic notch, 64-65, fig 3.3-3.4, 301, auscultation of, 196, fig 5.36
fig 7.1b, 303, fig 7.3 blood supply of, 212-213, fig 5.47
Greater wing of sphenoid bone, 360, fig 8.2, 369, borders of, 199
fig 8.11, 371, fig 8.13, 400, 405, 408, cardiopulmonary reanimation (CPR), 196
fig 8.45 conduction system of, 215, fig 5.49
infratemporal crest of, 400 in situ, 196-198, fig 5.36-5.38
infratemporal surface of, 365, fig 8.7 lymphatics of, 217-218, fig 5.50
maxillary surface of, 375, fig 8.17 muscle of (myocardium), 215
orbital surface of, 375 nerves of, 214-216, fig 5.48-5.49
parietal margin of, 376, fig 8.18 rhythm of, 202
squamosal margin of, 376, fig 8.18 surface anatomy of, 199-202, fig 5.39-5.40
temporal surface of, 365, fig 8.7, 375, fig 8.17 surfaces of, 199
zygomatic margin of, 375, fig 8.17 surrounding neurovasculature of, 198
Gustatory area of cerebrum, 497, fig 9.3 visceral relations of, 198, fig 5.38
Gustatory glands, 441, fig 8.76 Heart valves, 208-211, fig 5.44-5.46
Gyrus(i), 495-496, fig 9.2, 499, fig 9.4 aortic valve, 206, 208, fig 5.44
ambient, 536, fig 9.30 coronary leaflet(s)
angular, 495-496, fig 9.2 left, 208, fig 5.44
cingulate, 498 right, 208, fig 5.44
frontal, 495-496, fig 9.2 noncoronary leaflet, 208, fig 5.44
inferior, 495-496, fig 9.2 atrioventricular valve, 208, fig 5.44
middle, 495-496, fig 9.2 left atrioventricular (mitral/bicuspid),
superior, 495-496, fig 9.2 206, fig 5.43, 207-208, fig 5.44, 210,
parahippocampal, 536, fig 9.30 fig 5.46
paraterminal, 536-537, fig 9.30 tendinous chords of, 206-207, fig 5.43, 210,
postcentral, 495-497, fig 9.2 fig 5.46
precentral, 495-497, fig 9.2 right (tricuspid), 202-204, fig 5.41-5.42,
temporal, 495-496, fig 9.2 208-210, fig 5.41, fig 5.44-5.46
inferior, 495-496, fig 9.2 vestibule of, 204, 207
middle, 495-496, fig 9.2 pulmonary valve, 202, 204, fig 5.42, 208-210,
superior, 495-496, fig 9.2 fig 5.44-5.46

Heart valves Hip and thigh neurovasculature
semilunar, 208, fig 5.44 descending genicular artery, 103-104, fig 3.33,
aortic, 208, fig 5.44 106
pulmonary, 208, fig 5.44 femoral artery, 103-104, fig 3.33-3.34, 106,
Heart valves see also individual valves fig 3.35, 228-230, fig 6.4-6.5, 347, 349
Helicis muscle branches of, 106, fig 3.35
major, 431 deep femoral artery, 103-104, fig 3.33, 106,
minor, 431 fig 3.35
Helicotrema, 433, fig 8.68, 435, fig 8.70 lateral circumflex femoral artery, 103-104,
Helix of ear, 430-431, fig 8.65-8.66 fig 3.33, 106, fig 3.35
Hemiazygos vein, 198, fig 5.38 pathway of, 106, fig 3.35
Hemispheres of brain, 493-494, fig 9.1 perforating arteries, 106, fig 3.35
Hemispheres of cerebellum, 510, fig 9.12 femoral nerve, 62, 70, 72, 103, fig 3.33, 105, 110,
Hemorrhoidal venous plexus, 276, fig 6.38 283-284, fig 6.43
Hepatic artery(ies) femoral vein, 103-104, 109, fig 3.33, 228, fig 6.4
common, 177, fig 5.22, 226, fig 6.3, 239, tributaries, 103, fig 3.33
fig 6.13, 257-258, fig 6.27, 285-289, lateral femoral cutaneous nerve, 103,
fig 6.44-6.46, 285-287, fig 6.44-6.45, fig 3.33, 105
289, fig 6.46 gluteal nerve, 104-105, fig 3.34, 107, fig 3.36
left, 251-252, fig 6.22-6.23, 285, fig 6.44 inferior, 71, 104-105, fig 3.34, 107, fig 3.36,
proper, 239, fig 6.13, 251-252, fig 6.22-6.23, 342-343, fig 7.29
257-258, fig 6.27, 287-289, superior, 71, 104-105, fig 3.34, 107, fig 3.36,
fig 6.45-6.46 342-343, fig 7.29
right, 251-252, fig 6.22-6.23, 285, fig 6.44 inferior gluteal artery, 104, fig 3.34, 275, fig 6.37
Hepatic duct internal pudendal artery, 104, fig 3.34, 269,
common, 251-254, fig 6.22-6.25 fig 6.34, 275, fig 6.37
left, 251, fig 6.22, 253-254, fig 6.24 lumbar plexus, 104-105, 283-284, fig 6.43
right, 251, fig 6.22, 253-254, fig 6.24-6.25 function of, 281, 284
Hepatic lymph node(s), 290-295, fig 6.47-6.49 muscular branches of femoral nerve, 103,
Hepatic plexus(i), 253, fig 6.24, 264, fig 6.31 fig 3.33
Hepatic portal system, 289, fig 6.46 obturator nerve, 71-73, 103, 105, 283-284
Hepatic portal vein, 235, fig 6.10, 251-252, of female, 345-346, fig 7.31
fig 6.22-6.23, 254-255, fig 6.25, of male, 344-345, fig 7.30
287-289, fig 6.45-6.46 popliteal artery, 103, fig 3.33, 106, 108-110,
duodenum, 257-258, fig 6.27 fig 3.38
Hepatic veins, 241, fig 6.15, 251-252, fig 6.22-6.23, branches, 108, fig 3.37
292 posterior femoral cutaneous nerve, 103,
pancreas, 254-255, fig 6.25 fig 3.33-3.34, 105, 342-343, fig 7.29
Hepatoduodenal ligament, 240-241, fig 6.14-6.15, pudendal nerve, 104, fig 3.34, 276, fig 6.38, 330,
254, fig 6.25, 258, 289 342-346, fig 7.29-7.30
Hepatogastric ligament, 248, fig 6.20 sacral plexus, 104-105, 283, 342-343, fig 7.29,
Hepatopancreatic ampulla (ampulla of Vater), 345
253, fig 6.24, 256, fig 6.26 branches of, 343
Hepatopancreatic sphincter (of Oddi), 256, fig 6.26 function of, 343
Hilum of kidney, 277-280 saphenous nerve, 103, fig 3.33, 105, 108-110,
Hilum of liver, 251, 292 fig 3.37-3.38, 112
Hilum of lung, 190-191, fig 5.32, 193 sciatic nerve, 104, fig 3.34, 106, 107-110,
Hilum of spleen, 246-247, fig 6.19, 251 fig 3.36, 342-343, fig 7.29
Hilum of testis, 323 Hip bone
Hip and thigh ilium, 63-65, fig 3.2-3.4, 322
bones of, 63-68, fig 3.2-3.7 ischium, 63-65, fig 3.2-3.4, 322
ligaments of, 68, fig 3.7 pubis, 63-65, fig 3.2-3.4, 322
muscles of, 69-73, fig 3.8-3.9 Hip joint
neurovasculature of, 103-107, fig 3.33-3.36 acetabular fossa, 68, fig 3.7
Hip and thigh neurovasculature acetabular labrum, 68, fig 3.7
circumflex arteries acetabular margin, 68, fig 3.7
deep circumflex iliac artery, 103-104, acetabulum, 68, fig 3.7
fig 3.33, 106, fig 3.35 articulating surfaces of hip joint, 68, fig 3.7
lateral circumflex femoral artery, 103, head of femur, 68, fig 3.7
fig 3.33, 106, fig 3.35 lunate surface of acetabulum, 68, fig 3.7
medial circumflex femoral artery, 103, head of femur, 68, fig 3.7
fig 3.33, 106, fig 3.35 lunate surface of, 68, fig 3.7
superficial circumflex iliac artery, 103, synovial ball-and-socket joint, 68
fig 3.33, 106, fig 3.35 synovial membrane, 68, fig 3.7
cluneal nerves, 104, fig 3.34 transverse acetabular ligament, 68, fig 3.7
inferior, 104-105, fig 3.34, 104-105, fig 3.34, zona orbicularis, 68, fig 3.7
104-105, fig 3.34 Hip region, 62, fig 3.1
Index 587
Histological layers of stomach, 244, fig 6.17 Hypoglossal nerve (CN XII)
Hook of hamate bone, 31-32, fig 2.16 (continued)
Horizontal part of duodenum, 235, fig 6.10, branches of, 565
241, fig 6.15, 248, fig 6.20, 254-258, function of, 564-565
fig 6.25-6.27, 291 geniohyoid branch of, 479, fig 8.105, 565
Horn of spinal cord nucleus of, 565, fig 9.48
anterior, 526, fig 9.24 of tongue, 565, fig 9.48
lateral, 526, fig 9.24 structure and features of, 565, fig 9.48
posterior, 526, fig 9.24 thyrohyoid branch of, 479, fig 8.105, 565
Humeral artery Hypophyseal artery(ies)
anterior circumflex, 44-45, fig 2.25-2.26 inferior, 397, fig 8.36, 515, fig 9.15
posterior circumflex, 44-45, fig 2.25-2.26 superior, 397, fig 8.36, 515, fig 9.15
Humeral vein Hypophyseal fossa, 369, fig 8.11
anterior circumflex, 46-47, fig 2.27-2.28 Hypothalamic area
posterior circumflex, 46-47, fig 2.27-2.28 lateral, 566, fig 9.49
Humeroradial joint, 25-26, fig 2.12-2.13 Hypothalamus, 502-503, fig 9.7
Humeroulnar joint, 25-26, fig 2.12-2.13 function of, 503, fig 9.7
Humerus, 13-14, 25-26, fig 2.3-2.4, fig 2.12-2.13 location of, 503, fig 9.7
anatomical neck of, 13-14, fig 2.3-2.4 Hypothenar compartment of hand, 38-39,
anterior view of, 13, fig 2.3 fig 2.21-2.22
body of, 13-14, fig 2.3 Hypothenar muscles, 38
capitulum, 13-14, fig 2.3
condyles of humerus, 13-14, fig 2.3-2.4 I
coronoid fossa of, 13-14, fig 2.3 Ileal papilla, 259, fig 6.28, 267, 267
distal end of, 14 female, 349-350, fig 7.33
epicondyle(s) of Ileocecal junction, 259, fig 6.28
lateral, 13-14, fig 2.3, 20, 25, fig 2.12, 28-30 large intestine, 267, fig 6.33
medial, 13-14, fig 2.3, 25, fig 2.12, 28-30 Ileocolic artery, 268, 271, fig 6.35, 273, fig 6.36
head of, 13-14, fig 2.3-2.4 colic branch, 271, fig 6.35
intertubercular sulcus, 13, fig 2.3-2.4 ileal branch, 271, fig 6.35
lateral epicondyle of, 25, fig 2.12 Ileocolic lymph nodes 265-266, fig 6.32, 268
olecranon fossa, 14, fig 2.4 Ileum, 222, 235-236, fig 6.10-6.11, 238, fig 6.12,
posterior view of, 13-14, fig 2.3 259, fig 6.28, 263-265, 267, fig 6.33, 297
radial fossa, 13-14, fig 2.3 definition of, 260
radial groove, 14, fig 2.4 functions of, 259-260, fig 6.28
shaft of, 13-14, fig 2.3 lymphatics of, 265-266, fig 6.32, 297
supracondylar process, 14 terminal part of, 267-268, fig 6.33
supracondylar ridge Iliac artery
lateral, 13-14, fig 2.3 common, 131, fig 4.13, 275, fig 6.37, 281, fig 6.42
medial, 13-14, fig 2.3 left, 349, fig 7.33
surgical neck of, 13-14, fig 2.3 right, 309-312, fig 7.7-7.8, 321-322, fig 7.15
trochlea of, 13-14, fig 2.3, 26, fig 2.13 ureteric branches of, 281, fig 6.42
tubercles of, 13-14, fig 2.3-2.4 deep circumflex, 106, fig 3.35, 311, fig 7.8
Hyaloid canal, 419-420, fig 8.54 external, 103-104, 131, fig 4.13, 233, fig 6.8,
Hyoglossus muscle, 442-443, fig 8.77-8.78, 483, 269, fig 6.34, fig 6.37, 275, fig 6.37, 281,
fig 8.109, 485, 565, fig 9.48 fig 6.42, 311, fig 7.8, 317-318, fig 7.12
Hyoid bone, 443-444, 459-460, fig 8.89, 462, right, 241, fig 6.15
464-465, fig 8.91, fig 8.92 left
body of, 459, fig 8.89 in male, 347-348, fig 7.32
functions of, 459, fig 8.89 internal, 103-104, 131, fig 4.13, 270-271, fig 6.35,
greater horn(s) of, 454-455, fig 8.86 275, fig 6.37, 281, fig 6.42, 311-312,
lesser horns of, 459, fig 8.89 fig 7.8, 322
Hypochondriac region, 221-222, fig 6.1 left
Hypogastric nerve, 273, fig 6.36 female, 309-311, fig 7.7-7.8, 349-350,
of female pelvis, 345-346, fig 7.31 fig 7.33
of male pelvis, 344-345, fig 7.30 male, 349-350, fig 7.33
Hypogastric plexus, 273, fig 6.36, 330 superficial circumflex iliac artery, 106, fig 3.35
inferior, 330, 332 Iliac crest, 5, fig 1.4, 65, fig 3.4, 71, 300-302,
branches, 273, fig 6.36 fig 7.1a-7.3, 304-305
superior Iliac fascia, 312, fig 7.9
of female, 345-346, fig 7.31 Iliac fossa, 64, fig 3.3, 300, fig 7.1a, 304
of male, 344-345, fig 7.30 Iliac lymph nodes, 281
Hypogastric region, 221-222, fig 6.1 common, 281, 295-297, fig 6.50, 351, fig 7.34
Hypoglossal canal, 366, fig 8.8, 369, fig 8.11, 371, 533 female, 354-355, fig 7.36
Hypoglossal nerve (CN XII), 442, 445, fig 8.79, male, 352-353, fig 7.35
457-458, fig 8.88, 477, fig 8.103, external, 281, 295-297, fig 6.50, 351, fig 7.34
479, fig 8.105, 485, 506, fig 9.9, 533, female, 354-355, fig 7.36
fig 9.28-9.29, 533-535, 560, 564-565, male, 352-353, fig 7.35
fig 9.48 internal, 281, 295-297, fig 6.50, 351, fig 7.34

Iliac lymph nodes Incus
female, 354-355, fig 7.36 ligament of
male, 352-353, fig 7.35 posterior, 434, fig 8.69
Iliac plexus superior, 434, fig 8.69
of male, 344, fig 7.30 long limb of, 434, fig 8.69
Iliac spine short limb of, 434, fig 8.69
anterior inferior, 64-65, fig 3.3-3.4, 300-303, Inferior anal nerve, 341, fig 7.28
fig 7.1a-7.3 of male, 344-345, fig 7.30
anterior superior, 4, fig 1.3, 64-65, fig 3.3-3.4, Inferior anastomotic vein, 520, fig 9.19
228, fig 6.4, 300-303, fig 7.1a-7.3 Inferior angle of scapula, 5, fig 1.4, 15, fig 2.5
posterior inferior, 64-65, fig 3.3-3.4, 300-303, Inferior anorectal plexus
fig 7.1a-7.3 of male, 344-345, fig 7.30
posterior superior, 64-65, fig 3.3-3.4, 300-303, Inferior as term of relationship, 2, fig 1.1
fig 7.1a-7.3 Inferior articular facet of axis, 120-121, fig 4.6
Iliac tubercle, 64-65, fig 3.4 Inferior articular facet of thoracic spine, 124,
Iliac tuberosity, 64, fig 3.3, 302-303, fig 7.2-7.3 fig 4.9
Iliacus muscle, 64, 69-70, fig 3.8, 304, fig 7.4, 311, inferior articular processes of thoracic spine, 124,
fig 7.8, 317-318, fig 7.12 fig 4.9
Iliac veins Inferior articular processes of vertebra, 116-117,
common, 232-233, fig 6.7-6.8, 276, fig 6.38 fig 4.3-4.4
right, 309-312, fig 7.7-7.8, 321-322, fig 7.15 Inferior border of spleen, 246, fig 6.18
external, 269, fig 6.34, 274, fig 6.38, 311-312, Inferior cerebral veins, 520-522, fig 9.19, fig 9.21
fig 7.8, 316-318, fig 7.12 Inferior cluneal nerve(s), 104-105, fig 3.34
left Inferior colliculus of brainstem, 505, fig 9.8, 507,
in male, 347-348, fig 7.32 fig 9.10, 539-540, fig 9.32
internal, 276, fig 6.38, 311-312, fig 7.8 Inferior (diaphragmatic) surface of heart, 201,
Iliococcygeus muscle, 307-308, fig 7.6 fig 5.40
Iliocostalis muscle Inferior ganglion of vagus nerve, 457-458, fig 8.88
cervicis, 138, fig 4.16, 141 Inferior genicular artery
lumborum, 138, fig 4.16, 141 lateral, 108-110, fig 3.37-3.38
thoracis, 138, fig 4.16, 141 medial, 108-110, fig 3.37-3.38
Iliofemoral ligament, 68, fig 3.7 Inferior glenohumeral ligament, 17-18, fig 2.7-2.8
Iliohypogastric nerve (L1), 224, 231-232, Inferior gluteal artery, 104, fig 3.34, 275, fig 6.37
fig 6.6-6.7, 283, fig 6.43 Inferior gluteal nerve, 105, fig 3.34
cutaneous branch of, 232, fig 6.7 Inferior head of lateral pterygoid muscle, 399,
Ilioinguinal nerve, 232, fig 6.7, 283, fig 6.43 fig 8.38
scrotal branch Inferior hypogastric plexus
anterior, 324-325, fig 7.17 left
Iliolumbar arteries, 131, fig 4.13 of female, 273-274, fig 6.36, 330, 332,
female, 349-350, fig 7.33 345-346, fig 7.31
male, 347-348, fig 7.32 Inferior lateral genicular artery, 108, fig 3.37
Iliopsoas muscle group, 69-70, fig 3.8, 223, 304, Inferior lobe
fig 7.4 left lung, 192, fig 5.34
iliacus muscle, 64, 69-70, fig 3.8, 304, fig 7.4, of right lung, 190-192, fig 5.32-5.34
311, fig 7.8, 317-318, fig 7.12 Inferior medial genicular artery, 108, fig 3.37
psoas major muscle, 69-70, fig 3.8, 226, fig 6.3, Inferior nuchal line of occipital bone, 362, fig 8.4,
258, 280-281, 283, 304, fig 7.4, 311, 365, fig 8.7
fig 7.8 Inferior petrosal sinus, 520, fig 9.19
psoas minor muscle, 69-70, fig 3.8, 304, fig 7.4 Inferior (/posterior) interventricular artery, 213
Iliopubic eminence, 64, fig 3.3, 70, 302-303, Inferior pubic ramus
fig 7.2-7.3 female, 316-318, fig 7.12, 331, fig 7.21
Iliopubic tract, 312, fig 7.9 male, 321-322, fig 7.15, 334-335, fig 7.22-7.23
Ilium Inferior ramus, 64, fig 3.3
ala, 63-65, fig 3.2-3.4 Inferior subscapular nerve, 43, fig 2.24
body of, 63, 303 Inferior suprarenal artery, 280
gluteal line of Inferior temporal line, 361, fig 8.3
anterior, 64, 65, fig 3.4, 71, 301, fig 7.1b Inferior tibiofibular joint, 75, fig 3.11
anterior, 64, 65, fig 3.4, 71, 301, fig 7.1b Inferior vein of left ventricle, 213
anterior, 64, 65, fig 3.4, 71, 301, fig 7.1b Inferior vena cava, 144, fig 4.18, 160-161, fig 5.10,
gluteal surface of, 64-65, fig 3.4, 71, 303 178, fig 5.23, 190-193, fig 5.32-5.34,
sacropelvic surface, 64, fig 3.3, 303 198, fig 5.38, 200-201, fig 5.39-5.40,
supraacetabular groove, 64, fig 3.3 203, fig 5.41
Impressions of spleen valve of, 203, fig 5.41
Incisive foramen, 362, fig 8.4, 366, fig 8.8 Inferior vesical artery
Incisor teeth, 448-449, fig 8.81-8.82 ureteric branches of, 281, fig 6.42
Incus, 433-434, fig 8.68-8.69 Inferior (/posterior) interventricular artery, 213
body of, 434, fig 8.69 Inferolateral branch of cardiac vein
lenticular process of, 434, fig 8.69 right, 213
Index 589
Infraglenoid tubercle of scapula, 15, fig 2.5-2.6, 20 Innervation of heart
Infrahyoid fascia, 487, fig 8.111 (continued)
Infraorbital artery, 388-389, fig 8.27, 396, efferent sympathetic fibers, 215-216
fig 8.35, 406, fig 8.43, 412, fig 8.47, lower cervical ganglia, 215-216
417-418, fig 8.52-8.53 thoracic ganglia, 215-216
Infraorbital foramen of maxilla, 360, fig 8.2, 408, parasympathetic fibers, 215-216
fig 8.45 vagus nerve, 215-216
Infraorbital groove, 408, fig 8.45 sympathetic fibers, 215-216
Infraorbital nerve, 394-395, fig 8.33-8.34, cardiac nerves, 215-216
405, fig 8.42, 414, fig 8.49, 417-418, Innervation of larynx, 470
fig 8.52-8.53, 545-546, fig 9.36-9.37 Innervation of parathyroid gland, 473, fig 8.100
Infraorbital region, 359, fig 8.1 Innervation of thyroid gland, 473, fig 8.100
Infraorbital vein, 407, fig 8.44, 412-413, fig 8.47, Innervation of tongue, 445, fig 8.79
417-418, fig 8.52-8.53 Insula of cerebrum, 496
Infrascapular branches of brachial plexus, 43, Insular lobe of brain, 493, 495, fig 9.1
fig 2.24 Interalveolar septa of mandible, 381, fig 8.23
Infrascapular region, 114, fig 4.1 Interarytenoid notch, 453, fig 8.85, 465, fig 8.92
Infraspinatus muscle, 17-18, fig 2.7-2.8 Interatrial septum, 203, fig 5.41
Infraspinous fossa of scapula, 15, fig 2.5 Intercapitular veins of hand, 58, fig 2.39
Infratemporal crest of sphenoid bone, 365, fig 8.7, Intercarpal interosseous ligaments, 37
375-376, fig 8.17-8.18 Intercarpal joints, 32, 37
Infratemporal region, 399-400, fig 8.38 Intercarpal ligament
Infratemporal surface of greater wing of dorsal, 35, fig 2.19, 37
sphenoid bone, 365, fig 8.7 palmar, 37
Infratrochlear nerve, 394-394, fig 8.33-8.34, Intercavernous septum
414-415, fig 8.49-8.50, 544, fig 9.35 of deep fascia of penis, 334, fig 7.22
Infundibulum Intercavernous sinus
gallbladder, 253, fig 6.24 posterior, 522, fig 9.21
uterine tube, 313-315, fig 7.10-7.11 Intercondylar areas of tibia
Inguinal canal, 228-229, fig 6.4 anterior, 75
Inguinal ligament, 223-225, fig 6.2, 228-229, posterior, 75
fig 6.4, 304-306, fig 7.4-7.5 Intercondylar eminence of tibia, 74, fig 3.10
Inguinal lymph nodes Intercondylar fossa of femur, 67, fig 3.6
deep, 296, fig 6.50 Intercondylar line, 67
female, 354, fig 7.36 Intercostal artery
male, 353, fig 7.35 anterior, 230, fig 6.5, 233, fig 6.8
inferior superficial lateral cutaneous branches of
male, 353, fig 7.34-7.35 anterior branches of, 230, fig 6.5
superficial, 296, fig 6.50 posterior, 131, 145, fig 4.19, 231, fig 6.6, 530,
female, 354, fig 7.36 fig 9.26
superolateral dorsal branch, 530, fig 9.26
male, 353, fig 7.35 spinal branch of, 530, fig 9.26
superomedial supreme, 398, fig 8.37
male, 353, fig 7.35 Intercostal nerves, 43, fig 2.24, 145, fig 4.19, 214,
Inguinal region, 221-222, fig 6.1 fig 5.48, 232, fig 6.7
Inguinal ring cutaneous branch
deep, 228, fig 6.4, 311, fig 7.8 anterior, 231-232, fig 6.7
superficial, 228, fig 6.4 lateral, 145, fig 4.19, 232, fig 6.7
Inner border cell of cochlear duct, 438, fig 8.73 Intercostal veins
Inner hair cell of cochlear duct, 438, fig 8.73 anterior, 233, fig 6.8
Inner layer (internal tunic) of eyeball, 420, fig 8.55 posterior, 132, fig 4.14, 145, fig 4.19, 231, fig 6.6
Inner phalangeal epithelial cell of cochlear duct, Intercrural joints
438, fig 8.73 tibiofibular joint
Internal pillar epithelial cell of cochlear duct, 438, Interdental cells, 437, fig 8.72
fig 8.73 Intergluteal cleft, 62, fig 3.10
Inner spiral sulcus of cochlear duct, 438, fig 8.73 Interlobar arteries of kidney, 279, fig 6.41
Inner sulcus cells of cochlear duct, 438, fig 8.73 Intermaxillary suture of skull, 360, fig 8.2
Inner tunnel of cochlear duct, 438, fig 8.73 Intermediate dorsal cutaneous nerve of foot, 112
Innervation of diaphragm, 160, 479 Intermediate tunnel of cochlear duct, 438, fig 8.73
Innervation of ear, 431, fig 8.66 Intermesenteric plexus, 273, fig 6.36, 561, fig 9.46
Innervation of heart Intermetacarpal joint, 32, 37
conduction service of, 215-216 Internal acoustic meatus, 369, fig 8.11
atrioventricular (AV) node, 215-216 Internal capsule of cerebral cortex, 500, fig 9.5
atrioventricular bundles, 215-216 Internal carotid artery, 389, fig 8.28, 397-398,
AV bundle, 215-216 fig 8.36, 412, fig 8.47, 422, 456, fig 8.87,
sinuatrial (SA) node, 215-216 472, fig 8.99, 474-475, fig 8.101,
subendocardial (Purkinje) fibers, 215-216 477-478, fig 8.104, 515, fig 9.15,
efferent parasympathetic, 215-216 515-516, fig 9.15-9.16, 518, 544, fig 9.35
vagal cardiac nerves, 215-216 right, 478, fig 8.104, 484, fig 8.110, 517, fig 9.17

