n rl
f
AIIAS OI Fourth Edition
FrankH.Netter, MD
Atlasof
Human Anatomy
Gonsulting Editors
JenniferK. Brueckner,PhD AssistantProfessor Department of Anatomyand Neurobiology University of KentuckyCollegeof Medicine Lexington, Kentucky
NoelleA. Granger,PhD Professor Biology Department of Celland Developmental of NorthCarolinaSchoolof Medicine University ChapelHill,NorthCarolina
StephenW. Garmichael,PhD, DSc Professor Surgery of Anatomyand Orthopedic Departments MayoClinic Minnesota Rochester,
John T. Hansen,PhD and Anatomy Professorof Neurobiology AssociateDeanfor Admissions Schoolof Medicineand Dentistry of Rochester University NewYork Rochester,
ThomasR. Gest,PhD AssociateProfessor Divisionof Anatomical Sciencesand Department of MedicalEducation of MichiganMedicalSchool University AnnArbor,Michigan
AnilH. Walji,MD,PhD Professorand Director,Divisionof Anatomy lmaging and Diagnostic of Radiology Professor Professorof Surgery Facultyof Medicineand Dentistry Universityof Alberta Edmonton,Alberta,Canada
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Atlas of Human Anatomy FourthEdition
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Copyright @ 2006, 2003, 1997, 1989 by Saunders, an imprint of Elsevier lnc. All rights reserved. No part of this book may be producedor transmittedin any form or by any means,electronicor mechanical,includingphotocopying,recording,or any informationstorage and retrievalsystem,without permissionin writingfrom the publishers.Permissionsfor Netter Art figuresmay be sought directlyfrom Elsevier'sHealthScienceLicensingDepartmentin Philadelphia, Pennsylvania, USA:phone1-800-523-1649, ext.3276,or215-239-3276; email:
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NOTICE Neitherthe Publishernor the Editorsassume any responsibility for any loss or injuryand/or damage to persons or property arisingout of or relatedto any use of the materialcontained in this book. lt is the responsibility of the treatingpractitioner, relyingon independentexpertise and knowledge of the patient, to determinethe best treatment and method of applicationfor the oatient. Previouseditionscopyrighted2003, 1997, 1989.
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Printedin the UnitedStatesof America. L a s t d i g i t i s t h e p r i n t n u m b e r 9:
8
7 6
5
4
3 2
1
I wwwsabre.org
To my dear wife, Vera
Head and Neck Superficial Face
Oral Region
Plates 23-26
Plates 5l-62
2s SuperficialArteries andVeins ofFace andScalp
5r
24 Cutaneous Nerves of Head andNeck
52 Roofof Mouth
2s Facial Nerve Branches andParotid Gland
of Mouth 53 Floor
26 Muscles of Facial Expresssion: LateralView
Involved s4 Muscles inMastication (continued) Involved inMastication 55 Muscles
Neck
56 Teeth (continued) s7 Teeth
Plates 27-35
27 Muscles of NeckLateralView
Inspection of OralCavity
n
Muscles of Neck:Anterior View
58 Tongue (continued) s9 Tongue
x,
Infrahyoid andSuprahyoid Muscles
60 Tongue andSalivary Glands:Sections
30 Scalene andPrevertebral Muscles
6r
3r
Innervation of MouthandPharynx 62 Afferent
Superficial Veins andCutaneous Nerves of Neck
Glands Salivary
32 Cervical Plexus inSitu 33 Subclavian Artery
Pharynx
s4 Carotid Arteries
Plates 6$73
3s Fascial Layers of Neck
Median 63 Pharynx: Section 64 Fauces
Nasal Region
(Sagittal) 65 Muscles of Pharynr Median Section
Plates
0pened View 66 Pharynx: Posterior
36*5O
36 Nose
Posterior View of Pharynx Partially 0pened 67 Muscles
s7 LateralWall of Nasal Cavity
68 Muscles of Pharynx: LateralView
3a LateralWall ofNasal Cavig(continued) (Nasal 3e MedialWall ofNasal Cavity Septum)
of OralandPharyngeal Regions 69 Arteries
40 Maxillary Artery
7r
4r
72 Lymph Vessels of Head andNeck andNodes
Arteries of Nasal Cavity: Nasal Septum Turned Up
42 Nerves of Nasal Cavity: Nasal Septum Turned Up (continued) 4s Nerves of Nasal Cavity 44 Autonomic Innervation ofNasal Cavity (V,)andMaxillary (Vr)Nerves 4s 0phthalmic (V,) 46 Mandibular Nerve 4z Nose andParanasal Sinuses: Cross Section 4g Paranasal Sinuses (continued) 4s Paransal Sinsues so Paranasal Sinuses: Changes withAge
Atlas of l{uman Anatomy
7o Veins of 0ralandPharyngeal Regions Regions Nerves of 0ralandPharyngeal
Vessels 73 Lymph of Pharynx andTongue andNodes
1 Head and Neck Section Topographic Anatomy Plate I
HeadandNeck
Bones and Ligaments Plales 2-22
z
Anterior View Skull:
s
Skull:AnteroposteriorRadiograph
e
LateralView Skull:
s
Skull:LateralRadiograph Midsagittal Section Skull:
e z e g to
Calvaria View Base: Inferior Cranial SuperiorView Base: Bones ofCranial View Base: Inferior Foramina ofCranial
View Base: Superior ofCranial Foramina 12 SkullofNewborn andNeck of Head 13 BonyFramework rI
Fossae Base:Pterygoid 14 Cranial r5
Mandible
r6 TemporomandibularJoint r7 r8
CervicalVertebrae:AtlasandAxis (continued) Vertebrae Cervical
Joints Uncovertebral Vertebrae: Cervical Vertebrae intheCervical 20 Degenerative Changes Ligaments 2r External Craniocervical i9
Ligaments Craniocervical 22 Internal
Atlas of Human Anatomy
Frank H. Netter, MD
rank H. Netterwas born in New York City in 1906. He
Dr.Netter'sworks are among the finest examplesof the use
studied ad at the Art Students League and the of illustrationin the teachingof medicalconcepts.The 13-book NationalAcademy of Design before enteringmedical Netter Collection of Medical lllustrations, which includes the school at New York University,where he receivedhis Doctor of greater part of the more than 20,000 paintings created by Dr. Medicinedegree in 1931. During his student years, Dr. Netter's Netter.became and remainsone of the most famous medical notebook sketches attracted the attention of the medical faculty works ever published. The Netter Atlas of Human Anatomy, first and other physicians,allowinghim to augmenthis income by il- publishedin 1989, presentsthe anatomicpaintingsfrom the lustratingadicles and textbooks. He continued illustratingas a
Netter Collection.Now translated into 16 languages,it is the
sidelineafter establishinga surgicalpracticein 1933,but he ulti- anatomyatlas of choice among medicaland health professions mately opted to give up his practicein favor of a full-timecom- studentsthe world over. mitment to art. After service in the United States Army during
The Netter illustrationsare appreciatednot only for their
World War ll, Dr. Netter began his long collaborationwith the aesthetic qualities,but, more importantly,for their intellectual CIBA Pharmaceutical Company(now NovartisPharmaceuticals).content.As Dr. Netterwrote in l949 "clarificationof a subject is This 45-yearpartnershipresultedin the productionof the extra- the aim and goal of illustration.No matter how beautifully ordinarycollectionof medical art so familiarto physiciansand painted,how delicatelyand subtly rendereda subject may be, it other medicalprofessionalsworldwide. is of little value as a medical illustration if it does not serve to lcon Learning Systems acquired the Netter Collection in make clear some medicalpoint." Dr. Netter'splanning,concepJuly 2000 and continuedto update Dr.Netter'soriginalpaintings tion, point of view, and approachare what inform his paintings and to add newly commissionedpaintingsby artiststrained in and what make them so intellectuallyvaluable. the styleof Dr.Netter.In 2005, ElsevierInc. purchasedthe Netter Collection and all publications from lcon Learning Systems. Thereare now over 50 publicationsfeaturingthe art of Dr.Netter availablethrough ElsevierInc.
Frank H. Netter,MD, physicianand artist, died in 1991.
Preface to the First Edition
have often said that my career as a medical artist for al- and even revisionof a number of them in order to make them most 50 years has been a sort of "command performance" more pertinentto today's ever-expandingscope of medicaland in the sense that it has grown in responseto the desires surgicalpractice.In addition,I found that there were gaps in the and requestsof the medicalprofession.Over these many years, portrayalof medical knowledgeas pictorializedin the illustraI have producedalmost 4,000 illustrations,mostly for The CIBA tions I had previouslydone, and this necessitatedmy making a (now Netfer) Collection of Medical lllustrations but also for numberof new picturesthat are includedin this volume. ClinicalSymposla.These pictures have been concerned with the
In creatingan atlas such as this, it is importantto achievea
varied subdivisionsof medical knowledge such as gross happy medium between complexity and simplification.lf the anatomy, histology,embryology,physiology,pathology, diag- picturesare too complex,they may be difficultand confusingto nostic modalities,surgicaland therapeutictechniquesand clin- read; if oversimplified,they may not be adequatelydefinitiveor ical manifestationsof a multitudeof diseases.As the yearswent may even be misleading.I have thereforestriven for a middle by, however,there were more and more requestsfrom 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 studentsand membersof the medicaland allied anatomy.Thus, this atlas has come about, not through any in- professionswill find the illustrationsreadilyunderstandable,yet spirationon my part but rather,like most of my previousworks, instructiveand useful. as a fulfillmentof the desiresof the medicalorofession.
At one point,the publisherand I thoughtit might be niceto
It involvedgoing back over all the illustrationsI had made include a foreword by a truly outstanding and renowned over so many years,selectingthose pertinentto gross anatomy, anatomist,but there are so many in that categorythat we could classifyingthem and organizingthem by system and region, not make a choice. We did think of men like Vesalius.Leonardo adapting them to page size and space and arrangingthem in da Vinci,WilliamHunterand HenryGray,who of course are unlogicalsequence.Anatomy of course does not change,but our fortunatelyunavailable,but I do wonder what their comments understandingof anatomy and its clinical significancedoes might have been about this atlas. change,as do anatomicalterminologyand nomenclature. This thereforerequiredmuch updatingof many of the older pictures
Frank H. Netter.MD (1906-1991)
Gontents
Section 1 Anatomy Topographic Bones andLigamenb SuperficialFace Neck Nasal Region OralRegion Pharynx Thyroid Gland andLarynx 0rbitandGontenb Ear Meninges andBrain Nerves Cranial andCervical Vasculature Cerebral Regional Scans
1 Plate 2 Plates Plates 23-26 Plates 2 5 Plates 36-50 Plates 51-62 Plates 63-73 Plates 74{;0 Plates 81-91 Plates 92-98 Plates 9S-115 Plates 11ts135 Plates 136-148 Plates 14S-151
Anatomy Topographic Bones andLigamenb SpinalCord Muscles andNerves
152 Plate plates 1S3_159
Anatomy Topographic Mammary Gland Wall Body Lungs Heart Mediastinum Regional Scans Anatomy Cross-Sectional
181 Plate Pfates 182-184 Plates 18ts195 Plates 196-210 Plates 211-229 Plates 23F241 242 Pfate Pfates 24T246
Anatomy Topographic Body Wall Peritoneal Cavity (Gut) Viscera (Accesory Viscera Organs)
247 Pfate Plates 24V267 Plates 26F274 Pfates 27Y285 Plates 28F299 Plates 300-317 Plates 318-328 Pfates 32Y347 Plates 34f349 350 Plate
Section2 Plates 160-173 Pfates 171180
Section3
Section4
Vasculature Visceral lnnervation Glands Kidneys andSuprarenal Abdominal Sections Regional Scans
Section 5 Topographic Anabmy Bones andLigamenb PelvicFloorandContenb Bladder Urinary Vagina, Uterus, andSupporting Sfrncfures Regional Transverce Section Perineum andExternal Genihlia: Female Perineum andExtemal Male Geniblia: Homologues of Geniblia Epididymis, Testis, andDuctus Deferens
Restum Regional Scans Vasculafure Innervation
Plab Plates Platm Plates Plah Hate Platc Phtes Plates Plate Hatos Plate platc
351 3 55 35F364 36S368 3f375 376 377-379 3flH87 388-389 390 391-396 397 399_409 Pfates 10/J-4.17
Section6 Topographic Anabmy Shoulder andAxilla Arm ElbowandForearm WristandHand Neurcvasculature Regional Scans
Plato Haho Plabs Phbs Habs Pfatas Hah
Topognaphic ftrabmy HipandThigh Knee Leg AnkleandFoot Neurovasculature Regional Scans
i Plate Platc Plabs Plabe Plabs Plabs Plate
418 419-430 431-435 136-151 452471 17243 4U
Section 7
ion I KeyFigure forCross Sections References lndex
48s 48H05 5(H12 51 22 52 37 5$tl6 il7
Head and Neck Thyroid Gland and Larynx
Meninges and Brain
Plates 74-80
Plates 99-l 15
74 Thyroid View Gland:Anterior
99
7i
Arteries too Meningeal
Thyroid Gland Posterior View andPharynx:
Veins andDiploic Meninges
?6 Parathyroid Glands
lol
Hematoma Epidural
7z Cartilages of Larynx
to2
Veins Cerebral Meninges andSuperficial
zs Intrinsic Muscles ofLarynx
t03
7s Actions ofIntrinsic Muslces ofLarynx
Venous Sinuses Dural (continued) Venous Sinuses t 0 4 Dural
Bo Nerves of Larynx
t05
Lateral Views Cerebrum:
MedialViews Cerebrum: View Inferior t 0 7 Cerebrum: t06
Orbit and Gontents Plates 8l-9t
t08
Br Eyelids
r09
Ventricles of Brain
s2 LacrimalApparatus
Fluid ofCerebrospinal Circulation (Ganglia) Nuclei t t o Basal
so Fascia ofOrbit andEyeball
tll
Thalamus
EyeMuscles a4 Extrinsic
112
andFornix Hippocampus
andVeins 85 Arteries ofOrbit andEyelids
r'rs Cerebellum
86 Nerves of 0rbit
r re Brainstem
s7 Eyeball
Ventricle andCerebellum r rs Fourth
andPosterior 80 Anterior Chambers of Eye 8e LensandSupporting Structures
Granial and Gervical Nerves
Arteries 90 Intrinsic andVeins of Eye
Plates ttFl35
er
Ir6
Vascular Supply ofEye
Ear Plates 92'€8
92
Pathway ofSound Reception
93
EarandTympanic External Cavity
94
Tympanic Cavity
95
Bony andMembranous Labyrinths (continued) BonyandMembranous Labyrinths
96 g7 98
Orientation ofLabyrinth inSkull (Pharyngotympanic, Auditory Tube Eustachian)
inBrainstem: Schema Nerve Nuclei Cranial (continued) Schema Nuclei inBrainstem: Nerve 117 Cranial (Motor Distribution): Schema andSensory Nerves t t 8 Cranial (l):Schema Nerve 0lfactory (ll)(Visual Pathway): Schema 12|' 0pticNerve (Vl)Nerves: (lV),andAbducent (lll),Trochlear 121 Oculomotor Schema (V):Schema Nerve 122 Trigeminal
tt9
(Vll): Schema Facial Nerve (Vlll): Nerve Schema 124 Vestibulocochlear (lX): Nerve Schema 125 Glossopharyngeal 123
(X):Schema Nerve Vagus nerve(Xl):Schema 127 Accessory (Xll): Nerve Schema l 4 Hypoglossal 126
Plexus: Schema Cervical inNeck Nerves r 3 0 Autonomic 14,
t 3'l
Nerves inHead Autonomic
Atlas of l{uman Anatomy
Head and Neck roz Ciliary Ganglion: Schema rse Pterygopalatine andSubmandibular Ganglia: Schema
rlz Arteries ofBrain: Lateral andMedialViews
r34 0ticGanglion: Schema rss Taste Pathways; Schema
rs
reo Arteries of Posterior Cranial Fossa Veins of Posterior Cranial Fossa
rru Deep Veins ofBrain rrc SubependymalVeins ofBrain
Gerebral Vasculature
rlz Hypothalamus andHypophysis
Plates 136-148
rre Arteries andVeinsof Hypothalamus andHypophysis
r se Arteries to Brain andMeninges rsz Veins oftheVertebral Column-Vertebral Veins rse Arteries to Brain: Schema
Regional Scans Plates l4$-l5l
rss Arteries ofBrain: Inferior Views (ofWillis) reo CerebralArterial Circle
res Head Scans: Sagittal MRlmages
rer Arteries ofBrain: Frontal ViewandSection
rsr Head Scans: Coronal CTlmages
Atlas of Human Anatomy
r50 Head Scans:Axial CTlmages
Foreword
he Fourth Edition of Atlas of Human Anatomy by the uncovertebraljoints of the cervicalvertebrae,the vertebral Frank H. Netter, MD, has been updated by our veins, and the intricate vasculatureof the eye, to mention a few, Consulting Editor team of Jennifer K. Brueckner, with artistic brilliance,anatomicalprecision,and visual appeal Stephen W. Carmichael,Thomas R. Gest, Noelle A. Granger, that is unsuroassed.The sectionincludesa concisetreatmentof John T. Hansen,and Anil H. Walji.We haveeach reviewed,mod- the centralnervoussystem,includingthe cranialnervesand imified, and updated a section of the Atlas. Throughoutthe book, portant central pathways. new radiographs,computed tomographic(CT) images,CT an-
In the Back section, a new plate illustrates the proper
giograms, and magnetic resonance (MR) images have been placementof a lumbar epiduralanestheticagent,as well as the added, which reflectsthe importanceof diagnostic imaging in locationfor lumbarpunctureor "spinaltap." Autonomicsare traclinicalanatomyand medicine.In this edition,45 plates have ditionallythe bane of many students,and excellentnew drawbeen revised to show corrected anatomicalrelationships,290 ings of the autonomicnervoussystem by Dr.Machadowill serve plates have been relabeled,and there are 17 completelynew as a new educationalresourcefor these difficultconcepts. plates.Wonderfulnew artworkfor this edition has been created The Thorax section underwent minor editorial corrections by Carlos A. G. Machado, MD, who has contributed to the of terminologyand subtle artwork modificationsto more accuNetter illustrationsfor over ten years.Anatomicalnomenclature rately reflect the most common anatomical patterns. For inhas been broughtup to date, and clinicalterms and eponymsin stance, the representationof the azygos venous system patcommon usage have been included parenthetically. The genius tern was altered to reflect the most common arrangementof of Dr. Netter'spaintingsis that the anatomyis portrayedclearly, thesehighlyvariableveins.The inclusionof the thoraciccrossrealistically, and in a clinicallyrelatablefashionwhile maintaining sectional images at the end of the section, rather than in the the balance between complexity and oversimplification.We later section, reinforcesthe importanceof knowledgeof crosshave tried to adhere to these principlesin the creation of the sectional anatomy in the interpretationof cross-sectionalMR new plates for this edition. Finally,some of the plates were re- and CT images. arrangedas page-pairs,whereappropriate,to facilitateside-byThe Abdomen section has had the most extensiverevision side comparisonsof commonly illustratedelements.This fourth for labelchangesand positioningof leaderlines.By popularreedition owes much to the consultingeditors of the earlieredi- quest,the plateshowingthe common variationsin the branches tions, Drs.SharonColacino(Oberg)(firstedition),ArthurF.Dalley of the celiac artery which appearedin the first editionAbdomen ll (secondedition),and John T. Hansen(thirdedition),who shep- section,has been reinstated. herded their editions with great skill and uncompromisingprofessionalism,making our task significantlyeasier.
The anatomy of the pelvis is a particularlydifficult area to teach and, becauseof the depth and tight organizationof the in-
The head and neck is a particularlychallengingareafor stu- ternal structures,difficultto illustrate.The Netter illustrationsof dents, residentsand facultyto master,due not only to the sheer pelvic anatomy are outstandingbecause of the clarity of their numberof structurespacked in this relativelysmall regionof the presentationand their scope of coverage.A very small number human body, but also the complexityof their three-dimensional of plates were eliminatedto permit the inclusionof the illustraanatomical organization.The age-old aphorism that "there is tion of pelvic fascia, a parasagittalview of the broad ligament, more anatomy above the hyoid bone than below it" presentsa and normal imaging (male and female radiographs,cysuniquechallengeto anyonetrying to portraythe anatomyof this tourethrograms,and a hysterosalpingogram). Comparativeimregion in a simple, visually appealing, and clinically relevant ages of male and female pelvicanatomywere reorganizedto almanner.More than ten new plateshave been added to this sec- low their side-by-sidecomparison. tion. For the first time, spectacularoriginalpaintingscreatedby
New CT angiogramshave been includedin the Upper Limb
CarlosMachadoillustrateclinicallyimportantstructuressuch as and Lower Limb sections.This new technologynot only clearly
Foreword
demonstratesblood vessels,but vividlyshows bony landmarks help you better understandanatomy and its applicationto the to which the blood vessels are related.The ligamentsof the practice of clinical medicine.More informationabout the webwrist have been illustrated in more detail to reflect their in- site, includingthe PIN code for access,can be found on the increasedimportancein arthroscopicproceduresand other appli- side front cover of the Aflas. cations of new technologyto this joint. We hope you enjoy this new edition of the Aflas of Human
JenniferK. Brueckner,PhD StephenW. Carmichael,PhD, DSc
Anatomy and that you find it usefulfor learningand for your ca-
Thomas R. Gest, PhD
reer.For the standardeditionand enhancedinternationaledition
NoelleA. Granger,PhD
of the Aflas, we have included access to the website www.
John T. Hansen,PhD
netteranatomy.com.By registeringon this website, you will be
Anil H. Walji,MD, PhD
able to accesssupplementalmaterialthat has been organizedto
Acknowledgments
Editor,our It has been my pleasureto work with the other membersof the I would liketo thank MarybethThiel,Developmental editorial board, Carlos Machado, MD, and the Elsevierstaff. superb medical illustratorDr. Carlos Machado, and the entire Specialthanks go to John Hansen,PhD, for the opportunityto
Editorial,Production,Design,lllustration,and Marketingstaff at
work on this editorialteam. I am indebtedto my family for the Elsevierfor shepherdingthis edition to completion.For all our support and encouragementthat they have provided.
students,past, presentand future,this Aflas is for you. Finally,
to my wife, Paula,thank you for your love and encouragement -Jennifer K. Brueckner PhD throughoutthe years. -John T Hansen, PhD I would like to thank the specialistsat the Mayo Clinic who helped review the art, especiallyRichardA. Berger,MD, PhD, Shawn W. O'Driscoll,MD, PhD, EnriqueA. Sabater,MD, and I would like to thank my wife, Parviz,and my daughters,Amreen and Farah,for their patienceand constant support and encour-
RobertJ. Spinner,MD.
agement during my involvementwith this project. My special -Stephen W. Carmichael,PhD, DSc thanks go to Dr. Carlos Machado,who has my utmost admiration for his brilliantartwork and who was an absolutedelight to work with. I would also like to expressmy sincereappreciation I must thank my family and especiallymy daughter,Madison, to all the wonderfulstaff at Elsevier,in particularLinda Belfusfor and son, Taylor,for their support and understandingof my ef- her exemplaryleadership,and Anne Lenehan,MarybethThiel, fofts on this editorialtask. lt was a pleasureto work with my col- and Cecelia Bayruns for all of their hard work, patience,and leagueson the editorial board and with the staff of Elsevier.lt dedication,without which this atlas would not have been possihas been my sincerepleasureto work with Dr. Carlos Machado ble. Finally,I would like to thank my fellow coeditorsand all of on the artwork changesfor the 4th edition.
my colleagueswho helpedwith reviewingthe plates,in particular PierreLemelin,PhD,and DanielLivy,PhD,whosemeticulous
-Thomas R. Gest, PhD examinationof the artwork has helped greatly in ensuringthe accuracyof the head and neck sectionin this edition. I am deeply grateful to my colleaguesat Universityof North CarolinaSchoolof Medicine:JamesScatliff,MD, formerChairof the Departmentof Radiology, for his help with the imaging,and O.W Henson, PhD, ProfessorEmeritusof Anatomy,for his input. I especiallythank Carlos Machado, the exceptionalartist whose talent made any change requiredin the originalplates both seamlessand beautiful. -Noelle A. Granger,PhD
-AnilH.
Walji, MD, PhD
Head and Neck
Frontal bone Zygomatic bone
Supraorbital notch Superciliary arcn
Helix Tragus Antihelix
Nasal oone
Antitragus Ala of nose
A n t e r i o rn a r e s (nostril)
Lobule C o m m i s s u roef l i p s
Philtrum
A n g l eo f j a w ( m a n d i b l e )
Nasolabial
s ut c u s
S u b m a n d i b u lgalra n d
T u b e r c loef s u p e r i olri p
E x t e r n aj lu g u l a rv e i n
Mental
l n f e r i o rb e l l vo f o m o h v o i d m u s c l e
protuberance
Brachialplexus T h y r o i dc a r t i l a g e Trapeziusmuscle
-"€*r
. l u g u l anr o t c h
C l a v i c u l a hr e a d o f s t e r n o c l e i d o m a s t o im du s c l e
S t e r n ah l e a do f s t e r n o c l e i d o m a s t o im du s c l e
C/Fd4g/*
Topographic Anatomy
Plate I
Skull: Anterior View
C o r o n a ls u t u r e
Frontal bone Clabell.r
Parietalbone
Supraorbital notch(foranren)
S p h e n o i db o n e
O r b i t a ls u r f a c e
e s s e rw r n g C r e a t e rw l n g
Nasal bone
Temporalbone L a c r i m a lb o n e E t h m o i db o n e O r b i t a lp l a t e
Zygomatic bone
P e r p e n d i c u l aprl a t e
Frontap l rocess
M i d d l e n a s a lc o n c h a
O r b i t a ls u r f a c e Tenrporal process
Inferior nasal concha
Zygom at icofac iaI toramen
Vomer *;o
Maxilla Z y g o m a t i cp r o c e s s
rl
Mandible
'\
Ramus
O r b i t a ls u r f a c e I n f r a o r b i t aflo r a m e n Frontap l rocess
4{r
Body
^.,, { \,,
M e n t a lf o r a m e n M e n t a lt u b e r c l e
A l v e o l a rp r o c e s s
M e n t a lp r o t u b e r a n c e
A n t e r i o rr r a s asl p i n e
R i g h t o r b i t : f r o n t a l a n d s l i g h t l yl a t e r a lv i e w O r b i t a l s u r f a c eo f f r o n t a lb o n e O r b i t a ls u r f a c eo f l e s s e r w i n g o f s p h e n o i db o n e S u p e r i o ro r b i t a lf i s s u r e ( ) p t i c c a n a l( f o r a m e r . r )
P o s t e r i oar n d Anterior e t h m o i d a lf o r a m i n a O r b i t a lp l a t eo f e t h m o i db o n e L a c r i m a bl o n e
O r b i t a ls u r f a c eo f g r e a t e r w i n g o f s p h e n o i db o n e
F o s s af o r l a c r i m a sl a c
O r b i t a ls u r f a c eo f z y g o n r a t i cb o n e
O r b i t a l p r o c e s so f p a l a t i n eb o n e
I n f e r i o ro r b i t a lf i s s u r e Infraorbital!lroove
Plate 2
O r b i t a ls u r f a c e of maxilla
Bones and Ligaments
Skull: Anteroposterior Radiograph
A C E F G L M R
Bones and Ligaments
Angleof mandible Cristagalli Ethmoidair cells(sinuses) Frontalsinus Createrwingof sphenoid Lesser wing of sphenoid Maxillarysinus R a m u so f m a n d i b l e
Plate 3
Skull: Lateral View
S p h e n o i db o n e
Parietalbone
Iemporal bone
Temporalfossa
C r e a t e rw i n Frontal bone Supraorbital notch(foramen)
S q u a n r o u sp a r t Z y g o m a t i cp r o c e s s C o r o n a ls u t u r e A r t i c u l a rt u b e r c l e Pterion Croovefor posterior d e e p t e m p o r a la r t e r y
Clabella
E x t e r n aal c o u s t i c meatus
E t h m o i db o n e O r b i t a lp l a t
M a s t o i dp r o c e s s L a c r i m a lb o n e L a m b d o i ds u t u r e
F o s s at o r l a c r i m a sl a c
Occipital bone Nasal bone
L')
Sutural (wormian) bone
Maxilla External occipital protuberance
----)aFrontalprocess I n fr a o r b i t a l foramen Anterior Mandible
H e a d o f c o n d y l a rp r o c e s s M a n d i b u l a rn o t c h C o r o n o i dp r o c e s s Ramus O b l i q u el i n e Body M e n t a lf o r a m e n
Zygomatic bone Zygom aticofacial foramen T e m p o r a lp r o c e s s Z y g o m a t i ca r c h
S p h e n o i db o n e C r e a t e rw i n g
lnfratemporalfossaexposedby removalof zygomaticarchand mandible*-
I n f r a t e m p o r acl r e s t
P t e r y g o m a x i l l a rfyi s s u r e
L a t e r a pl l a t eo f p t e r y g o i dp r o c e s s
I n f e r i o ro r b i t a lf i s s u r e
P t e r y g o i dh a m u l u s ( o f m e d i a lp l a t eo f p t e r y g o i dp r o c e s s )
I n f r a t e m p o r asl u r f a c eo f m a x i l l a Temporal bone A l v e o l a rf o r a m i n a
Forame ovale
T u b e r o s i t yo f m a x i l l a
./.1 n
'.
.-*F _a*-
E x t e r n aal c o u s t i c meatus M a n d i b u l a rf o s s a A r t i c u l a rt u b e r c l e
'";*-"t
P t e r y g o p a l a t i nfeo s s a
S t y l o i dp r o c e s s
S p h e n o p a l a t i nfeo r a m e n * S u p e r f i c i a l l ym, a s t o i dp r o c e s sf o r m s p o s t e r i o r bourrcrary
Plate 4
Bones and Ligaments
Skull: Lateral RadiograPh
c
Anterior arch of atlas (Cl vertebra)
C
Creater wing of sphenoid
C o n d y l eo f m a n d i b l e
H
Hypophysealfossa(sellaturcica)
C P Coronoid processof mandible
cs Coronal suture D
Bones and Ligaments
L
L a m b d o i ds u t u r e
M
M a x i l l a r ys i n u s
D e n s o f a x i s( C 2 vertebra)
MS Mastoid air cells P Palatineprocessof maxilla
F r o n t a ls i n u s
S
S p h e n o i ds i n u s
Plate 5
Skull: Midsagittal Section
Sphenoidbone
Temporalbone
Parietalbone
Creater wing
Coronal sutur
Lesser wing Anteriorclinoid process Optic canal Sellaturcica S o h e n o i d sa il n u s Body Medialand lateral platesof pterygoid process
part Petrouspart
Croovesfor branches of middle meningeal vessels tr.M,I:ltg
lnternalacousticmeatus '?t'zt*
Groovefor superior petrosalsinus External openingof vestibular aqueduct Croove for s i g m o i ds i n u s
Lambdoidsuture
Frontalbone Frontalsinus
Occipital bone
Ethmoidbone Cristagalli Cribriformplate Perpendicular plate(bony nasalseptum)
for sinus transverse ;'---
Externaloccipital protuberance foramen Jugular
Nasalbone Croove for inferior petrosalsinus
Inferior nasal concha
Hypoglossal canal Maxilla Anterior nasalspine Nasalsu
Foramenmagnum
Occipitalcondyle
Palatinebone Vomer(bonynasalseptum)
Incisivecanal
part
Palatine Alveolar process
Frontalbone Nasalbone
sinus Openingof sphenoidal
1l':
Ethmoidbone Cribriformplate
foramen Sphenopalatine
Superior nasalconcha Middle nasalconcha
Lacrimalbone
Sphenoidbone Body
Inferior nasalconcha Maxilla Nasalsurf Palatineprocess Alveolar process
Medial I -. Platesof PterYgoidProcess 1;il i Pterygoidhamulus plate Perpendicular Horizontalplate I
View of lateral nasalwall with nasalseptum removed
Plate 6
euluttn" non"
*{r
Bones and Ligaments
Galvaria
Superiorview Frontalbone
Coronalsuture Bregma Parietalbone Sagittal suture Parietalforamen (for emissaryvein)
Lambdoidsuture Sutural(wormian) bone Occipital
Inferior view Frontalbone Frontalcrest Croovefor superiorsagittalsinus Coronalsuture Parietal bone Cranularfoveolae (forarachnoidgranulations) Diplod of Croovesfor branches m i d d l em e n i n g e av le s s e l s Croovefor superiorsagittal sinus suture Sagittal ambdoidsuture ipitalbone
Bones and Ligaments
4{tr Plate 7
Granial Base: Inferior View
Maxilla I n c i s i v ef o s s a Palatineprocess
Intermaxillary suture Zygomaticprocess Zygomatic bone Frontal bone
Palatomaxillary suture
Sphenoidbone Pterygoidprocess Hamulus M e d i ap l late Pterygoidfossa
Lateralplate Scaphoidfossa C r e a t e rw i n g Foramenovale F o r a m e ns p i n o s u m Spine
.b
Uit
Palatinebone Horizontal plate
ir
C r e a t epr a l a t i n feo r a m e n process Pyramidal L e s s epr a l a t i n feo r a m i n a Posterior nasalspine
Choanae Temporalbone Zygomaticprocess A r t i c u l atru b e r c l e Mandibularfossa Styloidprocess Petrotvmoanic fissure C a r o t i dc a n a l( e x t e r n aol p e n i n g Tympaniccanaliculus Externalacousticmeatus
Vomer Ala for auditory (pharyngotympanic, Eustachian)tube Foramenlacerum
M a s t o i dc a n a l i c u l u s Mastoid process Stylomastoidforamen
Petrous part Mastoid notch (for d i g a s t r i cm u s c l e ) Occipital groove (for occipital artery) J u g u l a fr o s s a (jugularforamen in its depth Mastoid foramen
Parietalbone Occipitalbone Hypoglossal canal O c c i p i t acl o n d y l e Condylar canal and fossa Basilarparl
Pharyngeal tubercle F o r a m e nm a g n u m I n f e r i o rn u c h a ll i n Externaloccipital crest S u p e r i o rn u c h a ll i n e Externaloccipital protuberance
Plate 8
Nr Bones and Ligaments
Bones of Granial Base: Superior View
Frontalbone C r o o v e f o r s u p e r i o rs a g i t t asl i n u s Frontalcrest C r o o v e f o r a n t e r i o rm e n i n e e a l F o r a m e nc e c u m Superiorsurfaceof orbital part
Ethmoidbone C r i s t ag a l l i Cribriform plate
*
tr
Anterior
t
Sphenoidbone L e s s ew r ing A n t e r i o rc l i n o i dp r o c e s s C r e a t e rw i n g C r o o v e f o r m i d d l em e n i n s e a l v e s s e l s( f r o n t a lb r a n c h e s )
,rr t ,{
fossa *
Body Jugum
I
Prechiasmaticgroove
:
t
tl
I
Middle cranial fossa
I Carotid g r o o v e ( f o r i n t . c a r o l i da . t
Clivus Temporal bone S q u a m o upsa r t part Petrous Croove for lesseroetrosalnerve Croove for greaterpetrosalnerve A r c u a t ee m i n e n c e T r i g e m i n ailm p r e s s i o n C r o o v e f o r s u p e r i o rp e t r o s a sl i n u s C r o o v e f o r s i g m o i ds i n u s
Posterior cranial fossa
Parietalbone C r o o v e f o r m i d d l em e n i n g e a l v e s s e l s( p a r i e t ahl r a n c h e s r M a s t o i da n g l e
Occipitalbone Clivus Croove for inferior oetrosal Basilap r art Croove for posterior m e n i n g e a vl e s s e l s Condyle sinus Croove f o r t r a n s v e r s e Croove f o r o c c i p i t a ls i n u s I nternal occipital crest l n t e r n a loccipital protuberance C r o o v e f o r s u p e r i o rs a g i t t asl i n u s
Bones and Ligaments
Nr Plate 9
Foramina of Granial Base: lnferiot View
Nasopalatine nerve) sph";;pi;il;" ""tldtil -----Greaterpalatinenerveandvessels -----Lesserpalatinenerveandvessels Createrpetrosalnerve-----Lesserpetrosalnerve) Mandibularnerve(Vr)t----Accessorymeningealartery) Middle menineealvessels I ----Meningealur"n.h o?-minii"di;?;r;;u;j I
Incisivefossa Greaterpalatineforamen Lesserpalatineforamen Foramenlacerum Foramen ovale
Foramenspinosum
Internalcarotidarteryl------Larotlo canal Carotidautonomicplexusf Chordatympaniof facialnerve(Vll)------
Petrotympanic
Tympanicbranchof glossopharyngeal nerve(lX)------Tympanic canaliculus Auricularbranchof vagusnerve(X)------ Mastoidcanaliculus Facialnerve(Vll)------
Glossopharyngeal nerve(lX)\ Vagusnerve(X)/ Spinalrootsofaccessorynerves(Xl))----InternaliugularveinI Inferiorp6trosalsinus)
Stylomastoid for
Jugular
Mastoidemissary vein) -- - -Mastold roramen Posterior meningeal irtery|-Hypoglossal nerve(Xll)-------
Plate I O
Hypoglossal canal
Bones and Ligaments
Foramina of Granial Base: Superior View
Foramencecum----Nasalslit Anteriorethmoidalforamen
Emissary vein to superiorsagittalsinus I J Anteriorethmoidalartery,vein, t I and nerve
Foramina of cribriformplate-----Olfactory nervebundles Posterior ethmoidalforamen----
opric canar
ljl"., I 3Bilt.n:i#:
Maxillarynerve(Vz)
Foramenrotundum--amenovale--
vein, Posterior ethmoidalartery, and nerve
( Mandibularnerve(Vr) - { Accessorymeningealartery ( Lesserpetrosalnerve(occasionally)
Foramen spinosum
I M:11i"rg:tffi?13?'fl1"Tfl,j3',".",
(inconstant) foramen(of Vesalius) Sphenoidemissary
Carotidcanalfor
- { Internalcarotidartery I Internalcarotidnerveplexus
Hiatusfor
Lesserpetrosalnerve
Hiatusfor
Createrpetrosalnerve
Internalacousticmeatus------{ Externalopeningof ----vestibular'aqueduct
{ Facialnerve(Vll) Vestibulocochlear nerve(Vlll) ( Labyrinthineartery Endolymphatic duct
--- Emissary Mastoidforamen(inconstant) vein(andoccasional branchof occipitalartery)
meningeal ''(' - - - - I tl:1:t::.:and pharyngeal branch condylarcanal(inconstant) artery I of ascending Hypoglossal canal------
nerve(Xll) Hypoglossal
4{F Bones and Ligaments
Plate I t
Skull of Newborn
Lateralview
Anteriorfontanelle
Sphenoidal fontanelle
Parietal bone Tuber(eminence) suture Squamous
Frontalbone part Squamous Supraorbital notch(foramen)
Posteriorfontanelle Lambdoidsuture
Ethmoidbone Anteriorethmoidal foramen Orbitalplate
bone Mastoidfontanelle
Temporalbone
Maxilla Infraorbital foramen Zygomaticbone Zygomaticofacial foramen Palatinebone Pyramidal
part fissure Petrosquamous Sphenoid bone Greaterwing Lateralplateof pterygoidprocess Hamulusof medial plateof pterygoid process
Petrouspart (mastoidprocessabsent) Tympanicpart (bony external acousticmeatusabsent) al (vestibular) window Round(cochlear)window Styloidprocess Mandibularfossa Zygomaticprocess
Frontalbone Anteriorfontanelle
Coronalsuture Parietalbone Sagittal suture
Posteriorfontanelle
Occipital bone
Lambdoidsuture
*{r Plate 12
Bones and Ligaments
Bony Framework of Head and Neck Temporalbone S p h e n o i db o n e Temporalfossa Zygomatic arch C o n d y l a rp r o c e s so f m a n d i b l e M a n d i b u l a rn o t c h Coronoid orocessof mandible Lateralpterygoid plate (broken line)
Hamulusof medialpterygoidplate(broken/ine)
Mastoid process External a c o u s t im c eatus A t l a s( C 1 ) Styloidprocess A x i s( C 2 )
raphe(brokenli ne) Pterygomandibular ( Ramus M a n d i b l e{ A n g l e ( BodyS t y l o h y o i dl i g a m e n t
Stylomandibular ligament
( Bodv H v o i db o n e{ L e s s bhro r n( C r e a t ehr o r n
C3 vertebra
Epiglottis Thyroid cartilage C r i c o i dc a r t i l a g e Trachea
C7 vertebra
Tl vertebra 1st rib
2nd cervicalto 1stthoracicvertebrae: right lateralview a.
Dens* Suoeriorarticularfacet Foramen um transverSafl Spinous
processes
Articularpillarformed by articularprocessesand interarticularparts (parsinterarticularis)
Spinousprocessof C7 (vertebraprominens)
Bones and Ligaments
Intervertebral f o r a m i n af o r spinalnerves
for spinal nerve In transverse process Zygapophyseal Cervical vertebrae (spine): lateral radiograph (facet)joints SpinousProcess(axis) S Transverseprocess T V P S p i n o u sp r o c e s so f C Z ( v e r t e b r aP r o m i n e n s ) Zygapophyseal(facet)joint Z Costalfacets Bodieso{ cervicalvertebrae 1-7 (for l st rib) ... Cervicalcurvature r-r Vertebral canal
Plate t 3
Granial Base: Pterygoid Fossae
Posteriorview
External occipitalprotuberance
S u p e r i onr u c h alli n e
External occipitalcrest
Nasalseptum Choana(posteriornasal aperture)
lnferior nuchal line F o r a m e nm a g n u m lnferior orbital fissure
astoid foramen Occipitomastoid suIUre al condyle
Mastoid proC€ss-
Lateralpterygoidplate Medialpterygoidplate
Styloidprocess Pterygoidfossa Zygomaticarch
Scaphoidfossa Pyramidalprocessof oalatinebone
Horizontal plate of palatinebone Inferior concha
Pterygoidhamulus
Tuberosity of maxilla processof maxilla Palatine
Alveolar orocessof maxilla
lncisivefossa
Cfd4/* Inferolateral view S p i n eo f s p h e n o i db o n e F o r a m e ns p i n o s u m Foramenovale
\ _,
Sphenopalatineforamen Pterygopalatinefossa Choanae (posteriornares)
Tuberosityof maxilla Infratemporalfossa Alveolar processof maxilla
Plate 14
Pyramidalprocessof palatinebone
*{r
Bones and Ligaments
Mandible
Head
Attachmentsfor major musclesof mastication
Lateralpterygoid Pterygoidfovea Neck
Condylar process Coronoid process
M a n d i b u l a rn o t c h Lingula
Temporalis
Attachmentsfor accessorvmusclesof mastication
Mylohyoid groove
Mandibular,,TemPoralis
O b l i q u el i n e Buccinator S u b m a n d i b u lfaors s a Mylohyoid line
S u b l i n g u faol s s a Interalveolar sepra
Masseter
Alveolar part (crest) Mental foramen Mental protuberance
M e n t atl u b e r c l e B a s eo f m a n d i b l e
Mandibleof adult: anterolateralsuperiorview Body l-ateralpterygoid
Coronoid process Head Neck
C o n d y l apr r o c e s s L i n g ul a
M a n d i b u l a rn o t c h
M a n d i b u l a rf o r a m e n groove
Pterygoidfovea
Temporalis
4{F
M y l o h y o i dl i n e
\Angle Medialpterygoid S u b m a n d i b u lfaors s a Digastric fossa Digastric,anteriorbelly M e n t asl p i n e s( g e n i atlu b e r c l e s )
Mandibleof adult: left posteriorview
Bones and Ligaments
Mandibleof aged person(edentulous)
Plate 15
Temporomandibular Joint
Lateralview Jointcapsule Lateral(temporomandibular) ligament S p h e n o m a n d i b ulliagra m e n t Sphenomandibular ligamen t (phantom\ Styloidprocess Stylomandibular ligament Mandibularnerve
Jointcapsule M i d d l em e n i n g e a l artery Auriculotemporal nerve Maxillaryartery Inferioralveolar Lingualnerve
S p h e n o m a n d i b ulliagra m e n t S t y l o m a n d i b ul iagra m e n t Mandibularfossa Articulardisc Articulartubercle l o i n tc a p s u l e
Medialview and mylohyoidnerve
faws closed
faws widely openeo ( h i n g ea n dg l i d i n g actioncombined)
Plate 16
4{tr Bones and Ligaments
Gervical Vertebrae: Atlas and Axis
t e r i o ra r t i c u l a r facet (for anterior arch of atlas)
Articularfacet for dens
Pedicle
Transverse process
S u p e r i o ra r t i c u l a r facet for atlas
Transverse foramen
Interarticular parr
Vertebral foramen
Suoeriorarticularsurface of lateralmassfor o c c i p i t a lc o n d y l e
Posteriorarch
Posterior tubercle
lnferior articular facet for C3
Croove for vertebralartery
Axis(C2):anteriorview
Atlas(C1):superiorview
Posterior tubercle
Posteriorarch
Dens Superiorarticular facet for atlas
Vertebral foramen
Transverse
P o s t e r i oarr t i c u l a r facet(fortransverse ligamentof atlas)
process
Transverse
lnterarticular parl
Transverse foramen l n f e r i o ra r t i c u l a r surfaceof lateral massfor axis
Articularfacet for dens Anteriorarch
lnferior articular
process
Anteriortubercle
A x i s ( C 2 ) : p o s t e r o s u P e r i o vr l e w
Atlas(Cl): inferiorview
Superior a r t i c ul a r surface for occipital condyle
Spinousprocess
A t l a s( C 1 )
Posterior articularfacet (fortransverse ligament of atlas)
n{r Bones and Ligaments
Radiosraphof atlantoaxialioint (openlnduth odontoidview) of atlas(C1vertebra) masses A Lateral D Dens of axis (C2 vertebra)
Plate 17
Gervical Vertebrae (continuedl
Inferioraspectof C3 and superioraspectof C4 showine the sitesof the facetand uniovertebialarticulations "
c3
Bifidspinousprocess
lnferior aspect
Lamina
Inferiorarticularprocessandfacet
Vertebral foramen Pedicle
Foramentransversarium Costallamella Area for articulationof left uncinate processof C4
Vertebralbody
.{ Left uncinate process
Articularsurfaceof rightuncinateprocess
Superiorarticularprocessand facet
Groove for spinal nerve (C4)
c4
Inferiorarticularprocess
Superioraspect
7th cervicalvertebra:anteriorview
lamella
Reduplicated foramentransversarium ncrnateprocess
Articularsurface
Inferior articular facet
Articularsurface
B o n ys p i c u l e dividingforamen
Body Foramentransversarium
Posterior tubercle) ( | ransverse Anteriortubercle( process ( r n c o n s p r c u o u s) ) 7th cervicalvertebra(vertebraprominens):superiorview Body
Articularsurfaceof uncinateorocess
Uncinate orocess
Costallamella Foramen t transversarium I n c o n s p i c u oa un s t e r i otru b e r c l e (transverse process) Pedicle
(reduplicated) Foramen transversarium Croovefor C7 process(posteriortubercle) Transverse Superiorarticularprocessandfacet Inferiorarticularprocess
Lamina
Vertebral foramen Spinousprocess
*The foramina transversariaof C7 transmit vertebral veins,but notthe vertebral artery,and areasymmetricalin this specimen
Plate | 8
eh4s/*
Bones and Ligaments
Gervical Vertebrae: Uncovertebral Joints
Cervicalvertebrae:antenorvrew Densof axis Anteriortubercleof atlas Anterior arch of atlas
m transversariu Foramen (forC3 spinalnerve) foramen Intervertebral disc lntervertebral Vertebralbody lnferiorarticularprocess(C3)
A x i s( C 2 )
S u p e r i oar r t i c u l aprr o c e s (sC 4 ) Groovefor spinalnerve joint (cleft)of Luschka Siteof uncovertebral Transverseprocess
Carotidtubercle
Articularcartilageon dens for median atlantoaxialjoint complex
Lateralatlantoaxial ioint Uncinate processes
Facet(zygapophyseal) joint between C2 and C3
Vertebra prominens Axis (C2)
Firstthoracic vertebra (T1)
Foramentransversarium Uncinate processes A n u l u sf i b r o s u s
joints(clefts)of Luschka Uncovertebral N u c l e u sp u l p o s u s process lransverse lntervertebral foramen(forC7 spinalnerve) Vertebralbody (C7) joints of the cervicalspine:anteriorview The uncovertebral (C3 to C7 havebeensectionedcoronallyto exposethe loints)
|\
C(d4/*
Bones and Ligaments
\
Plate 19
Degenerative Ghanges in the Gervical vertebrae
A t l a s( C 1 )
Degenerativechangesin the cervical spine (ankylosingspondylitis)
A x i s( C 2 ) C3 vertebralbody (sectioned in coronalplane)
Complete transversecleft i n i n t e r v e r t e b r adli s c
Uncovertebraljoint with cleft formation
Spreadof cleft formation into centralportion of intervertebral disc with age leadingto progressive degenerativechangesin the disc
Deformed vertebralbodies a n d l i p p i n go f v e r t e b r a m l argins
Spondylophytes(osteophytes) on uncinateprocesses
6/Fd4*/* Narrowine of intervertebralforamen
C7 vertebra
S u p e r i oar r t i c u l aprr o c e s s Advancedankylosingspondylitiswith uncovertebral arthrosisin C4 and C5
Advanced spondylophyte(osteophyte) formation on uncinateprocesses
Vertebralbody joint fused due to extensivespondylophytei Uncovertebra.l formation and ossification Potentialfor compressionof vertebralartery within foramen transversarium
Plate 2O
Facetjoint ossified due to advanced osteoarthriticchange Markedly narrowed intervertebralforamen may lead to compression of spinal nerve
Inferiorarticular processwith facet Croove for spinal nerve on transverseprocess
S p i n o u ps r o c e s s
Bones and Ligaments
External Graniocervical Ligaments
Anteriorview partof occipitalbone Basilar Pharyngeal tubercle membrane Anterioratlantooccipital Capsuleof atlantooccipital .ioint membrane Posterior atlantooccipital
A t l a s( C 1 )
joint (openedup) Lateralatlantoaxial l ament A n t e r i o lro n g i t u d i n lai g
Caosuleof lateral atlantoaxialjoint
Posteriorview
A x i s( C 2 )
Posterioratlantooccipitalmembrane
Capsuleof zygapophyseal joint (C3-4)
Capsuleof atlan tooccipital
Transverse process o f a t l a s( C 1 )
Anterior atlantooccipitalmembrane
Capsuleof lateral joint atlantoaxial
Capsuleof atlantooccipital joint
A x i s( C 2 )
Posterior atlantooccipital memDrane
artery
Suboccipitalnerve (dorsal r a m u so f C l s p i n a ln e r v e )
Ligamentaflava o f a x i s( C 2 ) L i g a m e n t u mn u c h a e -
discs(C2-3 and C3-4) Intervertebral
Zygapophysealjoints (C4-5 and cs-6) Anterior tubercle of C6 vertebra (carotidtubercle)
S p i n o ups r o c e s s of C7 vertebra ( v e r t e b rpar o m i n e n s )
Vertebralartery T1 vertebra
4{tr Rightlateralview
Bones and Ligaments
Plate 21
lnternal Graniocervical Ligaments
Clivus(surface feature) of basilarpartof occipitalbone
Upper part of vertebralcanalwith spinousprocesses and partsof vertebralarchesremovedto expose ligamentson posteriorvertebralbodies:posteriorview
Tectorialmembrane Capsuleof
partof tectorialmembrane Deeper(accessory)
joint
ligament Posterior longitudinal
A t l a s( C 1 )
Capsuleof lateral atlantoaxialjoint
Alarligaments
Axis(C2) Capsuleof zygapophyseal joint
(c2-3\
A t l a s( C 1 ) Superiorlongitudinal band Cruciate ligament
Transverse ligamentof atlas Inferiorlongitudinal band
partof tectorialmembrane Deeper(accessory) Principal part of tectorial membrane removed to expose deeper ligaments: posterior view
Apicalligamentof dens Alarligament A t l a s( C 1 )
Posteriorarticularfacetof dens(for transverse ligamentof atlas)
Alarligament
Anteriortubercleof atlas Svnovialcavities
Axis(C2)
Cruciateligamentremovedto show deepestligaments:posteriorview
*{r Plate 22
ligament Transverse of atlas
Median atlantoaxialjoint: superiorview
Bones and Ligaments
Superficial Arteries and Veins of Face and Scalp S k i na n d Scalp
t
t is s u e subcutaneou E p i c r a n iaapl o n e u r o s i s (galea poneurotica) (cut to revea/skull)
Parietalemissaryvein
Middle temporal artery and Zygomaticoorbitalartery Transversefacial artery and vein
Supraorbital arteryand vein Supratrochlear a r t e r ya n dv e i n Nasofrontalvein Dorsal nasal artery and vein Zygomaticotemporal a r t e r ya n d v e i n
Angular arrery a n dv e i n Zygomaticofacialartery and vein
Mastoidemissary v e i na n dm e n i n g e a l branchof occipital artery(posterior artery) meningeal
Infraorbital a r t e r ya n d
ipitalartery
Deep facialvein (from pterygoid plexus)
and vein (cut)
Posterior auricular arteryand vein
Facialartery and
jugularvein(cut) External vein Retromandibular Common facial vein
I n t e r n aj ul g u l avr e i n lnternalcarotidartery Externalcarotid artery Common carotid arterY Lingualartery and vein
Sourcesof arterialsupplyof face Black: from internalcarotid artery (via ophthalmic artery) Red: from externalcarotid artery
Superficial Face
Nr Plate 23
Gutaneous Nerves of Head and Neck SeealsoPlates 32, 36, 45,46,122
A u r i c u l a rb r a n c h o f v a g u sn e r v e ( X )
Fromophthalmicdivision of trigeminalnerve(V,) S u p r a o r b i tnael r v e Supratrochlearnerve
Medial branches of dorsalrami of cervicalspinal nerves
Palpebralbranch of lacriman l erve I n f r a t r o c h l e anr e r v e
Creater occipital n e r v e( C 2 )
External nasalbranchof a n t e r i oer t h m o i d anl e r v e
3rd occipital n e r v e( C 3 )
Frommaxillarydivision of trigeminalnerve(Vr)
F r o m4 t h , 5 t h , 6th, and 7th nervesIn successton below
I n f r a o r b i tn ae l rve Zygomaticofacialnerve Zygomaticotemporalnerve
Branchesfrom cervicalplexus Lesseroccipital n e r v e( C 2 )
Frommandibulardivision of trigeminalnerve(Vr)
Creatauricular n e r v e( C 2 ,3 )
Mentalnerve Buccalnerve
Transversecervical n e r v e( C 2 ,3 )
Auriculotemporal nerve
Supraclavicular n e r v e s( C 3 , 4 )
i Ophthalmicnerve(V,)-
i
Dorsalrami of cervicalspinal nerves
;'1
*\:" Trigeminal nerve(V)
Maxillarynerve(Vr)
N o t e : A u r i c u l a rb r a n c h of vagus nerve to externaa l coustic m e a t u sa n d s m a l l a r e ao n p o s t e r o m e d i a l s u r f a c eo f a u r i c l e
Mandibularnerve(Vr)
Branchesfrom cervicalplexus
4{tr Plale 24
Superficial Face
Facial Nerve Branches and Parotid Gland
Temporalbranches
Zygomatic branches
Parotidduct
M a i n t r u n ko f facial nerve emerging from stylomastoidforamen
Buccalbranches
M a r g i n a lm a n d i b u l a rb r a n c h Nerve to posterior belly of digastric m u s c l ea n d t o stylohyoid muscle Cervical branch
Medial pterygoid muscle
Horizontalsection Main trunk of facial ner
R a m u so f m a n d i b l e Massetermuscle
Mastoid process Parotidgland
Temoorofacialdivision
Temporalbranch
Posteriorauricularnerve Zygomatic branches Main trunk of facial nerve Nerve to posterior belly o f d i g a s t r i cm u s c l ea n d t o s t y l o h y o i dm u s c l e -
Buccalbranches
Cervicofacialdivision M a r g i n a lm a n d i b u l a rb r a n c h
*{r Superficial Face
Cervicalbranch
Plate 25
Muscles of Facial Expression: Lateral View S k i na n d
s."re subcutaneous tissue (galeaaponeurotica) aponeurosis { Epicranial Temporalfascia orbicularisoculimuscle{ o'0""' o"u Palpebral pa I Frontalbelly(frontalis) of epicranius muscle
Auricularis anteriormuscle Auricularis superiormuscle posteriormuscle Auricularis Occipitalbelly (occipitalis)of epicranius muscle
Corrugatorsupercilii muscle(frontalis and orbicularisoculi,partiallycut awa' Procerus muscle Levatorlabiisuperioris muscle Levatorlabiisuperioris alaequenasimuscle (partiallycut away)
NasalisJ Trrnru"rr"p.rt muscle( Alarnarty
Parotid fascia
Depressorsepti nasimuscle
Massetericfascia
Orbicularis orismuscle Zygomaticus minormuscle
Investing layerof (deep)cervicalfascia
Zygomaticus majormuscle Orbicularis orismuscle Mentalismuscle Depressor labiiinferiorismuscle
Deltoid fascia
Depressor anguliorismuscle Buccinator Risorius
4{F
Platvsma muscle Sternum Clavicle
Pectoralismajorfascia
Plate 26
Superficial Face
Muscles of Neck Lateral View
Parotidgland (cut) Ramusof mandible
Massetermuscle
S u b m a n d i b u lgalra n d muscle Hyoglossus
muscle Styloglossus
Mylohyoidmuscle Mastoidprocess Styloidprocess muscle Stylohyoid Body of mandible
D i g a s t r im c uscle (posterior belly) Middlepharyngeal muscle constrictor
Digastric muscle (anterior belly)
Longuscapitismuscle S p l e n i um s uscle muscl Sternocleidomastoid
Hyoid bone
Levatorscapulaemuscle
Thyrohyoidmuscle
/ \ Posterior
Omohyoidmuscle (superiorbelly)
Scalenemuscles{ Middle ( Anterior
muscte
Brachialplexus Inferiorpharyngeal muscle constrictor
muscle Trapezius Acromion
Sternothyroid muscle
Deltoidmuscle
Omohvoidmuscle(inferiorbelly) Clavicle
*{r Neck
maiormusclei Pectoralis
Manubrium of sternum Sternalhead
) muscle ) Sternocleidomastoid
head Clavicular )
Plate 27
Muscles of Neck Anterior View
gastricmuscle(anteriorbelly)
Masseter muscle
Mylohyoidmuscle Parotidgland S u b m a n d i b u lgalra n d Platysma muscle (cutaway)
Fibrousloopfor intermediate digastrictendon
Mastoidprocess
Stylohyoid muscle Digastricmuscle (posterior belly)
Hyoid bone
External carotidarterv
Carotid sheath
Internaljugularvein Fasciaof infrahyoid musclesand cut edge
Thyrohyoidmuscle muscle (superiorbelly)
Thyroidcartilage
Sternohyoid muscle
Investing layerof (deep) cervicalfasciaand cut edge
Sternothyroid muscle Scalenemuscles
Cricoid cartilage
Trapezius muscle Deltoidmuscle
icle
Omohvoidmuscle (inferiorbelly) Pretracheal layerof Pectoralismajor muscle
(deep) cervicalfasciaover
thyroidglandand trachea Clavicular head Sternalhead
Suprasternal space(of Burns) Manubriumof sternurh
Sternocleidomastoid muscle
Jugularnotch
4{r Plate 28
Neck
lnfrahyoid and Suprahyoid Muscles
Digastricmuscle(anteriorbelly) Mylohyoidmuscle
Thyrohyoidmembrane
muscle Hyoglossus External carotidartery
muscle Stylohyoid
Internal.iugular vein
Digastricmuscle (posteriorbelly)
Thyrohyoidmuscle
Fibrousloopfor intermediate tendon digastric
Thyroidcartilage O m o h y o i dm u s c l e (superiorbelly)
andomohyoid Sternohyoid muscles(cut)
muscle Sternohyoid
Thyrohyoidmuscle Median cricothyroid ligament
thyroidcartilage Cricoid cartilage
muscle Cricothvroid
Scalene muscles
muscle Sternothyroid mohyoid muscle (superior belly)(cut)
Trapezius muscle
Thyroidgland
Omohyoidmuscle (inferiorbelly)
muscle(cut) Sternohyoid Clavicle
Nr Styloidprocess Mastoid process
muscle Stylohyoid
Mylohyoidmuscle
Digastricmuscle(posteriorbelly)
Digastricmuscle(anteriorbelly) Ceniohvoid muscle
Thyrohyoidmuscle ue lineof thyroidcartilage
muscle Sternohyoid Omohyoidmuscle (superiorbelly)
Infrahyoidand suprahyoidmusclesand their action:schema
Omohyoidmuscle(inferiorbelly)
Sternothyroid muscle Sternum
Plate 29
Scalene and Prevertebral Muscles
Basilarpartof occipitalbone
Longuscapitismuscle(cut)
condyle
process of Jugular occipital bone
Rectuscapitis anteriormuscle
Mastoidprocess
Rectuscapitis lateralis muscle
Styloidprocess
processof atlas(C1) Transverse
L o n g u sc a p i t i sm u s c l e
Posteriortubercle of
processof axis(C transverse Slipsof originof anterior scalenemuscle(cut)
Longuscollimuscle
Slipsof originof posterior scalenemuscle Anterior Scalene muscles
Middle
I S."t"n" PosteriorI muscles
Middle
Posterior
Phrenic
plexus Brachial
4{tr + f:i'
Subclavian artery Subclavianveiri
Rightcommoncarotidartery
Posterior tubercleof transverse processof C7 vertebra
I n t e r n aj ul g u l avr e i n
Plate 3O
Neck
Superficial Veins and Gutaneous Nerves of Neck
muscle(cut) Platysma Facialarteryand vein
muscle Digastric (anterior belly)
Marginalmandibular branch offacial nerve
gland Submandibular Mylohyoidmuscle
Hyoid bone Parotid gland Retromandibularvein
Omohyoidmuscle(cut) Externalcarotid artery
I n t e r n a l j u g u l avre i n
muscle Thyrohyoid
Externaljugularvein
muscle(cut) Sternocleidomastoid
Anteriorjugularvein
thyroidarteryandvein Superior lnternaljugularvein
Communicatingvein
Common carotid artery Great auricularnerve
muscle Sternohyoid
Thyroidcartilage
id muscle Ansa cervicalis
cervicalnerves Transverse
Omohyoidmuscle (superior belly)(cut)
Thyroid gland
Omohyoidmuscle (inferiorbelly) muscle Trapezius
plexus Brachial
muscle(cut) Platysma
Pectoralismajor muscle
nerves Supraclavicular muscle Sternocleidomastoid
Clavicle muscle(cut) Sternocleidomastoid Sternothyroidmuscle
4{tr Neck
Plate 31
Gervical Plexus in Situ SeealsoPlates 127-129.199
Parotidgland
Creatauricular nerve
Facialarterv and vein
Lesseroccipital nerve
S u b m a n d i b u lgalra n d Mylohyoidmuscle
Sternocleidomastoid muscfe (cut, turned up)
Hypoglossalnerve (Xll)
Stylohyoid muscle
Digastricmuscle
Digastricmuscle (posterior belly)
( a n t e r i obr e l l y )
Lingualartery
C2 spinalnerve (ventralramus)
Externalcarotid art
Accessory nerve (Xl)
Internalcarotid artery
C 3 s p i n anl e r v e (ventralramus)
Thyrohyoidmuscle Superiorthyroidartery
Levatorscapulae muscle
O m o h y o i d m u s c l e( s u p e r i o rb e l l y )
M i d d l e s c a l e n em u s c l e Anterior scalenemuscle
C 5 s p i n anl e r v e (ventralramus)
Sternohyoidmuscle
ialcervical
Sternothyroidmuscle
artery
I n t e r n ajlu g u l a rv e i n
Phrenicnerve
Common carotid artery
Omohyoid muscle (inferior belly)(cut)
Inferiorthvroid arterv Vagusnerve (X)
plexus Brachial Dorsalscapular artery Suprascapular artery
Vertebral artery
Thyrocervical trunk
Nr
Subclavianartery and vei Accessory
Cervicalplexus:schema (S= grayramus fromsuperior
Hypoglossal nerve
Creat auricularnerve Lesseroccioital nerve
cervicalsympatheticganglion)
Torectuscapitislateralis, longuscapitis, andrectus caoitisanteriormuscles
To geniohyoid muscle To thyrohyoid muscle C o m m u n i c a t i o nt o v a g u sn e Transversecervical nerves
To omohyoid muscle To longuscapitisand l o n g u sc o l l i m u s c l e s
Ansa cervicalis To sternothyroidmuscle To sternohyoidmuscle To omohyoid muscle (inferior bellv)
To scaleneand levator s c a p u l a em u s c l e s
Supraclavicularnerves P h r e n i cn e r v e
Plate 32
Neck
Subclavian Artery
Rightanteriordissection
Thyroidgland(reflected)
l n t e r n a jl u g u l a rv e i Common carotid artery
ganglion Middlecervicalsympathetic
Ascendingcervicalartery
Vagusnerve(X)
P h r e n i cn e r v e A n t e r i o rs c a l e n em u s c l e
Vertebralartery
Inferior thvroid arterv
Commoncarotidartery
Superficialcervical artery
laryngeal nerve Recurrent
S u p r a s c a p ual ar rt e r y Dorsalscapularartery
trunk Brachiocephalic
Costocervical
jugularvein(cut) Internal
Thyrocervical trunk Subclavianartery and vei
cervicalartery(-30%) Commonorigin of superficialcervicaland dorsalscapulararteriesfrom transverse Superficialbranch of transversecervical artery (superficialcervical Inferiorthyroid artery Deep branch of transversecervical artery (dorsalscapularartery) Transversecervicalartery
Thyrocervical trunk artery Suprascapular
Rightobliqueschematicview Vertebralartery Deep cervical artery (ascending to anastomosewith descending branch of occipital artery)
Rightexternalcarotidartery Rightinternalcarotidartery Ascending cervicalartery
Suoerficialcervical arte Inferiorthyroid artery
Costocervical trunk
Superficialcervicalartery
S u p r e m (es u p e r i o r ) intercostal artery
Right common carotid artery
Dorsalscapularartery S u p e r i o ra n d i n f e r i o r transversescapularligaments Acromion
trunk Thyrocervical
t
Right subclavianartery (1st part medial to, 2nd part posterior to, 3rd part lateralto anterior scalenemuscle)
6
Dorsalscapularartery
B r a c h i o c e p h atlriuc n k artery Suprascapular
S u p r a s c a p u l aar
Aorticarch
Axillaryartery
artery Internalthoracic(mammary)
1 s ta n d2 n d p o s t e r i o r intercostal arteries
1 s t , 2 n da,n d3 r d a n t e r i oirn t e r c o s t a rl t e r i e s Circumflex scapularartery
Neck
4{tr C/Fd4/^
S u b s c a p u laarrt e r y horacodorsalartery
Plate 33
Garotid Arteries
Parotidspace (bed):right lateral dissection
Superficialtemporal artery
Transverse facialarterv Maxillaryartery
Mastoid process
External carotidarterv
Styloidprocess
Posterior auriculararterV
Facialnerve (Vll) (cut
Clossopharyngealnerve (lX)
Sternocleidomastoid muscle(cut)
Stylohyoid muscle
Digastricmuscle(posterior belly)(cut)
Hypoglossalnerve (Xll)
Occipital artery and sternocleidomastoidbrancn
Facialartery Lingualartery
Accessory nerve (Xl)
Mylohyoidmuscle H y o g l o s s umsu s c l e Vagus nerve (X)
Digastricmuscle (anteriorbelly)
Ascending pharyngeal artery
Hyoid bone
Carotidbranchof glossopharyngeal nerve (lX) and carotid body
Branchto thyrohyoidmuscle (fromansacervicalis)
Internalcarotid Internaljugular vein
Superiorlaryngeal artery Superiorthyroidartery External carotidartery
Superficialtemporal artery Transversefacial artery
Disastricmuscle (phantom)
Commoncarotidarterv
Maxillaryartery
Posterior auricularartery Occipitalartery Descending branch/ Sternocleidomastoid branch Internalcarotid artery Externalcarotid
Facialartery
Lingualartery Ascendingpharyngealartery
Superiorthyroidarteryand superiorlaryngeal branch Omohyoid muscle (phantom)
Common carotid arter
Externalcarotidbranches: schema Thyrocervicaltrunk
4{tr Plate 34
Neck
Fascial Layers of Neck seePlates 69-71 sheath ofcarotid Forcontents layer of deep ce.rvicalfascia
Superficial
P l a t v s m am u s c l e S t e r n o h y o i dm u s c l e Trachea
Infrahyoidfa
Sternothyroidmuscle T h y r o i dg l a n d
Pretracheal(visceral)fascia
Esophagus Omohyoid muscle 'Sternocleidomastoid muscle
Buccopharyngeal ( v i s c e r a lf)a s c i a Carotid sheath
Recurrentlaryngeal nerve
S u b c u t a n e o tui s s u e \ -----'-\
Common carotid artery I n t e r n a l u g u l a rv e i n Vagus nerve (X)
Superficial (investing l a)y e r of deep cervical fasciaroofing p o s t e r i o rt r i a n g l e
P h r e n i cn e r v e Anterior scalenemuscle S y m p a t h e t i ct r u n k
Fatin posterior triangle
S p i n a ln e r v e Middleand posterior s c a l e n em u s c l e s L o n g u sc o l l i m u s c l e
PrevertebralIayer of (deep) cervicalfascia
Levatorscapulaemuscle Trapeziusmuscle Deeo cervical muscles
Alar fascia Retropharyngeal space
Crosssection
Subcutaneous tissue
Cervicalvertebra (CZ)
Sagittal section
Mandible Pharynx
C e n i o h y o i dm u s c l e
Buccopharyngeal(visceral) fascia
Ceniohyoid fascia lnvestinglayer of (deep) cervicalfascia
Retropharyngeal space
F a s c i ao f i n f r a h y o i dm u s c l e s Alar fascia Pretracheal(visceral) fascia Prevertebralfascia
Thyroid gland
Trachea
S u b c u t a n e o u tsi s s u e
Esophagus
asternalspace (of Burns)
:w'-'-
'
M a n u b r i u mo f s t e r n u m Aorta Pericardium
Neck
4{F Plate 35
Nose
Anterolateralview
Inferiorview Major alar cartilage
Frontalbone N a s a lb o n e s
Lateral
Frontalprocessof maxilla
Medial crus
Lateralprocessof septal nasalcartilages Septalcartilage M i n o r a l a rc a r t i l a g e Accessory nasalcartilage
Alar fibrofatty trssue
Nasalseptalcartilage A n t e r i o rn a s a ls p i n eo f m
Nasalseptal cartilage
Alarfibrofattytis Infraorbitalforamen
Anterior n a s asl p i n e of maxilla Intermaxillary suture
F r o n t a l i sm u s c l e
Supraorbital arteryand ner Supratrochleararterv and
P r o c e r um s uscle C o r r u g a t osru p e r c i lm ii uscle Dorsal nasalarl Infratrochlearnerve Angular artery Externalnasalartery and nerve Nasalismuscle (transversepart Infraorbitalartery and nerve Lateralnasalartery Transversefacial artery N a s a l i sm u s c l e( a l a rp a r t ) Depressorsepti nasi muscte
O r b i c u l a ro i sr i sm u s c l e Facialartery
Nry Plate 36
Nasal Region
Lateral Wall of Nasal Gavity
Sohenoethmoidal recess
F r o n t asl i n u s
of s il n u s sphenoida
S u p e r i o rn a s a lc o n c h a Superior nasalmeatus
Hypophysis ( p i t u i t a rgyl a n d ) i n s e l l at u r c i c a
M i d d l e n a s a lc o n c h a Agger nasi
S p h e n o i d sa il n u s
Atrium of middle nasalmeatus
Pharyngeal tonsil (adenoidif enlarged) Basilarpartof occipitalbone Pharyngeal raphe
M i d d l e n a s a lm e a t u s Inferior nasalconcha (turbinate) L i m e nn a s i
Nasalvestibule Torustubarius
lnferior nasalme
O p e n i n go f a u d i t o r y (pharyngotympanic, E u s t a c h i atnu)b e recess Pharyngeal
Palatineprocessof maxilla I n c i s i v ec a n a l Tongue
Horizontalplateof palatinb eone Softpalate M i d d l e n a s a lc o n c h a M i d d l e n a s a lm e a t u s
Bulging septum rway to nasopharynx
*{ry
Inferior nasalconcha Inferior nasalmeatus Floor of nasalcavity
F r o n t a sl i n u
Cribriform plate of ethmoid bone P r o b e i n o p e n i n go f s p h e n o i d asl i n u s
P r o b e p a s s i n gf r o m s e m i l u n a r h i a t u si n t o f r o n t a ls i n u sv i a frontonasalduct
S p h e n o i d sa il n u s Suoeriornasalmeatus w i t h o p e n i n go f p o s t e r i o r
Middle nasalconcha (cut surface)
e t h m o i d acle l l s
E t h m o i d ablu l l a
part Basilar of occipitalbone
O p e n i n g so f m i d d l ee t h m o i d a lc e l l s S e m i l u n ah r i a t u s( o s t e o m e a t aul n i t ) w i t h o p e n i n go f a n t e r i o r e t h m o i d a la i r c e l l s U n c i n a t ep r o c e s s
Torustubarius ingof auditory
(pharyngotympanic, E u s t a c h i atnu)b e
l n f e r i o rn a s a lc o n c h a (cut surface)
Anterior arch
of atlas(C1vertebra)
O p e n i n go f n a s o l a c r i m a l lnferior nasalmeatus
Nasal Region
O p e n i n go f m a x i l l a r ys i n u s
Densof axis (C2vertebra)
Plate 37
Lateral Wall of Nasal Gavity (continuedf
Lacrimalbone
Middlenasalconcha Uncinate process
Cribriformplate
Ethmoid bone
S u p e r i o rn a s a lc o n c h a Highest nasalconcha
recess Sohenoethmoidal
Nasalbone
Sphenopalatine foramen
Agger nasi
partof Basilar occipitalbone
Lateralprocessof nasalseptalcartilage Major alar cartilage
Alarfibrofattytissue
Sphenoidal sinus Medial and Lateral S p h e n o i db o n e platesof pterygoid process Pterygoid hamulus
Frontalprocess
Anteriornasalspin Maxilla
Incisivecanal Palatineprocess Alveolar process
Inferior nasalconcha
E t h m o i d ablu l l a Frontalsi Opening of frontonasalcanal
O p e n i n go f m i d d l ee t h m o i d a lc e l l s
periornasalconcha(cutaway) gs of posteriorethmoidal cells
Middle nasalconcha (cutaway)
ingof sphenoidal sinus I n f u n d i b u l u ml e a d i n gt o frontonasalcanal
Semilunar hiatus(osteomeatal unit)
O p e n i n g si n t o m a x i l l a r ys i n u s
foramen Sphenopalatine
with opening of anterior e t h m o i d a la i r c e l l s Uncinate process lnferior nasalconcha (cut away)
processof Ethmoidal inferiornasalconcha Lesserpalatineforamen
O p e n i n go f n a s o l a c r i m a l Creater palatineforamen
Plate 38
4{tr
Nasal Region
Medial Wall of Nasal Gavity (Nasal Septum|
Falxcerebri Frontal
m plateof ethmoidbone Dura mater
Sphenoidal sin
Sellaturcica Nasal Choanae(posteriornasalapertures ) Lateralprocessof nasalseptalcartilage
alarcartilage Torustubarius Nasalvestibule Anteriornasalspi Incisivecanal Oral cavity Tongue Soft
4{tr
Cristagalli Cribriformplate
Ethmoidbone
Nasal Vomer Vomerine groove (for nasopalatine nerve
andvessels) Septalcartila Majoralar cartilage(medialcrus)
Anteriornasal NasalcrestIncisivecanal, Palatine oroce
Nasal Region
Createrpalatineforamen
Plate 39
Maxillary Artery
A n t e r i o r Deeptemporalarteriesand nerves Posterior Masseteric arteryand nerve
Lateralpterygoid artery and muscle
Supraorbital artery
Lateralligament of
Supratrochlear artery
joint temporomandibular
Ophthalmicartery
Middle meningealartery
Auriculotemporal nerve
Dorsalnasalartery
Maxillaryartery
Angularartery Infraorbital arterv
\
Superficial temporalartery Posterior auricular artery Facialnerve Inferioralveolar artery and nerve
Buccalarteryand nerve
S p h e n o m a n d i b ulliagra m e n t
Medial pterygoid artery and muscle
Mylohyoid nerve and branch of inferior alveolarartery
P t e r y g o m a n d i b urlaapr h e
Digastricmuscle(posteriorbelly)
Lingualnerve
muscle Stylohyoid
Facialartery
External carotidarterv
Mentalbranchof inferioralveolararl S u b m e n t a lr t e r y
Sphenopalatine artery Posterior lateralnasalbranch
Facialartery Lingualartery
Arteryof pterygoidcanal Pharyngealartery Sphenopalatineforamen
Infraorbital artery
Anterior I Oeeptemporalarteries I and nerves Posterior Accessory meningeal artery M i d d l e m e n i n g e a al r t e r y
Anteriortympanicartery Deepauricularartery Auriculotemporal nerve
Posterior suoerior alveolarartery Sphenopalatine artery Posterior septalbranches Creater (descending) palatineartery
Buccalartery Superficial temporalartery pharyngeal Ascending artery
Anastomosis in incisivecanal Left and right
Ascendingpalatineartery
greaterpalatinearteries
Tonsillarbranches
Leftand right lesserpalatinearteries Pterygoidarteries
4{tr Plate 40
Masseteric artery Inferior alveolarartery
Tonsillar artery External carotidartery Facialartery muscle Superiorpharyngeal constrictor muscle Styloglossus
Nasal Region
Arteries of Nasal Gavity: Nasal Septum Turned Up
Nasalseptalbranchof superiorlabialbranch (of facialartery)
Nasalseptum(turnedup
Schematichinge.
betweenposterior Anastomosis septalbranchof sphenopalatine arteryand greaterpalatineartery i n i n c i s i v cea n a l Septaland lateralnasal of posterior branches ethmoidalartery
Anterior septal branch, Anterior lateralnasalbr Externalnasalbranch of anterior ethmoidal artery
ti.
N,
Posteriorseptal branchof sphenopalatine artery Sphenopalatine artery Sphenopalatine foramen
Alarbranches of lateralnasal branch (of facialartery)
Posterior lateralnasal b r a n c h eosf sphenopalatine artery Maxillary artery Anastomosisbetween posterior septal branch
External carotid artery
of sphenopalatine artery and greaterpalatine ,/ artery in incisive
Lesserpalatineforamenand artery Creater palatineartery
Createrpalatineforamenandartery
Lateralwall of nasalcavity
Nr Nasal Region
Plate 41
Nerves of Nasal Gavity: Nasal Septum TUrned Up SeealsoPlates 44,45,119
Olfactory
Nasafseptum(turned up) Schematic hinge
I n c i s i v ec a n a l
Nasopalatine n e r v e( V z )
M e d i a l i n t e r n a ln a s a l , L a t e r a il n t e r n a ln a s a l , E x t e r n anl a s a l b r a n c h e so f a nteflor ethmoidal n e r v e( V 1 )
S p h e n o p a l a t i nfeo r a m e n (dlssectedaway) I n t e r n a ln a s a l b r a n c h e so f i n fr a o r b i t a l n e r v e( V 2 )
Pterygopalatine ganglion Nerve(Vidian) o f p t e r y g o i dc a n a l
P o s t e r i o sr u p e r i o rl a t e r a ln a s a l b r a n c ho f m a x i l l a r yn e r v e ( V 2 ) I
.I N a s a lb r a n c ho f a n t e r i o rs u p e r i o r a l v e o l a rn e r v e ( V 2 )
a
C r e a t e ra n d l e s s e rp a l a t i n en e r v e s
j
P o s t e r i o irn f e r i o rl a t e r a ln a s a l b r a n c ho f g r e a t e rp a l a t i n en e r v e ( V 2 ) L e s s e rp a l a t i n en e r v e s C o m m u n i c a t i o nb e t w e e n g r e a t e rp a l a t i n ea n d n a s o p a l a t i n e n e r v e sa t i n c i s i v ec a n a l
C r e a t e rp a l a t i n en e r v e
Lateral wall of nasal cavitv
4{tr Nasal Region
Nerves of Nasal Gavity (continuedf
Distribution of olfactory mucosa(shadedblue) Nasal septum
lateral wall of nasal cavitv
External nasalbranchof anteriorethmoidalnerve(Vr) Lateralinternalnasalbranchof anteriorethmoidalnerve(Vr) Olfactorybulb m Dlateof ethmoid bone
Olfactorytract
superiorlateralnasalbranches Posterior from maxillarynerve(Vz) Maxillarynerve(V2)(sphenopalatine foramendissectedaway) Pterygopalatineganglion
Createrpetrosalnerve Deep petrosalnerve Nerve(Vidian)of pterygoidcanal Pharyngeal branchof maxillarynerve(V2) nerve(Vz)passingto septum(cut) Nasopalatine inferiorlateralnasalbranch Posterior from greaterpalatinenerve(V2)
Lateral wall of nasal cavity
bulb Cribriformplate
Olfactorynerves(l) Createi
Palatinenerves(Vz) {
Nr
Medialinternalnasalbranch of anteriorethmoidalnerve(Vr Olfactorvnerves( Nasopalatinenerve (V2 Incisivecanal
Nasalseptum
Nasal Region
Plate 43
Autonomic lnnervation of Nasal Gavity
Superiorsalivatorynucleus(parasympathetic) Facialnerve(Vll) ganglion)of facialnerve Geniculum(geniculate Createrpetrosalnerve(parasympathetic) Deep petrosalnerve(sympathetic) Nerve(Vidian)of pterygoidcanal Maxillarynerve(Vz)enteringforamenrotundum ganglionin Pterygopalatine Lateraland medialposteriorsuperior nasalbranchesin pterygopalatine fossa nerve lnfraorbital Posteriorsuperior and inferiorlateral nasalnerves (cut ends)
Tympaniccavity ternalcarotid n e r v ea n d p l e x u s
Posterior supenor alveolar nerves
Maxillary sinus
cervicalganglion Postsynaptic fibersto vessels(sympathetic) and glands(parasympathetic) of nasalcaviry maxillary sinus,and palate Preganglionicparasympatheticfi bers Postganglionicparasympatheticfi bers Preganglionicsympatheticfi bers Presynaptic sympatheticcell bodiesin intermediolateral nucleus (lateralhorn)of graymatter(T1-T5)
Plate 44
Postganglionicsympatheticfi berc
*{r ]laoal Region
Ophthalmic (Vrl and Maxillarv (V"l Nerves
C o m m u n i c a t i n gb r a n c h Posteriorethmoidal nerve
Anterior ethmoidal nerve
nerve Supraorbital Supratrochlearnerve
Long and short ciliary nerves Lacrimalgland C i l i a r yg a n g l i o n Lacrimalnerve N a s o c i l i a r yn e r v e Frontalnerve Tentorialbranch
Infratrochlearnerve (from nasociliarynerve)
branchof Cutaneous lacrimalnerve Zygomaticotemporal nerve Zygomaticofacial nerve
O p h t h a l m i cn e r v e ( V r )
External nasal branchof anterior ethmoidal nerve
Trigeminal ( s e m i l u n a rg) a n g l Trigeminal
Meningeal
branch Foramen rotundum
lnfraorbital nerve
Foramen ovare
Anteriorsuperior alveolarnerve
M a n d i b u l a rn e r v e ( V 3 )
Nasal branch
Maxillary nerve (V2) Zygomatic nerve Nerve (Vidian)of pterygoid canal Pterygopalatineganglion
Createrand lesserpalatinenerves Canglionic branchesto pterygopalatineganglion
Mucousmembrane of maxillarysinus Dental and gingivalbranches
S u p e r i odr e n t apl l e x u s Infraorbitalnerve entering infraorbitalcanal
Middlesuperioralveolarnerve Posterior superioralveolarnerve
4{tr Nasal Region
Plate 45
Mandibular Nerve (V"l SeeafsoPlates 71,122, A n t e r i o rd i v i s i o n
Lateral view
Posteriordivision
Temporalfascia t e m p o r a l i sm u s c l e
Posterior Anterior
o""o temporal nerves I
Foramenovale
Massetericnerve
M e n i n g e a lb r a n c h ateral pterygoid nerve and muscle
F o r a m e ns p i n o s u m Middle meningealartery
Auriculotemporal nerve
Posterior a u r i c u l anre r v e F a c i an l e r v e( V l l ) C h o r d at y m p a n i nerve
Buccalnerve and buccinator muscle(cut)
L i n g u a ln e r v e
Submandibular ganglion
Inferioralveolarnerve (cut) Nerve to mylohyoid
Sublingual gland
Medialpterygoidmuscle(cut) Digastricmuscle (posteriorbelly)
*{r
Mylohyoid muscle(cut)
muscle Stylohyoid
Mentalnerve
Hypoglossalnerve S u b m a n d i b u l aer l a n d
Sublingua n le r v e Trigeminal ganglion O p h t h a l m i cn e r v e ( V r) Maxillary nerve (V2 M a n d i b u l a rn e r v e ( V t )
Inferior alveolarnerve (cut) D i g a s t r i cm u s c l e( a n t e r i o rb e l l y )
{
r$' rl,
d
(geniculate Ceniculum ganglion) of facialnerve Tympaniccavity Chordatympaninerve F a c i anl e r v e( V l l )
Anterior division Tensorveli palatini nerve and muscle Otic ganglio Chorda tympani nerve Medial pterygoid nerve and muscle (cut)
l e n s o rt y m p a n i m u s c l ea n d n e r v e
Lesseroetrosalnerve nerve Auriculotemooral Maxillaryartery Mylohyoidnerve
P t e r y g o ihda m u l u s L i n g u anl e r v e
Plate 46
Inferior alveolarnerve enterinq m a n d i b u l a rf o r a m e n
Nasal Region
Nose and Paranasal Sinuses: Gross Section
Major alar cartilage Nasalvestibule lnferior nasalconcha
Nasalseptalcartilage
Facialartery Facialvein
M a x i l l a rby o n e M a x i l l a rsyi n u s S p h e n o i bd o n e Massetermuscle Coronoid processof mandible
Medialpterygoid muscle
{ Lateral pterygoid m u s c l e\
Lateralpterygoid plate
J.
Levatorveli p a l a t i nm i uscle
Cartilage of auditory
recess Pharyngeal
tube
Longuscapitis muscle
Neck of mandible Parotid gland
Rectuscapitis anterior muscte
Retromandibular vetn
! /_\
\
Superficial temporal arrery
.\'i
\.\ Clossopharyngeal
+
I
Sympathetic trunk
nerve
Styloid proceSs
Styloglossus muscle Stylohyoid muscre
lnternalcarotid
artery
M a s t o i da i r c e l l s
Facialnerve
Medullaoblongata
Internal j u g u l a rv e i n
Vagusnerve Hypoglossalnerve
c4#
Nasal Region
Plale 47
Paranasal Sinuses
Olfactorybulbs
Falx
Brain
F r o n t asl i n u s
Nasalcavities
Orbitalfat N a s a ls e p t u m
E t h m o i d ac le l l s Middle nasalconcha
O p e n i n go f m a x i l l a rsyi n u s
Middle nasalmeatus
Infraorbital Recesses of Zygomatic maxillary s tn u s Alveolar
M a x i l l a rsyi n u s Inferior
Buccinatormuscle
nasalmeatus
ar processof maxilla
Inferior nasalconcha
of tongue Hard palate
Sublingug aland Oral cavit M a n d i b l e( b o d y )
*^--J
Nasalcavities
Nasal septum E t h m o i d acl e l l s
Orbitalfat and muscles
M e d i a lw a l l of orbit
O p t i c n e r v e( l l ) S p h e n o i d asl i n u s e s
4{r
Brain Optic chiasm
Horizontalsection
Plate 48
Nasal Region
Paranasal Sinuses (continuedl
Sagittalsection air cells Ethmoidal ( sni u s e s ) F r o n t asl i n u s
O p e n i n go f s il n u s sphenoida
O p e n i n g o f f r o n t o n a s adl u c
S p h e n o i d sa il n u s S e m i l u n ah r iatus (osteomeatalunit)
M i d d l en a s a l concha(cutaway)
U n c i n a t ep r o c
O p e n i n go f
m a x i l l a rsyi n u s
lnferior nasalconcha
F r o n t a sl i n u s
n i n g i n t o m i d d l e n a s a lm e a t u s
Pterygopalatinefossa
M a x i l l a r ys i n u s
Lateraldissection Roots of teeth
*{r Nasal Region
Plate 49
Paranasal Sinuses: Ghanges with Age
Bonesof nasalcavity and paranasalsinus6s at birth
Sinrs.r"p.resents one or moreanteriorethmoidalcells openinginto semilunar hiatusof middlenasalmeatus
I I
! Partof nasolacrimal duct that formedin depthsof nasoopticfurrow
Sinw represents one or moremiddleethmoidalcells 1 openinginto middlenasalmeatus I
\
Sinur",represent two or moreposteriorethmoidalcells openinginto superiornasalmeatus ! 1 \
Nasal
Spfr"noidal sinuswithinbonyshell(sphenoidal concha) locatedanteriorand lateralto body of sphenoidbone (brokenlineindicates sinuslateralto sphenoidbody) Bodyof sphenoidbone
Lacrimalbone Nasolacrimal foramen(becomes bonycanal)
Vestigialremnant of Rathke'spouch Medialplateof pterygoidprocess
Partof nasolacrimal ductwithinnasal cavitywith slit-like openingin inferior nasalmeatus
Lowerborderof highestnasalconcha Lowerborderof superiornasalconcha Palati bone
Uncinateprocessof ethmoidbond
Pterygoid
Semilunar
Superiornasalmeatus Middle nasalconcha(cut edge)(inferior nasalconchacompletelyremoved)
Maxillarysinuswith openinginto semilunar hiatus(striped arearepresentsmembraneformingmostof medialwall of sinus)
Grorythof frontal and maxillary sinu"ses throughout life Frontalsinus withinfrontal
I
I
r
Birth 1 year 4 years
I 7 years ffi 12years I Adult I Old age
Middlenasalconcha
Leftorbit
Nasal Nasalcavity
Maxillarvsinus withinmaxilla
Inferiornasalconcha Molar tooth
Nr Plate 50
Nasal Region
lnspection of Oral Gavity
F r e n u l u mo f u p p e r L i n g u am l i n o r s a l i v a r yg l a n d D e e p l i n g u a la r t e r ya n d v e r n s a n d l i n g u a ln e r v e F i m b r i a t e df o l d S u b m a n d i b u l ad ru c t
lff--
S u b l i n g u agll a n d F r e n u l u mo f t o n g u e S u b l i n g u aflo l d w i t h o p e n i n g s o f s u b l i n g u adl u c t s
L#
S u b l i n g u acla r u n c l ew i t h o p e n i o f s u b m a n d i b u l adru c t
Nr Oral Region
Plate 51
Roof of llouth
I n c i s i vpea p i l l a Incisivefossa palatine Transverse folds
Createrpalatinearteryand nerve Createrpalatineforamen
Palatineraphe
Lesserpalatineforamen
Palatineprocess of maxi
Lesserpalatinearteryand nerves Palatine glands
'endon of tensorveli palatinimuscle
Horizontalplate of palatinebone
Pterygoidhamulus Palatine aponeurosis (fromtensor velipalatini muscle)
Interdigitating fibersof levatorveli palatinimuscle Buccinator muscle
Uvularmuscle
Pterygomandibular raphe
M o l a rm i n o r salivaryglands
Superiorpharyngeal constrictor muscle
Palatopharyngeus muscle
Palatoglossus muscle
Palatine tonsil partof Basilar occipitalbone
Anterior view
part Cartilaginous of auditorv (pharyngotympanic, Eustachian) tube Levatorvelipalatinimuscle(cut)
Pharyngobasilar lascta
Tensorvelipalatinimuscle
Levatorveli palatinimuscle
Medialpterygoidmuscle( Medialpterygoidplate
Pterygoidhamulus
Pterygoid
Superiorpharyngeal muscle(cut) constrictor
Tendonof tensorvelipalatini Levatorveli palatinimuscle(cut
Palatopharyngeus muscle
Palatopharyngeus muscle(
*{r Plate 52
Posteriorview
Oral Region
Floor of Mouth
Lateral, slightly inferior view Hyoglossus muscle Mylohyoidmuscle Fibrousloop for intermediate digastrictendon Digastricmuscle(anteriorbelly) Medianraphebetweenmylohyoidmuscles
Anteroinferior view
Digastricmuscle(anteriorbelly) Mylohyoidmuscle muscle Stylohyoid muscle(posterior belly) Digastric
Hyoglossus muscle
digastrictendon Fibrousloopfor intermediate
Posterosuperior view Inferioralveolarnerveand arterv Mylohyoidnerveand artery glandandduct Submandibular
Ceniohyoid muscle
*{r Oral Region
Superiormentalspine(genialtubercle) muscle for originof genioglossus Createrhorn
Hyoglossus muscle(cut)
Plate 53
Muscles Involved in Mastication Forfacial muscles seePlate26
muscle Temporalis Temporalfascia
Superficial layer Deeplayer
Levatorlabii supenons alaequenasi muscre
Tygomatic arch
Levatorlabii supenons muscte
Articulardisc of t e m p o r o m a n d i b u l aj ro i n t
Deeppart I S u p e r f i c ipaal r t I
Zygomaticus minormuscle Zygomaticus major muscle
Masseter muscle
Parotidduct
Levator anguli ons muscle
B u c c i n a t o rm u s c l e
Orbicularis o r i sm u s c l e Mentalis
muscle D e p r e s s ol ar b i i inferiorismuscle
D e p r e s s oarn g u l i o r i sm u s c l e
T e m p o r a l i sm u s c l e I n s e r t i o no f t e m o o r a l i sm u s c l et o coronoid orocessof mandible Parotidduct B u c c i n a t o rm u s c l e
Orbicularo i sr i sm u s c l
Lateralpterygoid muscte Massetericnerve and artery
*{r Plate 54
Maxillary artery I n s e r t i o no f massetermuscle
Oral Region
Muscles Involved in Mastication (continuedl
,,ti;ij
Articulardiscof
j*i
t e m p o r o m a n d i b u l aj ro i n t A r t i c u l a rt u b e r c l e Lateralpterygoid muscle
S p h e n o m a n d i b ulliagra m e n t Medial pterygoid muscle Parotidduct B u c c i n a t o rm u s c l e
Pterygomandibularraph
l n s t r i c t omr u s c co S u p e r i opr h a r y n g e a
Lateralview
Choanae S p h e n o m a n d i b u l al irg a m e n
Otic ganglion
C a r t i l a g i n o ups a r t o f a u d i t o r y '(pharyngotympanic, Eustachian)tube
M a s s e t e n cn e r v e
2q
Middle meningealartery
Lateralpterygoidplate T e m p o r o m a n d i b u l aj or i n t
A u r i c u l o t e m p o r anl e r v e
teralpterygoidmuscle Massetericartery
Medialpterygoidmuscle
Maxillaryartery lnferior alveolarnerve L i n g u a ln e r v e M e d i a l p t e r y g o i dm u s c l e
Tensorveli palatini muscle (cut)
Medial pterygoid
Levatorveli palatini muscle (cut)
P t e r y g o ihda m u l u s
Pterygoidhamulus
Nerve to mylohyoid
4{tr Oral Region
Posteriorview
Plate 55
Teeth
Permanent (coloredblue) Usualageof eruption
Centralincisor(7thyear)
Centralincisor ( B - 1 0m o n t h s ) Lateralincisor ( B - 1 0m o n t h s C a n i n e( c u s p i d ) (16-20months)
Lateralincisor(Bthyear) C a n i n e( c u s p i d()11 t h - 1 2 t hy e a r ) st premolar(9thyear) 2 n d p r e m o l a r( 1 O t hy e a r )
1 s tm o l a r ( 1 5 - 2 1m o n t h s )
1 s tm o l a r( 6 t h y e a r )
2 n dm o l a r( 1 2 t h - 1 3 t yhe a r )
2 n dm o l a r (20-24 months)
l---3rd 2 n dm o l a r ( 2 0 - 2 4m o n t h s )
molars(.17th-25thyear)
2 n d m o l a r( 1 2 t h - 1 3 t yhe a r ) 1 s tm o l a r( 6 t hy e a r )
1 s tm o l a r ( 1 5 - 2 1m o n t h s ) C a n i n e( c u s p i d ) (16-20months)
year) 2 n dp r e m o l a(r1 O t h 1 s tp r e m o l a(r9 t hy e a r )
Lateralincisor ( 1 5 - 2 1m o n t h s )
e ( c u s p i d()11t h - 1 2 t hy e a r ) Lateralincisor (Bth year)
Centralincisor (6-9 months)
Central incisor(7th year)
Central incisors Lateralincisors Canines
Palatineprocess of maxilla
l st premolars
Horizontal plate of palatine oone\
2 n dp r e m o l a r s 1 s tm o l a r 2nd molars
3 r dm o l a r s
Greater and lesser palatineforamina
4{r Plate 56
Upperpermanentteeth
Lowerpermanentteeth
Oral Region
Teeth (continuedl
Enamel Dentineand dentinaltubules sPaces Interglobular Odontoblastlayer InterproximalsPaces Dentalpulp containingvessels and nerves ival (gum)epithelium(stratified) Cingivalgroove Laminapropriaof gingiva(gum) periosteum) (mandibular or maxillary Periodontium (alveolarperiosteum)
Root (central)canals containingvesselsand nerves Bone Apicalforamina
Leftupper permanent teeth: labiobuccal
Leftlower permanent teeth: labiobuccal vtew Central
4{tr Oral Region
Lateral
lncisors
12 Canines (cuspids)
Premolars
Plate 57
Tongue
Epiglottis Medianglossoepiglottic fold teralglossoepiglottic fold Vallecula topharyngeal archand muscle(cut) (cut) Palatinetonsil Lingualtonsil(lingualnodules) Palatoglossal archand muscle(cut) Foramen cecum Terminal sulcus Vallatepapillae 'Foliatepapillae
Filiformpapillae
papilla Fungiform Midlinegroove(mediansulcus)
Dorsumof tongue
Lingualtonsil
4{tr Filiformpapillae Fungiform papilla Keratinized tip of papilla
I n t r i n s im c uscle
Stratified squamous epithelium Sustentacular cell Sensorycell Tastepore Laminapropria Section of taste bud
Plate 58
Duct of gland Crypt Lymphfollicles Mucousglands Vallatepapilla Tastebuds Lingualglands(serousglandsofvon Ebner) Schematic stereogram: area indicated above
Oral Region
Tongue (continued|
Palatopharyngeus muscle Palatoglossus I n f e r i o rl o n g i t u d i n am l u s c l eo f
Mastoid process
/
Digastricmuscle(posterior belly)(cut) process fascra Pharyngobasilar pharyngeal constrictormuscle Superior ligament Stylohyoid S t y l o g l o s sm u su s c l e partof superior Clossopharyngeal pharyngealconstrictor muscle Stylopharyngeus muscle Stylohyoid Middle pharyngealconstrictormuscle
gastricmuscle(posteriorbelly)(cut) H y o g l o s s umsu s c l e msu s c l e ! Cenioglossu
lntermediatetendon of digastricmuscle (cut) loop for intermediatedigastrictendon
Mylohyoidmuscle(cut) C e n i o h y o i dm u s c l e
Lateralview L i n g u a ln e r v e S u b m a n d i b u l agr a n g l i o n
Superiorpharyngeal c o n s t r i c t omr u s c l e muscle Styloglossus muscle(cut) Palatoglossus
D e e pl i n g u aal r t e r y andvenaecomitantes
ligament Stylohyoid muscle Stylopharyngeus Hyoglossus muscle(cut) ngual artery Externalcarotid artery
Arteryto fren
jugularvein R e t r o m a n d i b u l avre i n
S u b m a n d i b u l adr u c t
Facialvein
artery Suprahyoid
S u b l i n g u aal r t e r ya n d Ceniohyoid muscki
Oral Region
C o m m o n t r u n kf o r f a c i a l , r e t r o m a n d i b u l aar n d l i n g u a lv e i n s( c o m m o n facial vein) I vein
Hyoid bone
Dorsal lingual artery and vein
Hypoglossalnerve
Vena comitans of hypoglossalnerve
4{tr Plate 59
Tongue and Salivary Glands: Sections
Horizontalsection below lingulaof mandible(superiorview) demonstratingbed of parotid gland
Orbicularo i sr i sm u s c l e Buccinatormuscle Buccopharyngeal fascia Facialartery and vein P t e r y g o m a n d i b u l ar ra p h e
Linguan l e r v e a n d s u p e r i o rp h a r y n g e acl o n s t r i c t o rm u s c l e
Masseter muscle Palatoglossus muscle in palatoglossalarch Palatinetonsil Palatopharyngeus muscle in palatopharyngealarc R a m u so f m a n d i b l Inferior alveolarartery,vein, and nerve Medial pterygoid muscle
Styloglossus muscle Facialnerve R e t r o m a n d i b u l avre i n
4{r
Externalcarotid artery
Parotidgland Stylopharyngeus muscle Stylohyoid muscle Sternocleidomastoid muscre Digastricmuscle(posteriorbelly) Internaljugular vein, internalcarotid artery a n d n e r v e sl X , X , a n d X l l i n c a r o t i d
L o n g u cs a p i t i sm u s c l e Prevertebralfascia
Superiorcervical sympatheticganglion
Buccopharyngeal fascia and retropharyngealspace
S u p e r i o rl o n g i t u d i n am l uscle Verticaland transversemusctes I n f e r i o rl o n g i t u d i n am l uscle
Styloglossus muscle B u c c i n a t omr u s c l e
I
ortonsu"
Musclesof facialexpression
Hyoglossus muscle Cenioglossu msu s c l e S u b l i n g u saal l i v a rgyl a n d S u b m a n d i b u ldaur c t andibularcanal,inferior alveolarartery,vein, and nerve Lingualnerve Nerve to mylohyoid V e n a c o m i t a n so f h y p o g l o s s anl e r v e ( t o l i n g u a lv e i n ) Linguaa l rtery . F a c i aal r t e r y Hypoglossalnerve (Xll) Submandibularsalivarygland
S u b m a n d i b u llay rm p hn o d e Mylohyoidmuscle F a c i avl e i n I n t e r m e d i a t ed i e a s t r i ct e n o o n Platysmamuscle Hyoid bone
Plate 60
Frontalsection behindl st molartooth (anteriorview) demonstrating bedsof sublingualand submandibularglands
Oral Region
Salivary Glands
Superficialtemporal artery and vein and auriculotemporalnerve Branchesof facial nerve facial artery Transverse Accessoryparotid gland Parotidduct B u c c i n a t o rm u s c l e( c u t ) Massetermuscle L i n g u a ln e r S u b m a n d i b u l agr a n g l i o n Tongue F r e n u l u mo f t o n g u e S u b l i n g u aflo l d w i t h o p e n i n g s
d lu c t s of sublingua
Parotid gland
S u b l i n g u acl a r u n c l ew i t h o p e n i n g o f s u b m a n d i b u l adr u c t
Retromandibular vein (anteriorand posterior branches)
gland Sublingua
Digastricmuscle (posteriorbelly)
S u b m a n d i b u ldaur c t
muscle Sublingualartery and vein
Externaljugular vein Sternocleidomastoidmuscle
Mylohyoidmuscle(cui) Digastricmuscle (anteriorbelly)
S u b m a n d i b u lgalra n d
4{F
Hyoid bone
Facialartery and vein
Parotidgland: totally serous
Oral Region
S u b m a n d i b u lgalra n d : mostlyserous,partiallymucous
Common trunk receivingfacial, anterior branch of retromandibular, a n d l i n g u a lv e i n s( c o m m o n f a c i a lv e i n )
I n t e r n aj ul g u l avr e i n Externalcarotid artery
S u b l i n g ug al a n d : almostcompletelymucous
Plate 61
Afferent Innervation of Mouth and pharynx SeealsoPlates45, 52, Sg,64, 1n,1?fg,,l25, ig3, lgs
Trigeminalnerve(V) :
Trigeminal(V) (maxillaryV2)
V i a s u p e r i o ra l v e o l a r Glossopharyngeal nerve 0n {,fffi nerves Vagus nerve (Xl ;-/"7.//.'r Via pterygopalatine g a n g l i o na n d n a s o p a l a t i n e Facialnerve(Vll) and greaterand lesser palatinenerves
Facial(Vll) (intermediate nerve) Via greater petrosalnerve, pterygopalatine g a n g l i o na , n d g r e a t e ra n d l e s s e rp a l a t i n en e r v e s
(lX) Glossopharyngeal Via pharyngealplexus V i a t o n s i l l a rb r a n c h e s Tasteplus generalsensation v i a l i n g u a lb r a n c h e s
Trigeminal(V) (maxillaryV2) a pharyngealbranch of pterygopalatineganglion
tr
Vagus(X) Via internalbranchof s u p e r i olra r y ng e a ln e r v e
Facial(Vll) (intermediate nerve) Via greaterpetrosalnerve and pterygopalatineganglion
(lX) Glossopharyngeal plexus Via pharyngeal V i a t o n s i l l a rb r a n c h e s Tasteplus general s e n s a t i o nv i a l i n g u a lb r a n c h e s
Vagus(X) and glossopharyngeal(lX) Via pharyngeal prexus Vagus(X) V i ai n t e r n a l branchof supenor laryngeal
Trigeminal (V) (maxillary V2) Via pterygopalatine g a n g l i o na n d nasopalatineand g r e a t e ra n d l e s s e r p a l a t i n en e r v e s
V i as u p e r i o r alveolarnerves
Trigeminal(V) (mandibularV3) Via buccal nerve Via inferior a l v e o l a rn e r v e
nerve
Trigeminal(V) (mandibularV3) ia lingual nerve Facial(Vll) (intermediate nerve) Tastevia chorda tympani and lingual nervt:
*{r Oral Region
Pharynx: Median Section
Sellaturcica Frontalsinus
S p h e n o o c c i p i t asly n c h o n d r o s i s
S p h e n o i d asl i n u s
tonsil Pharyngeal
Nasalseptum
Pharyngealtubercle of occipital bone aryngealraphe
Nasopharynx
A n t e r i o rl o n g i t u d i n allig a m e n t
Soft palate
terior atlantooccipitalmembrane
Palatineglands Hard palate.-
Pharyngealopening of auditory (pharyngotympanic,Eustachian) tube
A p i c a ll i g a m e n to f d e n s !
Anterior arch of atlas(C1 vertebra)
Oral cavity I n c i s i v ec a n a l Palatinetonsil-..-
Dens of axis (C2 vertebra)
Body of tongue
Oropharynx
Pharyngeal constrictor muscles
Foramencecum L i n g u a tl o n s i l
Buccopharyngeal fascia
Cenioglossus muscle Root of tongue
Retropharyngeal space
Epiglottis Mandible
i i!:rj"r,
Ceniohyoid muscle Hyoid bone Hyoepiglottic ligament
Prevertebral fasciaand anterior longitudinal ligament
Vertebral bodies
Thvrohvoid membrane
Laryngopharynx Laryngealinlet (aditus) Thyroid cartilage
Vocalfold Transversearytenoid Cricoid cartilage Trachea Esophagus
muscles Esophageal Thyroidgla Superficial(investing)layer of deep cervicalfascia Pretrachealfascia
space(of Burns Suprasternal of sternum Manubrium
Pharynx
4{tr Plate 63
Medialview Median (sagittal)section S o h e n o i d sa il n u s Pharyngeal tonsil Torustubarius Pharyngeal tubercle(basilarpartof occipitalbone) Pharyngeal raphe Pharyngealopening of auditory (pharyngotympanic,Eustachian)tube Hard palate Pharyngealrecess Salpingopharyngealfold Soft oalate Palatineglands
Uvula S e m i l u n a fro l d Supratonsillarfossa Palatinetonsil Palatopharyngeal arch Palatoglossal arch Oropharynx Triangularfold Tongue (drawn forward and downward) L i n g u a tl o n s i l
Epiglottis Vallecula
Pharyngealmucosaremoved C a r t i l a g i n o ups a r t o f a u d i t o r y( p h a r y n g o t y m p a n i cE,u s t a c h i a nt )u b e Medial pterygoid plate Tensorveli palatini muscle and tendon L e v a t o rv e l i p a l a t i n im u s c l e Ascendingpalatineartery Pharyngealbranch of ascendingpharyngealartery Lesserpalatineartery S a l p i n g o p h a r y n g e umsu s c l e Pterygoid hamulus Pterygomandibularraphe Tonsillarbranch of lesserpalatineartery Superiorpharyngealconstrictor muscle Tonsillarbranch of ascendingpharyngealartery Palatoglossus muscle Palatopharyngeus muscle Tonsillarbranch of ascendingpalatineartery Tonsillarbranch of facial Tonsillarbranch of dorsal lingualartery Glossopharyngealnerve (lX) and tonsillarbranch S t y l o h y o i dl i g a m e n t Hyoglossusmuscle Middle pharyngealconstrictor muscle S t y l o p h a r y n g e um s uscle
4{tr Plate 64
Pharynx
Muscles of Pharynx: Median (Sagittall Section
Medial pterygoid plate Cartilaginouspart of auditory (pharyngotympanic,Eustachian)tube Tensorveli palatinimuscle Pharyngobasilarfascia Levatorveli oalatinimuscle P a l a t i n ea o o n e u r o s i sa n d t e n d o n o f t e n s o rv e l i o a l a t i n im u s c l e
P h a r y n g etaul b e r c l e( b a s i l apra r to f o c c i p i t abl o n e ) P h a r y n g e arla p h e A n t e r i o rl o n g i t u d i n alli g a m e n t Anterior atlantooccipitalmembrane A p i c a l l i g a m e n to f d e n s
e u sm u s c l e lpingopharg yn Musclesof soft palate ridge) Palatopharyngealsphincter(Passavant's P t e r y g o i dh a m u l u s Superiorpharyngealconstrictormuscle Pterygomandibularraphe muscle Palatopharyngeus B u c c i n a t o rm u s c l e Clossopharyngealpart ol superior pharyngealconstrictor Stylopharyngeusmuscle Stylohyoidligament Styloglossusmuscle Middle pharyngealconstrictormuscle ibers to pharyngoepiglotticfold B u c c o p h a r y n g e af al s c i aa n d retropharyngealspace Prevertebralfasciaand anlenor l o n g i t u d i n alli g a m e n t
Hyoglossus muscle
I n t e r n abl r a n c ho f s u p e r i olra r y n g e anle r v e
Ceniohyoid muscte
L o n g i t u d i n apl h a r y ng e a lm u s c l e s
Mylohyoid muscte Hyoid bone
I n f e r i o rp h a r y n g e acl o n s t r i c t o rm u s c l e P h a r y n g e aal p o n e u r o s i s
Thyrohyoid memDrane
C r i c o p h a r y n g e um s uscle (part of inferior pharyngealconstrictor)
T h y r o i dc a r t i l a g e
r i c o i d a t t a c h m e n to f l o n g i t u d i n a l e s o p h a g e am l uscle
Median cricothyroid ligament
l uscle C i r c u l a re s o p h a g e am
C o r n i c u l a t ea n d arytenoid cartilages Cricoid cartilage Trachea
l s o p h a g e am l uscle o ng i t u d i n ae
#r . . . M a r g i n so f m i d d l ep h a r y n g e a l c o n s t r i c t o rm u s c l e - Margins and attachmentsof inferior pharyngeal constrictormuscle
Plate 65
Pharynx: Opened Posterior View
r a r t o f o c c i p i t a lb o n e ) B a s eo f s k u l l( b a s i l a p Pharyngealtonsil
\
Nasalseptum Torustubarius
Pharyngeal opening of auditory(pharyngotympanic, Eustachian) tube recess
Nasopharynx
Parotidgland
(fold Toruslevatorius causedby levator velipalatinimuscle) Salpingopharyngeal fold Soft palate A n g l eo f m a n d i b l e
bulargland Uvula Palatinetonsil
Oropharynx
Root of tongue
Palatopharyngeal arch Prominencecaused by greaterhorn
of hyoidbone Epiglottis Laryngealinlet (aditus)
P r o m i n e n ccea u s e db y s u p e r i ohr o r n of thyroid cartilage
Laryngopharynx
ielotticfold Piriformfossa(recess)
Cuneiformtubercle Foldover internalbranch of superiorlaryngealnerve Corniculatetubercle Interarytenoidnotch overlamina of cricoid cartilage
Esophagus
4{tr Trachea
Plate 66
Pharynx
Muscles of Pharynx: Partially Opened Posterior View
Basilarpart of occipital bone
't\
}i,ilri:l,
P h a r y n g e atlu b e r c l e
*-
Pharyngeal tonsil
* \:
Cartilaginouspart of auditory ( p h a r y n g o t y m p ainc , Eustachian)tube
Styloid process
Digastric muscle (Posterlor belly)
Pharyngobasilar fascia Choana
Stylohyoid muscte
Levatorveli p a l a t i n im u s c l e
Stylopharyngeus muscre
Superiorpharyngeal constrictormuscle
muscle Accessory b u n d l ef r o m
Salpingopharyngeus muscte
Petrouspart of t e m p o r a lb o n e
Uvula
Medial p t e r y g o i dm u s c l e
Palatopharyngeus muscle Middlepharyngeal constrictor muscle
Pharyngobasilar fascia
muscle Stylopharyngeus
Pharyngealraphe
goepiglotticfold Pharyn
Superiorpharyngeal c o n s t r i c t o rm u s c l e
fold Aryepiglottic
Hyoid bone (tip of greater
lnferiorpharyngeal constrictor muscle (cut edgeJ
Middle pharyngealconstrictormusc
l uscles L o n g i t u d i n apl h a r y n g e am
Epiglottis
S u p e r i ohr o r no f thyroidcartilage
Inferior pharyngealconstrictormuscle
Cuneiformtubercle
Thyrohyoid membrane
C o r n i c u l a t eu b e r c l e
lnternal branch of superior laryngealnerve
(Transverse and oblique) a r y t e n o i dm u s c l e s
P h a r y n g e aal p o n e u r o s i s
Posteriorcricoarytenoidmuscle C r i c o p h a r y n g e aml u s c l e( p a r to f inferior pharyngealconstrictor) l s o p h a g e am L o ng i t u d i n a e l uscle
C r i c o p h a r y n g e um s u s c l e( p a r to f inferior pharyngealconstrictor) Posteriorborder of thyroid cartilagelamina id attachment of longitudinal esophagealmuscle
muscle ularesophageal
4{tr Pharynx
Plate 67
Muscles of Pharynxl Lateral View
Pharyngobasilar fascia T e n s o rv e l i p a l a t i n im u s c l e Levatorveli palatini muscte Lateralpterygoid plate
P t e r y g o i dh a m u l u s B u c c i n a t o rm u s c l e( c u t )
P t e r y g o m a n d i b u l ar ra p h e igastricmuscle
(posterior belly)(cut) Buccinatorcrest of mandible
yloidprocess Superiorpharyngealconstrictor muscle Styloglossusmuscle
Obliqueline of mandible
Stylohyoidligament Stylopharyngeusmuscle M i d d l e p h a r y n g e acl o n s t r i c t o rm u s c l e H y o g l o s s u sm u s c l e reater horn of hyoid bone
Digastricmuscle (anteriorbelly
r i o r h o r n o f t h y r o i dc a r t i l a g e
M y l o h y o i dm u s c l e
T h v r o h v o i dm e m b r a n e
Inferiorpharyngeal constrictormuscle
Hyoid bone Stylohyoidmuscle (cut) Thyroid cartilage
T e n d i n o uasr c h Zone of sparsemusclefibers C r i c o p h a r y n g em u su s c l e (partof inferiorpharyngeal constrictor)
M e d i a n c r i c o t h y r o i dl i
C r i c o t h y r o im duscle C r i c o i dc a r t i l a g e
sopnaSus
Trachea
4{r Plate 68
Pharynx
Arteries of Oral and Pharyngeal Regions
5i"'{i',..',",. { S u p r a t r o c h l eaarr Supraorbitala
M i d d l e m e n i n g e a al r t e r y Deep temporal arteries Dorsal nasala Massetericartery A n g u l a ra r t e r y Infraorbitalartery S p h e n o p a l a t i naer t e r y D e s c e n d i n gp a l a t i n e
Transverse facial artery(cut)
P o s t e r i o sr u p e r i o r alveolarartery
Superficial temporal artery
S u p e r i o rl a b i a la r t Buccalartery
Maxillaryartery
B u c c i n a t o rm u s c l e and parotid duct (cut)
Posteriorauricularartery Ascendingpharyngealartery
I n f e r i o rl a b i a la r t
Occipital artery and s t e r n o c l e i d o m a s t o ibdr a n c h
S u p e r i o rp h a r y n g e a l c o n s t r i c t o rm u s c l e
C l o s s o p h a r y n g e anle r v e ( l X ) Ascendingpalatineartely
Mental branch of i n f e r i o ra l v e o l a ra r t
Tonsillar artery
Inferior alveolarartery a n d l i n g u a lb r a n c h
Facialartery Linguaa l rtery
Facialartery S u b m e n t a al r t e r y M y l o h y o i db r a n c ho f i n f e r i o ra l v e o l a ra r t e r y S u b m a n d i b u l agr l a n d H y p o g l o s s anl e r v e ( X l l ) Suprahyoidarter
External carotidartery S u p e r i o rl a r y n g e aal r t
S u p e r i otrh y r o i da C r i c o t h y r o i da r Common carotid Vertebralartery Subclavianartery
A s c e n d i n gp h a r y n g e aal r t e r y Internalcarotid artery Vagus nerve (X) Superiorcervical cardiac nerve
trunk Sympathetic A n t e r i o rs c a l e n em u s c l e P h r e n i cn e r v e M i d d l e s c a l e n em u s c l e Ascending cervicalartery
Inferiorthyroidartery cervical artery Suprascapularartery Costocervicaltrunk Thyrocervicaltrunk
4{tr Pharynx
Plate 69
Veins of Oral and Pharyngeal Regions SeealsoPlates 23,31,'lO4
S u p r a t r o c h l e avre i n S u p r a o r b i t avl e i n Nasofrontalvein S u p e r i o ro p h t h a l m i cv e i n A n g u l a rv e i n Externalnasalvein Emissaryvein (of Vesalius) c o m m u n i c a t i n gw i t h c a v e r n o u ss t n u s lnfraorbitalvein O c c i p i t a lv e i n and artery
Posterior superior 5;
alveolarveins
Superficialtemporal vein and artery
Palatinevein
Pterygoidplexus
Transversefacial vein (cut)
S u p e r i ol ra b i avl e i
Posteriorauricularvein
Deep facial vein
R e t r o m a n d i b u l avre i n (anteriorand
M a x i l l a r yv e i n s
posteriorbranches) jugularvein(cut) External
I n f e r i o rl a b i a lv e i n Mental vein
Inferior alveolarvein and artery ipital vein and artery
Facialvein and a
H y p o g l o s s anl e r v e ( X l l )
Externalpalatinevei S u b m e n t a vl e i n S u b m a n d i b u l agr l a n d Vena comitans of hypoglossalnerve D o r s a ll i n g u a lv e i n c o u r s i n g medial to hyoglossusmuscle L i n g u a vl e i n C o m m u n i c a t i o nt o a n t e r i o rj u g u l a rv e i n S u p e r i o rl a r y n g e avl e i n S u p e r i o rt h y r o i dv e i n Thyroid gland M i d d l e t h y r o i dv e i n Inferiorthyroid vei Termination o f a n t e r i o rj u g u l a rv e i n ( c u t ) Left brachiocephalicvein
Common trunkreceiving facial,anterior branch of retromandibular,and l i n g u a lv e i n s( c o m m o n f a c i a lv e i n ) Externalcarotid artery I n t e r n ajlu g u l a rv e i n Common carotid artery Vagus nerve (X) and sympathetictrunk iddle scalenemuscle
A n t e r i osr c a l e n m e uscle j ul g u l avr e i n( c u t ) Externa Transversecervical vein (cut) Suprascapularvein (cut) Subclavianartery S u b c l a v i a nv e i n
4{v Plate 70
Pharynx
Nerves of Oral and Pharyngeal Regions
Zygomaticotemporalnerve (V2) Deep temporal nerves(V3 Massetericnerve (V3) M a n d i b u l a rn e r v e ( V 3 ) Nerve to medial pterygoid and tensor veli palatinimuscles(V:) (cut) Zygomaticofacialnerve (V2
M a x i l l a rny e r v e( V z ) I n f r a o r b i tn ae l r v e( V z ) Pterygopalatineganglion Creater and lesser p a l a t i n en e r v e s( V 2 )
AuriculotemporaI nerve(V:)
A n t e r i o r ,m i d d l e ,a n d p o s t e r i o r s u p e r i o ra l v e o l a rn e r v e s( V 2 )
meningealartery
Nerve to lateralpterygoid m u s c l e( V 3 )( c u t )
Superficial temporal artery(cut) Facialnerve(Vll)(cut) Maxillaryartery
B u c c a ln e r v e ( V : ) C h o r d at y m p a n i n e r v e ( V l l ) Linguan l e r v e( V 3 )
Accessorynerve (Xl) (cut)
Medialpterygoidmuscle(cut)
C 1 s p i n anl e r v e (ventralramus)(cut)
(lateralpterygoid removed)
2 spinalnerve
l n f e r i o ra l v e o l a r nerve (V:)
(ventralramus)(cut)
Mental nerve (Vr) Nerve to mylohyoid (V3) S u b m a n d i b u l agr a n g l i o n Clossopharyngealnerve (lX) a n d t o n s i l l a rb r a n c h H y p o g l o s s anl e r v e ( X I l ) C a r o t i dn e r v e ( l X )a n d c a r o t i d N e r v e t o t h y r o h y o i dm u s c l e( C 1 , 2 v i a X l l ) Internaland externalbranches o f s u p e r i o rl a r y n g e a nl e r v e( X
slPerior oot A n s ac e r v i c a l i(sC l , 2 , r , I( lnferiorroot, Nerves to superior and inferior belliesof omohyoid, sternohyoid,and sternothyroidmuscles(ansacervicalis) Recurrentlaryngealnerve (X)
plexuscomposedof Pharyngeal geal branches from glossopharyn (lX),vagus(X),and sympathetic nerves Internalcarotidartery External carotidartery Vagusnerve(X)and superior cervicalcardiacbranch C 4 s p i n anl e r v e (ventralramus)(cut) Phrenin c e r v e( C 3 ,4 , 5 ) cervicalartery M i d d l e s c a l e n em u s c l e
r scalenemuscle Brachialplexus(cut)
Sympathetictrunk and middle cervical Common carotid artery
Thyrocervicaltrunk
Vertebralartery artery Subclavian
*{r Pharynx
Plate 7l
Lymph Vessels and Nodes of Head and Neck
parotidnodes Superficial (deepparotidnodes d e e pt o a n dw i t h i n parotid gland)
Subparotid node Facialnodes Nasolabial Buccinator
nodes Mastoid nodes
Mandibular
Sternocleidomastoid nodes
nodes
Superiorlateral superficialcervical jugular) (external node
Submandibular nodes
Jugulodigastricnode
Submental nodes
Suprahyoid node Superiordeeplateralcervical (internal jugular)nodesSuperiorthyroidnodes
superficial cervical (spinalaccessory) nodes
Intercalatednode
Inferiordeep lateralcervical (scalene) node
node Juguloomohyoid Thoracicduct Anteriordeepcervical (pretracheal and thyroid)nodes (deepto infrahyoidmuscles) Anteriorsuperficial cervical nodes(anteriorjugularnodes
Transverse cervical chain of nodes
J u g u l atr u n k Supraclavicular nodes* Subclaviantrunk and nooe
*Thesupraclavicular groupof nodes(also knownasthe lowerdeepcervicalgroup), especially on the left,arealsosometimes referredto asthe signalor sentinellymph nodesof Virchowor Troisier, especially when sufficiently enlargedand palpable. These nodes(or a singlenode)areso termedbecause theymaybe the firstrecognizedpresumptive evidenceof malignant diseasein the viscera.
