1. Skull and Face Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University

2. Bony Landmarks of Skull and Face
Vertex
Superciliary arch
Zygoma
Mental symphysis
Entrance to orbit
Anterior nasal aperture

3. Three foramina vertically alligned
Supraorbital foramen … for supraorbital nerve
Infraorbital foramen … for infraorbital nerve
Mental foramen ... for mental nerve

4. Muscles of Facial Expression
Develop from the 2nd branchial arch, thus all are supplied by CN VII.
Most are thin, originate from facial bones to insert on facial skin, except platysma, and are intermingled at their insertions.

5. Muscles of Facial Expression
Muscle of the forehead … frontalis, as part of the occipitofrontalis
Muscles of the mouth
Muscle of the eyelids
Muscle of the nose
Platysma

6. Muscles of the Mouth Orbicularis oris Zygomaticus major
Zygomaticus minor
Levator labii superioris
Levator labii superioris alaque nasi
Buccinator
Depressor anguli oris
Depressor labii inferioris
Mentalis
Risorius
Platysma

7. Muscles of the Mouth

8. Muscle of the Eyelids
Orbicularis oculi
Orbital part
Palpebral part

9. Buccal Pad Fat Between masseter and buccinator muscles
Brown fat … for heat generation, especially for children

10. Parotid Duct One finger-breadth below zygomatic arch
Open into the mouth cavity (vestibule) at the level of the 2nd molar tooth (crown)

11. Facial Nerve Comes out from stylomastoid foramen Five branches
Temporal
Zygomatic
Buccal
Mandibular
Cervical

12. Facial Palcy No wrinkle of forehead Angle of mouth drops
Sagging lower eyelid
Other signs relating to malfunctions of structures innervated by facial nerve

13. Trigeminal Nerve Sensory Ophthalmic division Maxillary division
Mandibular division
Motor .. To 1st branchial arch
Muscles of mastication
Messeter
Temporalis
Medial pterygoid
Lateral pterygoid

14. Arteries of the Face (rich, tortuous and highly anastomosed)
From external carotid artery
Facial artery
Superficial temporal artery
Transverse facial artery
From internal carotid artery
supraorbital artery
supratrochlear artery

15. Veins of the Face Two important veins Facial veins have no valves
Retromandibular vein
Facial veins have no valves
Connection of facial veins, pterygoid plexus and cavernous sinus

16. Lymph Drainage of the Face
Submental lymph nodes
Submandibular lymph nodes
Parotid lymph nodes

17. Scalp, Cranial Cavity and Venous Sinuses
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Head2.ppt in C (Mahidol)

18. Scalp Five layers of scalp skin dense subcutaneous tissue
epicranial aponeurosis
loose areolar connective tissue
periosteum

19. Scalp Clinical relevance
infection spreading from loose areolar connective tissue, via emissary veins, to meninges-meningitis
hematoma

20. Skull Cap or Calvaria Suture coronal (frontoparietal)
anterior fontanelle
sagittal (interparietal)
lambdoid (occipitoparietal)
posterior fontanelle

21. Skull Cap or Calvaria Three layers of skull cap outer table diploe
inner table

22. Cranial Fossae Anterior cranial fossa Middle cranial fossa
Posterior cranial fossa
Boundaries
lesser wing of sphenoid
superior border of petrous bone

23. Anterior Cranial Fossa
important landmarks
crista galli & cribriform plate of ethmoid
sella turcica
tuberculum sellae
hypophyseal fossa
dorsum sellae

24. Middle Cranial Fossa important landmarks foramina groove for middle
superior orbital fissure
foramen rotundum
foramen ovale
foramne spinosum
groove for middle
meningeal
artery

