Anatomy of the Head

Anatomy of the Head

The Head
is the superior part of the body that is attached to the trunk by the
neck.
consists of
The skull,
The brain, its protective coverings, and
The ears and the eyes and
The face.
 The skull

• AKA the cranium is the bony

framework of the head.
• composed of separate bones united
at immobile joints called sutures.
(exception -the mobile
temporomandibular joint).
• Has two parts:
• Neurocranium:
• viscerocranium
 Skelton of head ( Cranium)

• Skull is the body’s most complex bony structure.

• Has two parts:

– Neurocranium

– Viscerocranium

▪ 8 cranial bones and the 14 facial bones

▪ These 22 bones combine to form the cranial cavity and
the facial features.

4
 The Skull

❑Cranial Bones (8)

❑Facial bone (14)
➢frontal(1)
oLacrimal (2)
➢parietals(2)
oNasal (2)
➢temporal (2)
oMaxillary(2)
➢occipital (1)
oPalatine(2)
➢sphenoid (1)
oInferior nasal conchae(2)
➢ethmoid.(1)
oVomer(1)
oZygomatic(2)
oMandible(1)

Darba Samuel 5
Bones of the neurocranium

6
Skull
 Skelton of head ( Cranium)

▪ In addition, there are 3 bones in each inner ear to

assist in sound transmission.

▪ Most bones of the skull are flat bones.

▪ Except for the mandible, all bones are firmly united

by interlocking sutures

8
9
 Skull bones Cont….
▪ Bones of the skull provide . . .
✓ A case to house the brain, the cranium
✓ A framework for the face

✓ Cavities to house the organs of sight, taste,

hearing and smell.

✓ Passages for air and food

✓ Attachment sites for the teeth
✓ Attachment sites for muscle
10
11
 Neurocranium
(cranial vault)

• Is the bony covering of the brain and

the cranial meninges.
• Contains proximal parts of the cranial nerves
and the vasculature of the brain.

• Has a dome-like roof,

• the calvaria (skullcap),
• a floor or cranial base (basicranium).

12
 Neurocranium

• The bones forming the calvaria are primarily flat

bones (frontal, temporal, and parietal).

• The bones contributing to the cranial base are

primarily irregular bones with substantial flat
portions (sphenoidal and temporal).

13
Bones of the neurocranium

14
 Bones of neurocranium

– Frontal Bone
• Forms the anterior roof of the cranium, the
forehead.

– Parietal Bone-
• Paired, form the upper sides and roof of the
cranium.

– Temporal Bone-
• Paired, form the lower sides of the cranium

15
 Cont…
– Occipital Bone
• Forms the posterior and most of the base of the
skull.

– Sphenoid bone
• Forms part of the anterior base of the cranium.
– Ethimoid bone
• Forms the roof of the nasal cavity

16
 Viscerocranium
➢ Also known as facial skeleton, comprises the facial
bones (14).

➢ Not in contact with the brain.

➢ With the exceptions of the vomer and mandible, all of
the facial bones are paired.

17
Viscerocranium

18
 Viscerocranium cont…

• Viscerocranium forms the anterior part of the cranium

and consists of the bones :

➢ Surrounding the mouth (upper and lower jaws),

nose/nasal cavity.

➢ Most of the orbits (eye sockets or orbital cavities)

19
 Viscerocranium cont…

Maxilla and mandible

➢ The maxillae and mandible provide the sockets and
supporting bone for the maxillary and mandibular
teeth.

Zygomatic Bone(“cheekbones”)

• Form the lateral contours of the face.

20
21
 Viscerocranium cont…
Lacrimal Bone: Form the anterior part of the medial wall
of each orbit.

• These are the smallest of the facial bones.

Nasal Bone: Form the bridge of the nose.

Palatine Bone: Bones forming the posterior third of the
hard palate.

22
23
• The vomer is a thin
quadrilateral plate of
bone, which forms the
posteroinferior part of
the nasal septum.

24
 Viscerocranium cont…

Inferior Nasal Conchae

• Paired scroll-like bones on the lateral wall of the
nasal cavity.

25
 Viscerocranium cont…

• The palatine bone is a paired, irregular bone located

at the back of the nasal cavity, contributing to the
formation of the posterior portion of the hard palate
and the floor of the nasal cavity.

26
➢ The zygomatic arch is formed by the union of the
temporal process of the zygomatic bone and the
zygomatic process of the temporal bone

27
 Pterion

➢ superior to the midpoint of the zygomatic arch, is a

clinically important area of bone junctions.
➢ It is usually indicated by an H-shaped formation of
sutures that unite the frontal, parietal, sphenoid (greater
wing), and temporal bones 27
29
 Clinical correlation

• The pterion is an important area because it overlies the

middle meningeal artery.
• Fracture to the pterion can rupture the anterior branch
of this artery resulting in hematoma which exerts
pressure on the underlying cerebral cortex.

• An untreated meningeal artery can cause hemorrhage

which can lead to death in a few hours.
30
Clinical correlation

31
 Viscerocranium cont…
Mandible
• Is a u-shaped bone with an alveolar process that
supports the mandibular teeth

• Consists of a horizontal part, the body, and a vertical

part, the ramus.

• Inferiorly have the mental foramina for the mental

nerves and vessels.

32
Mandible

33
 Viscerocranium mandible cont…

– Condylar processes - processes that form the

temporomandibular joint (TMJ) with the temporal
bone.

– Coronoid processes - processes on which the

temporalis muscle inserts.

34
 Temporomandibular Joint

• The TMJ is a modified hinge

type of synovial joint.

• The articular surfaces involved

are the condyle of the
mandible, the articular tubercle
of the temporal bone, and the
mandibular fossa.
35
 Temporomandibular Joint

• Movement permits at the joint are:

– Protrusion and retrusion
– Depression and Elevation

36
 Superior Aspect of the Cranium
• Sutures are immovable fibrous joints that form the
boundaries between the cranial bones.

• Dense regular connective tissue seals cranial bones

firmly together at a suture.

• Allow the cranium to grow and expand during childhood.

• In adulthood, when cranial growth has stopped, the
sutures fuse and are obliterated.

37
38
 Superior Aspect of the Cranium cont….

