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Anatomy Tables - Upper GI Tract
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Anatomy Tables - Upper GI Tract |
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Osteology |
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|---|---|---|
| Bone | Structure | Description |
| occipital (N8, N9,N11, TG7-06, TG7-07) |
the bone forming the posterior surface of the skull; articulates superolaterally with the parietal bones through the lambdoid suture, anteroinferiorly with the temporal bone and anteriorly with the body of the sphenoid bone | |
| pharyngeal tubercle (N6, N8, TG7-06) |
projection located anterior to the foramen magnum; attachment site for the superior pharyngeal constrictor m. | |
| palate (N6, N8, TG7-06) |
hard palate | concave vaulted structure whose space is filled by the tongue when at rest |
| maxilla | frontal process (N4, TG7-03) | forms part of medial orbital wall & margin |
| zygomatic process (N4, TG7-03) | articulates with zygomatic bone | |
| infraorbital foramen (N2, TG7-03, TG7-57) | anterior opening of infraorbital canal, for infraorbital neurovascular bundle | |
| alveolar process (N2, TG7-03) | forms sockets for upper teeth | |
| zygomatic | temporal process (N4, TG7-04A) | articulates with zygomatic process of temporal bone to form the zygomatic arch (Greek, zygoma = a yoke, this bone yokes or joins several bones together) |
| frontal process (N4, TG7-04A) | forms most of lateral orbital margin and anteroinferior part of lateral orbital wall; articulates with frontal bone anteriorly and greater wing of sphenoid bone posteriorly | |
| maxillary process (N4, TG7-04A) | forms lateral part of inferior orbital margin and anterolateral part of orbital floor; articulates with maxilla | |
| mandible | body (N2, N15, TG7-32B, TG7-32C) | U-shaped, halves fused at symphysis menti |
| coronoid process (N15, TG7-32B) | anterosuperior projection from ramus; attachment of temporalis muscle | |
| condyle (N15, TG7-32B) | posterosuperior projection from ramus; articulates with mandibular fossa of temporal bone; constricted below articular surface at neck of mandible (Greek, kondylos = knuckle) | |
| mandibular notch (N15, TG7-32B) | notch between the coronoid and condylar processes; transmits masseteric neurovascular bundle | |
| lingula (N15, TG7-32C) | projection of bone medial to mandibular foramen; attachment of sphenomandibular ligament (Latin, lingula = tongue) | |
| mandibular foramen (N15, TG7-32C) | on medial surface of ramus, opening to mandibular canal; transmits inferior alveolar neurovascular bundle | |
| pterygoid fovea (N15, TG7-32C) | depression on anterior side of neck of mandible; insertion of lateral pterygoid m. (Greek, pterygoid = wing-shaped) | |
| symphysis menti (TG7-32C) | midline symphysis between the two halves of mandible; fuses during first year (Greek, symphysis = a growing together) | |
| mental protuberance (N15,N2, TG7-32B) | forms bone of chin anteriorly | |
| mental foramen (N15,N2, TG7-32B) | on anterior surface of body, inferior to premolar teeth; transmits mental neurovascular bundle | |
| ramus (N15,N2, TG7-32B) | rises nearly vertically from posterior end of body (Latin, ramus = a branch) | |
| angle (N15,TG7-32B, TG7-32C) | posteroinferior bend formed by union of body & ramus | |
| temporal | petrous part (TG7-06, TG7-07) | contains tympanic cavity & bony labyrinth |
| zygomatic process (N4, TG7-04A) | articulates with temporal process of zygomatic bone to form the zygomatic arch | |
| mastoid process (N4, TG7-04A) | projects inferiorly from junction of petrous & squamous parts; contains mastoid air cells that open into tympanic cavity through mastoid antrum | |
| styloid process (N4, TG7-04A, TG7-06) | projects inferiorly from petrous part; attachment for stylohyoid, styloglossus & stylopharyngeus muscles & stylomandibular & stylohyoid ligaments (Greek, styloid = resembles a pillar or post) | |
| stylomastoid foramen (N8, TG7-06) | located between the styloid and mastoid processes; exit of the facial nerve from the base of the skull | |
| pterygopalatine fossa (N4, TG7-32) | pyramidal space inferior to apex of orbit | lies between the pterygoid process of the sphenoid bone posteriorly and the posterior aspect of the maxilla anteriorly (Greek, pterygoid = wing-shaped) |
| temporal | temporal lines (TG7-04) | two low ridges that run parallel to each other, arching across the lateral surface of the calvaria; they define the upper limit of the temporalis m. origin |
| articular tubercle (TG7-06) | inferior projection anterior to mandibular fossa; important in dislocations of the mandible | |
| mandibular fossa (N4, TG7-32) | articulates with condylar process of mandible | |
| sphenoid | body (N8, TG7-07, TG7-08) | central part, containing sinuses (Greek, sphenoid = wedge-shaped) |
| infratemporal fossa (N4, TG7-32) | bounded superiorly by the infratemporal surface of greater wing of the sphenoid and inferiorly by the alveolar border of the maxilla; bounded laterally by the ramus of the mandible and medially by the lateral pterygoid plate of the sphenoid bone | |
| sphenoid | body (N6, TG7-07, TG7-08) | central part, containing sinuses (Greek, sphenoid = wedge-shaped) |
| foramen ovale (N4, N8, N11, TG7-06, TG7-07, TG7-32) | through greater wing between foramen rotundum & foramen spinosum; transmits mandibular division of trigeminal nerve | |
| foramen spinosum (N8,N11, TG7-06, TG7-07) | through greater wing; transmits middle meningeal artery | |
| lateral pterygoid plate (N6, N8, TG7-06, TG7-08) | projects posterolaterally from pterygoid process; attachment of lateral & medial pterygoid muscles (Greek, pterygoid = wing-shaped) | |
