Sobotta Atlas of Human Anatomy, Volume 1: Head, Neck, Upper Limb

Atlasof HumanAnatomy

Editedby R.PutzandR.Pabst Putz withRenate incollaboration

13th,revised Edition Translated byDr.M.Lutz,K.Kopsieker Dietz, Sarah Budowick, of Michael Withtheassistance Dr.Dorothea Hennessen plates 768coloured 76tables

URBAN& FISCHERMUNiCh. JCNA

Addressesof the editors: ProfessorDr. med. R. Putz Vorstanddes AnatomischenInstituts Ludwig-Maximilians-Universitet PettenkoferstraBe11 80336 Miinchen, Germany ProfessorDr. med. R. Pabst Leiter der Abteilung fiir Funktionelle und AngewandteAnatomie MedizinischeHochschule,Hannover Carl-Neuberg-StraBe I 30625 Hannover,Germany

This atlas consistsof two volumes: Vol. 1: Head,neck, upper limb

This atlas was founded by Iohannes Sobottat, former Professorof Anatomy and Director of the Anatomical Institute of the University of Bonn, Germany.

GermanEditions: l. Edition: 1904-1907I. F. LehmannsVerlag,Munich 2.-11.Edition:1913-19441. F. LehmannsVerlag,Munich 12. Edition: 1948and following editions Urban & Schwarzenberg,Munich 13.Edition:1953 14.Edition:1956 15.Edition:1957 16.Edition:1967(ISBN3-541-02816-5) 17.Edition:1972(ISBN3-541-02817-3) 18.Edition:1982ISBN 3-541-02818-1) 19.Edition:1988(ISBN3-541-02819-X) 20. Edition:1993(ISBN3-541-1736GX) 21. Edition: 2000 (ISBN 3-437-4194041

Vol. 2: Thorax, abdomen,pelvis, lower limb Foreign Editiors: Translation: Editorial staffat Urban & Fischer: Producer: Coverdesign: Coverillustration:

Dr. M. Lutz K. Kopsieker Dr. med. DorotheaHennessen AlexanderGattnarzik RenateHausdorf CarstenTschirner MichaelBudowick

Arabic Edition Modern TechnicalCenter,Damascus ChineseEdition HoChi Book Publishing,Taiwan CroatianEdition NakladaSlap,lastrebarsko Dutch Edition Bohn Stafleuvan Loghum,Houten English Edition (with nomenclaturein English) Lea & Iebiger previousEnglish Edition (with nomenclaturein latin) Urban & Schwarzenberg,Munich French Edition Atlas dAnatomieHumaine Tec& Doc Lavoisier,Paris Greek Edition GregoryParissianos,Athens Hungarian Edition az ember anat6mi6jiinakatlasza SemmelweisKiad6

Nomenclaturein latin Vol. 1 Head,Neck, Upperlimb. - 13th End. ed. - 2001 Vol. 2 Thorax, Abdomen,Pelvis,Lower Limb. - l3th Engl. ed. - 2001

IndonesianEdition Atlas Anatomi Manusia Penerbit Buku KedokteranEGC,Iakarta Italian Edition Atlante di Anatomia Umana UTEI Torino lapaneseEdition Igaku Shoin Ltd., Tokyo KoreanEdition Panmun Book Company,Seoul Polish Edition Atlas anatomii cztowieka Urban & Partner

All rights, including that of translation, reserved.No part of this publication may be reproduced,stored in a retrieval system,or transmitted in any other form or by any means,electronic,mechanical,recording,or otherwise without the prior written permission of the publisher. Typesetting:Typodata,Munich Repmduction:Typodata,Munich Printed in Germanyby Appl, Wemding @ Urban & Fischer 2001

UFtcdate information you find under: Urban & Fischer:http'.//www.urbanfischer.de

PortugueseEdition (with nomenclaturein PortuSuese) Atlasde AnatomieHumana Editoria GuanabaraKoogan,Rio de Janeiro PortugueseEdition (with nomenclaturein Latin) Atlas de Anatomie Humana Editoria GuanabaraKoogan,Rio de Janeiro SpanishEdition Atlas de Anatomia Humana Editorial Medica Panamericana.BuenosAires/Madrid Turkish Edition Insan Anatomisi Atlasi Beta Basim Yayim Dagitim, Istanbul

Preface Followingthe extremelygoodillustrationsin the last editionof the Atlaswhichwasbroughtinto beingbyl. Sobottain 1903,the editorsandpublishersaskedthemselves whatcouldbeimproved upon in such a classicwork. It becameclear from the many lettersand discussions with studentsand colleagues that the conceptobviouslystill fits into the panoramaof study,and that the macroscopic anatomyremainswithout question,together with other basicsciences, one of the fundamentsof medicine. Althoughthe Atlasis primarilydirectedat thosestudyingpreclinicalmedicine,it has nevertheless as "TheBookfor life as a doctor"all that is necessaryto be a companionthroughthe clinical studiesand a referencebook during working life. In with the most importanyurgentwishes,the new accordance editionhasa seriesof alterations. In the neweditionwe have - a total of 133 new illustrationsdrawn basedon original dissections, e.g.the series0f sectionsof the brainandthorax, - replacedthe blackandwhiteillustrations, - broughtillustrationsof clinicalapplication up to dateaccording to the development of the technique, e.g.endoscopy or X-ray, - introducedthe schematic ofjoint strainand - revisedthe tablesof musclescompletely. As the secondimportantgoalwe haveimprovedthe readability by - the introductionofconspicious coloursfor the chapters, - colourcodingthe labellingof topographic illustrations, - the consistentadditionof orientationsketchesto the cross sectionsandline of vision, - the revisionand new arransementof the tried and tested tablesandby - the introductionof small"wind mills" drawingyour attention to the surroundingillustrations.

R. Pabst: Head, neck, thoracic wall, abdominal wall, thorax, abdomen,pelvis.

The followingartistshaveearnedour thanksfor the manynew drawings which they have producedin their already proven manner:Ulrike Brugger,RiidigerHimmelhan,SonjaKlebe,and Horst RuB.It is due to their effortsthat the tried and tested Thefreeelectronicprocess"sobottaStyle"hasbeenmaintained. aswellastheproductionof the printswas ing of the photographs carriedout by MichaelBudowick.We are also gratefulto our in the variousclinicswho put the illustrationsat our colleagues disposalfor this editionaswell (seeAcknowledgements). from the instituteswho We wouldlike to thank the colleagues and for were involvedmost sincerelyfor their understanding the very importantstimulus.Dr. N. Sokolovand A. Buchhorn prepareddissections meticulouslyto serveas a basisfor many us with our S.Fryk andG.Hoppmannassisted newillustrations; wordprocessing. The editorswouldfinally like to thank explicitlythe colleagues and of the editorialoffice,especiallyDr. DorotheaHennessen A. Gattnarzik,w.ho despiteexternal turbulenceconsistently the productionof the new edition.Theproduction accompanied was lookedafter in the initial stagesby P. Mazzettiand finally carriedout with greatcommitmentby R. Hausdorf.RenatePutz was responsiblefor the conversionof the NominaAnatomica and the texts.A of the references and for the standardisation to the specialthanksto all the peoplewho devotedthemselves nerve-rackingproof readingand the putting togetherof the index. If "Sobotta"is able to appearwith new contentsand in new splendourthen it is due to the entirely constructive We wouldalsolike to thank our of all concerned. collaboration of the lack of time we had for familiesfor their understandins them.

Of course,the new nomenclatirre(Terminologia Anatomica), whichhasbeenvalidsinceOctober1998,hasbeenincluded.The Many innovationsin this atlas are basedon the critic and glossaryaidsthoseinterested in the background of our specialist suggestionsmade by studentsand colleagues.The editors languagc. were and are extremelythankfulfor theseand would ask the users of this edition not to shy away from sendingus their The division of the revisionof the chapters,apart from the comments. commondiscussions overthe conceptandthe mutualcorrection, wasretainedand is as follows: 1999 September R.Putz: Generalanatom)lupper limb, brain, eye,ear, back, MunichandHannover, lowerlimb; R.PutzandR.Pabst

Contents(volume I) Generalterms of directionand positionin the body Referencesto the coloured illustration plates . A c k n o w l e d g e m e n.t.s.

Parts and Regionsof the Body PassiveLocomotorSystem Active LocomotorSystem Digestiveand RespiratorySystem Urinary Tract and Genital Organs EndocrineSystem VascularSystem SurfaceProjectionof the Internal Organs Central and Peripheral Nervous System Skin and Appendages

Head, Caput, and Neck, Collum Regionsof the Head and Neck, Regiones capitis et colli . . . Skull, Ossacranii, and TemporomandibularIoint, Articulatio temporomandibularis . Muscles,Vesselsand Nerves of the Head Nose,Nasusexternus,and NasalCavity, C a v i t a sn a s i . . . ParanasalSinuses,Sinusparanasales.. Oral Cavity,Cavitasoris . . . Maxilla and Mandible,Mandibula Teeth,Dentes Palate,Palatum Tongug,Lingua SuprahyoidMuscles,Mm. suprahyoidei, and Hyoid Bone,Os hyoideum Large Salivary Glands,Glandulaesalivariae majores Arteriesand Nervesofthe Tongueand Palate Baseofthe Skull, Basiscranii . Vesselsand Nervesof the Tongue Frontal Sectionsofthe Head Larynx ThyroidGland,Glandulathyroidea Pharynx Muscles,Vesselsand Nervesofthe Neck Sectionsofthe Headand Neck

SurfaceAnatomy Bones, loints,Ligaments Musclesof the UpperLimb . Vessels and Nervesof the UpperLimb . . .... CrossSections ofthe UpperLimb . . Areasof Distributionof the CervicalPlexusand the BrachialPlexus.

VII VII VIII

6 -l 0 |-12 l3 14 l5 t6-21 22-23 24-27 28-29

30-I 63 30-31 3 2 - 7| 72-88 89-91 92-94 95-96 97-98 99-106 107 1 0 8 1- 1 2 113 114-117 118 119 l2O-121 122-123 124-133 134-135 136-140 141-159 160-163

164 165-185 186-222 223-250 251-256

Cranial Cavity,Cavitascranii, and Dura Mater of the Brain, Dura mater cranialis Vesselsof the Head Nerves of the Brain, Nervi craniales Dura Mater of the Brain, Dura mater cranialis, and A r a c h n o i dA, r a c h n o i d em a a t e r c r a n i a l i s. . . . . . . . . Vesselsof the Brain BrainC , e r e b r u m. . . . Diencephalon M i d b r a i n ,M e s e n c e p h a l o.n. . . . Brain Stem,Truncus encephali Nuclei of the Cranial Nerves . Cerebellum Ventricular Systemand SubarachnoidSpace DeepVesselsof the Brain Fornix . Associationand CommissuralFibres Internal Capsule,Capsulainterna, Pyramidal Tract, Tractus pyramidalis,and BasalNuclei . Frontal Sectionsof the Brain Horizontal Sectionsof the Brain SagittalSectionsof the Brain Magnet ResonanceTomographySectionsof the

B r a i n. . SpinalCord,Medullaspinalis E y e , O r g a n u m v i s.u s

278-281 282-285 286-293 294-295 296-298 299-300 301 302-305 306-315 316-317 318-319 320 321-323 324-327 328-334 335-338

.. 339-340 ...... 341-355 .....

35G380

Eyelid,Palpebrae, andOrbitalCavity,Orbita 356-360 LacrimalApparatus 361 u s ,c u b l i u l b i. . E x t r a o c u l a r M u s cMl e ...... 362-365 Eyeball,Bulbusoculi 366 Vessels of the Eye 367 I r i sa n dP u p i l. . 368 Fundusoculi . LenseandOcularFundus, 368-371 OpticNerve,N.opticus ..... 372-373 V i s u aP l a t h w a y. . . . . 374-375 Muscles, Vessels andNervesof theOrbital Cavity. 376-379 Sections of the OrbitalCavity . 380

381 Overview ..:::::::,:::::::::::::.. 382 Auricre AuricularMuscles,Musculiauriculares 383 ExternalAcousticMeatus,Meatusacusticus externus, andTympanicMembrane, Membranatympani. . . . 384 auditoria 385-386 AuditoryOssicles, Ossicula . . 387-389 TympanicCavity,Cavitastympani ...... 390-391 AuditoryTube,Tubaauditiva .. 392-396 InternalEar,Auris interna 397 AuditoryandVestibularPathways 398 TemporalBone,Ostemporale .. 399-400 NervesoflnternalEar.... Appendix Index..

25-

258-259 260-266 2 6 7- 2 7 7

4Ol-417 4Ol-417

II) ContentS(vrlurne Generalterms of directionand positionin the body References to the colouredillustrationplates . . . . . .. Acknowledgements ...

.

Back SurfaceAnatomy VertebralColumn,Columnavertebralis Musclesof the Back,Mm. dorsi,Musclesof the Nape o f t h e N e c k ,M m s u b o c c i p i t a l easn, d N e c kM u s c l e s , Mm. colli Sectionsthroughthe VertebralColumn Vesselsand Nervesof the Backand of the Occioital Region Vesselsand Nervesof the VertebralCanal.

Thoracic and Abdominal Walls SurfaceAnatomy.... Ribs,Costae Sternum ThoracicCage,Caveathoracis MammarG y l a n dM , a m m a. . . . . Vesselsand Nerves of the Thoracic and Abdominal Walls . . SegmentalSensoryInnervation Musclesof the Thorax,Mm. thoracis,and Abdominal M u s c l e sM, m . a b d o m i n i s. . . . . lnguinal Canal,Canalisinguinalis Diaphragm,Diaphragma

Lumbosacral PIexus, Plexuslumbosacralis AnteriorAbdominalWall Sectionsthrough the AbdominalWall

Thorax Heart,Cor Trachea Lungs,Pulmones . . .. OutlineSilhouette of theHeart Projection of the TracheaandBordersof the Lungs andPleura Oesophagus Thymus

VII VII VIII

pleuralis, and PleuralCavity, Cavitas 1 1 4 1- 1 5 Mediastinum 116-117 Aorta.. 118-119 Posterior Mediastinum . .2. 0 - 1 2 1 A u t o n o mN i ce r v o uSs y s t e m , P a r s a u t o n o m i c a . . . . 1 122-131 throughthe Thorax Sections

l-47 I 2 26

27-40 41 42-45 46-47

48-75 4B 49-50 5 t- 5 2 5 4 -5 5 56 57 58-66 67 68-70 71 72-73 74-75 76-t3l 76-91 92-93 94-102 103 104-105 106-110 ll1-113

Stomach, Gaster. tenue. Intestinum SmallIntestine, Colon..

132-136 137-139 140-141

Liver, Hepar,Gallbladder,Vesicabiliaris, and Bitiary Ducts Pancreas Spleen,Splen[Lien] PeritonealCavity,Cavitasperitonealis,Development. Positionof the Abdominal Viscera,Situs viscerum . . Truncus coeliacusand Aa. & Vv. mesentericae

142-149 l s 0 -1 5 2 153 1541 - 55 156-167

superiorandinferior Portalvein,V.portae Kidney,Ren[Nephros] S u p r a r e nG a l a n dG, l a n d u lsau p r a r e n a l i.s. . . . . . . . . UrinaryBladder,Vesicaurinaria..... Organs MaleUrogenital FemaleUrogenitalOrgans ... Rectum A. renalis Space. . . . Vessels andNervesofthe Retroperitoneal ExteriorMaleandFemale PelvisandPerineum, ... G e n i t aOl r g a n s throughthe AbdomenandPelvis Sections

SurfaceAnatomy Bones,JointsandLigaments Musclesof the LowerLimb . andNerves BloodVessels Sections throughthe LowerLimb . . Distributionof the Nervesof the Plexus lumbosacralis Appendix I n d e x. .

168-177 178-179 180-lB6 187 187-188 lB9-193 194-204 205-207 208 209-221 222-239 240-261

262 263-307 308-347 . . . 348-378 379-386 ....

387-388 389-405

.... 389-40

Generalterms of directionand positionin the body The following terms indicate the relative location of organs and parts of the body to each other, partly without taking into considerationthe position of the body in space as well as the location and direction to the extremities.This concept is not only acceptable for human anatomy but also for practical medicine and the comparativeanatomy.

General terms

= runninglengthways(e.g.Musculuslongitudinalongitudinalis lis superiorof the tongue) sagittalis= lying on a sagittalplane = lying on a transversalr/transverse plane transversalis = runningtransversely (e.g.Processus transversus transversus of the thoracicvertebrae)

Terms of direction and position for the extremities

anterior - posterior = from the front - from the back (e.g. Arteriae tibiales anterior et posterior) ventralis - dorsalis = lying ventral - dorsal superior - inferior = above - below (e.g. Conchaenasales superior et inferior) cranialis - caudalis = lying cranial - caudal dexter - sinister= right - left (e.g. Arteriae iliacae communes dextra et sinistra) internus - externus = internal - external superficialis - profundus = superficial - deep medius, intermedius = lying in the middle between two other things (the Concha nasalis media lies in the middle between the Conchanasalis superior and inferior) medianus= lying on the middle line (Fissuramedianaanterior of the spinal cord).By making a median sagittal sectionthe body is dividedinto two mirror images. medialis - Iateralis = lying towards the middle of the body, lying towards the side (e.g.Fossaeinguinales medialis et lateralis) frontalis = relating to the plane of the forehead (frontal plane), (e.g.Processusfrontalis of the maxilla)

proximalis - distalis = at the base of the extremity - at the end of the extremity (e.g. Articulationes radioulnares proximalis et distalis) For the upper limbs: radialis - ulnaris = relating to the radial - relating to the ulnar side (e.g. Arteriae radialis et ulnaris) For the hand: palmaris - dorsalis = relating to the palm - relating to the back of the hand (e.g. Aponeurosis palmaris, Musculus interosseus dorsalis) For the lower limbs: tibialis - fibularis = relating to the tibial side - relating to the fibular side (Arteria tibialis anterior) For the foot: plantaris - dorsalis= relating to the sole of the foot - relating to the back of the foot (instep)(e.g. Arteriae plantareslateralis et medialis,Arteria dorsalis pedis)

References to the colouredillustrationplates The multi-colouredillustrations of this book are basedon didactic observations:The contrasts should be emphasized.Where it is difficult to differentiatebetweenstructures,they should be made easily recognizable.The colours used for the different kinds of tissue (such as tendons, cartilage, bone and muscles) and the tracts (such as arteries, veins, lymphatic vessels, nerves) are different from those found in a living, dead or preserved body. Here, arteries are red, veins are blue, nerves yellow, lymphatic vesselsand glands are generally representedas green. In addition to the artists who createdthe basis for the complete collection of illustrations with Prof. Sobotta and the following editors Prof. Becher,Prof. Ferner and Prof. Staubesand(K. Hajek, Prof. E. Lepier,F. Batke,H. v. Eickstedt,K. Endtresser,I. Kosanke, I. v. Marchtaler,I. Dimes,U. Brugger,N. Lechenbauer,L. Schnellbiicher, and K. Schuhmacher),the following also drew for the current edition: Ulrike Brugger, Riidiger Himmelhan, Sonja Klebe, and Horst RuB. A series of original photographs were worked over electronically by Michael Budowick. A number of computer diagrams were producedby Henriette Rintelen.

platesas Thefollowingplatenumbersindicatenewlydeveloped well as drawingsdueto fundamental corrections: U.Brugger 3 6 - 3 8 ,5 2 , 5 3 , 6 1 ,1 3 6 ,1 3 7 , 2 3 5 - 2 3 7 , 2 8 4 , 3 9 6 - 3 9 8 , 4 3 0 1, 532-534,537,539-541,551,570-577,598 M. Budowick 449,452,474,486,498,548 R. Himmelhan 437 S.Klebe 138,460,507,508,511-514 H. Rintelen 604-606 H. RuJS 22 (insert),144,338-340,444,445,447,449,471,472, 545,687

Generaltermsof directionandpositionin the body The following terms indicate the relative location of organs and parts of the body to each other, partly without taking into considerationthe position of the body in space as well as the location and direction to the extremities.This concept is not only acceptable for human anatomy but also for practical medicine and the comparativeanatomy.

tongitudinalis= running lengthways(e.g. MusculuslongitudinaIis superiorof the tongue) sagittalis= lying on a sagittalplane = lying on a transversalplane transversalis = runningtransversally transversus (e.g.Processus transversus of the thoracicvertebrae)

General terms

Terms of direction and position for the extremities

anterior - postertor = from the front - from the back (e.g. Arteriae tibiales anterior et posterior) ventralis - dorsalis = lying ventral - dorsal superior- inferior = above- below (e.g. Conchaenasalessuperior

proximalis - distalis = at the base of the extremity - at the end of the extremity (e.g. Articulationes radioulnares proximalis et distalis)

et inferior) cranialis - caudalis = lying cranid - caudal dexter - stnister= right - left (e.g. Arteriae iliacae communes dextra et sinistra) internus - externus= internal - external superficialis - profundus = superficial - deep medius, intermedius = lying in the middle between two other things (the Concha nasalis media Iies in the middle between the Conchanasalis superior and inferior) medianus= lying on the middle line (Fissuramediana anterior of the spinal cord).By making a median sagittal sectionthe body is divided into two mirror images. medialis - lateralis = lying towards the middle of the body, lying towards the side (e.g.Fossaeinguinales medialis et lateralis) = frontalis relating to the plane of the forehead (frontal plane),

For the upper limbs: radialis - ulnaris = relatinS to the radial - relating to the ulnar side (e.g. Arteriae radialis et ulnaris)

(e.g.Processusfrontalis of the maxilla)

For the hand: palmaris - dorsalis= relating t0 the palm - relating to the back of the hand (e.g. Aponeurosis palmaris, Musculus interosseus dorsalis) For the lower limbs: tibtalis - fibularis = relating to the tibial side / relating to the fibular side (Arteria tibialis anterior) For the foot: plantaris - dorsalis = relating to the sole of the foot - relating t0 the back of the foot (instep)(e.g. Arteriae plantareslateralis et medialis, Arteria dorsalis Pedis)

to the colouredillustrationplates References The multi-colouredillustrations of this book are basedon didactic observations:The contrasts should be emphasized'Where it is difficult to differentiatebetweenstructures,they should be made easily recognizable.The colours used for the different kinds of tissue (such as tendons, cartilage, bone and muscles) and the tracts (such as arteries, veins, lymphatic vessels, nerves) are different from those found in a living, dead or preserved body. Here, arteries are red, veins are blue, nerves yellow, lymphatic vesselsand glands are generally representedas green' In addition to the artists who createdthe basis for the complete collection of illustrations with Prof. Sobotta and the following editors Prof. Becher,Prof. Ferner and Prof. Staubesand(K. Hajek, Prof. E. Lepier,F. Batke,H. v. Eickstedt,K. Endtresser,I' Kosanke, I. v. Marchtaler,K. Dimes,U. Brugger,N. Lechenbauer,L. Schnellbiicher, and K. Schuhmacher),the following also drew for the current edition: Ulrike Brugger, Rtidiger Himmelhan, Sonja Klebe, und Horst RuB. A series of original photographs were worked over electronically by Michael Budowick. A number of computer diagrams were producedby Henriette Rintelen.

platesas Thefollowingplatenumbersindicatenewlydeveloped corrections: well as drawingsdueto fundamental U.Brugger 707,923,924,927-932,934,936,937,1366,l37B R. Himmelhan 1367,1368,1370,1372, 1374,1375 S.Klebe 1162,1174,1175, 1218,1222,1223,1250,1349 H. Rul3 - 1284,1302-1304 7 BB,7 98,1281

Acknowledgements The editors would like to thank the following colleaguesfor providing the pictures of ultrasound,computedtomography, magneticresonancetomographyas well as endoscopicand colourphotographsof operationalpractice:

Prof. Reiser & Dr. Glaser, Institute of Clinical Radiology, Universityof Munich (figs.307,578-582,705a, b, 771,1369,1371,1373,13771 Prof. Rudzki-Ianson,Polyclinicfor Orthodontics,University of Munich (figs.80,8l) Dr. Scheibe,DepartmentofSurgery,RosmanHospital,Breisach ( f i g s1 . 233a-c) Prof.Schillinger,Gynaecological Clinic,Universityof Freiburg (figs.1072-10741 Dr. Dr. Schliephake,Facio-MaxillarySurgery, University of Medicine,Hannover (figs.167,212,2131 Prof. SchlijBer,GynaecologyCentre, University of Medicine, Hannover (figs.1071a, b, 1080,1082,1083,1130) Neuroradiology,Departmentof Radiology, Prof. Schuhmacher, Universityof Freiburg (figs.448a,b) Munich Dr. Sommer& AssistentProf.Bauer,Radiologists, (figs.650,1234-12361 Polyclinic,Universityof Munich Prof.Stotz,Orthopaedic (fig. 1193) Universityof Munich Prof.Vogl,Polyclinicfor Radiology, (figs.440, 442,631,632) Prof.Vollrath,ENTClinic,Miinchengladbach (tigs.246-2481 Prof. Wagner (dec.),DiagnosticalRadiologyII, University of Medicine,Hannover ( f i g s . 9 1 41,0 1 4 , 1 0 1120 2 01, 0 2 31, 0 9 0 ) Universityof Freiburg Prof.Wenz,Departmentof Radiology, (tig.7a7) Dr. Willfiihr, Departmentfor Abdominaland Transplantation Surgery,UniversityofMedicine,Hannover (fig. 1001) AssistentProf.Wimmer,Departmentof Radiology,Universityof Freiburg (tig.778\

Prof.Altaras,RadiologyCentre,GieBenUniversity (figs.964,979,9801 Dr. Baumeister, Departmentof Radiology, FreiburgUniversity (fig. 109s) Prof.Daniel,Departmentof Cardiology,Universityof Medicine, Hannover (figs.862-864,935) Prof. Galanski & Dr. Kirchoff, Department I of Diagnostic Radiology,Universityof Medicine,Hannover (figs.924,1144a,b,1154, 1155) Prof. Galanski & Dr. Schiifer, Department I of Diagnostic Radiology, Universityof Medicine,Hannover (figs.B3Ba, b, 888,933,958,1139,1147,1150,11521 Prof. Gebel Departmentof Gastroenterology and Hepatology, UniversityofMedicine,Hannover (figs.253a,b,966,975,976,981,990,991, 1026,1043) Dr.Goei,Radiology, Heerlen,TheNetherlands (figs.1010,1011) (with permissionfromRadiology173:137-141,19891 Dr.Greeven, St.ElizabethHospital,Neuwied (figs.166,1182) Prof. von der Hardt, PaediatricClinic, Universityof Medicine, Hannover (figs.893) Dr. Hennig,Departmentof Radiology,Universityof Freiburg (fig.529) Prof.Ionas,Urology,UniversityofMedicine,Hannover (figs.1050a,b, 1051) Prof.Kremers,Polyclinicfor DehtalPreservation and Periodontics, Universityof Munich (fig.182) Prof.Kunze,Paediatric Clinic,Universityof Munich (figs.15-18) Dr. Meyer, Departmentof Gastroenterologyand Hepatology, Universityof Medicine,Hannover Additionalillustrationsweretakenfromthe followingbooks: (figs.906.949a,b,959,1086) Prof. Pfeifer,RadiologyDepartmentof the SurgicalClinic, UniBirkner, R: The typical X-ray of the skeleton, Urban & 1990 versityof Munich Munich-Vienna-Baltimore Schwarzenberg, (figs.306,319,321,748-751,789-792,1199,1230,1231,1260, (fig.1200) 12611 Welsch,U. (Editor):Sobotta- Histology,5th Edition,Urban& 1985 AssistentProf. Rau, Departmentof Radiology,Universityof Munich-Vienna-Baltimore Schwarzenberg, (figs.635,646) Freiburg (figs.875,886,887) Wicke, L.: Atlas of X-ray Anatomy,3rd Edition, Urban & 1985 Prof.Ravelli,Instituteof Anatomy,Universityof Innsbruck, Munich-Vienna-Baltimore Schwarzenberg, (figs.905a,b, 1076) Itig.746l Prof. Reich, Clinic for FacioMaxillary Surgery,University of Wilhelm,K.,R.Putz,R.Hierner,R.E.Giunta:Plasticsurgeryof the 1997 Munich-Vienna-Baltimore Bonn hand,Urban& Schwarzenberg, (figs.133,134) (fig.s8)

Anatomy General 1 1

sagitlal plane

2 median sagittal plane 3 fronial olane 4 transverse olane

o

sagittalaxis transvers€axts longitudinalaxis

Figs. 1 a-c Planesand axis 0fthe humanbody. a sagittalplane,sagittaland Iongitudinal(= vertical)ax's b transverseplane(= horizontalplane),transverseand sagittalaxis c frontal plane(= coronalplane),longitudinaland transverseaxis

Lineamedianaanterior-

-

LineasternalisLin€aparasternalisLineamedioclavicularis

Linea medianaPostgtior Unea paravertebnlis -

cranialis(= superior)-

-

lateralis-

Lineascapularis Lineaaxlllarispostgrior

Linsaaxillarisanterior- -

palmaris-

-

r"oi"ti. /

/

caudalis(= inferior)/ libularis-

b directionaland Figs.2 a, b Linesof orientation, positionalterms usedfor the humanbody. a ventral (= anterior)view b dorsal(= posterior)view

\ lateralis

dorsalis

2

Parts of theBody

-----

Caput

----*

Collum

----Thorax

llembrum superius

F e m u r- - - - - -

llembrum Inferius

C r u s- - - - - - - -

Fig. 3 Surfaceanatomyof the male; veRtralview.

Fig. 4 Surfaceanatomy of the female; ventral view.

PartsoftheBody 3

---

Caput

Truntus, Dorsum

Membrum superlug

M a n u s- - - -

F e m u-r- - - - - -

Membrum lnterlus

C r u s- - - - - - - -

P e s- - - - - - - -

Fig. 5 Surfaceanatomyof the male; dorsalview.

Fig. 6 Surfaceanatomyof the female; dorsalview.

4

Regions of theBody

/ Regiocervlcalisanterior Rogiost€rnocleidomasloid€a \ Reglodeltoidea 1

- R€gioc€Mcalls lateralis : Trigonumclavipec{oralo - R€gioprestemalls

Regioaxillads R6giomammada R€giobrachii anledor -

-

Regiop€ctoralis

- - Regioinframammada - - Regloepigastdca - Raglohypochonddaca

Reglocubltalisanterior,Fossacubltalis

- Regloumbllicalig - Regloabdomlnalislateralis

R€gloantabrachliposterior - -

- Regioinguinalis

Rsgio ant€brachilanterior -

Reglopubica [Hypogastriuml

-

R€gio urogenitalis

Trigonum femoris-R€giofemorisantsrior/

R€giogenus anterior - -

Fig. 7 Regionsofthe humanbody,Regiouescorporis; venbal view.

oftheBodY Regiora

- Regilopadeialis - R€gloocclpiElls

- Regloc€rvicall6Posbtlo. Regiodelloidoa \

- Regloverl€bra[s

Rogioscapulans--

B€gio axillaris - - Rogloinftascapuletls

Regio brachil postsrior -Rogiocubltalb postorior

Regloant€brachliantotio. R€gioantsbrachilposledor -

Palmalvolal Regioglutealls /

Fegb lemotu posterlor

Regiog€nus postgrior,Fossapoplitea

R€giosura€ -

Rgglocrudspostador--\ R€giocruris anterior - -

OoEUmpedis Calx lReglo calcan€al

Fig. I Regionsofthe humanbody,Regionescorporis; dorsalview.