Plale 72
4{tr Pharynx
Lymph Vessels and Nodes of Pharynx and Tongue
gobasilar fascia Pharyn nodes Retropharyngeal I n t e r n aj ul g u l avr e i n belly) Digastricmuscle(posterior muscle Sternocleidomastoid node lntercalated node f ugulodigastric
Deep lateral cervical (internaljugular) nodes
J u g u l o o m o h y oni o dde
entralcollectingvessels Marginalcollectingvessels g vessels Basalcollectin to Communication
Lymphaticdrainageof pharynx: posteriorview
Lymphaticdrainageof tongue
node Submental S u b m a n d i b u lnaor d e node Jugulodigastric Deeo lateralcervical (internaljugular) nodes
node fuguloomohyoid
Pharynx
Plate 73
Thyroid Gland: Anterior View
Externalcarotid
Hyoid bone
Internalcarotidarterv
Superiorlaryngeal nerve Internalbranch Externalbranch
Superiorthyroidarteryand Superiorlaryngeal artery
Thyroidcartilage(lamina)
Thyrohyoidmembrane Ansa t cervicalis{
Mediancricothyroid ligament
Superior root Inferior root-
muscles Cricothyroid Cricoidcartilage
Commoncarotid Internaljugularvein Middlethyroidvein Inferiorthyroidveins Ascendingcervicalartery
Pretracheal lymphnodes
lnferiorthyroidartery
'Phrenicnerve
Superficial cervicalartery
Anteriorscalenemuscle
Suprascapular artery
Vagusnerve(X) Thyrocervical trunk
jugularvein External
Subclavian arteryand
Anteriorjugularvein 1strib (cut)
Vagus nerve (X)
Leftrecurrentlaryngeal nerve
Rightrecurrent laryngeal nerve Brachiocephalic trunk Brachiocephalicveins Supenor vena cava Aortic arch
Thyroid cartilage
Cricothyroid ligament Commoncarotidartery Medialmarginof sternocleidomastoidmuscle
Cricothyroid muscle Cricoid cartilage
*{ry Plate 74
Thyroidgland Cupula(dome)of pleura
Thyroid Gland and La;ynx
Thyroid Gland and Pharynx: Posterior View
Superiorpharyngeal constrictormuscle Middlepharyngeal muscle constrictor
ExternalcarotidarterY lnternalcarotidarterY Facialartery
Tip of greaterhorn of hyoid[ens-
Lingualartery
Inferiorpharyngeal muscle' constrictor
nerve Superiorlaryngeal -lnternal branch Externalbranch
raphe Pharyngeal
SuperiorthyroidarterY
Zoneof sparse musclefibers Cricopharyngeus muscle(partof inferior pharyngealconstrictor) Circularesophageal musclein V-shaped areaof sparse muscle longitudinal fibers (areaof Laimer)
SuperiorlaryngealarterY CommoncarotidarterY Vagusnerve(X) Internaljugularvein Thyroidgland (rightlobe) Superiorparathyroidgland
Longitudinal
esophagealmuscle lnferiorthvroidvein Trachea
lnferiorbulbof i n t e r n aj ul g u l avr e i n Vertebralarterv
cervicalartery gland Inferiorparathyroid lnferiorthyroidartery nerve Rightrecurrentlaryngeal cervicalartery artery
Leftsubclavian artervandvein
Thyrocervicaltrunk Rightsubclavian arteryandvein
Internalthoracic arteryandvein Left brachiocephalicvein Left recurrent laryngeal
Arch of aorta Leftvagusnerve
Thyroid Gland and Larynx
vein Rightbrachiocephalic trunk Brachiocephalic Rightvagusnerve(X) Superiorvenacava
Plate 75
Parathyroid Glands SeealsoPlate 80
Posterior view
h y r o h y o i dm e m b r a n e Hyoid bon
S u p e r i ol ra r y n g e a l Internalbranch External branch
External carotidartery Internalcarotidartery Superiorthyroidartery Superiorlaryngeal artery
Vagusnerve( Epiglottis
Inferiorpharyngeal constrictor muscle(cut) Common carotid artery
Superiorthyroid
Fibrouscapsuleof thyroidgland(cut)
Common carotid artery
F i b r o ucsa p s u l e of t h y r o i dg l a n d( c u t )
Cricopharyngeus muscle(partof inferiorpharyngeal constrictor) gland Superiorparathyroid
Superiorparathyroid gland Rightlobeof thyroidglano Leftlobeof thyroidgland Ascendingcervicalarter
glano Inferiorparathyroid (maybe morecaudallylocated, e v e nw i t h i nm e d i a s t i n u m ) lnferiorthyroidartery
Inferiorparathyroid gland recurrentlaryngealnerve Left recurrentlaryngealnerve
Esophagus
Superficialcervical artery Suprascapularartery
Thyrocervical trunk Subclavianartery
Vertebral artery
Trachea
Subclavianartery
B r a c h i o c e p h atlriuc n k
Rightlateralview Externalcarotio
Superiorlaryngeal arte S u p e r i otrh y r o i da r t e r y( c Inferior pharyngealconstrictor muscle
lnternalbranchof nerve superiorlaryngeal External branchof superiorlaryngeal nerve gland Superiorparathyroid
C o m m o n c a r o t i da
I n t e r n aj ul g u l a r Inferiorthyroidartery
T h y r o i dg l a n d( r i g h lto b e ) (retractedanteriorly) Inferior parathyroidgland
Rightrecurrentlaryngeal nerve Esophagus
Plate 76
*{r Thyroid Gland and Larynx
Gartilages of Larynx
Hyoidbone Thyrohyoidmembr Superiorhorn of thyroidcartil cartilage Corniculate Arytenoidcartilage Superiorthyroidnotch Thyroidcartilagelami Vocalligament ligament Mediancricothyroid Inferiorhornof thyroid Cricoid cartilage
Trachea
Posterior view
Anteriorview
Corniculatecartilage MuscularprocessI Arytenoid Vocalprocess f cartilage
Cricoid cartilage
Hyoepiglottic ligament Hyoidbone Thvrohvoidmembrane Thyroidcartilagelamina O b l i q u el i n e arynSealpromrnence
cart Corniculate Arytenoid Muscularprocess
*{r joint Cricothyroid
Right lateralview
Thyroid Gland and Larynx
Medial view, median (sagittal)section
Plale 77
lntrinsic Muscles of Larynx
piglottis
Foramen for superior laryngeal vessels and internalbranchof nerve superiorlaryngeal
yepiglottic
fold Cuneiform tubercle
andtransverse arytenoidmuscles
Corniculate tubercle Aryepiglottic muscle
Posterior cricoarytenoid muscle
Oblique arytenoidmuscle
I t
Transverse arytenoidmuscle
Straight part Oblique part
Posterior cricoarytenoid muscle
Cricothyroid muscte
ricoidcartilage
Rightlateralview
Posterior view Epiglottis Aryepiglottic
muscle O b l i q u ea n d transverse arytenoidmuscles Posterior cricoarytenoid muscle
Thyroepiglottic muscte Arytenoid cartilage
Thyroarytenoid muscte
Laminaof
Lateral cricoarytenoid muscte C o n u se l a s t i c u s
Cricothyroid muscle (cut away)
Lateraldissection Posteriorcricoarytenoidmuscre Lateralcricoarytenoid T
Transverse and obliquearytenoidmuscles Cricothyroid muscle
Conus elasticus
Thyroarytenoid muscle
Nr Plate 78
Vocalismuscle Vocal ligament
Lamina of thyroid cartilage
Thyroid Gland and Larynx
Actions of Intrinsic Muscles of Larynx
Nr Cricothyroidjoint (pivotpoint)
Action of posterior cricoarytenoidmuscles of vocalligaments Abduction
Action of cricothyroid muscles (increasing tension) Lengthening of vocalligaments
Action of lateral cricoarytenoidmuscles
++
Action of transverseand oblique arytenoidmuscles Adduction of vocal ligaments
Thyroid Gland and Larynx
Action of vocalisand thyroarytenoidmuscles Shortening(relaxation)of vocal ligaments
Plate 79
Nerves of Larynx
Superior
Internalbranchof superiorlaryngeal nerve
laryngealnerve
Internalbranch External branch
Sensorybranches to larynx of Calen Aryepiglottic muscle Thyroepi glotticmuscle Transverse and oblique arytenoidmuscles Thvroarvtenoid muscle Vocalismuscle
Cricothvroid muscle Cricopharyngeus muscle (partof inferior pharyngealconstrictor) Rightrecurrent laryngeal nerve
Lateralcricoarvtenoid muscle Posterior cricoarvtenoid muscle Thyroidarticularsurface Anteriorand posteriorbranches of inferiorlaryngeal nerve Rightrecurrentlaryngeal nerve
Rightlateralview: thyroid cartilagelamina removed Rightlateralview
Leftvagusnerve(X) Rightvagusnerve( Leftcommoncarotidartery Anomalous right inferior laryngealnerve (not recu
Leftinferiorlaryngealnerve
recurrentlaryngeal nerve Anomalous (retroesophageal) right subclavianartery
Leftsubclavian artery Right common carotid
Anomalous(retroesophageal) rightsubclavian arteryoriginating from leftsideof aorticarch
Archof aorta Leftrecurrentlaryngeal nerve
Anteriorview: anomalousright inferior laryngeal nerve,not recurrent, associatedwith anomalousright subclavianarterv
Plate 80
Nr Thyroid Gland and Larynx
Eyelids
S u p e r i o rp a l p e b r a cl o n j u n c t i v a t a r s a (l m e i b o m i a n )g l a n d s s h i n i n gt h r o u g h
l a p i l l aa n d p u n c t u m S u p e r i o rl a c r i m a p P I i c as e m i l u n a r i s L a c r i m acl a r u n c l ei n l a c r i m a l a k e( l a c u sl a c r i m a l i s )
C o r n e o s c l e r aj ul n c t i o n (cornealimbus)
l a p i l l aa n d p u n c t u m I n f e r i o rl a c r i m a p B u l b a rc o n j u n c t i v a over sctera In f e r i o rc o n j u n c t i v aflo r n i x
L e v a t o rp a l p e b r a es u p e r i o r i sm u s c l e
O r b i t asl e p t u m Sclera
S u p e r i o rt a r s a l( M i . i l l e r ' sm) u s c l e( s m o o t h )
B u l b a rc o n j u n c t i v a
S u p e r i o rc o n j u n c t i v aflo r n r x O r b i c u l a r i so c u l i m u s c l e( p a l p e b r apl a r t )
Palpebralconjunctiva
S u p e r i otra r s u s T a r s a(lm e i b o m i a n )g l a n d s
Cornea -Lens
S e b a c e o u sg l a n
A n t e r i ocr h a m b e r
( csi l i a ) Eyelashe
*{r
lris
O p e n i n g so f t a r s a lg l a n d s
P o s t e r i ocrh a m b e r
l n f e r i otra r s u s O r b i c u l a r i so c u l i m u s c l e( p a l p e b r apl a r t ) In f e r i o rc o n j u n c t i v aflo r n i x O r b i t a ls e p t u m
F r o n t a lb o n e l n s e r t i o no f l e v a t o rp a l p e b r a e
s u p e r i o r im suscle O r b i t a ls e p t u m
S u p e r i otra r s u s L a t e r ap l alpebraligament a n d o v e r l y i n gr a p h e I n f e r i o rt a r s u s
Supraorbitalartery and nerve S u p r a t r o c h l e aarr t e r ya n d n e r v e D o r s a ln a s a la r t e r y a n d i n f r a t r o c h l e anr e r v e Lacrimalsac M e d i a lp a l p e b r a l i g a m e n t
O r b i t a ls e p t u m M a x i l l a( f r o n t a lp r o c e s s ) Z y g o m a t i cb o n e - - F
Orbit and Gontents
Infraorbitalartery and nerve
Plate 81
Lacrimal Apparatus 6sjtif'a€:+
SeealsoPlates 45, 133
l a p i l l aa n d p u n c t u m S u p e r i o rl a c r i m a p O r b i t a lp a r t o f I a c r i m a gl l a n d L a c r i m acl a n a l i c u l i
Palpebral partof l a c r i m agl l a n d-
Excretoryducts of l a c r i m ag l land
Lacrimalsac
N a s o l a c r i m adl u c t
P l i c as e m i l u n a r i s O p e n i n go f n a s o l a c r i m adl u c t L a c r i m a cl a r u n c l e
4{tr
I n f e r i o rl a c r i m a lp a p i l l aa n d p u n c t
S u p e r i o rl a c r i m a p l a p i l l aa n d p u n c t u m Frontalbone (cut away)
O r b i t a lp a r t o f lacrimag l land
L a c r i m acl a n a l i c u l i
L a c r i m a sl a c Palpebralpart of l a c r i m ag l l a n da s o l a c r i m adl u c t Excretoryducts of l a c r i m ag l land
P l i c as e m i l u n a r i s and lacrimal
Middle nasal concna
Nasalcavity L a c r i m acl a r u n c l e
I n f e r i o rl a c r i m a lp a p i l l aa n d p u n c t u m
O p e n i n g o f n a s o l a c r i m adl u c t
Plate 82
I n f e r i o rn a s a l c o n c h a( c u t )
I n f e r i o rn a s a lm e a t u s
Orbit and Contents
Fascia of Orbit and Eyeball
Horizontalsection
Tarsusof eyelid
4{r
Palpebralconjunctiva M e d i a lp a l p e b r a l i g a m e n t
B u l b acr o n j u n c t i v a Nasalcavity
Cornea
C h e c kl i g a m e not f medialrectusmuscle
Lateralpalpebralligament r , - C h e c k l i g a m e n to f lateralrectus muscle
E t h m o i d ac le l l s
Periorbita
Periorbita
Sclera
M e d i a rl e c t u sm u s c l e andfascialsheath
sheathof eyeball Fascial (Tenon's capsule)
Fascialsheathof eyeball (Tenon'scapsule)
Episcleral space Lateralrectusmuscle andfascialsheath
Sclera
fat Retrobulbar (orbitalfat body) C o m m o nt e n d i n o ursi n g S p h e n o i d sa il n u s Levatorpalpebraesuperiorismuscle and fascialsheath
Frontal section
-{*y*
Superioroblique muscle and fascialsheath Medial rectus muscle and fascialsheath
S u o e r i o rr e c t u sm u s c l e and fascialsheath
Periorbita
Lacrimalgland
Ethmoidalcell
Lateralrectusmuscleand fascialsheath ascialsheathof eyeball
Periorbita
(Tenon's capsule)
Scler
lnferiorrectusmuscle andfascialsheath
Fascialsheathof eyeball (Tenon'scapsule)
I n f e r i o ro b l i q u e m u s c l e and fascialsheath
Episcleral space
Infraorbitalnerve (V2)
R e t r o b u l b a fra t ( o r b i t a lf a t
Muscleattachmentsand nervesand vesselsenteringorbit S u p e r i oor r b i t a l
muscle superioris Levatorpalpebrae
L a c r i m an l e r v e( V t )
S u p e r i o ro b l i q u em u s c l e
F r o n t a ln e r v e ( V t )
Suoeriorrectus muscle
Trochlearnerve (lV)
Medialrectusmuscle
S u p e r i o ro p h t h a l m i cv e i n Lateralrectus S u p e r i o rb r a n c ho f o c u l o m o t o rn e r v e( l l l )
Inferiororbitalfissure A b d u c e n tn e r v e ( V l )
Orbit and Contents
lnferior rectus muscle l n f e r i o rb r a n c ho f o c u l o m o t o rn e r v e ( l l l ) N a s o c i l i a r yn e r v e ( V 1 )
Plate 83
Extrinsic Eye Muscles
Rightlateralview
S u p e r i oor b l i q u em u s c l e Levatorpalpebrae superioris muscle
,Trochlea (pulley)
Suoeriorrectusmuscle O p t i c n e r v e( l l )
Medialrectusmuscle
al rectusmuscle(cut) C o m m o n t e n d i n o u sr i n g
Lateralrectusmuscle(cut)
lnferiorobliquemuscle
Inferiorrectusmuscle
periortarsus
Superiorview Levatorpalpebrae muscle(cut) superioris S u p e r i oor b l i q u em u s c l e Medialrectusmuscle Inferiorrectus C o m m o n t e n d i n o u sr i n g
cF
Superiorrectusmuscle(cut) Lateralrectusmuscle Optic nerve(ll) Superiorrectusmuscle(cut)
muscle(cut) Levatorpalpebrae superioris
Innervationof extrinsiceve muscles: anteriorview
Trochtear
S u p e r i oor b l i q u em u s c l et nerve(lV) (
Levatorpalpebrae superioris muscle Oculomotor n e r v e( l l l )
Superiorrectus Medialrectusmuscle Inferiorrectus
4{tr Plate 84
I n f e r i oor b l i q u e
Orbit and Gontents
Arteries and Veins of Orbit and Eyelids
Medialpalpebralartery
Superiorview
ateralpalpebralartery
Supratrochlear a Dorsalnasalarterv
artery Supraorbital A n t e r i om r eningeal Zygomaticbranches Anteriorethmoidal
Posterior ciliaryarteries
Posterior ethmoidal
M u s c u l abr r a n c h Lacrimal artery
Continuation of ophthalmic arter
Centralretinalartery
M u s c u l abr r a n c h Ophthalmic Internalcarotidartery
Supraorbital artery Supratrochlear artery nasalartery
Anteriorview Superiormedial palpebralartery
Frontalbranchof superficial temporal
Angular artery lnferior medial palpebral artery
Superiorlateralpalpebral Inferiorlateralpalpebral arter
S u p e r i oar n di n f e r i o r palpebralarterialarches
Zygomaticofacial artery
Facialartery Transversefacial
Infraorbital artery
(X = anastomosisof vesselsfrom externaland internalcarotid arteries)
Supratrochlear vein Lateral view
Supraorbitalvein S u p e r i o ro p h t h a l m i cv e i n
C a v e r n o ussi n u s
Nasofrontalvein
A n g u l avr e i n Vorticoseveins Facialvein
I n f e r i o ro p h t h a l m i cv e i n Pterygoid Maxillaryvein R e t r o m a n d i b u l avre i
Orbit and Gontents
Deep facialvein
4{F Plate 85
Nerves of Orbit
Superiorview
-&lLrJ
e
Levatorpalpebrae superioris muscle
Supratrochlear nerve
S u p e r i orre c t u sm u s c l e
Medialrectusmuscle
Lacrimalgland
S u p e r i oor b l i q u em u s c l e
Lacrimalnerve
Infratrochlear nerve
Lateralrectusmuscle Nasociliarynerve Frontalnerve Trochlearnerve (lV)
Maxillarynerve(Vz)
C o m m o n t e n d i n o u sr i n g
Meningealbranch of maxillarynerve
O p h t h a l m i cn e r v e ( V 1
M a n d i b u l anre r v e( V : )
O p t i c n e r v e( l l )
Lesserpetrosalnerve Internalcarotid artery and nerve plexus
Meningeal branch of mandibularnerve
O c u l o m o t o r n e r v e( l l l )
Createrpetrosalnerve
Trochlearnerve (lV) ,
T r i g e m i n a(l s e m i l u n a rg) a n g l i o n
Abducent nerve (Vl) Tentorium cerebelli
i:!;1 i il-
Tentorial(meningeal) branch of ophthalmic nerve
Long ciliary nerves
Superior view: levatorpalpebraesuperioris, superiorrectus,and superior obliquemusclespartially cut away Supratrochlear nerve(cut) Supraorbital nervebranches(cut) Infratrochlear n Anteriorethmoidal O p t i c n e r v e( l l ) Posteriorethmoidal nerve S u p e r i o rb r a n c ho f o c u l o m o t o rn e r v e ( l l l ) ( c u t Nasociliarynerve Internalcarotid plexus Trochlearnerve (lV) (cut) O c u l o m o t o r n e r v e( l l l ) A b d u c e n tn e r v e ( V l )
Plate 86
Short ciliary nerves Lacrimalnerve
C i l i a r yg a n g l i o n root of ciliary Parasympathetic ganglion(frominferiorbranch of oculomotornerve) theticroot of ciliary ganglion (from internal carotid olexus) Sensoryroot of ciliary ganglion
(fromnasociliary nerve) Branches to inferior and medialrectusmuscles A b d u c e n tn e r v e ( V l ) Inferior branch of oculomotor nerve (lll) Lacrimalnerve Frontalnerve (cut) O p h t h a l m i cn e r v e ( V 1 )
*{r
Orbit and Contents
Eyeball
Cornea
Horizontal section Z o r r u l afri b e r s ( s u s p e n s o rl yi g a m e n ot f l e n s )
C a p s u l eo f l e n s
A n t e r i o rc h am b e r
Posle r i o r c h a
S c l e r avl e n o u ss i n u s ( c a n a ol f S c h l e m m )
Iridoco
S c l e r asl p ur tl
C i l i a r yb o d y a n d c i l i a r yn r u s c l e
I angle 'ocesses B u l b a rc o n j u n c t i v a
C i l i a r yp a r t o f r e t i n . r I
T e n d o no 1 l a t e r a lr e c t u s muscle
Ora serrata Tendon medial muscte
, I
I t
{
I \ \
\ \.
V i t r e o u sb o d y H y a l o i dc a n a l
I space/ Sclera
L a m i n ac r i b r o s ao f s c l e r a
s h e a t ho f 's c a p s ul e
O p t i c n e r v e( l l ) C e n t r a lr e t i n a l a r t e r ya n d v e i n
4{tr" Orbit and Gontents
Subarachnoid spac'e
Plate 87
Anterior and Posterior Ghambers of Eye
Schwalbe'sline Trabecularmeshworkand spaces of iridocornealangle(of Fontana)
Posteriorlimitinglamina (Descemet'smembrane) Endotheliumof anteriorchamber
Scleralvenoussinus(canalof Schlemm)
Cornea
lridocorneal angle Pectinateligament Major arterial circleof iris Anteriorciliaryvein Bulbar conjunctiva
Anterior chamber
Sclera Minor arterial circleof iris
Ciliary part of
Meridional Circular fibers fibers Ciliarymuscle
Dilatorpupillae muscle
Ciliarybody Perichoroidal space
Note:For clarity,only singleplaneof zonularfibersshown; actually, fiberssurroundentirecircumference of lens.
Plate 88
Pigment epithelium (iridialpartof retina)
Nucleusof lens Capsuleof lens
Sphincterpupillaemuscle
4{tr Olbit and Contents
Lens and Supporting Structures
Optic part of retina
Ora serrata O r b i c u l ucsi l i a r i os f ciliarybodycovered by ciliarypartof retina Ciliaryprocesses
Cortex Equator
Z o n u l a fri b e r s
Eveballsectionedin frontal plane: airteriorsegmentviewedfrom behind Zonularfibers
4{r
Orbiculusciliarisof ciliarvbody
Horizontalsection
Ora serrata Optic part of retina
O r b i c u l ucsi l i a r ios f ciliarvbodvcovered by ciliarypartof retina
Zonularfibersfanningout and blendinginto lenscapsule
Enlargement of segmentoutlinedin top illustration(semischematic)
Orbit and Gontents
Plate 89
Intrinsic Arteries and Veins of Eye SeealsoPlate 85
Minor arterialcircle of iris Anterior chamber M a j o r a r t e r i a cl i r c l eo f i r i s S c l e r avl e n o u ss i n u s ( c a n a lo f S c h l e m m )
Blood vesselsof ciliary body coniunctivaand conjunctivalvessels Anterior ciliaryartery and vein
I
Ciliary body
IL e n s
lridocorneal
angre
Ora serrata
P o s t e r i ocrh a m b e i
M u s c u l aar r t e r ya n dv e i n
Z o n u l a fri b e r s Extrinsic eye muscle Vitreouschamber Long posterior ciliary artery
Vorticosevein
Episcleralartery and vein Retinalartery and vein
Long posteriorciliary artery posteriorciliary arteries Central retinalartery and vein
\
S u p e r i otre m p o r a l r e t i n aal r t e r i o l e
O p t i c n e r v e( l l )
Inferiortemporal retinalarteriole and venule
Right retinal vessels:ophthalmoscopic view
Plate 90
S u p e r i onr a s a l retinalarteriole a n dv e n u l e
ano
Macula Foveacentralis
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S u p e r i o rm a c u l a r arterioleand venule
Optic disc
Inferiornasal retinalarteriole a n dv e n u l e Inferior macular arterioleand venule
Orbit and Gontents
Vascular Supply of Eye
Vasculararrangements within the choroid (vasculartunic) of the eyeball Anterior tributariesof a vorticosevein Anterior ciliary arteries Tendonof superiorrectus muscle
J u n c t i o nosf s u p r a c h o r o i d a l formingvorticosevein tributaries
Sclera
S u p e r i oor p h t h a l m ivce i n
Posteriorconjunctival artery and vein
Bulb of vorticose(choroid)vein Vorticose(choroid)vein
A n t e r i o rc i l i a r yv e i n s
ciliaryartery Longposterior Malor arterialcircle of iris
Shortposterior ciliaryarteries
Minor arterial c i r c l eo f i r i s
External sheathof opticnerve(duramater)
Conjunctiva ano cornea
lnternalsheath of optic nerve (pia-arachnoidmater)
Shortposterior ciliaryarteries
Centralretinal arteryand vein
Arteriesand v e i n so f i r i s S c l e r avl e n o u ss i n u s ( c a n a lo f S c h l e m m )
Vessels of internal sheathof optic nerve
Veinsdrainingscleralvenous sinus(into anteriorciliaryveins)
ciliaryarteries Shortposterior
A n t e r i o rc i l i a r yv e i n s N o n p ig m e n t e da n d p i g m e n t e d regionsof the retina Recurrentbranch of anterior ciliarvarterv
Segmentof episcleralvein*
Muscular artery
lnferiorophthalmicvein Posteriortributariesof a vorticose vein
*The episcleralveinsare shown here anastomosin1with the vorticose veins, which they do; however they also drain into thi anterior ciliary veins.
Orbit and Gontents
Cryd4s/*
Plate 91
Pathway of Sound Reception
Frontalsection
Facialnerve (Vll) (cut) Limbs of stapes
Prominenceof lateralsemicircularcanal
Baseof stapesin oval (vestibular)window
Vestibule Semicircularducts, ampullae,utricle,and saccule
Tegmen tympani Facialnerve (Vll) (cut)
M a l l e u s( h e a d )
Vestibular nerve
Epitympanic
Cochlear nerve Internalacoustic meatus
Vestibulocochlear n e r v e( V l l l )
External acousticmeatus
Nasopharynx
Tympanicmembrane' Tympaniccavity
Cochlea
Promontory Round (cochlear)window ,
Auditory(pharyngotympanic,Eustachian)tube
4Ntr Plate 92
Scalatvmpi Note: Arrows indicatecourse of sound waves.
External Ear and fVmpanic GavitY
Otoscopicview of right tympanicmembrane
Rightauricle(pinna) Triangular fossa
C r u xo f h e l i x meatus acoustic External
Y a r Sf l a c C l O a
t
Scaphoidfossa
Lateralprocessof malleus
Posteriormallearfold
Anteriormallear fold
Cruraof antihelix
L o n gl i m bo f i n c u s
Auriculartubercle(of Darwin) Antihelix Concha of auricle
Lobuleof auricle
H a n d l eo f m a l l e u s
Tragus
Umbo
Intertragicnotch
tttragus Coneof light
fympanic
Parstensa Coronaloblique sectionof externalacousticmeatusand middle ear (tympaniccavity)
S u p e r i o rl i g a m e n to f m a l l e u s
of malleus Long limb of incus
S h o r lt i m bo f i n c u s
Tendonof stapediusmuscle Footplateof stapes
}, Chorda tympani nerve (cut)
Handleof malleus Promontory with tympanicplexus
Anterior ligment of malleus(cut)
Tensortympanimuscle
Tympanicmembrane Tensorveli palatinimuscle Tympaniccavity
Eustachian) tube Auditory(pharyngotympanic, (lateral view) Righttympaniccavity after removalof tympanicmembrane process malleus of Lateral Chorda tympani nerve Tendon of tensor tympani muscle L o n gl i m b o f i n c u s
Ossiclesarticulated:medial view Prominenceof facial canar
Pyramidaleminence and tendon of stapediusmuscle
Stapes
Handle of malleus
Tympanic
Fossaof round window
Lesserpetrosalnerve Tympanic nerve
Ear
plexuson promontory Tympanic
process Lenticular of incus
C/Fd4g/*
4{tr Plate 93
lVmpanic Gavity
tateral wall of tympaniccavity:medial(internal)view Superiorligament of malleus
Head of malleus
S u p e r i ol ri g a m e not f i n c u s
Epitympanic recess
S h o r tl i m bo f i n c u s
Anteriororocessof m
Posterior mallearfold
Chordatympaninerve
Posteriorligament of incus
Anteriormallearfold
Long limb of incus
Tensortympanimuscle
tympani nerve
H a n d l eo f m a l l e u s
Lenticular processof incus
Tympanic membrane (parsten
Facialnerve(Vll)
Auditory (pharyngotympanic, Eustachian) tube/ lnternalcarotid artery
Medial wall of tympaniccavity:lateralview
Prominenceof lateralsemicircularcanal Prominenceof facial canal
Mastoid antrum
G e n i c u l u m( g e n i c u l a t eg a n g l i o n )o f f a c i a ln e r v e Baseof stapesin fossaof oval (vestibular)
Creater petrosalnerve
Limbsof s
-/
Pyramidaleminence
Tensortympanimuscle (tendoncut)
Auditory (pharyngotympanic, Eustachian) tube
Chorda tympani nerve (cut)
Levatorveli palatini muscle
Mastoid cel
Tendonof stapedius muscle Fossa of round (cochlear) window
Promontory with tympanic n e r v e ( o f J a c o b s o n a) n d p l e x u s unoer mucosa
fossi Jugular Internalcarotid artery
Facialnerve (Vll)
in stylomastoid foramei
Plate 94
Tympaniccells
4{F
Bony and ltlembranous Labyrinths
Rightbony labyrinth(oticcapsule),anterolateralview: suiroundihgcincellousbone removed
Dissectedrieht bonv labvrinth(otic capsule): membranoui labyriirth rbmoved
Ellipticalrecess Cochlearrecess
Vestibule (note perforations for nerve fibers) Helicotrema
Internalopeningof aqueduct vestibular
Scalavestibuli Osseousspiral lamina Scalatympani
Rightmembranouslabyrinthwith nerves:posteromedialview duct Anteriorsemicircular ner Superiorpartof vestibular (fromutricleandanteriorand lateralmembranous ampullae)
ampulla Anteriormembranous ampulla Lateralmembranous
Cochlearduct (basalturn) Common membranous limb Cochlearnerve Lateral semicircular duct Posterior semicircular duct
Vestibulocochlear nerve Vestibular
membranous Posterior ampulla
ganglion Vestibular
4{F Ear
lnferiorpartof vestibular nerve(from sacculeand posteriormembranous ampulla)
duct Endolymphatic
Plate 95
Bony and Memblanous Labyrinths (continuedl
Bonyand membranouslabyrinths:schema A n t e r i o rs e m i c i r c u l acr a n a la n d d u c t Dura mater
Posteriorsemicircular c a n a la n d d u c t
Endolymphaticsac
Common bony and
Endolymphaticduct i n v e s t i b u l aa r queduct
m e m b r a n o ul is Lateralsemicircular canal and duct
f,\,
Utricle
Otic capsule
Saccule
Stapesin oval (vestibular)window
Helicotrema of cochlea
D u c t u sr e u n i e n s
In c u s
Scalavestibuli
Malleus
C o c h l e a rd u c t
Tympanic cavity
Scalatympani
Externalacoustic meatus
Umbo Tympa n rc memor ane------7 ) indow R o u n d ( c o c h l e a rw (closedby secondary t y m p a n i cm e m b r a n e )
ochlear aoueduct
Otic capsule Vestibule Pharyngotympanic(auditory) tube
Sectionthroughturn of cochlea Scalavestibuli Osseous s p i r alla m i n a
Nervefibers
(Reissner's) Vestibular memDrane Cochlearduct Spiral igament
M o d i o l u so f
Tectorialmembrane
Spiralorgan(of Corti) S p i r a lg a n g l i o n Basilam r embrane Scalatympani
Osseouscochlea
Outerhaircells Cochlear nerve
4{tr Plate 96
P i l l a(rr o d )c e l l s I n n e rh a i r c e l l
Orientation of Labyfinth in Skull
Superiorprojectionof right bony labyrinth on floor of skull
Croovefor greaterpetrosalnerve ganglion)of facialnerve Geniculum(geniculate
Cochlea
zPlaneof anterior canal ,/ semicircular Cochlear nerve
Facialnerve(Vl lnternalacoustic openrnS
Vestibulocochlear nerve(Vlll
Lateralsemicircular canal
Vestibular nerve Petrouspart of temporalbone External openingof vestibular aqueduct (forendolymphatic duct)
\. Planeof posterior canal semicircular
lateral projection of right membranouslabyrinth Cochlearduct
Ceniculum(geniculate of facialnerve
Cochlearnerve Trigeminal nerve (V)
part of vestibular nerve
Vestibulocochlear n e r v e( V l l l )
lnternaljugularvein Inferiorpart of vestibularnerve duct al semicircular duct Posterior semicircular
Superior petrosalsinus Sigmoid sinus Confluence of sinuses Transverse sinus
Ear
4{tr Plate 97
Auditory (Pharyngotympanic, Eustachian| Ti,rbe SeealsoPlates 52, 55, 65 C a r t i l a g i n o u sp a r t o f a u d i t o r y ( p h a r y n g o t y m p a n i c ,E u s t a c h i a n ) t u b e a t b a s eo f s k u l l : i n f e r i o r v i e w Palatineprocessof maxilla P t e r y g o i dh a m u l u sa n d medial pterygoid plate.
Horizontal plate of palatinebone
Lateralpterygoid plate
Choana .
Scaphoidfossa
) of cartilaginouspart of
f?l"l,il11ti"1t auditorylpharynsotympanic, M e d t a ll a m t n a ) E u s t a c f r i a nt u) b e "
Foramenovale Foramenlacerum
F O r a m e nS p r n o s u m
Petrouspart of temporal bone
S p i n eo f s p h e n o i db o n e Internalcarotid artery entering carotid
Occipital condyle
Mastoidprocess Foramenmagnum
Sectionthrough cartilaginouspart of auditory (pharyngotympanic, Eustachian) tube, with tube closed
Sectionthrough cartilaginouspart of auditory (pharyngotympanic, Eustachian) tube, with tube open Trigeminalganglion
T r i g e m i n agl a n g l i o n Internalcarotid artery in carotid canal Duramater
Internalcarotid artery in carotid cana
Duramater Laterallamina
of cartilage
Laterallamina of cartilage M e d i a ll a m i n a of cartilage
A u d i t o r yt u b el u m e n Tensorveli palatini muscte Levatorveli palatini muscle Salpingopharyngeu s muscte
M e d i a ll a m i n a of cartil
Auditorytubelumen Tensorvelipalatini muscte Levatorveli palatini
muscle S a l pni g o p h a r y n g e u s muScre
Nasopharynx
4{tr
Auditory(pharyngotympanic, Eustachian) tubeclosedby elasticrecoilof cartilage, tissueturgidity, and tensionof salpingopharyngeus muscles
Plate 98
Nasopharynx Lumen opened chiefly when attachment of tensor veli palatinimuscle pulls wall of tube laterallyduring swallowing
Eat
Meninges and Diploic Veins . : j ' , '
SeealsoPlate
D i p l o i cv e i n
Coronal dissection
S u p e r i o rs a g i t t aSl I NU E m i s s a r vy e i n
Frontaa l n d p a r i e t a lt r i b u t a r i e s o f s u p e r f i c i atle m p o r a lv e i n l ranches Frontaa l nd parietab o f s u p e r f i c i atle m p o r a la r t e r y C r a n u l a rf o v e o l a ( i n d e n t a t i o no f s k u l lb y a r a c h n o i dg r a n u l a t i o n )
A r a c h n o i dg r a n u l a t i o n C e r e b r a vl e i n ( b r i d g i n gv e i n ) p e n e t r a t e s u b d u r a sl p a c et o e n t e r s i n u s D u r a m a t e r( p e r i o s t e aal n d m e n i n g e a l a y e r s ) D u r a - s k u l li n t e r f a c e( s i t eo f e p i d u r a lh e m a t o m a ) Arachnoid space Subarachnoid P i am a t e r Middlemeningeal a r t e r ya n d v e i n Deep, m i d d l e ,a n d superficial temporal artefles and veins
L a t e r a (l v e n o u s )I a c u n a B r i d g i n gv e i n Inferior sagittal SINUS
/t
l{1, 'l ir,
I
S u p e r i o rt h a l a m o s t r i a t ae n d c h o r o i d a lv e i n s ,i n t e r n a lc e r e b r a l v e i n s ,a n d c h o r o i d p l e x u so f l a t e r a vl e n t r i c l e
Diploicand emissary v e i n so f s k u l l
Frontad l i p l o i cv e i n
A n t e r i o rt e n r p o r a l d i p l o i cv e i n
l iddle D e e p a n d s u p e r f i c i am c e r e b r a vl e i n s
P a r i e t ael m i s s a r yv e i n P o s t e r i o tre m p o r a l d i p l o i cv e i n O c c i p i t a le m i s s a r yv e i n d i p l o i cv e i n M a s t o i de m i s s a r yv e i n
Nr Meninges and Brain
Plate 99
Meningeal Arteries
Frontal(anterior)and parietal (posterior)branchesof m i d d l e m e n i n g e a al r t e r y Middle meningealartery
Anterior meningeal branch of anterior ethmoidal
Arachnoid sranulations
O p e n i n go f s u p e r i ocr e r e b r avle i n Lateral(venous)lacuna
Superiorsagittalsinus Dura mater
artery
Mastoid branch of occipital artery
M e n i n e e a lb r a n c h e so f ascendingpharyngealartery Mastoid branch of occipital artery Middle meningealartery Recurrentmeningealbranch of
c )r t e r y l a c r i m a( lo p h t h a l m i a Accessory meningealartery Anterior meningealbranch of
anteriorethmoidalartery Posteriorethmoidal artery Internalcarotid artery and its meningohypophysealtrunk* (phantom M i d d l e m e n i n g e a al r t e r y
4{tr
Accessorymeningeal
Superficial temporalartery Maxillaryartery Posterior auricularartery Occipitalartery External carotidarter
Anterior and posterior meningealbranchesof vertebralartery Tentorial,cavernoussinus,and meningeal branchesof meningohypophysealtrunk*
*Variant;most commonly, these branchesarisedirectly from internalcarotid artery.
Plate l OO
Meninges and Brain
Epidural Hematoma Temporalfossahematoma Medial displacementof middle cerebralvessels
Shiftof normal midlinestructures
Skullfracture middle crossing meningeal a.
Compressionof posteriorcerebrala.
Herniationof temporallobe undertentorium cerebelli
6ii
Herniationof cerebellartonsil Compressionof oculomotor(lll) n. pupil dilatation leadingto ipsilateral and 3rd cranialn. musclepalsv
Shiftof brainstemto opposite side may reverselateralization of signsby tentorial pressureon contralateralpathways.
hemiparesis, deeptendonhypersign reflexia, and Babinski's
"Questionmark" skin incision(black); outlineof free bone flap and burr holes(red)
Skinflap reflected(Raneyclipscontrolbleeding).Freebone flap removed and dura opened. Clot evacuatedby irrigation,
suction,andforceos.
Sectionshowingacutesubduralhematomaon rightsideand 'subduralhematoma associatedwith temooral lobe intracerebral hematoma ("burst" temporal lobe) on left
Meninges and Brain
Nr Plate I Ol
Meninges and Superficial Gerebral Veins
Calvaria Pericranium
Cranularfoveola
Galeaaponeurotica Arachnoidgranulation
Superiorsagittalsinus Emissarv vein Tributary of superficial temporalvein
(siteof epiduralhematoma) Duramater Arachnoid-durainterface (siteof subduralhematoma) Arachnoid
Bridgingvein
Subarachnoid space Piamater erebralartery Superiorcerebralvein Falxcerebri al hemisphere Branches of middlemeningeal artery Superiorsagittal
Superiorcerebralveins (bridgingveins)(penetrating arachnoidand dura materto entersuperiorsagittalsinus)
Duramater
Superiorcerebralveins (beneatharachnoid)
ior anastomotic vein (of Trolard)
Inferioranastomotic vein (of Labb6)
middle Superficial cerebralvein
4{r
Middlemeningeal arterVandveins/ Inferiorcerebralveins (beneatharachnoid)
Plate I 02
Meninges and Brain
Dural Venous Sinuses
S u p e r i osra g i t t asli n u s si Straight
Sagittalsection
Creatcerebralvein(of Calen) cerebelli Tentorium S u p e r i osra g i t t asli n u s
Inferiorsagittalsi
S p h e n o p a r i e t asli n u s
Anterior and oosterior intercavernoussinuses
Superior petrosalsinus Basilar v e n o u sp l e
Inferior petrosalsin Tojugular foramen
Sigmoid sinus Transversesinus
O c c i p i t asl i n u i Falxcerebelli
*{r Meninges and Brain
of sinuses Confluence
Plate 1O3
Dural Venous Sinuses (continuedl Skullsectionedhorizontally: superiorview
yland) H y p o p h y s (i p s i t u i t a rg ,
S u p e r i o rs a g i t t asl i n u s( c u t ) Falxcerebri (cut)
T O p t i c n e r v e( l l ) Internalcarotid artery
S u p e r i o ro p h t h a l m i cv e i n
O c u l o m o t o r n e r v e( l l l )
A n t e r i o ra n d p o s t e r i o r i ntercavernous s tn u s e s
S p h e n o p a r i est ai nl u s Trochlearnerve (lV) O p h t h a l m i cn e r v e ( V 1 )
S u p e r f i c i am l iddle cerebralvein (cut)
Maxillary nerve (V2)
C a v e r n o u ss i n u s
T r i g e m i n agl a n g l i o n
Basilar v e n o u sp t e
M a n d i b u l a rn e r v e ( V : )
Superior p e t r o s a sl i n u s
M i d d l e m e n i n g e a al r t e r y Abducent nerve (Vl)
Inferior p e t r o s a sl i n u s
Petrosalvein
Tentorial
F a c i a nl e r v e ( V l l ) , i n t e r m e d i a t en e r v e ,a n d v e s t i b u l o c o c h l e anre r v e ( V ll l )
artery Tentorium cerebelli
C l o s s o p h a r y n B(el X a l) andvagus(X)nerves
Inferior cerebralvein (cut
J u g u l a fro r a m e n
Transverse sinus I n f e r i osr a g i t t a l s i n u s( c u t )
Transverse sinus
S t r a i g h st i n u s
Accessory nerve (Xl)
Falxcerebri (cut) C o n f l u e n c eo f s i n u s e s
H y p o g l o s s anl e r v e ( X l l )
'#r"
r e a t c e r e b r a vl e i n ( o f C a l e n )
S u p e r i o rs a g i t t asl i n u s( c u t )
*{r
C a v e r n o u ss i n u s O c u l o m o t o r n e r v e( l l l )
ic chiasm Posterior c o m m u n i c a t i n ga r t e r y
Trochlearnerve (lV) A b d u c e n tn e r v e ( v l ) O p h t h a l m i cn e r v e
lnternalcarotid arrery Hypophysis ( p i t u i t a r yg l a n d )
M a x i l l a r yn e r v e S p h e n o i d asl i n u s
Coronal section t h r o u g h c a v e r n o u ss i n u s
Plate 1O4
Nasopharynx
Meninges and Brain
Gerebrum: Lateral Views
Centralsulcus(of Rolando)
gyrus Postcentral
gyrus Precentral
sulcus Postcentral
Precentral sulcus
Superiorparietallobule
Superiorfrontalgyrus Intraparietal sulcus Suoeriorfrontalsulcus Inferiorparietallobule pramarginal gyrus gurargyrus
Middlefrontalgyrus Inferiorfrontalsulcus Inferiorfrontalgyrus Opercularpart part Triangular Orbitalpart
tooccipital sulcus
Frontal pole
pole Calcarine sulcus Lunatesulcus (inconstant)
t t
Lateralsulcus Anteriorramus ramus (of Sylvius) Ascending Posterior ramus Temporalpole
Transverse occipitalsulcus Superiortemporalgyrui
notch Preoccioital
Superiortemporalsulcui Middletemporalgyru
Inferiortemporalgyrus
Inferiortemporalsulcui Frontallobe Parietallobe
Temoorallobe Occipital
Parietal ooerculum F r o n t aol p e r c u l u m Orbitalooerculum
4{r Meninges and Brain
lnsula (island of Reil)
Shortgyri Centralsulcus Limen
Longgyrus C i r c u l asr u l c u s
Temporaloperculum
Plate I 05
Gerebrum: Medial Views Forhypophysis seePlate 147 S a g i t t a ls e c t i o n o f brain in situ
C i n g u l a t eg y r u s Cingulate sulcus
M e d i a l f r o n t a lg y r S u l c u so f c o r p u sc a l l o s u
P a r a c e n t r aslu l c u s C e n t r a ls u l c u s( o f R o l a n d o ) P a r a c e n t r al ol b u l e M a r g i n a ls u l c u s C o r p u sc a l l o s u m
Fornix
;.
S e p t u n 'pr e l l u c i d u m I n t e r v e nt r i c u l a r f o r a m e n( o f M o n r o lnterthalamic adhesion
'/
T h a l a m ua snd 3rd ventricle
-,-Precuneus S u p e r i o rs a g i t t asl i n u s C h o r o i dp l e x u s of 3rd ventricle S t r i am e d u l l a r i s of thalamus 1 Parietooccipital S UI C U S
S ub c a l l o s a l (parolfactory)
C un e u s
Anterior commtssure
P i n e a lb o d y Posterior commtssure Calcarine s ur c u s S t r a i g h st i n u s in tentorium cerebelli
Habenular commrssure
S ub c a l l o s a l
gyrus Hypothalamic S UI C US
L.rmina te
r e a t c e r e b r a vl e i n
S up r a optrc recess
S u p e r i o cr o l l i c u l u s I n f e r i o rc o l l i c u l u s l )l a t e T e c t a l( q u a d r i g e m i n a p
Optic chi Tubercinereun'r
erebellum
H y p o p h y s i s( p i t u i t a r yg l a n o l M a m m i l l . r r yb o d y C e r e b r a lp e d u n c l e Cerebraa l queduct (ot Sylvius)
S u p e r i o rm e d u l l a r yv e l u m 4 t h v e n t r i c l ea n d c h o r o i d p l e x u s I n f e r i o rm e d u l l a r yv e l u m M e d u l l ao b l o n g a t a
M e d i a l s u r f a c eo f c e r e b r a l h e m i s p h e r e :b r a i n s t e m e x c i s e d C i n g u l a t eg y r u s M am m i l l o t h . r l a m i c fasciculus M a m m i l l a r yb o d y
l s t h m u so f c i n g u l a l eg y r u s P a r i e t o o c c i p i t as lu l c u s
C un e u s
uncu5 C a l c a r i n es u l c u s
O p t i c n e r v e( l l
Linguag l yrus
( ) l i a c t o r yt r a c t C o l l a t e r asl u l c u s R h i n asl u l c u s M e d i a l o c c i p i t o t e m p o r agl y r u s O c c i p i t o t e m p o r asl u l c u s L a t e r a ol c c i p i t o t e m p o r agl , y r u s
Plate I 06
orro,ni* Eifl,"" I F i m b r i ao f h i p p o c a m p u s D e n t a t eg y r u s P a r a h i p p o c a m p agly r u s
*{r
Meninges and Brain
Gerebrum: Inferior View
Frontalpole of cerebrum
Sectionedbrainstem
Straightgyrus Olfactorvsulcus Orbitalsulci
Longitudinal cerebralfissure Cenu of corpuscallosum L a m i n at e r m i n a l i s
Olfactorybulb factory tract
Orbitalgyri
O p t i cc h i a s m
Temporalpole of cerebrum
Optic nerve(ll) (cut)
Lateralsulcus(of Sylvius)
Hypophysis (pituitarygland)
Inferiortemporalsulcus Inferiortemporal
Anterior perforated substance Optic tract u b e rc i n e r e u m Mammillarybody
Inferior(inferol a t e r a lm ) argin of cerebrum
Posteriorperforated (in substance interpeduncular fossa)
R h i n asl u l c u s
ebralcrus Uncus
Lateralgeniculate body
Inferior temporal gyru
nigra Substantia Medialgeniculate body
Occipitotemporal surcus
ed nucleus Lateraloccipitotemporal gyrus
i n a ro f t h a l a m u s Superiorcolliculus(of corporaquadrigemina)
Collateral
ebralaqueduct Parahippocampal gyrus Splenium o f c o r p u sc a l l o s u m Medial occipitotemporalgyrus
Calcarine sulcu
Apexof cuneus Occipitalpole of cerebrum Longitudinal cerebralfissure
lsthmusof cingulate
4{r Meninges and Brain
Plate I 07
Ventricles of Brain
Left lateralphantomview
Frontal(anterior) horn
Rightlateralventricle
Centralpart
Left lateral ventricle
Temporal(inferior)horn Occipital (posterior)horn
Cerebralaqueduct(of Sylvius) 4th ventricle Leftlateralaperture (foramenof Luschka) Leftinterventricular foramen(of Monro)
Leftlateralrecess Medianaperture (foramenof Magendie)
3rd ventricle
Supraoptic recess Interthalamicadhesio6
I n f u n d i b u l ar er c e s 6
Centralcanalof soinalcord
Pinealrecess Suprapineal Corpus callosum S e p t u mp e l l u c i d u m Lateralventricle Body of caudate nucleus Choroid plexusof lateralventricle Striaterminalis Superiorthalamostriatevein Body of fornix Internalcerebralvein Tela choroidea of 3rd ventricle
id plexusof 3rd ventricle Thalamus Putamen ) , ) Lenurormnucreus C l o b u s p a l l i d u s) I n t e r n a cl a p s u l e 3rd ventricleand interthalamicadhesion
=
Hypothalamus Tail of caudate nucleus Optic tract
White arrow in left interventricular foramen (of Monro) -
Ependyma Pia mater
Coronal section of brain: posterior view
Plate I 08
Choroid plexusof lateralventricle Temporal (inferior)horn of lateralventricle F i m b r i ao f h i p p o c a m p u s
Hippocampus Dentategyrus gyrus Parahippocampal
4{F
Meninges and Brain
Girculation of Gerebrospinal Fluid
Choroid plexusof lateralventricle(phantom)
Superiorsagittalsinus achnoid space
C i s t e r no f c o r p u sc a l l o s u m
f, rachnoid granulations
Duramater Arachnoid
lnterventricular foramen (of Monro) Chiasmaticcistern
Choroidplexusof 3rd vent lnteroeduncularcistern
Cerebralaqueduct(of Sylvius)
Quadrigeminalcistern (of great cerebral vein)
Prepontinecistern
Lateralaperture(foramenof Luschka) Choroidolexusof 4th ven
cistern cerebellomedullary Medianaperture (foramenof Magendie)
Duramater Arachnoid Subarachnoid space Centralcanalof soinalcoro
Nr Meninges and Brain
Plate I 09
Basal Nuclei (Gangliaf
Horizontalsections throughcerebrum C e n u o f c o r p u sc a l l o s u m
H e a d o f c a u d a t en u c l e u s
L a t e r avl e n t r i c l e S e p t u mp e l l u c i d u m
C o l u m no f f o r n i x -
&
I n s ul a ( i s l a n do f R e i l )
t4".
3rd ventricle
Interthalamic adhesion
E x t e r n acl a p s u l e
Thalamus
Claustrum
C r u so f f o r n i x
R e t r o l e n t i c u l apra r t o f i n t e r n a lc a p s u l e
C h o r o i dp l e x u s o f l a t e r a vl e n t r i c l e
T a i lo f c a u d a t en u c l e u s
S p l e n i u mo f c o r p u sc a i l o s u m
H i p p o c a m p u sa n d f i m b r i a O c c i p i t a l( p o s t e r i o r h) o r n o f l a t e r a vl e n t r i c l e Habenula
O r g a n i z a t i o no f b a s a ln u c l e i ( g a n g l i a )
P i n e a lb o d y
C a u d a t eP u t a m e nC l o b u s nucleus pallidus Cleft for internalcapsule
Striatum
Lentifornt r-rucleus
Corpus striatum B a s anl u c l e i (ganglia)
Caudate t Body n u c l e u Is H e a d Levelsot sectrons {Babove
lA-
Thalamus
A
B Pulvinar
L e n t i f o r mn u c l e u s ( g l o b u sp a l l i d u sm e d i a l to putamen)
*{r Plate I I O
Amygdaloid body -
M e d i a l g e n i c u l a t eb o d y
\Tail of caudate nur
Interrelationship of thalamus,lentiformnucleus,caudate nucleus/and amygdaloidbody (schema): left lateralview
Meninges and Brain
Thalamus
orpuscallosum(cut)
Interventricular foramen(of Monro)
Headof caudatenucleus
Tela choroidea (cut edge) of 3rd ventricle-.
S e p t u mp e l l u c i d u m
3rd ventricle
Columnsof fornix
Choroid
Anteriortubercle
Superiorthalamostriate
Striaterminalis
Peshippoca
Interthalamicadhesion
(inferior)horn Temporal of lateral ventricle
Laminaaffixa
Internalcerebralvei
Striamedullaris
Dentategyrus
lartrigone
Collateralemi
Pulvinarketractedl
Hippocampus
Lateralgeniculatebody
F i m b r i ao f h i
I geniculatebody
Posterior commissure
Brachiumof superiorcolliculus
Habenular commissure
Brachiumof inferiorcolliculus
Pinealbody Collateral trigone
Superiorcolliculus
Calcaravi
lnferiorcolliculus
Occipital(posterior) horn of lateralventricle
Cerebellum
Calcarine 3rd ventricle
lnternal medullary lamina
lnterthalamic adhesion
Intralaminar nuclei
Reticular nucleus
External medullary lamina Mediannuclei
Schematicsection through thalamus (at level of broken line shown in figure at right)
Meninges and Brain
4{tr Pulvinar body Lateralgeniculate I geniculate body
T h a l a m i cn u c l e i CM [D l-P M MD VA Vl V[ VP VPt VPM
Centromedian Lateraldorsal Lateralposterior Medial Medialdorsal Ventralanterior Ventralintermedia. Ventrallateral Ventralposterior Ventralposterolateral Ventralposterornedial
Schematic representation of thalamus (external medullarylaminaand reticularnucleiremoved) I I
Lateralnuclei Medialnuclei 'r ,' ', ; ' Anteriornuclei
Plate | | 1
Hippocampus and Fornix
Superiordissection
Cenu of corpuscallosum(cut) Septumpellucidum Headof caudatenucleus Columnsof fornix Striaterminalis Bodyof fornix Peshippocampus Thalami of fornix Dentategyrus Fimbriaof hippocampus
Commissureof fornix Spleniumof corpuscallosum(cut) ventricle
Occipital(posterior)horn of lateralventricle
4{F
Tailof caudate
Temporal(inferior)horri
Fornix:schema
Plate I l2
Coronal section:posteriorview
lleninges and Brain
Gerebellum
Superiorsurface Anterior cerebellarnotc
lobule(H lV-V) Quadrangular Primaryfissure
C e n t r a ll o b u l e ( l l & l l l
Horizontalfissure C u l m e n( l V &
i m p l e l o b u l e( H V l )
Posteriorlobe P o s t l u n a ft ies s u r e i o rs e m i l u n a r (anseriform l o)b u l e( H V l l A )
F o l i u m( V l l A )
Horizontalfissure l n f e r i osr e m i l u n a r ( c a u d a l )o b u l e( H V l l B )
Posteriorcerebellarnotch
centrallobule
Superiorvermist ( L i n s u l(al ) S u p e r i om r e d u l l a rvve l u m (HX) ventricle
Inferior
lnferior surface
of centrallobule S u p e r i o)r Middle ) Cerebellar peduncles Inferior ) Flocculonodularlobe (dorsolateral) Posterolateral fissure fissure Retrotonsillar
velum
N o d u l e( ) Inferior vermis
Posteriorlobe
U v u l a( l X l onsil
Pyramid( Tuber(Vl Posteriorcerebellarnotch
Decussationof superiorcerebellar
B i v e n t e rl o b u l e ( H V l l l )
(postpyramidal) Secondary fissure Horizontalfissure l n f e r i osr e m i l u n a r ( c a u d a l )o b u l e( H V l l B ) Cerebralcrus M e d i a l l o n g i t u d i n afla s c i c u l u s
4th ventricle Nuclear layer of medulla oblongata
S u p e r i om r e du l l a r y
S u p e r i ocre r e b e l l a r peduncle
Fastigial
Clobose L i n g u l a( l )
Dentate Vermis LmDOtl
4{tr
Sectionin planeof superiorcerebellarpeduncle
Meninges and Brain
Plate I | 3
Brainstem
Posterolateral view
Thalamus(cut surtace) Lateralgeniculate body
Pulvinars of thalami
Optic tract
P i n e a lb o d y
Medial geniculatebody
S u p e r i ocro l l i c u l i
Brachiaof superiorand inferior colliculi
Inferiorcolliculi
erebralcrus
Trochlearnerve (lV)
Pons
Superiormedullaryvel
rigeminalnerve (V)
Superiorcerebellar
peduncle cerebellar
Rhomboid fossaof
Vestibulocochlear nerve(Vlll)
4th ventric
F a c i a nl e r v e ( V l l )
Clossopharyngeal(lX) and
vagus(X)
ferior cerebellarpeduncle
Cuneatetubercle
Hypoglossalnerve (Xll)
C r a c i l et u b e r c l e
Accessorynerve (Xl)
Dorsalrootsof
Nr
l s t s p i n a ln e r v e ( C 1)
Cuneatefasciculus Cracile fascicu
factorytract
Anteriorview
Anteriorperforated substance I n f u n d i b u l u(mp i t u i t a rsyt a l k )
Optic chiasm
M a m m i l l a rbyo d i e s Temporallobe (cut surtace)
Optic tract
n e r v e( l l l )
Tubercinereum
Trochlear nerve(lV) Cerebralcrus
Trigeminalnerve (V)
Lateralgeniculatebody
ucentnerve(Vl)
Posteriorperforatedsubstance
acial nerve (Vll) and intermediatenerve Vestibulocochlearnerve (Vlll) Flocculusof cerebellum
Middle cerebellarpeduncle Olive
oid plexusof 4th ventricle
lossopharyngeal nerve(lX) Pyramid
V e n t r arlo o t so f 1 s ts p i n a l Decussationof pyramids
Plate I 14
nerve(X) H y p o g l o s snael r v e( X l l ) n e r v e( X l )
Meninges and Brain
Fourth Ventricle and Gerebellum
Posteriorview 3rd ventricle Dorsalmediansulcus
Pulvinao r f thalam
peduncle Superiorcerebellar
Pinealbody
Locusceruleus
S u p e r i ocro l l i c u l u s
emrnence
lnferior
Facialcolliculus
Trochlearnerve (lV)
area Vestibular
Superiormedullary
Dentate nucleus of cerebellum
( Superior C e r e b e l l apre d u n c l e {s M i d d l e( Inferior-
riaemedullares
Lateralrecess
Taenia of 4th ventricle
Superiorfovea
Cuneatetubercle aciletubercle
S u l c u sl i m i t a n s
Dorsalmediansulcus
lnferior fovea
Lateralfuniculus
T r i g e m i n taul b e r c l e
lus fascicu
Hypoglossaltrigone Vagal t
e fasciculus
*{r
terthalamicadhesion
Median sagittalsection Bodyof forn
Posteriorcommissure
H a b e n u l acro m m i s s u r e
T h a l a m u(si n 3rd ventricle
Pinealbody
of corpuscallosum
Interventricular foramen (of Monro
Great cerebralvein (of Calen)
Anterior commissure Laminatermi H y p o t h a l a m i cs u l c
C e r e b r aple d u n c l e Cerebralaqueduct(of Sylvius Superiorco Tectal(quadrigeminal)plate
l n f e r i ocr o l l i c u l u s Pons
Superiormedullaryvelum eriormedullaryvelum
M e d i a l l o n g i t u d i n afla s c i
Choroidplexusof 4th ventric Medulla oblongata Median aperture (foramen of Magendie)
of pyrami Decussation Central canal of spinalcor
Meninges and Brain
Plate t t 5
Granial Nerve Nuclei in Brainstem: Schema Posteriorphantomview
O c u l o m o t o rn e r v e( l l l )
S u p e r i ocro l l i c u l u s
ed nucleus nucreus Accessorvoculomotor ( Edi n ger-Westphal) nucleus
Lateralgeniculate Mesencephalin c ucleus of trigeminal
Trochlearnucleus Trochlear nerve(lV)
Principal
sensorynucleusof
Motor nucleusof trigeminal nerve
trigeminal Trigeminalnerve (V) and ganglion
Trigeminal nerve(V) and ganglion
Facialnerve (Vll) and geniculate ganglion-
nucreus
Vestibulocochlear
Facialnucleus
n e r v e( V l l l )
Ceniculum (geniculateganglion) of facial nerve Superior and inferior salivatory nuclei
Anterior.
C o c h l e a rJ nuclei Posterior
I
Vestibular nuclei pharyngeal nerve(lX)
Glossopharyngeal n e r v e( l X )
Vagusnerve(X) Vagus nerve (X)
A c c e s s o r yn e r v e ( X l ) *
Spinaltract and spinal nucleusof trigeminalnerve
Nucleua s mbiguus (dorsal)nucleus
Solitarytract
Dorsalvagalnucleu
Efferentfibers I
Afferentfibers
-
Mixed fibers
o f v a g u s n e r v e( X )
H y p o g l o s snaul c l e u s S p i n anl u c l e u s of accessory nerve
4{tr
*Recent evidence
s_uggests that the accessorynerve lacksa cranialroot and has no connection to the vagus nerve. Verificationof this finding awaits further investigation.
Plate I 16
Granial and Gervical Nerves
Granial Nerve Nuclei in Brainstem: Schema (continuedl
Medialdissection
A c c e s s o r yo c u l o m o t o r (Edinger-Westphal) nucleus
R e dn u c l e u s
O c u l o m o t onr u c l e u s
O c u l o m o t o r n e r v e( l l l
Trochlear nucleus
Mesencephalin c ucleus of trigeminalnerve
Trochlearnerve (lV)
A b d u c e nnt u c l e u s Trigeminal nerve (V) and ganglion
lnternalgenu of facial nerve
Principal F a c i a nl u c l e u s
sensorynucleusof t r i g e m i n anle r v e -
V e s t i b u l a nr u c l e i Motor nucleusof t r i g e m i n a nl e r v e
Anteriorand posterior c o c h l e anr u c l e i
F a c i a nl e r v e ( V l l )
S u p e r i oar n d inferiorsalivatory nuclei
V e s t i b u l o c o c h l e anre r v e ( V l l
A b d u c e n tn e r v e ( V l )
Solitarytractnucleus
C l o s s o p h a r y n g e anle r v e ( l X )
(dorsal)nucleus Posterior o f v a g u sn e r v e( X )
Hypoglossalnerve (Xll)
nucleus Hypoglossal Vagusnerve(X) Nucleua s mbiguus Accessorynerve (Xl)* Spinalnucleusof accessorynerve
Olivei S p i n a lt r a c t a n d s p i n a l t nucleusof trigeminalnerve
I
Efferentfibers
-
.{nelenr rroers
-
Mixed fibers
*{Y
C(d4/^
*Recent evidence suggeststhat the accessorynerve lacksa cranialroot and has no connection to the vagus nerve. Verificationof this finding awaits further investigation.
Granial and Gervical Nerves
Plate I l7
Granial Nerves (Motor and Sensory Distributionf: Schema Spinalnervefibers Efferent(motor) fibers Afferent (sensory)fibers
ill
Oculomotor I Olfactory Nasalcavity
C i l i a r ym u s c l es,p h i n c t e r pupillae,and all externaleye musclesexceptthosebelow
tl Optic Eye
IV Trochlear S u p e r i o ro b l i q u e
vl Abduc
V Trigeminal Sensory-face sinuses,teeth
Lateralrectus muscte
Intermediate nerve Motor-submandibular, sublingual,lacrimalglands Taste-anterior% of tongue, sensorysoft palate
vtl Facial Musclesof face
vill Vestibulocochlear Cochlear Vestibular
IX Glossopharyngeal
Taste-posterior1Aof tongue Sensory-tonsil,pharynx, middle ear Motor-stylopharyn geus, parotid gland
Vagus XI Accessory Sternoclei
trapezius muscles
Motor-heart, lungs,palate,pharynx, larynx,trachea,bronchi, Cl tract Sensory-heart,lungs,trachea,
bronchi,larynx,pharynx, Gl tract,externalear
4{r
? Strap muscles (c1,2,3 fibers)
Plate I l8
Granial and Gervical Nerves
Olfactory Nerve (ll: Schema
S u b c a l l o s a( lp a r o l f a c t o r ya) r e a S e p t a la r e aa n d n u c l e i
Olfactorybulb cells:schema F i b e r sf r o m I C o n t r a l a t e r a l
yulb F i b e r tso I o l f a c t o r b
Efferentfibers to o l f a c t o r yb u l b
A n t e r i o rc o m m i s s u r e
Afferentfibersfrom bulb t o c e n t r acl o n n e c t i o n s a n dc o n t r a l a t e rbaul l b
Medial olfactory stria
a n u l ec e l l ( e x c i t e db y a n d i n h i b i t i n gt o m i t r a l a n d t u f t e dc e l l s ) M i t r a lc e l l R e c u r r e n pt r o c e s s l u ft e d c e l l Periglomerular cell Clomerulus
tory fi b e r s
.k
-T/
ta
t \:;
fftfnflt Olfactory trac ( ) l l a c ' t o tv t l
Olfactory trigone a n d o l f a c t o r yt u b e r c l e L a t e r aol l f a c t o r ys t r i a L a t e r aol l f a c t o r yt r a c t n u c l e u s A n t e r i o rp e r f o r a t e ds u b s t a n c e A m y g d a l o i db o d y ( p h a n t o m )
4{tr Granial and Cervical Nerves
UNCUS
Hippocampal fimbria Dentate gyrus P a r a h i p p o c a m p agly r u s
Plate 119
Optic Nerve (lll (Visual Pathwayl: Schema
C e n t r a ld a r k e r c i r c l er e p r e s e n t s m a c u t a rz o n e L i g h t e rs h a d e s represent n ' r o n o c u l afri e l d s E a c hc l u a d r a n t a d i f f e r e n tc o l o r
P r o j e c t i o no r r r i g h tr e t i n a
\i":,':
)Y_
Structure of retina: schema A B C C H P R
nerves ur)*
A n r a c r i n ec e l l s [ 3 i p o l acr e l l s Cones C a n g l i o nc e l l s H o r i z o n t a lc e l l s P i g m e n tc e l l s Rods
P r o j e c t i o ro. rn r i g h t d o r s a ll a t e r ; r l g e n i c u l a t en u c l e u s
I
Opticradiation
Optic radiation
1 ) i
\
{
C.rlcarine
I
1 {
I "\ .-<
l
I P r o j e c t i o no n l e f t occipital obe
Plate 12O
A P r o j e c t i o no n r i g h t occipital obe
Granial and Cervical Nerves
Oculomotor(llll, Tlochlear(lVl, and AbducentlVIl Nerves:Schema
L o n g c i l i a r yn e r v e Short ciliary nerves
C i l i a r yg a n g l i o n Posteriorethmoidal nerve
A n t e r i o re t h m o i d a ln e r v e
Abducentnucleus
S e n s o r yr o o t o f c i l i a r yg a n g l i o n
S u p e r i oor b l i q u em u s c l e
nucleus Trochlear
Sympatheticroot of ciliary ganglion
Levatorpalpebrae s u p e r i o r i sm u s c l e
O c u l o m o t onr u c l e u s
S u p e r i o rd i v i s i o no f oculomotor nerve
Superior rectusmuscle
oculomotor Accessory (Edinger-Westphal) nucleus(parasympathetic)
Frontalnerve (cut) Lacrimalnerve (cut)
tugr:l I t
Nasociliarynerve
l.\
l'r** tY-l.'
Trochlearnerve (lV)
Oculomotornerve(lll) O p h t h a l m i cn e r v e( V r )
Abducent nerve(Vl)
lnfraorbitalnerve Zygomalic nerve (cut)
Pterygopalatine ganglion
I n f e r i oor b l i o u em u s c l e
l n f e r i o rd i v i s i o no f oculomotor nerve
C i l i a r ym u s c l e e uscle D i l a t o rp u p i l l a m
Medialrectusmuscle
S p h i n c t epru p i l l a e muscle
I n f e r i o rr e c t u sm u s c l e
Efferentfibers Afferentfibers Sympatheticfibers fibers Parasympathetic
Parasympatheticroot o f c i l i a r yg a n g l i o n
Granial and Gervical Nerves
M a n d i b u l anre r v e( V 3 ) Internalcarotidartery a n dn e r v ep l e x u s Maxillary nerve (Vz) Lateralrectus muscle and abducent nerve (turned back)
plexus Cavernous C o m m o n t e n d i n o u sr i n g
4ftr Plate 121
Trigeminal Nerve (Vl: Schema SeealsoPlates 24,42,43,45,46, 167, 168
' --'-*" Efferent fibers '^** Afferent fibers ' " . " P r o p r i o c e p t i v ef i b e r s Parasympatheticfibers - -.* Sympatheticfibers
Ophthalmic nerve T e n t o r i a(l n r e n r n g e a bl )r a n c h N a s o c i l i a r yn e r v e
T r i g e m i n a ln e r v e ( V ) g a n g l i o na n d n u c l e i M o t o r n u rl e u s M t ' s t ' n 1e ' p h . r l i nc u c l e u s P r i r - r c . i psaeln s o r yn u r . l c u s S p i r r atlr a c t ; r r r r nl u c ' l t ' u s
L a c r i m a nl e r v e
S e n s o r yr o o t o f c i l i a r yg a n g l i o n Frontan l erve C i l i a r yg a n g l i o n
P o s t e r i o er t h m o i d a ln e r v L o n g c i l i a r yn e r v S h o r tc i l i a r yn e r v e s A n t e r i o re t h n r o i d a nl e r v S u p r a o r b i t anl S u p r a t r o c h l e anre r v e I n f r a t r o c h l e anr e Internan l a s a lb r a n c h e s an0 E x t e r n anl a s a lb r a n c h e s o f a n t e r i o re t h m o i d a ln e r v e Maxillary nerve (\ M e n i n g e a lb r a n c h Zygomaticotemporal nerve Zygomaticofacialnerve Zygomatic r-rerve l n f r a o r b i t anl e r v e Pterygopalatine ganglion Superior alveolar b r a n c h e so f i n f r a o r b i t anl e r v e
SWJ
N a s a lb r a n c h e s ( p o s t e r i o rs u p e r i o r l a t e r a l n, a s o p a l a t i n e , and posterior s u p e r i om r edial)
F a c i a nl e r v e ( V l l ) Chorda t y m p a n in e r v e
N e r v e ( V i d i a n )o f l r t e r y g o i dc a n a l ( f r o n rf a c i a ln e r v e l V l l l . r n dc a r o t i dp l e x r - r s )
n{r
P h a r y n g e abl r a n c h ( , r e a t e ra n d l e s s e r p a l a t i n en e r v e s
Superficial t e n r p o r ab l ranches
D e e p t e m p o r a ln e r v e s ( t o t e m p o r a l i sm u s c l e ) L a t e r a pl t e r y g o i d a n d m a s s e t e r i cn e r v e s
A r t i c u l a rb r a n c h and anterior a u f l c u l a rn e r v e s
T e n s o rv e l i p a l a t i n a i nd m e d i a lp t e r y g o i d
A u r i c u l o t e m p o r ani e r v e
B u c c a ln e r v e
Submandibulal ganglion
M e n t a ln e r v e I n f e r i o rd e n t a lp l e x u s Linguan l erve
Plate 122
M y l o h y o i dn e r v e
lnferior a l v e o l a rn e r v e Otic ganglion
Mandibular nerve (Vr) T e n s o rt y m p a n in e r v e
P a r o t i db r a n c h e s M e n i n g e a lb r a n c h Lesserpetrosalnerve (fron'r g , l o s s o p h a r y n g enael r v e I l X l )
Granial and Gervical Nerves
Facial Nerve (Vlll: Schema Seeals0
Creater petrosalnerve Deep petrosalnerve (from internalcarotid plexus) Lesserpetrosalnerve N e r v e ( V i d i a n )o f p t e r y g o i dc a n a l
Facial nerve (Vll)
c eatus In t e r n aal c o u s t i m l n t e r m e d i a t en e r v e
C e n i c u l a t eg a n g l i o n
M o t o r n u c l e u so f f a c i a ln e r v e
Internalcarotid Plexus (on internalcarotid arterY)
S u p e r i o rs a l i v a t o r yn u c l e u s
Solitarytractnucleus
Otic ganglion P t e r y g o p a l a t i ngea ng l i o n
Facialmuscles Frontalbellv(frontalis) of occipitofrontalis Orbicularisoculi Corrugatorsupercilii Zygomaticusmajor Zygomaticusminor Procerus Levator labii supeflofls
Levatorlabii supenons alaequenasi Levator angulioris Nasalis
Depressor septinasi
belly
Orbicularis ons
(occipitalis)of occipitofrontalis muscle
ipital
Depressor angulioris aurl nerve
labii Depressor inferior
anchesto auricularmuscles
Mentalis
a u r i c u l a rn e r v e
(Risorius) (notshown)
Nerve to staDediusmuscle Stylomastoidforamen
Buccinator
T y m p a n i cp l e x u s
S u b l i n g ug al a n d Submandibular Efferentfibers S u b m a n d i b u l agr a Afferentfibers Linguan l e r v e ( f r o m t r i g e m i n a nl e r v e ) fibers Parasympathetic C h o r d at y m p a n in e r v e fibers Sympathetic
Granial and Gervical Nerves
),'i'
Tvmpanic nerve (of Jacobson) (from glossopharyngealnerve) C l o s s o p h a r y n g e anle r v e ( l X )
s t r i cm u s c l e( p o s t e r i obre l l Y ) Stylohyoidmuscle
4{tr
aroticotympanicnerve (from internalcarotid plexus)
Plate 123
Vestibulocochlear Nerve (Vlll|: Schema ,I
-
i.il
Afferentfibers
nit.i,:.i:r1-e;Y+:fi9:::+-rr+1*+li++9!sr:::E!j+t!:+i:B!4$G[14fi!jeh]ii",8ddt:$riij.hr
F a c i acl a n a l Tympaniccavity C e n i c u l u m( g e n i c u l a t e g a n g l i o n )o f f a c i a ln e r v e
C h o r d a t y m p a n in e r v e
l erve C r e a t e rp e t r o s a n
Headof malleus
) anglion C o c h l e a r( s p i r a l g V e s t i b u l an r erve C o c h l e a rn e r v e Motor root of facial nerve a n d i n t e r m e d i a t en e r v e Vestibulocochlear nerve(Vlll) M e d u l l ao b l o n g a t a ( c r o s ss e c t i o r \
A m p u l l ao f l a t e r a l s e m i c i r c u l adr u c t Medial
Internal acoustic meatus
A m p u l l ao f s u p e r i o r s e m i c i r c u l adr u c t
Superior Inferior A m p u l l ao f p o s t e r i o r s e m i c i r c u l adr u c t
Lateral
*{r
Plate 124
I n f e r i o rc e r e b e l l a r p e d u n c l e( t o c e r e b e l l u m )
V e s t i b u l agr a n g l i o n
Saccule S u p e r i o rd i v i s i o n ) ) - I n f e r i o rd i v i s i o n )
o l v e s l i b u l a rn e r v e
Granial and Gervical Nerves
Glossopharyngeal Nerve (lXl: Schema SeealsoPlates167,168
-
Efferentfibers Afferentfibers Parasympathetic fibers
S p i n a lt r a c t a n d s p i n a ln u c l e u so f t r i g e m i n a nl e r v e S o l i t a r yt r a c t n u c l e u s T y m p a n i cn e r v e( o f J a c o b s o n ) T y m p a n i cc a v i t ya n d p l e x u s
N u c l e u sa m b i g u u s I n f e r i o rs a l i v a t o r yn u c l e u s
S t y l o m a s t o i fdo r a m e n Caroticotympanin c e r v e ( f r o m i n t e r n a lc a r o t i dp l e x u s ) Creater petrosalnerve Deep petrosan l erve N e r v e ( V i d i a n )o f p t e r y g o i dc a n a l L e s s ep r e t r o s a ln e r v e P t e r y g o p a l a t i ngea ng l i o n M a n d i b u l a nr e r v e( V t ) Otic ganglion A u r i c u l o t e m p o r anl e r v e l ' , r r oiIrI , l l , r r rI r- * * I r r l r . rllr r , r r rhr ( ) t l ) n t l ) , 1 | ] i1( , 1 , . ' . , , t - - . - - - - - - - - A u d i t o r yrp h a r y n g o t y m p a n i c , E u s t a c h i a nt )u b e a n d p h a r y n g e aol p e n i n g Clossopharyngeal nerve(lX)
S t y l o p h a r y n g e um s u s c l e( a n d b r a n c h irom glossopharyngea n le r v e )
l u g u l a rf o r a m e n C o m m u n i c a t i o nt o a u r i c u l a r b r a n c ho f v a g u s n e r v e
Tasteand somaltc sensatlon: posreflor Z of tongue
V a g u sn e r v e ( X ) S u p e r i o rc e r v i c a l s y m p a t h e t i cg a n g l i o n S y m p a t h e t i ct r u n k C a r o t i db r a n c ho f glossopharyngen ae l rve
,{
,t lt
I n t e r n a cl a r o t i da r t e r y
P h a r y n g e apl l e x u s C a r o t i ds i n u s P h a r y n g e a tl ,o n s i l l a ra, n d l i n g u a l ae l rve b r a n c h e so f g l o s s o p h a r y n g e n P h a r y n g e abl r a n c ho f v a g u sn e r v e
Carotid body C o m m o n c a r o t i da r t e r y E x t e r n acl a r o t i da r t e r y
Granial and Gervical Nerves
4{tr
Plate 125
Vagus Nerve (Xl: Schema Posterior nucleusof vagus nerve(parasympathetic andvisceralafferent)
Glossopharyngealnerve (lX)
Solitarytractnucleus(visceral includingtaste) afferents
Meningeal branch of vagus nerve
Auricularbranchof vagusnerve
S p i n atlr a c ta n ds p i n a l n u c l e uo s f t r i g e m i n anle r v e
Auditory(pharyngotympanic, Eustachian) tube
(somaticafferent)
Levatorveli palatinimuscle
Nucleua s mbiguus (motorto pharyngeal and laryngeal muscles)
Salpingopharyngeus muscle
Cranialroot of accessory nerve* (seenextplate)
Palatoglossus muscle Palatopharyngeus
Vagusnerve (X)
muscle
foramen Jugular
Superiorpharyngeal constrictormuscle-
Superiorganglion of vagus nerve
Stylopharyngeus muscle Middle pharyngealconstrictormuscle Inferiorpharyngealconstrictormuscle
Cricothyroid musc Trachea Esopha
R i g h st u b c l a v i aanr Right recurrentlaryngealnerve Heart Hepatic branch of anterior vagal trunk (in lesseromentum) Celiac branchesfrom anterior and posteriorvagal trunks
to celiacplexus C e l i a ca n d s u p e r i o rm e s e n t e r i c gangliaand celiac plexusl -e Hepatic plex Callbladder and bileducts Liver
Pyloricbranch from hepaticplexus Pancreas
Duodenum A s c e n d i n gc o l o Cecum
Appendix
Plate 126
Inferior ganglion of vagus nerve Pharyngealbranch of vagus nerve (motor to musclesof palate and pharynx;sensoryto lower pharynx) C o m m u n i c a t i n gb r a n c ho f v a g u sn e r v et o carotid branch of glossopharyngealnerve
Pharyngeal plexus Superiorlaryngealnerve:
Internalbranch(sensory andparasympathetic) External branch(motorto cricothvroidmuscle) Superiorcervicalcardiac branch of vagus nerve Inferiorcervicalcardiac branch of vagus nerve Thoraciccardiac branch ofvagus nerve Left recurrentlaryngealnerve (motor to musclesof larynx except cricothyroid;sensoryand parasympatheticto larynx below vocal folds; parasympathetic,efferent,and afferentto upper esophagusand trachea)
P u l m o n a rpyl e x u s
Nr
Cardiacplexus plexus Esophageal Anterior vagal trunk
Castric branchesof anterior vaeal trunk (branchesfrom posterior trunkbehind stomach)
Vagalfibers(parasympathetic motor, secretomotor, and afferentfibers)accompany superiormesentericartery and its branches usuallyas far as left colic (splenic)flexure S m a l li n t e s t i n e
Efferentfibers Afferentfibers Parasympathetic fibers
Granial and Cervical Nerves
Accessory Nerve (XIl: Schema Nucleua s mbiguus Vagus nerve (X)
nerve(joinsvagusnerve Cranialroot of accessory nervesuppliesmusclesof andvia recurrentlaryngeal larynx,exceptcricothyroid)* Spinalroot of nerve accessory Foramen magnum
Jugularforamen Superiorganglion of vagus nerve Accessory nerve (Xl)*
Inferior ganglion of vagus nerve
C.l spinalnerve
C2 spinalnerve Accessorv nerve (to sternocleidomastoid and trapeziusmuscles)
muscle(cut) Sternocleidomastoid 3 spinal nerve C4 soinalnerve
Trapezius muscle
*{r Efferentfibers Proprioceptivefibers *Recent evidence suggeststhat the accessorynerve lacksa cranialroot and has no connection to the vagus nerve' Verificationof this finding awaits further investigation.
Granial and Cervical Nerves
Plale 127
Hypoglossal Nerve (XIII: Schema
Hypoglossal nerve(Xll) (in hypoglossal canal) Superior longitudinal
Intrinsic muscres of tongue
Meningeal branch
H y p o g l o s snaul c l e u s
Transverse andvertical Inferior longitudinal
'." 1t:lr/. rt-::-
Occipitalcondyle Inferiorganglionof vagusnerve Ventralramiof C 1 , 2 , 3f o r m ansacervicalis of cervicalplexus Superiorcervical sympathetic ganglion Superiorrootof ansacervicalis
Cenioglossus muscre
Internalcarotid artery
C e n i o h y o i dm u s c l e ( v i aC 1 )
Hyoglossus muscle Thvrohvoidmusclei ( v i aC 1 ) Omohyoid muscle
( s u p e r i obre l l y ) Sternohyoidmuscle
Inferior root of ansacervicalis
Ansa cervicalis
I n t e r n ajlu g u l a rv e i n
Common carotid artery
Sternothyroid muscle Omohvoidmuscle(inferiorbel
Efi'erentfibers
4{tr
-
Plate 128
Granial and Cervical Nerves
Afferentfibers
Gervical Plexus: Schema SeealsoPlate32 Sternocleidomastoidmuscle (cut) Accessory nerve (Xl)
Creat auricularnerve Lesseroccipital nerve
H y p o g l o s s anl e r v e ( X l l ) muscte
Creater occipital nerve (from dorsal ramus of C2)
Nerves to anterior and lateral rectus capitisand longus c a o i t i sa n d c o l l i m u s c l e s
N e r v e st o l o n g u sc a p i t i sa n d muscles colliand levatorscapulae Thyrohyoidmuscle S u p e r i orro o t of ansa cervicalis lnferior root of ansa cervicalis Transversecervical nerve
Traoezius muscle N e r v e st o l o n g u sc a p i t i sa n d colli, levator scapulae,and m i d d l e s c a l e n em u s c l e s C o m m u n i c a t i o nt o brachialplexus Phrenicnerve
Omohyoidmuscle
(superior muscle Sternothyroid
Sternohyoid muscle
Supraclavicularnerves(medial, intermediate,and lateral)
A n s ac e r v i c a l i s
muscle(cut) Sternocleidomastoid Efferentfibers
Nr
Omohyoid muscle (inferior belly)
Granial and Cervical Nerves
Afferentfibers Proprioceptivefibers
Plate 129
Autonomic Nerves in Neck
Internal carotidnerve Clossopharyngeal n e r v e( l X )
Laryngopharyngeal sympatheticbranch
Vagusnerve(X)(cut) Superiorcervical sympatheticganglion
Pharyngeal plexus
Pharyngeal branch or vaSusnerve External carotidarteryand plexus Superiorlaryngeal nerve Internalcarotid artery and carotid branch of glossopharyngealnerve
Carotidbody arotidsinus Superiorcervical cardiac branch of vagus nerve Superiorcervical sympathetic cardiac nerve Phrenicnerve (cut) Middle cervicalsympatheticganglion
*{r
Commoncarotidarteryand plexus Middlecervicalsympathetic cardiacnerve Vertebralganglion Vertebralarteryand plexus Recurrent laryngeal nerve Cervicothoracic(stellate)ganglion Ansa subclavia Vagus nerve (X) (cut) lnferior cervical sympathetic cardiac nerve
Thoracicsympathetic and vagalcardiacnerves Subclavianarterv
Plate 13O
Granial and Cervical Nerves
Autonomic Nerves in Head SeeafsoPlates 4446,86, 121,132-134r,ffi, 106 Creater oetrosalnerve
Deep petrosalnerve
N a s o c i l i a r yn e r v e
Nerve (Vidian)of pterygoid canal O c u l o m o t o r n e r v e( l l l )
Trigeminalnerve (V)
M a x i l l a r yn e r v e ( V z )
Sensory
Roots of ciliary Sympathetic ganglion Parasympathetic
O p h t h a l m inc e r v e( V r )
Internalcarotid artery and plexus
Frontaa l nd lacrimal nerves (cut)
C e n i c u l u m( g e n i c u l a t eg a n g l i o n ) of facial nerve
C i l i a r yg a n g l i o n
ciliary nerve
F a c i a nl e r v e ( V l l ) Short ciliary nerves Vestibulocochlear
Posterior, superior, and inferiorlateral nasatnerves
Clossopharyngeal n e r v e( l X ) Vagus nerve ( Mandibular nerve (V:) Otic ganglion lnternal carotid nerve C h o r d at y m p a n i
Pterygopalatine ganglion
S u p e r i ol ra r y n g e a l
eater and lesser palatinenerves
nerve (cut) S u p e r i o rc e r v i c a l sympatheticganglion
L i n g u a ln e r v e l n t e r n a lc a r o t i d artery and plexus'
lnferior alveolarnerve
Carotid branch of glossopharyngeal
Submandibular ganglion
Pharyngeal plexus
C a r o t i ds i n u s Maxillaryartery and plexus
Cervical s y m p a t h e t i ct r u n k S u p e r i o rc e r v i c a l c a r d i a cb r a n c ho f v a S u sn e r v e
External carotid arteryand plexus
M i d d l e m e n i n g e a al r t e r ya n d p l e x u s Facialartery and plexus
Common carotid artery and plexus S u p e r i o rc e r v i c a ls y m p a t h e t i cc a r d i a cn e r v e
Granial and Gervical Nerves
*{r Plate 131
Giliary Ganglion: Schema
e uscle S p h i n c t epru p i l l a m Short ciliary nerves
e uscle D i l a t o rp u p i l l a m
Accessory oculomotor (Edinger-Westphal) nucleus(parasympathetic)
Oculomotor (parasympathetic) root of ciliaryganglion
Ciliary ganglion
Ciliarymuscle
S u p e r i ocro l l i c u l u s Lateral geniculatebody
Optic nerve (ll) Ophthalmic n e r v e( V t )
Nasociliarynerve L o n g c i l i a r yn e r v e
Trigeminal ganglion
Nasociliary(sensory) root of ciliary ganglion
Internal carotid plexui
Sympatheticroot of ciliary ganglio
t
I
.r-Tectosoinal
I !
-Th^,^-i-
<-
O p h t h a l m iacr t e r y
tract
^-.,
part ---fhoracic of spinalcord
Internal carotid artery Superiorcervical sympatheticganglion 1st thoracic sympathetictrunk ganglio C r a y r a m u sc o m m u n i c a
Preganglionic| _ PostganglionicfParasytpatheticfibers
T 1 s p i n a ln e r v e
Preganglionic sympathetic cellbodies in intermediolateral nucleus (lateral horn)of gray matter
Afferentfibers Visualpathway Descending pathway
Plate | 32
Nr Granial and Cervical Nerves
Pterygopalatine and Submandibular Ganglia: Schema
Ophthalmicnerve(Vr)
Trigeminalganglion
Deep petrosalnerve eaterpetrosalnerve
Mandibularnerve(V:) Otic ganglion
tympaninerve Trigeminal nerve(V) Facialnerve(Vll) nerve)
Lingualnerve Maxillarynerve(Vz) Nerve(Vidian)of pterygoidcanal ganglion Pterygopalatine
Superiorsalivatory nucleus
Lacrimalgland
palatinenerves Descending
Pharyngealnerve
Posteriornasalner
nerve(lX) -
I^
Superiorcervicalsympatheticganglion
.l
Palatinen"ru"r I ureater ( Lesser-
Sympathetictrunk T1 and T2 spinalnerves Thoracic spinal cord
ganglion
Dorsal root gland Sublingual Submandibular
White
Cray
\-+v-./
Facialartery
Lingualartery
Rami communicantes
carotidarterv
Externalcarotidartervand
Ventral root
presynapticcell bodiesin intermediolateral nucleus(lateral horn)of gray matter
Commoncarotidarteri
Nr Granial and Cervical Nerves
r r
r
r
r
r
Sympatheticpreganglionicfibers Sympatheticpostganglionicfibers preganglionicfibers Parasympathetic Parasympatheticpostganglionicfibers
Plate 133
Otic Ganglion: Schema
Mandibularnerve(V3)
ganglion Trigeminal Lesserpetrosalnerve
Otic ganglion
Chordatympaninerve Ophthalmicnerve(Vr)
Trigeminal nerve(V)
Maxillarynerve(Vz)
Facialnerve(Vll) Clossopharyngeal nerve(lX)
Auriculotemporalnerve
Inferiorsalivatorynucleus
Superficialtemporalartery
Pons Parotidgland Maxillary artery Medulla oblongata Tympanic plexus Inferior alveolar
Tympanic nerve (of Jacobson) Inferiorganglion(lX) cervicalsympatheticganglion Sympathetictrunk T1 and T2 spinalnerves
Externalcarotidarterv
Thoracic spinalcord
Internalcarotid
Commoncarotidar White
Cray
\*^\r-l
Ramicommunicantes
rr r r r
r r
Sympatheticpreganglionicfibers Sympatheticpostganglionicfibers Parasympatheticpreganglionicfibers postganglionicfibers Parasympathetic
Sympathetic preganglionic cell bodiesin intermediolateral nucleus(lateral horn)of gray matter
4{r Plate 134
Granial and Gervical J{erves
Taste Pathways: Schema
-Usual
pathway - - - - - -' Accessorypathway
Ventralposteromedial(VPM) nucleusof thalamus y cortex(justbelow facearea) Lateralhypothalamic area Amygdaloid body Pontinetastearea Trigeminal nerve(V) (semilunar) ganglion Trigeminal
Mesencephalic nucleus and Motor nucleus
h a l m i cn e r v e( V r )
of trigeminalnerve
Maxillarynerve(Vz) Mandibularnerve(Vr)
Createrpetrosalnerve
Nr
Ceniculate
Nerve(Vidian) of pterygoidcanal Otic ganglion
Facialnerve(Vll) and
Lingualnerve
Intermediatenerve
Nucleusof solitarytract (rostralpart)
Fungiform papillae
Clossopharyngeal nerve(lX)
Foliate papillae Medullaoblongata (lowerpart) Vallate papillae Inferior(petrosal) ganglion gealnerve of glossopharyn Inferior(nodose)ganglionof vagus Vagusnerve(X)
Granial and Gervical Nerves
nerve Superiorlaryngeal
Plate 135
Arteries to Brain and Meninges
Left middle meningealartery
Posterior cerebralartery Superiorcerebellar artery Basilar artery
Middlecerebralartery Anteriorcerebralartery Anterior communicatingartery
Ophthalmicartery
Leftlabyrinthine (internalacoustic) arterv
Posterior communicating artery
Mastoidbranchof leftoccipitalartery
Cavernous sinus Anteriorinferior cerebellar artery
Middle meningeal artery
Posterior meningeal branchof leftascendin pharyngeal Posterior inferior cerebellar artery Leftand right vertebralarteries (intracranial
Maxillary artery Superficial temporal artery
Posterior meningeal branchof vertebral arter
External carotid atrcry
Anteriormeningeal branchof vertebralartery Posterior auricular artery
Facialartery
Occipital
Internalcarotidartery Carotid
Lingualartery pharyngeal Ascending artery Superiorlaryngeal artery
Carotid body
Superiorthyroidartery Vertebral artery (cervicalpart) Transverseprocess of C6 Deep cervicalartery
Supremeintercostal artery Costocervical trunk Subclavianartery
Plate | 36
Common carotid arterv Ascendingcervicalartery (cut) Inferior thyroid artery Thyrocervicaltrunk
Brachiocephalic trunk thoracicartery
Nr
Gerebral Vasculature
Veins of the Vertebral Golumn: Vertebral Veins
Variation:right vertebralvein crossing anterior to right subclavianartery
Left vertebral artery Leftvertebralvein
Anterior vertebralveins
Left subclavianartery
Right deep cervicalvei
Left brachiocephalicvein
A c c e s s o r yv e r t e b r a l v e i n Right vertebralartery Vertebral veins: detail showing v e n o u sc o m m u n i c a t i o n s
Rightsubclavianarteryand vein
Anterior arch of atlas(C1) (cut)
R i g h ti n t e r n a jl u g u l a rv e i n ( i n f e r i o rb u l b ) R ig h t b r a c h i o c e p h a l ivce i n
I
Right vertebralvein
D u r am a t e r
R i g h tc l a v i c l e R i g h tc o m m o n c a r o t i da r t e r y
Rightvertebralartery
A n t e r i o ri n t e r n a l( e p i d u r a l ) vertebralvenous plexus Dens (C2) (cut) Venous plexusof vertebralartery Anterior externalvertebralvenous plexus
Epiduralfat and anterior internalvertebral(epidural)venous plexus C o m m u n i c a t i n gv e i n vein Basivertebral lntervertebralveins Veinsof the vertebral Vertebralartery with venous plexus
column:vertebralveins
S u p e r i obr u l bo f r i g h ti n t e r n aj ul g u l a rv e i n C o n d v l a re m m i s s a r vv e i n
ii.!-i, lar-r
Deep cervicalvein
Vertebralarteries Dura mater
Anteriorvertebral velns venouscommunlcauons
M a s t o i de m m i s s a r yv e i n
A n t e r i o ri n t e r n a l( e p i d u r a l v) e r t e b r a vl e n o u sp l e x u s
Venousplexusof vertebralartery Anterior externalvertebralvenous plexus C o m m u n i c a t i n gv e i n s
Anterior vertebralveins Left deep cervicalvein
R i g h td e e p c e r v i c a vl e i n Left vertebralvein Formingvertebralvein Accessoryvertebralvei Rightvertebralartery and vein
Left vertebralartery Left thyrocervicaltrunk L e f t i n t e r n a jl u g u l a rv e i n ( i n f e r i o rb u l b )
Dorsalscapularartery
Left subclavianartery
Costocervicaltrunk Left subclavianvein
Right thyrocervical ; trunk
Left brachiocephalicvein R i g h ts u b c l a v i a nv e i n
Left common carotid arterv
R i g h ti n t e r n a jl u g u l a rv e i n ( i n f e r i o rb u l b ) R i g h tb r a c h i o c e p h a l ivce i n Right subclavianartery
Gerebral Vasculature
C(d4s/*
R i g h tc o m m o n c a r o t i da r t e r y
Plate | 37
Arteries to Brain: Schema
Anteriorcerebralartery
communicatingartery
Ophthalmicartery
Middle cerebral
Suoraorbital arterv
Posteriorcommunicatingart
Supratrochlear artery Caroticotympanic branch of internalcarotid artery
Lacrimal artery Dorsalnasalartery
Posterior cerebral
Middle meningealartery
Superiorcerebellar artery
Angular artery
Anteriortympanicarter Superficial temporalartery Middle meningealar
Posterior auricular artery
Maxillaryarter
Facialartery
Occipitalartery
B a s i l aa r
artery
Anteriorinferior cerebellar artery
pharyngealartery Ascending
Posterior inferior cerebellar ar
Anteriorspinalartery Spinalsegmental medullary branches
External carotidarterf
Vertebral artery
InternalcarotidarterV
ommon carotid artery
Superiorthyroidartery
Deep cervicalartery
ial cervicalartery
Common carotid artery
Suprascapularartery
Vertebralartery
Supremeintercostal artery Ascendingcervicalarterir Costocervicaltrunk Inferiorthvroid arterv Thyrocervicaltrunk/
ii
Subclavian artery S u b c l a v i a na
Internalthoracic arterv
B r a c h i o c e p h atlriuc n k
Arch Descending
*{r Plate | 38
Ascending
Anastomoses 1 2 3 4 5
Right-Left Carotid-Vertebral Internalcarotid-External carotid Subclavian-Carotid Subclavian-Vertebral
Gerebral Vasculature
Arteries of Brain: lnferior Views
(orbitofrontal) arter Medialfrontobasal A n t e r i o rc o m m u n i c a t i n Ba r t e r y
Anterior cerebralarterv Distal medial striateartery (recurrentartery ot Internalcarotid artery
Anterolateral arteries central(lenticulostriate) Middle cerebralarterv Lateralfrontobasal(orbitofrontal)
arter Prefrontal Anterior choroidal arter P o s t e r i o cr o m m u n i c a t i n ga r t e r y
Posteriorcerebrala Superiorcerebellar
artery Basilar Pontinearteries
(internalacoustic) Labyrinthine arter Anterior inferior cerebellararterv (AlC
Vertebralar Anteriorspinalarte Posterior inferiorcerebellar artery(PICA) Posteriorspinal
Distalmedialstriateartery (recurrent arteryof Heubner)
Cerebralarterial circle(of Willis) (brokenline)
A n t e r i o rc o m m u n i c a t i n ga r t e r y
Anterior cerebralarterv Middle cerebralarterv Posteriorcommunicatingartery Anterior choroidal artery
1,.
fu
.
Optic tract Posteriorcerebralartery Cerebralcrus Lateralgeniculatebody Posteriormedial choroidal artery Posteriorlateralchoroidal artery Choroid plexusof lateralventricle
M e d i ag l e n i c u l a tbeo d y P u l v i n aorf t h a l a m u s Lateralventricle
Gerebral Vasculature
Nr Plate | 39
Gerebral Arterial Gircle (of Willisl
Vesselsdissectedout: inferiorview Anterior cerebralartery (A2 segment)
Distal medial striatearterv (recurrentartery of Heubner) Anteromedialcentral (perforating) arteries
A n t e r i o rc o m m u n i c a t i n ga r t e r y Anterior cerebralartery (A1 segment)
Hypothalamic artery Anterolateral central (lenticulostriate) arteries
Ophthalmicartery Internalcarotid Middle cerebralartery
Superiorhypophyseal artery Posteriorcommunicatingartery
Inferior hypophysealartery
Anteriorchoroidalarterv Posterior cerebralartery (P2segment) (P1segment)
Thalamotuberal (premammillary)artery
S u p e r i o rc e r e b e l l a a r
Basilar Pontinearteries Anterior inferior cerebellarartery (AICA)
Posteromedialcentral (perforating) arteries
g artery Thalamoperforatin Posteromedialcentral (paramedian)arteries Labyrinthine(internalacoustic)artery
Vertebralartery
Vesselsin situ: inferiorvrew Anteriorcerebralartery Hypothalamicarter
Anterior communicating,artery ic chiasm
sinus Cavernous Internalcarotid arter
Superiorhypophyseal Middle cerebrala
Inferiorhypophyseal artery Posteriorcommunicatingartery
I n f u n d i b u l u(mp i t u i t a rsyt a l k ) portalveins and longhypophyseal (anterior Adenohypophysis lobeof pituitarygland) (posterior Neurohypophysis lobeof pituitarygland) ial central (perforating) arteries
Efferent hypophyseal veins Superiorcerebellarartery
Posterior cerebral
Plate 14O
Basilarartery
Nr
Gerebral Vasculature
Arteries of Brain: Frontal View and Section
C o r p u sc a l l o s u m
Paracentralartery M e d i a l f r o n t a lb r a n c h e s
Anterolateral central (lenticulostriate a )r
Pericallosal artery
Lateralfrontobasal (orbitofrontal)arter
Callosomarginalartery
Polarfrontalartery Prefrontal Anterior cerebral arteries
Precentral(pre-Rolandic) a n d c e n t r a l( R o l a n d i c ) sulcalarteries
Medial frontobasal (orbitofrontal)artery
Anterior parietal ( p o s t c e n t r asl u l c a l )
medial striate artery (recurrent artery of Heubner)
artery Posterior parietal
lnternalcarotid artery
artery
Branchto a n g u l agr y r u s
Anterior choroidal artery
Temporal branches
Posteriorcerebral arterv
( a n t e r i o rm , iddle, and posterior
artery cerebellar Middle cerebralarterv
Basilarand pontine arteries
and branches (deep in lateralcerebral l S y l v i a n sl u l c u s )
Labyrinthine(internal acoustic)artery
A n t e r i o rc o m m u n i c a t i n g
Vertebralartery
Posteriorcommunicatingartery Anterior inferior cerebellarartery (AICA)
\Posterior
inferior cerebellarartery (PICA)
artery Anterior spinal
I {ffi
4.t'/
Posteriorspinalar Falxcerebri
C o r p u ss t r i a t u m (caudateand lentiform nuclei Anterolateralcentral (lenticulostriate)arteri I n s u l a( i s l a n do f R e i l L i m e no f i n s u l a Precentral(pre-Rolandic), c e n t r a l( R o l a n d i c s) u l c a l , and parietalarter
Callosomarginalarteries ano Pericallosal arteries (branchesof anterior cerebralarteries) T r u n ko f c o r p u sc a l l o s u m I n t e r n a cl a p s u l e S e p t u mp e l l u c i d u m Rostrumof corpus callosum
Lateralcerebral(Sylvian) Temooralbranchesof middle cerebralartery Temporallobe
Anterior cerebral arteries Distal medial striateartery (recurrentartery of Heubner) A n t e r i o rc o m m u n i c a t i n ga r t e r y
Middle cerebralarterv Internalcarotid
Gerebral Vasculature
Optic chiasm
Plate 141
Arteries of Brain: Lateral and Medial Views Anterior parietal(postcentralsulcal)artery{
parietalartery Posterior
C e n t r a(lR o l a n d i cs )u l c aal r t e r y
Branchto angulargyrus
Precentral(pre-Rolandic)sulcalartery
Terminalbranches of posteriorcerebral artery
Prefrontal sulcal artery Terminalbranchesof anterior cerebral artery Lateralfrontobasal (orbitofrontal)
left middle cerebralartery Left anterior cerebralartery Occipitotemporal branches
Anterior communicatingartery
Posteriortemporal branch
Rightanteriorcerebralarteri
M i d d l et e m p o r abl r a n c h Left internalcarotid artery
Polartemooralarterv
Posterior
Pericallosal artery
Intermediate
Anterior
Suoeriorand inferior terminal branches(trunks) Anterior temporal branch
4 4.
Paracentralartery
{r
Cingularbranches Rightposteriorcerebralartery Precunealartery
al
Polarfrontalartery
Dorsal branch to corpus callosum
Parietoocci oitalbranch Calcarinebranch
Rightanterior cerebralartery Medialfrontobasal(orbitofrontal)artery Anterior communicatingartery (cut) Medial occipital artery Distal medial striateartery ( r e c u r r e na t r t e r yo f H e u b n e r
Posteriortemporal brancn Anterior temooral branch
Right internalcarotid artery
Posteriorcommunicatingartery
*Note: Anterior parietal(postcentral sulcal)artery also occurs as separateanterior parietaland postcentralsulcalarteries.
Plate 142
Gerebral Vasculature
Arteries of Posterior Granial Fossa
T h a l a m o e e n i c u l a taer t e r i e s
L a t e r a al n d m e d i a lg e n i c u l a t eb o d i e so f l e f t t h a l a m u s
A n t e r i o rc h o r o i d a la r t e r y
C h o r o i d p l e x u s e so f l a t e r a vl e n t r i c l e s
P u l v i n a rosf l e f ta n dr i g h t h a l a m i
C r u r ao f f o r n i x
o f c o r p u sc a l l o s u m Splenium
Anterolateralcentral (lenticulostriate a )r t e r i e s
O c c i p i t a l( p o s t e r i o r h) o r n o f r i g h t l a t e r a vl e n t r i c l e
R i g hd t o r s abl r a n c ht o c o r p u sc a l l o s u m (posterior pericallosal artery)
H e a d so f c a u d a t en u c l e i
S e p t u mp e l l u c i d u m
P a r i e t o o c c i p i )t aB l r a n c h eosf | ) rightposterior Calcarine) cerebralartery
C o r p u sc a l l o s u m Anterior cerebralarteries
,}
Longitudinal cerebral
fissure
Superior colliculi Superior vermtan branch
O p t i c n e r v e( l l ) Ophthalmic artery
Posteriormedial choroidal artery to choroid plexus of 3rd ventricle
Anterior
cerebralartery Middle
Posteriorlateral choroidal artery
cerebralartery Posterior c o m m u n i c a t i n ga r t e r y
L a t e r a (l m a r g i n a l b) r a n c h
T h a l a m o p e r f o r a t i nagr t e r i e s
iiI.:
Inferiorvermian artery (phantom)
L e f t i n t e r n a lc a r o t i da r t e r v
Choroidal branch to 4th ventricle (phantom)and
Basilarartery Pontinearteries
e r e b e l l at ro n s i l l abrr a n c h of posterior inferior cerebellarartery
L a b y r i n t h i n e( i n t e r n aal c o u s t i c )a r t e r y
Posterior cerebralarterV S u p e r i o rc e r e b e l l a a r rtery Anterior inferior cerebellarartery (AICA) A n t e r i o rm e n i n g e a bl r a n c ho f v e r t e b r a a l rtery
Temporalbranches of posteriorcerebralarteri, A n t e r i o rs p i n a la r t e r y
Gerebral Vasculature
Outline of 4th ventricle(broken line) Posteriormeningealbranch of vertebralartery
inferiorcerebellar arterv(PICA) Posterior Leftposteriorspinalartery Leftvertebralartery
*{r Plate 143
Veins of Posterior Granial Fossa
Leftsuperiorand inferiorco Basalvein (of Rosenthal) Posteriormesencephalicvein Medial geniculatebody
Lateral mesencephalicvein
Lateralgeniculate body Leftthalamus (cut surface) Optic tracl
Confluence of sinuses
Inferiorthalamostriatevei
Lefttransverse sinus(cut)
Deepmiddle cerebral
Superior sagittal Srnus
vetn
Anterior cerebral vetn
Optic nerve(ll)
Superior vermtan veln nferior
vermlanvern Falxcerebelli(cut) and occipitalsinus
Anteriorpontomesencephalic veiri
inferiorcerebellar h e m i s p h e rvi ce i n s
Trigeminalnerve (V Transversepontine veiri
ntraculminatevein
ior cerebellar vein (inconstant)
Petrosalvein (draining
to superiorpetrosalsinui)
vetn
Lateralpontine vein
Precentral cerebellar vein Superiorretrotonsillar vein
Anteromedian medullarv veiri Vein of lateralrecessof 4th ventricle
4{tr Plate 744
Superior, middleand I inferiorcerebellar pedunclei Anterior soinalvein
(Inferiorretrotonsillar) veinof cerebellomedullarv Posteriorsoinalvein 4th ventricle
Partsof cerebellum
t
Lingula TU Tuber cL CentrallobuleP Pvramid c Culmen U Uvula D Declive N Nodule F Folium T Tonsil
Gerebral Vasculature
Deep Veins of Brain veins of brainseePlate 102 Forsuperficial
L o n g i t u d i n acl e r e b r a fl i s s u r e A n t e r i o rc e r e b r a vl e i n s R o s t r u mo f c o r p u sc a l l o s u m S e p t u mp e l l u c i d u m A n t e r i o rv e i n o f s e p t u mp e l l u c i d u m H e a d o f c a u d a t en u c l e u s A n t e r i o rv e i n o f c a u d a t en u c l e u s T r a n s v e r svee i n so f c a u d a t en u c l e u s I n t e r v e n t r i c u l af or r a m e n( o f M o n r o ) C o l u m n so f f o r n i x S u p e r i o rt h a l a m o s t r i a tvee t n S u p e r i o rc h o r o i dv e i n a n d c h o r o i d p l e x u so f l a t e r a vl e n t r i c l e lnalamus
T e l ac h o r o i d e ao f 3 r d v e n t r i c l e L a t e r a dl i r e c tv e i n P o s t e r i ovr e i n o f c a u d a t en u c l e u s l n t e r n a lc e r e b r a vl e i n s B a s a vl e i n ( o f R o s e n t h a l ) C r e a t c e r e b r a vl e i n ( o f C a l e n ) I n f e r i o rs a g i t t asl i n u s S t r a i g h st i n u s T e n t o r i u mc e r e b e l l i T r a n s v e r ssei n u s C o n f l u e n c eo f s i n u s e s S u p e r i o rs a g i t t asl i n u s
4ttr Dissection: superiorview U n c a lv e i n A n t e r i o rc e r e b r a lv e i n S u p e r f i c i am l i d d l ec e r e b r a lv e i n ( d r a i n i n gt o s p h e n o p a r i e t asli n u s
Optic chiasm
D e e p m i d d l e c e r e b r a vl e r n
C e r e b r aclr u s B a s a vl e i n ( o f R o s e n t h a l ) L a t e r a gl e n i c u l a t eb M e d i a l g e n i c u l a t eb o d y
Inferior cerebral VEI NS
P u l v i n aor f t h a l a m u s S p l e n i u mo f c o r p u sc a l l o s u m C r e a t c e r e b r a lv e i n ( o f C a l e n )
Inferio r anastomotrc vein (of Labb6)
Dissection: inferiorview
Gerebral Vasculature
Plate 145
Subependymal Veins of Brain
P o s t e r i ovre i n so f s e p t u mp e l l u c i d u m S u p e r i otrh a l a m i vc e i n S u p e r i ocrh o r o i dv e i n
Lateraldirect vein Posteriorterminalvein of caudate nucleus (posteriorpart of thalamostriatevein)
Internalcerebralveins(rightand left)
Transverse veinsof caudatenucleus
Medial(atrial)veinof lateralventricle
Superiorthalamostriatevein
Lateral(atrial)vein of lateralventricle
Lateralventricle
Splenium o f c o r p u sc a l l o s u m
Anterior vein of caudate nucleus
Creatcerebralvein
Anterior vein of
s e p t u mp e l l u c i d u m
sal vein of corous
callosum
C e n uo f corpus callosum
nferior sagittal
srnus lnternal occipital vein Straightsinus
Occipital (posterior) hornof lateral ventricle
Interventricular foramen (of Monro) Anterior commissure Interthalamica Anterior cerebralvein Optic chiasm
Cerebellum
3rd ventricle Deep middle cerebralvein
Inferiorthalamostriate Basalvein (of Rosenthal) Temporal(inferior)hornof lateralventricl6 Posteriormesencephalicvein
) u o e f l o r v e r m t a nv e t n
H i p p o c a m p a la n d i n f e r i o rv e n t r i c u l a vr e i n 6
Cerebralaqueduct
4{tr Plate 146
4th Lateraland medianapertures of 4th
Veinson lateralwall of ventricle Veinson medialwall and floor of ventricle All otherveins
Gerebral Vasculature
Hypothalamus and Hypophysis
Septumpellucidum Thalamus Fornix Hypothalamic sulcus Anteriorcommissure
Paraventricular Posterior
Principal nucleIof hypothalamus
Dorsomedial Supraoptic Ventromedial Arcuate (infundibular) Mammillarybody tract Mammillothalamic Optic chiasm (pituitarystalk) Infundibulum
4{tr
Dorsallongitudinal fasciculus andother descendingpathways/ I
(pituitary Hypophysis
Hypothalamic
sulcus Paraventricular hypothalamic nucleus hypothalamic Supraoptic Supraopticohypophyseal tract Tuberohypophyseal tract
Mammillary body
Hypothalamohypophyseal tract (pituitarystalk) Infundibulum
Parstuberalis
Adenohypophysis (anteriorlobe of pituitarygland)
Fibroustr Parsintermedia
Parsdistalis
Gerebral Vasculature
nucleus Arcuate(infundibular)
Medianeminence of tubercinereum lnfundibular stem
Neurohypophysis (posteriorlobe of pituitarygland)
Plale 147
Arteries and Veins of Hypothalamus and Hypophysis
portalsystem Superior hypophyseal artery
hypophysealportalveins
Arteryof trabecula portalveins hypophyseal (fibroustissue) Trabecula Efferent hypophyseal vein to cavernous sinus
Secondary plexus of hypophyseal portalsysteml
Efferent hypophyseal vein to cavernous sinus
Neurohypophysis (posterior lobeof pituitarygland)
Capillaryplexusof process infundibular
Efferent hypophyseal vein to cavernous sinus
Efferenthypophyseal
Inferiorhypophyseal artery
vernsto cavernous
4{r Plate 148
Gerebral Vasculature
Head Scans: Sagittal MR lmages
Median(A) and paramedian(8, C) sagittalMR images
c cc
Corpus callosum
N P Nasopharynx
Extraocular muscles
o
F
Frontalpole
P
FV
Fourth ventricle
PG Pituitarygland
Lateral ventricle Medulla oblongata
Regional Scans
Inferiornasal concha
Cerebellum
Occipitalpole
O N Opticnerve
s
Pons sinus Sphenoid
SC Spinalcord T
Thalamus
M B Midbrain
TC Tentorium cerebelli
sinus M S Maxillary
TO Tongue
Plate 149
Head Scans: Axial GT lmages
Axial CT imagesof the head from inferior (A) to superior(C)
B
Basilarartery
M
c
Cerebellum
M A M a s t o i da i rc e l l s
CH Cerebral hemisphere
MB Midbrain muscle MM Masseter
cs
C o n f l u e n c eo f stnuses
MR Medialrectus muscle
E
Eye
MS Maxillarysinus
EA Externalacoustic meatus
E S E t h m o i ds i n u s F
Fat in orbit
FV Fourthventricle t
Lens
TP Lateralpterygoid
t-R
Plate 15O
Medullaoblongata
N
Nasalconcha
NS Nasalseptum P
Pons
S
S p h e n o isdi n u s
SC Semicircular canats
muscte
SS Superiorsagittal srnus
Lateral rectus muscle
T
Temporalis muscle
Tt
Temporallobe
Regional Scans
Head Scans: Goronal GT Images
CoronalCT imagesof the headfrom anterior (A) to posterior(C)
c E
A n t e r i ocr l i n o i d process
Lateralrectus muscle
C r i s t ag a l l i Eye(vitreous chamber)
Levatorpalpebrae and superioris superiorrectus musctes
sinus ES E t h m o i d G
rc IR
Regional Scans
Createrwing of the sphenoid lnferiornasal concha lncisivecanal lnferiorrectus muscle
M
Maxillarysinus
M R Medialrectus
muscle N
Nasalseptum
oc
Oral cavity
S
S p h e n o isdi n u s
z
Zygomaticarch
Plate 151
2 Back and Spinal Gord Section Topographic Anatomy Plate 152
rs2 Back
Bones and Ligaments Plates 153-159
Column rss Vertebral Vertebrae r se Thoracic Vertebrae rss Lumbar RadiograPhs Vertebrae: r se Lumbar andCoccyx rsz Sacrum Lumbar Region Ligaments: rss Vertebral Region Lumbosacral Ligaments: rss Vertebral
Spinal Gord Plates l6(F173 160 161
inSitu Rami andVentral Cord Soinal Nerve toVertebrae Roots ofSpinal Relation
163
Manifestations DiscHerniation: Clinical Lumbar Anesthesia andEpidural Puncture Lumbar
t64
Dermatomes
165
Topography General Nervous System: Sympathetic pathetrc Topography : General Nervous System Parasym
162
166 167 t68
Schema Nervous System: Sympathetic Schema Nervous System: Parasympathetic
17l,
Roots andNerve Membranes Spinal Cross Origin: Sections Nerve Spinal
171
Cord: Schema ofSpinal Arteries
169
Atlas of Human Anatomy
Back and Spinal Gord rzz Arteries ofSpinal Cord: Intrinsic Distribution rzs Veins ofSpinal Cord andVertebral Column
Muscles and Nerves Plates 174-l80
rze Muscles ofBack: Superficial Layers rzs Muscles ofBack: Intermediate Layers tze Muscles ofBackDeep Layers rzz Nerves ofBack rze Suboccipital Triangle 'rzs Lumbar Region ofBack: Cross Section reo TypicalThoracic Spinal Nerve
Atlas of Human Anatomy
Back
occipitalprotuberance External
muscle Trapezius
L i g a m e n t u mn u c h a e
S p i n eo f s c a p u l a
Spinousprocessof C7 vertebra
Deltoid muscle Infraspinatus
muscle Tricepsbrachii muscle Long head Lateralhead Tendon
D e l t o i dm u s c l e
S p i n eo f s c a p u l a Triangleof auscultation Medialborderof scapula lnferiorangleof scapula major muscle
Latissimus L u m b a r( t r i a n g l e d o r s i m u s c l e of Petit)
Spinousprocessof T 1 2v e r t e b r a
C l u t e u sm e d i u s muscle
lliac crest Erectorspinae muscle
Posteriorsuperior iliacspine
Intergluteal(natal)
Sacrum
C l u t e u sm a x i m u s muscle Greatertrochanter of femur
cleft Clutealfold
e/fd4g/^
Topographic Anatomy
Plate 152
Vertebral Golumn
Anteriorview
left lateralview
Posteriorview A t l a s( C l ) A x i s( C 2 ) Cervical curvature
C7
C7 C7 T1
T1
t
Thoracic vertebrae
Thoracic curvature
Lumbar vertebrae
Lumbar curvature
(S1-5) Sacrum S a c r u m( S 1 - 5 )
*{w Plate | 53
Bones and Ligaments
Thoracic Vertebrae
articular processand facet
Superior costalfacet
Vertebralforamen
Pedicle
Body Transverse costalfacet
Superior
Superior costalfacet
vertebral notch (forms lower margin of intervertebral foramen)
Transverse process
Pedicle
lnferior articular process
Superior articularfacet
T6 vertebra: lateralview T6 vertebra: superiorview Superiorarticular processand facet Superiorarticular processandfacet 7th rib
Costal facet
S p i n o ups r o c e sos f T7 vertebra
T12vertebra: lateralview
processof Transverse T9 vertebra Inferiorarticularprocess(T9)
4{tr
Spinousprocess(T9)
T7,Tgand T9 vertebrae: posteriorview
Bones and Ligaments
Plate 154
Lumbar Vertebrae
A n u l u sf i b r o s u s
Vertebralbody
Nucleus purposus
Vertebral foramen
process Transverse
lntervertebraldisc
Superiorarticularprocess
Accessorvorocess
M a m m i l l a r yp r o c e s s Lamind
Spinousprocess Mammillary process
[2 vertebra: superiorview
Transverseprocess
Spinousprocess Vertebralbody
Vertebralcanal Superior
Intervertebral disc
articularprocess M a m m i l l a r yp r o c e s s Transverse process
Vertebralbody
Inferior articular process Inferior vertebralnotch
Intervertebral (neural)foramen Superior vertebral notch
Parsinterarticularis Accessory
process S p i n o ups r o c e s s of L3 vertebra
facet for sacrum
Inferior articularprocess
[3 and L4 vertebrae: posterior view
Plate 155
l-umbarvertebrae,assembled: left lateralview
Bones and Ligaments
Lumbar Vertebrae: RadiograPhs Lateralradiograph
Anteroposteriorradiograph
B IA t P
Body of L3 vertebra
D
Intervertebraldisc space
Inferiorarticularprocessof L1 vertebra L a m i n ao f L 4 v e r t e b r a
I lA
lntervertebralforamen Inferiorarticularprocessof L3 vertebra
Pedicleof L3 vertebra
lN
lnferior vertebralnotch of L2 vertebra
s
S p i n o u sp r o c e s so f L 4 v e r t e b r a
P
Pedicleof L3 vertebra
SA Superiorarticularprocessof L1 vertebra S F Sacralforamen T Transverseprocessof L3 vertebra
Bones and Ligaments
Spinousprocessof L3 vertebra SA Superiorarticularprocessof L4 vertebra SN Superiorvertebralnotch of L3 vertebra Note: The vertebralbodies are numbered
S
Plate 156
Sacrum and Goccyx SeealsoPlates 153, 159, 248,352-gS4 Superior articular process
Baseof sacrum Lumbosacral articularsurface
Superior articularprocess Ala (wing)
Promontory
r a lp a r t o f p e l v i cb r i m ( l i n e at e r m i n a l i s )
Sacralhiatus Transverse ridges
Mediansagittalsection
Apexof sacrum Transverseprocess of coccyx Facetsof superiorarticular
Anteriorinferior view
Pelvic surface
A u r i c u l asru r f a c e
Nr
Sacraltuberosity Lateralsacralcrest M e d i a n s a c r a lc r e s t Intermediatesacralcresl Posterior sacralforamen
Posterior sacral foramina Sacralcornu (horn) Coccygealcornu (horn)
Anterior (pelvic) sacralforamen
Coronalsection through52 foramina
Transverseprocess of coccyx
Posteriorsuperiorview
Plate 157
Bones and Ligaments
Vertebral Ligaments: Lumbar Region
left lateralview (partially sectioned in median plane)
Inferiorarticularprocess joint Capsuleof zygapophyseal (partiallyopened) S u p e r i oar r t i c u l aprr o c e s s process Transverse
Lumbarvertebral
S p i n o ups r o c e s s L i g a m e n t ufm lavum
lntervertebraldisc
I n t e r s p i n o ul i sg a m e n t ,i
i\srprarpinous
Anterior l o n g i t u d i n lai g l ament
ligament
l tl
Intervertebralforamen
Posterior l o n g i t u d i n lai g l ament
Posteriorvertebralsegments: anteriorview Anteriorvertebralsegments: posteriorview
Pedicle(cut surface)
(pedicles sectioned)
Pedicle (cut surface)
Ligamentumflavum
S u p e r i o ra r t i c u l a r
process Intervertebraldisc
process Transverse
l n f e r i o ra r t i c u l a r
Bones and Ligaments
Plate 158
Vertebral Ligaments: Lumbosacral Region
Superiorarticularprocess
Anterior longitudinal ligament
I ransverseprocess
Lamina Pedicle(cut)
Inferiorarticularprocess
Bodyof L1 vertebra
longitudinal ligament
Pedicle
lntervertebral foramen
Intervertebral discs
Spinousprocess lnterspinous ligament Supraspinous ligament
Superiorarticularprocesses; facettropism(difference in facetaxis)on rightside Spinousprocess
process Transverse Bodyof L5 vertebra
Inferiorarticularprocess Ligamentum flavum
L5 spinalnerve
lliolumbar lliaccrest
Auricularsurfaceof sacrum (forarticulation with ilium)
Posterior supeflor i l i a cs p i n e
Posterior inferior i l i a cs p i n e
left lateralview
Posteriorsacroiliacligamenl
Creatersciaticforamen S p i n eo f i s c h i u m
4{tr
Lateral,
Sacrospinous sacrococcySeal ligaments
Lesser sciaticforamen Sacrotuberous ligament
Posteriorview
Plate | 59
Bones and Ligaments
Spinal Gord and Ventral Rami in Situ
B a s eo f s k u l l C 1 s p i n anl e r v e C2 vertebra (axis) C B s p i n a ln e r v e T.l spinalnerve
C 1 v e r t e b r a( a t l a s )
C e r v i c apl l e x u s C7vertebra T1 vertebra B r a c h i apll e x u s
.l st rib
ldura mater
F i l a m e n t so f s p i n a ln e r v e roots (T7 and TB)
T't2 vertebra
L1 vertebra 1 2 t hr i b
L 1 s p i n a ln e r v e C o n u sm e d u l
llioinguinal nerve
L u m b apr l e x u s C a u d ae q u i n a
L5 vertebra
L5 spinal nerve Femoralnerve S 1 s p i n a ln e r v e Sacralplexus S a c r u m( c u t a w F i l u mt e r m i n a l ei n t e r n u m Terminationof dural sac F i l u mt e r m i n a l ee x t e r n u m t c o c c y g e al i g a m e n t )
S u p e r i o ra n d i n f e r i o r g l u t e a ln e r v e s Sciaticnerve Posteriorfemoral cutaneousnerve
5 5 s p i n a ln e r v e ' P u d e n d a ln e r v e Coccygealnerve
f,
Coccyx
Spinal Gord
nrlS 4.12
Plate 16O
Relation of Spinal Nerve Roots to Vertebrae
-. ' l s p i n a ln e r v e e x i t s '' I1Cabove C.l vertebra
'-C1
Uur" /
c2' C3 C3 ' c 4
of skull Cervical enlargemenl
---C4 C5
C5
t)
C7 T1 T1
T2
C B s p i n a ln e r v e exits below C7 vertebra (there are B cervical nervesbut only 7 cervicalvertebrae)
r2
T?
T3
r4
TA
T5
T5
r6
r7
Lumbar disc protrusiondoes not usuallyaffect nerve exiting above disc. Lateralprotrusion at disc level L4-5 affectsL5 spinalnerve, not L4 soinalnerve. Protrusionat disc level L5-S1 affectsS.l spinalnerve, not L5 spinal nerve.
T7
.-TB -T9 --T1O
'r Lumbar e n la rge me n t -----_____a
T10
-zT1l '
T11
-2r'T12 T 1 2
/Lr
L1
C o n u sm e d u l l a r i s ( t e r m i n a t i o no f s p i n a lc o r d )
,L2 L5 --'L3 C a u d ae q u i n a
-L4
Filum terminale Internum
-L5 -Sacrum S1
Filum terminale externum (coccygeal ligament)
S3 S4 S5
Terminationof d u r a ls a c
Nr Coccygealnerve
I I I I
Plate | 61
Cervicalnerves Thoracicnerves Lumbarnerves Sacraland coccygealnerves
Medial protrusionat disc level L4-5 rarelyaffects L4 spinal nerve but may affect L5 spinalnerve a n d s o m e t i m e sS 1 - 4 s o i n a ln e r v e s .
Spinal Gord
Lumbar Disc Herniation: Glinical Manifestations
Schematiccrosssection s h o w i n gc o m p r e s s i o no f nerve rool
,/." {''"'z;"" '//;.d,
.,,.| \ t
4{tr
Nucleus purposus Characteristic posture in left-sided l o w e r l u m b a rd i s c herniation
Nerverool
exposureof Surgical r isc l o w e rl u m b a d herniation
C l i n i c a fl e a t u r e so f h e r n i a t e dl u m b a r n u c l e u sp u l p o s u s Level of herniation
Pain
Numbness
Weakness
Atrophy
Reflexes
Minor
Changes uncommon i n k n e ea n d a n k l ej e r k s , but internal hamstring reflex diminished or absent
L3 L4 Over sacro\Ls iliac joint, hip, SL5 lateral \ L4-5 disc; t h i g h 5th lumbar and leg nerve root
[5-Sl disc; 1st sacral nerve toot
Spinal Gord
Over sacroiliac joint, hip, posrerolateral thigh and leg to heel
Dorsiflexion of great toe and foot; difficulty w a l k i n go n heels;foot Lateralleg, o r o p m a y first 3 toes occur
Plantar f l e x i o no f foot and great toe may be affected; difficulty Back of w a l k i n go n calf, lateral toes heel,foot to toe
A n k l ej e r k diminished or absent Castrocnemiusand soleus
Plate 162
Lumbar Puncture and Epidural Anesthesia
Lumbarpuncture C a u d ae q u i n a
Subarachnoid space Needleentering subarachnoidspace lliac crest
Arrows show locationsof insertionof needles.
Epiduralanesthesia
Dural sac Epiduralspace Spinousprocessof L4 Ligamentumflavum
Epiduralanesthesia and lumbarpunctureare performedby insertinga needleabove or below the L4 vertebralspine, which liesat the levelof the iliaccrest.Forepiduralanesthesia, the needlepassesinto the epiduralspace,and anesthetic agentbathesthe nerve rootsin proximity.Lumbarpuncture,on the other hand,is performedin order to collecta sample of cerebrospinal fluid (CSF)or to introducean anestheticagentinto the CSF(spinalanesthesia), so thereforethe needie penetratesthe duralsac to enter the subarachnoidspace.
Cryd4/^
Plate 163
Spinal Gord
Dermatones
Schematicdemarcationof dermatomes (accordingto Keeganand Carrett) Thereis shownas distinctsegments. actuallyconsiderableoverlapbetween any two adjacentdermatomes.An alternativedermatomemap is that providedby Foerster(seeReferences).