25. Posterior Cranial Fossa
important landmarks
grooves for transverse
& sigmoid sinuses
foramen magnum

26. Dura Mater Outer and inner layers
position of the middle meningeal artery

27. Dura Mater Falx cerebri Falx cerebelli Tentorial cerebelli and notch
Diaphragmatic sellae

28. Intradural Venous Sinuses
Superior and inferior sagittal sinuses
Straight sinus
Transverse and sigmoid sinuses

29. Intradural Venous Sinuses
Cavernous sinus
relationship among internal carotid artery, CN III, CN IV, CN V1 and CN VI
venous connections
clinical relevance
thrombophlebitis

30. Orbit and Eye Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University

31. Eye From the Outside eyelids palpebral fissure plica semilunaris
caruncle
lacrimal puncta
cornea
sclera
conjunctiva
bulbar
palpebral
Sty
pterygium

32. Bony Parts of the Orbit Entrance of the Orbit frontal bone
zygomatic bone
maxillary bone
More Bones Inside
ethmoid bone
greater and lesser wing of sphenoid
lacrimal bone

33. Foramina of the Orbit optic foramen (canal) optic n. ophthalmic a.
superior orbital fissure
all other nerves
superior ophthalmic vein
inferior orbital fissure
infraorbital n. & a.
inferior ophthalmic v.
infraorbital groove & foramen
zygomatic & infraorbital n.
supraorbital notch & foramen
supraorbital n.

34. Eyeball

35. Eyeball
Muscles
Extrinsic (Extra-ocular)
Intrinsic

36. Levator Palpebrae Superioris
Supplied by CN III
insert on the upper lid
if paralyzed
ptosis

37. Extra-Ocular Muscles Superior Rectus Inferior Rectus Lateral Rectus
Medial Rectus
Superior Oblique
Inferior Oblique

38. Actions of the Extra-Ocular Muscles
Around vertical axis
medial or adduction
lateral or abduction
Around horizontal axis
upward or elevation
downward or depression
Around antero-posterior axis
medial rotation
lateral rotation

39. Superior Rectus Make a 10-15 o with an AP axis adduct medial rotate
elevate

40. Inferior Rectus
depress
adduct
lateral rotate

41. Medial and Lateral Recti
Medial Rectus
adduction
Lateral Rectus
abduction

42. Superior Oblique
depress
abduction
medial rotate

43. Inferior Oblique
elevate
abduction
lateral rotate

44. Periorbita and Orbital Fat

45. Insertions of the Extra-Ocular Muscles

46. Nerves of the Extra-Ocular Muscles
Oculomotor Nerve (CN III)
supplies all except lateral rectus and superior oblique
Trochlear Nerve (CN IV)
superior oblique
Abducens Nerve (CN VI)
lateral rectus

47. Oculomotor nerve (CN III)
Superior Division
levator palpebrae superioris*
superior rectus
Inferior Division
inferior rectus
inferior oblique
medial rectus
*not an extra-ocular muscle

48. Functional Tests of the Extra-Ocular Muscle
Principle
align the muscle axis with the eyeball AP axis
contract the muscle
e.g., for Superior Rectus
abduct, first
then, elevate
Therefore, test for the superior rectus function is to abduct and elevate

49. Parts of the Eyeball Three layers sclera choroid retina
anterior chamber
posterior chamber
cornea
iris
ciliary muscle
suspensory ligament
lens
hyaloid canal
vitreous body
aqueous humor

50. Clinical Relevance lenticular cataract glaucoma Schlemn’s canal
Myopia (near sightedness)
hyperopia (far sightedness)
presbiopia (old-aged sightedness)

51. Blood Vessels of the Orbit & Eyeball
Ophthalmic
Frontal
anterior & posterior ethmoidal
supraorbital
supratrochlear
lacrimal
central retinal
in the choroid layer

52. Ophthalmoscopic Examination
optic disc
macula lutea & fovea centralis
retinal vessels in DM & hypertension

53. Veins of the Eyeball superior & inferior ophthalmic veins
drained to cavernous sinus
connection to pterygoid plexus
connection to facial veins

