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Atlas of
Human Anatomy
Consulting Editors
Jennifer K. Brueckner, PhD
Noelle A. Granger, PhD
Assistant Professor
Professor
Department of Anatomy and Neurobiology
Department of Cell and Developmental Biology
University of Kentucky College of Medicine
University of North Carolina School of Medicine
Lexington, Kentucky
Chapel Hill, North Carolina
Stephen W. Carmichael, PhD, DSc
John T. Hansen, PhD
Professor
Professor of Neurobiology and Anatomy
Departments of Anatomy and Orthopedic Surgery
Associate Dean for Admissions
Mayo Clinic
University of Rochester School of Medicine and Dentistry
Rochester, Minnesota
Rochester, New York
Thomas R. Gest, PhD
Anil H. Walji, MD, PhD
Associate Professor
Professor and Director, Division of Anatomy
Division of Anatomical Sciences and Department
Professor of Radiology and Diagnostic Imaging
of Medical Education
Professor of Surgery
University of Michigan Medical School
Faculty of Medicine and Dentistry
Ann Arbor, Michigan
University of Alberta Edmonton, Alberta, Canada
j.
*
F o u r t h
E d i t i o n
Frank H. Netter, MD
SAUNDERS
SAUNDERS ELSEVIER
1600 John F. Kennedy Boulevard -Suite 1800 Philadelphia, Pennsylvania 19103-2899
Atlas of Human Anatomy Fourth Edition
Edition with Student Consult Access: Professional Edition: International Edition: Enhanced International Edition with Student Consult Access:
ISBN-13: ISBN-10: ISBN-13: ISBN-10: ISBN-13: ISBN-10:
978-1-4160-3385-1 1 -4160-3385-8 978-1-4160-3699-9 1-4160-3699-7 978-0-8089-2384-8 0-8089-2384-6
ISBN-13: 978-0-8089-2379-4 ISBN-10: 0-8089-2379-X
Copyright © 2006, 2003, 1997, 1989 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier's Health Science Licensing Department in Philadelphia, Pennsylvania, USA: phone 1-800-523-1649, ext. 3276, or 215-239-3276; email:
[email protected].
NOTICE Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Previous editions copyrighted 2003, 1997, 1989.
Library of Congress Cataloging-in-Publication Data Netter, Frank H. (Frank Henry), 1906-1991. Atlas of human anatomy / Frank H. Netter.—4th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1 -4160-3385-1 ISBN-10: 1 -4160-3385-8 1. Human anatomy—Atlases. I. Title. [DNLM: 1. Anatomy—Atlases. QS 17 N474a 2006] QM25.N46 2006 611.0022'12—dc22
Acquisitions
Developmental
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Editor: Anne Lenehan
Editor: Marybeth Thiel
Publishing Services Manager: Frank Polizzano Senior Project Manager: Cecelia B a y r u n s Design Direction: Louis Forgione Illustration Manager: Cecilia Nuyianes Cover Design Concept: M a d e l e n e H y d e Marketing Manager: Megan Poles
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Printed in the United States of America. Last digit is the print number:
9
8
7
6
5
4
3
ELSEVIER
Intern^ional
S a b r e
Foundation
To my dear wife, Vera
T
by
the uncovertebral joints of the cervical vertebrae, the vertebral
Frank H. Netter, MD, has been updated by our
veins, and the intricate vasculature of the eye, to mention a few,
Consulting Editor team of Jennifer K. Brueckner,
with artistic brilliance, anatomical precision, and visual appeal
Stephen W. Carmichael, Thomas R. Gest, Noelle A. Granger,
that is unsurpassed. The section includes a concise treatment of
John T. Hansen, and Anil H. Walji. We have each reviewed, mod-
the central nervous system, including the cranial nerves and im-
ified, and updated a section of the Atlas. Throughout the book,
portant central pathways.
he Fourth Edition of Atlas
of Human
Anatomy
new radiographs, c o m p u t e d tomographic (CT) images, CT an-
In the Back section, a new plate illustrates the proper
giograms, and magnetic resonance (MR) images have been
placement of a lumbar epidural anesthetic agent, as well as the
added, which reflects the importance of diagnostic imaging in
location for lumbar puncture or "spinal tap." Autonomics are tra-
clinical anatomy and medicine. In this edition, 45 plates have
ditionally the bane of many students, and excellent new draw-
been revised to show corrected anatomical relationships, 290
ings of the autonomic nervous system by Dr. Machado will serve
plates have been relabeled, and there are 17 completely new
as a new educational resource for these difficult concepts.
plates. Wonderful new artwork for this edition has been created
The Thorax section underwent minor editorial corrections
by Carlos A. G. Machado, MD, w h o has contributed to the
of terminology and subtle artwork modifications to more accu-
Netter illustrations for over ten years. Anatomical nomenclature
rately reflect the most c o m m o n anatomical patterns. For in-
has been brought up to date, and clinical terms and eponyms in
stance, the representation of the azygos venous system pat-
c o m m o n usage have been included parenthetically. The genius
tern was altered to reflect the most c o m m o n arrangement of
of Dr. Netter's paintings is that the anatomy is portrayed clearly,
these highly variable veins. The inclusion of the thoracic cross-
realistically, and in a clinically relatable fashion while maintaining
sectional images at the end of the section, rather than in the
the balance between complexity and oversimplification. We
later section, reinforces the importance of knowledge of cross-
have tried to adhere to these principles in the creation of the
sectional anatomy in the interpretation of cross-sectional MR
new plates for this edition. Finally, some of the plates were re-
and CT images.
arranged as page-pairs, where appropriate, to facilitate side-by-
The A b d o m e n section has had the most extensive revision
side comparisons of commonly illustrated elements. This fourth
for label changes and positioning of leader lines. By popular re-
edition owes much to the consulting editors of the earlier edi-
quest, the plate showing the c o m m o n variations in the branches
tions, Drs. Sharon Colacino (Oberg) (first edition), Arthur F. Dalley
of the celiac artery, which appeared in the first edition A b d o m e n
II (second edition), and John T. Hansen (third edition), who shep-
section, has been reinstated.
herded their editions with great skill and uncompromising professionalism, making our task significantly easier.
The anatomy of the pelvis is a particularly difficult area to teach and, because of the depth and tight organization of the in-
The head and neck is a particularly challenging area for stu-
ternal structures, difficult to illustrate. The Netter illustrations of
dents, residents and faculty to master, due not only to the sheer
pelvic anatomy are outstanding because of the clarity of their
number of structures packed in this relatively small region of the
presentation and their scope of coverage. A very small number
human body, but also the complexity of their three-dimensional
of plates were eliminated to permit the inclusion of the illustra-
anatomical organization. The age-old aphorism that "there is
tion of pelvic fascia, a parasagittal view of the broad ligament,
more anatomy above the hyoid bone than below it" presents a
and
unique challenge to anyone trying to portray the anatomy of this
tourethrograms, and a hysterosalpingogram). Comparative im-
region in a simple, visually appealing, and clinically relevant
ages of male and female pelvic anatomy were reorganized to al-
manner. More than ten new plates have been added to this sec-
low their side-by-side comparison.
normal
imaging
(male and female
radiographs,
cys-
tion. For the first time, spectacular original paintings created by
New CT angiograms have been included in the Upper Limb
Carlos Machado illustrate clinically important structures such as
and Lower Limb sections. This new technology not only clearly
F@rew®rdl
demonstrates blood vessels, but vividly shows bony landmarks
help you better understand anatomy and its application to the
to which the blood vessels are related. The ligaments of the
practice of clinical medicine. More information about the web-
wrist have been illustrated in more detail to reflect their in-
site, including the PIN code for access, can be found on the in-
creased importance in arthroscopic procedures and other appli-
side front cover of the Atlas.
cations of new technology to this joint.
Jennifer K. Brueckner, PhD
We hope you enjoy this new edition of the Atlas of Human
Stephen W. Carmichael, PhD, DSc
Anatomy and that you find it useful for learning and for your ca-
Thomas R. Gest, PhD
reer. For the standard edition and enhanced international edition
Noelle A. Granger, PhD
of the Atlas,
we have included access to the website www.
John T. Hansen, PhD
netteranatomy.com. By registering on this website, you will be
Anil H. Walji, MD, PhD
able to access supplemental material that has been organized to
Acknowledgments
It has been my pleasure to work with the other members of the
I would like to thank Marybeth Thiel, Developmental Editor, our a
editorial board, Carlos Machado, MD, and the Elsevier staff.
superb medical illustrator Dr. Carlos Machado, and the entire
Special thanks go to John Hansen, PhD, for the opportunity to
Editorial, Production, Design, Illustration, and Marketing staff at
work on this editorial team. I am indebted to my family for the
Elsevier for shepherding this edition to completion. For all our
support and encouragement that they have provided.
students, past, present and future, this Atlas is for you. Finally, to my wife, Paula, thank you for your love and encouragement
—Jennifer
K. Brueckner,
PhD
throughout the years. —John
T. Hansen,
PhD
I would like to thank the specialists at the Mayo Clinic who helped review the art, especially Richard A. Berger, MD, PhD, Shawn W. O'Driscoll, MD, PhD, Enrique A. Sabater, MD, and
I would like to thank my wife, Parviz, and my daughters, Amreen
Robert J. Spinner, MD.
and Farah, for their patience and constant support and encouragement during my involvement with this project. My special —Stephen
W.: Carmichael,
PhD,
DSc
thanks go to Dr. Carlos Machado, w h o has my utmost admiration for his brilliant artwork and who was an absolute delight to work with. I would also like to express my sincere appreciation
I must thank my family and especially my daughter, Madison,
to all the wonderful staff at Elsevier, in particular Linda Belfus for
and son, Taylor, for their support and understanding of my ef-
her exemplary leadership, and Anne Lenehan, Marybeth Thiel,
forts on this editorial task. It was a pleasure to work with my col-
and Cecelia Bayruns for all of their hard work, patience, and
leagues on the editorial board and with the staff of Elsevier. It
dedication, without which this atlas would not have been possi-
has been my sincere pleasure to work with Dr. Carlos Machado
ble. Finally, I would like to thank my fellow coeditors and all of
on the artwork changes for the 4th edition.
my colleagues who helped with reviewing the plates, in particular Pierre Lemelin, PhD, and Daniel Livy, PhD, whose meticulous
—Thomas
ft
Gest,
PhD
examination of the artwork has helped greatly in ensuring the accuracy of the head and neck section in this edition.
I am deeply grateful to my colleagues at University of North Carolina School of Medicine: James Scatliff, MD, former Chair of the Department of Radiology, for his help with the imaging, and O.W. Henson, PhD, Professor Emeritus of Anatomy, for his input. I especially thank Carlos Machado, the exceptional artist whose talent made any change required in the original plates both seamless and beautiful.
—Noelle
A. Granger;
PhD
—Anil
H. Walji, MD,
PhD
Imaging Acknowledgements
Plate 151
Som, P., & Curtin, H. (2003). Head and Neck Imaging (4th ed). St. Louis, MO: Mosby.
Plates 355, 368, and 373
James Scatliff, MD Former Chair of the Department of Radiology University of North Carolina
Plates 484 and 547
Enrique A. Sabater, M.D. Department of Radiology Mayo Clinic
Preface to the First Edition
I
have often said that my career as a medical artist for al-
and even revision of a number of them in order to make them
most 50 years has been a sort of " c o m m a n d performance"
more pertinent to today's ever-expanding scope of medical and
in the sense that it has grown in response to the desires
surgical practice. In addition, I found that there were gaps in the
and requests of the medical profession. Over these many years,
portrayal of medical knowledge as pictorialized in the illustra-
I have produced almost 4,000 illustrations, mostly for The CIBA
tions I had previously done, and this necessitated my making a
(now Netter)
number of new pictures that are included in this volume.
Collection
of Medical
Illustrations
b u t also
for
Clinical Symposia. These pictures have been concerned with the varied subdivisions
of medical
knowledge
such as
In creating an atlas such as this, it is important to achieve a
gross
happy medium between complexity and simplification. If the
anatomy, histology, embryology, physiology, pathology, diag-
pictures are too complex, they may be difficult and confusing to
nostic modalities, surgical and therapeutic techniques and clin-
read; if oversimplified, they may not be adequately definitive or
ical manifestations of a multitude of diseases. As the years went
may even be misleading. I have therefore striven for a middle
by, however, there were more and more requests from physi-
course of realism without the clutter of confusing minutiae. I
cians and students for me to produce an atlas purely of gross
hope that the students and members of the medical and allied
anatomy. Thus, this atlas has c o m e about, not through any in-
professions will find the illustrations readily understandable, yet
spiration on my part but rather, like most of my previous works,
instructive and useful.
as a fulfillment of the desires of the medical profession. It involved going back over all the illustrations I had made
At one point, the publisher and I thought it might be nice to include a foreword
by a truly outstanding
and
renowned
over so many years, selecting those pertinent to gross anatomy,
anatomist, but there are so many in that category that we could
classifying them and organizing them by system and region,
not make a choice. We did think of men like Vesalius, Leonardo
adapting them to page size and space and arranging them in
da Vinci, William Hunter and Henry Gray, who of course are un-
logical sequence. Anatomy of course does not change, but our
fortunately unavailable, but I do wonder what their c o m m e n t s
understanding of anatomy and its clinical significance does
might have been about this atlas.
change, as do anatomical terminology and nomenclature. This therefore required much updating of many of the older pictures
Frank H. Netter, MD (1906-1991)
-
'
-
-
-
—
—
—
•
—
mm-
mm
Frank H. Netter, MD
F
rank H. Netter was born in New York City in 1906. He
studied art at the Art Students
League and the
National Academy of Design before entering medical
Dr. Netter's works are among the finest examples of the use of illustration in the teaching of medical concepts. The 13-book
Netter
Collection
of Medical
Illustrations,
which includes the
school at New York University, where he received his Doctor of
greater part of the more than 20,000 paintings created by Dr.
Medicine degree in 1931. During his student years, Dr. Netter's
Netter, became and remains one of the most famous medical
notebook sketches attracted the attention of the medical faculty
works ever published. The Netter Atlas of Human Anatomy,
and other physicians, allowing him to augment his income by il-
published in 1989, presents the anatomic paintings from the
lustrating articles and textbooks. He continued illustrating as a
Netter Collection. Now translated into 16 languages, it is the
sideline after establishing a surgical practice in 1933, but he ulti-
anatomy atlas of choice among medical and health professions
mately opted to give up his practice in favor of a full-time c o m -
students the world over.
first
mitment to art. After service in the United States Army during
The Netter illustrations are appreciated not only for their
World War II, Dr. Netter began his long collaboration with the
aesthetic qualities, but, more importantly, for their intellectual
CIBA Pharmaceutical Company {now Novartis Pharmaceuticals).
content. As Dr. Netter wrote in 1949 "clarification of a subject is
This 45-year partnership resulted in the production of the extra-
the aim and goal of illustration. No matter how
ordinary collection of medical art so familiar to physicians and
painted, how delicately and subtly rendered a subject may be, it
other medical professionals worldwide.
is of little value as a medical
illustration
beautifully
if it does not serve to
Icon Learning Systems acquired the Netter Collection in
make clear some medical point." Dr. Netter's planning, concep-
July 2000 and continued to update Dr. Netter's original paintings
tion, point of view, and approach are what inform his paintings
and to add newly commissioned paintings by artists trained in
and what make them so intellectually valuable.
the style of Dr. Netter. In 2005, Elsevier Inc. purchased the Netter Collection and all publications from Icon Learning Systems. There are now over 50 publications featuring the art of Dr. Netter available through Elsevier Inc.
Frank H. Netter, MD, physician and artist, died in 1991.
Contents
Head and Neck 1
Topographic Anatomy
Plate
Bones and Ligaments
Plates
2-22
Superficial Face
Plates
23-26
Neck
Plates
27-35
Nasal Region
Plates
36-50
Oral Region
Plates
51-62
Pharynx
Plates
63-73
Thyroid Gland and Larynx
Plates
74-80
Orbit and Contents
Plates
81-91
Ear
Plates
92-98
Meninges and Brain
Plates
99-115
Cranial and Cervical Nerves
Plates
116-135
Cerebral Vasculature
Plates
136-148
Regional Scans
Plates
149-151
Back and Spinal Cord 152
Topographic Anatomy
Plate
Bones and Ligaments
Plates
153--159
Spinal Cord
Plates
160--173
Muscles and Nerves
Plates
174--180
Thorax 181
Topographic Anatomy
Plate
Mammary Gland
Plates
182--184
Body Wall
Plates
185--195
Lungs
Plates
196--210
Heart
Plates
211--229
Mediastinum
Plates
230--241
Regional Scans
Plate
Cross-Sectional Anatomy
Plates
242 243--246
Abdomen 247
Topographic Anatomy
Plate
Body Wall
Plates
248--267
Peritoneal Cavity
Plates
268--274
Viscera (Gut)
Plates
275--285
Viscera (Accessory Organs)
Plates
286--299
Visceral Vasculature
Plates
300--317
Innervation
Plates
318--328
Kidneys and Suprarenal Glands
Plates
329--347
Abdominal Sections
Plates
348--349
Regional Scans
Plate
350
Section 5
Pelvis and Perineum Topographic Anatomy
Plate
Bones and Ligaments
Plates
352-355
Pelvic Floor and Contents
Plates
356-364
Plates
365-368
Uterus, Vagina, and Supporting Structures
Plates
369-375
Regional Transverse Section
Plate
Perineum and External Genitalia: Female
Plates
377-379
Perineum and External Genitalia: Male
Plates
380-387
Homologues of Genitalia
Plates
388-389
Testis, Epididymis, and Ductus Deferens
Plate
Rectum
Plates
Regional Scans
Plate
Vasculature
Plates
398-408
Innervation
Plates
409-417
Urinary Bladder
Section 8
Section 7
Section 8
'
351
376
390 391-396 397
Upper Limb Topographic Anatomy
Plate
Shoulder and Axilla
Plates
419-430
Arm
Plates
431-435
Elbow and Forearm
Plates
436-451
Wrist and Hand
Plates
452-471
Neurovasculature
Plates
472-483
Regional Scans
Plate
484
Topographic Anatomy
Plate
485
Hip and Thigh
Plates
486-505
Knee
Plates
506-512
Leg
Plates
513-522
Ankle and Foot
Plates
523-537
Neurovasculature
Plates
538-546
Regional Scans
Plate
547
Plate
548
418
Lower Limb
Cross-Sectional Anatomy Key Figure for Cross Sections References Index
a
Head and Neck Topographic Anatomy Plate 1
1
Head and Neck
Bones and Ligaments Plates 2 - 2 2 rnm^^mm^^^mm^mm^mmmmmmmmmmmmmmmmmmmmsm 2
Skull: Anterior View
3
Skull: Anteroposterior Radiograph
4
Skull: Lateral View
5
Skull: Lateral Radiograph
6
Skull: Midsagittal Section
7
Calvaria
8
Cranial Base: Inferior View
9
Bones of Cranial Base: Superior View
10
Foramina of Cranial Base: Inferior View
11
Foramina of Cranial Base: Superior View
12
Skull of Newborn
13
Bony Framework of Head and Neck
14
Cranial Base: Pterygoid Fossae
15
Mandible
16
Temporomandibular Joint
17
Cervical Vertebrae: Atlas and Axis
18
Cervical Vertebrae (continued)
19
Cervical Vertebrae: Uncovertebral Joints
20
Degenerative Changes in the Cervical Vertebrae
21
External Craniocervicai Ligaments
22
Internal Craniocervicai Ligaments
Superficial Face
Oral Region
Plates 23-26
Plates 51-62
23
Superficial Arteries and Veins of Face and Scalp
51
Inspection of Oral Cavity
24
Cutaneous Nerves of Head and Neck
52
Roof of Mouth
25
Facial Nerve Branches and Parotid Gland
53
Floor of Mouth
26
Muscles of Facial Expresssion: Lateral View
54
Muscles Involved in Mastication
55
Muscles Involved in Mastication (continued)
56
Teeth
Plates 27-35
57
Teeth (continued)
27
Muscles of Neck: Lateral View
58
Tongue
28
Muscles of Neck: Anterior View
59
Tongue (continued)
29
Infrahyoid and Suprahyoid Muscles
60
Tongue and Salivary Glands: Sections
30
Scalene and Prevertebral Muscles
61
Salivary Glands
31
Superficial Veins and Cutaneous Nerves of Neck
62
Afferent Innervation of Mouth and Pharynx
32
Cervical Plexus in Situ
33
Subclavian Artery
Pharynx
34
Carotid Arteries
Plates 63-73
35
Fascial Layers of Neck
63
Pharynx: Median Section
64
Fauces
65
Muscles of Pharynx: Median (Sagittal) Section
66
Pharynx: Opened Posterior View
Heck
Nasal Region Plates 36-50 36
Nose
67
Muscles of Pharynx: Partially Opened Posterior View
37
Lateral Wall of Nasal Cavity
68
Muscles of Pharynx: Lateral View
38
Lateral Wall of Nasal Cavity (continued)
69
Arteries of Oral and Pharyngeal Regions
39
Medial Wall of Nasal Cavity (Nasal Septum)
70
Veins of Oral and Pharyngeal Regions
40
Maxillary Artery
71
Nerves of Oral and Pharyngeal Regions
41
Arteries of Nasal Cavity: Nasal Septum Turned Up
72
Lymph Vessels and Nodes of Head and Neck
42
Nerves of Nasal Cavity: Nasal Septum Turned Up
73
Lymph Vessels and Nodes of Pharynx and Tongue
43
Nerves of Nasal Cavity (continued)
44
Autonomic Innervation of Nasal Cavity
45
Ophthalmic (V,) and Maxillary (V2) Nerves
46
Mandibular Nerve (V3)
47
Nose and Paranasal Sinuses: Cross Section
48
Paranasal Sinuses
49
Paransal Sinsues (continued)
50
Paranasal Sinuses: Changes with Age
Thyroid Gland and Larynx
Meninges and Brain
Plates 74-80
Plates 9 9 - 1 1 5
74
Thyroid Gland: Anterior View
99
75
Thyroid Gland and Pharynx: Posterior View
100 Meningeal Arteries
76
Parathyroid Glands
101 Epidural Hematoma
77
Cartilages of Larynx
102 Meninges and Superficial Cerebral Veins
78
Intrinsic Muscles of Larynx
103 Dural Venous Sinuses
79
Actions of Intrinsic Muslces of Larynx
104 Dural Venous Sinuses (continued)
so
Nerves of Larynx
105 Cerebrum: Lateral Views
Orbit and Contents
Meninges and Diploic Veins
106 Cerebrum: Medial Views 107 Cerebrum: Inferior View
Plates 81-91
108 Ventricles of Brain
si
Eyelids
109 Circulation of Cerebrospinal Fluid
82
Lacrimal Apparatus
110 Basal Nuclei (Ganglia)
83
Fascia of Orbit and Eyeball
111 Thalamus
84
Extrinsic Eye Muscles
112 Hippocampus and Fornix
85
Arteries and Veins of Orbit and Eyelids
113 Cerebellum
86
Nerves of Orbit
114 Brainstem
87
Eyeball
115 Fourth Ventricle and Cerebellum
88
Anterior and Posterior Chambers of Eye
89
Lens and Supporting Structures
Cranial and Cervical Nerves
90
Intrinsic Arteries and Veins of Eye
Plates 116-135
91
Vascular Supply of Eye
116 Cranial Nerve Nuclei in Brainstem: Schema
Ear Plates 92-98
117 Cranial Nerve Nuclei in Brainstem: Schema (continued) 118 Cranial Nerves (Motor and Sensory Distribution): Schema 119 Olfactory Nerve (I): Schema
92
Pathway of Sound Reception
120 Optic Nerve (II) (Visual Pathway): Schema
93
External Ear and Tympanic Cavity
121 Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves:
94
Tympanic Cavity
95
Bony and Membranous Labyrinths
122 Trigeminal Nerve (V): Schema
96
Bony and Membranous Labyrinths (continued)
123 Facial Nerve (VII): Schema
97
Orientation of Labyrinth in Skull
124 Vestibulocochlear Nerve (VIII): Schema
98
Auditory (Pharyngotympanic, Eustachian) Tube
125 Glossopharyngeal Nerve (IX): Schema
Schema
126 Vagus Nerve (X): Schema 127 Accessory nerve (XI): Schema 128 Hypoglossal Nerve (XII): Schema 129 Cervical Plexus: Schema 130 Autonomic Nerves in Neck 131 Autonomic Nerves in Head
132 Ciliary Ganglion: Schema
142
133 Pterygopalatine and Submandibular Ganglia: Schema
143 Arteries of Posterior Cranial Fossa
134 Otic Ganglion: Schema
144 Veins of Posterior Cranial Fossa
135 Taste Pathways: Schema
145 Deep Veins of Brain
Cerebral Vasculature Plates 136-148
146
Arteries of Brain: Lateral and Medial Views
Subependymal Veins of Brain
147 Hypothalamus and Hypophysis 148 Arteries and Veins of Hypothalamus and Hypophysis
136 Arteries to Brain and Meninges 137 Veins of the Vertebral Column—Vertebral Veins
Regional Scans
138 Arteries to Brain: Schema
Plates 149-151
139 Arteries of Brain: Inferior Views
149 Head Scans: Sagittal MR Images
140 Cerebral Arterial Circle (of Willis)
150 Head Scans: Axial CT Images
141 Arteries of Brain: Frontal View and Section
151 Head Scans: Coronal CT Images
Frontal bone
Infraorbital margin Zygomatic bone
Supraorbital notch Superciliary arch
Helix Glabella
Tragus Antihelix
Nasal bone
Antitragus Ala of nose
Anterior nares (nostril)
Lobule Commissure of lips
Philtrum
Angle of jaw (mandible)
Nasolabial sulcus
Submandibular gland
Tubercle of superior lip
External jugular vein
Mental protuberance
Inferior belly of omohyoid muscle Brachial plexus
Thyroid cartilage
Trapezius muscle Clavicle
jugular notch
Clavicular head of sternocleidomastoid muscle Sternal head of sternocleidomastoid muscle
Skull: Anterior View •MflnHHHHHMMHBMHHHM
Frontal bone Glabella
Parietal bone
Supraorbital notch (foramen)
Sphenoid bone
Orbital surface
Lesser wing Greater wing
Nasal bone
Temporal bone Lacrimal bone Ethmoid bone Orbital plate
Zygomatic bone Frontal process
Perpendicular plate
Orbital surface
Middle nasal concha
Temporal process
Inferior nasal concha
Zygomaticofacial foramen
Vomer
Maxilla
Mandible
Zygomatic process
Ramus
Orbital surface
Body
Infraorbital foramen
Mental foramen
Frontal process
Mental tubercle
Alveolar process —
Mental protuberance
Anterior nasal spine
Right orbit: frontal and slightly lateral view Orbital surface of frontal Orbital surface of lesser wing of sphenoid bone Superior orbital fissu Optic canal (foramen)
Posterior and Anterior ethmoidal foramina Orbital plate of ethmoid bone Lacrimal bone
Orbital surface of greater wing of sphenoid bone
Fossa for lacrimal sac
Orbital surface of zygomatic bone
Orbital process of palatine bone
Inferior orbital fissure Infraorbital groove
Orbital surface of maxilla
Skull: Anteroposterior Radiograph HWBHMBHWBHIwWHBBBB^
See also P l a t e 2
m
A A n g l e of m a n d i b l e C Crista galli E Ethmoid air cells (sinuses) F Frontal sinus G Greater w i n g of sphenoid L
Lesser w i n g of s p h e n o i d
M Maxillary sinus R Ramus of mandible
Skull: Lateral View
Sphenoid bone
Parietal bone
Greater wing Frontal bone Supraorbital notch (foramen)
Temporal bone
Temporal fossa
Squamous part
Superior temporal line
Zygomatic process
Inferior temporal li Coronal suture
Articular tubercle
Pterion
Groove for posterior deep temporal artery
Glabella
External acoustic meatus
Ethmoid bone Orbital plate
Mastoid process
Lacrimal bone Lambdoid suture
Fossa for lacrimal sac
Occipital bone
Nasal bone
Sutural (wormian) bone
Maxilla
External occipital protuberance
Frontal process Infraorbital foramen Anterior nasal spine Alveolar process
Mandible Head of condylar process
Zygomatic bone Zygomaticofacial foramen Temporal process Zygomatic arch
Mandibular notch Coronoid process Ramus Oblique line Body Mental foramen Sphenoid bone Greater wing
Infratemporal fossa exposed by removal of zygomatic arch and mandible
Infratemporal crest
Pterygomaxillary fissure
Lateral plate of pterygoid process
Inferior orbital fissure
Pterygoid hamulus (of medial plate of pterygoid process)
Infratemporal surface of maxilla Temporal bone
Alveolar foramina
External acoustic meatus
Tuberosity of maxilla
Mandibular fossa Articular tubercle Styloid process Sphenopalatine foramen
Superficially, mastoid process forms posterior boundary
Skull: Lateral Radiograph jffWfflffllMfflHMWBMffl
See also P l a t e 4
A
Anterior arch of atlas (CI vertebra)
G
Greater wing of sphenoid
C
Condyle of mandible
H
Hypophyseal fossa (sella turcica)
CP Coronoid process of mandible
L
Lambdoid suture
M
Maxillary sinus
CS Coronal suture D
Dens of axis (C2 vertebra)
F
Frontal sinus
MS Mastoid air ceils P
Palatine process of maxilla
S
Sphenoid sinus
Skull: Midsagittal Section
Sphenoid bone
Temporal bone
Parietal bone
Greater wing
Coronal suture
Lesser wing Anterior clinoid process
Squamous part
Grooves for branches of middle meningeal vessels
Petrous part Internal acoustic meatus Groove for superior petrosal sinus
Optic canal Sella turcica Sphenoidal sinus
External opening of vestibular aqueduct
Body Medial and lateral plates of pterygoid process
Groove for sigmoid sinus
Lambdoid suture
Frontal bone Frontal sinus
Occipital bone
Ethmoid bone Crista galli
Groove for transverse sinus
Cribriform plate Perpendicular plate (bony nasal septum)
External occipital protuberance Jugular foramen
Nasal bone
Groove for inferior petrosal sinus
Inferior nasal concha
Hypoglossal canal Maxilla
Foramen magnum
Anterior nasal spine Nasal surface Incisive canal Palatine process Alveolar process
Occipital condyle
Palatine bone Vomer (bony nasal septum)
Basilar part
Frontal bone
Opening of sphenoidal sinus
Nasal bone Ethmoid bone
Sphenopalatine foramen
Cribriform plate Superior nasal concha Middle nasal concha
Sphenoid bone
Lacrimal bone
Body Inferior nasal concha
Medial \ Lateral \
Maxilla Nasal surfa Palatine process Alveolar process
Plates of pterygoid process
Pterygoid hamulus Perpendicular plate J Horizontal plate
View of lateral nasal wall with nasal septum removed
j
Palatine bone
Superior view Frontal bone Coronal suture Bregma Parietal bone Sagittal suture Parietal foramen (for emissary vein) Lambda Lambdoid suture Sutural (wormian) bone Occipital bone
Inferior view
Frontal bone Frontal crest Groove for superior sagittal sinus Coronal suture Parietal bone Granular foveolae (for arachnoid granulations) Diploe Grooves for branches of middle meningeal vessels Groove for superior sagittal sinus Sagittal suture Lambdoid suture Occipital bone
Cranial Base: Inferior View
Maxilla incisive fossa Palatine process Intermaxillary suture Zygomatic process Zygomatic bone Frontal bone Sphenoid bone Pterygoid process Hamulus Medial plate Pterygoid fossa Lateral plate Scaphoid fossa Greater wing Foramen ovale Foramen spinosum Spine
Palatomaxillary suture
Palatine bone Fiorizontal plate Greater palatine foramen Pyramidal process Lesser palatine foramina Posterior nasal spine
Choanae Temporal bone Zygomatic process Articular tubercle Mandibular fossa Styloid process Petrotympanic fissure Carotid canal (external opening) Tympanic canaliculus External acoustic meatus Mastoid canaliculus Mastoid process Stylomastoid foramen Petrous part Mastoid notch (for digastric muscle) Occipital groove (for occipital artery) Jugular fossa (jugular foramen in its depth) Mastoid foramen Parietal bone Occipital bone Hypoglossal canal Occipital condyle Condylar canal and fossa Basilar part Pharyngeal tubercle Foramen magnum Inferior nuchal line External occipital crest Superior nuchal line External occipital protuberance
Vomer
Groove for auditory (pharyngotympanic, Eustachian) tube Foramen lacerum
Bones of Cranial Base: Superior View — •;•->• . •
• • . •. • •
m
Frontal bone Groove for superior sagittal sinus Frontal crest Groove for anterior meningeal vessels Foramen cecum Superior surface of orbital part
Ethmoid bone Crista gaili Cribriform plate
Sphenoid bone Lesser wing Anterior clinoid process Greater wing Groove for middle meningeal vessels (frontal branches) Body J u gum Prechiasmatic groove ( Tuberculum sellaeSella ) Hypophyseal fossa turcica j Dorsum sellae V Posterior clinoid process Carotid groove (for int. carotid a.) Clivus
Anterior cranial fossa
Middle cranial fossa
Temporal bone Squamous part Petrous part Groove for lesser petrosal n e r v e Groove for greater petrosal nerve Arcuate eminence Trigeminal impression Groove for superior petrosal sinus Groove for sigmoid sinus
Parietal bone Groove for middle meningeal vessels (parietal branches) — Mastoid angle
Occipital bone Clivus Groove for inferior petrosal sinus Basilar part Groove for posterior meningeal vessels Condyle Groove for transverse sinus Groove for occipital sinus Internal occipital crest Internal occipital protuberance — Groove for superior sagittal sinus
Posterior crania] fossa
Foramina of Cranial Base: Inferior View
Nasopalatine nerve) Sphenopalatine vessels! Greater palatine nerve and vessels Lesser palatine nerve and vessels Greater petrosal nerve Lesser petrosal nerve) Mandibular nerve (V3) > Accessory meningeal artery) Middle meningeal vessels) Meningeal branch of mandibular nerve (V$) j
Internal carotid artery) Carotid autonomic plexus) Chorda tympani of facial nerve (VII) Tympanic branch of glossopharyngeal nerve (IX) Auricular branch of vagus nerve (X) Facial nerve (VII)
Glossopharyngeal nerve (IX) \ Vagus nerve (X) / Spinal roots of accessory nerves (XI) \ Internal jugular vein ( Inferior petrosal sinus) Mastoid emissary vein) Posterior meningeal artery)
.. , Incisive tossa Greater palatine foramen Lesser palatine foramen Foramen lacerum Foramen ovale
Foramen spinosum
Carotid canal Petrotympanic fissure Tympanic canaliculus Mastoid canaliculus Stylomastoid foramen
Jugular fossa
- M a s t o i d foramen
Hypoglossal nerve (XII)-
- Hypoglossal canal
Medulla oblongata ) Vertebral arteries and venous plexus ? Spinal roots of accessory nerves (XI))
Foramen magnum
Foramen cecum Nasal slit Anterior ethmoidal foramen
Emissary vein to superior sagittal sinus I \ Anterior ethmoidal artery, vein, ) I and nerve
Foramina of cribriform plate
Olfactory nerve bundles
Posterior ethmoidal foramen
Posterior ethmoidal artery vein, and nerve Optic nerve (II) Ophthalmic artery
. , .. , Superior orbital fissure c
Oculomotor nerve Trochlear nerve (IV) ) Lacrimal, frontal, and nasociliary < b r a n c h e s 0 f ophthalmic nerve (Vi) Abducent nerve (VI) Superior ophthalmic vein
Foramen rotundum
Maxillary nerve (V2)
Foramen ovale
( Mandibular nerve (Vj) 1 Accessory meningeal artery ( Lesser petrosal nerve (occasionally)
r
( Middle meningeal artery and vein j M e n j n g e a , b r a 8 n c h o f mandibular nerve
Foramen sp.nosum
Sphenoid emissary foramen (of Vesalius) (inconstant) Foramen lacerum Carotid canal for
Internal carotid artery Internal carotid nerve plexus
Hiatus for
Lesser petrosal nerve
Hiatus for
Greater petrosal nerve
External opening of vestibular aqueduct
Facial nerve (VII) Vestibulocochlear nerve (VIII) Labyrinthine artery
!
Endolymphatic duct
Mastoid foramen (inconstant)
. , £ jugular foramen
Emissary vein (and occasional branch of occipital artery) Inferior petrosal sinus Glossopharyngeal nerve (IX) ) Vagus nerve (X) \ Accessory nerve (XI) Sigmoid sinus Posterior meningeal artery
Condylar canal (inconstant) — - j Hypoglossal canal
F.
.
c
^
(
E m i f a r > ' ve,in ancJ
meningeal branch ot ascending pharyngeal artery
Hypoglossal nerve (XII) Medulla oblongata Meninges , Vertebral arteries ) Meningeal branches of vertebral arteries Spinal roots of accessory nerves
Lateral view Sphenoidal fontanelle
Parietal bone
Anterior fontanelle
fuber (eminence)
Coronal suture
Squamous suture
Frontal bone Squamous part
/
Supraorbital notch (foramen)
. •'J&.V
Posterior fontanelle Lambdoid suture
Ethmoid bone Anterior ethmoidal foramen
Occipital bone
Orbital plate
Mastoid fontanelle
Lacrimal bone Nasal bone Temporal bone
Maxilla
Squamous part
Infraorbital foramen Zygomatic bone Zygomaticofacial foramen
Sphenoid bone Greater wing
Palatine bone
Petrosquamous fissure
\ \
Lateral plate of ^ pterygoid process
Pyramidal process
Hamulus of medial plate of pterygoid process
Superior view
Petrous part (mastoid process absent) Tympanic part (bony external acoustic meatus absent) Oval (vestibular) window Round (cochlear) w i n d o w Styloid process Mandibular fossa Zygomatic process
Frontal bone Anterior fontanelle
Coronal suture
Sagittal suture
Posterior fontanelle
Occipital bone
Lambdoid suture
Bony Framework of Head and Neck IJM1MJ
Temporal bone Sphenoid bone Temporal fossa Zygomatic arch Condylar process of mandible Mandibular notch Coronoid process of mandible Lateral pterygoid plate ( . b r o k e n line) Hamulus of medial pterygoid plate ( b r o k e n line) Pterygomandibular raphe {broken
Mastoid process External acoustic meatus Atlas (C1) Styloid process
line)
Ramus Mandible ^ Angle Body
Axis (C2)
Stylohyoid ligament
Stylomandibular ligament
Body Hyoid bone { Lesser horn Greater horn
C3 vertebra Epiglottis Thyroid cartilage Cricoid cartilage Trachea
C7 vertebra
-T'l vertebra 1st rib
2nd cervical to 1st thoracic vertebrae: right lateral view
Dens Superior articular facet Foramen transversarium Spinous processes
Articular pillar formed by articular processes and interarticular parts (pars interarticularis)
Spinous process of C (vertebra prominens)
Intervertebral foramina for spinal nerves
Groove for spinal nerve in transverse process Zygapophyseal (facet) joints
Costal facets (for I st rib)
Cervical vertebrae (spine): lateral radiograph S Spinous process (axis) T Transverse process VP Spinous process of C / (vertebra prominens) Z Zygapophyseal (facet) joint 1—7 Bodies of cervical vertebrae --- Cervical curvature i i Vertebral canal
Posterior view
External occipital protuberance
Superior nuchal line
External occipital crest
Nasal septum
Inferior nuchal line
Choana (posterior nasal aperture)
Foramen magnum Inferior orbital fissure
Mastoid foramen Occipitomastoid suture Occipital condyle
Mastoid process Lateral pterygoid plate Medial pterygoid plate
Styloid process Pterygoid fossa
Scaphoid fossa Pyramidal process of palatine bone
Zygomatic arch Horizontal plate of palatine bone Inferior concha
—Pterygoid hamulus
Tuberosity of maxilla
Alveolar process of maxilla
Palatine process of maxilla Incisive fossa
*
Inferolateral view
Af-7>.
Spine of sphenoid bone Foramen spinosum Foramen ovale
c
Sphenopalatine foramen Pterygopalatine fossa Choanae (posterior nares) Lateral plate Medial plate Hamulus Alveolar process of maxilla
of pterygoid process
Pyramidal process of palatine bone
Mandible SWi
Head
Attachments for major muscles of mastication
Lateral pterygoid
Condylar process Coronoid process
Attachments for accessory muscles of mastication
-Neck Mandibular notch
Temporalis
Lingula
Mylohyoid groove Oblique line Buccinator Submandibular fossa
Mandibular / T e m p o r a l i s foramen
Mylohyoid line Sublingual fossa Interalveolar septa
Masseter •
Alveolar part (crest) Mental foramen
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Ramus
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Mental protuberance-— nfv^jjp.Y.V V - V., ,
Mental tubercle
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Base of mandible
^
— —
v Body
M a n d i b l e of adult: anterolateral superior view
Lateral pterygoid Coronoid process Head Neck
Condylar process / - Lingula
Mandibular notch
Mandibular foramen
Pterygoid f o v e a s Temporalis Mylohyoid line
/
/
Ramus
ligament
\
V
\
NAngle
Medial pterygoid Pterygomandibular raphe Mylohyloid Submandibular fossa 'Sublingual fossa Digastric fossa Digastric, anterior belly Mental spines (genial tubercles)
Mandible of adult: left posterior view
Mandible of aged person (edentulous)
Temporomandibular Joint HHHaRBmMH
Lateral view joint capsule Lateral (temporomandibular) ligament Sphenomanclibular ligament Sphenomandibular ligament (phantom) Styloid process Stylomandibular ligament Mandibular nerve and otic ganglion
W/;/
Joint capsule
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— _ _ ^ I l l l
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Middle meningeal artery Auriculotemporal
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Maxillary artery-""-"""""""^
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Inferior alveolar n e r v e j & C tfff m
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Lingual n e r v e ^
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Sphenomandibular l i g a m e n t ' ^Mlifr
Stylomandibular ligament-""-""""""^ >
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Mandibular fossa Articular disc ^
joint capsule
^ ^ A r t i c u l a r tubercle Mylohyoid branch o f / inferior alveolar artery and mylohyoid nerve
Jaws closed
Jaws slightly opened
Jaws widely opened
(hinge action predominates)
(hinge and gliding action combined)
Medial view
Cervical Vertebrae: Atlas and Axis See also P l a t e s 1 3 , 1 5 3 A n t e r i o r tubercle Articular facet for dens
Anterior arch
Dens
Lateral mass
Transverse process Tubercle for transverse ligament of atlas
Transverse foramen Superior articular surface of lateral mass for occipital c o n d y l e
Superior articular facet for atlas
terior articular facet (for anterior arch of atlas) Pedicle Interarticular part
Vertebral foramen Posterior arch Posterior tubercle
ran s verse process
Inferior articular facet for C3
G r o o v e for vertebral artery
Atlas (C1): superior view
Posterior tubercle
Posterior arch
Dens Superior articular facet for atlas
Vertebral foramen
Transverse process
Posterior articular facet (for transverse ligament of atlas) Transverse process
Interarticular part
Transverse foramen Inferior articular surface of lateral mass for axis
Articular facet for dens A n t e r i o r tubercle
Inferic articular process
Spinous process
Atlas ( C I ) : inferior view
Dens Superior articular surface for occipital condyle Posterior articular facet (for transverse ligament of atlas)
Axis (C2)
C3
Upper cervical vertebrae, assembled: posterosuperior view
Radiograph of atlantoaxial joint (open mouth odontoid view) A
Lateral masses of atlas (C1 vertebra)
D
Dens of axis (C2 vertebra)
Cervical Vertebrae (continued) See also P l a t e s 1 3 , 1 5 3
Inferior aspect of C3 and superior aspect of C4 showing the sites ot the facet and uncovertebral articulations Bifid spinous process
C3 Inferior aspect
Lamina Vertebral foramen
Inferior articular process and facet
Pedicle
Foramen transversarium
Posterior tubercle
Costal lamella
Transverse process
Anterior tubercle
Area for articulation of left uncinate process of C4 Vertebral body
Left uncinate process
Articular surface of right uncinate process
Superior articular process and facet
Groove for spinal nerve (C4)
C4 Superior aspect
Inferior articular process 7th cervical vertebra: anterior view Superior articular process
4th cervical vertebra: anterior view Superior articular process
Reduplicated foramen transversarium Uncinate process
Spinous process Uncinate process
Costa|
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lar surface
Inferior articular facet
Articular surface
Bony spicule dividing foramen transversarium
Posterior tubercle . T Anterior (Transverse process tubercle ) Inferior articular facet for T1
Foramen transversarium
Posterior tubercle / (Transverse Anterior tubercle (process (inconspicuous) )
7th cervical vertebra (vertebra prominens): superior view Body^ Uncinate process Costal lamella
/ " V
/
Foramen transversarium*
Articular surface of uncinate process Foramen transversarium (reduplicated) Groove for C7 spinal nerve
Inconspicuous anterior tubercle (transverse process)
Transverse process (posterior tubercle) Superior articular process and facet
Pedicle
Inferior articular process Lamina
Vertebral foramen Spinous process
*The foramina transversaria veins, but not the vertebral
of C7 transmit vertebral artery; and are asymmetrical
CMc^/ta^ in this
specimen
*
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Cervical Vertebrae: Uncovertebral Joints
Cervical vertebrae: anterior view Dens of axis
Anterior tubercle of atlas
A n t e r i o r arch of atlas Foramen transversarium
Atlas ( C I )
Intervertebral f o r a m e n (for C3 spinal nerve) Intervertebral disc Vertebral b o d y
Axis (C2)
Inferior articular process (C3) Superior articular process (C4) G r o o v e for spinal nerve Site of uncovertebral j o i n t (cleft) of Luschka A n t e r i o r tubercle ) ^ . ti, i h i p i r l ,p (> Transverse 'process Pnct^rmr Posterior tubercle j Articular cartilage o n dens for m e d i a n atlantoaxial j o i n t c o m p l e x Carotid tubercle n
U n c i n a t e processes
Atlas (C1)
Vertebra p r o m i n e n s Axis (C2)
First thoracic vertebra ( T I )
Foramen transversarium Uncinate processes Anulus fibrosus U n c o v e r t e b r a l joints (clefts) of Luschka Nucleus pulposus Transverse process Intervertebral f o r a m e n (for C7 spinal nerve) Vertebral b o d y (C7) The u n c o v e r t e b r a l j o i n t s of t h e c e r v i c a l spine: a n t e r i o r v i e w (C3 t o C7 have been s e c t i o n e d c o r o n a l l y t o expose t h e j o i n t s )
/
A/.7). /y-A
Lateral atlantoaxial j o i n t Facet (zygapophyseal) j o i n t b e t w e e n C2 and C3
Degenerative Changes in the Cervical Vertebrae
Degenerative changes in the cervical spine (ankylosing spondylitis)
C3 vertebral b o d y (sectioned in coronal plane)
C o m p l e t e transverse cleft in intervertebral disc
Spread of cleft f o r m a t i o n into central p o r t i o n of intervertebral disc w i t h age leading t o progressive degenerative changes in the disc
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Uncovertebral j o i n t w i t h cleft f o r m a t i o n
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D e f o r m e d vertebral bodies and lipping of vertebral' margins
Spondylophytes (osteophytes) o n uncinate processes
N a r r o w i n g of intervertebral foramen
C7 vertebra
Superior articular process
Advanced ankylosing spondylitis w i t h uncovertebral arthrosis in C4 and C5
A d v a n c e d s p o n d y l o p h y t e (osteophyte) f o r m a t i o n on uncinate processes
Vertebral b o d y U n c o v e r t e b r a l j o i n t fused d u e to extensive s p o n d y l o p h y t e f o r m a t i o n and ossification Potential for compression of vertebral artery w i t h i n f o r a m e n transversarium
Facet j o i n t ossified due to advanced osteoarthritic change Markedly narrowed intervertebral f o r a m e n may lead to c o m p r e s s i o n of spinal nerve
Inferior articular process w i t h facet G r o o v e for spinal nerve o n transverse process Spinous process
External Craniocervicai Ligaments xeMitfiffiTViWitwMr^iC- ;£4fC4)aMi tz&mGmemu
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Anterior view Basilar part of occipital bone Pharyngeal tubercle Anterior atlantooccipital membrane Capsule of atlantooccipital joint Posterior atlantooccipital membrane
Atlas (C1)
Lateral atlantoaxial joint (opened up) Anterior longitudinal ligament
Capsule of lateral atlantoaxial joint
Posterior view
Axis (C2)
Posterior atlantooccipital membrane
Capsule of zygapophyseal joint (C3-4) Capsule of atlantooccipital nsverse process of atlas ( C I )
Anterior atlantooccipital membrane
Capsule of lateral atlantoaxial joint
Capsule of atlantooccipital joint
Axis (C2)
Posterior atlantooccipital membrane
Atlas ( C D
Ligamenta flava Vertebral artery
Suboccipital nerve (dorsal ramus of C I spinal nerve)
Ligamenta flava Body of axis (C2) Ligamentum nuchae
Intervertebral discs (C2-3 and C3-4)
Zygapophyseal joints (C4-5 and C 5 - 6 ) Anterior tubercle of C6 vertebra (carotid tubercle) Spinous process of C7 vertebra (vertebra prominens)
Vertebral artery T1 vertebra
Right lateral view
: .
Internal Craniooervical Ligaments BHMBMMMMMMBBBBBWWMBW^
Clivus (surface feature) of basilar part of occipital b o n e
M&MM
Upper part of vertebral canal w i t h spinous processes and parts of vertebral arches removed to expose ligaments on posterior vertebral bodies: posterior view
Tectorial m e m b r a n e Capsule of
atlantooccipitaLj^v^
Deeper (accessory) part of tectorial m e m b r a n e
Atlas (C'l)
Posterior longitudinal ligament
joint
.
Capsule of lateral atlantoaxial j o i n t Axis (C2)
. Alar ligaments
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Capsule of zygapophyseal joint ^ ^ ^ ^ ^ (C2-3)
(J|
Atlas (C1) Superior longitudinal b a n d Cruciate ligament
Transverse ligament of atlas Inferior longitudinal band-—
Axis (C2)
Deeper (accessory) part of tectorial m e m b r a n e
Principal part of tectorial membrane removed to expose deeper ligaments: posterior view
— Apical ligament of dens — Alar ligament Atlas ( C D
Posterior articular facet of dens (for transverse ligament of atlas) Alar l
i
g
a
m
e
n
t
^
^
—
,
A n t e r i o r tubercle of atlas ,
^ S y n o v i a l cavities
Axis (C2)
Cruciate ligament removed to show deepest ligaments: posterior view
Transverse ligament of atlas
Median atlantoaxial joint: superior view
Superficial Arteries and Veins of Face and Scalp See also
Scalp
Skin and subcutaneous tissue . Epicranial aponeurosis (galea aponeurotica) (cut to reveal
Plates 34, 40, 69, 70, 85, 104
Parietal emissary vein Frontal
skull)
Parietal
Middle temporal artery and vein
Branches of superficial temporal arterv and vein
Zygomaticoorbital artery Transverse facial artery and vein
Anterior auricular arteries
Supraorbital artery and vein Supratrochlear artery and vein Nasofrontal vein Dorsal nasal artery and vein Zygomaticotemporal artery and vein
Angular artery and vein Zygomaticofacial artery and vein
Mastoid emissary vein and meningeal branch of occipital artery (posterior meningeal artery)
Infraorbital artery and vein
Occipital artery and vein (cut)
Deep facial vein (from pterygoid plexus)
Posterior auricular artery and vein
Facial artery and vein
External jugular vein (cut.) Retromandibular vein Common facial vein Internal jugular vein Internal carotid artery External carotid artery Common carotid artery Lingual artery and vein
Sources of arterial supply of face Black: from internal carotid artery (via ophthalmic artery) Red: from external carotid artery
Cutaneous Nerves of Head and Neck See also
Plates 32, 36, 45, 46, 122
From ophthalmic division of trigeminal nerve (V-,)
Auricular branch of vagus nerve(X)
Supraorbital nerve Supratrochlear nerve Palpebral branch of lacrimal nerve Infratrochlear nerve External nasal branch of anterior ethmoidal nerve
Medial branches of dorsal rami of cervical spinal nerves Greater occipital nerve (C2) 3rd occipital nerve (C3)
From maxillary division of trigeminal nerve (V 2 ) Infraorbital nerve
From 4th, 5th, 6th, and 7th nerves in succession below
Zygomaticofacial nerve Zygomaticotemporal nerve —
From mandibular division of trigeminal nerve (V 3 ) Mental nerve
Lesser occipital nerve (C2) Great auricular nerve (C2, 3) Transverse cervical nerve (C2, 3)
Buccal nerve Auriculotemporal nerve
Trigeminal nerve (V)
Branches f r o m cervical plexus
Supraclavicular nerves (C3, 4)
O p h t h a l m i c nerve (V,>
Dorsal rami of cervical spinal nerves
Maxillary nerve (V 2 )
Note: Auricular branch of vagus nerve to external acoustic meatus and small area on posteromedial surface of auricle
Mandibular nerve (V 3 )
Branches f r o m cervical plexus
Facial Nerve Branches and Parotid Gland mssm
See also
Plate 123
Temporal branches Parotid gland Zygomatic branches Posterior auricular nerve
Parotid duct
Main trunk of facial nerve emerging from stylomastoid
Buccal branches
Marginal mandibular branch
Nerve to posterior belly of digastric muscle and to stylohyoid muscle
Cervical branch
Medial pterygoid muscle
Horizontal section Main trunk of facial
Ramus of mandible Masseter muscle
Mastoid process Parotid gland
Temporofacial division
Temporal branch
Posterior auricular nerve Zygomatic branches Main trunk of facial nerve Nerve to posterior belly of digastric muscle and to stylohyoid muscle
Buccal branches
Cervicofacial division Marginal mandibular branch
Cervical branch
w rn^mm
Muscles of Facial Expression: Lateral View
Scalp
Skin and subcutaneous tissue Epicranial aponeurosis (galea aponeurotica)
Auricularis anterior muscle Auricularis superior muscle
Orbicularis oculi muscle
Orbital part Palpebral part
Auricularis posterior muscle Occipital belly (occipitalis) of epicranius muscle
Corrugator supercilii muscle (frontalis and orbicularis oculi, partially cut away) Procerus muscle
\
/ /
i
Levator labii superioris alaeque nasi muscle (partially
cut
away)
Nasalis ) Transverse part muscle ) Alar part
Parotid fascia
Depressor septi nasi muscle
Masseteric fascia -
'
Orbicularis oris muscle. Zygomaticus minor muscle
mm
mm
Investing layer of (deep) cervical fascia
Zygomaticus major muscle Orbicularis oris muscle Mentalis muscle Deltoid fascia
Depressor labii inferioris muscle Depressor anguli oris muscle Buccinator muscle Risorius muscle Platysma muscle Sternum Clavicle Pectoralis major fascia
m
Muscles of Neck: Lateral View :/..:,/:.'
Parotid gland [cut) Ramus of mandible
:
.
Masseter muscle Submandibular gland Hyoglossus muscle
Styloglossus muscle
Mylohyoid muscle Mastoid process Styloid process Stylohyoid muscle Body of mandible
Digastric muscle (posterior belly) Middle pharyngeal constrictor muscle
Digastric muscle (anterior belly)
Longus capitis muscle Splenius muscle Sternocleidomastoid muscle
Hyoid bone
Levator scapulae muscle
Thyrohyoid muscle
I Posterior Scalene muscles \ Middle Anterior
O m o h y o i d muscle (superior belly) Sternohyoid muscle
Brachial plexus
Inferior pharyngeal constrictor muscle
Trapezius muscle Acromion
Sternothyroid muscle
Deltoid muscle
mm
mm
Manubrium of sternum
O m o h y o i d muscle (inferior belly) Clavicle
Sternal head Clavicular head
Sternocleidomastoid muscle
Muscles of Neck: Anterior View
Digastric muscle (anterior belly)
Masseter muscle
Mylohyoid muscle Parotid gland
Submandibular gland Fibrous loop for intermediate digastric tendon
Platysma muscle
{cut
away)
Mastoid process
Stylohyoid muscle Digastric muscle (posterior belly)
Hyoid bone
External carotid artery
Carotid sheath
Internal jugular vein Fascia of infrahyoid muscles and cut edge
Thyrohyoid muscle O m o h y o i d muscle (superior belly)
Thyroid cartilage
Sternohyoid muscle Investing layer of (deep) cervical fascia and cut edge
Sternothyroid muscle Scalene muscles
Cricoid cartilage
Trapezius muscle Deltoid muscle
Clavicle O m o h y o i d muscle (inferior belly) Pretracheal layer of (deep) cervical fascia over thyroid gland and trachea
Pectoralis major muscle Clavicular head ( Sternocleidomastoid Sternal head ( muscle
Suprasternal space (of Burns) Manubrium of sternum
jugular notch
Infrahyoid and Suprahyoid Muscles See also
Digastric muscle (anterior belly)
Hyoid bone
Mylohyoid muscle
Thyrohyoid membrane
Hyoglossus muscle
External carotid artery
Stylohyoid muscle
Internal jugular vein
Digastric muscle (posterior belly)
Thyrohyoid muscle
Fibrous loop for intermediate digastric tendon
Thyroid cartilage Omohyoid muscle (superior belly)
Sternohyoid and omohyoid muscles (cut)
Sternohyoid muscle
Thyrohyoid muscle
Median cricothyroid ligament
Oblique line of thyroid cartilage
Cricoid cartilage
Cricothyroid muscle
Scalene muscles
Sternothyroid muscle Omohyoid muscle (superior belly) (cut)
Trapezius muscle
Thyroid gland
Omohyoid muscle (inferior belly)
Sternohyoid muscle (cut) Trachea
Clavicle
Styloid process Mastoid process Stylohyoid muscle
Mylohyoid muscle
Digastric muscle (posterior belly)
Digastric muscle (anterior belly) Geniohyoid muscle
Thyrohyoid muscle Oblique line of thyroid cartilage
Sternohyoid muscle Omohyoid muscle (superior belly)
B
,
,
Plate 53
. .
.
Infrahyoid and suprahyoid muscles and their action: schema
Omohyoid muscle (inferior belly)
Sternothyroid muscle Sternum
Scapula
Scalene and Prevertebral Muscles
Basilar part of occipital bone
Longus capitis muscle (cut)
Occipital condyle Jugular process of occipital bone
<<.'0
Rectus capitis anterior muscle
' -
*
Rectus capitis lateralis muscle
Mastoid process
Styloid process
Transverse process of atlas ( C I )
Longus capitis muscle
Posterior tubercle of transverse process of axis (C2)
Antei ior
i
Tubercles of transverse
Posterior
j
P r o c e s s of C3 vertebra
Slips of origin of anterior scalene muscle {cut)
Longus colli muscle
Slips of origin of posterior scalene muscle Anterior • Scalene muscles
Middle
Middle
Posterior
Posterior
Scalene muscles
Anterior scalene muscle (cut)
Phrenic nerve Brachial plexus ijvJS
1st rib
Subclavian artery Subclavian vein Internal jugular vein
Right common carotid artery
Posterior tubercle of transverse process of C7 vertebra
^ n n n n i "••vjV
Superficial Veins and Cutaneous Nerves of Neck V
^ i x - . v
For deep veins of neck see
Plate 70
Platysma muscle (cut)
Facial artery and vein
Digastric muscle (anterior belly)
Marginal mandibular branch of facial nerve
Submandibular gland Mylohyoid muscle
Hyoid bone
Parotid gland
Retromandibular vein
Omohyoid muscle (cut)
Internal jugular vein
External carotid artery Thyrohyoid muscle
External jugular vein
Sternocleidomastoid muscle (cut)
Anterior jugular vein
Superior thyroid artery and vein Internal jugular vein
Communicating vein
Common carotid artery
Great auricular nerve
Sternohyoid muscle
Thyroid cartilage
Sternothvroid muscle /
Transverse cervical nerves
Ansa cervicalis Omohyoid muscle (superior belly) (cut)
Thyroid gland
Omohvoid muscle I (inferior belly)
Trapezius muscle
Brachial plexus
Platysma muscle (cut)
Pectoralis major muscle
Supraclavicular nerves Sternocleidomastoid muscle
Clavicle Sternocleidomastoid muscle (cut) Sternothyroid muscle
mmm
Vi l l i
lllftl
I^M
Cervical Plexus in Situ See also
Plates 127-129, 193
Great auricular nerve
Parotid gland Facial artery and vein
Lesser occipital nerve
Submandibular gland
Sternocleidomastoid muscle [cut, turned up)
Mylohyoid muscle Hypoglossal nerve (XII)
Stylohyoid muscle
Digastric muscle (anterior belly)
Digastric muscle (posterior belly)
Lingual artery
C2 spinal nerve (ventral ramus)
External carotid artery
Accessory nerve (XI)
Internal carotid arte
C3 spinal nerve (ventral ramus)
Thyrohyoid muscle
Levator scapulae muscle
Superior thyroid artery
— Middle scalene muscle
Omohyoid muscle (superior belly) ( Ansa cervicalis \
SuPerior
— Anterior scalene muscle
root
C5 spinal nerve (ventral ramus)
( Interior root Sternohyoid muscle
Superficial cervical artery
Sternothyroid muscle
Phrenic nerve
Internal jugular vein
Omohyoid muscle (inferior belly) (cut)
Common carotid artery Inferior thyroid arte Vagus nerve (X) Vertebral artery
Dorsal scapular artery Suprascapular artery
Thyrocervical trunk Subclavian artery and vei..
Cervical plexus: schema
Brachial plexus
Hypoglossal nerve (XII)
(S = gray ramus from superior cervical sympathetic ganglion)
Accessory nerve (XI) Great auricular nerve Lesser occipital nerve To rectus capitis lateralis, longus capitis, and rectus capitis anterior muscles
To geniohyoid muscle To thyrohyoid muscle Communication to vagus nerve Transverse cervical nerves To omohyoid muscle (superior belly) Ansa cervicalis
Superior root Inferior root
longus capitis and longus colli muscles
To sternothyroid muscle To sternohyoid muscle To omohyoid muscle (inferior belly) Supraclavicular nerves
To scalene and levator scapulae muscles
1BBKUKXBBBKBX&BBUKW
See also
Right anterior dissection
Plate 427
Thyroid gland ( r e f l e c t e d )
Internal jugular vei *
Common carotid artery
Middle cervical sympathetic ganglion
Ascending cervical artery Vagus nerve (X)
Phrenic nerve Anterior scalene muscle
Vertebral artery
Inferior thyroid artery
Common carotid artery
Superficial cervical artery
Recurrent laryngeal nerve
Suprascapular artery Dorsal scapular artery
Brachiocephalic trunk
Costocervical trunk
Internal jugular vein (cut)
Thyrocervical trunk Subclavian artery and vein
C o m m o n origin of superficial cervical and dorsal scapular arteries f r o m transverse cervical artery ( - 3 0 % ) Superficial branch of transverse cervical artery (superficial cervical artery) Inferior thyroid artery
Deep branch of transverse cervical artery (dorsal scapular artery) Transverse cervical artery
Thyrocervical trunk Suprascapular artery
Right oblique schematic view Vertebral artery Deep cervical artery (ascending to anastomose with descending branch of occipital artery)
Right external carotid artery Right internal carotid artery Ascending cervical artery Inferior thyroid artery
Costocervical trunk
Superficial cervical artery
Supreme (superior) intercostal artery
Right common carotid artery
Dorsal scapular artery Superior and inferior transverse scapular ligamen 1
Thyrocervical trunk Right subclavian artery (1st part medial to, 2nd part posterior to, 3rd part lateral to anterior scalene muscle)
Acromion
Brachiocephalic trunk
Dorsal scapular artery
Suprascapular artery
Suprascapular artery
Aortic arch
Axillary artery
Internal thoracic (mammary) artery
1 st and 2nd posterior intercostal arteries
1 st, 2nd, and 3rd anterior intercostal arteries Circumflex scapular artery
Thoracodorsal artery
Subscapular artery
See also
Plates 136, 138
Superficial temporal artery
Parotid space (bed): right lateral dissection
Transverse facial artery Maxillary artery
Mastoid process
External carotid artery
Styloid process
Posterior auricular artery
Facial nerve (VII) (cut)
Glossopharyngeal nerve (IX)
Sternocleidomastoid muscle (cut)
Stylohyoid muscle
Digastric muscle (posterior belly)
Hypoglossal nerve (XII)
Occipital artery and sternocleidomastoid branch
Facial artery Lingual artery
Accessory nerve (XI Ansa cervicalis
Mylohyoid muscle
Superior root Inferior root
Hyoglossus muscle
Vagus nerve (X)
Digastric muscle (anterior belly)
Ascending pharyngeal artery
Hyoid bone
Carotid branch of glossopharyngeal nerve (IX) and carotid body
Branch to thyrohyoid muscle (from ansa cervicalis)
Internal carotid artery Internal jugular vein
Superior laryngeal artery Superior thyroid artery
Superficial temporal artery Digastric muscle (phantom)
External carotid artery Transverse facial artery
Common carotid artery
Maxillary artery Posterior auricular artery
Occipital artery Descending branch Sternocleidomastoid branch Internal carotid a External carotid artery
Facial artery Lingual artery Ascending pharyngeal artery Superior thyroid artery and superior laryngeal branch Omohyoid muscle ( p h a n t o m )
Common carotid
External carotid branches: schema Thyrocervical trunk
Fascial Layers of Neck For contents of carotid sheath see
Superficial (investing) layer of deep cervical fascia
Plates 69-71
Platysma muscle Sternohyoid muscle Trachea
Infrahyoid fascia
Sternothyroid muscle T h y r o i d gland
Pretracheal (visceral) fascia
Esophagus Omohyoid muscle
Buccopharyngeal (visceral) fascia
Sternocleidomastoid muscle
Carotid sheath
Recurrent laryngeal nerve
Subcutaneous tissue
Common carotid artery
Superficial (investing) layer of deep cervical fascia roofing posterior triangle
Internal jugular vein Vagus nerve (X) Phrenic nerve Anterior scalene muscle Sympathetic trunk
Fat in posterior triangle
Spinal nerve Middle and posterior scalene muscles -ongus colli muscle
Prevertebral layer of (deep) cervical fascia
Levator scapulae muscle Trapezius muscle
Alar fascia
Cross section
Deep cervical muscles Retropharyngeal space
Subcutaneous tissue
Cervical vertebra (C7)
Sagittal section
Mandible
Pharynx
Geniohyoid muscle
Buccopharyngeal (visccral) fascia
Geniohyoid fascia
Retropharyngeal space
Investing layer of (deep) cervical fascia
Alar fascia Prevertebral fascia Trachea Esophagus
Fascia of infrahyoid muscles Pretracheal (visceral) fascia Thyroid gland Subcutaneous tissue —Suprasternal space (of Burns) Manubrium of sternum Aorta Pericardium
Anterolateral view
Inferior view Major alar cartilage
Frontal bone Nasal bo
Lateral
Frontal process of maxilla
Medial crus
Lateral process of septal nasal cartilages Septal cartilage Minor alar cartilage Accessory nasal cartil
Major alar cartilage
. Lateral crus Medial crus
Alar fibrofatty tissue
Nasal septal cartil Anterior nasal spine of maxil
Nasal septal cartilage
Alar fibrofatty tissue Infraorbital foramen
Frontalis muscle Supraorbital artery and Supratrochlear artery and n Procerus muscle Corrugator supercilii muscle Dorsal nasal a Infratrochlear nerve Angular artery External nasal artery and nerve Nasalis muscle (transverse part) Infraorbital artery and nerve Lateral nasal artery Transverse facial artery Nasalis muscle (alar part) Depressor septi nasi muscle Orbicularis oris muscle Facial arterv
4
Anterior nasal spine of maxilla Intermaxillary suture
Lateral Wall of Nasal Cavity HHBwBBnMHHHHRHHRBBH^HHH
Sphenoethmoidal recess
Frontal sinus
ing of dal sinus
Superior nasal concha Superior nasal meatus Middle nasal concha
\
Agger nasi
Hypophysis (pituitary gland) in sella turcica Sphenoidal sinus
Atrium of middle nasal meatus
Pharyngeal tonsil (adenoid if enlarged)
Middle nasal meatus
Basilar part of occipital bone Pharyngeal raphe
Inferior nasal concha (turbinate) Limen nasi
Choana
Nasal vestibule
Torus tubarius
Inferior nasal meatus
Opening of auditory (pharyngotympanic, Eustachian) tube Pharyngeal recess
Palatine process of maxilla Incisive canal Tongue
Horizontal plate of palatine bone Soft palate Middle nasal concha Middle nasal meatus Bulging septum rvvay to nasopharynx Inferior nasal concha Inferior nasal meatus Floor of nasal cavity
Speculum view Frontal sinus
Cribriform plate of ethmoid bone Probe in opening of sphenoidal sinus
Probe passing from semilunar hiatus into frontal sinus via frontonasal duct Middle nasal concha {cut
Sphenoidal sinus Superior nasal meatus with opening of posterior ethmoidal cells
surface)
Ethmoidal bulla
Basilar part of occipital bone
Openings of middle ethmoidal cells Semilunar hiatus (osteomeatal unit) with opening of anterior ethmoidal air cells
Torus tubarius Opening of auditory (pharyngotympanic, Eustachian) tube
Uncinate process Inferior nasal concha
Anterior arch of atlas (CI vertebra)
{cut surface)
Opening of nasolacrimal duct Inferior nasal meatus
Opening of maxillary sinus
Dens of axis (C2 vertebra)
Lateral Wall of Masai Cavity (continued) See also
Plate 6
Lacrimal bone
Frontal bone
Squamous part Sinus Nasal spine
Middle nasal concha Uncinate process Ethmoid bone Cribriform plate perior nasal concha Highest nasal concha Sphenoethmoidal recess
Nasal bone
Sphenopalatine foramen
Agger nasi
Basilar part of occipital bone
Lateral process of nasal septal cartilage Major alar carti Alar fibrofatty tissue
Sphenoidal sinus Medial and Lateral plates of pterygoid process
Frontal process Anterior nasal spine Maxilla
Incisive canal
Pterygoid hamulus Sphenoidal process
Palatine process Alveolar process
Sphenoid bone
Orbital process Posterior nasal s p i n e / p a , a t j n e
bong
Perpendicular plate Horizontal plate Ethmoidal bulla Frontal sinus Opening of frontonasal canal
ening of middle ethmoidal cells uperior nasal concha
(cutaway)
ings of posterior ethmoidal cells Middle nasal concha (cui awa Opening of sphenoidal sinus Infundibulum leading to frontonasal cana Semilunar hiatus (osteomeatal unit) with opening of anterior ethmoidal air cells
Openings into maxillary sinus Sphenopalatine foramen
Uncinate Inferior nasal concha (cut Opening of nasolacrimal can
Ethmoidal process of inferior nasal concha Lesser palatine foramen Greater palatine foramen
medial Wall ©t Masai Cavity Nasal Septum!
Falx cerebri Frontal sinus
Cribriform plate of ethmoid bone Dura mater
Sphenoidal sinus
Sella turcica Nasal septum Choanae (posterior nasal apertures ) Lateral process of nasal septal cartilage Major
mmi
alar cartilage
SKI— Torus tubarius
mm
Nasal vestibule Anterior nasal spine Incisive canal Oral cavity Tongue Soft palate
Squamous part Sinus Nasal spine
Frontal bone
Crista galli Cribriform plate /> Ethmoid bone Perpendicular plate Crest
Nasal bone
Body Sphenoidal sinus
Vomer Vomerine groove (for nasopalatine nerve and vessels) Septal cartilage
Basilar part of occipital bone
Major alar cartilage (medial crus)
Anterior nasal spine Maxilla
Nasal crest Incisive canal Palatine process
Sphenoid bone
Medial, Lateral plates of pterygoid process
Pharyngeal tubercle Perpendicular plate Nasal crestPosterior nasal spine Horizontal plate Lesser palatine foramen Greater palatine foramen
Palatine bone
Anterior Posterior
Lateral pterygoid artery and muscle Supraorbital artery
Deep temporal arteries and nerves Masseteric artery and nerve Lateral ligament of temporomandibular joint
Supratrochlear artery Ophthalmic artery
Middle meningeal artery Auriculotemporal nerve
Dorsal nasal artery
Maxillary artery
Angular artery
Superficial temporal artery
Infraorbital artery
Posterior auricular artery
Superior ( Posterior alveolar < M i d d l e arteries ( Anterior
Facial nerve Inferior alveolar artery and nerve
Buccal artery and nerve
Sphenomandibular ligament
Medial pterygoid artery and muscle
Mylohyoid nerve and branch of inferior alveolar artery
Pterygomandibular raphe
Digastric muscle (posterior belly)
Lingual nerve
Stylohyoid muscle
Facial artery
External carotid artery
Mental branch of inferior alveolar
Facial artery Lingual artery
Submental artery
Sphenopalatine artery. Posterior lateral nasal branch
Artery of pterygoid canal Pharyngeal artery enopalatine foramen
Infraorbital artery
Anterior ) Deep temporal arteries Posterior ) and nerves Accessory meningeal artery Middle meningeal artery Anterior tympanic artery Deep auricular artery
Posterior superior alveolar artery
Auriculotemporal nerve
Sphenopalatine artery Posterior septal branches Greater (descending) palatine artery Buccal artery
Superficial temporal artery
Anastomosis in incisive canal
Ascending pharyngeal arterv
Left and right greater palatine arteries
/
Ascending palatine artery Tonsillar branches
Left and right lesser palatine arteries
Tonsillar artery Pterygoid arteries Masseteric artery Inferior alveolar artery
External carotid artery Facial artery Superior pharyngeal constrictor muscle Styloglossus muscle
Arteries of Nasal Cavity: Nasal Septum Turned Up
Nasal septal branch of superior labial branch (of facial artery)
Nasal septum ( turned up
Schematic
hinge
Anastomosis between posterior septal branch of sphenopalatine artery and greater palatine artery in incisive canal Septal and lateral nasal branches of posterior ethmoidal artery
Anterior septal branch, Anterior lateral nasal branch, External nasal branch of anterior ethmoidal artery
Posterior septal branch of sphenopalatine artery Sphenopalatine artery Sphenopalatine foramen
Alar branches of lateral nasal branch (of facial artery) •Vii
Posterior lateral nasal branches of sphenopalatine artery Maxillary artery Anastomosis between posterior septal branch of sphenopalatine artery and greater palatine artery in incisive canal
External carotid artery Lesser palatine foramen and artery Greater palatine artery
Lateral wall of nasal cavity
Greater palatine foramen and artery
1
Nerves of Nasal Cavity: Nasal Septum Turned Up HHHMIMH
See also
Plates 44, 45, 119
Olfactory nerves (I)
Nasal septum ( t u r n e d up) Incisive canal
••v/.l
Schematic
hinge
Nasopalatine nerve (V 2 )
Medial internal nasal, Lateral internal nasal, External nasal branches of anterior ethmoidal nerve (V-j)
sWs
Sphenopalatine foramen [dissected
Internal nasal branches of infraorbital nerve (V 9 )
-
• • •
away)
Pterygopalatine ganglion Nerve (Vidian) of pterygoid canal
Posterior superior lateral nasal branch of maxillary nerve (V 2 ) Nasal branch of anterior superior alveolar nerve (V 2 )
Greater and lesser palatine nerves (V 2 ) Posterior inferior lateral nasal branch of greater palatine nerve (V 2 ) Lesser palatine nerves (V 2 )
Communication between greater palatine and nasopalatine nerves at incisive canal
Greater palatine nerve (V 2 )
Nerves of Nasal Cavity (continued) Y^ff'y^ji^*flBUfii
See also
Plate 119
Distribution of olfactory mucosa ( shaded blue) Nasal septum
Lateral wall of nasal cavity
External nasal branch of anterior ethmoidal nerve (V-j) Lateral internal nasal branch of anterior ethmoidal nerve (V q ) Olfactory bulb Cribriform plate of ethmoid bone Olfactory tract
Posterior superior lateral nasal branches from maxillary nerve (V 2 ) Maxillary nerve (V 2 ) (sphenopalatine foramen dissected away) Pterygopalatine ganglion Greater petrosal nerve Deep petrosal nerve Nerve (Vidian) of pterygoid canal Pharyngeal branch of maxillary nerve (V 2 ) Nasopalatine nerve (V 2 ) passing to septum (cut) Posterior inferior lateral nasal branch from greater palatine nerve (V 2 )
Lateral wall of nasal cavity
/Olfactory bulb
f$M'h*m
Wmki
Olfactory nerves (I) (
G
Palatine nerves (V 2 ) < ( Lesser
Medial internal nasal branch of anterior ethmoidal nerve (V Olfactory nerves (I) Nasopalatine nerve (V 2 ) Incisive canal
Nasal septum
/
/
/Cribriform plate /
/
/ O l f a c t o r y tract
Autonomic Innervation of Nasal Cavity See also
Plates 122, 131, 133 Superior salivatory nucleus (parasympathetic) Facial nerve (VII) Geniculum (geniculate ganglion) of facial nerve Greater petrosal nerve (parasympathetic) Deep petrosal nerve (sympathetic) Nerve (Vidian) of pterygoid canal Maxillary nerve (V 2 ) entering foramen rotundum Pterygopalatine ganglion in Dterygopalatine fossa Lateral and medial posterior superior nasal branches in pterygopalatine fossa Infraorbital nerve Posterior superior and inferior lateral nasal nerves (cut
ends)
Tympanic cavity w s s s Medulla oblongata
mm
Internal carotid nerve and plexus
Internal carotid artery
Sympathetic trunk
Greater and lesser palatine nerves
Superior cervical ganglion
MM
mm wm
Posterior superior alveolar nerves
Maxillary sinus
Nasopalatine nerve
Postsynaptic fibers to vessels (sympathetic) and glands (parasympathetic) of nasal cavity, maxillary sinus, and palate Preganglionic parasympathetic fibers Postganglionic parasympathetic fiber Preganglionic sympathetic fibers
Plate 44
Nasal Region
Ophthalmic (V.,) and Maxillary (V2) Nerves fm
'. ..•.
.
v . . ' • . v 7 / W M K m W B 9 M H W JJSSwS
See also P l a t e 122
Communicating branch Posterior ethmoidal nerve Long and short ciliary nerves
Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve Lacrimal gland
Ciliary ganglion Lacrimal nerve Nasociliary nerve Frontal nerve Tentorial branch
Infratrochlear nerve (from nasociliary nerve) Cutaneous branch of lacrimal nerve Zygomaticotemporal nerve Zygomaticofacial nerve
Ophthalmic nerve (V 1 )
External nasal branch of anterior ethmoidal nerve
Trigeminal (semilunar) ganglion Trigeminal nerve (V) Meningeal branch — Foramen rotund urn
Infraorbital nerve
Foramen ovale
Anterior superior alveolar nerve
Mandibular nerve (V 3 )
Nasal branch
Maxillary nerve (V 2 ) Zygomatic nerve Nerve (Vidian) of pterygoid canal Pterygopalatine ganglion Greater and lesser palatine nerves Ganglionic branches to pterygopalatine ganglion
Mucous membrane of maxillary sinus Dental and gingival branches Superior dental plexus Infraorbital nerve entering infraorbital canal Middle superior alveolar nerve Posterior superior alveolar nerve
Plate 45
Mandibular Nerve |W3f See also
Plates 71,122 Anterior division
Lateral view
Posterior division
Temporal fascia md temporalis muscle
Posterior Anterior
Deep temporal nerves
Foramen ovale
Masseteric nerve
Meningeal branch Lateral pterygoid nerve and muscle
Foramen spinosum Middle meningeal artery Auriculotemporal nerve Posterior auricular nerve
"mm
Facial nerve (VII) Chorda tympani nerve
Buccal nerve and buccinator muscle (cut)
Lingual nerve Inferior alveolar nerve (cut)
Submandibular ganglion
iNerve to mylohyoid o-
Sublingual
<•
Medial pterygoid muscle (cut) Mylohyoid muscle (cut)
Digastric muscle (posterior belly) Stylohyoid muscle
Mental nerve
Hypoglossal nerve Submandibular gland
Medial view Trigeminal (semilunar) ganglion
Inferior alveolar nerve (cut)
Sublingual nerve
Digastric muscle (anterior belly) Sensory root
Geniculum (geniculate ganglion) of facial nerve
Ophthalmic nerve (V-j)
Tympanic cavity
Maxillary nerve (V 2 )
Chorda tympani nerve
Mandibular nerve (V 3 )
Facial nerve (VII)
Anterior division Tensor veli palatini nerve and muscle Otic ganglion Chorda tympani nerve Medial pterygoid nerve and muscle (cut) Pterygoid hamulus Lingual nerve
Tensor tympani muscle and nerve Lesser petrosal nerve Auriculotemporal nerve Maxillary artery Mylohyoid nerve Inferior alveolar nerve entering mandibular foramen
Nasal Region
Nose and Paranasal Sinuses: Cross Section vCIfB l ftl&HMMMBIMBMtMHBI&fB li QQti
Nasal vestibule
Major alar cartilage Vomer Inferior nasal concha
Nasal septal cartilage
Facial artery
Facial vein
Maxillary bone
Maxillary sinus Sphenoid bone
Masseter muscle Coronoid process of mandible
Medial pterygoid muscle Lateral pterygoid plate
Lateral pterygoid muscle
Levator veli palatini muscle
Cartilage of auditory tube
Pharyngeal recess
Neck of mandible
Longus capitis muscle
Parotid gland
Rectus capitis anterior muscle
Retroman dibular vein
Superficial temporal artery
Glossopharyngeal nerve
Sympathetic trunk
Styloid process
Styloglossus muscle Stylohyoid muscle
Auricular cartilage
Medulla oblongata
Mastoid air cells Vagus nerve Facial nerve Hypoglossal nerve Accessory nerve
Nasal Region
Plate 47
Paranasal Sinuses
Coronal section Olfactory bulbs
Falx cerebri Brain
Frontal sinus
Nasal cavities
Orbital fat
Nasal septum
Ethmoidal cells
Middle nasal concha
Opening of maxillary sinus
Middle nasal meatus
Infraorbital
Recesses of maxillary sinus
Zygomatic
Maxillary sinus
Alveolar
Inferior nasal meatus
Buccinator muscle Alveolar process of maxilla
Inferior nasal concha
Body of tongue
Hard palate
m Jit V \
Oral cavity-
•
t,
-
Sublingual gland Mandible (body)
Nasal cavities
Nasal septum Ethmoidal cells
Orbital fat and muscles
Sphenoidal sinuses
- M e d i a l wall of orbit Optic nerve (II) Brain
V
Optic chiasm
Horizontal section
Plate 48
Nasal Region
Paranasal Sinuses (continued)
Sagittal section Ethmoidal air cells (sinuses) Frontal sinus
Opening of sphenoidal sinus
Opening of frontonasal duct Sphenoidal sinus
Semilunar hiatus (osteomeatal unit)
Middle nasal concha {cutaway)
Uncinate process
Opening of maxillary sinus
Inferior nasal concha
Frontal sinus
Opening into middle nasal meatus
Orbit
Pterygopalatine fossa
Lateral dissection Roots of teeth
Nasal Region
Plate 49
®8S
mmmmmmmmmmmmmmmssm
Bones of nasal cavity and paranasal sinuses at birth
Sinus represents one or more anterior ethmoidal cells opening into semilunar hiatus of middle nasal meatus
Sinus represents one or more middle ethmoidal cells opening into middle nasal meatus Part of nasolacrimal duct that formed in depths of nasooptic furrow
Sinuses represent two or more posterior ethmoidal cells opening into superior nasal meatus Sphenoidal sinus within bony shell (sphenoidal concha) located anterior and lateral to body of sphenoid bone (broken line indicates sinus lateral to sphenoid body)
Nasal bone
of sphenoid bone
Lacrimal bone
Hypophyseal fossa Nasolacrimal foramen (becomes bony canal)
Vestigial remnant of Rathke's pouch Medial plate of pterygoid process
Part of nasolacrimal duct within nasal cavity with slit-like opening in inferior nasal meatus
Lower border of highest nasal concha Lower border of superior nasal concha Superior nasal meatus
Maxilla
Middle nasal concha (cut edge) (inferior nasal concha completely removed)
Uncinate process of ethmoid bone Semilunar hi
Maxillary sinus with opening into semilunar hiatus (striped area represents membrane forming most of medial wall of sinus)
Growth of frontal and maxillary sinuses throughout life Frontal sinus within frontal bone Birth 1 year 4 years 7 years
Middle nasal concha
Left orbit
Nasal septum Nasal cavity
Maxillary sinus within maxilla
12 years Adult Old age
Plate 50
Inferior nasal concha Molar tooth
Nasal Region
Inspection of Oral Cavity
Philtrum of lip Soft palate Palatopharyngeal arch Uvula Palatoglossal arch -Palatine tonsil Posterior wall of pharynx
Frenulum of upper li Lingual minor salivary gland Deep lingual artery and veins and lingual nerve Fimbriated fold Submandibular duct Sublingual gland Frenulum of tongue Sublingual fold with openings of sublingual ducts Sublingual caruncle of submandibular du Frenulum of lower lip
Parotid papilla with opening of parotid duct
Plate 51
Roof of Mouth ramawe®
Incisive papilla
Incisive fossa
Transverse palatine folds
Greater palatine artery and nerve Greater palatine foramen
Palatine raphe
Lesser palatine foramen
Palatine process of maxilla
.esser palatine artery and nerves
Palatine glands
Tendon of tensor veli palatini muscle
Horizontal plate of palatine bone
Pterygoid hamulus
Palatine aponeurosis (from tensor veli palatini muscle)
Interdigitating fibers of levator veli palatini muscle Buccinator muscle
Uvular muscle
Pterygomandibular raphe Superior pharyngeal constrictor muscle
Molar minor salivary glands
Palatoglossus muscle
Palatopharyngeus muscle Palatine tonsil
Basilar part of occipital bone
Anterior view
Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube Levator veli palatini muscle (cut)
Pharyngobasilar fascia
Tensor veli palatini muscle
Levator veli palatini muscle
Medial pterygoid muscle (cut)
Choanae
Medial pterygoid plate
Pterygoid hamulus
Pterygoid hamulus-
Superior pharyngeal constrictor muscle (cut)
Tendon of tensor veli palatini muscle Levator veli palatini muscle (cut)
Palatopharyngeus muscle
Palatopharyngeus muscle (cut)' Uvular muscle
Posterior view
Oral Region
Floor of Mouth mmmwsM
See also P l a t e 29
Lateral, slightly inferior view Hyoglossus muscle Mylohyoid muscle Fibrous loop for intermediate digastric tendon Digastric muscle (anterior belly) Mastoid process
Median raphe between mylohyoid muscles
Styloid process Digastric muscle (posterior belly)
Anteroinferior view
Stylohyoid muscle Greater horn \ Lesser horn j Hyoid bone Body ' Thyrohyoid muscle Omohyoid muscle Sternohyoid muscle Digastric muscle (anterior belly) Mylohyoid muscle Stylohyoid muscle Digastric muscle (posterior belly)
Hyoglossus muscle
Fibrous loop for intermediate digastric tendon
Posterosuperior view Inferior alveolar nerve and artery Mylohyoid nerve and artery Submandibular gland and duct Mylohyoid muscle Geniohyoid muscle Lesser horn
0
V -
Oral Region
Hyoid bone
BodyGreater horn
Superior mental spine (genial tubercle) for origin of genioglossus muscle Hyoglossus muscle (cut)
Plate 53
Muscles Involved in Mastication ':•:
•• :• ;
.
For facial muscles see
Plate 26 ...
Temporalis muscle Temporal fascia Superficial layer Deep layer
Levator labii superioris alaeque nasi muscle
Zygomatic arch
Levator labii superioris muscle
Articular disc of temporomandibular joint Deep part \ Superficial part j
Zygomaticus minor muscle
Masseter muscle
Zygomaticus major muscle Levator anguli oris muscle Orbicularis oris muscle Mentalis muscle Depressor labii inferioris muscle
Insertion of temporalis muscle to coronoid process of mandible Parotid duct Buccinator muscle Orbicularis oris muscle Masseteric nerve and artery Maxillary artery Insertion of masseter muscle
Plate 54
Oral Region
Muscles Involved in Mastication (continued)
Articular disc of temporomandibular joint Articular tubercle Lateral pterygoid muscle Sphenomanclibular ligament Medial pterygoid muscle Parotid duct Buccinator muscle
Pte ry go m an d i b u I a r rap h e Superior pharyngeal constrictor muscle
Lateral view
Choanae Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube
Otic ganglion
Sphenomandibular ligament Masseteric nerve
Lateral pterygoid plate Middle meningeal artery Auriculotemporal nerve
•
Ai
\
am
— Lateral pterygoid muscle
Masseteric artery
Medial pterygoid muscle
Maxillary artery Inferior alveolar nerve Lingual nerve Medial pterygoid muscle Medial pterygoid plate
Tensor veli palatini muscle (cut)
Pterygoid hamulus
Levator veli palatini muscle (cut)
Nerve to mylohyoid
Pterygoid hamulus
Posterior view
Oral Region
Plate 55
Teeth
Permanent
Deciduous (primary) Usual age of .eruption^.
(colored blue) Usual age of eruption
Central incisor (7th year)
Central incisor (8-10 m o n t h s ) "
Lateral incisor (8th year)
Lateral incisor (8-10 months)-
Canine (cuspid) (11 th—12th year) "I st premolar (9th year)
Canine (cuspid) (16-20 months)
2nd premolar (1 Oth year) 1st molar (6th year)
1 st molar ( 15-2 I months)
2nd molar (12th- 13 th year)
2nd molar (20-24 months)
3rd molars (1 7th—25th year)
2nd molar (20-24 months)
2nd molar (12th—13th year)
I st molar (15-21 months)
I st molar (6th year) 2nd premolar (10th year)
Canine (cuspid) (16-20 months)
1st premolar (9th year)
Lateral incisor (15-21 months)
Canine (cuspid) (11 th—12th year) Lateral incisor (8th year)
Central incisor (6-9 months)"""
Central incisor (7th year)
Central incisors Incisive fossa
Lateral incisors Canines
Palatine process of maxilla
1st premolars 2nd premolars
Horizontal plate of palatine bone
1 st molars 2nd molars 3rd mola
Greater and lesser palatine foramina
Upper permanent teeth
Plate 56
Lower permanent teeth
Oral Region
Enamel Dentine and dentinal tubules Crown <
Interglobular spaces Odontoblast layer Interproximal spaces Dental pulp containing vessels and nerves Gingival (gum) epithelium (stratified)
Neck
Gingival groove Lamina propria of gingiva (gum) (mandibular or maxillary periosteum) Periodontium (alveolar periosteum) Papilla Root
Cement
<
Root (central) canals containing vessels and nerves Bone Apical foramina
|\
it
Left upper permanent teeth: labiobuccal
Left lower permanent teeth: labiobuccal view
ft.
m
Lateral Incisors
Oral Region
Canines (cuspids)
Premolars
Molars
Plate 57
Tongue
m&s.
iglottis Median glossoepiglottic fold Lateral glossoepiglottic fold Vallecula Palatopharyngeal arch and muscle (cut) Palatine tonsil {cut) Lingual tonsil (lingual nodules)
Root
Palatoglossal arch and muscle {cut) - F o r a m e n cecum Terminal sulcus Vallate papillae - Foliate papillae
Filiform papillae Body/ s Fungiform papilla Midline groove (median sulcus)
Dorsum of tongue Apex Lingual tonsil
Filiform papillae Fungiform papilla Keratinized tip of papilla
Intrinsic muscle Duct of gland Crypt Lymph follicles Stratified squamous epithelium Sustentacular cell Sensory cell
Mucous glands Vallate papilla Taste buds Furrow
Taste pore Lamina propria
Lingual glands (serous glands of von Ebner) y
Section of taste bud
Plate 58
Schematic stereogram: area indicated above
Oral Region
Plates 34, 46, 53, 128
See also
Palatoglossus muscle longitudinal muscle of tongue
Mastoid process ' ^W
Digastric muscle (posteric
^ W t i i K
\ \
m m m ^ / J ^ R ^ v w f ^ ^ B ^ ^ / / ' I
3
'
1 3
"
belly) (cut)
Styloid process
\
Pharyngobasilar fascia
\
Superior pharyngeal constrictor mus Stylohyoid ligament
Styloglossus muscle Glossopharyngeal part of superior r y n g e a l constrictor
| - ; : » l \ x S t y l o p h a r y n g e u s muscle Stylohyoid muscle Middle pharyngeal constrictor muse Digastric muscle (posterior belly) [ a Hyoglossus muscle
ossus muscle
^ I n t e r m e d i a t e tendon of digastric muscle (cut) Fibrous loop for intermediate digastric tendon
Lateral v i e w Lingual nerve
"uperior pharyngeal constrictor muscle Styloglossus muscle
Submandibular ganglion
Palatoglossus muscle (cut)
Deep lingual artery and venae comitantes
Stylohyoid ligament Stylopharyngeus muscle Hyoglossus muscle (cut) Lingual artery External carotid artery
Artery to frenulum
nternal jugular vein Retromandibular vein
Submandibular duct
Facial vein
• .i r Suprahyoid artery
Sublingual artery and vein Geniohyoid mu
Dorsal lingual artery and vein Hypoglossal nerve
Oral Region
Common trunk for facial, retromandibular and ingual veins (common facial vein) Lingual vein
Vena comitans of hypoglossal nerve
Plate 59
Tongue and Salivary Glands: Sections
Horizontal section below lingula of m a n d i b l e (superior v i e w )
demonstrating bed
of parotid gland
Orbicularis oris muscle
„ Buccinator muscle
Buccopharyngeal fascia Fada| artery and vein
Pterygomandibular raphe Lingual nerve and superior pharyngeal constrictor muscle Masseter muscle Palatoglossus muscle in palatoglossal arch Palatine tonsil Palatopharyngeus muscle in palatopharyngeal arch Ramus of mandible Inferior alveolar artery vein, and nerve Medial pterygoid muscle Styloglossus muscle Facial nerve Retromandibular vein External carotid arterv <
Parotid gland Stylopharyngeus muscle Stylohyoid muscle Sternocleidomastoid muscle Digastric muscle (posterior belly) Internal jugular vein, internal carotid artery and nerves IX, X, and XII in carotid sheath Superior cervical sympathetic ganglion
Longus capitis muscle Prevertebral fascia Buccopharyngeal fascia and retropharyngeal space
Superior longitudinal muscle Vertical and transverse muscles of tongue Inferior longitudinal muscle Styloglossus muscle Buccinator muscle Muscles of facial expression Hyoglossus muscle Genioglossus muscle Sublingual salivary gland Submandibular duct Mandibular canal, inferior alveolar artery, vein, and nerve Lingual nerve Nerve to mylohyoid Vena comitans of hypoglossal nerve (to lingual vein) Lingual artery Facial arterv Hypoglossal nerve (XII) Submandibular salivary gland Submandibular lymph node Frontal section Mylohyoid muscle behind 1st molar tooth Facial vein (anterior view) Intermediate digastric tendon demonstrating Platysma muscle Hyoid bone
Plate 60
beds of sublingual and submandibular glands
Oral Region
Salivary Glands See also
Plates 25, 53, 133, 134, 167, 168
Superficial temporal artery and vein and auriculotemporal nerve Branches of facial nerve Transverse facial artery Accessory parotid gland Parotid duct Buccinator muscle (cut) Masseter muscle Lingual nerve Submandibular ganglion Tongue Frenulum of tongue Sublingual fold with openings of sublingual ducts
Parotid gland
Sublingual caruncle with opening of submandibular duct
Retromandibular vein (anterior and posterior branches)
Sublingual gland
Digastric muscle (posterior belly)
Submandibular duct
Stylohyoid muscle Sublingual artery and vein
External jugular vein Sternocleidomastoid muscle
Mylohyoid muscle (cut) Digastric muscle (anterior belly) Hyoid bone
Submandibular gland
Internal jugular vein
Facial artery and vein
ffct'
m m &
mm
&
v'AJfft?x.
Oral Region
/
«
-
v
Mm
'
*
Common trunk receiving facial, anterior branch of retromandibular, and lingual veins (common facial vein)
External carotid arterv
-ir-
•
<
\
i>
feiB
St.,
Sublingual gland: almost completely mucous
Plate 61
Afferent Innervation of Mouth and Pharynx BgaSHffigB&RMMm See also
mmmmsmsmsmm
Plates 45, 52, 59, 64, 122, 123, 125, 133, 135
Trigeminal (V) (maxillary V 2 ) Trigeminal nerve (V) Via superior alveolar Glossopharyngeal nerve (IX) nerves Va§us nerve Via pterygopalatine W ganglion and nasopalatine Facial nerve (VII) and greater and lesser palatine nerves Facial (VII) (intermediate nerve) Via greater petrosal nerve, pterygopalatine ganglion, and greater and lesser palatine nerves
B B B B t B a g M a a a M B g g
':
j&BZSCse&sxaxsa&z&Bi
Glossopharyngeal (IX) Via pharyngeal plexus Via tonsillar branches Taste plus general sensation via lingual branches Trigeminal (V) (maxillary V 2 ) a pharyngeal branch of pterygopalatine ganglion Facial (VII) (intermediate nerve) Via greater petrosal nerve and pterygopalatine ganglion
L-gggg
Vagus(X) Via internal branch of superior laryngeal nerve
Glossopharyngeal (IX) Via pharyngeal plexus Via tonsillar branches Taste plus general sensation via ingual branches Vagus(X)and glossopharyngeal (IX) Via pharyngeal plexus Vagus(X) Via internal branch of superior laryngeal nerve
Trigeminal (V) (maxillary V 2 ) Via pterygopalatine ganglion and nasopalatine and greater and lesser palatine nerves Via superior alveolar nerves
Trigeminal (V) (mandibular V 3 ) Via buccal nerve Via inferior alveolar nerve
Trigeminal (V) (mandibular Via lingual nerve Facial (VII) (intermediate nerve) Taste via chorda tympani and lingual nerve
Plate 62
Oral Region
Pharynx: Median Section
Sella turcica Frontal sinus
Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube Sphenooccipital synchondrosis
Sphenoidal sinus
Pharyngeal tonsil
Nasal septum
Pharyngeal tubercle of occipital bone
Nasopharynx
Pharyngeal raphe 'Anterior longitudinal ligament
Soft palate
-Anterior atlantooccipilal membrane
Palatine glands
Apical ligament of dens
Hard palate Oral cavity
Anterior arch of atlas (CI vertebra)
Incisive canal Palatine tonsil
Dens of axis (C2 vertebra)
mm
Body of tongue Oropharynx
Pharyngeal constrictor muscles
Foramen cecum Lingual tonsil Genioglossus muscle
Buccopharyngeal fascia
Root of tongue
Retropharyngeal space
Epiglottis Mandible Geniohyoid muscle Hyoid bone Hyoepiglottic ligament < ;
Thyrohyoid membrane Laryngopharynx Laryngeal inlet (aditus) Thyroid cartilage Vocal fold Transverse arytenoid muscle Cricoid cartilage Trachea Esophagus Esophageal muscles^ Thyroid gland Superficial (investing) layer of deep cervical fascia Pretracheal fascia Suprasternal space (of Burns) Manubrium of sternum
Pharynx
.
.s
Prevertebral fascia and anterior longitudinal ligament Vertebral bodies
Medial view Median (sagittal) section Sphenoidal sinus Pharyngeal tonsil Torus Iubarius Pharyngeal tubercle (basilar part of occipital bone) Pharyngeal raphe Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube Hard palate Pharyngeal recess Salpingopharyngeal fold Soft palate Palatine glands Uvula Semilunar fold Supratonsillar fossa Palatine tonsil Palatopharyngeal arch Palatoglossal arch Oropharynx Triangular fold Tongue (drawn Lingual tonsil Epiglottis Vallecula
forward
and
downward)
Pharyngeal mucosa removed Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube Medial pterygoid plate Tensor veli palatini muscle and tendon Levator veli palatini muscle Ascending palatine artery Pharyngeal branch of ascending pharyngeal artery Lesser palatine a r t e r y Salpingopharyngeus muscle Pterygoid hamulus Pterygomandibular raphe Tonsillar branch of lesser palatine artery Superior pharyngeal constrictor muscle Tonsillar branch of ascending pharyngeal artery Palatoglossus muscle Palatopharyngeus muscle Tonsillar branch of ascending palatine artery Tonsillar branch of facial artery Tonsillar branch of dorsal lingual artery Glossopharyngeal nerve (IX) and tonsillar branch
*
/
Plate 64
Stylohyoid ligament Hyoglossus muscle Middle pharyngeal constrictor muscle Stylopharyngeus muscle
Pharynx
Muscles of Pharynx: Median (Sagittal) Section mgiftiMTiiTKiwiOTiifrifl
Medial pterygoid plate Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube
T BSKhI
Tensor veli palatini muscle Pharyngobasilar fascia Levator veli palatini muscle Palatine aponeurosis and tendon of tensor veli palatini muscle Pharyngeal tubercle (basilar part of occipital bone) Pharyngeal raphe Anterior longitudinal ligament Anterior atlantooccipital membrane Apical ligament of dens Salpingopharyngeus muscle 'Muscles of soft palate Palatopharyngeal sphincter (Passavant's ridge) Pterygoid hamulus Superior pharyngeal constrictor muscle P tery g o m andibularra p h e Palatopharyngeus muscle Buccinator muscle
Aj FT}
Glossopharyngeal part of superior pharyngeal constrictor Stylopharyngeus muscle Stylohyoid ligament Styloglossus muscle Middle pharyngeal constrictor muscle Fibers to pharyngoepiglottic fold Buccopharyngeal fascia and retropharyngeal space Prevertebral fascia and anterior longitudinal ligament
Hyoglossus muscle
Internal branch of superior laryngeal nerve
Geniohyoid muscle
Longitudinal pharyngeal muscles
Mylohyoid muscle
Inferior pharyngeal constrictor muscle Pharyngeal aponeurosis
Hyoid bone Thyrohyoid membrane
\
Thyroid cartilage Median cricothyroid ligament Corniculate and arytenoid cartilages
Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Cricoid attachment of longitudinal esophageal muscle — Circular esophageal muscle inal esophageal muscle
Cricoid cartilage Trachea Margins of middle pharyngeal constrictor muscle Margins and attachments of inferior pharyngeal constrictor muscle
Plate 65
Pharynx: Opened Posterior View
Styloid process Nasal septum Torus tubarius Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube
Nasopharynx
Pharyngeal recess Parotid gland Torus levatorius (fold caused by levator veli palatini muscle) Salpingopharyngeal fold Soft palate Angle of mandible Submandibular gland Uvula Palatine tonsil
Oropharynx <
Root of tongue Palatopharyngeal arch Prominence caused by greater horn of hyoid bone Epiglottis Laryngeal inlet (aditus) Prominence caused by superior horn of thyroid cartilage
Laryngopharynx ^
iglottic fold Piriform fossa (recess) Cuneiform tubercle Fold over internal branch of superior laryngeal nerve Corniculate tubercle Interarytenoid notch Prominence over lamina of cricoid cartilage
Esophagus
Trachea
Plate 66
Pharynx
Muscles of Pharynx: Partially Opened Posterior View jflBMIIflgjgBIMBWfi^^ See also
Basilar part of occipital bone
Plate 235
Pharyngeal tubercle Pharyngeal tonsil Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube
Styloid process
/
Digastric muscle (posterior belly)
Pharyngobasilar fascia Choana
Stylohyoid muscle
Levator veli palatini muscle
Stylopharyngeus muscle
Superior pharyngeal constrictor muscle
Accessory muscle bundle from petrous part of temporal bone
Salpingopharyngeus muscle Uvula
Medial
Palatopharyngeus muscle
pterygoid muscle
Middle pharyngeal
Pharyngobasilar fascia
constrictor muscle
Pharyngeal raphe Superior pharyngeal constrictor muscle Hyoicl bone (tip of greater horn) Middle pharyngeal constrictor muscle Epiglottis Inferior pharyngeal constrictor muscle Cuneiform tubercle Corniculafe tubercle (Transverse and oblique) arytenoid muscles Posterior cricoarytenoid muscle Cricopharyngeal muscle (part of inferior pharyngeal constrictor) Longitudinal esophageal muscle
toyvw-
Stylopharyngeus muscle Pharyngoepiglottic fold Aryepiglottic fold Inferior pharyngeal constrictor muscle (cut
edge)
Longitudinal pharyngeal muscles Superior horn of thyroid cartilage Thyrohyoid membrane Internal branch of superior laryngeal nerve Pharyngeal aponeurosis Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Posterior border of thyroid cartilage lamina Cricoid attachment of longitudinal esophageal muscle Circular esophageal muscle
Pharynx
Plate 67
Eg
Muscles of Pharynx: Lateral View
Pharyngobasiiar fascia
N9HMI
Tensor veli palatini muscle Levator veli palatini muscle Lateral pterygoid plate
Pterygoid hamulus Buccinator muscle (cut)
Pterygomandibularraphe
Digastric muscle (posterior belly) (cut)
Buccinator crest of mandible
Styloid process Superior pharyngeal constrictor muscle Styloglossus muscle
Oblique line of mandible
Stylohyoid ligament Stylopharyngeus muscle Middle pharyngeal constrictor muscle Hyoglossus muscle Greater horn of hyoid bone
Digastric muscle (anterior belly)
Superior horn of thyroid cartilage
Mylohyoid muscle
Thyrohyoid membrane Inferior pharyngeal constrictor muscle
Hyoid bone
Tendinous arch
Stylohyoid muscle (cut)
Zone of sparse muscle fibers
Thyroid cartilage Median cricothyroid ligament
C ri co p h a ryn ge u s muscle (part of inferior pharyngeal constrictor)
Cricothyroid muscle Cricoid cartilage
Esophagus
Trachea
Plate 68
Pharynx
Arteries of Oral and Pharyngeal Regions asm
See also
From f Supraorbital artery ophthalmic < artery
/IV. .
Plates 34, 40
_
ml
( Supratrochlear artery Middle meningeal artery
S'/iiiV
B
Deep temporal arteries Dorsal nasal artery Masseteric artery Angular artery Infraorbital artery Sphenopalatine artery Transverse facial artery (cut)
Descending palatine artery Posterior superior alveolar artery
Superficial temporal artery
Superior labial artery Buccal artery
Maxillary artery
Buccinator muscle and parotid duct (cut)
Posterior auricular artery Ascending pharyngeal artery
Inferior labial artery
Occipital artery and sternocleidomastoid branch
Superior pharyngeal constrictor muscle
Glossopharyngeal nerve (IX)
Mental branch of inferior alveolar artery
Ascending palatine artery Tonsillar artery
Inferior alveolar artery and lingual branch
Facial artery
Facial artery Submental artery Mylohyoid branch of inferior alveolar artery Submandibular gland Hypoglossal nerve (XII) Suprahyoid artery External carotid artery Superior laryngeal artery Superior thyroid artery Cricothyroid artery Common carotid artery Vertebral artery Subclavian artery
Pharynx
Lingual artery Ascending pharyngeal artery Internal carotid artery Vagus nerve (X) Superior cervical cardiac nerve Sympathetic trunk Anterior scalene muscle Phrenic nerve Middle scalene muscle Ascending cervical artery Inferior thyroid artery Superficial cervical artery Suprascapular artery Costocervical trunk Thyrocervical trunk
Plate 69
mm
Veins of Oral and Pharyngeal Regions ........ -•....,,.....,..,.........• See also
••.: x;•• ;
'..,.".:/ ""."":
.... . .. ....... .. ...---• -
:;;;..; :.
r"::
" • • :.'•'.:;/:v.::v;".;' 'r:::;
Plates 23, 31, 104
Supratrochlear vein Supraorbital vein Nasofrontal vein Superior ophthalmic vein Angular vein External nasal vein Emissary vein (of Vesalius) communicating with cavernous sinus Infraorbital vein
Occipital vein and artery
Posterior superior alveolar veins
Superficial temporal vein and artery
Palatine vein Pterygoid plexus
Transverse facial vein (cut)
Superior labial vein
Posterior auricular vein Retromandibular vein (anterior and posterior branches)
Deep facial vein Maxillary veins
External jugular vein (cut)
Inferior labial vein
Inferior alveolar vein and artery
Mental vein Facial vein and artery
Occipital vein and artery
External palatine vein
Hypoglossal nerve (XII)
Submental vein Submandibular gland Vena co mi tans of hypoglossal nerve Dorsal lingual vein coursing medial to hyoglossus muscle Lingual vein Communication to anterior jugular vein (cut) Superior laryngeal vein Superior thyroid vein Thyroid gland Middle thyroid vein Inferior thyroid veins Termination of anterior jugular vein (cut) Left brachiocephalic vein
POat®
7©
Common trunk receiving facial, anterior branch of r e t r o m a n d i b u I a r, a n d lingual veins (common facial vein) External carotid artery Internal jugular vein Common carotid arteryVagus nerve (X) and sympathetic trunk Middle scalene muscle Anterior scalene muscle External jugular vein (cut) Transverse cervical vein (cut) Suprascapular vein (cut) Subclavian artery Subclavian vein
Pharynx
Nerves of Oral and Pharyngeal Regions mammm
See also
Plates 25, 45, 46, 122, 125, 126
Zygomaticotemporal nerve (V 2 > Deep temporal nerves (V 3 ) Masseteric nerve (V 3 )
mmm
'i
Mandibular nerve (V 3 ) Nerve to medial pterygoid and tensor veli palatini muscles (V 3 ) (cut) Zygomaticofacial nerve (V 2 ) M M
Maxillary nerve (V 2 )
-'fflmmOt-t
Infraorbital nerve (V 2 ) P t e r y g o p a latinegangl i o 1i Greater and lesser palatine nerves (V 2 )
Auriculotemporal nerve (V 3 )
Anterior, middle, and posterior ^ superior alveolar nerves (V 2 ) Nerve to lateral pterygoid muscle (V 3 ) (cut)
Middle meningeal artery Superficial temporal artery (cut)
Buccal nerve (V:$)
Facial nerve (VII) (cut)
Chorda tympani nerve (VII)
Maxillary artery
Lingual nerve (V 3 )
Accessory nerve (XI) (cut)
Medial pterygoid muscle (cut) (lateral pterygoid removed)
C I spinal nerve (ventral ramus) (cut)
C2 spinal nerve (ventral ramus) (cut)
Inferior alveolar nerve (V 3 ) Mental nerve ( V 3 ) ^ \ , Nerve to mylohyoid (V 3 ) Submandibular ganglion Glossopharyngeal nerve (IX) and tonsillar branch Hypoglossal nerve (XII) Carotid nerve (IX) and carotid body Nerve to thyrohyoid muscle (CI, 2 via XII) Internal and external branches of superior laryngeal nerve (X). - i^ nx ( Superior root Ansa cervicalis (CI,2, 3) ) ' Inferior root Nerves to superior and inferior bellies of omohyoid, sternohyoid, and sternothyroid muscles (ansa cervicalis) Recurrent laryngeal nerve (X)
Pharyngeal plexus composed of branches from glossopharyngeal (IX), vagus (X), and sympathetic nerves Internal carotid artery External carotid artery Vagus nerve (X) and superior cervical cardiac branch C4 spinal nerve (ventral ramus) (cut) Phrenic nerve (C3, 4, 5) •Ascending cervical artery Middle scalene muscle -Anterior scalene muscle Brachial plexus (cut)
Sympathetic trunk and middle cervical ganglion Common carotid artery
Thyrocervical trunk
Vertebral artery f>-— Subclavian artery )
Plate 71
Lymph Vessels and Nodes of Head and Neck jJJjjiJfj vi/jy./lv
BwnagR See also
krhssk
Plate 208
Superficial parotid nodes (deep parotid nodes deep to and within parotic! gland) mm
Subparotid node Facial nodes Nasolabial Buccinator
Occipital nodes Mastoid nodes
Mandibular nodes
Sternocleidomastoid nodes
Submandibular nodes
Superior lateral superficial cervical (external jugular) node Jugulodigastric node
Submental nodes Suprahyoid node Superior deep lateral cervical (internal jugular) nodes Superior thyroid nodes Juguloomohyoid node Anterior deep cervical (pretracheal and thyroid) nodes (deep to infrahyoid muscles) Anterior superficial cervical nodes (anterior jugular nodes)
Posterior lateral superficial cervical (spinal accessory) nodes
Intercalated node Inferior deep lateral cervical (scalene) node Thoracic duct Transverse cervical chain of nodes
Jugular trunk S upraclavi cuI ar nodes" Subclavian trunk and node
*The supraclavicular group of nodes (also known as the lower deep cervical group), especially on the left, are also sometimes referred to as the signal or sentinel lymph nodes of Virchow or Troisier, especially when sufficiently enlarged and palpable. These nodes (or a single node) are so termed because they may be the first recognized presumptive evidence of malignant disease in the viscera.
Plate 72
Pharynx
Lymph Vessels and Nodes of Pharynx and Tongue •
Rectus capitis anterior muscle (cut) •
. - * ••
;.v.
M. \
ft'*
•
Pharyngobasilar fascia
-..A
Retropharyngeal nodes
\ V
Internal jugular vein
^
Digastric muscle (posterior belly) Sternocleidomastoid muscle Intercalated node Jugulodigastric node
Deep lateral cervical (internal jugular) nodes Juguloomohyoid node
Apical collecting vessels Central collecting vessels Marginal collecting vessels Basal collecting vessels Communication to opposite side
Lymphatic drainage of pharynx: posterior view
Lymphatic drainage of tongue
Submental node Submandibular node Jugulodigastric node Deep lateral cervical (internal jugular) nodes Juguloomohyoid node
Pharynx
Plate 73
H
H
Thyroid Gland: Anterior View
Hyoicl bone
External carotid artery
Superior laryngeal nerve Internal branch External branch
Internal carotid Superior thyroid artery and vein Superior laryngeal artery
Thyroid cartilage (lamina) Median cricothyroid ligament
Thyrohyoid membrane Ansa S Superior root cervicalis ( Inferior root
Cricothyroid muscles Cricoid cartilage
Common carotid artery
Pyramidal lobe (often absent or small) Right lobe Left lobe Isthmus
Internal jugular vein Middle thyroid vein Inferior thyroid veins Ascending cervical artery
\ / ( / \ /
Thyroid gland
Pretracheal lymph nodes
Inferior thyroid artery-
Phrenic nerve
Superficial cervical artery
Anterior scalene muscle
Suprascapular a r t e r y —
Vagus nerve (X)
Thyrocervical trunk
External jugular vein
Subclavian artervi and vein
Anterior jugular vein 1 st rib {cut)
Vagus nerve (X)
Left recurrent laryngeal nerve
Right recurrent laryngeal nerve B rach i oce p h a I i c I r u n k Brachiocephalic veins Superior vena cava Aortic arch
Thyroid cartilage Cricothyroid ligament Common carotid artery Medial margin of sternocleidomastoid muscle Cricothyroid muscle Cricoid cartilage Thyroid gland Cupula (dome) of pleura Trachea
Plate 74
Thyroid Gland and Larynx
Thyroid Gland and Pharynx: Posterior View
Superior pharyngeal constrictor muscle Middle pharyngeal constrictor muscle
External carotid artery Internal carotid artery Facial artery
Tip of greater horn of hyoid bone
Lingual artery
Inferior pharyngeal constrictor muscle
Superior laryngeal nerve Internal branch External branch
Pharyngeal raphe Zone of sparse muscle fibers
Superior thyroid artery Superior laryngeal artery
Cricopharyngeus muscle (part of inferior pharyngeal constrictor)
C o m m o n carotid artery
Circular esophageal muscle in V-shaped area of sparse longitudinal muscle fibers (area of Laimer)
Internal jugular vein
Longitudinal esophageal muscle Inferior thyroid vein Trachea Inferior bulb of internal jugular vein Vertebral artery
Vagus nerve (X)
Thyroid gland (right lobe) Superior parathyroid gland Ascending cervical artery Inferior parathyroid gland Inferior thyroid artery Right recurrent laryngeal nerve Superficial cervical artery Suprascapular artery
Left subclavian artery and vein
Thyrocervical trunk Right subclavian artery and vein
Internal thoracic artery and vein Left brachiocephalic vein Left recurrent laryngeal nerve Arch of aorta Left vagus nerve (X)
Thyroid Gland and Larynx
Right brachiocephalic vein Brachiocephalic trunk Right vagus o nerve (X) Superior vena cava
Plate 75
Parathyroid Glands See also
Plate 80
Posterior view
Thyrohyoid membrane
External carotid artery
/ H y o i d bonev
Internal carotid artery
Superior laryngeal nerve Internal branch Externa) branch
Superior thyroid artery Superior laryngeal artery
Vagus nerve (X)
Inferior pharyngeal constrictor muscle (cut)
Epiglottis
Common carotid artery Superior thyroid artery
Fibrous capsule of (cut)
Common carotid artery Fibrous capsule of thyroid gland (cut) Superior parathyroid gland Left lobe of thyroid gland Ascending cervical artery Inferior parathyroid gland Left recurrent laryngeal nerve
Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Superior parathyroid gland Right lobe of thyroid gland Inferior parathyroid gland (may be more caudally located, even within mediastinum) Inferior thyroid artery Right recurrent laryngeal nerve Superficial cervical artery •r-
Suprascapular artery
Esophagus
Thyrocervical trunk
Subclavian artery
Vertebral artery Subclavian artery
Trachea
Brachiocephalic trunk
Right lateral view External carotid Superior laryngeal artery Superior thyroid artery Inferior pharyngeal constrictor muscle Common carotid arte Internal jugular vein Inferior thyroid artery Right recurrent laryngeal nerve Esophagus
Plate 76
Internal branch of superior laryngeal nerve External branch of superior laryngeal nerve Superior parathyroid gland Thyroid gland (right lobe) (retracted
anteriorly)
Inferior parathyroid gland
Cartilages of Larynx
-Epiglottis—
_
Hyoid :
ff| ^^^-Thyrohyoid membrane-^^ Superior horn of thyroid cartilage Corniculate c a r t i l a g e - ^ ^
y| |
t i
Arytenoid cartilage Superior thyroid notch
—-Thyroid cartilage lamina——_
Vocal ligament-
Median cricothyroid ligament
J ^ ^ - I n f e r i o r -Cricoid horn of thyroid cartilagecartilageTrachea^—_ KV-V >>••«..A
,,
Anterior view
Cricoid cartilage
Posterior view Corniculate cartilage
Arytenoid articular surface
Muscular process Vocal process
Lamina
Arytenoid cartilage
Anterosuperior view ___——Epiglottis Hyoepiglottic ligament-—
b
Hyoid bone
-Thyrohyoid membrane-Thyroid cartilage lamina ^ ^
Oblique line
--Laryngeal prominence Corniculate cartilage —
• I
Arytenoid cartilage-— Muscular p r o c e s s — Median Lateral
Vocal processVocal ligament-"""""^ Thyroepiglottic ligament — Cricothyroid ligament" ^ • C r i c o i d cartilage— ^ " C r i c o t h y r o i d joint
Right lateral view
Thyroid Gland and Larynx
^ ^ ^ ^ T r a ch e a
^ ^ ^
Medial view, median (sagittal) section
Plate 77
Intrinsic Muscles of Larynx vw&mSBS :'•
mm mexmrnm
Epiglottis
Foramen for superior laryngeal vessels and internal branch of superior laryngeal nerve
Aryepiglottic Cuneiform tubercle
Oblique and transverse arytenoid muscles
Corniculate tubercle Aryepiglottic muscle
Posterior cricoarytenoid muscle
Oblique arytenoid muscle Transverse arytenoid muscle
Straight ] part ( Oblique ( part )
Posterior cricoarytenoid muscle
Cricothyroid muscle
Cricoid cartilage
Right lateral view
Posterior view Epiglottis Aryepiglottic muscle muscle Oblique and transverse arytenoid m Posterior cricoarytenoid muscle Thyroid articular surface
piglottic
Arytenoid I Muscular cartilage, ) V o c a l
Thyroarytenoid muscle
Lamina of cricoid cartila
Lateral cricoarytenoid muscle Conus elasticus
Cricothyroid muscle (cutaway)
Lateral dissection Posterior cricoarytenoid muscle Lateral cricoarytenoid muscle Transverse and oblique arytenoid m Cricothyroid muscle
Conus elasticus
Thyroarytenoid muscle Vocalis muscle
Lamina of thyroid cartilage
Vocal ligament
Superior view
Plate 78
Thyroid Gland and Larynx
Cricothyroid joint (pivot point)
Action of cricothyroid muscles Lengthening (increasing tension) of vocal ligaments
Action of posterior cricoarytenoid muscles
Action of lateral cricoarytenoid muscles
Abduction of vocal ligaments
Adduction of vocal ligaments
Action of transverse and oblique arytenoid muscles Adduction of vocal ligaments
Thyroid Gland and Larynx
Action of vocalis and thyroarytenoid muscles Shortening (relaxation) of vocal ligaments
Plate 79
See also
Plates 74-76, 235
Superior laryngeal nerve
Internal branch of superior laryngeal nerve Sensory branches to larynx
Internal branch External branch
of Galen Aryepiglottic muscle Thyroepiglottic muscle
Inferior pharyngeal constrictor muscle
Transverse and oblique arytenoid muscles Thyroarytenoid muscle Vocalis muscle
Cricothyroid muscle Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Right recurrent laryngeal nerve
Lateral cricoarytenoid muscle Posterior cricoarytenoid muscle d articular surface nterior and posterior branches of inferior laryngeal nerve Right recurrent laryngeal nerve
Right lateral view: thyroid cartilage lamina removed Right lateral view
Left vagus nerve (X) Right vagus nerve (X)
r
>f
Left common carotid artery Anomalous right inferior laryngeal nerve (not recurrent)
Left inferior laryngeal nerve
Left recurrent laryngeal nerve Anomalous (retroesophageal) right subclavian artery Left subclavian artery Right common carotid artery
malous (retroesophageal) right subclavian artery originating from left side of aortic arch
Arch of aorta Left recurrent laryngeal nerve
Anterior view: anomalous right inferior laryngeal nerve, not recurrent, associated w i t h anomalous right subclavian artery
Plate 80
Superior palpebral conjunctiva: tarsal (meibomian) glands shining through Seen through \ cornea
Superior lacrimal papilla and punctum Plica semilunaris
Pupil
Lacrimal caruncle in lacrimal lake (lacus lacrimalis)
Corneoscleral junction (corneal limbus)
Inferior lacrimal papilla and punctum
Bulbar conjunctiva over sclera Inferior conjunctival fornix Inferior palpebral conjunctiva: tarsal glands shining throu^,.