➢ The coronal suture

separates the
frontal and parietal
bones.

➢ The sagittal suture

separates the
parietal bones.

39
 Superior Aspect of the Cranium cont….

➢ The lambdoid
suture separates the
parietal and
temporal bones
from the occipital
bone

40
 Superior Aspect of the Cranium cont….

➢ Lambda:is the
landmark formed by
the intersection of
the sagittal and
lambdoid suture.

41
 Superior Aspect of the Cranium cont….

• The bregma is the

landmark formed by
the intersection of
the sagittal and
coronal sutures

42
 Superior Aspect of the Cranium cont….

• The vertex is the

most superior point
of the calvaria.

43
 Superior aspect cont’d…

• The parietal foramen is a small, inconstant aperture

located posteriorly in the parietal bone near the
sagittal suture.

• Paired parietal foramina may be present

44
 Superior aspect cont’d…

• Most irregular, highly variable foramina that occur in

the neurocranium are emissary foramina that transmit
emissary veins, veins connecting scalp veins to the
venous sinuses of the dura mater.

45
The parietal foramen

46
 Internal Surface of the Cranial Base

➢ The internal surface of the cranial base has three large

depressions that lie at different levels.

➢ The anterior, middle, and posterior cranial fossae,

which form the floor of the cranial cavity.

➢ The anterior cranial fossa is at the highest level, and

the posterior cranial fossa is at the lowest level.
47
48
 Internal Surface of the Cranial Base cont…
• The boundary between the anterior and middle is
marked off by anterior edge of the body of
sphenoidal bone and sphenoidal crest.

49
 Internal Surface of the Cranial Base cont…
• The middle cranial fossa is marked off the posterior
fossa by the upper border of petrous temporal on
each side, and dorsum sellae of sphenoid bone in
the middle.

50
51
 Anterior cranial fossa
• It is formed by:
➢ Frontal bone in the
anterior and lateral
direction.
➢ Ethmoid bone in the
midline.
➢ Two parts of the sphenoid
bone, the body, and lesser
wing, posteriorly.

52
 Anterior cranial fossa

➢ The anterior cranial fossa is

above the nasal cavity and
the orbits.

53
➢ The frontal crest is a median bony extension of the
frontal bone.
➢ The crista galli is a thick, median ridge of bone which
projects superiorly from the ethmoid bone.
54
➢ On each side of this ridge is the sieve-like cribriform
plate of the ethmoid ,its numerous tiny foramina
transmit the olfactory nerves (CN I).

55
➢ At its base of frontal crest is the foramen cecum of the
frontal bone, which gives passage to vessels during fetal
development but is insignificant postnatally.

56
 Anterior cranial fossa cont…

➢ Foramen cecum varies in size in different individuals,

and is frequently impervious; when open, it
transmits the emissary vein from the nose to the
superior sagittal sinus.

➢ This has clinical importance in that infections of the

nose and nearby areas can be transmitted to the
meninges and brain.

57
 Middle cranial fossa

Formed mainly by the:

i. Parts of the sphenoid bone
ii. Parts of the temporal bone
➢ The parts of sphenoid
involved are:
iii. Sella turcica which is part of the
body of sphenoid.
iv. Greater wings of sphenoid
laterally.
58
Foramina/fissure of middle cranial fossa

59
 Foramen of middle cranial fossa
• Optic canal : Lies within the lesser wing of the
sphenoid.
– it allows ophthalmic artery and cranial nerve
(CNII), the optic nerve.

• Superior orbital fissure:

– lies just posterior and lateral to the optic canal, can be
better appreciated if viewed from the front, as it lies
at the back of the eye orbit or socket
60
 Foramen of middle cranial fossa
• Structures passing through it:
➢ Cranial nerves III, IV and VI (occulomotor,
trochlear and abducens nerves).

➢ Ophthalmic division of trigerminal nerve (CN

V1)

➢ Ophthalmic vein

61
62
 Foramen of middle cranial fossa
• Foramen rotundum:
– This small round hole lies posterior to the optic
canal and the superior orbital fissure on the floor
of the skull.

– Allows for the passage of the maxillary division of

the trigeminal nerve (CN V2).

63
 Foramen of middle cranial fossa

• Foramen ovale : This oval shaped hole lies posterior

and lateral to the foramen rotundum. It allows
passage of the final division of the trigeminal nerve,
the mandibular nerve (CNV3).

• It also allows passage of the lesser petrosal nerve (a

branch of the ninth cranial nerve (CNIX).

64
 Foramen of middle cranial fossa
• Foramen spinosum is
situated posterior-lateral
to foramen [Link]
transmits middle
meningeal artery.

65
 Foramen of middle cranial fossa
• Foramen lacerum: Is located posterior and medial to
the foramen ovale.

• Lacerated or torn foramen) is not part of the crescent

of foramina.

• In life, it is closed by a cartilage plate. Only some

meningeal arterial branches and small veins are
transmitted vertically through the cartilage, completely
traversing this foramen.
66
Foramina/fissure of middle cranial fossa

67
 Posterior cranial fossa
• Largest and deepest of
the 3 cranial fossa
• Formed mainly by the
occipital bone and the
temporal bone with
some contribution from
parietal and sphenoid
bones .

68
Foramen in the posterior cranial fossa

69
 Foramen of posterior cranial fossa

• Internal acoustic meatus (meatus = passage): it is an

oval foramen found laterally across the upper half of
the posterior surface of the petrous part of the
temporal bone.

• Seventh (CNVII), the facial nerve, eighth (CNVIII), the

vestibulocochlear nerve and labyrinthine artery pass
through it.

70
 Foramen of posterior cranial fossa

• Jugular foramen: The jugular foramen is also an

easier one to locate as its shape is more consistent
with a fissure than it is with some of the rounder
holes.
• It allows passage for the ninth (CNIX), tenth (CNX),
and eleventh (CNXI) cranial nerves, the
glossopharyngeal, the vagus, and the spinal accessor
nerve respectively.
71
 Foramen of posterior cranial fossa

• Hypoglossal canal: This hole is the one closest to the

foramen magnum. It allows passage of the twelfth
cranial nerve (CNXII), the hypoglossal nerve.

