Atlas of Human Anatomy 4th ed by Frank H. Netter.pdf

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Atlas of

Human Anatomy

Consulting Editors

Jennifer K. Brueckner, PhD

Noelle A. Granger, PhD

Assistant Professor

Professor

Department of Anatomy and Neurobiology

Department of Cell and Developmental Biology

University of Kentucky College of Medicine

University of North Carolina School of Medicine

Lexington, Kentucky

Chapel Hill, North Carolina

Stephen W. Carmichael, PhD, DSc

John T. Hansen, PhD

Professor

Professor of Neurobiology and Anatomy

Departments of Anatomy and Orthopedic Surgery

Associate Dean for Admissions

Mayo Clinic

University of Rochester School of Medicine and Dentistry

Rochester, Minnesota

Rochester, New York

Thomas R. Gest, PhD

Anil H. Walji, MD, PhD

Associate Professor

Professor and Director, Division of Anatomy

Division of Anatomical Sciences and Department

Professor of Radiology and Diagnostic Imaging

of Medical Education

Professor of Surgery

University of Michigan Medical School

Faculty of Medicine and Dentistry

Ann Arbor, Michigan

University of Alberta Edmonton, Alberta, Canada

j.

*

F o u r t h

E d i t i o n

Frank H. Netter, MD

SAUNDERS

SAUNDERS ELSEVIER

1600 John F. Kennedy Boulevard -Suite 1800 Philadelphia, Pennsylvania 19103-2899

Atlas of Human Anatomy Fourth Edition

Edition with Student Consult Access: Professional Edition: International Edition: Enhanced International Edition with Student Consult Access:

ISBN-13: ISBN-10: ISBN-13: ISBN-10: ISBN-13: ISBN-10:

978-1-4160-3385-1 1 -4160-3385-8 978-1-4160-3699-9 1-4160-3699-7 978-0-8089-2384-8 0-8089-2384-6

ISBN-13: 978-0-8089-2379-4 ISBN-10: 0-8089-2379-X

Copyright © 2006, 2003, 1997, 1989 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier's Health Science Licensing Department in Philadelphia, Pennsylvania, USA: phone 1-800-523-1649, ext. 3276, or 215-239-3276; email: [email protected].

NOTICE Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Previous editions copyrighted 2003, 1997, 1989.

Library of Congress Cataloging-in-Publication Data Netter, Frank H. (Frank Henry), 1906-1991. Atlas of human anatomy / Frank H. Netter.—4th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1 -4160-3385-1 ISBN-10: 1 -4160-3385-8 1. Human anatomy—Atlases. I. Title. [DNLM: 1. Anatomy—Atlases. QS 17 N474a 2006] QM25.N46 2006 611.0022'12—dc22

Acquisitions

Developmental

2006047497

Editor: Anne Lenehan

Editor: Marybeth Thiel

Publishing Services Manager: Frank Polizzano Senior Project Manager: Cecelia B a y r u n s Design Direction: Louis Forgione Illustration Manager: Cecilia Nuyianes Cover Design Concept: M a d e l e n e H y d e Marketing Manager: Megan Poles

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Printed in the United States of America. Last digit is the print number:

9

8

7

6

5

4

3

ELSEVIER

Internîonal

S a b r e

Foundation

To my dear wife, Vera

T

by

the uncovertebral joints of the cervical vertebrae, the vertebral

Frank H. Netter, MD, has been updated by our

veins, and the intricate vasculature of the eye, to mention a few,

Consulting Editor team of Jennifer K. Brueckner,

with artistic brilliance, anatomical precision, and visual appeal

Stephen W. Carmichael, Thomas R. Gest, Noelle A. Granger,

that is unsurpassed. The section includes a concise treatment of

John T. Hansen, and Anil H. Walji. We have each reviewed, mod-

the central nervous system, including the cranial nerves and im-

ified, and updated a section of the Atlas. Throughout the book,

portant central pathways.

he Fourth Edition of Atlas

of Human

Anatomy

new radiographs, c o m p u t e d tomographic (CT) images, CT an-

In the Back section, a new plate illustrates the proper

giograms, and magnetic resonance (MR) images have been

placement of a lumbar epidural anesthetic agent, as well as the

added, which reflects the importance of diagnostic imaging in

location for lumbar puncture or "spinal tap." Autonomics are tra-

clinical anatomy and medicine. In this edition, 45 plates have

ditionally the bane of many students, and excellent new draw-

been revised to show corrected anatomical relationships, 290

ings of the autonomic nervous system by Dr. Machado will serve

plates have been relabeled, and there are 17 completely new

as a new educational resource for these difficult concepts.

plates. Wonderful new artwork for this edition has been created

The Thorax section underwent minor editorial corrections

by Carlos A. G. Machado, MD, w h o has contributed to the

of terminology and subtle artwork modifications to more accu-

Netter illustrations for over ten years. Anatomical nomenclature

rately reflect the most c o m m o n anatomical patterns. For in-

has been brought up to date, and clinical terms and eponyms in

stance, the representation of the azygos venous system pat-

c o m m o n usage have been included parenthetically. The genius

tern was altered to reflect the most c o m m o n arrangement of

of Dr. Netter's paintings is that the anatomy is portrayed clearly,

these highly variable veins. The inclusion of the thoracic cross-

realistically, and in a clinically relatable fashion while maintaining

sectional images at the end of the section, rather than in the

the balance between complexity and oversimplification. We

later section, reinforces the importance of knowledge of cross-

have tried to adhere to these principles in the creation of the

sectional anatomy in the interpretation of cross-sectional MR

new plates for this edition. Finally, some of the plates were re-

and CT images.

arranged as page-pairs, where appropriate, to facilitate side-by-

The A b d o m e n section has had the most extensive revision

side comparisons of commonly illustrated elements. This fourth

for label changes and positioning of leader lines. By popular re-

edition owes much to the consulting editors of the earlier edi-

quest, the plate showing the c o m m o n variations in the branches

tions, Drs. Sharon Colacino (Oberg) (first edition), Arthur F. Dalley

of the celiac artery, which appeared in the first edition A b d o m e n

II (second edition), and John T. Hansen (third edition), who shep-

section, has been reinstated.

herded their editions with great skill and uncompromising professionalism, making our task significantly easier.

The anatomy of the pelvis is a particularly difficult area to teach and, because of the depth and tight organization of the in-

The head and neck is a particularly challenging area for stu-

ternal structures, difficult to illustrate. The Netter illustrations of

dents, residents and faculty to master, due not only to the sheer

pelvic anatomy are outstanding because of the clarity of their

number of structures packed in this relatively small region of the

presentation and their scope of coverage. A very small number

human body, but also the complexity of their three-dimensional

of plates were eliminated to permit the inclusion of the illustra-

anatomical organization. The age-old aphorism that "there is

tion of pelvic fascia, a parasagittal view of the broad ligament,

more anatomy above the hyoid bone than below it" presents a

and

unique challenge to anyone trying to portray the anatomy of this

tourethrograms, and a hysterosalpingogram). Comparative im-

region in a simple, visually appealing, and clinically relevant

ages of male and female pelvic anatomy were reorganized to al-

manner. More than ten new plates have been added to this sec-

low their side-by-side comparison.

normal

imaging

(male and female

radiographs,

cys-

tion. For the first time, spectacular original paintings created by

New CT angiograms have been included in the Upper Limb

Carlos Machado illustrate clinically important structures such as

and Lower Limb sections. This new technology not only clearly

F@rew®rdl

demonstrates blood vessels, but vividly shows bony landmarks

help you better understand anatomy and its application to the

to which the blood vessels are related. The ligaments of the

practice of clinical medicine. More information about the web-

wrist have been illustrated in more detail to reflect their in-

site, including the PIN code for access, can be found on the in-

creased importance in arthroscopic procedures and other appli-

side front cover of the Atlas.

cations of new technology to this joint.

Jennifer K. Brueckner, PhD

We hope you enjoy this new edition of the Atlas of Human

Stephen W. Carmichael, PhD, DSc

Anatomy and that you find it useful for learning and for your ca-

Thomas R. Gest, PhD

reer. For the standard edition and enhanced international edition

Noelle A. Granger, PhD

of the Atlas,

we have included access to the website www.

John T. Hansen, PhD

netteranatomy.com. By registering on this website, you will be

Anil H. Walji, MD, PhD

able to access supplemental material that has been organized to

Acknowledgments

It has been my pleasure to work with the other members of the

I would like to thank Marybeth Thiel, Developmental Editor, our a

editorial board, Carlos Machado, MD, and the Elsevier staff.

superb medical illustrator Dr. Carlos Machado, and the entire

Special thanks go to John Hansen, PhD, for the opportunity to

Editorial, Production, Design, Illustration, and Marketing staff at

work on this editorial team. I am indebted to my family for the

Elsevier for shepherding this edition to completion. For all our

support and encouragement that they have provided.

students, past, present and future, this Atlas is for you. Finally, to my wife, Paula, thank you for your love and encouragement

—Jennifer

K. Brueckner,

PhD

throughout the years. —John

T. Hansen,

PhD

I would like to thank the specialists at the Mayo Clinic who helped review the art, especially Richard A. Berger, MD, PhD, Shawn W. O'Driscoll, MD, PhD, Enrique A. Sabater, MD, and

I would like to thank my wife, Parviz, and my daughters, Amreen

Robert J. Spinner, MD.

and Farah, for their patience and constant support and encouragement during my involvement with this project. My special —Stephen

W.: Carmichael,

PhD,

DSc

thanks go to Dr. Carlos Machado, w h o has my utmost admiration for his brilliant artwork and who was an absolute delight to work with. I would also like to express my sincere appreciation

I must thank my family and especially my daughter, Madison,

to all the wonderful staff at Elsevier, in particular Linda Belfus for

and son, Taylor, for their support and understanding of my ef-

her exemplary leadership, and Anne Lenehan, Marybeth Thiel,

forts on this editorial task. It was a pleasure to work with my col-

and Cecelia Bayruns for all of their hard work, patience, and

leagues on the editorial board and with the staff of Elsevier. It

dedication, without which this atlas would not have been possi-

has been my sincere pleasure to work with Dr. Carlos Machado

ble. Finally, I would like to thank my fellow coeditors and all of

on the artwork changes for the 4th edition.

my colleagues who helped with reviewing the plates, in particular Pierre Lemelin, PhD, and Daniel Livy, PhD, whose meticulous

—Thomas

ft

Gest,

PhD

examination of the artwork has helped greatly in ensuring the accuracy of the head and neck section in this edition.

I am deeply grateful to my colleagues at University of North Carolina School of Medicine: James Scatliff, MD, former Chair of the Department of Radiology, for his help with the imaging, and O.W. Henson, PhD, Professor Emeritus of Anatomy, for his input. I especially thank Carlos Machado, the exceptional artist whose talent made any change required in the original plates both seamless and beautiful.

—Noelle

A. Granger;

PhD

—Anil

H. Walji, MD,

PhD

Imaging Acknowledgements

Plate 151

Som, P., & Curtin, H. (2003). Head and Neck Imaging (4th ed). St. Louis, MO: Mosby.

Plates 355, 368, and 373

James Scatliff, MD Former Chair of the Department of Radiology University of North Carolina

Plates 484 and 547

Enrique A. Sabater, M.D. Department of Radiology Mayo Clinic

Preface to the First Edition

I

have often said that my career as a medical artist for al-

and even revision of a number of them in order to make them

most 50 years has been a sort of " c o m m a n d performance"

more pertinent to today's ever-expanding scope of medical and

in the sense that it has grown in response to the desires

surgical practice. In addition, I found that there were gaps in the

and requests of the medical profession. Over these many years,

portrayal of medical knowledge as pictorialized in the illustra-

I have produced almost 4,000 illustrations, mostly for The CIBA

tions I had previously done, and this necessitated my making a

(now Netter)

number of new pictures that are included in this volume.

Collection

of Medical

Illustrations

b u t also

for

Clinical Symposia. These pictures have been concerned with the varied subdivisions

of medical

knowledge

such as

In creating an atlas such as this, it is important to achieve a

gross

happy medium between complexity and simplification. If the

anatomy, histology, embryology, physiology, pathology, diag-

pictures are too complex, they may be difficult and confusing to

nostic modalities, surgical and therapeutic techniques and clin-

read; if oversimplified, they may not be adequately definitive or

ical manifestations of a multitude of diseases. As the years went

may even be misleading. I have therefore striven for a middle

by, however, there were more and more requests from physi-

course of realism without the clutter of confusing minutiae. I

cians and students for me to produce an atlas purely of gross

hope that the students and members of the medical and allied

anatomy. Thus, this atlas has c o m e about, not through any in-

professions will find the illustrations readily understandable, yet

spiration on my part but rather, like most of my previous works,

instructive and useful.

as a fulfillment of the desires of the medical profession. It involved going back over all the illustrations I had made

At one point, the publisher and I thought it might be nice to include a foreword

by a truly outstanding

and

renowned

over so many years, selecting those pertinent to gross anatomy,

anatomist, but there are so many in that category that we could

classifying them and organizing them by system and region,

not make a choice. We did think of men like Vesalius, Leonardo

adapting them to page size and space and arranging them in

da Vinci, William Hunter and Henry Gray, who of course are un-

logical sequence. Anatomy of course does not change, but our

fortunately unavailable, but I do wonder what their c o m m e n t s

understanding of anatomy and its clinical significance does

might have been about this atlas.

change, as do anatomical terminology and nomenclature. This therefore required much updating of many of the older pictures

Frank H. Netter, MD (1906-1991)

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mm-

mm

Frank H. Netter, MD

F

rank H. Netter was born in New York City in 1906. He

studied art at the Art Students

League and the

National Academy of Design before entering medical

Dr. Netter's works are among the finest examples of the use of illustration in the teaching of medical concepts. The 13-book

Netter

Collection

of Medical

Illustrations,

which includes the

school at New York University, where he received his Doctor of

greater part of the more than 20,000 paintings created by Dr.

Medicine degree in 1931. During his student years, Dr. Netter's

Netter, became and remains one of the most famous medical

notebook sketches attracted the attention of the medical faculty

works ever published. The Netter Atlas of Human Anatomy,

and other physicians, allowing him to augment his income by il-

published in 1989, presents the anatomic paintings from the

lustrating articles and textbooks. He continued illustrating as a

Netter Collection. Now translated into 16 languages, it is the

sideline after establishing a surgical practice in 1933, but he ulti-

anatomy atlas of choice among medical and health professions

mately opted to give up his practice in favor of a full-time c o m -

students the world over.

first

mitment to art. After service in the United States Army during

The Netter illustrations are appreciated not only for their

World War II, Dr. Netter began his long collaboration with the

aesthetic qualities, but, more importantly, for their intellectual

CIBA Pharmaceutical Company {now Novartis Pharmaceuticals).

content. As Dr. Netter wrote in 1949 "clarification of a subject is

This 45-year partnership resulted in the production of the extra-

the aim and goal of illustration. No matter how

ordinary collection of medical art so familiar to physicians and

painted, how delicately and subtly rendered a subject may be, it

other medical professionals worldwide.

is of little value as a medical

illustration

beautifully

if it does not serve to

Icon Learning Systems acquired the Netter Collection in

make clear some medical point." Dr. Netter's planning, concep-

July 2000 and continued to update Dr. Netter's original paintings

tion, point of view, and approach are what inform his paintings

and to add newly commissioned paintings by artists trained in

and what make them so intellectually valuable.

the style of Dr. Netter. In 2005, Elsevier Inc. purchased the Netter Collection and all publications from Icon Learning Systems. There are now over 50 publications featuring the art of Dr. Netter available through Elsevier Inc.

Frank H. Netter, MD, physician and artist, died in 1991.

Contents

Head and Neck 1

Topographic Anatomy

Plate

Bones and Ligaments

Plates

2-22

Superficial Face

Plates

23-26

Neck

Plates

27-35

Nasal Region

Plates

36-50

Oral Region

Plates

51-62

Pharynx

Plates

63-73

Thyroid Gland and Larynx

Plates

74-80

Orbit and Contents

Plates

81-91

Ear

Plates

92-98

Meninges and Brain

Plates

99-115

Cranial and Cervical Nerves

Plates

116-135

Cerebral Vasculature

Plates

136-148

Regional Scans

Plates

149-151

Back and Spinal Cord 152

Topographic Anatomy

Plate

Bones and Ligaments

Plates

153--159

Spinal Cord

Plates

160--173

Muscles and Nerves

Plates

174--180

Thorax 181

Topographic Anatomy

Plate

Mammary Gland

Plates

182--184

Body Wall

Plates

185--195

Lungs

Plates

196--210

Heart

Plates

211--229

Mediastinum

Plates

230--241

Regional Scans

Plate

Cross-Sectional Anatomy

Plates

242 243--246

Abdomen 247

Topographic Anatomy

Plate

Body Wall

Plates

248--267

Peritoneal Cavity

Plates

268--274

Viscera (Gut)

Plates

275--285

Viscera (Accessory Organs)

Plates

286--299

Visceral Vasculature

Plates

300--317

Innervation

Plates

318--328

Kidneys and Suprarenal Glands

Plates

329--347

Abdominal Sections

Plates

348--349

Regional Scans

Plate

350

Section 5

Pelvis and Perineum Topographic Anatomy

Plate

Bones and Ligaments

Plates

352-355

Pelvic Floor and Contents

Plates

356-364

Plates

365-368

Uterus, Vagina, and Supporting Structures

Plates

369-375

Regional Transverse Section

Plate

Perineum and External Genitalia: Female

Plates

377-379

Perineum and External Genitalia: Male

Plates

380-387

Homologues of Genitalia

Plates

388-389

Testis, Epididymis, and Ductus Deferens

Plate

Rectum

Plates

Regional Scans

Plate

Vasculature

Plates

398-408

Innervation

Plates

409-417

Urinary Bladder

Section 8

Section 7

Section 8

'

351

376

390 391-396 397

Upper Limb Topographic Anatomy

Plate

Shoulder and Axilla

Plates

419-430

Arm

Plates

431-435

Elbow and Forearm

Plates

436-451

Wrist and Hand

Plates

452-471

Neurovasculature

Plates

472-483

Regional Scans

Plate

484

Topographic Anatomy

Plate

485

Hip and Thigh

Plates

486-505

Knee

Plates

506-512

Leg

Plates

513-522

Ankle and Foot

Plates

523-537

Neurovasculature

Plates

538-546

Regional Scans

Plate

547

Plate

548

418

Lower Limb

Cross-Sectional Anatomy Key Figure for Cross Sections References Index

a

Head and Neck Topographic Anatomy Plate 1

1

Head and Neck

Bones and Ligaments Plates 2 - 2 2 rnm^^mm^^^mm^mm^mmmmmmmmmmmmmmmmmmmmsm 2

Skull: Anterior View

3

Skull: Anteroposterior Radiograph

4

Skull: Lateral View

5

Skull: Lateral Radiograph

6

Skull: Midsagittal Section

7

Calvaria

8

Cranial Base: Inferior View

9

Bones of Cranial Base: Superior View

10

Foramina of Cranial Base: Inferior View

11

Foramina of Cranial Base: Superior View

12

Skull of Newborn

13

Bony Framework of Head and Neck

14

Cranial Base: Pterygoid Fossae

15

Mandible

16

Temporomandibular Joint

17

Cervical Vertebrae: Atlas and Axis

18

Cervical Vertebrae (continued)

19

Cervical Vertebrae: Uncovertebral Joints

20

Degenerative Changes in the Cervical Vertebrae

21

External Craniocervicai Ligaments

22

Internal Craniocervicai Ligaments

Superficial Face

Oral Region

Plates 23-26

Plates 51-62

23

Superficial Arteries and Veins of Face and Scalp

51

Inspection of Oral Cavity

24

Cutaneous Nerves of Head and Neck

52

Roof of Mouth

25

Facial Nerve Branches and Parotid Gland

53

Floor of Mouth

26

Muscles of Facial Expresssion: Lateral View

54

Muscles Involved in Mastication

55

Muscles Involved in Mastication (continued)

56

Teeth

Plates 27-35

57

Teeth (continued)

27

Muscles of Neck: Lateral View

58

Tongue

28

Muscles of Neck: Anterior View

59

Tongue (continued)

29

Infrahyoid and Suprahyoid Muscles

60

Tongue and Salivary Glands: Sections

30

Scalene and Prevertebral Muscles

61

Salivary Glands

31

Superficial Veins and Cutaneous Nerves of Neck

62

Afferent Innervation of Mouth and Pharynx

32

Cervical Plexus in Situ

33

Subclavian Artery

Pharynx

34

Carotid Arteries

Plates 63-73

35

Fascial Layers of Neck

63

Pharynx: Median Section

64

Fauces

65

Muscles of Pharynx: Median (Sagittal) Section

66

Pharynx: Opened Posterior View

Heck

Nasal Region Plates 36-50 36

Nose

67

Muscles of Pharynx: Partially Opened Posterior View

37

Lateral Wall of Nasal Cavity

68

Muscles of Pharynx: Lateral View

38

Lateral Wall of Nasal Cavity (continued)

69

Arteries of Oral and Pharyngeal Regions

39

Medial Wall of Nasal Cavity (Nasal Septum)

70

Veins of Oral and Pharyngeal Regions

40

Maxillary Artery

71

Nerves of Oral and Pharyngeal Regions

41

Arteries of Nasal Cavity: Nasal Septum Turned Up

72

Lymph Vessels and Nodes of Head and Neck

42

Nerves of Nasal Cavity: Nasal Septum Turned Up

73

Lymph Vessels and Nodes of Pharynx and Tongue

43

Nerves of Nasal Cavity (continued)

44

Autonomic Innervation of Nasal Cavity

45

Ophthalmic (V,) and Maxillary (V2) Nerves

46

Mandibular Nerve (V3)

47

Nose and Paranasal Sinuses: Cross Section

48

Paranasal Sinuses

49

Paransal Sinsues (continued)

50

Paranasal Sinuses: Changes with Age


Meninges and Brain

Plates 74-80

Plates 9 9 - 1 1 5

74

Thyroid Gland: Anterior View

99

75

Thyroid Gland and Pharynx: Posterior View

100 Meningeal Arteries

76

Parathyroid Glands

101 Epidural Hematoma

77

Cartilages of Larynx

102 Meninges and Superficial Cerebral Veins

78

Intrinsic Muscles of Larynx

103 Dural Venous Sinuses

79

Actions of Intrinsic Muslces of Larynx

104 Dural Venous Sinuses (continued)

so

Nerves of Larynx

105 Cerebrum: Lateral Views

Orbit and Contents

Meninges and Diploic Veins

106 Cerebrum: Medial Views 107 Cerebrum: Inferior View

Plates 81-91

108 Ventricles of Brain

si

Eyelids

109 Circulation of Cerebrospinal Fluid

82

Lacrimal Apparatus

110 Basal Nuclei (Ganglia)

83

Fascia of Orbit and Eyeball

111 Thalamus

84

Extrinsic Eye Muscles

112 Hippocampus and Fornix

85

Arteries and Veins of Orbit and Eyelids

113 Cerebellum

86

Nerves of Orbit

114 Brainstem

87

Eyeball

115 Fourth Ventricle and Cerebellum

88

Anterior and Posterior Chambers of Eye

89

Lens and Supporting Structures


90

Intrinsic Arteries and Veins of Eye

Plates 116-135

91

Vascular Supply of Eye

116 Cranial Nerve Nuclei in Brainstem: Schema

Ear Plates 92-98

117 Cranial Nerve Nuclei in Brainstem: Schema (continued) 118 Cranial Nerves (Motor and Sensory Distribution): Schema 119 Olfactory Nerve (I): Schema

92

Pathway of Sound Reception

120 Optic Nerve (II) (Visual Pathway): Schema

93

External Ear and Tympanic Cavity

121 Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves:

94

Tympanic Cavity

95

Bony and Membranous Labyrinths

122 Trigeminal Nerve (V): Schema

96

Bony and Membranous Labyrinths (continued)

123 Facial Nerve (VII): Schema

97

Orientation of Labyrinth in Skull

124 Vestibulocochlear Nerve (VIII): Schema

98

Auditory (Pharyngotympanic, Eustachian) Tube

125 Glossopharyngeal Nerve (IX): Schema

Schema

126 Vagus Nerve (X): Schema 127 Accessory nerve (XI): Schema 128 Hypoglossal Nerve (XII): Schema 129 Cervical Plexus: Schema 130 Autonomic Nerves in Neck 131 Autonomic Nerves in Head

132 Ciliary Ganglion: Schema

142

133 Pterygopalatine and Submandibular Ganglia: Schema

143 Arteries of Posterior Cranial Fossa

134 Otic Ganglion: Schema

144 Veins of Posterior Cranial Fossa

135 Taste Pathways: Schema

145 Deep Veins of Brain

Cerebral Vasculature Plates 136-148

146

Arteries of Brain: Lateral and Medial Views

Subependymal Veins of Brain

147 Hypothalamus and Hypophysis 148 Arteries and Veins of Hypothalamus and Hypophysis

136 Arteries to Brain and Meninges 137 Veins of the Vertebral Column—Vertebral Veins

Regional Scans

138 Arteries to Brain: Schema

Plates 149-151

139 Arteries of Brain: Inferior Views

149 Head Scans: Sagittal MR Images

140 Cerebral Arterial Circle (of Willis)

150 Head Scans: Axial CT Images

141 Arteries of Brain: Frontal View and Section

151 Head Scans: Coronal CT Images

Frontal bone

Infraorbital margin Zygomatic bone

Supraorbital notch Superciliary arch

Helix Glabella

Tragus Antihelix

Nasal bone

Antitragus Ala of nose

Anterior nares (nostril)

Lobule Commissure of lips

Philtrum

Angle of jaw (mandible)

Nasolabial sulcus

Submandibular gland

Tubercle of superior lip

External jugular vein

Mental protuberance

Inferior belly of omohyoid muscle Brachial plexus

Thyroid cartilage

Trapezius muscle Clavicle

jugular notch

Clavicular head of sternocleidomastoid muscle Sternal head of sternocleidomastoid muscle

Skull: Anterior View •MflnHHHHHMMHBMHHHM

Frontal bone Glabella

Parietal bone

Supraorbital notch (foramen)

Sphenoid bone

Orbital surface

Lesser wing Greater wing

Nasal bone

Temporal bone Lacrimal bone Ethmoid bone Orbital plate

Zygomatic bone Frontal process

Perpendicular plate

Orbital surface

Middle nasal concha

Temporal process

Inferior nasal concha

Zygomaticofacial foramen

Vomer

Maxilla

Mandible

Zygomatic process

Ramus

Orbital surface

Body

Infraorbital foramen

Mental foramen

Frontal process

Mental tubercle

Alveolar process —

Mental protuberance

Anterior nasal spine

Right orbit: frontal and slightly lateral view Orbital surface of frontal Orbital surface of lesser wing of sphenoid bone Superior orbital fissu Optic canal (foramen)

Posterior and Anterior ethmoidal foramina Orbital plate of ethmoid bone Lacrimal bone

Orbital surface of greater wing of sphenoid bone

Fossa for lacrimal sac

Orbital surface of zygomatic bone

Orbital process of palatine bone

Inferior orbital fissure Infraorbital groove

Orbital surface of maxilla

Skull: Anteroposterior Radiograph HWBHMBHWBHIwWHBBBB^

See also P l a t e 2

m

A A n g l e of m a n d i b l e C Crista galli E Ethmoid air cells (sinuses) F Frontal sinus G Greater w i n g of sphenoid L

Lesser w i n g of s p h e n o i d

M Maxillary sinus R Ramus of mandible

Skull: Lateral View

Sphenoid bone

Parietal bone

Greater wing Frontal bone Supraorbital notch (foramen)

Temporal bone

Temporal fossa

Squamous part

Superior temporal line

Zygomatic process

Inferior temporal li Coronal suture

Articular tubercle

Pterion

Groove for posterior deep temporal artery

Glabella

External acoustic meatus

Ethmoid bone Orbital plate

Mastoid process

Lacrimal bone Lambdoid suture

Fossa for lacrimal sac

Occipital bone

Nasal bone

Sutural (wormian) bone

Maxilla

External occipital protuberance

Frontal process Infraorbital foramen Anterior nasal spine Alveolar process

Mandible Head of condylar process

Zygomatic bone Zygomaticofacial foramen Temporal process Zygomatic arch

Mandibular notch Coronoid process Ramus Oblique line Body Mental foramen Sphenoid bone Greater wing

Infratemporal fossa exposed by removal of zygomatic arch and mandible

Infratemporal crest

Pterygomaxillary fissure

Lateral plate of pterygoid process

Inferior orbital fissure

Pterygoid hamulus (of medial plate of pterygoid process)

Infratemporal surface of maxilla Temporal bone

Alveolar foramina


Tuberosity of maxilla

Mandibular fossa Articular tubercle Styloid process Sphenopalatine foramen

Superficially, mastoid process forms posterior boundary

Skull: Lateral Radiograph jffWfflffllMfflHMWBMffl


A

Anterior arch of atlas (CI vertebra)

G

Greater wing of sphenoid

C

Condyle of mandible

H

Hypophyseal fossa (sella turcica)

CP Coronoid process of mandible

L

Lambdoid suture

M

Maxillary sinus

CS Coronal suture D

Dens of axis (C2 vertebra)

F

Frontal sinus

MS Mastoid air ceils P

Palatine process of maxilla

S

Sphenoid sinus

Skull: Midsagittal Section

Sphenoid bone

Temporal bone

Parietal bone

Greater wing

Coronal suture

Lesser wing Anterior clinoid process

Squamous part

Grooves for branches of middle meningeal vessels

Petrous part Internal acoustic meatus Groove for superior petrosal sinus

Optic canal Sella turcica Sphenoidal sinus

External opening of vestibular aqueduct

Body Medial and lateral plates of pterygoid process

Groove for sigmoid sinus

Lambdoid suture

Frontal bone Frontal sinus

Occipital bone

Ethmoid bone Crista galli

Groove for transverse sinus

Cribriform plate Perpendicular plate (bony nasal septum)

External occipital protuberance Jugular foramen

Nasal bone

Groove for inferior petrosal sinus


Hypoglossal canal Maxilla

Foramen magnum

Anterior nasal spine Nasal surface Incisive canal Palatine process Alveolar process

Occipital condyle

Palatine bone Vomer (bony nasal septum)

Basilar part

Frontal bone

Opening of sphenoidal sinus

Nasal bone Ethmoid bone

Sphenopalatine foramen

Cribriform plate Superior nasal concha Middle nasal concha

Sphenoid bone

Lacrimal bone

Body Inferior nasal concha

Medial \ Lateral \

Maxilla Nasal surfa Palatine process Alveolar process

Plates of pterygoid process

Pterygoid hamulus Perpendicular plate J Horizontal plate

View of lateral nasal wall with nasal septum removed

j

Palatine bone

Superior view Frontal bone Coronal suture Bregma Parietal bone Sagittal suture Parietal foramen (for emissary vein) Lambda Lambdoid suture Sutural (wormian) bone Occipital bone

Inferior view

Frontal bone Frontal crest Groove for superior sagittal sinus Coronal suture Parietal bone Granular foveolae (for arachnoid granulations) Diploe Grooves for branches of middle meningeal vessels Groove for superior sagittal sinus Sagittal suture Lambdoid suture Occipital bone

Cranial Base: Inferior View

Maxilla incisive fossa Palatine process Intermaxillary suture Zygomatic process Zygomatic bone Frontal bone Sphenoid bone Pterygoid process Hamulus Medial plate Pterygoid fossa Lateral plate Scaphoid fossa Greater wing Foramen ovale Foramen spinosum Spine

Palatomaxillary suture

Palatine bone Fiorizontal plate Greater palatine foramen Pyramidal process Lesser palatine foramina Posterior nasal spine

Choanae Temporal bone Zygomatic process Articular tubercle Mandibular fossa Styloid process Petrotympanic fissure Carotid canal (external opening) Tympanic canaliculus External acoustic meatus Mastoid canaliculus Mastoid process Stylomastoid foramen Petrous part Mastoid notch (for digastric muscle) Occipital groove (for occipital artery) Jugular fossa (jugular foramen in its depth) Mastoid foramen Parietal bone Occipital bone Hypoglossal canal Occipital condyle Condylar canal and fossa Basilar part Pharyngeal tubercle Foramen magnum Inferior nuchal line External occipital crest Superior nuchal line External occipital protuberance

Vomer

Groove for auditory (pharyngotympanic, Eustachian) tube Foramen lacerum

Bones of Cranial Base: Superior View — •;•->• . •

• • . •. • •

m

Frontal bone Groove for superior sagittal sinus Frontal crest Groove for anterior meningeal vessels Foramen cecum Superior surface of orbital part

Ethmoid bone Crista gaili Cribriform plate

Sphenoid bone Lesser wing Anterior clinoid process Greater wing Groove for middle meningeal vessels (frontal branches) Body J u gum Prechiasmatic groove ( Tuberculum sellaeSella ) Hypophyseal fossa turcica j Dorsum sellae V Posterior clinoid process Carotid groove (for int. carotid a.) Clivus

Anterior cranial fossa

Middle cranial fossa

Temporal bone Squamous part Petrous part Groove for lesser petrosal n e r v e Groove for greater petrosal nerve Arcuate eminence Trigeminal impression Groove for superior petrosal sinus Groove for sigmoid sinus

Parietal bone Groove for middle meningeal vessels (parietal branches) — Mastoid angle

Occipital bone Clivus Groove for inferior petrosal sinus Basilar part Groove for posterior meningeal vessels Condyle Groove for transverse sinus Groove for occipital sinus Internal occipital crest Internal occipital protuberance — Groove for superior sagittal sinus

Posterior crania] fossa

Foramina of Cranial Base: Inferior View

Nasopalatine nerve) Sphenopalatine vessels! Greater palatine nerve and vessels Lesser palatine nerve and vessels Greater petrosal nerve Lesser petrosal nerve) Mandibular nerve (V3) > Accessory meningeal artery) Middle meningeal vessels) Meningeal branch of mandibular nerve (V$) j

Internal carotid artery) Carotid autonomic plexus) Chorda tympani of facial nerve (VII) Tympanic branch of glossopharyngeal nerve (IX) Auricular branch of vagus nerve (X) Facial nerve (VII)

Glossopharyngeal nerve (IX) \ Vagus nerve (X) / Spinal roots of accessory nerves (XI) \ Internal jugular vein ( Inferior petrosal sinus) Mastoid emissary vein) Posterior meningeal artery)

.. , Incisive tossa Greater palatine foramen Lesser palatine foramen Foramen lacerum Foramen ovale

Foramen spinosum

Carotid canal Petrotympanic fissure Tympanic canaliculus Mastoid canaliculus Stylomastoid foramen

Jugular fossa

- M a s t o i d foramen

Hypoglossal nerve (XII)-

- Hypoglossal canal

Medulla oblongata ) Vertebral arteries and venous plexus ? Spinal roots of accessory nerves (XI))

Foramen magnum

Foramen cecum Nasal slit Anterior ethmoidal foramen

Emissary vein to superior sagittal sinus I \ Anterior ethmoidal artery, vein, ) I and nerve

Foramina of cribriform plate

Olfactory nerve bundles

Posterior ethmoidal foramen

Posterior ethmoidal artery vein, and nerve Optic nerve (II) Ophthalmic artery

. , .. , Superior orbital fissure c

Oculomotor nerve Trochlear nerve (IV) ) Lacrimal, frontal, and nasociliary < b r a n c h e s 0 f ophthalmic nerve (Vi) Abducent nerve (VI) Superior ophthalmic vein

Foramen rotundum

Maxillary nerve (V2)

Foramen ovale

( Mandibular nerve (Vj) 1 Accessory meningeal artery ( Lesser petrosal nerve (occasionally)

r

( Middle meningeal artery and vein j M e n j n g e a , b r a 8 n c h o f mandibular nerve

Foramen sp.nosum

Sphenoid emissary foramen (of Vesalius) (inconstant) Foramen lacerum Carotid canal for

Internal carotid artery Internal carotid nerve plexus

Hiatus for

Lesser petrosal nerve

Hiatus for

Greater petrosal nerve

External opening of vestibular aqueduct

Facial nerve (VII) Vestibulocochlear nerve (VIII) Labyrinthine artery

!

Endolymphatic duct

Mastoid foramen (inconstant)

. , £ jugular foramen

Emissary vein (and occasional branch of occipital artery) Inferior petrosal sinus Glossopharyngeal nerve (IX) ) Vagus nerve (X) \ Accessory nerve (XI) Sigmoid sinus Posterior meningeal artery

Condylar canal (inconstant) — - j Hypoglossal canal

F.

.

c

^

(

E m i f a r > ' ve,in ancJ

meningeal branch ot ascending pharyngeal artery

Hypoglossal nerve (XII) Medulla oblongata Meninges , Vertebral arteries ) Meningeal branches of vertebral arteries Spinal roots of accessory nerves

Lateral view Sphenoidal fontanelle

Parietal bone

Anterior fontanelle

fuber (eminence)

Coronal suture

Squamous suture

Frontal bone Squamous part

/

Supraorbital notch (foramen)

. •'J&.V

Posterior fontanelle Lambdoid suture

Ethmoid bone Anterior ethmoidal foramen

Occipital bone

Orbital plate

Mastoid fontanelle

Lacrimal bone Nasal bone Temporal bone

Maxilla

Squamous part

Infraorbital foramen Zygomatic bone Zygomaticofacial foramen

Sphenoid bone Greater wing

Palatine bone

Petrosquamous fissure

\ \

Lateral plate of ^ pterygoid process

Pyramidal process

Hamulus of medial plate of pterygoid process

Superior view

Petrous part (mastoid process absent) Tympanic part (bony external acoustic meatus absent) Oval (vestibular) window Round (cochlear) w i n d o w Styloid process Mandibular fossa Zygomatic process

Frontal bone Anterior fontanelle

Coronal suture

Sagittal suture

Posterior fontanelle

Occipital bone

Lambdoid suture

Bony Framework of Head and Neck IJM1MJ

Temporal bone Sphenoid bone Temporal fossa Zygomatic arch Condylar process of mandible Mandibular notch Coronoid process of mandible Lateral pterygoid plate ( . b r o k e n line) Hamulus of medial pterygoid plate ( b r o k e n line) Pterygomandibular raphe {broken

Mastoid process External acoustic meatus Atlas (C1) Styloid process

line)

Ramus Mandible ^ Angle Body

Axis (C2)

Stylohyoid ligament

Stylomandibular ligament

Body Hyoid bone { Lesser horn Greater horn

C3 vertebra Epiglottis Thyroid cartilage Cricoid cartilage Trachea

C7 vertebra

-T'l vertebra 1st rib

2nd cervical to 1st thoracic vertebrae: right lateral view

Dens Superior articular facet Foramen transversarium Spinous processes

Articular pillar formed by articular processes and interarticular parts (pars interarticularis)

Spinous process of C (vertebra prominens)

Intervertebral foramina for spinal nerves

Groove for spinal nerve in transverse process Zygapophyseal (facet) joints

Costal facets (for I st rib)

Cervical vertebrae (spine): lateral radiograph S Spinous process (axis) T Transverse process VP Spinous process of C / (vertebra prominens) Z Zygapophyseal (facet) joint 1—7 Bodies of cervical vertebrae --- Cervical curvature i i Vertebral canal

Posterior view


Superior nuchal line

External occipital crest

Nasal septum

Inferior nuchal line

Choana (posterior nasal aperture)

Foramen magnum Inferior orbital fissure

Mastoid foramen Occipitomastoid suture Occipital condyle

Mastoid process Lateral pterygoid plate Medial pterygoid plate

Styloid process Pterygoid fossa

Scaphoid fossa Pyramidal process of palatine bone

Zygomatic arch Horizontal plate of palatine bone Inferior concha

—Pterygoid hamulus

Tuberosity of maxilla

Alveolar process of maxilla

Palatine process of maxilla Incisive fossa

*

Inferolateral view

Af-7>.

Spine of sphenoid bone Foramen spinosum Foramen ovale

c

Sphenopalatine foramen Pterygopalatine fossa Choanae (posterior nares) Lateral plate Medial plate Hamulus Alveolar process of maxilla

of pterygoid process

Pyramidal process of palatine bone

Mandible SWi

Head

Attachments for major muscles of mastication

Lateral pterygoid

Condylar process Coronoid process

Attachments for accessory muscles of mastication

-Neck Mandibular notch

Temporalis

Lingula

Mylohyoid groove Oblique line Buccinator Submandibular fossa

Mandibular / T e m p o r a l i s foramen

Mylohyoid line Sublingual fossa Interalveolar septa

Masseter •

Alveolar part (crest) Mental foramen

'••

.

v

Ramus

::

Mental protuberance-— nfv^jjp.Y.V V - V., ,

Mental tubercle

(sssi

Base of mandible

^

— —

v Body

M a n d i b l e of adult: anterolateral superior view

Lateral pterygoid Coronoid process Head Neck

Condylar process / - Lingula

Mandibular notch

Mandibular foramen

Pterygoid f o v e a s Temporalis Mylohyoid line

/

/

Ramus

ligament

\

V

\

NAngle

Medial pterygoid Pterygomandibular raphe Mylohyloid Submandibular fossa 'Sublingual fossa Digastric fossa Digastric, anterior belly Mental spines (genial tubercles)

Mandible of adult: left posterior view

Mandible of aged person (edentulous)

Temporomandibular Joint HHHaRBmMH

Lateral view joint capsule Lateral (temporomandibular) ligament Sphenomanclibular ligament Sphenomandibular ligament (phantom) Styloid process Stylomandibular ligament Mandibular nerve and otic ganglion

W/;/

Joint capsule

||# W

— _ _ ^ I l l l

"'

Middle meningeal artery Auriculotemporal

%

n e r v e j | l

Maxillary artery-""-"""""""^

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Inferior alveolar n e r v e j & C tfff m

,

Lingual n e r v e ^

%s

N&C \ /vjk <

Sphenomandibular l i g a m e n t ' ^Mlifr

Stylomandibular ligament-""-""""""^ >

W r I

Mandibular fossa Articular disc ^

joint capsule

^ ^ A r t i c u l a r tubercle Mylohyoid branch o f / inferior alveolar artery and mylohyoid nerve

Jaws closed

Jaws slightly opened

Jaws widely opened

(hinge action predominates)

(hinge and gliding action combined)

Medial view

Cervical Vertebrae: Atlas and Axis See also P l a t e s 1 3 , 1 5 3 A n t e r i o r tubercle Articular facet for dens

Anterior arch

Dens

Lateral mass

Transverse process Tubercle for transverse ligament of atlas

Transverse foramen Superior articular surface of lateral mass for occipital c o n d y l e

Superior articular facet for atlas

terior articular facet (for anterior arch of atlas) Pedicle Interarticular part

Vertebral foramen Posterior arch Posterior tubercle

ran s verse process

Inferior articular facet for C3

G r o o v e for vertebral artery

Atlas (C1): superior view

Posterior tubercle

Posterior arch

Dens Superior articular facet for atlas

Vertebral foramen

Transverse process

Posterior articular facet (for transverse ligament of atlas) Transverse process

Interarticular part

Transverse foramen Inferior articular surface of lateral mass for axis

Articular facet for dens A n t e r i o r tubercle

Inferic articular process

Spinous process

Atlas ( C I ) : inferior view

Dens Superior articular surface for occipital condyle Posterior articular facet (for transverse ligament of atlas)

Axis (C2)

C3

Upper cervical vertebrae, assembled: posterosuperior view

Radiograph of atlantoaxial joint (open mouth odontoid view) A

Lateral masses of atlas (C1 vertebra)

D


Cervical Vertebrae (continued) See also P l a t e s 1 3 , 1 5 3

Inferior aspect of C3 and superior aspect of C4 showing the sites ot the facet and uncovertebral articulations Bifid spinous process

C3 Inferior aspect

Lamina Vertebral foramen

Inferior articular process and facet

Pedicle

Foramen transversarium

Posterior tubercle

Costal lamella

Transverse process

Anterior tubercle

Area for articulation of left uncinate process of C4 Vertebral body

Left uncinate process

Articular surface of right uncinate process

Superior articular process and facet

Groove for spinal nerve (C4)

C4 Superior aspect

Inferior articular process 7th cervical vertebra: anterior view Superior articular process

4th cervical vertebra: anterior view Superior articular process

Reduplicated foramen transversarium Uncinate process

Spinous process Uncinate process

Costa|

|ame]|a

lar surface

Inferior articular facet

Articular surface

Bony spicule dividing foramen transversarium

Posterior tubercle . T Anterior (Transverse process tubercle ) Inferior articular facet for T1

Foramen transversarium

Posterior tubercle / (Transverse Anterior tubercle (process (inconspicuous) )

7th cervical vertebra (vertebra prominens): superior view Body^ Uncinate process Costal lamella

/ " V

/

Foramen transversarium*

Articular surface of uncinate process Foramen transversarium (reduplicated) Groove for C7 spinal nerve

Inconspicuous anterior tubercle (transverse process)

Transverse process (posterior tubercle) Superior articular process and facet

Pedicle

Inferior articular process Lamina

Vertebral foramen Spinous process

*The foramina transversaria veins, but not the vertebral

of C7 transmit vertebral artery; and are asymmetrical

CMc^/ta^ in this

specimen

*

A/.7>,

Cervical Vertebrae: Uncovertebral Joints

Cervical vertebrae: anterior view Dens of axis

Anterior tubercle of atlas

A n t e r i o r arch of atlas Foramen transversarium

Atlas ( C I )

Intervertebral f o r a m e n (for C3 spinal nerve) Intervertebral disc Vertebral b o d y

Axis (C2)

Inferior articular process (C3) Superior articular process (C4) G r o o v e for spinal nerve Site of uncovertebral j o i n t (cleft) of Luschka A n t e r i o r tubercle ) ^ . ti, i h i p i r l ,p (> Transverse 'process Pnct^rmr Posterior tubercle j Articular cartilage o n dens for m e d i a n atlantoaxial j o i n t c o m p l e x Carotid tubercle n

U n c i n a t e processes

Atlas (C1)

Vertebra p r o m i n e n s Axis (C2)

First thoracic vertebra ( T I )

Foramen transversarium Uncinate processes Anulus fibrosus U n c o v e r t e b r a l joints (clefts) of Luschka Nucleus pulposus Transverse process Intervertebral f o r a m e n (for C7 spinal nerve) Vertebral b o d y (C7) The u n c o v e r t e b r a l j o i n t s of t h e c e r v i c a l spine: a n t e r i o r v i e w (C3 t o C7 have been s e c t i o n e d c o r o n a l l y t o expose t h e j o i n t s )

/

A/.7). /y-A

Lateral atlantoaxial j o i n t Facet (zygapophyseal) j o i n t b e t w e e n C2 and C3

Degenerative Changes in the Cervical Vertebrae

Degenerative changes in the cervical spine (ankylosing spondylitis)

C3 vertebral b o d y (sectioned in coronal plane)

C o m p l e t e transverse cleft in intervertebral disc

Spread of cleft f o r m a t i o n into central p o r t i o n of intervertebral disc w i t h age leading t o progressive degenerative changes in the disc

f'fsmm

Uncovertebral j o i n t w i t h cleft f o r m a t i o n

•BHHfi

XShbiSSSSJS-

D e f o r m e d vertebral bodies and lipping of vertebral' margins

Spondylophytes (osteophytes) o n uncinate processes

N a r r o w i n g of intervertebral foramen

C7 vertebra

Superior articular process

Advanced ankylosing spondylitis w i t h uncovertebral arthrosis in C4 and C5

A d v a n c e d s p o n d y l o p h y t e (osteophyte) f o r m a t i o n on uncinate processes

Vertebral b o d y U n c o v e r t e b r a l j o i n t fused d u e to extensive s p o n d y l o p h y t e f o r m a t i o n and ossification Potential for compression of vertebral artery w i t h i n f o r a m e n transversarium

Facet j o i n t ossified due to advanced osteoarthritic change Markedly narrowed intervertebral f o r a m e n may lead to c o m p r e s s i o n of spinal nerve

Inferior articular process w i t h facet G r o o v e for spinal nerve o n transverse process Spinous process

External Craniocervicai Ligaments xeMitfiffiTViWitwMrîC- ;£4fC4)aMi tz&mGmemu

mmmmmmmm

Anterior view Basilar part of occipital bone Pharyngeal tubercle Anterior atlantooccipital membrane Capsule of atlantooccipital joint Posterior atlantooccipital membrane

Atlas (C1)

Lateral atlantoaxial joint (opened up) Anterior longitudinal ligament

Capsule of lateral atlantoaxial joint

Posterior view

Axis (C2)

Posterior atlantooccipital membrane

Capsule of zygapophyseal joint (C3-4) Capsule of atlantooccipital nsverse process of atlas ( C I )

Anterior atlantooccipital membrane

Capsule of lateral atlantoaxial joint

Capsule of atlantooccipital joint

Axis (C2)

Posterior atlantooccipital membrane

Atlas ( C D

Ligamenta flava Vertebral artery

Suboccipital nerve (dorsal ramus of C I spinal nerve)

Ligamenta flava Body of axis (C2) Ligamentum nuchae

Intervertebral discs (C2-3 and C3-4)

Zygapophyseal joints (C4-5 and C 5 - 6 ) Anterior tubercle of C6 vertebra (carotid tubercle) Spinous process of C7 vertebra (vertebra prominens)

Vertebral artery T1 vertebra

Right lateral view

: .

Internal Craniooervical Ligaments BHMBMMMMMMBBBBBWWMBW^

Clivus (surface feature) of basilar part of occipital b o n e

M&MM

Upper part of vertebral canal w i t h spinous processes and parts of vertebral arches removed to expose ligaments on posterior vertebral bodies: posterior view

Tectorial m e m b r a n e Capsule of

atlantooccipitaLj^v^

Deeper (accessory) part of tectorial m e m b r a n e

Atlas (C'l)

Posterior longitudinal ligament

joint

.

Capsule of lateral atlantoaxial j o i n t Axis (C2)

. Alar ligaments

gg

Capsule of zygapophyseal joint ^ ^ ^ ^ ^ (C2-3)

(J|

Atlas (C1) Superior longitudinal b a n d Cruciate ligament

Transverse ligament of atlas Inferior longitudinal band-—

Axis (C2)

Deeper (accessory) part of tectorial m e m b r a n e

Principal part of tectorial membrane removed to expose deeper ligaments: posterior view

— Apical ligament of dens — Alar ligament Atlas ( C D

Posterior articular facet of dens (for transverse ligament of atlas) Alar l

i

g

a

m

e

n

t

^

^

—

,

A n t e r i o r tubercle of atlas ,

^ S y n o v i a l cavities

Axis (C2)

Cruciate ligament removed to show deepest ligaments: posterior view

Transverse ligament of atlas

Median atlantoaxial joint: superior view

Superficial Arteries and Veins of Face and Scalp See also

Scalp

Skin and subcutaneous tissue . Epicranial aponeurosis (galea aponeurotica) (cut to reveal

Plates 34, 40, 69, 70, 85, 104

Parietal emissary vein Frontal

skull)

Parietal

Middle temporal artery and vein

Branches of superficial temporal arterv and vein

Zygomaticoorbital artery Transverse facial artery and vein

Anterior auricular arteries

Supraorbital artery and vein Supratrochlear artery and vein Nasofrontal vein Dorsal nasal artery and vein Zygomaticotemporal artery and vein

Angular artery and vein Zygomaticofacial artery and vein

Mastoid emissary vein and meningeal branch of occipital artery (posterior meningeal artery)

Infraorbital artery and vein

Occipital artery and vein (cut)

Deep facial vein (from pterygoid plexus)

Posterior auricular artery and vein

Facial artery and vein

External jugular vein (cut.) Retromandibular vein Common facial vein Internal jugular vein Internal carotid artery External carotid artery Common carotid artery Lingual artery and vein

Sources of arterial supply of face Black: from internal carotid artery (via ophthalmic artery) Red: from external carotid artery

Cutaneous Nerves of Head and Neck See also

Plates 32, 36, 45, 46, 122

From ophthalmic division of trigeminal nerve (V-,)

Auricular branch of vagus nerve(X)

Supraorbital nerve Supratrochlear nerve Palpebral branch of lacrimal nerve Infratrochlear nerve External nasal branch of anterior ethmoidal nerve

Medial branches of dorsal rami of cervical spinal nerves Greater occipital nerve (C2) 3rd occipital nerve (C3)

From maxillary division of trigeminal nerve (V 2 ) Infraorbital nerve

From 4th, 5th, 6th, and 7th nerves in succession below

Zygomaticofacial nerve Zygomaticotemporal nerve —

From mandibular division of trigeminal nerve (V 3 ) Mental nerve

Lesser occipital nerve (C2) Great auricular nerve (C2, 3) Transverse cervical nerve (C2, 3)

Buccal nerve Auriculotemporal nerve

Trigeminal nerve (V)

Branches f r o m cervical plexus

Supraclavicular nerves (C3, 4)

O p h t h a l m i c nerve (V,>

Dorsal rami of cervical spinal nerves

Maxillary nerve (V 2 )

Note: Auricular branch of vagus nerve to external acoustic meatus and small area on posteromedial surface of auricle

Mandibular nerve (V 3 )

Branches f r o m cervical plexus

Facial Nerve Branches and Parotid Gland mssm

See also

Plate 123

Temporal branches Parotid gland Zygomatic branches Posterior auricular nerve

Parotid duct

Main trunk of facial nerve emerging from stylomastoid

Buccal branches

Marginal mandibular branch

Nerve to posterior belly of digastric muscle and to stylohyoid muscle

Cervical branch

Medial pterygoid muscle

Horizontal section Main trunk of facial

Ramus of mandible Masseter muscle

Mastoid process Parotid gland

Temporofacial division

Temporal branch

Posterior auricular nerve Zygomatic branches Main trunk of facial nerve Nerve to posterior belly of digastric muscle and to stylohyoid muscle

Buccal branches

Cervicofacial division Marginal mandibular branch

Cervical branch

w rn^mm

Muscles of Facial Expression: Lateral View

Scalp

Skin and subcutaneous tissue Epicranial aponeurosis (galea aponeurotica)

Auricularis anterior muscle Auricularis superior muscle

Orbicularis oculi muscle

Orbital part Palpebral part

Auricularis posterior muscle Occipital belly (occipitalis) of epicranius muscle

Corrugator supercilii muscle (frontalis and orbicularis oculi, partially cut away) Procerus muscle

\

/ /

i

Levator labii superioris alaeque nasi muscle (partially

cut

away)

Nasalis ) Transverse part muscle ) Alar part

Parotid fascia

Depressor septi nasi muscle

Masseteric fascia -

'

Orbicularis oris muscle. Zygomaticus minor muscle

mm

mm

Investing layer of (deep) cervical fascia

Zygomaticus major muscle Orbicularis oris muscle Mentalis muscle Deltoid fascia

Depressor labii inferioris muscle Depressor anguli oris muscle Buccinator muscle Risorius muscle Platysma muscle Sternum Clavicle Pectoralis major fascia

m

Muscles of Neck: Lateral View :/..:,/:.'

Parotid gland [cut) Ramus of mandible

:

.

Masseter muscle Submandibular gland Hyoglossus muscle

Styloglossus muscle

Mylohyoid muscle Mastoid process Styloid process Stylohyoid muscle Body of mandible

Digastric muscle (posterior belly) Middle pharyngeal constrictor muscle

Digastric muscle (anterior belly)

Longus capitis muscle Splenius muscle Sternocleidomastoid muscle

Hyoid bone

Levator scapulae muscle

Thyrohyoid muscle

I Posterior Scalene muscles \ Middle Anterior

O m o h y o i d muscle (superior belly) Sternohyoid muscle

Brachial plexus

Inferior pharyngeal constrictor muscle

Trapezius muscle Acromion

Sternothyroid muscle

Deltoid muscle

mm

mm

Manubrium of sternum

O m o h y o i d muscle (inferior belly) Clavicle

Sternal head Clavicular head

Sternocleidomastoid muscle

Muscles of Neck: Anterior View


Masseter muscle

Mylohyoid muscle Parotid gland

Submandibular gland Fibrous loop for intermediate digastric tendon

Platysma muscle

{cut

away)

Mastoid process

Stylohyoid muscle Digastric muscle (posterior belly)

Hyoid bone

External carotid artery

Carotid sheath

Internal jugular vein Fascia of infrahyoid muscles and cut edge

Thyrohyoid muscle O m o h y o i d muscle (superior belly)

Thyroid cartilage

Sternohyoid muscle Investing layer of (deep) cervical fascia and cut edge

Sternothyroid muscle Scalene muscles

Cricoid cartilage

Trapezius muscle Deltoid muscle

Clavicle O m o h y o i d muscle (inferior belly) Pretracheal layer of (deep) cervical fascia over thyroid gland and trachea

Pectoralis major muscle Clavicular head ( Sternocleidomastoid Sternal head ( muscle

Suprasternal space (of Burns) Manubrium of sternum

jugular notch

Infrahyoid and Suprahyoid Muscles See also


Hyoid bone

Mylohyoid muscle

Thyrohyoid membrane

Hyoglossus muscle


Stylohyoid muscle

Internal jugular vein

Digastric muscle (posterior belly)

Thyrohyoid muscle

Fibrous loop for intermediate digastric tendon

Thyroid cartilage Omohyoid muscle (superior belly)

Sternohyoid and omohyoid muscles (cut)

Sternohyoid muscle

Thyrohyoid muscle

Median cricothyroid ligament

Oblique line of thyroid cartilage

Cricoid cartilage

Cricothyroid muscle

Scalene muscles

Sternothyroid muscle Omohyoid muscle (superior belly) (cut)

Trapezius muscle

Thyroid gland

Omohyoid muscle (inferior belly)

Sternohyoid muscle (cut) Trachea

Clavicle

Styloid process Mastoid process Stylohyoid muscle

Mylohyoid muscle


Digastric muscle (anterior belly) Geniohyoid muscle

Thyrohyoid muscle Oblique line of thyroid cartilage

Sternohyoid muscle Omohyoid muscle (superior belly)

B

,

,

Plate 53

. .

.

Infrahyoid and suprahyoid muscles and their action: schema

Omohyoid muscle (inferior belly)

Sternothyroid muscle Sternum

Scapula

Scalene and Prevertebral Muscles

Basilar part of occipital bone

Longus capitis muscle (cut)

Occipital condyle Jugular process of occipital bone

<<.'0

Rectus capitis anterior muscle

' -

*
Rectus capitis lateralis muscle

Mastoid process

Styloid process

Transverse process of atlas ( C I )

Longus capitis muscle

Posterior tubercle of transverse process of axis (C2)

Antei ior

i

Tubercles of transverse

Posterior

j

P r o c e s s of C3 vertebra

Slips of origin of anterior scalene muscle {cut)

Longus colli muscle

Slips of origin of posterior scalene muscle Anterior • Scalene muscles

Middle

Middle

Posterior

Posterior

Scalene muscles

Anterior scalene muscle (cut)

Phrenic nerve Brachial plexus ijvJS

1st rib

Subclavian artery Subclavian vein Internal jugular vein

Right common carotid artery

Posterior tubercle of transverse process of C7 vertebra

^ n n n n i "••vjV

Superficial Veins and Cutaneous Nerves of Neck V

^ i x - . v

For deep veins of neck see

Plate 70

Platysma muscle (cut)



Marginal mandibular branch of facial nerve

Submandibular gland Mylohyoid muscle

Hyoid bone

Parotid gland

Retromandibular vein

Omohyoid muscle (cut)


External carotid artery Thyrohyoid muscle


Sternocleidomastoid muscle (cut)

Anterior jugular vein

Superior thyroid artery and vein Internal jugular vein

Communicating vein

Common carotid artery

Great auricular nerve

Sternohyoid muscle

Thyroid cartilage

Sternothvroid muscle /

Transverse cervical nerves

Ansa cervicalis Omohyoid muscle (superior belly) (cut)

Thyroid gland

Omohvoid muscle I (inferior belly)

Trapezius muscle

Brachial plexus

Platysma muscle (cut)

Pectoralis major muscle

Supraclavicular nerves Sternocleidomastoid muscle

Clavicle Sternocleidomastoid muscle (cut) Sternothyroid muscle

mmm

Vi l l i

lllftl

I^M

Cervical Plexus in Situ See also

Plates 127-129, 193

Great auricular nerve

Parotid gland Facial artery and vein

Lesser occipital nerve

Submandibular gland

Sternocleidomastoid muscle [cut, turned up)

Mylohyoid muscle Hypoglossal nerve (XII)

Stylohyoid muscle



Lingual artery

C2 spinal nerve (ventral ramus)


Accessory nerve (XI)

Internal carotid arte


Thyrohyoid muscle

Levator scapulae muscle

Superior thyroid artery

— Middle scalene muscle

Omohyoid muscle (superior belly) ( Ansa cervicalis \

SuPerior

— Anterior scalene muscle

root


( Interior root Sternohyoid muscle

Superficial cervical artery

Sternothyroid muscle

Phrenic nerve


Omohyoid muscle (inferior belly) (cut)

Common carotid artery Inferior thyroid arte Vagus nerve (X) Vertebral artery

Dorsal scapular artery Suprascapular artery

Thyrocervical trunk Subclavian artery and vei..

Cervical plexus: schema

Brachial plexus

Hypoglossal nerve (XII)

(S = gray ramus from superior cervical sympathetic ganglion)

Accessory nerve (XI) Great auricular nerve Lesser occipital nerve To rectus capitis lateralis, longus capitis, and rectus capitis anterior muscles

To geniohyoid muscle To thyrohyoid muscle Communication to vagus nerve Transverse cervical nerves To omohyoid muscle (superior belly) Ansa cervicalis

Superior root Inferior root

longus capitis and longus colli muscles

To sternothyroid muscle To sternohyoid muscle To omohyoid muscle (inferior belly) Supraclavicular nerves

To scalene and levator scapulae muscles

1BBKUKXBBBKBX&BBUKW

See also

Right anterior dissection

Plate 427

Thyroid gland ( r e f l e c t e d )

Internal jugular vei *


Middle cervical sympathetic ganglion

Ascending cervical artery Vagus nerve (X)

Phrenic nerve Anterior scalene muscle

Vertebral artery

Inferior thyroid artery



Recurrent laryngeal nerve

Suprascapular artery Dorsal scapular artery

Brachiocephalic trunk

Costocervical trunk

Internal jugular vein (cut)

Thyrocervical trunk Subclavian artery and vein

C o m m o n origin of superficial cervical and dorsal scapular arteries f r o m transverse cervical artery ( - 3 0 % ) Superficial branch of transverse cervical artery (superficial cervical artery) Inferior thyroid artery

Deep branch of transverse cervical artery (dorsal scapular artery) Transverse cervical artery

Thyrocervical trunk Suprascapular artery

Right oblique schematic view Vertebral artery Deep cervical artery (ascending to anastomose with descending branch of occipital artery)

Right external carotid artery Right internal carotid artery Ascending cervical artery Inferior thyroid artery

Costocervical trunk


Supreme (superior) intercostal artery

Right common carotid artery

Dorsal scapular artery Superior and inferior transverse scapular ligamen 1

Thyrocervical trunk Right subclavian artery (1st part medial to, 2nd part posterior to, 3rd part lateral to anterior scalene muscle)

Acromion


Dorsal scapular artery

Suprascapular artery


Aortic arch

Axillary artery

Internal thoracic (mammary) artery

1 st and 2nd posterior intercostal arteries

1 st, 2nd, and 3rd anterior intercostal arteries Circumflex scapular artery

Thoracodorsal artery

Subscapular artery

See also

Plates 136, 138

Superficial temporal artery

Parotid space (bed): right lateral dissection

Transverse facial artery Maxillary artery

Mastoid process


Styloid process

Posterior auricular artery

Facial nerve (VII) (cut)

Glossopharyngeal nerve (IX)

Sternocleidomastoid muscle (cut)

Stylohyoid muscle



Occipital artery and sternocleidomastoid branch

Facial artery Lingual artery

Accessory nerve (XI Ansa cervicalis

Mylohyoid muscle

Superior root Inferior root

Hyoglossus muscle

Vagus nerve (X)


Ascending pharyngeal artery

Hyoid bone

Carotid branch of glossopharyngeal nerve (IX) and carotid body

Branch to thyrohyoid muscle (from ansa cervicalis)

Internal carotid artery Internal jugular vein

Superior laryngeal artery Superior thyroid artery

Superficial temporal artery Digastric muscle (phantom)

External carotid artery Transverse facial artery


Maxillary artery Posterior auricular artery

Occipital artery Descending branch Sternocleidomastoid branch Internal carotid a External carotid artery

Facial artery Lingual artery Ascending pharyngeal artery Superior thyroid artery and superior laryngeal branch Omohyoid muscle ( p h a n t o m )

Common carotid

External carotid branches: schema Thyrocervical trunk

Fascial Layers of Neck For contents of carotid sheath see

Superficial (investing) layer of deep cervical fascia

Plates 69-71

Platysma muscle Sternohyoid muscle Trachea

Infrahyoid fascia

Sternothyroid muscle T h y r o i d gland

Pretracheal (visceral) fascia

Esophagus Omohyoid muscle

Buccopharyngeal (visceral) fascia


Carotid sheath

Recurrent laryngeal nerve

Subcutaneous tissue


Superficial (investing) layer of deep cervical fascia roofing posterior triangle

Internal jugular vein Vagus nerve (X) Phrenic nerve Anterior scalene muscle Sympathetic trunk

Fat in posterior triangle

Spinal nerve Middle and posterior scalene muscles -ongus colli muscle

Prevertebral layer of (deep) cervical fascia

Levator scapulae muscle Trapezius muscle

Alar fascia

Cross section

Deep cervical muscles Retropharyngeal space

Subcutaneous tissue

Cervical vertebra (C7)

Sagittal section

Mandible

Pharynx

Geniohyoid muscle

Buccopharyngeal (visccral) fascia

Geniohyoid fascia

Retropharyngeal space

Investing layer of (deep) cervical fascia

Alar fascia Prevertebral fascia Trachea Esophagus

Fascia of infrahyoid muscles Pretracheal (visceral) fascia Thyroid gland Subcutaneous tissue —Suprasternal space (of Burns) Manubrium of sternum Aorta Pericardium

Anterolateral view

Inferior view Major alar cartilage

Frontal bone Nasal bo

Lateral

Frontal process of maxilla

Medial crus

Lateral process of septal nasal cartilages Septal cartilage Minor alar cartilage Accessory nasal cartil

Major alar cartilage

. Lateral crus Medial crus

Alar fibrofatty tissue

Nasal septal cartil Anterior nasal spine of maxil

Nasal septal cartilage

Alar fibrofatty tissue Infraorbital foramen

Frontalis muscle Supraorbital artery and Supratrochlear artery and n Procerus muscle Corrugator supercilii muscle Dorsal nasal a Infratrochlear nerve Angular artery External nasal artery and nerve Nasalis muscle (transverse part) Infraorbital artery and nerve Lateral nasal artery Transverse facial artery Nasalis muscle (alar part) Depressor septi nasi muscle Orbicularis oris muscle Facial arterv

4

Anterior nasal spine of maxilla Intermaxillary suture

Lateral Wall of Nasal Cavity HHBwBBnMHHHHRHHRBBH^HHH

Sphenoethmoidal recess

Frontal sinus

ing of dal sinus

Superior nasal concha Superior nasal meatus Middle nasal concha

\

Agger nasi

Hypophysis (pituitary gland) in sella turcica Sphenoidal sinus

Atrium of middle nasal meatus

Pharyngeal tonsil (adenoid if enlarged)

Middle nasal meatus

Basilar part of occipital bone Pharyngeal raphe

Inferior nasal concha (turbinate) Limen nasi

Choana

Nasal vestibule

Torus tubarius

Inferior nasal meatus

Opening of auditory (pharyngotympanic, Eustachian) tube Pharyngeal recess

Palatine process of maxilla Incisive canal Tongue

Horizontal plate of palatine bone Soft palate Middle nasal concha Middle nasal meatus Bulging septum rvvay to nasopharynx Inferior nasal concha Inferior nasal meatus Floor of nasal cavity

Speculum view Frontal sinus

Cribriform plate of ethmoid bone Probe in opening of sphenoidal sinus

Probe passing from semilunar hiatus into frontal sinus via frontonasal duct Middle nasal concha {cut

Sphenoidal sinus Superior nasal meatus with opening of posterior ethmoidal cells

surface)

Ethmoidal bulla


Openings of middle ethmoidal cells Semilunar hiatus (osteomeatal unit) with opening of anterior ethmoidal air cells

Torus tubarius Opening of auditory (pharyngotympanic, Eustachian) tube

Uncinate process Inferior nasal concha


{cut surface)

Opening of nasolacrimal duct Inferior nasal meatus

Opening of maxillary sinus


Lateral Wall of Masai Cavity (continued) See also

Plate 6

Lacrimal bone

Frontal bone

Squamous part Sinus Nasal spine

Middle nasal concha Uncinate process Ethmoid bone Cribriform plate perior nasal concha Highest nasal concha Sphenoethmoidal recess

Nasal bone

Sphenopalatine foramen

Agger nasi


Lateral process of nasal septal cartilage Major alar carti Alar fibrofatty tissue

Sphenoidal sinus Medial and Lateral plates of pterygoid process

Frontal process Anterior nasal spine Maxilla

Incisive canal

Pterygoid hamulus Sphenoidal process

Palatine process Alveolar process

Sphenoid bone

Orbital process Posterior nasal s p i n e / p a , a t j n e

bong

Perpendicular plate Horizontal plate Ethmoidal bulla Frontal sinus Opening of frontonasal canal

ening of middle ethmoidal cells uperior nasal concha

(cutaway)

ings of posterior ethmoidal cells Middle nasal concha (cui awa Opening of sphenoidal sinus Infundibulum leading to frontonasal cana Semilunar hiatus (osteomeatal unit) with opening of anterior ethmoidal air cells

Openings into maxillary sinus Sphenopalatine foramen

Uncinate Inferior nasal concha (cut Opening of nasolacrimal can

Ethmoidal process of inferior nasal concha Lesser palatine foramen Greater palatine foramen

medial Wall ©t Masai Cavity Nasal Septum!