5

PassiveLocomotorSystem.Skeleton

Sternum\

(Pars ceruicalis)

(Parslumbahs) R a d i u-s* - ----

O sc o x a e- - --Ossa catpi---:--

o s s a- melacarp' o s s a- - digitorum lPhalangesl

Patella -

Ossatarsi - - Ossametatarsi

Fig.9 Skeleton,Systemaskeletale; ventral view.

Ossatarsi-

Fig. l0 Skeleton,Systemaskeletale; dorsalview.

Regions of the human body Caput Collum Truncus Thorax Abdomen Pelvis Membrum superius Cingulumpectorale[Cingulummembrisuperioris] Parsliberamembrisuperioris Membrum inferius Cingulumpelvicum[Cingulummembriinferioris] Parslibera membriinferioris

Marrow Bone

I I

(Cafiila9oarticularrs)

_-

Substantia soonoiosa Medullaossiumiubra

; --' (Extremitas proximalis)

-

Bones lhat can be touched through the skin Distnbutionof haematopoiesis in the bone marrow

Figs. 11a, b Skeleton,Systemaskeletale. a ventral view b dorsalview

Ltnea epiphysialis

Melaphysis (proximalis)

Corpus Periosteum

- -

Metaphysis (distalis)

(Extremitas distalis)

Cavitas medullaris; Medulla ossium llava

/ Fossa olecrani

--

Substantiaspongiosa Medulla ossium rubra

\ Cartilagoarticularis

Fig. 12 Structure0f a longbone,0s longum, the humerusis shownas an examPle; longitudinalsection. lines)are discs(epiphyseal Theossifiedepiphyseal just visible.

7

8

Passive Locomotor System, 7. EW -_ 18.-19.U \ 15.-18.U :-\

1 5 . - 1 6 . u- _ ^ 1.U --__

--

18.-20.U --13,-15.U

18.-21.U 2.-5. LM --

------10.-12.

5.U --

------18. U ------18.-19.

2.-s.u-2,-1,|J -'.

a m-25..u/

U

-7.-8.U --

LJ

6.-7.EM - 16.-18.U

--8. EW --7\

---15.-18. U

\ ts.-zo. u

1

7.-8.EW --

13.-15.U

\ 4.-6.U

\ re.-zo. u EWEM. LM. U.

13.-16. u -_

8.-r3.U -

1.U --

5.-7. U 1.1.-18. U 10.-12. U

__--12.U -- 8.-12.U --

!--..-.."

19.-17.U 1 0 .E M - - -

L--

5.-6.U -17.-19.U-12.-11.1J-'

1 7 F 1 8 .U

7. EW 7.-8. EW --

--N.11.U

--7.+.U --s.-2. u

6. Ll,l -\

--

17.-18.U

17.-18.U -2.-4.1) .'

,--3.-1.U 9. EW 3.-4.U 1.-z.u 3.-5.U -

\ .|5.-21. U --

5. EM

v

\8.EM \9.Ew

Os scapholdeum 3.-6. LM Os lunatum3.-6. Ll Os fep€zlum 3.-8. U Os t"pezoHeum 3.-7. U

Os plsiforme8.-12. U Os tiquetrum 1.- 4. U Os hainatrm 2.-5. LM Os cadhtrm 2.-4. LM

Fig. 13 Appearanceofendochondralossificationcentes and the ossiflcationof the epiphysealplatesof the upporlimb (averageagesaccordingto v. [.lxz, 1956;Exnnn,1990;Heucr and B,rsr,1994).

Talus7. EM Calcaneus5.-6. EM Os navicularo4. U Oscriboldoum10. EM

Os c|lnefformom€dlab 2.-3. U Os clinglformoInbimedum 3.-4. U Os glnellbrme labralg .|2. LM

Fig. 14 Appearanceofendochondralossification centresand the ossiflcailonof the epiphysealplatesof the lower limb (averageagesaccordingto v. Lrrz, 1956; Exxrn, 1990;Hnucxand Bmr, 1994).

. -t System,SkeletalDevelopment

Fig. 15 Radiographof the hand of a 4t/z-year-okl child; dorsopalmarorientation(PA); ( m a l e ,r . ) .

1 2 3 4

Ulna, diaphysis Radius,diaphysis Ulna, dislal epiphysis Radius,distal epiphysis

5 Lunatebone,Os lunatum bone,Os triquetrum 6 Triquetral 7 Scaphord bone, Os scaphoideum

Fig.l7 R a d i o g r a pohf t h e h a n do f a n l l - y e a r old arlolescent; d o r s o l l a l m aorr i e n t a t i o n( P A ) ; (femak:,r )

Fig. 16 Radiographof the hand of a 7-year-old c hi l d ; dorsopalmarorientation(PA); ( m a l e ,r . ) .

I Hamate bone, Os hamatum 9 Capitate bone Os capitatum

10 Trapezoidbone, Os trapezoideum 11 Trapeziumbone, Os trapezium

Fig. lB Radiographof the hand of a 13-year-old adolescent; tlrientation(PA); rkrrsopalmar (male ,r )

10

Passive Locomotor System,Ioints

Fig. 19 Fibrousjoint,Articulatio fibrosa,exemplified by the sutures r of theskull.

joint, Fig. 21 Osseous Articulatioossea,exemplified by thesacrum.

joint, Fig.20 Cartilaginous Articulatiocartilaginea, exemplified by the symphysis.

1 1a lb 2 3 4 5 6 7 I 9 10

Membrana synovialis Intima Subinlima Membrana tibrosa A-cells B-cells Fat cells Capillaryvessels with fenestration Venules Lymphatic vessels Nerves Collagenfibres

Capsula articularis

--

Labrumarticulare

--

(Cartilago articularis)

- -

Cavilasarticularis

Linea epiphysialis ----

--

Recessus articularis

- -

Membrana svnovialis lslratum synbvialel Capsula articularis fibrosa Membrana lStratumlibrosuml

Vagina synovialis

--

Fig.22 Synovialjoint, Articulatio synovialis,exemplifiedby the shoulder joint; sectionin the scapularplane.

11

Musclesand TendonSheaths System, ActiveLocomotor

1 Lineot muscle action 2 Leverarm of muscle 3 Axis of rotalion ol joint

(Cavitassynovialis)\\ Mesotendineum \ Tendo

\

Epitendineum \

Fig. 23 Structureof the skeletalmuscle, the brachialismuscleis shownas an example.

a Musculusfusiformis

e Musculusintersectus

b Musculusbiceps

f Musculussemipennatus

Fig.24 Structureofthe tendonsheath,Vaginatendinis, by the finger. exemplified

c Musculusbiventer

g Musculuspennatus

d Musculusplanus

Figs.25a-g Typesofmuscle. a singlehead, parallelmusclefibres b doublehead, parallelmusclefibres c doublebelly, parallelmusclefibres d multi head. flat muscle e parallelmulti-bellymuscle fibreswith tendinous intersections muscle f unipennate g bipennatemuscle

12

ActiveLocomotor System, MuscleGroups

Fig.26 Surveyof themuscular system; ventralview.

Fig.27 Surveyof the muscularsystem; rlorsalview.

Digestiveand RespiratorySystem

*t """'riilr,ii-::! propria\_ fCavilasoris

Glandula p arotidea -'(jlanoulae l, | -salrvariaeI Glandula sublingualis/ majores | -/ \ Glandula submandibularis

|

.

Oesophagus

----

Gaster

Vesica biliaris lfellea] - -

Fig. 28 Survey ofthe digestivesystem; medial view (headand neck); ventral view (trunk).

/ Sinusparanasales ---.-7t'

Lobussuperior I I Pulmo srnrster I / Lobusinferior

rvey of the respiratory system; (headand neck);ventral view (thorax).

13

T4

UrinaryTractand GenitatCrgans

Organa uflnafla

--

Duciusdeferens

Vesicaurinaria - Glandula vesiculosa - Ductusdeferens - Proslata

Urethramasculina -Penis Organa genitalia masculinaexterna

----

Urethra masculina

-----

Glandula bulbourethralis

Organa genitalia masculinainterna

Epididymis Ductusdelerens Testis

Scrotum----l-

Fig. 30 Surveyof the urinaryandreproductive systemof the male; medialview.

Organa uflnana

Vesicaurinaria\ U r e t h rfae m i n i n a- - : : \ _

Organa genitalia leminina externa

C l i t o r i s- - - - Labiumminus pudendi Labiummajus pudendi

Fig. 31 Survey of the urinary and reproductive system of the female; medial view.

Organa genitalia feminina interna

system Endocrine 15 HYPothalamus

-' - -

Glandula pineafts ICorpus Pineale]

---

---

G l a n d u l a e. - parathyroideae superioret inferior

Glandulathyroidea

Glandula suprarenalrs - -

I n s u l a ep a n c r e a l i c a e- - ' -

-'l

O v a r i u m- - - - - - -

------*

lesLls

Fig. 32 Survel'of the endocrinesystemof the male; ventralview

Fig. 33 Surveyof the endocrinesystemof the female; ventralview.

Endocrine organs All organs whose primary funcdon is the producdon of hormonesare calledendocrineorgans.Theseare: hypophysis, pineal gland, Glandula pinealis [Corpus pineale], thpotd and parathyroid glands,pancreadcislands,testis and ovary. Other organs are also endocrinologicallyactive. The brain for exampleproducesthe hormonesthat contol the hypophysis,but the production of hormones is not a primary function of the brain. Other examplesare the kidneysthat producethe erythre

poietin and the right atrium of the heart, where the atrial natriuredc peptide is produced.Betweenthe epithelold cells of the gasfrointestinalpassagetlere are cells of the diffirse neuro endocrtnesystem(A?IJDsystem).Theymainly affect adJacent cells, and coordlnatethe different functions of an organ. Stric0y speaking, nearly dl organs produce hormones, as in the immune system where they coordinate tlte production and funcdon of cells of the immune system.

I6 A carotisinterna-_ A carotisexterna- A carotiscommunis dextra- - - A subclavia dextra--

- - - - -

A carotiscommunissinistra /

/ Truncusbrachiocephalicus sinistra - - A. subclavia - - Arcusaortae --

Parsascendensaortae lAorlaascendens]

- -

Parsdescendensaortae[Aorladescendensl, Parsthoracicaaortae[Aorlathoracical

- - Truncuscoeliacus A mesentericasuperior

-A. orofundabrachii- - --

- A. renalis --

Parsdescendensaortae[Aortadescendens] ParsabdominalisaortaelAortaabdominalis] --

A. testicularis'

--

Bifurcatio aortae

--

inferior A. mesenlerica

--

A iliaca communis

--

A iliacaexterna --

A. femoralis/ A profundafemoris /

A tibialisoosterior--

A. tibialisanterior- -

A dorsalispedis - -:

Fig. 34 Surveyofthe vascularsystem: arteriesof the systemiccirculation; ventralview. ' in the female: A. ovarica

A. iliaca inlerna

VascularSYstem,Veins

externa\ V iugularis anteraor V jugularis \ \ interna. V iugutaris V subclavia \ V azvoos

L7

V brachiocephalacadexlra V brachiocephalica sinistra

/

-

V thoracicainterna

\

V cavasuPerior

.-V axillaris- -

-

Col

V cephalica- V b a s i l i c a- - Vv brachiales---

- V renalis --

sinistra. V testicularis V portaehepatis * V splenica

dextra'- V testicularis *..- V mesentericainlerior

V iliaca communis - -

--

V iliaca interna - -

V mesentericasuPerlor -

V. iliaca externa -:

/ V lemoralis

\

V cava inlerior

\ V temoralis \ V prolundalemoris

- -

V poplitea

V saphenamagna--( --

V saphenaParua

--

--

V tibialisantenor

V tibialisPostenor

Fig. 35 Surveyofthe vascularsystem: venoussystem; ventralview. The superficialveinsare shownin the right' the deepveinsin the left leg. * in the female: V. ovarica

18

VascularSystem, Main Branchesof Arteriesand Veins

\.

t12

9

I 1 2 3 4 5

A subclavia A lhoracicainterna Truncusthyrocervicalis Truncuscostocervicalis A. vertebralis

1 2 3 4

1 2 3 4 5 6

Truncuscoeliacus A gaslricasinislra A hepaticacommunis A solenica

A iliacacommunis A. iliacainterna A iliacaexterna A. epigaslrica inferior A. circumflexa iliumprofunda R. pubicus

19a 'I Pars ascendensaortae 2 Bulbusaortae 3 Aa coronariae 4 Arcusaortae 5 lsthmusaortae 6 TruncusbrachioceDhalicus 7 A. carotiscommunis sinistra 8 A subclavia sinistra 9 A carotiscommunis dextra 10 A subclaviadextra 11 A carotisinterna 12 A carotisexterna 13 Parsthoracicaaortae 14 Parsabdominalisaortae 15 A sacralismediana 16 Biturcatioaortae 17 A. iliacacommunis 18 A iliacainlerna 19 A iliacaexterna

1 A carotiscommunis 2 A carotisexlerna 3 A carotisinterna 4 A. thyroidea superior 5 A. pharyngeaascendens 6 A lingualis 7 A facialis I A occioitalis 9 A. auricularis oosterior 10 A. temporalis suoerficialis 1l A. maxillaris

Figs. 36 a-g Aorta and the main arteries; diagram of the branches. a Aorta b A. subclavia c A. carotis externa

1 2 3 4 5 6 7 I I 10 l1

A mesenterica superior A pancrealicoduodenalisinlerior Aa jejunales Aa ileales A ileocolica A. colica dexlra A colica media A mesentericainlerior A. colica sinistra Aa sigmoideae A. rectalissuperior

1 A iliacacommunis 2 A iliacaexterna 3 A, iliacainterna 4 A obturatoria 5 A. pudendainterna 6 A gluteainferior 7 A iliolumbalis I Aa sacraleslaterales 9 A gluteasuperior 10 A. umbilicalis, Parspatens 11 A. vesicalis inferior 12 A. rectalismedia

d Truncuscoeliacus e A. mesentericasuperior and A. mesentericainferior f A. iliaca externa I A. iliacainterna

16 rl

14 \4

1 2 3 4 5

V. cavasuoerior V. brachioceohalica dextra V. brachioceohalica sinistra V jugularisinterna V. subclavia

Fig.37

6 7 I 9

V azygos W. intercostales oosleriores V. hemiazygosaccessoria V. hemiazygos

V. cavasuperior,tributaries.

1 2 3 4 5 6 7

V cavainlerior Vsacralismediana V iliacacommunis V iliacainterna V iliacaexterna V. phrenica inferior Vv.heoaticae

Fig.38

4

8 V renalis 9 Vlesticularis/ovarica 10 V suDrarenals 1'l Vv intercostalesoosteriores 12 V lumbalisascendens 13 Vv.lumbales 14 V. iliolumbalis

V. cavainferior,tributaries.

Veins System, Vascular 19

Fig. 39 Diagram showing the function of the venous valves.The arrows pointing right indicate the normal blood flow towardsthe heart when the valvesopen.The arrows pointing left indicate the reverseddirection of the blood flow when the valvescloseto stop regurgitation.

f,

Corpus numerl

AP-radiograph(phlebography)of the brachial, Fig. 40 axillary and cephalicveins and some of their tributary vessels. The venousvalves can be clearly identified, especiallyin the axillary vein.

Fetutcircutatiott

20

Arcus aortae

I

\

Aa pulmonales

Truncus brachioceohalicus - -

--

D u c t ua srleriosus" - -

Truncus pulmonalis

V cava superior - --

Atnum cordissinislrum

Foramen ovale' Atrium cordis dextrum - - - - -

--

V cava inlerior - Vv hepalicae

Venlriculuscordis sinister

Septum interventriculare

- Ventriculuscordis dexter

-_L---____

I

i,

-\: \ l\r

\ R alveolaris Suoerlor

,.1

meolus

$' \

N alveolaris lnt"rio, //

I

,\

N. tinsuatisi

Y,

N palatinus major

/

N palatinus maJor

I

i-i

\ N sublingualis

Ganglion submandibulare N mylohyordeus /

Fig. 145 Nervesof the face,trigeminal(V), facial(VII), glossopharyngealnerves (IX), and their branches; mediansection;

\

N mentalis

the parts of the nervesin view are colouredyellow,those hiddenby boneare light yellow; medialview (60%). * b r a n c h e ss u p p l y i n gt h e m u s c l e so f m a s t i c a t i o n

N maxillaris[V/2]

N mandibularis[Vi3]

Fig. 146 Faceand neck, Faciesand Collum;sensoryinnervation; lateralview (30%).

Muscles, Vesselsand Nervesof the Head

V temporalissuperliclalls,B trontalis€ I I A lemporalissuperticialis.R parietalisa t

\

V temporalissuperlicialis,R parietaliss \

N auriculotemporalis

,'

(v/3)

ffi,fYgomaticotemgorates

ti_

A a u r i c u l a r i s o\ posteflor

Rr zygomataci (vil)

V occipitalis49 \

Rr zygomaticotaciales (V/2)

\ occipitalisa --/

G V angularrs

/

oA angulans

N occipitalis malor cervicahs[C2], R posterior)

Rr temporales (vil)

N occipitalisminor (Plexuscervicalis)

-

a A transversa tacrei

--A transversal faciei

Dr"trs . parotideus

-

\ c V tacialis \ o A facialis

N auriculaflsmagnus (Plexusceruicalis) \ V retromandibularisqJ /

\

R buccalis(Vll)

R marginalismandibularis(Vll)

#

265

Vesselsand nerves of the head; Fig.147 layer; superficial Iateralview (90%). * clinical: STENSEN's duct

148

Head, Caput

Galea aponeurotica

/

..

/ OA temporalis superficialis, H. lrontails

/ A. temporalisa -\ supenrcralrs, R parietalis

N. suora(V/1), orbitalis Rr.medialis

,t

',/

el lateralis

//

aA..supraorortails

i --

oA supra-

R zygomaticolemporalis

(vt2')

trochlearis

N auriculolemporalis (v/3)

N supralrochlearis(V/1)

B auricularis o -anterior

R. zygomaticofacialis(V/2)

A ;V temporaliso o guperficialis

A auricularisposterior;o R. auricularis

(x)

N laciatislvil] \ Plexus intraparotideus (vil)

\ \

a

A.; N. infra(V/2) orbitalis

Rr zygomatici (Vll) oA labialissuperior

R buccalis \ N auricularis maonus (Plexuscervic-alis)

\ \

R marginalismandibularis \

.t1 V retromandibularis a -' V jugularis externaO /

\ \

oA facialis

oV facialis

* v,149 r47tl 266

Fig. 148 Vesselsand nerves of the head; middle layer; the superficial part of the parotid gland has been removed to show the Plexus intraparotideus; lateral view (90%).

(Vll) Rr buccales oA labialisinferior

N buccalis (V/3)

N mentalis(v/3)

and Nervesof theHead Muscles,Vessels

Fasciatemporalis,Laminasuperlicialis\

V temporalismediaa r i

o \ A temporalissupedicialis, R. parietalis \

M temporalis

la

R. frontalis t o A temporalissuperficialis' lateralis R. N. supraorbitalis, ! / M occipitoirontalis' O M. epicranius, 'r Venterfrontalis

! i

oculi / a M. orbicularis

Fascialemporalis,\ Laminaorofunda \

i

N. supraorbitalis, R. laleralis

/ /'

M epicranius, o \ \ M iemporoparietalis

/ a A. supratrochlearis '

A. temporalis O\ \ superlicialis

N. supraorbitalis, R medialis

' -

N. zvoomatiius, R. zir[omaticotemporalis

A zvoomaticoa -orbitalis

N supratrochlearis N. inlratrochlearis N. zygomaticus, R. zygomalicofacialis -

N. occipitalis ma,or

N ethmoidalis anleflor, R nasalis exlernus

- o A. angularis

A occipitalisa -

-

N. infraorbitalis a M. masseter -I M. lovatorlabii superlons \ O M. zygomatacus maior

N auriculolemporalis N auricularis postenor A auricularispostetiota / - -

N lacialis [Vlll

\

l------

N occipitalisminor

''-

\oA.buccalis

.--l-r \ t..t. \

.. 4., I I I I I

(vll) R stylohyoideus M stylohyoideus a)

I

A carotisinternao I

\

\

oA. lacialis o M. zygomalicusmajot

\

a M. buccin'rtor N. masselericus t M odicularisoris N. buccalis

\ Ramusmandibulae \ N mentalis N. alveolarisinleriol

tr.

\ a A. alveolarisinferior \ 1M. masseter \oAlacialis

t\\ \

\ \

t oM digastricus,venleranlerior

I o v submenlalis A. lingualisa V. retromandibularis o

o V. facialis

exlerna 1 V jugularis

17150

A8m Fig. 149 Vesselsand nervesof the head; mostof the craniofacialmuscles,the parotidglandand the branchesof the facialnervehavebeenremoved; the massetermuscleand the temporalfasciahavebeen sectionedand reflected; the mandibularcanalis partially exposed; lateralview(90%).

Head, Caput

protunda postenor; I N massetericis: 7 oA temporalis N temporalisprofundus ;OA masseterica / / 1 /rM.pterygoideuslateralis 1// protunda anterior / a A, temporalis

a M temporalis \ A temporalis mediao \ A temporalissupedicialis,a \ R. panetalis

Arcuszygomaticus \

N supraorbitalis, Fl lateralis

/

\

N supraorbitalis,R medrafts

/

A zygomalico-o \ orbilalis \

/ Os zygomalicum

/

Articulatio \ temporomandibularis, Lig laterale

/ /

N infraorbitalis O A supratrochlearis

A transversaO \ \ faciei --

Meatusacusticus\ externus \ cartilagineus

aA angularis N infratrochlearis

N meatusacustici \ externi

--

aA

N vagus[X], R auricularis N auriculotemporalis

infraorbitalis N ethmoidalis anterior,R nasalis

exlernus

N faciahs[Vll] A stylomastoidea o -

N inlraorbitalis

A auricularisposteflor O -

A auricularisprofunda o / A tympanicaanteriorO / A occipilaliso

A maxillaris a /

/

A meningea media o /

\ :

/

\ \

A carotisexternaa / \

M massetera / \

N mylohyoideus

t

'ttirti

/

/ clandula submandibularis N mylohyoideus

Fig. 150 Arteriesand nervesof the face; deeplayer;the zygomaticarch,the ramus of the mandible,the masseterand the temporal muscleshave been partially removed;

/

A maxillaris A occipitalis

N buccalis c M buccinator

o A tacialis N mentalts 1R AiN

mentalis alveolarisinferior

a M pterygoideusmedialis I

oA submenlalis

\

aA faciatrs

the mandibularcanalis exposed; lateralview

A meningea media

-condylans A auricularis/ Posterior

o

t

aA buccalis

\

N lingualis

M'{?

' a Rr.dentales; A. alveotaris I o Rr.peridentales.i superior posterlor

,'l

/

Rr alveolares supenores posteriores

M pterygoideus lateralis

/ N alveolarisinferior / N lingualis

A a l v e o l a r i -s- infeflor A carotis -

Figs. 151a-c Variationsof the maxillary arterv.

A. maxillarislateralof M. pterygoideuslateralis(60%1, A meningeamediaoriginates proximalof A. alveolarisinferior b A meningeamediaoriginatesoppositeto A. alveolarisinferior C A. meningeamediaoriginatesdistal of A. alveolarisinferior

Muscles,Vesselsand Nervesof the Head

N auflculotemporalis / I I t

a \ A temporalis superticiahs, R. panetalis \

'A

temporalismedia / *M /'

temporalis , Arcus zygomalicus

/

N meatus \

'

acusltcl

externi

prolundaposterior; / o A. temporalis prolundus N. temporalis ,

Nmandibularislv/3] lateralis o N.;M. pterygoideus

u R auricularis \

/ a A. maxillaris . N inlraorbitalis

\

/ Os zygomaticum A ; N a u r i c u l a r i s oa posteflor

/ a A inlraorbitalis , O A. sphenoPalatina N supratrochlearis

a \ A. temooraiis supediciaIs

Rr alveolaressuperiores posteflores N. intratrochlearis

-

N lacialis[Vlll N auriculotemporaIs

on angularis

]--

R digastricus -

A occipitalisa / / A tympanicaanteriora

/

A meningea mediaa'

a / A maxillaris Chordatympani '

/ /

/ M styloglossusa/ /

N massetericus

1

N buccalis --

A, alveolaris nlerior o /

\:

M. digastricus, a Venterposlerior N hypoglossus [Xl|] / A tingualis a / A palatinaascendenso /

N infraorbitalis

---

I M buccinator 1 A. buccalis

a M pterygoideusmedialis Lingua inlerior N. alveolaris

i

N lingualis

M . h y o g l o s s u s/o _ i / M stylohyoideusa N, vagus[X] / Ansacervicalis '/ A caroliscommunis a / I A thyroidea superiora'

-

Mandibula

- sublingualis Glandula

\\-\

: I M. mylohyoideus

/

/ Glandula submandibularis N. mylohyotdeus

Fig. 152 Arteries and nervesof th.eface;deeplayer; the zygomatit;alch and malor parts of the right half of the mandible have been removed;the buccinator muscle togetherwith the mucous membraneof the mouth ]tave been partially removed; lateralview.

6%

37o

4

c

Variationsof Figs. l53a-d the maxillary artery.

o/o

tB% d

A. maxillarismedialof M. pterygoideuslateralisand medialof N. lingulis and N. alveolarisinferior b A. maxillarisbetweenN. lingulis and N. alveolarisinferior c A. maxillaristhrough a loop of N. alveolarisinferior d Origin of A. meningeamediadistal of the origin of A. alveolarisinferior

Head, Caput

\

a Plexuspterygoideus Fascialemporalis,LaminaprofundaI

/cVtemporalismedia

Ramusmandibulae N massetericus;A masseterica O V. maxillarist A temporalissuperficialis, O\ R. parietalis \ N. auriculo- \ temporalis \

/ a A. temporalissuperficialis, R. frontalis 7 ,/

t aM temporalis .t

/ a M epjcranius,M occipitotrontalis, Venterfrontalis lateralis N supraorbitalis,R

/

V temporalis{} \ media

7 oM orbicularisoculi

A lemporalisa \ \ meora

N supraorbitalis, R medialis - - Os zygomaticum

N. auriculo- \ temporalis ar.

N supratrochlearis / o A angularis

V temporalis{s \ superficialis .a

N inlratrochlearis

Meatusacusti-\ cusexlernus \ cartilagineus ..

---

R auricularis

oA dorsalisnasi --

(x)

aA facialis

N auricularis posterior

N inlraorbitalis

N. facialis

tvilI A temporalis o superficialis

-

--

A auricularisa posterior A. maxillaris a /

-

A occioitaliso

-

A. carotisexlernaa z V. retromandi-: bularis

-

/

/ tig' sphenomandibulare ,, Mmasselera/ t N ;A alveolaris inlerior a /

* V prolundalaciei

o M buccinator

o A buccalis

\ a M orbicularisoris '

-;-lVlacialis

/

/

N lingualis A carotis inlerna I

N buccalis

-

/ \

/

A carotisexternaar

N mentalis

Plexus dentalis inferior

/

M digastricus, Venterposterior1 A. lingualisI

o M digastricus,Venteranlerior

/ \

/

I A facialis

'

M stylohyoideus t

M pterygoideus medialisa V retromandibularis e

N mylohyoideus I ,u V submentalis s V tacialis

Fig. 154 Vesselsand nerves of the face; deep layer; state of dissectionsimilar to Fig. 150; lateral view.

(

Nose,Nasusexternus

Carlilago alaris major, \ Crus laterale \

(Cartilago nasi lateralis)

/ z Carlilaoo alarisriajor, Cruslaterale

- - Cartilagines nasl accessoflae

Carlilagoalarismaior, Crusmediale

Cartilago - septi nasi

\ Cartilago alarisminol

Cartilagoseptinasi

/

/ Ala nasi

Nasalcartilages,Cartilaginesnasi; Fig. 156 inferior view (90%).

Fig. 155 Nasal skeleton; ventral view (90%).

SuluralrontonasalisI / Suturalrontome.xillaris

Maxilla, Proc \ - trontalis

- Sutura nasomaxillaris

Os nasale - -(Cartilagines nasilaterales)

Cartilagoalarismajor, Cruslaterale Cartilago / alaris major, Crus mediale

\

- - Cartilagines alaresminores

// Cartilagoseptinasi

Fig. 157 Nasalskeleton; lateralview (90%).

Head, Caput

/ Crista galli Lamina el Foraminacribrosa

Sinussphenoidalis \

\

\

It;di" r I

i: 1--

frontonasatis Sutura

r,t$,

\-\ Fril

-t

Laminaperpendicularis - - - Os ethmordale,

!\.U

Dorsumsellae-Fossahypophysialis

\

Sinuslrontalis

)',...

Clivus-

.- Yomer'

Cartilaooalarismaior. Crusm-ediale

\ Spinanasalisanterior

FossapterygoideaHamuluspterygoideus/ Suturapalatinatrana""ra"

/

- Fossaincisiva: Canalisincisivus

/ \

/ (Suturavomeromaxillaris)

Maxilla,Proc palatinus

Fig. 158 Nasalseptum,Septumnasi; lateralview (r.).

Concha nasalis media \

ii Carlilagos€ptinasi --

Meatusnasi inferior

---

- -

Fig. 159 Part of the lower concha,Conchanasalis inferior, with mucosaand Plexus cavernosus.

Conchanasalisinferior

Glandulae nasales

nast9 Cavitas Cavity, SinuslrontalisI

Tractusolfactorius \ Sellaturcica r

./

Nn. oltactorii[l

\ ) / Conchanasalismedia

SinussDhenoidalis-

/ Conchanasalisinferior

/ Umonnasi Tonsillapharyngea- -

Fig. 160 Lateralwall ofthe nasalcavity,Cavitasnasi; paramediansection;the mucousmembranehasbeenpartially removed; medialview (1.). Conchanasalismedia \

\

Cellulae--ethmoidal€s posteriores Sinus - - sphenoidalis

Tonsilla- - pnaryngea -Vestibulum nasl

Palatummolle - Conchanasalisinf€rior

I N. nasooalatinus 1 2 3 { 5 6

Sinuslrontalis Ouctusnasolacrimalis Cellulaeethmoidalesanleriores Sinusmaxillaris Cellulaeethmoidales oosteriores Sinussphenoidalis

lMttilt"

Fig. 161 NasalcavitY,Cavitasnasi; orificesof the paranasalsinuses,Sinusparanasales, duct,Ductusnasolacrimalis; andof the nasolacrimal paramediansection;partsof the middleand inferior nasalconchaehavebeenremoved; medialview(1.). Thecolouredprobesare situatedin the orificesof the paranasalsinusesand the nasolacrimalduct.