Internal ear, 435-438, fig 8.70-8.73 Intestinal lymph trunk, 165, 265, 295-297,
bony labyrinth of, 435, fig 8.70 fig 6.50, 351, fig 7.34
functions of, 435, fig 8.70 Intracapsular ligaments, 68, fig 3.7
membranous labyrinth of, 435, fig 8.70 Intrahepatic lymph vessels, 253, fig 6.24
parts of, 437, fig 8.72 Intramedullary venous plexus, 531
vestibule of, 433, fig 8.68 Intraperitoneal organs, 234-235, fig 6.9-6.10
Internal iliac artery, 103-104, fig 3.33, 271, Intrapulmonary lymph nodes, 194, fig 5.3
fig 6.35 Intrinsic innervation
anterior division of, 131, fig 4.13 of anal canal, 276, fig 6.38
large intestine, 270 of ileum, 260
posterior division of, 131, fig 4.13 of jejunum, 260
Internal occipital crest, 369, fig 8.11 of large intestine, 272
Internal occipital protuberance, 369, fig 8.11 of rectum, 276, fig 6.38
Internal pillar epithelial cell of cochlear duct, 438, of small intestine, 263-264, fig 6.31, 274
fig 8.73 Ipsilateral hemidiaphragms, 192
Internal pudendal artery, 104, fig 3.34, 269, Iridocorneal angle, 420, fig 8.55
fig 6.34, 275, fig 6.37 Iris of eyeball, 413, 415, 419-421, fig 8.54-8.56,
Interosseous compartments of hand, 38-39, 423, fig 8.58
fig 2.21-2.22 minor arterial circle of, 422, fig 8.57
Interosseous crest of fibula, 75, fig 3.11 major arterial circle of, 422, fig 8.57
Interosseous ligaments, 37 Ischial spine, 62, fig 3.3, 64-65, fig 3.3-3.4,
Interosseous membrane of forearm, 24-25, 301-303, fig 7.1b-7.3, 337, fig 7.25
fig 2.12 Ischial tuberosity, 65, fig 3.4, 71-73, 301-303,
Interosseous metacarpal ligaments, 35, fig 2.19, 37 fig 7.1a-7.3
Interosseous sacroiliac ligament, 305-306, female, 336-338, fig 7.24-7.35
fig 7.4-7.5 Ischioanal fossa, 269-270, fig 6.34, 336, 338
Interphalangeal accessory collateral ligaments, anterior recess, 338
36-37, fig 2.20 Ischiocavernosus muscle, 307, fig 7.6, 310, 317-318,
Interphalangeal collateral ligaments, 36, fig 2.20 fig 7.12, 338
Interphalangeal joints of hand, 31-32, fig 2.16, 37 of female, 317, fig 7.12, 331, fig 7.21, 338
Interphalangeal ligaments of male, 333, fig 7.23
palmar, 34, fig 2.18, 37 Ischiocrural muscles, 70-73, fig 3.8-3.9
Interscapular region, 114, fig 4.1 biceps femoris muscle, 70, 73, fig 3.9, 105
Intersigmoid recess, 235, fig 6.10 semimembranosus muscle, 70, 73, fig 3.9, 105
Interspinales muscle(s) semitendinosus muscle, 70, fig 3.9, 73, 77, 105
cervicis, 139, fig 4.17, 143 Ischiofemoral ligaments, 68, fig 3.7
lumborum, 139, fig 4.17, 143 Ischiopubic ramus, 63, fig 3.2, 302-303, fig 7.2-7.3,
thoracis, 139, fig 4.17, 143 308
Interspinous ligament(s), 118, 122, fig 4.8 of hip bone, 337, fig 7.25
Interthalamic adhesion, 503, fig 9.7 Ischium
Intertragic incisure, 431, fig 8.66 body of, 63-64, fig 3.2-3.4, 270
Intertransverse ligament, 117-118, fig 4.3-4.4, ramus of, 63-65, fig 3.2-3.4
155, fig 5.7 Isthmus of fauces, 439, fig 8.74
Intertransversarii muscles, 143 Isthmus of thyroid gland, 471, fig 8.98
lumborum, 139, fig 4.17 Isthmus of uterine tube, 313, fig 7.10
colli, 139, fig 4.17
Intertrochanteric crest, 67 J
Intertrochanteric line, 67 Jejunum, 235-236, fig 6.10-6.11, 238, fig 6.12,
Intertubercular sulcus of humerus, 13-14, fig 2.3, 254-257, 259-260, fig 6.25-6.28
fig 2.4, 136, 157 definition of, 260
Interureteric crest, 328, fig 7.19 function, 259-260, fig 6.28
of female, 331-332, fig 7.21 lymphatics of, 265-266, fig 6.32, 297
of male, 330 Joint of head of rib see costocorporeal joint
Interventricular artery(ies) Joints
anterior, 197, fig 5.37, 212, 213, fig 5.47 ankle joint, 74, fig 3.10
inferior/posterior, 212-213, fig 5.47 elbow joint, 25-26, fig 2.12-2.13
Interventricular foramen (of Monro), 513, fig 9.14 hip joint, 67, fig 3.6
Interventricular septum, 205-206, fig 5.43, 210, synovial ball-and-socket joint, 68
fig 5.46, 212 knee joint, 67, fig 3.6
Interventricular sulcus complex synovial joint, 77-81, fig 3.12-3.16
anterior, 200-201, fig 5.39-5.40 shoulder joint, 17-21, fig 2.7-2.8
inferior, 201, fig 5.40 Joints of coccyx, 129
Intervertebral disc, 117, fig 4.4, 127 Joints of femur
Intervertebral foramina, 132, fig 4.14 hip joint, 67, fig 3.6
Intervertebral symphysis joints, 118, 123, 127 knee joint, 67, fig 3.6
Intervertebral veins, 132, fig 4.14, 531, fig 9.27 Joints of thoracic spine
Intervillous spaces of placenta, 320, fig 7.14 costocorporeal joints, 125
Intestinal arteries, 271, fig 6.35 costotransverse joints, 125, 154
Intestinal branch of vagus nerve, 561, fig 9.46 Joints see also individual joints
Index 591
Jugular foramen, 366, fig 8.8, 369, fig 8.11, 556, Knee joint
fig 9.43, 560, fig 9.45, 563, fig 9.47 (continued)
Jugular fossa of temporal bone, 379, fig 8.21 tibial collateral ligament, 79, fig 3.14
Jugular ganglion transverse ligament, 79, fig 3.14
inferior, 560, fig 9.45 menisci
superior, 560, fig 9.45 lateral, 79-81, fig 3.14-3.15
Jugular lymphatic trunk, 482, fig 8.108 medial, 79-80, fig 3.14-3.16
Jugular vein movements of, 80
external, 47, fig 2.28, 392, fig 8.31, 446, fig 8.80, muscles, 77, fig 3.12
473, fig 8.100, 476, fig 8.102 patellar retinaculum
internal, 47, fig 2.28, 366, 390-391, fig 8.29, lateral, 77, fig 3.12
392, fig 8.31, 432-433, 456, fig 8.87, medial, 77, fig 3.12
473, fig 8.100, 476, fig 8.102, 478, popliteus muscle, 78, fig 3.13, fig 3.15
fig 8.104, 484, fig 8.110, 489, fig 8.113 synovial membrane, 81, fig 3.16
left, 196, fig 5.36, 445, fig 8.79, 520, fig 9.19 tendon of quadriceps femoris muscle, 81,
right, 196, fig 5.36 fig 3.16
superior bulb of, 456, fig 8.87 Knee region, 62, fig 3.10
Jugular wall of tympanic cavity, 432-433,
fig 8.67-8.68 L
Jugulodigastric lymph node, 481-482, Labia minora, 337-338, fig 7.24-7.25
fig 8.107-8.108 frenulum of, 337-338, fig 7.25
Juguloomohyoid lymph node, 481-482, Labial artery
fig 8.107-8.108 inferior, 388, fig 8.27, 396, fig 8.35
Juxtacardial nodes, 292-295, fig 6.48-6.49 superior, 387, fig 8.26, 396, fig 8.35
Juxtaintestinal lymph nodes, 266, fig 6.32 nasal septal branch, 427, fig 8.62
Labial commissure
K anterior, 336-338, fig 7.24-7.35
Kidneys, 222, 235, 241-242, 277-279, fig 6.39-6.41, posterior, 337-338, fig 7.25
281, fig 6.42 Labial nerves
definition of, 278, fig 6.40 posterior, 341, fig 7.28
functions of, 277-278, fig 6.39-6.40 Labial vein
left, 239, fig 6.13, 241, fig 6.15 inferior, 390, fig 8.29, 392, fig 8.31
lymphatics of, 351, fig 7.34 superior, 391-392, fig 8.30-8.31
neurovasculature structures of, 278, fig 6.40 Labium majus of vulva, 310, fig 7.7, 337-338,
parts of, fig 6.39-6.40 fig 7.25
right, 240, fig 6.14, 241, fig 6.15, 243, fig 6.16 Labyrinthine artery, 398, fig 8.37, 516, fig 9.16
Knee and leg Labyrinthine (medial) wall of middle ear, 433,
fibula, 75-76, fig 3.11 fig 8.68
knee, 77-81, fig 3.12-3.16 Lacrimal apparatus, 423, fig 8.58
tibia, 74-75, fig 3.10 components of, 424, fig 8.59
Knee joint functions of, 424, fig 8.59
articular capsule of knee joint, 78, 81, fig 3.13, Lacrimal artery, 412-413, fig 8.47-8.48
fig 3.16 Lacrimal bone(s), 360, fig 8.2, 362, fig 8.4, 408,
articular cartilage of, 81, fig 3.16 fig 8.45, 425, fig 8.60
bursae of, 77, fig 3.12 Lacrimal canaliculus, 424, fig 8.59
fat pads of, 81, fig 3.16 Lacrimal caruncle, 424, fig 8.59
joints of Lacrimal gland, 424, fig 8.59
complex synovial joint, 77-81, fig 3.12-3.16 Lacrimal nerve, 394, fig 8.33, 414, fig 8.49,
patellofemoral joint, 77, 81, fig 3.12-3.16 416-418, fig 8.51-8.53, 544, fig 9.35
tibiofemoral joint, 77-81, fig 3.12-3.16 Lacrimal papilla, 424, fig 8.59
ligaments of Lacrimal sac, 424, fig 8.59
collateral ligament of knee joint Lacunae of urethra, 329, fig 7.20
fibular, 77-78, fig 3.12-3.13 Lacunar lymph node
tibial, 77-78, fig 3.12-3.13 intermediate, 296-297, fig 6.50
cruciate ligaments of knee female, 354-355, fig 7.36
anterior, 79-80, fig 3.14-3.15 medial
posterior, 80, fig 3.15 male, 353, fig 7.35
meniscofemoral ligament Lambdoid suture, 362-363, fig 8.4-8.5
posterior, 80, fig 3.15 Laminae of vertebral arch, 116, fig 4.3
meniscotibial ligament of thoracic vertebrae, 124, fig 4.9
anterior, 79, fig 3.14 Lamina of cricoid cartilage, 466, fig 8.93, 469,
medial, 79, fig 3.14 fig 8.96-8.97
patellar ligament, 77, fig 3.12, 81, fig 3.16 vertical ridge of, 465, fig 8.92
popliteal ligaments Lamina propria, 537, fig 9.31
arcuate, 77-78, fig 3.13 Large intestine, 267-268, fig 6.33
oblique, 77-78, fig 3.13 anal canal, 267-268, fig 6.33
posterior cruciate ligament, 79, fig 3.14 arteries of, 270-271, fig 6.35
posterior meniscofemoral ligament, 79, cecum, 267-268, fig 6.33
fig 3.14 colon, 267-268, fig 6.33

Large intestine Left internal jugular vein, 520, fig 9.19
(continued) Left lobe of liver, 238, fig 6.12, 243, fig 6.16, 248,
rectum, 267-268, fig 6.33 fig 6.20
vermiform appendix, 267-268, fig 6.33 Left lower quadrant of abdomen, 222, fig 6.1
Laryngeal artery Left marginal branch of circumflex artery of
superior, 396, fig 8.35, 456, fig 8.87 heart, 212-213, fig 5.47
Laryngeal inlet, 453, fig 8.85 Left (pulmonary) surface of heart, 201, fig 5.40
Laryngeal nerve Left semilunar valve see aortic (semilunar valve)
fold of, 453, fig 8.85 Left upper quadrant of abdomen, 222, fig 6.1
recurrent, left, 196, fig 5.36, 214, fig 5.48, Leg muscles
457-458, fig 8.88, 477, fig 8.103, 561, extensor digitorum longus muscle, 82, fig 3.17
fig 9.46 extensor hallucis longus muscle, 82, fig 3.17
right, 214, fig 5.48, 457-458, fig 8.88, 561, fibularis brevis muscle, 82, fig 3.17
fig 9.46 fibularis longus muscle, 82-83, fig 3.17-3.18
superior, 453, fig 8.85, 457-458, fig 8.88, 560, fibularis tertius, 82, fig 3.17
fig 9.45, 566, fig 9.49 flexor digitorum longus muscle, 82, fig 3.17
external branch of, 457-458, fig 8.88, 561, flexor hallucis longus muscle, 82, fig 3.17
fig 9.46 gastrocnemius muscle, 82, fig 3.17
internal branch of, 457-458, fig 8.88, 561, plantaris muscle, 82, fig 3.17
fig 9.46 popliteus muscle, 82, fig 3.17
Laryngeal saccule, 465, fig 8.92 soleus muscle, 82, fig 3.17
Laryngeal vein tibialis anterior muscle, 82, fig 3.17
superior, 456, fig 8.87 tibialis posterior muscle, 82, fig 3.17
Laryngopharynx, 453, fig 8.85, 464, 458, 559, 562 triceps surae muscle, 82, fig 3.17
Larynx, 457, 459-460, 462, 464-470, fig 8.91-8.97 Leg region, 62, fig 3.10
cartilages of, 470 Lens, 419-421, fig 8.54-8.56, 423, fig 8.58
function of, 464, 470 capsule of, 420, fig 8.55
innervation of, 470 Lentiform nucleus, 501, fig 9.6
ligaments of, 470 globus pallidus of, 501-502, fig 9.6
membranes of, 470 putamen of, 501-502, fig 9.6
muscles of, 470 Lesser occipital nerve (C2), 144, fig 4.18, 395,
spaces, 470 fig 8.34, 479-480, fig 8.105
Lateral as term of relationship, 2, fig 1.1 Lesser palatine nerve, 429, fig 8.64
Lateral atlantoaxial joints, 120, 123 Lesser sciatic notch, 64-65, fig 3.3-3.4, 82, fig 3.17
Lateral calcaneal branches of sural nerve, 107, Levator anguli oris, 384
fig 3.36 Levator ani muscle, 269-270, fig 6.34, 307-308,
Lateral cervical lymph nodes fig 7.6-7.7, 310, 316-318, fig 7.12,
deep, 481, fig 8.107 321-322, fig 7.15, 322
inferior, 482, fig 8.108 of female, 331, fig 7.21
superior, 482, fig 8.108 of male, 334-335, fig 7.22-7.23
superficial, 481-482, fig 8.107-8.108 nerve to, 342-343, fig 7.29
Lateral circumflex femoral artery, 103-104, tendinous arch of, 312, fig 7.9
fig 3.33, 106, fig 3.35 Levatores costarum muscle, 143
Lateral dorsal cutaneous nerve of foot, 111, Levator labii superioris alaeque nasi muscle,
fig 3.40 383-384, fig 8.25
Lateral femoral cutaneous nerve, 103, fig 3.33, 105 Levator labii superioris muscle, 383, fig 8.25
Lateral lumbosacral ligament, 127 Levator palpebrae superioris muscle, 410,
Lateral mass of atlas, 120, fig 4.6 fig 8.46, 418, fig 8.53, 541, fig 9.33
Lateral pectoral nerve, 43, fig 2.24 Levator scapulae muscle, 136, 483, fig 8.109, 489,
Lateral plantar artery, 112 fig 8.113, 479, fig 8.105
Lateral plantar nerve, 101-102, 107, fig 3.36, Ligamenta flava, 117-118, fig 4.4, 122, fig 4.8
111-112, fig 3.40 Ligament of head of femur, 68, fig 3.7
Lateral plate of pterygoid process of sphenoid Ligaments
bone, 370, fig 8.12, 375, fig 8.17 of elbow and forearm, 24
Lateral regions of abdomen of elbow joint, 25-26, fig 2.12
left, 221-222, fig 6.1 of fingers, 33-37, fig 2.16-2.20
right, 221-222, fig 6.1 of hip joint, 68, fig 3.7
Lateral sulcus of brain, 493, fig 9.1 of larynx, 470
Lateral tarsal artery, 111-112, fig 3.40 of ovary
Latissimus dorsi muscle, 135-136, fig 4.15 suspensory, 312, fig 7.9
Left atrioventricular valve, 206, fig 5.43 of pelvis, 304-306, fig 7.4-7.5
anterior leaflet, 208, fig 5.44 of shoulder joint, 17-18, fig 2.7-2.8
fibrous ring, 208, fig 5.44 Ligaments of atlantoaxial joint, 121, fig 4.7, 123
posterior leaflet, 208, fig 5.44 Ligaments of atlantooccipital joint, 121, fig 4.7, 123
Left colic artery, 271, fig 6.35 Ligaments of hip joint
descending branch, 271, fig 6.35 capsular ligaments, 68, fig 3.7
Left coronary artery, 212-213, fig 5.47 iliofemoral ligaments, 68, fig 3.7
Left hepatic artery, 251-252, fig 6.22-6.23, 285, ischiofemoral ligaments, 68, fig 3.7
fig 6.44 pubofemoral ligament, 68, fig 3.7
Index 593
Ligaments of hip joint Liver
intracapsular ligaments, 68, fig 3.7 umbilical fissure (for ligamentum teres and
ligament of head of femur, 68, fig 3.7 for ligamentum venosum), 249
transverse ligament of acetabulum, 68, functions of, 248, fig 6.20
fig 3.7 hepatic artery of, 251, fig 6.22
Ligaments of liver left, 251-252, fig 6.22-6.23
coronary ligament, 249, 250-252, fig 6.21-6.23 proper, 251-252, fig 6.22-6.23
falciform, 238, fig 6.12, 243, fig 6.16, 248-249, right, 251-252, fig 6.22-6.23
250, fig 6.21, 252 hepatic duct of
hepatogastric, 240, 248-249, fig 6.20, 252 common, 251-252, fig 6.22-6.23
hepatoduodenal, 248-249, fig 6.20 left, 251, fig 6.22
ligamentum venosum, 249 right, 251, fig 6.22
round, 238, fig 6.12, 248-251, fig 6.20-6.22 hepatic veins of, 241, fig 6.15, 251, fig 6.22
triangular intermediate, 252, fig 6.23
left, 248, fig 6.20 left, 252, fig 6.23
right, 248, fig 6.20 right, 252, fig 6.23
Ligaments see also individual ligaments portal, 235, fig 6.10, 251-252, fig 6.22-6.23
Ligamentum arteriosum, 192, fig 5.34, 197, fig 5.37 inferior border of, 248, fig 6.20
lymph node of, 194, fig 5.3 ligaments of
Ligamentum venosum, 249 coronary ligament, 249, 250-252,
Limbic association area of cerebrum, 497-498, fig 6.21-6.23
fig 9.3 falciform, 238, fig 6.12, 243, fig 6.16,
Limbic lobe of cerebrum, 494, fig 9.1 248-249, 250, fig 6.21, 252
Limb regions, 3, fig 1.2 hepatoduodenal, 248-249, fig 6.20
Limbus of fossa ovalis, 203, fig 5.41 hepatogastric, 240, 248-249, fig 6.20, 252
Linea alba, 5, 223-225, fig 6.2 ligamentum venosum, 249
Linea aspera, 67, fig 3.6 round, 238, fig 6.12, 248-251, fig 6.20-6.22
Lingual artery, 396, fig 8.35, 475, fig 8.101 triangular ligament
dorsal, 445, fig 8.79 left, 248, fig 6.20
Lingual branches of glossopharyngeal nerve, 556, right, 248, fig 6.20
fig 9.43 lobes of
Lingual frenulum, 446, fig 8.80 caudate, 248-249, fig 6.20, 251-252,
Lingual gland fig 6.22-6.23
posterior, 441, fig 8.76 left, 238, fig 6.12, 243, fig 6.16, 250, fig 6.21
Lingual lymph nodes of head and neck, 480, right, 238, fig 6.12, 243, fig 6.16, 250-251,
fig 8.106 fig 6.21-6.22
Lingual nerve, 445, fig 8.79, 549-551, fig 9.39, 566, quadrate, 248, fig 6.20, 251, fig 6.22
fig 9.49 lymphatics of, 292-295, fig 6.48-6.49
branch to submandibular ganglion, 549, fig 9.39 deep pathway, 295
lingual branches of, 549, fig 9.39 superficial pathway, 294
Lingual papillae, 441, fig 8.76 porta hepatis, 251-252, fig 6.22, 285, fig 6.44, 294
filiform, 441, fig 8.76 quadrate lobe of, 252, fig 6.23
foliate, 441, fig 8.76 related gallbladder, 253, fig 6.24
fungiform, 441, fig 8.76 right lobe, 252, fig 6.23
vallate, 441, fig 8.76 surfaces of
Lingual tonsil, 440-441, fig 8.75-8.76 diaphragmatic, 250, fig 6.21
crypt of, 441, fig 8.76 visceral surface of, 250, fig 6.21
Lingual vein umbilical vein of, 250, fig 6.21
dorsal, 445, fig 8.79 Lobar bronchi, 186, fig 5.28, 191, fig 5.33
Lingula of mandible, 191, 381 superior, 191
Liver, 235, fig 6.10, 240, fig 6.14, 248-252, intermediate, 191
fig 6.20-6.23 inferior, 191
arteries of, 285-286, fig 6.44 Lobes of cerebellum
bare area of, 250-252, fig 6.21-6.23 anterior, 510, fig 9.12
bile duct, 251, fig 6.22 flocculonodular, 510, fig 9.12
caudate lobe of, 251-252, fig 6.22-6.23 frontal, 493-496, fig 9.1-9.2
caudate process of, 251-252, fig 6.22-6.23 insular, 493-496, fig 9.1-9.2
coronary ligament of limbic, 493-496, fig 9.1-9.2
posterior part of, 251-252, fig 6.22-6.23 occipital, 493-496, fig 9.1-9.2
cystic artery of, 251-252, fig 6.22-6.23 parietal, 493-496, fig 9.1-9.2
cystic duct of, 251-252, fig 6.22-6.23 posterior, 510, fig 9.12
diaphragmatic surface of, 241, fig 6.15, 250, temporal, 493-496, fig 9.1-9.2
fig 6.21 Lobes of liver
fibrous appendix of, 250-252, fig 6.21-6.23 caudate, 248-249, fig 6.20, 251-252, fig 6.22-6.23
fissures of left, 238, fig 6.12, 243, fig 6.16, 250, fig 6.21
main portal fissure, 249 right, 238, fig 6.12, 243, fig 6.16, 250-251,
right portal fissure, 249 fig 6.21-6.22
left portal fissure, 249 quadrate, 248, fig 6.20, 251, fig 6.22