Falx cerebri Frontal sinus

Cribriform plate of ethmoid bone Dura mater

Sphenoidal sinus

Sella turcica Nasal septum Choanae (posterior nasal apertures ) Lateral process of nasal septal cartilage Major

mmi

alar cartilage

SKI— Torus tubarius

mm

Nasal vestibule Anterior nasal spine Incisive canal Oral cavity Tongue Soft palate

Squamous part Sinus Nasal spine

Frontal bone

Crista galli Cribriform plate /> Ethmoid bone Perpendicular plate Crest

Nasal bone

Body Sphenoidal sinus

Vomer Vomerine groove (for nasopalatine nerve and vessels) Septal cartilage


Major alar cartilage (medial crus)

Anterior nasal spine Maxilla

Nasal crest Incisive canal Palatine process

Sphenoid bone

Medial, Lateral plates of pterygoid process

Pharyngeal tubercle Perpendicular plate Nasal crestPosterior nasal spine Horizontal plate Lesser palatine foramen Greater palatine foramen

Palatine bone

Anterior Posterior

Lateral pterygoid artery and muscle Supraorbital artery

Deep temporal arteries and nerves Masseteric artery and nerve Lateral ligament of temporomandibular joint

Supratrochlear artery Ophthalmic artery

Middle meningeal artery Auriculotemporal nerve

Dorsal nasal artery

Maxillary artery

Angular artery


Infraorbital artery


Superior ( Posterior alveolar < M i d d l e arteries ( Anterior

Facial nerve Inferior alveolar artery and nerve

Buccal artery and nerve

Sphenomandibular ligament

Medial pterygoid artery and muscle

Mylohyoid nerve and branch of inferior alveolar artery

Pterygomandibular raphe


Lingual nerve

Stylohyoid muscle

Facial artery


Mental branch of inferior alveolar

Facial artery Lingual artery

Submental artery

Sphenopalatine artery. Posterior lateral nasal branch

Artery of pterygoid canal Pharyngeal artery enopalatine foramen

Infraorbital artery

Anterior ) Deep temporal arteries Posterior ) and nerves Accessory meningeal artery Middle meningeal artery Anterior tympanic artery Deep auricular artery

Posterior superior alveolar artery

Auriculotemporal nerve

Sphenopalatine artery Posterior septal branches Greater (descending) palatine artery Buccal artery


Anastomosis in incisive canal

Ascending pharyngeal arterv

Left and right greater palatine arteries

/

Ascending palatine artery Tonsillar branches

Left and right lesser palatine arteries

Tonsillar artery Pterygoid arteries Masseteric artery Inferior alveolar artery

External carotid artery Facial artery Superior pharyngeal constrictor muscle Styloglossus muscle

Arteries of Nasal Cavity: Nasal Septum Turned Up

Nasal septal branch of superior labial branch (of facial artery)

Nasal septum ( turned up

Schematic

hinge

Anastomosis between posterior septal branch of sphenopalatine artery and greater palatine artery in incisive canal Septal and lateral nasal branches of posterior ethmoidal artery

Anterior septal branch, Anterior lateral nasal branch, External nasal branch of anterior ethmoidal artery

Posterior septal branch of sphenopalatine artery Sphenopalatine artery Sphenopalatine foramen

Alar branches of lateral nasal branch (of facial artery) •Vii

Posterior lateral nasal branches of sphenopalatine artery Maxillary artery Anastomosis between posterior septal branch of sphenopalatine artery and greater palatine artery in incisive canal

External carotid artery Lesser palatine foramen and artery Greater palatine artery

Lateral wall of nasal cavity

Greater palatine foramen and artery

1

Nerves of Nasal Cavity: Nasal Septum Turned Up HHHMIMH

See also

Plates 44, 45, 119

Olfactory nerves (I)

Nasal septum ( t u r n e d up) Incisive canal

••v/.l

Schematic

hinge

Nasopalatine nerve (V 2 )

Medial internal nasal, Lateral internal nasal, External nasal branches of anterior ethmoidal nerve (V-j)

sWs

Sphenopalatine foramen [dissected

Internal nasal branches of infraorbital nerve (V 9 )

-

• • •

away)

Pterygopalatine ganglion Nerve (Vidian) of pterygoid canal

Posterior superior lateral nasal branch of maxillary nerve (V 2 ) Nasal branch of anterior superior alveolar nerve (V 2 )

Greater and lesser palatine nerves (V 2 ) Posterior inferior lateral nasal branch of greater palatine nerve (V 2 ) Lesser palatine nerves (V 2 )

Communication between greater palatine and nasopalatine nerves at incisive canal

Greater palatine nerve (V 2 )

Nerves of Nasal Cavity (continued) Y^ff'y^ji^*flBUfii

See also

Plate 119

Distribution of olfactory mucosa ( shaded blue) Nasal septum


External nasal branch of anterior ethmoidal nerve (V-j) Lateral internal nasal branch of anterior ethmoidal nerve (V q ) Olfactory bulb Cribriform plate of ethmoid bone Olfactory tract

Posterior superior lateral nasal branches from maxillary nerve (V 2 ) Maxillary nerve (V 2 ) (sphenopalatine foramen dissected away) Pterygopalatine ganglion Greater petrosal nerve Deep petrosal nerve Nerve (Vidian) of pterygoid canal Pharyngeal branch of maxillary nerve (V 2 ) Nasopalatine nerve (V 2 ) passing to septum (cut) Posterior inferior lateral nasal branch from greater palatine nerve (V 2 )


/Olfactory bulb

f$M'h*m

Wmki

Olfactory nerves (I) (

G

Palatine nerves (V 2 ) < ( Lesser

Medial internal nasal branch of anterior ethmoidal nerve (V Olfactory nerves (I) Nasopalatine nerve (V 2 ) Incisive canal

Nasal septum

/

/

/Cribriform plate /

/

/ O l f a c t o r y tract

Autonomic Innervation of Nasal Cavity See also

Plates 122, 131, 133 Superior salivatory nucleus (parasympathetic) Facial nerve (VII) Geniculum (geniculate ganglion) of facial nerve Greater petrosal nerve (parasympathetic) Deep petrosal nerve (sympathetic) Nerve (Vidian) of pterygoid canal Maxillary nerve (V 2 ) entering foramen rotundum Pterygopalatine ganglion in Dterygopalatine fossa Lateral and medial posterior superior nasal branches in pterygopalatine fossa Infraorbital nerve Posterior superior and inferior lateral nasal nerves (cut

ends)

Tympanic cavity w s s s Medulla oblongata

mm

Internal carotid nerve and plexus

Internal carotid artery

Sympathetic trunk

Greater and lesser palatine nerves

Superior cervical ganglion

MM

mm wm

Posterior superior alveolar nerves

Maxillary sinus

Nasopalatine nerve

Postsynaptic fibers to vessels (sympathetic) and glands (parasympathetic) of nasal cavity, maxillary sinus, and palate Preganglionic parasympathetic fibers Postganglionic parasympathetic fiber Preganglionic sympathetic fibers

Plate 44

Nasal Region

Ophthalmic (V.,) and Maxillary (V2) Nerves fm

'. ..•.

.

v . . ' • . v 7 / W M K m W B 9 M H W JJSSwS


Communicating branch Posterior ethmoidal nerve Long and short ciliary nerves

Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve Lacrimal gland

Ciliary ganglion Lacrimal nerve Nasociliary nerve Frontal nerve Tentorial branch

Infratrochlear nerve (from nasociliary nerve) Cutaneous branch of lacrimal nerve Zygomaticotemporal nerve Zygomaticofacial nerve

Ophthalmic nerve (V 1 )

External nasal branch of anterior ethmoidal nerve

Trigeminal (semilunar) ganglion Trigeminal nerve (V) Meningeal branch — Foramen rotund urn

Infraorbital nerve

Foramen ovale

Anterior superior alveolar nerve


Nasal branch

Maxillary nerve (V 2 ) Zygomatic nerve Nerve (Vidian) of pterygoid canal Pterygopalatine ganglion Greater and lesser palatine nerves Ganglionic branches to pterygopalatine ganglion

Mucous membrane of maxillary sinus Dental and gingival branches Superior dental plexus Infraorbital nerve entering infraorbital canal Middle superior alveolar nerve Posterior superior alveolar nerve

Plate 45

Mandibular Nerve |W3f See also

Plates 71,122 Anterior division

Lateral view

Posterior division

Temporal fascia md temporalis muscle

Posterior Anterior

Deep temporal nerves

Foramen ovale

Masseteric nerve

Meningeal branch Lateral pterygoid nerve and muscle

Foramen spinosum Middle meningeal artery Auriculotemporal nerve Posterior auricular nerve

"mm

Facial nerve (VII) Chorda tympani nerve

Buccal nerve and buccinator muscle (cut)

Lingual nerve Inferior alveolar nerve (cut)

Submandibular ganglion

iNerve to mylohyoid o-

Sublingual

<•

Medial pterygoid muscle (cut) Mylohyoid muscle (cut)

Digastric muscle (posterior belly) Stylohyoid muscle

Mental nerve

Hypoglossal nerve Submandibular gland

Medial view Trigeminal (semilunar) ganglion

Inferior alveolar nerve (cut)

Sublingual nerve

Digastric muscle (anterior belly) Sensory root

Geniculum (geniculate ganglion) of facial nerve

Ophthalmic nerve (V-j)

Tympanic cavity


Chorda tympani nerve


Facial nerve (VII)

Anterior division Tensor veli palatini nerve and muscle Otic ganglion Chorda tympani nerve Medial pterygoid nerve and muscle (cut) Pterygoid hamulus Lingual nerve

Tensor tympani muscle and nerve Lesser petrosal nerve Auriculotemporal nerve Maxillary artery Mylohyoid nerve Inferior alveolar nerve entering mandibular foramen

Nasal Region

Nose and Paranasal Sinuses: Cross Section vCIfB l ftl&HMMMBIMBMtMHBI&fB li QQti

Nasal vestibule

Major alar cartilage Vomer Inferior nasal concha

Nasal septal cartilage

Facial artery

Facial vein

Maxillary bone

Maxillary sinus Sphenoid bone

Masseter muscle Coronoid process of mandible

Medial pterygoid muscle Lateral pterygoid plate

Lateral pterygoid muscle

Levator veli palatini muscle

Cartilage of auditory tube

Pharyngeal recess

Neck of mandible

Longus capitis muscle

Parotid gland

Rectus capitis anterior muscle

Retroman dibular vein


Glossopharyngeal nerve

Sympathetic trunk

Styloid process

Styloglossus muscle Stylohyoid muscle

Auricular cartilage

Medulla oblongata

Mastoid air cells Vagus nerve Facial nerve Hypoglossal nerve Accessory nerve

Nasal Region

Plate 47

Paranasal Sinuses

Coronal section Olfactory bulbs

Falx cerebri Brain

Frontal sinus

Nasal cavities

Orbital fat

Nasal septum

Ethmoidal cells

Middle nasal concha


Middle nasal meatus

Infraorbital

Recesses of maxillary sinus

Zygomatic

Maxillary sinus

Alveolar


Buccinator muscle Alveolar process of maxilla


Body of tongue

Hard palate

m Jit V \

Oral cavity-

•

t,

-

Sublingual gland Mandible (body)

Nasal cavities

Nasal septum Ethmoidal cells

Orbital fat and muscles

Sphenoidal sinuses

- M e d i a l wall of orbit Optic nerve (II) Brain

V

Optic chiasm

Horizontal section

Plate 48

Nasal Region

Paranasal Sinuses (continued)

Sagittal section Ethmoidal air cells (sinuses) Frontal sinus

Opening of sphenoidal sinus

Opening of frontonasal duct Sphenoidal sinus

Semilunar hiatus (osteomeatal unit)

Middle nasal concha {cutaway)

Uncinate process



Frontal sinus

Opening into middle nasal meatus

Orbit

Pterygopalatine fossa

Lateral dissection Roots of teeth

Nasal Region

Plate 49

®8S

mmmmmmmmmmmmmmmssm

Bones of nasal cavity and paranasal sinuses at birth

Sinus represents one or more anterior ethmoidal cells opening into semilunar hiatus of middle nasal meatus

Sinus represents one or more middle ethmoidal cells opening into middle nasal meatus Part of nasolacrimal duct that formed in depths of nasooptic furrow

Sinuses represent two or more posterior ethmoidal cells opening into superior nasal meatus Sphenoidal sinus within bony shell (sphenoidal concha) located anterior and lateral to body of sphenoid bone (broken line indicates sinus lateral to sphenoid body)

Nasal bone

of sphenoid bone

Lacrimal bone

Hypophyseal fossa Nasolacrimal foramen (becomes bony canal)

Vestigial remnant of Rathke's pouch Medial plate of pterygoid process

Part of nasolacrimal duct within nasal cavity with slit-like opening in inferior nasal meatus

Lower border of highest nasal concha Lower border of superior nasal concha Superior nasal meatus

Maxilla

Middle nasal concha (cut edge) (inferior nasal concha completely removed)

Uncinate process of ethmoid bone Semilunar hi

Maxillary sinus with opening into semilunar hiatus (striped area represents membrane forming most of medial wall of sinus)

Growth of frontal and maxillary sinuses throughout life Frontal sinus within frontal bone Birth 1 year 4 years 7 years

Middle nasal concha

Left orbit

Nasal septum Nasal cavity

Maxillary sinus within maxilla

12 years Adult Old age

Plate 50

Inferior nasal concha Molar tooth

Nasal Region

Inspection of Oral Cavity

Philtrum of lip Soft palate Palatopharyngeal arch Uvula Palatoglossal arch -Palatine tonsil Posterior wall of pharynx

Frenulum of upper li Lingual minor salivary gland Deep lingual artery and veins and lingual nerve Fimbriated fold Submandibular duct Sublingual gland Frenulum of tongue Sublingual fold with openings of sublingual ducts Sublingual caruncle of submandibular du Frenulum of lower lip

Parotid papilla with opening of parotid duct

Plate 51

Roof of Mouth ramawe®

Incisive papilla

Incisive fossa

Transverse palatine folds

Greater palatine artery and nerve Greater palatine foramen

Palatine raphe

Lesser palatine foramen


.esser palatine artery and nerves

Palatine glands

Tendon of tensor veli palatini muscle

Horizontal plate of palatine bone

Pterygoid hamulus

Palatine aponeurosis (from tensor veli palatini muscle)

Interdigitating fibers of levator veli palatini muscle Buccinator muscle

Uvular muscle

Pterygomandibular raphe Superior pharyngeal constrictor muscle

Molar minor salivary glands

Palatoglossus muscle

Palatopharyngeus muscle Palatine tonsil


Anterior view

Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube Levator veli palatini muscle (cut)

Pharyngobasilar fascia

Tensor veli palatini muscle


Medial pterygoid muscle (cut)

Choanae

Medial pterygoid plate

Pterygoid hamulus

Pterygoid hamulus-

Superior pharyngeal constrictor muscle (cut)

Tendon of tensor veli palatini muscle Levator veli palatini muscle (cut)

Palatopharyngeus muscle

Palatopharyngeus muscle (cut)' Uvular muscle

Posterior view

Oral Region

Floor of Mouth mmmwsM


Lateral, slightly inferior view Hyoglossus muscle Mylohyoid muscle Fibrous loop for intermediate digastric tendon Digastric muscle (anterior belly) Mastoid process

Median raphe between mylohyoid muscles

Styloid process Digastric muscle (posterior belly)

Anteroinferior view

Stylohyoid muscle Greater horn \ Lesser horn j Hyoid bone Body ' Thyrohyoid muscle Omohyoid muscle Sternohyoid muscle Digastric muscle (anterior belly) Mylohyoid muscle Stylohyoid muscle Digastric muscle (posterior belly)

Hyoglossus muscle

Fibrous loop for intermediate digastric tendon

Posterosuperior view Inferior alveolar nerve and artery Mylohyoid nerve and artery Submandibular gland and duct Mylohyoid muscle Geniohyoid muscle Lesser horn

0

V -

Oral Region

Hyoid bone

BodyGreater horn

Superior mental spine (genial tubercle) for origin of genioglossus muscle Hyoglossus muscle (cut)

Plate 53

Muscles Involved in Mastication ':•:

•• :• ;

.

For facial muscles see

Plate 26 ...

Temporalis muscle Temporal fascia Superficial layer Deep layer

Levator labii superioris alaeque nasi muscle

Zygomatic arch

Levator labii superioris muscle

Articular disc of temporomandibular joint Deep part \ Superficial part j

Zygomaticus minor muscle

Masseter muscle

Zygomaticus major muscle Levator anguli oris muscle Orbicularis oris muscle Mentalis muscle Depressor labii inferioris muscle

Insertion of temporalis muscle to coronoid process of mandible Parotid duct Buccinator muscle Orbicularis oris muscle Masseteric nerve and artery Maxillary artery Insertion of masseter muscle

Plate 54

Oral Region

Muscles Involved in Mastication (continued)

Articular disc of temporomandibular joint Articular tubercle Lateral pterygoid muscle Sphenomanclibular ligament Medial pterygoid muscle Parotid duct Buccinator muscle

Pte ry go m an d i b u I a r rap h e Superior pharyngeal constrictor muscle

Lateral view

Choanae Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube

Otic ganglion

Sphenomandibular ligament Masseteric nerve

Lateral pterygoid plate Middle meningeal artery Auriculotemporal nerve

•

Ai

\

am

— Lateral pterygoid muscle

Masseteric artery

Medial pterygoid muscle

Maxillary artery Inferior alveolar nerve Lingual nerve Medial pterygoid muscle Medial pterygoid plate

Tensor veli palatini muscle (cut)

Pterygoid hamulus

Levator veli palatini muscle (cut)

Nerve to mylohyoid

Pterygoid hamulus

Posterior view

Oral Region

Plate 55

Teeth

Permanent

Deciduous (primary) Usual age of .eruption^.

(colored blue) Usual age of eruption

Central incisor (7th year)

Central incisor (8-10 m o n t h s ) "

Lateral incisor (8th year)

Lateral incisor (8-10 months)-

Canine (cuspid) (11 th—12th year) "I st premolar (9th year)

Canine (cuspid) (16-20 months)

2nd premolar (1 Oth year) 1st molar (6th year)

1 st molar ( 15-2 I months)

2nd molar (12th- 13 th year)

2nd molar (20-24 months)

3rd molars (1 7th—25th year)

2nd molar (20-24 months)

2nd molar (12th—13th year)

I st molar (15-21 months)

I st molar (6th year) 2nd premolar (10th year)

Canine (cuspid) (16-20 months)

1st premolar (9th year)

Lateral incisor (15-21 months)

Canine (cuspid) (11 th—12th year) Lateral incisor (8th year)

Central incisor (6-9 months)"""

Central incisor (7th year)

Central incisors Incisive fossa

Lateral incisors Canines


1st premolars 2nd premolars


1 st molars 2nd molars 3rd mola

Greater and lesser palatine foramina

Upper permanent teeth

Plate 56

Lower permanent teeth

Oral Region

Enamel Dentine and dentinal tubules Crown <

Interglobular spaces Odontoblast layer Interproximal spaces Dental pulp containing vessels and nerves Gingival (gum) epithelium (stratified)

Neck

Gingival groove Lamina propria of gingiva (gum) (mandibular or maxillary periosteum) Periodontium (alveolar periosteum) Papilla Root

Cement

<

Root (central) canals containing vessels and nerves Bone Apical foramina

|\

it

Left upper permanent teeth: labiobuccal

Left lower permanent teeth: labiobuccal view

ft.

m

Lateral Incisors

Oral Region

Canines (cuspids)

Premolars

Molars

Plate 57

Tongue

m&s.

iglottis Median glossoepiglottic fold Lateral glossoepiglottic fold Vallecula Palatopharyngeal arch and muscle (cut) Palatine tonsil {cut) Lingual tonsil (lingual nodules)

Root

Palatoglossal arch and muscle {cut) - F o r a m e n cecum Terminal sulcus Vallate papillae - Foliate papillae

Filiform papillae Body/ s Fungiform papilla Midline groove (median sulcus)

Dorsum of tongue Apex Lingual tonsil

Filiform papillae Fungiform papilla Keratinized tip of papilla

Intrinsic muscle Duct of gland Crypt Lymph follicles Stratified squamous epithelium Sustentacular cell Sensory cell

Mucous glands Vallate papilla Taste buds Furrow

Taste pore Lamina propria

Lingual glands (serous glands of von Ebner) y

Section of taste bud

Plate 58

Schematic stereogram: area indicated above

Oral Region

Plates 34, 46, 53, 128

See also

Palatoglossus muscle longitudinal muscle of tongue

Mastoid process ' ^W

Digastric muscle (posteric

^ W t i i K

\ \

m m m ^ / J ^ R ^ v w f ^ ^ B ^ ^ / / ' I

3

'

1 3

"

belly) (cut)

Styloid process

\


\

Superior pharyngeal constrictor mus Stylohyoid ligament

Styloglossus muscle Glossopharyngeal part of superior r y n g e a l constrictor

| - ; : » l \ x S t y l o p h a r y n g e u s muscle Stylohyoid muscle Middle pharyngeal constrictor muse Digastric muscle (posterior belly) [ a Hyoglossus muscle

ossus muscle

^ I n t e r m e d i a t e tendon of digastric muscle (cut) Fibrous loop for intermediate digastric tendon

Lateral v i e w Lingual nerve

"uperior pharyngeal constrictor muscle Styloglossus muscle


Palatoglossus muscle (cut)

Deep lingual artery and venae comitantes

Stylohyoid ligament Stylopharyngeus muscle Hyoglossus muscle (cut) Lingual artery External carotid artery

Artery to frenulum

nternal jugular vein Retromandibular vein

Submandibular duct

Facial vein

• .i r Suprahyoid artery

Sublingual artery and vein Geniohyoid mu

Dorsal lingual artery and vein Hypoglossal nerve

Oral Region

Common trunk for facial, retromandibular and ingual veins (common facial vein) Lingual vein

Vena comitans of hypoglossal nerve

Plate 59

Tongue and Salivary Glands: Sections

Horizontal section below lingula of m a n d i b l e (superior v i e w )

demonstrating bed

of parotid gland

Orbicularis oris muscle

„ Buccinator muscle

Buccopharyngeal fascia Fada| artery and vein

Pterygomandibular raphe Lingual nerve and superior pharyngeal constrictor muscle Masseter muscle Palatoglossus muscle in palatoglossal arch Palatine tonsil Palatopharyngeus muscle in palatopharyngeal arch Ramus of mandible Inferior alveolar artery vein, and nerve Medial pterygoid muscle Styloglossus muscle Facial nerve Retromandibular vein External carotid arterv <

Parotid gland Stylopharyngeus muscle Stylohyoid muscle Sternocleidomastoid muscle Digastric muscle (posterior belly) Internal jugular vein, internal carotid artery and nerves IX, X, and XII in carotid sheath Superior cervical sympathetic ganglion

Longus capitis muscle Prevertebral fascia Buccopharyngeal fascia and retropharyngeal space

Superior longitudinal muscle Vertical and transverse muscles of tongue Inferior longitudinal muscle Styloglossus muscle Buccinator muscle Muscles of facial expression Hyoglossus muscle Genioglossus muscle Sublingual salivary gland Submandibular duct Mandibular canal, inferior alveolar artery, vein, and nerve Lingual nerve Nerve to mylohyoid Vena comitans of hypoglossal nerve (to lingual vein) Lingual artery Facial arterv Hypoglossal nerve (XII) Submandibular salivary gland Submandibular lymph node Frontal section Mylohyoid muscle behind 1st molar tooth Facial vein (anterior view) Intermediate digastric tendon demonstrating Platysma muscle Hyoid bone

Plate 60

beds of sublingual and submandibular glands

Oral Region

Salivary Glands See also

Plates 25, 53, 133, 134, 167, 168

Superficial temporal artery and vein and auriculotemporal nerve Branches of facial nerve Transverse facial artery Accessory parotid gland Parotid duct Buccinator muscle (cut) Masseter muscle Lingual nerve Submandibular ganglion Tongue Frenulum of tongue Sublingual fold with openings of sublingual ducts

Parotid gland

Sublingual caruncle with opening of submandibular duct

Retromandibular vein (anterior and posterior branches)

Sublingual gland


Submandibular duct

Stylohyoid muscle Sublingual artery and vein

External jugular vein Sternocleidomastoid muscle

Mylohyoid muscle (cut) Digastric muscle (anterior belly) Hyoid bone

Submandibular gland



ffct'

m m &

mm

&

v'AJfft?x.

Oral Region

/

«

-

v

Mm

'

*

Common trunk receiving facial, anterior branch of retromandibular, and lingual veins (common facial vein)

External carotid arterv

-ir-

•

<

\

i>

feiB

St.,

Sublingual gland: almost completely mucous

Plate 61

Afferent Innervation of Mouth and Pharynx BgaSHffigB&RMMm See also

mmmmsmsmsmm

Plates 45, 52, 59, 64, 122, 123, 125, 133, 135

Trigeminal (V) (maxillary V 2 ) Trigeminal nerve (V) Via superior alveolar Glossopharyngeal nerve (IX) nerves Va§us nerve Via pterygopalatine W ganglion and nasopalatine Facial nerve (VII) and greater and lesser palatine nerves Facial (VII) (intermediate nerve) Via greater petrosal nerve, pterygopalatine ganglion, and greater and lesser palatine nerves

B B B B t B a g M a a a M B g g

':

j&BZSCse&sxaxsa&z&Bi

Glossopharyngeal (IX) Via pharyngeal plexus Via tonsillar branches Taste plus general sensation via lingual branches Trigeminal (V) (maxillary V 2 ) a pharyngeal branch of pterygopalatine ganglion Facial (VII) (intermediate nerve) Via greater petrosal nerve and pterygopalatine ganglion

L-gggg

Vagus(X) Via internal branch of superior laryngeal nerve

Glossopharyngeal (IX) Via pharyngeal plexus Via tonsillar branches Taste plus general sensation via ingual branches Vagus(X)and glossopharyngeal (IX) Via pharyngeal plexus Vagus(X) Via internal branch of superior laryngeal nerve

Trigeminal (V) (maxillary V 2 ) Via pterygopalatine ganglion and nasopalatine and greater and lesser palatine nerves Via superior alveolar nerves

Trigeminal (V) (mandibular V 3 ) Via buccal nerve Via inferior alveolar nerve

Trigeminal (V) (mandibular Via lingual nerve Facial (VII) (intermediate nerve) Taste via chorda tympani and lingual nerve

Plate 62

Oral Region

Pharynx: Median Section

Sella turcica Frontal sinus

Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube Sphenooccipital synchondrosis

Sphenoidal sinus

Pharyngeal tonsil

Nasal septum

Pharyngeal tubercle of occipital bone

Nasopharynx

Pharyngeal raphe 'Anterior longitudinal ligament

Soft palate

-Anterior atlantooccipilal membrane

Palatine glands

Apical ligament of dens

Hard palate Oral cavity


Incisive canal Palatine tonsil


mm

Body of tongue Oropharynx

Pharyngeal constrictor muscles

Foramen cecum Lingual tonsil Genioglossus muscle

Buccopharyngeal fascia

Root of tongue

Retropharyngeal space

Epiglottis Mandible Geniohyoid muscle Hyoid bone Hyoepiglottic ligament < ;

Thyrohyoid membrane Laryngopharynx Laryngeal inlet (aditus) Thyroid cartilage Vocal fold Transverse arytenoid muscle Cricoid cartilage Trachea Esophagus Esophageal muscles^ Thyroid gland Superficial (investing) layer of deep cervical fascia Pretracheal fascia Suprasternal space (of Burns) Manubrium of sternum

Pharynx

.

.s

Prevertebral fascia and anterior longitudinal ligament Vertebral bodies

Medial view Median (sagittal) section Sphenoidal sinus Pharyngeal tonsil Torus Iubarius Pharyngeal tubercle (basilar part of occipital bone) Pharyngeal raphe Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube Hard palate Pharyngeal recess Salpingopharyngeal fold Soft palate Palatine glands Uvula Semilunar fold Supratonsillar fossa Palatine tonsil Palatopharyngeal arch Palatoglossal arch Oropharynx Triangular fold Tongue (drawn Lingual tonsil Epiglottis Vallecula

forward

and

downward)

Pharyngeal mucosa removed Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube Medial pterygoid plate Tensor veli palatini muscle and tendon Levator veli palatini muscle Ascending palatine artery Pharyngeal branch of ascending pharyngeal artery Lesser palatine a r t e r y Salpingopharyngeus muscle Pterygoid hamulus Pterygomandibular raphe Tonsillar branch of lesser palatine artery Superior pharyngeal constrictor muscle Tonsillar branch of ascending pharyngeal artery Palatoglossus muscle Palatopharyngeus muscle Tonsillar branch of ascending palatine artery Tonsillar branch of facial artery Tonsillar branch of dorsal lingual artery Glossopharyngeal nerve (IX) and tonsillar branch

*

/

Plate 64

Stylohyoid ligament Hyoglossus muscle Middle pharyngeal constrictor muscle Stylopharyngeus muscle

Pharynx

Muscles of Pharynx: Median (Sagittal) Section mgiftiMTiiTKiwiOTiifrifl

Medial pterygoid plate Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube

T BSKhI

Tensor veli palatini muscle Pharyngobasilar fascia Levator veli palatini muscle Palatine aponeurosis and tendon of tensor veli palatini muscle Pharyngeal tubercle (basilar part of occipital bone) Pharyngeal raphe Anterior longitudinal ligament Anterior atlantooccipital membrane Apical ligament of dens Salpingopharyngeus muscle 'Muscles of soft palate Palatopharyngeal sphincter (Passavant's ridge) Pterygoid hamulus Superior pharyngeal constrictor muscle P tery g o m andibularra p h e Palatopharyngeus muscle Buccinator muscle

Aj FT}

Glossopharyngeal part of superior pharyngeal constrictor Stylopharyngeus muscle Stylohyoid ligament Styloglossus muscle Middle pharyngeal constrictor muscle Fibers to pharyngoepiglottic fold Buccopharyngeal fascia and retropharyngeal space Prevertebral fascia and anterior longitudinal ligament

Hyoglossus muscle

Internal branch of superior laryngeal nerve

Geniohyoid muscle

Longitudinal pharyngeal muscles

Mylohyoid muscle

Inferior pharyngeal constrictor muscle Pharyngeal aponeurosis

Hyoid bone Thyrohyoid membrane

\

Thyroid cartilage Median cricothyroid ligament Corniculate and arytenoid cartilages

Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Cricoid attachment of longitudinal esophageal muscle — Circular esophageal muscle inal esophageal muscle

Cricoid cartilage Trachea Margins of middle pharyngeal constrictor muscle Margins and attachments of inferior pharyngeal constrictor muscle

Plate 65

Pharynx: Opened Posterior View

Styloid process Nasal septum Torus tubarius Pharyngeal opening of auditory (pharyngotympanic, Eustachian) tube

Nasopharynx

Pharyngeal recess Parotid gland Torus levatorius (fold caused by levator veli palatini muscle) Salpingopharyngeal fold Soft palate Angle of mandible Submandibular gland Uvula Palatine tonsil

Oropharynx <

Root of tongue Palatopharyngeal arch Prominence caused by greater horn of hyoid bone Epiglottis Laryngeal inlet (aditus) Prominence caused by superior horn of thyroid cartilage

Laryngopharynx ^

iglottic fold Piriform fossa (recess) Cuneiform tubercle Fold over internal branch of superior laryngeal nerve Corniculate tubercle Interarytenoid notch Prominence over lamina of cricoid cartilage

Esophagus

Trachea

Plate 66

Pharynx

Muscles of Pharynx: Partially Opened Posterior View jflBMIIflgjgBIMBWfi^^ See also


Plate 235

Pharyngeal tubercle Pharyngeal tonsil Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube

Styloid process

/


Pharyngobasilar fascia Choana

Stylohyoid muscle


Stylopharyngeus muscle

Superior pharyngeal constrictor muscle

Accessory muscle bundle from petrous part of temporal bone

Salpingopharyngeus muscle Uvula

Medial

Palatopharyngeus muscle

pterygoid muscle

Middle pharyngeal


constrictor muscle

Pharyngeal raphe Superior pharyngeal constrictor muscle Hyoicl bone (tip of greater horn) Middle pharyngeal constrictor muscle Epiglottis Inferior pharyngeal constrictor muscle Cuneiform tubercle Corniculafe tubercle (Transverse and oblique) arytenoid muscles Posterior cricoarytenoid muscle Cricopharyngeal muscle (part of inferior pharyngeal constrictor) Longitudinal esophageal muscle

toyvw-

Stylopharyngeus muscle Pharyngoepiglottic fold Aryepiglottic fold Inferior pharyngeal constrictor muscle (cut

edge)

Longitudinal pharyngeal muscles Superior horn of thyroid cartilage Thyrohyoid membrane Internal branch of superior laryngeal nerve Pharyngeal aponeurosis Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Posterior border of thyroid cartilage lamina Cricoid attachment of longitudinal esophageal muscle Circular esophageal muscle

Pharynx

Plate 67

Eg

Muscles of Pharynx: Lateral View

Pharyngobasiiar fascia

N9HMI

Tensor veli palatini muscle Levator veli palatini muscle Lateral pterygoid plate

Pterygoid hamulus Buccinator muscle (cut)

Pterygomandibularraphe

Digastric muscle (posterior belly) (cut)

Buccinator crest of mandible

Styloid process Superior pharyngeal constrictor muscle Styloglossus muscle

Oblique line of mandible

Stylohyoid ligament Stylopharyngeus muscle Middle pharyngeal constrictor muscle Hyoglossus muscle Greater horn of hyoid bone


Superior horn of thyroid cartilage

Mylohyoid muscle

Thyrohyoid membrane Inferior pharyngeal constrictor muscle

Hyoid bone

Tendinous arch

Stylohyoid muscle (cut)

Zone of sparse muscle fibers

Thyroid cartilage Median cricothyroid ligament

C ri co p h a ryn ge u s muscle (part of inferior pharyngeal constrictor)

Cricothyroid muscle Cricoid cartilage

Esophagus

Trachea

Plate 68

Pharynx

Arteries of Oral and Pharyngeal Regions asm

See also

From f Supraorbital artery ophthalmic < artery

/IV. .

Plates 34, 40

_

ml

( Supratrochlear artery Middle meningeal artery

S'/iiiV

B

Deep temporal arteries Dorsal nasal artery Masseteric artery Angular artery Infraorbital artery Sphenopalatine artery Transverse facial artery (cut)

Descending palatine artery Posterior superior alveolar artery


Superior labial artery Buccal artery

Maxillary artery

Buccinator muscle and parotid duct (cut)

Posterior auricular artery Ascending pharyngeal artery

Inferior labial artery

Occipital artery and sternocleidomastoid branch



Mental branch of inferior alveolar artery

Ascending palatine artery Tonsillar artery

Inferior alveolar artery and lingual branch

Facial artery

Facial artery Submental artery Mylohyoid branch of inferior alveolar artery Submandibular gland Hypoglossal nerve (XII) Suprahyoid artery External carotid artery Superior laryngeal artery Superior thyroid artery Cricothyroid artery Common carotid artery Vertebral artery Subclavian artery

Pharynx

Lingual artery Ascending pharyngeal artery Internal carotid artery Vagus nerve (X) Superior cervical cardiac nerve Sympathetic trunk Anterior scalene muscle Phrenic nerve Middle scalene muscle Ascending cervical artery Inferior thyroid artery Superficial cervical artery Suprascapular artery Costocervical trunk Thyrocervical trunk

Plate 69

mm

Veins of Oral and Pharyngeal Regions ........ -•....,,.....,..,.........• See also

••.: x;•• ;

'..,.".:/ ""."":

.... . .. ....... .. ...---• -

:;;;..; :.

r"::

" • • :.'•'.:;/:v.::v;".;' 'r:::;

Plates 23, 31, 104

Supratrochlear vein Supraorbital vein Nasofrontal vein Superior ophthalmic vein Angular vein External nasal vein Emissary vein (of Vesalius) communicating with cavernous sinus Infraorbital vein

Occipital vein and artery

Posterior superior alveolar veins

Superficial temporal vein and artery

Palatine vein Pterygoid plexus

Transverse facial vein (cut)

Superior labial vein

Posterior auricular vein Retromandibular vein (anterior and posterior branches)

Deep facial vein Maxillary veins

External jugular vein (cut)

Inferior labial vein

Inferior alveolar vein and artery

Mental vein Facial vein and artery

Occipital vein and artery

External palatine vein


Submental vein Submandibular gland Vena co mi tans of hypoglossal nerve Dorsal lingual vein coursing medial to hyoglossus muscle Lingual vein Communication to anterior jugular vein (cut) Superior laryngeal vein Superior thyroid vein Thyroid gland Middle thyroid vein Inferior thyroid veins Termination of anterior jugular vein (cut) Left brachiocephalic vein

POat®

7©

Common trunk receiving facial, anterior branch of r e t r o m a n d i b u I a r, a n d lingual veins (common facial vein) External carotid artery Internal jugular vein Common carotid arteryVagus nerve (X) and sympathetic trunk Middle scalene muscle Anterior scalene muscle External jugular vein (cut) Transverse cervical vein (cut) Suprascapular vein (cut) Subclavian artery Subclavian vein

Pharynx

Nerves of Oral and Pharyngeal Regions mammm

See also

Plates 25, 45, 46, 122, 125, 126

Zygomaticotemporal nerve (V 2 > Deep temporal nerves (V 3 ) Masseteric nerve (V 3 )

mmm

'i

Mandibular nerve (V 3 ) Nerve to medial pterygoid and tensor veli palatini muscles (V 3 ) (cut) Zygomaticofacial nerve (V 2 ) M M


-'fflmmOt-t

Infraorbital nerve (V 2 ) P t e r y g o p a latinegangl i o 1i Greater and lesser palatine nerves (V 2 )

Auriculotemporal nerve (V 3 )

Anterior, middle, and posterior ^ superior alveolar nerves (V 2 ) Nerve to lateral pterygoid muscle (V 3 ) (cut)

Middle meningeal artery Superficial temporal artery (cut)

Buccal nerve (V:$)

Facial nerve (VII) (cut)

Chorda tympani nerve (VII)

Maxillary artery

Lingual nerve (V 3 )

Accessory nerve (XI) (cut)

Medial pterygoid muscle (cut) (lateral pterygoid removed)

C I spinal nerve (ventral ramus) (cut)

C2 spinal nerve (ventral ramus) (cut)

Inferior alveolar nerve (V 3 ) Mental nerve ( V 3 ) ^ \ , Nerve to mylohyoid (V 3 ) Submandibular ganglion Glossopharyngeal nerve (IX) and tonsillar branch Hypoglossal nerve (XII) Carotid nerve (IX) and carotid body Nerve to thyrohyoid muscle (CI, 2 via XII) Internal and external branches of superior laryngeal nerve (X). - i^ nx ( Superior root Ansa cervicalis (CI,2, 3) ) ' Inferior root Nerves to superior and inferior bellies of omohyoid, sternohyoid, and sternothyroid muscles (ansa cervicalis) Recurrent laryngeal nerve (X)

Pharyngeal plexus composed of branches from glossopharyngeal (IX), vagus (X), and sympathetic nerves Internal carotid artery External carotid artery Vagus nerve (X) and superior cervical cardiac branch C4 spinal nerve (ventral ramus) (cut) Phrenic nerve (C3, 4, 5) •Ascending cervical artery Middle scalene muscle -Anterior scalene muscle Brachial plexus (cut)

Sympathetic trunk and middle cervical ganglion Common carotid artery

Thyrocervical trunk

Vertebral artery f>-— Subclavian artery )

Plate 71

Lymph Vessels and Nodes of Head and Neck jJJjjiJfj vi/jy./lv

BwnagR See also

krhssk

Plate 208

Superficial parotid nodes (deep parotid nodes deep to and within parotic! gland) mm

Subparotid node Facial nodes Nasolabial Buccinator

Occipital nodes Mastoid nodes

Mandibular nodes

Sternocleidomastoid nodes

Submandibular nodes

Superior lateral superficial cervical (external jugular) node Jugulodigastric node

Submental nodes Suprahyoid node Superior deep lateral cervical (internal jugular) nodes Superior thyroid nodes Juguloomohyoid node Anterior deep cervical (pretracheal and thyroid) nodes (deep to infrahyoid muscles) Anterior superficial cervical nodes (anterior jugular nodes)

Posterior lateral superficial cervical (spinal accessory) nodes

Intercalated node Inferior deep lateral cervical (scalene) node Thoracic duct Transverse cervical chain of nodes

Jugular trunk S upraclavi cuI ar nodes" Subclavian trunk and node

*The supraclavicular group of nodes (also known as the lower deep cervical group), especially on the left, are also sometimes referred to as the signal or sentinel lymph nodes of Virchow or Troisier, especially when sufficiently enlarged and palpable. These nodes (or a single node) are so termed because they may be the first recognized presumptive evidence of malignant disease in the viscera.

Plate 72

Pharynx

Lymph Vessels and Nodes of Pharynx and Tongue •

Rectus capitis anterior muscle (cut) •

. - * ••

;.v.

M. \

ft'*

•


-..A

Retropharyngeal nodes

\ V


^

Digastric muscle (posterior belly) Sternocleidomastoid muscle Intercalated node Jugulodigastric node

Deep lateral cervical (internal jugular) nodes Juguloomohyoid node

Apical collecting vessels Central collecting vessels Marginal collecting vessels Basal collecting vessels Communication to opposite side

Lymphatic drainage of pharynx: posterior view

Lymphatic drainage of tongue

Submental node Submandibular node Jugulodigastric node Deep lateral cervical (internal jugular) nodes Juguloomohyoid node

Pharynx

Plate 73

H

H

Thyroid Gland: Anterior View

Hyoicl bone


Superior laryngeal nerve Internal branch External branch

Internal carotid Superior thyroid artery and vein Superior laryngeal artery

Thyroid cartilage (lamina) Median cricothyroid ligament

Thyrohyoid membrane Ansa S Superior root cervicalis ( Inferior root

Cricothyroid muscles Cricoid cartilage


Pyramidal lobe (often absent or small) Right lobe Left lobe Isthmus

Internal jugular vein Middle thyroid vein Inferior thyroid veins Ascending cervical artery

\ / ( / \ /

Thyroid gland

Pretracheal lymph nodes

Inferior thyroid artery-

Phrenic nerve


Anterior scalene muscle

Suprascapular a r t e r y —

Vagus nerve (X)

Thyrocervical trunk


Subclavian artervi and vein

Anterior jugular vein 1 st rib {cut)

Vagus nerve (X)

Left recurrent laryngeal nerve

Right recurrent laryngeal nerve B rach i oce p h a I i c I r u n k Brachiocephalic veins Superior vena cava Aortic arch

Thyroid cartilage Cricothyroid ligament Common carotid artery Medial margin of sternocleidomastoid muscle Cricothyroid muscle Cricoid cartilage Thyroid gland Cupula (dome) of pleura Trachea

Plate 74


Thyroid Gland and Pharynx: Posterior View

Superior pharyngeal constrictor muscle Middle pharyngeal constrictor muscle

External carotid artery Internal carotid artery Facial artery

Tip of greater horn of hyoid bone

Lingual artery


Superior laryngeal nerve Internal branch External branch

Pharyngeal raphe Zone of sparse muscle fibers

Superior thyroid artery Superior laryngeal artery

Cricopharyngeus muscle (part of inferior pharyngeal constrictor)

C o m m o n carotid artery

Circular esophageal muscle in V-shaped area of sparse longitudinal muscle fibers (area of Laimer)


Longitudinal esophageal muscle Inferior thyroid vein Trachea Inferior bulb of internal jugular vein Vertebral artery

Vagus nerve (X)

Thyroid gland (right lobe) Superior parathyroid gland Ascending cervical artery Inferior parathyroid gland Inferior thyroid artery Right recurrent laryngeal nerve Superficial cervical artery Suprascapular artery

Left subclavian artery and vein

Thyrocervical trunk Right subclavian artery and vein

Internal thoracic artery and vein Left brachiocephalic vein Left recurrent laryngeal nerve Arch of aorta Left vagus nerve (X)


Right brachiocephalic vein Brachiocephalic trunk Right vagus o nerve (X) Superior vena cava

Plate 75

Parathyroid Glands See also

Plate 80

Posterior view

Thyrohyoid membrane


/ H y o i d bonev


Superior laryngeal nerve Internal branch Externa) branch

Superior thyroid artery Superior laryngeal artery

Vagus nerve (X)

Inferior pharyngeal constrictor muscle (cut)

Epiglottis

Common carotid artery Superior thyroid artery

Fibrous capsule of (cut)

Common carotid artery Fibrous capsule of thyroid gland (cut) Superior parathyroid gland Left lobe of thyroid gland Ascending cervical artery Inferior parathyroid gland Left recurrent laryngeal nerve

Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Superior parathyroid gland Right lobe of thyroid gland Inferior parathyroid gland (may be more caudally located, even within mediastinum) Inferior thyroid artery Right recurrent laryngeal nerve Superficial cervical artery •r-


Esophagus

Thyrocervical trunk

Subclavian artery

Vertebral artery Subclavian artery

Trachea


Right lateral view External carotid Superior laryngeal artery Superior thyroid artery Inferior pharyngeal constrictor muscle Common carotid arte Internal jugular vein Inferior thyroid artery Right recurrent laryngeal nerve Esophagus

Plate 76

Internal branch of superior laryngeal nerve External branch of superior laryngeal nerve Superior parathyroid gland Thyroid gland (right lobe) (retracted

anteriorly)

Inferior parathyroid gland

Cartilages of Larynx

-Epiglottis—

_

Hyoid :

ff| ^^^-Thyrohyoid membrane-^^ Superior horn of thyroid cartilage Corniculate c a r t i l a g e - ^ ^

y| |

t i

Arytenoid cartilage Superior thyroid notch

—-Thyroid cartilage lamina——_

Vocal ligament-

Median cricothyroid ligament

J ^ ^ - I n f e r i o r -Cricoid horn of thyroid cartilagecartilageTrachea^—_ KV-V >>••«..A
,,

Anterior view

Cricoid cartilage

Posterior view Corniculate cartilage

Arytenoid articular surface

Muscular process Vocal process

Lamina

Arytenoid cartilage

Anterosuperior view ___——Epiglottis Hyoepiglottic ligament-—

b

Hyoid bone

-Thyrohyoid membrane-Thyroid cartilage lamina ^ ^

Oblique line

--Laryngeal prominence Corniculate cartilage —

• I

Arytenoid cartilage-— Muscular p r o c e s s — Median Lateral

Vocal processVocal ligament-"""""^ Thyroepiglottic ligament — Cricothyroid ligament" ^ • C r i c o i d cartilage— ^ " C r i c o t h y r o i d joint

Right lateral view


^ ^ ^ ^ T r a ch e a

^ ^ ^

Medial view, median (sagittal) section

Plate 77

Intrinsic Muscles of Larynx vw&mSBS :'•

mm mexmrnm

Epiglottis

Foramen for superior laryngeal vessels and internal branch of superior laryngeal nerve

Aryepiglottic Cuneiform tubercle

Oblique and transverse arytenoid muscles

Corniculate tubercle Aryepiglottic muscle

Posterior cricoarytenoid muscle

Oblique arytenoid muscle Transverse arytenoid muscle

Straight ] part ( Oblique ( part )

Posterior cricoarytenoid muscle

Cricothyroid muscle

Cricoid cartilage

Right lateral view

Posterior view Epiglottis Aryepiglottic muscle muscle Oblique and transverse arytenoid m Posterior cricoarytenoid muscle Thyroid articular surface

piglottic

Arytenoid I Muscular cartilage, ) V o c a l

Thyroarytenoid muscle

Lamina of cricoid cartila

Lateral cricoarytenoid muscle Conus elasticus

Cricothyroid muscle (cutaway)

Lateral dissection Posterior cricoarytenoid muscle Lateral cricoarytenoid muscle Transverse and oblique arytenoid m Cricothyroid muscle

Conus elasticus

Thyroarytenoid muscle Vocalis muscle

Lamina of thyroid cartilage

Vocal ligament

Superior view

Plate 78


Cricothyroid joint (pivot point)

Action of cricothyroid muscles Lengthening (increasing tension) of vocal ligaments

Action of posterior cricoarytenoid muscles

Action of lateral cricoarytenoid muscles

Abduction of vocal ligaments

Adduction of vocal ligaments

Action of transverse and oblique arytenoid muscles Adduction of vocal ligaments


Action of vocalis and thyroarytenoid muscles Shortening (relaxation) of vocal ligaments

Plate 79

See also

Plates 74-76, 235

Superior laryngeal nerve

Internal branch of superior laryngeal nerve Sensory branches to larynx

Internal branch External branch

of Galen Aryepiglottic muscle Thyroepiglottic muscle


Transverse and oblique arytenoid muscles Thyroarytenoid muscle Vocalis muscle

Cricothyroid muscle Cricopharyngeus muscle (part of inferior pharyngeal constrictor) Right recurrent laryngeal nerve

Lateral cricoarytenoid muscle Posterior cricoarytenoid muscle d articular surface nterior and posterior branches of inferior laryngeal nerve Right recurrent laryngeal nerve

Right lateral view: thyroid cartilage lamina removed Right lateral view

Left vagus nerve (X) Right vagus nerve (X)

r

>f

Left common carotid artery Anomalous right inferior laryngeal nerve (not recurrent)

Left inferior laryngeal nerve

Left recurrent laryngeal nerve Anomalous (retroesophageal) right subclavian artery Left subclavian artery Right common carotid artery

malous (retroesophageal) right subclavian artery originating from left side of aortic arch

Arch of aorta Left recurrent laryngeal nerve

Anterior view: anomalous right inferior laryngeal nerve, not recurrent, associated w i t h anomalous right subclavian artery

Plate 80

Superior palpebral conjunctiva: tarsal (meibomian) glands shining through Seen through \ cornea

Superior lacrimal papilla and punctum Plica semilunaris

Pupil

Lacrimal caruncle in lacrimal lake (lacus lacrimalis)

Corneoscleral junction (corneal limbus)

Inferior lacrimal papilla and punctum

Bulbar conjunctiva over sclera Inferior conjunctival fornix Inferior palpebral conjunctiva: tarsal glands shining throu^,.

Levator palpebrae superioris muscle Orbital septum Sclera

Superior tarsal (Muller's) muscle (smooth)

Bulbar conjunctiva

Superior conjunctival fornix Orbicularis oculi muscle (palpebral part)

Palpebral conjunctiva

Superior tarsus

Cornea

Tarsal (meibomian) glands

Lens

Sebaceous glands

Anterior chamber

Eyelashes (cilia)

Iris

Openings of tarsal gla

Posterior chamber

Inferior tarsus Orbicularis oculi muscle (palpebral part) Inferior conjunctival fornix Orbital septum

Frontal bone Insertion of levator palpebrae superioris muscle Orbital septum Superior tarsus Lateral palpebral ligament and overlying raphe Inferior tarsus Orbital septum Zygomatic bone

Orbit and Contents

Supraorbital artery and nerve Supratrochlear artery and nerve Dorsal nasal artery and infratrochlear nerve Lacrimal sac Medial palpebral ligament Maxilla (frontal process) Infraorbital artery and nerve

Plate 81

.Mh

R •BrasB i i i '

pilf lir

ftftit gSRSfS^Jy

Lacrimal Apparatus îSKfBMSfiBRRW-' ^^CyMfrfry'^^^

See also

vftôi'xiwSwc^JiWy.v^ji atiK^'wNwKvi.*!!KJ5 .', •

IM-Wei

Plates 45, 133

Superior lacrimal papilla and punctum Orbital part of lacrimal gland

Palpebral part of lacrimal gland

Excretory ducts of lacrimal gland

Plica semilu

Lacrimal canaliculi

Lacrimal sac

Nasolacrimal duct

Opening of nasolacrimal duct

Lacrimal caruncle

Inferior lacrimal papilla and punctu

Superior lacrimal papilla and punctum Frontal bone (cut

Orbital part of lacrimal gland

Lacrimal canaliculi

Lacrimal sac Palpebral part of lacrimal gland Nasolacrimal duct Excretory ducts of lacrimal gland

Plica semilunaris and lacrimal lake

Middle nasal concha

Nasal cavity Lacrimal caruncle

Inferior lacrimal papilla and punctum

Opening of nasolacrimal duct

Plate 82

Inferior nasal concha (cut)


Horizontal section

Tarsus of eyelid I conjunctiva

Medial palpebral ligament

Bulbar conjunctiva

Nasal cavity

Cornea

Check ligament of medial rectus muscle

Lateral palpebral ligament

Ethmoidal cells

Check ligament of lateral rectus muscle Periorbita

Periorbita

Sclera

Medial rectus muscle and fascial sheath

Fascial sheath of eyeball (Tenon's capsule)

Fascial sheath of eyeba I (Tenon's capsule)

Episcleral space Lateral rectus muscle and fascial sheath

Sclera Episcleral space

Retrobulbar fat (orbital fat body)

O p t i c nerve (II) and outer sheath'

C o m m o n tendinous ring

Sphenoidal sinus Levator palpebrae superioris muscle and fascial sheath

Frontal section

Superior o b l i q u e muscle and fascial sheath Medial rectus muscle and fascial sheath

Superior rectus muscle and fascial sheath

Periorbita

Lacrimal gland

Ethmoidal cell

Lateral rectus muscle and fascial shealh

Sclera Fascial sheath of eyeball (Tenon's capsule)

Periorbita Scl

Inferior rectus muscle and fascial sheath

Fascial sheath of eyeba (Tenon's capsule)

Inferior oblique muscle and fascial sheath

Episcleral space Retrobulbar fat (orbital fat body)

Infraorbital nerve (V 2 )

Muscle attachments and nerves and vessels entering o r b i t Superior orbital f

i

s

s

u

r

e

L

e

v

Lacrimal nerve

r

palpebrae superioris muscle

Medial rectus muscle nerve

-^^^ffi

Superior branch of o c u l o m o t o r nerve ( I I I ) ^ ^

j

Inferior orbital f i s s u r e ^ ^ / Abducent nerve (VI)

Orbit and Contents

o

Superior rectus muscle

Trochlear nerve ( I V ) ^ ^ ^ ^

Lateral rectus muscle

t

— - S u p e r i o r oblique muscle

Frontal nerve ( V , ) Superior ophthalmic vein

a

(ll)

artery

\

\ \

in optic canal

^ - I n f e r i o r rectus muscle ^ I n f e r i o r branch of o c u l o m o t o r nerve (III)

Nasociliary nerve (Vj)

Plate 83

Right lateral view

Superior oblique muscle Levator palpebrae superioris muscle Superior rectus muscle Medial rectus muscle

Optic nerve (II) Lateral rectus muscle (cut)

C o m m o n tendinous ring

Lateral rectus muscle (cut)

Inferior oblique muscle

Inferior rectus muscle

Superior tarsus

Superior view Levator palpebrae superioris muscle (cut) Superior oblique muscle Medial rectus muscle

Superior rectus muscle (cut) Lateral rectus muscle

„

*

Optic nerve (II) Common tendinous ring

Superior rectus muscle (cut) Levator palpebrae superioris muscle (cut)

Innervation of extrinsic eye muscles: anterior view

Superior oblique muscle

Trochlear nerve (IV)


Abducent nerve (VI)

Levator palpebrae superioris muscle Oculomotor nerve (III)

Superior rectus muscle Medial rectus muscle Inferior rectus muscle Inferior oblique muscle

Plate 84

Orbit and Contents

liilpfil: mMmrn

See also

Plates 23,104

Medial palpebral artery

Superior view

Lateral palpebral artery

Supratrochlear artery

Lacrimal gland

Dorsal nasal artery

Supraorbital artery Anterior meningeal artery

Zygomatic branches

Anterior ethmoidal artery

Posterior ciliarv arteries

Posterior ethmoidal artery

Muscular branch

Continuation of ophthalmic artery-

Lacrimal artery

Muscular branch

Central retinal artery

Ophthalmic artery Internal carotid artery

Supraorbital artery Supratrochlear artery Dorsal nasal artery

Anterior view

Superior medial palpebral artery

Frontal branch of superficial temporal artery

Angular artery Inferior medial palpebral artery

Superior lateral palpebral arteryInferior lateral palpebral artery

Superior and inferior palpebral arterial arches

Zygomaticofacial artery

Facial artery

Transverse facial arterv Infraorbital artery

(X = anastomosis of vessels from external and internal carotid arteries)

Supratrochlear vein

Lateral view

Supraorbital vein Superior ophthalmic vein

Cavernous sinus

Nasofrontal vein Angular vein Vorticose veins Facial vein

Inferior ophthalmic vein-—' Pterygoid plexus Maxillary vein-—. Retromandibular vein

Orbit and Contents

Deep facial vein

Plate 85

Nerves of Orbit See also

Plates 45, 121, 132

Superior view Supratrochlear nerve Medial rectus muscle

Medial branch ) Supraorbital nerve Lateral branch ) Levator palpebrae superioris muscle Superior rectus muscle Lacrimal gland


Lacrimal nerve

Infratrochlear nerve


Nasociliary nerve

Frontal nerve



Common tendinous ring

Meningeal branch of maxillary nerve

Ophthalmic nerve (V-j)


Optic nerve (II)

Lesser petrosal nerve

Internal carotid artery and nerve plexus

Meningeal branch of mandibular nerve

Oculomotor nerve (III) Trochlear nerve (IV) Abducent nerve (VI) Tentorium cerebelli

Superior view: levator palpebrae superioris, superior rectus, and superior oblique muscles partially cut away Supratrochlear nerve (cut) Supraorbital nerve branchesfcuO Infratrochlear nerve Anterior ethmoidal nerve Optic nerve (II) Posterior ethmoidal nerve Superior branch of oculomotor nerve (III) Nasociliary nerve Internal carotid plexus Trochlear nerve (IV) {cut) Oculomotor nerve (III) Abducent nerve (VI)

Plate 86

Greater petrosal nerve Trigeminal (semilunar) ganglion Tentorial (meningeal) branch of ophthalmic nerve

Long ciliary nerves Short ciliary nerves Lacrimal nerve Ciliary ganglion Parasympathetic root of ciliary ganglion (from inferior branch of oculomotor nerve) Sympathetic root of ciliary ganglion (from internal carotid plexus) Sensory root of ciliary ganglion (from nasociliary nerve) Branches to inferior and medial rectus muscles Abducent nerve (VI) Inferior branch of oculomotor nerve (III) Lacrimal nerve Frontal nerve (cut) Ophthalmic nerve (V,)

Orbit and Contents

Eyeball

Horizontal section

Cornea

Zonular fibers (suspensory ligament of lens)

Capsule of lens

Anterior chamber Posterior chamber

Scleral venous sinus (canal of Schlemm)

Iridocorneal angle

Scleral spur

Ciliary processes

Ciliary body and ciliary muscle

Bulbar conjunctiva

Ciliary part of retina

Ora serrata

Tendon of lateral rectus muscle

Tendon of medial rectus muscle ::

•fflmm. V

mm

SfflH -Si.'/'Mi/W:

mrnmmmi

M

M

Optic (visual) part of retina \ itreous body

Choroid

•Hyaloid canal

Perichoroidal space Sclera

•Lamina cribrosa of sclera

Fascial sheath of eyeball (Tenon's capsule)

Optic nerve (II)

Episcleral space Fovea centralis in macula (lutea)

Central retinal artery and vein

Outer sheath of optic nerve Subarachnoid space

Orbit and Contents

Plate 87

Schwalbe's line Trabecular meshwork and spaces of iridocorneal angle (of Fontana)

Posterior limiting lamina (Descemet's membrane) Endothelium of anterior chamber


Cornea

Scleral spur Iridocorneal angle Pectinate ligament Major arterial circle of i r i s — \

\

\

Anterior chamber

onjunctiva Sclera \

Minor arterial circle of iris

Posterior chamber

Ciliary process Ciliary part of retina

Meridional fibers

Circular fibers

Dilator pupillae muscle Zonular fibers (suspensory ligament of lens)

Pigment epithelium (iridial part of retina)

Nucleus of

Sphincter pupillae muscle

Note: For clarity, only single plane of zonular fibers shown; actually, fibers surround entire circumference of lens.

Plate 88

Orbit and Contents

Lens and Supporting Structures

Sclera Choroid Optic part of retina Ora serrata Orbiculus ciliaris of ciliary body covered by ciliary part of retina

Nucleus Capsule Cortex

Ciliary processes Zonular fibers Anterior chamber

Lens

Iris Posterior chamber Ciliary body

Eyeball sectioned in frontal plane: anterior segment viewed f r o m behind

Ciliary

Preequatorial Zonular fibers <( Equatorial Postequatorial Orbiculus ciliaris of ciliary body Ora serrata

Horizontal section

Optic part of retina Ora serrata Optic part of retina

i

Orbiculus ciliaris of ciliary body covered by ciliary part of retina

Zonular fibers fanning out and blending into lens capsule Zonular fibers

xm

Enlargement of segment outlined in top illustration (semischematic)

Orbit and Contents

Plate 89

of Eye

Cornea


Anterior chamber

Major arterial circle of iris


Blood vessels of ciliary body Bulbar conjunctiva and conjunctival vessels Anterior ciliary artery and vein

Iridocorneal angle Posterior cham

Muscular artery and vein

Zonular fibers

Extrinsic eye muscle

Retina Vitreous chamber

Long posterior ciliary artery Choroid

Sclera Vorticose vein Episcleral artery and vein f

Retinal artery and vein

Long posterior ciliary artery Short posterior ciliary arteries Central retinal artery and vein

Optic nerve (II)

Superior temporal retinal arteriole and venule

Superior macular arteriole and venule Superior nasal retinal arteriole and venule

Macula Fovea centralis

Inferior temporal retinal arteriole and venule

Right retinal vessels: ophthalmoscopic view

Plate 90

Inferior nasal retinal arteriole and venule Inferior macular arteriole and venule

Orbit and Contents

Vascular arrangements within the choroid (vascular tunic) of the eyeball Anterior ciliary arteries

Anterior tributaries of a vorticose vein

Tendon of superior rectus muscle

Episcleral vein* Junctions of suprachoroidal tributaries forming vorticose vein

Sclera

Superior ophthalmic vein

Posterior conjunctival artery and vein

Bulb of vorticose (choroid) vein Vorticose (choroid) vein

Anterior ciliary veins

Long posterior ciliary artery Major arterial circle of iris Short posterior ciliary arteries


External sheath of tic nerve (dura mater)

Conjunctiva and cornea

Internal sheath of optic nerve (pia-arachnoid mater)

Short posterior ciliary arteries

Central retinal artery and vein

Arteries and veins of iris Scleral venous sinus (canal of Schlemm)

Vessels of internal sheath of optic nerve

Veins draining scleral venous sinus (into anterior ciliary veins)

Short posterior ciliary arteries

Anterior ciliary veins Nonpigmented and pigmented regions of the retina Recurrent branch of anterior ciliary artery

Segment of episcleral vein* Muscular artery

Inferior ophthalmic vein Posterior tributaries of a vorticose vein

*The episcleral veins are shown here anastomosing with the vorticose veins, which they do; however they also drain into the anterior ciliary veins.

Orbit and Contents

/

Plate 91

Pathway of Sound Reception

Frontal section

Facial nerve (VII) (cut) Limbs of stapes

Prominence of lateral semicircular canal Incus Tegmen tympani

Base of stapes in oval (vestibular) w i n d o w Vestibule Semicircular ducts, ampullae, utricle, and saccule Facial nerve (VII) (cut)

Malleus (head)

Vestibular nerve

Epitympanic recess

Cochlear nerve

i

Auricle

Internal acoustic meatus Vestibulocochlear nerve (VIII)

/

External

Helicotrema

acoustic meatus

Nasopharynx

Scala vestibuii

Tympanic membrane Tympanic cavity Promontory Round (cochlear) w i n d o w

Cochlear duct containing spiral organ (of Corti)

Cochlea

Scala tympani

Auditory (pharyngotympanic, Eustachian) tube Note: Arrows indicate course of sound waves.

Plate 92

External Ear and Tympanic Cavity

Right auricle (pinna) Triangular fossa

Otoscopic view of right tympanic membrane Crux of helix External acoustic meatus

Helix Scaphoid fossa

Pars flaccida tiaccida

Lateral process of malleus

Posterior mallear fold Anterior mallear fold

Crura of antihelix

Long limb of incus

Auricular tubercle (of Darwin) Antihelix

Handle of malleus

Tragus

Concha of auricle

Umbo

Intertragic notch Antitragus

Lobule of auricle

Cone of light

Tympanic Pars tensa

Coronal oblique section of external acoustic meatus and middle ear (tympanic cavity) Epitympanic recess Superior ligament of malleus

Tegmen tympani Dura mater Head of malleus Long limb of incus

Short limb of incus

Tendon of stapedius muscle Footplate of stapes Handle of malleus

Chorda tympani nerve (cut)

Promontory with tympanic plexus

Anterior ligment of malleus {cut)

tympani muscle

Tympanic membrane Tensor veli palatini muscle


Auditory (pharyngotympanic, Eustachian) tube Right tympanic cavity after removal of tympanic membrane (lateral view) Chorda tympani nerve ^ Long limb of incus

Lateral

Proce5S of malleus Tendon of tensor tympani muscle Ossicles articulated: medial view

Prominence of facial canal

Pyramidal eminence and tendon of stapedius muscle Stapes Fossa of round w i n d o w Tympanic nerve

Ear

Malleus

Handle of malleus Tympanic

Incus

Lenticular process of incus Stapes

CMc^ML * —

Lesser petrosal nerve Tympanic plexus on promontory

Plate 93

Tympanic Cavity See also

Plates 46, 123, 124, 135

Lateral w a l l o f t y m p a n i c c a v i t y : m e d i a l ( i n t e r n a l ) v i e w Superior ligament of malleus

Head of malleus

Superior ligament of incus

Epilympanic recess

Short limb of incus

Anterior process of malle

Posterior mallear fold

Chorda tympani

Posterior ligament of incus

Anterior mallear fold

Long limb of incus

Tensor tympani muscle


Handle of malleus

Lenticular process of incus

Tympanic membrane (pars tensa)

Facial nerve (VII)

Auditory (p h a r y n g o ty m p a n i c, Eustachian) tube Internal carotid artery

M e d i a l wall of t y m p a n i c cavity: lateral view

Prominence of lateral semicircular canal V

"""

Prominence of facial canal

Mastoid antrum

Geniculum (geniculate ganglion) of facial nerve Base of stapes in fossa of oval (vestibular) window

Greater petrosal nerve Tensor tympani muscle (tendon

Limbs of stapes Pyramidal eminence

cut)

Auditory (pharyngotympanic, Eustachian) tube

Chorda tympani nerve (cut)

Levator veli palatini m uscle

Mastoid cells Tendon of stapedius muscle

Promontory with tympanic nerve (of Jacobson) and plexus under mucosa

Fossa of round (cochlear) w i n d o w

Internal carotid artery Facial nerve (VII) in stylomastoid foramen

Plate 94

Tympanic, cells

Ear

Bony and Membranous Labyrinths See also

Right bony labyrinth (otic capsule), anterolateral view: surrounding cancellous bone removed Posterior Lateral Anterior ^

Plate 124

Dissected right bony labyrinth (otic capsule): membranous labyrinth removed D

Semicircular canals

osterior Lateral Anterior

Semicircular canals

Elliptical recess

mmon bony limb

Cochlear recess

mpullae

Spherical recess

Vestibule Cochlea

Vestibule (note perforations for nerve fibers) H el i cot re ma

Hamulus of spiral lamina Oval (vestibula window

Internal opening of vestibular aqueduct (for endolymphatic duct)

Cochlear cupula

Round (cochlear) window

Scala vestibuli Osseous spira lamina

Round (cochlear) window

Scala tympani

Right membranous labyrinth w i t h nerves: posteromedial view Anterior semicircular duct Superior part of vestibular nerve (from utricle and anterior and lateral membranous ampullae)

Anterior membranous ampulla

Utricle

Lateral membranous ampulla

Cochlear duct (basal turn)

Common membranous limb

Coc hlear nerve

Lateral semicircular duct Posterior semicircular duct

Vestibulocochlear nerve (VIII) Vestibular nerve

Posterior membranous ampulla

Vestibular ganglion Inferior part of vestibular nerve (from saccule and posterior membranous ampulla)

Ear

Endolymphatic duct

Plate 95

Bony and Membranous Labyrinths (continued)

Bony and membranous labyrinths: schema Anterior semicircular canal and duct Dura mater

Posterior semicircular canal and cluct

|-r

Common bony and membranous limbs Lateral semicircular canal and duct

§mm mmm mmm

Endolymphatic sac Endolymphatic duct in vestibular aqueduct Utricle Saccule

Otic capsule

Helicotrema of cochlea

Stapes in oval (vestibular) window

Ductus reuniens

Incus

Scala vestibuli

Malleus

Cochlear duct

Tympanic cavity

— Scala tympani

External acoustic meatus Umbo . . .

' ' • : . ' .

Tympanic membrane Round (cochlear) window (closed by secondary tympanic membrane)

Vestibule

Otic capsule

Pharyngotympanic (auditory) tube

Section through turn of cochlea Scala vestibuli Osseous spiral lamina

Nerve fibers

Vestibular (Reissner's) membrane Cochlear duct Spiral ligament Tectorial membrane Spiral organ (of Corti)

Spiral ganglion

Scala tympani

Basilar membrane Osseous cochlea Outer hair cells

Cochlear nerve

Pillar (rod) cells Inner hair cell

Plate 96

Orientation of Labyrinth in Skull HBHWMBBHHMBB^SS

Superior projection of right bony labyrinth on floor of skull

Groove for greater petrosal nerve Geniculum (geniculate ganglion) of facial nerve

Cochlea /

Cochlear nerve

z Plane of anterior semicircular canal

Facial nerve (VII) Internal acoustic opening Vestibulocochlear nerve (VIII)

Lateral semicircular canal

Vestibular nerve Petrous part of temporal bone External opening of vestibular aqueduct (for endolymphatic cluct)

Plane of posterior semicircular canal

Lateral projection of right membranous labyrinth Cochlear duct


Cochlear nerve Trigeminal nerve (V)

uperior part of vestibular nerve

Vestibulocochlear nerve (VIII)

Internal jugular vein Inferior part of vestibular nerve

Anterior semicircular cluct

Lateral semicircular cluct Cerebellum Posterior semicircular duct Superior petrosal sinus Sigmoid sinus Confluence of sinuses Transverse sinus

Ear

Plate 97

Auditory (Pharyngotympanic, Eustachian) Tube See also

Plates 5 2 , 5 5 , 6 5

Cartilaginous part of auditory (pharyngotympanic, Eustachian) tube at base of skull: inferior view Palatine process of maxilla Pterygoid hamulus and medial pterygoid plate


Lateral pterygoid plate

Choana ) of cartilaginous part of Lateral lamina ( auditory (pharyngotympanic, Medial lamina) Eustachian) tube

Scaphoid fossa Foramen ovale

Foramen I ace rum

Foramen spinosum

— Petrous part of temporal bone

Spine of sphenoid bone

Occipital condyle

Internal carotid artery entering carotid canal Mastoid process

Foramen magnum

Section through cartilaginous part of auditory (pharyngotympanic, Eustachian) tube, with tube closed

Section through cartilaginous part of auditory (pharyngotympanic, Eustachian) tube, w i t h tube open Trigeminal ganglion

Trigeminal ganglion Internal carotid artery in carotid canal Dura mater Lateral lamina of cartilage

Internal carotid artery in carotid Dura mater Lateral lamina of cartilage Medial lamina of cartilage

Medial lamina of cartilage Auditory tube lumen Tensor veli palatini muscle Levator veli palatini muscle Salpingopharyngeus muscle

Auditory tube lumen Tensor veli palatini muscle Levator veli palatini muscle Salpingopharyngeus muscle

Nasopharynx Auditory (pharyngotympanic, Eustachian) tube closed by elastic recoil of cartilage, tissue turgidity, and tension of salpingopharyngeus muscles

Plate 98

Nasopharynx Lumen opened chiefly when attachment of tensor veli palatini muscle pulls wall of tube laterally during swallowing

Meninges and Diploic Veins See also

Coronal dissection

Diploic veins Superior sagittal sinus Emissary vein

Frontal and parietal tributaries of superficial temporal vein Frontal and parietal branches of superficial temporal artery Granular foveola (indentation of skull by arachnoid granulation)

Arachnoid granulation Cerebral vein (bridging vein) penetrates subdural space to enter sinus Dura mater (periosteal and meningeal layers) Dura-skull interface (site of epidural hematoma) Arachnoid Subarachnoid space Pia mater Middle meningeal artery and vein Deep, middle, and superficial temporal arteries and veins

Lateral (venous) lacuna Bridging vein Inferior sagittal sinus

Superior thalamostriate and choroidal veins, internal cerebral veins, and choroid plexus of lateral ventricle

Diploic and emissary veins of skull

Frontal diploic vein

Anterior temporal diploic vein

Plate 23

Deep and superficial middle cerebral veins

Parietal emissary vein Posterior temporal diploic vein Occipital emissary vein Occipital diploic vein Mastoid emissary vein

Meninges and Brain

Plate 99

See also

Plates 40,136

Frontal (anterior) and parietal (posterior) branches of middle meningeal artery Middle meningeal artery Anterior meningeal branch of anterior ethmoidal artery

Arachnoid granulations Opening of superior cerebral vein Lateral (venous) lacuna Superior sagittal sinus Dura mater

Mastoid branch of occipital artery

Meningeal branches of ascending pharyngeal artery Mastoid branch of occipital artery Middle meningeal artery Recurrent meningeal branch of lacrimal (ophthalmic) artery Accessory meningeal artery Anterior meningeal branch of anterior ethmoidal artery Posterior ethmoidal artery Internal carotid artery and its meningohypophyseal trunk* {phantom) Middle meningeal artery Accessory meningeal artery Superficial temporal artery Maxillary artery Posterior auricular artery Occipital artery

Anterior and posterior meningeal branches of vertebral artery tentorial, cavernous sinus, and meningeal branches of meningohypophyseal trunk*

^'Variant; most commonly, these branches arise directly from internal carotid artery.