| medial pterygoid plate (N6, N8, TG7-06, TG7-08) | projects posteriorly from pterygoid process; attachment of superior pharyngeal constrictor & pharyngobasilar fascia (Greek, pterygoid = wing-shaped) | |
| pterygoid hamulus (N6,N8, TG7-06, TG7-08) | hook-like projection from the inferior end of the medial pterygoid plate; it acts as a pulley for the tendon of the tensor veli palatini m. (Greek, pterygoid = wing-shaped; Latin, hamus = hook) | |
| hyoid (N13, N77, TG7-09, TG7-25, TG7-26) |
a "U"-shaped bone consisting of several parts: body, 2 greater horns, 2 lesser horns; the hyoid bone ossifies completely in middle life; the body articulates with the greater horns via cartilage and with the lesser horns via fibrous joints prior to ossification; an important site for muscle attachments (suprahyoid and infrahyoid muscle groups) (Greek, hyoid = U-shaped) | |
| body | the middle portion of the "U"-shaped bone; the body of the hyoid bone continues with the greater horns posteriorly | |
| greater horn (cornu) | posteriorly directed limbs of the "U"-shaped bone; each greater horn articulates with the body and lesser horns anteriorly; origin of middle pharyngeal constrictor m. and hyoglossus m. | |
| lesser horn (cornu) | articulates with the greater horn at its junction with the body; the inferior end of the stylohyoid ligament attaches to the lesser horn | |
Muscles |
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| Muscle | Origin | Insertion | Action | Innervation | Notes | Image |
| depressor anguli oris (N26, N54, TG7-29, TG7-30A) | oblique line of mandible | angle of mouth | pulls the corner of the mouth downward | marginal mandibular & buccal branches of facial nerve (VII) | a "frown" muscle | ) |
| levator labii superioris (N26, N54, TG7-29, TG7-30A) | inferior margin of orbit | skin of upper lip | elevates upper lip | buccal branch of facial nerve (VII) | (Latin, levator = to lift) | ) |
| zygomaticus major (N26, N54, TG7-29, TG7-30A) | zygomatic bone, upper lateral surface | skin of angle of mouth | elevates and draws the corner of mouth laterally | zygomatic and buccal branches of facial nerve (VII) | a "smile" muscle | ) |
| orbicularis oris (N26, N54, TG7-29, TG7-30A) | skin and fascia of lips and area surrounding lips | skin and fascia of lips | purses the lips | buccal branch of facial nerve (VII) | (Latin, orbicularis = a small disk) | ) |
| buccinator (N26, N54, TG7-29) | pterygomandibular raphe, mandible, and maxilla lateral to molar teeth | angle of mouth & lateral portion of upper and lower lips | pulls corner of mouth laterally; pulls cheek against teeth | buccal branches of facial nerve (VII) | although buccinator is important in mastication, it is innervated by the facial nerve, and NOT by the buccal nerve from V3 (a sensory nerve) (Latin, buccinator = trumpeter) | ) |
| platysma (N26, TG7-29, TG7-30A) | fascia overlying the pectoralis major and deltoid muscles | inferior border of mandible and skin of lower face | draws corners of mouth down; aids in depression of the mandible | facial nerve (VII), cervical branch | (Greek, platysma = a flat plate) | ) |
| levator veli palatini (N64,N65,N68, TG7-20, TG7-24) | apex of the petrous part of the temporal bone and the medial surface of the auditory tube cartilage | muscles and fascia of the soft palate; palatine aponeurosis | elevates the soft palate | vagus nerve (X) via the pharyngeal plexus | a derivative of the fourth pharyngeal arch (Latin, levator = to lift) | ) |
| tensor veli palatini (N64,N65,N68, TG7-20, TG7-24) | scaphoid fossa, lateral wall of the auditory tube cartilage | palatine aponeurosis | opens the auditory tube; tenses the soft palate | mandibular division of the trigeminal nerve (V) | remember: V3 innervates both tensor muscles (tympani and veli palatini); ALL other palatal muscles are innervated by vagus | ) |
| masseter (N54, TG7-31) | zygomatic arch and zygomatic bone | lateral surface of ramus and angle of mandible | elevates mandible | nerve to masseter, from mandibular division of trigeminal nerve (V) | a powerful chewing muscle (Greek, masseter = the chewer) | ) |
| temporalis (N54, TG7-31, TG7-34) | temporal fossa and temporal fascia | coronoid process and anterior surface of the ramus of the mandible | elevates mandible; retracts mandible (posterior fibers) | anterior and posterior deep temporal nerves from mandibular division of trigeminal nerve (V) | a powerful chewing muscle | ) |
| pterygoid, lateral (N55, TG7-34) | superior head: greater wing of sphenoid; inferior head: lateral surface of lateral pterygoid plate | superior head: capsule & articular disk of temporomandibular joint; inferior head: neck of mandible | protracts mandible; opens mouth | lateral pterygoid branch of mandibular division of trigeminal nerve (V) | the only one of the muscles of mastication that opens the mouth; the superior head of lateral pterygoid is sometimes called sphenomeniscus due to its insertion into the disc of the temporomandibular joint (Greek, pterygoid = wing-shaped) | ) |
| pterygoid, medial (N55, TG7-34) | medial surface of the lateral pterygoid plate, pyramidal process of palatine bone, tuberosity of maxilla | medial surface of ramus and angle of mandible | elevates and protracts mandible | medial pterygoid branch of mandibular division of trigeminal nerve (V) | this muscle mirrors the masseter m. in position and action with the ramus of the mandible between (Greek, pterygoid = wing-shaped) | ) |
| digastric (N27, N28 TG7-12, TG7-17) | anterior belly: digastric fossa of the mandible; posterior belly: mastoid notch of the temporal bone | body of the hyoid via a fibrous loop over an intermediate tendon | elevates the hyoid bone; depresses the mandible | anterior belly: mylohyoid nerve, from the mandibular division of the trigeminal nerve (V); posterior belly: facial nerve (VII) | the digastric m. forms two sides of the submandibular triangle; it is formed from mesenchyme derived from the first two pharyngeal arches, hence its dual innervation | ) |