Lobes of thyroid gland Lumbar spine, 115-116, fig 4.2, 126-127, fig 4.10
isthmus lobe, 471, fig 8.98 articular process of
left lobe, 471, fig 8.98 superior, 126
pyramidal lobe, 471, fig 8.98 joints of, 127
right lobe, 471, fig 8.98 vertebrae of L1-L5, 127
Lobule of ear, 430-431, fig 8.65-8.66 Lumbar splanchnic nerve (L1-L2), 273-274, 278,
Lobules of cerebellum 311, 322
quadrangular lobule of female, 345-346, fig 7.31
anterior, 509, fig 9.11 of male, 344-345, fig 7.30
posterior, 509, fig 9.11 Lumbar veins, 132, fig 4.14, 145, fig 4.19, 231-232,
semilunar fig 6.6-6.7
inferior, 509, fig 9.11 ascending, 233, fig 6.8
superior, 509, fig 9.11 Lumbar vertebrae, 127
Longissimus capitis muscle, 138, fig 4.16, 141 Lumbosacral enlargement, 524, fig 9.22
Longissimus cervicis muscle, 138, fig 4.16, 141 Lumbosacral joint, 127, 129, 306, fig 7.2-7.5
Longissimus thoracis muscle, 138, fig 4.16, 141 type, 127
Longitudinal ligament articular surfaces of, 127
anterior, 117-118, fig 4.4, 122, fig 4.8, 304, 306, ligaments of, 127
fig 7.4-7.5 movements of, 127
posterior, 117-118, fig 4.4, 122, fig 4.8, 132, fig 4.14 Lumbosacral ligament
Longitudinal muscle(s) of tongue lateral, 304-306, fig 7.4-7.5
inferior, 442-444, fig 8.77-8.78 Lumbosacral plexus, 283, 342-343, fig 7.29
superior, 442-444, fig 8.77-8.78 Lumbosacral trunk, 283, fig 6.43, 342-343, fig 7.29
Long posterior ciliary arteries, 413, 422, fig 8.57 male pelvis, 344-345, fig 7.30
Long thoracic nerve, 43, fig 2.24 Lumbrical muscles of hand, 38-39, fig 2.21-2.22
Longus capitis muscle, 460, fig 8.90, 463 Lunate bone, 31-32, fig 2.16
Longus colli muscle, 43, fig 2.24, 460, fig 8.90, Lung, 184-195, fig 5.27-5.35
463, 489, fig 8.113 apex of, 190-192, fig 5.32-5.34
Lower limb hilum of, 190-191, fig 5.32-5.33
ankle and foot, 86-102, fig 3.19-3.32 lymphatics of, 194-195, fig 5.35
hip and thigh, 63-73, fig 3.2-3.9 respiratory system, 184-195, fig 5.27-5.35
knee and leg, 74-85, fig 3.10-3.18 right, middle lobe of, 192, fig 5.34
regions of, 62, fig 3.1 surface projections of, 193
Lumbar arteries, 131, 145, fig 4.19, 230, fig 6.5, Lung left
232-233, fig 6.7-6.8 lateral view, 190-191, fig 5.32-5.33
Lumbar ganglion of sympathetic trunk, 344, fig 7.30 medial view, 190-191, fig 5.32-5.33
of female pelvis, 345, fig 7.31 Lung right
Lumbar joints lateral view, 190-191, fig 5.32-5.33
facet joints, 127 medial view, 190-191, fig 5.32-5.33
intervertebral symphyseal joints, 127 Lunotriquetral interosseous ligament, 35, fig 2.19,
lumbosacral joint, 127 37
Lumbar lordosis, 115, fig 4.2 Lymphatic duct
Lumbar lymphatic trunk, 295-297, fig 6.50 right, 482, fig 8.108
right, 351, fig 7.34 Lymphatics of female genitalia, 354-355, fig 7.36
female, 354-355, fig 7.36 Lymphatics of heart, 217-218, fig 5.50
Lumbar lymph nodes, 281, 351, fig 7.34 Lymphatics of urinary bladder, 351, fig 7.34
right lumbar (caval), 295-297, fig 6.50 Lymphatics of urinary organs, 350-351, fig 7.34
male, 353, fig 7.35 Lymphatics of abdomen, 297
intermediate lumbar, 295-297, fig 6.50 Lymphatic plexuses of the heart
female, 354-355, fig 7.36 myocardiac plexus, 218
male, 353, fig 7.35 subendocardiac plexus, 218
left (aortic), 295-297, fig 6.50 subepicardiac plexus, 218
female, 354-355, fig 7.36 Lymphatics of diaphragm, 182, fig 5.26
male, 352, 353, fig 7.35 Lymphatics of duodenum, 265, 290-291, fig 6.47,
Lumbar lymph trunks, 350-351 297
Lumbar nerves Lymphatics of female genitalia, 354-355, fig 7.36
anterior rami of, 345-346, fig 7.31 Lymphatics of gall bladder, 292-295,
ganglion of sympathetic trunk, 344, fig 7.30 fig 6.48-6.49
of female pelvis, 345, fig 7.31 Lymphatics of head and neck, 480-483,
splanchnic nerve fig 8.106-8.108
of female, 345-346, fig 7.31 cervical lymph nodes
of male, 344-345, fig 7.30 anterior, 482, fig 8.108
Lumbar plexus, 104-105, 283-284, fig 6.43 lateral, 483
function of, 281, 284 Lymphatics of ileum
of female pelvis, 345-346, fig 7.31 Lymphatics of jejunum
roots of, 281, 284 Lymphatics of liver, 292-295, fig 6.48-6.49
Lumbar region, 114, fig 4.1 Lymphatics of male genitalia, 353, fig 7.35
left, 295-297, fig 6.50 Lymphatics of male urethra, 351, fig 7.34
right, 295-297, fig 6.50 Lymphatics of pancreas, 290-291, fig 6.47
Index 595
Lymphatics of pelvic wall, 295-297, fig 6.50 Mandible
Lymphatics of posterior abdominal wall, 295-297, (continued)
fig 6.50 oblique line of mandible, 381, fig 8.23
Lymphatics of spleen, 290-291, fig 6.47 pterygoid fovea of, 381-382, fig 8.23-8.24
Lymphatics of stomach, 292-295, fig 6.48-6.49 ramus of, 360, fig 8.2, 380, fig 8.22
Lymphatic trunk sublingual fossa of, 382, fig 8.24
left coronary, 117, fig 5.50 submandibular fossa of, 382, fig 8.24
right coronary, 117, fig 5.50 Mandibular foramen, 362, fig 8.4, 381, fig 8.23
Lymphatic trunk and ducts of head and neck, 480, Mandibular fossa of temporal bone, 366, fig 8.8,
fig 8.106 379, fig 8.21
Lymph nodes see also individual lymph nodes Mandibular lymph nodes, 480, fig 8.106
Lymphoid nodule, 441, fig 8.76 Mandibular nerve (CN V3), 393, 533-535,
fig 9.28-9.29, 545, fig 9.36, 547-550,
M fig 9.38-9.39, 552, fig 9.41, 566,
Main bronchus, 191 fig 9.49
Major arterial circle of iris, 422, fig 8.57 anterior division of, 548-549, fig 9.38-9.39
Malar lymph node, 480, fig 8.106 auriculotemporal nerve branch of, 431,
Male pelvic cavity, 321-325, fig 7.15-7.17 fig 8.66
blood supply of, 322 branches of, 550
digestive organs of, 322 function of, 550
innervation of, 322 meningeal branch of, 366, 548-549,
peritoneal pouches of, 322 fig 9.38-9.39
reproductive organs of, 322 motor branches of, 394, fig 8.33
urinary organs of, 322 posterior division of, 548-549, fig 9.38-9.39
walls and floors of, 322 structure and features, 549
Malleolar artery tensor tympani of, 434
anterior lateral, 108, fig 3.37 Mandibular notch, 380, fig 8.22
medial, 108, fig 3.37 Marginal artery of colon (of Drummond), 270-271,
Malleolar groove of tibia, 74, fig 3.10 fig 6.35, 275, fig 6.37
Malleolus(i) of fibula Marginal branch of circumflex artery of heart
lateral malleolus, 5, fig 1.4, 75, fig 3.11 left, 212, fig 5.47
medial malleolus, 75, fig 3.11 Marginal branch of right coronary artery, 213
Malleolus(i) of tibia Marginal vein of heart
medial, 74-75, fig 3.10 left, 212, fig 5.47
lateral, 74-75, fig 3.10 right, 212, fig 5.47
Malleus, 433-434, fig 8.68-8.69 Masseteric artery, 389, fig 8.28, 396, fig 8.35
handle of, 434, fig 8.69 Masseteric nerve, 400, 548-549, fig 9.38-9.39
head of, 434, fig 8.69 Masseteric tuberosity of mandible, 381, fig 8.23
ligament of Masseteric vein, 392, fig 8.31
anterior, 434, fig 8.69 Masseter muscle, 399-400, fig 8.38-8.39, 446,
superior, 434, fig 8.69 fig 8.80
neck of, 434, fig 8.69 deep part of, 399, fig 8.38
process of superficial part of, fig 8.38
anterior, 434, fig 8.69 Mastication
lateral, 434, fig 8.69 muscles of, 399-400, fig 8.38
Mammillary body, 503, fig 9.7 Mastoid foramen, 362, fig 8.4, 366, fig 8.8
Mammillary processes of lumbar vertebrae, 127 Mastoid foramen of temporal bone, 379, fig 8.21
Mandible, 362, fig 8.4, 380-382, fig 8.22-8.24, Mastoid lymph nodes, 481, fig 8.107
401, fig 8.40, 450, 455, 461 Mastoid notch of temporal bone, 366, fig 8.8, 377,
angle of, 380, fig 8.22 379, fig 8.19, fig 8.21
articulations of, 382, fig 8.24 Mastoid process of temporal bone, 360-361,
body of, 360, fig 8.2, 380, fig 8.22 fig 8.2-8.3, 365, fig 8.7, 377, 379,
alveolar part, 380, fig 8.22 fig 8.19, fig 8.21, 401, fig 8.40
base part, 380, fig 8.22 Mastoid region, 359, fig 8.1
bony features of, 382, fig 8.24 Mastoid wall of tympanic cavity, 432-433,
condylar process of, 380, fig 8.22 fig 8.67-8.68
coronoid process of, 380, fig 8.22 Maternal circulation, 320, fig 7.14
digastric fossa of, 382, fig 8.24 Maxilla, 360, fig 8.2, 362, fig 8.4, 364, fig 8.6, 371,
interalveolar septa of, 381, fig 8.23 fig 8.13, 404, fig 8.41, 408, fig 8.45
lingula of, 190-191, fig 5.32-5.33, 381, fig 8.23 alveolar process of, 360, fig 8.2, 365, fig 8.7,
main parts, 382, fig 8.24 370, fig 8.12
mandibular foramen, 362, fig 8.4, 381, fig 8.23 anterior nasal spine of, 360, fig 8.2, 370, fig 8.12
mandibular notch, 380, fig 8.22 frontal process of, 360, fig 8.2, 408, fig 8.45
masseteric tuberosity of, 381, fig 8.23 infraorbital foramen of, 360, fig 8.2
mental foramen of, 360, fig 8.2, 381, fig 8.23 nasal surface of, 425, fig 8.60
mental protuberance of, 381, fig 8.23 orbital surface of, 408, fig 8.45
mental spines of, 382, fig 8.24 palatine process of, 371, fig 8.13, 362, fig 8.4,
mylohyoid groove of, 381, fig 8.23 365, fig 8.7, 426, fig 8.61
mylohyoid line of, 381, fig 8.23 zygomatic process of, 360, fig 8.2

Maxillary artery, 389, fig 8.28, 396, fig 8.35, 398, Membranes of larynx, 470
fig 8.37, 412, fig 8.47, 427, fig 8.62 Membranous ampulla of membranous labyrinth
branches of, 389 anterior, 436, fig 8.71
deep auricular artery of, 431, fig 8.66 lateral, 436, fig 8.71
pharyngeal branch of, 396, fig 8.35 posterior, 436, fig 8.71
pterygopalatine part of, 406, fig 8.43 Membranous labyrinth
Maxillary nerve (CN V2), 393, 405, fig 8.42, 412, anterior semicircular duct of, 436, fig 8.71
fig 8.47, 414-416, fig 8.49, fig 8.51, Membranous limb of membranous labyrinth
533-535, fig 9.28-9.29, 545, fig 9.36, common, 436, fig 8.71
549, fig 9.39, 551, fig 9.40, 566, fig 9.49 Membranous part of male urethra, 329, fig 7.20
branches of, 547 Membranous wall (tympanic membrane) see also
branches to pterygopalatine ganglion, 545, tympanic membrane
fig 9.36 Meningeal artery
function of, 547 accessory, 366, 396, fig 8.35
meningeal branch of, 545, fig 9.36 middle, 366, 396, fig 8.35, 548-549,
structure and features of, 546 fig 9.38-9.39
Maxillary surface of greater wing of sphenoid posterior, 366, 396, fig 8.35
bone, 375, fig 8.17 Meningeal branches of vertebral artery, 398,
Maxillary vein, 407, fig 8.44 fig 8.37
Medial as term of relationship, 2, fig 1.1 Meningeal layer of cranial dura mater, 511,
Medial border of fibula, 75-76, fig 3.11 fig 9.13
Medial border of tibia, 74, fig 3.10 Meningeal spaces
Medial calcaneal branches of sural nerve, 107, epidural, 513
fig 3.36, 112 subarachnoid, 511, fig 9.13, 513
Medial circumflex femoral artery, 104 subdural, 511, fig 9.13, 513
Medial cluneal nerve(s), 104-105, fig 3.34 subpial, 511, fig 9.13, 513
Medial dorsal cutaneous nerve of foot, 112 Meninges, 511-512, fig 9.13-9.14
Medial eminence of rhomboid fossa, 507, fig 9.10 arachnoid mater, 511-512, fig 9.13
Medial lobe of right lung, 190-191, fig 5.32-5.33 definition of, 512
Medial malleolus of tibia, 74, fig 3.10 dura mater, 511-512, fig 9.13
Medial plantar artery, 111, fig 3.39 function of, 512
Medial plantar nerve, 107, fig 3.36, 111-112, fig 3.40 pia mater, 511-512, fig 9.13
Medial plate of pterygoid process of sphenoid Meningohypophyseal trunk, 398, fig 8.37
bone, 370, fig 8.12, 375, fig 8.17 Mental foramen of mandible, 360, fig 8.2, 381,
Medial tarsal artery, 111-112, fig 3.40 fig 8.23
Medial thigh muscle, 69, fig 3.8, 72-73 Mentalis muscle, 383-384, fig 8.25
Median artery, 50, fig 2.31 Mental nerve, 394, fig 8.33, 549, fig 9.39
Median atlantoaxial joint, 121, 123 Mental protuberance of mandible, 381, fig 8.23
Median fissure of spinal cord Mental region, 359, fig 8.1
anterior, 525, fig 9.23 Mental spines of mandible, 382, fig 8.24
Median nerve, 43, fig 2.24, 48, fig 2.29, 54, fig 2.35 Mental tubercle, 381, fig 8.23
common palmar digital branches of, 59, fig 2.40 Mental vein, 392, fig 8.31
communicating branch of, 54, fig 2.35 Mesenteric artery
muscular branches of, 54, fig 2.35 inferior, 241, fig 6.15, 270, 271, fig 6.35, 273, 275,
palmar branch of, 59, fig 2.40 fig 6.37, 281, fig 6.42
palmar digital branch of in male, 347, fig 7.32
proper, 59, fig 2.40 of large intestine, 270-271, fig 6.35, 275-276,
recurrent branch of, 59, fig 2.40 fig 6.37-6.38
Median palatine suture, 365, fig 8.7 superior, 235, fig 6.10, 254-255, 257-258,
Median plane, 2, fig 1.1 fig 6.27, 261-262, fig 6.29, 270, 271,
Median sacral artery, 131 fig 6.35, 273-274, 279-280, 287-289,
Median umbilical ligament of urinary bladder, 327, fig 6.45-6.46
fig 7.18 of large intestine, 270, 271, fig 6.35
Mediastinum, 6-7, fig 1.5 of pancreas, 255
Medulla oblongata, 493-494, fig 9.1, 503, fig 9.7, Mesenteric ganglion
505-508, fig 9.8-9.10, 556, fig 9.43 inferior, 273, fig 6.36
functions of, 507-508, fig 9.10 superior, 264, fig 6.31, 561, fig 9.46
major landmarks of, 507-508, fig 9.10 Mesenteric lymph nodes
pyramid of, 505-506, fig 9.8-9.9 inferior, 296, fig 6.50
Medulla of kidney, 278, fig 6.40 intermediate, 266, fig 6.32
Medullary cone, 524, fig 9.22 superior, 265-266, fig 6.32, 290-291, fig 6.47,
Medullary striae of fourth ventricle, 507, fig 9.10 294, 296, fig 6.50
Medullary vein Mesenteric plexus, 263-264, fig 6.31
posteromedian, 521, fig 9.20 inferior, 273, fig 6.36
Medullary velum superior, 263-264, fig 6.31, 273, fig 6.36
inferior, 505, fig 9.8 Mesenteric vein
superior, 505, fig 9.8, 507, fig 9.10 inferior, 276, 289, fig 6.46
Meissner’s plexus see submucosal plexus superior, 255, 257, fig 6.27, 287-289,
(Meissner’s plexus) fig 6.45-6.46
Index 597
Mesentery, 236-237, fig 6.11, 267, fig 6.33 Midsagittal skull, 370-371, fig 8.12-8.13
definition of, 237 neurocranium, 370, fig 8.12
function of, 237 viscerocranium, 370, fig 8.12
mesoappendix, 235, fig 6.10 Mitral valve see left atrioventricular
mesocolon (mitral/bicuspid) valve
transverse, 235, fig 6.10 Modiolus, 437, fig 8.72
proper, 259, fig 6.28 Molar teeth, 448-449, fig 8.81-8.82
related liver, 248, fig 6.20 Mons pubis, 338
root of, 241, fig 6.15, 254, fig 6.25 Motor and sensory cortical homunculus(i), 499,
sigmoid, 235, fig 6.10 fig 9.4
small intestine, 236, fig 6.11 Motor, sensory and association cortices
structure of, 23 7 of cerebrum, 497, fig 9.3
Mesoappendix, 235, fig 6.10, 237, 267, fig 6.33 Mucosa
Mesocolic tenia, 267, fig 6.33 of ileum, 260
Mesocolon of jejunum, 260
sigmoid, 236-237, fig 6.11, 241, fig 6.15, 267-268, of male urinary bladder, 330
fig 6.33, 321, fig 7.15 of stomach, 244, fig 6.17
transverse, 236-240, fig 6.10-6.13, 267-268, Mucosa of gastric wall, 245
fig 6.33, 271, fig 6.35 Mucosa of tongue, 442, fig 8.77
Mesometrium, 313-314, fig 7.10-7.11 Mucus plug, 319, fig 7.13-7.14
Mesosalpinx, 313-314, fig 7.10-7.11 Multifidus muscle, 138, fig 4.16, 142, 489,
Mesovarium, 314, fig 7.11 fig 8.113
Metacarpal arteries Muscle(s)
dorsal, 57, fig 2.38 of arm, 19-21, fig 2.9
palmar, 56, fig 2.37 of anterior neck, 460-463, fig 8.90
palmar, perforating branches, 56, fig 2.37 of arm and shoulder, 19-21, fig 2.2-2.9
Metacarpal bones, 31-32, fig 2.16 of elbow and forearm, 27-30, fig 2.14-2.15
Metacarpal ligaments of ear
deep transverse, 34, fig 2.18 extrinsic, 431, fig 8.66
dorsal, 35, fig 2.19 intrinsic, 431, fig 8.66
palmar, 34, fig 2.18 of eyeball, 410, fig 8.46
Metacarpal veins of hand, 38-41, fig 2.21-2.22
dorsal, 58, fig 2.39 of heart (myocardium), 215
palmar, 58, fig 2.39 of hip and thigh, 69-73, fig 3.8-3.9
Metacarpophalangeal joint, 30-31, fig 2.16, 34, of larynx
37, 40-41 extrinsic, 470
Metacarpophalangeal ligaments intrinsic, 470
palmar, 34, fig 2.18, 37 of leg, 82-85, fig 3.17-3.18
Metatarsal arteries of orbit, 408, fig 8.45
dorsal, 111, fig 3.39 of pharynx, 454, fig 8.86
plantar, 111, fig 3.39 of rotator cuff, 17-18, 21, fig 2.7-2.8
Metatarsal region, 62, fig 3.10 of tongue, 442-444, fig 8.77-8.78
Midbrain, 493-494, fig 9.1, 501, 503, fig 9.8, Muscles see also individual muscles
505-507 Muscular branches of brachial plexus, 43,
functions of, 507, fig 9.10 fig 2.24
major landmarks of, 507, fig 9.10 Muscular branches of femoral nerve, 103,
Midcarpal joint, 31, fig 2.16 fig 3.33
Middle anorectal plexus of male, 344, fig 7.30 Muscular branches of ophthalmic artery, 412,
Middle cardiac vein, 212-213, fig 5.47 fig 8.47
Middle cervical ganglion, 214, fig 5.48, 457, Muscular coat (muscularis externa) of stomach,
fig 8.88 244, fig 6.17
Middle colic artery, 235, fig 6.10, 238-239, circular layer of, 244-245, fig 6.17
fig 6.12-6.13 circular muscular fibers of, 244, fig 6.17
left branch of, 271, fig 6.35 longitudinal layer of, 244-245, fig 6.17
ascending branch of, 271, fig 6.35 longitudinal muscle fibers of, 244, fig 6.17
right branch of, 271, fig 6.35 oblique muscular fibers of, 244, fig 6.17
ascending branch of, 271, fig 6.35 of gastric wall, 245
Middle ear Muscular coat of duodenum
arterial supply of, 433, fig 8.68 circular layer of, 257, fig 6.27
auditory ossicles, 433, fig 8.68 longitudinal layer of, 244, fig 6.17
function of, 434, fig 8.69 Muscularis externa of stomach see muscular coat
innervation of, 434, fig 8.69 (muscularis externa) of stomach
muscles of, 433, fig 8.68 Muscular layer of urinary bladder, 328, fig 7.19
parts of, 433, fig 8.68 Muscular (omotracheal) triangle of neck, 485
walls of, 433, fig 8.68 Muscular process of arytenoid cartilage, 465,
Middle glenohumeral ligament, 17-18, fig 2.7-2.8 fig 8.92, 467, fig 8.94, 469,
Middle phalanx of hand, 31, fig 2.16 fig 8.96-8.97
Middle tibiofibular joint, 75, fig 3.1 Muscular triangle of neck, 483, fig 8.109

Musculocutaneous nerve, 43, fig 2.24, 48, fig 2.29 Neck
Musculophrenic artery, 231, 233, fig 6.8 anterior
Musculotendinous structures of diaphragm, muscles of, 460-463, fig 8.90
226-227, fig 6.3 infrahyoid muscles, 460, fig 8.90, 462
Myelin, 500, fig 9.5 prevertebral, 460, fig 8.90, 463
Myenteric plexus (plexus of Auerbach), 263-264, scalene, 460-461, fig 8.90
fig 6.31 superficial, 460-461, fig 8.90
large intestine, 272 suprahyoid muscles, 460, fig 8.90, 462
small intestine, 274 arteries of, 475, fig 8.101
Mylohyoid groove of mandible, 381, fig 8.23 autonomic nerves, 477, fig 8.103
Mylohyoid line of mandible, 381, fig 8.23 brachial plexus, 477, fig 8.103
Mylohyoid muscle, 394, 403, 439, 446-447, cervical plexus, 477, fig 8.103
fig 8.80, 460, fig 8.90, 462, 470, 483, compartments of, 486
fig 8.109 contents of, 489, fig 8.113
Myocardium see heart muscle (myocardium) cranial nerves, 477, fig 8.103
Myometrium of uterus, 313-314, fig 7.10-7.11, internal structures of
319-320, fig 7.13-7.14 vascular compartments, 486
vertebral compartment, 486
N visceral compartment, 486
Nasal artery neurovasculature of, 474-478, fig 8.101-8.104
dorsal, 388-389, fig 8.28, 412-413, fig 8.47 triangles of, 483-485, fig 8.109-8.110
lateral, 397 Neck of femur, 66-67, fig 3.5-3.6
Nasal bone, 360, fig 8.2, 362, fig 8.4, 408, Neck of fibula, 75-76, fig 3.11
fig 8.45, 425, fig 8.60 Neck of glans penis, 334, fig 7.22
Nasal cartilage Neck of tooth, 451, fig 8.83
lateral, 425, fig 8.60 Neck of urinary bladder
Nasal cavity, 425, fig 8.60 of female, 331, fig 7.21
apertures of, 426, fig 8.61 Nerve of clitoris
boundaries of, 426, fig 8.61 dorsal, 341, fig 7.28
function of, 426, fig 8.61 Nerve of penis
nerves of, 429, fig 8.64 dorsal, 344-345, fig 7.30
olfactory region of, 425, fig 8.60 Nerves and vessels see Neurovasculature
respiratory region of, 425, fig 8.60 Nerves of anterolateral wall of abdomen,
skeletal framework of, 426, fig 8.61 232-233, fig 6.7-6.8
vestibule region of, 425, fig 8.60 Nerves of heart, 214-216, fig 5.48-5.49
Nasal concha of ethmoid bone Nerves of nasal cavity, 429, fig 8.64
inferior, 424, fig 8.59 Nerves of neck, 477, fig 8.103
middle, 371-373, fig 8.13-8.15, 424-425, Nerves of orbit, 416, fig 8.51
fig 8.59, 453, fig 8.85 Nerves of pharynx, 457-458, fig 8.88
superior, 371-373, fig 8.13-8.15 Nerves see also individual nerves
Nasalis muscle, 383, fig 8.25, 385 Nerve to levator ani muscle, 342, fig 7.29
Nasal meatus Nerve to obturator internus muscle, 342, fig 7.29
inferior, 424-426, fig 8.59-8.60 Nerve to piriformis muscle, 342, fig 7.29
middle, 373, 426, fig 8.60 Nerve to quadratus femoris muscle, 342, fig 7.29
superior, 372, fig 8.14, 426, fig 8.60 Neurocranium, 360, fig 8.2, 371, fig 8.13
Nasal region, 359, fig 8.1 Neurovasculature
Nasal septum, 372-373, 375, 389, 425-427, of abdominal wall, 230-233, fig 6.5-6.8
fig 8.60-8.61, 453, fig 8.85 of anal canal, 275-276, fig 6.37-6.38
cartilage of, 426, fig 8.61 of arm and shoulder, 44-50, fig 2.25-2.31
posterior process of, 426, fig 8.61 of back, 144-146, fig 4.18-4.19
Nasal spine of maxilla of brachial plexus, 42-43, fig 2.23-2.24
anterior, 360, fig 8.2, 370, fig 8.12 of elbow and forearm, 50-55, fig 2.31-2.36
Nasal veins of foot, 110-112, fig 3.39-3.40
external, 392, fig 8.31 of hand and wrist, 56-60, fig 2.37-2.42
Nasociliary nerve, 414-418, fig 8.49-8.53, of heart, 214-216, fig 5.48-5.49
543-544, fig 9.35-9.35 of hip and thigh, 103-107, fig 3.33-3.36
branch to ciliary ganglion, 414, fig 8.49, 416, of knee and leg, 108-112, fig 3.37-3.40
fig 8.51, 544, fig 9.35 of neck, 474-478, fig 8.101-8.104
Nasofrontal vein, 392, fig 8.31 of rectum, 275-276, fig 6.37-6.38
Nasolabial lymph nodes, 480, fig 8.106 of spleen, 247, fig 6.19
Nasolacrimal duct, 424, fig 8.59 of tongue, 445, fig 8.79
opening of, 424, fig 8.59 of ureter, 330
Nasopalatine nerve, 366, 405, fig 8.42, 429, Nodule of cerebellum, 510, fig 9.12
fig 8.64, 545, fig 9.36, 546-547, Nonarticular ligaments, 306
fig 9.37 Notch of cerebellum
Nasopharynx, 453, fig 8.85 anterior, 509, fig 9.11
Navicular fossa of male urethra, 329, fig 7.20, posterior, 509-510, fig 9.11-9.12
335, fig 7.23 Nuchal ligament, 118, 122, fig 4.8, 489, fig 8.113
Index 599
Nuchal line Occipital artery, 144, fig 4.18, 389, fig 8.28, 396,
inferior fig 8.35, 398, fig 8.37, 456, fig 8.87
of occipital bone, 362, fig 8.4 medial, 517, fig 9.17
superior calcarine branch of, 517, fig 9.17
of occipital bone, 362, fig 8.4, 365, fig 8.7 dorsal branch to corpus callosum, 517,
supreme fig 9.17
of occipital bone, 362, fig 8.4 parietooccipital branch of, 517, fig 9.17
Nucleus accumbens, 501-502, fig 9.6 Occipital bone, 361-364, fig 8.3-8.6, 367, fig 8.9,
Nucleus ambiguus, 556, fig 9.43, 560, fig 9.45, 371, fig 8.13
563, fig 9.47 basilar part of, 122, fig 4.8, 370, fig 8.12
Nucleus of oculomotor nerve, 541, fig 9.33 clivus of, 369, fig 8.11
Nucleus pulposus, 127 condylar fossa of, 366, fig 8.8
Nucleus of solitary tract, 560, fig 9.45 nuchal line
Nutrient artery of humerus, 44, fig 2.25 inferior, 362, fig 8.4, 365, fig 8.7
Nutrient artery of radius, 50, fig 2.31 superior, 362, fig 8.4, 365, fig 8.7
Nutrient artery of ulna, 50, fig 2.31 supreme, 362, fig 8.4
Nutrient branches, 131 pharyngeal tubercle of, 365, fig 8.7
small branches of, 431, fig 8.66
O Occipital condyle(s), 123, 362, fig 8.4, 365, fig 8.7
Oblique arytenoid muscle, 468, fig 8.95 Occipital crest
Oblique cord, 24-25, fig 2.12 external, 365, fig 8.7
Oblique fibers of muscular coat of stomach, 244, internal, 369, fig 8.11
fig 6.17 Occipital lobe of cerebrum, 493-496, fig 9.1-9.2
Oblique fissure of right lung, 190-191, Occipital lymph nodes, 481, fig 8.107
fig 5.32-5.33 Occipital margin of temporal bone, 377-379,
Oblique line of mandible, 381, fig 8.23 fig 8.19-8.21
Oblique muscle(s) Occipital nerve
external abdominal, 223-224, fig 6.2 greater, 395, fig 8.34
inferior, 410-411, fig 8.46, 541, fig 9.33 lesser, 395, fig 8.34
internal abdominal, 223-224, fig 6.2 third, 144, fig 4.18
superior, 410-411, fig 8.46, 418, fig 8.53, 542, Occipital protuberance
fig 9.34 external, 362, fig 8.4, 365, fig 8.7
trochlea of, 410, fig 8.46 internal, 369, fig 8.11
Oblique muscle(s) see also obliquus capitis muscle Occipital region, 359, fig 8.1
Oblique vein of left atrium, 212, fig 5.47 Occipital sinus, 520, fig 9.19
Obliquus auriculae muscle, 431, fig 8.66 Occipital triangle of neck, 483, fig 8.109, 485
Obliquus capitis muscle Occipital vein, 144, fig 4.18
inferior, 135, fig 4.15, 140 internal, 521, fig 9.20
superior, 140 Occipitofrontalis muscle, 385
Obliquus capitis muscle see also Oblique Occipitomastoid suture, 362, fig 8.4, 365, fig 8.7
muscle(s) Ocular bulb, 539, fig 9.32
Obturator Oculomotor nerve (CN III), 412, fig 8.47, 414-416,
canal of, 311, fig 7.8 fig 8.49-8.51, 533-535, fig 9.28-9.29,
crest of, 64-65, fig 3.3-3.4 540-541, fig 9.33
fascia of, 312, fig 7.9 branch to ciliary ganglion, 541, fig 9.33
foramen of, 65, fig 3.4 function of, 540, 542
groove of, 64, fig 3.3 inferior branch of, 414, fig 8.49, 418, fig 8.53,
tubercles of, 64, fig 3.3 541, fig 9.33
Obturator artery (ies), 103, 104, 275, fig 6.37, 311, superior branch of, 414, fig 8.49, 418, fig 8.53,
fig 7.8, 347-350, fig 7.32-7.33 541, fig 9.33
Obturator foramen, 65, fig 3.4 Olecranon bursa, 26, fig 2.13
of hip bone, 300-303, fig 7.1a-7.3 Olecranon fossa of humerus, 14, fig 2.4
Obturator muscle Olecranon of ulna, 23-26, fig 2.11-2.13
externus, 69-71, 105 Olecranon region, 10-11, fig 2.1
internus, 70-71, fig 3.9, 269, fig 6.34, 307-308, Olfactory area of cerebrum, 497, fig 9.3
fig 7.6, 310, 317, fig 7.12, 322, 331, Olfactory bulb, 536-537, fig 9.30
fig 7.21 Olfactory cilia, 537, fig 9.31
Obturator nerve, 72-73, 103-105, fig 3.33, 283, Olfactory cortex, 537
fig 6.43 Olfactory epithelium, 537, fig 9.31
accessory, 283, fig 6.43 Olfactory glands (of Bowman), 537, fig 9.31
of female, 345-346, fig 7.31 Olfactory glomerulus, 537, fig 9.31
Obturator nerve, 71-73, 103, 105, 283-284 Olfactory nerve (CN I), 429, fig 8.64, 429, fig 8.64,
of female, 345-346, fig 7.31 533-535, fig 9.28-9.29, 536-537,
of male, 344-345, fig 7.30 fig 9.30-9.31
Obturator vein, 276, fig 6.38 function of, 537
left olfactory pathway, 536, fig 9.30
female, 349-350, fig 7.33 Olfactory organ, 537
male, 347-348, fig 7.32 Olfactory part of nasal mucosa, 537, fig 9.31