Plate 100

Meninges and Brain

mm

Epidural Hematoma •WIBBHMMMIllllHIIMI^^ Temporal fossa hematoma Medial displacement of middle cerebral vessels

Shift of normal midline structures

Skull fracture crossing middle meningeal a.

Compression of posterior cerebral a. Shift of brainstem to opposite side may reverse lateralization of signs by tentorial pressure on contralateral pathways.

Herniation of temporal lobe under tentorium cerebelli

Compression of corticospinal and associated pathways, resulting in contralateral hemiparesis, deep tendon hyperreflexia, and Babinski's sign

Compression of oculomotor (III) n. leading to ipsilateral pupil dilatation and 3rd cranial n. muscle palsy

mm

''Question mark" skin incision (biack); outline of free bone flap and burr holes (red) Brain Dura

Skin flap reflected (Raney clips control bleeding). Free bone flap removed and dura opened. Clot evacuated by irrigation, suction, and forceps.

Burst

Section showing acute subdural hematoma on right side and subdural hematoma associated with temporal lobe intracerebral hematoma ("burst" temporal lobe) on left

Meninges and Brain

Plate 101

Meninges and Superficial Cerebral Veins For deep veins of brain see

Plate 145 Calvaria

Pericranium Galea aponeurotica Skin

Granular foveola

ior sagittal sinus Emissary vein Tributary of superficial temporal vein Diploic vein Dura-skull interface (site of epidural hematoma) Dura mater Arach noid-dura i nterface (site of subdural hematoma)

Bridging vein

Arachnoid Subarachnoid space Pia mater Cerebral artery Superior cerebral vein Falx cerebri Ce reb ra I h e m i s p here

Branches of middle meningeal artery Superior sagittal sinu

Superior cerebral veins (bridging veins) (penetrating arachnoid and dura mater to enter superior sagittal sinus)

Dura mater

Superior cerebral veins (beneath arachnoid)

Superior anastomotic vein (of Trolard)

Inferior anastomotic vein (of Labbe)

Superficial middle cerebral vein

Middle meningeal artery and veins

Plate 102

Inferior cerebral veins (beneath arachnoid)

Meninges and Brain

Bora! Venous Sinuses mmmssstSB^msms^msmemmsmSi

Superior sagittal sinus Straight sinus

Sagittal section

Great cerebral vein (of Galen) Tentorium cerebelli Superior sagittal sinus

Falx cerebri

Inferior sagittal sinus

Sphenoparietal sinus

Anterior and posterior intercavernous sinuses Superior petrosal sinus Basilar venous plexus

Inferior petrosal sinus To jugular foramen

Sigmoid sinus Transverse sinus Occipital sinus Falx cerebelli Confluence of sinuses

Meninges and Brain

Plate 103

Dural Venous Sinuses (continued) See also

Plate 85

Skull sectioned horizontally: superior view Superior sagittal sinus (cut) Falx cerebri (cut) Superior ophthalmic vein Anterior and posterior , /> intercavernous sinuses

-Hypophysis (pituitary gland) Optic nerve (II) Internal carotid artery Oculomotor nerve (III) Sphenoparietal sinus 'Trochlear nerve (IV) Ophthalmic nerve (V-j)

Superficial middle cerebral vein (cut)


Cavernous sinus

-Trigeminal ganglion

Basilar venous plexus


Superior petrosal sinus

Middle meningeal artery Abducent nerve (VI)

Inferior petrosal sinus

Petrosal vein

Tentorial artery

Facial nerve (VII), intermediate nerve, and vestibulocochlear nerve (VIII)

Tentorium cerebelli

Glossopharyngeal (IX) and vagus (X) nerves

Inferior cerebral vein

Jugular foramen

(cut)

Transverse sinus

Sigmoid sinus (continuation of transverse sinus)

Inferior sagittal sinus (cut)

Transverse sinus

Straight sinus


Falx cerebri (cut) Confluence of sinuses

Hypoglossal nerve (XII) Great cerebral vein (of Galen)

Superior sagittal sinus (cut)

Cavernous sin Oculomotor nerve (III)

Optic chiasm Posterior communicating artery

Trochlear nerve (IV) Abducent nerve (VI) Ophthalmic nerve (Vq Maxillary nerve (V 2

Internal carotid artery Hypophysis (pituitary gland) Sphenoidal sinus

Coronal section through cavernous sinus

Plate 104

Nasopharynx

Meninges and Brain

Cerebrum: Lateral Views

Central sulcus (of Rolando) Precentral gyrus

Postcentral sulcus

Precentral sulcus Superior frontal gyrus Superior frontal sulcus Inferior parietal lobule Supramarginal gyrus Angular gyrus

Middle frontal gyrus Inferior frontal sulcus Inferior frontal gyrus Opercular part Triangular part Orbital part

Parietooccipital sulcus

Frontal pole —

Occipital pole Calcarine sulcus Lunate sulcus (inconstant)

Lateral sulcus ( Anterior ramus (of Sylvius) ) Ascending ramus ( Posterior ramus Temporal pole

Transverse occipital sulcus Superior temporal gyrus

Preoccipital notch

Superior temporal sulcus

Inferior temporal gyrus

Middle temporal gyrus Inferior temporal sulcus Frontal lobe Parietal lobe

Temporal lobe Occipital lobe

Parietal operculum Frontal operculum Orbital operculum Insula (island of Reil)

Meninges and Brain

Short gyri Central sulcus Li men Long gyrus Circular sulcus

Temporal operculum

Cerebrum: Medial Views ......

. . ...

• -• • • ••.•

. . . . . . . . • . . ••-• •.

.• .-,•;:•: v . -

. •• :•:•• :•"..•: '/.

;

:

'

'

;

•: :

'

Plate 147

For hypophysis see

Sagittal section of brain in situ

Cingulate gyrus

, .

,

Cingulate sulcus Medial frontal gyrus

Paracentral sulcus Central sulcus (of Rolando) Paracentral lobule Marginal sulcus Corpus callosum Precu neus Superior sagittal sinus Choroid plexus of 3rd ventricle Stria medullaris of thalamus Parietooccipital sulcus Cuneus

Sulcus of corpus callosum Fornix Septum pellucidum Interventricular foramen (of Monro) Interthalamic / / *7 adhesion— Thalamus and 3rd ventricle Subcallosal (parolfactory) area

Habenular commissure Pineal body Posterior commissure

Anterior commissure Subcallosal gyrus

Calcarine sulcus Straight sinus in tentorium cerebelli

Hypothalamic sulcus Lamina terminals

/

Great cerebral vein (of Galen)

Supraoptic recess Optic chiasm Tuber cinereum Hypophysis (pituitary gland) Mammillary body Cerebral peduncle Pons

Medial surface of cerebral hemisphere: brainstem excised Cingulate gyrus Mamillothalamic fasciculus Mammillary body

Cerebral aqueduct (of Sylvius)

.

Superior colliculus Inferior colliculus Tectal (quadrigeminal) plate Cerebellum Superior medullary velum 4th ventricle and choroid plexus Inferior medullary velum Medulla oblongata

Genu Rostrum Trunk Splenium

corpus callosum

Islhmus of cingulale gyrus Parietooccipital sulcus Cuneus

Uncus

Calcarine sulcus

Optic nerve (II)

Lingual gyrus

Olfactory tract

Crus Body V of fornix Column

Collateral sulcus Rhinal sulcus Medial occipitotemporal gyru Occi p i totem po ra (sulcus Lateral occipitotemporal gyrus

Plate 108

Fimbria of hippocampus Dentate gyrus Parahippocampal gyrus

Meninges and Brain

Cerebrum: inferior View For hypophysis see

Sectioned brainstem

Plate 147

Frontal pole of cerebrum Straight gyrus Lamina terminalis

Olfactory sulcus

Olfactory bulb

Orbital sulci

Olfactory tract

Orbital gyri

/ O p t i c chiasm

Temporal pole of cerebrum

Optic nerve (II) (cut)

Lateral sulcus (of Sylvius)

Hypophysis (pituitary gland)

Inferior temporal sulcus Inferior temporal gyrus

•Anterior perforated substance Optic tract Tuber cinereum

Inferior (inferolateral) margin of cerebrum

•»88

Mammillary body

v'-oS

Posterior perforated substance (in interpeduncular

sss Rhinal sulcus

Cerebral cr us Uncus

Lateral geniculate body

\

Inferior temporal gyrus-

\

X

\

Substantia nigra

X

Medial geniculate body

Occipitotemporal sulcus MS®

Red nucleus

Lateral occipitotemporal gyrus

Pulvinar of thalamus Superior colliculus (of corpora quadrigemina)

\\ Pa ra h i p p o ca m p a I gy r u s

Cerebral aqueduct Splenium of corpus callosum

Medial occipitotemporal gyrus" Calcarine sulcus

Apex of cuneus Occipital pole of cerebrum Longitudinal cerebral fissure

Meninges and Brain

Plate 107

Ventricles of Brain H6W&aamSBl

Left lateral phantom view

Frontal (anterior) horn Central part

v;'

Right lateral ventricle

Temporal (inferior) horn

Left lateral ventricle

Occipital (posterior) horn

Cerebral aqueduct (of Sylvius) 4th ventricle Left lateral aperture (foramen of Luschka) Left lateral recess

Left interventricular foramen (of M o n r o ) 3rd ventricle

Median aperture (foramen of Magendie)

^yvW/MJfj

Supraoptic recess Interthalamic adhesion Infundibular recess

Central canal of spinal cord

Pineal recess Suprapineal recess Corpus callosum Septum pellucidum Lateral ventricle Body of caudate nucleus Choroid plexus of lateral ventricle Stria terminalis Superior thalamostriate vein Body of fornix Internal cerebral vein Tela choroidea of 3rd ventricle Choroid plexus of 3rd ventricle Thalamus Putamen

/ . , > Lentiform nucleus Globus pallidus ) Internal capsule 3rd ventricle and interthalamic adhesion Hypothalamus Tail of caudate nucleus Optic tract ;

/

)

White arrow in left interventricular foramen (of M o n r o ) Ependyma Pia mater

Coronal section of brain: posterior view

Plate 108

Choroid plexus of lateral ventricle Temporal (inferior) horn of lateral ventricle Fimbria of hippocampus Hippocampus Dentate gyrus Parahippocampal gyrus

Circulation of Cerebrospinal Fluid mm^mmm

wmsmmm

Choroid plexus of lateral ventricle

{phantom)

Superior sagittal sinus Subarachnoid space

Cistern of corpus callosum Dura mater

Arachnoid granulations

Arachnoid

Interventricular foramen (of Monro) Chiasmatic cistern

Interpeduncular cistern Cerebral aqueduct (of Sylvius) Prepontine cistern Lateral aperture (foramen of Luschka) Choroid plexus of 4th ventricle

Quadrigeminal cistern (of great cerebral vein) (Posterior) cerebellomedullary cistern Median aperture (foramen of Magendie)

Dura mater Arachnoid Subarachnoid space Central canal of spinal cord

Meninges and Brain

Plate 109

Horizontal sections through cerebrum Genu of corpus callosum

Head of caudate nucleus

Lateral ventricle

Anterior limb ~

Septum pellucidum

G e n u

Posterior limb

Column of fornix

( (

of internal capsule

Putamen

\

Lentiform

Globus pallidus S nucleus

Insula (island of Reil)

3rd ventricle Interthalamic adhesion

External capsule

Thalamus

Claustrum

Crus of fornix

Retrolenticular part of internal capsule

Choroid plexus of lateral ventricle

Tail of caudate nucleus Hippocampus and fimbria

Splenium of corpus callosum

Occipital (posterior) horn of lateral ventricle Habenula

Organization of basal nuclei (ganglia)

Pineal body

Caudate Putamen Globus nucleus pallidus

Striatum

Lentiform nucleus

Corpus striatum K Basal nuclei (ganglia)

Cleft for internal capsule

Caudate J Body nucleus ) H e a d

Thalamus

Levels of ( ^ sections \ above ( Pulvinar Lentiform nucleus (globus pallidus medial to putamen) Amygdaloid body

Medial geniculate body Lateral geniculate body Tail of caudate nucleus

Interrelationship of thalamus, lentiform nucleus, caudate nucleus, and amygdaloid body (schema): left lateral view

Plate 110

Meninges and Brain

Thalamus

Corpus callosum [cut)

Interventricular foramen (of Monro)

Head of caudate nucleus

Tela choroiclea (cut edge) of 3rd ventricle

Septum pellucidum

3rd ventricle

Columns of fornix

Choroid plexus

Anterior tubercle

Superior thalamostriate vei

Stria terminalis

Pes hippocampi

Interthalamic adhesion

Temporal (inferior) horn of lateral ventricle

Lamina affixa

Internal cerebral vei

Stria medullaris

Dentate gyrus

Habenular trigone

Collateral eminence

Pulvinar (retracted)

Hippocampus


Fimbria of hippocampus-


Posterior commissure

Brachium of superior colliculus

Habenular commissure

Brachium of inferior colliculus

Pineal-body Collateral trigon

Superior colliculus

Calcar

Inferior colliculus

Occipital (posterior) horn of lateral ventricle

Cerebellum

Calcarine sulcu Internal medullary lamina

3rd ventricle


Pulvinar Intralaminar nuclei

3rd ventricle Reticular nucleus

Thalamic nuclei

Median nuclei

Schematic section through thalamus (at level of broken line shown in figure at right)

Meninges and Brain

CM LD LP M MD VA VI VL VP VPL VPM

Centromedian Lateral dorsal Lateral posterior Medial Medial dorsal Ventral anterior Ventral intermedial Ventral lateral Ventral posterior Ventral posterolateral Ventral posteromedial

Pulvinar geniculate body Medial geniculate body

Schematic representation of thalamus (external medullary lamina and reticular nuclei removed) Lateral nuclei Medial nuclei Anterior nuclei

Plate 11i

mm imi W

Hippocampus and Fornix

mm iffii1lTwii*iiiii
'Sm1CSM0ES5®:

Genu of corpus callosum (cut)

Superior dissection

Septum pellucidum Head of caudate nucleus Columns of fornix Stria terminalis Body of fornix Pes hippocampus Thalami ra of fornix Dentate gyrus Fimbria of hippocampus Hippocampus Commissure of fornix Splenium of corpus callosum (cut) Lateral ventricle Calcar avis Occipital (posterior) horn of lateral ventricle

Tail of caudate nucleus Choroid Fimbria of hippocampus

Body of fornix Columns of fornix

O p t i c tract

Commissure of fornix Crura of fornix

Hippocampal sulcus Dentate gyrus Hippocampus

Fimbria of hippocampus Hippocampus

Fornix: schema

Plate 112

Alveus of hippocampus Temporal (inferior) horn of lateral ventricle

Coronal section: posterior view

Meninges and Brain

Cerebellum mwmmmMmm®mm

Anterior cerebellar notch

Anterior lobe Quadrangular lobule (H IV-V)

Central lobule (II &

Primary fissure Horizontal fissure

Culmen (IV & V)

Superior vermis

Simple lobule (H VI) Posterior lobe

Declive (VI)

Postlunate fissure Folium (VII A)

Superior semilunar (anseriform) lobule (H VII A) Horizontal fissure Inferior semilunar (caudal) lobule (H VII B)

Posterior cerebellar notch

Superior vermis

Central lobule Lingula (I)

Inferior surface

Anterior lobe W i n g of central lobule Superior J Middle > Cerebellar peduncles Inferior \

Superior medullary velum Flocculus (H X)

Flocculonodular lobe

4th ventricle

Posterolateral (dorsolateral) fissure

Inferior medullary velum Nodule (X) Inferior vermis

Retrotonsillar fissure

Uvula (IX) Tonsil

Pyramid (VIII)

Posterior lobe

Biventer lobule (H VIII)

Tuber (VII B)

Secondary (postpyramidal) fissure

Posterior cerebellar notch

Horizontal fissure Inferior semilunar (caudal) lobule (H VII B)

Decussation of superior cerebellar peduncles

Cerebral c.rus Medial longitudinal fasciculus

4th ventricle Nuclear layer of medulla oblongata

Superior medullary velum Fastigial Cerebellar nuclei

Superior cerebellar peduncle

Globose Lingula (I)

Dentate

Vermis

Emboliform

Section in plane of superior cerebellar peduncle

Meninges and Brain

Plate 113

11111r^^S

Brainstem .v-^"?.'IjWTMHNHMMBH

alamus (cut surface)

Posterolateral view

Lateral geniculate body Optic tract

Pulvinars of thalami Pineal body


Superior colliculi

Brachia of superior and inferior colliculi

Inferior colliculi

Cerebral crus


Pons

Superior medullary velu


Superior cerebellar peduncle

Middle cerebellar peduncle

Rhomboid fossa of 4th ventricle

bulocochlear nerve (VIII) Facial nerve (VII)

Glossopharyngeal (IX) and vagus(X)

Inferior cerebellar peduncle

Cuneate tubercle


Gracile tubercle


Dorsal roots of 1 st spinal nerve (C1) Cuneate fasciculu Gracile fascicul

Olfactory tract

Anterior view

Anterior perforated substance >f

Infundibulum (pituitary stalk) Optic chiasm

Mammillarv bodies Temporal lobe (cut surface)

Optic tract

Oculomotor nerve (111)

Tuber cinereum

chlear nerve (IV)

Cerebral crus

geminal nerve (V) Abducent nerve (VI)


Facial nerve (VII) and intermediate nerve

Posterior perforated su


Pons

Flocculus of cerebellum Middle cerebellar pedun Olive Pyramid Ventral roots of 1st spinal nerve (C I Decussation of pyramids

Plate 114

Choroid plexus of 4th ventricle Glossopharyngeal nerve (IX) s nerve (X) ypoglossal nerve (XII) Accessory nerve (XI)

Meninges and Brain

Fourth Ventricle and Cerebellum mam

mmmmmmmmwm\wmmmm

rJm$mm

Habenular trigone

Posterior view

literal' j Geniculate bodies

3rd ventricle Pulvinar of thalamus

Dorsal median sulcus

Pineal body

Superior cerebellar peduncle Locus ceruleus

Superior collicul

Medial eminence

Inferior colliculu

Facial colliculus


Vestibular area

Superior medullary velu

Dentate nucleus of cerebellum

Superior Middle Inferior

Cerebellar peduncles {

•

Striae medullares

Lateral recess

enia of 4th ventricle

Superior fovea

Cuneate tubercle

Sulcus limitans

Gracile tubercle

Inferior fovea

Dorsal median sulcus

Trigeminal tubercle

Lateral funiculus

Hypoglossal trigone Vagal trigone

uneate fasciculus Gracile fasciculus

Obex


Median sagittal section

Posterior commissure

Body of fornix

Habenular commissure

Thalamus (in 3rd ventricle)

Pineal body

Interventricular foramen (of Monro)—

Splenium of corpus callosum Great cerebral vein (of Galen)

Anterior commissure Lamina terminalis

Lingula (I)

Hypothalamic sulcus

Central lobule (ll-III)

Cerebral peduncle

Culm en (IV-V)

Cerebral aqueduct (of Sylvius)

Declive (VI)

Superior colliculus

Vermis of cerebellum

Folium (VII A)

Tectal (quadrigeminal) plate Superior medullary velum

Inferior colliculus

-Inferior medullary velum

Pons Medial longitudinal fasciculus

Tuber (VII B)

4th ventricle

Pyramid (VIII)

Choroid plexus of 4th ventricle

Uvula (IX)

Medulla oblongata

Nodulus (X)

Median aperture (foramen of Magendie) Decussation of pyramids Central canal of spinal cord

Meninges and Brain

Vermis of cerebellum

Choroid plexus of 4th ventricle Tonsil of cerebellum

FBafe 115

Rv

i;

Cranial Nerve Nuclei in Brainstem: Schema jvA'^v^t^KvXffi'K^;:

Posterior phantom view

fit:

Oculomotor nerve (III) Superior colliculus

Red nucleus Oculomotor nucleus Accessory oculomotor (Edinger-Westphal) nucleus

Lateral geniculate body Mesencephalic nucleus of trigeminal nerve

Trochlear nucleus Trochlear nerve (IV)

Principal sensory nucleus of trigeminal nerve

Motor nucleus of trigeminal nerve

Trigeminal nerve (V) and ganglion


Facial nerve (VII) and geniculate ganglion

Abducent nucleus Facial nucleus

Vestibulocochlear nerve (VIII)-


Cochlear nuclei

Superior and inferior salivatory nuclei

Anterior Posterior

Vestibular nuclei



Vagus nerve (X)

Vagus nerve(X)

Accessory nerve (XI)*

Spinal tract and spina nucleus of trigeminal nerve Solitary tract nucleus Dorsal vagal nucleus

Efferent fibers

Nucleus ambiguus Posterior (dorsal) nucleus of vagus nerve (X) Hypoglossal nucleus Spinal nucleus of accessory nerve

Afferent fibers Mixed fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.

Plate 116


Cranial Nerve Nuclei in Brainstem: Schema (continued) WjjBWSKj

Medial dissection

Accessory oculomotor (Edinger-Westphal) nucleus

Red nucleus

Oculomotor nucleus

Oculomotor nerve

nucleus

Mesencephalic nucleus of trigeminal nerve

nerve (IV) Abducent nucleus


Internal genu of facial nerve

Principal sensory nucleus of trigeminal nerve

Facial nucleus Vestibular nuclei

Motor nucleus of trigeminal nerve

Anterior and posterior cochlear nuclei

Facial nerve (VII) Superior and inferior salivatory nuclei

Vestibulocochlear nerve (VIII) Abducent nerve (VI)

Solitary tract nucleus


Posterior (dorsal) nucleus of vagus nerve (X)

Hypoglossal nerve (XII) Hypoglossal nucleus Vagus nerve (X) Nucleus ambiguus Accessory nerve (XI)* Spinal nucleus of accessory nerve

Spinal tract and spinal nucleus of trigeminal nerve

Efferent fibers

4P

Afferent fibers Mixed fibers

"Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.

Plate 117

Cranial Nerves (Motor and Sensory Distribution): Schema mûmemmmmm

M M H I

asJefSKSS

Spinal nerve fibers Efferent ( m o t o r ) fibers Afferent (sensory) fibers

Oculomotor

^

^

Ciliary muscle, sphincter pupillae, and all external eye muscles except those below

Olfactory

Nasal cavity

Trochlear Superior oblique muscl

VI Abducent___y/^ Lateral r e c t u s ^ / / / muscle yyx

Trigeminal

Motor—muscles of mastication-^""

mm

Sensorv—face I sinuses, teeth

• .

Intermediate nerve M o t o r—s u b m a n d i b u I a r, sublingual, lacrimal glands Taste—anterior -/i of tongue, sensory soft palate

VII Facial

Muscles of face

VIII Vestibulocochlear j,

Cochlear

v-

Vestibular

Glossopharyngeal

Taste—posterior of tongue Sensory—tonsil, pharynx, middle ear Motor—stylopharyngeus, parotid gland

liiiK;

Vagus

pfe^l'S.f

XII ill Hypoglossal Tongue muscles

tj* ^

Accessory

\

Sternocleidomastoid trapezius muscles

Motor—heart, lungs, palate, pharynx, larynx, trachea, bronchi, Gl tract Sensory—heart, lungs, trachea, bronchi, larynx, pharynx, ^ Gl tract, external ear IB

Strap muscles (CI, 2, 3 fibers)

Plate 118


Subcallosal (parolfactory) area Septal area and nuclei

Olfactory bulb cells: schema

Fibers from \ Contralateral Fibers to \ olfactory bulb

Efferent fibers to olfactory bulb Afferent fibers from bulb to central connections and contralateral bulb

Anterior commissure Medial olfactory stria

Granule cell (excited by and inhibiting to mitral and tufted cells) Mitral cell •/

••

-• 7

Olfactory nerve fibers

Dura mater

Olfactory cells Olfactory mucosa Olfactory nerves (I)

Olfactory tract Olfactory trigone / and olfactory tubercle

Olfactorv bulb Cribriform plate of ethmoid bone Anterior olfactory nucleus

Lateral olfactory stria

Uncus

Lateral olfactory tract nucleus Anterior perforated substance

Dentate gyrus

Amygdaloid body Piriform lobe


Hippocampal fimbria

Parahippocampal gyrus

Plate 119

Optic Nerve (II) (Visual Pathway): Schema

mm*

• 1

•

•

Mttmrn

Overlapping i visual fields 1

Central darker circle represents macular zone Lighter shades represent monocular fields Each quadrant a different color

Projection on right retina

Projection on left retina

Choroid

Choroid

Periphery

Macula

\

\ \ Optic chiasm y s ^ / j

Structure of retina: schema A B C G H P R

O p t i c nerves ( I I ) j

Projection on left dorsal lateral geniculate nucleus

Amacrine cells Bipolar cells Cones Ganglion cells Horizontal cells Pigment cells Rods

Optic tracts

Projection on right dorsal lateral geniculate nucleus

Lateral geniculate bodies \ Optic radiation

Optic radiation

Calcarine sulcusv Calcarine sulcus

mm

Projection on right occipital lobe

Projection on left occipital lobe

Plate 120

Cranial and

Cervical Nerves

Oculomotor (III), Trochlear (IV), and Abducent (VI) Nerves: Schema IIIIIIIIMIIlllillllilllWIilWM^

mmmxtm

See also

Long ciliary nerve Short ciliary nerves

Plates 86,132, 167, 168

Ciliary ganglion Posterior ethmoidal nerve

Anterior ethmoidal nerve

Abducent nucleus

Sensory root of ciliary ganglion


Trochlear nucleus

Sympathetic root of ciliary ganglion

Levator palpebrae superioris muscle

Oculomotor nucleus

Superior division of oculomotor nerve

Superior rectus muscle

Accessory oculomotor (Edinger-Westphal) nucleus (parasympathetic)

Frontal nerve (cut) Lacrimal nerve (cut) Nasociliary nerve


O c u l o m o t o r nerve (III) Ophthalmic nerve (V |)

Abducent nerve (VI)

Infraorbital nerve Zygomatic nerve (cut)

Pterygopalatine ganglion

Inferior oblique muscle

Inferior division of oculomotor nerve

Ciliary muscle Dilator pupillae muscle

Medial rectus muscle

Sphincter pupillae muscle

Inferior rectus muscle Efferent fibers Afferent fibers Sympathetic fibers

Parasympathetic root of ciliary ganglion

Parasympathetic fibers


Mandibular nerve (V3) Internal carotid artery and nerve plexus Maxillary nerve (V 2 ) Lateral rectus muscle and abducent nerve {turned back) Cavernous plexus Common tendinous ring

Plate 121

Trigeminal Nerve (V): Schema mflMMMHBM^^ See also

—

Plates 24, 42, 43, 45, 46, 167, 168

Efferent fibers Afferent fibers Proprioceptive fibers Parasympathetic fibers Sympathetic fibers

Ophthalmic nerve (V^) Tentorial (meningeal) branch Nasociliary nerve

Trigeminal nerve (V) ganglion and nuclei Motor nucleus Mesencephalic nucleus Principal sensory nucleus Spinal tract and nucleus

Lacrimal nerve Sensory root of ciliary ganglion

Frontal nerve Ciliary ganglion Posterior ethmoidal nerve Long ciliary nerve Short ciliary nerves Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve Infratrochlear nerve Internal nasal branches and External nasal branches of anterior ethmoidal nerve Maxillary nerve (V 2 ) Meningeal branch

mk*

Zygomaticotemporal nerve Zygomaticofacial nerve Zygomatic nerve Infraorbital nerve Pterygopalatine ganglion Superior alveolar branches of infraorbital nerve Nasal branches (posterior superior lateral, nasopalatine, and posterior superior medial)

Facial nerve (VII) Chorda tympani nerve

Nerve (Vidian) of pterygoid canal (from facial nerve [Vllj and carotid plexus) Pharyngeal branch Greater and lesser palatine nerves

Superficial temporal branches

Deep temporal nerves (to temporalis muscle)

Articular branch and anterior auricular nerves

Lateral pterygoid and masseteric nerves Tensor veli palatini and medial pterygoid nerves Buccal nerve Mental nerve Inferior dental plexu Lingual nerve

Plate 122

Auriculotemporal nerve

Submandibular ganglion Mylohyoid nerve

Inferior \ alveolar nerve /

\ \ I \

Otic ganglion

\

Mandibular nerve (V 3 ) Tensor tympani nerve

Parotid branches Meningeal branch Lesser petrosal nerve (from glossopharyngeal nerve IIX])


Facial Merwe (VII): Schema See also Facial nerve (VII)


Internal acoustic meatus

Geniculate ganglion

Deep petrosal nerve (from internal carotid plexus)

Intermediate nerve Motor nucleus of facial nerve

Internal carotid plexus (on internal carotid artery)

Lesser petrosal nerve Nerve (Vidian) of pterygoid ca nal

Plates 25, 167, 168

Superior salivatory nucleus Solitary tract nucleus

Otic gang lion Pterygopalatine ganglion

Facial muscles Frontal belly (frontalis) of o c c i p i t o f r o n t a l Orbicularis oculi Corrugator supercilii Zygomaticus major Zygomaticus minor Procerus Levator labii superiors Levator labii superioris alaeque nasi Levator anguli oris Nasalis

omatic £ Depressor septi nasi

jwOccipital If belly

Buccal femches

Orbicularis oris

Occipital branch of posterior auricular nerve

Depressor anguli oris Depressor labii inferioris

Branches to auricular muscles

Mentalis

Posterior auricular nerve

(Risorius) (not shown)

Nerve to stapedius muscle

Buccinator

Stylomastoid foramen tympanic plexus

Platysma

Tympanic nerve (of Jacobson) (from glossopharyngeal nerve)

Sublingual gland Submandibular gland -

Efferent fibers

-

Afferent fibers .. r-i n •• Parasympathetic fibers -

Sympathetic fibers

W m I ( ° c c ' P ' t a ' ' s ) of occipitofrontal muscle

Submandibular ganglion Lingual nerve (from trigeminal nerve) ° ° Chorda tympani nerve


Glossopharyngeal nerve (IX) Digastric muscle (posterior belly) Stylohyoid muscle Caroticotympanic nerve (from internal carotid plexus)

Plate 123

Afferent fibers

Facial canal Geniculum (geniculate ganglion) of facial nerve



Head of malleus

Cochlear (spiral) ganglion

Incus

Vestibular nerve Cochlear nerve Motor root of facial nerve and intermediate nerve Vestibulocochlear nerve (VIII) Medulla oblongata (cross section)

mm* \ ' V-' •

&

vm

; v1- . /

V-

ms

Internal acoustic meatus

Medial Vestibular nuclei (diagrammatic)

Ampulla of lateral semicircular duct Ampulla of superior semicircular duct

SuperiorAnterior Interior

Posterior

Utricle

Cochlear nuclei

Ampulla of posterior semicircular duct

Lateral Inferior cerebellar peduncle (to cerebellum) Vestibular ganglion

Saccule Superior division Inferior division

Plate 124

of vestibular nerve


Glossopharyngeal Nerve (IX): Schema

Efferent fibers Afferent fibers Parasympathetic fibers

Spinal tract and spinal nucleus of trigeminal nerve Solitary tract nucleus Tympanic nerve (of Jacobson) Tympanic cavity and plexus Stylomastoid foramen

Caroticotympanic nerve (from internal carotid plexus)

Nucleus ambiguus Inferior salivatory nucleus Geniculum (geniculate ganglion) of facial nerve \i

Greater petrosal nerve Deep petrosal nerve Nerve (Vidian) of pterygoid canal Lesser petrosal nerve Pterygopalatine ganglion Mandibular nerve (V 3 ) Otic ganglion Auriculotemporal nerve Parotid gland Tubal branch of tympanic plexus Auditory (pharyngotympanic, Eustachian) tube and pharyngeal open ng •j*


"

Stylopharyngeus muscle (and branch from glossopharyngeal nerve)

Jugular foramen Communication to auricular branch of vagus nerve Superior and Inferior ganglia of Glossopharyngeal nerve Communication to facial nerve (VII) Taste and somatic sensation: posterior V>of tongue

Vagus nerve (X) Superior cervical sympathetic ganglion Sympathetic trunk Carotid branch of glossopharyngeal nerve Internal carotid artery

Pharyngeal plexus

Carotid sinus

Pharyngeal, tonsillar, and lingual branches of glossopharyngeal nerve

Carotid body C o m m o n carotid artery

Pharyngeal branch of vagus nerve External carotid artery


Plate 125

Vagus Nerve (X): Schema I8fififiQfDSffln99BfiK&3fi3BS

See also

Plates 167, 168

/I*


N

v i\

£v' Xt X/Posterior nucleus of vagus n e r v e (parasympathetic I \ \ ~ ' / \h„, / and visceral afferent) Solitary tract nucleus (visceral afferents including taste)

Meningeal branch of vagus nerv Auricular branch of vagus nerve

Spinal tract and spinal nucleus of trigeminal nerve (somatic afferent)

Auditory (pharyngotympanic, Eustachian) tube Levator veli palatini muscle

Nucleus ambiguus (motor to pharyngeal and laryngeal muscles)

Salpingopharyngeus muscle

Cranial root of accessory nerve* (see next plate)

Palatoglossus muscle Palatopharyngeus muscle

Vagus nerve (X) Jugular foramen


Superior ganglion of vagus nerve


Inferior ganglion of vagus nerve

Middle pharyngeal constrictor muscl Inferior pharyngeal constrictor muscle Cricothyroid muscle Trachea Esophagus Right subclavian a Right recurrent laryngeal nerve Heart Hepatic branch of anterior vagal trunk (in lesser omentum) Celiac branches from anterior and posterior vagal trunks to celiac plexus Celiac and superior mesenteric ganglia and celiac plexus Hepatic plexus Gallbladder and bile ducts Liver Pvloric branch

Pharyngeal branch of vagus nerve (motor to muscles of palate and pharynx; sensory to lower pharynx) Communicating branch of vagus nerve to carotid branch of glossopharyngeal nerve Pharyngeal plexus Superior laryngeal nerve: Internal branch (sensory and parasympathetic) External branch (motor to cricothyroid muscle) Superior cervical cardiac branch of vagus nerve Inferior cervical cardiac branch of vagus nerve A

Thoracic cardiac branch of vagus nerve Left recurrent laryngeal nerve (motor to muscles of larynx except cricothyroid; sensory and parasympathetic to larynx below vocal folds; parasympathetic, efferent, and afferent to upper esophagus and trachea) Pulmonary plexus Cardiac plexus Esophageal plexus Anterior vagal trunk Gaslric branches of anterior vagal trunk (branches from posterior trunk behind stomach)

/

from hepatic plexus Pancreas Duodenum Ascending colon Cecum Appendix

Plate 126

fibers (parasympathetic motor, secretomotor, and afferent fibers) accompany superior mesenteric artery and its branches usually as far as left colic (splenic) flexure Small intestine Efferent fibers Afferent fibers Parasympathetic fibers


mmrnm

A c c e s s o r y Merwe (XI): S c h e m a p i l i See also Nucleus ambiguus Vagus nerve (X)

Plate 32

Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of larynx, except cricothyroid) Jugular foramen Superior ganglion of vagus nerve Accessory nerve (XI)*

Inferior ganglion of vagus nerve

CI spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle

Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation.


Plate 127

JHll

Hypoglossal Nerve (XII): Schema K&.vl-j,-:

See also

Plate 32

Hypoglossal nerve (XII) (in hypoglossal canal)

Hypoglossal nucleus

Superior longitudinal

Intrinsic muscles of tongue

Transverse and vertical Inferior longitudinal

Meningeal branch

Styloglossus muscle

Occipital condyle Inferior ganglion of vagus nerve Ventral rami of C1, 2 , 3 form ansa cervicalis of cervical plexus

Superior cervical sympathetic ganglion Superior root of ansa cervicalis

Genioglossus muscle Geniohyoid muscle (via CI)'

Internal carotid artery Inferior root of ansa cervicalis

Thyrohyoid muscle' (via C I ) Omohyoid muscle (superior belly)

Ansa cervicalis Internal jugular vein Common carotid artery

Efferent fibers Afferent fibers

Plate 128

See also

Sternocleidomastoid muscle (cut) Accessory nerve (XI) Hypoglossal nerve (XII) Geniohyoid muscle

Plate 32

Great auricular nerve Lesser occipital nerve Greater occipital nerve (from dorsal ramus of C2)

Nerves to anterior and lateral rectus capitis and longus capitis and colli muscles Nerves to longus capitis and colli and levator scapulae muscles Thyrohyoid muscle Superior root of ansa cervicalis Inferior root of ansa cervicalis Transverse cervical nerve

rapezius muscle Nerves to longus capitis and colli, levator scapulae, and middle scalene muscles Communication to brachial plexus Phrenic nerve

Omohyoid muscle (superior belly) Sternothyroid muscle

Sternohyoid muscle

Supraclavicular nerves (medial, intermediate, and lateral)

Ansa cervicalis Sternocleidomastoid muscle {cut) Omohyoid muscle (inferior belly)

Efferent fibers Afferent fibers Proprioceptive fibers

Plate 129

B V /

Q •.

Autonomic Nerves in Neck QBmUBXSi

See also

Plates 71, 125, 126, 165, 166, 209, 226, 240, 318

Internal carotid nerve

j

*

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fi m 4

rV;JT

fe

w

V"

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1

V

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i

La r y n go p h a r y n gea I sympathetic branch

0x8:

M

m

Vagus nerve (X) (cut)

m m

m

Superior cervical sympathetic ganglion

K

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f

t*

are

C2

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^ J t

i I

u

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m:

i

"^Pharyngeal plexus Pharyngeal branch of vagus nerve

111

External carotid artery and plexus

Gray rami communicantes

Superior laryngeal nerve Internal carotid artery and carotid branch of glossopharyngeal nerve Carotid body Carotid sinus

9

/

Superior cervical cardiac branch of vagus nerve

W IC

7

V'VA

I

.• ,

i

Superior cervical sympathetic cardiac nerve Phrenic nerve (cut) Middle cervical sympathetic ganglion

iflHH

Common carotid artery and plexus

'•'^•ig

C8

ISw jB

W

•t AT: m

Vertebral artery and plexus Recurrent laryngeal nerve

Vagus nerve (X) (cut)

mm M

K

—Ansa subclavia Inferior cervical sympathetic cardiac nerve

-Ma V

Vertebral ganglion

Cervicothoracic (stellate) ganglion

JfP5B

X;

Middle cervical sympathetic cardiac nerve

-•-y'y

>VS:

—Thoracic sympathetic and vagal cardiac nerves

Subclavian artery

Plate 130


Autonomic Nerves in Head See also

Greater petrosal nerve Sensory root Trigeminal nerve (V) <{ Motor root Ganglion

Plates 44-46, 86, 121, 132-134, 165, 166

Deep petrosal nerve

Nasociliary nerve

Nerve (Vidian) of pterygoid canal Oculomotor nerve (III) Maxillary nerve (V 2 )

Sensory

)

Sympathetic

Roots

of

> ciliary

Parasympathetic )

Ophthalmic nerve (V ,)

Internal carotid artery and plexus

Frontal and lacrimal nerves {cut)


Ciliary ganglion

Long ciliary nerve

Facial nerve (VII) Short ciliary nerves


Posterior, superior, and inferior lateral nasal nerves

Glossopharyngeal nerve (IX) Vagus nerve (X) Mandibular nerve (V 3 ) Otic ganglion Internal carotid nerve Chorda tympani nerve


Superior laryngeal nerve (cat)

Greater and lesser palatine nerves


Lingual nerve Internal carotid artery and plexus

Inferior alveolar nerve

Carotid branch of glossopharyngeal nerve Carotid sinus Cervical sympathetic trunk Superior cervical cardiac branch of vagus nerve

Submandibular ganglion Maxillary artery and plexus External carotid artery and plexus

Middle meningeal artery and plexus Facial artery and plexus

Common carotid artery and plexus Superior cervical sympathetic cardiac nerve

Plate 131

Ciliary Ganglion: Schema See also

Plates 167, 168

Sphincter pupillae muscle Short ciliary nerves Ciliary

Oculomotor (parasympathetic) root of ciliary ganglion

Accessory oculomotor (Edinger-Westphal) nucleus (parasympathetic)

Ciliarv muscle

Superior colliculus Lateral geniculate body

•81

Optic nerve (ll) / Ophthalmic nerve (V.)

Nasociliary nerve' Long ciliary nerve

Trigeminal ganglion-

Nasociliary (sensory) root of ciliary ganglion

Internal i carotid plexus

Sympathetic root of ciliary ganglion Ophthalmic artery

Tympanic, plexus

Tectospinal tract

Thoracic part of spinal cord

Internal . carotid artery

Superior cervical sympathetic ganglion 1 st thoracic sympathetic trunk ganglionGray ramus communicans Preganglionic I n * * r - ( Sympathetic fibers Postganglionic)

White ramus communicans T1 spinal nerve

Preganglionic \ Postganglionic)

..

Preganglionic sympathetic cell bodies in intermediolateral nucleus (lateral horn) of gray matter


• Visual pathway Afferent fibers Descending pathway

Plate 132


Pterygopalatine and Submandibular Ganglia: Schema See also

Ophthalmic nerve (V-j) Mandibular nerve (V 3 ) Otic ganglion

Plates 167, 168

Trigeminal ganglion Deep petrosal nerve Greater petrosal nerve Chorda tympani nerve

Lingual nerve



Facial nerve (VII) (intermediate nerve)

Nerve (Vidian) of pterygoid canal

Superior salivatory nucleus

Pterygopalatine ganglion Lacrimal gland

Descending palatine nerves Posterior nasal nerves

Glossopharyngeal nerve (IX) Superior cervical sympathetic ganglion

Palatine nerves

Sympathetic trunk T1 and T2 spinal nerves Thoracic spinal cord


Dorsal root Sublingual gland Submandibular gland Ventral 'OOt

Facial arteryLingual artery External carotid artery and plexus Common carotid artery

if

nternal carotid artery

Sympathetic preganglionic cell bodies in intermediolateral nucleus (lateral horn) of gray matter

Sympathetic preganglionic fibers Sympathetic postganglionic fibers Parasympathetic preganglionic fibers Parasympathetic postganglionicfibers


Plate 133

Otic Gangliem Schema See also

Plates 167, 168 Mandibular nerve (V 3 )

Trigeminal ganglion Lesser petrosal nerve

Otic ganglion

Chorda tympani nerve Ophthalmic nerve (V-j)



Facial nerve (VII) Glossopharyngeal nerve (IX)

AuricuIotemporal nerve

Inferior salivatory nucleus


Pons

Parotid gland Maxillary artery Medulla oblongata Tympanic plexus Inferior alveolar nerve

Tympanic nerve (of Jacobson) Inferior ganglion (IX)

Lingual nerve

Superior cervical sympathetic ganglion Sympathetic trunk Thoracic spinal cord


Dorsal root Internal carotid artery

Common carotid artery White

Gray

Rami communicantes

i

i Sympathetic preganglionic fibers

^ ^ ^

Sympathetic postganglionic fibers

Sympathetic preganglionic cell bodies in intermediolateral nucleus (lateral horn) of gray matter

M^vttw^wi Parasympathetic preganglionic fibers »

m ess] Parasympathetic postganglionic fibers

Plate 134


Taste Pathways: Schema See also

\

.J

f

Plates 46, 94,123, 125, 126

n

Usual pathway ~ Accessory pathway

Ventral posteromedial (VPM) nucleus of thalamus Sensory cortex (just below face area) -ateral hypothalamic area Amygdaloid body Pontine taste area Trigeminal nerve (V) Trigeminal (semilunar) ganglion

Mesencephalic nucleus and Motor nucleus of trigeminal nerve

Ophthalmic nerve (V j) Maxillary nerve (V 2 ) Mandibular nerve (V 3 )


\ Im

Fungiform papillae Glossopharyngeal nerve (IX)

Foliate papillae

Medulla oblongata (lower part) « Inferior (petrosal) ganglion of glossopharyngeal nerve

•Vallate papillae

Epiglottis

Inferior (nodose) ganglion of vagus nerve Vagus nerve (X)


Larynx Superior laryngeal nerve

7

..;; K

Plate 135

Arteries to Brain and Meninges See also

Plates 33, 34

Left middle meningeal artery Posterior cerebral artery Superior cerebellar artery Basilar artery

Middle cerebral artery Anterior cerebral artery Anterior communicating artery hthalmic artery

Left labyrinthine (internal acoustic) artery

Posterior communicating artery

Mastoid branch of left occipital artery

Cavernous sinus Anterior inferior cerebellar artery

Middle meningeal artery

Posterior meningeal branch of left ascending pharyngeal artery Posterior inferior cerebellar artery Left and right vertebral arteries (intracranial part)

Maxillary artery Superficial temporal artery

Posterior meningeal branch of vertebral artery


Anterior meningeal branch of vertebral artery Posterior auricular artery

Facial artery

Occipital artery Internal carotid artery Carotid sinus Carotid body Vertebral artery (cervical part) Transverse process of C6 Deep cervical artery Supreme intercostal artery Costocervical trunk Subclavian artery

Plate 136

Lingual artery Ascending pharyngeal artery Superior laryngeal artery Superior thyroid artery Common carotid artery Ascending cervical artery (cut) Inferior thyroid artery Thyrocervical trunk Brachiocephalic trunk Internal thoracic artery


Veins of the Vertebral Column: Vertebral Veins

Variation: right vertebral vein crossing anterior to right subclavian artery

Left vertebral artery

,

Left vertebral vein

Anterior vertebral veins

Left subclavian artery

Right deep cervical vein

Left brachiocephalic vein

Accessory vertebral vein Right vertebral artery rib Right subclavian artery and vein

Vertebral veins: detail showing venous communications Anterior arch of atlas (CI) (cut)

Right internal jugular vein (inferior bulb) Dura mater

Right brachiocephalic vein Right vertebral vein Right clavicle

Right c o m m o n carotid artery

Right vertebral artery

Anterior internal (epidural) vertebral venous plexus Dens (C2) (cut) Venous plexus of vertebral artery Anterior external vertebral venous plexus

Epidural fat and anterior internal vertebral (epidural) venous plexus Communicating vein Basivertebral vein Intervertebral veins Veins of the vertebral Vertebral artery with venous plexus c o l u m n : vertebral veins Superior bulb of right internal jugular vein Condylar emmissary vein

Mastoid emmissary vein

Vertebral arteries

Deep cervical vei

Dura mater

Anterior vertebral veins

Body of C3 cut away to show venous communications

Anterior internal (epidural) vertebral venous plexus

Venous plexus of vertebral artery Anterior external vertebral venous plexus Communicating veins Right deep cervical vein Forming vertebral vein Accessory vertebral vein Right vertebral artery and vein

Anterior vertebral veins Left deep cervical vein Left vertebral vein Left vertebral artery Left thyrocervical trunk Left internal jugular vein (inferior bulb)

Dorsal scapular artery


Costocervical trunk

Left subclavian vein

Right thyrocervical trunk

Left brachiocephalic vein Right subclavian vein

Left c o m m o n carotid artery

Right internal jugular vein (inferior bulb) Right brachiocephalic vein Right subclavian artery

C e r e b r a l

W a s e u l a t y r e

C'/Ytf^cwb-

Right c o m m o n carotid artery

P l a t e

1 3 7

Arteries to Brain: Schema BBgBggBBSBSSag^^

Anterior cerebral artery

Illllllll

Anterior communicating artery Ophthalmic artery

Middle cerebral artery

Supraorbital artery


Supratrochlear artery Caroticotympanicbranch of internal carotid artery

-acrimal artery Dorsal nasal artery

Posterior cerebral artery


Superior cerebellar artery

Angular artery

Anterior tympanic artery



Posterior auricular artery Facial artery

Maxillary artery

Occipital artery

Basilar artery

Lingual artery

Anterior inferior cerebellar artery

Ascending pharyngeal artery Anterior spinal artery

Posterior inferior cerebellar artery

Spinal segmental medullary branches


Vertebral artery


Common carotid arterv

Superior thyroid artery

Deep cervical artery Superficial cervical artery

Common carotid arte ry


Vertebral artery

Supreme intercostal artery Ascending cervical artery

Costocervical trunk

Inferior thyroid artery Thyrocervical trunk

Subclavian artery

Subclavian arterv

Internal thoracic artery


Anastomoses Aorta

Descending Ascending-

Plate 138

1 2 3 4 5

Right-Left CaroticJ-Vertebral Internal carotid-External carotid Subclavian-Carotid Subclavian-Vertebral


Arteries of Brain: Inferior Views .......

SwEBîMvyMi

y,-.*.—

Medial frontobasal (orbitofrontal) arter Anterior communicating artery Anterior cerebral artery Distal medial striate artery (recurrent artery of Heubner) Internal carotid artery Anterolateral central (lenticulostriate) arteries M i d d l e cerebral artery Lateral frontobasal (orbitofrontal) Prefrontal artery Anterior choroidal artery Posterior communicating artery Posterior cerebral artery Superior cerebellar Basilar artery Pontine arteries Labyrinthine (internal acoustic) arter Anterior inferior cerebellar artery (AICA) - Vertebral artery Anterior spinal Posterior inferior cerebellar artery (PICA) (cut) Posterior spinal artery Cerebral arterial circle (of Willis) Distal medial striate artery (recurrent artery of Heubner)

{broken

line)

Anterior communicating artery Anterior cerebral artery Middle cerebral artery Posterior communicating artery Anterior choroidal artery Optic tract Posterior cerebral artery Cerebral crus Lateral geniculate body Posterior medial choroidal artery Posterior lateral choroidal artery Choroid plexus of lateral ventricle Medial geniculate body Pulvinar of thalamus Lateral ventricle


Plate 139

Cerebral Arterial Circle (of Willis) For hypophyseal arteries see

Plate 148

Vessels dissected out: inferior view Anterior cerebral artery (A 2 segment) — Anterior communicating artery Anterior cerebral artery (A] segment)

Distal medial striate artery (recurrent artery of Heubner) Anteromedial central (perforating) arteries Hypothalamic artery Anterolateral central (lenticulostriate) arteries

Ophthalmic artery Internal carotid artery Middle cerebral

Superior hypophyseal artery


Inferior hypophyseal artery Anterior choroidal artery

Posterior c e r e b r i artpr (P2 segment) (P] segment) Superior cerebellar artery Basilar artery Pontine arteries Anterior inferior cerebellar artery (AICA)

fhalamotuberal (premammillary) artery Posteromedial central (perforating) arteries Thalamoperforating artery Posteromedial central (paramedian) arteries Labyrinthine (internal acoustic) artery

Vertebral artery

Vessels in situ: inferior view Anterior cerebral artery I lypothalamic artery Internal carotid arte Superior hypophyseal artery Middle cerebral artery I n f e r i o r h y p o p h y seal Posterior communicating artery Efferent hypophyseal veins Posterior cerebral artery

Anterior communicating artery Optic chiasm Cavernous sinus Infundibulum (pituitary stalk) and long hypophyseal portal veins Adenohypophysis (anterior lobe of pituitary gland) Neurohypophysis (posterior lobe of pituitary gland) Posteromedial central (perforating) arteries Superior cerebellar artery Basilar arterv


Arteries of Brain: Frontal View and Section llllliliiM |iilMIIHIHi|l|i'Mlll

Paracentral artery

Corpus callosum

Medial frontal branches

Anterolateral central (lenticulostriate)

Pericallosal artery

Lateral frontobasal (orbitofrontal) artery

Callosomarginal artery Polar frontal artery

Prefrontal

Anterior cerebral arteries

Precentral (pre-Rolandic) and central (Rolandic) sulcal arteries

Medial frontobasal (orbitofrontal) artery

Anterior parietal (postcentral sulcal) artery

Distal medial striate artery (recurrent artery of Heubner)

Posterior parietal artery


Branch to angular gyrus

Anterior choroidal artery

Temporal branches (anterior, middle and posteri

Posterior cerebral artery Superior cerebellar artery

M i d d l e cerebral artery and branches (deep in lateral cerebral [Sylvian] sulcus)

Basilar and pontine arteries Labyrinthine (internal acoustic) artery

Anterior communicating artery

Vertebral artery


Posterior inferior cerebellar artery (PICA)

Anterior inferior cerebellar artery (AICA) Posterior spinal a

Anterior spinal artery , Falx cerebri

Corpus striatum (caudate and lentiform nuclei Anterolateral central (lenticulostriate) a Insula (island of Reil) Limen of insula Precentral (pre-Rolandic), central (Rolandic) sulcal, and parietal arteries

Temporal branches of middle cerebral artery Temporal lobe Middle cerebral artery Internal carotid artery


Callosomarginal arteries and Pericallosal arteries (branches of anterior cerebral arteries) Trunk of corpus callosum Internal capsule Septum pellucidum Rostrum of corpus callosum Anterior cerebral arteries Distal medial striate artery (recurrent artery of Heubner) Anterior communicating artery Optic chiasm

MW&

Arteries of Brain: Lateral and Medial Views Anterior parietal (postcentral sulcal) artery

Posterior parietal artery

Central (Rolandic) sulcal artery Precentral (pre-Rolandic) sulcal artery

Terminal branches of posterior cerebral artery

Prefrontal sulcal artery Terminal branches of anterior cerebral artery Lateral frontobasal (orbitofrontal) artery Left middle cerebral artery Left anterior cerebral artery

Occipitotemporal branches

Anterior communicating artery

Posterior temporal branch

Right anterior cerebral artery

Middle temporal branch Left internal carotid artery Polar temporal artery

Medial * Posterior frontal < Intermediate branches Anterior

Pericaliceal artery

Superior and inferior terminal branches (trunks) Anterior temporal branch Paracentral artery Cingular branches Right posterior cerebral artery Precuneal artery

Callosomarginal arterv Polar frontal artery

Dorsal branch to corpus callosum Parietooccipital branch Calcarine branch

Right anterior cerebral artery Medial frontobasal (orbitofrontal) artery

Anterior communicating artery (cut) Distal medial striate artery (recurrent artery of Heubner) Right internal carotid artery

Medial occipital artery Posterior temporal branch Anterior temporal branch Posterior communicating artery

*Note: Anterior parietal (postcentral sulcal) artery also occurs as separate anterior parietal and postcentral sulcal arteries.

Plate 142


Arteries of Posterior Cranial Fossa H

H

H

B

H

H

M

H

H

n

M

H

M

M

B

H

H

B

B

B

n

H

I

M

R

M

W

n

n

B

H

B

H

'WglfiigM H H i

M

Thalamogeniculate arteries

Lateral and medial geniculate bodies of left thalamus

Anterior choroidal artery Crura of fornix Anterolateral central (lenticulostriate) arteries Heads of caudate nuclei Septum pellucidum

Choroid plexuses of lateral ventricles Pulvinars of left and right thalami Splenium of corpus callosum Occipital (posterior) horn of right lateral ventricle Right dorsal branch to corpus callosum (posterior pericallosal artery) Parietooccipital ) Branches of > right posterior Calcarine ) cerebral artery

Corpus callosum Anterior cerebral arteries Longitudinal cerebral fissure

Superior colliculi Superior vermian branch

Optic nerve (II) Ophthalmic artery

Posterior medial choroidal artery to choroid plexus of 3rd ventricle

Anterior cerebral artery Middle

Posterior lateral choroidal artery

cerebral artery Posterior

Lateral (marginal) branch

communicating artery

Inferior vermian artery (phantom)

Thalamoperforating arteries Left internal carotid artery

Choroidal branch to 4th ventricle (phantom) and Cerebellar tonsillar branch of posterior inferior cerebellar artery

Basilar artery Pontine arteries Labyrinthine (internal acoustic) artery Posterior cerebral artery Superior cerebellar artery Anterior inferior cerebellar artery (AICA) Anterior meningeal branch of vertebral artery Temporal branches of posterior cerebral artery Anterior spinal artery


Outline of 4th ventricle (broken line) Posterior meningeal branch of vertebral artery Posterior inferior cerebellar artery (PICA) Left posterior spinal artery Left vertebral artery

P0ate 143

Left superior and inferior colliculi

Left pulvinar

Basal vein (of Rosenthal)

Right pulvinar Internal cerebral veins

Posterior mesencephalic vein




Lateral mesencephalic vein

Dorsal vein of corpus callosum


Inferior sagittal sinus

Left thalamus (cut surface)

Straight sinus Falx cerebri

Optic tract

Confluence of sinuses

Tentorium cerebelli (cut)

Inferior thalamostriate veins

Left transverse sinus {cut)

Deep middle cerebral vein {cut)

Superior sagittal sinus

Anterior cerebral vein Optic nerve (II)

*

>>

*

*

yf

"f

Superior vermian vein

)

Inferior vermian vein Falx cerebelli (cut) and occipital sinus

Anterior pontomesencephalic vein

Inferior cerebellar hemispheric veins

Trigeminal nerve (V) Transverse pontine vein

Intraculminate vein Superior cerebellar vein (inconstant)

Petrosal vein (draining to superior petrosal sinus)

Preculminate vein

Lateral pontine vein

Precentral cerebellar vein Superior retrotonsillar vein

Anteromedian medullary vein Vein of lateral recess of 4th ventricle Superior, middle and inferior cerebellar peduncle's Anterior spinal vein

Plate 144

(Inferior retrotonsillar) vein of cerebellomedullary cistern Posterior spinal vein 4th ventricle

Parts of cerebellum L CL C D F

Lingula Central lobule Culmen Declive Folium

TU P U N T

Tuber Pyramid Uvula Nodule Tonsil


For superficial veins of brain see

Plate 102

Longitudinal cerebral fissure Anterior cerebral veins Rostrum of corpus callosum Septum pellucidum Anterior vein of septum pellucidum Head of caudate nucleus Anterior vein of caudate nucleus Transverse veins of caudate nucleus Interventricular foramen (of Monro) Columns of fornix Superior thalamostriate vein Superior choroid vein and choroid plexus of lateral ventricle Thalamus a choroidea of 3rd ventricle Lateral direct vein Posterior vein of caudate nucleus Internal cerebral veins Basal vein (of Rosenthal) Great cerebral vein (of Galen) Inferior sagittal sinus traight sinus um cerebelli nsverse sinus Confluence of sinuses Superior sagittal sinus

Dissection: superior view

Anterior cerebral vein Superficial middle cerebral vein (draining to sphenoparietal sinus

Optic chiasm

Deep middle cerebral vei Cerebral crus Basal vein (of Rosenthal) Lateral geniculate body Medial geniculate body

Inferior cerebral veins

Pulvinar of thalamus Splenium of corpus callosum Great cerebral vein (of Galen)

Inferior anastomotic vein (of Labbe)

Dissection: inferior view

Plate 145

Subependymal Veins of Brain

Posterior veins of septum pellucidum Superior thalamic veins Superior choroid vein Transverse veins of caudate nucleus

Lateral direct vein Posterior terminal vein of caudate nucleus (posterior part of thalamostriate vein) Internal cerebral veins (right and left) Medial (atrial) vein of lateral ventricle

Superior thalamostriate vein

Lateral (atrial) vein of lateral ventricle

Lateral ventricle


Anterior vein of caudate nucleus


Anterior vein of septum pellucidum

Dorsal vein of corpus callosum

Genu of corpus callosum

Inferior sagittal sinus Internal occipital vein Straight sinus Occipital (posterior) horn of lateral ventricle

Interventricular foramen (of Monro) Anterior commissure nterthalamic adhesion Anterior cerebral vein Optic chiasm Cerebellum

3rd ventricle Deep middle cerebral vein Inferior thalamostriate veins Basal vein (of Rosenthal) Temporal (inferior) horn of lateral ventricle Posterior mesencephalic vein

Superior vermian vein

Hippocampal and inferior ventricular veins Cerebral aqueduct 4th ventricle Lateral and median apertures of 4th ventricle

Plate 146

Veins on lateral wall of ventricle Veins on medial wall and floor of ventricle All other veins


Hypothalamus and Hypophysis MMHnHHHRHHHHnnnn^ See also

Plates 106, 107

Septum pellucidum Thalamus Fornix Hypothalamic sulcus Anterior commissure

Paraventricular Posterior Dorsomedial

Principal nuclei of hypothalamus

Supraoptic Ventromedial Arcuate (infundibular) Mammillary body — V Optic chiasm Infundibulum (pituitary stalk) Hypophysis (pituitary gland)

Lamina terminalis

Hypothalamic sulcus

Paraventricular hypothalamic nucleus Supraoptic hypothalamic nu Supraopticohypophyseal tract Tuberohypophyseal tract

Mammillary body

/

Hypothalamohypophyseal tract Infundibulum (pituitary stalk)

Pars tuberalis

Adenohypophysis (anterior lobe of pituitary gland)

Fibrous trabecu Pars intermedia Pars distalis

Arcuate (infundibular) nucleus

Median eminence of tuber cinereum Infundibular stem

Neurohypophysis (posterior lobe of pituitary gland)

Infundibular process

Plate 147

Arteries and Veins of Hypothalamus and Hypophysis See also

Plate 140

v.

,

1{ v

Primary plexus of hypophyseal portal system Superior hypophyseal artery

Long hypophyseal portal veins

Short hypophyseal portal veins Trabecula (fibrous tissue) Efferent hypophyseal vein to cavernous sinus

Secondary plexus of hypophyseal portal system

Adenohypophvsis (anterior lobe of pituitary gland)

Efferent hypophyseal vein to cavernous sinus

Neurohypophysis (posterior lobe of pituitary gland)

Capillary plexus of infundibular process

Efferent hypophyseal vein to cavernous sinus

Efferent hypophyseal veins to cavernous sinus

Plate 148

Inferior hypophyseal artery


Head Scans: Sagittal MR Images

Median (A) and paramedian (B, C) sagittal MR images A

c cc

Cerebellum

N

Corpus callosum


NP

Nasopharynx

Extraocular muscles

O

Occipital pole

F

Frontal pole

P

Pons

FV

Fourth ventricle

PG

Pituitary gland

L

Lateral ventricle

S

Sphenoid sinus

SC

Spinal cord

M

Medulla oblongata

T

Thalamus

TC

Tentorium cerebelli

TO

Tongue

E

O N Optic nerve

MB Midbrain MS Maxillary sinus

mm

B

Regional Scans

Plate 149

SSoB8S8BS$zS3

Axial CT images of the head f r o m inferior (A) to superior (C) A B

Basilar artery

M

C

Cerebellum

MA Mastoid air cells

CH

Cerebral hemisphere

MB

CS

Confluence of sinuses

MR Medial rectus muscle

E

Eye

MS

Maxillary sinus

EA


N

Nasal concha

NS

Nasal septum

P

Pons

S

Sphenoid sinus

SC

Semicircular canals

Medulla oblongata Midbrain

M M Masseter muscle

ES

Ethmoid sinus

F

Fat in orbit

FV

Fourth ventricle

L

Lens

LP

Lateral pterygoid muscle

SS

Superior sagittal sinus

LR


T

Temporalis muscle

TL

Temporal lobe

B

Plate 150

Regional Scans

Head Scans: Coronal CT Images See also

Plates 48, 83

A

Coronal CT images of the head from anterior (A) to posterior (C)

Regional Scans

A

Anterior clinoid process

L


C

Crista gaili

LS

E

Eye (vitreous chamber)

Levator palpebrae superioris and superior rectus muscles

ES

Ethmoid sinus

G

Greater wing of the sphenoid

M

Maxillary sinus

I '


IC

Incisive canal

IR

Inferior rectus muscle

MR Medial rectus muscle N

Nasal septum

OC Oral cavity S

Sphenoid sinus

Z

Zygomatic arch

Back and Spinal Cord Topographic Anatomy Plate 152

152 Back

Bones and Ligaments Plates 153-159 153 Vertebral Column 154 Thoracic Vertebrae 155 Lumbar Vertebrae efflgp

156

Lumbar Vertebrae: Radiographs

157 Sacrum and Coccyx 158

Vertebral Ligaments: Lumbar Region

159

Vertebral Ligaments: Lumbosacral Region

Spinal Cord Plates 160-173 160 Spinal Cord and Ventral Rami in Situ 161 Relation of Spinal Nerve Roots to Vertebrae 162 Lumbar Disc Herniation: Clinical Manifestations 163 Lumbar Puncture and Epidural Anesthesia 164

Dermatomes

165 Sympathetic Nervous System: General Topography 166 Parasympathetic Nervous System: General Topography 167 Sympathetic Nervous System: Schema 168 Parasympathetic Nervous System: Schema 169 Spinal Membranes and Nerve Roots 170 Spinal Nerve Origin: Cross Sections 171

Arteries of Spinal Cord: Schema

Atlas of Human Anatomy

Back and Spinal Cord 172 Arteries of Spinal Cord: Intrinsic Distribution 173 Veins of Spinal Cord and Vertebral Column ESS

Muscles and Nerves Plates 174-180

174 Muscles of Back: Superficial Layers 175 Muscles of Back: Intermediate Layers 176 Muscles of Back: Deep Layers 177 Nerves of Back 178 Suboccipital Triangle 179 Lumbar Region of Back: Cross Section 180 Typical Thoracic Spinal Nerve

1


Back


Trapezius muscle

Ligamentum nuchae

Spine of scapula

Spinous process of C7 vertebra

Deltoid muscle Infraspinatus muscle

Triceps brachii muscle Long head Lateral head Tendon

Deltoid muscle

Spine of scapula Triangle of auscultation Medial border of scapula Inferior angle of scapula Spinous process of T12 vertebra

Lumbar (triangle of Petit)

Latissimus dorsi muscle

Gluteus medius muscle

Iliac crest Erector spinae muscle

Sacrum

Gluteus maximus muscle

Posterior superior iliac spine

Greater trochanter of femur

Intergluteal (natal) cleft

Gluteal fold

* . —

Topographic Anatomy

Plate 152

Vertebral Column See also P l a t e s 1 3 , 1 7 , 1 8 , 1 5 4 , 1 5 5 , 1 5 7 , 1 8 5 , 2 4 8

Anterior view Atlas (C1) Axis (C2)

Left lateral view

Posterior view -Atlas (C1) Axis (C2) >

Cervical vertebrae

Thoracic vertebrae

Lumbar

> vertebrae

Sacrum ( S I - 5 ) Sacrum (SI —5)

Coccyx

Plate 153

Coccyx

Bones and Ligaments

See also


Superior costal facet

Vertebral foramen

Plate 187

Pedicle Transverse costal facet

Superior vertebral notch (forms lower margin of intervertebral foramen)

Superior costal facet

nsverse process

Pedicle

Inferior articular process

sverse costal facet

Interior costal Inferior vertebral notch

Superior articular facet

Spinous process

spinous process

T6 vertebra: lateral view

T6 vertebra: superior view

Superior articular process and facet Vertebral cana 7th rib


sverse process

Costal facet Inferior articular process and Spinous process of T7 vertebra

T12 vertebra: lateral view

Transverse process of T9 vertebra Inferior articular process (T9)

Lamina

Spinous process (T9)

T7, T8 and 19 vertebrae: posterior view

Bones and Ligaments

PDafte 1S4

Anulus fibrosus

Vertebral body

Nucleus pulposus

Vertebral foramen

Pedicle me?.

Transverse process

Intervertebral disc

Superior articular process Mammillary process Lamina Superior articular process

Spinous process

Mammillary process

Pedicle

L2 vertebra: superior view

Transverse process Spinous process

Vertebral body

Vertebral canal Superior articular process Mammillary process Transverse process

\

Intervertebral disc \

\


\

Inferior vertebral notch

Vertebral body

Intervertebral (neural) foramen Superior vertebral notch

Pars interarticularis Accessory process—

Lamina

Spinous process of L3 vertebra - -

Lamina •Articular facet for sacrum


L3 and L4 vertebrae posterior view

PQate

USS

Lumbar vertebrae, assembled left lateral view

H o w e s

a m d

L i g a m e n t s

LyoirafeaB*

W e r S e f e r a e ^

Anteroposterior radiograph

f ^ a d o e g r a p B i s

Lateral radiograph

B

Body of L3 vertebra

D

Intervertebral disc space

IA

Inferior articular process of L1 vertebra

I

Intervertebral foramen

L

Lamina of L4 vertebra

IA

Inferior articular process of L3 vertebra

P

Pedicle of L3 vertebra

IN

Inferior vertebral notch of L2 vertebra

S

Spinous process of L4 vertebra

P

Pedicle of L3 vertebra

SA

Superior articular process of L1 vertebra

S

Spinous process of L3 vertebra

SF

Sacral foramen

SA

Superior articular process of L4 vertebra

T

Transverse process of L3 vertebra

SN

Superior vertebral notch of L3 vertebra

Note: The vertebral bodies are numbered B©iraes

and]

Ugameinr&s

P l a t ®

1S©

Sacrum and Coccyx See also

Plates 153, 159, 248, 352-354 Superior articular process

Base of sacrum Lumbosacral articular surface

Sacral canal Superior articular process —Ala (wing)

mm.