72
 Foramen of posterior cranial fossa

• Foramen magnum: The name in Latin means “great

hole”
– Allows for the passage of
✓ The spinal cord which is continuous with the
medullar obongata

✓ Vertebral arteries
✓ The spinal contribution of accessory nerve, the
spinal accessory nerve

73
Foramen in the posterior cranial fossa

74
 Meninges of the brain
➢ Fibrous and delicate membranes that are deep to the skull

➢ From outer to inner are: dura – arachnoid - pia matter

74
 Dura matter
➢ Is the tough, external, thick, fibrous two layered
membrane of the meninges.
➢ Is made up of
➢ An external periosteal layer
➢ An internal meningeal layer

76
 Dural Infoldings or Reflections

Dural partitions (Dural Septa)

• Double layers of dura formed when the meningeal layer
of dura pulls away forming dural septa
• Project into cranial cavity & partially subdivide cranial
cavity.
➢ Falx cerebri
➢ Tentorium cerebelli
➢ Falx cerebell
➢ Diaphragma sellae

77
Dural Infoldings or Reflections

78
 Dural infoldings

Falx cerebri:

➢ Crescent-shaped
➢ Projects downward b/n the two cerebral
hemispheres.

Tentorium cerebelli:
➢ A horizontal projection that covers & separates
cerebellum from posterior parts of cerebrum.

79
 Dural infoldings

Flax cerebelli:
➢ A small midline projection b/n the two cerebellar
hemispheres.

Diaphragma sellae:
➢ Covers the hypophysial fossa in the sella turcica of
sphenoid bone

80
 The Dura Matter: Clinical Conditions

• The dura is sensitive to pain

• distention of scalp or meningeal vessels (or both)
may be one cause of headache.

• Many headaches appear to be dural in origin:

• ➔These headaches may result from stimulation of
sensory nerve endings in the dura.

81
 Arachnoid mater

➢ Is a filmy, thin, transparent, and delicate membrane

that is connected to pia matter by web-like trabeculations.

82
 Arachnoid mater cont…
➢ Separated from the dura by a capillary interval, the
subdural space which is occupied by a film of fluid to
moisten the surfaces & CSF.

➢ The space between the arachnoid and pia is called the

subarachnoid space.

83
 The Pia mater
➢ It is the thinnest and most delicate membrane of the
brain.
➢ Adheres to the surface of the brain and follows all its
contours.

84
 Clinical Conditions cont…

• Subdural space is a potential space b/n dura &

arachnoid.

• Subdural hematomas: commonly result from

tearing of a cerebral vein (usually, superior cerebral
vein) as it enters superior sagittal sinus.

85
 Clinical Conditions cont…

• Subarachnoid space is the normal space b/n

arachnoid & pia, which contains cerebrospinal fluid
(CSF).

• Subarachnoid hemorrhage: results from bleeding

within subarachnoid space, e.g., from rupture of an
aneurysm.

86
Extradural (epidural)
hematomas

Subarachnoid
hemorrhage

87
Scalp
 Scalp

• The scalp is soft tissue

which covers the calvaria

of the skull.

89
 Scalp cont…

• It extends to the
o supra-orbital margin in front(Superiorciliary
arch),
o external occipital protuberance and
superior nuchal line behind,
o zygomatic arch (superior temporal line) on each
side.

90
 Layers of Scalp

• The scalp consists of five layers and can be memorised

by a mnemonic using the initial letters of the word
SCALP :
➢ Skin
➢ Connective tissue layer
➢ Aponeurosis (galea aponeurotica) and occipito-frontalis muscle
➢ Loose subaponeurotic tissue
➢ Pericranium or outer periosteum of the skull.
• The first three layers of scalp are intimately connected and
move as one unit.
91
Layers of Scalp
 Layers of Scalp
• Skin
– It is thick and provided with numerous hairs,
sebaceous ,and sweat glands.
– The scalp is the common site for the formation of
sebaceous cysts.

93
 Layers of Scalp
• Connective tissue layer
– It is composed of dense network of fibro-fatty
tissue and connects firmly the overlying skin and
underlying galea aponeurotica and epicranius
muscles.

– The dense tissue contains large blood vessels and

nerves of the scalp.

94
 Layers of Scalp

• Epicranius muscle and its aponeurosis

– The epicranius includes the occipito-frontalis and a
variable slip known as the temporo-parietalis.

– Occipito-frontatis—It consists of a pair of occipital

bellies (occipitalis) behind, and a pair of frontal
bellies (frontalis) in front.

95
➢ Both bellies are united by intervening galea
aponeurotica or epicranial aponeurosis .

96
 Layers of Scalp
Loose subaponeurotic tissue
• It consists of loose areolar
tissue and forms a
potential space beneath
the epicranius muscle and
its aponeurosis.

• This space contains

emissary veins.
97
 Layers of Scalp

Pericranium
➢ It is the outer periosteum of skull and loosely covers
the bones except at the sutural lines, where it is
continuous with the endocranium through the
sutural membrane.

➢ The endocranium is derived from the endosteal

layer of dura mater.
 Layers of Scalp

➢ Collection of fluid beneath the pericranium

produces localised swelling in the form of
cephalohematoma.

➢ Bleeding is regionally limited because such a

bleeding cannot cross suture lines.

99
Pericranium

100
 Clinical correlation

➢ The layer of loose areolar tissue is called dangerous

layer of scalp because blood and pus freely tend to
collect in this layer.

101
 Clinical correlation cont…

• Operation on the scalp should be preferably done

under general anaesthesia, because dermatomes of
trigeminal and cervical nerves undergo considerable
overlap and density of subcutaneous tissue prevents
ready diffusion of local anaesthetic in the scalp.

102
Face
 The Face
➢ Is the anterior aspect of the head
➢ It extends superiorly to superciliary arches, the lower
edge of the mandible inferiorly, and as far back as the ears
on either side.
 The Face cont…..

➢ Provides our identity as an individual human

➢ The basic shape of the face is determined by the
underlying bones.

• The individuality of the face results primarily from

anatomical variation.

103
 Skin of face

• The skin of the face is thick, elastic, and very vascular.

• It contains large number of sweat and sebaceous
glands.