I

Head, Caput

--Sinuslrontalis

Cellulaeethmoidales ---

Sinusmaxillaris

Fig.162 Paranasalsinuses,Sinusparanasales; projection onto the face; ventral view. The sphenoidalsinusesare not shown.

Sinustrontalis-

Sinusmaxillaris/

Fig. 163 Paranasalsinuses,Sinus paranasales; projection onto the face; lateral view. The ethmoidal sinuses,Cellulaeethmoidales, are not shown.

ParanasalSinusegSinusparanasales

/ Sinusfronialis ,/ (Foramencaecum) Cellulae elhmoidales \ anleriores

gyrorum 7 lmpressiones

Cellulae ethmoidales mediae Cellulae ethmoidales - oosleriores

Chiasmaopticum

/

sinuses,Sinusparanasales; Fig. 164 Paranasal sinuses,frontalsinusesand projectionof the sphenoidal ontothe anterior ethmoidales) ethmoidalsinuses(Cellulae cranialfossa; superiorview (80%).

Os ethmoidale

septumnasi

o,

Orlrita,Pariesinlerior

/1.LJ 4. LJ

0 Sinusmaxillaris

Il

Maxilla,Proc.palalinus

_:_

f

_ _

M a x i l l a- - - - - - - -

of the maxillaryand frontal sinuses. Fig. 165 Development Ll {= 1"o"nt,*r) agein Years.

Head,Caput

/ Sinusfronlales

/ Cellulae ethmoidales anteriores

Os zygomaticum, Proc frontalis r

-:-\

Cellulaeethmoidalesoosteriores- -

Os zygomaticum, Proc frontalis

- - Forameninfraorbirate

- - Cellulaeethmoidalesposteriores - - Arcuszygomaticus

\ Sinussohenoidalis

Fig. 166 Paranasalsinuses,Sinus paranasales; PA-radiograph;the beam is oriented in the occipito-oral direction with the mouth open; anteroinferiorview (80%).

OralCavity,Cavitasoris

I Densincisivus

---:--

Arcuspalatoglossus - -

Arcuspalatopharyngeus

Fig. 167 Oral cavity,Cavitasoris; ventral view.

Glandulae labiales

M. orbicularisoris

Glandulae buccales

\

/

M levatorlabiisuoerioris -

M. levatorangulioris

/ /

M. zygomaticus maiol

--

Glandulaebuccales

M buccinator--

--

M risorius

\ M buccinator Glandulae buccales et labiales /

Labiuminferius /

I

/M. rant"li.

\ M. orbicularisoris

Fig. 168 Musclesofthe oralregion,Regiooralis; the mucousmembranehasbeenremoved; somesmall salivaryglandshavebeenpreserved; internalview(80%).

Head, Caput

Proc.pterygoideus, LaminamedialisI M tensorveli palatiniI

M. pterygoideus medialis /

Torustubarius

7/ , M. levatorvati oalatini f ,i u..

pharyngea / Tonsilla / M pterygoideus / laieralis / Lig spheno/ mandibulare / Ramusmandibulae

..FqplF-

pterygomandrbulafls

- -

Lig.apicisdentis

- - Membranaatlantooccipitalisanterior

Glandulae labiales - .-

- - Articulatioatlantoaxialismediana --Proc styloideus -M styloglossus -M stylopharyngeus --- Caruncula sublingualis

Lig.stylohyoideum Lig stytomandibulare \ M. stylohyoideus

Glandulasublingualis- -

\ M longuscapitis

M. orbicularisoris -

- Fasciacervicalis, Lamina pretrachealis

M. genioglossus M. digastricus

\ Os hyoideum, Cornumajus

M. mylohyoideus-

\ Membrana thyrohyoidea M geniohyoideus

/

\ M hyoglossus \ Fasciacsrvicalis, Laminapretrachealis

Os hyoideum, Corpus

\ M sternocleidomastoroeus \ \ os hvoideum. \ M. thyrohyoideus Cornl minus

Fig. 169 Oral cavity,Cavitasoris; paramediansection;the pharynx,larynx and tonguehave beenremoved; medialview. Thepharyngealtonsil becomessmallerin ageand is often barelyidentifiable.

Maxilla and Mandible, Mandibula

Juga alveolaria --

Fig. 170 Upperandlowerdentalarch,Arcusdentalis male; of a 2B-yearold superiorandinferior,viscerocranium teeth; occlusionof the lateralview.

Densmolarislll [serotinusl

Dentesoremolares\

---Dens

Denscaninus/

molarisll

- Densmolarislll [serotinusl'

Dentesincisivi--< DenscaninusDensmolarisl-Dentesoremolares,Radices

--

Foramenmentale/

Fig. 171 Maxilla, Maxilla and mandible, Mandibula, of a 20-yearold male; the dental rou$ have been exposed by removing the alveolar walls; lateral view. ' Thelowerthird molarhasnotyeterupted.

Head,Caput

Suturapalatomaxillaris \

Suturapalatinamediana\

Maxilla,Proc.palatinus-__

Maxilla,Proc.alveolaris---_

-

Dentesmolares

-

Sulcuspalatinus malor

\

Foramina palatinaminora

--Foramenpalatinum malus

'

Fig.172 Hardpalate,palatumosseum;upperdentalarch, Arcusdentalissuperior; photograph of the specimenof an adult: inferiorview (150%).

\ Ospalatinum, Lamina horizontalis

Cho"n"

Note the variation of the four incisors from the normal position (Fig. 192).

-

Foramen mandibulae

vestibulal -Densmolarislll [serotinusl

Densmolarisll

-

Densmolaris|

Tunicamucosaoris,Gingiva

-

Denspremolaris ll

Foramen mentale

/ Denspremolaris | / Denscaninus / Densincisivus lateralis

\

Densincisivus mediatis

Fig. 173 Mandible,Mandibula;lowerdentalarch,Arcus dentalis inferior; gingiva, Gingiva; superiorview (110%). ' oral: lingual in the mandible and palatal in the mnilla

Dentes{p Teeth,

vestlbulal - Enamelum Corona clinica

Corona dentis

Cervix dentis

Margogingivalis

--

Radix dentis

-

-

Foramen apicis dentis

-

-

Radix clinica

Cementum

Periodontium IDesmodontiuml

Canalisradicis dentis; Pulparadicularis

Aoex radicisdentis

Fig. 174 Incisor,Densincisiws; Iongitudinalsectionwith alveolarboneandsurroundingtissues. schematic

+

dlstal

Faciesvestibularis

7 Cuspisdentis

Cuspisdentas -

Apexcuspidis -

/ lFacies contactus); Faciesmesialis / Cuspisdentis

(Faciescontactus); Faciesdistalis \ Cuspisdentis \ Tuberculum dentis

Facies lingualis

lowercanine,Denscaninus Fig. 175 Permanent permanens; vestibularview (r.,400%). Fig. 176 Secondlowerdeciduousmolar,Densmolarisdeciduus; vestibularview (1.,400%). Thetwo strongrootsare slightly bent distally (typicalfeatureof theseroots).

Fig. 177 First upperpermanentmolar,Densmolaris primus; viewofthe occlusalsurface(r',250%1. Theocclusalsurface,Faciesocclusalis,usuallyhastwo vestibular(buccal)and two oral (lingual)cusps' Cuspides. * Occasionally (60%)a fifth cuspexists,locatedon the rnesiolingual surfaceof tfie crownof the first uppermolar,TuberculumCARABEII'

100

Head,caput

1234567

8

Fig. 178 Permanentteeth,Dentespermanentes; vestibularview (1.,120%).

1 2 3 4

Oensincbiws I Densincisiws ll Denscaninus DenspremolarisI

5 6 7 8

Denspremolarisll Dens molaris I Densmolarisll Densmolarislll lserotinusl

1234567

8

Fig. 179 Permanentteeth,Dentespermanentes; mesialview 0., 120%).

Dentesl reeth, 0 1

7

I

654321

Fig. 180 Permanentteeth,Dentespermanentes; oral view 0., 120%). (Foridentificationof numbersseepage100)

87654321

Fig. 181 Permanentteeth,Dentespermanentes; distalview (1.,120%). (Foridentificationof numbersseepage100)

Head, Caput

Arcuszygomaticus\ intraorbitalis\ .\ \ Canalis

Palatumdurum

/, Tuberculumarticulare

TSeptumnasi /Orbita

\

/

aill

Meatusacusticus externus

Proc condylaris -

Velum palatinum -

- - Dens molafls ll

Canalis mandibulae -

- Os hyoideum

Dens caninus /

\

Foramenmentale -

\ D"na premolaris ll

\ Dens molarisI

Fig. 182 Maxilla,Maxilla and mandible,Mandibula; panoramicradiograph;completedentition;no wisdom teeth; some teeth are filled. * piece to bite on of the panoramic radiograph machine

right

t6 15 14 13 t2 4 B 47 46 45 44 43 42

22 23 24 25 26 27 28 left mandible

Nomenclatureof the teethin the adult

reeth,Dentes 103 Dentesincisivi

Dentesincisivi

Dens caninus

Dens ll molaris

Dens molarisI

D€ns canlnus

Dens molarisI

Dens ll molaris

Fig. 183 Deciduousteeth,Dentesdecidui,ofa 3-yearold child; vestibularview (1.,130%).

Dens D€ns incisivuslateralis caninus

Dens molarisI

Dens molarisll

w0ffiw

D€ns Dens incisivuslaleralis caninus

Dens molarisI

Dens molarisll

Fig. 184 Deciduousteeth,Dentesdecidui,ofa 2-yearold child; upperroq vestibularview; lowerrow,obliqueinferior view (1.'130%). The dentalrootsare not yet fully calcified'

maxilla 63 64 S 73 74 I J mandible

left

Head,Caput

Dentesmolares(decidui)

Densmolaris(p€rmanens)ll /

Dentespremolares(permanentes)/

-

Denscaninuslpermanens)/

\

-

Canalis mandibulae

-

Densmolaris(permanens)|

Foramenmentale

Dentesincisivi(permanentes)

Fig. 185 Facialskeleton, Viscerocranium; deciduous teeth, Dentesdecidui,of a S-year-old child; the permanentteethare colouredblue; ventralview

Denscaninus(deciduus)/

Canalismandibulae

Dentesmolares(decidui)/ \

Dentesmolares(decidui)/

: \

Denscaninus(permanens)-

\

\

ll Densmolaris(permanens)

Densmolaris(permanens)|

Dentespremolares(permanentes)

Foramenmenlale

Fig. 186 Facial skeleton,Viscerocranium;deciduousteeth, Dentesdecidui; same specimenas in Fig. 185; ventrolateral view.

Teeth,Dentes

8-12 M 16-20 M

'12-16

M

\

/4

-_

20-30 M -

Fig. 187 Maxilla,Maxilla,with deciduousteeth,Dentes decidui; inferior view The numbers on the left give the mean time of eruption in months(M),the numberson the right the sequenceof eruption. The times oferuption vary considerably;somedifferencesexist betweenmale and female,and there are also differences betweenthe maxilla and the mandible

9-13J \

\\

9 - 1 2J \ 1 0 - 1 3J \

5-7 J -

Fig. lBB Maxilla,Maxilla,with permanentteeth,Dentes permanentes; inferior view. The numbers on the left give the mean time of eruption in years(l), the numbers on the right the sequenceof eruption. The times of eruption vary considerably

Head, Caput

N ophlhalmicuslV/1]-----

. ,'/

N maxillans[V/2]

/

Nn alveolaressupeflores

N trigeminus [V] Ganglion kigeminale 'N mandibularis lV/31

N lingualis /

N alveolaris inletiot /

Plexus dentalis inletiot /

the maxilla and the mandible have been partially removed; the mandibularcanalhas beenexposed; lateral view

Fig. 189 Maxillarynerve(V/2),N maxillaris;mandibular nerve(V/3),N. mandibularis;

Ganglion trigeminale

\

/

N infraorbitalis

/

/

Rr ganglionares [Radix sensorial

/

/

R alveolaris superiorantenor

/

Cavitastympani--

.-

_--

Sinusmaxillaris

N intraorbitalis

ChordatympaniN tympanicus/ Foramenstylomastoideum

,,,9, N vaguslXl' 1' ,' / N glossopharyngeusllXl ,/ N caroticusinternus/ A. carotisinterna/

' Rr.alveolares anteriores, superiores PlexusdentalissuPerior

t I I M pterygoideus medialis/

medii superiores Rr alveolares I R alveolaris superiormedius

' N. canalis pterygoidei Ganglion pterygopalatinum

Fig. 190 Rootsof the pterygopalatineganglion; sagittal section; the facial canal, the tympanic cavity and the pterygoid canal

Br alveolaressuperioresposteriores

the trigeminalSanglionhasbeenlifted havebeenexposed; superolaterally; lateralview.

Palate,Palatum

Dens incisivus(latelalis) \

(medialis) / Densincisivus

Denscaninus-- D e n sp r e m o l a r|i s- - -

-

Papilla incisiva

- Plicae palatinaetransversae

ll - -: Denspremolaris --Densmolarisl

Palatumdurum

Densmolarisll -

Densmolarislll Iserotinus]

- Raphe Palati

Palatum molle [Velum palatinuml

--Arcuspalatoglossus - Arcuspalalopharyngeus

Fig. 191 Hard and soft palate,Palatumdurum and molle; upper dentalarch,Arcus dentalissuperior; inferior view.

' orifices of the palatine glands,Glandulaepalatinae

-

Raphe palati /

Glandulae Palatinae

/ o A palatinamalor major N palatinus

-Hamulus plerygoideus \ \

malus FoamenPalatinum

-/

- - HamulusPterygoideus M uvulae N ---

pharyngls supenor' a M constrictor ParsbuccoPharYngea

---

ArcuspalatopharYngeus

>--

aM

Arcuspalatoglossus

-

RaphePterygomandibularis

- t M palatoglossus

/ Tonsilla Palatina

\

lsthmustaucium, Parsoralispharyngis

\

\

\

Fig. 192 Oral cavity,Cavitasoris; palatinemuscles'Mm' palati; the tongue has been pulled forward; most of the oral mucosa

buccinator

N lingualis

a M constrictorPharyngissuPerior, ParsglossoPharYngea

TonsillaPalatina

o M palatopharyngeus

palatine glands coveringthe palatehas been removedto show the andtheorientationofthemusclesofthesoftpalate;ventralview.

108

Head,caput -

LabiumsuperiusVestibulumons Maxilla -

Palatummolle [Velumpalatinuml

Tonsillapalatina / / - /

oorsum-linguae

Plica salpingopharyngea Arcus palatopharyngeus

.Labiuminlerius--

Parsoralispharyngis

Veslibulum/ ons

I Arcuspalatoglossus i I Tonsillalingualis;Cryptaetonsillares

Fig. 193 Oral cavity,Cavitasoris; pharynx,Pharynx; paramediansection;the tonguehasnot beencut but

extendsoverthe planeof the section; medialview. Epiglonis \

Plicaglossoepiglonica lateralis, Tonsillalingualis;Cryptaetonsillares\\

Plica glossoepiglotlica mediana /

Vallecula epiglottica /

Foramencaecumlinguae\

Fladixlinguae

/ M. palalopharyngeus

Sulcusterminalislinguae

- - Tonsillapalalina

Fossulaelonsillares,Cryptaetonsillares --

Dorcumlinguae,-Pars poslerior

(Plicatriangularis)

Arcuspalaloglossus

Papillae loliatae -

-\ Papillaefungiformes-\ Papillaeliliformes-

Dorsumlinguae, Parsanterior Margolinguae

\ Corpuslinguae Sulcusmedianuslinguae

Apexlinguae--

Fig. 194 Dorsum ofthe tongue,Dorsum linguae; root ofthe tongue,Radix linguae; palatine tonsils, Tonsillae palatinae; the right palatine tonsil has been sectioned; superior view (80%).

us[Xl

---

I I I I

N glossopharyngeus[X]

bitt6r sout salty sw€€l

N. lingualis

Innervationanddistributionofthe fourtypes Fig. 195 oftastein the dorsumofthe tongue,Dorsumlinguae.

Lingua rongue, 1 09 superior\ M longitudinalis

/. M transversuslinguae

linguae -Aponeurosis / Seplumlinguae

Tunicamucosalinguae - -

7 Foramencaecumlinguae

Radixlinguae

--

Carlilago ePiglotlica

//

/ Aditus laryngis

- Ventriculuslaryngis

M. mylohyoideus

M geniohyoideus

I / os hyoideum

\

cartilagothyroidea

Lingua;mandible,Mandibula; Fig. 196 Tongue, partsof the larynx,LarYnx; mediansection; lateralview M. verticalislinguae -

_--

superior M longitudinalis

linguae -M. transversus

\M. longitudinalis inlsrior Septumlinguae

lMm.genioglossi

Fig.197 Tongue,lingua; frontalsectionthroughthe centralpart of the tongue; ventralview. z Aponeurosislinguae Seplum --

/ M. transversuslinguae

linguae

Glandulalingualis -

-

Fig. 198 Tongue,lingua; frontal sectionthroughthe tip of the tongue; ventralview.

11ff

Head,caput

Dorsumlinguae,Parsanteriorr

/

Corpuslinguae\

!

Tunicamucosaoris-

\

Papillaefoliatae t Papillavallata , Dorsumlinguae,Parsposterior

7' /

\,

/Radixtinguae

/.t

/

-^

Mpalatoglossus

/

--

M. styloglossus

--

M stylopharyngeus

M. longitudinalis inlerior-' - -

M constrictorpharyngismedius

/-

M. genioglossus/ t M. geniohyoideus/

/

M. hyoglossus/

\

/

Os hyoideum,Comu majus

Os hyoideum,Corpus/

Membranathyrohyoidea/ \ M. thyrohyoideus

Fig. 199 Musclesof the tongue,Mm.linguae; the mandiblehas beensectioned: lateralview (80%).

M. hyoglossus

Tunicamucosaoris\

M. palatoglossus /

M. styloglossus / M stylopharyngeus M conslrictorpharyngissuperior, Parsglossopharyngea

Mandibulapharyngis medius, M. constriclor Parsceratopharyngea

M. longitudinalis inletiot -

g"nonyli-"rr//

i

\

M. genioglossus,

/ M. geniohyoideus/ / M chondroglossus/

Os hyoideum, Cornuminus/

I s/

Fig. 200 Musclesof the tongue,Mm. linguae; the mandible has been sectioned;the hyoglossusmuscle has been partially removed; lateral view (80%).

Musclesof the Tongue,Musculi linguae

Frenulumlinguae

Ap€xlinguae\

z Faciesinferiorlinguae,Plicafimbriata

-

Tunicamucosaons

Ssptumlinguae - M. genioglossus 7 M. palatoglossus

M. constriclorpharyngissuperior, Parsglossopharyngea M. chondroglossus / M. constrictorpharyngismedius, Parschondropharyngea / M. hyoglossus I

Mm.geniohyoidei

Fig. 201 Musclesof the tongue,Mm.linguae; muscleshavebeenremoved the genioglossus from the mandible: ventroinferiorview (80%). M. styloglossus I

Papillaefoliatae\ \l

Tunicamucosaoris \

r M. palatoglossus Tonsillapalatina

/ Proc.styloideus /

Apexlinguae-interior- M. longitudinalis 7- - -

Lie. stylohyoideum

M.stylopharyngeus M. genioglossus-

M. constrictorpharyngissuporior, Pars glossophatyrEoa

Mandibula -

M. constrictorpharyngism€dius, Pars chordr@haryng€a M. constrictorpharyngism€dius, ParsceratoPharyngea

/ M. geniohyoideus

Os hyoideum,Cornuminus

M€mbranathyrohyokjea-

Os hyoideum,Cornumaius

/

A.; v. laryngeasup€.ior; N. laryngeussup€not M. thyrohyoideus

Cartilagothyroidea,Laminasinistra/

M, constrictorpharyngisinf€rior' Parsthyrbpharynges Tub€rculumthyroidouminl€rius

Fig.2O2 Musclesof the tongue,Mm. linguae;musculature of the pharynx,Tunicamuscularispharyngis;larynx,Larynx; geniohyoid andthyrohyoidmuscleshavebeen the hyoglossus, sectioned; lateralview (60%).

It11

Head, Caput

Muscles of the tongue, Musculi linguae (Figs.196-200) Onedifferentiatesbetweeninternal (lvlrn.longitudinatressuperior and iuferior and M. tansversus linguae) and external (Ivt gonlogloseus, M. hltgbssus, M. drondmgllossus, M. atyioglossue and M. palatoglossus) muscleso1thetongue. Muscle Innervatlon

Origin

tnsertion

Function

L.M:'Iongltsdlnalts su&dff N. hytpogloss.ts [XI{] Closeto the Dorsum linguae

Apextinguae

Radix linguae

Retractsandbroadens the tongue

Radixlinguae

Retractsandbroadens the tongue

2. IW longiturllnrlls lnftrlor Apexlinguae /V.ltpogfossrrsEnl """ Closeto the,inftrlor guxface of the tongue 3. M. transWnsus[ngtiee N. hypoglossus ffi 4' M. gentoglossus ati N. hypoglossu,s ffil

Lateralmarginsof the tongue; Lateralmarginsof the tongue; Narrowsand elongatesthe Septumlinguae Aponeurosislinguae tongue Spinamentalismandibulae Aponeurosis linguae Protrudesanddepresses the rongue, movesthe tip of the tongue 5. M. hyoglosgs linguae t::ll1::::: CornumajusandCorpusossis Aponeurosis Depresses andretracts N. hypogkiisus hyoidei (lateralpart) [XIl "'ll the tongueandthe rootof the 6. M. chondroglossus Cornuminusossishyoidei Aponeurosis linguae tongue (lateralpart) N,hw&assws,FIII,: N. hypglossns[XI] ri:

.-

'l',,1

8. M. palatogl,ossus N. glossopharyngeus [fr], N. vags [XJ,and .,i, i{ accessOllirs,Rrdlix::::': crantalls[XIJ

(anterior Proc.styloideus margin)ofOstemporale, Lig.srylomandibulare and Lig.stylohyoideum

Entersthe lateralpartsof the tonguefrom dorsocranial

palatina Aponeurosis

Musclesof tongue,especially Elevates the rootof the transverse muscle tongue,depresses the soft palate,narrowsthe Isthmusfaucium

Retractsandelevates the tongue

Muscles of the palate (Figs.192,682) Th;:;ur.le";l* Muscle .::r::. Innervation

velipaladn! o.t;i are:lvl tensor ".li*.. .::,,,,

*ti:paaunifii ru.u

Origin

Insertion

pslefliif l. l{. levabitli plwrygeus [n, X] Plexr.r,s

palatina Parspetrosaossistemporalis Aponeurosis (inferiorsurface); Cartilagotubaeauditivae

2. M. tensor veli palatfud N. musanf tensoriswli patatiniof N. mandihilaris : :r::r::rr i'l:::ll::' tV/31 Surroundsthe Hamulus

Fossascaphoidea on the basisof the Laminamedialis of the Proc.pterygoideus; Spinaossissphenoidalis; Tubaauditiva(membranous part)

palatina Aponeurosis

3. M. uvulae' Plwtsphayryettsof ,.

Aponeurosis linguae

Stromaof the uwla

. Function Elevates andtensesthesoft palate;narrowsthe Isthmus faucium;dilatesthe auditory tube Tenses the softpalate; dilatesthe auditorytube

Shortensandthereby broadens the uvula

SuprahyoidMuscles,Mm. suprahyoidei,and Hyoid Bone, Os hyoideum

-

(Raphe mylohyoidea) --

Alveolusdenlalis m o l a r i sl l l (Dens extractus) Foramen mentale

- Tuberculum mentale

I Venteranteflor:M dioastricus { \Venterposterior -

---

M s t y l o h y o i d e -u-s- -

Lig stylohyoideum

M stylohyoideus

M drgastflcus.(Ansa lendinis) - -

Os hyoideum, Corpus

M digastricus,Tendo inlermedius

Cornumajus-Os hyoideum, Fig. 203

'

Mandible, Mandibula;

suprahyoid muscles, Mm. suprahyoidei;

l i n e o f o r i g l n o f t h e m y l o h y o i dm u s c l e

*

" arca of insertion of the anterior belly 0f the digastric muscle

ventroinferior view. Soinamentalis suoerior\

M g e n i o g l o s s u s- -

M m y l o h y o i d e u s- -

/ M geniohyoideus Os hvoideum.Cornua minora -

Foramen / z mandibulae

Os hyoideum, Cornumajus

Fig. 204 Mandible,Mandibula;suprahyoidmuscles, Mm suprahyoidei; hyoid bone,Os hyoideum;

I

os hyoideum Corpus

musclesand the mandiblehavebeensectioned; the genioglossal suDenorvlew

, Cornumrnus

Corpus- -

Fig. 205 Hyoid bone,Os hyoideum; ventrosuperiorview.

Hyoid bone,Os hyoideum; Fig. 206 dorsolateralview.

t.

,:i

T

.i{

-*""ri

Head,Caput

M zygomalicusmalor I I I masseter \ I I I I t. I I I I t I I I I rl

Glandulaparotidea, Pars superticialis

-

Glandrla parotid€a :loogssoria

-

Corpus adiposumbuccae

-

M. risorius

-

M. dopressorangulioris

M. masseler; Fasciarmssoteri€

Fasciaparotidoa Platysma M. sternodeido.nasloirsus: Fasciacawicalis, Laminasuperficialis

Fasciacowicalis, Laminasuporticialis Os hyoid€um

FIg.207 Paroddgland, Glandulaparotidea; lateralview (70%). Notethe accessorygland along the parotid duct

v.: A. tacialis

LargeSalivaryGlands,Glandulaesalivariaemaiores

submandibulares 7 Nodilymphoidei

A ;V facialiso o 1

\\ Glandulasubmandibularis

\

- - GlandulaParotidea N facialis[VlU,R. colli

a V. jugularisexterna

//

o M. dioastricus, VentdrPoslerior

/ /

N. hypoglossus[Xlll --

Platysmao

o M stylohyoideus o o N. laryngeussuperior; V; A. laryngeasuPenor

M. digastricus,Venteranterioro

- o o A.; v. thyroideasup€rior Fascia cervicalis, Lamina superficialis

\ o M. mylohyoideus

/

o M constrictorpharyngisinlerior

'o

o A submentalis

i' l

\

Nodilymphoideisubmandibulares

M thyrohyoideus

o M. omohyoideus, Ventersupenor

O M. sternohyoideus

gland,Glandulasubmandibularis; Fig. 208 Submandibular the platysmahasbeenremoved; view (80%). inferolateral

A;V submentalis'ol Platysmao ..

A . ;V l a c i a l i s o o l

i

o r, M. mylohyoideus

o M. Plerygoideus medialis / DuctusParotideus GlanoulaParotideaaccossona / rt a

M. massglor: Fasciamassetenca

- -

Glandulasublingualis\ M. digastricus,'- -Venteranterior

Glandula Parotidea

- -

NoduslymPhoideus submandibularls

- -

Fasciacervicalis, LaminasuPerficialis

-M genioglossuso

V retromandibularis

-V sublingualiso

M. digastricus' VenterPostenor

A lingualiso Ganglion submandibulare / M genionyoideuso / M mylohyoideus'

/) /

/

\

Ductussubmandibularis

-

Glandula submandibularis

submandibularis Glandula / M slyloglossusO N hypoglossus [Xlll

t'

I M hyoglossuso'

\o t,t .tytot'yoio"r.

Fasciacervicalis, LaminasuPerficialis

\ a M digastricus,Venteranterior

Large salivary Slands, Glandulae salivariae majores; Fig. 209 the mylohyoid muscle and the anterior belly of the digastric muscle have been sectioned; inferolateral view (80%).

Head, Caput

Ductussublinguales minores Carunculasublingualis \

--

M pterygoideusmedialis

Duclussublingualis maior * *--

N lingualis

M genioglossus- Glandula submandibularis

M geniohyoideus -

\ Ductussubmandibularis M digastricus,Venteranterior -

- Os hyoideum

Glandulasublingualis' M mytohyoideus

Fig. 210 Submandibulargland,Glandulasubmandibularis; sublingualgland,Glandulasublingualis; mediansectionthrough the mandibleand the hyoid bone;

medialview. Notethe closetopographicalrelationshipof the lingual nerve and the submandibularduct.

major / Ouctussublingualis Denscaninus - Carunculasublingualis - -

Oenspremolans | Densoremolaris ll - -

_ - Ductussubmandibularis

D e n s m o l a r i s -l -

- -

Gingiva

Densmolarisll - - - Glandula sublinoualis

Oensmolarislll lserotinusl--

- Glandula submandibularis \ M hyoglossus Radix linguae /

N

hypoglossus IXll]

Os hyoideum,Cornu majus

Fig. 211 Sublingualglan-d,Glandulasublingualis; supenorvlew. submandibulargland,Glandulasubmandibularis; Notethe closetopographicalrelationshipof the lingual nerve the genioglossus andthe hyoglossus muscleshavebeensectioned; and the submandibularduct. the tonguehasbeenremoved;

maiores sativariae LargeSalivaryGlands,Glandulae 1

T7

Lingua,Faciesinferior-- -

Densmolarislll [serotinus]

--

DensmolarisI

-Frenulumlinguae - Plicasublingualis Carunculasublingualis--

-

Denspremolarisll

-

DensPremolarisI

--

Denscaninus -

I oensincisivus I Oral cavity, Cavitasoris; orifice of the Fig.2l2 submandibularduct, Caruncula sublingualis; obliquesuperior view ( 170%).

Papilladuclusparolidei-

Ftg. 213 Orificeofthe parotidduct,Papillaductusparotidei; venhal view (300%). The orifice of the duct is locatedoppositeto the secondupper molar.

ll Densincisivus

Head, Caput

- Maxilla

-

Uvula palatina - -

N lingualis

M palatoglossus a -_-

M styloglossusa -Mm.pharyngis r --

1 M genioglossus

- - 1 A. prolundalinguae --

Mandibula

- r M mylohyoideus --

r M geniohyoideus

N hypoglossus[Xl|l M. hyoglossusr* /

\1 A sublingualis

/

M. constrictorpharyngismedius,I Parschondropharyngea

Fig. 214 Arteries and nerves of the tongue,Lingua; paramediansection;the pharynx has been exposedand the hyoglossusmuscle sectioned; medial view (80%).

/

N palatinus major A. Palatinamaior , o

Tonsillapalatina\ _ R tonsillaris N. glossopharyngeus IXl A. palatinaascendens, OFl tonsillaris N glossopharyngeus IXl, Rr linouales

Fig.215 Arteriesandnervesofthe palate,Palatum,and of the inferior surfaceof tongue,Radixlinguae; mediansection;the backofthe tonguehasbeenpulled forward;the mucousmembranehasbeenpartially removed; medialview (80%).