Levator palpebrae superioris muscle Orbital septum Sclera
Superior tarsal (Muller's) muscle (smooth)
Bulbar conjunctiva
Superior conjunctival fornix Orbicularis oculi muscle (palpebral part)
Palpebral conjunctiva
Superior tarsus
Cornea
Tarsal (meibomian) glands
Lens
Sebaceous glands
Anterior chamber
Eyelashes (cilia)
Iris
Openings of tarsal gla
Posterior chamber
Inferior tarsus Orbicularis oculi muscle (palpebral part) Inferior conjunctival fornix Orbital septum
Frontal bone Insertion of levator palpebrae superioris muscle Orbital septum Superior tarsus Lateral palpebral ligament and overlying raphe Inferior tarsus Orbital septum Zygomatic bone
Orbit and Contents
Supraorbital artery and nerve Supratrochlear artery and nerve Dorsal nasal artery and infratrochlear nerve Lacrimal sac Medial palpebral ligament Maxilla (frontal process) Infraorbital artery and nerve
Plate 81
.Mh
R •BrasB i i i '
pilf lir
ftftit gSRSfS^Jy
Lacrimal Apparatus ^iSKfBMSfiBRRW-' ^^CyMfrfry'^^^
See also
vft^oi'xiwSwc^JiWy.v^ji atiK^'wNwKvi.*!!KJ5 .', •
IM-Wei
Plates 45, 133
Superior lacrimal papilla and punctum Orbital part of lacrimal gland
Palpebral part of lacrimal gland
Excretory ducts of lacrimal gland
Plica semilu
Lacrimal canaliculi
Lacrimal sac
Nasolacrimal duct
Opening of nasolacrimal duct
Lacrimal caruncle
Inferior lacrimal papilla and punctu
Superior lacrimal papilla and punctum Frontal bone (cut
Orbital part of lacrimal gland
Lacrimal canaliculi
Lacrimal sac Palpebral part of lacrimal gland Nasolacrimal duct Excretory ducts of lacrimal gland
Plica semilunaris and lacrimal lake
Middle nasal concha
Nasal cavity Lacrimal caruncle
Inferior lacrimal papilla and punctum
Opening of nasolacrimal duct
Plate 82
Inferior nasal concha (cut)
Inferior nasal meatus
Horizontal section
Tarsus of eyelid I conjunctiva
Medial palpebral ligament
Bulbar conjunctiva
Nasal cavity
Cornea
Check ligament of medial rectus muscle
Lateral palpebral ligament
Ethmoidal cells
Check ligament of lateral rectus muscle Periorbita
Periorbita
Sclera
Medial rectus muscle and fascial sheath
Fascial sheath of eyeball (Tenon's capsule)
Fascial sheath of eyeba I (Tenon's capsule)
Episcleral space Lateral rectus muscle and fascial sheath
Sclera Episcleral space
Retrobulbar fat (orbital fat body)
O p t i c nerve (II) and outer sheath'
C o m m o n tendinous ring
Sphenoidal sinus Levator palpebrae superioris muscle and fascial sheath
Frontal section
Superior o b l i q u e muscle and fascial sheath Medial rectus muscle and fascial sheath
Superior rectus muscle and fascial sheath
Periorbita
Lacrimal gland
Ethmoidal cell
Lateral rectus muscle and fascial shealh
Sclera Fascial sheath of eyeball (Tenon's capsule)
Periorbita Scl
Inferior rectus muscle and fascial sheath
Fascial sheath of eyeba (Tenon's capsule)
Inferior oblique muscle and fascial sheath
Episcleral space Retrobulbar fat (orbital fat body)
Infraorbital nerve (V 2 )
Muscle attachments and nerves and vessels entering o r b i t Superior orbital f
i
s
s
u
r
e
L
e
v
Lacrimal nerve
r
palpebrae superioris muscle
Medial rectus muscle nerve
-^^^ffi
Superior branch of o c u l o m o t o r nerve ( I I I ) ^ ^
j
Inferior orbital f i s s u r e ^ ^ / Abducent nerve (VI)
Orbit and Contents
o
Superior rectus muscle
Trochlear nerve ( I V ) ^ ^ ^ ^
Lateral rectus muscle
t
— - S u p e r i o r oblique muscle
Frontal nerve ( V , ) Superior ophthalmic vein
a
(ll)
artery
\
\ \
in optic canal
^ - I n f e r i o r rectus muscle ^ I n f e r i o r branch of o c u l o m o t o r nerve (III)
Nasociliary nerve (Vj)
Plate 83
Right lateral view
Superior oblique muscle Levator palpebrae superioris muscle Superior rectus muscle Medial rectus muscle
Optic nerve (II) Lateral rectus muscle (cut)
C o m m o n tendinous ring
Lateral rectus muscle (cut)
Inferior oblique muscle
Inferior rectus muscle
Superior tarsus
Superior view Levator palpebrae superioris muscle (cut) Superior oblique muscle Medial rectus muscle
Superior rectus muscle (cut) Lateral rectus muscle
„
*
Optic nerve (II) Common tendinous ring
Superior rectus muscle (cut) Levator palpebrae superioris muscle (cut)
Innervation of extrinsic eye muscles: anterior view
Superior oblique muscle
Trochlear nerve (IV)
Lateral rectus muscle
Abducent nerve (VI)
Levator palpebrae superioris muscle Oculomotor nerve (III)
Superior rectus muscle Medial rectus muscle Inferior rectus muscle Inferior oblique muscle
Plate 84
Orbit and Contents
liilpfil: mMmrn
See also
Plates 23,104
Medial palpebral artery
Superior view
Lateral palpebral artery
Supratrochlear artery
Lacrimal gland
Dorsal nasal artery
Supraorbital artery Anterior meningeal artery
Zygomatic branches
Anterior ethmoidal artery
Posterior ciliarv arteries
Posterior ethmoidal artery
Muscular branch
Continuation of ophthalmic artery-
Lacrimal artery
Muscular branch
Central retinal artery
Ophthalmic artery Internal carotid artery
Supraorbital artery Supratrochlear artery Dorsal nasal artery
Anterior view
Superior medial palpebral artery
Frontal branch of superficial temporal artery
Angular artery Inferior medial palpebral artery
Superior lateral palpebral arteryInferior lateral palpebral artery
Superior and inferior palpebral arterial arches
Zygomaticofacial artery
Facial artery
Transverse facial arterv Infraorbital artery
(X = anastomosis of vessels from external and internal carotid arteries)
Supratrochlear vein
Lateral view
Supraorbital vein Superior ophthalmic vein
Cavernous sinus
Nasofrontal vein Angular vein Vorticose veins Facial vein
Inferior ophthalmic vein-—' Pterygoid plexus Maxillary vein-—. Retromandibular vein
Orbit and Contents
Deep facial vein
Plate 85
Nerves of Orbit See also
Plates 45, 121, 132
Superior view Supratrochlear nerve Medial rectus muscle
Medial branch ) Supraorbital nerve Lateral branch ) Levator palpebrae superioris muscle Superior rectus muscle Lacrimal gland
Superior oblique muscle
Lacrimal nerve
Infratrochlear nerve
Lateral rectus muscle
Nasociliary nerve
Frontal nerve
Trochlear nerve (IV)
Maxillary nerve (V 2 )
Common tendinous ring
Meningeal branch of maxillary nerve
Ophthalmic nerve (V-j)
Mandibular nerve (V 3 )
Optic nerve (II)
Lesser petrosal nerve
Internal carotid artery and nerve plexus
Meningeal branch of mandibular nerve
Oculomotor nerve (III) Trochlear nerve (IV) Abducent nerve (VI) Tentorium cerebelli
Superior view: levator palpebrae superioris, superior rectus, and superior oblique muscles partially cut away Supratrochlear nerve (cut) Supraorbital nerve branchesfcuO Infratrochlear nerve Anterior ethmoidal nerve Optic nerve (II) Posterior ethmoidal nerve Superior branch of oculomotor nerve (III) Nasociliary nerve Internal carotid plexus Trochlear nerve (IV) {cut) Oculomotor nerve (III) Abducent nerve (VI)
Plate 86
Greater petrosal nerve Trigeminal (semilunar) ganglion Tentorial (meningeal) branch of ophthalmic nerve
Long ciliary nerves Short ciliary nerves Lacrimal nerve Ciliary ganglion Parasympathetic root of ciliary ganglion (from inferior branch of oculomotor nerve) Sympathetic root of ciliary ganglion (from internal carotid plexus) Sensory root of ciliary ganglion (from nasociliary nerve) Branches to inferior and medial rectus muscles Abducent nerve (VI) Inferior branch of oculomotor nerve (III) Lacrimal nerve Frontal nerve (cut) Ophthalmic nerve (V,)
Orbit and Contents
Eyeball
Horizontal section
Cornea
Zonular fibers (suspensory ligament of lens)
Capsule of lens
Anterior chamber Posterior chamber
Scleral venous sinus (canal of Schlemm)
Iridocorneal angle
Scleral spur
Ciliary processes
Ciliary body and ciliary muscle
Bulbar conjunctiva
Ciliary part of retina
Ora serrata
Tendon of lateral rectus muscle
Tendon of medial rectus muscle ::
•fflmm. V
mm
SfflH -Si.'/'Mi/W:
mrnmmmi
M
M
Optic (visual) part of retina \ itreous body
Choroid
•Hyaloid canal
Perichoroidal space Sclera
•Lamina cribrosa of sclera
Fascial sheath of eyeball (Tenon's capsule)
Optic nerve (II)
Episcleral space Fovea centralis in macula (lutea)
Central retinal artery and vein
Outer sheath of optic nerve Subarachnoid space
Orbit and Contents
Plate 87
Schwalbe's line Trabecular meshwork and spaces of iridocorneal angle (of Fontana)
Posterior limiting lamina (Descemet's membrane) Endothelium of anterior chamber
Scleral venous sinus (canal of Schlemm)
Cornea
Scleral spur Iridocorneal angle Pectinate ligament Major arterial circle of i r i s — \
\
\
Anterior chamber
onjunctiva Sclera \
Minor arterial circle of iris
Posterior chamber
Ciliary process Ciliary part of retina
Meridional fibers
Circular fibers
Dilator pupillae muscle Zonular fibers (suspensory ligament of lens)
Pigment epithelium (iridial part of retina)
Nucleus of
Sphincter pupillae muscle
Note: For clarity, only single plane of zonular fibers shown; actually, fibers surround entire circumference of lens.
Plate 88
Orbit and Contents
Lens and Supporting Structures
Sclera Choroid Optic part of retina Ora serrata Orbiculus ciliaris of ciliary body covered by ciliary part of retina
Nucleus Capsule Cortex
Ciliary processes Zonular fibers Anterior chamber
Lens
Iris Posterior chamber Ciliary body
Eyeball sectioned in frontal plane: anterior segment viewed f r o m behind
Ciliary
Preequatorial Zonular fibers <( Equatorial Postequatorial Orbiculus ciliaris of ciliary body Ora serrata
Horizontal section
Optic part of retina Ora serrata Optic part of retina
i
Orbiculus ciliaris of ciliary body covered by ciliary part of retina
Zonular fibers fanning out and blending into lens capsule Zonular fibers
xm
Enlargement of segment outlined in top illustration (semischematic)
Orbit and Contents
Plate 89
of Eye
Cornea
Minor arterial circle of iris
Anterior chamber
Major arterial circle of iris
Scleral venous sinus (canal of Schlemm)
Blood vessels of ciliary body Bulbar conjunctiva and conjunctival vessels Anterior ciliary artery and vein
Iridocorneal angle Posterior cham
Muscular artery and vein
Zonular fibers
Extrinsic eye muscle
Retina Vitreous chamber
Long posterior ciliary artery Choroid
Sclera Vorticose vein Episcleral artery and vein f
Retinal artery and vein
Long posterior ciliary artery Short posterior ciliary arteries Central retinal artery and vein
Optic nerve (II)
Superior temporal retinal arteriole and venule
Superior macular arteriole and venule Superior nasal retinal arteriole and venule
Macula Fovea centralis
Inferior temporal retinal arteriole and venule
Right retinal vessels: ophthalmoscopic view
Plate 90
Inferior nasal retinal arteriole and venule Inferior macular arteriole and venule
Orbit and Contents
Vascular arrangements within the choroid (vascular tunic) of the eyeball Anterior ciliary arteries
Anterior tributaries of a vorticose vein
Tendon of superior rectus muscle
Episcleral vein* Junctions of suprachoroidal tributaries forming vorticose vein
Sclera
Superior ophthalmic vein
Posterior conjunctival artery and vein
Bulb of vorticose (choroid) vein Vorticose (choroid) vein
Anterior ciliary veins
Long posterior ciliary artery Major arterial circle of iris Short posterior ciliary arteries
Minor arterial circle of iris
External sheath of tic nerve (dura mater)
Conjunctiva and cornea
Internal sheath of optic nerve (pia-arachnoid mater)
Short posterior ciliary arteries
Central retinal artery and vein
Arteries and veins of iris Scleral venous sinus (canal of Schlemm)
Vessels of internal sheath of optic nerve
Veins draining scleral venous sinus (into anterior ciliary veins)
Short posterior ciliary arteries
Anterior ciliary veins Nonpigmented and pigmented regions of the retina Recurrent branch of anterior ciliary artery
Segment of episcleral vein* Muscular artery
Inferior ophthalmic vein Posterior tributaries of a vorticose vein
*The episcleral veins are shown here anastomosing with the vorticose veins, which they do; however they also drain into the anterior ciliary veins.
Orbit and Contents
/
Plate 91
Pathway of Sound Reception
Frontal section
Facial nerve (VII) (cut) Limbs of stapes
Prominence of lateral semicircular canal Incus Tegmen tympani
Base of stapes in oval (vestibular) w i n d o w Vestibule Semicircular ducts, ampullae, utricle, and saccule Facial nerve (VII) (cut)
Malleus (head)
Vestibular nerve
Epitympanic recess
Cochlear nerve
i
Auricle
Internal acoustic meatus Vestibulocochlear nerve (VIII)
/
External
Helicotrema
acoustic meatus
Nasopharynx
Scala vestibuii
Tympanic membrane Tympanic cavity Promontory Round (cochlear) w i n d o w
Cochlear duct containing spiral organ (of Corti)
Cochlea
Scala tympani
Auditory (pharyngotympanic, Eustachian) tube Note: Arrows indicate course of sound waves.
Plate 92
External Ear and Tympanic Cavity
Right auricle (pinna) Triangular fossa
Otoscopic view of right tympanic membrane Crux of helix External acoustic meatus
Helix Scaphoid fossa
Pars flaccida tiaccida
Lateral process of malleus
Posterior mallear fold Anterior mallear fold
Crura of antihelix
Long limb of incus
Auricular tubercle (of Darwin) Antihelix
Handle of malleus
Tragus
Concha of auricle
Umbo
Intertragic notch Antitragus
Lobule of auricle
Cone of light
Tympanic Pars tensa
Coronal oblique section of external acoustic meatus and middle ear (tympanic cavity) Epitympanic recess Superior ligament of malleus
Tegmen tympani Dura mater Head of malleus Long limb of incus
Short limb of incus
Tendon of stapedius muscle Footplate of stapes Handle of malleus
Chorda tympani nerve (cut)
Promontory with tympanic plexus
Anterior ligment of malleus {cut)
tympani muscle
Tympanic membrane Tensor veli palatini muscle
External acoustic meatus
Auditory (pharyngotympanic, Eustachian) tube Right tympanic cavity after removal of tympanic membrane (lateral view) Chorda tympani nerve ^ Long limb of incus
Lateral
Proce5S of malleus Tendon of tensor tympani muscle Ossicles articulated: medial view
Prominence of facial canal
Pyramidal eminence and tendon of stapedius muscle Stapes Fossa of round w i n d o w Tympanic nerve
Ear
Malleus
Handle of malleus Tympanic
Incus
Lenticular process of incus Stapes
CMc^ML * —
Lesser petrosal nerve Tympanic plexus on promontory
Plate 93
Tympanic Cavity See also
Plates 46, 123, 124, 135
Lateral w a l l o f t y m p a n i c c a v i t y : m e d i a l ( i n t e r n a l ) v i e w Superior ligament of malleus
Head of malleus
Superior ligament of incus
Epilympanic recess
Short limb of incus
Anterior process of malle
Posterior mallear fold
Chorda tympani
Posterior ligament of incus
Anterior mallear fold
Long limb of incus
Tensor tympani muscle
Chorda tympani nerve
Handle of malleus
Lenticular process of incus
Tympanic membrane (pars tensa)
Facial nerve (VII)
Auditory (p h a r y n g o ty m p a n i c, Eustachian) tube Internal carotid artery
M e d i a l wall of t y m p a n i c cavity: lateral view
Prominence of lateral semicircular canal V
"""
Prominence of facial canal
Mastoid antrum
Geniculum (geniculate ganglion) of facial nerve Base of stapes in fossa of oval (vestibular) window
Greater petrosal nerve Tensor tympani muscle (tendon
Limbs of stapes Pyramidal eminence
cut)
Auditory (pharyngotympanic, Eustachian) tube
Chorda tympani nerve (cut)
Levator veli palatini m uscle
Mastoid cells Tendon of stapedius muscle
Promontory with tympanic nerve (of Jacobson) and plexus under mucosa
Fossa of round (cochlear) w i n d o w
Internal carotid artery Facial nerve (VII) in stylomastoid foramen
Plate 94
Tympanic, cells
Ear
Bony and Membranous Labyrinths See also
Right bony labyrinth (otic capsule), anterolateral view: surrounding cancellous bone removed Posterior Lateral Anterior ^
Plate 124
Dissected right bony labyrinth (otic capsule): membranous labyrinth removed D
Semicircular canals
osterior Lateral Anterior
Semicircular canals
Elliptical recess
mmon bony limb
Cochlear recess
mpullae
Spherical recess
Vestibule Cochlea
Vestibule (note perforations for nerve fibers) H el i cot re ma
Hamulus of spiral lamina Oval (vestibula window
Internal opening of vestibular aqueduct (for endolymphatic duct)
Cochlear cupula
Round (cochlear) window
Scala vestibuli Osseous spira lamina
Round (cochlear) window
Scala tympani
Right membranous labyrinth w i t h nerves: posteromedial view Anterior semicircular duct Superior part of vestibular nerve (from utricle and anterior and lateral membranous ampullae)
Anterior membranous ampulla
Utricle
Lateral membranous ampulla
Cochlear duct (basal turn)
Common membranous limb
Coc hlear nerve
Lateral semicircular duct Posterior semicircular duct
Vestibulocochlear nerve (VIII) Vestibular nerve
Posterior membranous ampulla
Vestibular ganglion Inferior part of vestibular nerve (from saccule and posterior membranous ampulla)
Ear
Endolymphatic duct
Plate 95
Bony and Membranous Labyrinths (continued)
Bony and membranous labyrinths: schema Anterior semicircular canal and duct Dura mater
Posterior semicircular canal and cluct
|-r
Common bony and membranous limbs Lateral semicircular canal and duct
§mm mmm mmm
Endolymphatic sac Endolymphatic duct in vestibular aqueduct Utricle Saccule
Otic capsule
Helicotrema of cochlea
Stapes in oval (vestibular) window
Ductus reuniens
Incus
Scala vestibuli
Malleus
Cochlear duct
Tympanic cavity
— Scala tympani
External acoustic meatus Umbo . . .
' ' • : . ' .
Tympanic membrane Round (cochlear) window (closed by secondary tympanic membrane)
Vestibule
Otic capsule
Pharyngotympanic (auditory) tube
Section through turn of cochlea Scala vestibuli Osseous spiral lamina
Nerve fibers
Vestibular (Reissner's) membrane Cochlear duct Spiral ligament Tectorial membrane Spiral organ (of Corti)
Spiral ganglion
Scala tympani
Basilar membrane Osseous cochlea Outer hair cells
Cochlear nerve
Pillar (rod) cells Inner hair cell
Plate 96
Orientation of Labyrinth in Skull HBHWMBBHHMBB^SS
Superior projection of right bony labyrinth on floor of skull
Groove for greater petrosal nerve Geniculum (geniculate ganglion) of facial nerve
Cochlea /
Cochlear nerve
z Plane of anterior semicircular canal
Facial nerve (VII) Internal acoustic opening Vestibulocochlear nerve (VIII)
Lateral semicircular canal
Vestibular nerve Petrous part of temporal bone External opening of vestibular aqueduct (for endolymphatic cluct)
Plane of posterior semicircular canal
Lateral projection of right membranous labyrinth Cochlear duct
Geniculum (geniculate ganglion) of facial nerve
Cochlear nerve Trigeminal nerve (V)
uperior part of vestibular nerve
Vestibulocochlear nerve (VIII)
Internal jugular vein Inferior part of vestibular nerve
Anterior semicircular cluct
Lateral semicircular cluct Cerebellum Posterior semicircular duct Superior petrosal sinus Sigmoid sinus Confluence of sinuses Transverse sinus
Ear
Plate 97
Auditory (Pharyngotympanic, Eustachian) Tube See also
Plates 5 2 , 5 5 , 6 5
Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube at base of skull: inferior view Palatine process of maxilla Pterygoid hamulus and medial pterygoid plate
Horizontal plate of palatine bone
Lateral pterygoid plate
Choana ) of cartilaginous part of Lateral lamina ( auditory (pharyngotympanic, Medial lamina) Eustachian) tube
Scaphoid fossa Foramen ovale
Foramen I ace rum
Foramen spinosum
— Petrous part of temporal bone
Spine of sphenoid bone
Occipital condyle
Internal carotid artery entering carotid canal Mastoid process
Foramen magnum
Section through cartilaginous part of auditory (pharyngotympanic, Eustachian) tube, with tube closed
Section through cartilaginous part of auditory (pharyngotympanic, Eustachian) tube, w i t h tube open Trigeminal ganglion
Trigeminal ganglion Internal carotid artery in carotid canal Dura mater Lateral lamina of cartilage
Internal carotid artery in carotid Dura mater Lateral lamina of cartilage Medial lamina of cartilage
Medial lamina of cartilage Auditory tube lumen Tensor veli palatini muscle Levator veli palatini muscle Salpingopharyngeus muscle
Auditory tube lumen Tensor veli palatini muscle Levator veli palatini muscle Salpingopharyngeus muscle
Nasopharynx Auditory (pharyngotympanic, Eustachian) tube closed by elastic recoil of cartilage, tissue turgidity, and tension of salpingopharyngeus muscles
Plate 98
Nasopharynx Lumen opened chiefly when attachment of tensor veli palatini muscle pulls wall of tube laterally during swallowing
Meninges and Diploic Veins See also
Coronal dissection
Diploic veins Superior sagittal sinus Emissary vein
Frontal and parietal tributaries of superficial temporal vein Frontal and parietal branches of superficial temporal artery Granular foveola (indentation of skull by arachnoid granulation)
Arachnoid granulation Cerebral vein (bridging vein) penetrates subdural space to enter sinus Dura mater (periosteal and meningeal layers) Dura-skull interface (site of epidural hematoma) Arachnoid Subarachnoid space Pia mater Middle meningeal artery and vein Deep, middle, and superficial temporal arteries and veins
Lateral (venous) lacuna Bridging vein Inferior sagittal sinus
Superior thalamostriate and choroidal veins, internal cerebral veins, and choroid plexus of lateral ventricle
Diploic and emissary veins of skull
Frontal diploic vein
Anterior temporal diploic vein
Plate 23
Deep and superficial middle cerebral veins
Parietal emissary vein Posterior temporal diploic vein Occipital emissary vein Occipital diploic vein Mastoid emissary vein
Meninges and Brain
Plate 99
See also
Plates 40,136
Frontal (anterior) and parietal (posterior) branches of middle meningeal artery Middle meningeal artery Anterior meningeal branch of anterior ethmoidal artery
Arachnoid granulations Opening of superior cerebral vein Lateral (venous) lacuna Superior sagittal sinus Dura mater
Mastoid branch of occipital artery
Meningeal branches of ascending pharyngeal artery Mastoid branch of occipital artery Middle meningeal artery Recurrent meningeal branch of lacrimal (ophthalmic) artery Accessory meningeal artery Anterior meningeal branch of anterior ethmoidal artery Posterior ethmoidal artery Internal carotid artery and its meningohypophyseal trunk* {phantom) Middle meningeal artery Accessory meningeal artery Superficial temporal artery Maxillary artery Posterior auricular artery Occipital artery
Anterior and posterior meningeal branches of vertebral artery tentorial, cavernous sinus, and meningeal branches of meningohypophyseal trunk*
^'Variant; most commonly, these branches arise directly from internal carotid artery.
Plate 100
Meninges and Brain
mm
Epidural Hematoma •WIBBHMMMIllllHIIMI^^ Temporal fossa hematoma Medial displacement of middle cerebral vessels
Shift of normal midline structures
Skull fracture crossing middle meningeal a.
Compression of posterior cerebral a. Shift of brainstem to opposite side may reverse lateralization of signs by tentorial pressure on contralateral pathways.
Herniation of temporal lobe under tentorium cerebelli
Compression of corticospinal and associated pathways, resulting in contralateral hemiparesis, deep tendon hyperreflexia, and Babinski's sign
Compression of oculomotor (III) n. leading to ipsilateral pupil dilatation and 3rd cranial n. muscle palsy
mm
''Question mark" skin incision (biack); outline of free bone flap and burr holes (red) Brain Dura
Skin flap reflected (Raney clips control bleeding). Free bone flap removed and dura opened. Clot evacuated by irrigation, suction, and forceps.
Burst
Section showing acute subdural hematoma on right side and subdural hematoma associated with temporal lobe intracerebral hematoma ("burst" temporal lobe) on left
Meninges and Brain
Plate 101
Meninges and Superficial Cerebral Veins For deep veins of brain see
Plate 145 Calvaria
Pericranium Galea aponeurotica Skin
Granular foveola
ior sagittal sinus Emissary vein Tributary of superficial temporal vein Diploic vein Dura-skull interface (site of epidural hematoma) Dura mater Arach noid-dura i nterface (site of subdural hematoma)
Bridging vein
Arachnoid Subarachnoid space Pia mater Cerebral artery Superior cerebral vein Falx cerebri Ce reb ra I h e m i s p here
Branches of middle meningeal artery Superior sagittal sinu
Superior cerebral veins (bridging veins) (penetrating arachnoid and dura mater to enter superior sagittal sinus)
Dura mater
Superior cerebral veins (beneath arachnoid)
Superior anastomotic vein (of Trolard)
Inferior anastomotic vein (of Labbe)
Superficial middle cerebral vein
Middle meningeal artery and veins
Plate 102
Inferior cerebral veins (beneath arachnoid)
Meninges and Brain
Bora! Venous Sinuses mmmssstSB^msms^msmemmsmSi
Superior sagittal sinus Straight sinus
Sagittal section
Great cerebral vein (of Galen) Tentorium cerebelli Superior sagittal sinus
Falx cerebri
Inferior sagittal sinus
Sphenoparietal sinus
Anterior and posterior intercavernous sinuses Superior petrosal sinus Basilar venous plexus
Inferior petrosal sinus To jugular foramen
Sigmoid sinus Transverse sinus Occipital sinus Falx cerebelli Confluence of sinuses
Meninges and Brain
Plate 103
Dural Venous Sinuses (continued) See also
Plate 85
Skull sectioned horizontally: superior view Superior sagittal sinus (cut) Falx cerebri (cut) Superior ophthalmic vein Anterior and posterior , /> intercavernous sinuses
-Hypophysis (pituitary gland) Optic nerve (II) Internal carotid artery Oculomotor nerve (III) Sphenoparietal sinus 'Trochlear nerve (IV) Ophthalmic nerve (V-j)
Superficial middle cerebral vein (cut)
Maxillary nerve (V 2 )
Cavernous sinus
-Trigeminal ganglion
Basilar venous plexus
Mandibular nerve (V 3 )
Superior petrosal sinus
Middle meningeal artery Abducent nerve (VI)
Inferior petrosal sinus
Petrosal vein
Tentorial artery
Facial nerve (VII), intermediate nerve, and vestibulocochlear nerve (VIII)
Tentorium cerebelli
Glossopharyngeal (IX) and vagus (X) nerves
Inferior cerebral vein
Jugular foramen
(cut)
Transverse sinus
Sigmoid sinus (continuation of transverse sinus)
Inferior sagittal sinus (cut)
Transverse sinus
Straight sinus
Accessory nerve (XI)
Falx cerebri (cut) Confluence of sinuses
Hypoglossal nerve (XII) Great cerebral vein (of Galen)
Superior sagittal sinus (cut)
Cavernous sin Oculomotor nerve (III)
Optic chiasm Posterior communicating artery
Trochlear nerve (IV) Abducent nerve (VI) Ophthalmic nerve (Vq Maxillary nerve (V 2
Internal carotid artery Hypophysis (pituitary gland) Sphenoidal sinus
Coronal section through cavernous sinus
Plate 104
Nasopharynx
Meninges and Brain
Cerebrum: Lateral Views
Central sulcus (of Rolando) Precentral gyrus
Postcentral sulcus
Precentral sulcus Superior frontal gyrus Superior frontal sulcus Inferior parietal lobule Supramarginal gyrus Angular gyrus
Middle frontal gyrus Inferior frontal sulcus Inferior frontal gyrus Opercular part Triangular part Orbital part
Parietooccipital sulcus
Frontal pole —
Occipital pole Calcarine sulcus Lunate sulcus (inconstant)
Lateral sulcus ( Anterior ramus (of Sylvius) ) Ascending ramus ( Posterior ramus Temporal pole
Transverse occipital sulcus Superior temporal gyrus
Preoccipital notch
Superior temporal sulcus
Inferior temporal gyrus
Middle temporal gyrus Inferior temporal sulcus Frontal lobe Parietal lobe
Temporal lobe Occipital lobe
Parietal operculum Frontal operculum Orbital operculum Insula (island of Reil)
Meninges and Brain
Short gyri Central sulcus Li men Long gyrus Circular sulcus
Temporal operculum
Cerebrum: Medial Views ......
. . ...
• -• • • ••.•
. . . . . . . . • . . ••-• •.
.• .-,•;:•: v . -
. •• :•:•• :•"..•: '/.
;
:
'
'
;
•: :
'
Plate 147
For hypophysis see
Sagittal section of brain in situ
Cingulate gyrus
, .
,
Cingulate sulcus Medial frontal gyrus
Paracentral sulcus Central sulcus (of Rolando) Paracentral lobule Marginal sulcus Corpus callosum Precu neus Superior sagittal sinus Choroid plexus of 3rd ventricle Stria medullaris of thalamus Parietooccipital sulcus Cuneus
Sulcus of corpus callosum Fornix Septum pellucidum Interventricular foramen (of Monro) Interthalamic / / *7 adhesion— Thalamus and 3rd ventricle Subcallosal (parolfactory) area
Habenular commissure Pineal body Posterior commissure
Anterior commissure Subcallosal gyrus
Calcarine sulcus Straight sinus in tentorium cerebelli
Hypothalamic sulcus Lamina terminals
/
Great cerebral vein (of Galen)
Supraoptic recess Optic chiasm Tuber cinereum Hypophysis (pituitary gland) Mammillary body Cerebral peduncle Pons
Medial surface of cerebral hemisphere: brainstem excised Cingulate gyrus Mamillothalamic fasciculus Mammillary body
Cerebral aqueduct (of Sylvius)
.
Superior colliculus Inferior colliculus Tectal (quadrigeminal) plate Cerebellum Superior medullary velum 4th ventricle and choroid plexus Inferior medullary velum Medulla oblongata
Genu Rostrum Trunk Splenium
corpus callosum
Islhmus of cingulale gyrus Parietooccipital sulcus Cuneus
Uncus
Calcarine sulcus
Optic nerve (II)
Lingual gyrus
Olfactory tract
Crus Body V of fornix Column
Collateral sulcus Rhinal sulcus Medial occipitotemporal gyru Occi p i totem po ra (sulcus Lateral occipitotemporal gyrus
Plate 108
Fimbria of hippocampus Dentate gyrus Parahippocampal gyrus
Meninges and Brain
Cerebrum: inferior View For hypophysis see
Sectioned brainstem
Plate 147
Frontal pole of cerebrum Straight gyrus Lamina terminalis
Olfactory sulcus
Olfactory bulb
Orbital sulci
Olfactory tract
Orbital gyri
/ O p t i c chiasm
Temporal pole of cerebrum
Optic nerve (II) (cut)
Lateral sulcus (of Sylvius)
Hypophysis (pituitary gland)
Inferior temporal sulcus Inferior temporal gyrus
•Anterior perforated substance Optic tract Tuber cinereum
Inferior (inferolateral) margin of cerebrum
•»88
Mammillary body
v'-oS
Posterior perforated substance (in interpeduncular
sss Rhinal sulcus
Cerebral cr us Uncus
Lateral geniculate body
\
Inferior temporal gyrus-
\
X
\
Substantia nigra
X
Medial geniculate body
Occipitotemporal sulcus MS®
Red nucleus
Lateral occipitotemporal gyrus
Pulvinar of thalamus Superior colliculus (of corpora quadrigemina)
\\ Pa ra h i p p o ca m p a I gy r u s
Cerebral aqueduct Splenium of corpus callosum
Medial occipitotemporal gyrus" Calcarine sulcus
Apex of cuneus Occipital pole of cerebrum Longitudinal cerebral fissure
Meninges and Brain
Plate 107
Ventricles of Brain H6W&aamSBl
Left lateral phantom view
Frontal (anterior) horn Central part
v;'
Right lateral ventricle
Temporal (inferior) horn
Left lateral ventricle
Occipital (posterior) horn
Cerebral aqueduct (of Sylvius) 4th ventricle Left lateral aperture (foramen of Luschka) Left lateral recess
Left interventricular foramen (of M o n r o ) 3rd ventricle
Median aperture (foramen of Magendie)
^yvW/MJfj
Supraoptic recess Interthalamic adhesion Infundibular recess
Central canal of spinal cord
Pineal recess Suprapineal recess Corpus callosum Septum pellucidum Lateral ventricle Body of caudate nucleus Choroid plexus of lateral ventricle Stria terminalis Superior thalamostriate vein Body of fornix Internal cerebral vein Tela choroidea of 3rd ventricle Choroid plexus of 3rd ventricle Thalamus Putamen
/ . , > Lentiform nucleus Globus pallidus ) Internal capsule 3rd ventricle and interthalamic adhesion Hypothalamus Tail of caudate nucleus Optic tract ;
/
)
White arrow in left interventricular foramen (of M o n r o ) Ependyma Pia mater
Coronal section of brain: posterior view
Plate 108
Choroid plexus of lateral ventricle Temporal (inferior) horn of lateral ventricle Fimbria of hippocampus Hippocampus Dentate gyrus Parahippocampal gyrus
Circulation of Cerebrospinal Fluid mm^mmm
wmsmmm
Choroid plexus of lateral ventricle
{phantom)
Superior sagittal sinus Subarachnoid space
Cistern of corpus callosum Dura mater
Arachnoid granulations
Arachnoid
Interventricular foramen (of Monro) Chiasmatic cistern
Interpeduncular cistern Cerebral aqueduct (of Sylvius) Prepontine cistern Lateral aperture (foramen of Luschka) Choroid plexus of 4th ventricle
Quadrigeminal cistern (of great cerebral vein) (Posterior) cerebellomedullary cistern Median aperture (foramen of Magendie)
Dura mater Arachnoid Subarachnoid space Central canal of spinal cord
Meninges and Brain
Plate 109
Horizontal sections through cerebrum Genu of corpus callosum
Head of caudate nucleus
Lateral ventricle
Anterior limb ~
Septum pellucidum
G e n u
Posterior limb
Column of fornix
( (
of internal capsule
Putamen
\
Lentiform
Globus pallidus S nucleus
Insula (island of Reil)
3rd ventricle Interthalamic adhesion
External capsule
Thalamus
Claustrum
Crus of fornix
Retrolenticular part of internal capsule
Choroid plexus of lateral ventricle
Tail of caudate nucleus Hippocampus and fimbria
Splenium of corpus callosum
Occipital (posterior) horn of lateral ventricle Habenula
Organization of basal nuclei (ganglia)
Pineal body
Caudate Putamen Globus nucleus pallidus
Striatum
Lentiform nucleus
Corpus striatum K Basal nuclei (ganglia)
Cleft for internal capsule
Caudate J Body nucleus ) H e a d
Thalamus
Levels of ( ^ sections \ above ( Pulvinar Lentiform nucleus (globus pallidus medial to putamen) Amygdaloid body
Medial geniculate body Lateral geniculate body Tail of caudate nucleus
Interrelationship of thalamus, lentiform nucleus, caudate nucleus, and amygdaloid body (schema): left lateral view
Plate 110
Meninges and Brain
Thalamus
Corpus callosum [cut)
Interventricular foramen (of Monro)
Head of caudate nucleus
Tela choroiclea (cut edge) of 3rd ventricle
Septum pellucidum
3rd ventricle
Columns of fornix
Choroid plexus
Anterior tubercle
Superior thalamostriate vei
Stria terminalis
Pes hippocampi
Interthalamic adhesion
Temporal (inferior) horn of lateral ventricle
Lamina affixa
Internal cerebral vei
Stria medullaris
Dentate gyrus
Habenular trigone
Collateral eminence
Pulvinar (retracted)
Hippocampus
Lateral geniculate body
Fimbria of hippocampus-
Medial geniculate body
Posterior commissure
Brachium of superior colliculus
Habenular commissure
Brachium of inferior colliculus
Pineal-body Collateral trigon
Superior colliculus
Calcar
Inferior colliculus
Occipital (posterior) horn of lateral ventricle
Cerebellum
Calcarine sulcu Internal medullary lamina
3rd ventricle
Interthalamic adhesion
Pulvinar Intralaminar nuclei
3rd ventricle Reticular nucleus
Thalamic nuclei
Median nuclei
Schematic section through thalamus (at level of broken line shown in figure at right)
Meninges and Brain
CM LD LP M MD VA VI VL VP VPL VPM
Centromedian Lateral dorsal Lateral posterior Medial Medial dorsal Ventral anterior Ventral intermedial Ventral lateral Ventral posterior Ventral posterolateral Ventral posteromedial
Pulvinar geniculate body Medial geniculate body
Schematic representation of thalamus (external medullary lamina and reticular nuclei removed) Lateral nuclei Medial nuclei Anterior nuclei
Plate 11i
mm imi W
Hippocampus and Fornix
mm iffii1lTwii*iiiii
'Sm1CSM0ES5®:
Genu of corpus callosum (cut)
Superior dissection
Septum pellucidum Head of caudate nucleus Columns of fornix Stria terminalis Body of fornix Pes hippocampus Thalami ra of fornix Dentate gyrus Fimbria of hippocampus Hippocampus Commissure of fornix Splenium of corpus callosum (cut) Lateral ventricle Calcar avis Occipital (posterior) horn of lateral ventricle
Tail of caudate nucleus Choroid Fimbria of hippocampus
Body of fornix Columns of fornix
O p t i c tract
Commissure of fornix Crura of fornix
Hippocampal sulcus Dentate gyrus Hippocampus
Fimbria of hippocampus Hippocampus
Fornix: schema
Plate 112
Alveus of hippocampus Temporal (inferior) horn of lateral ventricle
Coronal section: posterior view
Meninges and Brain
Cerebellum mwmmmMmm®mm
Anterior cerebellar notch
Anterior lobe Quadrangular lobule (H IV-V)
Central lobule (II &
Primary fissure Horizontal fissure
Culmen (IV & V)
Superior vermis
Simple lobule (H VI) Posterior lobe
Declive (VI)
Postlunate fissure Folium (VII A)
Superior semilunar (anseriform) lobule (H VII A) Horizontal fissure Inferior semilunar (caudal) lobule (H VII B)
Posterior cerebellar notch
Superior vermis
Central lobule Lingula (I)
Inferior surface
Anterior lobe W i n g of central lobule Superior J Middle > Cerebellar peduncles Inferior \
Superior medullary velum Flocculus (H X)
Flocculonodular lobe
4th ventricle
Posterolateral (dorsolateral) fissure
Inferior medullary velum Nodule (X) Inferior vermis
Retrotonsillar fissure
Uvula (IX) Tonsil
Pyramid (VIII)
Posterior lobe
Biventer lobule (H VIII)
Tuber (VII B)
Secondary (postpyramidal) fissure
Posterior cerebellar notch
Horizontal fissure Inferior semilunar (caudal) lobule (H VII B)
Decussation of superior cerebellar peduncles
Cerebral c.rus Medial longitudinal fasciculus
4th ventricle Nuclear layer of medulla oblongata
Superior medullary velum Fastigial Cerebellar nuclei
Superior cerebellar peduncle
Globose Lingula (I)
Dentate
Vermis
Emboliform
Section in plane of superior cerebellar peduncle
Meninges and Brain
Plate 113
11111r^^S
Brainstem .v-^"?.'IjWTMHNHMMBH
alamus (cut surface)
Posterolateral view
Lateral geniculate body Optic tract
Pulvinars of thalami Pineal body
Medial geniculate body
Superior colliculi
Brachia of superior and inferior colliculi
Inferior colliculi
Cerebral crus
Trochlear nerve (IV)
Pons
Superior medullary velu
Trigeminal nerve (V)
Superior cerebellar peduncle
Middle cerebellar peduncle
Rhomboid fossa of 4th ventricle
bulocochlear nerve (VIII) Facial nerve (VII)
Glossopharyngeal (IX) and vagus(X)
Inferior cerebellar peduncle
Cuneate tubercle
Hypoglossal nerve (XII)
Gracile tubercle
Accessory nerve (XI)
Dorsal roots of 1 st spinal nerve (C1) Cuneate fasciculu Gracile fascicul
Olfactory tract
Anterior view
Anterior perforated substance >f
Infundibulum (pituitary stalk) Optic chiasm
Mammillarv bodies Temporal lobe (cut surface)
Optic tract
Oculomotor nerve (111)
Tuber cinereum
chlear nerve (IV)
Cerebral crus
geminal nerve (V) Abducent nerve (VI)
Lateral geniculate body
Facial nerve (VII) and intermediate nerve
Posterior perforated su
Vestibulocochlear nerve (VIII)
Pons
Flocculus of cerebellum Middle cerebellar pedun Olive Pyramid Ventral roots of 1st spinal nerve (C I Decussation of pyramids
Plate 114
Choroid plexus of 4th ventricle Glossopharyngeal nerve (IX) s nerve (X) ypoglossal nerve (XII) Accessory nerve (XI)
Meninges and Brain
Fourth Ventricle and Cerebellum mam
mmmmmmmmwm\wmmmm
rJm$mm
Habenular trigone
Posterior view
literal' j Geniculate bodies
3rd ventricle Pulvinar of thalamus
Dorsal median sulcus
Pineal body
Superior cerebellar peduncle Locus ceruleus
Superior collicul
Medial eminence
Inferior colliculu
Facial colliculus
Trochlear nerve (IV)
Vestibular area
Superior medullary velu
Dentate nucleus of cerebellum
Superior Middle Inferior
Cerebellar peduncles {
•
Striae medullares
Lateral recess
enia of 4th ventricle
Superior fovea
Cuneate tubercle
Sulcus limitans
Gracile tubercle
Inferior fovea
Dorsal median sulcus
Trigeminal tubercle
Lateral funiculus
Hypoglossal trigone Vagal trigone
uneate fasciculus Gracile fasciculus
Obex
Interthalamic adhesion
Median sagittal section
Posterior commissure
Body of fornix
Habenular commissure
Thalamus (in 3rd ventricle)
Pineal body
Interventricular foramen (of Monro)—
Splenium of corpus callosum Great cerebral vein (of Galen)
Anterior commissure Lamina terminalis
Lingula (I)
Hypothalamic sulcus
Central lobule (ll-III)
Cerebral peduncle
Culm en (IV-V)
Cerebral aqueduct (of Sylvius)
Declive (VI)
Superior colliculus
Vermis of cerebellum
Folium (VII A)
Tectal (quadrigeminal) plate Superior medullary velum
Inferior colliculus
-Inferior medullary velum
Pons Medial longitudinal fasciculus
Tuber (VII B)
4th ventricle
Pyramid (VIII)
Choroid plexus of 4th ventricle
Uvula (IX)
Medulla oblongata
Nodulus (X)
Median aperture (foramen of Magendie) Decussation of pyramids Central canal of spinal cord
Meninges and Brain
Vermis of cerebellum
Choroid plexus of 4th ventricle Tonsil of cerebellum
FBafe 115
Rv
i;
Cranial Nerve Nuclei in Brainstem: Schema jvA'^v^t^KvXffi'K^;:
Posterior phantom view
fit:
Oculomotor nerve (III) Superior colliculus
Red nucleus Oculomotor nucleus Accessory oculomotor (Edinger-Westphal) nucleus
Lateral geniculate body Mesencephalic nucleus of trigeminal nerve
Trochlear nucleus Trochlear nerve (IV)
Principal sensory nucleus of trigeminal nerve
Motor nucleus of trigeminal nerve
Trigeminal nerve (V) and ganglion
Trigeminal nerve (V) and ganglion
Facial nerve (VII) and geniculate ganglion
Abducent nucleus Facial nucleus
Vestibulocochlear nerve (VIII)-
Geniculum (geniculate ganglion) of facial nerve
Cochlear nuclei
Superior and inferior salivatory nuclei
Anterior Posterior
Vestibular nuclei
Glossopharyngeal nerve (IX)
Glossopharyngeal nerve (IX)
Vagus nerve (X)
Vagus nerve(X)
Accessory nerve (XI)*
Spinal tract and spina nucleus of trigeminal nerve Solitary tract nucleus Dorsal vagal nucleus
Efferent fibers
Nucleus ambiguus Posterior (dorsal) nucleus of vagus nerve (X) Hypoglossal nucleus Spinal nucleus of accessory nerve
Afferent fibers Mixed fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.
Plate 116
Cranial and Cervical Nerves
Cranial Nerve Nuclei in Brainstem: Schema (continued) WjjBWSKj
Medial dissection
Accessory oculomotor (Edinger-Westphal) nucleus
Red nucleus
Oculomotor nucleus
Oculomotor nerve
nucleus
Mesencephalic nucleus of trigeminal nerve
nerve (IV) Abducent nucleus
Trigeminal nerve (V) and ganglion
Internal genu of facial nerve
Principal sensory nucleus of trigeminal nerve
Facial nucleus Vestibular nuclei
Motor nucleus of trigeminal nerve
Anterior and posterior cochlear nuclei
Facial nerve (VII) Superior and inferior salivatory nuclei
Vestibulocochlear nerve (VIII) Abducent nerve (VI)
Solitary tract nucleus
Glossopharyngeal nerve (IX)
Posterior (dorsal) nucleus of vagus nerve (X)
Hypoglossal nerve (XII) Hypoglossal nucleus Vagus nerve (X) Nucleus ambiguus Accessory nerve (XI)* Spinal nucleus of accessory nerve
Spinal tract and spinal nucleus of trigeminal nerve
Efferent fibers
4P
Afferent fibers Mixed fibers
"Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.
Plate 117
Cranial Nerves (Motor and Sensory Distribution): Schema m^umemmmmm
M M H I
asJefSKSS
Spinal nerve fibers Efferent ( m o t o r ) fibers Afferent (sensory) fibers
Oculomotor
^
^
Ciliary muscle, sphincter pupillae, and all external eye muscles except those below
Olfactory
Nasal cavity
Trochlear Superior oblique muscl
VI Abducent___y/^ Lateral r e c t u s ^ / / / muscle yyx
Trigeminal
Motor—muscles of mastication-^""
mm
Sensorv—face I sinuses, teeth
• .
Intermediate nerve M o t o r—s u b m a n d i b u I a r, sublingual, lacrimal glands Taste—anterior -/i of tongue, sensory soft palate
VII Facial
Muscles of face
VIII Vestibulocochlear j,
Cochlear
v-
Vestibular
Glossopharyngeal
Taste—posterior of tongue Sensory—tonsil, pharynx, middle ear Motor—stylopharyngeus, parotid gland
liiiK;
Vagus
pfe^l'S.f
XII ill Hypoglossal Tongue muscles
tj* ^
Accessory
\
Sternocleidomastoid trapezius muscles
Motor—heart, lungs, palate, pharynx, larynx, trachea, bronchi, Gl tract Sensory—heart, lungs, trachea, bronchi, larynx, pharynx, ^ Gl tract, external ear IB
Strap muscles (CI, 2, 3 fibers)
Plate 118
Cranial and Cervical Nerves
Subcallosal (parolfactory) area Septal area and nuclei
Olfactory bulb cells: schema
Fibers from \ Contralateral Fibers to \ olfactory bulb
Efferent fibers to olfactory bulb Afferent fibers from bulb to central connections and contralateral bulb
Anterior commissure Medial olfactory stria
Granule cell (excited by and inhibiting to mitral and tufted cells) Mitral cell •/
••
-• 7
Olfactory nerve fibers
Dura mater
Olfactory cells Olfactory mucosa Olfactory nerves (I)
Olfactory tract Olfactory trigone / and olfactory tubercle
Olfactorv bulb Cribriform plate of ethmoid bone Anterior olfactory nucleus
Lateral olfactory stria
Uncus
Lateral olfactory tract nucleus Anterior perforated substance
Dentate gyrus
Amygdaloid body Piriform lobe
Cranial and Cervical Nerves
Hippocampal fimbria
Parahippocampal gyrus
Plate 119
Optic Nerve (II) (Visual Pathway): Schema
mm*
• 1
•
•
Mttmrn
Overlapping i visual fields 1
Central darker circle represents macular zone Lighter shades represent monocular fields Each quadrant a different color
Projection on right retina
Projection on left retina
Choroid
Choroid
Periphery
Macula
\
\ \ Optic chiasm y s ^ / j
Structure of retina: schema A B C G H P R
O p t i c nerves ( I I ) j
Projection on left dorsal lateral geniculate nucleus
Amacrine cells Bipolar cells Cones Ganglion cells Horizontal cells Pigment cells Rods
Optic tracts
Projection on right dorsal lateral geniculate nucleus
Lateral geniculate bodies \ Optic radiation
Optic radiation
Calcarine sulcusv Calcarine sulcus
mm
Projection on right occipital lobe
Projection on left occipital lobe
Plate 120
Cranial and
Cervical Nerves
Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves: Schema IIIIIIIIMIIlllillllilllWIilWM^
mmmxtm
See also
Long ciliary nerve Short ciliary nerves
Plates 86,132, 167, 168
Ciliary ganglion Posterior ethmoidal nerve
Anterior ethmoidal nerve
Abducent nucleus
Sensory root of ciliary ganglion
Superior oblique muscle
Trochlear nucleus
Sympathetic root of ciliary ganglion
Levator palpebrae superioris muscle
Oculomotor nucleus
Superior division of oculomotor nerve
Superior rectus muscle
Accessory oculomotor (Edinger-Westphal) nucleus (parasympathetic)
Frontal nerve (cut) Lacrimal nerve (cut) Nasociliary nerve
Trochlear nerve (IV)
O c u l o m o t o r nerve (III) Ophthalmic nerve (V |)
Abducent nerve (VI)
Infraorbital nerve Zygomatic nerve (cut)
Pterygopalatine ganglion
Inferior oblique muscle
Inferior division of oculomotor nerve
Ciliary muscle Dilator pupillae muscle
Medial rectus muscle
Sphincter pupillae muscle
Inferior rectus muscle Efferent fibers Afferent fibers Sympathetic fibers
Parasympathetic root of ciliary ganglion
Parasympathetic fibers
Cranial and Cervical Nerves
Mandibular nerve (V3) Internal carotid artery and nerve plexus Maxillary nerve (V 2 ) Lateral rectus muscle and abducent nerve {turned back) Cavernous plexus Common tendinous ring
Plate 121
Trigeminal Nerve (V): Schema mflMMMHBM^^ See also
—
Plates 24, 42, 43, 45, 46, 167, 168
Efferent fibers Afferent fibers Proprioceptive fibers Parasympathetic fibers Sympathetic fibers
Ophthalmic nerve (V^) Tentorial (meningeal) branch Nasociliary nerve
Trigeminal nerve (V) ganglion and nuclei Motor nucleus Mesencephalic nucleus Principal sensory nucleus Spinal tract and nucleus
Lacrimal nerve Sensory root of ciliary ganglion
Frontal nerve Ciliary ganglion Posterior ethmoidal nerve Long ciliary nerve Short ciliary nerves Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve Infratrochlear nerve Internal nasal branches and External nasal branches of anterior ethmoidal nerve Maxillary nerve (V 2 ) Meningeal branch
mk*
Zygomaticotemporal nerve Zygomaticofacial nerve Zygomatic nerve Infraorbital nerve Pterygopalatine ganglion Superior alveolar branches of infraorbital nerve Nasal branches (posterior superior lateral, nasopalatine, and posterior superior medial)
Facial nerve (VII) Chorda tympani nerve
Nerve (Vidian) of pterygoid canal (from facial nerve [Vllj and carotid plexus) Pharyngeal branch Greater and lesser palatine nerves
Superficial temporal branches
Deep temporal nerves (to temporalis muscle)
Articular branch and anterior auricular nerves
Lateral pterygoid and masseteric nerves Tensor veli palatini and medial pterygoid nerves Buccal nerve Mental nerve Inferior dental plexu Lingual nerve
Plate 122
Auriculotemporal nerve
Submandibular ganglion Mylohyoid nerve
Inferior \ alveolar nerve /
\ \ I \
Otic ganglion
\
Mandibular nerve (V 3 ) Tensor tympani nerve
Parotid branches Meningeal branch Lesser petrosal nerve (from glossopharyngeal nerve IIX])
Cranial and Cervical Nerves
Facial Merwe (VII): Schema See also Facial nerve (VII)
Greater petrosal nerve
Internal acoustic meatus
Geniculate ganglion
Deep petrosal nerve (from internal carotid plexus)
Intermediate nerve Motor nucleus of facial nerve
Internal carotid plexus (on internal carotid artery)
Lesser petrosal nerve Nerve (Vidian) of pterygoid ca nal
Plates 25, 167, 168
Superior salivatory nucleus Solitary tract nucleus
Otic gang lion Pterygopalatine ganglion
Facial muscles Frontal belly (frontalis) of o c c i p i t o f r o n t a l Orbicularis oculi Corrugator supercilii Zygomaticus major Zygomaticus minor Procerus Levator labii superiors Levator labii superioris alaeque nasi Levator anguli oris Nasalis
omatic £ Depressor septi nasi
jwOccipital If belly
Buccal femches
Orbicularis oris
Occipital branch of posterior auricular nerve
Depressor anguli oris Depressor labii inferioris
Branches to auricular muscles
Mentalis
Posterior auricular nerve
(Risorius) (not shown)
Nerve to stapedius muscle
Buccinator
Stylomastoid foramen tympanic plexus
Platysma
Tympanic nerve (of Jacobson) (from glossopharyngeal nerve)
Sublingual gland Submandibular gland -
Efferent fibers
-
Afferent fibers .. r-i n •• Parasympathetic fibers -
Sympathetic fibers
W m I ( ° c c ' P ' t a ' ' s ) of occipitofrontal muscle
Submandibular ganglion Lingual nerve (from trigeminal nerve) ° ° Chorda tympani nerve
Cranial and Cervical Nerves
Glossopharyngeal nerve (IX) Digastric muscle (posterior belly) Stylohyoid muscle Caroticotympanic nerve (from internal carotid plexus)
Plate 123
Afferent fibers
Facial canal Geniculum (geniculate ganglion) of facial nerve
Chorda tympani nerve
Greater petrosal nerve
Head of malleus
Cochlear (spiral) ganglion
Incus
Vestibular nerve Cochlear nerve Motor root of facial nerve and intermediate nerve Vestibulocochlear nerve (VIII) Medulla oblongata (cross section)
mm* \ ' V-' •
&
vm
; v1- . /
V-
ms
Internal acoustic meatus
Medial Vestibular nuclei (diagrammatic)
Ampulla of lateral semicircular duct Ampulla of superior semicircular duct
SuperiorAnterior Interior
Posterior
Utricle
Cochlear nuclei
Ampulla of posterior semicircular duct
Lateral Inferior cerebellar peduncle (to cerebellum) Vestibular ganglion
Saccule Superior division Inferior division
Plate 124
of vestibular nerve
Cranial and Cervical Nerves
Glossopharyngeal Nerve (IX): Schema
Efferent fibers Afferent fibers Parasympathetic fibers
Spinal tract and spinal nucleus of trigeminal nerve Solitary tract nucleus Tympanic nerve (of Jacobson) Tympanic cavity and plexus Stylomastoid foramen
Caroticotympanic nerve (from internal carotid plexus)
Nucleus ambiguus Inferior salivatory nucleus Geniculum (geniculate ganglion) of facial nerve \i
Greater petrosal nerve Deep petrosal nerve Nerve (Vidian) of pterygoid canal Lesser petrosal nerve Pterygopalatine ganglion Mandibular nerve (V 3 ) Otic ganglion Auriculotemporal nerve Parotid gland Tubal branch of tympanic plexus Auditory (pharyngotympanic, Eustachian) tube and pharyngeal open ng •j*
Glossopharyngeal nerve (IX)
"
Stylopharyngeus muscle (and branch from glossopharyngeal nerve)
Jugular foramen Communication to auricular branch of vagus nerve Superior and Inferior ganglia of Glossopharyngeal nerve Communication to facial nerve (VII) Taste and somatic sensation: posterior V>of tongue
Vagus nerve (X) Superior cervical sympathetic ganglion Sympathetic trunk Carotid branch of glossopharyngeal nerve Internal carotid artery
Pharyngeal plexus
Carotid sinus
Pharyngeal, tonsillar, and lingual branches of glossopharyngeal nerve
Carotid body C o m m o n carotid artery
Pharyngeal branch of vagus nerve External carotid artery
Cranial and Cervical Nerves
Plate 125
Vagus Nerve (X): Schema I8fififiQfDSffln99BfiK&3fi3BS
See also
Plates 167, 168
/I*
Glossopharyngeal nerve (IX)
N
v i\
£v' Xt X/Posterior nucleus of vagus n e r v e (parasympathetic I \ \ ~ ' / \h„, / and visceral afferent) Solitary tract nucleus (visceral afferents including taste)
Meningeal branch of vagus nerv Auricular branch of vagus nerve
Spinal tract and spinal nucleus of trigeminal nerve (somatic afferent)
Auditory (pharyngotympanic, Eustachian) tube Levator veli palatini muscle
Nucleus ambiguus (motor to pharyngeal and laryngeal muscles)
Salpingopharyngeus muscle
Cranial root of accessory nerve* (see next plate)
Palatoglossus muscle Palatopharyngeus muscle
Vagus nerve (X) Jugular foramen
Superior pharyngeal constrictor muscle
Superior ganglion of vagus nerve
Stylopharyngeus muscle
Inferior ganglion of vagus nerve
Middle pharyngeal constrictor muscl Inferior pharyngeal constrictor muscle Cricothyroid muscle Trachea Esophagus Right subclavian a Right recurrent laryngeal nerve Heart Hepatic branch of anterior vagal trunk (in lesser omentum) Celiac branches from anterior and posterior vagal trunks to celiac plexus Celiac and superior mesenteric ganglia and celiac plexus Hepatic plexus Gallbladder and bile ducts Liver Pvloric branch
Pharyngeal branch of vagus nerve (motor to muscles of palate and pharynx; sensory to lower pharynx) Communicating branch of vagus nerve to carotid branch of glossopharyngeal nerve Pharyngeal plexus Superior laryngeal nerve: Internal branch (sensory and parasympathetic) External branch (motor to cricothyroid muscle) Superior cervical cardiac branch of vagus nerve Inferior cervical cardiac branch of vagus nerve A
Thoracic cardiac branch of vagus nerve Left recurrent laryngeal nerve (motor to muscles of larynx except cricothyroid; sensory and parasympathetic to larynx below vocal folds; parasympathetic, efferent, and afferent to upper esophagus and trachea) Pulmonary plexus Cardiac plexus Esophageal plexus Anterior vagal trunk Gaslric branches of anterior vagal trunk (branches from posterior trunk behind stomach)
/
from hepatic plexus Pancreas Duodenum Ascending colon Cecum Appendix
Plate 126
fibers (parasympathetic motor, secretomotor, and afferent fibers) accompany superior mesenteric artery and its branches usually as far as left colic (splenic) flexure Small intestine Efferent fibers Afferent fibers Parasympathetic fibers
Cranial and Cervical Nerves
mmrnm
A c c e s s o r y Merwe (XI): S c h e m a p i l i See also Nucleus ambiguus Vagus nerve (X)
Plate 32
Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of larynx, except cricothyroid) Jugular foramen Superior ganglion of vagus nerve Accessory nerve (XI)*
Inferior ganglion of vagus nerve
CI spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle
Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.
Cranial and Cervical Nerves
Plate 127
JHll
Hypoglossal Nerve (XII): Schema K&.vl-j,-:
See also
Plate 32
Hypoglossal nerve (XII) (in hypoglossal canal)
Hypoglossal nucleus
Superior longitudinal
Intrinsic muscles of tongue
Transverse and vertical Inferior longitudinal
Meningeal branch
Styloglossus muscle
Occipital condyle Inferior ganglion of vagus nerve Ventral rami of C1, 2 , 3 form ansa cervicalis of cervical plexus
Superior cervical sympathetic ganglion Superior root of ansa cervicalis
Genioglossus muscle Geniohyoid muscle (via CI)'
Internal carotid artery Inferior root of ansa cervicalis
Thyrohyoid muscle' (via C I ) Omohyoid muscle (superior belly)
Ansa cervicalis Internal jugular vein Common carotid artery
Efferent fibers Afferent fibers
Plate 128
See also
Sternocleidomastoid muscle (cut) Accessory nerve (XI) Hypoglossal nerve (XII) Geniohyoid muscle
Plate 32
Great auricular nerve Lesser occipital nerve Greater occipital nerve (from dorsal ramus of C2)
Nerves to anterior and lateral rectus capitis and longus capitis and colli muscles Nerves to longus capitis and colli and levator scapulae muscles Thyrohyoid muscle Superior root of ansa cervicalis Inferior root of ansa cervicalis Transverse cervical nerve
rapezius muscle Nerves to longus capitis and colli, levator scapulae, and middle scalene muscles Communication to brachial plexus Phrenic nerve
Omohyoid muscle (superior belly) Sternothyroid muscle
Sternohyoid muscle
Supraclavicular nerves (medial, intermediate, and lateral)
Ansa cervicalis Sternocleidomastoid muscle {cut) Omohyoid muscle (inferior belly)
Efferent fibers Afferent fibers Proprioceptive fibers
Plate 129
B V /
Q •.
Autonomic Nerves in Neck QBmUBXSi
See also
Plates 71, 125, 126, 165, 166, 209, 226, 240, 318
Internal carotid nerve
j
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fe
w
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^A
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wSKB
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Glossopharyngeal nerve (IX)
1
V
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i
La r y n go p h a r y n gea I sympathetic branch
0x8:
M
m
Vagus nerve (X) (cut)
m m
m
Superior cervical sympathetic ganglion
K
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f
t*
are
C2
15
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^ J t
i I
u
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m
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•• •X
V
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m:
i
"^Pharyngeal plexus Pharyngeal branch of vagus nerve
111
External carotid artery and plexus
Gray rami communicantes
Superior laryngeal nerve Internal carotid artery and carotid branch of glossopharyngeal nerve Carotid body Carotid sinus
9
/
Superior cervical cardiac branch of vagus nerve
W IC
7
V'VA
I
.• ,
i
Superior cervical sympathetic cardiac nerve Phrenic nerve (cut) Middle cervical sympathetic ganglion
iflHH
Common carotid artery and plexus
'•'^•ig
C8
ISw jB
W
•t AT: m
Vertebral artery and plexus Recurrent laryngeal nerve
Vagus nerve (X) (cut)
mm M
K
—Ansa subclavia Inferior cervical sympathetic cardiac nerve
-Ma V
Vertebral ganglion
Cervicothoracic (stellate) ganglion
JfP5B
X;
Middle cervical sympathetic cardiac nerve
-•-y'y
>VS:
—Thoracic sympathetic and vagal cardiac nerves
Subclavian artery
Plate 130
Cranial and Cervical Nerves
Autonomic Nerves in Head See also
Greater petrosal nerve Sensory root Trigeminal nerve (V) <{ Motor root Ganglion
Plates 44-46, 86, 121, 132-134, 165, 166
Deep petrosal nerve
Nasociliary nerve
Nerve (Vidian) of pterygoid canal Oculomotor nerve (III) Maxillary nerve (V 2 )
Sensory
)
Sympathetic
Roots
of
> ciliary
Parasympathetic )
Ophthalmic nerve (V ,)
Internal carotid artery and plexus
Frontal and lacrimal nerves {cut)
Geniculum (geniculate ganglion) of facial nerve
Ciliary ganglion
Long ciliary nerve
Facial nerve (VII) Short ciliary nerves
Vestibulocochlear nerve (VIII)
Posterior, superior, and inferior lateral nasal nerves
Glossopharyngeal nerve (IX) Vagus nerve (X) Mandibular nerve (V 3 ) Otic ganglion Internal carotid nerve Chorda tympani nerve
Pterygopalatine ganglion
Superior laryngeal nerve (cat)
Greater and lesser palatine nerves
Superior cervical sympathetic ganglion
Lingual nerve Internal carotid artery and plexus
Inferior alveolar nerve
Carotid branch of glossopharyngeal nerve Carotid sinus Cervical sympathetic trunk Superior cervical cardiac branch of vagus nerve
Submandibular ganglion Maxillary artery and plexus External carotid artery and plexus
Middle meningeal artery and plexus Facial artery and plexus
Common carotid artery and plexus Superior cervical sympathetic cardiac nerve
Plate 131
Ciliary Ganglion: Schema See also
Plates 167, 168
Sphincter pupillae muscle Short ciliary nerves Ciliary
Oculomotor (parasympathetic) root of ciliary ganglion
Accessory oculomotor (Edinger-Westphal) nucleus (parasympathetic)
Ciliarv muscle
Superior colliculus Lateral geniculate body
•81
Optic nerve (ll) / Ophthalmic nerve (V.)
Nasociliary nerve' Long ciliary nerve
Trigeminal ganglion-
Nasociliary (sensory) root of ciliary ganglion
Internal i carotid plexus
Sympathetic root of ciliary ganglion Ophthalmic artery
Tympanic, plexus
Tectospinal tract
Thoracic part of spinal cord
Internal . carotid artery
Superior cervical sympathetic ganglion 1 st thoracic sympathetic trunk ganglionGray ramus communicans Preganglionic I n * * r - ( Sympathetic fibers Postganglionic)
White ramus communicans T1 spinal nerve
Preganglionic \ Postganglionic)
..
Preganglionic sympathetic cell bodies in intermediolateral nucleus (lateral horn) of gray matter
Parasympathetic fibers
• Visual pathway Afferent fibers Descending pathway
Plate 132
Cranial and Cervical Nerves
Pterygopalatine and Submandibular Ganglia: Schema See also
Ophthalmic nerve (V-j) Mandibular nerve (V 3 ) Otic ganglion
Plates 167, 168
Trigeminal ganglion Deep petrosal nerve Greater petrosal nerve Chorda tympani nerve
Lingual nerve
Trigeminal nerve (V)
Maxillary nerve (V 2 )
Facial nerve (VII) (intermediate nerve)
Nerve (Vidian) of pterygoid canal
Superior salivatory nucleus
Pterygopalatine ganglion Lacrimal gland
Descending palatine nerves Posterior nasal nerves
Glossopharyngeal nerve (IX) Superior cervical sympathetic ganglion
Palatine nerves
Sympathetic trunk T1 and T2 spinal nerves Thoracic spinal cord
Submandibular ganglion
Dorsal root Sublingual gland Submandibular gland Ventral 'OOt
Facial arteryLingual artery External carotid artery and plexus Common carotid artery
if
nternal carotid artery
Sympathetic preganglionic cell bodies in intermediolateral nucleus (lateral horn) of gray matter
Sympathetic preganglionic fibers Sympathetic postganglionic fibers Parasympathetic preganglionic fibers Parasympathetic postganglionicfibers
Cranial and Cervical Nerves
Plate 133
Otic Gangliem Schema See also
Plates 167, 168 Mandibular nerve (V 3 )
Trigeminal ganglion Lesser petrosal nerve
Otic ganglion
Chorda tympani nerve Ophthalmic nerve (V-j)
Trigeminal nerve (V)
Maxillary nerve (V 2 )
Facial nerve (VII) Glossopharyngeal nerve (IX)
AuricuIotemporal nerve
Inferior salivatory nucleus
Superficial temporal artery
Pons
Parotid gland Maxillary artery Medulla oblongata Tympanic plexus Inferior alveolar nerve
Tympanic nerve (of Jacobson) Inferior ganglion (IX)
Lingual nerve
Superior cervical sympathetic ganglion Sympathetic trunk Thoracic spinal cord
External carotid artery
Dorsal root Internal carotid artery
Common carotid artery White
Gray
Rami communicantes
i
i Sympathetic preganglionic fibers
^ ^ ^
Sympathetic postganglionic fibers
Sympathetic preganglionic cell bodies in intermediolateral nucleus (lateral horn) of gray matter
M^vttw^wi Parasympathetic preganglionic fibers »
m ess] Parasympathetic postganglionic fibers
Plate 134
Cranial and Cervical Nerves
Taste Pathways: Schema See also
\
.J
f
Plates 46, 94,123, 125, 126
n
Usual pathway ~ Accessory pathway
Ventral posteromedial (VPM) nucleus of thalamus Sensory cortex (just below face area) -ateral hypothalamic area Amygdaloid body Pontine taste area Trigeminal nerve (V) Trigeminal (semilunar) ganglion
Mesencephalic nucleus and Motor nucleus of trigeminal nerve
Ophthalmic nerve (V j) Maxillary nerve (V 2 ) Mandibular nerve (V 3 )
Pterygopalatine ganglion
\ Im
Fungiform papillae Glossopharyngeal nerve (IX)
Foliate papillae
Medulla oblongata (lower part) « Inferior (petrosal) ganglion of glossopharyngeal nerve
•Vallate papillae
Epiglottis
Inferior (nodose) ganglion of vagus nerve Vagus nerve (X)
Cranial and Cervical Nerves
Larynx Superior laryngeal nerve
7
..;; K
Plate 135
Arteries to Brain and Meninges See also
Plates 33, 34
Left middle meningeal artery Posterior cerebral artery Superior cerebellar artery Basilar artery
Middle cerebral artery Anterior cerebral artery Anterior communicating artery hthalmic artery
Left labyrinthine (internal acoustic) artery
Posterior communicating artery
Mastoid branch of left occipital artery
Cavernous sinus Anterior inferior cerebellar artery
Middle meningeal artery
Posterior meningeal branch of left ascending pharyngeal artery Posterior inferior cerebellar artery Left and right vertebral arteries (intracranial part)
Maxillary artery Superficial temporal artery
Posterior meningeal branch of vertebral artery
External carotid artery
Anterior meningeal branch of vertebral artery Posterior auricular artery
Facial artery
Occipital artery Internal carotid artery Carotid sinus Carotid body Vertebral artery (cervical part) Transverse process of C6 Deep cervical artery Supreme intercostal artery Costocervical trunk Subclavian artery
Plate 136
Lingual artery Ascending pharyngeal artery Superior laryngeal artery Superior thyroid artery Common carotid artery Ascending cervical artery (cut) Inferior thyroid artery Thyrocervical trunk Brachiocephalic trunk Internal thoracic artery
Cerebral Vasculature
Veins of the Vertebral Column: Vertebral Veins
Variation: right vertebral vein crossing anterior to right subclavian artery
Left vertebral artery
,
Left vertebral vein
Anterior vertebral veins
Left subclavian artery
Right deep cervical vein
Left brachiocephalic vein
Accessory vertebral vein Right vertebral artery rib Right subclavian artery and vein
Vertebral veins: detail showing venous communications Anterior arch of atlas (CI) (cut)
Right internal jugular vein (inferior bulb) Dura mater
Right brachiocephalic vein Right vertebral vein Right clavicle
Right c o m m o n carotid artery
Right vertebral artery
Anterior internal (epidural) vertebral venous plexus Dens (C2) (cut) Venous plexus of vertebral artery Anterior external vertebral venous plexus
Epidural fat and anterior internal vertebral (epidural) venous plexus Communicating vein Basivertebral vein Intervertebral veins Veins of the vertebral Vertebral artery with venous plexus c o l u m n : vertebral veins Superior bulb of right internal jugular vein Condylar emmissary vein
Mastoid emmissary vein
Vertebral arteries
Deep cervical vei
Dura mater
Anterior vertebral veins
Body of C3 cut away to show venous communications
Anterior internal (epidural) vertebral venous plexus
Venous plexus of vertebral artery Anterior external vertebral venous plexus Communicating veins Right deep cervical vein Forming vertebral vein Accessory vertebral vein Right vertebral artery and vein
Anterior vertebral veins Left deep cervical vein Left vertebral vein Left vertebral artery Left thyrocervical trunk Left internal jugular vein (inferior bulb)
Dorsal scapular artery
Left subclavian artery
Costocervical trunk
Left subclavian vein
Right thyrocervical trunk
Left brachiocephalic vein Right subclavian vein
Left c o m m o n carotid artery
Right internal jugular vein (inferior bulb) Right brachiocephalic vein Right subclavian artery
C e r e b r a l
W a s e u l a t y r e
C'/Ytf^cwb-
Right c o m m o n carotid artery
P l a t e
1 3 7
Arteries to Brain: Schema BBgBggBBSBSSag^^
Anterior cerebral artery
Illllllll
Anterior communicating artery Ophthalmic artery
Middle cerebral artery
Supraorbital artery
Posterior communicating artery
Supratrochlear artery Caroticotympanicbranch of internal carotid artery
-acrimal artery Dorsal nasal artery
Posterior cerebral artery
Middle meningeal artery
Superior cerebellar artery
Angular artery
Anterior tympanic artery
Superficial temporal artery
Middle meningeal artery
Posterior auricular artery Facial artery
Maxillary artery
Occipital artery
Basilar artery
Lingual artery
Anterior inferior cerebellar artery
Ascending pharyngeal artery Anterior spinal artery
Posterior inferior cerebellar artery
Spinal segmental medullary branches
External carotid artery
Vertebral artery
Internal carotid artery
Common carotid arterv
Superior thyroid artery
Deep cervical artery Superficial cervical artery
Common carotid arte ry
Suprascapular artery
Vertebral artery
Supreme intercostal artery Ascending cervical artery
Costocervical trunk
Inferior thyroid artery Thyrocervical trunk
Subclavian artery
Subclavian arterv
Internal thoracic artery
Brachiocephalic trunk
Anastomoses Aorta
Descending Ascending-
Plate 138
1 2 3 4 5
Right-Left CaroticJ-Vertebral Internal carotid-External carotid Subclavian-Carotid Subclavian-Vertebral
Cerebral Vasculature
Arteries of Brain: Inferior Views .......
SwEB^iMvyMi
y,-.*.—
Medial frontobasal (orbitofrontal) arter Anterior communicating artery Anterior cerebral artery Distal medial striate artery (recurrent artery of Heubner) Internal carotid artery Anterolateral central (lenticulostriate) arteries M i d d l e cerebral artery Lateral frontobasal (orbitofrontal) Prefrontal artery Anterior choroidal artery Posterior communicating artery Posterior cerebral artery Superior cerebellar Basilar artery Pontine arteries Labyrinthine (internal acoustic) arter Anterior inferior cerebellar artery (AICA) - Vertebral artery Anterior spinal Posterior inferior cerebellar artery (PICA) (cut) Posterior spinal artery Cerebral arterial circle (of Willis) Distal medial striate artery (recurrent artery of Heubner)
{broken
line)
Anterior communicating artery Anterior cerebral artery Middle cerebral artery Posterior communicating artery Anterior choroidal artery Optic tract Posterior cerebral artery Cerebral crus Lateral geniculate body Posterior medial choroidal artery Posterior lateral choroidal artery Choroid plexus of lateral ventricle Medial geniculate body Pulvinar of thalamus Lateral ventricle
Cerebral Vasculature
Plate 139
Cerebral Arterial Circle (of Willis) For hypophyseal arteries see
Plate 148
Vessels dissected out: inferior view Anterior cerebral artery (A 2 segment) — Anterior communicating artery Anterior cerebral artery (A] segment)
Distal medial striate artery (recurrent artery of Heubner) Anteromedial central (perforating) arteries Hypothalamic artery Anterolateral central (lenticulostriate) arteries
Ophthalmic artery Internal carotid artery Middle cerebral
Superior hypophyseal artery
Posterior communicating artery
Inferior hypophyseal artery Anterior choroidal artery
Posterior c e r e b r i artpr (P2 segment) (P] segment) Superior cerebellar artery Basilar artery Pontine arteries Anterior inferior cerebellar artery (AICA)
fhalamotuberal (premammillary) artery Posteromedial central (perforating) arteries Thalamoperforating artery Posteromedial central (paramedian) arteries Labyrinthine (internal acoustic) artery
Vertebral artery
Vessels in situ: inferior view Anterior cerebral artery I lypothalamic artery Internal carotid arte Superior hypophyseal artery Middle cerebral artery I n f e r i o r h y p o p h y seal Posterior communicating artery Efferent hypophyseal veins Posterior cerebral artery
Anterior communicating artery Optic chiasm Cavernous sinus Infundibulum (pituitary stalk) and long hypophyseal portal veins Adenohypophysis (anterior lobe of pituitary gland) Neurohypophysis (posterior lobe of pituitary gland) Posteromedial central (perforating) arteries Superior cerebellar artery Basilar arterv
Cerebral Vasculature
Arteries of Brain: Frontal View and Section llllliliiM |iilMIIHIHi|l|i'Mlll
Paracentral artery
Corpus callosum
Medial frontal branches
Anterolateral central (lenticulostriate)
Pericallosal artery
Lateral frontobasal (orbitofrontal) artery
Callosomarginal artery Polar frontal artery
Prefrontal
Anterior cerebral arteries
Precentral (pre-Rolandic) and central (Rolandic) sulcal arteries
Medial frontobasal (orbitofrontal) artery
Anterior parietal (postcentral sulcal) artery
Distal medial striate artery (recurrent artery of Heubner)
Posterior parietal artery
Internal carotid artery
Branch to angular gyrus
Anterior choroidal artery
Temporal branches (anterior, middle and posteri
Posterior cerebral artery Superior cerebellar artery
M i d d l e cerebral artery and branches (deep in lateral cerebral [Sylvian] sulcus)
Basilar and pontine arteries Labyrinthine (internal acoustic) artery
Anterior communicating artery
Vertebral artery
Posterior communicating artery
Posterior inferior cerebellar artery (PICA)
Anterior inferior cerebellar artery (AICA) Posterior spinal a
Anterior spinal artery , Falx cerebri
Corpus striatum (caudate and lentiform nuclei Anterolateral central (lenticulostriate) a Insula (island of Reil) Limen of insula Precentral (pre-Rolandic), central (Rolandic) sulcal, and parietal arteries
Temporal branches of middle cerebral artery Temporal lobe Middle cerebral artery Internal carotid artery
Cerebral Vasculature
Callosomarginal arteries and Pericallosal arteries (branches of anterior cerebral arteries) Trunk of corpus callosum Internal capsule Septum pellucidum Rostrum of corpus callosum Anterior cerebral arteries Distal medial striate artery (recurrent artery of Heubner) Anterior communicating artery Optic chiasm
MW&
Arteries of Brain: Lateral and Medial Views Anterior parietal (postcentral sulcal) artery
Posterior parietal artery
Central (Rolandic) sulcal artery Precentral (pre-Rolandic) sulcal artery
Terminal branches of posterior cerebral artery
Prefrontal sulcal artery Terminal branches of anterior cerebral artery Lateral frontobasal (orbitofrontal) artery Left middle cerebral artery Left anterior cerebral artery
Occipitotemporal branches
Anterior communicating artery
Posterior temporal branch
Right anterior cerebral artery
Middle temporal branch Left internal carotid artery Polar temporal artery
Medial * Posterior frontal < Intermediate branches Anterior
Pericaliceal artery
Superior and inferior terminal branches (trunks) Anterior temporal branch Paracentral artery Cingular branches Right posterior cerebral artery Precuneal artery
Callosomarginal arterv Polar frontal artery
Dorsal branch to corpus callosum Parietooccipital branch Calcarine branch
Right anterior cerebral artery Medial frontobasal (orbitofrontal) artery
Anterior communicating artery (cut) Distal medial striate artery (recurrent artery of Heubner) Right internal carotid artery
Medial occipital artery Posterior temporal branch Anterior temporal branch Posterior communicating artery
*Note: Anterior parietal (postcentral sulcal) artery also occurs as separate anterior parietal and postcentral sulcal arteries.
Plate 142
Cerebral Vasculature
Arteries of Posterior Cranial Fossa H
H
H
B
H
H
M
H
H
n
M
H
M
M
B
H
H
B
B
B
n
H
I
M
R
M
W
n
n
B
H
B
H
'WglfiigM H H i
M
Thalamogeniculate arteries
Lateral and medial geniculate bodies of left thalamus
Anterior choroidal artery Crura of fornix Anterolateral central (lenticulostriate) arteries Heads of caudate nuclei Septum pellucidum
Choroid plexuses of lateral ventricles Pulvinars of left and right thalami Splenium of corpus callosum Occipital (posterior) horn of right lateral ventricle Right dorsal branch to corpus callosum (posterior pericallosal artery) Parietooccipital ) Branches of > right posterior Calcarine ) cerebral artery
Corpus callosum Anterior cerebral arteries Longitudinal cerebral fissure
Superior colliculi Superior vermian branch
Optic nerve (II) Ophthalmic artery
Posterior medial choroidal artery to choroid plexus of 3rd ventricle
Anterior cerebral artery Middle
Posterior lateral choroidal artery
cerebral artery Posterior
Lateral (marginal) branch
communicating artery
Inferior vermian artery (phantom)
Thalamoperforating arteries Left internal carotid artery
Choroidal branch to 4th ventricle (phantom) and Cerebellar tonsillar branch of posterior inferior cerebellar artery
Basilar artery Pontine arteries Labyrinthine (internal acoustic) artery Posterior cerebral artery Superior cerebellar artery Anterior inferior cerebellar artery (AICA) Anterior meningeal branch of vertebral artery Temporal branches of posterior cerebral artery Anterior spinal artery
Cerebral Vasculature
Outline of 4th ventricle (broken line) Posterior meningeal branch of vertebral artery Posterior inferior cerebellar artery (PICA) Left posterior spinal artery Left vertebral artery
P0ate 143
Left superior and inferior colliculi
Left pulvinar
Basal vein (of Rosenthal)
Right pulvinar Internal cerebral veins
Posterior mesencephalic vein
Splenium of corpus callosum
Medial geniculate body
Great cerebral vein (of Galen)
Lateral mesencephalic vein
Dorsal vein of corpus callosum
Lateral geniculate body
Inferior sagittal sinus
Left thalamus (cut surface)
Straight sinus Falx cerebri
Optic tract
Confluence of sinuses
Tentorium cerebelli (cut)
Inferior thalamostriate veins
Left transverse sinus {cut)
Deep middle cerebral vein {cut)
Superior sagittal sinus
Anterior cerebral vein Optic nerve (II)
*
>>
*
*
yf
"f
Superior vermian vein
)
Inferior vermian vein Falx cerebelli (cut) and occipital sinus
Anterior pontomesencephalic vein
Inferior cerebellar hemispheric veins
Trigeminal nerve (V) Transverse pontine vein
Intraculminate vein Superior cerebellar vein (inconstant)
Petrosal vein (draining to superior petrosal sinus)
Preculminate vein
Lateral pontine vein
Precentral cerebellar vein Superior retrotonsillar vein
Anteromedian medullary vein Vein of lateral recess of 4th ventricle Superior, middle and inferior cerebellar peduncle's Anterior spinal vein
Plate 144
(Inferior retrotonsillar) vein of cerebellomedullary cistern Posterior spinal vein 4th ventricle
Parts of cerebellum L CL C D F
Lingula Central lobule Culmen Declive Folium
TU P U N T
Tuber Pyramid Uvula Nodule Tonsil
Cerebral Vasculature
For superficial veins of brain see
Plate 102
Longitudinal cerebral fissure Anterior cerebral veins Rostrum of corpus callosum Septum pellucidum Anterior vein of septum pellucidum Head of caudate nucleus Anterior vein of caudate nucleus Transverse veins of caudate nucleus Interventricular foramen (of Monro) Columns of fornix Superior thalamostriate vein Superior choroid vein and choroid plexus of lateral ventricle Thalamus a choroidea of 3rd ventricle Lateral direct vein Posterior vein of caudate nucleus Internal cerebral veins Basal vein (of Rosenthal) Great cerebral vein (of Galen) Inferior sagittal sinus traight sinus um cerebelli nsverse sinus Confluence of sinuses Superior sagittal sinus
Dissection: superior view
Anterior cerebral vein Superficial middle cerebral vein (draining to sphenoparietal sinus
Optic chiasm
Deep middle cerebral vei Cerebral crus Basal vein (of Rosenthal) Lateral geniculate body Medial geniculate body
Inferior cerebral veins
Pulvinar of thalamus Splenium of corpus callosum Great cerebral vein (of Galen)
Inferior anastomotic vein (of Labbe)
Dissection: inferior view
Plate 145
Subependymal Veins of Brain
Posterior veins of septum pellucidum Superior thalamic veins Superior choroid vein Transverse veins of caudate nucleus
Lateral direct vein Posterior terminal vein of caudate nucleus (posterior part of thalamostriate vein) Internal cerebral veins (right and left) Medial (atrial) vein of lateral ventricle
Superior thalamostriate vein
Lateral (atrial) vein of lateral ventricle
Lateral ventricle
Splenium of corpus callosum
Anterior vein of caudate nucleus
Great cerebral vein (of Galen)
Anterior vein of septum pellucidum
Dorsal vein of corpus callosum
Genu of corpus callosum
Inferior sagittal sinus Internal occipital vein Straight sinus Occipital (posterior) horn of lateral ventricle
Interventricular foramen (of Monro) Anterior commissure nterthalamic adhesion Anterior cerebral vein Optic chiasm Cerebellum
3rd ventricle Deep middle cerebral vein Inferior thalamostriate veins Basal vein (of Rosenthal) Temporal (inferior) horn of lateral ventricle Posterior mesencephalic vein
Superior vermian vein
Hippocampal and inferior ventricular veins Cerebral aqueduct 4th ventricle Lateral and median apertures of 4th ventricle
Plate 146
Veins on lateral wall of ventricle Veins on medial wall and floor of ventricle All other veins
Cerebral Vasculature
Hypothalamus and Hypophysis MMHnHHHRHHHHnnnn^ See also
Plates 106, 107
Septum pellucidum Thalamus Fornix Hypothalamic sulcus Anterior commissure
Paraventricular Posterior Dorsomedial
Principal nuclei of hypothalamus
Supraoptic Ventromedial Arcuate (infundibular) Mammillary body — V Optic chiasm Infundibulum (pituitary stalk) Hypophysis (pituitary gland)
Lamina terminalis
Hypothalamic sulcus
Paraventricular hypothalamic nucleus Supraoptic hypothalamic nu Supraopticohypophyseal tract Tuberohypophyseal tract
Mammillary body
/
Hypothalamohypophyseal tract Infundibulum (pituitary stalk)
Pars tuberalis
Adenohypophysis (anterior lobe of pituitary gland)
Fibrous trabecu Pars intermedia Pars distalis
Arcuate (infundibular) nucleus
Median eminence of tuber cinereum Infundibular stem
Neurohypophysis (posterior lobe of pituitary gland)
Infundibular process
Plate 147
Arteries and Veins of Hypothalamus and Hypophysis See also
Plate 140
v.
,
1{ v
Primary plexus of hypophyseal portal system Superior hypophyseal artery
Long hypophyseal portal veins
Short hypophyseal portal veins Trabecula (fibrous tissue) Efferent hypophyseal vein to cavernous sinus
Secondary plexus of hypophyseal portal system
Adenohypophvsis (anterior lobe of pituitary gland)
Efferent hypophyseal vein to cavernous sinus
Neurohypophysis (posterior lobe of pituitary gland)
Capillary plexus of infundibular process
Efferent hypophyseal vein to cavernous sinus
Efferent hypophyseal veins to cavernous sinus
Plate 148
Inferior hypophyseal artery
Cerebral Vasculature
Head Scans: Sagittal MR Images
Median (A) and paramedian (B, C) sagittal MR images A
c cc
Cerebellum
N
Corpus callosum
Inferior nasal concha
NP
Nasopharynx
Extraocular muscles
O
Occipital pole
F
Frontal pole
P
Pons
FV
Fourth ventricle
PG
Pituitary gland
L
Lateral ventricle
S
Sphenoid sinus
SC
Spinal cord
M
Medulla oblongata
T
Thalamus
TC
Tentorium cerebelli
TO
Tongue
E
O N Optic nerve
MB Midbrain MS Maxillary sinus
mm
B
Regional Scans
Plate 149
SSoB8S8BS$zS3
Axial CT images of the head f r o m inferior (A) to superior (C) A B
Basilar artery
M
C
Cerebellum
MA Mastoid air cells
CH
Cerebral hemisphere
MB
CS
Confluence of sinuses
MR Medial rectus muscle
E
Eye
MS
Maxillary sinus
EA
External acoustic meatus
N
Nasal concha
NS
Nasal septum
P
Pons
S
Sphenoid sinus
SC
Semicircular canals
Medulla oblongata Midbrain
M M Masseter muscle
ES
Ethmoid sinus
F
Fat in orbit
FV
Fourth ventricle
L
Lens
LP
Lateral pterygoid muscle
SS
Superior sagittal sinus
LR
Lateral rectus muscle
T
Temporalis muscle
TL
Temporal lobe
B
Plate 150
Regional Scans
Head Scans: Coronal CT Images See also
Plates 48, 83
A
Coronal CT images of the head from anterior (A) to posterior (C)
Regional Scans
A
Anterior clinoid process
L
Lateral rectus muscle
C
Crista gaili
LS
E
Eye (vitreous chamber)
Levator palpebrae superioris and superior rectus muscles
ES
Ethmoid sinus
G
Greater wing of the sphenoid
M
Maxillary sinus
I '
Inferior nasal concha
IC
Incisive canal
IR
Inferior rectus muscle
MR Medial rectus muscle N
Nasal septum
OC Oral cavity S
Sphenoid sinus
Z
Zygomatic arch
Back and Spinal Cord Topographic Anatomy Plate 152
152 Back
Bones and Ligaments Plates 153-159 153 Vertebral Column 154 Thoracic Vertebrae 155 Lumbar Vertebrae efflgp
156
Lumbar Vertebrae: Radiographs
157 Sacrum and Coccyx 158
Vertebral Ligaments: Lumbar Region
159
Vertebral Ligaments: Lumbosacral Region
Spinal Cord Plates 160-173 160 Spinal Cord and Ventral Rami in Situ 161 Relation of Spinal Nerve Roots to Vertebrae 162 Lumbar Disc Herniation: Clinical Manifestations 163 Lumbar Puncture and Epidural Anesthesia 164
Dermatomes
165 Sympathetic Nervous System: General Topography 166 Parasympathetic Nervous System: General Topography 167 Sympathetic Nervous System: Schema 168 Parasympathetic Nervous System: Schema 169 Spinal Membranes and Nerve Roots 170 Spinal Nerve Origin: Cross Sections 171
Arteries of Spinal Cord: Schema
Atlas of Human Anatomy
Back and Spinal Cord 172 Arteries of Spinal Cord: Intrinsic Distribution 173 Veins of Spinal Cord and Vertebral Column ESS
Muscles and Nerves Plates 174-180
174 Muscles of Back: Superficial Layers 175 Muscles of Back: Intermediate Layers 176 Muscles of Back: Deep Layers 177 Nerves of Back 178 Suboccipital Triangle 179 Lumbar Region of Back: Cross Section 180 Typical Thoracic Spinal Nerve
1
Atlas of Human Anatomy
Back
External occipital protuberance
Trapezius muscle
Ligamentum nuchae
Spine of scapula
Spinous process of C7 vertebra
Deltoid muscle Infraspinatus muscle
Triceps brachii muscle Long head Lateral head Tendon
Deltoid muscle
Spine of scapula Triangle of auscultation Medial border of scapula Inferior angle of scapula Spinous process of T12 vertebra
Lumbar (triangle of Petit)
Latissimus dorsi muscle
Gluteus medius muscle
Iliac crest Erector spinae muscle
Sacrum
Gluteus maximus muscle
Posterior superior iliac spine
Greater trochanter of femur
Intergluteal (natal) cleft
Gluteal fold
* . —
Topographic Anatomy
Plate 152
Vertebral Column See also P l a t e s 1 3 , 1 7 , 1 8 , 1 5 4 , 1 5 5 , 1 5 7 , 1 8 5 , 2 4 8
Anterior view Atlas (C1) Axis (C2)
Left lateral view
Posterior view -Atlas (C1) Axis (C2) >
Cervical vertebrae
Thoracic vertebrae
Lumbar
> vertebrae
Sacrum ( S I - 5 ) Sacrum (SI —5)
Coccyx
Plate 153
Coccyx
Bones and Ligaments
See also
Superior articular process and facet
Superior costal facet
Vertebral foramen
Plate 187
Pedicle Transverse costal facet
Superior vertebral notch (forms lower margin of intervertebral foramen)
Superior costal facet
nsverse process
Pedicle
Inferior articular process
sverse costal facet
Interior costal Inferior vertebral notch
Superior articular facet
Spinous process
spinous process
T6 vertebra: lateral view
T6 vertebra: superior view
Superior articular process and facet Vertebral cana 7th rib
Superior articular process and facet
sverse process
Costal facet Inferior articular process and Spinous process of T7 vertebra
T12 vertebra: lateral view
Transverse process of T9 vertebra Inferior articular process (T9)
Lamina
Spinous process (T9)
T7, T8 and 19 vertebrae: posterior view
Bones and Ligaments
PDafte 1S4
Anulus fibrosus
Vertebral body
Nucleus pulposus
Vertebral foramen
Pedicle me?.
Transverse process
Intervertebral disc
Superior articular process Mammillary process Lamina Superior articular process
Spinous process
Mammillary process
Pedicle
L2 vertebra: superior view
Transverse process Spinous process
Vertebral body
Vertebral canal Superior articular process Mammillary process Transverse process
\
Intervertebral disc \
\
Inferior articular process
\
Inferior vertebral notch
Vertebral body
Intervertebral (neural) foramen Superior vertebral notch
Pars interarticularis Accessory process—
Lamina
Spinous process of L3 vertebra - -
Lamina •Articular facet for sacrum
Inferior articular process
L3 and L4 vertebrae posterior view
PQate
USS
Lumbar vertebrae, assembled left lateral view
H o w e s
a m d
L i g a m e n t s
LyoirafeaB*
W e r S e f e r a e ^
Anteroposterior radiograph
f ^ a d o e g r a p B i s
Lateral radiograph
B
Body of L3 vertebra
D
Intervertebral disc space
IA
Inferior articular process of L1 vertebra
I
Intervertebral foramen
L
Lamina of L4 vertebra
IA
Inferior articular process of L3 vertebra
P
Pedicle of L3 vertebra
IN
Inferior vertebral notch of L2 vertebra
S
Spinous process of L4 vertebra
P
Pedicle of L3 vertebra
SA
Superior articular process of L1 vertebra
S
Spinous process of L3 vertebra
SF
Sacral foramen
SA
Superior articular process of L4 vertebra
T
Transverse process of L3 vertebra
SN
Superior vertebral notch of L3 vertebra
Note: The vertebral bodies are numbered B©iraes
and]
Ugameinr&s
P l a t ®
1S©
Sacrum and Coccyx See also
Plates 153, 159, 248, 352-354 Superior articular process
Base of sacrum Lumbosacral articular surface
Sacral canal Superior articular process —Ala (wing)
mm.
Promontory
Sacral part of pelvic brim (linea terminalis)
BK5
Anterior (pelvic) sacral foramina
Sacral hiatus
Transverse ridges
Median sagittal section
- — A p e x of sacrum Transverse process of coccyx Coccyx
Anterior inferior view
Facets of superior articular processes^
Pelvic surface
Auricular surface Sacral tuberosity Lateral sacral crest Median sacral crest
Median sacral crest
Intermediate sacral crest
Sacral canal
Posterior sacral foramen
Intervertebral foramen
Posterior sacral foramina
•Mi W y .
r
-Sacral cornu (horn)
^
Coccygeal cornu (horn)
Sacral hiatus Anterior (pelvic) sacral foramen
Dorsal surface
Transverse process of coccyx
Coronal section through S2 foramina
Posterior superior view
PiaSe
1 5 7
B@p©s
a n d
L i g a m e n t s
Vertebral Ligaments: Lumbar Region
Left lateral view (partially sectioned in median plane)
Inferior articular process Capsule of zygapophyseal joint (partially
Anterior longitudinal ligament
opened)
Superior articular process Transverse process
Lumbar vertebral body
Spinous process Ligamentum flavum
Intervertebral disc •
•
Interspinous ligament
:
a l l • • ^
Anterior longitudinal ligament••
Supraspinous ligament
^ ' . r - ' S v . ;
•Intervertebral foramen Posterior longitudinal ligament
TV
\ f
" .' • : . -
:
—
—
Posterior vertebral segments: anterior view Anterior vertebral segments: posterior view (pedicles sectioned)
Pedicle (cut
surface)
Pedicle (cut
surface)
Ligamentum flavum
Posterior surface of vertebral bod' Lamina Posterior longitudinal ligament
Superior articular process
Intervertebral disc
Bones and Ligaments
Plate 158
2
Superior articular process
Anterior longitudinal ligament
Transverse process Lamina Pedicle [cut)
Inferior articular process
Body of LI vertebra
Pedicle
Posterior longitudinal ligament
Intervertebral foramen
Intervertebral discs
Spinous process Interspinous ligament
L2 spinal nerve
Supraspinous ligament
Superior articular processes; facet tropism (difference in facet axis) on right side Spinous process Lamina Transverse process Body of L5 vertebra
Inferior articular process Ligamentum flavum Iliolumbar ligament
L5 spinal nerve
Iliac crest
Auricular surface of sacrum (for articulation with ilium)
Posterior superior iliac spine
Sacrum
Coccyx
Posterior inferior iliac spine
Left lateral view
Posterior sacroiliac ligaments Greater sciatic foramen Spine of ischium
Lateral, Posterior sacrococcygeal ligaments
Sacrospinous ligament Lesser sciatic foramen Sacrotuberous ligament
Plate 159
Posterior view
Bones and Ligaments
Spinal Cord and Ventral Rami in Situ
C I vertebra (atlas) C1 spinal nerve C2 vertebra (axis) C8 spinal nerve
Cervical plexus C7 vertebra T1 vertebra Brachial plexus
T1 spinal nerve 1 st rib
Spinal dura mater
Filaments of spinal nerve roots (T7 and T8) Intercostal nerves T12 vertebra
mat
T12 spinal nerve
LI vertebra 12th rib Iliohypogastric nerve Subcostal nerve L1 spinal nerve
Ilioinguinal nerve
Conus medullaris
Lumbar plexus Cauda equina
L5 vertebra
L5 spinal nerve
Femoral nerve
S1 spinal nerve Sacrum (cut
away)
Filum terminale internum Termination of dural sac Filum terminale externum (coccygeal ligament) S3 spinal nerve Coccygeal nerve
SporaaQ
ist
Sacral plexus Superior and inferior gluteal nerves Sciatic nerve Posterior femoral cutaneous nerve Pudendal nerve Coccyx
PGafe
<3 6 ©
Relation of Spinal Nerve Roots to Vertebrae
C1 spinal nerve exits above C1 vertebra
Base of skull Cervical enlargement
C8 spinal nerve exits below C7 vertebra (there are 8 cervical nerves but only 7 cervical vertebrae)
Lumbar disc protrusion does not usually affect nerve exiting above disc. Lateral protrusion at disc level L4-5 affects L5 spinal nerve, not L4 spinal nerve. Protrusion at disc level L5-S1 affects SI spinal nerve, not L5 spinal nerve.
Lumbar enlargement Conus medullaris (termination of spinal cord)
Cauda equina
Filum terminale internum
Sacrum Filum terminale externum (coccygeal ligament)
S4 S5
Termination of clural sac
Coccygeal nerve Coccyx
Coccygeal nerve
Cervical nerves Thoracic nerves Lumbar nerves Sacral and coccygeal nerves
Plate 161
Medial protrusion at disc level L4-5 rarely affects L4 spinal nerve but may affect L5 spinal nerve and sometimes S I - 4 spinal nerves.
Spinal Cord
Lumbar Disc Herniation: Clinical Manifestations
Schematic cross section showing compression of nerve root
Nucleus pulposus Characteristic posture in left-sided lower lumbar disc herniation
Nerve root Dura
Surgical exposure of lower lumbar disc herniation
Clinical features of herniated lumbar nucleus pulposus Level of herniation
L4—5 disc; 5th lumbar nerve root
L 5 - S 1 disc; 1st sacral nerve root
SpinaS ©@rdl
Pain
Over sacroiliac joint, hip, lateral thigh and leg
Over sacroiliac joint, hip, posterolateral thigh and leg to heel
Numbness
Lateral leg, first 3 toes
Back of calf, lateral heel, foot to toe
Weakness
Dorsiflexion of great toe and foot; difficulty walking on heels; foot drop may occur
Atrophy
Reflexes
Minor
Changes uncommon in knee and ankle jerks, but internal hamstring reflex diminished or absent
Plantar flexion of foot and great toe may be affected; difficulty walking on toes Gastrocnemius and soleus
Ankle jerk diminished or absent
Pflate 162
Lumbar Puncture and Epidural Anesthesia
Lumbar puncture Cauda equina
Subarachnoid space Needle entering subarachnoid space Iliac crest
Arrows show locations of insertion of needles.
Epidural anesthesia
Dural sac Epidural space Spinous process of L4 Ligamentum flavum Needle entering epidural space
Epidural anesthesia and lumbar puncture are performed by inserting a needle above or below the L4 vertebral spine, which lies at the level of the iliac crest. For epidural anesthesia, the needle passes into the epidural space, and anesthetic agent bathes the nerve roots in proximity. Lumbar puncture, on the other hand, is performed in order to collect a sample of cerebrospinal fluid (CSF) or to introduce an anesthetic agent into the CSF (spinal anesthesia), so therefore the needle penetrates the dural sac to enter the subarachnoid space. ^ , ,
r
Plate 163
Spinal Cord
Dermatomes — , — _
See also
Plates 483, 543; for maps of cutaneous nerves see Plates 24, 472, 474-476, 478, 481, 538-542
Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any two adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).
Levels of principal dermatomes C5 C5, 6, 7 C8, T1 C6 C6, 7, 8 C8 T4
Spinal Cord
Clavicles Lateral parts of upper limbs Medial sides of upper limbs Thumb Hand Ring and little fingers Level of nipples
T10 L1 LI/ 2, 3, 4 L4, 5, SI L4 51, 2, L5 SI 52, 3, 4
Level of umbilicus Inguinal or groin regions Anterior and inner surfaces of lower limbs Foot Medial side of great toe Posterior and outer surfaces of lower limbs Lateral margin of foot and little toe Perineum
Plate 164
Sympathetic Nervous System: General Topography
Internal carotid plexus Internal carotid nerve Superior cervical gan
Gray rami communicantes
External carotid nerve
Cervical sympathetic trunk Middle cervical ganglion
Cervical cardiac nerves
Cervicothoracic (stellate) ganglion Thoracic visceral nerves Pulmonary plexus
Cardiac plexus
White and gray rami communicantes Esophageal plexus Greater thoracic splanchnic nerve
Lesser thoracic splanchnic nerve Aorticorenal ganglion Lumbar splanchnic nerves
Celiac plexus Celiac ganglion
Superior mesenteric ganglion Superior mesenteric plexus Inferior mesenteric ganglion Inferior mesenteric plexus Superior hypogastric plexus Hypogastric nerve
Sacral splanchnic nerves
Inferior hypogastric plexus
C/YczdwL / —
Plate 165
Spinal Cord
Oculomotor nerve (CN III) Facial nerve (CN VII)
Glossopharyngeal nerve (CN IX) Vagus nerve (CN X)
Lacrimal gland Ciliary ganglion Pterygopalatine ganglion Parotic! gland Submandibular ganglion Sublingual and submandibular glands Cervical cardiac branch
Cardiac plexus Pulmonary plexus
Esophageal plexus
Anterior and posterior vagal trunks
Celiac plexus
Superior mesenteric plexus
Pelvic splanchnic nerves (from S2-4) Inferior hypogastric plexus
Cavernous nerves
C/Yc^avk/ —
Spinal Cord
Plate 166
Internal carotid nerve and plexus
Superior cervical ganglion
External carotid nerve and plexus
Grav rami communicantes First thoracic ganglion
Parotid gland
Innervation to arrector pili muscles, vascular smooth muscle, and sweatglands of skin Submandibular gland Larynx Trachea Bronchi Lungs Cardiac branches ^ — - G r e a t e r thoracic —' splanchnic nerve Heart
Celiac ganglion
{W' \
-—"Lesser thoracic splanchnic nerve
Stomach 0
White r a m u s ' communicans
Liver
Aorticorenal ganglion
Gallbladder ...
Bile ducts
Pancreas ^^ \
Gray ramus ^ communicans
i
\
Least thoracic splanchnic nerve Superior mesenteric ganglion
Intestines First lumbar ganglion Sacral splanchnic nerves
f Descending / colon Sigmoid colon
First sacral ganglion
Lumbar splanchnic nerves Inferior mesenteric ganglion
Rectum Urinary bladder
Inferior hypogastric plexus
Prostate Preganglionic fibers Postganglionic fibers
Plate
External genitalia
Spinal Cord
Parasympathetic Nervous System: Schema
Pterygopalatine ganglion
Ciliary ganglion ,
Branch of oculomotor nerve (III)
, Lacrimal glands
Branch of facial nerve (VII) Medulla oblongata Branch of glossopharyngeal nerve (IX)
Parotid glands
Otic ganglion
Sublingual glands
A jRg^L
Submandibular ganglion
""--III!
4.-, Larynx
Submandibular glands
3 Trachea Bronchi Vagus nerve (X)
Lungs ^
} ...
Pulmonary plexus
Heart
Celiac ganglion
x
Stomach Liver
Superior mesenteric ganglion x
* Gallbladder Bile ducts V.;:
Pancreas
Kidnevs
Intestines Descending colon Interior hypogastric plexus
Sigmoid colon Rectum
Pelvic splanchnic nerves Preganglionic fibers Postganglionic fibers
Spinal Cord
External genitalia
Urinary bladder Prostate
C/ictf/tatik-
/—/y.P.
Plate 168
Posterior view
Ventral root of spinal nerve Dorsal root of spinal nerve Dorsal root (spinal) ganglion White and gray rami communicantes to and from sympathetic trunk Ventral ramus of spinal Dorsal ramus of spinal nerve Dura mater
Arachnoid mater
Mesothelial septum in dorsal median sulcu
Pia mater overlying spinal cord Filaments of dorsal root Denticulate ligament Dorsal horn Membranes removed: anterior view
(greatly
magnified)
Lateral horn
Ventral horn
Gray matter White matter
Filaments of dorsal root Dorsal root of spinal nerve Filaments of ventral root Dorsal root (spinal) ganglion Dorsal ramus of spinal nerve Ventral ramus of spinal nerve root of spinal nerve Spinal nerve
ray and white rami communicantes
Plate 169
Spinal Cord
Spinal Nerve Origin: Cross Sections —
— H — M M W M M
_ _
_
—
HMMMMHMMMMBMBM—i
——••
See also
Plates 169,172,173
Section through thoracic vertebra Body of vertebra Dura mater
Fat in epidural space
Arachnoid mater*
Sympathetic ganglion Denticulate ligament Ventral root
Subarachnoid space Pia mater*
White and gray rami communicantes
Recurrent meningeal branches of spinal nerve
Spinal nerve Ventral ramus (intercostal nerve) Dorsal ramus
Dorsal root (spinal) ganglion Dorsal root Lateral horn of gray matter of spinal cord Medial branch
Section through lumbar vertebra
Sympathetic ganglion
Lateral branch
of dorsal ramus of spinal nerve
Internal vertebral (epidural) venous plexus (of Batson)
Dura mater Arachnoid mater
Gray ramus communicans
Ventral root
Fat in epidural space
Spinal nerve Ventral ramus (contributes to lumbar plexus) Dorsal ramus
4 Dorsal and ventral roots of lumbar and sacral spinal nerves forming cauda equina
SpimaS
©©G^d]
Dorsal root (spinal) ganglion Dorsal root Conus medullaris
*
Leptomeninges
Plate 170
2
Arteries of Spinal Cord: Schema See also
Plate 138 Anterior view
Posterior view
Posterior cerebral artery Superior cerebellar artery
Posterior spinal arteries
Basilar artery Anterior inferior cerebellar artery (AICA)
Vertebral artery
Posterior inferior cerebellar artery (PICA)
Posterior segmental medullary arteries
Anterior spinal artery
Deep cervical artery
Vertebral artery Anterior segmental medullary arteries
Ascending cervical artery
Ascending cervical artery Subclavian artery
Deep cervical artery Subclavian artery
Posterior segmental medullary arteries
Anterior segmental medullary artery
Posterior intercostal artery Pial plexus
Thoracic vertebrae
Posterior intercostal arteries
Major anterior segmental medullary artery (great radicular artery of Adamkiewicz)
Posterior segmental medullary arteries
Anterior segmental medullary artery
Anastomotic loops to anterior spinal artery Lumbar artery
W i W
Lumbar > vertebrae <
Anastomotic loops to posterior spinal arteries-
Lateral (or medial) sacral arteries
Lateral (or medial) sacral arteries Sacrum
Plate 171
Lumbar arteries
Note: All spinal nerve roots have associated r a d i c u l a r or s e g m e n t a l m e d u l l a r y a r t e r i e s . M o s t roots have radicular arteries {see Plate 172). Both types of arteries run along roots, but radicular arteries end before reaching anterior or posterior spinal arteries; larger segmental medullary arteries continue o n to supply a segment of these arteries.
Spinal Cord
Posterior spinal arteries Anterior spinal artery Anterior segmental medullary artery Anterior radicular artery Posterior radicular artery Branch to vertebral body and dura mater Spinal branch Dorsal branch of posterior intercostal artery Posterior intercostal artery Paravertebral anastomoses Prevertebral anastomoses Thoracic (descending) aorta
Section through thoracic level: anterosuperior view
Sulcal (central) branches to right side of spinal cord Posterior radicular artery Anterior segmental medullary artery
Right posterior spinal artery Peripheral branches from pial plexus Sulcal (central) branches to left side of spinal cord Left posterior spinal artery
Pial arterial plexus Anterior and posterior radicular arteries Anterior spinal artery Posterior radicular artery
Arterial distribution: schema
Note: All spinal nerve roots have associated r a d i c u l a r or s e g m e n t a l m e d u l l a r y a r t e r i e s . Most roots have radicular arteries. Both types of arteries run along roots, but radicular arteries end before reaching anterior or posterior spinal arteries; larger segmental medullary arteries continue on to supply a segment of these arteries.
Spinal Cord
Anterior segmental medullary artery Pial arterial plexus
Plate 172
Internal vertebral (epidural) venous plexus External vertebral venous plexus
Intervertebral vein j
• " (. V
Internal vertebral (epidural) venous plexus (Batson's veins)
External vertebral venous plexus
External vertebral venous plexus
Basivertebral vein
Basivertebral vein Internal vertebral dural) venous plexus
mem
Anterior spinal vein Anterior sulcal (central) vein
wm
Segmental medullary/ radicular veins /
ft
Basivertebral vein
Intervertebral vein
Internal vertebral (epidural) venous plexus (Batson's veins)
Internal vertebral (epidural) venous plexus External vertebral venous plexus Intervertebral vein Anterior segmental medullary/radicular vein Posterior segmental medullary/radicular vein Pial venous plexus Posterior sulcal (central) vein Posterior spinal vein Internal vertebral (epidural) venous plexus
Plate 173
Spinal Cord
Muscles of Back: Superficial Layers
Superior nuchal line of skull Spinous process of C2 vertebra Sternocleidomastoid muscle Posterior triangle of neck Trapezius muscle
S e m i s p i n a l capitis muscle Splenius capitis muscle Spinous process of C7 vertebra Splenius cervicis muscle Levator scapulae muscle Rhomboid minor muscle (cut) Supraspinatus muscle
Infraspinatus fascia
Serratus posterior superior muscle
Teres minor muscle
Rhomboid major muscle (cut)
Teres major muscle
Infraspinatus fascia (over infraspinatus muscle)
Latissimus dorsi muscle
Spinous process of T12 vertebra
Teres minor and major muscles Latissimus dorsi muscle (cut)
Thoracolumbar fascia Serratus anterior muscle External oblique muscle Internal oblique muscle in lumbar triangle (of Petit) Iliac crest Gluteal aponeurosis (over gluteus medius muscle)
Serratus posterior inferior muscle 12th rib Erector spinae muscle External oblique muscle Internal oblique muscle
Gluteus maximus muscle
Muscles and Nerves
Plate 174
2
Superior nuchal line of skull
Rectus capitis posterior minor muscle Obliquus capitis superior muscle
Longissimus capitis muscle
Rectus capitis posterior major muscle Obliquus capitis inferior muscle Longissimus capitis muscle
Splenius capitis and splenius cervicis muscles
S e m i s p i n a l capitis muscle (cut) Spinalis cervicis muscle Spinous process of C7 vertebra
I l i o c o s t a l muscle
Longissimus cervicis muscle lliocostalis cervicis muscle
Erector spinae < muscle
lliocostalis thoracis muscle Spinalis muscle
Hook Spinalis thoracis muscle Longissimus thoracis muscle
Serratus posterior inferior muscle
Tendon of origin of transversus abdominis muscle
Internal oblique muscle
lliocostalis lumborum muscle Spinous process of T12 vertebra Transversus abdominis muscle and tendon of origin Thoracolumbar fascia (posterior layer) (cut)
External oblique muscle (cut)
Iliac crest
Plate 175
Muscles and Nerves
Rectus capitis posterior minor muscle
Superior nuchal line of skull
Obliquus capitis superior muscle
Mastoid process
Rectus capitis posterior major muscle
Posterior tubercle of atlas (CI vertebra)-
Transverse process of atlas ( C I )
Spinous process of axis (C2 vertebra)
Obliquus capitis inferior muscle Longus
Semispinalis capitis muscle
Brevis
Spinous process of C7 vertebra
Rotatores cervicis muscles
Levator costae muscle
External intercostal muscles
Longus ) Rotatores Brevis \ thoracis muscles Semispinalis thoracis muscles
Brevis \ Levatores Longus \ costarum muscles
iMultifidus muscles
Thoracolumbar fascia (anterior layer)
Interspinals lumborum muscle
Intertransversarius muscle
Thoracolumbar fascia (posterior layer) (cut)
Quadratus lumborum muscle
Transversus abdominis muscle and tendon of origin
Iliac crest iMultifidus muscles
Erector spinae muscle (cut)
GlyseOes
a n d
i l e r w e s
iMultifidus muscles (cut) S,\»«V
.•
. . .