| geniohyoid (N53, N59,N63, TG7-38, TG7-40) | mental spines of mandible | body of hyoid bone | elevates hyoid; depresses mandible | C1 ventral primary ramus via fibers carried by hypoglossal nerve | thyrohyoid and geniohyoid receive ansa cervicalis fibers that travel with the hypoglossal nerve distal to the superior limb of the ansa cervicalis | ) |
| genioglossus (N63, N59, TG7-38, TG7-40) | mental spine on inner aspect of mental symphysis | fans out to insert into the tongue from tip to base | protrudes tongue (inferior fibers); depresses tongue (middle fibers) | hypoglossal nerve (XII) | an extrinsic muscle of the tongue; XII innervates all tongue muscles except palatoglossus (innervated by vagus (X), as are most of the palate and pharynx muscles) | ) |
| hyoglossus (N53, N59, TG7-40) | upper border of greater horn of the hyoid and body of the hyoid bone | mingles with intrinsic muscles of the tongue | depresses sides of tongue; retracts tongue | hypoglossal nerve (XII) | an extrinsic muscle of the tongue | ) |
| mylohyoid (N27,N28, N53, N59, TG7-12, TG7-37, TG7-40) | mylohyoid line of mandible | midline raphe and body of the hyoid bone | elevates the hyoid bone and the tongue; depresses the mandible | mylohyoid nerve from the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve (V) | the nerve to mylohyoid also innervates the anterior belly of digastric m.; both muscles are derivatives of the second pharyngeal arch | ) |
| styloglossus (N59, N68, TG7-20, TG7-40) | styloid process | side of the tongue | retracts and elevates tongue | hypoglossal nerve (XII) | an extrinsic muscle of the tongue | ) |
| stylohyoid (N59, TG7-17, TG7-40) | posterior side of the styloid process | splits around the intermediate tendon of the digastric m. to insert on the body of the hyoid bone | elevates and retracts the hyoid bone | facial nerve (VII) | facial nerve innervates both the stylohyoid m. and the posterior belly of the digastric m. shortly after exiting from the stylomastoid foramen | ) |
| constrictor, superior pharyngeal (N65, N75, TG7-21, TG7-22, TG7-24) |
medial pterygoid plate, pterygoid hamulus, pterygomandibular raphe, mylohyoid line of mandible | pharyngeal tubercle and midline pharyngeal raphe | constricts the pharyngeal cavity | vagus (X), via pharyngeal plexus | none | ) |
| constrictor, middle pharyngeal (N65, N75, TG7-21, TG7-22, TG7-24) |
lesser and greater horns of hyoid bone and inferior part of the stylohyoid ligament | midline pharyngeal raphe | constricts the pharyngeal cavity | vagus, via pharyngeal plexus | none | ) |
| constrictor, inferior pharyngeal (N65, N75, TG7-21, TG7-22, TG7-24) |
oblique line of thyroid cartilage, lateral surface of cricoid cartilage | midline pharyngeal raphe | constricts pharyngeal cavity | vagus (X), via pharyngeal plexus, with aid from superior laryngeal and recurrent laryngeal nerves | most external of the three pharyngeal constructor mm. | ) |
| stylopharyngeus (N65, N67, TG7-21, TG7-24) |
medial side of styloid process | superior border of thyroid cartilage and also into the pharyngeal wall | elevates the larynx | glossopharyngeal nerve (IX) | stylopharyngeus, the only muscle innervated by IX, is the only pharyngeal muscle NOT innervated by vagus (X) nerve | ) |
| thyrohyoid (N28,N29,N31, TG7-13) | oblique line of thyroid cartilage | lower border of hyoid bone | elevates larynx; depresses/stabilizes hyoid bone | C1&2 fibers running with hypoglossal nerve that leave XII anterior to the superior root of ansa cervicalis | thyrohyoid lies deep to the sternohyoid | ) |
Nerves |
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| Nerve | Source | Branches | Motor | Sensory | Notes |
| facial (N92, N94, N97,N104,N123, TG7-47, TG7-65, TG7-68, TG7-87) | pons & medulla: nucleus solitarius of medulla via nervus intermedius (SVA sensory root) from geniculate ganglion; superior salivatory nucleus (GVE preganglionic parasympathetic) of pons via nervus intermedius, facial motor nucleus of pons via motor root | greater petrosal (preganglionic parasympathetic to pterygopalatine ganglion, postganglionic parasympathetic travels with brs. of maxillary div. of V), chorda tympani (SVA taste from anterior 2/3rds of tongue; preganglionic parasympathetic to submandibular ganglion, postganglionic parasympathetic to submandibular & sublingual glands), n. to stapedius, posterior auricular, intraparotid plexus with temporal, zygomatic, buccal, marginal mandibular & cervical brs. | stapedius, stylohyoid, posterior belly of digastric, muscles of facial expression; secretomotor to lacrimal, submandibular, sublingual, and mucous glands of nasal & oral cavities | taste (SVA) from anterior 2/3rds of tongue; part of skin of external auditory meatus | also known as: CN VII, 7th cranial nerve; passes into internal acoustic meatus, goes through facial canal, exits at stylomastoid foramen |
| ganglion, geniculate (N92, N94, N97, N123, TG7-67B, TG7-68B) | chorda tympani, from facial n. (VII) | nucleus solitarius of medulla via nervus intermedius (SVA sensory root of facial n.) | taste (SVA) from ant. 2/3rds of tongue | a sensory ganglion equivalent in structure and function to a dorsal root ganglion; some taste from palate travels through greater petrosal n. to geniculate ganglion; located in facial canal of petrous temporal bone (Latin, geniculate = to bend) | |
| petrosal, greater (N104,N123, TG7-67B, TG7-68B) | facial (VII) | joins deep petrosal n. to form n. of pterygoid canal | secretomotor (preganglionic parasympathetic) to lacrimal gland & mucous glands of lower nasal cavity, maxillary sinus, palate | contains: preganglionic parasympathetic axons bound for the pterygopalatine ganglion where they will synapse; passes through hiatus of canal of greater petrosal n. in petrous part of temporal bone | |