• The skin of face is lax except on the nose where it is

firmly attached to the underlying cartilages and
provides insertion to the muscles of facial expression.
 Skin of face cont…

• Since the blood supply to the skin of the face is

profuse,therefore it is rare in plastic surgery for skin
flaps to necrose in this region.

• Face is also the common site for acne due to the

presence of large number of sebaceous glands in this
region.
 Face cont….
Superficial Fascia
• It contains muscles of facial expression, vessels and
nerves, and variable amount of fat.

• The fat is absent in the eyelids but is well-developed in

cheeks forming buccal pad of fat, which provides
rounded contour to cheeks.
 Face cont….

• The buccal pads of fat are very prominent in infants

in whom they help in suckling the milk and are called
suctorial pad of fat.

107
 Face cont…
Deep Fascia
➢ The deep fascia is absent in the region of face except
over the parotid gland and masseter muscle, which
are covered by parotidomasseteric fascia.

➢ The absence of deep fascia in the face is essential for

the facial expression.
 Muscles of the face
• Muscles of the face are thin muscles, closely applied
to the skin.

• Primarily developed to guard the openings of the

skull such as the orbital, nasal and oral apertures.

111
 Muscles of the face

• Arranged around the

orifices of the face: orbit,
nasal cavity, mouth & ear.

• May act as sphincters or

dilators to control opening
or closing of the eyelids,
nose or mouth.

112
 Types of muscles of face
• Muscle of facial
expression

• Muscles of
mastication
 Muscles of facial expression
• The muscles of facial expression are embedded in the
superficial fascia.

• Most of them arise from bones of the skull and are

inserted into the skin.

• They bring about different types of facial expressions,

hence the name muscles of facial expression, the
actions of many of them are implied by their names.
 Lie in subcutaneous tissue

Inserted in to the skin

muscles of Named as muscles of facial expression

the face Arranged in groups around the orbit,

nose, mouth and auricles
• functionally considered as regulators of
openings (sphincters and dilators)

All supplied from branches of facial

nerve (CN-VII)

11
5
 Muscle of Facial expression

Occipito forntalis

Corrugator supercili

Orbicularis oculi

Orbicularis Oris

Zygomaticus major

Buccinator 116
117
Muscles of facial expression
 Muscles Around the Orifice of the Eye
• These include:
1. Orbicularis oculi.
2. Corrugator supercilii.
3. Frontalis.
4. Levator palpebrae superioris.
 Frontalis.

Elevates eyebrows and wrinkles skin of forehead;

protracts scalp (indicating surprise or curiosity).
 Orbicularis oculi
• Orbicularis oculi consists of three parts—orbital,
palpebral, and lacrimal.

• Orbital part
– It closes the eye tightly to protect the eye from
intense light and dust particles.

– It is also used by people for winking.

 Orbicularis oculi
• Palpebral part

– It closes the eyelids gently as in sleep or in blinking

• Lacrimal part
– It dilates the lacrimal sac by exerting traction on the
lacrimal fascia, thus helping in the drainage of
lacrimal fluid.

117
 Orbicularis oculi

Winking
 Corrugator supercilii

➢ Is deep to orbicularis oculi muscle.

➢ Actions :It drags the eye brows medially and down-
ward, and protects the eye from bright sunlight.
 Corrugator supercilii

➢ Actions :It also produces vertical wrinkles of the forehead

in frowning as an expression of annoyance.
 Levator palpebra superioris
• It is not a muscle of the face but
one of the orbital muscles.

• It elevates the upper eyelid.

 Muscles of the nose

This group comprises

Procerus

Nasalis

Depressor septi.
 Muscles the nose

• Procerus
• Action—It produces
transverse wrinkles
across the bridge of
nose in frowning.
 Muscles the nose
• Depressor septi
– Action—It helps
dilatation of anterior
nasal aperture, and also
is active in anger.
 Muscles around the Mouth

• The muscles around the mouth are responsible for the

movement of lips and cheek.

• Muscles around the oral fissure consist of a sphincteric

component formed by the orbicularis oris, and a dilator
component formed by a number of facial muscles
which radiate outwards from the lips.
 Orbicularis oris

➔The orbicularis oris, the first of the series of

sphincters associated with the alimentary system
(digestive tract), encircles the mouth within the lips,
controlling entry and exit through the oral fissure a
sphincter muscle of the mouth.
Muscles around the Mouth
 Orbicularis oris
Muscles around the Mouth

Forms the greater part of the lips.

Actions
➢ It closes the lips
➢ The deep and oblique fibres compress the lips against
the teeth and help in mastication
 Muscles of Mastication

• The muscles of mastication are concerned with

movements of mandible at the temporomandibular
joints during mastication.
Principal muscles are:
(a) Temporalis
(b) Masseter
(c) Lateral pterygoid
(d) Medial pterygoid.
.
Muscles of Mastication
 Muscles of Mastication
• The characteristic features of the principal muscles of
mastication are as follows:
1. All are located in or around the infratemporal fossa.
2. All are inserted into the ramus of the mandible.
3. All are innervated by the mandibular division of the
trigeminal nerve.
4. All are concerned with movements of the mandible on
the temporomandibular joints.
5. All develop from mesoderm of the first pharyngeal arch
 Muscles of Mastication
• Masseter
The masseter (Greek:
masseter = a chewer) is a
thick quadrilateral muscle
covering the lateral
surface of the ramus of
the mandible including its
coronoid process.
Temporalis
➢ It is a fan-shaped muscle located in the temporal
fossa.
Lateral Pterygoid : arises
from 2 heads: 1). Infra-
temporal surface & crest of
greater wing of sphenoid, 2).
lateral surface of lateral
pterygoid plate. & inserts
into neck of mandible, TM
joint & articular disc.
• Medial pterygoid: arises from 2 heads
– Origin: Tuberosity of maxilla and Medial surface of
lateral pterygoid plate & Inserts into (medial surface
of) angle of mandible
 Muscles of Mastication Acting on TMJ

▪ Elevation (close mouth):

▪ Temporalis, masseter, and medial pterygoid
▪ Depression (open mouth):
▪ Lateral pterygoid
▪ Protrusion (protrude chin):
▪ Lateral pterygoid, masseter, and medial pterygoid
 Muscles of Mastication Acting on TMJ

▪ Retrusion (retrude chin):

▪ Temporalis mainly and masseter
▪ Lateral movements (grinding and chewing):
▪ Pterygoids of opposite side, Temporalis of same side, and
masseter
 Nerve supply of face

• The sensory nerves are derived from the branches of

trigeminal nerve and from the great auricular nerve
of cervical plexus.