P l a t e
1 7 ®
2
Nerves of Back See also
Plates 180, 192, 254, 258
Accessory nerve (XI) Trapezius muscle ( r e f l e c t e d ) Levator scapulae muscle Transverse cervical artery and vein Subtrapezial plexus
Greater occipital nerve (dorsal ramus of C2 spinal nerve) 3rd occipital nerve (dorsal ramus of C3 spinal nerve) Lesser occipital nerve / _ . . ( Great auricular nerve ) Trapezius muscle Posterior cutaneous branches (from medial branches of dorsal rami of C4-T6 spinal nerves; C7, 8 are minimal) ..
Supraspinatus muscle
Cervical plexus (ventral rami of C2, 3 spinal nerves)
/
Deltoid muscle Infraspinatus fascia
Spine of scapula
Teres minor and major muscles
Infraspinatus fascia
Superior lateral brachial cutaneous nerve (from axillary nerve C5, 6) Posterior cutaneous branches (from lateral branches of dorsal rami of T7-12 spinal nerves)
Rhomboid minor muscle Rhomboid major muscle
Lateral cutaneous branches of ventral rami (intercostal nerves)
Latissimus dorsi muscle External oblique muscle Spinous process of T12 vertebra
Iliac crest
Thoracolumbar fascia
Iliohypogastric nerve (ventral ramus of LI spinal nerve) Superior clunial nerves (dorsal rami of L1, 2, 3 spinal nerves)
Gluteus maximus muscle
Medial clunial nerves (dorsal rami of S1, 2, 3 spinal nerves) Inferior clunial nerves from posterior femoral cutaneous nerve (sacral plexus S1, 2, 3)
Plate 177
Muscles and Nerves
Suboccipital Triangle
Epicranial aponeurosis (galea aponeurotica)
Semispinalis capitis muscle (cut and reflected)
Occipital belly (occipitalis) of occipitofrontalis muscle
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
Vertebral artery (atlantic part) Obliquus capitis superior muscle
SEfe '
Suboccipital nerve (dorsal ramus of C1 spinal nerve)
Occipital artery mm
Posterior arch of atlas (CI vertebra)
Third occipital nerve (dorsal ramus of C3 spinal nerve)
Occipital artery Obliquus capitis inferior muscle
Semispinalis capitis and splenius capitis muscles in posterior triangle of neck
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
Posterior auricular artery
Great auricular nerve (cervical plexus C2, 3)
Splenius capitis muscle (cut and reflected) Third occipital nerve (dorsal ramus of C3 spinal nerve) Longissimus capitis muscle
Lesser occipital nerve (cervical plexus C2)
Splenius cervicis muscle Semispinalis cervicis muscle
Sternocleidomastoid muscle
Trapezius muscle
Posterior cutaneous branches of dorsal rami of C4, 5, 6 spinal nerves
ilyseles and Nerwes
Semispinalis capitis muscle (cut) Splenius capitis muscle (cut)
Plate 178
Descending (2nd) part of duodenum Kidney Renal (Gerota's) fascia (anterior and posterior layers) Perirenal fat Pararenal fat Peritoneum Extraperitoneal (subserous) fascia (areolar tissue)
Inferior vena cava Pancreas Anterior longitudinal ligament Crura of diaphragm Superior mesenteric artery and vein Mesentery Abdominal aorta
Transversalis fascia
Duodenojejunal junction Body of L2 vertebra Psoas major muscle and fascia Lumbar spinal nerve Transverse process
External oblique muscle
Spinal dura mater Cauda equina
Internal oblique muscle
Transversus abdominis muscle Tendon of origin of transversus abdominis and internal oblique muscles Serratus posterior inferior muscle Latissimus dorsi muscle Quadratus lumborum muscle
Spinous process of L1 vertebra Supraspinous ligament Erector spinae muscle Thoracolumbar fascia (posterior layer) Thoracolumbar fascia (middle layer) Thoracolumbar fascia (anterior layerquadratus lumborum fascia)
Plate 179
Muscles and Nerves
Typical Thoracic Spinal Nerve See also
Plates 192, 258
Anterior cutaneous branch Medial branch
Lateral branch
Sternum
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
-Anterior branch Lateral cutaneous branch
Intervertebral foramen
Posterior branch
Serratus anterior muscle Latissimus dorsi muscle
— Subscapularis muscle
Teres major muscle
Scapula
Infraspinatus muscle
Dorsal ramus Medial branch Lateral branch Posterior cutaneous branch
Rhomboid major muscle Erector spinae muscle nternal intercostal membrane
Note: In lower thoracic region, lateral branch of dorsal ramus is longer, motor, and cutaneous; medial branch is shorter and motor only.
Muscles and Nerves
4
Plate 180
*' v
2 *
ion 3 Thorax Topographic A n a t o m y Plates 181 MeMMJXMMMMMl
181
Thorax
Mammary Gland Plates 182-184
182
Mammary Gland
183 Arteries of Mammary Gland 184
Lymph Vessels and Nodes of Mammary Gland
B o d y Wall Plates 185-195
185
Bony Framework of Thorax
186
Ribs and Sternocostal Joints
187
Costovertebral Joints
188 Anterior Thoracic Wall 189 Anterior Thoracic Wall (continued) 190
Chest Drainage Tube Placement
191
Anterior Thoracic Wall: Internal View
192
Intercostal Nerves and Arteries
193
Phrenic Nerve
194
Diaphragm: Thoracic Surface
195
Diaphragm: Abdominal Surface
L y ^ g s Plates 196-210
196 Topography of Lungs: Anterior View 197 Topography of Lungs: Posterior View 198
Lungs in Situ: Anterior View
Atlas of Human Anatomy
Thorax 199
Lungs: Medial Views
226
Nerves of Heart
200
Bronchopulmonary Segments
227
Innervation of Heart: Schema
201
Bronchopulmonary Segments (continued)
228
Innervation of Blood Vessels: Schema
202
Trachea and Major Bronchi
229
Prenatal and Postnatal Circulation
203
Nomenclature of Bronchi: Schema
204
Intrapulmonary Airways: Schema
205
Intrapulmonary Blood Circulation: Schema
206
Great Vessels of Superior Mediastinum
230
Mediastinum: Right Lateral View
207
Bronchial Arteries and Veins
231
Mediastinum: Left Lateral View
208
Lymph Vessels and Nodes of Lung
232
Esophagus in Situ
209 Autonomic Nerves in Thorax
233
Topography and Constrictions of Esophagus
210
234
Musculature of Esophagus
235
Pharyngoesophageal Junction
Heart
236
Esophagogastric Junction
Plates 211-229
237 Arteries of Esophagus
211
Heart in Situ
238 Veins of Esophagus
212
Heart: Anterior Exposure
239
Lymph Vessels and Nodes of Esophagus
213
Radiograph of Chest
240
Nerves of Esophagus
214
Heart: Base and Diaphragmatic Surfaces
241
Mediastinum: Cross Section
215
Pericardial Sac
216
Coronary Arteries and Cardiac Veins
217
Coronary Arteries and Cardiac Veins: Variations
218
Coronary Arteries: Arteriographic Views
219
Coronary Arteries: Arteriographic Views (continued)
220
Right Atrium and Ventricle
221
Left Atrium and Ventricle
Innervation of Tracheobronchial Tree: Schema
Mediastinum Plates 230-241
#
Regional S c a n s Plate 242
242
Chest Scans: Axial CT Images
Cross-Sectional Anatomy Plates 243-246
222 Valves and Fibrous Skeleton of Heart
243
Cross Section of Thorax at T3 Level
223
244
Cross Section of Thorax at T3-4 Disc Level
224 Atria, Ventricles, and Interventricular Septum
245
Cross Section of Thorax at T4-5 Disc Level
225
246
Cross Section of Thorax at T7 Level
Valves and Fibrous Skeleton of Heart (continued)
Conducting System of Heart
Atlas of Human Anatomy
Thorax H6M
H H mwHESNKn! 36
.
Biceps brachii muscle Sternocleidomastoid muscle Sternal head Clavicular head
Triceps brachii muscle Axilla
Clavicle Anterior axillary fold
Jugular notch
Posterior axillary fold
Deltoid muscle
Pectoralis major muscle Clavicular head Sternal head
Body of sternum Nipple
Latissimus dorsi muscle
Cephalic vein
Xiphoid process of sternum Serratus anterior muscle Linea alba Rectus abdominis muscle Tendinous intersection
fmm-:..
Serratus anterior muscle
T@p@gsraptilc Anatomy
External oblique muscle C/farfatk/ Af.7>.
Plate 181
3
3
M a m m a r y
G l a n d
Anterolateral dissection
•Suspensory ligaments of breast (Cooper's) (y
Pectoralis major muscle (deep to pectoral fascia)
•••••••• v
Wmmt : Is? Wfam • W*
A
f
fel
/
I
M
sjviy
' f|
-Areolar glands A
m*
Axillary tail (of Spence) Serratus anterior muscle m
External oblique muscle
m
m
.
i m '
n
gSeM
v
Clavicle :•
JB5 Im
Lv^"-" M. *
s*.
di
m
1
S3
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m.
major muscle v <.
v w
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1
<
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<
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-i
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.
v;-"
Areola
. V .
Nipple
ft
IC': (
iM
Fat
^
Ik I ^ L
s f t l ! is 1
•mm
if
M AH
Lactiferous ducts
Gland lobules
it
Intercostal muscles
Intercostal vessels and nerve
V
1
M
Pectoral fascia-
•X
«
- y ^ Z ^ h . ,
Lactiferous sinus
' •yi •
•
Suspensory ligaments of breast (Cooper's)
...
Lactiferous duct -
> )
•v
V;
Lactiferous sinus Lung-
I AM ' .|
r / ; v i l l i . V-
6th rib •
Plate 182
v
M
V V,
m
;.
•;<
•
•'•
^
:•'
••• - ' v . y - N v ; ' ; ,
\\
W
Gland lobules
Fat (subcutaneous tissue layer)
J;
-./m •»:
?•
Sagittal section
Mammary Gland
Arteries of Mammary Gland
Subclavian artery Internal thoracic artery and its perforating branches Medial mammary branches Axillary artery Brachial plexus Brachial artery
i§mm
Lateral thoracic artery and Lateral mammary branches Axillary tail (of Spence) Lateral mammary branches of lateral cutaneous branches of posterior intercostal arteries
Mmmmar^
©Darsdj
Plate 183
Lymph Vessels and Nodes of Mammary Gland
Parasternal nodes Apical axillary Interpectoral (Rotter's) nodes (subclavian) nodes Central axillary nodes
WK
Lateral axillary (humeral) nodes
is®
Posterior axillary (subscapular) nodes Anterior axillary (pectoral) nodes
Pathway to anterior mediastinal nodes
P l a t e
1 8 4
M a m m a r y
© l a n d
Bony Framework of Thorax See also
Plate 248
Anterior view Acromion Coracoicl process
Scapula
Glenoid cavity Neck
•
Sternum
Xiphoid process
Scapular notch Subscapular fossa
True ribs (1-7) Costal cartilages False ribs (8-12) Floating ribs (11-12)
Clavicle
Posterior view
Acromion Supraspinous fossa Spine
Scapula
Infraspinous fossa
True ribs (1-7)
False ribs (8-12)
Floating ribs
(11-12)
Body Wall
Plate 185
3
Ribs and Sternocostal Joints
Subclavius muscle
1st left rib: superior view
Muscle attachments
Grooves for subclavian vein and artery
\
Head
Origins
Neck
Insertions
Tubercle (no angle)
Anterior' 1 scalene muscle^""
Middle rib: posterior view
Head Neck
Serratus anterior muscle (1 st digitation)
Head
Tubercle
Middle scalene muscle
Neck
Posterior scalene muscle
%U
2nd left rib: N superior view
for transverse process of vertebra
Serratus anterior m u s c l e ^ (2nd digitation)
Interclavicular ligament Articular disc
^•^^Clavicle .
Articular facets for vertebral body
Manubrium
Costal groove Costoclavicular ligament Articular cavity
Manubriosternal joint
Intraarticular sternocostal ligament Articular cavities
Costal cartilages
Costochondral joints Vst^V
A
Radiate sternocostal ligaments
Note: The head of a typical rib articulates with the superior costal facet of the thoracic vertebra of the same number (by its inferior articular facet), the inferior costal facet of the vertebra above (by its superior articular facet), and the intervertebral disc between the two vertebrae. The costal tubercle articulates with the transverse process of the vertebra of the same number.
Costal cartilages
Interchondral joints
/
/
Xiphoid process
Costoxiphoid ligament
Plate 186
i
y
f x .
Sternocostal articulations: anterior view
Body Wall
Costovertebral Joints See also
Anterior longitudinal ligament
Plate 154
Transverse costal facet (for tubercle of rib of same number as vertebra) Lateral costotransverse ligament
Inferior costal facet (for head of rib one number greater)
Intertransverse ligament
Interarticular ligament of head of rib Superior costal facet (for head of rib of same number)
Superior costotransverse ligament Superior articular facet of rib head
Radiate ligament of head of rib
Intraarticular ligament
Radiate ligament of head of rib
Synovial cavities
Left lateral view
Superior costotransverse ligament (cut) Superior costal facet (for head of rib of same number)
'
jijjjitiVlf"
Transverse process [cut
Costotransverse ligament Lateral costotransverse ligament Radiate ligament of head of rib
Transverse section: superior view
Costotransverse ligament
Lateral costotransverse ligament Superior costotransverse ligament
Intertransverse ligament
Right posterolateral view
Plate 187
3
Anterior Thoracic Wall
Sternocleidomastoid muscle Posterior triangle of neck Trapezius muscle Perforating branches of internal thoracic artery and anterior cutaneous branches of intercostal nerves
Sternothyroid muscle ' Sternohyoid muscle [ l n v e ? t e f ' b V . • . . . . \ cervical fascia Omohyoid muscle Clavicle Subclavius muscle invested by clavipectoral fascia Thoracoacromial artery (pectoral branch) and lateral pectoral nerve
Pectoralis major muscle
Costocoracoid ligament
Cephalic vein Acromion
Coracoid process
Deltoid muscle
Medial pectoral nerve
>.•.>'y
Long thoracic nerve and lateral thoracic artery
Pectoralis minor muscle invested by Clavipectoral fascia
Latissimus dorsi muscle
Digitations of serratus anterior muscle
Digitations of serratus anterior muscle Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries External oblique muscle-
Sternalis muscle (inconstant)
Plate 188
External intercostal muscles Body and xiphoid process of sternum
Anterior layer of rectus sheath
/—/y.p.
External intercostal membranes anterior to internal intercostal muscles
Internal oblique muscle Rectus abdominis muscle Cutaneous branches of thoracoabdominal (abdominal portions of intercostal) nerves and superior epigastric artery
Body Wall
Anterior Thoracic Wali (continued) iHMHMi
CWC5C
a l Wg jB i IMyMM li ^
Omohyoid, sternothyroid and sternohyoid muscles Clavicle Subclavius muscle
Thoracoacromial artery
I
HI—inlHHilil PW—Wr •••.••
.'
...
.
nternal jugular vein Levator scapulae muscle Anterior Middle > Scalene muscles Posterior Phrenic nerve
Coracoid process Cephalic vein Pectoralis major muscle (cut) Deltoid muscle
Brachial plexus Thoracic duct Subclavian artery and vein Axillary artery and vein
Intercostobrachial nerve
Superior thoracic artery
Long thoracic nerve and lateral thoracic artery
Internal thoracic artery and veins
Pectoralis minor muscle Digitations of serratus anterior muscle Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries External intercostal muscles
External intercostal muscle Internal intercostal muscle (cut) Transversus thoracis muscle Anterior intercostal branches of internal thoracic artery Intercostal nerve
External intercostal membranes anterior to internal intercostal muscles
Musculophrenic artery and vein Transversus abdominis muscle
Rectus abdominis muscle and sheath (cat)
Body Wall
Superior epigastric arteries and veins
Plate 189
3
3
Chest Drainage Tube Placement
Preferred sites 1. For pneumothorax (2nd or 3rd interspace at midclavicular line) 2. For hemothorax (5th interspace at midaxillary line)
A.Trocar and cannula pushed through intercostal space
B.Trocar withdrawn; tube passed into chest through cannula
C.Cannula withdrawn; tube connected to underwater seal (with suction if indicated)
D. Intercostal space is pierced above rib to avoid damage to neurovascular bundle lying in costal groove
Thoracocentesis and tube drainage with underwaterseal drainage usually suffices.
Plate 190
Body Wall
A n t e r i o r
Y h m m e i e
W a l l :
^a^gBgRi^^
I n t e r n a l
W i e w
n mmm
Sternothyroid muscle Sternohyoid muscle
Manubrium of sternum Common carotid artery Inferior thyroid artery
Internal jugular vein
Vertebral artery
Anterior scalene muscle
Brachiocephalic trunk
Subclavian artery and vein
Subclavian artery and vein
Clavicle (cut) Brachiocephalic vein
Brachiocephalic vein
Phrenic nerve and pericardiacophrenic artery and vein
Internal thoracic artery and vein Anterior intercostal arteries and veins and intercostal nerve
Internal thoracic artery and vein Anterior intercostal arteries and veins and intercostal nerve
Internal intercostal muscles
Perforating branches of internal thoracic artery and vein and anterior cutaneous branch of intercostal nerve
Innermost intercostal muscles
Collateral branches of intercostal artery and vein
Transversus thoracis muscle
mm
Body of sternum Sternocostal triangle
"mm
Diaphragm Slips of costal origin of diaphragm Musculophrenic artery and vein
I
Transversus abdominis muscle
Transversus abdominis muscle Sternal part of diaphragm
Internal thoracic artery and veins Superior epigastric artery and veins
Body Wall
Plate 191
3
Intercostal Nerves and Arteries See also
Plates 180, 258 Ventral root Dorsal root (spinal) ganglion
— Spinal (radicular, or segmental medullary) branch of posterior intercostal artery Dorsal branch of posterior intercostal artery Trapezius muscle
Erector spinae muscle Dorsal ramus of thoracic nerve Costotransverse ligament
Medial branch Lateral branch
Rhomboid major muscle Erector spinae muscle Posterior intercostal artery
Intercostal nerve (ventral ramus of thoracic spinal nerve)
Internal intercostal membrane
Internal intercostal membrane deep to external intercostal muscle
Scapula Infraspinatus muscle Subscapulars muscle
Serratus anterior muscle
Serratus anterior muscle
TV •vu
»
Gray and white / rami communicantes Thoracic aorta
Sympathetic trunk and ganglia — Innermost intercostal muscle Internal intercostal muscle
Right posterior intercostal arteries (cut)
Innermost intercostal muscle Internal intercostal muscle
External intercostal muscle Transversus thoracis muscle
External intercostal muscle Sternum
Internal thoracic artery
Lateral cutaneous branch of intercostal nerve Anterior branch of lateral cutaneous branch of intercostal nerve External oblique muscle Pectoral is major muscle Anterior cutaneous branch of intercostal nerve
External oblique muscle Perforating branch Superior epigastric artery
I
Rectus abdominis muscle
Lateral cutaneous branch of posterior intercostal artery External intercostal membrane Anterior intercostal arteries
Body Wall
Phrenic Nerve See also
Ventral rami
Ventral rami
Anterior scalene muscle Right common carotid artery
Anterior scalene muscle MM
Brachial plexus
Brachial plexus
Left phrenic nerve
Right phrenic nerve
Left subclavian artery
Right subclavian artery
Left vagus nerve (X)
Right vagus nerve { X r
Left common carotid artery
Right internal ^ thoracic artery ( c u t ) ^
^
Thoracic cardiac nerves ^ l I X L e f t pericardiaco> phrenic Left periartery (cut) phrenic
— - r * — ;
Superior vena cava
Left recurrent laryngeal nerve
Root of right lungPericardial branch of phrenic nerve-" Mediastinal part of parietal pleura
Left internal thoracic artery (cut)
Brachiocephalic trunk Right pericardiacophrenic artery (cut)-
Plates 32, 129
Root of left lung Mediastinal part of parietal pleura
AS
; Jp
Costal part of parietal pleura
Diaphragmatic part of parietal pleura (cut)—— Phrenicoabdominal branches of phrenic nerves to inferior surface of diaphragm
lipi Phrenic nerves (efferent and afferent fibers)
mm
W&M
i.
Lower intercostal nerves (afferent only from peripheral part of diaphragm)
Body Wall
Plate 193
D i a p h r a g m s See also
T h o r a c i c
S u r f a c e
Plates 230, 231
Thoracic (descending) aorta
Neck of rib Left sympathetic trunk
T8~9 intervertebral disc
Left greater thoracic splanchnic nerve
Right sympathetic trunk
Hemiazygos vein
Right greater thoracic splanchnic nerve
Mediastinal pleura
Costal part of parietal pleura
Esophagus
Azygos vein
Thoracic duct V * Right leaflet of J central tendon
Diaphragmatic part of Parietal pleura (cutaway)
Diaphragmatic part of parietal pleura (cut away)
Left leaflet of central tendon
Right phrenic nerve and pericardiacophrenic artery and vein
Mediastinal part of parietal pleura and pericardium (cut)
Mediastinal part of parietal pleura and pericardium (cut)
Left phrenic nerve and pericardiacophrenic artery and vein
Right costodiaphragmatic recess of pleural c a v i t y —
Pericardium
Inferior vena cava (receiving hepatic veins)
Left costomediastinal recess of pleural cavity
Right internal thoracic artery and veins
Transversus thoracis muscle
Right costomediastinal recess of pleural cavity
Left internal thoracic artery and veins
Anterior mediastinum Sternum
Plate 194
oth costal cartilage Middle leaflet of central tendon covered by pericardium
Body Wall
Diaphragm: Abdominal Surface See also
Sternal part of diaphragm
Plates 253, 263, 270
Sternocostal triangle
Anterior branch of right phrenic nerve
Anterior branch of left phrenic nerve Costal part of diaphragm Central tendon of diaphragm
Right inferior phrenic artery
Esophageal hiatus
Caval opening
Fibers from right crus passing to left of esophageal hiatus
Right crus of diaphragm
Left inferior phrenic artery
Greater thoracic splanchnic nerve
Recurrent branch to esophagus
Lesser thoracic splanchnic nerve
Anterior branch Lateral branch Left superior suprarenal artery
Least thoracic splanchnic nerve
Left phrenic nerve
Costal part of diaphragm ft*:;
'
Left crus of diaphragm
Transversus abdominis muscle Lumbocostal triangle 12th rib Lateral arcuate ligament Lumbar part of diaphragm
Quadratus lumborum muscle
Medial arcuate ligament Transverse process of L1 vertebra
Sympathetic trunk Celiac trunk
Body Wall
Aortic hiatus
Median arcuate ligament Abdominal aorta
?
C/ikM&c^ / w.t>.
Plate 195
Topography of Lungs: Anterior View
Thyroid gland
Trachea
Cervical (cupula, or dome, of) parietal pleura
Jugular (suprasternal) notch Apex of lung
Sternoclavicular joint
Arch of aorta
Clavicle 1st rib and costal cartilage
Cardiac notch of left lung
WS&l •
••:'
Left border of heart
Right border of heart
Horizontal fissure of right lung (often incomplete)
iA" yS8
."•
Costomediastinal recess of pleural cavity
Oblique fissure of right lung
Oblique fissure of left lung
Costodiaphragmatic recess of pleural cavity
Costodiaphragmatic recess of pleural cavity
Spleen Inferior border of left lung Left dome of diaphragm
Pleural reflection
Pleural reflection Stomach Right dome of diaphragm
Bare area of pericardium Liver
Xiphoid process
L m g s
Topography of Lungs: Posterior View
Cervical (cupula, or dome, of) parietal pleura Apex of left lung 1 st rib
1st rib Oblique fissure of right lung Clavicle
Oblique fissure of left lung
Horizontal fissure of right lung (often incomplete)
Spine of scapula Left border of costal parietal pleura
Right border of costal parietal pleura
Costodiaphragmatic recess of pleural cavity
Costodiaphragmatic recess of pleural cavity
Spleen
Liver
Pleural reflection
Pleural reflection Inferior border of right lung Left kidney
Right kidney Right dome of diaphragm
Left suprarenal gland
Lwngs
Right suprarenal gland
Plate 197
3
Lungs in Situs Anterior View
Thyroid gland
Trachea and inferior thyroid veins C o m m o n carotid artery
Omohyoid, sternothyroid and sternohyoid muscles
Internal jugular vein
Manubrium of sternum
Phrenic nerve
Sternocleidomastoid muscle
Anterior scalene muscle
External jugular vein
Thoracic duct
Costal part of parietal pleura (cutaway/)
Brachial plexus
Clavicle
Subclavian artery and vein
Pectoralis major muscle
Internal thoracic artery and vein
Pectoral is minor muscle
Axillary artery and vein
Intercostal muscles
Cardiac notch of left lung
-
; >
ivAi'JvX
Superior lobe, Middle lobe, Inferior lobe of right lung
Superior lobe, Inferior lobe of left lung Costomediastinal space
Oblique fissure Horizontal fissure of right lung
Oblique fissure
Costodiaphragmatic recess
Musculophrenic artery
Diaphragmatic part of parietal pleura
Lingula of superior lobe of left lung
Diaphragm 7th costal cartilage
/
Xiphoid process
Internal thoracic artery Mediastinal part of parietal pleura Fibrous pericardium
Plate 198
Lungs
Lungs: Medial Views
Right lung Groove for subclavian artery
Apex Area for trachea Area for esophagus
Groove for brachiocephalic vein
Groove for azygos vein
Groove for 1 st rib
Oblique fissure
Groove for superior vena cava
Pleura (cut edge) Right superior lobar (eparterial) bronchus
Area for thymus and fatty tissue of anterior mediastinum
Right pulmonary arteries Right bronchial artery
Anterior border
Right intermediate bronchus
Hilurm
Right superior pulmonary veins
Horizontal fissure
Bronchopulmonary (hilar) lymph nodes
Cardiac impression
Right inferior pulmonary veins
Oblique fissure
Inferior lobe
M i d d l e lobe
Groove for esophagus
Groove for inferior vena cava
Pulmonary ligament
Diaphragmatic surface
Inferior border
Apex Groove for subclavian artery Area for trachea and esophagus Oblique fissure Groove for arch of aorta Pleura (cut edge) Left pulmonary artery-
Groove for left brachiocephalic vein Groove for 1 st rib Anterior border Area for thymus and fatty tissue of anterior mediastinum
Left bronchial arteries Left main bronchus Left superior pulmonary veins Bronchopulmonary (hilar) lymph nodes Inferior lobe Left inferior pulmonary vein Groove for descending aorta Inferior border
Hilum Cardiac impression Pulmonary ligament Cardiac notch Oblique fissure Groove for esophagus Diaphragmatic surface Lingula
[Plate 1©®
Bronchopulmonary Segments
Right lung
Anterior view
Left l u n g
Superior lobe
Superior lobe
Apical (S1)
A pi coposterior
Anterior (S3)
Superior division (culmen)
(S 1 + 2)
Posterior (S2
Anterior (S3) Superior j lingular (S 4) Inferior lingular (S 5)
Middle lobe Lateral (S4)
Lingular division
Medial (S5)
Inferior lobe
Inferior lobe
Anterior basal (S8)
Antero medial basal (S 7+8 )
Medial basal (S7)
Posterior basal (S10)
Lateral basal (S9)
Lateral basal (S9)
Posterior basal (S10) Posterior view Left l u n g
S
Superior lobe /
Apicoposterior (S 1+2 ) Anterior
/
/
/
/
Right lung
s
Superior lobe Apical (S1) Posterior (S2)
v /
Anterior (S3)
(S3)
Lingular ( Superior division I lingular (S4) Middle lobe
•N S W ' \ Inferior lobe Superior (S{)) Lateral basal (S9)
•"V
\
I
f
1 \
it:
.
Inferior lobe Superior (S6) Lateral basal (S9)
Posterior basal (S10)
Posterior basal (S10) <1 '91 o v 1' no x
Plate 200
Lateral (S4)
4P
E L m g s
3
Bronchopulmonary Segments (continued)
Lateral views Left lung Superior lobe
Superior lobe
Apical (S1)
Api coposterior (S1+2>
Posterior (S2) Anterior (S3)
Superior division (culmen)
Anterior (S3) Superior lingular (S4) Inferior lingular (S5)
M i d d l e lobe Lateral (S4) Medial (S5)
Lingular division
Inferior lobe Superior (S6)
Inferior lobe
Anteromedial basal (S7+B)
Superior (S6) Anterior basal (S8)
Lateral basal (S9)
Lateral basal (S9)
Medial views Right lung Superior lobe Apical (S1)
Left lung Superior lobe
Posterior (S2)
Apicoposterior (S 1+2 )
Anterior (S3)
Anterior (S3)
Middle lobe Medial (S5)
Superior lingular (S4) Inferior lingular (S J)
Superior division (culmen)
Lingular division
Inferior lobe
Medial basal (S7) Anterior basal (S8) Lateral basal (S9) Posterior basal (S l0 ) —
Lungs
Inferior lobe Superior (S6) -Anteromedial basal (S 7+8 ) Lateral basal (S9) Posterior basal (S10)
Plate 201
3
Trachea and Major Bronchi
Connective tissue sheath (visceral layer of pretracheal fascia)
Thyroid cartilage Median cricothyroid ligament
Tracheal cartilage (ring) Elastic fibers
Cricoid cartilage
Gland Small artery
ill
Lymph vessels
Connective tissue sheath (visceral layer of pretracheal fascia) (cut away)
Nerve Epithelium
Annular (intercartilaginous) ligaments
interior wa//
Tracheal cartilages Cross section through trachea Mucosa of posterior tracheal wall shows longitudinal folds formed by dense collections of elastic fibers
Posterior wall
Superior lobar (eparterial) bronchus
Nerve | Small arteries Gland Elastic fibers Superior lobar bronchus
To superior ^ lobe
Trachealis (smooth) muscle Esophageal muscle Epithelium Lymph vessels
B3 — Superior division bronchus Lingular bronchus
Middle lobar bronchus
|F v
Right and left main bronchi
To lingula
^Intermediate bronchus
To middle lobe
Inferior lobar bronchus
Inferior lobar bronchus ^
(
To inferior < lobe
v Intrapulmonary
Plate 202
_
_
" Extrapulmonary
To inferior lobe
v Intrapulmonary
Lungs
Nomenclature of Bronchi; Schema i 'iWlfipnii ii
}t
ii
W ' MI'IPI li'-li'ii'llln Wi' ' ij i |
'i
•Trachea
1 +2c\
Superior lobar bronchus
B (apical) Sai
B
2 b
Superior lobar (eparterial) / bronchus , /
^
B 2 (poslerior)
B
^
^
/B4a
Right and l e f t ^ main bronchi
(anterior)
B* ( a n t e r i o r ) \ Lingular bronchus
B6
(superior, lower lobe)~
^—B
4
(superior lin
^ - B ^ (superior, lower lobe) (inferior lingular)
\
(medial) J
(apicoposterior)
Superior division bronchus
Intermediate bronchus Middle lobar bronchus g4 (lateral)
B
Inferior lobar bronchus
B
}
(anteromedial basal)
g7+8a
B (medial basal)
g7-'-8ai
B 8 (anterior basal)
„ .
B8av
tf 0dn '
B8b-
B 9 (lateral basal) B 1 0 (posterior basal)
A
B 9 (lateral b a s a l ) ^ B 1 0 (posterior basal)
Nomenclature in common usage for bronchopulmonary segments (Plates 200 and 201) is that of Jackson and Huber, and segmental bronchi are named accordingly. Ikecla proposed nomenclature (as demonstrated here) for bronchial subdivisions as far as 6th generation. For simplification on this illustration, only some bronchial subdivisions are labeled as far as 5th or 6th generation. Segmental bronchi (B) are numbered from 1 to 10 in each lung, corresponding to pulmonary segments. In left lung,
Lptrags
B1 and B2 are combined as are B7 and B8. Subsegmental, or 4th order, bronchi are indicated by addition of lowercase letters a, b, or c when an additional branch is present. Fifth order bronchi are designated by Roman numerals i (anterior) or ii (posterior) and 6th order bronchi by Greek letters a or (3. Several texts use alternate numbers (as proposed by Boyclen) for segmental bronchi. Variations of standard bronchial pattern shown here are common, especially in peripheral airways.
P l a t ©
2 0 3
3
Intrapulmonary Airways? Schema
Terminal bronchiole
Smooth muscle Elastic fibers Alveolus
c c ^ - o c -Q 2 S
Cartilages
£ *
1st order
E 53
cc $ ^00
•
BH
u c o CD
2nd order
S i cu ^ DJD ^
3rd order
Respiratory bronchioles (alveoli appear at this level)
i _
1 -
o -D .
Cartilages become sparser (mostly at points of branching)
O
ro
(o i—
C
CD
— i
C
1 —
Alveolar sac Alveoli
Co
C —
C
~
O
ro - — '
i—
No further cartilages
cn Ji o -C u c o 5cc •
Acinus (part of lung supplied by terminal bronchiole)
MB
Terminal bronchiole
Respiratory bronchioles (3-8 orders) Alveolar sacs and alveoli
> Acinus
Subdivisions of i n t r a p u l m o n a r y airways
Opening of alveolar duct
Pores of Kohn
Structure of i n t r a p u l m o n a r y airways
Lungs
Intrapulmoiiary Blood Circulation: Schema MMHMMMttfll^S^^^^^Sit^^SSSIiSS^S^S^^S^SSBWHSi^Si:^^!
Terminal bronchiole /Bronchial artery (from left heart / via thoracic aorta) I W — w r r t
Pulmonary artery (from right heart)"
1
Pulmonary vein (to left heart)
^ "
Respiratory bronchioles
Pulmonary vein (to left heart)
Capillary plexuses within alveolar wall v
Septum
Septum
Pulmonary arteries and their branches distribute segmentally with the bronchi. Pulmonary veins and their tributaries drain intersegmental^.
LpGlgjS
Capillary bed within alveolar wall (cut away in places)
POate 2@S
Great Vessels of Superior Mediastinum
Cricoid cartilage Thyroid gland Right common carotid artery Right vagus nerve (X)
Thyroid cartilage Trachea Left common carotid artery Left vagus nerve (X)
Anterior scalene muscle
Anterior scalene muscle
Phrenic nerve
Phrenic nerve (cut)
Right internal jugular vein
Thoracic duct
External jugular vein
Brachial plexus
Brachial plexus
Left subclavian artery and vein
Right subclavian artery and vein
Left brachiocephalic vein
Brachiocephalic trunk
Internal thoracic artery
Right brachiocephalic vein
Arch of aorta
Phrenic nerve and pericardiacophrenic artery and vein {cut)
Vagus nerve (X)
Superior vena cava
Left recurrent laryngeal nerve
Right superior lobar (eparterial) bronchus
Ligamentum arteriosum
Right pulmonary artery—
Left pulmonary artery
Pulmonary trunk Right pulmonary veins
Left pulmonary veins
Mediastinal part of parietal pleura (cut edge)
J vfy<<
Costal part of parietal pleura (cut edge)
Mediastinal part of parietal pleura (cut edge) Costal part of parietal pleura (cut edge)
Diaphragmatic part of parietal pleura
Phrenic nerve (cut)
Right costodiaphragmalic recess of pleural cavity.
Diaphragmatic part of parietal pleura and cut edge Right intermediate bronchus Left main bronchus
Phrenic nerve (cut) Azygos vein Thoracic duct Inferior vena cava
Plate 206
Pericardium (cut edge) Diaphragm Esophagus and esophageal plexus
Lungs
3
£
Esophagus
Trachea ( pulled to left by
3rd right posterior intercostal artery Superior left bronchial artery Right bronchial artery
Aorta (pulled aside by hook)
Left main bronchus (pulled to right by hook)
Inferior left bronchial artery
Esophageal artery Esophageal branch of bronchial artery
Variations in bronchial arteries
Bronchial veins
Left main bronchu? ( turn >d up by hook Right bronchial vein Accessory hemiazygos vein Right and left bronchial arteries originating from aorta by single stem
L m g s
Only single bronchial artery to each bronchus (normally, two to left bronchus)
Right main bronchus { pulled to left and rotated by hook)
PGafe 2@7
Lymph Vessels and Nodes of Lung See also
Plates 72, 184, 239 Right paratracheal nodes
Left paratracheal nodes
Right superior tracheobronchial nodes
Bronchomediastinal lymphatic trunk Brachiocephalic vein
Bronchomediastinal lymphatic trunk
Inferior deep cervical (scalene) node
Brachiocephalic vein Inferior deep cervical (scalene) node
A/irchow's node /Thoracic duct
Internal jugular vein and jugular lymphatic trunk-
Left superior tracheobronchial nodes (Aortic arch) node of igamentum arteriosum
Right lymphatic duct Subclavian vein and subclavian lymphatic trunk
Bronchopulmonary (hilar) nodes Pulmonary (intrapulmonary) nodes
B r o n c h o p u I m o nary (hilar) nodes Pulmonary (intrapulmonary) n o d e s / .
Subpleural lymphatic plexus
\
Subpleural lymphatic plexus
Interlobular lymph vessels
Interlobular lymph vessels-
Drainage follows bronchi, arteries and veins
Drainage follows bronchi, arteries and veins
Inferior tracheobronchial (carinal) nodes Pulmonary ligaments^ Routes to mediastinum
Drainage routes Right lung: All lobes drain to pulmonary and bronchopulmonary (hilar) nodes, then to inferior tracheobronchial (carinal) nodes, right superior tracheobronchial nodes, and right paratracheal nodes on way to brachiocephalic vein via bronchomediastinal lymphatic trunk and/or inferior deep cervical (scalene) node.
Plate 208
Left lung: Superior lobe drains to pulmonary and bronchopulmonary (hilar) nodes, inferior tracheobronchial (carinal) nodes, left superior tracheobronchial nodes, left paratracheal nodes and/or (aortic arch) node of ligamentum arteriosum, then to brachiocephalic vein via left bronchomediastinal trunk and thoracic duct. Left inferior lobe drains also to pulmonary and bronchopulmonary (hilar) nodes and to inferior tracheobronchial (carinal) nodes, but then mostly to right superior tracheobronchial nodes, where it follows same route as lymph from right lung.
Lungs
Autonomic Nerves in Thorax See also
Cervicothoracic (stellate) ganglion Ansa subclavia Cervical cardiac nerves (sympathetic and vagal) Thoracic (sympathetic) cardiac branches Sympathetic trunk Vagus nerve (X) (cut) and branches to cardiac and pulmonary plexuses Thoracic (sympathetic) cardiac branches Anterior pulmonary plexus Posterior pulmonary plexus (protruding from behind right bronchus) 6th intercostal nerve Gray and white rami communicantes
Plates 130, 131, 165, 166, 318
Left recurrent laryngeal nerve Cervical cardiac nerves (sympathetic and vagal) Vagus nerve (X) (cut) Thoracic (sympathetic) cardiac branches Left recurrent laryngeal nerve Thoracic cardiac branch of vagus nerve Cardiac plexus Anterior pulmonary plexus Posterior pulmonary plexus (protruding from behind left bronchus) Sympathetic trunk Thoracic aortic plexus Esophageal plexus 8th intercostal nerve
6th thoracic sympathetic ganglion Greater thoracic splanchnic nerve Sympathetic branch to esophageal plexus
Gray and white rami communicantes Greater thoracic splanchnic nerve Lesser thoracic splanchnic nerve
Thoracic duct Anterior vagal trunk Lesser thoracic splanchnic nerve
Diaphragm (pulled
down)
Least thoracic splanchnic nerve Azygos vein (cut) Inferior vena cava (cut)
L m g s
PQafe
3
Innervation of Tracheobronchial Tree: Schema See also
Plates 167,168
From hypothalamic and higher centers Glossopharyngeal nerve (IX)
Descending tracts in spinal cord
Vagus nerve (X) (cholinergic; efferent to smooth muscle and glands; afferent from aorta, tracheobronchial „ mucosa and alveoli) \
Superior cervical I sympathetic ganglion |
/Sympathetic nerves
Afferent nerves from nose and sinuses (via trigeminal [V] and glossopharyngeal [IX] nerves) may also initiate reflexes in airways
Larynx
Superior laryngeal nerve
(adrenergic)
Carotid sinus Carotid body Thoracic spinal cord
Common carotid arterv Cough receptors Left recurrent laryngeal J nerve \ Js
Arch of aorta-.
Sympathetic trunk
Pulmonary plexus
Cough receptors
Parasympathetic fibers Sympathetic fibers Afferent fibers
Irritant receptors
Stretch receptors (Hering-Breuer reflex)
Plate 210
Lungs
Heart in Situ
Inferior thyroid veins
Trachea
Thymus
Left c o m m o n carotid artery Left brachiocephalic vein
Brachiocephalic trunk
Internal jugular vein
Right brachiocephalic vein Phrenic nerve Anterior scalene muscle Brachial plexus External jugular vein
Vagus nerve (X) Arch of aorta
.1
\I fsA
A
V
Thoracic duct
r M te-l \l 4 an \ y f \tw m f:I\ 'M t M f \l
Left recurrent laryngeal nerve
Subclavian artery and vein
Internal thoracic artery
Superior vena cava
Phrenic nerve and pericardiacophrenic artery and vein
1 st rib
Mediastinal part of parietal pleura
Phrenic nerve and pe r i ca r d i aco p h re n i c artery and vein
&
Right lung Left lung
'•if
j'i
m% r
gf
r
Pericardium Diaphragm Mediastinal Diaphragmatic Costal
Heart
Parts of parietal pleura
Line of fusion of fibrous pericardium to diaphragm
Internal thoracic artery Superior epigastric artery
Musculophrenic artery
3
Heart: Anterior Exposure
Pericardium (cut edge) at site of reflection from great vessels
Brachiocephalic trunk
Right vagus nerve
Left brachiocephalic vein
Right internal jugular vein
Arch of aorta
Right recurrent laryngeal nerve Right brachiocephalic vein
Left common carotid artery
Phrenic nerve
Left internal jugular vein
Subclavian artery and vein
Left vagus nerve (X)
Internal thoracic artery and vein
Ligamentum arteriosum
Phrenic nerve and pericardiacophrenic arterv and vein
Left recurrent laryngeal nerve Pulmonary trunk
Superior vena cava
Left pulmonary artery
Right pulmonary artery
Transverse pericardial sinus
Transverse pericardial sinus Right superior pulmonary vein
Left superior pulmonary vein
Hilum of right lung Mediastinal pleura (cut edge)
Hilum of leftlung
Pericardium (cut edge)
nX/,
w
; 111
Mediastinal part of parietal pleura edge) Pericardium (cut edge)
Right I ventricle Conus arteriosus Right auricle (atrial appendage) Right atrium
Plate 212
Coronary sulcus and right coronary artery
Anterior interventricular sulcus and anterior interventricular branch of left coronary artery
Left \ auricle \ (atrial appendage) Inferior border (acute margin) of heart
Apex of heart Left ventricle
Left border (obtuse margin) of heart
Heart
I l a d E t o g F a p O i ]
©if
© t e s t
HHHHHHHHHSHHHH
Precordial areas of auscultation
A
Apex of heart
AA
Aortic arch
C
Clavicle
CP
Coracoid process of scapula
D
D o m e of diaphragm (right)
IV
Inferior vena cava
PA
Pulmonary artery (left)
RA
Right atrium
Valves
S
Spine of scapula
Pulmonic valve
sv
Superior vena cava
T
Trachea (air)
V
Left ventricle
Aortic area
Pulmonic: area
Tricuspid area
Aortic valve Mitral valve
Mitral area
Tricuspid area
CMctt/iM/v/
Heart
Plate 213
Heart: Base and Diaphragmatic Surfaces
Right pulmonary
Arch of aorta
Left pulmonary artery
Right auricle (atrial appendage)
Left auricle (atrial appendage)
Superior vena cava
Left superior pulmonary vein
Right superior pulmonary vein
Left atrium
Right atrium
Left inferior pulmonary vein
Sulcus terminalis
Pericardial reflection
—Right inferior pulmonary vein
Oblique vein of left atrium (of Marshall)
Coronary sulcus Inferior vena cava
Coronary sinus
Right ventricle
Left ventricle Apex
Base of heart: posterior view
Left subclavian artery Left common carotid Left pulmonary artery Left superior pulmonary vein Left auricle (atrial appendage) Left inferior pulmonary vein Oblique vein of left atrium (of Marshall) Left atrium Pericardial reflection Coronary sinus Left ventricle
Brachiocephalic trunk Superior vena cava Arch of aorta Right pulmonary artery Right superior pulmonary vein Right inferior pulmonary vein Sulcus terminalis Right atrium Inferior vena cava Coronary sulcus and right coronary artery Posterior interventricular sulcus and posterior interventricular branch of right coronary artery (posterior descending artery) Right ventricle
Base and diaphragmatic surfaces: posteroinferior view
Heart
Pericardial Sac warn
Superior vena cava
^mmmmmmmmmmmmmmmmmmamm
Arch of aorta
Pericardium (cut edge) Ascending aorta Left auricle (atrial appendage) Left ventricle Coronary sinus Posterior interventricular sulcus Right ventricle Diaphragmatic part of pericardium Sternocostal part of pericardium (cut edge)
Heart drawn out of opened pericardial sac: left lateral view
Pulmonary trunk
nsverse pericardial sinus Left pulmonary veins Oblique vein of left atrium (Marshall's) Oblique pericardial sinus Left atrium Right pulmonary vein Esophageal prominence Right atrium Inferior vena cava
Arch of aorta Ascending aorta Right phrenic nerve and pericardiacophrenic vessels Superior vena cava Transverse pericardial sinus
Mediastinal part of parietal pleura (cut edge) Left phrenic nerve and pericardiacophrenic vessels Pulmonary trunk (bifurcation)
Superior vena cava Right pulmonary veins Mediastinal part of parietal pleura (cut edge) Pericardium (cut edge) Inferior vena cava Line of fusion of fibrous pericardium to diaphragm
Pericardial sac w i t h heart removed: anterior view
C^earS
Left lung Left pulmonary veins Pericardium (cut edge) Oblique pericardial sinus Esophageal prominence Diaphragmatic part of pericardium
3
3
Coronary Arteries and Cardiac Veins
Sinuatrial (SA) nodal branch
Left auricle (cut) Left coronary artery
Atrial branch of right coronary artery Circumflex branch of left coronary artery Right coronary artery Great cardiac vein Left (obtuse) marginal artery
Anterior cardiac veins
Anterior interventricular branch (left anterior descending) of left coronary artery
Small cardiac vein
Right (acute) marginal branch of right coronary artery
Diagonal branch of anterior interventricular artery
Interventricular septal branches
Sternocostal surface
Sinuatrial (SA) nodal branch Oblique vein of left atrium (of Marshall) Sinuatrial (SA) node
Great cardiac vein Circumflex branch of left coronary artery
Small cardiac vein
Left marginal branch Coronary sinus Posterior left ventricular branch
Right coronary artery Posterior interventricular branch (posterior descending) of right coronary artery
Posterior vein of left ventricle
Middle cardiac vein Interventricular septal branches
Plate 216
Right marginal branch
Diaphragmatic surface
Heart
Coronary Arteries and Cardiac Veinss Variations
Anterior interventricular (left anterior descending) branch of left coronary artery is very short. Apical part of anterior (sternocostal) surface supplied by branches from posterior interventricular (posterior descending) branch of right coronary artery curving around apex.
Posterior interventricular (posterior descending) branch is derived from circumflex branch of left coronary artery instead of from right coronary artery.
Posterior branch is branches coronary
Posterior interventricular (posterior descending) branch is absent. Area supplied chiefly by elongated anterior interventricular (left anterior descending) branch curving around apex.
Heart
interventricular (posterior descending) absent. Area supplied chiefly by small from circumflex branch of left artery and from right coronary artery.
POate 2117
3
Coronary Arteries: Arteriographic Views
Right coronary artery: left anterior oblique view Sinuatrial (SA) nodal branch
Right coronary artery
Arteriogram
Atrioventricular
(AV)
noda[
branch Branches to back of left ventricle Right (acute) marginal branch Posterior interventricular branch (posterior descending artery)
Right coronary artery: right anterior oblique view Sinuatrial (SA) nodal branch Conus (arteriosus) branch Right coronary artery Right (acute) marginal branch
Arteriogram Atrioventricular (AV) nodal branch Right posterolateral branches (to back of left ventricle) Posterior interventricular branch (posterior descending artery)
Plate 218
EKIeairt
Coronary Arteries: Arteriographic Views (continued) SHflBBBMH . v , vfx-*•..:.;.•
IS fi SB fi SS
Left coronary artery: left anterior oblique view
Left coronary artery Circumflex branch
mm
Arteriogram Anterior interventricular branch (left anterior descending) Diagonal branches of anterior interventricular branch Atrioventricular branch of circumflex branch Left (obtuse) marginal branch Posterolateral branches (Perforating) interventricular septal branches
Left coronary artery: right anterior oblique view Leftcoronary artery Anterior interventricular branch (left anterior descending)
WSIlk
Circumflex branch (Perforating) \ intervenes. tricular ^ s e p t a l branches
Arteriogram
Left (obtuse) marginal branch Posterolateral branches Diagonal branch of Anterior interventricular branch Atrioventricular branch of circumflex branch
Plate 219
3
Right Atrium and Ventricle
Ascending aorta
Pulmonary trunk Right auricle (atrial appendage)
Superior vena cava
Conus arteriosus
Right pulmonary artery
Crista terminalis
Pericardial reflection
Atrioventricular part of membranous septum
Right superior pulmonary vein
eptal cusp of tricuspid valve
Left atrium Right inferior pulmonary vein
Pectinate muscles ning of coronary sinus
Interatrial septum
Valve (Thebesian) of coronary sinus
Limbus of fossa ovalis Fossa ovalis Valve (Eustachian) of inferior vena cava Inferior vena
Opened right atrium: right lateral view
Pericardial reflection Aorta Transverse pericardial sinus Superior vena cava Right auricle (atrial appendage) Right atrium Parietal limb Membranous part of interventricular septum Anterior cusp Tricuspid valve
Pulmonary trunk pericardial sinus Anterior semilunar cusp Right semilunar cusp Left semilunar cusp
J > Pulmonary { valve )
Conus arteriosus Supraventricular crest Septal papillary muscle Interventricular septum (muscular part)
Septal cusp Posterior cusp
Septomarginal trabecula (moderator band)
Chordae tendineae Posterior papillary muscle Anterior papillary muscle Trabeculae carneae
Plate 220
Opened right ventricle: anterior view
Heart
Left Atrium and Ventricle
Pericardial reflection
Transverse pericardial sinus Fold of left superior vena cava (ligament of Marshall)
Ligamentum arteriosum Left pulmonary artery
Left auricle (atrial appendage) Oblique vein of left atrium (of Marshall) ( Mitral )
Posterior cusp
valve
Anterior cusp
|
Arch of aorta
Right pulmonary arteryLeft pulmonary veins Left atrium
Anterior papillary muscle
Right pulmonary veins
Chordae tendineae
Coronary sinus
Posterior papillary muscle
Inferior vena cava
Flap opened in posterolateral wall of left ventricle
Left auricle (atrial appendage) Con us arteriosus
Left pulmonary arterv
Left semilunar cusp Aortic valve
/
Right pulmonary artery
Right semilunar cusp Posterior semilunar cusp
Membranous septum
Arch of aorta
Left superior pulmonary vein
Interventricular part
Valve of foramen ovale Right pulmonary veins
Muscular part of interventricular septum
Left atrium Coronary sinus
Mitral valve (cutaway)
Inferior vena cava
^ T
< ' '
^ llll I * I Ml -
^
Section through left atrium and ventricle w i t h mitral valve cut away
Heart
Plate 221
3
Valves of Fibrous Skeleton of Heart
Anterior semilunar cusp
Pulmonary valve
Right semilunar cus Left semilunar cusp
Conus arteriosus Left fibrous trigone Right coronary artery
Right (coronary) semilunar cusp Atrioventricular part of membranous septum Anterior cusp
Left (coronary) semilunar cu
Aortic valve
Posterior (noncoronary) semilunar cusp Circumflex branch • Anterior Mitral valve
Tricuspid valve
Septal cusp Posterior cusp
Commissural cusps
Right fibrous ring (of tricuspid valve)
Posterior cus
Right fibrous trigone Atrioventricular (AV) nodal branch1'
Left fibrous ring (of mitral valve
Posterior interventricular branch 1
Heart in diastole: viewed f r o m base w i t h atria removed
Anterior semilunar cusp
Pulmonary valve
Right semilunar cusp Left semilunar cu
Conus arteriosus Left fibrous trigone Right coronary artery
Right (coronary) semilunar cusp Aortic valve
Interventricular part
Left (coronary) semilunar cusp
Atrioventricular part
Posterior (noncoronary) semilunar cusp
Anterior cusp
Circumflex branch*
Mitral valve
cusp
Anterior cusp
Tricuspid valve
Posterior
Posterior cusp
Right fibrous ring (of tricuspid valve)
Left fibrous ring (of mitral valve) Posterior interventricular branch 1
Membranous septum
Right fibrous trigone
Heart in systole: viewed from base w i t h atria removed
Atrioventricular (AV) nodal branch1"
* O f left coronary artery 'Of right coronary artery
IHJeacrU:
Valves and Fibrous Skeleton of Heart (continued) HHHHMBMMNMKHiHM!
.
^ ... .
Commissure of semilunar valve cusps Opening of left coronary artery
Ascending aorta
Nodule of semilunar valve (body of Arantius)
Aortic sinuses (of Valsalva) Opening of right coronary artery ( Membranous septum
Lunula Left semilunar cusp
Interventricular
) Part J Atrioventricular V part
Posterior semilunar cusp
Aortic valve
Right semilunar cusp
Broken line indicating level of origin of tricuspid valve on opposite side of septum-"'
Anterior papillary muscle Anterior cusp of mitral valve
Muscular part of interventricular septum
Aortic valve oventricular Par*
Opening of inferior vena cava
(
Right atrium
Interventricular ( part (behind valve)
Opening of coronary sinus
Posterior cusp Anterior cusp
Chordae tendineae
Septal cusp
Septal papillary muscle
Membranous sePtum
V Tricuspid \ valve
Posterior papillary muscle (sectioned)
Posterior papillary muscle (sectioned)
Anterior papillary muscle
Tricuspid (right atrioventricular) valve Anterior cusp
Left atrium
Posterior cusp
\
Chordae tendineae
Mitral valve
Commissural cusps Anterior papillary muscle (sectioned)
Anterior papillary muscle (sectioned)
Posterior papillary muscle
Fibrous (Albini's) nodules
Mitral (left atrioventricular) valve
Heart
Plate 223
3
Atria, Ventricles, and Interventricular Septum y':
MMMIMHNMIMHIMWMNMMHM^
Mitral valve
Posterior cusp Anterior cusp
Right superior pulmonary vein
Pulmonarv trunk Anterior cusp of mitral valve
Openings of coronary arteries Ascending aorta Right auricle (atrial appendage)
Aortic sinus (of Valsalva)
Left semilunar cusp
Ascending aorta Left semilunar cusp Aortic valve
Right semilunar cusp
Posterior semilunar (noncoronary) cusp /
Superior vena cava
m . / ' " , . ^
Aortic valve
Supra ventricular crest
X
t
J monarv t r u n k
4
Con us arteriosus
Right anterior papillary muscle (cut) Right ventricle
Right atrium
CD
Septomarginal trabecula (moderator hand)
Anterior cusp {retracted)
Septal (medial) papillary muscle
Septal cusp— Posterior cusp Right ventricle Right anterior papillary muscle (cut) Right posterior papillary muscle Left ventricle Muscular part of interventricular septum
Plate 224
Plane of section
Heart
Ascending aorta Atrioventricular part ) v Membranous septum Interventricular part \
Superior vena cava Sinuatrial (SA) nodal artery
Pulmonary valve Atrioventricular (AV) node
Sinuatrial (SA) node
Atrioventricular (AV) bundle (of His)
Crista terminalis
Right bundle
Note: Specific internodal conduction pathways in the atria may exist based on strong physiological and some anatomical evidence
Purkinje fibers Septomarginal trabecula (moderator band) Anterior papillary muscle
Right fibrous ring (of tricuspid valve
Subendocardial branches (Purkinje fibers)
Inferior vena cava
Right side
(f Posterior semilunar Aortic valve
) . f. .. \ Lett semilunar cusp
Arch of aorta
Right semilunar
Membranous septum
Pulmonary trunk
Interventricular part
Superior vena cava
Atrioventricular part
Left auricle
Left bundle Anterior papillary muscle
Right pulmonary veins Mitral valve (cutaway)
Subendocardial branches (Purkinje fibers)
Muscular part of interventricular septum
Posterior papillary muscle Vi
Left s i d e
H e a r t
Plate 22S
3
Nerves of Heart See also P l a t e s 1 3 0 , 1 6 5 , 1 6 6 , 2 0 9
Superior cervical sympathetic ganglion Right vagus nerve (X) (Conjoined sympathetic and vagal) superior cervical cardiac nerves Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Phrenic nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Inferior thyroid artery Vertebral artery Cervicothoracic (stellate) ganglion Ansa subclavia
Superior cervical sympathetic ganglion Left vagus nerve (X) Superior cervical (sympathetic) cardiac nerve Superior cervical (vagal) cardiac branch Middle cervical sympathetic ganglion Phrenic nerve Middle cervical (sympathetic) cardiac nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Cervicothoracic (stellate) ganglion Inferior cervical sympathetic cardiac nerves
Right recurrent laryngeal nerve
Inferior cervical (sympathetic) cardiac nerves Thoracic cardiac branch of vagus nerve 4th thoracic sympathetic ganglion Thoracic (sympathetic) cardiac branches Cardiac plexus
3rd thoracic sympathetic ganglion oracic (sympathetic) cardiac branches oracic cardiac branch of vagus nerve Left recurrent laryngeal nerve
Phrenic nerve (cut)
Plate 226
Heart
Innervation of Heart: Schema See also P l a t e s 126, 167, 168
Superior cervical sympathetic ganglion
Posterior nucleus of vagus nerve
Nucleus of
Superior cervical (sympathetic) cardiac nerve Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Vertebral ganglion (variation Ansa subclavia Cervicothoracic (stellate) ganglion 1st intercosta nerve Inferior cervical (sympathetic) cardiac nerve Thoracic cardiac branch of vagus nerve 2nd thoracic sympathetic ganglion While ramus communicans Cray ramus communicans Thoracic (sympathetic) cardiac branches 4th thoracic sympathetic ganglion
—- —
Sympathetic preganglionic Sympathetic postganglionic
—
Parasympathetic preganglionic
— — - — — Parasympathetic postganglionic u — — V i s c e r a l afferent accompanying sympathetic fibers Visceral afferent accompanying parasympathetic fibers
Heart
Plate 227
Innervation of Blood Vessels: Schema See also P l a t e s 1 6 7 , 1 6 8
Cervical sympathetic trunk ganglia Spinal nerves Gray rami communicantes
i ':.•• •-
. ";
Spinal nerves
Spinal nerves Gray ramus communicans Lower lumbar sympathetic trunk ganglia
Sympathetic fibers
Postganglionic sympathetic fibers to lumbar and sacral plexuses and to nerves of lower limb
Preganglionic Postganglionic
Plate 228
Heart
Prenatal and Postnatal Circulation iwiMMMiwiiiiiii '!ijfjin;;w"WPirirrmr~T
n
r~n 111htr*w i wMrin 'i Brw i nmP i nri
fiMaBM—a— i Thb i m—MBMBBTr^B i afg i BawBB—w i
For occluded part of umbilical vessels, see Plate 253
Prenatal circulation
rta Pulmonary trunk Superior vena cava Right pulmonary
Ductus arteriosus Left pulmonary artery Left pulmonary vein
Right pulmonary vein Foramen ovale
Inferior vena cava
Hepatic vein Aorta
Ductus venosus
Celiac trunk
Liver Hepatic portal vein Umbilical vein
Superior mesenteric artery Kidney Gut
Ligamentum arteriosum (obliterated ductus arteriosus)
Umbilical arteries
Fossa oval is (obliterated foramen ovale Ligamentum venosum (obliterated ductus venosus) Ligamentum teres (round ligament) of liver (obliterated umbilical vein) Medial umbilical ligaments (occluded part of umbilical arteries)
Postnatal circulation
Heart
Plate 229
3
Mediastinum: Right Lateral View
Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson's fascia)
Anterior scalene muscle and phrenic nerve Brachial plexus
1 st rib Right subclavian artery and vein Trachea Right vagus nerve (X) Esophagus Sympathetic trunk Right superior intercostal vein 4th thoracic vertebral body Arch of azygos vein Right main bronchu and bronchial artery Azygos vein Posterior intercostal vein and artery and intercostal nerve Internal intercostal muscle Internal intercostal membrane deep to external intercostal m u s cl e Gray and white rami communicantes Costal part of parietal pleura (cut edge) Greater thoracic splanchnic nerve Esophagus and esophageal plexus Bronchopulmonary (hilar) lymph nodes
Clavicle Subclavius muscle 1st rib Right and left brachiocephalic veins Right internal thoracic artery Thymus (seen through mediastinal pleura) Superior vena cava Phrenic nerve and pericardiacophrenic artery and vein* Right pulmonary artery /Mediastinal part of parietal pleura (cut edge) Fibrous pericardium over right atrium Right pulmonary veins Inferior vena cava (covered by mediastinal part of parietal pleura) Diaphragm (covered by diaphragmatic part of parietal pleura) Costal part of parietal pleura (cut edge) C o s t o d i a p h r a g m a t i c re cess of pleural cavity
Pulmonary ligament (cut)
*Nerve and vessels commonly run independently
Plate 230
Mediastinum
Mediastinum: Left Lateral View
Anterior scalene muscle and phrenic nerve Brachial plexus Left subclavian vein and artery Subclavius muscle Clavicle Left brachiocephalic vein
Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson's fascia) 1 st rib Esophagus Thoracic duct Left vagus nerve (X) Left superior intercostal vein
Left internal thoracic artery Arch of aorta Thymus (seen through mediastinal pleura) Ligamentum arteriosum Left pulmonary artery Left phrenic nerve and pericard iacop h ren ic artery and vein Mediastinal part of parietal pleura (cut ec/ge) Fibrous pericardium Left pulmonary veins Pulmonary ligament (cut) Fat pad Esophagus and esophageal plexus (covered by mediastinal part of parietal pleura) Diaphragm (covered by diaphragmatic part of parietal pleura) Costodiaphragmatic recess of pleural cavity
Left recurrent laryngeal nerve Bronchopulmonary (hilar) lymph nodes Accessory hemiazygos vein Posterior intercostal vein and artervt and intercostal nerve Internal intercostal muscle Internal intercostal membrane deep to external intercostal muscle Gray and white rami communicantes Costal pleura {cut edge) Sympathetic trunk Greater thoracic splanchnic nerve Thoracic (descending) aorta Left main bronchus and bronchial artery
Costal part of parietal pleura {cut edge)
*Nerve and vessels commonly run independently
[fcdiastoMEFP
POafe 231
i
L~
^ H
Esophagus in Situ
Longus colli muscle
C o m m o n carotid artery
Cervical part of esophagus
Anterior scalene muscle
Recurrent laryngeal nerves
Phrenic nerve
Thoracic duct
Posterior scalene muscle
Internal jugular vein (cut)
Brachial plexus
Subclavian vein (cul)
Subclavian artery
Left brachiocephalic vein (cut)
Thyrocervical trunk
Internal thoracic artery (cut)
Vagus nerve (X)
Phrenic nerve (cut)
1 st rib (cut)
Common carotid artery
Brachiocephalic trunk
Subclavian artery Vagus nerve (X)
Trachea
Left recurrent laryngeal nerve
Arch of aorta
— Bifurcation of trachea
Arch of azygos vein
Costal pleura (cut edge)
Right main bronchus Superior lobar (eparterial) bronchus
M
Left main bronchus Thoracic (descending) aorta
Thoracic part of esophagus Esophageal plexus BliiPlte
Mediastinal part of parietal pleura (cut edge)
Mediastinal part of parietal pleura (cut edge) Pericardium (cut edge) Diaphragm Diaphragmatic part of parietal pleura
Inferior vena cava (cut)
Anterior vagal trunk Bfc,
Hepatic veins (cut) Inferior vena cava — Right and left crura of diaphragm Inferior phrenic arteries Celiac trunk Abdominal aorta
Plate 232
Stomach '
:
_
•
BH
m •mm 'TONE
Abdominal part of esophagus
Mediastinum
Topography and Constrictions of Esophagus BBSBBBSSgeaSSMHSBM
Incisor teeth
Interior pharyngeal constrictor muscle
Oropharynx
Thyroid carti
Epiglottis Piriform fossa (recess) Pharyngoesophageal constriction
fSKjftwR'.>.ft • I mMm
Cricoid cartilage
Cricoid cartilage
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor Trachea
Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
cn v .
OJ
£ c
u
Thoracic (aortobronchial)| . constriction
Esophagus Arch of aorta Sternum
Trachea Arch of aorta
oc c jl; w>
Left main bronchus
l. O) >
<
mmi Diaphragmatic constriction (in ferior esophageal "sphincter' 7 ) Abdominal part of esophagus
Lateral view Diaphragm
Fundus of stomach
Cardiac part of stomach
ileciasfiitiQsira
PQate 233
3
Musculature of Esophagus MBlMUMi^fffffcs.. .;' ,v:*;
Inferior pharyngeal constrictor muscle Pharyngeal rap Thyroid cartilage
Zone of sparse muscle fibers Cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Cricoid cartilage
Main longitudinal muscle bundle passing upward and ventrally to attach to middle of posterior surface of cricoid cartilage Accessory muscle bundle from lateral surface of cricoid cartilage Additional fibers from contralateral side of cricopharyngeus (muscle) part of inferior pharyngeal constrictor
Trachea
Circular muscle layer with sparse longitudinal fibers in V-shaped area (of Laimer) Hook Bare area on ventral surface of esophagu Lateral mass of longitudinal muscle Fibroelastic membranes with sparse muscle fibers
W i n d o w cut in longitudinal muscle layer
Circular muscle layer
Left main bronchus
Plata 234
Mediastinum
Pharyngoesophageal Junction See also Plate 67
•Superior pharyngeal constrictor muscle Root of tongue Epiglottis Middle pharyngeal constrictor muscle Palatopharyngeus muscle )
Longitudinal
Stylopharyngeus muscle
muscles 6 3 '
\
Pharyngoepiglottic fold Laryngeal inlet (aclitus) •Thyroid cartilage (superior horn) Thyrohyoid membrane Internal branch of superior laryngeal nerve and superior laryngeal artery and vein Oblique arytenoid muscle -Transverse arytenoid muscle Thyroid cartilage Posterior cricoarytenoid muscle Inferior pharyngeal constrictor muscle Pharyngeal aponeurosis (cutaway) Zone of sparse muscle fibers Cricopharyngeus (muscle) part of inferior pharyngeal constrictor Cricoid cartilage (lamina) Cricoesophageal tendon (attachment of longitudinal esophageal muscle)
Posterior view w i t h pharynx opened and mucosa removed
Circular esophageal muscle Esophageal mucosa and submucosa Circular muscle in V-shaped area (of Laimer) Right recurrent laryngeal nerve
M%
ri '
:
'
;
Longitudinal esophageal muscle B V \ | 'A i l fl il m WR i mm V:; ;
W i n d o w cut in longitudinal muscle exposes circular muscle layer
Mediastinum
Plate 235
3
Esophagogastric Junction
Sliding hernia Esophagus Squamocolumnar junction Peritoneal sac
Longitudinal esophageal muscle Esophageal mucosa Sub mucosa
Circular esophageal muscle Gradual slight muscular thickening Phrenoesophageal ligament (ascending or upper limb)
Diaphragm
Supradiaphragmatic fascia Diaphragm Infradiaphragmatic (transversalis) fascia
Subhiatal fat ring Zigzag (Z) line: juncture of esophageal and gastric mucosa'
Gastric folds (rugae) —
Phrenoesophageal ligament ing limb) Peritoneum Cardiac notch
Longitudinal esophageal muscle (cut) Circular esophageal muscle (shown here as spiral) Cardiac notch Fundus of stomach
Outer longitudinal muscle layer of stomach (cut)
Plate 236
Mediastinum
Arteries of Esophagus See also Plate 300 Esophageal branch of Inferior thyroid artery Common carotid artery Subclavian artery
^
Esophageal branch of Inferior thyroid artery Cervical part of esophagus Thyrocervical trunk
$
Subclavian artery Vertebral artery Internal thoracic artery C o m m o n carotid artery Brachiocephalic trunk Trachea Arch of aorta 3rd right posterior intercostal artery Right bronchial artery Superior left bronchial artery Esophageal branch of right bronchial artery Inferior left bronchial artery and esophageal branch Thoracic (descending) aorta Esophageal branches of thoracic aorta
Thoracic part of esophagus
Abdominal part of esophagus
— Esophageal branch of left gastric artery Left gastric artery Inferior phrenic arteries C o m m o n hepatic artery [cut)
Celiac trunk
C o m m o n variations: Esophageal branches may originate from left inferior phrenic artery and/or directly from celiac trunk. Branches to abdominal esophagus may also come from splenic or short gastric arteries.
Splenic artery (cut)
!P0afe
2 3 7
Veins of Esophagus Bs&8KBSg£
See also Plate 312 Inferior thyroid vein Internal jugular vein
Inferior thyroid vein Internal jugular vein
External jugular vein Subclavian vein Subclavian vein
Vertebral vein
Thoracic cluct
Right brachiocephalic vein Superior vena cava Right superior intercostal vein Esophagus
Left brachiocephalic vein Left superior intercostal vein Esophageal veins (plexus) —Accessory hemiazvgos vein
6th right posterior intercostal vein Azygos vein Junction of accessory hemiazygos and azygos veins Inferior vena cava (cut)
Hemiazygos
vein
Submucous venous plexus
Left inferior phrenic vein
Diaphragm
Short gastric veins
Liver
Hepatic veins Inferior vena cava Hepatic portal vein
^•Splenic vein NLeft
suprarenal vein
Right renal vein Left gastric vein Right gastric vein Esophageal branches of left gastric vein
Plate 238
Left renal vein
Omental (epiploic) veins Left gastro-omental (gastroepiploic) vein
Inferior mesenteric vein Superior mesenteric vein Right gastro-omental (gastroepiploic) vein
Mediastinum
Lymph Vessels and Nodes of Esophagus See also Plates 208, 266
Inferior deep cervical (internal jugular) nodes Virchow's node Thoracic duct
Paratracheal nodes Posterior mediastinal nodes Superior and inferior tracheobronchial nodes
Intercostal nodes
Posterior parietal nodes
Superior phrenic nodes
Left gastric nodes (cardiac nodes of stomach)
Juxtaesophageal and superior phrenic nodes
Celiac nodes
Plate 239
3
Nerves of Esophagus mm
mm
See also Plates 165, 166, 209
Superior ganglion of vagus nerve
Anterior view
Superior cervical sympathetic ganglion
/
Inferior ganglion of vagus nerve Pharyngeal branch of vagus nerve
Esophagus
// M z&l
•Vagus nerve (X) — Superior laryngeal nerve
Recurrent laryngeal nerves
Cervical sympathetic trunk J;
Right recurrent laryngeal nerve
\
Middle cervical .sympathetic ganglion Cervical (sympathetic and vagal) cardiac nerves •Vertebral ganglion of cervical sympathetic trunk
Ansa subclavia
\\L
Ansa subclavia Branch to esophagus and recurrent nerve from stellate ganglion
I :
3rd intercostal nerve
•••
V
Cervicothoracic (stellate) ganglion
%
Left recurrent laryngeal nerve
FA ! \
Thoracic (vagal and sympathetic) cardiac branches
Gray and white rami communicantes
Cardiac plexus
3rd thoracic sympathetic ganglion —
Pulmonary plexuses Esophageal plexus (anterior portion)
%
Thoracic sympathetic trunk-
Branches to esophageal plexus from sympathetic trunk, greater thoracic splanchnic nerve, and thoracic aortic plexus
>0
Right greater thoracic splanchnic nerve
Left greater thoracic splanchnic nerve 'Anterior vagal trunk
Sympathetic fibers along left inferior phrenic artery Branch of posterior vagal trunk to celiac plexus
Posterior view
ll i
•Vagal branch to hepatic plexus via lesser omentum
5 V;
Esophageal plexus (posterior portion)
Principal anterior vagal branch to lesser curvature of stomach
I
Vagal branch to fundus and body of stomach
Posterior vagal trunk
Greater thoiYK ic
kv
splanchnic nerves Sympathetic fibers along esophageal branch of left gastric arteryCeliac plexus and ganglia
Plate 240
mm
1
w*
'ft'.
Vagal branch to celiac plexus
RSSI Vagal branc to fundus and cardiac part of stomach
Posterior vagal branch to sser curvature
Mediastinum
See also Plate 246
Sternum
Right ventricle Septal cusp
5th left costal cartilage Internal thoracic artery and vein ansversus thoracis muscle
Tricuspid ) Posterior cusp v/rnI\/o \
Pectoralis major muscle
Anterior cusp
Pleural cavity
Interventricular part, Atrioventricular part of membranous septum
Muscular part of interventricular septum Left ventricle
Superior vena cava
Papillary muscle
Right atrium
Phrenic nerve and p e r i ca r d i a CO phrenic artery and vein
Pericardial cavity Mediastinal part of parietal pleura
Anterior cusp I
Right lung (middle lobe)
Posterior ( cusp
Mitral valve
Left atrium
Phrenic nerve and pericardiacophrenic artery and vein
Coronary sinus
Branches of right main bronchus *
Left lung (superior lobe)
Right inferior pulmonary vein
Branches of left main bronchus Left inferior pulmonary vein
Oblique pericardial sinus
Thoracic (descending) aorta
Esophagus and esophageal plexus
Azygos vein Hemiazygos vein Thoracic duct
Left sympathetic trunk T8 vertebra
Mediastinum
Left greater thoracic splanchnic nerve
Plate 241
CO
Mediastinum: Cr oss Section
C h e s t
S e a n s ^
A x i a l
C T
l i n a g e s
wmmmmmmmmmmmmmmmmmmmmmmmmmmmmmMMmmmmmmmfrmmmir
Series of chest axial C T images from superior (A) to inferior (C)
C A,
Ascending aorta
A, AZ B IV L LB LSL LV PA
Descending aorta Azygos vein Body of vertebra Inferior vena cava
R RB RSL RV S
Liver
sc
Left (main stem) bronchus
SP
Left superior lobe of lung
sv
Left ventricle
T
Rib Right (main stem) bronchus Right superior lobe of lung Right ventricle Sternum Spinal cord Spinous process of vertebra Superior vena cava Trachea (bifurcation)
Pulmonary artery
Plate 242
Regional Scans
Q
o
Transverse Section: Lower Level of T3, Sternoclavicular Joint
Plate 243
Mediastinal lymph node
m
k
Sternoclavicular joint (articular disc)
© o mm •
Clavicle
/
O
Manubrium Brachiocephalic trunk Trachea
Right brachiocephalic vein
3
SL >
Left brachiocephalic vein
Costal cartilage of 1st rib
3
Left common carotid artery
Pectoralis major muscle
gl ©
Left vagus nerve (X)
Right lung
3
Pectoralis minor muscle
Axillary fossa
<
Left subclavian artery
Tendon of long head of biceps brachii muscle
Shaft of left humerus
Surgical neck , of right / humerus
-ong head of triceps brachii muscle
Deltoid muscle Teres minor muscle
j y
Intercostal muscles
Scapula Left lung
Subscapularis muscle Phrenic nerve
Infraspinatus muscle
Right vagus nerve (X)
Serratus anterior muscle
Esophagus
Left recurrent laryngeal nerve
Rhomboid major muscle
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Thoracic duct
Costotransverse joint Trapezius muscle Body of T3 vertebra
(ft)
Teres minor muscle
Spinal cord
Erector spinae muscle Rhomboid major muscle Transversospinal muscle
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Transverse Section: T 3 - 4 Intervertebral Disc, M a n u b r i u m T3-4
Plate 244.
Superior tracheobronchial lymph node
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Superior vena cava Right phrenic nerve
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Arch of azygos vein
Manubrium Arch of aorta Internal thoracic artery and vein
Right lung
Left lung
Intercostal muscles
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Serratus anterior muscle
Pectoralis major muscle /Pectoralis minor muscle Axillary fossa
Tendon of long head of biceps brachii muscle
Combined short head of biceps brachii and c o r a c o b r a c h i a l muscles
Latissimus dorsi tendon
Tendon of long head of biceps brachii muscle
Shaft of humerus Deltoid muscle
Shaft of humerus
Long head of triceps brachii muscle
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Lateral head of triceps brachii muscle
Teres major muscle
Long head of triceps brachii muscle
Teres minor muscle
Left latissimus dorsi tendon (inserting onto humerus)
Scapula
Teres major muscle
Esophagus
Subscapulars muscle
Thoracic duct T 3 - 4 intervertebral disc
Teres minor muscle
Rhomboid muscle Trapezius muscle
Left vagus nerve (X)
Scapula Infraspinatus muscle
Oblique fissure (of left lung) '.— /y.p.
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Transverse Section: T 4 - 5 Intervertebral Disc, Sternal Angle Plate 245
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Inferior tracheobronchial lymph nodes
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Ascending aorta o
Right pulmonary artery
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Internal thoracic artery and vein 2nd costal cartilage
Superior vena cava
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Manubriosternal junction
Pulmonary trunk
Pectoralis major muscle
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Right lung
Left pulmonary artery
Intercostal muscles
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Left lung
Axillary fossa
Pectoralis minor muscle
Tendon of long head of biceps brachii muscle
Long head of biceps brachii muscle
Deltoid muscle
Shaft of humerus
Lateral head of triceps brachii muscle
Latissimus dorsi tendon
Latissimus dorsi tendon
Teres major muscle Serratus anterior muscle
Teres major muscle
Subscapularis muscle
Scapula
Left main bronchus
Infraspinatus muscle
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Descending aorta
Rhomboid major muscle
Accessory hemiazygos vein
Right main bronchus
Trapezius muscle
Azygos vein «B
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Long head of triceps brachii muscle
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Coracobrachialis muscle
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Transverse Section: Level of T7, 3rd I n t e r c h o n d r a l Space Plate 246
Orifice of tricuspid valve
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Coronary sulcus Internal thoracic artery and vein Left atrium
Sternum (body) Right ventricle Anterior interventricular sulcus
Right atrium
Pectoralis major muscle
Interatrial septum
Apex of heart
Superior vena cava
Interventricular septum
Right inferior pulmonary vein
Papillary muscle Left ventricle
Esophagus Azygos vein
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Leaflet of mitral valve
Serratus anterior muscle
Coronary sulcus
Latissimus dorsi muscle
Coronary sinus Oblique pericardial sinus
Inferior angle of scapula
Descending aorta
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Thoracic duct
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Latissimus dorsi muscle Triangle of auscultation
Triangle of auscultation
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Head of 7th rib
Neck of 7th rib Zygapophyseal (facet) joint
Body of T7 vertebra Trapezius muscle '.
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Abdomen
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Topographic Anatomy
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247
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Abdomen
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Body Wall Plates 248-267
248
Bony Framework of Abdomen
249 Anterior Abdominal Wall: Superficial Dissection 250 Anterior Abdominal Wall: Intermediate Dissection 251 Anterior Abdominal Wall: Deep Dissection 252 Rectus Sheath: Cross Sections 253
Anterior Abdominal Wall: Internal View
254
Posterolateral Abdominal Wall
255 Arteries of Anterior Abdominal Wall 256
Veins of Anterior Abdominal Wall
257 Nerves of Anterior Abdominal Wall 258 Thoracoabdominal Nerves 259
Inguinal Region: Dissections
2 6 0 Inguinal Canal and Spermatic Cord 2 6 1 indirect Inguinal Hernia
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262 Femoral Sheath and Inguinal Canal 263
Posterior Abdominal Wall: Internal View
264
Arteries of Posterior Abdominal Wall
265
Veins of Posterior Abdominal Wall
266 Lymph Vessels and Nodes of Posterior Abdominal Wall 267
Nerves of Posterior Abdominal Wall
Atlas of Human Anatomy
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Visceral Vasculature Plates 300-317
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268 Regions and Planes of Abdomen
300 Arteries of Stomach, Liver, and Spleen
2 6 9 Greater Omentum and Abdominal Viscera
301 Arteries of Liver, Pancreas, Duodenum, and Spleen
270 Mesenteric Relations of Intestines
302 Variations in Celiac Trunk
271 Mesenteric Relations of Intestines (continued)
303 Celiac Arteriogram
272 Omental Bursa: Stomach Reflected
3 0 4 Arteries of Duodenum and Head of Pancreas
273 Omental Bursa: Cross Section
305 Arterial Variations and Collateral Supply of Liver
2 7 4 Peritoneum of Posterior Abdominal Wall
and Gallbladder 306 Arteries of Small Intestine
Viscera (Gut)
3 0 7 Arteries of Large Intestine
Plates 275-285
3 0 8 Variations in Colic Arteries
275 Stomach in Situ
309 Veins of Stomach, Duodenum, Pancreas, and Spleen
2 7 6 Mucosa of Stomach
310 Veins of Small Intestine
2 7 7 Musculature of Stomach
311 Veins of Large Intestine
2 7 8 Duodenum in Situ
312 Hepatic Portal Vein Tributaries: Portacaval Anastomoses
2 7 9 Mucosa and Musculature of Duodenum
313 Variations of Hepatic Portal Vein
2 8 0 Mucosa and Musculature of Small Intestine
314 Lymph Vessels and Nodes of Stomach
2 8 1 Ileocecal Region
315 Lymph Vessels and Nodes of Pancreas
282 Ileocecal Region (continued)
316 Lymph Vessels and Nodes of Small Intestine
283 Vermiform Appendix
317 Lymph Vessels and Nodes of Large Intestine
2 8 4 Mucosa and Musculature of Large Intestine 2 8 5 Sigmoid Colon: Variations in Position
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Innerwation Plates 318-328
Viscera (Accessory Organs)
318 Autonomic Nerves and Ganglia of Abdomen
PSates 286-299
319 Nerves of Stomach and Duodenum
286 Topography of Liver
320 Nerves of Stomach and Duodenum (continued)
2 8 7 Surfaces and Bed of Liver
321 Innervation of Stomach and Duodenum: Schema
288 Liver in Situ and Variations in Form
322 Nerves of Small Intestine
2 8 9 Liver Segments and Lobes: Vessel and Duct Distribution
3 2 3 Nerves of Large Intestine
2 9 0 Intrahepatic Vascular and Duct Systems
3 2 4 Innervation of Small and Large Intestines: Schema
291 Liver Structure: Schema
325 Autonomic Reflex Pathways: Schema
2 9 2 Intrahepatic Biliary Systems: Schema
3 2 6 Intrinsic Autonomic Plexuses of Intestine: Schema
2 9 3 Schematic Cross Section of Abdomen at T10
3 2 7 Innervation of Liver and Biliary Tract: Schema
294 Gallbladder and Extrahepatic Bile Ducts
3 2 8 Innervation of Pancreas: Schema
295 Junction of (Common) Bile Duct and Duodenum 296 Variations in Cystic and Hepatic Ducts 2 9 7 Schematic Cross Section of Abdomen at T12
Kidneys and Suprarenal Glands Plates 329-347
2 9 8 Pancreas in Situ
329 Kidneys in Situ: Anterior Views
299 Spleen
3 3 0 Kidneys in Situ: Posterior Views
Atlas of Human Anatomy
Abdomen 3 3 1 Schematic Cross Section of Abdomen at T12
344 Nerves of Kidneys, Ureters, and Urinary Bladder
3 3 2 Renal Artery and Vein in Situ
3 4 5 Innervation of Kidneys and Upper Ureters: Schema
3 3 3 Variations in Renal Artery and Vein
3 4 6 Nerves of Suprarenal Glands: Dissection and Schema
3 3 4 Gross Structure of Kidney
3 4 7 Arteries and Veins of Suprarenal Glands in Situ
3 3 5 Intrarenal Arteries and Renal Segments 3 3 6 Nephron and Collecting Tubule: Schema 3 3 7 Blood Vessels in Parenchyma of Kidney: Schema
Abdominal Sections Plates 348-349
3 3 8 Schematic Cross Section of Abdomen at T12—L1
3 4 8 Abdominal Wall and Viscera: Paramedian (Sagittal) Section
3 3 9 Schematic Cross Section of Abdomen at L 1 - 2
3 4 9 Schematic Cross Section of Abdomen at L3,4
34© Ureters 3 4 1 Arteries of Ureters and Urinary Bladder 3 4 2 Renal Fascia 3 4 3 Lymph Vessels and Nodes of Kidneys and Urinary Bladder
Plate 350
3 5 0 Abdominal Scans: Axial CT Images
Atlas ©f Human Anatomy
For regions see Plate 268
Deltopectoral triangle
Sternocleidomastoid muscle Sternal head Clavicular head Trapezius muscle
Sternum Body Xiphoid process
Deltoid muscle Pectoral is major muscle
Serratus anterior muscle
Tendinous intersection Rectus abdominis muscle
External oblique muscle Linea alba Semilunar line
Anterior superior iliac spine Superficial circumflex iliac vein Superficial epigastric veins Pubic symphysis
Umbilicus Iliac crest
Inguinal ligament Pubic tubercle
Topographic Anatomy
Plate 247
Bony Framework of Abdomen
Body of sternum
Xiphoid process
Costal cartilages
12th rib
Inner lip Iliac < crest
Sacral
Transverse processes of lumbar vertebrae Iliac tuberosity
Intermediate zone —
Iliac crest
Outer lip
Wing (ala) of ilium
Tuberculum
Greater sciatic notch Arcuate line Anterior superior iliac spine
Ischial spine Lesser sciatic notch
Anterior inferior iliac spine Iliopubic eminence
Greater trochanter of femur
Superior pubic ramus
Pecten pubis (pectineal line)
Obturator foramen
Pubic symphysis
Pubic tubercle
Ischial tuberosity
Inferior pubic ramus
Plate 248
Inferior pubic ligament
Lesser trochanter of femur
Body Wall
Anterior Abdominal Wall: Superficial Dissection
Pectoralis major muscle
Xiphoid process Rectus sheath Linea alba Serratus anterior muscle Latissimus dorsi muscle External oblique muscle
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Muscular part
Subcutaneous tissue (superficial fascia) of abdomen Thoracoepigastric vein
Anterior superior iliac spine
Camper's (fatty) layer, Scarpa's (membranous) layer of subcutaneous tissue of abdomen {turned back)
Inguinal ligament (Poupart's)
Attachment of Scarpa's layer to fascia lata
Intercrural fibers Superficial inguinal r i n g ^ _ External spcrmatic fascia on spermatic c o r d Cribriform fascia in saphenous opening Fascia lata Great saphenous ve Superficial dorsal vein of peni
Body
Wall
Superficial circumflex iliac vessels Superficial epigastric vessels Superficial external pudendal vessels Fundiform ligament Superficial fascia of penis and scrotum (dartos fascia) (cut)
Deep (Buck's) fascia of penis with deep dorsal vein of penis showing through
Plate 249
Anterior Abdominal Walls Intermediate Dissection
Pectoralis major muscles Anterior layer of rectus sheath (cut edges) Latissimus dorsi muscle Serratus anterior muscle External oblique muscle (cut away) External intercostal muscles External oblique aponeurosis (cut edge) Rectus sheath Internal oblique muscle Anterior superior iliac spine Inguinal ligament (Pou part's) Cremaster muscle (lateral origin) Inguinal falx (conjoint tendon Reflected inguinal ligament
Linea alba Rectus abdominis muscle External oblique muscle (cut away) Tendinous intersection Internal oblique muscle Pyramidalis muscle Inguinal falx (conjoint tendon) (Poupart's) Anterior superior iliac spine External oblique aponeurosis (cut and turned down) Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Reflected inguinal ligament Pubic tubercle
Femoral vein (in femoral sheath)
Suspensory ligament of penis
Saphenous opening
Cremaster muscles and cremasteric fascia
Cremaster muscle (medial origin) Fascia lata Great saphenous vein
Plate 250
Deep (Buck's) fascia of penis External spermatic fascia (cut) Superficial fascia of penis and scrotum (cut)
Body WsaQO
Anterior Abdominal Wall: Deep Dissection
Superior epigastric vessels
External oblique muscle (cut away)
Anterior layer of rectus sheath (cut) Linea alba
Rectus abdominis muscle
Anterior layer of rectus sheath
External oblique aponeurosis (cut)
Tra n svers u s a b d o m i n is muscle (cu()
Internal oblique aponeurosis (cut)
Transversalis fascia (opened on left)
Transversus abdominis muscle
Extraperitoneal fascia (areolar tissue)
Internal oblique muscle (cut)
Medial umbilical ligament (occluded part of umbilical artery)
Posterior layer of rectus sheath Arcuate line Inferior epigastric vessels
Inferior epigastric artery and vein (cut)
Anterior superioi iliac spine
Site of deep inguinal ring (origin of internal spermatic fascia)
Inguinal ligament (Poupart's) Superficial circumflex iliac, Superficial epigastric, Superficial external pudendal arteries (cut)
Cremasteric and pubic branches of inferior epigastric artery
Inguinal falx (conjoint tendon) —
Inguinal ligament (Poupart's)
Pectineal ligament (Cooper's)
Lacunar ligament (Gimbernat's)
Lacunar ligament (Gimbernat's)
Pectineal ligament (Cooper's)
Femoral sheath (contains femoral artery and vein)
Fat in retropubic space (of Retzius)
Reflected inguinal ligament
Pectineal fascia Pubic tubercle
Internal spermatic fascia
Cremaster muscle and fascia External spermatic fascia (cut)
Body Wall
Deep (Buck's) fascia of penis
Superficial fascia of penis and scrotum (cut)
Cremaster muscle and fascia (cut) External spermatic fascia (cut)
Plate 251
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Rectus Sheath: Cross Sections
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Section above arcuate line Aponeurosis of external oblique muscle
Anterior layer of rectus sheath
External oblique muscle
Aponeurosis of internal oblique muscle Aponeurosis of transversus abdominis muscle
utaneous tissue (fatty layer)
Peritoneum Ex I ra pe r i to n e a I fa sc i a
Transversalis fascia
Aponeurosis of internal oblique muscle splits to form anterior and posterior layers of rectus sheath. Aponeurosis of external oblique muscle joins anterior layer of sheath; aponeurosis of transversus abdominis muscle joins posterior layer. Anterior and posterior layers of rectus sheath unite medially to form linea alba.
Section below arcuate line Aponeurosis of external oblique muscle
Anterior layer of rectus sheath
External oblique muscle
Aponeurosis of internal oblique muscle Aponeurosis of transversus abdominis muscle
itoneum Extraperitoneal fascia
Median umbilical ligament (obliterated urachus) in median umbilical fold
Subcutaneous tissue (fatty and membranous layers)
Aponeurosis of internal oblique muscle does not split at this level but passes completely anterior to rectus abdominis muscle and is fused there with both aponeurosis of external oblique muscle and that of transversus abdominis muscle. Thus, posterior wall of rectus sheath is absent below arcuate line, and rectus abdominis muscle lies on transversalis fascia.
PSate 252
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Anterior Abdominal Wall: Internal View .
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For umbilical vessels see Plate 229 Diaphragm
Parietal pleura
Diaphragmatic fascia
Round ligament (ligamentum teres) of liver and paraumbilical veins
Falciform ligament Peritoneum (cut edges) Transversalis fascia and its cut edge
Umbilicus Peritoneum Transversalis fascia
Arcuate line Rectus abdominis muscle
External and Internal oblique muscles
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Inferior epigastric vessels —
Transversus abdominis muscle
Inguinal triangle (Hesselbach's)
Left medial umbilical ligament (obliterated left umbilical artery)
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Transversalis fascia (cut) Interfoveolar ligament
Right medial umbilical fold
Deep circumflex iliac vessels Deep inguinal ring
Median umbilical ligament (obliterated urachus) and paraumbilical veins in median umbilical fold
P&3&-
Cremasteric and pubic branches of inferior
Umbilical prevesical fascia
epigastric artery Testicular vessels External iliac vessels
Lateral umbilical fold (contains inferior epigastric vessels)
Spermatic cord
Femoral nerve
Femoral sheath Lacunar ligament (Gimbernat's)
Iliopsoas muscle
Pectineal ligament (Cooper's)
External iliac vessels
Inguinal falx (conjoint tendon)
Supravesical fossa Transverse vesical fold
Umbilical artery (occluded part distal to this point)
Obturator internus muscle
Obturator nerve and vessels
Ureter (cut) Anterior recess of ischioanal fossa Superior vesical artery Ductus (vas) deferens
Body Wall
Levator ani muscle Seminal vesicle
Bulbourethral (Cowper's) gland embedded in deep transverse perineal muscle
Prostate and sphincter urethrae muscle Urinary bladder Perineal membrane
Plate 253
Posterolateral Abdominal Wall See also Plates 174, 177, 179, 180, 258
Serratus anterior muscle Infraspinous fascia Rhomboid major muscle Auscultatory triangle Lateral cutaneous branch of dorsal ramus of T7 spinal nerve Medial cutaneous branch of dorsal ramus of T7 spinal nerve Trapezius muscle Latissimus dorsi muscle External oblique muscle Thoracolumbar fascia (posterior layer) Lateral cutaneous branch of subcostal nerve (ventral ramus ofT12) Lumbar triangle (of Petit) Iliac crest Lateral cutaneous branch of iliohypogastric nerve (LI) Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3 spinal nerves) Gluteal aponeurosis over gluteus medius muscle Gluteus maximus muscle
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Latissimus dorsi muscle Latissimus dorsi muscle (cut and turned back) Serratus posterior inferior muscle Digitations of costal origin of latissimus dorsi muscle Digitations of costal origin of external oblique muscle External oblique muscle (cut and turned back) Tendon of origin of transversus abdominis muscle • Internal oblique muscle — Lateral cutaneous branch of subcostal nerve (ventral ramus of T1 2) — Lateral cutaneous branch of iliohypogastric nerve (LI) Iliac crest Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3 spinal nerves) Gluteus maximus muscle
Plate 254
Body Wall
Arteries of Anterior Abdominal Wall
Axillary artery
Subclavian artery Internal thoracic arteries
Lateral thoracic artery
Pericardiacophrenic artery with phrenic nerve
Subscapular artery
Transversus thoracis muscle
Thoracodorsal artery
Branch to falciform ligament of liver Anterior intercostal arteries Intercostal muscles
Musculophrenic arteries Superior epigastric arteries
External Internal In nermost
Diaphragm Tra n s v e r s u s a b d o m i n i s muscle and aponeurosis
Anastomoses with lower intercostal, subcostal, and lumbar arteries
Rectus abdominis muscles Internal oblique muscle
External, Internal oblique muscles
External oblique muscle Posterior layer of rectus sheath
Transversus abdominis muscle Ascending branch of deep circumflex iliac artery
-Arcuate line Inferior epigastric artery
Super tidal circumflex iliac artery
Superficial epigastric artery
Superficial epigastric artery (cut) Femoral arlerv Femoral artery
j
Superficial external pudendal artery Deep external pudendal artery
Cremasteric and testicular arteries and artery to ductus deferens in spermatic cord
Body Wall
Dorsal arteries of penis (deep to Buck's fascia)
Plate 255
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Veins of Anterior Abdominal Wall .
Subclavian vein Axillary vein
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External Internal Anterior
Jugular veins ^vw
Cephalic vein Intercostal tributaries to axillary vein
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Lateral thoracic vein Anterior intercostal veins Internal thoracic vein Musculophrenic vein Superior epigastric v e i n s —
Cephalic vein Axillary vein Lateral thoracic vein Areolar venous plexus
Thoracoepigastric vein
Perforati n g tributaries to internal thoracic vein
Paraumbilical veins in round ligament of liver
Thoracoepigastric vein
Inferior epigastric veins Tributaries to deep circumflex iliac veins Thoracoepigastric vein (cut) Superficial circumflex iliac vein
Tributaries of paraumbilical veins Thoracoepigastric vein Superficial epigastric vein Superficial circumflex r)C v e i n
Superficial epigastric vein External pudendal vein Saphenous opening
External pudendal vein Cribriform fascia over saphenous opening
Femoral vein Great saphenous vein Pampiniform (venous) plexus
-Great saphenous vein Anterior scrotal veins
Deep dorsal vein of penis (deep to Buck's fascia)— Superficial dorsal vein of penis
Plate 256
Body Wall
Nerves of Anterior Abdominal Wall See also Plates 177, 254, 267, 498
Medial brachial cutaneous nerve Intercostobrachial nerve (T 1,2) Long thoracic nerve Latissimus dorsi muscle
Serratus anterior muscle External oblique muscle (cut) Posterior layer of rectus sheath Anterior layer of rectus sheath (cut)
Lateral cutaneous branches of intercostal nerve (T2-1. I) Anterior cutaneous branches of intercostal nerve (T1 - 1 1 ) Lateral cutaneous branch of subcostal nerve (T1 2) Lateral cutaneous branch of iliohypogastric nerve (LI) Anterior cutaneous branch of subcostal nerve (T1 2) Lateral femoral cutaneous nerve (L2, 3) — Anterior cutaneous branch of iliohypogastric nerve (LI) Femoral branches of genitofemoral nerve (LI, 2) Anterior scrotal branch of ilioinguinal nerve (LI)
Rectus abdominis muscle Transversus abdominis muscle Internal oblique muscle and aponeurosis (cut) Anterior and lateral cutaneous branches of subcostal nerve (T12) Anterior branch of iliohypogastric nerve (LI) Ilioinguinal nerve (LI) External oblique aponeurosis (cut) Anterior cutaneous branch of iliohypogastric nerve (L I) Ilioinguinal nerve (LI) Cremasteric muscle of spermatic cord External spermatic fascia of spermatic cord
Genital branch of genitofemoral nerve (LI, 2) y
Body Wall
Plate 257
Thoracoabdominal Nerves See also Plates 180, 192 Spinal nerve trunk
Ventral (anterior) ramus of spinal nerve (intercostal nerve)
Erector spinae muscle
Meningeal branch
Collateral branch
Spinal sensory (dorsal root) ganglion
External intercostal muscle
Dorsal root
Internal intercostal muscle
Ventral root
Innermost intercostal muscle Latissimus clorsi muscle
s Subcostal muscles
Serratus anterior muscle
Lateral cutaneous branch
Innermost intercostal muscle
Greater and lesser thoracic splanchnic nerves
Internal intercostal muscle
Sympathetic trunl< Gray and white rami communicantes
External intercostal muscle
Rectus abdominis muscle Linea alba
External intercostal membrane External oblique muscle
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Anterior cutaneous branch
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Plate 258
Body Wall
Linea alba
External oblique muscle and aponeurosis
Rectus sheath (anterior layer)
Anterior superior iliac spine
Transversalis fascia within inguinal triangle (site of direct inguinal hernia)
Internal oblique muscle (cut and reflected) Transversus abdominis muscle Deep inguinal ring (in transversalis fascia)
Inguinal falx (conjoint tendon)
Cremaster muscle (lateral origin)
Reflected inguinal ligament
Inferior epigastric vessels (deep to transversalis fascia)
Intercrural fibers
Inguinal ligament (Poupart' Lacunar ligament (Gimbernat's)
External spermatic fascia on spermatic cord exiting
Cremaster muscle (medial origin) Superficial inguinal ring .Lateral crus Medial crus
Superficial inguinal ring Fundiform ligament of penis
Pubic crest
Anterior view Posterior (internal) view Rectus sheath (posterior layer) Arcuate line umbilical ligament Anterior superior iliac spine fascia {cut away) Rectus abdominis muscle Iliopubic tract Inferior epigastric vessels Inguinal (Hesselbach's) triangle Femoral nerve Genital branch of genitofemoral nerve and testicular vessels Deep inguinal ring Iliopsoas muscle External iliac vessels Femoral ring ( d i l a t e d ) (broken line) Lacunar ligament (Gimbernat's) Rectineal ligament (Cooper's) Ductus (vas) deferens Obturator-pubic anastomosis Obturator vessels Pubic branches of inferior epigastric vessels Median umbilical ligament Pubic symphysis Hesselbach's
Body Wall
triangle by Carlos Machado
after Frank Netter
/
Plate 259
External oblique muscle
Testicular vessels covered by peritoneum Testicular vessels and genital branch of genitofemoral nerve
\
Internal oblique muscle
Ductus (vas) deferens
Transversus abdominis muscle Transversalis fascia
Cremasteric vessels External iliac vessels covered by peritoneum
Extraperitoneal fascia (loose connective tissue)
Ductus (vas) deferens covered by peritoneum Inferior epigastric vessels
Peritoneum
Medial umbilical ligament (occluded part of umbilical artery) Umbilical prevesical fascia Urinary bladder Rectus abdominis muscle Pyramidalis muscle Median umbilical ligament (urachus) Superficial inguinal rings
Anterior superior iliac spine Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring Ilioinguinal nerve
Pubic symphysis (covered by intermingling fibers of external oblique aponeurosis)
Spermatic cord j \\
Femoral vessels
III
Cremaster muscle and cremasteric fascia on spermatic corcl
Pubic tubercle External spermatic fascia enveloping spermatic corc 1 Inguinal falx (conjoint tendon)
Inguinal ligament (Poupart's) Intercrural fibers
Plate 260
Body Wall
Indirect Inguinal Hernia Compare to Plate 260 Loop of bowel entering hernial sac
• Ductus (vas) deferens, testicular vessels, I and genital branch of genitofemoral nerve forming spermatic cord
Neck of hernial sacInferior epigastric vessels Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring
Peritoneum
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Extraperitoneal fascia Transversalis fascia
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Deep inguinal ring
External spermatic fascia
Cremaster muscle and fascia
Superficial inguinal ring
Internal spermatic fascia
Hernial sac Ductus (vas) deferens and vessels of spermatic cord
Body Wall
Plate 261
Femoral Sheath and Inguinal Canal
Transversalis fascia (cut edge) Extraperitoneal fascia Parietal peritoneum Median umbilical ligament (urachus) Medial umbilical ligament (occluded part umbilical artery) Inferior epigastric vessels Deep circumflex iliac vessels Testicular vessels asteric artery Ductus (vas) deferens External iliac vessels Pubic (obturator anastomotic) vessels External oblique aponeurosis (cut) Internal spermatic fascia on spermatic cord Femoral nerve (deep to iliopsoas fascia) Femoral vessels in femoral sheath Falciform margin of saphenous opening (cut and reflected) Ureter Genitofemoral nerve Urinary bladder Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Inguinal ligament (Pou part's)
Transversalis fascia forms anterior wall of femoral sheath (posterior wall formed by iliopsoas fascia) •••
••
Lateral femoral cutaneous nerve Iliac fascia Genital branch of genitofemoral nerve Femoral branch of genitofemoral nerve Testicular vessels External iliac vessels Inferior epigastric vessels Ductus (vas) deferens and cremasteric artery Pectineal ligament (Cooper's) Femoral ring Transversalis fascia forms anterior wall of femoral sheath Lacunar ligament (Gimbernat's) Inguinal ligament (Poupart's)
Lymph node (Cloquet's) in femoral canal Femoral sheath (cut open) Pectineal fascia
Plate 262
Body Wall
Posterior Abdominal Wall: Internal View mmmMmmmmmmmmmmmmmmmmmmmmmmmm
For diaphragm see also Plate 195
Cava I opening Diaphragm Central tendon of diaphragm Esophagus and vagal trunks Right crus of diaphragm Left crus of diaphragm Median arcuate ligament Aorta and thoracic duct Greater, lesser, and least thoracic splanchnic nerves Medial arcuate ligament Lateral arcuate ligament Sympathetic trunk
Quad rat us [umbo rum muscle Psoas minor muscle Psoas major muscle Transversus abdominis muscle Internal oblique muscle External oblique muscle lliacus muscle
Anterior superior iliac spine Piriformis muscle Coccygeus (ischiococcygeus) muscle
Anterior inferior iliac spine
Ischial spine Inguinal ligament (Poupart's) Obturator internus muscle Rectococcygeus muscle Tendinous arch of levator ani muscle Opening for femoral vessels Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Pubic symphysis Perineal membrane
Levator ani muscle Lesser trochanter of femur
Urethra Pubic tubercle
Body Wall
Rectum
Plate 263
4
Recurrent branch to esophagus
Celiac trunk with c o m m o n hepatic, left gastric, and splenic arterie
Superior suprarenal arteries Middle suprarenal artery Superior mesenteric artery
Superior suprarenal arteries
Inferior suprarenal artery
Middle suprarenal artery Inferior
Left renal artery
suprarenal artery Right renal artery
i
Testicular (ovarian) arteries
•i / A b d o m i n a l aorta
Psoas major muscle (cut)
Inferior mesenteric artery
Quadratus I umbo rum muscle
Left colic artery Sigmoid arteries
Subcostal artery*?
Superior rectal artery
T
1st to 4th right lumbar a r t e r i e s - ^ Common iliac arteries
Median sacral artery
Iliolumbar artery
Internal iliac artery Superior gluteal artery
Lateral sacral arteries External iliac artery
Umbilical (patent part) artery giving rise to superior vesical arteries
Testicular (ovarian) artery Ascending branch of deep circumflex iliac artery
Obturator artery Inferior vesical artery and artery to ductus deferens
Superficial circumflex iliac artery
Middle rectal artery Internal pudendal artery
Inferior epigastric artery Pubic, Cremasteric branches of inferior epigastric artery Superficial epigastric artery (cut)
Inferior gluteal artery
Swa
Transversalis fascia ( c u t ) y
Inferior epigastric artery
Femoral artery Ductus deferens and testicular artery (cut) Superficial external pudendal artery Deep external pudendal artery
Plate 264
Anterior abdominal wall (turned down)
k Medial
umbilical ligament (occluded part of umbilical artery)
Body Wall
Veins of Posterior Abdominal Wall :, .:;• . .
.....: .. . . :'
' •: . . . . . . • :
..:./.
.•
Inferior phrenic veins
Diaphragm
Hepatic veins Esophagus
Inferior vena cava
Left suprarenal veins and anastomosis with inferior phrenic vein
Right inferior suprarenal vein Right renal vein
Left renal vein
Psoas major muscle (cut)
Ovarian (testicular) veins
Quadratus ft lumborum muscle s J
Ascending lumbar veins
Subcostal vein
Common iliac vein
1st to 4th rightlumbar veins
Internal iliac vein
Iliolumbar vein
Superior gluteal vein
Common iliac vein
Inferior gluteal vein
Ovarian (testicular) veins and ureter (cut)
Internal pudendal vein External iliac vein
Internal iliac vein Median sacral vein
Middle rectal vein
Lateral sacral veins
Uterine vein Superior vesical vein
Deep circumflex iliac vein
Deep circumflex iliac vein
Superficial circumflex iliac vein
Obturator vein Round ligament of uterus
Inferior epigastric vein (cut)
Inferior epigastric vein Superficial epigastric vein (cut)
Rectal venous plexus
Pubic (obturator anastomotic) vein
Uterovaginal venous plexus
Femoral vein Great saphenous vein External pudendal vein
Body Wall
Anterior abdominal wall (turned down)
Vesical venous plexus
Plate 265
Lymph Vessels and Nodes of Posterior Abdominal Wall See also Plate 407
Thoracic duct Right subclavian trunk
Tracheobronchial nodes
Inferior phrenic nodes Thoracic duct
Cisterna chyli
Right lumbar trunk
Intestinal trunk
Left lumbar trunk
C o m m o n iliac nodes
Middle sacral nodes
Celiac nodes Superior mesenteric nodes
Visceral (preaortic) lymph nodes
In ferior mesenteric node ^ Lumbar nodes (lateral aortic nodes) Common iliac nodes Internal iliac nodes External iliac nodes
Lateral sacral nodes Inferior epigastric node
Node of Cloquet, or Rosenmuller (highest deep inguinal node)
Superficial inguinal nodes (superior, horizontal, and inferior [verticall groups)
Deep inguinal nodes
Plate 266
Body Wall
Nerves of Posterior Abdominal Wall
Greater, lesser, and least thoracic splanchnic nerves
Celiac, superior mesenteric, and aorticorenal ganglia Iliohypogastric nerve (LI)
Sympathetic trunks
Ilioinguinal nerve (L1)
Subcostal nerve (T12)
Muscular branches from lumbar plexus
Iliohypogastric nerve (L1) '
Subcostal nerve (T12) Psoas major muscle (cut)
Ilioinguinal nerve (LI)
/Quadratus lumborum muscle
Genitofemoral nerve (LI,2) Transversus abdominis muscle (cut)
Iliohypogastric nerve (LI) Ilioinguinal nerve (LI)
Subcostal nerve (T12) and its lateral cutaneous branch
Genitofemoral nerve (LI,2)
Intermesenteric (paraaortic) plexus
Lateral femoral cutaneous nerve (L2, 3) $
Femoral branch, Genital branch of genitofemoral nerve (LI,2)
mm
Gray and white rami communicantes
Lumbosacral trunks (14, 5) Obturator nerves
Gray rami communicantes
Accessory obturator nerve (L3, 4) (occasional)
Lateral femoral cutaneous nerve (L2,3)
Femoral nerve Sacral plexus (L4-S4)
Femoral nerve (L2-L4)
Pudendal nerve (S2, 3, 4)
Obturator nerve (L2, 3, 4)
Anterior cutaneous branch of iliohypogastric nerve (L'l) Anterior scrotal (labial) branches of ilioinguinal nerve (L1) Genital branch ....
S o d y
WsaOO
....
Femoral branches
of genitofemoral nerve (LI, 2)
Plate 267
4
Regions and Planes of Abdomen BHCppaPjHaBy
V y'Vs
Right lateral rectus plane (semilunar line)
Left upper quadrant
Right upper, quadrant) (RUQ)-
Right midclavicular line
•• "ffiKSrt^'^^
Left lateral rectus plane (semilunar line)
Left midclavicular line
Left lower quadrant..,:
ght lovver quadrant , (RLQ)
Epigastric region
Right hypochondrium (hypochondriac region) Trans pyloric plane
hypochondrium (hypochondriac on)
Subcostal plane Umbilical region Right flank (lumbar regi
Left flank (lumbar region)
Intertubercular plane Interspinous plane Right groin (inguinal re
Left groin (inguinal region)
Pubic (hypogastric region)
P l a t e
2 6 8
Peritoneal Cavity
See also Plates 275, 348, 349
Falciform ligament
Left lobe of liver
- Right lobe of liver
Stomach
Gallbladder
Greater omentum overlying transverse colon and small intestine (jejunum and ileum)
Greater omentum {turned up)
Transverse colon (turned up)
Transverse mesocolon
Left colic (splenic) flexure
Right colic (hepatic) flexure
Small intestine (jejunum and ileum)
Ascending colon
Cecum Small intestine (covering descending colon)
Sigmoid colon
Urinary bladder
Peritoneal Cavity
it
4
Mesenteric Relations of Intestines
nsverse colon (elevated) Transverse mesocolon Superior duodenal fold Superior duodenal fossa Left colic (splenic) flexure Paraduodenal fossa Inferior duodenal fossa Inferior duodenal fold Mesentericoparietal recess (fossa) Superior mesenteric artery in root of «mesentery Inferior mesenteric artery and vein Abdominal aorta
Esophagus Right crus of diaphragm (part passing to right of esophageal hiatus) Right crus of diaphragm (part passing to left of esophageal hiatus) Left crus of diaphragm
Exposure of suspensory muscle of d u o d e n u m (ligament of Treitz)
Celiac trunk Suspensory muscle of duodenum (ligament of Treitz) Superior mesenteric artery Duodenojejunal flexure ncling (4th) part of duodenum ejunum Inferior (horizontal, or 3rd) part of duodenum Descending (2nd) part of duodenum
Plate 270
Peritoneal Cavity
Mesenteric Relations of Intestines (continued)
rse colon [elevated)
mesocolon (elevated over pancreas)
Greater omentum (elevated)
Jejunum (cut) Free taenia (taenia libera)
Mesentery (cut and small intestine removed)
Omental (epiploic) append
Left colic (splenic) flexure
Right colic (hepatic) flexure
Descending colon
Right paracolic gutter
Left paracolic gutter
Ascending colon
Sigmoid mesocolon
Terminal part of ileum (cut)
Sigmoid colon
Cecum
Rectum
Retrocecal recess Vermiform appendix
Sigmoid colon ( reflected) Sigmoid mesocolon Intersigmoid Ureter
Parietal peritoneum
Common iliac vessels
Peritoneal Cavity
Plate 271
Omental Bursa: Stomach Reflected
Inferior vena cava (retroperitoneal) C o m m o n hepatic artery (in peritoneal fold)
in gastrocolic ligament)
Hepatoduodenal ligament (right margin of lesser omentum) Probe in omental (epiploic) foramen
Stomach (posterior surface) Caudate lobe of liver Probe in superior recess of omental bursa Left gastric artery (in gastropancreatic fold) Left inferior phrenic artery (retroperitoneal)
Gallbladder
Gastrophrenic ligament
Diaphragm
Left suprarenal gland and superior pole of kidney (retroperitoneal)
Liver
Gastrosplenic (gastrolienal) ligament
7
Spleen
Right colic (hepatic) flexure
Left colic (splenic) flexure
Kidney (retroperitoneal) Descending (2nd) part of duodenum Right gastro-omental (gastroepiploic) artery (covered by peritoneum) Anterior superior pancreaticoduodenal artery (retroperitoneal) Head of pancreas (retroperitoneal)
Plate 272
Phrenicocolic ligament Splenorenal (lienorenal) ligament Tail of pancreas (intraperitoneal) Posterior layers ) Anterior layers (cut) j
of gastrocolic ligament
ransverse mesocolon Body of pancreas (retroperitoneal)
Peritonea! Cavity
.raj
© m e r a f a B
E i w r s a ^
© r @ s s
S e ^ t i © ^
See also Plate 331
Vertebral body of L1 Abdominal aorta
Inferior vena cava
Splenic vein
Diaphragm Right kidney
Left kidney
,: -
l l l l
\
v?
b.
-a »
m&lfZM
« p
^
Gastrosplenic (gastrolienal) ligament Greater omentum Visceral peritoneum (cut edges) Omental (epiploic) foramen (of Winslow)
Stomach *
(Common) bile duct Portal triad
Hepatic portal vein
Peritoneal Cawity
Pancreas Omental bursa (lesser sac) Lesser omentum (hepatoduodenal and hepatogastric ligaments)
Plate 273
4
Peritoneum of Posterior Abdominal Wall
Abdominal aorta and celiac trunk
Inferior vena cava (Common) bile cluct and proper hepatic artery Coronary ligament of liver
Falciform ligament
Hepatic veins
Superior recess of omental bursa (lesser sac) Attachment of lesser omentum and left gastric artery
Right suprarenal gland O m e n t u m (epiploic) foramen behind right free margin of lesser omentum
Esophagus
Left triangular ligament of liver
Right triangular ligament
Gastrophrenic ligament and left inferior phrenic artery
Attachment of transverse mesocolon and right gastro-omental (gastroepiploic) vessels
j
Splenorenal (lienorenal) ligament and splenic vessels
Duodenum Right kidney
Phrenicocolic ligament
Parietal peritoneum
K 3 r>.
a
Root of mesentery
/f>
Site of ascending colon
Attachment of sigmoid mesocolon and sigmoid vessels
Testicular vessels (retroperitoneal)
Median umbilical fold (contains urachus)
Attachment of transverse mesocolon
Site of descending colon
External iliac artery (retroperitoneal)
Site of deep inguinal ring
Pancreas and splenic artery (retroperitoneal)
Superior mesenteric vessels
Common iliac artery (retroperitoneal)
Ureters (retroperitoneal)
Short gastric vessels
Superior rectal vessels
mm
Rectum
Urinary bladder
Sacrogenital fold (ligament) Lateral umbilical fold (contains inferior epigastric vessels) Medial umbilical fold (contains occluded part of umbilical artery)
Plate 274
Peritoneal Cavity
Stomach in Situ mtA
Left lobe of liver
Hepatoduodenal ligament Hepatogastric ligament
Falciform ligament
Lesser omentum
Abdominal part of esophagus
Fundus of stomach
Rou nd ligament of liver (obliterated umbilical vein)
Diaphragm /
Spleen
Inferior border of liver Cardiac
Quadrate lobe of liver
stomach
Right lobe of liver Body of stomach
Gallbladder Angular notch Mincisyre)
Omental (epiploic) foramen' (of Winslow) Pylorus
st°niac
Duodenum
h
Right kidney (retroperitoneal) Right colic (hepatic) flexure
Greater omentum
Left colic (splenic) flexure
Variations in position and c o n t o u r of stomach in relation to body habitus
Hypertonic stomach
Viscera (Gut)
Orthotonic: stomach
Hypotonic stomach
Atonic stomach
PGaf© 27S
See also Plate 236
Zigzag (Z) line (junction of gastric and esophageal mucosa)
Cardiac zone
Cardiac orifice
Pyloric orifice
Superior (1 st) part of duodenum (ampulla, or duodenal cap)
Gastric and fundic zones
sV Pyloric zone
Surface epithelial cell
Mucous cell
Parietal cell (between mucous cell and chief cell)
Chief cell Solitary lymph follicle (nodule) Neuroendocrine G cell Muscularis mucosae Pyloric glands
Plate 278
Submucosa
Gastric (fundic) glands
Viscera (Gut)
Musculature of Stomach .
-
.
•
A
v
i
"
i
i
i
i
.
.
Kafiv •'AV.vivJSLuv/;','£
.V:
:
Longitudinal muscle of esophagus
Outer longitudinal muscle layer of stomach (concentrated chiefly at lesser and greater curvatures and at pyloric part)
Middle circular muscle layer of stomach
Collar of Helvetius (middle circular and innermost oblique fibers blend here)
Longitudinal muscle of duodenum
Section through pylorus (composed chiefly of thickened circular muscle)
Circular muscle of duodenum Longitudinal muscle of duodenum {cut away)
Viscera (Gut)
Windows cut in middle circular muscle layer
Pilate 277
Duodenum in Situ
Suprarenal gland
Hepatic portal vein Portal triad
Superior mesenteric vessels
Proper hepatic artery
Kidney Transverse mesocolon and its cut edges
Celiac trunk
(Common) bile duct
Splenic artery
Transverse colon (cut)
Right free margin of lesser omentum (hepatoduodenal ligament)
Left colic (splenic) flexure
Liver (cut) Suprarenal gland
Jv'v.yiV;
Pylorus KidneyTransverse mesocolon and its cut edges Right colic (hepatic) flexure
X
iiif i l l mMm iW -^i"' . ' tS' ' " V.