| chorda tympani (N94, N123, TG7-67B, TG7-68A) | facial (VII) | secretomotor to submandibular & sublingual glands (preganglionic parasympathetic to submandibular ganglion) | taste to anterior 2/3rds of tongue | joins lingual nerve in infratemporal fossa and continues with it to the tongue (Latin, chorda = a cord; Greek, tympanum = a kettle drum) | |
| glossopharyngeal (N104, TG7-90C) | medulla: spinal trigeminal nucleus from superior ganglion (GVA); nucleus solitarius from inferior ganglion (SVA); nucleus ambiguus (GVA); inferior salivatory nucleus (GVE preganglionic parasympathetic) | tympanic nerve to tympanic plexus & lesser petrosal n., carotid sinus n., stylopharyngeus brs., pharyngeal brs. | GSE: stylopharyngeus; GVE: secretomotor to parotid gland (preganglionic parasympathetic via tympanic n. to lesser petrosal n. to otic ganglion, postganglionic parasympathetic via auriculotemporal n.) | GVA: carotid body & sinus, pharynx, middle ear; GSA: skin of external ear; SVA: taste from posterior 1/3rd of tongue | also known as: CN IX, 9th cranial nerve; passes through jugular foramen; may penetrate the stylopharyngeus m. |
| tympanic (TG7-90C) | glossopharyngeal | tympanic plexus, which gives rise to lesser petrosal n. | secretomotor (pregang. parasymp., synapsing in otic gang.) to parotid gland | mucous lining of middle ear cavity | passes from inferior ganglion of CN IX through tympanic canaliculus to middle ear (Greek, tympanum = a kettle drum) |
| vagus (N126, TG7-20, TG7-21, TG7-91, TG7-92) | medulla: dorsal nucleus (GVA & GVE preganglionic parasympathetic) from inferior ganglion, nucleus ambiguus (SVE); spinal trigeminal nucleus (GSA) from superior ganglion; nucleus solitarius (SVA) from inferior ganglion | auricular br., pharyngeal br., superior laryngeal, superior & inferior cervical cardiac brs., recurrent laryngeal, thoracic cardiac brs., brs. to pulmonary plexus, esophageal plexus, anterior & posterior vagal trunks | SVE: intrinsic muscles of larynx, pharynx (except stylopharyngeus), & palate (except tensor veli palatini); GVE: smooth muscle of respiratory tree & gut (proximal to splenic flexure), heart; secretomotor: mucous glands of larynx, respiratory tree, pharynx & gut, digestive glands | GSA: skin of external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to splenic flexure; SVA: taste to epiglottis | also known as: CN X, 10th cranial nerve; passes through jugular foramen; (Latin,vagus = wanderer, because of its wide distribution to the body cavities) |
| superior laryngeal (N74, N75, N76, TG7-21, TG7-26) |
vagus (X) | internal & external brs. | cricothyroid, inferior pharyngeal constrictor, secretomotor to mucous glands of larynx above vocal folds | mucous lining of larynx above vocal folds | external br. supplies cricothyroid m.; all other intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve |
| inferior laryngeal (N74, N75, N76, TG7-21, TG7-26) |
recurrent laryngeal br. of vagus (X) | all muscles of larynx except cricothyroid: thyroarytenoid, oblique & transverse arytenoid, posterior & lateral cricoarytenoid, aryepiglottic, thyroepiglottic, vocalis; secretomotor to mucous glands of larynx below vocal fold | mucous lining of larynx below vocal fold | continuous with recurrent laryngeal at inferior border of cricopharyngeus | |
| recurrent laryngeal (N74, N75, N76, TG7-21, TG7-26) |
vagus (X) | esophageal brs., tracheal brs., cardiac brs., pharyngeal brs., inferior laryngeal n. | upper esophagus, lower pharynx, laryngeal ms. (except cricopharyngeus); smooth muscle of trachea; secretomotor to mucous glands in upper esophagus, lower pharynx, larynx below vocal fold, trachea; cardiac muscle of heart (slows rate, decreases force of contraction) | upper esophagus, lower pharynx, larynx below vocal folds, GVA from heart | right recurrent loops posteriorly around right subclavian a.; left recurrent loops posteriorly around aortic arch & ligamentum arteriosum; inferior laryngeal br. supplies all intrinsic muscles of the larynx EXCEPT cricothyroid m. |
| pharyngeal plexus of nerves (N71, N125, N130, N131, TG7-20, TG7-21, TG7-90) |
pharyngeal branches of glossopharyngeal (IX), vagus (X), and sympathetic trunk | pharyngeal brs. | all muscles of pharynx (except stylopharyngeus) via vagus; mucous glands (vagal parasympathetic) and blood vessels (sympathetic) of pharynx | oropharynx (glossopharyngeal) and laryngopharynx (vagus) | stylopharyngeus m. is innervated by glossopharyngeal n. |
| accessory (N71, N127, TG7-18, TG7-93) | cranial root: nucleus ambiguus; spinal root: spinal nucleus of upper cervical spinal cord | cranial root joins vagus; spinal root ascends through foramen magnum | GSE: sternocleidomastoid and trapezius mm. | also known as: CN XI, 11th cranial nerve; passes through jugular foramen; accessory n. is motor only; proprioceptive fibers reach sternocleidomastoid via C2&C3 and trapezius via C3&C4 (subtrapezial plexus) | |
| hypoglossal (N71, N128, TG7-21, TG7-94) | medulla: hypoglossal nucleus | branches of C1&2 carried by this nerve are not considered to be branches of the hypoglossal nerve | intrinsic and extrinsic muscles of the tongue (except palatoglossus m.) | also known as: CN XII, 12th cranial nerve; passes through the hypoglossal canal; superior root of ansa cervicalis travels with the hypoglossal n. | |