Baseof the Skull,

M. lrapezius,Tendo, M. recluscapitisposl€riorminor , I M. semispinahs capilis ,

occipiialisexlerna , Protuberantia

M. rectuscapilisposteriormajor , \

/

Canaliscondylaris

Condylusoccipitalis. M. obliquuscapitissuperior\

/

M. recluscapilislateralis\

petrooccipilalis Synchondrosis

/

Ap€x partaspelrosae

M. sternocleidomasloideus \

Canaliscaroticus

/ M spleniuscapilis \

Forameniugulete

M. longissimuscapitis \

//, lubaeaudilivae / Cdrtilago

M. digaslricus,\ Venterposlerior - j M. slyloglossus\

\

'/

Arliculalio / temporomandibularis, Caosulaarticularis

/

laleralis M. pterygoid€us

M stylohyoideus\ Articulatio- -\' I temDoromandibulais, \ Capsulaarliculatis

Li9. laterale

,-

Collummandibulae

--

M. stylopharyngeus -_ M lemporalis-M. zygomaticusmaiof Lig.pleryEospinale Proc.plerygoideus,-Laminalal€ralis lale'alis -' M. pferygoideus \r

-

M. masseler Lig.stylohyoid€um

--

M stylohyoideus

\-

M masseler.Parssuoerticialisz-

Lig.stylomardibulare

--

- -

M. masseter,Parsprolw:dlaz/

-

medialis M. Plerygoid€us

Angulusmandibulae

M. levator veli Dalatini

\ Hamulusplerygoideus

M. levator veli Dalatini / I

medialis/ M. pterygoideus

I I

\ Proc.pterygoideus, Laminamedialis

I

M. lensorveli Palatinil

\ M. longuscapilis

\-

\ Basismandibulae \ M. recluscaDilisanterior

M. genioglossus/ i

\ M. mylohyoideus l\

| M. geniohyoideus

\ M. digaslricus,V€nteranlerior

Baseof the skull, Basiscranii,with Fig. 216 muscularorigins;masticatorymuscles, Mm. masticatorii; the left half of the mandiblehasbeenremoved; inferior view (80%).

Head, Caput

/

lingualis Glandula

Ductussublingualis major /

Plica fimbriata

Caruncula sublingualis Ductussublingualis major \

/

Ouctussublingqales minores Plicasublingualis

Ductussubmandrbularis \ Septum linguae \

\

a M genioglossus

/

I

o M geniohYoideus

.

N ;A;V sublingualO i sO - _

/ Glandulasublingualis

A. tinguatis: O _' v, com[ansnervrnypogtossr a

oM stYloglossus

--

o M hyoglossus

N lingualis A M mylohyoideus Ganglionsubmandibulare Glandula submandibularis

--N hypoglossus [Xll] --

M mylohyoideus a ---Glandula submandibularis

1M slylohyoideus Oshyoideum

-

A ; V laryngea superior:O O / N. laryngeus superior

Venteranterior O M digaslricus,

Ventersuperior a M omohyoideus,

\ o M sternohyoideus

z Membranathyrohyoidea medianum Lig thyrohyoideum Cartilago thyroidea -

a M thyrohyoideus pharyngis inferior a M constnctor

(Lobus pyramrdalis,Var 1 -"

M cricothyroideus1 -/

\

Glandula thyroidea, / Lobus dexter

Cartilago cricoidea /

Fig.2l7 Vesselsandnervesofthe tongue,Lingua; largesalivaryglands,Glandulaesalivariaemajores; larynx, Larynx;thyroid gland,Glandulathyroidea; the suprahyoidmuscleshavebeensectioned;the infrahyoidmuscleshavebeenpartially removed; ventroinferiorview ( 140%).

C M sternothyroideus

/

Plica fimbriata

M genioglossus / a

sublingualis / Glandula A sublingualtsa -

z o o A: V sublingualis

OA Profundalinguae

/

N lingualis

/

o Y P r o f u n d al i n g u a e

---

M h y o g l o s s uas - - - - -

aM

_--

styloglossus

N hypoglossus [Xll] A sublingualisO

A l i n g u a l ias) - -

a M hyoglossus ----

M h y o g l o s s uas - - -

oA carotisexterna suPerior' N laryngeus R internus

superiorI -A lhyrordea

A carotis exlerna O

/

----

/a

-

carotidis a Bifurcatlo

OAlaryngeasuPerior

M geniohyoideus a \

oA thyroideasuPerior

Os hyoideum \ oA carotiscommunis

Membrana thyrohyoidea

Glandula thyroidea, Lobus dexter

/

\

\

/ A thyroideasuPerior,I R. glandularisanterior -M cricothyroideusI

/

Cartilagothyroidea

Glandula thyroadea' Lobus sinister

Lig cncothYroideummedianum

\ lsthmus glandulaethyroideae

I i

I racnea '

Fig.218 Vesselsandnervesofthe tongue'Lingua; larynx, Larynx;thyroid gland,Glandulathyroidea; the suprahyoidmuscleshavebeensectioned; the infrahyoidmuscleshavebeenremoved; ventroinferiorview (140%).

I22

Head,caput

Falx cerebri

R. lateralis . r N. supraorbitalis, /

Sinuslrontialis '

oA. suPraorbitalis

.

Duramatercranialis '

. o N'suPraorbitalis

hz'

t

- o M. obliquussuperior

M.temporalisO-_

superioris; - - - - o M:'.,3i?JT$3i3l"" O A. lacrimalis

Cellulaeethmoidales -__

Glandula lacrimalis ,l N.opticus rul: retinae O O V;4. cenlralis

Septumnasi--_ ---

Conchanasalis-infgrior

t\

A. transversatacieio

c M.rectuslaleralis a M.r€ctusmedialis Corpusadiposumorbitae a M. reclusinfgrior

.aN.infraorbitalis .

R. buccalis(Vll)

\

Densmolarisll ---

a M. massgter

\ Sinusmaxillaris

A.; V.facialis1 o ---

\ Ductusparotideus

' Ductussubmandibulans- Glandulasublingualis--

\

a M buccinator

\

Lingua

V.;A,; N. alveolarisinferiorI j s /

PlatysmaO / / M. mylohyoideus a

/

/

M. digastricus,Venleranleriora

\

\1aA.;

a M. genioglossus r1 M. geniohyoideus

Fig. 219 Oral cavity,Cavitasoris; maxillary sinus,Sinus maxillaris;orbit, Orbita;cranialcavity,Cavitascranii;, frontal sectionthroughthe headof a 48-yearoldmaleat the levelof the seconduppermolar;the oral cavity,the maxillary sinusand the cranialcavityhavebeenexposed; ventralview. Notethe sizeof the maxillarv sinus.

Vlingualis

Frontal Sectionof the Head

SinussaoitlalissuDerior,

\

Galeaaponeurotica ,\ l t\

\

\\

alx cerebri -

M. levator palpebrae a suPerioris

- o M. rectusmedialis SePtumnasi

-M r e c l u s u p e r i o r a- - - - - - - - - - - - - -Suturafrontozygomatica M obliquus superiu1 -'

- - -

, concha nasalisinferior

l' i,---

D e n sm o l a r ilsl

___-

Lingua Corpusadiposumbuccae Ductussubmandibularis

N intraorbitalis /

// sublingualis Glandula

A facialisa -

inferior O a N ;A ; V alveolaris

--_

A. lingualisa-

SK \\ a

M genioglossus '

z' M. geniohyoiders a

mytorryoideus;i

\

platysma

I M digastricus,Venteranterior

"

Fig.22O Oral cavity,Cavitasoris; orbit, Orbita; cranialcavity,Cavitascranii; frontal sectionthroughthe headof a neonateat the levelof the seconduppermolar;the oral cavityand the cranialcavityhavebeenexPosed; ventralview. Notethe absenceof the maxillary sinusand the close topographicalrelationshipof the developingteethand to Fig.219. the orbit.ComPare

Neck,Collum

_-

Incrsura thyroidea supeflor

Cornusuperius

- - Tuberculum thyroideum super|us

z Cornusuperius

Lamina - _ dextra

/

- Prominentia laryngea

- -

/ Lineaobliqua-

-

D

lncisural thyroidea inferior

Fig.22l Thyroidcartilage,Cartilagothyroidea; lateral view.

/ Tuberculum thyroideum supeflus Lamina sinistra Tuberculum lhyroideum rnrenus Cornuinferius

Fig.222 Thyroidcartilage,Cartilagothyroidea; ventral view.

Facies articulares aMenoideae ,

/

/

Cartilago epiglonica

I

Facies articutaris tnyroioeal Laminacartilaginisi

f:?:

cricoideae

Fig.223 Cricoidcartilage, Cartilagocricoidea; ventrosuperiorview.

Colliculus I Foveatriangularis j , Cristaarcuata:_ \

Fig.224

Fig.225 Epiglotticcartilage, Cartilagoepiglottica; dorsal view.

Cricoidcartilage,

Cartilago cricoidea; dorsal view.

I Cartilagocorniculata | , Cartltagoarytenoidsa 1)^i I proc.m

/, Cartilagocorniculata

/, Cartilago corniculaia

/

Proc muscularis

Fovea - oblonga Ptoc / muscularis

/

Lig. vocale

Facies-articularis lhyroidea Arcus cartilaginis cricoideae'

/ Cartilago arytenoidea; Articulatio cricoaMenoidea

I Facies' I

articularis thyroidea

Fig.226 Cricoidcartilage, Cartilago cricoidea;arytenoidcartilage,Cartilago arytenoidea;corniculatecartilage, Cartilagocorniculata; ventrosuperiorview.

'

Lamina cartilaginis cricoideae

Fig.227 Cricoidcartilage,Cartilago cricoidea;arytenoidcartilage,Cartilago arytenoidea;corniculatecartilage, Cartilagocorniculata; dorsalview.

I Arcusl cartilaginis cncoroeae

I

Facies arlicularis thyroidea

Fig.22B Cricoidcartilage,Cartilago cricoidea;arytenoidcartilage,Cartilago arytenoidea;corniculatecartilage, Cartilagocorniculata; lateralview.

Larynx - Os hyoideum, Cornumajus -_ Os hyoideum, Os.r Cornumrnus h y o. r. d e u m , Corpus Lig thyrohyo-

Cartilago eprglonrca

I

t

t

ideum laterale t

Membrana thyrohyoidea

Lt9 thyrohyoideum medranum

c"rtilago tflticea Cartilago thyroidea, Cornu supenus

Cartilago epiglottica

Lig thyro-hyordeum medranum

Petiolus-epiglottidrs corpu, preadiposum epiglottrcum Lig thyro- /

pharyngeum

epiglotlicum Cartilagothyroidea -

- Cartilago arylenotoea, Proc.vocalis

Ligg vocalra thyroidea, Cornu inferius

Lig --.cricothyroideum meoranum

\

Capsula articularis cricothyroidea

/ Lig cricothyroideum medlanum

--

/ Arcus cartilaginrs cricoideae

Arcuscartilaginis cncoideae Lig cricotracheale /

Conuselaslicus-

)-

- Cartitaglnestracheales

Fig.229 Larynx,Larynx;hyoid bone,Os hyoideum; trachea,Trachea; ventralview. The adiposetissueof the larynx fills the spacebetween the thyrohyoidmembraneand the epiglottis. * f o r a m e nf o r t h e s u l ) t ' r t o rl a r l n g t r a la r t c r ) a n ( l \ e i n a n d t h e i n t e r n a l l ) r a n c ho f t h e s u l x ' r i o rl a r , v n g ( t anle r v e

\ Facres articularis thyroidea

Cartilaginestracheales

Fig. 230 Larynx,Larynx;hyoid bone,Os hyoideum; the upper part of the larynx and the hyoid bonehavebeensectioned in the medianplane;both arytenoidcartilages,the cricoidcartilage and the upper trachealcartilageshavebeenpreserved; lateral view. *foramenforthesuperiorlar-vngealarter}andveinandtheintelna|l)Ianchofthe superior larYngealnerve

epiglotlrca / / Cartilago

Corpus \ _ Os hyoideum, _ Lig hyoepiglotticum -\

- - Membrana thyrohYoidea

Bursa infrahyordea -

-

Cartilagothyroidea,Cornu superius

thyroidea,Lamina dextra - - Carltlago

m e d r a n u m- - - Lig thyrohyoideum Corpus adiposum preepiglotticum

--

/ Lrg thyroepiglotticum,Petiolusepiglottidis

--

Lig cricopharyngeum

--

-

Cartilagoarytenoldea

Lig vestibulare Lig vocale /

Li9 cricopharyngeum Lig cflcothyrordeummedianum

-

- - - Lamina cartilaginiscricoideae

- - .Tunicamucosa Pharvnx,

Ligg anularra /

Lamina cartilaginis cricoideae

----

Trachea. Paries membranaceus

Fig.231 Larynx,Larynx;hyoidbone,Oshyoideum; mediansection;lateralview (r.). Ihe probe is situated between the epiglottis and the laryngeal adipose tissue.

Neck,Collum

Laminacartilaginiscricoideae Lig.cricoarytenoideum \

\

---fA Cartilagothyroidea,Cornusuperius

/ Cartilagocorniculala \

-

- -Conuselaslicus

Conuselasticus

Lig.vocale

Arcuscartilaginisc ricoideae' / Cartilagothyroidea

Incisurathyroideasuperior

Fig. 232 Laryngealcartilages,Cartilagineslaryngis; vocalligament,Lig.vocale;elasticcone,Conuselasticus; ventrosuperiorview.

Os hyoideum, Cornuminus; z Os hyoideum,Cornumaius

Cadilago epiglonica \ \

//

lalerale Lig thyrohyoideum

Carlilagolriticea\\ Membrana thyrohyoidea

- Corpusadiposumpreepiglotticum ----

Cornusuperius Cartilago thyroidea,

Cartilagocorniculata

Cariilagothyroidea,Laminasinistra- - -Cartilagoarytenoidea

- - -- Capsulaarticulariscticoarytenoidea

Lg. cncoarlenoroeum

- -

-' capsulaarticulariscricolhyroidea

- -

'

Cartilagothyroidea,Cornuinterius

Capsulaarticulariscricoihyroidea

Lig.cricopharyngeum

Ligg.anularia

Fig. 233 Laryngealcartilages,Cartilagineslaryngis; Iaryngealjoints,Articulationeslaryngis;hyoidbone, Oshyoideum;trachea,Trachea; larynx of an adolescent; dorsalview. In the adult the laryngealcartilagesoftencalcifyor ossify'

- - Cornuminus Os hyoideum, ------

Corpus Os hyoideum,

Membranathyrohyoidea

Os hyoideum,Cornumajus laterale Lig.thyrohyoideum Cartilagotriticea

Cartilagothyroidea,Cornusuperius

medianum , thyrohyoideum

Cartilagothyroidea,Laminasinistra Incisurathyroideasuperior Lineaobliqua

Lig cricothyroideum

Cartilagothyroidea,Cornuinferius Capsulaarticulariscricothyroidea

-' Arcuscartilaginiscricoideae Parsrecta M cricothyroideus,

/

r'

,'I tracheales Cartilagines //

Parsobliqua M. cricothyroideus,

Fig.234 Larynx,Larynx;hyoidbone,Oshyoideum; cricothyroidmuscle,M. cricothyroideus; ventrolateralview. *

foramen for the superior laryngeal artery and vein and the internal branch of the superior laryngeal nerve '* axis of Articulatio cricothyroidea

Cornumalus Os hyoideum,

Epiglonis

-------

--

Cartilagothyroidea,Cornusuperius

- Tuberculumcuneiforme - Cartilagocorniculata

Membranathyrohyoidea Corpusadiposumpreepiglonicum obliquus, M. arytenoideus Parsaryepiglonica

Cartilagoarytenoidea M aMenoideusobliquus transversus M arytenoideus M cricoaMenoideusposterior Faciesarticularisthyroidea

--- - -

lateralis M cricoaMenoideus Parsrecta l ' M cricothvroideus Parsobliqua ) Cartilagotrachealis

- Trachea,Pariesmembranaceus

Fig. 235 Laryngealmuscles,Mm.laryngis; partsof the right thyroidcartilageandof the riSht greater horn (Cornumajus)of the Oshyoideumare sectioned; dorsolateralview. ' foramenfor the superiorlaryngealartery and vein and the internal branchof the superiorlaryngealnerve

Neck, Collum

---

Os hyoideum, Cornumajus

- - Cartilagotriticea ---

Cartilago thyroidea, Cornusuperius

-M a$enoideus obliquus, Parsaryepiglonica

- Cartilago cuneiformis

- ---

---

M aMenoideusobliquus

M aMenoideus transversus

---

Capsulaarticulariscricothyroidea- - Carlilago cricoidea, Lamina - - -

Carlilago corniculata CartilagoaMenddea

Carlilago thyroidea,Cornu inferius

- - - M. cricoaMenoideusposterior

Carlilago trachealis Trachea, Paries membranaceus --

Fig. 236 Laryngealmuscles,Mm. laryngis; The mucosaon the epiglottisand on the larynx can still be seen; dorsal view. ' tbramen lbr the superior laryngeal artery and vein and the internal branch of the superior laryngeal nerve

Os hyoideum, Cornuminus - _ Os hyoideum, Cornumajus Epiglonis Cartilaoo lrilicea -

Tuberculumcuneitorme --]

thyroidea, Cornusuperius _-- Cartilago - - - Catlilagocuneilormis

-Tuberculumepiglotticum

M. aMenoideustransversus- Ventriculus laryngis--- M aMenoideus obliquus-

---------. --.--

posterior M cricoarytenoideus

Cartilagothyroidea,Laminasinistra -

-

i

Plica vocalis M vocalis M cricothyroideus M cricoaMenoideus lateralis

-

Cartlago thyroidea, Lamina dextra

Cartilagotrachealis

Fig.237 Larynx,Larynx; the dorsalwall hasbeensplit in the medianplane,the two halves areretractedlaterallyby two'hooks;on the right sidethe mucous membranehasbeenremoved: dorsalview. * foramen for the superior laryngeal artery and vein and the internal branch of the superior laryngeal nerue

Larynx

Musclesof the larynx (Figs.234-237) partsofthe larynxto eachother. Themusclesof,thelarynxconnectthe cartilaginous Muscle Innervation

Origin

Insertion

1, M. cricothyroideus N. larpgeus superiorof N.vags [X] . Parsrecta {sUpqIficial) :rr,,r Parsobliqttar{AQi*)::,,

Arcusof Cartilagocricoidea (outersurface)

the vocalcordsby Laminaof CartilagothYroidea Tenses cricoidea (caudalmarginto the anterior movingthe Cartilago axis to its transverse according borderof the inferiorhorn)

N. laryngeus recuirensof N. vagu.s[X] 3. M. cricoarytenoideus lateralis . ..,,:,,.:r,,r: N. laryngew rectrrensof N. vagus[X] ,4. M. arytenoiitdiig,::';' hansversus recurreruof N. Iaryngeu,s N. vagu.s[X] 5. M. arytenoideus obllguus ',,,,,,,,:,,, ,, N. laryngeusre:$rbns of N. vagus[X] .

:; l: :: i,:::::: ].: '

]

6. M. vocalis recuryens of N. laryngeus N. vagus[X] ,,,:t:),,

Laminaof Cartilagocricoidea Proc.muscularisand dorsalsurfaceof Cartilago (dorsalsurface) arytenoidea

Opensthe RimaglottidisbY turningCartilagoarYtenoidea outwardsalongits longitudinal axisand movingit laterally Closesthe Rimaglottidis(Pars bYturning intermembranacea) inthe Cartilagoarytenoidea wardsalongits longitudinalaxis

Arcusof Cartilagocricoidea (lateralmarginof upperpart)

Proc.muscularisof Cartilago arytenoidea

Cartilagoarytenoidea (lateraledgeanddorsal surface)

Closesthe Rimaglottidis of the Cartilagoarytenoidea bY oppositeside(lateraledgeand (Parsintercartilaginea) the two approaching dorsalsurface) arYtenoideae Cartilagines Rimaglottidis the Narrows the Proc.muscularisof bY (Parsintercartilaginea) side(aPexand opposite the two approaching dorsalsurface) arytenoideae Cartilagines Pars aryepiglottica: CartilagoepiSlottica (lateralborder) Tensesthe vocalfoldsand Proc.vocalisandFovea formsthe edgeof the vocal oblongaof Cartilago cord arytenoidea

(basis arytenoidea Cartilago of dorsalsurface) Parsaryepiglottica: Cartilagoarytenoidea (apex) Cartilagothyroidea (dorsalsurfaceof Incisura)

Continuation -+ p 131

a M. cricothyroideus

b Mm. arytenoideiobliquusandtransversus

c M. cricoarytenoideuslateralis

d M. cricoarytenoideus Posterior

Figs. 238 a-d Diagram showing the function of the laryngeal muscles,Mm. laryngis; the direction of movementis indicated by arrows; the yellow arrows indicate tension of the vocal cord;

bluearrows ofthe muscles; the redarrowsshowcontraction indicaterotation.On the left sidethe musclesare relaxed,on the right they are contracted;superiorview.

Neck,Collum

Lig hyoepigbnicum \

-z

preepisronicum corpus adiposum .r*}s

Radix linguae //

Cartilago epiglotlica

Os hyoideumlaryngis / Vestibulum

Bursaintrahyoidea-Lig thyrohyoideum medianum--

,, Tuberculumcuneiforme;Canilagocuneiformis Cartilagocorniculata / Tuberculumcorniculatum;

Lig thyro€piglotlicum -Canilago thyroidea - -

M. arylenoideus lransversus

--

Plica vestibularis -

Ventriculuslaryngis$ Plica vocalis /

a

-

Lamina carlilaginis cricoideae

Conuselasticus;Cavitasinfraglonica

Lig cricothyroideum medianum/ \ Tunicamucosa

Arcus cariilaginis cncoideae /

- Trachea. Paries membranaceus Cartilagines tracheales -' \

lslhmusglandulaethyroideae--

Fig.239 Larynx,Larynx; mediansection; medialview(r.,90%).

--

(Spatium o€sophagot;acheale) Trachea

'

clinical: Macula flava, becauseof the yellowishelastic tissue underneath the mucosa

"

clinical: MoRGAcNT's ventricle

Radixtinguae..

Radix linguae :-

-$.\

c"p.$-""f,1ff.:H -- *NN\ preepiglotticum \ Os hyoideum-

Corpusadiposum preepiglotlicum Lig. lhyrohyoideummedianum

Os hyoideum-

/ Tuberculumcunsilorme; Cartilagocuneiformis --

hyoepigbnicum

-

Carlilago epiglottica

- - Tuberculumcun€ilorme: Cartilagocuneitormis \ Tuberculum

Tuberculum comiculatum: Cariilagocorniculata

Lig.thyroepiglotticum

M. aMenoideus transversus

Cartilagothyroidea' -

Lamina cartilaginis cricoideae

Fig.240 larynx,Iarynx; mediansection;the positionof the epiglotticcartilage is shownduring respiration; medialview (r., 80%).

Flg.24l Larynx,Larynx; mediansection;the positionof the epiglotticcartilage when swallowing;due to the elevationof the whole larynx the epiglottic cartilage is passivelypushedposteriorly by the prffipiglottic adiposetissue,CorpusadiposumpreepiSlotticum; medialview (r., 80%).

Larynx

7 Papillaevallatae

Rr linguales

7 Tunica mucosa ltnguae N glossopharyngeus[lX]

\

/

N glossopharyngeus [lX]

f

A palatinaascendens,R tonsillarisa \\

Rr tonsillares

TonsillaPalatina

---

Cornumaius\\ Os hyoideum, - - -

Epiglottis

N l a r y n g e u s s u P e r i -o-r- _ Fa

Vallecula ePiglottica

A l a r y n g e as u p e r i o r o - - - - l - -

- - -

Cartilagothyroidea,Cornu supenus

Rr interni suPerior, N laryngeus

----

a M aMenoideusobliquus

Cartilagothyroidea.Lamrnasinistra

N laryngeusrecurrens

Cartilagothyroidea,Cornu inferius

i

M cricoaMenoideus Posterior

Glandula thYroidea A laryngeainferioro

--

Rr trachealesa

- -

--

Trachea N laryngeusrecurrens'Rr oesophageales

of the Fig.242 Arteriesand nervesof the larynx, Larynx,and linguae: Radix root of the tongue,

Glandula parathyroideasuperior

Glandula parathyroideainleriol

O A thyroideainlerior

recurrens N laryngeus tongue has the mucous membranecovering the root of the partially removed; dorsalview (140%).

been

Musclesof the larYnx (Continuation) Muscle Innervation

Origin

7. M. thyroarYtenoideus N. Iaryngeusrecurrensof N. vagus[X]

Laminaof cartilagothYroidea (inner surfacecloseto the origin of M. vocalis)

ParsthyroePiglottica _ N. Iaryngeusrecurrensof N. vagusftl

Insertion

Function

Narrowsthe Rima glottidis Proc.muscularis(anterior bY surface),Cartilagoarytenoidea (Parsintermembranacea) movingthe Cartilagines (anteriorsurface) inwardsalong arytenoideae their longitudinalaxis

Laminaof cartilagothYroidea CartilagoePiSlottica (lateralmargin) (inner surfacecloseto the origin of M. thYroarytenoideus)

Narrows the larYngeal entrance

Neck, Collum

Sacculuslaryngis\

Glandulae laryngeales \ / Plica vocalis

,&\\ M lhyroarytenoideus - z Rima glottidis

N laryngeus superior, R internus

M vocalis

--

superior OA laryngea --

Cartilago --lhyroidea, Lamina sinislra

Cartilagoarytenoidea

.:x

a Vv laryngeae superiores

\ '---/: Becessus pirilormis

-- -

'{'

a M constrictorpharyngis meotus "

=--

:-.-M.constrictorpharyngis inlerior

-W

?-^ -I

---.- --r-__

Mm pharyngis {Tunicamuscularispharyngisl

_...-..1---.-F

. ,,"""#i3,3?l"oti'8,i'

Fig.243 Larynx,Larynx; crosssectionthroughthe vestibularfolds; superiorview(2007o).

Cavitas pharyngis

't) Plexus pharyngeus venosus The white arrow showsthe connectionbetweenthe laryngeal ventricleand the laryngealsaccule. * c l i n i c a l :M o R c A c N r 'vse n t r i c l e

/Rrmaglonidis, /' ParsInlermembranacea Lig vocale \ M vocahs

7

/ ,l M thyroarytenoideus

N laryngeus superior \ A laryngeasuperiorO -

a

E

Vv laryngeaesuperioreso --l Cartilagothyroidea,Laminasinistra

- / Carlilagoarytenoidea

- Articulatiocricoarytenoidea

i

\. Recessuspirilormis c

qoo6Jc

'

Tunicamucosa

s M. cricoarytenoideus Frosterior

/ 'Lamina Tunica mucosal

carlilagi cflcoroeae

Fig.244 Larynx,Larynx; crosssectionthroughthe vocalfolds; superiorview(200%).

\ . M- constrictorpharyngisrnterior

Larynx

Figs. 245a, b Laryngoscopy. a indirectlaryngoscopy. The tongue has been pulled forward to create sufficient spacefor the laryngoscope, in order to see the vocal folds. b direct, endoscopical laryngoscopy.

Rima glottidis Plica vestibularis

Fig.246 Directlaryngoscopy; positionof the vocalfolds duringrespiration.

Carlilago arytenoidea; - Cartilagocorniculata Recessus pirilormis - -

lncisura interaMenoidea

Rima glotlidis Plica veslibularis

lncisura interaMenoidea

Fig.247 Directlaryngoscopy; positionof the vocalfoldsduring phonation.

Epiglottis

Fig. 248 Directlaryngoscopy; positionof the vocalfoldsduring whispering(the intercartilaginous part of the Rimaglottidisis open). Notethe bulgingforwardof the vestibularfold.

Plica vocalis Rima glotiidis, Pars inlercartilaginea

Rimagbnidis, Parsintermembranacea Plicavestibularis

Neck,Collum

Cornuminus

/

Os hyoideum,Corpus Bursaeinfrahyoideae-_

Cornumajus - /

- /

Cartilaoo triticea-

_-

Liq. thyrghyoideum medianum

-

Glandula thyroidea; (Lobus pyramidalis' Var )

Membrana thyrohyoidea Membrana-lhyrohyoidea

Cartilago- thyroidea, Cornusuperius ' - Prominenlia laryngea

Cartilagothyroidea, Laminadextra

Cartilago thyroidea, Laminadextra

Lig.cricothyroideum - - medianum M cricothyroideus, \ P'arsrecta

medianum Glandula - thvroidea. LobuSdexter

Glandula\ thyroidea, Lobusdexter

/

- Glandula thyroidea, Lobu:;sinister

/ M cricothyroideus, Parsobliqua

/

/ M cricothyroideus, Parsrecta

- Trachea

Fig.249 Hyoidbone,Oshyoideum; larynx,Larynx; thyroidgland,Glandulathyroidea;trachea,Trachea; ventralview (80%).

Fig.250 Hyoid bone,Os hyoideum;larynx, Larynx; thyroid gland, Glandulathyroidea;trachea,Trachea; ventralview (80%). * A conical pyramidal lobe (Lobus pyramidalis)can reach the Lig. thyrohyoideum medianum It is consideredto be a developmental variant

Cartilago epiglottica \

- - -Os hyoideum\ Membranathyrohyoidea\

\!

\.

\\

- Membranaquadrangularis

;

- - Vestibulum laryngis

obliquus,Parsaryepiglottica / - M. arytenoideus Sacculuslaryngis

_z

_- M thyrohyoideus Fasciacervicalis.Laminaoretrachealis-Lig.vestibulare- -

Plica vestibularis

-- -

Rimavestibuli- Ventriculuslaryngis- -

Plica vocalis

- -

M constrictorpharyngisinferior, Parsthyropharyngea

Cartilagothyroidea,Laminasinistra*-

Lig vocals --

A; V.thyroideasuperior--

M sternothyroideus

--

lateralis M cricoarvtenoideus

Rimaglonidis '

- M vocalis

Cavitasinfraglottica--7

\ M cricothyroideus

Cartilago cricoidea --

- Conuselastrcus

Lig cricotracheale --

-

CartilagotrachealisLigg anularia -'

- - -

Glandula lhyroidea

Trachea

Glandula oarathvroideainferior

Fig.251 Larynx,Larynx;thyroidgland,Glandulathyroidea; frontal sectionthroughthe centreof the larynx; dorsalview (120%1.

Thvroid Gtand, Glandula thYroidea

lsthmus glandulaethyroideae Lamina superficialis / Fascia cervicalis, / sPlatysma \,/

rmpara \ Plexusthyroideus Laminapretrachealis Fasciacerulcalis, \

/

I

Glandula thyroidea,Capsula fibrosa \

- | V. jugularisanterior tr M sternohyoideus _---- tM sternothyroideus

Tunica mucosa tlacheae; \ Cartilago trachealis \ \ Glandula thvroidea, \ Lobus sinister

--

o M sternocleidomasloideus

t\

--

fachea

R cardiacusceruicalis \ \ superior

--

Oesophagus

Ansa cervicalis,

(Rr musculares)

\

N laryngeusrecurrens

internaa V jugularis -N vagus[Xl A carotiscommunlsO .- cervico' Ganolion thoracicu-m [stellatuml M longuscolli s - -. M scalenusanterior.; - M scalenusmedius"-1- *

--

\\ '{ a

i!