. ?
p
Transverse colon {cut)
[
m^
Ascending colon
,
/
Psoas major muscle
/
fi
fjm &L^'l /
•M'
'(
;'l m
Superior (1 st) part
J
Descending colon
Descending (2nd) part Duodenum
Inferior duodenal fold and fossa
Inferior (horizontal, or 3rd) part Ascending (4th) partRoot of mesentery (cut edges)
Duodenojejunal flexure and jejunum {cut) Inferior mesenteric artery Abdominal aorta Inferior vena cava
Plate 278
Viscera (Gut)
Proper hepatic artery
Hepatic portal vein
Gastroduodenal artery.
(Common) bile duct
Right gastric artery Right free margin of lesser omentum (hepatoduodenal ligament)
,
w
Pyloric orifice
Superior duodenal flexure
(Common) bile duct
Superior (1 st) part (ampulla, or duodenal cap) (no circular folds)
Accessory pancreatic duct (of Santorini) (Principal) pancreatic duct (of Wirsung)
Descending (2nd) part Minor duodenal papilla (inconstant)
D u od en oj e j u n a I f I ex u re
Circular folds (valves of Kerckring)
Jejunum
Major duodenal papilla (of Vater)
Ascending (4th) part Head of pancreas
Superior mesenteric artery and vein
Inferior duodenal flexure Inferior (horizontal, or 3rd) part
Outer longitudinal muscle layer (with window cut)
Inner circular muscle layer (with window cut) Submucosa with duodenal (Brunner's) glands
Viscera (Gut)
Barium radiograph of stomach, d u o d e n u m , and proximal j e j u n u m B
Body of stomach
D
Duodenal cap (1 st part)
D2
Descending (2nd) part of duodenum
F
Fundus of stomach
J
Proximal jejunum
P
Pylorus
PA
Pyloric antrum
Plate 279
Mucosa and Musculature of Small Intestine
Jejunum Mesen Anastomotic loop (arcade) of jejunal arteries Straight arteries (arteriae rectae) Serosa (visceral peritoneum) Longitudinal muscle layer Circular muscle layer
Barium radiograph of jejunum
Submucosa Mucosa Circular folds (valves of Kerckring) Solitary lymphoid nodule
Ileum Mesentery Anastomotic loops (arcades) of ileal a r t e r i e s - — _ Straight arteries (arteriae rectae) Serosa (visceral peritonei] m)-—" Longitudinal muscle layer Circular muscle layer
Barium radiograph of ileum
Submucosa Mucosa Circular folds Solitary lymphoid nodules Aggregate lymphoid nodules (Peyer's patches)
Plate 280
Wiseera JOutJ
Ileocecal Region
Ileocolic artery Colic branch Ileal branch Superior mesenteric artery v
Posterior cecal artery Appendicular artery Anterior cecal artery Vascular fold of cecum Superior ileocecal recess Ileocecal fold (bloodless fold of Treves) Terminal part of ileum Inferior ileocecal recess —Mesoappendix Appendicular artery Vermiform appendix Free taenia (taenia libera)
External iliac vessels (retroperitoneal) Retrocecal recess Cecal folds Appendicular artery
Right paracolic gutter Omental taenia
4
J*'
Mesocolic taenia
Posterior cecal artery Cecal folds Retrocecal reces
Some variations in posterior peritoneal attachment of cecum Lines of posterior peritoneal reflection
Viscera (Gut)
Lines of posterior peritoneal reflection
Lines of posterior peritoneal reflection
Lines of posterior peritoneal reflection
P l a t e
28H
Ileocecal Region (continued)
Free taenia (taenia libera)
Ileocecal lips: labial form of ileal orifice (as seen commonly postmortem and occasionally in vivo)
Terminal part of ileum
Orifice of vermiform appendix
Ileal papilla: papillary form of ileal orifice (found most commonly in vivo)
Schema of muscle fibers at ileal orifice
Plate 282
Viscera (Gut)
McBurney's point (on spinoumbilical line)
Barium radiograph of unusually long appendix (A Appendix; C Cecum)
/ A, '
V
Fixed retrocecal appendix
Variations in position of appendix
Mesoappendix •Serosa (visceral peritoneum) Longitudinal muscle Circular muscle Submucosa -•r
.
Viscera (Gut)
;
v
.
'iv
' is'.1
•Aggregate lymphoid nodules Crypts of Lieberkuhn
Plate 283
For rectum and anal canal see Plates 391-396
Greater omentum ( c u t a w a y ) Right colic (hepatic) flexure
Left colic (splenic) flexure
Omental taenia
Omental (epiploic) appendices Haustra Peritoneum ¥ (cutaway)
Peritoneum (cut away) Omental taenia (exposed by hook)
-—Descending colon
Mesocolic taenia (exposed by hook)
Ascending colon
Free taenia (taenia libera) Ileal orifice
Cecum Vermiform appendix
Sigmoid colon Sigmoid mesocolon Levator ani muscle External anal sphincter muscle
Plate 284
0 y
Viscera (Gut)
Sigmoid Colon: Variations in Position For rectum see Plates 360, 361, 391-394
Typical
Short, straight, obliquely into Ik.
Looping to right side
Wiscera (Gut)
•
Ascending high into abdomen
Plate 285
4
Topography of Liver
Transpyloric
Lateral rectus (semilunar) plane
Liver covered by diaphragm, pleura and lung (percussion dullness)
Diaphragm
Liver covered by diaphragm and pleura (percussion flatness)
Liver covered by diaphragm, pleura, and lung (percussion dullness)
Liver covered by diaphragm (percussion flatness or intestinal resonance)
Liver covered by diaphragm and pleura (percussion flatness)
Diaphragm
Plate 286
Liver covered by diaphragm, pleura, and lung (percussion
Liver covered by diaphragm and pleura (percussion flatness)
Gallbladder Inferior border of liver
Viscera (Accessory Organs)
Surfaces and Bed of Liver Diaphragm ( p u l l e d up)
Left triangular ligament
Right triangular ligament
Fibrous appendix of liver Left lobe of liver
Right lobe of liver
Falciform ligament
Round ligament (ligamentum teres) of liver (obliterated umbilical vein) forming free border of falciform ligament
Costal impressions
Anterior view Gallbladder (fundus) Porta hepatis Fissure for ligamentum teres Hepatic portal vein
Colic impression Round ligament of liver
Proper hepatic artery Caudate process
Gallbladder
Papillary process Caudate lobe
Quadrate lobe Duodenal impressio
Fissure for ligamentum venosum
Renal impressio
Esophageal impression Gastric impression
Cystic duct Common hepatic duct (Common) bile duct
Left triangular ligament
Right triangular ligament Hepatorenal portion of coronary ligament Suprarenal impression Bare area Inferior vena cava Coronary ligament
Hepatic veins
Visceral surface Falciform ligament
Left triangular ligament
Coronary ligament Bare area Inferior vena cava Suprarenal gland Right kidney
Left triangulai ligament
Right triangular ligament
Fissure for ligamentum venosum
Superior recess of omental bu
Groove for (inferior) vena cava
Posterior view
Viscera (Accessory Organs)
Duodenum
Stomach
Bed of liver
Plate 287
4
Liver in Situ and Variations in Form mmmm
Left lobe of liver
Round ligament (ligamentum teres) of liver (obliterated umbilical vein) Quadrate lobe
Caudate lobe seen through lesser omentum (hepatogastric ligament)
Right lobe of liver
W i n d o w cut in lesser omentum (hepatoduodenal ligament) Proper hepatic artery
Omental (epiploic) foramen (of Winslow)
(Common) bile duct portal vein Lesser omentum (hepatogastric ligament)
Kidney (retroperitoneal)
Spleen
Duodenum
Stomach Greater omentum
I A-I+ /•^J'xll/'-
flexure Right colic (hepatic) flexure
Variations in f o r m of liver
Very small left lobe, deep costal impressions
"Tonguelike" process of right lobe
Plate 288
Complete atrophy of left lobe (left portal vein compression)
Very deep renal impression and "corset constriction"
Transverse, "saddlelike" liver, relatively large left lobe
Diaphragmatic grooves
Viscera (Accessory Organs)
Liver Segments and Lobes: Vessel and Duct Distribution ... ..
.
..-.
Anatomic \ lobes )
Division into segments is based upon ramifications of bile ducts and hepatic vessels. It does not entirely correspond with division into anatomic lobes
Left (part of) liver Functional surgical segments
Lateral division
Posterior lateral segment (VII) (Posterior superior area)—^
Right anterior lateral segment (VI) (Posterior inferior area)—/
Medial division
Medial division
Lateral division
Lateral segment (II) . (Lateral superior area) Posterior medial segment (VIII) (Anterior superior area)
(Medial superior Medial segment
Anterior medial segment (V) (Anterior inferior area)
\
Left a n t e r o lateral segment tilt) (Lateral inferior
Parietal surface
(Medial inferior area)
UAnterior
Visceral surface
anterior \ lateral \ segment ( V I ) \ (Posterior inferior area)
A
Anterior medial segment (V)
(Medial inferior Quadrate lobe
Posterior lateral segment (VII) (Posterior superior area) ^I'iMyy.
Medial segment (IV)
<1
/I - ^ // ' /
anterjor
lateral segment (I (Lateral
| Lateral feegment (II) \ (Lateral superior yV':ik area) i (Medial superior area)
Caudate process
Distribution of vessels and ducts
Phantom division between anterior and y posterior superior areas
I Inferior vena cava
Wishers (Accessory ©rgamsj
Common hepatic duct, hepatic portal vein, and proper hepatic artery
Right branch Left branch Anterior segment Medial segment Posterior segment Lateral segment Anterior inferior area Medial inferior area Anterior superior area Medial superior area Posterior inferior area Lateral inferior area Posterior superior area Lateral superior area Caudate lobe (right and left) Caudate process
Plate 289
Sublobular vein
Hepatic vein Sublobular veins
Central vein
Sinusoids Portal triad
Sinusoids
Central vein Portal triad
Portal triads
Proper hepatic artery Hepatic portal vein Common hepatic duct
hepatis along vessels and bile duct Vv
Hepatic artery branch Portal vein branch
/
Portal triad
Bile ductules Sinusoids Liver cell "plates" Central veins (tributary to hepatic vein via sublobular veins)
Normal lobular pattern of liver
Plate 290
Viscera (Accessory Organs)
Liver Structure: Schema
Lymph vessel Limiting plate of portal space
Central vein Sublobular vein (tributary to hepatic vein)
Periportal space (of Mall)
Perisinusoidal spaces (of Disse)
Central vein
Sinusoids Central vein
.-•.•v.".-
jsffgg- i
Branch of portal vein
Branch of / hepatic artery Portal arteriole Periportal arteriole
Central vein
Intralobular arteriole
Periportal bile ductule (canal of Hering) Inlet venule Distributing vein
Viscera (Accessory Organs)
Plate 291
4
Intrahepatic Biliary Systems: Schema
Branch of portal vein
Bile canaliculi
Bile ducts
Note: In the above illustration, bile canaliculi appear as structures with walls of their own. However, as shown in the histologic section at right, boundaries of canaliculi are actually a specialization of surface membranes of adjoining liver parenchymal cells.
Sinusoid
Branch of portal vein
Bile ducts Bile ductules
Bile canaliculi Branch of hepatic artery
Low-power section of liver
Plate 292
Viscera (Accessory Organs)
<
W o
•T
as >
Transverse Section: Level of T10, Esophagogastric j u n c t i o n Plate 293
T10
o 0 (D m
Diaphragm
Rectus abdominis muscle
o
Xiphoid process
Costal cartilages
Esophagogastric junction (Q
fi> 3
W
Right crus of diaphragm (forming right boundary of esophageal hiatus)
Gastric folds (rugae)
Fundus of stomach Inferior vena cava Right crus of diaphragm (forming left boundary of esophageal hiatus)
Serratus anterior muscle
Thoracic aorta
Azygos vein
Left crus of diaphragm
Diaphragm
Latissimus dorsi muscle
Spleen
Inferior lobe of left lung in costodiaphragmatic recess
Inferior lobe of right lung in costodiaphragmatic recess
2
Body of T10 vertebra
Erector spinae muscle
ST (D If (0 Q
Thoracic duct CAf^a^ / —
Gallbladder and Extrahepatic Bile Ducts
Right and left hepatic arteries
Right and left hepatic ducts
Proper hepatic artery
Common hepatic duct
Anterior layer of lesser omentum (cut edge)
Cystic artervi
Right gastric artery
Cystic duct Common hepatic artery
Hepatic portal vein
Gastroduodenal artery
Liver
Stomach
(Common) bile duct Gallbladder Hepatic ducts
Superior (1 st) part of duodenum
Right
Left
Cystic duct
Transverse colon (cut)
Spiral fold
Head of pancreas Neck Infundibulu (Hartmann's pouch)
Smooth
Common hepatic uct Gland orifices
Gallbladder
(Common) bile duct
Fundus
Descending (2nd) part of duodenum Pancreatic duct
Hepatopancreatic ampulla (of Vater) Major duodenal papilla (of Vater)
Plate 294
Viscera (Accessory Organs)
Junction of (Common) Bile Duct and Duodenum
(Common) bile duct (ductus choledochus) Minor duodenal papilla
Longitudinal muscle of duodenum
Longitudinal duodenal muscle seen through opening in circular muscle
Circular folds Major duodenal papilla
Circular muscle of duodenum Pancreatic duct Sphincter of (common) bile duel (choledochus) Longitudinal bundle
Reinforcing fibers
Longitudinal fold
Sphincter of pancreatic duct (inconstant)
Fibers to longitudinal bundle
Reinforcing fibers Duodenal muscle fibers to longitudinal bundle
Interior of descending (2nd) part of duodenum
Dissection Duodenal mucosa —
(Common) bile duct
(Common) bile duct
Pancreas /
:
Longitudinal) Duodenal —-—Circular ) muscle m§ -(Common) bile duct UM u — — L o n g i t u d i n a l bundle —
^ ^ ^ - S p h i n c t e r of (common) bile duct (choledochus)
p i r ^ Fibers to longitudinal bundle
J
/
^-——Sphincter of pancreatic duct (inconstant)
Sphincter of (common) bile ductLongitudinal bundle Pancreatic ductDuodenal muscle — Pancreas Section, level A
I /
— Pancreatic duct
(Common) bile duct Sphincter of hepatopancreatic ampulla—— ' Longitudinal bundle Pancreatic d u c t - ^
Sphincter of hepatopancreatic ampulla
Section, level B Sphincter of hepatopancreatic ampulla—
Major duodenal papilla
Reconstruction
Hepatopancreatic ampulla v (common \ channel)-"""*""^
Variations in union of bile and pancreatic ducts I
1m'^(Common) i m m bile duct ;
hinder of hepatopancreatic ampulla
(Common) bile duct
Section, level C jl f
\j >.
Pancreatic duct Sphincter of ampulla
Short common channel
Pancreatic duct Duodenal wall No common channel
Viscera (Accessory Organs)
Sphincter of ampulla
Long common channel
Plate 295
Variations in Cystic and Hepatic Ducts
Variations in cystic duct Low union with common hepatic duct
Adherent to common hepatic duct
Cystic duct absent or very short
Anterior spiral joining common hepatic duct on left side
High union with common hepatic duct
Posterior spiral joining common hepatic duct on left side
Accessory (aberrant) hepatic ducts Joining common hepatic duct
Joining (common) bile duct
Joining cystic duct-
Joining gallbladder Two accessory hepatic ducts
Plate 296
Viscera (Accessory Organs)
W o
o o
Transverse Section: Level of T12, Inferior to Xiphoid i ji
t
h—
T12
Plate 297
Pyloric canal
)
Stomach
1
Pylorus
Jejunum
W
(/)
0 <
Right colic (hepatic) flexure of colon
O as
3
(A
Transverse colon (ascending to left colic flexure)
Gallbladder Bifurcation of celiac trunk
Superior (1 st) part of duodenum Hepatoduodenal ligament
Descending colon (descending from left colic flexure)
Liver
Spleen
(Common) bile duct
Portal triad
Splenic artery and vein
Prope hepatic artery
Left suprarenal gland Superior pole of left kidney
Portal vein Inferior vena cava
Left crus of diaphragm Thoracic aorta
Right suprarenal gland Pancreas •o
Right crus of diaphragm
ST ro
(0 -si
CAfcU^&k/—/1.7>.
Inferior vena cava
Celiac trunk
Splenic artery
Stomach {cut)
Hepatic portal vein Portal triad
Spleen
Proper hepatic artery (Common) bile duct
Right free margin of lesser omentum Suprarenal gland Duodenum Right kidney (retroperitoneal)
Pancreas Left colic (splenic) flexure
Attachment of transverse mesocolon
Right colic (hepatic) flexure
Transverse colon (cut) Left kidney (retroperitoneal)
Transverse colon (cut)
• Attachment of transverse mesocolon Inferior mesenteric vein (retroperitoneal) jejunum (cut)
Middle colic artery and vein
Duodenojejunal flexure
Superior mesenteric artery and vein
Root of mesentery (cut)
Uncinate process of pancreas
Low-power section of pancreas
Islets (of Langerhans)
Pancreatic notch Pancreatic duct (of Wirsung)
Interlobular duct Interlobular septum
Plate 298
Viscera (Accessory Organs)
Posterior extremity
Gastrosplenic ligament
Posterior extremitv
Superior bordei
Short gastric vessels
Gastric impression
Renal impression
Hilum
Inferior border Splenorenal (lienorenal) ligament Splenic artery Left gastro-omental (gastroepiploic) vessels
WBmm
mIUM
Splenic vei
siiiai M l
Colic impression
Diaphragmatic surface
Visceral surface
Short gastric vessels in gastrosplenic ligament
Inferior border
Anterior extremity
Diaphragm Spleen
Stomach (cut)
Serosa (visceral peritoneum)
9th rib
Fibrous capsule Splenic pulp Splenic trabeculae Splenic vein and artery — Hilum
Cross section
Suprarenal gland Left kidney Splenic artery and vein Transverse colon
Splenorenal (lienorenal) ligament Attachment of transverse mesocolon (cut)
"ail of pancreas
Spleen in situ
Viscera (Accessory Organs)
Plate 299
Arteries of Stomach, Liver, arid Spleen
Right and left inferior phrenic arteries
Left gastric artery
Abdominal aorta
Splenic artery
Celiac trunk
Esophageal branch of left gastric artery
Left hepatic artery
Recurrent branch of left inferior phrenic artery to esophagus
Right hepatic artery
Short gastric arteries
1 \
Proper hepatic arterv (Common) bile duct-""" Hepatic portal vein Right gastric artery-^ Supraduodenal artery '
\
Posterior superior, / Anterior superior ' pancreaticoduodenal arteries
Plate 300
Common hepatic artery Right gastro-omental (gastroepiploic) artery
/
/
Splenic branches of splenic artery
Left gastro-omental (gastroepiploic) artery
Visceral Vasculature
Arteries of Liver, Pancreas, Duodenum, and Spleen MPf Sasfjsf
Intermediate hepatic artery Proper hepatic artery Right hepatic artery Cystic artery
Right and left inferior phrenic arteries (shown here from common stem)
Hepatic portal vein
Celiac trunk
C o m m o n hepatic artery
Abdominal aorta
Left gastric artery
Gallbladder.
Short gastric arteries
'mmMm
mm
Cystohepatic triangle (of Calot) • —
wm
/ i
Cystic duct
^wmWk IA ••> ^fcfflPfc"^- J r m
Common hepatic duct (Common) bile duct Right gastric artery
Left gastro-omental (gastroepiploic) artery
Supraduodenal artery
Artery to tail of pancreas
Gastroduodenal artery
Greater pancreatic artery hM ' SS® it: 1W i l w •iSi\ ® Sv IS Itim » j H . Xf. > p i l l kV
Splenic artery
Pi
Dorsal pancreatic artery Inferior pancreatic artery Anastomotic branch Middle colic artery (cut)
Posterior superior pancreaticoduodenal artery {phantom)
z
Superior mesenteric artery
Inferior pancreaticoduodenal artery
Anterior superior pancreaticoduodenal artery Right gastro-omental (gastroepiploic) artery
Visceral Vasculature
Posterior inferior pancreaticoduodenal artery Anterior inferior pancreaticoduodenal artery
Plate 301
Variations in Celiac Trunk mmmm.:^——
Common origin of celiac trunk and superior mesenteric artery
Splenic and hepatic arteries take origin from superior mesenteric
Replaced right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal and I st jejunal arteries from replaced right hepatic
Accessory right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal arteries from accessory right hepatic; 1 st jejunal artery from anterior inferior pancreaticoduodenal
Plate 302
Celiacomesenteric trunk
Hepatolienomesenteric trunk
^ I n c o m p l e t e Y^ celiac trunk « Hepatomesenteric
Splenic artery takes origin from superior mesenteric (note replaced left hepatic artery from left gastric)
Replaced hepatic artery takes origin from superior mesenteric (note inferior pancreaticoduodenal artery from 1st jejunal)
Accessory right hepatic artery takes origin from superior mesenteric
Hepatogastric trunk /tf^ Lienomesenteric trunk
Lienogastric trunk Hepatomesenteric tru nl<
Complete celiac trunk Hepatomesenteric trunk
Right gastroepiploic (gastro-omental) Complete celiac trunk artery takes origin from Hepatomesenteric superior \trunk mesenteric | | (Note accessory (note accessory I left gastric artery left hepatic H | from left hepatic) artery from left gastric)
Wisceral Vasculature
Celiac Arteriogram mmmmmmBwmiwwmm
See also Plates 300, 301
CH CT C GD H RG S
Visceral Vasculature
Common hepatic artery Celiac trunk Left gastric artery Gastrocluoclenal artery Proper hepatic artery Right gastric artery Splenic artery
Plate 303
Arteries of Duodenum and Head of Pancreas j
D u o d e n u m and head of pancreas reflected to left
(Common) bile duct Gastroduoclenal artery Posterior superior pancreaticoduodenal artery Anterior superior pancreaticoduodenal artery (phantom)
Superior mesenteric artery Inferior pancreaticoduodenal artery Posterior inferior pancreaticoduodenal artery
Anterior inferior pancreaticoduodenal artery (partially in phantom) Inferior vena cava Celiac trunk
Proper hepatic artery Common hepatic artery
Splenic artery
Supraduodenal artery Gastroduodenal artery (partially in phantom) Posterior superior pancreaticoduodenal artery (Common) bile duct Right gastro-omental (gastroepiploic) artery (phantom, cut) Anterior superior pancreaticoduodenal artery (phantom)
WBmi
Inferior pancreatic artery
Anastomotic branch
Dorsal pancreatic artery Superior mesenteric arterv Inferior pancreaticoduodenal artery
Plate 304
Posterior inferior pancreaticoduodenal artery
•vMV,
Anterior inferior pancreaticoduodenal artery (phantom) pflfll
Posterior view
Visceral Vasculature
Arterial Variations and Collateral Supply of Liver and Gallbladder
Umbilicus (turned up)
Internal thoracic arteries Falciform and round ligaments with arteries Short gastric arteries
Cystic artery
Intercostal arteries
m&B
ifp
iSx ai C a C • 1 HK l'kit 11
1 IMl I •
Left gastro-omental (gastroepiploic) artery
Inferior phrenic artery Gastroduodenal artery-
Left gastric artery
Common hepatic artery'
Celiac trunk
Posterior superior pancreaticoduodenal artery
Splenic artery Dorsal pancreatic artery
Anterior superior pancreaticoduodenal artery Right gastric artery
Superior mesenteric artery
Right gastro-omental (gastroepiploic) artery
Inferior pancreatic artery
Inferior pancreaticoduodenal artery Omental (epiploic) arteries Omental (epiploic) arterial arc
Cystic Accessory or replaced arteries 1. Right or common hepatic 2. Left hepatic 3. Right hepatic 4. Cystic Anastomoses of corresponding arteries 5. Inferior phrenic/left gastric < > left hepatic 6. Right < > left hepatic
Effects of hepatic artery obstruction
Capsular
A. Zone of relative safety B. Zone of questionable effects C. Zone of inevitable infarction
Plate 305
Arteries of Small Intestine >
'•'*
""•"
"
''''.
.
;'_-_*
'.
••:
•
-• •
Common hepatic artery
Supraduodenal artery Gastroduodenal artery Posterior superior pancreaticoduodenal artery
Splenic artery and vein
Dorsal pancreatic artery
Right gastro-omental (gastroepiploic) artery
Inferior pancreatic artery Superior mesenteric artery and vein
Anterior superior pancreaticoduodenala r te r y Inferior pancreaticoduodenal arteries
Celiac trunk
(Common portion) Posterior-^^ Anterior-^
J**^
Middle colic artery (cut)
Anastomosis (inferior pancreaticoduodenal to 1 st jejunal artery)
Right colic artery Ileocolic artery
Superior mesenteric artery Anterior cecal artery Posterior cecal artery Appendicular artery
Jejunal and ileal (intestinal) arteries Anastomotic loops (arcades) Straight arteries (arteriae rectae)
Plate 306
Visceral Vasculature
Arteries of Large Intestine For arteries of rectum see also Plate 398
Middle colic artery i Transverse mesocolon Straight arteries (arteriae rectae) (Common portion)
Inferior pancreaticoduodenal arteries
Posterior Anterior
Superior mesenteric artery Marginal artery Jejunal and ileal (intestinal) arteries Marginal arteryInferior mesenteric artery Left colic artery Ascending branch Descending branch
artery. Right colic artery
Marginal artery
Ileocolic artery Colic branch Ileal branch
Sigmoid arteries Sigmoid mesocolon
Marginal artery
Anterior cecal artery Posterior cecal artery Appendicular artery—
Internal iliac artery
Median sacral artery (from abdominal aorta)
Straight arteries (arteriae rectae) Superior rectal arterv
Middle rectal artery Branch of superior rectal artery
Visceral Vasculature
Inferior rectal artery
Plate 307
4
Variations in Colic Arteries
Middle colic artery
Superior mesenteric artery
Right colic artery
Middle colic artery
Right colic artery
Ileocolic artery Ileocolic artery
C o m m o n trunk for right colic and ileocolic arteries
C o m m o n trunk for right colic and middle colic arteries
Middle ic artery
Large branch from left colic artery
Middle colic artery absent
Right colic artery absent
Right colic artery Ileocolic artery
Ileocolic artery
Absence of middle colic artery replaced by large branch f r o m left colic artery
Absence of right colic artery
of Riolan Middle colic artery Right colic artery Ileocolic artery
Superior mesenteric artery Inferior mesenteric artery Left colic artery
Arc of Riolan between middle colic and left colic arteries
Plate 308
Visceral Vasculature
Veins of Stomach, Duodenum, Pancreas^ and Spleen HHMHHHMHHi
—M—
Hepatic veins
Hepatic portal vein
Inferior vena cava Left gastric vein and esophageal tributary M
Posterior superior pancreaticoduodenal vein
Short gastric veins
Right gastric vein Prepyloric vein Anterior superior pancreaticoduodenal vein Right gastro-omental (gastroepiploic) vein
Left gastroomental v. & (gastro. ; epiploic) -I vein
Posterior inferior pancreaticoduodenal vein
111
Anteriorinferior pancreaticoduodenal vein Left gastric vein vein
Splenic vein Short gastric veins
Hepatic portal vein Right gastric vein Posterior superior pancreaticoduodenal vein Superior mesenteric vein Right gastro-omental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein
Left gastro-omental (gastroepiploic) vein (Great) pancreatic vein Inferior mesenteric vein
Visceral Vasculature
Plate 309
4
Veins of Small Intestine
Hepatic portal vein Left gastric vein Splenic vein Right gastric vein
Superior mesenteric: vein
Middle colic vein (cut)
Jejunal and ileal (intestinal) veins Anastomotic loops
Right colic vein
Straight veins (venae rectae)
Ileocolic vein
Superior mesenteric artery and vein
Jejunal and ileal (intestinal) vessels
Relations of superior mesenteric vein and artery in root of mesentery
Plate 310
Visceral Vasculature
Veins of Large Intestine For veins of rectum see also Plate 399
Hepatic portal vein
Left gastric vein
Splenic vein
Prepyloric vein Superior mesenteric vein Right gastroomental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein Tributary from colon (cut) Posterior inferior pancreaticoduodenal vein Anterior inferior pancreaticoduodenal vein Middle colic vein (cut) Right colic vein Ileocolic vein Anterior cecal vein Posterior cecal vein Appendicular vein
(Dorsal or superior) pancreatic vein Inferior mesenteric vein Jejunal and ileal (intestinal) veins Left colic vein Left testicular (ovarian) vessels Inferior mesenteric vein Sigmoid veins Median sacral vein Superior rectal vein
Right testicular (ovarian) vessels FxternaJ iliac vessels Internal iliac vein Superior gluteal vein Obturator vein
Tributaries of left and right superior rectal veins Perimuscular rectal venous plexus Left middle rectal vein Left internal pudendal vein in pudendal canal (Alcock's) External rectal venous plexus
Right middle rectal vein Right inferior rectal vein (to internal pudendal vein)
Visceral Vasculature
Plate 311
4
Hepatic Portal Vein Tributaries: Portacaval Anastomoses
Falciform ligament and round ligament of liver Paraumbilical veins
Esophageal veins Blood f r o m superior mesenteric vein Blood f r o m splenic, gastric, and inferior mesenteric veins M i x t u r e of above t w o
Right gastric vein
Caval tributaries mm
Hepatic portal vein
Left gastric vein Short gastric veins
Posterior, Anterior superior pancreaticoduodenal veins
Left gastroomental (gastroepiploic) vein
Superior mesenteric vein Posterior, ^ Anterior inferior pancreaticoduodenal veins
Splenic vein
V \ —
*
Right gastroomental (gastroepiploic) vein Inferior mesenteric vein
4 Middle colic vein
Left colic vein
Right colic vein
Sigmoid veins
Ileocolic vein Left and right superior rectal veins
Anterior, Posterior cecal veins Appendicular vein
Middle rectal veins Levator ani muscle Portacaval anastomoses 1
Esophageal
3
Rectal
2
Paraumbilical
4
Retroperitoneal
Plate 312
Inferior rectal veins
Visceral Vasculature
Variations of Hepatic Portal Vein
Typical arrangement
Esophageal vein Right gastric vein
Cystic vein Hepatic portal vein
_ L
Left gastric vein Splenic vein
- j — 1.09 cm
Short gastric veins
V
Posterior superior pancreaticoduodenal vein Superior mesenteric vein
V — Pancreatic veins Left gastro-omental (gastroepiploic) vein
Right gastro-omental (gastroepiploic) vein
Inferior mesenteric vein
Inferior pancreaticoduodenal veins Middle colic vein Right colic vein
Left colic vein Jejunal and ileal (intestinal) veins
Ileocolic vein
Inferior mesenteric vein may enter j u n c t i o n of splenic and superior mesenteric veins Hepatic portal vein Superior mesenteric vein
Hepatic portal vein
Splenic vein
Inferior mesenteric vein
Left gastric vein may enter splenic vein (24% of cases) ight gastric vein plenic vein Left gastric vein
Inferior mesenteric vein may enter superior mesenteric vein Hepatic portal vein Superior mesenteric vein
High intestinal veins Splenic vein
Inferior mesenteric vein
Left gastric vein often enters junction of splenicand superior mesenteric veins Hepatic portal vein Superior mesenteric vein
Visceral Vasculature
Plate 313
Lymph Vessels and Nodes of Stomach
Celiac nodes
Nodes around cardia Left gastric nodes
Hepatic
Right superior pancreatic node
Suprapyloric nodes Splenic nodes
Subpyloric nodes
Left gastroomental (gastroepiploic) node
Right gastro-omental (gastroepiploic) nodes
Left gastric nodes Nodes around cardia Left gastroomental (gastroepiploic) node
Zones and pathways of gastric lymph drainage (zones not sharply demarcated)
Splenic nodes
Right gastro-omental (gastroepiploic) nodes
Suprapyloric., retropyloric, and subpyloric nodes
Left superior pancreatic nodes Celiac nodes
Right superior pancreatic node
Plate 314
Superior mesenteric nodes
Visceral Vasculature
Lymph Vessels and Nodes of Pancreas
mmmma
Anterior view
wmM
B ! 1 •j/.'W-'*.
Splenic nodes Superior pancreatic nodes Celiac nodes Superior mesenteric nodes (central superior group)
Cystic node (of Calot) Hepaticportal vein Celiac nodes
Posterior view
Superior pancreatic nodes Splenic vein
Hepatic nodes around bile duels and proper hepatic artery
Inferior mesenteric vein Superior mesenteric artery and vein
Pancreaticoduodenal nodes
Superior mesenteric nodes (central superior group)
Visceral Vasculature
Plate 315
4
Lymph Vessels and Nodes of Small Intestine
Right lymphatic trunk
Thoracic cluct
Thoracic duel
Cisterna chyli
Intestinal lymphatic trunk
Right and left lumbar lymphatic trunks
Superior mesenteric nodes (juxtaintestinal group)
> CAf&M&fr/— /i.j>.
Plate 316
Visceral Vasculature
Lymph Vessels and Nodes of Large Intestine
Epicolic nodes Paracolic nodes
Middle colic nodes Superior mesenteric nodes (central superior group)
Inferior mesenteric nodes
Left colic nodes
Right colic nodes
Preaortic nodes
Sigmoid nodes
Ileocolic nodes
Paracolic nodes Prececal nodes
Superior rectal nodes
y-Kwv
Appendicular nodes Inferior mesenteric nodes Left colic nodes Preaortic nodes
C o m m o n iliac nodes Internal iliac nodes External iliac nodes
Superior rectal nodes Middle rectal nodes
Middle rectal nodes Superficial inguinal nodes Perineal lymph vessels (drain largely to inguinal nodes)
Visceral Vasculature
Plate 317
Autonomic Nerves and Ganglia of Abdomen See also Plates 165, 166
Right sympathetic trunk Thoracic duct
Anterior, Posterior vagal trunks
Right greater and lesser thoracic splanchnic nerves
Left gastric artery and plexus
Right phrenic nerve
Left greater thoracic splanchnic nerve
Inferior phrenic arteries and plexuses Right greater and lesser thoracic splanchnic nerves Right suprarenal plexus Right aorticorenal ganglion
Celiac ganglia
Left lesser thoracic splanchnic nerve Splenic artery and plexus C o m m o n hepatic artery and plexus Superior mesenteric ganglion and plexus Left aorticorenal ganglion
Right least thoracic splanchnic nerve
Left sympathetic trunk
Right renal artery and plexus
Intermesenteric (aortic) plexus
Right sympathetic trunk
Inferior mesenteric ganglion
White and gray rami communicantes
Left colic artery and plexus
Cisterna chyli
Inferior mesenteric artery and plexus
Gray ramus communicans 3rd lumbar ganglion of sympathetic trunk 2nd and 3rd lumbar splanchnic nerves Right ureter and plexu Right testicular (ovarian) artery and plexus 4th lumbar splanchnic nerve 1 st sacral ganglion of sympathetic trunk Gray rami communicantes
Plate 318
Left common iliac artery and plexus Superior rectal artery and plexus Superior hypogastric plexus Internal and external iliac arteries and plexuses Right and left hypogastric nerves to inferior hypogastric (pelvic) plexus
Nerves of Stomach and Duodenum See also Plates 165, 166
Right and left inferior phrenic arteries and plexuses Anterior and posterior layers of lesser omentum
Hepatic branch of anterior vagal trunk Anterior vagal trunk Celiac branch of posterior vagal trunk
Right greater thoracic splanchnic nerve
Celiac branch of anterior vagal trunk Left gastric artery and plexus
Vagal branch from hepatic plexus to pyloric part of stomach Hepatic plexus Right gastric artery and plexus
Anterior gastric branch of anterior vagal trunk Left greater thoracic splanchnic nerve Left lesser thoracic splanchnic nerve Splenic artery and plexus Celiac ganglia and plexus Plexus on gastro-omental (gastroepiploic) arteries Superior mesenteric artery and plexus
Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries (posterior pancreaticoduodenal arteries and plexuses not visible in this view)
Innervation
Plate 319
4
Nerves of Stomach and Duodenum (continued) See also Plates 165, 166
Posterior gastric branch of posterior vagal trunk
Plexus on gastro-omental (gastroepiploic) arteries
Hepatic branch of anterior vagal trunk via lesser omentum
Hepatic plexus
Branch from hepatic plexus to cardia via lesser omentum
Right gastric artery and plexus
Right inferior phrenic artery and plexus Posterior vagal trunk Celiac branch of posterior vagal trunk Celiac branch of anterior vagal trunk Left gastric artery and plexus Left inferior phrenic artery and plexus Celiac ganglia and plexus Greater, lesser, and least thoracic splanchnic nerves Aorticorenal ganglia Splenic artery and plexus
Phrenic ganglion
Greater, Lesser, Least thoracic splanchnic nerves
Branch from right inferior phrenic plexus to cardia of stomach Right and left inferior phrenic arteries and plexuses Anterior vagal trunk Posterior vagal trunk
View with stomach reflected cephalad
Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries
Right greater, esser, and east thoracic splanchnic nerves
Plexus on gastroduodenal artery Plexus on posterior superior and posterior inferior pancreaticoduodenal arteries
Celiac ganglia
Superior mesenteric ganglion and plexus
Right aorticorenal ganglion
Superior mesenteric ganglion and plexus
Plate 320
Celiac branches of anterior and posterior vagal trunks Left gastric artery and plexus Left greater, lesser, and least thoracic splanchnic nerves Left aorticorenal ganglion
Innervation
Innervation of Stomach and Duodenum: Schema See also Plates 167, 168 Right 6th thoracic ganglion of sympathetic trunk
[rtnli
Esophageal plexus
Gray, White rami communicantes Spinal sensory (dorsal root) ganglion Anterior (ventral) root of spinal nerve Right greater thoracic splanchnic nerve Right lesser thoracic splanchnic nerve Celiac ganglia Least thoracic splanchnic nerve
Left greater thoracic splanchnic nerve Aortic plexus Left 9th thoracic ganglion of sympathetic trunk Posterior vagal trunk and celiac branch Anterior vagal trunk and celiac branch of vagus nerve (X) Left gastric artery Celiac trunk Splenic artery
Common hepatic artery
Short gastric arteries
Proper hepatic artery Superior mesenteric ganglion Aorticorenal ganglia Right gastric artery
mSBm
Right renal artery Gastroduodenal artery Posterior and anterior superior pancreatico- • duodenal arteries Superior mesenteric artery Posterior and anterior inferior pancreaticoduodenal arteries
f
Left, Right gastroomental (gastroepiploic) arteries
Sympathetic fibers Preganglionic Postganglionic
—— - - -
Parasympathetic fibers Preganglionic Postganglionic Afferent fibers
Innervation
Plate 321
4
Nerves of Small Intestine See also Plates 165, 166
Anterior vagal trunk Posterior vagal trunk
Celiac branches of anterior and posterior vagal trunks
Hepatic plexus Greater thoracic splanchnic nerves Celiac ganglia and plexus Gastroduodenal artery and plexus Lesser thoracic splanchnic nerves Least thoracic splanchnic nerves Aorticorenal ganglia Superior mesenteric ganglion Intermesenteric (aortic) plexus Inferior pancreaticoduodenal arteries and plexuses Superior mesenteric artery and plexus Middle colic artery and plexus (cut) Right colic artery and plexus Ileocolic artery and plexus Superior mesenteric artery and plexus Peritoneum (cut edge) Mesenteric branches Mesoappendix (contains appendicular artery and nerve plexus)
Plate 322
Innervation
Nerves of Large Intestine For nerves of rectum see Plates 165, 166, 410-413
Anterior vagal trunk and hepatic branch\ Posterior vagal trunks
^ V
Marginal artery and plexus Esophagus
Right greater thoracic splanchnic nerve
Left greater thoracic splanchnic nerve
Celiac ganglia and plexus Left suprarenal plexus Left lesser and least thoracic splanchnic nerves
Right aorticorenal ganglion Superior mesenteric ganglion Middle colic artery and plexus
Left aorticorenal ganglion Left renal artery and plexus I st left lumbar splanchnic nerve Left lumbar sympathetic trunk Intermesenteric (aortic) plexus
Right colicartery and plexus Ileocolic artery and plexus Cecal and appendicular arteries and plexuses
Sacral sympathetic trunk Right sacral plexus Pelvic splanchnic nerves Middle rectal artery and plexus
Left colic artery and plexus
gv H4
Inferior mesenteric ganglion, artery, and plexus Sigmoid arteries and plexuses Superior hypogastric plexus Superior rectal artery and plexus Right and left hypogastric nerves
Right inferior hypogastric (pelvic) plexus Nerves from inferior hypogastric (pelvic) plexuses to sigmoid colon, descending colon, and left colic (splenic) flexure
Innervation
Plate 323
4
Thalamus
Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths Posterior (dorsal) nucleus of vagus nerve
Myclencephalon (medulla oblongata)
K
Spinal sensory (dorsal root) ganglion
Thoracolumbar spinal cord
Sacral spinal cord Levator ani muscle External anal sphincter muscle "Abdominopelvic splanchnic nerves
Pudendal nerve
Chief segmental sources of sympathetic libers innervating different regions of intestinal tract are indicated. Numerous afferent libers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.
"
Thalamus
A b d o m i n a l aorta
Posterior (dorsal) nucleus of vagus nerve
Celiac ganglia Myelencephalon (medulla oblongata)
Ccliac trunk
^
Spinal sensory (dorsal root) ganglion
Thoracolumbar spinal cord
Sacral spinal cord
Pudendal nerve * A b d o m i n o p e l v i c splanchnic nerves
Plate 324
Innervation
Innervation of Small and Large Intestines: Schema
Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths
V
T 1 0 - 12
Superior rectal artery and Rectal plexus
Inferior anal (rectal) nerve
Innervation
Levator ani muscle External anal sphincter muscle
Chief segmental sources of sympathetic fibers innervating different regions of intestinal tract are indicated. Numerous afferent fibers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.
Plate 324
4
Autonomic Reflex Pathways: Schema
Spinal sensory (dorsal root) ganglion
Sympathetic trunk-
Dorsal (posterior) root
Thoracic part of spinal cord Intermediolateral cell column
Ganglion of sympathetic trunk
Spinal nerve to vessels and glands of skin
Ventral (anterior) root Meningeal branch to spinal meninges and spinal perivascular plexuses (usually arises from spinal nerve) n.
White ramus communicans Gray ramus communicans
/Abdominopelvic ^ f (greater, lesser, / and least) thoracic \| / splanchnic nerves
Ganglion of sympathetic trunk
Stretch (distention)
IJ til wftrj Vagus nerve (X)
VA : Celiac ganglion Ganglion of sympathetic trunk
\
•: v •.••• :
Enteric plexuses of gut —
I ;
V !
Superior mesenteric ganglion
Sympathetic
(
Preganglionic
^
f
Postganglionic
e r s
Plate 325
Parasympathetic J Preganglionic — fibers ) „ . . ( Postganglionic —
Afferent fibers
Innervation
Intrinsic Autonomic Plexuses of Intestine: Schema
Peritoneal layers of mesentery
Branch of straight artery (arteriae rectae) to intestine and accompanying nerves
Subserous plexus
Longitudinal intramuscular plexus
Myenteric (Auerbach's) plexus
Circular intramuscular plexus
Submucous (Meissner's) plexus
Periglandular plexus
Visceral peritoneum (serosa) Subserous connective tissue Longitudinal muscle Intermuscular stroma -Circular muscle Submucosa Submucosal glands
\0 y
Muscularis mucosae Mucosa and intestinal glands Lumen
Note: Intestinal wall is shown much thicker than in actuality.
Innervation
Plate 326
4
Innervation of Liver and Biliary Tract: Schema See also Plates 167, 168
Sympathetic trunk Common areas of referred pain in biliary disease
Dorsal root (spinal) ganglion Thoracic pari of spinal cord Right greater thoracic splanchnic nerve-
Left greater thoracic splanchnic nerve
Posterior vagal trunkRight phrenic nerve to diaphragmatic part of parietal (and visceral?) peritoneum
Anterior vagal trunk
Hepatic branch of anterior vagal trunk Diaphragm Phrenic ganglion Celiac ganglia Common hepatic artery Splenic artery Anterior hepatic plexus Posterior hepatic plexus
Aorta Gastroduodenal artery and plexus Sympathetic fibers Preganglionic Postganglionic
Sphincter of hepatopancreatic ampulla
Parasympathetic fibers Preganglionic ——• Postganglionic Afferent fibers
Plate 327
Ramification of nerve fibers around fine branch of hepatic artery
Innervation
I n n e r v a t i o n
o f
P a i W N f l s s
S c h e m a
See also Plates 167, 168
Dorsal root (spinal) ganglion
Right sympathetic trunk
Left sympathetic trunk Thoracic part of spinal cord
Right greater thoracic splanchnic nerve —
Left greater thoracic splanchnic nerve Anterior vagal trunk
Posterior vagal trunk Common areas of pancreatic pain
Celiac ganglia
Splenic artery Celiac trunk-
XV®
S u perio r mesenteric ganglion Superior mesenteric artery and plexus
Sympathetic fibers Preganglionic Postganglionic
Schema of intrinsic nerve supply
Parasympathetic fibers Preganglionic • Postganglionic - 0 """" Afferent fibers
Innervation
Plate 328
4
Kidneys in Situ: Anterior Views
Diaphragm Right suprarenal gland
Esophagus Left suprarenal gland iac trunk
Right kidney
Left kidney
Right renal artery and vein
Left renal artery and vein
Right subcostal nerve
Superior mesenteric artery (cut)
Transversus abdominis muscle
Subcostal nerve
Quadratus lumborum muscle Iliac crest Psoas major muscle lliacus muscle Right ureter Right common iliac Right external iliac arte Right internal iliac artery Urinary bladder
Esophagus Inferior vena cava Area for bare area of liver Right suprarenal gland Peritoneum (cut) Area for liver Duodenum Peritoneum (cut) Area for colon Area for small intestine
Plate 329
Abdominal aorta Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous nerve Genitofemoral nerve Left testicular (ovarian) artery and vein Inferior mesenteric artery (cut) neum (cut) grnoid mesocolon (cut) Rectum
Gastrophrenic ligament Left suprarenal gland Splenorenal ligament Area for stomach Area for spleen Tail of pancreas Transverse mesocolon Area for small intestine Area for descending colon
Anterior relations of kidneys
Kidneys and Suprarenal Olands
Kidneys in Situ: Posterior Views
Pleura (costodiaphragmatic recess)
Latissimus clorsi muscle
Lumbocostal ligament
Serratus posterior inferior muscle
Quadratus lumborum muscle (cut)
External oblique muscle
Diaphragm
Aponeurosis of transversus abdominis muscle
Subcostal nerve
Internal oblique muscle
Ascending colon
Right kidney
Transversus abdominis muscle
Thoracolumbar fascia (posterior layer)
Iliohypogastric nerve Iliac crest
Ilioinguinal nerve Quadratus lumborum muscle (cut)
Gluteal aponeurosis (over gluteus medius muscle)
Psoas major muscle Iliolumbar ligament
Gluteus maximus muscle
Aorta Projection of 11th rib
Inferior vena cava
Posterior relations of kidneys
Area for diaphragm
Area for diaphragm
Projection of 12th ri
Projection of 12th rib
Area for aponeurosis of transversus abdominis muscle
Area for aponeurosis of transversus abdominis muscle
Area for quadratus lumborum muscle
for quadratus lumborum muscle
Area for psoas major muscle
Area for psoas major muscle
ICidneys and Suprarenal Glands
Plate 330
885 Wr •
Schematic Cross Section of Abdomen at T12 See also Plates 293, 297, 338, 339 Liver Falciform ligament Superior epigastric vessels
Linea alba Rectus abdominis muscle Lesser omentum
Transversalis fascia Parietal peritoneum Visceral peritoneum of liver
Left gastric artery and vein
Proper hepatic artery (bifurcation) Common hepatic duct. Gallbladder Cystic duct Hepatic portal vein Costodiaphragmatic recess of pleural cavity
7th coslal cartilage External oblique muscle Diaphragm Stomach Gastrosplenic ligament and short gastric vessels Spleen
i <xM>
•
>
Pleura ^
,7
mm
Intercostal vessels nerve Omental (epiploic) foramen (of Winslow) Common hepatic artery (retroperitoneal)
Intercostal muscles Splenorenal ligament with splenic vessels
Hepatorenal recess (Morison's pouch) Inferior vena cava Omental bursa (lesser sac) Right sympathetic trunk Right crus of diaphragm Azygos vein Thoracic duct Anterior longitudinal ligament Celiac ganglia Abdominal aorta Body of T'l 2 vertebra
Plate 331
Parietal peritoneum on posterior wall of omental bursa Left kidney Left suprarenal gland Latissimus dorsi muscle lliocostalis -Longissimus ? Erector spinae \ muscle Spinalis
Kidneys and Suprarenal Glands
Renal Artery and Vein in Situ
Inferior vena cava
Esophagus Left inferior phrenic vein
Right and left inferior phrenic arteries
Left superior suprarenal arteries
Celiac trunk
Left middle suprarenal artery
Right superior suprarenal arteries
Left suprarenal vein
Right middle suprarenal artery
Left inferior suprarenal artery
Right suprarenal vein Right inferior suprarenal artery
Sir
um
mm®
mm
Ureteric branch of left renal artery Left renal artery and vein Ureteric branch of right renal artery
Left testicular (ovarian) artery and vein
Right renal artery and vein Left 2nd lumbar vein and communication to ascending lumbar vein
Right testicular (ovarian) artery and vein Inferior vena cava Abdominal aorta
Kidneys and Suprarenal Glands
Inferior mesenteric artery Superior mesenteric artery (cut)
Plate 332
A
Variations in Renal Artery and Vein
Proximal subdivision of renal artery
A Low accessory right renal artery may pass anterior to inferior vena cava instead of posterior to it B Inferior phrenic artery with superior suprarenal arteries may arise from renal artery (middle suprarenal artery absent) Double left renal vein may form ring around abdominal aorta
Multiple renal veins Persistent left inferior vena cava may join left renal vein
Plate 333
Kidneys and Suprarenal Glands
Gross Structure of Kidney m
Superior pole
—
Anterior surface of right kidney
Fibrous capsule [cut and peeled back) Medial border Lateral border Hilum Renal artery Renal vein Renal pelvis Stellate veins visible through capsule
Medial border Ureter
Inferior pole
Suprarenal gland and lobulated kidney of infant
Fibrous capsule Cortex
Minor calices
Medulla (pyramids)
Blood vessels entering renal parenchyma
Renal papilla
Renal sinus
Major calices Renal column (of Bertin)
Renal pelvis Fat in renal sinus Minor calices
Base of pyramid Ureter
Right kidney sectioned in several planes, exposing parenchyma and renal pelvis
Kidneys and Suprarenal Glands
Plate 334
Superior (apical) segmental artery
Frontal section of left kidney: anterior view
Anterior superior segmental artery Capsular and perirenal branches
Interlobar arteries
Inferior suprarenal artery Anterior branch of renal artery
Arcuate arteries
Renal artery Posterior branch of renal artery (posterior segmental artery)
Cortical radiate (interlobular) arteries
Pelvic and ureteric branches Anterior inferior segmental artery
(Capsular) perforating radiate artery
Posterior segmental arteries Inferior segmental artery
Vascular renal segments Superior
Anterior superior Posterior Anterior inferior
Inferior—-wj
Anterior surface of left kidney
Plate 335
Posterior surface of left kidney
Kidneys and Suprarenal Glands
Nephron and Collecting Tubule: Schema
Fibrous capsule Proximal convoluted tubule 7
Subcapsular zone
Cortical"" corpuscle Juxtamedullary renal corpuscle
Renal cortex
Proximal convoluted tubu
y
Distal convoluted
convoluted tubule
Henle's loop Descending limb Ascending limb
Collecting tubule CD
•Z
o
CL>
CL
CD
£= o N
_^ """
CD -i—• =5
O
CD CD C L
Descending limb Renal ii. medulla ^ (pyramid)
Renal (malpighian) corpuscle; glomerular (Bowman's) capsule with glomerulus
Ascending
Afferent and efferent glomerular arterioles
<
I ^
Proximal segment Neck Proximal convolution Thick segment of x descending limb
Thin segment
Henle's loop
Distal segment Thick segment of y ascending limb Distal convolution — Macula densa
Openings of papillary ducts
Collecting tubules
Cribriform area of renal papilla
Kidneys and Suprarenal Glands
Plate 336
4
Blood Vessels in Parenchyma of Kidney: Schema
Afferent glomerular arteriole Efferent glomerular arteriole Juxtameclullary glomerulus (efferent glomerular arteriole descends into renal pyramid) Fibrous capsule
Cortical glomerulus Efferent glomerular arteriole (joins cortical capillary plexus) 1
Corticomedullary glomerulus Cortical capillary plexus
Efferent glomerular arteriole (joins cortical capillary plexus and also descends into renal pyramid)
Stellate veins Capsular and perforating veins Cortical I I Cl l Vradiate (interlobular) arteries ^ I and veins >
jJS
' X
s
- J •
P
Subcapsular —r rv i^v ^ zone
yX
S h
Arcuate arterv and vein w
j-4—Vasa rectae ) / " spuria (from juxtamedullary '•'•/r- J W efferent AJ glomerular { 4 / - J r$ a r t e r ' ° ' e s )
JMft
—
^
A
\ p
•Vasa rectae j vera (from - ^ darcuate 1 ^ U d I C dand 11U ^ J:. j | " cortical radiate % arteries)
—^r-Venulae T \ • rectae
rTT
, V t K i
s
t , Medullary p capillary plexus -Interlobar artery and vein
i
^
f
H
y • v; \x V
R e n a i
' V / column (of Bertin) Henle's loop ^ of nephron •Collecting tubule -Interlobar artery and vein in perirenal fat of renal sinus
Plate 337
Kidneys and Suprarenal Glands
Transverse Section: Level of T12-L1 Intervertebral Disc
T12-L1
Superior mesenteric vein (becoming portal vein)
Pancreas (head)
Celiac trunk
Splenic vein
Transverse colon
Transverse colon
Jejunum
Ascending colon (right colic flexure)
External oblique muscle (Common) bile duct Descending colon Descending (2nd) part of duodenum
Left suprarenal gland
Interior vena cava
Spleen
Right suprarenal gland
Renal cortex
Liver
Left kidney
Superior pole of right kidney
Renal medulla
Right crus of diaphragm
T12-L1 intervertebral disc
Left crus of diaphragm
Abdominal aorta
CAfcx/tat/h-
f
u u
o
Transverse Section: Level of L I - 2 Intervertebral Disc
\
r LI-2
Plate 3 3 9
i f
Superior mesenteric vein
{
1 Greater omentum
Superior mesenteric artery
Pancreas with uncinate process
Transverse colon Ileum
Transverse colon
Jejunum
Junction of 2nd and 3rd parts of duodenum
Perirenal fat
Ascending colon
Ureteropelvic junction
Liver Descending colon
Right renal vein (entering inferior vena cava) a
3
Renal fascia
Right kidney
Left kidney
(A &>
3 a
Major calyx and renal pelvis Pararenal fat
Interior vena cava
CO
c
"O
a
s 3
tt
sr3 ^
0)
Left renal arterv
Right crus of diaphragm Psoas major muscle
Left renal vein (enterin inferior vena cava)
LI —2 intervertebral disc Conus medullars and cauda equina
Abdominal aorta
Left crus of diaphragm
/
//.pm
Ureters •SSs&iSS^t^^^^'^SsSl^^K
See also Plates 362, 363, 369
Ureters in male: anterior view Left kidney
Right kidney
Left ureter
Duodenum
Inferior
Superior
mesenteric artery
mesenteric artery
Left colic artery
Right colic artery
Sigmoid arteries Superior rectal artery (cut)
Right ureter Ileocolic artery
Genitofemoral nerve
Testicular vessels Common iliac artery Internal iliac artery External iliac artery-
Inferior vesical arterv
Middle rectal artery
Ductus deferens
Diagonal course of ureter through bladder wall
Urinary bladder Urinary bladder
Bladder mucosa
Medial umbilical ligament (occluded part of umbilical artery)
Ureter
Round ligament of uterus Superior vesical artery
Ovary Broad ligament
Uterine artery Umbilical artery Obturator artery and nerve Ureter
Uterosacral (sacrogenital) fold
Vaginal artery and inferior vesical branch
Ureter
External iliac artery
(retroperitoneal) Intersigmoid recess Sigmoid mesocolon
Ureters in female superior view
Kidneys and Suprarenal Glands
Ovarian vessels Internal iliac artery C o m m o n iliac arterv Root of mesentery
Plate 340
Arteries of Ureters and Urinary Bladder
Abdominal aorta Superior mesenteric arterv
Renal artery and vein Ureteric branch from renal artery Ovarian artery Ureter
Inferior mesenteric artery (cut) Ureteric branch from aorta Ureteric branches from ovarian and common iliac arteries Common iliac artery Median sacral artery Internal iliac artery Iliolumbar artery Superior gluteal artery Lateral sacral artery Inferior gluteal and internal pudendal arteries Umbilical artery (patent part) Uterine artery
Inferior vesical artery and ureteric branch Superior vesical arteries Inferior epigastric artery Ureteric branch from superior vesical artery Medial umbilical ligament
Plate 341
Kidneys and Suprarenal Glands
Renal Fascia
Duodenum Right kidneyRight colic (hepatic) flexure Liver
Left renal vein and artery
Duodenojejunal flexure Superior mesenteric vein and artery Abdomina, • c Inferior vena cava
I I
Left kidney Peritoneum
aorta i /
Descending colon
< /
Transversalis fascia Pararenal fat (retroperitoneal) Quadratus lumborum muscle
Transverse section through 2nd lumbar vertebra demonstrates horizontal disposition of fascia
Crura of diaphragm Psoas major muscle and fascia
Perirenal fat Fibrous capsule of kidney Anterior and posterior layers of renal (Gerota's) fascia
Diaphragm Diaphragmatic fascia (continuation of transversalis fascia)
Lung Liver
Costodiaphragmatic Bare area of liver Suprarenal gland Perirenal fat 12th rib Pararenal fat (retroperitoneal) Transversalis
Fibrous capsule of kidney Peritoneum Anterior and posterior layers of renal (Gerota's) fascia Right kidney Right colic (hepatic) flexure
Quadratus lumborum muscle Iliac crest
Sagittal section through right kidney and lumbar region demonstrates vertical disposition of renal fascia
Kidneys and Suprarenal Glands
Plate 342
4
4
Lymph Vessels and Nodes of Kidneys and Urinary Bladder See also Plates 406, 408
Subcapsular lymphatic plexus
Cortical lymph vessels along cortical radiate (interlobular) arteries Lymph vessels along arcuate arteries Lymph vessels along interlobar arteries
Note: Arrows indicate direction of flow.
Lumbar lymph trunks to cisterna chyli and thoracic duct
Lateral aortic (lumbar), precaval, and postcaval nodes Common iliac nodes
Promontorial (middle sacral) node
Internal iliac nodes
External iliac nodes
Lymph vessels from dorsal part and trigone of bladder
Lymph vessels from superior and anterior parts of bladder
Lateral vesical and prevesical nodes
Plate 343
Kidneys and Suprarenal Glands
Nerves of Kidneys, Ureters, and Urinary Bladder j ^ See also Plates 165, 166
Anterior vagal trunk Posterior vagal trunk Greater thoracic splanchnic nerve Celiac ganglia and plexus Lesser thoracic splanchnic nerve Superior mesenteric ganglion Least thoracic splanchnic nerve Aorticorenal ganglion Renal plexus and ganglion 2nd lumbar splanchnic nerve Renal and upper ureteric branches from intermesenteric plexus Intermesenteric (aortic) plexus
Inferior mesenteric ganglion Sympathetic trunk and ganglion Middle ureteric branch Superior hypogastric plexus Sacral splanchnic nerves (branches from upper sacral sympathetic ganglia to hypogastric plexus) Gray ramus communicans Hypogastric nerves Sacral plexus
Pelvic splanchnic nerves Inferior hypogastric (pelvic) plexus with periureteric loops and branches to lower ureter Rectal plexus Vesical plexus Prostatic plexus
V P ®
Kidneys and Suprarenal Glands
$
Plate 344
4
Innervation of Kidneys and Upper Ureters; Schema See also P l a t e s 1 6 7 , 168, 4 1 7
ucleus of solitary tract
Posterior (dorsal) nucleus of vagus nerve
Spinal sensory (dorsal root) gangl
Medulla oblongata Gray ramus communicans Vagus nerve (X)
Descending fibers
Ventral ramus o f T 1 0 (intercostal nerve)
Ascending fibers W h i t e ramus communicans
Spinal cord segments T10-L1
Ganglia of sympathetic trunk
Lesser thoracic splanchnic nerve
1 st lumbar splanchnic nerve
Least thoracic splanchnic nerve
Celiac ganglia and plexus
Superior mesenteric ganglion »
Aorticorenal ganglion
Intermesenteric plexus
Superior hypogastric plexus
Hypogastric nerve
Sympathetic fibers Preganglionic
—
Postganglionic
— —
-
• A CSV
Sacral plexus
Parasympathetic fibers Preganglionic Postganglionic Afferent fibers
Plate 345
1
——
- - - - - - - - -
Pelvic splanchnic > nerves
Inferior hypogastric (pelvic) plexus
Kidneys and Suprarenal Glands
Nerves of Suprarenal Glands: Dissection and Schema See also Plates 165-168
Left phrenic nerve
Right phrenic nerve
Posterior vagal trunk
Anterior vagal trunk
Left inferior phrenic artery and plexus
Right inferior phrenic artery and plexus
Left suprarenal gland
Right suprarenal gland
Left greater thoracic splanchnic nerve
Right greater thoracic splanchnic nerve
Celiac plexus and ganglia
Right lesser thoracic splanchnic nerve
Left lesser thoracic splanchnic nerve
Right least t h o r a c i c f splanchnic nerve
Aorticorenal ganglia
Right renal ganglion and plexus
Left least thoracic splanchnic nerve
ymz
rwmmm
Left renal ganglion and plexus
bSVAV;
i as
Left sympathetic trunk
Right sympathetic trunk
Left 1 st lumbar splanchnic nerve
Right 1st lumbar splanchnic nerve
Superior mesenteric ganglion .--T" j r - . ^ ^ M ^ J m ^ X
olumn / Intermediolateral cell ccolun (lateral horn of gray matter)
-i Cortex
Medulla Thoracic splanchnic nerves (preganglionic fibers)
Spinal cord
Celiac ganglion
Postganglionic fibers supply b l o o d vessels
Sympathetic trunk
Preganglionic j fibers ramify \ around cells of medulla Suprarenal gland
Kidneys and Suprarenal Glands
Plate 346
Arteries and Weins of Suprarenal Elands in Situ
Liver {retracted
Superior suprarenal arteries (from inferior phrenic artery)
superiorly)
I n f e r i o r vena cava (retracted
medially)
Suprarenal vein Branches of middle suprarenal arteries (from abdominal aorta) P e r i t o n e u m (cut
edge)
Pancreas and spleen (retracted
superiorly)
Left inferior phrenic artery Superior suprarenal arteries Suprarenal gland Renal (Gerota's) fascia Left kidney
Splenic veii"K Aorta
Renal (Gerota's) fascia Right kidney (pulled
Duodenum
down)
(pulled down)
Suprarenal gland Inferior suprarenal artery (from renal artery)
A b d o m i n a l exposure of right suprarenal gland
Cross section through suprarenal
Capsule Cortex Medulla
Duodenojejunal flexure Left colic (splenic) flexure (pulled medially)' Middle suprarenal artery Suprarenal vein Inferior suprarenal artery
Left renal artery and vein
Peritoneum (cut
edges)
A b d o m i n a l exposure of left suprarenal gland
Plate 347
Kidneys and Suprarenal Glands
Abdominal Wall and Viscera: Paramedian (Sagittal) Section iwjBiMiiWBM w mm. wii— immmmmmmmmmmmmmmmmmimKmmm
^sawsSsS
Coronary ligament enclosing bare area of liver
Diaphragm (central tendon)
Esophagus Parietal p e r i t o n e u m
Superior recess of omental bursa (lesser sac)
Liver Lesser o m e n t u m Hepatic portal vein and proper hepatic artery in right margin of lesser o m e n t u m —
O m e n t a l (epiploic) f o r a m e n (of W i n s l o w )
O m e n t a l bursa (lesser sac)
Celiac trunk
Stomach
Splenic vessels
M i d d l e colic artery
Renal vessels
Transverse m e s o c o l o n
Pancreas
Parietal p e r i t o n e u m (of anterior abdominal wall)
Superior mesenteric artery Inferior (horizontal, or 3rd) part of d u o d e n u m
Transverse c o l o n Greater o m e n t u m Small intestine
A b d o m i n a l aorta
Rectus abdominis muscle
Parietal p e r i t o n e u m (of posterior abdominal wall) Mesentery of small intestine
Transversalis fascia
M e d i a n umbilical ligament (urachus) Fatty layer of subcutaneous tissue (Camper's fascia)
Rectovesical p o u c h Rectum
M e m b r a n o u s layer of subcutaneous tissue (Scarpa's fascia)
Rectoprostatic (Denonvilliers') fascia
Urinary bladder
Levator ani muscle Prostate
Pubic b o n e
\ ?eeP • , ( Superficial \ Subcutaneous )
Retropubic (prevesical) space (cave of Retzius)
External anal Sphincter ^ ^
D e e p and superficial transverse perineal muscles
D e e p (Buck's) fascia of penis
Bulbospongiosus muscle
Perineal m e m b r a n e and bulbourethral (Cowper's) gland Tunica vaginalis testis
Abdominal Sections
Testis
Puborectalis muscle (thickened medial edge of left levator ani muscle)
CAftf^avL /.—a.p.
Plate 348
S c h e m a t i c D r o s s S e c t i o n of A b d o m e n at L3, 4
Round ligament (ligamentum teres) of liver Transverse colon Branches of inferior epigastric vessels Rectus sheath Transversus abdominis aponeurosis External oblique aponeurosis Internal oblique aponeurosis
Linea alba Rectus abdominis muscle Omental appendices Greater omentum Parietal peritoneum Transversalis fascia Transversus abdominis muscle
Mesentery of small intestine
Internal oblique muscle
Superior mesenteric vessels Small intestine (ileum)
External oblique muscle
Lymph node Ascending colon
Small intestine (jejunum)
Right paracolic gutter
Descending colon Left paracolic gutter
Left ureter
Tendon of origin of transversus abdominis muscle
Quadratus lumborum muscle
Iliohypogastric nerve
Latissimus dorsi muscle
Ilioinguinal nerve Layers of ( thoracolumbar ' fascia (
Testicular (ovarian) vessels
Combined Middle Posterior
Psoas minor muscle Parietal peritoneum Psoas major muscle
Right genitofemoral nerve
Inferior vena cava
Left sympathetic trunk
Anterior longitudinal ligament Ligamentum flavum
Erector spinae muscle
Abdominal aorta Spinous process of L3 vertebra
Intervertebral disc between L3 and L4 vertebrae Intermesenterir. (aortic) plexus
Plate 349
Abdominal Sections
Abdominal Scans: Axial CT Images
Series of abdominal axial CT images from superior (A) to inferior (D)
B
C
D
A
Aorta
M
Deep back muscles
AC
Ascending colon
P
Psoas muscle
B
Body of vertebra
R
Rib
DC
Descending colon
RA
Rectus abdominis muscle
IL
Ileum
Rl
Right c o m m o n iliac artery
IV
Inferior vena cava
RK
Right kidney
LA
Linea alba
RL
Right lobe of liver
LI
Left c o m m o n iliac artery
S
Spleen
LK
Left kidney
ST
Stomach
LL
Left lobe of liver
TC
Transverse colon
Abdominal Sections
Plate 350
Pelwis and Perineum Topographic A n a t o m y Plate 351 Z 'i "'. ".' .
. . . ,
:
-
351 Pelvis and Perineum
Bones and Ligaments Plates 352-355
352 Bones and Ligaments of Pelvis 353
Bones and Ligaments of Pelvis (continued)
354 Sex Differences of Pelvis: Measurements 355 Radiographs of the Male and Female Pelvis
Pelvic Floor a n d C o n t e n t s Plates 356-364
356 Pelvic Diaphragm: Female 357
Pelvic Diaphragm: Female (continued)
358 Pelvic Diaphragm: Male 3 5 9 Pelvic Diaphragm: Male (continued) 3 6 0 Pelvic Viscera and Perineum: Female 361 Pelvic Viscera and Perineum: Male 3 6 2 Pelvic Contents: Female 3 6 3 Pelvic Contents: Male 364 Endopelvic Fascia and Potential Spaces
Urinary Bladder Plates 365-368
SjMjgjraBHBMMBMMMB
365 Urinary Bladder: Orientation and Supports 366 Urinary Bladder: Female and Male 36? Sphincters 3 6 8 Male and Female Cystourethrograms
Atlas of Human Anatomy
Pelvis a n d P e r i n e u m Uterus, Vagina, and Supporting Structures Plates 369-375
Plates 391-396
391 Rectum in Situ: Female and Male
369 Pelvic Viscera: Female
392 Ischioanal Fossae
370 Uterus, Vagina, and Supporting Structures 371
Rectum
393
Uterus and Adnexa
Rectum and Anal Canal
3 9 4 Anorectal Musculature
372 Pelvic Ligaments
3 9 5 External Anal Sphincter Muscle: Perineal Views
3 7 3 Uterus: Age Changes and Muscle Pattern
396 Actual and Potential Perineopelvic Spaces
374 Uterus: Position and Prolapse 375
Regional Scans
Ectopic Pregnancy
Plate 397
Regional Transverse Section
397
Plate 376
Vasculature
376 Male Pelvis: Bladder-Prostate Junction
Plates 398-408 m^mmm^^mmmmm^mmmi^^msmmm^^^^^m^^mmmmmism^m
Perineum and External Genitalia: Female
398 Arteries of Rectum and Anal Canal (Male) 3 9 9 Veins of Rectum and Anal Canal (Female)
Plates 377-379
377
Pelvic Scans: Sagittal MR Images
Female Perineum and External Genitalia (Pudendum or Vulva)
400
Arteries and Veins of Pelvic Organs: Female
401 Arteries and Veins of Testis
378 Female Perineum (Superficial Dissection)
402 Arteries and Veins of Pelvis: Female
3 7 9 Female Perineum and Deep Perineum
4 0 3 Arteries and Veins of Pelvis: Male
Perineum and External Genitalias Male Plates 380-387
""•* •W -. ^; v...:/:' . \ ::: .; ; •• v:-: • .•'"/.• " " WBWWW'BB W W lB liW I WWW W li-:•BW
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404
Arteries and Veins of Perineum and Uterus
405 Arteries and Veins of Perineum: Male i. " :
,".
4 0 6 Lymph Vessels and Nodes of Pelvis and Genitalia: Female
380 Perineum and External Genitalia (Superficial Dissection)
407 Lymph Vessels and Nodes of Perineum: Female
381 Perineum and External Genitalia (Deeper Dissection)
408 Lymph Vessels and Nodes of Pelvis and Genitalia: Male
382 Penis
Innervation
383 Perineal Spaces 384 Prostate and Seminal Vesicles 385 Urethra 386 Descent of Testis 387 Scrotum and Contents
Homologues of Genitalia Plates 388-389
Plates 409-417 frWHiiMiiiWii^88MBBMii
i
ii UMii in
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mmaxmiiiimsmMumtMiB
409 Nerves of External Genitalia: Male 410 Nerves of Pelvic Viscera: Male 411 Nerves of Perineum: Male 412 Nerves of Pelvic Viscera: Female 413 Nerves of Perineum and External Genitalia: Female 414 Neuropathways in Parturition
388 Homologues of External Genitalia
415 Innervation of Female Reproductive Organs: Schema
389 Homologues of Internal Genitalia
416 Innervation of Male Reproductive Organs: Schema
Testis, Epididymis, and Ductus Deferens Plate 390 mmmmmm^m^^emrnmmmmm^mmMmmmmmmi^mm^^^^m^mmm^m^m
390 Testis, Epididymis, and Ductus Deferens
Atlas of Human Anatomy
417 Innervation of Urinary Bladder and Lower Ureter: Schema
5 Sternocleidomastoid muscle
Trapezius muscle Deltoid muscle Pectoralis major muscle
Nipple
Serratus anterior muscle
Semilunar line
Tendinous intersection External oblique muscle Rectus abdominis muscle
Linea alba
Anterior superior iliac spine
Umbilicus Iliac crest
Superficial circumflex iliac vein Superficial epigastric veins
Inguinal ligament
Pubic symphysis
Pubic tubercle
Superficial dorsal vein of penis Glans of penis
Body (shaft) of penis
External urethral orifice (meatus)
Scrotum *
Topographic Anatomy
—
Plate 351
B o n e s a n d L i g a m e n t s of Pelvis MM
See also Plate 486 M e d i a n (sagittal) section
Body of L5 vertebra Iliac ) Intermediate zone crest | Inner lip
False pelvis Lumbosacral (L5-S1) intervertebral disc
Iliac fossa (wing of ilium)
Sacral p r o m o n t o r y
Anterior superior iliac spine
Greater sciatic foramen
^
sw®
mm
Arcuate line
True pelvis Ischial spine
Anterior inferior iliac spine
Sacrospinous ligament
Iliopubic eminence
1
Lesser sciatic foramen
O b t u r a t o r canal
Sacrotuberous ligament
Superior pubic ramus
Coccyx
Pecten pubis (pectineal line)
Ischial tuberosity
Pubic tubercle
,.<
Symphyseal surface Obturator membrane
Lateral view
Body of L4 vertebra
Supraspinous ligament Posterior, anterior, and inferior gluteal lines
Posterior superior iliac spine Median sacral crest Posterior inferior iliac spine Posterior sacroiliac ligament Greater sciatic foramen Sacrospinous ligament Posterior and lateral sacrococcygeal ligaments Sacrotuberous ligamen Ischial spine Lesser sciatic foramen
Intermediate zone / O u t e r lip > Iliac crest Iliac tubercle \ W i n g (ala) of ilium (gluteal surface) Body of ilium Anterior superior iliac spine Anterior inferior iliac spine Acetabulum Acetabular labrum Acetabular margin Lunate (articular) surface bular notch nsverse acetabular ligament Superior pubic ramus Pubic tubercle Obturator crest
Ischial tuberosity Obturator membrane
Plate 352
Obturator canal Inferior pubic ramus
Bones and Ligaments
B o n e s a n d L i g a m e n t s of Pelvis ( c o n t i n u e d ) See also Plate 157
Iliolumbar ligament
Hrh,s.bB... W
SmKhSSOT
Iliac crest Supraspinous ligament Posterior superior iliac spine Posterior sacroiliac ligaments Iliac tubercle Posterior sacral foramina Greater sciatic foramen Anterior superior iliac spine Sacrospinous ligament Sacrotuberous ligament Lesser sciatic foramen Acetabular margin Ischial tuberosity Anterior longitudinal ligament
Tendon of long head of biceps femoris muscle Iliolumbar ligament
Posterior sacrococcygeal Superficial J ligaments
(03
O u t e r lip Intermediate zone Iliac tubercle Inner lip
Iliac crest
Lateral sacrococcygeal ligament Posterior view
Anterior sacroiliac ligament
• Vj-\r&
Sacral p r o m o n t o r y
:.
Greater sciatic foramen
\i
Anterior superior iliac spine Sacrotuberous ligament
•
..
Sacrospinous ligament Anterior inferior iliac spine Ischial spine /
7 Anterior sacral foramina
Arcuate line Lesser sciatic foramen
lliopectineal line
(
Iliopubic eminence
Coccyx
Anterior sacrococcygeal ligaments j\
Superior pubic ramus Pecten pubis (pectineal line) Obturator foramen Inferior pubic ramus A n t e r i o r view
Bones and Ligaments
Pubic
t u b e r d e
Pubic symphysis
Plate 353
S e x D i f f e r e n c e s of Pelvis: M e a s u r e m e n t s See also Plate 248 Female pelvis/female pelvic inlet: anterior view
Sacroiliac joint Sacral p r o m o n t o r y Diagonal conjugate (~12cm) Diameters of the pelvis
Transverse (—13 cm) O b l i q u e (~12.5 cm) Ischial spine Iliopubic eminence Pubic symphysis
M a l e p e l v i s / m a l e pelvic inlet: anterior view
All measurements slightly shorter in relation to body size than in female Pelvic inlet oriented more anterop o s t e r i o r ^ than in female, where it tends to be transversely oval Pubic symphysis deeper (taller) Pubic arch (subpubic angle) narrower Ischial tuberosities less far apart Iliac wings less flared
Transverse diameter of pelvic outlet (—11 cm)
Pubic symphysis
Sacral
promontory
jp
Ischial tuberositv Anteroposterior diameter of pelvic outlet (varies 9.5—11.5 cm because of mobility of coccyx)
Ischial spine
Tip of coccyx Female pelvis/female pelvic outlet: inferior view
Plate 354
Pubic symphysis
Anteroposterior diameter of pelvic outlet (9.5—11.5 cm)
Female: sagittal section
Bones and Ligaments
s
F e m a l e a n d M a l e Pelvis R a d i o g r a p h s
•
Female Pelvis A
Sacrum
B
Ilium
C
Pubis
D
Ischium
E
Pubis symphysis
F
O b t u r a t o r foramen
G
Head of femur
H
Greater trochanter
1
Lesser trochanter
J
Femur
K
Pelvic foramina
L
Air in c o l o n
M
Sacroiliac j o i n t Acetabulum
• wmmm
Pelvic inlet
Male Pelvis A
L5
B
Sacrum
C
Ala of sacrum
D
Ilium
E
Pubis
F
Ischium
G
Pubic symphysis
H
O b t u r a t o r foramen
I
Ischial tuberosity
J
Ischial spine
L
Greater trochanter
M
Lesser trochanter
N
Femur
K
O P
Head of femur
Air in c o l o n Sacroiliac joint —
Acetabulum
- - - Subpubic angle
Bones and Ligaments
Plate 355
•
Pelvic D i a p h r a g m : F e m a l e m
www
See also Plates 263, 366, 370, 392 Inferior (arcuate) pubic ligament
Superior view
Deep dorsal vein of clitoris
Pubic symphysis
Transverse perineal ligament
Inguinal ligament (Poupart's)
Fascia of deep perineal muscles Urethra Vagina O b t u r a t o r canal O b t u r a t o r fascia (over obturator internus muscle) Pubococcygeus muscle (part of levator ani muscle) Tendinous arch of levator ani muscle -Rectum lliococcygeus muscle
w
(part of levator ani muscle) Ischial spine Levator plate (median raphe) of levator ani muscle Coccygeus (ischiococcygeus) muscle Piriformis muscle
Coccyx Anterior sacrococcygeal ligament Sacral p r o m o n t o r y Piriformis muscle
M e d i a l view
Ischial spine
Arcuate line of ilium Obturator internus muscle and obturator fascia (cut) Tendinous arch of levator ani muscle Obturator canal lliococcygeus muscle (part of levator ani muscle) Rectum Urethra Pubococcygeus muscle (part of levator ani muscle) Vagina Sphincter urethrae muscle Left puborectalis muscle and perineal membrane /—/y.i>.
Plate 356
Compressor urethrae and urethrovaginal sphincter (portions of sphincter urethrae muscle)
Coccygeus (ischiococcygeus) muscle Left levator ani muscle (cut) External anal sphincter muscle Superficial and deep transverse perineal muscles
Pelvis Floor and Contents
Pelvic D i a p h r a g m : F e m a l e ( c o n t i n u e d ) For urogenital diaphragm see Plate 379 Inferior view
Musculofascial extensions to urethra Pubic symphysis
Musculofascial extensions to vagina
Inferior (arcuate) pubic ligament
Interdigitating fibers of perineum Puborectalis muscle (part of levator ani muscle)
Deep dorsal vein of clitoris
Pubococcygeus muscle (part of levator ani muscle)
Inferior pubic ramus
Tendinous arch of levator ani muscle
Urethra
O b t u r a t o r internus muscle
Vagina P i V<" <•• '
Rectum
( • ' W ' l M S
.V I
V V-
lliococcygeus muscle (part of levator ani muscle)
•!
Ischial tuberosity Ischial spine O b t u r a t o r internus tendon Sacrospinous ligament Sacrotuberous ligament Piriformis muscle M e d i a n raphe of levator ani muscle
Ischial spine Coccygeus (ischiococcygeus) muscle —
A n o c o c c y g e a l b o d y (ligament) (attachment of external anal sphincter muscle)
Piriformis muscle (cut)
Tip of coccyx
Sacrospinous ligament (cut) Sacrotuberous ligament (cut) Sacrum
Piriformis muscle Greater sciatic f o r a m e n Lateral view
Ischial spine lliococcygeus muscle (part of levator ani muscle)
M e d i a n sacral crest
inous arch of levator ani muscle Pubococcygeus muscle (part of levator ani muscle)
Sacrotuberous ligament (cut)
Puborectalis muscle (part of levator ani muscle) Coccygeus (ischiococcygeus) muscle Sacrospinous ligament ( Pubic b o n e (cut surface)
Coccyx
Deep dorsal vein of clitoris Urethra Vagina
Pelvic Floor and Contents
Plate 357
5
Pelvic D i a p h r a g m : M a l e Hwp
See also Plates 263, 266, 392 Inferior (arcuate) p u b i c ligament Pubic symphysis
Superior view
(viscera
removed)
Pubic crest Pubic tubercle
Pecten pubis (pubic part of iliopectineal line)
Hiatus for deep dorsal vein of penis Transverse perineal ligament (anterior thickening of perineal membrane) Hiatus for urethra
Superior ramus of pubis
Muscle fibers f r o m levator ani to c o n j o i n e d longitudinal muscle of anal canal
O b t u r a t o r canal
Puborectalis Pubococcygeus lliococcygeus
O b t u r a t o r fascia Iliopubic eminence
,
,
^
Tendinous arch of levator ani muscle
Acetabular margin Anterior inferior iliac spine
Obturator internus muscle
mmW&M&imi
W i n g (ala) of ilium Arcuate line (iliac part of iliopectineal line)
Ischial spine Coccygeus (ischiococcygeus) muscle Piriformis muscle
Ischial spine Sacroiliac j o i n t
Anterior sacral (pelvic) foramina Sacrum
Anterior sacrococcygeal ligament Sacral canal
Plate 358
Anorectal hiatus
Pelvic Floor and Contents
Pelvic D i a p h r a g m : M a l e ( c o n t i n u e d ) For urogenital diaphragm see Plate 383 Inferior view
D e e p dorsal veins of penis Fat in retropubic (prevesical) space Sphincter urethrae muscle ascending anterior aspect of prostate
Inferior p u b i c (arcuate) ligament Perineal b o d y Fibromuscular extensions of levator ani muscle to prostate Pubic tubercle Rectourethralis superior muscle
Urethra Rectoprostatic (Denonvilliers 7 ) fascia
Prerectal muscle fibers (of Luschka) f r o m levator ani muscle
Medial border (pillar) of levator ani muscle Perineal m e m b r a n e
Pubic symphysis
Muscle fibers f r o m levator ani to c o n j o i n e d longitudinal muscle of anal canal
{cutaway)
Ischiopubic ramus
Obturator internus tendon
Gluteus maximus muscle
Ischial tuberosity Sacrotuberous ligament (cut)
O b t u r a t o r internus muscle
Sacrospinous ligament (cut)
endinous arch of levator ani muscle
O b t u r a t o r internus muscle Coccygeus (ischiococcygeus) muscle Sacrospinous ligament (cut) Sacrotuberous ligament (cut) Tip of coccyx
lliococcygeus Pubococcygeus Puborectalis Circular muscle layer C o n j o i n e d longitudinal muscle
Levator ani muscle
0
f anorectal j u n c t i o n
/—/y.p.
Pelvic Floor and Contents
Plate 359
Pelvic V i s c e r a a n d P e r i n e u m : F e m a l e
P a r a m e d i a n (sagittal) dissection
Ureter Uterine (fallopian) tube Ovary
Rectouterine p o u c h (of Douglas) Peritoneum {cut edge)
Ligament of ovary
couterine pouch Rectum
Round ligament of uterus Broad ligament (cut)
Ureter Urinary bladder Vagina
Superior pubic ramus (cut)
Pelvic diaphragm (levator ani muscle)
Inferior pubic ramus (cut) —
Deep transverse perineal muscle (cut)
Ischiocavernosus muscle
External anal sphincter muscle
Body of clitoris Labium minus Labium majus Median (sagittal) section
Sacral p r o m o n t o r y Ureter Suspensory ligament of ovary Uterine (fallopian) tube Ovary External iliac vessels Ligament of ovary Body of uterus Round ligament of uterus (ligamentum teres) Fundus of uterus Urinary bladder Pubic symphysis Urethra Sphincter urethrae Deep tra perineal muscle
Uterosacral ligament Vesicouterine p o u c h Rectouterine pouch (of Douglas) Cervix of uterus Posterior part of vaginal fornix Anterior part of vaginal fornix Rectum Vagina Perineal membrane . Levator am muscle Anal canal External anal sphincter muscle
Deep dorsal vein of clitoris Crus of clitoris External urethral orifice Superficial transverse perineal muscle Labium minus Labium majus
Plate 360
us
/.—//.p.
Vaginal orifice
Pelvic Floor and Contents
Pelvic V i s c e r a a n d P e r i n e u m : M a l e BBWHWMMBMBMWMHWMBBg^^
1 1
11'MMWWWWWM
Ductus (vas) deferens
P a r a m e d i a n (sagittal) dissection
Urinary bladder and fascia
External iliac vessels
Ureter (cut)
Peritoneum
Seminal vesicle
Rectus abdominis muscle
Rectovesical pouch
Anterior layer of rectus sheath
Rectum Rectoprostatic (Denonvilliers') fascia
Transversalis fascia Umbilical prevesical fascia
Prostate (covered by fascia)
Sub( f a t t y (Camper's) cutaneous < m e m b r a n o u s tissue ((Scarpa's)
Ischiopubic ramus (cut) Pelvic diaphragm (levator ani muscle)
Superior pubic ramus (cut) Fundiform ligament of penis
D e e p transverse perineal muscle
Suspensory ligament of peni
Perineal b o d y Deep ) External anal Superficial > sphincter Subcutaneous ) muscle
Areolar tissue and vesical venous plexus in retropubic (prevesical) space
Deep perineal (investing or Gallaudet's) fascia
Deep dorsal vein of penis Corpus cavernosum
Superficial perineal (Colles') fascia (inferior fascia of superficial perineal space)
Deep (Buck's) fascia of penis Corpus spongiosum
Superficial (dartos) fascia of scrotum
Superficial (dartos) fascia of penis and scrotum
External spermatic fascia
Septum of scrotum Vesical fascia Testis
Rectovesical p o u c h Rectum
M e d i a n (sagittal) section
Urinary bladder \
Seminal vesicle
Urachus Apex Fundus Body Trigone Neck
Prostate
Rectoprostatic (Denonvilliers') fascia
Pubic symphysis Fundiform ligament of penis
Sphincter urethrae muscle
Suspensory ligament of penis Inferior (arcuate) pubic ligamentTransverse perineal ligament (anterior thickening of perineal membrane) Perineal m e m b r a n e Superficial perineal space
Bulbourethral (Cowper's) gland
smut
Perineal b o d y Bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia
Corpus cavernosum Corpus spongiosum Superficial (dartos) fascia of penis and scrotum Deep (Buck's) fascia of penis Prepuce Glans penis and external urethral meatus
Superficial perineal (Colles') fascia Buck's fascia Septum of scrotum Navicular fossa
y
C/ikMa^ * /Y2>. —
Pelvic Floor and Contents
Plate 361
Pelvic C o n t e n t s : F e m a l e
Uterus (fundus)
Superior view
Ligament of ovary Ovary Uterine (fallopian) tube
Round ligament of uterus
Linea alba
Urinary bladder and transverse vesical fold Rectus abdominis muscle M e d i a l umbilical fold and ligament (occluded part of umbilical artery)
Median umbilical fold and ligament (urachus)
Rectouterine p o u c h (of Douglas) Rectum Inferior epigastric vessels and lateral umbilical fold Uterosacral fold Ureteric fold Suspensory ligament of ovary (contains ovarian vessels)
Broad (lateral uterine) ligament Femoral ring Deep inguinal ring Iliopubic tract (covered by peritoneum) External iliac vessels Iliac fossa (false pelvis)
Cecum Cecal folds Right paracolic gutter
Left paracolic gutter
m
/
7 /
•
'
•
v
f
7
/
r
f
/
Sigmoid c o l o n Quadratus lumborum muscle _ ,. , Descending colon Transversus abdominis Internal o b l i q u e External oblique
Plate 362
) ( ( )
Abdominal muscles
Psoas major and minor muscles Sympathetic trunk Anterior longitudinal ligament Body of L3 vertebra
I
IBr*'. /•/'v*^ . \
SfflW Jwjr ;
f !•
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lv: • / / / V
w vSSw-Sf--NfcVvxv. •K-msm Z l ^ /.i-jfSfci. H E n SkS:
/W
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^ 111 Jlfc* J yb ;.,>,>
Ovarian vessels
Transversalis fascia
Pararectal fossa Inferior vena cava Sacral p r o m o n t o r y A b d o m i n a l aorta Superior hypogastric plexus
Parietal p e r i t o n e u m Ascending colon Terminal ileum Ureter Root of mesentery
Pelvic Floor and Contents
Pelvic Contents: Male Superior view
Rectum Seminal vesicle (subperitoneal) Ductus deferens (in peritoneal fold) Linea terminalis of pelvis Femoral ring
Urinary bladder and transverse vesical fold
Linea alba Median umbilical fold and ligament (urachus)
Medial umbilical fold and ligament (occluded part of umbilical artery)
Pubic branch of inferior epigastric artery (obturator anastomotic)
Rectus abdominis muscle Rectovesical pouch Inferior epigastric vessels and lateral umbilical fold Vesicosacral (sacrogenital) fold
Deep inguinal ring
Pararectal fossa
External iliac vessels
Ureteric fold
Testicular vessels (in peritoneal fold)
Iliopubic tract (extraperitoneal)
Iliac fossa (false pelvis)
Cecum
Transversalis fascia Parietal peritoneum
Cecal folds
2X "
Left paracolic gutter
si
KoX1 &
/
/
/
Quadratus lumborum muscle
Sigmoid colon
Descending colon Transversus Abdominal abdominis Internal oblique ( muscles External oblique
j
Psoas minor and major muscles
j
/
/
/
Sympathetic trunk Anterior , longitudinal ligament Body of L3 vertebra
Pelvic Floor and Contents
I I
Testicular vessels
Inferior vena cava Sacral p r o m o n t o r y A b d o m i n a l aorta Superior hypogastric plexus
Right paracolic gutter Ascending colon Terminal ileum Ureter Root of mesentery
Plate 363
Endopelvic Fascia and Potential Spaces
Female: superior view ( p e r i t o n e u m a n d loose areolar tissue r e m o v e d )
Umbilical prevesical fascia Medial umbilical ligament (occluded part of umbilical artery) Urinary bladder and vesical fascia Rectus abdominis muscle Superior vesical artery in lateral ligament of bladder Linea terminalis of pelvis Femoral ring Inferior epigastric artery and Pubic branch D e e p inguinal ring
M e d i a n umbilical ligament (urachus) Pubic symphysis Inferior (arcuate) pubic ligament Deep dorsal vein of clitoris Retropubic (prevesical) space Transverse perineal ligament (anterior thickening of perineal m e m b r a n e ) M e d i a l pubovesical ligament Lateral pubovesical ligament Vesicocervical fascial fibers Superior fascia of pelvic diaphragm (superior levator ani fascia)
Iliopubic tract
O b t u r a t o r canal and obturator artery
Transversalis fascia External iliac vessels Femoral nerve (under fascia) Deep circumflex iliac vessels Tendinous arch § of pelvic fascia /, (reflected laterally) Iliac fascia Ovarian vessels in suspensory ligament of ovary lliacus muscle
Obturator internus fascia
Ureter Psoas major muscle Internal iliac vessels
Tendinous arch of levator ani muscle
Inferior vesical and vaginal arteries'
Tendinous arch of pelvic fascia
Hypogastric (neurovascular) sheath
Uterosacral ligament
M i d d l e rectal artery Cervix of uterus and uterine fascia Superior rectal artery (left branch) Rectum and rectal fascia Rectovaginal (potential) space Presacral (potential) space ( spread open) M e d i a n sacral artery
Plate 364
Cardinal (transverse cervical or M a c k e n r o d t ' s ) ligament w i t h uterine artery Vaginorectal fascial fibers Presacral fascia (pulled
away)
Anterior sacrococcygeal ligament Vesicocervical and vesicovaginal (potential) spaces
Pelvic Floor and Contents
Urinary Bladder: Orientation and Supports
Female: midsagittal section
Peritoneum Transversalis fascia M e d i a n umbilical ligament (urachus) Umbilical prevesical fascia Uterus (fundus) Vesicouterine p o u c h Fundus Apex Body Ureteric orifice Trigone Neck
Urinary bladder
Pubic symphysis Retropubic (prevesical) space and venous plexus Inferior (arcuate) pubic ligament Deep dorsal vein of clitoris Transverse perineal ligament Sphincter urethrae and Sphincter u r e t h r o v a g i n a l muscles Perineal m e m b r a n e Urethra Vagina Labium minus Rectum
Perineal b o d y External anal ' A m p u l l a of rectum sphincter muscle Pubic symphysis Inferior (arcuate) pubic ligament Deep dorsal vein of clito
Labium majus Superior view with peritoneum a n d vesical fascia removed
Medial pubovesical ligament (medial puboprostatic ligament in male) Transverse perineal ligament (anterior thickening of perineal membrane) Tendinous arch of levator ani muscle O b t u r a t o r canal Lateral pubovesical ligament (lateral puboprostatic ligament in male) Tendinous arch of pelvic fascia Superior fascia of pelvic diaphragm (covering levator ani muscle) O b t u r a t o r fascia over obturator internus muscle Urinary bladder pulled up and back (vesical fascia removed) M e d i a n umbilical ligament (urachus) (cut) Inferior vesical and vaginal arteries //.p.
Urinary Bladder
Ureter-
Plate 365
Urinary Bladder: Female and Male mmmMBsmmmmmMommm
• M
See also Plates 343, 360, 361, 365, 400, 402, 403, 417 Female: frontal section
— Peritoneum — Body of bladder Fundus of bladder Interureteric crest Left ureteric orifice Trigone of bladder N e c k of bladder Paravesical endopelvic fascia and vesical venous plexus Vesical fascia Tendinous arch of levator ani muscle - O b t u r a t o r internus muscle Levator ani muscle Tendinous arch of pelvic fascia Urethra Sphincter urethrae muscle Perineal m e m b r a n e Inferior pubic ramus Crus of clitoris and ischiocavernosus muscle Bulb of vestibule and bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia Superficial perineal (Colles') fascia
Round ligament of uterus
Vagina M a l e : frontal section
Peritoneum Body of bladder Fundus of bladder Ductus (vas) deferens Interureteric crest Right ureteric orifice Trigone of bladder Neck of bladder Paravesical endopelvic fascia and vesical venous plexus Tendinous arch of levator ani muscle Uvula of bladder O b t u r a t o r internus muscle Levator ani muscle Capsule of prostate Prostate and prostatic urethra Seminal colliculus Bulbourethral (Cowper's) gland Perineal m e m b r a n e and sphincter urethrae muscle Bulbous p o r t i o n of spongy urethra Corpus spongiosum and bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia /
nternal urethral sphincter Tendinous arch of pelvic fascia Anterior recess of ischioanal fossa Inferior pubic ramus Crus of penis and ischiocavernosus muscle Superficial perineal (Colles') fascia
/V.®. —/YP.
Plate 366
Urinary Bladder
•••;••—
•:•-:••-:
*
••••
:• •-:: -••.-.»
-.-••
/
Trigonal ring Posterior loop Loop of Heiss
Internal sphincter (involuntary)
Bladder Vagina Urethra Levator ani muscle Urogenital hiatus
Sphincter urethrae muscle Urethrovaginal muscle
a ^
Compressor urethrae muscle
Pubic b o n e
External sphincter (voluntary)
JOHN A.CRAIC—/*D
C/i&davL / M. D .
Plate 367
Lft
Sphincters
Female urethra, 8-year-old child
Voiding cystourethrogram, 2-year-old male
Prostatic
Membranous Spongy urethra
Plate 363
urethra
Urinary Bladder
Pelvic V i s c e r a : F e m a l e
Superior view with p e r i t o n e u m intact
M e d i a n umbilical fold (urachus) Vesicouterine pouch
Urinary bladder Fundus of uterus
Paravesical fossa
Deep inguinal ring Round ligament of uterus Body of uterus Broad ligament Ligament of ovary Mesosalpinx (of broad ligament) Cervix of uterus Ovary Rectouterine p o u c h (of Douglas) Rectouterine fold Uterine (fallopian) t u b e External iliac vessels -Pararectal fossa Suspensory ligament of ovary (contains ovarian vessels) Ureteric fold Urinary bladder Vesical fascia (cut edge) O b t u r a t o r fascia
Sigmoid colon Sacral p r o m o n t o r y M e d i a n sacral vessels A b d o m i n a l aorta O b t u r a t o r canal O b t u r a t o r artery Superior fascia of pelvic diaphragm Cervix of uterus and uterovaginal fascia Uterine vessels Cardinal (transverse cervical or Mackenrodt's) ligament Rectocervical and rectovaginal (potential) spaces Rectal fascia (cut edge) Rectouterine (sacrouterine) ligament External iliac vessels Ureter Sacral p r o m o n t o r y
Superior view with p e r i t o n e u m and uterus removed
Uterus, Vagina, and Supporting Structures
Plate 369
Uterus, V a g i n a , a n d S u p p o r t i n g S t r u c t u r e s See also Plates 400, 402, 404, 406, 412, 414, 415 Mesovarium Broad ligament Cut edge of p e r i t o n e u m f o r m i n g floor of paravesical p o u c h
Plane of section Angle of view
Suspensory ligament of ovary
Cervix of uterus
Uterine vessels H
j — C a r d i n a l (transverse cervical or Mackenrodt's) ligament
Obturator membrane Obturator fascia
Tendinous arch of levator ani muscle
Obturator internus muscle
Vaginal artery
Levator ani muscle (iliococcygeus and pubococcygeus muscles)
Ureter v
Anterior recess of ischioanal fossa
Ischiopubic ramus Compressor urethralis muscle
Crus of clitoris Ischiocavernosus muscle
Perineal m e m bra r
Fascia lata of thigh
Artery of bulb of vesti
Superficial perineal space
Sphincter u r e t h r o v a g i n a l muscle
Perineal artery
Terminal part of round ligament of uterus
Superficial perineal (Colles') fascia
Labium majus
Bulbospongiosus muscle and deep perineal (investing or Gallaudet's) fascia
Labium minus
CAfctf/t&Jo/—fi.7>.
Bulb of vestibule
Vestibule
Vaginal wall Vagina
Plate 370
Uterovaginal fascia
Hymenal caruncle
Uterus, Vagina, and Supporting Structures
5
Uterus and Adnexa .
Suspensory ligament of ovary
Posterior view
Isthmus
Mesosalpinx (of broad ligament)
.
.
.
.
.
Uterine (fallopian) tube Ampulla Infundibulum
A
Epophoron
syi®
Ligament of ovary
Vesicular appendix (hydatid of Morgagni)
Fundus of uterus Fimbriae
Abdominal ostium
Mas
Corpus luteum Ovary Body of uterus
Suspensory ligament of ovary
:wm
Mesometrium (of broad ligament)
Ovary Mesovarium (of broad ligament)
•mm
Ureter
Ligament of ovary
mmm
Uterosacral ligament
Uterine (fallopian) tube
Rectouterine pouch (of Douglas) —
Fundus of uterus Body of uterus
Uterine ostium Uterine part
Isthmus
Infundibulum Folds of uterine tube Isthmus of uterus Internal os
Fimbriae
Ligament of ovary
Suspensory ligament of ovary (contains ovarian vessels)
Endometrium Myometrium Mesometrium (of broad ligament) Uterine vessels Cardinal (transverse cervical or Mackenrodt's) ligament
Vesicular appendix (hydatid of Morgagni) Epoophoron Follicle (Graafian) Corpus albicans
of ovary
Corpus luteum
Cervical canal with palmate folds External os
Vaginal fornix
Frontal section
•—Vagina
Uterus, Vagina, and Supporting Structures
Plate 371
Pelvic L i g a m e n t s
Anterior
Posterior
-Suspensory ligament of the ovary (containing the ovarian vessels) Subdivisions and contents of the b r o a d ligament
I n f u n d i b u l u m of uterine tube External iliac vessels Fimbriae of uterine tube A m p u l l a of uterine tube Round ligament Right ovary Right ureter Laminae of the mesosalpinx O b l i t e r a t e d umbilical artery Ovarian branches of uterine vessels Round ligament
Laminae of the mesovarium Posterior lamina of broad ligament Anterior lamina of broad ligament
Transverse vesical fold Vesicouterine (uterovesical) p o u c h
Horizontal p o r t i o n of pubocervical fascia supports bladder and vagina
Uterine artery and venous plexus Vaginal artery
Uterosacral ligament Cardinal ligament Pelvic fascia and ligaments
Cervix
Horizontal portion of vagina Vertical p o r t i o n of vagina jOHN A.CRAI^d
C/icfrdadfi-
Plate 372
u r e th ra
Arcus tendineous fasciae pelvis Distal (vertical) portion of pubocervical fascia supports urethra and U-V junction and provides backstop against which urethra is compressed during straining
Uterus, Vagina, and Supporting Structures
Uterus: A g e Changes and Muscle Pattern
Adult (nulliparous)
Adult (postmenopausal)
Adult (parous)
C Contrast medium in abdominal cavity H Hysterosalpingogram uterus R Right fallopian tube infection
Uterine (fallopian) tube Ligament of ovary Round ligament of uterus
Uterine musculature (schema)
Uterosacral ligament Cardinal (transverse cervical or Mackenrodt's) ligament
Spiral fibers pass deeply into wall and interlace (schema) Vaginal wall
Uterus, Vagina, and Supporting Structures
Plate 373
5
Uterus: Position a n d Prolapse mm Altered rectal contour in 3rd degree
Degrees of retroversion A
^/Normal
Variations in position
-Normal
^/Normal
Normal
VSiv.w v, V s j r * •
Retroflexion
Anteflexion (normal and severe)
Retrocession
Uterine prolapse
Urinary bladder Uterus
Slight descent (1 st degree)
Complete
Sagittal section Rectum
\
• v,
,/
Cervix at introitus (2nd degree)
Plate 374
Uterus, Vagina, and Supporting Structures
Ectopic Pregnancy
J
Sites of ectopic implantation
Interstitial
Tubal (isthmic)
Tubal (ampullar)
Abdominal
vwavi'VSi'Je-S
Ovarian
Unruptured tubal pregnancy
Villi invading tubular wall
Chorion
Hemorrhage in tubal wall
Amnion
Section through tubal pregnancy
Lumen of tube
Uterus, Vagina, and Supporting Structures
Plate 375
5
Transverse Section: Pubic Crest, Femoral Heads, Coccyx
Superior portion of pubic symphysis Spermatic cord
Interior of urinary bladder Adductor longus muscle of pubis
Beginning of urethra
Pectineus muscle
Prostate gland with prostatic urethra
Femoral vein
Psoas muscle and ten
Femoral artery
lliacus muscle
Femoral nerve
Head of femur
Sartorius muscle
Neck of femur
iopsoas muscle
Gluteus medius muscle
Rectus femoris muscle Tensor fasciae latae muscle
Gluteus minimus tendon
Gluteus medius muscle
Greater trochanter Inferior gemellus muscle
Obturator artery, vein, and nerve
Right
Acetabular fossa
sciatic nerve
Lunate (articular) surface of acetabulum
Gluteus maximus muscle Obturator internus muscle
Left sciatic nerve
Sacrotuberous ligament
Internal pudendal artery and vein
Ejaculatory ducts Perineal flexure (termination of rectum, beginning of anal canal) Tip of coccyx
Pudendal nerve Fat body of ischioanal fossa Levator ani muscle (puborectalis)
/
M.j>.
Female Perineum and External Genitalia (Pudendum or Vulva) See also Plates 404, 406, 407, 413
Mons pubis Anterior commissure of labia majora Prepuce of clitoris Pudendal cleft (groove or space between the labia majora) lans of clitoris Frenulum of clitoris External urethral orifice Labium minus Labium majus Openings of paraurethral (Skene's) ducts Vestibule of vagina (cleft or space surrounded by labia minora)
Wgm : K^fi&Sa^v.
: JkcgBHRSSW-' M'mF^
orifice SeBSat&w
O p e n i n g of greater vestibular (Bartholin's) gland Hymenal caruncle Vestibular fossa Frenulum of labia minora Posterior commissure of labia majora Perineal raphe (over perineal body) Anus
Annular hymen
Septate hymen
Cribriform hymen
Perineum and External Genitalia: Female
Parous introitus
Plate 377
Superficial fatty (Camper's) layer / ( Deeper m e m b r a n o u s ( (Scarpa's) layer )
Subcutaneous tissue
Rectus sheath (anterior layer) Aponeurosis of external o b l i q u e muscle Superficial inguinal ring Anterior superior iliac spine Round ligament of uterus and coverings (cut) Inguinal ligament (Poupart's) Pubic tubercle Pubic symphysis Saphenous o p e n i n g Suspensory ligament of clitoris Fascia lata of thigh ichiopubic ramus Superficial perineal (Colles') fascia {cutaway) to o p e n superficial perineal space Ischiocavernosus muscle Bulbospongiosus muscle (covers bulb of vestibule) Perineal m e m b r a n e D e e p perineal (investing or Gallaudet's) fascia ( p a r t i a l l y cut away) Superficial transverse perineal muscle Ischial tuberosity Superficial perineal (Colles') fascia (cut edge turned down) Fat b o d y of ischioanal fossa Peritoneum Urachus •Transversalis fascia Superficial perineal fascia Round li w of uterus and coverings
Rectus abdominis muscle
Subcutaneous f Fatty tissue ( Membranous
Vesical fascia Uterovaginal fascia Rectal fascia
Rectus sheath (anterior layer) Pubic symphysis Inferior (arcuate) pubic ligament Transverse perineal ligament Suspensory ligament of clitoris
Sphincter urethrae and sphincter urethrovaginal'^ muscles
if
Perineal m e m b r a n e Superficial perineal space Superficial perineal (Colles') fascia Perineal bodySuperior fascia of pelvic diaphragm Inferior fascia of pelvic diaphragm Levator ani muscle
Plate 378
External anal sphincter muscle
Perineum and External Genitalia: Female
Female Perineum and Deep Perineum
Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia partially r e m o v e d
Suspensory ligament of clitoris Ischiocavernosus muscle Bulb of vestibule
Superficial perineal space (pouch or c o m p a r t m e n t )
Perineal m e m b r a n e
Ischiopubic ramus w i t h cut edge of superficial perineal (Colles') fascia
Greater vestibular (Bartholin's) gland Bulbospongiosus muscle (cut away)
Perineal membrane
Superficial transverse perineal muscle
Ischial tuberosity Sacrotuberous ligament
Perineal body
Gluteus maximus muscle
Ischioanal fossa
Coccyx Urethra
Crus of clitoris
Sphincter urethrae muscle
Ischiopubic ramus
Perineal m e m b r a n e {cut and reflected) Compressor urethrae muscle
Bulb of vestibule
Obturator fascia Tendinous arch of levator ani muscle Inferior fascia of pelvic diaphragm (cut) Levator ani muscle External anal sphincter muscle A n o c o c c y g e a l (ligament) b o d y
Sphincter urethrovaginalis muscle Vagina (Bartholin's) gland
Deep transverse perineal muscle
Perineal m e m b r a n e
Perineum and External Genitalia: Female
Plate 379
P e r i n e u m a n d E x t e r n a l G e n i t a l i a (Superficial D i s s e c t i o n )
Deep (investing) fascia over external oblique muscle
Superficial fatty (Camper's) and deeper membranous (Scarpa's) layers of subcutaneous tissue
External spermatic fascia
wSSKs
mmk
Anterior superior iliac spine
Deep (Buck's) fascia of penis
Inguinal ligament (Poupart's)
Superficial (dartos) fascia of penis and scrotum
Fascia lata (deep fascia) of thigh
Saphenous opening and femoral artery and vein Great saphenous vein Superficial perineal (Colles') fascia Broken line indicates line of attachment of Colles' and Scarpa's fasciae with deep fascia
Ischiopubic ramus
Anus
Pubic symphysis
Fat body in ischioanal fossa
Urogenital triangle Ischiopubic ramus
Regions (triangles) of p e r i n e u m : surface t o p o g r a p h y
Ischial tuberosity Anal triangle
\,vV
Plate 380
Tip of coccyx
Perineum and External Genitalia: Male
Perineum and External Genitalia (Deeper Dissection) See also Plates 403, 405, 408-411, 416
Skin of penis Superficial (dartos) fascia of penis Aponeurosis of external oblique muscle Deep m e m b r a n o u s (Scarpa's) layer of subcutaneous tissue (cutaway) Inguinal ligament (Poupart's) Deep (Buck's) fascia of penis Superficial inguinal ring External spermatic fascia investing spermatic cord Fascia lata (deep fascia) of thigh Bulbospongiosus muscle — Ischiocavernosus muscle covers crus of penis Superficial perineal (Colles') fascia (cut away to open superficial perineal space) Perineal m e m b r a n e Deep perineal (investing or Gallaudet's) fascia ( p a r t i a l l y cut away) covers muscles of superficial perineal space Superficial transverse perineal muscle Ischial tuberosity Superficial perineal (Colles') fascia (cut edge) Levator ani muscle roofing ischioanal fossa External anal sphincter muscle Gluteus maximus muscle
Superficial dorsal vein Dorsal artery and nerve Lateral superficial vein Corpus cavernosum and its tunica albuginea D e e p artery Corpus spongiosum and its tunica albuginea Section t h r o u g h b o d y of penis
Perineum and External Genitalia: Male
Plate 381
Penis
External urethral orifice (meatus) Glans penis C o r o n a of glans Frenulum
Neck of glans O p e n i n g of preputial (Tyson's) gland
Skin
Superficial (dartos) fascia of penis Deep (Buck's) fascia of penis External spermatic fascia investing spermatic cord (cut) Superficial perineal (Colles') fascia (cut away to open superficial perineal space) Ischiopubic ramus
D e e p perineal (investing or Gallauclet's) fascia (cutaway) over muscles of superficial perineal space Ischiocavernosus muscle
(cutaway)
Superficial transverse perineal muscle Anus Glans penis C o r p o r a cavernosa of penis Intercavernous septum of deep (Buck's) fascia Corpus spongiosum Pubic tubercle Superior ramus Ischial tuberosity
Perineal membrane
Ischiopubic ramus
Gluteus maximus muscle Levator ani muscle and inferior fascia of pelvic diaphragm roofing ischioanal fossa
Perineal body Bulb of penis Tip of coccyx Crus of penis
External anal sphincter muscle
Perineal membrane
Ischial tuberosity Perineal body
Plate 382
External anal sphincter muscle
Perineum and External Genitalia: Male
Perineal Spaces iMr^ii Ti*i MT i m-
^
e
t
c
?
'
: .::.
• • •
Pubic symphysis
KSaHBMDffSi
Pubic bone
Superior pubic ramus
Transverse perineal ligament (anterior thickening of perineal m e m b r a n e ) Dorsal artery and nerve of penis
Inferior (arcuate) pubic ligament
D e e p artery of penis Urethral arteryy
Deep dorsal vein of penis
D u c t of bulbourethral (Cowper's) gland
Ischiopubic ramus
Artery of bulb of penis
Urethra
Deep perineal (investing or Gallaudet's) fascia over ischiocavernosus, bulbospongiosus, and superficial transverse perineal muscles (cutaway)
Perineal membrane
Superficial perineal (Colles') fascia
(cutaway)
Superficial transverse perineal muscle (cut and reflected) Ischial tuberosity
Perineal body
Inferior views
External anal sphincter muscle Dorsal artery and nerve of penis Deep artery of peni Urethral artery Bulbourethral (Cowper's) gland
Sphincter urethrae muscle
Artery of bulb of penis Perineal m e m b r a n e (cut edge) Internal pudendal artery and dorsal nerve of penis Internal pudendal artery and perineal branch
Levator ani muscle Perineal m e m b r a n e Deep transverse perineal muscle Deep perineal (investing or Gallaudet's) fascia Corpus cavernosum (crus of penis) and deep (Buck's) fascia of peni Ischiocavernosus muscle Superficial perineal (Colles') fascia (closes superficial perineal space)
Urinary bladder Prostate O b t u r a t o r internus muscle Ischiopubic ramus Sphincter urethrae muscle Bulbourethral (Cowper's) gland Ischiocavernosus muscle Bulb of penis (corpus spongiosum) and deep (Buck's) fascia of penis Bulbospongiosus muscle
Frontal section, anterior view of p e r i n e u m : schema
Perineum and External Genitalia: Male
Plate 383
5
Prostate and Seminal Vesicles W M W H M j ^ i l ^ W W W W M i W i W I i . 1 IWHlilUiliPHiji .il IHIil'lli' i "" iMBMilMWi
jiiMfMlillfflllf^^
"
\T"illttWrfffilirffiffflfl ifgmfllWWWWiTWWW
"M
See also Plates 361, 363, 366, 403, 410 Ureteric orifice Trigone of urinary Internal urethral sphincter Uvula of bladder
Prostate Seminal colliculus
Urethral crest
Prostatic utricle
Openings of prostatic ducts in prostatic sinus
O p e n i n g of ejaculatory duct Sphincter urethrae muscle Bulbourethral (Cowper's) gland O p e n i n g of bulbourethral duct
Rectum and rectal fascia
Perineal b o d y Rectovesical or rectoprostatic (Denonvilliers') fascia
Frontal section, anterior view of bulbous portion of spongy urethra schematically extended
Seminal vesicle
Sagittal section
Ureter
Urinary bladder
—A/.J>.
Ductus deferens Anterior muscular band of skeletal muscle (continuation of sphincter urethrae) Isthmus and fibromuscular stroma (smooth muscle)
Prostatic urethra^
Ampulla of ductus deferens
Seminal colliculus
Beginning of ejaculatory d
Inferolateral
Prostate
Prostatic utricle .'"~ X-
•
A
/ I
/ M e d i a n lobe W
Inferolateral lobe
a
Seminal vesicle
Ischiopubic ramus Deep transverse perineal muscle and fascia
Prostatic sinus —
Bulbourethral (Cowper's) glands Posterior view
Plate 384
Capsule of prostate Inferoposterior lobe Cross section t h r o u g h prostate
Urethra
Internal urethral sphincter
Trigone of urinary bladder
Prostate Urethral crest Prostatic urethra
Openings of prostatic ducts
Prostatic utricle
Intermediate part of (membranous) urethra
Openings of ejaculatory ducts Bulb of penis Crus of penis
Bulbourethral (Cowper's) gland
Bulbous , portion
Openings of bulbourethral ducts Corpus cavernosum Tunica albuginea Corpus spongiosum
ra
J E 4—'
Tunica albuginea
o> u 1/T D c
Deep artery of penis 'V-Vivlfi
s -< >
Intercavernous septum of deep (Buck's) fascia
re
w) 5
Pendulous ^ (penile) portion
Urethral lacunae (Morgagni) and urethral glands (Littre)
Lacuna magna (inconstant) Navicular fossa Glans penis External urethral orifice (meatus) Roof of urethra
Perineum and External Genitalia: Male
Floor o f urethra
Plate 385
D e s c e n t of Testis
Suprarenal gland
Suprarenal gland
Suspensory (diaphragmatic) ligament
Kidney Suspensory (diaphragmatic) ligament (atrophic)
Gonads Mesonephric (wolffian) duct
Testes • Epididymis
Gubernaculum
Gubernaculum
Urinary bladder
Deep inguinal ring
|F
Urinary bladder
•
8 weeks (22.5-mrn crown-rump)
11 weeks (43-mm crown-rump)
Testis Gubernaculum
Epididymis
Deep inguinal ring
4 lunar m o n t h s (107-mm crown-rump)
Superficial inguinal ring Ductus deferens Scrotum (cut open) Epididymis Testis Processus vaginalis Gubernaculum (26-cm crown-rump)
Plate 386
Cavity of tunica vaginalis (cut open)
Perineum and External Genitalia: Male
Scrotum and Contents •HHMHI
Skin of penis Superficial fascia of penis (Colles' fascia) Deep (Buck's) fascia of penis
Superficial inguinal ring
Testicular artery
External spermatic fascia
Ductus deferens Artery to ductus deferens
Cremaster muscle and fascia
Genital branch of genitofemoral nerve Pampiniform (venous) plexus
Septum of scrotum (formed by clartos fascia)
Epididymis Appendix of epididymis
Superficial (dartos) fascia of scrotum
Appendix of testis Testis (covered by visceral layer of tunica vaginalis)
Skin of scrotum
Parietal layer of tunica vaginalis
Superficial (dartos) fascia of scrotum External spermatic fascia Cremaster muscle and fascia Internal spermatic fascia Parietal layer of tunica vaginalis Epididymis Testis (covered by visceral layer of tunica vaginalis) Skin of scrotum
Perineum and External Genitalia: Male
Plate 387
mmmmm
Undifferentiated
Glans area Epithelial tag Urogenital fold
Genital tubercle
Urogenital groove Lateral part of tubercle Anal tubercle Anal pit
Male
Female
—Glans 45—50 mm (-10 weeks)
Epithelial tag Coronal sulcus Site of future origin of prepuce
45—50 mm (~10 weeks)
Urethral fold Urogenital groove Lateral tubercle (shaft or corpus) Labioscrotal swelling Urethral folds partly fused (urethral raphe) Anal tubercle Anus External urethral orifice
Body of clitoris
Prepuce
Fully developed
Prepuce Fully developed
Glans of clitoris
Body (shaft) of penis
External urethral orifice
Raphe of penis
Labium minus Scrotum
Labium majus Vaginal orifice Posterior commissure
Perineal raphe Perianal tissues (including external anal sphincter muscle)
Plate 388
Homologues of Genitalia
H o m o l o g u e s of Internal G e n i t a l i a imm
msm
Diaphragmatic ligament (suspensory ligament of ovary)
Paramesonephric (mullerian) duct Gonad Mesonephric tubules
Mesonephric (wolffian) duct
Genital cord Inguinal fold
Urogenital sinus
Primordium of prostate (<J) or of paraurethral (Skene's) ( 2 ) glands _ ,
Primordium of bulbourethral (Cowper's) ( 5 ) or of greater vestibular (Bartholin's) ( 2 ) glands
jp
Undifferentiated Female
Uterine (fallopian) tube Broad ligament Cranial mesonephric (Gartner's) duct Epophoron (cranial mesonephric tubules) i Parophoron (caudal 1 mesonephric tubules) i Vesicular appendix
Seminal vesicle Ductus deferens Prostatic utricle Prostate Opening of ejaculatory duct Bulbourethral (Cowper's) gla Appendix of epididymis Epididymis Efferent ductules Appendix of testis Testis Paradidymis Scrotal ligament (gubernaculum)
Homologues of Genitalia
mm
r ^ T r . a .