| mandibular (N46, N55, TG7-37, TG7-84A, TG7-84B, TG7-84C, TG7-85A, TG7-85B) | trigeminal ganglion; motor root of trigeminal from pons | meningeal br., medial & lateral pterygoid, masseteric, anterior & posterior deep temporal, buccal, auriculotemporal, lingual, inferior alveolar | mylohyoid, anterior belly of digastric; tensor tympani, tensor veli palatini; muscles of mastication (temporalis, masseter, medial & lateral pterygoid) | GSA: skin of lower lip & jaw extending superiorly above level of ear; GVA: tongue, & floor of mouth, lower teeth & gingiva | also known as: V3, mandibular division of trigeminal; passes through foramen ovale; otic ganglion hangs off medial side of V3 below foramen ovale; auriculotemporal n. carries postganglionic parasympathetic to parotid gland; submandibular ganglion hangs off lingual n. near submandibular gland; postganglionic parasympathetics reach this gland & sublingual gland |
| auriculotemporal (N46, N61,N122, TG7-30, TG7-84) | mandibular division of trigeminal n. (V3) | parotid brs., articular brs., anterior auricular brs. | secretomotor to parotid gland: postganglionic parasympathetic from communicating br. of otic ganglion; preganglionic parasympathetic from lesser petrosal br. of glossopharyngeal n. (IX) | skin of anterior ear & anterosuperior to ear; part of external auditory meatus; temporomandibular joint | two roots of auriculotemporal encircle the middle meningeal a. |
| inferior alveolar (N42,N122, TG7-36, TG7-84) | mandibular division of trigeminal (V3) | n. to mylohyoid; inferior dental plexus; terminates as mental nerve | mylohyoid muscle via n. to mylohyoid | teeth of mandible; skin of chin | |
| mylohyoid, n. to (N42,N122, TG7-36, TG7-84) | inferior alveolar | mylohyoid, anterior belly of digastric | arises near lingula of mandible | ||
| lingual (N55, N57, N65, TG7-37, TG7-84A, TG7-84C) | mandibular division of trigeminal (V3) | general sense from anterior 2/3rds of tongue, floor of mouth | joined by chorda tympani (taste & pregang. parasymp.) from facial n. in infratemporal fossa; submandibular gang. hangs from lingual nerve in paralingual space | ||
| buccal (N50, N128, TG7-37, TG7-84) | mandibular division of trigeminal n. (V3) | skin of cheek, oral mucosa | not a motor nerve | ||
| masseteric (TG7-85A) | mandibular division of trigeminal | masseter | passes over mandibular notch | ||
| temporal, anterior deep (N42, N122, TG7-36, TG7-85) | mandibular division of trigeminal (V3) | temporalis | |||
| temporal, posterior deep (N42, N122, TG7-36, TG7-85) | mandibular division of trigeminal (V3) | temporalis | |||
| mental (N24,N46,N122, TG7-29, TG7-84) | inferior alveolar | skin of chin & lower lip | passes through mental foramen | ||
| auriculotemporal (N24,N46,N122, TG7-29, TG7-30, TG7-84) | mandibular division of trigeminal n. (V3) | parotid brs., articular brs., anterior auricular brs. | secretomotor to parotid gland: postganglionic parasympathetic from communicating br. of otic ganglion; preganglionic parasympathetic from lesser petrosal br. of glossopharyngeal n. (IX) | skin of anterior ear & anterosuperior to ear; part of external auditory meatus; temporomandibular joint | two roots of auriculotemporal encircle the middle meningeal a. |
| buccal nerve (N24, N122, TG7-29) | mandibular division of trigeminal n. (V3) | skin of cheek, oral mucosa | not a motor nerve | ||
| buccal branches of facial n. (N25, TG7-31A, TG7-87C) | facial n. (VII); has temporofacial & cervicofacial divisions | zygomaticus major & minor, buccinator, orbicularis oris, levator anguli oris, levator labii superioris & alaeque nasi, risorius, procerus, nasalis | not a sensory nerve | ||
| trigeminal (TG7-81AB, TG7-81C, TG7-81D) | pons: trigeminal motor nucleus (SVE) to motor root; spinal trigeminal nucleus from trigeminal ganglion (GSA) via sensory root | ophthalmic, maxillary & mandibular divisions | SVE: temporalis, masseter, lateral & medial pterygoid, anterior belly of digastric, mylohyoid, tensor veli palatini, tensor tympani | skin of face, nasal & oral cavities, ant. 2/3rds of tongue (GSA only) | also known as: CN V, 5th cranial nerve; some brs. carry pre- or postganglionic parasympathetic fibers; divides into three divisions at trigeminal ganglion; SVE supplies muscles of branchial arch origin |
| hypoglossal (N32, N71, N128, TG7-17, TG7-18, TG7-94AB, TG7-94C) | medulla: hypoglossal nucleus | branches of C1 carried by this nerve are not considered to be branches of the hypoglossal nerve | intrinsic and extrinsic muscles of the tongue (except palatoglossus m.) | also known as: CN XII, 12th cranial nerve; passes through the hypoglossal canal; superior root of ansa cervicalis travels with the hypoglossal n. | |
| ganglion, submandibular (N46, N59, N61, N122, TG7-37, TG7-40, TG7-84) | preganglionic parasympathetic from chorda tympani accompanying lingual n. | postganganglionic parasympathetic to submandibular & sublingual glands | secretomotor to submandibular & sublingual glands | hangs off lingual n. above deep part of submandibular gland | |
Joints | ||
|---|---|---|
| Joint | Description | Significance |
| temporomandibular joint (N12,N17, TG7-06 N16, TG7-32B, TG7-32C) | synovial, hinge | separated into 2 joint spaces by intracapsular fibrous articular disc |
Arteries | ||||
|---|---|---|---|---|
| Artery | Source | Branches | Supply | Notes |
| common carotid (N31,N32,N33,N34, TG 7-19, TG 7-71) |
brachiocephalic trunk (right), aortic arch (left) | external & internal carotid (terminal brs.) | most of head & upper neck | common carotid a. bifurcates at the level of the superior border of the thyroid cartilage; carotid sinus & body located at bifurcation |
| internal carotid (N69, N136, TG7-72) |
common carotid | none in the neck; in the head: ophthalmic, post. communicating, ant. & middle cerebral (terminal brs.) | brain, eye, forehead | primary blood supply to the brain; anastomoses with vertebral aa. |
| external carotid (N31, N32, N33, N34, TG7-19, TG7-71) |
common carotid | superior thyroid, ascending pharyngeal, lingual, facial, occipital, post. auricular, maxillary & superficial temporal (terminal brs.) | upper neck, face & scalp | primary blood supply to face & superficial head |