Promontory

Sacral part of pelvic brim (linea terminalis)

BK5

Anterior (pelvic) sacral foramina

Sacral hiatus

Transverse ridges

Median sagittal section

- — A p e x of sacrum Transverse process of coccyx Coccyx

Anterior inferior view

Facets of superior articular processes^

Pelvic surface

Auricular surface Sacral tuberosity Lateral sacral crest Median sacral crest

Median sacral crest

Intermediate sacral crest

Sacral canal

Posterior sacral foramen


Posterior sacral foramina

•Mi W y .

r

-Sacral cornu (horn)

^

Coccygeal cornu (horn)

Sacral hiatus Anterior (pelvic) sacral foramen

Dorsal surface

Transverse process of coccyx

Coronal section through S2 foramina

Posterior superior view

PiaSe

1 5 7

B@p©s

a n d

L i g a m e n t s

Vertebral Ligaments: Lumbar Region

Left lateral view (partially sectioned in median plane)

Inferior articular process Capsule of zygapophyseal joint (partially

Anterior longitudinal ligament

opened)

Superior articular process Transverse process

Lumbar vertebral body

Spinous process Ligamentum flavum

Intervertebral disc •

•

Interspinous ligament

:

a l l • • ^

Anterior longitudinal ligament••

Supraspinous ligament

^ ' . r - ' S v . ;

•Intervertebral foramen Posterior longitudinal ligament

TV

\ f

" .' • : . -

:

—

—

Posterior vertebral segments: anterior view Anterior vertebral segments: posterior view (pedicles sectioned)

Pedicle (cut

surface)

Pedicle (cut

surface)

Ligamentum flavum

Posterior surface of vertebral bod' Lamina Posterior longitudinal ligament


Intervertebral disc

Bones and Ligaments

Plate 158

2



Transverse process Lamina Pedicle [cut)


Body of LI vertebra

Pedicle

Posterior longitudinal ligament


Intervertebral discs

Spinous process Interspinous ligament

L2 spinal nerve

Supraspinous ligament

Superior articular processes; facet tropism (difference in facet axis) on right side Spinous process Lamina Transverse process Body of L5 vertebra

Inferior articular process Ligamentum flavum Iliolumbar ligament

L5 spinal nerve

Iliac crest

Auricular surface of sacrum (for articulation with ilium)


Sacrum

Coccyx

Posterior inferior iliac spine

Left lateral view

Posterior sacroiliac ligaments Greater sciatic foramen Spine of ischium

Lateral, Posterior sacrococcygeal ligaments

Sacrospinous ligament Lesser sciatic foramen Sacrotuberous ligament

Plate 159

Posterior view

Bones and Ligaments

Spinal Cord and Ventral Rami in Situ

C I vertebra (atlas) C1 spinal nerve C2 vertebra (axis) C8 spinal nerve

Cervical plexus C7 vertebra T1 vertebra Brachial plexus

T1 spinal nerve 1 st rib

Spinal dura mater

Filaments of spinal nerve roots (T7 and T8) Intercostal nerves T12 vertebra

mat

T12 spinal nerve

LI vertebra 12th rib Iliohypogastric nerve Subcostal nerve L1 spinal nerve

Ilioinguinal nerve

Conus medullaris

Lumbar plexus Cauda equina

L5 vertebra

L5 spinal nerve

Femoral nerve

S1 spinal nerve Sacrum (cut

away)

Filum terminale internum Termination of dural sac Filum terminale externum (coccygeal ligament) S3 spinal nerve Coccygeal nerve

SporaaQ

ist

Sacral plexus Superior and inferior gluteal nerves Sciatic nerve Posterior femoral cutaneous nerve Pudendal nerve Coccyx

PGafe

<3 6 ©

Relation of Spinal Nerve Roots to Vertebrae

C1 spinal nerve exits above C1 vertebra

Base of skull Cervical enlargement

C8 spinal nerve exits below C7 vertebra (there are 8 cervical nerves but only 7 cervical vertebrae)

Lumbar disc protrusion does not usually affect nerve exiting above disc. Lateral protrusion at disc level L4-5 affects L5 spinal nerve, not L4 spinal nerve. Protrusion at disc level L5-S1 affects SI spinal nerve, not L5 spinal nerve.

Lumbar enlargement Conus medullaris (termination of spinal cord)

Cauda equina

Filum terminale internum

Sacrum Filum terminale externum (coccygeal ligament)

S4 S5

Termination of clural sac

Coccygeal nerve Coccyx

Coccygeal nerve

Cervical nerves Thoracic nerves Lumbar nerves Sacral and coccygeal nerves

Plate 161

Medial protrusion at disc level L4-5 rarely affects L4 spinal nerve but may affect L5 spinal nerve and sometimes S I - 4 spinal nerves.

Spinal Cord

Lumbar Disc Herniation: Clinical Manifestations

Schematic cross section showing compression of nerve root

Nucleus pulposus Characteristic posture in left-sided lower lumbar disc herniation

Nerve root Dura

Surgical exposure of lower lumbar disc herniation

Clinical features of herniated lumbar nucleus pulposus Level of herniation

L4—5 disc; 5th lumbar nerve root

L 5 - S 1 disc; 1st sacral nerve root

SpinaS ©@rdl

Pain

Over sacroiliac joint, hip, lateral thigh and leg

Over sacroiliac joint, hip, posterolateral thigh and leg to heel

Numbness

Lateral leg, first 3 toes

Back of calf, lateral heel, foot to toe

Weakness

Dorsiflexion of great toe and foot; difficulty walking on heels; foot drop may occur

Atrophy

Reflexes

Minor

Changes uncommon in knee and ankle jerks, but internal hamstring reflex diminished or absent

Plantar flexion of foot and great toe may be affected; difficulty walking on toes Gastrocnemius and soleus

Ankle jerk diminished or absent

Pflate 162

Lumbar Puncture and Epidural Anesthesia

Lumbar puncture Cauda equina

Subarachnoid space Needle entering subarachnoid space Iliac crest

Arrows show locations of insertion of needles.

Epidural anesthesia

Dural sac Epidural space Spinous process of L4 Ligamentum flavum Needle entering epidural space

Epidural anesthesia and lumbar puncture are performed by inserting a needle above or below the L4 vertebral spine, which lies at the level of the iliac crest. For epidural anesthesia, the needle passes into the epidural space, and anesthetic agent bathes the nerve roots in proximity. Lumbar puncture, on the other hand, is performed in order to collect a sample of cerebrospinal fluid (CSF) or to introduce an anesthetic agent into the CSF (spinal anesthesia), so therefore the needle penetrates the dural sac to enter the subarachnoid space. ^ , ,

r

Plate 163

Spinal Cord

Dermatomes — , — _

See also

Plates 483, 543; for maps of cutaneous nerves see Plates 24, 472, 474-476, 478, 481, 538-542

Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any two adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).

Levels of principal dermatomes C5 C5, 6, 7 C8, T1 C6 C6, 7, 8 C8 T4

Spinal Cord

Clavicles Lateral parts of upper limbs Medial sides of upper limbs Thumb Hand Ring and little fingers Level of nipples

T10 L1 LI/ 2, 3, 4 L4, 5, SI L4 51, 2, L5 SI 52, 3, 4

Level of umbilicus Inguinal or groin regions Anterior and inner surfaces of lower limbs Foot Medial side of great toe Posterior and outer surfaces of lower limbs Lateral margin of foot and little toe Perineum

Plate 164

Sympathetic Nervous System: General Topography

Internal carotid plexus Internal carotid nerve Superior cervical gan


External carotid nerve

Cervical sympathetic trunk Middle cervical ganglion

Cervical cardiac nerves

Cervicothoracic (stellate) ganglion Thoracic visceral nerves Pulmonary plexus

Cardiac plexus

White and gray rami communicantes Esophageal plexus Greater thoracic splanchnic nerve

Lesser thoracic splanchnic nerve Aorticorenal ganglion Lumbar splanchnic nerves

Celiac plexus Celiac ganglion

Superior mesenteric ganglion Superior mesenteric plexus Inferior mesenteric ganglion Inferior mesenteric plexus Superior hypogastric plexus Hypogastric nerve

Sacral splanchnic nerves

Inferior hypogastric plexus

C/YczdwL / —

Plate 165

Spinal Cord

Oculomotor nerve (CN III) Facial nerve (CN VII)

Glossopharyngeal nerve (CN IX) Vagus nerve (CN X)

Lacrimal gland Ciliary ganglion Pterygopalatine ganglion Parotic! gland Submandibular ganglion Sublingual and submandibular glands Cervical cardiac branch

Cardiac plexus Pulmonary plexus

Esophageal plexus

Anterior and posterior vagal trunks

Celiac plexus

Superior mesenteric plexus

Pelvic splanchnic nerves (from S2-4) Inferior hypogastric plexus

Cavernous nerves

C/Ycâvk/ —

Spinal Cord

Plate 166

Internal carotid nerve and plexus

Superior cervical ganglion

External carotid nerve and plexus

Grav rami communicantes First thoracic ganglion

Parotid gland

Innervation to arrector pili muscles, vascular smooth muscle, and sweatglands of skin Submandibular gland Larynx Trachea Bronchi Lungs Cardiac branches ^ — - G r e a t e r thoracic —' splanchnic nerve Heart

Celiac ganglion

{W' \

-—"Lesser thoracic splanchnic nerve

Stomach 0

White r a m u s ' communicans

Liver

Aorticorenal ganglion

Gallbladder ...

Bile ducts

Pancreas ^^ \

Gray ramus ^ communicans

i

\

Least thoracic splanchnic nerve Superior mesenteric ganglion

Intestines First lumbar ganglion Sacral splanchnic nerves

f Descending / colon Sigmoid colon

First sacral ganglion

Lumbar splanchnic nerves Inferior mesenteric ganglion

Rectum Urinary bladder

Inferior hypogastric plexus

Prostate Preganglionic fibers Postganglionic fibers

Plate

External genitalia

Spinal Cord

Parasympathetic Nervous System: Schema


Ciliary ganglion ,

Branch of oculomotor nerve (III)

, Lacrimal glands

Branch of facial nerve (VII) Medulla oblongata Branch of glossopharyngeal nerve (IX)

Parotid glands

Otic ganglion

Sublingual glands

A jRg^L


""--III!

4.-, Larynx

Submandibular glands

3 Trachea Bronchi Vagus nerve (X)

Lungs ^

} ...

Pulmonary plexus

Heart

Celiac ganglion

x

Stomach Liver

Superior mesenteric ganglion x

* Gallbladder Bile ducts V.;:

Pancreas

Kidnevs

Intestines Descending colon Interior hypogastric plexus

Sigmoid colon Rectum

Pelvic splanchnic nerves Preganglionic fibers Postganglionic fibers

Spinal Cord

External genitalia

Urinary bladder Prostate

C/ictf/tatik-

/—/y.P.

Plate 168

Posterior view

Ventral root of spinal nerve Dorsal root of spinal nerve Dorsal root (spinal) ganglion White and gray rami communicantes to and from sympathetic trunk Ventral ramus of spinal Dorsal ramus of spinal nerve Dura mater

Arachnoid mater

Mesothelial septum in dorsal median sulcu

Pia mater overlying spinal cord Filaments of dorsal root Denticulate ligament Dorsal horn Membranes removed: anterior view

(greatly

magnified)

Lateral horn

Ventral horn

Gray matter White matter

Filaments of dorsal root Dorsal root of spinal nerve Filaments of ventral root Dorsal root (spinal) ganglion Dorsal ramus of spinal nerve Ventral ramus of spinal nerve root of spinal nerve Spinal nerve

ray and white rami communicantes

Plate 169

Spinal Cord

Spinal Nerve Origin: Cross Sections —

— H — M M W M M

_ _

_

—

HMMMMHMMMMBMBM—i

——••

See also

Plates 169,172,173

Section through thoracic vertebra Body of vertebra Dura mater

Fat in epidural space

Arachnoid mater*

Sympathetic ganglion Denticulate ligament Ventral root

Subarachnoid space Pia mater*

White and gray rami communicantes

Recurrent meningeal branches of spinal nerve

Spinal nerve Ventral ramus (intercostal nerve) Dorsal ramus

Dorsal root (spinal) ganglion Dorsal root Lateral horn of gray matter of spinal cord Medial branch

Section through lumbar vertebra

Sympathetic ganglion

Lateral branch

of dorsal ramus of spinal nerve

Internal vertebral (epidural) venous plexus (of Batson)

Dura mater Arachnoid mater

Gray ramus communicans

Ventral root

Fat in epidural space

Spinal nerve Ventral ramus (contributes to lumbar plexus) Dorsal ramus

4 Dorsal and ventral roots of lumbar and sacral spinal nerves forming cauda equina

SpimaS

©©G^d]

Dorsal root (spinal) ganglion Dorsal root Conus medullaris

*

Leptomeninges

Plate 170

2

Arteries of Spinal Cord: Schema See also

Plate 138 Anterior view

Posterior view

Posterior cerebral artery Superior cerebellar artery

Posterior spinal arteries

Basilar artery Anterior inferior cerebellar artery (AICA)

Vertebral artery

Posterior inferior cerebellar artery (PICA)

Posterior segmental medullary arteries

Anterior spinal artery

Deep cervical artery

Vertebral artery Anterior segmental medullary arteries

Ascending cervical artery

Ascending cervical artery Subclavian artery

Deep cervical artery Subclavian artery


Anterior segmental medullary artery

Posterior intercostal artery Pial plexus

Thoracic vertebrae

Posterior intercostal arteries

Major anterior segmental medullary artery (great radicular artery of Adamkiewicz)


Anterior segmental medullary artery

Anastomotic loops to anterior spinal artery Lumbar artery

W i W

Lumbar > vertebrae <

Anastomotic loops to posterior spinal arteries-

Lateral (or medial) sacral arteries

Lateral (or medial) sacral arteries Sacrum

Plate 171

Lumbar arteries

Note: All spinal nerve roots have associated r a d i c u l a r or s e g m e n t a l m e d u l l a r y a r t e r i e s . M o s t roots have radicular arteries {see Plate 172). Both types of arteries run along roots, but radicular arteries end before reaching anterior or posterior spinal arteries; larger segmental medullary arteries continue o n to supply a segment of these arteries.

Spinal Cord

Posterior spinal arteries Anterior spinal artery Anterior segmental medullary artery Anterior radicular artery Posterior radicular artery Branch to vertebral body and dura mater Spinal branch Dorsal branch of posterior intercostal artery Posterior intercostal artery Paravertebral anastomoses Prevertebral anastomoses Thoracic (descending) aorta

Section through thoracic level: anterosuperior view

Sulcal (central) branches to right side of spinal cord Posterior radicular artery Anterior segmental medullary artery

Right posterior spinal artery Peripheral branches from pial plexus Sulcal (central) branches to left side of spinal cord Left posterior spinal artery

Pial arterial plexus Anterior and posterior radicular arteries Anterior spinal artery Posterior radicular artery

Arterial distribution: schema

Note: All spinal nerve roots have associated r a d i c u l a r or s e g m e n t a l m e d u l l a r y a r t e r i e s . Most roots have radicular arteries. Both types of arteries run along roots, but radicular arteries end before reaching anterior or posterior spinal arteries; larger segmental medullary arteries continue on to supply a segment of these arteries.

Spinal Cord

Anterior segmental medullary artery Pial arterial plexus

Plate 172

Internal vertebral (epidural) venous plexus External vertebral venous plexus

Intervertebral vein j

• " (. V

Internal vertebral (epidural) venous plexus (Batson's veins)

External vertebral venous plexus

External vertebral venous plexus

Basivertebral vein

Basivertebral vein Internal vertebral dural) venous plexus

mem

Anterior spinal vein Anterior sulcal (central) vein

wm

Segmental medullary/ radicular veins /

ft

Basivertebral vein

Intervertebral vein

Internal vertebral (epidural) venous plexus (Batson's veins)

Internal vertebral (epidural) venous plexus External vertebral venous plexus Intervertebral vein Anterior segmental medullary/radicular vein Posterior segmental medullary/radicular vein Pial venous plexus Posterior sulcal (central) vein Posterior spinal vein Internal vertebral (epidural) venous plexus

Plate 173

Spinal Cord

Muscles of Back: Superficial Layers

Superior nuchal line of skull Spinous process of C2 vertebra Sternocleidomastoid muscle Posterior triangle of neck Trapezius muscle

S e m i s p i n a l capitis muscle Splenius capitis muscle Spinous process of C7 vertebra Splenius cervicis muscle Levator scapulae muscle Rhomboid minor muscle (cut) Supraspinatus muscle

Infraspinatus fascia

Serratus posterior superior muscle

Teres minor muscle

Rhomboid major muscle (cut)

Teres major muscle

Infraspinatus fascia (over infraspinatus muscle)


Spinous process of T12 vertebra

Teres minor and major muscles Latissimus dorsi muscle (cut)

Thoracolumbar fascia Serratus anterior muscle External oblique muscle Internal oblique muscle in lumbar triangle (of Petit) Iliac crest Gluteal aponeurosis (over gluteus medius muscle)

Serratus posterior inferior muscle 12th rib Erector spinae muscle External oblique muscle Internal oblique muscle


Muscles and Nerves

Plate 174

2

Superior nuchal line of skull

Rectus capitis posterior minor muscle Obliquus capitis superior muscle

Longissimus capitis muscle

Rectus capitis posterior major muscle Obliquus capitis inferior muscle Longissimus capitis muscle

Splenius capitis and splenius cervicis muscles

S e m i s p i n a l capitis muscle (cut) Spinalis cervicis muscle Spinous process of C7 vertebra

I l i o c o s t a l muscle

Longissimus cervicis muscle lliocostalis cervicis muscle

Erector spinae < muscle

lliocostalis thoracis muscle Spinalis muscle

Hook Spinalis thoracis muscle Longissimus thoracis muscle

Serratus posterior inferior muscle

Tendon of origin of transversus abdominis muscle

Internal oblique muscle

lliocostalis lumborum muscle Spinous process of T12 vertebra Transversus abdominis muscle and tendon of origin Thoracolumbar fascia (posterior layer) (cut)

External oblique muscle (cut)

Iliac crest

Plate 175

Muscles and Nerves

Rectus capitis posterior minor muscle

Superior nuchal line of skull

Obliquus capitis superior muscle

Mastoid process

Rectus capitis posterior major muscle

Posterior tubercle of atlas (CI vertebra)-

Transverse process of atlas ( C I )

Spinous process of axis (C2 vertebra)

Obliquus capitis inferior muscle Longus

Semispinalis capitis muscle

Brevis

Spinous process of C7 vertebra

Rotatores cervicis muscles

Levator costae muscle

External intercostal muscles

Longus ) Rotatores Brevis \ thoracis muscles Semispinalis thoracis muscles

Brevis \ Levatores Longus \ costarum muscles

iMultifidus muscles

Thoracolumbar fascia (anterior layer)

Interspinals lumborum muscle

Intertransversarius muscle

Thoracolumbar fascia (posterior layer) (cut)

Quadratus lumborum muscle

Transversus abdominis muscle and tendon of origin

Iliac crest iMultifidus muscles

Erector spinae muscle (cut)

GlyseOes

a n d

i l e r w e s

iMultifidus muscles (cut) S,\»«V

.•

. . .

P l a t e

1 7 ®

2

Nerves of Back See also

Plates 180, 192, 254, 258

Accessory nerve (XI) Trapezius muscle ( r e f l e c t e d ) Levator scapulae muscle Transverse cervical artery and vein Subtrapezial plexus

Greater occipital nerve (dorsal ramus of C2 spinal nerve) 3rd occipital nerve (dorsal ramus of C3 spinal nerve) Lesser occipital nerve / _ . . ( Great auricular nerve ) Trapezius muscle Posterior cutaneous branches (from medial branches of dorsal rami of C4-T6 spinal nerves; C7, 8 are minimal) ..

Supraspinatus muscle

Cervical plexus (ventral rami of C2, 3 spinal nerves)

/

Deltoid muscle Infraspinatus fascia

Spine of scapula

Teres minor and major muscles


Superior lateral brachial cutaneous nerve (from axillary nerve C5, 6) Posterior cutaneous branches (from lateral branches of dorsal rami of T7-12 spinal nerves)

Rhomboid minor muscle Rhomboid major muscle

Lateral cutaneous branches of ventral rami (intercostal nerves)

Latissimus dorsi muscle External oblique muscle Spinous process of T12 vertebra

Iliac crest

Thoracolumbar fascia

Iliohypogastric nerve (ventral ramus of LI spinal nerve) Superior clunial nerves (dorsal rami of L1, 2, 3 spinal nerves)


Medial clunial nerves (dorsal rami of S1, 2, 3 spinal nerves) Inferior clunial nerves from posterior femoral cutaneous nerve (sacral plexus S1, 2, 3)

Plate 177

Muscles and Nerves

Suboccipital Triangle

Epicranial aponeurosis (galea aponeurotica)

Semispinalis capitis muscle (cut and reflected)

Occipital belly (occipitalis) of occipitofrontalis muscle

Greater occipital nerve (dorsal ramus of C2 spinal nerve)

Vertebral artery (atlantic part) Obliquus capitis superior muscle

SEfe '

Suboccipital nerve (dorsal ramus of C1 spinal nerve)

Occipital artery mm

Posterior arch of atlas (CI vertebra)

Third occipital nerve (dorsal ramus of C3 spinal nerve)

Occipital artery Obliquus capitis inferior muscle

Semispinalis capitis and splenius capitis muscles in posterior triangle of neck

Greater occipital nerve (dorsal ramus of C2 spinal nerve)


Great auricular nerve (cervical plexus C2, 3)

Splenius capitis muscle (cut and reflected) Third occipital nerve (dorsal ramus of C3 spinal nerve) Longissimus capitis muscle

Lesser occipital nerve (cervical plexus C2)

Splenius cervicis muscle Semispinalis cervicis muscle


Trapezius muscle

Posterior cutaneous branches of dorsal rami of C4, 5, 6 spinal nerves

ilyseles and Nerwes

Semispinalis capitis muscle (cut) Splenius capitis muscle (cut)

Plate 178

Descending (2nd) part of duodenum Kidney Renal (Gerota's) fascia (anterior and posterior layers) Perirenal fat Pararenal fat Peritoneum Extraperitoneal (subserous) fascia (areolar tissue)

Inferior vena cava Pancreas Anterior longitudinal ligament Crura of diaphragm Superior mesenteric artery and vein Mesentery Abdominal aorta

Transversalis fascia

Duodenojejunal junction Body of L2 vertebra Psoas major muscle and fascia Lumbar spinal nerve Transverse process

External oblique muscle

Spinal dura mater Cauda equina


Transversus abdominis muscle Tendon of origin of transversus abdominis and internal oblique muscles Serratus posterior inferior muscle Latissimus dorsi muscle Quadratus lumborum muscle

Spinous process of L1 vertebra Supraspinous ligament Erector spinae muscle Thoracolumbar fascia (posterior layer) Thoracolumbar fascia (middle layer) Thoracolumbar fascia (anterior layerquadratus lumborum fascia)

Plate 179

Muscles and Nerves

Typical Thoracic Spinal Nerve See also

Plates 192, 258

Anterior cutaneous branch Medial branch

Lateral branch

Sternum

External intercostal muscle

Internal intercostal muscle

Innermost intercostal muscle

-Anterior branch Lateral cutaneous branch


Posterior branch

Serratus anterior muscle Latissimus dorsi muscle

— Subscapularis muscle

Teres major muscle

Scapula

Infraspinatus muscle

Dorsal ramus Medial branch Lateral branch Posterior cutaneous branch

Rhomboid major muscle Erector spinae muscle nternal intercostal membrane

Note: In lower thoracic region, lateral branch of dorsal ramus is longer, motor, and cutaneous; medial branch is shorter and motor only.

Muscles and Nerves

4

Plate 180

*' v

2 *

ion 3 Thorax Topographic A n a t o m y Plates 181 MeMMJXMMMMMl

181

Thorax

Mammary Gland Plates 182-184

182

Mammary Gland

183 Arteries of Mammary Gland 184

Lymph Vessels and Nodes of Mammary Gland

B o d y Wall Plates 185-195

185

Bony Framework of Thorax

186

Ribs and Sternocostal Joints

187

Costovertebral Joints

188 Anterior Thoracic Wall 189 Anterior Thoracic Wall (continued) 190

Chest Drainage Tube Placement

191

Anterior Thoracic Wall: Internal View

192

Intercostal Nerves and Arteries

193

Phrenic Nerve

194

Diaphragm: Thoracic Surface

195

Diaphragm: Abdominal Surface

L y ^ g s Plates 196-210

196 Topography of Lungs: Anterior View 197 Topography of Lungs: Posterior View 198

Lungs in Situ: Anterior View


Thorax 199

Lungs: Medial Views

226

Nerves of Heart

200

Bronchopulmonary Segments

227

Innervation of Heart: Schema

201

Bronchopulmonary Segments (continued)

228

Innervation of Blood Vessels: Schema

202

Trachea and Major Bronchi

229

Prenatal and Postnatal Circulation

203

Nomenclature of Bronchi: Schema

204

Intrapulmonary Airways: Schema

205

Intrapulmonary Blood Circulation: Schema

206

Great Vessels of Superior Mediastinum

230

Mediastinum: Right Lateral View

207

Bronchial Arteries and Veins

231

Mediastinum: Left Lateral View

208

Lymph Vessels and Nodes of Lung

232

Esophagus in Situ

209 Autonomic Nerves in Thorax

233

Topography and Constrictions of Esophagus

210

234

Musculature of Esophagus

235

Pharyngoesophageal Junction

Heart

236

Esophagogastric Junction

Plates 211-229

237 Arteries of Esophagus

211

Heart in Situ

238 Veins of Esophagus

212

Heart: Anterior Exposure

239

Lymph Vessels and Nodes of Esophagus

213

Radiograph of Chest

240

Nerves of Esophagus

214

Heart: Base and Diaphragmatic Surfaces

241

Mediastinum: Cross Section

215

Pericardial Sac

216

Coronary Arteries and Cardiac Veins

217

Coronary Arteries and Cardiac Veins: Variations

218

Coronary Arteries: Arteriographic Views

219

Coronary Arteries: Arteriographic Views (continued)

220

Right Atrium and Ventricle

221

Left Atrium and Ventricle

Innervation of Tracheobronchial Tree: Schema

Mediastinum Plates 230-241

#

Regional S c a n s Plate 242

242

Chest Scans: Axial CT Images

Cross-Sectional Anatomy Plates 243-246

222 Valves and Fibrous Skeleton of Heart

243

Cross Section of Thorax at T3 Level

223

244

Cross Section of Thorax at T3-4 Disc Level

224 Atria, Ventricles, and Interventricular Septum

245

Cross Section of Thorax at T4-5 Disc Level

225

246

Cross Section of Thorax at T7 Level

Valves and Fibrous Skeleton of Heart (continued)

Conducting System of Heart


Thorax H6M

H H mwHESNKn! 36

.

Biceps brachii muscle Sternocleidomastoid muscle Sternal head Clavicular head

Triceps brachii muscle Axilla

Clavicle Anterior axillary fold

Jugular notch

Posterior axillary fold

Deltoid muscle

Pectoralis major muscle Clavicular head Sternal head

Body of sternum Nipple


Cephalic vein

Xiphoid process of sternum Serratus anterior muscle Linea alba Rectus abdominis muscle Tendinous intersection

fmm-:..

Serratus anterior muscle

T@p@gsraptilc Anatomy

External oblique muscle C/farfatk/ Af.7>.

Plate 181

3

3

M a m m a r y

G l a n d

Anterolateral dissection

•Suspensory ligaments of breast (Cooper's) (y

Pectoralis major muscle (deep to pectoral fascia)

•••••••• v

Wmmt : Is? Wfam • W*

A

f

fel

/

I

M

sjviy

' f|

-Areolar glands A

m*

Axillary tail (of Spence) Serratus anterior muscle m


m

m

.

i m '

n

gSeM

v

Clavicle :•

JB5 Im

Lv^"-" M. *

s*.

di

m

1

S3

• > .i

SOr.

X

v

7>fr

m.

major muscle v <.

v w

.-• ^

1

<

jJKfc'

. - v V

<

,.•

-i

••

.

v;-"

Areola

. V .

Nipple

ft

IC': (

iM

Fat

^

Ik I ^ L

s f t l ! is 1

•mm

if

M AH

Lactiferous ducts

Gland lobules

it

Intercostal muscles

Intercostal vessels and nerve

V

1

M

Pectoral fascia-

•X

«

- y ^ Z ^ h . ,

Lactiferous sinus

' •yi •

•

Suspensory ligaments of breast (Cooper's)

...

Lactiferous duct -

> )

•v

V;

Lactiferous sinus Lung-

I AM ' .|

r / ; v i l l i . V-

6th rib •

Plate 182

v

M

V V,

m

;.

•;<

•

•'•

^

:•'

••• - ' v . y - N v ; ' ; ,

\\

W

Gland lobules

Fat (subcutaneous tissue layer)

J;

-./m •»:

?•

Sagittal section

Mammary Gland

Arteries of Mammary Gland

Subclavian artery Internal thoracic artery and its perforating branches Medial mammary branches Axillary artery Brachial plexus Brachial artery

i§mm

Lateral thoracic artery and Lateral mammary branches Axillary tail (of Spence) Lateral mammary branches of lateral cutaneous branches of posterior intercostal arteries

Mmmmar^

©Darsdj

Plate 183

Lymph Vessels and Nodes of Mammary Gland

Parasternal nodes Apical axillary Interpectoral (Rotter's) nodes (subclavian) nodes Central axillary nodes

WK

Lateral axillary (humeral) nodes

is®

Posterior axillary (subscapular) nodes Anterior axillary (pectoral) nodes

Pathway to anterior mediastinal nodes

P l a t e

1 8 4

M a m m a r y

© l a n d

Bony Framework of Thorax See also

Plate 248

Anterior view Acromion Coracoicl process

Scapula

Glenoid cavity Neck

•

Sternum

Xiphoid process

Scapular notch Subscapular fossa

True ribs (1-7) Costal cartilages False ribs (8-12) Floating ribs (11-12)

Clavicle

Posterior view

Acromion Supraspinous fossa Spine

Scapula

Infraspinous fossa

True ribs (1-7)

False ribs (8-12)

Floating ribs

(11-12)

Body Wall

Plate 185

3

Ribs and Sternocostal Joints

Subclavius muscle

1st left rib: superior view

Muscle attachments

Grooves for subclavian vein and artery

\

Head

Origins

Neck

Insertions

Tubercle (no angle)

Anterior' 1 scalene muscle^""

Middle rib: posterior view

Head Neck

Serratus anterior muscle (1 st digitation)

Head

Tubercle

Middle scalene muscle

Neck

Posterior scalene muscle

%U

2nd left rib: N superior view

for transverse process of vertebra

Serratus anterior m u s c l e ^ (2nd digitation)

Interclavicular ligament Articular disc

^•^^Clavicle .

Articular facets for vertebral body

Manubrium

Costal groove Costoclavicular ligament Articular cavity

Manubriosternal joint

Intraarticular sternocostal ligament Articular cavities

Costal cartilages

Costochondral joints Vst^V

A

Radiate sternocostal ligaments

Note: The head of a typical rib articulates with the superior costal facet of the thoracic vertebra of the same number (by its inferior articular facet), the inferior costal facet of the vertebra above (by its superior articular facet), and the intervertebral disc between the two vertebrae. The costal tubercle articulates with the transverse process of the vertebra of the same number.

Costal cartilages

Interchondral joints

/

/

Xiphoid process

Costoxiphoid ligament

Plate 186

i

y

f x .

Sternocostal articulations: anterior view

Body Wall

Costovertebral Joints See also


Plate 154

Transverse costal facet (for tubercle of rib of same number as vertebra) Lateral costotransverse ligament

Inferior costal facet (for head of rib one number greater)

Intertransverse ligament

Interarticular ligament of head of rib Superior costal facet (for head of rib of same number)

Superior costotransverse ligament Superior articular facet of rib head

Radiate ligament of head of rib

Intraarticular ligament

Radiate ligament of head of rib

Synovial cavities

Left lateral view

Superior costotransverse ligament (cut) Superior costal facet (for head of rib of same number)

'

jijjjitiVlf"

Transverse process [cut

Costotransverse ligament Lateral costotransverse ligament Radiate ligament of head of rib

Transverse section: superior view

Costotransverse ligament

Lateral costotransverse ligament Superior costotransverse ligament

Intertransverse ligament

Right posterolateral view

Plate 187

3

Anterior Thoracic Wall

Sternocleidomastoid muscle Posterior triangle of neck Trapezius muscle Perforating branches of internal thoracic artery and anterior cutaneous branches of intercostal nerves

Sternothyroid muscle ' Sternohyoid muscle [ l n v e ? t e f ' b V . • . . . . \ cervical fascia Omohyoid muscle Clavicle Subclavius muscle invested by clavipectoral fascia Thoracoacromial artery (pectoral branch) and lateral pectoral nerve


Costocoracoid ligament

Cephalic vein Acromion

Coracoid process

Deltoid muscle

Medial pectoral nerve

>.•.>'y

Long thoracic nerve and lateral thoracic artery

Pectoralis minor muscle invested by Clavipectoral fascia


Digitations of serratus anterior muscle

Digitations of serratus anterior muscle Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries External oblique muscle-

Sternalis muscle (inconstant)

Plate 188

External intercostal muscles Body and xiphoid process of sternum

Anterior layer of rectus sheath

/—/y.p.

External intercostal membranes anterior to internal intercostal muscles

Internal oblique muscle Rectus abdominis muscle Cutaneous branches of thoracoabdominal (abdominal portions of intercostal) nerves and superior epigastric artery

Body Wall

Anterior Thoracic Wali (continued) iHMHMi

CWC5C

a l Wg jB i IMyMM li ^

Omohyoid, sternothyroid and sternohyoid muscles Clavicle Subclavius muscle

Thoracoacromial artery

I

HI—inlHHilil PW—Wr •••.••

.'

...

.

nternal jugular vein Levator scapulae muscle Anterior Middle > Scalene muscles Posterior Phrenic nerve

Coracoid process Cephalic vein Pectoralis major muscle (cut) Deltoid muscle

Brachial plexus Thoracic duct Subclavian artery and vein Axillary artery and vein

Intercostobrachial nerve

Superior thoracic artery

Long thoracic nerve and lateral thoracic artery

Internal thoracic artery and veins

Pectoralis minor muscle Digitations of serratus anterior muscle Lateral cutaneous branches of intercostal nerves and posterior intercostal arteries External intercostal muscles

External intercostal muscle Internal intercostal muscle (cut) Transversus thoracis muscle Anterior intercostal branches of internal thoracic artery Intercostal nerve

External intercostal membranes anterior to internal intercostal muscles

Musculophrenic artery and vein Transversus abdominis muscle

Rectus abdominis muscle and sheath (cat)

Body Wall

Superior epigastric arteries and veins

Plate 189

3

3

Chest Drainage Tube Placement

Preferred sites 1. For pneumothorax (2nd or 3rd interspace at midclavicular line) 2. For hemothorax (5th interspace at midaxillary line)

A.Trocar and cannula pushed through intercostal space

B.Trocar withdrawn; tube passed into chest through cannula

C.Cannula withdrawn; tube connected to underwater seal (with suction if indicated)

D. Intercostal space is pierced above rib to avoid damage to neurovascular bundle lying in costal groove

Thoracocentesis and tube drainage with underwaterseal drainage usually suffices.

Plate 190

Body Wall

A n t e r i o r

Y h m m e i e

W a l l :

â^gBgRi^^

I n t e r n a l

W i e w

n mmm

Sternothyroid muscle Sternohyoid muscle

Manubrium of sternum Common carotid artery Inferior thyroid artery


Vertebral artery



Subclavian artery and vein


Clavicle (cut) Brachiocephalic vein

Brachiocephalic vein

Phrenic nerve and pericardiacophrenic artery and vein

Internal thoracic artery and vein Anterior intercostal arteries and veins and intercostal nerve

Internal thoracic artery and vein Anterior intercostal arteries and veins and intercostal nerve

Internal intercostal muscles

Perforating branches of internal thoracic artery and vein and anterior cutaneous branch of intercostal nerve

Innermost intercostal muscles

Collateral branches of intercostal artery and vein

Transversus thoracis muscle

mm

Body of sternum Sternocostal triangle

"mm

Diaphragm Slips of costal origin of diaphragm Musculophrenic artery and vein

I

Transversus abdominis muscle

Transversus abdominis muscle Sternal part of diaphragm

Internal thoracic artery and veins Superior epigastric artery and veins

Body Wall

Plate 191

3

Intercostal Nerves and Arteries See also

Plates 180, 258 Ventral root Dorsal root (spinal) ganglion

— Spinal (radicular, or segmental medullary) branch of posterior intercostal artery Dorsal branch of posterior intercostal artery Trapezius muscle

Erector spinae muscle Dorsal ramus of thoracic nerve Costotransverse ligament

Medial branch Lateral branch

Rhomboid major muscle Erector spinae muscle Posterior intercostal artery

Intercostal nerve (ventral ramus of thoracic spinal nerve)

Internal intercostal membrane

Internal intercostal membrane deep to external intercostal muscle

Scapula Infraspinatus muscle Subscapulars muscle



TV •vu

»

Gray and white / rami communicantes Thoracic aorta

Sympathetic trunk and ganglia — Innermost intercostal muscle Internal intercostal muscle

Right posterior intercostal arteries (cut)

Innermost intercostal muscle Internal intercostal muscle

External intercostal muscle Transversus thoracis muscle

External intercostal muscle Sternum


Lateral cutaneous branch of intercostal nerve Anterior branch of lateral cutaneous branch of intercostal nerve External oblique muscle Pectoral is major muscle Anterior cutaneous branch of intercostal nerve

External oblique muscle Perforating branch Superior epigastric artery

I

Rectus abdominis muscle

Lateral cutaneous branch of posterior intercostal artery External intercostal membrane Anterior intercostal arteries

Body Wall

Phrenic Nerve See also

Ventral rami

Ventral rami

Anterior scalene muscle Right common carotid artery

Anterior scalene muscle MM

Brachial plexus

Brachial plexus

Left phrenic nerve

Right phrenic nerve


Right subclavian artery

Left vagus nerve (X)

Right vagus nerve { X r

Left common carotid artery

Right internal ^ thoracic artery ( c u t ) ^

^

Thoracic cardiac nerves ^ l I X L e f t pericardiaco> phrenic Left periartery (cut) phrenic

— - r * — ;

Superior vena cava


Root of right lungPericardial branch of phrenic nerve-" Mediastinal part of parietal pleura

Left internal thoracic artery (cut)

Brachiocephalic trunk Right pericardiacophrenic artery (cut)-

Plates 32, 129

Root of left lung Mediastinal part of parietal pleura

AS

; Jp

Costal part of parietal pleura

Diaphragmatic part of parietal pleura (cut)—— Phrenicoabdominal branches of phrenic nerves to inferior surface of diaphragm

lipi Phrenic nerves (efferent and afferent fibers)

mm

W&M

i.

Lower intercostal nerves (afferent only from peripheral part of diaphragm)

Body Wall

Plate 193

D i a p h r a g m s See also

T h o r a c i c

S u r f a c e

Plates 230, 231

Thoracic (descending) aorta

Neck of rib Left sympathetic trunk

T8~9 intervertebral disc

Left greater thoracic splanchnic nerve

Right sympathetic trunk

Hemiazygos vein

Right greater thoracic splanchnic nerve

Mediastinal pleura

Costal part of parietal pleura

Esophagus

Azygos vein

Thoracic duct V * Right leaflet of J central tendon

Diaphragmatic part of Parietal pleura (cutaway)

Diaphragmatic part of parietal pleura (cut away)

Left leaflet of central tendon

Right phrenic nerve and pericardiacophrenic artery and vein

Mediastinal part of parietal pleura and pericardium (cut)

Mediastinal part of parietal pleura and pericardium (cut)

Left phrenic nerve and pericardiacophrenic artery and vein

Right costodiaphragmatic recess of pleural c a v i t y —

Pericardium

Inferior vena cava (receiving hepatic veins)

Left costomediastinal recess of pleural cavity

Right internal thoracic artery and veins


Right costomediastinal recess of pleural cavity

Left internal thoracic artery and veins

Anterior mediastinum Sternum

Plate 194

oth costal cartilage Middle leaflet of central tendon covered by pericardium

Body Wall

Diaphragm: Abdominal Surface See also

Sternal part of diaphragm

Plates 253, 263, 270

Sternocostal triangle

Anterior branch of right phrenic nerve

Anterior branch of left phrenic nerve Costal part of diaphragm Central tendon of diaphragm

Right inferior phrenic artery

Esophageal hiatus

Caval opening

Fibers from right crus passing to left of esophageal hiatus

Right crus of diaphragm

Left inferior phrenic artery

Greater thoracic splanchnic nerve

Recurrent branch to esophagus

Lesser thoracic splanchnic nerve

Anterior branch Lateral branch Left superior suprarenal artery

Least thoracic splanchnic nerve

Left phrenic nerve

Costal part of diaphragm ft*:;

'

Left crus of diaphragm

Transversus abdominis muscle Lumbocostal triangle 12th rib Lateral arcuate ligament Lumbar part of diaphragm


Medial arcuate ligament Transverse process of L1 vertebra

Sympathetic trunk Celiac trunk

Body Wall

Aortic hiatus

Median arcuate ligament Abdominal aorta

?

C/ikM&c^ / w.t>.

Plate 195

Topography of Lungs: Anterior View

Thyroid gland

Trachea

Cervical (cupula, or dome, of) parietal pleura

Jugular (suprasternal) notch Apex of lung

Sternoclavicular joint

Arch of aorta

Clavicle 1st rib and costal cartilage

Cardiac notch of left lung

WS&l •

••:'

Left border of heart

Right border of heart

Horizontal fissure of right lung (often incomplete)

iA" yS8

."•

Costomediastinal recess of pleural cavity

Oblique fissure of right lung

Oblique fissure of left lung

Costodiaphragmatic recess of pleural cavity


Spleen Inferior border of left lung Left dome of diaphragm

Pleural reflection

Pleural reflection Stomach Right dome of diaphragm

Bare area of pericardium Liver

Xiphoid process

L m g s

Topography of Lungs: Posterior View

Cervical (cupula, or dome, of) parietal pleura Apex of left lung 1 st rib

1st rib Oblique fissure of right lung Clavicle

Oblique fissure of left lung

Horizontal fissure of right lung (often incomplete)

Spine of scapula Left border of costal parietal pleura

Right border of costal parietal pleura



Spleen

Liver

Pleural reflection

Pleural reflection Inferior border of right lung Left kidney

Right kidney Right dome of diaphragm

Left suprarenal gland

Lwngs

Right suprarenal gland

Plate 197

3

Lungs in Situs Anterior View

Thyroid gland

Trachea and inferior thyroid veins C o m m o n carotid artery

Omohyoid, sternothyroid and sternohyoid muscles


Manubrium of sternum

Phrenic nerve




Thoracic duct

Costal part of parietal pleura (cutaway/)

Brachial plexus

Clavicle



Internal thoracic artery and vein

Pectoral is minor muscle

Axillary artery and vein

Intercostal muscles

Cardiac notch of left lung

-

; >

ivAi'JvX

Superior lobe, Middle lobe, Inferior lobe of right lung

Superior lobe, Inferior lobe of left lung Costomediastinal space

Oblique fissure Horizontal fissure of right lung

Oblique fissure

Costodiaphragmatic recess

Musculophrenic artery

Diaphragmatic part of parietal pleura

Lingula of superior lobe of left lung

Diaphragm 7th costal cartilage

/

Xiphoid process

Internal thoracic artery Mediastinal part of parietal pleura Fibrous pericardium

Plate 198

Lungs

Lungs: Medial Views

Right lung Groove for subclavian artery

Apex Area for trachea Area for esophagus

Groove for brachiocephalic vein

Groove for azygos vein

Groove for 1 st rib

Oblique fissure

Groove for superior vena cava

Pleura (cut edge) Right superior lobar (eparterial) bronchus

Area for thymus and fatty tissue of anterior mediastinum

Right pulmonary arteries Right bronchial artery

Anterior border

Right intermediate bronchus

Hilurm

Right superior pulmonary veins

Horizontal fissure

Bronchopulmonary (hilar) lymph nodes

Cardiac impression

Right inferior pulmonary veins

Oblique fissure

Inferior lobe

M i d d l e lobe

Groove for esophagus

Groove for inferior vena cava

Pulmonary ligament

Diaphragmatic surface

Inferior border

Apex Groove for subclavian artery Area for trachea and esophagus Oblique fissure Groove for arch of aorta Pleura (cut edge) Left pulmonary artery-

Groove for left brachiocephalic vein Groove for 1 st rib Anterior border Area for thymus and fatty tissue of anterior mediastinum

Left bronchial arteries Left main bronchus Left superior pulmonary veins Bronchopulmonary (hilar) lymph nodes Inferior lobe Left inferior pulmonary vein Groove for descending aorta Inferior border

Hilum Cardiac impression Pulmonary ligament Cardiac notch Oblique fissure Groove for esophagus Diaphragmatic surface Lingula

[Plate 1©®

Bronchopulmonary Segments

Right lung

Anterior view

Left l u n g

Superior lobe

Superior lobe

Apical (S1)

A pi coposterior

Anterior (S3)

Superior division (culmen)

(S 1 + 2)

Posterior (S2

Anterior (S3) Superior j lingular (S 4) Inferior lingular (S 5)

Middle lobe Lateral (S4)

Lingular division

Medial (S5)

Inferior lobe

Inferior lobe

Anterior basal (S8)

Antero medial basal (S 7+8 )

Medial basal (S7)

Posterior basal (S10)

Lateral basal (S9)

Lateral basal (S9)

Posterior basal (S10) Posterior view Left l u n g

S

Superior lobe /

Apicoposterior (S 1+2 ) Anterior

/

/

/

/

Right lung

s

Superior lobe Apical (S1) Posterior (S2)

v /

Anterior (S3)

(S3)

Lingular ( Superior division I lingular (S4) Middle lobe

•N S W ' \ Inferior lobe Superior (S{)) Lateral basal (S9)

•"V

\

I

f

1 \

it:

.

Inferior lobe Superior (S6) Lateral basal (S9)

Posterior basal (S10)

Posterior basal (S10) <1 '91 o v 1' no x

Plate 200

Lateral (S4)

4P

E L m g s

3

Bronchopulmonary Segments (continued)

Lateral views Left lung Superior lobe

Superior lobe

Apical (S1)

Api coposterior (S1+2>

Posterior (S2) Anterior (S3)


Anterior (S3) Superior lingular (S4) Inferior lingular (S5)

M i d d l e lobe Lateral (S4) Medial (S5)

Lingular division

Inferior lobe Superior (S6)

Inferior lobe

Anteromedial basal (S7+B)

Superior (S6) Anterior basal (S8)

Lateral basal (S9)

Lateral basal (S9)

Medial views Right lung Superior lobe Apical (S1)

Left lung Superior lobe

Posterior (S2)

Apicoposterior (S 1+2 )

Anterior (S3)

Anterior (S3)

Middle lobe Medial (S5)

Superior lingular (S4) Inferior lingular (S J)


Lingular division

Inferior lobe

Medial basal (S7) Anterior basal (S8) Lateral basal (S9) Posterior basal (S l0 ) —

Lungs

Inferior lobe Superior (S6) -Anteromedial basal (S 7+8 ) Lateral basal (S9) Posterior basal (S10)

Plate 201

3

Trachea and Major Bronchi

Connective tissue sheath (visceral layer of pretracheal fascia)

Thyroid cartilage Median cricothyroid ligament

Tracheal cartilage (ring) Elastic fibers

Cricoid cartilage

Gland Small artery

ill

Lymph vessels

Connective tissue sheath (visceral layer of pretracheal fascia) (cut away)

Nerve Epithelium

Annular (intercartilaginous) ligaments

interior wa//

Tracheal cartilages Cross section through trachea Mucosa of posterior tracheal wall shows longitudinal folds formed by dense collections of elastic fibers

Posterior wall

Superior lobar (eparterial) bronchus

Nerve | Small arteries Gland Elastic fibers Superior lobar bronchus

To superior ^ lobe

Trachealis (smooth) muscle Esophageal muscle Epithelium Lymph vessels

B3 — Superior division bronchus Lingular bronchus

Middle lobar bronchus

|F v

Right and left main bronchi

To lingula

Întermediate bronchus

To middle lobe

Inferior lobar bronchus

Inferior lobar bronchus ^

(

To inferior < lobe

v Intrapulmonary

Plate 202

_

_

" Extrapulmonary

To inferior lobe

v Intrapulmonary

Lungs

Nomenclature of Bronchi; Schema i 'iWlfipnii ii

}t

ii

W ' MI'IPI li'-li'ii'llln Wi' ' ij i |

'i

•Trachea

1 +2c\

Superior lobar bronchus

B (apical) Sai

B

2 b

Superior lobar (eparterial) / bronchus , /

^

B 2 (poslerior)

B

^

^

/B4a

Right and l e f t ^ main bronchi

(anterior)

B* ( a n t e r i o r ) \ Lingular bronchus

B6

(superior, lower lobe)~

^—B

4

(superior lin

^ - B ^ (superior, lower lobe) (inferior lingular)

\

(medial) J

(apicoposterior)

Superior division bronchus

Intermediate bronchus Middle lobar bronchus g4 (lateral)

B

Inferior lobar bronchus

B

}

(anteromedial basal)

g7+8a

B (medial basal)

g7-'-8ai

B 8 (anterior basal)

„ .

B8av

tf 0dn '

B8b-

B 9 (lateral basal) B 1 0 (posterior basal)

A

B 9 (lateral b a s a l ) ^ B 1 0 (posterior basal)

Nomenclature in common usage for bronchopulmonary segments (Plates 200 and 201) is that of Jackson and Huber, and segmental bronchi are named accordingly. Ikecla proposed nomenclature (as demonstrated here) for bronchial subdivisions as far as 6th generation. For simplification on this illustration, only some bronchial subdivisions are labeled as far as 5th or 6th generation. Segmental bronchi (B) are numbered from 1 to 10 in each lung, corresponding to pulmonary segments. In left lung,

Lptrags

B1 and B2 are combined as are B7 and B8. Subsegmental, or 4th order, bronchi are indicated by addition of lowercase letters a, b, or c when an additional branch is present. Fifth order bronchi are designated by Roman numerals i (anterior) or ii (posterior) and 6th order bronchi by Greek letters a or (3. Several texts use alternate numbers (as proposed by Boyclen) for segmental bronchi. Variations of standard bronchial pattern shown here are common, especially in peripheral airways.

P l a t ©

2 0 3

3

Intrapulmonary Airways? Schema

Terminal bronchiole

Smooth muscle Elastic fibers Alveolus

c c ^ - o c -Q 2 S

Cartilages

£ *

1st order

E 53

cc $ ^00

•

BH

u c o CD

2nd order

S i cu ^ DJD ^

3rd order

Respiratory bronchioles (alveoli appear at this level)

i _

1 -

o -D .

Cartilages become sparser (mostly at points of branching)

O

ro

(o i—

C

CD

— i

C
1 —

Alveolar sac Alveoli

Co

C —

C

~

O

ro - — '

i—

No further cartilages

cn Ji o -C u c o 5cc •

Acinus (part of lung supplied by terminal bronchiole)

MB

Terminal bronchiole

Respiratory bronchioles (3-8 orders) Alveolar sacs and alveoli

> Acinus

Subdivisions of i n t r a p u l m o n a r y airways

Opening of alveolar duct

Pores of Kohn

Structure of i n t r a p u l m o n a r y airways

Lungs

Intrapulmoiiary Blood Circulation: Schema MMHMMMttfll^S^^^^^Sit^^SSSIiSS^S^S^^S^SSBWHSi^Si:^^!

Terminal bronchiole /Bronchial artery (from left heart / via thoracic aorta) I W — w r r t

Pulmonary artery (from right heart)"

1

Pulmonary vein (to left heart)

^ "

Respiratory bronchioles

Pulmonary vein (to left heart)

Capillary plexuses within alveolar wall v

Septum

Septum

Pulmonary arteries and their branches distribute segmentally with the bronchi. Pulmonary veins and their tributaries drain intersegmental^.

LpGlgjS

Capillary bed within alveolar wall (cut away in places)

POate 2@S

Great Vessels of Superior Mediastinum

Cricoid cartilage Thyroid gland Right common carotid artery Right vagus nerve (X)

Thyroid cartilage Trachea Left common carotid artery Left vagus nerve (X)



Phrenic nerve

Phrenic nerve (cut)

Right internal jugular vein

Thoracic duct


Brachial plexus

Brachial plexus

Left subclavian artery and vein

Right subclavian artery and vein




Right brachiocephalic vein

Arch of aorta

Phrenic nerve and pericardiacophrenic artery and vein {cut)

Vagus nerve (X)

Superior vena cava


Right superior lobar (eparterial) bronchus

Ligamentum arteriosum

Right pulmonary artery—

Left pulmonary artery

Pulmonary trunk Right pulmonary veins

Left pulmonary veins

Mediastinal part of parietal pleura (cut edge)

J vfy<<

Costal part of parietal pleura (cut edge)

Mediastinal part of parietal pleura (cut edge) Costal part of parietal pleura (cut edge)

Diaphragmatic part of parietal pleura

Phrenic nerve (cut)

Right costodiaphragmalic recess of pleural cavity.

Diaphragmatic part of parietal pleura and cut edge Right intermediate bronchus Left main bronchus

Phrenic nerve (cut) Azygos vein Thoracic duct Inferior vena cava

Plate 206

Pericardium (cut edge) Diaphragm Esophagus and esophageal plexus

Lungs

3

£

Esophagus

Trachea ( pulled to left by

3rd right posterior intercostal artery Superior left bronchial artery Right bronchial artery

Aorta (pulled aside by hook)

Left main bronchus (pulled to right by hook)

Inferior left bronchial artery

Esophageal artery Esophageal branch of bronchial artery

Variations in bronchial arteries

Bronchial veins

Left main bronchu? ( turn >d up by hook Right bronchial vein Accessory hemiazygos vein Right and left bronchial arteries originating from aorta by single stem

L m g s

Only single bronchial artery to each bronchus (normally, two to left bronchus)

Right main bronchus { pulled to left and rotated by hook)

PGafe 2@7

Lymph Vessels and Nodes of Lung See also

Plates 72, 184, 239 Right paratracheal nodes

Left paratracheal nodes

Right superior tracheobronchial nodes

Bronchomediastinal lymphatic trunk Brachiocephalic vein

Bronchomediastinal lymphatic trunk

Inferior deep cervical (scalene) node

Brachiocephalic vein Inferior deep cervical (scalene) node

A/irchow's node /Thoracic duct

Internal jugular vein and jugular lymphatic trunk-

Left superior tracheobronchial nodes (Aortic arch) node of igamentum arteriosum

Right lymphatic duct Subclavian vein and subclavian lymphatic trunk

Bronchopulmonary (hilar) nodes Pulmonary (intrapulmonary) nodes

B r o n c h o p u I m o nary (hilar) nodes Pulmonary (intrapulmonary) n o d e s / .

Subpleural lymphatic plexus

\

Subpleural lymphatic plexus

Interlobular lymph vessels

Interlobular lymph vessels-

Drainage follows bronchi, arteries and veins

Drainage follows bronchi, arteries and veins

Inferior tracheobronchial (carinal) nodes Pulmonary ligaments^ Routes to mediastinum

Drainage routes Right lung: All lobes drain to pulmonary and bronchopulmonary (hilar) nodes, then to inferior tracheobronchial (carinal) nodes, right superior tracheobronchial nodes, and right paratracheal nodes on way to brachiocephalic vein via bronchomediastinal lymphatic trunk and/or inferior deep cervical (scalene) node.

Plate 208

Left lung: Superior lobe drains to pulmonary and bronchopulmonary (hilar) nodes, inferior tracheobronchial (carinal) nodes, left superior tracheobronchial nodes, left paratracheal nodes and/or (aortic arch) node of ligamentum arteriosum, then to brachiocephalic vein via left bronchomediastinal trunk and thoracic duct. Left inferior lobe drains also to pulmonary and bronchopulmonary (hilar) nodes and to inferior tracheobronchial (carinal) nodes, but then mostly to right superior tracheobronchial nodes, where it follows same route as lymph from right lung.

Lungs

Autonomic Nerves in Thorax See also

Cervicothoracic (stellate) ganglion Ansa subclavia Cervical cardiac nerves (sympathetic and vagal) Thoracic (sympathetic) cardiac branches Sympathetic trunk Vagus nerve (X) (cut) and branches to cardiac and pulmonary plexuses Thoracic (sympathetic) cardiac branches Anterior pulmonary plexus Posterior pulmonary plexus (protruding from behind right bronchus) 6th intercostal nerve Gray and white rami communicantes

Plates 130, 131, 165, 166, 318

Left recurrent laryngeal nerve Cervical cardiac nerves (sympathetic and vagal) Vagus nerve (X) (cut) Thoracic (sympathetic) cardiac branches Left recurrent laryngeal nerve Thoracic cardiac branch of vagus nerve Cardiac plexus Anterior pulmonary plexus Posterior pulmonary plexus (protruding from behind left bronchus) Sympathetic trunk Thoracic aortic plexus Esophageal plexus 8th intercostal nerve

6th thoracic sympathetic ganglion Greater thoracic splanchnic nerve Sympathetic branch to esophageal plexus

Gray and white rami communicantes Greater thoracic splanchnic nerve Lesser thoracic splanchnic nerve

Thoracic duct Anterior vagal trunk Lesser thoracic splanchnic nerve

Diaphragm (pulled

down)

Least thoracic splanchnic nerve Azygos vein (cut) Inferior vena cava (cut)

L m g s

PQafe

3

Innervation of Tracheobronchial Tree: Schema See also

Plates 167,168

From hypothalamic and higher centers Glossopharyngeal nerve (IX)

Descending tracts in spinal cord

Vagus nerve (X) (cholinergic; efferent to smooth muscle and glands; afferent from aorta, tracheobronchial „ mucosa and alveoli) \

Superior cervical I sympathetic ganglion |

/Sympathetic nerves

Afferent nerves from nose and sinuses (via trigeminal [V] and glossopharyngeal [IX] nerves) may also initiate reflexes in airways

Larynx

Superior laryngeal nerve

(adrenergic)

Carotid sinus Carotid body Thoracic spinal cord

Common carotid arterv Cough receptors Left recurrent laryngeal J nerve \ Js

Arch of aorta-.

Sympathetic trunk

Pulmonary plexus

Cough receptors

Parasympathetic fibers Sympathetic fibers Afferent fibers

Irritant receptors

Stretch receptors (Hering-Breuer reflex)

Plate 210

Lungs

Heart in Situ

Inferior thyroid veins

Trachea

Thymus

Left c o m m o n carotid artery Left brachiocephalic vein



Right brachiocephalic vein Phrenic nerve Anterior scalene muscle Brachial plexus External jugular vein

Vagus nerve (X) Arch of aorta

.1

\I fsA

A

V

Thoracic duct

r M te-l \l 4 an \ y f \tw m f:I\ 'M t M f \l




Superior vena cava


1 st rib

Mediastinal part of parietal pleura

Phrenic nerve and pe r i ca r d i aco p h re n i c artery and vein

&

Right lung Left lung

'•if

j'i

m% r

gf

r

Pericardium Diaphragm Mediastinal Diaphragmatic Costal

Heart

Parts of parietal pleura

Line of fusion of fibrous pericardium to diaphragm

Internal thoracic artery Superior epigastric artery

Musculophrenic artery

3

Heart: Anterior Exposure

Pericardium (cut edge) at site of reflection from great vessels


Right vagus nerve


Right internal jugular vein

Arch of aorta

Right recurrent laryngeal nerve Right brachiocephalic vein


Phrenic nerve

Left internal jugular vein



Internal thoracic artery and vein

Ligamentum arteriosum

Phrenic nerve and pericardiacophrenic arterv and vein

Left recurrent laryngeal nerve Pulmonary trunk

Superior vena cava


Right pulmonary artery

Transverse pericardial sinus

Transverse pericardial sinus Right superior pulmonary vein

Left superior pulmonary vein

Hilum of right lung Mediastinal pleura (cut edge)

Hilum of leftlung

Pericardium (cut edge)

nX/,

w

; 111

Mediastinal part of parietal pleura edge) Pericardium (cut edge)

Right I ventricle Conus arteriosus Right auricle (atrial appendage) Right atrium

Plate 212

Coronary sulcus and right coronary artery

Anterior interventricular sulcus and anterior interventricular branch of left coronary artery

Left \ auricle \ (atrial appendage) Inferior border (acute margin) of heart

Apex of heart Left ventricle

Left border (obtuse margin) of heart

Heart

I l a d E t o g F a p O i ]

©if

© t e s t

HHHHHHHHHSHHHH

Precordial areas of auscultation

A

Apex of heart

AA

Aortic arch

C

Clavicle

CP

Coracoid process of scapula

D

D o m e of diaphragm (right)

IV

Inferior vena cava

PA

Pulmonary artery (left)

RA

Right atrium

Valves

S

Spine of scapula

Pulmonic valve

sv

Superior vena cava

T

Trachea (air)

V

Left ventricle

Aortic area

Pulmonic: area

Tricuspid area

Aortic valve Mitral valve

Mitral area

Tricuspid area

CMctt/iM/v/

Heart

Plate 213

Heart: Base and Diaphragmatic Surfaces

Right pulmonary

Arch of aorta


Right auricle (atrial appendage)

Left auricle (atrial appendage)

Superior vena cava


Right superior pulmonary vein

Left atrium

Right atrium

Left inferior pulmonary vein

Sulcus terminalis

Pericardial reflection

—Right inferior pulmonary vein

Oblique vein of left atrium (of Marshall)

Coronary sulcus Inferior vena cava

Coronary sinus

Right ventricle

Left ventricle Apex

Base of heart: posterior view

Left subclavian artery Left common carotid Left pulmonary artery Left superior pulmonary vein Left auricle (atrial appendage) Left inferior pulmonary vein Oblique vein of left atrium (of Marshall) Left atrium Pericardial reflection Coronary sinus Left ventricle

Brachiocephalic trunk Superior vena cava Arch of aorta Right pulmonary artery Right superior pulmonary vein Right inferior pulmonary vein Sulcus terminalis Right atrium Inferior vena cava Coronary sulcus and right coronary artery Posterior interventricular sulcus and posterior interventricular branch of right coronary artery (posterior descending artery) Right ventricle

Base and diaphragmatic surfaces: posteroinferior view

Heart

Pericardial Sac warn

Superior vena cava

^mmmmmmmmmmmmmmmmmmamm

Arch of aorta

Pericardium (cut edge) Ascending aorta Left auricle (atrial appendage) Left ventricle Coronary sinus Posterior interventricular sulcus Right ventricle Diaphragmatic part of pericardium Sternocostal part of pericardium (cut edge)

Heart drawn out of opened pericardial sac: left lateral view

Pulmonary trunk

nsverse pericardial sinus Left pulmonary veins Oblique vein of left atrium (Marshall's) Oblique pericardial sinus Left atrium Right pulmonary vein Esophageal prominence Right atrium Inferior vena cava

Arch of aorta Ascending aorta Right phrenic nerve and pericardiacophrenic vessels Superior vena cava Transverse pericardial sinus

Mediastinal part of parietal pleura (cut edge) Left phrenic nerve and pericardiacophrenic vessels Pulmonary trunk (bifurcation)

Superior vena cava Right pulmonary veins Mediastinal part of parietal pleura (cut edge) Pericardium (cut edge) Inferior vena cava Line of fusion of fibrous pericardium to diaphragm

Pericardial sac w i t h heart removed: anterior view

CêarS

Left lung Left pulmonary veins Pericardium (cut edge) Oblique pericardial sinus Esophageal prominence Diaphragmatic part of pericardium

3

3

Coronary Arteries and Cardiac Veins

Sinuatrial (SA) nodal branch

Left auricle (cut) Left coronary artery

Atrial branch of right coronary artery Circumflex branch of left coronary artery Right coronary artery Great cardiac vein Left (obtuse) marginal artery

Anterior cardiac veins

Anterior interventricular branch (left anterior descending) of left coronary artery

Small cardiac vein

Right (acute) marginal branch of right coronary artery

Diagonal branch of anterior interventricular artery

Interventricular septal branches

Sternocostal surface

Sinuatrial (SA) nodal branch Oblique vein of left atrium (of Marshall) Sinuatrial (SA) node

Great cardiac vein Circumflex branch of left coronary artery

Small cardiac vein

Left marginal branch Coronary sinus Posterior left ventricular branch

Right coronary artery Posterior interventricular branch (posterior descending) of right coronary artery

Posterior vein of left ventricle

Middle cardiac vein Interventricular septal branches

Plate 216

Right marginal branch


Heart

Coronary Arteries and Cardiac Veinss Variations

Anterior interventricular (left anterior descending) branch of left coronary artery is very short. Apical part of anterior (sternocostal) surface supplied by branches from posterior interventricular (posterior descending) branch of right coronary artery curving around apex.

Posterior interventricular (posterior descending) branch is derived from circumflex branch of left coronary artery instead of from right coronary artery.

Posterior branch is branches coronary

Posterior interventricular (posterior descending) branch is absent. Area supplied chiefly by elongated anterior interventricular (left anterior descending) branch curving around apex.

Heart

interventricular (posterior descending) absent. Area supplied chiefly by small from circumflex branch of left artery and from right coronary artery.

POate 2117

3

Coronary Arteries: Arteriographic Views

Right coronary artery: left anterior oblique view Sinuatrial (SA) nodal branch

Right coronary artery

Arteriogram

Atrioventricular

(AV)

noda[

branch Branches to back of left ventricle Right (acute) marginal branch Posterior interventricular branch (posterior descending artery)

Right coronary artery: right anterior oblique view Sinuatrial (SA) nodal branch Conus (arteriosus) branch Right coronary artery Right (acute) marginal branch

Arteriogram Atrioventricular (AV) nodal branch Right posterolateral branches (to back of left ventricle) Posterior interventricular branch (posterior descending artery)

Plate 218

EKIeairt

Coronary Arteries: Arteriographic Views (continued) SHflBBBMH . v , vfx-*•..:.;.•

IS fi SB fi SS

Left coronary artery: left anterior oblique view

Left coronary artery Circumflex branch

mm

Arteriogram Anterior interventricular branch (left anterior descending) Diagonal branches of anterior interventricular branch Atrioventricular branch of circumflex branch Left (obtuse) marginal branch Posterolateral branches (Perforating) interventricular septal branches

Left coronary artery: right anterior oblique view Leftcoronary artery Anterior interventricular branch (left anterior descending)

WSIlk

Circumflex branch (Perforating) \ intervenes. tricular ^ s e p t a l branches

Arteriogram

Left (obtuse) marginal branch Posterolateral branches Diagonal branch of Anterior interventricular branch Atrioventricular branch of circumflex branch

Plate 219

3

Right Atrium and Ventricle

Ascending aorta

Pulmonary trunk Right auricle (atrial appendage)

Superior vena cava

Conus arteriosus


Crista terminalis


Atrioventricular part of membranous septum


eptal cusp of tricuspid valve

Left atrium Right inferior pulmonary vein

Pectinate muscles ning of coronary sinus

Interatrial septum

Valve (Thebesian) of coronary sinus

Limbus of fossa ovalis Fossa ovalis Valve (Eustachian) of inferior vena cava Inferior vena

Opened right atrium: right lateral view

Pericardial reflection Aorta Transverse pericardial sinus Superior vena cava Right auricle (atrial appendage) Right atrium Parietal limb Membranous part of interventricular septum Anterior cusp Tricuspid valve

Pulmonary trunk pericardial sinus Anterior semilunar cusp Right semilunar cusp Left semilunar cusp

J > Pulmonary { valve )

Conus arteriosus Supraventricular crest Septal papillary muscle Interventricular septum (muscular part)

Septal cusp Posterior cusp

Septomarginal trabecula (moderator band)

Chordae tendineae Posterior papillary muscle Anterior papillary muscle Trabeculae carneae

Plate 220

Opened right ventricle: anterior view

Heart

Left Atrium and Ventricle


Transverse pericardial sinus Fold of left superior vena cava (ligament of Marshall)

Ligamentum arteriosum Left pulmonary artery

Left auricle (atrial appendage) Oblique vein of left atrium (of Marshall) ( Mitral )

Posterior cusp

valve

Anterior cusp

|

Arch of aorta

Right pulmonary arteryLeft pulmonary veins Left atrium

Anterior papillary muscle

Right pulmonary veins

Chordae tendineae

Coronary sinus

Posterior papillary muscle

Inferior vena cava

Flap opened in posterolateral wall of left ventricle

Left auricle (atrial appendage) Con us arteriosus

Left pulmonary arterv

Left semilunar cusp Aortic valve

/


Right semilunar cusp Posterior semilunar cusp

Membranous septum

Arch of aorta


Interventricular part

Valve of foramen ovale Right pulmonary veins

Muscular part of interventricular septum

Left atrium Coronary sinus

Mitral valve (cutaway)

Inferior vena cava

^ T

< ' '

^ llll I * I Ml -

^

Section through left atrium and ventricle w i t h mitral valve cut away

Heart

Plate 221

3

Valves of Fibrous Skeleton of Heart

Anterior semilunar cusp

Pulmonary valve

Right semilunar cus Left semilunar cusp

Conus arteriosus Left fibrous trigone Right coronary artery

Right (coronary) semilunar cusp Atrioventricular part of membranous septum Anterior cusp

Left (coronary) semilunar cu

Aortic valve

Posterior (noncoronary) semilunar cusp Circumflex branch • Anterior Mitral valve

Tricuspid valve

Septal cusp Posterior cusp

Commissural cusps

Right fibrous ring (of tricuspid valve)

Posterior cus

Right fibrous trigone Atrioventricular (AV) nodal branch1'

Left fibrous ring (of mitral valve

Posterior interventricular branch 1

Heart in diastole: viewed f r o m base w i t h atria removed

Anterior semilunar cusp

Pulmonary valve

Right semilunar cusp Left semilunar cu

Conus arteriosus Left fibrous trigone Right coronary artery

Right (coronary) semilunar cusp Aortic valve


Left (coronary) semilunar cusp

Atrioventricular part

Posterior (noncoronary) semilunar cusp

Anterior cusp

Circumflex branch*

Mitral valve

cusp

Anterior cusp

Tricuspid valve

Posterior

Posterior cusp

Right fibrous ring (of tricuspid valve)

Left fibrous ring (of mitral valve) Posterior interventricular branch 1

Membranous septum

Right fibrous trigone

Heart in systole: viewed from base w i t h atria removed

Atrioventricular (AV) nodal branch1"

* O f left coronary artery 'Of right coronary artery

IHJeacrU:

Valves and Fibrous Skeleton of Heart (continued) HHHHMBMMNMKHiHM!

.

^ ... .