' / S u s p e n s o r y ligament of ovary — Ligament of ovary Ovary llterus Round ligament of uterus Vagina (upper 4/r>) M Residua of caudal mesonephric duct Vagina (lower 1/•«">) Urethra Paraurethral (Skene's) gland Greater vestibular (Bartholin's) gland Vestibule
Plate 388
5
Testis, E p i d i d y m i s , a n d D u c t u s D e f e r e n s .
.
.—--—- '
'
'••"""•""•••""V"':™"-"''''
",' ••..••••---—-—
.. ."
"''""Syv '
.....
. • • • M H M j vg<\'5S.
"~"STTy:'vf
S-S ' W-.&vSSJJ
Efferent ductules Aberrant ductule (vestigial mesonephric tubule) Ductus deferens
Area of rete testis (in mediastinum testis) Septa Head
Tunica albuginea
Epididymi s
Lobules Epididymal duct Aberrant ductule
Frontal section
Ductus deferens Efferent ductules Epididymal duct Rete testis (in mediastinum testis) Aberrant ductule Seminiferous tubules
Schema
Skin of scrotum Superficial (dartos) fascia Lobules of testis
External spermatic fascia Cremaster muscle and fascia
Scrotal septum (dartos)
Internal spermatic fascia Septa
Parietal layer of tunica vaginalis Visceral layer of tunica vaginalis
Rete testis (in mediastinum testis)
nica albuginea of testis
Ductus deferens
Sinus of epididymis Epididymis
Cross section through scrotum and testis
Plate 390
Testis, Epididymis, and Ductus Deferens
R e c t u m in Situ: F e m a l e a n d M a l e
Male
Sigmoid colon Free taenia (taenia libera)
Sigmoid m e s o c o l o n Rectosigmoid j u n c t i o n
Ductus (vas) deferens (cut)
Peritoneal reflection
Ureter (cut)
Rectovesical p o u c h
Urinary bladder
Rectum and rectal fascia
Seminal vesicle
Levator ani muscle (pelvic diaphragm)
Rectoprostatic (Denonvilliers') fascia
Coccyx
Prostate
Puborectalis part of levator ani muscle
Ischiocavernosus muscle and deep perineal (investing or Gallaudet's) fascia (partially cut away)
External anal \ ?eeP ~ sphincter muscle* ) Superficial ( Subcutaneous
Deep transverse perineal muscle Female
Superficial transverse perineal muscle and deep perineal (investing) fascia
Sigmoid mesocolon Rectosigmoid junction
Superficial perineal (Codes') fascia
Peritoneal reflection
Sigmoid colon Free taenia (taenia libera)
Rectal fascia and rectum
Uterus couterine p o u c h
Rectouterine pouch (of Douglas)
Ureter (cut) Vagina and vaginal fascia
Coccyx
Urinary bladder and vesical fascia
Levator ani muscle (pelvic diaphragm)
Ischiocavernosus muscle and deep perineal (investing or Gallaudet's) fascia
Puborectalis part of levatoi ani muscle External anal sphincter muscle* Deep Superficial Subcutaneous
Deep transverse perineal muscle and perineal m e m b r a n e Superficial perineal (Colles') fascia Superficial transverse perineal muscle and deep perineal (investing or Gallaudet's) fascia Perineal b o d y
*Parts variable and often indistinct
Rectum
Plate 391
Ischioanal Fossae See also Plates 317, 410-413
1
'';; ^
Sigmoid colon
lliacus muscle and fascia
External iliac vessels
Iliopectineal
Obturator internus muscle and fascia
Pudendal canal (Alcock's) contains internal pudendal vessels, pudendal nerve, and perineal nerve
Ischial tuberosity
Ureter
Tendinous arch of levator ani muscle
Extraperitoneal (supralevator) space ffibrofatty tissue) at b o d y of ( Deeper part ischioanal < Superficial fossa ( (perianal) part Transverse fibrous septum of ischioanal fossa Submucous space (internal venous plexus) Perianal space (external venous plexus) Intersphincteric groove (anocutaneous line)
Plate 392
Sacrogenital fold (uterosacral in female) Levator ani muscle and superior and inferior fascia of pelvic diaphragm Peritoneum (cut edge) f o r m i n g floor of pararectal fossa Rectal fascia External anal sphincter muscle C o n j o i n e d longitudinal muscle Internal anal sphincter muscle
Rectum
Rectum and Anal Canal mmaimm
gg: if.iBimwjbi—wijifumwww
Sigmoid c o l o n
15-17 cm
Rectosigmoid j u n c t i o n Superior
11-13 cm
j
Middle
/ \ (
Inferior
J
Transverse folds of rectum (valves of Houston)
Peritoneal reflection
8 - 9 cm
Rectal fascia Longitudinal muscle layer Circular muscle layer Muscularis mucosae 5 - 6 cm
Levator ani muscle ^ A n o r e c t a l line Anal columns (Morgagni's) Anal sinus Pectinate (dentate) line Internal rectal venous plexus in submucous space
4 - 5 cm
Deep part* of external sphincter muscle C o n j o i n e d longitudinal muscle 2 . 5 - 3 cm
Internal sphincter muscle Anal valve Anal crypt Superficial part* of external sphincter muscle
0 . 5 - 1 cm
Anal glands Transverse fibrous septum Muscularis mucosae of anal canal Perianal space
Sweat glands and hairs in perianal skin
Anal verge / Pecten > Anoderm
Subcutaneous part* of external sphincter muscle Corrugator cutis ani muscle External rectal venous plexus in perianal space Intersphincteric groove (anocutaneous line)
f
*Parts variable and often indistinct
Rectum
Plate 393
5
Anorectal Musculature
Rectosigmoid junction
Anterior view
Sigmoid colon
Free taenia (taenia libera)
Fibers of taenia spread o u t to f o r m longitudinal muscle layer of rectum Fibers f r o m longitudinal muscle j o i n circular muscle layer W i n d o w cut in longitudinal muscle layer to expose underlying rcular muscle layer
Levator ani muscle eep Superficial Subcutaneous
Frontal section
Parts* of external anal sphincter muscle
mMM Fibrous septum
M
Corrugator cutis ani muscle
•
:
•mmm
WKSIS
Perianal skin
Superior fascia of pelvic diaphragm Inferior fascia of pelvic diaphragm Levator ani muscle Rectal fascia Longitudinal muscle of rectum
8 • i-aeSii^v
vv.
Circular muscle of rectum Muscularis mucosae of rectum Deep part* of external anal sphincter muscle Internal rectal venous plexus C o n j o i n e d longitudinal muscle Superficial part* of external anal sphincter muscl
mm
mm
Internal anal sphincter muscle Muscularis mucosae of anal canal Transverse fibrous septum of ischioanal fossa Subcutaneous part* of external anal sphincter muscle Corrugator cutis ani muscle External rectal venous plexus
Intersphincteric groove (anocutaneous line)
*Parts variable and often indistinct
Plate 394
Rectum
External Anal Sphincter Muscle: Perineal Views
Male
Superficial scrotal (dartos) fascia Septum of scrotum Deep (Buck's) fascia of penis Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia removed Ischiocavernosus muscle with deep perineal (investing or Gallaudet's) fascia removed Perineal membrane Ischiopubic ramus Perineal body Superficial transverse perineal muscle with deep perineal (investing or Gallaudet's) fascia removed Subcutaneous • i c Superiicial Deep
) n . * c . , , ( Parts ot external anal > s . , ) P ™ n c t e r muscle
Superficial perineal (Colles7) fascia {cut edges) fibrous septum of ischioanal fossa (cut) schial tuberosity Sacrotuberous ligament Pubococcygeus ) Puborectalis ? Levator ani muscle lliococcygeus ) Anococcygeal body (ligament) (posterior extensions of superficial external anal sphincter muscle) Gluteus maximus muscle p of coccyx Female
Clitoris External urethral orifice Vagina Superficial perineal (Colles') fascia (cut edge) Ischiocavernosus muscle with deep perineal (investing or Gallaudet's) fascia removed Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia removed Fibers from superficial external anal sphincter muscle to ischiopubic ramus Perineal membrane Superficial transverse perineal muscle with deep perineal (investing or Gallaudet's) fascia removed Superficial perineal (Colles') fascia (cut edge) Perineal body Crossed fibers from superficial and deep external sphincters to superficial transverse perineal muscle Parts* of external anal ) J^ e e | 3 . sphincter muscle ) Superficial ( Subcutaneous ( Pubococcygeus Levator ani muscle < Puborectalis ( lliococcygeus Gluteus maximus muscle Anococcygeal body (ligament) (posterior exten: of superficial external anal sphincter muscle) *Parts variable and often indistinct
Rectum
Ischiopubic ramus Anus
Actual and Potential Perineopelvic Spaces
Sagittal section
Peritoneum — -Vesical fascia ,
Rectal fascia \ Rectal fascia Presacral fascia
smIM Retropubic \ (prevesical) space (of Retzius)
Presacral space
Recto- ( Retrovesical vesical \ Prerectal space ( R e t r o p r o s t a t i c — : Sphincter urethrae
C
^x :
^ ... M^f f /
N
ff
Levator ani muscle and fascia of pelvic diaphragm
transverse perineal muscles External anal sphincter muscle*
Deep Superficial Subcutaneous
Deep postanal space A n o c o c c y g e a l b o d y (ligament)
D e e p (Buck's) fascia of penis Superficial perineal
(Colles 7 )
Rectovesical or rectoprostatic (Denonvilliers') fascia (septum)
Superficial postanal space (part of perianal space)
fascia
*Parts variable and often indistinct
Submucous space Perianal space Bulbospongiosus muscle and deep perineal (Gallaudet's) fascia Superficial perineal c o m p a r t m e n t (space or pouch)
Perineal membrane, Deep transverse perineal muscle and Superficial transverse perineal muscle (cut away) to expose Anterior recess of ischioanal fossa Preanal c o m m u n i c a t i o n (inconstant) b e t w e e n right and left ischioanal fossae Pus in ischioanal fossa Posterior c o m m u n i c a t i o n b e t w e e n right and left ischioanal fossae via deep postanal space deep to anococcygeal b o d y (ligament) Gluteus maximus muscle and Sacrotuberous ligament (cut) Posterior recess of ischioanal fossa
Perineal view Spread of perineal abscess in perineal spaces
Plate 396
M.J>
Rectum
Pelvic S c a n s : Sagittal M R I m a g e s M e d i a n (A) a n d p a r a m e d i a n (B) sagittal M R images of female pelvis A
B
A C D P R
Anal canal External os of cervix Dural (thecal) sac Pubic symphysis Rectum
RA S U UB V
Rectus abdominis muscle Sacrum Uterus Urinary bladder Vagina
M e d i a n (C) and p a r a m e d i a n ( D ) sagittal M R images of male pelvis C
D
C Corpus spongiosum CC Corpus cavernosum G Glans penis P Pubic symphysis PS Prostate
Regional Scans
R S T U
Rectum Sacrum Testis Urinary bladder
Plate 397
A r t e r i e s of R e c t u m a n d A n a l C a n a l ( M a l e )
Posterior view
Left colic artery Ascending branch Descending branch
Inferior mesenteric artery A b d o m i n a l aorta Inferior vena cava M e d i a n sacral artery
Sigmoid arteries
C o m m o n iliac artery
Marginal arterv
External iliac artery
Rectosigmoid arteries
Internal iliac artery
Superior rectal artery (bifurcation)
Lateral sacral artery Superior gluteal artery
/
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i ii A
wEVSA Ay/.
iffl m
Middle rectal artery-
ft . •
I : , I it
: t
/
I/
/ I
Inferior epigastic artery
Inferior gluteal artery
Ischial spine
O b t u r a t o r artery
Obturator internus muscle
Internal pudendal artery Umbilical artery
Internal pudenda] artery
Inferior vesical artery
Pudendal canal (Alcock's)
Artery to ductus deferens
Ischial tuberosity
Superior vesical artery
Coccygeus (ischiococcygeus) muscle Inferior rectal artery Levator ani muscle
Plate 398
External anal sphincter muscle Puborectalis muscle {severed)
M i d d l e rectal artery Inferior rectal artery
Vasculature
V e i n s of R e c t u m a n d A n a l C a n a l ( F e m a l e ) •MHHHHHHMHHi
A n t e r i o r view
Inferior mesenteric vein (to portal vein via splenic vein) Inferior vena cava Sigmoid veins C o m m o n iliac veins
Median sacral vein Superior rectal vein (bifurcation)
External iliac vein
Internal iliac vein
Obturator vein
Superior vesical and uterine veins (from uterine venous plexus)
M i d d l e rectal vein
Internal pudendal vein
C o m m u n i c a t i o n between internal and perimuscular rectal plexuses
Vaginal vein (from vaginal venous plexus)
Inferior vesicular vein
Internal pudendal vein in pudendal canal (Alcock's)
Inferior rectal vein
C o m m u n i c a t i o n between internal and external venous plexuses
Internal rectal plexus Perimuscular rectal venous plexus External rectal plexus
Vasculature
Plate 399
A r t e r i e s a n d Veins of Pelvic O r g a n s : F e m a l e
A n t e r i o r view
I tilll Renal artery and vein Kidney Ovarian artery and vein Ureter Inferior vena cava Psoas major muscle Peritoneum (cut edge) Suspensory ligament of ovary contains ovarian vessels Rectum Ovary Uterine (fallopian) tube Uterus Round ligament of uterus
Renal artery and vein Ovarian artery and vein A b d o m i n a l aorta Ureter Inferior mesenteric artery Psoas major muscle C o m m o n iliac artery M e d i a n sacral vessels Superior rectal artery (cut) Round ligament of uterus (cut) Ovarian artery Internal iliac artery Anterior division External iliac artery O b t u r a t o r artery and nerve Umbilical artery (patent part) M i d d l e rectal artery Uterine artery Vaginal artery Inferior vcsical artery Round ligament of uterus (cut)
Vagina
Superior vesical arteries
Urinary bladder
Inferior epigastric artery and vein
Medial umbilical fold
Umbilical artery (occluded part) Superior vesical arteries Medial umbilical ligament M e d i a n umbilical ligament (urachus)
Plate 400
Vasculature
Anterior view
Renal vessels Inferior vena cava
Mm > .
A b d o m i n a l aorta Testicular vessels (part of spermatic cord) Ureter Inferior mesenteric artery C o m m o n iliac vessels Internal iliac vessels External iliac vessels Inferior vesical artery Inferior epigastric vessels Artery to ductus deferens Cremasteric vessels Testicular vessels in spermatic corcl Femoral vessels Superficial external pudendal vessels {cut—pass superficial to spermatic cord)
mm mm
Deep external pudendal vessels Pampiniform venous plexus Deep dorsal vein and dorsal arteries of penis under deep (Buck's) fascia of penis
i•
Vasculature
Plate 401
5
A r t e r i e s a n d V e i n s of Pelvis: F e m a l e
M e d i a n sacral artery
A b d o m i n a l aorta Right
Iliolumbar artery
} C o m m o n iliac arteries
Lateral sacral arteries
Internal iliac artery Posterior division Anterior division External iliac artery Umbilical artery (patent part) O b t u r a t o r artery
Superior gluteal artery
M i d d l e rectal artery Uterine artery
Piriformis muscle
Vaginal artery Inferior vesical artery
Inferior gluteal arterv
Superior vesical arteries
Internal pudendal artery—
/ / •
Medial umbilical ligament (occluded part of umbilical artery) Pubic symphysis Sagittal section
Coccygeus (ischiococcygeusj muscle
Right p a r a m e d i a n section: lateral view
Sacrotuberous ligament O b t u r a t o r fascia (of obturator internus muscle)
A b d o m i n a l aorta Inferior vena cava
Internal pudendal artery in pudendal canal (Alcock's)
Right c o m m o n iliac artery
Levator ani muscle (cut edge)
Left c o m m o n iliac artery Ureter? External iliac artery (cut)
Superior gluteal artery Umbilical artery (patent part) O b t u r a t o r artery
—Internal iliac artery Posterior division Anterior division
Piriformis muscle Internal pudendal artery Inferior gluteal artery Coccygeus (ischiococcygeus) muscle M i d d l e rectal artery Uterine artery Vaginal artery Inferior vesical artery Internal pudendal artery Inferior rectal artery Superior vesical arteries Medial umbilical ligament (occluded distal part of umbilical artery)
Plate 402
Obturator
canal Obturator internus muscle Levator ani muscle
Vasculature
A r t e r i e s a n d V e i n s of Pelvis: M a l e
Left p a r a m e d i a n section: lateral view
Inferior vena cava
Abdominal aorta
Right obturator vessels
C o m m o n iliac vessels
Right umbilical artery (patent part)
Median sacral vessels External iliac vessels (cut)
Superior vesical artery
Internal iliac vessels
Umbilical artery (occluded part)
Iliolumbar artery
Deep circumflex iliac vessels Inferior epigastric vessels
Lateral sacral artery Superior gluteal artery Obturator artery \
Umbilical artery Ureter (cut)
Ductus deferens and its artery
Inferior gluteal artery Inferior vesical artery
Medial umbilical ligament-
Middle rectal artery
Median umbilical ligament (urachus)
Internal pudendal artery Ductus deferens and its artery
Superior vesical artery
Prostatic branches of inferior vesical artery
Superficial dorsal vein of penis—
Inferior rectal artery Prostatic venous plexus
Deep dorsal vein and dorsal artery of penis
Sphincter urethrae muscle Perineal artery
Deep (Buck's) fascia of penis
Posterior scrotal arteries
Testicular artery
Internal pudendal artery on superior aspect of perineal membrane
Pampiniform (venous) plexus Artery to ductus deferens
Inferior vesical artery
Vesical (retropubic) venous plexus
Branch to Urethral branches Capsular branches Hyperplastic middle lobe W
0
W /
- « » " T -w — M .
Z>
Hyperplastic lateral lobe Sphincter urethrae mucle Arterial supply of prostate
(Frontal section, anterior view of specimen with benign hyperplasia)
Vasculature
Plate 403
I
,•;
, .'vl
;'•
A r t e r i e s a n d Veins of P e r i n e u m a n d U t e r u s w^q^s-wssM^.
• •
1
• i fH 1 1 H11
Posterior labial artery
Dorsal artery of clitoris Deep artery of clitoris
Ischiocavernosus muscle
Bulb of vestibule Compressor urethrae muscle
Bulbospongiosus muscle
Artery to bulb of vestibule
Superficial perineal space
Greater vestibular (Bartholin's) gland Deep transverse perineal muscle
Perineal membrane
Internal pudendal (clitoral) artery Perineal m e m b r a n e ( c u t a w a y )
Perineal artery
Perineal artery {cut)
Superficial transverse perineal muscle
Superficial perineal (Colles') f asci a (cut and reflected) t o ° P e n superficial perineal space
mm "M
Internal pudendal artery in pudendal canal (Alcock's)
Perineal artery
Inferior rectal artery
Internal pudendal artery in pudendal canal (Alcock's)
Branches of uterine artery
Round ligament
Inferior rectal artery External anal sphincter muscle Note: D e e p perineal (investing or Gallaudet's) fascia r e m o v e d f r o m muscles of superficial perineal space.
Ovarian vessels Tubal branches of ovarian vessels Uterine vessels Ureter Vaginal branches of uterine artery Vaginal artery Levator ani muscle Perineal m e m b r a n e Internal pudendal artery Perineal artery /
A/.7>,
Superficial perineal space •
/
)
\
:
•
:
'! •
Superficial perineal (Colles 7 ) fascia
Vasculature
Arteries and Veins of Perineum? Male
External spermatic fascia over testis and spermatic c o r d
Superficial (dartos) fascia of scrotum Septum of scrotum Posterior scrotal arteries Deep (Buck's) fascia of penis
Bulbospongiosus muscle
Superficial perineal (Colles') fascia {cut edge)
Ischiocavernosus muscle
Superficial perineal space
{opened)
Perineal artery and vein
Perineal membrane
Internal pudendal artery passes superior to perineal m e m b r a n e
Perineal b o d y
Superficial transverse perineal muscle and transverse perineal artery {cut and reflected)
Superficial transverse perineal muscle
Internal pudendal vessels and pudendal nerve {cut) in pudendal canal (Alcock's) ( opened up)
Transverse perineal
Inferior rectal artery Inferior fascia of pelvic diaphragm (roof of ischioanal fossa)
Superficial perineal (Colles') fascia (cut edge) Pudendal canal (Alcock's)
Note: Deep perineal (investing or Gallaudet's) fascia r e m o v e d f r o m muscles of superficial perineal space D e e p artery of penis Deep dorsal vein of penis Dorsal artery and nerve of penis Transverse perineal ligament (anterior thickening of perineal membrane) Deep artery of penis Dorsal artery of penis Urethral artery Perineal m e m b r a n e ( cut edge) Artery of bulb of penis Internal pudendal artery Perineal artery {cut) Internal pudendal vessels in pudendal canal (Alcock's) Superficial perineal (Colles') fascia {cut edge)
Vasculature
Plate 405
Lymph Vessels and Nodes of Pelvis and Genitalia: Female
Lateral aortic (lumbar) nodes Preaortic lymph nodes Promontorial (middle sacral) nodes C o m m o n iliac nodes
(Lateral) sacral node
Internal iliac node Lateral (superior) external iliac node
Medial (inferior) external iliac nodes
Obturator node
Superficial inguinal nodes Highest deep inguinal node (of Cloquet) Deep inguinal nodes
Plate 406
Vasculature
Lymph Vessels and Nodes of Perineum: Female
Inguinal ligament (Po u part's) Highest deep inguinal node (of Cloquet)
Fascia lata ( c u t a w a y ) Inferior nodes (vertical group) Superolateral nodes (horizontal group)
Femoral vessels and nerve Superficial inguinal nodes
Deep inguinal nodes
Superomedial nodes (horizontal group)
Vasculature
Plate 407
Lymph Vessels and Nodes of Pelvis and Genitalia: Male
Preaortic nodes
Pathways f r o m testes along testicular vessels
C o m m o n iliac nodes
Promontorial (middle sacral) nodes
(Lateral) sacral n o d e
Internal iliac nodes
External iliac nodes
Highest deep inguinal n o d e (of Cloquet)
— Deep inguinal nodes
Superficial inguinal nodes
Preaortic node Promontorial n o d e
Presymphyseal node
C o m m o n iliac node
External iliac nodes
Pathway along inferior vesical vessels to internal iliac nodes (principal pathway)
Pathway over bladder to external iliac nodes
Internal iliac nodes (Middle and lateral) sacral nodes
Pathway alongside rectum to (middle and lateral) sacral nodes
Prevesical plexus and pathway ( b r o k e n line) to external iliac nodes
Lymphatic drainage f r o m prostate
Plate 408
Pathway {broken line) f r o m lower prostate and m e m b r a n o u s urethra along internal pudendal vessels (beneath pelvic diaphragm) to internal iliac nodes
Vasculature
Nerves of External Genitalia: Male See also Plates 165, 166, 318
Splanchnic nerves
Greater Lesser Least
Celiac ganglia
Superior mesenteric ganglion
Subcostal nerve (T12) Iliohypogastric nerve
Lumbar splanchnic nerves
Ilioinguinal nerve
Inferior mesenteric ganglion
Sympathetic trunk and ganglia Genitofemoral nerve
Testicular artery and plexus
Lateral femoral cutaneous nerve
Superior hypogastric plexus
Femoral branch and Genital branch of genitofemoral nerve
Hypogastric nerves
Femoral nerve
Inferior hypogastric (pelvic) plexus
Lateral femoral cutaneous nerve
Ductus deferens and plexus
Femoral branches of genitofemoral nerve
Femoral nerve
Anterior cutaneous branches of femoral nerve
Testicular artery and plexus
Anterior cutaneous branch of iliohypogastric nerve Dorsal nerves of penis Genital branch of genitofemoral
Anterior scrotal nerve (from ilioinguinal nerve)
Innervation
Plate 409
Nerves of Pelvic Viscera: Male mmmmmmmmmm
See also Plates 165, 166, 318
Anterior vagal trunk Posterior vagal trunk and Celiac branch
spinal nerve (ventral ramus) W h i t e and gray rami c o m m u n i c a n t e s Greater / Lesser } , ^ t Least \
Inferior phrenic arteries and plexuses Left gastric artery and gastric
Left renal artery and plexus
Left aorticorenal gan
LI spinal nerve (ventral ramus)
Superior mesenteric ganglion Superior mesenteric artery and plexu
Gray \ White j
Intermesenteric (aortic) plexus
Ureter and ureteric plexus Superior hypogastric plexus Superior rectal artery and plexus Hypogastric nerves
, . . SPlanchnic nerves
Diaphragm
Celiac ganglia, plexus, and trunk
Inferior mesenteric ganglion, artery and plexus
r
Rami communicantes
1st, 2nd, 3rd lumbar splanchnic nerves Gray rami c o m m u n i c a n t e s Sympathetic trunk and ganglia 5th lumbar splanchnic nerve L5 spinal nerve (ventral ramus) Lumbosacral trunk
Nerve f r o m inferior hypogastric plexus to sigmoid and descending colon (parasympathetic)
Gray rami c o m m u n i c a n t e s SI spinal nerve (ventral ramus)
Sacral splanchnic nerves (sympathetic)
Pelvic splanchnic nerves (parasympathetic)
Inferior hypogastric (pelvic) plexus
Sacral plexus
O b t u r a t o r nerve and artery
Piriformis muscle
Ductus deferens and plexus
Gluteus maximus muscle and sacrotuberous ligament
Vesical plexus
Coccygeus (ischiococcygeus) muscle and sacrospinous ligament
Rectal plexus Prostatic plexus Cavernous nerves of penis
Pudendal nerve Levator ani muscle Inferior anal (rectal) nerve Perineal nerve Dorsal nerve of penis
/
M. 7>.
Plate 410
Posterior scrotal nerves
Innervation
Nerves of Perineum: Male See also Plate 416
Posterior scrotal nerves Perineal nerves
Superficial Deep ^
Dorsal nerve of penis Perineal m e m b r a n e (cut to show neurovascular structures on superior aspect of perineal membrane)
Dorsal nerve of penis (continuation of pudendal nerve supplying muscles on superior aspect of perineal membrane) Superficial perineal (Colles') fascia (cut to open superficial perineal space) Superficial and deep branches of perineal nerve Dorsal nerve of penis (passes superior to perineal membrane) Perineal nerve O b t u r a t o r fascia (of obturator intern us muscle) Posterior femoral cutaneous nerve Pudendal canal (Alcock's) (opened
up)
Pudendal nerve
Inferior clunial nerves
Piriformis muscle
Inferior anal (rectal) nerves Perforating cutaneous nerve A n o c o c c y g e a l nerve Sacrotuberous ligament (cut) Gluteus maximus muscle (cut)
Innervation
Coccygeus (ischiococcygeus) muscle Ischial spine Pudendal nerve Levator ani muscle O b t u r a t o r internus muscle Inferior anal (rectal) nerve Perineal nerve
Plate 411
Nerves of Pelvic Viscera: Female See also Plates 165,166, 318
Sympathetic trunk and L2 ganglion
Peritoneum
minal aorta Inferior vena cava Extraperitoneal (subserous) fascia
W h i t e and gray rami communicantes
Common iliac vessels and plexus
Lumbar splanchnic
Ureter Intermesenteric (aortic) plexus Ovarian artery and plexus
GravI rami communicantes
Superior hypogastric plexus
L5 spinal nerve
Sacral prom on tor Superior hypogastric plexus
Right hypogastric nerve [cut)
Common iliac artery and plexus
Right and left sacral sympathetic trunks and ganglia
Ureter Internal iliac artery and plexus
igmoid colon
External iliac artery and plexus
Piriformis muscle
Right and left hypogastric nerves Uterus Right sympathetic trunk
Sacral splanch nic nerves (sympathetic)
Left hypogastric nerve Inferior hypogastric (pelvic) plexus Uterine (fallopian) tube
Pudendal nerve
Ovary Symphyseal surface of pubis
Pelvic splanchnic nerves (parasympathetic)
Urinary bladder Vesical plexus
Coccygeus (ischiococcygeus) muscle
Uterovaginal plexus Uterus
(retracted)
Rectum (retracted)
!nn0*vaii©ii
Nerves of Perineum and External Genitalia: Female See also Plate 415
Anterior labial nerve (from ilioinguinal nerve) Dorsal nerve of clitoris Posterior labial nerves Superficial ( Branches > or perineal Deep \ nerve Perineal branch of posterior femoral cutaneous nerve
Dorsal nerve of clitoris passing superior to perineal m e m b r a n e Perineal nerve Pudendal nerve in pudendal canal (Alcock's) {dissected) Inferior clunial nerves Gluteus maximus muscle ( c u t a w a y ) Sacrotuberous ligament Perforating cutaneous nerve Inferior anal (rectal) nerves A n o c o c c y g e a l nerves
— Ischial tuberosity Ischial spine
Block anesthesia of pudendal and other nerves of perineal area
Innervation
Plate 413
Neuropafhways in Parturition See also Plates 165, 166
Greater
Splanchnic nerves
Lesser
spinal nerve (anterior ramus)
Least
Celiac ganglion
Sympathetic trunk and ganglia
Aorticorenal ganglion I I spinal nerve (anterior ramus)
Superior mesenteric ganglion
Rami communicantes Intermesenteric (aortic) plexus
Subcostal nerve (T12) Inferior mesenteric ganglion
Lumbar splanchnic nerves
Intermesenteric (aortic) plexus Superior hypogastric plexus S1 spinal nerve (anterior ramus) Iliohypogastric nerve ( L I )
Hypogastric nerves
Ilioinguinal nerve ( L I )
Pelvic splanchnic nerves
Vesical plexus
Inferior hypogastric (pelvic) plexus
Dorsal nerve of clitoris
Uterovaginal plexus
Posterior labial nerves
Pudendal nerve (S2, 3, 4) Inferior anal (rectal) nerve
Sensory fibers f r o m uterine body and fundus accompany sympathetic fibers via hypogastric plexuses t o T 1 1 , 12 (L1?)
—• Sensory fibers from cervix and upper vagina accompany pelvic splanchnic nerves (parasympathetic) to S2, 3, 4
Sensory fibers from lower vagina and perineum accompany somatic fibers via pudendal nerve to S2, 3, 4
M o t o r fibers to uterine body and fundus (sympathetic)
M o t o r fibers to lower uterine segment, cervix, and upper vagina (parasympathetic)
- - - - - - M o t o r fibers to lower vagina and perineum via pudendal nerve (somatic)
Plate 414
Innervation
Innervation of Female Reproductive Organs: Schema m
See also Plates 167,168
Sympathetic trunk and ganglion Celiac ganglia and plexus Gray ramus communicans White ramus communicans Aorticorenal ganglia Greater splanchnic nerve
Superior mesenteric ganglion
Lesser splanchnic nerve Least splanchnic nerve
T11
Intermesenteric (aortic) plexus
Sympathetic trunk
Lumbar splanchnic nerves Inferior mesenteric ganglion
L3 spinal nerve
Ovarian artery and plexus
Superior hypogastric plexus
Uterine (fallopian) tube Hypogastric nerves Note: Pain from intraperitoneal pelvic viscera (e.g., uterine contractions) goes via uterovaginal and pelvic plexuses, hypogastric nerves, superior hypogastric plexus, lower aortic plexus, lower lumbar splanchnic nerves, sympathetic trunk from L4 to L5 to spinal nerves T11, 12. Pain from subperitoneal pelvic viscera (e.g., cervical dilation and upper vagina) goes via pelvic splanchnic nerves to S2, 3, 4. Afferent fibers from lower vagina and perineum go via pudendal nerves to S2, 3, 4. Sympathetic f'bers
( )
Preganglionic Postganglionic
Innervation
Inferior extent of peritoneum — Uterovaginal and inferior hypogastric (pelvic) plexuses Pelvic splanchnic nerves
Sacral plexus
if Pudendal nerve Parasympathetic fibers
Preganglionic
Afferent fibers
Postganglionic
Plate 415
Innervation of Male Reproductive Organs: Schema See also Plates 167, 168
Celiac ganglia
Sympathetic trunk and g a n g l i a Greater splanchnic nerve (T5-9)
Superior mesenteric ganglion Gray ramus communicans
T11
W h i t e ramus communicans
Left aorticorenal ganglion
Lesser splanchnic nerve — Least splanchnic nerve
Renal ganglion L1
Upper lumbar splanchnic Intermesenteric (aortic) plexus
L2
Inferior mesenteric ganglion Gray ramus communicans Testicular artery and plexus
Superior hypogastric plexus
Testicular artery and plexus
Hypogastric nerves
Ductus deferens and plexus
Inferior extent of peritoneuiru
Ductus deferens and plexus
Pelvic splanchnic nerves Pelvic splanchnic nerves Sacral plexus Sacral plexus
Pudendal nerve
Pudendal nerve
Dorsal nerves of penis
Inferior hypogastric (pelvic) plexus Vesical plexus
Epididymis
Prostatic plexu
Testis
(Greater and lesser) cavernous nerves of penis
Sympathetic fibers
\ Preganglionic — ) postganglionic —
Plate 416
Parasympathetic fibers
\ Preganglionic ^ ^ ^ ^ ) Postganglionic — — — —
Afferent fibers
Innervation
innervation of Urinary Bladder and Lower Ureter: Schema See also Plates 167,168 >orsa! (posterior) root
Spinal sensory (dorsal root) ganglion
Ventral (anterior) root Superior mesenteric ganglion Rami communicantes Aorticorenal ganglion
Renal artery and plexus
Intermesenteric (aortic) plexus
Inferior mesenteric ganglion
1 st and 2nd lumbar splanchnic nerves
Lumbar part > of spinal corcl
L2 spinal nerve (ventral ramus)
Sacral part of spinal cord
Sympathetic trunk
Descending fibers
1
\
Gray rami - communicantes
Superior hypogastric plexus Ureter
Hypogastric nerves
Sacral splanchnic % nerves from If sacral sympathetic / trunk to inferior hypogastric (pelvic) I® plexus
Inferior hypogastric (pelvic) plexus
Urinary bladder
Pudendal nerve Vesical plexus
Sacral plexus
Prostatic plexus
Pelvic splanchnic nerves
Sphincter urethrae muscle superior to perineal membrane Bulbospongiosus muscle
Sympathetic
(
Preganglionic
fibers
)
Postganglionic
Innervation
Parasympathetic fibers
j )
Preganglionic Postganglionic
Somatic efferent fibers Afferent fibers
Plate 41
EUpper Limb Topographic A n a t o m y Plate
418
4 1 8 Upper Limb
S h o u l d e r a n d Axilla Plates 419-430
419
Clavicle and Sternoclavicular Joint
420
Humerus and Scapula: Anterior Views
421 Humerus and Scapula: Posterior View 4 2 2 Shoulder: Anteroposterior Radiograph 423 Shoulder (Glenohumeral Joint) 424 Muscles of Shoulder 425 Muscles of Rotator Cuff 426 Scapulohumeral Dissection 427 Axillary Artery and Anastomoses around Scapula 428
Pectoral, Clavipectoral, and Axillary Fasciae
429 Axilla (Dissection): Anterior View 430
Brachial Plexus: Schema
Arm Plates 431-435
431
Muscles of Arm: Anterior Views
432 Muscles of Arm: Posterior Views 4 3 3 Brachial Artery in Situ 434
Brachial Artery and Anastomoses around Elbow
4 3 5 Arm: Serial Cross Sections
Atlas of Human Anatomy
Upper Limb Elbow a n d F o r e a r m
463 Lumbrical Muscles and Bursae, Spaces, and Sheaths: Schema
Plates 436-451
436
Bones of Elbow
464 Flexor and Extensor Tendons in Fingers
437
Elbow: Radiographs
465
Intrinsic Muscles of Hand
438 Ligaments of Elbow
466
Arteries and Nerves of Hand: Palmar Views
4 3 9 Bones of Forearm
467
Wrist and Hand: Superficial Radial Dissection
440 Individual Muscles of Forearm: Rotators of Radius
468 Wrist and Hand: Superficial Dorsal Dissection
441 Individual Muscles of Forearm: Extensors of Wrist and Digits
469 Wrist and Hand: Deep Dorsal Dissection
442 Individual Muscles of Forearm: Flexors of Wrist
470 Extensor Tendons at Wrist
4 4 3 Individual Muscles of Forearm: Flexors of Digits
471 Fingers
4 4 4 Muscles of Forearm (Superficial Layer): Posterior View 4 4 5 Muscles of Forearm (Deep Layer): Posterior View 446
Muscles of Forearm (Superficial Layer): Anterior View
Neurovasculature Plates 472-483
Cutaneous Innervation of Wrist and Hand
447 Muscles of Forearm (Intermediate Layer): Anterior View
472
448 Muscles of Forearm (Deep Layer): Anterior View
4 7 3 Arteries and Nerves of Upper Limb
4 4 9 Forearm: Serial Cross Sections
4 7 4 Musculocutaneous Nerve
450 Attachments of Muscles of Forearm: Anterior View
475
451 Attachments of Muscles of Forearm: Posterior View
4 7 6 Ulnar Nerve 477
Median Nerve
Radial Nerve in Arm and Nerves of Posterior Shoulder
Wrist a n d H a n d
4 7 8 Radial Nerve in Forearm
Plates 452-471
4 7 9 Cutaneous Nerves and Superficial Veins of Shoulder
452
Carpal Bones
453
Movements of Wrist
454 Ligaments of Wrist 4 5 5 Ligaments of Wrist (continued) 456 Bones of Wrist and Hand 4 5 7 Wrist and Hand: Anteroposterior Radiograph 458
Metacarpophalangeal and Inlerphalangeal Ligaments
4 5 9 Wrist and Hand: Superficial Palmar Dissections 460
Wrist and Hand: Deeper Palmar Dissections
461 Flexor Tendons, Arteries, and Nerves at Wrist 462
Bursae, Spaces, and Tendon Sheaths of Hand
Atlas of Human Anatomy
and Arm 480
Cutaneous Nerves and Superficial Veins of Forearm
481
Cutaneous Innervation of Upper Limb
482
Dermatomes of Upper Limb
483
Lymph Vessels and Nodes of Upper Limb
Regional Scans Plate 484
484 CT Angiograms of Arteries of the Upper Limb
Anterior view
Trapezius muscle Clavicle Acromion Deltoid muscle Cephalic vein
Biceps brachii muscle Pectoralis major muscle Cubital fossa Posterior view Deltoid muscle
Cephalic vein Serratus anterior muscle
Median cubital vein
Triceps brachii muscle (long head)
Brachioradialis muscle Flexor carpi radialis tendon Thenar eminence
Basilic vein Intermediate (median) antebrachial vein Triceps Palmaris longus brachji m u $ d e tendon , , . Long head Flexor digitorum Lateral head superficialis tendons Tendon Flexor carpi ulnaris tendon Hypothenar eminence Proximal palmar crease Proximal digital crease
Brachioradialis and extensor carpi radialis longus muscles
Middle digital crease Radial ' longitudinal
Distal digital crease
crease
C o m m o n name of digits 1 2 3 4 5
Thumb Index Middle Ring Little
Extensor pollicis longus tendon Extensor indicis tendon
Extensor carpi radialis brevis muscle
Olecranon of ulna
Flexor carpi ulnaris muscle Extensor carpi ulnaris muscle Cephalic vein
Extensor digitorum tendons Site of proximal interphalangeal (PIP) joint Site of distal interphalangeal (DIP) joint
Topographic Anatomy
*.—//.p.
Plate 418
6
Clavicle and Sternoclavicular Joint
Right clavicle
Superior surface
Acromial end end
Shaft body
Impression for costoclavicular ligament
Acromial facet
Trapezoid line Conoid tubercle Trapezius muscle
Sternal facet Subclavian groove (for subclavius muscle)
Muscle origins Muscle insertions
Superior surface
Ligament attachments
Sternocleidomastoid muscle Deltoid muscle Deltoid muscle Inferior surface
Anterior
Coracoclavicular igament
Trapezoid ligament Conoid ligament
Pectoralis major muscle Pectoralis major muscle
„
Costoclavicular ligament
Posterior Subclavius muscle Sternohyoid muscle
Anterior sternoclavicular ligament Clavicle Subclavius muscle Costoclavicular ligament
Sternoclavicular joint Interclavicular ligament
Articular disc of sternoclavicular joint
" t ^ jv v T
Articular cavities of sternoclavicular joint -Costoclavicular ligament Synchondrosis of 1st rib
Costal cartilages 2nd rib Radiate sternocostal ligament
Plate 419
Manubrium -Sternocostal (synovial) joint Manubriosternal synchondrosis
Shoulder and Axilla
Humerus and Scapula: Anterior Views m
See also Plate 185
Acromial angle
Acromion
Coracoid process
Clavicle (cat) ^ / S u p e r i o r angle
Supraglenoid tubercle
Superior border
Anatomical neck
—Suprascapular notch
Greater tubercle
—Neck
Lesser tubercle
Medial border
Surgical neck
•Subscapular fossa
Intertubercular sulcus
Glenoid \ cavity of scapula
Crest of greater tubercle
nfraglenoid tubercle Lateral border
| Head of :! humerus
Crest of lesser tubercle
Inferior angle Trapezius muscle Pectoralis minor muscle
Humerus
O m o h y o i d muscle
Deltoid tuberosity Deltoid muscle
Medial supracondylar ridge
Biceps brachii muscle (long head)
Lateral supracondylar ridge
Supraspinatus muscle Subscapularis muscle
Medial Condyles j ^ ,
C o r a c o b r a c h i a l muscle and Biceps brachii muscle(short head)
Radial fossa-
Pectoralis major muscle
Lateral epicondyle
Latissimus dorsi muscle
Capitulum
Teres major muscle
Coronoid fossa
Deltoid muscle C o r a c o b r a c h i a l muscle
Trochlea Medial epicondyle
Brachialis muscle Brachioradialis muscle
Triceps brachii muscle (long head)
Serratus anterior muscle
Subscapularis muscle
Muscle attachments Origins Insertions
Extensor carpi radialis longus muscle Pronator teres muscle (humeral head)
C o m m o n extensor tendon (extensor carpi radialis brevis, extensor digitorum with extensor digiti minimi, and extensor carpi ulnaris muscles) Brachialis muscle Supinator muscle Biceps brachii muscle
Shoulder and Axilla
C o m m o n flexor tendon (flexor carpi radialis, palmaris longus, flexor carpi ulnaris and flexor digitorum superficialis [humeroulnar head] muscles) Flexor digitorum superficialis muscle (humeroulnar head) Pronator teres muscle (ulnar head) Flexor pollicis longus muscle (ulnar head)
Plate 420
6
Humerus and Scapula: Posterior Views See also Plate 185
Suprascapular notch
Clavicle [cut) Coracoid process
Superior border. Superior angleSupraspinous fossa
M
'
Acromion
-
Acromial angle Notch connecting supraspinous and infraspinous fossae
Spine Neck
Greater tubercle Head of humerus
Infraspinous fossa
Anatomical neck
Medial border
Surgical neck
Lateral border
Groove for circumflex scapular vessels
Inferior angle
Supraspinatus muscle
Trapezius muscle
levator scapulae muscle
Infraglenoid tubercle Deltoid tuberosity Radial groove
Humerus
Scapula
Medial supracondylar ridge
Deltoid muscle -Supraspinatus muscle
Rhomboid minor muscle
Lateral supracondylar ridge
-Infraspinatus muscle Teres minor muscle
Rhomboid major muscle
Triceps brachii muscle (Ions hi
Infraspinatus muscle
Teres minor muscle
Latissimus dorsi muscle (small slip of origin)
Teres major muscle
Olecranon fossa
Triceps brachii muscle (lateral head)
Lateral epicondyle
Groove for ulnar nerve
Deltoid muscle Brachialis muscle
Medial epicondyle
Triceps brachii muscle (medial head) Muscle attachments W m
Origins
w m m Insertions Triceps brachii muscle
C o m m o n flexor tendon
C o m m o n extensor tendon
Anconeus muscle
Plate 421
Shoulder and Axilla
Shoulder: Anteroposterior Radiograph See also Plate 420
Shoulder and Axilla
A AN C CP G GT H HH LT S SN
Acromion
ss
Spine of scapula
Anatomical neck of humerus Clavicle Coracoid process Glenoid cavity of scapula Greater tubercle Humerus Head of humerus Lesser tubercle Scapula (lateral border) Surgical neck of humerus
Plate 422
6
Shoulder (Glenohumeral Joint)
Anterior view Acromioclavicular j o i n t capsule (incorporating acromioclavicular l i g a m e n t ) - ^
Clavicle
Acromion Coracoacromial l i g a m e n t —
/
—Trapezoid ligament
^g^R^.
Conoid ligament
Supraspinatus t e n d o n ( c u t ) - ^ ^ ^ C o r a c o h u m e r a l ligament Greater tubercle a n d - ^ ^ / Lesser t u b e r c l e - — < " ' of humerus — L "' Transverse humeral ligament Intertubercular t e n d o n sheath—
J I / \ )
Coracoclavicular ligament
Superior transverse scapular ligament and suprascapular notch
^ -
^ C o r a c o i d process
i
- C o m m u n i c a t i o n of subtendinous bursa of subscapularis
"
(communicates w i t h synovial cavity)
Broken line indicates position of subtendinous bursa of subscapularis
Subscapularis tendon ( c u t ) ^ Biceps brachii t e n d o n (long head)
Capsular ligaments
Anterior view
sasfcs:
Supraspinatus muscle Subdeltoid bursa fused w i t h subacromial bursa
Deltoid muscle (.reflected)
Subscapularis muscle Subdeltoid bursa
Capsular ligament
Deltoid muscle
•
\ \ \
Capsular ligament \
Synovial m e m b r a n e
\
Acromion \ \
/ /
.Acromioclavicular /joint
C o r a c o i d process
— — B i c e p s brachii t e n d o n (long head) ]mk
f: Jmm G l e n o i d cavity ( c a r t i l a g e ) - ^ " - ^
:•:
^ s
edge)'
O p e n i n g of subtendinous bursa of subscapularis —
vP ||<> ^ilffflM W l f \
Superior glenohumeral ligament Subscapularis t e n d o n (fused to capsule)
J^BPv m™ \ A M i d d l e glenohumeral \ ligament Inferior glenohumeral ligament
Joint opened: lateral view
Plate 423
\
f m ^ ^ J ^ — " C o r a c o h u m e r a l ligament
Subdeltoid bursa
Synovial m e m b r a n e (cut
\
Coracoacromial ligament
Supraspinatus t e n d o n (fused to capsule)
Teres minor t e n d o n (fused t o capsule)
Supraspinatus t e n d o n \
Acromion
Infraspinatus tendon(fused t o capsule)
\
y.. • • .
I V }
Glenoid labrum'
I I
Glenoid cavity of scapula
Axillary recess
Coronal section through j o i n t
Shoulder and Axilla
See also Plates 27,174,188,189
Posterior view
Semispinalis capitis muscle
Not connected to upper limb
Splenius capitis muscle
Spinous process of C7 vertebra Levator scapulae muscle Trapezius muscle
Rhomboid minor muscle Rhomboid major muscle ion
Deltoid muscle
Supraspinatus muscle Spine of scapula
Infraspinatus fascia
Infraspinatus muscle Teres minor muscle Teres major muscle Latissimus dorsi muscle Long head Lateral head )
of triceps brachii muscle
Spinous process of T12 vertebra
Triangle of auscultation Trapezius muscle
Anterior view Acromion Deltopectoral triangle
O m o h y o i d muscle and investing layer of deep cervical fascia Sternocleidomastoid muscle Clavicle
Deltoid muscle Deltoid branch of thoracoacromial artery Cephalic vein Biceps ( L o n g h e a d brachii \ muscle ( Short head Triceps brachii muscle (lateral head) Latissimus dorsi muscle Serratus anterior muscle
Clavicular head Sternocostal head Abdominal part
Pectoralis major muscle
Sternum 6th costal cartilage Anterior layer of rectus sheath
External oblique muscle
SSioylcfer aoid ^aciOia
PQate 424
Superior view
^
^
^
|igament
j
Trape2oid
ligamen;
( C o n o i d ligament
Coracoacromial ligament
1ft Supraspinatus tendon Infraspinatus tendon Teres minor tendon Acromion
Clavicle Superior border of scapula Subscapularis muscle
Spine of scapula Supraspinatus muscle
^ ' r a c o a c r o m i a l ligament
Acromion Supraspinatus tendon
process
Supraspinatus muscle
Superior transverse scapular ligament and suprascapular notch
Spine of scapula Acromion Supraspinatus tendon
Biceps brachii tendon
Infraspinatus muscle Teres minor muscle
CA/cit/favL
Anterior view
Plate 425
Axillary nerve
Posterior view
Shoulder and Axilla
Scapulohumeral Dissection See also Plate 477 Lateral view
Levator scapulae muscle Accessory nerve (XI)
Phrenic nerve Scalene muscles
Anterior Middle Posterior
Brachial plexus Subclavian artery and vein Superior thoracic artery External intercostal membrane anterior to internal intercostal mu
Scapula (retracted)
Perforating branch of internal thoracic artery and anterior cutaneous branch of intercostal nerve
Subscapularis muscle major muscle
Intercostobrachial nerve
Long thoracic nerve
External intercostal Lateral thoracic artery Lateral cutaneous branches of intercostal nerves and posterior intercostal Serratus anterior muscl
t
Anterior view
Coracoacromial ligament
Acromion
Coracoid process Suprascapular artery and nerve
Supraspinatus tendon Greater tubercle of humerus Subscapularis tendon Intertubercular tendon sheath Anterior circumflex humeral artery Biceps brachii tendon (long head) (cut) Axillary nerve and posterior circumflex humeral artery Quadrangular space Radial nerve Biceps \ Long head brach,ii
j Short head muscle (
C o r a c o b r a c h i a l muscle Triangular space
•ov.yay*
^ ^ - - S u p c r i o r transverse scapular ligament and suprascapular notch — Pectoralis minor tendon (cut) Biceps brachii tendon (short head) (cut) and coracobrachialis tendon (cut) Subscapularis muscle Subscapular artery Lower subscapular nerve (to teres major muscle) Circumflex scapular artery Thoracodorsal artery and nerve (to latissimus dorsi muscle) Subscapularis muscle Teres major muscle
Latissimus dorsi muscle Suprascapular artery and nerve Acromion Posterior view Superior transverse scapular ligament and suprascapular notch Supraspinatus muscle (cut) Spine of scapula Infraspinatus muscle (cut) Triangular space with circumflex scapular artery deep to space Teres major muscle
ShouldlesT and ibdlia
Infraspinatus tendon (reflected) Joint capsule of shoulder Deltoid muscle (reflected) minor muscle Quadrangular space transmitting axillary nerve and posterior circumflex humeral artery Superior lateral brachial cutaneous nerve Profunda brachii (deep brachial) artery and Radial nerve shown between Lateral head and Long head of triceps brachii muscle
POafe 426
6
Axillary Artery and Anastomoses around Scapula See also Plates 33, 434 Ascending cervical artery Transverse cervical artery
Anterior view
Inferior t h y r o i d artery Thyrocervical trunk
Suprascapular
Subclavian artery
A c r o m i o n and acromial anastomosis
Anterior scalene muscle Clavicle {cut)
Dorsal scapular a
Superior thoracic artery
Coracoid process
oracoacromial artery
Anterior circumflex humeral artery
Clavicular branch
Posterior circumflex humeral artery
Acromial branch
Subscapular a
Pectoral branch
Deltoid branch
Circumflex scapular artery
1, 2, 3 indicate 1st, 2nd, and 3rd parts of axillary artery
Brachial artery Thoracodorsal artery Lateral thoracic arte, 7
O m o h y o i d muscle (inferior belly) Suprascapular artery
Levator scapulae muscl
. .. . Acromial branch ot thoracoacromial artery A c r o m i o n and acromial plexus
Dorsal scapular arte
Infraspinous branch of suprascapular artery
Supraspinatus muscle
Posterior circumflex humeral artery (in quadrangular space)and ascending and descending branches
Superior transverse scapular ligament and suprascapular notch
Spine of scapula
Infraspinatus muscle
Circumflex scapular artery
Teres minor muscle [cut)
Lateral head ) Triceps / of brachii Long head ) muscle
Teres major muscle
CAfctt/tfrk* /YT>—
Posterior view
Plate 427
Shoulder and Axilla
Pectoral, Clavipectoral, arid Axillary Fasciae See also Plate 188 Thoracoacromial arte
Trapezius muscle muscle invested by fascia of infrahyoid muscles
C o r a c o i d process
Clavicle Fascia investing subclavius muscle*
Cephalic vein
C o s t o c o r a c o i d ligament*
Deltoid muscle
Costoclavicular ligament Costocoracoid membrane*
Pectoralis major muscle (cut)
Fascia investing pectoralis minor muscle* Suspensory ligament of axilla* Pectoralis major muscle and pectoral fascia (superficial and deep layers)
Biceps brachii muscle Short head Long head
Latissimus dorsi fascia Serratus anterior fascia Axillary fascia (anterior part)
Brachial fascia (cut edge) over coracobrachial and biceps brachii muscles
Anterior view
O m o h y o i d muscle
O b l i q u e parasagittal section of axilla Trapezius muscle ( Brachial plexus < (
Lateral cord Posterior cord Medial c o r d
Supraspinatus muscle
Scapula
|
Body
Infraspinatus muscle Subscapularis muscle Teres minor muscle Teres major muscle Latissimus dorsi muscle ( dllary l y m p h nodes ) (
Central
avicle Subclavius muscle and fascia* C o s t o c o r a c o i d ligament* Thoracoacromial artery and cephalic vein Costocoracoid membrane* Lateral pectoral nerve Axillary artery and vein Pectoralis major muscle and fascia Pectoralis minor muscle and fascia* M e d i a l pectoral nerve Suspensory ligament of axilla Axillary fascia ( f e n e s t r a t e d )
pectQra[
(anterior) ^ C o m p o n e n t s of clavipectoral fascia
Shoulder and Axilla
Plate 428
Axilla (Dissection): Anterior View
Trapezius muscle
Thoracoacromial artery A c r o m i a l branch
Pectoralis m i n o r t e n d o n (cut)
Suprascapular artery and nerve Dorsal scapular artery and nerve
D e l t o i d branch
C o r a c o i d process
Transverse cervical artery
Clavicular branch
Acromion Cephalic vein
Pectoral branch
M u s c u l o c u t a n e o u s nerve
Axillary artery
Anterior circumflex humeral artery
A n t e r i o r scalene muscle
Clavicle and subclavius muscle (cut)
Axillary nerve and posterior circumflex humeral artey Pectoralis major muscle (cut)
Sternocleidomastoid muscle
C o r a c o b r a c h i a l muscle Phrenic Deltoid muscle
n e r v e
Biceps brachii muscle
m
M
M
M
Omohyoid muscle
f
' IWJi
Musculocutaneous nerve
Brachialisi muscle
Ulnar nerve
/
Medial brachial cutaneous nerve
Profunda brachii (deep brachial) artery
\A wm-L : IwM}.
Intercostobrachial nerve /m Circumflex / 1 scapular artery I
Radial nerve Triceps brachii muscle Brachial veins
\ \
Lower sub- / scapular nerve Teres major muscle
Subscapular artery
Ulnar nerve
Latissimus dorsi muscle
X
1
Thoracodorsal artery and nerve U p p e r subscapular nerve
Medial antebrachial i cutaneous nerve f Basilic vein
Subclavian artery and vein
T ^ ^ w^ 1
M e d i a n nerve Brachial artery
I * •^ s
1 I
Serratus anterior muscle
Lateral thoracic artery and long thoracic nerve t Ansa pectoralis
1st rib Brachial plexus Superior thoracic artery Lateral pectoral nerve Medial pectoral nerve
Pectoralis minor (cut)
Plate 429
Shoulder and Axilla
Brachial Plexus: Schema
Note: Usual composition shown. Prefixed plexus has large C4 contribution but lacks T1. Postfixed plexus lacks C5 but has T2 contribution.
Contribution from C4 Dorsal ramus
Musculocutaneous nerve (C5, 6, 7
To longus colli and scalene muscles (C5, 6, 7t 8)
Axillary nerve (C5, 6) Radial nerve (C5, 6, 7r 8, T1 Median nerve (C5, 6, 7, 8 , 1 1 ) Ulnar nerve (C7, 8, T1)
1 st intercostal nerve Long thoracic nerve (C5, 6, 7) Medial pectoral nerve (C8, T1) Medial brachial cutaneous nerve (T1) Medial antebrachial cutaneous nerve (C8, T1)
Inconstant contribution
Upper subscapular nerve (C5, 6) Thoracodorsal (middle subscapular) nerve (C6, 7f 8) Lower subscapular nerve (C5, 6)
Shoulder and Axilla
PQafa 43©
Muscles of Arm: Anterior Views See also Plate 474
Acromion
Coracoacromial ligament
CoracoicJ process
Subdeltoid bursa
Pectoralis minor t e n d o n {cut) Greater tubercle, Lesser tubercle of humerus
muscle M u s c u l o c u t a n e o u s nerve (cut)
Intertubercular t e n d o n sheath
C o r a c o b r a c h i a l muscle Circumflex scapular artery (cut)
D e l t o i d muscle (.reflected)
Teres major muscle Latissimus dorsi muscle
Pectoralis major muscle ( r e f l e c t e d ) Anterior circumflex humeral artery Biceps brachii
( \
Long head
muscle
(
Short head Biceps brachii tendons (cut) Short head Long head
Brachial artery (cut) M e d i a n nerve [cut) Brachialis muscle
Coracobrachialis muscle
Lateral antebrachial cutaneous nerve
Musculocutaneous Branch to biceps brachii (cut)
Bicipital aponeurosis
D e l t o i d muscle (cu Biceps brachii t e n d o n Brachioradialis muscle Pronator teres muscle Flexor carpi radialis muscle Brachialis muscle
Superficial layer
Lateral intermuscular septum
Medial intermuscular septum
Lateral e p i c o n d y l e of humerus Lateral antebrachial cutaneous nerve Head of radiu
Medial epicondyle of humerus
Biceps brachii t e n d o n Radial tuberosity
Tuberosity of ulna
Deep layer
Arm
Muscles of Arm: Posterior Views See also Plate 477
Superficial layer
Acromion
Supraspinatus muscle Greater tubercle of humerus Infraspinatus muscle Teres m i n o r muscle Axillary nerve and posterior circumflex humeral artery D e l t o i d muscle (cut and
reflected)
Superior lateral brachial cutaneous nerve Long head Lateral head Tendon
) > ofTriceps brachii muscle \
Brachioradialis muscle ^ psule of shoulder joint Supraspinatus t e n d o n Teres major
Infraspinatus and eres minor tendons (cut)
Posterior brachial cutaneous nerve (from radial nerve
Axillary nerve
Medial intermuscular septum
Posterior circumflex humeral artery
Teres major muscle
Ulnar nerve Medial epicondyle of humerus
Superior lateral brachial cutaneous nerve
O l e c r a n o n of ulna
Profunda brachii (deep brachial) artery
Flexor carpi ulnaris muscle
Radial nerve
A n c o n e u s muscle
M i d d l e collateral artery
Extensor carpi radialis longus muscle
Radial collateral arterv
Extensor carpi ulnaris muscle
Inferior lateral brachial cutaneous nerve
/
Posterior antebrachial cutaneous nerve (fro radial nerve)
Long head of triceps brachii muscle
Extensor d i g i t o r u m muscl
Lateral head ot triceps brachii muscle (cut)
Extensor carpi radialis brevis m
Medial head of triceps brachii muscle Medial e p i c o n d y l e of humerus
Lateral intermuscular septum N e r v e to anconeus and medial head of triceps brachii muscle Posterior antebrachial cutaneous nerve
Ulnar nerve O l e c r a n o n of ulna
Deep layer
Lateral epicondyle of humerus
A n c o n e u s muscle
PQate 432
Brachial Artery in Situ
Coracoid process
Axillary artery
Deltoid muscle
Pectoralis minor muscle (cut)
Anterior circumflex humeral artery
Lateral cord, Medial cord of brachial plexus
Humerus
Musculocutaneous nerve
Pectoralis major muscle and tendon (cut)
Subscapularis muscle Biceps brachii muscle
Long head
Anterior and posterior circumflex humeral arteries
Short head
Teres major muscle
C o r a c o b r a c h i a l muscle
Latissimus dorsi muscle Profunda brachii (deep brachial) artery
Muscular branch
Medial brachial cutaneous nerve
Median nerve
Ulnar nerve Medial antebrachial cutaneous nerve
Muscular branch
Long head Medial head
Biceps brachii muscle
ofTriceps brachii muscle
Superior ulnar collateral artery Brachialis muscle Medial intermuscular septum Inferior ulnar collateral artery Medial epicondyle of humerus
Biceps brachii tendon
Bicipital aponeurosis Radial artery
Pronator teres muscle .tfctf;:
Ulnar artery Flexor carpi radialis muscle Brachioradialis muscle
Plate 433
Arm
Brachial Artery and Anastomoses around Elbow See also Plate 427
Clavicular branch A
Pectoral branch
Acromial branch Deltoid branch Thoracoacromial artery
Superior thoracic artery
Axillary artery
Lateral thoracic artery
Anterior circumflex humeral artery Posterior circumflex humeral artery
Subscapular artery Circumflex scapular artery
Brachial artery
Thoracodorsal artery Profunda brachii (deep brachial) artery of lower margin of teres major muscle is landmark for name change from axillary to brachial arterv Radial collateral artery
Middle collateral artery Superior ulnar collateral artery
Inferior ulnar collateral artery Radial recurrent artery
Posterior interosseous artery
Anterior ulnar recurrent artery Posterior ulnar recurrent artery
Radial artery
C o m m o n interosseous artery Anterior interosseous artery Ulnar artery
Plate 434
6
Arm: Serial Cross Sections
Musculocutaneous nerve
Pectoralis major muscle and tendon
Median nerve
Cephalic vein
Medial antebrachial cutaneous nerve
Biceps brachii muscle
Brachial artery and veins Coracobrachialis muscle
Basilic vein
Humerus
Profunda brachii (deep brachial) artery
Deltoid muscle of Triceps brachii muscle
Ulnar nerve Radial nerve
Lateral head Long head
Medial brachial cutaneous nerve
Biceps brachii muscle
Latissimus dorsi tendon Musculocutaneous nerve
Teres major muscle
Brachialis muscle
Brachial fascia
Cephalic vein
Median nerve Brachial artery and veins
Radial nerve Posterior antebrachial cutaneous nerve (from radial nerve)
Medial antebrachial cutaneous nerve Basilic vein
Radial collateral artery
Medial brachial cutaneous nerve
Middle collateral artery
Neurovascular compartment
Lateral intermuscular septum of Triceps ( brachii < muscle
(
Ulnar nerve
Medial head Lateral head
*
Superior ulnar collateral artery Medial intermuscular septum
Long head
Brachial fascia
Biceps brachii muscle
Lateral antebrachial cutaneous nerve (from musculocutaneous nerve)
Cephalic vein
Medial antebrachial cutaneous nerve
Brachialis muscle
Basilic vein Brachioradialis muscle
Median nerve
Radial nerve
Ulnar nerve
Extensor carpi radialis Iongus muscle Posterior antebrachial cutaneous nerve (from radial nerve)
Plate 435
Brachial artery and veins Medial intermuscular septum
p
Humerus Triceps brachii muscle and tendon Lateral intermuscular septum
Arm
H e m e s ©f EDfe@w
Right elbow Medial
Condyle
Humerus
Humerus
Lateral
Medial supracondylar ridge
Lateral supracondylar ridge
Olecranon fossa^
Coronoid fossa
Radial fossa
Lateral epicondyle Lateral epicondyle
Medial epicondyle
Capitulum
Olecranon
Trochlea Groove for ulnar nerve
Coronoid process
Tuberosity
Radial notch of ulna Tuberosity
Tuberosity
Radius
Radius
In extension: anterior view
In extension: posterior view Sublime tubercle Humerus
Radius
Humerus
In extension: lateral view
!n extension: medial view Humerus Medial epicondyl Capitulum Trochlea Head Neck Tuberosity Radius
Ulna Coronoid process ( r , . . . > of ulna Trochlear notch Olecranon
In 90° flexion: lateral view
E!fe@w and Forearm
Coronoid process Trochlear notch Olecranon
In 90° flexion: medial view
Plate 436
Jwj Elbow: Radiographs See also
Plate 436
Lateral radiograph
Anteroposterior radiograph
Plate 437
C
Capitulum
CP
Coronoid process of ulna
H
Humerus
HR
Head of radius
L
Lateral epicondyle
M
Medial of epicondyle
NR
Neck of radius
O
Olecranon
OF
Olecranon fossa
R
Radius
T
Trochlea of humerus
RT
Radial tuberosity
U
Ulna
c
Capitulum
CP
Coronoid process of ulna
H
Humerus
HR
Head of radius
L
Lateral epicondyle
O
Olecranon
R
Radius
T
Trochlear notch
U
Ulna
•mSS^m^n H s a i wMtfi f»
W-1 i
H 81 i ill
lift:
i f s i y
Elbow and Forearm
Right elbow Anterior view
Humerus
Joint capsule Medial epicondyle
Lateral epicondyle Radial collateral ligament
Ulnar collateral ligament
Insertion of brachialis muscle Biceps brachii tendon Oblique cord Radius
Humerus
Joint capsule
Joint capsule
Ulnar collateral ligament
Radial collateral ligament
Annular ligament of radius
Annular ligament of radius
Triceps brachii tendon
Humerus
Biceps brachii tendon
Triceps brachii tendon
Biceps brachii tendon Oblique cord Radius
Subcutaneous olecranon bursa
In 90° flexion: medial view
In 90° flexion: lateral view
Humerus
Subcutaneous olecranon bursa
Joint capsule (cut edge)
Humerus
Fat pads
Opened j o i n t : anterior view
Synovial membrane
Opened j o i n t : posterior view
Articular cartilage
Radius
Elbow and Forearm
Radius
Plate 438
Bones of Forearm
— Olecranon
Right radius and ulna in supination: anterior view
Right radius and ulna in pronation: anterior view
Trochlear notch Coronoid process
Head
Radial notch of ulna Ulnar tuberosity
Neck
Oblique cord Ulnar tuberosity
Oblique cord
Radial tuberosity
Radius
Ulna
Radius
Ulna
Anterior surface
Anterior su
Lateral surface Posterior border
Anterior border Anterior border
Posterior surface Interosseous membrane
Interosseous border Interosseous border
Interosseous membrane
Dorsal tubercle Groove for extensor pollicis longus muscl
Groove for extensor carpi radialis longus and brevis muscles
Groove for extensor digitorum and extensor indicis muscles
Area for extensor pollicis brevis and abductor pollicis longus muscles
Styloid process of ulna Styloid process
Styloid process
Radius Ulnar notch of radius Styloid process
Styloid process ted)
Area for scaphoid bone
Area for lunate bone
Carpal articular suface
Plate 439
Coronal section of radius demonstrates how thickness of cortical bone of shaft diminishes to thin layer over cancellous bone at distal end
Eib@w and Forearm
Individual Muscles of Forearm: Rotators of Radius iff §
Right f o r e a r m : anterior view Supinated position
Pronated position
Medial epicondyle
Medial epicondyle
Lateral epicondyle
Supinator
Pronator teres
Radius Radius
Pronator quadratus
Elbow and Forearm
POat© 44®
Individual Muscles of Forearm: Extensors of Wrist and Digits
(Note: Anconeus muscle not shown because it is extensor of elbow
Medial epicondyle Olecranon Lateral epicondyle
Extensors of wrist Olecranon Lateral epicondyle
Extensor carpi radialis longus
mmon extensor tendon
Extensor carpi radialis brevisExtensor carpi ulnaris
Common extensor tendon
Extensors of digits (except t h u m b ) Extensor d i g i t o r u m
Extensor digitorum and extensor digiti minimi (cutaway)
Interosseous membrane Radius
Extensor digiti m i n i m i Extensor indicis
Extensors of t h u m b A b d u c t o r pollicis longus Extensor pollicis brevis Extensor pollicis longus
Extensor indicis tendon
Extensor digitorum and extensor digiti minimi tendons
Right forearm: posterior (dorsal) views
Plate 441
Elbow and Forearm
Individual Muscles of Forearm: Flexors of Wrist Wimivm
Note: Brachioradialis muscle not shown because it is flexor of elbow Medial epicondyle
Lateral epicondyle
C o m m o n flexor tendon
Flexor carpi radialis
Palmaris longus
Radius
Pisiform H o o k of hamate Palmar aponeurosis (cut)
Right forearm: anterior (palmar) view
Elbow and Forearm
Plate 442
Individual Muscles of Forearm: Flexors of Digits
Medial epicondyle
Medial epicondyle
Lateral epicondyle
Lateral epicondyle
Coronoid process Coronoid process Interosseous membrane Interosseous membrane Radius
Radius
Flexor d i g i t o r u m superficialis
Flexor d i g i t o r u m profundus
Flexor pollicis longus
Radius
. Ulna
Radius
Flexor digitorum superficialis tendons (cut a
Right forearm: anterior ( p a l m a r ) views
Plate 443
E!b@w and Forearm
Muscles of Forearm (Superficial Layer): Posterior View See also Plates 470, 478
Superior ulnar collateral artery (anastomoses distally with posterior ulnar recurrent artery)
Triceps brachii muscle
Brachioradialis muscle Ulnar nerve Extensor carpi radialis longus muscle Medial epicondyle of humerus C o m m o n extensor tendon Olecranon of ulna
Anconeus muscle
Extensor carpi radialis brevis muscle
Extensor digitorum muscle
Extensor digiti minimi muscle
Extensor pollicis brevis muscle
Extensor pollicis longus t e n d o n Extensor retinaculum (compartments numbered)
Dorsal branch of ulnar nerve
Extensor carpi radialis brevis tendon Extensor carpi radialis longus tendon
Superficial branch of radial nerve
A b d u c t o r pollicis longus tendon Extensor carpi ulnaris tendon
Extensor pollicis brevis tendon
Extensor digiti minimi tendon
Extensor pollicis longus tendon
Extensor digitorum tendons Extensor indicis tendon
5th metacarpal bone
EIb©w and F@rearnn
Plate 444
Muscles of Forearm (Deep Layer): Posterior View See also Plates 470, 479
, ( Superior ulnar collateral f branches oi ) inferior ulnar collateral brachial artery ) , . . . ( (posterior branch) P
Medial intermuscular septum
Ulnar nerve
Posterior ulnar recurrent artery
Medial epicondyle of humerus
Triceps brachii tendon [cut)
O l e c r a n o n of ulna
Anconeus muse
Flexor carpi ulnaris muscl
Recurrent interosseous artery
Posterior interosseous artery
M i d d l e collateral branch of deep brachial artery
Lateral intermuscular septum
Brachioradialis muscle
Extensor carpi radialis longus muscle
Lateral epicondyle of humerus
C o m m o n extensor t e n d o n ( p a r t i a l l y cut)
Extensor carpi radialis brevis muscle
Supinator muscle
Posterior interosseous nerve
Pronator teres muscle (slip of insertion)
Radius
-
interosseous nerve Extensor pollicis longus muscle
Extensor indicis muscle
Anterior interosseous artery (termination)
uctor pollicis longus muscle
Extensor pollicis brevis muscle
Extensor carpi radialis brevis t e n d o n Extensor carpi radialis longus t e n d o n
Extensor carpi ulnaris t e n d o n (cut) Extensor digiti minimi tendon (cut) Extensor d i g i t o r u m tendons (cut)
Extensor retinaculum (co m part m e n ts n u m bered)
oth metacarpal bone
Plate 445
Radial artery
1 st metacarpal b o n e 2nd metacarpal bone 1 st dorsal interosseous muscle
Elfoow and Forearm
Muscles of Forearm (Superficial Layer): Anterior View mmmmmmmmmmmmmmmmmsm
wmrnmrnm
See also Plates 475, 476
Medial antebrachial cutaneous nerve
Biceps brachii muscle
Ulnar nerve
Brachial artery and median nerve
Triceps brachii muscle Lateral antebrachial cutaneous nerve (terminal musculocutaneous nerve)
M e d i a l intermuscular septum
Brachialis muscle
Ulnar artery
Medial e p i c o n d y l e of humerus
Biceps brachii t e n d o n
C o m m o n flexor t e n d o n
Radial artery
Pronator teres muscle Bicipital aponeurosis Flexor carpi radialis muscle
Brachioradialis muscle
Palmaris longus muscle
Extensor carpi radialis longus m u
Superficial flexor muscles
Flexor carpi ulnaris muscle
Extensor carpi radialis brevis muscle
Flexor digitorum superficialis muscle Flexor pollicis longus muscle a n d t e n d o n Palmaris longus tendon
Dorsal branch of ulnar nerve
M e d i a n nerve
Palmar carpal ligament (continuous w i t h extensor retinaculum)
Thenar muscles
Palmar aponeurosis
EIb@w and Forearm
Ulnar artery and nerve
Pisiform
Palmar branch of median nerve
H y p o t h e n a r muscles
Plate 446
6
Muscles of Forearm (Intermediate Layer): Anterior View See also Plates 475, 476
Ulnar nerve
Biceps brachii muscle
M e d i a n nerve
Brachialis muscle
Brachial artery Lateral antebrachial cutaneous nerve (cut) (from musculocutaneous nerve)
Medial intermuscular septum Pronator teres muscle (humeral head) (cut and reflected)
Radial nerve Deep branch Superficial branch
Medial epicondyle Flexor carpi radialis and palmaris longus tendons (cut)
Biceps brachii t e n d o n
Anterior ulnar recurrent artery
Radial recurrent artery
Flexor d i g i t o r u m superficialis muscle (humeroulnar head)
Radial artery
Ulnar artery Supinator muscle
C o m m o n interosseous artery Pronator teres muscle (ulnar head) (cut)
Brachioradialis muscle
rior interosseous artery Pronator teres muscle (
Flexor carpi ulnaris muscle exor d i g i t o r u m superficialis muscle
Flexor d i g i t o r u m superficialis muscle (radial head)
Ulnar artery Flexor pollicis longus muscle
Palmar carpal ligament (continuous w i t h extensor retinaculum) w i t h palmaris longus t e n d o n (cut and reflected)
Flexor carpi radialis t e n d o n (cut)
Ulnar nerve and dorsal branch M e d i a n nerve Palmar branches of median and ulnar nerves (cut) Pisiform D e e p palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve
Superficial palmar branch of radial artery
Flexor retinaculum (transverse carpal ligament)
Elbow and Forearm
Muscles of Forearm (Deep Layer): Anterior View See also Plates 475, 476
Brachialis muscle
Ulnar nerve
M u s c u l o c u t a n e o u s nerve (becomes) Lateral antebrachial cutaneous nerve
M e d i a n nerve Brachial artery
Lateral intermuscular septum
Medial intermuscular septum
Radial nerve
Pronator teres muscle (humeral head cut and
Lateral e p i c o n d y l e
or ulnar recurrent artery
Biceps brachii t e n d o n (cut)
Medial epicondyle of humerus
Radial recurrent artery Radial artery
Flexor carpi radialis, palmaris longus, flexor d i g i t o r u m superficialis (humeroulnar head), and flexor carpi ulnaris muscles (cut)
Supinator muscle V
Posterior and anterior interosseous
Posterior ulnar recurrent artery
Flexor d i g i t o r u m superficialis muscle (radial head) {cut)
reflected)
—
Ulnar artery
0
Pronator teres muscle (cut and reflected)
n interosseous artery
Radial artery Flexor pollicis longus muscle and t e n d o n (cut) Radius Pronator quadratus muscle Brachioradialis t e n d o n (cut) Radial artery and superficial palmar branch
Pronator teres muscle (ulnar head) (cut) M e d i a n nerve (cut) Flexor d i g i t o r u m profundus muscle terior interosseous artery and nerve Ulnar nerve and dorsal branch Palmar carpal branches of radial and ulnar arteries Flexor carpi ulnaris tendon (cut)
Flexor pollicis longus t e n d o n Pisiform Flexor carpi radialis tendon (cut) A b d u c t o r pollicis longus t e n d o n
Deep palmar branch of ulnar artery and deep branch of ulnar nerve
Extensor pollicis brevis tendon
H o o k of hamate
1 st metacarpal b o n e
Elb@w and Forearm
*
5th metacarpal b o n e
Plate 448
Forearm: Serial Cross Sections
Median antebrachial vein
Flexor digitorum superficialis muscle (radial head)
Pronator teres muscle
Anterior branch of medial antebrachial cutaneous nerve
Radial artery and superficial branch of radial nerve
Flexor pollicis longus muscle
Radius
I nterosseous m em brane
Brachioradialis muscle
Flexor carpi radialis muscle
Cephalic vein and lateral antebrachial cutaneous nerve (from musculocutaneous nerve)
Ulnar artery and median nerve Palmaris longus muscle Flexor digitorum superficialis muscle (humeroulnar head)
Supinator muscle D e e p branch of radial nerve
C o m m o n interosseous artery
Extensor carpi radialis longus muscle
Ulnar nerve
Extensor carpi radialis brevis muscle
Flexor carpi ulnaris muscle Basilic vein
Extensor digitorum muscle
Flexor digitorum profundus muscle
Extensor digiti minimi muscle
Ulna and antebrachial fascia
Extensor carpi ulnaris muscle
Anconeus muscle
Flexor carpi radialis muscle
Posterior antebrachial cutaneous nerve (from radial nerve)
Brachioradialis muscle Radial artery and superficial branch of radial nerve
Palmaris longus muscle Flexor digitorum superficialis muscle
Flexor pollicis longus muscle
Median nerve
Extensor carpi radialis longus muscle and tendon
Ulnar artery and nerve Flexor carpi ulnaris muscle
Radius
Anterior interosseous artery and nerve (from median nerve)
Extensor carpi radialis brevis muscle and tendon
Flexor digitorum profundus muscle Ulna and antebrachial fascia
Abductor pollicis longus muscle
Interosseous membrane and extensor pollicis longus muscle
Extensor digitorum muscle Extensor digiti minimi muscle
Posterior interosseous artery and nerve (continuation of deep branch of radial nerve)
Extensor carpi ulnaris muscle
Palmaris longus tendon
Flexor carpi radialis tendon
Median nerve
Radial artery
Flexor digitorum superficialis muscle and tendons Flexor carpi ulnaris muscle and tendon
Brachioradialis tendon
Ulnar artery and nerve
A b d u c t o r pollicis longus tendon
Dorsal branch of ulnar nerve
Superficial branch of radial nerve
Flexor digitorum profundus muscle and tendons
Extensor pollicis brevis t e n d o n ^
Antebrachial fascia
Extensor carpi radialis longus tendon
Ulna Extensor carpi ulnaris t e n d o n
Extensor carpi radialis brevis tendon
Pronator quadratus muscle and interosseous membrane
Flexor pollicis longus muscle
Extensor indicis muscle and tendon
Extensor pollicis longus t e n d o n
Extensor digiti minimi tendon Radius
Plate 449
Extensor digitorum tendons ( c o m m o n tendon to digits 4 and 5 at this level)
Elbow and Forearm
Attachments of Muscles of Forearm: Anterior View mmmmamm* mss*
Brachioradialis muscle Extensor carpi radialis longus muscle
Brachialis muscle Pronator teres muscle (humeral head)
Supinator Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris muscles
Common extensor tendon
Brachialis muscle Biceps brachii muscle
Common flexor tendon
Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis (humeroulnar head) muscles
Flexor digitorum superficialis muscle (humeroulnar head) Pronator teres muscle (ulnar head)
Supinator muscle Flexor digitorum superficialis muscle (radial head)
Flexor digitorum profundus muscle
Pronator teres muscle Flexor pollicis longus muscle
Radius Pronator quadratus muscle Pronator quadratus muscle Brachioradialis muscle
Note: Attachments of intrinsic muscles of hand not shown
Abductor pollicis longus muscle — Flexor carpi ulnaris muscle Extensor carpi ulnaris muscle Flexor carpi radialis muscle
Flexor pollicis longus muscle
4
Flexor digitorum superficialis muscle
Flexor digitorum profundus muscle
Origins
Elbow and Forearm
Insertions
Plate 450
Attachments of Muscles of Forearm: Posterior View
Triceps brachii muscle (medial head)
Note: Attachments of intrinsic muscles of hand not shown
riceps brachii tendon Supinator
Flexor carpi ulnaris muscle (humeral origin via c o m m o n flexor tendon
Anconeus muscle
Biceps brachii muscle
Flexor carpi ulnaris muscle (ulnar origin)
Supinator muscle
Flexor digitorum profundus muscle
Abductor pollicis longus muscle Extensor carpi ulnaris muscle (ulnar origin) Pronator teres muscle Extensor pollicis longus Extensor pollicis brevis muscle Extensor indicis muscle-
Ulna
Radius
Extensor carpi radialis longus muscle
Brachioradialis muscle
Extensor carpi radialis brevis muscl Abductor pollicis longus muscle Extensor carpi ulnaris muscle
Extensor digitorum muscle (central bands)
Extensor cligiti minimi
Extensor pollicis brevis muscle
Extensor pollicis longus muscle
Extensor indicis muscle Extensor digitorum muscle (lateral bands) r
I
Plate 451
i Origins
j M i
Insertions
C a r p a i SS@mes
Anterior (palmar) view
Radius
Ulna
Radial styloid
Ulnar styloid process
Scaphoid
Lunate
Tubercle of scaphoid
Triquetrum
Trapezium
Pisiform
Tubercle of trapeziu
Hamate
Trapezoi
H o o k of hamate Capitate
Metacarpal bones
Posterior (dorsal) view Radius Dorsal tubercle of radius (Lister's)
Ulnar styloid process
Scaphoid Radial styloid process pezium Triquetrum
Trapezoid
Hamate Capitate
Metacarpal bones
Wrist and Hand
Plate 452
Movements of Wrist m
Ulna
Radius
Ulna
Radius
Lunate
Scaphoid
net rum
Capitate Trapezoid
Lunate
Tra
Pisiform Capitate Hamate Trapezoid
Sesamoid bo Pisiform
Trapezium
Hamate
Metacarpal bones
Metacarpal bones Sesamoid bones
Position of carpal bones w i t h hand in abduction: anterior (palmar) view
Position of carpal bones w i t h hand in adduction: anterior (palmar) view Wrist (radiocarpal) joint
Radius
Radius
Midcarpal joint Carpometacarpal joint
Wrist (radiocarpal) nt
. Palm
Articular disc of wrist joint Lunate Midcarpal oint
H a n d in flexion
Capitate Carpometacarpal joint
Wrist (radiocarpal) joint
3rd metacarpal bone
Midcarpal joint Carpometacarpal joint
Dorsum Hand in anatomical position
Sagittal sections through wrist and middle finger
Plate 453
Hand in extension
Carpal tunnel: palmar view
Ulna Interosseous m e m b r a n e
Palmaris longus t e n d o n Palmar carpal ligament (thickening of deep antebrachial fascia) [cut and reflected)
Ulnar artery and nerve Flexor carpi ulnaris t e n d o n
Radial artery and superficial palmar branch
Flexor digitorum profundus tendons
Flexor carpi radialis t e n d o n
Flexor d i g i t o r u m superficialis tendons
Flexor pollicis longus t e n d o n
Pisiform
M e d i a n nerve
Deep palmar branch of ulnar artery and deep branch of ulnar nerve
Palmar aponeurosis Tubercle of scaphoid
H o o k of hamate
Tubercle of trapezium Flexor retinaculum (transverse carpal ligament)
Metacarpal bones
Flexor retinaculum removed: palmar view
Short radiolunate ligamentPalmar radiolunate ligament
Long radiolunate ligament
Ulnolunate ligament
Radioscaphocapitate ligament
Ulnocapitate ligament Scaphotrapeziotrapezoid ligament
Ulnotriquetral ligament
Scaphocapitate ligment
Lunotriquetral ligament
Trapeziotrapezoid ligament
Triquetrohamate ligament Triquetrocapitate ligament
Capitohamate ligament Trapeziocapitate ligament
1
Metacarpal bones
Wrist asrad Hainsd
Plate 454
Ligaments of Wrist (continued)
Posterior (dorsal) view Dorsal radial metaphyseal arcuate ligament Dorsal radiocarpal ligament Dorsal radioulnar ligament Ulnotriquetral ligament (dorsal view)
Scapholunate ligament
Triquetrohamate ligament
Trapeziotrapezoid ligament
Dorsal intercarpal ligament Trapeziocapitate ligament
Capitohamate ligament
Metacarpal bones
Coronal section: dorsal view Ulna
Radius «
Distal radioulnar joint
Lunate
Articular disc of wrist joint
Wrist (radiocarpal) joint
Meniscus
Scaphoid Midcarpal joint
Interosseous intercarpal ligaments
Trapezoid
Triquetrum
Trapezium
Hamate
Carpometacarpal joint
Capitate
Intermetacarpal joints
Metacarpal bones
Plate 455
Wrist aind Hand
Bones of Wrist and Hand
Carpal bones
Scaphoid and Tubercle
Lunate Triquetrum Pisiform
Trapezium and Tubercle
L
itate
Carpal bones
7
Hamate and Hook
Trapezoid
Base Shafts Head
Sesamoid bones
Base Shafts Head Base | Shafts V Head J
Metacarpal bones y '
Right hand: anterior (palmar) view
Proximal phalanges
M i d d l e phalanges
Base Shafts Tuberosity Head
L [
Distal phalanges
Lunate
Carpal bones
Scaphoid Capitate Trapezoid Carpal bones
Metacarpal bones
Proximal phalanges Right hand: posterior (dorsal) view M i d d l e phalanges
Distal phalanges
WsrSsf audi Haoid]
<
Triquetrum jl Hamate |
Base < Shafts [ Head
Base Shafts Head Base Shafts Head
Base Shafts Tuberosity
Pfefe 456
mm
Plate 457
BM
Base of 5th metacarpal
P
Pisiform
BP
Base of 4th proximal phalanx
PP
Proximal phalanx of t h u m b
C
Capitate
PPI
Proximal phalanx of index finger
DP
Distal phalanx of t h u m b
R
Radius
DPR
Distal phalanx of ring finger
S
Scaphoid
H
Hamate
SH
Shaft of 5th metacarpal
HH
H o o k of hamate
SP
Styloid process of ulna
HM
Head of 5th metacarpal
SPR
Styloid process of radius
HP
Head of proximal phalanx
T
Triquetrum
L
Lunate
TP
Trapezoid
M
Metacarpal of index finger
TZ
Trapezium
MP
Middle phalanx of middle finger
U
Ulna
Wrist and Hand
Metacarpophalangeal and Interphalangeal Ligaments
Pisiform
Anterior (palmar) view
H o o k of hamate Palmar carpometacarpal ligaments Palmar metacarpal ligaments
Joint capsule
Deep transverse metacarpal ligaments
Collateral ligaments
Palmar ligaments (plates) Cut margins of digital fibrous sheaths
Flexor digitorum superficialis tendons (cut)
Flexor digitorum profundus tendons
Metacarpophalangeal (MP) joint \\gament V Metacarpal bone
In extension: medial view
Dorsal surface
Palmar surface
C°"ateral
/ Proximal interphalangeal (PIP) joint
T r u e collateral / ligament /
Proximal
Middle
Distal interphalangeal / ( D I P ) joint
Distal
Palmar ligament (volar plate) Accessory collateral ligament
In flexion: medial view
Phalanges
True collateral ligament Palmar ligament (volar plate)
Note: Ligaments of metacarpophalangeal and interphalangeal joints are similar
Wrist and Hand
Plate 458
6
Wrist and Hand: Superficial Palmar Dissections
Palmaris longus t e n d o n
Palmar branch of ulnar nerve
Branch of superficial radial nerve to skin of lateral thenar area
Pisiform Deep palmar branch of ulnar artery and deep branch of ulnar nerve
Palmar carpal ligament (thickening of deep antebrachial fascia continuous w i t h extensor retinaculum)
Superficial branch of ulnar nerve Ulnar artery Palmaris brevis muscle
Palmar branch of median nerve
H y p o t h e n a r muscles
Thenar muscles
Palmar aponeurosis
Recurrent (motor) branch of median nerve t o thenar muscles
Palmaris brevis muscle ( r e f l e c t e d )
M i n u t e fasciculi attach palmar aponeurosis to dermis
Anterior (palmar) views
Palmar digital nerves f r o m superficial branch of ulnar nerve to 5th and medial half of 4th fingers
Palmar aponeurosis
Transverse fasciculi
Palmar digital arteries and nerves
Plate 459
Wrist and Hand
Wrist and Hand: Deeper Palmar Dissections
Radial artery and venae comitantes
Ulnar artery w i t h venae comitantes and ulnar nerve
Flexor carpi radialis t e n d o n
Flexor carpi ulnaris t e n d o n
Tendinous sheath of flexor pollicis longus (radial bursa)
C o m m o n flexor sheath (ulnar bursa) containing superficialis and profundus flexor tendons Pisiform
M e d i a n nerve Palmaris longus t e n d o n and palmar carpal ligament Transverse carpal ligament (flexor retinaculum)
Deep palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve Palmar digital nerves to 5th finger and medial half of 4th finger
Thenar muscles
M e d i a n nerve
Proper palmar digital nerves of t h u m b
C o m m o n flexor sheath (ulnar bursa) Superficial palmar arterial and venous arches
(Synovial) tendinous sheath of flexor pollicis longus i. (radial bursa)
—2nd, 3rd, and 4th lumbrical muscles (in fascial sheaths) (Synovial) flexor t e n d o n sheaths of fingers
Probe in I st lumbrical fascial sheath C o m m o n palmar digital artery Proper palmar digital arteries Septa f r o m palmar aponeurosis f o r m i n g canals Palmar aponeurosis (.reflected)
Anterior (palmar) views
Superficial palmar branch of radial artery and recurrent branch of median nerve to thenar muscles Ulnar artery and nerve C o m m o n palmar digital branches of median nerve (cut) Hypothenar muscles
Proper palmar digital nerves of t h u m b Fascia over adductor pollicis muscle
C o m m o n flexor sheath (ulnar bursa) 5th finger (synovial) tendinous sheath
Probe in dorsal extension of thenar space deep to a d d u c t o r pollicis muscle Thenar space (deep to flexor tendons and 1st lumbrical muscle) Septum separating thenar f r o m midpalmar space C o m m o n palmar digital artery Proper palmar digital arteries and nerves Annular and c r u c i f o r m parts of fibrous sheath over (synovial) flexor t e n d o n sheaths
Wrist and Hand
Probe in midpalmar space M i d p a l m a r space (deep to flexor tendons and lumbrical muscles) Insertion of flexor digitorum superficialis t e n d o n Insertion of flexor digitorum profundus t e n d o n
Plate 460
Mi
1mm
6
Flexor Tendons, Arteries, and Nerves at Wrist Palmar view
M e d i a n nerve
Flexor d i g i t o r u m superficialis tendons and flexor d i g i t o r u m profundus tendons
Radial artery
C o m m o n flexor sheath (ulnar bursa)
Palmaris longus t e n d o n
Flexor carpi radialis tendon Flexor pollicis longus t e n d o n in t e n d o n sheath (radial bursa) Palmar carpal ligament
Ulnar artery Ulnar nerve Flexor carpi ulnaris tendon
(reflected)
(Synovial) t e n d o n sheath Pisiform
Flexor retinaculum (transverse carpal ligament)
A b d u c t o r digiti minimi muscle
Trapezium 1st metacarpal bone
Flexor digiti m i n i m i brevis muscle
O p p o n e n s pollicis muscle A b d u c t o r pollicis brevis muscle (reflected)
O p p o n e n s digiti m i n i m i muscle
Superficial palmar (arterial) arch
Lumbrical muscles
Flexor pollicis brevis muscle (reflected)
A d d u c t o r pollicis muscle
Transverse cross section of wrist demonstrating carpal tunnel Palmaris longus tendon
Flexor retinaculum (transverse carpal ligament)
M e d i a n nerve'"
Ulnar artery and nerve Flexor carpi ulnaris tendo Flexor digitorum superficialis tendons*
Flexor carpi radialis t e n d o n
Flexor digitorum profundus tendons*
Flexor pollicis longus t e n d o n in tendon sheath* Radial artery
Simple m e t h o d of d e m o n s t r a t i n g arrangement of flexor digitorum superficialis tendons within carpal tunnel
Capitate
Trapezoid ^Contents of carpal tunnel
Wrist and Hand
Bursae, Spaces, and Tendon Sheaths of Hand m&m
Pronator quadratus muscle Flexor carpi radialis t e n d o n Common flexor sheath (ulnar bursa)
Tendinous sheath of flexor pollicis longus (radial bursa Flexor retinaculum (transverse carpal ligament)
(reflected)
Flexor d i g i t o r u m profundus t e n d o Tendinous sheath of flexor pollicis longus (radial bursa) Fascia of a d d u c t o r pollicis muscle
Flexor d i g i t o r u m superficialis tendons
Thenar space
C o m m o n flexor sheath (ulnar bursa) (opened)
(deep to flexor t e n d o n and 1st lumbrical muscle) (Synovial) t e n d o n sheath of finger
Lumbrical muscles in fascial sheaths
.
M i d p a l m a r space
(deep to flexor tendons and lumbrical muscles)
Lumbrical muscles in fascial sheaths (cut and reflected)
Fibrous and synovial (tendon) sheaths of finger (opened)
Annular and cruciform parts (pulleys) of fibrous sheath over synovial sheath) of finger
Flexor d i g i t o r u m superficialis tendon
if
Flexor d i g i t o r u m profundus tendon
/—Af.7>.
Midpalmar space Palmar aponeurosis
forming canals Profundus and superficialis flexor tendons to 3rd digit Septum b e t w e e n midpalmar and thenar spaces
Thenar space
C o m m o n palmar digita. artery and nerve
Flexor pollicis longus t e n d o n in t e n d o n sheath (radial bursa)
Lumbrical muscle in its fascial sheath
Extensor pollicis longus tendon
Flexor tendons to 5th digit in c o m m o n flexoi sheath (ulnar bursa H y p o t h e n a r muscles Dorsal interosseous fascia Dorsal subaponeurotic space Dorsal fascia of hand Dorsal subcutaneous space
Wrist and Hand
A d d u c t o r pollicis muscle Palmar interosseous fascia Palmar interosseous muscles Dorsal interosseous muscles Extensor tendons
Plate 462
Lumbrical Muscles and Bursae, Spaces, and Sheaths: Schema Usual arrangement
C o m m o n variation
Tendinous sheath of flexor pollicis longus (radial bursa) Intermediate bursa (communication between c o m m o n flexor sheath [ulnar bursa] and tendinous sheath of flexor pollicis longus [radial bursa])
C o m m o n flexor sheath (ulnar bursa) Thenar space Midpalmar space
Lumbrical muscles (in fascial sheaths) (Synovial) tendon sheaths of fingers
Lumbrical muscles: schema
Flexor digitorum profundus tendons
1st and 2nd lumbrical muscles (unipennate)
Camper chiasm
3rd and 4th lumbrical muscles (bipennate)
Flexor digitorum superficialis tendons (cut)
Note: Flexor digitorum superficialis and profundus tendons encased in synovial sheaths are b o u n d to phalanges by fibrous digital sheaths made up of alternating strong annular (A) and weaker cruciform (C) parts (pulleys). Tendons of flexor digitorum superficialis and profu muscles
(Synovial) tendon sheath
Plate 463
Wrist and Hand
Flexor and Extensor Tendons in Fingers
Insertion of central band of extensor t e n d o n t o base of middle phalanx Slips of long extensor t e n d o n t o lateral bands
Triangular aponeurosis
Posterior (dorsal) view
Extensor expansion (hood)
Interosseous muscles
Long extensor tendon
Metacarpal b o n e
BBS!
Insertion on extensor tendon to base of distal phalanx Lateral bands
Interosseous t e n d o n slip to lateral band Lumbrical muscle
Extensor expansion (hood)
Lateral band
Insertion of extensor t e n d o n to base of middle phalanx
Part of interosseous t e n d o n passes to base of proximal phalanx and joint capsule
Long extensor t e n d o n
Central band
Insertion of extensor t e n d o n to base of distal phalanx
Metacarpal b o n e
Finger in extension: lateral view Collateral ligaments'
Vinculum breve
Vincula longa
Flexor d i g i t o r u m profundus t e n d o n Flexor digitorum superficialis t e n d o n
Interosseous muscles Lumbrical muscle
Collateral ligament Insertion of small deep slip of extensor tendon to proximal phalanx and j o i n t capsule
Extensor t e n d o n
A t t a c h m e n t of interosseous muscle to base of proximal phalanx and j o i n t capsule
Interosseous muscles Insertion of lumbrical muscle to extensor t e n d o n
m superficialis t e n d o n (cut)
Lumbrical muscle
Collateral ligaments
Finger in flexion: lateral view
Flexor d i g i t o r u m profundus t e n d o n (cut) Palmar ligament (plate)
C/feit/tadL / Af.p.
Wrist and Hand
Note: Black arrows indicate pull of long extensor tendon; red arrows indicate pull of interosseous and lumbrical muscles; dots indicate axis of rotation of joints
Plate 464
Radial artery and palmar carpal branch
Pronator quadratus muscle
Radius
Ulnar nerve Ulnar artery and palmar carpal branch
Superficial palmar branch of radial
Flexor carpi ulnaris t e n d o n
Flexor retinaculum (transverse carpal ligament) ( r e f l e c t e d )
Palmar carpal arterial arch Pisiform
O p p o n e n s pollicis muscle
M e d i a n nerve
Branches of median nerve to thenar muscles and to 1st and 2 n d lumbrical muscles
A b d u c t o r digiti minimi muscle (cut) Deep palmar branch of ulnar artery and deep branch of ulnar nerve
A b d u c t o r pollicis brevis muscle {cut)
Flexor digiti m i n i m i brevis muscle (cut)
Flexor pollicis brevis muscle
O p p o n e n s digiti m i n i m i muscle D e e p palmar (arterial) arch
A d d u c t o r pollicis muscle
Palmar metacarpal arteries C o m m o n palmar digital arteries
1 st dorsal interosseous muscle
D e e p transverse metacarpal ligaments
Branches from deep branch of ulnar nerve lo 3rd and 4th lumbrical muscles and to all interosseous muscles Lumbrical muscles
(reflected)
Anterior (palmar) view
Radius
Palmar interosseous muscles (unipennate)
Radius
Deep transverse metacarpal ligaments
Radial artery
A b d u c t o r digiti minimi muscle
A b d u c t o r pollicis brevis muscle
Dorsal interosseous muscles (bipennate)
Posterior (dorsal) view
Anterior (palmar) view
Tendinous slips to extensor expansions (hoods)
*.—w.
Note: A r r o w s indicate action of muscles.
Plate 465
Arteries and Nerves of Hand: Palmar Views mm
Radial artery
Ulnar artery and nerve
Median nerve and palmar branch Superficial palmar branch of radial artery
Palmar carpal ligament (continuous with extensor retinaculum) Flexor retinaculum (transverse carpal ligament)
A b d u c t o r pollicis brevis muscle (cut)
Deep palmar branch of ulnar artery and deep branch of ulnar nerve
O p p o n e n s pollicis muscle
Superficial branch of ulnar nerve
Flexor pollicis brevis muscle
C o m m o n flexor sheath (ulnar bursa)
Recurrent (motor) branch of median nerve to thenar muscles-"""
Superficial palmar (arterial) arch
Proper digital nerves and arteries to t h u m b
C o m m o n palmar digital nerves and arteries C o m m u n i c a t i n g branch of median nerve with ulnar nerve
A d d u c t o r pollicis muscle
Proper palmar digital nerves and arteries
Branches of median nerve to 1st and 2nd lumbrical muscles Flexor tendons, synovial and fibrous sheaths
Branches of proper palmar digital nerves and arteries to dorsum of middle and distal phalanges
Ulnar artery and nerve Radial artery
Palmar carpal branches of radial and ulnar arteries
Median nerve
Pisiform
Superficial palmar branch of radial Deep palmar (arterial) arch and deep branch of ulnar nerve Princeps pollicis artery
Deep palmar branch of ulnar artery and deep branch of ulnar nerve Branches to hypothenar muscles Superficial branch of ulnar nerve
Proper digital arteries and nerves of thumb
H o o k of hamate Distal limit of superficial palmar arch Radialis indicis a Palmar metacarpal arteries C o m m o n palmar digital arteri Proper palmar digital arteri Proper palmar digital nerves f r o m median nerve-
Wrist arad HawcO
Deep palmar branch of ulnar nerve to 3rd and 4lh lumbrical, all interosseous, adductor pollicis, and deep head of flexor pollicis brevis muscles mmunicating branch of median nerve with ulnar nerve Proper palmar digital nerves from ulnar nerve
Wrist and Hand: Superficial Radial Dissection
Lateral (radial) view Superficial branch of radial nerve Medial branch
Extensor retinaculum
Lateral branch Dorsal digital branches of radial nerve
Dorsal carpal branch of radial artery
Scaphoid Radial artery in anatomical snuffbox
Extensor carpi radialis brevis tendon
ium
Extensor carpi radialis longus tendon
Insertion of abductor pollicis longus t e n d o n
1 st metacarpal bone Radial artery 1st dorsal interosseous muscle
Insertion of extensor pollicis brevis tendon
Insertion of extensor pollicis longus tendon Deep fascia (cut)
Fracture of middle third (waist) of scaphoid (most common)
Plate 467
Wrist and Hand
Wrist and Hand: Superficial Dorsal Dissection
Posterior (dorsal) view Posterior antebrachial cutaneous nerve (from radial nerve) Cephalic vein Superficial branch of radial nerve Extensor retinaculum (thickening of posterior antebrachial fascia) C o m m u n i c a t i n g branches of radial and ulnar nerves Basilic vein Dorsal branch of ulnar nerve Dorsal venous network of hand Dorsal metacarpal veins
Probe in dorsal subaponeurotic space (between opened dorsal fascia of hand and dorsal interosseous fascia) Intercapitular veins
Dorsal digital nerves and veins
Dorsal branches of proper palmar digital nerves
Note: Lymphatic pathways shown in black; arrows indicate direction of drainage
Wrist amdl Hand
6
Wrist and Hand: Deep Dorsal Dissection MMMM
m
Medial antebrachial cutaneous nerve
Lateral antebrachial cutaneous nerve (terminal part of musculocutaneous nerve)
Posterior antebrachial cutaneous nerve (branch of radial nerve)
Superficial branch of radial nerve Extensor digitorum, extensor digiti minimi, and extensor indicis tendons (cut)
Extensor retinaculum Radial artery in anatomical snuffbox Dorsal branch of ulnar nerve A b d u c t o r pollicis longus tendon Dorsal carpal branch of ulnar artery Extensor carpi ulnaris tendon
Extensor pollicis brevis tendon Extensor pollicis longus tendon Extensor carpi radialis longus tendon Extensor carpi radialis brevis tendon
Dorsal carpal (arterial) arch Dorsal metacarpal arteries
Dorsal digital arteries
Dorsal digital branches of dorsal branch of ulnar nerve
Dorsal digital branches of superficial branch of radial nerve to 1st, 2nd, 3rd, and radial half of 4lh fingers Dorsal branches of proper palmar digital branches of ulnar nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 5th and ulnar half of 4th fingers
Dorsal branches of proper palmar digital branches of median nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 2nd, 3rd, and radial half of 5th fingers
Wrist and Hand
Posterior (dorsal) view Extensor carpi ulnaris - C o m p a r t m e n t 6
Extensor digitorum Extensor indicis
I ) \
^ Compartment 4
Extensor pollicis longus - C o m p a r t m e n t 3 Extensor carpi radialis brevis ) . . . . . . ( Compartment 2 Extensor carpi radialis longus ) Abductor pollicis longus )
Plane of cross section shown below
Extensor pollicis brevis
)
^ Compartment 1
Extensor retinaculum
Radial artery in anatomical snuffbox
Abductor digiti minimi muscle
Dorsal interosseous muscles
I n terte n d i n o us co n necti o n s
Transverse fibers of extensor expansions (hoods)
Cross section of most distal portion of forearm Extensor retinaculum Extensor pollicis longus - C o m p a r t m e n t 3 C o m p a r t m e n t 4 \ Extensor digitorum and 1 / extensor mdici
Extensor carpi radialis brevis
\ Extensor Compartment 5 ^ digiti minimi
Extensor carpi radialis longus
Compartment 2
Extensor pollicis brevis
Extensor C o m p a r t m e n t 6 ^ carpi ulnaris
Abductor pollicis longus
Compartment 1
Radius
Wrist and Hand
Plate 47©
Epiphysis Nail matrix
Synovial membrane Articular cartilage
Lateral band / Extensor Central tendon \ mechanism
Middle phalanx
Nail root Eponychium (c uti cle)
Sagittal section
un ule Na
bed
Flexor digitorum superficialis tendon
Bodv of nail
Distal phalanx Fibrous tendon sheath of finger Synovial (flexor tendon) sheath of finger Nerves
Flexor digitorum profundus tendon
Arteries
Palmar ligament (plate) Distal anterior closed space (pulp)
Articular cavitv Body of nail
Cross section through distal phalanx
Subungual space
Nail bed
M i n u t e arteries -
Distal phalanx
Fine nerves
Fibrous septa and areolar tissue in anterior closed space (pulp)
Dorsal digital artery and nerve
Dorsal branches of proper palmar digital arteries and nerves to dorsum of middle and terminal phala
Arteries and nerves
Nutrient branches to metaphysis
Plate 471
Proper palmar digital artery to neighboring digit Proper palmar digital artery and nerve
Cutaneous Innervation of Wrist and Hand
Anterior (palmar) view Lateral antebrachial cutaneous nerve
Musculocutaneous nerve
Radial nerve
J |
M e d i a l antebrachial cutaneous nerve
Superficial branch
Palmar branch
Ulnar nerve
Palmar digital branches
Median nerve
/
Palmar branch
Posterior (dorsal) view
Palmar digital branches
V I '
M e d i a l antebrachia cutaneous nerve ^ Division between ulnar and radial nerve innervation on dorsum of hand is variable.
Lateral antebrachial cutaneous nerve
i
f
v.
>
Musculocutaneous nerve
Posterior antebrachial cutaneous nerve
aiiiliiii:! Radial nerve
Slllsli Dorsal branch and dorsal digital branches Ulnar nerve
Superficial branch and dorsal digital branches
<
Proper palmar digital branches
Proper palmar digital branches
Median nerve
Plate 472
6
Arteries and Nerves of Upper Limb
Anterior view D e l t o i d muscle Cor a c o b r a c hialismuscle \ Biceps brachii muscle \
Short head (cut)
(
Long head (cut)
ntercostobrachial nerve Medial brachial cutaneous nerve
M u s c u l o c u t a n e o u s nerve
Radial nerve
Brachialis muscle
Ulnar nerve
Biceps brachii muscle (cut) and t e n d o n Lateral antebrachial cutaneous nerve (from musculocutaneous ner Radial nerve
( \
D e e p branch
I
Superficial branch
Medial antebrachial cutaneous nerve M e d i a n nerve Brachial artery
Supinator muscle Brachioradialis muscle Radial artery Pronator teres muscle (partially
cut)
M e d i a n nerve Flexor pollicis longus muscle Flexor carpi radialis t e n d o n (cut) Flexor retinaculum (transverse carpal ligament) Superficial branch of radial nerve Recurrent (motor) branch of median nerve t o thenar muscles
Bicipital aponeurosis Humeral head (cut) Ulnar head
Pronator teres muscle
Flexor carpi radialis muscle (cut) H u m e r o u l n a r head
)
Flexor digitorum
Radial head
)
superficialis muscle (cut)
Flexor d i g i t o r u m profundus muscleFlexor carpi ulnaris muscle Ulnar artery and nerve Dorsal branch of ulnar nerve Flexor d i g i t o r u m superficialis tendons (cut) Deep palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve Superficial palmar arch (cut)
C o m m o n palmar digital branches of median nerve
Proper palmar digitial branches of median nerve
C o m m o n palmar digital branch of ulnar nerve C o m m u n i c a t i n g branch of median nerve with ulnar nerve Proper palmar digital branches of ulnar nerve
Neurovasculature
Musculocutaneous Nerve
Anterior view Note: Only muscles innervated by musculocutaneous nerve shown
Musculocutaneous nerve (C5, 6, 7) Medial Posterior Lateral
Cords of brachial plexus
C o r a c o b r a c h i a l muscle Medial brachial cutaneous nerve Biceps brachii muscle [retracted)
Medial antebrachial cutaneous nerve Ulnar nerve Median nerve Radial nerve
Brachialis muscle
Axillary nerve
Articular branch
Lateral antebrachial cutaneous nerve
Anterior branch
Posterior
Cutaneous innervation (via lateral antebrachial cutaneous nerve)
A n t e r i o r (palmar) view
Heyrowascylafyre
Posterior (dorsal) view
Plate 474
Anterior view
Note: Only muscles innervated by median nerve shown
M U S C ulocutaneousnerve
M e d i a n nerve (C5, 6, 7, 8 , 1 1 ) Medial Posterior Lateral
Inconstant c o n t r i b u t i o n
Pronator teres muscle (humeral head
Cords of brachial plexus
Medial brachial cutaneous nerve
Articular branch
Medial antebrachial cutaneous nerve
Flexor carpi radialis muscle
Axillary nerve Palmaris longus muscle
Radial nerve
Pronator teres muscle (ulnar head)
Ulnar nerve
Flexor digitorum superficialis muscle {turned up) Flexor digitorum profundus muscle (lateral part supplied by median [anterior interosseous] nerve; medial part supplied by ulnar nerve) Anterior interosseous nerve Flexor pollicis longus muscle Pronator quadratus muscle
Cutaneous innervation
Palmar branch of median nerve
/
Abductor pollicis brevis
\
Opponens pollicis
Thenar J muscles \
Superficial head of flexor pollicis brevis ) (deep head / supplied by I ulnar nerve)
1st and 2nd lumbrical muscles
Communicating branch of median nerve with ulnar nerve
Palmar view
C o m m o n palmar digital nerves
Dorsal branches to dorsum of middle and distal phalanges
Proper palmar digital nerves
Posterior (dorsal) view
Plate 475
Neurovasculature
r
'
'
Anterior view
Note: Only muscles innervated by ulnar nerve shown Ulnar nerve (C7, 8, T1) (no branches above elbow) Inconstant c o n t r i b u t i o n
Medial epicondyle
ular branch (behind condyle)
Cutaneous innervation
Flexor digitorum profundus muscle (medial part only; lateral part supplied by anterior interosseous branch of median nerve)
Palmar view
Flexor carpi ulnaris muscle (drawn aside)
Dorsal branch of ulnar nerve
Posterior (dorsal) view
Flexor pollicis brevis muscle (deep head only; superficial head and other thenar muscles supplied by median nerve)
Adductor pollicis muscle
Palmar branch
Superficial branch Deep branch Palmaris brevis Abductor digiti minimi Flexor digiti minimi brevis f
Hypothenar muscles
Opponens digiti minimi C o m m o n palmar digital nerve Communicating branch of median nerve with ulnar nerve
3rd and 4th lumbrical muscles {turned
down)
Proper palmar digital nerves (dorsal digital nerves are from dorsal branch)
Neurovaseulatyre
Plate 476
R a d i a l N e r v e in A r m a n d N e r v e s of P o s t e r i o r S h o u l d e r
Dorsal scapular nerve (C5)
Posterior view
Supraspinatus muscle Suprascapular nerve (C5, 6) Levator scapulae muscle (supplied also by branches from C3 and C4)
Deltoid muscle "•'^V-'iT ' ^riBsTT*r
Teres minor muscle Axillary nerve (C5, 6) Superior lateral brachial cutaneous nerve
Rhomboid minor muscle
Radial nerve (C5, 6, 7, 8, T1) Inconstant c o n t r i b u t i o n
Rhomboid major muscle
Inferior lateral brachial cutaneous nerve
Posterior antebrachial cutaneous nerve
Infraspinatus muscle Teres major muscle Lower subscapular nerve (C5, 6) Posterior brachial cutaneous nerve (branch of radial nerve in axilla) Long head Triceps brachii muscle <
Lateral intermuscular septum
Brachialis muscle (lateral part; remainder of muscle supplied by musculocutaneous nerve)
Lateral head /Medial head Brachioradialis muscle
Triceps brachii tendon Medial epicondyle
Extensor carpi radialis longus muscle
Olecranon Anconeus muscle
Extensor carpi radialis brevis muscle
Extensor digitorum muscle / A/.7>.
Extensor carpi ulnaris muscle
N eu ro vase u I a t u re
See also Plate 467
Inconstant c o n t r i b u t i o n
Radial nerve (C5, 6, 7,8, T1) Superficial (terminal) branch Deep (terminal) branch
Posterior view
Lateral epicondyle Anconeus muscle Brachioradialis muscle Extensor carpi radialis longus muscle Supinator muscle Extensor carpi radialis brevis muscle Extensor carpi ulnaris muscle Extensor digitorum muscle and extensor digiti minimi muscle
Extensor-supinator group of muscles
Extensor indicis muscle Extensor pollicis longus muscle bductor pollicis longus muscle Extensor pollicis brevis muscle Posterior interosseous nerve (continuation of deep branch of radial nerve distal to supinator muscle) Superficial branch of radial nerve
Superior lateral brachial cutaneous nerve
brachial cutaneous nerve Posterior brachial cutaneous From radial nerve Posterior antebrachial cutaneous nerve Superficial branch of radial nerve and dorsal digital branches
Dorsal digital nerves Cutaneous innervation f r o m radial and axillary nerves
Neurovasculature
Plate 478
6
Cutaneous Nerves and Superficial Veins of Shoulder and Arm
Anterior view
Supraclavicular nerves (from cervical plexus)
Posterior view Medial Intermediate Lateral
Acromial branch of thoracoacromial vein
Acromial branches of thoracoacromial vein
Superficial branches of posterior circumflex humeral vein
Medial brachial cutaneous nerve
Intercostobrachial nerve
Intercostobrachial nerve
Medial brachial cutaneous nerve
Superior lateral brachial cutaneous nerve (from axillary nerve)
Superior lateral brachial cutaneous nerve (from axillary nerve)
Cephalic vein
Posterior brachial cutaneous nerve (from radial nerve)
Inferior lateral brachial cutaneous nerve (from radial nerve)
Inferior lateral brachial cutaneous nerve (from radial nerve)
Posterior antebrachial cutaneous nerve (from radial nerve) Accessory cephalic vein
Posterior antebrachial cutaneous nerve (from radial nerve)
Branches of medial antebrachial cutaneous nerve Basilic vein Lateral antebrachial cutaneous nerve (terminal part of muscuIocutaneous nerve)
Branches of medial antebrachial cutaneous nerve ~
Median cubital vein Intermediate (median) antebrachial vein Basilic vein Perforating veins Cephalic vein
Plate 479
Branches of lateral antebrachial cutaneous nerve (terminal part of musculocutaneous nerve)
Neurovasculature
Anterior (palmar) view
Cephalic vein Posterior antebrachial cutaneous nerve (from radial nerve)
Posterior (dorsal) view
Basilic vein
Lateral antebrachial cutaneous nerve (from musculocutaneous nerve)
terior branch nd Posterior branch of medial antebrachial cutaneous nerve Posterior
Accessory cephalic vein
Median basilic vein
Median cephalic vein
branch of medial antebrachial cutaneous nerve
Bicipital aponeurosis
Perforating veins
Note: In 70% of cases, a median cubital vein (tributary to basilic vein) replaces median cephalic and median basilic veins (see Plate 479). Superficial branch of radial nerve Palmar branch of median nerve Intercapitular veins
Accessory cephalic vein Posterior branch of lateral antebrachial cutaneous nerve (from musculocutaneous nerve)
Cephalic vein
Median antebrachial vein
Posterior antebrachial cutaneous nerve (from radial nerve)
Basilic vein
Cephalic vein Extensor retinaculum
Palmar branch of ulnar nerve Dorsal branch of ulnar nerve Palmar carpal ligament (continuous with extensor retinaculum) Palmar aponeurosis
Dorsal branch of ulnar ne
Dorsal metacarpal veins
Superficial branch of radial nerve Dorsal venous network
Intercapitular veins
Superficial transverse metacarpal ligament
Proper palmar digital nerves and palmar digital veins
Neurewaseu!ature
Dorsal digital nerves and veins
Plate 480
Cutaneous Innervation of Upper Limb
Anterior (palmar) view
Posterior (dorsal) view
Supraclavicular nerves (from cervical plexu$-C3, 4)
MMm
Axillary nerve Superior lateral brachial cutaneous nerve (C5, 6)
Radial nerve Inferior lateral brachial cutaneous nerve (C5, 6)
Radial nerve Superficial branch (C6-8)
Median nerve Palmar branch and Palmar digital branches (C6-8)
Radial nerve Posterior brachial cutaneous nerve ( C 5 - 8 ) Inferior lateral cutaneous nerve Posterior antebrachial cutaneous nerve (C[5], 6 - 8 )
Intercostobrachial nerve (T2) and medial brachial cutaneous nerve (C8, T l / 2 )
Lateral antebrachial cutaneous nerve (C5, 6 [71) (terminal part of musculocutaneous nerve)
Medial antebrachial cutaneous nerve (C8, T1)
Axillary nerve Superior lateral brachial cutaneous nerve (C5, 6)
>
Ulnar nerve (C8, T l ) A Palmar branch
Dorsal branch and dorsal digital branches
Palmar digital branches
Proper palmar digital branches
Lateral antebrachial cutaneous nerve ( C 5 , 6 [7]) (terminal part of musculocutaneous nerve)
Radial nerve Superficial branch and dorsal digital branches ( C 6 - 8 )
Median nerve Proper palmar digital branches
Note: Division variable between ulnar and radial innervation on dorsum of hand and often aligns with middle of 3rd digit instead of 4th digit as shown
Meur©waseij!atiy]re
Dermatomes of Upper Limb
Note: (according to Keegan and Garrett) s h o w n as distinct segments. There is actually considerable overlap b e t w e e n adjacent dermatomes. An alternative d e r m a t o m e map is provided by Foerster (see references).