| superior thyroid (N31, N32, N33, N34, TG7-13, TG7-14, TG7-25) |
external carotid | infrahyoid br., sternocleidomastoid br., sup. laryngeal, cricothyroid br., ant., post. & lat. glandular brs. | thyroid gland, upper larynx, infrahyoid muscles, sternocleidomastoid | |
| ascending pharyngeal (N31, N32, N33, N34, TG7-19, TG7-71) |
external carotid | pharyngeal brs., inf. tympanic, post. meningeal | pharynx | arises from the medial side of the external carotid a. close to the birfurcation |
| lingual (N31, N32, N33, N34, TG7-19, TG7-71) |
external carotid | suprahyoid br., dorsal lingual brs., deep lingual, sublingual | tongue, suprahyoid muscles, palatine tonsil | (Latin, lingula = tongue) |
| facial (N23, N31, N32, N33, N34, N69, TG7-19, TG7-31, TG7-71) |
external carotid | ascending palatine a., tonsilar br., submental a., sup. & inf. labial aa., lat. nasal br., angular a. | lower part of palatine tonsil, submandibular gland, facial muscles & fascia | its angular branch anastomoses with the ophthalmic a. |
| labial, inferior (N69, TG7-71) | facial | lower lip - skin, muscles & mucosa | ||
| labial, superior (N69, TG7-71) | facial | septal br. | lower nasal septum; upper lip - skin, muscles & mucosa | |
| occipital (N31, N32, N33, N34, TG7-19, TG7-71) |
external carotid | sternocleidomastoid brs., auricular br., mastoid br., descending br., occipital brs. | lateral & post. neck, post. scalp | anastomoses with deep cervical; joins greater occipital nerve posteriorly |
| maxillary (N69, TG7-19, TG7-34, TG7-35) | external carotid | deep auricular, anterior tympanic, middle meningeal, inferior alveolar, masseteric, post. & ant. deep temporal, buccal, post. superior alveolar, infraorbital, art. of pterygoid canal, descending palatine, sphenopalatine | deep face, infratemporal fossa, tympanic cavity, muscles of mastication | may course medial or lateral to the lateral pterygoid m. in equal frequency |
| alveolar, inferior (N69, TG7-34, TG7-35) | maxillary artery | lingual branch, mylohyoid, dental, nutrient, mental | lower teeth & gingiva, mandible, closely associated muscles | runs with the inferior alveolar nerve within the mandibular canal |
| middle meningeal (N69, TG7-35) | maxillary | frontal br., parietal br., petrous br., superior tympanic | most of the dura mater (approx. 80%), cranial vault bones | passes through foramen spinosum; may be torn by fracture at pterion |
| temporal, anterior deep (N69, TG7-35) | maxillary | temporalis anteriorly | branches in the infratemporal fossa and runs deep to temporalis m. | |
| temporal, posterior deep (N69, TG7-35) | maxillary | temporalis posteriorly | branches in the infratemporal fossa and runs deep to temporalis m. | |
| buccal (N69, TG7-34, TG7-35) | maxillary | cheek and associated muscles | runs with the buccal branch of CN V | |
| masseteric (N69, TG7-34, TG7-35) | maxillary | masseter m. | ||
| alveolar, posterior superior (N69, TG7-35) | maxillary artery | dental, mucosal | upper molar teeth, part of maxillary sinus | enters the maxilla in the infratemporal fossa |
| lingual (N69, N59, N51, TG7-19, TG7-40) | external carotid | suprahyoid br., dorsal lingual brs., deep lingual, sublingual | tongue, suprahyoid muscles, palatine tonsil | |
| superficial temporal (N69, N23, TG7-33, TG7-34, TG7-35, TG7-71) | external carotid a. | transverse facial a.; anterior auricular brs.; zygomatico-orbital a.; middle temporal a.; frontal br.; parietal br. | scalp of the lateral side of the head; lateral face; temporalis m. | superficial temporal a. and maxillary a. are the terminal branches of the external carotid a. |
| facial, transverse (N69, N23, TG7-71) | superficial temporal a. | parotid gland; masseter m.; skin of the face | anastomoses with branches of the buccal, infraorbital and facial arteries |
Veins |
|||||
|---|---|---|---|---|---|
| Vein | Tributaries | Drains Into | Region Drained | Notes | |
| pterygoid plexus (N70, TG7-73) | descending palatine, sphenopalatine, infraorbital, posterior superior alveolar, ant. & post. deep temporal, middle meningeal, masseteric, inferior alveolar | maxillary v. | meninges, nasal cavity, infratemporal fossa | valveless; connects with cavernous sinus & pharyngeal plexus (Latin, plexus = a braid) | |
| retromandibular (N70, TG7-11, TG7-73) | formed by the union of the superficial temporal & maxillary vv. | anterior & posterior divisions of retromandibular; anterior division unites with facial to form common facial, posterior division unites with posterior auricular to form external jugular | side of head & scalp; deep face | contained within the parotid gland | |
| internal jugular (N27,N70, TG7-11, TG7-73) | formed by the union of the sigmoid & inferior petrosal sinuses; tributaries: pharyngeal vv.; lingual, common facial, sternocleidomastoid, superior & middle thyroid vv. | brachiocephalic v. | brain & skull, face, viscera of neck | largest vein of the nead and neck (Latin, jugulum = throat) |
Viscera/Fascia |
||
|---|---|---|
| Organ | Location/Description | Notes |
| torus tubarius (TG7-23) | mucosal fold covering the anteromedial end of the auditory tube cartilage | torus tubarius projects toward the midline from the lateral wall of the nasopharynx (Latin, torus = knot) |
| auditory (pharyngotympanic) tube (TG7-65, TG7-67) | joins the middle ear to the nasopharynx | |
| soft palate (TG7-24, TG7-43) | the movable posterior third of the palate, which is suspended from the posterior border of the hard palate | |
| uvula (TG7-41) | conical process that is the posteroinferior extension of the soft palate | (Latin, uva/uvula = a grape) |
| parotid gland (N25, N61, N54, TG7-30A, TG7-30B, TG7-31A) | largest salivary gland; located lateral & posterior to mandibuilar ramus; innervated by postganglionic parasympathetic fibers from the oticic ganglion via the auriculotemporal n. (Greek, parotid = the gland beside the ear) | |