• The motor nerves of the face are derived from facial

nerve to the muscles of facial expression and the
motor root of the trigeminal nerve/mandibular nerve
to the muscles of mastication.
Trigeminal nerve
Facial nerve
 Facial nerve

The motor root of CN VII

supplies the muscles of facial
expression, including the
superficial muscle of the neck
(platysma), auricular muscles,
scalp muscles, and certain
other muscles derived from
mesoderm in the embryonic
second pharyngeal arch.
 Branches of facial nerve

[Link] petrosal nerve—arises from the geniculate

ganglion. It consists of preganglionic parasympathetic
fibres which supply the secretomotor fibres to the
lacrimal gland and the mucous glands of nasal cavity
and palate.

2. Nerve to stapedius—arises from the vertical part of

the facial [Link] supplies stapedius muscle.
 Branches of facial nerve

• 3. Chorda tympani nerve—arises from the vertical part

of the facial nerve about 6 mm above the stylomastoid
foramen, and enters the middle ear
The chorda tympani nerve consists of two types of
fibres:
(a) Preganglionic parasympathetic (GVE) fibres,
which provide secretomotor supply to the
submandibular and sublingual glands.
(b) Special visceral afferent fibres, which carry
taste sensations from anterior two-third of the
 Branches of facial nerve

• [Link] auricular nerve—supplies the occipital belly

of occipitofrontalis.
5. Nerve to the posterior belly of digastric—supplies the
concerned muscle.
6. Nerve to stylohyoid—supplies the concerned muscle
• 7. Five terminal branches (temporal, zygomatic, buccal,
marginal, mandibular, and cervical)—supply the muscles of
facial expression.
Terminal
Branches
Branches of facial nerve
Branches of facial nerve
 Terminal branches of facial nerve
• The main trunk of CN VII runs anteriorly and is
engulfed by the parotid gland, in which it forms the
parotid plexus, which gives rise to the five terminal
branches of the facial nerve:
– Temporal
– Zygomatic
– Buccal
– Mandibula
– Cervical
154
155
 Facial Nerve & Parotid Gland

▪ During parotidectomy
(surgical excision of the
parotid gland),
identification,
dissection, and
preservation of the
branches of the facial
nerve are critical.
 Injury of facial nerve

• Injury to branches of the facial nerve causes paralysis

of the facial muscles, with or without loss of taste on
the anterior two thirds of the tongue or altered
secretion of the lacrimal and salivary glands.
 Injury of facial nerve

• Bell’s palsy : It is lower motor neuron type paralysis

of facial muscles due to compression of facial nerve
in the facial canal near stylomastoid foramen.

• The exact etiology is not known but it is probably due

to viral infection.
Bell’s palsy on the right side. Note the facial
asymmetry (right side appears to be pulled on the left
side)
 Injury of facial nerve
• Characteristics feature of Bell’s palsy
1. Facial asymmetry (affected side is drawn to the
healthy side)—due to unopposed action of muscles of
normal side.

2. Loss of horizontal wrinkles on forehead—due to

paralysis of occipitofrontalis muscle.
 Injury of facial nerve
• 3. Inability to close the eye—due to paralysis of
orbicularis oculi.
4. Tears flow down from the eye (epiphora)—due to
paralysis of the lower part of the orbicularis oculi.
5. Sagging of the angle of the mouth towards the
affected side and inability of the angle of the mouth to
move upwards and laterally during laughing—due to
paralysis of zygomaticus major.
 Facial nerve palsy
• 6. Loss of nasolabial furrow—due to paralysis of
levator labii superioris alaeque nasi.

7. Accumulation of food into the vestibule of the

mouth— due to paralysis of buccinator muscle.
 Facial nerve palsy

8. Dribbling of saliva from the angle of the mouth—due

to paralysis of orbicularis oris.

9. Loss of resistance when one presses cheek with

inflated vestibule and air leaks out from between the
lips—due to paralysis of buccinator muscle.

157
Bell’s palsy on the right side. Note the facial
asymmetry (right side appears to be pulled on the left
side)
 Trigeminal nerve

• The trigeminal nerve (CN V) originates from the lateral

surface of the pons by two roots: motor and sensory.

• These roots are comparable to the motor (anterior) and

sensory (posterior) roots of spinal nerves.

• CN V is the sensory nerve for the face and the motor

nerve for the muscles of mastication and several small
muscles
 Branches of trigeminal nerve (CN V)

• Three divisions of trigeminal nerve

➢ Ophthalmic

➢ Maxillary

➢ Mandibular.

160
 Sensory branches of trigeminal nerve

Ophthalmic division
➢ Supplies the skin over top of the head, forehead,
upper eyelid, conjunctiva & a portion of the nose
which roughly corresponds to the upper 1/3 of the
face & head.
Sensory branches of trigeminal nerve
 Sensory branches of trigeminal nerve

Maxillary
➢ Supplies skin, over the lower eyelid, portion of the
nose, upper part of the cheek & upper lip and
approximately corresponds to the area in relation to
the upper jaw.

Mandibular branch
➢ Supplies the skin over the lower jaw.
Sensory branches of trigeminal nerve
 Clinical correlation :Trigeminal nerve injury
• Lesions of the Trigeminal Nerve
– Lesions of the entire trigeminal nerve cause
widespread anesthesia involving the
corresponding anterior half of the scalp.

– Face, except for an area around the angle of the

mandible, the cornea, and conjunctiva.
 Clinical correlation :Trigeminal nerve injury
• Lesions of the Trigeminal Nerve cont..
– Mucous membranes of the nose, mouth, and
anterior part of the tongue.