Laminaprevertebralis Fasciacervicalis,

i I VertebracervicalisVll

! 'a

t A trryluruEdrrrr'rl

membranaceus A. thvroidea inferior; Glaniiula parathyroidea inlerior

Thyroidgland,Glandulathyroidea; Fig.252 transversesection through the viscera of the neck at the level of the secondtrachealcartilage;

inferior view (90%). * clinical: retro-oesophageal space,Spatium retrooesopha8eum

A carolis communls

I

A carotisl communls

i M tonous - colli

it

u"n"or"' Vll ceruicalis

Figs. 253a, b Thyroidgland,Glandulathyroidea' a transversesonographicsection;the wavesrun from ventralto dorsal; inferior view (r., 200%). ' shadow of the trachea

lV jugularisinterna oA carotiscommunis

/ M longuscolli

thyroidea, , Glandula Lobusdexter i lsthmusglandulaer I thyroideaei I l1

v tnY'o'do"al

I A thyroidea

'l

b transversesonographicsection;the wavesrun from ventral to dorsal;inferiorview (r.' 200%)' Thedireciionof the bloodflow is indicatedby different colours(red:towardsthe receiver,artery;blue:awayfrom sonography' the receiver,vein);colour-coded ' shadow of the trachea

Neck.Cotlum

Concha nasahsInferior Synchondrosispetrooccipitalis\-

Tonsillapharyngea \

\

,Clivus

\

I

pharyngeum Tuberculum / Os occiprtale, nasalis supenor / Concha

'#wF,n

M levator -veli palalini

-/

-

Pr^.

| _tf '-

'c

- - Foramen

stylomastoideum

---Al

-.-J,.Recessus pnaryngeus

mrel^i.la'

Cellutae mastoideae

---Ptoc

stylordeus

\ - -rli - - M digastricus,--Venter posterior

C o n c h an a s a l i s

media

"7 - - - - ostiumpharyngeum I tubae auditivae 'I

Glandula parotidea Noduli lymphoideipharyngeales

--

-

-Torus levatorius Halalum molle [Velum palatrnum]

,, )r

-Arcuspalalopharyngeus Uvula palatina

-

t\

\

-

Glandula submandibularis

/

\

\

/ Lingua, Paprllaev allatae Radix linguae: Papillaevallatae

/

\

\Os -

Eprqronrs / Plica aryepiglottrca

/

t

/ /

Tuberculumcunerlor^e, Cartilago cuneiformis

\

/ \

/

/ Tuberculum corniculatum; Cartilago corniculata

Glandulae parathyroideaeinleriores

-

Fig.254 Pharynx,Pharynx; frontal section through the mastoid processes;

Plica salpingopharyngea

Glandulae pharyngeales

Septumnasi

\Tonsilla

(Plica pharyngoepiglottica)

M pterygoideusmedialis Lig stylomandibulare

palatina,Fossulaetonsrllares

hyoideum.Cornu majus

Cartilagothyroidea,Cornu superius

Recessus pinformis Plica nerui laryngeisuperioris Incisurainterarytenoidea

\; V thyroideainferior

the pharynx has beenexposedby a longitudinalmediansection; dorsalview (80%).

Musclesof the pharynx (Figs.255,256,258) Themusclesof the pharynxcanbe dividedinto constrictor (Mm.constrictores pharyngissuperior,mediusand:inferior) andlevator (M.stylopharyngeus, M. salpingopharyngeus, andM. palatopharyngeus) muscles. Muscle

Origin

Insertion

Function

Membranapharyngobasilaris, Raphepharyngis(from Tuberculumpharyngeumof Os occipitaleto the Angulus mandibulae)

Constrictthe pharynx from dorsally.In srvallowingtogetherwith the soft palateit closesthe Epipharynxfrom the Mesopharynx. Contractionsin u'aveform help to transportthe foodto the oesophagus.

Innervation

Constrictor musclesof the pharynx pharyngis Parspterygopharyngea: 1. M. constrictor superior Rr.pharyngealesof N. glossopharyngeus [IX]

Laminamedialisof Proc pterygoideus(dorsalmargin), Hamulus ossis ptefygoidei Pars buccopharyngea: Raphe pterygomandibularis, M. buccinator Pars mylopharyngea: Linea mylohyoideaof the mandible Pars glossopharyngea: M. transversuslinguae

Pharynx

-..Arcuszygomaticus M tensor veli palatini -M levatorveli palatini - -

tf'

//

extelnus; / Porusacusticus externus Mealusacusticus , / Fasciapharyngobasilaris

malor M l e v a t o r- - - labii superions alaeque nasi M levator labii superioris

/ - z M. stvlohyoideus

--

- - Condylus occipitalis - - Proc mastoideus

Proc pterygoideus, Laminalateralis M zygomaticusminor M levator anguli oris

-

--

M. digastricus, Venterposterior - Proc styloideus -. Hamuluspterygoideus - Lig stylohyoideum .- Raphepterygomandibularis

--1

- Ductusparotideus; M buccinator M orbicularis oris,- Parslabialis

-----

M depressor angulioris ---

styloglossus ". stylopharyngers M. VenterPosterior M digastricus,

M h y o g l o s s u s- M mentalis Platysma

-

Venteranterior M digastricus, M mylohyoideus

- .Cornumaius Os hyoideum, - superior; A.;v. laryngea N. laryngeus superior

/

/ M sternohyoideus

-

./

/ M omohyoideus

/

- M constrictorpharyngisinferior, Parsthyropharyngea

/ M thyrohyoideus Cartilago thyroidea, Lamina sinistra

Membrana thyrohyoidea

.- M constrictorpharyngisinlerior, Parscricopharyngea

-

M cricothyroideus, Pars recla

- - Oesophagus

-

Cartilago lrachealis

/ M cricothvroideus,Pars obliqua

Fig. 255 Pharyngealmuscles,Mm. pharyngis; facialmuscles,Mm. faciei; the mandiblehas beenpartiallyremoved; lateralview (1.).

'1 3

of the constrictorPharyngis supenormuscle

Muscles of the pharynx (continuation) Muscle Innervation

Origin

Insertion

Constrictormusclesof,theph,r,::,:: 2.M.conshictorpharyngis Parschondropharyngea: Raphepharyngis medius fu. pharyngealesof N. glossopharyngeus [X] andof N.vagttsffi 3. M. constrictor pharyngis lnferior Rn pharyngealesof N.vag.s [X]

(medialthird) Cornumajusossishyoidei Parsceratopharyngea:Cornu majusossishyoidei

Pars thyropharyngea:Carti- Raphepharyngis lagothyroidea(outersurface, (medialandlowerthird) behindLineaobliqua) Pars cricopharyngea:CartiIagocricoidea(lateralsurface) Parstracheopharyngea:CartilagotrachealisI (lateral surface)

Function . , . 4 . : , r . : : i . , ., , . ' .:. .:.. :::.t,:i:l:i.::

Constrictthe pharynxfrom dorsally.In swallowingtogetherwith the palatine muscles- theYclosethe Epipharynxfrom the Mesopharynx.Their contractions in waveformhelp to transport the foodto the oesophagus.

Neck. Collum

{

Svnchondrosis \ p6kooccipitaIs

:

\ evator, )alatrnr \

Cellulae \ i .>\ mastoideae

\\

, , Dorsum lt---ll lr 1l

\

rl

\

1l

, Fascia pha(yngobasilatis

t

lr

, For.amen . . slytonlastoroeum

) / ..i/,/

lt

l/,t,

muscularis - (Fasciculus accessonus) - Llg sphenomandibulare ti

M pterygoideus laleralis

t

_-

- Proc styloideus

M. constriclor pharyngis superior, Parspterygopharyngea

Glandulae pharyngeales - Lig stylohyoideum -

-

M stylohyoideus M pterygoideus medialis-

-

*

Glandula parotidea -

/--

M digastricus, Venterposterior-

M pterygordeus medialis/ Mandibula -

-

lvl digastricus,Venter postenor M constrictorpharyngissuperior Pars buccopharyngea M stylopharyngeus

M styloglossus ttS sphenomandibulare M constrictorpharyngissuperior, Pars mylopharyngea

M pterygoideusmedialis

\ M stylohyoideus

Glandulasubmandibularis

\

M styloglossus /

M digastricus,Venter posterior

v

\ M constrictor pharyngis superior, Parsglossopharyngea \ \ M constrictor pharyngis medius, Parschondropharyngea

/ M stylohyoideus Os hyoideum, Cornumajus /

\ M constrictorpharyngis medius, Pars ceratopharyngea \ M constrictorpharyngisinJerior,Pars thyropharyngea

/ Raphepharyngis

-

l. Glandula thvroidea.Lobus sinisler -

M conslriclorpharyngisinferior,Pars cricopharyngea

-

Oesophagus,Tunica musculans

-

Glandula thyroidea,Lobus dexter

Glandulae parathyroideaesuperioret inferior -

Tunicamuscularis- - Oesophagus,

-

Glandulae parathyroideaesuperioret inferior

Trachea

Fig.256 Pharynx,Pharynx; frontal sectionthroughthe mastoidprocesses; the pharyngealfasciahas beencompletelyremoved; dorsalview (8070).

Muscles of the pharynx (continuation) Muscle Innervation

Origin

Levatormusclesof the pharynx 1. M. palatopharyngeus Rn plgtyngealeeof,,.1:: :l:l N. glossopharyngeus [X] 2. M. salpin$ophdiynipuj' ::' Rr.pharyngealesof pharyngeus IIX] N. glosso 3. M. stylopharyngeus R. musculistylopharyngei rrb./ lt :lglossiip/r arynSdlisIIE

palatina, Aponeurosis Hamulusossispterygoidei

Insertion

Function

.-.

.::

lateral Obliquelydescending, and dorsalwall of pharynx, Cartilagothyroidea

the Isthmus Constricts faucium,lowerssoftpalate

Cartilago tubaeauditivae 0bliquely descending,lateral (freemargin,inferiorsurface) wall of pharynx

Elevates thepharynx

Proc.styloideus of 0s temporale

Elevates thepharynx

0bliquely descending, lateralwall of pharynx, (Cartilagothyroidea)

Pharyrw

N vagus[X] N glossopharyngeus [lX] BulbussuPeriora \ venaelugularls \ '\ S i n u sI - - * , \ lransversus Sinusa sigmoideus Ganglion supenus

N accessorius [Xll,R internus pharyngis superior . d4M constrictor

\

OVv pharyngeae

,

jugulare / Foramen

"rl

-'Os

/r

: Rr cutanei posleriores

\-

N cutaneusbrachiiposteriorI N radialis. N cutaneus brachii medialis

Fig. 392

N cutaneus antebrachiimedialis

Cutaneousnerves of the upper limb; dorsal view.

N medianus,Nn digitales palmares propfll

224

upperlimb

Plexus brachialis. . Pars supraclavicularis'\

----

A axillaris

N cutaneus brachii medialis

N axillaris-----

N cutaneus-.brachiilateralis sup€nor

N cutaneus antebrachii medialis

A. circumflexa .- -_ humeri posterior A circumtlexa humeri anterior A orolundabrachii ---

N. musculoculaneus

A. collateralis

e.

utnans supenor

A collateralismedia ----

N radialis

A brachialis

N cutaneusbrachii Post€rior A collateralis radialis---N. cutaneus brachii*-lateralisinferior

- - A collateralis ulnarisinterior

N cutaneus-antebrachii lateralis

-*

A radialis --

R. superficialis

*-

A recurrens radialis---

R profundus

--

----A radialis -

---

A int"ror""" communrs

A interossea anteflor A comitans nervimediani

A interosseaoosterior- - - R. dorsalis(N ulnaris)

R posterior - A recurrens ulnaris - A ulnans

A interossearecurrens

N. cutaneus antobrachii posterior

- Retearticulare cubiti R anterior

R palmaris(N ulnaris) - R carpalisdorsalis

R communicans cum nervoulnari -_-----

Nn.digitales- palmares communes

---

/ Nn disitales---1< parmares propnl

(N ulnaris) B Profundus (N ulnaris) R superlicialis Nn. digitales patmares communes

palmares proprii A radialisindicis

/

-

Aa digitales oalmares communes

Aa digitales palmares propnae

Fig.393 Nervesof the upperlimb; ventralview.

Fig.394 Arteriesof theupperlimb; ventralview.

of theAxilla LymphaticVessels

/ I

225

Vasa lymphaticasuperlicialia

V cephalica

t'

\ \ \ \ \ \ \

- /

Nodi lymphoidei axillares

t\

(Plexuslymphaticus axillaris)

Papilla / mammana

'11.'

Vasa / lymphatica supenrcralla

Vv thoraco- / eprgastricae

V basilica -

Nodi lymphotdeicubitales

/

V cephalica -

-Esg0 Fig. 395 Superficiallymphaticvessels,lymph nodes andveins of the arm, lateralthoracicwall and axillary reSlon; ventralview (1.,50%).

226

rJpperLimb

Nn supraclaviculares intermedii Nn supraclaviculares laterales

\

A M deltoideus,Fascra t

.=l

A t h o r a c o a c r o m i aRl i sp ,e c t o r a l iOs - - - L I

I I

I

, tM

V c e p h a l i c aa - - -

+. Fascia brachii ,

/. ,,

Nodi lymphoideiaxillaressuperficiales ,'/ A thoracicalaterals o /

/ ,'

V thoracoepigastricaa zl M latissimusdorsi, Fascia 6 / Br cutanei lateralespectorales (Nn intercostales) M serratusanterior,Fascia g /

,ru'#t" Fig. 396 Vesselsand nerves ofthe upper arm, shoulder and clavipectoraltriangle, Trigonum clavipectorale; lateral view (r., 50%).

p€ctoralis major

Rr cutanei anteriores pectorales (Nn intercostales)

221 postertor Fasciculus lateralis Fasciculus medialis Fasciculus Clavicula

ReteacromialeO Acromion-

/

a A subclavia

\ O V subclavia

/

M d e l t o i d e u s , O- Pars clavicularis

-

O M subclavius

M d e l t o i d e u s , -aParsacromialis Fasciaclavipectoralis V cephalicaa

Nn.pectorales medrates

O A thoracoacromialis, Rr pectorales -

O M. Pectoralismajor, Pars clavicularls

- a M. pectoralas major, Parssternocostalls

,no'*"t triangle,Trigonumclavipectorale; Fig. 397 Clavipectoral the clavicular part of the pectoralismajor muscle has been sectioned; ventral view (r., 5070).

Clavicula I Rete acromiale \ :-----

R clavicularis

R acromialis / A axillaris /

A subclavia

- -

A thoracoacromialis

pectorales

Fig.398 BranchesofA.thoracoacromialis, ventral view.

228

(JpperLimb

n

N intercoStobrachialis A : V t h o r a c r c al a l e r a h sO a M pectorallsmalor a Papilla mammaria

,

€

I

o V axillaris

au subscapularis

L \ t

Nn thoracici, Nn Intercostales, Rr mammarii lalerales

OV lhoracoepigastrica

i

\ \ \ \ \

i

c i r c u m l l e xhau m e rpi o s t e r i o r I o aA rv les les s brachialis, nfraclavicularis

M serratusanteflor a .

\

'l t;

\ \ \

3M

N intercosto brachialis

N axlllaris teresmajor

l.'

\aan,Vcircumflexa scapulae

\

t

\

dorsi ar M latissimus

a aA; V lhoracodorsalis

N thoracodorsalis

N t h o r a c i c u sl o n g u s

I

tM obriqrr. externus abdominis

Nn thoracici,Nn intercoslales, Rr cutanei lateralespectorales '

a Vv thoracoepigastricae

2!7r+oo 815407 996/l Fig. 399 Axillary fossa,Fossaaxillaris; the fasciae of the axillary region and of the lateral thoracic wall have been removed: inferior view (1.,50%).

229

Lateral Watlof the Thoraxand theAxilla

Plexus brachialis,Pars supraclavrcularrs N phrenicus M scalenusanteflora

A subclavia / a 7 Clavicula

\

T r u n c u s t h y r o c e r u i c a l i s O \, A vertebralisO A carotrscommunrs O\ Ansa ceruicalis

7 O A axillaris

\

M sternothyroideus a --.---\----.-_ M s t e r n o h y o i d eau s- - ; - _ N v a g u s[ X ] V b r a c h i o c e p h a l i coa - -

__*_*

------------3* M de toideus

M sternocrero a o -- - - - - - -

Nn intercostales, Rr cutanei anteriores pectorales

4.. \ \

a M Pectoralis major

a V cephalica

o A axillaris

o V axillaris \

1M

pectoralisminor

N intercostobrachaalis

N thoracodorsalis a a A ; V thoracicalateralis OoA:V

lhoracodorsalls

N thoracicuslongus

\

\iM \

/

externusabdominis M obliquus / M. ser tus anleriorr

N thoracicus [T4],N ntercostalis pectoralis R. cutaneusldler-alis latissimusdorsi

o V thoracoePigastrica

Rr mammarii laterales

,nnlft,no' Lateral thoracic wall; infraclavicular fossa, Fig. 400 Fossainfraclavicularis;axillary fossa,Fossaaxillaris; the pectoralismajor muscle has been removed; Iateral view (1.,6070).

upperLimb

230

r Nodr lymphordercervicalesanleriores, Nodi superficialesel protundi i V iugularisexterna O M sternocleidomastoideusa \

j| i

len l r sn um aiie ls d i u s . sq ecaa le scm M. splenius ceruicis

,

I i I

cM

levalor scapulae

M . o m o h y o i d e u s ,a \ Venler superior

Nn supraclaviculareslaterales /

A , V t r a n s v e r s aa l l colli, R superlicialis

\

/ Nodr lymphoideicervicales laterales.Nodi superficiales /

\

aM trapezrus

/ Clavicula /

,,

N suprascapularis

aM deltoideus

,/ Nodilymphoidei \. -* ceruicaies ant cil^adi.

ot

- OaA;V suprascapurafls

nr^l

M scalenus| anterior

- oM pectoralis m tn o r

--

M s t e r n o h y o i d e*u s- -

- OV cephalica

Truncus.-sinister ,ugularis

-

Noduslymphoideus- lateralis, cervicalis Nodusprotundus inlerior B u l b u si n l e r i o r * v e n a el u g u l a n s

-

oM pectoralis malor

--

Ductus' thoracrcus, Pars cervicalis V jugularis anlerior )

-

Arcus t / venosusJUgularis Articulatio/ sternoclavicularis, Discusarticularis

---

/,1

;/

/ M subclavius| lvf pectoralis maior)

/

aV cephalica \

'

A subclaviao /

OA circumtlexa humefl posleflor OV brachtahs

-

/ V jugularisexlerna| / T r u n csi u b c l a v i u s et bronchomediastinalissinister

N radialis

N musculocutaneus

- --

/

Nodi lymphoidei subscapulares

N ulnaris Nodi lymphoidei axillareslaterales

N cutaneus brachii medialis

\ a V brachialis \

,/."qGe{ Costall

/

Nodi lymphordeiintercostales

N thoracicuslongus

f ' r " * ^ ^ , ,|" . 1

/ Nodilymphoidei N intercosto pectorales brachrahs

OM serratusanterior o A , V t h o r a c i cl a t e r a l r s

Axillary fossa,Fossaaxillaris; Fig.401 deep layer of the neck; the clavicle has been partially removed;the pectoral muscleshave been sectioned; ventral view (1.,60%). Compareto Fig. 814.

NervesoftheArm 23I Nn suoraclaviculareslaterales

N cutaneus brachii medialis

N cutaneus antebrachiimedialis

V cephalica

--

-/

N. musculocutaneus' N. cutaneus antebrachiilateralls

/

.-

V medianacublti

N cutaneus antebrachilmedlalis, R Posterior ---

N radialis,Ncutaneus antebrachiiPosterior

--N cutaneus antebrachiimedialls. R anterior --

V mediana antebrachil

w5$ao7 4lr Fig. 402 Superficialveins anclnervesof the anteriorbrachial region,Regiobrachiianterior,and of the anteriorelbou region' Resiocubitalisanterior;r'entralvier'r(1.,35%) V cephalica

V cephalica -

-

-

V basilica

(V mediana cephalica)

V mediana antebrachii

Figs. 403 a-c Variationsof the superficialveins of the region of the right elbow. The veins of this regionare preferredfor venipunctureand i ntravenousiniections.

V baslllca

-

(A. brachiahs Var )' superJicialis,

-

(V mediana basilica)

-

V basilica

-

V mediana antebrachil c

-

v cephalica -

iniections there iS ThiS \ artation is rare llorvever,u ith regard to intravenous r o n s i r l e r a l r lrei s k o f a ( c i d e n t a li n t r a a r t e r i ailn i e c t i o n

232

upperLimb Rete acromiale \ Nn supraclaviculareslaterales

N axrllaris. cutaneus brachrilateralissuperior

Rr cutanei (A ; V circumflexa humeri posterior)

N axillaris.N cutaneus brachii lateralissuoerior

N. cutaneus brachiiposteriorf It radialis interior| ru cutaneusbrachiilateralis

V cephalica -N radialis,N cutaneus antebrachiiposterior --

*

N cutaneus brachii medialis

a14O9

tr

4t2 Fig. 404 Superficialvesselsand nervesof the posterior brachialregion,Regiobrachii posterior,and of the elltowregittn, Regiocubitalisposterior; d o r s a lv i e w ( 1 . , 3 5 % 1 .

Superficialveinsof the arm The cephalic vein developson the radial side of the back of the hand out of the Retevenosumdorsalemanus,receives intakefrom the palmthroughthe intercapitularveins and then runs proximally on the radial side of the forearmtowardsthe elbow.There it anastomoses with the basilic vein and then continues,generallyratherweaker,in the lateralbicipitalsulcus to the clavipectoraltriangle where it perforatesthe fasciaand flows into the axillary vein. The basilicvein originateson the ulnar side of the backof the hand, runs in the ulnar area of the forearm on the ventral surfaceproximallytowardsthe elbowandjoins up herethrough

the median cubital vein with the cephalicvein, whereby it usuallybecomes sffon8er.It piercesthe Fasciabrachiibelowthe middleof the upperarm in the medialbicipitalsulcusandflows into the medialbranchof the brachialvein. A very variabletransverseanastomosiscalled mediancubital vein connectsthe basilic vein and the cephalic vein. It is supplied from the front side of the arm over the median vein. antebrachial The medianbasilic and the median cephalicveins form connectionsbetweenthe basilic,cephalicand medianantebrachial velns.

and Nervesof theAxilla and Shoulder Vessels

superlus\ \ scapulae Lig transversum N suprascapularis\

233

Venterinlerior r o M omohyoideus,

Nn subscapulares -_ / Proc coracoideus Parsinfraclavicularis' Plexusbrachialis, '/ medialis Fasciculus

A axillarisO : Plexus brachialis.Pars infraclavicularis, \

/ OM pectoralisminor

posterior Fasciculus

/ a M. deltoideus

N axillaris \

-

A circumllexascapulae O :

a M coracobrachialis O M biceosbrachii,Caputbreve

/ -

Plexusbrachialis, Parsintraclavicularis, Fasciculuslateralis N musculoculaneus

M subscaoularisO -

- a M. pectoralismajor -

M teresmaiorO - -

O M. biceos brachii, Caput longum

- OA circumflexa humeri anlerlor - O A. circumflexahumeriposterior

O A subscapularis O A thoracodorsalis N thoracodorsalis

M latissimus dorsiO -

N cutaneus brachii medialis

N ulnaris N medianus

-

N radialis

aA

brachialis

N culaneus anlebrachirmedialis o vu brachiales O M triceps brachii, Caput longum : --

Fig. 405 Vesselsand nervesof the axillary fossaand the shoulder; the clavicle has been sectioned;the arm has been removedfrom the thorax; ventralview (1.,60%).

/, a M suPraspinalus

Clavicula \ R.acromiatiso-

M s u p r a s p ' n a l u s\a-

_-

/=-

l/--

o A suprascapularls - -

Lig transversumscapulae supenus

scapulae Inlerius

--

M inlrasoinatus a -

a M deltoideus --

Arliculatiohumen, Capsula articularis

Spina scapulae

--

a M inlraspinatus )--

M deltoideusa -

lM -

N axillarrs N axillaris,N cutaneus brachii laleralissuperior / A circumflexa humeri posterioro

OA circumllexa scapulae

\

N a x i l l a r i s . Rm u s c u l a r i s

\ a M tricepsbrachii,CaPutlongum

Fig. 406 Vesselsand nervesof the shoulder; the deltoitland the trapeziusmuscleshavebeenpartially removed; d o r s a lv i c w ( 1 . 6, 0 % )

leresminor

aM teresmaior

796 lt "7AA,ff ' 410

234

upperlimb

Plexus brachialis,Pars infraclavicularis, Fasciculusmedialis

/

o M deltoideus

Plexus brachialis,Pars infraclavicularis, Fasciculusposterior

--

a V cephalica

Plexus brachialis,Pars infraclavicularis, Fasciculuslateralis

--

a A circumflexahumeri anterior

--

a M bicepsbrachii, Caput longum, Tendo

A axillarisO N axillaris N cutaneus brachii medialis

--t

M pectoralismajor

N cutaneus antebrachiimedialis

N musculocutaneus--7, N.ulnaris N. radialis ----

Vv brachialeso/

s M biceps brachii,Caput breve

N medianus

A brachialisO

-

/

/ A prolundabrachiiO V basilicaO

/

a

--

*

M biceps brachri,Caput longum

A collateralis ulnarissuoeriora --

a V cephalica

Seotum intermuscularebrachii mediale -

N musculocutaneus, lateralis N cutaneusantebrachii A collateralis ulnarisInlerioro--

N medianus

-

muscullbicipitis brachii Aooneurosis

Fig.407 Vessels andnervesof the anterior brachialregion,Regiobrachiianterior; ventralview (1.,45%).

235 M coracobrachialis |

\ /

oM deltoideus

N axillans

taM oectoralis major --M t e r e s m a j oar

-

N radialis

-

oM coracobrachialis

N musculocutaneus

N medianus

-

brachii A protunda

aM. biceps brachii

M triceDsbrachii,Caput longum a

N ulnaris ulnarissuPeriot A collateralis -M triceos brachii,Caput medlale Q

N. musculocutaneus, lateralis antebrachii N. cutaneus

ulnarisinleriora A collateralis -

aA brachialis

N, medianus

medialis Epicondylus -

aM. brachioradialis

a/ Mm tlexoresantebrachll

Arteriesand nervesof the anterior Fig. 408 brachialregion,Regiobrachii anterior; ventralview (1.,45%).

236

upperLimb

M deltoideus a

--

a M l e r e sm a j o r

N axillaris,N cutaneus brachii lateralissuperior

--

i, deltoideus O A p r o t u n d a b r a c h rR

\ a i,4 triceps brachii,Caput longum N radialis,N culaneus brachii posterior

'

\

N radialis

\ \

M triceps brachii,Caput lateralea .- -

prolundabrachii

OA

O A brachialis

M bicepsbrachiro --.Septum intermuscularebrachii laterale .- .- .M b r a c h i a l i s O- - . - _ A collateralisradralisO -- -N cutaneus brachii lateralisinterior

N radialis,N cutaneus antebrachiiposterior M triceps brachii,Caput medialea -N musculocutaneus,N culaneus anlebrachiilateralis

-

--

O A collalerahsulnarisInleflor

-j

Epicondyluslaleralis- - M b r a c h i o r a d i a h s o- -

N ulnaris - -

O Rete articularecubilr

M anconeusO Olecranon M extensor carpr radrals longus rt M extensor carpi radialis brevisa

*,#ii\

Arteriesand nervesof the posterior Fig. 409 brachial region, Regiobrachii posterior; dorsal view (1.,40%).

Arteriesand l,lervesof the Arm

237

, Articulattohumerl, /'Capsula articularis N axillaris

/

'

, | M t e r e sm i n o r t

o M t e r e sm a i o r

M d e l t o i d e u sa -

- -

O A c i r c u mlfe x a h u m e r ip o s t e r l o l

N radralrs,N cutaneus brachiiposterrol p r o f u n d ab r a c h i i ,l l d e l t o i d e u s

-

aA

-- -

--

OA brachralls a i/rt triceps brachii Caput longum

O A P r o l u n d ab r a c h r i

M t r i c e o s b r a c h i iC a p u t l a t e r a l ea - N c u l a n e u sb r a c h i il a t e r a l l sI n t e r l o r M bicePs brachii il -

a M t r i c e p sb r a c h i i ,C a p u t l a t e r a l e

- -

A collateralisradialis,(R anterior) O M b r a c h i a l i sa -

--

aA

- -

a M triceps brachii Caput medrale

c o l l a l e r a l lm s edla

N radialis,N cutaneus antebrachlrposterlor

N musculocutaneus N cutaneus antebrachlrlateralis --

aA

) -A c o l l a t e r a l irsa d i a l i s (, R p o s t e r i o r O

N ulnarls

E p i c o n d y l u sl a l e r a l r s- - M b r a c h r o r a d i a l ias - l\,4extensor carpi radialis longus o

* -

M extensor carpi radialisbrevis a

- -

c o l l a l e r a l iu s l n a r i sI n l e r l o r

I

--

-

O Rete articularecubrtl

-

O A r e c u r r e n su l n a r l s

aM anconeus

Arteriesandnervesof the posterior Fig. 410 brachialregion,Regiobrachiiposterior; dorsalview(1.,45Y.1. * quadrangular space,Spatium axillare laterale

238

trpperLimb

N .r a d i a l i s , N. cutaneus I brachiiposterior I

V basilica a -

N cutaneus brachiimedrahs

\ /\

N radialis, N cutaneus antebrachii Posterior

N cutaneus brachii medialis

-

o V cephalica

N cutaneus

V cephalica * -

antebrachiimedialis

N musculocutaneus N cutaneus antebrachii lateralis

N cutaneus antebrachiimedialis, R posteflor

--

a V mediana cubrti

-

N cutaneus antebrachiimedialis, R anterior

* V mediana antebrachii N cutaneus antebrachii medialis, R posterior

(V mediana s ' basillca) V b a s i l i c a* - -

N muSCUlocUtaneUs, N cutaneus antebrachii lateralis

--

s V cephalica

N radiahs, R supedicialis -

R palmarrs (N ulnaris)

N radialis, N cutaneus antebrachii posterior

N radialis, R superticialis

--

i

V basilica

O A radralis

R palmaris (N medianus)

V c e p h a l i c as - B dorsalrs (N ulnaris)

402 ,.^ lt/+tt + /l 423 Fig.411 Superficialveins and nerves of the anterior antebrachialregion, Regio antebrachii anterior; ventral view (1.,45%).

Fig.4l2 Superficial veins and nerves of the posterior antebrachialregion, Regio antebrachiiposterior; dorsalview (1.,45%1.