Olfactory stria(e) Optic radiation, 539, fig 9.32
medial, 536-537, fig 9.30 Optic tract, 539, fig 9.32
Olfactory tract, 536-537, fig 9.31 Ora serrata, 421, fig 8.56
afferent fibers of, 537, fig 9.31 Oral cavity, 439, fig 8.74
Olfactory trigone, 536, fig 9.30 functions of, 439, fig 8.74
Olivary nuclei, 506, fig 9.9 oral cavity proper, 439, fig 8.74
Omental appendices, 267, fig 6.33 oral vestibule, 439, fig 8.74
Omental bursa, 239-240, fig 6.13-6.14 Oral region, 359, fig 8.1
borders of, 240, fig 6.14 Oral vestibule, 439, fig 8.74
definition of, 240, fig 6.14 Orbicularis oculi muscle, 383, fig 8.25, 385
recesses of, 240, fig 6.14 Orbicularis oris muscle, 383-384, fig 8.25
walls of, 240, fig 6.14 Orbiculus ciliaris, 421, fig 8.56
Omental foramen, 239, fig 6.13 Orbifrontal artery
related liver, 248, fig 6.20 lateral, 516, fig 9.16
Omental recesses, 240, fig 6.14 medial, 517, fig 9.17
inferior, 240, fig 6.14 Orbit
splenic, 240, fig 6.14 arteries of, 413, fig 8.48
superior, 240, fig 6.14 bones of, 408, fig 8.45
Omental tenia, 267, fig 6.33 fissures and foramina of, 408, fig 8.45
Omentum muscles of, 410, fig 8.46
blood supply of, 238, fig 6.12 neurovasculature of, 412-416, fig 8.47-8.51
definition of, 238, fig 6.12 veins of, 413, fig 8.48
function of, 238, fig 6.12 walls of, 408, fig 8.45
greater, 236-239, fig 6.11-6.13, 243, fig 6.16, Orbit see also eyeball
267, fig 6.33 Orbital fissure(s)
related liver, 248, fig 6.20 inferior, 366, fig 8.8, 404, fig 8.41, 408, fig 8.45
lesser, 243, fig 6.16, 249 neurovasculature of
venous drainage of, 238, fig 6.12 inferior, 417, fig 8.52
Omentum foramen, 243, fig 6.16 superior, 417, fig 8.52
Omoclavicular triangle of neck, 483, fig 8.109, 485 superior, 418, fig 8.53
Omohyoid branch(es) of ansa cervicalis Orbital plate of ethmoid bone, 360, fig 8.2, 373,
inferior, 479, fig 8.105 fig 8.15
superior, 479, fig 8.105 superior surface, 369, fig 8.11, 372, fig 8.14
Omohyoid muscle, 460, fig 8.90, 462, 483, Orbital process of palatine bone, 408, fig 8.45
fig 8.109, 489, fig 8.113, 565, fig 9.48 Orbital region, 359, fig 8.1
Openings of diaphragm, 227 Orbital surface of frontal bone orbital surface of,
Operculum, 495 360, fig 8.2, 408, fig 8.45
Ophthalmic artery, 388-389, fig 8.27-8.28, Orbital surface of greater wing of sphenoid bone,
397, fig 8.36, 398, fig 8.37, 412-413, 375, fig 8.17
fig 8.47-8.48, 418, fig 8.53, 422, Orbital surface of maxilla, 360, fig 8.2
fig 8.57, 515, fig 9.15 Orbital surface of zygomatic bone, 408, fig 8.45
branches of, 389 Orbitofrontal artery
muscular, 412-413, fig 8.47, 422, fig 8.57 lateral, 518, fig 9.18
Ophthalmic nerve (CN V1), 412, fig 8.47, 414, Oropharynx, 453, fig 8.85
fig 8.49, 416, fig 8.51, 533-535, Os of uterus
fig 9.28-9.29, 543-544, fig 9.35, 549, external, 314, fig 7.11
fig 9.39 internal, 314, fig 7.11
branches of, 394, fig 8.33, 544 Osseous spiral lamina, 437, fig 8.72
function of, 544 Osteoligamentous ring, 123
structure and features, 544 Otic ganglion, 551, fig 9.40, 566, fig 9.49
tentorial branch of, 544, fig 9.35 Outer border cells (Hensen’s cells) of cochlear
Ophthalmic vein duct, 438, fig 8.73
inferior, 412-413, fig 8.47-8.48 Outer hair cells of cochlear duct, 438, fig 8.73
inferior branch of, 417-418, fig 8.52-8.53 Outer phalangeal epithelial cells of cochlear duct,
superior branch of, 417-418, fig 8.52-8.53 438, fig 8.73
superior, 412-413, fig 8.47-8.48, 417, fig 8.52, Ovarian artery, 311, fig 7.8, 314, fig 7.11
522, fig 9.21 Ovarian follicle
Opponens digiti minimi muscle of hand, 38-39, tertiary, 314, fig 7.11
fig 2.21-2.22 Ovarian ligament
Opponens pollicis muscle, 38-39, fig 2.21-2.22 proper, 310, fig 7.7, 313, fig 7.10
Optic canal, 369-370, fig 8.11-8.12, 408, fig 8.45 Ovarian vein, 314, fig 7.11
Optic chiasm, 503, fig 9.7, 522, fig 9.21, 539, fig 9.32 Ovary(ies), 235, fig 6.10, 313, fig 7.10, 317-318,
Optic nerve (CN II), 412, fig 8.47, 416, fig 8.51, fig 7.12
418-420, fig 8.53-8.54, 422, 533-535, definition of, 315
fig 9.28-9.29, 538-540, fig 9.32, 544, function of, 315
fig 9.35 ligaments of, 315
sheath of, 418, fig 8.53 suspensory ligament of, 312, fig 7.9, 314,
Optic part of retina, 418, fig 8.53, 421, fig 8.56 fig 7.11
Index 601
P Pancreatic duct (of Wirsung), 253, fig 6.24, 256,
Palate fig 6.26
hard, 426, fig 8.61, 439, fig 8.74 Pancreatic duct system, 256, fig 6.26
soft, 426, fig 8.61, 439, fig 8.74, 453, fig 8.85 Pancreatic lymph nodes, 293, fig 6.48
Palatine artery inferior, 266, fig 6.32
descending, 396, fig 8.35 superior, 290-291, fig 6.47, 294, fig 6.49
greater, 406, fig 8.43, 427, fig 8.62 Pancreaticoduodenal arcades, 288
Palatine bone, 362, fig 8.4, 364, fig 8.6, 370-371, Pancreaticoduodenal arteries
fig 8.12-8.13, 404, fig 8.41, 425, fig 8.60 duodenal branches, 287-288, fig 6.45
horizontal plate of, 365, fig 8.7, 426, fig 8.61 inferior
orbital process of, 408, fig 8.45 anterior, 287-288, fig 6.45
posterior nasal spine of, 365, fig 8.7, 426, fig 8.61 posterior
pyramidal process of, 365, fig 8.7 inferior, 287-288, fig 6.45
Palatine foramen superior
greater, 366, fig 8.8 anterior, 285, 287-288, fig 6.44-6.45
lesser, 366, fig 8.8 Pancreaticoduodenal lymph nodes
Palatine nerves, 405, fig 8.42, 545-546, inferior, 266, fig 6.32, 290-291, fig 6.47, 294,
fig 9.36-9.37 fig 6.49
greater, 366, 429, fig 8.64 superior, 266, fig 6.32, 290-291, fig 6.47
lesser, 429, fig 8.64 Pancreaticoduodenal veins, 255, 289, fig 6.46
Palatine process of maxilla, 362, fig 8.4, 365, Pancreatic plexus, 264, fig 6.31
fig 8.7, 371, fig 8.13 Pancreatic veins, 255
Palatine suture Papilla(e)
median, 365, fig 8.7 foliate, 440, fig 8.76
transverse, 365, fig 8.7 sulcus of, 441, fig 8.76
Palatine tonsil, 439-440, fig 8.74-8.75, 453, vallate, 440, fig 8.76
fig 8.85, 556, fig 9.43 Papillary muscle
Palatine vein anterior, 204, fig 5.42, 209, fig 5.45
greater, 407, fig 8.44 chordae tendineae, 205
Palatoglossal arch, 439, fig 8.74 inferior, 204, fig 5.42, 209, fig 5.45
Palatoglossus muscle, 442-443, fig 8.77-8.78 septal, 204, fig 5.42, 209, fig 5.45
Palatopharyngeal arch, 439, fig 8.74, 453, fig 8.85 of left ventricle
Palatopharyngeus muscle, 454-455, fig 8.86 inferior, 206, fig 5.43, 210, fig 5.46
Palatovaginal canal, 366, fig 8.8, 404, fig 8.41 superior, 206, fig 5.43, 210, fig 5.46
Palmar arch Paracentral branches of callosomarginal artery,
deep, 56, fig 2.37 517, fig 9.17
deep venous, 58, fig 2.39 Paracolpium, 316-318, fig 7.12
superficial, 56, fig 2.37 Parahippocampal gyrus, 536, fig 9.30
superficial venous, 58, fig 2.39 Paraproctium, 269, fig 6.34
Palmar as term of relationship, 2, fig 1.1 Pararectal fossa, 311-312, fig 7.8-7.9
Palmar carpal branch of radial artery, 56, fig 2.37 Parasympathetic innervation
Palmaris longus muscle, 27-28, fig 2.14 of small intestine, 263-264, fig 6.31, 274
Palmar ligament(s), 33-37, fig 2.17-2.18 Paraterminal gyrus, 536-537, fig 9.30
Palmar radial digital artery of thumb, 56, fig 2.37 Parathyroid glands, 471, fig 8.98
Palpebral artery arterial supply, 472, fig 8.99
median, 389, fig 8.28 functions, 473, fig 8.100
Pampiniform plexus, 228, fig 6.4, 321, fig 7.15, inferior, 471, fig 8.98
325, fig 7.17 innervation, 473, fig 8.100
pharyngeal, 456, 476 superior, 471, fig 8.98
Pancreas, 235, fig 6.10, 239, fig 6.13, 241, fig 6.15 venous drainage, 473, fig 8.100
arteries of, 287-288, fig 6.45 Paratracheal lymph nodes, 194, fig 5.3, 482,
body of, 256, fig 6.26 fig 8.108
definition, 255 Paraurethral gland opening, 337, fig 7.24
head of, 255, fig 6.26 Parenchymal plexus, 351, fig 7.34
in situ, 254-255, fig 6.25 Parietal artery
lymphatics of, 290-291, fig 6.47 anterior, 518, fig 9.18
body, 290-291, fig 6.47 posterior, 518, fig 9.18
head, 290-291, fig 6.47 Parietal bone(s), 360, fig 8.2, 362-364, fig 8.4-8.6,
tail, 290-291, fig 6.47 367, fig 8.9, 371, fig 8.13
neck of, 255 Parietal decidua, 320, fig 7.14
neurovascular, 255 Parietal foramen, 363, fig 8.5
related gallbladder, 253, fig 6.24 Parietal layer, 323, fig 7.16, 325
related liver, 248, fig 6.20 Parietal lobe of cerebrum, 493-496, fig 9.1-9.2
tail of, 255 Parietal margin of greater wing of sphenoid bone,
artery of, 287, fig 6.45 376, fig 8.18
uncinate process of, 255 Parietal margin of temporal bone, 377-378,
Pancreatic artery fig 8.19-8.20
dorsal, 287, fig 6.45 Parietalocciptiotemporal area of cerebrum,
inferior, 287, fig 6.45 497-498, fig 9.3

Parietal peritoneum, 236, fig 6.11, 238, fig 6.12, Penis
241, 243, fig 6.15-6.16 (continued)
Parietal pleura corpus spongiosum of, 329, fig 7.20, 335,
cervical part of, 192, fig 5.34 fig 7.23
costal part of, 198, fig 5.38 crus of, 329, fig 7.20, 335, fig 7.23, 335, fig 7.23
diaphragmatic part of, 198, fig 5.38 deep artery of, 329, fig 7.20, 335, fig 7.23,
mediastinal part of, 192, fig 5.34, 197-198, 347-348, fig 7.32
fig 5.37-5.38 deep fascia of (Buck’s fascia) 334
Parietal region, 359, fig 8.1 intercavernous septum of, 334, fig 7.22
Parotid duct, 446-447, fig 8.80 dorsal nerve of, 344-345, fig 7.30
Parotid gland, 446, fig 8.80, 556, fig 9.43 ejaculatory duct opening, 335, fig 7.23
Parotid veins, 392, fig 8.31 erectile bodies of, 333-334
Pecten pubis, 64, fig 3.3, 70, 224, 300, fig 7.1a, 303 functions of, 334-335, fig 7.22-7.23
Pectinate line, 269, fig 6.34 glans penis, 5, 325, fig 7.17, 329, fig 7.20,
Pectinate muscles, 203-204, fig 5.41, 207 334-335, fig 7.22-7.23, 335, fig 7.23,
Pectineal line of femur, 67, fig 3.6 352-353
Pectineus muscle, 69, fig 3.8 ligaments of, 334-335, fig 7.22-7.23
Pectoral nerve prepuce of, 329, fig 7.20, 334-335, fig 7.22-7.23
lateral, 48, fig 2.29 seminal colliculus, 329, fig 7.20, 335, fig 7.23,
medial, 48, fig 2.29 335, fig 7.23
Pedicle of vertebral arch, 116, fig 4.3, 119 superficial fascia of (Colles’ fascia), 334, fig 7.22
of thoracic vertebrae, 124, fig 4.5 tunica albuginea of corpus cavernosum, 335,
of lumbar vertebrae, 127 fig 7.23
Peduncle of cerebellum Perforated substance
inferior, 510, fig 9.12 anterior, 536, fig 9.30
middle, 510, fig 9.12 Perforating arteries of femoral artery, 106,
Pelvic cavity Perforating branches of palmar metacarpal
female, 309-312, fig 7.7-7.8 arteries, 56, fig 2.37
male, 321-322, fig 7.15 Perforating cutaneous nerve, 342-343, fig 7.29
Pelvic cavity see also female pelvic cavity Periarterial nervous plexus, 232
Pelvic cavity see also male pelvic cavity Periarterial plexus, 264, fig 6.31
Pelvic diaphragm, 308-309, 321, 332, 336-338 Pericallosal artery, 517, fig 9.17
Pelvic fascia precuneal branch of, 517, fig 9.17
tendinous arch of, 331, fig 7.21 Pericardiacophrenic artery, 196, fig 5.36
visceral, 321, fig 7.15 Pericardiacophrenic vein, 196, fig 5.36
Pelvic floor Pericardium, 196, fig 5.36, 198, fig 5.38
muscles of, 307-308, fig 7.6 Periglomerular cell, 537, fig 9.31
Pelvic inlet, 64, 300-303, fig 7.1a-7.3 Perilymph, 437, fig 8.72
Pelvic lymph node groups, 197 Perimetrium, 313-314
Pelvic lymph nodes Perineal artery, 317, fig 7.12, 339, fig 7.26
male, 353, fig 7.35 Perineal body, 308, fig 7.7, 310, fig 7.7, 321, fig 7.15,
Pelvic plexus 337, 339-340
rectal, 322 Perineal fascia, 317-318, fig 7.12, 338
Pelvic splanchnic nerves (S2-S4), 268, 273-274, deep
276, 281, 311, 322, 343 of female, 317-318, fig 7.12, 331, fig 7.21
of female pelvis, 345-346, fig 7.31 superficial
of male, 344-345, fig 7.30 of female, 331, fig 7.21
of anal canal, 276, fig 6.38 Perineal ligament
of rectum, 276, fig 6.38 transverse, 312, fig 7.9
Pelvic visceral fascia, 309-310, fig 7.7, 330 Perineal membrane
of female, 309-310, fig 7.7, 331-332, fig 7.21 of female, 331-332, fig 7.21, 336, 338
of male, 321, fig 7.15, 330 Perineal muscle
tendinous arch of, 312, fig 7.9 transverse
Pelvic wall deep, 307, fig 7.6
lymphatics of, 295-297, fig 6.50 of female, 317, fig 7.12, 337-341
Pelvis superficial, 307, fig 7.6
function of, 302-306, fig 7.2-7.5 of female, 341
ligaments of, 302-306, fig 7.2-7.5 of male, 334, fig 7.22
lymphatics of, 342-343, fig 7.29 Perineal nerve, 269, fig 6.34, 341, fig 7.28
nerves of male, 344-345, fig 7.30 Perineal raphe, 337, fig 7.25
nerves of female, 345-346, fig 7.31 Perineal veins, 340, fig 7.27
neurovasculature of, 342-343, fig 7.29 Perineum
visceral fascia of, 309-312, fig 7.7-7.8 female, 336-338, fig 7.24-7.25
Penis, 325, fig 7.17, 333-335, fig 7.22-7.23 neurovasculature, 339-341, fig 7.26-7.28
bulb of, 329, fig 7.20, 335, fig 7.23 Periodontal ligament, 452, fig 8.84
cavernous nerves of, 344-345, fig 7.30 Periosteal arteries, 130
corpus cavernosum of, 329, fig 7.20, 335, Periosteal branches, 131
fig 7.23 Periosteal layer of dura mater, 511, fig 9.13
Index 603
Periosteum, 511, fig 9.13 Pia mater of cranial meninges, 511-512, fig 9.13
Perirenal fat plexus, 351, fig 7.34 vascular plexus of, 526, fig 9.24
Peritoneal pouches, 311 Pia mater of spinal cord, 528, fig 9.25
Peritoneum, 234-242, fig 6.9-6.15, 321-322, Piriform recess, 453, fig 8.85
fig 7.15, 330 Piriformis muscle, 70-71, fig 3.9, 107, 307, fig 7.6,
intraperitoneal, 234, fig 6.9 310
extraperitoneal, 234, fig 6.9 nerve to, 342-343, fig 7.29
mesentery, 236-237, fig 6.11 Pisiform bone, 31-32, fig 2.16
parietal, 234, fig 6.9 Pisohamate ligament, 33, fig 2.17, 37
visceral, 234, fig 6.9, 239, fig 6.13 Pisotriquetral ligament, 37
Perpendicular plate of ethmoid bone, 370, fig 8.12, Pituitary gland, 493, fig 9.1, 503, fig 9.7, 522,
372-373, fig 8.14-8.15 fig 9.21
Petrosal nerve Placenta, 319-320, fig 7.13-7.14
greater, 552, fig 9.41, 566, fig 9.49 definition of, 320, fig 7.14
lesser, 366, 551, fig 9.40, 556, fig 9.43 functions, 320, fig 7.14
Petrosal sinus Placental septum, 320, fig 7.14
inferior, 366, 520, fig 9.19, 522, fig 9.21 Plane synovial joint, 74, 76, 80
superior, 520, fig 9.19, 522, fig 9.21 Plantar arch, 111, fig 3.39
Petrosal vein, 520, fig 9.19 Plantar, as term of relationship, 2, fig 1.1
Petrosquamous fissure of temporal bone, 378, Plantar artery
fig 8.20 deep, 112
Petrotympanic fissure of skull, 366, fig 8.8 lateral, 111-112, fig 3.39
Petrotympanic fissure of temporal bone, 377, medial, 111-112, fig 3.39
fig 8.19 superficial branch, 111-112, fig 3.39
Petrous part of temporal bone, 361, fig 8.3, Plantar as term of relationship, 2, fig 1.1
377-379, fig 8.19-8.21 Plantar metatarsal arteries, 111, fig 3.39
apex of, 378-379, fig 8.20-8.21 Plantar nerves
Phalanges, 31-32, fig 2.16 lateral, 107, fig 3.36, 111-112, fig 3.40
Phalangoglenoid ligaments, 34, fig 2.18, 37 medial, 107, fig 3.36, 111-112, fig 3.40
Pharyngeal artery, 406, fig 8.43 Platysma muscle, 383-384, fig 8.25, 460, fig 8.90,
ascending, 396, fig 8.35, 398, fig 8.37, 456, 489, fig 8.113
fig 8.87 Pleural cavity, 7, fig 1.6, 192-193
Pharyngeal branches of glossopharyngeal nerve, Pleural recesses, 192-193
556, fig 9.43 Plexi
Pharyngeal branch of vagus nerve, 560, fig 9.45 anorectal
Pharyngeal constrictor muscle, 556, fig 9.43 female
inferior, 454-455, fig 8.86 middle, 346, fig 7.31
cricopharyngeal part of, 454, fig 8.86 male
thyropharyngeal part of, 454, fig 8.86 inferior, 344-345, fig 7.30
middle, 454-455, fig 8.86 middle, 344-345, fig 7.30
superior, 454-455, fig 8.86 aortic, 232, 281
Pharyngeal mucosa, 452, fig 8.84 brachial, 42-43, fig 2.23-2.24, 145-146,
Pharyngeal nerve, 405, fig 8.42, 545, fig 9.36-9.37, 161-162, 164-165, fig 5.13, 474,
546 477-478, fig 8.103-8.104, 484-485,
Pharyngeal plexus, 442-443, 445, 457-458, 560 fig 8.110
Pharyngeal raphe, 454, fig 8.86 cardiac, 214, fig 5.48, 561, fig 9.46
Pharyngeal recess, 453, fig 8.85 cervical, 477, fig 8.103, 479, fig 8.105
Pharyngeal tonsil, 426, fig 8.61, 452, fig 8.84 coccygeal plexus, 342
Pharyngeal tubercle of occipital bone, 365, fig 8.7 of female, 345-346, fig 7.31
Pharyngeal veins, 456, fig 8.87 of male, 344-345
Pharyngobasilar fascia, 454, fig 8.86 deferential plexus of male, 344-345, fig 7.30
Pharynx, 452, fig 8.84 dental
blood vessels of, 456, fig 8.87 superior, 545, fig 9.36
innervation of enteric (of Auerbach)
motor, 457-458, fig 8.88 of anal canal, 276
sensory, 457-458, fig 8.88 of rectum, 276
muscles of, 454, fig 8.86 esophageal, 179-181, 561, fig 9.46
nerves of, 457-458, fig 8.88 hypogastric, 322
Phrenic artery inferior, 281, 330
inferior, 177, fig 5.22, 226-227, fig 6.3, 232 superior, 281
left, 285, fig 6.44 of female, 345-346, fig 7.31
right, 285, fig 6.44 iliac of male, 344-345, fig 7.30
superior, 179 intermesenteric
Phrenic nerve, 196, fig 5.36, 226-227, fig 6.3, ureteric branches of, 281
477-479, fig 8.103-8.105, 484, fig 8.110, lumbar, 281
489, fig 8.113 of female, 345-346, fig 7.31
left, 214, fig 5.48 mesenteric, 263-264, fig 6.31
right, 214, fig 5.48 myenteric (plexus of Auerbach), 263-264,
Phrenic veins fig 6.31, 272
inferior, 232, fig 6.7 pampiniform, 321, fig 7.15