S3 S4
ss 15, Ll, L2
S1
4{F
L5 L4
Levels of principal dermatomes C5 C5,5,7 C8,Tl C6 C6,7,8 C8 T4
Spinal Gord
Clavicles Lateralpartsof upperlimbs Medialsidesof upperlimbs Thumb Hand Ringand littlefingers Levelof nipples
T10 t1 Ll,2,3,4 L4,5, 51 L4 sl, 2, L5 s1 s2,3,4
Levelof umbilicus Inguinalor groin regions Anteriorand innersurfacesof lower limbs Foot Medialsideof greattoe Posteriorand outer surfacesof lower limbs Lateralmarginof foot and little toe Perineum
Plate 164
Sympathetic Nervous System: General Topography
I n t e r n a cl a r o t i dp l e x u s I n t e r n a cl a r o t i dn e r v e S u p e r i o rc e r v i c a lg a ng l i o n
Cray ramicommunicantes
Externalcarotid nerve
C e r v i c a ls y m p a t h e t i ct r u n k M i d d l e c e r v i c a lg a n g l i o n
C e r v i c a lc a r d i a cn e r v e s
C e r v i c o t h o r a c i (cs t e l l a t eg) a n g l i o n Thoracic visceralnerves P u l m o n a r yp l e x u s
C a r d i a cp l e x u s
W h i t e a n d g r a yr a m i c o m m u n i c a n t e s
E s o p h a g epalle x u s C r e a t e rt h o r a c i cs p l a n c h n i cn e r v e
L e s s e rt h o r a c i cs p l a n c h n i cn e r v e
Aorticorenalganglion L u m b a rs p l a n c h n i cn e r v e s
Celiacplexus C e l i a cg a n g l i o n
S u p e r i o rm e s e n t e r i cg a n g l i o n S u p e r i o rm e s e n t e r i cp l e x u s
In f e r i o rm e s e n t e r i cg a n g l i o n In f e r i o rm e s e n t e r i cp l e x u s S u p e r i o rh y p o g a s t r i cp l e x u s
Hypogastricnerve S a c r a sl p l a n c h n i cn e r v e s
Inferiorhypogastricplexus
C/Fd4ae
Plate 165
Spinal Gord
Parasympathetic Nervous System: General Topography
O c u l o m o t o r n e r v e( C N l l l ) F a c i a nl e r v e ( C N V l l )
C l o s s o p h a r y n g e anle r v e ( C N l X ) Vagus nerve (CN X)
L a c r i m agl l a n d C i l i a r yg a n g l i o n
P t e r y g o p a l a t ignaen g l i o n Parotidgland S u b m a n d i b u lgaar n g l i o n S u b l i n g ua n l ds u b m a n d i b u lgalra n d s Cervical cardiacbranch
C a r d i a cp l e x u s P u l m o n a r yp l e x u s
Esophagealplexus
Anterior and posteriorvagal tru nks
C e l i a cp l e x u s
plexus mesenteric Superior
P e l v i cs p l a n c h n i cn e r v e s( f r o m 5 2 - 4 )
Inferior hypogastricplexus
Cavernousnerves
Cryd4s4*
Spinal Gord
Plate 166
Sympathetic Nervous System: Schema
Superiorcervicalganglion
Internalcarotid nerve and olexus Externalcarotid nerve and olexus
$flacrimalgland C r a y r a m ic o m m u n i c a n t e s Firstthoracicgan
.\
lnnervationto arrectorpili muscles,..,' vascularsmooth muscle,and sweat i'} g l a n d so f s k i n
diac branches Createrthoracic s p l a n c h n i cn e r v e Celiacganglion tl:
Lesserthoracic splanchnicnerve
1 . t . . . - - 1 . . -
\.-.-'r'
Aorticorenal ganglion
Liver
Whiteramus communtcans
Callbladder Bileducts Pancreas
Cray ramus communtcans
Leastthoracic splanchnicnerve Kidneys
mesenteflc ganglion
Intestines F i r s tl u m b a r
Lumbar splanchnic nerves
Descending lnferior mesenteric colon
ganglion
Firstsacralganglion
Sigmoidcolon
Urinary bladder
lnferior hypogastric plexus
Prostate Preganglionicfibers Postganglionic fibers
Plate | 67
Externalgenitalia
CryW Spinal Gord
Parasympathetic Nervous System: Schema
ganglion Pterygopalatine
C i l i a r yg a n g l i o n B r a n c ho f o c u l o m o t o rn e r v e( l l l ) Branchof facialnerve (Vll) Medulla oblongata Branchof glossopharyngeal n e r v e( l X ) Otic ganglion S u b m a n d i b u l agra n g l i o n
fr /t,
(f
plexus Pulmonary
i
Liver
)
Callbladder
n g
K' ."
\
B i l ed u c t s Pancreas
lntestines Descendingcolon Inferiorhypogastric
prexus
s2
Sigmoidcolon Rectum
53j
Urinarb y ladder
S4
P e l v i cs p l a n c h n i cn e r v e s Preganglionic fibers Postganglionic fibers
Spinal Gord
Externalgenitalia
Prostate 6ry4c/*
Plate 168
Spinal Membranes and Nerve Roots
Posteriorview
V e n t r a lr o o t o f s p i n a ln e r v e Dorsal root of soinalnerve ) anglion D o r s a lr o o t ( s p i n a l g W h i t e a n d g r a yr a m i c o m m u n i c a n t e s to and from sympathetictrunk V e n t r a lr a m u so f s o i n a ln e r Dorsal ramus of soinalnerve
D u r am a t e r
M e s o t h e l i sa el o t u mi n d o r s am l e d i a ns u l c u s
P i a m a t e ro v e r l y i n gs p i n a lc o r d Filamentsof dorsal root D e n t i c u l a t el i g a m e n t
Dorsalhorn Membranes removed: anterior view
(greatly magnified) Lateral horn Craymatter White matter
Ventralhorn
F i l a m e no t sf d o r s arl o o t Dorsal root of spinalnerve Filamentsof ventral root Dorsal root (spinal)ganglion Dorsal ramus of spinal nerve Ventral ramus of spinalnerve Ventral root of soinal nerve
Cray and white rami communicantes
Plate | 69
4{tr
Spinal Gord
Spinal Nerve Origin: Gross Sections SeealsoPfates 169, 172,173 Sectionthroughthoracicvertebra Body of vertebra Dura mater
F a ti n e p i d u r a ls p a c e
Arachnoid mater*
Sympatheticganglion D e n t i c u l a t el i g a m e n t Ventral root
S u b a r a c h n osi d pace Pia mater*
White and gray rami communrcantes
Recurrent meningeal b r a n c h e so f s p i n a l nerve
S p i n a ln e r v e Ventral ramus (intercostalnerve)
Pleura LUnS
Dorsalramus
Dorsalroot (spinag l )a n g l i o n Dorsal root Lateralhorn of g r a y m a t t e ro f s p i n a lc o r d
of dorsal ramus of spinal nerve
M e d i a lb r a n c h
Sectionthrough lumbarvertebra
Lateralbranch
lnternalvertebral (epidural)venous plexus(of Batson)
Dura mater Arachnoid mater Ventral root S p i n a ln e r v e
to lumbarplexus) Ventralramus(contributes D o r s arl a m u s
Dorsal and ventral r o o t s o f l u m b a ra n d s a c r a ls p i n a ln e r v e s f o r m r n gc a u o ae q u r n a
Spinal Gord
Dorsalroot Dorsal root
Nr
ganglion *Leptomeninges
C o n u sm e d u l l a r i s
Plate | 7O
Arteries of Spinal Gord: Schema SeealsoPlate 138 Posterior view Posteriorinferior cerebellarartery
Posterior cerebralar Superiorcerebellarartery
Posteriorsoinalarteries Basilarartery Anterior inferior cerebellarartery (Al
Vertebralartery
Posteriorinferior c e r e b e l l aa r r t e r y( P I C A )
Posteriorsegmental m e d u l l a r ya r t e r i e s
_o
A n t e r i o rs p i n a l
Deep cervicalartery
ao
Vertebral artery A n t e r i o rs e g m e n t a l medullary arteries
U
Ascendingcervicalartery
A s c e n d i n gc e r v i c a l
arrery Subclavianartery
Deep cervicala S u b c l a v i a na r t e r
(t:,
t,.l
Anterior segmental
m e d u l l a ray r t e r y
3
/;:,
Posteriorsegmental medullary arteries
,:.i\
g
ifi
Posteriorintercostalartery i)
L
Pialplexus
Thoracic vertebrae
Liki \UI /n
Posterior intercostalarteries
ifj ,t
Major anterior segmental m e d u l l a r ya r t e r y( g r e a t r a d i c u l a ra r t e r yo t Adamkiewicz)
'9,
4{tr
Posteriorintercostalarter l"-l
, T i I'
A n t e r i o rs e g m e n t a l m e d u l l a r ya r t e r y
Posteriorsegmental medullary arteries omotic loops to
anteriorspinalartery Lumbar artery Lumbar arteries
Lumbar vertebrae Anastomoticloops to posterior spinalarteri
fi,
Lateral(or medial) sacralarteries
C a u d ae q u i n aa r t e r Lateral(or medial) sacralarteries
'u
(s rb
Plate 171
Sacrum
\
N o t e : A l l s p i n a ln e r v e r o o t s h a v e associated radicular or segmental medullary arleries Most roots have radicular arteries (see Plate 172) Both types of arteries run along roots, but r a d i c u l a ra r t e r i e se n d b e f o r e r e a c h i n g a n t e r i o ro r p o s t e r i o rs p i n a la r t e r i e s ; l a r g e rs e g m e n t a lm e d u l l a r ya r t e r i e s c o n t i n u e o n t o s u p p l y a s e g m e n to f t h e s ea r t e r i e s
Spinal Gord
Arteries of Spinal Gord: Intrinsic Distribution Posteriorspinalarteries
Anteriorspinalartery Anterior segmental medullary artery
artery Anteriorradicular radicular artery Branchto vertebralbody and dura mater
nalbranch Dorsalbranchof posterior intercostal artery intercostal artery Posterior Paravertebral anastomoses Prevertebralanastomoses Thoracic (descending)aorta
*{r Sectionthroughthoraciclevel: anterosuperiorview
Sulcal(central)branchesto
rightsideof spinalcord Posterior radicular artery Anterior segmental
Rightposteriorspinalartery from pialplexus Peripheral branches to leftside Sulcal(central)branches of spinalcord Leftposteriorspinalartery
medullaryartery Pial arterialolexus Anterior and posterior
radicular arteries A n t e r i o rs p i n a l
artery Posterior radicular
Arterialdistribution:schema
Note: All spinal nerve roots have associated radicular or segmental medullary arteries Most roots have radicular arteries. B o t h t y p e s o f a r t e r i e sr u n a l o n g r o o t s , b u t r a d i c u l a ra r t e r i e se n d before reaching anterior or posterior spinal arteries;larger segmental medullary arteries continue on to supply a segment of these arteries
Spinal Gord
Anterior segmental m e d u l l a r ya r t e r y
Pialarterialplexus
Plate 172
Veins of Spinal Gord and Vertebral Golumn
I n t e r n a vl e r t e b r a (l e p i d u r a lv) e n o u sp l e x u s External vertebralvenous
plexus l n t e r v e r t e b r avle i n
I n t e r n a vl e r t e b r a l ( e p i d u r a l v) e n o u s p l e x u s( B a t s o n ' s veins)
Externalvertebralvenous olexus
B a s i v e r t e b r av le i n
t e r n a lv e r t e b r a vl e n o u sp l e x u s Basivertebralvein I n t e r n a vl e r t e b r a l ( e p i d u r a l v) e n o u sp l e x u s S e g m e n t am l edullary/ r a d i c u l a rv e i n s
A n t e r i o rs p i n a lv e i n A n t e r i o rs u l c a l ( c e n t r a l v) e i n
B a s i v e r t e b r av le i n
Intervertebral vetn
n t e r n a lv e r t e b r a l
( e p i d u r avl )e n o u sp l e x u s
Internalvertebral ( e p i d u r a l v) e n o u sp l e x u s Externalvertebral v e n o u sp r e x u s
l n t e r v e r t e b r avl e i n A n t e r i o rs e g m e n t am l e d u l l a r y / r a d i c u l av re i n P o s t e r i o sr e g m e n t am l e d u l l a r y / r a d i c u l av re i n P i a lv e n o u sp l e x u s P o s t e r i osr u l c a l( c e n t r a l v) e i n P o s t e r i o sr p i n a lv e i n I n t e r n a vl e r t e b r a (l e p i d u r a l v) e n o u sp l e x u s
Plate 173
*{ry Spinal Gord
Muscles of Back Superficial Layers
S u p e r i onr u c h alli n eo f Spinousprocessof C2 ver Sternocleidomastoidmuscl
Posterior trianeleof neck Trapeziusmuscle S p i n eo f
S e m i s p i n a l icsa p i t i sm u s c l e l e n i u sc a o i t i sm u s c l e Spinousprocessof C7 vertebra Spleniuscervicismuscle L e v a t o rs c a p u l a em u s c l e R h o m b o i dm i n o r m u s c l e( c u t )
D e l t o i dm u s c
Supraspinatus muscle
natus Infraspi fascia
tus posterior
s u p e r i om r uscle
major muscle (cut)
Teresmajor muscte
Infraspinatus fascia(over infraspinatus muscle)
Latissimus dorsimuscle
Teresminor and major musctes
Spinousprocess of T12 vertebra
dorsimuscle(cut) Latissimus
fascia Thoracolumbar Serratusanterior muscle External o b l i q u em u s c l e
I n t e r n aol b l i q u e m u s c l ei n l u m b a tr r i a n g l e (of Petit)
Serratusposteriorinferior
muscre 1 2 t hr i b rector spinaemuscle
lliac crest
Cluteal aponeurosis ( o v e r g l u t e u sm e d i u sm u s c l e
Muscles and Nerves
External o b l i q u em u s c l e nternal o b l i q u em u s c l e
4{tr
Plale 174
Muscles of Back: Intermediate Layers
S u p e r i onr u c h alli n eo f s k u l l Posterior tubercleof atlas(C.l L o n g i s s i m ucsa p i t i s
Rectuscapitisposteriorminormuscle Obliquuscapitissuperiormuscle Rectuscapitisposteriormajormuscle r uscle O b l i q u u sc a p i t i si n f e r i om
S e m i s p i n a l icsa p i t i s
L o n g i s s i m cuas p i t i sm u s c l e S p l e n i ucsa p i t i sa n d s p l e n i u sc e r v i c i s
posteriorsuperior Serratus
S e m i s p i n acl iasp i t i sm u s c l e( c u t ) Spinalis cervicismuscle Spinousprocessof C7 vertebra
l l i o c o s t a l im s uscle o n q t s s t m ucse r v t c t sm u s c t e Erector sprnae muscle
lliocostaliscervicismuscle
Longissimm u su s c l e lliocostalis thoracismuscle S p i n a l im s uscle
Hook Spinalisthoracismuscle L o n g i s s i m utsh o r a c i sm u s c l e lliocostalislumborum muscre SpinousprocessofT12 vertebra
Tendon of origin of transversusabdominis muscle
Transversus abdominis muscle and tendon of origin
Internao l blique
muscle
Thoracolumbarfascia (posteriorlayer)(cut)
E x t e r n aol b l i q u e muscle (cut)
lliac crest
4ttr Plate | 75
Muscles and Nerves
Muscles of Back: Deep Layers
S u p e r i onr u c h alli n eo f Mastoid Drocess
Posterior tubercleof atlas (Cl vertebra) Spinousprocessof axis (C2vertebra S e m i s p i n a l icsa p i t i s
Spinousprocess of C7 vertebra
Rectuscapitisposteriorminormuscle Obliquuscapitissuperiormuscle Rectuscapitisposteriormajormuscle processof atlas(C1) Transverse Obliquuscapitisinferiormuscle Loneus ) " ) Rotatores cervicismuscles Brevis ) Interspinaliscervicismuscle
Levatorcostaemuscle External intercostal muscles
Semispinalis thoracismuscles
Multifidusmuscles
Thoracolumbarfascia (anteriorlayer)
Thoracolumbar fascia (posteriorlayer)(
Transversus abdominismuscle
lumborummuscle lntersoinalis
muscle Intertransversarius
atuslumborummuscle
and tendon of origin
liaccrest Multifidusmuscles Erectorspinaemuscle(cut)
Multifidusmuscles(cut)
4{tr Muscles and Nerves
PIate 176
Nerves of Back
Accessorynerve (Xl)
Trapeziusmuscle(refI ected)
o c c i p i t a ln e r v e ( d o r s a lr a m u so f C 2 s p i n a ln e r v e )
3rd occipitalnerve(dorsalramusof
Levatorscapulae muscle Cervicalplexus (ventralramiof C2, 3 spinalnerves)
Transversecervical artery and vein
plexus Subtrapezial
Posterior cutaneous branches(frommedial branches of dorsalramiof C4-T6soinal t C 7 , B a r em i n i m a l )
Deltoidmuscle S up r a s p i n a t u s muscle
Infrasoinatus fascia
S p i n eo f
Teresminorand majormuscles
scapula
Superiorlateralbrachial cutaneous nerve(from axillarynerveC5, 6)
Infraspinatus fascia
Posterior cutaneous branches(fromlateral branches of dorsalrami o I f T - 1 2 s p i n anl e r v e s )
Rhomboid m i n o rm u s c l e Rhomboid m a l o rm u s c l e
Lateralcutaneous branches of ventralrami(intercostal nerves)
L a t i s s i m ud so r s im u s c l e E x t e r n aolb l i q u em u s c l e Spinousprocessof T12vertebra Thoracolumbarfascia
lliaccrest lliohypogastric nerve ( v e n t r arla m u so f L l s p i n a l nerve) Superior clunialnerves ( d o r s ar la m io f L l , 2 , 3 s p i n a l nerves)
C l u t e u sm a x i m u s muscle
4{tr Plate 177
Medialclunialnerves ( d o r s ar la m io f 5 1 , 2 , 3s p i n a l nerves) lnferiorclunialnervesfrom posteriorfemoralcutaneous n e r v e( s a c r apl l e x u sS 1 ,2 , 3 )
Muscles and Nerves
Suboccipital TFiangle
Rectuscapitisposteriorminormuscle Rectuscapitis posterior major muscle
E p i c r a n iaapl o n e u r o s i s (galeaaponeurotica Occipital belly (occipitalis)of occioitofrontalis
a l i sc a p i t i sm u s c l e (cutand reflected\ Vertebralartery (atlanticpart) Obliquuscapitis suoeriormuscle
Greater occioital nerve (dorsalramus of C2 s p i n a ln e r v e )
nerve Suboccipital (dorsalramusof C1 spinalnerve)
Occipitalartery
Posteriorarchof atlas(C1vertebra) Third occipital nerve ( d o r s a lr a m u so f C 3 spinal nerve)
italartery O b l i q u u sc a p i t i s inferiormuscle
S e m i s p i n a l icsa p i t i s a n d s p l e n i u sc a p i t i s
musclesin posterior triangleof neck
Creater occioital nerve (dorsalramus
of C2 spinalnerve) Posterior auricularartery
C r e a ta u r i c u l anre r v e (cervicalplexusC2,3
capitismuscle Splenius (cut and reflected) occipital nerve
(dorsalramusof C3 spinalnerve)
Longissimus capitismuscle Lesseroccipital nerve (cervicalplexusC2)
cervicismuscle Splenius cervicismuscle Semispinalis
Sternocleidomastoidmuscle
Traoezius muscle
Posterior cutaneous branches of dorsalramiof C4, 5 , 6 spinalnerves
and Nerves
liscapitismuscle(cut) capitismuscle(cut) Splenius
4{tr Plate | 78
Lumbar Region of Back: Gross Section
lnferiorvena cava Descending(2nd) part of duodenum Kidney Renal(Cerota's)fascia (anterior and posterior layers)
Pancreas Anterior longitudinalligament
Perirenalfat Cruraof diaphragm
Superior mesenteric artervandvein Extraperitoneal (subserous) fascia (areolar tissue)
Mesentery Abdominal aorta
Transversalis fascia
Duodenojejunal junction Bodyof L2 vertebra Psoasmajor muscte and fascia Lumbar spinalnerve Transverse process
External oblique muscle
Spinal duramater Cauda equina
Internal o b l i q u em u s c l e
Transversus abdominis muscle
Tendonof originof transversus abdominis and internalobliquemuscles posterior Serratus inferiormuscle Latissimus dorsi muscle
lumborummuscle Quadratus
process Spinous of L1vertebra ligament Supraspinous Erector spinaemuscle Thoracolumbarfascia(posteriorlayer) Thoracolumbarfascia(middlelayer) Thoracolumbarfascia(anteriorlayerquadratuslumborum fascia)
Plate 179
*{r
Muscles and Nerves
fiTpical Thoracic Spinal Nerve
Anterior cutaneousbranch Lateralbranch
External I intercostal membrane
Transversus thoracis muscle
muscle External intercostal lnternalintercostal muscle muscle lnnermostintercostal
Ventralroot Dorsal root Anterior branch
lntervertebral foramen
Dorsalroot (spinal) ganglion
lateral cutaneousbranch Posteriorbranch
Spinalnerve Sympatheticganglion ray and white rami communicantes
Ventralramus(intercostalnerve
Serratusanterior muscle
atissimusdorsi muscle
Subscapularis muscle Teresmaiormuscle
Dorsalramu6 M e d i a lb r a n c h
Lateralbranch Posteriorcutaneousbranch
Traoezius muscle Rhomboidmaiormuscle Erectorspinaemuscle lnternalintercostalmembrane
Note: In lower thoracic region, lateralbranch of dorsal ramus is longer, motor, and cutaneous; medial branch is shorter and motor onlv.
Muscles and Nerves
muscle Infrasoinatus
*{r Plate l8O
3 Thorax Section Topographic Anatomy Plates l8t
181 Thorax
Mammary Gland Plates 142-144
Gland 182 Mammary Gland ofMammary 183 Arteries Gland of Mammary andNodes Vessels 184 Lymph
Body Wall Plates 185-195
ofThorax 185 BonyFramework Joints 186 RibsandSternocostal Joints 187 Costovertebral Wall Thoracic 188 Anterior Wall(continued) Thoracic 189 Anterior Placement Tube Drainage 190 Chest InternalView Wall: Thoracic 191 Anterior Nerves andArteries 192 Intercostal Nerve 193 Phrenic Surface Thoracic 194 Diaphragm: Abdominal Surface 195 Diaphragm:
Lungs Plates t9G2lO
AnteriorView ofLungs: 196 Topography PosteriorView of Lungs: 197 Topography View inSitu: Anterior 198 Lungs
Atlas of Human Anatomy
Thorax 199 Lungs: Medial Views
226 Nerves of Heaft
200 Bronchopulmonary Segments
227 lnnervation of HeartSchema
201 Bronchopulmonary (continued) Segments
228 lnnervation ofBlood Vessels: Schema
202 Tracheaand MajorBronchi
229 Prenatal andPostnatal Circulation
203 Nomenclature ofBronchi: Schema 204 Intrapulmonary Airuvays: Schema
Mediastinum
205 Intrapulmonary Blood Circulation: Schema
Pfates 23O-24l
206 Great Vessels ofSuperior Mediastinum
230 Mediastinum: Right Lateral View
207 BronchialArteries andVeins
231 Mediastinum: LeftLateralView
208 Lymph Vessels andNodes ofLung
232 Esophagus inSitu
209 Autonomic Nerves inThorax
233 Topography andConstrictions of Esophagus
210 Innervation ofTracheobronchial Tree: Schema
234 Musculature of Esophagus 235 Pharyngoesophageal Junction
Heart
236 EsophagogastricJunction
Plates 211-2X,
237 Arteries of Esophagus
211 Heart inSitu
238 Veins ofEsophagus
212 Heart: Anterior Exposure
239 Lymph Vessels andNodes of Esophagus
213 Radiograph ofChest
240 Nerves of Esophagus
214 HearL BaseandDiaphragmatic Surfaces
241 Mediastinum: Cross Section
215 Pericardial Sac 216 Coronary Arteries andCardiac Veins
Regional Scans
2'17 Coronary Arteries andCardiac Veins:Variations
Plale 242
218 Coronary Arteries: Arteriographic Views
242 Chest Scans: AxialCTlmages
219 Coronary Arteries: (continued) Arteriographic Views 220 Right Atrium andVentricle
Gross-Sectional Anatomy
221 LeftAtrium andVentricle
Plates 243-246
222 Yalves andFibrous Skeleton of Heart
243 Cross Section ofThorax atT3Level
(continued) 223 Valves andFibrous Skeleton ofHeart
244 Cross Section ofThorax atT3-4DiscLevel
224 Alria, Ventricles, andInterventricu larSeptu m 225 Conducting System ofHeart
245 Cross Section ofThorax atT't-5DiscLevel
Atlas of Human Anatomy
246 Cross Section ofThorax atTTLevel
Thorax
Biceps brachii muscle muscle Sternocleidomastoid Sternalhead head Clavicular
Triceps brachii muscle Axilla
Anterior axillaryfold
Jugular notch
Posterior axillaryfold
Deltoid muscle
Pectoralismajor muscle head Clavicular Sternalhead
Bodyof sternum
dorsi Latissimus muscle Cephalic
Xiphoidprocess of sternum
vetn
Serratus anteriormuscle Lineaalba Rectusabdominis muscle Tendinous intersection External oblique muscle Serratus anteriormuscle
Topographic Anatomy
64a4#
Plate l8l
Mammany Gland
Anterolateral dissection
Suspensory ligaments of breast(Cooper's) ar glands
Pectoralis m a j o rm u s c l e (deepto pectoral fascia) A x i l l a r yt a i l ( o f S p e n c e )
Serratus anteriormuscle External o b l i q u em u s c l e
2nd ri Pectoralis maJor
muscle Pectoral fascia Intercostal muscles
ligaments Suspensory of breast(Cooper's) Lactiferousduct actiferoussinus
C l a n dl o b u l e s
Fat (subcutaneous tissuelayer)
Sagittalsection
Plate 182
4{tr Mammary Gland
Arteries of Mammary Gland
Subclavianarter I n t e r n a tl h o r a c i c artery and its perforatingbranches M e d i a l m a m m a r yb r a n c h e s
Axillara y rter Brachialplexu Brachial
Lateralthoracic art ano Lateralmammary branches A x i l l a r yt a i l ( o f S p e n c e ) Lateralmammary branchesof lateralcutaneous branchesof posterior intercostalarteries
*fr Mammary Gland
Plate 183
Lymph Vessels and Nodes of Mammary Gland
Parasternalnodes Apical axillary
(Rotter's) Interpectoral nodes ( s u b c l a v i a nn) o d e s C e n t r a la x i l l a r yn o d e s
Lateral axillary (humeral) nodes Posterior axillary
(subscapular) nodes
Anterior axillary (pectoral) nodes
Pathwayto anterior mediastinalnodes
Pathwaysto opposite breast Pathwaysto inferior phrenic (subdiaphragmatic)nodes and livei
Plate 184
4{tr Mammary Gland
Bony Framework of Thorax Jugularnotch
Anteriorview
Manubrium Angle
Sternum
Coracoid
process
Body
Glenoid cavity
Xiphoid process
Neck Scapular
Subscapular fossa Clavicle
Trueribs(l-7) Costal cartilages
Falseribs(B-.12 loatingribs(.11-12)
Head
Posteriorview Neck
Tubercle Angle
Body
Acromion Supraspinous fossa Spine lnfraspinous fossa
T r u er i b s( 1 - Z )
4{r
F a l s rei b s( B - 1 2 )
Floatingribs fi1-12)
Body Wall
Plate t 85
Ribs and Sternocostal Joints
Subclavius muscle
1st left rib: superiorview
Muscleattachments Origins
Croovesfor subclavian
Insertions
I
Anterior scalene muscle
Middle rib: posterior view
Head Neck
Serratus anterior muscle
Tubercle
Middle scalene muscle
l st digitation)
Posterior scalene muscle Articular for transverse processof vertebra
2nd left rib: superiorview Serratus anterior (2nddigitation)
\-V^r-l
Articularfacets for vertebralbodv
lnterclavicula i gra m e n t Manubrium Costalgroove Costoclavicular ligament Articularcavity lntraarticular sternocostal ligament
Costalcartilages
ndraljoints
Radiatesternocostal ligaments
Note:The headof a typicalrib articulates with the superior costalfacetof the thoracic vertebraof the samenumber(by its inferiorarticularfacet),the inferiorcostalfacetof the vertebraabove(by its superior articularfacet),and the intervertebral disc betweenthe two vertebrae.The costal tuberclearticulateswith the processof the transverse vertebraof the samenumber.
Costalcartilages
joints Interchondral
4{tr
Xiphoid process Costoxiphoid ligament
Plate 186
Sternocostalarticulations: anteriorview
Body Wall
Gostovertebral Joints
Transverse costalfacet(fortubercleof rib of samenumberasvertebra)
Anteriorlongitudinal ligament
Lateralcostotransverseligament
Inferior costal facet (for head o{ rib one number
greater)
Intertransverseligament
Interarticular ligamentof head of ri
ligament Superiorcostotransverse
Superiorcostal facet (for head of rib of same
Superiorarticular facetof rib head
number Radiate ligament of
ligament Intraarticular
headof
Radiate ligament of head Synovial cavities
of rib
Left lateral view
ligament(cut) Superiorcostotransverse Superiorcostal facet(for headof rib of samenumber) Transverseprocess
(cutoff ligament Costotransverse Lateralcostotransverseligament
Transverse section:superiorview Radiateligamentof head of rib
ostotransverseligament
Lateralcostotransverseligament
uperior costotransverseligament
ansverseligament
Right posterolateralview
Body Wall
Nr Plate 187
Anterior Thoracic Wall
Sternothyroidmuscle tnu"st"d by Sternohyoidmuscle I cervicalfascia Omohyoid muscleJ
Sternocleidomastom i du Posteriortriangleof Trapeziusmuscle
Clavicle
Perforating branches of internal thoracicarteryand anteriorcutaneous branches of intercostal nerves
Subclavius muscleinvestedby fascia clavipectoral Thoracoacromial artery(pectoral branch)and lateralpectoralnerve
Pectoralismajor muscle C e p h a l i cv e i n
Costocoracoidligament Coracoid process
Acromion
D e l t o i dm u s c l e
Medial pectoral nerve
Long thoracic nerve and lateralthoracic artery
minor Pectoralis muscleinvestedby Clavipectoral fascia
Latissimu d so r s im u s c l e
Digitations of serratus a n t e r i om r uscle
D i g i t a t i o n so f serratusanterior muscle
xternal intercostal membranesanterior to internalintercostal muscles
Lateralcutaneous branches of intercostalnervesand posterior intercostalarteries
External intercostal muscles E x t e r n aolb l i q u e musc
Bodyandxiphoidprocess of sternum
Anteriorlayerof rectussheath
4{tr Cryd4*/* Plate 188
I n t e r n aol b l i q u em u s c l e
Sternalismuscle (inconstant) L i n e aa l b a
R e c t u sa b d o m i n i sm u s c l e Cutaneousbranchesof thoracoabdominal (abdominalportions of intercostal)nerves and superiorepigastricartery
Body Wall
Anterior Thoracic Wall (continuedl
Omohyoid, sternothyroidand sternohyoidmuscles Clavicle
S u b c l a v i umsu s c l e Trapezius muscle
I n t e r n a jl u g u l a rv e i n Levatorscaoulaemuscle Anterior
)
/ ruiddl" ! s.rl"n" muscles / eotturio,)
Thoracoacromialartery
Phrenicnerve Coracoid process
prexus C e p h a l i cv e i n Thoracicduct Pectoralismajor muscle (cut)
Subclavian artery and vein
Deltoid muscle
artery and vein
Intercostobrachialnerve
Superiorthoracic artery
Long thoracic nerve andlateral thoracic artery
lnternalthoracic artery and veins
Pectoralisminor muscle
xternal intercostalmuscle
Digitationsof serratusanterior muscle Lateralcutaneous branchesof intercostal nervesand posterior intercostalarteries
intercostal muscle (cut) Transversusthoracis muscle Anterior intercostal branchesof internal thoracic artery
Externalintercostalmuscles lntercostalnerve
External intercostal membranes anterior to internal intercostalmuscli-'s
l n t e r n a lo b l i o u e m u s c l e R e c t u sa b d o m i n i sm u s c l ea n d s h e a t h( c u t )
Body Wall
Musculophrenicartery and vein
abdominismuscre Transversus S u p e r i o re p i g a s t r i ca r t e r i e sa n d v e i n s
*{r Plate | 89
Ghest Drainage Ti,rbe Placement
Preferredsites (2ndor 3rd 1.Forpneumothorax interspace at midclavicular line) (5thinterspace 2. Forhemothorax at midaxillarv line)
B.Trocarwithdrawn; tubepassed into chestthroughcannula
C.Cannulawithdrawn; tube connected to underwater seal(with suctionif indicated)
D, Intercostal_+ spacers pierced above rib to avoid damageto neurovascutar b u n d l el y i n gi n costal groove
Thoracocentesis and tube drainage with underwatersealdrainage usuallysuffices.
Plate | 9O
Nr Body Wall
Anterior Thoracic Wall: lnternal View
S t e r n o t h y r om i du s c l e S t e r n o h y o im du s c l e I n t e r n a jl u g u l a rv e i n
Manubrium of sternum C o m m o n c a r o t i da r t e r y lnferior thyroid artery
Vertebralartery
Anterior scalenemu S u b c l a v i a na r t e r ya n d v e i n
trunk Brachiocephalic Subclavianartery and vein
C l a v i c l e( c u t ) - - *
B r a c h i o c e p h a l ivce i n
Brachiocephalicvein --'
Internalthoracic artery and vein
P h r e n i cn e r v e a n d pericardiacophrenic artery and vei
Anterior intercostal arteriesand veins and intercostalnerve
Internalthoracic artery and vein
intercostal
Anterior intercostal a r t e r i e sa n d v e i n s and intercostalnerve
muscles
Perforatingbranches of internalthoracic artery and vein and anterior cutaneous branch of intercostalnerve
Innermost intercostal muscles
Transversus thoracis muscte
Collateral branchesof intercostalartery and vein
Bodyof ster Sternocostal triangle
4{tr
Diaphragm S l i p so f c o s t a lo r i g i n of diaphragm
Musculophrenic arteryandvein
Transversus abdominis muscle
Transversus abdominis muscle Sternalpart of diaphragrh X i p h o i dp r o c e s S
Body Wall
Internalthoracic artery and veins S u p e r i o re p i g a s t r i ca r t e r ya n d v e i n s
Plate | 91
Intercostal Nerves and Arteries
Ventralroot Dorsalroot (spinal)ganglion
Spinal(radicular, or segmental medullary) branchof posteriorintercostalartery Trapeziusmuscle
Erectorspinae Medialbranch Lateralbr
Dorsalramusof thoracicner
Dorsalbranchof posteriorintercostalartery Rhomboidmajormuscle Erectorspinaemuscle
Costotransverse ligamen
Posteriorintercostalarterv
Intercostal nerve(ventral ramusof thoracicspinal
Internalintercostalmembrane
Internalintercostalmembrane deep to externalintercostal muscle
muscle
Serratusanterior
is muscle Serratus anterior muscle
Lateral cutaneous branchof intercostal nerve Anteriorbranch of lateralcutaneous branchof intercostalnerve External muscle
*{r
Pectoralismajormuscle Anteriorcutaneousbranchof intercostalnervb
Plate 192
External oblique muscle Perforating branch Superior epigastricartery Rectusabdominis
Lateralcutaneous branchof posterior intercostalartery al intercostalmembrane Anteriorintercostalarteries
Body Wall
Phrenic Nerve
!1 u"",'",*', |
Ventralrami
{:; Anterior scalenemuscle
Anterior scalenemuscle
Right common carotid a
plexus Brachial
Brachial
Left phrenic nerve
Rightphrenicnerve
artery Leftsubclavian
R i g h st u b c l a v i aanr t
Leftvagusnerve(X)
R i g h tv a g u sn e r v e (
Left common carotid arterv
Right internal
Leftinternal thoracicartery(cut)
thoracicartery(cut) Brachioceohalic trunk
Thoracic cardiac nerves
Right pericardiaco-
Left pericardiacophrenic artery (cut)
phrenicartery(cut 5upeflor vena cava
Leftrecurrent nerve laryngeal
Rootof rightlung
Rootof leftlung
Pericardialbranch of phrenic nerve
partof Mediastinal parietalpleura
Mediastinalpart of parietalpleura,
Costalpart of parietalpleura
Diaphragmatic part of parietal
pleura(cut) P h r e n i c o a b d o m ibnraal n c h e s of ohrenicnervesto inferior surfaceof diaphragm
Phrenic (efferentand afferentfibers)
Lower intercostalnerves
(afferentonlyfrom peripheral partof diaphragm)
Body Wall
4ttr Plate 193
Diaphragm: Thoracic Surface SeealsoPlates23O,231 T h o r a c i c( d e s c e n d i n ga) o r t a
Neck of rib Left sympathetictrunk
TB-9 intervertebral disc
Left greaterthoracic s p l a n c h n i cn e r v e
R i g h st y m p a t h e ttircu n k
Hemiazygosvein
Right greaterthoracic s p l a n c h n i cD € r V € 1
M e d i a s t i n apl l e u r a Costal part of parietalpleura
Esophagus
Azygos V€lD-
Thoracic duct R i g h tl e a f l e to f central
Diaphragmatic part of
parietalpleura (cutaway)
Diaphragmatic part of parietal pleura (cut away)
Left leaflet of central tendon
R i g h tp h r e n i cn e r v ea n d pericardiacophrenic artery and vein
Mediastinalpart of parietalpleura and pericardium(cut)
Mediastinalpart of parietal p l e u r aa n d p e r i c a r d i u m( c u t )
Left phrenic nerve and pericardiacophrenic artery and vein
R i g h tc o s t o d i a p h r a g m a t i c recessof pleuralcavity
Pericardium
lnferior vena cava (receivinghepatic vein!)
Left costomediastinal recessof pleuralcavity
Right internalthoracic artery and veins R i g h tc o s t o m e d i a s t i n a l recessof pleuralcavity
n{r Plate 194
A n t e r i o rm e d i a s t i n u m Sternum
Transversus thoracismuscle Left internalthoracic artery and veins 5th costal cartilage Middle leafletof central tendon covered bv oericardium
Body Wall
Diaphragm: Abdominal Surface SeealsoPlates253,263, Sternocostaltriangle Sternalpart of diaphragm A n t e r i o rb r a n c ho f r i g h t p h r e n i cn e r v e
Anterior branch of left phrenic nerve Costal part of diaphragm Centraltendon of diaphragm
R i g h ti n f e r i o rp h r e n i ca r t e r y
hiatus Esophageal
C a v a lo p e n i n g
F i b e r fsr o mr i g h tc r u sp a s s i n g hiatus to leftof esophageal
R i g h ct r u so f d i a p h r a g m
Left inferior phrenic artery
Creater thoracic solanchnicnerve
Recurrentbranch to esophagus
L e s s e rt h o r a c i cs p l a n c h n i cn e r v e
Anterior branch Lateralbranch
Leftsuperior artery suprarenal
Leastthoracic s p l a n c h n i cn e r v e .
Left phrenic nerve Costal part of diaphragm
Leftcrusof diaphragm
Transversus abdominis m
triangle Lumbocostal 1 2 t hr i b Lateralarcuateligament
Lumbarpartof diaphragm Quadratus
M e d i a la r c u a t el i g a m e n t
l u m b o r u mm u s c l e P s o a sm a j o r m u s c l e S y m p a t h e t i ctru nk
Aortichiatus
C e l i a ct r u n k
Body Wall
Plate t 95
Topography of Lungs: Anterior View
Thyroid cartilage Thyroid gland Cervical(cupula,or dome, of) parietalpleura
Cricoid cartilage Trachea
J ug u l a r( s u p r a s t e r nnaol )t c h A p e xo f l u n g
j or i n t Sternoclavicula
Arch of aorta
Clavicle
Cardiacnotchof leftlune
I st rib and costalcartila
Left border of heart
R i g h tb o r d e ro f h e a r t
Horizontal fissure of right lung (often incomplete)
Right nipple
Left nipple
Costomediastinal recessof pleural cavtty
fissure O b l i q u ef i s s u r e of leftlung
Costodiaphragmatic recessof pleural cavity
Costodiaphragmatic recessof pleuralcavity
Spleen I n f e r i o rb o r d e r o f r i g h t l u n g
Inferiorborderof leftlung Left dome of diaphragm
Pleuralreflection
Pleuralreflection Callbladdei Stomach R i g h td o m e o f d i a p h r a g m
Bare area of pericardium Xiphoid process
Plate 196
*{r Lungs
Topography of Lungs: Posterior View
Spinousprocessof T1 vertebra
A p e xo f l e f tl u n g 1s t r i b Obliquefissureof leftlung
Cervical(cupula,or dome, of) parietalpleura
1 s tr i b e f r i g h tl u n g O b l i q u ef i s s u r o Clavicle
H o r i z o n t af ils s u r e of rightlung(often incomplete)
S p i n eo f s c a p u l a Left border of costal parietap l leura
R i g hb t order of costal parietalpleura
Costodiaphragmatic recessof pleural cavity
Costodiaphragmatic recessof pleural cavity
Spleen
Liver
Pleuralreflection
Pleuralreflection
Inferiorborderof leftlung
*{r Lungs
Inferiorborderof rightlung
Left kidney
R i g h tk i d n e y
Left dome of diaphragm
R i g h td o m e o f d i a p h r a g m
Left suprarenalgland
R i g h ts u p r a r e n agl l a n d
Plate | 97
Lungs in Situ: Anterior View
Thyroidgland Omohyoid, sternothyroidand sternohyoidmuscles
Manubrium of sternum
Tracheaand inferior thyroid veins Common carotid artery I n t e r n ajlu g u l a rv e i n Phrenicnerve
Sternocleidomastoidmuscle
j ul g u l avr e i n Externa
Anteriorscalenemuscle Thoracicduct
Costal part of parietalpleura (cut away)
a c h i apl l e x u s
Clavicle
Subclavianartery and vein
Pectoralismaior muscle
Pectoralis m i n o rm u s c l e
Internalthoracic artery and vein Axillaryartery and vein
Intercostal musctes
notch
of leftlung
Superiorlobe, M i d d l el o b e , I n f e r i olro b e o f r i g h tl u n g
Superiorlobe, Inferiorlobe of leftlung Costomediastinal space
O b l i q u ef i s s u r e Horizontal fissure o f r i g h tl u n g
Oblique fissure
Costodiaphragmaticrecess Diaphragmatic part of parietalpleura
M u s c u l o p h r e nai cr t e r y L i n g u lo a f s u p e r i olro b eo f l e f tl u n g
Diaphragm
*{r Plate | 98
7th costal cartilage Xiphoid process Pleuralreflectioni
Internalthoracic artery Mediastinalpart of parietalpleura F i b r o u sp e r i c a r d i u m
Lungs
Lungs: Medial Views
Rightlung Areafor trachea Groovefor subclavian a
Areafor esophagus
Croovefor brachiocephalic vein
Croovefor azygosvein
Croovefor 1stri
Obliquefissure Pleura(cutedge)
Croove for superiorvena cava
Rightsuperiorlobar (eparterial) bronchus
Superiorlobe Areafor.thymus and fatty. tissueof anteriormediasti
Rightpulmonaryarteries Rightbronchialartery
Anteriorborder
Rightintermediate bronchus
Hilum
R i g h st u p e r i opr u l m o n a rvye i n s Horizontalfissure
(hilar) Bronchopulmonary lymphnodes
C a r d i a ci m p r e s s i o n
Rightinferiorpulmonaryveins
Obliquefissure
lnferior lobe
Middle lobe
for esophagus
Groove for inferior vena cava
ligament Pulmonary Diaphragmaticsurface
Inferiorborder
4{ffi
Left lung
4t-/
Apex arterv Croovefor subclavian
Areafor tracheaand esophagus Oblique
Croovefor left vein brachiocephalic roovefor l st rib
Croove for arch of aor
Anteriorborder Pleura (cut edge)
Leftpulmonary Leftbronchialarteries Leftmainbronchus L e f ts u p e r i o rp u l m o n a r yv e i n s
Areafor_thymus and fatty. tissueof anteriormediastinum Superiorlobe Hilum Cardiacimpression P u l m o n a rl yi g a m e n t
B r o n c h o p u l m o n a r (yh i l a r )
lymphnodes
Cardiacnotch Inferior
Leftinferiorpulmonaryvei Croovefor descending aorta Inferiorborder
Lungs
Obliquefissure tor esophagus surface Diaphragmatic ingula
Plate 199
Bronchopulmonary Segments
Rightlung
Anteriorview
Superiorlobe
Superiorlobe
Apical(S1 Anterior(S3 Posterior(S
Middle lobe
l i n g u l a(rS a ) l,lnferior
I l/
Lateral(Sa
f
t.
'
, ^q '
(5") \ lrngutar I I
rl l1
Medial(Ss)
I I
, \
ii
Inferiorlobe Anterior
Inferior lobe Anteromedial basal(S7*8)
basal(SB) Medial
basal(S7
Posterior basal(S1o)
\
Lateral basal(Se)
,
Posterior basal(S1o)
'..,
Lateral basal(Se)
---f-'EE
Posteriorview
Left lung
--+--' T
-.i;--1:,
Superiorlobe Apical(Sr) (S2) Posterior Anterior(S3)
-'iir'Middle lobe
isl Inferior lobe
tl 7'
Lateral(Sa) Inferior lobe
Superior(56)
Superior(56)
Lateral basal(Se)
Lateral basal(Se)
'-lZ.tr.-
Posterior b a s a1l S t o l
rr!
Posterior basal(Sro)
lt tt t, ll, \t,
', ,I
Plate 2OO
r/-\
t--t
iri
4{F Lungs
Bronchopulmonary Segments (continuedl
Lateralviews Rightlung Superiorlobe
Superiorlobe
Apical(S1) Posterior(52) A n t e r i o r( S 3 )
Middle lobe Lateral(Sa) M e d i a (l S s ) lnferiorlobe S u p e r i o r( 5 6 )
lnferiorlobe
Anteromedial basal(S7*8)
Superior(56) Anterior basal(58)
Lateral basal(Se)
Lateral basal(Se)
Medialviews
Superiorlobe
4{tr Superiorlobe
A p i c a l( S l ) Posterior(S2) A n t e r i o r( 5 3 )
Middle lobe (Ss) tr4edial
Inferiorlobe S u p e r i o(r5 6 ) Medial
lnferiorlobe
basal(Si
Superior(56)
Anterior basal(S
Anteromedial basal(S7*8)
Lateral
Lateral basal(Se)
basal(Se) Posteriorbasal(S1o)
Lungs
Posteriorbasal(Slo)
Plate 2Oi
l|achea and Major Bronchi
Connective tissuesheath (visceral layerof pretracheal fascia)
Thyroid cartilage Median cricothyroid ligament...-
Trachealcartilage(ring)
Elastic fibers Cland Smallartery Lymphvessels
Cricoid cartilage
Connective tissue sheath(viscerallaver of pretracheal fascia)
Nerve
(cutaway)
A n n u l a (r i n t e r c a r t i l a g i n o u s ) ligaments Trachealcart
Mucosaof oosteriortracheal wallshowslongitudinal folds formedby densecollections of elasticfibers
Superiorlobar (eparterial) bronchus Gland Elastic fibers Superiorlobar bronchus
To supenor lobe
(smooth) Trachealis muscle muscle Esophageal Epithelium Lymphvessels
Suoeriordivisionbronchus Lingularbronchus Middle lobar bron
{r
To middle lobe
Rightand left m a i nb r o n c h i Intermediate bronchus Inferiorlobar bronchus
Inferiorlobar bronchus
Pfate 2O2
g6 87+8
To inferior lobe
To inferior lobe
Intrapulmonary
To superior lobe
Extrapulmonary
*{r
Intrapulmonary
Lungs
Nomenclature of Bronchi: Schema
g 1 + 2 b i ci
Trachea
glbic
BlbiP
B 1 + 2 bci
glbiic
p B1+2bii B 1 + 2 a i0i
9 1 + 2 b iB
glbiiP
p 91+2aii
lbi
glai
B1 b
g1+2aii
B1a g 2 a iP
92aii
1+2a
B
g 1+ 2 b i
S u p e r i o rl o b a r (eparterial)I oroncnus
B2b
g3ai
B2(posterior)
g 3 a iP
Superior lobar
B1(apical)
92bii g 3 a ie
81+2ci +2cii B1
g2ai c
92ai
81+2b
Superior division
B1+2(apicoposterior) g:c7p
bronch
9 3 a i ia g 3 a i iP
g3bii
g3bi
and left main bronchi
B3 (anterior)
ir3b
g6a -
B6bi Middle lobar bronchus
\
a6!
86 lsuperior, I lower lobe)---_
B6 (superior,tower lobe)
ga (lateral) g4ai
Brb $.3:bii Lingular bronchus
---
Intermediate bronchus
B6c .. ;p Socrt
4a
g4aii
84 (superiorlingutar)
gabi
B6c
94ai g4aii
B5 (inferior lingular)
r B4bi
b4b
Bsb I n f e r i o rl o b a r bronchus
(medial)
g4bii
84a
b6b
g6ci
gs B
33ai
B3 (anterior)
g6ai B6aii
g:a
gabii
I n f e r i o rl o b a r
bronchus
B7*8(anteromedialbasal)
Bz (medialbasal)
g7+8a -97+8ai
B8 (anteriorbasal) 89 (lateralbasat)
gSai g o a i iv
87b gab gTbi
gsbi 89 (lateralbasal g9ai o
g7+8aii
Blo (posteriorbasal)
B7+8b 7+8bi
g10a g7+8bii
ETbii
Bel
B9a
B9ai
Blo (posteriorbasal)
geaiP
gl Oaii
g10b
g 9 a i io g e a i iP
g10c [e"ii g9bii
g1Oci
g9bii
gsbiiP
g10aii [10ai d
glObi
glObii
4{tr
Nomenclature in common usagefor bronchopulmonary segments(Plates200 and 201) is that of .lacksonand Huber, and segmentalbronchi are named accordingly. lkeda proposed nomenclature(as demonstratedhere) for bronchialsubdivisionsas far as 6th generation.For simplification on this illustration.onlv some bronchial subdivisions are labeled as far as 5th or 6th generation.Segmental b r o n c h i( B ) a r e n u m b e r e df r o m 1 t o 1 0 i n e a c h l u n g , correspondingto pulmonary segments.ln left lung,
Lungs
g 9 b ic 'B1Obi gl0cii
gebiP
globii
Bt and 82 are combined as are 87 and 88. Subsegmental, or 4th order, bronchi are indicated by addition of lowercase lettersa,b,or cwhen an additional branch is present. Fifth order bronchi are desisnatedbv Roman numeralsi (anterior)or ii (posterior)a;d 6th oriler bronchi by Greek lettersa or p. Severaltexts use alternatenumbers (as proposed bv Bovden)for segmentalbronchi. ' Variationsof'standardbronchial pattern shown here are common, especiallyin peripheralairways.
Plate 2O3
lntrapulmon ary Airways: Schema
*{Y
€9 @!
E
s
Cartilages
92
^:
Respiratory bronchioles (alveoli appearat thislevel)
tro N@
$n oc N6' J
c
Cartilages Decomesparser (mostlyat pointsof branching)
! . =
ii
m-
Alveolarducts Alveolarsac Alveoli
E
No further cartilages
Acinus (part of lung supplieb dy terminal bronchiole)
q
lermtnat bronchiole
OJ
Respiratory bronchioles (3-B orders)
Acinus Alveolar s a c sa n d alveoli Poresof Kohn
Subdivisions of intrapulmonaryairways Structureof intrapulmonaryairways
Plale
2O4
Lungs
lntrapulmonaty Blood Girculation: Schema
Terminalbronchiole Bronchialartery (from left heart via thoracic aorta) -.>
P u l m o n a rvye i n (to leftheart)
Pulmonary artery (from
r i g h th e a r t
Pulmonary vein (to left heart)
4{tr
V i s c e r a pl l e u r aa n d s u b p l e u r acl a p i l l a r i e s
C a p i l l a rbye dw i t h i na l v e o l awr a l l (cutawayin places)
Pulmonaryarteriesand their branchesdistributesegmentallywith the bronchi. Pulmonaryveinsand their tributariesdrain intersegmentally.
Lungs
Plate 2O5
Great Vessels of Superior Mediastinum
C r i c o i dc a r t i l a g e T h y r o i dg l a n d R i g h tc o m m o n c a r o t i da r t e r y R i g h tv a g u sn e r v e( X )
Thyroid cartilage I racnea
Left common carotid artery Leftvagus nerve (X)
A n t e r i o rs c a l e n em u s c l e
A n t e r i o rs c a l e n em u s c l e
P h r e n i cn e r v e
Phrenicnerve (cut)
R i g h ti n t e r n a jl u g u l a rv e i n Thoracic duct
E x t e r n aj lu g u l a rv e i n
B r a c h i apll e x u s
B r a c h i a pl l e x u s
Left subclavianartery and vein
Right subclavianartery and vein
Left brachioceohalicvein
B r a c h i o c e p h a l itcr u n k
Internalthoracic artery
R i g h tb r a c h i o c e p h a l ivce i n
Arch of aorta
Phrenicnerve and pericardiacophrenic artery and vein (cut
Vagus nerve (X)
S u p e r i o rv e n a c a v a
Left recurrent laryngealnerve
R i g h ts u p e r i o rl o b a r (eparterial)
Ligamentum arteriosum
bronchus R i g h tp u l m o n a r y
Left purmonary artery
P u l m o n a r yt r u n k Right purmonary verns
Left
g:lilo"u"
Mediastinal part of parietalpleura (cut edge)
Mediastinal part of parietap l leura (cut edge)
Costal part of parietalpleura (cut edge)
Costal part of parietalpleura (cut edge)
Diaphragmatic part of parietap l leura
P h r e n i cn e r v e (cut)
Rightcostodiaphragmatic recessof pleuralcavity
Diaphragmatic part of parietap l leura and cut edge
R i e h ti n t e r m e d i a t eb r o n c n u s P h r e n i cn e r v e( c u t ) Azygos vein T h o r a c i cd u c t I n f e r i o rv e n a c a v a
Plate 2O6
Left main bronchus Pericardium(cut edge) Diaphragm E s o p h a g uas n d e s o p h a g e apl l e x u s
*{r Lungs
Bronchial Arteries and Veins
Esophagus
Nr
Trachea(pulledto left by hook
3 r d r i g h tp o s t e r i o r intercostalartery-
Superiorleft b r o n c h i aalr t e r y R i g h tb r o n c h i a a l rtery
Aorta(pulledaside by hook\
R i g h tm a i n b r o n c h u s
Left main bronchus (pulled to right by hook)
lnferior left bronchialartery
Esophagealartery
Esophageal branch of bronchialartery
Variationsin bronchialarteries
Bronchialveins
Azygos
Right b r o n c h i a vl e i n
Left main
bronchus(turned up by hook) Leftbronchialvein Accessory hemiazygos vein
R i g h ta n d l e f t b r o n c h i a l a r t e r i e so r ig i n a t i n gf r o m aorta by singlestem
Lungs
O n l y s i n g l eb r o n c h i a la r t e r y t o e a c h b r o n c h u s( n o r m a l l y , two to left bronchus)
Plate 2O7
Lymph Vessels and Nodes of Lung SeealsoPlates 72, 184.,239 R i g h tp a r a t r a c h e anl o d e s
Left paratrachealnodes
R i g h ts u p e r i o rt r a c h e o b r o n c h i anl o d e s
B r o n c h o m e d i a s t i n layl m p h a t i ct r u n k
B r o n c h o r r r e d i a s t i nl vam l p h a t i ct r u n k
Brachiocephalicvein I n f e r i o rd e e p c e r v i c a l (scalene)node
B r a c h i o c e p h a l ivce i n l n f e r i o rd e e p c e r v i c a l ( s c a l e n en) o d e
V i r c h o w ' sn o d e Thoracicduct
I n t e r n a jl u g u l a rv e i n a n d j u g u l a rl y m p h a t i ct r u n k
Left superior t r a c h e o b r o n c h i anl o d e s
R i g h tl y m p h a t i cd u c t Subclavian vein and subclavian l y m p h a t i ct r u n k
Bronchopulmonary ( h i l a r )n o d e s P u l m o n a r y( i n t r a p u l m o n a r y )n o d e s
Bronchopulmonary ( h i l a r )n o d e s
Subpleural lymphatic prexus
P u l m o n a r y( i n t r a p u l m o n a r y )n o d e s
Subpleural Iymphatic prexus
Interlobular lymph vessets
Interlobular lymph vessel Drainage follows bronchi, arterres and v e tn s
lnferior t r a c h e o b r o n c iha l ( c a r i n a ln ) odes
Drainage follows bronchi, arteries and veins
Pulmonary ligaments Routesto mediastinum
4{tr Drainageroutes R i g h t l u n g : A l l l o b e sd r a i n t o p u l m o n a r ya n d b r o n c n o p u l m o n a r y( h i l a r )n o d e s ,t h e n t o i n f e r i o rt r a c h e o b r o n c h i a l ( c a r i n a ln ) o d e s ,r i g h t s u p e r i o rt r a c h e o b r o n c h i anl o c r e s , and right paratrachealnodes on way to brachiocephalic v e i n v i a b r o n c h o m e d i a s t i n al yl m p h a t i ct r u n k a n d / o r i n f e r i o rd e e p c e r v i c a l( s c a l e n e n) o d e .
Plate 2O8
L e f t l u n g : S u p e r i o rl o b e d r a i n st o p u l m o n a r ya n d b r o n c h o p u l m o n a r y( h i l a r )n o d e s ,i n f e r i o rt r a c h e o b r o n c h i a( lc a r i n a l ) nodes,left superiortracheobronchialnodes,left paratracheal nodes and/or (aortic arch) node of ligamentumarteriosum, t h e n t o b r a c h i o c e o h a l ivce i n v i a l e f t b r o n c h o m e d i a s t i n at rlu n k a n d t h o r a c i cd u c t . L e f t i n f e r i o rl o b e d r a i n sa l s ot o o u l m o n a r v a n d b r o n c h o p u l m o n a r y( h i l a r )n o d e sa n d t o i n f e r i o rt r a c h e o ) o d e s ,b u t t h e n m o s t l yt o r i g h ts u p e r i o r b r o n c h i a l( c a r i n a l n t r a c h e o b r o n c h i anl o d e s ,w h e r e i t f o l l o w ss a m e r o u t e a s l y m p h f r o m r i g h tl u n g .
Lungs
Autonomic Nerves in Thorax SeealsoPlates 130, 131, 165, 166, 318
Cervicothoracic ( s t e l l a t eg) a n g l i o n A n s as u b c l a v i a Cervicalcardiac nerves (sympathetia c nd vagal) T h o r a c i c( s y m p a t h e t i c ) c a r d i a cb r a n c h e s
Left recurrentlaryngealnerve Cervicalcardiac nerves (sympatheticand vagal) Vagus nerve (X) (cut) Thoracic(sympathetic) c a r d i a cb r a n c h e s Left recurrentlaryngealnerve
S y m p a t h e t i ct r u n k Vagus nerve (X) (cut) a n d b r a n c h e st o c a r d i a c a n d p u l m o n a r yp l e x u s e s T h o r a c i c( s y m p a t h e t i c ) c a r d i a cb r a n c h e s A n t e r i o rp u l m o n a r yp l e x u s
T h o r a c i cc a r d i a cb r a n c h ofvagusnerve C a r d i a cp l e x u s
A n t e r i opr u l m o n a rpy l e x u s P o s t e r i opru l m o n a rpyl e x u s ( p r o t r u d i nfgr o mb e h i n d leftbronchus)
P o s t e r i opru l m o n a rpyl e x u s ( p r o t r u d i n gf r o m b e h i n d r i g h tb r o n c h u 5 ) 6th intercostalnerve Cray and white ramicommunicantes
Sympathetictrunk Thoracicaortic olexus
E s o p h a g epal le x u s Bth intercostalnerve
6th thoracic s y m p a t h e t i cg a n g l i o n Creater thoracic s p l a n c h n i cn e r v e S y m p a t h e t i cb r a n c h t o e s o p h a g e apl l e x u s
ay andwhite ramicommunicantes Creater thoracic s p l a n c h n i cn e r v e L e s s e tr h o r a c i c s p l a n c h n i cn e r v e
T h o r a c i cd u c t A n t e r i o rv a g a lt r u n k L e s s e tr h o r a c i c s p l a n c h n i cn e r v e
Diaphragm (pulled down)
Leastthoracic s p l a n c h n i cn e r v e Azygosvein (cut) I n f e r i o rv e n a c a v a ( c u t )
Lungs
Nr Plate 2O9
Innervation of Tlacheobronchial Tlee: Schema SeealsoPlates 167,168
C l o s s o p h a r y n g e anle r v e( l X )
D e s c e n d i n gt r a c t s i n s p i n a lc o r d
Vagus nerve (X) (cholinergic;efferent to smooth muscle and glands;afferent f r o m a o r t a ,t r a c h e o b r o n c h i a l m u c o s aa n d a l v e o l i ) S u p e r i o rc e r v i c a l s y m p a t h e t i cg a n g l i o n Sympathetic nerves
Afferent nervesfrom n o s e a n d s i n u s e s( v i a t r i g e m i n a [l V ] a n d glossopharyngealflXl nerves)may also initiate reflexesin airways
Superior laryngeal nerve
Larynx
(adrenergic)
T3 Cough receptors
T4
T5
S y m p a t h e t i ct r u n k
n{r
P u l m o n a rpyl e x u s
ough receptors
Parasympathetic fibers Sympathetic fibers Afferentfibers lrritant receptors
Stretchreceptors(Hering-Breuerreflex)
Plate 21O
Lungs
Heart in Situ
Inferiorthyroid veins
Thymus
Trachea Left common carotid artery Left brachiocephalicvein
B r a c h i o c e o h a l itcr u n k
I n t e r n ajlu g u l a rv e i n
R i g h tb r a c h i o c e p h a l ivce i n
Vagus nerve (X)
P h r e n i cn e r v e
Arch of aorta
A n t e r i o rs c a l e n em u s c l e
T h o r a c idc u c t
B r a c h i apl l e x u s
Left recurrentlaryngealnerve
E x t e r n aj lu g u l a rv e i n
Internalthoracic artery
Subclavianartery and vein
Phrenicnerve and ic pericardiacophren artery and vein
Superiorvena cava
1s t r i b
Mediastinalpart of parietalpleura
P h r e n i cn e r v ea n d pericardiacophrenic artery and vei R i g h tl u n g
Leftlung
Pericardium Diaphragm
I
Mediastinal
*{r Heart
Diaphragmatic Costal
\
Partsof parietal pleura
L i n eo f f u s i o n of fibrous pericardium to diaphragm
lnternal thoracic artery
Superior epigastric artery
Musculophrenic arrery
Plate 211
Heart: Anterior Exposure
Pericardium(cut edge) at site of reflectionfrom great vessels
Brachiocephalic
Right vagus nerve
Left brachiocephalicvein
R i g h itn t e r n al u l g u l avr e i n Arch of aorta
Right recurrentlaryngealnerve R i g h tb r a c h i o c e p h a l ivce i n
Left common carotid artery
Phrenicnerve Left internaljugular vein
S u b c l a v i a na r t e r ya n d v e i n Internalthoracic artery and vein
Left vagus nerve
Ligamentum arteriosum
P h r e n i cn e r v ea n d pericardiacophrenic artery and vei
Left recurrentlaryngealnerve
P u l m o n a rtyr u n k
Superiorvena cava
Leftpulmonary artery
Right p u l m o n a r ya r t e r Transverse pericardial
Transverse p e r i c a r d i sailn u s
R i g h st u p e r i o r p u l m o n a rvye i n
Left supenor pulmonary vetn
Hilumof r i g h tl u n g Mediastinal pleura (cut edge)
Hilum of left lung
Pericardium (cut edge)
Mediastinal part of parietal preura (cut edge) Pericardium (cut edge)
Right ventricle
4{tr
Conusarteriosus R i g h ta u r i c l e ( a t r i a la p p e n d a g e )
R i g ha t trium
Plate 212
C o r o n a r ys u l c u s right coronary artery
A n t e r i o ri n t e r v e n t r i c u l a i
s u l c u sa n da n t e r i o r i n t e r v e n t r i c u bl ar ra n c h of leftcoronaryartery
Left auricle (atrial appendage)
Inferior border (acute margin) of heart
Apex of heart Left ventricle
Leftborder ( o b t u s em a r g i n ) of heart
Heart
Radiograph of Chest
Precordialareasof auscultation A
Apex of heart
AA
Aortic arch
C
Clavicle
CP
C o r a c o i d p r o c e s so f s c a p u l a D o m e o f d i a p h r a g m( r i g h t )
D lV
l n f e r i o rv e n a c a v a
PA
P u l m o n a r ya r t e r y ( l e f t )
RA
R i g h ta t r i u m
S
Spineof scapula
SV
S u p e r i o rv e n a c a v a
T
T r a c h e a( a i r )
V
Left ventricle
Aortic area
Valves valve Pulmonic
P u l m o n i ca r e a
Tricuspidarea
Aortic valve Mitral
M i t r a la r e a
Tricuspidarea
eUd4/* Heart
Plate 213
Heart: Base and Diaphragmatic Surfaces
R i g h tp u l m o n a r ya r t e
Arch of aorta
Left pulmonary artery
Right auricle (atrialappendage)
Left auricle ( a t r i a la p p e n d a g e )
Superiorvena cava
Left superior p u l m o n a r yv e i n
R i g h ts u p e r i o r p u l m o n a r yv e i n
Left atrium
Rightatrium
Left inferior p u l m o n a r yv e i n
S u l c u tse r m i n a l i s
Pericardialreflection Right inferior p u l m o n a r yv e i n
O b l i q u ev e i n of left atrium (of Marshail)
C o r o n a r sy u l c u s
C o r o n a r ys i n u s
Inferiorvena cava
Left ventricle
R i g h tv e n t r i c l e
Apex
Baseof heart:posteriorview
Left subclavianartery L e f tc o m m o n c a r o t i da r t e r y
Leftpulmonaryartery L e f ts u p e r i o rp u l m o n a r yv e i n
B r a c h i o c e p h atlriucn k S u p e r i o rv e n a c a v a Arch of aorta Right pulmonary artery R i g h ts u p e r i o rp u l m o n a r yv e i n
Left auricle (atrialappendage)
R i g h ti n f e r i o rp u l m o n a r yv e i n
Left inferior pulmonary vein
terminalis
O b l i q u e v e i n o f l e f ta t r i u m
R i g h at t r i u m Left atrium Pericardialreflection
C o r o n a r sy i n u s Leftventricle
*{r Plate 214
Inferiorvena cava Coronary sulcusand right coronary artery Posteriorinterventricularsulcus and posterior interventricular branch of right coronary artery (posteriordescendingartery) R i g h tv e n t r i c l e
Baseand dia.phragmatic surfaces: posrerornreflor vtew
Heart
Pericardial Sac
Suoeriorvena cava
Archof aorta
Pericardium(cut edge)
P u l m o n a rtyr u n k Ascendingaorta Left auricle (atrialappendage)
pericardial sinus Transverse
Left ventricle
eft pulmonary veins
Coronary sinus
Oblioue vein of left atrium (Marshall's)
Posterior i n t e r v e n t r i c usl aurl c u s
O b l i q u ep e r i c a r d i sa iln u s
R i g h tv e n t r i c l e
Leftatrium
Diaphragmaticpart of pericardium
R i g h tp u l m o n a r yv e i n Esophagealprominence
Sternocostaloart of pericardium(cut edge)
Heart drawn out of opened pericardialsac:left lateralview
R i g h at t r i u m {r.";.1"h
!,
lnferior vena cava
Arch of aorta Ascendingaorta R i g h tp h r e n i cn e r v ea n d pericardiacophren ic 5 U p e n o rv e n a c a v a
Mediastinalpart of parietalpleura (cut edge) phrenic nerve and pericardiacophrenicvessels
pericardial Transverse sinus P u l m o n a rtyr u n k( b i f u r c a t i o n ) Superiorvena cava
Leftlung R i g h tp u l m o n a r yv e i n s Mediastinalpart of parietalpleura (cut edge) Pericardium(cut edge)
eft pulmonary veins Pericardium(cut edge)
sinus Obliquepericardial Esophagealprominence
Inferiorvena cava Line of fusion
Diaphragmaticpart of oericardium
o f f i b r o u sp e r i c a r d i u m to diaphragm
', Pericardialsacwith heart removed:anteriorview
Heart
4{tr Plate 215
Goronary Arteries and Gardiac Veins
(SA) Sinuatrial nodal branch
Leftauricle(cut) Leftcoronaryartery
Atrialbranchof right coronaryartery
Circumflexbranchof left coronaryartery Rightcoronaryartery Creatcardiacvein Left (obtuse)marginalartery Anteriorinterventricular branch(leftanterior descending) of left coronaryartery
Anteriorcardiacveins
Smallcardiacvei
Right(acute)marginalbranch of rightcoronaryiltery -
Diagonalbranch of anterior interventricu lar artery
Interventricular septalbranches
Sternocostalsurface
(SA)nodalbranch Sinuatrial
Obliqueveinof leftatrium (of Marshall)
(SA)node Sinuatrial
Creat cardiacvein
Circumflex branchof " leftcoronaryartery Smallcardiacvein
Leftmarginalbranch Coronarysinus Posterior left ventricular branch Posterior veinof left ventricle
Middle cardiac vein Interventricular
septalbranches
Plate 216
Rightcoronaryartery Posteriorinterventricular branch(posteriordescendin g) of right coronaty artery
Right marginalbranch
Diaphragmaticsurface
4{tr Heart
Coronary Arteries and Gardiac Veins: Variations
(leftanteriordescending) Anteriorinterventricular branchof left coronaryarteryis very short.Apicalpart surfacesuppliedby branches of anterior(sternocostal) (posterior descending) from posteriorinterventricular branchof rightcoronaryarterycurvingaroundapex.
(posteriordescending) Posteriorinterventricular branchis derivedfrom circumflexbranchof left coronaryarteryinsteadof from right coronaryartery.
(posteriordescending) Posteriorinterventricular branchis absent.Areasuppliedchieflyby small branchesfrom circumflexbranchof left coronaryarteryand from rightcoronaryartery.
g) (posterior descendin interventricular Posterior branchis absent.Areasuppliedchieflyby elongated (leftanteriordescending) anteriorinterventricular branchcurvingaroundapex.
Heart
Plate 217
Goronary Arteries: Arteriographic Views
Rightcoronaryartery:left anteriorobliqueview (SA) Sinuatrial nodalbranch
Right coronaryartery
Branches to back of left ven
Right(acute)marginalbranch Posterior interventricular branch(posterior descending artery)
Rightcoronaryartery:right anteriorobtiqueview (SA)nodalbranch Sinuatrial Conus(arteriosus) brancn coronaryartery R i g h (t a c u t e ) marginalbranch
Atrioventricular(AV)nodalbranch Rightposterolateral branches(to back of left ventricle) Posteriorinterventricular branch (posterior descending artery)
Plate 218
4{r Heart
Goronary Arteries: Arteriographic Views (continued|
Left coronaryartery:left anteriorobliqueview
coronary artery C i r c u m f l e xb r a n c h
A n t e r i o ri n t e r v e n t r i c u l abrr a n c h( l e f ta n t e r i o rd e s c e n d i n g ) Diagonal branchesof anterior interventricularbranch Atrioventricularbranch of circumflexbranch Le{t (obtuse)marginalbranch
rolateralbranches (Perforating)interventricularseptal branches
Left coronaryartery:right anteriorobliqueview
coronary artery Anterior interventricular branch (left anterior descending) Circumflex branch Perforating) Interventricular septalbranches
Arteriogram
Left (obtuse)marginalbranch
branches erolateral
4{F
D i a g o n a lb r a n c h
of A n t e r i o irn t e r v e n t r i c u bl ar ra n c h Atrioventricularbranch of circumflexbranch
Heart
Plate 2l9
Right Atrium and Ventricle
A s c e n d i n ga o r t a
P u l m o n a r yt r u n k Right auricle (atrialappendage)
Superiorvena cava
C o n u sa r t e r i o s u s
R i g h tp u l m o n a r ya r t
Cristaterminalis
Pericardialreflection
Atrioventricular part of membranous septum
R i g h st u p e r i o r p u l m o n a rvye i n
a lc u s p
Left atri
of tricuspidvalve R i g h ti n f e r i o r p u l m o n a r yv e i n
Pectinatemuscles ingof
Interatrialseptum
c o r o n a r sy r n u s
Limbusof fossaovalis
alve
(Thebesian) of coronary s r nu 5
Fossaovalis Valve(Eustachian) of inferiorvena cava Inferiorvena cav
Openedright atrium: right lateralview
Pericardialreflection Aorta
Transverse p e r i c a r d i sa il n u s Superiorvena cava R i g h ta u r i c l e( a t r i a la p p e n d a g e ) Right atrium P a r i e t alli m b M e m b r a n o u sp a r t o f interventricularseptum
Pulmonary trunk Transversepericardialsinus
A n t e r i osr e m i l u n acru s p Pulmonary
Rightsemilunar cusp
VAIVC
L e f ts e m i l u n a cr u s p
C o n u sa r t e r i o s u s Supraven tricular crest Septal
p a p i l l a rm y uscle lnterventricularseptum (musculap r art)
Tricuspid valve S e p t o m a r g i n at rl a b e c u l a (moderator band) Chordae tendineae
P o s t e r i opra p i l l a rm y uscle
4{tr
A n t e r i o pr a p i l l a rm y uscle Trabeculaecarneae
Plate 22O
Openedright ventricle:anteriorview
Heart
Left Atrium and Ventricle
Arch of aorta
s il n u s T r a n s v e r spee r i c a r d i a F o l do f l e f ts u p e r i o r v e n ac a v a( l i g a m e n t of Marshall)
Ligamentum arteflosum L e f tp u l m o n a r y artery
l ppendage) L e f ta u r i c l e( a t r i a a O b l i q u ev e i n o f left atrium (of Marshall)
R i g h tp u l m o n a r y artery f t p u l m o n a r yv e i n s
Leftatrium A n t e r i o rp a p i l l a r y
R i g hp t ulmonary vetns
C h o r d a et e n d i n e a e
Coronary srnus
Posteriorpapillarymuscle
lnferior venacava
4{F
Flap opened in posterolateral wall of left ventricle
L e f ta u r i c l e( a t r i a la p p e n d a g e )
Archof aorta eftpulmonary artery
L e f t s e m i l u n a cr u s p Aortic VAIVE
R i g h ts e m i l u n a cr u s p P o s t e r i o sr e m i l u n a cr u s p
Membranous septum
R i g h tp u l m o n a r y artery Left superior p u l m o n a r yv e i n Valve of
foramenovale R i g hp t ulmonary vetns
M u s c u l a rp a r t o f i n t e r v e n t r i clua r
seprum
Leftatrium C o r o n a r ys i n u s
Mltral valve kut away
lnferior vena cava
Sectionthrough left atrium and ventricle with mitral valvecut away
Heart
Plale
221
Valves of Fibrous Skeleton of Heart
A n t e r i o rs e m i l u n a rc u s p Pulmonary VAIVE
t
R i g h ts e m i l u n a cr u s p
C o n u sa r t e r i o s u s Left fibrous trigone
L e f ts e m i l u n a rc u s p Right coronary artery
Right (coronary) s e m i l u n a cr u s p
Aortic valve
Atrioventricular partof membranous
Left (coronary) semilunar Posterior (noncoronary) s e m i l u n a rc u s p
C i r c u m f l e xb r a n c h l
Mitral
Commissural
VAIVE
cusps Posterior
\Right
fibrou
-Atrioventricul; nodalbrancht
Left fibrous ring (of mitral valve
Posteriorinterventricularbrancht
Heart in diastole: viewedfrom basewith atria removed
A n t e r i o rs e m i l u n a cr u s o Pulmonary valve
t
R i g h ts e m i l u n a rc u s p
L e f ts e m i l u n acru s p
*{r
Conusarteriosus eft fibrous trigone
Rightcoronaryartery
Right (coronary) semilunar
l n t e r v e n t r i clua r part
Left (coronary) s e m i l u n a rc u s p
Atrioventricular part
Posterior (noncoronary) semilunar
Membranous septum
Anterior cusp
C i r c u m f l e xb r a n c h l
Septal cusp
Tricuspid VAIVC
Rightfibrousring (of tricuspidvalve)
Left fibrous ring (of mitral valve)
Rightfibroustrigone
Posteriorinterventricularbrancht
Heart in svstole: viewedfrom basewith atria removed
Atrioventricular(AV) nodal brancht
.Of left coronary artery tOf right coronary artery
Pfate 222
Heart
Valves and Fibrous Skeleton of Heart (continued|
C o m m i s s u r eo f s e m i l u n a vr a l v ec u s p s Opening of left coronary artery
Ascendingaorta
N o d u l e o f s e m i l u n a vr a l v e (body of Arantius)
Aortic sinuses(of Valsalva) O p e n i n go f right coronary artery
Membranous septum
B r o k e nl i n e i n d i c a t i n gl e v e l of origin of tricuspidvalve o n o p p o s i t es i d eo f s e p t u m - '
y uscle A n t e r i opr a p i l l a rm Anteriorcusp of mitralvalve
Muscularpartof interventricularseptum
Atrioven tricular part
O p e n i n go f inferiorvena cava
Membranous septum
- lnterventricular part (behind valve)
R i g h ta t r i u m O p e n i n go f c o r o n a r ys r n u s
Posterior cusp Anteriorcusp
C h o r d a et e n d i n e a e
Septalcusp
Septal p a p i l l a rm y uscle
I
t
Tricuspid VAIVE
Posteriorpapillary muscle (sectioned)
Posterior p a p i l l a r ym u s c l e (sectioned)
A n t e r i o pr a p i l l a r y muscle
Tricuspid(right atrioventricular)valve Anteriorcusp
Left atrium
Mitral
cusp Posterior
VAIVE
C h o r d a et e n d i n e a e
Commissural cusps Anterior
p a p i l l a rm y uscle (sectioned)
Anterior papillary muscle (sectioned)
Mitral (left atrioventricular) valve
Heart
*{r Plale 223
Atria, Ventricles, and Interventricular Septum
P u l m o n a r yt r u n k
R i g h ts u p e r i o rp u l m o n a r yv e i n Aortic sinus(of Valsalva)
Anteriorcuspof mitralvalve Left atrium
Openings of coronary arteries Ascendingaorta R i g h ta u r i c l e( a t r i a la p p e n d a g e )
Left auricle ( a t r i a la p p e n d a g e )
Left semil u n a rc u s p
Ascendingaorta L e f ts e m i l u n a cr u s p
Aortic valve
t
Aortic valve
Left pulmonary vetns
R i g h ts e m i r u n a rc u s p
Posterior s e m i l u n a r( n o n coronary) cusp
Superior venacava Atrioventric ut a r part \ Interventric ular
Outflow to putmonary trunk
pdrr\\
onus arteriosus Right anteflor papillary muscle (cut) Right ventricle
Rightatriurir S e p t o m a r g i n at rl a b e c u l a (moderator band)
Anterior cusp (retracted)
S e p t a l( m e d i a l )p a p i l l a r ym u s c l e
Septal
cusp Posterior cusgi R i g h tv e n t r i c l e
Left ventricle
4{tr
Leftposterior p a p i l l a rm y uscle
R i g h ta n t e r i o r
papillarymuscle(cut)
Left anterior
p a p i l l a rm y uscle Right posterior papillarymuscle Left ventricle M u s c u l a rp a r t o f i n t e r v e n t r i c u l asre p t u m
Plale 224
Planeof section
Heart
Gonducting System of Heart
Ascendingaorta A t r i o v e n t r i c u l apr a r t
S u p e r i o rv e n a c a v a
I n t e r v e n t r i c u l apra r t S i n u a t r i a(lS A ) nodal artery
septum v"ru,.rnous I
P u l m o n a r yv a l v e Atrioventricular(AV) node
Sinuatrial ( S A )n o d e
(AV) Atrioventricular b u n d l e( o f H i s )
C r i s t at e r m i n a l i s
R i g hb t undle
Note: Specific i n t e r n o d a cl o n d u c t i o n pathwaysin the atria may exist based on s t r o n gp h y s i o l o g i c a l and someanatomical evidence
Purkinjefibers L,
Septomarginal trabecula ( m o d e r a t o rb a n d )
terior p a p i l l a rm y uscle
R i g h ft i b r o u sr i n g ( o ft r i c u s p i vda l v e
Subendocardial branches
Inferior vena cava ----{
( P u r k i n jfei b e r s )
Rightside
P o s t e r i o sr e m i l u n a rc u s o
Aortic valve
L e f ts e m i l u n a rc u s p
Arch of aorta
R i g h st e m i l u n acru s p
Membranous septum
P u l m o n a r yt r u n k
I n t e r v e n t r i c u l apra r t
S u p e r i o rv e n a c a v a
Atrioventricularpart
Left auricle
Leftbundle Right p u l m o n a r yv e i n s
Anterior p a p i l l a r ym u s c l e
Mitral valve (cut awaY)
Subendocardial branches ( P u r k i n j ef i b e r s )
M u s c u l apr a r to f i n t e r v e n t r i c usl aerp t u m
/\_ Left side
Plale 225
Nerves of Heart $@So Pmts13O, 1€5,ltr, ffi
S u p e r i o rc e r v i c a l sympatheticganglio Rightvagus nerve (X) ( C o n j o i n e ds y m p a t h e t i ca n d vagal)superiorcervicalcardiac nerves Middle cervical sympathetic Middle cervical (sympathetic)cardiac nerve Phrenicnerve Inferior cervical (vagal)cardiac branch Vertebralganglion
I n f e r i otrh y r o i da r t e r y Vertebralartery Cervicothoracic ( s t e l l a t eg) a n g l i o n Ansa subclavia
S u p e r i o rc e r v i c a l sympatheticganglion Leftvagus nerve (X) Superiorcervical (sympathetic)cardiac nerve Superiorcervical (vagal)cardiac branch Middle cervical s y m p a t h e t i cg a n g l i o n Phrenicnerve Middle cervical (sympathetic)cardiac nerve Inferiorcervical (vagal)cardiac branch
ertebralganglion Cervicothoracic ( s t e l l a t eg) a n g l i o n Inferiorcervical sympathetic cardiac nerves
Right recurrent laryngealnerve
Inferior cervical ( s y m p a t h e t i cc)a r d i a cn e r v e s Thoracic cardiac brancn of vagus nerve 4th thoracic sympatheticganglion Thoracic (sympathetic) c a r d i a cI p 1 n 6 h s 5 Cardiac plexus
3rd thoracic s y m p a t h e t i cg a n g l i o n Thoracic (sympathetic) cardiac branches 'Thoraciccardiac branch of vaSusnerve Left recurrent laryngealnerve
Phrenic nerve (cut)
Plale
226
Heart
lnnervation of Heart: Schema Posterior nucleus Superiorcervical s y m p a t h e t i cg a n g l i o n
ofvagusnerve
Nucleusof solitarytract
Superiorcervical (sympathetic)cardiac nerve
Middle cervical sympatheticga S u p e r i o rc e r v i c a l (vagal)cardiac br
Middle cervical (sympathetic)cardiac nerve
lnferior cervical (vagal)cardiac branches
I I I
Vertebralganglion (variation)
t I I
Ascending connections
A n s as u b c l a v i a
Cervicothoracic
(stellate)
I I I I I
lst intercostal nerve
lnferior cervical (sympathetic)cardiac nerve
Thoracic cardiac branch ofvagus nerve
2nd thoracic sympatheticganglion
W h i t e r a m u sc o m m u n i c a
C r a y r a m u sc o m m u n i c a n s Thoracic (sympathetic) cardiac branches-
gangliori 4th thoracicsympathetic Cardiac prexus
Sympatheticpreganglionic postganglionic Sympathetic preganglionic Parasympathetic postganglionic Parasympathetic Visceralafferentaccompanying sympatheticfibers Visceralafferentaccompanying parasympathetic fibers
Heart
*{r Plale 227
lnnervation of Blood Vessels: Schema
Cervicalsympathetic trunkganglia
-
I
-
Internalcarotidnerve ------r-r-----r
,a---
White ramuscommunicans Cervicalcardiacnerves Brachial plexus
Cardiopulmonarysplanchnic \ aand : : _ aortic _ _ : _nerves
lntercostal nerves
Spinalnerves
Upperlumbar sympathetic trunkgangli
Spinalnerves Grayramuscommunicans
*{r
Lowerlumbar sympathetic trunkganglia
Sympatheticfibers
Postganglionic sympathetic fibersto lumbarand sacralplexuses and to nervesof lowerlimb
Preganglionic Postganglionic
Plate 22a
Heart
Prenatal and Postnatal Girculation
Prenatalcirculation
Pulmonarv trunk Superiorvena Rightpulmonary
Ductusarteriosus Leftpulmonaryartery eft pulmonaryvein
Rightpulmonaryvein Foramen ovale
Inferiorvenacava Hepaticvein Ductusvenosus Celiactrunk artery Superiormesenteric Ligamentur arteriosum
Umbilicalarteries
*{r
Fossaovalis (obliterated foramenovale Ligamentum venosum (obliterated ductusvenosus) Ligamentum teres (roundligament)of liver (obliteratedumbilicalvei Medialumbilicalligaments (occludedpartof umbilicalarteries) Postnatal circulation
Heart
Plate 229
Mediastinum: Right Lateral View Cervical(cupula,or dome, of) parietalpleura and suprapleuralmembrane (Sibson'sfascia)
Anterior scalenemuscle and phrenic nerve
B r a c h i apll e x u s 1s t r i b R i g h ts u b c l a v i a na r t e r ya n d v e i n Trachea Clavicle Rightvagus nerve (X)
S u b c l a v i umsu s c l e 1s t r i b
Sympathetictrunk
Right and left b r a c h i o c e p h a l ivce i n s
Right superior intercostalvei 4th thoracic vertebral Arch of azygosvein R i g h tm a i n b r o n c h u s a n d b r o n c h i a la r t e r y
Right internalthoracic artery
Thymus(seenthrough m e d i a s t i npalle u r a ) S u p e r i o rv e n a c a v a
Azygos vein Posteriorintercostal v e i n a n d a r t e r ya n d intercostalnerve Internalintercostal muscte Internalintercostal m e m b r a n ed e e p t o externalintercostal
muscle Cray and white r a m tc o m m u n r c a n t e s Costal part of parietap l leura (cut edge) Creater thoracic s p l a n c h n i cn e r v e
E s o p h a g uasn d plexus esophageal B r o n c h o pl m u onary (hilar)lymph P u l m o n a r yl i g a m e n t (cut)
* N e r v e a n d v e s s e l sc o m m o n l y r u n i n d e p e n d e n t l y
Plate 23O
P h r e n i cn e r v ea n d pericardiacophrenic artery and vein" R i g h tp u l m o n a r y artery
M e d i a s t i np aa l rt of parietalpleura (cutedge) F i b r o u ps e r i c a r d i u m overrightatrium Righp t ulmonary vetns lnferior vena cava (covered by m e d i a s t i n apl a r t of parietalpleura) Diaphragm (covered by diaphragmaticpart of parietalpleura)
Costalpartof parietalpleura(cutedge) Costodiaphragmaticrecess of pleuralcavity
Nr Mediastinum
Mediastinum: Left Lateral View
A n t e r i o rs c a l e n em u s c l ea n d o h r e n i cn e r v e
Cervical(cupula,or dome, of) parietalpleura and s u p r a p l e u r am l e m b r a n e( S i b s o n ' sf a s c i a )
B r a c h i apll e x u s 1s t r i b Left subclavianvein and artery
S u b c l a v i umsu s c l e
Esophagus Thoracicduct
Clavicle
v a g u sn e r v e( X )
Left brachiocephalicvein
Leftsuperior vein intercostal
Left internalthoracic arterv
Archof aorta T h y m u s( s e e nt h r o u g h Leftrecurrent nerve laryngeal
m e d i a s t i n apl l e u r a ) L i g a m e n t u ma r t e r i o s u m
Bronchopulmonary ( h i l a rl)y m p hn o d e s
Left pulmonary artery
Accessory hemiazygosvein
Left phrenic nerve and pericardiacophrenic artery and veinl
Posteriorintercostal vein and artery and intercostalnerve
Mediastinalpart o{ parietalpleura (cut edge)
Internalintercostal muscle
F i b r o u sp e r i c a r d i u m
Internalintercostal m e m b r a n ed e e p t o externalintercostal muscre
L e f tp u l m o n a r y vetns
Crayand white ramicommunicantes
P u l m o n a r yl i g a m e n t (cut)
Costalpleura (cut edge; E s o p h a g uasn d plexus esophageal (coveredby mediastinal
thetic trunk
part of parietalpleura)
reater thoracic splanchnicnerve
Diaphragm (covered b y d i a p h r a g m a t i cp a r t
Thoracic (descending)aorta
of parietalpleura)
Leftmainbronchus andbronchialartery
C o s t o di a p h r a g m a t i c recessof pleuralcavity
Costalpartof parietalpleura(cutedge) *Nerve and vesselscommonly run independently
Mediastinum
4{F Plate 231
Esophagus in Situ
C o m m o n c a r o t i da r t e r y A n t e r i o rs c a l e n em u s c l e P h r e n i cn e r v e P o s t e r i o sr c a l e n em u s c l e B r a c h i apl l e x u s S u b c l a v i a na r t e r y T h y r o c e r v i c at lr u n k
I p a r to f e s o p h a g u s Recurrentlaryngealnerves Thoracicduct I n t e r n ajlu g u l a rv e i n ( c u t ) S u b c l a v i a nv e i n ( c u t ) L e f tb r a c h i o c e p h a l ivce i n ( c u t ) Internalthoracic artery (cut)
V a g u sn e r v e( X
Phrenicnerve (cut)
1 s tr i b( c u t )
Common carotid artery
t Brachiocephalic
trunk-'
L o n g u sc o l l i m u s c l e
S u b c l a v i a na r t e r y
i
Vagus nerve (X)
Trachea
Left recurrent l a r y n g e anl e r v e
Arch of aorta
Bifurcation of trachea
Arch of a z y S o sv e t n R i g h tm a i n
pleura (cut edge)
bronchus S u p e r i ol ro b a r
eft main bronchus
(eparterial)
bronchus
Thoracic (descending) aorta
Thoracicpart of esophagus Esophageal plexus
M e d i a s t i n apl a r t o f parietalpleura (cut edge)
Mediastinal part ot parietap l leura Gut eagel-
Pericardium (cut edge) Diaphragm Diaphragmatic part of parietap l leura
Inferior vena cava
Anterior v a g a lt r u n k
(cur) Hepatic v e i n s( c u t ) Inferior v e n ac a v a R i g h ta n d l e f t c r u r ao f diaphragm In f e r i o rp h r e n i ca r t e r i e s
4{tr
C e l i a ct r u n k A b d o m i n a la o r t a
Plale 232
Stomach Abdominal part of esopnagus
Mediastinum
Topography and Gonstrictions of Esophagus
lnferiorpharyngeal muscle constrictor Thyroidcartilage Piriformfossa(recess) Pharyngoesophageal constriction
Thyroidcartilage Cricoidcartilage
16 q O
Thoracic (aortobronchial) constriction
o
E o
Cricoidcartila
(muscle) Cricopharyngeus partof inferiorpharyngeal constrictor
Cricopharyngeus (muscle)partof inferior Archof aorta pharyngeal constrictor Sternum Trachea
.E Arch of aorta
oo
s DO GI q,
Leftmain bronchus
Lateralview
38 40
Diaphragmatic constriction (inferior esophageal "sphincter";+ Abdominalpart of
Fundusof stomach
Cardiacparl of
4{tr Mediastinum
Plate 233
Musculature of Esophagus
nferior pharyngealconstrictor muscle
Zone of sparsemusclefibers (muscle) Cricopharyngeus partof inferiorpharyngeal constrictor
Cricoid cartilage
Mainlongitudinal musclebundle passingupwardandventrallyto attachto middleof posterior surfaceof cricoidcartilage Accessory musclebundlefrom posterolateralsurfaceof cricoidcartilageAdditionalfibersfrom contralateral (muscle) sideof cricopharyngeus partof inferiorpharyngeal constrictor
Trachea
Circularmusclelaverwith sparselongitudinal fibers in V-shaped area(of Laimer) Bareareaon ventralsurfaceof Lateralmassof longitudinal muscle Fibroelastic membranes with sparsemusclefibers
Windowcut in longitudinal musclelayer Circularmusclelayer
Leftmain bronchus
4{r Plate 234
Mediastinum
Pharyngoesophageal Junction
muscle constrictor Superiorpharyngeal Rootof tongue Epiglottis Middle pharyngealconstrictormuscle Palatopharyngeusmuscle I Longitudinal
Stylopharyngeusmuscle t lil"r'J:g*' fold inlet(aditus) Laryngeal Thyroidcartilage(superiorhorn) Thyrohyoidmembrane branchof superiorlaryngeal artery nerveandsuperiorlaryngeal andvein arvtenoidmuscle Transverse arvtenoidmuscle Thyroidcartilage Posteriorcricoarytenoidmuscle muscle constrictor Inferiorpharyngeal Pharyngeal aponeurosis(cut away\ Zoneof sparsemusclefibers (muscle)partof inferior Cricopharyngeus pharyngeal constrictor Cricoidcartilage(lamina) Cricoesophagealtendon (attachmentof longitudinalesophagealmuscle)
Posteriorview with pharynxopenedand mucosaremoveo
muscle Circularesophageal mucosaand submucosa Esophageal area(of Laimer) Circularmusclein V-shaped Rightrecurrentlaryngealnerve
muscle esophageal Longitudinal
muscle Windowcut in longitudinal exposescircularmusclelayer
4{F Mediastinum
Plate 235
Esophagogastric Junction
Esophagus
gitudinalesophagealmuscle Esophageal m
Circularesophagealmuscle
Submucosa Cradualslightmuscularthickening Phrenoesophageal ligament (ascendingor upper limb) Supradiaphragmatic fascia Diaphragm nfradiaphragmatic (transversalis) fascia Phrenoesophageal Iigament (descendinglimb) Peritoneum
Subhiatal fat ring Zigzag (Z) line: junctureof esophagealand gastnc
Cardiacnotch
Cardiacpart (cardia) of stomach
Longitudinalesophagealmuscle(cut) Circularesophagealmuscle (shown hereas spiral) Cardiacnotch
Castricfolds (rugae)
Fundus of stomach Collarof Helvetius
Window cut in middlecircularmusclelayerof stomach
Innermostobliquemusclelayerof stomach (formssling)
Outer longitudinalmusclelayerof stomach(cut)
4{F Plate 236
Mediastinum
Arteries of Esophagus
branchof Esophageal Inferiorthyroidartery Common carotidartery Subclavian
Esophageal branchof Inferiorthyroidartery Cervicalpartof esophagus trunk Thvrocervical artery Subclavian Vertebralartery lnternalthoracicartery Commoncarotidartery trunk Trachea Arch of aorta artery 3rd rightposteriorintercostal t bronchialarterv Superiorleftbronchialartery branchof rightbronchialartery Esophageal branch Inferiorleftbronchialarteryand esophageal aorta Thoracic(descending) of thoracicaorta branches Esophageal
Thoracicpart of esophagus
inalpart of esophagus Diaphragm Stomach
Inferior phrenic Common hepatic artery
Mediastinum
Esophageal branchof left gastricartery Leftgastricartery Celiactrunk artery(cut)
EsoPhageal Commonvariations: branchesmayoriginatefrom left inferiorphrenicarteryand/or directlvfrom celiactrunk. to abdominalesophagus Branches mayalsocomefrom splenicor shortgastricarteries.
Plale 237
Veins of Esophagus SeealsoPlate 312 I n f e r i o rt h y r o i dv e i n I n t e r n ajlu g u l a rv e i n
I n f e r i o rt h y r o i dv e i n
I n t e r n aj ul g u l a r vetn
E x t e r n aj lu g u l a rv e i n S u b c l a v i a nv e i n \ Subclavian vetn
Vertebralvein
Thoracic duct
Right b r a c h i o c e p h a l ivce i n
Left brachioc e p h a l i cv e i n
S u p e r i o rv e n a c a v a
Left superior i n t e r c o s t avl e i n
R i g h ts u p e r i o r i n t e r c o s t avl e i n
E s o p h a g e avle i n s
(plexus)
Esophagus
Accessory h e m i a z y g ovse i n
6 t h r i g h tp o s t e r i o r i n t e r c o s t avl e i n Azygos vein Junctionof accessory nemrazygos a n d a z y g o sv e i n s Hemiazygos Submucous venousplexus vetn inferior phrenic vein TLeft
Inferiorvena cava ( Diaphragml
,il
S h o r tg a s t r i cv e i n s
Liver
H e p at i c verns
Hepatic portal vetn
R i g h tr e n a lv e i n Left gastricvein
Omental (epiploic) verns Left gastro-omental ( g a s t r o e p i p l o i cv)e i n
Right gastricvei Esophagealbranchesof left gastricveiri
Plate 238
I n f e r i o rm e s e n t e r i cv e i n S u p e r i o rm e s e n t e r i cv e i n R ig h t g a s t r o - o m e n t a( g l a s t r o e p i p l o i cv)e i n
Nr
Mediastinum
Lymph Vessels and Nodes of Esophagus SeealsoPlates 2O8,266
Inferior deep cervical ( i n t e r n ajlu g u l a r )n o d e s V i r c h o w ' sn o d e T h o r a c i cd u c t
Paratracheal nooes Posterior mediastinal nodes S u p e r i o ra n d i n f e r i o r t r a c h e o b r o n c iha l nooes
Posterior parietalnodes
Intercostal nooes
S u p e r i o rp h r e n i cn o d e s
Left eastricnodes (cardiacnodes of stomach)
Juxtaesophageal and superior phrenic
C e l i a cn o d e s
*{r Mediastinum
Plate 239
Nerves of Esophagus
Anterior view
Superiorganglionof vagusnerve
*{r
ganglion Superiorcervicalsympathetic nferior ganglionof vagus nerve
Esophagus
Pharyngealbranch of vagus nerve
Vagusnerve(X) Recurrent laryngeal nerves Rightrecurrent laryngeal nerve
nerve Superiorlaryngeal Cervicalsympathetic trunk ganglion Middlecervicalsympathetic Cervical(sympathetic andvagal)cardiacnerves ganglionof cervicalsympathetic Vertebral trunk
Ansasubclavia
Ansasubclavia Branchto esophagus and recurrent nervefrom stellateganglion
3rd intercostal
(stellate) Cervicothoracic ganglion Leftrecurrentlaryngeal nerve
Crayand white rami communicantes
Thoracic(vagal and sympathetic) cardiacbranches
Posterior view
Cardiacolexus 3rd thoracic sympathetic ganglion Thoracic
sympathetic trunk_ Rightgreater thoracic splanchnic nerve Sympathetic fibers along left inferior phrenic artery
Branchof posteriorvagal trunkto celiac plexus
plexuses Pulmonary plexus Esophageal (anteriorportion) Branchesto esophageal plexusfrom sympathetic trunk,greaterthoracic splanchnic nerve,and thoracicaorticplexus Leftgreaterthoracic nerve solanchnic Anteriorvagaltrunk Vagalbranchto hepaticplexus via lesseromentum
Esophageal prexus (posterior portion)
Principal anteriorvagalbranch to lessercurvatureof stomach Vagalbranchto fundus and bodyof stomach
Posterior vagaltrunk
Greater thoracic splanchnic nerves
Vagalbranch to celiacplexus
Sympathetic fibers along esophageal branch of left
gastricartery Celiacplexus and ganglia
Plate 24O
Vagal branch to fundus and cardiac part of stomach
Posterior vagal branchto lesser curvature
Mediastinum
Mediastinum: Gross Section
5th left costal cartilage
Rightventricle
Internalthoracicarteryand vein
thoracismuscle Transversus ma.jormuscle Pectoralis Pleuralcavity
part, Interventricular part Atrioventricular of membranous septum
Muscularpartof interventricular septum Leftventricle
Suoeriorvena cava
Papillarymuscle
Rightatrium
Phrenicnerveand pericardiacophrenic artery and vein
Pericardialcavity
partof Mediastinal parietalpleura R i g hltu n g (middlelobe) Leftatrium
Phrenicnerveand pericardiacophrenic arteryand vein
Coronarysinus
Branchesof right
Leftlung (superior lobe)
mainbronchus
of Branches leftmainbronchus
Rightinferior pulmonaryvein
Leftinferior pulmonary vein
Oblique pericardialsinus
Thoracic (descending)aorta
Esophagusand esophagealplexus
8th rib Azygosvein Hemiazygos vein Thoracicduct
trunk Leftsympathetic TBvertebra
Mediastinum
Leftgreaterthoracicsplanchnicnerve
*{r Plale
241
Ghest Scans: Axial GT lmages Seriesof chestaxialCT imagesfrom superior(A) to inferior(C)
A
A B C
ery# A, A, AZ B IV t TB
tst_ LV PA
Ascendingaorta D e s c e n d i n ga o r t a Azygos vein Body of vertebra Inferiorvena cava Liver Left (main stem) bronchus L e f t s u p e r i o rl o b e o f l u n g Left ventricle Pulmonaryartery
Plate 242
R Rib R B R i g h (t m a i ns t e m )b r o n c h u s RSI- Rightsuperiorlobeof lung RV Rightventricle S Sternum SC Spinalcord SP Spinousprocessof vertebra SV Superiorvenacava T Trachea(bifurcation)
Regional Scans
o t o o o
f oint TransverseSection:LowerLevelof T3, Sternoclavicular Plate243
M e d i a s t i n allv m p h n o d e
Manubrium
T
o o o t o
Sternoclavicularioint (articulardisc) Clavicle
Brachiocephalictrunk Trachea
II
R i g h tb r a c h i o c e p h a l ivce i n
5
g
Left brachiocephalicvein
C o s t a lc a r t i l a s eo f 1 s t r i b
D
Left common carotid arterY
Pectoralismajor muscle
3 !f t
Left vagus nerve (X)
R i g h tl u n g
o
Pectoralisminor muscle
3
Axillaryfossa Left subclavian artery
Tendon of long head of biceps brachii muscle
Shaft of left humerus
S u r g i c anl e c k of right
Long headof triceps brachii muscle
humerus Delroid muscte
Teres mrnor muscle
lntercostal muscles
Scapula
5
o t o rl ql
Left recurrent laryngealnerve
t
R h o m b o i dm a i o r m u s c l e
{
Thoracic duct
5 G)
o
x
Serratusanterior muscle
Esophagus
N
o o t
ll
Right vagus nerve (X
o
o
5
I n f r a s p i n a tm u su s c l e
Phrenicnerve
t
o o
{
Leftlung
muscle Subscapularis
!
o
II
Teres mtnor muscle
qt
o -
q)
Costotransverseioint
muscle Trapezius Body ofT3 vertebra
S p i n acl o r d
F
Erectorspinae muscle Rhomboid maior muscle muscle Transversospinalis
C./Td4s/*
o o
!
ql
o
o -
Transverse Section:T3-4 Intervertebral Disc,Manubrium
t
o
Plate 244
N
S u p e r i o rt r a c h e o b r o n c h i al yl m p h n o d e
D D
o o
Trachea
Superiorvena cava
o o o t
Right phrenic nerve Arch of azygosvein
IT
R i g h tl u n g
o
Internalthoracic artery and vein
Intercostalmuscl
Left lung
Serratusanterior muscle
Ribs
P e c t o r a l i sm i n o r m u s c l e
Tendon of long head of b i c e p sb r a c h i im u s c l e
5
C o m b i n e ds h o r t h e a d o f b i c e p sb r a c h i ia n d coracobrachialismuscles
Shaft o{
T e n d o no f l o n g head of biceps brachii muscle
numerus Deltoid muscte
Shaft of numerus
LOnS head of tnceps brachii
Lateral head of tnceps brachii muscle
muscte rl
o
o o I
o o o =, o 5
Teres maJor muscte
Long head of triceps brachii muscle
Teresminor muscle
Left latissimusdorsi tendon ( i n s e r t i n go n t o h u m e r u s )
Scapula Esophagus
Teresmajor muscle
g
Thoracic duct
D
T3-4 intervertebraldisc
5 ql
S p i n a lc o r d
R h o m b o i dm u s c l e
t
o l
S u b s c a p u l am r i su s c l e
Left recurrent laryngealnerve Left vagus nerve (X) Trapeziusmuscle
Obliquefissure(of leftlung)
o rh {
Axillaryfossa
L a t i s s i m udso r s i tendon
o
5
Pectoralismaior muscle
T e r e sm i n o rm u s c l e Scapula I n f r a s p i n a t um s uscle
CUd4*/*
o r| !l
x !, t
{
g) I
D
I
o o F
o g
o
TransverseSection: T4-5 Intervertebral Disc, Sternal Angle
rt
o o o
I n f e r i o rt r a c h e o b r o n c h i al yl m p h n o d e s
I
o o o
M a n u b r i o s t e r n aj ul n c t i o n
A s c e n d i n ga o r t a Internalthoracic arterYand vein R i g h tp u l m o n a r ya r t e r y
=.
o
2nd costal cartilage
Superiorvena cava
3
g
Pectoralismajor muscle
D
R i g h tl u n g
= ql
P u l m o n a rtyr u n k Left pulmonary artery
i
o
rt
o
P e c t o r a l im s inor muscle
Axillaryfossa
3
o
Left lung
lntercostalmuscles
Tendon of long head of biceps b r a c h i im u s c l e
L o n gh e a d of biceps b r a c h i im u s c l e
Deltoid muscle
Shaftof numerus
Lateral head of triceps brachii muscle
Latissimus dorsi tendon
Teresmajor muscle
N
D
|,|
ll
anterior Serratus muscle
{
D e s c e n d i n ga o r t a
Trapeziusmuscle
R i g h tm a i n b r o n c h u s Azygos vein
Esophagus
Thoracic duct T4-5 intervertebraldisc
$ I (tl
o F o
Accessoryhemiazygosvein
Rhomboid maior muscle!
t
9. o
Left main bronchus
I n f r a s p i n a t um s uscl
o
o rt
Teres major muScle
S u b s c a p u l am r i su s c l e
Scapula
t
{ ,
x
Long head of triceps b r a c h i im u s c l e
!l
o o =. o a o t ll
Latissimus dorsi tendon
!-
o
Ribs
Coracobrachialis muscre
o o
Cfd4*/*
q
!
!f t
o
Transverse Section:Levelof T7,3rd InterchondratSpace
o
rt
o
N
D
o
o o
Orifice of tricuspidvalve
Coronarysulcus Internalthoracic artery and vein
o
S t e r n u m( b o d y )
o o t
R i g h tv e n t r i c l e
IT
o
Anterior interventricularsulcus R i g h ta t r i u m
5
o rt
Pectoralismajor muscle
Interatrialseptum Apex of heart
{
Superiorvena cava l n t e r v e n t r i c u l asre p t u m R i g h ti n f e r i o r p u l m o n a r yv e i n
ry muscte Left ventricle
Azygos vein
Leafletof mitralvalve Serratus a n t e r i o rm u s c l e
Coronarysulcus
L a t i s smi u s dorsi muscle
o rt
o
Coronarysinus Oblique
Inferior a n g l eo f s c a p u l a
pericardialsinus
o o
Descendingaorta
I
o o o -t o
Thoracic duct L a t i s s i m uds o r s i m u s c l e
-a
f
g D
= ql t
o
3
Triangleof auscultation
Triangleof auscultation
Neckof 7th rib Zygapophyseal(facet)joint
Head of 7th rib Body offT vertebra Trapezius muscle
CUd4/^
5
o rl !t
x qf t { {
F
o o
4 Abdomen Section Topographic Anatomy Plale 217
z+z Abdomen
Body Wall Plates 24&167
ofAbdomen zca Bony Framework Dissection Wall: Superficial Abdominal zlg Anterior Dissection Abdominal Wdl:Intermediate zso Anterior Deep Dissection Abdominal Wall: zsr Anterior Cross Sections zsz Rectus Sheath: Internal View AbdominalWall: zsg Anterior Wall Abdominal zsl Posterolateral Abdominal Wall zss Arteries ofAnterior Abdominal Wall zse Veins ofAnterior Wall Abdominal z5z Nerves ofAnterior Nerves zss Thoracoabdominal Dissections Region: zss Inguinal Spermatic Cord zeo Inguinal Canaland Inguinal Hernta zer Indrrect Canal Sheath andInguinal zez Femoral Wdl:Internal View Abdominal zee Posterior Abdominal Wall ofPosterior zec Arteries Wall Abdominal zes Veins ofPosterior Abdominal Wall of Posterior Vessels andNodes zee Lymph Abdominal Wall ofPosterror zsz Nerves
Atlas of Human Anatomy
Abdomen Peritoneal Gavity
Visceral Vasculature
Plates 26,&174
Plates 3OO-317
zea Regions andPlanes ofAbdomen
Arteries ofStomach, Liver, andSpleen 301 Arteries ofLiver, Pancreas, Duodenum, andSpleen
zeg Greater Omentum andAbdominalVrscera zzo Mesenteric Relations ofIntestines zzr Mesenteric Relations (continued) ofIntestines zzz Omental Bursa: Stomach Reflected zzg 0mental Bursa: Cross Section zzc Peritoneum ofPosterior Abdominal Wall
300
3o2
Variations inCeliac Trunk
303
Arteriogram Celiac
Arteries of Duodenum andHead ofPancreas 305 ArterialVariations andCollateral Supply ofLiver andGallbladder 304
306
Arteries ofSmall Intestine
Viscera (Gutl
307
Arteries ofLarge Intestine
Pfates 275-285
308
Variations inColic Arteries
zzs Stomach inSitu zzs Mucosa ofStomach
309
zzz Musculature ofStomach zza Duodenum inSitu
3tt
Veins ofLarge lntestine
312
Hepatic Portal VeinTributaries: Portacaval Anastomoses
zzs Mucosa andMusculature of Duodenum zso Mucosa andMusculature ofSmall Intestine zar lleocecal Region
313
zsz lleocecal (continued) Region zss Vermiform Appendix zac Mucosa andMusculature ofLarge Intestine position zas Sigmoid Colon:Variations in
Veins ofStomach, Duodenum, Pancreas, andSpleen 3 t o Veins ofSmall Intestine
Variations Portal ofHepatic Vein 314 Lymph Vessels andNodes ofStomach
315
Lymph Vessels andNodes ofPancreas
3t6
Lymph Vessels andNodes Intestine ofSmall
317
Lymph Vessels andNodes Intestine ofLarge
Innervation Plates 318-328
Viscera (Accessory Organsf Plates 286-299
zae Topography ofLiver
Autonomic Nerves andGanglia ofAbdomen 3 t 9 Nerves ofStomach andDuodenum 318
Nerves (continued) ofStomach andDuodenum 321 Innervation ofStomach andDuodenum: Schema 3.20
zez Surfaces andBedofLiver zaa LiverinSituandVariations inForm
322
Nerves ofSmall Intestine
zag Liver Segments andLobes:Vessel andDuctDistribution
323
Nerves ofLarge Intestine
zso Intrahepatic Vascular andDuctSystems zsr Liver Structure: Schema zsz Intrahepatic Biliary Systems: Schema
Innervation ofSmall andLarge Intestines: Schema 325 Autonomic Reflex Pathways: Schema
zse Schematic Cross Section ofAbdomen atT10 zse Gallbladder andExtrahepatic BileDucts (Common) zss Junction of BileDuct andDuodenum
324
Intrinsic Autonomic Plexuses ofIntestine: Schema 327 Innervation andBiliary ofLiver Tract: Schema 326
328
lnnervation ofPancreas: Schema
zge Variations inCystic andHepatic Ducts
Kidneys and Suprarenal Glands
zsz Schematic Cross Section ofAbdomen atT'12 zgs Pancreas inSitu zss Spleen
Plates
Atlas of Human Anatomy
SZC}-347
szs Kidneys inSitu: Anterior Views inSitu:Posterior seo Kidneys Views
Abdomen ofAbdomen atT12 Cross Section 33r Schematic andVeininSitu sez RenalArtery inRenalArtery andVein eos Variations ggr Gross Structure ofKidney andRenal Segments sos IntrarenalArteries Tubule: Schema andCollecting sse Nephron gsz Blood ofKidney: Schema Vessels inParenchyma atT12-11 Section ofAbdomen Cross esa Schematic atLl-2 Cross Section ofAbdomen esg Schematic geo Ureters Bladder andUrinary ofUreters ser Arteries
Bladder andUrinary Ureters, ofKidneys, sce Nerves ges Innervation Schema Ureters: andUpper ofKidneys andSchema Dissection Glands: ofSuprarenal oee Nerves gcz Arteries inSitu Glands ofSuprarenal andVeins
Abdominal Sections Plates 348-349
(Sagittal) gcg AbdominalWall Section Paramedian andViscera: at 13,4 ofAbdomen CrossSection srs Schematic
Regional Scans
Fascia sez Renal
Plate 35O
Bladder andUrinary Vessels andNodes of Kidneys a+s Lymph
CTlmages Scans:Axial eso Abdominal
Atlas of Human AnatomY
Abdomen
muscle Sternocleidomastoid Deltopectoral
triangle
Sternalhead Clavicularhead
muscle Trapezius Sternum Body
Deltoidmuscle
Xiphoid process
Pectoralis major muscle
Serratus anterior muscle
Tendinous intersection External oblique muscle Lineaalba S e m i l u n al irn e Umbilicus
Anteriorsuperior i l i a cs p i n e
lliaccrest
Superficial circumflexiliac vein Superficial epigastricveins
lnguinal ligament
Pubicsymphysis
Pubictubercle
c(d4#
Topographic Anatomy
Plale 247
Bony Framework of Abdomen
4{tr Transverseorocessesof lumbar vertebrae I n n e rl i p lliactuberosity
Intermediate zone
lliaccrest
Outerlip Wing (ala)of ilium
Tuberculum
Creater sciatic notch Arcuateline
Anteriorsuperior
lschialspine
iliacspine
Lesser sciaticnotch
Anteriorinferior
iliacspine Iliopubic emtnence
ter trochanter of femur
Superior pubicramus
Pectenpubis (pectinealline)
Obturator
Pubicsymphysis
foramen
lschial tuberosity
Pubictubercle Inferior pubicramus Inferiorpubic ligament
Plate 248
Pubicarch
Lessertrochanter of femur
Body Wall
Anterior Abdominal Wall: Superficial Dissection
*{r major Pectoralis muscle Xiphoidprocess Rectussheath L i n e aa l b a Serratus anterior
External oblique muscle
tissue Subcutaneous (superficialfascia) of abdomen
Muscular part Aponeurotic
pan
Anteriorsuperior i l i a cs p i n e
I n g u i n al il g a m e n t (Poupart's) lntercrural fibers
Thoracoepigastric vein Camper's(fatty)layer, (membranous) Scarpa's layerof subcutaneous tissueof abdomen (turned back) of layerto Scarpa's fascialata Superficial circumflex iliacvessels
Superficial i n g u i n arli n g External spermatic fasciaon spermatic cord Cribriformfascia in saphenous openrnS Fascialata
Creat s a p h e n o uvse i n Superficial dorsalveinof penis
Body Wall
Superficial vessels epigastric external pudendalvessels ligament Fundiform fasciaof Superficial penisand scrotum (dartosfascia)(cut) Deep(Buck's) fasciaof peniswith deepdorsalveinof penisshowingthrough
Plate 249
Anterior Abdominal wall: Intermediate Dissection
Nr Pectoralismajor muscles 'Anteriorlayerof rectussheath (cutedges) Latissimus d o r s im u s c l e
L i n e aa l b a
Serratus anteriormuscle
Rectusabdominis muscle
External o b l i q u em u s c l e
External o b l i q u em u s c l e lcut away)
\cut away)
Tendinous intersection External intercostal muscles External oblique aponeurosts (cut edge
Rectussheath Internal o b l i q u em u s c l e Anteriorsuperior i l i a cs p i n e - I n g u i n al i g a m e n t
(Poupart's) Cremaster muscle (lateralorigin Inguinalfalx (conjointtendon Reflected i n g u i n al il g a m e n t
Internaloblique muscle Pyramidalis muscle Inguinalfalx (conjointtendon) l n g u i n al il g a m e n t (Poupart's) Anteriorsuperior i l i a cs p i n e External oblique (cutand aponeurosis turneddown) Pectineal ligament (Cooper's) Lacunarligament (Cimbernat's) Reflected inguinal ligament Pubictubercle
Femoralvein (in femoral sheath)
ligament Suspensory of penis
Saphenous openrnS
muscles Cremaster and cremasteric fascia
Cremaster muscle ( m e d i a lo r i
Deep(Buck's) fasciaof penis
Fascialata
External spermatic fascia(cut)
Great saphenousvein
Plate 25O
Superficial fascia of penisand scrotum(cut)
Body Wall
Anterior Abdominal Wall: Deep Dissection
Superior vessels epigastric
4{tr
External o b l i q u em u s c l e \cut away)
Anteriorlayerof rectussheath(cut) L i n e aa l b a
R e c t u sa b d o m i n i s muscte
Anteriorlayerof rectussheath
E x t e r n aol b l i q u e aponeurosis(cut)
abdominis Transversus muscle(cut)
I n t e r n ao l blique a p o n e u r o s i s( c u t )
fascia Transversalis (opened on left)
Transversus a b d o m i n i sm u s c l e
Extraperitoneal fascia(areolartissue)
Internal
o b l i q u em u s c l e( c u t )
M e d i a lu m b i l i c a l l i g a m e n t( o c c l u d e dp a r t o f u m b i l i c a la r t e r y )
Posteriorlayer of rectus sheath A r c u a t el i n e Inferior epigastricvessels
I n f e r i o re p i g a s t r i c artery and vein (cut)
A n t e r i osr u p e r i o r i l i a cs p i n e
S i t eo f d e e p i n g u i n a l r i n g ( o r i g i no f i n t e r n a l spermaticfascia)
lnguinal ligament
(Poupart's)
C r e m a s t e r i ca n d p u b i c branchesof inferior epigastricartery
Superficial circumflexiliac, S u p e r f i c i ael p i g a s t r i Superficial externalpudendal arteries(cut)
Femoralsheath (containsfemoral a r t e r ya n d v e i n )
I n g u i n a fl a l x (conioint tendon)
I n g u i n al i g a m e n t (Poupart's)
P e c t i n e alli g a m e n t
L a c u n a rl i g a m e n t (Cimbernat's)
(Cooper's)
P e c t i n e alli g a m e n t (Cooper's)
L a c u n a rl i g a m e n l (Cimbernat's)
Fat in retropubic space (of Retzius)
Reflected inguinaligament
Pectinealfascia
P u b i ct u b e r
nternal spermaticfascia
C r e m a s t e rm u s c l ea n d f a s c i a E x t e r n asl p e r m a t i cf a s c i a
Body Wall
Deep(Buck's) fasciaof penis
Superficialfascia o f p e n i sa n d scrotum (cut)
muscleandfascia(cut) Cremaster xternal spermaticfascia(cut)
Plate 251
Rectus Sheath: Gross Sections
Sectionabovearcuateline Aponeurosis of externalobliquemuscle
Rectusabdominis muscle
Aponeurosis of
External oblique
Anteriorlayerof rectussheath
i n t e r n a lo b l i q u e m u s c l e
Skin
lnternal o b l i q u em u s c l e
L i n e aa l b a
Transversus a b d o m i n im s uscle
Aponeurosis of transversus a b d o m i n im s uscle
Posterior layer of rectussheath
Peritoneum Extraperitoneal fascia
Falciform ligament
Subcutaneous tissue(fattylayer)
Transversalis fascia
Aponeurosis of internalobliquemusclesplitsto formanteriorandposterior layersof rectussheath. Aponeurosis of external obliquemusclejoinsanteriorlayerof sheath; aponeuiosis of transversus abdominis musclejoinsposterior layer.Anteriorandposterior layeisof rectussheathunitemedially to formlineaalba.
Sectionbelow arcuateline Aponeurosis of e x t e r n aol b l i q u em u s c l e A p o n e u r o s i so f internaloblique muscle
R e c t u sa b d o m i n i sm u s c l e
Aponeurosis of transversus a b d o m i n im s uscle
Extraperitonealfascia
Internal oblique muscle
Transversus a b d o m i n im s uscle
Transversalis fascia Peritoneum
External o b l i q u em u s c l e
Anteriorlayerof rectussheath
Median umbilical ligament(obliterated u r a c h u s i)n m e d i a n u m b i l i c aflo l d
M e d i a lu m b i l i c a l ligamentand fold aneouS
tissue(fattyand membranous layers)
A p o n e u r o soi sf i n t e r n aol b l i q u em u s c l ed o e sn o t s p l i ta t t h i sl e v e b l u t p a s s ecso m p l e t e layn t e r i otro rectusabdominismuscleand is fusedtherewith both aponeurosis of externalobliquemuscleund thut of transversus abdominismuscle.Thus,posteriorwalloi rectussheathis absentbelbwarcuateiine, and rectusabdominismusclelieson transversalis fascia.
Plale 252
*{r
Body Wall
Anterior Abdominal Wall: Internal View seePlate229 Forumbilicalvessels Parietal pleura
Diaphragm Diaphragmatic fascia
Round ligament (ligamentum teres)of liver ano paraumbilical vetns
Falciform ligament Peritoneum (cut edges)
tcus
Transversalis fasciaand its cut edge
Peritoneum
A r c u a t el i n e
ransversalis fascia
Rectus abdominis muscle
Externaland lnternal oblique musctes
Inferior epigastric
Transversus abdominis muscle
VCSSCIS
Inguinal triangle (Hesselbach's)
Left medial umbilical ligament (obliterated leftumbilical artery)
Transversalis fascia(cut) lnterfoveolar ligament
R i g h tm e d i a l u m b i l i c a fl o l d
Deep circumflex i l i a cv e s s e l s
Median umbilical ligament (obliterated urachusa ) nd paraumbilical v e i n si n m e d i a n u m b i l i c a fl o l d
Deep i n g u i n arl i n g Cremasteric and pubic branchesof inferior epigastricartery
U m b i l i c a lp r e v e s i c a l fascia
Testicularvessels
L a t e r a ul m b i l i c a fl o l d (containsinferior epigastricvessels)
E x t e r n aill i a cv e s s e l s Spermaticcord
oral nerve Femoralsheath Lacunarligament (Cimbernat's)
muscle lliopsoas
Pectinealligament (Cooper's)
xternal iliac vessels Supravesicalfossa
I n g u i n afl a l x ( c o n j o i n t e n d o n )
Transversevesicalfold
U m b i l i c a la r t e r y (occluded part distalto this point)
Obturator internusmuscle
Obturator nerve and vessel6
Ureter(cut) Anterior recessof ischioanalfossa Superiorvesicalartery Ductus (vas)deferens
Body Wall
L e v a t o ra n i m u s c l e
"**r --Brlbourethral (Cowper,s) gland embedded perinealmuscle inalvesicle in deeptransverse Prostateand sphincterurethraemuscle
U r i n a r yb l a d d e r P e r i n e am l embrane
Plate 253
Posterolateral Abdominal Wall
Serratus anteriormuscle lnfraspinousfascia
Rhomboim d a j o rm u s c l e Auscultatory triangle Lateralcutaneous branchof dorsalramusof TZ soinal Medialcutaneous branchof dorsalramusof TZ spinal Trapezius muscle Latissimu d so r s im u s c l e E x t e r n aolb l i q u em u s c l e Thoracolumbar fascia(posterior layer) Lateralcutaneous branchof subcostal nerve(ventralramusof T12) Lumbartriangle(of Petit) lliaccrest Lateralcutaneous branchof iliohypogastric nerve(11) Superiorclunialnerves(lateralcutaneous branches of dorsalramiof L1-13spinalnerves) Glutealaponeurosis overqluteusmediusmuscle Cluteusmaximusmuscle
Latissimus dorsimuscle Latissimus dorsimuscle(cutand turnedback) Serratus oosteriorinferiormuscle Digitations of costaloriginof latissimus dorsimuscle Digitations of costaloriginof externalobliquemuscle Externalobfique muscle(cutand turnedback) Tendon of origin of transversusabdominis muscle Internaloblioue muscle
Lateralcutaneous branchof subcostal nerve(ventralramusofTl 2) Lateralcutaneous branchof iliohypogastric nerve(Ll ) l l i a cc r e s t
Superiorclunialnerves(lateralcutaneous branches of dorsalramiof L1-13soinalnerves) Cluteusmaximusmuscle
Plate 254
4{tr Body Wall
Arteries of Anterior Abdominal Wall
arterv Subclavian Lateralthoracic artery Subscapular
Internalthoracicarteries Pericardiacophrenic arterywith phrenicnerve
*{r arterv Thoracodorsal
ransversus thoracis muscle anch to falciform
ligamentof liver Anterior intercostal arteries
Musculophrenic arteries Superiorepigastric arteries Diaphragm Transversus abdominis muscleand aponeurosis
with lower Anastomoses intercostal, subcostal, a n dl u m b a r Ex Internal oblique muscres Transversus abdominismuscre Ascendingbranch of deep circumflexiliac artery
Superficial circumflexiliac Superficial epigastric artery
Rectusabdominis muscles Internal o b l i q u em u s c l e External o b l i q u em u s c l e Posteriorlaverof rectussheath ate line
Inferiorepigastric artery Superficialepigastric arterv
Femoralartery Femoralartery
Superficial external pudendalartery Deepexternal pudendalartery
Cremasteric andtesticular arteriesand artervto ductus deferensin spermatic
Body Wall
arteriesof penis (deep to Buck's fascia)
Plate 255
Veins of Anterior Abdominal Wall
Subclavian vein Axillaryvein
External Internal Anterior
Cephalicvein
Intercostal tributaries to axillary vern
Lateralthoracicvein
C e p h a l i cv e i n
Anterior intercostalveins
Axillaryvein
Internalthoracic vein
al thoracicvein
Musculophrenic vei
venousplexus
Superiorepigastric veins Thoracoepigastric vein
Perforatin g tributaries to internalthoracic vetn
Paraumbilical veinsin roundligamentof liver
gastricvein Thoracoepi
Inferiorepigastric veins
tariesof paraumbilicalveins
Tributaries to deep circumflexiliacveins
Thoracoepigastric vein
Thoracoepi gastricvein Superficial epigastric vein Superficial circumflexiliacvein
al circumflex iliacvein
Superficialepigastricvein
External pudendalvein
Externalpudendalvein
S a p h e n o u so p e n i n g
fascia over
s a p h e n o uosp e n i n g Femoralvein
Creatsaphenous vein (venous)plexus Pampiniform Deep dorsal vein of penis (deep to Buck'sfascia)Superficialdorsalvein of penis
Plate 256
saphenousvein
Anteriorscrotalveins
Nr Body Wall
Nerves of Anterior Abdominal Wall
Medial brachial cutaneous nerve
Intercostobrachial n e r v e( T 1 , 2 ) Long thoracic nerve
Latissimus dorsimuscle
Serratus anteriormuscle External obliquemuscle(cut) Posteriorlayerof rectussheath Anteriorlayerof rectussheath(cut)
Lateralcutaneous branches of intercostalnerve(T2-11 Anteriorcutaneous branches of intercostal nerve(T1-11 Lateralcutaneous branch of subcostal nerve(T12) Lateralcutaneous branch of iliohypogastric nerve(11) Anteriorcutaneous branch of subcostal nerve(T12 Lateralfemoralcutaneous nerve(12,3) Anterior cutaneousbranch of iliohypogastricnerve (11 Femoralbranchesof genitofemoralnerve (11,2)
Anteriorscrotalbranch o f i l i o i n g u i nn ae l r v e( 1 1 )
Rectusabdominismuscle Transversus abdominis muscle Internalobliquemuscle (cut) and aponeurosis Anteriorand lateral branches cutaneous of subcostal nerve(T12) Anteriorbranchof iliohypogastric nerve(11) i o i n g u i n anle r v e( 1 1 ) External oblique aponeurosis(cut) Anteriorcutaneous branch nerve(11) of iliohypogastric llioinguinn ae l r v e( 1 1) muscle Cremasteric cord of soermatic External spermatic fascia of spermatic cord
Cenitalbranchof genitofemoralnerve (11, 2)
Body Wall
4{tr Plate 257
Thoracoabdominal Nerves
Spinalnervetrunk Meningealbranch Spinalsensory (dorsalroot)ganglion Dorsalroot Ventral rool
Erectorspinaemuscle Medialbranch, Lateralbranchof Dorsal(posterior) r
Ventral(anterior) ramusof spinalnerve(intercostal nerve) Collateral branch External intercostal muscle Internalintercostal muscle Innermostintercostal muscle Latissimus dorsi muscle
Subcostal muscles
Serratus anterior muscle
Windowcut in innermosl intercostal muscl6
Lateral cutaneous branch
Communicating branch
Creater and lesser thoracic s p l a n c h n i c
nerves Sympathetictru Cray and white rami communicante!