Posterior view
Neurovasculature
Plate 482
See also Plates 184, 468
Deltopectoral node
Lateral axillary nodes (along axillary vein)
Basilic vein
Cubital nodes
Median cubital vein Vessels passing to dorsum of hand
Cephalic vein
Vessels passing to dorsum of hand
Vessels passing around w e b to dorsum of hand Vessels passing to dorsum of fingers
Note: Arrows indicate direction of drainage
Plate 483
Neurovasculafure
•r
-
mmm
Scans
Plate 484
Lower Limb 3
Topographic A n a t o m y Plate 485 mmmmMmm
485 Lower Limb
Hip and Thigh Plates 486-505
486 Hip (Coxai) Bone 487 Hip Joint 488
Hip Joint: Anteroposterior Radiograph
489
Femur
490 Bony Attachments of Muscles of Hip and Thigh: Anterior View 491 Bony Attachments of Muscles of Hip and Thigh: Posterior View 492 Muscles of Thigh: Anterior Views 493
Muscles of Thigh: Anterior Views (continued)
4 9 4 Muscles of Hip and Thigh: Lateral View 4 9 5 Muscles of Hip and Thigh: Posterior Views 496 Psoas and lliacus Muscles 4 9 7 Lumbosacral and Coccygeal Plexuses 498
Lumbar Plexus
4 9 9 Sacral and Coccygeal Plexuses 500 Arteries and Nerves of Thigh: Anterior Views 501 Arteries and Nerves of Thigh: Anterior Views (continued) 502 Arteries and Nerves of Thigh: Posterior View 503
Nerves of Hip and Buttock
5 0 4 Arteries of Femoral Head and Neck 505
Thigh: Serial Cross Sections
Atlas of Human Anatomy
7
Lower Limb 5 2 7 Ligaments and Tendons of Ankle Plates
506-512
528 Ligaments and Tendons of Foot: Plantar View
5 0 6 Knee: Lateral and Medial Views
5 2 9 Tendon Sheaths of Ankle
507 Knee: Anterior Views
5 3 0 Muscles of Dorsum of Foot: Superficial Dissection
508 Knee: Interior
531 Dorsum of Foot: Deep Dissection
5 0 9 Knee: Cruciate and Collateral Ligaments
5 3 2 Sole of Foot: Superficial Dissection
5 1 0 Knee: Anteroposterior Radiograph
5 3 3 Muscles of Sole of Foot: First Layer
511 Knee: Posterior and Sagittal Views
5 3 4 Muscles of Sole of Foot: Second Layer
5 1 2 Arteries of Thigh and Knee: Schema
535 Muscles of Sole of Foot: Third Layer 5 3 6 Interosseous Muscles and Deep Arteries of Foot
Leg
5 3 7 Interosseous Muscles of Foot
Plates 513-522
5 1 3 Tibia and Fibula
Neurovasculature
5 1 4 Tibia and Fibula (continued)
Plates 538-546
515 Attachments of Muscles of Leg
5 3 8 Femoral Nerve and Lateral Femoral Cutaneous Nerve
5 1 6 Muscles of Leg (Superficial Dissection): Posterior View
539 Obturator Nerve
517 Muscles of Leg (Intermediate Dissection): Posterior View
5 4 0 Sciatic Nerve and Posterior Femoral Cutaneous Nerve
518 Muscles of Leg (Deep Dissection): Posterior View
541 Tibial Nerve
5 1 9 Muscles of Leg (Superficial Dissection): Anterior View
5 4 2 Common Fibular (Peroneal) Nerve
5 2 0 Muscles of Leg (Deep Dissection): Anterior View
543 Dermatomes of Lower Limb
521 Muscles of Leg: Lateral View
5 4 4 Superficial Nerves and Veins of Lower Limb: Anterior View
5 2 2 Leg: Cross Sections and Fascial Compartments
545 Superficial Nerves and Veins of Lower Limb: Posterior View
„
5 4 6 Lymph Vessels and Nodes of Lower Limb
Ankle and Foc&t Plates 523-537
Regional S c a n s
5 2 3 Bones of Foot
Plate 547
5 2 4 Bones of Foot (continued)
547 CT Angiograms of Arteries of the Lower Limb
525 Calcaneus 5 2 6 Ankle: Radiographs
Atlas of Human Anatomy
Lower Limb Posterior view
Anterior view Iliac crest Iliac crest
Gluteus maximus muscle
Gluteus medius muscle -
Anterior superior iliac spine ^
Inguinal ligament
Tensor fasciae latae muscle-"
Sartorius muscle
Greater trochanter of femur
Vastus lateralis muscle Rectus femoris muscle
Great saphenous vein
Semitendi nosus muscle —
lliotibial tract
Adductor / 1 magnus / muscle / Vastus medialis muscle
|
Gracilis tendon \ lliotibial tract
Fibularis (peroneus) longus muscle
Rectus femoris tendon (becoming part of quadriceps femoris tendon) Great saphenous Patella vein—-—
Biceps femoris muscle Long head — Short head
Patellar ligament Tibial tuberosity Great saphenous vein
Gastrocnemius muscle — Medial head ^ Lateral head
Tibialis anterior muscle Anterior border of tibia Calcaneal (Achilles) tendon ^
Lateral malleolus
Extensor digitorum longus tendons —
Small saphenous vein
Fibularis (peroneus) longus and brevis tendons
Medial malleolus Medial malleolus
Lateral malleolus
Plantar surface of foot —
Calcaneal tuberosity
Extensor hallucis longus tendon
Topographic Anatomy
Plate 485
Hip (Coxal) Bone See also Plates 248, 352, 353
Lateral view
Intermediate zone lum > Iliac crest Outer lip
Anterior Inferior Posterior
Gluteal lines
W i n g (ala) of ilium (gluteal surface)
Posterior superior iliac spine
terior superior iliac: spine Anterior inferior iliac spine
Posterior inferior iliac spine
Acetabulum Lunate surface Margin (limbus) of acetabulum Acetabular notch
Greater sciatic notch
Superior pubic ramus
Body of ilium Ischial spine
bic tubercle
Lesser sciatic notch Obturator crest
Body of ischium
Inferior pubic ramus Ischial tuberosity
Intermediate zone \ Inner lip (
Iliac crest
Iliac tuberosity
Ramus of ischium
Posterior superior iliac spine
Anterior superior iliac spine W i n g (ala) of ilium (iliac fossa)
ricular surface (for sacrum)
Anterior inferior iliac spine Arcuate line
Posteriorinferior iliac spine
Iliopubic eminence Superior pubic ramus
Greater sciatic notch
Pecten pubis (pectineal line)
Ischial spine Body of ilium
Pubic tubercle
Lesser scialic notch Symphyseal surface
Body of ischium
Ilium Ischium Pubis
Obturator groove
Ischial tuberosity Ramus of ischium
Inferior pubic i
Medial view
Plate 486
Hip and Thigh
Erlip
J @ i M f
Anterior view liofemoral ligament (Y ligament of Bigelow) Iliopectineal bursa (over gap in ligaments)
Anterior superior iliac spine
bofemoral ligament Obturator crest
Anterior inferior iliac spine
Superior pubic ramus
Greater trochanter
Posterior view Iliofemoral liagment Ischiofemoral ligament Zona orbicularis Greater trochanter Lesser trochanter
Ischial spine Ischial tuberosity
Intertrochanteric, line
Intertrochanteric crest
Joint opened: lateral view
Lesser trochanter
Anterior superior iliac spine Lunate (articular) surface of acetabulum
Anterior inferior iliac spine Iliopubic eminence Acetabular labrum (fibrocartilaginous)
Articular cartilage
Fat in acetabular fossa (covered by synovial membrane)
Greater trochanter
O b t u r a t o r artery Anterior branch Posterior branch Acetabular branch
Head of femur Neck of femur
Obturator membrane
Intertrochanteric line Ligament of head of femur (cut)
[34]op a r a d l
TfiogEfti
Ischial tuberosity Lesser trochanter
Plate 487
7
Hip Joints Anteroposterior Radiograph See also Plates 487, 489
A
Acetabulum
F
Femur
G
Greater trochanter
H
Head of femur
1
Ischium
IC
Intertrochanteric crest
IL
Ilium
IT
Ischial tuberosity
I
Lesser trochanter
N O P
Plate 488
-
Neck O b t u r a t o r foramen Pubis (superior ramus)
Hip and Thigh
Femur
Anterior view
Posterior view Trochanteric fossa
Head
Greater trochanter
Greater trochanter
Head Fovea for ligament of head
Fovea for ligament of head
Ma ' /•:' Neck
Neck
Intertrochanteric crest Lesser trochanter
Calcar Lesser trochanter
Intertrochanteric line
Pectineal line Gluteal tuberosity
Linea aspera, \ |
Medial lip Lateral lip
Nutrient foramen Shaft (body)
Shaft (body) Line of attachment of border of synovial membrane
MV
Line of reflection of synovial membrane Line of attachment of fibrous capsule Line of reflection of fibrous capsule (unattached) Popliteal surface
Lateral epicondyle
Lateral epicondyle
Lateral condyle Lateral condyle
Hip and Thigh
Patellar surface
Intercondylar fossa
Plate 48®
Bony Affachmenfs of Muscles of Hip and Thigh: Anterior View
lliacus muscle
Origin of psoas major muscle from sides of vertebral bodies, intervertebral discs, and transverse processes (T12-L4)
Sartorius muse Rectus femoris muscle Pectineus muscle
Obturator internus and superior and inferior gemellus muscles
Adductor longus muscle
Piriformis muscle
Adductor brevis muscle
Gluteus minimus muscl Vastus lateralis muscl Iliopsoas muscle Vastus medialis muscl
Gracilis muscle Obturator externus muscle Adductor magnus muscle Quadratus femoris muscle
Vastus intermedins muscle
Origins Insertions
Articularis genus muscle Adductor magnus muscle
lliotibial tract Biceps femoris muscle Quadriceps femoris muscle (rectus femoris, vastus lateralis, vastus intermedins, and vastus medialis via patellar ligament)
Plate 490
Sartorius muscle Gracilis muscle
Pes anserinus
Semitendinosus muscle
Hip and Thigh
Bony Attachments of Muscles of Hip and Thigh: Posterior View
Gluteus medius muscle Gluteus minimus muscle Tensor fasciae latae muscle Gluteus maximus muscle
Sartorius muscle Rectus femoris muscle
Superior gemellus muscle
Obturator externus muscle
Inferior gemellus muscle
Gluteus medius muscle
Quadratus femoris muscle
Quadratus femoris muscle
Obturator internus muscle
Iliopsoas muscle
Adductor magnus muscle Biceps femoris (long head) and semitendinosus muscles
Gluteus maximus muscle Vastus lateralis muscle Adductor magnus muscle Adductor brevis muscle Vastus intermedins muscle Biceps femoris muscle (short head)
Origins Insertions
Adductor longus muscle
Adductor magnus muscle Vastus lateralis muscle
Adductor magnus muscle
Plantaris muscle Gastrocnemius muscle (lateral head)
Gastrocnemius muscle (medial head)
Popliteus muscle
Semimembranosus muscle*
Popliteus muscle
Note: W i d l h of zone of attachments to posterior aspecl of femur (linea aspera) is greally exaggerated.
Hip and Thigh
Plate 491
Muscles of Thighs Anterior Views
Anterior superior iliac spine Anterior superior iliac spine
Hliacus muscle
us muscle (origin)
-Psoas major muscle
Anterior inferior iliac spine
Gluteus medius muscle Inguinal ligament
Ligaments of hip joint
Pubic tubercle Iliopsoas muscle
Pectineus muscle
Tensor fasciae latae muscle Pectineus muscle Tensor fasciae latae muscle (origin Rectus femoris muscle (origin) Greater trochanter Iliopsoas muscle (cut) A d d u c t o r longus muscle Gracilis muscle
—
Sartorius muscle Rectus femoris muscle* — V a s t u s lateralis muscle" Vastus intermedius muscle* — V a s t u s medialis muscle lliotibial tract Rectus femoris tendon (becoming part of quadriceps femoris tendon) Lateral patellar retinaculum Patella Medial patellar retinaculum
Anteromedial intermuscular septum
Patellar ligament --Sartorius tendon Gracilis tendon Semitendinosus tendon Tibial tuberosity
Pes anserinus lliotibial tract {cut) Rectus femoris t e n d o n (cut) Quadriceps femoris tendon Patella Lateral patellar retinaculum Medial patellar retinaculum Head of fibula Patellar ligament Tibial tuberos'
Sartorius tendon
*Muscles of quadriceps femoris
Plate 492
Hip and Thigh
Muscles of Thigh: Anterior Views (continued)
Deep dissection
IRC PtPi Wmi^M
Anterior superior iliac spine
Superior ramus of pubis
A d d u c t o r longus muscle (cut and
reflected)
Ligaments of hip joint Greater trochanter of femur Iliopsoas muscle {cut)
Pubic tubercle
Pectineus muscle (cut and reflected)
Gracilis muscle (cut)
A d d u c t o r brevis muscle (cut and reflected)
O b t u r a t o r externus muscle
Vastus intermedins muscle
Quadratus femoris muscle
A d d u c t o r longus muscle (cut and reflected)
A d d u c t o r minimus part of A d d u c t o r magnus muscle
Femoral artery and'vein passing through hiatus of adductor magnus muscle
- O p e n i n g s for perforating branches of profunda femoris (deep femoral) artery
Vastus medialis muscle (cut) Rectus femoris t e n d o n (cut as it becomes pari of quadriceps tendon) Vastus lateralis muscle (cut)
T e n d o n of a d d u c t o r magnus muscle inserting on adductor tubercle on medial epicondyle of femur
Gracilis muscle (cut)
Lateral e p i c o n d y l e of femui Tibial collateral ligament Patella Lateral patellar retinaculum Fibular collateral ligament Head of fibula
M e d i a l patellar retinaculum
Sartorius tendon (cut)
Gracilis t e n d o n
Pes anserinus
Patellar ligament Tibial tuberosity
Hip and Thigh
Plate 493
7
Muscles of Hip and Thigh: Lateral View
External o b l i q u e muscle
Iliac crest
Anterior superior iliac spine
Gluteal aponeurosis over gluteus medius muscle
Sartorius muscle Gluteus maximus muscle
Tensor fasciae latae muscle
Rectus femoris muscle
Vastus lateralis muscle
lliotibial tract
Long head Biceps femoris muscle Short head
Lateral c o n d y l e of tibia and Gerdy's tubercle
Semimembranosus muscle Lateral patellar retinaculum Fibular collateral ligament Patella Plantaris muscle Extensor d i g i t o r u m longus muscle Gastrocnemius muscle (lateral head)
Head of fibula
Fibularis (peroneus) longus muscle
Plate 494
Patellar ligament
Tibialis anterior muscle
Hip and Thigh
Muscles of Hip and Thighs Posterior Views For piriformis and obturator internus see also Plates 356, 357; For obturator externus see Plate 501
Superficial dissection
Deeper dissection Iliac crest Gluteal aponeurosis over Gluteus medius muscle Gluteus minimus muscle Gluteus maximus muscle Piriformis muscle Sciatic nerve Sacrospinous ligament Superior gemellus muscle Obturator internus muscle Inferior gemellus muscle Sacrotuberous ligament Quadratus femoris muscle Ischial tuberosity Semitendinosus muscle Greater trochanter Biceps femoris muscle (long head) Adductor minimus part of Adductor magnus muscle Semimembranosus muscle lliotibial tract Gracilis muscle Biceps femoris muscle Short head Long head Semimembranosus muscle Semitendinosus muscle Popliteal vessels and tibial nerve C o m m o n fibular (peroneal) nerve Plantaris muscle Gastrocnemius muscle Medial head Lateral head Sartorius muscle Popliteus muscle Tendinous arc Soleus muscle Plantaris tendon (cut)
Hip and Thigh
Plate 495
7
7 See also Plate 2 6 3
Quadratus l u m b o r u m muscle
12th rib
Ilioinguinal nerve
Origin of psoas major muscle from vertebral bodies, transverse processes, and intervertebral discs (Tl 2 - L 4 ) and origin of psoas minor muscle from vertebral bodies (Tl2, LI)
Psoas minor muscle
Lumbar plexus
Tra n sve rsu s abdo m i n is muscle [cut) Iliohypogastric nerve
Psoas major muscle Lumbosacral trunk Genitofemoral nerve Iliac crest
Lateral femoral cutaneous nerve
terior superior iliac spine
Iliacus muscle Femoral nerve
IJiopectineal bursa
Superior pubic r a m i Greater trochanter of fern ur
Iliofemoral ligament of hip joint (Y ligament of Bigelow)
Iliopsoas muscle passes backward to insertion on lesser trochanter
Shaft (body) of femur
Abductors (gluteus medius and minimus muscles)
Note: Arrows indicate direction of action of iliopsoas muscle.
Adductors
Plate 496
Hip and Thigh
Lumbosacral and Coccygeal Plexuses • H n H H H H H • H H B H H H n H H H H H H H H H H H H H n H n H H
Intercostal nerve
/.•v.
mm
Subcostal nerve (T12) Iliohypogastric nerve (T12, L I ) Ilioinguinal nerve (LI) To psoas major and psoas minor muscles
Anterior division Posterior division
Sympathetic trunk Rami communicantes
Genitofemoral nerve (LI, 2) Lateral femoral cutaneous nerve (L2, 3) Genital branch and Femoral branch of genitofemoral nerve
> Lumbar plexus
To psoas major and iliacus muscles Anterior branches and Lateral branches of subcostal and iliohypogastric nerves Lumbosacral trunk Nerve to quadratus femoris (and inferior gemellus) (L4. 5, SI) Nerve to obturator internus (and superior gemellus) (L5, SI, 2)
>• Sacral plexus
Superior gluteal nerve (L4, 5, SI) Nerve to piriformis (SI, 2) Obturator nerve (L2, 3, 4) Accessory obturator nerve (L3, 4) (inconstant) -
Coccygeal plexus
Inferior gluteal nerve (L5, SI, 2) Femoral nerve (L2, 3, 4)
Pelvic splanchnic nerves
Sciatic nerve-——
Perforating cutaneous nerve (S2, 3)
Posterior femorai cutaneous nerve (S1, 2,
Nerve to ievalor ani and coccygeus (S3,. 4)
Pudendal nerve (S2, 3, 4)
Perineal branch of 4th sacral nerve
Sciatic nerve
<
Anococcygeal nerves
C o m m o n fibular (peroneal) nerve (L4, 5, SI, 2) Tibial nerve (L4, 5, S1, 2, 3)
Hip and Thigh
Obturator nerve Inferior anal (rectal) nerve Posterior femoral cutcineous neive
Dorsal nerve of penis/clitoris p e r j n e a ( nerve and Posterior scrotal/iabial branche:
Plate 497
Lumbar Plexus mmmmmmmmmmmmmmmmmmmammmamm
Schema
Subcostal nerve (TI2)
\
White and gray rami communicantes Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve
>
Ventral rami of nerves
Lateral femoral cutaneous nerve Gravt rami communicantes Muscular branches to psoas and iliacus muscles Femoral nerve
J
Accessory obturator nerve (often Obturator nerve
A n t e r i o r division Posterior division
Lumbosacral trunk Diaphragm (cut) Subcostal nerve (T12) Sympathetic trunk Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve (cut) Lateral femoral cutaneous ne Femoral nerve Obturator nerve Psoas major muscle (cut) Lumbosacral trunks Inguinal ligament (Poupart's)
White and gray rami communicantes Subcostal nerve (TI2) Iliohypogastric nerve Ilioinguinal nerve Transversus abdominis muscle Quadratus lumborum muscle Psoas major muscle Gray rami communicantes G e n i to fern o r a I n er ve Iliacus muscle Lateral femoral cutaneous nerve Femoral nerve Genital branch and Femoral branch of g e n i t o fe m o ra I n e r ve Obturator nerve
Plate 493
Hip and Thigh
Sacral and Coccygeal Plexuses
Schema
Lumbosacral trunk
A n t e r i o r division Posterior division
Gray rami communicantes
Pelvic splanchnic nerves (parasympathetic to inferior hypogastric [pelvic) plexus)
Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis
Tibial nerve Sciatic nerve
Coccygeal nerve
C o m m o n fibul ai (peroneal) nei ve
Anococcygeal nerve Perineal branch of 4th sacral nerve Nerve to levator ani and coccygeus (ischiococcygeus) muscles
Nerve to quadratus femoris (and inferior gemellus Nerve to obturator internus (and superior gemellus)
Lumbosacral trunk Psoas major muscle Superior gluteal artery and nerve Obturator nerve lliacus muscle
Pudendal nerve Perforating cutaneous nerve
(J^*-
Posterior femoral cutaneous nerve
/x. i
Sympathetic trunk Gray rami communicantes Pelvic splanchnic nerves (cut) (parasympathetic to inferior hypogastric [pelvicl plexus)
Inferior gluteal artery Nerve to quadratus femoris Internal pudendal arter Nerve to obturator internus Pudendal nerve Obturator internus muscle Superior pubic ramus Piriformis muscle Coccygeus (ischiococcygeus) muscle Nerve to levator ani muscle Levator ani m Topography: medial and slightly anterior view of h e m i s e c t e d pelvis
Hip and Thigh
Sacral splanchnicnerves {cut) (sympathetic to inferior hypogastric [pelvic] plexus)
Plate 499
Arteries and Nerves of Thigh; Anterior Views See also Plate 5 3 8
Anterior superior iliac spineLateral femoral cutaneous nerve Inguinal ligament Iliopsoas muscle
Superficial dissections Tensor fasciae latae muscle {retracted) Gluteus minimus and medius muscles
Superficial circumflex iliac vessels Superficial epigastric vessels
Superficial and Deep external pudendal vessels
Rectus femoris muscle
Femoral sheath
Pectineus muscle Profunda femoris (deep femoral) artery
Fascia lata (cut) Rectus femoris muscle Vastus lateralis muscle tensor fasciae latae muscle
Plate SCO
Profunda femoris (deep femoral) artery
Saphenous nerve
Femoral nerve, artery, and vein
Vastus medialis muscle
Femoral nerve, artery, and vein
A d d u c t o r canal (opened by removal of sartorius muscle)
Vastus medialis muscle
Sartorius muscle
Iliopsoas muscle
Adductor longus muscle
Vastus lateralis muscie
Adductor longus muscle
Sartorius muscle (cut)
Pectineus muscle
Lateral circumflex femoral
Gracilis muscle
Lateral femoral cutaneous nerve {cut)
Saphenous nerve and saphenous branch of descending genicular artery Articular bra of descending genicular artery (emerges f r o m vastus medialis muscie) Patellar anastomosis Infrapatellar branch of Saphenous nerve
Nerve to vastus medialis muscle Adductor magnus muscle Anlerornedial intermuscular septum covers entrance of femoral vessels to popliteal fossa (adductor hiatus) Sartorius muscle (cut) Superior medial genicular artery (from popliteal artery) Inferior medial genicular artery (from popliteal artery)
Hip and Thigh
Arteries and Nerves of Thigh: Anterior Views (continued) m
See also Plates 5 3 8 , 5 3 9
Deep dissection External iliac artery and vein nguinal ligament (Poupart's)
Lateral femoral cutaneous nerve
Femoral artery and vein (cut)
Sartorius muscle (cut)
Pectineus muscle (cut)
Iliopsoas muscle O b t u r a t o r canal Tensor fasciae latae muscle {retracted) Gluteus medius and minimus muscles Femoral n Rectus femoris muscle (cut) Ascending, transverse and descending branches of Lateral circumflex femoral artery Medial circumflex femoral artery Pectineus muscle (cut) Profunda femoris (deep femoral) artery Perforating branches A d d u c t o r longus muscle (cut) Vastus lateralis muscle Vastus intermedius muscle Rectus femoris muscle (cut) Saphenous nerve A n t e r o m e d i a l intermuscular septum (opened) Vastus medialis muscle Quadriceps femoris t e n d o n Patella and patellar anastomosis Medial patellar retinaculum Patellar ligament
Hip and Thigh
O b t u r a t o r externus muscle A d d u c t o r longus muscle (cut) Anterior branch and osterior branch of o b t u r a t o r nerve Quadratus femoris muscle A d d u c t o r brevis muscle Branches of posterior branch of o b t u r a t o r nerve uctor magnus muscle Gracilis muscle Cutaneous branch of obturator nerve Femoral artery and vein (cut) Descending genicular artery rticular branch Saphenous branch A d d u c t o r hiatus Sartorius muscle (cut) uctor magnus t e n d o n uctor tubercle on medial e p i c o n d y l e of femur Superior medial genicular artery (from popliteal artery) Infrapatellar branch of Saphenous nerve Inferior medial genicular artery (from popliteal artery)
Plate 501
7
7
Arteries and Nerves of Thigh: Posterior View See also Plate 540
Deep dissection Iliac crest Superior clunial nerves Gluteus maximus muscle (cut) Medial clunial nerves Inferior gluteal artery and nerve
Gluteal aponeurosis and gluteus medius muscle (cut) Superior gluteal artery and nerve Gluteus minimus muscle Tensor fasciae latae muscle
Pudendal nerve Piriformis muscle Nerve to obturator internus (and superior gemellus)
Gluteus medius muscle (cut) Superior gemellus muscle
Posterior femoral cutaneous nerve-
Greater trochanter of femur
Sacrotuberous ligament Ischial tuberosity Inferior clunial nerves (cut)
rator internus muscle Inferior gemellus muscle Gluteus maximus muscle (cut)
A d d u c t o r magnus muscle
Quadratus femoris muscle
Gracilis muscle
Medial circumflex femoral artery
Sciatic nerve Muscular branches of sciatic nerve Semilendinosus muscle
{retracted)
Semimembranosus muscle Sciatic nerve Articular branch A d d u c t o r hiatus Popliteal vein and a Superior medial genicular a Medial e p i c o n d y l e of femur Tibial nerve Gastrocnemius muscle (medial head) Medial sural cutaneous nerve Small saphenous vein
Plate 502
Vastus lateralis muscle and a iliotibial tract A d d u c t o r minimus part of adductor magnus muscle 1st perforating artery (from profunda femoris artery) A d d u c t o r magnus muscle 2nd and 3rd perforating arteries (from profunda femoris artery) 4th perforating artery (from profunda femoris artery) Long head (retracted) Short head
I \
Biceps femoris muscle
Superior lateral genicular artery C o m m o n fibular (peroneal) nerve Plantaris muscle Gastrocnemius muscle (lateral head) Lateral sural cutaneous nerve
Hip and Thigh
Gluteus maximus muscle {cut)
Iliac: crest A
i
Superior gluteal nerve Gluteus minimus muscle
Sciatic nerve
Piriformis muscle
Inferior gluteal nerve
Superior gemellus muscle
Posterior femoral cutaneous nerve-
AVvv'i Tensor fasciae latae muscle
Nerve to obturator interims (and superior gemellus)
Gluteus medius muscle (cut)
Pudendal nerve
Obturator internus muscle
Ischial spine Sacrospinous ligament
Nerve to quadratus femoris (and inferior gemellus) supplying articular branch to hip joint
Perforating cutaneous nerve Sacrotuberous ligament
l \JJtfSi
Inferior anal (rectal) nerve
Greater trochanter of femur
pVSE
Intertrochanteric crest
Dorsal nerve of penis
Inferior gemellus muscle
Perineal nerve
Quadratus femoris muscle
Posterior scrotal nerve
Gluteus maximus muscle (cut)
Perineal branches of posterior femoral cutaneous nerve
Sciatic nerve Ischial tuberosity Semitendinosus muscle
Posterior femoral cutaneous nerve Inferior clunial nerves
Biceps femoris muscle (long head) (covers semimembranosus muscle)
Hip and Thigh
POaiie S©3
Arteries of Femoral Head and Neck See also Plate 512
Anterior view
Posterior view Acetabular branch of obturator artery {often minute)
Superior Anterior Inferior >
Relinacular arteries (subsynovial)
Superior Posterior Inferior
Anastomosis between medial and lateral circumflex femoral ^ ^ arteries
Relinacular arteries (subsynovial) Anastomosis
Ischiofemoral ligament and joint capsule Medial circumflex femoral artery
Iliopsoas tendon
Iliofemoral (Y) ligament and joint capsule -
Medial circumflex femoral artery
Ascending, ^ ^ Transverse, ^ Descending ^ ^ ^ branches of Lateral circumflex femoral artery —
Profunda femoris (deep femoral) artery
Lateral circumflex femoral artery Nutrient artery of femur
Nutrient artery of femur
Anterior view in situ Coronal section
Medial circumflex femoral artery
Acetabular labi um
Anastomosis
Ligaments and joint capsule v
Femoral artery
Lateral circumflex femoral artery ^ Ascending, Transverse, \ Descending \ branches
Synovial membrane Retinacular arteries \
Iliopsoas muscle
\\:\
Pectineus muscle
•• -
Acetabular branch
m
•\
•
:
w
Obturator artery
m
Medial circumflex femoral artery
a
Epiphyseal plate Medial circumflex femoral artery
Profunda femoris (deep femoral) artery Medial circumflex femoral artery ""^Iliopsoas tendon Lateral circumflex femoral artery
Femur of child: anterior view
Plate S©4
Hip and Thigh
Thigh: Serial Cross Sections
Sartorius muscle Profunda femoris (deep femoral) artery and vein Pectineus mu Iliopsoas muscle
Fascia lata Branches of femoral nerve Femoral artery and vein A d d u c t o r longus muscle Great saphenous vein
Rectus femoris muscle
O b t u r a t o r nerve (anterior branch)
Vastus meclialis mu
A d d u c t o r brevis muscle
Lateral femoral cutaneous ne
Obturator nerve (posterior branch)
Vastus intermedius m Femur
Gracilis muscle
Vastus lateralis muscl
A d d u c t o r magnus muscle
Tensor fasciae latae m
Sciatic nerve
lliotibial tract
Posterior femoral cutaneous nerve
Gluteus maximus muscle
Semimembranosus muscle Semitendinosus muscle Biceps femoris muscle (long head)
Vastus medialis muscle Rectus femoris muscle
intermuscular septum of thigh
Vastus intermedius muscle Vastus lateralis muscle lliotibial tract Lateral intermuscular septum of thigh Biceps ( Short head femoris
( Long head
Semitendinosus muscle Semimembranosus muscle
Sartorius muscle Nerve to vastus meclialis muscle
j / V
in adductor
Saphenous nerve
/
canal
Femoral artery and vein ) Great saphenous vein A d d u c t o r longus muscle Gracilis muscle A d d u c t o r brevis muscle Profunda femoris (deep femoral) artery A d d u c t o r magnus muscle
Rectus femoris tendon Vastus intermedius muscle lliotibial tr
Sciatic nerve Vastus medialis muscle
Vastus lateralis muse Articularis genus muscle Lateral intermuscular septum of thigh Femur Biceps femoris muscle C o m m o n fibular (peroneal) nerve Tibial nerve
Hip and Thigh
Posterior intermuscular septum of thigh
Sartorius muscle Saphenous nerve and descending genicular artery Great saphenous vein Gracilis muscle uctor magnus tendon Popliteal vein and artery Semimembranosus muscle Semitendinosus muscle
Plate 505
Knee: Lateral and Medial Views
Lateral view
Vastus lateralis muscle
lliotibial tract Quadriceps femoris tendon
Biceps femoris \ L o n g h e a d muscle j short head Bursa deep to iliotibial tract
Patella
Fibular collateral ligament and bursa deep to it Lateral patellar retinaculum
Plantaris muscle Biceps femoris tendon and its inferior subtendinous bursa
Joint capsule of knee
C o m m o n fibular (peroneal) nerve
Patellar ligament
Head of fibula Gastrocnemius muscle
Tibial tuberosity
Soleus muscle Fibularis (peroneus) longus muscle
Tibialis anterior muscle
Medial view Sartorius muscle Vastus medialis muscle
Quadriceps femoris tendon
Gracilis muscle Tendon of semitendinosus muscle Semimembranosus muscle and tendon
Medial epicondyle of femur
Patella
Medial patellar retinaculum
Joint capsule
A d d u c t o r magnus tendon Parallel fibers
) Tit;jal , > collateral O b l i q u e fibers \ ligament Semimembranosus bursa Anserine bursa deep to Semitendinosus, racilis, and Sartorius tendons
Pes anserinus
Gastrocnemius muscle Tibial tuberosity Soleus muscle
Plate S@®
BCsne®
Knee: Anterior Views
Right knee in extension Femur
Vastus intermedius muscle
Articularis genus muscle
Vastus lateralis muscle
Vastus medialis muscle
lliotibial tract
Rectus femoris t e n d o n ( b e c o m i n g quadriceps femoris tendon)
Lateral patellar retinaculum Lateral e p i c o n d y l e of f e m u r
Patella
Fibular collateral ligament and bu
Medial e p i c o n d y l e of femur
Biceps femoris t e n d o n and its inferior subtendinous bursa
M e d i a l patellar retinaculum
Broken line indicates bursa deep to iliotibial tract
Tibial collateral ligament Semitendinosus, Gracilis, and Sartorius tendons
Insertion of iliotibial tract to Gerdy's tubercle and oblique line of tibia C o m m o n fibular (peroneal) nerve
Pes anserinus
Anserine bursa
Head of fibula
M e d i a l condyle of tibia
Fibularis (peroneus) longus muscle
Patellar ligament
Extensor d i g i t o r u m longus muse
Tibial tuberosity
Tibialis anterior muscle
Gastrocnemius muscle
Joint opened, knee slightly in flexion Femur Articularis genus muscle Synovial m e m b r a n e (cut edge)
Suprapatellar (synovial) bursa Cruciate ligaments (covered by synovial membrane)
Medial condyle of f e m u r
Lateral c o n d y l e of femur Origin of poplileus tendon (covered by synovial m e m b r a
Infrapatellar synovial fold
M e d i a l meniscus Subpopliteal recess Lateral meniscus Fibular collateral ligament
Alar folds (cut)
Infrapatellar fat pads (lined by synovial m e m b r a n e )
Head of fibula Suprapatellar (synovial) bursa (roof Patella (articular surface on posterior aspect)
Vastus medialis muscle (reflected
reflected)
inferiorly)
Vastus lateralis muscle (reflected inferiorly)
ECiraee
Plate S©7
7
Knee: Interior wmm
Inferior view Patellar ligament
lliotibial tract blended into lateral patellar retinaculum and capsu
Medial patellar retinaculum blended into joint capsule
Bursa
Suprapatellar synovial bursa
Subpopliteal
Synovial membrane (cut edge)
Popliteus tendon
Infrapatellar synovial fold
Fibular collateral ligament
Posterior cruciate ligament
Bursa
collateral ligament (superficial and deep parts)
Lateral condyle of femui
Medial condyle of femur
Anterior cruciate ligament
Oblique popliteal ligament
Arcuate popliteal ligament
Semimembranosus tendon
Superior view Semimembranosus tendon
Posterior meniscofemoral ligament
Oblique popliteal ligament
Arcuate popliteal ligament
Posterior cruciate ligament
Fibular collateral ligament
Tibial collateral ligament (deep part bound to medial meniscus)
Bursa Popliteus tendon
Medial meniscus
Subpopliteal recess
Synovial membrane
Lateral meniscus
Superior articular surface of tibia (medial facet)
Superior articular surface of tibia (lateral facet)
Joint capsule
lliotibial tract blended into capsule
Anterior cruciate ligament
Infrapatellar fat pad
Patellar ligament
Anterior aspect A Superior view: ligaments and cartilage removed Attachment of posterior cruciate l i g a m e n t -
st
Intercondylar eminence Attachment of synovial membrane
Attachment of synovial membrane
Superior articular surface of tibia (medial facet)
Superior articular surface of tibia (lateral facet)
Attachment of anterior cruciate ligament
Attachments of horns of lateral meniscus Attachments of horns of medial men Anterior aspect
Plate 508
Knee
Knee: Cruciate and Collateral Ligaments
Right knee in flexion: anterior view Posterior cruciate ligament
Anterior cruciate ligament
Lateral condyle of femur (articular surface)
Medial condyle of femur (articular surface)
Medial meniscus
Popliteus tendon
Fibular collateral ligament —
Lateral meniscus
Medial condyle of tibia
mm Transverse ligament of kne
Right knee in extension: posterior view
Gerdy's tubercle
Posterior cruciate ligament Anterior cruciate ligament
Adductor tubercle on medial epicondyle of femur
Posterior meniscofemoral ligament Lateral condvle of femur (articular surface) /
Medial condyle of femur (articular surface)
Popliteus tendon Medial meniscus Fibular collateral ligament Tibial collateral ligament Lateral meniscus Head of fibula
faee
PDafe 509
7
7
Knee: Anteroposterior Radiograph
Plate 510
F
Fibula
FE
Femur
HF
Head of fibula
ICE
Intercondylar eminence
L
Lateral epicondyle
LCF
Lateral condyle of femur
LCT
Lateral condyle of tibia
M
Medial epicondyle
MCF
Medial condyle of femur
MCT
Medial condyle of tibia
P
Patella
T
Tibia
Knee: Posterior and Sagittal Views
Right knee: posterior view Femur (popliteal surface) A d d u c t o r magnus t e n d o n
A t t a c h m e n t of joint capsule
Medial head of gastrocnemius muscle and subtendinous bursa
Plantaris muscle Lateral head of gastrocnemius muscle and subtendinous bursa
Tibial collateral ligament Semimembranosus tendon
Fibular collateral ligament and its inferior Subtendinous bursa
O b l i q u e popliteal ligamen (tendinous expansion of semimembranosus muscle)
Biceps femoris t e n d o n and bursa beneath it
Semimembranosus bursa deep to t e n d o n ( b r o k e n
ate popliteal ligament (edge of capsule that arches over popliteus muscle)
Popliteus muscle
Head of fibula Posterior ligament of fibular head A t t a c h m e n t of joint capsule
Femur
Interosseous m e m b r a n e
Articularis genus muscle Quadriceps femoris t e n d o n Suprapatellar fat b o d y v
Lateral subtendinous bursa of gastrocnemius muscle
Suprapatellar (synovial) bursa
•
-
j,
vl^-
w m m m ^ -
Patella Subcutaneous prepatellar bursa Articular cavity Synovial m e m b r a n e
Synovial membrane
m ^ s & f r f r x * ^ Wm* " ^ t t
•Infrapatellar fat pad Subcutaneous infrapatellar bursa D e e p (subtendinous) infrapatellar bursa Lateral meniscus
Articular cartilages
Tibial tuberosity
A-;,
.
GCmee
VCV
Vv'-yy. V
Sagittal section (lateral to midline of knee)
Plate 511
7
Arteries of Thigh and Knee: Schema
Superficial epigastric artery
Superficial circumflex iliac artery
Superficial external pudendal artery Femoral artery
O b t u r a t o r artery Deep external pudendal artery Medial circumflex femoral artery
Ascending branch, Transverse branch, Descending branch of Lateral circumflex femoral artery
Femoral artery
Muscular branches
Profunda femoris (deep femoral) artery
Perforating branches
Femoral artery passing through a d d u c t o r hiatus Descending genicular artery Articular branch Saphenous branch
Superior medial genicular artery Superior lateral genicular a Popliteal artery
Patellar anastomosis
(phantom)
(phantom)
M i d d l e genicular artery
Inferior lateral genicular (partially in phantom)
Inferior medial genicular artery (partially in phantom)
Posterior tibial recurrent artery (phantom)
Anterior tibial recurrent artery
Circumflex fibular branch
Posterior tibial artery
Anterior tibial arter Interosseous m e m b r a n e
(phantom)
Fibular (peroneal) artery
(phantom)
•f-
Plate 512
Knee
Tibia and Fibula
Bones of right leg
Anterior intercondylar area
Anterior view
Posterior view
Intercondylar eminence
Intercondylar eminence
Lateral intercondylar tubercle
Medial intercondylar tubercle
Lateral condyle
Posterior intercondylar area
Medial intercondylar tubercle
Lateral intercondylar tubercle
Medial condyle
Apex, Head, Neck of fibula
Lateral condyle
Gerdy's tubercle (insertion of iliotibial tract)
Head, Neck fibu a
Oblique line
Groove for insertion of semimembranosus tendon
Tibial tuberosity Soleal lin^ Lateral surface
Lateral surface
Nutrientforamen
Anterior border
Anterior border
Interosseous border
Superior articular surfaces (medial and lateral facets)
Interosseous border
Interosseous border
Posterior surface
jfx
Posterior surface
Medial surface Medial surface
Medial border
Medial crest
Medial border Lateral surface
Tibia
Tibia
Fibula
Fibula
Posterior border Groove for tibialis posterior and flexor digitorum longus tendons Fibular notch Lateral malleolus
Articular facet of lateral malleolus
Leg
Medial malleolus
Inferior articular surface
Articular facet of medial malleolus
Medial malleolus
Articular facet of medial malleoli
Lateral malleolus
surface
Malleolar fossa of lateral malleolus
Plate 513
Tibia a n d Fibula ( c o n t i n u e d )
Anterior view w i t h ligament attachments lliotibial tract
Posterior ^ Anterior j
Fibular collateral ligament
Cruciate ligaments
Anterior border-
Interosseous border Lateral surface
Posterior intercondylar area (origin of posterior cruciate ligament)
Head
Intercondylar eminence
Fibula
Tibia
Anterior ligament of fibular head
Head of fibula
Gerdy's tubercle
Posterior ligament of fibular head
bial collateral ieament
Biceps femoris tendon
Anterior ligament of fibular head
Superior view
Patellar ligament
ial tuberosity
Medial condyle
Lateral condyle Superior articular surface (lateral facet)
Interosseous membrane
Medial ( Lateral (
Anterior intercondylar area (origin of anterior cruciate ligament)
Anterior border Interosseous border
Superior articular surface (medial facet) Intercondylar tubercles
Tibial tuberosity
Cross section Interosseous border
Lateral surface Anterior border
Interosseous membrane
Medial surface
Interosseous border
Tibia Lateral surface
Anterior border
Medial border
Lateral surface Fibula
Tibia
Posterior surface
Fibula
Medial surface Medial crest
Posterior border
Posterior surface
Inferior view Anterior tibiofibular ligament
Anterior tibi-.; "ibular ligament
Lateral malleolus
Calcaneofibular ligament
Plate 514
Articular facet of lateral malleolu Fibula Medial malleolus Medial (deltoid) ligament of ankle
Malleolar fossa of lateral malleolus Posterior , tibiofibular ligament
Articular facet of medial malleolus Medial malleolus Tibia Inferior articular surface of tibia
L e g
A t t a c h m e n t s of M u s c l e s of Leg
Posterior view
Anterior view
Gastrocnemius muscle (medial head) lliotibial tract
Plantaris muscle Gastrocnemius muscle (lateral head) Popliteus muscle
Semimembranosus muscle Sartorius muscle Fibularis (peroneus) longus muscle
Extensor digitorum longus muscle
Gracilis muscle Semitendinosus muscle
Soleus muscle
Tibialis posterior muscle
anterior Flexor digitorum longus muscle
Extensor hallucis longus muscle
Fibularis (peroneus) tertius muscle
Popliteus muscle
Quadriceps femoris muscle via patellar ligament
muscle
Fibularis (peroneus) brevis muscle
Pes anserinus
Origins Insertions Note: Attachments of intrinsic muscles of foot not shown
Tibialis posterior muscle
Flexor hallucis longus muscle
Fibularis (peroneus) brevis muscle
Plantaris muscle
Soleus and gastrocnemius muscles via calcaneal (Achilles) tendon
Fibularis (peroneus) brevis muscle Tibialis anterior muscle
Fibularis (peroneus) tertius muscle
Fibularis (peroneus) longus muscle
Extensor digitorum longus muscle
Extensor hallucis longus muscle
Leg
Flexor hallucis longus muscle
Flexor digitorum longus muscle
Plate S1S
Muscles of Leg (Superficial Dissection): Posterior View See also Plate 540
Semitendinosus muscle Semimembranosus muscle Gracilis muscle Popliteal artery and vein Sartorius muscle Superior medial genicular Gastrocnemius muscle (medial head) Nerve to soleus muscle
lliotibial tract Biceps femoris muscle nerve C o m m o n fibular (peroneal) nerve Superior lateral genicular artery Plantaris muscle astrocnemius muscle (lateral head) Lateral sural cutaneous nerve (cut) Medial sural cutaneous nerve (cut)
Small saphenous vein
Gastrocnemius muscle
Soleus muscle
Soleus muscle
Plantaris tendon
Flexor digitorum longus tendon Tibialis posterior tendon Posterior tibial artery and vei Tibial nerve Medial malleolus Flexor hallucis longus tendon Flexor retinaculu Calcaneal branch of posterior tibial
Plate 516
Fibuiaris (peroneus) longus tendon Fibularis (peroneus) brevis tendon Calcaneal (Achilles) tendon Lateral malleolus Superior fibular (peroneal) retinaculum Fibular (peroneal) artery Calcaneal branches of fibular (peroneal) artery Calcaneal tuberosity
Leg
Muscles of Leg (Intermediate Dissection): Posterior View See also Plate 541
Adductor magnus t e n d o n Popliteal artery and vein
nerve C o m m o n fibular (peroneal) nerve (cut) Superior lateral genicular artery
Superior medial genicular artery Gastrocnemius muscle (medial head) (cut) Tibial collateral ligament Semimembranosus tendon (cut)
Lateral and medial sural cutaneous nerves (cut) Gastrocnemius muscle (lateral head) (cut) Fibular collateral ligamentBiceps femoris tendon (cut) Plantaris muscle
Inferior medial genicular artery Popliteus muscle Tendinous arch of Soleus muscle Plantaris tendon
Inferior lateral genicular artery Head of fibula m m o n fibular (peroneal) nerve (cut) Nerve to soleus muscle Fibularis (peroneus) longus muscle
V
Gastrocnemius muscle (cut)
Soleus muscle
Soleus muscle inserting into calcaneal (Achilles) tendon
Flexor digitorum longus tendon Tibialis posterior t e n d o n Posterior tibial artery and vein Tibial ne Medial malleol Flexor hallucis longus tendo Flexor retinaculum Calcaneal (Achilles) tendon Calcaneal branch of posterior tibial a. ,
Leg
Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis tendon Lateral malleolus Superior fibular (peroneal) retinaculum Fibular (peroneal) artery Calcaneal branches of fibular (peroneal) artery Calcaneal tuberosity
Plate 517
Muscles of Leg (Deep Dissection): Posterior View See also Plate 541
Superior medial genicular artery Gastrocnemius muscle (medial head) (cut) Sural (muscular) branches Popliteal artery and tibial nerve Tibial collateral ligament Semimembranosus t e n d o n (cu Inferior medial genicular arte
Superior lateral genicular artery Plantaris muscle [cut) Gastrocnemius muscle (lateral head) (cut) Fibular collateral ligament Biceps femoris t e n d o n (cut) Inferior lateral genicular artery of fibula C o m m o n fibular (peroneal) nerve
Popliteus muscle Posterior tibial recurrent artery Tendinous arch of soleus muscle
Posterior tibial artery
Flexor d i g i t o r u m longus muscle
eus muscle (cut and
reflected)
Anterior tibial artery
Fibular (peroneal) artery
Tibial nerve Flexor hallucis longus muscle
(retracted)
Tibialis posterior muscle
Fibular (peroneal) artery
Calcaneal (Achilles) t e n d o n (cut)
Interosseous m e m b r a n e
Flexor digitorum longus t e n d o n
Perforating branch \ C o m m u n i c a t i n g branch \
Tibialis posterior t e n d o n Medial malleolus and posterior medial malleolar branch of posterior tibial Flexor retinaculum M e d i a l calcaneal branches of posterior tibial artery and tibial nerve Tibialis posterior tendon Medial plantar artery and nerve Lateral plantar artery and nerve Flexor hallucis longus tendon 1 st metatarsal b o n e
Plate 518
of fibular (peroneal) artery
Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis t e n d o n Lateral malleolus and posterior lateral malleolar branch of fibular (peroneal) artery Superior fibular (peroneal) retinaculum Lateral calcaneal branch of fibular (peroneal) artery Lateral calcaneal branch of sural nerve Inferior fibular (peroneal) retinaculum Fibularis (peroneus) brevis t e n d o n Fibularis (peroneus) longus tendon Flexor d i g i t o r u m longus t e n d o n 5th metatarsal b o n e
Leg
Muscles of Leg (Superficial Dissection): Anterior View See also Plate 542
Vastus lateralis muscle Rectus femoris tendon (becomi quadriceps femoris tendon) lliotibial tract Superior lateral genicular artery Lateral patellar retinaculum Biceps femoris tendon Inferior lateral genicular C o m m o n fibular (peroneal) nerve Head of fibula
Vastus medialis muscle Patella Superior medial genicular artery bial collateral ligament Medial patellar retinaculum Inferior medial genicular artery Infrapatellar branch (cut) of Saphenous nerve (cut) Joint capsule Patellar ligament Insertion of sartorius muscle
Fibularis (peroneus) longus muscle
Tibial tuberosity bia
Tibialis anterior muscle Gastrocnemius muscle Superficial fibular (peroneal) nerve (cut) Soleus muscle Fibularis (peroneus) brevis muscle
Extensor digitorum longus muscle
Extensor hallucis longus muscle
Fibula Superior extensor retinaculum
Medial malleolus
Lateral malleolus Inferior extensor retinaculum Extensor digitorum longus tendons Fibularis (peroneus) tertius tendon Extensor digitorum brevis tendons
ialis anterior tendon Medial branch of deep fibular (peroneal) nerve Extensor hallucis longus tendon Extensor hallucis brevis tendon Dorsal digital branches of deep fibular (peroneal) nerve
Dorsal digital nerves
Leg
Plate 519
7
Muscles of Leg (Deep Dissection): Anterior View See also Plate 542
Superior medial genicular artery
Superior lateral genicular artery
Quadriceps femoris t e n d o n
Fibular collateral ligament
collateral ligament
Lateral patellar retinaculum
Medial patellar retinaculum
Iliotibial tract (cu Biceps femoris tendon (cut) Inferior lateral genicular a C o m m o n fibular (peroneal) nerve Head of fibula Fibularis (peroneus) longus muscle (cu Anterior tibial artery Extensor digitorum longus muscle (cu Superficial fibular (peroneal) nerve Deep fibular (peroneal) nerve Fibularis (peroneus) longus muscle
Infrapatellar branch of saphenous nerve (cut) Inferior medial genicular artery Saphenous nerve (cut) Patellar ligament Insertion of sartorius tendon Anterior tibial recurrent artery and recurrent branch of deep peroneal nerve Interosseous membrane ibialis anterior muscle (cut) Gastrocnemius muscle
Extensor digitorum longus muscle Fibularis (peroneus) brevis muscle and tendon
Soleus muscle Tibia Superficial fibular (peroneal) nerve (cut) Extensor hallucis longus muscle and tendon (cut)
Fibularis (peroneus) longus tendon Perforating branch of fibular (peroneal) artery Anterior lateral malleolar arte Lateral malleolus and arterial network Lateral tarsal artery and lateral branch of deep fibular (peroneal) Extensor digitorum brevis and extensor hallucis brevis muscles (cu Fibularis (peroneus) brevis tendon Posterior perforating branches from deep plantar arch
Interosseous membrane Anterior medial malleolar artery Medial malleolus and arterial network Dorsalis pedis artery ialis anterior tendon Medial tarsal artery Medial branch of deep fibular (peroneal) nerve Arcuate artery Deep plantar artery
Extensor digitorum longus tendons
Dorsal metatarsal arteries
Extensor digitorum brevis tendons (cu
Extensor hallucis longus tendon (cut)
Dorsal digital arteries Branches of proper plantar digital arteries and nerves
Plate 520
Extensor hallucis brevis tendon (cut) Dorsal digital branches of deep fibular (peroneal) nerve
Leg
Muscles of Leg: Lateral View See also Plate 542
Vastus lateralis muscle Biceps femoris muscle
Long head
lliotibial tract
Short head
Quadriceps femoris t e n d o n
Tendon
Superior lateral genicular artery Patella
Fibular collateral ligament Lateral patellar retinaculum C o m m o n fibular (peroneal) nerve
Lateral c o n d y l e of tibia Patellar ligament
Inferior lateral genicular artery
Tibial tuberosity Head of fibula
Gastrocnemius muscle
Soleus muscle
Extensor d i g i t o r u m longus muscle
Fibularis (peroneus) longus muscle and t e n d o n
Superficial fibular (peroneal) nerve (cut)
Extensor d i g i t o r u m longus t e n d o n Extensor hallucis longus muscle and t e n d o n
Fibularis (peroneus) brevis muscle and t e n d o n
Superior extensor retinaculum Inferior extensor retinaculum
Fibula
xtensor d i g i t o r u m brevis muscle
Lateral malleolus
Extensor hallucis longus t e n d o n
Calcaneal (Achilles) t e n d o n
Extensor d i g i t o r u m longus tendons
(Subtendinous) bursa of tendocalcaneus
Fibularis (peroneus) brevis t e n d o n
Superior fibular (peroneal) retinaculum
Fibularis (peroneus) tertius t e n d o n 5th metatarsal bone
Inferior fibular (peroneal) retinaculum ,
•>»
v >
Fibularis (peroneus) longus t e n d o n passing to sole o f f o o t
Leg
Plate 521
7
Leg: Cross Sections and Fascial Compartments
Deep fascia of leg (crural fascia)
Interosseous membrane
Anterior compartment Extensor muscles Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis (peroneus) tertius Anterior tibial artery and veins Deep fibular (peroneal) nerve
Deep posterior c o m p a r t m e n t Deep flexor muscles Flexor digitorum longus Tibialis posterior Flexor hallucis longus Popliteus Posterior tibial artery and veins Tibial nerve Fibular (peroneal) artery and veins
Anterior intermuscular septum Lateral c o m p a r t m e n t Fibularis (peroneus) longus muscle Fibularis (peroneus) brevis muscle Superficial fibular (peroneal) nerve
intermuscular septum Superficial posterior c o m p a r t m e n t Superficial flexor muscles Soleus Gastrocnemius Plantaris (tendon)
Posterior intermuscular septum
Deep fascia of leg (crural fascia)
Cross section just above middle of leg Tibialis anterior
Anterior tibial artery and'veins and deep fibular (peroneal) nerve
Extensor hallucis longus muscle a
Extensor digitorum longus muscle
Interosseous membrane
Superficial fibular (peroneal) n
Great saphenous vein and saphenous nerve
Anterior intermuscular septum
Tibialis posterior muscle
Deep fascia of (crural fascia) Fibularis (peroneus) longus muscle
Flexor digitorum longus muscle Fibular (peroneal) artery and veins
Fibularis (peroneus) brevis muscle
Posterior tibial artery and veins and tibial nerve
Posterior intermuscular septum Fibu
Flexor hallucis longus muscle
Lateral sural cutaneous nerve
Deep fascia of leg (crural fascia)
Transverse intermuscular septum
Plantaris tendon
Soleus muscle Gastrocnemius muscle (lateral head) Sural communicating branch of lateral sural cutaneous nerve
Plate 522
«*
Gastrocnemius muscle (medial head) Medial sural cutaneous nerve Small saphenous vein
Bones of Foot
Dorsal view Calcaneus Body Fibular (peroneal) trochlea Tarsal sinus Transverse tarsal joint
Lateral tubercle al tubercle Groove for tendon of flexor hallucis longus Trochlea
Metatarsal bones
>
Talus
Neck Head
Cuboid Tuberosity of 5th metatarsal bone
Posterior process
Navicular Tuberosity Lateral Intermediate Medial
C u n e i f o r m bones
Tarsometatarsal joint Base
Plantar view
Shaft (body)
Lateral tubercle
Phalanges Proximal
Head
Middle Distal
Medial tubercle
Talus
Base
Posterior process
Shaft (body)
Head
Head
Transverse tarsal joint
Base
Navicular Tuberosity
.uberosity C u n e i f o r m bones
Lateral Intermediate Medial
Calcaneus Tuberosity Medial process Lateral process Sustentaculum tali Groove for tendon of flexor hallucis longus Fibular (peroneal) trochlea Cuboid Tuberosity Groove for fibularis (peroneus) longus tendon Tuberosity of 5 th metatarsal bone
Tarsometatarsal joint Shaft (body) Metatarsal bones .,. f Medial Sesamoid bones j ^ ^
c
Proximal Phalanges -<
Head Base Shaft (body) Head Base Head Base Tuberosity
Middle Distal
Ankle and Foot
Plate 523
7
Bones of Foot (continued)
Lateral view Transverse tarsal joint
Head Talus
Navicular Intermediate
Trochlea
C u n e i f o r m bones
Lateral
Lateral process Tarsometatarsal joint
Posterior process
Metatarsal bones Tarsal sinus
Phalanges
Fibular (peroneal) trochlea Calcaneus
< Tuberosity Tuberosity of 5th metatarsal bone
Groove for fibularis (peroneus) longus tendon
/
Groove for fibularis I (peroneus) longus tendon
Medial view Transverse tarsal joint Navicular — Tuberosity C u n e i f o r m bones J
Intermediate Medial
Tarsometatarsal joint
Neck
Talus Head
Posterior process
Metatarsal bones
Tuberosity
Sesamoid bone
Groove for tendon of flexor hallucis longus
>
Calcaneus
Sustentaculum tali
Plate 524
Ankle and Foot
Calcaneus
Right f o o t
Posterior talar articular surface
Articular surface for cuboid bone
Anterior talar articular surface
Middle talar articular surface Anterior talar articular surface
Middle talar articular surface Articular surface for cuboid bone /
f" 1 1
Tuberosity Lateral process of tuberosity
^Fibular (peroneal) trochlea
Fibular (peroneal) trochlea
Sustentaculum tali
Groove for fibularis (peroneus) longus tendon Lateral view
Anterior talar articular surface
1
Posterior talar articular surface
Calcaneal sulcus
M i d d l e talar articular surface
Tuberosity
Posterior talar articular surface
Superior view
M i d d l e talar articular surface
Articular surface for c u b o i d bone
Tuberosity
Posterior talar articular surface
Sustentaculum tali
Sustentaculum tali
Groove for tendon of flexor hallucis longus
Medial process of tuberositv
M e d i a l view
Fibula Interosseous membrane Posterior tibiofibular ligament
Medial (deltoid) ligament of ankle-
Posterior talocalcaneal ligament
Groove for tendon of flexor hallucis l o n g u s Medial process of tuberosity
Fibular (peroneal) trochlea j' r
Lateral process of tuberosity
Tuberosity Posterior view
Posterior talofibular ligament Calcaneofibular ligament Fibular (peroneal) tendons in inferior fibular (peroneal) retinaculum Critical Posterior view with ligaments
angle
^^-Ji
Functional relations of calcaneus
7
Ankle: Radiographs
Lateral view
c CB F HT LC N PT ST T TC TM TT
Anterior view F LM MM T TA
Fibula Lateral malleolus Medial malleolus Tibia Talus
Calcaneus Cuboid Fibula Head of talus Lateral cuneiform Navicular Posterior process of talus Sustentaculum tali of calcaneus Tibia Tuberosity of calcaneus Tuberosity of 5th metatarsal Trochlea of talus
Ligaments and Tendons of Ankle
Right foot: lateral view
i Posterior talofibular ligament ) Components of lateral Calcaneofibular ligament > (collateral) ligament Anterior talofibular ligament \ of ankle
Fibula Anterior and Posterior tibiofibular ligaments
Interosseous talocalcaneal ligament Dorsal talonavicular ligament Calcaneonavicular ligament
(
caneocuboid ligament
J
__ Blfurcate
h
^ament
Dorsal cuboideonavicular ligament
Superior fibular (peroneal) retinaculum
Dorsal cuneonavicular ligaments Dorsal intercuneiform ligaments Dorsal tarsometatarsal ligaments
Calcaneal (Achilles) tendon (cut)
Inferior fibular (peroneal) retinaculum
Dorsal metatarsal ligaments
Lateral talocalcaneal ligament
Dorsal c u n e o c u b o i d ligament
Long plantar ligament
Cuboid bone
Fibularis (peroneus) longus
Dorsal calcaneocuboid ligament
Fibularis (peroneus) brevis Right foot: medial view
Posterior tibiotalar part Medial (deltoid) ligament of ankle )
Medial talocalcaneal ligament
Tibiocalcaneal part Tibionavicular part Anterior tibiotalar part
Posterior process of talus
Dorsal talonavicular ligament Posterior talocalcaneal igament
Navicular bone Dorsal cuneonavicular ligaments Medial cuneiform bone
Calcaneal (Achilles) tendon (cut)
Dorsal intercuneiform ligament Dorsal tarsometatarsal ligaments
u ...
1st metatarsal bone Tuberosity
ii i
^
J
j ,
•;
^y^i
Tibialis anterior tendon Tibialis posterior tendon
„
Short plantar ligament Plantar calcaneonavicular (spring) ligament
Sustentaculum tali ^ L o n g plantar ligament
7
7
Ligaments and Tendons of Foot: Plantar View
Flexor digitorum longus tendon to 2nd toe [cut)
Distal phalanx of great toe
Flexor digitorum brevis tendon to 2nd toe (cut)
nterphalangeal (IP) joint
4th distal phalanx
Flexor hallucis longus tendon (cut)
4th middle phalanx
Proximal phalanx of great toe
Deep transverse metatarsal ligaments Metatarsophalangeal (MP) joint
5th proximal phalanx
Sesamoid bones
4th lumbrical tendon (cut)
A b d u c t o r hallucis and medial head of flexor hallucis brevis tendons (cut)
A b d u c t o r digiti minimi and flexor digiti minimi brevis tendons (cut)
Adductor hallucis and lateral head of flexor hallucis brevis tendons (cut)
Plantar ligaments (plates) Interosseous muscles (cut)
1 st metatarsal bone
5th metatarsal bone
Plantar tarsometatarsal ligaments
Plantar metatarsal ligaments
Medial cuneiform bone
Tuberosity of 5th metatarsal bone
Tibialis anterior tendon (cut)
Fibularis (peroneus) brevis tendon
Plantar cuneonavicular ligament
Cuboid bone
Plantar cuboideonavicular ligament
Fibularis (peroneus) longus t e n d o n
Tuberosity of navicular bone Plantar calcaneonavicular (spring) ligament
Tuberosity of cuboid bone Long plantar ligament
Tibialis posterior tendon
Plantar calcaneocuboid (short plantar) ligament
Flexor digitorum longus tendon (cut) Sustentaculum tali
Calcaneus
Flexor hallucis longus tendon (cut)
Medial process and Lateral process of Tuberosity of calcaneus
Posterior process of talus (medial and lateral tubercles)
Phalanges A
Joint capsule Metatarsal bone
Distal Capsules and ligaments of metatarsophalangeal a n d interphalangeal joints: lateral view
Collateral ligaments
Plantar ligament (plate)
T e n d o n S t e a t i t e ©f
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Lateral view
Soleus muscle
Extensor digitorum longus muscle
Fibularis (peroneus) longus muscle
Superior extensor retinaculum /Tendinous sheath of tibialis anterior
Fibularis (peroneus) brevis muscle
Lateral malleolus and subcutaneous bursa
Calcaneal (Achilles) tendon
Inferior extensor retinaculum
C o m m o n tendinous sheath of fibularis (peroneus) longus and brevis
Tendinous sheath of extensor digitorum longus and fibularis (peroneal) tertius Tendinous sheath of extensor hallucis longus
Subcutaneous calcaneal bursa (Subtendinous) bursa of calcaneal tendon Superior and Inferior fibular (peroneal) retinacula Calcaneus Extensor digitorum brevis muscle
Fibularis (peroneus) longus tendon
A b d u c t o r digiti minimi muscle
M e d i a l view
Tibialis anterior tendon and sheath Tibia Sheath of tibialis posterior tendon Superior extensor retinaculum Medial malleolus and subcutaneous bursa Inferior extensor retinaculum Tibialis posterior tendon and sheath Tibialis anterior t e n d o n and sheath
Fibularis (peroneus) brevis tendon
Fibularis (peroneus) tertius tendon Tuberosity of 5th metatarsal bone
Calcaneal (Achilles) tendon Tendinous sheath of flexor digitorum longus Posterior tibial artery and tibial nerve Tendinous sheath of flexor hallucis longus Subcutaneous calcaneal bursa
Tendinous sheath of extensor hallucis longus
(Subtendinous) bursa of calcaneal tendon Flexor retinaculum Calcaneus Lateral plantar nerve Medial plantar nerve Tendinous sheath of flexor digitorum longus
A b d u c t o r hallucis muscle {cut) Plantar aponeurosis (cut) Flexor digitorum brevis muscle (cut)
7
Muscles of Dorsum of Foot: Superficial Dissection
Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) brevis muscle Fibularis (peroneus) longus tendo Extensor digitorum longus muscle and tendon Superior extensor retinaculum Fibula Perforating branch of fibular (peroneal) artery Lateral malleolus and anterior lateral malleolar artery Inferior extensor retinaculum Lateral tarsal artery and lateral branch of deep peroneal nerve (to muscles of dorsum of foot)
bialis anterior tendon Anterior tibial artery and deep fibular (peroneal) nerve Tibia Extensor hallucis longus tendon Tendinous sheath of extensor digitorum longus Medial malleolus Tendinous sheath of tibialis anterior Tendinous sheath of extensor hallucis longus terior medial malleolar artery Dorsalis pedis artery and medial branch of deep fibular (peroneal) nerve Medial tarsal artery
Fibularis (peroneus) brevis tendon Arcuate artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tend Extensor digitorum brevis and extensor hallucis brevis muscles Extensor digitorum longus tend Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Dorsal metatarsal arteries Dorsal digital arteries Dorsal branches of proper plantar digital arteries and nerves —
Deep plantar artery passing between heads of 1 st dorsal interosseous muscle to join deep plantar arch Extensor hallucis longus tendon Extensor expansions
Dorsal digital branches of deep fibular (peroneal) nerve
Dorsal digital branches of superficial fibular (peroneal) nerve
Dorsum of Foot: Deep Dissection
Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis muscle and tendon Extensor digitorum longus muscle and t e n d o n Fibula Perforating branch of fibular (peroneal) artery Anterior lateral malleolar artery Lateral malleol Lateral branch of deep peroneal nerve (to muscles of dorsum of foot) and lateral tarsal artery Fibularis (peroneus) longus tendon (cut)
Soleus muscle Tibialis anterior muscle and tendon bia nterior tibial artery and deep fibular (peroneal) nerve Extensor hallucis longus muscle and tendon terior medial malleolar artery Medial malleolus Dorsalis pedis artery Medial branch of deep fibular (peroneal) nerve Medial tarsal arteries Tuberosity of navicular bone /
Extensor digitorum brevis and extensor hallucis brevis muscles (cut) Fibularis (peroneus) brevis tendon (cu Fibularis (peroneus) tertius tendon (cut) A b d u c t o r digiti minimi muscle Dorsal metatarsal arteries
Arcuate artery Posterior perforating branches deep plantar arch Deep plantar artery to deep plantar arch uctor hallucis muscle Extensor hallucis longus tendon
Metatarsal bones Dorsal interosseous muscles Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Anterior perforating branches from plantar metatarsal arteries Dorsal digital arteries — Dorsal branches of proper plantar digital arteries and nerves
Extensor hallucis brevis tendon (cut) Extensor digitorum brevis tendons (cut) Extensor digitorum longus tendons (cut) Extensor expansions Dorsal digital branches of deep fibular (peroneal) nerve Dorsal digital branches of superficial fibular (peroneal) nerve
7
7
Sole of Foot: Superficial Dissection
Superficial transverse metatarsal ligaments-
Proper plantar digital arteries and nerves
Superficial branch of medial plantar artery
Transverse fasciculi
Digital slips of plantar aponeurosis
Lateral plantar fascia
Medial plantar fascia
Cutaneous branches of lateral plantar artery and nerve Cutaneous branches of medial plantar artery and nerve
Lateral band of plantar aponeurosis (calcaneometatarsal ligament)
Plantar aponeurosis
Medial calcaneal branches of tibial nerve and posterior tibial artery Tuberosity of calcaneus w i t h overlying fat pad (partially cut away)
Muscles of Sole of Foot: First Layer
Proper plantar digital branches of medial plantar nerve
Proper plantar digital branches of lateral plantar nerve Proper plantar digital arteries
C o m m o n plantar digital arteries from plantar metatarsal arteries
Lumbrical muscles Fibrous sheaths of flexor tendons
Flexor digitorum brevis overlying Flexor digitorum longus tendons
Superficial branch of medial plantar artery
Lateral head and Medial head of flexor hallucis brevis muscle
Flexor hallucis longus tendon Plantar metatarsal branch of lateral plantar artery
Abductor hallucis muscle and tendon
Flexor digitorum brevis muscle
Abductor digiti minimi muscle (deep to lateral plantar fascia)
Plantar aponeurosis (cut) Medial process and Lateral process of Tuberosity of calcaneus
Medial calcaneal branches of tibial nerve and posterior tibial artery
7
7
Muscles of Sole of Foot: Second Layer
Proper plantar digital branches of medial plantar nerve
Flexor digitorum longus tendons Proper plantar digital branches of lateral plantar nerve
Flexor digitorum brevis tendons Fibrous sheaths (opened) Sesamoid bones C o m m o n plantar digital nerves and arteries Lumbrical muscles
Flexor digiti minimi brevis muscle
Lateral head and Medial head of flexor hallucis brevis muscle Flexor hallucis longus tendon
Superficial branch and Deep branch of lateral plantar nerve
Lateral plantar nerve and artery
uctor hallucis tendon and muscle {cut) Flexor digitorum longus tendon
Superficial and deep branches of medial plantar artery Medial plantar artery and nerve
Quadratus plantae muscle
Tibialis posterior tendon Flexor hallucis longus tendon
Nerve to abductor digiti minimi mu (from lateral plantar nerve)
Posterior tibial artery and tibial nerve (dividing) Flexor retinaculum
Flexor digitorum brevis muscle and plantar aponeurosis (cut)
Lateral calcaneal nerve and artery (from sural nerve and fibular [peroneal] artery
A b d u c t o r hallucis muscle (cut) Medial calcaneal artery and nerve Tuberosity of calcaneus
Muscles of Sole of Fool: Third Layer
Proper plantar digital branches of medial plantar nerve
Proper plantar digital branches of lateral plantar nerve Proper plantar digital branch of superficial branch of medial plantar artery Anterior perforating arteries to dorsal metatarsal arteries Tendons of lumbrical muscles (cut) Sesamoid bones Flexor digitorum longus tendons
Transverse head and Oblique head of adductor hallucis muscle
Flexor d i g i t o r u m brevis tendons {cut)
Medial head and Lateral head of flexor hallucis brevis muscle
Flexor digiti minimi brevis muscle
Plantar metatarsal arteries
Superficial branches of medial plantar artery and nerve
Plantar interosseous muscles
Flexor hallucis longus t e n d o n (cut)
Superficial branch of lateral plantar nerve
A b d u c t o r hallucis muscle (cut)
Deep plantar arterial arch and deep branches of lateral plantar nerve
Deep branches of medial plantar artery and nerve
Tuberosity of 5th metatarsal b o n e
Flexor d i g i t o r u m longus t e n d o n (cut) Tibialis posterior t e n d o n
Peroneus brevis t e n d o n
Medial plantar artery and nerve
Peroneus longus t e n d o n and fibrous sheath
Flexor hallucis longus t e n d o n Quadratus plantae muscle (cut and slightly retracted)
Flexor retinaculum A b d u c t o r hallucis muscle (cut)
Lateral plantar artery and nerve A b d u c t o r digiti minimi muscle (cut) Lateral calcaneal artery and nerve Tuberosity of calcaneus
fljw . 5 i-
Flexor digitorum brevis muscle and plantar aponeurosis (cut) M e d i a l calcaneal artery and nerve
7
Interosseous Muscles and Deep Arteries of Foot
Dorsal view
Fibularis (peroneus) longus tendon (cut) Fibularis (peroneus) brevis tendon (cut) Cuboid bone Lateral tarsal artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tendon (cut) Posterior perforating branches (from deep plantar arterial arch) Dorsal metatarsal arteries Extensor digitorum longus tendons (cu
Navicular bone Dorsalis pedis artery Medial tarsal artery Lateral ) Intermediate / Cuneiform bones Medial ) Dorsal tarsometatarsal ligaments Dorsal metatarsal ligaments artery Deep plantar artery passes to contribute to deep plantar arch interosseous muscles
Metatarsal bones
Extensor expansions Anterior perforating branches (from plantar metatarsal arteries)
Extensor hallucis longus tendon (cut) Extensor digitorum brevis and extensor hallucis brevis tendons (cut)
Dorsal digital arteries
Plantar view
Proper plantar digital arteries C o m m o n plantar digital arteries Lumbrical muscles (cut) Deep transverse metatarsal ligament and plantar ligaments (plates) Interosseous muscles
Plantar Dorsal
A b d u c t o r digiti minimi muscles Plantar metatarsal arteries Flexor digiti minimi brevis muscle Deep plantar arch Lateral plantar artery (cut) Tuberosity of 5th metatarsal bone Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis tendon Tuberosity of cuboid bone Long plantar li Calcaneocuboid (short plantar) ligament
Flexor hallucis longus tendon (cut) Anterior perforating branches (to dorsal metatarsal arteries) Sesamoid bones Insertion of adductor hallucis and lateral head of flexor hallucis brevis muscles (cut) Insertion of abductor hallucis and medial head of flexor hallucis brevis muscles (cut) Medial origin of flexor hallucis brevis muscle (cut) Deep plantar artery (from dorsalis pedis artery) Posterior perforating branches (to dorsal metatarsal arteries) Plantar metatarsal ligaments (between bases of metatarsal bones) Medial cuneiform bone bialis anterior tendon (cut) Lateral origin of flexor hallucis brevis tendon (cut) berosity of navicular bone Tibialis posterior tendon (cut) Plantar calcaneonavicular (spring) ligament
Interosseous Muscles of Foot
Dorsal view
Cuboid Tuberosity of 5th metatarsal b o n e
Navicular
Lateral Intermediate > C u n e i f o r m bones Medial
Dorsal interosseous muscles (bipennate)
5th metatarsal b o n e
I Proximal phalanx Little \ (5th) < M i d d l e phalanx toe / ( Distal phalanx
1 st metatarsal b o n e
Proximal phalanx of great toe
Distal phalanx of great toe
Plantar view
Distal phalanx of great toe
Proximal phalanx of great toe Distal phalanx
Sesamoid bones
M i d d l e phalanx Proximal phalanx
1 st metatarsal b o n e Plantar interosseous muscles (unipennate)
5th metatarsal bo
Lateral / Intermediate / Medial \
Tuberosity of 5th metatarsal b o n e Cuboid
Navicular
C u n e i f o r m bones
7
Femoral Nerve and Lateral Femoral Cutaneous Nerve
Lateral femoral cutaneous nerve (L2, 3) Femoral nerve (12, 3, 4)
>
Lumbar plexus
O b t u r a t o r nerve Lumbosacral trunk lliacus muscle Psoas major muscle (lower pa Articular branch Sartorius muscle (cut and reflected) Pectineus muscle
Rectus femoris muscle (cut and reflected) Quadriceps femoris -< muscle
Vastus intermedius muscle
Lateral femoral cutaneous nerve
Anterior cutaneous branches of femoral nerve Sartorius muscle (cut and reflected)
Vastus meclialis muscle Vastus lateralis muscle
Saphenous nerve
Articularis genus muscle
Infrapatellar branch of saphenous nerve
Note: O n l y muscles innervated by femoral nerve shown
Medial crural cutaneous nerves (branches of saphenous nerve)
Cutaneous innervation
7
Obturator Nerve
Iliohypogastric nerve >• Lumbar plexus Ilioinguinal nerve
Genitofemoral nerve
Lumbosacral trunk
Lateral femoral cutaneous nerve
Femoral nerve Obturator externus muscle
Obturator nerve (L2, 3, 4)
Posterior branch
Articular branch A d d u c t o r brevis muscle Anterior branch
A d d u c t o r longus muscle (cut) \
A d d u c t o r magnus muscle (ischiocondylar, or hamstrings/' part supplied by sciatic [tibial! nerve)
Posterior branch
Cutaneous branch
V
I
Gracilis muscle
A
Articular branch to knee joint
i
/
A d d u c t o r hiatus
Note: Only muscles innervated by obturator nerve shown Cutaneous innervation
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7
Sciatoe Merwe and Posterior Femoral ©MfameoMS Merwe
Posterior femoral cutaneous nerve (SI, 2 , 3 )
Greater sciatic foramen Inferior clunial nerves Sciatic nerve (L4, 5, SI, 2, 3)
Perineal branches
C o m m o n fibular (peroneal) division of sciatic nerve
Tibial division of sciatic nerve
Long head (cut) of biceps femoris muscle
Short head of biceps femoris muscle
Adductor magnus muscle (also partially supplied by obturator nerve)
^ , • Cutaneous innervation
Long head (cut) of biceps femoris muscle
Semitendinosus muscle
Semimembranosus muscle
Tibial nerve
Common fibular (peroneal) nerve
Articular branch
Posterior femoral cutaneous nerve
Articular branch
Plantaris muscle
Medial sural cutaneous nerve
Lateral sural cutaneous nerve
Sural communicating branch
Gastrocnemius muscle
Sural nerve
Soleus muscle
Medial sural cutaneous nerve From sciatic nerve
Tibial nerve
Medial calcaneal branches
Medial and lateral plantar nerves
C o m m o n fibular (peroneal) nerve via lateral sural cutaneous nerve
Superficial fibular (peroneal) nerve Sural nerve
Lateral calcaneal branches
Lateral dorsal cutaneous nerve
Tibial nerve via medial calcaneal branches
Tibial Nerve
C o m m o n fibular (peroneal) nerve
Tibial nerve (L4, 5, SI, 2, 3)
Articular branch Lateral sural cutaneous nerve (cut)
Medial sural cutaneous nerve (cut)
Medial calcaneal branches (SI, 2)
Articular branches
Medial plantar nerve (L4, 5)
From tibial nerve
Plantaris muscle
Lateral plantar nerve (SI, 2)
Gastrocnemius muscle (cut)
Saphenous nerve (L3, 4) Sural nerve (SI, 2) via lateral calcaneal and lateral dorsal cutaneous branches
Nerve to popliteus muscle
Popliteus muscle
Interosseous nerve of leg
Cutaneous innervation of sole
Flexor retinaculum (cut)
Soleus muscle (cut partly retracted)
Flexor cli longus muscle
Tibialis posterior m
Flexor hallucis longus muscle
Sural nerve
Lateral calcaneal branch
Medial calcaneal branch
Flexor retinaculum (cut)
Lateral dorsal cutaneous nerve
Tibial nerve
Medial calcaneal branch Medial plantar nerve
Flexor d i g i t o r u m brevis muscle and nerve A b d u c t o r hallucis muscle and nerve Flexor hallucis brevis muscle and nerve 1st lumbrical muscle and nerve Common plantar digital nerves Proper plantar digital nerves
Lateral calcaneal branch of sural nerve Lateral plantar nerve
N e r v e to abductor digiti minimi muscle Quadratus plantae muscle and nerve A b d u c t o r digiti minimi muscle Deep branch to interosseous muscles, 2nd, 3rd, and 4th lumbrical muscles and A d d u c t o r hallucis muscle uperficial branch t o 4th interosseous muscle and Flexor digiti minimi brevis muscle
C o m m o n and Proper plantar digital nerves
Note: Articular branches not s h o w n
7
Common Fibular (Peroneal) Nerve W S V f i K y . ' - i W • sr.*
See also Plates 520, 521
C o m m o n fibular (peroneal) nerve (phantom)
Lateral sural cutaneous nerve
(phantom)
Articular branches Biceps femoris t e n d o n Recurrent articular nerve Common fibular nerve (L4, 5, SI, 2)
Extensor d i g i t o r u m longus muscle (cut)
Head of fibula Deep fibular (peroneal) nerve
Fibularis (peroneus) longus muscle (cu
bialis anterior muscle
Cutaneous innervation
Superficial fibular (peroneal) nerve
Branches of lateral sural cutaneous nerve
Fibularis (peroneus) longus muscle
Extensor d i g i t o r u m longus muscle
Extensor hallucis longus muscle
Fibularis (peroneus) brevis muscle Lateral sural cutaneous nerve
Medial dorsal cutaneous nerve
Intermediate dorsal cutaneous nerve
Inferior extensor retinaculum (partially
cut)
Lateral dorsal cutaneous nerve (branch of sural nerve)
Superficial fibular (peroneal) nerve Lateral branch of deep fibular (peroneal) nerve to Extensor hallucis brevis and Extensor d i g i t o r u m brevis muscles Medial branch of deep fibular (peroneal) nerve
Deep fibular (peroneal) nerve
Sural nerve via lateral dorsal cutaneous branch
Dermatomes of Lower Limb
Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any t w o adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).
Autonomous sensory zones A
SI
Anterior
Posterior view
Segmental innervation of lower limb m o v e m e n t s
Knee
Extension
Dorsiflexion
Flexion
Foot
14, 5
Ankle Flexion
Extension
Plantar flexion
7
Superficial Nerves and Veins of Lower Limb: Anterior View
Lateral cutaneous branch of subcostal nerve Superficial epigastric vein Inguinal ligament (Poupart's) Superficial circumflex iliac vein Femoral branches of genitofemoral Lateral femoral cutaneous Saphenous opening (fossa ovalis) Fascia lata
Ilioinguinal nerve (scrotal branch) (usually passes through superficial inguinal ring) Genital branch of genitofemoral nerve Femoral vein uperficial external pudendal vein Accessory saphenous vein Great saphenous vein
Anterior cutaneous branches of femoral nerve Cutaneous branches of obturator nerve
Patellar nerve plexus
Branches of lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve Deep fascia of leg (crural fascia)
Infrapatellar branch of saphenous nerve
Saphenous nerve (terminal branch of femoral nerve)
Great saphenous vein
Superficial fibular (peroneal) nerve Medial dorsal cutaneous branch Intermediate dorsal cutaneous branch
Small saphenous vein and lateral dorsal cutaneous nerve (from sural nerve) Lateral dorsal digital nerve and vein of 5th
Dorsal digital nerves
Dorsal venous arch
Dorsal digital nerve and vein of medial side of great toe Dorsal metatarsal veins Dorsal digital branch of deep fibular (peroneal) nerve Dorsal digital nerves and veins
Superficial Nerves and Veins of Lower Limb: Posterior View
Lateral cutaneous branch of iliohypogastric nerve Iliac crest Medial clunial nerves (from dorsal rami of S1, 2, 3)
Superior clunial nerves (from dorsal rami of LI, 2, 3) Inferior clunial nerves (from posterior femoral cutaneous nerve)
Perforating cutaneous nerve (from dorsal rami of SI, 2, 3)
Branches of posterior femoral cutaneous nerve
Branches of lateral femoral cutaneous nerve
Accessory saphenous vein
Branch of femoral cutaneous nerve Branch of cutaneous branch of femoral nerve
Terminal branches of posterior femoral cutaneous nerve
Great saphenous vein
Lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve)
Small saphenous vein Sural c o m m u n i c a t i n g nerve Branches of saphenous nerve — Medial sural cutaneous nerve (from tibial nerve)
Sural nerve
Lateral calcaneal branches of sural nerve
Lateral dorsal cutaneous nerve (continuation of sural nerve)
Medial calcaneal branches of tibial nerve
Plantar cutaneous branches of medial plantar nerve
V mw&m^M
Plantar cutaneous branches of lateral plantar nerve
7
Lymph Vessels and Nodes of Lower Limb See also Plates 407, 408
Popliteal vein Popliteal lymph nodes
Cribriform fascia within saphenous opening
Horizontal group: Superolateral nodes Superomedial ^ nodes Vertical group: Inferior nodes
Superficial inguinal nodes
Fascia lata Great saphenous vein
Small saphenous vein
Superficial lymph vessels
External iliac lymph nodes
Deep fascia of leg (crural fascia) Femoral nerve
Femoral ring Great saphenous vein
Inguinal ligament (Poupart's)
Lacunar ligament (Gimbernat's)
Ductus (vas) deferens Femoral sheath Femoral canal (opened) Femoral artery and vein
Great saphenous vein
Deep inguinal lymph nodes
CT Angiograms of Arteries of the Lower Limb
8
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References
Plate 58
Plates 291, 2 9 2
Braus H. A n a t o m i e des M e n s c h e n . Berlin, Verlag von Julius
Elias H. Liver morphology. Biol Rev 1955; 30:263.
Springer, 1924.
. Origin a n d early d e v e l o p m e n t of the liver in various ver-
Plate 8 9
tebrates. A c t Hepat 1955;3:1.
Nishida S. The Structure of t h e Eye. New York, Elsevier NorthHolland, 1982.
L a c h m a n N, A c l a n d RD, Rosse C. Anatomical evidence for t h e absence of morphologically distinct cranial root of t h e a c c e s sory nerve in man. Clin Anat 2002; 15:4.
Injury, Trans
11th
. A re-examination of the structure of the mammalian liver: the hepatic lobule and its relation to the vascular and biliary system. A m J Anat 1949; 85:379. . A re-examination of the structure of t h e m a m m a l i a n liver:
Plates 164, 4 8 2 , 525, 5 4 3
parenchymal architecture. A m J Anat 1949; 84:311.
Foerster O. The d e r m a t o m e s in man. Brain 1933; 56:1. Garrett FD. The segmental distribution of t h e c u t a n e o u s nerves in the limbs of man. Anat Rec 1948; 102:409.
Plates 305, 3 0 8 Michels
NA.
Blood
Supply
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Anatomy
of
the
Upper
A b d o m i n a l Organs, With a Descriptive Atlas. Philadelphia, J B
Keegan JJ. D e r m a t o m e hypalgesia with posterolateral herniation of lower cervical intervertebral disc. J Neurosurg
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Lippincott, 1955. Plate 3 2 6 T h o m a s MD. In The Ciba Collection of Medical Illustrations, Vol
Plate 172
3, Part II. Summit, NJ, CIBA, p 78.
Turnball IM. B l o o d y s u p p l y of t h e spinal cord. In Vinken PJ, GW
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Clinical
Neurology,
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A m s t e r d a m , North-Holland, 1972, p p 4 7 8 - 4 9 1 .
J a c k s o n CL, Huber JF. Correlated applied a n a t o m y of t h e bronchial tree and lungs with a system of nomenclature. Dis Chest 1943; 9:319.
Ikeda S, O n o Y, Miyazawa S, et al. Flexible b r o n c h o - f i b e r s c o p e . Otolaryngology (Tokyo) 1970; 42:855.
Plates 3 5 6 , 360, 365, 370, 378, 3 7 9 Oelrich T M . The striated urogenital sphincter muscle in the female. Anat Rec 1983; 205:223.
J a m e s TN. The internodal pathways of t h e human heart. Prog Cardiovas Dis 2001; 43:495.
ated urethral sphincter a n d radical prostatectomy: the apical
Plates 359, 361, 3 8 3 , 384 Oelrich T M . The urethral sphincter muscle in the male. A m J Anat 1980; 158:229.
Plates 253, 3 6 6 , 370, 3 8 3 Myers RP, King BF, Cahill DR. Deep perineal " s p a c e " as defined by magnetic resonance imaging. Presented at 14th Annual Session
Myers RP, Goellner JR, Cahill DR. Prostate shape, external stridissection. J Urol 1987; 138:543.
Plate 2 2 5
of t h e A m e r i c a n
Association
of
Clinical
Anatomists, Honolulu, HI, 1997. [Abstract: Clin Anat 1998;11].
Plate 4 0 3 Flocks RH, Kerr HD, Elkins HB, et al. Treatment of c a r c i n o m a of the prostate by interstitial radiation with radio-active gold (Au 198): a preliminary report. J Urol 1952; 68(2):510. Plate 4 8 2
Plate 282 DiDio LJA. Anatomo-Fisiologia d o Piloro ileo-ceco-colica Actas
S t o r m o n t TJ, Cahill DR, King BF, Myers RP. Fascias of the male
Plates 359, 361
Plate 2 0 3
Scientific
Plates 348, 361, 384, 396, 4 1 4 external genitalia and perineum. Clin Anat 1994; 7:115.
Plates 200, 201
homen.
of the liver. In Liver
Conference. N e w York, M a c y Foundation, 1953.
Plates 116, 117, 127
Bruyn
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das
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Argentinas de Gastroenterologia, Rosario, 1954. . Dados a n a t o m i c o s sobre o "piloro"
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(Com observacao direta in vivo de "papila" ileo-ceco-colico.) [English summary]. Thesis, Fac M e d , Univ de Sao Paulo, 1952. Plate 290 Healey JE Jr, Schroy PC. A n a t o m y of t h e biliary d u c t within the human liver: analysis of the prevailing pattern of branchings a n d the major variations of t h e biliary ducts. Arch Surg 1953; 66:599. Healey JE Jr, Schroy PC, Sorensen RJ. The intrahepatic distribution of the hepatic artery in man. J Int Coll Surg 1953; 20:133.
Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec 1948; 102:409. Plate 5 4 3 Keegan JJ. Neurological interpretation of d e r m a t o m e hypalgesia with herniation of the lumbar intervertebral disc. J Bone Joint Surg 1944; 26:238. Last RJ. Innervation of the limbs. J Bone Joint Surg 1949; 31(B):452.
Index
References are to plate numbers. In most cases, structures are listed under singular nouns.