Commissure of semilunar valve cusps Opening of left coronary artery

Ascending aorta

Nodule of semilunar valve (body of Arantius)

Aortic sinuses (of Valsalva) Opening of right coronary artery ( Membranous septum

Lunula Left semilunar cusp

Interventricular

) Part J Atrioventricular V part

Posterior semilunar cusp

Aortic valve

Right semilunar cusp

Broken line indicating level of origin of tricuspid valve on opposite side of septum-"'

Anterior papillary muscle Anterior cusp of mitral valve


Aortic valve oventricular Par*

Opening of inferior vena cava

(

Right atrium

Interventricular ( part (behind valve)

Opening of coronary sinus

Posterior cusp Anterior cusp

Chordae tendineae

Septal cusp

Septal papillary muscle

Membranous sePtum

V Tricuspid \ valve

Posterior papillary muscle (sectioned)

Posterior papillary muscle (sectioned)

Anterior papillary muscle

Tricuspid (right atrioventricular) valve Anterior cusp

Left atrium

Posterior cusp

\

Chordae tendineae

Mitral valve

Commissural cusps Anterior papillary muscle (sectioned)

Anterior papillary muscle (sectioned)

Posterior papillary muscle

Fibrous (Albini's) nodules

Mitral (left atrioventricular) valve

Heart

Plate 223

3

Atria, Ventricles, and Interventricular Septum y':

MMMIMHNMIMHIMWMNMMHM^

Mitral valve

Posterior cusp Anterior cusp


Pulmonarv trunk Anterior cusp of mitral valve

Openings of coronary arteries Ascending aorta Right auricle (atrial appendage)

Aortic sinus (of Valsalva)

Left semilunar cusp

Ascending aorta Left semilunar cusp Aortic valve

Right semilunar cusp

Posterior semilunar (noncoronary) cusp /

Superior vena cava

m . / ' " , . ^

Aortic valve

Supra ventricular crest

X

t

J monarv t r u n k

4

Con us arteriosus

Right anterior papillary muscle (cut) Right ventricle

Right atrium

CD

Septomarginal trabecula (moderator hand)

Anterior cusp {retracted)

Septal (medial) papillary muscle

Septal cusp— Posterior cusp Right ventricle Right anterior papillary muscle (cut) Right posterior papillary muscle Left ventricle Muscular part of interventricular septum

Plate 224

Plane of section

Heart

Ascending aorta Atrioventricular part ) v Membranous septum Interventricular part \

Superior vena cava Sinuatrial (SA) nodal artery

Pulmonary valve Atrioventricular (AV) node

Sinuatrial (SA) node

Atrioventricular (AV) bundle (of His)

Crista terminalis

Right bundle

Note: Specific internodal conduction pathways in the atria may exist based on strong physiological and some anatomical evidence

Purkinje fibers Septomarginal trabecula (moderator band) Anterior papillary muscle

Right fibrous ring (of tricuspid valve

Subendocardial branches (Purkinje fibers)

Inferior vena cava

Right side

(f Posterior semilunar Aortic valve

) . f. .. \ Lett semilunar cusp

Arch of aorta

Right semilunar

Membranous septum

Pulmonary trunk


Superior vena cava

Atrioventricular part

Left auricle

Left bundle Anterior papillary muscle

Right pulmonary veins Mitral valve (cutaway)

Subendocardial branches (Purkinje fibers)


Posterior papillary muscle Vi

Left s i d e

H e a r t

Plate 22S

3

Nerves of Heart See also P l a t e s 1 3 0 , 1 6 5 , 1 6 6 , 2 0 9

Superior cervical sympathetic ganglion Right vagus nerve (X) (Conjoined sympathetic and vagal) superior cervical cardiac nerves Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Phrenic nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Inferior thyroid artery Vertebral artery Cervicothoracic (stellate) ganglion Ansa subclavia

Superior cervical sympathetic ganglion Left vagus nerve (X) Superior cervical (sympathetic) cardiac nerve Superior cervical (vagal) cardiac branch Middle cervical sympathetic ganglion Phrenic nerve Middle cervical (sympathetic) cardiac nerve Inferior cervical (vagal) cardiac branch Vertebral ganglion Cervicothoracic (stellate) ganglion Inferior cervical sympathetic cardiac nerves

Right recurrent laryngeal nerve

Inferior cervical (sympathetic) cardiac nerves Thoracic cardiac branch of vagus nerve 4th thoracic sympathetic ganglion Thoracic (sympathetic) cardiac branches Cardiac plexus

3rd thoracic sympathetic ganglion oracic (sympathetic) cardiac branches oracic cardiac branch of vagus nerve Left recurrent laryngeal nerve

Phrenic nerve (cut)

Plate 226

Heart

Innervation of Heart: Schema See also P l a t e s 126, 167, 168


Posterior nucleus of vagus nerve

Nucleus of

Superior cervical (sympathetic) cardiac nerve Middle cervical sympathetic ganglion Middle cervical (sympathetic) cardiac nerve Vertebral ganglion (variation Ansa subclavia Cervicothoracic (stellate) ganglion 1st intercosta nerve Inferior cervical (sympathetic) cardiac nerve Thoracic cardiac branch of vagus nerve 2nd thoracic sympathetic ganglion While ramus communicans Cray ramus communicans Thoracic (sympathetic) cardiac branches 4th thoracic sympathetic ganglion

—- —

Sympathetic preganglionic Sympathetic postganglionic

—

Parasympathetic preganglionic

— — - — — Parasympathetic postganglionic u — — V i s c e r a l afferent accompanying sympathetic fibers Visceral afferent accompanying parasympathetic fibers

Heart

Plate 227

Innervation of Blood Vessels: Schema See also P l a t e s 1 6 7 , 1 6 8

Cervical sympathetic trunk ganglia Spinal nerves Gray rami communicantes

i ':.•• •-

. ";

Spinal nerves

Spinal nerves Gray ramus communicans Lower lumbar sympathetic trunk ganglia

Sympathetic fibers

Postganglionic sympathetic fibers to lumbar and sacral plexuses and to nerves of lower limb

Preganglionic Postganglionic

Plate 228

Heart

Prenatal and Postnatal Circulation iwiMMMiwiiiiiii '!ijfjin;;w"WPirirrmr~T

n

r~n 111htr*w i wMrin 'i Brw i nmP i nri
fiMaBM—a— i Thb i m—MBMBBTr^B i afg i BawBB—w i

For occluded part of umbilical vessels, see Plate 253

Prenatal circulation

rta Pulmonary trunk Superior vena cava Right pulmonary

Ductus arteriosus Left pulmonary artery Left pulmonary vein

Right pulmonary vein Foramen ovale

Inferior vena cava

Hepatic vein Aorta

Ductus venosus

Celiac trunk

Liver Hepatic portal vein Umbilical vein

Superior mesenteric artery Kidney Gut

Ligamentum arteriosum (obliterated ductus arteriosus)

Umbilical arteries

Fossa oval is (obliterated foramen ovale Ligamentum venosum (obliterated ductus venosus) Ligamentum teres (round ligament) of liver (obliterated umbilical vein) Medial umbilical ligaments (occluded part of umbilical arteries)

Postnatal circulation

Heart

Plate 229

3

Mediastinum: Right Lateral View

Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson's fascia)

Anterior scalene muscle and phrenic nerve Brachial plexus

1 st rib Right subclavian artery and vein Trachea Right vagus nerve (X) Esophagus Sympathetic trunk Right superior intercostal vein 4th thoracic vertebral body Arch of azygos vein Right main bronchu and bronchial artery Azygos vein Posterior intercostal vein and artery and intercostal nerve Internal intercostal muscle Internal intercostal membrane deep to external intercostal m u s cl e Gray and white rami communicantes Costal part of parietal pleura (cut edge) Greater thoracic splanchnic nerve Esophagus and esophageal plexus Bronchopulmonary (hilar) lymph nodes

Clavicle Subclavius muscle 1st rib Right and left brachiocephalic veins Right internal thoracic artery Thymus (seen through mediastinal pleura) Superior vena cava Phrenic nerve and pericardiacophrenic artery and vein* Right pulmonary artery /Mediastinal part of parietal pleura (cut edge) Fibrous pericardium over right atrium Right pulmonary veins Inferior vena cava (covered by mediastinal part of parietal pleura) Diaphragm (covered by diaphragmatic part of parietal pleura) Costal part of parietal pleura (cut edge) C o s t o d i a p h r a g m a t i c re cess of pleural cavity

Pulmonary ligament (cut)

*Nerve and vessels commonly run independently

Plate 230

Mediastinum

Mediastinum: Left Lateral View

Anterior scalene muscle and phrenic nerve Brachial plexus Left subclavian vein and artery Subclavius muscle Clavicle Left brachiocephalic vein

Cervical (cupula, or dome, of) parietal pleura and suprapleural membrane (Sibson's fascia) 1 st rib Esophagus Thoracic duct Left vagus nerve (X) Left superior intercostal vein

Left internal thoracic artery Arch of aorta Thymus (seen through mediastinal pleura) Ligamentum arteriosum Left pulmonary artery Left phrenic nerve and pericard iacop h ren ic artery and vein Mediastinal part of parietal pleura (cut ec/ge) Fibrous pericardium Left pulmonary veins Pulmonary ligament (cut) Fat pad Esophagus and esophageal plexus (covered by mediastinal part of parietal pleura) Diaphragm (covered by diaphragmatic part of parietal pleura) Costodiaphragmatic recess of pleural cavity

Left recurrent laryngeal nerve Bronchopulmonary (hilar) lymph nodes Accessory hemiazygos vein Posterior intercostal vein and artervt and intercostal nerve Internal intercostal muscle Internal intercostal membrane deep to external intercostal muscle Gray and white rami communicantes Costal pleura {cut edge) Sympathetic trunk Greater thoracic splanchnic nerve Thoracic (descending) aorta Left main bronchus and bronchial artery

Costal part of parietal pleura {cut edge)

*Nerve and vessels commonly run independently

[fcdiastoMEFP

POafe 231

i

L~

^ H

Esophagus in Situ

Longus colli muscle

C o m m o n carotid artery

Cervical part of esophagus


Recurrent laryngeal nerves

Phrenic nerve

Thoracic duct

Posterior scalene muscle

Internal jugular vein (cut)

Brachial plexus

Subclavian vein (cul)

Subclavian artery

Left brachiocephalic vein (cut)

Thyrocervical trunk

Internal thoracic artery (cut)

Vagus nerve (X)

Phrenic nerve (cut)

1 st rib (cut)



Subclavian artery Vagus nerve (X)

Trachea


Arch of aorta

— Bifurcation of trachea

Arch of azygos vein

Costal pleura (cut edge)

Right main bronchus Superior lobar (eparterial) bronchus

M

Left main bronchus Thoracic (descending) aorta

Thoracic part of esophagus Esophageal plexus BliiPlte

Mediastinal part of parietal pleura (cut edge)

Mediastinal part of parietal pleura (cut edge) Pericardium (cut edge) Diaphragm Diaphragmatic part of parietal pleura

Inferior vena cava (cut)

Anterior vagal trunk Bfc,

Hepatic veins (cut) Inferior vena cava — Right and left crura of diaphragm Inferior phrenic arteries Celiac trunk Abdominal aorta

Plate 232

Stomach '

:

_

•

BH

m •mm 'TONE

Abdominal part of esophagus

Mediastinum

Topography and Constrictions of Esophagus BBSBBBSSgeaSSMHSBM

Incisor teeth

Interior pharyngeal constrictor muscle

Oropharynx

Thyroid carti

Epiglottis Piriform fossa (recess) Pharyngoesophageal constriction

fSKjftwR'.>.ft • I mMm

Cricoid cartilage

Cricoid cartilage

Cricopharyngeus (muscle) part of inferior pharyngeal constrictor Trachea

Cricopharyngeus (muscle) part of inferior pharyngeal constrictor

cn v .

OJ £ c

u

Thoracic (aortobronchial)| . constriction

Esophagus Arch of aorta Sternum

Trachea Arch of aorta

oc c jl; w>

Left main bronchus

l. O) >

<

mmi Diaphragmatic constriction (in ferior esophageal "sphincter' 7 ) Abdominal part of esophagus

Lateral view Diaphragm

Fundus of stomach

Cardiac part of stomach

ileciasfiitiQsira

PQate 233

3

Musculature of Esophagus MBlMUMi^fffffcs.. .;' ,v:*;

Inferior pharyngeal constrictor muscle Pharyngeal rap Thyroid cartilage

Zone of sparse muscle fibers Cricopharyngeus (muscle) part of inferior pharyngeal constrictor

Cricoid cartilage

Main longitudinal muscle bundle passing upward and ventrally to attach to middle of posterior surface of cricoid cartilage Accessory muscle bundle from lateral surface of cricoid cartilage Additional fibers from contralateral side of cricopharyngeus (muscle) part of inferior pharyngeal constrictor

Trachea

Circular muscle layer with sparse longitudinal fibers in V-shaped area (of Laimer) Hook Bare area on ventral surface of esophagu Lateral mass of longitudinal muscle Fibroelastic membranes with sparse muscle fibers

W i n d o w cut in longitudinal muscle layer

Circular muscle layer

Left main bronchus

Plata 234

Mediastinum

Pharyngoesophageal Junction See also Plate 67

•Superior pharyngeal constrictor muscle Root of tongue Epiglottis Middle pharyngeal constrictor muscle Palatopharyngeus muscle )

Longitudinal


muscles 6 3 '

\

Pharyngoepiglottic fold Laryngeal inlet (aclitus) •Thyroid cartilage (superior horn) Thyrohyoid membrane Internal branch of superior laryngeal nerve and superior laryngeal artery and vein Oblique arytenoid muscle -Transverse arytenoid muscle Thyroid cartilage Posterior cricoarytenoid muscle Inferior pharyngeal constrictor muscle Pharyngeal aponeurosis (cutaway) Zone of sparse muscle fibers Cricopharyngeus (muscle) part of inferior pharyngeal constrictor Cricoid cartilage (lamina) Cricoesophageal tendon (attachment of longitudinal esophageal muscle)

Posterior view w i t h pharynx opened and mucosa removed

Circular esophageal muscle Esophageal mucosa and submucosa Circular muscle in V-shaped area (of Laimer) Right recurrent laryngeal nerve

M%

ri '

:

'

;

Longitudinal esophageal muscle B V \ | 'A i l fl il m WR i mm V:; ;

W i n d o w cut in longitudinal muscle exposes circular muscle layer

Mediastinum

Plate 235

3

Esophagogastric Junction

Sliding hernia Esophagus Squamocolumnar junction Peritoneal sac

Longitudinal esophageal muscle Esophageal mucosa Sub mucosa

Circular esophageal muscle Gradual slight muscular thickening Phrenoesophageal ligament (ascending or upper limb)

Diaphragm

Supradiaphragmatic fascia Diaphragm Infradiaphragmatic (transversalis) fascia

Subhiatal fat ring Zigzag (Z) line: juncture of esophageal and gastric mucosa'

Gastric folds (rugae) —

Phrenoesophageal ligament ing limb) Peritoneum Cardiac notch

Longitudinal esophageal muscle (cut) Circular esophageal muscle (shown here as spiral) Cardiac notch Fundus of stomach

Outer longitudinal muscle layer of stomach (cut)

Plate 236

Mediastinum

Arteries of Esophagus See also Plate 300 Esophageal branch of Inferior thyroid artery Common carotid artery Subclavian artery

^

Esophageal branch of Inferior thyroid artery Cervical part of esophagus Thyrocervical trunk

$

Subclavian artery Vertebral artery Internal thoracic artery C o m m o n carotid artery Brachiocephalic trunk Trachea Arch of aorta 3rd right posterior intercostal artery Right bronchial artery Superior left bronchial artery Esophageal branch of right bronchial artery Inferior left bronchial artery and esophageal branch Thoracic (descending) aorta Esophageal branches of thoracic aorta

Thoracic part of esophagus


— Esophageal branch of left gastric artery Left gastric artery Inferior phrenic arteries C o m m o n hepatic artery [cut)

Celiac trunk

C o m m o n variations: Esophageal branches may originate from left inferior phrenic artery and/or directly from celiac trunk. Branches to abdominal esophagus may also come from splenic or short gastric arteries.

Splenic artery (cut)

!P0afe

2 3 7

Veins of Esophagus Bs&8KBSg£

See also Plate 312 Inferior thyroid vein Internal jugular vein

Inferior thyroid vein Internal jugular vein

External jugular vein Subclavian vein Subclavian vein

Vertebral vein

Thoracic cluct

Right brachiocephalic vein Superior vena cava Right superior intercostal vein Esophagus

Left brachiocephalic vein Left superior intercostal vein Esophageal veins (plexus) —Accessory hemiazvgos vein

6th right posterior intercostal vein Azygos vein Junction of accessory hemiazygos and azygos veins Inferior vena cava (cut)

Hemiazygos

vein

Submucous venous plexus

Left inferior phrenic vein

Diaphragm

Short gastric veins

Liver

Hepatic veins Inferior vena cava Hepatic portal vein

^•Splenic vein NLeft

suprarenal vein

Right renal vein Left gastric vein Right gastric vein Esophageal branches of left gastric vein

Plate 238

Left renal vein

Omental (epiploic) veins Left gastro-omental (gastroepiploic) vein

Inferior mesenteric vein Superior mesenteric vein Right gastro-omental (gastroepiploic) vein

Mediastinum

Lymph Vessels and Nodes of Esophagus See also Plates 208, 266

Inferior deep cervical (internal jugular) nodes Virchow's node Thoracic duct

Paratracheal nodes Posterior mediastinal nodes Superior and inferior tracheobronchial nodes

Intercostal nodes

Posterior parietal nodes

Superior phrenic nodes

Left gastric nodes (cardiac nodes of stomach)

Juxtaesophageal and superior phrenic nodes

Celiac nodes

Plate 239

3

Nerves of Esophagus mm

mm

See also Plates 165, 166, 209

Superior ganglion of vagus nerve

Anterior view


/

Inferior ganglion of vagus nerve Pharyngeal branch of vagus nerve

Esophagus

// M z&l

•Vagus nerve (X) — Superior laryngeal nerve

Recurrent laryngeal nerves

Cervical sympathetic trunk J;

Right recurrent laryngeal nerve

\

Middle cervical .sympathetic ganglion Cervical (sympathetic and vagal) cardiac nerves •Vertebral ganglion of cervical sympathetic trunk

Ansa subclavia

\\L

Ansa subclavia Branch to esophagus and recurrent nerve from stellate ganglion

I :

3rd intercostal nerve

•••

V

Cervicothoracic (stellate) ganglion

%


FA ! \

Thoracic (vagal and sympathetic) cardiac branches

Gray and white rami communicantes

Cardiac plexus

3rd thoracic sympathetic ganglion —

Pulmonary plexuses Esophageal plexus (anterior portion)

%

Thoracic sympathetic trunk-

Branches to esophageal plexus from sympathetic trunk, greater thoracic splanchnic nerve, and thoracic aortic plexus

>0


Left greater thoracic splanchnic nerve 'Anterior vagal trunk

Sympathetic fibers along left inferior phrenic artery Branch of posterior vagal trunk to celiac plexus

Posterior view

ll i

•Vagal branch to hepatic plexus via lesser omentum

5 V;

Esophageal plexus (posterior portion)

Principal anterior vagal branch to lesser curvature of stomach

I

Vagal branch to fundus and body of stomach

Posterior vagal trunk

Greater thoiYK ic

kv

splanchnic nerves Sympathetic fibers along esophageal branch of left gastric arteryCeliac plexus and ganglia

Plate 240

mm

1

w*

'ft'.

Vagal branch to celiac plexus

RSSI Vagal branc to fundus and cardiac part of stomach

Posterior vagal branch to sser curvature

Mediastinum

See also Plate 246

Sternum

Right ventricle Septal cusp

5th left costal cartilage Internal thoracic artery and vein ansversus thoracis muscle

Tricuspid ) Posterior cusp v/rnI\/o \


Anterior cusp

Pleural cavity

Interventricular part, Atrioventricular part of membranous septum

Muscular part of interventricular septum Left ventricle

Superior vena cava

Papillary muscle

Right atrium

Phrenic nerve and p e r i ca r d i a CO phrenic artery and vein

Pericardial cavity Mediastinal part of parietal pleura

Anterior cusp I

Right lung (middle lobe)

Posterior ( cusp

Mitral valve

Left atrium


Coronary sinus

Branches of right main bronchus *

Left lung (superior lobe)

Right inferior pulmonary vein

Branches of left main bronchus Left inferior pulmonary vein

Oblique pericardial sinus

Thoracic (descending) aorta

Esophagus and esophageal plexus

Azygos vein Hemiazygos vein Thoracic duct

Left sympathetic trunk T8 vertebra

Mediastinum


Plate 241

CO

Mediastinum: Cr oss Section

C h e s t

S e a n s ^

A x i a l

C T

l i n a g e s

wmmmmmmmmmmmmmmmmmmmmmmmmmmmmmMMmmmmmmmfrmmmir
Series of chest axial C T images from superior (A) to inferior (C)

C A,

Ascending aorta

A, AZ B IV L LB LSL LV PA

Descending aorta Azygos vein Body of vertebra Inferior vena cava

R RB RSL RV S

Liver

sc

Left (main stem) bronchus

SP

Left superior lobe of lung

sv

Left ventricle

T

Rib Right (main stem) bronchus Right superior lobe of lung Right ventricle Sternum Spinal cord Spinous process of vertebra Superior vena cava Trachea (bifurcation)

Pulmonary artery

Plate 242

Regional Scans

Q

o

Transverse Section: Lower Level of T3, Sternoclavicular Joint

Plate 243

Mediastinal lymph node

m

k

Sternoclavicular joint (articular disc)

© o mm •

Clavicle

/

O

Manubrium Brachiocephalic trunk Trachea

Right brachiocephalic vein

3

SL >


Costal cartilage of 1st rib

3



gl ©


Right lung

3

Pectoralis minor muscle

Axillary fossa

<


Tendon of long head of biceps brachii muscle

Shaft of left humerus

Surgical neck , of right / humerus

-ong head of triceps brachii muscle

Deltoid muscle Teres minor muscle

j y

Intercostal muscles

Scapula Left lung

Subscapularis muscle Phrenic nerve


Right vagus nerve (X)


Esophagus


Rhomboid major muscle

w

Thoracic duct

Costotransverse joint Trapezius muscle Body of T3 vertebra

(ft)

Teres minor muscle

Spinal cord

Erector spinae muscle Rhomboid major muscle Transversospinal muscle

C/farfack/—v.?.

2 S T H» ISd

Transverse Section: T 3 - 4 Intervertebral Disc, M a n u b r i u m T3-4

Plate 244.

Superior tracheobronchial lymph node

-M

Superior vena cava Right phrenic nerve

^

1

Arch of azygos vein

Manubrium Arch of aorta Internal thoracic artery and vein

Right lung

Left lung

Intercostal muscles

/

Ribs /


Pectoralis major muscle /Pectoralis minor muscle Axillary fossa


Combined short head of biceps brachii and c o r a c o b r a c h i a l muscles

Latissimus dorsi tendon


Shaft of humerus Deltoid muscle

Shaft of humerus

Long head of triceps brachii muscle

O m m

m

o a

HDD

O

3

SL & 3

E © 3

Lateral head of triceps brachii muscle

Teres major muscle


Teres minor muscle

Left latissimus dorsi tendon (inserting onto humerus)

Scapula

Teres major muscle

Esophagus

Subscapulars muscle

Thoracic duct T 3 - 4 intervertebral disc

Teres minor muscle

Rhomboid muscle Trapezius muscle


Scapula Infraspinatus muscle

Oblique fissure (of left lung) '.— /y.p.

i

Transverse Section: T 4 - 5 Intervertebral Disc, Sternal Angle Plate 245

" T4-5

Inferior tracheobronchial lymph nodes

m

Ascending aorta o


1

E

Internal thoracic artery and vein 2nd costal cartilage

Superior vena cava

§5

Manubriosternal junction

Pulmonary trunk


3

Right lung


Intercostal muscles

© 3

o

Left lung

Axillary fossa

Pectoralis minor muscle


Long head of biceps brachii muscle

Deltoid muscle

Shaft of humerus

Lateral head of triceps brachii muscle



Teres major muscle Serratus anterior muscle

Teres major muscle

Subscapularis muscle

Scapula

Left main bronchus


»

Descending aorta


Accessory hemiazygos vein

Right main bronchus

Trapezius muscle

Azygos vein «B

o

m O

3 ©

5f

O

X


s©

(ft

Ribs

Coracobrachialis muscle

o

Esophagus

Thoracic duct T4-5 intervertebral disc

C/i&rfach-

"0

5T 5" 10

Transverse Section: Level of T7, 3rd I n t e r c h o n d r a l Space Plate 246

Orifice of tricuspid valve

m

Coronary sulcus Internal thoracic artery and vein Left atrium

Sternum (body) Right ventricle Anterior interventricular sulcus

Right atrium


Interatrial septum

Apex of heart

Superior vena cava

Interventricular septum

Right inferior pulmonary vein

Papillary muscle Left ventricle

Esophagus Azygos vein

o ©

Leaflet of mitral valve


Coronary sulcus


Coronary sinus Oblique pericardial sinus

Inferior angle of scapula

Descending aorta

m m

&

Thoracic duct

© © ©

Latissimus dorsi muscle Triangle of auscultation

Triangle of auscultation

£ > 3

S3 FSr ©

3

Head of 7th rib

Neck of 7th rib Zygapophyseal (facet) joint

Body of T7 vertebra Trapezius muscle '.

A/. P.

mm&mm

Abdomen

m

Topographic Anatomy

4 \

Plate 217

247

m

Abdomen

m

Body Wall Plates 248-267

248

Bony Framework of Abdomen

249 Anterior Abdominal Wall: Superficial Dissection 250 Anterior Abdominal Wall: Intermediate Dissection 251 Anterior Abdominal Wall: Deep Dissection 252 Rectus Sheath: Cross Sections 253

Anterior Abdominal Wall: Internal View

254

Posterolateral Abdominal Wall

255 Arteries of Anterior Abdominal Wall 256

Veins of Anterior Abdominal Wall

257 Nerves of Anterior Abdominal Wall 258 Thoracoabdominal Nerves 259

Inguinal Region: Dissections

2 6 0 Inguinal Canal and Spermatic Cord 2 6 1 indirect Inguinal Hernia

•

262 Femoral Sheath and Inguinal Canal 263

Posterior Abdominal Wall: Internal View

264

Arteries of Posterior Abdominal Wall

265

Veins of Posterior Abdominal Wall

266 Lymph Vessels and Nodes of Posterior Abdominal Wall 267

Nerves of Posterior Abdominal Wall


whHH&vto i^mimm

till

i i i i p

Abdomen Peritoneal Cavity Plates 268-274 inn

ihiiiiw mi

in iiiiniinii

• — i i i » 111 iihiiwin hiii11 Miniihiiiiiiiiihiiih—wih

Visceral Vasculature Plates 300-317

MBSBfe

268 Regions and Planes of Abdomen

300 Arteries of Stomach, Liver, and Spleen

2 6 9 Greater Omentum and Abdominal Viscera

301 Arteries of Liver, Pancreas, Duodenum, and Spleen

270 Mesenteric Relations of Intestines

302 Variations in Celiac Trunk

271 Mesenteric Relations of Intestines (continued)

303 Celiac Arteriogram

272 Omental Bursa: Stomach Reflected

3 0 4 Arteries of Duodenum and Head of Pancreas

273 Omental Bursa: Cross Section

305 Arterial Variations and Collateral Supply of Liver

2 7 4 Peritoneum of Posterior Abdominal Wall

and Gallbladder 306 Arteries of Small Intestine

Viscera (Gut)

3 0 7 Arteries of Large Intestine

Plates 275-285

3 0 8 Variations in Colic Arteries

275 Stomach in Situ

309 Veins of Stomach, Duodenum, Pancreas, and Spleen

2 7 6 Mucosa of Stomach

310 Veins of Small Intestine

2 7 7 Musculature of Stomach

311 Veins of Large Intestine

2 7 8 Duodenum in Situ

312 Hepatic Portal Vein Tributaries: Portacaval Anastomoses

2 7 9 Mucosa and Musculature of Duodenum

313 Variations of Hepatic Portal Vein

2 8 0 Mucosa and Musculature of Small Intestine

314 Lymph Vessels and Nodes of Stomach

2 8 1 Ileocecal Region

315 Lymph Vessels and Nodes of Pancreas

282 Ileocecal Region (continued)

316 Lymph Vessels and Nodes of Small Intestine

283 Vermiform Appendix

317 Lymph Vessels and Nodes of Large Intestine

2 8 4 Mucosa and Musculature of Large Intestine 2 8 5 Sigmoid Colon: Variations in Position

X

*

Innerwation Plates 318-328


318 Autonomic Nerves and Ganglia of Abdomen

PSates 286-299

319 Nerves of Stomach and Duodenum

286 Topography of Liver

320 Nerves of Stomach and Duodenum (continued)

2 8 7 Surfaces and Bed of Liver

321 Innervation of Stomach and Duodenum: Schema

288 Liver in Situ and Variations in Form

322 Nerves of Small Intestine

2 8 9 Liver Segments and Lobes: Vessel and Duct Distribution

3 2 3 Nerves of Large Intestine

2 9 0 Intrahepatic Vascular and Duct Systems

3 2 4 Innervation of Small and Large Intestines: Schema

291 Liver Structure: Schema

325 Autonomic Reflex Pathways: Schema

2 9 2 Intrahepatic Biliary Systems: Schema

3 2 6 Intrinsic Autonomic Plexuses of Intestine: Schema

2 9 3 Schematic Cross Section of Abdomen at T10

3 2 7 Innervation of Liver and Biliary Tract: Schema

294 Gallbladder and Extrahepatic Bile Ducts

3 2 8 Innervation of Pancreas: Schema

295 Junction of (Common) Bile Duct and Duodenum 296 Variations in Cystic and Hepatic Ducts 2 9 7 Schematic Cross Section of Abdomen at T12

Kidneys and Suprarenal Glands Plates 329-347

2 9 8 Pancreas in Situ

329 Kidneys in Situ: Anterior Views

299 Spleen

3 3 0 Kidneys in Situ: Posterior Views


Abdomen 3 3 1 Schematic Cross Section of Abdomen at T12

344 Nerves of Kidneys, Ureters, and Urinary Bladder

3 3 2 Renal Artery and Vein in Situ

3 4 5 Innervation of Kidneys and Upper Ureters: Schema

3 3 3 Variations in Renal Artery and Vein

3 4 6 Nerves of Suprarenal Glands: Dissection and Schema

3 3 4 Gross Structure of Kidney

3 4 7 Arteries and Veins of Suprarenal Glands in Situ

3 3 5 Intrarenal Arteries and Renal Segments 3 3 6 Nephron and Collecting Tubule: Schema 3 3 7 Blood Vessels in Parenchyma of Kidney: Schema

Abdominal Sections Plates 348-349

3 3 8 Schematic Cross Section of Abdomen at T12—L1

3 4 8 Abdominal Wall and Viscera: Paramedian (Sagittal) Section

3 3 9 Schematic Cross Section of Abdomen at L 1 - 2

3 4 9 Schematic Cross Section of Abdomen at L3,4

34© Ureters 3 4 1 Arteries of Ureters and Urinary Bladder 3 4 2 Renal Fascia 3 4 3 Lymph Vessels and Nodes of Kidneys and Urinary Bladder

Plate 350

3 5 0 Abdominal Scans: Axial CT Images

Atlas ©f Human Anatomy

For regions see Plate 268

Deltopectoral triangle

Sternocleidomastoid muscle Sternal head Clavicular head Trapezius muscle

Sternum Body Xiphoid process

Deltoid muscle Pectoral is major muscle


Tendinous intersection Rectus abdominis muscle

External oblique muscle Linea alba Semilunar line

Anterior superior iliac spine Superficial circumflex iliac vein Superficial epigastric veins Pubic symphysis

Umbilicus Iliac crest

Inguinal ligament Pubic tubercle

Topographic Anatomy

Plate 247

Bony Framework of Abdomen

Body of sternum

Xiphoid process

Costal cartilages

12th rib

Inner lip Iliac < crest

Sacral

Transverse processes of lumbar vertebrae Iliac tuberosity

Intermediate zone —

Iliac crest

Outer lip

Wing (ala) of ilium

Tuberculum

Greater sciatic notch Arcuate line Anterior superior iliac spine

Ischial spine Lesser sciatic notch

Anterior inferior iliac spine Iliopubic eminence


Superior pubic ramus

Pecten pubis (pectineal line)

Obturator foramen

Pubic symphysis

Pubic tubercle

Ischial tuberosity

Inferior pubic ramus

Plate 248

Inferior pubic ligament

Lesser trochanter of femur

Body Wall

Anterior Abdominal Wall: Superficial Dissection


Xiphoid process Rectus sheath Linea alba Serratus anterior muscle Latissimus dorsi muscle External oblique muscle

n \

Muscular part

Subcutaneous tissue (superficial fascia) of abdomen Thoracoepigastric vein

Anterior superior iliac spine

Camper's (fatty) layer, Scarpa's (membranous) layer of subcutaneous tissue of abdomen {turned back)

Inguinal ligament (Poupart's)

Attachment of Scarpa's layer to fascia lata

Intercrural fibers Superficial inguinal r i n g ^ _ External spcrmatic fascia on spermatic c o r d Cribriform fascia in saphenous opening Fascia lata Great saphenous ve Superficial dorsal vein of peni

Body

Wall

Superficial circumflex iliac vessels Superficial epigastric vessels Superficial external pudendal vessels Fundiform ligament Superficial fascia of penis and scrotum (dartos fascia) (cut)

Deep (Buck's) fascia of penis with deep dorsal vein of penis showing through

Plate 249

Anterior Abdominal Walls Intermediate Dissection

Pectoralis major muscles Anterior layer of rectus sheath (cut edges) Latissimus dorsi muscle Serratus anterior muscle External oblique muscle (cut away) External intercostal muscles External oblique aponeurosis (cut edge) Rectus sheath Internal oblique muscle Anterior superior iliac spine Inguinal ligament (Pou part's) Cremaster muscle (lateral origin) Inguinal falx (conjoint tendon Reflected inguinal ligament

Linea alba Rectus abdominis muscle External oblique muscle (cut away) Tendinous intersection Internal oblique muscle Pyramidalis muscle Inguinal falx (conjoint tendon) (Poupart's) Anterior superior iliac spine External oblique aponeurosis (cut and turned down) Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Reflected inguinal ligament Pubic tubercle

Femoral vein (in femoral sheath)

Suspensory ligament of penis

Saphenous opening

Cremaster muscles and cremasteric fascia

Cremaster muscle (medial origin) Fascia lata Great saphenous vein

Plate 250

Deep (Buck's) fascia of penis External spermatic fascia (cut) Superficial fascia of penis and scrotum (cut)

Body WsaQO

Anterior Abdominal Wall: Deep Dissection

Superior epigastric vessels

External oblique muscle (cut away)

Anterior layer of rectus sheath (cut) Linea alba



External oblique aponeurosis (cut)

Tra n svers u s a b d o m i n is muscle (cu()

Internal oblique aponeurosis (cut)

Transversalis fascia (opened on left)


Extraperitoneal fascia (areolar tissue)

Internal oblique muscle (cut)

Medial umbilical ligament (occluded part of umbilical artery)

Posterior layer of rectus sheath Arcuate line Inferior epigastric vessels

Inferior epigastric artery and vein (cut)

Anterior superioi iliac spine

Site of deep inguinal ring (origin of internal spermatic fascia)

Inguinal ligament (Poupart's) Superficial circumflex iliac, Superficial epigastric, Superficial external pudendal arteries (cut)

Cremasteric and pubic branches of inferior epigastric artery

Inguinal falx (conjoint tendon) —


Pectineal ligament (Cooper's)

Lacunar ligament (Gimbernat's)



Femoral sheath (contains femoral artery and vein)

Fat in retropubic space (of Retzius)

Reflected inguinal ligament

Pectineal fascia Pubic tubercle

Internal spermatic fascia

Cremaster muscle and fascia External spermatic fascia (cut)

Body Wall

Deep (Buck's) fascia of penis

Superficial fascia of penis and scrotum (cut)

Cremaster muscle and fascia (cut) External spermatic fascia (cut)

Plate 251

4

Rectus Sheath: Cross Sections

BSKX&M5H5

wammmmmmmmnmm

mm

Section above arcuate line Aponeurosis of external oblique muscle



Aponeurosis of internal oblique muscle Aponeurosis of transversus abdominis muscle

utaneous tissue (fatty layer)

Peritoneum Ex I ra pe r i to n e a I fa sc i a


Aponeurosis of internal oblique muscle splits to form anterior and posterior layers of rectus sheath. Aponeurosis of external oblique muscle joins anterior layer of sheath; aponeurosis of transversus abdominis muscle joins posterior layer. Anterior and posterior layers of rectus sheath unite medially to form linea alba.

Section below arcuate line Aponeurosis of external oblique muscle



Aponeurosis of internal oblique muscle Aponeurosis of transversus abdominis muscle

itoneum Extraperitoneal fascia

Median umbilical ligament (obliterated urachus) in median umbilical fold

Subcutaneous tissue (fatty and membranous layers)

Aponeurosis of internal oblique muscle does not split at this level but passes completely anterior to rectus abdominis muscle and is fused there with both aponeurosis of external oblique muscle and that of transversus abdominis muscle. Thus, posterior wall of rectus sheath is absent below arcuate line, and rectus abdominis muscle lies on transversalis fascia.

PSate 252

\\v

fS'

Body Wall

Anterior Abdominal Wall: Internal View .

: . " ' . . ' •;..•: .•::.'. ' '

•

• . . : " ' ."

...

".

.

. .:

. :•:•':

wsmmmmmmmmmmmnmsammmgm

For umbilical vessels see Plate 229 Diaphragm

Parietal pleura

Diaphragmatic fascia

Round ligament (ligamentum teres) of liver and paraumbilical veins

Falciform ligament Peritoneum (cut edges) Transversalis fascia and its cut edge

Umbilicus Peritoneum Transversalis fascia

Arcuate line Rectus abdominis muscle

External and Internal oblique muscles

giHjvS

[r.y--'.

Inferior epigastric vessels —


Inguinal triangle (Hesselbach's)

Left medial umbilical ligament (obliterated left umbilical artery)

\

Transversalis fascia (cut) Interfoveolar ligament

Right medial umbilical fold

Deep circumflex iliac vessels Deep inguinal ring

Median umbilical ligament (obliterated urachus) and paraumbilical veins in median umbilical fold

P&3&-

Cremasteric and pubic branches of inferior

Umbilical prevesical fascia

epigastric artery Testicular vessels External iliac vessels

Lateral umbilical fold (contains inferior epigastric vessels)

Spermatic cord

Femoral nerve

Femoral sheath Lacunar ligament (Gimbernat's)

Iliopsoas muscle


External iliac vessels

Inguinal falx (conjoint tendon)

Supravesical fossa Transverse vesical fold

Umbilical artery (occluded part distal to this point)

Obturator internus muscle

Obturator nerve and vessels

Ureter (cut) Anterior recess of ischioanal fossa Superior vesical artery Ductus (vas) deferens

Body Wall

Levator ani muscle Seminal vesicle

Bulbourethral (Cowper's) gland embedded in deep transverse perineal muscle

Prostate and sphincter urethrae muscle Urinary bladder Perineal membrane

Plate 253

Posterolateral Abdominal Wall See also Plates 174, 177, 179, 180, 258

Serratus anterior muscle Infraspinous fascia Rhomboid major muscle Auscultatory triangle Lateral cutaneous branch of dorsal ramus of T7 spinal nerve Medial cutaneous branch of dorsal ramus of T7 spinal nerve Trapezius muscle Latissimus dorsi muscle External oblique muscle Thoracolumbar fascia (posterior layer) Lateral cutaneous branch of subcostal nerve (ventral ramus ofT12) Lumbar triangle (of Petit) Iliac crest Lateral cutaneous branch of iliohypogastric nerve (LI) Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3 spinal nerves) Gluteal aponeurosis over gluteus medius muscle Gluteus maximus muscle

v. . \ v v,

vr-v

Latissimus dorsi muscle Latissimus dorsi muscle (cut and turned back) Serratus posterior inferior muscle Digitations of costal origin of latissimus dorsi muscle Digitations of costal origin of external oblique muscle External oblique muscle (cut and turned back) Tendon of origin of transversus abdominis muscle • Internal oblique muscle — Lateral cutaneous branch of subcostal nerve (ventral ramus of T1 2) — Lateral cutaneous branch of iliohypogastric nerve (LI) Iliac crest Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3 spinal nerves) Gluteus maximus muscle

Plate 254

Body Wall

Arteries of Anterior Abdominal Wall

Axillary artery

Subclavian artery Internal thoracic arteries

Lateral thoracic artery

Pericardiacophrenic artery with phrenic nerve

Subscapular artery


Thoracodorsal artery

Branch to falciform ligament of liver Anterior intercostal arteries Intercostal muscles

Musculophrenic arteries Superior epigastric arteries

External Internal In nermost

Diaphragm Tra n s v e r s u s a b d o m i n i s muscle and aponeurosis

Anastomoses with lower intercostal, subcostal, and lumbar arteries

Rectus abdominis muscles Internal oblique muscle

External, Internal oblique muscles

External oblique muscle Posterior layer of rectus sheath

Transversus abdominis muscle Ascending branch of deep circumflex iliac artery

-Arcuate line Inferior epigastric artery

Super tidal circumflex iliac artery

Superficial epigastric artery

Superficial epigastric artery (cut) Femoral arlerv Femoral artery

j

Superficial external pudendal artery Deep external pudendal artery

Cremasteric and testicular arteries and artery to ductus deferens in spermatic cord

Body Wall

Dorsal arteries of penis (deep to Buck's fascia)

Plate 255

4

Veins of Anterior Abdominal Wall .

Subclavian vein Axillary vein

...

External Internal Anterior

Jugular veins ^vw

Cephalic vein Intercostal tributaries to axillary vein

PW9P

Lateral thoracic vein Anterior intercostal veins Internal thoracic vein Musculophrenic vein Superior epigastric v e i n s —

Cephalic vein Axillary vein Lateral thoracic vein Areolar venous plexus

Thoracoepigastric vein

Perforati n g tributaries to internal thoracic vein

Paraumbilical veins in round ligament of liver

Thoracoepigastric vein

Inferior epigastric veins Tributaries to deep circumflex iliac veins Thoracoepigastric vein (cut) Superficial circumflex iliac vein

Tributaries of paraumbilical veins Thoracoepigastric vein Superficial epigastric vein Superficial circumflex r)C v e i n

Superficial epigastric vein External pudendal vein Saphenous opening

External pudendal vein Cribriform fascia over saphenous opening

Femoral vein Great saphenous vein Pampiniform (venous) plexus

-Great saphenous vein Anterior scrotal veins

Deep dorsal vein of penis (deep to Buck's fascia)— Superficial dorsal vein of penis

Plate 256

Body Wall

Nerves of Anterior Abdominal Wall See also Plates 177, 254, 267, 498

Medial brachial cutaneous nerve Intercostobrachial nerve (T 1,2) Long thoracic nerve Latissimus dorsi muscle

Serratus anterior muscle External oblique muscle (cut) Posterior layer of rectus sheath Anterior layer of rectus sheath (cut)

Lateral cutaneous branches of intercostal nerve (T2-1. I) Anterior cutaneous branches of intercostal nerve (T1 - 1 1 ) Lateral cutaneous branch of subcostal nerve (T1 2) Lateral cutaneous branch of iliohypogastric nerve (LI) Anterior cutaneous branch of subcostal nerve (T1 2) Lateral femoral cutaneous nerve (L2, 3) — Anterior cutaneous branch of iliohypogastric nerve (LI) Femoral branches of genitofemoral nerve (LI, 2) Anterior scrotal branch of ilioinguinal nerve (LI)

Rectus abdominis muscle Transversus abdominis muscle Internal oblique muscle and aponeurosis (cut) Anterior and lateral cutaneous branches of subcostal nerve (T12) Anterior branch of iliohypogastric nerve (LI) Ilioinguinal nerve (LI) External oblique aponeurosis (cut) Anterior cutaneous branch of iliohypogastric nerve (L I) Ilioinguinal nerve (LI) Cremasteric muscle of spermatic cord External spermatic fascia of spermatic cord

Genital branch of genitofemoral nerve (LI, 2) y

Body Wall

Plate 257

Thoracoabdominal Nerves See also Plates 180, 192 Spinal nerve trunk

Ventral (anterior) ramus of spinal nerve (intercostal nerve)

Erector spinae muscle

Meningeal branch

Collateral branch

Spinal sensory (dorsal root) ganglion


Dorsal root


Ventral root

Innermost intercostal muscle Latissimus clorsi muscle

s Subcostal muscles


Lateral cutaneous branch

Innermost intercostal muscle

Greater and lesser thoracic splanchnic nerves


Sympathetic trunl< Gray and white rami communicantes


Rectus abdominis muscle Linea alba

External intercostal membrane External oblique muscle

•

•

Anterior cutaneous branch

I M&MM^MM&^M^'

.

raijiaSBcafifs!?

Mm

Tffiw

•

Plate 258

Body Wall

Linea alba

External oblique muscle and aponeurosis

Rectus sheath (anterior layer)


Transversalis fascia within inguinal triangle (site of direct inguinal hernia)

Internal oblique muscle (cut and reflected) Transversus abdominis muscle Deep inguinal ring (in transversalis fascia)

Inguinal falx (conjoint tendon)

Cremaster muscle (lateral origin)

Reflected inguinal ligament

Inferior epigastric vessels (deep to transversalis fascia)

Intercrural fibers

Inguinal ligament (Poupart' Lacunar ligament (Gimbernat's)

External spermatic fascia on spermatic cord exiting

Cremaster muscle (medial origin) Superficial inguinal ring .Lateral crus Medial crus

Superficial inguinal ring Fundiform ligament of penis

Pubic crest

Anterior view Posterior (internal) view Rectus sheath (posterior layer) Arcuate line umbilical ligament Anterior superior iliac spine fascia {cut away) Rectus abdominis muscle Iliopubic tract Inferior epigastric vessels Inguinal (Hesselbach's) triangle Femoral nerve Genital branch of genitofemoral nerve and testicular vessels Deep inguinal ring Iliopsoas muscle External iliac vessels Femoral ring ( d i l a t e d ) (broken line) Lacunar ligament (Gimbernat's) Rectineal ligament (Cooper's) Ductus (vas) deferens Obturator-pubic anastomosis Obturator vessels Pubic branches of inferior epigastric vessels Median umbilical ligament Pubic symphysis Hesselbach's

Body Wall

triangle by Carlos Machado

after Frank Netter

/

Plate 259


Testicular vessels covered by peritoneum Testicular vessels and genital branch of genitofemoral nerve

\


Ductus (vas) deferens

Transversus abdominis muscle Transversalis fascia

Cremasteric vessels External iliac vessels covered by peritoneum

Extraperitoneal fascia (loose connective tissue)

Ductus (vas) deferens covered by peritoneum Inferior epigastric vessels

Peritoneum

Medial umbilical ligament (occluded part of umbilical artery) Umbilical prevesical fascia Urinary bladder Rectus abdominis muscle Pyramidalis muscle Median umbilical ligament (urachus) Superficial inguinal rings

Anterior superior iliac spine Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring Ilioinguinal nerve

Pubic symphysis (covered by intermingling fibers of external oblique aponeurosis)

Spermatic cord j \\

Femoral vessels

III

Cremaster muscle and cremasteric fascia on spermatic corcl

Pubic tubercle External spermatic fascia enveloping spermatic corc 1 Inguinal falx (conjoint tendon)

Inguinal ligament (Poupart's) Intercrural fibers

Plate 260

Body Wall

Indirect Inguinal Hernia Compare to Plate 260 Loop of bowel entering hernial sac

• Ductus (vas) deferens, testicular vessels, I and genital branch of genitofemoral nerve forming spermatic cord

Neck of hernial sacInferior epigastric vessels Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring

Peritoneum

vVW V ji

Extraperitoneal fascia Transversalis fascia

-iVr."

Deep inguinal ring

External spermatic fascia

Cremaster muscle and fascia

Superficial inguinal ring

Internal spermatic fascia

Hernial sac Ductus (vas) deferens and vessels of spermatic cord

Body Wall

Plate 261

Femoral Sheath and Inguinal Canal

Transversalis fascia (cut edge) Extraperitoneal fascia Parietal peritoneum Median umbilical ligament (urachus) Medial umbilical ligament (occluded part umbilical artery) Inferior epigastric vessels Deep circumflex iliac vessels Testicular vessels asteric artery Ductus (vas) deferens External iliac vessels Pubic (obturator anastomotic) vessels External oblique aponeurosis (cut) Internal spermatic fascia on spermatic cord Femoral nerve (deep to iliopsoas fascia) Femoral vessels in femoral sheath Falciform margin of saphenous opening (cut and reflected) Ureter Genitofemoral nerve Urinary bladder Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Inguinal ligament (Pou part's)

Transversalis fascia forms anterior wall of femoral sheath (posterior wall formed by iliopsoas fascia) •••

••

Lateral femoral cutaneous nerve Iliac fascia Genital branch of genitofemoral nerve Femoral branch of genitofemoral nerve Testicular vessels External iliac vessels Inferior epigastric vessels Ductus (vas) deferens and cremasteric artery Pectineal ligament (Cooper's) Femoral ring Transversalis fascia forms anterior wall of femoral sheath Lacunar ligament (Gimbernat's) Inguinal ligament (Poupart's)

Lymph node (Cloquet's) in femoral canal Femoral sheath (cut open) Pectineal fascia

Plate 262

Body Wall

Posterior Abdominal Wall: Internal View mmmMmmmmmmmmmmmmmmmmmmmmmmmm

For diaphragm see also Plate 195

Cava I opening Diaphragm Central tendon of diaphragm Esophagus and vagal trunks Right crus of diaphragm Left crus of diaphragm Median arcuate ligament Aorta and thoracic duct Greater, lesser, and least thoracic splanchnic nerves Medial arcuate ligament Lateral arcuate ligament Sympathetic trunk

Quad rat us [umbo rum muscle Psoas minor muscle Psoas major muscle Transversus abdominis muscle Internal oblique muscle External oblique muscle lliacus muscle

Anterior superior iliac spine Piriformis muscle Coccygeus (ischiococcygeus) muscle

Anterior inferior iliac spine

Ischial spine Inguinal ligament (Poupart's) Obturator internus muscle Rectococcygeus muscle Tendinous arch of levator ani muscle Opening for femoral vessels Pectineal ligament (Cooper's) Lacunar ligament (Gimbernat's) Pubic symphysis Perineal membrane

Levator ani muscle Lesser trochanter of femur

Urethra Pubic tubercle

Body Wall

Rectum

Plate 263

4

Recurrent branch to esophagus

Celiac trunk with c o m m o n hepatic, left gastric, and splenic arterie

Superior suprarenal arteries Middle suprarenal artery Superior mesenteric artery

Superior suprarenal arteries

Inferior suprarenal artery

Middle suprarenal artery Inferior

Left renal artery

suprarenal artery Right renal artery

i

Testicular (ovarian) arteries

•i / A b d o m i n a l aorta

Psoas major muscle (cut)

Inferior mesenteric artery

Quadratus I umbo rum muscle

Left colic artery Sigmoid arteries

Subcostal artery*?

Superior rectal artery

T

1st to 4th right lumbar a r t e r i e s - ^ Common iliac arteries

Median sacral artery

Iliolumbar artery

Internal iliac artery Superior gluteal artery

Lateral sacral arteries External iliac artery

Umbilical (patent part) artery giving rise to superior vesical arteries

Testicular (ovarian) artery Ascending branch of deep circumflex iliac artery

Obturator artery Inferior vesical artery and artery to ductus deferens

Superficial circumflex iliac artery

Middle rectal artery Internal pudendal artery

Inferior epigastric artery Pubic, Cremasteric branches of inferior epigastric artery Superficial epigastric artery (cut)

Inferior gluteal artery

Swa

Transversalis fascia ( c u t ) y

Inferior epigastric artery

Femoral artery Ductus deferens and testicular artery (cut) Superficial external pudendal artery Deep external pudendal artery

Plate 264

Anterior abdominal wall (turned down)

k Medial

umbilical ligament (occluded part of umbilical artery)

Body Wall

Veins of Posterior Abdominal Wall :, .:;• . .

.....: .. . . :'

' •: . . . . . . • :

..:./.

.•

Inferior phrenic veins

Diaphragm

Hepatic veins Esophagus

Inferior vena cava

Left suprarenal veins and anastomosis with inferior phrenic vein

Right inferior suprarenal vein Right renal vein

Left renal vein

Psoas major muscle (cut)

Ovarian (testicular) veins

Quadratus ft lumborum muscle s J

Ascending lumbar veins

Subcostal vein

Common iliac vein

1st to 4th rightlumbar veins

Internal iliac vein

Iliolumbar vein

Superior gluteal vein

Common iliac vein

Inferior gluteal vein

Ovarian (testicular) veins and ureter (cut)

Internal pudendal vein External iliac vein

Internal iliac vein Median sacral vein

Middle rectal vein

Lateral sacral veins

Uterine vein Superior vesical vein

Deep circumflex iliac vein

Deep circumflex iliac vein

Superficial circumflex iliac vein

Obturator vein Round ligament of uterus

Inferior epigastric vein (cut)

Inferior epigastric vein Superficial epigastric vein (cut)

Rectal venous plexus

Pubic (obturator anastomotic) vein

Uterovaginal venous plexus

Femoral vein Great saphenous vein External pudendal vein

Body Wall

Anterior abdominal wall (turned down)

Vesical venous plexus

Plate 265

Lymph Vessels and Nodes of Posterior Abdominal Wall See also Plate 407

Thoracic duct Right subclavian trunk

Tracheobronchial nodes

Inferior phrenic nodes Thoracic duct

Cisterna chyli

Right lumbar trunk

Intestinal trunk

Left lumbar trunk

C o m m o n iliac nodes

Middle sacral nodes

Celiac nodes Superior mesenteric nodes

Visceral (preaortic) lymph nodes

In ferior mesenteric node ^ Lumbar nodes (lateral aortic nodes) Common iliac nodes Internal iliac nodes External iliac nodes

Lateral sacral nodes Inferior epigastric node

Node of Cloquet, or Rosenmuller (highest deep inguinal node)

Superficial inguinal nodes (superior, horizontal, and inferior [verticall groups)

Deep inguinal nodes

Plate 266

Body Wall

Nerves of Posterior Abdominal Wall

Greater, lesser, and least thoracic splanchnic nerves

Celiac, superior mesenteric, and aorticorenal ganglia Iliohypogastric nerve (LI)

Sympathetic trunks

Ilioinguinal nerve (L1)

Subcostal nerve (T12)

Muscular branches from lumbar plexus

Iliohypogastric nerve (L1) '

Subcostal nerve (T12) Psoas major muscle (cut)

Ilioinguinal nerve (LI)

/Quadratus lumborum muscle

Genitofemoral nerve (LI,2) Transversus abdominis muscle (cut)

Iliohypogastric nerve (LI) Ilioinguinal nerve (LI)

Subcostal nerve (T12) and its lateral cutaneous branch

Genitofemoral nerve (LI,2)

Intermesenteric (paraaortic) plexus

Lateral femoral cutaneous nerve (L2, 3) $

Femoral branch, Genital branch of genitofemoral nerve (LI,2)

mm

Gray and white rami communicantes

Lumbosacral trunks (14, 5) Obturator nerves


Accessory obturator nerve (L3, 4) (occasional)

Lateral femoral cutaneous nerve (L2,3)

Femoral nerve Sacral plexus (L4-S4)

Femoral nerve (L2-L4)

Pudendal nerve (S2, 3, 4)

Obturator nerve (L2, 3, 4)

Anterior cutaneous branch of iliohypogastric nerve (L'l) Anterior scrotal (labial) branches of ilioinguinal nerve (L1) Genital branch ....

S o d y

WsaOO

....

Femoral branches

of genitofemoral nerve (LI, 2)

Plate 267

4

Regions and Planes of Abdomen BHCppaPjHaBy

V y'Vs

Right lateral rectus plane (semilunar line)

Left upper quadrant

Right upper, quadrant) (RUQ)-

Right midclavicular line

•• "ffiKSrt^'^^

Left lateral rectus plane (semilunar line)

Left midclavicular line

Left lower quadrant..,:

ght lovver quadrant , (RLQ)

Epigastric region

Right hypochondrium (hypochondriac region) Trans pyloric plane

hypochondrium (hypochondriac on)

Subcostal plane Umbilical region Right flank (lumbar regi

Left flank (lumbar region)

Intertubercular plane Interspinous plane Right groin (inguinal re

Left groin (inguinal region)

Pubic (hypogastric region)

P l a t e

2 6 8

Peritoneal Cavity


Falciform ligament

Left lobe of liver

- Right lobe of liver

Stomach

Gallbladder

Greater omentum overlying transverse colon and small intestine (jejunum and ileum)

Greater omentum {turned up)

Transverse colon (turned up)

Transverse mesocolon

Left colic (splenic) flexure

Right colic (hepatic) flexure

Small intestine (jejunum and ileum)

Ascending colon

Cecum Small intestine (covering descending colon)

Sigmoid colon

Urinary bladder

Peritoneal Cavity

it

4

Mesenteric Relations of Intestines

nsverse colon (elevated) Transverse mesocolon Superior duodenal fold Superior duodenal fossa Left colic (splenic) flexure Paraduodenal fossa Inferior duodenal fossa Inferior duodenal fold Mesentericoparietal recess (fossa) Superior mesenteric artery in root of «mesentery Inferior mesenteric artery and vein Abdominal aorta

Esophagus Right crus of diaphragm (part passing to right of esophageal hiatus) Right crus of diaphragm (part passing to left of esophageal hiatus) Left crus of diaphragm

Exposure of suspensory muscle of d u o d e n u m (ligament of Treitz)

Celiac trunk Suspensory muscle of duodenum (ligament of Treitz) Superior mesenteric artery Duodenojejunal flexure ncling (4th) part of duodenum ejunum Inferior (horizontal, or 3rd) part of duodenum Descending (2nd) part of duodenum

Plate 270

Peritoneal Cavity

Mesenteric Relations of Intestines (continued)

rse colon [elevated)

mesocolon (elevated over pancreas)

Greater omentum (elevated)

Jejunum (cut) Free taenia (taenia libera)

Mesentery (cut and small intestine removed)

Omental (epiploic) append



Descending colon

Right paracolic gutter

Left paracolic gutter

Ascending colon

Sigmoid mesocolon

Terminal part of ileum (cut)

Sigmoid colon

Cecum

Rectum

Retrocecal recess Vermiform appendix

Sigmoid colon ( reflected) Sigmoid mesocolon Intersigmoid Ureter

Parietal peritoneum

Common iliac vessels

Peritoneal Cavity

Plate 271

Omental Bursa: Stomach Reflected

Inferior vena cava (retroperitoneal) C o m m o n hepatic artery (in peritoneal fold)

in gastrocolic ligament)

Hepatoduodenal ligament (right margin of lesser omentum) Probe in omental (epiploic) foramen

Stomach (posterior surface) Caudate lobe of liver Probe in superior recess of omental bursa Left gastric artery (in gastropancreatic fold) Left inferior phrenic artery (retroperitoneal)

Gallbladder

Gastrophrenic ligament

Diaphragm

Left suprarenal gland and superior pole of kidney (retroperitoneal)

Liver

Gastrosplenic (gastrolienal) ligament

7

Spleen



Kidney (retroperitoneal) Descending (2nd) part of duodenum Right gastro-omental (gastroepiploic) artery (covered by peritoneum) Anterior superior pancreaticoduodenal artery (retroperitoneal) Head of pancreas (retroperitoneal)

Plate 272

Phrenicocolic ligament Splenorenal (lienorenal) ligament Tail of pancreas (intraperitoneal) Posterior layers ) Anterior layers (cut) j

of gastrocolic ligament

ransverse mesocolon Body of pancreas (retroperitoneal)

Peritonea! Cavity

.raj

© m e r a f a B

E i w r s a ^

© r @ s s

S e ^ t i © ^

See also Plate 331

Vertebral body of L1 Abdominal aorta

Inferior vena cava

Splenic vein

Diaphragm Right kidney

Left kidney

,: -

l l l l

\

v?

b.

-a »

m&lfZM

« p

^

Gastrosplenic (gastrolienal) ligament Greater omentum Visceral peritoneum (cut edges) Omental (epiploic) foramen (of Winslow)

Stomach *

(Common) bile duct Portal triad

Hepatic portal vein

Peritoneal Cawity

Pancreas Omental bursa (lesser sac) Lesser omentum (hepatoduodenal and hepatogastric ligaments)

Plate 273

4

Peritoneum of Posterior Abdominal Wall

Abdominal aorta and celiac trunk

Inferior vena cava (Common) bile cluct and proper hepatic artery Coronary ligament of liver

Falciform ligament

Hepatic veins

Superior recess of omental bursa (lesser sac) Attachment of lesser omentum and left gastric artery

Right suprarenal gland O m e n t u m (epiploic) foramen behind right free margin of lesser omentum

Esophagus

Left triangular ligament of liver

Right triangular ligament

Gastrophrenic ligament and left inferior phrenic artery

Attachment of transverse mesocolon and right gastro-omental (gastroepiploic) vessels

j

Splenorenal (lienorenal) ligament and splenic vessels

Duodenum Right kidney

Phrenicocolic ligament

Parietal peritoneum

K 3 r>.

a

Root of mesentery

/f>
Site of ascending colon

Attachment of sigmoid mesocolon and sigmoid vessels

Testicular vessels (retroperitoneal)

Median umbilical fold (contains urachus)

Attachment of transverse mesocolon

Site of descending colon

External iliac artery (retroperitoneal)

Site of deep inguinal ring

Pancreas and splenic artery (retroperitoneal)

Superior mesenteric vessels

Common iliac artery (retroperitoneal)

Ureters (retroperitoneal)

Short gastric vessels

Superior rectal vessels

mm

Rectum

Urinary bladder

Sacrogenital fold (ligament) Lateral umbilical fold (contains inferior epigastric vessels) Medial umbilical fold (contains occluded part of umbilical artery)

Plate 274

Peritoneal Cavity

Stomach in Situ mtA

Left lobe of liver

Hepatoduodenal ligament Hepatogastric ligament

Falciform ligament

Lesser omentum


Fundus of stomach

Rou nd ligament of liver (obliterated umbilical vein)

Diaphragm /

Spleen

Inferior border of liver Cardiac

Quadrate lobe of liver

stomach

Right lobe of liver Body of stomach

Gallbladder Angular notch Mincisyre)

Omental (epiploic) foramen' (of Winslow) Pylorus

st°niac

Duodenum

h

Right kidney (retroperitoneal) Right colic (hepatic) flexure

Greater omentum


Variations in position and c o n t o u r of stomach in relation to body habitus

Hypertonic stomach

Viscera (Gut)

Orthotonic: stomach

Hypotonic stomach

Atonic stomach

PGaf© 27S

See also Plate 236

Zigzag (Z) line (junction of gastric and esophageal mucosa)

Cardiac zone

Cardiac orifice

Pyloric orifice

Superior (1 st) part of duodenum (ampulla, or duodenal cap)

Gastric and fundic zones

sV Pyloric zone

Surface epithelial cell

Mucous cell

Parietal cell (between mucous cell and chief cell)

Chief cell Solitary lymph follicle (nodule) Neuroendocrine G cell Muscularis mucosae Pyloric glands

Plate 278

Submucosa

Gastric (fundic) glands

Viscera (Gut)

Musculature of Stomach .

-

.

•

A

v

i

"

i

i

i

i

.

.

Kafiv •'AV.vivJSLuv/;','£

.V:

:

Longitudinal muscle of esophagus

Outer longitudinal muscle layer of stomach (concentrated chiefly at lesser and greater curvatures and at pyloric part)

Middle circular muscle layer of stomach

Collar of Helvetius (middle circular and innermost oblique fibers blend here)

Longitudinal muscle of duodenum

Section through pylorus (composed chiefly of thickened circular muscle)

Circular muscle of duodenum Longitudinal muscle of duodenum {cut away)

Viscera (Gut)

Windows cut in middle circular muscle layer

Pilate 277

Duodenum in Situ

Suprarenal gland

Hepatic portal vein Portal triad

Superior mesenteric vessels

Proper hepatic artery

Kidney Transverse mesocolon and its cut edges

Celiac trunk

(Common) bile duct

Splenic artery

Transverse colon (cut)

Right free margin of lesser omentum (hepatoduodenal ligament)


Liver (cut) Suprarenal gland

Jv'v.yiV;

Pylorus KidneyTransverse mesocolon and its cut edges Right colic (hepatic) flexure

X

iiif i l l mMm iW -î"' . ' tS' ' " V.

. ?

p

Transverse colon {cut)

[

m^

Ascending colon

,

/

Psoas major muscle

/

fi

fjm &L^'l /

•M'

'(

;'l m

Superior (1 st) part

J

Descending colon

Descending (2nd) part Duodenum

Inferior duodenal fold and fossa

Inferior (horizontal, or 3rd) part Ascending (4th) partRoot of mesentery (cut edges)

Duodenojejunal flexure and jejunum {cut) Inferior mesenteric artery Abdominal aorta Inferior vena cava

Plate 278

Viscera (Gut)


Hepatic portal vein

Gastroduodenal artery.

(Common) bile duct

Right gastric artery Right free margin of lesser omentum (hepatoduodenal ligament)

,

w

Pyloric orifice

Superior duodenal flexure

(Common) bile duct

Superior (1 st) part (ampulla, or duodenal cap) (no circular folds)

Accessory pancreatic duct (of Santorini) (Principal) pancreatic duct (of Wirsung)

Descending (2nd) part Minor duodenal papilla (inconstant)

D u od en oj e j u n a I f I ex u re

Circular folds (valves of Kerckring)

Jejunum

Major duodenal papilla (of Vater)

Ascending (4th) part Head of pancreas

Superior mesenteric artery and vein

Inferior duodenal flexure Inferior (horizontal, or 3rd) part

Outer longitudinal muscle layer (with window cut)

Inner circular muscle layer (with window cut) Submucosa with duodenal (Brunner's) glands

Viscera (Gut)

Barium radiograph of stomach, d u o d e n u m , and proximal j e j u n u m B

Body of stomach

D

Duodenal cap (1 st part)

D2

Descending (2nd) part of duodenum

F

Fundus of stomach

J

Proximal jejunum

P

Pylorus

PA

Pyloric antrum

Plate 279

Mucosa and Musculature of Small Intestine

Jejunum Mesen Anastomotic loop (arcade) of jejunal arteries Straight arteries (arteriae rectae) Serosa (visceral peritoneum) Longitudinal muscle layer Circular muscle layer

Barium radiograph of jejunum

Submucosa Mucosa Circular folds (valves of Kerckring) Solitary lymphoid nodule

Ileum Mesentery Anastomotic loops (arcades) of ileal a r t e r i e s - — _ Straight arteries (arteriae rectae) Serosa (visceral peritonei] m)-—" Longitudinal muscle layer Circular muscle layer

Barium radiograph of ileum

Submucosa Mucosa Circular folds Solitary lymphoid nodules Aggregate lymphoid nodules (Peyer's patches)

Plate 280

Wiseera JOutJ

Ileocecal Region

Ileocolic artery Colic branch Ileal branch Superior mesenteric artery v

Posterior cecal artery Appendicular artery Anterior cecal artery Vascular fold of cecum Superior ileocecal recess Ileocecal fold (bloodless fold of Treves) Terminal part of ileum Inferior ileocecal recess —Mesoappendix Appendicular artery Vermiform appendix Free taenia (taenia libera)

External iliac vessels (retroperitoneal) Retrocecal recess Cecal folds Appendicular artery

Right paracolic gutter Omental taenia

4

J*'

Mesocolic taenia

Posterior cecal artery Cecal folds Retrocecal reces

Some variations in posterior peritoneal attachment of cecum Lines of posterior peritoneal reflection

Viscera (Gut)

Lines of posterior peritoneal reflection



P l a t e

28H

Ileocecal Region (continued)

Free taenia (taenia libera)

Ileocecal lips: labial form of ileal orifice (as seen commonly postmortem and occasionally in vivo)

Terminal part of ileum

Orifice of vermiform appendix

Ileal papilla: papillary form of ileal orifice (found most commonly in vivo)

Schema of muscle fibers at ileal orifice

Plate 282

Viscera (Gut)

McBurney's point (on spinoumbilical line)

Barium radiograph of unusually long appendix (A Appendix; C Cecum)

/ A, '

V

Fixed retrocecal appendix

Variations in position of appendix

Mesoappendix •Serosa (visceral peritoneum) Longitudinal muscle Circular muscle Submucosa -•r

.

Viscera (Gut)

;

v

.

'iv

' is'.1

•Aggregate lymphoid nodules Crypts of Lieberkuhn

Plate 283

For rectum and anal canal see Plates 391-396

Greater omentum ( c u t a w a y ) Right colic (hepatic) flexure


Omental taenia

Omental (epiploic) appendices Haustra Peritoneum ¥ (cutaway)

Peritoneum (cut away) Omental taenia (exposed by hook)

-—Descending colon

Mesocolic taenia (exposed by hook)

Ascending colon

Free taenia (taenia libera) Ileal orifice

Cecum Vermiform appendix

Sigmoid colon Sigmoid mesocolon Levator ani muscle External anal sphincter muscle

Plate 284

0 y

Viscera (Gut)

Sigmoid Colon: Variations in Position For rectum see Plates 360, 361, 391-394

Typical

Short, straight, obliquely into Ik.

Looping to right side

Wiscera (Gut)

•

Ascending high into abdomen

Plate 285

4

Topography of Liver

Transpyloric

Lateral rectus (semilunar) plane

Liver covered by diaphragm, pleura and lung (percussion dullness)

Diaphragm

Liver covered by diaphragm and pleura (percussion flatness)

Liver covered by diaphragm, pleura, and lung (percussion dullness)

Liver covered by diaphragm (percussion flatness or intestinal resonance)


Diaphragm

Plate 286

Liver covered by diaphragm, pleura, and lung (percussion


Gallbladder Inferior border of liver


Surfaces and Bed of Liver Diaphragm ( p u l l e d up)

Left triangular ligament


Fibrous appendix of liver Left lobe of liver

Right lobe of liver

Falciform ligament

Round ligament (ligamentum teres) of liver (obliterated umbilical vein) forming free border of falciform ligament

Costal impressions

Anterior view Gallbladder (fundus) Porta hepatis Fissure for ligamentum teres Hepatic portal vein

Colic impression Round ligament of liver

Proper hepatic artery Caudate process

Gallbladder

Papillary process Caudate lobe

Quadrate lobe Duodenal impressio

Fissure for ligamentum venosum

Renal impressio

Esophageal impression Gastric impression

Cystic duct Common hepatic duct (Common) bile duct


Right triangular ligament Hepatorenal portion of coronary ligament Suprarenal impression Bare area Inferior vena cava Coronary ligament

Hepatic veins

Visceral surface Falciform ligament


Coronary ligament Bare area Inferior vena cava Suprarenal gland Right kidney

Left triangulai ligament


Fissure for ligamentum venosum

Superior recess of omental bu

Groove for (inferior) vena cava

Posterior view


Duodenum

Stomach

Bed of liver

Plate 287

4

Liver in Situ and Variations in Form mmmm

Left lobe of liver

Round ligament (ligamentum teres) of liver (obliterated umbilical vein) Quadrate lobe

Caudate lobe seen through lesser omentum (hepatogastric ligament)

Right lobe of liver

W i n d o w cut in lesser omentum (hepatoduodenal ligament) Proper hepatic artery

Omental (epiploic) foramen (of Winslow)

(Common) bile duct portal vein Lesser omentum (hepatogastric ligament)

Kidney (retroperitoneal)

Spleen

Duodenum

Stomach Greater omentum

I A-I+ /•^J'xll/'-

flexure Right colic (hepatic) flexure

Variations in f o r m of liver

Very small left lobe, deep costal impressions

"Tonguelike" process of right lobe

Plate 288

Complete atrophy of left lobe (left portal vein compression)

Very deep renal impression and "corset constriction"

Transverse, "saddlelike" liver, relatively large left lobe

Diaphragmatic grooves


Liver Segments and Lobes: Vessel and Duct Distribution ... ..

.

..-.

Anatomic \ lobes )

Division into segments is based upon ramifications of bile ducts and hepatic vessels. It does not entirely correspond with division into anatomic lobes

Left (part of) liver Functional surgical segments

Lateral division

Posterior lateral segment (VII) (Posterior superior area)—^

Right anterior lateral segment (VI) (Posterior inferior area)—/

Medial division

Medial division

Lateral division

Lateral segment (II) . (Lateral superior area) Posterior medial segment (VIII) (Anterior superior area)

(Medial superior Medial segment

Anterior medial segment (V) (Anterior inferior area)

\

Left a n t e r o lateral segment tilt) (Lateral inferior

Parietal surface

(Medial inferior area)

UAnterior

Visceral surface

anterior \ lateral \ segment ( V I ) \ (Posterior inferior area)

A

Anterior medial segment (V)

(Medial inferior Quadrate lobe

Posterior lateral segment (VII) (Posterior superior area) Î'iMyy.