R e c t ua s b d o m i n im s uscle
Internal intercostal Internalintercostal muscle membranes anteriorto externalintercostal muscles Collateral branch rejoiningintercostal Transversus abdominismuscle
lnnermost intercostal muScle Internal intercostal muscle External intercostal muscte
Lineaalba
External intercostal membrane External o b l i q u em u s c l e Anteriorcutaneous branch
*{r Plate 258
Body Wall
lnguinal Region: Dissections
L i n e aa l b a
E x t e r n aol b l i q u e m u s c l ea n d aponeurosrs
Rectussheath (anteriorlayer)
A n t e r i o rs u p e r i o ri l i a cs p i n e
Transversalis fasciawithin inguinaltriangle (site of direct i n g u i n a lh e r n i a )
Internao l b l i q u em u s c l e kut and reflected\
Transversus abdominismuscle D e e pi n g u i n arli n g
l n g u i n a fl a l x (conjoint tendon)
(in transversalis fascia) Cremastermuscle (lateralorigin)
Reflected inguinal ligament
InferiorepiBastricvessels (deep to transversalis fascia) I ng u i n a ll i g a m e n t( P o u p a r t ' s )
fibers
L a c u n a rl i g a m e n t( C i m b e r n a t ' s )
External spermaticfascia on spermatic cord exiting
Cremaster muscle ( m e d i a lo r i g i n ) S u p e r f i c i ai ln g u i n a lr i n g L a t e r a cl r u s -
Superficial i n g u i n a lr i n g Fundiform l i g a m e n to f p e n i s
M e d i a cl r u s Pubiccrest
Posterior(internal)view
4{tr Rectussheath(posteriorlayer) Arcuateline M e d i au l m b i l i c al il g a m e n t Anteriorsuperioriliacspine Transversalis fascia(cutaway) Rectusabdominismuscle l l i o p u b i tcr a c t vessels Inferiorepigastric i n a l ( H e s s e l b a c h ' st r)i a n g l e Femoralnerve enital branch of genitofemoralnerve and testicularvessels D e e p i n g u i n a lr i n g lliopsoasmuscle Externaliliac vessels al ring (dilated)(broken line) L a c u n a rl i g a m e n t( C i m b e r n a t ' s ) Rectinealligament (Cooper's) Ductus (vas)deferens
anastomosis Obturator-pubic Obturatorvessels vessels Pubicbranches of inferiorepigastric M e d i a nu m b i l i c al il g a m e n t Pubicsymphysis Hesselbach'striangle by Carlos Machado after Frank Netter
Body Wall
Cryd4/*
Plate 259
lnguinal Ganal and Spermatic Gord
Testicularvesselscovered by peritoneum
External obliquemuscle
Testicularvesselsand genital branch of genitofemorai
Internao l b l i q u em u s c l e
Ductus (vas)deferens
Transversus abdominis muscle
Cremastericvessels
Transversalis fasc
Externaliliac vesselscovered by peritoneum
Extraperitoneal fascia(loose connectivetissue)
Ductus (vas)deferenscovered by peritoneum I n f e r i o re p i g a s t r i cv e s s e l s
Peritoneum
Medialumbilicaligament ( o c c l u d e dp a r t o f u m b i l i c a la r t e r y ) U m b i l i c a lp r e v e s i c afla s c i a
Urinarybladder R e c t u sa b d o m i n i sm u s c l e P y r a m i d a l im s uscle Medianumbilical ligament (urachus) Superficial i n g u i n a lr i n g s
Anterior supeflor i l i a cs p i n e gin of internal spermaticfascia from transversalis fasciaat deep i n g u i n a lr i n g llioinguinalnerve
Pubic symphysis
S p e r m au c cord
(covered by intermingling fibers of external oblique aponeurosts)
Femoral vessets
P u b i ct u b e r c l e
Cremastermuscle and cremasteric fasciaon spermaticcord
Externalspermaticfascia e n v e l o p i n gs p e r m a t i c
In g u i n a l i g a m e n t(P o u p a r t ' s ) Inguinalfalx (conjoint tendon) Intercruralfibers
Plate 260
Body Wall
Indirect Inguinal Hernia
Loop of bowel e n t e r i n gh e r n i a ls a c
vessels, testicular Ductus(vas)deferens, nerve and genitalbranchof genitofemoral forming spermaticcord
Neck of hernialsac Inferiorepigastric vessels Origin of
internalspermatic fasciafrom fasciaat transversalis d e e p i n g u i n a lr i n g
Peritoneum Extraperitoneal fascia fascia Transversalis
*;';, D e e p i n g u i n a lr i n g
"?,:',
,
External spermatic fascia
Cremaster muscleand fascia
Superficial i n g u i n arli n g
Internalspermatic fascia
H e r n i a ls a c
Ductus(vas)deferensand cord vessels of spermatic
Body Wall
*{r Plate 261
Femoral Sheath and Inguinal Ganal
Transversalis fascia(cutedge) Extraperitoneal fascia peritoneum Parietal Medianumbilicalligament(urachus) Medialumbilicalligament(occludedpart of umbilicalarterv) Inferiorepigastricvessels Deepcircumflexiliacvessels Testicular vessels teric artery Ductus(vas)deferens External iliacvessels Pubic(obturatoranastomotic) vessels (cut) External obliqueaponeurosis Internalspermatic fasciaon spermatic cord Femoralnerve(deepto iliopsoas fascia) Femoralvessels in femoralsheath Falciform marginof saphenous opening (cutand reflected) Ureter Cenitofemoral nerve Urinary bladder Pectineal ligament (Cooper's)
Lacunar ligament (Gimbernat's) Inguinal ligament (Poupart's
Transversalis fasciaforms anteriorwall of femoralsheath (posterior wall formedby iliopsoas fascia) Lateralfemoralcutaneous lliac fascia Cenital branch of genitofemoralnerve Femoralbranch of genitofemoral
Testicular vessels Externaliliac Inferior epigastric
Ductus(vas)deferensandcremasteric a Pectinealligament (Cooper's
*{r Plate 26.2
Femoralring Transversalis fasciaforms anterior wall of femoral sheath L a c u n a rl i g a m e n t( C i m b e r n a t '
I n g u i n al il g a m e n(tP o u p a r t ' s Lymphnode(Cloquet's) in femoral Femoralsheath(cutopen) Pectineal fascia
Body Wall
Posterior Abdominal Wall: Internal View
Cavalopening Diaphragm tendonof diaphragm andvagaltrunks crusof diaphragm Leftcrusof diaphragm Medianarcuateligament Aortaandthoracicduct and least ; lesser, nerves thoracicsplanchnic Medialarcuateligament Lateralarcuateligament trunk Sympathetic
Quadratuslumborum muscle minormuscle majormuscle abdominis Transversus muscle Internal obliquemuscle obliquemuscle External lliacusmuscle
iliacspine superior muscle Piriformis (ischiococcygeus) muscle ligament(Poupart's) internusmuscle muscle Rectococcygeus Tendinous archof levatorani muscle Openingfor femoralvessels ligament(Cooper's) Pectineal Lacunarligament(Cimbernat's) Pubicsymphysis Lesser trochanterof femur membrane Urethra Pubictubercle
Body Wall
*{r Plate 263
Arteries of Posterior Abdominal Wall
Inferior phrenic
Recurrent branch esophagus
Celiactrunkwith commonhepatic, leftgastric, and splenicarteriel
Superiorsuprarenal arteries artery $iddle suprarenal Superiormesenteric artery
Superiorsuprarenal arteries
Inferiorsuprarenal artery
Middlesuprarenal artery lnferior suprarenal artery
Leftrenalartery
Right renalartery
(ovarian) Testicular arteries
Psoasmajor muscle(cut)
Abdominalaorta mesenteric artery
Quadratus lumborum muscle
Leftcolic artery arteries
Subcostal artery
Superiorrectal artery
1stto 4th right lumbararteries Common iliacarteries
Mediansacral artery
lliolumbar artery
Internaliliac artery Superiorgluteal artery
Lateral sacralarteries External iliac artery
Umbilical(patent part)arterygiving riseto superior vesicalarteries
Testicular
(ovarian) artery Ascending branch of-
Obturatorarterv
qeep circumflex iliacartery
Inferiorvesical arteryand arteryto ductusdeferens
Superficial circumflex iliacartery
Middlerectal artery
lnferior epigastric
Internalpudendal artery
artery
Inferiorgluteal artery
Pubic, Cremasteric branches of inferior epigastric artery Superficial epigastric artery(cua)
Transversalis fascia(cut)
Femoralartery Ductusdeferensand testicular artery(cut) Superficial externalpudendalarteri Deepexternalpudendalartery
Plate 264
abdominalwall (turned down)
Medialumbilicalligament (occludedpartof umbilical artery)
4{F
Body Wall
Veins of Posterior Abdominal Wall
lnferiorphrenic
Diaphragm
Hepatic veins
Esophagus
lnferior vena cava
veinsand Leftsuprarenal with inferior anastomosis phrenicvein
Right inferior s u p r a r e n avl e i n Right renal vein
Leftrenalvein
Psoasmajor muscle (cut)
Ovarian(testicular) verns
Quadratus
Ascending l u m b a rv e i n s
l u m b o r u mm u s c l e vein Subcostal
iliac
vetn l st to 4th right lumbar vei
Internaliliac vetn
l l i o l u m b a rv e i n
Superiorgluteal vetn
Common i l i a cv e i n
nferiorgluteal veln
Ovarian
(testicular) v e i n sa n d ureter(cut)
lnternal pudendal vein
Internal
iliac External vetn
i l i a cv e i n
Middlerectal veln
Median sacralvein
Uterinevein
Lateral sacralvei
Superiorvesical vern
Deepcircumflex i l i a cv e i n
Deep circumflex iliacvein
Superficial circumflex i l i a cv e i n
Obturatorvein of uterus
lnferior epigastricvein (cut)
Inferiorepigastric vetn Superficialepigastricvein (cut)
tal venous
plexus
Pubic (obturator anastomotic)vein
Uterovaginalvenous plexus
Femoralvein
4{tr Body Wall
vein Creatsaohenous pudendalvein External
Vesicalvenousplexus Anteriorabdominal wall fturned down)
Plate 265
Lymph vessels and Nodes of posterior Abdominal wall
R i g h st u b c l a v i at n runk
Thoracicduct
Tracheobronchialnodes
Inferiorphrenicnodes Thoracicduct Cisternachyli R i g h ltu m b a trr u n k Intestinal trunk
Celiac nooes Superior mesenteric nodes
Visceral (preaortic) lymph nodes
lnferior mesenteric node
Leftlumbartrunk
Lumbarnodes (lateralaorticnodes)
Common iliac nodes
Common iliac nodes
Middle sacralnodes
Internaliliacnodes External iliacnodes
Lateralsacralnodes
Inferior epigastric OOO€-
Node of Cloquet, or Rosenmi.iller (highestdeep i n g u i n anl o d e )
Superficial inguinal nooes (superior, horizontal, and inferior lverticall groups)
Deep inguinal nooes
Plate 266
n{r Body Wall
Nerves of Posterior Abdominal Wall
and least Creater,lesser, nerves thoracicsplanchnic trunks Sympathetic nerve(T12) Subcostal lliohypogastricnerve (L 1 )
Celiac,superiormesenteric, and aorticorenalganglia
lliohypogastric nerve(11) llioinguinalnerve (Ll)
Muscularbranches from lumbarplexus nerve(T12) Subcostal
llioinguinal n e r v e( L l
Psoasmajor muscle(cut)
Cenitofemoral n e r v e( L 1 , 2 )
Quadratus lumborum muscle
Transversus abdominis muscle(cut)
lliohypogastric nerve(11)
Subcostal nerve (T1 and its lateral
cutaneous branch Intermesenteric (paraaortic)
plexus Crayand white rami communicantes
llioinguinal n e r v e( 1 1 ) Cenitofemoral n e r v e( L 1 , 2 ) Lateralfemoral cutaneous nerve(L2,3) Femoralbranch, Cenitalbranch of genitofemoral n e r v e( L 1 , 2 ) Lumbosacral trunks(14,5) Obturatornerves Accessorvobturator nerve(13,4) (occasional)
Lateral femoral cutaneous nerve (L2,3\ Femoral nerve
Femoralnerve plexus(14-54)
Pudendal nerve(S2,3, 4)
(L2-L4)
Obturatornerve(12,3, 4)
*{r Body Wall
nerve(11) Anteriorcutaneous branchof iliohypogastric 'Anterior nerve(L.l) of ilioinguinal scrotal(labial)branches
Plate 267
Regions and Planes of Abdomen
Right lateralrectusplane ( s e m i l u n al irn e )
Righthypochondrium (hypochondriac region
Umbilical region
Rightflank(lumbarregion)
Left lateralrectusplane ( s e m i l u n al irn e )
Left hypochondr
Leftflank(lumbar region)
.Et9$g!9tc!elplaE nous Dlane
Rightgroin(inguinalregion
eft groin(inguinal region)
Pubic(hypogastric region)
Plate 268
Peritoneal Gavity
Greater Omentum and Abdominal Viscera
Falciformligament
Left lobe of liver
Right lobe of liver
Stomach
Callbladder
Creater omentum overlYing colon and small transverse i n t e s t i n e( j e j u n u ma n d i l e u m )
Createromentum(turnedup) Transverse colon(turnedup) Transverse mesocolon
Left colic (splenic)fle
R i g h tc o l i c ( h e p a t i c )f l e x u r
S m a l li n t e s t i n e( l e j u n u ma n d i l e u m )
A s c e n d i n gc o l o n
Cecum S m a liln t e s t i n(ec o v e r i ndge s c e n d i ncgo l o n ) S i g m o i dc
U r i n a r yb l a d d e r
Peritoneal Gavity
4{v Plate 269
Mesenteric Relations of Intestines
Transverse colon (e/evated) Transversemesocolon
S u p e r i odr u o d e n af lo l d Superiorduodenal fossa Left colic (splenic)flexure Paraduodenalfossa Inferior duodenal fossa I n f e r i o rd u o d e n a lf o l d Mesentericoparietalrecess(fossa)
Superiormesenteric artery in root of mesentery ferior mesentericartery and vein A b d o m i n a la o r t a
Esophagus R i g h tc r u s o f d i a p h r a g m ( p a r tp a s s i n gt o r i g h t of esophagealhiatus) R i g h tc r u s o f d i a p h r a g m (part passingto left of esophagealhiatus) Left crus of diaphragm
Exposureof suspensory muscleof duodenum (ligamentof Treitz)
Celiac trunk Suspensorymuscle of tf d u o d e n u m( l i g a m e n o Treitz) Superiormesentericartery Duodenojejunalflexure e n d i n g( 4 t h ) p a r t of duodenum Jejunum
4{tr Pfate 27O
Inferior (horizontal,or 3rd) partof duodenum D e s c e n d i n g( 2 n d ) p a r t of duodenum
Peritoneal Gavity
Mesenteric Relations of Intestines (continuedl
colon ransverse (e/evated)
mesocolon
Creater omentum (e/evated)
(e/evatedover pancreas\
fejunum(cut) Freetaenia (taenialibera)
Mesentery(cutand smallintestineremoved)
Omental (epiploic) append
flexure eft colic(splenic)
Rightcolic (hepatic) flexure Rightparacolic gutter
Leftparacolicgutter
Ascending
Sigmoidmesocolon
Terminalpartof i l e u m(
gmoidcolon
Cecum Retrocecal
recess Vermiform appendix
*{r
Sigmoid colon (reflected) Sigmoid mesocolon
Intersigmoid Parietal peritoneum Commoniliacvessels
Peritoneal Gavity
Plale 271
Omental Bursa: Stomach Reflected
Inferior vena cava (retroperitoneal)
Castro-omental(gastroepiploic)arterialanastomosis(enclosed in gastrocolicligament)
Common hepatic artery (in peritonealfold) Hepatoduodenalligament (right margin of lesseromentum) Probe in omental (epiploic)foramen
Stomach(posteriorsurface) Caudatelobeof liver in superiorrecessof omentalbursa Left gastricartery (in gastropancreaticfold)
Leftinferiorphrenicartery (retroperitoneal)
Callbladder
Castrophrenicligament
Diaphragm
Leftsuprarenal glandand superior poleof kidney(retroperitoneal)
Liver
stro-
splenic (gastrolienal) ligament Spleen
R i g h tc o l i c (hepatic)flexure
Left colic (splenic)flexure ligament
Kidney(retroperitoneal) (2nd)partofduodenurh Descending Rightgastro-omental (gastroepiploic) artery(coveredby peritoneum) A n t e r i osr u p e r i opr a n c r e a t i c o duodenal artery (retroperitoneal) Head of pancreas(retroperitoneal)
Plate 272
S p l e n o r e n a(ll i e n o r e n a ll)i g a m e n t Tailof pancreas(intraperitoneal)
I Posteriorlayers | ^, ligament Anteriortry"r, iiril I of Sastrocolic Transverse mesocolon Body of pancreas(retroperitoneal)
Nr
Peritoneal Gavity
Omental Bursa: Cross Section
Vertebralbodyof L1
Left kidney
R i g h tk i d n e y
Parietal perttoneum
C r e a t e ro m e n t u m Visceralperitoneum (cut edges) O m e n t a l( e p i p l o i c ) / foramen (of Winslow) ( C o m m o n )b i l e d u c t Portal triad
Stomach
Pancreas O m e n t a l b u r s a( l e s s e sr a c )
Hepatic portal vein Proper hepatic artery
Peritoneal Gavity
L e s s eo r m e n t u m( h e p a t o d u o d e n a l and hepatogastricligaments)
Nr Plate 273
Peritoneum of Posterior Abdominal wall
Inferiorvena cava ( C o m m o n )b i l e d u c t a n d proper hepatic artery C o r o n a r yl i g a m e n to f l i v e r
R i g h st u p r a r e ngal a n d O m e n t u m ( e p i p l o i c )f o r a m e n \ behind right free margin o f l e s s e ro m e n t u m R i g h tt r i a n g u l a r ligament---1 Attachment of transverse mesocolon and right gastro-omental (gastroepiploic) vessels
Abdominal aorta and celiac trunk F a l c i f o r ml i g a m e n t Hepatic VCINS
Superiorrecessof omental bursa (lessersac) Attachment of lesseromentum and left gastricartery
Esophagus
Left triangular ligament of liver Castrophrenic l i g a m e n ta n d left inferior phrenic artery t gastflc
vessels
R i g h tk i d n e y
Splenorenal (lienorenal) l i g a m e n ta n d splenicvessels
Parietal peritoneum
Phrenicocolic ligament
Duodenum
Root of mesentery Site of ascending colon Common iliac artery (retroperitoneal) Externaliliac artery (retroperitonea
Testicular v e s s e l(sr e t r o peritoneal)
Ureters(retroperitoneal Siteof deep i n g u i n a lr i n g Median umbilical fold (contains
uracnus)
Nr Plale 274
Pancreasand splenicartery (retroperitoneal) Attachment of transverse meS0colon Superior mesenteric vessels Siteof descending colon Attachment of sigmoid mesocoton and sigmoid vessets Superior rectal vessels Sacrogenital fold (ligament) Lateral u m b i l i c a fl o l d (contains inferior epigastricvessels) Medial u m b i l i c a fl o l d (contarns occluded part of umbilical artery)
Peritoneal Cavity
Stomach in Situ
Leftlobeof liver Falciform ligament
ligament ) Hepatoduodenal omentum I Lesser ligament, Hepatogastric Abdominalpart of esophagus
notch(incisure) Cardiac
Round ligament ofl (obliterated umbilical vein)
Fundusof stomach Diaphragm
lnferior border of Quadrate lobeof liver Riehtlobe ofliver.Gallbladder Omental (epiploic) fora
(of Winslow) Pylorus Duodenum Rightkidney (retroperitoneal)
*{r
Rightcolic (hepatic) flexure
createromentum
flexure Leftcolic(splenic)
Variationsin positionand contour of stomachin relationto bodv habitus
Hypertonic stomach
Viscera (Gutl
Orthotonic stomach
Hypotonic stomach
Atonic stomach
Plate 275
Mucosa of Stomach SeeatsoPhe 236
Z i g z a g( Z ) l i n e (junction of gastric and esophagealmucosa)
Cardiacorifice
Gastricfolds(rugae) Pyloricorifice
Gastriccanal (magenstrasse)
S u p e r i o(r1 s t )p a r t of duodenum ( a m p u l l ao,r
Pylorus
d u o d e n a lc a p )
Castric and fundic zones
4{F Pyloriczone
Surfaceepith e l i a l
e1 M u c o u sc e l l
Parietal cell (betweenmucouscell a n dc h i e fc e l l )
S o l i t a r yl y m p h f o l l i c l e( n o d u l e ) N e u r o e n d o c r i n eC c e l l
Muscularis Submucosa
Plate 276
Castric (fundic)glands
Viscera (Gutl
Musculature of Stomach
muscleof esopha Longitudinal
musclelayerof stomach Outerlongitudinal (concentratedchieflyat lesserand Sreater curvaturesand at pyloric part)
Middlecircularmusclelaverof stomach
4{tr Collarof Helvetius (middlecircularand i n n e r m o sotb l i q u e fibersblendhere)
Outer longitudinalmuscle
layer(cutaway)
Section through pylorus (composeo chieflyof thickened circular muscle)
Middlecircular musclelayer lnnermost obliquemuscle layer
Circularmuscle of duodenum Longitudinal m u s c l eo f d u o d e n u m
Viscera lGutl
Windowscut in m i d d l ec i r c u l a r musclelayer
Plale 277
Duodenum in Situ
Head of pancreas
Suprarenal gland Kidney
Superiormesentericvessets
Transverse mesocolon and itscut edges
Celiactrunk Rightfreemarginof lesser omentum(hepatoduodenal ligament)
Splenicartery
Transverse colon (cut) Leftcolic (splenic) flexure
Suprarenal gland
Pylorus Ki Transverse mesocolon and its cut edges Right colic (hepatic)
flexure Transverse colon(cut)
Ascending colon
Psoas maJor muscle
S u p e r i o(r1 s t )p a r t
Descending colon
Descending(2nd) part
Duodenum
Inferiorduodenalfold andfossa
Inferior (horizontal,
or 3rd)part Ascending (4th)par Rootof mesentery(cut edgei)
Duodenojejunal flexureandjejunum(cut) Inferiormesenteric artery Abdominalaorta Inferiorvena cava
Plate 278
4{r Viscera (Gutl
Mucosa and Musculature of Duodenum Hepatic portal vein
Properhepaticartery artery troduodenal
( C o m m o nb) i l ed u c t
Rightgastricartery Rightfreemarginof lesser omentum(hepatoduodenal ligament)
Commonhepaticartery
Pyloricorifice
Superiorduodenal
(Common)bileduct
S u p e r i o(r1 s t )p a r t ( a m p u l l ao,r duodenalcap) (no circularfolds)
Accessorypancreatic duct (of Santorini) (Principal)pancreatic duct (of Wirsung)
Descending
(2nd)part Minor duodenal papilla (inconstant
flexure Duodenojejunal
Circularfolds (valves of
Jejunum
Major duodenal papilla(of Vater)
(4th)part Ascending Head of pancreas
mesentericartery and vein
Inferiorduodenalflexure Inferior(horizontal, or 3rd)part
Outer longitudinal musclelayer (with window cut)
lnner
circular muscle layer (with window cut)
Laversof dubdenalwall
Submucosa with duodenal (Brunner's) glands
*{r Viscera lGutl
of stomach, Barium radiograph -proximal jejunum duodenum, and B Bodyof stomach D Duodenalcap (1st part) D 2 D e s c e n d i n(g2 n d )p a r t of duodenum F Fundusof stomach jejunum Proximal I P Pylorus PA Pyloricantrum
Plate 279
Mucosa and Musculature of small Intestine
fejunum Mesentery A n a s t o m o t i cl o o p ( a r c a d e )o f jejunal arteri Straightarteries (arteriaerectae) Serosa(visceral pefltoneum) Longitudinal m u s c l el a y e r Circular m u s c l el a y e r Barium radiographof jejunum
Submucosa Mucosa
C i r c u l afro l d s (valves of Kerckring) Solitary l y m p h o i dn o d u l e
lleum Mesentery Anastomotic loops (arcades)of ileal arteries Straightarteries (arteriaerectae Serosa(visceral pefltoneum)
Longitudinal musclelayer Circular musclelayer
Barium radiographof ileum
Submucosa Mucosa
Circularfol S o l i t a r yl y m p h o i dn o d u l e s Aggregatelymphoid n o d u l e s( P e y e r ' sp a t c h e s
Plate 28O
4{tr Viscera (Gutl
lleocecal Region
lleocolicartery -Colic branch llealbranch Superiormesentericartery Posteriorcecalarterv artery Appendicular Anteriorcecalartery Vascularfold of cecum uoeriorileocecalrecess lleocecalfold (bloodlessfold of Treves) Terminalpartof ileum Inferiorileocecalrecess
Appendicular artery Vermiformappendix Freetaenia (taenialibera)
External iliacvessels (retroperitoneal) Retrocecalrecess Cecalfolds Rightparacolicgutter Omental taenia
*{r
Posteriorcecal Cecalfolds
Somevariationsin posteriorperitonealattachmentof cecum nesof
Viscera (Gutl
Plate 281
lleocecal Region (continuedl
Free taenia (taenia libera)
Ileocecallips:labialform of ilealorifice (asseencommonlypostmortem and occasionally in vivo)
Terminalpartof ileum
Orifice of vermiform appendix
Freetaenia (taenialibera) Vermiform appendix
Circularmuscleof colon Mesocolic taenia
Fibersto papilla Fibersto ileum Fibersaround ileocecaljunction
C i r c u l am r u s c l eo f i l e u m
llealpapilla:papillary formof ilealorifice (found.mostcommonly In vtvol
Schemaof musclefibersat ileal orifice
Plate 282
4{F Viscera (Gutl
Vermiform Appendix
long of unusually Bariumradiograph appendix(A Appendix;C Cecum)
Variationsin position of appendix
Mesoappendix (visceral peritoneum) o n g i t u d i n aml u s c l e Circularmuscle
4{tr Viscera lGutl
Plate 283
Mucosa and Musculature of Large Intestine Forrectum andanalcanal seeplates391-396
Creater omentum (cut away) R i g h tc o l i c (hepatic)flexure
Transversemesocolon Transversecolon Omental taenia
Omental (epiploic) appendices Haustra
(cut away)
Peritoneum (cutaway)
Omental taenia (exposed
Descending colon
Peritoneum
by hook
Freetaenia (taenialibera)
Ascending coton
Mesocolic taenta (exposed by hook)
S e m i l u n af or l d s R e c t o s i g m o i jdu n c t i o n (taeniaespreadout and unite to form longitudinal
Freetaenia (taenialibera)
musclelayer) lleal orifice
Vermiform appendix
Levatorani muscl
Externalanal sphinctermuscle
Plate 284
Nr Viscera (Gutl
Sigmoid Golon: Variations in Position
Short,straight, obliquelyinto pelvis
*{r
Looping to right side
Viscera lGutl
Ascendinghigh into abdomen
Plate 285
Topography of Liver
Lateralrectus ( s e m i l u n a rp) l a n e
Transpyloric plane
Diaphragm
Liver covered by diaphragm, p l e u r aa n d rung (percussion duliness) Diaphragm Liver covered by diaphragm and pleura (percussion flatness)
Liver coveredby diaphragm, p l e u r aa, n d rung (percussion dullness)
Liver covered by diaphragm (percussion flatnessor intestinal resonance)
Liver covered by diaphragm and pleura (percussion flatness)
Nr Diaphragm
Plate 286
Livercovered bydiaphragm, preura, a n dl u n g (percussion d ul l n e s s )
Livercovered by diaphragm and pleura (percussron flatness)
allbladder lnferior border of liver
Viscera (Accessory Organsl
Surfaces and Bed of Liver Coronaryligament
Diaphragm(pulled
ligament Lefttriangular
Right triangular
Fibrousappendixof liver
ligament Leftlobe of liver Rightlobe of liver-
ligament Falciform
teres)of liver Roundlieament(ligamentum (obliteraiedumbiliial vein)formingfree borderof falciformligament
Costal
*{r
Anteriorview
Portahepatis teres Fissure for ligamentum Hepaticportalvein
C o l i ci m p r e s s i o n
hepaticartery process process Papillary Caudatelobe for Fissure venosum ligamentum sophageal
Roundligamentof liver Callbladder Quadratelobe Duodenal R e n ailm p r e s s i Cysticduct
rmpresslon
Castricimpression
Common hepatic duct ( C o m m o n )b i l e d u c t
ligament Righttriangular portionof Hepatorenal coronary ligament
impr Suprarenal Bare area lnferior vena
Coronary ligament
Hepatic veins
Visceralsurface
Lefttriangular ligament
ligament Coronary Barearea lnferior vena cava Suprarenalgland
Rightkidney
Left triangular ligament
R i g ht r i a n g u l a r ligament
Superiorrecess of omentalbur
for Fissure ligamentum venosum
Duodenum
Stomach
Croove for (inferior)vena
Posteriorview
Viscera (Accessory Olgansl
Bedof liver
Plale 287
Liver in Situ and Variations in Form
Roundligament(ligamentum teres)of liver (obliterated umbilicalvein) Quadrate Callbladder
Leftlobe of liver Caudatelobeseenthroughlesser omentum(hepatogastric ligament)
Rightlobeof liver
cut in lesseromentum (hepatoduodenal ligament)
Omental (epiploic) foramen (of Winslow)
Properhepaticartery (Common)bileduct portalvein
Kidney (retroperitoneal)
Lesser omentum (hepatogastric ligament)
Duodenum
Spleen
Leftcolic (splenic) flexure Rightcolic (hepatic) flexure
*{r Variationsin form of liver
Verysmallleft lobe,deepcostal impressions
Completeatrophy of leftlobe (leftportalvein compression)
Transverse, "saddlelikd'liver, relativelylargeleft lobe
Verydeep renal impression and 'torsetconstriction"
Plate 288
Viscera lAccessory Olgansl
Liver Segments and Lobes: Vessel and Duct Distribution -
6b;;
l
Functional surgical segments
Leftlobe
Rightlobe
Anatomicf
Right(partof) liver Lateral division
Medial division
is Divisioninto segments basedupon ramificationsof bile ductsand hepaticvessels. It doesnot entirelycorresPond with divisioninto anatomiclobes.
Left(partof) liver Medial division
Posterior lateral seBment (vil) (Posterior supenor
Lateraldivision
Parietal surface
area)
Right anterior lateral segment
Rightlobe
(vt)
(Posterior inferior area
Visceral surface
4{F
Distributionof vessels and ducts I 2 3 4 D
Phantomdivision betweenanteriorand posteriorsuperiorareas
Inferiorvenacavd
Viscera lAccesso;y Organsl
Commonhepaticduct,hepaticportal vein,and properhepaticarterY
6 7 8 9 10 11 12 13 t4 l5 16
Rightbranch Left branch Anteriorsegment Medialsegment Posteriorsegment Lateralsegment Anteriorinferiorarea Medialinferiorarea Anteriorsuperiorarea Medialsuperiorarea Posteriorinferiorarea Lateralinferiorarea Posteriorsuperiorarea Lateralsuperiorarea Caudatelobe (rightand left) Caudateprocess
Plate 289
lntrahepatic vascutar and Duct systems
S u b l o b u l avre i n
H e p a t i cv e i n
o b u l a rv e i n s
Portal triad
Portal triads
Properhepaticartery Perivascular fibrous(Clisson,s) capsuleextendinginto porta hepatisalongvesielsa'jd bileduct
Hepatic portal vein C o m m o n h e p a t i cd u c t
Portaltriad
to hepatic vein
Normallobularpatternof liver
Plate 29O
4{tr Viscera (Accessory Olgansl
Liver Structure: Schema
Lymphvessel
Connective tissue Limiting plate
Centralvein
of portal space
vein (tributary to hepaticvein) Sublobular
Periportal space(of Mall)
Perisinusoidal spaces(of Disse)
Centralvein Sinusoids Centralvein
Periportal bileductule (canalof
Branchof portal vein
Bileduct
Branchof hepaticartery Portalarteriole Intralobular bileductule(cholangiole)
Periportal arteriole Intralobular arteriole
Central vein
Periportal bileductule(canalof Hering) Inletvenule Distributing vein
Viscera (Accessory Organsl
4{tr Plate 291
Intrahepatic Biliary Systems: Schema
l l i l , ' , . rn . r l i tu l i
Si r ru s o i c i
&.1' $
#
I n l t , r l , r, tl r l , rIrr r l l r l r r rl L r l r , r ,J r , , l ,rr, r; j , , 1 , . ( ,
N o l r . ; l r r t l t e . t l r o v r ,i l l u s l r . r t i o r r , l r i c r . l r . r l r cu l i , r 1 t p r ' , rars : l t . t rlrr r r l sr r i l l rr r , r l l , , r lt l r r . i r o , , rn l l o t t e \ ( , r ,i t \ r l t o t t n l r l r t l
, t c lr r , r i l t , ,st l t e ' ri . t l i z , r l r o O r tl - t r ' l ' { t s r , r l ' r . , . , - , , t r { 1 , , ri i | r l i v t ' r p . r r r , n lr t l r n a l r r ' l l s .
(,
ic?
4{tr .::'
''
i'\
d)
L o w - p o w e rs e c t i o n o f l i v e r
Plate 292
Viscera (Accessory Organsl
s
o o o rt
TransverseSection: Level of T1 0, Esophagogastricfunction
ql ,-'
D o o o
Diaphragm
o o
R e c t u sa b d o m i n i sm u s c l e
o
Xiphoidprocess
Costal cartilages
o o
!
o
5
ju nction Esophagogastric
o
rt
|o ql 3
-o
3 ql
Castric folds (rugae)
R i g h tc r u s o f d i a p h r a g m (forming right boundary of esophagealhiatus)1
t II
o F u n d u so f s t o m a c h
Right crus of diaphragm (forming left boundary of esophagealhiatus)
Serratus a n t e r i o rm u s c l e
Thoracic aorta Azygos vein
=
Left crus of diaphragm
o rh
Spleen
lnferior lobe of left lung in costodiaphragmaticrecess
I n f e r i o rl o b e o f r i g h t l u n g i n costodiaphragmaticrecess
Bodyof T10 vertebrS
o gf
r c o 3 o f
Erectorspinae muscle
!t rl
!r rf
N
o o t IT
Latissimusdorsi muscle
o
o o o to
o
Diaphragm
!
o rt
lnferior vena cava
.{
Thoracic duct
cryd4#
d
0
Gallbladder and Extrahepatic Bile Ducts
Right and left h e p a t i cd u c t s
Rightand left hepaticarteries Properhepaticartery
Common hepatic ducl
Anteriorlayerof lesseromentum(cutedge)
Cystic artery
Rightgastricartery Cystic duct ommon hepatic artery
Hepatic p o r t a lv e i n
Gastroduodenal artery Liver Stomach (Common) bileduct
Callbladder Hepaticducts
S u p e r i o(r1 s t ) partof duodenum
t
Left
Cysticduct
Transverse colon (cut)
Spiral Smooth par! fold
Head of pancreas
4{tr
(Hartmann's pouch)
Common hepatic duct Cland orifices
Callbladder
(Common) bileduct
Descending ( 2 n d )p a r t o f duoden
Hepatopancreatic ampulla (of Vater) M a j o r d u o d e n a lp a p i l l a( o f V a t e r
Plate 294
Viscera (Accessory Organsl
Junction of (Gommonl Bile Duct and Duodenum
(Common) bile duct ( d u c t u sc h o l e d o c h u s ) Longitudinalmuscle of duodenum
Minor duodenal Longitudinal duodenal muscteseen through openrng in circular
papilla Circular folds Major duodenal papilla
ircularmuscle of duodenum Pancreaticduct Sphincterof (common) bile duct (choledochus)
muscle
o n g i t u d i n ablu n d l e Reinforcing
of pancreatic Sphincter duct (inconstant)
fibers Longitudinal
fold
Fibersto longitudinal
Reinforcing fibers Duodenalmusclefibersto longitudinal bundle
bundle
Interior of descending (2nd)part of duodenirm
Sphincterof hepatopancreatic ampulla
D u o d e n am l ucosa
( C o m m o n )b i l e d u c t
( C o m m o n )b i l e d u c t
Pancreas
Sphincterof ( c o m m o n )b i l e L o n g i t u d i n aIl D u o d e n a l L o n e i t u d i nbaul n d l e Circular I muscle Pancreatic ( C o m m o n )b i l e d u c t
D u o d e n am l uscle
L o n g i t u d i n abl u n d l e
Pancreas
S p h i n c t e ro f ( c o m m o n ) bileduct (choledochus) Pancreaticduct
Fibersto longitudinb au l ndle Sphincterof pancreatic duct (inconstant)
( C o m m o nb) i l ed u c t of Sphincter hepatopancreatic ampulla
L o n g i t u d i nbaul n d l e Pancreaticduct
S p h i n c t eorf hepatopancreatic ampulla
ion, level B Sphincterof hepatopancreatic
Major d u o d e n a lp a p i l l a
Reconstruction
ampulla Hepatopancreatic ampulla (common channel)
Variationsin union of bile and pancreaticducts (Common) b i l ed u c t
Pancreatic duct tncter
of ampulla Short common channel
f (Common; I bileduct
Pancreatic duct Duodenal
ncter of
ampulla
watl
No common channel
Viscera (Accessory Olgansl
L o n gc o m m o n channel
4{tr Plate 295
Variations in Gystic and Hepatic Ducts
Variationsin cysticduct Adherentto common hepaticduct
Highunion with common hepaticduct
Anteriorspiral , o r n r n cgo m m o n hepaticducton left side
Accessory(aberrant)hepatic ducts
Plate 296
Viscera (Accessory Organsl
s
o
TransverseSection: level of T12, Inferior to Xiphoid
o o rt !f A
D o o o
Pyloric canal
o o
o -
Right colic (hepatic)flexure of colon Transversecolon (ascendingto left colic flexure)
o
Gallbladder
rt
to !l =
o
Y
t
IT
o
o rt
D e s c e n d i n gc o l o n (descendingfrom left colic flexure)
(Common) b i l ed u c t
Splenicartery and vein
Proper hepatic
Left suprarenalgland
anery Superiorpoleof leftkidney
Portal Inferiorvena cav
D
Thoracic aorta Pancreas
5 ll
Rightcrusof diaphragm
t
t
{
o o !i. o 5 o + r c o 3 o
Left crus of diaphragm
Right suprarenalgland
o
o o
o
Spleen
o N o
5
o ll
of duodenum
Hepatoduodenal ligament
!ql
o
3
Superior(.1st)part
Portaltriad
o
cr7#
{ -
N \
Pancreas in Situ
C e l i a ct r u n k
Splenicartery
Stomach (cut)
Portal triad( Proper heparrc I ( ( C o m m o n )b i l e
Right free margin of lesseromen Suprarenalgla Duodenum R i g h tk i d n e y (retroperitoneal)
Attachment of transverse mesocolon
R i g h tc o l i c (hepatic) flexure
Transverse colon (cut) Transverse colon (cut
Left kidney (retroperitoneal) Attachment of transversemesocolon Inferior mesentericvein (retroperitoneal)
Middlecolicarteryandveifi Superiormesentericartery and veir{
Duodenofejunal flexure
Uncinate processof panc
Root of mesentery(cut)
4ttr
Low-power section of pancreas
Pancreaticnotch (of Langerhans)
n t e r l o b u l adru c t Interlobula r ptum se
Plate 298
Pancreaticduct (ofWirsung)
y pancreaticduct (of Santorini)
Viscera (Accessory Organsl
Spleen
Posterior extremity
ligament Castrosplenic
Posterior extremity
Superior
Short gastric vessels
Castric impression
Renal impression
Hilum
lnferior border Splenorenal (lienorenal) ligament
Splenicartery Leftgastro-omental (gastroepiploic) vessels Splenic Colic Anteriorextremi
Diaphragmatic surface
Visceralsurface
Anteriorextremitv
Shortgastricvessels Stomach(cut) Serosa(visceral
S p l e n ip culp Splenic trabeculae Splenicvein
Crosssection
gland Suprarenal
Splenicarteryand
*{r
(lienorenal) ligament Splenorenal (cut) mesocolon Attachmentof transverse
Viscera (Accessory Organsl
Spleenin situ
Plate 299
Arteries of Stomach, Liver, and Spleen
Right and left inferior phrenic arteries A b d o m i n a la o r t
Left gastricartery Splenicartery
Celiac trunk
Esophagealbranch of left gastricartery
Lefthepaticartery Recurrentbranch of left inferior phrenic artery to esophagus
Right hepatic artery
Short gastric arteries
Cystic
artery Cystic duct Proper hepatic artery (Common;
bileduct Hepatic portal vein Right gastric
artery Supraduodenal artery
*{ry Posterior superior, A n t e r i osr u p e r i o r pancreaticoduodenalarteries
C o m m o n h e p a t i ca r t e r v Right gastro-omental ( g a s t r o e p i p l o i ca)r t e r y Castroduodenalartery
Plate 3OO
S p l e n i cb r a n c h e so f splenicartery Left gastro-omental (gastroepiploic)artery Dorsal pancreaticartery
Visceral Vasculature
Arteries of Liver, Pancreas, Duodenum, and Spleen
Intermediate hepaticartery Properhepaticartery Righthepaticartery
Rightand leftinferiorphrenic arteries(shownherefrom commonstem)
Lefthepaticartery Hepatic portal vein
e l i a ct r u n k
Common hepatic
artery
Abdominalaorta
Cysticartery Left gastric artery
Callbladder
Short gastric arteries
Cystohepatic triangle (of Calot) Cystic Commonhepaticduc ( C o m m o n )b i l e
Rightgastricartery Leftgastro-omental (gastroepiploic) artery
Supraduodenal a
Arteryto tail of pancreas
Gastroduodenal artery
eaterpancreaticartery Splenicartery I pancreaticartery pancreatic artery Anastomotic branch Middlecolicartery(cut) Posterior superior pancreaticoduodenal attery (phantom
artery Superiormesenteric artery Inferiorpancreaticoduodenal
Anteriorsuperior pancreaticoduodenalartery Right gastro-omental
(gastroepiploic) arteri
Visceral Vasculature
Posterior inferior pancreaticoduodenal artery Anteriorinferior pancreaticoduodenal artery
*{r Plate 3Ol
Variations in Geliac llunk
Splenicartery t a k e so r i g i n
C o m m o no r i g i no f c e l i a ct r u n ka n d superiormesenteric arrery
Splenicand hepatic arteriestakeorigin rromsupenor mesenteric
Replacedright hepatic artery takes origin from superior mesenteric; inferior pancreaticod u o d e n a la n d 1s t jejunal arteriesfrom replaced right hepatic
Accessory righthepatic arterytakesoriginfrom superiormesenteric; inferioroancreaticoduodenalarteriesfrom accessory righthepatic; I stjejunalartery from anteriorinferior pancreaticoduodenal
Plate 3O2
f
,/
f r o ms u p e r i o r m e s e n t e n(cn o t e replacedleft hepaticartery from leftgastric)
Hepatolieno-
mesenteric trunk
Replacedhepatic artery takes origin Tromsupenor mesenteric(note inferior pancreaticoduodenalartery from 1st jejunal)
Lienogastric trunk
Hepatomesenteric trunk
te c e l i a ct r u n k teflc
Accessory right hepatic artery takes origin from supeflor mesenteric
Complete celiac trunk
Hepatomesenteric trunk
Rightgastroepiploic (gastro-omental) :r
celiac trunk artery takes origin from Hepatomesenteric supenor mesenteric (Noteaccessorv (note accessory left gastricartery left hepatic from left hepatic) artery from left gastric)
Visceral Vasculature
Geliac Arteriogram SeealsoPlates 300, 301
1i
Visceral Vasculature
CH CT G CD H RC
C o m m o n h e p a t i ca r t e r y C e l i a ct r u n k Left gastricartery
s
S p l e n i ca r t e r y
C a s t r o d u o d e n aal r t e r y P r o p e rh e p a t i ca r t e r y R i g h tg a s t r i ca r t e r y
Plate 3O3
Arteries of Duodenum and Head of Pancreas
Duodenum and head of pancreasreflectedto left ( C o m m o nb) i l ed u c t Castroduodenal artery Posterior superiorpancreaticoduodenal Anteriorsuperiorpancreaticoduodenal artery (phantom\
Superiormesenteric artery Inferior pancreaticoduodenalarterv
Posterior inferior pancreaticoduodenalartery
Anteriorinferior pancreaticoduodenalartery (partially in phantom)
Inferiorvena cava
Celiactrunk Splenicartery
oper hepatic artery Common hepatic artery Supraduodenalartery
Castroduodenal artery (partiallyin phantom\ Posterior superior pancreaticoduodenal artery ( C o m m o nb) i l ed u c t Rightgastro-omental (gastroepiploic) artery (phantom,cut) Createrpancreaticartery Inferior pancreaticartery Dorsal pancreaticartery
Anteriorsuperior pancreaticoduodenal artery (phantom) ic branch Posteriorinferior pancreaticoduodenalartery
Superior mesentericartery Inferior
Anterior inferior pancreaticoduodenaf artery (ph antom)
pancreaticoduodenalartery
Posteriorview
Plate 3O4
Visceral Vasculature
ArterialVariationsandGollateralSupplyof Liverand Gallbladder Umbilicus(turnedup\
Internalthoracicarteries with arteries alciformand roundligaments
Right,middle(variable), and lefthepaticarteries
Shortgastricarteries
Cystic artery
lntercostal arteries
Left gastro-omental (gastroepiploic) artery
Inferior phrenic artery Castroduodenal artery
Leftgastric artery
Common hepatic
Celiactrunk Posteriorsuperior
pancreaticoduodenal artery
Splenicartery
Anteriorsuperior pancreaticoduodenal arter
Dorsal pancreatic artery
Rightgastricartery
Superior mesenteric artery
Rightgastro-omental (gastroepiploic)
Inferiorpancreatic artery
Inferior pancreaticoduodenalartery
Omental(epiploic)arteri Omental(epiploic)arterialarc
*{r Accessoryor replacedarteries 1. Rightor commonhepatic 2. Lefthepatic 3. Righthepatic 4. Cvstic Anastomoses of correspondingarteries left hepatic 5. Inferiorphrenic/leftgastricH 6. Right<-+ left hepatic
Visceral Vasculature
Cystic
Capsular
Right gastric Gastroduodenal relativesafety Effectsof hepatic I l" Zonr.of
;[il;;'i''ffiil"I Bi:ffi:1iJ""Ji':;E?i?"",'5: Plate 3O5
Arteries of Small Intestine
Common hepatic artery
S u p r a d u o d e n aal r t e r v
C e l i a ct r u n k S p l e n i ca r t e r va n d v e i n
C a s t r o d u o d e n aal r t e r y
Posterior superior pancreaticoduodenalartery Right gastro-omental ( g a s t r o e p i p l o i ca)r A n t e r i o rs u p e r i o r pancreaticoduodenalartery
Dorsal pancreatrcartery nor
pancreatrc artery Superiormesenteric arteryandvein
Anastomosis (inferior pancreattcoduodenal to 1s t j e j u n a l
artery
R i g h tc o l i c artery lleocolic anery
Superior mesenteflc
artery Anterior cecal artery Posterior cecal artery
Appendicular artery
J e j u n aal n d i l e a l( i n t e s t i n a la) r t e r i e b A n a s t o m o t i cl o o p s ( a r c a d e s ) Straightarteries(arteriaerectae)
Plate 3O6
4{tr Visceral Vasculature
Arteries of Large Intestine Forafteries Superiormesentericartery
Middle colic artery Transverse mesocoron
Marginal dr rEr y
Straightarteries (arteriaerectae
i u n a la n d i l e a l (intestinal)arteries
\ Marginal artery
(Common portion)
lnferior mesenteric aruery
Posterior Anterior
eft colic
artery
Marginal artery
Ascending branch Descending branch Marginal arrery
lleocolic a Colic branch lleal branch
Sigmoid arteries igmoid mesocolon
Anterior cecal arter
Posterior cecalartery Appendicular
arrery
I n t e r n a li l i a c aight artenes (arteriae rectae)
Median sacralartery (from abdominal aorta)
Middlerectalartery Branchof superior rectalartery
Visceral Vasculature
rior rectalartery
,d, nferiorrectalartery
4{r
Plate 3O7
Variations in Golic Arteries
Middlecolic
Middle colic artery
artery
Right colic arrery
R i g h tc o l i c
arrery lleocolic artery
Commontrunk for right colic and middle colic arteries Largebranch from left colic artery
Middlecolic artery absent
R i g h tc o l i c artery absent
Right colic artery lleocolic artery -
lleocolic
artery
Absenceof middlecolic artery replacedby large branchfrom left colic artery of Riolan Middlecolic
artery
Superior mesenteric artery
R i g h tc o l i c
arrery
Inferiormesenteric artery
lleocolic
Leftcolic artery
artery
Arc of Riolanbetween middlecolic and left colicarteries
Plate 3O8
$r Visceral Vasculature
Veins of Stomach, Duodenum, Pancreasr and Spleen
H e p a t i cv e Hepatic portal
lnferior vena cava Left gastricvein and esophagealtributary
Posterior supenor pancreaticoduodenal
Short gastnc vetns
vetn
Right gastricvei Prepyloric vetn
Anterior supenor pancreatrcoduodenal vern Right gastro-omental (gastroepiploic)
Leftgastroomental (gastroepiploic) vetn
vel
Posterior inferior pancreatrcoduodenal vet
Anterior inferior pancreaticod u o d e n a lv e i n vern n t cv e t n
S u p e r i o rm e s e n t e r i c
gastric verns Hepatic portal vein R i g h tg a s t r i cv e i n P o s t e r i o sr u p e r i o r pancreaticoduodenalvein S u p e r i o rm e s e n t e r i cv e i n Right gastro-omenta ( g a s t r o e p i p l o i cv)e i Anterior superior pancreaticoduodenalvei
Left gastro-omental (gastroepiploic)vein (Creat) pancreaticvein
Anterior inferior oancreaticoduodenaJ vein Posteriorinferior oancreaticoduodenalvei
Visceral Vasculature
Inferior mesentericvein
*{r Plate 3O9
Veins of Small Intestine
Hepatic portal vein
Left gastricvein
S p l e n i cv e i n Right gastric vern
S u p e r i o rm e s e n t e r i cv e i n
Middle colic vetn (cut)
J e i u n a al n d i l e a l( i n t e s t i n a lv)e i n s A n a s t o m o t i cl o o p s
Right colic vetn
Straightveins (venae rectae)
Transversecolon (e/evated) Transverse mesocoton
*{r S u p e r i o rm e s e n t e r i ca r t e r ya n d v e i n
l e j u n a la n d i l e a l( i n t e s t i n a lv)e s s e l
Relations of superior mesentericvein and artery in root of mesenterv
Plate 31O
Visceral Vasculature
Veins of Large lntestine
Left gastric vein
Hepatic portal vein
S p l e n i cv e i n
Prepyloric vetn
Superior mesenteric Rightgastroomental(gastroepiploic) vei
(Dorsalor superior) pancreaticvein lnferior vein mesenteric
Anteriorsuperior pancreaticoduodenalvein
from colon(cut) Tributary Posterior inferior pancreaticoduodenalvein Anterior inferior pancreaticoduodenalvei Middle colic vein (cut) Right colic lleocolic Anterior cecal vein Posteriorcecal vein
Appendicular
Jeiunaland ileal (intestinal) veins eft colic vein
Lefttesticular (ovarian)vessels mesentertcveln Sigmoidveins Median sacralvein
Superior rectalvein
Righttesticular (ovarian) vessels iliacvessels External lnternaliliac ve
Superiorglutealvein Obturator
Tributaries of left and rightsuperior rectalveins rectalvenousplexus Perimuscular Leftmiddlerectalvein Leftinternalpudendalvein in pudendalcanal(Alcock's) Externalrectalvenousplexus
Right middle rectalvein Right inferior rectalvein
(to internalpudendalvein)
Visceral Vasculature
Nr Plate 3l I
Hepatic Portal Vein Tlibutaries: Portacaval Anastomoses
Falciform ligamentand roundligamentof liver Paraumbilical veins
Right gastric vetn
Esophageal veins
I I I
Bloodfrom superior mesentericvein Bloodfrom splenic,gastric, and inferior mesentericveins Mixture of above two Cavaltributaries Leftgastricvein
Hepatic portal
Short gastric veins
Posterior, Anterior superior pancreaticoduodenal
Left gastroomental (gastroepiploic) vein
vernS
Superiormesenteric vein Splenicvein Posterior, Anterior inferior pancreati duodenal verns Middle colicvein
Rightgastroomental(gastroepiploic)vein Inferior mesenteric vein Leftcolic vein
Right colicvein
Sigmoidveins
Anterior, Posterior
Leftand right superior rectalveins
cecal vetns
i
Appendicular vetn
Middlerectalveins Levatorani muscle
1 2
Portacavalanastomoses Esophageal 3 Rectal Paraumbilical 4 Retroperitoneal
Pfate 312
lnferiorrectalveins
4{tr Visceral Vasculature
Variations of Hepatic Portal Vein
Typicalarrangement
Esophagealvein Cysticvein
Short gastric vetn
Leftgastric veln
Hepatic portal vein
--t---, 1 . 0 9c m
__t___ Posterior superior pancreaticoduodenalvein
Pancreaticveins
Suoeriormesentericvei
Leftgastro-omental (gastroepiploic) vein
Rightgastro-omental (gastroepiploic) vein
lnferior mesentericvein
Inferiorpancreatico-
Left colic vein
duodenal veins
Middlecolicvein Right colic
and ileal Jejunal (intestinal) veins
l l e o c o l i cv e i n
lnferior mesenteric vein mav enter junctionof splenic and superior mesentericveins Hepatic portal vein
S p l e n i cv e i n
lnferior mesentericvern mayentersuperior mesentericvein Hepatic portal vetn
Superior mesenteric
Superior mesenteric
vetn
High intestinalveins
Splenicvein lnferior vein mesenteric
vetn
Leftgastricvein oftenentersjunction of splenicandsuperior mesentericveins
Left gastricvein may entersplenicvein (24% of cases) Right gastricvein Hepatic
portal vetn
Hepatic Left gastric vein
Leftgastric
portal vetn
Superior mesenteric vetn
4{tr Visceral Vasculature
Plate 313
Lymph Vessels and Nodes of Stomach
Celiac nodes Nodes around cardia Left gastricnodes
Right supeflor pancreatlc
Suprapyloric nodes. Splenic nodes
Subpyloric nooes.
Leftgastroomental (gastroepiploic) nooe
Right gastro-omental (gastroepiploic)
Left gastric nodes
Nodesaround cardia Leftgastroomental
z' Z o n e sa n d pathwaysof gastriclymph d r a i n a g e( z o n e s not sharply demarcated)
Right gastro-omental(gastroepiploic)n
4{tr Plate 314
Suprapyloric, retropyloric, and s u b p y l o r inco d e s
Left superior pancreatic nodes Celiac nodes
Right superior pancreaticnode
Superiormesentericnodes
Visceral Vasculature
Lymph Vessels and Nodes of Pancreas
Anterior view gastricnodes
Hepatic nodes
Splenicnodes nodes Superiorpancreatic Celiacnodes nodes Superiormesenteric (centralsuperiorgrouP)
node (of Calot)
Pancreaticoduodenalnodes Hepatic
portalvein Celiacnodes
Posteriorview
nodes Superiorpancreatic
Hepaticnodes aroundbileducts andproperhepatic artery
S p l e n i vc e i n lnferior mesentericvein Superiormesenteric
arteryand vein
nodes Superiormesenteric (centralsuperiorgroup)
Visceral Vasculature
Pancreaticoduodenal nodes
4{tr Plate 315
Lymph Vessels and Nodes of Small Intestine
R i g h tl y m p h a t i ct r u n k
Thoracic duct
Celiac nodes Superiormesenteric nodes (central s u p e n o rg r o u p ) Thoracic duct
Cisternachyli
Intestinal lymphatic tru nk -
R i g ha t nd leftlumbar lymphatic trun
Plate 316
Superior mesenteric nodes (juxtaintestinal group)
Visceral Vasculature
Lymph Vessels and Nodes of Large Intestine
E p i c o l i cn o d e s
Middle c o l i cn o d e s Superior mesenleflc nooes (central supenor
lnferior mesentericnodes
group)
Left colic nodes
Right colicnodes
Preaorticnodes
S i g m o i dn o d e s
P a r a c o l i cn o d e s
Superiorrectal nodes
Left colic nooeS Preaortic nooes
Common iliac I n t e r n a li l i a cn o d e s
Superior rectal nodes Middle rectal nooes
E x t e r n aill i a cn o d M i d d l e r e c t a ln o d e s
Nr
S u p e r f i c i ai ln g u i n a l Perineallymph vessels ( d r a i nl a r g e l yt o i n g u i n a l
Visceral Vasculature
Plate 317
Autonomic Nerves and Ganglia of Abdomen $eealsoPlates lGi, 166
R i g h ts y m p a t h e t i ct r u n k Thoracic duct
Anterior, Posterior vagal trunks
Right greater a n d l e s s e rt h o r a c i c s p l a n c hn i c nerves
Left gastricartery and plexus
R i g h tp h r e n i cn e r v e
Left greaterthoracic s p l a n c h n i cn e r v e
Celiac ganglia
I n f e r i o rp h r e n i c a r t e r i e sa n d p l e x u s e s
Left lesserthoracic s p l a n c h n i cn e r v e
Right greater a n d l e s s e rt h o r a c i c s p l a n c hn i c nerves
S p l e n i ca r t e r y and plexus Common hepatic artery and plexus
R i g h ts u p r a r e n a l
prexus
Superiormesenteric g a n g l i o na n d p l e x u s
Right aorticor e n a lg a n g l i o n
Left aorticorenal ganglion
R i g h tl e a s tt h o r a c i c s p l a n c h n i cn e r v e/
Left sympathetic t r un k
R i g h tr e n a l artery and plexus
Intermesenteric (aortic)plexus
Right s y m p a t h e t i ct r u n k
Inferior mesenteric ganglion
W h i t ea n dg r a y r a m ic o m m u n i c a n t e s
Left colic artery and plexus
C i s t e r n ac h y l i
Inferior mesenteric artery and plexus
C r a y r a m u sc
Left common iliac artery and plexus
3 r d l u m b a rg a n g l i o n of sympathetictrunk
Superiorrectal artery and plexus
2nd and 3rd lumbar s p l a n c h n i cn e r v e s
Superior hypogastric prexus
R i g h tu r e t e ra n d p l e x u s R i g h tt e s t i c u l a (r o v a r i a n ) artery a n d p l e x u s 4 t h l u m b a rs p l a n c h n i cn e r v e l st sacralganglion o f s y m p a t h e t i ct r u n k
Internaland external i l i a ca r t e r i e sa n d plexuses Right and left hypogastricnerves to inferior hypogastric(pelvic)plexus
Cray ramicommunicantes
4{tr Plate 318
Innervation
Nerves of Stomach and Duodenum
Right and left inferior phrenic arteriesand plexu A n t e r i o ra n d p o s t e r i o rl a v e r so f l e s s e ro m e n t u m
H e p a t i cb r a n c ho f a n t e r i o rv a g a lt r u n k A n t e r i o rv a g a lt r u n k Celiac branch of posteriorvagal trunk
Right greaterthoracic s p l a n c h n i cn e r v e
C e l i a cb r a n c ho f a n t e r i ovr a g a tl r u n k Left gastricartery and plexus
Vagal branch from hepatic plexus to pyloric part of stomach H e p a t i cp l e x u s R i g h tg a s t r i c
Anterior gastric branch of anterior vagal trunk Left greaterthoracic s p l a n c h n i cn e r v e
$.' i?,
Left lesserthoracic s p l a n c h n i cn e r v e
Splenicarteryand plexus C e l i a cg a n g l i aa n d p l e x u s Plexuson gastro-omenta (gastroepiploic)arteries Superiormesentericartery and plexus
*{Y lnnervation
P l e x u so n a n t e r i o rs u p e r i o ra n d a n t e r i o r inferior pancreaticoduodenalarteries (posteriorpancreaticoduodenalarteries a n d p l e x u s e sn o t v i s i b l ei n t h i s v i e w )
Plate 319
Nerves of Stomach and Duodenum (continuedl SeealsoPlates 16ti, 166 Plexuson gastro-omental (gastroepiploic)arteries
Posteriorgastricbranch of posteriorvagal trunk Hepatic branch of anteriorvagal trunk via lesseromentum
H e p a t i cp l e x u s
Branchfrom hepatic plexusto cardia via lesseromentum
Rightgastric arteryand prexus
Rightinferiorphrenicarteryand plexus teriorvagaltrunk Celiacbranchof posteriorvagaltrunk Celiac branch of anterior vagal trunk eft gastricartery and plexus
eft inferiorphrenicarteryand plexus Celiac gangliaand plexus Creater, lesser,and least thoracic splanchnicnerves Aorticorenalganglia Splenicartery and plexus
4{tr Greater, Lesser,
ganglion anch from right inferior phrenic
Least
plexusto cardiaof stomach
thoracic splanchnic nerveS
Rightand leftinferiorphrenic arteriesand plexuses Anteriorvagaltrunk
View with stomach reflected cephalad
Plexus on anteriorsuperior and anteriorinferior pancreaticoduodenal arteries Plexuson gastroduodenalartery
Plexuson posteriorsuperior and posteriorinferior pancreaticoduodenal arterie6 S u p e r i o rm e s e n t e r i cg a n g l i o na n d p l e x u ' s
Right greater, lesser,and leastthoracic s p l a n c h n i cn e r v e s
Left gastric C e l i a cg a n g l i a R i g h ta o r t i c o r e n a lg a n g l i o n
S u p e r i o rm e s e n t e r i cg a n g l i o na n d p l e x u s
Plate 32O
Celiac branches of anterior and posterior vagal trunks
arteryand plexus Leftgreater,lesser, and leastthoracic splanchnn i ce r v e s Left aorticorenalganglion
Innervation
lnnervation of Stomach and Duodenum: Schema SeealsoPlates 167, 168 R i g h t6 t h t h o r a c i c g a n g l i o no f s y n rp a t he t i c trunk
-y
\ pl exus Esophagea
-"-o=
2
Cray, White r a t n lc o m m u n r c a n t e s
e t t g r e a t e rt h o r a c i c s p l a nc hn i < nerve
s/
S p i n a sl e n s o r v ( c l o r s ar lo o t ) ganglion
ticplexus L e f t9 t h t h o r a c i c g a n g l i o no f s y m p a t h e t i ct r u n k
Anterior ( v o n t r a l r) o o t of spinan l erve
P o s t e r i ovr a g a lt r u n k a n d c e l i a cb r a n c h
R i g h tg r e a t e rt h o r a r . i < s p l a n c h n i ct ' t e f v € - -
\, \ \
R ig , h tl e s s e rt l r o r . r c - i < s p l a n c h n i nc e r v e
A n t e r i o rv a g a lt r u n k a n d c . e l i a cb r a n c ho f v a g u sn e r r v e( X ) Left gastricartery
C e l i a cg a n g l i . r t* t
L e r a st th o r a c i c s p l a n c h n i nc e r v e
I
/\s-
e l i a ct r u n k .rrtery
Cornn'ror.r h e p a t i ca r t e r l -
t\ I
Short gastflc arIefles
Proper h e p a t i ca r t e r y Superior nresenterc gangJion Aortir.orenal g,.r n glia R i g h tg a s t r i ca r t e r y , R i g , hrte n a la r t e r v ( l a s t r o d u o d e n aal r t u r y P o s t e r i oar n d a n t e r i o r s u p e r i o pr a n c r e a t i r . o c l u o c l e n aalr t e r i e s
Superior r ) r e s et e n rc
Left, R i g h tg a s t r o o n r e nt a I (gastroepiploic) artenes
ar r e r y Posterior . r n da n t e r i o r ilttenor p.rnc.reatico cluocler-ral
Sympatheticfibers Preganglionic P o s t g a n g l i o n i .- - * * * Parasympatheticfibers
.lrteI es
4{tr lnnervation
Preganglionic Postganglionic Afferent fibers
Plate 321
Nerves of Small Intestine SeealsoPlates 165,166
A n t e r i o rv a g a lt r u n Posteriorvagal trunk
C e l i a cb r a n c h e so f a n t e r i o r and posteriorvagal t
Hepatic plexus Creater thoracic s p l a n c h n i cn e r v e s C e l i a cg a n g l i aa n d p l e x u s Castroduodenalartery and plexus Lesserthoracic s p l a n c h n i cn e r v e s Leastthoracic s p l a n c h n i cn e r v e s Aorticorenalganglia S u p e r i o rm e s e n t e r i cg a n g l i o n I n t e r m e s e n t e r i(ca o r t i c )p l e x u s Inferior pancreaticoduodenal arteriesand plexuses S u p e r i o rm e s e n t e r i c
arteryand plexus Middle colic artery and plexus (cut) R i g h tc o l i c a r t e r ya n d p l e x u s l l e o c o l i ca r t e r ya n d p l e S u p e r i o rm e s e n t e r i c artery and plexus Peritoneum(cut edge)
M e s e n t e r ibcr a n c h e s M e s o a p p e n d i x( c o n t a i n s a p p e n d i c u l a ar r t e r ya n d nerve ptexus
4{tr Plate 322
Innervation
Nerves of Large Intestine of Fornerves
A n t e r i o rv a g a lt r u n k a n d hepatic branc Posteriorv a g a lt
Right greaterthoracic s p l a n c h n i cn e r v e
M a r g i n aal r t e r ya n dp l e x u s Esophagus
Left greaterthoracic s p l a n c h n i cn e r v e
C e l i a cg a n g l i aa n d p l e x u s
Leftsuprarenal plexus Left lesserand leastthoracic s p l a n c h n i cn e r v e s
R i g ha t orticor e n ag l anglion
Left aorticorenal ganglion
Superior mesenteric ganglion
Leftrenalartery a n dp l e x u s
Middlecolic artery and plexus
l s t l e f tl u m b a r nerve splanchnic Leftlumbar sympathetictrunk lntermesenteric (aortic)plexus Left colic artery and plexus
R i g h tc o l i c arrery and plexus
lnferior mesenteric ganglion,artery, and plexus
lleocolic artery and plexus
Sigmoid arteries and plexuses
C e c a la n d appendicular arteries and plex
Superior hypogastric plexus tor
rectal arrery and plexus
Sacralsympathetictru
Rightsacralplexu
ightand left
P e l v i cs o l a n c h n i cn e r v e s
hypogastric nerves
Middle rectal arterv and plexus R i g h ti n f e r i o rh y p o g a s t r i c
( p e l v i cp) l e x u s Vesicalplexus
Nr lnnervation
Rectalplexus
Nerves from inferior hypogastric(pelvic) p l e x u s e st o s i g m o i dc o l o n , d e s c e n d i n g c o l o n , a n d l e f t c o l i c ( s p l e n i c f)l e x u r e
U r i n a r yb l a d d e r
Plate 323
Innervation of Small and Large Intestines: Schema SeealsoPlates 167, 168
Thalanrus
l{
t .J
Hypothalamus ( r e d : s y m p a t h e r i cp a r t , b l u e = p a r a s y n r p a t h e t pi ca r t )
P o s t e r i o (r d o r s a l ) n u c l e u so f v a g u s
V a g u sn e r v e ( X ) M y e l e n c e pl . r al o n (medulla oblongata) S y n r p a t h e t itcr u n k
I wr'it" I
S p i n a ls e n s o r y ( d o r s a lr o o t ) g a n g l i r > n
I cray/
|
Creater Thoracic { Lesser ( splanchnic L e a st nerves*
T10
T h o r a c o lu n r b a r s p i n a lc o r d
T11
Aorticorenal ganglion
T12
I n t e r m e s e tne r i c ( a o r t i c )p l e x u s
L.l
l n f er i or mesenteilc ganglion
L2
=1t--' [3
Lunrbar splanchnic ne r v e s *
L4 t5 Hypogastric ne r v e s
Sacral s p i n a lc o r d
rJ
S
Sacral s p l a n c h ni c n e r v e s-
I n f e r io r hypogastric ( p e l v i c )p l e x u s
{ rY P e l v i cs p l . r n c h n i nc e r v e s P u d e n d a ln e r v e * A b d o m i n o p e l v i cs p l a n c h n i cn e r v c s
Plate 324
lnnervation
Innervation of Small and Large Intestines: Schema
Sympatheticefferents Parasympathetic efferents Somaticefferents Afferentsand CNSconnections Indefinitepaths -----
4{tr S u p e r i o rr e c t a l a r t e r v a n d n e r v e s
Rectalplexus
I n f e r i o r a n a l ( r e c t a l )n e r v e
Innervation
Levator ani muscle E x t e r n a la n a l s p h i n c t e rm u s c l e
C h i e f s e g m e n t a ls o u r c e s of sympathetic fibers i n n e r v a t i n gd i f f e r e n t r e g i o n so f i n t e s t i n a l tract are indicated. N u m e r o u s a f f e r e n tf i b e r s are carriedcentripetally through approximately the same sympathetic s p l a n c h n i cn e r v e s that transmit preganglionic fibers.
Plate 324
Autonomic Reflex Pathways: Schema
Sympathetic
Spinal Dorsal(posterior) root sensory (dorsal root) ganglion
Thoracicpart of spinalcord lntermediolateral c e l lc o l u m n
C a n g l i o no f s y m p a t h e t i ct r u n k
Spinalnerve to vesselsand
g l a n d so f s k i n
r ror V e n t r a(la n t eior)
W h i t er a m u sc o m m u n i c a n s C r a yr a m u sc o m m u n i c a n d C a n g l i o no f
s y m p a t h e tti rcu n k
Meningeal branch to spinal m e n i n g e sa n d s p i n a lp e r i v a s c u l a r Stretch plexuses(usuallyarisesfrom (distention) spinalnerve)
Abdominopelvic (greater, lesser, and least)thoracic splanchnn i ce r v e s Vagus nerve(X)
Enteric prexuses
C a n g l i o no f sympathetictrunk
of gut
Superior mesenteric ganglion
Sympatheticf Preganglionic fibers I eostganglionic-----
Plate 325
Parasympathetic Preganglionic fibers P o s t g a n g l i o n -i c- - - -
4{tr Afferentfibers -
lnnervation
Intrinsic Autonomic Plexuses of Intestine: Schema
Peritoneal layersof mesentery
Branchof straight artery (arteriae rectae) to intestineand accompanying nerves plexus Longitudinalintramuscular
(Auerbach's)plexus
plexus r intramuscular
(Meissner's)plexus
plexus Periglandular
Visceralperitoneum(serosa) Subserous connectivetissue muscle Longitudinal Intermuscular stroma Circularmuscle Submucosa S u b m u c o sgal a n d s
Nr
Muscularismucosae glands Mucosaand intestinal
Note:Intestinal wall is shown muchthickerthanin actualitv.
lnnervation
Plate 326
Innervation of Liver and Biliary Tlact: Schema SeeahoPlateo 167,168
S y m p a t h e ttircu n k Dorsalroot (spinag l )a n g l i o n Thoracicpartof spinal cord R i g h tg r e a t e rt h o r a c i cs p l a n c h n i c
Leftgreaterthoracic nerve splanchnic
Posteriorvagal trunk Right phrenic nerve to diaphragmatic part of parietal(and visceral?)periton
Anteriorvagaltrunk
*{r ic branchof anterior vagal trunk Diaphragm P h r e n i cg a n g l i o n C e l i a cg a n g l i a Common hepatic artery Splenicartery Anterior hepatic plexus Posteriorhepatic plexus
\Castroduodenal arteryand plexus Sympatheticfibers Preganglionic P o s t g a n g l i o n i-c- - - - - Parasympathetic fibers Preganglionic P o s t g a n g l i o n i-c- - - - - Afferentfibers
Plate 327
S o h i n c t e ro f h e p a t o p a n c r e a t iacm p u l l a
Ramificationof fibersaroundfine of hepaticartery
lnnervation
Innervation of Pancreas: Schema
Dorsalroot (spinag l )a n g l i o n
Right sympathetic t r u n k_
trunk eft sympathetic Thoracic part of spinalcord
Rightgreater thoracic splanchnic nerve
t
Leftgreaterthoracic splanchnic nerve Anteriorvagaltrunk
Posterior vagaltrunk Common areasof p a n c r e a t i cp a i n
Celiac ganglia
n{r
mesenteric ganglion
Superiormesenteric arteryand plexus
Sympatheticfibers Preganglionic Postganglioni
S c h e m ao f intrinsic nerve supply
Parasympathetic fibers Preganglionic Postganglioni Afferentfibers
lnnervation
Plate 328
Kidneys in Situ: Anterior Views
Esophagus Diaphragm Left suprarenalgland R i g h ts u p r a r e n a l gland
C e l i a ct r u n k
R i g h tk i d n e y
Left kidney
R i g h tr e n a l artery and vein
Left renal artery and vein
Right subcostalnerve
mesenteric artery (cut)
Transversus a b d o m i n i sm u s c l e
tal nerve Abdominal aorta
Quadratus
Iumborum muscle
liohypogastricnerve
l l i a cc r e s t
l i o i n g u i n anl e r v e
P s o a sm a j o r m u s c l e l l i a c u sm u s c l e
Lateral femoral cutaneousnerve
Right ureter
Cenitofemoral nerve Left testicular (ovarian)artery and vein
R i g h tc o m m o n iliac artery
Inferior mesenteric artery (cut)
Right external i l i a ca r t e r
Peritoneum(cut)
R i g h ti n t e r n a l iliac artery
Sigmoid mesocolon (cut)
U r i n a r yb l a d d e r
Rectum
*{r Esophagus Inferiorvena cava Area for bare a r e ao f l i v e r
eft suprarenalgland S p l e n o r e n al li g a m e n t
Right s u p r a r e n agl l a n d
Area for stomach
Peritoneum
Area for spleen
(cut) Area for liver
Tailof pancreas
Duodenum
Transversemesocolon
Peritoneum
Area for small intestine
(cut) Area for colon Area for s m a l li n t e s t i n e
Plate 329
A r e a f o r d e s c e n d i n gc o l o n
Anterior relations of kidneys
Kidneys and Suprarenal Glands
Kidneys in Situ: Posterior Views
Latissimus dorsi Serratusposterior inferiormuscle-
Pleura(costodiaphragmaticrecess) mbocostalligament Quadratuslumborum muscle(cut)
External obliquemuscle
Diaphragm
Aponeurosis of transversus abdominismuscle
Subcostalnerve
lnternal obliquemuscle
Ascending colon
Thoracolumbar fascia (posterior layer)
ightkidney
Transversus abdominismuscle nerve lliohypogastric
lliaccrest Erectorspinae Clutealaponeurosis (overgluteusmedius muscle)
dratuslumborum muscle(cut) Psoasmajor muscle r ligament
Gluteusmaximus muscle
Projection of 11th rib Areafor Projectionof 12th
*{r Posteriorrelations of kidneys Areafor diaphragm o f 1 2 t hr i b
Areafor aponeurosis ot transversus abdominismuscle
Areafor aponeurosis of transversus abdominismuscle
Areafor quadratus lumborummuscle
Areafor quadratus lumborummuscle
Areafor psoasmajormuscle
Areafor psoas majormuscle
Kidneyls and Supralenal Glands
Plate 33O
Schematic Cross Section of Abdomen at T12 Lineaalba Falciformligamenl Superiorepigastricvessels Transversalis fascia Parietalperitoneum Visceralperitoneumof liver
Properhepatic (bifurcation)
Rectusabdominismuscle Lesseromentum Leftgastricarteryand vein
7th costalcartilage External obliquemuscle Diaphragm Stomach
Commonhepaticduct Cysticduct Hepatic portalvein Costodiaphragmatic recessof pleural cavity
Castrosplenic ligamentand short gastric vessets Spleen
lntercostal vessets and nerve Omental (epiploic) foramen (of Winslow) Common hepaticartery (retroperitoneal) Hepatorenalrecess (Morison'spouch) Inferiorvena cava Omentalbursa(lessersac)
Intercostal muscles ligament Splenorenal with splenicvessels Parietalperitoneum on posteriorwall of omentalbursa
Rightsympathetic trunk Rightcrusof diaphragm Azygosvein Thoracicduct Anteriorlongitudinal ligament Celiacganglia Abdominalaorta Body of T12 vertebra
Plate 331
Left kidney Leftsuprarenalgland
musc'e iH*F;"Trs 4{tr [fft;f*r,
Kidneys and Supranenal Glands
Renal Artery and Vein in Situ
Inferiorvena cava
Esophagus Left inferior phrenic vein
Right and left inferior phrenic arteries
Leftsuperiorsuprarenalarteries
Celiac trunk
Leftmiddle suprarenal artery
Rightsuperior suprarenala
vein Leftsuprarenal R i g h tm i d d l e suprarenalartery
Leftinferior artery suprarenal
vein Rightsuprarenal Rightinferior suprarenal arter
Uretericbranchof left renalartery Leftrenal arteryandvein Uretericbranch
Left testicular (ovarian) arterv and vein
of right renal artery Right renal artery and vein
Left2nd lumbarveinand communication lumbarvein to ascending
Right testicular (ovarian) artery and vein
Inferiorvenacavi Abdominalaortd
Kidneys and Suprarenal Glands
arterv Inferiormesenteric artery(cut) Superiormesenteric
*{r Plate 332
Variations in Renal Artery and Vein
Proximal subdivision of renal artery
A Low accessoryrightrenal arterymay passanteriorto inferior venacavainsteadof posteriorto it B Inferiorphrenicarterywith superiorsuprarenal arteriesmayarise from renalartery(middlesuprarenal arteryabsent) Doubleleftrenal vein mayform ringaround abdominalaorta
Multiplerenalveins Persistent left inferiorvenacava mayjoin leftrenalvein
*{r Plate 333
Kidneys and Suprarenal Glands
Gross Structure of Kidney
Anteriorsurface of right kidney
Fibrouscapsule (cutand peeledback) Medialborder Hilum Renalartery R e n avl e i n Renalpelvis Stellateveins visible
throughcapsule
Medialborder Ureter
Suprarenalgland and lobulated kidney of infant
Fibrouscapsule Cortex
Medulla(pyramids)
Renalpapilla
Minorcalices Bloodvessels enteringrenal parenchyma I sinus Majorcalices
Renalcolumn (of Bertin)
Renalpelvis Fatin renalsinus Minor calices
Baseof pyramid Ureter
Rightkidneysectionedin severalplanes,exposing parenchymaand renal pelvis
Kidneys and Suprarenal Glands
Plate 334
Intrarenal Arteries and Renal Segments
Superior(apical)segmental
Frontalsectionof left kidnev: anteriorview
Anteriorsuperior segmental artery Capsular and perirenalbranches Inferior suprarenalartery Anteriorbranch of renalartery Renal
Posteriorbranch of renalartery (posterior segmental artery) Pelvicand uretericbranches Anteriorinferior segmental artery Posterior segmental arteries Inferiorsegmentalartery
Vascularrenalsegments
Nr Anteriorsurfaceof left kidnev
Plate 335
Posteriorsurfaceof left kidney
Kidneys and Supralenal Glands
Nephron and Gollecting Ti,rbule:Schema
Fibroustuot''".--.-----.= "
'
convolutedtubule Proximal
--ciitl-.il-renalcorpuscle luxtamedullary renalcorpuscle Proximal convoluted tubule
L
Distal
I convolutedtubule
convoluted tubule
H e n l e ' sl o o p D e s c e n d i n gl i m b A s c e n d i n gl i m b
C o l l e c t i n gt u b u l e
5 -
Henle's
loop
LCJ
t
Descending Renal medulla (pyramid)
R e n a l( m a l p gi h i a n )c o r p u s c l e ; g l o m e r u l a r( B o w m a n ' s )c a p s u l e with glomerulus
Ascending
li
Afferent and efferent glomerulaa r rterioles
C N
c c
Openings of papillary ducts
Nr
ffi
tubutes Cottecting
C r i b r i f o r ma r e a o f r e n a lp a p i l l a
Kidneys and Suprarenal Glands
Plate 336
Blood Vessels in Parenchyma of Kidney: Schema
A f f e r e n tg l o m e r u l a ra r t e r i o l e E f f e r e ngt l o m e r u l a ra r t e r i o l e
J u x t a m e d u l l agrlyo m e r u l u s ( e f f e r e ngtl o m e r u l aarr t e r i o l e d e s c e n disn t or e n a p l yramid)
C o r t i c a lg l o m e r u l u s E f f e r e n gt l o m e r u l a r a r t e r i o l e( j o i n sc o r t i c a l c a p i l l a r yp l e x u s
Corticomedullarg y lomerulus Cortical capillary US
f f e r e n tg l o m e r u l a ra r t e r i o l e ( j o i n sc o r t i c a lc a p i l l a r yp l e x u s a n d a l s od e s c e n d si n t o r e n a lp y r a m i d )
Stellate vetn
F i b r o u sc a p s
C a p s u l a ra n d p e r f o r a t i n gv e i n s Cortical radiate (interlobular) artefles a n dv e i n s Subcapsular
,> zone
X
uate artery andvein Vasa rectae s p u r i a( f r o m juxtamedullary efferent glomerular arterioles)
\1 i 1
Vasa rectae vera (from a r c u a t ea n d cortical radiate artefles) Venulae rectae Medullary capillary plexus Interlobar arrery andvein
e,
Renal cotumn (of Bertin) H e n l e ' sl o o p of nephron Collecting tubule
4{tr Plate 337
lnterlobar a r t e r ya n d v e t nI n perirenal fat of r e n a ls i n u s
Kidneys and Suprarenal Glands
5
c
TransverseSection: Level of T12-L1 lntervertebral Disc
f
o o
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o tr
o
S u p e r i o rm e s e n t e r i cv e i n ( b e c o m i n gp o r t a lv e i n )
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o o o
o o o
=i.
D e s c e n d i n g( 2 n d ) partof duodenum Left suprarenalgland
o J
o D
I n f e r i o rv e n a c a v a
rh
Spleen
r
R i g h ts u p r a r e n agl l a n d
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TransverseSection:Levelof L1-2 IntervertebralDisc
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Superiormesentericartery
o rt
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o
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lleum
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lejunum
o o rt
Perirenalfat
IT
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o rh
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D e s c e n d i n gc o l o n
R i g h tr e n a lv e i n (enteringinferior vena cava)
Left kidney Major calyx and renal pelvis
ql f
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o 3
t o I
o 3 o o
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Renalfascia
Right kidney
Pararenalfat
Inferior vena cav
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Right crus of diaphragm Psoasmajor muscl
I
Left renal artery
N
Left renal vein (entering inferior vena cava)
L1-2 intervertebraldist Left crus of diaphragm C o n u sm e d u l l a r i sa n d c a u d a e q u i n
Cfd4/*
Ureters
Uretersin male: anterior view Leftkidney Rightkidney Leftureter Duodenum lnferior mesenteric artery
Superior mesenteric
Leftcolic artery Rightcolicartery Sigmoidarteries R i g hu t re lleocolic artery
Superiorrectal artery(cut)
Testicular vessel
nerve Cenitofemoral
C o m m o n i l i a ca r t e r lnternal iliac arter Externaliliac arter
Inferiorvesicalarterv
Middle rectal a
Diagonalcourse of ureter throughbladder wall Bladdermucosa
Ductusdeferens narybladder
4{tr
Ureter
Urinarybladder Medialumbilical ligament(occluded partof umbilicalartery) Roundligament of uterus Superiorvesicalartery
Broadligament
Uterineartery Umbilicalartery Obturatorartery and nerve Ureter
Uterosacral (sacrogenital) fold
Vaginalarteryand inferiorvesicalbranch External iliacartery
Ureter (re Intersigmoid Sigmoid mesocolon
Uretersin female: superiorview
Kidneys and Suprarenal Glands
ian vessels
Internaliliacartery iliacartery Root of mesenterv
Plate 34O
Arteries of Ureters and Urinary Bladder a
A b d o n r i n aal o r t a S u p e r i o nr r e s e n t e r i c arterv
R e n aa l r t e r ya n d v e i n Uretericbrar-rch from renalartery Ovarianartery Ureter
Inferior mesentencartery(cut) Uretericbranchfronr aorta Uretericbranchesfron'r ovarianand conrmon r l i a ca r t e r i e s C o m n r o ni l i a ca r t e r y M e d i a ns a c r aal r t e r y I n t e r n aill i a ca r t e r y l l i o l u n r b aar r t e r y S u p e r i o gr l u t e aal r t e r y Lateralsacral:rrtery Inferiorglute.rland i n t e r n apl u d e n d aal r t e r i e s U m b i l i c aal r t e r y (patentpart) U t e r i n ea r t e r y
Inferiorvcsicalartery a n d u r e t e r i cb r a n c - h S u p e r i ovr e s i c aal r t e r i e s I n f e r i o cr p i g a s t r iac r t e r y Uretericbranc-hfronr s u p e r i o vr e s i c aal r t e r y M e d i a lu n r b i l i c al il g a n r e n t
Plate 341
Kidneys and Suprarenal Glands
Renal Fascia
Duodenum Right Rightcolic (hepatic)flexure Liver
flexure Duodenojejunal Superiormesenteric vein and artery Abdominal
Left renal vein and artery Left kidney
lnferior vena cava
Transversalis fascia fat Pararenal (retroperitoneal) Quadratuslumborum muscre
Cruraof diaphragm
Transverse sectionthrough 2nd lumbarvertebrademonstrates horizontaldispositionof fascia
Psoasmaior muscleand fascia
Perirenal fat Fibrouscapsuleof kidney Anterior and posterior layersof renal (Cerota's) fascia
Diaphragm Diaphragmaticfascia ( c o n t i n u a t i o no f transversalis fascia)
Lung Liver
Costodiaphragmatic
recess
Bare area of liver
S u p r a r e n agl l a n d
F i b r o u sc a p s u l eo f k i d n e y
Perirenalfat
Peritoneum
1 2 t hr i b
Anterior and posterior layersof renal (Cerota's)fascia
Pararenalfat (retroperitoneal) R i g h tk i d n e y Transversalis fa
Right colic (hepatic)flexure
Q u a d r a t ulsu m b o r u mm u s c l l l i a cc r e s t
*{r Kidneys and Suprarenal Glands
Sagittalsectionthrough right kidney and lumbarregiondemonstrates verticaldispositionof renalfascia
Plate 342
Lymph Vessels and Nodes of Kidneys and Urinary Bladder SeealsoPlates406,408
Subcapsular l y m p h a t ipc l e x u s
Cortical lymph vesselsalong cortical r a d i a t e( i n t e r l o b u l a rat r t e r i e s Lymph vesselsalong arcuatearteries Lymph vesselsalong interlobararteries
Medullary lymphvessels
*{r Note:Arrows indicatedirection of flow.
L u m b alry m p ht r u n k st o cisternachyliandthoracicduct
Lateralaortic (lumbar),precaval, and postcavalnodes
C o m m o n i l i a cn o d e s
P r o m o n t o r i a(l m i d d l es a c r a l )n o d e
I n t e r n a li l i a cn o d e s
E x t e r n aill i a cn o d e s
Lymph vesselsfrom dorsal part and trigone of bladder
Lymphvessels fromsuperior andanteriorpartsof bladder
Lateralvesicaland prevesicalnodes
Plate 343
Kidneys and Supralenal Glands
Nerves of Kidneysr Ureters, and Urinary Bladder
Anteriorvagaltrunk Posteriorvagaltrunk nerve Createrthoracicsplanchnic Celiac gangliaand plexus
Lesser nerve thoracicsplanchnic ganglion Superiormesenteric Leastthoracic splanchnicnerve Aorticorenal ganglion
Renalplexusand ganglion 2nd lumbarsplanchnic Renaland upperuretericbranches fromintermesenteric (aortic)plexus Intermesenteric
ganglion Inferiormesenteric trunkand ganglion Sympathetic Middleuretericbranch Superiorhypogastric nerves Sacralsplanchnic (branches from uppersacral sympatheticgangliato hypogastricplexus)-
Cravramuscommunicans Hypogastricnerves
Sacralplexus
Pelvicsplanchnic (pelvic)plexus Inferiorhypogastric loopsand with periureteric branches to lowerureter Rectalplexus Vesicalplexus Prostaticplexu
Kidneys and Suprarenal Glands
4{tr Plate 344
Innervation of Kidneys and Upper Ureters: Schema
ucleusof solitarvtract (dorsal)nucleus Posterior of vagusnerve Medullaoblongata Crayramuscommunicans Vagusnerve(X) ng fibers
Ventralramusof T10 (intercostal nerve)
Ascending fibers W h i t er a m u sc o m m u n i c a n s
nalcord segments T10-11
Cangliaof sympathetic trunk
Lesser thoracic splanchnic nerve
1 s tl u m b a sr p l a n c h n n i ce r v e
splanchnic nerve
thoracic
Celiacgangliaand plexus Superiormesenteric ganglion ganglion Aorticorenal plexus Intermesenteric
4{tr Sympatheticfibers Preganglionic P o s t g a n g l i o n i-c- - - - - - - . Parasympathetic f ibers Preganglionic Postganglioni
Superiorhypogastric plexus
Hypogastric nerve Sacralplex Pelvic splanchnic
nerves
Afferentfibers
Plate 345
Kidneys and Suprarenal Glands
Nerves of Suprarenal Glands: Dissection and Schema
Left phrenic nerve
Right phrenic nerve
vagaltrunk Posterior Left inferior phrenic artery and plexus Left suprarenalgland Left greaterthoracic s p l a n c h n i cn e r v e
R i g h st u p r a r e n g al a n d Right greaterthoracic splanchnich€rv€:-
C e l i a cp l e x u s a n dg a n g l i a Leftlesserthoracic splanchnn i ce r v e Aorticorenal ganglia
R i g h tr e n a l g a n g l i o na n d p l e
Left least thoracic splanchnic nerve Left renal ganglion and prexus
trunk Leftsympathetic
R i g h ts y m p a t h e t i c
L e f t 1 s t l u m b a rs p l a n c h n i cn e r v e
Righ1 t s tl u m b a sr p l a n c h n n i ce r v e
S u p e r i o rm e s e n t e r i cg a n g l i o n In t e r m e d i o l a t e r acle l l c o l u m n (lateralhorn of gray matter)
T5
T6 T7
Medulla Thoracic splanchnic nerves (preganglionic flbers)
Postganglionic f i b e r ss u p p l y bloodvessels
Celiac ganglion
T8 t I I I
4{tr
Preganglionic fibers ramify a r o u n dc e l l s of medulla Suprarenalgland
Kidneys and Suprarenal Glands
Plate 346
Artefes and Veins of Suprarenal Glands in Situ
Liver(retractedsuperiorly)
Superiorsuprarenal arteries (frominferiorphrenicartery) lnferior vena cava (retracted mediallvl
Suprarenal vein Branches of middlesuprarenal arteries(fromabdominalaorta) (cutedge) Peritoneum
Pancreasand spleen (re tr acted sup eri o r Iy)
Leftinferiorphrenicartery ior suprarenal arteries gland Suprarenal Renal(Cerota's) fascia Left kidney
Renal (Cerota's) fascia Right kidney
(pulleddown) gland Suprarenal Inferiorsuprarenal artery (from renalartery) Abdominal exposure of right suprarenal gland
Crosssection through suprarenal gland
psule Cortex Medulla
Duodenojejunalflexure Leftcolic(splenic) flexure(pulled Middlesuprarenal artery
*{r
Suprarenalvein
Inferiorsuprarenal arterir
Leftrenalartery andvein
Peritoneum (cut edges)
Abdominalexposureof left suprarenalgland
Plate 347
Kidneys and Supranenal Glands
AbdominalWall and Viscera: Paramedian(Sagittall Section
D i a p h r a g m( c e n t r a tl e n d o n )
C o r o n a r yl i g a m e n t e n c l o s i n gb a r e a r e a of liver
-,":ij
Esophagus P a r i e t apl e r i t o n e u m Superiorrecessof omental bursa (lessersac)
Liver L e s s e ro m e n t u m
H e p a t i cp o r t avl e i na n d properhepaticartery i n r i g h tm a r g i no f
O m e n t a l( e p i p l o i c ) foramen (of Winslow)
l e s s e ro m e n t u m O m e n t a lb u r s a (lessersac)
e l i a ct r u n k
Stomach
S p l e n i cv e s s e l s
Middle colic artery
Renalvessels
Transversemesocolon
Pancreas
Parietalperitoneum (of a n t e r i o ra b d o m i n a lw a l l )
Superiormesentericartery Inferior (horizontal,or 3rd) part of duodenum
Transversecolon Creater omentum S m a l li n t e s t i n e
Abdominal aorta
Rectusabdominis
muscle
Parietaloeritoneum (of posterior abdominal wall) Mesenteryof small intestine
Transversalis fascia
Medianumbilical l i g a m e n t( u r a c h u s ) Fatty layer of
subcutaneou t is s u e
Rectovesicaloouch
(Camper'sfascia)
Rectum
M e m b r a n o u sl a y e r o f s u b c u t a n e o u tsi s s u e (Scarpa'sfascia)
Rectoprostatic ( D e n o n v i l l i e r sf' a ) scia
U r i n a r yb l a d d e r
Levatorani muscle Prostate
P u b i cb o n e
Deep Superficial Subcutaneous
R e t r o p u b i c( p r e v e s i c a l ) space (cave of Retzius)
Deep and superficial p e r i n e a lm u s c l e s
D e e p ( B u c k ' s f) a s c i a of penis
B u l b o s p ogni o s u sm u s c l e
P e r i n e am l e m b r a n ea n d b u l b o u r e t h r a(lC o w p e r ' s )g l a n d Tunica vaginalistestis
Abdominal Sections
P u b o r e c t a l im s u s c l e( t h i c k e n e dm e d i a l edge of left levator ani muscle)
Plate 348
Schematic Gross Section of Abdomen at L3, 4
Round ligament(ligamentumteres)of liver Transverse colon Branchesof inferiorepigaslricvessels
Rectussheath Transversus abdominis aooneurosis Externaloblique aponeurosis Internaloblique aponeurosis
L i n e aa l b a Rectusabdominismuscle Omental appendices
Createromentum Parietalperitoneum Transversalis fascia Transversus abdominismuscre
Mesenteryof smallintestine
I n t e r n aol b l i q u e muscte
Superiormesentericvessels
S m a liln t e s t i n(ei l e u m )
External oblique muscle
L y m p hn o d e Ascending coton
R i g h t1
paracolic gutter
Smallintestine (jejunum) X,
Descending coron Left paracolic gutter
Left ureter
Tendon of origin of transversus abdominis muscle
Quadratus lumborum muscle
lliohypogastricnerve
Latissimus dorsimuscle
l l i o i n g u i n anl e r v e
Testicular(ovarian)vessels
( Combined Laversof thoracolumba' I| ftiddl. ""'' ; Tascra ( posterior
Psoasminor muscle Parietalperitoneum
Psoasmajormuscle Right genitofemoral nerve
Inferiorvena cava
Leftsympathetictrunk
Anterior longitudinalligament Ligamentumflavum
Erectorspinaemuscle
Abdominal aorta Spinousprocessof L3 vertebra Intermesenteric(aortic)plexus
Plate 349
Abdominal Sections
Abdominal Scans: Axial GT lmages
Seriesof abdominalaxial CT imagesfrom superior(A) to inferior (D)
A AC B DC It lV tA tl tK tt
Aorta Ascending colon Bodyofvertebra Descending colon lleum Inferiorvenacava Lineaalba Leftcommoniliacartery Leftkidney Leftlobeof liver
Abdominal Sections
M P R RA RI Rt
s ST TC
Deepbackmuscles Psoasmuscle Rib Rectusabdominismuscle Rightcommoniliacartery Rightlobeof liver Spleen Stomach Transverse colon
Plate 35O
5 Pelvis and Perineum Section Topographic AnatomY Plate 351
andPerineum ssr Pelvis
Bones and Ligaments Plates 352-355
of Pelvis andLigaments ssz Bones (continued) of Pelvis andLigaments 3s3 Bones Measurements of Pelvis: sse SexDifferences Pelvis oftheMaleandFemale sss Radiographs
Pelvic Floor and Gontents Plates 35F364
gse Pelvic Female Diaphragm: (continued) Female Diaphragm: ssz Pelvic Male Diaphragm: ssa Pelvic Male(continued) Diaphragm: oss Pelvic geo Pelvic Female Viscera andPerineum: Male Viscera andPerineum: ser Pelvic Female Contents: aez Pelvic Male Contents: ses Pelvic Spaces Fascia andPotential oel Endopelvic
Urinary Bladder Plates 36$€68
andSupports Bladder: 0rientation oes Urinary Female andMale Bladder: eee Urinary oez Sphincters Cystourethrograms 368 MaleandFemale
Atlas of Human Anatomy
Pelvis and Perineum
ina, andSupporti ns t.r".i3ft,vas Plates 369€75
oes Pelvic Viscera: Female
Rectum Plates 391-396
ssr Rectum inSitu:Female andMale
ozo Uterus, Vagina, andSupporting Structures
Fossae ogz lschioanal gss Rectum andAnalCanal
szr Uterus andAdnexa
Musculature sgl Anorectal
szz Pelvic Ligaments
AnalSphincter Muscle: Perineal Views sss External
3zs Uterus: AgeChanges andMuscle Pattern
andPotential Perineopelvic 396 Actual Spaces
szl Uterus: Position andProlapse ozs Ectopic Pregnancy
Regional Scans Plate 397
Regional Tlansverse Section
ssz Pelvic Scans: Sagittal MRlmages
Plate 376
Bladder-Prostate sze MalePelvis: Junction
Vasculature Plates 398409
Perineum and External Genitalia: Female Plates 377-379
(Pudendum ezz Female Perineum andExternal Genitalia orVulva) (Superficial Perineum szs Female Dissection) gzs Female Perineum andDeep Perineum
(Male) ofRectum andAnalCanal ese Arteries (Female) ess Veins of Rectum andAnalCanal loo Arteries Female andVeins ofPelvic 0rgans: cor Arteries andVeins ofTestis coz Arteries andVeins of Pelvis: Female Male eos Arteries andVeins of Pelvis:
Perineum and External Genitalia: Male
eoe Arteries andVeins andUterus of Perineum
Plates 38G€87
me Lymph Vessels andNodes ofPelvis andGenitalia: Female
(Superficial oso Perineum andExternal Genitalia Dissection)
Female mz Lymph Vessels andNodes ofPerineum:
(Deeper set Perineum andExternal Genitalia Dissection) gaz Penis ges Perineal Spaces
Vessels Male eoe Lymph andNodes ofPelvis andGenitalia:
sal Prostate andSeminalVesicles
eos Arteries Male andVeins of Perineum:
lnnervation Plates
4O9-4l7
ses Urethra
409
Nerves of External Male Genitalia:
sse Descent ofTestis
4lo
Nerves ofPelvic Viscera: Male
sgz Scrotum andContents
4ll
Nerves Male ofPerineum:
412
Nerves Viscera: Female ofPelvic
413
Female Nerves ofPerineum andExternal Genitalia:
414
Neuropathways in Parturition
see Homologues of External Genitalia
415
Innervation Reproductive Organs: Schema of Female
ees Homologues ofInternal Genitalia
4t6
Innervation ofMaleReproductive 0rgans: Schema
417
Innervation Bladder of Urinary andLowerUreter: Schema
Homologues of Genitalia Plates 38&389
Testis, Epididymis, and Ductus Deferens Plate 39O
Epididymis, ogo Testis, andDuctus Deferens
Atlas of Human Anatomy
Pelvis and Perineum
Sternocleidomastoid muscle
muscle Trapezius Deltoidmuscle Pectoralis majormuscle
Serratus anterior muscle
Semilunar line
Tendinous intersection External oblique muscle Rectus abdominis muscle
Lineaalba
Anteriorsuperior i l i a cs p i n e
Umbilicus lliaccrest
Superficial circumflexiliacvein Superficial epigastricveins
Inguinal ligament
Pubicsymphysis
Pubictubercle dorsal Superficial veinof penis C l a n so f p e n i s
Body(shaft)of penis
External urethral orifice(meatus)
Scrotum +* f"{,
Topographic Anatomy
6(d4/*
PIate 351
Bones and Ligaments of Pelvis
Bodyof L5 vertebra lliac J Intermediate zone c r e s t I n n e rl i p I
Falsepelvis
(15-S1) intervertebral Lumbosacral disc
llia.cfossa(wing OI lllum)--
Sacralpromontory
Anteriorsuperior
Creatersciaticforamen
iliac
'Truepelvis
Arcuateline
ial spine
Anteriorinferior iliac spine
Sacrospinous ligament
lliopubiceminence
Lessersciaticforamen
Obturatorcanal
Sacrotuberous ligament
Superiorpubicramus
Coccyx
Pectenpubis (pectineal line)
lschialtuberosity
Pubictu Symphyseal surface Obturatormembrane
lateral view
Bodyof L4 vertebra
Supraspinous ligament Posterior,anterior,and inferiorgluteallines
Posterior superioriliacspine Mediansacralcrest Posterior inferioriliacspine
rmediateron" ) Outerlip ) lliaccrest lliactubercle ) Wing (ala)of ilium (glutealsurface) Bodyof ilium Anteriorsuperior iliacspine Anteriorinferior iliacspine
Posteriorsacroiliacligament labrum
Greatersciaticforamen Sacrospinous ligament Posterior and lateral sacrococcygeal ligaments Sacrotuberous ligament lschialspine Lessersciaticforamen
*{r Plate 352
Acetabularmargin (articular) surface notch Transverse acetabular ligament Superiorpubicramus Pubictubercle Obturatorcrest
lschialtuberosity Obturatormembrane
canal Inferiorpubicramus
Bones and Ligaments
Bones and Ligaments of Pelvis (continuedl
lliolumbarligament
ligament Supraspinous Posterior superioriliacspine Posteriorsacroiliacligaments
Posteriorsacralforamina reatersciaticforamen Anteriorsuperioriliacspine ligament acrospinous ligament Sacrotuberous Lessersciaticforamen margin Acetabular tuberosity Tendonof longheadof bicepsfemorismuscle lliolumbar ligament
Anterior sacroiliacligament
Sacralpromontory Creatersciaticforamen Anteriorsuperioriliacspi ligament Sacrotuberous ligament Sacrospinous Anterior inferior iliac spine
lschialspine
/ z-----Arcuateline..sciaticforamen Lesser / ,t --{ lliopectineal lliopubic eminence
Nr Bones and Ligaments
Anterior sacrococcygeal
(pectineal line) Obturatorforamen Inferiorpubicr Anteriorview Pubictubercle
Plate 353
Sex Differences of Pelvis: Measurements SFSo'Blrb,2l8 Femalepelvis/femalepelvic inlet: anteriorview S a c r o i l i a jco i n t al promontory Diagonal conjugate (-12 cm)
Diameters of the pelvis
(-13cm) Transverse O b l i q u e( - 1 2 . 5c m ) l l i o p u b i ce m i n e n c e
Nr
Pubicsymphysis lschialtuberosity
Male pelvis/malepelvic inlet: anteriorview Allmeasurements slightly shorter in relationto body sizethanin female Pelvicinletorientedmoreanteroposteriorly thanin female,where it tendsto be transversely oval Pubicsymphysis deeper(taller) Pubicarch(subpubicangle)narrower lschialtuberosities lessfar apart lliacwingslessflared
Transverse diameter of pelvic o u t l e t( - 1 1c m )
Pubic symphysis
Sacral oromontorv-
onjugate
schial
diameter of pelvic inlet ("11cm)
tuberosity Anteroposterior diameter of pelvic outlet ( v a r i e s9 . 5 - l 1 . 5c m becauseof mobility of coccyx)
l s c h i a sl p i n e
Tip of coccyx
pelvis/femalepelvicoutlet: Fema.le tntenor vtew
Plate 354
Pubic symphysis
Anteroposterior diameter of pelvic outlet ( 9 . 5 - 1 1 . 5c m )
Female:sagittalsection
Bones and Ligaments
Female and Male Pelvis Radiographs
FemalePelvis A B C D E F G H I I K L M
Sacrum llium Pubis lschium P u b i ss y m p h y s i s Obturatorforamen Headof femur Creatertrochanter trochanter Lesser Femur P e l v i cf o r a m i n a Airincolon S a c r o i l i aj oci n t Acetabulum Pelvicinlet
Male Pelvis AL5 B C D E F C H I I K L M N O P
Bones and Ligaments
Sacrum Ala of sacrum llium Pubis lschium P u b i cs y m p h y s i s Obturatorforamen lschialtuberosity l s c h i asl p i n e Headof femur Creatertrochanter trochanter Lesser Femur Airincolon S a c r o i l i aj oci n t Acetabulum S u b p u b iac n g l e
Plate 355
Pelvic Diaphragm: Female SeealsoPlates 263,366,370,392 ) ubic ligament l n f e r i o r( a r c u a t e p
Superiorview
Deeo dorsal vein of clitoris
P u b i cs y m p h y s i s
perinealligament Transverse Inguinaligament (Poupart's)
Fasciaof deep perinealmuscles Urethra Vagina Obturator canal
Obturatorfascia ( o v e ro b t u r a t o r i n t e r n um s uscle) Pubococcygeus muscle (partof levatorani muscle) Tendinous archof levatorani muscle Rectum lliococcygeusmuscle ( p a r to f l e v a t o ra n i m u s c l e ) l s c h i a sl p i n e Levatorplate (median raphe) of levatorani muscle Coccygeus(ischiococcygeus) muscte mismuscle
Coccyx A n t e r i o rs a c r o coccygealligament Sacralpromontory
Piriformis muscte
Medialview
l s c hi a l sprne
A r c u a t el i n e o f i l i u m o b t u r a t o r i n t e r n u sm u s c l e and obturator fascia(cut) T e n d i n o u sa r c h o f l e v a t o ra n i m u s c l e O b t u r a t o rc a n a l , l l i o c o c c y g e u sm u s c l e ( p a r to f l e v a t o ra n i m u s c l e )
Rectum Urethra Pubococcygeusmuscle ( p a r to f l e v a t o ra n i m u s c l e ) Vagina S p h i n c t e ru r e t h r a em u s c l e
4{ffi* Plate 356
Left puborectalismuscle and p e r i n e a lm e m b r a n e C o m p r e s s o ru r e t h r a ea n d u r e t h r o v a g i n a l s p h i n c t e r( p o r t i o n so f s p h i n c t e ru r e t h r a em u s c l e
Coccygeus ( i s c hi o c o c c y g e u s ) muscre Left levatorani muscle (cut) Externalanal s p h i n c t e rm u s c l e Superficialand deep transverseperinealmuscles
Pelvis Floor and Contents
Pelvic Diaphragm: Female (continuedl
lnferior view to urethra Musculofascial extensions Pubicsymphysi
to vagina Musculofascial extensions
Inferior(arcuate) pubicligament
fibersof perineum Interdigitating muscle (partof levatorani muscle)
Deepdorsal vein of c
muscle Pubococcygeus (partof levatorani muscle)
Inferiorpubicra
Tendinous archof levatorani muscle
Urethra
Obturatori nternusmuscle
Vagina
lliococcygeus muscle (partof levatorani muscle)
Rectum
lschialtuberositv l s c h i asl p i n e Obturatorinternus tendon ligament Sacrospinous ligament Sacrotuberous muscle Piriformis Median raphe of levator ani muscle
lschialspine
Coccygeus (ischiococcygeus)
Anococcygeal body (ligament) (attachmentof externalanal sphinctermuscle)
muscle Piriformis muscle(
Tip of coccyx
Sacrospinous ligament Sacrotuberous ligament
Piriformis muscle sciaticforamen
Lateralview Mediansacralcrest
l s c h i asl p i n e lliococcygeusmuscle (part of levator ani muscle)
Tendinous archof levatorani muscle muscle Pubococcygeus (partof levatorani muscle)
Sacrotuberous ligament(cut)
muscle Puborectalis (partof levatorani muscle)
4th posterior(dorsal)sacralfor Coccygeus (ischiococcygeus) muscle
liBament(cut) Sacrospinous Coccyx
4{tr Pelvic Floor and Contents
Pubicbone (cut surface) Deepdorsalvein of clitoris Urethra
Plate 357
Pelvic Diaphragm: Male SeealsoPlates 263, 266, 392 ) ubicligament I n f e r i o r( a r c u a t e p
P u b i cs y m p h y s i s
Superiorview (viscera removedl
H i a t u sf o r d e e p d o r s a lv e i n o f p e n i s Pubic crest P u b i ct u b e r c l e
P e c t e np u b i s( p u b i cp a r t o f i l i o p e c t i n elai nl e )
Transverseperinealligament ( a n t e r i o rt h i c k e n i n go f r i n e a lm e m b r a n e ) Hiatus for urethra
S u p e r i orra m u so f p u b i s
Muscle fibers from levator anr ro l u s c l eo f a n a lc a n a l c o n l o i n e dl o n g i t u d i n am
O b t u r a t ocr a n a l Obturator fascia
Levatorani muscle
l l i o p u b i ce m i n e n c e Tendinousarch of l e v a t o ra n i m u s c l e
A c e t a b u l a rm a r g i n A n t e r i o ri n f e r i o r i l i a cs p i n e
Obturator i n t e r n um s uscle
Wing (ala) of ilium A r c u a t el i n e ( i l i a cp a r t o f i l i o p e c t i n e al li n e )
l s c h i a sl p i n e Coccygeus(ischiococcygeus) muscle
l s c h i a sl p i n e
P i r i f o r mm i su s c l e
S a c r o i l i a jco i n t
A n t e r i o rs a c r a l( p e l v i c )f o r a m r n a
Sacrum
Anterior sacrococcygealligament Sacralcanal
Plate 358
A n o r e c t a lh i a t u s
4{tr
Pelvic Floor and Gontents
Pelvic Diaphragm: Male (continuedl seePlate 383 Forurogenital diaphragm Inferiorview D e e p d o r s a lv e i n so f p e n i s Fat in retropubic (prevesical)space S p h i n c t e ru r e t h r a em u s c l ea s c e n d i n g a n t e r i o ra s p e c to f p r o s t a t e
P u b i cs y m p h y s i s I n f e r i o rp u b i c ( a r c u a t e l)i g a m e n t P e r i n e abl o d y F i b r o m u s c u l aerx t e n s i o n so f l e v a t o r ani muscle to orostate P u b i ct u b e r c l e R e c t o u r e t h r a l si su p e r i o rm u s c l e
Urethra ) scia R e c t o p r o s t a t i(cD e n o n v i l l i e r sf' a
Prerectal musclefibers(of Luschka) f r o ml e v a t oar n im u s c l e
M e d i a l b o r d e r( p i l l a r ) o f l e v a t o ra n i m u s c l e
Musclefibersfrom levator longitudinal a n it o c o n j o i n e d m u s c l eo f a n a lc a n a l
P e r i n e am l e m b r a n e( c u t a w a y lschiopubic ramus\ -"t*
i'PF" ti
Obturator i n t e r nu s tendon
C l u t e u sm a x i m u s muscle
l s c h i a tl u b e r o s i t y S a c r o t u b e r o ulsig a m e n t( c u t )
Obturator internusmuscle
S a c r o s p i n o ulsi g a m e n t( c u t ) O b t u r a t o ri n t e r n u sm u s c l e ( i s c h i o c o c c y g e u sm)u s c l e S a c r o s p i n o ulsi g a m e n t( c u t ) Sacrotuberousligament (cut) Tip of coccyi
Pelvic Floor and Gontents
Plate 359
Pelvic Viscera and Perineum: Female
Paramedian(sagittal)dissection Ureter Uterine (fallopian) tube Ovary Ligament of ovary Round ligament of uterus Broad
pouch Rectouterine (of Douglas) Peritoneum(cutedge) pouch Vesicouterine Rectum reter Urinarybladder
ligament(cut) S u p e r i opr u b i c ramus(cut) Inferiorpubic ramus(cut)
Vagina
Ischiocavernosus muscle
External anal sphinctermuscle
Pelvicdiaphragm (levatorani muscle) Deeptransverse perinealmuscle(cut)
Bodvof clitoris Labia minora Labium
marus
Median (sagittal)section Sacralpromontory Ureter Suspensory ligamentof ovary Uterine(fallopian) tube Ovary External iliacvessels Ligament of ovary Bodyof uterus R o u n dl i g a m e not f u t e r u s (ligamentumteres
F u n d u os f u t e r u s Urinarybladder Pubicsymphysis Urethra Sphincterurethrae Deep transverse perinealmuscle
terosacral ligament pouch Vesicouterine pouch Rectouterine (of DouBlas) Cervixof uterus part Posterior of vaginalfornix Anteriorpart of vaginalfornix -Rectum Vagina .Peiineal memDrane Levatorani muscle
Analcanal
Deepdorsalveinof clitoris Crusof clitoris External urethralorifice perinealmuscle Superficial transverse L a b i u mm i n u s Labiummajus Vaginalorifice
Plate 360
Pelvic Floor and Contents
Pelvic Viscera and Perineum: Male
Ductus(vas)deferens
(sagittal)dissection Paramedian
Urinarvbladderandfascia Ureter(cut)
iliacvessels External Peritoneum
Seminalvesicle
Rectusabdominis
muscte
Rectovesicalpouch
Anterior layer of rectus sheath
Rectoprostatic (Denonvilliers') fascia
Transversalis fascia Umbilical
te (covered by fascia)
prevesicalfascia
Sub( fatty{Camper' c u t a n e o u{sm e m b r a n o u s tissue ( ts.urpu'rtSuperiorpubicramus(cut
ramus(cut) lschiopubic Pelvicdiaphragm (levatorani muscle) Deeptransverse perinealmuscle
Fundiform l i g a m e not f p e n i s Suspensory ligamentof penis Areolartissueandvesical venousplexusin retropubic(prevesical) space Deepdorsalveinof pen Corpuscavernosum Deep(Buck's)
Perineal body anal Deep ) External Superficial ) sPhincter Subcutaneous ) muscle Deep perineal(investingor Callaudet's)fascia Superficialperineal(Colles')fascia (inferiorfasciaof superficial perinealspace)
fasciaof peni
Corpusspongiosum (dartos) fascia Superficial of penisand scrotum Septumof scrotum
Superficial(dartos)fasciaof scrotum Externalspermatic fascia
Vesical fascia Rectovesicalpouch
Rectum
Median (sagittal)section
Seminal vesicle
Prostate U r i n a r yb l a d d e r Rectoprostatic (Denonvilliers') fascia Fundiformligamentof
Sphincter urethrae muscte
Suspensoryligamentof peni lnferior (arcuate)pubic ligamen
Bulbourethral (Cowper's) gland
Transverseperinealligament (anterior t h i c k e n i n go f p e r i n e a lm e m b r a n s ) Perinealmembrane
Perinealbody
muscle Bulbospongiosus
perinealspace Superficial
Deep perineal(investingor Callaudet's)fascia
Corpuscavernosum Corpusspongiosum Superficial(dartos)fasciaof penis and scrotum Deep (Buck's)fasciaof penis Prepuce
Clanspenisandexternalurethralmeatus
Pelvic Floor and Gontents
Superficialperineal(Colles')fascia
Buck'sfascia Septumof scrotum fossa Navicular
Plate 361
Pelvic Gontents: Female
Uterus(fundus)
Superiorview
Ligamentof ovary Ova U t e r i n e( f a l l o p i a nt)u b e
R o u n dl i g a m e not f u l Broad(lateraluterine)ligament
Urinarybladderand transverse vesicalfold Rectusabdominismuscle Medialumbilicalfold and ligament (occludedpartof umbilicalartery)
Lineaalba
Median umbilical fold and ligament (urachus)
pouch(of Douglas) Rectouterine Inferiorepigastric vessels and lateralumbilicalfold Uterosacralfold Uretericfold
Femoralring Deepinguinalring lliopubictract (coveredby peritoneum) External iliacvessels
Suspensoryligament of ovary (contains ovarian vessels)
lliac fossa (false pelvis)
Cecum
Cecalfolds
Left paracolic
Right paracolic
Butter
gut
4{F Sigmoidcolori Quadratus lumborum muscle Descendingcolon
Psoasmajor a n dm i n o r muscles
Sympathetic trunk Anterior Abdominal longitudinalligament muscles Bodyof L3 vertebrd
Plate 362
aflan
vessels Pararectal fossa Inferiorvena cava
Sacralpromontory Abdominalaorta plexus Superiorhypogastric
Transversalis fascia peritoneum Parietal Ascending colon ileum Terminal Ureter Root of mesenterv
Pelvic Floor and Gontents
Pelvic Gontents! Male Superiorview Rectum S e m i n a vl e s i c l e( s u b p e r i t o n e a l )
fold) Ductusdeferens(in peritoneal Lineaterminalisof pelvis
vesicalfold Urinarybladderandtransverse
L i n e aa l b a Median umbilical fold and ligament (urachus)
M e d i a l u m b i l i c a fl o l d a n d l i g a m e n t (occluded part of umbilical artery)
s uscle R e c t ua s b d o m i n im
Femoralring
Pubicbranchof in{eriorepigastric
Rectovesicalpouch Inferior epigastricvesselsand lateralumbilicalfold Vesicosacral (sacrogenital)fold
arterv (obturator anastomotic) D e e p i n g u i n a lr i n g
fossa Pararectal Uretericfold
iliacvessels External vessels Testicular ( i n p e r i t o n e af ol l d )
l l i o p u b i ct r a c t, (extraperitoneal) Cecum
l l i a cf o s s a( f a l s ep e l v i s ) fascia Transversalis
Cecal folds
Parietal perl Left paracolic
guttef
Quadratui
S i g m o i dc o l o n
lumborum muscle D e s c e n d i n gc o l o n
Transversus Abdominal abdominis I n t e r n aol b l i q u e m u s c l e s E x t e r n aol b l i q u e
Psoasminor and major muscles Svmpathetictrunk Anterior l o n g i t u d i n alli g a m e n t Body of L3 vertebra
Pelvic Floor and Contents
Testicular vessels Inferior vena cava
Sacralpromontory Abdominal aorta
plexus Superiorhypogastric
Right paracolic gutter
A s c e n d i ncgo l o n ileum Terminal Ureter
ormesentery fi{tr Plate 363
Endopelvic Fascia and Potential Spaces Female:superiorview (peritoneumand looseareolartissueremoved) Umbilicalprevesical fascia Medialumbilicalligament(occludedpartof umbilicalartery) Urinary bladder and vesicalfascia
Rectusabdominismuscle Superiorvesicalarteryin lateralligamentof bladder Lineaterminalisof pelvis Femoral ring
Inferiorepigastric artery and Pubic branch
Medianumbilicalligament(urachus) Pubicsymphysis Inferior(arcuate) pubicligament dorsalveinof clitoris pubic(prevesical) space perinealligament(anterior Transverse t h i c k e n i nogf p e r i n e aml e m b r a n e ) Medial pubovesicalligament
Lateralpubovesical ligament Vesicocervicalfascialfibers
Superiorfasciaof pelvic 4iaphragm(superior levatoranifascia) Obturatorcanaland obturatorarterv
D e e pi n g u i n arli n g lliopubic trac Transversalis fascia
External iliac vessels Femoral nerve (under fascia)
Deep circumflex iliac vessels Tendinous arch of pelvicfascia (reflected laterally) lliac fascia Ovarian vesselsin suspensory ligament of ovary
lliacusmuscle urator internus fascia
Psoasmaiormuscle Internaliliacvessels Inferiorvesical and vaginalarterie
(neurovascular) Hypogastric sheath Middlerectalarterv Cervixof uterusand uterinefascia Superiorrectalartery(leftbranc6) Rectum and rectal fascia Rectovaginal(potential)spa
(potential)space(spreadoperi) Presacral
4{tr Plate 364
Median sacralarteri
Tendinous archof Jevator ani muscle Tendinous archof pelvicfascia Uterosacralligament
Cardinal(transverse cervicalor Mackenrodt's) ligamentwith uterineartery Vaginorectal fascialfibers Presacraltascia(pulled away) Anterior sacrococcygealligament Vesicocervicaland vesicovaginal(potential)spaces
Pelvic Floor and Gontents
Urinary Bladder: Orientation and Supports Female:midsagittalsection Peritoneum fascia Transversalis M e d i a n u m b i l i c a l i g a m e n t( u r a c h u s ) Umbilical prevesicalfascia U t e r u s( f u n d u s ) Vesicouterinepouch
Fundus Uretericorifice Trigone P u b i cs y m p h y s i s Retropubic(prevesical)space and venous plexus Inferior (arcuate)pubic ligament Deep dorsal vein of clitoris Transverseperinealligament Sphincterurethraeand S p h i n c t e ru r e t h r o v a B i n a l t s musctes Perinealmembrane
Urethra Vagina L a b i u mm i n u s Perinealbody 'Ampulla External anal of rectum s o h i n c t emr u s c l e
P u b i cs y m p h y s i s ) ubicligament I n f e r i o r( a r c u a t e p Deep dorsal vein of cli
Labium ma.jus
Superiorview with peritoneum and vesical fascia removed
M e d i a l p u b o v e s i c alli g a m e n t ( m e d i a lp u b o p r o s t a t i cl i g a m e n ti n m a l e ) Transverseperinealligament (anterior t h i c k e n i n go f p e r i n e a lm e m b r a n e ) - Tendinousarch of levatorani muscle Obturator canal Lateralpubovesicalligament (lateralpuboprostaticligament in male) Tendinousarch of pelvic fascia S u p e r i o rf a s c i ao f p e l v i cd i a p h r a g m ( c o v e r i n gl e v a t o ra n i m u s c l e ) Obturator fasciaover obturator internusmusc Urinary bladder pulled up and back (vesica/fasciaremoved)
4{tr e/Fd4/*
M e d i a n u m b i l i c a l i g a m e n t( u r a c h u s () c u t ) I n f e r i o rv e s i c a a l n d v a g i n a la r t e r i e s
Urinary Bladder
Ureter
Plate 365
Urinary Bladder: Female and Male StraboPfatsg{q ffi1, St,oGq {S, M,4oo.417 Female:frontal section Peritoneum Body of bladder F u n d u so f b l a d d e r Interuretericcrest Left uretericorifice Trigoneof bladder Neck of bladder Paravesicalendopelvicfascia and vesicalvenous plexus Vesicalfascia Tendinousarch of levatorani muscle
O b t u r a t oirn t e r n u m s uscle Levatorani muscle Tendinousarch of pelvic fascia
Urethra Sphincter urethraemuscle Perinealmembrane
I n f e r i opr u b i cr a m u s
Round ligament of uterus
C r u so f c l i t o r i sa n d i s c h i o c a v e r n o s umsu s c l e
B u l bo f v e s t i b u laen db u l b o s p o n g i o sm u su s c l e Deep perineal(investingor Gallaudet's)fascia Superficialperineal(Colles')fascia
Peritoneum Body of bladder F u n d u so f b l a d d e r Ductus (vas)deferens Interuretericcrest Right uretericorifice Trigone of bladder Neckof bladder Paravesicalendopelvic fascia a n d v e s i c a vl e n o u so l e x u s T e n d i n o u sa r c h o f l e v a t o ra n i m u s c l e Uvula of bladder O b t u r a t o ri n t e r n u sm u s c l e L e v a t o ra n i m u s c l e
Capsuleof prostate Prostateand prostaticurethra
Internal urethral sphincter Tendinous arch of pelvic fascia Anterior recessof ischioanal fossa Inferior pubic ramus
Seminal
B u l b o u r e t h r(aCl o w p e r ' sg)l a n d P e r i n e am l e m b r a n ea n d s p h i n c t e ru r e t h r a em u s c l
tg
4
Nffi
C r u so f p e n i sa n d ischiocavern o s u sm u s c t e
Bulbousportionof spongyurethraC o r p u ss p o n g i o s u a mn db u l b o s p o n g i o sm u su s c l e Deepperineal(investing or callaudet's) fascia
"Cryr4gl*
Plate 366
Urinary Bladder
Sphincters
Vagina Urethra Levatorani muscle Urogenitah l iatus
Sphincter u r e t h r a em u s c l e Perineal
body
External sphincter (voluntary)
U rethrovaginal muscle Compressor urethraemuscle
Urinary Bladder
Plate 367
Male and Female Gystourethrograms
Femaleurethra, 8-year-oldchild
Voiding cystourethrogram, 2-year-oldmale
Plate 368
Urinary Bladder
Pelvic Viscera: Female
Superiorview with peritoneumintact Medianumbilicalfold (urachus) Vesicouterine pouch
bladder of uterus Deepinguinalring
Paravesical
fossa
Roundligamentof uterus Bodyof uterus Broad ligament Ligamentof ovary
lpinx(of broadligament) Cervixof uterus pouch(of Douglas) Rectouterine fold Rectouterine Uterine(fallopian)tube iliacvessels External fossa ligamentof ovary Suspensory (containsovarianvessels) Uretericfold bladder fascia (cut edge) Obturator fascia Sigmoidcolon
Sacral Median sacral
Abdominalaorta Obturatorcanal Obturatorartery Superiorfasciaof pelvicdiaphragm fascia Cervixof uterusand uterovaginal Uterinevessels Cardinal(transversecervical or Mackenrodt's) Rectocervicaland rectovaginal(potential) Rectal fascia (cut edge)
4{tr
(sacrouterine) Rectouterine ligament Externaliliac vessels Ureter
Sacralpromon
Superiorview with peritoneum and uterusremoved
Uterus, Vagina, and Supporting Structures
Plate 369
Uterus, Vagina, and Supporting Structures Mesovarium Broad ligament Cut edge of peritoneum forming floor of paravesicalpouch
Ovary Planeof section
Uterine ( f a l l o p i a nt)u b e
+\
A n g l eo f v i e w
R o u n dl i g a m e n t
il
Uterus
(pulled
Ligament of ovary.
I n t e r n a li l i a c artery and vein
\q
Lineaterminalis (pelvic brim)
d !