Plexi Posterior tubercle of vertebra, 119
(continued) Posterior vagal trunk
pancreatic, 264, fig 6.31 celiac branches of, 264, fig 6.31, 561-562, fig 9.46
parenchymal, 351, fig 7.34 gastric, 562
pelvic, 322 renal, 562
periarterial nervous, 232 Posterior wall of pharynx, 439, fig 8.74
periarterial, 264, fig 6.31 Preaortic lymph nodes
perirenal fat, 351, fig 7.34 male, 353, fig 7.35
pharyngeal, 457-458, fig 8.88 Precaval lymph nodes, 351, fig 7.34
prostatic, 330, 344-345, fig 7.30 male, 353, fig 7.35
renal, 278, fig 6.40, 281 Precentral arterial branch, 130
sacral plexus of female, 345-346, fig 7.31 Precentral gyrus(i), 495-497, fig 9.2
subcapsular, 351, fig 7.34 Precentral sulcus
submucosal (Meissner’s plexus), 263, 272 artery of, 518, fig 9.18
tympanic, 551, fig 9.40 Prefrontal area of cerebrum, 498
uterovaginal, 346, fig 7.31 Prefrontal artery, 518, fig 9.18
vascular plexus of pia mater, 526, fig 9.24 Prefrontal sulcus, 516, fig 9.16
vesical plexus of male, 344-345, fig 7.30 Prelaminar arterial branch, 130, 131
Plexus of Auerbach see myenteric plexus Prelaryngeal lymph nodes, 482, fig 8.108
(plexus of Auerbach) Premolar teeth, 448-449, fig 8.81-8.82
Poles of kidney Premotor area of cerebrum, 497, fig 9.3
inferior, 277-278, fig 6.39-6.40 Preolivary groove, 506, fig 9.9
superior, 278, fig 6.40 Prepatellar bursa of the knee, 81, fig 3.16
Pons, 493, fig 9.1, 503, fig 9.7, 505, 556, fig 9.43, Prepubic lymph node
566, fig 9.49 male, 353, fig 7.35
functions of, 507, fig 9.10 Prepuce of clitoris, 336-338, fig 7.24-7.25
major landmarks of, 507, fig 9.10 Prepuce of penis, 329, fig 7.20, 334, fig 7.22
Pontine arteries, 398, fig 8.37, 398, fig 8.37, 516, Presacral fascia, 312, fig 7.9
fig 9.16 Presacral space, 312, fig 7.9
Popliteal artery, 103, fig 3.33, 106, 108-110, Preterminal infraclavicular branches of brachial
fig 3.38 plexus, 43, fig 2.24
branches, 108, fig 3.37 Pretracheal fascia, 487, fig 8.111
Popliteal fossa, 62, fig 3.10 Pretracheal lymph nodes, 482, fig 8.108
Popliteal surface of femur, 67, fig 3.6 Pretracheal space, 488, fig 8.112
Popliteal vein, 108-110, fig 3.37-3.38 Prevertebral part (V1)
Porta hepatis, 251-252, fig 6.22, 285, fig 6.44, 294 of vertebral artery, 398, fig 8.37
Postcentral arterial branch, 130, fig 4.12 Prevesical lymph nodes, 351, fig 7.34
Postcentral gyrus(i), 495-497, fig 9.2 Primary auditory area of cerebrum, 497, fig 9.3
Posteriomedial nucleus Primary motor area of cerebrum, 497, fig 9.3
ventral, 566, fig 9.49 Primary somatosensory area of cerebrum, 497,
Posterior arch of atlas, 120-122, fig 4.6-4.8 fig 9.3
Posterior articular facet of dens axis, 120-121, Primary visual area of cerebrum, 497, fig 9.3
fig 4.6 Princeps pollicis artery, 56, fig 2.37
Posterior as term of relationship, 2, fig 1.1 Procerus muscle, 383, fig 8.25, 385
Posterior atlantooccipital ligament, 123 Projection fibers, 500, fig 9.5
Posterior border of fibula, 75-76, fig 3.11 Projection neurons, 537, fig 9.31
Posterior border of neck of fibula, 75, fig 3.11 Promontorial lymph nodes, 296, fig 6.50, 351,
Posterior branch of renal artery, 279-280, fig 7.34
fig 6.41 female, 354, fig 7.36
Posterior cerebral arteries, 398, fig 8.37 male, 353, fig 7.35
Posterior chamber of eyeball, 420, fig 8.55, 423, Promontory of sacrum, 128
fig 8.58 Pronator quadratus muscle, 27-28, fig 2.14
Posterior circumflex humeral artery, 44, fig 2.25 Pronator teres muscle, 27-28, fig 2.14
Posterior clinoid process, 369, fig 8.11, 376, fig 8.18 Pronator tuberosity of radius, 24, fig 2.10
Posterior crus, 431, fig 8.66 Proper collateral interphalangeal ligaments, 36,
Posterior extremity of spleen, 246, fig 6.18 fig 2.20, 37
Posterior femoral cutaneous nerve, 103, Proper collateral ligaments of finger, 35, fig 2.19
fig 3.33-3.34, 105, 342-343, fig 7.29 Proper collateral metacarpophalangeal
Posterior intercostal artery, 130 ligaments, 36, fig 2.20, 37
dorsal branch of, 130 Proper hepatic artery, 239, fig 6.13, 251-252,
Posterior labial nerves, 341, fig 7.28 fig 6.22-6.23, 257-258, fig 6.27,
Posterior lingual gland, 441, fig 8.76 287-289, fig 6.45-6.46
Posterior longitudinal ligament, 117-118, fig 4.4, Proper plantar digital nerves, 111, fig 3.40
122, fig 4.8, 132, fig 4.14 Prostate, 321-322, fig 7.15, 329, fig 7.20, 335,
Posterior nasal spine of palatine bone, 365, fig 8.7 fig 7.23
Posterior nucleus, 560, fig 9.45 Prostatic
Posterior scrotal nerves, 344-345, fig 7.30 ductules, 329, fig 7.20, 335, fig 7.23
Posterior scrotal vein, 347, fig 7.32 plexus, 344-345, fig 7.30
Posterior surface of heart (base), 202 utricle, 329, fig 7.20
Posterior tibial artery, 109-110, fig 3.37-3.38, 112 Prostatic part of male urethra, 329, fig 7.20
Index 605
Proximal as term of relationship, 2, fig 1.1 Pubic symphysis, 64, 300, fig 7.1a, 302-303,
Proximal end of femur, 67, fig 3.6 fig 7.2-7.3, 311, fig 7.8, 319-320,
Proximal end of ulna, 23, 24 fig 7.13-7.14
Proximal phalanges of hand, 31-32, fig 2.16 female, 336-338, fig 7.24-7.25
Proximal phalanx of hand, 31-32, fig 2.16 Pubic tubercle, 64-65, fig 3.3-3.4, 302, fig 7.2, 305
Proximal radioulnar joint, 25, fig 2.12 Pubis
Psoas muscle body of, 64, fig 3.3
major, 69-70, fig 3.8, 226, fig 6.3, 258, 280-281, crest of, 300, fig 7.1a
283, 304, fig 7.4, 311, fig 7.8 symphyseal surface of, 64, fig 3.3
minor muscle, 69-70, fig 3.8, 304, fig 7.4 symphysis, 300, fig 7.1a
Pterion, 361, fig 8.3 Pubococcygeus muscle, 307-308, fig 7.6
Pterygoid branches, 396, fig 8.35 Pubofemoral ligaments, 68, fig 3.7
Pterygoid canal, 366, fig 8.8, 375, fig 8.17 Puborectalis muscle, 307-308, fig 7.6
artery of, 396, fig 8.35, 404, fig 8.41, 406, Pubovesical ligament
fig 8.43 medial, 312, fig 7.9
nerve of, 405, fig 8.42, 546, fig 9.37 Pudendal artery
Pterygoid fossa of sphenoid bone, 366, fig 8.8, internal, 269, fig 6.34, 275, fig 6.37, 322, 339,
376, fig 8.18 fig 7.26
Pterygoid fovea of mandible, 381-382, female, 349, fig 7.33
fig 8.23-8.24 male, 347, fig 7.32
Pterygoid hamulus of sphenoid bone, 365, fig 8.7, Pudendal nerve, 104, fig 3.34, 276, fig 6.38, 330,
375, fig 8.17 342-346, fig 7.29-7.30
Pterygoid muscle of female pelvis, 346
lateral, 399-401, fig 8.38-8.39 of male pelvis, 344-345, fig 7.30
inferior head of, 401, fig 8.40 Pudendal vein
nerve to, 548-549, fig 9.38-9.39 internal, 269, fig 6.34, 276, fig 6.38, 340, fig 7.27
superior head of, 401, fig 8.40 right
medial, 399-401, fig 8.38-8.39, 401, fig 8.40 female, 349, fig 7.33
deep head of, 401, fig 8.40 Pulmonary artery
nerve to, 548-549, fig 9.38-9.39 left, 192, fig 5.34, 200-201, fig 5.39-5.40, 206,
superior head of, 401, fig 8.40 fig 5.43, 210, fig 5.46
Pterygoid notch of sphenoid bone, 375, fig 8.17 right, 192, fig 5.34, 201, fig 5.40, 203, fig 5.41
Pterygoid process of sphenoid bone, 362, fig 8.4, Pulmonary nervous plexus, 191
376, fig 8.18 Pulmonary surface of heart
lateral plate of, 375, fig 8.17 left, 201, fig 5.40
medial plate of, 370, fig 8.12, 375, fig 8.17 right, 201, fig 5.40
Pterygoid venous plexus, 392, fig 8.31, 404, Pulmonary trunk, 192, fig 5.34, 197, fig 5.37,
fig 8.41, 407, fig 8.44, 412, fig 8.47, 428, 200, fig 5.39, 202, 206, fig 5.43, 210,
fig 8.63 fig 5.46
Pterygomaxillary fissure, 404, fig 8.41 Pulmonary valve, 202, 204, fig 5.42, 208-210,
Pterygopalatine fossa, 399-400, fig 8.38, fig 5.44-5.46
403-407, fig 8.41-8.44, 404, fig 8.41, semilunar leaflet
417 anterior, 208, fig 5.44
arteries of, 406, fig 8.43 left, 208, fig 5.44
borders of, 405, fig 8.42 right, 208, fig 5.44
gateways of, 405, fig 8.42 Pulmonary veins, 190-192, fig 5.32-5.33
nerves of, 406, fig 8.43 left, 200, fig 5.39, 206, fig 5.43, 210, fig 5.46
veins of, 406, fig 8.43 right, 201, fig 5.40, 203, fig 5.41
Pterygopalatine ganglion, 405, fig 8.42, 429, Pulp cavity of crown, 451, fig 8.83
fig 8.64, 545-546, fig 9.36-9.37, 552, Pupil, 420, fig 8.55
fig 9.41, 566, fig 9.49 Purkinje fibers see subendocardiac (Purkinje)
branches of maxillary nerve to, 405, fig 8.42, fibers
546, fig 9.37 Putamen, 500-502, fig 9.5-9.6
inferior posterior nasal branches of, 429, Pyloric antrum, 244, fig 6.17
fig 8.64 Pyloric canal, 244, fig 6.17, 256, fig 6.26
lateral superior posterior nasal branches, 429, Pyloric lymph nodes, 266, fig 6.32, 291-295,
fig 8.64 fig 6.48-6.49
orbital branches of, 405, fig 8.42, 417-418, retropyloric, 294, fig 6.49
fig 8.52-8.53, 546, fig 9.37 subpyloric, 293-294, fig 6.49
Pubic crest, 64, fig 3.3 suprapyloric, 293-294, fig 6.49
Pubic ligament Pyloric orifice, 256, fig 6.26
anterior, 304-306, fig 7.4-7.5 Pyloric sphincter, 244, fig 6.17, 256, fig 6.26, 258,
inferior, 304-306, fig 7.4-7.5 fig 6.27
posterior, 305-306, fig 7.5 Pylorus, 243, fig 6.16
superior, 304-306, fig 7.4-7.5 Pyramidalis muscle, 223, 225, fig 6.2
Pubic ramus Pyramidal lobe of thyroid gland, 471, fig 8.98
inferior Pyramidal process of palatine bone, 365, fig 8.7
female, 316-318, fig 7.12, 331, fig 7.21 Pyramid of medulla oblongata, 505-506,
male, 321-322, fig 7.15, 334-335, fig 7.22-7.23 fig 9.8-9.9

Radius
Q
Quadrangular membrane, 465, fig 8.92 (continued)
Quadrate lobe, 248, fig 6.20, 251, fig 6.22 body of, 22-24, fig 2.10-2.11
Quadratus lumborum muscle, 223-225, fig 6.2 carpal articular surface, 24
Quadriceps femoris muscle, 5, 69, fig 3.8, 74 distal end of, 22-24, fig 2.10
nerve to, 342-343, fig 7.29 dorsal radial tubercle, 23-24, fig 2.11
rectus femoris muscle, 69, fig 3.8, 72 elbow joint, 25-26, fig 2.12
vastus lateralis muscle, 69, fig 3.8, 72 head of, 22-24, fig 2.10-2.11
vastus intermedius muscle, 69, fig 3.8 ligaments of (radius and ulna), 24
vastus medialis muscle, 69, fig 3.8, 72 neck of, 22, fig 2.10
pronator tuberosity of, 22-24, fig 2.10
R proximal end of, 22-24, fig 2.10
Radial artery, 50-51, fig 2.31-2.32 radial styloid process of, 22-24, fig 2.10-2.11
carpal branch of radial tuberosity of, 22, 24, fig 2.10
dorsal, 57, fig 2.38 shaft of, 22
palmar, 56, fig 2.37 styloid process of, 22-23, fig 2.10
muscular branches, 50, fig 2.31 suprastyloid crest of, 24
radial digital artery of thumb ulnar notch of, 23
dorsal, 57, fig 2.38 Radius and ulna ligaments, 24
palmar, 56, fig 2.37 anular ligament of radius, 24
recurrent, 50, fig 2.31 dorsal radioulnar ligament, 24
superficial branch of interosseous membrane of forearm, 24
palmar, 56, fig 2.37 oblique cord, 24
Radial as term of relationship, 2, fig 1.1 palmar radioulnar ligament, 24
Radial collateral artery, 44, fig 2.25 radial collateral ligament of elbow joint, 24
Radial collateral ligament ulnar collateral ligament of the elbow joint, 24
of elbow joint, 24-26, fig 2.12 Rami communicantes
of wrist joint, 37 of spinal nerve
Radial digital artery of thumb gray, 283, fig 6.43, 344, fig 7.30
palmar, perforating branches, 56, fig 2.37 of female pelvis, 346, fig 7.31
Radial fossa, 13-14, fig 2.3 white, 283, fig 6.43
Radial foveola, 10-11, fig 2.1 Ramus(i)
Radial groove, 14, fig 2.4 iliac tuberosity, 64, fig 3.3
Radialis indicis artery, 56, fig 2.37 ischiopubic, 303, fig 7.3
Radial nerve, 29-30, 43, fig 2.24, 45, 48-49, of lumbar nerves
fig 2.29-2.30, 54-55, fig 2.35-2.36 anterior
deep branch of, 54-55, fig 2.35-2.36 of female pelvis, 346, fig 7.31
dorsal digital branches of, 59, fig 2.40 of spinal nerves C5-C8
muscular branches of, 54, fig 2.35 anterior, 477
superficial branch of, 54-55, fig 2.35-2.36, 59, pubis
fig 2.40 inferior, 64, fig 3.3, 310, fig 7.7
Radial notch of ulna, 24 superior, 64, fig 3.3, 309-312, fig 7.7-7.8
Radial tuberosity of radius, 22, 24, fig 2.10 Ramus of mandible, 360, fig 8.2, 380, fig 8.22
Radial veins, 52, fig 2.33 Ramus(i) communicans of spinal nerve
Radiate carpal ligament, 37 gray, 526, fig 9.24, 528, fig 9.25
Radicular artery(ies) white, 526, fig 9.24, 528, fig 9.25
anterior, 131, 530, fig 9.26 Ramus(i) of spinal nerve
posterior, 131, 530, fig 9.26 anterior, 526, fig 9.24
Radicular vein, 132, fig 4.14 posterior, 526, fig 9.24, 528, fig 9.25
anterior, 531, fig 9.27 Recesses of duodenum, 235
posterior, 531, fig 9.27 Rectal ampulla, 269, fig 6.34
Radiocarpal anastomosis Rectal fascia, 312, fig 7.9
dorsal, 57, fig 2.38 Rectal venous plexus
Radiocarpal joint, 32, 37 external, 269, fig 6.34
Radiocarpal ligament, 37 internal, 269, fig 6.34
dorsal, 35, fig 2.19 Rectosigmoid junction, 269, fig 6.34
palmar, 37, fig 2.17 Rectouterine pouch, 310, fig 7.9, 312, fig 7.7
Radiolunate ligaments, 37 Rectovesical pouch, 321-322, fig 7.15
Radioscaphocapitate ligament, 2, 33, fig 2.17, 37 Rectum, 235-236, fig 6.10-6.11, 241, fig 6.15,
Radioscapholunate ligament, 33, fig 2.17, 37 267-268, fig 6.33, 269-270, fig 6.34,
Radioulnar joint, distal, 37 309-312, fig 7.7-7.8, 316-318, fig 7.12,
Radioulnar ligament, 24, 33, fig 2.17 319-322, fig 7.13-7.15, 322
palmar, 24, 33, fig 2.17, 37 blood vessels of, 275
dorsal, 24, 35, fig 2.19, 37 function of, 270
Radioulnate ligament landmarks of, 270
long, 33, fig 2.17, 37 transverse folds of, 269, fig 6.34
short, 33, fig 2.17, 37 Rectus abdominis muscle, 5, 164, fig 5.13, 223,
Radius, 22-25, fig 2.10-2.12 fig 6.2, 228, fig 6.4, 311, fig 7.8, 319,
anterior border of, 22, fig 2.10 fig 7.13, 321, fig 7.15
anular ligament of, 24-26, fig 2.12 Rectus femoris muscle, 69, fig 3.8
Index 607
Rectus sheath, 312, fig 7.9 Rhythm of heart, 202
Recurrent branches of deep palmar arch, 56, fig 2.37 Rib(s), 150-153, fig 5.2-5.5
Recurrent laryngeal nerve, 489, fig 8.113 11th, 226, fig 6.3
Recurrent meningeal branches of spinal nerve, 12th, 226, fig 6.3
528, fig 9.25 joints of, 154-155, fig 5.6-5.7
Refractive media of eyeball, 420, fig 8.55 Right atrioventricular valve
Renal arteries fibrous ring, 208, fig 5.44
anterior branch of, 279-280, fig 6.41 inferior leaflet, fig 5.44
branches of, 279-281, fig 6.41-6.42 septal leaflet, fig 5.44
functions of, 279-280, fig 6.41 superior leaflet, fig 5.44
pelvic branches of, 279-280, fig 6.41 Right colic artery, 271, fig 6.35
right, 277-280, fig 6.39-6.41 descending branch, 271, fig 6.35
ureteric arteries, 281, fig 6.42 Right hepatic artery, 251-252, fig 6.22-6.23, 285,
ureteric branches of renal artery, 281, fig 6.42 fig 6.44
ureteric branches of superior, 281, fig 6.42 Right inferolateral branch of right coronary
Renal calyx artery, 213
major, 278, fig 6.40 Right lobe of liver, 238, fig 6.12, 243, fig 6.16, 248,
minor, 278, fig 6.40 fig 6.20
Renal capsule, 277-278, fig 6.39-6.40 Right lower quadrant of abdomen, 222, fig 6.1
Renal column, 277-278, fig 6.39-6.40 Right marginal branch of right coronary artery,
Renal cortex, 277-278, fig 6.39-6.40 213, fig 5.47
Renal impression on spleen, 246, fig 6.18 Right (pulmonary) surface of heart, 201, fig 5.40
Renal medulla, 278, fig 6.40 Right upper quadrant of abdomen, 222, fig 6.1
Renal papilla, 277, fig 6.39-6.40 Rima glottidis, 465, 467, fig 8.94, 469, fig 8.97
Renal pelvis, 277, fig 6.39-6.40 Risorius muscle, 383-384, fig 8.25
Renal plexus, 278, fig 6.40 Root canal, 451, fig 8.83
Renal pyramid Root of ansa cervicalis
base of, 278, fig 6.40 inferior, 565, fig 9.48
Renal vein superior, 565, fig 9.48
right, 277, fig 6.39 Root of spinal nerve
Reproductive system posterior, 528, fig 9.25
female, 309-320, fig 7.7-7.14 Root of tongue, 440, fig 8.75, 453, fig 8.85
male, 321-326, fig 7.15-7.17 Root of tooth, 451, fig 8.83
Respiratory system Rostral as term of relationship, 2, fig 1.1
lungs, 184-195, fig 5.27-5.35 Rostral solitary nucleus, 566, fig 9.49
Rete testis, 323-324, fig 7.16 Rotator cuff muscles
Retina infraspinatus muscle, 17-18, 21, fig 2.7-2.8
optic part of, 418, fig 8.53, 421, fig 8.56 subscapularis muscle, 17-18, 21, fig 2.7-2.8
Retinal artery supraspinatus muscle, 17-18, 21, fig 2.7-2.8
central, 413, fig 8.48, 418, fig 8.53, 422, fig 8.57 teres minor muscle, 17-18, 21, fig 2.7-2.8
Retinal vein Rotatores muscles
central, 413 breves, 139, fig 4.17, 142
Retroaortic lymph nodes, 296, fig 6.50 longi, 139, fig 4.17, 142
female, 354, fig 7.36 Round ligament
Retrocaval lymph nodes, 296, fig 6.50, 351, fig 7.34 of liver, 238, fig 6.12, 243, fig 6.16, 248-251,
female, 354, fig 7.36 fig 6.20-6.22
Retroduodenal arteries, 288 of uterus, 310, fig 7.7, 317, fig 7.12, 331, fig 7.21
Retromalleolar region
lateral, 62, fig 3.10 S
medial, 62, fig 3.10 Saccular nerve, 436, fig 8.71, 554, fig 9.42
Retromandibular vein, 392, fig 8.31, 407, fig 8.44, Sacral arteries
445, fig 8.79 lateral, 131, fig 4.13
anterior division, 392, fig 8.31, 446, fig 8.80 median, 131, fig 4.13, 232, fig 6.7, 275, fig 6.37,
posterior division of, 392, fig 8.31, 446, fig 8.80 311, fig 7.8, 322
Retroolivary groove, 506, fig 9.9 female, 349, fig 7.33
Retroperitoneal organs, 235, fig 6.10 male, 347, fig 7.32
primary, 242 Sacral crest
secondary, 242 median, 128, 302, fig 7.2
Retroperitoneum, 241-242, fig 6.15 Sacral foramina
anterior pararenal space, 241, fig 6.15 anterior, 128
definition, 242 Sacral horns, 129
perirenal space, 241, fig 6.15 Sacral kyphosis, 115, fig 4.2
posterior pararenal space, 241, fig 6.15 Sacral lymph nodes, 296, fig 6.50
Retropharyngeal space, 488, fig 8.112 female, 354, fig 7.36
Retropubic space, 312, fig 7.9 lateral
Rhomboid fossa, 507, fig 9.10 male, 353, fig 7.35
medial eminence of, 507, fig 9.10 median
Rhomboid muscle male, 353, fig 7.35
major, 135-136, fig 4.15 Sacral plexus, 104-105, 283, 342-343, fig 7.29, 345
minor, 135-136, fig 4.15 branches of, 343