Vesselsand Nervesof the Forearm

F a s c i a b r a c h i i\

\\ \\

. o A. collateralis 7 Septum I ulnaris /'intermusculare mediale brachrr superior I ,,

V cephalicaa\

V b a s i l i c aa - _

| M tricepsbrachii,a Caputmediale

-

N ulnaris; A collateralsO ulnarissuperior

Fascia / antebrachii

a M biceps brachii

-

--

aA --

,r'

ToAbrachiatis ,, a M, biceps brachii

N ulnaris ulnaris inferior / M b r a c h i a l i sa

brachialis

Epicondylus medialis

--

\ A ulnaris1 /

-

\ M flexor a carpi ulnaris

-

r M supinator

O M biceps brachii,Tendo

-

a A radialis \

lM pronalor aM pronator teres gM brachioradralis

a M extensor carpiradialis DTEVIS

-

brachrl N radialis, R prolundus

a M biceps Tendo brachii,

teres

\

M llexor a carpl radialis

N radialis, R superficialis N radralis, R profundus

\ aA recurrens radialis \

M palmarisa tongus

1 M supinator

aM flexorcarpi radialis M flexor O carpi ulnaris

M palmaris O longus --

OM flexordigitorum superficialis

---

a M flexor p o l l i c i sl o n g u s

---

Aponeurosrs palmaris

Aponeurosis musculibicrPitis

--

a A radialis

-\:

Fascia -antebrachii

a A collateralis radialis

- /

: I

Aponeurosis

--

A u l n a r i sO - - -

a M brachioradialis

musculibacipitis N rnedianus brachii

/

N ulnaris, R dorsalis

N radialis

7

A collateralis O -

a M brachiahs

N medianus

Septumintermusculare brachiimediale H u m e r u s-, Epicondylus medialis

239

OM abductor pollicislongus -

M flexora drgrtorum supedicialis

N ulnaris A u l n a n sa - -

a A radialis a M. pronator quaoralus

-

O M brachioradialis, Tendo

-

aA radialis

N medianus R palmaris (N ulnaris) R dorsalis (N ulnaris) A u l n a r i sO , --

\,M exrensor - :3l33il: p o l l r c rosr e v r s Tendo

M palmaris| brevrs

407 n,n

v""

n'-1/l 423

Fig. 413 Arteries and nerves of the anterior antebrachial region, Regio antebrachii anterior; ventral view (r., 45%).

Arteriesand nervesof the anterior Fig. 414 antebrachialregion,Regioantebrachiianterior; ventralview (1.,45Y").

240

(rpperLimb

M bicepsbrachiie \_

/ .-

a A collateralis u l n a r i ss u p e r i o r

A brachialis a N ulnaris

N ulnaris

|

N. radialis, R. 'Profundus

/

-

tprconoylus medialis

O A collateralis radialis (R anterior)

M b r a c h i a l i s|

-t-

u O A radialis

N medianus

--

-

a A recurrens radialis

M pronatora teres, Caputulnare

N radialis, R superficialis / \

A recurrensO / ulnans

i

a M brachioradialis

\

t

-

M flexor a / drgitorum superficialis, Caput radiale

a M pronatorteres

A u l n a r i s ,O / B carpalis dorsalis

M flexor t carpr ulnans

aA

radialis

--

*M tlexorcarpi radialis.Tendo -.-

OA radiahs, R palmaris superlicialis

r_ \

Fig.415 Arteriesandnervesof the anterior antebrachialregion,Regioantebrachiianterior; deeplayer; ventralview (1.,45%).

-

t M biceps brachii.Tendo

R dorsalis (N ulnaris) M flexora d i g i l o r u ms u p e r ifc i a l i s , Tendines

M flexor* c a r P ru l n a n s , Tendo

--

a A, interossea communts

-

| M pronator teres

\

O A interossea posteflor

N interosseus antebrachii anterior a M brachioradialis, Tendo

-

N radialis, R super,ficialis O A radialis

-

N medianus -

I

- t

M brachroradialis, Tendo M pronalor quadratus

- a M flexor pollicis longus -

t

-._

M flexor carpi radralis, Tendo

a A radialis, R palmaris superlicialis - I M palmarrs longus,Tendo

* M palmaris l o n g u s ,T e n d o

408 ".. lrt+to " 414/l 424

a A recurrens radialis

-

-

M llexor+ -digitorumprofundus, Tendines

R palmaris (N medianus)

/

-,

I M brachioradialis. Tendo

\

/

A interossea a anterior A u l n a r iO s -

N radialis, R superficialis

--'1

R dorsalis

-

N ulnaris -:

--

(N ulnaris)

Mm flexores a antebrachii

A c o m r t a nas neruimediani

OA radialis

-

-

o A interossea communrs | M tlexor pollicislongus

--

-

l,/ supinator

N .r a d i a l i s . H. prolunous

A recurrensa ulnaris

N medianus

/

M f l e x o r c a r p iI ulnaris,Tendo

M bicepsbrachii N radialis

z O A ulnaris

M b r a c h i a l i sa

M flexor I carpi radrals

-

ulnaris inlerior

' /

M pronator t teres

O A brachialis

A collateralis a -

N radialis E'omi ceodnidavl liuss- - :

-

408

* I'

415/l 424

Arteriesandnervesof the anterior Fig.416 antebrachialregion,Regioantebrachiianterior; deeplayer;the flexor digitorumsuperficialismuscle hasbeenpartiallyremoved; ventralview (1.,45%).

Arteriesand Nervesof theElbowRegion

a \ A collateralis ulnarissuperior

.t

/ a A collateralis ulnarisinlerior N medianus

Septum- intermusculare brachiimediale

--

\ Epicondylus medialis N ulnaris

a A brachialis

--

o M bicepsbrachii

--

e M brachialis

- - Aponeurosis muscull brachii biciPitis

- Olecranon

--

I - f Caputhumerale M. llexor.l carpiulnarisI CaPUtulnareo *I

a M brachioradialis N radialis

--

-f H .p o s t e r i o r a A recurrens{ urnafls R.anteriora__ I

; Mm tlexores antebrachii

--

a A ulnaris

--

a A radialis

-M.flexora digitorumprolundus

a M oronatorteres N medianus

--

Fig. 417 Arteries and nerves of the ulnar and anterior elbow region, Regiocubitalis anterior; the flexor musclesof the forearm have been partially removed; medial(ulnar)view (1.,6070)' -

N radialis

- -- a A. collateralis (R.anterioo radialis, A b r a c h i a l i sO - -

N medianus

a M brachioradialis

.-

---

a Mm extensores carpi radiales

N radralis, R superficralis

N radialis, R prolundus

-A radialisa A recurrens a radialis

-..

--

-carpiw --M extensor radialisbrevis

t M extensol digitorum

e M.supinator N radialis, R profundus

--

a A interossea recurrens

Arteries and nerves of the anterior elbow Fig. 4f8 region, Regiocubitalis anterior; the radial muscles of the forearm have been sectioned; Iateral (radial) view (1.,60%).

24r

242

upperLimb

.t

z O A collateralis radialis

A collateralisO -radialis

--

M b r a c h i o r a d i a l i s *- -

-

M extensorcarpia radialislongus

-

a A collateralis ulnarisinferior N ulnaris

M. brachioradialisO -

N ulnaris

a A recurrensM extensor carpia utnafls radialislongus

- Epicondylus medialis Epicondylus lateralis

- a Retearticulare cubiti

M extensor carpi a radialisbrevis

--

O M anconeus

- O A interossea recurrens

- | M anconeus M supinator a -

a M extensor N radialis, carpiulnaris R prolundus

N radialis, R profundus

M extensor carpia radialisbrevis

A interossea a poslenor

- O A interossea poslerior

Rr musculares

\

M e x t e n s oar - digitorum

M abductorpolhcisa \ longus M extensorpolliciso \

I

--

M. abductor | poilrcrsrongus

--

a M exlensor carpiulnaris, Tendo

orevts N radialis, R superticialis A interosseaanterior a -

-Retinaculum musculorum extensorum

- a M extensor digitiminimi, Tendo

- a Retecarpale oorsale R dorsalis (N ulnaris)

Fig.419 Arteriesandnervesofthe posterior antebrachialregion,Regioantebrachiiposterior; dorsalview (1.,45%).

a M extensor digitorum

--

Fl profundus nerviradialis, N interosseus antebrachii posterior

Membrana inlerossea -N radialis, B superficialis M extensorl pollicisbrevis

a M extensor pollicislongus,Tendo

--

O M extensor pollicislongus

---

I

M extensol

carpiulnaris, Tendo Retinaculum musculorum extensorum -

R dorsalis (N uharis)

Fig. 420 Arteries and nerves of the posterior antebrachial region, Regio antebrachii posterior; deep layer; dorsal view (1.,45%).

teriesoftheHand 243 - -

A ulnaris

--

B carpalisPalmaris R carpalisdorsalis

----

R palmarisProlundus

--fR palmaris superlicialis

Aa metacarpalesPalmares ArcuspalmarissuPerlicialis

- -

communes Aa digitales Palmares

/ Aa digitalespalmaresproorrae - Aa digitales PalmaresProPnae

Fig.421 Arteriesof thehand; palmarview(r.,70%).

Figs.422 a-d Variationsof the deeppalmar arch,Arcus palmaris profundus. a simple,closedArcus palmarisprofundus("textbook"case) b doubledulnar part

with A. interosseaanterior(.) c anastomosis d both radial fingers are supplied by A. radialis, the three ulnar fingers are supplied by A. ulnaris

244

UpperLimb

N m e d i a n u s .R p a l m a r i s

N cutaneus antebrachiilateralis

N ulnaris,R palmaris A u l n a r i sa - -

N ulnafls

palmaris _ - Aponeurosis M p a l m a r i s b r e vai s - N u l n a r i s ,R p a l m a r i s

// N medranus.Rr oalmares

N ulnaris,Rr palmares palmares proprii Nn digrtales A d i g i t a l ipsa l m a r icso m m u n ias - Aa digrtalespalmares propriae a

Lrg metacarpaletransversum superficiale

q),+z+

Fig.423 Arteries and nerves of the palm of the hand, Palma; palmarview (1.,70%).

O A p r i n c e p sp o l l i c i s

Arteries and Nervesof the Hand

A u l n a r i sa

_-

O A radralts N medtanus

M tlexor carpi ulnarisa -.N u l n a r i s ,R p a l m a r i s

--

l l e x o r c a r p ir a d i a l i s , T e n d o

aM

, palmarissuperficialis a A r a d i a l i sR

Os pisiforme

N medianus, R Palmaris F e t i n a c u l u mm u s c u l o r u ml l e x o r u m

-

N ulnaris,R Protundus

-

A u l n a r i sR p a l m a r i s p r o l u n d u s- -O

a M abductor Pollicisbrevrs .-

N medianus

N ulnaris R superficialis -'-

.) M flexor Pollicisbrevis

N digitalisPalmarisProprlus

a M adduclor Polllcrs

R c o m m u n i c a n sc u m n e r v ou l n a r l

N digitalisPalmarrscommunrs

N medranus, N digitalisPalmarls communrs

--

Arcus palmaris suPerficialisI

-

- Aa digitalespalmares communes a

I I I I '

a Aa digitalesPalmaresProprrae

Nn digitalesPalmaresProprrl

nrr?o'u r\rteriesantl nervesof the palm of the hand, Fig.424 Palma; has been removed; deeplayer;the palmaralroneurosis p a l m a rr i e u ( 1 . 7, 0 % )

37'1n

35Yo Figs. 425 a-c Variations of the superficial palmar arch, Arcus palmaris suPerficialis a closedArcus palmaris superficialis ("textbook"case) b supply to the three ulnar fingers by A. ulnaris c supply to all fingers by A. ulnaris

13Yo

245

246

upperLimb

/ aM pronatorquadratus

/ aA radialis

A u l n a n sO - - -

-

M llexor caroi ulnaris t

O R carpalis palmaris a M tlexor carpi radialis,Tendo

A ulnaris,R carpalisa) palmaris N ulnaris,R palmaris

superlicialis a R palmaris llexorum Retinaculum musculorum -

N ulnaris,R, superficialis N ulnaris,R prolundus

o M flexorpollicislongus,Tendo cM

-z -z

.,

M abductorI digitiminimi

opponensPollicis

) M llexor pollicisbrevis, Caput superficiale

z O Arcuspalmarisprolundus /

A u l n a r i sa, - R palmarisprofundus

a M adductorpollicis O A PrincepsPollicis

_--

palmares Mm interossei o --

a M abductorpollicisbrevts

--_--

M adductorpollicis a - -

---

Aa metacarpalesO -palmares Mm llexores digitorum,a -lendtnes I

a Aa digitalespalmares propriae

dorsalisI a M interosseus

M m l u m b r i c a l e s -O-

416

#

Nn digitales palmares proprii a Aa. digrtales palmares propnae

424

Fig.426 Arteriesandnervesof the palmof the hand,Palma; deeplayer;the transverseheadof the adductormuscleof the thumb,M. adductorpollicis,hasbeensectioned; palmarview(1.,75%1.

241 N radialis,Rr superliciales -

OA radialis

:exlenSorum musculorum Retinaculum \,-

posterior N radials,N cutaneusantebrachii

Rete carPaledorsale a

Vaornatendtnismusculi llexorrscarpi radialis

/

alA radialis,R palmarissuperlicialis

-

OA radialis

-

A radiahs,R carpalisdorsalis a -

M extensor carDiradialisbrevis,Tendo a

-

-

-.ndo M e x t e n s o r c a rrpaid i a l i s l o n g u s , T e a

-

A radtaliso --

/

a M abductor Pollicisbrevis

-

Tendines e -M extensordigitorum, Os metacarPill

pollicisbrevis'Tendo o M extensor

aM opPonensPollicis

-

pollicislongus'Tendo o M extensor

/

Aa metacarpales dorsales O

-

/

Nn digitales dorsales

-

OA digilalisdorsalis

-

oM

adductorpollicis

M interosseusdorsalis I a

M l u m b r i c a l ias /

N digitalispalmaris ProPrius O A digitalis Propria Palmaris

-

N digrtalisdorsalis

4r9

42s#42s l-lv' Vaoinaetendinummusculorumextensorum: i vlEiiii teintinummusculorumabductorislongi et dxlensorisPollicisbrevis m extenso.Illn.caaj radialium rr Viiirii i6-n'din'um'muscutoru lll Vadinatendinismusculiexlensorispolllcls.longl lV Vadinatsndinummusculorumextensorisdlgltorum et Extensorisindicis

Fig.427 Arteriesand nervesofthe hand; lateral(radial)view (r.,65%).

24SupperLimb N radialis,N cutaneus antebrachiiposterior

I I

V cephalica \

N radialis,Fl superficiails -

venosum oorsaremanus

/

V cephalica

Nn digitalesdorsales

/

Fig. 428 Vesselsand nervesof the back of the hand.Dorsummanus: dorsalview (1.,70%\.

Vv intercapitulares

Arteries and Nervesof the Hand

Membrana inlerossea\

M extensor pollcis brevts a \

249

O M extensor carpi ulnaris

/

\

M abductor pollicislongus.Tendo a \\

interosseaanterior

aA

/

N. radialis,R. Profundus, N. interosseusantebrachiiposterior

z

extensorum--musculorum Retinaculum

Rete carpale dorsale O --

-

O A u l n a r i s , Rc a r p a l i s d o r s a l i s

A radialis O -

--

R perforans I --

oA radialis,R carpalisdorsalis

A princepspollicisO - -

M extensor pollicislongus, | Tendo

-

M adductorpollicisa -

\

lAa

metacarpalesdorsales

420

xil7+ Fig.429 Arteriesand nervesof the backof the hand,Dorsummanus; deeplayer; dorsalview (1.,70%).

250

upperLimb

Canalis carpi

i

1/ i/

M flexor carpi radialis,Tendo

-i

z Fascia antebrachii

/Aulnaris

N medianus

i M palmarislongus, Tendo .-

1/

z N. ulnaris

)\

.-.

Retinaculummusculorumflexorum .- .- --

O sp i s i f o r m e

--Thenar .---_

,.t----'HyPothenar - - Lrgg metacarpaliaPalmaria :-

Canalis carpi - -

, )---

M extensor Tendo digitorum, Ossametacarpi

t

-:--I I

profunous, M flexordigitorum Tendines

{ J-----.-

patmaris ooon"rrosis M tlexordigitorum Tendines superficialis,

---Mr lumbricales (Aponeurosis dorsalis)- Phalanxproximalis-- profundus, M tlexordigitorum Tendo M llexordigilorumsuperficialis, Tendines

-'i

Vaginatendinum

Fig. 430 Fasciasof the hand; the compartmentshavebeenpartly opened; palmar view * ** '""

c l i n i c a l :G R A Y S o Nl'isg a m e n t c l i n i c a l :C L E L A N Dl 'i sg a m e n t c l i n i c a l :C a n a l i su l n o c a r p a l i s( l o g ed e G U Y o N )

oftheHand 25I

A. interosseaanteriora

---

interossea Membrana

---

O A. interossea Posterior

---

a M extensordigilorum

- O M abductorpollicislongus'Tendines

' quadratus M. Pronator

-

pollicislongus,Tendo a M extensor

- Radius

' Tendines profundus' M llexordigitorum ---

Articulatioradiocarpalis

f lexorum musculorum Retinaculum o Tendines superficialis, M. llexordigitorum

--

Os lunatum

--

o Retecarpaledorsale

- -

- - Os caPitatum

Rete caroale PalmareO *--

AooneurosisPalmaris- -.

- - Os metacarPi lll, Basis

lll O --r A metacarpalis Palmaris ---

--

ll a M. interosseus Palmaris

lll o --palmariscommunis A digitalis

--

dorsalislll a M interosseus

--

dorsalisI O A metacarPalis

' supedicialis ArcusPalmaris

-M l u m b r i c a l i sl l l , T e n d oO - A digitalispalmaris PropriaO O A digitalis dorsalis

Phalanx oroximalis -

Vagina tendinum

-

Phalanx media

\ Phalanx distalis

Fig.431 Hand,Manus; ,ulittut sectionthroughthe ulnar aspectof the middlefinger; ulnar view . * clinical: CLELAND's ligament * * clinical: GRAYSoN'sliSament

252

upperLimb N digitalisdorsalis

Fig.432 Arteriesand nervesof the index finger,Index; lateral(radial)view (r., B0%)

digitorum,

Corpus phalangis \ N digitalisdorsalis

N drgitalisdorsalis

Peflosteum

il M tlexor digilorum prolundus,Tendo

; A digitalispalmaris propria

N digitalispalmarisproprius \

Vagina tendinum digiti

M tlexor digitorum superficialis,fendo a /

Fig. 433 Middle finger,Digitusmedius [IIl]; crosssectionthroughthe shaft of the proximalphalanx; distal view.

s o t : a l l e dd o r s a la p o n e u r o s i isn w h i c h t h c t e n ( l o n so f t h ( ' c r t c n s o rr l i g i t o r u m l u s (l c s r a ( l i a t e m u s ( : l ea n ( l t h o t ( ' n d o n so f t h e i n t e R r s s r r r uasn d l u m l r r i r : am

Periosleum \

--

N digitalispalmarisproprius / lrrf flexor digrtorumprolundus fendo I

\

I

A drgitalispalmarispropna

Vagina tendinum digiti

/

Fig. 434 Middle finger, Digitus medius [II!; cross section through the shaft ofthe middle phalanx; distal view.

* so called dorsal aponeurosis The position of the arteries and nerves of the finSers remains constant,enabling easy accessfor local anaesthesiaor to stop bleeding.

CrossSectionof the Arm

253

N culaneus brachii lateralassupertor

M bicepsbrachii * r. V cephalica o \

,/

,/

N. cutaneus .. brachil meolalrs

/

N medianus aA brachialis

-'

OV brachialis

--

- Telasubcutanea, Panniculus adiposus

N cutaneus mediahs antebrachii

H u m e r u s-

N ulnaris --

Fasciabrachii-

cutaneus brachrl lateralisinferior

oV basilica

\ {}M. triceps brachii, Caput mediale

N cutaneus antebrachii posterlor \ l M t r i c e p sb r a c h r i , C a p u tl o n g u m / Seplum intermusculare brachii laterale

'3"""0t"i c / lJ8::l: " Brat;hialregion,Brachium; Fig. 435 crosssectionthrough the mitltlleof the upperarm; distal 'v'ien(r , 120'/,).

\

N radialis

N cutaneus brachiimedialis

\Vhenthe shaft of the humerusfractures,the radial nerve is in its path through the radial sulcus,due to its enrlangerecl p r o x i m i t yt 0 t h e h u m e r a ls h a f t

V cephalrca

M brachialis Humerus

Septum intermuscularebrachii laterale

Fig. 436 Brachial region, Brachium; cross-sectionalimage obtainedwith magneticresonance

--

M b i c e p sb r a c h l l

- -

V brachialis

--

V basilica

- -

Septum intermuscularebrachii mediale

--

M triceps brachii

(MRT)throughthe middleof the upperarm; tomography distalview(r.).

254

IrpperLimb M. palmarislongus,Tendoo I I

/ O v mediana antebrachii

M flexordigitorum a \ suoenrcralrs \

/ O A. ulnaris

N medianus \ N ulnaris

M flexorc€rpia \ raorails \ flexorpollicislongusa \

\

_-

a M flexorcarpiulnaris

A r a d i a l i s a\ \ N radialis

M brachioradialis o

---

V cephalica O --

o M flexordigitorum profundus

M. extensorcarpi O -radialis brevis Radius --

-Fascia antebrachii

o M extensorcarpiulnaris

/

M extensorcarpiradialislonguso

\ o M. extensor indicis; M extensorpollicislongus

/

t \' M abductorpollicislongus

\ OA interosseaposterior posterior N. interosseus antebrachii

o M. extensordigitorum

Forearm,Antebrachium; Fig.437 crosssectionthroughthe middleof the forearm; distalview (r., 720o/o\.

M flexorcarpi -radialis

M. flexordigitorum- superficialis

--

M paharis longus,Tendo

- -

M. llexor carpiulnaris

--

M flexor protundus digitorum

- -

Ulna

M. brachioradialis---

M. flexorpollicis- - longus R a d i u s- - -

---

Fig.438 Forearm,Antebrachium; imageobtainedwith magnetic cross-sectional resonancetomography(MRT)throughthe middle of the forearm: distalview (r.).

interossea Membrana antebrachii

255 CutisI \. \

longus, M. palmaris Tendines M tlexordigitorum superticialis, N. medianus, R. palmaris -_ \.\l -

N medianus

\ \, t.

-

'\

/ Fascia antebrachii

i l

/ O M, flexof digitorumsuperficialis' I

/

M flexor carpi radialis,Tendo'

A . ;N u l n a r i s

/O

7 I M flexorcarpiulnaris

M llexorpollicislongus,Tendo*a --_ A r a d i a l i s o- - -

N ulnaris,R. dorsalis

N musculocutaneus. lateralis N cutaneus antebrachii pollicis longus,Tendines'a - M abductor a V.ceohalica; N radialis,R superficialis

) M flexordigilorumprolundus'

------

quadratus o M pronator

- - - - Articulatioradioulnaris distalis, Recessussaccilormis

-'

pollicisbrevis'Tendo*a -M extensor Tendoa / M brachioradialis, Mm.extensorescaroiradialesa longuset brevis,Tendines*

---*----

- -

Ulna Tendo' carpiulnaris, o M. extensor

-

Radius/

,"

Fasciaantebrachii

/ Telasubcutanea

,j

/ I M extensorpollicislongus,Tendo*| V basilicao

Articulatioradioulnarisdistalis - a M extensor digitiminimi' \oM

t, t

extensorindicis*

aM exrensordigitorum'

l I Retinaculum extensorum musculorum

Fig. 439 Forearm,Antebrachium; cross-sectionalimage at the level of the distal radio-ulnarjoint; distal view (r., 90%). ' Thesetendons run through synovial sheaths,Vaginaetendinum, at this level

Mm llexores-

- - Ulna,Caputulnae

- - Articulatioradioulnarisdistalis, Cavilasarticularis

Fig.440 Forearm,Antebrachium; imageobtainedwith computedtomography cross-sectional (CT)at the levelof the distal radioulnar joint; distalview (r.).

256

(rpperLimb M palmaris longus,Tendo C \

/, Hypofienal

Retinaculummusculorumflexorum \

-l n' e\ n a r

.\

\\

N medianus- -_

)

--

M f l e x o rp o l l i c i sl o n g u s ,T e n d oC - 'M

a

A;N

flexor carpi radialis,Tendo t - - _ Ostrapezium ---

M abductorpollicislongus, Tendo | -M extensor oollicisbrevis. Tendo I

--

---

V cephalica a --

-..

A r a d i a l i so - ..

Mm extensorescarpi radiales,Tendines * --

t

M extensor pollicislongus, Fendo * / t

\

/ Os traoezotdeunr

\

Fig.441 Carpus,Carpus; crosssectionthroughthehamulusof thehamatebone,Hamulus ossishamati;thesynovial Vaginae sheaths, tendinum, areshown; distalview(r.,100%).

oahamatum

* M extensor digiti minimi, Tendo

taV

.. \

* M extensor carpi ulnaris,Tendo

basitica

os capitatum

ts M extensor digitorum,Tendo

* M extensor indicis,Tendo ' carpal tunnel syndrome:comprossionof tht: median nerve in the carpal canal . . u l n a r t u n n o l s y n d r o m c :c o m p r e s s i o n o f t h e u l n a r n e r v ei n t h e s o c a l l e du l n a r t u n n e l{ l o g ( d : e GUYoN)

Thenar --

Os metacarpipollicis,Basis - -

- - -

Retinaculummusculorumtlexorum

---

Canaliscarpi; (Mm flexoresdigitorum)

- - -

Hamulus ossis hamati

Os trapezium- - Os trapezoideum

- -

Hypothenar

- -

Os hamatum

--*

Oscapitatum

--(Mm extensoresdigitorum)

Fig.442 Carpus,Carpus;cross-sectional imageobtainedwith computedtomography(CT)throughthe hamulusof the hamatebone; distal view (r.). palmares a Aa digitales communes; N medianus Mm lumbricalesa M flexor polhcisbrevis, rF . Caput superficiale

superlicialis, , t M. flexordigilorum Tendines I

\ tt

/

i M abductor digiti minimi

/

M flexor pollicis longus, Tendo, a -. ' Vagina iendinis

a M. gPponens

--

M abductor pollicis longus t - - -

olgllt mlnlml

- - Os metacarpiV

M opponens pollicis a - -

*-

profundus, c M tlexordigilorum Tendines

Os metacarpipollicis - --

M extensor pollicrsbrevis a - -

e M e x t e n s o r d i g i tm i inimi

M extensor pollicis longus, c -Tendo, Vagina tendinrs M tlexor oollicisbrevis. I Cad,utorofundum

'

\

r -M adductorpollicis

\

M interosseusdorsalisI a \

,'i

lll Os metacarpr

Fig. 443

/

,ti

a M interosseuspalmaris lll

dorsalislV t M interosseus lv Os metacarpr

palmansll t M interosseus

o M interosseus dorsakslll t M extensor digitorum,Tendines

Metacarpus,Metacarpus;crosssectionthrough the middle of the 3rd metacarpalbone;distal view (r., 95%).

n

Ptexusbrachiatis Z)

rFl

Innervation patterns of Plexus cervicalis and Plexus brachialis motor

sensory

Plexus cervicalis

c 1 - c 4( c 5 )

Ansa cervicalis Radixsuperior Radixinferior

Mm. infrahyoidei Skin supeliolof PI'ocmastoldeus Sl'X Foramen

- Plexustympanicus

Ganglion superius(lX) - - - -,-:.R . c o m m u n i c a n- s - - * - \ t .. i.,u, cumramoauriculari nerurvagl GanglioninleriuslVtl'y " R musculistylopharyngei R sinus caroticr /

- N tympanicus

/

A carotisinterna,Sinuscaroticus Glomuscaroticum/

\R,ringuares

\

\

\

\ \

/ A carotis communis

Rr tonsillares

Rr pharyngeates

Fig.467 Glossopharyngealnerve, N. glossopharyngeus IX]; lateralview (r.).

J '/1 Pons --+'--

.:\ vi

. R auricularis - R meningeus _ - R .c o m m u n i c a cnus m nervogrossopnaryngeo

- '

inferius(X) / Ganglion

--

Rr pharyngeales

N- vagus[X] -

--

N laryngeus supenor

N laryngeus--recurrens A subclavia -

A carotiscommunisTruncusbrachiocephaIcus Arcusaortae Parsthoracica aortae Truncusvagalis Posterior Plexus oesophageus Diaphragma Rr, hepatici Truncus coeliacus -

the Cisternabasalis Locationrin subarachnoid space jugulare Foramen Pointofentry base through:,the of skull "r: Distributionarea . Motor: - Musclesof the pharynx(cranialpart), M. levatorvelipalatini,M. uvulae, ::r:,,,, ' M. palatoglossus, M. palatopharyngeus, M. stylopharyngeus ' Sensitive: - Pharyngeal mucousmembrane ,:r: (cranialpart),palatinetonsil,tongue (posterior third) - Plexustympanicus, Tubaauditiva - Sinuscaroticus . Sensory: .,,r - Tongue(posteriorthird) ' ParasymPathetic: Glandulaparotidea(viaGgl.oticum) - Glandulae (posterior) ":ii linguales

j=-'

Sulcusretroolivaris Ganglion superius(X) - Fo?men jugulate

oliveandTuberculumcuneatum Pointof exit from Between the brain,

- Br cardiaci ceruicales - supeflores

N laryngeus recurrens

--2--Rt - - -

---

cardiaci ceruicalesinferiores Rr cardiacrthoracici

Plexuscardiacus

- - Rr bronchiales - - Plexuspulmonalis - .-.Truncusvaoalisanterior

: _--

-----*-

Hiatusoesophageus

Rr gasficiposteriores Rr coeliaci Rr renales

Fig.468 Vagalnerve,N. vagus[Xl; bothnerves; ventralview.

N. vagus [X] (SVE) Nuclei(qualities) . Nucl.ambiguus . Nucl.spinalisn. V (GVA) . Nucl.solitarius(SVA) . Nucl.dorsalisn. X (GVE) Pointof exit from Sulcusposterolateralis ,,thebrainii:'I Cisternabasalis Locationin the space subarachnoid jugulare Foramen Pointof e4.try throughttiCbase of skull Distributionarea . Motor: - Musclesof thepharynx(inferiorpart), M. levatorveli palatini,M. uvulae - Musclesof the larynx . Sensory: - Tongue(posterior third) . Sensitive: - Duraof Fossacranialisposterior - Meatusacusticus externus(m00nshaped, inferiorpart) . Parasympathetic: - Organsof the neck,thoraxand abdomenup to the ClNnoupoint BdHrrr

tcrantates2T5

Cranial Nerves,Nerv

N. accessorius[XI] R a d i c e s c r a n i a l e s- - = _

--

Truncus nerui accessorii

--

Radices sOinales---

\

N vaguslxl R internus \ R externus \ Foramen jugulare

Xucfei:(tlUli@s),: ' Nucl' ambiguusand Nucl' n' Xl (SVE) Pointof exit from ' Radicescraniales(dorsalof the olive) ' RadicessPinales the brain (Medullacervicalis- lateral) Locationin the subarachnold spac€ Pointof'Cntryin the baseof skull

Cisternabasalis

Foramenmagnum(Radicesspinales)

Disribiiiiiliilarea''

Mfl loriernocleidomastoideus - M. trapezius

Fig.469 AccessorYnerve, N. accessorius[XI]; lateralview (r.).