'
Suspensory ligamentof ovary
of uterus
',t,
Uterinevessels Obturator membrane
Cardinal(transverse cervicalor Mackenrodt's) ligament
Obturator fascia
Tendinousarch of levator ani muscle
Obturator i n t e r n um s uscle
Vaginalartery
Levatorani muscle (iliococcygeusand puDococcygeus muscles)
Ureter Uterovaginalfascia
Anteriorrecess of ischioanal fossa
l s c h i o p u b i cr a m u s
Compressor urethralis musc
of clitoris lschi ocavernosus muscle
Perineal memorane
Fascialata of thigh
Artery of bulb of ves
Superficialperineal space
S p h i n c t eurr e t h r o v a g i n aml ius s c l
Perinealartery Terminalpart of round
perineal Superficial (Colles') fascia
ligamentof uterus L a b i u mm a
B u l b o s p o n g i o s um s u s c l ea n d d e e p perineal(investingor Callaudet's)fascia
L a b i u mm i n u d
Bulbof vestibule
Vestibule
Vaginalwall H y m e n a lc a r u n c l e
Plate 37O
Uterus, Vagina, and Supporting Structures
Uterus and Adnexa
Suspensoryligamentof ovary
Posteriorview
Mesosalpinx(of broad ligament)
tube Uterine(fallopian) Infundibulum Ampulla
Ligamentof ovary
Vesicular appendix (hydatidof Mor8agni)
Fundus of uterus
Abdominal ostium
Corpusluteum Ovary
ligament Suspensory of ovary Ovary
Body of uterus
Mesovarium(of broad ligament)
Mesometrium(of broad ligament)
Ligamentof ovary
Ureter Uterine(fallopian)tube
Uterosacralligament Rectouterineoouch (of Douglas)
Fundus of uterus Body of uterus lnfundibulum Foldsof utenne tube
lsthmus of uterus
Ligament of ovary
Internal
Endometrium
os
Fimbriae
Vesicularappendix (hydatid of Morgagni)
Myometrium Mesometrium(of broad ligament)
Cervix of uterus
ligament Suspensory of ovary(contains ovarianvessels)
Epoophoron
Uterine vessels Cardinal(transverse cervicalor Mackenrodt's) ligament Cervicalcanal with palmatefolds Vaginalfornix Vagina
Uterus, Vagina, and Supporting Structures
Frontalsection
*{r Plate 371
Pelvic Ligaments
Anterior
Posterior Suspensory ligament of theovary (containing theovarianvessels)
Subdivisions and contentsof the broad ligament
External iliacvessels
A m p u l l ao f u t e r i n et u b e R o u n dl i g a m e n t
Rightovary Rightureter Laminaeof the mesosalpinx ObliteratedumbilicalarteryOvarian branches of uterine vessels R o u n dl i g a m e n t
Laminaeof the mesovarium Posterior laminaof broadligament Anteriorlaminaof broadligament
Transversevesicalfold Vesicouterine (uterovesical)pouch
Uterinearteryandvenousplexus Vaginalartery
Horizontal portion of
ligament Uterosacral Cardinalligament
Pelvicfascia and ligaments
Horizontal portionof vagina Vertical portion of vagrna
,ol'INAC{-ro
e4a4/*
Plate 372
Urethra
Arcustendineous fasciaepelvis portionof Distal(vertical) pubocervical fasciasupports urethraand U-Vjunctionand providesbackstopagainst which urethrais compressed duringstraining
Uterus, Vagina, and Supporting Structures
Uterus: Age Ghanges and Muscle Pattern
Adult (nulliparous)
Adult (postmenopausal)
Adult (parous)
C Contrastmediumin abdominalcavity uterus H Hysterosalpingogram R Rightfallopiantube infection
Ligament of ovary
Round ligament of uterus
Uterine musculature (schema)
Uterosacral ligament Cardinal (transverse cervicalor Mackenrodt's) ligament
fiberspass Spiral deeplyintowall and interlace (schema) Vaginalwall
Uterus, Vagina, and Supporting Structures
Nr Plate 373
Uterus: Position and Prolapse Degrees of retroversion 3rd degree 2nd degree l st degree
Variations in position
Retroflexion
Anteflexion (normal and severe)
Slightdescent(1st degree)
Cervixat introitus (2nd degree)
Plate 374
*{r Uterus, Vagina, and Supporting Structures
Ectopic Pregnaney
Sitesof ectopic implantation Interstitial
Tubal (isthmic)
Abdominal Iuoal
(ampullar)
o
lnfundibular (ostial)
*{r
Unruptured tubalpregnancy Villi invading tubularwall
Chorion Amnion
Sectionthrough tubal pregnancy
Uterus, Vagina, and Supporting Structures
Plate 375
!
ql
fransverse Section: Pubic Crest, Femoral Heads, Coccyx
i
=
o
!l I
GI {
Superiorportionof pubicsymphysis
o
Spermaticcord Plate 376
o
Interior of urinary bladder
!
g
A d d u c t o lro n s u sm u s c l e
s.
of pubis
B e g i n n i n go f u r e t h r a
2 tr
s muscte
Prostategland with prostatic urethra
Femoralvein P s o a sm u s c l ea n d
I
qt
Femoralartery l l i a c u sm u s c l e Femoralnerve Headof femur
S a r t o r i um s uscle
I
Neckof femur l l i o p s o a sm u s c l e
Cluteus medius muscle
Rectusfemoris muscle
Tensor fasciaelatae muscle
Cluteus mtntmus tendon
Cluteus medius muscre
Creater
trochanter
1
o 9. o
lnferior gemellus muscl
Obturator artery,vein, and nerve
f
g
+
ql f
o
o rt o o o o o t o II
5
c c o rt
Acetabular fossa Cluteus
L u n a t e( a r t i c u l a r ) surfaceof acetabulum
O b t u r a t o ri n t e r n u sm u s c l e Sacrotuberousligament
Left sciaticnerve
Ejaculatory ducts
Internalpudendal artery and vein
Perinealflexure (terminationof rectum, beginningof anal canal) Tip of coccyi
Pudendalnerve Fat bodv of ischioanalfossa Levatorani muscle (puborectalis)
Cfd4/*
!rl
o o t It t
o c C 5
o
!L
o 5
FemalePerineumand ExternalGenitalia(Pudendumor Vulva|
M o n sp u b i s of Anteriorcommissure labiamajora Prepuceof clitoris Pudendal cleft(grooveor spacebetweenthe labiamajora) Clansof clitoris Frenulumof clitoris urethralorifice L a b i u mm i n u s Labiummajus Openingsof paraurethral (Skene's) ducts of vagina
(cleftor spacesurrounded by labiaminora) Openingof greater (Bartholin's) gland vestibular Hymenalcaruncle Vestibularfossa Frenulum of labiaminora ol commrssure labiamajora raphe Perineal (overperinealbody) Anus
A n n u l ahr v m e n
Septatehymen
Perineum and External Genitalia: Female
*{r
Parousintroitus
Plate 377
Female Perineum (Superficial Dissection)
S u p e r f i r . i af al t t y ( C a n r p e r ' sl)a y c r
)
Su b c u t an e o u s trssue
R e i t u s s h e a t h( a n t e r i o rl a y e r ) A p o n e u r o s i so f e x t e r n a o i b l i q u en r u s c l e S u p e r f i ir. r li n g u i n . rrl i n g A t t l e r i o r s t t l t e r i o ri l i , t t : p i n e
I l o u n c l i g a m e n to f u t e r u sa n d c o v e r i n g s( c u t ) l n g , u i n aI li g a n r e n(t P o u p a r t ' s ) P u b i ct u b e r c l e P u b i cs y n r p h y s i s S a p h e n o uosp e n i n g S u s p e n s o r lyi g a n r e not f c l i t o r i s F a s c . il.ar t ao f t h i g h l s c ' h i o p u b ri ca n r u s S L r p e r i i c ipael r i n e a(l C o l l e s 'f)a s c i a ( c r / ta \ v . r v t)o o p e n s u p e r i i c i a l p e r i n e asl p a c e Is r - hio c a v e r no su s n rr - r s c l e B u l b o s p o n g , i o s runsu s c l e( c o v e r s br,rllrot vestiltr-rle ) l ) e r i n e . rnl r e n r b r a n e D e e l rp e r i n e a{l i n v e s t i nogr C a l l a u c l e t ' s ) iascia(lrartia//),cut a\1,.ry) S r r rl t ' r t i ri . r ll r . t t r ' re r r e l l e r i t r e a n l ru\cle
I s c h i a tl r - r b e r o s i t y S u p e rl i c i a lp e ' r i n e a(lC o l l e s ' i)a s c i a (c'utc'c/gc, trrlrcc/c/orvn) F a tb o c l yo f i s c h i o a n aflo s s a
-:-Rt't
Sulrcutanr:ous \ f ..xy-------l
ltts
i ii:lt.;;,,,,./
Superficial perir.rea (C l olles') iascia
I
rvl.l
tr,t r l
t{ ,U\_
-.,-
R e t l u . r l t e . t t l tt . r r t l e r i o lr , r t t t t /
I
|f';ilX,l'.-:ili"' c()vennBS
Tt'atrsve,rs,tIis i.rsc.i.t
P u b i cs y n t p h y s i-s. -
(arcuafe) tnferior tiganrcr,r---__ uubir' T r a n s v e r s e1 l t ' r i t ' t t ' al il g . t r l r t ' l l t
___=-.=N
S u s l ; e n s o r yl i g a n t e n to l t l i l o r i s
Sphi nc:teru rethrae ar-rcl slth i nc'teru rethrovaginalis ntust lt,s---l-\ l l . r i n t , arl r t ' n r l t r . r r r t , Sr-r1re rf ir:ia | 1rc ri nt' a| (( rrIIt's' ) l,\ s( id -------/ S u l t t ' r i o r[ . r s ri a < >p[ r ' l v i r r l i a l t h r a g n r I r ' v . r l o r. r r r n i ruscle
Plate 378
Anococcygeal body E x t e r n aal n a l s p h i n c t enr r u s c l e
Perineum and External Genitalia: Female
Female Perineum and DeeP Perineum
B u l b o s p o n g i o smu us s c l e with deepperineal(investing
S u s p e n s o r yl i g a m e n to f c l i t o r i s
Clitoris
o r C a l l a u d e t ' sf;a s c i a partiallyremoved
lschiocavernosusmuscle
B u l bo f v e s t i b u l e S u p e r f i c i apl e r i n e a sl p a c e ( p o u c ho r c o m p a r
membrane Perineal
l s c h i o p u b irca m u s w i t h c u t e d g eo f superficial p e r i n e a(lC o l l e s ' ) fascia-
Creatervestibular ( B a r t h o l i n 'Bs l)a n d Bulbospongiosus muscte lcut away)
Perineal membrane lschial tuberosity
Superficial transverse perineal muscle
Sacrotuberous ligament,
Perineal body
Cluteus maxrmus muscte
lschioanalfossa
Coccyx
Obturator fascia
Urethra Tendinousarch of levator ani muscle
Crusof clitoris-
S p h i n c t e ru r e t h r a e muscle
lschiopubic ram
P e r i n e aml e m b r a n e (cutand reflected) urethrae Compressor muscte
lnferior fasciaof pelvic diaphragm (cut) Levatorani muscle Externalanal sphinctermuscle Anococcygeal(ligament)body
S p h i n c t e ru r e t h r o v a g i n a l i s
muscle Vagina Creater vestibular ( B a r t h o l i n ' sg)l a n d
Deeptransverse p e r i n e aml u s c l e
4{tr
P e r i n e am l embrane
Perineum and External Genitalia: Female
Plate 379
Perineum and External Genitalia (Superficial Dissectionf
SLrpcrlia cl l.rtt\'{(-.rnl)er's) in(| (|('('l)('l n r t ' n rIr T , n t c lL rs
{ S
Anterior ol sul)e11 i l i a cs p i n t ' S L r l ; t ' ri lr . i l l ( c l a r t o s ) l a s ci a o 1 p c n i s a n c l s( rotu|ll
Ingr,rin.rl lrSainrent (Poupart's)
b
S .p r h c r ro L r s ol)('nilr{l .lnd
1r'nror.rl .trt('rv a r r r lv t , i n
l l r o l < t ' nl i n e in(li(.lt('s lint'o1 n t f . r h( n r ( ' n t ol (.olles' a n r lS ca r p a ' s l . r s r . i . rwt ,i t l r cleep l-.rsc'iir
l s ch i o pulrit rJnrLrs
I : , r l r o c l yi n i s c h i o a n . r{ lo s s a
P u b i cs y m p h y s i s
U r o g e n i t at lr i a n g l e l s c hi o p r . r l r irca-n r u s
R e g i o n s( t r i a n g l e s ) ot penneum: s u r l a c et o p o g r a p h y
\ n ( l lt r i a n g l e
Nr Plate 38O
Tip of cocc.vr
%tc#
Perineum and External Genitalia: Male
Perineum and External Genitalia (Deeper Dissectionf
Skinof penis (dartos) Superficial fasciaof penis of Aponeurosis externaloblique muscre (Scarpa's) Deepmembranous layerof subcutaneous tissue(cutaway) I n g u i n al il g a m e n t (Poupart's) Deep(Buck's) fasciaof penis Superficial i n g u i n arli n g Externalspermaticfascia investingspermaticcord *J,
Fascialata (deep fascia)of thigh
B u l b o s p o n g i o smuus s c l e muscle lschiocavernosus coverscrusof penis perineal(Colles')fascia(cut Superficial perinealspacel awayto open superficial Perinealmembrane
or Callaudet's) Deepperineal(investing fascia(partiallycut away)covers perinealspace musclesof superficial perinealmuscle transverse Superficial lschialtuberosity fascia(cutedge) perineal(Colles') Superficial fossa Levatoranimuscleroofingischioanal xternalanalsphinctermuscle s uscle C l u t e u sm a x i m um
Superficialdorsalvein
Dorsalarteryand nerve Deep dorsal vein
vein Lateralsuperficial Superficial(dartos)fasciaof pe
Corpus cavernosumand its tunica albuginea
Deep (Buck's)fasciaof penis
Deep artery Intercavernousseptum of deep fascia
Urethra
and its Corpusspongiosum t u n i c aa l b u g i n e a
4{tr
Sectionthrough body of penis
Perineum and External Genitalia: Male
Plate 381
Penis
E x t e r n aul r e t h r a o l r i f i c e( m e a t u s )
C l a n sp e n i s oronaof glans Frenulum
Neckof glans O p e n i n g o f p r e p u t i a l( T y s o n ' sg) l a n d
Skin
Superficial(dartos)fasciaof penis
D e e p( B u c k ' sf )a s c i ao f p e n i s Externalspermaticfasciainvestingspermaticcord (cut) Superficialperineal(Colles')fascia(cut away to open supe rfi cial per i neal space\ Deep perineal(investingor Gallaudet's)fascia (cut away) over musclesof superficialperinealspace lschiocavernosusmuscle (cut away) Superficialtransverseperinealmuscle
C l a n sp e n i s oroora cavernosa of penis
lntercavernous septumof deep (Buck's)fascia C o r p u ss p o n g i o s u m Pubictubercle Superior p u b i cr a m u s lschial
Perineal membrane
tuberosity C l u t e u sm a x i m u m s uscle L e v a t o ra n i m u s c l e and inferior fascia of pelvic dia.phragm I rooilng rscnroanatlossa
Perineal body
B u l bo f p e n i s Tip of coccyx
C r u so f p e n i s
Externalanal s p h i n c t e rm u s c l e
Perineal memorane
4{F
lschial tuberosity
External anal s p h i n c t emr u s c l e
Plate 38.2
Perineum and External Genitalia: Male
Perineal Spaces
Pubic
P u b i cb o n e
Superior pubic
perinealligament(anterior Transverse t h i c k e n i nogf p e r i n e aml e m b r a n e )
ramus\\ \
Dorsalarteryand nerveof penis
Inferior (arcuate) pubic ligament
Deeparteryof penis
D e e pd o r s a l veinof penis
(Cowper's) gland Ductof bulbourethral
Urethralartery
Arteryof bulbof penis fasciaover or Callaudet's) Deepperineal(investing and bulbospongiosus, ischiocavernosus, perinealmuscles(cutaway) transverse superficial
Urethra Perineal m e m b r. at l lnt re-
ficial perineal(Colles')fascia(cutaway)
perinealmuscle transverse Superficial kut and reflected) Perineal body
Inferior views
tuberosity External a n a ls p h i n c t e r muscte
Dorsal artery and nerve of Deep artery of penis
Urethral (Cowper's) gland Bulbourethral Arteryof bulbof penis membrane(cutedge) Perineal
Sphincter urethrae muscle
Internalpudendalartery and dorsalnerveof penis I n t e r n apl u d e n d aal r t e r ya n dp e r i n e abl r a n c h
Urethra Deeptransverse perinealmuscle Levatorani muscle P e r i n e am l embrane Deep transverseperinealmuscle Deep perineal(investing
fascia or Callaudet's) Corpus cavernosum(crus of penis) and deep (Buck's)fasciaof peni lschiocavernosusmuscle S u p e r f i c i apl e r i n e a l( C o l l e s ' f) a s c i a ( c l o s e ss u p e r f i c i apl e r i n e a sl p a c e )
U r i n a r yb l a d d e r Prostate uratorinternusmuscle l s c h i o p u b ri ca m u s urethraemuscle Sohincter (Cowper's) gland Bulbourethral muscle lschiocavernosus a )n d B u l bo f p e n i s( c o r p u s p o n g i o s u m d e e p( B u c k ' sf )a s c i ao f p e n i s B u l b o s p o n g i o smuus s c l e
q
1frffi
"'"erfu# A
Frontalsection,anteriorview of perineum:schema
Perineum and External Genitalia: Male
aa
Plate 383
Prostate and Seminal Vesicles SeealsoPlates361,363,366,403, 410 Ureteric orifice Trigone of urinary
bladder In t e r n a l urethral sphincter Uvula of bladder
Prostate S e m i n aclo l l i c u l u s
Urethral crest
Prostatic utricle
Openings of prostatic d u c t si n prostatrc
O p e n i n go f ejaculatoryduct
S I NU S
Sphincter urethrae muscle Bulbourethral (Cowper's) gland i+...j
O p e n i n go f b u l b o u r e t h rdaul c t
Perinealbody
Rectovesicalor rectoprostatic (Denonvilliers')fascia
Frontalsection,anteriorview of bulbousportion of sponsy urethraschematicallv extendtid
Rectum and rectal fascia
;
Seminal vesicle
Sagittalsection
U r i n a r yb l a d d e r Ductusdeferens Anteriormuscularbandof skeletalmuscle (continuationof sphincterurethrae)
Ampulla of ductus
Prostatic urethra
deferens
I s t h m u sa n d f i b r o m u s c u l a r ma (smooth muscle) atic utricle
Seminal
ian lobe
col Beginning of ejaculatory duct
Inferolateral lobe
Inferolateral
lobe
Prostate l s c h i o p u b i cr a m Deep t perineam l uscle and fascia
Capsuleof prostate
(Cowper's) Bulbourethral glands
Posteriorview
Plate
lnferooosteriorlobe
Crosssectionthrough prostate
Perineum and External Genitalia: Male
Urethra
i
Trigoneof urinary bladder
of bladder Prostate Urethralcrest Prostatic sinuses Prostatic u rethra
O p e n i n g os f prostaticducts
Prostaticutricle
lntermediate part of (membranous) urethra
urethrae
Bulbof oeni C r u so f p e n i s Bulbous portion
Bulbourethral (Cowper's) gland
:el
,:,_$s/ Corpus cavern T u n i c aa l b u g i n e a
Corpusspongiosum T u n i c aa l b u g i n e a
T
f
Deeparteryof peni
-
lntercavernousseptum of deep (Buck's)fascia oo
PendutouS (penile)
Urethrallacunae(Morgagni) and urethralglands(Littr6)
portion
LacunamaBna(inconstant)
fossa Navicular C l a n sp e n i s External urethralorifice(meatus)
Roof of urethra
Perineum and External Genitalia: Male
Floor of urethra
Plate 385
Descent of Testis
gland Suprarenal
gland Suprarenal
Kidney
Suspensory (diaphragmatic) ligament
Suspensory (diaphragmatic) ligament (atrophic)
Mesonephric (wolffian)duct
Testes Epididymis
Cubernacul
Cubernaculum
Urinarybla
Deepinguinalring Urinarybladder
I weeks (22.5-mmcrown-rump)
(43-mm crown-rump)
Cubernaculum
f
4 lunar months (107-mmcrown-rump)
S u p e r f i c iianlg u i n arli n g Ductusdeferens Scrotum(cutopen)
*{r Processus vaginalis
Cubernaculum
8 lunarmonths (26-cm crown-rump)
Plate 386
Cavityof tunica vaginalis (cutopen)
Perineum and External Genitalia: Male
Scrotum and Gontents
Skinof penis Superficialfascia of penis(Colles'fascia) Deep(Buck's) fasciaof penis
Superficial i n g u i n arli n g
Testicular artery
External fascia spermatic
Ductusdeferens to ductusdeferens
muscle Cremaster
italbranchof genitofemoralnerve
and fascia
(venous) plexus Pampiniform
Septumof scrotum (formedby dartosfascia)
Appendixof epididymis Superficial (dartos)fascia of scrotum
Appendixof testis Testis(coveredby visceral layerof tunicavaginalis)
Skinof scrotum Parietal layerof tunicavaginalis
(dartos) Superficial fasciaof scrotum fascia External spermatic Cremastermuscleand fascia Internalspermatic fascia Parietal layerof tunicavagi Epididymis Testis(coveredby viscerallayerof tunicavaginalis)
*{r
Skinof
Perineum and External Genitalia: Male
Plate 387
Homologues of External Genitalia
Undifferentiated Epithelialtag
fold Urogenital
Cenitaltubercle
Urogenitalgroove Lateralpart of tubercle Analtubercle Anal pit
Male
45-50 mm (-10 weeks)
Female
Epithelial tag Coronalsulcus Siteof futureoriginof prepuce Urethralfold
45-50 mm (-10 weeks)
Urogenital groove
Lateraltubercle (shaftor corpus) Labioscrotal swelling Urethralfoldspartly fused(urethralraphe) Analtubercle Anus External urethralorifice
Body of
clitoris Prepuce Fully developed
Clansof clitoris Raphe of penis
External urethral orifice
Labium mrnus Labium maJus
Posterior commrssure Perinealraphe
Perianal tissues (includingexternal analsphincter muscle)
Plate 388
Homologues of Genitalia
Homologues of lnternal Genitalia
--
Diaphragmaticligament
(suspensory ligamentof ovarY)
(mi.illerian) duct Paramesonephric
Mesonephric tubules
(wolffian)duct Mesonephric
Cenitalcord
fold1 Inguinal
\
sinus Urogenital i
(d) (Cowper's) of bulbourethral Primordium (9 ) glands (Bartholin's) or of greatervestibular
(d ) Primordium of prostate (Skene's) or of paraurethral (9) glands
M^r" 2,/
Undifferentiated 1*
4{tr Femare
Seminalvesicle deferens
Prostatic utricle Prostate Openingof ejaculatory Bulbourethral (Cowpe/s) of epididymis Epididymis Efferent ductules Appendixof testis Testis Paradidvmis Scrotalligamen (gubernaculum)
Homologues of Genitalia
Plate 389
Testis, Epididymis, and Ductus Deferens
Efferentductules Aberrantductule(vestigial mesonephric tubule) Ductusdeferens
Areaof rete testis(in mediastinumtestis)
Epididymis
Frontal section Ductusdeferens Efferentductules Epididymalduct Retetestis(in mediastinum testis) Aberrantductule Seminiferous tubules Schema Skinof scrotum (dartos)fascia Superficial Lobulesof testis
External spermatic fascia muscleandfascia
Scrotalseptum(dartos)
Internalspermatic fascia Septa
Parietallayerof tunicavaginalis
Retetestis(in mediastinum testis)
Viscerallayerof tunicavaginalis Tunicaalbuginea of testis
Ductusdeferens
Sinusof epididymis Epididymis
Crosssectionthroughscrotumand testis
Plate 39O
Nr
Testis, Epididymis, and Ductus Defenens
Rectum in Situ: Female and Male
Sigmoidcolon Free taenia (taenialibera)
Sigmoidmesocolon Rectosigmoid
Ductus(vas) deferens(cut)
Peritoneal reflection
Ureter(cut)
pouch Rectovesical
Urinary bladder
Rectumand rectalfascia
Seminal vesicle
Levatorani muscle (pelvicdiaphr
(Denonvilliers') fascia
Coccyx
Prostate
part of Puborectalis levatorani muscle
lschiocavernosus muscleanddeep perineal(investing or Callaudet's) fascia(partially cut away)
Deep External anal sphinctermuscle* Superficial Subcutaneous
Deep transverse perinealmuscle
Female
Perineal body transverse perinealmuscle and deep perineal (investing) fascia
Sigmoid mesocolon
Rectosigmoid lunction
perineal(Colles') fascia
Peritoneal reflection
Sigmoidcolon Freetaenia(taenialibera)
Rectalfascia and rectum
pouch
Rectouterine pouch (of Douglas)
4{y
Ureter(cut) Vaginaand vaginalfascia
Coccyx
Urinarybladderandvesicalfascia
Levatorani muscle (pelvic diaphragm)
muscleand lschiocavernosus or deepperineal(investing fascia Callaudet's) Deeptransverseperinealmuscle and perinealmembrane
Puborectalis part of levator
ani muscle
fascia perineal(Colles') Superficial perinealmuscleand deep Superficialtransverse fascia perineal(investing or Callaudet's) bodv Perineal
*Partsvariableand often indistinct
Rectum
Plate 391
lschioanal Fossae SaeahoPt$asO' ?, 41o-{t8
lliacus muscle andfascia
External iliac vessels
Obturator internus m u s c l ea n d fascia
canal
(Alcock's) contains internalpudendal pudendal vessels, nerve,and perinealnerve
lschial tuberosity
Ureter
Tendinousarch of levator ani muscle
Extraoeritoneal (supralevator) space (fibrofatty tissue) Fatbody of ( DeePerPart 1 ischioanal J Superficial I tossa ( (perianal) part Transverse fibrousseptum of ischioanal fossa S u b m u c o ussp a c e( i n t e r n avle n o u sp l e x u i ) Perianal space(external venousplexui) Intersphinctericgroove (anocutaneouslinb)
Pfate 392
Sacrogenitalfold (uterosacral in female) Levatorani muscle and superiorand inferior fasciaof pelvic diaphragm
(cutedge)formingfloorof pararectal fossa Peritoneum Rectalfascia
External analsphinctermuscle l uscle C o n j o i n e dl o n g i t u d i n am
4{tr
Internalanal sphinctermuscle
Rectum
Rectum and Anal Ganal
Sigmoidcolon
15-17
junction Rectosigmoid 11-13
folds Transverse of rectum(valves of Houston)
reflection Peritoneal
8-9
fascia
musclelayer Longitudinal musclelayer mucosae Muscularis evator ani muscle
5-6
4-5
2.5-3
0.s-1
Anal verge
Pecten Anoderrh
*Partsvariableand oftenindistinct
Rectum
Anorectalline A n a lc o l u m n s( M o r g a g n i ' s ) Analsinus (dentate)line InternalrectalvenousPlexus in submucous space Deep part* of external sphinctermuscle muscle Conjoinedlongitudinal Internalsphinctermuscle Analvalve Analcrypt Superficialpart* of external sphinctermuscle Analglands fibrousseptum Transverse mucosaeof analcanal Muscularis space utaneouspart*of externalsphinctermuscle Corrugator cutisani muscle rectalvenousplexusin perianalspace External line) groove(anocutaneous Intersphincteric
4{F
Plate 393
Anorectal Musculature Rectosigmoid junction
Anteriorview
S i g m o i dc o l o n
Freetaenia (taenialibera)
of taeniaspreadout to form longitudinal musclelayerof rectum ibersfrom longitudinalmusclejoin circular muscle layer Window cut in longitudinalmuscle layerto expose underlying
rculam r u s c l el a y e r
Levatorani muscle
Frontalsection
Deep Parts"of externalanal Superficial S u b c u t a n e o u s s p h i n c t emr u s c l e
Fibrousseptum Corrugator cutis a n im u s c l e
4{tr
Perianal skin
Superiorfasciaof pelvic diaphr Inferiorfasciaof pelvic diaphr
Levatorani muscle Rectalfascia L o n g i t u d i nm a lu s c l eo f r e c t u m Circularmuscleof rectum Muscularis mucosaeof rectum Deep part* of externalanal sphincterm
Internalrectalvenousplexus Conjoinedlongitudinal muscle part*of externalanalsphincter Superficial I n t e r n aa l n a l s o h i n c t e rm Muscularismucosaeof anal canal Transversefibrous septum of ischioanalfossa
part*of externalanalsphincter Subcutaneous Corrugatorcutis ani muscle Externalrectalvenous plexus
Intersphincteric groove (anocutaneous line)
*Partsvariableand often indistinct
Plate 394
Rectum
External Anal Sphincter Muscle: Perineal Views
scrotal(dartos)fascia Superficial tum of scrotum (Buck's)fasciaof penis B u l b o s p o n g i o sm u su s c l ew i t h d e e pp e r i n e a l (investingor Callaudet's)fasciaremoved musclewith deep perineal schiocavernosus (investingor Gallaudet's) fasciaremoved Perinealmembrane I s c h i o p u b irca m u s Perinealbody perinealmusclewith deep transverse Superficial peiineal(investingor Callaudet's)fasciaremoved subculaneous ) ,uur- of externalanal 5uPerllclal I sohinctermuscle ueep , Superficialperineal(Colles')fascia(cut edges) fibrousseptumof ischioanalfossa(cut) Transverse lschialtuberosity t u b e r o u sl i g a m e n t Pubococcygeus) Puborectalis I Levatorani muscle lliococcygeus ) Anococcygealbody (ligament)(posteriorextensions of superficialexternalanalsphinctermuscle) C l u t e u sm a x i m u sm u s c l e Tip of coccyx
Female Clitoris Externalurethral orifice Superficialperineal(Colles')fascia(cut edge) lschiocavernosus musclewith deep perineal (investingor Callaudet's)fasciaremoved Bulbospongiosus musclewith deep perineal (investingor Callaudet's)fasciaremoved Fibersfrom superficialexternalanal sphinctermuscleto ischiopubicramus P e r i n e aml e m b r a n e transverseperinealmusclewith Superficial deep perineal(investingor Callaudet's) fasciaremoved Superficialperineal(Colles')fascia(cut edge) Perinealbody Crossedfibersfrom superficialand deep external sphinctersto superficialtransverseperinealmuscle
iopubic ramuS Anus
P a r r so* f e x t e r n a l a n- a Il P e e P r / s'o h i n c t e r ' m u s ; i ; - J S u p e r f i c i a l ( Subcutaneous . ( Puoococcygers L e v a t o r a nm i u s c l e{ P u b o r e c t a l i s / ( lliococcygeusC l u t e u sm a x i m u sm u s c l e Anococcygealbody (ligament)(posteriorextensions of superficialexternalanalsphinctermuscle) "Partsvariableand often indistinct
Rectum
Plate 395
Actual and Potential Perineopelvic Spaces Sagittalsection Peritoneum fascia Rectal fascia Rectal fascia Presacral fascia Retropubic (prevesical) space(of Retzius) Recto-( Retrovesicall vesicalI P1g1ss16lspace ( Retroprostatic Sphincter urethrae
Presacral space Rectovesical or rectoprostatic (Denonvilliers') fascia(septum)
DeePand superficialperinealmuscles transverse
Levatorani muscle and fasciaof pelvicdiaphragm Deep postanalspace Anococcygeal body (ligament)
Deep(Buck's) fasciaof penis Superficial perineal(Colles') fascia
postanalspace(part Superficial of perianalspace) Submucous space
*Partsvariableand oftenindistinct
Perianalspace Bulbospongiosus muscleanddeepperineal(Gallaudet's) fascia perinealcompartment (spaceor pouch) Superficial
Perineal membrane, perinealmuscleand Deeptransverse perinealmuscle Superficial transverse (cutaway)to expose Anteriorrecessof ischioanal fossa -Preanalcommunication (inconstant) between rightand leftischioanal fossae Pusin ischioanal fossa Posterior communication betweenrightand left ischioanalfossaevia deeppostanalspace deepto anococcygeal body(ligament) Gluteusmaximusmuscleand ligament Sacrotuberous (cut) Posteriorrecessof ischioanalfossa
Perinealview Spreadof perinealabscessin perinealspaces
Plate 396
4{ft* Rectum
Pelvic Scans: Sagittal MR lmages Median (A) and paramedian(B) sagittalMR imagesof femalepelvis AB
A
c D P R
Analcanal External os of cervix sac Dural(thecal) Pubicsymphysis Rectum
muscle RA Rectusabdominis s Sacrum U Uterus U B Urinarybladder v Vagina
Median (C) and paramedian(D) sagittalMR imagesof male pelvis
c
c cc
Corpusspongiosum Corpuscavernosum G Glanspenis P Pubicsymphysis PS Prostate
Regional Scans
R
s T U
Rectum Sacrum Testis Urinarybladder
Plate 397
Arteries of Rectum and Anal Ganal (Male|
Posteriorview
Left colic artery Ascendingbranch
Inferiormesenteric artery Abdominal aorta
D e s c e n d i n gb r a n c h
Inferiorvena cava
Sigmoid arteries
Median sacralartery Common iliac artery
Marginal artery
Externaliliac artery
Rectosigmoidarteries
Internaliliac artery
Superior rectal arrery (bifurcation)
Lateral sacral artery
Superiorgluteal artery
Middle rectal artery
Inferior gluteal artery
l s c h i a sl p i n e
Obturatorartery
Obturator
I n t e r n apl u d e n d a l artery
i n t e r n um s uscle lnternal pudendalartery
ical artery nferior vesicalartery
Pudendalcanal (Alcock's) lschialtuberosity Coccygeus(ischiococcygeus)muscle Inferior rectal artery Levatorani muscle
Plate 398
to ductus deferens
Anus
Superiorvesicalartery External anal s p h i n c t emr u s c l e P u b o r e c t a lm i su s c l e (severed)
Middle rectal artery Inferior rectal artery
Nr
Vasculature
Veins of Rectum and Anal Ganal (Femalel
Anterior view Inferiormesentericvein (to portalvein via splenicvein) lnferior vena cava S i g m o i dv e i n s Common iliac veins
Median sacralvein
Superiorrectalvein(bifurcation) iliacvein External
Internaliliacvein
Obturatorvein Superiorvesicaland uterineveins(from uterinevenousplexus) Middle rectalvein nternalpudendalvein betweeninternal Communication rectalplexuses and perimuscular aginalvein (fromvaginal venousplexus) vein lnferiorvesicular Internalpudendalveinin pudendalcanal(Alcock's) lnferiorrectalvein betweeninternal and externalvenousplexuses
Internalrectalplexus Perimuscular rectalvenousplexus External rectalolexus
Vasculature
4{tr Plate 399
Arteries and Veins of Pelvic Organs: Female
Anteriorview Renalarteryandvein Renal artery andvein
Ovarianarteryand vein Abdominalaorta
Kidney
Ureter
Ovarian artery andvein
Inferiormesenteric artery Psoasmajormuscle
Ureter
Commoniliacartery
Inferior venacava
Mediansacralvessels Superiorrectalartery(cut)
Psoasmajor muscle
ligamentof uterus(cut) Peritoneum (cut edge)
artery nternal iliac artery
Suspensory ligament of ovary contains
Anteriordivision Externaliliacarterv
ovanan vessels
Obturatorarteryand nerve
Rectum
Umbilicalartery (patentpart)
Ovary
Middle rectalartery
Uterine (fallopian)
Uterinearterv 'aginal artery
Uterus
Inferiorvesicalartery
Round ligament of uterus
Roundligament of uterus(cut)
Vagina
Superiorvesicalarteries
Urinary bladder
ior epigastric arteryandvein
Medial umbilicalfold
Umbilicalartery (occludedpart) Superiorvesicalarteries
*{r
Medialumbilicalligament Medianumbilicalligament(urachus)
Vasculature
Arteries and Veins of Testis
Anteriorview *
q
Renalvessels lnferior vena cava Abdominal aorta Testicularvessels (part of spermaticcord) Ureter Inferior mesenteflcarterY o m m o n i l i a cv e s s e l s l n t e r n a li l i a cv e s s e l s Externaliliac vessels Inferiorvesical artery Inferior epigastric vessels Artery to ductus deferens Cremasteric vessers Testicularvessels in spermaticcord
Femoral vessels Superficial external pudendal vessels(cut-Pass superficialto s p e r m a t i cc o r d ) Deep external pudendal vessels Pampiniform v e n o u sp l e x u s Deep dorsal vein and dorsal arteriesof p e n i su n d e r deep (Buck's) fasciaof penis
4{r Vasculature
Plate 4Ol
Arteries and Veins of Pelvis: Female
M e d i a ns a c r a l
A b d o m i n a la o r t a
arrery
n i g h t I C o m m o ni l i a c Left I arteries
lliolumbar artery Lateral sacral arteries
I n t e r n a il l i a ca r t e r y P o s t e r i odr i v i s i o n Anterior division Externaliliac artery Umbilicalartery (patent part)
Superior gluteal arter
Obturator artery
Piriformis muscle
U t e r i n ea r t e r y
M i d d l e r e c t a la r t e r y
Vaginalartery
Inferior gluteal
Inferiorvesicalartery Superiorvesicalarteries
artery
M e d i a lu m b i l i c a l i g a m e n t (occluded part of umbilicalartery)
Internal pudendal artery
P u b i cs y m p h y s i s
Coccygeus (ischiococcygeus muscle
Right paramedian section: lateral view
Sacrotuberous ligament---Obturator fascia ( o f o b t u r a t o ri n t e r n u sm u s c l e
A b d o m i n a la o r t a
Internap l u d e n d a la r t e r y i n p u d e n d a lc a n a l( A l c o c ks t
Inferiorvena cava R i g h tc o m m o n i l i a ca r t e r y
L e v a t o ra n i m u s c l e{ c u t e d g e
Left common iliac artery
Ureters Externaliliac artery (cut) S u p e r i o rg l u t e a la r t e r U m b i l i c a la r t e r y( p a t e n tp a r t )
I n t e r n a il l i a ca r t e r y P o s t e r i odr i v i s i o n A n t e r i o rd i v i s i o n
Obturatorartery Piriformm isuscle Internap l u d e n d a la r Inferior glutealartery C o c c y g e u s( i s c h i o c o c c y g e u sm) u s c l e Middle rectal artery-----j U t e r i n ea r t e r y Vaginalartery I n f e r i o rv e s i c a a l rt Internap l u d e n d a la r t e r
4{tr
Inferior rectal arte S u p e r i o rv e s i c a a l rteries M e d i a lu m b i l i c a l i s a m e n r ( o c c l u d e dd i s t a lp a r t o f u m b i l i c a a l rtery)
Plate 4O2
turator canal Obturator tnlernus muscle Levatorani muscle
Vasculature
Arteries and Veins of Pelvis: Male left paramediansection: lateralview
Abdominalaorta
lnferior vena cava
Rightobturator
Commoniliacvessels
Righu t m b i l i c aalr t e r (patentpart)
Mediansacralvessels (cut) External iliacvessels
Superiorvesicalartery
Internaliliacvessels
Umbilicalartery (occludedpart)
lliolumbararterv
Deep circumflex iliac
teralsacralartery Superiorglutealartery Obturatorartery
Inferior epigastric
Umbilicalartery
vessels
Ureter(cut)
Ductus deferens and its artery
Inferiorglutealartery Inferiorvesicalartery
M e d i a lu m b i l i c a l ligament
Middle rectalartery
M e d i a nu m b i l i c a l ligament(urachus)
Internalpudendal artery Ductusdeferensand its arterv
Superior vesicalartery
of Prostatic branches inferiorvesicalartery
Superficial dorsalvein of
Inferiorrectalarterv venousplexus
Deepdorsalvein a n dd o r s a l arteryof Deep(Buck's) fascia of pen
Testicular a
urethraemuscle Sphincter Perineal artery Posterior scrotal arteries
lnternalpudendalartery on superioraspectof perinealmembrane
Pampiniform
(venous) Arteryto ductusdeferens Vesical(retropubic) venousplexu6
Inferior vesical
Branchto prostate Urethralbranches Capsular branches Hyperplastic middlelobe Hyperplasticlaterallobe urethraemucle Sohincter
Arterialsupplyof prostate (Frontal section, anterior viewof specimenwith benign hyperplasia)
Vasculature
Plate 4O3
Arteries and Veins of Perineum and Uterus
Posterior labialartery
Dorsalarteryof clitoris Deeparteryof clitoris
Ischiocavernosu s
B u l bo f v e s t i b u l e
muscte
Compressor urethraemuscle
Bulbospongiosus muscle
Arteryto bulbof vestibule (Bartholin's) gland Creatervestibular
Superficial perinealspace
perinealmuscle Deeptransverse
Perineal
Internalpudendal(clitoral)artery
membrane
Perinealmembrane(cut away)
Perineal artery
Perinealartery(cut) perineal(Colles') Superficial fascia(cutand reflected) perinealspace to opensuperficial Internalpudendalartery in pudendalcanal(Alcock's)
Superficial transverse perineal
muscle Perineal art
Inferiorrectalartery
Internal pudendal arteryin pudendal canal (Alcock's)
Roundligament Tubal
Inferior rectalartery
Branches of uterine artery
External analsphinctermuscle Note:Deepperineal(investing or Callaudet's) fasciaremovedfrom perinealspace. musclesof superficial
Ovarianvessels Tubal branchesof ovarianvessels
Vaginalbranches of uterine Vaginalarter
Levatorani Perineal membrane Internalpudendalartery Perineala
perinealspace Superficial perineal(Colles') f, Superficial
Plate 4O4
Vasculature
Arteries and Veins of Perineum: Male
(dartos)fasciaof scrotum Superficial
External spermatic fasciaover testis ano spermatic cord
Septumof scrotum Posteriorscrotalarteries fasciaof penis Deep(Buck's)
Bulbospongiosus muscle
perineal(Colles')fascia(cutedge)
Ischiocavernosu s muscle
perinealspace(opened) Superficial Perinealartery and vein
Perineal membrane
superior Internalpudendalarterypasses to perinealmembrane
Perineal body
perineal rficialtransverse perineal muscleand transverse arterv(cut and reflected)
Superficial transverse perineal muscle
and Internalpudendalvessels pudendalnerve(cut)in pudendal (openedup) canal(Alcock's)
Transverse perineal arter
lnferiorrectalarterv Inferiorfasciaof pelvicdiaphragm (roof of ischioanalfossa)
Superficial perineal (Colles')fascia (cut edge
Pudendal canal(Alcock'
Note:Deepperineal (investing or Gallaudet's)fascia removedfrom muscles of superficialperinealspace
Deep arteryof penis Deepdorsalveinof peni Dorsalartervand nerveof
4{tr
Transverseperinealligament (anterior thickeningof perinealmembrane;-
Deep arteryof penis Dorsalarteryof penis Urethralartery Perineal membrane(cutedge) Arteryof bulbof penis Internalpudendalartery Perineal artery(cut)
Internalpudendalvessels in pudendalcanal(Alcock's) perineal(Colles') Superficial fascia(cutedge)
Vasculature
Plate 4O5
Lymph Vessels and Nodes of Pelvis and Genitalia: Female
L a t e r . ral o r t i c( l u n r b a r ) nodes P r e a o r t i cl y n r p hn o d e s P r o n r o n t o r i a(lm i c l d l es a c r a l )n o d e s iliac r-rodes Conrnror-r
( L a t e r a ls)a c r anl o d e
l n t e r n aill i a cn o d e
L a t e r a(l s u p e r i o r ) e x t e r n aill i a cn o d e
O b t u r a t o rr r o d e
Su p e r i i c i aI inguinal nodes Hig,hest deep i n pl,ui r-ral no(le (of Cloquet) f)een
inguinaI nodes
t,/
Nr Plate 406
Vasculature
Lymph Vessels and Nodes of Perineum: Female
Highestdeep inguinal node (of Cloquet)
'ascialata(cutaway\ lnferior nodes (verticalgroup)
vessels and nerve
Superolateralnodes
(horizontal group
Deepinguinalnodes
Suoeromedialnodes
(horizontal group)
4{tr Vasculature
Plate 4OZ
Lymph Vessels and Nodes of Pelvis and Genitalia: Male
Preaorticnodes
Pathwaysfrom testesalong testicularvessels
C o m m o n i l i a cn o d e s
Promontorial
sacral)nodes
Lateral)sacralnode
I n t e r n a il l i a cn o d e s
E x t e r n aill i a cn o d e s
H i g h e s td e e p i n g u i n a l node (of Cloquet)
D e e p i n g u i n a ln o d e s
S u p e r f i c i ai ln g u i n a ln o d e s y : t.
Preaorticnode
is Promontorialnode
Presymphysealnode
Common iliac
E x t e r n aill i a cn o d e s
Pathwayalong inferior vesicalvessels t o i n t e r n a li l i a cn o d e s( p r i n c i p apl a t h w a y )
P a l h w a yo v e r b l a d d e rt o e x t e r n a il l i a cn o d e s
Internal i l i a cn o d e s (Middle and lateral) sacralnodes
Pathway alongside rectum to ( m i d d l ea n d lateral)sacral nodes
Prevesicalplexusand pathway (broken line\ to externaliliac nodes
Pathway(broken /ine)from lower p r o s t a t ea n d m e m b r a n o u su r e t h r a a l o n g i n t e r n a lp u d e n d a lv e s s e l s( b e n e a t h p e l v i cd i a p h r a g m )t o i n t e r n a li l i a cn o d e s
Plate 4O8
Vasculature
Nerves of External Genitalia: Male SeealsoPlates165,166,318
5
Splanchnic nerves
I
Creater Lesser
C e l i a cg a n g l i a
Least
S u p e r i o rm e s e n t e r i cg a n g l i o n
S u b c o s t anl e r v e ( T 1 2 )
ganglia
lliohypogastricnerve
L u m b a rs p l a n c h n i cn e r v e s
llioinguinalnerve
nferior mesenteflc ganglion
5 y m p a t h e t ti cr u n k and ganglia Cenitofemoral nerve
artery Testicular a n dp l e x u s
Lateralfemoral cutaneousnerve
Superior hypogastric plexus
Femoralbranch ano C e n i t a lb r a n c h of genitofemoral nerve
Femoralnerve
lnferior hypogastric (pelvic) prexus
Lateralfemoral c u t a n e o us nerve
Ductus deferens a n dp l e x u s
Femoral b r a n c h e so f genitofemoral nerve
Anterior cutaneous b r a n c h e so f femoral nerve
A n t e r i o rc u t a n e o u s branch of iliohypogastric
Cenital branch of senitofemoralnerve
Testicular artery and plexus
D o r s a ln e r v e so f p e n i s
4{ry
Anterior scrotalnerve (from ilioinguinalnerve)
lnnervation
Plate 4O9
Nerves of Pelvic Viscera: Male
Anteriorvagaltrunk
T10spinalnerve(ventralramus)
Posterior vagaltrunk
te and grayramicommunicantes
and Celiac branch
lnferiorphrenicarteriesand Leftgastricarteryand gastric
Diaphragm
plexus,andtrunk Celiacganglia,
Leftrenalartery and plexus
Left aorticorenalganglion
L 1s p i n anl e r v e (ventralramus)
Superiormesentericganglion
Superiormesenteric arteryand (aortic)plexus Intermesenteric Inferiormesenteric ganglion, arteryand plexus Ureterand uretericplexus Superiorhypogastric plexus Superiorrectalarteryand plex Hypogastricner
1 s t2 , n d ,3 r dl u m b a sr p l a n c h n n i ce r v e s Cravramicommunicantes Sympathetic trunkand ganglia 5th lumbarsplanchnic nerve L5 spinalnerve(ventralramus) Lumbosacral trunk
Nerve from inferior hypogastricplexus to sigmoid and descending
Crayramicommunicantes
colon(parasympathetic)
S 1 s p i n a ln e r v e (ventralramus)
Sacralsplanchnic nerves (sympathetic) 1_
ic splanchnic nerves (parasympathetic)
Inferiorhypogastric (pelvic)plexus-
al plexus
Obturatornerve and artery
Piriformis muscle
Ductusdeferens and plexus
C l u t e u sm a x i m u s muscleandsacrotuberousligament
Vesicalplexus Rectalplexus
(ischiococcygeus) Coccygeus muscleand sacrospinous
Prostatic plexus
ligament
Cavernous nerves of penis
Pudendalnerve
atorani muscle nferior anal (rectal)nerve Perinealnerve Dorsal nerve of penis
Posterior scrotalnerves
Plate 41O
Innervation
Nerves of Perineum: Male
Posteriorscrotal nerves Perineal nerves
t t
Superficial
Deep
Dorsal nerve of penis
P e r i n e aml e m b r a n (ec u t t os h o w on superior structures neurovascular aspectof perinealmembrane) Dorsalnerveof oenis ( c o n t i n u a t i oonf p u d e n d anl e r v es u p p l y i n g muscleson superioraspect of oerinealmembrane)
#
f
Superficialperineal (Colles')fascia(cut to open superficial perineal space) Superficialand deep branchesof perinealnerve
ffi
nerve of penis
(passes superiorto p e r i n e aml e m b r a n e ) Perinealnerve
Obturatorfascia (of obturator internusmuscle) Posteriorfemoral cutaneousnerve Pudendalcanal
(Alcock's) (openedup) Pudendalnerve
Inferior c l u n i a ln e r v e s
Piriformm isuscle
Inferior anal (rectal) Perforating curaneousnerve Anococcygealnerve
Coccygeus(ischiococcygeus) muscle -------_--.\ l s c h i a sl p i n e Pudendalnerve Levatorani muscle
Obturatorinternusmuscle
4{r
Sacrotuberousligament (cut)
lnnervation
C l u t e u sm a x i m u m s u s c l e( c u t )
l n f e r i o ra n a l( r e c t a l )n e r v e Perinealnerve
Plate 411
Nerves of Pelvic Viscera: Female SeealsoPlates165,166,318
S y m p a t h e ttircu n k and L2 ganglio
Peritoneum
A b d o m i n a la o r t a Inferiorvena cava Extraperitoneal
W h i t ea n d grayraml communicantes
( s ub s e r o u s ) fascia Common i l i a cv e s s e l s
\.
a n dp l e x u s Lumbar splanchnic
Ureter
nerves
Intermesenteric ( a o r t i c )p l e x u s
Crayrami communicantes
Ovarian artery and plexus
Superior hypogastric
prexus Sacral promontory Superior hypogastric prexus
Right hypogastric
nerve(cut)
Common i l i a ca r t e r y and plexus
R i g h ta n d left sacral sympathetic t r u n k sa n d ganglia
Ureter Internal iliac artery ano prexus External iliac artery and plexus
Piriformis muscle
Right and left hypogastricnerves
Uterus Sacral s p l a n cnhi c nerves (sympathetic)
R ig h t s y m p a t h e t i ct r u n k eft hypogastricnerve Inferior hypogastric(pelvic)plexus
U t e r i n e( f a l l o p i a nt u) b e Ovary Pelvic splanchnic nerves (parasympathetic)
Symphyseal surfaceof pubis U r i n a r yb l a d d e r Vesicalplexus
Coccygeus(ischiococcygeus) muscle
R e c t apl l e x u s
plexus Uterovaginal (retracted)
Nr
Rectum (retracted)
Plate 412
Innervation
Nerves of Perineum and External Genitalia: Female
Anteriorlabialnerve (fromilioinguinal nerve) Dorsalnerveof clitoris labialnerves Posterior 'suoer[;.;u; ) B'unth"' ,/---) otperineal nerve ,/ ,zDeep ) branchof posteriorfemoral cutaneousnerve
Dorsalnerveof clitorispassing superiorto perinealmembrane nerve nervern pudendalcanal (Alcock's)(dissected) nferiorclunial nerves maxtmus
muscle(cut away) ligament Sacrotuberous g cutaneous nerve Perforatin Inferioranal(rectal)nerves Anococcygeal nerves
lschialtuberosity sprne
*fr Innervation
Plate 413
Neuropathways in Parturition
Greater Splanchnic Lesser nerves Least
Celiac ganglion
T7 spinal nerve(anterior ramus) Sympathetic trunk and ganglia
Aorticorenalganglion
Superiormesenteric ganglion
T 11 s p i n a l nerve(anterior ramus) R a m ic o m m u n i c a n t e s
Intermesenteric
(aortic)plexus Lumbar splanchnic nerves
I n e r v e( T 1 2 ) nferior mesentericganglion Intermesenteric (aortic) plexus
Superiorhypogastric plexus Sl spinalnerve (anteriorramus) lliohypogastric nerve (Ll )
Hypogastricnerves
l l i o i n g u i n anl e r v e( 1 1)
Pelvicsplanchnic nerves
Vesicalplexus Dorsalnerveof clitoris Posterior labial
Inferiorhypogastric (pelvic)plexus plexus Uterovaginal Pudendalnerve(S2,3, 4) Inferioranal(rectal)nerve
Sensorv fibersfrom uterine Sensoryfibersfrom cervixand upper Sensoryfibersfrom lower vagina bodyandfundusaccompanysympathetic vaginaaccompanypelvicsplanchnic nerves and perineumaccompanysomaticfibers fibersvia hypogastric plexuses to T11, 12 (11?) (parasympathetic) via pudendalnerveto 52,3,4 to 52,3, 4 Motor fibersto uterinebody Motor fibersto loweruterinesegment, Motor fibersto lowervaginaand dus(sympathetic) cervix,and uppervagina(parasympathetic) perineumvia pudendalnerve(somatic)
Plate 414
Innervation
lnnervation of Female Reproductive Organs: Schema
S y m p a t h e ttircu n k
rT5
and ganglion
Celiac gangliaand plexus C r a y r a m u sc o m m u n i c a n s
W h i t e r a m u sc o m m u n i c a n s
'+-
ganglia Aorticorenal
Creater splanchnn i ce r v e Superiormesenteric ganglion
Lesser s p l a n c h n i cn e r
T11 '-'
Least s p l a n c h n i cn e r v e
r12 trunk Sympathetic
L u m b a rs o l a n c h n i c
L 3 s p i n a ln e r v e
Ovarian artery and plexus
Superiorhypogastric plexus
U t e r i n e( f a l l o p i a nt)u b e
nerves Hypogastric Note: Painfrom intraperitonealpelvic viscera(e.g.,uterine contractions)goesvia uterovaginaland pelvic plexuses,hypogastric nerves/supenor hypogastricplexus,lower aortic plexus,lower
- - - - - l n f e r i o re x t e n t of peritoneum and inferior Uterovaginal (pelvic)plexuses hypogastric
Ovary
nerves Pelvicsplanchnic
nerves, lumbarsplanchnic sympathetic trunkfrom L4to L5to soinalnerves T11, 12. Painfrom subperitonealpelvic viscera(e.g.,cervical dilationand upper vagina)goesvia pelvic splanchnicnervesto 52,
3, 4. Afferentfibersfrom lowervaginaandperineum go viapudendalnerves to 52,3,4. Sympatheticf Preganglioni6postganglionic fibers ----I
lnnervation
Sacralplexus
*{r Pudendalnerve
Parasympathetic{ Preganglionic fibers lpostganglionic-----
Afferentfi[s15 -
Plate 415
Innervation of Male Reproductive Organs: Schema SeealsoPlatos 167, 168
Sympathetictrunk and ganglia
C e l i a cg a n g l i a
Creater splanchnicnerve (T5-9)
T1 Superiormesentericganglion G r a y r a m u sc o m m u n i c a n s
T11;1 W h i t er a m u sc o m m u n i c a n s
Left aorticorenalganglion
T12
Lessersplanchnicnerve Leastsplanchnicnerve
R e n a lg a n g l i o n
L1.7 U p p e rl u m b a sr p l a n c h n i c Intermesenteric (aortic)plexus
L2:';
nferior mesentericganglion
L3 C r a y r a m u sc o m m u n i c a n s
Testicular arteryand plexus
plexus Superiorhypogastric
Testicular artervand olexus
Hypogastric nerves
Ductusdeferensand plexus
Inferiorextentof peritoneum
Ductusdeferens and plexus
P e l v i cs p l a n c h n i cn e r v e s ic splanchnic nerves
Sacralplexus $2sp3lplgxu5-
Pudendalnerve
Pudendan l erve Inferior hypogastric(pelvic)plexus
Dorsalnervesof penis
Vesical plexus
Epididymis
4{F
plexus Prostatic Testis (Createrand lesser) cavernous nervesof penis
Sympathetic{ Preganglionicfibers f postganglionic__-__
Plate 416
Parasympathetic Preganglionic fibers Postganglionic-----
Afferentfibers -
Innervation
lnnervation of Urinalv Bladder and Lower Ureter: Schema
root sal(posterior) Ventral(anterior) root
S p i n asl e n s o r y (dorsalroot) ganglion
Celiac ganglia
Superiormesentericganglion
white I Rami lCraY I communicantes
Aorticorenalganglion
arteryand plexus lntermesenteric (aortic)plexus
ganglion Inferiormesenteric l s t a n d2 n d l u m b a r nerves splanchnic
Lumbarpart of spinalcord
plexus Superiorhypogastric
L 2s p i n a l nerve(ventral ramus)
nerves Hypogastric
Sacralpart of spinalcord
Sympathetic trunk
Descending fibers
Ascending
fibers
Crayrami communicantes
Inferiorhypogastric (pelvic)plexus
nervesfrom sacral sympathetic trunkto inferior hypogastric (pelvic) plexus
Urinarybladder
\
f,"--
nerve Pudendal
Sacralplexus Pelvicsplanchnicnerves
plexus Vesical Prostatic urethraemuscle Sphincter superior to perinealmembrane
Bulbospongiosus
Sympathetic f Preganglionic fibers I P o s t g a n g l i o n- i-c- - -
lnnervation
Parasympathetic( Preganglionic fibers ipostganglionic-----
Somaticefferentfibers Afferent fibers -
Plate 417
6 Upper Limb $ection Topographic AnatomY Plate 418
Limb ere Upper
Shoulder and Axilla Plates 419430
Joint andSternoclavicular ers Clavicle Views andScapula:Anterior lzo Humerus View Posterior andScapula: lzt Humerus Radiograph Anteroposterior ezz Shoulder: (Glenohumeral Joint) cze Shoulder ofShoulder lzl Muscles Cuff ofRotator ezs Muscles Dissection eze Scapulohumeral Scapula around andAnastomoses Artery ezz Axillary Fasciae andAxillary Clavipectoral, eze Pectoral, View (Dissection): Anterior lzs Axilla Schema Plexus: mo Brachial
Arm Plates 43t4il5
Views ofArm:Anterior csr Muscles Views ofArm:Posterior esz Muscles inSitu ess BrachialArterY Elbow around andAnastomoses Artery ege Brachial Sections Cross lss Arm:Serial
Atlas of Human AnatomY
Upper Limb Elbow and Forearm
Lumbrical Muscles andBursae, Spaces, andSheaths: Schema
Plates 436-451
r3e Bones of Elbow
464
Flexor andExtensor Tendons inFingers
eez Elbow: Radiographs
465
Intrinsic Muscles ofHand
ese Ligaments of Elbow lgg Bones of Forearm
466
Arteries andNerves of Hand: Palmar Views Wrist andHand: Superficial Radial Dissection
clo Individual Muscles ofForearm: Rotators ofRadius eer Individual Muscles of Forearm: Extensors ofWristandDigits llz Individual Muscles of Forearm: Flexors ofWrist
468
elg Individual Muscles ofForearm: Flexors of Digits lec Muscles (Superficial of Forearm Layer): Posterior View
471
ss
Muscles (Deep of Forearm Layer): Posterior View
ele Muscles (Superficial of Forearm Layer):Anterior View lez Muscles (lntermediate ofForearm Layer):Anterior View lle Muscles (Deep ofForearm Layer):Anterior View lcg Forearm: Serial Cross Sections eso Attachments of Muscles of Forearm: Anterior View
467
469 47|,
Wrist andHand: Superficial Dorsal Dissection Wrist andHand: Deep Dorsal Dissection Extensor Tendons atWrist Fingers
Neurovasculatune Plates 472483
ezz Cutaneous Innervation ofWristandHand lzs Arteries andNerves ofUpper Limb lzl Musculocutaneous Nerve czs Median Nerve
lsr Attachments of Muscles of Forearm: Posterior View
eze Ulnar Nerve
Wrist and Hand
lzz Radial NerveinArmandNerves of Posterior Shoulder rzs RadialNerve inForearm
Pfates 45471
rsz Carpal Bones lss Movements ofWrist csl Ligaments ofWrist ess Ligaments ofWrist(continued) es6 Bones ofWristandHand lsz Wrist andHand:Anteroposterior Radiograph ese Metacarpophalangeal andInterphalangeal Ligaments css WristandHand: Superficial Palmar Dissections eeo WristandHand: Deeper Palmar Dissections eer Flexor Tendons, Arteries, andNerves atWrist lez Bursae, Spaces, andTendon Sheaths of Hand
Atlas of Human Anatomy
lzg Cutaneous Nerves andSuperficial Veins ofShoulder andArm eso Cutaneous Nerves andSuperficial Veins ofForearm lat Cutaneous lnnervation ofUpper Limb lsz Dermatomes ofUpper Limb ces Lymph Vessels andNodes of Upper Limb
Regional Scans Plate 484
eal CTAngiograms ofArteries of theUpper Limb
Anterior view
Trapeziusmuscle Clavicle
Acromion Deltoidmuscle Cephalicvein
Bicepsbrachiimuscle Pectoralismajor muscle Cubitalfossa Posteriorview Deltoid muscle
Cephalicvein
muscle
Mediancubitalvein
Tricepsbrachii muscle(longhead) silicvein
Brachioradialis muscle Flexorcarpi radialis tendon Thenar
(median) Intermediate vein antebrachial Triceps longus Palmaris brachiimuscle tendon Longhead Flexordigitorum Lateralhead superficialis tendons Tendon Flexorcarpiulnaristendon \ Hypothenar eminence Proximal palmar crease
Proximaldigitalcrease
Brachioradialis and extensor
carpiradialis longusmuscles
Middle digital crease
Radial longitudinal crease
Commonname of digits 1 Thumb 2 Index 3 Middle 4 Ring 5 Little
Distaldigitalcrease
pollicis Extensor longustendon
Extensor carpi radialisbrevis muscte
Olecranonof ulna
Flexorcarpiulnarismuscle Extensorcarpiulnarismuscle
Extensor indicis tendon
Cephalicvein
digitorumtendons Extensor Siteof proximal (PlP)joint interphalangeal Siteof distal (DlP)joint interphalangeal
Topographic Anatomy
e/fZN*
Plate 4t I
Glavicle and Sternoclavicular Joint
Right clavicle
Superiorsurface
A c r o m i a le n d
Posbrior
S t e r n a el n d
4a
Inferior surface Anterior -
T r a p e z o i dl i n e
Postertor
Conoid tubercle S u b c l a v i a ng r o o v e ( f o r s u b c l a v i u sm u s c l e )
I I I
T r a p e z i u sm u s c l e
Superiorsurface
Muscleorigins Muscleinsertions Iigament attachments
'Dosterior
S t e r n o c l e i d o m a s tm ou i ds c l e D e l t o i dm u s c l e Deltoid P e c t o r a l im s ajormuscle t o r a l i sm a j o r m u s c l e C o s t o c l a v i c u l al irg a m e n t
C o r a c o c l a v i c u rl a ligament
I
I
Trapezoid ligament Conoidligamen
A n t e r i o rs t e r n o c l a v i c u l al irq a m e n
Postertor S u b c l a v i u sm u s c l e S t e r n o h y o i dm u s c l e
Sternoclavicular foint
A r t l c u l a rd i s c o f s t e r n o c l a v i c u l aj or i n t
Clavicle
S u b c l a v i umsu s c l C o s t o c l a v i c u l al irg a m e n t
C o s t o c l a v l c u l al irg a m e n t
''"it'.
\fEr. S y n c h o n d r o s iosf 1 s t r i b
Costal cartilages
*{ry Plate 419
Manubrium Sternocostal ( s y n o v i a lj)o i n t
R a d i a t es t e r n o c o s t al li s a m e n
t e r n a ls y n c h o n d r o s i s
Shoulder and Axilla
Humerus and Scapula: Antelior Views
Acromial angle
Acromion
Coracoid process
Clavicle(cut) Superiorangle
Supraglenoid tubercle.-
Superiorborder
Anatomical neck
scapularnotch
Creater tubercle
Neck
Lesser tubercle
Medialborder
neck Surgical
fossa Subscapular
lntertubercular sulcus
Clenoid cavity of scapura
Crestof
Head of numerus
SreaIer
lnfraglenoid tubercle Lateralborder Inferiorangle
Trapezius muscle
Crest of
lessertubercle
minormuscle Pectoralis
Humerus
muscle
Deltoidtuberosity Medial ridge. supracondylar
B i c e p sb r a c h i im u s c l e ( l o n gh e a d )
Lateral
Supraspinatus muscle muscle Subscapularis Coracobrachialismuscle and Bicepsbrachii musc (short head)
Radial fossa
Pectoralis majormuscle
Lateral epicondyle
Latissimus dorsimuscle
Capitulum
Teresmajor muscle
Coronoid fossa
Deltoidm muscle Coracobrachialis
Trochlei M e d i a le o i c o n d v l e
B r a c h i a lm i su s c l e Brachioradialis muscle
Triceps brachii muscle ( l o n gh e a d )
atus anterior muscle
Subscapularid muscle
Muscleattachments Origins I Insertions I
longusmuscle Extensor carpiradialis Pronatorteresmuscle(humeralhead) Common flexor tendon Common extensortendon (extensorcarpi radialisbrevis,extensor digitorum with extensordigiti minimi, and extensorcarpi ulnarismuscles) B r a c h i a l im s uscle
4{tr Shoulder and Arilla
Supinatormuscle Bicepsbrachii muscle
(flexorcarpiradialis, palmarislongus, flexorcarpiulnarisandflexordigitorum head]muscles) superficialis [humeroulnar muscle Flexordigitorumsuperficialis ( h u m e r o u l nh ae r ad) Pronatorteresmuscle(ulnarhead) Flexorpollicislongusmuscle(ulnarhead)
Plate 42O
Humerus and Scapula: Posterior View
Suprascapular notch Superiorborder S u p e r i o ra n g l e angle
Supraspinous fossa
Notchconnecting supraspinous and Inlrasprnous tossae
Spine Neck
Greatertubercle
Infraspinousfossa
Headof humerus Anatomical neck
Medial border
Surgicalneck
Lateralborder
Croovefor circumflex scapular vessels
Inferiorangle Supraspinatus muscle
Trapezius muscle
Scapula
Infraglenoid tubercle Deltoidtuberosity Radialgroove
Humerus
Medial supracondylarridge
Deltoid muscle aspinatusmuscle Rhomboid mtnor muscle
Lateral supracondylarridge
Infraspinatus muscle Teresminormuscle
Olecranon fossa Rhomboid maJor
Triceosbrachii muscle
Triceps brachii muscte ( l o n gh e a d )
muscle
Lateraleoicondvle
(lateralhead)
Trochlea
Infraspinatus
muscle
Croove for ulnarnerve
Teresminor muscle
Latissimusdorsi m u s c l e( s m a l l slip of origi
Teresmajor muscle
Brachialismuscle
Medial epicondyle
iceps brachii muscle ( m e d i a lh e a d )
Muscleattachments I I
Origins Insertions
Tricepsbrachii
Commonflexortendo
Commonextensortendon
Anconeus muscle
Plale
421
*{r
Shoulder and Axilla
Shoulder: Anteroposterior Radiograph SeealsoPlate 420
Shoulder and Axilla
A
r\rronr()n
AN
, \ n . t t o n r i r , r rl l r I ' o l h L t t l t ' t t t s
C
( l , r ri
CP G
( o r a co i t l l ) r () ( ( ' \ \ ( , l t ' r t o i r l( , r \ l \ ( ) l \ ( J l ) l . ,t t
GT
( , t t ' , t 1 t 'l tL t l r t ' tl ir '
H
I lrllc'rrrs
HH
[ ] t , . r rol L l r r r r r r l l t t
LT
Lt ' : r t , rl u l r c t r l
S
S c. t l t t t l , rl , r l c r , tl lr o t c l t ' r
SN
S L r r g , i r .nrcl t l . o l i r t r l r t t ' t u s
SS
S p i n t .o l s r , r 1 r r t [ , r
Plate 422
Shoulder (Glenohumeral Joint| Anteriorview A c r o m i o c l a v i c u l aj or i n t c a p s u l e
( i n c o r p o r a t i nagc r o m i o c l a v i c ulliagra m e n t )
Clavicle
Acromion Coracoacromialligament Supraspinatustendon (cut) Coracohumeralligament
Superiortransverse scapularligamentand suprascapular notch
Creater tubercle and
Lesser tubercle of humerus
process
Transverse humeralligament
Communication oI subrtendinous
Intertubercular tendonsheath
bursaof subscapularis
(communicateswith synovialcavity)
Brokenlineindicates positionof subtendinous bursaof subscapularis
Subscapularis tendon(cut) Bicepsbrachii tendon (long head)
Capsular ligaments
Anterior view
4{r
aspinatus muscle Subdeltoid bursafusedwith subacromial bursa
Deltoid muscle (reflected)
Subscapularis muscle Subdeltoid bursa Supraspinatus tendon Capsularligament
Capsular ligament
Svnovialmembrane
Deltoid muscte acoacromialligament Acromion Coracoid process
Supraspinatus (fusedto capsule)
o r a c o h u m e r alli g a m e n t
Subdeltoid bursa
Bicepsbrachiitendon ( l o n gh e a d )
Infraspinatustendon (fusedto capsule)
S u p e r i ogr l e n o h u m e r a l ligament
Clenoid cavity (cartilage)
S u b s c a o u l atrei sn d o n (fusedto capsule)
Teresminor tendon
(fusedto capsule) Synovialmembrane (cut edge) O p e n i n go f s u b t e n d i n o u s
b u r s ao f s u b s c a o u l a r i s
M i d d l eg l e n o h u m e r a l ligament I n f e r i o rg l e n o h u m e r a l ligament
loint opened:lateralview
Plate 423
Clenoid
labrum
Clenoid cavity of scapula
Axillaryrecess
Coronalsectionthroughjoint
Shoulder and Axilla
Muscles of Shoulder
Posteriorview
capitismuscleI Not .onn".t"d Semispinalis to upperlimb spleniuscapitismuscle I Spinousprocessof C7 vertebra muscle Levatorscapulae
Trapezius muscle
Rhomboim d i n o rm u s c l e id majormuscle
Deltoid muscle
muscle Supraspinatus S p i n eo f s c a p u l a muscle lnfraspinatus Teresminormuscle Teresmajormuscle issimus dorsimuscle Longhead
)
of tricePs
> Dracnll
Lateralhead ! muscle Spinousprocessof T12vertebra
Triangle of auscultation muscle Trapezius
Anteriorview Acromion
Omohyoidmuscleand investing layerof deep cervicalfascia Sternocleidomastoid muscle
Deltopectoraltriangle Deltoid muscle
Deltoidbranchof thoracoacromial artery
Pectoralis maJor muscte
Cephalicvein
Biceps Longhead, f Dracnil1 muscle ( Shorthead Tricepsbrachiimuscle (lateralhead) Latissimus dorsimuscle Serratus anteriormuscle
-Sternum 6th costalcartilage 'Anterior laver of rectus sheath
External obliquemuscle
Shoulder and Axilla
Plate 424
Muscles of Rotator Guff
Superiorview
"t
C o r a c o c l a v i c u l a r l i g a m e n{t
Trapezoidligament Conoidligamenl
Coracoid orocess
ubscapularis tendon oracoacromialligament
u l a rj o i n t Supraspinatus tendon Infraspinatus tendon Teresminor tendon
4{r nfraspinatus muscle Superiorborderof sca Subscapularis muscle
Spineof scapula
Supraspinatus muscle
Coracoacromialligament Coracoid process
Superiortransverse s c a p u l al irg a m e nat n d suprascapular notch
Acromion Supraspinatus tendon
Biceps brachii tendon
Infraspinatus muscle
(long head)
Teres mtnor muscle
Subscapulari6
Anteriorview
Plate 425
e&4/*
Axillarynerve
Posteriorview
Shoulder and Axilla
Scapulohumeral Dissection Lateral view P h r e n i cn e r v e
L e v a t o rs c a p u l a em u s c l e A c c e s s o r yn e r v e ( X l )
( Anterior' S c a l e n em u s c l e s { t r , t i d a t e( Posterior B r a c h i a lp l e x u s S u b c l a v i a na r t e r y a n d v e i n S u p e r i o rt h o r a c i c a r t e r y l embrane E x t e r n a il n t e r c o s t a m l usc a n t e r i o rt o i n t e r n a li n t e r c o s t a m
Scapula (rettacted\ Subscapularis muscle
P e r f o r a t i n gb r a n c h o f i n t e r n a t h o r a c i ca r t e r y a n d a n t e r i o r c u t a n e o u sb r a n c h o f i n t e r c o s t a ln e r v e
major muscle
l n t e r c o s t o b r a c h i anl e r v e
L o n g t h o r a c i cn e r v e
E x t e r n a il n t e r c o s t a l L a t e r a lt h o r a c i c a r t e r y L a t e r a lc u t a n e o u sb r a n c h e s l e r v e sa n d of intercostan p o s t e r i o ri n t e r c o s t a l S e r r a t u sa n t e r i o r
Anterior view Acromion S u p r a s p i n a t utse n d o n C r e a t e r t u b e r c l eo f h u m e r S u b s c a p u l a r itse n d o n l n t e r t u b e r c u l a tre n d o n s h e a t h A n t e r i o r c i r c u m f l e xh u m e r a la r t e r y B i c e p sb r a c h i it e n d o n ( l o n g h e a d )( c u A x i l l a r yn e r v e a n d p o s t e r i o rc i r c u m f l e x h u m e r a la r t e r y Q u a d r a n g u l a rs p a c e Radial nerve -/-)
C o r a c o a c r o m i al i g a m e n t coid process S u p r a s c a p u l aar r t e r Ya n d n e r v e S u p e r i o rt r a n s v e r s es c a P u l a r l i g a m e n ta n d s u P r a s c a P u l a r notch P e c t o r a l i sm i n o r t e n d o n ( c u t ) B i c e p sb r a c h i i t e n d o n (short head) (cut) and c o r a c o b r a c h i a l i tse n d o n b s c a p u l a r i sm u s c l e
artery Subscapular nerve Lowersubscapular (to teresmaiormuscle) Circumflexscapularartery Thoracodorsal artery and n e r v e ( t o l a t i s s i m u sd o r s i muscle) S u b s c a p u l a r im s uscle
C o r a c o b r a c h i a l i sm u s c l e
Teres maior muscle
Triangular L a t i s s i m u sd o r s i m u s c l e S u p r a s c a p u l aar r t e r ya n d n e r v e Acromion
Posteriorview S u p e r i o rt r a n s v e r s es c a p u l a r l i g a m e n ta n d s u p r a s c a p u l a r notch
nfraspinatustendon (reflected) c a p s u l eo f s h o u l d e r Deltoid muscle (reflected) T e r e sm i n o r m u s c l e
S u p r a s p i n a t um s u s c l et c u t ) S p i n eo f s c a p u l a I n f r a s p i n a t u sm u s c l e( c u t ) T r i a n g u l a rs p a c ew i t h c i r c u m f l e xs c a p u l a ra r t e r y deep to space
4{tr
T e r e sm a j o r m u s c l e
Shoulder and Axilla
Q u a d r a n g u l a rs p a c e t r a n s m i t t i n ga x i l l a r Y nerve and posterior c i r c u m f l e xh u m e r a la r t e r Y S u p e r i o rl a t e r a lb r a c h i a l cutaneouSnerve P r o f u n d ab r a c h i i ( d e e P b r a c h i a l )a r t e r ya n d R a d i a ln e r v e shown between eral head and Lone head of trice-psbrachii muscle
Pfate 426
Axillary Artery and Anastomoses around scapula SeealsoPlates 33, 434 scendingcervicalartery
Anteriorview
Transversecervicalartery
Inferiorthyroidartery Thvrocervical trunk
Suprascapular artery
Subclavian artery
A c r o m i o na n d acromial anastomosis
Anterior scalenemuscle Clavicle(cut)
Dorsalscapular
Superiorthoracic artery
Coracoidprocess
Thoracoacromialartery
Anteriorcircumflex humeralartery
cularbranch
Posterior circumflex humeralartery
Acromialbranch Deltoidbranch
Subscapular art
Pectoral branch
Circumflex scapulararl
1,2, 3 indicate1st, 2nd, and 3rd partsof axillaryartery
Brachial artery
Nr
Thoracodorsala Lateralthoracic
Omohyoid muscle (inferiorbelly)
Suprascapular artery
Levatorscapulaemu
Acromial branch of thoracoacromialartery A c r o m i o na n d acromial plexus
Dorsal scapularart
Infraspinous branchof suprascapurar artery
Supraspinatus muscle(cut)
Posterior circumflex humeral a r t e r y( i n quadrangular space)and ascending and descending branches
Superiortransverse s c a p u l al irg a m e n t and suprascapular notch
S p i n eo f s c a p u l a
Infraspinatus muscle(cut) Circumflex scapular artery Teresminor muscle (cut)
Teresmajormuscle
Lateralhead L o n gh e a d
c4d4/* Posteriorview
Plate 427
Shoulder and Axilla
Pectoral, Glavipectoral, and Axillary Fasciae
Thoracoacromial arter
Trapeziusmuscle muscleinvestedby fasciaof infrahyoidmuscles
Coracoidprocess
Clavicle Fascia investing subclavius muscle*
Cephalicvein
Costocoracoidligament* Deltoid muscle
ligament Costoclavicular membrane* Costocoracoid
Pectoralis maJor muscle(cut)
Fasciainvesting pectoralis minormuscle* ligamentof axilla* Suspensory Pectoralismajormuscleand pectoralfascia(superficial anddeeplayers)
Biceps brachii muscle Shorthead
Latissimus dorsifascia
Long head
Serratus anteriorfascia Axillaryfascia(anteriorpart)
Brachial fascia (cut edge) over coracobrachialis and biceps brachii muscles
Nr Omohyoidmuscle
Oblique parasagittalsectionof axilla Trapezius muscle ( Lateralcordplexus Brachial cord J Posterior ( Medialcordmuscle Supraspinatus
scapura;U; { Infraspinatus muscle Subscapularis muscle Teresminormuscle Teresmaiormuscle Latissimus dorsimuscle
lavicle
muscleandfascia* Subclavius ligament* ostocoracoid Thoracoacromial artery and cephalic vein
membrane* ostocoracoid Lateralpectoralnerve Axillaryarteryandvein majormuscleand fascia Pectoralis Pectoralisminor muscle and fascia* Medial pectoral nerve
ligamentof axilla Suspensory Axillaryfascia(fenestrated)
*Components fascia of clavipectoral
Shoulder and Axilla
Plate 428.
Axilla (Dissection|: Anterior View
Thoracoacromial artery Pectoralisminor tendon (cut)
Trapezius muscte
A c r o m i a lb r a n c h
Deltoidbranch
Coracoid process Acromion C e p h a l i cv e i n
Suprascapularartery and nerve
Dorsalscapular arteryandnerve Transversecervical artery
Clavicularbranch Pectoralbranch
Musculocutaneous nerve
Axillaryartery
Anteriorcircumflexhumeralartery
Clavicleand subclavius muscle (cut)
Axillarynerve and posterior circumflexhumeralartey Pectoralismajor muscle (cut)
Anterior scalene muscle Sternocleidomastoid muscte
Coracobrachialis muscle Phrenic nerve
Deltoidmuscle
Omohyoid muscte
B i c e p sb r a c h i im u s c l e
Musculocutaneousnerve
Brachi muscle
U l n a rn e r v e M e d i a lb r a c h i a l cutaneousnerve
Profunda brachii (deep brachial) artery
Intercostobrachial nerve
Circumflex scapularartery
Radialnerve
Lower sub-
scapular
Triceps brachii muscle B r a c h i avle i n i Ulnarnervi:
Teresmajor muscle
Latissimus dorsimuscle
Median nerve
Brachial arterf
Plate 429
1st rib
Thoracodorsalartery and nerve
M e d i a la n t e b r a c h i a l c u t a n e o u sn e r v e B a s i l i cv e i n
*{r
Subclavian artery and vein
Subscapular artery
Uppersubscapular nerve S e r r a t uasn t e r i om r uscle
Lateralthoracic artery and long thoracic nerve
Ansapectoralis
B r a c h i apll e x u s Suoeriorthoracic arterv Lateralpectoral nerve Medial pectoral nerve
Pectoralisminor (cut)
Shoulder and Axilla
Brachial Plexus: Schema
shown. Note:Usualcomposition PrefixedplexushaslargeC4 contributionbut lacksT1. PostfixedplexuslacksC5 but hasT2 contribution.
Contribution from C4 Dorsal ramus
Dorsalscapular nerve(C5)
jt(\$\Ss Suprascapular n e r v e( C 5 , 6 )
Tophrenic nerve
Tosubclavius n e r v e( C 5 , 6 )
..ts" aLateralpectoral n e r v e( C 5 , 6 ,7 )
^"$'" Musculocutaneou s n e r v e( C 5 , 6 ,7
Contribution from T2 fo longuscolli and scalene muscles (c5,6,7,9)
Axillary nerve(C5,6) Radialnerve ( c 5 , 6 , 7 ,8 , T 1 ) Mediannerve ( c 5 , 6 , 7 ,8 , T 1 Ulnarnerve
(c7,8,T"1
1st intercostalnerve Longthoracic nerve(C5,6, 7) Medialpectoralnerve(C8,T1) Medialbrachialcutaneousnerve(T1) nerve (C8,Tl) cutaneous antebrachial
Inconstant contribution
nerve(C5,6) Uppersubscapular (middlesubscapular) nerve(C6,Z 8) acodorsal nerve(C5,6) subscapular
Shoulder and Axilla
4{r
Plate 43O
Muscles of Arm: Anterior Views SeealsoPlate 474
Acromion
C o r a c o a c r o m i al li g a m e n t
Coracoidprocess
S u b d e l t o ibdu r s a
Pectoralis minortendon(cut) Creatertubercle, Lesser tubercle of humerus
Subscapularis muscle
Intertubercular tendonsheath
C o r a c o b r a c h i aml ius s c l e
Musculocutaneous nerve(cut)
Circumflex scapularartery(cut)
D e l t o i dm u s c l e
Teresmajormuscle
(reflected)
Latissimus dorsimuscle Pectoralismajor muscle (reflected) Anterior circumflex h u m e r a la r t e r y
B i c e p s L o n gh e i f oracnil \ m u s c l e( S h o r n te Brachial artery(cut)
B i c e p sb r a c h i i tendons (cut) S h o r th e a d Long head
Median nerve (cut) B r a c h i a l im s uscle
C o r a c o b r a c h i a l im suscle Lateralantebrachial cutaneousnerve
M u s c u l o c u t a n e o uns e r Branchto biceps brachii (cut)
B i c i p i t aal p o n e u r o s i s
D e l t o i d m u s c l e( c u t ) Bicepsbrachiitendon B r a c h i o r a d i a lm i su s c l e Pronatorteres muscle Flexorcarpi r a d i a l i sm u s c l e B r a c h i a l im s uscle
Superficiallayer Lateralintermuscularseptum
Medial intermuscular septum
Lateralepicondyleof humerus Lateralantebrachialcutaneousnerve Head of radius
Nry
Medial epicondyle of humerus
B i c e o sb r a c h i it e n d o n R a d i a tl u b e r o s i t y
Tuberosity of ulna
Deep layer
Plate 431
Arm
Muscles of Arm: Posterior Views
Superficiallayer
Acromion
S u p r a s p i n a tm u su s c l e atertubercleof humerus muscle Infraspinatus Teresminor muscle Axillary nerve and posterior circumflexhumeral artery Deltoid muscle (cut and reflected) Superiorlateralbrachialcutaneousnerve .ateralhead I of Tricepsbrachii muscle -endon ) B r a c h i o r a d i a lm i su s c l e
r int C a p s u lo e f s h o u l d ej o tendon Supraspinatus Teresmaiormuscle
and Infraspinatus Teresminortendons(cut)
Posteriorbrachial c u t a n e o u sn e r v e (from radial nerve
Axillarynerve
Medial interm u s c u l a rs e p t u m
Teres malor muscle
Ulnar nerve M e d i a le p i c o n d y l e
Posterior circumflex humeralartery Superiorlateralbrachial nerve cutaneous
of humerus Profundabrachii(deep artery brachial) Radialnerve
O l e c r a n o no f u l n a Flexorcarpi u l n a r i sm u s c l e
artery Middlecollateral
A n c o n e um s uscle Extensor carpi
Radialcollateral artery
r a d i a l i sl o n g u sm u s c l e
Inferiorlateralbrachial nerve cutaneous
Extensorcaroi ulnarismuscle Posteriorantebrachial cutaneousnerve (f radial nerve)
Long head of tricepsbrachii muscle
E x t e n s odri g i t o r u m muscle Extensorcarpi radialisbrevis muscle
Lateralhead of triceps
b r a c h im i u s c l e( c u t ) Medialheadof tricepsbrachiimuscle Medialepicondyle of humerus
*{r
Nerve to anconeusand medial head of tricepsbrachii muscle Posteriorantebrachial cutaneousnerve
U l n a rn e r v e Olecranon of ulna
Deep layer
Arm
Lateralintermuscular septum
Lateralepicondyle of humerus
A n c o n e u sm u s c l e
Plate 432
Brachial Artery in Situ
C o r a c o i dp r o c
Axillaryartery D e l t o i dm u s c l e Pectoralisminor muscle (cut) Anterior circumflex humeral artery
Lateralcord, Medialcord of brachialplexus
Humerus
Musculocutaneous nerve
Pectoralismajor m u s c l ea n d t e n d o n (
S u b s c a p u l am r i su s c l e B i c e p s ( L o n gh e a d b r a c h i i{ m u s c l e ( S h o r th e
Anterior and oosterior circumflexhumeral arteries Teresmajor muscle
Coracobrachialismuscle
atissimusdorsi muscle Brachial Profundabrachii (deeo brachial)arterv M u s c u l a rb r a n c h Medial brachialcutaneousnerve Median nerve
Ulnar nerve Medial antebrachialcutaneousnerve
M u s c u l a rb r a n c h
B i c e p sb r a c h i im u s c l e Superiorulnar collateralartery B r a c h i a l im s uscle
i n t e r m u s c u lsaer p t u m Radialrecurrentartery
B i c e p sb r a c h i it e n d o n
Inferior ulnar collateralartery M e d i a le p i c o n d y l eo f h u m e r u s B i c i p i t aal p o n e u r o s i s
Radialartery
Pronator
muscre
nar artery F l e x o rc a r o i r a d i a l i sm u s c l e r a c h i o r a d i a l im s uscle
Plate 433
4{tr Arm
Brachial Artery and Anastomoses around Elbow
branch Clavicular
Pectoralbranch
Acromialbranch Deltoidbranch Thoracoacromial arterv
thoracicarterv
Axillary artery
al thoracicartery
Anteriorcircumflexhumeralarter Posterior circumflexhumeral
artery Subscapular ircumflexscapular artery
Brachialartery
artery Thoracodorsal Profundabrachii(deepbrachial) artery of lowermargin of teresmajormuscle is landmarkfor name changefrom axillary to brachialartery Radialcollateral
Middlecollateral artery Superiorulnarcollateralartery
artery Inferiorulnarcollateral Radialrecurrent artery
Recurrent interosseous arterv Anteriorulnarrecurrentartery ulnarrecurrentarterv Posterior Radialartery
artery common interosseous artery Anteriorinterosseous
4{tr
Ulnarartery
Arm
Plate 434
Arm: Serial Gross Sections
neousnerve
Pectoralis majormuscleandtendon
Mediannerve
Cephalicvein
Medialantebrachial nerve cutaneous
( shorthea Biceps brachii muscleI ( Long hea,
Brachial artervandveins Coracobrachialis muscle
vern Profundabrachii(deep brachial) artery Ulnarnerve
Deltoidmuscle
Radialnerve Medialbrachial nerve cutaneous
Bicepsbrachiimuscle
Latissimus dorsitendon Musculocutaneous nerve
Teresmajor muscle
Brachialis muscle
Brachial fascia
Cephalicvein
Mediannerve
Radial Posterior an cutaneous nerve (fromradialnerve)
Brachial artervandveins Medial antebrachial cutaneousnerve
silicvein
Radialcollateral artery
Medialbrachialcutaneous nerve
Middlecollateral arterv
Neurovascular compartment Lateralintermuscular septum
Ulnarnerve
of Triceps( u"ai"tr'""a brachii { muscle (
Superiorulnarcollateral artery
Lateralhead Longhead-
Medialintermuscular septum Brachialfascia
Bicepsbrachii
ateralantebrachial cutaneous nerve (frommusculocutaneous nerve)
Cephalicvein
Brachialis muscle Brachioradialis muscle Radialnerve Extensor carpi radialislongus muscte
Medialantebrachial nerve cutaneous Basilicvein Median nerve
Ulnarnerve Brachial artervandveins Medialintermuscular septum
Posterior antebrachial cutaneous nerve(from radialnerve)
Plate 435
Humerus Tricepsbrachiimuscleand tendon Lateralintermuscular septum
*{r
Bones of Elbow
Rightelbow Humerus
Humerus
*{r
edial supracondylarridge Coronoid fossa
Radialfossa
Olecranon fossa
Lateralepicondyle Lateralepicondyle
Medial epicondyle
Capitulum
Olecranon
Trochlea
Head
Head
Coronoid process
Neck
K
Tuberosity
Radialnotchof ulna
Tuberosity
Tuberosity Ulna
In extension: anterior view
In extension:posteriorview
ln extension:medialview Humerus Medialepicondyle Capitulum
Lateralepicondyle
Capitulum Head
Tuberosity
Radialnotch Coronoid process Trochlearnotch Olecranon
Tuberosity Coronoid process of ulna
In 90" flexion: lateral view
Elbow and Forearm
Trochlearnotch Olecranon Olecr In 90'flexion: medialview
Plate 436
Elbow: Radiographs
Lateralradiograph
c CP H HR t
o R T U
Capitulum Coronoidprocessof ulna Humerus Headof radius Lateralepicondyle Olecranon Radius Trochlear notch Ulna
Anteroposteriorradiograph
c CP H HR t M NR
o OF R T RT U
Plate 437
Capitulum Coronoidprocessof ulna Humerus Headof radius Lateralepicondyle Medialof epicondyle Neckof radius Olecranon Olecranonfossa Radius Trochleaof humerus Radialtuberosity Ulna
Elbow and Folearm
Ligaments of Elbow
Rightelbow Anteriorview
Humerus
Jointcapsule Medial epicondyle
Lateralepicondyle Radialcollateralligament
ligament Ulnarcollateral
A n n u l alri g a m e not f r
Insertionof brachialismuscle
Bicepsbrachiitendon
Obliquecord
Humerus
4{r
Joint ioint capsule
ligament Ulnarcollateral
Radialcollateralligament
A n n u l a lri g a m e not f r a d i u s
A n n u l alri g a m e not f r a d i u s Biceosbrachiitendon
Humerus
Triceps brachii tendon
Bicepsbrachiitendon
Obliquecord
Subcutaneous olecranon
-$=::---:.Ff
DUTSA
ln 90o flexion:medialview
In 90o flexion:lateralview
Jointcapsule(cutedge)
Subcutaneous olecranon bursa
Humerus
Fatpads
Openrd joint: antenor vrew
Synovialmembrane
Openedjoint: postenorvrew
Articularcartilage
Elbow and Forearm
Plate 438
Bones of Forearm
Olecranon
Rightradiusand ulna in supination:anteriorview
Trochlearnotch
Rightradiusand ulna in pronation: anteriorview
Coronoid process R a d i a ln o t c h o f u l n a
U l n a rt u b e r o s i t y
Ulnartuberosity
O b l i q u ec o r d
R a d i atlu b e r o s i t y
Anterior surface
Anteriorsurface
Obliquecord
Lateralsurface Posterior border
Anterior border
Anteriorborder
Posterior surface lnterosseous
membrane Interosseous border Interosseous border
Interosseous membrane
Dorsaltubercle Croove for extensor
p o l l i c i sl o n g u sm u Croove for extensor digitorum and extensor
i n d i c i sm u s c l e s Styloidprocess of ulna
Croove for extensor carpi radialislongus and brevis muscles
Areafor extensor pollicib s r e v i sa n d abductorpollicis longusmuscles
Styloidprocess
Styloidprocess
U l n a rn o t c h of radius Styloid process
Styloidprocess
Areafor s phoid bone
Area for lunate bone
Carpalarticularsuface
Plate 439
4{F
Coronal sectionof radiusdemonstrates how thicknessof cortical bone of shaftdiminishes to thin layerover cancellousbone at distalend
Elbow and Forearm
lndividual Muscles of Forearm: Rotators of Radius
Rightforearm:anteriorview Pronatedposition
Supinatedposition
Medial eoicondvle
Lateralepicondyle
Pronatorteres
*{r
Elbow and Forearm
Plate 44O
Individual Muscles of Forearm:Extensorsof Wrist and Digits
N o t e : A n c o n e u sm u s c l en o t s h o w n becauseit is extensorof elbow
al epicondyle Olecranon Lateralepicondyle
Extensorsof wrist Olecranon
Extensor carpi radialislongus
Lateral epicondyle
Extensor carpi radialisbrevis Extensor carpiulnaris
Common extensor tendon
Extensors of digits (exceptthumb)
Common extensor tendon
Extensor digitorum and extensor d i g i t im i n i m i (cutaway\
Interosseous memDrane
Extensor digitorum Extensor digiti minimi Extensorindicis
Extensors of thumb Abductorpollicis pollicisbrevis Extensor Extensorpollicislongus
E x t e n s odr i g i t o r u m and extensordigiti m i n i m i t e n d o n s( c u t
t! I
Plale
441
Rightforearm: posterior (dorsal)views
4{tr Elbow and Forearm
Individual Muscles of Forearm: Flexors of Wrist
Note:Brachioradialis musclenot shown becauseit is flexorof elbow Medial epicondyle
Lateralepicondyle flexortendon
Flexorcarpiradialis Palmarislongus Flexorcarpiulnaris
(cut) almaraponeurosis
Rightforearm: anterior(palmar)view
Elbow and Forearm
Plate 442
lndividual Muscles of Forearm: Flexors of Digits
Medial epicondyle Lateralepicondyle
Lateralepicondyle Common flexor tendon Coronoid process Interosseousmembrane
Flexorpollicislongus
Flexordigitorumsuperficialis tendons (cut away)
4{tr Plate 443
Rightforearm: anterior(palmar)views
Elbow and Forearm
Muscles of Forearm (Superficial Layerf: Posterior View
S u p e r i our l n a rc o l l a t e r aalr ( a n a s t o m o sdeiss t a l lw y itn posteriorulnarrecurrentartery)
Tricepsbrachiimuscle
B r a c h i o r a d i aml ius s c l e U l n a rn e r v e Extensor carpi radialislongus muscle
M e d i ael p i c o n d y loef h u m e r u s Common extensortendon O l e c r a n o no f u l n a
Extensorcarpi radialisbrevis muscle Anconeus muscle
Flexorcarpi ulnarismuscle
Extensorcaroi ulnaris
Extensordigitorum muscle
Extensordigiti minimi muscle
Abductorpollicislongusmuscle
Extensor oollicisbrevismuscle xtensorpollicislongustendon Extensorcarpi radialisbrevistendon
Extensor retinaculum (compartments numbered)
Dorsal branch of ulnar nerve
Extensorcarpi radialislongustendon
Suoerficialbranch of radial nerve
A b d u c t op r o l l i c i lso n g u st e n d o n E x t e n s ocr a r p i u l n a r i st e n d o n E x t e n s o dr i g i t im i n i m i t e n d o n
Extensor oollicisbrevistendon E x t e n s opro l l i c i sl o n g u st e n d o n
Extensordigitorum E x t e n s o irn d i c i st e n d o n Anatomical snuffbox
Nr
5th metacarpalbone
Elbow and Forearm
Plate 444
Muscles of Forearm (Deep Layerf: Posterior View SeeafsoPlates 47O,479
Middlecollateral branchof deepbrachialartery
Superiorulnarcollateral Branches of { tnreflorutnar brachial'arterv " ! ' / I ( p o s t e r i o r coilareral branch)1 ( Medialintermuscular septum
Lateralintermuscular septum Brachioradialis muscle
U l n a rn e r v e
longusmuscle Extensor carpiradialis
Posterior ulnarrecurrenta M e d i a el p i c o n d y loef h u m e r u s
Lateralepicondyleof humerus Commonextensortendon(partiallycut)
Tricepsbrachiitendon(cut) O l e c r a n o no f u l n a
Extensor carpiradialis brevismuscle
Anconeus
S u p i n a t omr u s c l e
F l e x ocr a r p iu l n a r i m s
nerve interosseous Posterior
Recurrent interosseous artery
onatorteresmuscle(slipof insertion)
Posterior interosseous artery
Radius
Ulna
nerve rnterosseous
pollicislongusm Extensor
t o r p o l l i c i lso n g u sm u s c l e
Extensor indicismuscle
pollicisbrevismuscle
Anterior interosseousartery (termination)
xtensorcarpiradialis brevistendon xtensorcarpiradialis longustendon
Extensor carpiulnaristendon(cut)
adialartery
Extensordigiti minimi tendon (cut)
Extensor digitorumtendons(cut)
2'"
4
ir, '&,
1st metacarpalbone
C
Nr Plate 445
Extensor retinaculum (compartments numbered) 5th metacarpal bone
bone 2nd metacarpal I st dorsal muscle interosseous
Elbow and Folearm
Muscles of Forearm (superficial Layerl: Anterior View SeeahoPtaH 475,476
Medialantebrachial cutaneous nerve
Bicepsbrachii muscle
Ulnarnerve
Brachialartery and median nerve
Tricepsbrachiimuscle Lateralantebrachialcutaneousnerve (terminam l u s c u l o c u t a n e o unse r v e )
septum Medialintermuscular B r a c h i a lm i su s c l e
Ulnarartery M e d i ael p i c o n d y loef h u m e r u s
B i c e p sb r a c h i it e n d o n
ommon flexor tendon
Radialartery
Pronatorteres muscle B i c i p i t aal p o n e u r o s i s Flexorcarpi radialismuscle Brachioradialm isuscle
longus Palmaris muscle
Extensor carpi r a d i a l ilso n g u sm u s c l e
f ) f
Superficial flexor muscles
Extensorcaroi radialisbrevis muscle
F l e x opr o l l i c i lso n g u s muscle and tendon
P a l m a r li o s n g u st e n d o n Radialartery
Median nerve
branch of ulnar nerve
artery and nerve
Palmarcarpal ligament ( c o n t i n u o u sw i t h
e x t e n s orre t i n a c u l u m )
T h e n am r u
P a l m a ra p o n e u r o s i s
Elbow and Forearm
Pisiform
Palmarbranch of median nerve
Hypothenar muscles
4{tr Pfate 446
Muscles of Forearm (lntermediate Layer|: Anterior View Sceal$oPbba{ft4 {ru
Bicepsbrachiimuscle
Brachialis muscle
U l n a rn e r v e
Median nerve
Brachial artery Lateralantebrachialcutaneousnerve (cut)
(frommusculocutaneous nerve)
intermuscular septum Pronatorteresmuscle (humeralhead) (cut and reflected)
Radialnerve Deepbranch Superficial branch
Medial epicondyle Flexorcarpi radialisand palmaris longus tendons (cut)
Biceosbrachiitendon
Anteriorulnarrecurrentartery Radialrecurrentarterv
Flexordigitorumsuperficialis ae r ad) m u s c l e( h u m e r o u l n h Radialartery U l n a ra r t e r y S u p i n a t omr u s c l e
Common interosseousarterv
Pronatorteresmuscle(ulnarhead)(cut)
B r a c h i o r a d i aml ius s c l e
Anteriorinterosseous artery Pronatorteresmuscle(cut
lexorcarpiulnarismuscle or digitorumsuperficialis muscle
Flexordigitorumsuperficialis muscle(radialhead)
U l n a ra r t e r y F l e x o rp o l l i c i sl o n g u sm u s c l e
Ulnarnerveanddorsalbranch Median nerve
Palmar of medianand ulnarnerves(cut) branches siform Flexorcarpi radialis tendon (cut)
Deeppalmarbranchof ulnarartery anddeepbranchof ulnarnerve Superficial branchof ulnarnerve
palmarbranch Superficial of radialartery
Plate 447
Flexorretinaculum (transverse carpalligament)
Nr
Elbow and Forearm
Muscles of Forearm (Deep Layerf: Anterior View
B r a c h i a lm i su s c l e
U l n a rn e r v e
M u s c u l o c u t a n e o unSe r v e (becomes) Lateralantebrachialcutaneousnerve
M e d i a nn e r v e Brachialartery
septum Lateralintermuscular
Medialintermuscular septum
Radialnerve
Pronatorteresmuscle (humeralheadcut and reflected)
Lateralepi
ulnarrecurrentartery
Bicepsbrachiitendon (cut) 'Medial
Radialrecurrentartery Radialartery
epicondyle of humerus
Flexorcarpi radialis, palmarislongus, flexor digitorum superficialis ( h u m e r o u l n ahr e a d ) ,a n d flexor carpi ulnaris muscles(cut)
S u p i n a t o rm u s c l Posteriorand anterior i nterosseousarteries-
Posterior ulnarrecurrentartery
Flexordigitorumsuperficialis muscle (radialhead) (cut)
Ulnarartery Pronatorteres muscle (cut and reflected)
ommon Interosseousarterv
Radialartery
Flexorpollicislongus muscleandtendon(cu
r e a d )( c u t ) t o r t e r e sm u s c l e( u l n a h Median nerve (cut)
Flexordigitorumprofundusmuscle Pronatorquadratusmuscle B r a c h i o r a d i a l ti e s n d o n( c u t ) Radialartery and
Anterior interosseousartery and nerve U l n a r n e r v e a n d d o r s a lb r a n c h Palmarcarpal branchesof radialand ulnar arteries
palmarbranch superficial Flexorcarpi ulnaristendon (cut) F l e x o rp o l l i c i sl o n g u st e n d o n Pisiform Flexorcarpi radialistendon (cut)
A b d u c t o pr o l l i c i lso n g u s Extensorpollicis brevistendon l s t m e t a c a r o abl o n e
Elbow and Forearm
palmar branch of ulnar artery and deeo branch of ulnar nerve of hamate 5th metacarpalbone
Nr Plate 44A
Forearm: Serial Gross Sections
l e x o rd i g i t o r u m superficialis
M e d i a n a n t e b r a c h i avl e i n
m u s c l e( r a d i a lh e a d ) Pronatorteres muscle
Anterior branch of media antebrachialcutaneousnerve
Radialarterv and superficialbranch of radial nerve
F l e x o rp o l l i c i sl o n g u sm u s c l e
Radius
Interosseousmembrane
B r a c h i o r a d i a lm i su
Flexorcarpi radialismuscle
Cephalicvein and lateralantebrachial cutaneousnerve (from musculocutaneous nerve) S u p i n a t o rm u s c l e
Ulnararteryand mediannerve P a l m a r il so n g u sm u s c l e Flexordigitorumsuperficialis ae r ad) m u s c l e( h u m e r o u l n h
Deep branch of radial nerve
Commoninterosseous artery
E x t e n s o cr a r p i r a d i a l i sl o n g u sm u s c l e
U l n a rn e r v e
Extensorcaroi radialisbrevismuscle
F l e x ocr a r o iu l n a r i m s uscle
Extensordigitorum muscle
B a s i l i cv e i n
E x t e n s odr i e i t i m i n i m i m u s c l e
p r o f u n d um s uscle F l e x odr i g i t o r u m
E x t e n s ocra r p iu l n a r i m s uscle
and antebrachialfascia A n c o n e u sm u s c l e
F l e x ocr a r p ir a d i a l im s uscle
Posterior antebrachial cutaneous
B r a c h i o r a d i a lm i su s c l e
nerve (from radial nerve)
Radialartery and superficial branch of radial nerve
P a l m a r i sl o n g u sm u s c l e
muscle Flexordigitorumsuperficialis
F l e x o rp o l l i c i sl o n g u sm u s c l e
Median nerve
Extensorcaroi radialis l o n g u sm u s c l ea n d t e n d o n
Ulnar artery and nerve 'lexorcarpi ulnarismuscle
Radiu
Anterior interosseousartery and nerve (from median nerve)
E x t e n s ocr a r o i r a d i a l i s b r e v i sm u s c l ea n d t e n d o n
F l e x o rd i g i t o r u mp r o f u n d u sm u s c l e U l n a a n d a n t e b r a c h i af la s c i a
A b d u c t o pr o l l i c i lso n g u sm u s c l
In t e r o s s e o u m s e m b r a n ea n d e x t e n s o rp o l l i c i sl o n g u sm u s c l e
E x t e n s odri e i t o r u m muscle E x t e n s o dr i g i t im i n i m i m u s c l e
Posteriorinterosseousartery and nerve (continuationof deep branch of radialnerve)
E x t e n s o cr a r p i u l n a r i sm u s c l e
P a l m a r i sl o n g u st e n d o n
F l e x o rc a r p i r a d i a l i st
Median nerve
Radialartery
digitorum superficialismuscle and tendons Flexorcaroi ulnarismuscle and tendon
B r a c h i o r a d i a lti e sndon
Ulnar artery and nerve
A b d u c t o pr o l l i c i sl o n g u s S u p e r f i c i abl r a n c ho f r a d i a l
E x t e n s opro l l i c i sb r e v i st e n d o n E x t e n s ocra r p ir a d i a l i s l o n g u st e n d o n
Dorsalbranchof ulnarnerve lexor digitorum profundus muscle and tendons Antebrachialfascia
Ulna t e n s o rc a r p i u l n a r i st e n d o n
Extensorcaroi radialisbrevis tendon
F l e x opr o l l i c i lso n g u sm u s c l e E x t e n s o pr o l l i c i sl o n g u st e n d o n
*{ry Plate 449
s embrane P r o n a t o ro u a d r a t u sm u s c l ea n d i n t e r o s s e o um E x t e n s o irn d i c i sm u s c l ea n d t e n d o n E x t e n s o dr i g i t im i n i m i t e n d o n E x t e n s odr i g i t o r u mt e n d o n s( c o m m o n t e n d o n t o d i g i t s4 a n d 5 a t t h i s l e v e l )
Elbow and Forearm
Attachments of Muscles of Forearm: Anterior View
a c h i a l i sm u s c l e
B r a c h i o r a d i am l iu sscle Extensor longusmuscle carpiradialis
Pronatorteresmuscle(humeralhead)
Supinator Extensor carpiradialisbrevis, extensordigitorum,extensor d i g i t im i n i m ie, x t e n s ocra r p i ulnarim s uscles Brachialis muscle Flexordigitorumsuperficialis muscle ( h u m e r o u l nh ae r ad) B i c e p sb r a c h i im u s c
r ead) t e r e sm u s c l e( u l n a h S u p i n a t o rm u s c l e
Flexordigitorumsuperficialis m u s c l e( r a d i ahl e a d ) -
Flexordigitorumprofundusmuscle
Pronatorteresmuscl F l e x o rp o l l i c i sl o n g u sm
Pronatorquadratusmuscle Pronatorquadratusmuscle
Note:Attachments of intrinsic musclesof handnot shown
B r a c h i o r a d i aml ius s c l e A b d u c t o pr o l l i c i sl o n g u sm u s c l e
F l e x o rc a r o i u l n a r i sm u s c l e
Extensor caroiulnarismuscle Flexorcarpi radialis
Flexorpollicis l o n g u sm u s c l e
Flexordigitorumsuperficialis muscle
Flexordigitorum profundus muscle
I
Elbow and Forearm
origins
I
Insertions
Plate 45O
Attachments of Muscles of Forearm: Posterior View
Tricepsbrachii muscle (medial head)
Note: Attachmentsof intrinsic musclesof hand not shown
Tricepsbrachii tendon Supinator
F l e x ocr a r p iu l n a r i m s u s c l e( h u m e r a l origin via common flexor tendon
A n c o n e um s uscle
s brachiimuscle
Flexorcarpi ulnarismuscle
p r o f u n d um s uscle F l e x odr i g i t o r u m
S u p i n a t o rm u s c l e
Abductorpollicislongusmuscle r rigin) E x t e n s ocra r p iu l n a r i m s u s c l e( u l n a o Pronatorteres muscle
Extensor pollicislongusmuscle pollicisbrevismuscle Extensor Extensorindicis
Extensorcarpi radialislongus muscle B r a c h i o r a d i a lm i su s c l e
Extensorcarpi radialisbrevismuscl
A b d u c t o pr o l l i c i sl o n g u sm u s c l e Extensor caroiulnarismuscle
Extensordigitorum muscle (centralbands)
E x t e n s o dr i g i t im i n i m i m u s c l e
Extensoroollicis brevis muscle
pollicislongusmuscle Extensor
Extensor indicismuscle Extensordigitorum muscle (lateralbands)
I
Plate 451
origins
I
Insertions
4{ry Elbow and Forearm
Garpal Bones
Anterior(palmar)view
Ulna Radialstyloidproc
Ulnarstyloidprocess Lunate
Tubercleof scaphoid
Triquetrum Pisiform
Tubercleof trapeziu
Hamate of hamate
pitate
Metacarpalbones
Posterior(dorsal)view
Dorsaltubercleof radius(Lister's)
Ulnarstyloid
Radialstyloidprocess Trapezium Trapezoid
Metacarpalbones
Wrist and Hand
4{tr Plate 452
Movements of Wrist
-Ulna
-Ulna
Radius
: ,zLunare
Scaphoid
Triquetrum Capitate
Scaphoid.
Trapezoid
Pisiform
Lunate
Capitate
Trapezium
Triquetrum
Trapezoid Trapezium
Pisiform
Hamate Metacarpal Metacarpal bones
00nes
Sesamoid DOnes
P o s i t i o no f c a r p a l b o n e s w i t h h a n d i n a b d u c t i o n : anterior (palmar)view
P o s i t i o no f c a r p a l b o n e s w i t h h a n d i n a d d u c t i o n : anterior (palmar)view ) int W r i s t ( r a d i o c a r p a jl o
Radius
M i d c a r p a lj o i n t C a r p o m e t a c a r p aj ol i n l
Wrisl (radiocarpal) lornr A r t i c u l a rd i s c o f w r i s tj o i n t L un a t e Midcarpal joint aprtate Carpometacarpal JOrnt
) int W r i s t ( r a d i o c a r p a jl o
3 r d m e t a c a r p abl o n e
M i d c a r p a jl o i n t C a r p o m e t a c a r p aj ol i n t
Dorsum-)
f-Palm Hand in anatomical position
Sagittal sectionsthroughwrist and middlefinger
Plate 453
Hand in extension
4{v Wrist and Hand
Ligaments of Wrist
Carpaltunnel:palmarview
Ulna
Radius
l n t e r o s s e o um s embrane
P a l m a r i sl o n g u st e n d o n P a l m a rc a r p a ll i g a m e n t (thickeningof deep antebrachial fascia)(cut and reflected)
Ulnar artery and nerve Flexorcarpi ulnaristendon
Radialartery and s u p e r f i c i apl a l m a rb r a n c h
F l e x o rd i g i t o r u m profundustendons
Flexorcarpi radialistendon
Flexordigitorum superficialistendons
F l e x o rp o l l i c i sl o n g u st e n d o n
Pisiform
M e d i a nn e r v e
Deep palmar branch of ulnar artery a n d d e e p b r a n c ho f u l n a rn e r v e
P a l m a ra p o n e u r o s i s Tubercleof scaphoid
Hook of hamate Tubercleof trapezium Flexorretinaculum (transversecarpal ligament)
Flexorretinaculumremoved: palmarview
S h o r tr a d i o l u n a t el i g a m e n t P a l m a rr a d i o l u n a t el i g a m e n t L o n g r a d i o l u n a t el ig a m e n t U l n o l u n a t el i g a m e n t R a d i o s c a p h o c a p i t altieg a m e n t U l n o c a p i t a t el i g a m e n t Scaphotrapeziotrapezoidligament
Ulnotriquetralligament
Scaphocapitateligment
Lunotriquetralligament
Trapeziotrapezoidligament
Triquetrohamateligament Triquetrocapitateligament
Capitohamateligament Trapeziocapitate ligament
Metacarpalbones
Wrist and Hand
Plate 454
Ligaments of Wrist (continuedl
Posterior(dorsal)view Dorsal radial metaphysealarcuateligament Dorsal radiocarpalligament D o r s a lr a d i o u l n a lri g a m e n t U l n o t r i q u e t r alli g a m e n t( d o r s a vl i e w )
S c a p h o l u n a t lei g a m e n t
Triquetrohamateligament
Trapeziotrapezoidligament
D o r s a li n t e r c a r p alli g a m e n t Trapeziocapitateligament
C a p i t o h a m a t el i g a m e n t
Metacarpalbones
Coronal section: dorsal view Ulna
Radius
D i s t arl a d i o u l n aj or i n t
Lunate
joint Wrist(radiocarpal)
A r t i c u l adr i s co f w r i s tl o i n t
Scaphoid
Meniscus
M i d c a r p a lj o i n t Trapezoid
I n t e r o s s e o uisn t e r c a r p alli g a m e n
Trapezium
Triquetrum
Carpometacarpaljoint
Hamate
ntermetacarpaljoints
Capitate
4{tr 6(a4*/* Metacarpalbones
Plate 455
Wrist and Hand
Bones of Wrist and Hand
saseI
Shafts) Head J
Metacarpalbones
Righthand: anterior(palmar)view
gase I
Proximal Phalanges
nXf f oaseI n'jf
Middlephalanges
I
Lunate
Carpal bones
\ -.-scaphoid \ Capitate
Carpalbones {
Metacarpalbones (
phalanges{ Proximal Riehthand: (dorsal)view po-sterior Middle phalanges{
Wrist and Hand
r
Trapezoid Trapezium
Triquetrum Hamate l.
1' a"r"
Shafts I Head
Base Shafts I Head
f
f ert"
Shafts I Head
Plate 456
Wrist and Hand: Anteroposterior Radiograph Seealso
BM BP C DP
Baseof 5th metacaroal Baseof 4th proximal phalanx Capitate Distal phalanxof thumo
DPR Distal phalanx of ring finger H Hamate HH Hook of hamate HM Head of 5th metacaroal HP
Plate 457
L
H e a d o f p r o x i m a lp h a l a n x Lunate
M MP
Metacarpalof index finger Middle phalanxof middle finger
P PP PPI R S SH SP SPR T TP TZ U
Pisiform Proximalphalanxof thumb Proximalphalanxof indexfinger Radius Scaphoid Shaftof 5th metacarpal Styloidprocessof ulna Styloidprocessof radius Triquetrum Trapezoid Trapezium Ulna
Wrist and Hand
Metacarpophalangeal and lnterphalangeal Ligaments
form
Anterior (palmar)view
of hamate Trapezium mar carpometacarpalligaments Palmarmetacarpalligaments
J o i n tc a p s u l e
Deeptransverse ligaments metacarpal
CollateralIigam
Palmarligaments (plates)
Cut marginsof digitalfibrousshea
Flexordigitorum suoerficialistendons (cut) Flexordigitorum profundustendons
M e t a c a r p o p h a l a n g(eMaPl )i o i n t collateral proximal interphalangeal(plp) joint Accesso.ry 7
ligament Truecollateral ligament
Metacarpalbone
Distal interphalangeal ( D l P )j o i n t
ln extension: medialview Palmarsurface
Proximal
Middle
Palmarligament (volarplate
Accessory collateral ligament
In flexion: medialview
Phalanges
True collateralligament Palmarligament(volarplate)
4{tr
Note: Ligamentsof metacarpophalangeal and inteiphalangealjoints are similar
Wrist and Hand
Plate 458
Wrist and Hand: Superficial Palmar Dissections
Palmarislongustendon
Palmarbranch of ulnar nerve
Branchof superficial radial nerve to skin of lateralthenar area
Pisiform Deep palmar branch of ulnar artery and deep branch of ulnar nerve
P a l m a rc a r p a ll i g a m e n t ( t h i c k e n i n go f d e e p antebrachialfascia c o n t i n u o u sw i t h extensorretinaculum)
Superficial branchof ulnarnerve U l n a ra r t e r y Palmaris brevismuscle
Palmarbranch of m e d i a nn e r v e
Hypothenar muscles
T h e n a rm u s c l e s
Palmar aponeurosis
Recurrent (motor) branch of median nerve to thenar
muscres
Palmarisbrevis muscle (reflected)
Minute fasciculi attach palmar a p o n e u r o s i st o d e r m i s
Anterior (palmar)views
Palmardigital nervesfrom superficial branch of ulnar nerve to 5th and medial half of 4th fingers
Palmaraponeurosis
Transversefasciculi
Palmardigital arteriesand nerves
Superficialtransversemetacarpalli
*{ry Plate 459
Wrist and Hand
Wrist and Hand: Deeper Palmar Dissections Radialartery and venae comitantes
Ulnar artery with venae comitantesand ulnar nerve
Flexorcarpi radialistendon
Flexorcarpi ulnaristendon
T e n d i n o u ss h e a t ho f flexor pollicislongus
C o m m o n f l e x o rs h e a t h( u l n a rb u r s a )c o n t a i n i n g superficialisand profundusflexor tendons
( r a d i abl u r s a )
Pisiform
Median nerve P a l m a r i sl o n g u st e n d o n a n d p a l m a rc a r p a ll i g a m e n l Transversecarpal
Deep palmar branch of ulnar artery and deep branch of ulnar nerve Superficialbranch of ulnar nerve Palmardigital nervesto 5th finger and medial half of 4th finger
ligament(flexor retinaculum)
n nerve
T h e n am r uscles Properpalmar
Commonflexorsheath(ulnarbursa)
digital nerves of thumb-
palmararterialandvenousarches Superficial 2nd.3rd.and4th lumbricalmuscles(in fascialsheaths)
(Synovial) tendinous
(Synovial) of fingers flexortendonsheaths
sheathof flex p o l l i c i sl o n g u s (radialbursa) P r o b ei n I s t lumbrical
Superficial palmarbranch of radialartery and recurrent branchof mediannerve to thenar muscles
fascial Common palmar digital
Properpalmar digitalarteries Septafrom.palmar a p o n e u r o srrosr m r n g Palmaraponeurosis (reflected)
Anterior(palmar)views
Ulnarartery ano nerve Common palmar digital branches of median nerve (cut)
muscles Proper palmar digital nervesof Fasciaover adductor oollicismuscl
l s t d o r s ailn t e r o s s e o m u su s c l e
s h e a t h( u l n a r bursa) 5th finger (synovial) t e n d i n o ussh e a t h
Probein dorsalextension of thenar space deep to adductor pollicis
Probein midpalmarspace
Thenarspace (deep to flexor tendons
'l and st lumbricalmuscle
Septum separatingthenar from midpalmarspace C o m m o n p a l m a rd i g i t a l Proper palmar digital arteriesand Annular and cruciform oartsof fibrous sheath over (synovial)flexor tendon sheaths
Wrist and Hand
M i d p a l m asrp a c e (deepto flexor tendonsand l u m b r i c aml u s c l e s ) Insertionof flexor digitorum superficialistendon lnsertionof flexor digitorum profundustendon
Plate 460
Flexor Tendons, Arteries, and Nerves at Wrist Palmar view Flexordigitorumsuperficialis t e n d o n sa n d flexordigitorumprofundus tendons Commonflexorsheath ( u l n ab r ursa)
P a l m a r i sl o n g u st e n d o n Median nerve Radialartery Flexorcarpi radialis tendon
F l e x opr o l l i c i lso n g u s t e n d o ni n t e n d o n sheath(radialbursa)
Ulnarartery U l n a rn e r v e F l e x ocr a r p iu l n a r i s tendon
Palmarcarpal ligament (reflec (Synovial)tendon sheath
Pisiform
Flexorretinaculum(transverse carpalligament) Trapezium
A b d u c t o rd i g i t im i n i m i m u s c l e
1st metacarpalbone Flexordigiti minimi brevis muscle
s uscle Opponenp s ollicim Abductorpollicis b r e v i sm u s c l e
O p p o n e n sd i g i t i m i n i m i m u s c l e
(reflec
Superficialpalmar (arterial)arch
u m b r i c am l uscles
Flexorpollicis b r e v i sm u s c l e
4{tr
A d d u c t o r o o l l i c i sm u s c r e
(reflected)
Transverse crosssectionof wrist demonstratingcarpaltunnel Palmarislongus tendon
Flexorretinaculum(transverse carpalligament)
Median nerve* Ulnar artery and nerve Flexorcarpi
u l n a r i tse n d o n Flexor digitorum superficialis tendons'
Flexorcarpi radialistendon
Flexor digitorum profundus tendons*
Flexorpollicis longustendon in tendonsheath* Radialartery
Trapezium S i m p l em e t h o d o f d e m o n s t r a t i n g arrangementof flexor di gitorum superficialis tendonswithin carpaltunnel
Plate 461
Capitate
Trapezoid *Contentsof carpal tunnel
Wrist and Hand
Bursae, Spaces, and Tendon Sheaths of Hand
muscle Pronatorquadratus Flexorcarpiradialis tendon Common flexorsheath (ulnarbursa)
Tendinous sheathof flexorpollicislongus(radialbursa Flexorretinaculum(transverse carpalligament)(reflectedl Flexordigitorumprofundus Tendinous sheathof flexorpollicis longus(radialbursa) Fascia of adductorpollicismuscle
Flexordigitorum tendons superficialis
Thenarspace (deepto flexortendon and1stlumbrical muscle
Commonflexorsheath (ulnarbursa)(opened) Lumbricalmusclesin fascialsheaths
(Synovial) tendon sheathof finger
Midpalmar space (deepto flexortendons and lumbricalmuscles)
Lumbricalmusclesin fascialsheaths (cutand
Fibrousand synovial(tendon) sheathsof finger(opened)
Annularand cruciformparts (pulleys) of fibroussheathover synovialsheath)of finger
4{ffi*
Flexordigitorumsuperficialis tendon Flexordigitorumprofundus tendon
Midpalmarspace
Palmaraponeurosis
Septaformingcanals flexortendonsto 3rd diSit and superficialis Profundus and thenarspaces Septumbetweenmidpalmar
Thenarspace Commonpalmardigital arteryand nerve\
Flexorpollicislongus tendonin tendon sheath(radialbursa)
Lumbricalmuscle in its fascialsheath
pollicis Extensor longustendon
Flexortendonsto 5th digitin commonflexor sheath(ulnarbur Hypothenarmuscles Dorsalinterosseous fascia Dorsalsubaponeurotic space Dorsalfasciaof hand Dorsalsubcutaneous space
Wrist and Hand
Adductorpollicismuscle fascia Palmarinterosseous muscles Palmarinterosseous muscles Dorsalinterosseous Extensortendons
Plate 462
Lumbrical Muscles and Bursae,Spaces,and Sheaths:Schema Usualarrangement
Commonvariation
Tendinoussheathof flexor p o l l i c i sl o n g u s( r a d i a lb u r s a ) Intermediatebursa (communication between common flexor sheath Iulnar b u r s a la n d t e n d i n o u s sheathof flexor pollicis l o n g u sI r a d i a lb u r s a ] )
Common flexor sheath
( u l n ab r ursa)
Thenar
L u m b r i c aml u s c l e s (in fascialsheaths) J
( S y n o v i a lt)e n d o n s h e a t h so f f i n g e r s
[umbricalmuscles: schema
Flexordigitorum profundustendons
1 s t a n d 2 n d l u m b r i c a lm u s c r e s (unipennate)
3rd and 4th lumbricalmuscles (bipennate)
C a m p e rc h i a s m
N o t e : F l e x o rd i g i t o r u ms u p e r f i c i a l iasn d p r o f u n d u st e n d o n se n c a s e di n s y n o v i a l s h e a t h sa r e b o u n d t o p h a l a n g e sb y f i b r o u s digital sheathsmade up of alternating s t r o n ga n n u l a r( A ) a n d w e a k e rc r u c i f o r m( C ) p a r t s( p u l l e y s ) . 41
Flexordigitorum s u p e r f i c i a l itse n d o n s( c u t )
Cl
C2
A3
C3
C4
n)
Tendonsof flexor digitorum superficiali
a n dp r o f u n d u s /i muscres ,i
tendon sheath
Plate 463
a l m a rl i g a m e n t s( p l a t e s
4{tr Wrist and Hand
Flexor and Extensor Tendons in Fingers
Long extensor Extensor expansron tendon (hood)
lnsertionof central band of extensor tendon to base of middle phalanx
S l i p so f l o n g extensortendon to lateral
T r i a n g u l aarp o n e u r o s i s
lnterosseous muscles
Posterior (dorsal) vtew
Metacarpal bone
Insertionon extensortendon
lnterosseous t e n d o ns l i p to lateralband
to baseof distalphalanx Lateralbands
Lumbricalmuscle
(hood) Extensor expansion
Lateralband
Insertionof extensortendon
to baseof middlephalan
tendon Partof interosseous passes to baseof proximal phalanxandjoint capsule
Long extensortendon
Centralband
-1S
Insertionof extensor tendon to base
o f d i s t apl h a l a n x
Metacarpalbone
Fingerin extension: lateralview Collateral ligament
Vinculum oreve
Flexordigitorum orofundustendon
Vincula longa
Flexordigitorum superficialistendon
Insertionof smalldeepslipof extensor x n dj o i n tc a p s u l e t e n d o nt o p r o x i m apl h a l a n a
muscles lnterosseous Lumbricalmuscle
.-,
#
Attachment of interosseousmuscle to base of proximal phalanxand joint capsule
)>
,4
aa Insertionof lumbrical
muscleto extensor
/,
Palmarligament(plate) Flexordigitorum superficialis tendon(cut)
muscles lnterosseous Lumbrical muscle
ligaments Collateral Flexordigitorum
profundustendon(cut) Palmarligament(plate)
c44e/^
Wrist and Hand
Note: Blackarrows indicate pull of long extensortendon; red arrows indicatepull of interosseousand lumbrical muscles;dots indicate axis of rotation of ioints
Pfate 464
lntrinsic Muscles of Hand
Radialartery and palmar carpal br
Pronatorouadratusmuscle
U l n a rn e r v e
Radius
ar artery and palmar carpal branch
Superficialpalmar branch of radial
c a r o iu l n a r i st e n d o n
Flexorretinaculum(transverse carpal ligament)(reflected)
Palmarcaroalarterialarch
Opponenp s o l l i c i sm u s c l e
l'rsrlorm Median nerve
Branchesof median nerve t o t h e n a rm u s c l e sa n d t o 1 s t a n d 2 n d l u m b r i c a lm u s c l e s
A b d u c t o r d i g i t im i n i m i m u s c l e( c u t )
D e e pp a l m a br r a n c ho f u l n a ra r t e r y and deeobranchof ulnarnerve
A b d u c t o rp o l l i c i s
brevismuscle(cut
F l e x o rd i g i t im i n i m i b r e v i sm u s c l e( c u t )
F l e x opr o l l i c i s
O p p o n e n sd i g i t i m i n i m i m u s c l e
brevis muscle
Deep palmar (arterial)arch
A d d u c t o rp o l l i c i s
muscle
Palmarmetacarpalarteries Common palmar digital arteries
lst dorsal
interosseous muscle
Deep transversemetacarpalligaments
Branches from deep branch of ulnar nerve to 3rd and 4th lumbrical musclesand to all interosseousmuscles
Anterior(palmar)view Lumbrical muscles(reflec
Palmarinterosseous m u s c l e(su n i o e n n a t e Deep transverse metacarpalligaments
Radialartery
A b d u c t o rd i g i t i m i n i m im u s c l e
A b d u c t o pr o l l i c i s brevismuscle Dorsalinterosseous m u s c l e(sb i p e n n a t e )
T e n d i n o ussl i p s to extensor expansrons (hoods)
Cryd4*/* Posterior (dorsal)view Note: Arrows indicateaction of muscles.