54. Sensory Nerves of the Eyeball and Orbit
frontal
supraorbital
supratrochlear
lacrimal nerve
nasociliary nerve
anterior ethmoidal
posterior ethmoidal
infratrochlear

55. Autonomic Nerves of the Eyeball and Orbit
Sympathetic
post-ganglionic sympathetic fibers
artery (ophthalmic a)
long ciliary n.
eyeball
iris (radial fibers)
Parasympathetic
pre-ganglionic parasympathetic fibers (in the nerve to inferior oblique)
ciliary ganglion
short ciliary n.
Eyeball
ciliary muscle & iris (circular fibers)

56. Ciliary Ganglion

57. Lacrimal Gland and Lacrimal Apparatus
Lacrimal puncta
lacrimal canaliculi
lacrimal sac
nasolacrimal duct
opening into the inferior meatus of nasal cavity

58. Parasympathetic Supply to the Lacrimal Gland
Preganglionic parasympathetic fibers
pterygopalatine ganglion
maxillary n
zygomatic branch
zygomatico-temporal branch
lacrimal n
lacrimal gland

59. Eyelid upper & lower eyelids conjunctiva
palpebral fissure & palpebral sac
tarsal plates (superior & inferior)
tarsal muscle & nerve (sympathetic n)
tarsal gland & ciliary gland; Meibomitis & sty
attachment of levator palpebrae superioris

60. Orbital Septum, Medial & Lateral Palpebral Ligament

61. Submandibular Region, Nasal Region and Oral Cavity
Boonsirm Withyachumnarnkul, M.D., Ph.D.
Department of Anatomy, Faculty of Science
Mahidol University
Head 6. ppt in C (Mahidol)

62. Submandibular Region Inferior border of mandible Suprahyoid muscles
Including submandibular triangle
Submandibular gland
Nerves
lingual
hypoglossal
mandibular branch of CN VII
Blood vessels
facial
Lymph nodes, submandibular lymph nodes

63. Submandibular Triangle
Anterior belly of digastric muscle
Origin, digastric fossa of mandible
Nerve, nerve to mylohyoid (CN V)
Posterior belly of digastric muscle
Origin, mastoid notch
Nerve, CN VII
Inferior border of mandible

64. Actions of Digastric Muscle
Elevate hyoid bone
Open jaw
Raising floor of mouth for swallowing reflex

65. Suprahyoid Muscles Digastric Mylohyoid Geniohyoid Hyoglossus
Stylohyoid

66. Mylohyoid Muscle Origin, mylohyoid line of mandible Insertion
Body of hyoid bone
Median fibrous raphe
Nerve, nerve to mylohyoid (CN V)

67. Geniohyoid Muscle Origin, mental spine Insertion, hyoid bone
Nerve, C1 spinal nerve

68. Hyoglossus Muscle From hyoid bone to side of the tongue
Nerve, hypoglossal nerve

69. Stylohyoid Muscle Origin, styloid process
Insertion, hyoid bone (two slips)
Nerve, CN VII

70. Concerted Action of Suprahyoid Muscles
Elevate floor of mouth for swallowing reflex

71. Submandibular Gland superficial part deep part
the two parts are separated by mylohyoid muscle
mixed serous and mucous gland
submandibular duct
from deep part
open at sublingual caruncle

72. Anatomical Relationship
Hypoglossal and lingual nerves are between mylohyoid and hyoglossus muscles
Closed relationship between lingual nerve and submandibular duct

73. Chorda tympani special sense (taste) from anterior 2/3 of tongue
preganglionic parasympathetic fibers to submandibular and sublingual gland, via submandibular ganglion

74. The Nasal Region Nostrils Vestibule Nasal cavity Choanae Nasal septum
Cartilage, septal cartilage
Bone
perpendicular plate of ethmoid
vomer
maxillary & palatine