Sacral plexus Scaphoid fossa of ear, 431, fig 8.66
(continued) Scaphoid fossa of sphenoid bone, 366, fig 8.8, 376,
function of, 343 fig 8.18
mnemonic for main branches, 343 Scapholunate interosseous ligament, 35, fig 2.19,
of female pelvis, 346, fig 7.31 37
of male pelvis, 345 Scaphotriquetral ligament
Sacral promontory, 129, 302, fig 7.2 palmar, 33, fig 2.17
Sacral region, 114, fig 4.1 Scapula, 13-16, fig 2.3-2.6
Sacral veins, 132-133, fig 4.14 acromion of, 15, fig 2.5
left lateral anterior view of, 15, fig 2.5
of male pelvis, 347-348, fig 7.32 coracoid process of, 15, fig 2.5
Sacral vertebrae, S1-S5, 129 deltoid tubercle of, 15, fig 2.5
Sacrococcygeal joint, 129 glenoid fossa of, 15, fig 2.5-2.6
Sacrococcygeal ligament inferior angle of, 5, fig 1.4, 15, fig 2.5
anterior, 304-305, fig 7.4-75, 312, fig 79 infraglenoid tubercle of, 15, fig 2.5-2.6
deep posterior, 305, fig 7.5 infraspinous fossa of, 15-16, fig 2.5-2.6
lateral, 305, fig 7.5 lateral border of, 15
superficial posterior, 305, fig 7.5 medial border of, 5, fig 1.4, 15, fig 2.5
Sacroiliac joint(s), 129, 300, fig 7.1a, 303, fig 7.3 neck of, 15, fig 2.5-2.6
Sacroiliac ligament, 322 scapular notch, 15, fig 2.5
anterior, 304-306, fig 7.4-7.5 spine of, 5, fig 1.4, 15, fig 2.5
posterior, 305-306, fig 7.5 spinoglenoid notch, 15, fig 2.5
Sacropelvic surface subscapular fossa of, 15, fig 2.5
auricular surface of, 64, fig 3.3 superior angle of, 15, fig 2.5
iliac tubercle, 64, fig 3.3 superior border of, 15, fig 2.5
Sacrospinous ligament, 304-306, fig 7.4-7.5, 322 supraglenoid tubercle of, 15, fig 2.5
Sacrotuberous ligament, 303-306, fig 7.2-7.5, supraspinous fossa of, 15, fig 2.5
337-338 Scapular notch, superior, 15, fig 2.5
Sacrum, 116-117, 126, 127, 128-129, fig 4.11, Scapular region, 114, fig 4.1
302-303, fig 7.2-7.3, 322 Scapular vein
ala of, 302, fig 7.2 circumflex, 46, fig 2.27
apex of, 128, fig 4.11 Sciatic nerve, 104, fig 3.34, 105, 107, fig 3.36,
articular process of 108-110, 342-343, fig 7.29
superior, 302, fig 7.2 branches of, 107, fig 3.36, 108
base of, 302, fig 7.2 pathway of, 107, fig 3.36
joints of, 129 Sciatic notch of hip bone
parts of, 129 greater, 64-65, fig 3.3-3.4, 301, fig 7.1b, 303
structure of, 129 lesser, 64-65, fig 3.3-3.4, 301, fig 7.1b, 303
Sagittal plane, 2, fig 1.1 Sclera, 418, fig 8.53, 421, fig 8.56
Sagittal sinus Scrotal arteries
inferior, 521, fig 9.20 posterior, 347, fig 7.32
superior, 511, fig 9.13, 520, fig 9.19, 522, fig 9.21 Scrotum, 5, 324-325, fig 7.17, 353
Sagittal suture, 362-363, fig 8.4-8.5 dartos fascia of, 324-325, fig 7.17
Salivary glands, 446-447, fig 8.80 function of, 324-325, fig 7.17
function of, 446 Sebaceous glands, 423, fig 8.58
of tongue, 446-447, fig 8.80 Segmental artery of kidney
parotid, 446, fig 8.80 anterior
sublingual, 446, fig 8.80 inferior, 279, fig 6.41
submandibular, 446, fig 8.80 superior, 279, fig 6.41
Salivary nucleus inferior, 279, fig 6.41
inferior, 556, fig 9.43 posterior, 279, fig 6.41
superior, 556, fig 9.43 superior, 279, fig 6.41
Salpingopharyngeal fold, 453, fig 8.85 Segmental medullary artery
Salpingopharyngeus muscle, 454, fig 8.86 anterior, 530, fig 9.26
Saphenous nerve, 103, fig 3.33, 105, 108-110, Segmental muscles, 137
fig 3.37-3.38, 112 Segmental portal veins
Saphenous vein tributaries, 253, fig 6.24
accessory, 104 Segmental spinal branches, 131
great, 104 Sella turcica, 369-371, fig 8.11-8.12
Sartorius muscle, 69, fig 3.8, 72, 77 Semicircular canal of bony labyrinth
Scala tympani, 435, fig 8.70, 437, fig 8.72 anterior, 433, fig 8.68
Scala vestibuli, 435, fig 8.70, 437, fig 8.72 bony ampullae of, 433, fig 8.68
Scalene muscle, 43, fig 2.24 lateral, 435, fig 8.70
Scalenus muscle posterior, 435, fig 8.70
anterior, 460-461, fig 8.90, 483, fig 8.109 Semicircular duct of bony labyrinth
medius, 460-461, fig 8.90, 483, fig 8.109, 489, lateral, 436, fig 8.71
fig 8.113 posterior, 436, fig 8.71
posterior, 460-461, fig 8.90, 483, fig 8.109, Semilunar folds of colon, 267-278, fig 6.33
489, fig 8.113 Semilunar valve, 208, fig 5.44
Scaphocapitate ligament, 37 aortic, 208, fig 5.44
Scaphoid bone, 31-32, fig 2.16 pulmonary, 208, fig 5.44
Index 609
Semimembranosus muscle, 70, 73, fig 3.9, 73, 105 Somatosensory association area of cerebrum,
Seminal colliculus, 329-330, fig 7.20, 335, fig 7.23 497, fig 9.3
Seminal gland, 330 Somatosensory innervation
right, 321, fig 7.15 map of, 499, fig 9.4
Seminal vesicles, 322 Spaces of larynx, 470
Seminiferous tubule(s) Spermatic cord, 228-229, fig 6.4, 324-325, fig 7.17,
convoluted, 323-324, fig 7.16 324-325, fig 7.17
straight, 323-324, fig 7.16 Spermatic fascia
Semispinalis muscle external, 228, fig 6.4, 324-325, fig 7.17
capitis, 138, fig 4.16, 142, 489, fig 8.113 internal, 228, fig 6.4, 324-325, fig 7.17
cervicis, 138, fig 4.16, 142, 489, fig 8.113 Sphenoethmoidal recess, 425, fig 8.60
Semitendinosus muscle, 70, fig 3.9, 73, 77, 105 Sphenofrontal suture of skull, 361-362, 371, 376
Sensory cortex, 497-498, fig 9.3 Sphenofrontal suture of sphenoid bone, 376,
Septa of testis, 323-324, fig 7.16 fig 8.18
Septomarginal trabecula, 204-205, fig 5.42, 209, Sphenoidal concha, 375, fig 8.17
fig 5.45 Sphenoidal crest, 375, fig 8.17
Serosa, 244-245, fig 6.17, 314, fig 7.11, 330, 332 Sphenoidal margin of temporal bone, 377-379,
Serratus muscle fig 8.19-8.21
anterior, 44, 156-157, fig 5.8, 164, fig 5.13, 168 Sphenoidal rostrum, 376, fig 8.18
posterior inferior, 135, fig 4.15, 137, 158-159, fig 5.9 Sphenoidal sinus, 370-371, fig 8.13, 425, fig 8.60,
posterior superior, 134-135, fig 4.15, 137, 375, fig 8.17, 425, fig 8.60
158-159, fig 5.9 Sphenoidal yoke, 369, fig 8.11
Shaft of femur, 67, fig 3.6 Sphenoid bone, 360, fig 8.2, 362, fig 8.4,
Shaft of humerus, 13-14, fig 2.3 364, fig 8.6, 367, fig 8.9, 370-371,
Shaft of radius, 22 fig 8.12-8.13, 374-376, fig 8.16-8.18,
Short posterior ciliary arteries, 413, 422, fig 8.57 404, fig 8.41, 425, fig 8.60
Shoulder and arm anterior clinoid process of, 369, fig 8.11, 376,
bones of, 12-18, fig 2.2-28 fig 8.18
glenohumeral joint of, 17-18, fig 27-2.8 body of, 369, fig 8.11, 374, fig 8.16
muscles of, 19-21, fig 2.9 greater wing of, 360, fig 8.2, 369, fig 8.11, 371,
nerves of, 44-50, fig 2.25-2.30 fig 8.13, 373-376, fig 8.15-8.18, 408,
Shoulder joint, see Glenohumeral (shoulder) joint fig 8.45
Sigmoid arteries, 271, fig 6.35, 273, fig 6.36 infratemporal surface of, 365, fig 8.7
Sigmoid colon, 235-236, fig 6.11, 267-269, maxillary surface of, 375, fig 8.17
fig 6.33-6.34, 310, fig 7.7, 321-322, orbital surface of, 375, fig 8.17
fig 7.15, 322 temporal surface of, 365, fig 8.7, 375,
Sigmoid mesocolon, 310, fig 7.7, 321-322, fig 7.15 fig 8.17
Sigmoid sinus, 520, fig 9.19, 522, fig 9.21 infratemporal crest of, 365, fig 8.7
Sigmoid veins, 276, fig 6.38 lesser wing of, 360, fig 8.2, 369, fig 8.11, 371,
Simple bony limb of bony labyrinth, 435, fig 8.70 fig 8.13, 373-376, fig 8.15-8.18, 408,
Sinuatrial nodal branch of right coronary artery, fig 8.45
212-213, fig 5.47 parts of, 376, fig 8.18
Sinuatrial node (SA) node, 202, 204, 215-216, fig 5.49 pterygoid fossa of, 366, fig 8.8
Sinus pterygoid hamulus of, 365, fig 8.7
ethmoid, 372 pterygoid process of, 362, fig 8.4, 376, fig 8.18
frontal, 370-371, fig 8.12, 414, 425, fig 8.60, 536, lateral plate of, 370, fig 8.12
fig 9.30 medial plate of, 370, fig 8.12, 425, fig 8.60
maxillary, 372 scaphoid fossa of, 366, fig 8.8
sphenoid, 370, 375, fig 8.1, 415 spine of, 375, fig 8.17
Skin, 489, fig 8.113 sutures of, 376, fig 8.18
Skull vaginal process of, 365, fig 8.7
midsagittal, 371, fig 8.13 zygomatic margin of, 375, fig 8.17
bones, 362, fig 8.4, 371, fig 8.13 Sphenomandibular ligament, 401, fig 8.40
sutures, 362, fig 8.4, 371, fig 8.13 Spheno-occipital suture of sphenoid bone, 376,
Small cardiac vein, 212-213, fig 5.47 fig 8.18
Smaller cardiac impression Sphenopalatine artery, 366, 396, fig 8.35, 406,
on right lung, 190-191, fig 5.32-5.33 fig 8.43, 427, fig 8.62
Smallest cardiac vein(s) posterior lateral nasal branches of, 427, fig 8.62
atrial, 212-213 posterior septal branches of, 427, fig 8.62
ventricular smallest (thebesian veins), 212-213 Sphenopalatine foramen, 404, fig 8.41, 425,
Small intestine, 235, fig 6.10 fig 8.60
intrinsic innervation of, 274 Sphenopalatine vein, 428, fig 8.63
parasympathetic innervation of, 274 posterior septal branches, 428, fig 8.63
sympathetic innervation of, 274 posterior lateral nasal branches of, 428, fig 8.63
Soleal line of tibia, 74-75, fig 3.10 Sphenoparietal sinus, 522, fig 9.21
Soleus muscle, 75, fig 3.11 Sphenoparietal suture of skull, 361-362, fig 8.3,
Solitary nucleus and tract, 556, fig 9.43 376
Somatic nervous system Sphenoparietal suture of sphenoid bone, 376,
of anal canal, 276, fig 6.38 fig 8.18
of rectum, 276, fig 6.38 Sphenosquamosal suture of skull, 361, fig 8.3

Sphenosquamosal suture of sphenoid bone, 376, Spiral line of femur, 67, fig 3.6
fig 8.18 Spiral organ (of Corti), 437, fig 8.72
Sphincter of Oddi see hepatopancreatic sphincter Spiral prominence, 437, fig 8.72
(of Oddi) Spiral sulcus
Sphincter pupillae muscle, 420, fig 8.55 outer, 437, fig 8.72
Spinal artery(ies), 398, fig 8.37 Splanchnic nerve(s)
anterior, 516, fig 9.16, 526, fig 9.24, 530, fig 9.26 greater, 255, 263-264, fig 6.31
posterior left, 264, fig 6.31
left, 530, fig 9.26 right, 264, fig 6.31
right, 530, fig 9.26 lesser, 255, 263-264, fig 6.31
Spinal cord, 489, fig 8.113, 528, fig 9.25, 530, lumbar (L1-L2), 273-274, 278, 311, 322
fig 9.26 of female, 345-346, fig 7.31
anterior median fissure of, 525, fig 9.23 of male, 344-345, fig 7.30
arachnoid mater of, 528, fig 9.25 pelvic (S2-S4), 268, 273-274, 276, 281, 311, 322,
arteries of, 530-531, fig 9.27 343
blood vessels of, 529-531, fig 9.26-9.27 of female pelvis, 345-346, fig 7.31
function of, 525, fig 9.23 of male, 344-345, fig 7.30
horn of of anal canal, 276, fig 6.38
anterior, 526, fig 9.24 of rectum, 276, fig 6.38
lateral, 526, fig 9.24, 528, fig 9.25 sacral, 276
posterior, 526, fig 9.24 of anal canal, 276, fig 6.38
location of, 525, fig 9.23 of rectum, 276, fig 6.38
pia mater of, 528, fig 9.25 sacral plexus, 343
parts of, 525, fig 9.23 thoracic (T5-T12), 176, 179, fig 5.24, 226, fig 6.3,
surfaces of, 525, fig 9.23 263-264, fig 6.31, 273-274
topology and morphology, 524-525, Spleen, 235, fig 6.10, 240, fig 6.14, 243, fig 6.16,
fig 9.22-9.23 246-247, fig 6.18-6.19, 248, fig 6.20
veins, 531, fig 9.27 arteries of, 287-288, fig 6.45
Spinal ganglion, 526, fig 9.24, 528, fig 9.25 borders of
Spinalis cervicis muscle, 139, fig 4.17 inferior border of, 246, fig 6.18
Spinalis thoracis muscle, 138, fig 4.16 superior border of, 246, fig 6.18
Spinal meninges and nerve roots, 526-527, celiac node of, 247, fig 6.19
fig 9.24 celiac plexus of, 247, fig 6.19
arachnoid mater, 525, fig 9.23, 527 definition of, 247, fig 6.19
dura mater, 525-527, fig 9.23-9.24 extremities of
nerve rootlets of, 527 anterior extremity of, 246, fig 6.18
pia mater, 525, fig 9.23, 527 posterior extremity of, 246, fig 6.18
spaces of, 527 fibrous capsule of, 247, fig 6.19
Spinal nerve(s), 526-529, fig 9.24-9.25 impressions of
anterior root of, 525-526, fig 9.23-9.25, 528 colic impression of, 246, fig 6.18
rootlets of, 526, fig 9.24 gastric impression of, 246, fig 6.18
branches of, 529 gastrosplenic ligament of, 246, fig 6.18
formation of, 529 renal impression of, 246, fig 6.18
medial branch of, 528, fig 9.25 lymphatics of, 290-291, fig 6.47
posterior root of, 525-526, fig 9.23-9.24, 528, neurovascular supply of, 247, fig 6.19
fig 9.25 related liver, 248, fig 6.20
rootlets of, 526, fig 9.24 splenic pulp, 247, fig 6.19
ramus communicans of splenic trabeculae, 247, fig 6.19
gray, 526, fig 9.24, 528, fig 9.25 surfaces of
white, 526, fig 9.24, 528, fig 9.25 diaphragmatic surface, 246, fig 6.18
ramus of anterior extremity, 246, fig 6.18
anterior, 526, fig 9.24, 528, fig 9.25 inferior border, 246, fig 6.18
posterior, 526, fig 9.24, 528, fig 9.25 posterior extremity, 246, fig 6.18
recurrent meningeal branches of, 528, superior border, 246, fig 6.18
fig 9.25 visceral surface, 246, fig 6.18
rootlets of, 525, fig 9.23 trabecular
supply area of, 529 artery, 247, fig 6.19
Spinal vein vein, 247, fig 6.19
anterior, fig 9.27 splenic
posterior, 531, fig 9.27 artery, 246-247, fig 6.18
Spine of scapula, 15, fig 2.5 vein, 246-247, fig 6.18
Spine of sphenoid bone, 375, fig 8.17 splenorenal ligament, 246, fig 6.18
Spinoglenoid notch of scapula, 15, fig 2.5 Splenic artery, 226, fig 6.3, 235, fig 6.10, 239,
Spinous process of axis, 120, fig 4.6 fig 6.13, 241, fig 6.15, 246-247,
Spinous process of lumbar vertebrae, 127 fig 6.18-6.19, 254-255, fig 6.25, 261,
Spinous process of thoracic vertebrae, 124, fig 4.9 fig 6.29, 285-289, fig 6.44-6.46
Spinous process of vertebra, 116, fig 4.3, 119, 127 pancreatic branches of, 287-288, fig 6.45
Spiral artery of uterus, 320, fig 7.14 Splenic lymph nodes, 291, 294-295, fig 6.47,
Spiral ligament, 437, fig 8.72 fig 6.49
Spiral limbus, 437, fig 8.72x Splenic plexus, 561, fig 9.46
Index 611
Splenic pulp, 247, fig 6.19 Styloglossus muscle, 442-443, fig 8.77-8.78,
Splenic trabeculae, 247, fig 6.19 564-565, fig 9.48
Splenic vein, 235, fig 6.10, 246, fig 6.18, 246-247, Stylohyoid muscle, 460, fig 8.90, 462
fig 6.18-6.19, 255, 262, fig 6.30, Stylohyoid muscle of neck, 483, fig 8.109
287-289, fig 6.45-6.46 Styloid process
Splenii muscles, 137 of fibula, 75-76, fig 3.11
Splenius capitis muscle, 138, fig 4.16, 140, 483, of radius, 22-23, fig 2.10
fig 8.109, 489, fig 8.113 of temporal bone, 360, fig 8.2, 365, fig 8.7,
Splenius cervicis muscle, 140, 489, fig 8.113 377-379, fig 8.19-8.21, 401, fig 8.40
Splenorenal ligament, 246, fig 6.18 of ulna, 22-23, fig 2.10, fig 2.11
Spongy part of urethra, 329, fig 7.20 Stylomandibular ligament, 401, fig 8.40
Squamosal margin of greater wing of sphenoid Stylomastoid artery, 366
bone, 376, fig 8.18 Stylomastoid foramen, 366, fig 8.8, 556, fig 9.43
Squamous part of temporal bone, 361, fig 8.3, 370, Stylopharyngeal branch of glossopharyngeal
fig 8.12, 377, fig 8.19 nerve, 557, fig 9.43
Squamous suture of skull, 361, fig 8.3 Stylopharyngeus muscle, 454, fig 8.86, 458, 470,
Stapedius muscle, 433-434, fig 8.69, 551 556-558, fig 9.43
Stapedius nerve, 434, fig 8.69 Subarachnoid space, 528, fig 9.25
Stapes Subarcuate fossa of temporal bone, 378, fig 8.20
base of, 433-434, fig 8.68-8.69 Subcallosal area, 536, fig 9.30
head, 434, fig 8.69 Subcapsular plexus, 351, fig 7.34
limbs of, 433-434, fig 8.68-8.69 Subclavian artery, 44-45, fig 2.24-2.26, 161-162,
Sternal articular surface of clavicle, 12, fig 2.2 191, 398, fig 8.37, 456-457, 472,
Sternoclavicular joint, 12 fig 8.99, 475, fig 8.101, 478, fig 8.104,
Sternocleidomastoid branch of ansa cervicalis, 484, fig 8.110
479, fig 8.105 left, 169, fig 5.17, 174-177, fig 5.20-5.22, 196,
Sternocleidomastoid muscle, 4-5, fig 1.3, 145, fig 5.36, 200-201, fig 5.39-5.40
457, 460-461, fig 8.90, 478, 483-485, right, 174-177, fig 5.20-5.22, 196, fig 5.36
fig 8.109, 487, 489, fig 8.113, 563-564, Subclavian nerve, 43, fig 2.24, 48, fig 2.29
fig 9.47 Subclavian vein, 46-47, fig 2.27-2.28, 476, fig 8.102,
Sternocostal surface of heart see anterior 478, fig 8.104, 482, 484, fig 8.110
(sternocostal) surface of heart left, 196, fig 5.36
Sternohyoid muscle, 460, fig 8.90, 462, 483, Subclavian vein of thymus
fig 8.109, 489, fig 8.113, 565, fig 9.48 right, 196, fig 5.36
Sternothyroid branch of ansa cervicalis, 479, Subclavian vein of thyroid, 473, fig 8.100
fig 8.105 Subcostal artery(ies), 130, 145, fig 4.19, 162, 230,
Sternothyroid muscle, 460, fig 8.90, 462, 489, fig 6.5, 233, fig 6.8
fig 8.113, 565, fig 9.48 Subcostal nerve, 232, fig 6.7, 283, fig 6.43
Sternum, 198, fig 5.38, 226, fig 6.3 cutaneous branch
Stomach, 235, fig 6.10, 238, fig 6.12 lateral, 232, fig 6.7
arteries of, 285-286, fig 6.44 Subcostal vein, 145, fig 4.19, 231, fig 6.6, 233, fig 6.8
body of, 243-244, fig 6.16-6.17 Subcutaneous infrapatellar bursa of the knee, 81,
cardia of, 243-244, fig 6.16-6.17 fig 3.16
definition of, 243, fig 6.16, 245 Subdeltoid and subacromial bursae, 17-18,
function of, 243, fig 6.16, 245 fig 2.7-2.8
fundus of, 243-244, fig 6.16-6.17 Subendocardial (Purkinje) fibers, 215-216
gastric canal, 244, fig 6.17 Sublime tubercle of ulna, 24
gastric folds, 244, fig 6.17 Sublingual artery, 445-446, fig 8.79-8.80
gastric wall, 245 Sublingual caruncle, 446, fig 8.80
greater curvature of, 243, fig 6.16 Sublingual fold, 446, fig 8.80
in situ, 243, fig 6.16 Sublingual fossa of mandible, 382, fig 8.24
lesser curvature of, 243, fig 6.16 Sublingual gland, 446-447, fig 8.80
lymphatics of, 292-295, fig 6.48-6.49 Sublingual nerve, 549, fig 9.39
main parts of, 243, fig 6.16 Sublingual vein, 446, fig 8.80
muscular layers of Submandibular duct, 446, fig 8.80
circular layer of, 244-245, fig 6.17 Submandibular ganglion, 445, fig 8.79, 549,
longitudinal layer of, 244-245, fig 6.17 fig 9.39, 552, fig 9.41
oblique fibers of, 244-245, fig 6.17 Submandibular gland, 446-447, fig 8.80
pyloric antrum, 244, fig 6.17 Submandibular lymph nodes, 480, fig 8.106, 482,
pyloric canal, 244, fig 6.17 fig 8.108
pyloric orifice, 244, fig 6.17 Submandibular nerves, 549, fig 9.39
pyloric part of, 243, fig 6.16 Submandibular triangle of neck, 483-485,
related liver, 248, fig 6.20 fig 8.109-8.110
pyloric sphincter, 244, fig 6.17 Submental artery, 387, fig 8.26, 396, fig 8.35, 475,
related pancreas, 255 fig 8.101
structure of stomach, 243, fig 6.16 Submental lymph nodes, 480, fig 8.106, 482,
Straight arteries of colon, 271, fig 6.35 fig 8.108
Straight sinus, 521, fig 9.20 Submental triangle of neck, 483-485,
Stria vascularis, 437, fig 8.72 fig 8.109-8.110