Plate 465
Wrist and Hand
Arteries and Nerves of Hand: Palmar Views
Radialartery
Ulnar artery and nerve P a l m a rc a r p a ll i g a m e n t( c o n t i n u o u s w i t h e x t e n s o rr e t i n a c u l u m )
M e d i a n n e r v ea n d o a l m a rb r a S u p e r f i c i apl a l m a rb r a n c ho f r a d i a la r t e r
Flexorretinaculum(transverse c a r p a ll i g a m e n t )
A b d u c t o r p o l l i c i sb r e v i sm u s c l e( c u t )
D e e p p a l m a rb r a n c ho f u l n a ra r t e r y and deep branch of ulnar nerve
O p p o n e n sp o l l i c i sm u s c l e
Suoerficialbranch of ulnar nerve F l e x o ro o l l i c i sb r e v i sm u s c r e Common flexor sheath ( u l n a rb u r s a )
Recurrent(motor) branch of median nerve to thenar mu
palmar (arterial)arch
Proper digital nerves a n d a r t e r i e st o t h u m b
o m m o n p a l m a rd i g i t a ln e r v e s and arteries
A d d u c t o r p o l l i c i sm u s c l e
Communicatingbranch of median nerve with ulnar nerve Proper palmar digital nerves and arteries
Branchesof median nerve to l s t a n d 2 n d l u m b r i c a lm u s c l e s Flexortendons,
ovial
and fibrous
Branchesof proper palmar digital nervesand arteriesto dorsum of middle and distal phalanges
Ulnar artery and nerve Radial
Palmarcarpal branchesof radialand ulnar arteries
M e d i a nn e r
Pisiform
Superficialpalmar branch of radialarter D e e p p a l m a r( a r t e r i a la) r c h a n d d e e o b r a n c ho f u l n a rn e r v e P r i n c e p sp o l l i c i sa r t e r y
Deep palmar branch of u l n a ra r t e r ya n d d e e p branch of ulnar nerve Branchesto hypothenar muSctes Superficialbranch of u l n a rn e r v e Hook of hamate
D i s t a ll i m i t o f s u p e r f i c i apl a l m a ra r c h R a d i a l i si n d i c i s Palmarmetacaroalarteries Common palnrardigital arteri Proper palmar digital arter Proper palmar digital nervesfrom median nerve
Wrist and Hand
Deep palmar branch of u l n a rn e r v et o 3 r d a n d 4 t h l u m b r i c a l a, l l interosseous,adductor p o l l i c i s a, n d d e e p h e a d of flexor pollicis brevis muscles ing branch of median nerve with u l n a rn e r v e Proper palmar digital nervesfrom ulnar nerve
Plate 466
Wrist and Hand: Superficial Radial Dissection
lateral (radial)view branch of radial nerve
Extensor retinaculum
M e d i ab l ranch Lateralbranch Dorsal digital branchesof radial nerve
Dorsal carpal branch
of radialartery
Scaphoid Radialartery in anatomicalsnuffbox
Extensorcarpi r a d i a l i sb r e v i s tendon
Trapezium
Extensor carpi r a d i a l ilso n g u s
lnsertionof abductor p o l l i c i sl o n g u st e n d o n
tendon l s t m e t a c a r p abl o n e Radialartery
1 s td o r s ailn t e r o s s e o u msu s c l
Insertionof extensor pollicisbrevis tendon
nsertionof extensor p o l l i c i sl o n g u st e n d o n Deep fascia(cut
Fractureof middle third (waist)of scaphoid(most common)
4{F Plate 467
Wrist and Hand
Wrist and Hand: Superficial Dorsal Dissection
Posterior(dorsal)view cutaneous Posterior antebrachial nerve(from radialnerve)
branchof radialnerve Superficial (thickening retinaculum Extensor fascia) of posteriorantebrachial of branches Communicating radialand ulnarnerves
Dorsalbranchof ulnar Dorsalvenous network of
Dorsalmetacarpalveins
Probein dorsal space subaponeurotic (betweenopened dorsalfasciaof handand dorsalinterosseous fascia) Intercapitular veins Dorsaldigitalnervesand
Dorsalbranches of properpalmardigitaln
4{tr pathwaysshownin black; Note:Lymphatic arrowsindicatedirectionof drainage
Wrist and Hand
Plate 468
Wrist and Hand: Deep Dorsal Dissection
M e d i a la n t e b r a c h i a l cutaneousnerve
Lateralantebrachlalcutaneousnerve (terminalpart of musculocutaneousnerve)
Posteriorantebrachial culaneous nerve (branch of radial nerve
Suoerficialbranch of radial nerve
Extensordigitorum, extensordigiti minimi, and extensorindicistendons (cut)
Extensor retinaculum Radialartery in anatomicalsnuffbox
Dorsalbranchof ulnar Abductorpollicislongustendon pollicisbrevistendon Extensor
Dorsal carpal branch of ulnar artery
e n s o rp o l l i c i sl o n g u st e n d o n Extensorcarpi radialislongus tendon Extensorcarpi radialisbrevis tendon
Extensorcarpi ulnaris
Dorsal carpal (arterial)
Dorsaldigitalarteries
Dorsal metacarpalarteries
Dorsal digital branches of dorsal branch o f u l n a rn e r v e
Dorsal digital branchesof superficial 'lst,2nd, branch of radial nerve to 3rd, and radial half of 4th fingers Dorsal branchesof proper p a l m a rd i g i t a lb r a n c h e s of ulnar nerve and of p r o p e r p a l m a rd i g i t a l arteriesto dorsum o f m i d d l ea n d distal phalangesof 5 t h a n d u l n a rh a l f of 4th fingers
4ttr Plate 469
Posterior(dorsal)view Dorsalbranches of properpalmardigital branches of mediannerveand of properpalmardigitalarteriesto d o r s u mo f m i d d l ea n dd i s t apl h a l a n g e s o f 2 n d , 3 r d a, n dr a d i ahl a l fo f 5 t h fingers
Wrist and Hand
Extensor Tendons at Wrist
Posterior(dorsal)view Extensor carpiulnaris- Compartment6 Extensor digitiminimi- Compartment5
Extensor 9'qlt:"t I co.partment+ indicis I Extensor xtensorpollicislongus- Compartment3 ---: --;:-:.-,- Compartment2 longus |) r carprraoralrs Abductorpollicislongus) comPartment1 pollicisbrevis i Extensor
Planeof crosssection
shownbelow Extensor retinaculum
snuffbox Radialarteryin anatomical A b d u c t odr i g i t i m i n i m im u s c l e
l n t e r t e n d i n o u cs o n n e c t i o n s
Transverse fibersof (hoods) extensorexpansions
Crosssectionof most distalportion of forearm Extensor retinaculum ComRartment +
{ extensorindicis
I
c o m 'p a r t m e n t s I E l t g l s o . r . (
pollicislongus- Compartment3 Extensor
E x t e n s odri g i t o r u m and
olSltl mlnlml
carpi Extensor radialisbrevis carpi Extensor r a d i a l ilso n g u s
Compartment2
{ Extensor Compartment5 J carpi ( ulnaris
Wrist and l{and
Plate 47O
Fingers
Svnovialmembrane Articularcartilage
Sagittalsection
Eponychium (cuticle) Lunule Flexor digitorum superficialis tendon
Bodyof nail
Distalphalanx
Nerves
Arteries
\--------
Septa --___--t
v Distalanteriorclosedspace(pulp)
tendon sheathof finger Synovial(flexortendon) sheathof finger Flexordigitorumprofundustendon Palmarligament(plate) Articularcavity Bodyof nail
Crosssection throush distal phalaix
Subungual space
Nailbed
Minutearteries
Distalphalanx
Fine nerves
Fibrousseptaand areolar tissuein anterior closedspace(pulp)
Dorsaldigitalarteryand nerve
Dorsalbranches of properpalmar digitalarteriesand nervesto dorsum of middleandterminalphalanges
Arteriesand nerves
4{tr Nutrientbranchto epiphysis Nutrientbranches to metaphysis
Plate 471
Properpalmardigitalartery t o n e i g h b o r i ndgi g i t
Properpalmardigitalarteryand nervti
Wrist and Hand
Gutaneous lnnervation of Wrist and Hand
A n t e r i o r ( p a l m a r )v i e w
nadial S u p e r f i c i a l nerve J branch t
Ulnar nerve
Palmar digital branches
Median nerve
Palmar branch
Posterior(dorsal)view
Palmar digital branches
M usculocutaneous nerye
Medial an
cutaneousnerve D i v i s i o nb e t w e e n u l n a ra n d r a d i a l n e r v ei n n e r v a t i o no n d o r s u mo f handisvariable.
Dorsal branch ano dorsal digital
Superficial branch ano dorsal digital branches
Dranc
Nr Neurovasculature
Proper palmar digital branches
Proper palmar digital branches
Median nerve
Plate 472
Arteries and Nerves of Upper Limb
Anteriorview D e l t o i dm u s c l e C o r a c o b r a c h i a l im s uscle Intercostobrachial nerve M e d i a lb r a c h i a l cutaneousnerve
M u s c u l o c u t a n e o uns B r a c h i a l im s uscle
Radialnerve
B i c e p sb r a c h i im u s c l e( c u t )a n d t e n d o n
U l n a rn e r v e
Lateralantebrachialcutaneousnerve (from musculocutaneousner
Radialnerve
Medial antebrachial cutaneousnerve
oeeobranch-1 J branch I Superficial
Median nerve Brachialartery
S u p i n a t o rm u s c l e
Bicipitalaponeurosis
B r a c h i o r a d i a lm i su s c l Radialartery Pronator teres muscle (partially cut Median nerve
Flexorcarpi radialismuscle (cut)
F l e x o rp o l l i c i sl o n g u s Flexorcarpi radialis tendon (cut) F l e x o rr e t i n a c u l u m (transversecarpal ligament) S u p e r f i c i abl r a n c h of radial nerve R e c u r r e n (t m o t o r ) branch of median nerve to
Flexordigitorum profundus muscle F l e x o rc a r p i u l n a r i sm u s c l e U l n a r a r t e r ya n d n e r v e D o r s a lb r a n c ho f u l n a rn e r v e F l e x o rd i g i t o r u ms u p e r f i c i a l itse n d o n s( c u t )
t h e n am r uscles D e e p p a l m a rb r a n c ho f u l n a ra r t e r ya n d d e e p b r a n c ho f u l n a rn e r v e S u p e r f i c i abl r a n c ho f u l n a rn e r v e S u p e r f i c i apl a l m a ra r c h ( c u t ) Common palmar digital branches of median nerve
P r o p e rp a l m a r digitialbranches of median nerve
Plate 473
C o m m o n p a l m a rd i g i t a lb r a n c ho f u l n a rn e r v e C o m m u n i c a t i n gb r a n c ho f m e d i a nn e r v ew i t h u l n a rn e r v e P r o p e rp a l m a rd i g i t a lb r a n c h e so f u l n a rn e r v e
4{tr
Neurovasculature
Musculocutaneous Nerve
Anteriorview Note: Only musclesinnervated by musculocutaneous nerve snown
Musculocutaneous nerve(C5,6,7) 1 i e d i a l ) Cordsof . Posterior) brachial Lateral ) p r e x u s Coracobrachialismuscle
Medialbrachial nerve cutaneous Bicepsbrachiimuscle (retracted\
Medial antebrachial cutaneousnerve
Ulnarnerve
Nr
Median nerve Radialnerve
Brachialis muscle
Axillarynerve
Articularbr
Anterior branch
Posterior bra
Cutaneous innervation (via lateral antebrachial cutaneous nerve) Anterior (palmar)view
Neurovasculatune
Posterior(dorsal)view
Plate 474
Median Nerve Anterior view
Note:Onlv musclesinnervated by mediannerveshown
Musculocutaneous nerve Mediannerve(C5,6,7, 8,T1 Medial Posterior
lnconstantcontribution
Lateral
Cordsof brachial prexus
Pronatorteresmuscle(humeral Medialbrachial cutaneous nerve Articularbranch Medialantebrachial nerve cutaneous Flexorcaroi radialismuscre Axillarynerve
Palmaris longusmuscle
Radial nerve
Pronatorteresmuscle(ulnarhead)
Nr
Ulnarnerve
Flexordigitorumsuperficialis muscle (turnedupl Flexordigitorumprofundusmuscle (lateralpartsuppliedby median nerve; [anteriorinterosseous] medialpartsuppliedby ulnarnerve) Anterior interosseousnerve
Flexorpollicislongusmuscle Pronatorquadratus muscle Palmarbranchof mediannerve
Thenar muscles
Abductoroollicisbrevis Opponenp s ollicis Superficial headof flexorpollicisbrevis (deephead suppliedby u l n a rn e r v e )
1st and 2nd lumbricalmuscles
Palmar view C o m m u n i c a t i nbgr a n c h of mediannervewith ulnarnerve Commonoalmar digitalnerves
Dorsalbranches to dorsumof middleand distalphalanges
Properpalmar digitalnerves
Posterior(dorsal)view
Plate 475
Neurovasculature
Ulnar Nerve
Anterior view
Note:Only musclesinnervated bv ulnarnerveshown Ulnar nerve(C7,8,T11 (no branchesaboveelbow) tnconstantcontribution
Medialepicondyle branch (behindcondyle) digitorumprofundus muscle(medialpart only; lateralpart suppliedby anteriorinterosseous branchof mediannerve)
Palmarview
Flexorcarpiulnarismuscle (drawn aside)
I branchof ulnarnerve
Palmarbranch Flexorpollicisbrevismusclel (deepheadonly;superficial\ headand otherthenarmuscles suppliedby mediannerve)
Adductorpollicis
Abductordigitiminimi Flexordigitiminimibrevis Opponensdigitiminimi
Hypothenar muscles
Commonpalmardigitalnerve branchof mediannervewith Communicating ulnarnerve muscles Palmarand dorsalinterosseous 3rd and 4th lumbricalmuscles(turneddownl
4{r Neurovasculatule
Properpalmardigitalnerves (doisaldigitalnervesarefrom dorsalbranch) to dorsumof middleanddistalphalanges branches
Plate 476l
Radial Nerve in Arm and Nerves of Posterior Shoulder
scapularnerve(C5) S u p r a s p i n a tm u su s c l e pular nerve(C5,6) Levatorscapulae muscle(supplied alsobv branches from C3 and C4
Deltoidmuscle Teresminormuscle Axillary nerve(C5, 6) Superiorlateralbrachial nerve cutaneous
Rhomboid m i n o rm u s c l e
Radialnerve ( c 5 ,6 , 7 , 8 , T 1 ) lnconstantcontribution
Rhomboid majormuscle
lnferiorlateralbrachial nerve cutaneous
Posteriorantebrachial nerve cutaneous Infraspinatus muscld Teresmajormuscld Lowersubscapularnerve(C5, 6) Posteriorbrachialcutaneousnerve (branchof radial nerve in axilla)
Long head
Tricepsbrachiimuscle
Lateralintermuscular septum
Brachialis muscle(lateral part;remainder of muscle suppliedby musculonerve) cutaneous
Lateral Medial Brachioradialis muscle
Tricepsbrachii Medial epicondyle
Extensor carpiradialis longusmuscle
Olecr Anconeus Extensor digitorum Extensor carpiulnaris
Pfate 477
Neurovasculature
Radial Nerve in Foreatm
Radialnerve(C5,6, Z8,T1l
I nconstantcontribution
(terminal) Superficial branch Deep (terminal)branch
Posteriorview
Lateralepicondyle
A n c o n e um s uscle B r a c h i o r a d i aml ius s c l e Extensorcarpi radialislongus muscle S u p i n a t o rm u s c l e
xtensorcarpiradialisbrevismuscle Extensor caroiulnarismuscle
Extensor-supinator groupof muscles
Extensor digitorummuscleand extensordigitiminimimuscle Extensor indicismuscle pollicislongusmuscle Extensor Abductorpollicislongusmuscle Extensorpollicis brevis muscle
4{tr
Posterior i nterosseous nerve (continuation of deepbranchof radialnervedistalto supinatormuscle) Suoerficial branchof radialnerve
Fromaxillarynerve
Superiorlateral brachialcutaneous nerve
lnferiorlateral brachialcutaneous nerve
Posterior brachial cutaneousnel From radial nerve
Posterior antebrachial
I
cutaneousnerve Superficialbranch of radialnerve and dorsal digital branches
Dorsaldigitalnerves Cutaneousinnervationfrom radialand axillarynerves
Neurovasculature
Plate 478
GutaneousNervesand SuperficialVeinsof Shoulderand Arm
Posteriorview
Anterior view
Supraclavicular nerves (fromcervicalplexus)
Lateralsupraclavicular nerve
Medial
lntermediate Lateral
branchof
Acromialbranches of thoracoacromial vein
Superficial branches of posterior circumflex humeralvein Intercosto brachialnerve Medialbrachial cutaneous nerve
Superiorlateral brachialcutaneous nerve(from
Superiorlateral brachial cutaneous nerve (fromaxillary nerve)
axillarynerve)
Cephalic
Posterior brachial nerve cutaneous (from radialnerve)
Inferiorlateral brachialcutaneous nerve(from radialnerve)
Inferiorlateral brachialcutaneous nerve(from radialnerve)
Posterior antebrachial cutaneous nerve(from radialnerve) Accessory
Posterior antebrachial cutaneous nerve (fromradial nerve)
Branches of medial antebrachial cutaneousnerve Basilicvein Lateralantebrachial cutaneousnerve (terminaloart of m u s c u l o c u t a n e o unse r v e )
Branches of medial antebrachial cutaneous
nerve
Median cubital vein Intermediate(median) antebrachialvein tcvetn Perforatingveins Cephalicvein
Branches of lateralantebrachial nerve cutaneous (terminalpartof nerve musculocutaneous
4{tr Plate 479
Neurovasculatule
Gutaneous Nerves and Superficial Veins of Forearm
Posterior(dorsal)view
Anterior(palmar)view
C e p h a l i cv e i n Posteriorantebrachial cutaneousnerve (from radial nerve)
B a s i l i cv e i n
(frommusculoc u t a n e o unse r v e )
terior branch and Posteriorbranch of medial antebrachial cutaneous nerve Posterior
Accessory cephalicvein
Median b a s i l i cv e i n
Lateralantebrachial cutaneousnerve
branch of medial antebrachial cutaneous nerve
Median c e p h a l i cv e i
Bicipital aponeurosrs
C e p h a l i cv e i
B a s i l i cv e i n Perforating vetns
Median antebrachialvein Note: ln 7O"/"o( cases, a median cubital vein (tributaryto basilicvein) replaces m e d i a nc e p h a l i c a n d m e d i a nb a s i l i c veins (see PlaLe479\. Superficialbranch of radial nerve Palmarbranch of median lntercaoitularveins
Posterior antebrachial cutaneous nerve (from radial nerve)
Accessory cephalic vetn Posterior branchof lateral antebrachial cutaneous nerve(from musculocutaneousnerve) Cephalicvein
B a s i l i cv e i n
Extensor retinaculum r branch o f u l n a rn e r v e Dorsal branch of ulnar nerve Palmarcarpal ligament (continuous with extensor retinaculum) Palmar aponeuroSrs
Dorsalbranch of ulnarnerve Dorsal metacarpal v e tn s
Suoerficialbranch of radial nerve
Dorsal venous network
lntercapitular vetns
transverse metacarpal ligament
Proper palmar digital nerves a n d p a l m a rd i g i t a lv e i n s
Neurovasculature
Dorsal digital nervesand veins
Plate 48O
Gutaneous Innervation of Upper Limb
Anterior (palmar)view
Posterior(dorsal)view aclavicularnerves (from cervical plexus-C3,4)
Supraclavicular nerves (from cervical plexus-C3,4)
Axillarynerve Superiorlateral brachialcutaneous nerve (C5,6)
Axillarynerve lateralbrachial cutaneousnerve (c5,6)
Radialnerve Inferiorlateral brachialcutaneous n e r v e( C 5 , 6 ) Intercosto' brachial nerve (T2) and medial brachial cutaneous nerye (c8,T1,2)
Lateralantebrachial cutaneousnerve
(cs,5171)
(terminalpart of musculocutaneous nerve)
Radialnerve Superficialbranch (c6-8) \
Plate 481
(clsl,6-8)
Medial antebrachial cutaneous nerve ( c 8 ,T 1 )
Lateralantebrachialcutaneous nerve (c5,6 [7]) (terminalpart of musculocutaneous nerve)
Ulnarnerve(C8,T1)
digital branches
Mediannerve Palmarbranch and Palmar digitalbranches (c6-8)
Radialnerve Posteriorbrachialcutaneous nerve(C5-8) Inferiorlateralcutaneous nerye Posteriorantebrachial cutaneousnerve
Nr
Dorsalbranch and dorsal digital Properpalmar digital branches
Radialnerve Superficialbranch and dorsaldigital branches(C6-8)
Mediannerve Properpalmar digitalbranches
Note: Divisionvariablebetweenulnarand radial innervationon dorsumof handand often alignswith middleof 3rd digit insteadof 4th digit as shown
teurovasGulatur€
Dermatomes of Upper Limb
Note: Schematicdemarcationof dermatomes (accordingto Keeganand Carrett) shown as distinct segments.There is actuallyconsiderable overlap between adjacent dermatomes.An alternativedermatome map is provided by Foerster(seereferences).
Anteriorview
s
*:.
ki
$'r s
$ ii
Neurovasculature
*{r Plate 482
Lymph Vessels and Nodes of Upper Limb SeealsoPlates 184, 468
D e l t o p e c t o r anl o d e
Lateralaxillarynodes ( a l o n ga x i l l a r yv e i n )
C e p h a l i cv e i n
B a s i l i cv e i n
C u b i t anl o d e s
M e d i a n c u b i t a lv e i n
Vessels passing to d o r s u mo f h a n d
C e p h a l i cv e i n
Vesselspassingto d o r s u mo f h a n d
V e s s e l sp a s s i n ga r o u n d web to dorsum of hand Vesselspassingto dorsum of fingers
Note: Arrows indicate d i r e c t i o no f d r a i n a g e
Plate 483
Neurovasculature
GT Angiograms of Arteries of the Upper Limb
Regional Scans
PIate 484
7 Lower Limb Section Topographic Anatomy Plate 485
las Lower Limb
Hip and Thigh Plates
486-505
486
Bone Hip(Coxal)
487 488
HipJoint Anteroposterior Radiograph HipJoint:
489
Femur
View of Muscles of HipandThigh:Anterior BonyAttachments Posterior of HipandThigh: of Muscles 49t Bony Attachments View View Views Anterior 492 Muscles ofThigh: (continued) Views 493 Muscles ofThigh:Anterior
490
Lateral View Muscles ofHipandThigh: Views Posterior 495 Muscles ofHipandThigh: Muscles 496 Psoas andlliacus 494
497
Plexuses andCoccygeal Lumbosacral
498
Lumbar Plexus
Plexuses andCoccygeal Sacral Views ofThigh:Anterior 500 Arteries andNerves (continued) Views ofThigh:Anterior 501 Arteries andNerves 499
502
View Posterior ofThigh: Arteries andNerves
Nerves of HipandButtock Head andNeck of Femoral 504 Arteries Cross Sections 505 Thigh: Serial 503
Atlas of ]luman Anatomy
Lower Limb Knee
szz Ligaments andTendons ofAnkle
Platec 506-512
sza Ligaments andTendons Plantar ofFoot: View
soe Knee: Lateral andMedialViews
Sheaths szg Tendon ofAnkle
soz Knee: AnteriorViews
sso Muscles of Dorsum ofFoot:Superficial Dissection
sos Knee: lnterior
ssr Dorsum ofFoot: Deep Dissection
Ligaments sog Knee: andCollateral Cruciate
ssz SoleofFoot: Superficial Dissection
Radiograph sro Knee: Anteroposterior
ses Muscles ofSoleofFoot: FirstLayer
st r Knee: Posterior Views andSagittal
sse Muscles ofSoleof FootSecond Layer
andKnee: Schema sr z Arteries ofThigh
sss Muscles ofSoleofFoot:Third Layer sse Interosseous Muscles Arteries andDeep of Foot
Leg
ssz Interosseous Muscles of Foot
Pfates 513-622
srs Tibia andFibula (continued) srr TibiaandFibula
Neurovasculature Plates 538-546
srs Attachments ofLeg ofMuscles View Dissection): Posterior sre Muscles of Leg(Superficial
sse Femoral Nerve andLateral Femoral Cutaneous Nerve
View Dissection): Posterior sr z Muscles ofLeg(lntermediate Dissection): Posterior View sre Muscles ofLeg(Deep
Nerve slo Sciatic andPosterior Femoral Cutaneous Nerve
View Dissection):Anterior srg Muscles ofLeg(Superficial Dissection):Anterior szo Muscles View ofLeg(Deep
(Peroneal) Fibular sez Common Nerve
szr Muscles ofLeg:LateralView
Nerves ss Superficial andVeins ofLower Limb:Anterior View
szz Leg:Cross andFascial Compartments Sections
ses Superficial Nerves andVeins of Lower Limb: Posterior View
Nerve sos 0bturator Nerve ser Tibial ses Dermatomes ofLower Limb
*e
Vessels Lymph andNodes of Lower Limb
Ankle and Foot Plates 523-537
Regional Scans
szs Bones of Foot szl Bones of Foot(continued)
Plate 547
szs Calcaneus szs Ankle: Radiographs
Atlas of Human Anatomy
scz CTAngiograms ofArteries of theLowerLimb
Lower Limb Posteriorview
Anterior view
l l i a cc r e s t Cluteus medius
l l i a cc r e s t Anterior s u p e r i o ri l i a
MUSCIE
spn re
Inguinal ligament
T e n s o rf a s c i a e l a t a em u s c l e
S a r t o r i u sm u s c l e
muscle
Creater trochanter of femur
Cluteal fold
Vastus l a t e r a l i sm u s c l e R e c t u sf e m o r i s
Cluteus maxrmus muscle
Creat s a p h e n o us vetn
Semitendinosus
muscle Adductor maSnus
muscre Vastus medialis MUSCIE
C racilis tenoon l l i o t i b i a tl r a c t
F i b ul ar i s (peroneus) l o n g u sm u s c l e
R e c t u sf e m o r i s t e n d o n( b e c o m i n g p a r to f q u a d r i c e p s Creat f e m o r i st e n d o n ) saphenous vern Patella
B i c e p sf e m o r i s muscle L o n gh e a d Short head
Popliteal fossa
P a t e l l a lri g a m e n t T i b i a lt u b e r o s i t y Creatsaphenous vetn
Castrocnemius muscte M e d i a lh e a d Lateralhead
Tibialis a n t e r i om r uscle A n t e r i o rb o r d e r of tibia
Small sapnenous vetn
Calcaneal tendon
L a t e r aml a l l e o l u s
Fibularis ( p e r o n e u s l)o n g u s a n d b r e v i st e n d o n s
Medial malleolus M e d i a lm a l l e o l u s
E x t e n s o dr i g i t o r u m l o n g u st e n d o n s
P l a n t a rs u r f a c e of foot
L a t e r am l alleolus Calcaneal tuberosity
6ryd4/*
Topographic Anatomy
Plate 485
Hip lGoxalf Bone Lateralview
Intermediate ron" ) -Tuberculum ) lliaccrest --Outerlip )
Posterior
(ala)of ilium (glutealsurface)
Posterior superior iliacspine
superioriliacspine Anteriorinferioriliacspine
Posterior inferior iliac lum Lunatesurface Margin(limbus)of acetabulum Acetabularnotch
Creatersciaticnotch
pubicramus
Bodyof ilium lschialspine
*{r
tubercle
Lesser sciatic Bodyof ischium
Obturatorcrest ior pubicramus
lschialtuberosity
Ramusof ischium
Anteriorsuperioriliacspine Wing (ala)of ilium (iliacfossa) Anteriorinferioriliacspine
surface (for sacrum)
Arcuateline l l i o p u b i ce m i n e n c e Superiorpubicramus Pectenpubis (pectinealline) Pubictubercle
inferior iliacspine Creatersciaticnotch sprne of ilium Lessersciaticnotch
Symphyseal surface
f
llium
I
lschium
f
eutis
Plate 486
of ischium Obturatorgroove Inferiorpubicr
lschialtuberosity Ramusof ischium
Hip and Thigh
Hip Joint
Anteriorview l l i o f e m o r a l i g a m e n t( Y l i g a m e n to f B i S e l o w ) lliopectinealbursa (over gap in ligaments)
Anterior
\\
supenor i l i a cs p i n s -
P u b o f e m o r alli g a m e n t
Obturatorcrest
A n t e r i o ri n f e r i o r i l i a cs p i n e
S u p e r i opr u b i cr a m u s
Creater trochanter
Posteriorview l l i o f e m o r al i a g m e n t l s c h i o f e m o r al li g a m e n t Zonaorbicularis
Creater trochanter Lessertrochanter lschial tuberosity
Protrusion of synovial memDrane
l n t e r t r o c h a n t e r ilci n e
\ n te rtrochan teric crest
HlJ"iliJ;o' b
Lessertrochanter
A n t e r i o rs u p e r i o ri l i a cs p i n e L u n a t e( a r t i c u l a r ) surfaceof acetabulum
A n t e r i o ri n f e r i o ri l i a cs p i n e l l i o p u b i ce m i n e n c e A c e t a b u l a rl a b r u m( f i b r o c a r t i l a g i n o u s )
A r t i c u l a rc a r t i l a g e
Fatin acetabularfossa (covered by s y n o v i am l embrane)
Creater trochanter
Obturatorartery A n t e r i o rb r a n c h Posteriorbranch Acetabularbranch
Headof Neckof femur
O b t u r a t o rm e m b r a n e
lntertrochanteric line L i g a m e n to f h e a do f f e m u r
(cut)
Hip and Thigh
Transverseacetabularligament l s c h i a tl u b e r o s i t y
4{ry
Lessertrochanter
Plate 487
Hip Joint: Anteroposterior Radiograph
A F G H I lC It lT L N O P
Plate 488
Acetabulum Femur Greatertrochanter Headof femur lschium Intertrochanteric crest llium lschialtuberosity Lessertrochanter Neck Obturatorforamen P u b i s( s u p e r i orra m u s )
Hip and Thigh
Femur
Anteriorview Creater trochanter
Neck
Intertrochanteric crest
trochanter Lesser Pectinealline Cluteal tuberosity
Shaft(body) Lineof attachment of borderof synovialmembrane Lineof reflection of synovialmembrane Lineof attachment of fibrouscapsule Lineof reflectionof fibrous capsule(unattached) Poplitealsurface
4{F Adductortubercle
Lateralepicondyle
Lateralcondyle
Hip and Thigh
Lateralepicondyle
Patellar surface
fossa Intercondvlar
Plate 489
Bony Attachments of Muscles of Hip and Thigh: Anterior View
lliacum s uscle
Origin of psoasmajor muscle from sidesof vertebralbodies, intervertebraldiscs,and transverseprocesses (J'l 2-L4)
#: ",,
Sartorius Piriformm isuscle
Rectusfemorismuscl
Pectineus muscle
Obturatori and superiorand inferior g e m e l l u sm u s c l e s
Adductorlongusmuscle
Piriformis muscle
Adductorbrevismuscle
C l u t e u sm i n i m u s
racilismuscle
Vastuslateralis mu
Obturatorexternusmuscle
l l i o p s o a sm u s c l e Vastusmedialismu
A d d u c t om r a g n u sm u s c l e femorismuscle Quadratus
Vastusintermedius muscle
I I
Origins Insertions
Articularis genusmuscle u c t o r m a g n u sm u s c l e
lliotibialtract
Bicepsfemorismuscle Quadricepsfemoris muscle (rectus femoris, vastuslateralis, vastusintermedius/ and vastusmedialis via patellarligament)
Plate 49O
Pesanserinus
4{tr Hip and Thigh
Bony Attachments of Muscles of Hip and Thigh: Posterior View
C l u t e u sm e d i u sm u s c l e C l u t e u sm i n i m u sm u s c l e Tensor fasciaelatae muscte C l u t e u sm a x i m u sm u s c l e
S a r t o r i u sm u s c l e R e c t u sf e m o r i sm u s c l e
s uscle S u p e r i ogr e m e l l um
Obturatorexternusmuscle
s uscle I n f e r i ogr e m e l l um
C l u t e u sm e d i u sm u s c l e
' Q u a d r a t ufse m o r i sm u s c l e
Q u a d r a t ufse m o r i sm u s c l e
l l i o p s o am s uscle
O b t u r a t o ri n t e r n u sm u s c l e A d d u c t o r m a g n u sm u s c l e B i c e p sf e m o r i s( l o n g h e a d ) a n d s e m i t e n d i n o s um s uscles
s uscle C l u t e u sm a x i m u m a s t u sl a t e r a l i sm u s c l e A d d u c t o r m a g n u sm u s c l e
S e m i m e m b r a n o s um s uscle uctor brevis muscle
Pectineusmuscle
I I
V a s t u sm e d i a l i sm u s c l e
V a s t u si n t e r m e d i u sm u s c l e B i c e o sf e m o r i sm u s c l e( s h o r th e a d )
Origins lnserlions
A d d u c t o r l o n g u sm u s c l e
d u c t o r m a g n u sm u s c l e V a s t u sl a t e r a l i sm u s c l e
Plantarim s uscle A d d u c t o r m a g n u sm u s c l e C a s t r o c n e m i u sm u s c l e( l a t e r a hl e a d ) C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d )
muscte
S e m i m e m b r a n o s um s uscle
P o p l i t e u sm u s c l e
Note: Width of zone of attachmentsto posterioraspect o f f e m u r ( l i n e aa s p e r a )i s g r e a t l ye x a g g e r a t e d .
Hip and Thigh
4{tr Plate 491
Muscles of Thigh: Anterior Views
A n t e r i osr u p e r i oirl i a cs p i n e A n t e r i o rs u p e r i o ri l i a cs p i n e
l i a c u sm u s c l e
S a r t o r i um s u s c l e( o r i g i n )
majormuscle
Anteriorinferior i l i a cs p i n e
C l u t e u sm e d i u sm u s c l e I n g u i n al i g a m e n t
ments of hip joint
Pubictubercle
Pectineus muscte
Tensorfasciaelatae muscle Pectineusmuscle Tensorfasciaelatae muscle (origin R e c t u sf e m o r i sm u s c l e( o r i g i n ) Creater trochanter l l i o p s o a sm u s c l e( c u t )
A d d u c t o lro n g u sm u s c l e racilim s uscle Sartorius muscle Rectusfemorismuscle* Vastuslateralis muscle* Vastusintermedius muscle* 'astus medialismuscle" lliotibialtract Rectusfemoris tendon (becoming part of quadricepsfemoris tendon) Lateralpatellarretinaculum Patella M e d i a l p a t e l l a rr e t i n a c u l u m
Anteromedial intermuscular
septum
Patellarligament Sartoriustendon C r a c i l i st e n d o n S e m i t e n d i n o s utse n d o n Tibial tuberosity
P e sa n s e r i n u s l l i o t i b i a tl r a c t ( c Rectusfemoris tendon Quadricepsfemoris I Lateralpatellarretinaculum Medial patellarretinaculum
4{tr
Head of fibula P a t e l l a lri g a m e n t Tibial tuberosity
Sartorius tendon
* M u s c l e so f q u a d r i c e p sf e m o r i s
Plate 492
Hip and Thigh
Muscles of Thigh: Anterior Views (continuedl
Deepdissection Pectineusmuscle (cut and reflected\ A n t e r i o rs u p e r i o ri l i a c
S u p e r i orra m u so f p u b i s
A n t e r i o ri n f e r i o ri l i a cs o i
tor longusmuscle(cutand reflected) L i g a m e n t so f h i p j o i n t Creater trochanterof femur
l l i o p s o am s u s c l e( c u t ) P e c t i n e ums u s c l e
ctor brevismuscle(cut)
P u b i ct u b e r c l e
C r a c i l im s u s c l e( c u t )
(cut and reflected)
Adductorbrevismuscle (cut and reflected) V a s t u si n t e r m e d i u sm u s c l e
Obturatorexternusmuscle
Q u a d r a t ufse m o r i sm u s c l e
A d d u c t o lro n g u sm u s c l e (cut and reflected)
A d d u c t om r i n i m u sp a r to t A d d u c t om r a g n u sm u s c l e
Femoralarteryandvein p a s s i ntgh r o u g hh i a t u s of adductormagnusmuscle
ingsfor perforating branchesof profunda femoris (deep femoral) artery
V a s t u sm e d i a l i sm u s c l e( c u t ) Rectusfemoris tendon (cut as it becomes part of quadriceps tendon)
Vastuslateralis muscle(
Tendon of adductor magnus muscle insertineon adductor tubercle on medial eoicondvle of femur
Cracilismuscle(cut)
Lateraleoicondvle of femur Tibialcollateralligament
Lateralpatellar F i b u l a rc o l l a t e r alli g a m e n t Head of fibula
P e sa n s e r i n u s
Patellarligament Tibial tuberosity
Hip and Thigh
4{r Plate 493
Muscles of Hip and Thigh: Lateral View
l l i a cc r e s t
Clutealaponeurosis s e d i u sm u s c l e o v e rg l u t e u m
External oblique muscle
Anteriorsuperior i l i a cs p i n e
Sartorius muscle G l u t e u sm a x i m u m s uscle Tensorfasciaelatae muscle
Rectusfemoris muscle
Vastuslateralis muscle
l l i o t i b i at rl a c t
Lateralcondvle of tibia and Cerdv's tubercle S e m i m e m b r a n o s um s uscle
Lateralpatellarretinaculum Fibularcollateralligament
Plantaris muscle tensordigitorumlongusmuscle Gastrocnemius muscle(lateralhead)
Head of fibula
F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e
Plate 494
Patellar ligament
T i b i a l ias n t e r i om r uscle
*{r
Hip and Thigh
Muscles of Hip and Thigh: Posterior Views Forpiriformis andobturator internus seealsoPlates356,357;For
seePlate
Superficialdissection
C l u t e a la p o n e u r o s i so v e r
C l u t e u sm e d i u sm u s c l e C l u t e u sm i n i m u sm u s c l e s uscle C l u t e u sm a x i m u m Piriformis muscle Sciaticnerve S a c r o s p i n o ulsi g a m e n t S u p e r i o rg e m e l l u sm u s c l e O b t u r a t o ri n t e r n u sm u s c l e l n f e r i o rg e m e l l u sm u s c l e Sacrotuberousligament
femorismuscle Quadratus lschialtuberosity Semitendinosusmuscle Creater trochanter B i c e p sf e m o r i sm u s c l e{ l o n g h e a d ) Adductor minimus part of Adductor magnus muscle
S e m i m e m b r a n o smuuss c l e l l i o t i b i a tl r a c t C r a c i l i sm u s c l e
B i c e p fse m o r i sm u s c l e S h o r th e a d Long head S e m i m e m b r a n o s um s uscle S e m i t e n d i n o s um s uscle Poplitealvesselsand tibial nerve ) erve C o m m o n f i b u l a r( p e r o n e a l n
tarismuscle C a s t r o c n e m i u sm u s c l e M e d i a lh e a d Lateralhead Sartoriusmuscle Popliteusmuscle T e n d i n o u sa r c h o
Soleum s uscle Plantaris tendon(cut
Hip and Thigh
Plate 495
Psoas and lliacus Muscles SeealsoPlate 263
Q u a d r a t ulsu m b o r u m muscle
1 2 t hr i b
'l
l l i o i n g u i n anl e r v e
Origin of psoas major musclefrom vertebral bodies,transverse procesSes/ ano intervertebraldiscs $12-L4) and origin of psoas minor muscle from vertebralbodies ( T 1 2 ,L 1 )
P s o a sm i n o r muscte
L u m b a rp l e x u s
T 1 2\
Transversus abdominis muscle (cut)
[1 lliohypogastricnerve
Psoasmajor muscte
umbosacral trunk Cenitofemoral nerve lliac crest
Lateralfemoral cutaneousnerve
Anteriorsuperior i l i a cs p i n e
l l i a c u sm u s c l e Femoralnerve
lliopectinealbursa
S u p e r i opr u b i cr a m u s Creatertrochanter
lliofemoral l i g a m e n to f hipjoint (Y ligament of Bigelow)
of femur
lliopsoasmuscle passesbackward to insertionon lessertrochanter
Shaft(bodv)of femur
Abductors ( g l u t e um s edius and m r n t m ums u s c l e s )
Note: Arrows indicate direction of action of ilioosoasmuscle.
Adductors
Plate 496
4{r Hip and Thigh
Lumbosaeral and Goccygeal Plexuses
.l Intercostalnerve (T1 )
f
-1:::
Anteriordivision Posteriordivision
Subcostal nerve(T12 lliohypogastricnerve ( T 1 2 ,L 1 )
Sympathetictrunk
l l i o i n g u i n anl e r v e ( L l )
To psoasmajorand osoasminormuscles ,) C e n i t o f e m o r a nl e r v e( 1 1 2 Lateralfemoral cutaneous
n e r v e( 1 2 ,3 ) G e n i t a lb r a n c ha n d Femorab l ranch of genitofemoralnerve
Lumbarplexus
To ro psoasmalor major and i l i a c u sm u s c l e s Anterior branches. and\l
;
Lateralbranches and of subcostal iliohypogastricnerves
L u m b o s a c rtar u l nk
*{r
Nerve to quadratus femoris (and inferior g e m e l l u s () 1 4 ,5 , S 1 ) Nerve to obturator
Sacralplexus
i n t e r n u(sa n ds u p e r i o r g e m e l l u s( 1 ) 5 ,S 1 ,2 S u p e r i ogr l u t e a l n e r v e( 1 4 ,5 , S 1) N e r v e t o p i r i f o r m i s( S 1 ,2 O b t u r a t o r n e r v e( L 2 , 3 , 4 l Accessoryobturator nerve ( 1 3 ,4 ) ( i n c o n s t a
I n f e r i ogr l u t e anl e r v e( L 5 ,5 1, 2
)
ao""r*"at plexus
Femoralnerve (12, 3, 4
P e l v i cs p l a n c h n i c nerves
Sciaticnerve
Perforatingcutaneous nerve (S2,3)
Posteriorfemoral c u t a n e o u sn e r v e( S 1 , 2 , Pudendalnerve (S2,3, 4)
Nerve to levator ani and coccygeus(53, 4) Perinealbranch of 4th sacralnerve Anococcygealnerves Obturator nerve lnferior anal (rectal)nerve Dorsal nerve of penis/clitoris
branches scrotal/labial Perineal nerveand Posterior
Hip and Thigh
Plate 497
Lumbar Plexus
Schema
Subcostal nerve
T12
White and gray rami communicantes
lliohypogastric nerve l l i o i n g u i n anl e r v e
Ventral ramiof spinal nerves
Genitofemoralnerve
Lateralfemoral cutaneous nerve Cray rami
M u s c u l abr r a n c h e s to psoasand iliacusmusctes
t5
Femoralnerve Accessoryobturator nerve (often a
Obluratornerve Lumbosacral trunk
I ffi
Anteriordivision Posteriordivision
(cut) Diaphragm
White and gray ramicommunicantes
Subcostal nerve(T12)
Subcostalnerve (T12)
Sympathetic trunk
lliohypogastricnerve l l i o i n g u i n anl e r v e
l l i o h y p o g a s t rniec r v e llioinguina n le r v e Genitofemoralnerve (cut) Lateralfemoral cutaneous
Transversus abdominis
muscre Quadratuslumborummuscle Psoasmajormuscle Cray ramicommunicantes Cenitofemoral nerve
Femoralnerve obturator nerve
Psoasmajormuscle( Lumbosacraltrunks I n g u i n a l i g a m e n t( P o u p a r t ' s )
l l i a c u sm u s c l e Lateralfemoral cutaneousnerve Femoralnerve Cenital branch and Femoralbranch of genitofemoralnerve
Obturatornerve
Nr Plate 498
Hip and Thigh
Sacral and Goccygeal Plexuses
Schema I
Anterior division
f
Posteriordivision
trunk Lumbosacral
Gray rami communicantes
sl Superiorglutealner lnferiorgluteal
S2
nerves Pelvicsplanchnic (parasympathetic to inferiorhypogastric lpelviclplexus)
Nerveto oiriformis
Tibial nerve Coccygeal nerve
Commonfibular
Anococcygealnerve branchof 4th sacralnerve Perineal
(peroneal)
to levator ani and
(ischiococcygeus) muscles coccygeus nerve Pudendal g cutaneousnerve Perforatin Nerveto obturatorinternus(andsuperiorgemellu's)
nerve femoralcutaneous Posterior
4{F
trunk Sympathetic trunk Lumbosacral
Gravramicommunicantes
Psoasmaiormuscle Superiorglutealarteryand nerve Obturatornerve lliacusmuscle
splanchnic nerves(cut) (parasympathetic to inferior hypogastric lpelviclplexus)
Inferiorglutealartery Nerveto ouadratus
Nerveto obturatorinternus Pudendalnerve
Obturatorinternusmuscle, Superiorpubicramus Piriformis muscle (ischiococcygeus) muscle Coccygeus Nerve to levatorani muscle
Levatorani
Topography:medialand slightlyanteriorview of hemisectedpelvis
Hip and Thigh
I splanchnic nerves(cut) (sympathetic to inferior hypogastric lpelviclplexus)
Plate 499
Arteries and Nerves of Thigh: Anterior Views SeealsoPlate 538
A n t e r i o rs u p e r i o ri l i a cs p i n e Lateralfemoral cutaneousnerve I n g u i n al i g a m e n t l l i o p s o a sm u s c l e
Superficial dissections Lateralfemoral cutaneousnerve (cut) Tensorfasciaelatae muscle (retracted)
Cluteus mtntmus
Superficialcircumflex i l i a cv e s s e l s
Sartorius muscle(cut) lliopsoasmuscle
and medius
Superficial epigastric vessels
muscres
Superficialand Deep external p u d e n d a lv e s s e l s
Pectineus muscre
Lateral circumflex femoral artery Rectus femoris
Vastus lateralis muscle Vastus medialis muscle Femoral sheath
Pectineus muscle ofunda femoris (deep femoral) artery
Adductor longus muscle Sartorius muscle
Vastusmedialis muscle
Saphenous n e r v ea n o sapnenous branch of descending genicula
artery Articularbra of descending genicularartery (emergesfrom v a s t u sm e d i a l i s muscle)
Fascialata (cut) Rectusfemoris muscle Vastuslateralismuscle Tensorfasciaelatae muscle
Plate 5OO
*{r
u n d af e m o r i s (deep femoral) artery Adductor l o n g u sm u s c l e Adductor canal ( o p e n e db y removal of sartorius muscle) Saphenous nerve
Femoralnerve, artery,and vein
Cracilis muscle
Femoralnerve, artery,and vetn
Patellar anastomos Infrapatellar branch of S a p h e n o u sn e r v e
Nerve to vastusmedialis muscte Adductor magnus muscle
Anteromedial intermuscular septum covers entranceof femoralvessels to poplitealfossa (adductorhiatus) Sartorius muscle (cut) S u p e r i o rm e d i a l genicular artery (from popliteal artery) I n f e r i o rm e d i a l genicular artery (from popliteal artery)
Hip and Thigh
Arteries and Nerves of Thigh: Anterior Views (continuedf
Deepdissection Externaliliac artery and vein
Deep circumflex iliac artery
Inguinalligament (Poupart's)
Lateralfemoral c u t a n e o u sn e r v e
Femoralartery and vein (cut)
Sartorius muscle(cut)
Pectineus muscle(cut)
l l i o p s o a sm u s c
Obturatorcanal Tensorfasciaelatae muscle (retracted)
Obturatorexternusmuscle
C l u t e u sm e d i u sa n d
Adductorlongusmuscle(cut)
m i n i m u sm u s c l
Anterior branch and ior branch of
Femoral
obturatornerve Rectusfemoris muscle
femorismuscle Quadratus
Ascending,transverseand d e s c e n d i n gb r a n c h e so f
Adductorbrevismuscle
Lateralcircumflex femoralar
of posteriorbranch Branches of obturatornerve
Medial circumflexfemoral artery Pectineusmuscle (cut
r magnusmuscle
Profundafemoris(deepfemoral)artery
C r a c i l im s uscle
Perforatingbranches
utaneousbranch of obturator nerve
A d d u c t o lro n g u sm u s c l e( c u t )
Femoralartery and vein (cut)
V a s t u sl a t e r a l im s uscle Descendinggenicularartery
Articularbranch S a p h e n o ubsr a n c h
Vastusintermediusmuscle
Rectusfemorismuscle(cut)
A d d u c t o hr i a t u s
S a p h e n o u sn e r v
muscle(cut) Sartorius
Anteromedialintermuscular septum (opened)
magnustendon Adductor tubercle on medial eoicondvle of femur
Vastusmedialismuscle Quadricepsfemoris tendon
Superiormedial genicularartery (from poplitealartery)
Patellaand patellar anastomosis
Nr
Infrapatellarbranch of Saphenousnerve
Medialpatellarretinaculu l------
Hip and Thigh
Inferior medial genicularartery (from popliteal artery)
Plate 5Ol
Arteries and Nerves of Thigh: Posterior Views Seealm Pfatc 310
l l i a cc r e s t S u p e r i o rc l u n i a ln e r v e s Gluteus maximus muscle (cut) M e d i a l c l u n i a ln e r v e s Inferior glutealartery and nerve
C l u t e a la o o n e u r o s i sa n d gluteusmedius muscle (cut) Superiorglutealartery and nerve t e u sm i n i m u sm u s c l e Tensorfasciaelatae muscre
Pudendan l erve
Piriformm isuscle Nerve to obturator internus
( a n ds u p e r i ogr e m e l l u s )
C l u t e u sm e d i u sm u s c l e( c u t ) s uscle S u p e r i ogr e m e l l um
Posteriorfemoral culaneous nerve
Greatertrochanter of femur Sacrotuberouslieament
lschialtuberosity Inferiorclunialnerves(cut) A d d u c t o r m a q n u sm u s c l e C r a c i l i sm u s c Sciaticnerve Muscular branchesof sciaticnerve Semitendinosusmuscle (retracted) S e m i m e m b r a n o s um s
Sciaticnerve A r t i c u l abr r a n c h
Obturatorinternusmuscle lnferiorgemellusmuscle uteus maximus muscle (cut) Quadratusfemoris muscle Medial circumflexfemorar artery Vastuslateralismuscle and iliotibialtract A d d u c t o r m i n i m u sp a r t o f adductor magnus muscle .l st perforating artery (from profunda femoris artery) A d d u c t o r m a g n u sm u s c l e 2nd and 3rd perforatingarteries (from profunda femoris artery)
Adductorhiatus P o p l i t e avl e i n a n d a r S u p e r i o rm e d i a lg e n i c u l a ra r t e r y Medial epicondyle of femur T i b i a ln e r v e Castrocnemiusmuscle (medial head) Medial suralcutaneousnerve
*{ry Plate 5O2
S m a l ls a o h e n o u sv e i n
4th perforatingartery (from profunda femoris artery) Long head (retractecl)| ,,."0, femoris muscle Short head J S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y Common fibular (peroneal)nerve Plantarim s uscle Castrocnemiusmuscle (lateralhead) Lateralsuralcutaneousnerve
Hip and Thigh
Nerves of Hip and Buttock
lliac crest
Cluteusmaximusmuscle(cut) C l u t e u sm e d i u sm u s c l e( c u t ) Superiorglutealnerve C l u t e u sm i n i m u sm u s c l e Sciaticnerve
formismuscle Inferior gluteal nerve
s uscle S u p e r i ogr e m e l l um Posteriorfemoral culaneous nerve Tensorfasciaelatae muscle
Nerve to obturator internus ( a n d s u p e r i o rg e m e l l u s )
C l u t e u sm e d i u s muscle(cut)
Pudendalnerve l s c h i a sl p i n e
Sacrospinous
e to quadratus
ligament
femoris (and inferior gemellus) supplying articularbranch to hipjoint
Perforating cutaneousnerve
Sacrotuberous ligamentGreater trochanter of femur
I n f e r i o ra n a l (rectal)nerve
Intertrochanteric crest
Dorsal nerve of penis
Inferiorgemellus muscle
Perineal nerve
femoris Quadratus muscle
Posterior scrotal
C l u t e u sm a x i m u s muscle(cut)
P e r i n e abl r a n c h e s of posteriorfemoral cutaneous
Sciaticnerve l s c h i a tl u b e r o s i t y
S e m i t e n d i n o sm uu s scle B i c e p fse m o r i sm u s c l e( l o n gh e a d ) (coverssemimembranosus muscle)
Hip and Thigh
Posteriorfemoral cutaneousnerve
I n f e r i ocr l u n i anl e r v e s
4{tr Plate 5O3
Arteries of Femoral Head and Neck SeealsoPlate 512 Posteriorview
Anteriorview AcetabuJar branchof obturator artery (often minute)
Retinacular Superior I artefles I Anterior (subsynoviall ( lnferior
Superior Posterior lnferior
I
Anastomosis betweenmedial and lateral circumflex femoral arteries
Retinacular arteries (subsynovial) nastomosrs
lschiofemoral ligamentand joint capsule
lliofemoral(Y) ligamentand joint capsule
Medial circumflex femoral artery
tendon Medial circumflex femoral artery
Ascending, Transverse, Descending branchesof Lateralcircumflex
Profunda femoris (deepfemoral) artery
Lateral circumflex femoral artery'
Nutrientartery of femur
femoralartery Nutrientartery of femur
Coronal section
Medial circumflex femoral artery
Acetabular labrum Ligamentsand joint capsule1
Retinacular
muscre
Anastomosis
Femoral artery
Lateralcircumflex femoral artery Ascending, Transverse, Descending branches
Pectineus muscte
Acetabular branch Obturator artery
Medial circumflex femoral artery Profundafemoris (deepfemoral) artery Medial circumflexfemoralartery lliopsoastendon Lateralcircumflexfemoral artery
4{N
Femur of child: anterior view
Plate 5O4
Hip and Thigh
Thigh: Serial Gross Sections
S a r t o r i um suscle Profundafemoris (deep femoral) artery and vein Pectineus
lliopsoas
Fascialata Branchesof femoral nerve Femoralartery and vein
Adductorlongusmuscle Creat saphenousvein
Rectusfemorismuscle
Obturatornerve(anteriorbranch)
V a s t u sm e d i a l i s
Adductorbrevismuscle
Lateralfemoralcutaneous
Obturatornerve (posteriorbranch)
V a s t u si n t e r m e d i u s
C r a c i l im s uscle Vastuslateralis
A d d u c t om r a g n u sm u s c l e
Tensorfasciaelatae muscre
Sciaticnerve
l l i o t i b i a tl r a c t
femoral Posterior nerve cutaneous
C l u t e u sm a x i m u sm u s c l e
S e m i m e m b r a n o smuuss c l e S e m i t e n d i n o sm u su s c l e Bicepsfemoris muscle (long head)
Vastusmedialism Rectusfemoris muscle V a s t u si n t e r m e d i u sm u s c l e
i n t e r m u s c u lsaer p t u mo f t h i g h muscle Sartorius
Vastuslateralis muscle in adductor canal
lliotibialtract Lateralintermuscular
septumof thigh Biceps { S h o r th e a d temons I muscle ( Long head
Creat saphenousvein
Adductorlongusmuscle Cracilismuscle
S e m i t e n d i n o s um s uscle S e m i m e m b r a n o s um s uscle
Adductorbrevismuscle femoris (deep femoral) artery
A d d u c t om r a q n u sm u s c l e Rectusfemoris tendon V a s t u si n t e r m e d i u sm u s c l e l l i o t i b i a tl r a c
septumof thigh intermuscular Posterior Sciaticnerve V a s t u sm e d i a l i sm u s c l e
Vastuslateralis
muscle Sartorius
A r t i c u l a rg i se n u sm u s c l e
genicular artery aphenousnerveand descending
Lateralintermuscular septumof thigh Fem Bicepsfemoris muscle Common fibular (peronealn ) erve Tibial nerve
Hip and Thigh
Creat saphenousvein
C r a c i l im s uscle AdductormaBnustendon Poplitealvein and artery
Nr
S e m i m e m b r a n o s um s uscre Semitendinosusmuscle
Plate 5O5
Knee: Lateral and Medial Views
Lateral view
Vastuslateralis muscle
lliotibialtract femoristendon Quadriceps
Bicepsfemoris { Lone head
muscle
I Snoitneao
Bursadeep to iliotibialtr
Patella
F i b u l a rc o l l a t e r alli g a m e n t and bursa deep to it---
Plantaris muscle
Lateralpatellarretinaculum
Bicepsfemoris tendon and its
inferiorsubtendinous bursa
Jointcapsuleof knee
C o m m o nf i b u l a r (peroneal) nerve P a t e l l a lri g a m e n t Head of fibula
Castrocnemius muscle
Tibialtuberosity
Soleum s uscle F i b u l a r (i sp e r o n e u s ) l o n g u sm u s c l e
Tibialisanterior muscle
Medialview Sartorius muscle
Vastus medialis muscle Quadricepsfemoris tendon
Cracilim s uscle Tendon of semitendinosusmuscle anosusmuscle and tendon
Medialepicondyle of femur
A d d u c t om r a g n u tse n d o n Parallel - . . - fibers --) Tibial ) collateral Obliquefibers ligament )
Medialpatellarretinaculum
Nr
Patellarli
Semimembranosus DUrSa Anserinebursa deep to Semitendinosus, l Pes C r a c i l i s a, n d ) anseflnus Sartoriustendons )
Castrocnemim u su s c l e T i b i atlu b e r o s i Soleusmuscle
Plate 506
Knee
Knee: Anterior Views Rightknee in extension Femur muscle Vastusintermedius
genusmuscle Articularis
Vastuslateralis muscle Vastusmedialismuscle
lliotibialtract Lateralpatellarretinacul
Rectusfemoristendon(becoming femoristendon) quadriceps
Lateralepicondyleof femur
Patella
Fibularcollateralligament and
Medialepicondyleof femur
Bicepsfemoris tendon and its
Medialpatellarretinaculum
inferiorsubtendinous
ligament Tibialcollateral
Broken line indicates bursa deep to iliotibialtract
Pes ansennus
Insertionof iliotibialtract to Cerdy's t u b e r c l ea n d o b l i o u el i n e o f t i b i a ) erveC o m m o n f i b u l a r( p e r o n e a l n
A n s e r i n be u r s a
Head of finut.-=}
Medialcondyleof tibia
(peroneus) longusmuscle Fibularis
ligament Patellar
digitorumlongus Extensor
Tibialtuberosity
T i b i a l ias n t e r i om r uscle
muscle Castrocnemius
foint opened, kneeslightlyin flexion (synovial) bursa Suprapatellar genusmuscle Articularis Synovialmembrane (cut edge
Cruciate ligaments(covered by synovialmembrane)
Medial condyle of femur
Lateralcondyle of Infrapatellarsynovialfold Origin of popliteustendon (covered by synovialmembrane
M e d i a lm e n i s c u s
recess Subpopliteal Alar folds (cut) Lateralmeniscus Fibularcollateralligament Head of fibula
Infrapatellarfat pads (lined by synovialmembrane)
Suprapatellar(synovial)bu rsa (roof re flected)
(articular surface Patella on posterioraspect)
Vastuslateralis muscle (reflected i nferiorly\
Knee
Vastus medialis muscle (reflected inferiorly)
4{r Plate 5O7
Knee: Interior
lnferior view P a t e l l a lri g a m e n t
l l i o t i b i a tl r a c t b l e n d e di n t o l a t e r a l p a t e l l a rr e t i n a c u l u ma n d c a p s u l e
patellarrelinaculum Yedial b l e n d e di n t o j o i n t c a p s u l e
, --------
Bursa
S u p r a p a t e l l asry n o v i a b l ursa
Subpopliteal
S y n o v i am l e m b r a n e( c u t e d g e ) P o p l i t e u st e n d o
I n f r a p a t e l l asry n o v i a fl o l d '---
ri
Posterior cruciaIe ligamenl
p-Iibi al col la.tera| |igament (superlicia d ln d d e e p p a r l s ) l' L . r t e r acl o n d y l eo f f e m u r
M e d i a l c o n d y l eo f f e m u r
A n t e r i o rc r u c i a t el i g a m e n t
Obliquepopliteal igament
A r c u a t ep o p l i t e a l i g a m e n t
S e m i m e m b r a n o s ut se n d o n Posterior aspect Superior view --- .-
P o s t e r i om r e n i s c o f e m o r al lig a m e n t
semimembranosustendon Obliquepopliteal igament
A r c u a t ep o p l i t e a l i g a m e n t
Posteriorcruciate ligament T i b i a lc o l l a t e r alli g a m e n t ( d e e pp a r t b o u n d t o m e d i a lm e n i s c u s )
P o p l i t e u st e n d o n
M e d i a lm e n i s c u s
S u b p o p l i t e arle c e s s
S y n o v i am l embrane
L a t e r am l eniscus
S u p e r i o ra r t i c u l a rs u r f a c e
S u p e r i o ra r t i c u l a sr u r f a c e o f t i b i a ( l a t e r afl a c e t )
\.:l'l:;Jffdia'|fa'ce,
l l i o t i b i a tl r a c t b l e n d e di n t o c a p s u l e
A n t e r i o rc r u c i a l el i g a m e n t
I n f r a p a t e l l af ra t p a d
P a t e l l a lri g a m e n t
ani".io, aspectI S u p e r i o r v i e w : l i g a m e n t sa n d c a r t i l a g er e m o v e d A t t a c h m e n to f p o s t e r i o rc r u c i a t el i g a m e n t
A l t a rh m e n t o f s y n o v i a m l embrane---r-_
S u p e r i o ra r t i c u l a rs u r f a c e o f t i b i a( l a t e r afl a c e t )
A t t a c h m e n t so f h o r n s o f l a t e r a lm e n i s c u s
In t e r c o n d y l aer m i n e n c e A t l a c h m e nol I s y n o v i am l embrane S u p e r i o ra r t i c u l a sr u r f a c e o f t i b i a ( m e d i a lf a c e t ) A t t a c h m e n to f a n t e r i o r c r u c i a t el i g a m e n t
A t t a c h m e n t so f h o r n so f m e d i a lm e n i s
T i b i atl u b e r o s i t y
Plate 5O8
Nr Knee
Knee: Gruciate and Gollateral Ligaments
Right knee in flexion: anterior view Posterior cruciateligament
Anteriorcruciate Lateralcondvleof femur(articular
surface) Medialcondyleof femur(articular
surf Medialmeniscus
Popliteus tendon Fibularcollateral ligament
ligament collateral
Medialcondyleof tibia
Lateralmeni Transverse ligamentof
'Tibialtuberosity
Headof fibu
Right knee.inextension: posteflor vlew
Cerdv'stubercle
Posteriorcruciateligament Anteriorcruciateligament Posteriormeniscofemoral ligament
Adductortubercleon medialepicondyleof
Lateralcondyleof femur (articular surface)
Medialcondyleof femur(articular surface)
Popliteustendon Medialmeniscus Fibularcollateral ligament ligament Tibialcollateral Lateralmeniscus Medialcondyleof ti
of fibula
4{tr Knee
Plate 5O9
Knee: Anteroposterior Radiograph
F FE HF ICE L l-CF
Fibula Femur Head of fibula Intercondylareminence L a t e r ael p i c o n d y l e
Lateralcondyle of femur tCT Lateralcondyle of tibia M M e d i a le p i c o n d y l e M C F M e d i a lc o n d y l eo f f e m u r M C T M e d i a l c o n d y l eo f t i b i a P Patella T
Plate 5l O
Tibia
Knee
Knee: Posterior and Sagittal Views
Rightknee: Femur(poplitealsurface) A d d u c t o r m a g n u st e n d o n
Attachment of joint capsule
Medial head of gastrocnemrus m u s c l ea n d s u b t e n d i n o u sb u r s a
Plantarismuscle Lateralhead of gastrocnemiusmuscle a n d s u b t e n d i n o u sb u r s a
T i b i a lc o l l a t e r alli g a m e n t S e m i m e m b r a n o s ut se n d o n
F i b u l a rc o l l a t e r alli g a m e n t and its inferior S u b t e n d i n o u sb u r s a
Obliquepopliteal igament ( t e n d i n o u se x p a n s i o no f s e m i m e m b r a n o s um s uscle)
Biceosfemoris tendon and bursa beneath it
S e m i m e m b r a n o s ubsu r s a deep to tendon (broken line
Arcuate popliteal ligament (edge of capsulethat arches o v e r p o p l i t e u sm u s c l e )
Popliteusmuscle
Headof fibula Posteriorligament of f i b u l a rh e a d Attachment of joint capsule
Femur
Articularis S e n u sm u s c l e
Interosseousmembrane Tibia
Quadriceps femoristendon
Lateral subtendinous bursaof
S u p r a p a t e l l(asry n o v i abl )u r s a Patella
gastrocnemius muscte
S u b c u t a n e o up s r e p a t e l l abr u r s a Articularcavity S y n o v i am l embrane P a t e l l a lri g a m e n t Synovial memDrane
Infrapatellarfat pad
infrapatellar bursa Subcutaneous D e e p( s u b t e n d i n o ui ns f) r a p a t e l lbaur r s a Lateralmeniscus
A r t i c u l acra r t i l a g e s
Tibia
Knee
Tibialtuberosity
*{r
Sagittalsection (lateralto midlineof knee)
Plate 511
Arteries of Thigh and Knee: Schema
Superficial circumflex iliac artery
Superficialepigastricartery Superficialexternalpudendal artery
Femoralartery
Obturator artery Deep externalpudendal artery Medial circumflexfemoral artery
A s c e n d i n gb r a n c h , Transversebranch, Descendingbranch of Lateralcircumflex femoral artery
Profundafemoris (deep femoral)
Femoralartery
Muscularbranches
artery
Perforatingbranches
Femoralartery passing through adductor hiatus Descendinggenicularartery .zArticular branch
S a p h e n o ubsr a n c h S u p e r i om r e d i agl e n i c u l aarr t e r y S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y
Popliteal artery(phantom) Patellaranastomosis Inferior lateralseniculararter (partiallyin phintom) Posteriortibial recurrentartery (phantom\
C i r c u m f l efxi b u l a b rr Anterior tibial a
Nr
Plate 512
I n t e r o s s e om u se m b r a n e
Middlegeniculararrery(phantom) lnferiormedialgenicularartery (partiallyin phantom)
Anteriortibialrecurrentartery Posterior tibialartery(phantom) Fibular(peroneal) artery(phantom)
Knee
Tibia and Fibula
B o n e so f right leg
Anterior i n t e r c o n d y l aar r e a
view Posterior
Anterior view
-lntercondylar eminencel Lateral Medial intercondylar intercondylar
/-lntercondylar eminencel Lateral Medial intercondylar intercondylar tubercle tubercle
tubercle Posterior intercondylar \ area
L a t e r a cl o n d y ' " \ ,
tubercle /___-
Medial condyle
Lateralcondyle
C e r d y ' st u b e r c l e ( i n s e r t i oonf iliotibialtract)
Neck of fibula
Apex, Head, Neck of fibula Croove for insertionof semimembranosus tendon
Tibial Solealine Lateral
Superior articularsurfaces ( m e d i a la n d lateralfacets)
Lateralsurface Nutrient foramen A n t e r i o rb o r d e r
Anterior border..............._
Interosseous
border
Interosseous border
Posterior surface
It
Medial surface
I
Posterior surface
Medial crest
Medial surface M e d i a lb o r d e r
M e d i a lb o r d e r - . Lateralsurface
Tibia
Posterior border
4ftr
Croove for t i b i a l i sp o s t e r i o r a n d f l e x o rd i g i t o r u m l o n g u st e n d o n s F i b u l a rn o t c h
Lateral malleolus
Medial malleolus
Lateral malleolus
malleolus-
\
\
i
{ Y
Articularfacet of lateral malleolus
Leg
lnferior articular surface
r t i c u l a rf a c e to f m e d i a lm a l l e o l u s
Articularfacet of medial malleolus
lnferior articular surface
M a l l e o l a rf o s s a of lateral malleolus
Plate 513
Tibia and Fibula (continuedl
Anteriorview with ligamentattachments lliotibialtract
Superiorview
osterior I Cruciate Anterior J ligaments
Fibular collateral ligament
Posteriorligament of fibular head
intercondylararea (origin of posterior cruciate ligament)
Tibial collateral ligament
Biceps femoris
Fibula
te
Intercondylar emtnence
Posterior
Tibia
Anterior ligament of fibular head
Head of
Medial condvle
fibula
Lateral condyle
Anterior ligament of fibular
Superior articularsurface (medialfacet)
Superior articularsurface (lateralfacet)
head
Tibial tuberosity
Cerdy's tubercle
\tuuai"t I
Anterior
Lateralt
Anterior
intercondylar area (originof anterior
Intercondylar tubercles
cruciate ligament
Anterior border
Anterior border
Crosssection
Interosseous border
Interosseous border
Interosseousborder
Lateralsurface
nterosseous membrane
Lateral surface
Lateral surface Tibia
4{ry
Posteriorsurface
Inferior view Anterior Anterior tibiofibular ligament
Articularfacet
Anterior
of lateral
Fibula
Lateral malleolus
Calcaneofibular ligament
Pfate 514
Medial malleolus
Anterior talofibular ligament
Medial (deltoid) ligament of ankle
Malleolar fossaof lateralmalleol Posterior tibiofibularligament
Articular facet of medial malleolus Medial malleolus
Tibia Posterior Inferiorarticular surfaceof tibia
Leg
Attachments of Muscles of Leg
Anteriorview
Posteriorview
Plantaris muscle
muscle Castrocnemius ( m e d i a lh e a d )
(lateralhead)
l l i o t i b i a tl r a c t
muscle Popliteus
Bicepsfemoris muscle
Fibularis (peroneus) l o n g u sm u s c l e
Extensor digitorum l o n g u sm u s c l e
Quadricepsfemoris m u s c l ev i a p a t e l l a rl i g a m e n t
Soleus
Tibialisposterior muscle
musc
T i b i a l i sa n t e r i o r muscle
Flexor digitorum l o n g u sm u s c l e
Extensor hallucis l o n g u sm u s c l e
Fibularis (peroneus) brevismuscle
Fibularis (peroneus) t e r t i u sm u s c l e
!
Origins
f
Insertions
Note:Attachments of intrinsicmuscles of foot not shown
Tibialis posteriormuscle
Flexorhallucis l o n g u sm u s c l e
F i b u l a r i(sp e r o n e u s ) brevismuscle Plantaris muscle S o l e ua snd gastrocnemius via muscles (Achilles) calcaneal tendon
Fibularis (peroneus) b r e v i sm u s c l e Fibularis (peroneus) tertiusmuscle Extensor digitorum l o n g u sm u s c l e
4fF Leg
Flexorhallucis Extensor longusmuscle hallucis l o n g u sm u s c l e
Fibularis (peroneus) rongus muscre Flexor digitorum longus muscle
Plate 515
Muscles of Leg (superficial Dissection|: Posterior view Seealm Plate 540
l l i o t i b i at rl a c t
S e m i t e n d i n o s um s uscre
B i c e p fse m o r i sm u s c l e
S e m i m e m b r a n o s um s uscre
Tibialnerve
Cracilim s uscle
) erve C o m m o n f i b u l a r( p e r o n e a l n
P o p l i t e aal r t e r ya n d v e i
S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y
S a r t o r i u sm u s c l e
t a r i sm u s c l e
S u p e r i o rm e d i a lg e n i c u l a ra r t e r y
Castrocnemim u su s c l e( l a t e r ahl e a d )
C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d
Lateralsuralcutaneous nerve(cut)
N e r v et o s o l e u sm u s c l e
Medialsuralcutaneous nerve(cut) S m a l ls a p h e n o u sv e i n
C a s t r o c n e m i u sm u s c l e
S o l e u sm u s c l e
S o l e u sm u s c l e
P l a n t a r ti e s ndon
Flexordigitorum longus tendon --__* Tibialis posterior t"naon __________ Posteriortibial artery and vei T i b i a ln e r v e
-"---j Medialmalleolus Flexorhallucislongus tendon F l e x o rr e t i n a c u l u
*{r Plate 516
Calcanealbranch of posterior tibial artery
F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n i Fibularis(peroneus)brevis tendon a l c a n e a (l A c h i l l e st)e n d o n L a t e r am l alleolus S u p e r i o rf i b u l a r( p e r o n e a l r) e t i n a c u l u m
i b u l a r( p e r o n e aal )r t e r y Calcanealbranchesof fibular (peroneal)artery alcanealtuberosity
Leg
Muscles of Leg (lntermediate Dissection): Posterior View SeealsoPlate 541
Tibial nerve
Adductor magnustendon
Common fibular (peroneal)nerve (cut) P o p l i t e aal r t e r ya n d v e i n Superiorlateralgenicularartery S u p e r i o rm e d i a lg e n i c u l a ra r t e r y C a s t r o c n e m i u sm u s c l e ( m e d i a lh e a d )( c u t ) T i b i a fc o l l a t ear l | g a m e n t /
{
Lateraland medial suralcutaneousnerves(cut) C a s t r o c n e m i u sm u s c l e( l a t e r ahl e a d )( c u t ) F i b u l a rc o l l a t e r alli g a m e n t Bicepsfemoris tendon (cut)
S e m i m e m b r a n o s ut se n d o n ( taris muscle I n f e r i o rm e d i a lg e n i c u l a ra r t e r y lnferior lateralgenicularartery
Popliteus muscle T e n d i n o uasr c ho f Soleum s uscle
Head of fibula ) e r v e( c u t ) m m o n f i b u l a r( p e r o n e a l n N e r v e t o s o l e u sm u s c l e
P l a n t a r i tse n d o n F i b u l a r i (sp e r o n e u s l)o n g u sm u s c l e C a s t r o c n e m i u sm u s c l e( c u t ) muscle
S o l e u sm u s c l ei n s e r t i n gi n t o c a l c a n e a(l A c h i l l e st)e n d o n
F l e x o rd i g i t o r u ml o n g u st e n d o n T i b i a l i sp o s t e r i o rt e n d o n Posteriortibial artery and vein Tibial Medial F l e x o rh a l l u c i sl o n g u st e n d o n Flexorretinaculum Calcaneal(Achilles)tenoon Calcanealbranch of posteriort i b i a la r
Leg
F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n F i b u l a r i s( p e r o n e u s b) r e v i st e n d o n L a t e r am l alleolus S u p e r i o rf i b u l a r( p e r o n e a l r) e t i n a c u l u m Fibular(peroneal)artery Calcanealbranches of fibular (peroneal)artery Calcanealtuberosity
4{tr Plate 517
Muscles of Leg (Deep Dissectionf: Posterior View
Superiormedialgenicular artery Castrocnemius muscle(medialhead)(cut) S u r a(l m u s c u l abr )r a n c h e s Popliteal arteryand tibialnerve Tibial collateralligament
Semimembranosus tendon(cut
Superiorlateralgenicular artery Plantaris muscle(cut) Castrocnemius muscle(lateralhead)(cut) Fibularcollateral ligament Bicepsfemoristendon(cut) Inferiorlateralgenicular artery of fibula
Inferiormedialgenicular artery Commonfibular(peroneal) nerve Popliteus muscle Posterior tibialrecurrentartery Tendinous archof soleusmuscre
Posterior tibialartery
Flexordigitorumlongusmuscle
muscle(cutand reflected) Anteriortibialartery
Fibular(peroneal) artery
Tibial nerve
Flexorhallucislongusmuscle(retracted) Tibialisposterior muscle
Fibular(peroneal) artery
(Achilles) Calcaneal tendon
Interosseous membrane
Flexordigitorumlonguste Tibialisposteriortendon Medial malleolusand posterior medial malleolarbranch of posteriortibial art<
Flexorretinaculum
(peroneus) Fibularis longustendon (peroneus) Fibularis brevistendon Lateralmalleolus and posteriorlateral malleolar branchof fibular(peroneal) artery Superiorfibular(peroneal) retinaculum
Medial calcanealbranchesof posteriortibial artery and tibial
Lateralcalcaneal branch of fibular(peroneal) artery
Tibialisposteriortendon
Lateralcalcaneal branchof suralnerve
Medialplantararteryand nerve
Inferiorfibular(peroneal) retinaculum
Lateralplantararteryand nerve
*{r Plate 518
Flexorhallucislongustendon l st metatarsalbone
(peroneus) Fibularis brevistendon (peroneus) Fibularis longustendon Flexordigitorumlongustendon 5th metatarsal bone
Leg
Muscles of Leg (superficial Dissection|: Anterior View
muscle Vastuslateralis
Vastusmedialismuscle Patella
Rectusfemoris tendon q u a d r i c e p sf e m o r i st e n d o n )
Superiormedialgenicularartery
lliotibialt
artery Superiorlateralgenicular
ligament Tibialcollateral M e d i a pl a t e l l arre t i n a c u l u m
Lateralpatellarretinaculum Bicepsfemoristendon Inferiorlateralgenicular ) erve C o m m o n f i b u l a r( p e r o n e a l n
Headof fibula
artery nferiormedialgenicular lnfrapatellar branch(cut)of nerve(cut) Saphenous J o i n tc a p s u l e ligament Patellar muscle Insertion of sartorius
(peroneus) Fibularis longusmuscle
Tibialtuberosity Tibia
T i b i a l ias n t e r i om r uscle muscle Gastrocnemius Superficial fibular (peroneal)nerve
Soleum s uscle
Extensor digitorumlongusmuscle
Extensor hallucislongusmuscle
Fibula Superiorextensorretinaculum
Medialmalleolus
Lateralmalleolus Inferiorextensorretinaculum
lis anterior tendon
Extensor digitorumlongustendons
Medial branch of deep fibular (peroneal)nerve
F i b u l a r (i sp e r o n e u st e) r t i u st e n d o n
E x t e n s o hr a l l u c i sl o n g u st e n d o n
Extensor digitorumbrevistendons Extensorhallucisbrevistenoon Dorsaldigital branches of deep fibular (peroneal)nerve
Dorsaldigitalnerves
Leg
4{tr Plate 519
Muscles of Leg (Deep Dissection): Anterior view SeeafsoPlate &2
S u p e r i o rm e d i a lg e n i c u l a ra r t e r y
S u p e r i o rl a t e r a lg e n i c u l a ra r t e r y
Q u a d r i c e p sf e m o r i st e n d o n
Fibular collateralliBament---_____-_ L a t e r a pl a t e l l a r e t i n a c u l u m
T i b i a lc o l l a t e r alli g a m e n t
l l i o t i b i a tl r a c t ( c u r Bicepsfemoris tendon (cut) I n f e r i o rl a t e r a lg e n i c u l a ra r t e r y C o m m o n f i b u l a r( p e r o n e a rnJ e r v e Headof fibula F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e( c u t
M e d i a l p a t e l l a rr e t i n a c u l u m nfrapatellarbranch of saphenousnerve (cuf) I n f e r i o rm e d i a lg e n i c u l a ra r t e r y Saphenousnerve (cut) P a t e l l a lri g a m e n t Insertionof sartoriustenoon
A n t e r i o rt i b i a la r t e r y
E x t e n s odri g i t o r u m l o n g u sm u s c l e( c u t ) erve S u p e r f i c i af li b u l a r( p e r o n e a t n D e e p f i b u l a r( p e r o n e a rnl e r v e F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e
A n t e r i o rt i b i a lr e c u r r e n ta r t e r ya n d r e c u r r e n tb r a n c ho f d e e p p e r o n e a ln e r v e I n t e r o s s e o um s embrane T i b i a l i sa n t e r i o rm u s c l e( c u t ) C a s t r o c n e m i u sm u s c l e
E x t e n s o dr i g i t o r u ml o n g u sm u s c l e F i b u l a r i s( p e r o n e u s ) b r e v i sm u s c l ea n d t e n d o n
Soleum s uscle Tibia ) e r v e( c u t ) S u p e r f i c i af li b u l a r( p e r o n e a l n
F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n Perforatingbranch of ) rtery f i b u l a r( p e r o n e a l a Anterior lateralmalleolarar L a t e r am l a l l e o l u sa n d a r t e r i a n l etwork Lateraltarsalartery and lateral b r a n c ho f d e e p f i b u l a r( p e r o n e a rn. ,e r v E x t e n s o dr i g i t o r u mb r e v i sa n d e x t e n s o rh a l l u c i sb r e v i sm u s c l e s( c u t
E x t e n s oh r a l l u c i sl o n g u sm u s c l ea n d t e n d o n ( c u t ) l n t e r o s s e o um s embrane A n t e r i o rm e d i a lm a l l e o l a ra r t e r y ial malleolusand arterialnetwork D o r s a l i sp e d i sa r t e r y T i b i a l i sa n t e r i o rt e n d o n M e d i a lt a r s a la r t e r y M e d i a l b r a n c ho f d e e p f i b u l a r( p e r o n e a l n ) erve
) r e v i st e n d o n F i b u l a r i s( p e r o n e u s b Arcuate artery Posteriop r e r f o r a t i n gb r a n c h e s from deep plantar aich
Deep plantar artery
E x t e n s odr i g i t o r u ml o n g u st e n d o n s( c u t )
Dorsal metatarsalarteries
Extensordigitorum brevis tendons (cut
Extensorhallucislongus tendon (cut)
D o r s a ld i g i t a la r t e r i e s
4{tr Pfate 52O
Branc.hes of proper plantar d i g i t a la r t e r i e sa n d
E x t e n s o hr a l l u c i sb r e v i st e n d o n ( c u t ) digital branchesof d e e p f i b u l a r( p e r o n e a l )n e r v e
Leg
Muscles of Leg: Lateral View
muscle Vastuslateralis Biceps femoris muscle
I
I
Long
lliotibialtract
Short head
femoristendon Quadriceps
Tendon
artery Superiorlateralgenicular Patella
F i b u l a rc o l l a t e r a l i g a m e n t
Lateralpatellarretinaculum C o m m o nf i b u l a r ( p e r o n e anl )e r v e
Lateralcondyle of tibia Patellarligament
lnferior lateral genicularartery
Tibialtuberosity
Headof fibula Tibialisanteriormuscle C a s t r o c n e m i u sm u s c l e
digitorumlongusmuscle Extensor
F i b u l a r (i sp e r o n e u sl o) n g u s
fibular Superficial (peroneal) nerve(cut)
muscle and tendon
Extensordigitorum longus tendon Extensorhallucislongus muscle and tendon
F i b u l a r (i sp e r o n e u sb)r e v i s
S u p e r i oer x t e n s orre t i n a c u l u m
m u s c l ea n d t e n d o n
Inferiorextensorretinaculum
Fibula
nsor digitorum brevis muscle
Lateralmalleolus
xtensor hallucislongus tendon
(Achilles) tendon Calcaneal \\ (Subtendinous) bursa of tendocalcaneus\ Superiorfibular ( p e r o n e arl e ) tinaculum l n f e r i ofri b u l a r ( p e r o n e arl e ) tinaculum (peroneus) longus Fibularis to soleof foot tendonpassing
Leg
l o n g u st e n d o n s E x t e n s odri g i t o r u m \
-l'
(peroneus) brevistendon (peroneus) tertiustendon Fibularis 5th metatarsal oone
*{r Plate 521
Leg: Gross Sections and Fascial Gompartments
Deepfasciaof (cruralfascia)
Interosseous membrane
Anteriorcompartmenl Extensor muscles T i b i a l ias n t e r i o r E x t e n s odri g i t o r u m longus E x t e n s ohra l l u c ilso n g u s F i b u l a r i(sp e r o n e u st e) r t i u s A n l e r i o tri b i a a l r t e r ya n dv e i n s D e e pf i b u l a (r p e r o n e anl )e r v e
ilDra
Deepposteriorcompartment Deepflexormuscles F l e x odr i g i t o r u m longus T i b i a l ios o s t e r i o r F l e x ohr a l l u c ilso n g u s Popliteus Posteriortibial artery and veins T i b i a ln e r v e ) r t e r ya n d v e i n s F i b u l a r( p e r o n e a l a
Anteriorintermuscular septum Lateral compartment F i b u l a r i s( p e r o n e u s l)o n g u sm u s c l e F i b u l a r i s( p e r o n e u s b) r e v i sm u s c l e Superficialfibular (peroneal)nerve
Transverseintermuscular septum
Superficialposteriorcompartmenl flexormuscles Superficial Soleus Gastrocnemius P l a n t a r (i st e n d o n )
Posteriorintermuscular septum FIDUIA
Deep fascia of leg (crural fascia)
Crosssectionjust abovemiddle of leg T i b i a l i sa n t e r i o rm u s c l e E x t e n s ohr a l l u c i sl o n q u sm u s c r e E x t e n s odr i g i t o r u ml o n g u sm u s c l e
A n t e r i o rt i b i a la r t e r ya n d v e i n sa n d d e e p f i b u l a r( p e r o n e a l )n e r v e ilDta
l n t e r o s s e o um s embrane
S u p e r f i c i af li b u l a r( p e r o n e a l )
Creat saphenousvein a n d s a p h e n o u sn e r v e
A n t e r i o ri n t e r m u s c u l asr e p l
r uscle T i b i a l ipso s t e r i om
Deep fasciaof leg (cruralfascia)
Flexordigitorum longus muscre
F i b u l a r i(sp e r o n e u s ) l o n g u sm u s c l e F i b u l a r i s( p e r o n e u s ) b r e v i sm u s c l e
) rtery F i b u l a r( p e r o n e a l a and veins
P o s t e r i o irn t e r m u s c u l asre D r u m
Posteriortibial artery a n d v e i n sa n d t i b i a ln e r v e
F
Flexorhallucislongus muscte
Lateralsuralcutaneousnerve
Deep fasciaof leg (cruralfascia)
TransverseintermuscularseDtum
P l a n t a r i tse n d o n
Soleum s uscle C a s t r o c n e m i u sm u s c l e( l a t e r ahl e a d )
4{tr Pfate 522
S u r a lc o m m u n i c a t i n gb r a n c h o f l a t e r a sl u r a lc u t a n e o u sn e r v e
C a s t r o c n e m i u sm u s c l e( m e d i a lh e a d ) M e d i a l s u r a lc u t a n e o u sn e r v e S m a l ls a p h e n o u sv e t n
Leg
Bones of Foot
Dorsalview
Lateral tubercle
tubercle
Calcaneus BodyFibular
Posterior process
Croove for tendon of flexor hallucis longus Trochlea Neck ao
(peroneal) trochlea
Navicular Tuberosity
Tuberosity of 5th metatarsal DOne
.q
r"rroretatarsaljoint Base
Plantarview
Calcaneus Tuberosity Medial process
Shaft(body)
Lateral tubercle
ateralprocess tali Sustentaculum
Medial tubercle
Croove for tendono{ flexor h a l l u c ilso n g u s Fibular(peroneal) trochlea
Posterior process Head
Transverse tarsaliointl,
Cuboid Tuberosity roove for
Tuberosity
Navicular Tuberosity
fibularis (peroneus, longustendon Tuberosity of 5th metatarsal bone
al iointj Tarsometatars
Base Shaft(body)
Metatarsalbones
r ''-dirl Sesamoid Uones{ i"lYj Lareral t
Head Base Shaft(body) Head Base Head Tuberosity
*{r Ankle and Foot
Phalanges
Plate 523
Bones of Foot (continued|
lateral view ransversetarsaljoint Navicular
l"T;1J;: cun"iro,. tron", I joint Tarsometatarsal Metatarsalbones
Body t.
Fibular (peroneal)
trochlea Tuberosity Croovefor f i b ul a r i s (peroneus)
Cuboid Tuberosity
Tuberosity of 5th metatarsal bone
l o n g u st e n d o n Croove for fibularis
( p e r o n e u sl o) n g u st e n d o n
M e d i a l vew i Transversetarsaljo i n t
Navicular Tuberosity cuneiform"uon", " -" { I
Intermediate \ Mediat-f
Tarsometatarsal ioint--a Metatarsalbones
Tuberosityof l st metatarsal bone Sesamoidbone
Tuberosity Croove for tendon of flexor hallucisloneus
Calcaneus
Sustentaculum tali
Plate 524
Ankle and Foot
Galcaneus Rightfoot Posteriortalar articularsurface
Articularsurface for cuboidbone
Anteriortalar a r t i c u l asru r f
Middletalar articularsurface Anteriortalar articularsurface
Middletalar articularsurface
Posterior talar articular surface
Articularsurface f o r c u b o i db o n e
Fibular (peroneal) trochlea
Tuberosity Lateralprocess
Sustentaculumtali
Croovefor fibularis
of tuberosity
Body
( p e r o n e u s l)o n g u st e n d o n
Lateralview Anterior talar articularsurface
ibular (peroneal) trochlea
C a l c a n e asl u l c u s
Middle talar articularsurface
Tuberosity
Posterior talar articularsurface
Superiorview Middletalararticularsurtace
Articular surface for cuboid
rior talar articularsurface
Tuberosity
bone
tali Sustentaculum Sustentaculumtali
Groovefor tendon o f f l e x o rh a l l u c ilso n g u s
Medial processof tuberosity
Medialview
I n t e r o s s e om u se m b r a n e
Medial (deltoid) ligament of ankle
Posterior talocalcaneal ligament
*{r Ankle and Foot
Fibular (peroneal) trochlea
h a l l u c ilso n g u s Medial
Fibula
Talus
Croove for tendon of flexor
Posterior tibiofibular ligament
processof tuberosity
teral processof tuberosity
Tuberosity
Posteriorview
Posterior talofibular ligament Calcaneofibular ligament F i b u l a r( p e r o n e a l ) t e n d o n si n i n f e r i o r f i b u l a r( p e r o n e a l ) retinaculum
Posteriorview with ligaments
Functionalrelationsof calcaneus
Plate 525
Ankle: Radiographs
Lateralview C CB F HT tC N PT ST T TC TM TT
Calcaneus Cuboid Fibula Headof talus Lateralcuneiform Navicular processof talus Posterior Sustentaculum taliof calcaneus Tibia Tuberosity of calcaneus Tuberosity of 5th metatarsal Trochleaof talus
Anterior view F
t-M MM T TA
Plate 526
Fibula Lateralmalleolus M e d i am l alleolus Tibia Talus
Ankle and Foot
Ligaments and Tendons of Ankle
Rightfoot: lateralview
Tibia
of lateral Components (collateral) ligament of ankle
Fibula--------
lnterosseoustalocalcanealligament Dorsal talonavicularligament
A n t e r i o ra n d
Posterior tibiofibular ligaments
C a l c a n e o n a v i c u l a r l i g a m e| n t^ . . a,:-----.-a BlturcatellEament / c.l.rn"o.uboid lig--amentI cu boideonavicularligament
Superiorfibular(peroneal) retinaculum-
ligaments Dorsalcuneonavicular ligaments Dorsalintercuneiform ligaments Dorsaltarsometatarsal
Calcaneal(Achilles) tendon (cut
lnferior fibular (peroneal) retinaculum
Dorsal metatarsalligaments
Lateraltalocalcanealligament
Dorsalcuneocuboidligament
Long plantar ligament
Cuboidbone
F i b u l a r (i sp e r o n e u sl o) n g u st e n d o n
Dorsal calcaneocuboidliqament
(peroneus) Fibularis brevistendon
Rightfoot: medialview ligament Medialtalocalcaneal
Medial(deltoid) l i g a m e n to f a n k l e
processof talus Posterior Dorsal talonavicularligament
Posterior talocalcaneal
Navicularbone
ligament
Dorsal cuneonavicularli Medial cuneiform bone
Calcaneal (Achilles) tendon (cut)
Dorsal intercuneiformligament
Dorsaltarsometatarsal ligaments I st metatarsal
Tuberosity
Nr
T i b i a l i sa n t e r i o r
Ankle and Foot
Tibialisoosteriortendon
Shortplantar ligament Plantarcalcaneon a v i c u l a r( s p r i n g )l i g a m e n t
ong plantarligament
Plale 527
Ligaments and Tendons of Foot: Plantar View
F l e x o rd i g i t o r u ml o n g u st e n d o n t o 2 n d t o e ( c u t
Distalphalanxof greattoe
Flexordigitorum brevis tendon to 2nd toe (cut
I n t e r p h a l a n g e( laPl )j o i n t
4 t h d i s t apl h a l a n x
F l e x ohr a l l u c ilso n g u st e n d o n( c u t )
4 t h m i d d l ep h a l a n x Proximalphalanxof great toe Deep transversemetatarsalIigaments Metatarsophalangeal(MP) joint
5 t h p r o x i m a lp h a l a n
S e s a m o i db o n e s
4 t h l u m b r i c a lt e n d o n ( c u t )
A b d u c t oh r a l l u c iasn dm e d i ahl e a d of flexorhallucisbrevistendons(cut)
A b d u c t o rd i g i t i m i n i m i a n d f l e x o rd i g i t im i n i m i brevistendons (cut)
Adductor hallucisand lateralhead of flexor hallucisbrevis tendons (cut)
Plantarligaments(plates)
Interosseous muscles(cut)
l st metatarsal bone
5th metatarsalbone
Plantartarsometatarsalligaments
Plantarmetatarsalligaments
M e d i a lc u n e i f o r mb o n e
Tuberosity of 5th metatarsal bone Tibialisanterior tendon (cut)
F i b u l a r (i sp e r o n e u s ) brevistendon
P l a n t a rc u n e o n a v i c u l alri g a m e n t
Cuboidbone
P l a n t a rc u b o i d e o n a v i c u l al ri g a m e n t
F i b u l a r i s( p e r o n e u s ) longus tendon
T u b e r o s i toyf n a v i c u l abro n e P l a n t a rc a l c a n e o n a v i c u l a( sr p r i n g )l i g a m e n t
T u b e r o s i t yo f c u b o i d b o n e L o n g p l a n t a rl i g a m e n t
Tibialisoosteriortendon
Plantarcalcaneocuboid (short plantar)ligament,
Flexordigitorum longustendon (cut)
S u s t e n t a c u l ut aml i
Calcaneus
F l e x o rh a l l u c i sl o n g u st e n d o n ( c u t )
Medial process and Lateralprocess of
Posteriororocessof talus ( m e d i a la n d l a t e r a tl u b e r c l e s )
Tuberosity of calcaneus
*{r P h a l a ng e s
J o i n ct a p s u l e Proximal
Metatarsalbone
Capsulesand ligaments of metatarsophalangealand i n t e r p h a l a n g e a jl o i n t s : lateral view Collateralligaments
Plate 528
P l a n t a rl i g a m e n t
Ankle and Foot
Tendon Sheaths of Ankle
Lateralview
S o l e u sm u s c l e
Extensordigitorum longus muscle
F i b u l a r (i sp e r o n e u s ) l o n g u sm u s c l e
Suoeriorextensorretinaculum snterior T e n d i n o ussh e a t ho f t i b i a l i a
F i b u l a r (i sp e r o n e u s ) b r e v i sm u s c l e
b su r s a L a t e r aml a l l e o l uasn ds u b c u t a n e o u
C a l c a n e a(l A c h i l l e st)e n d o n
Inferiorextensorretinaculum
C o m m o n t e n d i n o u ss h e a t h
sheathof extensordigitorum Tendinous tertius longusandfibularis(peroneal)
o f f i b u l a r i(sp e r o n e u s ) l o n g u sa n d b r e v i
Tendinous sheathof extensorhallucislongus
Subcutaneouscalcanealoursa
( S u b t e n d i n o ubsu)r s a of calcanealtendon S u p e r i o ra n d l n f e r i o r-
f i b u l a (r p e r o n e a l ) r e t i n a clua Calcaneus Extensordigitorum brevis
Fibularis (peroneus) ronSus tendon
Abductordigiti
Medialview T i b i a l i sa n t e r i o rt e n d o n a n d s h e a t h
4{tr
Tibia S h e a t ho f t i b i a l i so o s t e r i o rt endo
Superiorextensor Medialmalleolus and subcutaneous bursa lnferior extensorretinaculum Tibialisoosteriortendon and sheat
Fibularis (peroneus) brevis tendon
(peroneus) tertiustendon Fibularis bone Tuberositv of 5th metatarsal
Calcaneal(Achilles) tendon T e n d i n o u ss h e a t ho f flexor digitorum longus
tibialartery Posterior and tibialnerve sheathof Tendinous f l e x o rh a l l u c ilso n g u s Subcutaneous bursa calcaneal
Tibialisanterior tendon and sheath T e n d i n o u ss h e a t h o f e x t e n s o rh a l l u c i sl o n e u
( S u b t e n d i n o ubsu)r s a tendon of calcaneal F l e x or e t i n a c u l u m Calcaneus
Lateralplantarnerve M e d i a lp l a n t a r 1st metatarsal Tendinoussheathof flexor hallucislongui
Ankle and Foot
Tendinoussheathof flexor digitorum
Abductorhallucismuscle(cut) Plantaraponeurosis(cut)
Flexordigitorumbrevismuscle(cut)
Pfate 529
Muscles of Dorsum of Foot: Superficial Dissection
Superficialfibular (peroneal)nerve (cut) F i b u l a r i s( p e r o n e u s b) r e v i sm u s c l e
Tibialisanterior tendon A n t e r l o rt i b i a la r t e r ya n d ) erve d e e p f i b u l a r( p e r o n e a l n
Fibularis(peroneus)longus tendon---] Tibia Extensordigitorum l o n g u sm u s c l ea n d t e n d o n S u p e r i o re x t e n s o r e t i n a c u r u m
F i b ul a Perforatingbranch of fibular (peroneal)artery L a t e r am l a l l e o l u sa n d a n t e n o r lateralmalleolarartery I n f e r i o re x t e n s o rr e t i n a c u r u m Lateraltarsalartery and lateral b r a n c ho f d e e p p e r o n e a ln e r v e (to musclesof dorsum of foot)
E x t e n s o hr a l l u c i sl o n g u st e n d o n T e n d i n o u ss h e a t ho f extensordigitorum longus M e d i a lm a l l e o l u s T e n d i n o u ss h e a t ho f t i b i a l i sa n t e r i o r T e n d i n o u ss h e a t ho f e x t e n s o rh a l l u c i sl o n g u s ior medial malleolarartery Dorsalispedis arterv and medial branch o f d e e p f i b u l a r( p e r o n e a l )n e r v e Medial tarsalartery
) r e v i st e n d o n F i b u l a r i s( p e r o n e u s b Arcuate artery
Tuberosity of 5th metatarsal bone F i b u l a r i s( p e r o n e u s t)e r t i u st e n d o n E x t e n s odr i g i t o r u mb r e v i sa n d e x t e n s o rh a l l u c i sb r e v i sm u s c l e s
Deepplantar .l arterypassingbetween headsof st dorsalinterosseous m u s c l et o j o i n d e e pp l a n t aar r c h E x t e n s oh r a l l u c i sl o n e u st e n d o n Extensorexpansions
E x t e n s odri s i t o r u m rongus Lateraldorsal cutaneous n e r v e( c o n t i n u a t i o no f sural nerve) (cut) Dorsal metatarsalarteries
Dorsaldigitalarteries D o r s abl r a n c h eosf properplantardigital arteriesand nerves
Plate 53O
Dorsaldieitalbranches of deepfibular(peroneal) nerve
Dorsal digital branches o f s u p e r f i c i af li b u l a r ( p e r o n e a l )n e r v e
4ffffi
4.t'/
Ankle and Foot
Dorsum of Foot: Deep Dissection
Soleum s uscle
Superficialfibular (peroneal)nerve (cut)
r u s c l ea n dt e n d o n T i b i a l ias n t e r i om
F i b u l a r i s( p e r o n e u s l)o n g u st e n d e n F i b u l a r i s( p e r o n e u s b) r e v i s m u s c l ea n d t e n d o n
Tibia Anterior tibial artery and
d e e pf i b u l a (r p e r o n e anl )e r v e
E x t e n s o dr i g i t o r u ml o n g u s m u s c l ea n d t e n d o n-
E x t e n s ohra l l u c ilso n g u s m u s c l ea n dt e n d o n
hrbula
Perforatingbranch of fibular (peroneal)artery
A n t e r i o rm e d i a lm a l l e o l a a r rtery M e d i a lm a l l e o l u s
Anterior lateralmalleolarartery
Dorsalispedis artery
Lateral
M e d i a l b r a n c ho f d e e p f i b u l a r (peronealn ) erve
Lateralbranch of deep peroneal n e r v e( t o m u s c l e so f d o r s u m of foot) and lateraltarsalartery
Medial tarsalarteries
Fibularis(peroneus)longustendon (cut)---_.Extensordigitorum brevis and extensor hallucis breiris muscles (cut)-----------<
l'
F i b u l a r i(sp e r o n e u sb)r e v i st e n d o n( c u 0 - 1 F i b u l a r (i sp e r o n e u s ) tertiustendon (cut)
Tuberosityof navicularbone Arcuate artery Posteriorperforatingbranches from deep plantar arch
f ,. Deep plantar artery to deep plantar arch
A b d u c t o dr i g i t i m i n i m i m u s c l e A b d u c t o hr a l l u c im s uscle Dorsalmetatarsalarteries E x t e n s o hr a l l u c i sl o n q u st e n d o n Metatarsalbones D o r s a li n t e r o s s e o um s uscles Lateraldorsal cutaneous n e r v e( c o n t i n u a t i o no f sural nerve) (cut) Anterior perforating branches from plantar metatarsalarteries
E x t e n s o hr a l l u c i sb r e v i st e n d o n (cut) Extensordigitorum brevis t e n d o n s( c u t ) E x t e n s o dr i g i t o r u m l o n g u st e n d o n s( c u t ) E x t e n s oer x p a n s i o n s
Dorsal digital arteries D o r s a lb r a n c h e so f p r o p e r p l a n t a rd i g i t a l arteriesand nerves
Dorsal digital branchesof ) erve d e e p f i b u l a r( p e r o n e a l n Dorsal digital branches of superficialfibular ( p e r o n e a l )n e r v e
Nr Ankle and Foot
Plate 531
Sole of Foot: Superficial Dissection
Superficial transverse metatarsal ligaments
Properplantardigital arteriesand nerves
Superficial branchof medialplantarartery
Transversefasciculi
Digitalslipsof plantaraponeurosis
Lateralolantarfascia
Medial olantarfascia
Cutaneous branches of lateralplantar artery and nerve
Cutaneous branchesof medial plantararteryand nerve
Lateralbandof plantaraponeurosis (calcaneometatarsal ligament)
Plantaraponeurosis
Medial calcanealbranchesof tibial nerve and posteriortibial artery
Tuberosity of calcaneus with overlyingfat pad (partially cut awa
4{F Plate 532
Ankle and Foot
Muscles of Sole of Foot: First Layer
Proper plantar digital branches o f m e d i a lo l a n t a rn e r v e
Properplantardigitalbranches of lateralolantarnerve plantar digital arteries
plantar digital arteries from plantar metatarsalarteries
L u m b r i c am l uscles
F i b r o ussh e a t h s of flexortendons
Flexordigitorum brevis overlying F l e x o rd i g i t o r u ml o n g u st e n d o n s
Superficialbranch o{ medial plantarartery
Lateralhead and Medial head of flexor hallucis brevis muscle
F l e x o rh a l l u c i sl o n g u st e n d o n
Plantarmetatarsal branchof lateralplantarartery Abductorhallucismuscle andtendon F l e x o rd i e i t im i n i m i b r e v i sm u s c l e
Flexordigitorumbrevismuscle
Abductordigiti minimi muscle (deepto lateralplantarfascia) Plantaraponeurosis(cut) Medial process ano Lateralprocess of
Medial calcanealbranchesof tibial nerve and posteriortibial artery
Tuberosity of calcaneus
4{tr Ankle and Foot
Plate 533
Muscles of Sole of Foot: Second Layer
Proper plantar digital branches of medial plantar ner
Flexordigitorumlongustendons Properplantardigitalbranches of lateralplantarnerve
Flexordigitorum brevis tendons
Fibroussheaths(opened) S e s a m o i db o n e s C o m m o n p l a n t a rd i g i t a l nervesand arteries Lumbrical muscles Lateralhead ano Medial head of F l e x o rd i g i t i m i n i m i brevis muscle
flexorhallucisbrevismuscre Flexorhallucislongustendon
Superficialbranch and
Deepbranch of lateral plantarnerve
Lateralplantar nerve and a
Abductorhallucistendon and muscle(cut) Flexordigitorumlongustendon and deep branches of medial plantar artery Medial plantarartery and nerve
Quadratusplantaemuscle T i b i a l i so o s t e r i o rt e n d o n
A b d u c t o dr i g i t im i n i m m i u s c l e( c u r )
N e r v e t o a b d u c t o rd i g i t i m i n i m i m u s c l e (from lateralplantar nerve)
F l e x ohr a l l u c ilso n g u st e n d o n Posterior tibialarteryand tibialnerve(dividing) Flexorretinaculum
Flexordigitorum brevis muscle and plantar aponeurosis(cut)
Lateralcalcanealnerve and arterv (from sural nerve and fibular [peroneal]artery
Abductorhallucismuscle(cut) Medial calcanealartery and nerve Tuberosityof calcaneus
Plate 534
Nr
Ankle and Foot
Muscles of Sole of Foot: Third Layer
of medialplantarnerve Properplantardigitalbranches
P r o p e rp l a n t a rd i g i t a lb r a n c h e s of lateralplantar nerve Proper plantar digital branch of superficialbranch of medial plantar artery Anterior perforating arteries to dorsal metatarsalarteries
Tendonsof lumbricalmuscles(cut) S e s a m o i db o n e s Flexordigitorum l o n g u st e n d o n s Flexordigitorum brevistendons (cut
Flexordigiti minimi brevismuscle Plantarmetatarsal arteries Plantarinterosseous muscles
Transversehead and Obliqueheadof adductorhallucismuscle head and Lateral head of flexor hallucis brevis muscle Superficialbranchesof medial plantar artery and nerve Flexorhallucislongustendon (cut)
Superficialbranch of lateralplantar nerv Deep plantar arterialarch and deep branchesof lateralplantar nerve Tuberosityof 5th metatarsalbone Peroneusbrevistendon
Peroneus longustendon andfibroussheath
Abductor hallucismuscle (cut) Deep branchesof media plantarartery and nerve Flexordigitorum longus tendon (cut) Tibialisposteriortendon Medial plantar artery and nerve F l e x o rh a l l u c i sl o n g u st e n d o n
Q u a d r a t u sp l a n t a em u s c l e (cut and slightly retracted) L a t e r a pl l a n t a ra r t e r ya n d n e r v e A b d u c t o r d i g i t i m i n i m i m u s c l e( c u t Lateralcalcanealartery and
Flexorretinaculum Abductorhallucismuscle(cut) Flexordigitorum brevis muscle a n d p l a n t a ra p o n e u r o s i s( c u t ) edial calcanealartery and nerve
Tuberosity of calcaneus
Ankle and Foot
Plate 535
lnterosseous Muscles and Deep Arteries of Foot
Dorsalview (peroneusl-./ Fibularis l o n g u st e n d o n\ c u t ) / , /
['3ii:1:lt:'f i::,i/)
N a v i c u l a rb o n e Dorsalispedisartery Medial tarsalartery
Lateral l bones I n t e r m e d i a tIe C u n e i f o r m Medial )
Cuboidbone Dorsaltarsometatarsalligaments Lateraltarsalartery Tuberosityof 5th metatarsalbone F i b u l a r i s( p e r o n e u s ) tertiustendon (cut) Posteriorperforating branches (from deep plantar arterialarch Dorsal metatarsalarteries E x t e n s o dr i g i t o r u m longus tendons (cut) E x t e n s o er x p a n s i o n s
Dorsal metatarsalligaments
Arcuateartery D e e p p l a n t a ra r l e r yp a s s e st o contribute to deep plantar arch
muscles interosseous Metatarsalbones E x t e n s o hr a l l u c i sl o n g u st e n d o n
A n t e r i o rp e r f o r a t i n gb r a n c h e s (from plantar metatarsalarteries) D o r s a ld i g i t a la r t e r i e s
Plantarview Proper plantar digital arteries C o m m o n p l a n t a rd i g i t a la r t e r i e s
L u m b r i c aml u s c l e(sc u t ) Deep transversemetatarsalligament a n d p l a n t a rl i g a m e n t s( p l a t e s )
Interosseous musclesI Plantar I Dorsal. A b d u c t o r d i g i t i m i n i m i m u s c l e s( c u t ) Plantarmetatarsalarteries F l e x o rd i g i t i m i n l m i b r e v i sm u s c l e Deep plantar arch Lateralplantarartery (cut) T u b e r o s i t yo f 5 t h m e t a l a r s abl o n e F i b u l a r i s( p e r o n e u s l)o n g u st e n d o n F i b u l a r i s( p e r o n e u s b) r e v i st e n d o n ( c u t ) T u b e r o s i t yo f c u b o i d b o n e L o n g p l a n t a rl i g a m e n C a l c a n e o c u b o i d( s h o r tp l a n t a r )l i g a m e n l
Plate 536
F l e x o rh a l l u c i sl o n g u st e n d o n ( c u t ) A n t e r i o rp e r f o r a t i n gb r a n c h e s (to dorsal metatarsalarteries) S e s a m o i db o n e s l n s e r t i o no f a d d u c t o rh a l l u c i s and laterah l e a d o f f l e x o rh a l l u c i s brevis muscles(cut) l n s e r t i o no f a b d u c t o rh a l l u c i s a n d m e d i a lh e a d o f f l e x o rh a l l u c i s b r e v i sm u s c l e s( c u t ) M e d i a l o r i g i no f f l e x o rh a l l u c i s brevis muscle (cut) Deep plantarartery (from dorsalis pedis artery) Posteriorperforatingbranches (to dorsal metatarsalarteries) Plantarmetatarsalligaments(between basesof metatarsalbones) M e d i a lc u n e i f o r mb o n e Tibialisanteriortendon (cut) L a t e r a ol r i g i no f f l e x o rh a l l u c i s brevis tendon (cut) Tuberosityof navicularbone T i b i a l i sp o s t e r i o rt e n d o n ( c u t ) P l a n t a rc a l c a n e o n a v i c u l a r ( s p r i n g )l i g a m e n t
Ankle and Foot
Interosseous Muscles of Foot
Dorsalview Navicular
Tuberosity of 5th metatarsal bone ateral
Dorsalinterosseousmuscles (bipennate) 5th metatarsalbone
Little
(srh) toe
1stmetatarsal bone
Proximalphalanx Middlephalanx
Distalphalanx Proximalphalanxof greattoe
Distalphalanxof greattoe
Plantarview
Distalphalanxof greattoe
Proximalphalanxof greattoe
Little (sth)
Distal phalanx
Sesamoid bones
Middlephalanx
toe
Proximalphalanx
1stmetatarsal bone Plantarinterosseous muscles (unipennate) 5th metatarsal
Tuberosity of 5th metatarsal bone Navicular
Ankle and Foot
4{tr Pfate 537
Femoral Nerve and Lateral Femoral Gutaneous Nerve
T12 lateral femoral cutaneousnerve (12, 3) Femoralnerve (12, 3, 4) Obturatornerve
'Lumbosacral trunk
l l i a c u sm u s c l e Psoasmajormuscle(lowerpart Articularbranch Sartorius muscle (cutand reflected) Pectineus muscle
Rectusfemoris muscle (cut
and reflected) Quadriceps Vastus intermedius femoris muscle Vastus
Lateralfemoral nerve cutaneouS
Anteriorcutaneous of branches femoralnerve muscle Sartorius kut and reflected)
medialismuscle Vastus lateralismuscle
nerve Saphenous
genusmuscle Articularis branch nfrapatellar nerve of saphenous
Medialcruralcutaneous of nerves(branches Note:Only muscles innervated by femoral nervesnown
saphenousnerve)
Cutaneous innervation
4{tr Plate 538
Neurovaseulature
Obturator Nerve
l l i o h y p o g a s t r inc e r v e
l l i o i n g u i n anl" r r . - F
C e n i t o f e m o r a nl e r v e
z Lumbosacra
L a t e r afl e m o r a l c u t a n e o u sn e r v e
"
Femoran l erve
r*
r|F
s uscre O b t u r a t oer x t e r n um Obturatornerve ( L 2 , 3 ,4 )
$,i1";r
P o s t e r i ob r ranch
A r t i c u l a rb r a n c A d d u c t o rb r e v i sm u s c l e A d d u c t o r l o n g u sm u s c l e( c u t )
A n t e r i o rb r a n c h
A d d u c t o r m a g n u sm u s c l e ( i s c h i o c o n d y l aor ,r " h a m s t r i n g s ,p" a r t s u p p l i e d b y s c i a t i cI t i b i a l ]n e r v e )
P o s t e r i ob rr
C u t a n e o u sb r a n c h
€
3
= ,.€
:::i€
C r a
A r t i c u l a rb r a n c h t o k n e ej o i n t
A d d u c t o rh i a t u s
N o t e :O n l y m u s c l e s i n n e r v a t e db y o b t u r a t o r nerve snown
r, ij
Cutaneous innervation
4{tr Neurovasculature
Plate 539
Sciatic Nerve and Posterior Femoral Gutaneous Nerve
Posteriorfemoral cutaneousnerve
(s1,2, 3)
Creatersciaticforamen Inferiorclunialnerves S c i a t i cn e r v e( 1 4 ,5 , 5 1 , 2 , 3 ) Perineal branches ilDtatotvtston of sciaticnerve
Long head (cut) of biceps femoris muscle
Adductor magnus muscle (also partiallysupplied by obturator nerve)
*tY
' C o m m o nf i b u l a (r p e r o n e a l ) divisionof sciaticnerve
Shortheadof biceosfemorismuscle
Cutaneousi n n e r v a t i o n
Long head (cut) of biceps femoris muscle
Semitendinosusmuscle
S e m i m e m b r a n o s um s uscle
Tibial nerve
Commonfibular (peroneal)nerve
Articular branch
Articular branch
Plantarismuscle
M e d i a ls u r a l cutaneous nerve
Sural communicating branch
Castrocnemiusmuscle
C o m m o nf i b u l a r (peroneal) nerve via lateralsural cutaneous nerve
S u r anl e r v e Medialsural cutaneous nerve Soleum s uscle
From sciatic nerve
Tibialnerve Medial
plantarnerves
Plate 54O
(peroneal)nerve Suralnerve
Lateralcalcaneal branches
calcanealbranches
Medial and lateral
Superficial fibular
Tibial nerve via medial calcaneal branches
Lateraldorsal cutaneousnerve
Neurovasculature
Tibial Nerve
) erve C o m m o n f i b u l a r( p e r o n e a l n
Tibialnerve (L4,5,51,2,31
Articular branch
nerve(cut) Lateralsuralcutaneous M e d i a sl u r a l cutaneousnerve
4{F
Medial calcaneal
branches (s1,2) Articularbranch
Medial
From tibial nerve
plantar nerve (14, 5)
Plantaris muscle
Lateral plantar nerve
(s1,2) Gastrocnemius muscle(cut)
Saphenousnerve
(L3,4) Suralnerve
Nerveto popliteusmuscle
(S1,2)via lateralcalcaneal and lateraldorsal cutaneous branches
P o p l i t e um s uscle
Cutaneousinnervationof sole
Interosseousnerve ot Flexor retinaculum
Soleusmuscle(cut partly retracted)
Flexordigi
longusmuscle
Tibialisposterior
Flexorhallucis l o n g u sm u s c l e
Suralnerve (
Lateralplantar nerve
Tibial nerve Medial
Nerveto abductor digitiminimimuscle
calcaneal Dranc
Medialplantar nerve Flexordigitorum brevis muscle and nerve
A b d u c t o hr a l l u c i s m u s c l ea n dn e r v e Flexorhallucis brevismuscle ano nerve
Lateralcalcanealbranch
1 s tl u m b r i c a l m u s c l ea n d l]€IV€-
Medial calcaneal branch
Flexorretinaculum(cut)
Common plantar digital ner Proper plantar digital nerves
Lateralcalcaneal branch of sural nerve
,l
{
Quadratusplantae muscleand nerve Abductor digiti minimimuscle
Deepbranch to interosseous muscles, 2 n d , 3 r da, n d4 t h lumbricalmuscles and Adductorhallucis muscle branch to 4th interosseous muscle ano F l e x odr i g i t im i n i m i brevismuscle Common and plantar
Note: Articular branchesnot shown
Neurovasculature
Plate 541
Gommon Fibular (Peroneall Nerve
Commonfibular (peroneal) nerve
Lateralsuralcutaneousnerve (phantom)
(phantom)
Articularbranches
*{r
Bicepsfemoris tendon
Recurrent articularnerve Commonfibular(peroneal) nerve(L4,5,51,2')
Extensor digitorumlongusmuscle(cut)
Headof fibula Deep fibular (peroneal)nerve (peroneus) Fibularis longusmuscle(cut)
Tibialisanteriormuscle
Cutaneousinnervation
Superficialfibular (peroneal)nerve
Branches of lateral suralcutaneous
(peroneus) Fibularis l o n g u sm u s c l e
Extensor digitorum longusmuscle
xtensorhallucis l o n g u sm u s c l e
F i b u l a r i(sp e r o n e u s ) brevismuscle
Medial dorsal cutaneousnerve
Superficial fibular (peroneal)nerve
Inferiorextensor (partiallycut\ retinaculum
Lateraldorsal cutaneous nerve (branch of sural nerve)
Lateralbranchof deepfibular (peroneal) nerveto Extensor hallucisbrevis and tensordisitorumbrevis muscles Medialbranchof deepfibular (peroneal) nerve
Deep fibular (peroneal) D€l'V€ r
Suralnerve Dorsal digital nerves
Plate 542
via lateraldorsal cutaneousbranch
Neurovasculature
Dermatomes of Lower Limb
Schematic demarcationof dermatomes (accordingto Keeganand Carrett)shownas distinctsegments. Thereis actually considerable overlap between any two adjacent dermatomes.An alternative dermatomemap is that provided by Foerster(see References).
Autonomous sensoryzones
Posteriorview
Anterior view
Segmentalinnervation of lower limb movements
I
*,, r
Dorsiflexion
$r
5 1' 2 Plantarflexion
J{eurovasculaturc
PHo 543
Superficial Nerves and Veins of Lower Limb: Anterior View
Lateralcutaneous b r a n c ho f s u b c o s t anl e r v e Superficialepigastricvein I n g u i n a l i g a m e n t( P o u p a r t ' s
l r a n c h )( u s u a l l y l l i o i n g u i n anl e r v e ( s c r o t a b p a s s e st h r o u g hs u p e r f i c i ai ln g u i n a lr i n g )
S u p e r f i c i acl i r c u m f l e xi l i a cv e i n Femoralbranches of genitofemoral
Cenital branch of genitofemoralnerve Femoralvein
Lateralfemoral cutaneous uperficialexternalpudendal vein S a p h e n o u so p e n i n g( f o s s ao v a l i s ) Accessorvsaphenousvein Fascialata C r e a t s a o h e n o u sv e i n A n t e r i o rc u t a n e o u s branchesof femoral nerve C u t a n e o u sb r a n c h e so f o b t u r a t o rn e r v e
Patellarnerve plexus
Infrapatellarbranch of saphenousnerve
l ranch S a o h e n o u sn e r v e ( t e r m i n a b of femoral nerve) B r a n c h e so f l a t e r a sl u r a lc u t a n e o u sn e r v e ( f r o m c o m m o n f i b u l a r[ p e r o n e a l ]n e r v e ) C r e a t s a p h e n o u sv e i n Deep fasciaof leg (cruralfascia)
S u p e r f i c i af li b u l a r( p e r o n e a l )n e r v e M e d i a ld o r s a l c u t a n e o u sb r a n c h I n t e r m e d i a t ed o r s a l c u t a n e o u sb r a n c h
S m a l ls a p h e n o u sv e i n a n d l a t e r a l d o r s a lc u t a n e o u sn e r v e ( f r o m s u r a ln e r v e ) Lateraldorsal digital nerve and veinof 5th t
D o r s a ld i g i t a ln e r v e s
Nry
Dorsal venous arch
D o r s a ld i g i t a ln e r v ea n d v e i n o f m e d i a ls i d eo f g r e a tt o e Dorsal metatarsalveins Dorsal digital branch of deep fibular (peroneal)nerve Dorsal dieital nervesand verns
Plate 544
Neurovasculature
Superficial Nerves and Veins of Lower Limb: Posterior View
Lateralcutaneousbranch nerve of iliohypogastric lliaccrest Medial clunial nerves(from
d o r s arl a m io f 5 1 , 2 , 3 )
Superiorclunialnerves(from d o r s arl a m io f L l , 2 , 3 ) Inferiorclunialnerves(from nerve) posteriorfemoralcutaneous
Perforatingcutaneousnerve (from dorsal rami of S1,2, 3)
Branchesof posterior femoral cutaneousnerve
A c c e s s o r ys a p h e n o u sv e i n
Branch of cutaneous branch of femoral nerve
Great saohenousvein
Terminalbranchesof posterior femoral cutaneousnerve
Lateralsuralcutaneous nerve (from c o m m o n f i b u l a rI p e r o n e a l ]n e r v e )
S m a lsl a p h e n o uvse t n Suralcommunicating nerve Branchesof saphenousner Medial suralcutaneousnerve (from tibial nerve)
S u r a ln e r v e
Lateralcalcanealbranchesof suralnerve
Medial calcanealbranchesof tibial nerve
4{F
P l a n t a rc u t a n e o u sb r a n c h e s of medial olantar nerve
Neurovasculature
Lateraldorsal cutaneousnerve (continuationof sural nerve)
of branches Plantarcutaneous lateralolantarnerve
Plate 545
Lymph Vessels and Nodes of Lower Limb
Cribriform fascia within saphenous openrnS
Small s a p h e n o uvs
Deep fascia of leg (crural fascia)
Externaliliac lymph nodes
Femoralnerve
Femoralring Creat s a p h e n o u sv e i n
lnguinal ligament
(Poupart's)
Lacunar ligament (Cimbernat's)
Ductus(vas)deferens Femoral sheath Femoralcan (opened)
Femoralartery and vein
Creat saphenousvein
Plate 546
Deep inguinal lymph nodes
Neurovasculatune
GT Angiograms of Arteries of the Lower Limb
Regional Scans
Plate 547
Section I Gross-Sectional Anatomy Plate 548
Sections forCross s+e KeyFigure
Atlas of Human Anatomy
Gross-Sectional Anatomy
Key Figure for Gross Sections
Plate 548
References
Plate 58 Plates 2911 292 Braus H. Anatomiedes Menschen.Berlin,Verlagvon Julius EliasH. Livermorphology.Biol Rev 1955;30:263. Springer,1924. Origin and early developmentof the liver in variousver_. Plate 89 tebrates.Act Hepat 1955;3:1. NishidaS. The Structureof the Eye. New York, ElsevierNorthMorphology of the liver. In Liver Injury Trans 11th _. Holland,'1982. Conference.New York, Macy Foundation,1953. Pfates I16, 1 17, 127 A re-examinationof the structureof the mammalianliver: LachmanN, Acland RD, Rosse C. Anatomicalevidencefor the _. the hepatic lobuleand its relationto the vascularand biliarysysabsence of morphologicallydistinct cranial root of the accestem. Am Anat J 1949;85:379. sory nervein man.ClinAnat 2O02:15:4. A re-examinationof the structureof the mammalianliver: _. Plates 164, 482, 525, 543 parenchymalarchitecture.Am J Anat '1949;84:311. FoersterO. The dermatomesin man. Brain 1933;56:'l. Garrett FD. The segmentaldistributionof the cutaneousnerves Plates 3O5, 3O8 Michels NA. Blood Supply and Anatomy of the Upper in the limbsof man.Anat Rec 1948;1O2:4O9. Abdominal Organs, With a DescriptiveAtlas. Philadelphia,JB Keegan JJ. Dermatomehypalgesiawith posterolateralhernia- Lippincott,1955. tion of lower cervical intervertebraldisc. J Neurosurg 1947; Plate 326 4 : 11 5 . Thomas MD. In The Ciba Collectionof Medical lllustrations,Vol Plale 172 3, Part ll. Summit,NJ, CIBA,p 78. Turnball lM. Bloody supply of the spinal cord. In Vinken pJ, Bruyn GW (eds): Handbook of Clinical Neurology, Xll. P l a t e s 3 4 8 , 3 6 1 , 3 8 4 , 3 9 6 , 4 1 4 StormontTJ, Cahill DR, King BF,Myers RP.Fasciasof the male Amsterdam,North-Holland , 1912,pp 47849i. externalgenitaliaand perineum.ClinAnat 1994;7:115. Plates 2OO,2O1 Jackson CL, Huber JF. Correlated applied anatomy of the Plates 356, 360,365, 37O,378, 379 bronchialtree and lungs with a system of nomenclature.Dis OelrichTM. The striated urogenitalsphinctermuscle in the female.Anat Rec 1983;205:223. C h e s t1 9 4 3 ; 9 : 3 1 9 . Plates 359, 361 Plate 2O3 lkeda S, Ono Y MiyazawaS, et al. Flexiblebroncho-fiberscope. Myers RP,GoellnerJR, Cahill DR. Prostateshape, externalstriated urethralsphincter and radical prostatectomy:the apical Otolaryngofogy(-fokyo)197O; 42:855. dissection.J Urol 1987:138:543. Plale 225 James TN. The internodalpathwaysof the human heart. prog Plates 359, 361, 383, 384 Oelrich TM. The urethralsphincter muscle in the male. Am J CardiovasDis 2001;43:495. Anat 1980;158:229. Plates 253, 366, 37O, 383 MyersRP,King BF,CahillDR. Deepperineal"space,'asdefined Plate 4O3 by mag,neticresonance imaging. Presented at 14th Annual Flocks RH, Kerr HD, ElkinsHB, et al. Treatmentof carcinomaof prostate by interstitialradiationwith radio-activegold (Au Scientific Session of the American Associationof Clinical the 198): a preliminary report.J Urol 1952;68(2):510. Anatomists,Honolulu,Hl, 1997.[Abstract:ClinAnat 1998;11]. Plate 482 Plate 282 Keegan JJ, Garrett FD. The segmentaldistributionof the cutaDiDio LJA. Anatomo-Fisiologiado Piloro ileo-ceco-colicano neous nerves in the limbsof man.Anat Rec 1948:102:409. homen. Actas das Primeiras Jornadas Interuniversitarias Argentinasde Gastroenterologia, Rosario,1954. Plate 543 Dados anatomicos sobre o "piloro" ileo-ceco-colico. KeeganJJ. Neurologicalinterpretationof dermatome hypalge-. disc. J Bone Joint (Com observacao direta in vivo de "papila" ileo-ceco-colico.) sia with herniationof the lumbarintervertebral Surg 1944; 26:238. paulo, summary]. Thesis,Fac Med, Univde Sdo [English 1952. Last RJ. Innervationof the limbs. J Bone Joint Surg 1949; Plate 29O 3 1(B):452. HealeyJE Jr, Schroy PC. Anatomy of the biliaryduct within the human liver:analysisof the prevailingpattern of branchingsand the majorvariationsof the biliaryducts. Arch Surg 1953;66:5g9. HealeyJE Jr, Schroy PC, S6rensenRJ. The intrahepaticdistributionof the hepaticarteryin man.J Int Coll Surg 1953;20:133.
Atlas of Human Anatomy
Index
Referencesare to olate numbers.In most cases,structuresare listed under singular nouns.