75. Lateral Wall of the Nasal Cavity
Chonchae
superior, part of ethmoid
middle, part of ethmoid
inferior, separate bone

76. Lateral Wall of the Nasal Cavity
Meatuses
sphenoethmoidal recess, opening of sphenoidal sinus
superior, opening of posterior ethmoidal air cells
middle
bulla ethmoidalis, opening of middle ethmoidal air cells
hiatus semilunaris, opening of
maxillary sinus
anterior ethmoidal air cells
frontal sinus, infundibulum
inferior, opening of nasolacrimal duct
common meatus

77. Nerves of the Nasal Cavity
Special sense, olfactory n. "olfactory mucosa"
General sense, "respiratory mucosa"
branch of nasociliary n.
anterior ethmoidal n.
branches of maxillary n.
nasopalatine n.
posterior superior lateral nasal n.
posterior inferior lateral nasal n.
Test of olfactory function

78. Third Part of the Maxillary Artery
superior alveolar a.
posterior
anterior, from infraorbital a.
infraorbital a.
descending palatine a.
greater palatine a.
lesser palatine a.
sphenopalatine a.

79. Blood Supply of the Nasal Cavity
from sphenopalatine a.
posterior lateral nasal br.
posterior septal br.
from ophthalmic a.
anterior and posterior ethmoidal a

80. Paranasal Air Sinuses Locations frontal sinuses ethmoidal air cells
posterior
middle
anterior
sphenoidal sinuses
maxilary sinus
Functions
warm and humidify air
resonance

81. Maxillary Nerve out of the skull through foramen rotundum branches
zygomatic n.
zygomaticotemporal n.
zygomaticofacial n.
infraorbital n., out from the infraorbital foramen
superior alveolar n.; anterior, middle, posterior
two small br. to pterygopalatine ganglion

82. Pterygopalatine Ganglion
pterygopalatine br. from maxillary n., general sense
nerve of pterygoid canal
parasympathetic
sympathetic
Out
pterygopalatine br. to maxillary n., parasympathetic fibers to lacrimal gland
pharyngeal n.
greater and lesser palatine n.
superior and inferior lateral nasal n.
nasopalatine n

83. Pterygopalatine Ganglion
All the "out" branches supply
submucosal gland, parasympathetic
general sense
lacrimal gland, parasympathetic

84. Mouth & Lips vestibule oral cavity proper nasolabial sulcus philtrum
labial gland
frenulum
palatoglossal arch
palatopharyngeal arch
opening of parotid duct
opening of submandibular & sublingual ducts

85. The Teeth Types incisor, 2 canine, 1 premolar, 2 molar, 3
Nerves and vessels (to teeth and gingivae)
alveolar
superior (maxillary n. and a.)
anterior
middle
posterior
inferior (mandibular n., maxillary a.)
nasopalatine (maxillary n. and a.)
greater palatine (maxillary n. and a.)

86. The Tongue sulcus terminalis foramen caecum papillae circumvallate
fungiform
filiform
foliform
lingual tonsil

87. Muscles of the Tongue Intrinsic longitudinal transverse vertical
Extrinsic
hyoglossus
genioglossus (movement of tongue)
styloglossus
palatoglossus

88. Artery & Nerves of the Tongue
lingual a.
Nerves
motor, hypoglossal n., except palatoglossus (vagus n.)
sensory
general, CN V, IX & X
special, CN VII (anterior 2/3) & CN IX (posterior 1/3), CN X

89. The Palate Hard palate Soft palate, muscles Clinical relevant
tensor veli palatini (CN V)
levator veli palatini (CN X)
musculus uvulae (CN X)
palatoglossus (CN X)
palatopharyngeus (CN X)
Clinical relevant
openning of auditory
tube
test of CN X

90. Blood Supply of Palatine Tonsil (important for tonsillectomy)
from lingual a.
dorsal lingual a.
from facial a.
tonsillar br.
ascending palatine a.
from ascending pharyngeal a.
palatine br.
lesser palatine a.