Submental vein, 392, fig 8.31 Superior articular facets of atlas, 123
Submucosa Superior articular process of axis, 119-120,
of duodenum, 257, fig 6.27 fig 4.5-4.6
of ileum, 260 Superior articular process of vertebra, 116, fig 4.3
of jejunum, 260 Superior as term of relationship, 2, fig 1.1
of stomach, 244-245, fig 6.17 Superior border of spleen, 246, fig 6.18
Submucosal plexus (Meissner’s plexus), 263 Superior bulb of internal jugular vein, 956, fig 8.87
of anal canal, 276, fig 6.38 Superior cerebral vein(s), 520, fig 9.19
of large intestine, 272 Superior cervical ganglion, 214, fig 5.48, 457, fig 8.88
of rectum, 276, fig 6.38 Superior cluneal nerve(s), 104-105, fig 3.34
Suboccipital nerve, 144, fig 4.18 Superior colliculus of brainstem, 507, fig 9.10,
Subpubic angle, 300, fig 7.1a 539-540, fig 9.32
Subpyloric lymph nodes, 293-294, fig 6.48 Superior costal facet, 124, fig 4.9
Subscapular artery, 44-45, fig 2.25-2.26 Superior genicular artery
Subscapular fossa of scapula, 15, fig 2.5 lateral, 108-110, fig 3.37-3.38
Subscapular vein, 46-47, fig 2.27-2.28 medial, 108-110, fig 3.37-3.38
Subserosal areolar tissue, 292 Superior glenohumeral ligament, 17-18, fig 2.7-2.8
Substantia nigra, 501-502, fig 9.6 Superior gluteal artery, 104
related basal nuclei, 501-502, fig 9.6 Superior gluteal nerve, 105, fig 3.34
Subtalar joint, 91 Superior head of lateral pterygoid muscle, 399,
Subtendinous bursa of biceps femoris of knee fig 8.38
inferior, 77, fig 3.12 Superior hypogastric plexus
Subtendinous bursa of gastrocnemius muscle of female, 345-346, fig 7.31
of knee of male, 344-345, fig 7.30
lateral, 81, fig 3.16 Superior laryngeal nerve
Subtendinous bursa of iliotibial tract of knee, 77, fold of, 453, fig 8.85
fig 3.12 Superior lobe
Subthalamic nucleus, 501-502, fig 9.6 of right lung, 190, fig 5.32
related basal nuclei, 501-502, fig 9.6 Superior medial genicular artery, 108-110,
Subthalamus, 502-503, fig 9.7 fig 3.37-3.38
function of, 503, fig 9.7 Superior nasal concha of ethmoid bone, 371, fig 8.13
location of, 503, fig 9.7 Superior nuchal line of occipital bone, 365, fig 8.7
Sulcal arteries, 530, fig 9.26 Superior orbital fissure, 408, fig 8.45
Sulcal veins, 531, fig 9.27 Superior part of duodenum, 235, 244, fig 6.17, 248,
Sulcus of auditory tube, 376, fig 8.18 fig 6.20, 254-256, fig 6.26, 257-258,
Sulcus of brain, 493, fig 9.1 fig 6.27
central, 493, fig 9.1 Superior petrosal sinus, 520, fig 9.19
lateral, 493, fig 9.1 Superior ramus
Sulcus of papilla, 441, fig 8.76 iliopubic eminence, 64, fig 3.3
Sulcus of spinal cord obturator crest, 64, fig 3.3
anterolateral, 525, fig 9.23 obturator groove, 64, fig 3.3
posterior obturator tubercles, 64, fig 3.3
intermediate, 525, fig 9.23 pecten pubis, 64, fig 3.3
median, 525, fig 9.23 Superior sagittal sinus, 520, fig 9.19
posterolateral, 525, fig 9.23 Superior subscapular nerve, 43, fig 2.24
Sulcus of tongue Superior surface
median, 440, fig 8.76 of urinary bladder, 327, fig 7.18
Supinator crest of ulna, 24 Superior temporal line, 361, fig 8.3
Sympathetic fibers Superior thoracic artery, 43, fig 2.24
postganglionic, 264 Superior thyroid artery, 398, fig 8.37
preganglionic, 264 Superior/proximal tibiofibular joint, 75, fig 3.11
Superficial circumflex iliac artery, 103, fig 3.33 Superior vena cava, 46-47, 173, fig 5.19, 175-176,
Superficial fibular nerve, 112 fig 5.21, 178, fig 5.23, 191-192,
Superficial head of medial pterygoid muscle, 399, fig 5.32-5.34, 200-203, fig 5.39-5.41
fig 8.38 Supinator crest, 24
Superficial lateral cervical lymph nodes, 481, Supinator muscle, 29-30, fig 2.15
fig 8.107 Supporting cells, 437, fig 8.72
Superficial middle cerebral vein (of Sylvius), 520, Supraacetabular groove, 64, fig 3.3
fig 9.19, 522, fig 9.21 Supraclavicular branches of brachial plexus, 43,
Superficial palmar arch, 56, fig 2.37 fig 2.24
Superficial palmar branch of radial artery, 56, Supraclavicular lymph nodes, 482, fig 8.108
fig 2.37 Supraclavicular nerve(s) (C3-C4), 48-49,
Superficial parotid lymph nodes, 480, fig 8.106 fig 2.29-2.30, 479, fig 8.105
Superior anastomotic vein, 520, fig 9.19 Supraclavicular nerves, 145, fig 4.19
Superior articular facets of atlas, 123 Supracondylar lines
Superior articular facet of lumbar vertebra, 126, lateral, 67, fig 3.6
fig 4.10 medial, 67, fig 3.6
Superior articular facet of thoracic vertebra, 124, Supracondylar process, 14
fig 4.9 Supracondylar ridge
Superior articular facet of vertebra, 116-117, lateral, 13-14, fig 2.3
fig 4.3-4.4 medial, 13-14, fig 2.3
Index 613
Supraduodenal artery, 285, fig 6.44, 287-288 Surfaces of urinary bladder
Supraglenoid tubercle of scapula, 15, fig 2.5 inferolateral, 327, fig 7.18
Supraorbital artery, 388, fig 8.27, 413, fig 8.48 superior, 327, fig 7.18
Supraorbital foramen Surrounding neurovasculature of heart, 198
of frontal bone, 408, fig 8.45 Suspensory ligament of ovary, 312, fig 7.9
Supraorbital nerve, 394-395, fig 8.33-8.34, 544, Sustentaculum tali, 90-91, fig 3.22-3.23
fig 9.35 Sutures of the skull, 361, fig 8.3
Supraorbital vein, 391-392, fig 8.30-8.31 coronal, 361, fig 8.3, 362, fig 8.4
Suprapatellar bursa of knee, 81, fig 3.16 frontonasal, 361, fig 8.3
Suprapyloric lymph nodes, 293-294, frontozygomatic, 361, fig 8.3
fig 6.48-6.49 intermaxillary, 361, fig 8.3
Suprarenal (adrenal) gland(s), 222, 239, fig 6.13, lambdoid suture, 362-363, fig 8.4-8.5
251-252, 277, fig 6.39, 279-280, 297 occipitomastoid, 362, fig 8.4
inferior, 279-280, fig 6.14-6.15 palatine
left, 239-241, fig 6.13, 247, 255 median, 365, fig 8.7
right, 254, fig 6.25 sagittal, 362-363, fig 8.4-8.5
Suprarenal artery(ies) sphenofrontal, 362, fig 8.4
inferior, 277, fig 6.39, 280 sphenoparietal, 361-362, fig 8.3-8.4
middle, 277, fig 6.39 sphenosquamosal, 361, fig 8.3
superior, 226, fig 6.3, 277, fig 6.39 squamous, 361-362, fig 8.3-8.4
Suprarenal vein, 277, fig 6.39 temporozygomatic, 362, fig 8.4
Suprascapular artery, 44, fig 2.25, 43, fig 2.24, 472, zygomaticomaxillary, 361, fig 8.3
fig 8.99, 475, fig 8.101, 478, fig 8.104, Sutures of the sphenoid bone, 376, fig 8.18
484, fig 8.110 sphenofrontal suture, 376, fig 8.18
lateral, 48, fig 2.29 spheno-occipital suture, 376, fig 8.18
Suprascapular nerve, 43, fig 2.24 sphenoparietal suture, 376, fig 8.18
Suprascapular region, 114, fig 4.1 sphenosquamosal suture, 376, fig 8.18
Suprascapular vein, 46-47, fig 2.27-2.28 Sympathetic trunk(s), 457-458, fig 8.88, 489,
Supraspinatus muscle, 16-19, fig 2.7-2.9, 49 fig 8.113
Supraspinous fossa of scapula, 15, fig 2.5 ganglion of, 528, fig 9.25
Supraspinous ligament, 117, fig 4.4 lumbar ganglion
Suprastyloid crest, 24 of female pelvis, 345-346, fig 7.31
Supratragic notch, 431, fig 8.66 Symphyseal surface of pubis, 64, fig 3.3
Supratragic tubercle, 431, fig 8.66 Symphysis joint
Supratrochlear artery, 388, fig 8.27, 412, fig 8.47 lumbosacral, 127
Supratrochlear nerve, 394-395, fig 8.33-8.34, Synovial ball-and-socket joints
414, fig 8.49, 544, fig 9.35 of hip, 68
Supratrochlear vein, 391, fig 8.30, 392 of shoulder, 18, fig 2.7
Supraventricular crest, 204, fig 5.42, 209, fig 5.45 Synovial ellipsoid joint, 123
Sural arteries, 108-109, fig 3.38 Synovial hinge joint, 80
Sural cutaneous nerve ankle, 93
lateral, 110 Synovial membrane, 68, fig 3.37
medial, 110 Synovial plane joints
Sural nerve lumbosacral joint, 127
medial calcaneal branches, 107, fig 3.36, 112 Synuatrial node, 215, fig 5.49
lateral calcaneal branches, 107, fig 3.36
Surface anatomy, 4, fig 1.3-1.4 T
Surface anatomy of heart, 199-202, Tail of ear, 431, fig 8.66
fig 5.39-5.40 Tail of pancreas
Surface landmarks of body, 4-5, fig 1.3-1.4, 43, artery of, 287, fig 6.45
fig 2.24 Talar articular surface, 90, fig 3.22
Surface of tongue, 440, fig 8.75 anterior, 90-91, fig 3.22-3.23
Surfaces of cerebellum middle, 90-91, fig 3.22-3.23
anterior (petrosal), 508, 510 posterior, 90-91, fig 3.22-3.23
inferior (suboccipital), 508 Talocrural joint, 75, fig 3.11
superior (tentorial), 508 Talocrural region, 62, fig 3.10
Surfaces of fibula Talofibular ligament
medial, 75, fig 3.11 anterior, 93, fig 3.25
lateral, 75, fig 3.11 Talus bone, 74-75, fig 3.11, 86-87, fig 3.19, 88-89,
posterior, 75, fig 3.11 fig 3.20-3.21, 90-94, fig 3.24-3.25
Surfaces of heart, 199 articulations
anterior (sternocostal), 201 subtalar joint, 89
inferior (diaphragmatic), 201 talonavicular joint, 89
left (pulmonary), 201 facet for calcaneus, 88, fig 3.20
Surfaces of spleen anterior, 88, fig 3.20
diaphragmatic surface, 246, fig 6.18 middle, 88, fig 3.20
visceral surface, 246, fig 6.18 malleolar facet, 88, fig 3.20
Surfaces of tibia lateral, 88-89, fig 3.20-3.21
medial, 74, fig 3.10 medial, 88-89, fig 3.20-3.21
posterior, 74, fig 3.10 superior, 88, fig 3.20

Talus bone Temporal bone(s)
medial tubercle of posterior process, 88, fig 3.20 squamous part of, 361, fig 8.3, 370, fig 8.12,
navicular articular surface, 88-89, fig 3.20-3.21 377-378, fig 8.19-8.20
posterior calcaneal articular facet, 89, fig 3.21 styloid process of, 360, fig 8.2, 365, fig 8.7,
posterior process, 88-89, fig 3.20-3.21 377-379, fig 8.19-8.21, 401, fig 8.40
lateral tubercle of, 88-89, fig 3.20-3.21 subarcuate fossa of, 378, fig 8.20
medial tubercle of, 88-89, fig 3.20-3.21 styloid process of, 361, fig 8.3, 377, fig 8.19
of talus, 88, fig 3.20 tympanic part of, 377, fig 8.19, 379, fig 8.21
superior facet, 89, fig 3.21 tympanomastoid fissure of, 377, 379, fig 8.19,
talar sulcus, 88-89, fig 3.20-3.21 fig 8.21
tarsal sinus, 89, fig 3.21 tympanosquamous fissure of, 377, fig 8.19
trochlea of talus, 89 zygomatic process of, 361, fig 8.3, 365, fig 8.7,
tubercle 377-379, fig 8.19-8.21
medial, 89 Temporal fossa, 361, fig 8.3
lateral, 89 Temporal gyrus(i)
Tarsal artery inferior, 495-496, fig 9.2
lateral, 111-112, fig 3.40 middle, 495-496, fig 9.2
medial, 111-112, fig 3.40 superior, 495-496, fig 9.2
Tarsal muscle Temporalis muscle, 399, fig 8.38, 400, fig 8.38
inferior, 423, fig 8.58 Temporal line
superior, 423, fig 8.58 inferior, 361, fig 8.3
Taste buds, 441, fig 8.76 superior, 361, fig 8.3
Taste pathway, 566, fig 9.49 Temporal lobe of cerebrum, 493-496, fig 9.1-9.2
Tectorial membrane Temporal nerve
of cervical vertebral column, 121-123, fig 4.8 anterior
of cochlear duct, 438, fig 8.73 deep, 548-549, fig 9.39
Tectum, 505, fig 9.8 posterior
Teeth, 380-381, 448-452, fig 8.81-8.84 deep, 548-549, fig 9.38-9.39
Tegmen tympani of temporal bone, 432, fig 8.67 Temporal process of zygomatic bone, 365, fig 8.7
Tegmental wall of tympanic cavity, 432-433, Temporal region, 359, fig 8.1
fig 8.67-8.68 Temporal surface of greater wing of sphenoid,
Tegmentum, 505, fig 9.8 365, fig 8.7, 375, fig 8.17
Telencephalon, 502 Temporal vein
Temporal artery middle, 392, fig 8.31
anterior deep, 389, fig 8.28, 396, fig 8.35 superficial, 390, fig 8.29, 392, fig 8.31, 446,
middle, 387, fig 8.26 fig 8.80
posterior deep, 389, fig 8.28, 396, fig 8.35 Temporomandibular joint, 380, 382, 399, 400,
inferior, 517, fig 9.17 401-402, fig 8.39-8.40
superficial, 387, fig 8.26, 396, fig 8.35, 427, Temporomandibular joint capsule
fig 8.62, 431, 446-447, fig 8.80 articular capsule of, 401-402, fig 8.39-8.40
Temporal association area of cerebrum, 497-498 anterior, 402, fig 8.40
Temporal bone(s), 360, fig 8.2, 362, fig 8.4, posterior, 402, fig 8.40
364, fig 8.6, 367, fig 8.9, 371, fig 8.13, articular cartilage of, 402, fig 8.40
377-379, fig 8.19-8.21, 401, fig 8.40 articular surface of condyle of mandible, 402,
arcuate eminence of, 378, fig 8.20 fig 8.40
articular tubercle of, 365, fig 8.7, 369, fig 8.21, articular surface of mandibular fossa, 402, fig 8.40
402, fig 8.40 band of, 402, fig 8.40
articulations of, 379, fig 8.21 anterior band, 402, fig 8.40
bony external acoustic opening of, 377-379, posterior band, 402, fig 8.40
fig 8.19-8.21 cavity of
bony features of, 379, fig 8.21 inferior, 402, fig 8.40
fissures of, 379, fig 8.21 superior, 402, fig 8.40
groove for middle meningeal artery of, 378, condylar process of mandible, 402, fig 8.40
fig 8.20 intermediate zone of, 402, fig 8.40
groove for sigmoid sinus, 378, fig 8.20 ligaments of, 402, fig 8.40
jugular fossa of, 379, fig 8.21 retrodiscal tissue of, 402, fig 8.40
main parts of, 379, fig 8.21 rotational movements of, 403
mandibular fossa of, 366, fig 8.8, 379, fig 8.21 synovial membrane of, 402, fig 8.40
mastoid foramen of, 379, fig 8.21 translation movements of, 403
mastoid notch of, 366, fig 8.8, 377, 379, fig 8.19, Temporomandibular ligament
fig 8.21 lateral, 401, fig 8.40
mastoid process of, 361, fig 8.3, 365, fig 8.7, 377, Temporoparietalis muscle, 385
fig 8.19, 379, fig 8.21, 401, fig 8.40 Temporozygomatic suture, 362, fig 8.4
parietal margin of, 377-378, fig 8.19-8.20 Tendinous arch
petrosquamous fissure of, 378, fig 8.20 of pelvic fascia, 331, fig 7.21
petrotympanic fissure, 377, fig 8.19 Tendinous chords, 209, fig 5.45
petrous part of, 361, fig 8.3, 377-379, of biceps brachii muscle, 19-21, 25, fig 2.9, fig 2.12
fig 8.19-8.21 of left atrioventricular valve, 206, fig 5.43, 210,
apex of, 378-379, fig 8.20-8.21 fig 5.46
sphenoidal margin of, 377-379, fig 8.19-8.21 of papillary muscles, 204, fig 5.42
Index 615
Tendon of diaphragm Thoracic vein
central, 226, fig 6.3 lateral, 46, fig 2.27
Tendon of extensor carpi ulnaris muscle, 35, Thoracic vertebrae
fig 2.19 atypical vertebrae (T1), (T10-12), 124
Tendon sheath of extensor carpi ulnaris muscle, typical vertebrae (T2-T9), 124, fig 4.9
35, fig 2.19, 35 Thoracoabdominal nerves, 231, fig 6.6
Tenia Thoracoacromial artery, 44, fig 2.25
free, 267, fig 6.33 acromial branch of, 44, fig 2.25
mesocolic, 267, fig 6.33 clavicular branch of, 43, fig 2.24
omental, 267, fig 6.33 deltoid branch of, 44, fig 2.25
Teniae coli, 236, fig 6.11, 310, fig 7.7 pectoral branch of, 43, fig 2.24
Tensor fascia latae muscle, 70-71, fig 3.9 Thoracoacromial vein, 47, fig 2.28
Tensor tympani muscle, 434, fig 8.69 Thoracodorsal artery, 45, fig 2.26
Teres major muscle, 17-20, fig 2.7-2.9 Thoracodorsal nerve, 43, fig 2.24
Teres minor muscle, 17-21, fig 2.7-2.9 Thoracoepigastric vein, 231, fig 6.6
Terminal branches of brachial plexus, 43, fig 2.24 Thumb, 10-11, fig 2.1
Terminal stria, 501, fig 9.6 Thyroarytenoid muscle, 465-467, fig 8.93-8.94
Terminal sulcus of tongue, 440, fig 8.75 Thyrocervical trunk, 44-45, fig 2.25-2.26, 398,
Terminology fig 8.37, 456, fig 8.87, 472-473, fig 8.99,
anatomical position, 2 475, fig 8.101, 478, fig 8.104, 484, fig 8.110
anterior, 2, fig 1.1 Thyroepiglottic ligament, 466, fig 8.93
appendicular, 3, fig 1.2 Thyroepiglottic muscle, 466, fig 8.93
axial, 3, fig 1.2 Thyrohyoid ligament
body planes median, 466, fig 8.93
coronal, 2, fig 1.1 lateral, 466, fig 8.93
median, 2, fig 1.1 Thyrohyoid membrane, 459, fig 8.89, 464, fig 8.91,
sagittal, 2, fig 1.1 465, fig 8.92
transverse, 2, fig 1.1 aperture of, 465, fig 8.92
body regions, 3, fig 1.2 Thyrohyoid muscle, 460, fig 8.90, 462, 483,
cavities of the body, 6, fig 1.5 fig 8.109, 565, fig 9.48
directional terms, 2, fig 1.1 Thyroid artery
surface landmarks, 5, fig 1.4 inferior, 398, fig 8.37, 456, fig 8.87, 472, fig 8.99,
Tertiary ovarian follicle, 314, fig 7.11 475, fig 8.101
Testicular artery, 228, fig 6.4, 323, fig 7.16, 325, superior, 396, fig 8.35, 398, fig 8.37, 456,
fig 7.17 fig 8.87, 472, fig 8.99, 475, fig 8.101,
ureteric branches of, 281, fig 6.42 478, fig 8.104, 484, fig 8.110
Testis, 323-324, fig 7.16 Thyroid articular surface of cricoid cartilage, 465,
function of, 324 fig 8.92
septa of, 323-324, fig 7.16 Thyroid cartilage, 454, fig 8.86, 459, fig 8.89, 464,
tunica albuginea of, 325, fig 7.17 fig 8.91, 467-469, 471, fig 8.94-8.98
tunica vaginalis of, 325, fig 7.17 inferior horn of, 465, fig 8.92
Thalamus, 272, 493, fig 9.1, 500, fig 9.5, 502-503, superior horn of, 465, fig 8.92
fig 9.7, 507, 518, 539-540, 566 Thyroid gland
function of, 503, fig 9.7 arterial supply of, 472, fig 8.99
location of, 503, fig 9.7 functions of, 473
Thenar compartment of hand, 38, fig 2.21-2.22 innervation of, 473
Thoracic aorta, 130, fig 4.12, 198, fig 5.38 isthmus lobe, 471, fig 8.98
descending, 530, fig 9.26 left lobe, 471, fig 8.98
Thoracic artery pyramidal lobe, 471, fig 8.98
internal, 196, fig 5.36, 231, fig 6.5 right lobe, 471, fig 8.98
lateral, 43-44, fig 2.24-2.25, 230, fig 6.5 venous drainage of, 473, fig 8.100
Thoracic cavity, 6-7, fig 1.6 Thyroid ima artery, 472-473, 475
Thoracic duct, 266, fig 6.32, 482, fig 8.108 Thyroid lymph nodes, 482, fig 8.108
Thoracic ganglion, 214, fig 5.48 Thyroid vein
2nd, 214, fig 5.48 external, 473, fig 8.100
3rd, 214, fig 5.48 inferior, 473, fig 8.100, 476, fig 8.102
Thoracic kyphosis, 115, fig 4.2 internal, 473, fig 8.100
Thoracic nerve middle, 473, fig 8.100, 476, fig 8.102
long, 48, fig 2.29 superior, 476, fig 8.102
Thoracic spine, 116, fig 4.2, 124 Thyroid venous plexus, 473
joints of, 125 Thyropharyngeal part of inferior pharyngeal
structure of, 124, fig 4.9 constrictor muscle, 454-455, fig 8.86
vertebrae of, 125 Tibia, 74-75, fig 3.10
Thoracic splanchnic nerve(s) (T5-T12), 176, 179, ankle, 92-93, fig 3.24-3.25
fig 5.24, 226, fig 6.3, 263-264, fig 6.31, articular facet of medial malleolus, 74,
273-274 fig 3.10
greater, 263-264, fig 6.31 border(s) of
lesser, 263, fig 6.31 anterior, 74-75, fig 3.10
left, 264, fig 6.31 interosseous, 74-75, fig 3.10
Thoracic surface of diaphragm, 160-161, fig 5.10 medial border, 74-75, fig 3.10

Tibia Tragicus muscle, 431, fig 8.66
(continued) Tragus, 431, fig 8.66
condyle(s) of Transversalis fascia, 228-229, fig 6.4, 312, fig 7.9
lateral, 74-75, fig 3.10 Transverse arytenoid muscle, 468, fig 8.95
medial, 74-75, fig 3.10 Transverse cervical artery, 145, fig 4.19, 472,
intercondylar eminence of, 74, fig 3.10 fig 8.99, 475, fig 8.101, 478, fig 8.104,
malleolar groove of, 74, fig 3.10 484-485, fig 8.110
malleolus(i) Transverse cervical nerve (C2-C3) 477, fig 8.103,
medial, 74-75, fig 3.10 479, fig 8.105
lateral, 74-75, fig 3.10 Transverse colon, 235-236, fig 6.10-6.11, 238-239,
soleal line of, 74-75, fig 3.10 fig 6.12-6.13, 240, 243, fig 6.16, 248,
surfaces of fig 6.20, 267-268, fig 6.33
medial, 74, fig 3.10 Transverse facial artery, 446, fig 8.80
posterior, 74, fig 3.10 Transverse foramen of atlas, 120, fig 4.6
tibial plateau, 74-75, fig 3.10 Transverse humeral ligament, 17-18
tibial tuberosity, 5, 74-75, fig 3.10 Transverse ligament of acetabulum, 68, fig 3.7
tubercle of iliotibial tract, 74, fig 3.10 Transverse ligament of atlas, 120-122, fig 4.6-4.8
Tibial artery Transverse muscle of tongue, 442-444,
anterior, 108, 110, fig 3.37-3.38 fig 8.77-8.78
posterior, 108-110, fig 3.37-3.38 Transverse plane, 2, fig 1.1
Tibial nerve, 108-110, fig 3.37-3.38 Transverse processes of lumbar vertebrae, 127
Tibial plateau, 74-75, fig 3.10 Transverse process of atlas, 120, fig 4.6
Tibial tuberosity, 5, 74-75, fig 3.10 Transverse process of axis, 120-121, fig 4.6
Tibiocalcaneal ligament, 92, fig 3.24 Transverse process of thoracic vertebra, 124,
Tibiofemoral joint, 77, 80-81, fig 3.15-3.16 fig 4.9
Tibiofibular joint costal facet, 124, fig 4.9
inferior, 75-76 Transverse process of vertebra, 116-117,
middle, 75-76 fig 4.3-4.4
superior, 75-76 Transverse ridges, 129
Tibiofibular joint types Transverse sinus, 520, fig 9.19, 522, fig 9.21
fibrous joint, 74 Transversospinal muscles, 137
plane synovial, 74 Transversus auriculae, 431, fig 8.66
syndesmosis, 74 Trapeziotrapezoidal interosseous ligament, 35,
Tibiofibular trunk, 109, fig 3.38 fig 2.19, 37
Tibionavicular ligament, 92, fig 3.24 Trapezium bone, 31-32, fig 2.16
Tibiotalar ligament Trapezius muscle, 135-136, fig 4.15, 483, fig 8.109,
anterior, 93, fig 3.25 489, fig 8.113, 563, fig 9.47
posterior, 92-93, fig 3.24-3.25 Trapezocapitate ligament, 37
Tongue Trapezoid bone, 31-32, fig 2.16
apex of, 440, fig 8.75 Trapezoid line, 12, fig 2.2
body of, 440, fig 8.75 Trapezoid line of clavicle, 12, fig 2.2
glossopharyngeal nerve of (CN IX), 556-557, Trapezoideocapitate interosseous ligament
fig 9.43-9.44 palmar, 33, fig 2.17, 35, fig 2.19, 37
hypoglossal nerve of, 565, fig 9.48 Trapezoideocapitate ligament
muscles of, 442-444, fig 8.77-8.78 palmar, 37
neurovasculature of, 445, fig 8.79 Triangle of auscultation, 114, fig 4.1
arterial supply of, 445, fig 8.79 Triangles of neck, 483-485, fig 8.109-8.110
innervation of, 445, fig 8.79 Triangular fibrocartilage complex, 37
venous drainage of, 445, fig 8.79 Triangular fossa of antihelix, 431, fig 8.66
root of, 440, fig 8.75, 453, fig 8.85 Triangular ligaments
salivary glands of, 446-447, fig 8.80 left, 249-250, fig 6.21, 252, fig 6.23
surface of, 440, fig 8.75 right, 249-250, fig 6.21, 252, fig 6.23
Tonsil of cerebellum, 510, fig 9.12 Triangular ligaments of liver
Tonsillar branches of glossopharyngeal nerve, left, 249
556, fig 9.43 right, 249
Tooth Triceps brachii muscle, 19-20, fig 2.9
parts and landmarks, 451, fig 8.83 distal tendon of, 25, fig 2.12
supporting structures, 452, fig 8.84 Tricuspid valve see atrioventricular valve right
Torus levatorius, 452, fig 8.84 (tricuspid)
Torus tubarius, 426, fig 8.61, 452, fig 8.84 Trigeminal ganglion, 544, fig 9.35, 549, fig 9.39,
Trabeculae carneae, 204-205, fig 5.42, 209, 566, fig 9.4
fig 5.45 Trigeminal impression, 369, fig 8.11
Trabecular artery, 247, fig 6.19 Trigeminal nerve (CN V) 387, 393, 412, fig 8.47, 414,
Trabecular vein, 247, fig 6.19 fig 8.49, 429, fig 8.64, 506, fig 9.9, 522,
Trachea, 192, fig 5.34, 464-465, fig 8.91-8.92, fig 9.21, 533-535, fig 9.28, 543-545,
471, fig 8.98, 489, fig 8.113 fig 9.35-9.36, 566, fig 9.49
Tracheal cartilages, 465, fig 8.92 motor root of, 549, fig 9.39
Tracheobronchial lymph nodes, 180-182, fig 5.26 sensory root of, 549, fig 9.39
Inferior, 194, fig 5.35, 217-218, fig 5.50 spinal nucleus and tract of, 556, fig 9.43, 560,
Index 617
Trigone of urinary bladder, 328, fig 7.19 Ulna
of female, 331-332, fig 7.21 (continued)
Triquetrocapitate ligament, 33, fig 2.17, 37 dorsal radial tubercle of, 23-24, fig 2.11
Triquetrohamate ligament elbow joint, 25-26, fig 2.12-2.13
dorsal, 35, fig 2.19 head of, 24
palmar, 37 ligaments between radius and ulna, 24
Triquetrum bone, 31-32, fig 2.16 olecranon of, 23-26, fig 2.11-2.13
Triticeal cartilage, 465, fig 8.92 proximal end of, 23, 24
Trochanteric fossa, 67 radial notch of, 24
Trochanters of femur, 66, fig 3.5 styloid process of, 22-24, fig 2.10-2.11
greater, 66-67, fig 3.5-3.6 sublime tubercle, 24
lesser, 66-67, fig 3.5-3.6 supinator crest of, 24
Trochlea, 26, fig 2.13 trochlear notch of, 24-26, fig 2.13
articular cartilage of, 26, fig 2.13 tuberosity of, 22, 24, fig 2.10
of superior oblique muscle, 410, fig 8.46 ulnar styloid process, 22-24, fig 2.10-2.11
Trochlea of humerus, 13-14, fig 2.3 Ulna and radius ligaments
Trochlea of superior oblique muscle, 410, fig 8.46 anular ligament of radius, 24
Trochlear nerve (CN IV), 412, fig 8.47, 416, fig 8.51, dorsal radioulnar ligament, 24
506-507, fig 9.9-9.10, 531, fig 9.27, interosseous membrane of forearm, 24
533-535, fig 9.28-9.29, 540, 542-543, oblique cord, 24
fig 9.34 palmar radioulnar ligament, 24
function of, 540 radial collateral ligament of elbow joint, 24
nucleus of, 542, fig 9.34 ulnar collateral ligament of the elbow joint,
Trochlear notch of ulna, 24-26, fig 2.13 24-25
Trochlear notch, articular cartilage, 26, fig 2.13 Ulnar artery(ies), 50-51, fig 2.31-2.32
Tuber cinereum, 503, fig 9.7 carpal branch of
Tubercle dorsal, 57, fig 2.38
anterior, 119-120, fig 4.5-4.6 palmar, 56, fig 2.37
iliotibial tract, 74, fig 3.10 deep palmar branch, 56, fig 2.37
of axis, 119 digital artery of thumb
of humerus, 13-14, fig 2.3-2.4 dorsal, 57, fig 2.38
Tuberculum sellae, 369, fig 8.11 palmar, 56, fig 2.37
Tuberosities dorsal carpal branch of
gluteal tuberosity, 67, fig 3.6 dorsal, 57, fig 2.38
of ulna, 22, 24, fig 2.10 muscular branches of, 50, fig 2.31
Tunica albuginea Ulnar as term of relationship, 2, fig 1.1
of corpus cavernosum, 329, fig 7.20, 335, fig 7.23 Ulnar collateral artery
of testis, 323-325, fig 7.16-7.17 inferior, 44-45, fig 2.25-2.26, 51, fig 2.32
Tunica vaginalis superior, 44-45, fig 2.25-2.26, 51, fig 2.32
cavity of, 323, fig 7.16 Ulnar collateral ligaments of
of testis, 323-325, fig 7.16-7.17 elbow joint, 24-25, fig 2.12
Tunica vasculosa, 324 palmar perforating branches, 56, fig 2.37
Tympanic artery wrist joint, 35, fig 2.19, 37
anterior, 396, fig 8.35 Ulnar nerve, 43, fig 2.24, 48, fig 2.29, 54-55,
Tympanic cavity, 432-433, fig 8.67-8.68 fig 2.35-2.36
inferior tympanic cavity proper (atrium), 432, common palmar digital branch of, 59, fig 2.40
fig 8.67 deep branch of, 59, fig 2.40
proper, 432-433, fig 8.67-8.68 dorsal branch of, 55, fig 2.36, 59, fig 2.40
superior epitympanic recess (attic), 432, fig 8.67 dorsal digital branches of, 59, fig 2.40
walls of muscular branches of, 54, fig 2.35
tegmental, 432, fig 8.67 palmar branch of, 59, fig 2.40
mastoid, 432, fig 8.67 palmar digital branch of little finger, 59, fig 2.40
jugular, 432, fig 8.67 palmar digital branches of
Tympanic membrane, 40, fig 8.65, 433-434, proper, 59, fig 2.40
fig 8.68-8.69 superficial branch of, 59, fig 2.40
Tympanic part of temporal bone, 378, fig 8.21 Ulnar recurrent artery
Tympanic part of temporal bone, 377-379, anterior, 50, fig 2.31
fig 8.19-8.21 posterior, 50, fig 2.31
Tympanic plexus, 434, fig 8.69, 551, fig 9.40, 556, Ulnar styloid process, 22-24, fig 2.10-2.11
fig 9.43 Ulnocapitate ligament, 37
tubal branch of, 556, fig 9.43 Ulnocarpal ligaments, 37
Tympanomastoid fissure of temporal bone, 377, palmar, 37
379, fig 8.19, fig 8.21 Ulnolunate ligament, 33, fig 2.17, 37
Ulnomeniscal homologue, 35, fig 2.19, 35
U Ulnopisiform ligament, 33, fig 2.17, 37
Ulna, 23-26, fig 2.10-2.13 Ulnotriquetral ligament, 33, fig 2.17, 37
anterior border of, 22, fig 2.10 Umbilical artery, 311, fig 7.8, 320, fig 7.14
body of, 24 left
coronoid process of, 23, fig 2.10, 26, fig 2.13 female, 349-350, fig 7.33
distal end of, 22-24, fig 2.10-2.11 male, 347-348, fig 7.32