– Paralysis of the muscles of mastication also occurs

 Blood supply of face

• The arterial supply to the face is primarily from

branches of the external carotid artery, though there
is some limited supply from a branch of the internal
carotid artery.
Blood supply of face

The face is the highly vascular

region and is supplied by the
following arteries
1. Facial artery.
2. Transverse facial artery.
3. Branches of maxillary artery
4. Branches of ophthalmic
artery
 Blood supply of face
Transverse facial artery

Maxillary artery

Facial artery
 Venous drainage

• The venous blood from the face is drained by two

veins .

– Facial vein.

– Retromandibular vein.
 Venous drainage
• The retromandibular vein is formed by the union of the
superficial temporal and the maxillary vein within the
parotid gland.

• On leaving the parotid gland, it divides into two

divisions: anterior and posterior.

• The anterior division joins the facial vein to form the

common facial vein, whereas posterior division joins the
posterior auricular vein to form the external jugular vein
 Venous drainage
superficial temporal

maxillary vein
Retroman
dibular
vein
 Venous drainage
• The facial vein communicates with the cavernous
sinus through the following two routes.

• At the point of commencement, the facial vein

communicates with the superior ophthalmic vein,
which passes backwards within the orbit and drains
into cavernous sinus.
 Venous drainage
maxillary vein
superficial temporal
 Venous drainage
• In the cheek, the facial vein is joined to the pterygoid
venous plexus by the deep facial vein.

• The deep facial vein communicates with the

pterygoid venous plexus, which in turn
communicates with the cavernous sinus through an
emissary vein.

181
Ophthalmic vein

pterygoid
venous
plexus

Facial vein

182
 Lymphatic drainage
• The face is divided into three lymphatic territories
• 1. Upper territory—comprising greater part of the
forehead, later halves of the eyelids including
conjunctiva, parotid area, and adjoining part of the
cheek.

• Lymph from upper territory is drained into

preauricular lymph nodes(also called superficial
parotid lymph nodes).
 Lymphatic drainage

• 2. Middle territory—comprising central part of the

forehead, medial halves of the eyelids, external nose,
upper lip, lateral part of lower lip, medial part of
cheek, and greater part of the lower jaw.

• Lymph from middle territory is drained into

submandibular lymph nodes.
 Lymphatic drainage

• 3. Lower territory—comprising central part of the

lower lip and chin.

• Lymph from lower territory is drained into submental

lymph nodes
Lymphatic drainage
 Dangerous area of the face
• The facial vein and its communications are devoid of valves in

their lumens.

• Since facial vein rests directly on the muscles of facial

expression, the movements of these muscles may facilitate the

spread of septic emboli from infected area of the lower part of

the nose, upper lip, and adjoining part of the cheek in

retrograde direction through deep facial vein, pterygoid venous

plexus, and emissary vein into the cavernous sinus leading to

meningitis and cavernous sinus thrombosis.

 Dangerous area of the face

• For this reason, this

portion of the face is
called dangerous
area of the face

188
 cavernous sinus

Ophthalmic vein

pterygoid
venous
plexus

Facial vein Deep Facial

vein

189
Temporal
fossa
 Temporal fossa

• Temporal fossa: A narrow

fan-shaped space that
covers the lateral surface
of the skull (below the
inferior temporal line).

191
 Temporal fossa cont…

Boundaries:

• Superior: Superior temporal line

• Inferior: Zygomatic arch and Infratemporal crest

(greater wing of the sphenoid)

192
 Temporal fossa cont…
Boundaries:
• Anterior: Posterior surfaces of
the frontal process of
the zygomatic bone and the
zygomatic process of the
frontal bone

• Lateral: Temporal fascia

• Floor: Pterion

193
188
Infratemporal Fossa
 Infratemporal Fossa
• The infratemporal fossa is
an irregularly shaped space
deep and inferior to the
zygomatic arch, deep to
the ramus of the mandible
and posterior to the
maxilla.

197
 Infratemporal Fossa
• Structures that travel between
❖ . the cranial cavity,
❖ neck,
❖ pterygopalatine fossa,
❖ floor of the oral cavity,
❖ floor of the orbit,
❖ temporal fossa,
• superficial regions of the head pass
through it
198
 Boundaries of the Infratemporal Fossa
Laterally: the ramus

of the mandible
Medially: the lateral
pterygoid plate

Anteriorly: the posterior aspect of the maxilla

Posteriorly: the tympanic plate and the mastoid and
styloid processes of the temporal bone
199
 Boundaries of the Infratemporal Fossa

Superiorly: the inferior (infratemporal) surface of the

greater wing of the sphenoid.

Inferiorly: where the medial pterygoid muscle attaches to

the mandible near its angle.
200
201
 Contents of the Infratemporal Fossa

The infratemporal fossa contains the:

– Inferior part of the temporal muscle
– Lateral and medial pterygoid muscles
– Maxillary artery(1 st and 2 nd parts)
– Pterygoid venous plexus
– Mandibular, inferior alveolar, lingual, buccal, and
chorda tympani nerves and the otic ganglion.

194
Contents of the Infratemporal Fossa

195
204
 Contents of the Infratemporal Fossa

• The maxillary artery is the larger of the two terminal

branches of the external carotid artery.

• It arises posterior to the neck of the mandible and is

divided into three parts based on its relation to the
lateral pterygoid muscle.

205
Maxillary artery

206
207
 Contents of the Infratemporal Fossa cont..

• First part (mandibular part):

– It extends from the neck of the mandible to the
sphenomandibular ligament.

– Runs along the lower border of lateral pterygoid

muscle.

208
 Contents of the Infratemporal Fossa cont..

• Second part (pterygoid part): It runs upwards and

forwards either superficial or deep to the lower head of
the lateral pterygoid muscle.

• Third part (pterygopalatine part): It passes between the

two heads of lateral pterygoid muscle and the enters
pterygopalatine fossa by passing through the pterygo-
maxillary fissure.

209
210
 Contents of the Infratemporal Fossa cont…
➢ The pterygoid venous
plexus is located partly
between the temporal
and the pterygoid
muscles.

203
 Contents of the Infratemporal Fossa cont…

• It is the venous equivalent of most of the maxillary

artery, that is, most of the veins that accompany the
branches of the maxillary artery drain into this plexus.

• The plexus anastomoses anteriorly with the facial vein

via the deep facial vein and superiorly with the
cavernous sinus via emissary veins.