| parotid duct (N25, N61, N54, TG7-30A, TG7-30B, TG7-31A) | drains parotid gland across masseter through cheek to oral cavity near upper 2nd molar tooth (Greek, parotid = the gland beside the ear) | |
| intrinsic muscles of the tongue (N126, TG7-38) | includes the superior and inferior longitudinals, transverse, and vertical muscles | |
| submandibular triangle (N60, N61, N69, N73, TG7-02, TG7-12, TG7-37) | comprised of the submandibular gland and lymph nodes, hypoglossal nerve, mylohyoid nerve, and parts of the facial artery and vein | |
| submandibular gland (N60, N61, N69, N73, TG7-12, TG7-37A, TG7-37B) | salivary gland; located beneath mylohyoid in submandibular triangle; innervated by postgang. parasymp. fibers from submandibular gang. | |
| sublingual gland (TG7-37A, TG7-37B) | salivary gland; located beneath oral mucosa in floor of mouth; drains via multiple small ducts | |
| submandibular duct (N60, N61, N69, N73, TG7-12, TG7-37A, TG7-37B) | drains submandibular gland to sublingual caruncle in floor of mouth | |
| foramen cecum (of tongue) (N58, TG7-39) | located on midline of tongue in sulcus terminalis; remnant of thyroid diverticulum (Latin, foramen cecum = blind apeture) | |
| vallate papillae (N58, TG7-39) | located in line anteriorly along sulcus terminalis of tongue; possess taste buds in circular sulcus; a.k.a. circumvallate papillae | |
| frenulum of tongue (N51, TG7-38) | fold of mucous membrane under tongue (Latin, frenulum = a bridle, a narrow reflection or fold of mucous membrane, passing from a more fixed to a movable part) | |
| sublingual caruncle (N51, TG7-38) | papilla on lateral side of frenulum of tongue; opening of the duct of the submandibular gland | |
| carotid sheath (N35A,N35B, TG7-10, TG7-13) |
fascial investment that extends from the base of the skull to the root of the neck | blends anteriorly with the investing and pretracheal layers of fascia and posteriorly with the prevertebral layer of deep cervical fascia |
| carotid bifurcation (N31,N32,N33,N34, TG 7-19, TG 7-71) |
point at which common carotid artery splits into external and internal carotid, usually at the level of upper border of thyroid lamina | location of carotid body and sinus |
| carotid body (N131, TG7-90) |
small reddish-brown ovoid mass that lies on the medial side of the carotid bifurcation | serves as a chemoreceptor that monitors the amount of oxygen and carbon dioxide in the blood |
| carotid sinus (N131, TG7-90) |
a slight dilation of the beginning of internal carotid and upper common carotid artery | serves as a baroreceptor that reacts to changes in arterial pressure |
| pharyngobasilar fascia (N67, TG7-21) |
blends with the periosteum of the base of the skull and defines the limits of the pharyngeal wall in its superior part | penetrated by the passage of the auditory tube into the nasopharynx |
| pharynx (N67, TG7-21, TG7-23) |
connects nasal & oral cavities with larynx & esophagus | divided into 3 parts: nasopharynx, oropharynx & laryngopharynx |
| nasopharynx (TG7-22, TG7-23) |
connects nasal cavity with oropharynx; located posterior to posterior nasal apertures and superior to pharyngeal isthmus (soft palate & posterior wall of pharynx) | contains torus tubarius, pharyngeal recess, pharyngeal tonsil |
| torus tubarius (TG7-22, TG7-23) |
mucosal fold covering the anteromedial end of the auditory tube cartilage | torus tubarius projects toward the midline from the lateral wall of the nasopharynx (Latin, torus = knot) |
| pharyngeal recess (TG7-22, TG7-23) |
posterosuperior to the torus tubarius | pharyngeal tonsil may extend variably into the pharyngeal recess |
| uvula (TG7-22, TG7-23) |
conical process that is the posteroinferior extension of the soft palate | (Latin, uva/uvula = a grape) |
| oropharynx (TG7-22, TG7-23) |
connects: anteriorly with oral cavity through oropharyngeal isthmus (palatoglossal arch), superiorly with nasopharynx through pharyngeal isthmus (posterior margin of soft palate), inferiorly with laryngopharynx at superior margin of epiglottis | contains palatine tonsil in tonsilar bed between palatoglossal & palatopharyngeal arches |
| palatoglossal fold (TG7-23) |
fold of mucosa covering the palatoglossus m. | palatoglossal fold marks the anterior boundary of the tonsillar fossa or bed of the palatine tonsil |
| palatopharyngeal fold (TG7-22, TG7-23) |
fold of mucosa covering the palatopharyngeus m. | palatopharyngeal fold marks the posterior boundary of the tonsillar fossa or bed of the palatine tonsil |
| laryngopharynx (N70, TG7-22, TG7-23) |
connects: superiorly with oropharynx at superior border of epiglottis, anteriorly with larynx through laryngeal inlet (epiglottis, aryepiglottic folds, arytenoid cartilages), inferiorly with esophagus at lower border of cricoid cartilage | contains piriform recesses lateral to aryepiglottic folds |
| lateral glossoepiglottic fold (TG7-39) |
located between base of tongue & epiglottis lateral to valleculae epiglottica | |
| median glossoepiglottic fold (TG7-39) |
located between base of tongue & epiglottis | separates the paired valleculae epiglottica |
| piriform recess (N70, TG7-22, TG7-23) |
located lateral to aryepiglottic folds | (Latin, pirum = pear + forma = form) |
| esophagus (N70, TG7-22, TG7-23) |
connects: superiorly with laryngopharynx at lower border of cricoid cartilage, inferiorly through diaphragm at t10 vert. level to reach stomach; upper third is skeletal muscle innervated by recurrent laryngeal | lower 2/3rds is smooth muscle innervated by vagus via esophageal plexus |
Lymphatics |
|||||
|---|---|---|---|---|---|
| Structure | Location | Afferents from | Efferents to | Regions drained | Notes |