A Abdomen, 268 autonomic nerves and ganglia of, 318 axial CT images of, 350 bony framework of, 248 cross sections of at L3, 349 at L3, 4, 349 at L1-L2, 339 at T10, 293 at T12, 297, 331, 338 innervation of, 318 left lower quadrant of, 268 left upper quadrant of, 268 regions and planes of, 268 right lower quadrant of, 268 right upper quadrant of, 268 subcutaneous tissue of, 249 surface anatomy of, 247 viscera of, 269 Abdominal aortic plexus. See Intermesenteric plexus Abdominalis muscle, transversus, 362 Abdominal muscles, transversus, 363 aponeurosis of, 252 Abdominal wall anterior, 249, 265 arteries of, 255 deep dissection of, 251 intermediate dissection of, 250 internal view of, 253 nerves of, 257 superficial dissection of, 249 veins of, 255 arteries of, 263 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 median (sagittal) section of, 348 posterior arteries of, 264 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 posterolateral, 254 Abdominis aponeurosis, transversus, 252, 330, 349 Abdominis muscle aponeurosis of, 255, 330 rectus, 181, 188, 189, 192, 247, 250, 251, 258, 259, 293, 349, 351, 378 axial CT image of, 350 capsular branch of, 335 cross section of, 252 pelvic branch of, 335
Abdominis muscle (Continued) sheath of, 189 transversus, 25, 94, 96, 179, 189, 255, 257, 258, 263, 267, 329, 498 aponeurosis of, 252, 330, 349 tendon of origin of, 175, 176, 179 Abducent nerve (VI), 83, 84, 86, 114, 117, 118, 121 distribution of, 118 schema of, 118 Abducent nucleus, 116, 117, 121 Abductor digiti minimi muscle, 465, 470, 476, 533, 534, 536, 541 nerve to, 534 tendon of, 533 Abductor hallucis muscle, 533, 534, 535, 541 insertion of, 534, 536 Abductor hallucis nerve, 541 Abductor pollicis brevis muscle, 461, 465 Abductor pollicis longus muscle, 441, 444, 449, 451 area for, 439 Abductor pollicis longus tendon, 444, 469, 470 Aberrant ductule, 390 Accessory muscle bundle, 67 Accessory nerve (XI), 34, 114, 116, 117, 129, 177 cranial root of, 126, 127 schema of, 118, 127 spinal nucleus of, 116, 117 spinal roots of, 10, 118, 127 Accessory oculomotor nucleus, 116, 117, 121, 132 Acetabular fossa, 376, 487 fat in, 487 transverse section of, 376 Acetabular labrum, 352, 487 Acetabular ligament, transverse, 352, 487 Acetabular notch, 352, 486 Acetabulum, 352, 486 anteroposterior radiograph of, 488 articular surface of, 376 lunate surface of, 486 margin of, 352, 353, 486 radiograph of, 355 Achilles tendon. See Calcaneal (Achilles) tendon Acinus, 204 Acoustic artery, internal. See Labyrinthine artery Acoustic meatus external, 8, 13, 92, 93 auricular branch of vagus nerve to, 24 axial CT images of, 150 axial MR image of, 150 cartilaginous and osseous, 93 coronal oblique section of, 93 internal, 92, 97, 123 Acoustic opening, internal, 97 Acromial anastomosis, 427 Acromial angle, 420, 421 Acromial plexus, 427
Acromioclavicular joint, 423, 425 capsule of, 423 Acromioclavicular ligament, 423 Acromion, 27, 33, 185, 287, 418, 420, 421, 422, 423, 424, 425, 427, 429, 431, 432 anteroposterior radiograph of, 422 Adamkiewicz, artery of, 171 Adductor brevis muscle, 489, 493, 539 attachments of, 489, 491 Adductor canal, 500 Adductor hallucis muscle, 541 deep tibial nerve branch to, 541 insertion of, 536 oblique head of, 535 transverse head of, 535 Adductor hiatus, 539 femoral artery passing through, 512 Adductor longus muscle, 376, 489, 492, 493, 500, 505, 539 attachments of, 489, 491 innervation of, 540 transverse section of, 521 Adductor magnus muscle, 485, 489, 495, 500, 502, 505, 540 adductor minimus part of, 493 attachments of, 489, 491 hiatus of, 493 innervation of, 540 tendon of, 493 Adductor magnus tendon, 501, 506, 510, 511 Adductor muscles, thigh, 496 Adductor pollicis muscle, 462, 465, 476, 535 fascia over, 460, 462 Adductor tubercle, 489 Adenohypophysis, 140, 147, 148 cleft of, 147 Adnexa, 371 Afferent fibers, olfactory bulb, 119 Afferent nerves of mouth and pharynx, 62 of nose and sinuses, 210 of stomach and duodenum, 321 Agger nasi, 37, 38 Air, in colon, radiograph of, 355 Air cells, mastoid, axial MR image of, 150 Airway intrapulmonary, 204 to nasopharynx, 37 Airway reflexes, nerves initiating, 210 Ala, 8 lateral part of, 157 wing of, 157 Alar fibrofatty tissue, 36, 38 Alar fold, 507 Alar ligament, 22 Albini's nodules. See Fibrous (Albini's) nodule Alcock's canal. See Pudendal canal (Alcock's)
Alveolar artery anterior superior, 40 inferior, 40, 53, 60 lingual branch of, 69 mental branch of, 40, 69 middle superior, 40 posterior superior 40, 69 Alveolar duct, 204 opening of, 204 Alveolar nerve, 53, 55, 122, 131, 134 anterior superior, 45 nasal branch of, 42 inferior, 16, 40, 53, 55, 60, 131, 134 branch of, 40 entering mandibular foramen, 46 middle superior, 45 posterior superior, 44, 45 superior, 62, 71 Alveolar sac, 204 Alveolar vein inferior, 60, 70 posterior superior, 60, 70 Alveolus, 204 capillary bed in, 205 Amacrine cells, 120 Ampulla ear, 95, 96 semicircular, 92 of uterine tube, 372 Amygdaloid body, 110, 112, 119 thalamus and, 110 Anal canal, 393 anatomical, 393 arteries of, 398 beginning of, 376 beginning of, transverse section of, 357, 521 longitudinal muscle of, 356, 357 muscularis mucosae of, 393, 394 sagittal MR images of, 397 surgical, 393 veins of, 399 Anal columns, 393 Anal glands, 393 Anal nerve, inferior, 410, 411, 414, 496, 503 AnaS pit, 388 Anal sinus, 393 Anal sphincter muscle external, 356, 358, 360, 365 deep part of, 394, 395, 396 peripheral view of, 395 subcutaneous of, 391, 393, 395, 396 superficial part of, 391, 393, 394, 395 internal, 393, 394 Anal triangle, 380 Anal tubercle, 388 Anal valve, 393 Anal verge, 393 Anastomosis around elbow, 434 around scapula, 427 carotid-vertebral, 138 gastro-omental arterial, 272 in incisive canal, 40 obturator-pubic arterial, 259 paravertebral, 172 patellar, 500, 512 portacaval, 312 right-left, 138
Anastomosis (Continued) between septal sphenopalatine artery and greater palatine artery, 41, 138 subclavian-carotid, 138 subclavian-vertebral, 138 Anastomotic branch, 301 Anastomotic loop of ileal arteries, 280 of jejunal arteries, 280 of posterior spinal arteries, 171 of small intestinal veins, 310 of small intestine, 306 Anastomotic vein inferior, 102, 145 superior, 102 Anatomical snuffbox, 444 radial artery to, 469, 470 Anconeus muscle, 432, 444, 445, 477 nerve to, 432 origin of, 421 Angular artery, 23, 36, 68, 85, 138 Angular gyrus, 105 cerebral artery to, 141 cerebral branches to, 141, 142 Angular vein, 23, 70, 85 Ankle dorsiflexion and plantar flexion of, 543 lateral ligament of, 514 ligaments and tendons of, 514 ligaments of, 527 medial ligament of, 514 radiograph of, 526 tendons of, 527 Annular ligament of radius, 438 of trachea, 202 Anococcygeal body, 357, 378, 379, 395, 396 Anococcygeal nerve, 411, 412, 499 Anocufaneous line, 392, 393, 394 Anoderm, 393 Anorectal hiatus, 358 Anorectal junction, circular muscle layer of, 359 Anorectal line, 393 Anorectal musculature, 394 Ansa cervicalis, 31, 32, 128, 129 inferior root of, 32, 34, 71, 74, 128, 129 superior root of, 32, 34, 71, 74, 128, 129 ventral rami of, 128 Ansa of Galen, 80 Ansa subclavia, 130, 209, 226, 240 Anserine bursa, 506, 507 Antebrachial vein intermediate, 418, 479 median, 449 Anterior chamber, 81, 87, 88, 89, 90 endothelium of, 88 Anterolateral central arteries, 140, 141 Anteromedial central arteries, 140 Antihelix, 1, 93 crura of, 1, 93 Antitragus, 1, 93 Anulus fibrosus, 19, 155 Anum, fibrous septum of, 394 Anus, 360, 377, 380, 382, 388, 395 fetal, 388 transverse fibrous septum of, 393
Aorta, 207, 263, 324, 330, 342 abdominal, 27, 179, 195, 207, 225, 232, 270, 273, 274, 278, 298, 300, 301, 324, 327, 329, 330, 331, 332, 339, 341, 342, 363, 369, 398, 400, 401, 403, 412 cross section of, 338 arch of, 237, 244 ascending, 138, 215, 220, 223, 224, 225, 242, 245 axial CT images of, 242, 350 descending, 237, 242, 245, 246 thoracic, 194, 242 prenatal, 229 thoracic, 172, 297 cross section of, 297 descending, 172, 231, 241 esophageal branches of, 237 ureteric branch from, 341 Aortic arch. See Arch of aorta Aortic hiatus, 195 Aortic lymph node, lateral, 266, 343, 406 Aortic lymph nodes, 266 Aortic nerve, 228 Aorticorenal ganglion, 165, 167, 267, 318, 320, 321, 322, 324, 344, 345, 346, 409 celiac, 267 left, 318, 320, 323, 410, 415 right, 318, 320, 323 superior mesenteric, 267 Aortic plexus, 321, 322, 412 Aortic sinus, 223, 224 Aortic valve anatomy of, 223 semilunar cusps of, 221, 222, 223, 224, 225 left, 224 Apical foramen, 57 Apical ligament, of dens, 63, 65 Appendicular artery, 281, 306, 307, 322,323 Appendicular nodes, 317 Appendicular plexus, 322, 323 Appendicular vein, 311, 312 Appendix, 126 fibrous, 287 vermiform, 271, 281, 283, 284, 362, 363 aggregate lymphoid nodules of, 283 barium radiograph of, 283 circular muscle of, 283 fixed retrocecal, 283 orifice of, 282 serosa of, 283 submucosa of, 283 variations in position of, 283 Arachnoid, 102, 109 cerebral veins penetrating, 102 Arachnoid-dura interface, 102 Arachnoid granulation, 100, 102, 109 granular foveola for, 99 skull indentation for, 99 Arachnoid mater, 169 lumbar, 170 thoracic, 170 Arantius, body of, 223
Arch of aorta, 74, 75, 80, 138, 206, 210, 211,212,213,214,215,221,232, 233 groove for, 199 radiograph of, 213 Arcuate artery, 335, 337, 530, 531, 536 afferent glomerular arteriole from, 337 lymph vessels along, 343 Arcuate eminence, 9 Arcuate ligament dorsal radial metaphyseal, 455 lateral, 195, 263 medial, 195, 263 median, 195, 263 Arcuate line, 248, 251, 255, 259, 279, 348, 352, 353, 356, 486 section above, 252 section below, 252 Arcuate nucleus, 147 Arcuate popliteal ligament, 508, 511 Arcuate vein, 337 Arcus tendineous fasciae pelvis, 372 Areola, 182 Areolar gland, 182 Areolar tissue, 179, 251, 361, 471 in anterior closed space of finger, 471 Areolar venous plexus, 256 Arm. See also Forearm arteries of, 484 cutaneous nerves of, 479, 481 inferior lateral, 432, 477, 479, 481 medial, 257, 429, 432, 435, 473, 474, 479 ~ ' posterior, 432, 477, 479, 481 superior lateral, 432, 477, 478, 479, 481 deep artery of, 429, 432, 433, 434, 435 middle collateral branch of, 445 muscles of, 432 anterior views of, 430 deep layer of, 430, 432 posterior, 432 posterior view of, 432 superficial layer of, 430, 432 superior lateral, 432 neurovascular compartment of, 435 radial nerve in, 477 serial cross section of, 435 superficial veins of, 480 Arrector muscle, hair follicle, 167 Arteriae rectae, 307 Arteriogram, celiac, 303 Arteriole intralobular, 291 periportal, 291 portal, 291 Artery(ies). See also specific arteries of anterior abdominal wall, 255 of arm, 484 to brain, 136-137, 138, 141, 142 frontal view of, 141 lateral and medial views of, 142 colic, 308 of duodenum and head of pancreas, 301, 304 of esophagus, 237 of face, 23 of female pelvic organs, 400 of female pelvis, 403 of female perineum and uterus, 405 of femoral head, 504
Artery(ies) (Continued) of femoral head and neck, 504 of fingers, 471 of foot, 536 of foot, deep, 536 of hand, palmar view of, 466 of head, 23 of hip and thigh, 500-502 of hypothalamus and hypophysis, 148 intrarenal, 335 intrinsic distribution of, in spinal cord, 172 of large intestine, 307 of liver, 301 of liver, pancreas, duodenum, and spleen, 301, 305 of liver and gallbladder, variations in, 305 of male pelvis, 403 of male perineum, 405 of mammary gland, 183 to meninges, 136 of nasal cavity, 41 of neck, 504 of oral and pharyngeal regions, 69 of oral region, 69 of pancreas, 301 of posterior abdominal wall, 264 of posterior cranial fossa, 142, 143 of rectum and anal canal, 398 renal, 335 of scalp, 23 of spinal cord, 171 of spleen, 301 of stomach, liver, and spleen, 300 of testis, 401 of thigh anterior view of, 501 posterior view of, 502 of upper limb, 473 computed tomography of, 484 at wrist, 461 Articular cavity, 471 of finger, 471 Articular disc, 16, 243 Articularis genus muscle, 505, 507, 511, 538 attachment of, 489 Articular nerve great, 32 recurrent, 542 Articular process inferior, lumbar, 155 superior, lumbar, 155 Articular tubercle, 55 Aryepiglottic fold, 66, 67, 78 Aryepiglottic muscle, 78, 80 Arytenoid muscle oblique, 67, 78, 79, 80, 235 transverse, 63, 78, 79, 80, 235 action of, 79 Atlantoaxial joint, 19 lateral, 19 capsule of, 21 median, superior view of, 22 radiograph of, 17 Atlantooccipital joint capsule, 21, 22 Atlas (C1 j, 13, 17, 19, 22, 153, 160 anterior, 21 anterior arch of, 5, 17, 19, 37, 62, 137 anterior tubercle of, 19 dens of, articular facet for, 17 inferior view of, 17
Atlas (C1) (Continued) lateral mass of, 17 occipital condyle of, 17 posterior, 21 posterior arch of, 17, 18, 178 posterior tubercle of, 17, 175, 176 spinous process of, 18 superior articular facet for, 17 superior view of, 17 transverse foramen of, 17 transverse process of, 17, 21, 30, 39, 176 Atrioventricular bundle, 225 Atrioventricular node, 22, 218, 225 Atrioventricular valve left. See Mitral valve right. See Tricuspid valve Atrium, 224 internodal conduction pathways of, 225 left, 214, 215, 220, 221, 224, 246 auricle of, 212 oblique vein of, 214, 215, 216 section through, 221 right, 212, 213, 214, 215, 220, 223, 224, 241,246 opened, 220 radiograph of, 213 Auditory ossicles, 93 Auditory (pharyngotympanic, Eustachian) tube, 92, 93, 96, 125, 126 cartilage of, 47 cartilaginous part of, 52, 55, 64, 65, 67 groove for, 8 opening of, 37 pharyngeal opening of, 63, 64, 66, 125 Auerbach's plexus. See Myenteric (Auerbach's) plexus Auricle, 92, 97 concha of, 93 left, 212, 213, 215, 216, 224, 225 lobule of, 93 posteromedial surface of, 24 right, 93, 212, 214, 219, 220, 224 Auricular artery anterior, 23 deep, 40 posterior, 23, 34, 40, 100, 136, 138, 178 Auricularis anterior muscle, 26 Auricularis posterior muscle, 26 Auricularis superior muscle, 26 Auricular muscle, facial nerve branches to, 123 Auricular nerve, 122 anterior, 122 articular branch of, 122 great, 21, 22, 24, 32, 129, 177, 178 greater, 31 posterior, 25, 123 occipital branch of, 123 Auricular tubercle (of Darwin), 93 Auricular vein, posterior, 23, 70 Auriculotemporal nerve, 16, 24, 40, 55, 71, 122, 125, 134 Auscultation, triangle of, 152, 246, 424 precordial area of, 213 Autonomic ganglion, abdominal, 318 Autonomic nerves of abdomen, 318 in head, 131
Autonomic nerves (Continued) of nasal cavity. 44 to neck, 24 in thorax, 209 Autonomic nervous system schema of, 167 topography of, 167 Autonomic plexus, intrinsic, 326 Autonomic reflex pathways, 325 Axilla dissection of, 181 anterior view of, 429 dissection of, anterior view, 429 muscles of, 424 oblique parasagittal section of, 428 oblique parasagittal section of, 428 suspensory ligament of, 428 Axillary artery, 183, 189, 198, 200, 255, 427, 428, 429, 433, 434 acromial branch of, 434 anterior view of, 434 clavicular branch of, 434 computed tomography of, 484 deltoid branch of, 434 pectoral branch of, 434 posterior view of, 434 Axillary fold, 181 anterior, 181 posterior, 181 Axillary fossa, 243, 244, 245 Axillary lymph nodes, 428 along axillary vein, 484 apical, 184 brachial, 184 central, 184, 428 lateral, 483 along axillary vein, 483 parasagittal section of, 428 pectoral, 184, 428 subscapular, 184 Axillary nerve, 177, 425, 427, 429, 432, 476, 477, 481 superior lateral cutaneous nerve of arm from, 479 Axillary recess, 423 Axillary tail (of Spence), 182, 183 Axillary vein, 189, 198, 256, 428 intercostal tributaries to, 256 lymph nodes along, 483 Axis (02), 13, 17, 19, 22, 153 anterior view of, 153 body of, 17, 21 dens of, 5, 17, 37, 63 inferior articular process of, 17 interarticular part of, 17 left lateral view of, 153 pedicle of, 17 posterosuperior view of, 17 posterior articular facet of, 17 posterior lateral view of, 153 posterior tubercle of transverse process of, 30 spinous process of, 17, 174, 176 transverse process of, 30 Azygos vein, 17, 21, 153, 194, 206,.207, 209, 230, 241, 245, 246, 293, 331, 349 arch of, 230, 232, 244 axial CT images of, 242 groove for, 199
B Babinski's sign, 101 Back bones and ligaments of, 153-157 lumbar region, cross section of, 179 muscles of deep layer of, 176 axial CT images of, 350 intermediate layer of, 175 superficial layers of, 174 nerves of, 177. 179 surface anatomy of, 152 Bartholin's gland. See Vestibular gland, greater Basal nucleus, organization of, 110 Basal vein, 144, 145, 146 Basilar artery, 140, 141, 143, 171 axial MR image of, 150 Basilar membrane, 96 Basilar venous plexus, 103 Basilic vein, 418, 429, 449, 468, 480, 483, 484 intermediate, 480 Basivertebral vein, 137, 173 Biceps brachii muscle, 181, 418, 420, 429, 433, 435, 446, 447, 451 fascia over, 428 insertion of, 420 long head of, 424, 426, 428, 433, 435, 474 origin of, 420 tendon of, 243, 244, 245 short head of, 424, 428, 430, 433, 434, 435, 474 combined, 244 origin of, 420 tendon of, 425, 432, 433, 438, 446, 447 long head of, 423, 425, 430 short head of, 430 Biceps femoris muscle, 485, 489, 495, 503, 515 attachments of, 489, 515 long head of, 485, 494, 495, 540 attachments of, 491 short head of, 488, 494, 495, 540 attachments of, 491 tendon of, 506, 511, 514, 517, 520, 542 bursa of, 511 inferior subtendinous, 506, 507 long head of, 353 Bicipital aponeurosis, 430, 433. 446, 480 Bifurcate ligament, 527 Bigelow, Y ligament of, 487, 496 Bile canaliculus, 292 Bile duct, 126, 290, 291, 292 common, 167, 273, 274, 278, 279, 288, 294, 295, 297, 298, 300, 301, 304 cross section of, 338 hepatic ducts joining, 290 junction with duodenum, 295 extrahepatic, 294 union of pancreatic ducts and, 295 Bile ductule, 290 intralobular, 290 periportal, 290, 291, 292 Biliary tract innervation of, 327 intrahepatic, 292 Bipolar cells, 120
Bladder-prostate junction, 376 Blood circulation intrapulmonary, 205 postnatal, 229 prenatal, 229 Blood vessels, innervation of, 228 Bone(s) See also specific bones of abdomen, 248 of cranial base, 9 of elbow, 436 of foot, 523, 524 of forearm, 439 of hand, 474 of head, 2-16 of lower limb, 513, 524 of nasal cavity and paranasal cavity, at birth, 50 pelvic, 352-353 of right leg, 513 of thorax, 185 of wrist, 453, 456 Bowel loop, entering hernial sac, 261 Bowman's capsule, 336 Brachial anastomosis, around elbow, 433 Brachial artery, 27, 30, 31, 183, 193, 198, 206, 211, 230, 427, 429, 447 branches of, 433, 434 muscular branch, 433, 434 cords of, lateral, 428, 433 deep, 429 computed tomography of, 484 in situ, 433, 434 medial, 428, 433 posterior, 428 Brachial cutaneous nerve, superior Bateral, 177 Brachialis muscle, 420, 429, 430, 433, 435, 446, 447, 448 insertion of, 420, 438 origin of, 420, 421 Brachial plexus, 27, 30, 31, 32, 129, 160, 183, 189, 193, 198, 206, 211, 228, 230, 231, 232, 428, 429 anterior and posterior divisions of, 430 communication to, 129 cords of lateral, 428, 433 medial, 428 posterior, 428 medial, 428, 433 posterior, 428 roots of, 430 schema of, 430 terminal branches of, 430 trunks of, 430 Brachial vein, 429, 435 Brachiocephalic trunk, 33, 74, 75, 76, 136, 193, 206, 211, 212, 214, 232, 237, 243, 420 Brachiocephalic vein, 74, 208 groove for, 199 left, 70, 75, 137, 206, 211, 212, 230, 231, 243 right, 75, 137, 206, 210, 211, 212, 230, 243 Brachioradialis muscle, 418, 433, 444, 446, AA7 origin of, 420 Brachioradialis tendon, 448, 449
Brain, 48 arteries to, 136, 141, 142 frontal views of, 141 inferior views of, 139 lateral and medial views of, 142 schema of, 138 coronal section of, 108 deep veins of, 145 sagittal section of, in situ, 106 subependymal veins of, 146 ventricles of, 108 Brainstem anterior view of, 114 cranial nerve nuclei in, 116, 117 medial dissection of, 117 posterior phantom view of, 116 schema of, 117 sectioned, 107 Bregma, 7 Broad ligament, 389 anterior lamina of, 372 of female ureter, 340 mesometrium of, 371 mesosalpinx of, 369 posterior lamina of, 372 subdivisions and contents of, 372 uterine, 360, 362 Bronchial artery, 204, 205, 207 esophageal branch of, 207 inferior left, 207 left, 199, 231 esophageal branch of, 237 inferior, 237 superior, 237 right, 199, 207, 230, 237 superior left, 207 variations in, 207 Bronchial vein left, 207 right, 207 Bronchiole respiratory, 204, 205 terminal, 204, 205 Bronchomediastinal lymphatic trunk, 208 left, 266 right, 266 Bronchopulmonary lymph nodes, 199, 208, 230, 231 Bronchopulmonary segments, 200, 201 anterior view of, 200 lateral view of, 201 medial view of, 201 nomenclature for, 203 posterior view of, 200 Bronchus, 167, 202, 204, 234 anterior basal, 203 anteromedial basal, 203 apicoposterior, 203 elastic fibers of, 204 extrapulmonary, 202 inferior lobar, 202 intermediate, 202 intrapulmonary, 202, 204 lateral basal, 203 left, 203 axial CT images of, 242 left main branches of, 199, 206, 232, 233, 241 lingular, 202
Bronchus (Continued) major, 202 medial basal, 203 middle lobar, 202, 203 nomenclature of, 203 posterior basal, 203 right axial CT images of, 242 intermediate, 206 right main branches of, 207, 230, 245 smooth muscle of, 204 superior lobar, 202, 203, 206 Brunner's gland. See Duodenal glands Buccal artery, 40, 69 Buccal nerve, 24, 40, 46, 62, 71, 122 branches of, 25 Buccinator crest, 68 Buccinator lymph node, 72 Buccinator muscle, 15, 26, 48, 52, 54, 55, 60, 65, 68, 123 Buccopharyngeal fascia, 60, 63, 65 Buck's fascia. See Deep (Buck's) fascia Bulbar conjunctiva, 81, 87 Bulbospongiosus muscle, 358, 366, 370, 380, 381, 383, 404, 405, 417 bulb of vestibule of, 366 Bulbourethral (Cowper's) gland, 253, 361, 366, 383, 384, 389, 417 duct of, 383 opening of, 384, 385 perineal membrane and, 348 primordium of, 389 Bulging septum, 37 Bursa anserine, 506, 507 fibular collateral, 507 of hand, 462 iliopectineal, 496 infrapatellar, 511 patellar, 508 radial, 460 subdeltoid, 423 ulnar, 460 Buttock, nerves of, 503 c C1 spinal nerve, 127 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C2 spinal nerve, 127 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 C3 spinal nerve, 19 dorsal ramus of, 177 ventral ramus of, 32, 71, 177 C4 spinal nerve, 127 C5 spinal nerve, ventral ramus of, 32 C8 spinal nerve, 160 exit of, 161 C6 transverse process, 136 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19
C3 vertebra (Continued) tubercles of transverse process of anterior, 26 posterior, 26 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 posterior tubercle of, 18 posterosuperior view of, 17 C7 vertebra, 13, 153, 160 posterior tubercle of transverse process of, 30 spinous process of, 18, 152, 174, 175, 176, 424 superior view of, 18 Calcaneal artery lateral, 534, 535 medial, 534, 535 Calcaneal nerve lateral, 534, 535 medial, 534, 535 Calcaneal (Achilles) tendon, 485, 515, 516, 517, 518, 521, 527 soleus muscle insertion in, 515, 517 Calcaneocuboid ligament, 527, 536 dorsal, 527 plantar, 528 Calcaneofibular ligament, 514, 525, 527 Calcaneometatarsal ligament, 532 Calcaneonavicular ligament, 527 plantar, 527, 528, 536 Calcaneus, 524, 527, 528 anterior talar articular surface of, 525 body of, 523, 524, 525 dorsal view of, 523 fibular, 524 fibular trochlea of, 523 functional relations of, 525 groove for tendon of flexor hallucis longus, 523 lateral process, 523, 533 lateral view of, 525 medial process, 523 medial view of, 525 middle talar articular surface of, 525 plantar view of, 523 posterior talar articular surface of, 525 posterior view of, 525 radiograph of, 54 superior view of, 525 sustentaculum tali of, 523 trochlea of, 524 tuberosity of, 485, 488, 516, 517, 523, 533, 534, 535 radiograph of, 54 Calcar, 489 Calcar avis, 111, 112 Calcarine artery, 142, 143 Calcarine sulcus, 105, 106, 107, 111, 120 Callosomarginal artery, 141, 142 Calot, cystic node of, 315 Calot, triangle of, 301 Calvaria, 102 inferior view of, 7 superior view of, 7 Calyx, major, 339 Camper chiasm, 461 Camper's fascia, 348
Camper's (fatty) layer of subcutaneous tissue, 249, 361, 348, 378, 380 Canal of Schlemm. See Scleral venous sinus (canal of Schlemm) Canine teeth, 57 Capillary plexus, 148, 205 cortical, 337 medullary, 337 Capitate, 452, 453, 455, 456, 461 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 radiograph of, 457 Capitis muscle, rectus anterior, 32, 47, 73 anterior and lateral, nerves to, 129 lateral, nerves to, 129 lateralis, 30, 32 posterior major, 175, 176, 178 posterior minor, 175, 176, 178 Capitohamate ligament, 454, 455 Capitulym, 420, 436, 437 Capsular artery, 335 Capsular ligament, 423 of shoulder, 423 Capsular vein, 337 Capsule, internal, 141 Cardia, nodes around, 314 Cardiac nerve, cervical, 165 Cardiac notch, 236, 275 Cardiac orifice, 276 Cardiac plexus, 126, 165, 209, 226, 227, 240 Cardiac vein anterior, 216 of diaphragmatic surface, 216 great, 216 middle, 216 small, 216 of sternocostal surface, 216 Cardinal ligament, 360, 364, 370, 371, 372, 373 Caroticotympanic nerve, 123, 125 Carotid arterial arch, dorsal, 469 Carotid artery common, 23, 29, 31, 32, 33, 34, 71, 74, 75, 76, 100, 125, 128, 130, 133, 134, 136, 137, 198, 210, 232, 237 external, 28, 32, 34, 40, 59, 75, 76, 85, 86, 121, 123, 128, 130, 131 schema of, 34 internal, 10, 23, 28, 33, 34, 44, 47, 69, 71, 75, 76, 85, 86, 100, 123, 125, 130, 131, 132, 134, 138, 139, 140, 141, 142 caroticotympanic branch of, 138 groove for, 9 left common, 74, 80, 137, 193, 211, 214, 243 left internal, 142, 143 right common, 30, 80, 137, 193 right internal, 142 right lateral dissection of, 34 Carotid autonomic plexus, 10 Carotid body, 34, 125, 130, 210 Carotid canal, 10 external opening of, 8 for internal carotid artery, 11 for internal carotid nerve plexus, 9 Carotid groove, 9
Carotid nerve ( I X ) , 71 external, 165, 167 internal, 130, 131, 133, 165, 167 Carotid plexus, 86, 121, 131, 209, 226 common, 130, 131 external, 130, 133, 167 internal, 86, 123, 132, 165, 167 Carotid sheath, 28, 32 cranial nerves in, 60 Carotid sinus, 125, 130, 131, 210 Carotid vein, common, 70 Carpal arterial arch, dorsal, 469 Carpal articular surface, 439 Carpal bones, 452 in abduction, 453 in adduction, 453 anterior (palmar) view of, 452 posterior (dorsal) view of, 452 Carpal ligament palmar, 454, 460 transverse. See Flexor retinaculum Carpal tunnel, 461 palmar view of, 454 transverse cross section of, 461 Carpometacarpal joint, 455 articular capsule of, 454 capsule of first, 455 Carpometacarpal ligament dorsal, 455 palmar, 454 Carpotriquetral ligament, 454 Cartilage accessory nasal, 36 alar lateral and medial crus of, 36 major, 36, 38, 39 minor, 36 articular of elbow, 438 of finger, 471 of hip joint, 487 of knee, 511 arytenoid, 77, 78 muscular process of, 78 vocal process of, 78 auricular, 47 bronchial, 204 corniculate, 77 costal, 186, 248, 293, 419 cross section of, 196 eighth, -115 fifth, 194 fifth left, 241 of first rib, 243 second, 245 seventh, 198, 331 sixth, 424 cricoid, 20, 28, 29, 74, 77, 78, 196, 233, 234 arch of, 77 lamina of, 77, 78 longitudinal muscle bundle attached to, 234 posterolateral surface of, 234 prominence over lamina of, 66 of larynx, 77 septal, 39 septal nasal, 36 lateral process of, 38. 39
Cartilage (Continued) thyroid, 28, 29, 31, 74, 196, 202, 206, 233, 234, 235 lamina of, 77, 78 oblique line of, 29 superior horn of, 77 tracheal, 28, 202 Cartilage lamina, thyroid, 77 posterior border of, 67 Cauda equina, 160, 161, 170, 179, 339 in lumbar puncture, 162 Cauda equina artery, 171 Caudal mesonephric duct, residua off, 389 Caudate nucleus, 141 anterior vein of, 145, 146 body of, 108, 110 head of, 110, 111, 112, 145 posterior vein of, 145 terminal, 146 tail of, 108, 110, 112 thalamus and, 110 transverse veins of, 145, 146 Cavernous nerve, 166, 410, 412 Cavernous plexus, 121 Cavernous sinus, 85, 100, 104, 136, 140 coronal section through, 104 efferent hypophyseal vein to, 148 emissary vein communicating with, 70 superior view of, 104 Cecal artery, 323 anterior, 281, 306, 307 posterior, 281, 307 Cecal fold, 281, 362, 363 Cecal plexus, 323 Cecal vein anterior, 311, 312 posterior, 311, 312 Cecum,. 126, 269, 272, 281, 284, 362, 363 variations in posterior peritoneal attachment of, 281 vascular fold of, 281 Celiac ganglion, 44, 126, 165, 167, 168, 219, 267, 318, 320, 321, 323, 324, 325, 327, 328, 331, 345, 346, 409 Celiac lymph node, 266, 314, 315 Celiac plexus, 126, 165, 166, 240, 319, 320, 322, 323, 344, 345, 346, 410, 415 posterior vagal trunk to, 240 vagal branch to, 240 Celiac trunk, 165, 195, 206, 278, 298, 300, 305, 321, 324, 328, 329, 333 arteriogram of, 303 bifurcation of, 297 common origin of, 302 cross section of, 338 prenatal, 229 variations in, 302 Ceneus, apex of, 107 Central artery anterolateral, 141 anteromedial, 140 central, anterolateral, 143 posteromedial, 140 precentral, 141 Centra!! sulcus, 106
Central vein, 290, 291 of liver, 290, 291 Cephalic vein, 181, 188, 189, 256, 418, 424, 428, 429, 449, 468, 479, 480, 483, 484 accessory, 479, 480 intermediate, 480 Cerebellar artery anterior, 140 anterior inferior, 136, 138, 139, 140, 141, 143, 171 posterior, 141, 143 inferior, 143 posterior inferior, 141, 171 superior, 136, 138, 139, 140, 141, 143, 171 Cerebellar hemispheric vein, inferior, 144 Cerebellar notch anterior, 97 posterior, 97, 113 Cerebellar nucleus, 113 dentate, 113 emboliform, 113 fastigial, 113 globose, 113 Cerebellar peduncle inferior, 113, 144 inferior, superior, middle, 144 middle, 113, 114, 144 superior, 113, 114, 115,144 decussation of, 113 superior plane of, 113 Cerebellar tonsil, herniation of, 101 Cerebellar tonsillar artery, 143 Cerebellar vein hemispheric inferior, 151 precentral, 144 superior, 144 Cerebellomedullary cistern posterior, 109 vein of, 144 Cerebellum, 106, 111, 115, 146 anterior lobe of, 113 axial MR image of, 150 biventer lobe of, 113 dentate nucleus of, 115 flocculonodular lobe of, 113 flocculus of, 114 horizontal fissure of, 113 inferior fovea of, 115 inferior surface of, 113 lateral recess of, 115 lateral views of, 105 medial eminence of, 115 median sagittal section of, 115 parts of, 144 posterior lobe of, 113 posterior view of, 115 posterolateral fissure of, 107 sagittal MR image of, 149 secondary fissure of, 107 superior fovea of, 115 superior surface of, 113 tonsil of, 107, 115 Cerebral aqueduct, 106, 107, 108, 109, 146 Cerebral arterial circle (of Willis), 139,140
Cerebral artery anterior, 136, 138, 140, 141, 143 branches of, 141 left, 142 right, 142 terminal branches of, 142 communicating, 140 left anterior, 142 left middle, 142 middle, 136, 138, 140, 141, 143 branches of, 141 left, 142 temporal branches of, 141 posterior, 136, 138, 140, 141, 143, 171 branches to, 136, 138 right, 142, 143 temporal branches of, 143 terminal branches of, 142 right anterior, 142 temporal branches of, 143 posterior and anterior, 142 terminal branches of, 142 Cerebral crus, 107, 113, 114, 139, 145 Cerebral falx, 48 Cerebral fissure anterior, 143 longitudinal, 107, 143, 145 Cerebral hemisphere axial CT images of, 150 axial MR image of, 150 medial surface of, 106 Cerebral peduncle, 106, 115 Cerebral sulcus, lateral, 141 Cerebral vasculature, 136-138, 139-141, 143-144, 145-146 Cerebral veins anterior, 144, 145, 146 deep, 99 middle, 144, 145 great, 103, 104, 106, 115, 144, 145, 146 quadrigeminal cistern of, 109 inferior, 102, 104, 145 internal, 99, 108, 111, 144, 145, 146 lateral direct, 146 middle deep, 144, 145, 146 superficial, 145 penetrating subdural space, 99 superficial, 99, 102 middle, 99, 102, 104 superior, 102 opening of. 101 Cerebrospinal fluid, circulation of, 109 Cerebrum, 113 anterior lobe of, 113 biventer lobule of, 113 external capsule of, 110 flocculonodular lobe, 113 frontal pole of, 107 gyri of, 107 horizontal fissure of, 113 horizontal sections through, 110 inferior surface of, 113 inferior view of, 107 internal capsule of, 110 lateral views of, 105 medial view of, 106 medial views of, 106
occipital pole of, 107 posterior lobe of, 113
Cerebrum (Continued) posterolateral fissure of, 113 sulci of, 107 superior surface of, 113 superior vermis of, 113 temporal pole of, 107 tonsil of, 113 Cervical artery ascending, 33, 69, 71, 74, 75, 76, 136, 138, 171, 427 deep, 33, 136, 138, 171 superficial, 74, 75 transverse, 32, 69, 74, 75, 76, 138, 177, 427, 429 Cervical canal, 371 CervicaB cardiac nerve, 166, 209 inferior, 165, 226 middle, 165, 226 superior, 69, 71, 165, 226 sympathetic and vagal, 226 Cervical! curvature, 18, 153 Cervical enlargement, 161 Cervical ganglion middle, 165 superior, 165, 167 CervicaB nerve, 130-133, 134-135, 161 branches of, 25 superficial, 177 transverse, 24, 31, 71, 129 vertebrae and, 127, 161 Cervical plexus, 160, 177, 178, 481 ansa cervicalis of, 32, 128 branches from, 24 in situ, 32 schema of, 32, 129 supraclavicular nerves from, 479 Cervical spinal nerves, 160 C1, 160 exit of, 161 C2, dorsal ramus of, 177 C3, dorsal ramus of, 177 C4, dorsal ramus of, 177 C8, 160 exit of, 160 dorsal rami of, 24, 32, 177 medial branches of, 24 posterior cutaneous branches of, 178 Cervical sympathetic cardiac nerve inferior, 130, 226, 227 middle, 33, 130, 165, 226, 227 superior, 32, 60, 128, 130, 132, 133, 134, 165, 226, 227, 240 Cervical sympathetic ganglion, middle, 32, 60, 130, 131, 132, 133, 134, 167 Cervical sympathetic trunk, 131, 240 vertebral ganglion of, 240 Cervical vagal cardiac nerve inferior, 227 superior, 227 CervicaB vein deep, 137 left, 137 right, 137 right, deep, 137 superficial, 177 transverse, 70, 177
Cervical vertebrae. See also Atlas (C1); Axis (C2); specific vertebrae anterior view of, 17, 171 arteries of, 171 articular pillar of, 21 costal facets of, 21 external craniocervical ligaments of, 21 inferior aspect of, 18 lateral radiograph of, 21 number of, 161 right lateral view of, 21 superior aspect of, 18 superior view of, 18 upper, 17 Cervicis muscle, interspinals, 176 Cervicofacial nerve, 25 Cervicothoracic (stellate) ganglion, 13, 130, 165, 209, 226, 227, 240 esophageal and recurrent nerve branches from, 240 Cervix, 360, 364, 369, 370, 371, 372 external os of, 371 sagittal MR images of, 397 C5 spinal nerve, ventral ramus of, 32 C4 spinal nerve, 127 Cheek ligament, 83 Chest axial CT images of, 242 radiograph of, 213 Chest drainage tubes, placement of, 190 Chiasmatic cistern, 109 Chief cell, 276 Choana, 8, 13, 14, 37, 38, 39, 52, 55, 66, 67 Cholangiole, 292 Chordae tendineae, 220, 221, 223 Chorda tympani nerve, 62, 71, 93, 94, 122, 123, 124, 131, 133, 134, 135, 165 Choroid, 87, 89, 90 vascular arrangements within, 91 Choroidal artery anterior, 139, 140, 141, 143 posterior lateral, 139, 143 posterior medial, 139, 143 Choroid plexus, 111, 112, 145 of fourth ventricle, 106, 108, 109, 114, 115 of lateral ventricle, 108, 109, 110, 143, 145 of third ventricle, 106, 108, 109 Choroid vein, 91 bulb of, 91 Choroid vein, superior, 99, 145, 146 Ciliary artery anterior, 90, 91 recurrent branch of, 91 long posterior, 90, 91 posterior, 85 short, 91 short posterior, 90, 91 Ciliary body, 87, 90 blood vessels of, 90 fibers of, 88 orbicularis ciliaris of, 89 Ciliary ganglion, 45, 86, 121, 122, 131, 132, 165, 166, 168 nasociliary root of, 86, 131, 132 oculomotor root of, 132 parasympathetic root of, 86, 121
Ciliary ganglion (Continued) roots of, 131 schema of, 132 sensory root of, 86, 121, 122, 131 sympathetic root of, 86, 121, 132 Ciliary muscle, 87, 118, 121, 132 circular fibers of, 88 meridional fibers of, 88 Ciliary nerve long, 86, 121, 122, 131, 132 short, 86, 121, 122, 131, 132 Ciliary process, 87, 88, 89 Ciliary vein, anterior, 88, 90, 91 Cingular artery, 142 Cingulate gyrus, 106 isthmus of, 106, 107 Cingulate sulcus, 106 Circle of Willis. See Cerebral arterial circle (of Willis) Circular muscle, 326 Cisterna chyli, 266, 314, 318 lumbar lymph trunk to, 343 Claustrum, 110 Clavicle, 1, 26, 27, 28, 29, 31, 181, 182, 184, 186, 188, 189, 196, 197, 198, 213, 230, 231, 243, 418, 420, 421, 422, 423, 424, 425, 427, 428, 429 acromial end of, 419 acromial facet of, 419 anteroposterior radiograph of, 422 conoid tubercle of, 419 costoclavicular ligament impression on, 419 inferior surface of, 419 radiograph of, 422 right, 419 shaft body of, 419 sternal end of, 419 sternal facet of, 419 subclavian groove of, 419 superior surface of, 419 trapezoid line of, 419 Clavipectoral fascia, 428 pectoralis minor muscle invested by, 188 subclavius muscle invested by, 188 Clavipectoral fossa, 428 Clinoid process anterior, 9 coronal CT images of, 151 posterior, 9 Clitoris body of, 388 crus of, 360, 366, 370 deep artery of, 404 deep dorsal vein of, 356, 357, 360, 364, 365 dorsal artery of, 404 dorsal nerve of, 267, 413, 414 frenulum of, 377 glans of, 377, 388 prepuce of, 377 suspensory ligament of, 378, 379, 380 Clivus, 9 surface of, 22 Cloquet, node of, 266, 408 Clunial nerve inferior, 177, 411, 413, 503, 540, 545 medial, 177, 502, 545 superior, 177, 254, 502, 545 Coccygeal cornu, 157 Coccygeal ligament, 160, 161
Coccygeal nerve, 160, 161, 499 vertebrae and, 161 Coccygeal plexus, 499 schema of, 499 Coccygeus (ischiococcygeus) muscle, 263, 358, 359, 398, 402, 410, 411, 412 Coccyx, 153, 157, 160, 161, 248, 352, 353, 357, 376, 379, 391 anterior inferior view of, 157 posterior superior view of, 157 spinal nerves and, 161 tip of, 354, 357, 359, 376, 380, 382, 395 transverse process of, 157 Cochlea, 92, 95, 97 helicotrema of, 92, 96 osseous, 92, 96 section through, 92, 96 Cochlear aqueduct, 96 Cochlear cupula, 95 Cochlear ganglion, 124 Cochlear nerve, 92, 95, 96, 97 distribution of, 118 posteromedial view of, 95 Cochlear nucleus, anterior and posterior, 116, 117, 124 Cochlear recess, 95 Cochlear window. See Round window (cochlear) Cochleus, modiolus of, 96 Colic artery arc of Riolan between middle and left, 308 ascending branch of, 307, 398 descending branch of, 307, 398 left, 264, 307, 318, 323, 324, 340, 398 middle, 290, 298, 301, 306, 307, 318, 322, 323, 340, 348 absence of, 308 right, 306, 307, 308, 322, 323, 340 absence of, 308 variations of, 308 Colic flexure . left, 126, 269, 270, 271, 272, 275, 278, 284, 288, 298, 347 right, 269, 288, 297 Colic impression, 287 Colic lymph nodes left, 317 middle, 317 right, 317 Colic plexus left, 278, 284, 318, 323 middle, 322, 323 right, 275, 322, 323 Colic vein left, 311,312,313 middle, 298, 303, 311, 312 right, 311, 312, 313 Collateral artery middle, 432, 434, 435 radial, 434, 435 Collateral eminence, 111 Collateral ligament, 509 fibular, 493, 499 radial, 438 tibial, 493, 514 ulnar, 438 Collateral sulcus, 106 Collateral trigone, 111
Collecting tubule, 336, 337 schema of, 337 Colles' fascia. See Superficial perineal (Colles') fascia Colliculus brachia of, 114 inferior, 106, 111 brachium of, 111 left, 144 superior, 106, 107, 111, 114, 115, 116, 132, 143, 144 brachium of, 111 left, 144 Colli muscle, nerves to, 129 Colon air in, radiograph of, 355 area for, 329 ascending, 126, 269, 272, 278, 284, 339, 349 axial CT images of, 350 cross section of, 338 site of, 274 circular muscle of, 282 descending, 167, 271, 278, 339, 342 area for, 329 cross section of, 338, 349 descending from left colic flexure, 297 from left colic flexure, 297 site of, 274 mucosa and musculature of, 284 nerve to, 410 right colic flexure of, 297 cross section of, 297 , sigmoid, 167, 168, 269, 271, 284, 391, 392, 393, 394, 412 looping to right side, 284 nerve to, 410 reflected, 271 variations in position of, 285 transverse, 269, 270, 273, 278, 284, 291, 294, 298, 299, 339 ascending to left colic flexure, 297 axial CT images of, 350 cross section of, 338 tributary from, 309 tributary from, 311 Commissure anterior, 106, 115, 146, 147 of fornix, 112 habenular, 106, 111 posterior, 106, 111, 388 Communicating artery anterior, 136, 138, 139, 140, 141, 142 posterior, 104, 136, 139, 140, 141, 142, 143 Communicating vein, 31, 137 Compressor urethra, female, 356 Compressor urethrae muscle, 367, 404 Compressor urethralis muscle, 370 Computed tomography (CT) abdominal, 350 of arteries of the arm, 484 of chest, 242 of head, 150 coronal images of, 151 of upper limb arteries, 484 Concha inferior, 14 nasal. See Nasal concha Conducting system, 225
Condylar canal, 11 Condylar emissary vein, 137 Condyle lateral, 489 medial, 489 Coneus, 106 C1 spinal nerve, 133 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C1 vertebra. See Atlas (C1) Conjunctiva, 91 bulbar, 81, 83, 88, 90 inferior palpebral, 81 palpebral, 83 superior palpebral, 81 Conjunctival artery, posterior, 91 Conjunctival fornix inferior, 81 superior, 81 Conjunctival vein, posterior, 91 Conjunctival vessels, 90, 91 Connective tissue of liver, 291 subserous, 326 Connective tissue sheath, 202 Conoid ligament, 425, 423 attachment of, 419 Conus arteriosus, 212, 218, 220, 222, 224 Conus elasticus, 78 Conus medullars, 160, 161, 170, 339 Convoluted tubule distal, 336 proximal, 336 Cooper's ligament. See Pectineal ligament (Cooper's) Coracoacromial ligament, 423, 425, 426, 430 Coracobrachialis muscle, 244, 245, 429, 430, 433, 435, 474 fascia over, 428 insertion of, 420 origin of. 420 Coracoclavicular ligament, 423 Coracohumeral ligament, 423 Coracoid process, 185, 189, 420, 421, 423, 425, 427, 428, 429, 433 anteroposterior radiograph of, 422 Cornea, 81, 83, 87, 88, 90, 91 Corneal limbus, 81 Corneoscleral junction, 81 Corniculate tubercle, 77 Coronal sulcus, 246, 385, 388 Coronal suture, 2, 5 Coronary artery anterior interventricular branch of, 219 diagonal branches of, 219 arteriographic views of, 218, 219 arterioventricular nodal branch of, 218 circumflex branch of, 219 atrioventricular branch of, 219 conus branch of, 218 of diaphragmatic surface, 216 interventricular septal branches of, 216, 217
Coronary artery (Continued) left, 216, 217, 219 anterior interventricular branch of, 216, 217, 219 circumflex branch of, 216, 217, 219 marginal branch of, 216, 217, 218 opening of, 224 posterior interventricular branch of, 218 posterior left ventricular branch of, 217 posterolateral branches of, 218, 219 right, 217, 218 atrial branch of, 216, 217 marginal branch of, 216, 217 opening of, 223 posterior interventricular branch of, 216, 217 posterolateral branches of, 216 sinuatrial nodal branch of, 216, 218 of sternocostal surface, 217 variations in, 217 Coronary ligament enclosing bare area of liver, 348 hepatorenal portion of, 287 of liver, 287 Coronary sinus, 214, 215, 216, 221, 233, 241 opening of, 220, 223 valve of, 220 Coronary sulcus, 214 Coronary vein, variations in, 217 Coronoid fossa, 420 Coronoid process, 15, 436, 443 radiograph of, 422 Corpora cavernosa, 382 Corpora quadrigemia, 107 Corpus albicans, 371 Corpus callosum, 106, 107, 108, 111, 141, 143 anterior, 145 cistern of, 109 dorsal vein of, 144, 146 genu of, 106, 107, 110, 112, 146 right dorsal branch to, 143 rostrum of, 106, 141 sagittal MR image of, 149 splenium of, 106, 107, 110, 112, 143, 144, 145, 146 sulcus of, 106 trunk of, 106, 141 Corpus cavernosum, 361, 382, 383, 385 sagittal MR images of, 371, 397 Corpus luteum, 371 Corpus spongiosum, 361, 366, 381, 382, 383 sagittal MR images of, 397 Corpus striatum, 110, 141 Corrugator cutis ani muscle, 393 Corrugator supercilii muscle, 25, 36, 123 Corti, organ of. See Spiral organ (of Corti) Cortical radiate artery, 335, 337 lymph vessels along, 343 Cortical radiate vein, 337 Costal facet inferior, 187 superior, 187 Costal groove, 186 Costal impression, 287
Costal pleural, 231, 232 Costocervical trunk, 33, 69, 136, 137, 138 Costochondral joint, 186 Costoclavicular ligament, 186, 419 attachment of, 419 Costocoracoid ligament, 188, 428 Costocoracoid membrane, 428 Costodiaphragmatic recess, 198, 230, 231, 293, 330, 332, 342, 349 right, 206 Cosfomediastinal space, 331 lateral, 198 superior, 198 Costovertebral joint, 243 left lateral view of, 187 right posterolateral view of, 187 transverse section of, 187 Cough receptor, 210 Cowper's gland. See Bulbourethral (Cowper's) gland Coxal bone. See Hip bone Cranial base bones of, 9 foramina of, 10, 11 inferior view of, 10 inferior view of, 8 Cranial fossa anterior, 9 middle, 9 posterior, 9 arteries of, 142, 143 veins of, 144 posterior veins of, 144 Cranial mesonephric (Gartner's) duct, 389 Cranial mesonephric tubule, 389 Cranial nerve, 116, 130-133, 134-135 in carotid sheath, 60 communicating branch of, 45 motor and sensory distribution of, 118 nuclei of medial dissection of, 117 posterior phantom view of, 116 schema of, 116 palsy of, 101 Cranial nuclei, in brainstem, schema of, 117 Craniocervical ligaments external anterior view of, 21 posterior view of, 21 right lateral view of, 21 internal, 22 Cremaster fascia, 250 Cremasteric artery, 255 Cremasteric muscle, 250, 251, 259, 261, 390 lateral origin of, 259 medial origin of, 259 Cremasteric vessels, 260, 401 Cribriform fascia, 546 Cribriform plate, 6, 9, 37, 39, 119 foramina of, 11 Cricoarytenoid muscle lateral, 78, 80 action of, 78, 79 posterior, 78, 80, 235 action of, 79
Cricopharyngeus muscle, 75, 76, 80, 233, 234, 235 Cricothyroid artery, 69 Cricothyroid joint, 77 pivot point of, 79 Cricothyroid ligament lateral, 77 median, 74, 77, 202 Cricothyroid muscle, 29, 68, 74, 78, 80, 126
action of, 79 oblique part of, 79 straight part of, 79 Crista galli, 3, 6, 9, 39 coronal CT images of, 151 Crista terminalis, 220, 225 Cross section of abdomen at L1-2, 339, 349 at L3, 349 at L3, 4, 349 at T10, 293 at T12, 297, 331, 338 of descending duodenum, 179 forearm, serial, 449 of gallbladder, 297 of scrotum, 390 of testis, 390 Cruciate ligament, 22, 507, 509 anterior, 508, 509, 514 attachment of, 508 origin of, 514 inferior longitudinal band of, 22 posterior, 514 attachment of, 514 superior longitudinal band of, 22 transverse, 22 C3 spinal nerve, 19, 127 dorsal ramus of, 178 ventral ramus of, 32, 71, 178 C2 spinal nerve, 133 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 Cubital fossa, 418 Cubital lymph nodes, 483, 484 Cubital node, 483 Cubital vein intermediate, 480 median, 418, 479, 483, 484 Cuboid bone, 523, 524, 527, 536, 537 articular surface for, 525 base of, 523 dorsal view of, 523 groove for fibularis longus tendon insertion, 523 plantar view of, 523 radiograph of, 54 shaft of, 523 tuberosity of, 523, 524, 528, 536 Cuboideonavicular ligament, plantar, 528 Culrnen, 113, 115, 144 Cuneate fasciculus, 114 Cuneate tubercle, 114 Cuneiform bone intermediate, 523, 536 lateral, 523, 536 radiograph of, 54 medial, 523, 524, 527, 536 plantar view of, 523
Cuneiform tubercle, 66, 67, 78 Cuneocuboid ligament, dorsal, 527 Cuneonavicular ligament dorsal, 527 plantar, 528 Cuneus, 106 apex of, 107 Cuspid teeth. See Teeth, canine Cutaneous nerve(s) antebrachial lateral, 469 dorsal, lower limb intermediate, 540, 541, 542 lateral, 542, 545 medial, 541, 542 femoral lateral, 409 posterior, 411 of forearm, medial, 469 of head, 24 lateral antebrachial, 447 lateral dorsal, 544 lateral femoral, 329, 499, 538, 539 medial antebrachial, 429, 432, 469 of neck, 24, 31 perforating, 411, 499 posterior antebrachial, 469 superior lateral brachial, 177 Cuticle, 471 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19 tubercles of transverse process of anterior, 30 posterior, 30 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 „
posterior tubercle of, 18 posterosuperior view of, 18 superior articular process of, 19 C7 vertebra, 13, 153, 160 posterior tubercle of transverse process of, 30 spinous process of, 18, 152, 174, 175, 176, 424 superior view of, 18 Cymfea, 93 Cystic artery, 294, 300, 301, 305 Cystic duct, 331 smooth part of, 294 spiral fold of, 294 variations in, 296 Cystic node (of Calot), 315 Cystic vein, typical arrangement off, 313 Cystohepatic triangle, 301 Cystourethrograms, male and female, 368
D Declive, 113 Deep (Buck's) fascia, 249, 250, 348, 361, 380, 381, 382, 383, 396, 401, 403, 405 intercavernous septum of, 382, 385
Deep palmar arch, 465 Deltoid muscle, 152, 174, 177, 188, 189, 243, 244, 245, 423, 428, 429 attachments of, 420 insertion of, 420, 421 origin of, 419, 420 Deltoid tuberosity, 420 Deltopectoral lymph node, 483, 484 Deltopectoral node, 483 Deltopectoral triangle, 247, 424 Denonvilliers' fascia. See Rectoprostatic (Denonvilliers') fascia Dens, 137 apical ligament of, 63, 65 of axis, 19, 37 posterior auricular facet of, 22 Dental plexus inferior, 122 superior, 122 Dental puBp, 57 Dentate gyrus, 106, 108, 111, 112, 119 Dentate nucleus, 108, 112, 119 Denticulate ligament, 169, 170 Dentinal tubules, 57 Dentine, 57 Depressor anguli oris muscle, 54 Depressor labii inferioris muscle, 26, 54, 123 Depressor septi nasi muscle, 36, 123 Dermatomes anterior, 482 levels of, 164 of lower limb, 543 posterior, 482 schematic demarcation of, 164 of upper limb anterior and posterior views of, 482 Descemet's membrane. See Posterior limiting lamina (Descemet's membrane) Diaphragm, 198, 206, 211, 215, 230, 233, 236, 237, 272, 273, 275, 286, 327, 329, 331, 342, 498 abdominal surface of, 195 area for, 330 caval opening for, 195, 263, 267 central tendon of, 263 right leaflet of, 194 costal part of, 195, 258 cross section of, 338 crura of, 179, 293, 338, 342 left, 263, 270, 297, 339 right, 263, 270, 293, 297, 331, 339 domes of, 213 left, 196, 197 right, 196, 197 lateral view of, 233 lumbar part of, 195 pelvic, 361 fascia of, 364 female, 356, 357 inferior and superior fascia of, 392 male, 358-359 superior fascia of, 360, 364, 365, 369, 394 phrenic nerves to, 193 slip of origin of, 349 sternal part of, 195 thoracic surface of, 193 Diaphragmatic constriction, 233
Diaphragmatic ligament, 389 Digastric fossa, 15 Digastric muscle, 29, 123 anterior belly of, 27, 28, 29, 31, 32, 34, 46, 53, 61, 68 intermediate tendon of, 59, 60 fibrous loop for, 59 phantom, 34 posterior belly of, 27, 28, 29, 32, 34, 40, 59, 73 nerve to, 25 Digastric tendon, intermediate, 59, 60 fibrous loop for, 28, 29, 53 Digital artery common, computed tomography of, 484 common palmar, 465 common plantar, 536 dorsal, 469, 471, 530, 536 nutrient branches of, 471 palmar common, 460 proper, 460 proper palmar, 460, 471 dorsal branches of, 471 proper plantar, 533, 535, 536 dorsal branches of, 530 Digital creases, 418 Digital nerves common palmar, 476 common plantar, 476, 541 dorsal, 468, 471, 475, 542, 544 lateral dorsal, 544 palmar to fourth and fifth fingers, 460 proper, 476 proper palmar, 460, 471, 476 dorsal branches of, 468 to thumb, 460 proper plantar, 535, 541 Digital vein dorsal, 468, 480, 544 Dilator pupillae muscle, 88, 121 DipBoe, 7 Diploic vein, 102 anterior temporal, 99 coronal dissection of, 99 frontal, 99 occipital, 99 posterior temporal, 99 Direct vein, lateral, 145, 146 Distal interphalangeal (DIP) joint, site off, 418 Distal medial striate artery (recurrent artery of Heubner), 140, 141, 142 Dorsalis pedis artery, 520, 530, 536 Dorsal ramus, spinal, 170, 258, 430 medial clunial nerves from, 545 perforating cutaneous nerves from, 545 Dorsal tubercle of radius (Lister's), 452 Dorsal venous arch, foot, 544 Dorsomedial nucleus, 147 Dorsum sellae, 9 Douglas, cul-de-sac of. See Rectouterine pouch (of Douglas) Ductus arteriosus obliterated, 229 prenatal, 229
Ductus choledochus. See Bile duct, common Ductus (vas) deferens, 259, 261, 340, 389, 390, 409, 546 ampulla of, 384 artery to, 255, 264, 340, 398, 401, 403 Ductus deferens plexus, 409, 415 Ductus plexus, 409 Ductus reuniens, 96 Ductus venosus obliterated, 229 prenatal, 229 Duodenal cap, 279 Duodenal flexure inferior, 279 superior, 279 Duodenal fold inferior, 278 superior, 270 Duodenal fossa inferior, 270 superior, 270 Duodenal glands, 279 Duodenal impression, 287 Duodenal papilla major, 279, 294, 295 minor, 279 Duodenal wall circular muscle layer of, 279 longitudinal muscle layer of, 279 submucosa of, 279 Duodenojejunal flexure, 270, 279, 342 Duodenojejunal junction, 179 Duodenum, 126, 248, 273, 275, 278, 288, 329, 340, 342 arteries of, 301, 304 ascending, 270, 278, 279 barium radiograph of, 279 circular muscle of, 277, 295 descending, 272, 279, 294 cross section of, 179 descending part of, 270 inferior part of, 270 in situ, 278 innervation of, 321 junction with common bile duct, 295 longitudinal fold of, 279 longitudinal muscle of, 277 mesentery root of, 278 mucosa of, 279 musculature of, 279 nerves of, 319, 320, 321 second-third parts of, 338 junction of, 339 submucosa of, 279 superior, 276, 278 cross section of, 297 superior part of, 294 superior (1st) part of, 297 suspensory ligament of, 270 suspensory muscle of, 270 veins of, 309 Dural sac in lumbar puncture, 162 sagittal MR images of, 397 termination of, 160, 161 Dural venous sinuses, 104 coronal section through, 104 sagittal section of, 103 superior view of, 104
Dura mater, 39, 91, 93, 96, 99, 100, 102, 109, 119, 137, 169 around bony and membranous labyrinths, 96 cerebral veins penetrating, 102 lumbar, 170 periosteal and meningeal layers of, 99 spinal, 160, 179 spinal arteries to, 172 of thoracic spine, 170 Dura-skull interface, 102
Ear, 93 bony and membranous labyrinths of, 95 external coronal oblique section of, 93 superolateral view of, 93 lobule of, 1 middle coronal oblique section of, 93 surface anatomy of, 1 Edinger-Westphal nucleus, 116, 117, 132 Efferent ductule, 389, 390 Efferent fiber, to olfactory bulb, 119 Ejaculatory duct, 376 beginning of, 384 openings of, 316, 384, 385 Elbow anastomoses around, 434 bones of, 436 ligaments of, 438 muscles of, 447-448 attachments of, 450, 451 radiographs of anteroposterior, 437 lateral, 437 Emissary vein, 99, 102 communicating with cavernous sinus, 70 condylar, 137 coronal dissection of, 99, 102 mastoid, 23, 99, 137 occipital, 99 parietal, 23, 94, 99 parietal foramen for, 7 of skull, 99 to superior sagittal sinus, 7 Endolymphatic duct, 11, 95 opening for, 97 in vestibular aqueduct, 96 Endolymphatic sac, 96 Endometrium, 371 Endopelvic fascia, 364 Ependyma, 108 Epicolic nodes, 317 Epicondyles lateral, 438, 440, 441, 442, 443, 489 radiograph of, 510 medial, 437, 440, 441, 442, 443, 447, 476, 489 Epicranial aponeurosis, 26, 178 Epicranius muscle frontal belly of, 26 occipital belly of, 26 Epididymal duct, 390 Epididymis, 390 appendix of, 389 body of, 390 head of, 390
Epididymis (Continued) sinus of, 390 tail of, 390 Epidural anesthesia, for lumbar puncture, 162 Epidural hematoma, 101 Epidural space fat in, 170 in lumbar puncture, 162 Epigastric artery superficial, 211, 511 superior, 188, 189, 192 Epigastric lymph nodes, inferior, 266 Epigastric region, 268 Epigastric vein inferior 251, 256, 265, 400 superficial, 247, 256, 265, 544 superior, 189, 256 Epigastric vessels inferior, 251, 259, 261, 349, 362, 363, 401, 403 superficial, 249, 500 superior, 331, 500 Epiglottis, 13, 58, 63, 66, 67, 76, 77, 78, 135, 233, 235 Epiphyseal plate, 504 Epiphysis, 471 nutrient arterial branch to, 471 Epiploic appendices. See Omental appendices Epiploic foramen, 331 Epiploic foramen. See Omental foramen Episcleral artery, 90 Episcleral space, 83, 87 Episcleral vein, 90, 91 segment of, 91 Epithelial cell, stomach surface, 276 Epithelial tag, 388 Epitympanic recess, 92, 93 Eponychium, 471 Epodphoron, 343 Epoophoron canal, 389 Erector spinae muscle, 152, 174, 175, 179, 180, 192, 243, 258, 293, 330, 331 Esophageal artery, 207 Esophageal hiatus, 195 Esophageal impression, 287 Esophageal junction, 236 Esophageal muscle, 202 circular, 75, 235, 236 longitudinal, 75, 235, 236 cricoesophageal tendon of, 235 Esophageal plexus, 126, 165, 166, 206, 209, 230, 231, 232, 241, 321 anterior, 240 posterior portion of, 240 sympathetic branches to, 209, 240 Esophageal prominence, pericardial, 215 Esophageal vein, 312, 313 Esophagogastric junction, 236 transverse section of, 293 Esophagus, 63, 68, 76, 126, 194, 204, 206, 207, 230, 231, 233, 240, 241, 243, 244, 245, 246, 263, 264, 270, 274, 323, 329, 332, 348 abdominal part of, 233, 237, 275 anterior view of, 240
Esophagus (Continued) arteries of, 237 common variations in, 237 bare area on ventral surface, 234 cervical part of, 237 circular muscle layer of, 234, 277 gradual slight muscular thickening of, 232 greater curvature of, 277 groove for, 199 in situ, 232 lateral view of, 233 longitudinal muscle layer of, 234, 277 lateral mass of, 234 mucosa of, 235, 236 junction with gastric mucosa, 276 musculature of, 239 nerves of, 240 opened posterior view of, 66 posterior view of, 240 pyloric part of, 277 recurrent arterial branch to, 195, 264 submucosa of, 235, 236 thoracic part of, 232, 237 topography and constrictions of, 233 zone of sparse muscles of, 234, 235 Ethmoidal artery anterior, 11, 85 meningeal branch of, 100 septal and meningeal branches of, 41 posterior, 11, 85, 100 septal and meningeal branches of, 41 Ethmoidal bulla, 37, 38 Ethmoidal cells, 48, 49, 83 anterior, 50 opening of, 37, 38 semilunar hiatus of, 37 middle, 50 opening of, 37, 38 posterior, 37, 38 opening of, 38 Ethmoidal foramen anterior, 2, 11, 12 posterior, 2, 11 Ethmoidal nerve anterior, 11, 43, 86, 121, 122 external nasal branches to, 24, 122 lateral internal nasal branches to, 42, 43 medial internal nasal branches to, 42 posterior, 11, 45, 86, 121, 122 Ethmoidal vein anterior, 122 posterior, 122 Ethmoid bone, 4, 6, 9, 38 anterior ethmoidal foramen of, 12 cribriform plate of, 37, 38, 39, 119 crista galli of, 39 middle nasal concha of, 2 nasal concha of, 38 orbital plate of, 2, 4, 12 perpendicular plate of, 2, 6, 39 uncinate process of, 38 Ethmoid sinus axial MR image of, 150 coronal CT images of, 151 Eustachian tube. See Auditory (pharyngotympanic, Eustachian) tube
Extensor carpi radialis brevis muscle, 418, 420, 444, 446, 477 groove for, 439 tendon of, 444, 445, 449, 469, 470 attachment of, 420 Extensor carpi radialis longus muscle, 432, 435, 441, 444, 445, 446, 449, 451, 477 groove for, 439 origin of, 439 tendon of, 444, 469, 470 Extensor carpi ulnaris muscle, 418, 420, 432, 441, 444, 449, 451, 477 tendon of, 444, 469, 470 ulnar origin of, 451, 470 Extensor digiti minimi muscle, 420, 441, 444, 450, 451 tendon of, 420, 441, 444, 449, 470 Extensor digitorum brevis muscle, 520, 521, 530, 531, 542 innervation of, 542 tendon of, 519, 520, 531, 536 Extensor digitorum longus muscle, 494, 519, 520, 522, 530, 531, 542 attachments of, 515 tendon of, 519, 520, 521, 530, 531, 536, 537 sheath of, 530 Extensor digitorum minimi tendon, 469 Extensor digitorum muscle, 432, 441, 449, 450, 477 central bands of, 451 CP
*
groove for, 439 lateral bands of, 451 tendon of, 418, 441, 444, 445, 449, 469, 470, 471 Extensor expansions, 536 tendinous slips to, 465 transverse fibers of, 470 Extensor hallucis brevis muscle, 520, 530, 542 innervation of, 542 tendon of, 519, 531, 536 Extensor hallucis longus muscle, 519, 520, 521, 522, 531 attachments of, 515 innervation of, 542 tendon of, 519, 520, 521, 530, 531, 536 sheath of, 530 Extensor indicis muscle, 441, 445, 449 groove for, 439 tendon of, 418, 441, 444, 469, 470 Extensor pollicis brevis muscle, 441, 443, 444, 445, 451 area for, 439 tendon of, 444, 469 Extensor pollicis longus muscle, 418, 441, 444, 449 groove for, 439 tendon of, 418, 444, 462, 468, 469 Extensor pollicis longus tendon, 444, 469, 470 Extensor retinaculum, 444, 446, 468, 469, 470, 530, 542 inferior, 530, 542 superior, 519, 521, 530
Extensor tendons, 420, 441, 444 common, of forearm, 420, 441, 444 in fingers, 464 of hand, 445 at wrist, 470 Extraocular muscles, sagittal MR image of, 149 Extraperitoneal fascia, 412 Extraperitoneal space, fibrofatty tissue of, 392 Eye, 168 anterior and posterior chambers of, 88 axial CT images of, 150 axial MR image of, 150 coronal CT images of, 151 external muscles of, 90 extrinsic muscles of, 84, 90 intrinsic arteries and veins of, 90 muscular artery and vein of, 90 vascular supply of, 91 Eyeball, 81 arteries and veins of, 85 choroid of vascular arrangements within, 91 tarsus of, 83 vascular supply of, 91 Eyelashes, 81 Eyelid, 81 arteries and veins of, 85 tarsus of, 83
Face arterial supply sources of, 19 muscles of. 123 sensory nerves of, 123 superficial arteries and veins of, 23 Facets, 246 Facial artery, 31, 32, 34, 36, 40, 60, 75, 85, 131, 133, 136, 138 lateral nasal alar branch of, 41 nasal septal branch of, 41 superior labial branch of, 41 tonsillar branch of, 64 transverse, 23, 34, 36, 69, 85 Facial canal, 124 prominence of, 93 Facial expression muscles, 26, 60 lateral view of, 26 Facial lymph node, 72 Facial muscles, 123 Facial nerve (VII), 11, 34, 40, 62, 71, 92, 104, 114, 116, 117, 122, 131, 133, 134, 135, 165, 166 branches of, 25, 168 buccal branches of, 123 cervical branches of, 123 communications to, 123, 125 distribution of, 118 geniculum (geniculate ganglion) of, 97, 123, 124, 125 intermediate, 133 internal genu of, 117 main trunk of, 25 marginal mandibular branch of, 30 motor nucleus of, 123 motor root of, 124 schema of, 118, 123, 134 in stylomastoid foramen, 94
Facial nerve (VII) (Continued) temporal branches of, 123 zygomatic branches of, 123 Facial nucleus, 116, 117 Facial plexus, 131 Facial vein, 23, 30, 32, 59, 60, 85 common trunk for, 23 deep, 23, 85 transverse, 23, 70 Falciform ligament, 252, 269, 274, 275, 305, 312, 331, 349 branch to, 255 of liver, 305 Fallopian tube. See Uterine (fallopian) tube Falx cerebelli, 144 Falx cerebri, 39, 102, 103, 141, 144 Fascia axillary, 428 anterior part of, 428 fenestrated, 428 brachial, 428 buccopharyngeal, 60, 63, 65 Camper's, 348, 361, 378 cervical investing layer of, 26, 28 muscles invested by, 188 pretracheal layer of, 28 clavicopectoral, 188 clavipectoral, 428 cremaster, 390 cremasteric, 250, 261 cribriform, in saphenous opening, 249 dartos, 390 deep (Buck's), 249, 250, 253, 348, 380, 381, 382, 383, 396, 401, 403, 405 deltoid, 26 diaphragmatic, 342 inferior, 348, 349 endopelvic, 364 extraperitoneal, 252, 261, 412 infradiaphragmatic, 236 infrahyoid, 28 of infrahyoid muscle, 428 infraspinatus, 174, 177 interosseous dorsal, 462 palmar, 462 infraspinous, 424 investing pectoralis minor muscle, 428 investing subclavius muscle, 428 latissimus dorsi, 428 of leg, 522, 546 obturator, 356, 369, 379, 402, 411 over obturator internus muscle, 365 obturator internus, 364, 392, 402, 411 of orbit and eyeball, 83 over adductor pollicis muscle, 460 paravesical endopelvic, 366 parotid, 26 pectoral, 182, 428 superficial and deep layers of, 428 of pectoralis minor muscle, 428 pelvic, 372 penile, 249 perineal, 356 deep, 355, 361, 370, 378, 381, 382, 383, 391, 396, 404, 405 deep transverse, 384 superficial, 348, 366, 370, 378, 380, 381, 395, 396, 404, 405, 411
Fascia (Continued) pharyngobasilar, 52, 73 plantar lateral, 532 medial, 532 posterior antebrachial, thickening of, 468 presacral, 348, 364, 396 pretracheal, 63 visceral layer of, 202 prevertebral, 60, 63, 65 pubocervical distal portion of, 372 horizontal portion of, 372 quadratus lumborum, 179 rectal, 348, 364, 378, 384, 391, 392, 393, 394, 396 rectoprostatic (Denonvilliers'), 348, 359, 361, 386, 391, 396 rectovesical, 384, 391, 396 renal, 339, 342, 347 anterior layer of, 179 Gerota's, 342 posterior layer of, 179, 342 sagittal section of, 342 transverse section of, 342 Scarpa's, 348, 361, 378 attachment of, 380 scrotal, 249 superficial, 395 serratus anterior, 428 Sibson's, 230 spermatic, 249, 250, 259, 261 external, 249, 250, 251, 257, 259, 260, 261, 361, 380, 390, 405 internal, 251, 261, 390 origin of, 260, 261 subclavius, 428 subserous, 412 superficial, 390 supradiaphragmatic, 236 temporal, 26, 54 deep layer of, 54 superficial layer of, 54 thoracolumbar, 174, 175, 176, 177, 330 anterior layer of, 176, 179 layers of, 179 middle layer of, 179 posterior layer of, 176, 179, 330 transversalis, 179, 252, 259, 261, 331 umbilical prevesical, 251, 252, 260, 348, 364, 365 uterine, 364 uterovaginal, 369, 370, 378 vaginal, 391 vesicle, 348, 361, 366, 369, 391, 396 Fascia lata, 250, 500, 544 attachment to Scarpa's layer, 249 of leg, 546 Fascial compartments, leg, 522 Fascial sheath of eyeball (Tenon's capsule), 83, 87 Fasciculus dorsal longitudinal, 147 medial longitudinal, 113 Fat of elbow, 438 epidural, 137, 170 infrapatellar, 507, 508, 511 of mammary gland, 182 in orbit, axial MR image of, 150 pararenal, 179, 339
Fat (Continued) perirenal, 179, 339, 342 retrobulbar, 83 of sole of foot, 532 suprapatellar, 511 Fat body, of ischioanal fossa, 376 Fat pad infrapatellar, 511 suprapatellar, 511 Fauces, 64 Female reproductive organs, innervation of, 415 Femoral artery, 250, 493, 500, 512, 546 circumflex ascending, 501, 512 descending, 501, 512 lateral, 500, 512 medial, 501, 502, 504, 512 transverse, 501, 512 deep, 493, 500, 512 muscular branches of, 512 Femoral canal, 546 lymph nodes in, 546 Femoral nerve, 160, 259, 267, 376, 409, 496, 498, 500, 538, 546 anterior cutaneous branches of, 409 branches of, 545 cutaneous, 545 anterior, 538, 544 lateral, 267, 329, 496, 498, 500, 544, 565 posterior, 160, 177, 503, 540, 545, 546 terminal branch of, 544 Femoral ring, 259, 262, 363, 364, 546 Femoral sheath, 250, 251, 262, 500, 546 Femoral vein, 250, 256, 376, 380, 493, 500, 505, 544, 546 Femoral vessels, 260, 401, 407 openings for, 263, 500 Femoris muscle, rectus, 376, 485, 489, 491, 492, 494, 500, 538 attachments of, 490, 491 origin of, 492 Femoris tendon, rectus, 485, 493, 505, 507, 519 Femur, 489, 511 adductor tubercle of, 489 anteroposterior radiograph of, 488 anterior view of, 489 calcar of, 489 of child, 504 fibrous capsule of, 489 gluteal tuberosity of, 489 greater trochanter of, 152, 489, 493 head of, 376, 487, 489 anteroposterior radiograph of, 488 arteries of, 504 fovea of ligament of, 489 radiograph of, 355 intercondylar fossa of, 489 intertrochanter crest of, 489 lateral condyle of, 489, 493, 510 lateral epicondyle of, 489 lesser trochanter of, 263, 489 ligament of head of, 487, 489 linea aspera of, 489 medial condyle of, 489 adductor magnus muscle insertion on, 493 adductor tubercle on, 493
Femur (Continued) neck of, 376 nutrient artery of, 504 nutrient foramen of, 489 patellar surface of, 489 pectinal line of, 489 popliteal surface of, 489, 511 posterior view of, 489 radiograph of, 355, 510 shaft of, 489, 496 Fibroelastic membranes, 234 Fibrous (Albini's) nodule, 223 Fibrous sheath, of sole of foot, 534 Fibrous trabecula, 147 Fibula, 513, 517, 530 at ankle, 525, 527, 531 anterior border of, 513 anterior intercondylar, 514 anterior view of, 513, 514 with ligament attachments, 514 apex of, 513, 514 cross section of, 514 head of, 492, 493, 494, 511, 513, 514, 515, 518, 520, 521, 542 anterior ligament of, 514 anteroposterior radiograph of, 510 posterior ligament of, 514 radiograph of, 510 interosseous border of, 513, 514 lateral condyle of, 514 lateral surface of, 513, 514 medial crest of, 514 medial surface of, 513 neck of, 513 posterior view of, 513 radiograph, of, 54, 510 superior articular surface of, 513 superior view of, 513 trochlea of, 522 Fibular artery, 512, 516, 517, 518, 522, 534 calcaneal branches of, 516, 517 circumflex, 512 communicating branch of, 518 perforating branch of, 518, 520, 530, 531 posterior lateral malleolar branch of, 518 Fibular collateral bursa, 507 Fibular collateral ligament, 506, 507, 508, 511, 514, 517, 520, 521 inferior subtendinous bursa of, 511 Fibularis brevis muscle, 530, 531, 542 attachments of, 515 innervation of, 542 tendon of, 485, 516, 517, 518, 520, 521, 527, 528, 530, 536 Fibularis brevis tendon, 530, 535 Fibularis longus muscle, 485, 494, 515, 517, 519, 521, 522, 542 attachments of, 515 innervation of, 542 tendon of, 485, 516, 517, 520, 521, 527, 528, 530, 531, 536 groove for, 524 to sole of foot, 521 Fibularis longus tendon, 536 Fibularis tertius muscle, 530 attachments of, 515 tendon of, 519, 521, 530, 531, 536
Fibular nerve articular branch of, 540, 541 common, 495, 499, 505, 506, 507, 508, 518, 519, 520, 521, 540, 541, 542, 544, 545 muscles innervated by, 542 deep, 520, 522, 542 dorsal digital branches of, 520, 530, 531, 544 dorsal digital branch of, 544 lateral branch of, 520, 542 medial branch of, 519, 520, 530, 531, 542 superficial, 519, 520, 521, 530, 542, 544 dorsal digital branches of, 530 intermediate dorsal cutaneous branch of, 544 medial dorsal cutaneous branch of, 544 Fibular notch, 513 Fibular retinaculum inferior, 518, 521, 525, 527 superior, 516, 517, 521, 527 Fibular tendon, 525 Fibular vein, 522 Filiform papillae, 58 Filum terminale externum, 160, 161 Filum terminale internum, 160, 161 Fimbriated fold, 51 Fingernail body of, 471 lunule of, 471 nailbed of, 471 Fingernail, body of, 471 Fingers, 418 arteries and nerves of, 471 arteries of, 471 bones of, 452 common names of, 418 cross section of, 471 cross section through, 471 distal anterior closed space of, 471 dorsum of lymph vessels passing to, 483 in extension, 464 extensor mechanism of, 471 extensor muscles of, 441 extensor tendons of, 464 fibrous septa of, 471 fibrous sheath, annular and cruciform parts of, 462 fibrous sheath of, 471 fifth palmar digital nerves to, 460 synovial tendinous sheath of, 460 in flexion, 464 flexor and extensor tendons in, 471 flexors of, 443 flexor tendons of, 464 fourth, palmar digital nerves to, 460 index, metacarpal of, radiograph of, 457 innervation of, 469 lateral view of, 464 lymph vessels passing through, 483 middle, middle phalanx of, 457 middle, sagittal section of, 453 muscle attachments of, 450 nerves of, 471 posterior (dorsal) view of, 464 ring, distal phalanx of, 457 sagittal section through, 453, 471
Fingers (Continued) septa of, 471 synovial flexor tendon sheaths of, 460 tendon sheaths of, 462 fibrous, 471 Flank left, 268 * right, 268 Flexor carpi radialis muscle, 420, 433, 442, 446 tendon of, 418, 420, 447, 448, 454, 460, 461 Flexor carpi radialis tendon, 447, 454 Flexor carpi ulnaris muscle, 418, 420, 444, 446, 447, 476 humeral origin of, 451 tendon of, 418, 420, 448, 449, 454, 461, 465 ulnar origin of, 451 Flexor carpi ulnaris tendon, 418, 454, 460, 465 Flexor digiti minimi brevis muscle, 465, 476, 533, 534, 536, 541 superficial tibial nerve branch to, 541 tendon of, 528 Flexor digitorum brevis muscle, 533, 534, 535 tendon of, 533, 534, 535 Flexor digitorum brevis nerve, 541 Flexor digitorum longus muscle, 515, 535, 541 innervation of, 541 tendon of, 513, 516, 517, 528, 533, 534, 535 Flexor digitorum profundus muscle medial part of, 476 tendon of, 460 Flexor digitorum superficialis muscle, 420, 443, 444, 446, 447, 448, 449, 450, 451, 474, 475, 476 humeroulnar head of, 420 origin of, 420 radial head of, 447, 448, 449, 450, 474 tendon of, 418, 420, 446, 449, 454, 461, 462, 474 Flexor digitorum superficialis tendon, 418, 454, 471 insertion of, 460 Flexor digitorum profundus muscle, 476 Flexor hallucis brevis muscle, 541 insertion of, 536 lateral head of, 533, 535 insertion of, 536 medial head of, 533, 534, 535 insertion of, 536 medial origin of, 536 tendon of adductor hallucis and lateral head of, 528 lateral origin of, 536 medial head of, 528 Flexor hallucis longus muscle, 541 attachment of, 515 innervation of, 541 tendon of, 516, 517, 518, 528, 533, 534, 535, 536 groove for, 523, 524, 525 on lalus, 523
Flexor muscles of fingers, 444 of forearm, superficial, 446 of leg deep, 522 superficial, 522 of wrist, 442 Flexor pollicis brevis muscle, 465 : 476 deep head of, 476 superficial head of, 476 Flexor pollicis longus muscle, 444, 446, 447, 448, 449, 450, 474 superficial head of, 443, 446 synovial tendinous sheath of, 460 tendinous sheath of, 460, 462 tendon of, 446, 448, 449, 454 in tendon sheath, 461, 462 ulnar head of, origin of, 420 Flexor pollicis longus tendon, 454 Flexor retinaculum, 447, 460, 461, 462, 465, 474, 516, 517, 534, 535, 541 removed, 454 transverse, 465 Flexor sheath, common, 460 Flexor tendons common, of forearm, 443, 446 in fingers, 464 profundus and superficialis, 462 at wrist, 461 Flexor tendon sheath common, 460 common ulnar, 462 fibrous, of sole of foot, 533 fibrous sheath over, annular and cruciform parts of, 460 of finger, 471 Flocculonodular lobe, 113 Flocculus, 113 Foliate papillae, 58, 135 Folium, 113, 115, 144 Follicle, 371 Fontalis muscle, 36 Fontanelle anterior, 12 mastoid, 12 posterior, 12 Foot arteries of, 536 bones of, 523, 524, 525 deep arteries of, 536 dorsal view of, 536 dorsum of deep dissection of, 530, 531 muscles of, 530 fibrous longus tendon passing to, 521 interosseous muscles of, 530, 536 inversion and eversion of, 543 lateral dorsal cutaneous nerve of, 530 ligaments and tendons of, 527 plantar view of, 528 plantar surface of, 485 plantar view of, 536 right lateral view of, 527 medial view of, 527 sole of muscles Of, 533, 534, 535 superficial dissection of, 532 tendons of, plantar view of, 528
Foramen lacerum, 8, 10 petrosal nerves of, 10 Foramen magnum, 8, 9, 11, 14, 58, 123, 127 Foramen of Luschka. See Lateral aperture (foramen of Luschka) Foramen of Magendie. See Median aperture (foramen of Magendie), 109 Foramen of Monro. See Interventricular foramen (of Monro) Foramen of Winslow. See Omental foramen (of Winslow) Foramen ovale, 4, 8, 11, 14, 45, 46 obliterated, 229 prenatal, 229 valve of, 221 Foramen rotundum, 11, 45 Foramen spinosum, 11, 14, 46 Foramen transversarium, 19 Forearm bones of, 439 cutaneous nerves of, 480 lateral, 435, 446, 447, 448, 449, 469, 473, 481 branches of, 479 posterior branch of : 480 deep muscle layer of anterior view of, 447 posterior view of, 445 distal, cross section of, 470 intermediate muscle layer of, anterior view of, 447 ligaments of, 438 medial, 429, 430, 433, 446, 469, 473, 479, 481, 474, 475 anterior branch of, 449, 480 posterior branch of, 480 muscles of, 440, 441, 442, 444, 446, 447 deep layer of, anterior view of, 448 muscular attachments of anterior view of, 450 posterior view of, 451 posterior, 432, 435, 449, 468, 469, 477, 479, 480, 481 pronated position of, 440 serial cross sections of, 449 superficial muscles of anterior view of, 446 posterior view of, 444 superficial veins of, 480 supinated position of, 440 Fornix, 106, 112, 147 body of, 106, 108, 112 columns of, 106, 110, 111, 112, 145 conjunctival, 81 crura of, 106, 110, 112, 143 schema of, 112 Fossa ovalis, 220, 544 limbus of, 220 Fovea centralis, 87, 90 Frenulum, 282 artery to, 59 of lower lip, 51 of tongue, 51, 61 of upper lip, 51 Frontal artery, 23 medial, 142 polar, 141, 142 Frontal artery, polar, 141, 142
Frontal bone, 9, 36, 38, 81, 82 glabella of, 4 nasal spine of, 38, 39 orbital part of, 2, 9 sinus of, 38, 39 squamous part of, 38, 39 supraorbital notch of, 4, 12 Frontal crest, 9 Frontal gyrus inferior, 105 medial, 106 middle, 105 superior, 105 Frontalis muscle, 36 Frontal lobe, 105 Frontal nerve, 83, 86, 121, 122 131 Frontal operculum, 105 Frontal pole, 105 sagittal MR image of, 149 Frontal sinus, 3, 5, 37, 38, 39, 48, 63 with frontal bone, 50 growth of, 50 Frontal sulcus inferior, 105 superior, 105 Frontobasal artery lateral, 141, 142 medial, 141, 142 Frontonasal canal infundibulum leading to, 38 opening of, 38 Frontonasal duct, 37 opening of, 49 Fundiform ligament, 249 of penis, 361 Fundus, of stomach, 293 Fungiform papilla, 58, 135
G Galea aponeurotica, 26, 102, 178 Galen, ansa of, 80 Galen, vein of. See Great cerebral vein (of Galen) Gallbladder, 126, 167, 196, 269, 272, 275, 294, 301, 331 arterial variations and collateral supply of, 305 body of, 294 cross section of, 297 fundus of, 294 gland orifices of, 294 infundibulum of, 294 innervation of, 168 joining hepatic duct, 294, 296 neck of, 294 Ganglion, basal nuclei of, 110 Ganglion cells, 120 Gartner's duct. See Cranial mesonephric (Gartner's) duct, 389 Gastric artery, 272, 300, 305, 318, 319, 320, 321 arteriogram of, 303 attached to lesser omentum, 274 esophageal branch of, 300 sympathetic fibers along, 240 left, 206, 237, 264, 300, 301, 306, 318, 319, 320, 321, 323, 331, 348, 349, 410 esophageal branch of, 237
Gastric artery (Continued) right, 279, 294, 300, 305, 320, 321, 331 arteriogram of, 303 short, 300, 301, 305, 321 sympathetic fibers along esophageal branch of, 240 Gastric canal, 276 Gastric-esophageal mucosa junction, 276 Gastric folds, 236, 276 Gastric glands, 276 Gastric impression, 286 Gastric lymph drainage pathways, 314 Gastric lymph nodes, 314, 315 Gastric plexus, 410 left, 318, 319, 320, 322, 323 right, 319, 320, 322 Gastric vein left, 309, 310, 311, 312, 313 esophageal tributary of, 309 right, 309, 310, 311, 312, 313 short, 309, 311, 312, 313 Gastric vessels, short, 331 Gastrocnemius muscle, 506, 507, 516, 519, 520, 521, 522, 540, 541 innervation of, 541 lateral head of, 485, 494, 495, 511, 515, 516, 517, 518 attachments of, 491, 515 subcutaneous bursa of, 511 lateral subtendinous bursa of, 511 medial head of, 485, 491, 495, 502, 511, 517, 518, 522 attachments of, 491, 515 Gastrocolic ligament, 272 Gastroduodenal artery, 279, 294, 301, 304, 305, 306, 321, 322, 327 arteriogram of, 303 plexus on, 320 Gastroduodenal plexus, 320, 322, 327 Gastroepiploic artery, left, 301 Gastrolienal ligament. See Gastrosplenic ligament Gastro-omental arterial anastomosis, 272 Gastro-omental artery left, 300, 301, 305, 306, 321 plexus on, 319, 320 right, 272, 300, 305, 306, 321 origin of, 302 Gastro-omental lymph nodes left, 314 right, 314 Gastro-omental vein, 312 left, 309, 311, 312, 313, 314 right, 309, 311, 312, 313 Gastro-omental vessels attachment to greater omentum, 274 left, 299 Gastropancreatic fold, 272 Gastrophrenic ligament, 272, 329 Gastrosplenic ligament, 272, 273, 299, 331 short gastric vessels in, 299 Gemellus muscle inferior, 376, 495, 503 attachments of, 489, 491 nerve to, 503 superior, 495, 499, 503 attachments of, 489, 491
Genicular artery descending, 512 articular branch of, 500, 512 saphenous branch of, 500, 512 inferior lateral, 512, 517, 518, 519, 520 inferior medial, 500, 512 middle, 512 superior lateral, 502, 512, 516, 517, 519, 520, 521 superior medial, 51, 500, 501, 502, 512, 516, 518, 519, 520 Geniculate body lateral, 107, 110, 111, 114, 116, 120, 132, 143, 144, 145 of left thalamus, 143 medial, 107, 108, 110, 111, 114, 115, 139, 143, 144, 145 Geniculate nucleus left dorsal lateral, 120 right dorsal lateral, 120 Geniculum (geniculate ganglion), 116, 131, 135 of facial nerve, 97, 116, 125 site of, 124 Genioglossus muscle, 29, 32, 59, 60, 128, 129 superior mental spine for origin of, 52 Geniohyoid muscle, 29, 53, 59, 128, 129 Genital cord, 389 Genitalia, 388 external, 167 female, 377, 388 homologues of, 388 innervation of, 168 male, 388 internal female, 389 homologues of, 389 male, 389 lymph nodes and vessels of, 406, 407, 408 undifferentiated, 388 Genital tubercle epithelial tag of, 388 glans area of, 388 lateral part of, 388 Genitofemoral nerve, 329, 340, 496, 498, 539, 409 femoral branch of, 267, 409, 498, 544 genital branch of, 259, 261, 267, 409, 544 testicular vessels and genital branch of, 259, 261 Genu, of corpus callosum, 146 Gerdy's tubercle, 494, 513 Gerota's fascia. See Renal fascia, Gerota's Gimhernat's ligament. See Lacunar ligament (Gimbernat's) Gingiva epithelium of, 57 lamina propria of, 57 Gingival groove, 57 Glenohumeral joint, 423 Glenohumeral ligament inferior, 423 superior, 423 Glenoid cavity, 185, 423 Glenoid labrum, 423
Glisson's capsule. See Perivascular fibrous (Glisson's) capsule Globus pallidus, 108, 110, 539 Glomerular arteriole afferent, 336 efferent, 336 Glomerulus, 119, 136 Glossoepigloitic fold lateral, 58 median, 58 Glossopharyngeal nerve, 34, 114, 116, 117, 118, 123, 125, 126, 130, 131, 133, 135, 166 branch of, 168 carotid branch of, 34, 125, 126, 130, 131 inferior ganglion of, 125, 135 pharyngeal, tonsillar and lingual branches, 125 schema of, 118, 125, 134 tympanic branch of, 10 Gluteal aponeurosis, 330, 494, 495 over gluteus medius muscle, 174 Gluteal artery inferior, 341, 499 superior, 499 Gluteal fold, 152 Gluteal line anterior, 352, 486 right inferior, 352, 486 superior, 265, 311 Gluteal nerve inferior, 160, 499, 503 superior, 160, 499, 503 Gluteal tuberosity, 489 Gluteal vein inferior, 311 superior, 311 Gluteus maximus muscle, 152, 174, 177, 254, 330, 376, 381, 382, 395, 396, 410, 411, 413, 485, 494, 495, 502, 503, 504 attachments of, 491 Gluteus medius muscle, 152, 376, 492, 496, 500, 501, 502, 503 attachments of, 491 gluteal aponeurosis over, 330, 494, 495 Gluteus minimus muscle, 489, 495, 496, 500, 501, 502, 503 attachments of, 489, 491 tendon of, 376 Gonads, 389 male, descent of, 386 Gracile fasciculus, 114, 115 Gracile tubercle, 114, 115 Gracilis muscle, 489, 492, 493, 495, 500, 501, 502, 505, 506, 516 attachments of, 489, 515 innervation of, 540 Gracilis tendon, 485, 492, 493, 506, 507 Granular foveola, 99, 102 Granule cells, 119 Gray matter, 169 interomediolateral nucleus of, 44, 132, 134 lateral horn of, 170, 325, 346 spinal, 169 sympathetic preganglionic cell bodies in, 132 Great cerebral artery, quadrigeminal cistern of, 109
Great cerebral vein (of Galen), 103, 104, 106, 144, 145, 146 Groin left, 268 right, 268 Gubernaculum, 389, 415 Gum, 57 Gut. See also Viscera enteric plexus of, 325 prenatal, 229
Habenula, 110 Habenular commissure, 106, 111, 115 Habenular trigone, 111, 115 Hair cells (cochlear) inner, 96 outer, 96 Hamate, 452, 455, 456, 474 anterior (palmar) view of, 452 coronal section of, 455 hook of, 442, 452, 454, 456 radiograph of, 457 posterior (dorsal) view of, 452 radiograph of, 457 Hamulus, 8, 14, 38, 52 of spiral lamina, 95 Harad in abduction, 453 in adduction, 453 in anatomical position, 453 anterior (palmar) view of, 459, 465, 472 anterior view of, 460 arteries and nerves of, palmar view of, 466, 484 bones of, 456 bursae of, 462 cutaneous innervation of, 472, 476 deep digital crease of, 418 deep dorsal dissection of, 469 deeper palmar dissection of, 460 dorsal fascia of, 462 dorsal venous network of, 468, 483 dorsum of, 483 lymph vessels passing to, 483 in extension, 453 in flexion, 453 lymphatic pathway of, 468 lymph vessels passing to around web in, 483 dorsum of, 483 middle digital crease of, 418 muscles of, 465 intrinsic, 465 nerves of, palmar view of, 466 palmar dissection of deeper, 460 superficial, 459-460 palm of, 453 posterior (dorsal) view of, 465, 472 proximal digital crease of, 418 proximal palmar crease of, 418 radial dissection of, superficial, 467 radial longitudinal crease of, 418 radiograph of, anteroposterior, 457 septa between spaces of, 462 spaces and sheaths of, 462 spaces of, 462 superficial dorsal dissection of, 468
Hand (Continued) surface anatomy of, 418 tendon sheaths of, 462 Hartmann's pouch. See Infundibulum (Hartmann's pouch) Haustra, 284 Head. See also Brain; Skull; specific parts of head arteries of, 40-41 autonomic nerves in, 131 axial CT image of, 150 axial MR image of, 150 bones and ligaments of, 4-16 coronal CT images of, 151 cutaneous nerves of, 24 fauces of, 64 lymph vessels and nodes of, 72-73 mastication muscles of, 54-55 muscles of, 26 nasal region of, 36-37, 46-47, 48-49 nerves of, 24 oral region of, 50-61 sagittal MR image of, 149 surface anatomy of, 1 Heart, 126, 233 anterior exposure of, 212 apex of, 212, 213, 214, 246 atria, ventricles, and interventricular septum of, 224 base of posterior view of, 214 surface of, 214 conducting system of, 225 diaphragmatic surface of, 214 in diastole, 222 fibrous skeleton of, 222 inferior border of, 212 in situ, 211 innervation of, 227 innervation of, schema of, 227 left border of, 196 left side of, 225 membranous septum of, 221, 222 nerves of, 226 pericardial sac and, 282 right border of, 196 right side of, 225 in systole, 222 valves of, 222 Heiss, Hoops of, 367 Helicotrema, 92, 95, 96 Helix, 93 crus of, 93 Helvetius, collar of, 236, 277 Hemiazygos vein, 236, 245 accessory, 194. 207 Hemothorax, chest drainage tube placement in, 190 Henle's loop, 337 ascending limb of, 336 descending limb of, 336 proximal segment of, 336 thin segment of, 336 Hepatic artery, 297, 337 branches of, 290, 291, 292 common, 237, 264, 272, 279, 294, 300, 301, 305, 306, 318, 321, 327, 331, 349 arteriogram of, 303 cross section of, 297 effects of obstruction on, 305
Hepatic artery (Continued) intermediate, 301 left, 294, 300, 301, 305 middle, 305 origin of, 302 proper, 273, 278, 279, 288, 290, 294, 298, 301, 321, 330 arteriogram of, 303 bifurcation of, 331 to lesser omentum, 348 right, 294, 300, 301, 305 accessory, 302 origin of, 302 Hepatic duct, 290 aberrant, 294, 296 accessory, 296 common, 287, 289, 290, 294, 301, 331 left, 294 right, 294 variations in, 294, 296 Hepatic flexure. See Colic flexure, right Hepatic lymph nodes, 314, 315 Hepatic nerve plexus, 349 Hepatic plexus, 126, 319, 320, 322 anterior, 327 branches from, 319 to cardia, 320 pyloric, 126 vagal, 319 common, 318 posterior, 327 pyloric branch from, 126 vagal branch to, 319 Hepatic portal vein, 273, 278, 279, 288, 294, 298, 300, 301, 311, 312, 315, 331, 349 to lesser omentum, 348 prenatal, 229 tributaries of, 312 typical arrangement of, 313 variations of, 313 Hepatic vein, 194, 232, 265, 274, 287, 290, 309 prenatal, 229 Hepatoduodenal ligament, 272, 275, 278, 297 Hepatogastric ligament, 275, 288 Hepatogastric trunk, 302 Hepatomesenteric trunk, 302 Hepatopancreatic ampulla, 294 sphincter of, 295, 327 Hepatorenal recess (Morison's pouch), 331 Hering, canal of, 291, 292 Hering-Breuer reflex, receptors for, 210 Hernia inguinal indirect, 261 site of, 261 sliding, 236 Hernial sac, 261 neck of, 261 Herniated disc. See Lumbar disc herniation Hesselbach, triangle of. See Inguinal (Hesselbach's) triangle Heubner, recurrent artery of. See Distal medial striate artery (recurrent artery of Heubner) High intestinal vein, 313
Hip anteroposterior radiograph of, 488 arteries of, 500-502 bony attachments of anterior view of, 490 posterior view of, 491 flexion and extension of, 543 muscles of, 496 lateral view of, 494 posterior view of, 495 nerves of, 503 Hip bone auricular cartilage of, 487 lateral view of, 486 medial view of, 486 Hip joint anteroposterior radiograph of, 488 anterior view of, 487 capsule of, 504 iliofemoral ligament of, 496 lateral view of, 487 ligaments of, 492 posterior view of, 487 Hippocampal fimbria, 119 Hippocampal sulcus, 112 Hippocampus, 110, 111, 112 alveus of, 112 fimbria of, 106, 108, 111, 112 superior dissection of, 112 His, bundle of, 225 Horizontal cells, 120 Houston, valves of, 393 Humeral artery, circumflex anterior, 427, 429, 433, 434 posterior, 427, 429, 432, 433, 434 Humeral ligament, transverse, 423 Humeral vein, circumflex, 479 Humeroulnar head, 447 Humerus, 433, 436, 438 anatomical neck of, 420, 421 anteroposterior radiograph of, 422 anterior view of, 420 anteroposterior radiograph of, 422 capitulum of, 420, 436 common extension tendon of, 421 common flexor tendon of, 421 condyles of, 420, 436 coronoid fossa of, 420 greater tubercle of, 420, 421, 423, 432 crest of, 420 head of, -120 anteroposterior radiograph of, 422 infraglenoid tubercle of, 421 intertubercular sulcus of, 420 intertubercular tubercle of, 420 lateral epicondyle of, 420, 421, 436, 437, 438, 441, 442, 444, 448 lateral supracondylar ridge on, 420 lesser tubercle of, 420, 423 medial epicondyle of, 420, 421, 432, 433, 437, 440, 442, 444, 445, 446, 447, 476, 477 medial supracondylar ridge on, 420 olecranon fossa of, 421, 436, 437 olecranon of, 437 posterior view of, 421 radial fossa of, 420 radial groove of, 421 radiographs of, 437 right surgical neck of, 243
Humerus (Continued) shaft of, 244, 245 surgical neck of, 420 anteroposterior radiograph of, 422 trochlea of, 420, 437 ulnar nerve groove of, 421 Hyaloid canal, 87 Hydatid of Morgagni. See Vesicular appendix (hydatid of Morgagni) Hymen annular, 377 cribriform, 377 septate, 377 Hymenal caruncle, 370, 377 Hyoepiglottic ligament, 63, 77 Hyoglossus muscle, 34, 60 Hyoid bone, 27, 28, 29, 34, 59, 60, 61, 63, 65, 68, 74, 76, 77 body of, 13, 53 greater horn of, 13, 53, 75 lesser horn of, 13, 53 tip of greater horn of, 67, 75 Hyothenar muscle, 444, 476 Hypochondrium left, 268 right, 268 Hypogastric nerve, 165, 218, 324, 344, 345, 409, 410, 414, 415, 416 inferior, 324 left, 318, 323, 412 pelvic, 414 right, 318, 323, 412 superior, 345, 415 Hypogastric plexus inferior, 165, 166, 168, 323, 324, 344, 345, 409, 412, 499 parasympathetic branch from, 165 with periureteric loops, 344 right, 323 superior, 165, 318, 323, 324, 345, 409, 412 Hypogastric sheath, 364 Hypoglossal canal, 8, 10, 11 Hypoglossal nerve, 10, 32, 34, 114, 117, 129, 344 distribution of, 118 meningeal branch of, 128 schema of, 118, 128 vena comitans of, 59, 60, 70 Hypoglossal nucleus, 116, 128 Hypoglossal trigone, 115 Hypoglossus muscle, 27, 53, 74, 77, 128 dorsal lingual vein medial to, 70 Hypophyseal artery inferior, 140, 148 superior, 140, 148 Hypophyseal fossa, 5, 9 at birth, 50 Hypophyseal portal system primary plexus of, 148 secondary plexus of, 148 Hypophyseal portal vein long, 140, 148 short, 148 Hypophyseal vein, efferent, 140 to cavernous sinus, 148 Hypophysis, 106, 107, 147. See also Pituitary gland arteries and veins of, 148 Hypothalamic area, lateral, 135
Hypothalamic artery, 140 Hypothalamic sulcus, 106, 147 Hypothalamic vessels, 148 Hypothalamohypophyseal tract, 147 Hypothalamus, 108, 147, 324 arteries of, 148 nuclei of arcuate, 147 dorsomedial, 147 paraventricular, 147 posterior, 147 supraoptic, 147 ventromedial, 147 parasympathetic, 324 sympathetic, 324 Hypothenar eminence, 418 Hypothenar muscle, 446, 462, 476 Hysterosalpingogram, uterus, 373
Ileal artery, 306, 307 anastomotic loops of, 280 Ileal fold, 311, 313 Ileal orifice, 284 muscles fibers of, 282 papillary, 282 Ileal papilla, 282 Ileocecal fold, 281 Ileocecal junction, muscle fibers around,282 Ileocecal lips, 282 Ileocecal recess inferior, 281 superior, 281 Ileocecal region, 281, 282 Ileocolic artery, 281, 307, 322, 323, 340 colic branch of, 281, 306, 307 ileal branch of, 281, 306, 307 Ileocolic lymph nodes, 317 Ileocolic plexus, 322, 323 Ileocolic vein, 311, 312, 313 Ileum, 269, 282, 284, 339, 349 barium radiograph of, 280 circular muscle layer of, 280, 282 longitudinal muscle layer of, 280, 282 lymphoid nodules of, 280 mucosa of, 280 muscle fibers to, 282 musculature of, 280 serosa of, 280 submucosa of, 280 terminal, 271, 281, 282, 362, 363 Iliac artery circumflex ascending branch of, 255, 264 deep, 501, 512 superficial, 247, 512 common, 264, 274, 340, 341, 398, 400, 412 left, 318 axial CT images of, 350 right, 329 axial CT images of, 350 ureteric branch from, 341 external, 264, 274, 318, 329, 340, 398, 400, 402, 412, 501, 512 right, 329
Iliac artery (Continued) internal, 264, 307, 318, 329, 340, 341, 370, 398, 412 anterior division of, 400 posterior and anterior divisions of, 402 right, 323, 329 Iliac crest, 152, 174, 175, 176, 177, 247, 248, 254, 329, 330, 342, 351, 485, 486, 494, 495, 496, 502, 503, 545 inner lip of, 248, 352, 353 intermediate zone of, 248, 352, 353, 486 in lumbar puncture, 162 outer lip of, 248, 352, 353, 486 tuberculum of, 248, 352, 353, 486 upper lip of, 486 Iliac fossa, 352, 353, 363, 486 Iliac lymph nodes common, 266, 317, 343, 408 external, 266, 317, 343, 408, 546 lymphatic pathways to, 408 internal, 266, 317, 343, 408 lateral, 406 medial external, 406 Iliac plexus common, 412 external, 318, 412 internal, 318, 412 left common, 317 right internal, 323 Iliac spine anterior, 247, 248, 250, 486, 487, 492 anterior superior, 248, 249, 259, 263, 486, 487, 492, 493, 496, 500 posterior inferior, 486 posterior superior, 152, 352, 353, 486 Iliac tubercle, 353 Iliac tuberosity, 248 lliacus muscle, 263, 329, 376, 490, 496, 498, 499, 538 attachment of, 490 muscular branch of, 498 lliacus wing, male, 354 Iliac vein, superficial circumflex, 544 Iliac vessels circumflex deep, 364, 403 superficial, 249, 500 common, 271, 401, 412 external, 259, 260, 281, 311, 360, 361, 362, 364, 372, 392, 401, 403 internal, 311 superficial circumflex, 249 lliococcygeus muscle, 356, 357, 358, 359, 395 lliocostalis cervicis muscle, 175 lliocostalis lumborum muscle, 175 lliocostalis muscle, 175, 331 lliocostalis thoracis muscle, 175 Iliofemoral ligament, 487, 496 Iliohypogastric nerve, 160, 177, 267, 329, 409, 496, 498, 539 anterior branch of, 257 anterior cutaneous branch of, 257, 267, 410 genital branch of, 409 lateral cutaneous branch of, 545 schema of, 498
Ilioinguinal nerve, 160, 257, 260, 267, 329, 330, 340, 409, 414, 496, 498, 539, 540, 544 anterior labial branch of, 413 anterior scrotal branches of, 267, 409 schema of, 498 scrotal branches of, 267, 409, 544 Iliolumbar artery, 264, 341, 402 Iliolumbar ligament, 330, 353 iliolumbar vein, 330, 353 Iliopectineal bursa, 496 iliopectineal line, 353, 392 iliac part of, 358 pubic part of, 358 Iliopsoas muscle, 259, 376, 489, 492, 493, 500 attachments of, 489, 491, 496 Iliopsoas tendon^ 504 Iliopubic eminence, 248, 352, 486, 487 female, 354 Iliopubic tract, 259, 362, 363, 364 lliotibial tract, 485, 492, 494, 495, 502, 506, 507, 514, 515, 519, 520 bursa deep to, 506, 507 insertions of, 515 lateral patellar retinaculum and capsule and,508 Ilium arcuate line of, 356 articular surface of, 486 axial CT images of, 350 body of, 352, 486 gluteal surface of, 352 radiograph of, 355 anteroposterior radiograph of, 488 wing of, 248, 352, 358, 486 Incisive canal, 37, 38, 39, 43, 63 anastomosis in, 40 posterior septal branch of sphenopalatine and greater palatine arteries in, 41 Incisive fossa, 10, 14, 52, 56 Incisive papilla, 52 Incisor teeth, 56, 233 Incus, 89, 93, 96, 124 articular surface for, 93 body of, 93 lateral view of, 93 long limb of, 93 posterior ligament of, 94 short limb of, 93 superior ligament of, 94 Infant, mandible of, 15 Inferior anastomotic vein (of Labbe), 102, 145 Infraglenoid tubercle, 420, 421 Infrahyoid muscle, 29 action of, 29 fascia of, 28, 428 Infraorbital artery, 23, 36, 40, 81, 85 Infraorbital canal, 45 Infraorbital foramen, 12, 36 Infraorbital groove, 2 Infraorbital margin, 1 Infraorbital nerve (V2), 24, 36, 44, 81, 83, 121, 122 entering infraorbital canal, 45 internal nasal branches of, 122 superior alveolar branches of, 122 Infraorbital vein, 23, 70
Infrapatellar bursa deep, 511 subcutaneous, 511 Infrapatellar synovial fold, 507, 508 Infraspinatus fascia, 174, 177 Infraspinatus muscle, 152, 180, 244, 245, 424, 425, 427, 428, 432 fascia over, 174 insertion of, 421 origin of, 421 Infraspinatus tendon, 423, 425 infratemporal fossa, 4, 13 Infratrochiear nerve, 24, 36, 56, 81, 86, 122 from nasociliary nerve, 45 Infundibular nucleus, 147 Infundibular process, 147 capillary plexus of, 148 Infundibular recess, 108 Infundibular stem, 147 Infundibuium (Hartmann's pouch), 114, 140, 147, 294 body of, 114 fundus of, 114 neck of, 114 of uterine tube, 372 Inguinal canal, 260, 262 Inguinal falx, 250 conjoint tendon of, 250, 253, 259, 263 Inguinal foid, 389 Inguinal hernia indirect, 261 site of, 261 Inguinal ligament (Poupart's}, 247, 249, 250, 259, 263, 351, 356, 378, 380, 381, 407, 485, 492, 498, 500, 501, 544, 546 reflected, 250, 251, 259 Inguinal lymph nodes deep, 266, 406, 407, 408, 546 highest deep, 266, 408 horizontal, 266 inferior, 266 superficial, 266, 317, 406, 407, 408, 546 superficial inferior, 407 superolateral, 407 superomedial, 407 Inguinal region, 259 anterior view of, 259 posterior view of, 259 Inguinal ring deep, 251, 259, 261, 362, 363, 369, 386 site of, 274 superficial, 249, 259, 261, 386, 544 lateral and medial crus of, 259 Inguinal (Hesselbach's) triangle, 259 Insula, 105, 110, 141 central and circular sulci of, 105 limen of, 105, 141 short and long gyri of, 105 Inieralveolar septa, 15 Interarticular ligament, 187 Interarytenoid notch, 66 Interatrial septum, 220, 246 Intercalated lymph node, 73 Intercapitular vein, 468, 480 Intercarpal ligament, 455 Intercavenous sinus anterior, 103 superior, 103
Intercavernous septum, 382, 385 of deep fascia, 381 Interchondral joints, 186 Interclavicular ligament, 186, 419 Intercondylar area anterior, 513 posterior, 513 Intercondylar condyle, radiograph of, 510 Intercondylar eminence, 514 anteroposterior radiograph of, 510 Intercostal artery, 183, 192, 305 anterior, 192 first posterior, 33 lower, anastomosis with, 255 posterior, 171, 172, 188, 189, 230, 231 dorsal branch of, 172 lateral mammary and cutaneous branches of, 183, 192 second, 33 third right, 207, 237 supreme, 33, 136, 138 Intercostal lymph nodes, 266 Intercostal membrane external, 180, 189, 192, 258 internal, 180, 192, 230, 258 Intercostal muscle, 198, 243, 244, 245, 331 anterior cutaneous branch of, 180 external, 176, 188, 189, 192, 250, 258 external intercostal membranes anterior to, 189 innermost, 180, 192, 258 internal, 189, 192, 230, 231, 255, 258 lateral branch of, 188 medial branch of, 188 Intercostal nerve, 160, 170, 180, 189, 192, 331 abdominal portions of, 188 anterior, 258 anterior cutaneous branches of, 177, 188, 192, 257 collateral branch rejoining, 258 eighth, 209 first, 227, 430 lateral cutaneous branches of, 177, 188, 189, 192 lateral cutaneous branches to, 177, 188, 189, 257 posterior, 192, 230 seventh right, 321 sixth, 165, 209 third, 240 ventral ramus of, 180 Intercostal vein anterior, 256 left superior, 231 posterior, 230, 231 right superior, 230 Intercostal vessels, 331 Intercostobrachial muscle, 189 Intercostobrachial nerve, 189, 257, 429, 474, 479, 481 Intercrural fibers, 249, 259 Intercuneiform ligament, dorsal, 527 Interglobular space, 57 Intergluteal cleft, 152 Interlobar artery, 335, 337 lymph vessels along, 343 Interlobar lymph vessels, 208
Interlumborum cervicis muscle, 176 Intermaxillary suture, 36 Intermediate nerve, 104, 114, 118, 123, 124, 133, 135 Intermediolateral cell column, 346 Intermediolateral nucleus, 133, 134 Intermediolateral nucleus, preganglionic sympathetic cell bodies in, 132 Intermesenteric plexus, 267, 318, 322, 323, 324, 344, 345, 412 renal and upper ureteric branches from, 344 Intermetacarpal joint, 455 Intermuscular septum anterior, 522 anteromedial, 492, 500, 501 lateral, 430, 432, 435, 445, 448 of arm, 477 medial, 430, 432, 433, 445, 446, 447, 448 posterior, 522 transverse, 522 Intermuscular stroma, 326 Internal capsule, 108, 141 cleft for, 110 genu of, 110 retrolenticular part of, 110 Interosseous artery anterior, 434, 447 computed tomography of, 484 common, 434, 447, 448, 449 posterior, 434, 445, 448, 449 recurrent, 434, 445 termination of, 445 Interosseous intercarpal ligament, 455 Interosseous ligament, intercarpal, 455 Interosseous membrane, 439, 441, 443, 444, 454, 455, 511, 512, 517, 518, 520, 522, 525 Interosseous muscle, 528 deep tibial nerve to, 541 dorsal, 462, 465, 470, 476, 531, 536, 537 first, 445, 460, 465, 530 of foot, 536, 537 dorsal, 536 palmar, 465, 476 plantar, 535 plantar dorsal, 536 superficial tibial nerve branch to, 541 Interosseous nerve anterior, 448, 449, 475 of leg, 541 plantar, 537 posterior, 445, 449 Interosseous talocalcaneal ligament, 527 Interpectoral (Rotter's) lymph nodes, 184 Interpeduncular cistern, 109 Interphalangeal joint, 418 capsules and ligaments of, 528 Interphalangeal ligaments, 458 Iniersigmoid recess, 271, 340 Intersphincteric groove, 392, 393, 394 Interspinalis cervicis muscle, 176
Interspinous ligament lumbar, 176 lumbosacral, 177 Interspinous plane, 268 Intertendinous connection, hand, 470 Interthalamic adhesion, 106, 108, 110, 111, 146 Intertragic notch, 93 Interiransversarius muscle, lateral, 176 Intertransverse ligament, 187 Intertrochanteric crest, 487, 503 anteroposterior radiograph of, 488 Intertrochanteric line, 487, 489 Intertubercular plane, 268 Intertubercular tendon sheath, 423 Interureteric crest, 366 Interventricular foramen (of Monro), 106, 109, 111, 115, 145, 146 left, 108 Interventricular septum, 216, 220 muscular part of, 220, 223, 224, 225 Interventricular sulcus anterior, 246 posterior, 214, 215 Intervertebral disc, 19, 155. Intervertebral disc, 19, 155. See also specific vertebrae anulus fibrosis of, 155 lumbar, 157, 339 lumbosacral, 352 nucleus pulposus of, 155 sternal angle of, 245 Intervertebral disc space, 156 Intervertebral foramen, 19, 180 lower margin of, 154 lumbar, 155 radiograph of, 156 Intervertebral joint, 18 Intervertebral vein, 137, 173 Intestinal glands, 326 Intestinal lymphatic trunk, 316 Intestinal trunk, 266 Intestine, 167. See also Colon; Duodenum; Jejunum; Mesocolon circular muscle of, 326 intrinsic autonomic plexuses of, 326 large arteries of ; 307 innervation of, 324 lymph nodes vessels and nodes of, 317 mucosa and musculature of, 284 nerves of, 323, 324 schema of, 324 veins of, 311 longitudinal muscle of, 326 lumen of, 326 mesenteric relations of, 270, 271 mucosa of, 326 small, 126, 269, 322 area for, 329 arteries of, 306 innervation of, 324 lymph nodes of, 316 lymph vessels of, 316 mesentery of, 348 mucosa and musculature of, 280 nerves of, 322 schema of, 324
Intestine (Continued) small (Continued) veins of, 310 submucosa of, 326 Intraarticular ligament, 187 Intraculminate vein, 144 Intrahepatic biliary system, schema of, 292 Intralaminar nuclei, 111 Iniraparieial sulcus, 105 Intrapulmonary airway schema of, 204 Intrapulmonary blood circulation, 205 Infraspinatus tendon, 423 Intrinsic artery, of eye, 90 Intrinsic muscle action of, 79 of larynx, 78 of tongue, 128 Intrinsic nerve, pancreatic, 328 Intrinsic vein, of eye, 90 Iridocorneal angle, 87, 88, 90 trabecular meshwork and spaces of, 88 iris, 81, 87, 89, 90 arteries of, 91 folds of, 88 major arterial circle of, 88, 90, 91 minor arterial circle of, 88, 90, 91 veins of, 91 Irritant receptors, 210 Ischial spine, 248, 263, 411, 486, 487, 503 female, 354 radiograph of, 355 Ischial tuberosity, 248, 352, 353, 359, 378, 379, 381, 390, 395, 398, 486, 487, 502, 503 anteroposterior radiograph of, 488 female, 354 male, 354 radiograph of, 355 Ischioanal fossa, 366, 392 anterior recess of, 366, 370, 396 fat body of, 376, 380, 392 posterior communication between right and left, 396 posterior recess of, 396 preanal communication between right and left, 396 pus in, 396 roof of, 405 transverse fibrous septum of, 392, 394, 395 Ischiocavernous muscle, 360, 361, 370, 378, 379, 381, 382, 383, 391, 395, 404, 405 crus of, 366 Ischiococcygeus muscle, 263, 356, 357, 398, 402, 411, 412, 499 nerve to, 499 Ischiocondylar muscle, 540 Ischiofemoral ligament, 487 Ischiopubic ramus, 359, 361, 378, 379, 380, 382, 383, 384, 395 Ischium anteroposterior radiograph of, 488 body of, 486 radiograph of, 355 ramus of, 486
J Jaw. See also Mandible; Maxilla angle of, 1 closed, 16 slightly opened, 16 widely opened, 16 Jejunal artery, 306, 307 anastomotic loop of, 280 first, 302 plexus on, 3190 Jejunal vein, 311, 313 Jejunum, 269, 270, 271, 278, 279, 297, 298 barium radiograph of, 279, 280 circular muscle layer of, 280 cross section of, 297, 338 longitudinal muscle layer of, 280 lymphoid nodule of, 280 mucosa of, 280 musculature of, 280 submucosa of, 280 Jugular foramen, 103, 125, 126, 127 Jugular fossa, 8, 11 Jugular lymphatic trunk, 208 Jugular nerve, internal, 1,10 Jugular notch, 28, 181, 196 Jugular trunk, 72 left, 266 right, 266 Jugular vein anterior, 30, 74, 256 communication to, 70 termination of, 70 external, 23, 31, 74, 198, 206, 211, 256 internal, 23, 28, 29, 30, 31, 32, 34, 59, 74, 75, 76, 97, 128, 189, 198, 206, 211, 232, 256 inferior bulb of, 75 left, 137 right, 137 Jugulodigastric muscle, 73 Juguloomohyoid node, 73 Jugunra, 9
K Kerckring, valves of, 279, 280 Kidneys, 167, 179, 272, 278, 338 anterior surface of, 335 base pyramid of, 334 blood vessels in parenchyma of, 334, 337 blood vessels of, 332, 333, 347 cortex of, 334, 336, 337 cortical radiate arteries of, 335 fibrous capsule of, 334 hilum of, 334 inferior pole of, 334 in situ anterior views of, 329 posterior, 330 innervation of, 345 inner zone of, 336 interlobar arteries of, 335 lateral border of, 334 left, 98, 197, 273, 299, 329, 331, 340, 347 axial CT images of, 350 frontal section of, 329 superior pole of, 297
Kidneys (Continued) lymph vessels and nodes of, 343 major calices of, 334 medial border of, 334 medulla of, 334 minor calices of, 334 nerves of, 334 outer zone of, 336, 345 perforating radiate artery of, 335 posterior surface of, 335 prenatal, 229 renal column of, 334 renal cortex of, 338 renal papilla of, 334 retroperitoneal, 288 right, 197, 275, 298, 329, 330, 340, 342, 347 subscapular zone of, 336, 337 superior pole of, 272, 334 cross section of, 338 Knee anterior views of, 507, 508 anteroposterior radiograph of, 510 arteries of, 507 articular cavity of, 511 attachment of, 511 collateral ligaments of, 509 cruciate ligaments of, 509 in extension of, 507 in flexion, 509, 543 interior of, 508 joint capsule of, 506, 508, 519 lateral view of, 506 ligaments of, 508, 509 medial view of, 506 posterior view of, 511 right in extension, 507, 509 in flexion, 509 sagittal view of, 511 slightly in flexion, 507 Kohn, pores of, 204
L L4-5 disc herniation, 162 L5-S1 disc herniation, 162 L2 ganglion, 412 L1 spinal nerve, 160 ventral ramus of, 177 L1-3 spinal nerves, dorsal rami of, 254 L5 spinal nerve, 160, 412 anterior ramus of, 410 L1 vertebra, 153, 160 body of, 273 inferior articular process of, 156 spinous process of, 179 superior articular process of, 156 transverse process of, 338 L2 vertebra body of, 179 superior view of, 155 L3 vertebra body of, 156, 336, 337 pedicle of, 156 posterior view of, 155 spinous process of, 156 transverse proccss of, 156
L4 vertebra body of, 352 inferior vertebral notch of, 156 lamina of, 156 posterior view of, 155 spinous process of, 156 L5 vertebra, 153, 160 body of, 352 superior vertebral notch of, 156 Labbe vein. See Inferior anastomotic vein (of Labbe) Labial artery inferior, 69 posterior, 404 superior, 69 Labial nerve, posterior, 413, 414 Labial vein inferior, 70 superior, 70 Labioscrotal swelling, 388 Labium majus, 360, 365, 388 Labium minus, 360, 365, 388 Labyrinth bony, 95, 96 common limbs of, 95 right, 95 schema of, 96 superior projection of, right, 97 common membranous limb of, 95 membranous, 95, 96 right, 95 schema of, 96 orientation of in skull, 97 Labyrinthine artery, 140, 141, 143 internal, 143 left, 136 Lacrimal apparatus, 82 Lacrimal artery, 85 recurrent meningeal branch of, 100 Lacrimal bone, 2, 4, 6, 12, 38 at birth, 46 Lacrimal canaliculi, 82 Lacrimal caruncle, 81, 82 Lacrimal gland, 83, 85, 86, 133, 166, 167, 168 excretory ducts of, 82 orbital part of, 82 palpebral part of, 82 Lacrimal lake, 81, 82 Lacrimal nerve, 83, 86, 121, 122, 131 cutaneous branch of, 45 palpebral branch of, 82 Lacrimal papilla inferior, 81, 82 superior, 81, 82 Lacrimal sac, 81, 82 fossa for, 2, 4 Lactiferous duct, 182 Lactiferous sinus, 182 Lacuna lateral (venous), 99, 100 magna, 385 Lacunar ligament (Gimbernat's), 250, 251, 259, 263, 546 Laimer, area of- See V-shaped area (of Laimer), 234, 235 Lambda, 7 Lamina, lumbar, 155 Lamina affixa, 111 Lamina cribrosa, 87 Lamina terminalis, 106, 107, 147
Langerhans, islets of, 298 Laryngeal vein, superior, 235 Laryngeal artery recurrent right, 126 superior, 34, 69, 74, 75, 136 Laryngeal inlet, 63, 66, 235 Laryngeal nerve (X) external branch to, 74 inferior anomalous right, 80 anterior and posterior branches of, 80 left, 80 internal branch of, 75, 235 left, anterior and posterior branches of,
80
recurrent, 33, 71, 76, 130, 206, 209, 210, 211, 212, 226, 231, 232, 240 left, 74, 75, 76, 126, 193, 210, 211, 243, 244 right, 74, 75, 80, 226, 235, 240 superior, 75, 76, 80, 130, 131, 235 external branch of, 75, 80, 126 fold over internal branch of, 66 foramen for internal branch of, 78 internal branches of, 62, 65, 71, 74, 75, 76, 78, 80, 126 Laryngeal prominence, 77 Laryngopharyngeal sympathetic branch, 130 Laryngopharynx, 63 opened posterior view of, 66 Larynx, 135, 167, 168, 210 cartilage of, 77 innervation of, 168 intrinsic muscles of, 78 action of, 79 lateral dissection of, 78 median view of, 77 nerves of, 80 posterior view of, 77, 78 right lateral view of, 77, 78 sensory branches to, 80 superior view of, 80 Lateral aperture (foramen of Luschka), 109 Lateral funiculus, 115 Lateral rectus muscle, 84 Lateral rectus plane, 286 left, 268 right, 268 Lateral sulcus, 107 anterior, ascending, and posterior rami of, 105 Latissimus dorsa tendon, 244, 245 left, 244 Latissimus dorsi muscle, 152, 174, 177, 179, 180, 181, 188, 246, 249, 250, 258, 293, 424, 428, 433 costal origin of, digitations of, 254 fascia of, 428 insertion of, 420 small slip of origin of, 421 Leg anterior fascial compartment of, 522 anterior intermuscular septum of, 522 cross section of, 522 deep fascia of, 522, 544, 546 posterior compartment, 522 fascial compartments of, 522 lateral, 522 superior posterior, 522
Leg (Continued) innervation of, 538, 539 interosseous membrane, 522 interosseous nerve of, 541 medial cutaneous nerves of, 538 muscles of anterior view of, 519, 520 attachments of, 515 deep dissection of, 518, 520 lateral view of, 521 posterior view of, 516, 517 superficial dissection of, 516 posterior intermuscular septum of, 522 right, bones of, 513 surface anatomy of, 485 transverse intermuscular septum of, 522 Lens, 81, 88, 90 axial MR image of, 150 axis of, 88, 89 capsule of, 87, 88 cortex of, 87, 88 equator of, 87, 88 nucleus of, 88, 89 supporting structures of, 88, 89 suspensory ligament of, 87, 88 Lenticulostriate artery, 140, 141, 143 anterolateral central, 139 Lentiform nucleus, 108, 141 globus pallidus of, 110 putamen of, 110 thalamus and, 110 Lepiomeninges, 170 Lesser sac,331 Levator anguli oris muscle, 54, 123 Levator ani muscle, 263, 284, 312, 367, 376, 411, 499 fibers to anal canal longitudinal muscle from, 358 fibromuscular extensions of, 359 left, 356 levator plate of, 356, 357 medial border of, 359 nerves to, 267, 499 pelvic, 360 prerectal muscles from, 359 puborectalis part of, 391 tendinous arch of, 263, 356, 357, 358, 359, 364, 365, 370, 379, 392 Levator costae muscle, 176 Levatores costarum muscle brevis, 176 longus, 176 Levator labii superioris alaeque nasi muscle, 26, 54, 123 Levator labii superioris muscle, 26, 54, 123 Levator palpebrae superioris muscle, 81, 83, 84, 86, 121 coronal CT images of, 151 fascial sheath of, 83 insertion of, 81 Levator scapulae muscle, 27, 32, 174, 177, 189, 424, 427, 477 insertion of, 421 nerves to, 129 Levator veli palatini muscle, 47, 51, 55, 64, 65, 67, 68, 93, 126 interdigitaging fibers of, 52 Lieberkuhn, crypts of, 283 Lienogastric trunk, 302 Lienomesenteric trunk, 302
Ligamenta flava, 21 Ligaments. See also specific ligaments of abdominal wall and viscera, 348 of ankle, 527 of elbow, 438 of foot, plantar view of, 528 of knee, 508, 509 pelvic, 352-353, 372 of wrist, 454, 455 Ligamentum arteriosum, 206, 212, 221, 229, 231 node of, 208 prenatal, 229 Ligamentum flavum, in lumbar puncture, 162 Ligamentum nuchae, 21, 152 Ligamentum teres, 229, 288, 349 fissure for, 287 prenatal, 229 Ligamentum venosum, 229 fissure for, 287 prenatal, 229 Light, cone of, 93 Limen, of insula, 141 Limen nasi, 37 Linea alba, 181, 188, 247, 249, 250, 258, 259, 331 axial CT images of, 350 Linea aspera, 489 Linea terminalis, 157, 353, 364, 370 Lingual artery, 23, 32, 34, 59, 60, 69, 75, 133, 136, 138 deep, 51, 59 dorsal, 59 tonsillar branch of, 64 Lingual glands (serous glands of von Ebner), 58 Lingual gyrus, 106 Lingual nerve, 23, 40, 53, 55, 59, 60, 122, 123, 131, 133, 134, 135 deep, 51 Lingual tonsil, 58, 63, 64 Lingual vein common trunk for, 59 deep, 59, 70 dorsal, 59 Lingula, 15, 113, 115, 144, 199 bronchi to, 202 Lip frenulum of, 51 lower, 51 philtrum of, 51 tubercle of, superior, 1 upper, 51 Lister's tubercle. See Dorsal tubercle of radius (Lister's) Liver, 126, 196, 197, 272, 278, 293, 294, 297, 331, 339, 342, 347 anatomic lobes of, 289 anterior view of, 287 area for, 329 arterial variations and collateral supply of, 305 arteries of, 300, 301 bare area of, 329, 342 bed of, 287 caudate lobe of, 272, 288 central veins of, 290 coronary ligament of, 274 cross section of, 297, 338 distributing vein of, 291
Liver (Continued) duct distribution in, 289 falciform ligament of, 255 fibrous appendix of, 287 functional surgical segments of, 289 inferior border of, 268, 275 in situ, 288 inlet venula of, 291 innervation of, 168, 326 intrahepatic vascular and duct systems of, 290 intralobular arteriole of, 291 left lobe of, 269, 275, 288 left triangular ligament of, 274 ligaments of, 287, 312 lobes of, 289 low-power section of, 292 lymph pathways to, 184 normal lobular pattern of, 290 papillary process of, 287 parietal surface of, 289 periportal arteriole of, 291 perivascular fibrous capsule of, 290 portal arteriole of, 291 posterior lateral segment of, 289 posterior view of, 287 prenatal, 229 quadrate lobe of, 275 right lobe of, 269, 275, 288 axial CT images of, 350 round ligament of, 229, 256, 275, 349 segments of, 289 structure of, 29 sublobular lobes of, 290 surfaces of, 287 topography of, 286 variations in form of, 288 vascular system of, 290 veins of, 291 visceral peritoneum of, 331 visceral surface of, 287, 289 Liver plate cells, 290 Lobule (ear), 1 Locus ceruleus, 115 Longissimus capitis muscle, 175, 178 Longissimus cervicis muscle, 175 Longissimus erector spinae muscle, 349 Longissimus muscle, 175, 331 Longissimus thoracic muscle, 175 Longitudinal esophageal muscle, cricoid attachment of, 65, 67 Longitudinal intramuscular plexus, 326 Longitudinal ligament anterior, 63, 65, 179, 187, 263, 331, 348, 349, 353, 362, 363 posterior, 22 Longitudinal muscle conjoined, 392, 394 conjoined rectal, 393 of intestine, 326 rectal, 393 of tongue inferior, 60 superior, 60 Longus capitis muscle, 27, 30 nerves to, 129 Longus colli muscle, 30 Loops of Heiss, 367