212
 Contents of the Infratemporal Fossa cont..

• The mandibular nerve descends through the foramen

ovale into the infratemporal fossa and divides into
sensory and motor branches.

• The branches of CN V3 are the auriculotemporal,

inferior alveolar, lingual, and buccal nerves
• Branches of the CN V3 also supply the four muscles of
mastication.
213
 Contents of the Infratemporal Fossa

mandibular nerve

auriculotemporal
Buccal nerve

inferior alveolar Lingual nerve 206

 Contents of the Infratemporal Fossa

• The otic ganglion (parasympathetic) is located in the

infratemporal fossa, just inferior to the foramen
ovale, medial to CN V3 and posterior to the medial
pterygoid muscle.

215
 Contents of the Infratemporal Fossa cont..

• The auriculotemporal nerve divides into numerous

branches and supplies sensory fibers to the auricle and
temporal region.

• The auricotemporal nerve also sends articular fibers to

the TMJ and parasympathetic secretomotor fibers to
the parotid gland.

216
 Contents of the Infratemporal Fossa
• The inferior alveolar nerve enters the mandibular foramen
and passes through the mandibular canal, forming the
inferior dental plexus, which sends branches to all
mandibular teeth on its side.

• Another branch of the plexus, the mental nerve, passes

through the mental foramen and supplies the skin and
mucous membrane of the lower lip, the skin of the chin, and
the vestibular gingiva of the mandibular incisor teeth
217
inferior alveolar nerve

Mental nerve 210

 Contents of the Infratemporal Fossa

• The lingual nerve lies anterior to the inferior alveolar

nerve.

• It is sensory to the anterior 2/3rd of the tongue, the floor

of the mouth, and the lingual gingivae.
• It enters the mouth between the medial pterygoid
muscle and the ramus of the mandible and passes
anteriorly under cover of the oral mucosa, just inferior to
the 3rd molar tooth.

211
 Contents of the Infratemporal Fossa

mandibular nerve

inferior alveolar Lingual nerve 212

 Contents of the Infratemporal Fossa

• The chorda tympani nerve, a branch of CN VII

carrying taste fibers from the anterior 2/3rd of the
tongue, joins the lingual nerve in the infratemporal
fossa.
• The chorda tympani also carries secretomotor fibers
for the submandibular and sublingual salivary
glands.

213
222
Pterygopal
atine Fossa
 Pterygopalatine Fossa

➢ The pterygopalatine
fossa is a small
pyramidal space
inferior to the apex of
the orbit.

224
 Pterygopalatine Fossa

• The pterygopalatine fossa lies beneath the posterior

surface of the maxilla and the pterygoid process of
the sphenoid bone.

• The fragile perpendicular plate of the palatine bone

forms its medial wall.
217
21
8
 Pterygopalatine Fossa

• The incomplete roof of the pterygopalatine fossa is

formed by the greater wing of the sphenoid.

• The floor of the pterygopalatine fossa is formed by

the pyramidal process of the palatine bone.

21
9
 Pterygopalatine Fossa cont…

• Its superior larger end opens into the inferior

orbital fissure; its inferior end is closed except
for the palatine foramina.

220
 Pterygopalatine Fossa
The pterygopalatine fossa communicates:

• Laterally with the infratemporal fossa through the

pterygomaxillary fissure.

• Medially with the nasal cavity through the

sphenopalatine foramen.

22
1
 Pterygopalatine Fossa
The pterygopalatine fossa communicates:
• Anterosuperiorly with the orbit through the inferior
orbital fissure.

• Posterosuperiorly with the middle cranial fossa

through the foramen rotundum and pterygoid canal.
22
3
 The contents of the pterygopalatine fossa

• Terminal (Third) part of the maxillary artery and the

initial parts of its branches.

• Maxillary nerve, with which are associated the:

– Nerve of the pterygoid canal

– Pterygopalatine ganglion

22
4
 The contents of the pterygopalatine fossa

• The 3rd part of the maxillary artery enters the fossa

through the pterygomaxillary fissure.

• It lies anterior to the pterygopalatine ganglion.

234
235
 The contents of the pterygopalatine fossa
Pterygopalatine ganglion
• Lies in the superior part of the pterygopalatine fossa
connected to maxillary nerve by two pterygopalatine
nerves.
• Branches:
1. Greater and lesser palatine nerves
2. Orbital branches
3. Pharyngeal branch
4. Nasal branch
236
 Parotid Region

• The parotid region is the area around the ear, bounded

• anteriorly by anterior border of masseter,

• superiorly by the zygomatic arch,

• posteriorly by mastoid process,

• inferiorly by line joining the angle of the mandible

to the mastoid process.
 Parotid Gland
• Is the largest of three paired salivary glands.
• Is usually examined with or immediately subsequent
to the dissection of the face to expose the facial
nerve.

• Is enclosed within a tough fascial capsule, the parotid

sheath, derived from the investing layer of deep
cervical fascia.

241
 Parotid Gland

• The parotid gland has an irregular shape because the

area occupied by the gland, the parotid bed, is
anteroinferior to the external acoustic meatus, where
it is wedged between the ramus of the mandible and
the mastoid process.

242
243
 Parotid gland cont….

➢ The apex of the parotid gland is posterior to the angle

of the mandible.

➢ The base is related to the zygomatic arch.

244
 Parotid gland cont….
• The parotid
duct(Stenson’s Duct)
passes horizontally
from the anterior edge
of the gland
• At the anterior border
of the masseter, the
duct turns medially,
pierces the buccinator,
and enters the oral
cavity through a small
orifice opposite the 2nd
maxillary molar tooth
246
 Parotid gland cont…

➢ Structures within the substance of the parotid gland,

from superficial to deep are:

➢ The facial nerve (CN VII) and its branches

➢ The retromandibular vein

➢ The external carotid artery

➢ On the parotid sheath and within the gland are
parotid lymph nodes.
247
 Innervation of Parotid Gland
• Although the parotid plexus of CN VII is embedded
within it, the CN VII does not provide innervation to
the gland.