Medial segment (IV)

<1

/I - ^ // ' /

anterjor

lateral segment (I (Lateral

| Lateral feegment (II) \ (Lateral superior yV':ik area) i (Medial superior area)

Caudate process

Distribution of vessels and ducts

Phantom division between anterior and y posterior superior areas

I Inferior vena cava

Wishers (Accessory ©rgamsj

Common hepatic duct, hepatic portal vein, and proper hepatic artery

Right branch Left branch Anterior segment Medial segment Posterior segment Lateral segment Anterior inferior area Medial inferior area Anterior superior area Medial superior area Posterior inferior area Lateral inferior area Posterior superior area Lateral superior area Caudate lobe (right and left) Caudate process

Plate 289

Sublobular vein

Hepatic vein Sublobular veins

Central vein

Sinusoids Portal triad

Sinusoids

Central vein Portal triad

Portal triads

Proper hepatic artery Hepatic portal vein Common hepatic duct

hepatis along vessels and bile duct Vv

Hepatic artery branch Portal vein branch

/

Portal triad

Bile ductules Sinusoids Liver cell "plates" Central veins (tributary to hepatic vein via sublobular veins)

Normal lobular pattern of liver

Plate 290


Liver Structure: Schema

Lymph vessel Limiting plate of portal space

Central vein Sublobular vein (tributary to hepatic vein)

Periportal space (of Mall)

Perisinusoidal spaces (of Disse)

Central vein

Sinusoids Central vein

.-•.•v.".-

jsffgg- i

Branch of portal vein

Branch of / hepatic artery Portal arteriole Periportal arteriole

Central vein

Intralobular arteriole

Periportal bile ductule (canal of Hering) Inlet venule Distributing vein


Plate 291

4

Intrahepatic Biliary Systems: Schema


Bile canaliculi

Bile ducts

Note: In the above illustration, bile canaliculi appear as structures with walls of their own. However, as shown in the histologic section at right, boundaries of canaliculi are actually a specialization of surface membranes of adjoining liver parenchymal cells.

Sinusoid


Bile ducts Bile ductules

Bile canaliculi Branch of hepatic artery

Low-power section of liver

Plate 292


<

W o

•T

as >

Transverse Section: Level of T10, Esophagogastric j u n c t i o n Plate 293

T10

o 0 (D m

Diaphragm


o

Xiphoid process

Costal cartilages

Esophagogastric junction (Q

fi> 3

W

Right crus of diaphragm (forming right boundary of esophageal hiatus)

Gastric folds (rugae)

Fundus of stomach Inferior vena cava Right crus of diaphragm (forming left boundary of esophageal hiatus)


Thoracic aorta

Azygos vein


Diaphragm


Spleen

Inferior lobe of left lung in costodiaphragmatic recess

Inferior lobe of right lung in costodiaphragmatic recess

2

Body of T10 vertebra


ST (D If (0 Q

Thoracic duct CAfâ^ / —

Gallbladder and Extrahepatic Bile Ducts

Right and left hepatic arteries

Right and left hepatic ducts


Common hepatic duct

Anterior layer of lesser omentum (cut edge)

Cystic artervi

Right gastric artery

Cystic duct Common hepatic artery

Hepatic portal vein

Gastroduodenal artery

Liver

Stomach

(Common) bile duct Gallbladder Hepatic ducts

Superior (1 st) part of duodenum

Right

Left

Cystic duct


Spiral fold

Head of pancreas Neck Infundibulu (Hartmann's pouch)

Smooth

Common hepatic uct Gland orifices

Gallbladder

(Common) bile duct

Fundus

Descending (2nd) part of duodenum Pancreatic duct

Hepatopancreatic ampulla (of Vater) Major duodenal papilla (of Vater)

Plate 294


Junction of (Common) Bile Duct and Duodenum

(Common) bile duct (ductus choledochus) Minor duodenal papilla

Longitudinal muscle of duodenum

Longitudinal duodenal muscle seen through opening in circular muscle

Circular folds Major duodenal papilla

Circular muscle of duodenum Pancreatic duct Sphincter of (common) bile duel (choledochus) Longitudinal bundle

Reinforcing fibers

Longitudinal fold

Sphincter of pancreatic duct (inconstant)

Fibers to longitudinal bundle

Reinforcing fibers Duodenal muscle fibers to longitudinal bundle

Interior of descending (2nd) part of duodenum

Dissection Duodenal mucosa —

(Common) bile duct

(Common) bile duct

Pancreas /

:

Longitudinal) Duodenal —-—Circular ) muscle m§ -(Common) bile duct UM u — — L o n g i t u d i n a l bundle —

^ ^ ^ - S p h i n c t e r of (common) bile duct (choledochus)

p i r ^ Fibers to longitudinal bundle

J

/

^-——Sphincter of pancreatic duct (inconstant)

Sphincter of (common) bile ductLongitudinal bundle Pancreatic ductDuodenal muscle — Pancreas Section, level A

I /

— Pancreatic duct

(Common) bile duct Sphincter of hepatopancreatic ampulla—— ' Longitudinal bundle Pancreatic d u c t - ^

Sphincter of hepatopancreatic ampulla

Section, level B Sphincter of hepatopancreatic ampulla—

Major duodenal papilla

Reconstruction

Hepatopancreatic ampulla v (common \ channel)-"""*""^

Variations in union of bile and pancreatic ducts I

1m'^(Common) i m m bile duct ;

hinder of hepatopancreatic ampulla

(Common) bile duct

Section, level C jl f

\j >.

Pancreatic duct Sphincter of ampulla

Short common channel

Pancreatic duct Duodenal wall No common channel


Sphincter of ampulla

Long common channel

Plate 295

Variations in Cystic and Hepatic Ducts

Variations in cystic duct Low union with common hepatic duct

Adherent to common hepatic duct

Cystic duct absent or very short

Anterior spiral joining common hepatic duct on left side

High union with common hepatic duct

Posterior spiral joining common hepatic duct on left side

Accessory (aberrant) hepatic ducts Joining common hepatic duct

Joining (common) bile duct

Joining cystic duct-

Joining gallbladder Two accessory hepatic ducts

Plate 296


W o

o o

Transverse Section: Level of T12, Inferior to Xiphoid i ji

t

h—

T12

Plate 297

Pyloric canal

)

Stomach

1

Pylorus

Jejunum

W

(/)

0 <

Right colic (hepatic) flexure of colon

O as

3

(A

Transverse colon (ascending to left colic flexure)

Gallbladder Bifurcation of celiac trunk

Superior (1 st) part of duodenum Hepatoduodenal ligament

Descending colon (descending from left colic flexure)

Liver

Spleen

(Common) bile duct

Portal triad

Splenic artery and vein

Prope hepatic artery

Left suprarenal gland Superior pole of left kidney

Portal vein Inferior vena cava

Left crus of diaphragm Thoracic aorta

Right suprarenal gland Pancreas •o


ST ro

(0 -si

CAfcU^&k/—/1.7>.

Inferior vena cava

Celiac trunk

Splenic artery

Stomach {cut)

Hepatic portal vein Portal triad

Spleen

Proper hepatic artery (Common) bile duct

Right free margin of lesser omentum Suprarenal gland Duodenum Right kidney (retroperitoneal)

Pancreas Left colic (splenic) flexure

Attachment of transverse mesocolon


Transverse colon (cut) Left kidney (retroperitoneal)


• Attachment of transverse mesocolon Inferior mesenteric vein (retroperitoneal) jejunum (cut)

Middle colic artery and vein

Duodenojejunal flexure


Root of mesentery (cut)

Uncinate process of pancreas

Low-power section of pancreas

Islets (of Langerhans)

Pancreatic notch Pancreatic duct (of Wirsung)

Interlobular duct Interlobular septum

Plate 298


Posterior extremity

Gastrosplenic ligament

Posterior extremitv

Superior bordei

Short gastric vessels

Gastric impression

Renal impression

Hilum

Inferior border Splenorenal (lienorenal) ligament Splenic artery Left gastro-omental (gastroepiploic) vessels

WBmm

mIUM

Splenic vei

siiiai M l

Colic impression


Visceral surface

Short gastric vessels in gastrosplenic ligament

Inferior border

Anterior extremity

Diaphragm Spleen

Stomach (cut)

Serosa (visceral peritoneum)

9th rib

Fibrous capsule Splenic pulp Splenic trabeculae Splenic vein and artery — Hilum

Cross section

Suprarenal gland Left kidney Splenic artery and vein Transverse colon

Splenorenal (lienorenal) ligament Attachment of transverse mesocolon (cut)

"ail of pancreas

Spleen in situ


Plate 299

Arteries of Stomach, Liver, arid Spleen

Right and left inferior phrenic arteries

Left gastric artery

Abdominal aorta

Splenic artery

Celiac trunk

Esophageal branch of left gastric artery

Left hepatic artery

Recurrent branch of left inferior phrenic artery to esophagus

Right hepatic artery

Short gastric arteries

1 \

Proper hepatic arterv (Common) bile duct-""" Hepatic portal vein Right gastric artery-^ Supraduodenal artery '

\

Posterior superior, / Anterior superior ' pancreaticoduodenal arteries

Plate 300

Common hepatic artery Right gastro-omental (gastroepiploic) artery

/

/

Splenic branches of splenic artery

Left gastro-omental (gastroepiploic) artery


Arteries of Liver, Pancreas, Duodenum, and Spleen MPf Sasfjsf

Intermediate hepatic artery Proper hepatic artery Right hepatic artery Cystic artery

Right and left inferior phrenic arteries (shown here from common stem)

Hepatic portal vein

Celiac trunk

C o m m o n hepatic artery

Abdominal aorta

Left gastric artery

Gallbladder.


'mmMm

mm

Cystohepatic triangle (of Calot) • —

wm

/ i

Cystic duct

^wmWk IA ••> ^fcfflPfc"^- J r m

Common hepatic duct (Common) bile duct Right gastric artery


Supraduodenal artery

Artery to tail of pancreas

Gastroduodenal artery

Greater pancreatic artery hM ' SS® it: 1W i l w •iSi\ ® Sv IS Itim » j H . Xf. > p i l l kV

Splenic artery

Pi

Dorsal pancreatic artery Inferior pancreatic artery Anastomotic branch Middle colic artery (cut)

Posterior superior pancreaticoduodenal artery {phantom)

z

Superior mesenteric artery

Inferior pancreaticoduodenal artery

Anterior superior pancreaticoduodenal artery Right gastro-omental (gastroepiploic) artery


Posterior inferior pancreaticoduodenal artery Anterior inferior pancreaticoduodenal artery

Plate 301

Variations in Celiac Trunk mmmm.:^——

Common origin of celiac trunk and superior mesenteric artery

Splenic and hepatic arteries take origin from superior mesenteric

Replaced right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal and I st jejunal arteries from replaced right hepatic

Accessory right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal arteries from accessory right hepatic; 1 st jejunal artery from anterior inferior pancreaticoduodenal

Plate 302

Celiacomesenteric trunk

Hepatolienomesenteric trunk

^ I n c o m p l e t e Y^ celiac trunk « Hepatomesenteric

Splenic artery takes origin from superior mesenteric (note replaced left hepatic artery from left gastric)

Replaced hepatic artery takes origin from superior mesenteric (note inferior pancreaticoduodenal artery from 1st jejunal)

Accessory right hepatic artery takes origin from superior mesenteric

Hepatogastric trunk /tf^ Lienomesenteric trunk

Lienogastric trunk Hepatomesenteric tru nl<

Complete celiac trunk Hepatomesenteric trunk

Right gastroepiploic (gastro-omental) Complete celiac trunk artery takes origin from Hepatomesenteric superior \trunk mesenteric | | (Note accessory (note accessory I left gastric artery left hepatic H | from left hepatic) artery from left gastric)

Wisceral Vasculature

Celiac Arteriogram mmmmmmBwmiwwmm

See also Plates 300, 301

CH CT C GD H RG S


Common hepatic artery Celiac trunk Left gastric artery Gastrocluoclenal artery Proper hepatic artery Right gastric artery Splenic artery

Plate 303

Arteries of Duodenum and Head of Pancreas j

D u o d e n u m and head of pancreas reflected to left

(Common) bile duct Gastroduoclenal artery Posterior superior pancreaticoduodenal artery Anterior superior pancreaticoduodenal artery (phantom)

Superior mesenteric artery Inferior pancreaticoduodenal artery Posterior inferior pancreaticoduodenal artery

Anterior inferior pancreaticoduodenal artery (partially in phantom) Inferior vena cava Celiac trunk

Proper hepatic artery Common hepatic artery

Splenic artery

Supraduodenal artery Gastroduodenal artery (partially in phantom) Posterior superior pancreaticoduodenal artery (Common) bile duct Right gastro-omental (gastroepiploic) artery (phantom, cut) Anterior superior pancreaticoduodenal artery (phantom)

WBmi

Inferior pancreatic artery

Anastomotic branch

Dorsal pancreatic artery Superior mesenteric arterv Inferior pancreaticoduodenal artery

Plate 304

Posterior inferior pancreaticoduodenal artery

•vMV,

Anterior inferior pancreaticoduodenal artery (phantom) pflfll

Posterior view


Arterial Variations and Collateral Supply of Liver and Gallbladder

Umbilicus (turned up)

Internal thoracic arteries Falciform and round ligaments with arteries Short gastric arteries

Cystic artery

Intercostal arteries

m&B

ifp

iSx ai C a C • 1 HK l'kit 11

1 IMl I •


Inferior phrenic artery Gastroduodenal artery-

Left gastric artery

Common hepatic artery'

Celiac trunk

Posterior superior pancreaticoduodenal artery

Splenic artery Dorsal pancreatic artery

Anterior superior pancreaticoduodenal artery Right gastric artery


Right gastro-omental (gastroepiploic) artery

Inferior pancreatic artery

Inferior pancreaticoduodenal artery Omental (epiploic) arteries Omental (epiploic) arterial arc

Cystic Accessory or replaced arteries 1. Right or common hepatic 2. Left hepatic 3. Right hepatic 4. Cystic Anastomoses of corresponding arteries 5. Inferior phrenic/left gastric < > left hepatic 6. Right < > left hepatic

Effects of hepatic artery obstruction

Capsular

A. Zone of relative safety B. Zone of questionable effects C. Zone of inevitable infarction

Plate 305

Arteries of Small Intestine >

'•'*

""•"

"

''''.

.

;'_-_*

'.

••:

•

-• •

Common hepatic artery

Supraduodenal artery Gastroduodenal artery Posterior superior pancreaticoduodenal artery

Splenic artery and vein

Dorsal pancreatic artery

Right gastro-omental (gastroepiploic) artery

Inferior pancreatic artery Superior mesenteric artery and vein

Anterior superior pancreaticoduodenala r te r y Inferior pancreaticoduodenal arteries

Celiac trunk

(Common portion) Posterior-^^ Anterior-^

J**^

Middle colic artery (cut)

Anastomosis (inferior pancreaticoduodenal to 1 st jejunal artery)

Right colic artery Ileocolic artery

Superior mesenteric artery Anterior cecal artery Posterior cecal artery Appendicular artery

Jejunal and ileal (intestinal) arteries Anastomotic loops (arcades) Straight arteries (arteriae rectae)

Plate 306


Arteries of Large Intestine For arteries of rectum see also Plate 398

Middle colic artery i Transverse mesocolon Straight arteries (arteriae rectae) (Common portion)

Inferior pancreaticoduodenal arteries

Posterior Anterior

Superior mesenteric artery Marginal artery Jejunal and ileal (intestinal) arteries Marginal arteryInferior mesenteric artery Left colic artery Ascending branch Descending branch

artery. Right colic artery

Marginal artery

Ileocolic artery Colic branch Ileal branch

Sigmoid arteries Sigmoid mesocolon

Marginal artery

Anterior cecal artery Posterior cecal artery Appendicular artery—

Internal iliac artery

Median sacral artery (from abdominal aorta)

Straight arteries (arteriae rectae) Superior rectal arterv

Middle rectal artery Branch of superior rectal artery


Inferior rectal artery

Plate 307

4

Variations in Colic Arteries

Middle colic artery


Right colic artery

Middle colic artery

Right colic artery

Ileocolic artery Ileocolic artery

C o m m o n trunk for right colic and ileocolic arteries

C o m m o n trunk for right colic and middle colic arteries

Middle ic artery

Large branch from left colic artery

Middle colic artery absent

Right colic artery absent

Right colic artery Ileocolic artery

Ileocolic artery

Absence of middle colic artery replaced by large branch f r o m left colic artery

Absence of right colic artery

of Riolan Middle colic artery Right colic artery Ileocolic artery

Superior mesenteric artery Inferior mesenteric artery Left colic artery

Arc of Riolan between middle colic and left colic arteries

Plate 308


Veins of Stomach, Duodenum, Pancreas^ and Spleen HHMHHHMHHi

—M—

Hepatic veins

Hepatic portal vein

Inferior vena cava Left gastric vein and esophageal tributary M

Posterior superior pancreaticoduodenal vein

Short gastric veins

Right gastric vein Prepyloric vein Anterior superior pancreaticoduodenal vein Right gastro-omental (gastroepiploic) vein

Left gastroomental v. & (gastro. ; epiploic) -I vein

Posterior inferior pancreaticoduodenal vein

111

Anteriorinferior pancreaticoduodenal vein Left gastric vein vein

Splenic vein Short gastric veins

Hepatic portal vein Right gastric vein Posterior superior pancreaticoduodenal vein Superior mesenteric vein Right gastro-omental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein

Left gastro-omental (gastroepiploic) vein (Great) pancreatic vein Inferior mesenteric vein


Plate 309

4

Veins of Small Intestine

Hepatic portal vein Left gastric vein Splenic vein Right gastric vein

Superior mesenteric: vein

Middle colic vein (cut)

Jejunal and ileal (intestinal) veins Anastomotic loops

Right colic vein

Straight veins (venae rectae)

Ileocolic vein


Jejunal and ileal (intestinal) vessels

Relations of superior mesenteric vein and artery in root of mesentery

Plate 310


Veins of Large Intestine For veins of rectum see also Plate 399

Hepatic portal vein

Left gastric vein

Splenic vein

Prepyloric vein Superior mesenteric vein Right gastroomental (gastroepiploic) vein Anterior superior pancreaticoduodenal vein Tributary from colon (cut) Posterior inferior pancreaticoduodenal vein Anterior inferior pancreaticoduodenal vein Middle colic vein (cut) Right colic vein Ileocolic vein Anterior cecal vein Posterior cecal vein Appendicular vein

(Dorsal or superior) pancreatic vein Inferior mesenteric vein Jejunal and ileal (intestinal) veins Left colic vein Left testicular (ovarian) vessels Inferior mesenteric vein Sigmoid veins Median sacral vein Superior rectal vein

Right testicular (ovarian) vessels FxternaJ iliac vessels Internal iliac vein Superior gluteal vein Obturator vein

Tributaries of left and right superior rectal veins Perimuscular rectal venous plexus Left middle rectal vein Left internal pudendal vein in pudendal canal (Alcock's) External rectal venous plexus

Right middle rectal vein Right inferior rectal vein (to internal pudendal vein)


Plate 311

4

Hepatic Portal Vein Tributaries: Portacaval Anastomoses

Falciform ligament and round ligament of liver Paraumbilical veins

Esophageal veins Blood f r o m superior mesenteric vein Blood f r o m splenic, gastric, and inferior mesenteric veins M i x t u r e of above t w o

Right gastric vein

Caval tributaries mm

Hepatic portal vein

Left gastric vein Short gastric veins

Posterior, Anterior superior pancreaticoduodenal veins

Left gastroomental (gastroepiploic) vein

Superior mesenteric vein Posterior, ^ Anterior inferior pancreaticoduodenal veins

Splenic vein

V \ —

*

Right gastroomental (gastroepiploic) vein Inferior mesenteric vein

4 Middle colic vein

Left colic vein

Right colic vein

Sigmoid veins

Ileocolic vein Left and right superior rectal veins

Anterior, Posterior cecal veins Appendicular vein

Middle rectal veins Levator ani muscle Portacaval anastomoses 1

Esophageal

3

Rectal

2

Paraumbilical

4

Retroperitoneal

Plate 312

Inferior rectal veins


Variations of Hepatic Portal Vein

Typical arrangement

Esophageal vein Right gastric vein

Cystic vein Hepatic portal vein

_ L

Left gastric vein Splenic vein

- j — 1.09 cm

Short gastric veins

V

Posterior superior pancreaticoduodenal vein Superior mesenteric vein

V — Pancreatic veins Left gastro-omental (gastroepiploic) vein

Right gastro-omental (gastroepiploic) vein

Inferior mesenteric vein

Inferior pancreaticoduodenal veins Middle colic vein Right colic vein

Left colic vein Jejunal and ileal (intestinal) veins

Ileocolic vein

Inferior mesenteric vein may enter j u n c t i o n of splenic and superior mesenteric veins Hepatic portal vein Superior mesenteric vein

Hepatic portal vein

Splenic vein


Left gastric vein may enter splenic vein (24% of cases) ight gastric vein plenic vein Left gastric vein

Inferior mesenteric vein may enter superior mesenteric vein Hepatic portal vein Superior mesenteric vein

High intestinal veins Splenic vein


Left gastric vein often enters junction of splenicand superior mesenteric veins Hepatic portal vein Superior mesenteric vein


Plate 313

Lymph Vessels and Nodes of Stomach

Celiac nodes

Nodes around cardia Left gastric nodes

Hepatic

Right superior pancreatic node

Suprapyloric nodes Splenic nodes

Subpyloric nodes

Left gastroomental (gastroepiploic) node

Right gastro-omental (gastroepiploic) nodes

Left gastric nodes Nodes around cardia Left gastroomental (gastroepiploic) node

Zones and pathways of gastric lymph drainage (zones not sharply demarcated)

Splenic nodes

Right gastro-omental (gastroepiploic) nodes

Suprapyloric., retropyloric, and subpyloric nodes

Left superior pancreatic nodes Celiac nodes

Right superior pancreatic node

Plate 314

Superior mesenteric nodes


Lymph Vessels and Nodes of Pancreas

mmmma

Anterior view

wmM

B ! 1 •j/.'W-'*.

Splenic nodes Superior pancreatic nodes Celiac nodes Superior mesenteric nodes (central superior group)

Cystic node (of Calot) Hepaticportal vein Celiac nodes

Posterior view

Superior pancreatic nodes Splenic vein

Hepatic nodes around bile duels and proper hepatic artery

Inferior mesenteric vein Superior mesenteric artery and vein

Pancreaticoduodenal nodes

Superior mesenteric nodes (central superior group)


Plate 315

4

Lymph Vessels and Nodes of Small Intestine

Right lymphatic trunk

Thoracic cluct

Thoracic duel

Cisterna chyli

Intestinal lymphatic trunk

Right and left lumbar lymphatic trunks

Superior mesenteric nodes (juxtaintestinal group)

> CAf&M&fr/— /i.j>.

Plate 316


Lymph Vessels and Nodes of Large Intestine

Epicolic nodes Paracolic nodes

Middle colic nodes Superior mesenteric nodes (central superior group)

Inferior mesenteric nodes

Left colic nodes

Right colic nodes

Preaortic nodes

Sigmoid nodes

Ileocolic nodes

Paracolic nodes Prececal nodes

Superior rectal nodes

y-Kwv

Appendicular nodes Inferior mesenteric nodes Left colic nodes Preaortic nodes

C o m m o n iliac nodes Internal iliac nodes External iliac nodes

Superior rectal nodes Middle rectal nodes

Middle rectal nodes Superficial inguinal nodes Perineal lymph vessels (drain largely to inguinal nodes)


Plate 317

Autonomic Nerves and Ganglia of Abdomen See also Plates 165, 166

Right sympathetic trunk Thoracic duct

Anterior, Posterior vagal trunks

Right greater and lesser thoracic splanchnic nerves

Left gastric artery and plexus

Right phrenic nerve


Inferior phrenic arteries and plexuses Right greater and lesser thoracic splanchnic nerves Right suprarenal plexus Right aorticorenal ganglion

Celiac ganglia

Left lesser thoracic splanchnic nerve Splenic artery and plexus C o m m o n hepatic artery and plexus Superior mesenteric ganglion and plexus Left aorticorenal ganglion

Right least thoracic splanchnic nerve

Left sympathetic trunk

Right renal artery and plexus

Intermesenteric (aortic) plexus


Inferior mesenteric ganglion

White and gray rami communicantes

Left colic artery and plexus

Cisterna chyli

Inferior mesenteric artery and plexus

Gray ramus communicans 3rd lumbar ganglion of sympathetic trunk 2nd and 3rd lumbar splanchnic nerves Right ureter and plexu Right testicular (ovarian) artery and plexus 4th lumbar splanchnic nerve 1 st sacral ganglion of sympathetic trunk Gray rami communicantes

Plate 318

Left common iliac artery and plexus Superior rectal artery and plexus Superior hypogastric plexus Internal and external iliac arteries and plexuses Right and left hypogastric nerves to inferior hypogastric (pelvic) plexus

Nerves of Stomach and Duodenum See also Plates 165, 166

Right and left inferior phrenic arteries and plexuses Anterior and posterior layers of lesser omentum

Hepatic branch of anterior vagal trunk Anterior vagal trunk Celiac branch of posterior vagal trunk


Celiac branch of anterior vagal trunk Left gastric artery and plexus

Vagal branch from hepatic plexus to pyloric part of stomach Hepatic plexus Right gastric artery and plexus

Anterior gastric branch of anterior vagal trunk Left greater thoracic splanchnic nerve Left lesser thoracic splanchnic nerve Splenic artery and plexus Celiac ganglia and plexus Plexus on gastro-omental (gastroepiploic) arteries Superior mesenteric artery and plexus

Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries (posterior pancreaticoduodenal arteries and plexuses not visible in this view)

Innervation

Plate 319

4

Nerves of Stomach and Duodenum (continued) See also Plates 165, 166

Posterior gastric branch of posterior vagal trunk

Plexus on gastro-omental (gastroepiploic) arteries

Hepatic branch of anterior vagal trunk via lesser omentum

Hepatic plexus

Branch from hepatic plexus to cardia via lesser omentum

Right gastric artery and plexus

Right inferior phrenic artery and plexus Posterior vagal trunk Celiac branch of posterior vagal trunk Celiac branch of anterior vagal trunk Left gastric artery and plexus Left inferior phrenic artery and plexus Celiac ganglia and plexus Greater, lesser, and least thoracic splanchnic nerves Aorticorenal ganglia Splenic artery and plexus

Phrenic ganglion

Greater, Lesser, Least thoracic splanchnic nerves

Branch from right inferior phrenic plexus to cardia of stomach Right and left inferior phrenic arteries and plexuses Anterior vagal trunk Posterior vagal trunk

View with stomach reflected cephalad

Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries

Right greater, esser, and east thoracic splanchnic nerves

Plexus on gastroduodenal artery Plexus on posterior superior and posterior inferior pancreaticoduodenal arteries

Celiac ganglia

Superior mesenteric ganglion and plexus

Right aorticorenal ganglion

Superior mesenteric ganglion and plexus

Plate 320

Celiac branches of anterior and posterior vagal trunks Left gastric artery and plexus Left greater, lesser, and least thoracic splanchnic nerves Left aorticorenal ganglion

Innervation

Innervation of Stomach and Duodenum: Schema See also Plates 167, 168 Right 6th thoracic ganglion of sympathetic trunk

[rtnli

Esophageal plexus

Gray, White rami communicantes Spinal sensory (dorsal root) ganglion Anterior (ventral) root of spinal nerve Right greater thoracic splanchnic nerve Right lesser thoracic splanchnic nerve Celiac ganglia Least thoracic splanchnic nerve

Left greater thoracic splanchnic nerve Aortic plexus Left 9th thoracic ganglion of sympathetic trunk Posterior vagal trunk and celiac branch Anterior vagal trunk and celiac branch of vagus nerve (X) Left gastric artery Celiac trunk Splenic artery

Common hepatic artery


Proper hepatic artery Superior mesenteric ganglion Aorticorenal ganglia Right gastric artery

mSBm

Right renal artery Gastroduodenal artery Posterior and anterior superior pancreatico- • duodenal arteries Superior mesenteric artery Posterior and anterior inferior pancreaticoduodenal arteries

f

Left, Right gastroomental (gastroepiploic) arteries

Sympathetic fibers Preganglionic Postganglionic

—— - - -

Parasympathetic fibers Preganglionic Postganglionic Afferent fibers

Innervation

Plate 321

4

Nerves of Small Intestine See also Plates 165, 166

Anterior vagal trunk Posterior vagal trunk

Celiac branches of anterior and posterior vagal trunks

Hepatic plexus Greater thoracic splanchnic nerves Celiac ganglia and plexus Gastroduodenal artery and plexus Lesser thoracic splanchnic nerves Least thoracic splanchnic nerves Aorticorenal ganglia Superior mesenteric ganglion Intermesenteric (aortic) plexus Inferior pancreaticoduodenal arteries and plexuses Superior mesenteric artery and plexus Middle colic artery and plexus (cut) Right colic artery and plexus Ileocolic artery and plexus Superior mesenteric artery and plexus Peritoneum (cut edge) Mesenteric branches Mesoappendix (contains appendicular artery and nerve plexus)

Plate 322

Innervation

Nerves of Large Intestine For nerves of rectum see Plates 165, 166, 410-413

Anterior vagal trunk and hepatic branch\ Posterior vagal trunks

^ V

Marginal artery and plexus Esophagus



Celiac ganglia and plexus Left suprarenal plexus Left lesser and least thoracic splanchnic nerves

Right aorticorenal ganglion Superior mesenteric ganglion Middle colic artery and plexus

Left aorticorenal ganglion Left renal artery and plexus I st left lumbar splanchnic nerve Left lumbar sympathetic trunk Intermesenteric (aortic) plexus

Right colicartery and plexus Ileocolic artery and plexus Cecal and appendicular arteries and plexuses

Sacral sympathetic trunk Right sacral plexus Pelvic splanchnic nerves Middle rectal artery and plexus

Left colic artery and plexus

gv H4

Inferior mesenteric ganglion, artery, and plexus Sigmoid arteries and plexuses Superior hypogastric plexus Superior rectal artery and plexus Right and left hypogastric nerves

Right inferior hypogastric (pelvic) plexus Nerves from inferior hypogastric (pelvic) plexuses to sigmoid colon, descending colon, and left colic (splenic) flexure

Innervation

Plate 323

4

Thalamus

Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths Posterior (dorsal) nucleus of vagus nerve

Myclencephalon (medulla oblongata)

K


Thoracolumbar spinal cord

Sacral spinal cord Levator ani muscle External anal sphincter muscle "Abdominopelvic splanchnic nerves

Pudendal nerve

Chief segmental sources of sympathetic libers innervating different regions of intestinal tract are indicated. Numerous afferent libers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.

"

Thalamus

A b d o m i n a l aorta

Posterior (dorsal) nucleus of vagus nerve

Celiac ganglia Myelencephalon (medulla oblongata)

Ccliac trunk

^


Thoracolumbar spinal cord

Sacral spinal cord

Pudendal nerve * A b d o m i n o p e l v i c splanchnic nerves

Plate 324

Innervation

Innervation of Small and Large Intestines: Schema

Sympathetic efferents Parasympathetic efferents Somatic efferents Afferents and CNS connections Indefinite paths

V

T 1 0 - 12

Superior rectal artery and Rectal plexus

Inferior anal (rectal) nerve

Innervation

Levator ani muscle External anal sphincter muscle

Chief segmental sources of sympathetic fibers innervating different regions of intestinal tract are indicated. Numerous afferent fibers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.

Plate 324

4

Autonomic Reflex Pathways: Schema


Sympathetic trunk-

Dorsal (posterior) root

Thoracic part of spinal cord Intermediolateral cell column

Ganglion of sympathetic trunk

Spinal nerve to vessels and glands of skin

Ventral (anterior) root Meningeal branch to spinal meninges and spinal perivascular plexuses (usually arises from spinal nerve) n.

White ramus communicans Gray ramus communicans

/Abdominopelvic ^ f (greater, lesser, / and least) thoracic \| / splanchnic nerves

Ganglion of sympathetic trunk

Stretch (distention)

IJ til wftrj Vagus nerve (X)

VA : Celiac ganglion Ganglion of sympathetic trunk

\

•: v •.••• :

Enteric plexuses of gut —

I ;

V !

Superior mesenteric ganglion

Sympathetic

(

Preganglionic

^

f

Postganglionic

e r s

Plate 325

Parasympathetic J Preganglionic — fibers ) „ . . ( Postganglionic —

Afferent fibers

Innervation

Intrinsic Autonomic Plexuses of Intestine: Schema

Peritoneal layers of mesentery

Branch of straight artery (arteriae rectae) to intestine and accompanying nerves

Subserous plexus

Longitudinal intramuscular plexus

Myenteric (Auerbach's) plexus

Circular intramuscular plexus

Submucous (Meissner's) plexus

Periglandular plexus

Visceral peritoneum (serosa) Subserous connective tissue Longitudinal muscle Intermuscular stroma -Circular muscle Submucosa Submucosal glands

\0 y

Muscularis mucosae Mucosa and intestinal glands Lumen

Note: Intestinal wall is shown much thicker than in actuality.

Innervation

Plate 326

4

Innervation of Liver and Biliary Tract: Schema See also Plates 167, 168

Sympathetic trunk Common areas of referred pain in biliary disease

Dorsal root (spinal) ganglion Thoracic pari of spinal cord Right greater thoracic splanchnic nerve-


Posterior vagal trunkRight phrenic nerve to diaphragmatic part of parietal (and visceral?) peritoneum

Anterior vagal trunk

Hepatic branch of anterior vagal trunk Diaphragm Phrenic ganglion Celiac ganglia Common hepatic artery Splenic artery Anterior hepatic plexus Posterior hepatic plexus

Aorta Gastroduodenal artery and plexus Sympathetic fibers Preganglionic Postganglionic

Sphincter of hepatopancreatic ampulla

Parasympathetic fibers Preganglionic ——• Postganglionic Afferent fibers

Plate 327

Ramification of nerve fibers around fine branch of hepatic artery

Innervation

I n n e r v a t i o n

o f

P a i W N f l s s

S c h e m a


Dorsal root (spinal) ganglion


Left sympathetic trunk Thoracic part of spinal cord

Right greater thoracic splanchnic nerve —

Left greater thoracic splanchnic nerve Anterior vagal trunk

Posterior vagal trunk Common areas of pancreatic pain

Celiac ganglia

Splenic artery Celiac trunk-

XV®

S u perio r mesenteric ganglion Superior mesenteric artery and plexus

Sympathetic fibers Preganglionic Postganglionic

Schema of intrinsic nerve supply

Parasympathetic fibers Preganglionic • Postganglionic - 0 """" Afferent fibers

Innervation

Plate 328

4

Kidneys in Situ: Anterior Views

Diaphragm Right suprarenal gland

Esophagus Left suprarenal gland iac trunk

Right kidney

Left kidney

Right renal artery and vein

Left renal artery and vein

Right subcostal nerve

Superior mesenteric artery (cut)


Subcostal nerve

Quadratus lumborum muscle Iliac crest Psoas major muscle lliacus muscle Right ureter Right common iliac Right external iliac arte Right internal iliac artery Urinary bladder

Esophagus Inferior vena cava Area for bare area of liver Right suprarenal gland Peritoneum (cut) Area for liver Duodenum Peritoneum (cut) Area for colon Area for small intestine

Plate 329

Abdominal aorta Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous nerve Genitofemoral nerve Left testicular (ovarian) artery and vein Inferior mesenteric artery (cut) neum (cut) grnoid mesocolon (cut) Rectum

Gastrophrenic ligament Left suprarenal gland Splenorenal ligament Area for stomach Area for spleen Tail of pancreas Transverse mesocolon Area for small intestine Area for descending colon

Anterior relations of kidneys

Kidneys and Suprarenal Olands

Kidneys in Situ: Posterior Views

Pleura (costodiaphragmatic recess)

Latissimus clorsi muscle

Lumbocostal ligament

Serratus posterior inferior muscle

Quadratus lumborum muscle (cut)


Diaphragm

Aponeurosis of transversus abdominis muscle

Subcostal nerve


Ascending colon

Right kidney


Thoracolumbar fascia (posterior layer)

Iliohypogastric nerve Iliac crest

Ilioinguinal nerve Quadratus lumborum muscle (cut)

Gluteal aponeurosis (over gluteus medius muscle)

Psoas major muscle Iliolumbar ligament


Aorta Projection of 11th rib

Inferior vena cava

Posterior relations of kidneys

Area for diaphragm

Area for diaphragm

Projection of 12th ri

Projection of 12th rib

Area for aponeurosis of transversus abdominis muscle

Area for aponeurosis of transversus abdominis muscle

Area for quadratus lumborum muscle

for quadratus lumborum muscle

Area for psoas major muscle

Area for psoas major muscle

ICidneys and Suprarenal Glands

Plate 330

885 Wr •

Schematic Cross Section of Abdomen at T12 See also Plates 293, 297, 338, 339 Liver Falciform ligament Superior epigastric vessels

Linea alba Rectus abdominis muscle Lesser omentum

Transversalis fascia Parietal peritoneum Visceral peritoneum of liver

Left gastric artery and vein

Proper hepatic artery (bifurcation) Common hepatic duct. Gallbladder Cystic duct Hepatic portal vein Costodiaphragmatic recess of pleural cavity

7th coslal cartilage External oblique muscle Diaphragm Stomach Gastrosplenic ligament and short gastric vessels Spleen

i

•

>

Pleura ^

,7

mm

Intercostal vessels nerve Omental (epiploic) foramen (of Winslow) Common hepatic artery (retroperitoneal)

Intercostal muscles Splenorenal ligament with splenic vessels

Hepatorenal recess (Morison's pouch) Inferior vena cava Omental bursa (lesser sac) Right sympathetic trunk Right crus of diaphragm Azygos vein Thoracic duct Anterior longitudinal ligament Celiac ganglia Abdominal aorta Body of T'l 2 vertebra

Plate 331

Parietal peritoneum on posterior wall of omental bursa Left kidney Left suprarenal gland Latissimus dorsi muscle lliocostalis -Longissimus ? Erector spinae \ muscle Spinalis


Renal Artery and Vein in Situ

Inferior vena cava

Esophagus Left inferior phrenic vein

Right and left inferior phrenic arteries

Left superior suprarenal arteries

Celiac trunk

Left middle suprarenal artery

Right superior suprarenal arteries

Left suprarenal vein

Right middle suprarenal artery

Left inferior suprarenal artery

Right suprarenal vein Right inferior suprarenal artery

Sir

um

mm®

mm

Ureteric branch of left renal artery Left renal artery and vein Ureteric branch of right renal artery

Left testicular (ovarian) artery and vein

Right renal artery and vein Left 2nd lumbar vein and communication to ascending lumbar vein

Right testicular (ovarian) artery and vein Inferior vena cava Abdominal aorta


Inferior mesenteric artery Superior mesenteric artery (cut)

Plate 332

A

Variations in Renal Artery and Vein

Proximal subdivision of renal artery

A Low accessory right renal artery may pass anterior to inferior vena cava instead of posterior to it B Inferior phrenic artery with superior suprarenal arteries may arise from renal artery (middle suprarenal artery absent) Double left renal vein may form ring around abdominal aorta

Multiple renal veins Persistent left inferior vena cava may join left renal vein

Plate 333


Gross Structure of Kidney m

Superior pole

—

Anterior surface of right kidney

Fibrous capsule [cut and peeled back) Medial border Lateral border Hilum Renal artery Renal vein Renal pelvis Stellate veins visible through capsule

Medial border Ureter

Inferior pole

Suprarenal gland and lobulated kidney of infant

Fibrous capsule Cortex

Minor calices

Medulla (pyramids)

Blood vessels entering renal parenchyma

Renal papilla

Renal sinus

Major calices Renal column (of Bertin)

Renal pelvis Fat in renal sinus Minor calices

Base of pyramid Ureter

Right kidney sectioned in several planes, exposing parenchyma and renal pelvis


Plate 334

Superior (apical) segmental artery

Frontal section of left kidney: anterior view

Anterior superior segmental artery Capsular and perirenal branches

Interlobar arteries

Inferior suprarenal artery Anterior branch of renal artery

Arcuate arteries

Renal artery Posterior branch of renal artery (posterior segmental artery)

Cortical radiate (interlobular) arteries

Pelvic and ureteric branches Anterior inferior segmental artery

(Capsular) perforating radiate artery

Posterior segmental arteries Inferior segmental artery

Vascular renal segments Superior

Anterior superior Posterior Anterior inferior

Inferior—-wj

Anterior surface of left kidney

Plate 335

Posterior surface of left kidney


Nephron and Collecting Tubule: Schema

Fibrous capsule Proximal convoluted tubule 7

Subcapsular zone

Cortical"" corpuscle Juxtamedullary renal corpuscle

Renal cortex

Proximal convoluted tubu

y

Distal convoluted

convoluted tubule

Henle's loop Descending limb Ascending limb

Collecting tubule CD

•Z

o

CL>

CL

CD

£= o N

_^ """

CD -i—• =5

O

CD CD C L

Descending limb Renal ii. medulla ^ (pyramid)

Renal (malpighian) corpuscle; glomerular (Bowman's) capsule with glomerulus

Ascending

Afferent and efferent glomerular arterioles

<

I ^

Proximal segment Neck Proximal convolution Thick segment of x descending limb

Thin segment

Henle's loop

Distal segment Thick segment of y ascending limb Distal convolution — Macula densa

Openings of papillary ducts

Collecting tubules

Cribriform area of renal papilla


Plate 336

4

Blood Vessels in Parenchyma of Kidney: Schema

Afferent glomerular arteriole Efferent glomerular arteriole Juxtameclullary glomerulus (efferent glomerular arteriole descends into renal pyramid) Fibrous capsule

Cortical glomerulus Efferent glomerular arteriole (joins cortical capillary plexus) 1

Corticomedullary glomerulus Cortical capillary plexus

Efferent glomerular arteriole (joins cortical capillary plexus and also descends into renal pyramid)

Stellate veins Capsular and perforating veins Cortical I I Cl l Vradiate (interlobular) arteries ^ I and veins >

jJS

' X

s

- J •

P

Subcapsular —r rv i^v ^ zone

yX

S h

Arcuate arterv and vein w

j-4—Vasa rectae ) / " spuria (from juxtamedullary '•'•/r- J W efferent AJ glomerular { 4 / - J r$ a r t e r ' ° ' e s )

JMft

—

^

A

\ p

•Vasa rectae j vera (from - ^ darcuate 1 ^ U d I C dand 11U ^ J:. j | " cortical radiate % arteries)

—^r-Venulae T \ • rectae

rTT

, V t K i

s

t , Medullary p capillary plexus -Interlobar artery and vein

i

^

f

H

y • v; \x V

R e n a i

' V / column (of Bertin) Henle's loop ^ of nephron •Collecting tubule -Interlobar artery and vein in perirenal fat of renal sinus

Plate 337


Transverse Section: Level of T12-L1 Intervertebral Disc

T12-L1

Superior mesenteric vein (becoming portal vein)

Pancreas (head)

Celiac trunk

Splenic vein

Transverse colon

Transverse colon

Jejunum

Ascending colon (right colic flexure)

External oblique muscle (Common) bile duct Descending colon Descending (2nd) part of duodenum


Interior vena cava

Spleen


Renal cortex

Liver

Left kidney

Superior pole of right kidney

Renal medulla


T12-L1 intervertebral disc


Abdominal aorta

CAfcx/tat/h-

f

u u

o

Transverse Section: Level of L I - 2 Intervertebral Disc

\

r LI-2

Plate 3 3 9

i f

Superior mesenteric vein

{

1 Greater omentum


Pancreas with uncinate process

Transverse colon Ileum

Transverse colon

Jejunum

Junction of 2nd and 3rd parts of duodenum

Perirenal fat

Ascending colon

Ureteropelvic junction

Liver Descending colon

Right renal vein (entering inferior vena cava) a

3

Renal fascia

Right kidney

Left kidney

(A &>

3 a

Major calyx and renal pelvis Pararenal fat

Interior vena cava

CO

c

"O

a

s 3

tt

sr3 ^

0)

Left renal arterv

Right crus of diaphragm Psoas major muscle

Left renal vein (enterin inferior vena cava)

LI —2 intervertebral disc Conus medullars and cauda equina

Abdominal aorta


/

//.pm

Ureters •SSs&iSS^t^^^^'^SsSl^^K


Ureters in male: anterior view Left kidney

Right kidney

Left ureter

Duodenum

Inferior

Superior

mesenteric artery

mesenteric artery

Left colic artery

Right colic artery

Sigmoid arteries Superior rectal artery (cut)

Right ureter Ileocolic artery

Genitofemoral nerve

Testicular vessels Common iliac artery Internal iliac artery External iliac artery-

Inferior vesical arterv

Middle rectal artery

Ductus deferens

Diagonal course of ureter through bladder wall

Urinary bladder Urinary bladder

Bladder mucosa

Medial umbilical ligament (occluded part of umbilical artery)

Ureter

Round ligament of uterus Superior vesical artery

Ovary Broad ligament

Uterine artery Umbilical artery Obturator artery and nerve Ureter

Uterosacral (sacrogenital) fold

Vaginal artery and inferior vesical branch

Ureter

External iliac artery

(retroperitoneal) Intersigmoid recess Sigmoid mesocolon

Ureters in female superior view


Ovarian vessels Internal iliac artery C o m m o n iliac arterv Root of mesentery

Plate 340

Arteries of Ureters and Urinary Bladder

Abdominal aorta Superior mesenteric arterv

Renal artery and vein Ureteric branch from renal artery Ovarian artery Ureter

Inferior mesenteric artery (cut) Ureteric branch from aorta Ureteric branches from ovarian and common iliac arteries Common iliac artery Median sacral artery Internal iliac artery Iliolumbar artery Superior gluteal artery Lateral sacral artery Inferior gluteal and internal pudendal arteries Umbilical artery (patent part) Uterine artery

Inferior vesical artery and ureteric branch Superior vesical arteries Inferior epigastric artery Ureteric branch from superior vesical artery Medial umbilical ligament

Plate 341


Renal Fascia

Duodenum Right kidneyRight colic (hepatic) flexure Liver

Left renal vein and artery

Duodenojejunal flexure Superior mesenteric vein and artery Abdomina, • c Inferior vena cava

I I

Left kidney Peritoneum

aorta i /

Descending colon

< /

Transversalis fascia Pararenal fat (retroperitoneal) Quadratus lumborum muscle

Transverse section through 2nd lumbar vertebra demonstrates horizontal disposition of fascia

Crura of diaphragm Psoas major muscle and fascia

Perirenal fat Fibrous capsule of kidney Anterior and posterior layers of renal (Gerota's) fascia

Diaphragm Diaphragmatic fascia (continuation of transversalis fascia)

Lung Liver

Costodiaphragmatic Bare area of liver Suprarenal gland Perirenal fat 12th rib Pararenal fat (retroperitoneal) Transversalis

Fibrous capsule of kidney Peritoneum Anterior and posterior layers of renal (Gerota's) fascia Right kidney Right colic (hepatic) flexure

Quadratus lumborum muscle Iliac crest

Sagittal section through right kidney and lumbar region demonstrates vertical disposition of renal fascia


Plate 342

4

4

Lymph Vessels and Nodes of Kidneys and Urinary Bladder See also Plates 406, 408

Subcapsular lymphatic plexus

Cortical lymph vessels along cortical radiate (interlobular) arteries Lymph vessels along arcuate arteries Lymph vessels along interlobar arteries

Note: Arrows indicate direction of flow.

Lumbar lymph trunks to cisterna chyli and thoracic duct

Lateral aortic (lumbar), precaval, and postcaval nodes Common iliac nodes

Promontorial (middle sacral) node

Internal iliac nodes

External iliac nodes

Lymph vessels from dorsal part and trigone of bladder

Lymph vessels from superior and anterior parts of bladder

Lateral vesical and prevesical nodes

Plate 343


Nerves of Kidneys, Ureters, and Urinary Bladder j ^ See also Plates 165, 166

Anterior vagal trunk Posterior vagal trunk Greater thoracic splanchnic nerve Celiac ganglia and plexus Lesser thoracic splanchnic nerve Superior mesenteric ganglion Least thoracic splanchnic nerve Aorticorenal ganglion Renal plexus and ganglion 2nd lumbar splanchnic nerve Renal and upper ureteric branches from intermesenteric plexus Intermesenteric (aortic) plexus

Inferior mesenteric ganglion Sympathetic trunk and ganglion Middle ureteric branch Superior hypogastric plexus Sacral splanchnic nerves (branches from upper sacral sympathetic ganglia to hypogastric plexus) Gray ramus communicans Hypogastric nerves Sacral plexus

Pelvic splanchnic nerves Inferior hypogastric (pelvic) plexus with periureteric loops and branches to lower ureter Rectal plexus Vesical plexus Prostatic plexus

V P ®


$

Plate 344

4

Innervation of Kidneys and Upper Ureters; Schema See also P l a t e s 1 6 7 , 168, 4 1 7

ucleus of solitary tract

Posterior (dorsal) nucleus of vagus nerve

Spinal sensory (dorsal root) gangl

Medulla oblongata Gray ramus communicans Vagus nerve (X)

Descending fibers

Ventral ramus o f T 1 0 (intercostal nerve)

Ascending fibers W h i t e ramus communicans

Spinal cord segments T10-L1

Ganglia of sympathetic trunk

Lesser thoracic splanchnic nerve

1 st lumbar splanchnic nerve

Least thoracic splanchnic nerve

Celiac ganglia and plexus

Superior mesenteric ganglion »

Aorticorenal ganglion

Intermesenteric plexus

Superior hypogastric plexus

Hypogastric nerve

Sympathetic fibers Preganglionic

—

Postganglionic

— —

-

• A CSV

Sacral plexus

Parasympathetic fibers Preganglionic Postganglionic Afferent fibers

Plate 345

1

——

- - - - - - - - -

Pelvic splanchnic > nerves

Inferior hypogastric (pelvic) plexus


Nerves of Suprarenal Glands: Dissection and Schema See also Plates 165-168

Left phrenic nerve

Right phrenic nerve

Posterior vagal trunk

Anterior vagal trunk

Left inferior phrenic artery and plexus

Right inferior phrenic artery and plexus





Celiac plexus and ganglia

Right lesser thoracic splanchnic nerve

Left lesser thoracic splanchnic nerve

Right least t h o r a c i c f splanchnic nerve

Aorticorenal ganglia

Right renal ganglion and plexus

Left least thoracic splanchnic nerve

ymz

rwmmm

Left renal ganglion and plexus

bSVAV;

i as



Left 1 st lumbar splanchnic nerve

Right 1st lumbar splanchnic nerve

Superior mesenteric ganglion .--T" j r - . ^ ^ M ^ J m ^ X

olumn / Intermediolateral cell ccolun (lateral horn of gray matter)

-i Cortex

Medulla Thoracic splanchnic nerves (preganglionic fibers)

Spinal cord

Celiac ganglion

Postganglionic fibers supply b l o o d vessels

Sympathetic trunk

Preganglionic j fibers ramify \ around cells of medulla Suprarenal gland


Plate 346

Arteries and Weins of Suprarenal Elands in Situ

Liver {retracted

Superior suprarenal arteries (from inferior phrenic artery)

superiorly)

I n f e r i o r vena cava (retracted

medially)

Suprarenal vein Branches of middle suprarenal arteries (from abdominal aorta) P e r i t o n e u m (cut

edge)

Pancreas and spleen (retracted

superiorly)

Left inferior phrenic artery Superior suprarenal arteries Suprarenal gland Renal (Gerota's) fascia Left kidney

Splenic veii"K Aorta

Renal (Gerota's) fascia Right kidney (pulled

Duodenum

down)

(pulled down)

Suprarenal gland Inferior suprarenal artery (from renal artery)

A b d o m i n a l exposure of right suprarenal gland

Cross section through suprarenal

Capsule Cortex Medulla

Duodenojejunal flexure Left colic (splenic) flexure (pulled medially)' Middle suprarenal artery Suprarenal vein Inferior suprarenal artery

Left renal artery and vein

Peritoneum (cut

edges)

A b d o m i n a l exposure of left suprarenal gland

Plate 347


Abdominal Wall and Viscera: Paramedian (Sagittal) Section iwjBiMiiWBM w mm. wii— immmmmmmmmmmmmmmmmmimKmmm

^sawsSsS

Coronary ligament enclosing bare area of liver

Diaphragm (central tendon)

Esophagus Parietal p e r i t o n e u m

Superior recess of omental bursa (lesser sac)

Liver Lesser o m e n t u m Hepatic portal vein and proper hepatic artery in right margin of lesser o m e n t u m —

O m e n t a l (epiploic) f o r a m e n (of W i n s l o w )

O m e n t a l bursa (lesser sac)

Celiac trunk

Stomach

Splenic vessels

M i d d l e colic artery

Renal vessels

Transverse m e s o c o l o n

Pancreas

Parietal p e r i t o n e u m (of anterior abdominal wall)

Superior mesenteric artery Inferior (horizontal, or 3rd) part of d u o d e n u m

Transverse c o l o n Greater o m e n t u m Small intestine

A b d o m i n a l aorta


Parietal p e r i t o n e u m (of posterior abdominal wall) Mesentery of small intestine


M e d i a n umbilical ligament (urachus) Fatty layer of subcutaneous tissue (Camper's fascia)

Rectovesical p o u c h Rectum

M e m b r a n o u s layer of subcutaneous tissue (Scarpa's fascia)

Rectoprostatic (Denonvilliers') fascia

Urinary bladder

Levator ani muscle Prostate

Pubic b o n e

\ ?eeP • , ( Superficial \ Subcutaneous )

Retropubic (prevesical) space (cave of Retzius)

External anal Sphincter ^ ^

D e e p and superficial transverse perineal muscles

D e e p (Buck's) fascia of penis

Bulbospongiosus muscle

Perineal m e m b r a n e and bulbourethral (Cowper's) gland Tunica vaginalis testis

Abdominal Sections

Testis

Puborectalis muscle (thickened medial edge of left levator ani muscle)

CAftfâvL /.—a.p.

Plate 348

S c h e m a t i c D r o s s S e c t i o n of A b d o m e n at L3, 4

Round ligament (ligamentum teres) of liver Transverse colon Branches of inferior epigastric vessels Rectus sheath Transversus abdominis aponeurosis External oblique aponeurosis Internal oblique aponeurosis

Linea alba Rectus abdominis muscle Omental appendices Greater omentum Parietal peritoneum Transversalis fascia Transversus abdominis muscle

Mesentery of small intestine


Superior mesenteric vessels Small intestine (ileum)


Lymph node Ascending colon

Small intestine (jejunum)

Right paracolic gutter

Descending colon Left paracolic gutter

Left ureter

Tendon of origin of transversus abdominis muscle


Iliohypogastric nerve


Ilioinguinal nerve Layers of ( thoracolumbar ' fascia (

Testicular (ovarian) vessels

Combined Middle Posterior

Psoas minor muscle Parietal peritoneum Psoas major muscle

Right genitofemoral nerve

Inferior vena cava


Anterior longitudinal ligament Ligamentum flavum


Abdominal aorta Spinous process of L3 vertebra

Intervertebral disc between L3 and L4 vertebrae Intermesenterir. (aortic) plexus

Plate 349

Abdominal Sections

Abdominal Scans: Axial CT Images

Series of abdominal axial CT images from superior (A) to inferior (D)

B

C

D

A

Aorta

M

Deep back muscles

AC

Ascending colon

P

Psoas muscle

B

Body of vertebra

R

Rib

DC

Descending colon

RA


IL

Ileum

Rl

Right c o m m o n iliac artery

IV

Inferior vena cava

RK

Right kidney

LA

Linea alba

RL

Right lobe of liver

LI

Left c o m m o n iliac artery

S

Spleen

LK

Left kidney

ST

Stomach

LL

Left lobe of liver

TC

Transverse colon

Abdominal Sections

Plate 350

Pelwis and Perineum Topographic A n a t o m y Plate 351 Z 'i "'. ".' .

. . . ,

:

-

351 Pelvis and Perineum

Bones and Ligaments Plates 352-355

352 Bones and Ligaments of Pelvis 353

Bones and Ligaments of Pelvis (continued)

354 Sex Differences of Pelvis: Measurements 355 Radiographs of the Male and Female Pelvis

Pelvic Floor a n d C o n t e n t s Plates 356-364

356 Pelvic Diaphragm: Female 357

Pelvic Diaphragm: Female (continued)

358 Pelvic Diaphragm: Male 3 5 9 Pelvic Diaphragm: Male (continued) 3 6 0 Pelvic Viscera and Perineum: Female 361 Pelvic Viscera and Perineum: Male 3 6 2 Pelvic Contents: Female 3 6 3 Pelvic Contents: Male 364 Endopelvic Fascia and Potential Spaces

Urinary Bladder Plates 365-368

SjMjgjraBHBMMBMMMB

365 Urinary Bladder: Orientation and Supports 366 Urinary Bladder: Female and Male 36? Sphincters 3 6 8 Male and Female Cystourethrograms


Pelvis a n d P e r i n e u m Uterus, Vagina, and Supporting Structures Plates 369-375

Plates 391-396

391 Rectum in Situ: Female and Male

369 Pelvic Viscera: Female

392 Ischioanal Fossae

370 Uterus, Vagina, and Supporting Structures 371

Rectum

393

Uterus and Adnexa

Rectum and Anal Canal

3 9 4 Anorectal Musculature

372 Pelvic Ligaments

3 9 5 External Anal Sphincter Muscle: Perineal Views

3 7 3 Uterus: Age Changes and Muscle Pattern

396 Actual and Potential Perineopelvic Spaces

374 Uterus: Position and Prolapse 375

Regional Scans

Ectopic Pregnancy

Plate 397

Regional Transverse Section

397

Plate 376

Vasculature

376 Male Pelvis: Bladder-Prostate Junction

Plates 398-408 m^mmm^^mmmmm^mmmi^^msmmm^^^^^m^^mmmmmism^m


398 Arteries of Rectum and Anal Canal (Male) 3 9 9 Veins of Rectum and Anal Canal (Female)

Plates 377-379

377

Pelvic Scans: Sagittal MR Images

Female Perineum and External Genitalia (Pudendum or Vulva)

400

Arteries and Veins of Pelvic Organs: Female

401 Arteries and Veins of Testis

378 Female Perineum (Superficial Dissection)

402 Arteries and Veins of Pelvis: Female

3 7 9 Female Perineum and Deep Perineum

4 0 3 Arteries and Veins of Pelvis: Male

Perineum and External Genitalias Male Plates 380-387

""•* •W -. ^; v...:/:' . \ ::: .; ; •• v:-: • .•'"/.• " " WBWWW'BB W W lB liW I WWW W li-:•BW

' '".*• •

•-"•'..'•• • •

404

Arteries and Veins of Perineum and Uterus

405 Arteries and Veins of Perineum: Male i. " :

,".

4 0 6 Lymph Vessels and Nodes of Pelvis and Genitalia: Female

380 Perineum and External Genitalia (Superficial Dissection)

407 Lymph Vessels and Nodes of Perineum: Female

381 Perineum and External Genitalia (Deeper Dissection)

408 Lymph Vessels and Nodes of Pelvis and Genitalia: Male

382 Penis

Innervation

383 Perineal Spaces 384 Prostate and Seminal Vesicles 385 Urethra 386 Descent of Testis 387 Scrotum and Contents

Homologues of Genitalia Plates 388-389

Plates 409-417 frWHiiMiiiWii^88MBBMii

i

ii UMii in

ii « • »

mmaxmiiiimsmMumtMiB

409 Nerves of External Genitalia: Male 410 Nerves of Pelvic Viscera: Male 411 Nerves of Perineum: Male 412 Nerves of Pelvic Viscera: Female 413 Nerves of Perineum and External Genitalia: Female 414 Neuropathways in Parturition

388 Homologues of External Genitalia

415 Innervation of Female Reproductive Organs: Schema

389 Homologues of Internal Genitalia

416 Innervation of Male Reproductive Organs: Schema

Testis, Epididymis, and Ductus Deferens Plate 390 mmmmmm^m^êmrnmmmmm^mmMmmmmmmi^mm^^^^m^mmm^m^m

390 Testis, Epididymis, and Ductus Deferens


417 Innervation of Urinary Bladder and Lower Ureter: Schema

5 Sternocleidomastoid muscle

Trapezius muscle Deltoid muscle Pectoralis major muscle

Nipple


Semilunar line

Tendinous intersection External oblique muscle Rectus abdominis muscle

Linea alba


Umbilicus Iliac crest

Superficial circumflex iliac vein Superficial epigastric veins

Inguinal ligament

Pubic symphysis

Pubic tubercle

Superficial dorsal vein of penis Glans of penis

Body (shaft) of penis

External urethral orifice (meatus)

Scrotum *

Topographic Anatomy

—

Plate 351

B o n e s a n d L i g a m e n t s of Pelvis MM

See also Plate 486 M e d i a n (sagittal) section

Body of L5 vertebra Iliac ) Intermediate zone crest | Inner lip

False pelvis Lumbosacral (L5-S1) intervertebral disc

Iliac fossa (wing of ilium)

Sacral p r o m o n t o r y


Greater sciatic foramen

^

sw®

mm

Arcuate line

True pelvis Ischial spine


Sacrospinous ligament

Iliopubic eminence

1

Lesser sciatic foramen

O b t u r a t o r canal

Sacrotuberous ligament


Coccyx


Ischial tuberosity

Pubic tubercle

,.<

Symphyseal surface Obturator membrane

Lateral view

Body of L4 vertebra

Supraspinous ligament Posterior, anterior, and inferior gluteal lines

Posterior superior iliac spine Median sacral crest Posterior inferior iliac spine Posterior sacroiliac ligament Greater sciatic foramen Sacrospinous ligament Posterior and lateral sacrococcygeal ligaments Sacrotuberous ligamen Ischial spine Lesser sciatic foramen

Intermediate zone / O u t e r lip > Iliac crest Iliac tubercle \ W i n g (ala) of ilium (gluteal surface) Body of ilium Anterior superior iliac spine Anterior inferior iliac spine Acetabulum Acetabular labrum Acetabular margin Lunate (articular) surface bular notch nsverse acetabular ligament Superior pubic ramus Pubic tubercle Obturator crest

Ischial tuberosity Obturator membrane

Plate 352

Obturator canal Inferior pubic ramus

Bones and Ligaments

B o n e s a n d L i g a m e n t s of Pelvis ( c o n t i n u e d ) See also Plate 157

Iliolumbar ligament

Hrh,s.bB... W

SmKhSSOT

Iliac crest Supraspinous ligament Posterior superior iliac spine Posterior sacroiliac ligaments Iliac tubercle Posterior sacral foramina Greater sciatic foramen Anterior superior iliac spine Sacrospinous ligament Sacrotuberous ligament Lesser sciatic foramen Acetabular margin Ischial tuberosity Anterior longitudinal ligament

Tendon of long head of biceps femoris muscle Iliolumbar ligament

Posterior sacrococcygeal Superficial J ligaments

(03

O u t e r lip Intermediate zone Iliac tubercle Inner lip

Iliac crest

Lateral sacrococcygeal ligament Posterior view

Anterior sacroiliac ligament

• Vj-\r&

Sacral p r o m o n t o r y

:.

Greater sciatic foramen

\i

Anterior superior iliac spine Sacrotuberous ligament

•

..

Sacrospinous ligament Anterior inferior iliac spine Ischial spine /

7 Anterior sacral foramina

Arcuate line Lesser sciatic foramen

lliopectineal line

(

Iliopubic eminence

Coccyx

Anterior sacrococcygeal ligaments j\

Superior pubic ramus Pecten pubis (pectineal line) Obturator foramen Inferior pubic ramus A n t e r i o r view

Bones and Ligaments

Pubic

t u b e r d e

Pubic symphysis

Plate 353

S e x D i f f e r e n c e s of Pelvis: M e a s u r e m e n t s See also Plate 248 Female pelvis/female pelvic inlet: anterior view

Sacroiliac joint Sacral p r o m o n t o r y Diagonal conjugate (~12cm) Diameters of the pelvis

Transverse (—13 cm) O b l i q u e (~12.5 cm) Ischial spine Iliopubic eminence Pubic symphysis

M a l e p e l v i s / m a l e pelvic inlet: anterior view

All measurements slightly shorter in relation to body size than in female Pelvic inlet oriented more anterop o s t e r i o r ^ than in female, where it tends to be transversely oval Pubic symphysis deeper (taller) Pubic arch (subpubic angle) narrower Ischial tuberosities less far apart Iliac wings less flared

Transverse diameter of pelvic outlet (—11 cm)

Pubic symphysis

Sacral

promontory

jp

Ischial tuberositv Anteroposterior diameter of pelvic outlet (varies 9.5—11.5 cm because of mobility of coccyx)

Ischial spine

Tip of coccyx Female pelvis/female pelvic outlet: inferior view

Plate 354

Pubic symphysis

Anteroposterior diameter of pelvic outlet (9.5—11.5 cm)

Female: sagittal section

Bones and Ligaments

s

F e m a l e a n d M a l e Pelvis R a d i o g r a p h s

•

Female Pelvis A

Sacrum

B

Ilium

C

Pubis

D

Ischium

E

Pubis symphysis

F

O b t u r a t o r foramen

G

Head of femur

H

Greater trochanter

1

Lesser trochanter

J

Femur

K

Pelvic foramina

L

Air in c o l o n

M

Sacroiliac j o i n t Acetabulum

• wmmm

Pelvic inlet

Male Pelvis A

L5

B

Sacrum

C

Ala of sacrum

D

Ilium

E

Pubis

F

Ischium

G

Pubic symphysis

H

O b t u r a t o r foramen

I

Ischial tuberosity

J

Ischial spine

L

Greater trochanter

M

Lesser trochanter

N

Femur

K

O P

Head of femur

Air in c o l o n Sacroiliac joint —

Acetabulum

- - - Subpubic angle

Bones and Ligaments

Plate 355

•

Pelvic D i a p h r a g m : F e m a l e m

www

See also Plates 263, 366, 370, 392 Inferior (arcuate) pubic ligament

Superior view

Deep dorsal vein of clitoris

Pubic symphysis

Transverse perineal ligament


Fascia of deep perineal muscles Urethra Vagina O b t u r a t o r canal O b t u r a t o r fascia (over obturator internus muscle) Pubococcygeus muscle (part of levator ani muscle) Tendinous arch of levator ani muscle -Rectum lliococcygeus muscle

w

(part of levator ani muscle) Ischial spine Levator plate (median raphe) of levator ani muscle Coccygeus (ischiococcygeus) muscle Piriformis muscle

Coccyx Anterior sacrococcygeal ligament Sacral p r o m o n t o r y Piriformis muscle

M e d i a l view

Ischial spine

Arcuate line of ilium Obturator internus muscle and obturator fascia (cut) Tendinous arch of levator ani muscle Obturator canal lliococcygeus muscle (part of levator ani muscle) Rectum Urethra Pubococcygeus muscle (part of levator ani muscle) Vagina Sphincter urethrae muscle Left puborectalis muscle and perineal membrane /—/y.i>.

Plate 356

Compressor urethrae and urethrovaginal sphincter (portions of sphincter urethrae muscle)

Coccygeus (ischiococcygeus) muscle Left levator ani muscle (cut) External anal sphincter muscle Superficial and deep transverse perineal muscles

Pelvis Floor and Contents

Pelvic D i a p h r a g m : F e m a l e ( c o n t i n u e d ) For urogenital diaphragm see Plate 379 Inferior view

Musculofascial extensions to urethra Pubic symphysis

Musculofascial extensions to vagina

Inferior (arcuate) pubic ligament

Interdigitating fibers of perineum Puborectalis muscle (part of levator ani muscle)

Deep dorsal vein of clitoris

Pubococcygeus muscle (part of levator ani muscle)

Inferior pubic ramus

Tendinous arch of levator ani muscle

Urethra

O b t u r a t o r internus muscle

Vagina P i V<" <•• '

Rectum

( • ' W ' l M S

.V I

V V-

lliococcygeus muscle (part of levator ani muscle)

•!

Ischial tuberosity Ischial spine O b t u r a t o r internus tendon Sacrospinous ligament Sacrotuberous ligament Piriformis muscle M e d i a n raphe of levator ani muscle

Ischial spine Coccygeus (ischiococcygeus) muscle —

A n o c o c c y g e a l b o d y (ligament) (attachment of external anal sphincter muscle)

Piriformis muscle (cut)

Tip of coccyx

Sacrospinous ligament (cut) Sacrotuberous ligament (cut) Sacrum

Piriformis muscle Greater sciatic f o r a m e n Lateral view

Ischial spine lliococcygeus muscle (part of levator ani muscle)

M e d i a n sacral crest

inous arch of levator ani muscle Pubococcygeus muscle (part of levator ani muscle)

Sacrotuberous ligament (cut)

Puborectalis muscle (part of levator ani muscle) Coccygeus (ischiococcygeus) muscle Sacrospinous ligament ( Pubic b o n e (cut surface)

Coccyx

Deep dorsal vein of clitoris Urethra Vagina


Plate 357

5

Pelvic D i a p h r a g m : M a l e Hwp

See also Plates 263, 266, 392 Inferior (arcuate) p u b i c ligament Pubic symphysis

Superior view

(viscera

removed)

Pubic crest Pubic tubercle

Pecten pubis (pubic part of iliopectineal line)

Hiatus for deep dorsal vein of penis Transverse perineal ligament (anterior thickening of perineal membrane) Hiatus for urethra

Superior ramus of pubis

Muscle fibers f r o m levator ani to c o n j o i n e d longitudinal muscle of anal canal

O b t u r a t o r canal

Puborectalis Pubococcygeus lliococcygeus

O b t u r a t o r fascia Iliopubic eminence

,

,

^


Acetabular margin Anterior inferior iliac spine


mmW&M&imi

W i n g (ala) of ilium Arcuate line (iliac part of iliopectineal line)

Ischial spine Coccygeus (ischiococcygeus) muscle Piriformis muscle

Ischial spine Sacroiliac j o i n t

Anterior sacral (pelvic) foramina Sacrum

Anterior sacrococcygeal ligament Sacral canal

Plate 358

Anorectal hiatus


Pelvic D i a p h r a g m : M a l e ( c o n t i n u e d ) For urogenital diaphragm see Plate 383 Inferior view

D e e p dorsal veins of penis Fat in retropubic (prevesical) space Sphincter urethrae muscle ascending anterior aspect of prostate

Inferior p u b i c (arcuate) ligament Perineal b o d y Fibromuscular extensions of levator ani muscle to prostate Pubic tubercle Rectourethralis superior muscle

Urethra Rectoprostatic (Denonvilliers 7 ) fascia

Prerectal muscle fibers (of Luschka) f r o m levator ani muscle

Medial border (pillar) of levator ani muscle Perineal m e m b r a n e

Pubic symphysis

Muscle fibers f r o m levator ani to c o n j o i n e d longitudinal muscle of anal canal

{cutaway)

Ischiopubic ramus

Obturator internus tendon


Ischial tuberosity Sacrotuberous ligament (cut)

O b t u r a t o r internus muscle

Sacrospinous ligament (cut)

endinous arch of levator ani muscle

O b t u r a t o r internus muscle Coccygeus (ischiococcygeus) muscle Sacrospinous ligament (cut) Sacrotuberous ligament (cut) Tip of coccyx

lliococcygeus Pubococcygeus Puborectalis Circular muscle layer C o n j o i n e d longitudinal muscle

Levator ani muscle

0

f anorectal j u n c t i o n

/—/y.p.