N. hypoglossus[XIII . Nucl.n. XII (SVE) Pointofre)dtfrom the braia r, in the Location subarachnoid space Pointof exit throughthe base of skull Distributionarea

.I'.1A) A

Radixsuperior- -a--l (Plexusceruicalis)

Radix inlerior --i (Plexus cervicalis) i

A n s a c e r v i c a l-i-sl -

\:. \

rR thyrohyoideus

Fig.470 HyPoglossalnerve, N. hypoglossus [XII]; lateralview (r.).

Sulcusanterolateralis Cisternabasalis

Canalisnervi hYPoglossi

. Motor: - Musclesof the tongue - M. styloglossus, M. hYoglossus' M. genioglossus

3 ? f)

Brain, Encephaton Corpuscallosum, Genu,

j Septumpellucidum

Falx cerebri \

A cerebrianterior -

..-t

.,

\---.-c

Bulbusolfactorius\ TractusolfactoriusChiasmaopticum N. ooticustlll -Tractusopticus N oculomotorius tltll .- _ _ (Plicap€troclinoidea _

''fi+itt:--:;iiffi- --"J:ffi ;::l; ---

anterior) N t r o c h l e a rtitsv l - _ _ _ _ _ N a b d u c e n s t v-t-l _ _ _ _

Nucleusruber

N t r i g e m i n ut vs l - - _ _ _ _ _ Tentoriumcerebelli ---

Colliculus superiorsinister

_ _ _

Col[culiinferiores

N .f a c i a ltivsl l l - - - - _ _ _ _ ' N . v e s t i b u l o c o c h l e a r i-s - -

- ---

.- tl

--l

Velummedullare superius Sinusrectus

[vil|]

Pedunculi cerebellares Vermis cerebelli

Ventriculus quartus - - r:

A . b a s i t a r i -s- Velummedullareinlerius 'N accessorius [Xl],Radicesspinales/

--

Plexus choroideusventriculiouarti

Apenura mediana ventriculiquarti

- - - rubercurum ;rl;=)1f, srac,re )=r)a\,Y;:---==->-!':l---Tubercurumcuneatum rJf $; .r: F t::t --:

\', - -=i \ - *--.j--i-

Fig' 471 course of the cranial nerves' Nn. craniales,through the subarachnoidspace;

-'_/

tu0er(

- - - _

Medulla spinalis

the left halvesof the cerebrum,cerebellumand tentorium of the cerebellum have been removed, dorsosuperiorview (1.).

The parasympatheticgangliaof the head Thesegangliacontain,first and foremost,perikaryaof post_ superius run through without interruption. A series of ganglionic,parasympathetic nerve cells. preganglioniccells small branchesof the ganglionsupply the secretionof the from the accessory nucleusof the oculomotornerve and the lacrimalglands,as well as the mucousmembranesor the inferiorandsuperiorsalivatorynucleiendthere. glands of the sinuses,of the nasal cavity and the palate Fibresfrom the accessorynucleusof the oculomotornerve etc. (Nucleusaccessorius nervi occulomotorii), which reach the The submandibularganglion alsogetsparasympathetic fibres ganglionover the N. oculomotorius (Radixparasympathica), from the Nucleussalivatoriussuperiorvia facial nerve and the are convertedin the Ganglionciliare.Sensoryfibresfrom the Chordatympaniwhichjoin the lingualnerve.Syrnpathetic roots nasociliarynerve(Radixsensoria)and the sympathetic fibres comefrom the ganglioncervicalesuperius.Thepostganglionic of the internalcarotidplexus(Radixsympathica)passit without fibres reach the submandibularand sublingualglands via transformation.Theparasympathetic fibresgo (via short ciliary lingualnerve. nerves)to the ciliary muscle (accommodation) and to the Parasympathetic fibres reachthe Ganglionoticum from the M. sphincterpupillae(constriction of the pupil). inferior salivatorynucleus over the trunk of the glossoParasympatheticfibres run ftom the Nucleus salivatorius pharyngeal nerveand the tympanicnervewhich emergesfrom superioroverthe trunk of the facialnerveto the greaterpetrosal it. The sympatheticroots come in turn from the Ganglion nerve, then into the nerve of the pterygoidcanal to the cervicale superius.The postganglionic fibres anive in the pterygopalatineganglion. Sensoryfibres from the maxillary auriculotemporal nerveoverthe R. communicans and go on to nerve and sympatheticfibres from the Ganglioncervicale the parotidgland.

277 / Capsulainterna

/ .t

Ventriculus lateralis,Cornutemporale

lateralis, Ventriculus cornufrontale

/

A. carotisinlerna, Parscerebralis

- -

A oohthalmica

-:

A cerebriposterior \C i s l e r n a a m b i e n s :- - - - . - - - - < . Pedunculuscerebri

A carotisinterna, Parscavernosa

- Gangliontrigeminale

\

/

N. ophthalmicus [V/3]

N maxillaris[V/2]

N mandibularisl Iv/3]

Fig. 472 Courseof the cranialnerves,Nn. craniales,through the middlecranialfossa,Fossacranii media;

the temporal lobe has been lifted and partially removed; lateral view.

V cerebelli --

I

N tacialis[Vll]

- Sinustransversus N t r i g e m i n u[ V s ]- -

Pons\ N vestibulocochlearis[Vlll]

Canalis nervi lacialis

-

N glossopharyngeuslxl

N vaousIXI /

=4..t-l

--.__E /.

\

/,

i N hypoglossus [Xl|]'

\

N accessorius[Xl]l

Fig. 473 Courseof the cranial nerves,Nn. craniales,through the posteriorcranialfossa,Fossacranii posterior;

For"t"n stylomastoideum

sinussigmoideus

Duramatercranialis

the left hemisphereand the tentorium of the cerebellumhave been partially removed; view dextroposterior

27

8

Brain, Encephato

Sinussaginalis superior:_

Laminainterna Granulationes\ arachnoideae \

A. meningea media, R frontalis

L a c u n a e- - - laterales

-I

Granulationes arachnoideae

Duramater cranialis

\

Fig.474 Cranialdura mater,Dura matercranialis; the cranialvault has beenremoved;the superiorsagittal sinus and some lateral lacunas.Lacunaelaterales.have been exposed; suDenorvtew.

A. meninoea media. R. parietilis

279

Sinus sagitlalis- suPeflor

Vv mediaesupediciales cerebrl - A sulci centralis

Vv supeflorescerebfl, Vv parietales

-

Rr.paracentrales

- A sulci poslcenvalis

- A parietalis Posterior Lacunae laterales

- R gyriangularis

Vv superiores cerebri,Vv occipitales

R parietooccipitalis

Fig.475 Superficialarteriesand veins of the brain; the cranialdura mater has beenremoved;the superior sagittalsinus has beenexposed; supenorvlew. arachnoideae, The arachnoidgranulations,Granulationes are the draining sitesfor the cerebrospinalfluid.

280

Brain, Encephato

cerebri / Fissuralongitudinalis

/ Arachnoidea mater cranialis

Vv superiores cerebfl, W parietales

\

Fig.476 Brain,Encephalon, with arachnoid, Arachnoideamatercranialis; superiorview. * also termed PAccHroNr's sranulations

arachnoideae* Granulationes

Meninges 28I

Bulbusolfactorius\

/ Tractusolfactorius

Hypophysis \

/ N. opticuslll

- A carotisinterna

Cisternainterpeduncularis

--

--

N aMucenslvll --

N. trigeminus [Vl

+ -

N. lacialis[vlll

- - N. vestibulocochlearis tvilrl --

N glossopharyng€us

ttxl ---

f i --

--

N vagus[X] N. accessorius [Xl]

Arachnoideamater cranialis

Pia matercranialis

\ Medullaoblongata

\ A. vertebralis / Hemispheriumcerebelli

Cisternacerebellomedullaris

with arachnoid, Fig.477 Brain,Encephalon, matercranialis; Arachnoidea inferiorview.

Brain, Encephato

282

A. communicans anterior\ Chiasmaopticum\ A frontobasalis lateralis1

\

z Bulbusollactorius

\

medialis / A. trontobasalis

\

/ Tractusoltactorius

/ N.opticus ul A. cerebrianterior,\ Parsprecommunicalis All lsegmentum Areasubcallosa\

,, A.carotisinterna posterior / A. communicans

\

N oculomotorius !lll

//

z A.cerebriposterior, Parspostcommunicalis lsegmentumP2l / A suoeriorcerebelli N trigeminus[V]

,z

z A. labyrinthi

A. cerebrimedia,- - Parsinsularis [SegmentumM2]

N facialislvlll

--' Lobusilemporalis

ryilrl -

Substantiaperforata poslerior A. cerebriposleaior,/ Parsprecommunicalis Pll [Segmentum

--

-l

A. superior' cerebelli

Plexus choroideus ventriculiquarti

N.glossopharyngeus

- A inferior anteriorcerebelli

A. basilarisN. abducens[Vl] /

/

N. hypoglossus[Xll]

V/454

N vestibulocochlearis

--

A. choroidea -anterior

-

Hemispherium cerebetli

\

A vertebralis

t

/

/ A. spinalisanterior

/ ,'

N vagus[X]

N. accessorius[Xl] '

'

Fig.478 Arteries ofthe brain; the temporal lobe has been partially removed; inferior view.

A. inlerior Dosterior cerebelli

Medullaspinalis

See Fig. 482 regarding the segments of the arteries of the brain.

/ A. communicans anterior -- Aa centralesanteromediales -" Aa. centrales anleromediales A. carolisinterna,Parscerebralis: _

- -

A communicans oosterior- - - -

\--- . -

--

Aa.centralesanterolaterales

--- A. choroidea anlerior - R. chiasmaticus nerviouutultu( R. ilervt n, oculomotorii

A.;;i;';;;;;ri;

- R.hypothalamicus t -Aa.iuberiscinerei \ '. A superiorcerebelli Aa ponlis- A. basilaris- A . v e r t e b r a l -i s- A. soinalisantsrior-

Fig.479

\

\

'Aa

Aa. centrales posteromediales

mesencephalicae

-- - A labyrinthi A inferioranteriorcerebelli - -

A inferior oosterior cerebelli

Arterialcircleof the cerebrum,Circulusarteriosuscerebri(Wruts).

283

Figs.480 a-g Arterialcircleof the cerebrum, Circulusarteriosuscerebri,variations. a-c Variationsin the anteriorpart d-f Variationsin the posteriorpart unitevery far caudal g Aa.vertebrales

A labyrinthi**

N trigeminus [V] \

cerebelli\ A suDerior

\

t A. cerebriPosterior, 7- Parsprecommunicalis / N oculomotorius [ll|l

A basilaris

,N vestibulocochlearis

Nilrl N tacialis [Vlll

Aa.pontis

Ftoccutus

--Plexuschoroideus quarti' ventriculi -N .v a g u s[ X ] - --) N glossopharyngeus [X]

\l.-.-.-N

-. N accessorius [Xl],Radicescraniales / N hypoglossus [Xll]

\

cerebelli A inleriorposterior lA

Fig. 481 Arteries of the rhombencephalon,Rhombencephalon; the midbrain has been sectioned; dextroinferior view. The anterior inferior cerebellarartery usually (in about B0%)

abducens[Vl]

A inferioranleriorcerebelli

Parsintracranialis vertebralis,

passesabovethe abducentnerve, N' abducens,but in this figure at one point it also runs beneath it ' clinical: BocHolLrK's structure of the choroid plexus * * In about 15%the labyrinthine artery, A labyrinthi, originatesdirectly from the l-.asilararterY

3*h"4 ,, Rr paracentrales R frontalisposteromedialis--

7 R precunealis

Rr lrontales--

Sulcusparietooccipitalis

,

R parietooccipitalis

--

R l r o n t a l i s- intermediomedialis

- -

R parietooccipitalis

- -

R parietalis

--

R calcarinus

*-

A occipitalismedialis lsegmentum P4l

- / A callosomarginalis

\

/ A trontobasalis medialis

A occipitalislateralis {Segmentum P3l

\ H corporiscallosidorsalis

/ A cerebrianterior, Parspostcommunicalis 42] [Segmentum

\

A cerebri media. Pars sphenoidalis[Segmentum M1]r

I

R occioitotemDoralis

A cerebrianterior

I

Parspostcommunicalis A cerebriposterior, P2] [Segmenlum

A cerebrimedia

Fig.482 Arteriesof the medialandbasalsurfaces of the cerebrum; medialview.

A cerebriposterior

I

SeeFig.478 regaldingthe segmentsof the arteriesof the brain.

Falx cerebri A callosomarginalis

/ ,'

/

callosum,Truncus /, Corpus

,

lateralis,Parscentralis Yentriculus

lL/

Fornix, Corpus

/

/

/

Plexus choroideus venlflcultlateralts

Capsulainterna Capsulaexterna

/

Capsulaextrema

i:-

--

\1

-\'

-

Aa insulares

/g

A cerebri media, Rr terminales

.- -

Aa centrales anterolaterales

.--- Corpus amygdaloideum

i V basalis/ Plexusbasilans/

A basilaris/

\

A cerebrrposterior Cisterna pontocerebellaris

\

A cerebri media, Pars sphenoidalis

Pons

Fig. 483 Arteriesand veins of the brain, Aa. et Vv. cerebri; frontal section;

the arteriesare shownon the right, the veins on the left; dorsalview.

MedianSecttonof theBrain

285

Adhesio interthalamica

Truncus Corouscallosum, Foramen inlerventriculare \

Septumpellucidum\

\

Corpus I Fornix, terlii ventriculi ctroroideus Plexus | 1 ventriculitertii Tela choroidea I I I pinealis / Glandula

Ventriculuslateralis,Cornufronlale\

Splenium / Corpuscallosum, /, V magna cerebrl

/ A. cerebnPoslerior

A. cerebrianterior,\ Parspostcommunicalis,\ A. oericallosa

/ Sulcusparieto/' occipitalis

Genu - - Corpuscallosum,

I -\: Corpuscallosum,Rostrum- -

t -\:i Commissuraanierior - L a m i n a l e r m i n a-l -i s-

--

anterior- .A communicans HypothalamusChiasmaopticum/ / A. carotisinterna

Sulcus calcarinus

.- Commissura poslerior - Aqueductus mesencephali

/

- Tectum mesencephali \

/ A basilaris /' ,/ Thalamus/ l' Pons / ,/ A vertebralis'

Fig. 4S4

Medial surface of the hemispheres, Facies medialis

Vermis cerebelli

\ Ventriculusquartus - -

Medulla oblongata

Hemispheriumcerebelli, Tonsillacerebelli

\ Canaliscenlralis

hemispherii cerebri; diencephalon, Diencephalon,

andbrainstem,Truncusencephali; anteriorly; mediansection,staggered viewedfromthe left.

Fig. 485 Diagramof the centralnervoussystem; mediansection.

' Theseparts of lhe brain togetherconstitutethe brain stem, Truncus encephali

286

Brain, Encephalo Fissuralonglludinalis cerebri

Polusfrontalis \

\

/ Sulcusfrontalissuperior

\

Gyrustrontalissuperior \ / Sulcuslrontialisinferior

Gyrusfrontalismedius -

- Sulcus prec€ntralis

Sulq/s centralis

Gyrusangularis--

Lobufusparietalissuperior .'

Sulcus intraDarietalis

-

Lobuluspariotalisinletiot /

--Srl"u" p"rigtooccipitalis I

I I Polus occipitalis t

Fig.486 Cerebrum,Cerebrum; the leptomeninges havebeenremoved; superiorview. Thesizeof the gyri canvary greatly. In this brain of an elderlypersonthe two Gyri frontalessuperiores vary enormously

BasalSurfaceof theBrain

Inlundibulum \ Sulcio.bitales\

/ Sulcusollaclorius

Gyriorbitales\

t \

N. opticusfll \

287

. Bulbusolfactorius '

, Tractusolfactorius

Hvooohvsis Polustemporalis\

\\

Substantiaperlorata \ anterior - N. oculomotorius [l] -

\

Gvrusoarahippocampalis, '' ljncus C o r p u s m a m i l l a -r _ e_ _

-

Gyrusoccipito- .- .- - .-i temporalis lateralis .j.

Fossa interpeduncularis [Vl, _- N. trigeminus Radixmotoria

-----rt inferior I ",i31:li: -

N. mandibularis [V/31

Pedunculuscerebti - - -

G y r u -s- - parahippocampalis

----

Ganglion trigeminale

----

N trochlearisllvl

-----

N trigeminuslY - -

Pons

----

N i n t e r m e d i u- s- - N facialis ---

--

tvill N vestibulo-cochlearis lvllll / Lobus / llocculonodularis, Flocculus .' / Hemispherium cerebelli Plexuschoroideus/ quarti ventriculi

N.trigeminusM, Radixsensoria N. abducens [Vl]

- - Hemispherium cerebelli - Oliva \ Pyramismedullae oblongatae

,// ,/

N glossopharyngeus lxl /

,'

\

/

N vagus[Xl / N hypoglossus [Xll] /

\ Tonsilla cerebelli

/ll

N. accessorius[Xll /

Medulla oblongata, Fissura mgdiana anlerior

t

i tt

.t,\

t Polusoccipilalis

I

t nervicervicalis Filaradicularia i tcll t / pyramidum Decussatio

\ Medullaspinalis Vermiscerebelli

Fig. 487 Cerebrum,Cerebrum,brain stem, Truncus encephali,with cerebellum,Cerebellum,and cranial nerves, Nervi craniales; the leptomeningeshave been removed; inferior view.

288

Brain,Encepharo , Sulcuscentralis Lobustrontalis \

Fissuralongitudinalis- cerebri Lobusfrontalis*

/

/Lobusparietalis

Lsulcusparietoz'occipitalis b.

SulcuscentralisPolustrontalis - Polus occipitalis Fossalateralis/ / cerebri I / Polustemporalis

parietooccipitalis LobusocciDiialis-

\ Lobus occipilalis

\

iLobusremporatis\ lncisura I prsoccipitalis lsulcuslateralis

Polusoccipitalis/

Lobicerebri; Fig.489 Lobesofthe cerebrum, lateralview.

Fig.488 Lobesof the cerebrum,Lobicerebri; supenorvlew. Poluslrontalis\ Lobusfrontalis\ Fissuralongitudinalis\ cerebri

\ tGyrus

Polustemporalis-_

Lobuslrontalis\

Fossa lateraliscerebri \ Lobustemporalis- --Dienc€phalon Lobuslimticus,- Gyrus parahippocampalis Sulcuscollateralis- Sulcushippocampalis

cinguli

/. Lobus limbicus -/ Sulcuspariotooccipitalis

Polusfrontalis

- Sulcus calcarinus - Polus occipilalis

-

Mesencephalon -

--

Incisura preoccipitalis /

/ LobusocciDitalis Polusoccipitalis/

//

Fig.490 Lobesofthe cerebrum,Lobicerebri; inferiorview.

Lobrc occipitalis

'\ lLobus temporalis lncisurapre' Diencephalon/ i! | Sulcushippocampalis/ | Sulcuscollateratis

Fig.491 Lobesofthe cerebrum,Lobicerebri; medialview. Operculum lronlale , Sulcuscentralis parietalis / Lobus -

\

Fig.492 Development of the bnain; embryo; modelof the brainof a 2-month-old mediansection. compareto Fig.485.

Operculumparietale

Lobustemporalis

ofthe brain; Fig.493 Development brain of an approximately4-month-oldfetus (crown-rump length,20 crn); lateralview.

Gyriof the CerebralHemisPheres

Margosuperior \

289

/ Sulcuscentralis

/ Sulcusintraparietalis

/ Sulcuset Fossalateraliscerebri

\

preocciPitalis Incisura

Fig.494 Gyri,Gyri,ofthe cerebralhemispheres; lateralview (1.).

I Margosup€rior

- -

\, ft./ -*la'Gyrustemporalisinferior \

Margoinferomediatis

Gyri,Gyri,ofthe cerebralhemispheres; Fig.495 medialview (r.).

lsthmusgyri cinguli

Encephalon

Operculumlrontale;Operculumparietale \ Gyrustrontalisinferior,, ', Parsopercularis

,'

,, Gyruspostcentralis , Sulcuspostcentralis

Gyrustrontalis superior\

, Sulcuslateralis,R poslerior Sulcusintraparielalis

_--

Gyrusfrontalismedius-

Gyrussupramarginalis

_ --

Gyrusangularis

_-Polusfrontalis-

>--

Lobulusparietalis supeflor

Gyrusfrontalis inferior,-Parstriangularis Gyrusfrontalisinlerior,'Pars - - orbitalis --( Ranterior/ Sulcuslateralis* - - I t R. ascendens/

parietooccipilalis --.-

Sulcustemporalis supenor

Polustemporalis, Gyrustemporalissupeior /

,, ----

i Sulcustemporalissuperior/ GyrustemporalismediusI

'

Polusoccipitalis

\ Incisurapreoccipitalis Sulcustemporalisinferior

Fig.496 Gyri, Gyri, and sulci, Sulci, of the cerebral hemispheres; lateralview (1.). * fissure of SYLvrus * * fissure of Ror.ANDo

insulae / Sulcuscircularis Sulcuscentralis insulae

/ Gyruslongusinsulae

Gyri breves insulae

/

\ Incisurapreoccipitalis ' Lobuslemporalis

Fig.497 Gyri, Gyri, and sulci,Sulci,ofthe cerebral hemispheres; the parts which coverthe insula,Opercula,of the frontal,parietaland temporallobeshavebeenremoved; lateralview (r.).

29r

Gyrtand Sulciof the CerebralHemispheres

Fissuralongiludinalis cerebri , Polusfrontalis\

i

Gyrusrectus \

/

Sulciorbitales

7 Tubercinereum

----

cerebri Fossalateralis Trigonumollactorium - -

Fossa-inlerpeduncularis

Sulcustemporalis inferior

Corpus mamillare

---

Gyrioccipito-- temporales medialiset lateralis

--

-Gyrus -lemporalis inferior Substantia'-perlorata Posterior -

Pedunculus c€r€bri

Substantia nrgra

Sulcus hippocampalis

Sulcus collateralis

Gyrus / parahippocampalis occipitotsmporalis lslhmusgyricinguli/ \ Teomentum meisencephali

Gyruscinguli/

\ Tectummesenceohali, ColliculussuPerior

Gyruslingualis/

\ Aeueductusmesencephali \ Corpuscallosum,Splenium Polusoccioitafis/

' Sulcuscalcarinus

Gyri, Gyri, and sulci,Sulci,ofthe Fig.49S cerebralhemispheres; the midbrainhasbeensectioned; inferior view.

292

Brain, Encephato

I JI

Fig.499 Cytoarchitectonicallydefinedcorticalareas of the cerebral hemispheresaccordingto Bnoou-lNN; individual areasare numbered;the different symbols indicate different cell types; lateral view (1.).

20 Fig. 500 Cytoarchitectonicallydefined cortical areas of the cerebral hemispheresaccordingto Bnoou.a.Nn; individual areasare numbered;the different symbols indicate different cell types; medial view (r.).

FunctionalCorticalAreasof the CerebralHemispheres

293

Gyrusfrontalisinferior,/ ParsoDercularis \

Fig. 501 Functionalcorticalareasofthe cerebralhemispheres accordingto FoEnsrEn; lateralview.

I

ffiffi

primarymolorar6a se@ndarymolor area

ffi

I

pnmarysensory area secondarysensoryarea

Gyrus temporalisttanevercusantelbl

Theprimary acousticregionO extendsoverthe upperrim of the temporallobeontoits internal surface.

I

ffiffi

I

ffiffi

primaryauditoryarea s€condaryauditoryarea primaryvisual atea s€condaryvisual atea

/ Gyrus prec€ntralis

Flg. 502 Functionalcortical areasofthe cerebral hemispheresaccordingto FoERSTER; medial view.

29

{

,**, Encephaton

c h o r o r d e av e n t r i c u ltie r t i i

F o r n i xC, o l u m n a- - Gyrusparaterminalis C o m m r s s uar a n t e r l o -r - * A r e a s u b c a l l o s- -at

*

---r-1'fela ---l-

-Thalamus

------

- S t r i a m e d u l l a r i st h a l a m i

- S u l c u sh y p o t h a l a m r c u s ---=- - - - - Commissura habenularum

Lamina t e r m i n a l i-s- - F Hypothalamus - Recessus supraopticus B e c e s s uisn f u n d i b u-l-i Chiasmaopticum- Corousmamillare sinrstrum-

- Becessus suoraoinealis

- Recessus pinealis - Glandula pinealis - Commissura postenor - .-Tectum

Cislerna chiasmatica -

mesencephali

l- -Tegmentummesencephali - Aqueductus mesencephali interpeduncularis Cisterna

A cerebriposterior-- Sinusintercavernosus Adenohypophysis

Lobuluscenlrahs -Velum medullare superius

-Neurohypophysis A basilaris'

- Pons

Plexusbasilaris-

Fig. 503 Third ventricle,Ventriculustertius; mediansection; medialview.

Fornix,Corpus \ Corpuscallosum, Rostrum- - _

Foramen interventriculare

Adhesio interthalamica

/Thalamus.

Columna fornicis - Commissura anterior - -

- - Nucleusdorsomedialis , //, / .{

-=-----::--: Area hypothatamicd --.--

Area hyPothalamica

-N u c l e ip r e o p t i c i - -

---:_____

NUCIeUSOOr Nucleus dorsalis hypotharaml

lateralis

- - Fasciculus mamillothalamicus

Nucleusoantenor

Sulcus hypothalamicus Tractus paraventric.ulg- -----hypophysialis

--_

Nucleusposterior hypothalami

suprachiasmaticus

Fasciculus mamillotegmentahs

------

Becessussupraoplrcus --

Chiasmaopticum Nucleussupraopticus N opticuslll

( N u c l ecio r p o r i s

--]--

mamillaris) .-

A hypophysialissuperior (A carotisinterna, Parscerebralis)

--

Tractushypothalamohypophysialis

-

-

.-Adenohypophysis

:--

Vv portales hypophysiales A hypophysralis inferior(A carotisinterna,Parscavernosa)

Nuclei tegmentales

-*--

-

\ -

Neurohypophysis Fig. 504 Hypothalamus; w i t h s e m i - t r a n s p a r en ut c l e i ; m e d i a lv i e w .

Nucleus ruber Subslantiapertorata posteflor Nucleus ventromedialis hypothalami

Nuclei tuberaleset arcuati Tractus supraopticohypophysialis

Nucleiof the Thalamus

295

Capsula interna

t"

Nucleireticulares

?/

/

/l

Nucleianteriores

k

/

Nuclei mediales

-

Nuclei mediani;Adhesio interthalamica

b left cerebralhemisphere;lateral view.

ta ttt )

\\

Nucleusparafascicularis \ \

)

I I I I

1 1

Nual"raa"ntromedianus Nuclei dorsales: Nucleus posterior; Nuclei pulvinares (Nuclei metathalami) Nucleus corporis

geniculati lateralis; Nucleuscorporis geniculati medialis

laleralis,/ Ventriculus Cornuoccipitale

transversesectionthrough the left cortical hemisphere;superiorview.

c right cerebralhemisphere;medial view.

Figs. 505 a-c Nucleiand corticalprojectionsof the thalamus. The nuclei and the cortical areaswhich belong togetherare shown in the samecolour.

Nucleuscaudatus, Corpus.

Fibraecorticorubrales; Fibraecorticosoinales: Fibrae Fibraecorlicoreticularos; Fibraelhalamoparietales corticothalamicae:

Genucapsulaeinternae, \ Fibraecorliconucleares \ \ Thalamus \

Badiationes thalami

centrales Fibl.ae temporopontinae

- _-

- -

->--

Radialiones thalami posteriores Fibrae Darieto

occipitopontinae - T r a c t u s o p t i c-u-s- -

- -

Pulvinar thalami

--colliculussuperior - Pedunculus cerebri---

inferior Colliculus

Fig. 506 Thalamic radiations, Radiationes thalami, and internal capsule,Capsulainterna; frontal section which has separated the two parts; lateral view (1.).

Radiatiooptica

Radiatioacustica

Crus posterius capsurae tnternae

29

6

Brain, Encephato

.\s\--/-

Ventriculus lateralis, Cornulrontare

.z

{:"';

Fissuralongitudinalis cerebri .z

(Cenlrumsemiovale)

Commissura anlerior

llll ./ N. oculomotorius

Chiasmaopticum - //

N trochlearis lvl

_-

N trigeminus [V]

N abducens[Vl]

-.-

--

-----.-

Plexuschoroideus ventriculi ouarti -

Hemispherium cerebelli -

N t a c i a l i s[ V l l ]

- N vestibulocochlearis [Vltll N. glossopharyngeus [tX]

- N. vagus [X]

/

- N accessorius [Xt]

Medulla oblongata /

\ N hypoglossvs [Xtt]

Fig. 507 Anteriorrostralcommissure, Commissura anrenor, andbrainstem,Truncusencephali; the basalpartsof the cerebrumhavebeenpartiallyremoved; inferiorview Chiasmaopticum- -

--

Inlundibulum. t u o e r c t n e r e u m- _ _ _

-----/'

Trigonum olfactorium

--

|yl .'/t

>-1 C o r p u s m a m i l l a r- e ___.,

N. oplicusflll

l.

N a |

, - tt,''

r,

--

SubstantiaDerlorataanterior

/-

Tractusopticus

ii.-- - /

SubstantiaperforataDosterior

\ Aqueduclus mesencephal

Fig. 508 Midbrain, Mesencephalon, and diencephalon, Diencephalon;

the midbrain

inferior view

has been transversely

sectioned:

Mesencephalon Midbrain, 297 Glandulapinealis*\ / Teclummesencephali

Colliculussuperior\ Stratagriseacolliculisuperioris\ Brachiumcolliculiinlerioris\

\

Aqueduclusmesencephali--

mesoncephali ' Tegmentum

Substantiagriseacentralis- -Formalioreticularis Pedunculus cerebri

compacta fPars Substantia I nr9ra lpars reticularis - Cruscetebri

Nucleusruber /

I

Fossainleroeduncularis

Fig. 509 Midbrain,MesencePhalon; crosssectionat the levelof the superiorcolliculi; inferiorview. * also termed cerebral ePiPhYsis

/ Stratagriseacolliculisuperioris medialis Fasciculuslongitudinalis Nucleusmotoriusnervilrigemini

/

/ Nucleusaccessoriusnervi oculomolorii - Nucleusnervioculomotorii

- Corpusgeniculatummedial€ Lemniscusmedialis-

- Nucleusnber -/

Tegtnontum.. mesenc€pna[

-

paristoFi pontinae; Fibraetemporopontinae

- Fi corticoEinal€s; corti@nu (FilaradbularianeNi oculomotorii) Fibraelronlopontinae

Nucleiand fibres of the midbrain, Fig. 510 Mesencephalon; schematiccrosssecdonat the lenelof the superior colliculi.