• The parasympathetic fibers are conveyed to the gland

by the auriculotemporal nerve.
• Stimulation of the parasympathetic fibers produces a
thin, watery saliva.
250
 Innervation of Parotid Gland cont…

• Sympathetic fibers are derived from the cervical

ganglia through the external carotid nerve plexus on
the external carotid artery.
• The vasomotor activity of these fibers may reduce
secretion from the gland.
• Sensory nerve fibers pass to the gland through the
great auricular and auriculotemporal nerves.

251
 Anatomy of brain and spinal cord

May 14, 2025 253

The Nerves
system

Lecture by D.S
AMU-2018
 Objectives

At the end of this topic you are expected to

describe the structures and organization of the nervous
system.
Contrast the histological characteristics and the functions
of neurons and neuroglia.
Describe the structure and functions of brain and spinal
cords
Describe the autonomic Nerves system
 Outline

➢Introduction
➢Histology of nervous system
➢Divisions of the nervous system
➢Central nervous system
▪ Brain and spinal cord
➢Peripheral nervous system
▪Cranial nerves and Spinal nerves
➢Autonomic nervous system
▪ Sympathetic and Parasympathetic
 Introduction

The nervous and endocrine systems act together to

coordinate functions of all body systems

they share responsibility for maintaining homeostasis

but the two systems achieve that objective very

differently
Comparison of Control by the Nervous and Endocrine
Systems
CHARACTERISTIC NERVOUS SYSTEM ENDOCRINE SYSTEM
Mediator Neurotransmitters released Hormones delivered to
molecules locally in response to nerve tissues throughout the
impulses. body by the blood.
Site of mediator act Close to site of release, at a Far from site of release
synapse; binds to receptors in (usually); binds to
postsynaptic membrane. receptors on or in target
cells
Types of target cells Muscle (smooth, cardiac, and Cells throughout the body.
skeletal) cells, gland cells,
other neurons.

Time to onset of act Typically within milliseconds Seconds to hours or days.

Duration of action (thousandths of a second). Generally longer (seconds
Generally briefer (milliseconds). to days).
 The Nerves system

Nervous system: controls and coordinates the

functions of the organ systems, enabling the body's
responses to and activities within its environment

Neuroanatomy Is a branch of anatomy that deals

with neuronal structures (NERVOUS SYSTEM)
 The Nerves system

is composed of an intricate network cells that are

specialized to generate and transmit impulses, the
neurons.

enables the body to react to continuous changes in

its internal and external environments
NERVOUS TISSUE
Nervous tissue includes:
❖Nerve cells:
➢Neurons
➢Supportive cells:
Schwann cells in peripheral nervous system
(P.N.S)
Glial cells in central nervous system (C.N.S)
❖Nerve fibers
❖Nerve endings
Receptors or sensory nerve endings
Effectors or motor nerve endings

261
 NERVOUS TISSUE

Neurons
The neuron is the structural and functional unit of
the nervous system
The neuron has 2 highly specialized physiologic
properties:
Irritability, is the capacity to generate nerve impulses in response to various
stimuli
Conductivity, is the ability to transmit the impulses along the processes of the
neuron

262
 Structure of a neuron
The neuron comprises 3 main
parts:
Cell body called perikaryon
which contains the nucleus
Single axon arising from the
cell body and conducts the
impulses away from it
One or more dendrites which
respond to stimuli and carry
impulses towards the cell body

263
TYPES OF NEURONS-Based on their
function
a-Motor (efferent) neurons
– control effector organs such as muscle fibers,
exocrine, and endocrine glands
b-Sensory (afferent) neurons
– reception of sensory stimuli from the environment
and from within the body
C- Interneurons/association neurons
- in the CNS

265
 TYPES OF NERVE FIBERS

In CNS, the fibers may be:

Non-myelinated (naked): as in grey matter
Myelinated: as in white matter
In PNS, all the fibers (except the nerve endings) have
neurilemma sheath and may be:
Non-myelinated: as post- ganglionic sympathetic fibers
Myelinated: as all the peripheral nerves

266
 Nerve trunks

In the PNS the nerve fibres are arranged in a trunk and

are surrounded by connective tissue arranged in 3
layers:-
•Epineurium: outermost layer surrounds the whole
nerve trunk
•Perineurium: surrounds a group of nerve fibres
forming a bundle or a fascicle
•Endoneurium: surrounds the individual nerve fibres
267
CT vs Nerve trunks

268
Neuroglia(supportive cells)
Neuroglia, or glial cells,
supportive cells in the nervous system
have limited mitotic abilities.
Schwann cells in peripheral nervous system (P.N.S)
Glial cells in central nervous system (C.N.S)
oAstrocytes provide physical and metabolic support
oOligodendrocytes: responsible for myelin
oMicroglial cells has phagocytic function
o Ependymal cells secrete the cerebrospinal fluid
(CSF).
270
 Terminology

Sensory (afferent) neuron

Nerve cell that transmits action potentials from an organ to the
CNS.
Motor (efferent) neuron
Nerve cell that transmits action potentials from the CNS to an
organ, such as a muscle or gland.
Nerve
Bundle of nerve fibers (elongated portions of neurons).
Nerve plexus
Convergence or network of nerves
Somatic motor nerve
Nerve that innervates skeletal muscle; conveys impulses causing
muscle contraction
Autonomic motor nerve
Nerve that innervates smooth muscle, cardiac muscle, and glands.
 Terminology
Ganglion
Cluster of neuron cell bodies outside the CNS.
Nucleus
Cluster of neuron cell bodies within the CNS.
Tract
Bundle of nerve fibers interconnecting regions of the CNS.
Meninges
fibrous membranes covering the CNS,
Cerebrospinal fluid (CSF)
Clear, watery medium that buoys and maintains homeostasis in
the brain and spinal cord
Neuron
Structural and functional cell of the nervous system; also called a
nerve cell.
 Classification

For descriptive purposes, the nervous system is divided

Anatomical and fictional divisions
Anatomically the nervous system is divided in to
Central nervous system (CNS)
oConsists the brain and spinal cord.
Peripheral nervous system (PNS)
oComposed of nerves, ganglia, and nerve plexuses.
 Classification

Functionally the nervous system is divided in to

Autonomic nervous system (ANS)
Sympathetic and parasympathetic
portions of the nervous system that
control the actions of the visceral organs
and skin.
Somatic nervous system
Includes neurons that control voluntary
activities
Organization of the nervous system