Umbilical cord, 319, fig 7.13 Urinary bladder
Umbilical fascia, 312, fig 7.8 (continued)
Umbilical fold fundus of, 331-332, fig 7.21
medial, 236, fig 6.11, 241, fig 6.15 neck of, 331-332, fig 7.21
median, 241, fig 6.15 of male, 329-330, fig 7.20
Umbilical ligament apex of, 330
of urinary bladder body of, 330
median, 312, fig 7.9, 327, fig 7.18 fundus of, 330
Umbilical region, 221-222, fig 6.1 neck of, 330
Umbilical vein of liver, 248, fig 6.20 trigone of, 329, fig 7.20
Umbilical vein of placenta, 320, fig 7.14 uvula of, 329-330, fig 7.20
Uncinate process(es) of female pelvis, 310-312, fig 7.7-7.9
of ethmoid bone, 372-373, fig 8.14-8.15 blood supply of, 349-350, fig 7.33
of pancreas, 255-256, fig 6.26, 288 nerves of, 345-346, fig 7.31
Uncovertebral joints, 117-118, 123 of male pelvis, 321-322, fig 7.15
Uncus, 536, fig 9.30 blood supply of, 347-348, fig 7.32
Uniaxial joint nerves of, 344-345, fig 7.30
ankle, 93 surfaces of
Upper limb inferolateral, 327, fig 7.18
elbow and forearm, 22-30, fig 2.10-2.15 superior, 327, fig 7.18
regions of, 3, fig 1.2, 10-11, fig 2.1 trigone of, 328, fig 7.19
shoulder and arm, 12-21, fig 2.2, fig 2.9 Urinary organs
Upper subscapular nerve, 43, fig 2.24 lymphatics of, 350-351, fig 7.34
Ureter(s) 277, fig 6.39, 280-281, fig 6.42, 316-318, Urogenital triangle
fig 7.12, 322, 327, fig 7.18 female, 337-338, fig 7.25
blood supply of, 281, fig 6.42 Urogenital triangle see also vulva
functions of, 281, fig 6.42 Uterine artery, 311, fig 7.8
in situ, 281, fig 6.42 right, 349, fig 7.33
innervation of, 281, fig 6.42 Uterine cavity, 319, fig 7.13
left, 241, fig 6.15, 278, fig 6.40 Uterine ostium of uterine tube, 314, fig 7.11
lymphatic drainage of, 281, fig 6.42 Uterine tubes, 235, fig 6.10, 310, fig 7.7, 313-318,
lymphatics of, 351, fig 7.34 fig 7.10-7.12
pelvic part of, 322 definition of, 315
right, 241, fig 6.15, 277, fig 6.39, 309-312, fimbriae of, 314, fig 7.11
fig 7.7-7.8 function of, 315
Ureteric branches of abdominal aorta, 281, fig 6.42 ligaments of, 315
Ureteric branch of renal arteries, 279-280, fig 6.41 uterine ostium of, 314, fig 7.11
Ureteric orifice uterine part of, 314, fig 7.11
internal, 328, fig 7.19 Uterine vein, 349-350, fig 7.33
left, 328, fig 7.19 Uterine venous plexus, 349, fig 7.33
of female, 331-332, fig 7.21 Uterosacral ligament, 313-314, fig 7.10
right Uterovaginal plexus, 346, fig 7.31
of female, 331-332, fig 7.21 Uterus, 235, fig 6.10, 310-312, fig 7.7-7.8, 313-315,
Urethra, 319, fig 7.13, 327-328, fig 7.18-7.19 fig 7.10-7.11
female, 331-332, fig 7.21 body of, 313, fig 7.10
male, 329-330, fig 7.20, 335, fig 7.23 broad ligament of, 313, fig 7.10
Urethral crest, 329, fig 7.20 definition, 314
Urethral lacunae, 329, fig 7.20 function of, 314
Urethral orifice layers of, 314
external ligaments of, 314
female, 337-338, fig 7.24-7.25 relations of, 314
male, 329, fig 7.20, 334-335, fig 7.22-7.23 round ligament of, 310, fig 7.7, 331, fig 7.21
internal, 328, fig 7.19 spiral artery of, 320, fig 7.14
female, 332 Utricular nerve, 436, fig 8.71, 554, fig 9.42
Urethral sphincter Uvula of palate, 439, fig 8.74, 453, fig 8.85
external, 307, fig 7.6 Uvula of urinary bladder, 329-330, fig 7.20
female, 331-332, fig 7.21, 338
male, 329-330, fig 7.20, 335, fig 7.23 V
internal, 328, fig 7.19 Vagal trunk
male, 329, fig 7.20 anterior, 264, fig 6.31, 561-562, fig 9.46
Urethrovaginalis muscle, 338 gastric branches of, 561-562, fig 9.46
Urinary bladder, 235, fig 6.10, 238, fig 6.12, 281, celiac branches of, 264, fig 6.31
fig 6.42, 327-328, fig 7.18-7.19 hepatic branch of, 264, fig 6.31, 561,
lateral ligament of, 312, fig 7.9 fig 9.46
lymphatics of, 351, fig 7.34 pyloric branch, 264, fig 6.31, 561, fig 9.46
median umbilical ligament of, 327, fig 7.18 posterior
muscular layer of, 328, fig 7.19 celiac branches of, 264, fig 6.31, 561-562,
of female, 331-332, fig 7.21 fig 9.46
apex of, 331, fig 7.21 gastric, 562
body of, 331-332, fig 7.21 renal, 562
Index 619
Vagina, 310, fig 7.7, 313-314, fig 7.10-7.11, 316-318, Venous plexus(es)
fig 7.12, 320, 331, fig 7.21 anorectal
definition of, 318 inferior of male, 344-345, fig 7.30
fornix of, 314, fig 7.11 middle
functions of, 318 of female, 346, fig 7.31
lymphatics of, 354-355, fig 7.36 of male, 344-345, fig 7.30
orifice of, 319, fig 7.13, 337, fig 7.25 basilar, 522, fig 9.21
parts of, 318 cavernous sinus, 522, fig 9.21
relations of, 318 coccygeal
vestibule of, 332, 337, fig 7.25 of female pelvis, 345-346, fig 7.31
Vagina see also female pelvis of male pelvis, 344-345
Vagina see also female reproductive organs coronal, 531, fig 9.27
Vagina see also vulva deferential, 344-345, fig 7.30
Vaginal process of sphenoid bone, 365, fig 8.7 external rectal, 269, fig 6.34
Vaginal venous plexus, 349, fig 7.33 hemorrhoidal, 276, fig 6.38
Vagus nerve (CN X), 442, 457-458, fig 8.88, hypogastric
477, fig 8.103, 489, fig 8.113, 506, inferior, 344-355, fig 7.30
fig 9.9, 531, fig 9.27-9.28, 533-535, superior, 344-355, fig 7.30
fig 9.28-9.29, 559-562, fig 9.45-9.46, iliac, 344, fig 7.30
563, fig 9.47, 566, fig 9.49 internal rectal, 269, fig 6.34
branches of, 561, fig 9.46 intramedullary, 531
functions of, 559, 561, fig 9.46 lumbar, 344-355, fig 7.30
inferior ganglion of, 457-458, fig 8.88, 563, pampiniform plexus, 228, fig 6.4, 321, fig 7.15,
fig 9.47, 566, fig 9.49 325, fig 7.17
left, 197, fig 5.37, 214, fig 5.48 pharyngeal plexus, 442-443, 445, 455-458,
right, 196, fig 5.36, 214, fig 5.48, 478, fig 8.104, fig 8.88, 560
484, fig 8.110 pterygoid, 392, fig 8.31, 406-407, fig 8.44,
structure of, 561, fig 9.46 412-413, fig 8.47, 428, fig 8.63
superior ganglion of, 563, fig 9.47 prostatic, 344-355, fig 7.30
Vallate papillae, 440-441, fig 8.76-8.77, 566, rectal
fig 9.49 external, 269, fig 6.34
Valves of heart internal, 269, fig 6.34
atrioventricular sacral, 344-355, fig 7.30
left atrioventricular (mitral or bicuspid), thyroid, 473
208-211, fig 5.44-5.46 uterine, 349, fig 7.33
right atrioventricular (tricuspid), 208-211, vaginal, 349, fig 7.33
fig 5.44-5.46 vertebral
semilunar anterior, 132-133, fig 4.14, 531, fig 9.27
aortic valve, 206, 208-211, fig 5.44-5.46 external, 132-133, fig 4.14, 531, fig 9.27
pulmonary, 208-211, fig 5.44-5.46 internal, 132-133, fig 4.14, 531, fig 9.27
Valves of heart see also individual valves posterior
Vascular compartment of neck, 488, fig 8.112 external, 132-133, fig 4.14, 531, fig 9.27
Vascular layer (middle tunic) of eyeball, 420, internal, 132-133, fig 4.14, 531, fig 9.27
fig 8.55 vesical
Vascular plexus of pia mater, 526, fig 9.24 of female urinary bladder, 331-332, fig 7.21
Vas spirale of cochlear duct, 438, fig 8.73 of male urinary bladder, 330, 344-345,
Vastus intermedius muscle, 69, fig 3.8 fig 7.30
Vastus lateralis muscle, 69, fig 3.8 Venous sinuses
Vastus medialis muscle, 69, fig 3.8 paired, 523
Veins of brain, 519-521, fig 9.19-9.20 unpaired, 523
deep (internal) venous system, 519 Venous sinus of sclera, 420, fig 8.55
superficial (external) venous system, 519 Ventral as term of relationship, 2, fig 1.1
veins of brainstem, 519 Ventricle(s) of brain, 512-513, fig 9.14
veins of cerebellum, 519-521, fig 9.19-9.20 central canal of spinal cord, 513, fig 9.14
Veins of heart, 212-23, fig 5.47 cerebral aqueduct, 513, fig 9.14
Veins of spinal cord, 531, fig 9.27 composition of, 513
Veins of the anterolateral abdominal wall, 231, definition of, 513
fig 6.6 fourth, 513, fig 9.14
Veins see also specific veins lateral recess of, 513, fig 9.14
Vena cava(e) function of, 513
inferior, 200-202, fig 5.39-5.40, 232-233, interventricular foramen of, 513, fig 9.14
fig 6.8, 235, fig 6.10, 241, fig 6.15, 248, lateral, 513, fig 9.14
fig 6.20, 276, fig 6.38, 285, fig 6.44, atrium of, 513, fig 9.14
287-288, fig 6.45, 531, fig 9.27 central part of, 513, fig 9.14
ligament of, 251, fig 6.22 frontal horn of, 513, fig 9.14
related, 251, fig 6.22 left, 513, fig 9.14
sinus of, 204 occipital horn of, 513, fig 9.14
superior, 197, fig 5.37, 200-203, fig 5.39-5.41 right, 513, fig 9.14
Vena comitans of hypoglossal nerve, 445, temporal horn of, 513, fig 9.14
fig 8.79 supraoptic recess, 513, fig 9.14

Ventricle(s) of brain Vertebral processes
(continued) inferior articular processes, 116, fig 4.3
suprapineal recess, 513, fig 9.14 spinous process, 116, fig 4.3
third, 513, fig 9.14 superior articular processes, 116, fig 4.3
infundibular recess of, 513, fig 9.14 transverse processes, 116, fig 4.3
pineal recess of third ventricle, 513, Vertebral region, 114, fig 4.1
fig 9.14 Vertebral vein(s), 132, fig 4.14, 476, fig 8.102
Ventricle(s) of heart Vertebral venous plexus
left, 197, fig 5.37, 200-201, fig 5.39-5.40, 206, anterior
fig 5.43 external, 132-133, fig 4.14, 531, fig 9.27
inferior vein of, 212, fig 5.47 internal, 132-133, fig 4.14, 531, fig 9.27
right, 200-201, fig 5.39-5.40, 204, fig 5.42, posterior
209, fig 5.45 external, 132-133, fig 4.14, 531, fig 9.27
anterior veins, 212, fig 5.47 internal, 132-133, fig 4.14, 531, fig 9.27
Ventricular branches of right coronary Vertebra prominens, (C7), 122
artery, 213 Vertebroaxial joint, 120
Vermiform appendix, 267-268, fig 6.33 Vertical muscle of tongue, 442-444, fig 8.77-8.78
Vermis of cerebellum, 494, 508-510, Vesical artery
fig 9.11-9.12 inferior, 322, 330
central lobule of, 509, fig 9.11 left
culmen of, 509, fig 9.11 female, 349, fig 7.33
declive of, 509, fig 9.11 male, 347, fig 7.32
folium of, 509, fig 9.11 right
Vertebra(e) female, 349, fig 7.33
articular process of male, 347, fig 7.32
inferior, 117, fig 4.4 superior, 311, fig 7.8, 322, 330, 332
superior, 117, fig 4.4, 119 left
atypical (C1-2) (C7), 119, 122 female, 349, fig 7.33
typical (C3-C6), 119, fig 4.5, 122 right
vertebral column, 115, fig 4.2 female, 349, fig 7.33
Vertebrae of the thoracic spine, fig 4.9 male, 347, fig 7.32
Vertebral arch, 116, 119, fig 4.3, fig 4.5, 127 Vesical lymph nodes
of lumbar vertebrae, 127 lateral, 351, fig 7.34
Vertebral artery, 144, fig 4.18, 396, fig 8.35, 398, Vesical vein
fig 8.37, 472, fig 8.99, 475, fig 8.101, inferior
515-516, fig 9.15-9.16, 518, 529 left
meningeal branches of, 398, fig 8.37 female, 349, fig 7.33
parts of male, 347, fig 7.32
atlantic part (V3), 398, fig 8.37 right
cervical part (V2), 398, fig 8.37 female, 349, fig 7.33
intracranial part (V4), 398, fig 8.37 male, 347, fig 7.32
prevertebral part (V1), 398, fig 8.37 superior
Vertebral artery of brain, 516, fig 9.16 right
Vertebral body, 116-117, 119, fig 4.3-4.5, 127 in male, 347, fig 7.32
anterior tubercle, 119, fig 4.5 Vesical venous plexus
groove for spinal nerve, 119, fig 4.5 of female urinary bladder, 331-332, fig 7.21
pedicle of vertebral arch, 119, fig 4.5 of male urinary bladder, 330, 344-345, fig 7.30
posterior tubercle, 119, fig 4.5 Vesicouterine pouch, 310, fig 7.7
superior articular process, 119, fig 4.5 Vestibular area of cerebrum, 497, fig 9.3
transverse foramen, 119, fig 4.5 Vestibular area of fourth ventricle, 507, fig 9.10
of spinous process of lumbar vertebrae, 127 Vestibular fold, 465, fig 8.92
Vertebral canal, 6, fig 1.5 Vestibular ganglion
Vertebral cervical artery, 131 inferior part of, 436, fig 8.71, 554, fig 9.42
Vertebral column superior part of, 436, fig 8.71, 554, fig 9.42
curvatures of, 115-116, fig 4.2-4.3 Vestibular labyrinth
functions of, 115-116, fig 4.2-4.3 saccule of, 436, fig 8.71
main regions of, 115-116, fig 4.2-4.3 utricle of, 436, fig 8.71
movements of, 115-116, fig 4.2-4.3 Vestibular ligament, 465, fig 8.92
Vertebral compartment of neck, 488, fig 8.112 Vestibular membrane, 437, fig 8.73
Vertebral foramen, 116, fig 4.3 Vestibular nerve(s), 433, fig 8.68, 436, fig 8.71, 552,
lumbar, 127 fig 9.41, 554, fig 9.42, 554, fig 9.42
thoracic, 124, fig 4.9 Vestibular nucleus
Vertebral ganglion, 214, fig 5.48 inferior, 554, fig 9.42
Vertebral joints medial, 554, fig 9.42
intervertebral symphysis, 117-118, fig 4.4 lateral, 554, fig 9.42
uncovertebral, 117-118 superior, 554, fig 9.42
zygapophyseal, 117-118 Vestibular window, 435, fig 8.70
Vertebral ligaments Vestibule of internal ear, 433, fig 8.68, 435,
accessory, 118 fig 8.70
main, 118 Vestibule of vagina, 317, fig 7.12, 337, fig 7.25
Index 621
Vestibulocochlear nerve (CN VIII), 433, fig 8.68, Vulva
533, fig 9.28-9.29, 533-535, (continued)
fig 9.28-9.29, 553-555, fig 9.42, 554, clitoris, 316, 318
fig 9.42 crus of, 317, fig 7.12, 331, fig 7.21, 338
cochlear nerve(s), 552, fig 9.41, 554, fig 9.42 deep artery of, 339, fig 7.26
function of, 552, fig 9.41, 555 deep veins of, 340, fig 7.27
structure and features, 555 dorsal, 311, fig 7.8, 341, fig 7.28
vestibular nerve(s), 552, fig 9.41, 554, fig 9.42 glans of, 337-338, fig 7.25
Vinculum breve, 36, fig 2.20 prepuce of, 337-338, fig 7.25
Vinculum longum, 36, fig 2.20 components of, 318
Virtual association area of cerebrum, 497, functions of, 318
fig 9.3 hymen, 316
Visceral compartment of neck, 488, fig 8.111 labium
Visceral fascia, 487, fig 8.111 majus of, 310, fig 7.7, 337-338, fig 7.25
Visceral fascia of pelvis, 309-310, fig 7.7 minus of, 310, fig 7.7, 337-338, fig 7.25
of female, 331, fig 7.21 lymphatics of, 354-355, fig 7.36
Visceral layer, 323, fig 7.16 mons pubis, 316
Visceral peritoneum vestibular bulb, 316
of ileum, 260 vestibular (Bartholin) glands, 316
of jejunum, 260 Vulva see also urogenital triangle
Visceral relations of heart, 198, fig 5.38 Vulva see also vagina
Visceral surface of liver, 248, fig 6.20
Visceral surface of spleen, 246, fig 6.18 W
anterior extremity, 246, fig 6.18 Wall of duodenum, 257
colic impression, 246, fig 6.18 Wernike’s area of cerebrum, 497-498, fig 9.3
gastric impression, 246, fig 6.18 White matter, 500, fig 9.5, 525, fig 9.23
gastrosplenic ligament, 246, fig 6.18 Wrist and hand, 31-41, fig 2.16-2.22
inferior border, 246, fig 6.18 bones of, 31-32, fig 2.16
posterior extremity, 246, fig 6.18 collateral ligaments of, 33
renal impression, 246, fig 6.18 ligaments of, 33-37, fig 2.17-2.20
splenic artery, 246, fig 6.18 muscles of, 38-41, fig 2.21, fig 2.22
splenic vein, 246, fig 6.18 Wrist as a region, 10-11, fig 2.1
splenorenal ligament, 246, fig 6.18
superior border of, 246, fig 6.18 Z
Viscerocranium, 360, fig 8.2, 371, fig 8.13 Zona orbicularis, 68, fig 3.37
Visual pathway, 539, fig 9.32 Zonular fibers, 420-421, fig 8.55-8.56
colliculus Zygomatic arch, 361, fig 8.3
superior, 540 Zygomatic bone(s), 360, fig 8.2, 362, fig 8.4, 364,
components, 539 fig 8.6, 408, fig 8.45
geniculate nucleus frontal process of, 360, fig 8.2
lateral, 540 orbital surface of, 360, fig 8.2, 408, fig 8.45
optic chiasm, 539 temporal process of, 360, fig 8.2, 365, fig 8.7
optic nerve (CN II), 539 Zygomatic margin of greater wing of sphenoid
optic radiation, 540 bone, 375, fig 8.17
optic tracts, 539 Zygomatic nerve, 405, fig 8.42, 414, fig 8.49, 417,
retina, 539 fig 8.52, 545-546, fig 9.36-9.37
visual cortex communicating branch to lacrimal nerve, 414,
primary, 540 fig 8.49, 544, fig 9.35, 545, fig 9.36
Vitreous body, 418, fig 8.53 Zygomaticofacial nerve, 394-395, fig 8.33-8.34,
Vitreous chamber, 418, fig 8.53 405, fig 8.42, 546, fig 9.37
Vitreous humor, 418, fig 8.53 Zygomaticomaxillary suture of skull, 361, fig 8.3
Vocalis muscle, 466-467, fig 8.93-8.94 Zygomaticoorbital artery, 387, fig 8.26
Vocal fold, 465, fig 8.92 Zygomaticotemporal nerve, 394-395,
Vocal ligament, 466-467, fig 8.93-8.94, 467, fig 8.33-8.34, 405, fig 8.42, 546, fig 9.37
fig 8.94, 469, fig 8.96-8.97 Zygomatic process of frontal bone, 408, fig 8.45
Vocal process of arytenoid cartilage, 465, Zygomatic process of maxilla, 361, fig 8.3
fig 8.92, 467, fig 8.94 Zygomatic process of temporal bone, 361, fig 8.3,
Vomer, 364, fig 8.6, 370, fig 8.12, 426, fig 8.61 365, fig 7.8, 377-379, fig 8.19-8.21
Vomerovaginal canal, 366, fig 8.8 Zygomatic region, 359, fig 8.1
Vorticose vein(s), 412-413, fig 8.47, 422, fig 8.57 Zygomaticus major muscle, 383-384, fig 8.25
bulb of, 422, fig 8.57 Zygomaticus minor muscle, 383-384, fig 8.25
Vulva, 316-318, fig 7.12 Zygapophyseal joints
classification of, 318 articular capsule of, 117, 123, fig 4.8

Kenhub Atlas of Human Anatomy 2023

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PELVIS AND

Originally published in Germany by Kenhub

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ISBN 978-3-96298-318-5 (print)

Printed and bound in India by Replika Press Pvt. Ltd.

Illustrations Paul Kim, Irina Munstermann, Liene Znotina, Begona Rodriguez,

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Kenhub is a company that greatly values diversity, defined as a broad spectrum

Representation matters. It is our vision to diversify our content so that every­

Shoulder and arm ........................................................................................ 12

Elbow and forearm ..................................................................................... 22

Wrist and hand ............................................................................................ 31

Nerves and vessels ...................................................................................... 42

3 LOWER LIMB ..................................................................................... 61

Hip and thigh .............................................................................................. 63

Knee and leg ................................................................................................ 74

Ankle and foot ............................................................................................ 86

Nerves and vessels .................................................................................... 103

4 SPINE AND BACK ............................................................................. 113

vi Kenhub Atlas of Human Anatomy

Back .......................................................................................................... 134

5 THORAX ........................................................................................... 147

Thoracic wall ............................................................................................. 148

Female breast ........................................................................................... 168

Mediastinum .............................................................................................. 173

Lungs ........................................................................................................ 184

Heart ........................................................................................................ 196

Table of contents vii

Abdominal wall .......................................................................................... 221

Peritoneum ............................................................................................... 234

Spleen ....................................................................................................... 246

Liver .......................................................................................................... 248

Small intestine .......................................................................................... 257

Large intestine .......................................................................................... 267

viii Kenhub Atlas of Human Anatomy

Kidneys and ureters ................................................................................... 277

Nerves, vessels and lymphatics of the abdomen ........................................ 283

7 PELVIS AND PERINEUM .................................................................. 299

Pelvic girdle and floor ............................................................................... 300

Female pelvis and reproductive organs..................................................... 309

Male pelvis and reproductive organs........................................................... 321

Urinary bladder and urethra 327

Nerves, vessels and lymphatics of the pelvis .............................................. 342

8 HEAD AND NECK ............................................................................. 357

Overview ................................................................................................... 359

Skull ......................................................................................................... 360

Face and scalp ............................................................................................383

Infratemporal region and pterygopalatine fossa ........................................399

Orbit and contents .................................................................................... 408

Nasal region............................................................................................... 425

x Kenhub Atlas of Human Anatomy

Oral cavity ................................................................................................. 439

Pharynx .................................................................................................... 453

Neck .......................................................................................................... 459

9 NEUROANATOMY ........................................................................... 491

Introduction to the brain ........................................................................... 493

Cerebrum .................................................................................................. 495

Brainstem and cerebellum ........................................................................ 505

Blood supply of the brain ............................................................................515

Spinal cord ................................................................................................ 524

Representation matters. It is our vision to diversify our content so that every

This atlas represents a collection of clear, comprehensible and didactically val