Lower limb- See also Leg arteries of, 500-502, 504 cutaneous innervation of, 487-489 dermatomes of, 543 lymph nodes and vessels of, 546 muscles of, 490-503 neurovasculature of, 538-546 segmental innervation of movements of, 543 superficial nerves and veins of, 544 anterior view of, 545 posterior view of, 545 surface anatomy of, 485 Lumbar artery? 171 fifth, 264 lower, anastomosis with, 255 right, 264 Lumbar curvature, 153 Lumbar disc herniation, 162 characteristic posture in, 161 clinical manifestations of, 161 left-sided lower, 161 level of and clinical features of, 161 surgical exposure of, 161 Lumbar disc protrusion, 161 Lumbar enlargement, 161 Lumbar ganglion, 167, 318 Lumbar lymphatic trunk to cisterna chyli and thoracic duct, 343 right and left, 316 Lumbar lymphatic trunk ganglion lower, 228 upper, 228 Lumbar lymph nodes, 266 Lumbar nerve, 161 Lumbar nucleus puiposus, herniated, 161 Lumbar plexus, 160, 496, 498, 538, 539 muscular branches from, 267 Lumbar puncture, 162 Lumbar region, 268 Lumbar spinal nerve, 161, 179 dorsal and ventrai roots of, 170 dorsal rami of, 177 origin of, 170 Lumbar triangle (of Petit), 152, 254 internal oblique muscle in, 174 Lumbar trunk ascending, 195, 263, 265, 332 left, 266 right, 266 Lumbar vein, ascending, 332 Lumbar vertebra anterior view of, 171 arteries of, 171 assembled, 153 body of, 153 cross section through, 170 dura mater of, 162 foramen of, 155 inferior articular process of, 155 inferior vertebral notch of, 155 intervertebral disc of, 155 lamina disc of, 155 left lateral view of, 155 mammillary process of, 155 muscles of, 179 pedicle, sectioned of, 179 posterior view of, 153 radiographs of, 156 spinous process of, 155
Lumbar vertebra (Continued) superior articular process of, 155 superior vertebral notch of, 155 superior view of, 155 transverse processes of, 248 transverse process of, 248 Lumbocostal ligament, 330 Lumbocostal triangle, 195 Lumborum muscle, interspinalis, 176 Lumbosacral articular surface, 157 Lumbosacral fascial sheath, 462 Lumbosacral trunk, 267, 496, 498, 499, 538, 539 Lumbosacral vertebrae inferior articular process of, 159 invertebral foramen of, 159 lamina of, 159 ligaments of, 159 ligamenturn flavum of, 159 pedicle of, 159 spinous process of, 159 superior articular process of, 159 transverse process of, 159 Lumbrical fascial sheath, 460 Lumbrical muscle, 465, 533, 534, 536 deep tibial nerve branch to, 541 in fascial sheaths, 460 first, 541 fourth, 460 in fascial sheath, 460 innervation of, 465, 541 schema of, 463 second, 460, 541 in fascial sheath, 460 tendons of, 535 third, 460 in fascial sheath, 460 third and fourth, 476, 541 Lumen, 326 Lunate, 376, 456, 487 anterior (palmar) view of, 452 area for, 439 . coronal section of, 455 posterior (dorsal) view of, 452 radiograph of, 457 Lunate sulcus, 105 Lungs, 167, 168, 170, 342 anterior border of, 196 anterior view of, 200 apex of, 196, 197 area for esophagus in, 196 area for trachea in, 196 bronchopulmonary segments of, 200, 201 cardiac impression of, 196 cardiac notch of, 196, 198 diaphragmatic surface of, 196 great vessels of, 206 groove for esophagus in, 196 hilum of, 196 horizontal fissure of, 196, 197, 198 inferior border of, 196 inferior iobe of, 198, 200 medial view of, 199 in situ, anterior view of, 198 left, 197, 211, 215, 243, 245 bronchopulmonary segments of, 200, 201 inferior lobe of, 201, 293 medial view of, 199
Lunate (Continued) oblique fissure of, 244 superior lobe of, 201, 242 left medial, 198 lingula of superior lobe of, 198 lobes of, 198 lymph nodes of, 208 lymph vessels and nodes of, 208 lymph vessels of, 208 medial view of, 198, 199 middle lobe of, 198, 200 oblique fissure of, 196, 197 right, 193, 196, 197, 198, 211, 243, 244, 245 bronchopulmonary segments of, 200, 201 inferior lobe of, 201, 293 medial view of, 199 middle lobe of, 201 superior lobe of, 201 root of, 193 spinal nerves to, 170 superior lobe of, 198, 200, 242 topography of anterior view of, 196 posterior view of, 197 Lunotriquetral ligament, 454 Lunula, 223 Luschka, foramen of, 19, 108, 109 Lymphatic drainage, from prostate gland, 408 Lymphatic duct, 208 Lymphatic pathway, hand, 468 Lymphatics apical collecting vessels, 73 basal collecting vessels, 73 central collecting vessels, 73 marginal collecting vessels, 73 Lymphatic trunk, 316 Lymph follicle, 58 of stomach, 276 Lymph nodes aortic, lateral, 266, 343, 406 axillary, 428 central, 428 pectoral (anterior), 428 bronchopulmonary, 199, 208, 230, 231 buccinator, 72 celiac, 266, 314, 315 cervical, 72, 73, 208 anterior deep, 72 anterior superficial, 72 deep lateral, 73 inferior deep, 72, 208 inferior deep lateral, 72 posterior lateral superficial, 72 superior deep lateral, 72 superior lateral superior, 72 transverse chain of, 72 colic, 317 of female pelvis and genitalia, 406 of female perineum, 407 gastro-omental, 314 of head and neck, 72 hepatic, 314 inguinal, 266 interpectoral, 184 of kidneys and urinary bladder, 343 of large intestine, 317 of lower limb, 546 of lung, 208
Lymph nodes (Continued) of male pelvis and genitalia, 408 of mammary gland, 184 mediastinal, 243 pancreatic, 315 pancreaticoduodenal, 315 paracolic, 317 * of pelvis and genitalia, 408 perianal, 317 of pharynx and tongue, 73 phrenic, 184, 266 of posterior abdominal wall, 266 pretracheal, 74 rectal, 317 sigmoid, 317 sinuatrial, 225 of small intestine, 316 splenic, 314 of stomach, 314 subclavian, 184 submandibular, 60, 73 submental, 73 subpyloric, 314 superior tracheobronchial, 244 suprapyloric, 314 tracheobronchial inferior, 245 of upper limb, 483 visceral, 266 Lymphoid nodule aggregate, 283 of ileum, 280 of jejunum, 280 Lymph vessels drainage routes of, 204 of female perineum, 407 of head and neck, 72 of kidneys and urinary bladder, 343 of large intestine, 317 of liver, 291 of lower limb, 546 of lung, 208 of male pelvis and genitalia, 408 of mammary gland, 184 of pelvis and genitalia, 408 of posterior abdominal wall, 266 of small intestine, 316 of stomach, 314 of trachea, 202 of upper limb, 483
M Macula, 90 fovea centralis in, 90 Macular arteriole inferior, 90 superior, 90 Macular zone, 120 Magendie, foramen of, 108 Magnetic resonance imaging (MRI) of head, 149, 150 pelvic, 397 Mallear fold anterior, 93 posterior, 93 Malleolar artery anterior lateral, 530 anterior medial, 530
Malleolus, 92 arterial network of, 520 lateral, 485, 513, 514, 520, 521, 530, 531 articular facet of, 513, 514 radiograph of, 54 medial, 485, 513, 514, 517, 518, 519, 530, 531 articular facets of, 514 radiograph of, 54 Malleus, 96 anterior process of, 93 handle of, 93 head of, 92, 93, 124 lateral process of, 93 lateral view of, 93 neck of. 93 superior ligament of, 93 Malpighian corpuscle, 336 Mammary gland anterolateral dissection of, 182 arteries of, 183 lobules of, 182 lymph vessels and nodes of, 184 sagittal section of, 182 subcutaneous tissue layer of, 182 suspensory ligaments of, 182 Mammillary body, 106, 107, 112, 114, 147 Mammillary process, lumbar, 155 Mammillothalamic fasciculus, 106 Mammillothalamac tract, 147 Mandible, 15 of adult anterolateral superior view of, 15 left posterior view of, 15 of aged persons, 15 alveolar part of, 15 angle of, 15 base of, 15 body of, 15, 27 condylar process of, 15 coronoid process of, 15 temporalis muscle insertion to, 54 head of, 15 of infant, 15 lingula of, 15 mental protuberance of, 15 mental spines of, 15 mental tubercle of, 15 neck of, 15 oblique line of, 15 pterygoid fovea of, 15 ramus of, 15, 25, 27 Mandibular canal, 60 Mandibular foramen, 15 inferior alveolar nerve entering, 46 Mandibular fossa, 4, 8, 12, 16 Mandibular lymph node, 72 Mandibular nerve (V3), 11, 24, 46, 86, 122, 125, 131, 133, 134, 135 anterior division of, 46 lateral view of, 46 marginal, 25, 31 medial view of, 46 meningeal branch of, 10, 86 motor root of, 46 posterior division of, 46 sensory root of, 46 Mandibular notch, 15 Manubriosternal joint, 186 Manubriosternal junction, 245
Manubriostemal synchondrosis, 419 Manubrium, 186, 198, 243, 244, 419 Marginal artery, 307, 323 of large intestine, 307 left, 216 Marginal plexus, 323 Marginal sulcus, 106 Marshall, ligament of, 221 Masseteric artery, 40, 54, 55 Masseteric nerve, 40, 54, 55, 122 Masseter muscle, 25, 27, 28, 47, 60, 61 axial CT image of, 150 axial MR image of, 150 deep part of, 54 insertion of, 54 superficial part of, 54 Mastication, muscles of, 54, 55 Mastoid angle, 9 Mastoid antrum, 94 Mastoid canaliculus, 10 Mastoid cells, 94 Mastoid emissary vein, 10, 137 Mastoid foramen, 10 Mastoid process, 14, 25, 27, 28, 29, 30, 34, 53, 59, 176 Maxilla, 2, 6, 38 alveolar process of, 2, 4, 6, 13, 38, 48 anterior nasal spine of, 2, 4, 6, 36, 38 at birth, 50 frontal process of, 2, 4, 36, 38, 81 incisive canal of, 6, 38, 40 incisive fossa of, 8 infraorbital foramen of, 2, 4, 12 infratemporal surface of, 4 maxillary sinus in, 50 medial palatine suture of, 8 nasal spine of, anterior, 36 nasal surface of, 6 orbital surface of, 2 palatine process of, 5, 6, 8, 14, 37, 38, 52, 56 tuberosity of, 4, 14 zygomatic process of, 2, 8 Maxillary artery, 16, 34, 40, 54, 71, 100, 131, 134 branches of, 40 Maxillary bone, 47 Maxillary nerve (V2), 45, 86, 121, 122, 131, 133, 134, 135 dental and gingival branches of, 45 meningeal branch of, 86, 122 nasal branch of, 122 pharyngeal branch of, 122 posterior superior lateral nasal branch of, 42, 43 Maxillary plexus, 131 Maxillary sinus, 3, 5, 44, 47, 48, 49 alveolar recess of, 48 axial MR image of, 150 coronal CT images of, 151 growth of, 50 infraorbital recess of, 48 mucous membrane of, 45 with opening into semilunar hiatus, 50 openings of, 37, 38, 48, 49, 50 postganglionic fibers to vessels and glands of, 44 sagittal MR image of, 149 zygomatic recess of, 48 Maxillary vein, 85 McBurney's point, 283
Medial rectus muscle, 83 Median aperture (foramen of Magendie), 109 Median nerve, 429, 433, 446, 447, 454, 460, 465, 474, 475 anterior interosseous part of, 476 anterior view of, 475 articular branch of, 475 branches to thenar and lumbrical muscles, 465 in carpal tunnel, 461 common palmar digital branches of, 460 communicating branch with ulnar nerve, 476 communicating with ulnar nerve, 475 to cutaneous innervation, 475 palmar branch of, 446, 447, 475, 481 palmar digital branches of, 473, 481 palmar view of, 475 posterior view of, 475 proper palmar digital branches of, 469 recurrent branch of, 474 to thenar muscles, 460 Median sulcus, dorsal, 115 Mediastinal lymph nodes, 184 anterior, pathway to, 184 posterior, 266 Mediastinum anterior lung area for, 194 cross section of, 241 fat pad in, 231 left lateral view of, 231 right lateral view of, 230 superior, great vessels of, 206 Medulla oblongata, 11, 106, 124, 134, 135, 168, 324, 345 axial MR image of, 150 cross section of, 124 lower part of, 135 nuclear layer of, 113 sagittal MR image of, 149 Medullary artery anterior segmental, 171, 172 posterior segmental, 171 Medullary lamina external, 111 internal, 111 Medullary (renal) lymph vessels, 343 Medullary vein anteromedian, 144 anterior segmental, 173 anteromedian, 144 posterior, 173 Medullary velum inferior, 106, 113 superior, 106, 113, 114, 115 Meibomian glands, 81 Meissner's plexus. See Submucous (Meissner's) plexus Membranous ampulla anterior, 95 lateral, 95 posterior, 95 Membranous septum atrioventricular part of, 222, 223, 225 interventricular part of, 223, 225 Meningeal artery, 99, 100 accessory, 11, 40, 100 anterior, 85 left middle, 136
Meningeal artery (Continued) middle, 40, 55, 99, 100, 102, 131, 138 posterior, 11 Meningeal nerve, 45 Meningeal plexus, middle, 131 Meningeal vein, middle, 102 Meningeal vessel grooves anterior, 9 middle, 6, 7, 9 posterior, 9 Meningeal vessels, middle, 10 Meninges, 10,136 arteries of, 99, 136 innervation of, 325 spinal, 102, 324, 325 superficial veins of, 102 veins of, 99 Meningohypophyseal trunk, 100 Meniscofemoral ligament, posterior, 508, 509 Meniscus, 455 lateral, 507, 508, 509, 511 horns of, 508 medial, 507, 508, 509 horns of, 508 Mental foramen, 2, 4, 15 Mentalis muscle, 26, 54, 123 Mental nerve, 24, 46, 71, 122 Mental protuberance, 1 Mesencephalic vein lateral, 144 posterior, 144, 146 Mesenteric artery inferior, 270, 278, 307, 308, 318, 323, 329, 332, 340, 341 superior, 179, 270, 281, 298, 301, 305, 306, 307, 308, 319, 321, 322, 328, 332, 339, 340, 342 common origin of, 302 relations of, 310 in root of mesentery, 270 Mesenteric ganglion, 126 inferior, 165, 167, 318, 323, 409 superior, 165, 167, 168, 267, 298, 318, 320, 322, 323, 324, 325, 328, 344, 345, 346, 409 Mesenteric lymph nodes, 315 inferior, 266, 317 superior, 266, 314, 317, 321 Mesentericoparietal recess, 179, 270, 271 Mesenteric plexus inferior, 165, 318, 323 superior, 165, 166, 318, 319, 320, 322, 328 Mesenteric vein inferior, 270, 298, 311, 312, 313, 315 superior, 179, 279, 306, 311, 312, 313, 338, 339, 342 cross section of, 338 relations of, 310 Mesenteric vessels, superior, 278, 349 Mesentery of ileum, 280 of jejunum, 280 peritoneal layers of, 326 root of, 270, 274, 278, 296, 298, 310, 340, 362, 363 superior mesenteric vein and, 310 of small intestine, 349
Mesoappendix, 281, 283, 322 Mesocolic taenia, 281, 282, 284 Mesocolon sigmoid, 271, 284, 307, 329, 340 attachment of, 274 transverse, 269, 270, 271, 272, 273, 278, 284, 307 attachment of, 298, 299 Mesometrium, 371 Mesonephric (wolffian) duct, 389 Mesonephric tubule vestigial, 390 Mesosalpinx, 369 laminae of, 372 Mesoihelial septum, 169 Mesovarium, 370 laminae of, 372 Metacarpal artery dorsal, 469, 530 palmar, 465 Metacarpal bone, 456 anterior (palmar) view of, 452 base of, 456 fifth, 444 base of, radiograph of, 457 head of, 456 posterior (dorsal) view of, 452 second, 445 shaft of, 456 third, 456 Metacarpal ligament deep transverse, 465 dorsal, 455 palmar, 465 superficial transverse, 480 Metacarpal vein, dorsal, 468 Metacarpophalangeal (MP) joint, 458 Metacarpophalangeal (MP) ligament, 458 Metaphyseal arcuate ligament, 455 Metaphysis, nutrient arterial branch to, 471 Metatarsal artery dorsal, 530, 535, 536 anterior perforating branches of, 535 posterior perforating branches of, 535 plantar, 535, 536 anterior perforating branches of, 535 Metatarsal bone, 523, 524, 536 base of, 523 fifth, 523 tuberosity of, 523, 530, 535, 536, 537 first, 523, 524, 537 fourth, 523 head of, 523 plantar view of, 523 second,523 shaft of, 523 third, 523 tuberosity of, 523, 524, 537 Metatarsal ligament deep transverse, 536 dorsal, 536 plantar, 528, 536 superficial transverse, 532 Metatarsal vein, dorsal, 544 Midbrain axial MR image of, 150 sagittal MR image of, 149
Midclavicular line left, 268 right, 268 Midline groove, 58 Midpalmar space, 460, 462 Minute arteries, of finger, 471 Mitral cell, 119 Mitral valve, 213, 225 anatomy of, 223 anterior cusp of, 222, 223, 224 commissural cusps of, 222 fibrous ring of, 222 leaflet of, 246 left fibrous ring of, 222 posterior cusp of, 222, 223, 224 Molar teeth first, 56 growth of, 50 second, 56 third, 56 Monro, foramen of- See Interventricular foramen (of Monro) Morgagni, hydatid of. See Vesicular appendix (hydalid of Margagni) Morison's pouch. See Hepatorenal recess (Morison's pouch) Mouth afferent innervation of, 62 floor of, 53 nerves of, 62 roof of, 52 anterior view of, 52 posterior view of, 52 Mucosa, intestinal, 279, 280 Mucous cell, stomach, 276 Mullerian duct. See Paramesonephric (mullerian) duct Multifidus muscle, 176 Muscles. See also specific muscles anorectal, 394 of arm anterior view of, 430 posterior view of, 432 of back, 174, 175, 176 deep layers of, 176 intermediate layers of, 175 superficial layers of, 174 of dorsum of foot, 530 of duodenum, 279 of esophagus, 234 extrinsic eye, 84 of face, 123 of facial expression, 26, 60 of foot, 536 of forearm, 440, 441, 446, 447, 448 of hand, 465 of hip and thigh, 492-493 lateral view of, 494 posterior view of, 495 innervated by femoral nerve, 538 innervated by obturator nerve, 540 of large intestine, 284 of larynx, 78 of leg anterior view of, 520 attachments of, 515 deep dissection of, 516, 520 posterior view of, 518 intermediate dissection of, 517 lateral view of, 521 posterior view of, 517
Muscles (Continued) superficial dissection of anterior view of, 518, 519 posterior view of, 516 of lower limb, 485 of mastication, 54, 55 of neck anterior view of, 28 lateral view of, 27 of pharynx, 65, 67, 68 lateral view of, 68 of rotator cuff, 425 of shoulder, 424 of small intestine, 280 of sole of foot first muscle layer of, 533 second muscle layer of, 534 third muscle layer of, 535 of stomach, 277 of thigh, 492-495 of tongue, 59, 60 of vermiform appendix, 283 Muscular artery, 90, 91 Muscularis mucosae, 276 of anal canal and rectum, 394 Muscular vein, 90 Musculocutaneous nerve, 429, 430, 433, 435, 447, 449, 474, 475, 480 terminal part of, 446, 469, 479, 482 Musculophrenic artery, 189, 198, 21 i, 215 Musculophrenic vein, 189, 256 Myelencephalon, 423. See also Medulla oblongata Myenteric (Auerbach's) plexus, 326 Mylohyoid groove, 15 Mylohyoid line, 15 Mylohyoid muscle, 27, 28, 29, 31, 32, 34, 53, 59, 60 median raphe between, 53 nerve to, 55, 60 Mylohyoid nerve, 16, 40, 46, 53, 122 Myometrium, 371
N Nail bed, 471 Nail matrix, 471 Nail root, 471 Nares anterior, 1 posterior, 14 Nasal artery dorsal, 23, 36, 40, 81, 85 external, 36 lateral, 36 Nasal bone, 1, 2, 4, 6, 12, 36, 38, 39 at birth, 50 Nasal cavity, 82, 83 arteries of, 41 autonomic innervation of, 44 bones of, at birth, 50 floor of, 37 growth of, 50 lateral wall of, 37, 38 medial wall of, 39 nerves of, 42-44 postganglionic fibers to vessels and glands of, 44 speculum view of, 37 Nasal cleft. See Intergluteal cleft
Nasal concha axial MR image of, 150 highest, 38 inferior, 37, 38, 82 coronal CT images of, 151 ethmoidal process of, 38 growth of, 50 sagittal MR image of, 149 middle, 2, 6, 37, 38, 48, 50, 82 growth of, 50 superior, 6, 37, 38 lower border of, 50 Nasalis muscle, 123 alar part of, 26, 76 transverse part of, 26, 36 Nasal meatus atrium of middle, 37 inferior, 37, 82 opening into, 50 middle, 37 atrium of, 37 opening into, 49 superior, 37, 50 Nasal nerve external, 36 inferior lateral, 131 posterior, 131, 133 posterior superior, 131 Nasal retinal arteriole inferior, 90 superior, 90 Nasal retinal venule inferior, 90 superior, 90 Nasal septum, 39, 41, 42, 47, 48, 63, 66 axial MR image of, 150 cartilage of, lateral process of, 38 coronal CT images of, 151 growth of, 48 Nasal slit, 11 Nasal spine anterior, 39 posterior, 39 Nasal vein dorsal, 23 external, 70 Nasal vestibule, 37, 39 Nasociliary nerve (V t ), 83, 86, 121, 122, 131, 132 infratrochlear nerve from, 45 Nasofrontal vein, 23, 85 Nasolabial lymph n c i e , 72 Nasolabial sulcus, 1 Nasolacrimal canal, opening of, 38 Nasolacrimal duct, 82 in nasooptic furrow, 50 opening of, 37, 82 Nasolacrimal foramen, at birth, 50 Nasooptic furrow, 50 Nasopalatine nerve (V 2 ), 10, 42, 43, 44, 62 communicating with greater palatine nerve, 42 passing to septum, 43 Nasopharynx, 92 airway to, 37 sagittal MR image of, 149 Navicular bone, 536, 537 plantar view of, 523 tuberosity of, 523, 524, 536 Navicular fossa, 361, 385
Neck arteries of, 33, 34, 39, 504 autonomic nerves in, 130 bony framework of, 13 cervical plexus in, 32 cutaneous nerves of, 24 fascial layers of, 28, 35 lymph nodes and vessels of, 72 muscles of, 27 anterior view of, 28 lateral view of, 27 nerves of, 24, 31, 71, 130 posterior triangle of, 174, 188 superficial veins and cutaneous nerves of, 23, 24, 31 surface anatomy of, 1 Nephron Henle's loop of, 337 schema of, 336 Nerves. See also specific nerves abdominal, 258 of abdominal wall, 267 of back, 177 to blood vessels, 228 cochlear fibers of, 96 cutaneous of arm and shoulder, 479 of forearm, 480 of head and neck, 224 of upper limb, 479, 481 of wrist and hand, 473 of esophagus, 240 of external genitalia, 409 of female pelvic viscera, 412 of female perineum and external genitalia, 413 of female reproductive organs, 415 of fingers, 471 of forearm, 480 of hand, 472 palmar view of, 466 of heart, 226, 227 of hip and buttock, 503 of kidneys and ureters, 344, 345 of large intestine, 323, 324 of larynx, 80 of liver and biliary tract, 327 of lower limb, 544, 545 of male external genitalia, 409 of male pelvic viscera, 410 of male perineum, 411 of mouth, 62 of nasal cavity, 42-44 of neck, 130 of pancreas, 328 of shoulder, 477 of small intestine, 322, 324 of spinal cord and vertebral column, 173 of stomach and duodenum, 319, 320 of suprarenal glands, 345, 346 of thigh, 500, 501, 540 of tracheobronchial tree, 210 of upper limb, 473 of urinary bladder, 344 of wrist, 461, 472 Neuroendocrine G cell, 276 Neurohypophysis, 140, 147, 148 Neuropathways, in parturition, 415 Neurovasculature of arm, 435 of lower limb, 538-546
Newborn, skull of, 12 Nipple, 181, 182 left, 196 right, 196 Nodose ganglion, 135 Nodule cerebellar, 144 inferior vermis, 113 Nose. See also Nasal cavity ala of, 1 anterolateral view of, 36 cross section of, 47 inferior view of, 36 lateral crus of, 36 medial crus of, 36 surface anatomy of, 1 Nostril, 1 Nuchal line inferior, 14 of skull, 174, 175, 176 Nucleus ambiguus, 117, 126 Nucleus pulposus, 155, 162 lumbar, 19 Nutrient artery, femoral, 504, 513 Nutrient foramen, 489, 513 0 Obex, 115 Oblique aponeurosis, 261 external, 250, 251, 260, 261, 349 internal, 253, 257 Oblique cord, 438, 439 Oblique fissure, 198 external, 188, 331 internal, 188, 189 of left lung, 244 Oblique muscle external, 174, 175, 177, 179, 182, 192, 247, 249, 250, 259, 263, 330, 424, 494 aponeurosis of, 250, 252, 259, 349 aponeurotic part of, 249 cross section of, 338 digitations of, 254 muscular part of, 249 inferior, 121 internal, 175, 179, 250, 259, 261, 263, 330 aponeurosis of, 252, 349 in lumbar triangle, 174 tendon of origin of, 179 superior, 83, 84, 86, 118, 121 Oblique popliteal ligament, 508 Oblique vein, left atrial, 214, 215, 221 Obliquus capitis inferior muscle, 175, 176, 178 Obliquus capitis superior muscle, 175, 176, 178 Obturator anastomotic vein, 265 Obturator anastomotic vessels, 262, 363 Obturator artery, 259, 264, 340, 369, 376, 398, 400, 402, 403, 410, 504, 512 acetabular branch of, 487 anterior branch of, 487 posterior branch of, 487 Obturator canal, 352, 358, 364, 365, 369, 402, 501 Obturator crest, 352, 486, 487
Obturator extemus muscle, 489, 493, 539 attachments of, 489, 491 Obturator foramen, 248 anteroposterior radiograph of, 488 radiograph of, 355 Obturator groove, 486 Obturator onternus muscle, 263, 376, 398, 411, 495, 499, 503 attachments of, 489, 491 nerve to, 499, 503 obturator fascia of, 364, 392, 402, 411 Obturator internus tendon, 359 Obturator lymph node, 406 Obturator membrane, 263, 352, 370, 487 Obturator nerve, 267, 340, 376, 498, 499, 538, 539, 540 accessory, 267, 498 articular branch of, 539 cutaneous branches of, 501, 544, 545 cutaneous branch of, 539 to knee joint, 539 posterior branch of, 539 Obturator-pubic arterial anastomosis, 259 Obturator vein, 311, 376 Obturator vessels, 259 right, 403 Occipital artery, 23, 34, 100, 178 descending branch of, 34 mastoid branch of, 100 medial, 142 CH
'
meningeal branch of, 23 occasional branch of, 11 sternocleidomastoid branch of, 34 Occipital bone, 4, 7, 8, 9, 1-2 basilar part of, 6, 8, 9, 22, 30, 37, 38, 39, 52, 65, 66, 67 clivus of, 22 condylar canal and fossa of, 8 condyle of, 9, 30, 128 external occipital crest of, 8 external occipital protuberance of, 4, 6, 8 foramen magnum of, 6 hypoglossal canal of, 6 inferior nuchal line of, 8 inferior petrosal sinus groove of, 6 internal occipital crest of, 9 internal occipital protuberance of, 9 jugular foramen of, 6 jugular process of, 30 pharyngeal tubercle of, 8, 63 superior nuchal line of, 83 transverse sinus groove of, 6 Occipital condyle, 9, 30, 128 Occipital crest, external, 14 Occipital lobe, 105 projection on, 120 Occipital lymph node, 72 Occipital nerve greater, 24, 177, 178 from C2 dorsal ramus, 129 lesser, 32, 129, 177, 178 third, 24, 177, 178 Occipital pole, 105 sagittal MR image of, 149 Occipital protuberance external, 14, 152 internal, 9
Occipital sinus, 103, 144 groove for, 9 Occipital sulcus, transverse, 105 Occipital vein, 23 internal, 146 O c c i p i t o f r o n t a l muscle frontal belly of, 123 occipital belly of, 123, 178 Occipitotemporal artery, 142 Occipitotemporal gyrus lateral, 106, 107 medial, 106, 107 Occipitotemporal sulcus, 106, 107 Oculomotor nerve (III), 84, 86, 101, 114, 116, 117, 166 branch of, 168 distribution of, 118 inferior branch of, 83, 86 inferior division of, 118, 121 schema of, 118 superior branch of, 83, 86 superior division of, 118, 121 Oculomotor nucleus, 116, 117, 121, 437, 438, 441, 444 accessory, 132 Odontoblast layer, 57 Olecranon, 436 Olfactory bulb, 107 cells of, 119 contralateral, 119 Olfactory cells, 119 Olfactory mucosa, 119 Olfactory nerve (I), 119 bundles of, 11 distribution of, 118 fibers of, 118, 119 schema of, 118, 119 Olfactory nucleus, anterior, 119 Olfactory stria lateral, 119 medial, 119 Olfactory sulcus, 107 Olfactory tract, 106, 107, 114 lateral nucleus of, 119 Olfactory trigone, 119 Olfactory tubercle, 119 Olive, 114, 117 Omental appendices, 272, 284 Omental arterial arch, 305 Omental artery, 305 Omental bursa, 272, 331 cross section of, 273 lesser sac of, 273 posterior wall of, 349 posterior wall of, parietal peritoneum on, 331 stomach reflected in, 272 superior recess of, 272, 274, 287 Omenta! foramen (of Winslow), 272, 273, 275, 288, 331 probe in, 272 Omental taenia, 281, 284 Omentum greater, 269, 271, 273, 284, 288, 339 anterior layers of, 294, 319 attachment of gastro-omental vessels to, 274 posterior layers of, 319 lesser, 273, 275, 288 anterior layer of, 319 attachment of gastric artery, 274
Omentum (Continued)'-:, blood vessels to right margin of, 348 posterior layer of, 319 right free margin of, 278, 279, 298 Omohyoid muscle, 29, 31, 34, 53, 189, 198, 420, 424, 428, 429 inferior belly of, 1, 27, 29, 31, 32, 128, 129, 427 invested by cervical fascia, 188 invested by fascia of infrahyoid muscle, 428 nerve to, 32, 71 31 origin of, 420 superior belly of, 27, 28, 29, 31, 32, 128, 129 Ophthalmic artery, 11, 23, 40, 83, 86, 132, 140, 143 continuation of, 85 muscular branch off, 85 supraorbital branch from, 69 supratrochlear branch from, 69 Ophthalmic nerve (VJ, 24, 45, 121, 122, 132, 133, 134, 135 external nasal branches of, 122 internal nasal branches of, 122 lacrimal, frontal, and nasociliary branches of, 11 tentorial branch of, 86, 122 Ophthalmic vein inferior, 85, 91 superior, 83, 85, 91 Opponens digiti minimi muscle, 465, 476 Opponens pollicis muscle, 461, 465, 475 Optic canal, 2, 6, 11, 83 Optic chiasm, 48, 104, 106, 107, 114, 140, 141, 145, 146, 147 Optic disc, 90 Optic nerve (II), 83, 86, 87, 90, 106, 107, 113, 132, 143, 144 coronal CT images of, 151 distribution of, 118 external sheath of, 91 internal sheath of, 91 vessels of, 91 outer sheath of, 32, 83, 87 sagittal MR image of, 149 in visual pathway, 120 Optic radiation, 120 Optic tract, 107, 108, 112, 114, 144 Oral cavity, 39, 48, 52-53, 63. See also Lip; Mouth; Teeth; specific parts of oral cavity coronal CT images of, 151 inspection of, 51 Oral region arteries of, 69 nerves of, 71 veins of, 70 Ora serrata, 87, 89, 90 Orbicularis ciliaris, 89 Orbicularis oculi muscle, 123 orbital part of, 26 palpebral part of, 26 Orbicularis oris muscle, 26, 36, 54, 81. 123 Orbiculus ciliaris, 89 Orbit arteries and veins of, 85 fascia of, 85
Orbit (Continued) fat in, 48, 83 axial MR image of, 150 growth of, 50 lateral dissection of, 49 medial wall of, 48 muscle attachments and nerves and vessels entering, 83 nerves of, 86 right, frontal, and slightly lateral view of, 2 Orbital fat body, 83 Orbital fissure inferior, 14, 83 superior, 83 Orbital gyrus, 107 Orbital muscle, 48 Orbital operculum, 105 Orbital septum, 81 Orbital sulcus, 107 Orbital surface, 2 Orbitofrental artery, 141, 142 lateral, 139 medial, 139 Oropharynx, 233 opened posterior view of, 66 Osfeomeatal unit, 37 Otic capsule, 96 anterolateral view of, 95 Otic ganglion, 55, 122, 123, 125, 131, 133, 134, 135, 168 schema of, 134 Oval window, 12, 95 base of stapes in, 92 fossa of, 94 stapes in, 93, 96 Ovarian artery, 341, 412 left, 329 right, 318, 322 ureteric branch from, 341 Ovarian plexus, 344, 412, 415 right, 318 Ovarian vein left, 311, 329, 332 right, 311, 332 Ovarian vessels, 332, 340, 362, 364, 404 left, 311 right, 311 tubal branches of, 404 Ovary, 340, 360, 362, 369, 370, 389, 410, 412, 415 ligament of, 360, 362, 369, 370, 371 right, 372 suspensory ligament of, 360, 362, 369, 370, 371, 372, 389, 400 ovarian vessels in, 364
P Pain pathway of, 325 referred, common areas of, 327 Palate growth of, 50 hard, 48, 63, 64 postsynaptic fibers to vessels and glands of, 44 soft, 37, 39, 51, 63, 64, 66 Palatine aponeurosis, 52 Palatine artery ascending, 40 greater, 52
Palatine artery (Continued) greater descending, 40 left, 40 lesser, 40 lesser left, 40 lesser right, 40 right, 40 Palatine bone, 39 at birth, 488 greater, 71 horizontal plate of, 14, 37, 38, 39, 52, 56 lesser, 71 lesser palatine foramen of, 39 nasal crest of, 39 orbital process of, 2, 38 perpendicular plate of, 38, 39 posterior nasal crest of, 39 posterior nasal spine of, 38 • pyramidal process of, 8, 12, 14 sphenoidal process of, 38 Palatine folds, transverse, 52 Palatine foramen greater, 8,11, 38, 56 lesser, 8, 11, 38, 39, 52, 56 Palatine gland, 52, 63, 64 Palatine nerve communicating with nasopalatine nerve, 42 descending, 133 greater, 11, 42, 43, 44, 45, 52, 62, 122, 131, 133 lesser, 42, 43, 45, 52, 62, 122, 131, 133 posterior inferior lateral nasal branch from, 42, 43 Palatine process, 14, 38, 52, 56 Palatine raphe, 52 Palatine suture median, 8 transverse, 8 Palatine tonsil, 51, 52, 58 Palatine vein, 70 external, 70 Palatine vessels, greater, 10 Palatoglossal arch, 51, 58 Palatoglossus muscle, 52, 58, 59, 64, 126 in palatoglossal arch, 60 Palatopharyngeal arch, 51, 58, 64, 66 Palatopharyngeal sphincter (Passavant's ridge), 65 Palatopharyngeus muscle, 52, 58, 59, 126, 235 Palmar aponeurosis, 442, 446, 454, 462, 480 reflected, 460 septa from, 460 Palmar arch, deep, 465 Palmar arterial arch deep, 465 superficial, 460 Palmar artery deep, computed tomography of, 484 superficial, computed tomography of, 484 Palmar carpal arterial arch, 465 Palmar carpal ligament, 446, 447, 454, 460 Palmar crease, proximal, 418
Palmar digital artery common, 462, 465 proper, 462, 471 Palmar digital nerve common, 476 proper palmar, 476 Palmaris brevis muscle, 476 Palmaris longus muscle, 442, 446, 448, 450, 475 Palmaris longus tendon, 418, 420, 446, 447, 454, 460 Palmar ligament, 471 Palmar venous arch, superficial, 460 Palpebral arterial arch, 85 Palpebral artery inferior lateral, 85 inferior medial, 85 lateral, 85 median, 85 superior lateral, 85 superior medial, 85 Palpebral conjunctiva, 81 Palpebral ligament lateral, 81 medial, 81, 83 Palpebral nerve, 24 Pampiniform plexus, 256 venous, 401, 403 Pancreas, 126, 167, 179, 273, 290, 297, 347 acini of, 298 anterior view of, 315 arteries of, 301 body of, 272 common areas of pain in, 328 cross section of, 297 head of, 272, 278, 279, 294, 298, 304, 338 arteries of, 304 in situ, 347 innervation of, 168, 328 lymph vessels and nodes of, 315 neck of, 298 posterior view of, 304, 315 tail of, 272, 298, 299, 329 artery to, 301 with uncinate process, 339 uncinate process of, 298 veins of, 309 Pancreatic artery dorsal, 300, 301, 305, 306 greater, 301 inferior, 301, 305, 306 Pancreatic duct, 294, 295, 298 accessory, 279, 298 principal, 279 sphincter of, 295 union of bile ducts and, 295 Pancreatic lymph nodes, superior, 314 left, 314 right, 314 Pancreatic notch, 298 Pancreaticoduodenal artery anastomosis of, 306 anterior superior, 272, 300, 301, 305, 306, 320, 321 inferior, 302, 305, 307, 322 anterior, 301, 306, 320, 321 common portion of, 306 plexus on, 319, 320, 322
Pancreaticoduodenal artery (Continued) inferior (Continued) posterior, 301, 306 posterior inferior, 301, 320, 321 posterior superior, 301, 305, 306, 320, 321 superior, 321 plexus on, 319 Pancreaticoduodenal lymph nodes, 315 Pancreaticoduodenal plexus, inferior, 322, 323 Pancreaticoduodenal vein anterior, 312 anterior inferior, 311 anterior superior, 311 inferior, 313 posterior, 312, 313 posterior inferior, 311 superior, 312 Pancreatic vein, 311, 313 dorsal or superior, 313 great, 313 Papilla muscle fibers to, 282 of teeth, 57 Papillary duct, 336 Papillary muscle anterior, 220, 223, 224,. 225 left anterior, 224 left posterior, 224 posterior, 220, 223, 225 right anterior, 224 right posterior, 224 septal, 220, 223, 224 Paracentral artery, 141, 142 Paracentral lobule, 106 Paracentral sulcus, 106 Paracolic gutter left, 271, 362, 363 right, 2 7 1 , 2 8 1 , 3 6 2 , 3 6 3 Paracolic lymph nodes, 317 Paradidymus, 389 Paraduodenal fossa, 270 Parahippocampal gyrus, 106, 107, 108, 119 Paramedian artery, 140 Paramesonephric (miillerian) duct, 389 Paramesonephric tubule, 389 Paranasal sinus age-related changes in, 50 bones of, at birth, 50 coronal section of, 48 cross section of, 47 horizontal section of, 48 lateral dissection of, 49 sagittal section of, 49 Pararectal fossa, 362, 363, 369 floor of, 392 Pararenal fat, 179 Parasternal lymph nodes, 184 Parasympathetic fibers postganglionic, 44 preganglionic, 44
Parasympathetic nerve, in tracheobronchial tree, 210 Parasympathetic nervous system schema of, 168 topography of, 166 Parathyroid gland, 76 inferior, 75, 76 * right lateral view of, 75, 76 superior, 75, 76 superior view of, 75, 76 Paratracheal lymph nodes left, 208 right, 208 Paraumbilical vein, 312 to round ligament of liver, 256 tributaries of, 256 Paraurethral (Skene's) glands, 389 primordium of, 389 Paraventricular nucleus, 147 Paravertebral anastomosis, 172 Paravesical fossa, 369 Parenchyma, blood vessels in, 337 Parietal artery, 141 anterior, 141, 142 anterior parietal, 142 posterior, 141, 142 Parietal bone, 2, 4, 6, 8, 9 tuber eminence of, 12 Parietal cells, 9, 276 Parietal emissary vein, 23 Parietal foramen, 7 Parietal limb, 220 Parietal lobe, 105 Parietal lobule inferior, 105 superior, 105 Parietal operculum, 105 Parietal pleura cervical, 196, 197, 230 costal, 194, 198, 206, 211, 230 left border of, 197 right border of, 197 diaphragmatic part of, 193, 194, 198, 206, 211 mediastinal part of, 193, 194, 198, 206, 211, 215, 230 Parietooccipital artery, 142, 143 Parietooccipital sulcus, 105, 106, 143 Parolfactory area, 106 Parotid duct, 25, 54, 55, 61, 69 Parotid gland, 25, 26, 27, 28, 31, 32, 55, 125, 134, 166, 167 accessory, 61 cholinergic and adrenergic synapses to serous, 61 horizontal section of, 25 Parotid lymph nodes deep, 72 superficial, 72 Parotid papilla, 51 Parotid space, 34 Pars distalis, 147 Pars flaccida, 93 Pars interarticularis, 155 Pars intermedia, 147 Pars tensa,93 Pars tuberalis, 147 Parturition, neuropathways in, 414
Passavant's ridge. See Palatopharyngeal sphincter (Passavant's ridge) Patella, 485, 492, 493, 494, 501, 507, 511, 519, 521 anteroposterior radiograph of, 510 radiograph of, 510 Patellar anastomosis, 500, 512 Patellar bursa, 508 Patellar capsule, iliotibial tract blended into, 508 Patellar ligament, 485, 489, 492, 493, 494, 508, 511, 514, 520, 521 Patellar nerve plexus, 544 Patellar retinaculum iliotibial tract blended into, 508 lateral, 492, 493, 507, 508, 519, 520 medial, 492, 493, 501, 506, 508, 519, 520 Pecten, 393 Pecten pubis, 248, 486 Pectinate ligament, 88 Pectinate line, 393 Pectinate muscle, 220 Pectineal ligament (Cooper's), 188, 250, 251, 259, 262, 263 Pectineal line, 248, 263, 352, 353, 486, 489, 505, 538 Pectineus muscle, 376, 489, 492, 493, 500, 538 attachments of, 489, 491 Pectoralis major muscle, 27, 28, 181, 182, 188, 192, 198, 243, 244, 245, 246, 247, 249, 250, 418, 419, 428 abdominal part of, 424 clavicular head of, 181 deep to pectoral fascia, 182 fascia of, 26, 428 insertion of, 420 origin of, 419 sternocostal head of, 424 tendon of, 433 Pectoralis minor muscle, 198, 243, 244, 245, 420, 428, 433 fascia of, 428 insertion of, 420 invested by clavicopectoral fascia, 188 Pectoralis minor tendon, 429, 430 Pectoralis muscle, 189 Pectoral nerve lateral, 188, 428, 430 medial, 188, 428, 429, 430 median, 428 Pedicle, lumbar, 155 Pelvic brim, 370 sacral part of, 157 Pelvic floor contents of, 354-366 female, 356 Pelvic foramina, radiograph of, 355 Pelvic inlet diameters of, 354 female, 354 male, 354 radiograph of, 355 Pelvic ligaments, 372 Pelvic organs, female, arteries and veins of, 400 Pelvic outlet anteroposterior diameter of, 35^ female, 354 transverse diameter of, 354
Pelvic plexus, 412 Pelvic scans, 397 Pelvic viscera female, 360, 369 nerves of, 412 male, 361 nerves of, 410 Pelvis, 351 anterior view of, 352 arcus tendineous fasciae, 372 bones and ligaments of, 352-353 false, 351, 362 female, 356 arteries and veins of, 402 contents of, 360 lymph nodes and vessels of, 407 radiograph of, 355 radiographs of, 355 sagittal MR images of, 397 structures in, 370-375 lateral view of, 352 linea terminalis of, 362, 364 male, 354 arteries and veins of, 401, 403, 405 contents of, 363, 387 lymph nodes and vessels of, 408 radiograph of, 355 radiographs of, 355 sagittal MR images of, 397 structures of, 380-387 surface anatomy of, 351 medial section of, 352 posterior view of, 352 renal, 339 sex differences of, 354 true, 352 viscera of, nerves of, 412 Penis body of, 351, 388 bulb of, 382, 383, 385 artery of, 383, 405 cavernous nerves of, 410, 412 crus of, 360, 366, 385 deep arteries of, 381, 383, 385, 404 deep dorsal vein of, 249 deep fascia of, 361, 380, 381, 382, 385, 387, 401, 403, 405 dorsal arteries of, 381, 383, 401 dorsal nerve of, 411 dorsal nerves of, 381, 383, 405, 409, 410, 411, 416, 503 dorsal veins of deep, 359, 361, 381, 383, 401, 403, 405 hiatus for, 358 superficial, 351, 381, 403 fetal development of, 388 frenulum of, 382 fundiform ligament of, 259, 361 glans, 351, 361, 382, 385, 388 corona of, 382 neck of, 382 sagittal MR images of, 397 internal pudendal artery of, 383 lateral superficial vein of, 381 raphe of, 388 section through body of, 381 skin of, 380, 381, 382, 387 superficial fascia of, 249, 250, 381, 382, 387 suspensory ligament of, 250, 361
Perforated substance, 114 anterior, 107, 114, 119 posterior, 107, 114 Perforating artery, 501 anteromedial central, 140 posteromedial, 140 radiate, 335 from thigh, 512 Perforating artery, radiate, 335 Perforating cutaneous nerve, 411, 413 of hip, 503 of lower limb, 545 sacral, 499 Perforating vein, 337 of arm, 479 of forearm, 480 Per hippocampus, 112 Perianal skin, 394 sweat glands and hair in, 393 Perianal space, 392, 393, 396 Perianal tissues, 388 Perianal venous plexus external, 392 internal, 392 Pericallosal artery, 141, 142 posterior, 143 Pericardiacophrenic artery, 194, 206, 211, 230, 241, 255 left, 193 right, 193 Pericardiacophrenic vein, 194, 206, 211, 212, 230, 231, 241 Pericardiacophrenic vessels, 215 Pericardial reflection, 214, 220 Pericardial sac anterior view of, 215 left lateral view of, 215 Pericardial sinus oblique, 215, 246 transverse, 215, 220 Pericardial sinus, transverse, 212 Pericardium, 211, 215, 233 bare area of, 196 diaphragmatic part of, 215 fibrous, 198, 230 line of fusion to diaphragm, 211 over right atrium, 230 mediastinal part of, 194 reflection of, 214, 220, 221 at site of great vessels reflection, 212 sternocostal part of, 215 Perichoroidal space, 87, 88 Pericranium, 102 Periformis muscle, 490 Periglandular plexus, 326 Periglomerular cells, 119 Perimuscular rectal venous plexus, 311 Perineal artery, 370, 403, 404, 405 transverse, 405 Perineal body, 359, 361, 365, 378, 380, 381, 382, 383, 384, 391, 395, 403, 404, 405 Perineal compartment, superficial, 396 Perineal flexure, 376 Perineal ligament, transverse, 356, 358, 361, 364, 380, 383, 405 Perineal lymph vessels, 317
Perineal membrane, 263, 358, 365, 366, 380, 381, 383, 391, 404, 405, 411, 413 left, 354 Perineal muscle deep fascia of, 356 deep transverse, 356, 360, 361, 381, 383, 404 superficial transverse, 356, 380, 381, 382, 391, 404, 405 Perineal nerve, 410, 411, 413, 503 deep, 411, 413, 530 lateral branch of, 530, 531 deep branches of, 411 in males, 411 posterior scrotal and labial branches of, 499 in pudendal canal, 392 superficial, 411, 413 superficial branches of, 411 Perineal raphe, 388 Perineal space male, 383 superficial, 361, 370, 378, 404, 405 Perineal vein, 405 Perineopelvic spaces, 396 Perineum, 347 abscess in, 396 female, 360, 377, 395 arteries and veins of, 404 deep, 379 lymph vessels and nodes of, 407 nerves of, 413 structures of, 371-375 superficial dissection of, 378 interdigitating fibers to, 357 male, 361 arteries and veins of, 405 deeper dissection of, 381 frontal section, anterior view of, 383 nerves of, 411 structures of, 380-387 superficial dissection of, 380 surface anatomy of, 351 Periodontium, 57 Periorbita, 83 Periosteum alveolar, 57 mandibular or maxillary, 57 Periportal space, 291 Perirenal fat, 179, 342 Perisinusoidal spaces, 291 Peritoneal fold hepatic artery in, 272 testicular vessels in, 363 Peritoneum, 179, 236, 252, 261, 284, 322, 329, 342, 412 female, 365, 366, 378, 400, 412 inferior, 415 potential spaces of, 364 forming pararectal fossa floor, 392 male, 361, 366 inferior extent of, 415 parietal, 271, 273, 331, 348, 362, 363, 373 of anterior abdominal wall, 348 on omental bursa posterior wall, 331 phrenic nerve to, 327 of posterior abdominal wall, 274 visceral, 273, 326 Perivascular fibrous (Glisson's) capsule, 290
Peroneal nerve, deep, 530 Peroneus brevis tendon, 535 Peroneus longus tendon, 535 fibrous sheath of, 535 Pes anserinus, 489, 492, 493 attachments of, 489, 515 Pes hippocampus, 111, 112 Petrosal ganglion, 131, 135 Petrosal nerve deep, 123, 125, 131, 133 greater, 86, 123, 124, 125, 131, 133, 135 groove for, 9, 97 hiatus for, 11 lesser, 86, 93, 122, 123, 125, 134 groove for, 9 hiatus for, 11 Petrosal sinus inferior, 11, 103 groove for, 6, 9 superior, 97, 103 groove for, 9 Petrosal vein, 144 draining to petrosal sinus, 144 Petrosquamous fissure, 12 Petrotympanic fissure, 11 Peyer's patches, 280 Phalanx, 524 distal, 456, 471 cross section of, 471 of great toe, 537 ulnar nerve innervation of, 476 dorsal, 523 fourth, base of, radiograph of, 457 middle, 456, 471, 523 radiograph of, 457 ulnar nerve innervation of, 476 plantar view of, 523 proximal, 456, 523 of great toe, 537 radiograph of, 457 of ring finger, distal, radiograph of, 457 of thumb, distal, radiograph of, 457 tuberosity of, 523 Pharyngeal aponeurosis, 235 Pharyngeal artery, 40 ascending, 11, 34, 40, 69, 136, 138 meningeal branches of, 100 pharyngeal branch of, 64 posterior meningeal branch of, 136 tonsillar branch of, 64 Pharyngeal constrictor muscle glossopharyngeal part of, 59 inferior, 27, 75, 76, 80, 126, 233, 234 cricopharyngeus part of, 233, 234 middle, 27, 59, 75, 126, 235 superior, 40, 52, 55, 59, 69, 75, 126, 235 glossopharyngeal part of, 59, 65 Pharyngeal muscle, longitudinal, 235 Pharyngeal nerve, 133 Pharyngeal plexus, 62, 71, 125, 126, 130, 131 Pharyngeal raphe, 37, 60, 63, 65, 67, 75, 76, 234 Pharyngeal recess, 37, 47, 64, 66 Pharyngeal region arteries of, 69 nerves of, 71 veins of, 70 Pharyngeal tonsil, 37, 63, 64, 66, 67 Pharyngeal tubercle, 64, 65, 67
Pharyngobasilar fascia, 52 Pharyngobasilar fossa, 59 Pharyngoepiglottic fold, 235 fibers to, 65 Pharyngoesophageal junction, 235 Pharyngotympanic tube. See Auditory (pharyngotympanic, Eustachian) tube Pharynx afferent innervation of, 62 arteries of, 69 lymphatic drainage of, 73 lymph nodes and vessels of, 73 median section of, 63 muscles of lateral view of, 68 median (sagittal) section of, 65 partially opened posterior view of, 67 nerves of, 62 opened posterior view of, 66 posterior view of, 75 posterior wall of, 51 veins of, 71 Philtrum, 1 Phrenic artery inferior, 237, 305, 318, 333, 347 left inferior, 272, 300, 319, 320, 332, 333 recurrent branch of, 300 sympathetic fibers along, 240 right inferior, 300, 319, 320,333, 346 Phrenic ganglion, 320, 327 Phrenic lymph nodes, inferior, 184, 266 Phrenic nerve, 30, 32, 74, 129, 130, 189, 193, 198, 206, 210, 211, 226, 230, 243, 429 anterior, 195, 321 efferent and afferent fibers of, 193 left, 193, 194, 215, 346 nerve to, 430 pericardial branch of, 193 phrenicoabdominal branches of, 193 right, 193, 194, 215, 244, 318, 327, 346 Phrenicocolic ligament, 272 Phrenic plexus, 410 inferior, 318 left inferior, 319, 320, 323, 346 right inferior, 319, 320, 323, 346 Phrenic vein inferior, 320 left inferior, 320 Phrenoesophageal ligament, 236 Pia-arachnoid mater, 91 Pial plexus, 171 arterial, 173 peripheral branches from, 173 venous, 173 Pia mater, 91, 99, 102 overlying spinal cord, 169 thoracic, 170 Pigment cells, 120 Pillar cells, 94, 120 Pineal body, 106, 110, 111, 114 Pineal recess, 108 Piriform fossa, 233 Piriformis muscle, 263, 411, 489, 495, 503 nerve to, 499 Piriform lobe, 119
Pisiform, 442, 446, 447, 454, 456, 460, 465 radiograph of, 457 Pituitary gland, 107, 147 anterior lobe of, 140, 147, 148 posterior lobe of, 148 posterior lobe of, 140, 147 sagittal MR image of, 149 in sella turcica, 37 Pituitary stalk, 147 Plantar aponeurosis, 533, 534, 535 digital slips of, 535 lateral band of, 535 Plantar arterial arch, deep, 531, 536 posterior penetrating branches from, 520, 536 Plantar artery deep, 530, 535, 536 lateral, 535, 536 cutaneous branches of, 535 medial, 534 cutaneous branches of, 534, 535 deep branches of, 534 superficial branch of, 533, 534, 535 posterior perforating branches of, 536 Plantar calcaneonavicular ligament, 536 Plantar digital artery, common, 534 Plantar digital nerve, common, 534, 541 Plantar interosseous muscle, 537 Plantaris muscle, 494, 495, 511, 515, 540, 541 attachments of, 491, 515 innervation of, 541 Plantaris tendon, 495, 516, 517, 522 Plantar ligament, 536 long, 528, 536 short, 527 Plantar nerve lateral, 534, 535, 540, 541 cutaneous branches of, 535 deep branches of, 535 plantar cutaneous branches of, 545 proper plantar digital branches of, 533, 534, 535 superficial branch of, 535 medial, 534, 540 deep branch of, 534, 535 plantar cutaneous branches of, 535, 545 proper plantar digital branches of, 533, 534, 535 superficial branch of, 534 Platysma muscle, 26, 28, 60, 124 Pleura, 331 abdominal, 349 cupula of, 74 mediastinal, 194 parietal, 206 spinal nerves of, 170 thoracic, 170 visceral, 205 Pleural cavity costodiaphragmatic recess of, 196, 197, 330, 331 left costodiaphragmatic recess of, 104, 206 left costomediastinal recess of, 194 right costodiaphragmatic recess of, 194 Pleural reflection, 196 Plica semilunaris, 81, 82
Pneumothorax, chest drainage tube placement in, 190 Pons, 106, 114, 134, 135 axial MR image of, 150 sagittal MR image of, 149 Pontine artery, 140, 141, 143 Pontine taste area, 135 Pontine vein lateral, 144 transverse, 144 Pontomesencephalic vein, anterior, 144 Popliteal artery, 512 Popliteal fossa, 485 Popliteal ligament, arcuate, 511 Popliteal ligament, oblique, 511 Popliteal lymph nodes, 546 Popliteal surface, 489 Popliteal vein, 546 Popliteal vessels, 495 Popliteus muscle, 491, 511, 515, 541 attachments of515, 541 nerve to, 541 Popliteus tendon, 508, 510 origin of, 507 Pores of Kohn, 204 Portacaval anastomosis, 312 Porta hepatis, 287 Portal space, limiting plate of, 291, 292 Portal triad, 273, 278, 290, 297, 298 cross section of, 273 Portal vein, 297 branch of, 291, 292 cross section of, 297, 338 Postanal space deep, 396 superficial, 396 Postcaval lymph nodes, lateral, 343 Postcentral gyrus, 105 Postcentral sulcus, 105 Posterior chamber, 81, 87, 88, 90 Posterior limiting lamina (Descemet's membrane), 88 Posteromedial central artery, 140 Postganglionic sympathetic fibers, 346 ciliary ganglion, 132 female reproductive organ innervation, 415 male reproductive organ innervation, 416 urinary bladder and lower ureter innervation, 417 Postlunate fissure, 113 Poupart's ligament. See Inguinal ligament (Poupart's) Preaortic lymph nodes, 317, 408 Precaval lymph nodes, lateral, 343 Prececal lymph nodes, 317 Precentral gyrus, 105 Precentral sulcus, 105 Prechiasmatic groove, 9 Preculminate vein, 144 Precuneal artery, 142 Precuneus, 106 Prefrontal artery, 141 Preganglionic sympathetic cell body, 44, 132
Preganglionic sympathetic fibers, 346 ciliary ganglion, 132 female reproductive organ innervation, 415 male reproductive organ innervation, 416 urinary bladder and lower ureter innervation, 417 Premolars, 56, 57 Preoccipital notch, 105 Prepatellar bursa, subcutaneous, 511 Prepontine cistern, 109 Prepuce, 388 of clitoris, 388 of penis, 361 site of, 388 site of future origin of, 388 Preputial gland, opening of, 382 Prepyloric vein, 311 Prerectal muscle fibers (of Luschka), 359 Presacral space, 364, 396 Presymphyseal node, 408 Pretracheal lymph node, 74 Prevertebral anastomosis, 172 Prevertebral muscle, 30 Prevesical lymph node, lateral, 343 Prevesical lymph plexus, 408 Prevesical plexus, 408 Princeps pollicis artery, computed tomography of, 484 Procerus muscle, 26, 36, 123 Profunda brachii artery, 429 Profundus flexor tendon, in common flexor sheath, 460 Promontorial lymph nodes, 343, 408 Promontory, 92, 93 Pronator quadratus muscle, 440, 448, 449, 450, 465, 475 Pronator teres muscle, 420, 433, 440, 446, 447 humeral head of, 420, 447, 450, 474, 475 origin of, 420 ulnar head of, 350, 420, 447, 448, 475 origin of, 420 Prostate gland, 167, 384 arterial supply of, 403 capsule of, 361, 366, 384 fibromuscular stroma of, 384 hyperplastic lateral lobe of, 403 hyperplastic middle lobe of, 403 inferolateral lobe of, 384 inferoposterior lobe of, 384 • innervation of, 168 isthmus lobe of, 384 lymphatic drainage from, 408 median lobe of, 384 primordium of, 389 with prostatic urethra, 376 sagittal MR images of, 397 skeletal muscle band of, 384 sphincter urethrae muscle ascending anterior aspect of, 359 Prostatic duct, openings of, 384, 385 Prostatic plexus, 165, 344, 416 Prostatic sinus, 384, 385 Prostatic urticle, 389 Prostatic vein, right, 31 I Prostatic venous plexus, 403
Proximal interphalangeal (PIP) Joint, 418 Psoas major fascia, 342 Psoas major muscle, 179, 267, 278, 329, 339, 342, 492, 496, 498, 499 area for, 330 articular branch of, 538 fascia of, 179, 342 lower part of, 538 origin of, 489, 496 Psoas minor muscle, 263, 496 origin of, 496 Psoas muscle, 376, 496 axial CT images of, 350 muscular branch of, 498 Psoas tendon,376 Pterion, 4 Pterygoid artery lateral, 40 medial, 40 Pterygoid canal artery of, 40 nerve of, 122, 123, 125, 131, 133, 135 Pterygoid fossa, posterior view of, 14 Pterygoid fovea, 15 Pterygoid hamulus, 4, 38, 46, 52, 55, 64, 65, 68 at birth, 50 Pterygoid muscle lateral, 40, 54, 55 axial MR image of, 150 medial, 15, 25, 40, 52, 55 nerve to, 71 Pterygoid nerve lateral, 46, 122 medial, 46, 122 Pterygoid plate lateral, 13, 47, 55, 68 medial, 52, 55, 64, 65 hamulus of, 13 Pterygoid plexus, 70, 85 deep facial nerve from, 23 Pterygoid process, 6, 8 hamulus of, 12, 13, 14 lateral plate of, 4, 12, 13, 14, 38, 39, 50 medial plate of, 12, 13, 14, 38, 39, 50 of palatine bone, 13 plates of, 6 Pterygomandibular raphe, 15, 40, 52, 55, 65, 68 Pierygomaxillary fissure, 4 Pterygopalatine fossa, 4, 13, 14, 40, 44, 49 Pterygopalatine ganglion, 122, 123, 125, 131, 133, 135, 166, 168 ganglionic branches of, 45 in pterygopalatine fossa, 44 schema of, 133 Pubic arch, 248 female, 354 male, 354 Pubic bone, 348, 357, 383 Pubic crest, 259, 376 Pubic hypogastric region, 268 Pubic ligament, inferior, 248, 356, 359, 360, 364, 365, 378, 383 Pubic ramus inferior, 248, 486 superior, 248, 486, 496, 499
Pubic symphysis, 247, 259, 263 female, 354 male, 354 radiograph of, 355 sagittal MR images of, 397 superior portion of, 376 Pubic tubercle, 247, 250, 263, 486, 492, 493 Pubic vein, 265 Pubis anteroposterior radiograph of, 488 body of, 376 radiograph of, 355 superior ramus of. 488, 493 symphyseal surface of, 412 Pubocervical fascia, 372 Pubococcygeus muscle, 357, 358, 359, 360 Pubofemoral ligament, 487 Puboprostatic ligament, lateral, 366 Puborectalis muscle, 356, 357, 358, 359, 376, 398 left, 356 Pubovesical ligament lateral, 364, 365 medial, 364, 365 Pudendal artery deep external, 512 internal, 341, 376, 499 superficial external, 512 Pudendal canal (Alcock's), 392, 411 internal pudendal artery in, 402, 404 internal pudendal vein in, 399 pudendal nerve in, 413 Pudendal canal, left internal pudendal vein in, 311 Pudendal cleft, 377 Pudendal nerve, 160, 267, 410, 411, 412, 415, 416, 417, 499, 500, 503 block of, 413 internal, 392 Pudendal vein external, 256, 265 internal, 376 left internal, 311 right internal, 311 superficial external, 544 Pudendal vessels deep external, 401 internal, 392 superficial, 500 superficial external, 401 Pudendal vessels, superficial, 249 Pudendum, 377 Pulmonary artery, 213 axial CT images of, 242 left, 206, 213, 214, 231, 245 prenatal, 229 radiograph of, 213 right, 205, 206, 210, 214, 220, 230, 245 prenatal, 229 Pulmonary ligament, 199, 208, 230, 231 Pulmonary Bymph nodes, 208 Pulmonary plexus, 126, 165, 166, 168, 210 anterior, 209 posterior, 209
Pulmonary trunk, 206, 212, 215, 220, 224, 225 bifurcation of, 215 outflow to, 224 prenatal, 229 Pulmonary valve, 213, 220, 222, 225 semilunar cusps of, 220, 222 Pulmonary vein left, 205, 206, 215, 221, 224, 231 inferior, 214, 241 prenatal, 229 superior, 214 right, 206, 215, 225, 230 inferior, 214, 220, 246 prenatal, 229 superior, 212, 214, 220, 224 Pulvinar, 110, 111, 143, 144, 145 left, 144 right, 144 of thalamus, 114 Pupil, 81 dilator muscle of, 88, 121, 132 muscles of, 132 sphincter muscle of, 88, 121, 132 Pupillae muscle dilator, 121 sphincter, 121 Purkinje fibers, 225 subendocardial branches of, 225 Putamen, 108 Pyloric antrum, 275 barium radiograph of, 279 Pyloric canal, 297 cross section of, 297 Pyloric gland, 276 Pyloric lymph nodes, 315 Pyloric orifice, 276, 279 Pylorus, 275, 276, 278, 297 barium radiograph of, 279 cross section of, 297 Pyramid, 114, 144 decussation of, 114 inferior vermis, 113 of vermis of cerebellum, 115 Pyramidalis muscle, 250, 260 Pyramidal process, 8, 12, 14 Q Quadrangular lobule, 113 Quadrangular space, posterior circumflex humeral artery in, 427 Quadratus femoris muscle, 492, 493, 495, 503, 511, 538 attachments of, 489, 491, 515 nerve to, 499, 503 Quadratus lumborum muscle, 176, 179, 263, 267, 329, 342, 496, 498 area for, 330 fascia of, 179 Quadratus plantae muscle, 534, 535, 541 Quadratus plantae nerve, 541 Quadriceps femoris muscle, 538 attachment of, 490 patellar ligament of, 515 Quadriceps femoris tendon, 485, 492, 501, 506, 511, 520, 521 Quadriceps tendon, 493
Quadrigeminal cistern, 109 Quadrigeminal plate, 115
R Radial artery, 433, 445, 446, 447, 448, 449, 454, 460, 461, 465, 474 in anatomical snuffbox, 469, 470 computed tomography of, 484 palmar carpal branch of, 448, 465 superficial palmar branch of, 454, 460, 465 Radial bursa, 460, 462 Radial collateral artery, 434 Radial collateral ligament, 454, 455 Radial nerve, 429, 430, 432, 435, 447, 448, 474, 475, 477 in arm, 477 branch of, 469 communicating branch of, 468 deep branch of, 445, 447, 449, 474 dorsal digital branch of, 473, 481 inferior lateral, 481 posterior cutaneous, 469, 473, 481 superficial branch of, 444, 447, 449, 468, 469, 473, 474, 480, 481 dorsal digital branch of, 469 Radial recurrent artery, 433, 434, 447 Radial styloid process, 452 Radiate artery, perforating, 335 Radiate capitate ligament, 454 Radiate ligament, 187 Radiate sternocostal ligament, 186 Radicular artery anterior, 172 posterior, 172, 173 Radicular vein, 173 Radiocarpal joint, 453, 455 Radiocarpal ligament dorsal, 455 palmar, 454 radiocapitate part of, 454 radioscapholunate part of, 454 Radiograph of ankle, 526 barium of ileum, 279 of jejunum, 279 of long vermiform appendix, 283 of stomach, duodenum, and proximal jejunum, 279 of cervical vertebrae, 18 of chest, 213 of elbow, 437 of female pelvis, 355 of hand, 457 of hip joint, 488 of knee, 510 lateral, of skull, 5 of lumbar vertebrae anteroposterior, 156 lateral, 156 of male and female pelvis, 355 of male pelvis, 355 pelvic female, 355 male, 355 of shoulder, 422 of wrist and hand, 457
Radiolunate ligament long, 454 palmar, 454 short, 454 Radioscaphocapitate ligament, 454 Radioulnar joint, distal, 455 Radioulnar ligament dorsal, 455 palmar, 454 Radius, 436, 438, 439, 440, 442, 443, 465 annular ligament of, 438 anterior branch of, 439 anterior (palmar) view of, 452 anterior surface of, 439 coronal section of, 439, 455 cross section of, 470 dorsal tubercle of, 452 head of, 439 right, 439 interosseous border of, 439 neck of, 437, 439 posterior cutaneous and inferior lateral cutaneous nerves of arm from, 479 posterior (dorsal) view of, 452 radiograph of, 437 rotators of, 440 tuberosity of, 437, 439 ulnar notch of, 439 Rami communicantes gray, 130, 132, 133, 134, 165, 167, 169, 170, 180, 196, 209, 230, 240, 258, 267, 318, 324, 325, 327, 344, 412, 498, 499 white, 130, 132, 133, 134, 165, 167, 169, 180, 196, 209, 230, 240, 258, 267, 318, 321, 324, 325, 345, 398, 412, 499 Rathke's pouch, vestigial remnant of, 50 Rectal artery inferior, 307, 398, 402, 403, 404, 405 middle, 264, 307, 323, 341, 364, 398, 400, 402, 403 superior, 264, 307, 318, 323, 324, 340, 364, 398, 400, 410 bifurcation of, 307 branch of, 307 Rectal lymph nodes, 317 middle, 317 superior, 31 / Rectal nerve inferior, 411, 503 superior, 503 Rectal plexus, 323, 344, 412 communication between internal and perimuscular, 399 middle, 323 superior, 318, 323 Rectal vein inferior, 312 left, tributaries of, 311 left middle, 311 left superior, 312 middle, 312 right, tributaries of, 311 right inferior, 311 right middle, 311 right superior, 312 superior, 311 bifurcation of, 399
Rectal venous plexus communication between internal and external, 399 external, 311, 393, 394, 399 internal, 393, 394, 399 perimuscular, 399 Rectal vessels, superior, 274 Rectineal ligament, 259 Rectocervical space, 369 Rectococcygeus muscle, 263 Rectoperinealis muscle, 262 Rectoprostatic (Denonvilliers') fascia, 348, 359, 361, 386, 391, 396 Rectosigmoid artery, 307, 323, 398 Rectosigmoid junction, 284, 391, 393, 394 Rectosigmoid plexus, 323 Rectosigmoid vein, 311, 312, 399 Rectourethralis superior muscle, 359 Rectouterine fold, 369 Rectouterine ligament, 369 Rectouterine pouch (of Douglas), 360, 362, 369, 371 f 391 Rectovaginal space, 364, 369 Rectovesical pouch, 348, 361, 391 Rectovesical space prerectal, 396 retroprostatic, 396 retrovesical, 396 Rectum, 263, 271, 284, 329, 356, 357, 361, 363, 364, 365, 378, 384, 391, 393, 400, 412 anal canal and, 393 arteries of, 398 circular muscle layer of, 393, 394 in situ, 391 female, 328, 396 male, 328, 396 innervation of, 168 ischioanal fossae of, 392 longitudinal muscle layer of, 393, 394 lymphatic pathway along, 408 marginal artery of, 398 muscularis mucosae of, 394 sagittal MR images of, 397 termination of, 376 transverse folds of, 393 veins of, 399 Rectus abdominis muscle, 189, 331 sagittal MR images of, 397 Rectus capitis anterior muscle, 73 Rectus capitis muscle. See Capitis muscle, rectus Rectus capitis posterior major muscle, 175, 176, 178 Rectus capitis posterior minor, 175, 176, 178 Rectus femoralis tendon, 492 origin of, 492 Rectus femoris tendon, 485 Rectus muscle inferior, 83, 84, 121, 151 lateral, 83, 84, 86, 121, 151 axial MR image of, 150 tendon of, 87 medial, axial MR image of, 150 superior, 83, 84, 86, 91, 121 tendon of, 91
Rectus sheath, 83, 189, 249, 250, 349 anterior layer of, 188, 250, 252, 259, 424 cross section of, 252 posterior layer of, 251, 252, 257, 259 Red nucleus, 107, 116, 117 Reil, island of- See Insula Renal artery, 335, 341, 345 anterior branch of, 335 in situ, 332 left, 323, 329, 339, 347 posterior branch of, 335 right, 318, 321, 329 ureteric branch of, 335, 336 variations in, 333 Renal column (of Bertin), 337 Renal corpuscle cortical, 336 juxtamedullary, 336 Renal cortex, 336, 337, 346 Renal ganglion, 344, 345 left, 346 right, 346 Renal fascia, 339, 342, 347 anterior layer of, 179 Gerota's, 342, 347 posterior layer of, 179, 342 sagittal section of, 342 transverse section of, 342 Renal medulla, 336, 337 preganglionic fibers and, 346 Renal papilla, 336 Renal parenchyma, 334 Renal plexus, 344, 345 left, 323, 346 right, 318, 346 Renal segment arteries of, 335 vascular, 335 Renal sinus, 337 fat in, 334 perirenal fat of, 337 Renal vein, 341 in situ, 332 left, 329, 333 double, 333 entering inferior vena cava, 339 multiple, 333 right, 265, 329, 332, 339 Reproductive organs, male, innervation of, 415 Respiratory bronchiole, 204 Rete testis, area of, 390 Reticular nucleus, 111 Retina, 91 ciliary part of, 87, 88 iridial part of, 88 non-pigmented areas of, 91 optic part of, 87, 89 pigmented areas of, 91 projection on, 120 structure of, 120 Retinacular artery, 504 subsynovial, 504 Retinal artery, 90 central, 85, 87, 90, 91 Retinal vein, 90 central, 87, 91 Retinal vessels, right, 90 Retrobulbar fat, 83 Retrocecal recess, 271, 281
Retromandibular vein, 23, 31, 59, 85 anterior, 61, 70 common trunk for, 59, 61, 70 posterior, 61, 70 Retroperitoneal artery, 331 Retropharyngeal lymph nodes, 73 Retropubic (prevesical) space (of Retzius), 48, 348, 364, 396 fat in, 251 Retropubic venous plexus, 365 Retropyloric lymph nodes, 314 Retrotonsillar fissure, 113 Retrotonsillar vein inferior, 144 superior, 144 Retzius, cave of, 348 Retzius space. See Retropubic (prevesical) space (of Retzius) Rhinal sulcus, 106, 107 Rhomboid major fossa, 114 Rhomboid major muscle, 174, 177, 180, 192, 243, 245, 424 insertion of, 421 Rhomboid minor muscle, 174, 177, 424, 477 insertion of, 421 Rhomboid muscle, 244 Ribs, 186, 244, 245 angle of, 185, 186 axial CT images of, 242, 350 body of, 185 eighth, 241, 349 eleventh, 330 false, 185 first, 94, 160, 186, 196, 197, 211, 230, 419, 429 costal cartilage of, 243 groove for, 199 synchondrosis of, 419 floating, 185 head of, 185, 186 interarticular ligament of, 187 middle, 186 neck of, 185, 186, 194 ninth, 299 second, 182, 185, 419 left, 186 seventh, head of, 246 sixth, 182 true, 185 tubercle, 185, 18G twelfth, 160, 174, 195, 342, 349 projection of, 330 Riolan, arc of, 308 Risorius muscle, 26, 123 Rod cells, 94, 120 Rods, 120 Rolando, sulcal artery of, 142 Rolando, sulcus of, 105, 106 Rosenmuller, node of, 266 Rosenthal, vein of, 144, 145, 146 Rotator cuff muscles, 425 Rotatores cervicis muscle brevis, 176 longus, 176 Round ligament, 372 of liver, 288, 312 of uterus, 389 Round window (cochlear), 92, 95 closed by secondary tympanic membrane, 96 fossa of, 93
51 spinal nerve, 160, 410 anterior ramus of, 414 52 spinal nerve, 160 Saccule, 92, 95, 96, 124 Sacral artery * lateral, 171, 264, 341, 398, 402, 403 median, 307, 341, 364, 398, 402 Sacral canal, 157, 358 Sacral cornu, 157 Sacral crest intermediate, 157 lateral, 157 median, 157, 352, 357 Sacral curvature, 153 Sacral foramen anterior, 157, 353, 358 fourth posterior, 357 posterior, 157, 353 radiograph of, 156 Sacral ganglion, 167, 318 Sacral hiatus, 157 Sacral lymph nodes lateral, 266, 408 middle, 266, 408 Sacral nerve, 161 perineal branch of, 499 vertebrae and, 161 Sacral parasympathetic outflow, 165 Sacral plexus, 160, 177, 267, 344, 345, 415, 416, 499 left, 318 right, 323 Sacral promontory, 157, 248, 412 Sacral sympathetic trunk left, 412 right, 412 Sacral vein, median, 311 Sacrogenital fold, 340 Sacroiliac joint, 358 female, 354 radiograph of, 355 Sacrospinous ligament, 159, 352, 353, 357, 359, 410, 495, 503 Sacrotuberous ligament, 357, 376, 379, 395, 402, 410, 411, 495, 502, 503 Sacrouterine ligament, 364 Sacrum (S1-5), 152, 160 ala of, radiograph of, 355 anterior view of, 153, 171 apex of, 157 arteries of, 171 articular facet for, 155 articular surface of, 157, 486 base of, 157 coronal section through, 157 dorsal surface of, 157 facets of superior articular process, 157 left lateral view of, 153 medial sagittal section of, 157 pelvic surface of, 157 posterior view of, 153 promontory of, 157, 248, 412 radiograph of, 355 sacral crest of, 157 sacral tuberosity of, 157 sagittal MR images of, 397 spinal nerves and, 161
Sacrum (S1-5) (Continued) superior articular process of, 157 transverse ridges of, 157 Sagittal sinus inferior, 103, 145, 146 superior, 99, 100, 102, 103, 106, 109, 144, 145 axial MR image of, 150 Sagittal suture, 7, 12 Sagittal vein, inferior, 144 Salivary glands, 61 frontal section of, 51, 60 horizontal section of, 51, 60 lingual minor, 51 molar minor, 52 sublingual, 51, 60 submandibular, 51. 60 Salivatory nucleus inferior, 116, 117, 125, 134 superior, 116, 117, 123, 133 Salpingopharyngeus muscle, 126 Saphenous nerve, 500, 538, 544 branches of, 538, 545 infrapatellar branch of, 500, 538 Saphenous opening, 250, 544 cribriform fascia in, 249 Saphenous vein accessory, 544, 546 great, 250, 485, 544, 545, 546 small. 485, 544, 545 Sartorius muscle, 376 Sartorius muscle, 485, 492, 495, 499, 500, 538 attachments of, 490, 491, 515 Sartorius tendon, 492, 493 Scala tympani, 92, 95, 96 Scala vestibuli, 91, 95, 96 Scalene muscle anterior, 27, 30, 32, 74, 186, 189, 193, 198, 206, 211, 230, 427, 429 slips of origin of, 30 middle, 27, 30, 32, 69, 70, 186, 189 nerves to, 129 nerves to, 129, 430 posterior, 27, 30, 186, 189, 232 slips of origin of, 30 Scalp epicranial aponeurosis of, 26 skin and subcutaneous tissue of, 26 superficial arteries and veins of, 23 Scapha, 93 Scaphocapitate ligament, 454 Scaphoid bone, 456 anterior (palmar) view of, 452 area for, 439 coronal section of, 455 posterior (dorsal) view of, 452 tubercle of, 452, 454, 456 Scaphoid fossa, 93 Scapholunate ligament, 455 Scaphotrapeziotrapezoid, 454 Scapula, 29, 180, 185, 192, 243, 244, 245 acromion of, 185 anastomoses around, 427 anterior view of, 420, 427 axillary artery and anastomoses around, 427 body of, 428 coracoid process of, 213 glenoid cavity of, 420 anteroposterior radiograph of, 422
Scapula (Continued) inferior angle of, 152, 246, 420 infraglenoid tubercle of, 420 infraspinous fossa of, 185 lateral border of, 420 anteroposterior radiograph of, 422 medial border of, 152, 420 neck of, 420 posterior view of, 421, 427 spine of, 152, 174, 177, 185, 197, 213, 424, 427, 428 anteroposterior radiograph of, 422 subscapular fossa of, 185 superior angle of, 420 superior border of, 420, 425 suprascapular notch of, 184 supraspinous fossa of, 421 Scapular artery circumflex, 427, 429, 430, 434 dorsal, 32, 137, 427, 429 Scapular ligament, superior transverse, 423, 425, 427 Scapular nerve, dorsal, 429, 477 Scapulohumeral dissection anterior view of, 426 lateral view of, 426 posterior view of, 426 Scarpa's (membranous) layer, 249, 380 fascia latae attachment to, 249 Schlemm's canal. See Scleral venous sinus (canal of Schlemm) Sciatic foramen greater, 352, 353, 357, 540 lesser, 352, 353, 357 Sciatic nerve, 160, 495, 499, 503, 539, 540 articular branch of, 502 branches of, 499, 540 common fibular division of, 499, 540 left, 376 muscles innervated by, 540 right, 376 tibial division of, 499, 540 Sciatic notch greater, 248, 486 lesser, 248, 486 Sclera, 81, 83, 87, 88, 91 bulbar conjunctiva, 81 lamina cribosa of, 87 Scleral spur, 8 / Scleral venous sinus (canal of Schlemm), 87, 88, 90, 91 veins draining, 91 Scrotal artery, posterior, 403, 406 Scrotal ligament, 389 Scrotal nerve anterior, 409 posterior, 411, 503 Scrotal nerve, posterior, 410, 411, 503 Scrotal vein, anterior, 256 Scrotum, 351, 388 cross section through, 390 skin of, 390 superficial fascia of, 249 Sebaceous gland, 81 Segmental artery anterior inferior, 335 anterior superior, 335 inferior superior, 335
Segmental artery (Continued) posterior, 335 superior, 335 Segmental medullary artery anterior, 171, 172 major anterior, 171 posterior, 171 Segmental medullary vein, 173 Sella turcica, 6, 9, 39 hypophysis in, 37 Semicircular canal anterior, 95, 96, 97 axial MR image of, 150 lateral, 95, 96, 97 plane of, 97 posterior, 95, 96, 97 prominence of, 92 Semicircular duct, 92 ampulla of, 92, 124 anterior, 95, 96 lateral, 95, 97, 124 posterior, 96T 97, 124 superior, ampulla of, 124 Semilunar fold, 284 Semilunar hiatus, 37, 38 with anterior ethmoidal cell openings, 38 at birth, 50 Semilunar line, 247 left, 268 right, 268 Semilunar lobule inferior, 113 posterior, 113 Semilunar plane, 286 Semilunar vale, nodule of, 223 Semimembranous bursa, 511 Semimembranous muscle, 494, 495, 540 attachments of, 491 tendinous expansion of, 511 Semimembranous tendon, 506, 508, 511, 518 groove for insertion of, 513 Seminal colliculus, 366, 384 Seminal vesicle, 361, 363, 384, 389, 391 Seminiferous tubule, 390 Semispinalis capitis muscle, 174, 175, 176, 178, 424 in posterior triangle of neck, 178 Semispinalis cervicis muscle, 178 Semispinalis thoracis muscle, 176 Semitendinosus muscle, 489, 495, 503, 515, 540 attachments of, 489, 491 Semitendinosus tendon, 492, 493, 506, 507 Sensory cortex, 135 Septal artery branches, 40 Septomarginal trabecula, moderate band of, 220, 224, 225 Septum, 205 Septum pellucidum, 106, 108, 110, 111, 112, 141, 143, 145, 147 anterior vein of, 145, 146 posterior veins of, 146 Serosa of ileum, 280 jejunal, 280 of spleen, 299 of vermiform appendix, 283
Serous glands of von Ebner. See Lingual glands (serous glands of von Ebner) Serratus anterior muscle, 174, 180, 181, 182, 186, 192, 243, 245, 246, 247, 249, 250, 258, 418, 420, 424 digitations of, 186, 188, 189 fascia of, 428 insertion of, 420 Serratus posterior inferior muscle, 175, 179, 254, 330 Serratus posterior muscle, 174 Serratus posterior superior muscle, 174, 175 Sesamoid bone, 456, 524, 534, 535, 536, 537 lateral, 523 medial, 523 plantar view of, 523 Shoulder anterior view of, 423, 474, 479 anteroposterior radiograph of, 422 capsule of, 432 coronal section of, 423 cutaneous nerves of, 479 glenohumeral joint, 423 lateral view of, 423 muscles of, 424 nerves of, 429-430 posterior, 477 posterior, nerves of, 477 posterior view of, 479 superficial veins of, 479 Sigmoid artery, 323, 340 Sigmoid lymph nodes, 317 Sigmoid plexus, 323 Sigmoid sinus, 11, 97, 103 groove for, 6, 9 Sigmoid vein, 311, 312 Sigmoid vessels, attachment of, 274 Sinuatrial lymph nodes, 225 SinuatriaB nodal artery, 216, 218, 225 Sinuses confluence of, 144, 145 axial MR image of, 150 frontal, 37, 38 maxillary, opening of, 37 paranasal, 47-50 sphenoidal, 37, 38 opening of, 37, 38 straight, 144 transverse, 145 transverse left, 144 Sinusoid, 290, 291, 292 Skene's glands. See Paraurethral (Skene's) glands Skin over rectus sheath, 252 perianal, 393, 394 SkuflB anterior view of, 2 anteroposterior radiograph of, 3 base of, 66, 160, 161 diploic and emissary veins of, 99 fracture of, 101 horizontal section through, 104 labyrinth orientation in, 97 lateral view of, 4 midsagittal section of, 6 of newborn, 12 skin of, 102 superior nuchal line of, 174, 175, 176
Soleal line, 513 Sole (foot) cutaneous innervation of, 541 muscle layers of, 532, 533, 535 Soleus muscle, 506, 516, 517, 520, 521, 522, 540 attachments of, 515 innervation of, 541 insertion of, 517 nerve to, 516, 517 tendinous arch of, 495, 517 Solitary tract nucleus, 116, 117, 123, 125, 126, 135, 345 Sound reception, pathway of, 92 Spermatic cord, 260, 261, 376 cremasteric fascia on, 260 cremasteric muscle of, 257 ductus deferens in, 255 external spermatic fascia of, 249, 257, 259 external spermatic fascia on, 249 external spermatic fascia over, 405 internal spermatic fascia on, 262 Sphenoethmoidal recess, 37, 38 Sphenoidal fontanelle, 12 Sphenoidal sinus, 6, 37, 38, 39, 48, 49, 63, 64, 83 axial MR image of, 150 within bony shell, 50 coronal CT images of, 151 opening of, 6, 37, 38, 49 sagittal MR image of, 149 Sphenoid bone, 9, 38 body of, 6, 9, 50 carotid groove of, 9 clivus of, 9 foramen ovale of, 9 foramen spinosum off, 8 greater wing of, 2, 3, 4, 5, 8, 9, 151 orbital surface of, 2 infratemporal crest of, 4 lesser wing of, 2, 3, 6, 9 orbital surface of, 2 pterygoid hamulus of, 6 pterygoid process of, 4, 8, 12, 38 lateral plate of, 39 medial plate of, 39 sphenoidal sinus of, 38 spine of, 14 Sphenoid emissary foramen, 11 Sphenomandibular ligament, 40, 55 Sphenooccipital synchondrosis, 63 Sphenopalatine artery, 40, 41, 69 posterior lateral nasal branch of, 40 posterior septal branch of, 40 Sphenopalatine foramen, 4, 6, 13, 14, 38, 40, 42 Sphenopalatine vessels, 11 Sphenoparietal sinus, 103, 145 Sphincter muscle external, 367 external anal, 284, 288, 388, 395 internal, 367 of pupil, 132 Sphincter of ampulla, variations in, 295 Sphincter urethrae, 396 Sphincter urethrae muscle, 356, 359, 361, 365, 366, 378, 379, 383, 384, 385, 403, 416
Sphincter urethrovaginalis muscle, 366, 370, 378, 379 Spinal artery anterior, 11, 141, 171, 172 anastomotic loops to, 171 posterior, 11, 172 anastomotic loops to, 171 * left, 143, 172 right, 172 Spinal cord, 243, 244 arteries of, 171 intrinsic distribution of, 172 ascending fibers of, 416 axial CT images of, 242 central canal of, 108, 109 descending fibers of, 416 descending tracts in, 108 in situ, 160 sacral, 324 sagittal MR image of, 149 schema of, 167, 346 thoracic, 134, 210, 327, 328 thoracic part of, 132 thoracolumbar, 324 veins of, 173 Spinal dura mater, 160 Spinal ganglion, dorsal, 170 Spinalis cervicis muscle, 175 Spinalis cervicis muscle, 175 Spinalis erector muscle, 349 Spinalis muscle, 175, 331 Spinalis thoracis muscle, 175 Spinal membranes, 169 Spinal meninges, 325 Spinal nerve, 258 anterior cutaneous branch of, 180 cervical, 127, 160 collateral branch of, 258 dorsal branch of, 258 dorsal ramus of, 169, 170 groove for, 19 intervertebral foramen for, 18 lumbar, 179 meningeal branch of, 258, 325 origin of, 170, 258 recurrent meningeal branches of, 170 recurrent meningeal branches of, 170 segmental medullary branches of, 138 to skin vessels and glands, 325 thoracic, 180, 258 ventral ramus of, 169, 258 Spinal nerve roots anterior, 321 anterior view of, 169 dorsal, 114, 169 filaments of, 160 posterior view of, 169 relation to vertebrae, 161 ventral, 114, 170, 180, 321 Spinal nerve trunk, 258 Spinal perivascular plexus, 322 Spinal sensory ganglion, 258, 321, 324, 327 anterior cutaneous fibers of, 258 ascending fibers of, 345 communicating branch of, 258 descending fibers of, 345 dorsal root of, 180, 325, 327, 328, 345 lateral cutaneous branch of, 258 ventral root of, 258
Spinal tract, 125, 126 trigeminal nerve and, 116, 117 Spinal vein anterior, 144, 173 posterior, 144, 173 Spinous process lumbar, 155 radiograph of, 156 thoracic, 154 Spiral ganglion, 96 Spiral lamina hamulus of, 95 osseous, 95, 96 Spiral ligament, 96 Spiral organ (of Corti), 92, 96 Splanchnic nerve abdominopelvic, 228, 324, 325 cardiopulmonary, 228 first lumbar, 323 fourth lumbar, 318 greater thoracic, 167, 209, 230, 240, 258, 263, 267, 320, 324, 327, 409 left, 194, 318, 321, 323, 327, 328, 346 right, 194, 240, 318, 320, 321, 327, 328, 346 least thoracic, 209, 263, 267, 320, 322, 323, 324, 325, 344, 345, 409 left, 323, 346 right, 318, 320, 346 lesser thoracic, 165, 167, 209, 258, 263, 267, 318, 320, 321, 322, 324, 325, 345, 409 left, 318, 319, 323, 346 right, 346 lumbar, 160, 165, 318, 345, 409, 412 left first, 346 right first, 346 second, 344 upper, 415 pelvic, 166, 168, 323, 344, 345, 412, 499 sacral, 165, 273, 344, 412, 499 thoracic, 346 Spleen, 196, 197, 272, 273, 288, 290, 293, 297, 331, 347, 349 anterior extremity of, 299 area for, 329 arteries of, 300, 301 axial CT images of, 350 colic impression of, 299 cross section of, 297, 299, 338 diaphragmatic surface of, 299 fibrous capsule of, 299 gastric impression of, 299 hilum of, 299 in situ, 299, 347 posterior extremity of, 299 pulp of, 299 renal impression of, 299 serosa of, 299 superior border of, 299 veins of, 309 visceral surface of, 299 Splenic artery, 237, 278, 297, 298, 299, 300, 301, 305, 306, 318, 319, 320, 321, 327, 328 arteriogram of, 303 left, 264 origin of, 302 pancreas and, 274 splenic branches of, 300
Splenic capitis muscle, 174, 175, 178, 424 Splenic cervicis muscle, 175, 178 Splenic flexure, 269, 271. See also Colic flexure, left Splenic lymph nodes, 314, 315 Splenic plexus, 318, 319, 320 Splenic pulp, 299 Splenic trabeculae, 299 Splenic vein, 273, 297, 299, 303, 306, 311, 312, 313, 315 cross section of, 338 Splenic vessels, 274, 348, 349 Splenium, of corpus callosum, 143, 145 Splenius capitis muscle, 174, 178, 424 in posterior triangle of neck, 178 Splenius cervicis muscle, 178 Splenius muscle, 27 Splenorenal ligament, 272, 299, 329 with splenic vessels, 331 Squamous suture, 12 S1 spinal nerve, 160 S5 spinal nerve, 160 Stapes, 92, 93 anterior limb of, 93 base of, 92, 93 footplate of, 93 head of, 93 limbs of, 92 in oval window, 96 posterior limb of, 93 Stapius muscle nerve to, 123 tendon of, 93 Stellate ganglion. See Cervicothoracic ganglion Stellate veins, 334 Sternal angle, 245 Sternalis muscle, inconstant, 188 Sternoclavicular joint, 196 articular cavities of, 419 articular disc of, 419 transverse section of, 243 Sternoclavicular ligament, anterior, 419 Sternocleidomastoid artery branch, 34 Sternocleidomastoid lymph node, 72 Sternocleidomastoid muscle, 27, 31, 32, 34, 73, 74, 127, 129, 174, 178, 188, 198, 247, 419, 424, 429 accessory nerve to, 127 clavicular head of, 27, 28, 181, 247 medial margin of, 74 origin of, 419 sternal head of, 27, 28, 181, 247 Sternocostal articulations, 186 Sternocostal joint, 419 Sternocostal ligament, 186 intraarticular, 186 radiate, 186, 419 Sternocostal triangle, 195 Sternohyoid muscle, 27, 28, 29, 31, 32, 53, 128, 129, 189, 198 invested by cervical fascia, 188 nerve to, 71 origin of, 419
Sternothyroid muscle, 27, 28, 29, 31, 32, 128, 129, 198 nerve to, 71 Sternum, 26, 29, 180, 194, 233, 246, 424 angle of, 185 axial CT images of, 242 body of, 181, 185, 247, 248 head of, 181 jugular notch of, 185 manubrium of, 27, 28, 185 xiphoid process of, 181, 184, 185, 247 Stomach, 167, 215, 237, 269, 273, 276, 294, 297, 298, 331 angular notch of, 275 area for, 329 arteries of, 300 atonic, 275 axial CT images of, 350 body of, 275, 279 cardiac parts of, 233, 236, 277 cardiac zone of, 276 chief cells of, 276 circular muscle layer of, 236 cross section of, 297 fundus of, 233, 236, 275, 293 barium radiograph of, 279 vagal branch to, 240 gastric zone of, 276 greater curvature of, 275 hypertonic, 275 hypotonic, 275 in situ, 275 innervation of, 321 lesser curvature of, 275 posterior vagal branch to, 240 longitudinal muscle layer of, 236, 277 lymph follicle of, 276 lymph vessels and nodes of, 314 mucosa of, 276 mucous cells of, 276 muscularis mucosae of, 276 musculature of, 236, 277 nerves of, 319, 320 oblique muscle layer of, 236 orthotonic, 275 posterior surface of, 272 reflected, 272 submucosa of, 276 surface epithelial cells of, 276 variations in position and contour of, 275 veins of, 309 zigzag line of, 236 Straight artery, 307 branch of, 326 of ileum, 280 of jejunum, 280 Straight gyrus, 107 Straight sinus, 144, 146 in tentorium cerebelli, 103 Strap muscle, 118 Stratified squamous epithelium, tongue,58 Stretch receptors, 210 Stretch reflex pathway, 325 Stria medullaris, 106 Striate artery, distal medial, 140, 141, 142 Stria terminalis, 108, 111, 112 Striatum, 110 Styloglossus muscle, 27, 32, 59, 60, 128
Stylohyoid ligament, 13, 59, 64, 65, 68 Stylohyoid muscle, 27, 28, 29, 34, 40, 59, 60, 61, 67, 68, 123 nerve to, 25 Styloid process, 14, 27, 29, 30, 34, 53, 59 radial, 439 ulnar, 439 Stylomandibular ligament, 15 Stylomastoid foramen, 25, 123, 125 Stylopharyngeus muscle, 59, 65, 68, 125, 126, 235 Subacromial bursa, 423 Subaponeurotic space, 468 Subarachnoid space, 87, 99, 102, 109 in lumbar puncture, 162 thoracic, 170 Subcallosal area, 106, 119 Subcallosal gyrus, 106 Subclavian artery, 30, 32, 74, 76, 130, 171, 183, 189, 198, 206, 211, 237, 427 anomalous, 80 grooves for, 186 left, 75, 80, 137, 193, 243 right, 75, 126, 137, 193, 230 anterior dissection of, 33 oblique schematic view of, 33 Subclavian lymphatic trunk, 208 Subclavian lymph node, 184 Subclavian trunk left, 266 right, 266 Subclavian vein, 30, 32, 74, 189, 198, 206, 211 grooves for, 186 left, 75, 137, 186 right, 75, 137, 230 Subclavius muscle, 186, 189, 230, 419, 428, 429 fascia investing, 428 fascia of, 428 insertion of, 419invested by clavicopectoral fascia, 188 nerve to, 430 Subcostal artery, 264 lower anastomoses with, 255 Subcostal muscle, 258 Subcostal nerve, 160, 267, 409, 498 lateral cutaneous branch of, 267 lateral femoral cutaneous branch of, 544 right, 329 Subcostal plane, 268 Subcostal vein, 498 Subcutaneous bursa, 511 Subcutaneous olecranon bursa, 438 Subcutaneous space, dorsal hand, 462 Subcutaneous tissue of abdomen, 249, 252 Camper's and Scarpa's layers of, 249 deep membranous, 380, 381 fatty layer of, 348, 361, 378 superficial, 380 of mammary gland, 182 membranous, 348, 361, 378 of rectus sheath, 252. Subdeltoid bursa, 423 Subdural hematoma, site of, 101 Subendocardial branch, 225 Subependymal vein, 146
Subhiatai fat ring, 236 Sublingual artery, 59, 61 Sublingual caruncle, 51 with openings of submandibular ducts, 51 Sublingual duct, 51 openings of, 61 Sublingual fold, 51 with openings of sublingual ducts, 51 Sublingual fossa, 15 Sublingual gland, 51, 53, 61, 123, 133, 167 mucous, 61 Sublingual nerve, 46 Sublobular vein, 290, 291 Submandibular duct, 51, 53, 59, 60 Submandibular fossa, 15 Submandibular ganglion, 59, 122, 123, 131, 133, 166, 168 schema for, 133 Submandibular giand, 27, 28, 31, 32, 53, 123, 133, 166, 167 mucous, 61 serous, 61 Submandibular lymph nodes, 73 Submental artery, 40 Submental vein, 70 Submucosa of intestine, 326 of stomach, 277 of vermiform appendix, 283 Submucosal gland, 326 Submucosal plexus, 326 Submucous (Meissner's) plexus, 326 Submucous space, 392 internal rectal venous plexus in, 393 perianal, 396 Suboccipital nerve, 21, 178 Suboccipital triangle, 178 Subparotid node, 72 Subpleural capillary, 205 Subpleural lymphatic plexus, 208 Subpopliteal recess, 507, 508 Subpubic angle, radiograph of, 355 Subpyloric lymph nodes, 314 Subscapular artery, 427, 434 computed tomography of, 484 Subscapular fossa, 185 Subscapularis muscle? 180, 192, 243, 244, 245, 425, 428, 433 insertion of, 420 origin of, 420 subtendinous bursa of, 423 Subscapularis tendinous muscle openings of, 423 position of, 423 Subscapularis tendon, 423, 425 Subscapular nerve lower, 429, 430, 477 upper, 429, 430 Subserous fascia, 412 Subserous plexus, 326 Substantia nigra, 107 Subtendinous bursa, 511 Subtrapezial plexus, 177 Subungual space, 471 Sulcal artery, 141 central, 141, 142 postcentral, 142 precentrai, 141 prefrontal, 142
Sulcal vein anterior, 173 posterior, 173 Sulcus dorsal median, mesothelial septum in, 169 hippocarnpal, 112 hypothalamic, 147 intraparietal, 105 occipital transverse, 105 occipitotemporal, 107 olfactory, 107 Sulcus limitans, 115 Sulcus terminalis, 214 Superciliary arch, 1 Superficialis flexor tendon, in common tendon sheath, 460 Superficial perineal (Colles9) fascia, 358, 361, 366, 370, 378, 380, 411 attachment of, 380 Supinator artery, 447 Supinator muscle, 420, 440 insertion of, 420 origin of, 420 Supraclavicular nerve, 24, 31 intermediate, 129, 479 lateral, 129, 479 medial, 129, 479 Supracondylar ridge, 436 Supraduodenal artery, 300, 301, 306 Supraglenoid tubercle, 420 Suprahyoid artery, 59 Suprahyoid muscle, action of, 29 Supramarginal gyrus, 105 Supraoptic nucleus, 147 Supraopticohypophyseal tract, 147 Supraoptic recess, 106, 108 Supraorbital artery, 23, 36, 40, 81, 85 Supraorbital nerve, 24, 36, 81, 122 branches of, 86 medial and lateral branches of, 86 Supraorbital notch, 1 foramen, 2 Supraorbital vein, 23, 70, 85 Suprapatellar synovial bursa, 511 Suprapineal recess, 108 Suprapleural membrane, 230 cervical, 231 Suprapyloric lymph nodes, 314 Suprarenal gland, 197, 278, 298, 299, 329, 340, 342 arteries and veins of, 332, 333 cross section of, 347 dissection of, 346 in situ, 332 left, 197, 272, 297, 329, 331, 338, 346 nerves of, 344, 346 dissection of, 346 right, 197, 297, 329, 346 schema of, 346 dissection of, 346 Suprarenal impression, 287 Suprarenal-phrenic vein anastomosis, 265 Suprarenal plexus left, 323 right, 318 Suprarenal vein, 333, 347 inferior, 347 middle, 347 right, 332, 338
Suprascapular artery, 32, 74, 75, 76, 427, 429 infraspinous branch of, 427 Suprascapular nerve, 429 Suprascapular notch, 184, 185, 420, 421, 423, 427 Suprascapular vein, 70 Supraspinatus ligament, 179 Supraspinatus muscle, 177, 423, 427 428, 428 insertion of, 420 origin of, 420 Supraspinatus tendon, 423, 425 Suprasternal space, 28 Supratrochlear artery, 23, 40, 81, 85 Supratrochlear crest, 220, 224 Supratrochlear nerve, 81, 122 Supratrochlear vein, 23, 24, 85 Sural cutaneous nerve articular branches of, 541, 542 communicating branch of, 540 lateral, 540, 541, 542, 545 branches of, 544 communicating branch of, 545 medial, 540, 541, 545 Sural nerve, 534, 540, 541, 545 lateral calcaneal branch of, 541 medial calcaneal branch of, 541 via lateral calcaneal and lateral dorsal cutaneous branches, 541 Sustentaculum tali, 523, 524 Sweat gland, 9, 167 Sylvius, sulcus of, 141 Sympathetic ganglion, 409 lumbar, 170 superior cervical, 130, 132 superior ganglion, 125, 128, 131, 133, 134,210, 226 thoracic, 209 thoracic, third, 240 Sympathetic nervous system general topography of, 165 schema of, 167 Sympathetic trunk, 125, 133, 192, 210, 230, 258, 263, 267, 290, 324, 325, 327, 344, 409, 412, 499 cervical, 165 ganglia of, 321, 325, 344, 345 ganglion of, first thoracic, 132 left, 194, 318, 324, 346 left lumbar, 323 right, 194, 318, 328, 331, 346 sacral, 323 left, 412 right, 412 thoracic, 240 thoracic ganglia of, 321 Synovial cavities, 22, 187 Synovial membrane, 423, 471 attachment of to femur, 511 of hip joint, 487
T T1 spinal nerve, 132, 133, 134, 160 T2 spinal nerve, 133, 133 T7 spinal nerve, 414 lateral cutaneous branch of, 254 medial cutaneous branch of, 254
T10 spinal nerve, 410 T11 spinal nerve, 414 T12 spinal nerve, 160 ventral ramus of, 254 T10 ventral ramus, 345, 410 T1 vertebra, 13, 153, 160 spinous process of, 197 T4 vertebra, 230 T6 vertebra lateral view of, 154 superior view of, 154 T8 vertebra, 241 T10 vertebra, 241 T12 vertebra, 153, 160 body of, 349 lateral view of, 154 spinous process of, 152, 174, 175, 177 Taenia free, 271, 281, 282 mesocolic, 281, 282, 284 omental, 281, 284 Talofibular Bigament anterior, 514 posterior, 514 Talus dorsal view of, 523 head of, 523, 524 lateral tubercle of, 523 medial tubercle of, 523 neck of, 523, 524 plantar view of, 523 posterior process of, 523 groove for tendon of flexor hallucis longus, 523 lateral tubercle, 523 medial tubercle, 523 trochlea of, 523, 524 Tarsal artery lateral, 530, 536 medial, 530, 536 Tarsal gland, 81 openings of, 81 Tarsal joint, transverse, 523 Tarsal sinus, 523, 524 Tarsometatarsal joint, 523 Tarsometatarsal ligament, dorsal, 536 Tarsus of eyelid, 81 inferior, 81 superior, 81 Taste buds, 58 section of, 58 Taste pathways, 135 Tectal plate, 106 Tectorial membrane, 22, 96 deeper part of, 22 Tectospinal tract, 132 Teeth apical foramina of, 57 canine, 57 cement of, 57 crown of, 57 deciduous, 56 dentinal tubules of, 57 dentine of, 57 enamel of, 57 incisors, 56, 57, 233 interglobular spaces between, 57 interproximal spaces between, 57 labiobuccal view of, 57
Teeth (Continued) molar first, 56 growth of, 50 second, 56 third, 56 molars, 56, 57 neck of, 57 nerves to, 57 odontoblast layer of, 57 papilla of, 57 permanent, 56, 57 left lower, 57 left upper, 57 lower, 56 upper, 56 premolars, 56, 57 root canals of, 57 roots of, 57 Tegmen tympani, 92, 93 Tela choroideae, 108, 111, 145 Temporal artery deep, 99 anterior, 40 posterior, 40 posterior, 40 middle, 23, 99 parietal branch of, 23 polar, 142 superficial, 23, 34, 40, 99, 100, 134 frontal branch of, 23, 85 Temporal bone, 9 petrous part of, 9, 97 squamous part of, 997 Temporal fossa, hematoma of, 101 Temporal gyrus inferior, 105, 107 middle, 105 superior, 105 Temporalis muscle, 54 axial MR image of, 150 insertion of, 15, 54 nerves to, 122 Temporal lobe, 105, 107, 141 axial MR image of, 150 hematoma of, 101 herniation of, 101 Temporal nerve branches of, 122 deep, 122 anterior, 40 posterior, 40 schema of, 122 Temporal sulcus inferior, 107 Temporal vein deep, 99 middle, 23, 99 superficial, 99 branches of, 23, 99 frontal and parietal branches of, 99 tributary of, 102 Temporomandibular joint articular disc of, 54, 55 lateral ligament of, 40 Tendinous intersection, 83 : 84, 86, 121, 181, 247 Tenon's capsule. See Fascial sheath of eyeball (Tenon's capsule)
Tensor fasciae latae muscle, 36, 485, 492, 494, 503 attachments of, 491 origin of, 492 Tensor tympani muscle, 93 tendon of, 93 Tensor tympani nerve, 122 Tensor veli papatini muscle, 52, 93, 122 tendon of, 52 Tensor veli papatini nerve, 55 Tentorium cerebelli, 86, 101, 103, 144, 145 sagittal MR image of, 149 straight sinus in, 106 Teres major muscle, 152, 174, 177, 180, 244, 245, 424, 427, 428, 433 insertion of, 420 lower margin of, 434 Teres minor muscle, 174, 177, 243, 244, 245, 423, 424, 425, 427, 428 Terminal sulcus, 58 Testicular artery, 387, 403, 409, 416 left, 329, 332 right, 332 Testicular plexus, 409, 416 right, 318 Testicular vein, 311, 329, 332 right, 311, 322 Testicular vessels, 340, 363 left, 332 lymphatic pathways along, 408 in spermatic cord, 401 Testis, 361, 386, 389, 390, 416 appendix of, 387, 389 arteries and veins of, 401 cross section of, 390 cross section through, 390 descent of, 386 external spermatic fascia over, 405 lobules of, 390 lymphatic pathways from, 408 pathways from, 408 sagittal MR images of, 397 schema of, 390 septa of, 390 tunica albuginea of, 390 visceral layer over, 387 Thalamic vein, superior, 146 Thalamogeniculate artery, 143 Thalamoperforating artery, 140, 143 Thalamostriate vein inferior, 144, 146 posterior part of, 146 superior, 108, 111, 145, 146 Thalamotuberal artery, 140 Thalamus, 106, 108, 110, 112, 114, 145, 147, 324 left, 144 geniculate bodies of, 143 nuclei of, 111 pulvinars of, 107, 111, 143, 145 sagittal MR image of, 149 schema of, 111 stria medullaris of, 106 stria terminalis of, 111 ventral posteromedial nucleus of, 135 Thecal sac, sagittal MR images of, 397 Thenar eminence, 418
Thenar muscle, 446, 460 innervation of, 460 supplied by median nerve, 476 Thenar space,462 dorsal extension of, 460 Thigh anterior cutaneous nerve of, 545 arteries of, 500, 501, 512 bony attachments of anterior view of, 490 posterior view of, 491 cutaneous innervation of, 538, 540 lateral cutaneous nerve of, 538 muscles of anterior views of, 491, 493 lateral views of, 494 posterior views of, 495 nerves of, 500, 501, 538, 540 anterior view of, 501 posterior view of, 502 serial cross sections of, 505 Thoracentesis, 190 Thoracic aortic plexus, 209 Thoracic artery anterior intercostal branches of, 189 internal, 189, 198, 206, 211, 237, 244, 245, 246, 305 perforating arteries of, 188 lateral, 183, 188, 189, 427, 434 left, 193, 194 perforating branches of, 183 right, 193, 230 superior, 189, 427, 429, 434 Thoracic cardiac nerve, 193, 209 Thoracic constriction, 233 Thoracic duct, 189, 194, 198, 206, 209, 211, 244, 245, 246, 263, 266, 293, 318 Thoracic ganglion, 167 Thoracic muscle, transversus, 194 Thoracic nerve, 161 dorsal ramus of, 192 long, 188, 189, 192 Thoracic spinal nerve, 133 dorsal root of, 133 ventral root of, 133 Thoracic sympathetic nerves, 130 Thoracic vein internal, 189, 198, 244, 245, 246 left, 194 right, 194 Thoracic vertebrae, 21 anterior view of, 171 arteries of, 171 cross section through, 170 Thoracic visceral nerves, 165 Thoracic wall anterior, 188-189 Thoracis muscle, transversus, 189 Thoracoabdominal nerve, cutaneous branch of, 188 Thoracoacromial artery, 424, 427, 428 acromial branch of, 424, 427, 429 clavicular branch of, 424, 427, 429 deltoid branch of, 424, 427, 429 pectoral branch of, 424, 427, 429 Thoracodorsal artery, 427, 434 Thoracoepigastric vein, 249
Thorax autonomic nerves in, 209 bony framework of, 185 cross sections of, 246 at T3-4 disc level, 244 at T4-5 disc level, 245 at T7 disc level, 246 at T3 lower level, 243 surface anatomy of, 181 Thumb distal phalanx of, 457 innervation of, 460 proper palmar digital nerves of, 460 Thymus, 211, 230, 244 Thyroarytenoid muscle, 78, 79, 80 Thyrocervical trunk, 32, 74, 75, 76, 237, 427 right, 137 Thyroepiglottic ligament, 77 Thyroepiglottic muscle, 80 Thyrohyoid membrane, 29, 74, 77, 235 Thyrohyoid muscle, 27, 28, 29, 31, 32, 53, 128, 129 Thyroid artery inferior, 32, 74, 76, 427 esophageal branch of, 237 superior, 31, 32, 34, 74, 75, 76 superior laryngeal branch of, 34 Thyroid gland, 29, 31, 196, 198, 206 anterior view of, 74 articular surface of, 78, 80 fibrous capsule of, 76 isthmus of, 74 posterior view of, 75 pyramidal lobe of, 74 right lobe of, 74, 75, 76 Thyroid notch, superior, 77 Thyroid vein inferior, 74, 75, 198 middle, 74 superior, 31, 74 Tibia, 511, 530 anterior border of, 485, 513, 514 anterior view of, 513 with posterior ligament attachments, 513 cross section of, 514 inferior articular surface of, 513, 514 interosseous border of, 513, 514 lateral condyle of, 494, 510, 513 lateral surface of, 513, 514 medial border of, 513, 514 medial condyle of, 513, 514 medial surface of, 513, 514 oblique line of, 513 posterior surface ofr 514 posterior view of, 513 radiograph of, 510 superior articular surface of, 514 superior view of, 514 tuberosity of, 492, 493, 511, 513, 514 Tibial artery anterior, 512, 530 posterior, 512, 534 medial calcaneal branch of, 533, 535 posterior medial malleolar branch of, 534 Tibial collateral ligament, 511
Tibialis anterior tendon, 485, 494, 536, 542 attachment of, 515 tendinous sheath of, 530 tendon of, 530 Tibialis posterior muscle, 534, 541 attachment of, 515 tendon of, 535, 536 Tibial nerve, 495, 540, 541 articular branches of, 540 lateral plantar, 541 medial calcaneal branch of, 533, 535, 540, 541, 545 medial plantar, 541 muscles innervated by, 541 posterior, 534 Tibiofibular ligament anterior, 514 posterior, 514 Toe fifth distal, middle, and proximal phalanxes of, 537 vein of, 544 great distal phalanx of, 537 medial side of, 544 proximal phalanx of, 537 Tongue, 37, 39, 59, 125 apex of, 58 body of, 58 crypt of, 58 dorsum of, 58 frenulum of, 51 frontal section of, 60 horizontal section of, 60 inferior longitudinal muscle of, 128 intrinsic muscles of, 128 lateral view of, 59 lymphatic drainage of, 73 lymph vessels and nodes of, 73 muscles of, 59, 60 vertical and transverse., 60 posterior, 125 root of, 58, 235 sagittal MR image of, 149 salivary glands and, 60 schematic stereogram of, 58 superior longitudinal muscle of, 128 taste anterior of, 125 Tonsil, palatine, 58 Tonsillar artery, 40 Torus tubarius, 37, 39 Trabecula, 148 artery of ; 148 Trabeculae carneae, 220 Trachea, 29, 74, 75, 77, 126, 168, 196, 198, 202, 211,213, 230, 234, 237, 243, 244 arteries of, 202 bifurcation of axial CT images of, 242 cartilage of, 28, 202 cross section through, 202 elastic fibers of, 202 epithelium of, 202 mucosa of posterior wall of, 202 nerve of, 202 Trachealis muscle, 202 Tracheobronchial lymph nodes, 244 inferior, 245
Tracheobronchial nodes, 266 Tracheobronchial tree, innervation of, 210 Transpyloric plane, 268 Transverse process, lumbar, 19, 179 Transverse process, lumbar, 155 Transverse sinus, 97, 103 groove for, 9 left, 144 Transversospinalis muscle, 243 Transversus abdominis muscle, 180, 192, 261 Transversus thoracis muscle, 180, 192 Trapeziocapitate ligament, 454, 455 Trapeziotrapezoid ligament, 455 Trapezium, 456 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 tubercle of, 452, 454, 456 Trapezius muscle, 27, 29, 127, 129, 152, 174, 177, 180, 188, 189, 192, 244, 246, 247, 418, 419, 420, 428 : 429 insertion of, 420 Trapezoid bone, 456 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 Trapezoid ligament, 423 Treitz, ligament of, 270 Triangle of auscultation, 152, 246, 424 Triangle of Petit. See Lumbar triangle (of Petit) Triangular fossa, 93 Triceps brachii muscle, 152, 429, 444, 446 lateral head of, 152, 181, 245, 418, 424, 427 long head of, 152, 243, 244, 418, 420, 424, 427, 433 tendon of, 152, 438 Tricuspid valve anatomy of, 223 anterior cusp of, 222, 223, 224 orifice of, 246 posterior of, 222, 223, 224 right fibrous ring of, 222, 225 septal cusp of, 222, 223, 224 Trigeminal ganglion of, 86, 116, 117, 132, 133, 134, 135 Trigeminal impression, 9 Trigeminal nerve, 24, 97, 114, 116, 117, 122, 133, 134, 135, 144 ganglion of, 131 maxillary division of, 24 mesencephalic nucleus of, 116, 117 motor nucleus of, 116, 117, 122, 135 motor root of, 131 ophthalmic division of, 24 parotid branches of, 122 principle sensory nucleus of, 116, 122 schema of, 122 sensory nucleus of, 117 sensory root of, 118, 131 spinal nucleus of, 116. 117, 122, 125, 126 spinal tract of, 117, 126 superficial branches of, 122
Trigeminal nucleus, 122 Trigone collateral, 111 habenular, 111 left fibrous, 222 right fibrous, 222 of urinary bladder, 361, 365, 366, 385 Triquetrocapitate ligament, 454 Triquetrohamate ligament, 454, 455 Triquetrum bone, 456 anterior (palmar) view of, 452 posterior (dorsal) view of, 452 Trochanter greater, 248, 376, 485, 487, 489, 492, 495, 496, 503 anteroposterior radiograph of, 488 radiograph of, 355 lesser radiograph of, 355 Trochlea, 420 Trochlear nerve (IV), 83, 84, 86, 114, 116, 121 schema of, 186 Trochlear nucleus, 117 Tuber cinereum, 106, 107, 114 median eminence of, 147 Tuberculum sellae, 9 Tuberohypophyseal tract, 147 Tufted cell, 119 Tunica albuginea, 390 Tunica vaginalis parietal layer of, 390 visceral layer of, 390 Turbinates, 37 Tympanic artery, anterior, 40 Tympanic canaliculus, 10 Tympanic cavity, 92, 93, 96, 124, 125 Tympanic membrane, 92, 93, 96 right, 93 Tympanic nerve, 93, 123, 125, 134 Tympanic plexus, 93, 123, 125, 132, 134 tubal branch of, 125
y Ulna, 436, 438, 439, 440, 441, 442, 443, 454, 465 anterior border of, 436 anterior (palmar) view of, 452 anterior surface of, 436 coronal section of, 455 coronoid process of, 437 dorsal tubercle of, 436 interosseous border of, 436 • lateral surface of, 429, 436 olecranon of, 418, 444 posterior border of, 436, 439 posterior (dorsal) view of, 452 posterior surface of, 436, 439 radial notch of, 436 radiograph of, 437 tuberosity of, 436, 439 Ulnar artery, 433, 434, 446, 447, 454, 460, 465 anterior recurrent, 447 computed tomography of, 484 deep palmar branch of, 447, 454, 460, 465 dorsal carpal branch of, 469 palmar carpal branch of, 465 with venae comitantes and ulnar nerve, 460
Ulnar bursa, 460 Ulnar collateral artery inferior, 433, 434 superior, 433, 434, 444 Ulnar nerve, 429, 433, 444, 446, 447, 454, 460, 465, 476 anterior view of, 476 articular branch of, 476 communicating branch of, 468 communicating branch with median nerve, 476 communicating with median nerve, 476 in cutaneous innervation, 476 to cutaneous innervation, 476 deep branch, 476 deep branch of, 447, 454, 465, 476 dorsal branches of to dorsum of middle and distal phalanges, 476 dorsal branch of, 444, 446, 468, 469, 476 dorsal digital branches of, 469 groove for, 436 inconstant contribution of, 476 muscles innervated by, 476 palmar branch of, 447, 476 palmar view of, 476 posterior (dorsal) view of, 476 posterior view of, 476 proper palmar digital branches of, 469 superficial branch of, 447, 460, 476 Ulnar recurrent artery anterior, 434 posterior, 434, 444 Ulnar styloid process, 452 Ulnocapitate ligament, 454 Ulnolunate ligament, 454 Ulnotriquetral ligament, 40, 454 Umbilical artery, 340, 341, 396 distal, "402 obliterated, 372 occluded part of, 229, 362, 363, 364, 400, 403 patent part of, 400, 402, 403 prenatal, 229 Umbilical ligament medial, 229, 259, 341, 401, 402, 403 median, 340, 364, 365, 400, 403, 409 Umbilical region, 268 Umbilical vein obliterated, 288 Umbilicus, 247, 305, 312 Umbo, 93, 96 Umbrical muscle fourth, 476 third, 476 Uncal vein, 145 Uncinate process, 19, 37, 38, 339 Uncovertebral joints, 19 Uncus, 106, 107, 119 Upper limb anterior view of, 418, 473 arteries of, 473 computed tomography of, 484 lymph nodes of, 483 lymph vessels and nodes of, 483 lymph vessels of, 483 nerves of, 473 posterior view of, 418 surface anatomy of, 418
Ureter, 271, 334, 341, 362, 363, 364, 365, 366, 391, 400, 402, 403, 410, 412 arteries of, 341 diagonal course of, 340 female, 340 left, 340 male, 340 nerves of, 344, 345 retroperitoneal, 340 right, 318, 329, 340, 372 upper, innervation of, 345 Ureteral plexus, right, 318 Ureteric fold, 362, 363, 369 Ureteric nerve, middle, 344 Ureteric orifice, 384 left, 366 right, 366 Ureteric plexus, 410 Ureieropelvic junction, 339 Urethra, 263, 367, 372, 389 beginning of, 376 cavernous, 368, 385 bulbous portion of, 371 pendulous portion of, 371 in children, 368 female, 356, 357, 360, 361, 389 frontal section, anterior view of, 379 schematic reconstruction of, 379 male, 381, 383 floor of, 385 hiatus for, 358 roof of, 385 membranous, 368, 385, 408 lymphatic pathway from, 408' musculofascial extensions to, 357 prostatic, 366, 368, 376, 384, 385 spongy, buibous portion of, 366 Urethral artery, 384, 405 Urethral crest, 384 Urethral fold, 388 partly fused, 388 Urethral gland, 380, 385 lacunae and openings of, 379 Urethral lacuna, 385 Urethral meatus, external, 361 Urethral orifice, 388 external, 360, 377, 379, 382, 385, 388 female external, 395 Urethral raphe, 388 Urethral sphincter, internal, 366, 367, 384, 385 Urethrovaginal sphincter, 367 Urinary bladder, 167, 269, 323, 329, 340, 367, 412 apex of, 361, 365 arteries of, 341 body of, 361, 365, 366 fascia of, 361, 364 female, 366 fundus of, 361, 365, 366 innervation of, 168, 417 interior of, 376 lateral ligament of, 364 lymph vessels and nodes of, 343 male, 366 mucosa of, 340 neck of, 362, 365, 366 nerves of, 344 orientation and supports of, 365 sagittal MR images of, 397 trigone of, 361, 365, 366, 385
Urinary bladder (Continued) ureteric orifice of, 366 uvula of, 366, 385 voiding cystourethrography of, 368 Urogenital fold, 388 Urogenital groove, 388 Urogenital hiatus, 367 Urogenital sinus, 389 Urogenital triangle, 380 Urticle, 92, 95, 96, 124 Uterine artery, 340, 341, 372 cardinal ligament with, 364 vaginal branches of, 404 Uterine ostium, 371 Uterine (fallopian) tube, 360, 362, 369, 370, 389, 400, 412, 415 abdominal ostium of, 371 ampulla of, 371, 372 fimbriae of, 371, 372 folds of, 371 infundibulum of, 371, 372 isthmus of, 371 uterine part of, 371 Uterine vein, 404 superior, 399 Uterine venous plexus, 399 Uterine vessels, 360, 361, 371 ovarian branches of, 372 Uterosacral fold, 362, 392 Uierosacral ligament, 360, 371, 372, 373 Uterovaginal venous plexus, 412 Uterovesical pouch, 372 Uterus, 370, 380, 388, 389, 400, 412 age changes and muscle pattern of, 373 anteflexion of, 377 arteries and veins of, 404 body of, 360, 371 cervix of, 360, 364, 369, 370, 371 degrees of retroversion of, 377 external os of, 371 frontal section of, 371 fundus of, 360, 362, 365, 369, 371 internal os of, 371 retracted, 412 round ligament of, 340, 389 sagittal MR images of, 397 U-V junction, 372 Uvula, 51 of urinary bladder, 366, 385 Uvular muscle, 52 V Vagal cardiac nerve, 130 Vagal fibers, 126 Vagal nucleus, dorsal, 116 Vagal trunk, 263, 321, 322, 323, 328 anterior, 126, 166, 209, 318, 319, 320, 321, 327, 344, 346 anterior gastric branch of, 319 celiac branches of, 216 celiac branch of, 319, 320, 321, 322 gastric branches of, 126 hepatic branch of, 126, 319, 320, 323, 327 celiac branches of, 320
Vagal trunk (Continued) posterior, 166, 318, 320, 321, 322, 323, 327, 328, 344, 346 branch to celiac plexus, 240 celiac branches of, 216, 319, 320, 321, 322 posterior gastric branch of, 320, 328 Vagina, 367 horizontal portion of, 372 musculofascial extensions to, 356 sagittal MR images of, 397 supporting structures of, 370 upper four-fifths of, 389 vertical portion of, 372 vestibule of, 370, 377 Vaginal artery, 340 Vaginal fornix, 371 anterior part of, 360 posterior part of, 360 Vaginal orifice, 388 Vaginal vein, 398 Vaginal venous plexus, 398 Vaginal vestibule, 389 artery of bulb of, 370 bulb of, 370, 404 artery to, 404 Vaginal! wall, 370, 373 Vagus nerve (X), 32, 34, 74, 75, 76, 114, 116, 117, 118, 125, 126, 127, 130, 131, 135, 206, 209, 210, 211, 325, 345 auricular branch of, 10, 24, 126 cardiac branch of, 209 celiac branch of, 321 cervical cardiac branch of inferior, 126 superior, 126 cholinergic, 210 communicating branch of, 126 communication to, 32 distribution of, 118 inferior ganglion of, 126, 127, 128, 135 left, 243, 244 meningeal branch of, 126 nucleus of, 324 pharyngeal branch of, 125, 126, 130 posterior nucleus of, 116, 117, 126, 324, 345 pulmonary plexus branch of, 209 right, 75, 80, 193, 226, 230 schema of, 118, 126 superior cervical cardiac branch of, 130, 131 superior ganglion of, 126, 127 thoracic cardiac branch of, 126, 226 Vallate papillae, 58, 135 Vallecula, 58 Vane comitantes, 59, 60 Vasa rectae spuria, 337 Vasa rectae vera, 337 Vastus intermedius muscle, 489, 493, 507, 538 attachments of, 489, 491 Vastus lateralis muscle, 485, 489, 491, 492, 493, 494, 500, 507, 538 attachments of, 489, 491 Vastus medialis muscle, 485, 489, 492, 493, 500, 538 attachments of, 489, 491, 538 nerve to, 500
Vater ampulla of, 294 major duodenal papilla of, 294 Vein brain, 146 of brain, 145 of forearm, 480 of hypophysis, 148 of hypothalamus, 148 of large intestine, 311 of pancreas, 309 of posterior cranial fossa, 144 of small intestine, 309 of spleen, 309 superficial, of lower limb, 545 of suprarenal glands, 347 vertebral, 137 Velum inferior medullary, 113 superior medullary, 113 Vena cava inferior, 179, 194, 206, 209, 213, 215, 220, 225, 230, 272, 273, 278, 293, 297, 298, 330, 331, 333, 339, 342, 347, 412 axial CT images of, 242, 350 cross section of, 297, 338 opening for, 223 persistent left, 333 right renal vein entering, 339 valve of, 220 superior, 74, 75, 206, 211, 213, 215, 220, 224, 225, 230, 244, 245, 246 axial CT images of, 242 prenatal, 229 Venae comitantes, 460 Venous arch, dorsal, 544 Venous plexus, 372 vertebral, 10 Ventral ramus, 170, 193 in situ, 160 Ventricle (cerebral) choroid plexus of, 109 fourth, 113, 115, 144, 146 axial MR image of, 150 choroid plexus of, 106, 114 lateral and median apertures of, 146 median sagittal section of, 114, 115 outline of, 143 posterior view of, 115 rhomboid fossa of, 114 sagittal MR image of, 149 vein of lateral recess of, 144 lateral, 108, 110, 146 choroid plexus, 109 choroid plexus of, 99, 108, 110, 143, 145 lateral vein of, 146 occipital horn of, 110, 111, 146 right, occipital horn of, 143 sagittal MR image of, 149 temporal horn of, 108, 111, 146 veins of, 146 left lateral, 108 aperture of, 108 central part of, 108 frontal horn of, 108 occipital horn of, 108 phantom view of, 108 temporal horn of, 108
Ventricle (cerebral) (Continued) right lateral, 108 third, 106, 108, 110, 111, 146 choroid plexus of, 106, 108 tela choroideae of, 108, 111, 145 Ventricle (heart) left, 213, 214, 221, 224, 246 axial CT images of, 242 posterior vein of, 216 posterior wall of, 221 right, 214, 215, 224, 246 axial CT images of, 242 opened, 220 Ventricular vein hippocampal, 146 inferior, 146 Ventromedial nucleus, 147 Venuiae rectae, 337 Vermian artery inferior, 143 superior, 143 Vermian vein inferior, 144 superior, 144, 146 Vermis, 113 inferior, 113 nodule of, 113 pyramid of, 113 tuber of, 113 uvula of, 113 superior, 113 central lobule of, 113 culmen of, 113 declive of, 113 folium of, 113 lingula of, 113 tuber of, 115 uvula of, 115 Vertebra. See also specific vertebrae body of, axial CT images of, 242, 350 lumbar, 155 radiographs of, 156 relation to spinal nerves, 161 spinous process of, axial CT images of, 242 thoracic, 154 Vertebral artery, 10, 21, 32, 75, 76, 100, 130, 140, 141, 171, 178, 226, 237 anterior meningeal branch of, 143 atlantic part of, 178 left, 143 meningeal branches of, 10 posterior meningeal branch of, 100, 143 right, 143 venus plexus of, 137 Vertebral body, 19 articular facets for, 186 fourth thoracic, 230 lumbar, 155 Vertebral canal, lumbar, 155 Vertebral column anterior view of, 153 left lateral view of, 153 posterior view of, 153 veins of, 137 Vertebral ganglion, 130, 226 Vertebral notch inferior, lumbar, 155 superior, lumbar, 155 Vertebral plexus, 130
Vertebral vein, 137 anterior, 137 Vertebral venous plexus, 137 external, 173 internal, 170, 173 Vertebra prominens, 19, 21 Vesical artery inferior, 340 ureteric branches of, 340 superior, 340, 341 ureteric branches of, 341 Vesical fold, transverse, 372 Vesical plexus, 323, 344, 412 Vesical vein right, 311 superior, 265, 399 Vesical venous plexus, 366, 403 in retropubic space, 361 Vesical vessels, lymphatic pathway along, 408 Vesicocervical fascial fibers, 364 Vesicocervical space, 364 Vesicosacral fold, 363 Vesicouterine pouch, 372 Vesicovaginal pouch, 362, 365, 391 Vesicovaginal space, 364 Vesicular appendix (hydatid of Morgagni), 371, 389 Vesicular vein, inferior, 399 Vestibular aqueduct endolymphatic duct in, 96 external opening of, 97 Vestibular area, 115 Vestibular fossa, 377 Vestibular ganglion, 95 Vestibular gland, 389 greater, 389', 404 opening of, 377 primordium of, 389 Vestibular membrane, 96 Vestibular nerve, 95, 97, 124 inferior, 95, 97, 124 superior, 95, 124 Vestibular nuclei, 117 Vestibular nucleus, 116, 124 diagrammatic, 124 Vestibular (oval) window, 95 Vestibule, 95, 389 cochlear recess of, 92, 95 elliptical recess of, 95 spherical recess of, 95 Vestibulocochlear nerve, 117 Vestibulocochlear nerve (VIII), 92, 95, 97, 114, 116, 131 schema of, 116, 118, 124 Vestigial mesonephric tubule, 390 Vidian nerve, 122 Viscera abdominal, 269 median sagittal section of, 348 pelvic female, 360 male, 361 nerves of, 412 vasculature of, 300-315 Visceral lymph nodes celiac, 266 inferior mesenteric, 266 superior mesenteric, 266 Visceral nerve, thoracic, 165 Visceral pleura, 205
Visual fields, overlapping, 120 Visual pathway, 120 Vitreous body, 87 Vitreous chamber, 90 coronal CT images of, 151 Vocalis muscle, 78, 80 action of, 79 Vocal ligament, 77, 78 abduction of, 79 adduction of, 79 lengthening of, 79 shortening of, 79 Voiding cystourethrograms, male and female, 368 Vomer, 39 Vomerine groove, 39 Vorticose vein, 85, 90, 91 anterior tributaries of, 91 bulb of, 91 posterior tributaries of, 91 suprachoroidal tributaries of, 91 V-shaped area (of Laimer), 234, 235 Vulva, 377
w White matter, spinal, 169 Willis, circle of. See Cerebral arterial circle (of Willis) Winslow, foramen of- See Omental foramen (of Winslow)
Wolffian duct. See Mesonephric (wolffian) duct) Wrist anterior (palmar) view of, 472 anterior view of, 460 arteries of, 461 articular disc of, 455 bones of, 456 coronal section of, 455 cross section, transverse, 461 cutaneous innervation of, 472 deep dorsal dissection of, 469 deeper palmar dissection of, 460 extensor muscles of, 441 extensor tendons at, 470 flexor muscles of, 442 flexor tendons, arteries, and nerves at, 461 ligaments of, 454, 455 movements of, 453 nerves at, 461 palmar dissection, deeper, 460 posterior (dorsal) view of, 455, 470, 472 radial dissection, superficial, 467 radiograph of, anteroposterior, 457 sagittal section of, 453 superficial dorsal dissection of, 468 superficial palmar dissection of, 459 tendons of, 461
Xiphoid process, 185, 191, 196, 198, 247, 248, 249, 285, 286, 293, 297, 298 cross section of, 297
Z Zigzag (Z) line, 236 Zona orbicularis, 487 Zonular fibers, 87, 88, 89, 90 Zygapophyseal (facet) joint, 246 C2-3, 19, 21, 22 capsule of, 21, 22 C3-4, 21 Zygomatic arch, 14, 54, 151 Zygomatic bone, 81 Zygomatic nerve, 121 Zygomaticofacial artery, 23 Zygomaticofacial nerve, 24, 122 Zygomaticofacial vein, 23 Zygomaticotemporal artery, 23 Zygomaticotemporal nerve, 24, 122 Zygomaticotemporal vein, 23 Zygomaticus major muscle, 26, 54, 123 Zygomaticus minor muscle, 26, 54, 123
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