Plate 359

Pelvic V i s c e r a a n d P e r i n e u m : F e m a l e

P a r a m e d i a n (sagittal) dissection

Ureter Uterine (fallopian) tube Ovary

Rectouterine p o u c h (of Douglas) Peritoneum {cut edge)

Ligament of ovary

couterine pouch Rectum

Round ligament of uterus Broad ligament (cut)

Ureter Urinary bladder Vagina

Superior pubic ramus (cut)

Pelvic diaphragm (levator ani muscle)

Inferior pubic ramus (cut) —

Deep transverse perineal muscle (cut)

Ischiocavernosus muscle

External anal sphincter muscle

Body of clitoris Labium minus Labium majus Median (sagittal) section

Sacral p r o m o n t o r y Ureter Suspensory ligament of ovary Uterine (fallopian) tube Ovary External iliac vessels Ligament of ovary Body of uterus Round ligament of uterus (ligamentum teres) Fundus of uterus Urinary bladder Pubic symphysis Urethra Sphincter urethrae Deep tra perineal muscle

Uterosacral ligament Vesicouterine p o u c h Rectouterine pouch (of Douglas) Cervix of uterus Posterior part of vaginal fornix Anterior part of vaginal fornix Rectum Vagina Perineal membrane . Levator am muscle Anal canal External anal sphincter muscle

Deep dorsal vein of clitoris Crus of clitoris External urethral orifice Superficial transverse perineal muscle Labium minus Labium majus

Plate 360

us

/.—//.p.

Vaginal orifice


Pelvic V i s c e r a a n d P e r i n e u m : M a l e BBWHWMMBMBMWMHWMBBg^^

1 1

11'MMWWWWWM

Ductus (vas) deferens

P a r a m e d i a n (sagittal) dissection

Urinary bladder and fascia


Ureter (cut)

Peritoneum

Seminal vesicle


Rectovesical pouch


Rectum Rectoprostatic (Denonvilliers') fascia

Transversalis fascia Umbilical prevesical fascia

Prostate (covered by fascia)

Sub( f a t t y (Camper's) cutaneous < m e m b r a n o u s tissue ((Scarpa's)

Ischiopubic ramus (cut) Pelvic diaphragm (levator ani muscle)

Superior pubic ramus (cut) Fundiform ligament of penis

D e e p transverse perineal muscle

Suspensory ligament of peni

Perineal b o d y Deep ) External anal Superficial > sphincter Subcutaneous ) muscle

Areolar tissue and vesical venous plexus in retropubic (prevesical) space

Deep perineal (investing or Gallaudet's) fascia

Deep dorsal vein of penis Corpus cavernosum

Superficial perineal (Colles') fascia (inferior fascia of superficial perineal space)

Deep (Buck's) fascia of penis Corpus spongiosum

Superficial (dartos) fascia of scrotum

Superficial (dartos) fascia of penis and scrotum


Septum of scrotum Vesical fascia Testis

Rectovesical p o u c h Rectum

M e d i a n (sagittal) section

Urinary bladder \

Seminal vesicle

Urachus Apex Fundus Body Trigone Neck

Prostate


Pubic symphysis Fundiform ligament of penis

Sphincter urethrae muscle

Suspensory ligament of penis Inferior (arcuate) pubic ligamentTransverse perineal ligament (anterior thickening of perineal membrane) Perineal m e m b r a n e Superficial perineal space

Bulbourethral (Cowper's) gland

smut

Perineal b o d y Bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia

Corpus cavernosum Corpus spongiosum Superficial (dartos) fascia of penis and scrotum Deep (Buck's) fascia of penis Prepuce Glans penis and external urethral meatus

Superficial perineal (Colles') fascia Buck's fascia Septum of scrotum Navicular fossa

y

C/ikMa^ * /Y2>. —


Plate 361

Pelvic C o n t e n t s : F e m a l e

Uterus (fundus)

Superior view

Ligament of ovary Ovary Uterine (fallopian) tube

Round ligament of uterus

Linea alba

Urinary bladder and transverse vesical fold Rectus abdominis muscle M e d i a l umbilical fold and ligament (occluded part of umbilical artery)

Median umbilical fold and ligament (urachus)

Rectouterine p o u c h (of Douglas) Rectum Inferior epigastric vessels and lateral umbilical fold Uterosacral fold Ureteric fold Suspensory ligament of ovary (contains ovarian vessels)

Broad (lateral uterine) ligament Femoral ring Deep inguinal ring Iliopubic tract (covered by peritoneum) External iliac vessels Iliac fossa (false pelvis)

Cecum Cecal folds Right paracolic gutter


m

/

7 /

•

'

•

v

f

7

/

r

f

/

Sigmoid c o l o n Quadratus lumborum muscle _ ,. , Descending colon Transversus abdominis Internal o b l i q u e External oblique

Plate 362

) ( ( )

Abdominal muscles

Psoas major and minor muscles Sympathetic trunk Anterior longitudinal ligament Body of L3 vertebra

I

IBr*'. /•/'v*^ . \

SfflW Jwjr ;

f !•

•yss™

lv: • / / / V

w vSSw-Sf--NfcVvxv. •K-msm Z l ^ /.i-jfSfci. H E n SkS:

/W

•' Y

;

iM •

^ 111 Jlfc* J yb ;.,>,>

Ovarian vessels


Pararectal fossa Inferior vena cava Sacral p r o m o n t o r y A b d o m i n a l aorta Superior hypogastric plexus

Parietal p e r i t o n e u m Ascending colon Terminal ileum Ureter Root of mesentery


Pelvic Contents: Male Superior view

Rectum Seminal vesicle (subperitoneal) Ductus deferens (in peritoneal fold) Linea terminalis of pelvis Femoral ring

Urinary bladder and transverse vesical fold

Linea alba Median umbilical fold and ligament (urachus)

Medial umbilical fold and ligament (occluded part of umbilical artery)

Pubic branch of inferior epigastric artery (obturator anastomotic)

Rectus abdominis muscle Rectovesical pouch Inferior epigastric vessels and lateral umbilical fold Vesicosacral (sacrogenital) fold

Deep inguinal ring

Pararectal fossa


Ureteric fold

Testicular vessels (in peritoneal fold)

Iliopubic tract (extraperitoneal)

Iliac fossa (false pelvis)

Cecum

Transversalis fascia Parietal peritoneum

Cecal folds

2X "


si

KoX1 &

/

/

/


Sigmoid colon

Descending colon Transversus Abdominal abdominis Internal oblique ( muscles External oblique

j

Psoas minor and major muscles

j

/

/

/

Sympathetic trunk Anterior , longitudinal ligament Body of L3 vertebra


I I

Testicular vessels

Inferior vena cava Sacral p r o m o n t o r y A b d o m i n a l aorta Superior hypogastric plexus

Right paracolic gutter Ascending colon Terminal ileum Ureter Root of mesentery

Plate 363

Endopelvic Fascia and Potential Spaces

Female: superior view ( p e r i t o n e u m a n d loose areolar tissue r e m o v e d )

Umbilical prevesical fascia Medial umbilical ligament (occluded part of umbilical artery) Urinary bladder and vesical fascia Rectus abdominis muscle Superior vesical artery in lateral ligament of bladder Linea terminalis of pelvis Femoral ring Inferior epigastric artery and Pubic branch D e e p inguinal ring

M e d i a n umbilical ligament (urachus) Pubic symphysis Inferior (arcuate) pubic ligament Deep dorsal vein of clitoris Retropubic (prevesical) space Transverse perineal ligament (anterior thickening of perineal m e m b r a n e ) M e d i a l pubovesical ligament Lateral pubovesical ligament Vesicocervical fascial fibers Superior fascia of pelvic diaphragm (superior levator ani fascia)

Iliopubic tract

O b t u r a t o r canal and obturator artery

Transversalis fascia External iliac vessels Femoral nerve (under fascia) Deep circumflex iliac vessels Tendinous arch § of pelvic fascia /, (reflected laterally) Iliac fascia Ovarian vessels in suspensory ligament of ovary lliacus muscle

Obturator internus fascia

Ureter Psoas major muscle Internal iliac vessels


Inferior vesical and vaginal arteries'

Tendinous arch of pelvic fascia

Hypogastric (neurovascular) sheath

Uterosacral ligament

M i d d l e rectal artery Cervix of uterus and uterine fascia Superior rectal artery (left branch) Rectum and rectal fascia Rectovaginal (potential) space Presacral (potential) space ( spread open) M e d i a n sacral artery

Plate 364

Cardinal (transverse cervical or M a c k e n r o d t ' s ) ligament w i t h uterine artery Vaginorectal fascial fibers Presacral fascia (pulled

away)

Anterior sacrococcygeal ligament Vesicocervical and vesicovaginal (potential) spaces


Urinary Bladder: Orientation and Supports

Female: midsagittal section

Peritoneum Transversalis fascia M e d i a n umbilical ligament (urachus) Umbilical prevesical fascia Uterus (fundus) Vesicouterine p o u c h Fundus Apex Body Ureteric orifice Trigone Neck

Urinary bladder

Pubic symphysis Retropubic (prevesical) space and venous plexus Inferior (arcuate) pubic ligament Deep dorsal vein of clitoris Transverse perineal ligament Sphincter urethrae and Sphincter u r e t h r o v a g i n a l muscles Perineal m e m b r a n e Urethra Vagina Labium minus Rectum

Perineal b o d y External anal ' A m p u l l a of rectum sphincter muscle Pubic symphysis Inferior (arcuate) pubic ligament Deep dorsal vein of clito

Labium majus Superior view with peritoneum a n d vesical fascia removed

Medial pubovesical ligament (medial puboprostatic ligament in male) Transverse perineal ligament (anterior thickening of perineal membrane) Tendinous arch of levator ani muscle O b t u r a t o r canal Lateral pubovesical ligament (lateral puboprostatic ligament in male) Tendinous arch of pelvic fascia Superior fascia of pelvic diaphragm (covering levator ani muscle) O b t u r a t o r fascia over obturator internus muscle Urinary bladder pulled up and back (vesical fascia removed) M e d i a n umbilical ligament (urachus) (cut) Inferior vesical and vaginal arteries //.p.

Urinary Bladder

Ureter-

Plate 365

Urinary Bladder: Female and Male mmmMBsmmmmmMommm

• M

See also Plates 343, 360, 361, 365, 400, 402, 403, 417 Female: frontal section

— Peritoneum — Body of bladder Fundus of bladder Interureteric crest Left ureteric orifice Trigone of bladder N e c k of bladder Paravesical endopelvic fascia and vesical venous plexus Vesical fascia Tendinous arch of levator ani muscle - O b t u r a t o r internus muscle Levator ani muscle Tendinous arch of pelvic fascia Urethra Sphincter urethrae muscle Perineal m e m b r a n e Inferior pubic ramus Crus of clitoris and ischiocavernosus muscle Bulb of vestibule and bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia Superficial perineal (Colles') fascia

Round ligament of uterus

Vagina M a l e : frontal section

Peritoneum Body of bladder Fundus of bladder Ductus (vas) deferens Interureteric crest Right ureteric orifice Trigone of bladder Neck of bladder Paravesical endopelvic fascia and vesical venous plexus Tendinous arch of levator ani muscle Uvula of bladder O b t u r a t o r internus muscle Levator ani muscle Capsule of prostate Prostate and prostatic urethra Seminal colliculus Bulbourethral (Cowper's) gland Perineal m e m b r a n e and sphincter urethrae muscle Bulbous p o r t i o n of spongy urethra Corpus spongiosum and bulbospongiosus muscle Deep perineal (investing or Gallaudet's) fascia /

nternal urethral sphincter Tendinous arch of pelvic fascia Anterior recess of ischioanal fossa Inferior pubic ramus Crus of penis and ischiocavernosus muscle Superficial perineal (Colles') fascia

/V.®. —/YP.

Plate 366

Urinary Bladder

•••;••—

•:•-:••-:

*

••••

:• •-:: -••.-.»

-.-••

/

Trigonal ring Posterior loop Loop of Heiss

Internal sphincter (involuntary)

Bladder Vagina Urethra Levator ani muscle Urogenital hiatus

Sphincter urethrae muscle Urethrovaginal muscle

a ^

Compressor urethrae muscle

Pubic b o n e

External sphincter (voluntary)

JOHN A.CRAIC—/*D

C/i&davL / M. D .

Plate 367

Lft

Sphincters

Female urethra, 8-year-old child

Voiding cystourethrogram, 2-year-old male

Prostatic

Membranous Spongy urethra

Plate 363

urethra

Urinary Bladder

Pelvic V i s c e r a : F e m a l e

Superior view with p e r i t o n e u m intact

M e d i a n umbilical fold (urachus) Vesicouterine pouch

Urinary bladder Fundus of uterus

Paravesical fossa

Deep inguinal ring Round ligament of uterus Body of uterus Broad ligament Ligament of ovary Mesosalpinx (of broad ligament) Cervix of uterus Ovary Rectouterine p o u c h (of Douglas) Rectouterine fold Uterine (fallopian) t u b e External iliac vessels -Pararectal fossa Suspensory ligament of ovary (contains ovarian vessels) Ureteric fold Urinary bladder Vesical fascia (cut edge) O b t u r a t o r fascia

Sigmoid colon Sacral p r o m o n t o r y M e d i a n sacral vessels A b d o m i n a l aorta O b t u r a t o r canal O b t u r a t o r artery Superior fascia of pelvic diaphragm Cervix of uterus and uterovaginal fascia Uterine vessels Cardinal (transverse cervical or Mackenrodt's) ligament Rectocervical and rectovaginal (potential) spaces Rectal fascia (cut edge) Rectouterine (sacrouterine) ligament External iliac vessels Ureter Sacral p r o m o n t o r y

Superior view with p e r i t o n e u m and uterus removed


Plate 369

Uterus, V a g i n a , a n d S u p p o r t i n g S t r u c t u r e s See also Plates 400, 402, 404, 406, 412, 414, 415 Mesovarium Broad ligament Cut edge of p e r i t o n e u m f o r m i n g floor of paravesical p o u c h

Plane of section Angle of view

Suspensory ligament of ovary

Cervix of uterus

Uterine vessels H

j — C a r d i n a l (transverse cervical or Mackenrodt's) ligament

Obturator membrane Obturator fascia



Vaginal artery

Levator ani muscle (iliococcygeus and pubococcygeus muscles)

Ureter v

Anterior recess of ischioanal fossa

Ischiopubic ramus Compressor urethralis muscle

Crus of clitoris Ischiocavernosus muscle

Perineal m e m bra r

Fascia lata of thigh

Artery of bulb of vesti

Superficial perineal space

Sphincter u r e t h r o v a g i n a l muscle

Perineal artery

Terminal part of round ligament of uterus

Superficial perineal (Colles') fascia

Labium majus

Bulbospongiosus muscle and deep perineal (investing or Gallaudet's) fascia

Labium minus

CAfctf/t&Jo/—fi.7>.

Bulb of vestibule

Vestibule

Vaginal wall Vagina

Plate 370

Uterovaginal fascia

Hymenal caruncle


5

Uterus and Adnexa .


Posterior view

Isthmus

Mesosalpinx (of broad ligament)

.

.

.

.

.

Uterine (fallopian) tube Ampulla Infundibulum

A

Epophoron

syi®

Ligament of ovary

Vesicular appendix (hydatid of Morgagni)

Fundus of uterus Fimbriae

Abdominal ostium

Mas

Corpus luteum Ovary Body of uterus


:wm

Mesometrium (of broad ligament)

Ovary Mesovarium (of broad ligament)

•mm

Ureter

Ligament of ovary

mmm

Uterosacral ligament

Uterine (fallopian) tube

Rectouterine pouch (of Douglas) —

Fundus of uterus Body of uterus

Uterine ostium Uterine part

Isthmus

Infundibulum Folds of uterine tube Isthmus of uterus Internal os

Fimbriae

Ligament of ovary

Suspensory ligament of ovary (contains ovarian vessels)

Endometrium Myometrium Mesometrium (of broad ligament) Uterine vessels Cardinal (transverse cervical or Mackenrodt's) ligament

Vesicular appendix (hydatid of Morgagni) Epoophoron Follicle (Graafian) Corpus albicans

of ovary

Corpus luteum

Cervical canal with palmate folds External os

Vaginal fornix

Frontal section

•—Vagina


Plate 371

Pelvic L i g a m e n t s

Anterior

Posterior

-Suspensory ligament of the ovary (containing the ovarian vessels) Subdivisions and contents of the b r o a d ligament

I n f u n d i b u l u m of uterine tube External iliac vessels Fimbriae of uterine tube A m p u l l a of uterine tube Round ligament Right ovary Right ureter Laminae of the mesosalpinx O b l i t e r a t e d umbilical artery Ovarian branches of uterine vessels Round ligament

Laminae of the mesovarium Posterior lamina of broad ligament Anterior lamina of broad ligament

Transverse vesical fold Vesicouterine (uterovesical) p o u c h

Horizontal p o r t i o n of pubocervical fascia supports bladder and vagina

Uterine artery and venous plexus Vaginal artery

Uterosacral ligament Cardinal ligament Pelvic fascia and ligaments

Cervix

Horizontal portion of vagina Vertical p o r t i o n of vagina jOHN A.CRAI^d

C/icfrdadfi-

Plate 372

u r e th ra

Arcus tendineous fasciae pelvis Distal (vertical) portion of pubocervical fascia supports urethra and U-V junction and provides backstop against which urethra is compressed during straining


Uterus: A g e Changes and Muscle Pattern

Adult (nulliparous)

Adult (postmenopausal)

Adult (parous)

C Contrast medium in abdominal cavity H Hysterosalpingogram uterus R Right fallopian tube infection

Uterine (fallopian) tube Ligament of ovary Round ligament of uterus

Uterine musculature (schema)

Uterosacral ligament Cardinal (transverse cervical or Mackenrodt's) ligament

Spiral fibers pass deeply into wall and interlace (schema) Vaginal wall


Plate 373

5

Uterus: Position a n d Prolapse mm Altered rectal contour in 3rd degree

Degrees of retroversion A

^/Normal

Variations in position

-Normal

^/Normal

Normal

VSiv.w v, V s j r * •

Retroflexion

Anteflexion (normal and severe)

Retrocession

Uterine prolapse

Urinary bladder Uterus

Slight descent (1 st degree)

Complete

Sagittal section Rectum

\

• v,

,/

Cervix at introitus (2nd degree)

Plate 374


Ectopic Pregnancy

J

Sites of ectopic implantation

Interstitial

Tubal (isthmic)

Tubal (ampullar)

Abdominal

vwavi'VSi'Je-S

Ovarian

Unruptured tubal pregnancy

Villi invading tubular wall

Chorion

Hemorrhage in tubal wall

Amnion

Section through tubal pregnancy

Lumen of tube


Plate 375

5

Transverse Section: Pubic Crest, Femoral Heads, Coccyx

Superior portion of pubic symphysis Spermatic cord

Interior of urinary bladder Adductor longus muscle of pubis

Beginning of urethra

Pectineus muscle

Prostate gland with prostatic urethra

Femoral vein

Psoas muscle and ten

Femoral artery

lliacus muscle

Femoral nerve

Head of femur

Sartorius muscle

Neck of femur

iopsoas muscle


Rectus femoris muscle Tensor fasciae latae muscle

Gluteus minimus tendon


Greater trochanter Inferior gemellus muscle

Obturator artery, vein, and nerve

Right

Acetabular fossa

sciatic nerve

Lunate (articular) surface of acetabulum

Gluteus maximus muscle Obturator internus muscle

Left sciatic nerve

Sacrotuberous ligament

Internal pudendal artery and vein

Ejaculatory ducts Perineal flexure (termination of rectum, beginning of anal canal) Tip of coccyx

Pudendal nerve Fat body of ischioanal fossa Levator ani muscle (puborectalis)

/

M.j>.

Female Perineum and External Genitalia (Pudendum or Vulva) See also Plates 404, 406, 407, 413

Mons pubis Anterior commissure of labia majora Prepuce of clitoris Pudendal cleft (groove or space between the labia majora) lans of clitoris Frenulum of clitoris External urethral orifice Labium minus Labium majus Openings of paraurethral (Skene's) ducts Vestibule of vagina (cleft or space surrounded by labia minora)

Wgm : K^fi&Sa^v.

: JkcgBHRSSW-' M'mF^

orifice SeBSat&w

O p e n i n g of greater vestibular (Bartholin's) gland Hymenal caruncle Vestibular fossa Frenulum of labia minora Posterior commissure of labia majora Perineal raphe (over perineal body) Anus

Annular hymen

Septate hymen

Cribriform hymen


Parous introitus

Plate 377

Superficial fatty (Camper's) layer / ( Deeper m e m b r a n o u s ( (Scarpa's) layer )

Subcutaneous tissue

Rectus sheath (anterior layer) Aponeurosis of external o b l i q u e muscle Superficial inguinal ring Anterior superior iliac spine Round ligament of uterus and coverings (cut) Inguinal ligament (Poupart's) Pubic tubercle Pubic symphysis Saphenous o p e n i n g Suspensory ligament of clitoris Fascia lata of thigh ichiopubic ramus Superficial perineal (Colles') fascia {cutaway) to o p e n superficial perineal space Ischiocavernosus muscle Bulbospongiosus muscle (covers bulb of vestibule) Perineal m e m b r a n e D e e p perineal (investing or Gallaudet's) fascia ( p a r t i a l l y cut away) Superficial transverse perineal muscle Ischial tuberosity Superficial perineal (Colles') fascia (cut edge turned down) Fat b o d y of ischioanal fossa Peritoneum Urachus •Transversalis fascia Superficial perineal fascia Round li w of uterus and coverings


Subcutaneous f Fatty tissue ( Membranous

Vesical fascia Uterovaginal fascia Rectal fascia

Rectus sheath (anterior layer) Pubic symphysis Inferior (arcuate) pubic ligament Transverse perineal ligament Suspensory ligament of clitoris

Sphincter urethrae and sphincter urethrovaginal'^ muscles

if

Perineal m e m b r a n e Superficial perineal space Superficial perineal (Colles') fascia Perineal bodySuperior fascia of pelvic diaphragm Inferior fascia of pelvic diaphragm Levator ani muscle

Plate 378



Female Perineum and Deep Perineum

Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia partially r e m o v e d

Suspensory ligament of clitoris Ischiocavernosus muscle Bulb of vestibule

Superficial perineal space (pouch or c o m p a r t m e n t )

Perineal m e m b r a n e

Ischiopubic ramus w i t h cut edge of superficial perineal (Colles') fascia

Greater vestibular (Bartholin's) gland Bulbospongiosus muscle (cut away)

Perineal membrane

Superficial transverse perineal muscle

Ischial tuberosity Sacrotuberous ligament

Perineal body


Ischioanal fossa

Coccyx Urethra

Crus of clitoris


Ischiopubic ramus

Perineal m e m b r a n e {cut and reflected) Compressor urethrae muscle

Bulb of vestibule

Obturator fascia Tendinous arch of levator ani muscle Inferior fascia of pelvic diaphragm (cut) Levator ani muscle External anal sphincter muscle A n o c o c c y g e a l (ligament) b o d y

Sphincter urethrovaginalis muscle Vagina (Bartholin's) gland

Deep transverse perineal muscle

Perineal m e m b r a n e


Plate 379

P e r i n e u m a n d E x t e r n a l G e n i t a l i a (Superficial D i s s e c t i o n )

Deep (investing) fascia over external oblique muscle

Superficial fatty (Camper's) and deeper membranous (Scarpa's) layers of subcutaneous tissue


wSSKs

mmk




Superficial (dartos) fascia of penis and scrotum

Fascia lata (deep fascia) of thigh

Saphenous opening and femoral artery and vein Great saphenous vein Superficial perineal (Colles') fascia Broken line indicates line of attachment of Colles' and Scarpa's fasciae with deep fascia

Ischiopubic ramus

Anus

Pubic symphysis

Fat body in ischioanal fossa

Urogenital triangle Ischiopubic ramus

Regions (triangles) of p e r i n e u m : surface t o p o g r a p h y

Ischial tuberosity Anal triangle

\,vV

Plate 380

Tip of coccyx


Perineum and External Genitalia (Deeper Dissection) See also Plates 403, 405, 408-411, 416

Skin of penis Superficial (dartos) fascia of penis Aponeurosis of external oblique muscle Deep m e m b r a n o u s (Scarpa's) layer of subcutaneous tissue (cutaway) Inguinal ligament (Poupart's) Deep (Buck's) fascia of penis Superficial inguinal ring External spermatic fascia investing spermatic cord Fascia lata (deep fascia) of thigh Bulbospongiosus muscle — Ischiocavernosus muscle covers crus of penis Superficial perineal (Colles') fascia (cut away to open superficial perineal space) Perineal m e m b r a n e Deep perineal (investing or Gallaudet's) fascia ( p a r t i a l l y cut away) covers muscles of superficial perineal space Superficial transverse perineal muscle Ischial tuberosity Superficial perineal (Colles') fascia (cut edge) Levator ani muscle roofing ischioanal fossa External anal sphincter muscle Gluteus maximus muscle

Superficial dorsal vein Dorsal artery and nerve Lateral superficial vein Corpus cavernosum and its tunica albuginea D e e p artery Corpus spongiosum and its tunica albuginea Section t h r o u g h b o d y of penis


Plate 381

Penis

External urethral orifice (meatus) Glans penis C o r o n a of glans Frenulum

Neck of glans O p e n i n g of preputial (Tyson's) gland

Skin

Superficial (dartos) fascia of penis Deep (Buck's) fascia of penis External spermatic fascia investing spermatic cord (cut) Superficial perineal (Colles') fascia (cut away to open superficial perineal space) Ischiopubic ramus

D e e p perineal (investing or Gallauclet's) fascia (cutaway) over muscles of superficial perineal space Ischiocavernosus muscle

(cutaway)

Superficial transverse perineal muscle Anus Glans penis C o r p o r a cavernosa of penis Intercavernous septum of deep (Buck's) fascia Corpus spongiosum Pubic tubercle Superior ramus Ischial tuberosity

Perineal membrane

Ischiopubic ramus

Gluteus maximus muscle Levator ani muscle and inferior fascia of pelvic diaphragm roofing ischioanal fossa

Perineal body Bulb of penis Tip of coccyx Crus of penis


Perineal membrane

Ischial tuberosity Perineal body

Plate 382



Perineal Spaces iMrîi Ti*i MT i m-

^

e

t

c

?

'

: .::.

• • •

Pubic symphysis

KSaHBMDffSi

Pubic bone


Transverse perineal ligament (anterior thickening of perineal m e m b r a n e ) Dorsal artery and nerve of penis

Inferior (arcuate) pubic ligament

D e e p artery of penis Urethral arteryy

Deep dorsal vein of penis

D u c t of bulbourethral (Cowper's) gland

Ischiopubic ramus

Artery of bulb of penis

Urethra

Deep perineal (investing or Gallaudet's) fascia over ischiocavernosus, bulbospongiosus, and superficial transverse perineal muscles (cutaway)

Perineal membrane

Superficial perineal (Colles') fascia

(cutaway)

Superficial transverse perineal muscle (cut and reflected) Ischial tuberosity

Perineal body

Inferior views

External anal sphincter muscle Dorsal artery and nerve of penis Deep artery of peni Urethral artery Bulbourethral (Cowper's) gland


Artery of bulb of penis Perineal m e m b r a n e (cut edge) Internal pudendal artery and dorsal nerve of penis Internal pudendal artery and perineal branch

Levator ani muscle Perineal m e m b r a n e Deep transverse perineal muscle Deep perineal (investing or Gallaudet's) fascia Corpus cavernosum (crus of penis) and deep (Buck's) fascia of peni Ischiocavernosus muscle Superficial perineal (Colles') fascia (closes superficial perineal space)

Urinary bladder Prostate O b t u r a t o r internus muscle Ischiopubic ramus Sphincter urethrae muscle Bulbourethral (Cowper's) gland Ischiocavernosus muscle Bulb of penis (corpus spongiosum) and deep (Buck's) fascia of penis Bulbospongiosus muscle

Frontal section, anterior view of p e r i n e u m : schema


Plate 383

5

Prostate and Seminal Vesicles W M W H M j ^ i l ^ W W W W M i W i W I i . 1 IWHlilUiliPHiji .il IHIil'lli' i "" iMBMilMWi

jiiMfMlillfflllf^^

"

\T"illttWrfffilirffiffflfl ifgmfllWWWWiTWWW

"M

See also Plates 361, 363, 366, 403, 410 Ureteric orifice Trigone of urinary Internal urethral sphincter Uvula of bladder

Prostate Seminal colliculus

Urethral crest

Prostatic utricle

Openings of prostatic ducts in prostatic sinus

O p e n i n g of ejaculatory duct Sphincter urethrae muscle Bulbourethral (Cowper's) gland O p e n i n g of bulbourethral duct

Rectum and rectal fascia

Perineal b o d y Rectovesical or rectoprostatic (Denonvilliers') fascia

Frontal section, anterior view of bulbous portion of spongy urethra schematically extended

Seminal vesicle

Sagittal section

Ureter

Urinary bladder

—A/.J>.

Ductus deferens Anterior muscular band of skeletal muscle (continuation of sphincter urethrae) Isthmus and fibromuscular stroma (smooth muscle)

Prostatic urethra^

Ampulla of ductus deferens

Seminal colliculus

Beginning of ejaculatory d

Inferolateral

Prostate

Prostatic utricle .'"~ X-

•

A

/ I

/ M e d i a n lobe W

Inferolateral lobe

a

Seminal vesicle

Ischiopubic ramus Deep transverse perineal muscle and fascia

Prostatic sinus —

Bulbourethral (Cowper's) glands Posterior view

Plate 384

Capsule of prostate Inferoposterior lobe Cross section t h r o u g h prostate

Urethra

Internal urethral sphincter

Trigone of urinary bladder

Prostate Urethral crest Prostatic urethra

Openings of prostatic ducts

Prostatic utricle

Intermediate part of (membranous) urethra

Openings of ejaculatory ducts Bulb of penis Crus of penis

Bulbourethral (Cowper's) gland

Bulbous , portion

Openings of bulbourethral ducts Corpus cavernosum Tunica albuginea Corpus spongiosum

ra

J E 4—'

Tunica albuginea

o> u 1/T D c

Deep artery of penis 'V-Vivlfi

s -< >

Intercavernous septum of deep (Buck's) fascia

re

w) 5

Pendulous ^ (penile) portion

Urethral lacunae (Morgagni) and urethral glands (Littre)

Lacuna magna (inconstant) Navicular fossa Glans penis External urethral orifice (meatus) Roof of urethra


Floor o f urethra

Plate 385

D e s c e n t of Testis

Suprarenal gland

Suprarenal gland

Suspensory (diaphragmatic) ligament

Kidney Suspensory (diaphragmatic) ligament (atrophic)

Gonads Mesonephric (wolffian) duct

Testes • Epididymis

Gubernaculum

Gubernaculum

Urinary bladder

Deep inguinal ring

|F

Urinary bladder

•

8 weeks (22.5-mrn crown-rump)

11 weeks (43-mm crown-rump)

Testis Gubernaculum

Epididymis

Deep inguinal ring

4 lunar m o n t h s (107-mm crown-rump)

Superficial inguinal ring Ductus deferens Scrotum (cut open) Epididymis Testis Processus vaginalis Gubernaculum (26-cm crown-rump)

Plate 386

Cavity of tunica vaginalis (cut open)


Scrotum and Contents •HHMHI

Skin of penis Superficial fascia of penis (Colles' fascia) Deep (Buck's) fascia of penis

Superficial inguinal ring

Testicular artery


Ductus deferens Artery to ductus deferens

Cremaster muscle and fascia

Genital branch of genitofemoral nerve Pampiniform (venous) plexus

Septum of scrotum (formed by clartos fascia)

Epididymis Appendix of epididymis

Superficial (dartos) fascia of scrotum

Appendix of testis Testis (covered by visceral layer of tunica vaginalis)

Skin of scrotum

Parietal layer of tunica vaginalis

Superficial (dartos) fascia of scrotum External spermatic fascia Cremaster muscle and fascia Internal spermatic fascia Parietal layer of tunica vaginalis Epididymis Testis (covered by visceral layer of tunica vaginalis) Skin of scrotum


Plate 387

mmmmm

Undifferentiated

Glans area Epithelial tag Urogenital fold

Genital tubercle

Urogenital groove Lateral part of tubercle Anal tubercle Anal pit

Male

Female

—Glans 45—50 mm (-10 weeks)

Epithelial tag Coronal sulcus Site of future origin of prepuce

45—50 mm (~10 weeks)

Urethral fold Urogenital groove Lateral tubercle (shaft or corpus) Labioscrotal swelling Urethral folds partly fused (urethral raphe) Anal tubercle Anus External urethral orifice

Body of clitoris

Prepuce

Fully developed

Prepuce Fully developed

Glans of clitoris

Body (shaft) of penis

External urethral orifice

Raphe of penis

Labium minus Scrotum

Labium majus Vaginal orifice Posterior commissure

Perineal raphe Perianal tissues (including external anal sphincter muscle)

Plate 388


H o m o l o g u e s of Internal G e n i t a l i a imm

msm

Diaphragmatic ligament (suspensory ligament of ovary)

Paramesonephric (mullerian) duct Gonad Mesonephric tubules

Mesonephric (wolffian) duct

Genital cord Inguinal fold

Urogenital sinus

Primordium of prostate (
Primordium of bulbourethral (Cowper's) ( 5 ) or of greater vestibular (Bartholin's) ( 2 ) glands

jp

Undifferentiated Female

Uterine (fallopian) tube Broad ligament Cranial mesonephric (Gartner's) duct Epophoron (cranial mesonephric tubules) i Parophoron (caudal 1 mesonephric tubules) i Vesicular appendix

Seminal vesicle Ductus deferens Prostatic utricle Prostate Opening of ejaculatory duct Bulbourethral (Cowper's) gla Appendix of epididymis Epididymis Efferent ductules Appendix of testis Testis Paradidymis Scrotal ligament (gubernaculum)


mm

r ^ T r . a .

' / S u s p e n s o r y ligament of ovary — Ligament of ovary Ovary llterus Round ligament of uterus Vagina (upper 4/r>) M Residua of caudal mesonephric duct Vagina (lower 1/•«">) Urethra Paraurethral (Skene's) gland Greater vestibular (Bartholin's) gland Vestibule

Plate 388

5

Testis, E p i d i d y m i s , a n d D u c t u s D e f e r e n s .

.

.—--—- '

'

'••"""•""•••""V"':™"-"''''

",' ••..••••---—-—

.. ."

"''""Syv '

.....

. • • • M H M j vg<\'5S.

"~"STTy:'vf

S-S ' W-.&vSSJJ

Efferent ductules Aberrant ductule (vestigial mesonephric tubule) Ductus deferens

Area of rete testis (in mediastinum testis) Septa Head

Tunica albuginea

Epididymi s

Lobules Epididymal duct Aberrant ductule

Frontal section

Ductus deferens Efferent ductules Epididymal duct Rete testis (in mediastinum testis) Aberrant ductule Seminiferous tubules

Schema

Skin of scrotum Superficial (dartos) fascia Lobules of testis

External spermatic fascia Cremaster muscle and fascia

Scrotal septum (dartos)

Internal spermatic fascia Septa

Parietal layer of tunica vaginalis Visceral layer of tunica vaginalis

Rete testis (in mediastinum testis)

nica albuginea of testis

Ductus deferens

Sinus of epididymis Epididymis

Cross section through scrotum and testis

Plate 390

Testis, Epididymis, and Ductus Deferens

R e c t u m in Situ: F e m a l e a n d M a l e

Male

Sigmoid colon Free taenia (taenia libera)

Sigmoid m e s o c o l o n Rectosigmoid j u n c t i o n

Ductus (vas) deferens (cut)

Peritoneal reflection

Ureter (cut)

Rectovesical p o u c h

Urinary bladder

Rectum and rectal fascia

Seminal vesicle

Levator ani muscle (pelvic diaphragm)


Coccyx

Prostate

Puborectalis part of levator ani muscle

Ischiocavernosus muscle and deep perineal (investing or Gallaudet's) fascia (partially cut away)

External anal \ ?eeP ~ sphincter muscle* ) Superficial ( Subcutaneous

Deep transverse perineal muscle Female

Superficial transverse perineal muscle and deep perineal (investing) fascia

Sigmoid mesocolon Rectosigmoid junction

Superficial perineal (Codes') fascia


Sigmoid colon Free taenia (taenia libera)

Rectal fascia and rectum

Uterus couterine p o u c h

Rectouterine pouch (of Douglas)

Ureter (cut) Vagina and vaginal fascia

Coccyx

Urinary bladder and vesical fascia

Levator ani muscle (pelvic diaphragm)

Ischiocavernosus muscle and deep perineal (investing or Gallaudet's) fascia

Puborectalis part of levatoi ani muscle External anal sphincter muscle* Deep Superficial Subcutaneous

Deep transverse perineal muscle and perineal m e m b r a n e Superficial perineal (Colles') fascia Superficial transverse perineal muscle and deep perineal (investing or Gallaudet's) fascia Perineal b o d y

*Parts variable and often indistinct

Rectum

Plate 391

Ischioanal Fossae See also Plates 317, 410-413

1

'';; ^

Sigmoid colon

lliacus muscle and fascia


Iliopectineal

Obturator internus muscle and fascia

Pudendal canal (Alcock's) contains internal pudendal vessels, pudendal nerve, and perineal nerve

Ischial tuberosity

Ureter


Extraperitoneal (supralevator) space ffibrofatty tissue) at b o d y of ( Deeper part ischioanal < Superficial fossa ( (perianal) part Transverse fibrous septum of ischioanal fossa Submucous space (internal venous plexus) Perianal space (external venous plexus) Intersphincteric groove (anocutaneous line)

Plate 392

Sacrogenital fold (uterosacral in female) Levator ani muscle and superior and inferior fascia of pelvic diaphragm Peritoneum (cut edge) f o r m i n g floor of pararectal fossa Rectal fascia External anal sphincter muscle C o n j o i n e d longitudinal muscle Internal anal sphincter muscle

Rectum

Rectum and Anal Canal mmaimm

gg: if.iBimwjbi—wijifumwww

Sigmoid c o l o n

15-17 cm

Rectosigmoid j u n c t i o n Superior

11-13 cm

j

Middle

/ \ (

Inferior

J

Transverse folds of rectum (valves of Houston)


8 - 9 cm

Rectal fascia Longitudinal muscle layer Circular muscle layer Muscularis mucosae 5 - 6 cm

Levator ani muscle ^ A n o r e c t a l line Anal columns (Morgagni's) Anal sinus Pectinate (dentate) line Internal rectal venous plexus in submucous space

4 - 5 cm

Deep part* of external sphincter muscle C o n j o i n e d longitudinal muscle 2 . 5 - 3 cm

Internal sphincter muscle Anal valve Anal crypt Superficial part* of external sphincter muscle

0 . 5 - 1 cm

Anal glands Transverse fibrous septum Muscularis mucosae of anal canal Perianal space

Sweat glands and hairs in perianal skin

Anal verge / Pecten > Anoderm

Subcutaneous part* of external sphincter muscle Corrugator cutis ani muscle External rectal venous plexus in perianal space Intersphincteric groove (anocutaneous line)

f


Rectum

Plate 393

5

Anorectal Musculature

Rectosigmoid junction

Anterior view

Sigmoid colon

Free taenia (taenia libera)

Fibers of taenia spread o u t to f o r m longitudinal muscle layer of rectum Fibers f r o m longitudinal muscle j o i n circular muscle layer W i n d o w cut in longitudinal muscle layer to expose underlying rcular muscle layer

Levator ani muscle eep Superficial Subcutaneous

Frontal section

Parts* of external anal sphincter muscle

mMM Fibrous septum

M

Corrugator cutis ani muscle

•

:

•mmm

WKSIS

Perianal skin

Superior fascia of pelvic diaphragm Inferior fascia of pelvic diaphragm Levator ani muscle Rectal fascia Longitudinal muscle of rectum

8 • i-aeSii^v

vv.

Circular muscle of rectum Muscularis mucosae of rectum Deep part* of external anal sphincter muscle Internal rectal venous plexus C o n j o i n e d longitudinal muscle Superficial part* of external anal sphincter muscl

mm

mm

Internal anal sphincter muscle Muscularis mucosae of anal canal Transverse fibrous septum of ischioanal fossa Subcutaneous part* of external anal sphincter muscle Corrugator cutis ani muscle External rectal venous plexus

Intersphincteric groove (anocutaneous line)


Plate 394

Rectum

External Anal Sphincter Muscle: Perineal Views

Male

Superficial scrotal (dartos) fascia Septum of scrotum Deep (Buck's) fascia of penis Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia removed Ischiocavernosus muscle with deep perineal (investing or Gallaudet's) fascia removed Perineal membrane Ischiopubic ramus Perineal body Superficial transverse perineal muscle with deep perineal (investing or Gallaudet's) fascia removed Subcutaneous • i c Superiicial Deep

) n . * c . , , ( Parts ot external anal > s . , ) P ™ n c t e r muscle

Superficial perineal (Colles7) fascia {cut edges) fibrous septum of ischioanal fossa (cut) schial tuberosity Sacrotuberous ligament Pubococcygeus ) Puborectalis ? Levator ani muscle lliococcygeus ) Anococcygeal body (ligament) (posterior extensions of superficial external anal sphincter muscle) Gluteus maximus muscle p of coccyx Female

Clitoris External urethral orifice Vagina Superficial perineal (Colles') fascia (cut edge) Ischiocavernosus muscle with deep perineal (investing or Gallaudet's) fascia removed Bulbospongiosus muscle with deep perineal (investing or Gallaudet's) fascia removed Fibers from superficial external anal sphincter muscle to ischiopubic ramus Perineal membrane Superficial transverse perineal muscle with deep perineal (investing or Gallaudet's) fascia removed Superficial perineal (Colles') fascia (cut edge) Perineal body Crossed fibers from superficial and deep external sphincters to superficial transverse perineal muscle Parts* of external anal ) J^ e e | 3 . sphincter muscle ) Superficial ( Subcutaneous ( Pubococcygeus Levator ani muscle < Puborectalis ( lliococcygeus Gluteus maximus muscle Anococcygeal body (ligament) (posterior exten: of superficial external anal sphincter muscle) *Parts variable and often indistinct

Rectum

Ischiopubic ramus Anus

Actual and Potential Perineopelvic Spaces

Sagittal section

Peritoneum — -Vesical fascia ,

Rectal fascia \ Rectal fascia Presacral fascia

smIM Retropubic \ (prevesical) space (of Retzius)

Presacral space

Recto- ( Retrovesical vesical \ Prerectal space ( R e t r o p r o s t a t i c — : Sphincter urethrae

C

^x :

^ ... M^f f /

N

ff

Levator ani muscle and fascia of pelvic diaphragm

transverse perineal muscles External anal sphincter muscle*

Deep Superficial Subcutaneous

Deep postanal space A n o c o c c y g e a l b o d y (ligament)

D e e p (Buck's) fascia of penis Superficial perineal

(Colles 7 )

Rectovesical or rectoprostatic (Denonvilliers') fascia (septum)

Superficial postanal space (part of perianal space)

fascia


Submucous space Perianal space Bulbospongiosus muscle and deep perineal (Gallaudet's) fascia Superficial perineal c o m p a r t m e n t (space or pouch)

Perineal membrane, Deep transverse perineal muscle and Superficial transverse perineal muscle (cut away) to expose Anterior recess of ischioanal fossa Preanal c o m m u n i c a t i o n (inconstant) b e t w e e n right and left ischioanal fossae Pus in ischioanal fossa Posterior c o m m u n i c a t i o n b e t w e e n right and left ischioanal fossae via deep postanal space deep to anococcygeal b o d y (ligament) Gluteus maximus muscle and Sacrotuberous ligament (cut) Posterior recess of ischioanal fossa

Perineal view Spread of perineal abscess in perineal spaces

Plate 396

M.J>

Rectum

Pelvic S c a n s : Sagittal M R I m a g e s M e d i a n (A) a n d p a r a m e d i a n (B) sagittal M R images of female pelvis A

B

A C D P R

Anal canal External os of cervix Dural (thecal) sac Pubic symphysis Rectum

RA S U UB V

Rectus abdominis muscle Sacrum Uterus Urinary bladder Vagina

M e d i a n (C) and p a r a m e d i a n ( D ) sagittal M R images of male pelvis C

D

C Corpus spongiosum CC Corpus cavernosum G Glans penis P Pubic symphysis PS Prostate

Regional Scans

R S T U

Rectum Sacrum Testis Urinary bladder

Plate 397

A r t e r i e s of R e c t u m a n d A n a l C a n a l ( M a l e )

Posterior view

Left colic artery Ascending branch Descending branch

Inferior mesenteric artery A b d o m i n a l aorta Inferior vena cava M e d i a n sacral artery

Sigmoid arteries

C o m m o n iliac artery

Marginal arterv

External iliac artery

Rectosigmoid arteries

Internal iliac artery

Superior rectal artery (bifurcation)

Lateral sacral artery Superior gluteal artery

/

' ;i

i ii A

wEVSA Ay/.

iffl m

Middle rectal artery-

ft . •

I : , I it

: t

/

I/

/ I

Inferior epigastic artery

Inferior gluteal artery

Ischial spine

O b t u r a t o r artery


Internal pudendal artery Umbilical artery

Internal pudenda] artery

Inferior vesical artery

Pudendal canal (Alcock's)

Artery to ductus deferens

Ischial tuberosity

Superior vesical artery

Coccygeus (ischiococcygeus) muscle Inferior rectal artery Levator ani muscle

Plate 398

External anal sphincter muscle Puborectalis muscle {severed)

M i d d l e rectal artery Inferior rectal artery

Vasculature

V e i n s of R e c t u m a n d A n a l C a n a l ( F e m a l e ) •MHHHHHHMHHi

A n t e r i o r view

Inferior mesenteric vein (to portal vein via splenic vein) Inferior vena cava Sigmoid veins C o m m o n iliac veins

Median sacral vein Superior rectal vein (bifurcation)

External iliac vein

Internal iliac vein

Obturator vein

Superior vesical and uterine veins (from uterine venous plexus)

M i d d l e rectal vein

Internal pudendal vein

C o m m u n i c a t i o n between internal and perimuscular rectal plexuses

Vaginal vein (from vaginal venous plexus)

Inferior vesicular vein

Internal pudendal vein in pudendal canal (Alcock's)

Inferior rectal vein

C o m m u n i c a t i o n between internal and external venous plexuses

Internal rectal plexus Perimuscular rectal venous plexus External rectal plexus

Vasculature

Plate 399

A r t e r i e s a n d Veins of Pelvic O r g a n s : F e m a l e

A n t e r i o r view

I tilll Renal artery and vein Kidney Ovarian artery and vein Ureter Inferior vena cava Psoas major muscle Peritoneum (cut edge) Suspensory ligament of ovary contains ovarian vessels Rectum Ovary Uterine (fallopian) tube Uterus Round ligament of uterus

Renal artery and vein Ovarian artery and vein A b d o m i n a l aorta Ureter Inferior mesenteric artery Psoas major muscle C o m m o n iliac artery M e d i a n sacral vessels Superior rectal artery (cut) Round ligament of uterus (cut) Ovarian artery Internal iliac artery Anterior division External iliac artery O b t u r a t o r artery and nerve Umbilical artery (patent part) M i d d l e rectal artery Uterine artery Vaginal artery Inferior vcsical artery Round ligament of uterus (cut)

Vagina

Superior vesical arteries

Urinary bladder

Inferior epigastric artery and vein

Medial umbilical fold

Umbilical artery (occluded part) Superior vesical arteries Medial umbilical ligament M e d i a n umbilical ligament (urachus)

Plate 400

Vasculature

Anterior view

Renal vessels Inferior vena cava

Mm > .

A b d o m i n a l aorta Testicular vessels (part of spermatic cord) Ureter Inferior mesenteric artery C o m m o n iliac vessels Internal iliac vessels External iliac vessels Inferior vesical artery Inferior epigastric vessels Artery to ductus deferens Cremasteric vessels Testicular vessels in spermatic corcl Femoral vessels Superficial external pudendal vessels {cut—pass superficial to spermatic cord)

mm mm

Deep external pudendal vessels Pampiniform venous plexus Deep dorsal vein and dorsal arteries of penis under deep (Buck's) fascia of penis

i•

Vasculature

Plate 401

5

A r t e r i e s a n d V e i n s of Pelvis: F e m a l e

M e d i a n sacral artery

A b d o m i n a l aorta Right

Iliolumbar artery

} C o m m o n iliac arteries

Lateral sacral arteries

Internal iliac artery Posterior division Anterior division External iliac artery Umbilical artery (patent part) O b t u r a t o r artery

Superior gluteal artery

M i d d l e rectal artery Uterine artery

Piriformis muscle

Vaginal artery Inferior vesical artery

Inferior gluteal arterv

Superior vesical arteries

Internal pudendal artery—

/ / •

Medial umbilical ligament (occluded part of umbilical artery) Pubic symphysis Sagittal section

Coccygeus (ischiococcygeusj muscle

Right p a r a m e d i a n section: lateral view

Sacrotuberous ligament O b t u r a t o r fascia (of obturator internus muscle)

A b d o m i n a l aorta Inferior vena cava

Internal pudendal artery in pudendal canal (Alcock's)

Right c o m m o n iliac artery

Levator ani muscle (cut edge)

Left c o m m o n iliac artery Ureter? External iliac artery (cut)

Superior gluteal artery Umbilical artery (patent part) O b t u r a t o r artery

—Internal iliac artery Posterior division Anterior division

Piriformis muscle Internal pudendal artery Inferior gluteal artery Coccygeus (ischiococcygeus) muscle M i d d l e rectal artery Uterine artery Vaginal artery Inferior vesical artery Internal pudendal artery Inferior rectal artery Superior vesical arteries Medial umbilical ligament (occluded distal part of umbilical artery)

Plate 402

Obturator

canal Obturator internus muscle Levator ani muscle

Vasculature

A r t e r i e s a n d V e i n s of Pelvis: M a l e

Left p a r a m e d i a n section: lateral view

Inferior vena cava

Abdominal aorta

Right obturator vessels

C o m m o n iliac vessels

Right umbilical artery (patent part)

Median sacral vessels External iliac vessels (cut)


Internal iliac vessels

Umbilical artery (occluded part)

Iliolumbar artery

Deep circumflex iliac vessels Inferior epigastric vessels

Lateral sacral artery Superior gluteal artery Obturator artery \

Umbilical artery Ureter (cut)

Ductus deferens and its artery

Inferior gluteal artery Inferior vesical artery

Medial umbilical ligament-

Middle rectal artery

Median umbilical ligament (urachus)

Internal pudendal artery Ductus deferens and its artery


Prostatic branches of inferior vesical artery

Superficial dorsal vein of penis—

Inferior rectal artery Prostatic venous plexus

Deep dorsal vein and dorsal artery of penis

Sphincter urethrae muscle Perineal artery


Posterior scrotal arteries

Testicular artery

Internal pudendal artery on superior aspect of perineal membrane

Pampiniform (venous) plexus Artery to ductus deferens

Inferior vesical artery

Vesical (retropubic) venous plexus

Branch to Urethral branches Capsular branches Hyperplastic middle lobe W

0

W /

- « » " T -w — M .

Z>

Hyperplastic lateral lobe Sphincter urethrae mucle Arterial supply of prostate

(Frontal section, anterior view of specimen with benign hyperplasia)

Vasculature

Plate 403

I

,•;

, .'vl

;'•

A r t e r i e s a n d Veins of P e r i n e u m a n d U t e r u s w^q^s-wssM^.

• •

1

• i fH 1 1 H11
Posterior labial artery

Dorsal artery of clitoris Deep artery of clitoris


Bulb of vestibule Compressor urethrae muscle


Artery to bulb of vestibule


Greater vestibular (Bartholin's) gland Deep transverse perineal muscle

Perineal membrane

Internal pudendal (clitoral) artery Perineal m e m b r a n e ( c u t a w a y )

Perineal artery

Perineal artery {cut)


Superficial perineal (Colles') f asci a (cut and reflected) t o ° P e n superficial perineal space

mm "M


Perineal artery

Inferior rectal artery


Branches of uterine artery

Round ligament

Inferior rectal artery External anal sphincter muscle Note: D e e p perineal (investing or Gallaudet's) fascia r e m o v e d f r o m muscles of superficial perineal space.

Ovarian vessels Tubal branches of ovarian vessels Uterine vessels Ureter Vaginal branches of uterine artery Vaginal artery Levator ani muscle Perineal m e m b r a n e Internal pudendal artery Perineal artery /

A/.7>,

Superficial perineal space •

/

)

\

:

•

:

'! •

Superficial perineal (Colles 7 ) fascia

Vasculature

Arteries and Veins of Perineum? Male

External spermatic fascia over testis and spermatic c o r d

Superficial (dartos) fascia of scrotum Septum of scrotum Posterior scrotal arteries Deep (Buck's) fascia of penis


Superficial perineal (Colles') fascia {cut edge)



{opened)

Perineal artery and vein

Perineal membrane

Internal pudendal artery passes superior to perineal m e m b r a n e

Perineal b o d y

Superficial transverse perineal muscle and transverse perineal artery {cut and reflected)


Internal pudendal vessels and pudendal nerve {cut) in pudendal canal (Alcock's) ( opened up)

Transverse perineal

Inferior rectal artery Inferior fascia of pelvic diaphragm (roof of ischioanal fossa)

Superficial perineal (Colles') fascia (cut edge) Pudendal canal (Alcock's)

Note: Deep perineal (investing or Gallaudet's) fascia r e m o v e d f r o m muscles of superficial perineal space D e e p artery of penis Deep dorsal vein of penis Dorsal artery and nerve of penis Transverse perineal ligament (anterior thickening of perineal membrane) Deep artery of penis Dorsal artery of penis Urethral artery Perineal m e m b r a n e ( cut edge) Artery of bulb of penis Internal pudendal artery Perineal artery {cut) Internal pudendal vessels in pudendal canal (Alcock's) Superficial perineal (Colles') fascia {cut edge)

Vasculature

Plate 405

Lymph Vessels and Nodes of Pelvis and Genitalia: Female

Lateral aortic (lumbar) nodes Preaortic lymph nodes Promontorial (middle sacral) nodes C o m m o n iliac nodes

(Lateral) sacral node

Internal iliac node Lateral (superior) external iliac node

Medial (inferior) external iliac nodes

Obturator node

Superficial inguinal nodes Highest deep inguinal node (of Cloquet) Deep inguinal nodes

Plate 406

Vasculature

Lymph Vessels and Nodes of Perineum: Female

Inguinal ligament (Po u part's) Highest deep inguinal node (of Cloquet)

Fascia lata ( c u t a w a y ) Inferior nodes (vertical group) Superolateral nodes (horizontal group)

Femoral vessels and nerve Superficial inguinal nodes

Deep inguinal nodes

Superomedial nodes (horizontal group)

Vasculature

Plate 407

Lymph Vessels and Nodes of Pelvis and Genitalia: Male

Preaortic nodes

Pathways f r o m testes along testicular vessels

C o m m o n iliac nodes

Promontorial (middle sacral) nodes

(Lateral) sacral n o d e

Internal iliac nodes


Highest deep inguinal n o d e (of Cloquet)

— Deep inguinal nodes

Superficial inguinal nodes

Preaortic node Promontorial n o d e

Presymphyseal node

C o m m o n iliac node


Pathway along inferior vesical vessels to internal iliac nodes (principal pathway)

Pathway over bladder to external iliac nodes

Internal iliac nodes (Middle and lateral) sacral nodes

Pathway alongside rectum to (middle and lateral) sacral nodes

Prevesical plexus and pathway ( b r o k e n line) to external iliac nodes

Lymphatic drainage f r o m prostate

Plate 408

Pathway {broken line) f r o m lower prostate and m e m b r a n o u s urethra along internal pudendal vessels (beneath pelvic diaphragm) to internal iliac nodes

Vasculature

Nerves of External Genitalia: Male See also Plates 165, 166, 318

Splanchnic nerves

Greater Lesser Least

Celiac ganglia


Subcostal nerve (T12) Iliohypogastric nerve

Lumbar splanchnic nerves

Ilioinguinal nerve


Sympathetic trunk and ganglia Genitofemoral nerve

Testicular artery and plexus

Lateral femoral cutaneous nerve


Femoral branch and Genital branch of genitofemoral nerve

Hypogastric nerves

Femoral nerve



Ductus deferens and plexus

Femoral branches of genitofemoral nerve

Femoral nerve

Anterior cutaneous branches of femoral nerve


Anterior cutaneous branch of iliohypogastric nerve Dorsal nerves of penis Genital branch of genitofemoral

Anterior scrotal nerve (from ilioinguinal nerve)

Innervation

Plate 409

Nerves of Pelvic Viscera: Male mmmmmmmmmm


Anterior vagal trunk Posterior vagal trunk and Celiac branch

spinal nerve (ventral ramus) W h i t e and gray rami c o m m u n i c a n t e s Greater / Lesser } , ^ t Least \

Inferior phrenic arteries and plexuses Left gastric artery and gastric

Left renal artery and plexus

Left aorticorenal gan

LI spinal nerve (ventral ramus)

Superior mesenteric ganglion Superior mesenteric artery and plexu

Gray \ White j


Ureter and ureteric plexus Superior hypogastric plexus Superior rectal artery and plexus Hypogastric nerves

, . . SPlanchnic nerves

Diaphragm

Celiac ganglia, plexus, and trunk

Inferior mesenteric ganglion, artery and plexus

r

Rami communicantes

1st, 2nd, 3rd lumbar splanchnic nerves Gray rami c o m m u n i c a n t e s Sympathetic trunk and ganglia 5th lumbar splanchnic nerve L5 spinal nerve (ventral ramus) Lumbosacral trunk

Nerve f r o m inferior hypogastric plexus to sigmoid and descending colon (parasympathetic)

Gray rami c o m m u n i c a n t e s SI spinal nerve (ventral ramus)

Sacral splanchnic nerves (sympathetic)

Pelvic splanchnic nerves (parasympathetic)


Sacral plexus

O b t u r a t o r nerve and artery

Piriformis muscle


Gluteus maximus muscle and sacrotuberous ligament

Vesical plexus

Coccygeus (ischiococcygeus) muscle and sacrospinous ligament

Rectal plexus Prostatic plexus Cavernous nerves of penis

Pudendal nerve Levator ani muscle Inferior anal (rectal) nerve Perineal nerve Dorsal nerve of penis

/

M. 7>.

Plate 410

Posterior scrotal nerves

Innervation

Nerves of Perineum: Male See also Plate 416

Posterior scrotal nerves Perineal nerves

Superficial Deep ^

Dorsal nerve of penis Perineal m e m b r a n e (cut to show neurovascular structures on superior aspect of perineal membrane)

Dorsal nerve of penis (continuation of pudendal nerve supplying muscles on superior aspect of perineal membrane) Superficial perineal (Colles') fascia (cut to open superficial perineal space) Superficial and deep branches of perineal nerve Dorsal nerve of penis (passes superior to perineal membrane) Perineal nerve O b t u r a t o r fascia (of obturator intern us muscle) Posterior femoral cutaneous nerve Pudendal canal (Alcock's) (opened

up)

Pudendal nerve

Inferior clunial nerves

Piriformis muscle

Inferior anal (rectal) nerves Perforating cutaneous nerve A n o c o c c y g e a l nerve Sacrotuberous ligament (cut) Gluteus maximus muscle (cut)

Innervation

Coccygeus (ischiococcygeus) muscle Ischial spine Pudendal nerve Levator ani muscle O b t u r a t o r internus muscle Inferior anal (rectal) nerve Perineal nerve

Plate 411

Nerves of Pelvic Viscera: Female See also Plates 165,166, 318

Sympathetic trunk and L2 ganglion

Peritoneum

minal aorta Inferior vena cava Extraperitoneal (subserous) fascia

W h i t e and gray rami communicantes

Common iliac vessels and plexus

Lumbar splanchnic

Ureter Intermesenteric (aortic) plexus Ovarian artery and plexus

GravI rami communicantes


L5 spinal nerve

Sacral prom on tor Superior hypogastric plexus

Right hypogastric nerve [cut)

Common iliac artery and plexus

Right and left sacral sympathetic trunks and ganglia

Ureter Internal iliac artery and plexus

igmoid colon

External iliac artery and plexus

Piriformis muscle

Right and left hypogastric nerves Uterus Right sympathetic trunk

Sacral splanch nic nerves (sympathetic)

Left hypogastric nerve Inferior hypogastric (pelvic) plexus Uterine (fallopian) tube

Pudendal nerve

Ovary Symphyseal surface of pubis

Pelvic splanchnic nerves (parasympathetic)

Urinary bladder Vesical plexus

Coccygeus (ischiococcygeus) muscle

Uterovaginal plexus Uterus

(retracted)

Rectum (retracted)

!nn0*vaii©ii

Nerves of Perineum and External Genitalia: Female See also Plate 415

Anterior labial nerve (from ilioinguinal nerve) Dorsal nerve of clitoris Posterior labial nerves Superficial ( Branches > or perineal Deep \ nerve Perineal branch of posterior femoral cutaneous nerve

Dorsal nerve of clitoris passing superior to perineal m e m b r a n e Perineal nerve Pudendal nerve in pudendal canal (Alcock's) {dissected) Inferior clunial nerves Gluteus maximus muscle ( c u t a w a y ) Sacrotuberous ligament Perforating cutaneous nerve Inferior anal (rectal) nerves A n o c o c c y g e a l nerves

— Ischial tuberosity Ischial spine

Block anesthesia of pudendal and other nerves of perineal area

Innervation

Plate 413

Neuropafhways in Parturition See also Plates 165, 166

Greater

Splanchnic nerves

Lesser

spinal nerve (anterior ramus)

Least

Celiac ganglion

Sympathetic trunk and ganglia

Aorticorenal ganglion I I spinal nerve (anterior ramus)


Rami communicantes Intermesenteric (aortic) plexus

Subcostal nerve (T12) Inferior mesenteric ganglion

Lumbar splanchnic nerves

Intermesenteric (aortic) plexus Superior hypogastric plexus S1 spinal nerve (anterior ramus) Iliohypogastric nerve ( L I )

Hypogastric nerves

Ilioinguinal nerve ( L I )

Pelvic splanchnic nerves

Vesical plexus


Dorsal nerve of clitoris

Uterovaginal plexus

Posterior labial nerves

Pudendal nerve (S2, 3, 4) Inferior anal (rectal) nerve

Sensory fibers f r o m uterine body and fundus accompany sympathetic fibers via hypogastric plexuses t o T 1 1 , 12 (L1?)

—• Sensory fibers from cervix and upper vagina accompany pelvic splanchnic nerves (parasympathetic) to S2, 3, 4

Sensory fibers from lower vagina and perineum accompany somatic fibers via pudendal nerve to S2, 3, 4

M o t o r fibers to uterine body and fundus (sympathetic)

M o t o r fibers to lower uterine segment, cervix, and upper vagina (parasympathetic)

- - - - - - M o t o r fibers to lower vagina and perineum via pudendal nerve (somatic)

Plate 414

Innervation

Innervation of Female Reproductive Organs: Schema m

See also Plates 167,168

Sympathetic trunk and ganglion Celiac ganglia and plexus Gray ramus communicans White ramus communicans Aorticorenal ganglia Greater splanchnic nerve


Lesser splanchnic nerve Least splanchnic nerve

T11


Sympathetic trunk

Lumbar splanchnic nerves Inferior mesenteric ganglion

L3 spinal nerve

Ovarian artery and plexus


Uterine (fallopian) tube Hypogastric nerves Note: Pain from intraperitoneal pelvic viscera (e.g., uterine contractions) goes via uterovaginal and pelvic plexuses, hypogastric nerves, superior hypogastric plexus, lower aortic plexus, lower lumbar splanchnic nerves, sympathetic trunk from L4 to L5 to spinal nerves T11, 12. Pain from subperitoneal pelvic viscera (e.g., cervical dilation and upper vagina) goes via pelvic splanchnic nerves to S2, 3, 4. Afferent fibers from lower vagina and perineum go via pudendal nerves to S2, 3, 4. Sympathetic f'bers

( )


Innervation

Inferior extent of peritoneum — Uterovaginal and inferior hypogastric (pelvic) plexuses Pelvic splanchnic nerves

Sacral plexus

if Pudendal nerve Parasympathetic fibers

Preganglionic

Afferent fibers

Postganglionic

Plate 415

Innervation of Male Reproductive Organs: Schema See also Plates 167, 168

Celiac ganglia

Sympathetic trunk and g a n g l i a Greater splanchnic nerve (T5-9)

Superior mesenteric ganglion Gray ramus communicans

T11

W h i t e ramus communicans

Left aorticorenal ganglion

Lesser splanchnic nerve — Least splanchnic nerve

Renal ganglion L1

Upper lumbar splanchnic Intermesenteric (aortic) plexus

L2

Inferior mesenteric ganglion Gray ramus communicans Testicular artery and plexus



Hypogastric nerves


Inferior extent of peritoneuiru


Pelvic splanchnic nerves Pelvic splanchnic nerves Sacral plexus Sacral plexus

Pudendal nerve

Pudendal nerve

Dorsal nerves of penis

Inferior hypogastric (pelvic) plexus Vesical plexus

Epididymis

Prostatic plexu

Testis

(Greater and lesser) cavernous nerves of penis

Sympathetic fibers

\ Preganglionic — ) postganglionic —

Plate 416


\ Preganglionic ^ ^ ^ ^ ) Postganglionic — — — —

Afferent fibers

Innervation

innervation of Urinary Bladder and Lower Ureter: Schema See also Plates 167,168 >orsa! (posterior) root


Ventral (anterior) root Superior mesenteric ganglion Rami communicantes Aorticorenal ganglion

Renal artery and plexus



1 st and 2nd lumbar splanchnic nerves

Lumbar part > of spinal corcl

L2 spinal nerve (ventral ramus)

Sacral part of spinal cord

Sympathetic trunk

Descending fibers

1

\

Gray rami - communicantes

Superior hypogastric plexus Ureter

Hypogastric nerves

Sacral splanchnic % nerves from If sacral sympathetic / trunk to inferior hypogastric (pelvic) I® plexus


Urinary bladder

Pudendal nerve Vesical plexus

Sacral plexus

Prostatic plexus


Sphincter urethrae muscle superior to perineal membrane Bulbospongiosus muscle

Sympathetic

(

Preganglionic

fibers

)

Postganglionic

Innervation


j )


Somatic efferent fibers Afferent fibers

Plate 41

EUpper Limb Topographic A n a t o m y Plate

418

4 1 8 Upper Limb

S h o u l d e r a n d Axilla Plates 419-430

419

Clavicle and Sternoclavicular Joint

420

Humerus and Scapula: Anterior Views

421 Humerus and Scapula: Posterior View 4 2 2 Shoulder: Anteroposterior Radiograph 423 Shoulder (Glenohumeral Joint) 424 Muscles of Shoulder 425 Muscles of Rotator Cuff 426 Scapulohumeral Dissection 427 Axillary Artery and Anastomoses around Scapula 428

Pectoral, Clavipectoral, and Axillary Fasciae

429 Axilla (Dissection): Anterior View 430

Brachial Plexus: Schema

Arm Plates 431-435

431

Muscles of Arm: Anterior Views

432 Muscles of Arm: Posterior Views 4 3 3 Brachial Artery in Situ 434

Brachial Artery and Anastomoses around Elbow

4 3 5 Arm: Serial Cross Sections


Upper Limb Elbow a n d F o r e a r m

463 Lumbrical Muscles and Bursae, Spaces, and Sheaths: Schema

Plates 436-451

436

Bones of Elbow

464 Flexor and Extensor Tendons in Fingers

437

Elbow: Radiographs

465

Intrinsic Muscles of Hand

438 Ligaments of Elbow

466

Arteries and Nerves of Hand: Palmar Views

4 3 9 Bones of Forearm

467

Wrist and Hand: Superficial Radial Dissection

440 Individual Muscles of Forearm: Rotators of Radius

468 Wrist and Hand: Superficial Dorsal Dissection

441 Individual Muscles of Forearm: Extensors of Wrist and Digits

469 Wrist and Hand: Deep Dorsal Dissection

442 Individual Muscles of Forearm: Flexors of Wrist

470 Extensor Tendons at Wrist

4 4 3 Individual Muscles of Forearm: Flexors of Digits

471 Fingers

4 4 4 Muscles of Forearm (Superficial Layer): Posterior View 4 4 5 Muscles of Forearm (Deep Layer): Posterior View 446

Muscles of Forearm (Superficial Layer): Anterior View

Neurovasculature Plates 472-483

Cutaneous Innervation of Wrist and Hand

447 Muscles of Forearm (Intermediate Layer): Anterior View

472

448 Muscles of Forearm (Deep Layer): Anterior View

4 7 3 Arteries and Nerves of Upper Limb

4 4 9 Forearm: Serial Cross Sections

4 7 4 Musculocutaneous Nerve

450 Attachments of Muscles of Forearm: Anterior View

475

451 Attachments of Muscles of Forearm: Posterior View

4 7 6 Ulnar Nerve 477

Median Nerve

Radial Nerve in Arm and Nerves of Posterior Shoulder

Wrist a n d H a n d

4 7 8 Radial Nerve in Forearm

Plates 452-471

4 7 9 Cutaneous Nerves and Superficial Veins of Shoulder

452

Carpal Bones

453

Movements of Wrist

454 Ligaments of Wrist 4 5 5 Ligaments of Wrist (continued) 456 Bones of Wrist and Hand 4 5 7 Wrist and Hand: Anteroposterior Radiograph 458

Metacarpophalangeal and Inlerphalangeal Ligaments

4 5 9 Wrist and Hand: Superficial Palmar Dissections 460

Wrist and Hand: Deeper Palmar Dissections

461 Flexor Tendons, Arteries, and Nerves at Wrist 462

Bursae, Spaces, and Tendon Sheaths of Hand


and Arm 480

Cutaneous Nerves and Superficial Veins of Forearm

481

Cutaneous Innervation of Upper Limb

482

Dermatomes of Upper Limb

483

Lymph Vessels and Nodes of Upper Limb

Regional Scans Plate 484

484 CT Angiograms of Arteries of the Upper Limb

Anterior view

Trapezius muscle Clavicle Acromion Deltoid muscle Cephalic vein

Biceps brachii muscle Pectoralis major muscle Cubital fossa Posterior view Deltoid muscle

Cephalic vein Serratus anterior muscle

Median cubital vein

Triceps brachii muscle (long head)

Brachioradialis muscle Flexor carpi radialis tendon Thenar eminence

Basilic vein Intermediate (median) antebrachial vein Triceps Palmaris longus brachji m u $ d e tendon , , . Long head Flexor digitorum Lateral head superficialis tendons Tendon Flexor carpi ulnaris tendon Hypothenar eminence Proximal palmar crease Proximal digital crease

Brachioradialis and extensor carpi radialis longus muscles

Middle digital crease Radial ' longitudinal

Distal digital crease

crease

C o m m o n name of digits 1 2 3 4 5

Thumb Index Middle Ring Little

Extensor pollicis longus tendon Extensor indicis tendon

Extensor carpi radialis brevis muscle

Olecranon of ulna

Flexor carpi ulnaris muscle Extensor carpi ulnaris muscle Cephalic vein

Extensor digitorum tendons Site of proximal interphalangeal (PIP) joint Site of distal interphalangeal (DIP) joint

Topographic Anatomy

*.—//.p.