A Abdomen,268 autonomicnervesand gangliaof, 318 axial CT imagesof, 350 bony frameworko1,248 cross sections of at L3, 349 at L3, 4, 349 at L1-L2, 339 at T10,293 atr12,297,331,338 innervationof, 318 left lower quadrant of, 268 left upper quadrantof, 268 regionsand planesof, 268 right lower quadrantof, 268 right upper quadrantof, 268 subcutaneoustissue of, 249 surface anatomy ot,247 visceraof, 269 Abdominal aortic plexus. See lntermesentericolexus Abdominalis muscle, ttansyetsust 362 Abdominal muscles, transversus, 363 aooneurosisof, 252 Abdominal wall anterior,249,265 arteries of, 255 deeo dissectionof, 251 intermediatedissectionof, 250 internalview of, 253 nerves of, 257 superficialdissectionof, 249 veins of, 255 arteries of, 263 internalview of, 263 lymph vesselsand nodes of, 266 nervesof, 267 peritoneumof, 274 veins of, 265 median(sagittal)sectionof, 348 posterior arteriesof, 264 internalview of, 263 lymph vesselsand nodes of, 266 nervesof, 267 peritoneum of, 274 veins of, 265 posterolateral, 254 Abdominis aponeurosis, transver. sus, 252, 330, 349 Abdominis muscle aponeurosisof, 255, 330 rectus,181,188, 189, 192,247, 250, 251, 258, 259, 293, 349, 351, 378 axial CT imageof, 350 capsularbranchof, 335 cross sectionof, 252 oelvic branchof, 335
Atlas of Human Anatomy
Abdominis muscle (Continued) sheathof, 189 transversus, 25, 94, 96, 179,189,255, 257, 258, 263, 267, 329, 498 aponeurosiso'f, 252, 330, 349 tendonof originof, 175,176,179 Abducent nervc (Vll' 83, 84, 86, 114, 1 1 7 .1 1 8 .1 2 1 of, 118 distribution schemaof, 118 Abducent nucleus, 116, 1 17, 121 Abductor digiti minimi muscle' 465, 470,476,533,534,536,541 nerveto, 534 tendon of, 533 Abductor hallucis muscle, 533, 534, 535, 541 insertionot, 534, 536 Abductor hallucis newe' 541 Abductot pollicis brevis muscle' 4 6 1 ,4 6 5 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 (Xll' 34,114,116, 1 1 7 ,1 2 9 , 1 7 7 cranialroot ot, 126, 127 s c h e m ao l , 1 1 8 , 1 2 7 soinalnucleusof, 116, 117 spinalroots ot, 10, 118,127 Accessory oculomotor nucleust 116,117,121,132 Acetabular fossa' 376, 487 lal in, 487 transversesection of, 376 Acetabular labrum' 352, 487 Acetabular ligamentr transvetset 352,487 Acetabular notch, 352, 486 Acetabulumt 352,486 anteroposteriorradiograph of , 488 articularsurfaceof, 376 lunatesurfaceof, 486 marginof, 352, 353, 486 radiograph of, 355 Achilles tendon. See Calcaneal (Achilles)tendon Acinus,204 Acoustic attety' internal. See Labyrinthineartery Acoustic meatus external,8, 13, 92, 93 auricularbranchof vagus nerveto, 24 axialCT imagesof, 150 axial MR imageof, 150 cartilaginousand osseous,93 coronalobliquesectionof, 93 internal,92,97, 123 Acoustic openingr internal' 97 Acromial anastomosis' 427 Acromial angle' 420, 421 Acromiaf glexusr 427
Acromioclavicular ioint' 423, 425 caosuleof, 423 Acromioclavicular ligament' 423 Acromion, 27, 185, 188, 418, 42O,423, 424, 425, 427, 429, 432 anteroposteriorradiographof , 422 arteiy ol, 171 Adamkiewicz' Adductor brovis muscle' 489, 493, 539 attachmentsof, 489, 491 Adductor Ganal' 500 Adductor hallucis muscle' 541 deep tibial nerve branch to, 541 insertionof, 536 obliquehead of, 535 transversehead of, 535 Adductor hiatus' 539 femoral artery passing through, 512 Adductor longue muscler 376,489, 492,493,500, 505, 539 attachmentsof, 489, 491 innervationof, 540 transversesection of, 521 Adductot magnus muscle' 485,489' 495, 500, 502, 505, 540 adductor minimuspart of, 493 attachmentsof, 489, 491 hiatusof, 493 innervationof, 540 tendon of, 493 Adductor magnus tendonr 501,506, 510,511 Adductot muscles' thigh' 496 Adductor pollicis muscle' 462, 465' 476, 535 fasciaover, 460,462 Adductot tubercle' 489 Adenohypophysis, 140, 147, 148 cletl ot, 147 Adnexa,371 Afferent fibers, ollaclory bulb' 119 Affetent nerves of mouth and pharynx,62 of nose and sinuses,210 of stomachand duodenum,321 Agger nasir 37, 38 Aglomerular a?teriol€' 337 Air, in colon' radiograPh of' 355 Air cells, mastoidr axial llR image of' 150 Airway 204 intrapulmonary, to nasopharynx,37 Airway reflexes, newes initiating' 210 Ala,8 lateralpart of, 157 wing of, 157 Alar fibrolatty tissuer 36,38 Alar fold, 507 Alar ligament, 22 Albini's nodules. See Fibrous(Albini's) nodule Alcock's canal. See Pudendalcanal (Alcock's)
Alveolat artery anteriorsuperior,40 inferior,40, 53, 60 lingualbranchof, 69 mentalbranch of, 40, 69 middlesuperior,40 posteriorsuperior,40, 69 Alveolar duct, 204 openingof, 204 Afveolar nerve, 53, 55,122,131,134 anteriorsuperior,45 nasalbranchof, 42 inferior,16, 40, 53, 55, 60, 131, 134 branchof, 40 enteringmandibularforamen,46 middlesuperior,45 posteriorsuperior,44, 45 superior,62, 71 Afveolar sac,2O4 Alveolar vein inferior.60. 70 posteriorsuperior,60, 70 Alveolus, 204 capillarybed in, 205 Amacrine cells, 120 Ampulla ear,95, 96 semicircular,92 of uterinetube, 372 Amygdaloid body, 110,112, 119 thalamusand, 110 Anal canal,393 anatomical,393 arteries of, 398 beginningof, 376 beginningof, transversesectionof, 357, 521 longitudinalmuscleof, 356, 357 muscularismucosaeof, 393, 394 sagittalMR imagesof, 397 surgical,393 veins of, 399 Anal columns,393 Anal glands,393 Anal nerve, inferior, 41O,411, 414, 496, 503 Anal pit, 388 Anal sinus, 393 Anal sphincter muscle external,356, 358, 360, 365 deep part of, 394, 395, 396 peripheralview of, 395 subcutaneousof, 391, 393, 395, 396 superficialpart of, 391, 393, 394, 395 internal,393, 394 Anal triangle, 380 Anal tubercle, 388 Anal valve, 393 Anal verge, 393 Anastomosis aroundelbow,434 aroundscapula,427 carotid-vedebral,138 gastro-omental arlerial,272 in incisivecanal,40 obturator-pubicarterial,259 paravertebral,172 patellar,500, 512 portacaval,312 right-|eft,138
l-2
Anastomosis (Continued) between septal sphenopalatineartery and greater palatine arlery, 41, 138 subclavian-carotid, 138 subclavian-vertebral, 138 Anastomotic branch, 3Ol Anastomotic loop of ilealarteries,280 of jejunalarteries,280 of posteriorspinalarteries,171 of small intestinalveins,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 nerveto. 432 originof, 421 Angular artery, 23, 36, 68, 85, 138 Angular gyrus, 105 cerebralarteryto, 141 cerebralbranchesto, 141, 142 Angulal vein,23,70,85 Ankle dorsiflexionand plantarflexionof, 543 lateralligamentof, 514 ligamentsand tendonsof,514 ligamentsof, 527 medialligamentof, 514 radiographof, 526 tendonsof, 527 Annular ligament of radius,438 of trachea,202 Anococcygeal body, 380, 381, 395, 396 Anococcygeal neiYe, 411, 412,499 Anocutaneous line, 392, 393, 394 Anoderm,393 Anorcctal hiatus, 358 Anorectal junction, circular muscle layer of, 359 Anorectal line, 393 Anorectal musculature, 394 Ansa cervicalis, 31, 32,128, 129 inferiorroot ot, 32, 34, 71, 74, 128, 129 superiorroot of, 32, 34, 71, 74, 128, 129 ventralrami of, 128 Ansa of Galen, 80 Ansa subcfavia, 130, 2O9,226, 24O Anserine bursa, 506, 507 Antebrachial vein intermediate.418.479 median,449 Anterior chamber, 81, 87, 88, 89, 90 endotheliumof, 88 Anterolateral central arteries, 140, 141 Anteromedial central arteries, 140 Antidromic conduction, 167 Antihelix, 1, 93 cruraof, 1, 93 Antitragus, 1, 93 Anulus fibrosus, 19, 155 Anum, fibrcus septum of,394 Anus, 360, 377, 38O,382, 388, 395 fetal, 388 transversefibrousseptum 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 sectionof, 338 abdominal,412 a r c ho f , 2 3 7 , 2 4 4 ascending,138, 215, 22O,223,224,225, 242,245 axjal CT imagesof, 242,350 descending,237, 242, 245, 246 thoracic,194,242 prenatal,229 thoracic,172,297 cross section of. 297 descending,172, 231, 241 esophagealbranchesof, 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, 41O,415 right,318, 320,323 superiormesenteric,267 Aortic pfexus, 321, 322, 412 Aortic sinus,223,224 Aortic valve anatomy ot,223 semilunarcusps of, 221, 222, 223, 224, 225 left,224 Apical foramen, 53 Apical ligament, of dens, 63,65 Appendicular artery, 281, 306, 307, 322,323 Appendicular nodes, 317 Appendicular plexus, 322, 323 Appendicular Yein, 311, 312 Appendir, 126 fibrous,287 vermiform,271, 281, 283, 284, 362, 363 aggregatelymphoidnodulesot, 283 barium radiographof, 283 circularmuscleof, 283 fixed retrocecal,283 oritice o1,282 serosa of, 283 submucosaof. 283 variationsin positionof, 283 Arachnoid, 102,109 cerebralveins penetrating,102 Arachnoid-dura interface, 102 Arachnoid granulation, 100, 102, 109 granular foveola for, 99 skull indentationfor, 99 Arachnoid mater, 169 lumbar,170 thoracic,170 Arantius, body olr223
Atlas of l{uman Anatomy
Arch of aorla,74, 75, 80, 138, 206, 210, 2 1 1 ,2 1 2 ,2 1 3 ,2 14 , 2 1 5 ,2 2 1 ,2 3 2 , 233 groove for, 'l99 radiographof, 213 Arcuate artery, 335, 337, 530, 531, 536 afferentglomerulararteriolefrom, 337 lymph vesselsalong,343 Arcuate eminence, 9 Arcuate ligament dorsal radialmetaphyseal,455 lateral,195, 263 medial,195,263 median,195,263 Arcuate line, 248, 251, 255,259,279, 348, 352, 353, 356, 486 sectionabove,252 sectionbelow,252 Arcuate nucleusr 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 anteriorclosed space ol tinger,471 Areolar venous plexus, 256 Arm. See a/so Forearm arteriesof, 484 cutaneousnervesof, 479,481 inferiorlateral,432,477, 479, 481 medial,257, 429, 432, 435,473, 474, 479 posterior,432, 477, 479, 481 superiorlaleral, 432, 477, 478, 479, 481 deep artery of , 429, 432, 433, 434, 435 middlecollateralbranchof, 445 musclesof, 432 anteriorviews of, 430 deep layer oI,43O,432 posterior,432 posteriorview ot,432 superficiallayerof, 430,432 superiorlateral,432 neurovascularcompartmentof, 435 radial nerve in, 477 serialcross sectionof, 435 superficialveins of, 480 Arr€ctor muscle, hair follicle, 167 Arteriae rectae, 307 Arteriogram, celiac, 303 Arteriole 291 intralobular, periportal,291 portal,291 Artery(iesl. See a/so specific arteries of anteriorabdominalwall, 255 ol atm,484 to brain,136-137,138,1 41, 142 frontalview of, 141 lateraland medialviews of, 142 colic, 308 of duodenumand head of pancreas, 301,304 of esophagus,237 of face, 23 of femalepelvicorgans,400 of femalepelvis,403 of femaleperineumand uterus,405 of femoralhead, 504
Atlas of Human Anatomy
Arteryfiesf (Continued) of femoralhead and neck, 504 of fingers,471 of foot, 536 of foot, deep, 536 of hand, palmarview of, 466 of head,23 of hip and thigh, 500-502 of hypothalamusand hypophysis,148 intrarenal,335 intrinsicdistributionof, in spinalcord,172 of largeintestine,307 of liver,301 of liver,pancreas,duodenum,and spleen,301,305 of liverand gallbladder,variationsin, 305 of male pelvis,403 of male oerineum,405 of mammarygland, 183 to meninges,136 of nasal cavity, 41 of neck, 504 of oral and pharyngealregions, 69 of oral region,69 of pancreas,301 of posteriorabdominalwall,264 of posteriorcranialfossa,142,143 of rectum and anal canal.398 renal,335 of scalp,23 of spinalcord, 171 of spleen,301 of stomach,liver,and spleen,300 of testis,401 of thigh anteriorview of, 501 posterior view of, 502 of upper limb, 473 computedtomographyof, 484 at wrist, 461 Articufar cavatyr 4Tl of finger,471 Articular disc, 16, 243 Articularis genus muscle, 505, 507, 511,538 attachmentof, 489 Articular newe great, 32 recurrent,542 Articular pnocess inferior,lumbar,155 superior,lumbar,155 Articular tubercle, 55 Aryepiglottic fold, 66, 67, 78 Aryepiglottic muscle, 78, 80 Aryltenoid muscle oblique,67, 78, 79, 80, 235 transverse,63, 78, 79, 80, 235 action of, 79 Atlantoaxial ioint, 19 lateral,19 capsuleof, 21 median,superiorview ot,22 radiographof, 17 joint caps,uae, 21, 22 Atlantooccipital Atfas (Gf f, 13, 17, 19,22, 153,160 anterior,21 anteriorarch of, 5, 17, 19,37,62, 137 anteriortubercleof, 19 dens of, articularfacet for, 17 inferiorview of, 17
Atlas lGl) (Continued) lateralmass of, 17 occipitalcondyleof, 17 posterior,21 posteriorarch of, 17,18,178 posteriortubercle ot, 17, 175, 176 spinousprocessof, 18 superiorarticularfacet for, 17 superiorview of, 17 transverseforamenof, 17 transverseprocessot, 17, 21,30, 39, 176 Atrioventricular bundle' 225 Atrioventricular node' 22, 218, 225 Atrioventricular valve left. See Mitralvalve right.See Tricuspidvalve A|lium,224 internodalconductionpathwaysof, 225 left, 214, 215, 220, 221, 224, 246 auricleot,212 obliqueveinof, 214, 215, 216 sectionthrough,221 right,212, 2'l'3,214, 215, 22O,223, 224, 241,246 opened,220 radiographof, 213 Auditory ossicles, 93 Auditory {pharyngotymPanic' Eustachianl tube' 92, 93, 96, 125,126 cartilageof, 47 cartilaginouspart of, 52, 55, 64, 65, 67 groove for, 8 openingof, 37 pharyngealopeningof, 63, 64, 66, 125 Auerbach's plexus. See MYenteric (Auerbach's)plexus Auricle, 92, 97 concha of, 93 teft, 212, 213, 215, 216, 224, 225 lobuleof, 93 oosteromedialsurfaceof, 24 right,93, 212, 214, 219,220, 224 Auricular attery anterior,23 deep, 40 posterior, 23,34,40,100, 136, 138,178 Auricularis antedor muscle' 26 Auriculads posterior muscle' 26 Audcularis supetior muscle' 26 Auricular muscler facial nerve branches to' 123 Auricular nervet 122 anterior,122 articular branch ol, 122 great,21, 22,24,32, 129,177,178 greater,31 posterior,25, 123 occipitalbranchof, 123 Auricular tubercle (of Darwinl' 93 Auricufar vein, poster-or, 23, 70 Auriculotemporal nerve, 16, 24, 40, 5 5 , 7 1 ,1 2 2 ,1 2 5 ,1 3 4 Auscultation' triangle ol, 152, 246, 424 precordialarea of, 213 Autonomic Aanglion, abdominal' 318 Autonomic netves of abdomen,318 in head,131
Autonomic nerves (Continued) of nasal cavily,44 to neck, 24 in thorax,209 Autonomic neryous system schemaof, 167 topographyof, 167 Autonomic plexus, intrinsic, 326 Autonomic reflex pathways, 325 Axilla dissectionof, 181 anteriorview of, 429 dissectionof, anteriorview,429 musclesof, 424 obliqueparasagittalsectionof, 428 obliqueparasagittalsectionof, 428 suspensoryligamentof, 428 Axillary artery, 183, 189,198,200,2S5, 427, 428, 429, 433, 434 acromialbranch of, 434 anteriorview of, 434 clavicular branch of, 434 computedtomographyof, 484 deltoid branch of, 434 pectoralbranchof, 434 posteriorview of, 434 Axillary fold, 181 anterior,181 posterior.181 Axif fary fossa, 243,244,245 Axillary lymph nodes, 428 along axillaryvein, 484 apical,184 brachial.184 central.184.428 lateral,483 along axillaryvein,483 parasagittalsection of, 428 pectoral,184,428 subscapular,lS4 Arif fary nerve, 177, 425,427, 429, 432, 476, 477. 481 superiorlateralcutaneousnerveof arm trom,479 Axillary tecess,423 Axillary tail lof Spence), 182, 183 Axillary vein, 189, 198,256,428 intercostaltributariesto, 256 lymph nodes along,483 Axis (G2f, 13, 17, 19,22, 153 anteriorview of, 153 b o d y o f ,1 7 , 2 1 dens of, 5, 17, 37, 63 inferiorarticularprocessof, 17 interarticularpaft ol, 17 left lateralview of, 153 pedicleof, 17 posterosuperiorview of , 17 posteriorarticularfacet of, 17 posteriorlateralview of, 153 posterior tubercle of transverse process of, 30 spinousprocessol, 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 imagesof, 242 groovefor, 199
l-4
B Babinski's sign, 101 Back bones and ligamentsof, 153-157 lumbarregion,cross sectionof, 179 musclesof deep layerof, 176 axial CT images of, 350 intermediatelayerof, 175 superficiallayersof, 174 nervesof, 177,179 surfaceanatomyof, 152 Bartholin's gland. See Vestibulargland, greater Basal nucleus, organization of, 110 Basaf vein, 144, 145, 146 Basifar artery, 140, 1 41, 143, 171 axial MR image of, 150 Basilar membtane, 96 Basilar venous plexus, 103 Basific 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 fasciaover,428 insertionof, 420 long head o1,424, 426, 428,433, 435, 474 originof, 420 tendonof, 243,244,245 short head ol, 424, 428, 430, 433, 434, 435,474 combined,244 originof, 420 tendon of, 425,432,433, 438, 446,447 long head ot, 423, 425, 430 short head of, 430 Biceps femoris muscle, 485, 489, 495, 503, 515 attachmentsof, 489, 515 long headof, 485, 494,495,540 attachmentsof, 491 short head of, 488, 494,495,540 attachmentsof, 491 tendon of, 506, 511, 514, 517, 520, 542 bursa of, 511 inferiorsubtendinous,506, 507 long head of, 353 Bicipital aponeurosis, 430, 433, 446, 480 Bifurcate ligament, 527 Bigeloq Y ligament ot, 487,496 Bile canaliculus,292 Bile duct, 126, 29O,291, 292 common, 167, 273, 274, 278, 279, 288, 294, 295, 297, 298, 300, 301, 304 cross sectionof, 338 hepaticducts joining,290 junctionwith duodenum,295 extrahepatic,294 union of pancreaticducts and, 295 Bile ductule, 290 intralobular, 290 periportal,29O,291, 292 Biliary tract innervationof, 327 intrahepatic,292 Bipolar cells, 120
Bladder-prostate junction, 376 Blood circulation intrapulmonary205 postnatal,229 prenatal,229 Bfood vessels, innervation o1,228 Bonefsf See a/so specific bones of abdomen,248 of cranialbase,9 of elbow,436 ol toot,523,524 of forearm,439 ot hand,474 of head,2-16 of lowerlimb,513,524 of nasal cavity and paranasalcavity, at birth,50 pelvic,352-353 of rightleg,513 ofthorax,185 of wrist. 453. 456 Bowel loop, entering hernial sac, 261 Bowman's capsule, 336 Brachial anastomosis, alound elboq 433 Brachiaf artery, 27, 30, 31, 183, 193, 198, 206, 211, 230, 427, 429, 447 branchesol,433,434 muscularbranch,433, 434 cords of , lateral, 428, 433 deep,429 computedtomographyof, 484 in situ, 433, 434 medial,428, 433 posterior,428 Brachial cutaneous nerye, superiol laletal, 177 Brachialis muscle, 420, 429, 430, 433, 435,446,447,448 insertionoI,420,438 originof, 420,421 Brachiaf plexus, 27,30, 31, 32, 129, 1 6 0 ,1 8 3 ,1 8 9 ,1 9 3 ,1 9 8 , 2 0 6 , 2 1 1 , 228, 230, 231, 232, 428, 429 anteriorand posteriordivisionsof, 430 communication to, 129 cords of lateral,428, 433 medial,428 posterior,428 medial.428. 433 posterior,428 roots of, 430 schemaof, 430 terminalbranchesof, 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 Yein, 74, 208 groovefor, 199 left,70, 75, 137,206, 211,212, 230, 231,243 right,75, 137,206,21O,211,212, 230, 243 Brachioradialis muscle, 418, 433, 444,446,447 originof, 420 Brachioradialis tendon, 448, 449
Atlas of Human Anatomy
Brain, 48 arteriesto, 136, 141, 142 frontalviews of, 141 inferiorviews of, 139 lateraland medialviews of, 142 schemaof, 138 coronalsectionof, 108 deep veinsof, 145 sagittalsectionof, in situ, 106 subependymalveins of, 146 ventriclesof, 108 Brainstem anteriorview of, 114 cranialnervenucleiin, 116, 117 medialdissectionof, 117 posteriorphantomview of, 116 schemaof, 117 sectioned,107 Bregma,7 Broad ligament, 389 anteriorlaminaot,372 of femaleureter,340 mesometriumof, 371 mesosalpinxof, 369 posteriorlaminaof,372 subdivisionsand contentsof, 372 uterine.360. 362 Bronchiaf artery, 204, 205, 207 esophagealbranch of, 207 inferiorleft, 207 left,199,231 esophagealbranch of, 237 inferior,237 superior,237 right,199, 2O7,230,237 suoeriorleft,2O7 variationsin, 207 Bronchial vein left,2O7 right,207 Bronchiole respiratory,2O4,205 terminal,204,2O5 Bronchomediastinal lymphatic trunkr 208 left, 266 right,266 Bronchopulmonary lymph nodes, 199,208,230,231 Bronchopulmonary segments, 200, 201 anteriorview of, 200 lateralview of, 201 medialview of, 201 nomenclaturefor, 203 posteriorview of, 200 Bronchus' 167,2O2,2o4, 234 anteriorbasal,203 anteromedialbasal,203 apicoposterior,203 elasticfibers of, 204 202 extrapulmonary, inferiorlobar,202 intermediate,202 intrapulmonary, 2O2,2O4 lateralbasal,203 left, 203 axialCT imagesof, 242 left mainbranchesof, 199,206,232, 233,241 lingular,202
Atlas of Human Anatomy
Bronchus (Continued) major,202 medialbasal,203 middle lobar,202,203 nomenclatureof, 203 oosteriorbasal.203 right axial CT imagesof, 242 intermediate,206 rightmainbranchesof,207,230,245 smooth muscleof, 204 superiorlobar,202, 2O3,2OG Brunnerts gland. See Duodenalglands Buccal artery, 40, 69 Buccal nerve, 24, 40, 46, 62, 71, 122 branchesof, 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 (Gowper'sl gland' 253, 361,366, 383, 384,389,417 duct of, 383 openingof, 384, 385 oerinealmembraneand. 348 orimordiumof, 389 Bulging septum,37 Bursa anserine.506. 507 fibularcollateral,507 of hand,462 iliopectineal,496 infrapatellar, 511 patellar,508 radial,460 subdeltoid,423 ulnar,460 Buttock, nerves of, 503
c Gf spinal nerve, 127 dorsal ramusof, 178 dorsal roots of, 114 exit of, 161 ventralramusof, 71 ventralroots of, 114 G2 spinal nerve,127 dorsalramusof, 177, 178 v e n t r arl a m u so f, 3 2 , 7 1 , 1 7 7 G3 spinal nerve, 19 dorsal ramusof, 177 v e n t r arl a m u so l , 3 2 , 7 1 ,1 7 7 G4 spinal nerrre, 127 G5 spinal nerve, Yenttal ramus of, 32 G8 spinal nerYe, 160 exit of, 161 G6 transverse process, 136 Gl vertebra. See Atlas (C1) G2 vertebra. See Axis (C2) G3 vertebra, 13 inferiorarticularfacet for, 19
G3 vertebra (Continued) tubercles of transverse process of anterior,26 posterior,26 C4 vertebra anteriortubercleof, 18 body of, 18 laminaof, 18 posteriortubercleof, 18 posterosuperiorview of, 17 G7 vertebra, 13, 153,160 posterior tubercle of transverse process of, 30 spinousprocessol, 18, 152, 174,175, 176,424 superiorview of, 18 Calcaneal artery lateral.534. 535 medial,534, 535 Calcaneal nerve lateral.534. 535 medial.534.535 Galcaneal lAchillesl tendon' 485, 5 1 5 ,5 1 6 ,5 1 7 ,5 1 8 ,5 2 ' 1 , 5 2 7 soleusmuscleinsertionin, 515, 517 Galcaneocuboid ligament' 527, 536 dorsal,527 plantat 528 Gaf caneofibular ligament, 514, 525, 527 Galcaneometatarsal ligamentr 532 Galcaneonavicular ligament' 527 plantar,527, 528, 536 Gafcaneus, 524, 527, 528 anteriortalar articularsurfaceof, 525 body of, 523,524,525 dorsal view of, 523 fibulal524 fibulartrochleaof, 523 functionalrelationsof, 525 groovefor tendon of flexor hallucis longus,523 lateralprocess,523, 533 lateralview of, 525 medialprocess,523 medialview of, 525 middletalar articularsurfaceof, 525 olantarview of, 523 oosteriortalar articularsurfaceof, 525 posteriorview of, 525 radiographof, 54 superiorview of, 525 sustentaculumtali of, 523 trochleaof, 524 tuberosityof, 485,488, 516, 517,523, 533. 534. 535 radiographof, 54 Calcar, 489 C a l c a r a v i s , 1 1 1 ,1 1 2 Gafcarine artery, 142, 143 G a f c a r i n e s u l c u s , 1 0 5 ,1 0 6 ,1 O 7 , 1 1 1 , 120 Gaf fosomarginal artery' 141, 142 Galot, cystic node of' 315 Galot, triangle of' 301 Galvaria, 102 inferiorview of, 7 superiorview of, 7 Galyx, maior,339 Gamper chiasm, 461 Camper's fascia, 348
I.5
Gamper's (fattyf layer of subcuta. neous tissue, 249, 361, 348, 378, 380 Ganal of Schlemm. See Scleral venous sinus (canalof Schlemm) Ganine teeth, 57 Gapiffary plexus, 148, 2O5 cortical.337 medullary,337 Gapitate, 452, 453, 455, 456, 461 anterior (palmar)view of, 452 coronal section of, 455 posterior (dorsal)view of, 452 radiograph of, 457 Gapitis muscle, rectus anterior,32, 47,73 anteriorand lateral,nervesto, 129 lateral,nervesto, 129 lateralis,30, 32 posteriormajor,175, 176,178 posteriorminor,175, 176, 178 Gapitohamate ligament, 454, 455 Gapitufum, 420, 436, 437 Gapsular artery, 335 Capsular ligament, 423 of shoulder.423 Gapsular vein, 337 Gapsule, internal, 141 Gardia, nodes around, 314 Cardiac nerve, cervical, 165 Gardiac notch, 236,275 Cardiac otificer 276 Gardiac plexus, 126, 165,2O9,226, 227,240 Gardiac vein anterior,216 of diaphragmaticsurface,216 great,216 middle,216 small,216 of sternocostalsurface,216 Gardinal ligament, 360, 364, 37O,371, 372,373 Garoticotympanic newe, 123, 125 Garctid arteria! arch, dorsalr 469 Garotid artery common, 23, 29, 31, 32, 33, 34, 71, 74, 75, 76, 100, 125, 128, 130, 133, 1 3 4 ,1 3 6 ,1 3 7 ,1 9 8 ,2 1 0 , 2 3 2 , 2 3 7 external,28, 32, 34,40, 59, 75, 76, 85, 86, 121, 123, 128, 130, 131 schemaof, 34 internal,10, 23,28,33,34, 44, 47,69, 71, 75, 76, 85, 86, 100, 123, 125, 1 3 0 ,1 3 1 ,1 3 2 ,1 3 4 ,1 3 8 ,1 3 9 ,1 4 0 , 1 4 1 ,1 4 2 caroticotympanicbranch of, 138 groove for, 9 left common, 74, 80, 137, 193, 211, 214, 243 left internal,142, 143 rightcommon,30, 80, 137,193 right internal,142 right lateral dissection of, 34 Carotid autonomic plexus, 10 Garotid body, 34, 125, 130, 210 Garctid canal, 10 externalopeningof, 8 for internal carotid artery 11 for internalcarotidnerveolexus,I Garotid groover 9
1.6
Garctid nerve llXf, 71 external,165,167 internal,130, 131, 133, 165, 167 Garctid plexus,86, 121, 131,209,226 common,130, 131 e x t e r n a l , 1 3 01,3 3 , 1 6 7 internal,86, 123,132, 165, 167 Garotid sheathr 28,32 cranialnervesin, 60 G a r o t i d s i n u s , 1 2 5 ,1 3 0 , 1 3 1 , 2 1 0 Garotid vein, common, 70 Garpal atterial arch, dorsal, 469 Garpal articular surtace, 439 Garpal bones,452 in abduction.453 in adduction,453 anterior(palmar)view of, 452 posterior (dorsal)view of, 452 Garpal ligament palmar,454, 460 transverse.See Flexorretinaculum Garpal tunnel, 461 palmarview of, 454 transversecross sectionof, 461 Garpometacarpal ioint, 455 articularcapsuleof, 454 capsuleof first, 455 Garpometacarpal ligament dorsal,455 palmat 454 Garpotriquetral ligament, 454 Gartilage 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 arylenoid,77,78 muscularprocessof, 78 vocal process of, 78 auricular,47 bronchial,204 corniculate,77 costal, 186, 248,293, 419 cross sectionof, 196 eighth,415 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 laminaot.77.78 longitudinalmusclebundleattached to,234 posterolateralsurface of, 234 prominenceover laminaof, 66 ol larynx,77 septal, 39 septal nasal,36 lateral process of, 38, 39
Gailifage (Continued) thyroid,28, 29, 31, 74, 196, 2O2,206, 233,234,235 laminao1,77,78 obliqueline of, 29 superiorhorn o1,77 tracheal,28,2O2 Gartifage lamina, lthyrold, 77 posterior border of, 67 Gauda equina, 160,161, 170,179,339 in lumbar puncture,162 Gauda equina arlery, 171 Gaudal mesonephric duct, residua of, 389 Gaudate nucleus, 141 anteriorvein of, 145, 146 bodyof,108,110 h e a do f , 1 1 0 ,1 1 1 ,1 1 2 ,1 4 5 posteriorvein of, 145 terminal,146 t a i lo f , 1 0 8 ,1 1 0 , 1 1 2 thalamusand, 110 transverseveins of, 145,146 Gavernous nerve, 166,41O,412 Gavernous plexus, 121 Gavernous sinus, 85, 100, 104, 136, 140 coronalsectionthrough,104 efferent hypophysealvein to, 148 emissaryvein communicatingwith, 70 superiorview of, 104 Gecal artery, 323 anterior,281, 306, 307 posterior,281,307 Gecal fold, 281, 362, 363 Gecal plexus, 323 Gecal vein a n t e r i o r , 311, 3 1 2 posterior,311,312 Gecum, 126, 269, 272, 281, 284, 362, 363 variationsin posteriorperitonealattachment of, 281 vascularfold of, 281 Geliac ganglion, 44, 126, 165, 167, 168, 219, 267, 318, 320, 321, 323, 324, 325, 327, 328, 331, 345, 346, 409 Geliac lymph node, 266,314,315 Geliac plexus, 126,165, 166,240,319, 320,322,323,344,345,346, 410, 415 posteriorvagaltrunk to, 240 vagal branch to, 240 Geliac trunk, 165, 195, 206, 278, 298, 300, 305, 321, 324, 328, 329, 333 arteriogramof, 303 bifurcationof, 297 common originof, 302 cross section of, 338 prenatal,229 variations in, 302 Ceneus, apex of, 107 Gentral artery anterolateral,141 anteromedial,140 central, anterolateral,143 posteromedial,140 precentral,141 Gentral sulcus, 106
Atlas of Human Anatomy
Gentral vein, 290, 291 of liver.290. 291 Gephalic vein, 181, 188,189,256, 418, 424, 428, 429, 449, 468, 479, 480, 483,484 accessory 479,48O intermediate,480 Gerebellar artery anterior,140 anteriorinferior,136, 138,139, 14O,141, 143,171 posterior,141, 143 inferior,143 posteriorinferior,141, 171 superior,136, 138, 139, 140, 141, 143, 171 Gerebellar hemispheric vein, infe. riot, 144 Gerebellar notch anterior,97 posterior,97,113 Cerebellar nucleus, 113 dentate,113 emboliform,113 fastigial,113 globose,113 Gercbellar peduncle inferior,113, 144 inferior,superior,middle,144 middle,113,114, 144 superior,113, 114, 115, 144 decussation of,113 superiorplaneof, 113 Gerebellar tonsil, herniation of, 101 Gercbellar tonsillar artery, 143 Gerebellar vein hemisphericinferior,151 precentral,l44 superior,144 cistern Gerebellomedullary posterior,109 veinof, 144 G e r c b e l l u m , 1 0 6 ,1 1 1 , 1 1 5 ,1 4 6 anteriorlobe of, 113 axial MR imageof, 150 biventerlobe of, 113 dentatenucleusof, 115 flocculonodularlobe of , 113 flocculusof, 114 horizontalfissureof, 113 inferiorfovea of , 115 inferiorsurfaceof, 113 lateralrecessof, 115 lateralviews of, 105 medialeminenceof, 115 mediansagittalsectionof, 115 parts of, 144 posteriorlobeof, 113 oosteriorview of. 115 posterolateral fissureof, 107 sagittalMR image of, 149 secondaryfissureof, 107 superior fovea of, 115 superiorsurfaceof, 113 tonsio l f , 1 0 7 ,1 1 5 Cerebral aqueduct, 106, 107, 108, 109,146 Cercbral arterial circle (of Willisf, 139,140
Atlas of Human Anatomy
Gerebral artery anterior,136,138, 1 40, 141, 143 branchesof, 141 left. 142 right,142 terminalbranchesof, 142 communicating, 140 left anterior,142 left middle,142 middle,136, 138, 140, 14'l, 143 branchesof, 141 left. 142 temporalbranchesof, 141 posterior,136, 138, 140, 141, 143, 171 branchesto, 136,138 right,142, 143 temporalbranchesof, 143 terminalbranchesof, 142 right anterior,142 temporalbranchesof, 143 posteriorand anterior,142 terminalbranchesof, 142 Cerebral crus, 107, 113,114,139,145 Cercbral lalx,48 Gerebral fissure anterior,143 longitudinal, 107, 143,145 Gerebral hemisphere axialCT imagesof, 150 axial MR imageof, 150 medialsurfaceof, 106 Gerebral peduncle, 106, 115 Gercbral sulcus, lateral, 141 Gerebral vasculature, 136-1 38, 139-141, 143-144,145-146 Gerebral veine anterior,144, 145, 146 deep, 99 middle,144,145 great,103, 104, 106, 115, 144, 145, 146 quadrigeminalcisternof, 109 inferior,102, 1O4,145 internal,99, 108, 111,144,145,146 lateraldirect, 146 middle d e e p , 1 4 41, 4 5 , 1 4 6 superficial,145 penetratingsubduralspace,99 superficial,99, 102 middle,99, 102, 1O4 superiot102 openingof, 101 Gerebrospinal fluid, circulation of, 109 Cel€brum, 113 anteriorlobe of , 113 biventerlobuleof , 113 externalcapsuleof, 110 flocculonodular lobe,113 frontalpole of, 107 gyri of, 107 horizontalfissureof, 113 horizontalsectionsthrouoh.110 inferiorsurfaceof , 113 inferiorview of, 107 internalcapsuleof, 110 lateralviews of, 105 medialview of, 106 medialviews of, 106 occipitalpole of, 107 posteriorlobe of , 113
Gerebrum (Continued) oosterolateralfissure of, 113 sulciof, 107 superior surface of, 113 superiorvermisof, 113 temporalpole of, 107 t o n s iol f , 1 1 3 Gervical artery ascending,33, 69, 71, 74,75,76, 136, 138.171.427 d e e p , 3 3 1, 3 6 ,1 3 8 , 1 7 1 superficial,74, 75 transverse,32, 69, 74, 75, 76, 138, 177, 427, 429 Gervical canal, 371 Gervical cardiac newe' 166,209 inferior.165. 226 middle.165.226 superior,69, 71, 165, 226 sympatheticand vagal,226 Gervical curvatute, 18, 153 Gervical enlargementr 161 Gervical ganglion middle,165 superior,165,167 Gervical nerve, 130-133,134-135,161 branchesof, 25 superficial,177 transverse,24, 31, 71, 129 vertebraeand,127,161 Gervical plexus, 160, 177, 178, 481 ansa cervicalisol,32, 128 brancheslrom,24 in situ, 32 schemaot,32,129 supraclavicularnerves from, 479 Gervical spinal nerves, 160 c1.160 exit of, 161 C2, dorsal ramusof, 177 C3, dorsal ramusof, 177 C4, dorsal ramusof, 177 c8. 160 exit of, 160 dorsaframi o1,24, 32, 177 medialbranchesof,24 posteriorcutaneousbranchesof, 178 Gervical sympathetic catdiac nelYe inferior,130, 226,227 middle,33, 130, 165,226,227 superior,32, 60, 128,130, 132,133, 134, 165,226,227,240 Gervical sympathetic ganglion' middle, 32, 60, 130, 131, 132, 133,134,167 Gervical sympathetic trunk, 131, 240 vertebralganglionof, 240 Gervical vagal cardiac netve interior,227 superior,227 Gervical vein deep,137 left,137 right,137 right,deep, 137 177 suoefficial, 70,177 transverse,
l-7
Gervical yertebrae. See a/so Atlas (C1);Axis (C2); specific vertebrae anteriorview of, 17, 171 arteriesof, 171 articularpillaro1,21 costal facets of, 21 externalcraniocervicalligamentsof, 21 inferioraspect of, 18 lateralradiographof, 21 numberof, 161 right lateralview of, 21 superioraspect of, 18 superiorview of, 18 upper,17 Geryicis muscle, interspinalis, 176 Gervicofacial nerve, 25 Gervicothoracic (stellatef ganglion, 13, 130,165,209, 226,227, 240 esophagealand recurrent nerve branchesfrom,24O Gervix, 360, 364, 369, 370, 371, 372 externalos of, 371 sagittalMR imagesof, 397 C5 spinal nerue, ventral ramus of, 32 G4 spinal nerve,127 Gheek ligament, 83 Ghest axial CT images of, 242 radiographof, 213 Ghest drainage tubes, placement of, 190 Ghiasmatic cistern, 109 Ghief cell, 276 Ghoana, 8, 13, 14, 37, 38, 39, 52, 55, 66, 67 Gholangiole,292 Ghordae tendineae, 220, 221, 223 Ghorda tympani nerve, 62, 7 1, 93, 94, 122, 123, 124, 131,133, 134, 135, 165 Ghorcid,87,89,90 vasculararrangementswithin,91 Ghoroidal artery anterior,139, 140, 141, 143 posteriorlateral,139, 143 posteriormedial,139, 143 Ghoroid pfexus, 111,112,145 of fourthventricle,106,108, 109, 114, 115 of lateralventricle,108, 109, 110, 143, 145 of third ventricle,106, 108, 109 Ghoroid Yein, 91 bulb of, 91 Ghoroid vein, superior, 99, 145, 146 Giliary artery anterior,90, 91 recurrentbranch of, 91 long posterior,90, 91 posterior,85 short, 91 short posterio( 90, 91 Giliary bodn 87,90 blood vesselsof, 90 fibers of. 88 orbicularisciliarisof. 89 Giliary ganglion, 45,86, 121, 122, 131, 132,165,166,168 nasociliary root of,86, 131, 132 oculomotorroot of, 132 parasympatheticroot of,86, 121
l-8
Gif iary ganglion (Continued) roots of, 131 schemaof, 132 sensoryroot of, 86, 121,122,131 sympathetic root of, 86, 121, 132 Giliary muscle,87, 118, 121,132 circularfibers of, 88 meridionalfibers of, 88 Giliary nerve long, 86, 121, 122, 131, 132 short,86, 121,122,131,132 Giliary process, 87, 88, 89 Giliary vein, anterior, 88, 90, 91 Gingular ant.cty, 142 Gingulate gyrus, 106 isthmusof, 106, 107 Gingulate sulcus, 106 Gircle of Willis. See Cerebral arterial circle (of Willis) Gircular muscle,326 Gisterna chyli, 266, 314, 318 lumbar lymph trunk to, 343 Glaustrum, 110 Glavicle, 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, 425 acromialend of, 419 acromialfacet of, 419 anteroposteriorradiograph ot, 422 conoid tubercleof, 419 costoclavicularligamentimpressionon, 419 inferiorsurfaceof, 419 radiograph of, 422 right,419 shaftbody of,419 sternalend of,419 sternalfacet of, 419 subclaviangrooveof, 419 superiorsurfaceof, 419 trapezoidline of, 419 Glavipectoral fascia, 428 pectoralisminor muscleinvestedby, 188 subclaviusmuscleinvestedby, 188 Glavipectoral lossa, 428 Glinoid pnocess anterior,9 coronalCT imagesof, 151 posterior,I Glitoris 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 ot,267, 413, 414 frenulumof, 377 glansof, 377,388 prepuceof, 377 suspensoryligamento1,378, 379, 380 Glivus,9 surface of, 22 Gloquet, node of, 266, 408 Glunial nerve interior,177, 411, 413,503, 540, 545 m e d i a l1, 7 7 , 5 0 2 , 5 4 5 superior,177, 254, 502, 545 Goccygeal co?nu, 157 Goccygeal lagament, 160, 161
Goccygeal nerYe, 160, 161,499 vertebraeand, 161 Goccygeal plexus,499 schemaof, 499 Goccygeus (ischiococcygeusf muscle, 263, 358, 359, 398, 4 0 2 , 4 1 0 ,4 1 1 , 4 1 2 Goccyx, 153, 157, 160,161, 248,352, 353, 357, 376, 379, 391 anteriorinferiorview of, 157 posteriorsuperiorview of, 157 spinalnervesand, 161 tip of, 354, 357, 359, 376, 380, 382, 395 transverseprocess of, 157 Gochfea, 92,95,97 helicotremaof, 92, 96 osseous,92, 96 sectionthrough,92, 96 Gochlear aqueduct, 96 Gochlear cupula,95 Gochlear ganglaon, 124 Gochlear nerYe, 92, 95, 96, 97 distributionof. 118 posteromedialview of, 95 Gochlear nucleus, anterior and posterior, 116, 117, 124 Gochlear necess, 95 Gochlear window. See Roundwindow (cochlear) Gochleus, modiolus of, 96 Golic artery arc of Riolan between middle and left, 308 ascendingbranchof, 307, 398 descendingbranchof, 307, 398 lett,264,307, 318, 323,324,340, 398 middle,29O,298,301 , 306,307, 318, 322,323,340,348 absence of, 308 right,306, 307, 308, 322, 323, 34O absence of, 308 variations of, 308 Golic flexurc left, 126, 269, 270, 271, 272, 275, 278, 284,288,298,347 right,269, 288,297 Golic impression,287 Golic lymph nodes left.317 middle,317 right,317 Golic plexus lett,278,284,318,323 middle,322, 323 right,275, 322,323 Golic vein left,311, 312, 313 middle,298,303, 311,312 right,311, 312,313 Gollateral artery middle,432, 434,435 radial,434, 435 Gollateral eminence, 111 Gollateral ligament, 509 fibular,493, 499 radial.438 tibial,493, 514 ulnar.438 Gollateral sulcus, 106 Gollateral trigone, 111
Atlas of Human Anatomy
Gollecting lubule, 336, 337 schemaof, 337 Golles' fascia. See Superficialperineal (Colles')fascia Golliculus brachiaof, 114 inferior,106, 111 brachium of,111 left, 144 s u p e r i o r1,0 6 ,1 0 7 ,1 1 1 ,1 1 4 ,1 1 5 ,1 1 6 , 132.143.144 brachiumof, 111 left, 144 Goffi muscle, netves lo, 129 Golon air in, radiographof, 355 area for, 329 ascending,126, 269, 272, 278, 284, 339, 349 axial CT images of, 350 cross sectionof, 338 site of.274 circularmuscleof, 282 descending,167, 271, 278, 339, 342 areafor,329 cross sectionof. 338. 349 descendingfrom left colic flexure,297 from left colic flexure, 297 site ol,274 mucosaand musculatureoI,284 nerveto, 410 right colic flexureof, 297 cross sectionof, 297 sigmoid,167, 168,269,271, 284,391, 392, 393, 394,412 loopingto right side, 284 nerveto, 410 reflected,271 variationsin positionof, 285 transverse,269, 270, 273, 278, 284, 291, 294,298,299,339 ascendingto left colic flexure,297 axialCT imagesof, 350 cross section of, 338 tributary from, 309 tributaryfrom, 311 Gommissure anterior,106, 115, 146, 147 of fornix, 112 habenular. 106. 111 posterior,106, 111, 388 artery Gommunicating anterior,136, 138, 139,140, 141,142 posterio( 104, 136, 139, 140, '141, 142, 143 Gommunicating vein, 31, 137 Gompressor uTethra, female, 356 Compressor urethrae muscle, 367, 404 Gompressor urethrali$ muscle, 370 Gomputed tomography lCTl abdominal,350 of arteries of the arm, 484 of chest, 242 of head, 150 coronalimagesof, 151 of upper limb arteries,484 Goncha inferior,14 nasal.See Nasalconcha Gonducting syslem,225
Atlas of Human Anatomy
Gondylar canal, 11 Gondylar emlssary vein' 137 Gondyle lateral,489 medial,489 Goneus, 106 Gl spinal nerve, 133 dorsal ramusof, 178 dorsal roots of, 114 exit of, 161 ventralramus of, 71 ventral roots of, 114 Gl vertebra. See Atlas (C1) Coniunctiva, 91 bulbar,81, 83, 88, 90 inferiorpalpebral,81 palpebral,83 superiorpalpebral,81 Goniunctival artery, posterior' 91 Gonjunctival fornir inferiot 81 superior,81 Gonjunctival vein, posterior, 91 Gonjunctival vessels, 90, 91 Gonnective tissue of liver,291 subserous,326 Connective tissue sheath' 202 Gonoid ligament, 425,423 attachmentof,419 Gonus arteriosus, 212, 218, 220, 222, 224 Gonus elasticus, 78 Gonus medullaris, 160,161, 170,339 Gonvoluted tubule distal,336 oroximal,336 Gooper's ligament. See Pectinealligament (Cooper's) Goracoacromial ligament' 423, 425, 426,430 Goracobrachialis muscle' 244, 245, 429, 430, 433, 435, 474 fascia over, 428 insertionof, 420 originof, 420 Goracoclavicular ligamenl, 423 Goracohumeral ligamentr 423 Goracoid pnDcess, 185, 189, 420, 421, 423, 425, 427, 428, 429, 433 anteroposteriorradiograph ot, 422 Gornea, 81,83,87,88, 90, 91 Corneal limbus,81 Gorneoscleral iunction, 81 Gorniculate tubercle, 77 Goronal sulcus, 246, 385, 388 Goronal suture,2,5 Goronary artery branchof, 219 anteriorinterventricular diagonalbranchesof, 219 arteriographicviews of, 218,219 arterioventricular nodal branchof, 218 circumflexbranchof, 219 atrioventricular branchof, 219 conus branchof, 218 of diaphragmaticsurface,216 interventricular septal branchesof, 216, 217
Goronary attery/ (Continued) l e f t ,2 1 6 ,2 1 7 , 2 1 9 branchof, 216, anteriorinterventricular 217,219 circumflexbranch of, 2'16,217, 219 marginalbranchof, 216,217,218 openingof, 224 posterior interventricularbranch ot, 218 oosteriorleft ventricularbranchof, 217 posterolateralbranches of, 218, 219 right,217,218 atrialbranch ol. 216, 217 marginalbranchof, 216,217 openingof, 223 oosterior interventricularbranch of, 216,217 posterolateralbranchesof, 216 sinuatrialnodal branch ol, 216, 218 of sternocostal surface, 217 variationsin, 217 Goronary ligament enclosing bare area of liver,348 hepatorenalportion of, 287 of liver.287 Goronary sinusr 214, 215, 216,221, 233,241 openingot,220,223 valve ol,22O Goronary sulcusr 214 Gorcnary vein, variations inr 217 Goronoid fossa, 420 Goronoid pnocess' 15, 436, 443 radiograph of,422 Gorpora cavernosar 382 Gorpora quadrigemia' 107 Gorpus albicansr 371 Gorpus callosum, 106, 107, 108,111, 1 4 1 ,1 4 3 anterior,145 cisternof, 109 dorsalvein of,144,146 g e n uo f , 1 0 6 ,1 0 7 ,1 1 0 ,1 1 2 ,1 4 6 right dorsal branchto, 143 rostrumof, 106, 141 sagittalMR imageof, 149 spleniumof, 106, 107, 110,112, 143, 144,145,'t46 sulcusof, 106 trunkof, 106, 141 Gorpus cavernosum, 361, 382,383, 385 sagittalMR imagesof, 371,397 Gorpus luteumr 3Tl Gorpus spongiosum' 361, 366, 381, 382, 383 sagittalMR imagesof, 397 Gorpus striatumr 110, 141 Gorrugator cutis ani muscle' 393 Gorrugator supercilii muscle' 25, 36, 123 Gorti, organ of. See Spiral organ (of Corti) Gortical radiate artery' 335, 337 lymph vesselsalong,343 Cortical radiate vein' 337 Gostal facet inferior,187 superior,187 Gostal groove, 186 Gostal impression' 287
1.9
Costal pleural, 231, 232 Gostocervical trunk, 33, 69, 136, 197, 138 Gostochondral joint, 186 Gostoclavicular ligament, 186, 419 attachmentof,419 Gostocoracoid ligament, 1BB,4Zg Gostocoracoid membrane, 428 Gostodiaphragmatic recess, 198, 230, 231, 293, 330, 332, 342. 349 right,206 Gostomediastinal space, 331 lateral,198 superior,198 joint, 243 Costovertebral left lateralview of, 187 right posterolateral view of, 187 transversesection of, 187 Cough receptor,210 Gowper's gland. See Bulbourethral (Cowper's)gland Coral bone. See Hip bone Granial base bones of, 9 foraminaof, 10, 11 inferiorview of, 10 inferiorview of, 8 Granial fossa anterior,9 middle,9 posterior,I arteriesot, 142, 143 veins of, 144 posterior veins of, 144 Granial mesonephric lGartner'sf duct, 389 Granial mesonephric tubule, 389 Granial nerye, 116, 130-133,134-135 in carotidsheath,60 communicatingbranchof, 45 motor and sensorydistributionof, 118 nucleiof medialdissectionof, 117 posteriorphantomview of, 116 schemaof, 116 palsy of, 101 Granial nuclei, in brainstem, schema ol, 117 Graniocervical ligaments external anteriorview of, 21 posteriorview of, 21 right lateralview of, 21 internal,22 Cremaster fascia, 250 Gremasteric artery, 255 Gremasteric muscle, 25O,251, 2Sg, 261 lateraloriginof, 259 medialoriginof, 259 Gremasteric yessels, 260, 4O1 Gremaster muscle, 390 lateraloriginof, 259 medialorigin of, 259 Cribriform fascia, 546 Gribriform plate, 6, 9, 37, 39, 119 foraminaof. 11 Gricoaryrtenoid muscle lateral,78, 80 action of. 78. 79
1.10
Gricoaryrtenoid muscle (Continued) posterior,78, 80, 235 action of, 79 Gricopharyngeus muscle | 75, 76, 80, 233,234,235 Gricothyrcid altery, 69 Gricothyroid ioanl,77 pivot point of, 79 Gricothyroid ligament lateral, TT m e d i a n7, 4 , 7 7 , 2 0 2 Cricothyroid muscle, 126 action of, 79 obliquepart of, 79 straightpart of, 79 Grista galli, 3,6,9,39 coronalCT imagesof, 151 Grista terrninalis, 220, 225 Gross section of abdomen atLl-2,339,349 at L3. 349 at L3, 4, 349 at T10, 293 atT12,297,331,338 of descendingduodenum,179 forearm,serial,449 of gallbladder,297 of scrotum.390 of testis,390 Cruciate ligament, 22, 507, 5Og anterior,508, 509, 514 attachment of, 508 origin of, 514 inferiorlongitudinalband of, 22 posterior,514 attachmentof. 514 superiorlongitudinalband ol,22 transverse.22 G3 spinal nerYe, 19,127 dorsal ramusof, 178 ventraframus ot, 32, 71, 178 G2 spinal nerve, 133 dorsalramusot.177. 178 ventralramus ot, 32, 7 1, 177 Gubital fossa, 418 Gubitaf lymph nodes, 483, 484 Gubital node,483 Gubital vein intermediate,480 median,418, 479, 483, 484 Guboid bone, 523,524,527,536,537 articularsurfacefor, 525 base of, 523 dorsalview of, 523 groovefor fibularislongustendon insertion, 523 plantarview of, 523 radiograph of, 54 shaft of, 523 tuberosityof, 523, 524, 528, 536 Guboideonavicular ligament, plantaT, 528 Gufmen, 113, 115,144 Cuneate fasciculus, 114 Cuneate tubercle, 114 Guneiform bone intermediate,523, 536 lateral,523, 536 radiographof, 54
Guneiform bone (Continued) medial,523, 524,527, 536 plantarview of, 523 Guneiform tuberrle, 66, 67, 78 Guneocuboid ligament, dorsal, 527 Guneonavicular ligament dorsal,527 plantar,528 Cuneus, 106 apex of, 107 Guspid teeth. See Teeth,canine Gutaneous nerve(sl antebrachiallateral,469 dorsal,lower limb intermediate,540, 541, 542 laleral,542,545 medial,541, 542 femoral lateral,409 posterior,411 of forearm, medial, 469 of head,24 lateral antebrachial,447 lateral dorsal, 544 lateralfemoral,329, 499,538, 539 medial antebrachial, 429, 432, 469 of neck, 24, 31 perforating,411, 499 posterior antebrachial,469 superiorlateralbrachial,177 Guticle,471 Cl vertebra. See Atlas (C1) G2 vertebra. See Axis (C2) C3 Yertebra, 13 inferior articular facet for, 19 tubercles of transverseprocess of anterior,30 posterior,30 G4 vertebra anteriortubercleof, 18 body of, 18 laminaof, 18 posteriortubercleof , 18 posterosuperiorview of, 18 superiorarticularprocessof, 19 G7 vertebra, 13, 153,160 posterior tubercle of transverse process of, 30 spinousprocessof, 18, 152, 174,175, 176,424 superiorview of, 18 Gymba,93 Gystic attery, 294, 300, 301, 305 Gystic duct, 331 smooth part of, 294 spiralfold of, 294 variationsin, 296 Gystic node (of Galotf, 315 Gystic vein, typical arrangement of, 313 Cystohepatic triangle, 301 Gystourethrograms, male and female,368
D Declive, 113 Deep (Buck'sf fascia, 249, 25O,348, 361, 380, 381, 382, 383, 396, 401, 403, 405 intercavernous septum of, 382, 385
Atlas of Human Anatomy
Deep palmar arch, 465 Deftoid muscle, 152, 174, 177, 188, 189,243,244,245, 423, 428, 429 attachments of, 420 insertionot,42O,421 origin of, 419,420 Deltoid tuberosity, 420 lymph node, 483, 484 Deltopectoral node, 483 Deltopectoral Deltopectoral triangler 247, 424 Denonvilliers' fascia, See Rectoprostatic(Denonvilliers') fascia Dens,137 apical ligamentof, 63, 65 of axis,19, 37 posteriorauricularfacet of ,22 Dental plexus inferior,122 superior,122 Dental pulp, 57 D e n t a t e g y r u s , 1 0 6 ,1 0 8 ,1 1 1 ,1 1 2 ,1 1 9 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 musclo, 36, 123 Dermatomes anterior,482 levelsof, 164 of lower limb, 543 posterior,482 schematicdemarcationof, 164 of upper limb anteriorand posteriorviews of, 482 Descemetts membrane. See Posterior limitinglamina(Descemet's membrane) Diaphragn, 198,206, 211,215,23O, 233, 236, 237, 272, 273, 275, 286, 3 2 7 , 3 2 9 , 3 3 13, 4 2 ,4 9 8 abdominalsurfaceof, 195 area for, 330 caval openingfor, 195, 263,267 central tendon of, 263 right leafletof, 194 costal part of, 195, 258 cross sectionof, 338 crura of, 179, 293,338, 342 left,263,27O,297,339 right,263,27O,293,297,331, 339 domesof, 213 .196, 197 left, right,196,197 lateral view of, 233 lumbar part of, 195 pelvic,361 fascia of, 364 female,356, 357 inferiorand superiorfasciaof, 392 male,358-359 superiorfasciaof, 360, 364, 365, 369, 394 phrenicnervesto, 193 slip of originot, 349 sternalpart of, 195 thoracicsurfaceof, 193 Diaphragmatic constriction, 233
Atlas of l{uman Anatomy
Diaphragmatic ligament, 389 Digastric fossa, 15 Digastric muscle, 29, 123 anteriorbellyof, 27,28,29,31,32,34, 46,53,61,68 intermediatetendon of, 59 fibrous loop for, 59 phantom,34 posteriorbellyof, 27,28,29,32,34, 40, 59, 73 nerveto, 25 Digastric tendon, intermediater 60 fibrousloop 1or,28, 29, 53 Digital artery common,computedtomographyof, 484 common palmar,465 common plantar,536 dorsal,469, 471, 530, 536 nutrientbranchesof, 471 oalmar common,460 proper,460 properpalmar,460,471 dorsalbranchesol,471 proper plantar,533, 535, 536 dorsal branches of, 530 Digital creases,418 Digital nerves common oalma', 476 common plantar,476, 541 dorsal,468,471, 475,542,544 lateraldorsal.544 parmar to fourth and fifth fingers, 460 proper, 476 proper palmar,460, 471, 476 dorsal branchesof, 468 to thumb. 460 properplantar,535, 541 Digital vein dorsal,468, 480,544 Dilator pupillae muscle, 88, 121 Diplo6, 7 Diploic vein, 102 anteriortemporal,99 coronaldissectionof, 99 frontal, 99 occipital,99 posteriortemporal,99 Dircct vein, lateral, 145, 146 Distal interphalangeal (DlPl joint' site of' 418 Distal medial striate artery (recurrent artery of Heubner)' 140, 141, 142 Dorsalis pedis artery, 520,530,536 Dorsaf ramus, spinal, 17O,258,430 medialclunialnervesfrom, 545 perforatingcutaneousnervesfrom, 545 Dorsal tubercle of radius (Listet'sl' 452 Dorsal venous arch, foot, 544 Dorsomedial nucleus, 147 Dorsum sellae,9 Douglas, cul.de-sac of. See Rectouterinepouch (of Douglas) Ductus arteriosus obliterated, 229 prenatal,229 Ductus choledochus. See Bile duct, common
Ductus (vasf deferensr 259, 261, 34O, 389, 390, 409, 546 ampullaof, 384 arteryto, 255,264,340, 398, 4O1,4O3 Ductus deferens plexus' 409, 415 Ductus plexusr 409 Ductus reuniensr 96 Ductus Yenosus obliterated,229 prenatal,229 Duodenal capr279 Duodenal flexure inferior,279 superior,279 Duodenal fold inferior,278 superior,270 Duodenal fossa inferior,2TO superior,270 Duodenal glandsr 2T9 Duodenal impression' 287 Duodenal papilla ma:1or,279,294,295 minor,279 Duodenal wall circularmuscle layerof, 279 longitudinalmusclelayerof, 279 submucosaof, 279 Duodenojejunal flexure, 270, 279, 342 Duodenojejunal iunction' 179 Duodenum, 126, 248, 273, 275, 278, 288,329,340,342 arteries of, 301, 304 ascending,27O,278, 279 bariumradiographol, 279 circularmuscleof, 277,295 descending,272, 279, 294 cross sectionof, 179 descendingpart of, 270 inferior pad of, 270 in situ.278 innervationof. 321 lunctionwith common bile duct, 295 longitudinalfold of, 279 longitudinalmuscleof, 277 mesentery root ot, 278 mucosaof. 279 musculatureof, 279 nervesof, 319,320,321 second-third parts of, 338 junctionof, 339 submucosaof, 279 superior,276,274 cross section of, 297 superiorpart of, 294 superior(1st)part of, 297 suspensoryligamentof, 270 suspensorymuscleof, 270 veins of, 309 Dural sac in lumbarpuncture,162 sagittalMR imagesof, 397 terminationof, 160, 161 Dural venous sanusesr 104 coronalsectionthrough,104 sagittalsectionof, 103 superiorview of, 104
l.t I
Dura mater, 39, 91, 93, 96, 99, 100,102, 109,119,137,169 around bony and membranous labyrinths,96 cerebralveins penetrating,102 lumbar,170 periostealand meningeallayersof, 99 s p i n a l , 1 6 01, 7 9 spinaladeriesto, 172 of thoracicspine, 170 Dura-skull intedace, 102
E Ear, 93 bony and membranouslabyrinthsof, 95 external coronalobliquesectionof, 93 superolateralview of, 93 lobuleof, 1 middle coronalobliquesectionof, 93 surface anatomy of, 1 Edinger.Westphal nucleus, 116, 117, 132 Efferent ductule, 389, 390 Effercnt fiber, to olfactory bulb, 119 Ejaculatory duct, 376 beginningof, 384 openingsof, 316, 384,385 Elbow anastomosesaround,434 bones of, 436 ligamentsof, 438 musclesot,447448 attachmentsof, 450, 451 radiographsof anteroposterior, 437 lateral,437 Emissary vein, 99, 102 communicatingwith cavernoussinus,70 condylar,137 coronaldissectionof,99, 102 mastoid,23,99, 137 occipital,99 parietal,23, 94, 99 parietal foramen for, 7 of skull,99 to superiorsagittalsinus,7 Endolymphatic duct, 11, 95 openingfor, 97 in vestibularaqueduct,96 Endolymphatac sac,96 Endometrium,371 Endopelvic fascia, 364 Ependyma, 108 Epicolic nodes,317 Epicondyles lateral,438, 440, 441, 442, 443, 489 radiographof, 510 medial,437, 440, 441, 442, 443,447, 476,489 Epicranial aponeurosis, 26, 178 Epicranius muscle frontalbelly of, 26 occipitalbelly of, 26 Epididymal duct,390 Epididymis,390 appendixof, 389 body of, 390 head of, 390
t-12
Epididymis (Continued) sinus of, 390 tail of, 390 Epidural anesthesia, for lumbar puncture,162 Epidural hematoma, 101 Epidural space fat in, 170 in lumbarpuncture,162 Epigastric artery superficial, 211, 511 s u p e r i o r , 1 8 81,8 9 , 1 9 2 Epigastric lymph nodes, inferior, 266 Epigastric lcgionr 268 Epigastric vein inferior,251, 256,265, 4OO 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 nutrientarterialbranchto, 471 Epiploic appendices. See Omental appendices Epiploic foramen, 331 Epiploic loramen. See Omental foramen Episcleral artery, 90 Episcleral space, 83, 87 Episcleral vein, 90,91 segmentof, 91 Epithelia! cell, stomach surface, 276 Epithelial tag, 388 Epitympanic recess, 92, 93 Eponychium,471 Epoiiphoron, 343 Epoiiphorcn canal,389 Erector spinae muscle, 152, 174, 175, 179, 180, 192, 243, 258, 293, 330, 331 Esophageal arleryr2OT Esophageal hiatus, 195 Esophageal impression, 287 Esophageal iunction, 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 sympatheticbranchesto, 2O9,24O Esophageal prominence, pericardial,215 Esophageal vein, 312, 313 Esophagogastric junction, 236 transversesection of, 293 Esophagus, 63, 68, 76, 126,194,2O4, 206, 207, 230, 231, 233, 240, 241, 243, 244, 245, 246, 263, 264, 270, 274,323,329,332,348 abdominalpart of,233, 237,275 anteriorview of, 240
Esophagus (Continued) arteries of, 237 common variationsin, 237 bare area on ventral surface. 234 cervicalpartot,237 circularmuscle layerof ,234,277 gradualslight muscularthickeningof, 232 greater curvature ol, 277 groove for, 199 in situ,232 lateralview of, 233 longitudinalmusclelayer ot, 234, 277 lateral mass of, 234 mucosa o1,235,236 lunctionwith gastricmucosa,276 musculatureof, 239 nerves of, 240 opened posterior view of, 66 posteriorview of, 240 pyloric part of, 277 recurrentarterialbranchto. 195. 264 submucosaof, 235, 236 thoracic parl ol, 232, 237 topographyand constrictionsof, 233 zone of sparsemusclesol,234,235 Ethmoidal artery anterior,11, 85 meningealbranchof, 100 septal and meningealbranchesof, 41 posterior, 11, 85, 100 septal and meningealbranchesof, 41 Ethmoidal bulla, 37,38 Ethmoidal cells, 48, 49, 83 anterior,50 openingof, 37, 38 semilunarhiatusof, 37 middle,50 openingof, 37, 38 posterior,37, 38 openingof, 38 Ethmoidal foramen 2, 11, 12 anterior, Posterior,2, 11 Ethrnoidal nerve anterior,11, 43, 86, 121, 122 externalnasalbranchesto,24,122 lateralinternalnasal branchesto. 42. 43 medial internal nasal branches to, 42 posterior, 11, 45, 86, 121,122 Ethmoidal vein anlerior,122 posterior,122 Ethmoid bone, 4,6,9,38 anteriorethmoidalforamenof, 12 cribriformplate of, 37, 38, 39, 119 crista galli of, 39 middle nasalconcha of, 2 nasalconcha of, 38 orbitalplateoI,2,4, 12 perpendicularplate of, 2, 6, 39 uncinateprocessof, 38 Ethmoid sinus axial MR imageof, 150 coronalCT imagesof, 151 Eustachian tube. See Auditory(pharyngotympanic,Eustachian)tube
Atlas of Human Anatomy
Extensor carpi radialis brevis muscle, 418, 420, 444, 446,477 groovefor, 439 tendon of, 444, 445, 449, 469, 470 attachmentof, 420 Extensor carpi radialis longus muscle, 432, 435, 441, 444, 445, 446, 449, 451,477 groove for, 439 originof, 439 tendonof, 444,469,47O Extensor carpi ulnaris muscle, 418, 420, 432, 441, 444, 449, 451,477 tendonof, 444,469,470 ulnarorigin ot, 451, 470 Extensor digiti minima muscle, 420, 441, 444, 450, 451 tendon of, 420, 441, 444, 449, 470 Extensor digitorum brevis muscle, 520, 521, 530, 531, 542 innervationof, 542 tendonof, 519,520, 531, 536 Extensor digitorum longus nuscle, 494, 519, 520,522, 530,531, 542 attachmentsof, 515 tendonof, 519, 520,521, 530,531, 536, Ra.7
sheathof, 530 Extensor digitorum minimi tendon, 469 Extensor digitorum muscle, 432, 441, 449, 450, 477 centralbands of, 451 groove for, 439 lateralbands of, 451 tendon of, 418, 441, 444, 445,449, 469, 470,471 Extensor expansions, 536 tendinousslips to, 465 transversefibers of, 470 Extensor hallucis brevis muscle, 520, 530, 542 innervationof, 542 t e n d o no f , 5 1 9 , 5 3 1 , 5 3 6 Extensor hallucis longus muscle, 519, 520, 521, 522, 531 attachmentsof, 515 innervationof, 542 tendon of, 519, 520, 521, 530, 531, 536 sheathof, 530 Extensor indicis muscle, 441, 445, 449 groove for, 439 tendon of, 418, 441, 444, 469, 47O Extensor pollicis brevis muscle, 441, 443,444,445,451 area for, 439 tendon of. 444.469 Extensor pollicis longus muscle, 418, 441, 444, 449 groovefor, 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
Atlas of Human Anatomy
Extensor tendons' 420, 441, 444 common,of forearm,42O,441, 444 in fingers,464 of hand, 445 at wrist, 470 Extraocular muscles, sagittal MR image of, 149 Extraperitoneal fascia, 412 space' fibrofatty Extraperitoneal tissue otr392 Eye, 168 anteriorand posteriorchambersof, 88 axial CT imagesof, 150 axialMR imageof, 150 coronalCT imagesof, 151 externalmusclesof, 90 extrinsicmusclesof. 84, 90 intrinsicarteriesand veinsof, 90 musculararteryand vein of, 90 vascularsupply of, 91 Eyeball,81 arteriesand veins of, 85 choroidof vasculararrangementswithin,91 tarsusof, 83 vascularsupply of, 91 Eyelashes,81 Eyelid, 81 arteriesand veins of, 85 tarsusof, 83
F Face arterialsupply sourcesof, 19 musclesof, 123 sensorynervesof, 123 superficialarteriesand veins of, 23 Facets,246 Faciaf artely' 31, 32, 34, 36, 40, 60, 75, 85, 131, 133, 136, 138 lateralnasalalar branch of, 41 nasalseotal branch of, 41 superiorlabialbranchof, 41 tonsillarbranch of, 64 transverse,23, 34, 36, 69, 85 Facial cana,' 124 orominenceof, 93 Facial expression muscles, 26,60 lateral view of, 26 Facial lymph node, 72 Facial muscles, 123 F a c i a f n e r v e ( V l l l , 1 1 , 3 4 ,4 0 , 6 2 , 7 1 , .1 92, 104,114, 16, 117, 122, 131, 133, 134, 135, 165, 166 branchesof.25. 168 buccal branchesof, 123 cervicalbranchesof, 123 to, 123,125 communications of, 118 distribution ganglion)of, 97, geniculum(geniculate 123.124.125 intermediate,133 internalgenu of, 117 main trunk of, 25 marginalmandibularbranchof, 30 motor nucleusof, 123 motor root of, 124 schemaof, 118, 123,134 in stylomastoidforamen,94
Facial nerve (Vlll (Continued) temooralbranchesof, 123 zygomaticbranchesof, 123 F a c i a l n u c l e u s ' 1 1 6 ,1 1 7 Facial plexus' 131 Facial vein, 23, 30, 32, 59, 60, 85 common trunk for, 23 deep,23, 85 transverse,23, 70 Falcilorm ligament' 252, 269, 274, 2 7 5 , 3 0 5 , 3 1 23, 3 1 ,3 4 9 branchto, 255 of liver,305 Fallopian tube. See Uterine(fallopian) tube Falx cerebeali' 144 Fafr cerebri, 39, 102, 103,141, 144 Fascia axillary,428 anterior c,att ot, 428 fenestrated, 428 brachial,428 60, 63, 65 buccopharyngeal, Camper's,348, 361, 378 cervical investinglayer ot, 26, 28 musclesinvestedby, 188 pretracheallaYerof, 28 clavicopectoral,188 clavipectoral,428 cremaster,390 cremasteric,25O,261 cribriform,in saphenousopening,249 dartos,390 deep (Buck's),249, 25O,253,348, 380, 381, 382, 383, 396, 401, 403, 405 deltoid,26 diaphragmatic,342 inferior.348, 349 endopelvic,364 252, 261, 412 extraperitoneal, 236 infradiaphragmatic, infrahyoid,28 of infrahyoidmuscle,428 174, 177 infraspinatus, interosseous dorsal,462 palman462 intraspinous,424 investingpectoralisminor muscle,428 investingsubclaviusmuscle,428 latissimusdorsi, 428 ol 1e9,522,546 obturator, 356,369, 379,4O2,411 over obturatorinternusmuscle,365 obturatorinternus,364,392, 4O2,411 of orbit and eyeball,83 over adductor Pollicismuscle,460 paravesicalendopelvic,366 parotid,26 pectoral,182,428 superficialand deep layersof, 428 of oectoralisminor muscle,428 pelvic,372 penile,249 oerineal.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
1 . 13
Fascia (Continued) pharyngobasilat52,73 olantar lateral,532 medial,532 posteriorantebrachial,thickeningof, 468 presacral,348, 364, 396 pretracheal,63 viscerallayer ot,2O2 prevertebral,60, 63, 65 oubocervical distal portionof, 372 horizontalportionof, 372 quadratuslumborum,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 anteriorlayerof, 179 Gerota's,342 posteriorlayerof, 179,342 sagittal section of, 342 transversesection of, 342 Scarpa's,348, 361, 378 attachmentof, 380 scrotal,249 superficial,395 serratusanterior,428 Sibson's,230 spermatic, 249, 250, 259, 261 external,249, 25O,251, 257, 259, 260, 261, 361, 380, 390, 405 internal,251, 261, 390 originof, 260,261 subclavius,428 subserous,412 superficial,390 supradiaphragmatic, 236 temporal,26, 54 deep layerof, 54 supediciallayerof, 54 thoracolumbar, 174, 175,176,177,33O anteriorlayerof, 176, 179 layersof, 179 middle layerof, 179 posterior layer of, 176, 179, 330 transversalis,179, 252, 259, 261, 331 umbifical 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 lTenon's capsulel, 83,87 Fasciculus dorsal longitudinal,147 mediallongitudinal, 113 Fat of elbow,438 epidural,137, 17O infrapatellar, 507, 508, 511 of mammarygland, 182 in orbit, axial MR image of, .|50 pararenal, 179,339
1.14
Fat (Continued) perirenal,179, 339, 342 retrobulbar,83 of sole of foot, 532 suprapatellar, 511 Fat body, of ischioanal fossa, 376 Fat pad infraoatellar. 511 suprapatellar, 511 Fauces, 64 Female ]eploductive organs, inner. vation ol,415 Femoral artery, 250, 493, 500, 512, 546 circumflex ascending,501, 512 descending, 501, 512 lateral,500,512 medial,501, 502,5O4,512 transverse,501, 512 deep,493, 500, 512 muscularbranchesof, 512 Femoral canal,546 lymph nodes in, 546 Femoral nerve, 160, 259, 267, 376, 409, 496, 498, 500, 538, 546 anteriorcutaneousbranchesof, 409 branchesof, 545 cutaneous,545 anterior.538. 544 lateral, 267, 329, 496,498, 500, 544, 565 posterior,160,177,503,540, 545,546 terminalbranch of, 544 Femoral ring, 259,262,363,364,546 Femoral sheath, 250, 251, 262, 5OO, 546 Femoral vein, 250, 256,376,380, 493, 500, 505, 544,546 Femoral vessels, 260, 401,4O7 openingsfor, 263, 500 Femoris muscle, rectus, 376,485, 489,491, 492,494,500,538 attachmentsof, 490, 491 originof, 492 Femoris tendon, nectus, 485, 493, 505, 507,519 Femur, 489, 511 adductortubercleof, 489 anteroposteriorradiograph of , 488 anteriorview of, 489 calcarof, 489 of child, 504 fibrouscapsuleof, 489 glutealtuberosityof, 489 greatertrochanterof, 152, 489, 493 headof, 376,487,489 anteroposteriorradiographof, 488 arteries of, 504 fovea of ligamentof, 489 radiographof, 355 intercondylarfossa of, 489 intertrochantercrest of, 489 lateralcondyleof, 489, 493, 510 lateralepicondyleof, 489 lessertrochanterof, 263, 489 ligamentof head ot,487, 489 lineaasperaof, 489 medialcondyleof, 489 adductor magnusmuscle insertionon, 493 adductortubercleon, 493
Femur (Continued) neck of. 376 nutrient artery of, 504 nutrient foramen of, 489 patellar surface of, 489 pectinalline of, 489 poplitealsurfaceof, 489, 511 posteriorview of, 489 radiographof, 355, 510 shaft of, 489, 496 Fibroelastie rnembranes, 234 Fibrous lAlbini'sl nodule, 223 Fibrous sheath, of sole of toot, 534 Fibrous trabecula, 147 Fibula, 513, 517,530 at ankle,525,527,531 anteriorborderof, 513 anteriorintercondylar, 514 anteriorview of, 513,514 with ligamentattachments,514 apex of,513,514 cross sectionof, 514 headof, 492,493,494,511, 513,514, 515, 518, 520, 521, 542 anteriorligamentof, 514 anteroposteriorradiographof, 510 posteriorligamentof, 514 radiographof, 510 interosseousborderof, 513, 514 lateralcondyleof, 514 lateralsurfaceof. 513. 514 medialcrest of, 514 medialsurfaceof, 513 n e c ko f , 5 1 3 posteriorview of, 513 radiographof, 54, 510 superiorarticularsurfaceof, 513 superiorview of, 513 trochleaof, 522 Fibular artery, 512, 516, 517, 518, 522, 534 calcanealbranchesof, 516, 517 circumflex,5l2 communicatingbranchof, 518 perforatingbranchof, 518, 520, 530, 531 posteriorlateralmalleolarbranchof, 518 Fibular collateral bursa, 507 Fibular collateral ligament, 506, 507, 508, 511, 514, 517, 520, 521 inferiorsubtendinousbursa of, 511 Fibularis brcvis muscle, 530, 531, 542 attachmentsof, 515 innervationof, 542 tendonof, 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 attachmentsof,515 innervationof, 542 tendon of, 485, 516, 517, 52O,521, 527 528,530,531,536 groove for, 524 to sole of foot, 521 Fibularis longus tendon, 536 Fibularis tertius muscle, 530 attachmentsof,515 tendonof, 519, 521, 530,531, 536
Atlas of Human Anatomy
Fibular nerve articularbranchof. 540. 541 common,495,499, 505, 506, 507,508, 518, 519, 520, 521, 540, 541, 542, 544,545 musclesinnervatedby, 542 deep,520, 522,542 dorsal digitalbranchesof, 520, 530, 531,544 dorsal digitalbranch of, 544 lateral branch ot, 520, 542 medialbranchof, 519,520, 530,531, 542 superficial,519, 520, 521, 530, 542, 544 dorsal digitalbranchesof, 530 intermediatedorsal cutaneousbranch ot,544 medialdorsalcutaneousbranchof, 544 Fibular notch,513 Fibular retinaculum inferior,518, 521, 525, 527 superior,516, 517, 521, 527 Fibular tendon, 525 Fibufar vein,522 Filiform papillae, 58 Filum terminale externum, 160, 161 Filum terminale internum, 160, 161 Fimbriated fold, 51 Fingernail body of, 471 lunuleof, 471 nailbedof, 471 Fingernail, body ol, 471 Fingers, 418 arteriesand nervesof, 471 arteriesof, 471 bones of, 452 common namesof, 418 cross section of, 471 cross sectionthrough,471 distal anterior closed space of, 471 dorsum of lymph vesselspassingto, 483 in extension,464 extensormechanismof, 471 extensormusclesof, 441 extensortendonsof, 464 fibroussepta of, 471 fibroussheath,annularand cruciform Parts of, 462 fibroussheathof, 471 fifth palmardigitalnervesto, 460 synovialtendinoussheathof, 460 in flexion,464 flexor and extensortendons in, 471 flexors of, 443 flexortendonsof, 464 fourth, palmardigitalnervesto, 460 index,metacarpalof, radiographof, 457 innervationof, 469 lateral view of, 464 lymph vesselspassingthrough,483 middle,middlephalanxof, 457 middle,sagittalsectionof, 453 muscleattachmentsof, 450 nervesof, 471 posterior(dorsal)view of, 464 ring, distal phalanxof, 457 sagittalsectionthrough,453,471
Atlas of Human Anatomy
Fingers (Continued) sePtaof, 471 synovialflexortendon sheathsof, 460 tendon sheathsof, 462 fibrous,471 Flank left, 268 right,268 Flexor carpi radaalis muscle' 420, 433,442,446 tendon of, 418,42O,447, 448, 454, 460, 461 Flexor carpi radialis tendon' 447, 454 Flexor carpi ulnaris muscle' 418, 420,444,446,447,476 humeralorigin of, 451 tendon of, 418, 420, 448, 449, 454, 461, 465 ulnaroriginof, 451 Flexor carpi ulnaris tendon' 418, 454,460,465 Flexor digiti minimi brcvis musclet 465,476,533,534, 536,541 superficialtibial nervebranchto, 541 tendon of, 528 Flexor digitorum brevis muscle' 533, 534, 535 tendon of, 533, 534, 535 Flexor digitorum brevis nerve, 541 Flexor digitotum longus muscle' 515, 535,541 innervationof, 541 tendonof, 513,516, 517,528,533,534, 535 Flexor digitotum profundus muscle medial part of, 476 tendon of, 460 Flexor digitorum superfi cialis muscle, 420, 443, 444, 446,447, 448,449,450,451,474,475,476 humeroulnarhead of. 420 originof, 420 radialhead ot,447, 448,449, 450,474 tendon of, 418, 420, 446, 449, 454, 461, 462,474 Flexor digitorum superficialis tendon, 418, 454,471 insertionof, 460 Flexor digitorum profundus muscle' 476 Fleror hallucis brcvis muscle' 541 insertionof, 536 lateral head of. 533. 535 insertion of, 536 medialhead of, 533, 534, 535 insertionof, 536 medialoriginof, 536 tendon of adductor hallucisand lateralhead of, 528 lateraloriginof, 536 medialhead of, 528 Flexor hallucis longus muscle' 541 attachmentof,515 innervationof, 541 tendonof, 516,517, 518,528, 533,534, c3c, cJo groove for, 523, 524, 525 on talus,523
Flexor muscles of fingers,444 of forearm,superficial,446 of leg deep,522 superficial,522 of wrist, 442 Flexor pollicis brevis muscle' 465, 4IO
deep head of, 476 superficialhead of, 476 Flexor pollicis longus muscle' 444, 446,447, 448, 449, 450, 474 superficialhead of, 443,446 synovialtendinoussheathof, 460 tendinoussheathof, 460,462 tendon of, 446, 448, 449, 454 in tendon sheath,461, 462 ulnar head ot, origin ot,42Q Flexor pollicis longus tendon' 454 Flexor r.etinaculum, 447, 460, 461, 462, 465,474, 516, 517, 534, 535, 541 removed,454 transverse,465 Flexor sheath, commonr 460 Flexor tendons common,of forearm,443,446 in fingers,464 profundusand superficialis,462 at wrist, 461 Fleror tendon sheath common,460 common ulnar,462 fibrous. of sole of foot, 533 fibroussheathover,annularand cruciform parts of, 460 ol finger,471 Flocculonodular lobe' 113 Flocculus, 113 Foliate papillae, 58, 135 F o l i u m , 1 1 3 ,1 1 5 ,1 4 4 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 dissectionof, 530, 531 musclesof, 530 fibrouslongustendon passingto, 521 interosseousmusclesof, 530, 536 inversionand eversionof, 543 lateral dorsal cutaneous nerve of, 530 ligamentsand tendonsof, 527 plantarview of, 528 olantarsurfaceof, 485 plantarview of, 536 right lateralview of, 527 medialview of, 527 sole of musclesof, 533, 534, 535 superficialdissectionof, 532 tendonsof, plantarview of, 528
l.l 5
Foramen lacerum,8, 10 petrosalnervesof, 10 Foramen magnum, 8,9, 11, 14, 58, 123,127 Foramen of Luschka. See Lateral aperture (foramenof Luschka) Foramen of tagendie. See Median aperture(foramenof 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 valveo1,221 Foramen rotundum, 11, 45 Foramen spinosum, 11, 14, 46 Foramentransversarium,19 Forearm bones of, 439 cutaneousnervesof, 480 lateral,435, 446, 447, 448, 449, 469, 473,481 branchesof, 479 posterior branch of, 480 deep muscle layerof anteriorview o1,447 posteriorview of. 445 distal,cross sectionof. 470 intermediatemusclelayerof, anterior view o1,447 ligamentsof, 438 medial,429, 430, 433, 446,469,473, 479, 481, 474, 475 anteriorbranch of, 449,480 posteriorbranch of, 480 musclesof, 44O,441,442, 444, 446,447 deep layerof, anteriorview of, 448 muscularattachmentsof anteriorview of, 450 posteriorview of, 451 posterior, 432, 435, 449, 468, 469, 477, 479, 480, 481 pronated position of, 440 serial cross sections of, 449 superficialmusclesof anteriorview of, 446 posterior view ol. 444 superficialveins of, 480 supinatedpositionof, 440 Fornix, 106,112,147 bodyof,106,108,112 c o l u m n s o f1, 0 6 ,1 1 0 ,1 1 1 , 1 1 21, 4 5 conlunctival,81 c r u r ao f , 1 0 6 ,11 0 , 1 1 2 , 1 4 3 schemaof, 112 Fossa ovalisr 22O,544 limbusof, 220 Fovea centralis, 87,90 Frenulum,282 artery to, 59 of lower lip, 51 of tongue,51, 61 of upperlip, 51 Frontal artery, 23 medial,142 polar,141,142 Frontal anlely, polaJ, 1 41, 142
l-16
Frontal bone, 9, 36, 38, 81, 82 glabellaof, 4 nasalspine of, 38, 39 orbital part of, 2, 9 sinus of, 38, 39 squamouspart of, 38, 39 supraorbital notchof,4, 12 Frcntal cnest, 9 Frontal gyrus inferior,105 medial,106 middle,105 suoerior.105 Frontalis muscle, 36 Frontal lobe, 105 Ftontal nerve, 83, 86, 121, 122 131 Frontal operculum, 105 Frontal pole, 105 sagittalMR 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 Frcntobasal artery lateral,141. 142 medial.141.142 Frpntonasal canal infundibulum leadingto, 38 openingof, 38 Frontonasal duct, 37 openingof, 49 Fundiform ligament, 249 of penis,361 Fundus, of stomach,293 Fungiform papilla, 58, 135
G Gafea aponeurotica, 26, 1O2,178 Galen, ansa of, 80 Galen, vein of. See Greatcerebralvein (of Galen) Gaf fbfadder, 126, 167, 196, 269, 272, 275,294,301,331 arterialvariationsand collateralsupply of, 305 body of, 294 cross sectionof, 297 fundusof,294 gland orificesof, 294 infundibulumof, 294 innervationof, 168 joining hepaticduct, 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, 3OO,305, 318, 319, 320,321 arteriogramof, 303 attachedto lesseromentum,274 esophagealbranchof, 300 sympatheticfibers along,240 left, 206, 237, 264, 300, 301, 306, 318, 319, 320, 321, 323,331, 348,349, 410 esophagealbranchof, 237
Gastric artery (Continued) right,279, 294, 300, 305, 320, 321, 331 arteriogramot,303 short,300, 301,305, 321 sympatheticf ibers along esophageal branchof, 240 Gastric c,anaar276 Gastric.esophageal mucosa junction,276 Gastric iolds,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 |eft,309,310, 311, 312, 313 esophagealtributaryof, 309 right,309,310, 311, 312, 313 short,309, 311, 312, 313 Gastric vesselg, short, 331 Gastrocnemius muscle, 506, 507, 516, 519, 520, 521, 522, 540, 541 innervationof, 541 lateralheadof, 485, 494,495,511,515, 516,517,518 attachmentsof. 491. 515 subcutaneousbursaof, 511 lateralsubtendinousbursaof, 511 medialheadof, 485, 491,495, 502, 511, 517,518,522 attachmentsof, 491, 515 Gastrocolic ligament, 272 Gastrcduodenal artery, 279, 294, 301, 304, 305,306, 321, 322,327 arteriogramof, 303 plexuson, 320 Gastroduodenal plexus, 320, 322, 327 Gastroepiploac artery, left, 301 Gastroilenal ligament. See Gastrosplenicligament Gastro-omental arterial anastomosis,272 Gastro-omental artery left, 300, 301, 305, 306, 321 plexuson, 319, 320 ri1ht,272, 300, 305, 306, 321 originof,3O2 Gastro.omental lymph nodes left,314 right,314 Gastro.omental Yein, 312 left, 309, 311, 312,313, 314 right,309, 311, 312,313 Gastro.omental vessels attachment to greater omentum,274 left, 299 Gastropancreat c Iold, 272 Gastrcphrenic ligament, 272, 329 Gastrcsplenic ligament, 272, 273, 299, 331 short gastricvesselsin, 299 Gemellus muscle inferior,376, 495, 503 attachmentsof. 489. 491 nerveto, 503 superior,495, 499, 503 attachmentsof, 489, 491
Atlas of Human Anatomy
Genicular artery descending,512 articularbranch of, 500, 512 saphenousbranch of, 500, 512 inferiorlateral,512, 517, 518, 519, 520 inferiormedial,500, 512 middle,S12 superiorlateral,502, 512, 516, 517, 519, 520,521 superiormedial,51, 500, 501, 5O2,512, 516,518,519,520 Geniculate body l a t e r a 1l ,0 7 ,1 1 0 ,1 1 1, 1 1 4 , 1 1 6 , 1 2 0 , 132,143,144,145 o f l e f t t h a l a m u s1,4 3 m e d i a l1, 0 7 ,1 0 8 ,1 1 0 ,1 1 1 , 1 1 4 ,1 1 5 , 139, 143, 144, 145 Geniculate nucleus left dorsal lateral,120 right dorsal lateral,120 Geniculum (geniculate ganglionf, 116, 131, 135 of facialnerve,97, 116, 125 site of, 124 Genioglossus muscle, 29, 32, 59, 60, 128, 129 superiormentalspine for originof, 52 Geniohyoid muscle, 29, 53, 59, 128, 129 Genital cold, 389 Genitalia, 388 external,167 female,377, 388 homologuesof, 388 innervationof, 168 male,388 internal female,389 homologuesof, 389 male,389 lymph nodes and vesselsot,406,4O7, 408 undifferentiated, 388 Genitaf tubercle epithelialtag of, 388 glans area of, 388 lateralpart of, 388 Genitofemoral nerve, 329, 340, 496, 498, 539, 409 femoralbranch of, 267,409, 498,544 genitalbranch of, 259, 261,267,409, 544 testicularvesselsand genitalbranchof, 259,261 Genu, of corpus callosurn, 146 Gerdy's tubercle, 494,513 Gerota's fascia. See Renalfascia, Gerota's Gimbernat's ligament. See Lacunar ligament(Gimbernat's) Gingiva epitheliumof, 57 laminapropriaof, 57 Gingivaf groove' 57 Gfenohumeral joint' 423 Gfenohumeral ligament inlerior,423 superior,423 Glenoid cavity, 185,423 Glenoid labtumr 423
Atlas of Human Anatomy
Glisson's capsule. See Perivascularfibrous (Glisson's)capsute Globus pallidus, 108, 110, 539 Glornerular arteriole afferent,336 efferent,336 G l o m e r u l u s , 1 1 9 ,1 3 6 Glossoepiglottic fold lateral,58 median,58 Glossopharyngeal nerve,34,114, 116,117,118,129,125,126,130, 1 3 1 ,1 3 3 ,1 3 5 ,1 6 6 branchof, 168 c a r o t i d b r a n c h o t , 3 4 , 1 2 5 , 1 2163, 0 ,1 3 1 i n f e r i o r g a n g l i o n o1f2, 5 ,1 3 5 pharyngeal,tonsillarand lingual branches,125 schemaof, 118, 125, 134 tympanicbranchof, 10 Gluteal aponeurosis, 330, 494, 495 over gluteusmediusmuscle,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 attachmentsof, 491 Gluteus medius muscle, 152,376, 492,496,500, 501, 502, 503 attachmentsof, 491 glutealaponeurosisover,330, 494, 495 Gluteus minimus muscle, 489, 495, 496, 500, 501, 502, 503 attachmentsof, 489, 491 tendon of, 376 Gonads, 389 male,descentof, 386 Gracile fasciculus, 114, 115 Gracile tubercle, 114, 115 Gracilis muscle, 489,492,493, 495, 500, 501, 502, 505, 506, 516 attachmentsof, 489, 515 innervationof, 540 Gracilis tendon, 485,492,493,506, 5O7 Granular foveola, 99, 102 Granule cells, 119 Gray matter, 169 interomediolateral nucleuso1,44, 132, 134 lateralhorn ot,170,325,346 spinal, 169 sympatheticpreganglioniccell bodies in, 132 Great cerebral artery, quadrigemi. nal cistern of, 109
Great cercbral vein lof Galenl, 103, 104, 106, 144, 145, 146 Groin left, 268 right,268 Gubernaculum, 389, 415 Gum,57 Gut. See a/so Viscera entericplexusof, 325 prenalal,229 H llabenula, 110 H a b e n u l a r c o m m a s s u n e , 1 0 6 ,1 1 1 , 1 1 5 l{abenulartrigone, 111,115 Hair cells (cochlearl inner,96 outer,96 Hamate, 452,455,456,474 anterior(palmar)view of, 452 coronalsectionof , 455 hook of, 442,452,454,456 radiographof,457 posterior(dorsal)view of, 452 radiographof, 457 l{amulus, 8, 14, 38, 52 of spirallamina,95 Hand in abduction,453 in adduction,453 in anatomicalposition,453 anterior(palmar)view of, 459,465,472 anteriorview of, 460 arteriesand nervesof, palmarview of, 466, 484 bones of, 456 bursaeof, 462 o'f,472,476 cutaneousinnervation deep digitalcreaseof, 418 deep dorsal dissectionof, 469 deeper palmardissectionof, 460 dorsalfasciaof, 462 dorsalvenous networkof, 468, 483 dorsum of, 483 lymph vesselspassingto, 483 in extension,453 in flexion,453 lymphaticpathwayof, 468 lymph vesselspassingto aroundweb in, 483 dorsum of, 483 middledigitalcreaseof, 418 musclesof, 465 intrinsic,465 nervesof, palmarview of, 466 palmardissectionof deeper,460 superficial,459-460 palm of, 453 posterior(dorsal)view of, 465,472 proximaldigitalcreaseof, 418 proximalpalmarcreaseof, 418 radialdissectionof, superficial,467 radiallongitudinalcreaseof, 418 radiographof, anteroposterior,4ST septa between spaces of, 462 spacesand sheathsof, 462 spacesof, 462 superficialdorsal dissectionof, 468
l.l7
Hand (Continued) surface anatomy o1,418 tendon sheathsof, 462 Hartmann's pouch. See Infundibulum (Hartmann'spouch) l{austra, 284 Head. See a/so Brain; Skull; speclflc parfs of head arteriesot,4041 autonomicnervesin, 13' axial CT imageof, 150 axial MR imageof, 150 bonesand ligamentsof,4-16 coronalCT imagesof, 151 cutaneousnervesof, 24 faucesof, 64 lymph vesselsand nodes of,72-73 masticationmusclesof, 54-55 musclesof, 26 nasalregionof, 36-37, 4M7, 48-49 nervesof, 24 oral regionof, 50-61 sagittalMR imageof, 149 surfaceanatomyof, 1 Heart,126,233 anteriorexposureof, 212 apex of, 212, 213, 214, 246 atria,ventricles,and interventricular septum ot,224 base of posteriorview of, 214 surfaceof,2.l4 conductingsystem of, 225 diaphragmaticsurfaceof, 214 in diastole,222 f ibrousskeletonof, 222 inferiorborderof, 212 i n s i t u ,2 1 1 innervationof, 227 innervationof, schemaof, 227 left borderof, 196 left side of, 225 membranousseptum ol, 221, 222 nerves of, 226 pericardiafsac and, 282 right borderof, 196 right side of, 225 in systole,222 valvesot,222 Heiss, loops of, 367 Helicotrema, 92, 95, 96 Helix,93 crus of, 93 l{elvetius, collar of, 236,277 Hemiazygos vein, 236, 245 accessory,194, 2O7 Hemothorax, chest drainage tube placement in, 190 Henle's loop,337 ascendinglimb of, 336 descendinglimb of, 336 proximalsegmentof, 336 thin segmentof, 336 Hepatic artery, 297, 337 branchesof, 290, 291, 292 common,237, 264, 272, 279, 294, 300, 301, 305, 306,318, 321,327,331, 349 arteriogramof, 303 cross section of, 297 effects of obstruction on. 305
1.18
Hepatic artery (Continued) intermediate,301 left,294,300,301,305 middle,305 originof, 302 proper,273, 278, 279, 288, 290, 294, 298,301,321,330 arteriogramof, 303 bifurcationof, 331 to lesseromentum,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 lett,294 right,294 variationsin,294,296 Hepatic llerure. See Colic flexure,right Hepatic lymph nodes, 314,315 Hepatic nerve plexus, 349 l{epatic plexus, 126, 319, 320, 322 anterior,327 branchesfrom, 319 to cardia,320 pyloric,126 vagal,319 common,318 posterior,327 pyloricbranchfrom, 126 vagal branchto, 319 Hepatic portal Yein, 273, 278, 279, 288,294,298, 300, 301, 311, 312, 315,331,349 to lesseromentum,348 orenatal,229 tributariesof, 312 typical arrangementof, 313 variations of,313 Hepatic vein, 194, 232, 265, 274, 287, 290, 309 prenatal,229 Hepatoduodenal ligamenl, 272, 275, 278,297 Hepatogastric ligament, 275, 288 Hepatogastric trunk, 302 l{epatomesenteric trunk, 302 Hepatopancreatic ampulla' 294 sphincterot,295,327 Hepatorenal neoesa (Morison's pouchl, 331 Hering, canal of, 291,292 Hering.Breuer reflex, receptors fort 210 Hernia inguinal indirect,261 site of, 261 sliding,236 Hernial sac,261 neck of, 261 Herniated disc. See Lumbardisc herniation Hesselbach, triangle of. See lnguinal (Hesselbach's) triangle Heubner, recurl€nt ailety of. See Distal medial striate artery (recurrent artery of Heubner) High intestinal vein, 313
Hip anteroposteriorradiograph of, 488 arteries of, 500-502 bony attachments of anterior view of, 490 posterior view of, 491 flexion and extension of. 543 musclesof, 496 lateral view of, 494 posteriorview of, 495 nerves of, 503 Hip bone auricularcartilageof, 487 lateral view of, 486 medialview of, 486 Hip joint anteroposteriorradiographof, 488 anteriorview of, 487 capsuleof, 504 iliofemoralligamentof, 496 lateral view of, 487 ligamentsof, 492 posteriorview of, 487 Hippocampal fimbria, 119 Hippocampal sulcus' 112 Hippocampus, 110, 111, 112 alveusof, 112 fimbriaof, 106, 108, 111, 112 superiordissectionof , 112 His, bundle olr 225 Horizontal cells, 120 Houston, valves of, 393 Humeral artery, circumflex anterior,427, 429, 433, 434 posterior,427, 429, 432, 433, 434 Humeral ligament, transverser 423 Humeral vein, circum|lext 479 Humeroulnar headt 447 Humetus, 433, 436, 438 anatomicalneck of, 42O,421 anteroposteriorradiograph of, 422 anteriorview of, 420 anteroposteriorradiograph of, 422 capitulumot,42O,436 common extensiontendon of, 421 common flexortendon of, 421 condylesof,42O,436 coronoidfossa of, 420 greatertubercle ol, 42O,421, 423, 432 crest of, 420 head of, 420 anteroposteriorradiographof , 422 infraglenoidtubercleof, 421 sulcusof, 420 intertubercular tubercleof, 420 intertubercular lateralepicondyleof, 42O,421, 436, 437, 438, 441,442, 444, 448 lateralsupracondylarridge on, 42O lessertubercleot, 420, 423 medialepicondyleot, 42O,421, 432, 433, 437,440, 442,444, 445, 446, 447, 476,477 medialsupracondylarridge on,42Q olecranon fossa of, 421, 436, 437 olecranon of, 437 posterior view of, 421 radial fossa of, 420 radial groove of, 421 radiographsof, 437 right surgicalneck ot,243
Atlas of Human Anatomy
Humerus (Continued) shaftof. 244.245 surgicalneck of, 420 anteroposteriorr adiograph ot, 422 trochleaot.42O.437 ulnarnervegrooveof, 421 Hyaloid canal, 87 Hydatid of Morgagni. See Vesicular appendix(hydatidof Morgagni) Hymen annular,377 cribriform,3TT septate,377 f{ymenal catuncle, 37O,377 Hyoepiglottic ligament, 63, 77 Hyoglossus muscle, 34, 60 Hyoid bone, 27, 28, 29, 34, 59, 60, 61, 63, 65, 68, 74, 76, 77 b o d yo f , 1 3 , 5 3 greaterhorn of, 13, 53, 75 lesserhorn of. 13. 53 tip of greaterhorn of, 67, 75 Hyothenar muscle, 444, 476 Hypochondrium left, 268 right,268 l{ypogastric nerve, 165, 218, 324, 344, 345, 409, 410,414,415, 416 inferior,324 left, 318, 323, 412 oelvic.414 right,318, 323, 412 superior,345,415 Hypogastric plexus inferior,165,166, 168,323,324,344, 345,409, 412,499 parasympatheticbranchfrom, 165 with periuretericloops,344 right,323 superior,165, 318, 323, 324, 345, 409, 412 Hypogastric sheath, 364 Hypoglossal canal, 8, 10, 11 f{ypogfossaf nerve, 10, 32, 34, 114, 117,129,344 distribution of, 118 meningealbranchof, 128 schemaof. 118. 128 vena comitansof, 59, 60, 70 Hypoglossal nucleus, 116, 128 Hypoglossaltrigone,115 Hypogfossus muscle, 27, 53, 74, 77, 128 dorsal lingualvein medialto, 70 Hypophyseal artery inferior,140, 148 superior,14O,148 Hypophyseal fossa, 5, 9 at birth, 50 Hypophyseal portal system primaryplexusof, 148 secondaryplexusof, 148 Hypophyseal portal vein l o n g ,1 4 0 , 1 4 8 short,148 Hypophyseal vein, eftercnt, 140 to cavernoussinus, 148 Hypophyeis, 106, 107, 147. See also Pituitarygland arteriesand veins of, 148 Hypothalamic area, lateral, 135
Atlas of Human Anatomy
Hypothalamic artery, 140 Hypothalamic sulcus, 106, 147 Hypothalamic vessels,'148 Hypothalamohypophyseal ttact, 147 Hypothalamus, 108, 147, 324 arteriesof, 148 nucleiof arcuate,147 .147 dorsomedial, paraventricular, 147 posterior,147 supraoptic,l4T ventromedial,147 parasympathetic, 324 sympathetic,324 l{ypothenar eminence, 418 l{ypothenar muscle, 446, 462, 476 Hysterosalpingogram, uterus, 373
I lleal artery, 306, 307 anastomoticloops of, 280 lleal fold, 311, 313 lleal orifice, 284 musclesfibers of, 282 papillary,282 lleal papilla, 282 lleocecal fold, 281 lleocecal junction, muscle fibers around, 282 lfeocecal llpsr 282 lleocecal necess inferior,281 superior,281 lfeocecal negaon, 281, 282 f leocolic artery, 281, 307, 322, 323, 340 colic branchof, 281, 306, 307 ilealbranchof, 281, 306, 307 lleocolic lymph nodes, 317 lleocolic plexus, 322, 323 l l e o c o l i c v e i n , 3 1 1 ,3 1 2 ,3 1 3 lleum, 269,282,284, 339, 349 bariumradiographof, 280 circularmusclelayer ot,280,282 longitudinalmuscle layer ol, 28O,282 lymphoidnodulesof, 280 mucosaof, 280 musclefibersto, 282 musculatureof, 280 serosa of, 280 submucosaof, 280 terminal,271, 281, 282, 362, 363 lliac artery circumflex ascendingbranchof, 255,264 deep,501,512 superficial,247, 512 common,264,274,340,341, 398,400, 412 left,318 axial CT imagesof, 350 right,329 axial CT imagesof, 350 uretericbranchfrom, 341 external,264, 274, 318, 329, 340, 398, 4 0 0 , 4 0 24 , 12,501,512 right,329
lliac artery (Continued) internal,264, 307, 318, 329, 340, 341, 370, 398, 412 anteriordivisionof, 400 posteriorand anteriordivisionsof, 402 right,323, 329 lliac crest, 152,174, 175, 176,177,247, 248,254,329, 330, 342, 351, 485, 486,494,495, 496, 502, 503, 545 innerlip ot,248,352,353 intermediatezone of, 248,352,353, 486 in lumbarpuncture,162 outer lip ot, 248, 352, 353, 486 tuberculumo1,248, 352, 353, 486 upper lip of, 486 lliac fossa, 352, 353, 363, 486 lliac lymph nodes common, 266, 317, 343, 408 external,266, 317, 343, 408, 546 lymphaticpathwaysto, 408 internal,266, 317,343, 408 lateral,406 medialexternal,406 lliac plexus common,412 external,318,412 internal,318,412 left common, 317 right internal,323 lliac spine anterior,247, 248, 250, 486, 487, 492 anteriorsuperior,248, 249, 259, 263, 486, 487, 492, 493,496, 500 posteriorinlerior,486 posteriorsuperior,152, 352, 353, 486 lliac tubercle, 353 lliac tuberosily,24S f fiacus muscle, 263,329,376, 490, 496, 498, 499, 538 attachmentof, 490 muscularbranchof, 498 lliacus wing, male, 354 lliac vein, superficialcircumflex,544 lliac vessels circumflex deep, 364, 403 superficial,249,5OO common,271, 401,412 external,259, 260,281, 311, 360, 361, 362, 364, 372, 392, 401, 403 internal,311 superficialcircumflex,249 lliococcygeus muscle, 356, 357, 358, 359, 395 lliocostalis cervicis muscle, 175 lliocostalis lumborum muscle, 175 lliocostalis muscle, 175, 331 lliocostalis thoracis muscle, 175 fliofemoral ligament, 487, 496 lf iohypogastric nerve, 160, 177, 267, 329,409,496,498, 539 anteriorbranch of. 257 anteriorcutaneousbranchof, 257,267, 410 genitalbranch of, 409 lateralcutaneousbranchof, 545 schemaof, 498
l,l9
f lioinguinal nerve, 160, 257, 260, 267, 329, 330,340, 409, 414,496,498, 539. 540. 544 anteriorlabialbranch of, 413 anteriorscrotalbranchesof. 267. 409 schemaof, 498 scrotalbranchesof, 267, 409,544 ffiofumbar attery, 264, 341, 4O2 lliolumbar ligament, 330, 353 lliolumbar vein, 330, 353 lliopectineal bursa, 496 lliopectineal line, 353, 392 iliac part of, 358 pubic part of, 358 f liopsoas muscle, 259, 376, 489, 492, 493, 500 attachmentsof, 489, 491, 496 lliopsoas tendon, 504 lf iopubic eminence, 248,352, 486, 487 female,354 lliopubic tract, 259, 362, 363, 364 lliotibial tract, 485, 492, 494, 495, 502, 5 0 6 ,5 0 7 ,5 1 4 ,5 1 5 ,5 1 9 ,5 2 0 bursa deep to, 506, 507 insertions of, 515 lateralpatellarretinaculumand capsule and, 508 llium arcuateline of, 356 adicularsurfaceof, 486 axial CT imagesof, 350 body of, 352, 486 glutealsurfaceof, 352 radiographof, 355 anteroposteriorradiographof, 488 wing of, 248, 352, 358, 486 Incisive canal, 37, 38, 39, 43, 63 anastomosisin, 40 posteriorseptal branchof sphenopalatine and greaterpalatinearteries in,41 I n c i s i v e f o s s a , 1 0 ,1 4 , 5 2 , 5 6 lncisive papilla, 52 Incisor teeth, 56, 233 Incus, 89, 93, 96, 124 articularsurfacefor, 93 body of, 93 lateral view of, 93 long limb of, 93 posteriorligamentof, 94 short limb of, 93 superiorligamentof, 94 lnfant, mandible of, 15 Inferior anastomotic vein lof Labb6f, 102,145 Infragfenoid tubercle, 420, 421 lnfrahyoid muscler 29 action of, 29 fasciaof. 28.428 Infraorbital ailery, 23, 36, 40, 81, 85 Inlraorbital canal, 45 lnfraorbital foramen, 12, 36 Infraorbital groovo,2 Infraotbital margin, 1 lnfraorbitaf nerve lVrf, 24, 36, 44, 81, 83, 121, 122 enteringinfraorbitalcanal,45 internalnasal branchesof, 122 superioralveolarbranchesof, 122 Infraorbital vein, 23, 70
a-2o,
lnfrapatellar bursa deep,511 subcutaneous,511 Infrapatellar synovial fold, 507, 508 lnfraspinatus fascaa, 174, 177 Infraspinatus rnuscle, 152, 18O,244, 245, 424, 425,427, 428,432 fasciaover,174 insertionof, 421 originof, 421 fnfraspinatus tendon, 423, 425 Infratemporal fossa, 4, 13 lnfratrochlear nerve, 24, 36, 56, 81, 86,122 from nasociliarynerve,45 Infundibular nucleus, 147 Inlundibular process, 147 capillaryplexusof, 148 lnfundibular necess, 108 lnfundibular stem, 147 Infundibulum (Hartrnann's pouchl, 1 1 4 , 1 4 0 ,1 4 7 , 2 9 4 body of, 114 fundusof, 114 neckof, 114 of uterinetube, 372 lnguinal canal, 260, 262 Inguinal falx, 250 conjoint tendon of, 250, 253, 259, 263 Inguinal fold, 389 Inguinal hernia indirect,261 site of, 261 Inguinal ligament (Poupart'sl, 247, 249, 250, 259, 263, 351, 356, 378, 380, 381, 407,485,492,498, 500, 501,544,546 reflected,25O,251, 259 lnguinal lymph nodes deep,266, 406,407,408,546 highestdeep, 266, 408 horizontal,266 inferior,266 superficial,266, 317, 406, 4O7,408, 546 superficialinferior,407 superolateral, 407 superomedial,407 Inguinal region,259 anteriorview of, 259 posteriorview of, 259 Inguinal ring deep, 251, 259, 261, 362, 363, 369, 386 site oI,274 superficial,249, 259, 261, 386, 544 lateraland medialcrus of, 259 Inguinal (Hesselbach'sf triangle, 259 I n $ u l a , 1 0 5 ,1 1 0 ,1 4 1 centraland circularsulci of, 105 limenof. 105. 141 short and long gyri of, 105 lnteralveolar septa, 15 Interarticular ligament, 187 lnterarytenoid notch, 66 fnteratrial septum, 22O,246 lntercalated lymph node, 73 lntercapitular Yean, 468, 480 Intercarpal ligament, 455 Intercavenous sinus anterior,103 suoerior.103
Intercavernous septum, 382, 385 of deep fascia,381 lnterchondral joints, 186 Interclavicular ligament, 186, 419 Intercondylat alea anterior,513 posterior,513 lntercondylar condyle, radiograph of,510 lntercondylat eminence, 514 anteroposteriorradiographof, 510 Intercostal artery, 183, 192,305 anterior,192 first posterior,33 lower,anastomosiswith, 255 posterior,171, 172, 188, 189, 23O,231 dorsal branchof, 172 lateral mammary and cutaneous branchesof, 183, 192 second,33 third right,207,237 s u p r e m e , 3 31, 3 6 , 1 3 8 lntercostal lymph nodes, 266 Intercostal membrane external,180, 189, 192, 258 internal,180, 192, 23O,258 lntercostal muscle, 198, 243, 244, 245,331 anteriorcutaneousbranch of, 180 external,176, 188, 189, 192, 250, 258 external intercostal membranes anterior to, 189 innermost,180,192,258 internal,189, 192, 23O,231,255,258 lateralbranchof, 188 medialbranchof, 188 lntercostal nerve, 160,170, 180, 189, 192,331 abdominalportionsof. 188 anterior,258 anteriorcutaneousbranchesof, 177, 188,192,257 collateralbranch reioining,258 eighth,209 tirsr. 227. 430 lateralcutaneousbranchesot, 177,188, 189,192 lateralcutaneousbranchesto, 177, 188, 189,257 posterior,192,23O seventhright,321 s i x t h ,1 6 5 , 2 0 9 third, 240 ventralramus of, 180 lntercostal vein anterior,256 left superior,231 posterior, 230,231 right superior,230 lntercostal vessels, 331 muscle, 189 lntercostobrachial Intercostobrachial nerve, 189, 257, 429,474,479,481 lntercrural flbers, 249, 259 ligament, dorsal, Intercuneiform 527 Interglobular space, 57 Intergluteal cleft, 152 lnterlobar artery, 335, 337 lymph vesselsalong,343 Interlobar lymph vessels, 208
Atlas of Human Anatomy
lnterlumborum cervicis muscle, 176 Intermarillary suture, 36 Intermediate nerve, 104,114, 118, 1 2 3 , 1 2 4 , 1 3 31,3 5 Intermediolateral cell column, 346 Intermediolateral nucleus, 133, 134 Intermediolateral nucleus, plegan. glionic sympathetic cell bodies in, 132 lntermesenteric plexus, 267, 318, 322, 323, 324, 344, 345, 412 renal and upper ureteric branches frofi,344 Intermetacarpal ioint, 455 Intermuscular septum anlerior,522 anteromedial, 492, 500, 501 lateral,430, 432, 435, 445, 448 oI arm,477 medial,430, 432, 433, 445, 446,447, 448 posterior, 522 transverse,522 lntermuscular stroma, 326 lnternal capsule, 108, 141 cleft for, 110 g e n uo f , 1 1 0 part of, 110 retrolenticular Interosseous artery anterior,434,447 computedtomographyof, 484 common, 434, 447, 448, 449 posterior, 434, 445, 448, 449 recurrent.434.445 terminationof, 445 Interosseous intercarpal ligament, 455 Interosseous ligament, intercarpal, 455 Interosseous membrane, 439, 441, 443,444, 454, 455,511,512,517, 5 1 8 ,5 2 0 ,5 2 2 , 5 2 5 Interosseous muscle, 528 deeo tibial nerveto. 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 plantardorsal,536 super{icialtibial nervebranchto, 541 lnterosseous nerve anterior,448, 449,475 of leg,541 plantar,537 posterior,445,449 Interosseous talocalcaneal ligament,527 Interpectotal (Rotter's) lymph nodes,184 lnterpeduncular cistern, 109 Interphalangeal ioint, 41I capsulesand ligamentsof, 528 Interphalangeal ligaments, 458 Intersigmoid recess, 271, 340 Intersphincteric groove, 392, 393, 394 lnterspinalis cervicis muscle, 176
Atlas of Human Anatomy
Interspinous ligament lumbar,176 lumbosacral, 177 lnterspinous plane, 268 Intertendinous connection, hand, 470 Interthalamic adhesion, 106,108, 110,111,146 lntertragic notch, 93 lntefiransversarius muscle, lateralt 176 lntertransverse ligament, 187 fntertrochanteric crest, 487, 503 anteroposteriorradiographof, 488 fntertrochantelic line, 487, 489 lntertubercular plane, 268 lntertubercular tendon sheath, 423 Interureteric crest, 366 Interventricular foramen (of Monrol, 1 0 6 ,1 0 9 ,1 ' r 1 , 1 1 51, 4 5 ,1 4 6 left,108 Interventricular septum, 216, 22O muscularparl ot, 220, 223, 224, 225 Interventricular sulcus anterior,246 posterior,214,215 Interveitebral disc, 19, 155. Intervertebral disc, 19, 155. See a/so specific veftebrae anulusfibrosisof, 155 lumbar,157,339 lumbosacral,352 nucleuspulposusof, 155 sternalangle of, 245 lntervertebral disc space, 156 lntervertebral foramen, 19, 180 lower marginof, 154 lumbar,155 radiographof, 156 Intervertebral joint, 18 fnterveftebral vein, 137, 173 Intestinal glands, 326 Intestinal lymphatic trunk, 316 Intestinal trunk, 266 Intestine, 167.Seea/soColon; Duodenum;Jejunum;Mesocolon circularmuscleof, 326 intrinsicautonomicplexusesof, 326 rarge arteriesof, 307 innervation of,324 lymph nodes vesselsand nodes of, 317 mucosaand musculatureo1,284 nervesof,323,324 schemaof, 324 veins of, 311 longitudinal muscleof, 326 lumenof, 326 mesentericrelationsot, 270, 271 mucosaof, 326 s m a l l ,1 2 6 , 2 6 9 , 3 2 2 area for, 329 arteriesof,306 innervationof, 324 lymphnodesof, 316 lymphvesselsof, 316 mesenteryof, 348 mucosa and musculatureof, 280 nervesof, 322 schemaof, 324
Intestine (Continued) small (Continued) v e i n so f , 3 1 0 submucosaof, 326 lntraarticular ligament, 187 Intraculminate vein, 144 lntrahepatic biliary system' scherna otr 292 lntralaminar nuclei, 111 lntraparietal sulcus, 105 lntrapulmonary airway schemaof, 204 lntrapulmonary blood circulation, 205 Intiaspanatus tendon, 423 Intrinsic arterg of eye, 90 Intrinsic muscle action of, 79 of larynx,78 of tongue,128 Intrinsic nerve, pancreatic, 328 Intrinsic vein, of eyer 90 lridocorneal angle, 87, 88, 90 trabecularmeshworkand spaces of, 88 lris, 81, 87, 89, 90 arteriesof, 9'1 folds of, 88 major arterialcircleof, 88, 90, 91 minor arterialcircle of, 88, 90, 91 veins of, 91 lrritant rcceptots, 210 lschial spine, 248,263, 411, 486, 487, 503 female,354 radiographof, 355 lschiaf tuberpsity, 248, 352,353, 359, 378, 379, 381, 390, 395, 398, 486, 487. 502. 503 anteroposteriorradiographof, 488 female,354 male,354 radiographof, 355 lschioanal fossa, 366, 392 anteriorrecessof, 366, 370, 396 fat body ot, 376, 380, 392 posteriorcommunicationbetweenright and left, 396 posterior recess of, 396 preanalcommunicationbetweenright and left, 396 pus in, 396 roof of, 405 transversefibrousseptum of, 392, 394, 395 muscle, 360, 361, lschiocavernous 370, 378,379,381, 382, 383,391, 395. 404. 405 crus of, 366 lschiococcygeus muscle, 263, 356, 357, 398, 402, 411, 412, 499 nerveto, 499 lschiocondylar muscle, 540 lschiofemoral ligament, 487 fschiopubic ramus, 359, 361, 378,379, 380, 382, 383, 384, 395 lschium anteroposteriorradiographof, 488 body of, 486 radiographof, 355 ramusof, 486
1.21
J Jaw. See a/so Mandible;Maxilla angleof, 1 closed,16 slightlyopened,16 widely opened, 16 Jejunal artery, 306, 307 anastomoticlooo of. 280 first, 302 plexuson, 3190 Jeiunal vean,311,313 Jejunum, 269,270,271, 278, 279,297, 298 bariumradiographot, 279, 280 circularmusclelayerof, 280 cross sectionof, 297, 338 longitudinalmuscle layerof, 280 lymphoidnoduleof, 280 mucosaof, 280 musculatureof, 280 submucosaof, 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 |runkr T2 left, 266 right,266 Jugular vein anterior,30,74,256 communicationto, 70 terminationof, 70 external,23, 31, 74, 198, 206, 211, 256 interna|,23,28,29,30, 31, 32, 34, 59, 74, 75, 76, 97, 128,189, 198,206, 211,232,256 inferiorbulb of, 75 left, 137 right,137 Jugulodigastric muscle, 73 Juguloomohyoid node, 73 Jugum,9
K Kerckring, valves ol, 279, 28O Kidneys, 167, 179,272, 278, 338 anterior surface of, 335 base pyramidof, 334 blood vesselsin parenchymaot,334, 337 blood vesselsof, 332, 333, 347 cortex of, 334, 336, 337 cortical radiate arteries of, 335 fibrouscapsuleof, 334 hilumof, 334 inferiorpole of, 334 in situ anteriorviews of, 329 posterior,330 innervationof, 345 innerzone of, 336 interlobararteriesof, 335 lateral border of, 334 left, 98, 197, 273, 299, 329, 331, 340, 347 axial CT imagesof, 350 frontal section of, 329 superiorpole of, 297
l-22
Kidneys (Continued) lymph vesselsand nodes of, 343 majorcalicesof, 334 medialborderof, 334 medullaof, 334 minor calicesof, 334 nervesof, 334 outer zone of. 336. 345 perforating radiate artery of, 335 posteriorsurfaceof, 335 prenatal,229 renalcolumn of, 334 renal cortex of. 338 renalpapillaof, 334 retroperitoneal, 288 right,197, 275,298,329,330, 34O,342, 347 subscapularzone of, 336, 337 superiorpole of, 272,334 cross section of, 338 Knee anteriorviews of, 507, 508 anteroposteriorradiographof, 510 arteriesof, 507 articularcavity of, 511 attachmentof, 511 collateralligamentsof, 509 cruciateligamentsof, 509 in extensionof, 507 in flexion,509, 543 interiorof, 508 joint capsuleof, 506, 508, 519 lateral view of, 506 ligamentsof, 508, 509 medialview of, 506 posteriorview of, 511 right in extension.507. 509 in flexion,509 sagittalview of, 511 slightlyin flexion,507 Kohn, pores otr 204
L Ltl-5 disc herniation, 162 L5-Sl disc herniation, 162 L2 gangLonr 4l2 Ll spinal nerve, 160 ventralramusof, 177 Ll-3 spinal neryes, dorsal rami of, 254 L5 spinal nerYe, 160,412 anteriorramusof,410 Ll vertebra, 153,160 body of, 273 inferiorarticularprocessof, 156 spinousprocessof, 179 superiorarticularprocessof, 156 transverse process of, 338 L2 vertebra body of, 179 suoeriorview of. 155 L3 vertebra b o d yo f , 1 5 6 , 3 3 6 , 3 3 7 pedicleof, 156 posteriorview of, 155 spinousprocessof, 156 transverse process of, 156
L4 vertebra body of, 352 inferiorvertebralnotch of, 156 laminaof, 156 posteriorview of , 155 spinous processof, 156 L5 Yenebra, 153, 160 body of, 352 superiorvertebralnotch of, 156 Labb5 vein. See Inferioranastomotic vein (of Labb6) Labial artery inferior,69 posterior,404 superior,69 Labiaf 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 schemaof, 96 superiorproiectionof, right,97 common membranouslimb of, 95 membranous,95, 96 right,95 schemaof, 96 orientationof in skull, 97 Labyrinthine artely, 1 40, 141, 143 internal,143 left, 136 Lacdmal apparatus,82 Lacrimal artery, 85 recurrentmeningealbranchof, 100 Lacrimal bone, 2, 4,6, 12,38 at birth,46 Lacrimal canaliculi, 82 Lacrimal carunele, 81, 82 Lacrimal gland, 83, 85, 86, 133,166, 167,168 excretory ducts of, 82 orbital part of, 82 palpebralpart of, 82 Lacrimal lake, 81, 82 Lacrimal nerye, 83, 86, 121, 122,131 cutaneousbranchof, 45 palpebralbranchof, 82 Lacrimal papilla inferior,81, 82 superior,81, 82 Lacrimal sac, 81, 82 fossa for, 2, 4 Lactilerous duct, 182 Lactiferous sinus, 182 Lacuna lateral(venous),99, 100 magna,385 Lacunar ligament (Gimbernat's|, 250,251,259,263,546 Laimer, anea 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
Atlas of Human Anatomy
Langerhans, islets of, 298 Laryngeal vein, superior, 235 Laryngeal artery recurrentright, 126 superior,34, 69, 74, 75, 136 Laryngeal inlet, 63, 66, 235 Laryngeal netve (Xl externalbranchto, 74 inferior anomalousright, 80 anterior and posterior branches of, 80 left, 80 internalbranch ol. 75. 235 left, anterior and posterior branches of, 80 recurrent,33, 71, 76, 130, 206, 2O9,21O, 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 externalbranch of, 75,80, 126 fold over internalbranchof, 66 foramenfor internalbranchof, 78 internalbranchesof, 62, 65, 71, 74, 75,76,78,80,126 Laryngeal plominence, 77 Laryngopharyngeal sympathetic branch, 130 Laryngopharynx, 63 opened posteriorview of, 66 L a r y n x , 1 3 5 ,1 6 7 ,1 6 8 , 2 1 0 carlilage o1,77 innervationof, 168 intrinsicmusclesof, 78 action of, 79 lateraldissectionof, 78 medianview of, 77 nerves of, 80 posteriorview ot, 77, 78 right lateralview of, 77, 78 sensorybranchesto, B0 superiorview of, 80 Lateral aperture (foranen of Luschkaf, 109 Lateral funiculus, 115 Lateral nectus muscle, 84 Lateral r€ctus plane, 286 left, 268 right,268 Lateral sulcus, 107 anterior,ascending,and posteriorrami 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 originof, digitationsof, 254 fascia of, 428 insertionof, 420 small slip ol origino1,421 Leg anterior fascial compartment of, 522 anteriorintermuscularseotum of. 522 cross section of, 522 deep fascia oI, 522,544, 546 posteriorcompartment,522 fascialcompartmentsof, 522 late'al,522 superiorposterior,522
Atlas of Human Anatomy
Leg (Continued) innervationof, 538, 539 interosseousmembrane,522 interosseousnerveof, 541 medial cutaneous nerves of, 538 musclesof anteriorview of, 519, 520 attachmentsof, 515 deep dissectionof, 518, 520 lateralview of, 521 posteriorview of, 516, 517 superficialdissectionof, 5'16 posteriorintermuscularseptum of, 522 right,bonesof, 513 surface anatomy of, 485 transverseintermuscularseptum of, 522 Lens,81,88,90 axialMR imageof, 150 axis of. 88. 89 capsuleof, 87, 88 cortex of, 87, 88 equatorof, 87, 88 nucleusof, 88, 89 supportingstructuresof, 88, 89 suspensoryligamentof, 87, 88 Lenticufostriate artery, 140, 141, 143 anterolateralcentral,139 Lentiform nucleus, 108, 141 globuspallidusof, 110 putamenof, 110 thalamusand, 110 Leptomeninges, 170 Lesser sac, 331 Levator anguli oris mu$cle, 54,123 Levator ani mu6cle, 263,284,312, 367,376,411, 499 fibersto anal canal longitudinalmuscle from, 358 fibromuscularextensionsof. 359 left, 356 levator plate ot, 356, 357 medialborderof, 359 nervesto. 267.499 pelvic,360 prerectalmusclesfrom, 359 puborectalispart of, 391 tendinousarch of, 263, 356, 357, 358, 359, 364, 365, 370, 379, 392 Levator costae muscle, 176 Levator€s costarum muscle brevis,176 longus,176 Levator labii superioris alaeque nasi muscler26,54, 123 Levator labii superioris muscle, 26, 54,123 Levator palpebrae superioris muscle, 81, 83, 84, 86, 121 coronalCT imagesof, 151 fascialsheathof, 83 insertionof, 81 Levatof scapulae muscl'e, 27,32, 174,177, 189,424,427,477 insertionof, 421 nervesto, 129 Levator veli palatini muscle, 47, 51, 55, 64, 65, 67, 68, 93, 126 interdigitaging fibers of, 52 Lieberk0hn, crypts ol, 283 Lienogastric trunk, 302 Lienomesenteric trunk, 302