298 Ventriculus tertius\ Recessus suprapinealis \\ \

/ C o m m r s s u r ap o s l e r i o r / .l

Trigonum habenulare : G l a n d u l ap i n e a l i s - _

Stra lermrnairs

/ ,'

/7

/ //

/

-

Iaeniachoroidea

4; - -

Brachiumcolliculiinferroris ---

- -

-I

- Trrgonum lemniscilateralis Frenulumveli medullarisSuperiorlg -

-

- -

-

N trochtearis[tV] -

-

Metalhalamus, Corpus geniculatummediale

M"t"th"r"rrr, Corpusgeniculatum laterale

Colliculus superior

Colliculus inlerior Pedunculus cerebeltaris medius

Pedunculus cerebellaris suoerror--

Thalamus, P u l v i n a rl h a l a m i

Velummedullare superius

Fossa rhomboidea,Eminentia medialis'

Fig. 511 Midbrain,Mesencephalon, and pineal body, Glandulapinealis; dorsosuperiorview.

Septumpellucidum\ Corpuscallosum, Truncus1 Nucleuscaudatus. Caput -_._

/ Fornix,Columnae

\--

--

ForamenInrerventriculare --

laleralis, Cornufrontate / Venlriculus /

//

(Recessus triangularis) anterior - / Commissura

Tuberculumanterius lhalami --

/ Ventriculus tertius .-.--+_ Striaterminalis

Btachiumcolliculi superioris

--

Laminaaflixa +--a T a e n i a c h o r o i d e a- - Trigonum habenulare ---

-'

Colliculus superior

.'.-

Corpusgeniculatum mediale

- posteiot Commissura ---

G l a n d u l a p i n e a l-i-s-

Corpusgeniculatum lalerale

Thalamus, Pulvinarthalami /

-

Pedunculus cerebri/ N trochlearis flVl

B r a c h i u mc o l l i c u liin f e r i o r i s

Colliculusinterior

/

Frenulum velimedullans supenons

-

Vermis cerebelli,Lingula cerebelli -

Tela choroidea ventriculiquarli /

\1

tt

Fossa rhomboidea,Sulcus medianus /

\1

/ Aperturamedianaventriculi quart Tuberculum cuneatum/

ta

tt /i

/ Fasciculus cuneatus

\ 1

M e d u l l as p i n a l i s

\ \

Pedunculus cerebellaris superior

\ - Froccurus .

\ \

t

Pedunculuscerebellarismeotus

Pedrnculra cerebellarisintenor

Peduncutus floccculi

quartl Ap"rtrr" lateralis ventricutr

Plexuschoroideus quarti ventricuti

gracile Tuberculum gracilis Fasciculus

Fig. 512 Brainstem,Truncusencephali; the Corpuscallosumand the majorpartsofthe cerebellum have beenremoved;the Telachoroideaof the fourth ventriclehas been split in the midlineandfoldeddownon the right side; dorsosuperiorview.

BrainStem,Truncusenceqhali

veli - - Frenulum medullarissuPerioris

Brachium colliculiinferioris --

Fig. 513 Rhomboidfossa,Fossarhomboidea; v i e w o f t h e f l o o r o f t h e f o u r t hv e n t r i c l e ; the cerebellarlteduncleshavebeenremoved; dorsosulleriorvien'.

299

- - Velummedullare superlus

C o l l i c u l u si n l e r l o r - - -

ce Pedunculu s r e b r i- - -

Locuscaeruleus

--

N t r o c h l e a r i s l l v-l- -

Eminentia medialis

--

- Colliculus lacialis PedunculuscerebellarissuPeflor

- - FoveasuPerior Pedunculuscerebellarismedius

Sulcuslimitans Pedunculuscerebellarisinlerior

-

\ Aperturalateralis quarti ventriculi

Sulcusmedianus

\ Areavestibularis

quarti / ventriculi Striamedullaris Velum medullareinferius

/

Trigonum nervi hypoglossi

\

Fovea inferior

/

Trigonum nervi vagi

\ Area Postrema

cuneatum Tuberculum

\ Funiculus lateralis Glandula Pinealls

\

Brachium colliculisuPerloris \ Corpus geniculatummedrale \ Brachium colliculiinlerioris \

/ Sulcusintermedius Posterior Sulcus medranus

\

Corpusgeniculatumlalerale

Tractusopticus - -

--

sR-

Pons Radrxmolorra N. trige-i minus[V] [ Rad* sensoria

N l a c r a l r s{ V l l l - - - ; --

N v e s t i b u l o c o c h l e a rIiVs l l l ]

--

--

. I Radices craniales N accessoflus l fYil ' "' I( RadrcessPtnales

N trochlearis {lvl

--

suPerrus Velummedullare

--

Pedunculuscerebellarlssuperror

--

s edrus P e d u n c u l u sc e r e b e l l a r i m

- -

PedunculuscerebellarrsInlerior

\ Fasciculus gracilis

-

Fossa rhomboidea Sulcus medianus

cuneatum Tuberculum Tuberculumgracile

F i g . 5 1 4 B r a i ns t e m ,T r u n c u se n c e p h a l i ; obli(luevieu of the floor of the fourth ventricle; the cerellellar[)eduncleshavebeenremoved; lateralvieu.

Radix anterior I N c e r v r c a | s[ C 1 ] I I Rad,, posterior

Walls of the tburth ventricle Roof/anterior wall

VelummedullaresuPerius

Floor

Fossarhomboidea Velummedullareinferius;Plexuschoroideus //'

G Y r u sc r n g u l i

Ventticuluslateralls, Cornu lrontale

-'

l l-

,

--

C o r p u sc a l o s u mR. o s t r u m

,7 ------' /\

Cavum sePti Pellucidi

CaPUt - - - Nucleuscaudatus,

Septum Pellucidum F o r n i x ,C o l u m n a Foramen interuentrlculare CaPsulainterna

Stria termrnalls Ventriculuslateralrs, Pars centralls Fornix,CorPUs Insula ILobus insularis]

F o r n i xC. r u s - Plexuschoroadeus lateralis ventriculi -FimbriahippocamPr -- .-

Hippocampus--

Tela choroideavenlriculiterlii

collaterale-Trigonum

Calcar avis -

Ventflculuslateralis, / Cornu occipitale

Fig.537 Lateralventricles,Ventriculilaterales; t h e u p p e rp a r t so f t h e c e r e b r ahl e m i s p h e r easn d the Corpuscallosumhavebeenremoved; suoertorview

$4x

Fissura longiludinaliscerebrr \

EPendYmum -- Ventriculuslateralis,Pars centralls

lateralis- .ventricuk Plexuschoroideus Nucleus caudatus.CorPUs - - -

Laminaatlixa ---,

lnatainus -

--

V thalamostriatasuperiol

--

F o r n i xC, o r P u s

* -

Plexus choroideusventriculiterlrl

Tela choroidea ventriculitertli /

Fig. 538 Centralparts,Partescentrales,of the lateralventricles' Ventriculilaterales,and the third ventricle,Ventriculustertius; schematicfrontal section.

Brain, Encepharon

3I4

F o r a m e n- - - - I - - inlpruanlrr.r

rlr /a

ILobusinsularisl

------. -

Cauda Fornix,Crus - --

Nucleuscaudatus, Corpus Plexuschoroideus ventriculi tertii Tela choroidea ventriculitertii

.--. Hippocampus Trigonumcollalerale ---

Ventnculus lateralis,-Cornuoccipitale

4s+r 537/l Fig.539 Lateralventricles,Ventriculilaterales; the Corpuscallosumand the columnsof the fornix havebeendissected; supenor vlew.

Taenia fornicis \ Taenia choroidea \\

\\

--

Fornix,Columna

_-

Forameninterventriculare

/ - _ _

Taenialhalami (Fissuratelodiencephatica)

Fig. 540 Taeniae ofthe Plexuschoroideus ofthe cerebrum; superiorview.

-

V interna cerebri

-

Glandula pinealis

-

V magna cerebri

-

Vermis cerebelli

Lateral Ventricles,Ventriculilaterales,anrl

Ventricle.Ventriculustertius

V e n t r i c u l u lsa l e r a l r s , C o r n uf r o n t a l e C a v u m s e p t rp e l l u c r d l

S e p t u mp e l l u c r d u m- - -

----j

,n I

!

- N u c l e ucsa u d a t u sC,a P U t

--

F o r n r xC o l u m n a

i'

F o r a m e n n t e r v e n l r i c u l a r e- - -

V,

supenor V thalamoslilata

- - - -'

Adhesro intenhalamica'

T a e n t at h a l a m l

S t f l at e r m t n a l t s

Taenia chorotdea

Aqueductus mesencePhala

N u c l e u sc a u d a t u s C a u d a

Commissura Posterior Recessus Pinealis

P l e x u sc h o r o i d e u s v e n t ( c u l rt e r t i i

Commissura habenularum - -

Tela chorordeaventflcullterlrl -

V magna cerebrl

G l a n d u l ap i n e a l i s

Recessus supraplnealls

V Inlernacerebrl

l./ Lateral ventricles,Ventriculi laterales,and the Fig. 541 third ventricle, Ventriculus tertius; parts of the cerebralhemispheres,Corpus callosum,fornix, choroidalplexus and Tela choroideaof the third ventricle have been removed; superroruew. * Adhesio interthalamica has been sectioned in the median plane

The walls of the thl rd ventricle Roof Anterior wall Lateral wall Posteriorwall

ventriculitertii;Plexuschoroideus Telachoroidea Laminaterminalis anterior; Commissura Fornix,Columnae; opticus Recessus triangularis; Recessus Sulcushypothalamicus; interthalamica; thalami;Adhesio Striamedullaris Thalamus; Hypothalamus posterior habenularum; Commissura Commissura pinealis Recessus Recessus suprapinealis;

Floor

infundibuli Recessus

Openings

< !..'\-.

lateralis N supraorbitalis,R

/-,-

{EM levatorpalpebraesuperions

Lr',

z Glandulalacrimalis, Pars orbitalis

, ..t N r1}^$

N supratrochlearis \ Corpusadiposum orbitae\\ R meningeus anteriorO \ \

M reclus superior

\

A ethmoidalisanterior O \-

OA lacrimalis

M obliquus superior N lacrimalis

N nasociliaris A o p h t h a l m i c aO - -

N frontalis --

:s---

-

N aMucens[Vl]

N trochlearis lvl N ophthalmicus[V/1]

N maxillaris[V/2]

Canalisopticus N. opticus[ll]

--G'i-1

--scA ophthatmica. A carotis interoa O --

N mandibularis [V/31, R meningeus N oculomotoriusllll

N mandibularis [V/31 N trochlearis lvl Ganglion trigeminale

N. abducens[Vll R tentorius

N trigeminus [Vl

654

Fig. 653 Arteriesand nervesof the orbital cavity,Orbita; the roof of the orbital cavityhasbeenremoved;the superior orbital fissurehasbeenexposed; superiorview (r.).

and Nervesof theOrbttalCavity Muscles,Vessels

lateralis N suoraorbitalis,R

,

A supraorbitalis O *-

3?

a M. levatorpalpebraesuperioris Parsorbitalis lacrimalis, - Glandula

R medialis N supraorbilalis, M rectus superlor

N supratrochlearis N lacrimalis

A ophthalmica O/

a M rectus lateralis

M obliquussuperioro-

Ganglion ciliare

N. abducens[Vll

N oculomotorius illll, R superior

N. nasociliaris

N ophthalmicus [V/11

N.opticus ul

N maxillaris[V/21

A ophthalmicao -

N mandibularis [v/31

A carotisinternao -

N oculomotolius illll

-

N trochleafls[Vl

-i-

Ganglion lrigeminale

N trigeminus[Vl

N abducens [Vll

+/'/655

6$tr Fig. 654 Arteriesandneryesof the orbitalcavity'Orbita; the roof of the orbital cavityhasbeencompletelyremoved; the frontal nervehasbeenpartially removed;the superior orbital fissurehasbeenexposed;demonstrationof the ciliary ganglionby retractingthe levatormuscleof the uppereyelidandthe superiorrectusmuscleof the eyeball; superiorview (r.).

Eye,Organumvisus

/ il M levator palpebraesuperioris

M obliquussuperior, Tendoa \

/ ll M rectussuperior

A supratrochlearisO \

/

M obliquussuperiora \

Glandula lacrimalis, Pars orbitalis

/

A dorsalsnasiO 1 R meningeus anteriora \

M reclus medialis I N infratrochlearis N lacrimalis

tA ethmoidalisanterior O

a A lacrimalis

--N ethmoidalisanterior

'----

a M rectuslateralis

N nasociliaris A elhmoidalisposterior O N ethmoidalisposterior

O Aa ciliares

N ciliarislongus N abducens [Vl]

M o b l i q u ussu p e r i oI r - - - ' 7

N oculomotorius!lll, R inlerior

-'--)

N t r o c h l e a nl tsv l

Ganglion crhare

N oculomoloriusll|]. H. SUOeflOr M levator palpebrae * supenofls

Radix parasympathica [oculomotoria](lll)

-

Radix sensoria (V/1)

M rectussuperiorI

Radix sympathica (N caroticus Internus)

/

N opticus [ll] A . o p h t h a l m i c aa

A c a r o t i si n t e r n aO /

...,

N o p h t h a l m i c u s[ V / 1 ] /o

-

N o c u l o m o t o r i u lsl l l

N trochlearis lvl

/

N trigeminus [V],Radixsensoria

N abducens [Vl]

654x Fig. 655 Arteries and nerves of the orbital cavity, Orbita; the roof of the orbital cavity has been removed;the superior orbital fissure has been exposed;the levator muscle of the upper eyelid, the superior rectus and the superior oblique musclesof the eyeballhave been partially removed;the lateral rectus muscle has been retractedlaterallv: superior view (r.).

rtrul,\'ervesof the OrbitalCa+'iA' .\luscles,I ?s.sc1s

t

levator palPebraesuPeriorls

zlM

a M rectus superior

M o b l i q u u ss u p e r l o r ,t Trochlea

--

M obliquus superior Tendo a

--

M o b l i q u u ss u p e r i o r*

--

/lM

rectuslateralis

retinae - O OA ; V centralis Vagina externa neryl opllcl

--

-

R meningeusanlerior O

N opticus[ll]

--

sM obliquusinlerior tM

--

rectusinferior

N inlratrochlearis A ethmoidalisanterior O

-

N ethmoidalisanterior

-

A ethmoidalisPosteriorlt

-

N zygomaticus

N ethmoidalisPosterlor

-- -

M rectus medialis *

--

A ophthalmica a

M levator palpebrae a

N infraorbitalis

--

M o b l i q u u ss u P e r i o rI

on infraorbrtalis

-

N oculomotorius Illl]' R interior

lM

rectuslateralis

--

-

superlorls M rectussuperiorl'

N abducens [Vl]

N o p t i c u Isl l ]

N maxillaris [V/2] Canalis opticus

\

N ophthalmicus[V/1]

A o p h t h a l m i c aO N mandibularis[V/31 N o c u l o m o t o r i u lsl l l N a b d u c e n s[ V l ]

\

N t r i g e m i n u[ V s1

655# Fig. 656 Arteries and nerves ofthe orbital cavity, Orbita; the roof of the orbital cavity has been removed;the superior orbital fissure and the optic canal have been exposed;the optic nerve and the extraocular muscles (with the exception of the inferior oblique muscle) have been partially removed; superior view (r.).

Eye,Organum vis

\ -----=-Os lrontale - - - - S q| *.'. -*i.i-'.+-.-

M levalorpatpebraesupenons -

-\

N. lrontal

/

ll--:.-\ z

M rrectus M e c t u ssuperior superior A. ophthalmica )hthalmrcaa

N. nasocrlrars

/

M obliquus ol supenof -"'

N rrochlearis lvl M. rectus medialis

N.. l aaccrri immaal ilsi s N N o c u l o m o t o r i u lsl l l ] , R n s s uuPp ee f f ur fi o r V. ophthalmr.a

-- - - - t ' l - ' L f ri 't---L # ' -

qtnarior

-

-AAq

-

M e a l l r sn a s i ssuperior lroprio nasi l,4eatus

4\

zy9omalrcum Concha nasalis media llll, B. inlerior N infraorbilalrs

rectus Inler M. recIUS M. infer

/rl)l

-L;--

I

( V ) ; A . i n l r a o r b i t a l i s' a - '

Sinusmaxillaris

Fig.657 Orbitalcavity,Orbita;frontal sectionthrough the middleof the extracranialcourseof the optrcnerve; v c n t r a lv i e w ( r ) . Os lrontale .- .--

/, O A supraorbltalis

- jfi)=----7:-t superioris

N supraorbitalis M obliquus superior M rectus medialis

-

- -- Os ethmoidale Meatus nasi superior

_-

c o r p u sa d i p o s u m o , u i t a e- - - ! l.l \t -\ -r.

-

C e l l u l a ee t h m o i d a l e s

- -

C o n c h an a s a l i sm e d i a

\1

-

Periorbita

aN intraorbitalis

Fig. 658 Orbitalcavity,Orbita;frontal sectionthrough the posteriorpart of the eyeballl)ehin(lthe tendinousinsertionof the inferior o b l i q u em u s c l e v; e n t r a lv i e w ( r . ) ,, Os lrontale

M epicranius /

/^

7 renorolla

/ Supercilia - i

t

N trontalis /

M levator palpebrae superions

M orbiculario s culi

/

M rectussuperior

Fornix conjuncttvaesuperior .- _

,, a A ophthalmica

Palpebra superior - i -

Palpebra inferior - Tarsus inferior Fornix conjunctivaeinfelor Sclera Septum orbitale Corpus adiposum orbilae -' Maxilla -

Fig.659

Vagina externa nerui optlci

M reclus inferior

M o b l i q u u si n t e r i o r

.*:-,

N infraorbilalis --.-.-

S i n u sm a x i l l a r i s

Orbitalcavity,Orbita;verticalser;tionthroughthe eyeballand the optic nerve;lateralvierv(l )

oftheEar vervtew

Os temporale I

Ossicula auditus

/, Cavitastympani

vestibularis - Labyrinthus

LabYrinthuscochlearis

Fig.660 Ear,Auris; semi-schematicdrawing; the external acousticmeatus, the tympanic cavity,the auditory tube and parts of the temporal bone have been exPosed; ventralview (r., 110%).

Parts of the ear,Auris Auris externa Auricula externus Meatusacusticus Auris media Cavitastympani Membranatympanica auditus Ossicula Tubaauditiva

Auris interna Labyrinthusmembranaceus - Labyrinthusvestibularis - Labyrinthuscochlearis Labyrinthusosseus - Vestibulum - Canalessemicircularesossei - Cochlea - Meatusacusticus internus

Partsof the membranouslabyrinth, Labyrinthus membranaceus(Figs.694,695) Labyrinthus vestlbularis Spatiumperilymphaticum Utriculus Ductussemicirculares - Ductussemicircularis anterior - Ducfussemicircularis posterior - Ductussemicircularis lateralis Ductusutriculosaccularis DuctusendolymPhaticus endolymphaticus Saccus Sacculus Ductusreuniens

Labyrinthus coohlqaris SpatiumperilYmPhaticum - Scalatympani - Scalavestibuli Aqueductusvestibuli Aqueductuscochleae Ductuscochlearis

3 8 1

382

Ear,Auris

Helix Scapha -

Cruraantihelicis

Fossatriangularis

Cymbaconchae

(Tuberculum - auriculare)

Crushelicrs

Antihelix -

Incisura anterior

Helix -

Cavitasconchae Tragus

Concha auriculae -

Cavitasconchae Helix / Incisuraintertragica Antitragus/

Lobulusauriculae/-

Fig. 661 Auricle,Auricula; lateralview (r.).

H e l i xC , r u sh e l i c i s

Scapha/

Spina helicis

- Os temporale Pars squamosa

A n t i h e l i x\

/

/ //

/ Incisuraintertragica

Cartilago meatusacustici/

/

/

Incisuraecartilaginismeatus acustici

/

stylordeus

/ Proc mastoideus

Fig. 662 Auricularcartilage, Cartilagoauricularis, with parts of the temporal bone; all soft tissues have been removed: oblique ventral view (r.).

Musculiauriculares AuricularMuscles,

383

M helicismajor

/

M helcis minor

_-

---

M tragrcus

C a u d ah e l i c i s

rM anlitragicus

Fig. 663 Auricular muscles;\'lm. auriculares; ventralvierv(r.).

/ M obliquus auriculae

Lig auriculare superius-__

---

M transversusauflculae

' - Meatusacusticus externus

\ Lig aurrcularepostertus

; l m .a u r i c u l a r e s ; F i g . 6 6 4 A u r i c u l a rm u s c l e sN tlorsalr ierr (r.)

Sensorynervesupplyof the auricle,Auricula N. vagus[X], R. auricularis: baseof the externalacousticmeatusandposterior part of the externalsurfaceof the tympanic sickle-shaped membrane N. auricularis magnus,R. posterior(Cz/C3lt posteriorsurfaceof the auricle N. auricularis magnus,R. anterior lC2/C3): anteriorsurfaceof the auricle

N. mandibularis [V/3]' N. auriculotemporalis,N. meatus acustici externi and Rr. membranaetympani: anteriorroot-of the auricle,floor,anteriorwall androofof the externalacousticmeatus'aswell as a largepart of the tympanicmembrane N. facialis [Vtr], N. auricularis posterior, R. auricularis: all auricularmuscles

Liar,Auris

384

Capul mallei

Becessusepitympanicus \

/

/ Lig malleisuperius , R"""".r. Pars ,. epitympanicus,

/

Os temporale Mealus acusticus externus

/

'i - --. 'l)/

,!'

--

z

Cartilagoauriculae

Porusacusticus externus

Meatusacusticusexternus cartilagineus

Membranatympanica Bulbussuperiorvenaejugularis Os occipitaleArliculatioatlanlooccipitalis

\

Carlilago auriculae

Cellulae mastordeae

Fig.665 Externalacousticmeatus,Meatusacusticusexternus; tympaniccavity,Cavitastympani,and cochlea,Cochlea; frontal section; dorsalview (r.).

Plica mallearisposterior \

Meatusacusticus externus, (Pariesposterior)

/

Pars flaccida*

/

/

Plica mallearis anletio(

Pars tensa

Anulus / fibrocartilagineus

Fig. 666 Tympanicmembrane,Membranatympanica; otoscopicimage; obliquelateralview (r.,600%). ' *t

Fig.667 Tympanicmembrane,Membranatympanica; diagramshowingits quadrants; lateralview (r.).

clinical: SHRAPNELL'smembrane typical light reflex

for betterorientation.Thelongerdiameteris 10-11mm and the shorterdlqmeterabout9 mm in the adult. A bright:hiangular'coneoflight" reflectedfrom the otoscope is usuallyseenin the anteroinferiorquadrant(II).

385 Caput mallei -

(Facies articularis).- _ .-

Proc lateralis- Proc lateralis- -

Proc anterior/

/ mallei Manubrium

M a n u b r i u mm a l l e i-

, alleus; F i g .6 6 9 M a l l e u sM v e n t r a lv i e $ ( r . ,7 0 0 % ) .

, alleus; F i g .6 6 8 M a l l e u s M lateralview (r, 700'ln)

Corpusincudis\ , (Faciesarticularis) Crusbreve--__

(Facies

\

Proc lateralis -

Proc lenticularis

Manubrium mallei

l n c u s ,I n c u s ; Fig.67l lateralview (r.,700%).

Fig. 670 Malleus,Malleus; d r l r s a vl i e u '( r , 7 0 0 % ) .

- Corpusincudis

---

Crusbreve

_--

CrusPoslerrus

BasrsslaPedis

Fig.672 Incus,Incus; medialview (r.,700%).

Fig.673 Stapes,StaPes; superiorview(r.,700%).

386

Ear,Auris C a p um t allei

Proc lateralis

C r u sl o n g u m Proc anterior / Articulatro"l ncudostapedialis

C r u sa n t e r i u s- Basis slapedis

Fig.674 Auditory ossicles,Ossiculaauditus; natural position; s u p e r o m e d i av li e w ( r , 6 0 0 % ) .

Lig mallei superius

I I

I I

Lig incudissuperius

_ - Lrg Incudis posterius

--[ t$

Lig mallei anterius - -

_ - Chorda tympani

-M tensor tympani,Tendo - -

A tympanica posterior

- - - Membrana stapedialis

Fig. 675 Iointsandligamentsof the auditoryossicles, Articulationesand Ligamentaossiculorumauditus; coveredby a mucousmembranein situ; superomedial view (r.,800%).

TympanicCavity,CavitastYmpani

L r g m a l l e rs u p e i l u S\ \

F l e c e s s u sm e m b r a n a et y m p a n i c a es u p e ro r C h o r d at y m p a n

C a p u t m a l l e iI

387

/ P a r e s t e g m e n t a l i sB, e c e s s u se p i t y m p a n r c u s

- -

-

M e a t u sa c u s t i c u se x t e r n u sqti^ac

/

Umbo membranae lympantcaeu

t

Membrana lympanca/

l : i g . 6 7 6 T t n r ; r a n i r . a irt r , C a ri t a st r m p a n i ; f l o n t a ls e t ; t i r t n l r e n t r a lr i e * ( t ' )

Bountlaries of the tympanic cavity, Cavitas tympani Name

Constituents

Paries tegmentalis (roof)

Recessus epitympani- Fossa craniimedia, tympani Meninges, cus,Tegmen l0c tpm nnra lp\ Lobustemporalis

Neighbouring organs

Suturapetrosquamosa

Pariesjugularis (floor)

Prominentiastyloidea

Specialfeatures

Clinical complications

Vascularcanaliculiin the Tegmenand in the suture:route of infection

Meningitis, abscessof the temporal lobe

Variableform and size Fossajugularis, Bulbussuperiorvenae of the Cellulae jugularis tympanicae,bony

Septicthrombosis of the V. jugularis interna (pyaemia)

laminaemay be partiallyabsent Promontorium,Fenestra cochleae,Fenestra vestibuli,Prominentia canalisfacialis, Membranatympanica secundaria

Labyrinthusmembranaceus, N. facialis

lvrrl

Infectionof the Iabyrinth(deafness), facialparesis

Pariesmembranaceus (lateralwall)

Membrana tympanica, Manubrium ma]lei (Chordatympani)

Meatusacusticus externus, Articulatio temporomandibularis

tympanic membrane (e.g.byoverzealous cleaning)

Pariesmastoideus (posterior wall)

Antrum mastoideum, Cellulaemastoideae, Prominentiacanalis semicircularis Iateralis, Prominentia canalisfacialis

Variable pneumatiN. facialisfVIIl, sationof the Cellulae Sinussigmoideus, Fossa craniiposterior, mastoideae cerebellum

Mastoiditis,sinus thrombosis,meningitis, cerebellarabscess, facial paresis

Pariescaroticus (anteriorwall)

Ostium tympanicum tubae auditivae, Canalismusculotubarius

Canalis caroticus, Sinuscavernosus, N. abducens [VI], Ganglion trigeminale

Parieslabyrinthicus (medialwall)

Apical pneumatisation of the pyramids (Cellulaetympanicae)

Auditory tube: route of infection of the apicalCellulae pneumaticae, abducensparesis, otitis media

388

Ear,Auris i/t tensor lympani. Tendo

anterior / Plicamallearis

I

Proc cochlearilormis \

epitympanicus , Recessus

M tensor tympani \

- -

C a P U tm a l l e i - - -

L i g m a l l e is u p e r i u s

---

L i g i n c u d i ss u p e r i u s

----

Septumcanalismusculotubarii Tuba auditiva /

Corpusincudis - Chorda tympani

/

Ostiumtympanicum' tubaeaudilivae Canalis caroticus

/

/

//

-

Incus, Crus breve

\

L i g i n c u d i sp o s t e r i u s

\

Fossa Incudis

\

I n c u s ,C r u s l o n g u m

t-

Anulustibrocarlilagineusz M a n u b r i u mm a l l e i /

\

/ t I

Membrana tympanica /

\ Plica mallearisposteriof \ N facialis IVI|]

Proc lenticularis

Fig. 677 Lateralwall, Pariesmembranaceus, of the t v m l ) u n i((a v i l ) ,( d v i t a st ) m l ) a n i : s a g i t t asl e c t i o nm ; o s to f t h e a u d i t o r yt u b ea n d t h e f a s c i ao f the tensormuscleof the t)'ml)anonhavelleenremove(l; m e d i a lv i e w ( r . ,1 0 0 % )

Malleus, Proc lateralis I I Spina tympanica minor \ \ I

Meatusacusticus\-

/

C o l l u mm a l l e i

/

S p i n a t y m p a n i c am a j o r

externus /

Plica malleans antenor.Chorda tympanl

-

- - Plica mallearisposterior: Chorda tympani

M tensor tympani,Tendo

- ----

Manubriummallei -.--

Eminentiapyramidalis /

M tensortympanl

-

Incus,Cruslongum/

\

Fossula lenestrae cochleae

I I I

\

Slapes

Incus Proc lenticulans

Promontorium

I M stapedius.Tendol

\ A n u l u sl i b r o c a r t i l a g i n e u s

Fig. 678 Tympanic cavity, Cavitastympani; the tympanic membrane has been removed; lateral view (r., 400%).

TympanicCavi$, CavitastYmPani

Cellulae mastoideae \

\

/

Feneslra vestibull Canalis nerui facialis

/

/

Proc cochlearilormis - -

-

\ t

ta

Canalis nervi facialis / Foramen stylomastoideum/

Psrrgs ls[yrrnthicus

\

I

z'

/ /

\ \

389

lmpresslo trigeminalis

---

Ostiumtympanicum tubae audrtivae

---

Canaliscaroticus

Fossula leneslrae vestibuli

Promontorium

srlcra promonlorrl

Fossulafenestrae cochleae

Fenestracochleae

subiculumpromontorii

Fig. 679 Medial wall, Paries labyrinthicus, of the tympanic cavity, Cavitas tympani; the lateral wall and the adjacent parts of the ventml and superior walls have been removed; the Canalis nervi facialis and Canalis caroticushave been exposed; ventrolateralview (r., 170%).

Antrum masloideum

\ /

,

Feneslra vestibuli

,'

-

Canahs nervi facrafts

C e l l u l a emasloroeae

Proc. cochlearitormrs

'

.-

_-zi'-

-

- --

Pafles masloroeus

Septum canalis musculotubarii

- 'Ostiumtympanicum tubaeauditivae

F o s s ai n c u d i s -

- -

S i n u sp o s t e r i o-r- -

-

(

Meatusacusticusexternus

Srl"us promontorii

Promontorium

\ cellulaetympanicae f

Sinustympani/

\ Fossulalenestrae cochleae \ Sulcus'tympanicus

/ promontorii Subiculum Proc mastoideus /

\ Proc stylordeus

Fig. 680 Medialwall, Parieslabyrinthicus,of the tympaniccavity, Cavitastympani; verticalsectionthroughthe longitudinalaxis of the petrosalbone; ventrolateralview (r., 170%).

390

Ear,Auris

I

- Os palatinum,Lamina horizontalis

I

Os sphenoidale, Ala major, Facies temporalis

Foramen ovale -

Sorna ossis sohenoidalis - - - Os temporale, Prrc

natr^a,

- Condylus occipitalis

Fig. 6Bt Cartilageof the au