| tonsil, pharyngeal (TG7-43) | roof and posterior wall of the nasopharynx | lymphatic vessels of the wall of the pharynx | superior deep cervical nodes | "guards" the entrance to the nasopharynx | part of the tonsillar ring (of Waldeyer); known as adenoids when inflamed |
| tonsil, palatine (TG7-38, TG7-39) | lateral wall of the oropharynx between the palatoglossal and palatopharyngeal arches | lymphatic vessels of the posterior tongue and palatoglossal/palatopharyngeal arch region | superior deep cervical nodes, especially the jugulodigastric node | "guards" the entrance of the oropharynx | part of the tonsillar ring (of Waldeyer); often referred to as "the" tonsils |
| tonsil, lingual (TG7-39) | superior surface of root of tongue | lymphatic vessels of the root of tongue and valleculae epiglottica | superior deep cervical nodes | "guards" entrance of oropharynx | part of tonsillar ring (of Waldeyer) |
| cervical nodes, deep (TG7-74) | in and around carotid sheath | lymphatic vessels from head & neck | jugular trunk | head & neck | superior and inferior subdivisions are delineated by the crossing of the omohyoid m. |
| cervical nodes, superficial (TG7-74) | in superficial fascia and along superficial vessels of the head & neck | lymphatic vessels from superficial structures in head & neck | varies by group; ultimate destination is the jugular trunk | head & neck | several groups are designated by location: occipital, retroauricular, anterior auricular, superficial parotid, facial, submental, submandibular, external jugular, anterior jugular |
Clinical Terms |
|
|---|---|
| Term | Definition |
| otitis media | infection or inflammation of the middle ear space and eardrum |
| myringotomy | removal of fluid from the middle ear space by creating an incision in the eardrum. In chronic cases of otitis media, a tube may be left in place to drain the fluid (tympanostomy tube). |
| tonsillitis | inflammation of the palatine tonsil |
| tonsillectomy | surgical removal of the palatine tonsils. Lingual tonsils are also taken. Indications include airway obstruction or recurrent tonsillitis. Complete recovery is in two weeks. Adults have a significantly longer period of recovery and a much higher complication rate than children. |
| Bell's palsy | a condition that involves the facial nerve (VII cranial nerve) and results in the paralysis of one side of the face. Bell's (facial nerve palsy) can be differentiated from a central (stroke) deficit by the inability to raise the eyebrow on the affected side. |
| trigeminal neuralgia/tic douloureux | a disorder of trigeminal nerve (cranial nerve V) dysfunction. Synonym: tic douloureux. Characterized by excruciating paroxysms of pain in the lips, gums, cheek or chin, and, very rarely, in the distribution of the eye (ophthalmic division of the trigeminal nerve). |
| Frey's syndrome | a condition in which the parasympathetic nerves (branches in the auriculotemporal) which normally supply the parotid gland innervate the sweat glands in the area, leading to sweating over the parotid when eating |
| parotid calculus | a stone in the parotid duct (Latin, calculus = a pebble) |
| sialogram | an X-ray study of the salivary ducts. A contrast material is injected into the salivary duct (within the mouth) to highlight the course and caliber of the ducts. This test is used to detect a stricture or blockage (for example stones, tumor) of the salivary ducts. |
| sialolithiasis | formation of a stone in a duct of a salivary gland |
| mumps | an infectious acute viral disease affecting the parotid glands. The gonads, meninges and pancreas can also be affected. The causative agent is a paramyxovirus. Humans are the only natural host for this disease. Common symptoms include weakness, fever, sore throat, malaise and puffiness to the cheeks (due to parotid gland swelling). Patients are contagious 1 day prior to the onset of swelling until the swelling is gone. Recovery is generally in 2 weeks. |
| submandibular (Wharton's) duct calculus | stone in the submandibular duct |
| TMJ syndrome/dislocation | TMJ syndrome: Disorder of the temporo-mandibular joint(s) causing pain usually in front of the ear(s). TMJ Dislocation: Excessive contraction of the lateral pterygoids may cause the jaw to dislocate anteriorly (pass anterior to the anterior tubercles. This could happen during yawning or when taking a large bite. Also sideway blows to the chin when the mouth is open dislocates the TMJ on the side that receives the blow. TMJ dislocation is frequently accompanied by fracture of the mandible. Posterior dislocation of the TMJ is uncommon due to the resistence by the postglenoid tubercle and the strong intrinsic lateral or temporomandibular ligament. Care must be taken during repair in regards to the facial and the auriculotemporal nerve; injury to the auriculotemporal nerve leads to laxity and instability of the TMJ. |
| bruxism | compulsive grinding or clenching of the teeth especially at night |
| LeForte fractures | classically described fractures of the face which occur with trauma
|
| Zenker's diverticulum | herniation of the mucosa of the laryngopharynx or esophagus through a defect in the wall of the muscular portion. The location is usually in the lowest portion of the laryngopharynx or upper one-third of the esophagus |
| Heimlich maneuver | an emergency, lifesaving procedure whereby the rescuer delivers a sharp upward and inward abdominal thrust on the victim (usually from behind) in an effort to expel a foreign object from the airway |
| The material presented in these tables is contained in the book: MedCharts Anatomy by Thomas R. Gest & Jaye Schlesinger Published by ILOC, Inc., New York Copyright © 1995, unauthorized use prohibited. |
The excellent editorial assistance of Dr. Pat Tank, UAMS is gratefully acknowledged. |