Ligamenta flavat 21 Ligaments. See a/so specific ligaments of abdominalwall and viscera,348 ol 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 prcnatal,229 Ligamentum flavum, in lumbar puncture, 162 Ligamentum nuchae, 21, 152 Ligamentum teres, 229, 288,349 fissurefor, 287 orenatal,229 Ligamentum venosumr 229 fissure fon 287 prenalal,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, 7 5 , 1 3 3 ,1 3 6 , 1 3 8 deep,51,59 dorsal,59 tonsillarbranch of. 64 Lingual glands lsercus glands of von Ebnerl, 58 Lingual gyruE, 106 Lingual nerve, 23, 40,53,55, 59, 60, 1 2 2 ,1 2 3 ,1 3 1 ,1 3 3 ,1 3 4 ,1 3 5 deep, 51 Lingual tonsil, 58 Lingual vein common trunk for, 59 deep, 59, 70 dorsal,59 L i n g u l a , 1 5 , 1 1 3 , 1 1 5 ,1 4 4 ,1 9 9 bronchito, 202 Lip frenulumof, 51 lower,51 ohiltrumof, 51 tubercleof, superior,1 upper,51 Lister's tubetcle. See Dorsaltubercle of radius (Lister's) Liver, 126, 196, 197, 272,278,293,294, 297,331, 339,342,347 anatomiclobes of, 289 anteriorview o1,287 areator,329 arterial variations and collateral supply of, 305 arteries of, 300, 301 bare area of,329,342 bed ot,287 caudatelobe of, 272,288 central veins of. 290 coronaryligamentof, 274 cross sectionof, 297, 338 distributingvein of, 291
1.23
Livet (Continued) duct distributionin, 289 falciformligamentof, 255 fibrousappendix ol, 287 functionalsurgicalsegmentsof, 289 inferiorborderof,268,275 in situ,288 inletvenulaof, 291 innervationof, 168, 326 intrahepaticvascularand duct systems of, 290 intralobulararterioleof, 291 left lobe ol, 269, 275, 288 left triangularligamentof, 274 ligamentsot,287,312 lobes of, 289 low-powersectionof, 292 lymph pathwaysto, 184 normallobularpatternof, 290 papillaryprocessof, 287 parietal surface of, 289 periportalarterioleof, 291 perivascularfibrouscapsuleof, 290 portal arterioleof, 291 posteriorlateralsegmentof, 289 posteriorview of, 287 prenatal,229 quadratelobe of, 275 rightlobeof, 269, 275,288 axial CT imagesof, 350 round ligamentot, 229, 256, 275, 349 segmentsof, 289 structureof, 29 sublobularlobes of, 290 surfacesof, 287 topographyof, 286 variations in form of, 288 vascularsystemof, 290 veins of, 291 visceralperitoneumof, 331 visceralsurfaceot. 287. 289 Liver plate cells, 290 Lobule (earl, 1 Locus ceruleus, 115 Longissimus capitis muscle, 175, 178 Longissimus cervacis 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 conjoinedrectal,393 of intestine,326 rectal,393 of tongue inferior,60 superior,60 Longus capitis muscle, 27, 30 nervesto, 129 Longus colli muscle,30 Loops of Heiss, 367
t-24
Lower limb. See a/so Leg arteriesof. 500-502. 504 cutaneousinnervationot, 487489 dermatomesof, 543 lymph nodes and vesselsof, 546 musclesof, 490-503 neurovasculature of , 538-546 segmentalinnervationof movementsof, 543 superficialnervesand veins of, 544 anteriorview of, 545 oosteriorview of. 545 surfaceanatomyof, 485 Lumbar artery, 171 fifth, 264 lower,anastomosiswith, 255 right,264 Lumbar curvature, 153 Lumbar disc herniation, 162 characteristicposturein, 161 clinicalmanifestationsof, 161 left-sidedlower,161 levelof and clinicalfeaturesof. 161 surgicalexposureof, 161 Lumbar disc protrusion, 161 Lumbar enlargement, 161 Lumbar ganglion, 167,318 Lumbar lymphatic trunk to cisternachyli and thoracicduct, 343 right and left, 316 Lumbar lymphatic trunk ganglion lower,228 upper,228 Lumbar lymph nodes,266 Lumbar nerve, 161 Lumbar nucleus pulposus, herniated, 161 Lumbar plexus, 160, 496, 498, 538, 539 muscufarbranchestrom, 267 Lumbar puncture, 162 Lumbar region, 268 Lumbar spinal nerve, 161,179 dorsal and ventralroots of, 170 dorsalramiof, 177 originof, 170 Lumbar triangle (of Petitf, 152,254 internalobliquemusclein, 174 Lumbar trunk ascending,195, 263, 265, 332 left, 266 right,266 Lumbar vein, ascending, 332 Lumbar Yertebra anteriorview of, 171 arteriesof, 171 assembled,153 body of, 153 cross sectionthrough,170 dura mater of, 162 foramenof, 155 inferiorarticularprocessof, 155 inferiorvertebralnotch of, 155 intervertebraldisc of, 155 laminadisc of, 155 left lateralview of, 155 mammillaryprocessof, 155 musclesof, 179 pedicle,sectionedof, 179 posteriorview of, 153 radiographsof, 156 spinousprocessof, 155
Lumbar vertebra (Continued) superiorarticularprocessof, 155 superiorvertebralnotch of, 155 superiorview of, 155 transverse processes of, 248 transverseprocess of, 248 Lumbocostal ligament, 330 Lumbocostal triangle, 195 Lumborum muscle, interspinalis, t/o
Lumbosacral articular surface, 157 Lumbosacral fascial sheath, 462 Lumbosacral trunk, 267, 496, 498, 499, 538, 539 Lumbosacral vertebrae inferiorarticularprocessof, 159 invertebralforamenof, 159 laminaof, 159 ligamentsof, 159 ligamentumflavumof, 159 pedicleof, 159 spinousprocessof, 159 superiorarticularprocessof, 159 transverseprocessof, 159 Lumbrical fascial sheath, 460 Lumbrical muscle, 465, 533, 534, 536 deep tibial nervebranchto, 541 in fascialsheaths,460 first, 541 fourth,460 in fascialsheath,460 innervationof, 465, 541 schemaof, 463 second,460, 541 in fascial sheath, 460 tendons of, 535 third, 460 in fascialsheath,460 third and fourth,476, 541 Lumen,326 Lunate, 376,456,487 anterior(palmar)view of, 452 area for, 439 coronalsectionof,455 posterior(dorsal)view of, 452 radiographof, 457 Lunatesulcus,105 Lungs,167, 168, 170, 342 anteriorborderof, 196 anteriorview of, 200 apex of, 196,197 areafor esophagusin, 196 area for tracheain, 196 bronchopulmonary segmentsof, 200, 201 cardiacimpressionof, 196 cardiacnotch of, 196, 198 diaphragmaticsurfaceof, 196 great vessels of, 206 groovefor esophagusin, 196 hilumof, 196 fissureof, 196, 197,198 horizontal inferiorborderof, 196 inferiorlobe of, 198,200 medialview of, 199 in situ, anteriorview of, 198 left, 197, 211, 215, 243, 245 bronchopulmonary segmentsof, 200, 201 inferiorlobe ol,2O1,293 medialview of, 199
Atlas of Human Anatomy
Lunate (Continued) obliquefissureof, 244 superiorlobe of, 201,242 left medial,198 lingulaof superiorlobe of, 198 lobesof, 198 lymph nodes of, 208 lymph vesselsand nodes of, 208 lymph vesselsof, 208 medialview of. 198.199 middlelobeof. 198.200 obliquefissureof, 196, 197 right,193, 196, 197, 198, 211, 243,244, 245 bronchopulmonary segmentsof, 200, 201 inferiorlobe ot. 201. 293 medialview of, 199 middlelobeof, 201 superiorlobe of, 201 root of, 193 spinalnervesto, 170 superiorlobeof, 198,2O0,242 topographyof anteriorview of, 196 posteriorview 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 apicalcollectingvessels,73 basalcollectingvessels,73 centralcollectingvessels,73 marginalcollectingvessels,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 c e r v i c a l7, 2 , 7 3 , 2 0 8 anteriordeep,72 anteriorsuper{icial,72 deep lateral,73 rnferiordeep,72,208 inferiordeep lateral,72 posteriorlateralsuperficial,72 superiordeep lateral,72 superiorlateralsuperior,72 transversechaino'f,72 colic,317 of femalepelvisand genitalia,406 of femaleperineum,407 gastro-omental, 314 of head and neck, 72 heoatic.314 inguinal,266 interoectoral.184 of kidneysand urinarybladder,343 of largeintestine,317 of lowerlimb,546 of lung,208
Atlas of Human Anatomy
Lymph nodes (Continued) of male pelvisand genitalia,408 of mammarygland,184 mediastinal, 243 pancreatic,3lS pancreaticoduodenal, 315 paracolic,317 of pelvisand genitalia,408 perianal, 317 of pharynxand tongue,73 phrenic,184,266 of posteriorabdominalwall, 266 pretracheal,74 rectal,317 sigmoid,317 sinuatrial,225 of smallintestine, 316 splenic,314 of stomach,314 subclavian, 184 submandibular, 60, 73 submental,73 subpyloric,314 superiortracheobronchial, 244 suprapyloric, 314 tracheobronchial inIerior,245 of upperlimb,483 visceral,266 Lymphoid nodule aggregate,283 of ileum,280 of jejunum,280 Lymph vessels drainageroutesof, 204 of femaleperineum,407 of head and neck, 72 of kidneysand urinarybladder,343 of largeintestine,317 of liver,291 of lowerlimb,546 of lung,208 of male pelvisand genitalia,408 of mammarygland,184 of pelvisand genitalia,408 of posteriorabdominalwall, 266 of smallintestine, 316 of stomach,314 of trachea,2O2 of upperlimb,483
M Macula,90 fovea centralisin, 90 Macular arteriole inferior,90 superior,90 Macular zone, 120 llagendie, foramen of, 108 Magnetic resonance imaging (MRII o f h e a d ,1 4 9 , 1 5 0 pelvic,397 Mallear fold anterior,93 posterior,93 Mafleolar arlely anteriorlateral,530 anteriormedial,530
Malleolus,92 arterialnetworkof, 520 lateral,485, 513, 514, 520, 521, 530, 531 articularfacet of, 513, 514 radiographof, 54 m e d i a l4, 8 5 ,5 1 3 ,5 1 4 ,5 1 7 ,5 1 8 ,5 1 9 , 530, 531 articularfacets of, 514 radiographof, 54 Malleus,96 anteriororocessof. 93 handleof, 93 h e a do f , 9 2 , 9 3 , 1 2 4 lateralprocessof, 93 lateralview of, 93 neck of, 93 superiorligamentof, 93 Malpighian corpuscle, 336 Mammary gland anterolateraldissectionof, 182 aderiesof, 183 lobulesof, 182 lymph vesselsand nodes of, 184 sagittalsectionof, 182 subcutaneoustissue layerof, 182 suspensoryligamentsof, 182 Mammiffary body, 106, 107,112,114, 147 llammillary pnocess, lumbar, 155 fasciculus, 106 llammillothalamic Mammillothalamic tract, 147 Mandible, 15 of adult anterolateralsuperiorview of, 15 left posteriorview of, 15 ofaged persons,l5 alveolarpart of, 15 angleof, 15 base of, 15 body of, 15,27 condylarprocessof, 15 coronoidprocessof, 15 temporalismuscleinsertionto, 54 headof, 15 of infant,15 lingulaof, 15 mentalprotuberanceof, 15 mentalspinesof, 15 mentaltubercleof, 15 neckof, 15 obliquelineof, 15 pterygoidfovea of, 15 ramusof, 15,25,27 Mandibular canal, 60 Mandibular foramen, 15 inferioralveolarnerveentering,46 llandibular fossa, 12, 16 llandibular lymph node, 72 Mandibular nerve (V"1, 11,24, 46,86, 122, 125,131, 133, 134, 135 anteriordivisionof, 46 lateralview of, 46 marginal,25,31 medialview of, 46 meningealbranchof, 10,86 motor root of, 46 posteriordivisionof, 46 sensoryroot of, 46 Mandibular notch, 15 Manubriosternal joint, 186 llanubraosternal junction, 245
1.25
Manubriosternal synchondrosis, 419 Manubrium, 186, 198,243,244,419 Marginal artery, 307, 323 of largeintestine,307 left,216 Marginal plexus, 323 Marginal sulcus, 106 Marshall, ligament ol, 221 Masseteric artery, 40, 54, 55 Masseteric nerve, 40, 54, 55, 122 Masseter muscle, 25, 27, 28, 47, 60, 61 axial CT imageof, 150 axialMR imageof, 150 deep part of, 54 insertionof, 54 superficialpart 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, 3 0 , 3 4 , 5 3 , 5 91, 7 6 Maxilla,2, 6, 38 alveolarprocessoI, 2, 4, 6, 13, 38, 48 anteriornasalspineol,2, 4,6, 36, 38 at birth, 50 frontalprocessot,2, 4,36, 38, 81 incisivecanal of, 6, 38, 40 incisivefossa of, 8 infraorbitalforamen ot, 2, 4, 12 infratemporalsurface of, 4 maxillarysinus in, 50 medialpalatinesutureof, 8 nasalspine of, anterior,36 nasal surface of, 6 orbital surface of, 2 palatineprocessof, 5, 6, 8, 14, 37, 38, 52,56 tuberosityot,4, 14 zygomaticprocessof, 2, 8 llaxiflary arte;y, 16,34, 40, 54,71, 100,131,134 branchesof, 40 lfaxillary bone,47 Maxillary nerve {Vrf, 45, 86, 121, 131,133,134,135 dentaland gingivalbranchesof, 45 meningealbranchof, 86,122 nasalbranchof, 122 pharyngealbranch ot, 122 posteriorsuperiorlateralnasal branchof, 42,43 llaxillary plexus, 131 Maxiflary sinus, 3, 5, 44, 47, 48, 49 alveolarrecessof, 48 axial MR image of, 150 coronalCT imagesof, 151 growth of, 50 infraorbitalrecessof, 48 mucous membraneof, 45 with openinginto semilunarhiatus,50 openingsof, 37, 38, 48, 49, 50 postganglionicfibersto vesselsand glandsof, 44 sagittalMR image of, 149 zygomatic recess of, 48 Maxillary vein, 85 McBurney's point, 283
t-26
Medial rectus muscle, 83 Median apertune lloramen of Magendief, 109 Median nerve, 429, 433, 446, 447, 454, 460, 465,474,475 anteriorinterosseouspart oI, 476 anteriorview of, 475 articularbranchof, 475 branchesto thenarand lumbricalmuscles, 465 in carpaltunnel,461 common palmardigitalbranchesof, 460 communicatingbranchwith ulnarnerve, 4IO
communicatingwith ulnar newe,475 to cutaneousinnervation,475 palmarbranch ol, 446, 447, 475, 481 palmardigitalbranchesot,473, 481 palmarview of, 475 posterior view of, 475 properpalmardigitalbranchesof, 469 recurrentbranch ol, 474 to thenar muscles,460 lledian sulcus, dorsal, 115 llediastinal lymph nodes, 184 anterior,pathwayto, 184 posterior,266 llediastinum anteriorlung area lor, 194 cross sectionof. 241 fat pad in, 231 left lateral view of, 231 right lateralview of, 230 superior,great vesselsof, 206 tedufla oblongata, 11, 106, 124,134, 1 3 5 ,1 6 8 , 3 2 4 , 3 4 5 axial MR imageof, 150 cross sectionof, 124 lower part of, 135 nuclearlayerof, 113 sagittalMR imageof, 149 lledullary artery anteriorsegmental,171,172 posteriorsegmental,171 tedullary lamina external,111 internal,111 lledullary (renall lymph vessels, J4J
lledullary vein anteromedian,144 anteriorsegmental,173 anteromedian,144 posterior,173 Medullary velum inferior,106, 113 superior,106, 113, 114, 115 lleibomian glands, 81 lleissnerts plexus. See Submucous (Meissner's)plexus Membranous ampulla anterior,95 lateral,95 posterior,95 llembranous septum atrioventricularparl ot, 222, 223, 225 part ot, 223, 225 interventricular lleningeal artery, 99, 100 accessory,11, 40, 100 anterior,85 left middle,136
lleningeal artery (Continued) middle,40, 55, 99, 100, 102, 131, 138 posterior,11 lleningeal nerve, 45 lleningeal plexus, middle, 131 teningeal vein, middle, 102 lleningeal vessel gnooves anterior,9 middle,6, 7, 9 posterior,9 Meningeal vessels, middle, 10 Meninges, 10,136 arteriesof. 99, 136 innervationof, 325 spinal,102,324,325 superficialveins of, 102 veins of. 99 Meningohypophyseal ttunk' 100 Meniscofemo?al ligament, posterior,508, 509 Meniscus,455 lateral,507, 508, 509, 511 horns of, 508 medial,507, 508, 509 horns of, 508 Mental foramen, 15 Mentafis muscle, 26, 54, 123 Mental nerYe, 24, 46, 71, 122 Mental plotuberance, 1 llesencephalic vein lateral,144 posterior,144, 146 Mesenteric artery inferior,270, 278, 307, 308, 318, 323, 329,332,340, 341 superior,179,27O,281, 298, 301, 305, 306, 307,308, 319, 321,322,328, 332,339,340,342 common ongrnof, 302 relationsof,310 in root of mesentery 270 llesenteric 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 necess, 179, 270.271 Mesenteric plexus inferior,165, 318, 323 superio( 165, 166, 318, 319, 32O,322, 328 Mesenteric vein inferiol''27O,298, 311, 312, 313, 315 superior,179,279, 306, 311, 312, 313, 338, 339, 342 cross section of, 338 relationsof,310 Mesenteric vessels, supeTiotr 278, 349 Mesentery of ileum,280 of lejunum,280 peritoneallayersof, 326 root of, 270, 274,278,296,298,310, 340, 362, 363 superiormesentericvein and, 310 of small intestine,349
Atlas of Human Anatomy
lf esoappendix, 281, 283, 322 llesocolic taenia, 281, 282, 284 llesocolon sigmoid,271, 284, 3O7,329, 340 attachmentof, 274 transverse,269, 270, 271, 272, 273, 278, 284,307 attachmentof, 298, 299 llesometrium, 371 llesonephric lwolffianl duct, 389 llesonephric tubule vestigial, 390 Mesosalpinx,369 laminaeof, 372 Mesothelial septum, 169 llesovarium,370 laminaeof, 372 Metacarpal artery dorsal.469. 530 palmat 465 Metacarpal bone,456 anterior(palmar)view of, 452 base of, 456 tifth,444 base of, radiograph of, 457 head of. 456 posterior (dorsal)view of, 452 second,445 shaft of, 456 third, 456 ligament lletacarpal deep transverse,465 dorsal,455 palmar,465 superficialtransverse,480 lletacarpal vein, dorsal, 468 lletacarpophalangeal lMPl ioint, 458 lletacarpophalangeal lllPl ligament,458 tetaphyseal arcuate ligament, 455 lletaphysis, nutrient arterial branch lor 471 lletatarsal artery dorsal,530, 535, 536 anterior perforating branches of, 535 posterior perforating branches of, 535 plantar,535, 536 anteriorperforatingbranchesof, 535 Metatarsal bone, 523, 524, 536 base of, 523 fifth, 523 tuberosityot,523,530, 535, 536, 537 first,523, 524,537 fourth, 523 head of, 523 plantarview of, 523 second,523 shaft of, 523 third,523 tuberosityof, 523, 524,537 ligament lletatarsal deep transverse,536 dorsal,536 plantar,528, 536 superficialtransverse,532 Metatarsal vein, dorsal, 544 Midbrain axial MR image of, 150 sagittalMR imageof, 149
Atlas of Human Anatomy
line Midclavicular left, 268 right,268 Midline gnoove, 58 Midpalmar space, 460, 462 Minute arteries, of finger, 471 Mitral cell, 119 Mitraf valve, 213,225 anatomyof, 223 anteriorcusp of, 222,223,224 commissuralcusps of, 222 fibrousring of, 222 leafletof, 246 left fibrous ring ol,222 posteriorcusp of, 222,223,224 Molar teeth first, 56 growth of, 50 second,56 third,56 Monro, foramen of. See Interventricular foramen(of Monro) llorgagni, hydatid of. See Vesicular appendix(hydalidof Margagni) llorison's pouch. See Hepatorenal recess(Morison'spouch) llouth afferent innervationof, 62 floor of, 53 nerves of, 62 roof of, 52 anteriorview of, 52 posteriorview of, 52 Mucosa, intestinal, 279, 280 Mucous cell, stomach, 276 lltllerian duct. See Paramesonephric (miillerian)duct Multifidus mu3cle, 176 lluscles. See also specific rnuscles anorectal,394 of arm anterior view of. 430 posterior view of, 432 of back, 174,175,176 deep layersof, 176 intermediatelayersof, 175 supediciallayersof, 174 of dorsum of foot, 530 of duodenum,279 of esophagus,234 extrinsiceye,84 of face. 123 of facialexpression,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 posteriorview of, 495 innervatedby femoralnerve,538 innervatedby obturatornerve,540 of largeintestine,284 of larynx,78 of leg anteriorview of, 520 attachments of , 515 deep dissectionof, 516, 520 posteriorview of, 518 intermediatedissectionof. 517 lateralview of, 521 posteriorview of, 517
lfuscles (Continued) superficialdissection of anteriorview ot, 518, 519 posteriorview 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 musclelayerof, 533 second musclelayerof, 534 third muscle layerof, 535 of stomach,277 of thigh, 492495 of tongue,59, 60 of vermiformappendix,283 Ituscular artery, 90, 91 lluscularis mucosae, 276 of anal canal and rectum,394 tuscular vein, 90 nerve,429,43O, 433, 435, 447, 449,474, 475, 480 terminalpart of, 446, 469,479,482 Musculophrenic artery' 189, 198, 211, 215 Musculophrenic vein, 189, 256 423. See a/so ifyelencephalon, Medullaoblongata (Auerbach'sl plexus' 326 llyenteric llylohyoid groove, 15 llylohyoid line, 15 lfyfohyoid muscle, 27, 28, 29, 31, 32, 34, 53, 59, 60 medianraphe between,53 nerveto, 55, 60 llylohyoid nerve, 16, 40, 46, 53, 122 llyometriumr 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 Nasaf bone, 1, 2, 4, 6, 12, 36, 38, 39 at birth,50 Nasal cavity, 82,83 arteriesof, 41 autonomicinnervationof. 44 bones of, at birth,50 floor of. 37 growth of, 50 lateralwall of, 37, 38 medialwall of, 39 newes ot,4244 postganglionicfibersto vesselsand glandsof, 44 speculumview of, 37 Nasal cleft. See Interglutealcleft
l-27
Nasal concha axialMR imageof, 150 highest,38 inferior,37, 38, 82 coronalCT imagesof, 151 ethmoidalorocessof. 38 growth of, 50 sagittalMR imageof, 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 ol, 26,76 transversepart of, 26, 36 Nasal meatus atriumof middle,37 inferior.37. 82 openinginto,50 middle,37 atriumof, 37 openinginto,49 superior,37, 50 l{asal nerve external,36 inferiorlateral,131 posterior, 131, 133 posteriorsuperior,131 Nasal retinal arteriole inferior,90 superior,90 Nasal retinal venule inferior,90 superior,90 Nasaf septum, 39, 41, 42,47, 48,63,66 axial MR imageof, 150 cartilageof, lateralprocessof, 38 coronalCT imagesof, 151 groMh of, 48 Nasal slit, 11 Nasal spine anterior,39 oosterior.39 Nasal vein dorsal,23 external,T0 Nasal yestibule, 37, 39 Nasociliary nerve (V,f, 83, 86, 121, 122, 131, 132 infratrochlearnervefrom, 45 Nasofrontal vein, 23, 85 Nasolabial lymph node, 72 Nasolabial sulcus, 1 Nasolacrimal canal, opening of,38 Nasolacrimal duct, 82 in nasoopticfurrow,50 o p e n i n go f , 3 7 , 8 2 Nasolacrimal foramen, at birth, 50 Nasooptic furroq 50 Nasopafatine nerve lV2l, 10,42, 43, 44,62 communicatingwith greaterpalatine nerye,42 passingto septum,43 Nasopharynx, 92 airwayto, 37 sagittalMR imageof, 149 Navicular bone, 536, 537 plantarview of, 523 tuberosity of , 523, 524, 536 Navicular fossa, 361,385
t-28
Neck arteriesof, 504 autonomicnervesin, 130 bony frameworkof, 185 cervicalolexusin. 32 cutaneousnervesof, 24 fasciallayersof, 28 lymph nodes and vesselsof, 72 musclesof, 27 anteriorview of, 28 oosteriorview ot.27 nervesof, 24 posteriortriangleol, 174, 188 suoedicialveins and cutaneousnerves of, 31 surfaceanatomyof, 1 Nephron Henle'sloop of, 337 schemaof, 336 Nerves. See a/so specific nerves abdominal,258 of abdominalwall,267 oI back,177 to blood vessels,228 cochlearfibers of, 96 cutaneous of arm and shoulder,479 of forearm,480 of head and neck,224 of upperlimb,479, 481 of wrist and hand,473 of esophagus,240 of externalgenitalia,409 of femalepelvicviscera,412 of femaleoerineumand external genitalia,413 of femalereproductiveorgans,415 of fingers,471 of forearm,480 ot hand,472 oalmarview of. 466 of heart,226,227 of hip and buttock, 503 of kidneysand ureters,344,345 of largeintestine,323,324 of larynx,80 of liverand biliarytract, 327 of lower limb. 544. 545 of male externalgenitalia,409 of malepelvicviscera,410 of maleoerineum.411 of mouth,62 of nasal cavily,42-44 of neck,130 of pancreas,328 of shoulder,477 322.324 of smallintestine. of spinalcord and vertebralcolumn,173 of stomachand duodenum,319,320 glands,345,346 of suprarenal of thigh,500, 501, 540 tree,210 of tracheobronchial of upperlimb,473 of urinarybladder,344 of wrist. 461. 472 Neuroendocrine G ceaat276 Neurohypophysis, 140, 147, 148 Neuropathways, in partur:taonr 415 Neurovasculature of arm, 435 of lower limb, 538-546
Newborn, skull of, 12 l{ippfe, 181, 182 left,196 right,196 Nodose ganglion, 135 Nodule cerebellar,144 inferiorvermis,113 Nose. See a/so Nasalcavitv ala of, 1 anterolateralview of, 36 cross sectionof, 47 inferiorview of, 36 lateralcrus of, 36 medialcrus of, 36 surfaceanatomyof, 1 Nostril, 1 Nuchal line inferior,14 o f s k u l l ,1 7 4 , 1 7 5 , 1 7 6 Nucleus ambiguus, 117, 126 Nucleus pulposus, 155, 162 lumbar,19 l{utrient artery, femoral, 504, 513 ilutrient fotamen, 489, 513
o Obex,115 Oblique aponeurosis, 261 external,25O,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 aponeurosisof, 250, 252, 259, 349 aponeurotic parl ot, 249 cross sectionof, 338 digitationsof, 254 muscularparl oI,249 inferiot121 internal,175, 179, 25O,259, 261, 263, 330 aponeurosisoI, 252, 349 in lumbartriangle,174 tendonof originof, 179 superior, 83, 84, 86, 118,121 Oblique popliteal ligament, 508 Oblique vein, left atrial, 214, 215, 221 Obliquus capitis inferior muscle' 1 7 5 .1 7 6 . 1 7 8 Obliquus capitis superior muscle' 175,176,178 Obturator anastomotac vein, 265 Obturator anastomotic vessels, 262,363 Obturator artery, 259, 264, 340, 369, 376, 398, 400,402,403,410, 504, 512 acetabularbranchof, 487 anteriorbranchof, 487 posteriorbranchof, 487 Obturator canal, 352, 358, 364, 365, 369,402, 501 Obturator crest, 352, 486,487
Atlas of Human Anatomy
Obturator externus muscle, 489, 493, 539 attachmentsof, 489, 491 Obturator lotamen, 248 anteroposteriorradiographof,488 radiographof, 355 Obturatorgroove,436 Obturator internus muscle, 263,376, 398, 411, 495, 499, 503 attachmentsof, 489, 491 nerveto, 499, 503 obturatorfasciaof, 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 articularbranchof, 539 cutaneousbranchesof, 501, 544,545 cutaneousbranchof,539 to kneejoint, 539 posteriorbranch of, 539 Obturator-pubic arterial anastomo. sis, 259 Obturator vein, 311, 376 Obturator vessels, 259 right,403 Occipitaf artery, 23, 34, 100, 178 descendingbranchof,34 mastoid branchof, 100 medial,142 meningealbranchof, 23 occasionalbranchof, 11 sternocleidomastoid branchof, 34 Occipital bone, 4,7,8,9,12 basifarpart of, 6, 8, 9,22,30,37, 38, 39, 52, 65, 66, 67 clivus of, 22 condylarcanaland fossaof, 8 condyleo1,9, 30, 128 externaloccipitalcrest of, I externaloccipitalprotuberance of,4,6,8 foramenmagnumof, 6 hypoglossalcanal of, 6 i n f e r i onr u c h a l i n e o f ,S inferiorpetrosalsinus grooveof, 6 internaloccipitalcrest of, 9 internaloccipitalprotuberanceof, 9 jugularforamenof , 6 jugularprocessof, 30 pharyngealtubercle of, 8, 63 superior nuchal line of, 83 transversesinus grooveof, 6 Occipital condylc, 9, 30, 128 Occipital crest, external, 14 Occipitaf fobe, 105 projectionon, 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 Occipitaf pole, 105 sagittalMR image of, 149 Occipital protuberance external,14, 152 internal,9
Atlas of Human Anatomy
Occipital sinus, 103, 144 groove for, I Occipital sulcus, transyerse, 105 Occipital vein, 23 internal,146 Occipitofrontalis muscle frontalbellyof, 123 occipitalbelly of, 123, 178 Occipitotemporal artery, 142 Occipitotemporal gyrus lateral,106, 107 medial,106, 107 Occipitotemporal sulcus, 106,107 Oculomotor nerve (llll, 84, 86, 101, 114, 116, 117, 166 branchof, 168 distributionof, 118 inferiorbranchof,83,86 inferiordivisionof , 118, 121 schemaof, 118 superiorbranchof, 83, 86 superiordivision of, 118,121 Oculomotor nucleus, 116, 117, 121, 437,438,441,444 accessory,132 Odontoblast layer, 57 Olecranon, 436 Olfactory bulb, 107 cellsof, 119 contralateral,119 Olfactory cells, 119 Olfactory mucosa, 119 Olfactory nerve (ll, 119 bundlesof, 11 distributionof, 118 fibers of , 118, 119 s c h e m ao f , 1 1 8 ,1 1 9 Olfactory nucleus, anterior, 119 Olfactory stria tateral,119 medial,119 Olfactory sulcus, 107 Olfactory tract, 106, 107, 114 lateralnucleusof, 119 Olfactory trigone, 119 Olfactory tubercle, 119 O l i v e , 1 1 4 ,1 1 7 Omental appendices, 272,284 Omental arterial arch,305 Omental artery, 305 Omental bursa, 272, 331 cross sectionof, 273 lesser sac of, 273 posterior wall of, 349 posteriorwall of, parietalperitoneumon, 331 stomach reflectedin,2T2 superiorrecessof, 272,274,287 Omental foramen (of Winslowl, 272, 273,275,288,331 probein,272 Omental taenia, 281, 284 Omentum qreater,269,271,273,284,288,339 anteriorlayersof, 294, 319 attachment of gastro-omentalvessels to, 274 posteriorlayersof, 319 lesser,273, 275,288 anteriorlayerof, 319 attachmentof gastric aftery,274
Omentum (Continued) blood vessels to right margin of, 348 posteriorlayerof, 319 right free marginof, 278,279,298 Omohyoid musole, 29,31 ,34,53, 189, 198,420,424,428,429 inferiorbellyot,1,27,29,31 ,32, 128, 129,427 investedby cervicalfascia,188 investedby fasciaof infrahyoidmuscle, 428 nerveto, 32,71 31 originof,420 superiorbelly of , 27, 28, 29, 31, 32, 128, 129 Ophthalmic artery, 11, 23, 40, 83, 86, 132, 140, 143 continuation of,85 muscularbranch off, 85 supraorbitalbranchfrom, 69 supratrochlearbranchfrom, 69 Ophthalmic nerye (Vrl, 24,45, 121, 122, 132, 133, 134, 135 externalnasalbranchesof, 122 internalnasalbranchesof, 122 lacrimal,frontal,and nasociliary branchesof, 11 tentorialbranch 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 O p t i c c h i a s m . 4 8 , 1 0 4 , 1 0 6 , 1 0 7 ,1 1 4 , 140, 141, 145, 146, 147 Optic disc, 90 Optic nerve (lll, 83, 86, 87, 90, 106, 107,113, 132,143,144 coronalCT imagesof, 151 distributionof, 118 externalsheathof,91 internalsheathof, 91 vesselsof, 91 o u t e r s h e a to hf , 3 2 , 8 3 , 8 7 sagittalMR image of, 149 in visualpathway,120 Optic radiation, 120 Optic tract, 107, 108, 112, 114, 144 Oral cavity, 39, 48, 52-53,63. See a/so Lip; Mouth; Teeth; speclflc pans of oral cavity coronalCT imagesof, 151 inspectionof, 51 Oral rcgion arteriesof, 69 nervesof,71 veinsof, 70 Ora serrata,87,89,90 Orbicularis ciliarls, 89 Orbicularis ocula muscle, 123 orbitalpart of, 26 palpebralpart of, 26 Orbicularis oris rnuccle, 26, 36, 54, 81, 123 Orbiculus ciliaris, 89 Orbit arteriesand veins of, 85 fasciaof, 85
t-29
Orbil (Continued) fat in. 48. 83 axialMR imageof, 150 growth of, 50 lateraldissectionof, 49 medialwall of, 48 muscleattachmentsand nervesand vesselsentering,83 nerves of, 86 right,frontal,and slightlylateralview of, 2 Orbital fat body, 83 Orbital fissure inferior.14. 83 superior,83 Orbital gyrus, 107 Orbital muscler 43 Orbital operculum, 105 Orbital septum,81 Orbital sulcus, 107 Orbital surface,2 Orbitofrontal artery, 1 41, 142 lateral,139 medial,139 Oropharynx, 233 opened posteriorview of, 66 (tsteomeatal unit, 37 Otic capsule,96 anterolateralview of, 95 Otic ganglion, 55, 122, 123, 125, 131, 133,134,135,168 schemaof, 134 Oval windoq 12,95 base of stapes in, 92 fossa of, 94 stapes in, 93, 96 Ovarian artery, 341, 412 left, 329 right,318,322 uretericbranchfrom, 341 Ovarian plexus, 344, 412, 415 right,318 Ovarian vein left, 311, 329,332 right,311, 332 ovarian vessels, 332, 34O,362, 364, 4O4 left, 311 right,311 tubal branchesof, 404 Ovarn 340, 360, 362, 369, 370, 389, 410, 412,415 ligamentof, 360, 362, 369, 370, 371 right,372 suspensoryligamentof, 360, 362, 369, 3 7 0 , 3 7 1 , 3 7 2 , 3 8 94, 0 0 ovarianvesselsin, 364
P Pain pathwayof, 325 referred,common areaso'f,327 Palate growth of, 50 hard, 48, 63, 64 postsynapticfibersto vesselsand glandsof, 44 soft,37, 39, 51, 63, 64, 66 Palatine aponeurosis, 52 Palatine artery ascending,40 greater,52
1.30
Palatine artery (Continued) greaterdescending,40 left, 40 lesser,40 lesserleft, 40 lesserright,40 right,40 Palatine bone, 39 at birth,488 greater,71 horizontalplateof, 14, 37,38,39, 52, 56 lesser,71 lesserpalatineforamenof, 39 nasalcrest of, 39 orbital processof, 2, 38 perpendicularplate of, 38, 39 posterior nasal crest of, 39 posteriornasalspine of, 38 pyramidalprocessof, 14 sphenoidalprocessof, 38 Palatine folds, transverse, 52 Palatine foramen g r e a t e rS, , 1 1 , 3 8 , 5 6 lesser,8, 11, 38, 39, 52, 56 Pafatine gland, 52, 63, 64 Palatine nerve communicatingwith nasopalatinenerve, 42 descending, l33 greater,11, 42, 43, 44, 45, 52, 62, 122, 131,133 lesser,42, 43, 45, 52, 62, 122,131, 133 oosteriorinferiorlateralnasalbranch from.42.43 Palatine process, 14, 38, 52, 56 Palatine raphe, 52 Palatine suture median,S transverse,8 Palatine tonsil, 51, 52, 58 Palatine vein, 70 external,70 Palatine vessels, greater, 10 Palatoglossal arch, 51, 58 Palatoglossus rnuscle, 52, 58, 59, 64, 126 in palatoglossalarch, 60 Palatopharyngeal arch, 51, 58, 64, 66 Palatopharyngeal nuscle, 58 Palatopharyngeal sphinctet lPassavant's ridgel, 65 Palatopharyngeus muscle, 52, 59, 126,235 Pafmar aponeurosis, 442, 446, 454, 462,480 reflected,460 septa from, 460 Palmar arch, deep, 465 Palmar arterial arch deeo. 465 superficial,460 Palmar artery deep, computedtomographyof, 484 superficial,computedtomographyof, 484 Palmar carpal arterial arch, 465 Pafmar carpal ligament, 446,447, 454,460 Palmar credse, proximal, 418
Palmar digital artery common. 462.465 proper,462,471 Palmar digital nerve common,476 properpalmar,476 Palmaris brevis muscle, 476 Palmaris longus muscle, 442,446, 448.450.475 Palmaris longus tendon, 418,420, 446, 447, 454, 460 Palmarligament,471 Palmar venous arch, superficial, 460 Palpebral arterial arch, 85 Palpebral artery inferiorlateral,85 inferiormedial,85 lateral,85 median,85 superiorlateral,85 superiormedial,85 Palpebral coniunctiYa, 81 Palpebral ligament lateral,81 medial,81, 83 Pafpebral nelver24 Pampiniform plexus, 256 venous,401,403 Pancreas, 126, 167, 179, 273, 29O,297, 347 acini of, 298 anteriorview of, 315 arteries of, 301 body ot,272 common areasof pain in, 328 cross sectionof, 297 head of, 272, 278, 279, 294, 298, 304, 338 arteries of, 304 in situ,347 innervationof, 168, 328 lymph vesselsand nodes of, 315 neck of, 298 posteriorview of, 304, 315 tail ot, 272, 298, 299, 329 arteryto, 301 with uncinateprocess,339 uncinateprocessof, 298 veins of, 309 Pancreatic artery dorsal,300, 301,305, 306 greater,301 inferiot301,305, 306 Pancreatic ducl, 294, 295, 298 accessory 279,298 principal,279 sphincterof, 295 union of bile ducts and, 295 Pancreatic lymph nodes, superior, 314 left,314 right,314 Pancrcatic notch, 298 Pancreaticoduodenal artery anastomosisof, 306 anteriorsuperior,272, 30O,305, 306, 320,321 inferior,302, 305, 307, 322 anterior,306, 320, 321 common portionof, 306 plexuson,319,320,322
Atlas of Human Anatomy
Pancreaticoduodenal artery (Continued) inlerior (Continued) posterior,306 posteriorinferiot 320, 321 posteriorsuperior,305, 306, 320, 321 suoerior.321 plexuson, 319 Pancreaticoduodenal lymph nodes, 315 Pancreaticoduodenal plexus, inferior, 322,323 Pancreaticoduodenal vein anterior,312 anteriorinferior,311 anteriorsuperior,311 inferior,313 posterior,312, 313 oosteriorinferior.311 superior,312 Pancreaticoduodenal artery anteriorsuperior,301 inferior anteriorbranch of, 301 posteriorbranch of, 301 phantom,301 posteriorsuperior,301 Pancreatic vein, 311, 313 dorsal or suoerior.313 great,313 Papilla musclefibers 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 anIerior,224 right posterior,224 septal,220,223, 224 Paracentral artery, 141, 142 Paracentral lobule, 106 Paracentral sulcus, 106 Paracolic Autter left,271,362,363 righr,271, 281, 362, 363 Paracolic lymph nodes, 317 Paradidymus,389 Paraduodenal fossa, 270 Parahippocampal gyrus, 106, 107, 108,119 Paramedian artery, 140 Paramesonephric lm0llerian! duct, 389 Paramesonephric tubule, 389 Paranasal sinus age-relatedchangesin, 50 bones of, at birth, 50 coronalsectionof, 48 cross sectionof, 47 horizontalsectionof, 48 lateraldissectionof, 49 sagittalsectionof, 49 Pararectal fossa, 362, 363, 369 floor of, 392 Pararenal fat, 179 Parasternal lymph nodesr 184 Parasympathetic fibers postganglionic,44 preganglionic,44
Atlas of Human Anatomy
Parasympathetic nerve, in tracheobronchial tree,210 Parasympathetic nervous system schemaof, 168 topographyof, 166 Parathyroid gland, 76 inferior, 75, 76 right lateralview of, 75, 76 superior,75, 76 superiorview of, 75, 76 Paratracheal lymph nodes left, 208 right,208 Paraumbilical vein, 312 to round ligamentof liver,256 tributariesof, 256 Paraurethral lSkene'sf glands, 389 primordiumof, 389 Paraventricular nucleus, 147 Paravertebral anastomosis, 172 Paravesical fossa, 369 Parenchyma, blood vessels in, 337 Parietal artery, 141 anterior.141. 142 anteriorparietal,142 posterior, 141, 142 Parietal bone, 2, 4,6,8,9 tubereminenceof, 12 Parietal cells, 9, 276 Parietal emissary vein, 23 Parietal foramen, 7 Parietal limb, 220 Parietal lobe, 105 Parietal lobule inferior,105 superior,-t05 Parietal operculum, 105 Parietal pleura cervical,196, 197,230 costal,194,198,206, 211, 230 left borderof, 197 right borderof, 197 part of, 193,194,198, diaphragmatic 206,211 part of, 193, 194, 198,206, mediastinal 211,215,230 Parietooccipital artery, 142, 143 Parietooccipital sulcus, 105, 106, 143 Parolfactory area, 106 Parotid duct, 25,54 Parotid gland, 25, 26, 27, 28, 31, 32, 5 5 , 1 2 5 ,1 3 4 , 1 6 61, 6 7 accessory,61 cholinergicand adrenergicsynapsesto horizontalsectionof, 25 Parotid lymph nodes deep,72 suoerficial.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
Passavantts ridge. See sphincter Palatopharyngeal (Passavant'sridge) Patella, 485, 492, 493, 494,501, 507, 511.519.521 anteroposteriorradiographof, 510 radiographof, 510 Patellar anastomosis, 500, 512 Patellar bursa, 508 Patellar capsule, iliotibial tract blended into, 508 Pateflar ligament, 485, 489, 492,493, 4 9 4 ,5 0 8 ,5 1 1 ,5 1 4 ,5 2 0 , 5 2 1 Patellar nerve plexus, 544 Patellar retinaculum iliotibialtract blendedinto, 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 lOooper'sl, 188, 250, 251, 259,262,263 Pectineal line, 248, 263, 352, 353, 486, 489. 505. 538 Pectineus muscle, 376, 489, 492,493, 500, 538 attachmentsot. 489, 491 Pectoraf is maior muscle, 27,28, 181, 1 8 2 ,1 8 8 ,1 9 2 ,1 9 8 ,2 4 3 , 2 4 4 , 2 4 5 , 246, 247, 249, 250, 418, 419, 428 abdominalpaftot,424 clavicularhead of, 181 deep to pectoral fascia, 182 fasciaof, 26,428 insertionof, 420 originof, 419 sternocostal head o1,424 tendon of, 433 Pectoralis minor muscle, 198,243, 244,245, 420,428,433 fasciaof, 428 insertionof, 420 investedby clavicopectoralfascia,188 Pectorafis minol tendon, 429,430 Pectoralis muscle, 189 Pectoral nerve lateral,188,428,43O medial,188, 428, 429, 43O median,428 Pedicle, lumbar, 155 Pelvic brim,370 sacraloart of, 157 Pelvic floor contentsof, 354-366 female,356 Pelvic foramina, radiograph of, 355 Pelvic inlet diametersof, 354 female,354 male,354 radiographof, 355 Pelvic ligaments,372 Pelvic organs, female, arteries and veins of,400 Pelvic outlet anteroposteriordiameter of, 354 female,354 transversediameter of. 354
Pelvic plexus, 412 Pelvic scans, 397 Pelvic Yiscera female,360, 369 nervesof, 412 male,361 nervesof, 410 Pelvis, 351 anteriorview of, 352 arcustendineousfasciae,372 bones and ligamentsof, 352-353 false,351, 362 female,356 arteriesand veins of, 402 contents of, 360 lymph nodes and vesselsof, 407 radiographof, 355 radiographsof, 355 sagittalMR imagesof, 397 structuresin, 370-375 lateralview of, 352 lineaterminalis of.362.364 male,354 arteriesand veins of, 401, 403, 405 contentsof, 363, 387 lymph nodes and vesselsof, 408 radiographof, 355 radiographsof, 355 sagittalMR imagesof, 397 structuresof, 380-387 surfaceanatomyof, 351 medialsectionof, 352 posteriorview of, 352 renal,339 sex differencesof, 354 true, 352 visceraof, nervesof,412 Penis b o d yo f , 3 5 1 , 3 8 8 bulb of, 382, 383, 385 arteryof, 383, 405 cavernousnervesof, 410,412 crus of, 360, 366, 385 deep arteriesof, 381, 383, 385, 404 deep dorsal vein of, 249 deep fasciaof, 361, 380,381, 382, 385, 387,401,403,405 dorsal arteriesof, 381, 383, 401 dorsal nele of, 411 dorsal nervesof, 381, 383, 405, 409, 4 1 0 , 4 1 14 , 1 6 ,5 0 3 dorsal veins of deep,359, 361, 381, 383, 401, 403, 405 hiatusfor, 358 superficial, 351,381, 403 fetal developmentof, 388 frenulumof, 382 fundiformligamentof, 259, 361 glans,351, 361, 382, 385, 388 corona of, 382 neck of, 382 sagittalMR imagesof, 397 internalpudendalarteryof, 383 lateralsuperficialvein of, 381 rapheof, 388 sectionthroughbody of, 381 skin of, 380,381, 382, 387 superficialfasciaof, 249,250,381, 382, 387 suspensoryligamentof, 250, 361
l-32
Perforated substance, 114 anterior,107, 114, 119 posterior,107, 114 Perforating artery, 501 anteromedialcentral,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 vean, 337 of arm,479 of forearm,480 Per hippocampus, 112 Perianal skin, 394 sweat glandsand hair in, 393 Perianal space, 392, 393, 396 Perianal tissues, 388 Perianal venous plexus external, 392 internal,392 Pericaf losal artery, 141, 142 posterior,143 Pericardiacophrenic a;te;y, 194, 206,211,230,241,255 left,193 right,193 Pericardiacophrenic vein, 194, 206, 211, 212, 230, 231, 241 Pericardiacophrenic yessels, 215 Pericardial ]eflection, 214, 220 Pericaldial sac anteriorview of, 215 left lateralview of, 215 Pericardial sinus oblique,215,246 transverse,215, 220 Pericardial sinus, transverse, 212 Pericardium, 211, 215, 233 bare area of, 196 diaphragmaticpart of, 215 fibrous.198.230 line of fusion to diaphragm,211 over right atrium,230 mediastinalpart of, 194 reflectionof, 214, 220, 221 at site of great vesselsrellecIion,2l2 sternocostalpart of, 215 Perichoroidal space, 87, 88 Pericranium, 102 Perilormis muscle, 490 Periglandular plexus, 326 Periglomerular cells, 119 Perimuscular rectal venous plexus, 3 11 Perineal artery, 370, 403, 4O4,405 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 fasciaof, 356 deeptransverse, 356, 360, 361,381, 383, 404 superficialtransverse,356, 380, 381, 382,391, 404,405 Perineal nerve, 410,411,413,503 deep,411, 413, 530 lateralbranchof, 530, 531 deep branchesof, 411 in males,411 posteriorscrotaland labialbranchesof, 499 in pudendalcanal,392 superficial, 411,413 superficialbranchesof, 411 Perineal raphe, 388 Perineal space male,383 superficial,361, 370, 378, 4O4,4Os Perineal vein, 405 Perineopelvic space6, 396 Peraneum,347 abscessin, 396 female,360, 377,395 arteriesand veins of, 404 deep, 379 lymph vesselsand nodes of, 407 nervesof, 413 structureso1,371-375 superficialdissectionof, 378 interdigitating fibers to, 357 male,361 arteries and veins of, 405 deeperdissectionof, 381 frontalsection,anteriorview of, 383 nervesof, 411 structuresof, 380-387 superficialdissectionof, 380 surfaceanatomyof, 351 Periodontium,57 Periorbita,83 Periosteum alveolar,57 mandibularor maxillary57 Periportal space,291 Perirenaf tal'179,342 Perisinusoidal spaces, 291 Peritoneal fold hepatic arteryin,272 testicularvesselsin, 363 Peritoneum, 179, 236, 252, 261, 284, 322,329,342,412 female,365, 366, 378, 4OO,412 inferior,415 potential spaces of, 364 forming pararectalfossa floor, 392 male,361, 366 inferiorextentof, 415 parietal,271, 273,331, 348, 362, 363, 373 of anteriorabdominalwall, 348 on omentalbursa posteriorwall, 331 phrenicnerveto, 327 of posteriorabdominalwall,274 visceral,273,326 Perivascular fibrous (Glisson'sf capsule,290
Atlas of Human Anatomy
Peroneal nerye, deep, 530 Peroneus brevis tendon, 535 PeronGus longus tendon, 535 fibroussheathof, 535 Pes anserinus, 489, 492, 493 attachmentsof, 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 groovefor, 9, 97 hiatusfor, 11 lesser,86, 93,122, 123, 125, 134 groovefor, 9 hiatusfor, 11 Petrosal sinus inferior,11, 103 groove for, 6, 9 superior,97, 103 groovefor, 9 Petrosal vein, 144 drainingto petrosalsinus,144 Petrosquamous fissur€, 12 Petrotympanic fissurc, 11 Peyer's patches, 280 Phafanx, 524 distal,456, 471 cross sectionof, 471 of great toe, 537 ulnarnerveinnervationof, 476 dorsal,523 fourth, base of, radiographof,457 middle,456, 471, 523 radiographof,457 ulnar nerveinnervationof, 476 plantarview of, 523 proximal,456,523 of great toe, 537 radiographof, 457 of ring finger,distal,radiographot,457 of thumb, distal,radiographof,457 tuberosityof, 523 Pharyngeal aponeurosis, 235 Pharyngeal artery, 40 a s c e n d i n g1,1 , 3 4 , 4 0 , 6 9 ,1 3 6 ,1 3 8 meningealbranchesof, 100 pharyngeal branchof,64 posteriormeningealbranchof, 136 tonsillar branch of, 64 Pharyngeal constrictor muscle part of,59 glossopharyngeal inlerior,27,75,76, 80, 126,233,234 cricopharyngeuspart of, 233,234 middle,27, 59,75, 126,235 superior,40,52,55,59,69,75,126,235 part of, 59, 65 glossopharyngeal Pharyngeal muscle, longitudinal, 235 Pharyngeal nerve, 133 Pharyngeaf pfexus,62,71,125, 126, 130, 131 Pharyngeal raphe, 37,60,63,65,67, 75, 76, 234 Pharyngeal necess, 37,47,64,66 Pharyngeal region arteriesof, 69 nervesof, 71 veins of, 70 Pharyngeal tonsil, 37, 63, 64, 66, 67 Pharyngeal tubercte, 64, 65, 67
Atlas of Human Anatomy
Pharyngobasilar fascia, 52 Pharyngobasitar fossa, 59 Pharyngoepiglottic fold, 235 fibersto, 65 Pharyngoesophageal junction, 235 Pharyngotympanic tube. See Auditory(pharyngotympanic, Eustachian)tube Pharynx afferentinnervation of,62 arteriesof, 69 lymphaticdrainageof, 73 lymph nodes and vesselsof, 73 mediansectionof, 63 musclesof lateralview of, 68 median (sagittal)section of, 65 partiallyopened posteriorview of, 67 nerves of, 62 opened posteriorview of, 66 posteriorview of, 75 posteriorwall of, 51 veinsof,71 Philtrum, 1 Phrenic artery inferior,237, 305, 318, 333, 347 ,eftinferior, 272,300,319,320, 332,333 recurrentbranchof, 300 sympatheticfibers along,240 right inferior,300, 319, 320, 333, 346 Phrenic ganglion, 320,327 Phrcnic 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 efferentand afferentfibersof, 193 left, 193, 194,215,346 nerveto, 430 pericardialbranchof, 193 phrenicoabdominal branchesof, 193 right,193, 194,215,244,318,327,346 Phrenicocolic ligament, 272 Phrenic plexus, 410 inferior,318 left inferior,319, 320, 323, 346 rightinferior,319,320, 323,346 Phrenic vein inferior,320 left inferior,320 Phrenoesophagea! ligament' 236 Pia.arachnoid mater, 91 Pial plexus, 171 arterial,173 peripheral branchesfrom,173 venous,173 Pia mater, 91,99, 102 overlyingspinalcord, 169 thoracic,170 Pigment cells, 120 Pillar cells, 94, 120 P i n e a l b o d y , 1 0 6 ,1 1 0 ,1 1 1 , 1 1 4 Pineal recess, 108 Piriform fossa,233 Piriformis muacte, 263,411,489, 495, 503 nerveto, 499 Piriform lobe, 119
Pisiform' 442, 446,447,454,456, 460, 465 radiographof, 457 Pituitaty gland' 107, 147 anteriorlobe of, 14O,147,148 posteriorlobe of, 148 posteriorlobe of, 140, 147 sagittalMR imageof, 149 in sellaturcica,37 Pituitary stalkr 147 Plantar aponeunosls' 533, 534,535 digitalslips of' 535 lateralband of, 535 Plantar arterial atch' deep' 531, 536 posteriorpenetratingbranchesfrom, 520, 536 Plantat ailery deep, 530, 535, 536 lateral, 535, 536 cutaneousbranchesof, 535 medial,534 cutaneousbranchesof, 534, 535 deep branchesof,534 superficialbranch of, 533, 534, 535 posteriorperforatingbranchesof, 536 Plantar calcaneonavicular ligament' 536 Plantar digital artery' common' 534 Plantar digital nenve' common' 534, 541 Plantar interosseous muscle' 537 Plantaris muscle' 494, 495, 511, 515, 540,541 attachmentsof , 491, 515 of,541 innervation Plantaris tendon' 495, 516, 517, 522 Plantar ligament' 536 long, 528, 536 short, 527 Plantar nerve lateral,534, 535, 540, 541 cutaneousbranchesof, 535 deep branchesof, 535 plantarcutaneousbranchesof, 545 proper plantardigitalbranchesof, 533, 534,535 superficialbranch of, 535 medial,534,540 deep branch of,534,535 plantarcutaneousbranchesof, 535, 545 properplantardigitalbranchesof, 533, 534,535 superficialbranchof, 534 Platysma muscler 26,28,60, 124 Pleura' 331 abdominal,349 cupulaof, 74 mediastinal,194 parietal,206 spinalnervesof, 170 thoracic,170 visceral,205 Pleural Gavity recessof, 196, 197, costodiaphragmatic 330,331 recessof, 104, left costodiaphragmatic 2Oo left costomediastinalrecessof, 194 recessof, 194 right costodiaphragmatic Pleural rcflection' 196 Plica semilunarisr 81, 82
1.33
Pneumothorax, chest drainage tube placement in, 190 P o n s , 1 0 6 ,1 1 4 ,1 3 4 , 1 3 5 axialMR imageof, 150 sagittalMR imageof, 149 Pontine artery, 14O,1 41, 143 Pontine taste atea, 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 attachmentsofS15,541 nerveto, 541 Popliteus tendon, 508, 510 origin of, 5O7 Pores of Kohn, 204 Portacaval anastomosis, 312 Porta hepatis, 287 Portal space, limiting plate of, 291, 292 Portaf ltiad, 273,278,290,297, 298 cross sectionof, 273 Portaf vein,297 branchof. 291.292 cross sectionof, 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 ciliaryganglion,132 femalereproductiveorgan innervation, 415 male reproductiveorgan innervation,416 urinarybladderand lower ureter innervation, 417 Postlunate tissure, 113 Poupart's ligament. See Inguinal ligament(Poupart's) Preaortic lymph nodes, 317, 4Og Precaval lymph nodes, lateral, 343 Prececal lymph nodes, 317 Precentral gyrus, 105 Precentral sulcus, 105 Prechiasmatic groove, 9 Preculminate vein, 144 Precuneal arlery,142 Precuneus,106 Prefrontal arleryr l4l Preganglionic sympathetic cell body,44,132
t.34
Preganglionic
sympathetic
fibers,
J40
ciliaryganglion,132 femalereproductiveorgan innervation, 415 male reproductiveorgan innervation,416 urinarybladderand lower ureter innervation, 417 Premolars,56,57 Preoccipital notch, 105 Prepatellar bursa, subcutaneous, ctl
Prepontine cistern, 109 Prepuce, 388 of clitoris,388 of penis,361 site of, 388 site of future originof, 388 Preputial gland, opening otr 382 Prepyloric vein, 31'l Prerectal muscle fibers (of Luschkaf, 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 artety, computed tomography ot,484 Procerus muscle, 26, 36, 123 Profunda brachii arlery, 429 Profundus flexor tendon, in com. mon flexor sheath, 460 Promontorial lymph nodes, 343,408 Promontory, 92,93 Pronator quadratus muscle, 440, 448, 449, 450, 465, 475 Pronator teres musclet 420, 433,44O, 446,447 humeralhead of, 420,447,45O,474, 475 originof, 420 ulnarheadof, 350, 420,447,448,475 originof, 420 Prostate gland, 167, 384 arterialsupply of, 403 capsuleof, 361, 366,384 fibromuscularstromaof, 384 hyperplasticlaterallobe of, 403 hyperplasticmiddle lobe of, 403 inferolaterallobe of, 384 inferooosteriorlobe of. 384 innervationof, 168 isthmuslobe of, 384 lymphaticdrainagefrom, 408 medianlobe of, 384 primordiumof, 389 with orostaticurethra.376 sagittalMR imagesof, 397 skeletalmuscle band of, 384 sphincterurethraemuscleascending anterioraspect of, 359 Prostatic duct, openings of, 384,385 Prostatic plexus, 165, 344, 416 Prostatic sinus, 384, 385 Prostatic urticle, 389 Prostatic vein, right, 311 Plostatic venous plexus, 403
Proximal interphalangeal (PlP| ioint, 418 Psoas major fascia, 342 Psoas major muscle, 179,267,278, 329, 339,342,492,496,498, 499 area for, 330 articularbranchof, 538 fasciaof. 179.342 lower part of, 538 originof, 489, 496 Psoas minor muscle, 263,496 originof, 496 Psoas muscle, 376,496 axial CT imagesof, 350 muscularbranchof, 498 Psoas tendon, 376 Pterion, 4 Pterygoid artery lateral,40 medial,40 Pterygoid canal artery of, 40 nerveof, 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 axialMR imageof, 150 medial,15, 25, 40, 52, 55 nerveto, 71 Pterygoid nerve lateral,46,122 medial,46, 122 Pterygoid plate lateral,13, 47, 55, 68 medial,52, 55, 64, 65 hamulusof, 13 Pterygoid plexus, 70, 85 deep facial nervefrom, 23 Pterygoid process, 6,8 h a m u l u so I , 1 2 , 1 3 ,1 4 lateralplateot, 4, 12, 13, 14, 38, 39, 50 medialplateof, 12, 13, 14, 38, 39, 50 of palatinebone, 13 platesof, 6 Pterygomandibular raphe, 15, 40, 52, 55, 65, 68 Pterygomaxillary fissure, 4 Pterygopalatine fossa, 4, 13, 14, 40, 44,49 Pterygopalatine ganglion, 122, 123, 1 2 5 ,1 3 1 ,1 3 3 ,1 3 5 ,1 6 6 ,1 6 8 ganglionicbranchesof, 45 in pterygopalatine fossa, 44 schemaof, 133 Pubic arch, 248 female,354 male,354 Pubie 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
Atlas of Human Anatomy
Pubic symphysis, 247, 259, 263 female,354 male,354 radiographof, 355 sagittalMR imagesof, 397 superiorportionof, 376 Pubic tubercle, 247,250, 263, 486, 492,493 Pubic vein, 265 Pubis anteroposteriorradiographof, 488 body of, 376 radiographof, 355 superiorramus of, 488, 493 symphysealsurfaceof, 412 Pubocervical tascia, 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 l:gament lateral.364. 365 medial.364. 365 Pudendal artery deep external,512 internal,341, 376, 499 superficialexternal,512 Pudendal canal (Alcock'sl' 392, 411 internalpudendalarteryin, 402, 4O4 internalpudendalvein in, 399 oudendalnervein, 413 Pudendal canal, left internal pudendal vein in' 311 Pudendal cleftr377 Pudendal nerve, 160,267,41O,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 superficialexternal,544 Pudendal vessels deeo external,401 internal,392 suoerficial,500 superficialexternal,401 Pudendal vesselsn superficial' 249 Pudendum,377 Pulmonary attery' 213 axial CT imagesof, 242 left,206, 213,214, 231,245 prenatal,229 radiographof, 213 right,205, 206, 21O,214, 220, 230, 245 prenatal,229 Pulmonary ligament, 199, 208, 230, 231 Pulmonary lymph nodes' 208 Pulmonary plexus, 126,165, 166,168, 210 anterior,209 posterior,209
Atlas of Human Anatomy
Pufmonary trunk, 206, 212, 215, 220' 224,225 bifurcationof, 215 outflow to, 224 orenatal,229 Pulmonary valve, 213, 22O,222, 225 semifunarcuspsof, 22O,222 Pulmonary vein left, 205, 206, 215, 221, 224, 231 infetior,214, 241 orenatal,229 superior,214 right,206, 215, 225, 230 inferioc214, 220,246 prenatal,229 212, 214,220,224 superior, Pulvinar, 110, 111 ,143,144,145 lett.144 right,144 of thalamus,114 Pupil,81 dilatormuscleof, 88, 121,132 musclesof, 132 sphinctermuscleof, 88, 121,132 Pupillae muscle dilator,121 sphincter,121 Purkinie fibers,225 subendocardialbranchesof, 225 Putamenr 108 Pyloric antrum' 275 bariumradiographot, 279 Pyforic canaar 297 cross sectionof, 297 Pyrloric gland' 276 Pyloric lymph nodes' 315 Pyforic odfice' 276,279 Pyrlorus, 275, 276, 278, 297 bariumradiographot, 279 cross section of, 297 Pyramid, 114, 144 of, 114 decussation inferiorvermis,113 115 of vermisof cerebellum, Pyrramidalis muscle' 25O,260 Pyramidal process' 8, 12
o Quadrangular lobule' 113 Quadrangular spacer Posterior circumflex humeral artely in, 427 Quadratus femoris muscle, 492, 493, 495,503,511,538 of, 489, 491, 515 attachments nerveto. 499. 503 Ouadratus lumborum muscler 176, 179,263,267, 329,342, 496, 498 area for, 330 fasciaof, 179 Quadratus plantae muscle' 534, 535' 541 Quadratus Plantae netYe' 541 Quadriceps femoris muscle' 538 attachment of, 490 patellarligamentof, 515 Quadriceps femoris tendon' 485, 492, 501, 506, 511, 520, 521 Quadriceps tendon' 493
Quadrigeminal cistern' 109 Quadrigemlnal plater 115
R Radiaf artery' 433, 445, 446,447' 448, 449,454,460,461, 465,474 in anatomicalsnuffbox,469,470 computedtomograPhYof, 484 palmarcarpal branchof, 448,465 superficialpalmar branch ot, 454' 460, 465 Radiaf bursa,460,462 Radiaf collateral artetY, 434 Radial collateral ligament' 454' 455 Radiaf netve, 429, 430, 432, 435, 447, 448,474,475,477 in arm,477 branch of, 469 communicatingbranch of, 468 deep branch ot, 445,447, 449, 474 dorsaldigitalbranchof, 473,481 inferiorlateral,481 oosteriorcutaneous,469,473, 481 superficialbranch of, 444, 447, 449, 468, 469, 473, 474, 480, 481 dorsaldigitalbranch of, 469 Radial tecurrent adery' 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 ioint, 453, 455 Badiocarpal ligamenl dorsal, 455 oalmar,454 radiocapitate Parl of , 454 radioscaPholunate Partof, 454 Radiograph of ankle,526 barium of ileum,279 of jejunum,279 of long vermiformaPPendix,283 of stomach,duodenum,and Proximal ieiunum,279 of cervicalvertebrae,18 of chest, 213 of elbow, 437 of femalepelvis,355 of hand,457 of hip joint,488 of knee.510 lateral,of skull, 5 of lumbarvertebrae '156 anterooosterior, lateral,156 of male and femalePelvis,355 of male pelvis,355 oelvic female,355 male,355 of shoulder,422 of wrist and hand, 457
1.35
Badiolunate ligament long,454 palmar,454 short, 454 Radioscaphocapitate ligament, 454 Badioulnar joint, distal, 455 Radioulnar ligament dorsal,455 palmar,454 Radius, 436, 438, 439,44O,442, 443, 465 annularligamentof, 438 anteriorbranch of, 439 anterior(palmar)view of, 452 anteriorsurfaceof, 439 coronalsectionof, 439, 455 cross sectionof, 470 dorsaltubercleof, 452 head of, 439 right,439 interosseousborderof, 439 neck of, 437,439 posteriorcutaneousand inferiorlateral cutaneous nervesof arm trom, 479 posterior(dorsal)view of, 452 radiographof, 437 rotators of, 440 tuberosityot,437,439 ulnar notch of, 439 Bami communicantes g r a y ,1 3 0 , 1 3 2 ,1 3 3 ,1 3 4 , 1 6 5 ,1 6 7 ,1 6 9 , 170, 180,196,209, 230, 240,258, 267, 318, 324,325,327, 344,412, 498, 499 w h i t e ,1 3 0 ,1 3 2 , 1 3 3 ,1 3 4 ,1 6 5 , 1 6 7 ,1 6 9 , 180, 196, 209, 230, 240, 258, 267, 318, 321, 324,325,345,398, 412, 499 Bathke's pouch, yestigial remnant of, 50 Bectal artery inferior,307, 398, 402, 403,4O4,4O5 middle,264, 307,323,341,364,398, 400,402,403 superior,264,3O7,318, 323, 324, 340, 364, 398,400, 410 bifurcationof, 307 branchof, 307 Rectal lymph nodes,317 middle,317 superior,317 Rectal nerve inferior,411, 503 superioG503 Rectaf pfexus, 323, 344, 412 communicationbetweeninternaland perimuscular, 399 middle,323 superior, 318, 323 Rectal vein inferior,312 left, tributariesof, 311 left middle,311 left superior,312 middle,312 right,tributariesof, 311 right inferior,311 rightmiddle,311 r i g h ts u p e r i o r , 3 1 2 superior,311 bifurcationof, 399
1.36
Rectal Yenous plexus communicationbetweeninternaland external,399 external,311, 393, 394, 399 internal,393, 394, 399 perimuscular, 399 Rectal vessels, zupetior, 274 Bectineal 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 iunction, 284, 391, 393, 394 Rectosigmoid plexus, 323 Rectosigmoid vein, 311, 312, 399 Rectourethralis superior mu3cle, 359 Rectouterine fold, 369 Rectouterine ligament, 369 Rectouterine pouch lof Douglasl, 360,362, 369, 371, 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 arteriesof, 398 circularmuscle layerof, 393, 394 in situ,391 female,328, 396 male.328. 396 innervationof, 168 ischioanalfossaeof, 392 longitudinalmuscle layerof, 393, 394 lymphaticpathwayalong,408 marginalarteryof, 398 muscularismucosaeof, 394 sagittalMR imagesof, 397 terminationof, 376 transversefolds of, 393 veinsof, 399 Bectus abdominis muscle, 189,331 sagittalMR imagesof, 397 Bectus capitis anterior muscle, 73 Rectus capitis muscle. See Capitis muscle,rectus Rectus capitis posterior major muscle, 175,176,178 Rectus capitis posterior rninor, 175, 176,178 Rectus femoralis tendon, 492 originof, 492 Rectus femoris tendon, 485 Rectus muscle inferior,83, 84, 121, 151 lateral,83, 84, 86, 121, 151 axial MR imageof, 150 tendon of, 87 medial,axialMR imageof, 150 superior,83, 84, 86, 91, 121 tendon of, 91
Rectus sheath, 83, 189, 249,250,349 anteriorlayerof, 188, 250, 252,259, 424 cross sectionof, 252 posteriorlayerof, 251,252,257,259 Red nucfeus, 1O7, 116, 117 Reil, island of. See Insula Renal artery, 335, 341, 345 anteriorbranch of, 335 in situ,332 left, 323, 329,339,347 posteriorbranchof, 335 right,318, 321,329 uretericbranchof. 335. 336 variationsin, 333 Renal column (of Bertinl,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 anteriorlayerof, 179 Gerota's.342,347 posteriorlayerof, 179,342 sagittalsectionof, 342 transversesectionof, 342 Benal medulla, 336,337 preganglionicfibers and, 346 Renal papilla,336 Renal parenchyma,334 Renal pfexusr344,345 left, 323, 346 right,318, 346 Renal segment arteriesof, 335 vascular,335 Renal sinus, 337 fat in, 334 perirenalfat of, 337 Renal vein, 341 in situ,332 left. 329. 333 double.333 enteringinferiorvena cava, 339 multiple,333 right,265,329, 332,339 Reproductive organs, male, innerYation of, 415 Respiratory bronchiole, 204 Rete testis, area of, 390 Reticular nucleus, 111 Retina, 91 ciliarypart of, 87, 88 iridialpart of, 88 non-pigmentedareasof, 91 optic part of, 87, 89 pigmentedareasof, 91 projectionon, 120 structureof, 120 Retinacular artery, 504 subsynovial,504 Retinal artery, 90 central,85, 87, 90, 91 Betinal vein,90 central,87, 91 Retinal vessels, right, 90 Retrobulbar fat, 83 Retrocecal necess, 271, 281
Atlas of Human Anatomy
Retromandibular vein, 23, 31, 59, 85 anteriot 61, 70 common trunk foc 59, 61, 70 posterior,61, 70 Retropedtoneal artery, 331 Retropharyngeal lymph nodes, 73 Retropubic lprevesicall space lof Retziusf, 48, 348, 364, 396 fat in, 251 Retropubic venous plexus, 365 Retropyloric lymph nodes, 314 Retrotonsillar fissurc, 113 Retrctonsillar Yein inferior.144 superior,144 Retzius, cave of, 348 Retzius space. See Retropubic (prevesical)space (of Retzius) Rhinal sulcus, 106,107 Rhomboid maior fossa, 114 Rhomboid major muscle, 174, 177, 180, 192, 243, 245, 424 insertionof, 421 Rhomboid minor muscae, 174, 177, 424,477 insertionof, 421 Rhomboid muscle,244 Ribs, 186,244,245 angleof, 185, 186 axialCT imagesof, 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 groovefor, 199 synchondrosisof, 419 floating,185 headof, 185,t86 interarticularligamentof, 187 middle,186 neck of, 185, 186, 194 ninth,299 second1 , 8 2 ,1 8 5 , 4 1 9 left, 186 seventh,head of, 246 sixth,182 true,185 t u b e r c l e , 1 8 51,8 6 twelfth, 160, 174, 195,342,349 projectionof, 330 Riolan, arc of, 308 Risorius muscle, 26, 123 Rod cells, 94, 120 Rods, 120 Rolando, sulcal artery ol, 142 Rolando, sulcus of, 105, 106 Rosenm0ller, node of, 266 Rosenthal, v€in 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 (cochlearf, 92,95 closed by secondarytympanicmembrane,96 fossa of. 93
Atlas of Human Anatomy
s Si spinal nerve, 160,410 anteriorramus of, 414 52 spinal newe, 160 Saccule, 92,95,96, 124 Sacral a[ery lateral,171, 264, 341,398, 402, 403 median,307, 341, 364, 398, 402 Sacraf Ganal, 157,358 Sacral cornu, 157 Sacral crest intermediate,157 lateral,157 median,157,352,357 Sacral cutvature, 153 Sacral foramen a n t e r i o r1,5 7 , 3 5 3 , 3 5 8 fourth posterior,357 posterior, 157,353 radiographof, 156 Sacral ganglion, 167,318 Sacral hiatus,157 Sacral lymph nodes lateral,266, 408 middle,266, 408 Sacral nerYe, 161 perinealbranchof, 499 vertebraeand, 161 Sacral parasympathetic outfloq toc
Sacraf plexus, 160,177,267,344,345, 415.416.499 left,318 right,323 Sacral pnomontory, 248, 412 Sacral $ympathetic trunk left,412 right,412 Sacral vein, median, 311 Sacrogenital fold, 340 Sacroiliac joint, 358 female,354 radiographof, 355 Sacrospinous lagament, 352, 353, 357, 359, 410,495, 503 Sacrotuberous lagament, 357, 376, 379, 395, 402, 410, 411, 495, 502, 503 Sacrouterine ligament, 364 Sacrum (51-51, 152,160 ala of, radiographof, 355 anteriorview of, 153,171 aoexof. 157 arteriesof, 171 articularfacet for, 155 articularsurfaceof, 157, 486 base of, 157 coronalsectionthrough,157 dorsal surfaceof, 157 facets of superiorarticularprocess,157 left lateral view of, 153 medialsagittalsectionof, 157 pelvicsurfaceof, 157 posteriorview of , 153 promontoryof, 157 radiographof, 355 sacralcrest of, 157 sacral tuberosity of, 157 sagittalMR imagesof, 397 spinalnervesand, 161
Sacrum (Sl-51 (Continued) superiorarticularprocessof, 157 transverseridgesof, 157 Sagittal sinus inferior,103, 145, 146 superior,99, 100, 102, 103, 106, 109, 144.145 axial MR imageof, 150 Sagittal sutur€, 7, 12 Sagittal vein, inferior, 144 Salivary glands, 61 frontalsectionof, 51, 60 horizontalsectionof, 51, 60 lingualminor,51 molar minor,52 sublingual,51, 60 submandibular, 51, 60 Salivatory nucleus 1 16, 117,125,134 inferior, superior,116,117, 123,133 Salpingopharyngeus muscle, 126 Saphenous nerve, 500, 538, 544 branchesof, 538, 545 infrapatellarbranchof, 500, 538 Saphenous opening, 25O,544 cribriformfascia 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 attachmentsof, 490, 491, 515 Sartorius tendon, 492, 493 Scala tympani, 91, 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 '189 middle,27, 30, 32, 69, 70, 186, nervesto, 129 nervesto. 129. 430 posterior,27,30, 186, 189,232 slips of origin of, 30 Scalp epicranialaponeurosisof, 26 skin and subcutaneoustissue of, 26 superficialarteriesand veins of, 23 Scapha,93 ligament, 454 Scaphocapitate Scaphoid bone,456 anterior(palmar)view of, 452 area for, 439 coronalsectionof, 455 posterior (dorsal)view of, 452 tubercle ol, 452, 454, 456 Scaphoid fossa,93 Scapholunate ligament, 455 454 Scaphotrapeziotrapezoid, Scapula, 29, 180, 185, 192, 243,244,245 acromionof, 185 anastomoses around,427 anteriorview of, 420,427 axillaryarteryand anastomosesaround, 427 body of, 428 coracoidprocessof, 213 glenoidcavity of, 420 anteroposteriorradiograph ol, 422
1.37
Scapula (Continued) inferiorangleot,152,246, 420 infraglenoidtubercleof, 420 infraspinousfossa of, 185 lateral border of, 420 anteroposteriorradiograph ot, 422 medialborder ot, 152, 420 neck of, 420 posteriorview of, 421,427 spineof, 152,174, 177, 185, 197,213, 424,427, 428 anteroposteriorradiograph ot, 422 subscapularfossa of, 185 superiorangle of, 420 superiorborderof, 42O,425 suprascapularnotch of, 184 supraspinousfossa of, 421 Scapular ailery circumflex,427, 429, 430, 434 dorsal,32, 137, 427, 429 Scapular ligament, superior trans. verse, 423,425,427 Scapular nerye, dorsal, 429 Scapulohumeral dissection anterior view of, 426 lateral view of, 426 posterior view of, 426 Scarpa's (membranousf layer, 249, 380 fascia latae attachment to, 249 Schlemm's canal. See Scleralvenous sinus (canalof Schlemm) Sciatic foramen greater,352, 353, 357, 540 lesser,352, 353, 357 Sciatic nerve, 160, 495, 499, 503, 539, 540 articularbranch of, 502 branchesof, 499, 540 common fibulardivisionof. 499. 540 left, 376 muscles innervated by, 540 right,376 tibial divisionof, 499, 540 Sciatic notch greater,248,486 lesser,248, 486 Sclera, 81, 83, 87, 88, 91 bulbarconjunctiva,81 laminacribosaof, 87 Scleral spur, 87 Scleral venous sanus (canal ot Schlemmf, 87,88,90,91 veins draining,91 Scrotal artery, posterior, 403, 406 Scrctal ligament,389 Scrotal nerve anterior,409 posterior,411, 503 Scrptal ne?Ye, posteraor, 41O,411, 503 Scrotal vein, anterior, 256 Scrotum, 351, 388 cross sectionthrough,390 skin of, 390 superficialfasciaof, 249 Sebaceous gland, 81 Segmental artery anteriorinferior,335 anteriorsuperior,335 inferiorsuperior,335
r.38
Segmental artely (Continued) posterior,335 superior,335 Segmental medullary artery anterior,171,172 malor anterior,171 posterior,171 Segmental medullary vein, 173 Sella turcica, 6, 9, 39 hypophysisin, 37 Semicircular canal anterior,95, 96, 97 axial MR image of, 150 lateral,95, 96, 97 planeof, 97 posterior,95, 96, 97 prominenceof, 92 Semicirculai duct, 92 ampullaot,92, 124 anterior.95. 96 lateral,95, 97, 124 posterior,96,97, 124 superior,ampullaof, 124 Semilunar lold,284 Senilunar hiatus, 37, 38 with anteriorethmoidalcell openings,38 at birth, 50 Semifunar 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 attachmentsof, 491 tendinousexpansionof, 511 Semimembranous tendon, 506, 508, 511,518 groovefor insertionof, 513 Seminal colliculus, 366, 384 Seminal yesicle, 361, 363, 384, 389, 391 Seminiferous tubule, 390 Semispinalis capitis muscle, 174, 175,176,178,424 in posteriortriangleof neck, 178 Semispinalis cervicis muscle, 178 Semispinalis thoracis muscle, 176 Semitendinosus muscle, 489, 495, 503, 515, 540 attachmentsof. 489. 491 Semitendinosus tendon, 492, 493, 506, 507 Sensory cortex, 135 Septal artery branches, 40 Septomarginal t?abecula, moderate band of,220,224,225 Septum,205 Septum pellucidum, 106,108, 110, 1 1 1 ,1 1 2 ,1 4 1 ,1 4 3 ,1 4 5 , 1 4 7 anteriorvein of. 145. 146 posteriorveins of, 146 Serosa of ileum,280 jejunal,280 of spleen,299 of vermiformappendix,283
Serous glands of von Ebnea See Lingualglands(serousglandsof von Ebner) Serratus anterior muscle, 174, 180, 181, 182, 186, 192, 243, 245, 246, 247,249,250,258,418,420,424 digitationsof, 186, 188,189 fasciaof, 428 insertionof, 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 anteriorview of, 423,474,479 anteroposterior'adiograph of ,422 capsuleof, 432 coronal section of, 423 cutaneous nerves of, 479 glenohumeralloint, 423 lateral view of, 423 musclesof. 424 nerves of, 429430 Posterior,477 posterior, neNes ol, 477 posterior view of, 479 superficialveinsof, 479 Sigmoid altery, 323, 340 Sigmoid lymph nodes, 317 Sigmoid plexus,323 S i g m o i d s i n u s , 1 1 , 9 7 ,1 0 3 groove for, 6, 9 Sigmoid vein,31 1,312 Sigmoid vessels, attachment ol, 274 Sinuatrial lymph nodes, 225 Sinuatriaf nodal artery, 216, 218, 225 Sinuses confluenceof,144,145 axial MR imageof, 150 frontal,37, 38 maxillaryopeningof, 37 paranasal,47-50 sphenoidal,37, 38 openingof, 37, 38 straight,144 transverse, 145 transverseleft, 144 Sinusoid, 290,291,292 Skene's glands. See Paraurethral (Skene's)glands Skin over rectus sheath, 252 perianal,393, 394 Skull anteriorview of, 2 anteroposteriorradiographof, 3 b a s eo f , 6 6 , 1 6 0 ,1 6 1 diploic and emissaryveins of, 99 fractureof. 101 horizontalsectionthrough,104 labyrinthorientationin, 97 lateralview of, 4 midsagittalsectionof, 6 of newborn,12 skin of, 102 superiornuchalline ol, 174, 175, 176
Atlas of Human Anatomy
Soleal line,513 Sole lfootf cutaneousinnervationof, 541 musclelayersot, 532,533, 535 Sofeus muscle, 506,516, 517,520, 521, 522, 540 attachments of,515 innervationof, 541 insertionof, 517 nerveto, 516,517 tendinousarch of, 495,517 Solitary tract nucleus, 116, 117, 123, 125, 126, 135, 345 Sound r€ception, pathway of,92 Spermatic cold, 260, 261,376 cremastericfasciaon, 260 cremastericmuscleof, 257 ductus deferensin, 255 externalspermaticfasciaof, 249,257, 259 externalspermaticfasciaon, 249 externalspermaticfasciaover,405 internalspermaticfascia on,262 Sphenoethmoidal recess, 37, 38 Sphenoidal fontanelle, 12 Sphenoidal sanus, 6, 37, 38, 39, 48, 49, 63, 64, 83 axial MR imageof, 150 within bony shell,50 coronalCT imagesof, 151 openingof, 6, 37, 38, 49 sagittalMR image of, 149 Sphenoid bone, 9,38 body of, 6, 9, 50 carotid groove of, 9 clivusof, 9 foramen ovale of, I foramen spinosum off, 8 greaterwing o1,2, 3, 4, 5, 8, 9, '151 orbital surface of, 2 infratemporalcrest of, 4 lesserwing of, 2, 3, 6, 9 orbital surface of, 2 pterygoidhamulusof, 6 pterygoidprocessof, 4,8, 12,38 lateral plate of, 39 medialplate of, 39 sphenoidalsinus of, 38 spineof, 14 Sphenoid emissary foramen, 11 Sphenomandibular ligament, 40, 55 Sphenooccipital synchondrosis, 63 Sphenopalatine artery, 40, 41, 69 posteriorlateralnasalbranchof, 40 posteriorseptal branchof, 40 Sphenopafatine foramen, 4, 6, 13, 14, 38,40,42 Sphenopalatine vessels, 11 Sphenoparietal sinus, 103, 145 Sphincter muscle external,367 externalanal,284, 288, 388, 395 internal,367 of pupil,132 Sphincter of ampulla, variations in, 295 Sphincter urcthrae, 396 Sphincter urcthrae muscle, 356, 359, 361, 365, 366, 378, 379, 383, 384, 385,403, 416
Atlas of Human Anatomy
Sphincter urethroyaginalis musclet 366,370,378,379 Spinal artery anterior,11, 141,171,172 anastomoticloops to, 171 posterior, 11, 172 anastomoticloops to, 171 left,143,172 righl,172 Spinaf cotd,243,244 arteriesof, 171 intrinsicdistributionof. 172 ascendingfibers of, 416 axial CT images ot,242 centralcanal of, 108, 109 descendingfibers of, 416 descendingtracts in, 108 i n s i t u ,1 6 0 sacral, 324 sagittalMR imageof, 149 schemaof. 167.346 thoracic,134, 210, 327, 328 thoracic part of, 132 thoracolumbar,324 veinsof, 173 Spinal dura mater, 160 Spinal ganglion, dorsal, 170 Spinalis cervicis muscle, 175 Spinalis cervicis muscle, 175 Spinalis enector muscle, 349 Spinalis muscle, 175, 331 Spinalis thoracis muscle, 175 Spinal membranes, 169 Spinal meninges,325 Spinal nerve,258 anteriorcutaneousbranchof. 180 cervical,127, 160 collateralbranchof, 258 dorsal branch of, 258 dorsal ramusof, 169, 170 groovefor, 19 intervertebralforamen for. 18 lumbar,179 meningealbranchof, 258,325 originof, 17O,258 recurrentmeningealbranchesof, 170 recurrentmeningealbranchesof, 170 segmentalmedullarybranchesof, 138 to skin vesselsand glands,325 thoracic,180,258 ventralramusof. 169.258 Spinal nerve roots anterior,321 anteriorview of , 169 dorsal,114,169 filamentsof, 160 posteriorview of, 169 relationto vertebrae,161 ventral,114, 17O,180, 321 Spinal nerve trunk, 258 Spinal perivascular plexusr 322 Spinal sensory ganglion, 258, 321, 324,327 anteriorcutaneousfibers of, 258 ascendingfibersof, 345 communicatingbranch of, 258 descendingfibers of, 345 dorsal root of, 180, 325,327,328, 345 lateralcutaneousbranchof, 258 ventral root of. 258
Spinal tract,125, 126 trigeminalnerveand, 116, 117 Spinal vein anterior,144, 173 posterior,144, 173 Spinous pnocess lumbar,155 radiographof, 156 thoracic,154 Spiral ganglion,96 Spiral lamina hamulusof, 95 osseous,95, 96 Spiral ligament,96 Spiral organ (of Gortil' 92, 96 Splanchnic nerve c, 228, 324, 325 abdominopelvi cardiopulmonary228 first lumbar,323 fourth lumbar,318 greaterthoracic,167, 2O9,230, 24O, 258, 263,267,320,324,327,409 left,194,318, 321, 323,327, 328,346 right, 194, 240, 318, 32O,321, 327, 328,346 leastthoracic,209, 263, 267, 320, 322, 323, 324, 325, 344, 345, 409 left. 323. 346 right,318, 320, 346 lesserthoracic,165, 167, 2O9,258,263, 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 Spfeen, 196, 197, 272,273,288,29O, 293, 297,331,347,349 anterior extremity of, 299 area for, 329 arteriesof, 300, 301 axial CT imagesof, 350 colic impressionof, 299 cross sectionof, 297, 299, 338 diaphragmaticsurfaceof, 299 fibrouscapsuleof, 299 gastricimpressionof, 299 hilum of. 299 in situ, 299, 347 posterior extremity of, 299 pulp of, 299 renalimpressionof, 299 serosa of, 299 superiorborderof, 299 veins of, 309 visceral surface of, 299 Splenic artery, 237, 278, 297, 298, 299, 300, 301, 305,306, 318, 319,320, 32',t,327,328 arteriogramof, 303 lefl,264 originof,302 oancreasand,274 splenic branches of, 300
t-39
Splenic capitis muscle, 174, 175, 178,424 Splenic cervicis muscle, 175, 178 Splenic f,exure, 269,271. See a/so 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 sectionof, 338 Spfenic vessels, 274, 348, 349 Splenium, of corpus callosum, 143, 145 Splenius capitis muscle, 174,178, 424 in posteriortriangleof neck, 178 Splenius cervicis muscle, 178 Splenius muscler 2T Splenorenal ligament, 272, 299, 329 with splenicvessels,331 Squarnous suture, 12 Si spinal nerve,160 55 spinal nerve, 160 Stapes, 92,93 anteriorlimb of, 93 base of, 92, 93 footplateof, 93 head of, 93 limbs of, 92 in oval window,96 posteriorlimb of, 93 Stapius muscle nerveto, 123 tendon of, 93 Stellate ganglion. See Cervicothoracic ganglion Stellate veins, 334 Sternaf angler 245 Sternalis muscle, inconstant, 188 Sternoclavicular joint, 196 adicularcavitiesof, 419 articulardisc of, 419 transversesectionof, 243 Sternoclavicular ligament, anteraor, 419 Sternocleidomastoid artery branch,34 Sternocleidomastoid lymph node, Sternocleidomastoid muscle, 27, 31, 3 2 , 3 4 , 7 3 , 7 4 ,1 2 7 ,1 2 9 ,1 7 4 ,1 7 8 , 188, 198, 247, 419,424, 429 accessorynerveto, 127 clavicularhead of, 27, 28, 181,247 medialmarginof, 74 originof, 419 sternalhead o1,27, 28, 181, 247 Sternocostal articulations, 186 Sternocostal joint, 419 Sternocostal ligament, 186 intraarticular, 186 r a d i a t e1, 8 6 , 4 1 9 Sternocostal triangle, 195 Sternohyoid muscle, 27, 28, 29, 31, 32, 53, 128,129, 189,198 investedby cervicalfascia,188 nerveto, 71 originof, 419
1.40
Sternothyroid muscle, 27, 28, 29, 31, 32, 128, 129, 198 nerveto, 71 Sternum, 26,29, 18O,194,233,246, 424 angleof, 185 axial CT images ol,242 body of, 181, 185,247, 248 head of, 181 jugularnotchof, 185 manubriumot, 27, 28, 185 xiphoidprocessof, 181, 184, 185,247 Stomach, 167, 215, 237, 269, 273, 276, 294,297,298,331 angularnotch of, 275 area tor, 329 arteries of, 300 atonic,275 axialCT imagesof, 350 body of, 275,279 cardiacparts of, 233,236,277 cardiaczone of,276 chief cells of, 276 circularmuscle layerof, 236 cross sectionof, 297 fundus of, 233, 236, 275, 293 barium radiographot, 279 vagal branchto, 240 gastriczone of, 276 greatercurvatureot, 275 hypertonic,275 hypotonic,275 in situ,275 innervationof, 321 fessercurvatureot, 275 posteriorvagal branchto, 240 longitudinalmusclelayer o1,236, 277 lymph follicleof, 276 lymph vesselsand nodes of, 314 mucosaof, 276 mucous cells of, 276 muscularismucosaeof, 276 musculatureot. 236. 277 nervesof. 319. 320 obliquemusclelayerof, 236 or.thotonic, 275 posterior surlace ol, 272 reflected,272 submucosaof, 276 surfaceepithelialcells of, 276 variationsin positionand contourof, 275 veins of, 309 zigzag line of,236 Straight artery, 307 branchof, 326 of ileum,280 of lejunum,280 Straight gyrus, 107 Straight sinus, 144, 146 in tentoriumcerebelli,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 Styfoglossus 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 nerveto, 25 Styloid pnocess, 14, 27, 29, 30, 34, 53, 59 radial,439 ulnar,439 Stylomandibular ligament, 15 Styfomastoid foramen, 25, 123, 125 Stylopharyngeus muocle, 59, 65, 68, 125, 126,235 Subacromial bursa,423 Subaponeurctic space, 468 Subarachnoid space, 87, 99, 102, 109 in lumbarpuncture,162 thoracic,170 Subcallosal area, 106, 119 Subcallosal gyrus, 106 Subcfavian artery, 30,32,74,76, 130, 171, 183, 189, 198, 206, 211, 237, 427 anomalous,80 groovesfor, 186 left, 75, 80, 137, 193, 243 right, 75, 126, 137, 193, 230 anteriordissectionof, 33 obliqueschematicview of, 33 Subclavian lymphatic trunk, 208 Subclavian lymph node, 184 Subclavian trunk left, 266 right,266 Subclavian Yein, 30, 32, 74, 189, 198, 206,211 groovesfor, 186 l e f t , 7 5 1, 3 7 , 1 8 6 right,75, 137, 230 Subclavius muscle, 186, 189,230, 419.428.429 fascia investing,428 fasciaof, 428 insertionof,419 investedby clavicopectoralfascia,188 nerveto, 430 Subcostaf anletyr264 lower anastomoseswith, 255 Subcostal muscle,258 Subcostal nerve, 160, 267, 409, 498 lateralcutaneousbranch of, 267 lateralfemoralcutaneousbranchof, 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'sand Scarpa'slayersof, 249 deep membranous,380, 381 fatty layerof, 348, 361, 378 superficial,380 of mammarygland,182 membranous, 348,361, 378 of rectussheath,252 Subdeltoid butsa, 423 Subdural hematoma, site of, 101 Subendocardial branch, 225 Subependymal vein, 146
Atlas of Human Anatomy
Subhiatal fat ringr 236 Sublingual artery, 59, 61 Sublingual caruncle' 51 ducts,51 with openingsof submandibular Sublingual duct, 51 openingsof, 61 Sublingual fold, 51 ducts,51 with openingsof sublingual 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 schemafor, 133 Submandibular gland' 27, 28, 31, 32, 5 3 , 1 2 3 , 1 3 31 , 6 6 ,1 6 7 mucous,61 serous,61 Submandibular lymph nodes' 73 Submental arteryr 40 Submental vein, 70 Submucosa of intestine,326 of stomach,277 of vermiformappendix,283 Submucosal gland' 326 Submucosal plexus,326 Submucous (Meissner's! plexus, 326 Submucous space, 392 internalrectalvenousplexusin, 393 perianal,396 Suboecipital netve' 21, 178 Suboccipital triangle, 178 Subparotid noderT2 Subpleural capillary, 205 Subpleural lymphatic plexus, 208 Subpopliteal recess, 507, 508 Subpubic angle, radiograph of' 355 Subpyloric lymph nodes, 314 Subscapular artery' 427, 434 computedtomographyof, 484 Subscapular fossar 185 Subscapufaris muscle, 180, 192, 243, 244, 245, 425, 428, 433 insertionof, 420 originof, 420 subtendinousbursaof, 423 Subscapularis tendinous muscle openingsof, 423 oositionof. 423 Subscapularis tendon, 423, 425 Subscapular nerve lower,429, 43O,477 upper,429,43O Subserous fasciar 412 Subserous plexus, 326 Substantia nigra, 107 Subtendinous bursa, 511 Subtrapezial plexus' 177 Subungual space, 471 Sulcal artery, 141 central,141,142 142 oostcentral. precentral, l4l orefrontal.142
Atlas of Human Anatomy
Sulcal vein anterior,173 oosterior.173 Sulcus dorsal median,mesothelialseptum in, 169 112 hippocampal, 147 hypothalamic, intraparietal,105 occipitaltransverse,105 occipitotemporal,107 olfactory,107 Sulcus limitans' 115 Sulcus terminalis' 214 Superciliary arch' 1 Superffcialis flexor tendon, in com' mon tendon sheath' 460 Superficial perineal {Colles'f fascia, 358,361,366,370,378,380,411 attachmentof, 380 Supinator arlery' 447 Supinator muscle, 42O,440 insertionof, 420 originof, 420 Supraclavicular nele, 24, 31 intermediate.129, 479 lateral.129.479 medial,129,479 Supracondylar ridge, 436 Sugraduodenal artery, 300, 301, 306 Supraglenoid tubercle, 420 Suprahyoid artery, 59 Suprahyoid muscle, action ofr 29 Supramarginal gyrus' 105 Supraoptic nucleus' 147 Supraopticohypophyseal ttact' 147 Supraoptic necess' 106, 108 Supraorbital attery' 23, 36, 40, 81, 85 Supraorbital nerye' 24, 36, 81, 122 branchesof, 86 medialand lateralbranchesof, 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 arteriesand veins of, 332, 333 cross sectionof, 347 dissectionof, 346 in situ, 332 |eft,197, 272, 297, 329, 331, 338, 346 nervesof, 344,346 dissectionof, 346 right, 197, 297, 329, 346 schemaof, 346 dissectionof, 346 Suprarenal impressionr 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 infraspinousbranch ol, 427 Suprascapulan nel e' 429 Suprascapular notch, 184, 185,42O' 421, 423,427 Suprascapular veinr 70 Supraspinatus ligament' 179 Supraspinatus muscle, 177, 423,427 428,428 insertionof, 420 originof, 420 Supraspinatus tendon, 423, 425 Suprasternal spacer 28 Supratrcchlear artery' 23, 40, 81, 85 Supratrochlear crest' 220, 224 Supratrochlear nerver 81, 122 Supratrochlear vein, 23, 24, 85 Sural cutaneous nelve articularbranchesot, 541, 542 communicatingbranchof, 540 Iateral,540, 541, 542,545 branchesof, 544 communicatingbranchof, 545 medial,540, 541, 545 Sural nerve, 534, 540, 541, 545 lateralcalcanealbranch of, 541 medialcalcanealbranchof, 541 via lateralcalcanealand lateraldorsal cutaneousbranches,541 Sustentaculum tali' 523, 524 Sweat gland' 9, 167 Syfvius, sulcus ol, 141 Sympathetic Aanglionr 409 lumbar,170 superiorcervical,130, 132 superiorganglion,125, 128, 131, 133, 134,210,226 thoracic,209 thoracic,third, 240 Sympathetic nervous sYstem generaltopographyof, 165 schemaof,-167 Sympathetic trunk' 125, 133,192, 210,230, 258, 263, 267,290,324, 325,327, 344, 409, 412, 499 cervical,165 gangliaof, 321,325,344,345 ganglionof, first thoracic,132 |eft,194, 318,324,346 left lumbac323 right,194, 318, 328,331, 346 sacral,323 left,412 right,412 thoracic,240 thoracicgangliaof, 321 Synovial cavities' 22, 187 Synovial membrane, 423, 471 attachment of to femur, 511 of hip joint,487
T Tl spinal netve' 132,133,134,160 T2 spinal nerve' 133, 133 T7 spinal netve, 414 lateralcutaneousbranchof, 254 medialcutaneousbranch of, 254
t-41
TIO spinal nerve, 410 Tl f spinal nele, 414 Tl2 spinal nerve, 160 ventralramus of, 254 TIO ventral ramus, 345, 410 Tl vertebra,13, 153, 160 spinousprocessof, 197 T4 veitebra,230 T6 vertebra lateralview of, 154 superiorview of, 154 TB vertebra, 241 TIO vertebra, 241 Tl2 vertebra, 153, 160 body of, 349 lateralview of, 154 spinousprocessot, 152,174, 175,177 Taenia free,271,281,282 mesocolic,281, 282, 284 omental,281.284 Talofibular ligament anterior,514 posterior,514 Talus dorsalview of, 523 head of, 523,524 lateraltubercleof, 523 medialtubercleof, 523 neck of, 523.524 plantarview of, 523 posterior process of, 523 groovefor tendon of flexor hallucis longus,523 lateraltubercle.523 medialtubercle,523 trochleaot,523,524 Tarsal artery lateral,530, 536 medial,530,536 Tarsal gland, 81 openingsof, 81 Tarsal joint, transverse, 523 Tarsal sinus, 523,524 Ta?sometatarsal ioint, 523 Tarsometatarsal ligament, dorsal, 536 Tarsus of eyelid,81 inferior,81 superior,81 Taste buds, 58 sectionof, 58 Taste pathways, 135 Tectal plate, 106 Tectorial membrane, 22, 96 deeper part of, 22 Tectospinal tract, 132 Teeth apicalforaminaof, 57 canine,57 cement of, 57 crown of, 57 deciduous,56 dentinaltubulesof, 57 dentineof, 57 enamelof, 57 incisors,56, 57, 233 interglobularspaces between,57 interproximalspaces between,57 labiobuccalview of, 57
t-42
Teeth (Continued) motar first, 56 growth of, 50 second,56 third, 56 molars.56. 57 neck of, 57 nervesto, 57 odontoblastlayerof, 57 papillaof, 57 permanent,56, 57 left lower, 57 left upper, 57 lower, 56 upper,56 premolars,56, 57 root canalsof, 57 roots of, 57 Tegmen tympani, 92,93 Tela choroideae, 108,111, 145 Temporal a?tery deep, 99 anterior,40 oosterior.40 posterior,40 middle.23. 99 parietalbranchof, 23 pola',142 superficial,23, 34, 40, 99, 100, 134 frontalbranchof. 23. 85 Temporal bone,9 petrouspart of, 9, 97 squamouspart of, 997 Temporal fossa, hematoma of, 101 Temporal gyrus inferior,105,107 middle,105 superior,105 Temporalis muscle, 54 axial MR image of, 150 insertionof, 15. 54 nervesto, 122 Temporal lobe, 105, 1O7,141 axial MR imageof, 150 hematomaof, 101 herniationof, 101 Temporal nerve branchesof, 122 deep,122 anterior,40 posterior,40 schemaof, 122 Temporal sulcus inferior,107 Temporal vein deep, 99 middle.23. 99 superficial,99 branchesof. 23. 99 frontal and parietal branches of, 99 tributaryof, 102 Temporomandibular ioint articulardisc of, 54, 55 lateralligamentof, 40 Tendinous intersection, 83, 84, 86, 1 2 1 ,1 8 1 , 2 4 7 Tenon's capsule. See Fascial sheath of eyeballfienon's capsule)
Tensor fasciae latae muscle,36, 485,492,494, 503 attachmentsof, 491 originof, 492 Tensor tympani muscle, 93 tendon of, 93 Tensor tympani nele, 122 Tensor veli papatini muscle, 52,93, 122 tendon of, 52 Tensor veli papatini nerve, 55 Tentorium celcbella,86, 101,103, 144, 145 sagittalMR imageof, 149 straightsinus in, 106 Teres major muscle, 152, 174, 177, 180, 244, 245, 424, 427, 428, 433 insertionof, 420 lower marginof, 434 Teres minor muscle, 174,177,243, 244,245, 423, 424, 425, 427, 428 Terminal sulcus,58 ?esticular 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 lymphaticpathwaysalong,408 in spermaticcord, 401 Testis, 361, 386, 389, 390, 416 appendixof, 387, 389 arteries and veins of, 401 cross section of, 390 cross sectionthrough,390 descent of, 386 external spermatic fascia over, 405 lobulesof, 390 lymphaticpathwaysfrom, 408 pathways from, 408 sagittalMR imagesof, 397 schemaof, 390 septa of, 390 tunica albugineaof, 390 visceral layer over, 387 Thalamic vein, superior, 146 Thalamogeniculate artery' 143 Thalamoperlorating artery, 140, 143 Thalamostriate Yean inferior.144.146 posteriorpart of, 146 superior,108, 111, 145, 146 Thalamotuberal aitery, 140 Thalamus, 106, 108, 11O,112, 114, 145, 147,324 left, 144 geniculatebodies of, 143 nucleiof, 111 pulvinarsof, 107,111, 143, 145 sagittalMR imageof, 149 schemaof, 111 stria medullarisof, 106 striaterminalisof, 111 ventralposteromedialnucleusof, 135 Thecal sac, sagattal MR images of, 397 Thenar eminence,418
Atlas of Human Anatomy
Thenar muscle, 446,460 innervationof, 460 suppliedby median newe,476 Thenar spac'e,462 dorsal extensionof, 460 Thigh anterior cutaneous nerve of, 545 arteriesof, 500, 501,512 bony attachments of anteriorview of, 490 posteriorview of, 491 cutaneousinnervationof, 538, 540 lateral cutaneous nerve of, 538 musclesof anteriorviews of. 491, 493 lateralviews of, 494 posteriorviews of, 495 neruesof, 500, 501, 538, 540 anteriorview of, 501 posteriorview of, 502 serialcross sectionsof, 505 Thoracentesis, 190 Thoracic aortic plexus, 209 Thoracic aitery anteriorintercostalbranchesof, 189 interior,198,206, 211, 305 internal,189,237, 244, 245, 246 perforatingarteriesof, 188 lateral,183, 188, 189, 427, 434 left,193,194 perforatingbranchesof, 183 right,193,230 superior,189,427, 429, 434 Thoracic cardiac netve, 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 nerYe, 161 dorsal ramus of, 192 l o n g , 1 8 81, 8 9 , 1 9 2 Thoracic spinal nerve, 133 .133 dorsal root of, ventralroot of, 133 Thoracic sympathetic nerves, 130 Thoracic vein internal,189, 198, 244,245,246 left, 194 right,194 Thoracic vertebrae, 21 anteriorview of, 171 arteriesof, 171 cross sectionthrough,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 acromialbranchof, 424, 427, 429 clavicularbranch of, 424, 427, 429 deltoid branch ot, 424, 427, 429 pectoralbranchof, 424,427, 429 Thoracodorsal artery, 427, 434 Thoracoepigastric vein, 249
Atlas of Human Anatomy
Thorax autonomicnervesin, 209 bony frameworkof, 185 cross sectionsof, 246 at T3-4 disc level,244 at T4-5 disc level,245 at T7 disc level,246 at T3 lower level,243 surfaceanatomyof, 181 Thumb distal phalanxof, 457 innervationof, 460 proper palmardigitalnervesof, 460 T h y m u s , 2 1 1, 2 3 0 , 2 4 4 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 esophagealbranchof, 237 superior,31, 32, 34, 74, 75, 76 superiorlaryngealbranchof, 34 T h y r o i d g l a n d , 2 9 , 3 1 , 1 9 6 ,1 9 8 , 2 0 6 anteriorview o1,74 articularsurfaceof, 78, 80 fibrouscapsuleof, 76 isthmusof, 74 posteriorview of, 75 pyramidallobe of,74 r i g h tl o b eo f, 7 4 , 7 5 , 7 6 Thyroid notch, superior, 77 Thyroid vein inferior,74, 75, 198 middle,74 superior,31, 74 Tibia, 511, 530 anteriorborderof, 485, 513, 514 anteriorview of, 513 with posteriorligamentattachments, 513 cross sectionof, 514 inferiorarticularsurfaceof, 513, 514 interosseousborderof, 513, 514 lateralcondyleo1,494,510,513 lateralsurfaceof, 513, 514 medialborderof. 513.514 medialcondyleof, 513,514 medialsurfaceof, 513, 514 obliouelineof" 513 posteriorsurfaceof, 514 posteriorview of, 513 radiographof, 510 superiorarticularsudace of, 514 superiorview of, 514 tuberosityo'f, 492,493, 511, 513, 514 Tibial artery anterior.512. 530 posterior,512,534 medialcalcanealbranch of, 533, 535 posteriormedialmalleolarbranchof, 534 Tibial collateral ligamentn 511
Tibiafis anterior tendon' 485, 494, 536,542 attachmentof, 515 tendinoussheathof, 530 tendon of, 530 Tibiafis posterior rnuscle' 534, 541 attachmentof,515 tendon of, 535, 536 Tibial nerve, 495, 540, 541 articularbranchesof, 540 lateralplantar,541 medialcalcanealbranch of, 533, 535, 540, 541, 545 medialplantar,541 musclesinnervatedby, 541 posterior,534 Tibiofibular ligament anterior,514 posterior,514 Toe fifth distal,middle,and proximalphalanxes ot,537 vein of, 544 great distal phalanxof, 537 medialside of, 544 proximalphalanxof, 537 T o n g u e , 3 7 , 3 9 , 5 9 ,1 2 5 apex of, 58 body of, 58 crypt of, 58 dorsum of, 58 frenulumoJ,51 frontalsectionof, 60 horizontalsection of, 60 inferiorlongitudinalmuscleof, 128 intrinsicmusclesof, 128 lateral view of, 59 lymphaticdrainageof, 73 lymph vesselsand nodes of, 73 musclesof, 59, 60 verticaland transverse,60 posterior,125 root of, 58, 235 sagittalMR imageof, 149 salivaryglandsand, 60 schematic stereogram of, 58 superiorlongitudinalmuscleof, 128 taste anteriorof, 125 Tonsil, palatine, 58 Tonsillar artery' 40 Torus tubarius, 37, 39 148 ftabecula, arteryof, 148 calneae, 22O Ilabecufae l?achea, 29, 74, 75, 77, 126,168,196, 198, 202, 211, 213, 230, 234, 237, 243,244 aderiesof, 202 bifurcation of axial CT imagesof, 242 car.tilageot,28,202 cross sectionthrough,202 elasticfibers of, 202 epitheliumof, 202 mucosaof posteriorwall ol,2O2 nerveo1,202 I?achealis muscle' 202 lymph nodest 244 Ilacheobronchial inferior,245
1.43
Ilacheobronchial nodes, 266 Ilacheobronchial tree, innervation ol,210 Ilanspyloric plane, 268 Ilansverse pnocess, lumbar, 19, 179 Ilansvelse pnocess, lumbar, 155 llansverse sinus, 97, 103 groove for, 9 left, 144 Ilansversospinalis muscle, 243 Ilansversus abdominis muscle, 180,192,261 Ilansvelsus thoracis muscle, 180, 192 Trapeziocapitate ligamenl, 454, 455 fiapeziotrapezoid ligament, 455 Ttapezium,456 anterior(palmar)view of, 452 coronalsectionof, 455 posterior(dorsal)view of, 452 tubercleot, 452, 454, 456 I?apezius muscle, 27,29, 127, 129, 152, 174,177, 180,188, 189, 192, 244,246,247,418,419, 420, 428, 429 insertionof, 420 Trapezoid bone, 456 anterior(palmar)view of, 452 coronalsectionof, 455 posterior(dorsal)view of, 452 Ttapezoid ligament, 423 Treitz, ligament of, 270 Tliangfe of auscultation, 152, 246, 424 Tliangle of Petit. See Lumbartriangle (of Petit) lliangular fossa, 93 Iliceps brachii muscle, 152,429, 444,446 lateralhead of, 152, 181, 245, 418,424, 427 long head of, 152, 243, 244, 418,42O, 424, 427, 433 tendonof. 152.438 Ilicuspid valve anatomyof, 223 anteriorcusp of, 222,223,224 orificeof, 246 posteriorof, 222, 223, 224 rightfibrousringof,222,225 septalcusp of, 222, 223, 224 Tiigeminal ganglion of,86, 116, 117, 132,133,134,135 Tiigeminal impression, 9 Tiigeminal nerye, 24, 97, 114,116, 1 1 7 ,1 2 2 ,1 3 3 ,1 3 4 ,1 3 5 ,1 4 4 ganglionof, 131 maxillarydivisionof, 24 mesencephalic nucleusof, 116, 117 motornucleusof, 116, 117,122, 135 motor root of, 131 ophthalmicdivisionof, 24 parotid branchesot, 122 principlesensorynucleusot, 116,122 schemaof, 122 sensorynucleusof, 117 sensoryroot of, 118,131 spinalnucleusof, 116, 117, 122, 125, 126 spinaltract ot, 117, 126 superficialbranchesof, 122
l-44
Tiigeminal nucleus, 122 T?igone collateral, 111 habenular, 111 left fibrous,222 right fibrous,222 of urinarybladder,361, 365, 366, 385 Iliquetrocapitate ligamenl, 454 Triquetrohamate ligament, 454, 455 Iliquetrum bone,456 anterior(palmar)view of, 452 posterior(dorsal)view of, 452 Tlochanter greater,248, 376, 485, 487, 489, 492, 495. 496. 503 anteroposteriorradiographof, 488 radiographof, 355 lesser radiographof, 355 Trochlea, 420 Ilochlear nerve llVf, 83, 84, 86, 114, 116,121 schemaof, 186 Ilochlear nucleus, 117 Tnber cinereum, 106, 107, 114 m e d i a ne m i n e n c o e f, 1 4 7 lUberculum sellae, I Tirberohypophyseal ltacl, 147 Tirfted cell, 119 lbnica albuginea,390 fUnica vaginalis parietallayerof, 390 viscerallayerof, 390 lUrbinates, 37 artery, anterior, 40 [lmpanic fimpanic canaliculus, 10 Ilrmpanic cavity, 92, 93, 96, 124, 125 Ilmpanic membrane, 92, 93, 96 right,93 Ilmpanic nerve, 93, 123, 125, 134 Ilmpanic plexus, 93, 123, 125,132,134 tubal branch of, 125
u Ulna, 436, 438, 439, 440, 441,442, 443, 454,465 anteriorborderof, 436 anterior(palmar)view of, 452 anteriorsurfaceof, 436 coronalsectionof, 455 coronoidprocessof, 437 dorsaltubercleof, 436 interosseousborderof, 436 lateralsurfaceot. 429.436 olecranonot,418,444 posteriorborderof, 436, 439 posterior(dorsal)view of, 452 posteriorsurfaceof, 436, 439 radialnotch of, 436 radiographof, 437 tuberosityof, 436, 439 Ulnar artery, 433, 434, 446, 447, 454, 460, 465 anterior recurrent,447 computedtomographyof, 484 deep palmarbranch of, 447, 454,460, 465 dorsalcarpal branchof, 469 palmarcarpal branchof, 465 with venaecomitantesand 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 anteriorview of, 476 adicularbranch of, 476 communicatingbranch of, 468 communicatingbranch with median nerve,476 communicatingwith mediannerve,476 in cutaneousinnervation,476 to cutaneousinnervation,476 deep branch,476 deep branch ol, 447, 454, 465, 476 dorsal branchesof to dorsum of middle and distal ohalanges,476 dorsal branch ot, 444, 446, 468, 469, 476 dorsaldigitalbranchesof, 469 groove for, 436 inconstantcontributionof, 476 musclesinnervatedby, 476 palmarbranch ol, 447, 476 palmarview of, 476 posterior(dorsal)view of, 476 posteriorview of, 476 proper palmardigitalbranchesof, 469 superficialbranch of, 447, 460, 476 Ulnar recurrent artery anterior,434 posterior,434,444 Ulnar styloid p?iocess, 452 Ulnocapitate ligament, 454 Ulnolunate lagament, 454 Ulnotriquetral ligament, 40, 454 Umbilical artery, 340, 341, 396 distal,402 obliterated,372 occluded pa1 o1,229, 362, 363, 364, 400, 403 patent part of, 400, 4O2,403 orenalal.229 Umbilical ligament medial,229,259,341, 401, 402, 403 median,340, 364, 365, 400, 403, 409 Umbilical rcgion,268 Umbilical vein obliterated,288 Umbilicus, 247, 3O5,312 Umbo, 93,96 Umbrical muscle fourth,476 third,476 Uncal vein, 145 Uncinate pnocess, 19, 37, 38, 339 Uncovertebral ioints, 19 U n c u s , 1 0 6 , 1 0 71, 1 9 Upper limb anteriorview of. 418.473 arteriesof, 473 computed tomography of, 484 lymph nodes of, 483 lymph vesselsand nodes of, 483 lymph vesselsof, 483 nervesof, 473 posteriorview of, 418 surfaceanatomyof, 418
Atlas of Human Anatomy
Urcter, 271, 334, 341, 362, 363, 364, 365, 366, 391, 400, 402, 403,410, 412 arteriesof, 341 diagonalcourseof, 340 female,340 left, 340 male,340 nervesof, 344,345 340 retroperitoneal, right,318, 329, 340,372 upper,innervationof, 345 U]€teral plexus, right, 318 Ureteric told, 362, 363, 369 Urcteric nerve, middle' 344 Ureteric orifice, 384 left, 366 right,366 Ureteric plexus,410 Ureteropelvic junction, 339 Urethra, 263, 367, 372, 389 beginningof, 376 cavernous,368, 385 bulbousportion of, 371 pendulousportionof, 371 in children,368 fema|e,356, 357, 360, 361, 389 frontalsection,anteriorview of, 379 schematicreconstructionof, 379 male.381,383 floor of, 385 hiatusfor, 358 roof of, 385 membranous,368, 385, 408 lymphaticpathwayfrom, 408 musculofascialextensionsto, 357 prostatic,366, 368, 376, 384, 385 spongy,bulbousportionof, 366 Urethral artery, 384, 405 Urethral crest, 384 Urethral fold, 388 partlyfused, 388 Urcthral gland, 380,385 lacunaeand openingsof, 379 Urcthral lacuna' 385 Urethral meatus, externalr 361 Urethral orifice,388 external,360, 377, 379, 382, 385, 388 femaleexternal,395 Urethral raphe, 388 Urethral sphincter, internal' 366, 367, 384, 385 Urethrovaginal sphincter, 367 Urinary bladder, 167, 269, 323, 329, 340, 367, 412 a p e xo f , 3 6 1 , 3 6 5 arteriesof, 34'l b o d yo f , 3 6 1 , 3 6 5 , 3 6 6 f a s c i ao f . 3 6 1 . 3 6 4 female,366 fundusof, 361, 365, 366 innervationof, 168, 417 interiorof, 376 lateralligamentof, 364 lymph vesselsand nodes of, 343 male,366 mucosaof, 340 neck of, 362, 365, 366 nervesof, 344 orientationand supportsof, 365 sagittalMR imagesof, 397 trigoneof, 361, 365, 366, 385
Atlas of Human Anatomy
Urinary bladder (Continued) uretericorificeof, 366 uvulaof. 366. 385 of, 368 voidingcystourethrography Urogenital fold' 388 Urogenatal groove,388 Urogenital hiatus' 367 Urogenital sinus' 389 Urogenital triangle, 380 Urticfe, 92,95,96, 124 Uterine artery, 34O,341, 372 cardinalligamentwith, 364 vaginalbranchesof, 404 Uterlne ostium' 371 Uterine lfallopianf tube' 360, 362, 369, 370, 389,400, 412,415 abdominalostium of, 371 a m p u l l ao f, 3 7 1 , 3 7 2 fimbriaeot,371,372 folds of, 371 infundibulum o'f. 371. 372 isthmusof, 371 uterinepart of, 371 Uterlne vein, 404 superior,399 Uterine venous plexusr 399 Uterlne vessels, 360, 361,371 ovarianbranchesol, 372 Uterosacral fold' 362, 392 Uterosacral ligament, 360, 371, 372, 373 Uterovaginal venous plexusr 412 Uterovesical pouch, 372 Uterus, 370, 380,388, 389, 400,412 age changesand musclepatternof, 373 anteflexionof, 377 arteriesand veins of, 404 body of, 360, 371 cervixof, 360, 364, 369, 370, 371 degreesof retroversionof, 377 externalos of, 371 frontalsectionof, 371 fundusof, 360, 362, 365,369,371 internalos of, 371 retracted,412 round ligamentof, 340, 389 sagittalMR imagesof, 397 U.V junction, 372 Uvula,51 of urinarybladder,366, 385 Uvular muscler 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 anteriorgastricbranch of, 319 celiac branchesof, 216 celiac branchof, 319, 320, 321, 322 gastricbranchesof, 126 hepaticbranchof, 126, 319, 320, 323, 327 celiac branchesof, 320
Vagal trunk (Continued) posterior, 166, 318, 32O,321,322,323' 327, 328,344,346 branchto celiac Plexus,240 celiacbranchesof, 216, 319, 320, 321,322 posteriorgastricbranch ot, 32O,328 Vaginar 367 horizontalportion of, 372 musculofascialextensionsto, 356 sagittalMR imagesof, 397 supportingstructuresof, 370 upper four-fifths of, 389 vertical portion of, 372 vestibuleo1,37O,377 Vaginal artery, 340 Vaginal fornix' 371 anteriorpart of, 360 posterior part of, 360 Vaginal orifice' 388 Vaginal vein,398 Vaginal venous plexus' 398 Vaginal vestibuler 389 arteryof bulb of, 370 bulb of, 370.404 artery to, 404 Vaginal wall, 370,373 Vagus nerve (Xf' 32,34,74,75,76, 114, 116, 117, 118, 125, 126,127, 130, 131, 135,206, 209,210, 211, 325, 345 auricularbranchof, 10,24,126 cardiacbranch of, 209 celiacbranch of, 321 cervicalcardiacbranchof inferior,126 superior,126 cholinergic,2l0 communicatingbranch of, 126 to, 32 communication of, 118 distribution inferiorganglionof, 126, 127, 128, 135 left,243,244 meningealbranchof, 126 nucleusof, 324 pharyngealbranch of, 125,126,13O posteriornucleusof, 116, 117, 126, 324, a^R
pulmonaryplexusbranch of, 209 right,75, 80, 193,226, 230 s c h e m ao f , 1 1 8 ,1 2 6 suoerior cervical cardiac branch of, 130,131 superiorganglionol, 126, 127 thoraciccardiacbranch of, 126,226 Vallate papillae' 58, 135 Vallecula, 58 Vane comitantes' 59,60 Vasa rectae sPuriar 337 Vasa rectae verar 337 Vastus interrnedius muscle' 489, 493, 507, 538 attachmentsof, 489, 491 Vastus lateralis muscle' 485,489, 491, 492, 493, 494,500, 507, 538 attachmentsof, 489, 491 Vastus medialis muscle, 485,489, 492,493,500,538 attachmentsof, 489, 491, 538 nerveto, 500
1.45
Vater ampullaof, 294 major duodenalpapillaof, 294 Vein brain,146 of brain,145 of forearm, 480 of hypophysis, 148 of hypothalamus, 148 of largeintestine,311 of pancreas,309 of posteriorcranialfossa, 144 of small intestine,309 of spleen,309 superficial,of lower limb, 545 of suprarenalglands,347 vertebral,137 Velum inferiormedullary113 superiormedullary 113 Vena cava inferior,179, 194, 206, 2O9,213, 215, 220, 225, 230, 272, 273, 278, 293, 297, 298, 330, 331, 333, 339, 342, 347, 412 axial CT imagesof, 242,35O cross sectionof, 297, 338 openinglor,223 persistent left, 333 right renalvein entering,339 valve ol,22O superior,74, 75, 206, 211, 213, 215, 220, 224,225, 230,244,245,246 axialCT imagesof, 242 prenatal,229 Venae comitantes,460 Venous arch, dorsal, 544 Venous plexus, 372 vertebral,10 Ventral ramus, 170,193 i n s i t u ,1 6 0 Ventricle lcerebralf choroid plexusof, 109 fourth,113, 115, 144, 146 axial MR imageof, 150 choroidplexusof, 106, 114 lateraland medianaperturesof, 146 mediansagittalsectionof, 114, 115 outlineof, 143 posteriorview of , 115 rhomboidfossa of, 114 sagittalMR imageof, 149 vein of lateralrecessof, 144 lateral,108, 110, 146 choroid plexus,109 choroidplexusof, 99, 108,110, 143, 145 lateralvein of, 146 o c c i p i t ahl o r no f , 1 1 0 ,1 1 1 ,1 4 6 right,occipitalhorn of, 143 sagittalMR imageof, 149 t e m p o r ahl o r no f , 1 0 8 ,1 1 1 , 1 4 6 veins of, 146 left lateral,108 aoertureof. 108 centralpart of, 108 frontalhorn of, 108 occipitalhorn of, 108 phantomview of, 108 temporalhorn of, 108
Ventricf e (cerebrall (Continued) right lateral,108 t h i r d1 , 0 6 ,1 0 8 ,1 1 0 ,1 1 1 ,1 4 6 choroid plexusof, 106, 108 tela choroideae of, 108, 111, 145 Ventricle (heartf left,213, 214,221,224,246 axial CT imagesof,242 posteriorvein of, 216 posteriorwall ol,221 right,214, 215, 224, 246 axial CT imagesof, 242 opened,220 Ventricular vein hippocampal, 146 inferior,146 Ventromedial nucleus, 147 Venulae rcctae, 337 Vermian artery inferior,143 superior,143 Vermian vein inlerior,144 superior,144, 146 Vermis, 113 inferior,113 n o d u l eo f , 1 1 3 pyramidof, 113 tuber of, 113 u v u l a o f ,1 1 3 superior,113 centrallobuleof, 113 c u l m e no f , 1 1 3 decliveof, 113 foliumof, 113 l i n g u l ao f , 1 1 3 tuberof, 115 uvulaof, 115 Vertebra. See a/so specific veriebrae body of, axial CT imagesof, 242,350 lumbar,155 radiographsof, 156 relationto spinalnerves,161 spinousprocessof, axial CT imagesof, 242 thoracic,154 Vertebral artery, 10, 21, 32, 75, 76, 100, 130, 140, 141, 171, 178,226, 237 anteriormeningealbranch of, 143 atlanticpart of, 178 left, 143 meningealbranchesof, 10 posteriormeningealbranchof, 100, 143 right,143 venus plexusof, 137 Vertebral body, 19 articularfacets for, 186 fourth thoracic,230 lumbar,155 Vertebral canal, lumbar, 155 Vertebral column anteriorview of, 153 left lateralview of, 153 posteriorview of, 153 veinsof, 137 Vertebral ganglion, 130, 226 Vertebral notch inferior,lumbat 155 superior,lumbar,155 Vertebral plexus, 130
Vertebral vein, 137 anterior,137 Vertebral Yenous plexus, 137 external,173 interna1 l ,7 O , 1 7 3 Vertebra prominens, 19, 21 Vesical artery inferior,340 uretericbranchesof, 340 superior,340,341 uretericbranchesof, 341 Vesicaf fold, transverse, 372 Vesical pfexus, 323, 344, 412 Vesical vein right,311 superior,265, 399 Vesical venous plexus, 366,403 in retropubicspace,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 Morgagnif, 371, 389 Vesicular yean, :nferior, 399 Vestibular aqueduct endolymphaticduct in, 96 externalopeningof, 97 Vestibular area, 115 Vestibular lo.sa,377 Vestibular ganglion, 95 Vestibular gland, 389 greater,389, 404 openingof, 377 orimordiumof. 389 Vestibular membrane, 96 Vestibufar nerve, 95, 97, 124 inferior, 95, 97,124 superior,95, 124 Uestibular nuclei, 117 Vestibular nucleus, 116, 124 diagrammatic, 124 Vestibular lovall window, 95 Vestibule, 95,389 cochlearrecessof, 92, 95 ellipticalrecessof, 95 spherical recess of, 95 Uestibulocochlear nerve, 117 Vestibulocochlear nerve (Vlllf, 92, 9 5 ,9 7 , 1 1 4 ,1 1 6 ,1 3 1 s c h e m ao f , 1 1 6 ,1 1 8 , 1 2 4 Vestigial mesonephric tubule, 390 Vidian nerve, 122 Viscera abdominal,269 median sagittal section of, 348 Pelvic female,360 male,361 nervesof, 412 vasculatureof, 300-315 Visceral lymph nodes celiac,266 inferiormesenteric,266 superiormesenteric,266 Visceral nerve, thoracic, 165 Visceral pleura, 205
Atlas of Human Anatomy
Visual fields, overlapping' 120 Visual pathway, 120 Vitreous body, 87 Vitreous chamber, 90 coronalCT imagesof, 151 Vocalis muscle, 78, 80 action of, 79 Vocaf ligamenl,77,78 abductionof, 79 adductionof, 79 lengtheningof, 79 shorteningof, 79 Voiding cystourethrograms, male and female, 368 Vomer,39 Vomerine groove, 39 Vorticose vein, 85, 90, 91 anteriortributariesof, 91 bulb of, 91 oosteriortributariesof. 91 suprachoroidaltributariesof, 91 V.shaped area (of Laimerf, 234,235 Vulva, 377
w White matter, spinal, 169 Willis, circle of. See Cerebralarterial circle (of Willis) Winslow, foramen of. See Omental foramen (of Winslow)
Atlas of Human Anatomy
Wolffian duct. See Mesonephric (wolffian)duct) Wrist anterior(palmar)view of, 472 anteriorview of, 460 arteries of, 461 articulardisc of, 455 bones of, 456 coronalsectionof, 455 cross section,transverse,461 cutaneousinnervationof, 472 deep dorsaldissectionof, 469 deeperpalmardissectionof, 460 extensormusclesof, 441 extensortendonsat, 470 flexor musclesof, 442 flexortendons,arteries,and nervesat, 461 ligamentsof, 454, 455 movementsof, 453 nerves at, 461 palmardissection,deeper,460 posterior(dorsal)view of, 455, 470, 472 radialdissection,superficial,467 457 radiographof, anteroposterior, sagittal section of, 453 superficialdorsaldissectionof, 468 superficialpalmardissectionof, 459 tendonsof, 461
x Xiphoid process' 185, 191, 196, 198, 247, 248, 249, 285, 286, 293, 297,298 cross sectionof, 297
z Zigzag (Zf line, 236 Zona orbicularis' 487 Zonular fibers, 87, 88, 89, 90 Zygapophyseal (facetl ioinl, 246 c2-3, 19,21,22 c a p s u l eo 1 , 2 1 , 2 2 c34,21 Zygomatic alch, 14,54, 151 Zygomatic bone' 81 Zygomatic nerve' 121 atlery, 23 Zygomaticolacial Zygomaticofacial nerve, 24, 122 Zygomaticofaclal vein' 23 arlery, 23 Zygomaticotemporal nerve' 24, 122 Zygomaticotemporal vein' 23 Zygomaticotemporal Zygomaticus maior muscle' 26, 54, 123 Zygomaticus minol muscler 26,54, 123