Plate 418

6

Clavicle and Sternoclavicular Joint

Right clavicle

Superior surface

Acromial end end

Shaft body

Impression for costoclavicular ligament

Acromial facet

Trapezoid line Conoid tubercle Trapezius muscle

Sternal facet Subclavian groove (for subclavius muscle)

Muscle origins Muscle insertions

Superior surface

Ligament attachments

Sternocleidomastoid muscle Deltoid muscle Deltoid muscle Inferior surface

Anterior

Coracoclavicular igament

Trapezoid ligament Conoid ligament

Pectoralis major muscle Pectoralis major muscle

„

Costoclavicular ligament

Posterior Subclavius muscle Sternohyoid muscle

Anterior sternoclavicular ligament Clavicle Subclavius muscle Costoclavicular ligament

Sternoclavicular joint Interclavicular ligament

Articular disc of sternoclavicular joint

" t ^ jv v T

Articular cavities of sternoclavicular joint -Costoclavicular ligament Synchondrosis of 1st rib

Costal cartilages 2nd rib Radiate sternocostal ligament

Plate 419

Manubrium -Sternocostal (synovial) joint Manubriosternal synchondrosis

Shoulder and Axilla

Humerus and Scapula: Anterior Views m

See also Plate 185

Acromial angle

Acromion

Coracoid process

Clavicle (cat) ^ / S u p e r i o r angle

Supraglenoid tubercle

Superior border

Anatomical neck

—Suprascapular notch

Greater tubercle

—Neck

Lesser tubercle

Medial border

Surgical neck

•Subscapular fossa

Intertubercular sulcus

Glenoid \ cavity of scapula

Crest of greater tubercle

nfraglenoid tubercle Lateral border

| Head of :! humerus

Crest of lesser tubercle

Inferior angle Trapezius muscle Pectoralis minor muscle

Humerus

O m o h y o i d muscle

Deltoid tuberosity Deltoid muscle

Medial supracondylar ridge

Biceps brachii muscle (long head)

Lateral supracondylar ridge

Supraspinatus muscle Subscapularis muscle

Medial Condyles j ^ ,

C o r a c o b r a c h i a l muscle and Biceps brachii muscle(short head)

Radial fossa-


Lateral epicondyle


Capitulum

Teres major muscle

Coronoid fossa

Deltoid muscle C o r a c o b r a c h i a l muscle

Trochlea Medial epicondyle

Brachialis muscle Brachioradialis muscle

Triceps brachii muscle (long head)


Subscapularis muscle

Muscle attachments Origins Insertions

Extensor carpi radialis longus muscle Pronator teres muscle (humeral head)

C o m m o n extensor tendon (extensor carpi radialis brevis, extensor digitorum with extensor digiti minimi, and extensor carpi ulnaris muscles) Brachialis muscle Supinator muscle Biceps brachii muscle

Shoulder and Axilla

C o m m o n flexor tendon (flexor carpi radialis, palmaris longus, flexor carpi ulnaris and flexor digitorum superficialis [humeroulnar head] muscles) Flexor digitorum superficialis muscle (humeroulnar head) Pronator teres muscle (ulnar head) Flexor pollicis longus muscle (ulnar head)

Plate 420

6

Humerus and Scapula: Posterior Views See also Plate 185

Suprascapular notch

Clavicle [cut) Coracoid process

Superior border. Superior angleSupraspinous fossa

M

'

Acromion

-

Acromial angle Notch connecting supraspinous and infraspinous fossae

Spine Neck

Greater tubercle Head of humerus

Infraspinous fossa

Anatomical neck

Medial border

Surgical neck

Lateral border

Groove for circumflex scapular vessels

Inferior angle


Trapezius muscle

levator scapulae muscle

Infraglenoid tubercle Deltoid tuberosity Radial groove

Humerus

Scapula


Deltoid muscle -Supraspinatus muscle

Rhomboid minor muscle


-Infraspinatus muscle Teres minor muscle


Triceps brachii muscle (Ions hi


Teres minor muscle

Latissimus dorsi muscle (small slip of origin)

Teres major muscle

Olecranon fossa

Triceps brachii muscle (lateral head)

Lateral epicondyle

Groove for ulnar nerve

Deltoid muscle Brachialis muscle

Medial epicondyle

Triceps brachii muscle (medial head) Muscle attachments W m

Origins

w m m Insertions Triceps brachii muscle

C o m m o n flexor tendon

C o m m o n extensor tendon

Anconeus muscle

Plate 421

Shoulder and Axilla

Shoulder: Anteroposterior Radiograph See also Plate 420

Shoulder and Axilla

A AN C CP G GT H HH LT S SN

Acromion

ss

Spine of scapula

Anatomical neck of humerus Clavicle Coracoid process Glenoid cavity of scapula Greater tubercle Humerus Head of humerus Lesser tubercle Scapula (lateral border) Surgical neck of humerus

Plate 422

6

Shoulder (Glenohumeral Joint)

Anterior view Acromioclavicular j o i n t capsule (incorporating acromioclavicular l i g a m e n t ) - ^

Clavicle

Acromion Coracoacromial l i g a m e n t —

/

—Trapezoid ligament

^g^R^.

Conoid ligament

Supraspinatus t e n d o n ( c u t ) - ^ ^ ^ C o r a c o h u m e r a l ligament Greater tubercle a n d - ^ ^ / Lesser t u b e r c l e - — < " ' of humerus — L "' Transverse humeral ligament Intertubercular t e n d o n sheath—

J I / \ )

Coracoclavicular ligament

Superior transverse scapular ligament and suprascapular notch

^ -

^ C o r a c o i d process

i

- C o m m u n i c a t i o n of subtendinous bursa of subscapularis

"

(communicates w i t h synovial cavity)

Broken line indicates position of subtendinous bursa of subscapularis

Subscapularis tendon ( c u t ) ^ Biceps brachii t e n d o n (long head)

Capsular ligaments

Anterior view

sasfcs:

Supraspinatus muscle Subdeltoid bursa fused w i t h subacromial bursa

Deltoid muscle (.reflected)

Subscapularis muscle Subdeltoid bursa

Capsular ligament

Deltoid muscle

•

\ \ \

Capsular ligament \

Synovial m e m b r a n e

\

Acromion \ \

/ /

.Acromioclavicular /joint

C o r a c o i d process

— — B i c e p s brachii t e n d o n (long head) ]mk

f: Jmm G l e n o i d cavity ( c a r t i l a g e ) - ^ " - ^

:•:

^ s

edge)'

O p e n i n g of subtendinous bursa of subscapularis —

vP ||<> îlffflM W l f \

Superior glenohumeral ligament Subscapularis t e n d o n (fused to capsule)

J^BPv m™ \ A M i d d l e glenohumeral \ ligament Inferior glenohumeral ligament

Joint opened: lateral view

Plate 423

\

f m ^ ^ J ^ — " C o r a c o h u m e r a l ligament

Subdeltoid bursa

Synovial m e m b r a n e (cut

\

Coracoacromial ligament

Supraspinatus t e n d o n (fused to capsule)

Teres minor t e n d o n (fused t o capsule)

Supraspinatus t e n d o n \

Acromion

Infraspinatus tendon(fused t o capsule)

\

y.. • • .

I V }

Glenoid labrum'

I I

Glenoid cavity of scapula

Axillary recess

Coronal section through j o i n t

Shoulder and Axilla

See also Plates 27,174,188,189

Posterior view

Semispinalis capitis muscle

Not connected to upper limb

Splenius capitis muscle

Spinous process of C7 vertebra Levator scapulae muscle Trapezius muscle

Rhomboid minor muscle Rhomboid major muscle ion

Deltoid muscle

Supraspinatus muscle Spine of scapula


Infraspinatus muscle Teres minor muscle Teres major muscle Latissimus dorsi muscle Long head Lateral head )

of triceps brachii muscle

Spinous process of T12 vertebra

Triangle of auscultation Trapezius muscle

Anterior view Acromion Deltopectoral triangle

O m o h y o i d muscle and investing layer of deep cervical fascia Sternocleidomastoid muscle Clavicle

Deltoid muscle Deltoid branch of thoracoacromial artery Cephalic vein Biceps ( L o n g h e a d brachii \ muscle ( Short head Triceps brachii muscle (lateral head) Latissimus dorsi muscle Serratus anterior muscle

Clavicular head Sternocostal head Abdominal part


Sternum 6th costal cartilage Anterior layer of rectus sheath


SSioylcfer aoid âciOia

PQate 424

Superior view

^

^

^

|igament

j

Trape2oid

ligamen;

( C o n o i d ligament


1ft Supraspinatus tendon Infraspinatus tendon Teres minor tendon Acromion

Clavicle Superior border of scapula Subscapularis muscle

Spine of scapula Supraspinatus muscle

^ ' r a c o a c r o m i a l ligament

Acromion Supraspinatus tendon

process



Spine of scapula Acromion Supraspinatus tendon

Biceps brachii tendon

Infraspinatus muscle Teres minor muscle

CA/cit/favL

Anterior view

Plate 425

Axillary nerve

Posterior view

Shoulder and Axilla

Scapulohumeral Dissection See also Plate 477 Lateral view

Levator scapulae muscle Accessory nerve (XI)

Phrenic nerve Scalene muscles

Anterior Middle Posterior

Brachial plexus Subclavian artery and vein Superior thoracic artery External intercostal membrane anterior to internal intercostal mu

Scapula (retracted)

Perforating branch of internal thoracic artery and anterior cutaneous branch of intercostal nerve

Subscapularis muscle major muscle


Long thoracic nerve

External intercostal Lateral thoracic artery Lateral cutaneous branches of intercostal nerves and posterior intercostal Serratus anterior muscl

t

Anterior view


Acromion

Coracoid process Suprascapular artery and nerve

Supraspinatus tendon Greater tubercle of humerus Subscapularis tendon Intertubercular tendon sheath Anterior circumflex humeral artery Biceps brachii tendon (long head) (cut) Axillary nerve and posterior circumflex humeral artery Quadrangular space Radial nerve Biceps \ Long head brach,ii

j Short head muscle (

C o r a c o b r a c h i a l muscle Triangular space

•ov.yay*

^ ^ - - S u p c r i o r transverse scapular ligament and suprascapular notch — Pectoralis minor tendon (cut) Biceps brachii tendon (short head) (cut) and coracobrachialis tendon (cut) Subscapularis muscle Subscapular artery Lower subscapular nerve (to teres major muscle) Circumflex scapular artery Thoracodorsal artery and nerve (to latissimus dorsi muscle) Subscapularis muscle Teres major muscle

Latissimus dorsi muscle Suprascapular artery and nerve Acromion Posterior view Superior transverse scapular ligament and suprascapular notch Supraspinatus muscle (cut) Spine of scapula Infraspinatus muscle (cut) Triangular space with circumflex scapular artery deep to space Teres major muscle

ShouldlesT and ibdlia

Infraspinatus tendon (reflected) Joint capsule of shoulder Deltoid muscle (reflected) minor muscle Quadrangular space transmitting axillary nerve and posterior circumflex humeral artery Superior lateral brachial cutaneous nerve Profunda brachii (deep brachial) artery and Radial nerve shown between Lateral head and Long head of triceps brachii muscle

POafe 426

6

Axillary Artery and Anastomoses around Scapula See also Plates 33, 434 Ascending cervical artery Transverse cervical artery

Anterior view

Inferior t h y r o i d artery Thyrocervical trunk

Suprascapular

Subclavian artery

A c r o m i o n and acromial anastomosis

Anterior scalene muscle Clavicle {cut)

Dorsal scapular a


Coracoid process

oracoacromial artery

Anterior circumflex humeral artery

Clavicular branch

Posterior circumflex humeral artery

Acromial branch

Subscapular a

Pectoral branch

Deltoid branch

Circumflex scapular artery

1, 2, 3 indicate 1st, 2nd, and 3rd parts of axillary artery

Brachial artery Thoracodorsal artery Lateral thoracic arte, 7

O m o h y o i d muscle (inferior belly) Suprascapular artery

Levator scapulae muscl

. .. . Acromial branch ot thoracoacromial artery A c r o m i o n and acromial plexus

Dorsal scapular arte

Infraspinous branch of suprascapular artery


Posterior circumflex humeral artery (in quadrangular space)and ascending and descending branches


Spine of scapula


Circumflex scapular artery

Teres minor muscle [cut)

Lateral head ) Triceps / of brachii Long head ) muscle

Teres major muscle

CAfctt/tfrk* /YT>—

Posterior view

Plate 427

Shoulder and Axilla

Pectoral, Clavipectoral, arid Axillary Fasciae See also Plate 188 Thoracoacromial arte

Trapezius muscle muscle invested by fascia of infrahyoid muscles


Clavicle Fascia investing subclavius muscle*

Cephalic vein

C o s t o c o r a c o i d ligament*

Deltoid muscle

Costoclavicular ligament Costocoracoid membrane*

Pectoralis major muscle (cut)

Fascia investing pectoralis minor muscle* Suspensory ligament of axilla* Pectoralis major muscle and pectoral fascia (superficial and deep layers)

Biceps brachii muscle Short head Long head

Latissimus dorsi fascia Serratus anterior fascia Axillary fascia (anterior part)

Brachial fascia (cut edge) over coracobrachial and biceps brachii muscles

Anterior view

O m o h y o i d muscle

O b l i q u e parasagittal section of axilla Trapezius muscle ( Brachial plexus < (

Lateral cord Posterior cord Medial c o r d


Scapula

|

Body

Infraspinatus muscle Subscapularis muscle Teres minor muscle Teres major muscle Latissimus dorsi muscle ( dllary l y m p h nodes ) (

Central

avicle Subclavius muscle and fascia* C o s t o c o r a c o i d ligament* Thoracoacromial artery and cephalic vein Costocoracoid membrane* Lateral pectoral nerve Axillary artery and vein Pectoralis major muscle and fascia Pectoralis minor muscle and fascia* M e d i a l pectoral nerve Suspensory ligament of axilla Axillary fascia ( f e n e s t r a t e d )

pectQra[

(anterior) ^ C o m p o n e n t s of clavipectoral fascia

Shoulder and Axilla

Plate 428

Axilla (Dissection): Anterior View

Trapezius muscle

Thoracoacromial artery A c r o m i a l branch

Pectoralis m i n o r t e n d o n (cut)

Suprascapular artery and nerve Dorsal scapular artery and nerve

D e l t o i d branch


Transverse cervical artery

Clavicular branch

Acromion Cephalic vein

Pectoral branch

M u s c u l o c u t a n e o u s nerve

Axillary artery


A n t e r i o r scalene muscle

Clavicle and subclavius muscle (cut)

Axillary nerve and posterior circumflex humeral artey Pectoralis major muscle (cut)


C o r a c o b r a c h i a l muscle Phrenic Deltoid muscle

n e r v e

Biceps brachii muscle

m

M

M

M

Omohyoid muscle

f

' IWJi

Musculocutaneous nerve

Brachialisi muscle

Ulnar nerve

/

Medial brachial cutaneous nerve

Profunda brachii (deep brachial) artery

\A wm-L : IwM}.

Intercostobrachial nerve /m Circumflex / 1 scapular artery I

Radial nerve Triceps brachii muscle Brachial veins

\ \

Lower sub- / scapular nerve Teres major muscle

Subscapular artery

Ulnar nerve


X

1

Thoracodorsal artery and nerve U p p e r subscapular nerve

Medial antebrachial i cutaneous nerve f Basilic vein


T ^ ^ w^ 1

M e d i a n nerve Brachial artery

I * •^ s

1 I


Lateral thoracic artery and long thoracic nerve t Ansa pectoralis

1st rib Brachial plexus Superior thoracic artery Lateral pectoral nerve Medial pectoral nerve

Pectoralis minor (cut)

Plate 429

Shoulder and Axilla

Brachial Plexus: Schema

Note: Usual composition shown. Prefixed plexus has large C4 contribution but lacks T1. Postfixed plexus lacks C5 but has T2 contribution.

Contribution from C4 Dorsal ramus

Musculocutaneous nerve (C5, 6, 7

To longus colli and scalene muscles (C5, 6, 7t 8)

Axillary nerve (C5, 6) Radial nerve (C5, 6, 7r 8, T1 Median nerve (C5, 6, 7, 8 , 1 1 ) Ulnar nerve (C7, 8, T1)

1 st intercostal nerve Long thoracic nerve (C5, 6, 7) Medial pectoral nerve (C8, T1) Medial brachial cutaneous nerve (T1) Medial antebrachial cutaneous nerve (C8, T1)

Inconstant contribution

Upper subscapular nerve (C5, 6) Thoracodorsal (middle subscapular) nerve (C6, 7f 8) Lower subscapular nerve (C5, 6)

Shoulder and Axilla

PQafa 43©

Muscles of Arm: Anterior Views See also Plate 474

Acromion


CoracoicJ process

Subdeltoid bursa

Pectoralis minor t e n d o n {cut) Greater tubercle, Lesser tubercle of humerus

muscle M u s c u l o c u t a n e o u s nerve (cut)

Intertubercular t e n d o n sheath

C o r a c o b r a c h i a l muscle Circumflex scapular artery (cut)

D e l t o i d muscle (.reflected)

Teres major muscle Latissimus dorsi muscle

Pectoralis major muscle ( r e f l e c t e d ) Anterior circumflex humeral artery Biceps brachii

( \

Long head

muscle

(

Short head Biceps brachii tendons (cut) Short head Long head

Brachial artery (cut) M e d i a n nerve [cut) Brachialis muscle

Coracobrachialis muscle

Lateral antebrachial cutaneous nerve

Musculocutaneous Branch to biceps brachii (cut)

Bicipital aponeurosis

D e l t o i d muscle (cu Biceps brachii t e n d o n Brachioradialis muscle Pronator teres muscle Flexor carpi radialis muscle Brachialis muscle

Superficial layer

Lateral intermuscular septum

Medial intermuscular septum

Lateral e p i c o n d y l e of humerus Lateral antebrachial cutaneous nerve Head of radiu

Medial epicondyle of humerus

Biceps brachii t e n d o n Radial tuberosity

Tuberosity of ulna

Deep layer

Arm

Muscles of Arm: Posterior Views See also Plate 477

Superficial layer

Acromion

Supraspinatus muscle Greater tubercle of humerus Infraspinatus muscle Teres m i n o r muscle Axillary nerve and posterior circumflex humeral artery D e l t o i d muscle (cut and

reflected)

Superior lateral brachial cutaneous nerve Long head Lateral head Tendon

) > ofTriceps brachii muscle \

Brachioradialis muscle ^ psule of shoulder joint Supraspinatus t e n d o n Teres major

Infraspinatus and eres minor tendons (cut)

Posterior brachial cutaneous nerve (from radial nerve

Axillary nerve


Posterior circumflex humeral artery

Teres major muscle

Ulnar nerve Medial epicondyle of humerus

Superior lateral brachial cutaneous nerve

O l e c r a n o n of ulna


Flexor carpi ulnaris muscle

Radial nerve

A n c o n e u s muscle

M i d d l e collateral artery

Extensor carpi radialis longus muscle

Radial collateral arterv

Extensor carpi ulnaris muscle

Inferior lateral brachial cutaneous nerve

/

Posterior antebrachial cutaneous nerve (fro radial nerve)


Extensor d i g i t o r u m muscl

Lateral head ot triceps brachii muscle (cut)

Extensor carpi radialis brevis m

Medial head of triceps brachii muscle Medial e p i c o n d y l e of humerus

Lateral intermuscular septum N e r v e to anconeus and medial head of triceps brachii muscle Posterior antebrachial cutaneous nerve

Ulnar nerve O l e c r a n o n of ulna

Deep layer

Lateral epicondyle of humerus

A n c o n e u s muscle

PQate 432

Brachial Artery in Situ

Coracoid process

Axillary artery

Deltoid muscle

Pectoralis minor muscle (cut)


Lateral cord, Medial cord of brachial plexus

Humerus


Pectoralis major muscle and tendon (cut)

Subscapularis muscle Biceps brachii muscle

Long head

Anterior and posterior circumflex humeral arteries

Short head

Teres major muscle

C o r a c o b r a c h i a l muscle

Latissimus dorsi muscle Profunda brachii (deep brachial) artery

Muscular branch


Median nerve

Ulnar nerve Medial antebrachial cutaneous nerve

Muscular branch

Long head Medial head


ofTriceps brachii muscle

Superior ulnar collateral artery Brachialis muscle Medial intermuscular septum Inferior ulnar collateral artery Medial epicondyle of humerus


Bicipital aponeurosis Radial artery

Pronator teres muscle .tfctf;:

Ulnar artery Flexor carpi radialis muscle Brachioradialis muscle

Plate 433

Arm

Brachial Artery and Anastomoses around Elbow See also Plate 427

Clavicular branch A

Pectoral branch

Acromial branch Deltoid branch Thoracoacromial artery


Axillary artery

Lateral thoracic artery

Anterior circumflex humeral artery Posterior circumflex humeral artery

Subscapular artery Circumflex scapular artery

Brachial artery

Thoracodorsal artery Profunda brachii (deep brachial) artery of lower margin of teres major muscle is landmark for name change from axillary to brachial arterv Radial collateral artery

Middle collateral artery Superior ulnar collateral artery

Inferior ulnar collateral artery Radial recurrent artery

Posterior interosseous artery

Anterior ulnar recurrent artery Posterior ulnar recurrent artery

Radial artery

C o m m o n interosseous artery Anterior interosseous artery Ulnar artery

Plate 434

6

Arm: Serial Cross Sections


Pectoralis major muscle and tendon

Median nerve

Cephalic vein

Medial antebrachial cutaneous nerve


Brachial artery and veins Coracobrachialis muscle

Basilic vein

Humerus


Deltoid muscle of Triceps brachii muscle

Ulnar nerve Radial nerve

Lateral head Long head



Latissimus dorsi tendon Musculocutaneous nerve

Teres major muscle

Brachialis muscle

Brachial fascia

Cephalic vein

Median nerve Brachial artery and veins

Radial nerve Posterior antebrachial cutaneous nerve (from radial nerve)

Medial antebrachial cutaneous nerve Basilic vein

Radial collateral artery


Middle collateral artery

Neurovascular compartment

Lateral intermuscular septum of Triceps ( brachii < muscle

(

Ulnar nerve

Medial head Lateral head

*

Superior ulnar collateral artery Medial intermuscular septum

Long head

Brachial fascia


Lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

Cephalic vein


Brachialis muscle

Basilic vein Brachioradialis muscle

Median nerve

Radial nerve

Ulnar nerve

Extensor carpi radialis Iongus muscle Posterior antebrachial cutaneous nerve (from radial nerve)

Plate 435

Brachial artery and veins Medial intermuscular septum

p

Humerus Triceps brachii muscle and tendon Lateral intermuscular septum

Arm

H e m e s ©f EDfe@w

Right elbow Medial

Condyle

Humerus

Humerus

Lateral



Olecranon fossa^

Coronoid fossa

Radial fossa

Lateral epicondyle Lateral epicondyle

Medial epicondyle

Capitulum

Olecranon

Trochlea Groove for ulnar nerve

Coronoid process

Tuberosity

Radial notch of ulna Tuberosity

Tuberosity

Radius

Radius

In extension: anterior view

In extension: posterior view Sublime tubercle Humerus

Radius

Humerus

In extension: lateral view

!n extension: medial view Humerus Medial epicondyl Capitulum Trochlea Head Neck Tuberosity Radius

Ulna Coronoid process ( r , . . . > of ulna Trochlear notch Olecranon

In 90° flexion: lateral view

E!fe@w and Forearm

Coronoid process Trochlear notch Olecranon

In 90° flexion: medial view

Plate 436

Jwj Elbow: Radiographs See also

Plate 436

Lateral radiograph

Anteroposterior radiograph

Plate 437

C

Capitulum

CP

Coronoid process of ulna

H

Humerus

HR

Head of radius

L

Lateral epicondyle

M

Medial of epicondyle

NR

Neck of radius

O

Olecranon

OF

Olecranon fossa

R

Radius

T

Trochlea of humerus

RT

Radial tuberosity

U

Ulna

c

Capitulum

CP

Coronoid process of ulna

H

Humerus

HR

Head of radius

L

Lateral epicondyle

O

Olecranon

R

Radius

T

Trochlear notch

U

Ulna

•mSS^m^n H s a i wMtfi f»

W-1 i

H 81 i ill

lift:

i f s i y

Elbow and Forearm

Right elbow Anterior view

Humerus

Joint capsule Medial epicondyle

Lateral epicondyle Radial collateral ligament

Ulnar collateral ligament

Insertion of brachialis muscle Biceps brachii tendon Oblique cord Radius

Humerus

Joint capsule

Joint capsule

Ulnar collateral ligament

Radial collateral ligament

Annular ligament of radius

Annular ligament of radius

Triceps brachii tendon

Humerus


Triceps brachii tendon

Biceps brachii tendon Oblique cord Radius

Subcutaneous olecranon bursa

In 90° flexion: medial view

In 90° flexion: lateral view

Humerus

Subcutaneous olecranon bursa

Joint capsule (cut edge)

Humerus

Fat pads

Opened j o i n t : anterior view

Synovial membrane

Opened j o i n t : posterior view

Articular cartilage

Radius

Elbow and Forearm

Radius

Plate 438

Bones of Forearm

— Olecranon

Right radius and ulna in supination: anterior view

Right radius and ulna in pronation: anterior view

Trochlear notch Coronoid process

Head

Radial notch of ulna Ulnar tuberosity

Neck

Oblique cord Ulnar tuberosity

Oblique cord

Radial tuberosity

Radius

Ulna

Radius

Ulna

Anterior surface

Anterior su

Lateral surface Posterior border

Anterior border Anterior border

Posterior surface Interosseous membrane

Interosseous border Interosseous border

Interosseous membrane

Dorsal tubercle Groove for extensor pollicis longus muscl

Groove for extensor carpi radialis longus and brevis muscles

Groove for extensor digitorum and extensor indicis muscles

Area for extensor pollicis brevis and abductor pollicis longus muscles

Styloid process of ulna Styloid process

Styloid process

Radius Ulnar notch of radius Styloid process

Styloid process ted)

Area for scaphoid bone

Area for lunate bone

Carpal articular suface

Plate 439

Coronal section of radius demonstrates how thickness of cortical bone of shaft diminishes to thin layer over cancellous bone at distal end

Eib@w and Forearm

Individual Muscles of Forearm: Rotators of Radius iff §

Right f o r e a r m : anterior view Supinated position

Pronated position

Medial epicondyle

Medial epicondyle

Lateral epicondyle

Supinator

Pronator teres

Radius Radius

Pronator quadratus

Elbow and Forearm

POat© 44®

Individual Muscles of Forearm: Extensors of Wrist and Digits

(Note: Anconeus muscle not shown because it is extensor of elbow

Medial epicondyle Olecranon Lateral epicondyle

Extensors of wrist Olecranon Lateral epicondyle

Extensor carpi radialis longus

mmon extensor tendon

Extensor carpi radialis brevisExtensor carpi ulnaris

Common extensor tendon

Extensors of digits (except t h u m b ) Extensor d i g i t o r u m

Extensor digitorum and extensor digiti minimi (cutaway)

Interosseous membrane Radius

Extensor digiti m i n i m i Extensor indicis

Extensors of t h u m b A b d u c t o r pollicis longus Extensor pollicis brevis Extensor pollicis longus

Extensor indicis tendon

Extensor digitorum and extensor digiti minimi tendons

Right forearm: posterior (dorsal) views

Plate 441

Elbow and Forearm

Individual Muscles of Forearm: Flexors of Wrist Wimivm

Note: Brachioradialis muscle not shown because it is flexor of elbow Medial epicondyle

Lateral epicondyle

C o m m o n flexor tendon

Flexor carpi radialis

Palmaris longus

Radius

Pisiform H o o k of hamate Palmar aponeurosis (cut)

Right forearm: anterior (palmar) view

Elbow and Forearm

Plate 442

Individual Muscles of Forearm: Flexors of Digits

Medial epicondyle

Medial epicondyle

Lateral epicondyle

Lateral epicondyle

Coronoid process Coronoid process Interosseous membrane Interosseous membrane Radius

Radius

Flexor d i g i t o r u m superficialis

Flexor d i g i t o r u m profundus

Flexor pollicis longus

Radius

. Ulna

Radius

Flexor digitorum superficialis tendons (cut a

Right forearm: anterior ( p a l m a r ) views

Plate 443

E!b@w and Forearm

Muscles of Forearm (Superficial Layer): Posterior View See also Plates 470, 478

Superior ulnar collateral artery (anastomoses distally with posterior ulnar recurrent artery)

Triceps brachii muscle

Brachioradialis muscle Ulnar nerve Extensor carpi radialis longus muscle Medial epicondyle of humerus C o m m o n extensor tendon Olecranon of ulna

Anconeus muscle


Extensor digitorum muscle

Extensor digiti minimi muscle

Extensor pollicis brevis muscle

Extensor pollicis longus t e n d o n Extensor retinaculum (compartments numbered)

Dorsal branch of ulnar nerve

Extensor carpi radialis brevis tendon Extensor carpi radialis longus tendon

Superficial branch of radial nerve

A b d u c t o r pollicis longus tendon Extensor carpi ulnaris tendon

Extensor pollicis brevis tendon

Extensor digiti minimi tendon

Extensor pollicis longus tendon

Extensor digitorum tendons Extensor indicis tendon

5th metacarpal bone

EIb©w and F@rearnn

Plate 444

Muscles of Forearm (Deep Layer): Posterior View See also Plates 470, 479

, ( Superior ulnar collateral f branches oi ) inferior ulnar collateral brachial artery ) , . . . ( (posterior branch) P


Ulnar nerve

Posterior ulnar recurrent artery


Triceps brachii tendon [cut)

O l e c r a n o n of ulna

Anconeus muse

Flexor carpi ulnaris muscl

Recurrent interosseous artery

Posterior interosseous artery

M i d d l e collateral branch of deep brachial artery


Brachioradialis muscle


Lateral epicondyle of humerus

C o m m o n extensor t e n d o n ( p a r t i a l l y cut)


Supinator muscle

Posterior interosseous nerve

Pronator teres muscle (slip of insertion)

Radius

-

interosseous nerve Extensor pollicis longus muscle

Extensor indicis muscle

Anterior interosseous artery (termination)

uctor pollicis longus muscle


Extensor carpi radialis brevis t e n d o n Extensor carpi radialis longus t e n d o n

Extensor carpi ulnaris t e n d o n (cut) Extensor digiti minimi tendon (cut) Extensor d i g i t o r u m tendons (cut)

Extensor retinaculum (co m part m e n ts n u m bered)

oth metacarpal bone

Plate 445

Radial artery

1 st metacarpal b o n e 2nd metacarpal bone 1 st dorsal interosseous muscle

Elfoow and Forearm

Muscles of Forearm (Superficial Layer): Anterior View mmmmmmmmmmmmmmmmmsm

wmrnmrnm




Ulnar nerve

Brachial artery and median nerve

Triceps brachii muscle Lateral antebrachial cutaneous nerve (terminal musculocutaneous nerve)

M e d i a l intermuscular septum

Brachialis muscle

Ulnar artery

Medial e p i c o n d y l e of humerus

Biceps brachii t e n d o n

C o m m o n flexor t e n d o n

Radial artery

Pronator teres muscle Bicipital aponeurosis Flexor carpi radialis muscle


Palmaris longus muscle

Extensor carpi radialis longus m u

Superficial flexor muscles

Flexor carpi ulnaris muscle


Flexor digitorum superficialis muscle Flexor pollicis longus muscle a n d t e n d o n Palmaris longus tendon


M e d i a n nerve

Palmar carpal ligament (continuous w i t h extensor retinaculum)

Thenar muscles

Palmar aponeurosis

EIb@w and Forearm

Ulnar artery and nerve

Pisiform

Palmar branch of median nerve

H y p o t h e n a r muscles

Plate 446

6

Muscles of Forearm (Intermediate Layer): Anterior View See also Plates 475, 476

Ulnar nerve


M e d i a n nerve

Brachialis muscle

Brachial artery Lateral antebrachial cutaneous nerve (cut) (from musculocutaneous nerve)

Medial intermuscular septum Pronator teres muscle (humeral head) (cut and reflected)

Radial nerve Deep branch Superficial branch

Medial epicondyle Flexor carpi radialis and palmaris longus tendons (cut)

Biceps brachii t e n d o n

Anterior ulnar recurrent artery

Radial recurrent artery

Flexor d i g i t o r u m superficialis muscle (humeroulnar head)

Radial artery

Ulnar artery Supinator muscle

C o m m o n interosseous artery Pronator teres muscle (ulnar head) (cut)


rior interosseous artery Pronator teres muscle (

Flexor carpi ulnaris muscle exor d i g i t o r u m superficialis muscle

Flexor d i g i t o r u m superficialis muscle (radial head)

Ulnar artery Flexor pollicis longus muscle

Palmar carpal ligament (continuous w i t h extensor retinaculum) w i t h palmaris longus t e n d o n (cut and reflected)

Flexor carpi radialis t e n d o n (cut)

Ulnar nerve and dorsal branch M e d i a n nerve Palmar branches of median and ulnar nerves (cut) Pisiform D e e p palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve

Superficial palmar branch of radial artery

Flexor retinaculum (transverse carpal ligament)

Elbow and Forearm

Muscles of Forearm (Deep Layer): Anterior View See also Plates 475, 476

Brachialis muscle

Ulnar nerve

M u s c u l o c u t a n e o u s nerve (becomes) Lateral antebrachial cutaneous nerve

M e d i a n nerve Brachial artery



Radial nerve

Pronator teres muscle (humeral head cut and

Lateral e p i c o n d y l e

or ulnar recurrent artery

Biceps brachii t e n d o n (cut)


Radial recurrent artery Radial artery

Flexor carpi radialis, palmaris longus, flexor d i g i t o r u m superficialis (humeroulnar head), and flexor carpi ulnaris muscles (cut)

Supinator muscle V

Posterior and anterior interosseous

Posterior ulnar recurrent artery

Flexor d i g i t o r u m superficialis muscle (radial head) {cut)

reflected)

—

Ulnar artery

0

Pronator teres muscle (cut and reflected)

n interosseous artery

Radial artery Flexor pollicis longus muscle and t e n d o n (cut) Radius Pronator quadratus muscle Brachioradialis t e n d o n (cut) Radial artery and superficial palmar branch

Pronator teres muscle (ulnar head) (cut) M e d i a n nerve (cut) Flexor d i g i t o r u m profundus muscle terior interosseous artery and nerve Ulnar nerve and dorsal branch Palmar carpal branches of radial and ulnar arteries Flexor carpi ulnaris tendon (cut)

Flexor pollicis longus t e n d o n Pisiform Flexor carpi radialis tendon (cut) A b d u c t o r pollicis longus t e n d o n

Deep palmar branch of ulnar artery and deep branch of ulnar nerve

Extensor pollicis brevis tendon

H o o k of hamate

1 st metacarpal b o n e

Elb@w and Forearm

*

5th metacarpal b o n e

Plate 448

Forearm: Serial Cross Sections

Median antebrachial vein

Flexor digitorum superficialis muscle (radial head)

Pronator teres muscle

Anterior branch of medial antebrachial cutaneous nerve

Radial artery and superficial branch of radial nerve

Flexor pollicis longus muscle

Radius

I nterosseous m em brane


Flexor carpi radialis muscle

Cephalic vein and lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

Ulnar artery and median nerve Palmaris longus muscle Flexor digitorum superficialis muscle (humeroulnar head)

Supinator muscle D e e p branch of radial nerve

C o m m o n interosseous artery


Ulnar nerve


Flexor carpi ulnaris muscle Basilic vein

Extensor digitorum muscle

Flexor digitorum profundus muscle

Extensor digiti minimi muscle

Ulna and antebrachial fascia


Anconeus muscle


Posterior antebrachial cutaneous nerve (from radial nerve)

Brachioradialis muscle Radial artery and superficial branch of radial nerve

Palmaris longus muscle Flexor digitorum superficialis muscle


Median nerve

Extensor carpi radialis longus muscle and tendon

Ulnar artery and nerve Flexor carpi ulnaris muscle

Radius

Anterior interosseous artery and nerve (from median nerve)

Extensor carpi radialis brevis muscle and tendon

Flexor digitorum profundus muscle Ulna and antebrachial fascia

Abductor pollicis longus muscle

Interosseous membrane and extensor pollicis longus muscle

Extensor digitorum muscle Extensor digiti minimi muscle

Posterior interosseous artery and nerve (continuation of deep branch of radial nerve)


Palmaris longus tendon

Flexor carpi radialis tendon

Median nerve

Radial artery

Flexor digitorum superficialis muscle and tendons Flexor carpi ulnaris muscle and tendon

Brachioradialis tendon


A b d u c t o r pollicis longus tendon


Superficial branch of radial nerve

Flexor digitorum profundus muscle and tendons

Extensor pollicis brevis t e n d o n ^

Antebrachial fascia

Extensor carpi radialis longus tendon

Ulna Extensor carpi ulnaris t e n d o n

Extensor carpi radialis brevis tendon

Pronator quadratus muscle and interosseous membrane


Extensor indicis muscle and tendon

Extensor pollicis longus t e n d o n

Extensor digiti minimi tendon Radius

Plate 449

Extensor digitorum tendons ( c o m m o n tendon to digits 4 and 5 at this level)

Elbow and Forearm

Attachments of Muscles of Forearm: Anterior View mmmmamm* mss*

Brachioradialis muscle Extensor carpi radialis longus muscle

Brachialis muscle Pronator teres muscle (humeral head)

Supinator Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris muscles

Common extensor tendon

Brachialis muscle Biceps brachii muscle

Common flexor tendon

Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis (humeroulnar head) muscles

Flexor digitorum superficialis muscle (humeroulnar head) Pronator teres muscle (ulnar head)

Supinator muscle Flexor digitorum superficialis muscle (radial head)


Pronator teres muscle Flexor pollicis longus muscle

Radius Pronator quadratus muscle Pronator quadratus muscle Brachioradialis muscle

Note: Attachments of intrinsic muscles of hand not shown

Abductor pollicis longus muscle — Flexor carpi ulnaris muscle Extensor carpi ulnaris muscle Flexor carpi radialis muscle


4

Flexor digitorum superficialis muscle


Origins

Elbow and Forearm

Insertions

Plate 450

Attachments of Muscles of Forearm: Posterior View

Triceps brachii muscle (medial head)

Note: Attachments of intrinsic muscles of hand not shown

riceps brachii tendon Supinator

Flexor carpi ulnaris muscle (humeral origin via c o m m o n flexor tendon

Anconeus muscle


Flexor carpi ulnaris muscle (ulnar origin)

Supinator muscle


Abductor pollicis longus muscle Extensor carpi ulnaris muscle (ulnar origin) Pronator teres muscle Extensor pollicis longus Extensor pollicis brevis muscle Extensor indicis muscle-

Ulna

Radius



Extensor carpi radialis brevis muscl Abductor pollicis longus muscle Extensor carpi ulnaris muscle

Extensor digitorum muscle (central bands)

Extensor cligiti minimi


Extensor pollicis longus muscle

Extensor indicis muscle Extensor digitorum muscle (lateral bands) r

I

Plate 451

i Origins

j M i

Insertions

C a r p a i SS@mes

Anterior (palmar) view

Radius

Ulna

Radial styloid

Ulnar styloid process

Scaphoid

Lunate

Tubercle of scaphoid

Triquetrum

Trapezium

Pisiform

Tubercle of trapeziu

Hamate

Trapezoi

H o o k of hamate Capitate

Metacarpal bones

Posterior (dorsal) view Radius Dorsal tubercle of radius (Lister's)

Ulnar styloid process

Scaphoid Radial styloid process pezium Triquetrum

Trapezoid

Hamate Capitate

Metacarpal bones

Wrist and Hand

Plate 452

Movements of Wrist m

Ulna

Radius

Ulna

Radius

Lunate

Scaphoid

net rum

Capitate Trapezoid

Lunate

Tra

Pisiform Capitate Hamate Trapezoid

Sesamoid bo Pisiform

Trapezium

Hamate

Metacarpal bones

Metacarpal bones Sesamoid bones

Position of carpal bones w i t h hand in abduction: anterior (palmar) view

Position of carpal bones w i t h hand in adduction: anterior (palmar) view Wrist (radiocarpal) joint

Radius

Radius

Midcarpal joint Carpometacarpal joint

Wrist (radiocarpal) nt

. Palm

Articular disc of wrist joint Lunate Midcarpal oint

H a n d in flexion

Capitate Carpometacarpal joint

Wrist (radiocarpal) joint

3rd metacarpal bone

Midcarpal joint Carpometacarpal joint

Dorsum Hand in anatomical position

Sagittal sections through wrist and middle finger

Plate 453

Hand in extension

Carpal tunnel: palmar view

Ulna Interosseous m e m b r a n e

Palmaris longus t e n d o n Palmar carpal ligament (thickening of deep antebrachial fascia) [cut and reflected)

Ulnar artery and nerve Flexor carpi ulnaris t e n d o n

Radial artery and superficial palmar branch

Flexor digitorum profundus tendons

Flexor carpi radialis t e n d o n

Flexor d i g i t o r u m superficialis tendons

Flexor pollicis longus t e n d o n

Pisiform

M e d i a n nerve


Palmar aponeurosis Tubercle of scaphoid

H o o k of hamate

Tubercle of trapezium Flexor retinaculum (transverse carpal ligament)

Metacarpal bones

Flexor retinaculum removed: palmar view

Short radiolunate ligamentPalmar radiolunate ligament

Long radiolunate ligament

Ulnolunate ligament

Radioscaphocapitate ligament

Ulnocapitate ligament Scaphotrapeziotrapezoid ligament

Ulnotriquetral ligament

Scaphocapitate ligment

Lunotriquetral ligament

Trapeziotrapezoid ligament

Triquetrohamate ligament Triquetrocapitate ligament

Capitohamate ligament Trapeziocapitate ligament

1

Metacarpal bones

Wrist asrad Hainsd

Plate 454

Ligaments of Wrist (continued)

Posterior (dorsal) view Dorsal radial metaphyseal arcuate ligament Dorsal radiocarpal ligament Dorsal radioulnar ligament Ulnotriquetral ligament (dorsal view)

Scapholunate ligament

Triquetrohamate ligament

Trapeziotrapezoid ligament

Dorsal intercarpal ligament Trapeziocapitate ligament

Capitohamate ligament

Metacarpal bones

Coronal section: dorsal view Ulna

Radius «

Distal radioulnar joint

Lunate

Articular disc of wrist joint

Wrist (radiocarpal) joint

Meniscus

Scaphoid Midcarpal joint

Interosseous intercarpal ligaments

Trapezoid

Triquetrum

Trapezium

Hamate

Carpometacarpal joint

Capitate

Intermetacarpal joints

Metacarpal bones

Plate 455

Wrist aind Hand

Bones of Wrist and Hand

Carpal bones

Scaphoid and Tubercle

Lunate Triquetrum Pisiform

Trapezium and Tubercle

L

itate

Carpal bones

7

Hamate and Hook

Trapezoid

Base Shafts Head

Sesamoid bones

Base Shafts Head Base | Shafts V Head J

Metacarpal bones y '

Right hand: anterior (palmar) view

Proximal phalanges

M i d d l e phalanges

Base Shafts Tuberosity Head

L [

Distal phalanges

Lunate

Carpal bones

Scaphoid Capitate Trapezoid Carpal bones

Metacarpal bones

Proximal phalanges Right hand: posterior (dorsal) view M i d d l e phalanges

Distal phalanges

WsrSsf audi Haoid]

<

Triquetrum jl Hamate |

Base < Shafts [ Head

Base Shafts Head Base Shafts Head

Base Shafts Tuberosity

Pfefe 456

mm

Plate 457

BM

Base of 5th metacarpal

P

Pisiform

BP

Base of 4th proximal phalanx

PP

Proximal phalanx of t h u m b

C

Capitate

PPI

Proximal phalanx of index finger

DP

Distal phalanx of t h u m b

R

Radius

DPR

Distal phalanx of ring finger

S

Scaphoid

H

Hamate

SH

Shaft of 5th metacarpal

HH

H o o k of hamate

SP

Styloid process of ulna

HM

Head of 5th metacarpal

SPR

Styloid process of radius

HP

Head of proximal phalanx

T

Triquetrum

L

Lunate

TP

Trapezoid

M

Metacarpal of index finger

TZ

Trapezium

MP

Middle phalanx of middle finger

U

Ulna

Wrist and Hand

Metacarpophalangeal and Interphalangeal Ligaments

Pisiform


H o o k of hamate Palmar carpometacarpal ligaments Palmar metacarpal ligaments

Joint capsule

Deep transverse metacarpal ligaments

Collateral ligaments

Palmar ligaments (plates) Cut margins of digital fibrous sheaths

Flexor digitorum superficialis tendons (cut)


Metacarpophalangeal (MP) joint \\gament V Metacarpal bone

In extension: medial view

Dorsal surface

Palmar surface

C°"ateral

/ Proximal interphalangeal (PIP) joint

T r u e collateral / ligament /

Proximal

Middle

Distal interphalangeal / ( D I P ) joint

Distal

Palmar ligament (volar plate) Accessory collateral ligament

In flexion: medial view

Phalanges

True collateral ligament Palmar ligament (volar plate)

Note: Ligaments of metacarpophalangeal and interphalangeal joints are similar

Wrist and Hand

Plate 458

6

Wrist and Hand: Superficial Palmar Dissections

Palmaris longus t e n d o n

Palmar branch of ulnar nerve

Branch of superficial radial nerve to skin of lateral thenar area

Pisiform Deep palmar branch of ulnar artery and deep branch of ulnar nerve

Palmar carpal ligament (thickening of deep antebrachial fascia continuous w i t h extensor retinaculum)

Superficial branch of ulnar nerve Ulnar artery Palmaris brevis muscle


H y p o t h e n a r muscles

Thenar muscles

Palmar aponeurosis

Recurrent (motor) branch of median nerve t o thenar muscles

Palmaris brevis muscle ( r e f l e c t e d )

M i n u t e fasciculi attach palmar aponeurosis to dermis

Anterior (palmar) views

Palmar digital nerves f r o m superficial branch of ulnar nerve to 5th and medial half of 4th fingers

Palmar aponeurosis

Transverse fasciculi

Palmar digital arteries and nerves

Plate 459

Wrist and Hand

Wrist and Hand: Deeper Palmar Dissections

Radial artery and venae comitantes

Ulnar artery w i t h venae comitantes and ulnar nerve


Flexor carpi ulnaris t e n d o n

Tendinous sheath of flexor pollicis longus (radial bursa)

C o m m o n flexor sheath (ulnar bursa) containing superficialis and profundus flexor tendons Pisiform

M e d i a n nerve Palmaris longus t e n d o n and palmar carpal ligament Transverse carpal ligament (flexor retinaculum)

Deep palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve Palmar digital nerves to 5th finger and medial half of 4th finger

Thenar muscles

M e d i a n nerve

Proper palmar digital nerves of t h u m b

C o m m o n flexor sheath (ulnar bursa) Superficial palmar arterial and venous arches

(Synovial) tendinous sheath of flexor pollicis longus i. (radial bursa)

—2nd, 3rd, and 4th lumbrical muscles (in fascial sheaths) (Synovial) flexor t e n d o n sheaths of fingers

Probe in I st lumbrical fascial sheath C o m m o n palmar digital artery Proper palmar digital arteries Septa f r o m palmar aponeurosis f o r m i n g canals Palmar aponeurosis (.reflected)

Anterior (palmar) views

Superficial palmar branch of radial artery and recurrent branch of median nerve to thenar muscles Ulnar artery and nerve C o m m o n palmar digital branches of median nerve (cut) Hypothenar muscles

Proper palmar digital nerves of t h u m b Fascia over adductor pollicis muscle

C o m m o n flexor sheath (ulnar bursa) 5th finger (synovial) tendinous sheath

Probe in dorsal extension of thenar space deep to a d d u c t o r pollicis muscle Thenar space (deep to flexor tendons and 1st lumbrical muscle) Septum separating thenar f r o m midpalmar space C o m m o n palmar digital artery Proper palmar digital arteries and nerves Annular and c r u c i f o r m parts of fibrous sheath over (synovial) flexor t e n d o n sheaths

Wrist and Hand

Probe in midpalmar space M i d p a l m a r space (deep to flexor tendons and lumbrical muscles) Insertion of flexor digitorum superficialis t e n d o n Insertion of flexor digitorum profundus t e n d o n

Plate 460

Mi

1mm

6

Flexor Tendons, Arteries, and Nerves at Wrist Palmar view

M e d i a n nerve

Flexor d i g i t o r u m superficialis tendons and flexor d i g i t o r u m profundus tendons

Radial artery

C o m m o n flexor sheath (ulnar bursa)

Palmaris longus t e n d o n

Flexor carpi radialis tendon Flexor pollicis longus t e n d o n in t e n d o n sheath (radial bursa) Palmar carpal ligament

Ulnar artery Ulnar nerve Flexor carpi ulnaris tendon

(reflected)

(Synovial) t e n d o n sheath Pisiform


A b d u c t o r digiti minimi muscle

Trapezium 1st metacarpal bone

Flexor digiti m i n i m i brevis muscle

O p p o n e n s pollicis muscle A b d u c t o r pollicis brevis muscle (reflected)

O p p o n e n s digiti m i n i m i muscle

Superficial palmar (arterial) arch

Lumbrical muscles

Flexor pollicis brevis muscle (reflected)

A d d u c t o r pollicis muscle

Transverse cross section of wrist demonstrating carpal tunnel Palmaris longus tendon


M e d i a n nerve'"

Ulnar artery and nerve Flexor carpi ulnaris tendo Flexor digitorum superficialis tendons*


Flexor digitorum profundus tendons*

Flexor pollicis longus t e n d o n in tendon sheath* Radial artery

Simple m e t h o d of d e m o n s t r a t i n g arrangement of flexor digitorum superficialis tendons within carpal tunnel

Capitate

Trapezoid ^Contents of carpal tunnel

Wrist and Hand

Bursae, Spaces, and Tendon Sheaths of Hand m&m

Pronator quadratus muscle Flexor carpi radialis t e n d o n Common flexor sheath (ulnar bursa)

Tendinous sheath of flexor pollicis longus (radial bursa Flexor retinaculum (transverse carpal ligament)

(reflected)

Flexor d i g i t o r u m profundus t e n d o Tendinous sheath of flexor pollicis longus (radial bursa) Fascia of a d d u c t o r pollicis muscle

Flexor d i g i t o r u m superficialis tendons

Thenar space

C o m m o n flexor sheath (ulnar bursa) (opened)

(deep to flexor t e n d o n and 1st lumbrical muscle) (Synovial) t e n d o n sheath of finger

Lumbrical muscles in fascial sheaths

.

M i d p a l m a r space

(deep to flexor tendons and lumbrical muscles)

Lumbrical muscles in fascial sheaths (cut and reflected)

Fibrous and synovial (tendon) sheaths of finger (opened)

Annular and cruciform parts (pulleys) of fibrous sheath over synovial sheath) of finger

Flexor d i g i t o r u m superficialis tendon

if

Flexor d i g i t o r u m profundus tendon

/—Af.7>.

Midpalmar space Palmar aponeurosis

forming canals Profundus and superficialis flexor tendons to 3rd digit Septum b e t w e e n midpalmar and thenar spaces

Thenar space

C o m m o n palmar digita. artery and nerve

Flexor pollicis longus t e n d o n in t e n d o n sheath (radial bursa)

Lumbrical muscle in its fascial sheath

Extensor pollicis longus tendon

Flexor tendons to 5th digit in c o m m o n flexoi sheath (ulnar bursa H y p o t h e n a r muscles Dorsal interosseous fascia Dorsal subaponeurotic space Dorsal fascia of hand Dorsal subcutaneous space

Wrist and Hand

A d d u c t o r pollicis muscle Palmar interosseous fascia Palmar interosseous muscles Dorsal interosseous muscles Extensor tendons

Plate 462

Lumbrical Muscles and Bursae, Spaces, and Sheaths: Schema Usual arrangement

C o m m o n variation

Tendinous sheath of flexor pollicis longus (radial bursa) Intermediate bursa (communication between c o m m o n flexor sheath [ulnar bursa] and tendinous sheath of flexor pollicis longus [radial bursa])

C o m m o n flexor sheath (ulnar bursa) Thenar space Midpalmar space

Lumbrical muscles (in fascial sheaths) (Synovial) tendon sheaths of fingers

Lumbrical muscles: schema


1st and 2nd lumbrical muscles (unipennate)

Camper chiasm

3rd and 4th lumbrical muscles (bipennate)

Flexor digitorum superficialis tendons (cut)

Note: Flexor digitorum superficialis and profundus tendons encased in synovial sheaths are b o u n d to phalanges by fibrous digital sheaths made up of alternating strong annular (A) and weaker cruciform (C) parts (pulleys). Tendons of flexor digitorum superficialis and profu muscles

(Synovial) tendon sheath

Plate 463

Wrist and Hand

Flexor and Extensor Tendons in Fingers

Insertion of central band of extensor t e n d o n t o base of middle phalanx Slips of long extensor t e n d o n t o lateral bands

Triangular aponeurosis

Posterior (dorsal) view

Extensor expansion (hood)

Interosseous muscles

Long extensor tendon

Metacarpal b o n e

BBS!

Insertion on extensor tendon to base of distal phalanx Lateral bands

Interosseous t e n d o n slip to lateral band Lumbrical muscle

Extensor expansion (hood)

Lateral band

Insertion of extensor t e n d o n to base of middle phalanx

Part of interosseous t e n d o n passes to base of proximal phalanx and joint capsule

Long extensor t e n d o n

Central band

Insertion of extensor t e n d o n to base of distal phalanx

Metacarpal b o n e

Finger in extension: lateral view Collateral ligaments'

Vinculum breve

Vincula longa

Flexor d i g i t o r u m profundus t e n d o n Flexor digitorum superficialis t e n d o n

Interosseous muscles Lumbrical muscle

Collateral ligament Insertion of small deep slip of extensor tendon to proximal phalanx and j o i n t capsule

Extensor t e n d o n

A t t a c h m e n t of interosseous muscle to base of proximal phalanx and j o i n t capsule

Interosseous muscles Insertion of lumbrical muscle to extensor t e n d o n

m superficialis t e n d o n (cut)

Lumbrical muscle


Finger in flexion: lateral view

Flexor d i g i t o r u m profundus t e n d o n (cut) Palmar ligament (plate)

C/feit/tadL / Af.p.

Wrist and Hand

Note: Black arrows indicate pull of long extensor tendon; red arrows indicate pull of interosseous and lumbrical muscles; dots indicate axis of rotation of joints

Plate 464

Radial artery and palmar carpal branch

Pronator quadratus muscle

Radius

Ulnar nerve Ulnar artery and palmar carpal branch

Superficial palmar branch of radial

Flexor carpi ulnaris t e n d o n

Flexor retinaculum (transverse carpal ligament) ( r e f l e c t e d )

Palmar carpal arterial arch Pisiform

O p p o n e n s pollicis muscle

M e d i a n nerve

Branches of median nerve to thenar muscles and to 1st and 2 n d lumbrical muscles

A b d u c t o r digiti minimi muscle (cut) Deep palmar branch of ulnar artery and deep branch of ulnar nerve

A b d u c t o r pollicis brevis muscle {cut)

Flexor digiti m i n i m i brevis muscle (cut)

Flexor pollicis brevis muscle

O p p o n e n s digiti m i n i m i muscle D e e p palmar (arterial) arch


Palmar metacarpal arteries C o m m o n palmar digital arteries

1 st dorsal interosseous muscle

D e e p transverse metacarpal ligaments

Branches from deep branch of ulnar nerve lo 3rd and 4th lumbrical muscles and to all interosseous muscles Lumbrical muscles

(reflected)


Radius

Palmar interosseous muscles (unipennate)

Radius

Deep transverse metacarpal ligaments

Radial artery


A b d u c t o r pollicis brevis muscle

Dorsal interosseous muscles (bipennate)



Tendinous slips to extensor expansions (hoods)

*.—w.

Note: A r r o w s indicate action of muscles.

Plate 465

Arteries and Nerves of Hand: Palmar Views mm

Radial artery


Median nerve and palmar branch Superficial palmar branch of radial artery

Palmar carpal ligament (continuous with extensor retinaculum) Flexor retinaculum (transverse carpal ligament)

A b d u c t o r pollicis brevis muscle (cut)


O p p o n e n s pollicis muscle

Superficial branch of ulnar nerve

Flexor pollicis brevis muscle

C o m m o n flexor sheath (ulnar bursa)

Recurrent (motor) branch of median nerve to thenar muscles-"""

Superficial palmar (arterial) arch

Proper digital nerves and arteries to t h u m b

C o m m o n palmar digital nerves and arteries C o m m u n i c a t i n g branch of median nerve with ulnar nerve


Proper palmar digital nerves and arteries

Branches of median nerve to 1st and 2nd lumbrical muscles Flexor tendons, synovial and fibrous sheaths

Branches of proper palmar digital nerves and arteries to dorsum of middle and distal phalanges

Ulnar artery and nerve Radial artery

Palmar carpal branches of radial and ulnar arteries

Median nerve

Pisiform

Superficial palmar branch of radial Deep palmar (arterial) arch and deep branch of ulnar nerve Princeps pollicis artery

Deep palmar branch of ulnar artery and deep branch of ulnar nerve Branches to hypothenar muscles Superficial branch of ulnar nerve

Proper digital arteries and nerves of thumb

H o o k of hamate Distal limit of superficial palmar arch Radialis indicis a Palmar metacarpal arteries C o m m o n palmar digital arteri Proper palmar digital arteri Proper palmar digital nerves f r o m median nerve-

Wrist arad HawcO

Deep palmar branch of ulnar nerve to 3rd and 4lh lumbrical, all interosseous, adductor pollicis, and deep head of flexor pollicis brevis muscles mmunicating branch of median nerve with ulnar nerve Proper palmar digital nerves from ulnar nerve

Wrist and Hand: Superficial Radial Dissection

Lateral (radial) view Superficial branch of radial nerve Medial branch

Extensor retinaculum

Lateral branch Dorsal digital branches of radial nerve

Dorsal carpal branch of radial artery

Scaphoid Radial artery in anatomical snuffbox

Extensor carpi radialis brevis tendon

ium

Extensor carpi radialis longus tendon

Insertion of abductor pollicis longus t e n d o n

1 st metacarpal bone Radial artery 1st dorsal interosseous muscle

Insertion of extensor pollicis brevis tendon

Insertion of extensor pollicis longus tendon Deep fascia (cut)

Fracture of middle third (waist) of scaphoid (most common)

Plate 467

Wrist and Hand

Wrist and Hand: Superficial Dorsal Dissection

Posterior (dorsal) view Posterior antebrachial cutaneous nerve (from radial nerve) Cephalic vein Superficial branch of radial nerve Extensor retinaculum (thickening of posterior antebrachial fascia) C o m m u n i c a t i n g branches of radial and ulnar nerves Basilic vein Dorsal branch of ulnar nerve Dorsal venous network of hand Dorsal metacarpal veins

Probe in dorsal subaponeurotic space (between opened dorsal fascia of hand and dorsal interosseous fascia) Intercapitular veins

Dorsal digital nerves and veins

Dorsal branches of proper palmar digital nerves

Note: Lymphatic pathways shown in black; arrows indicate direction of drainage

Wrist amdl Hand

6

Wrist and Hand: Deep Dorsal Dissection MMMM

m


Lateral antebrachial cutaneous nerve (terminal part of musculocutaneous nerve)

Posterior antebrachial cutaneous nerve (branch of radial nerve)

Superficial branch of radial nerve Extensor digitorum, extensor digiti minimi, and extensor indicis tendons (cut)

Extensor retinaculum Radial artery in anatomical snuffbox Dorsal branch of ulnar nerve A b d u c t o r pollicis longus tendon Dorsal carpal branch of ulnar artery Extensor carpi ulnaris tendon

Extensor pollicis brevis tendon Extensor pollicis longus tendon Extensor carpi radialis longus tendon Extensor carpi radialis brevis tendon

Dorsal carpal (arterial) arch Dorsal metacarpal arteries

Dorsal digital arteries

Dorsal digital branches of dorsal branch of ulnar nerve

Dorsal digital branches of superficial branch of radial nerve to 1st, 2nd, 3rd, and radial half of 4lh fingers Dorsal branches of proper palmar digital branches of ulnar nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 5th and ulnar half of 4th fingers

Dorsal branches of proper palmar digital branches of median nerve and of proper palmar digital arteries to dorsum of middle and distal phalanges of 2nd, 3rd, and radial half of 5th fingers

Wrist and Hand

Posterior (dorsal) view Extensor carpi ulnaris - C o m p a r t m e n t 6

Extensor digitorum Extensor indicis

I ) \

^ Compartment 4

Extensor pollicis longus - C o m p a r t m e n t 3 Extensor carpi radialis brevis ) . . . . . . ( Compartment 2 Extensor carpi radialis longus ) Abductor pollicis longus )

Plane of cross section shown below

Extensor pollicis brevis

)

^ Compartment 1

Extensor retinaculum

Radial artery in anatomical snuffbox

Abductor digiti minimi muscle

Dorsal interosseous muscles

I n terte n d i n o us co n necti o n s

Transverse fibers of extensor expansions (hoods)

Cross section of most distal portion of forearm Extensor retinaculum Extensor pollicis longus - C o m p a r t m e n t 3 C o m p a r t m e n t 4 \ Extensor digitorum and 1 / extensor mdici

Extensor carpi radialis brevis

\ Extensor Compartment 5 ^ digiti minimi

Extensor carpi radialis longus

Compartment 2

Extensor pollicis brevis

Extensor C o m p a r t m e n t 6 ^ carpi ulnaris

Abductor pollicis longus

Compartment 1

Radius

Wrist and Hand

Plate 47©

Epiphysis Nail matrix

Synovial membrane Articular cartilage

Lateral band / Extensor Central tendon \ mechanism

Middle phalanx

Nail root Eponychium (c uti cle)

Sagittal section

un ule Na

bed

Flexor digitorum superficialis tendon

Bodv of nail

Distal phalanx Fibrous tendon sheath of finger Synovial (flexor tendon) sheath of finger Nerves

Flexor digitorum profundus tendon

Arteries

Palmar ligament (plate) Distal anterior closed space (pulp)

Articular cavitv Body of nail

Cross section through distal phalanx

Subungual space

Nail bed

M i n u t e arteries -

Distal phalanx

Fine nerves

Fibrous septa and areolar tissue in anterior closed space (pulp)

Dorsal digital artery and nerve

Dorsal branches of proper palmar digital arteries and nerves to dorsum of middle and terminal phala

Arteries and nerves

Nutrient branches to metaphysis

Plate 471

Proper palmar digital artery to neighboring digit Proper palmar digital artery and nerve

Cutaneous Innervation of Wrist and Hand

Anterior (palmar) view Lateral antebrachial cutaneous nerve


Radial nerve

J |

M e d i a l antebrachial cutaneous nerve

Superficial branch

Palmar branch

Ulnar nerve

Palmar digital branches

Median nerve

/

Palmar branch



V I '

M e d i a l antebrachia cutaneous nerve ^ Division between ulnar and radial nerve innervation on dorsum of hand is variable.


i

f

v.

>


Posterior antebrachial cutaneous nerve

aiiiliiii:! Radial nerve

Slllsli Dorsal branch and dorsal digital branches Ulnar nerve

Superficial branch and dorsal digital branches

<

Proper palmar digital branches


Median nerve

Plate 472

6

Arteries and Nerves of Upper Limb

Anterior view D e l t o i d muscle Cor a c o b r a c hialismuscle \ Biceps brachii muscle \

Short head (cut)

(

Long head (cut)

ntercostobrachial nerve Medial brachial cutaneous nerve

M u s c u l o c u t a n e o u s nerve

Radial nerve

Brachialis muscle

Ulnar nerve

Biceps brachii muscle (cut) and t e n d o n Lateral antebrachial cutaneous nerve (from musculocutaneous ner Radial nerve

( \

D e e p branch

I

Superficial branch

Medial antebrachial cutaneous nerve M e d i a n nerve Brachial artery

Supinator muscle Brachioradialis muscle Radial artery Pronator teres muscle (partially

cut)

M e d i a n nerve Flexor pollicis longus muscle Flexor carpi radialis t e n d o n (cut) Flexor retinaculum (transverse carpal ligament) Superficial branch of radial nerve Recurrent (motor) branch of median nerve t o thenar muscles

Bicipital aponeurosis Humeral head (cut) Ulnar head

Pronator teres muscle

Flexor carpi radialis muscle (cut) H u m e r o u l n a r head

)

Flexor digitorum

Radial head

)

superficialis muscle (cut)

Flexor d i g i t o r u m profundus muscleFlexor carpi ulnaris muscle Ulnar artery and nerve Dorsal branch of ulnar nerve Flexor d i g i t o r u m superficialis tendons (cut) Deep palmar branch of ulnar artery and deep branch of ulnar nerve Superficial branch of ulnar nerve Superficial palmar arch (cut)

C o m m o n palmar digital branches of median nerve

Proper palmar digitial branches of median nerve

C o m m o n palmar digital branch of ulnar nerve C o m m u n i c a t i n g branch of median nerve with ulnar nerve Proper palmar digital branches of ulnar nerve

Neurovasculature

Musculocutaneous Nerve

Anterior view Note: Only muscles innervated by musculocutaneous nerve shown

Musculocutaneous nerve (C5, 6, 7) Medial Posterior Lateral

Cords of brachial plexus

C o r a c o b r a c h i a l muscle Medial brachial cutaneous nerve Biceps brachii muscle [retracted)

Medial antebrachial cutaneous nerve Ulnar nerve Median nerve Radial nerve

Brachialis muscle

Axillary nerve

Articular branch


Anterior branch

Posterior

Cutaneous innervation (via lateral antebrachial cutaneous nerve)

A n t e r i o r (palmar) view

Heyrowascylafyre


Plate 474

Anterior view

Note: Only muscles innervated by median nerve shown

M U S C ulocutaneousnerve

M e d i a n nerve (C5, 6, 7, 8 , 1 1 ) Medial Posterior Lateral

Inconstant c o n t r i b u t i o n

Pronator teres muscle (humeral head

Cords of brachial plexus


Articular branch



Axillary nerve Palmaris longus muscle

Radial nerve

Pronator teres muscle (ulnar head)

Ulnar nerve

Flexor digitorum superficialis muscle {turned up) Flexor digitorum profundus muscle (lateral part supplied by median [anterior interosseous] nerve; medial part supplied by ulnar nerve) Anterior interosseous nerve Flexor pollicis longus muscle Pronator quadratus muscle

Cutaneous innervation


/

Abductor pollicis brevis

\

Opponens pollicis

Thenar J muscles \

Superficial head of flexor pollicis brevis ) (deep head / supplied by I ulnar nerve)

1st and 2nd lumbrical muscles

Communicating branch of median nerve with ulnar nerve

Palmar view

C o m m o n palmar digital nerves

Dorsal branches to dorsum of middle and distal phalanges

Proper palmar digital nerves


Plate 475

Neurovasculature

r

'

'

Anterior view

Note: Only muscles innervated by ulnar nerve shown Ulnar nerve (C7, 8, T1) (no branches above elbow) Inconstant c o n t r i b u t i o n

Medial epicondyle

ular branch (behind condyle)


Flexor digitorum profundus muscle (medial part only; lateral part supplied by anterior interosseous branch of median nerve)

Palmar view

Flexor carpi ulnaris muscle (drawn aside)



Flexor pollicis brevis muscle (deep head only; superficial head and other thenar muscles supplied by median nerve)

Adductor pollicis muscle

Palmar branch

Superficial branch Deep branch Palmaris brevis Abductor digiti minimi Flexor digiti minimi brevis f

Hypothenar muscles

Opponens digiti minimi C o m m o n palmar digital nerve Communicating branch of median nerve with ulnar nerve

3rd and 4th lumbrical muscles {turned

down)

Proper palmar digital nerves (dorsal digital nerves are from dorsal branch)

Neurovaseulatyre

Plate 476

R a d i a l N e r v e in A r m a n d N e r v e s of P o s t e r i o r S h o u l d e r

Dorsal scapular nerve (C5)

Posterior view

Supraspinatus muscle Suprascapular nerve (C5, 6) Levator scapulae muscle (supplied also by branches from C3 and C4)

Deltoid muscle "•'^V-'iT ' ^riBsTT*r

Teres minor muscle Axillary nerve (C5, 6) Superior lateral brachial cutaneous nerve

Rhomboid minor muscle

Radial nerve (C5, 6, 7, 8, T1) Inconstant c o n t r i b u t i o n


Inferior lateral brachial cutaneous nerve

Posterior antebrachial cutaneous nerve

Infraspinatus muscle Teres major muscle Lower subscapular nerve (C5, 6) Posterior brachial cutaneous nerve (branch of radial nerve in axilla) Long head Triceps brachii muscle <


Brachialis muscle (lateral part; remainder of muscle supplied by musculocutaneous nerve)

Lateral head /Medial head Brachioradialis muscle

Triceps brachii tendon Medial epicondyle


Olecranon Anconeus muscle


Extensor digitorum muscle / A/.7>.


N eu ro vase u I a t u re

See also Plate 467

Inconstant c o n t r i b u t i o n

Radial nerve (C5, 6, 7,8, T1) Superficial (terminal) branch Deep (terminal) branch

Posterior view

Lateral epicondyle Anconeus muscle Brachioradialis muscle Extensor carpi radialis longus muscle Supinator muscle Extensor carpi radialis brevis muscle Extensor carpi ulnaris muscle Extensor digitorum muscle and extensor digiti minimi muscle

Extensor-supinator group of muscles

Extensor indicis muscle Extensor pollicis longus muscle bductor pollicis longus muscle Extensor pollicis brevis muscle Posterior interosseous nerve (continuation of deep branch of radial nerve distal to supinator muscle) Superficial branch of radial nerve

Superior lateral brachial cutaneous nerve

brachial cutaneous nerve Posterior brachial cutaneous From radial nerve Posterior antebrachial cutaneous nerve Superficial branch of radial nerve and dorsal digital branches

Dorsal digital nerves Cutaneous innervation f r o m radial and axillary nerves

Neurovasculature

Plate 478

6

Cutaneous Nerves and Superficial Veins of Shoulder and Arm

Anterior view

Supraclavicular nerves (from cervical plexus)

Posterior view Medial Intermediate Lateral

Acromial branch of thoracoacromial vein

Acromial branches of thoracoacromial vein

Superficial branches of posterior circumflex humeral vein





Superior lateral brachial cutaneous nerve (from axillary nerve)

Superior lateral brachial cutaneous nerve (from axillary nerve)

Cephalic vein

Posterior brachial cutaneous nerve (from radial nerve)

Inferior lateral brachial cutaneous nerve (from radial nerve)

Inferior lateral brachial cutaneous nerve (from radial nerve)

Posterior antebrachial cutaneous nerve (from radial nerve) Accessory cephalic vein


Branches of medial antebrachial cutaneous nerve Basilic vein Lateral antebrachial cutaneous nerve (terminal part of muscuIocutaneous nerve)

Branches of medial antebrachial cutaneous nerve ~

Median cubital vein Intermediate (median) antebrachial vein Basilic vein Perforating veins Cephalic vein

Plate 479

Branches of lateral antebrachial cutaneous nerve (terminal part of musculocutaneous nerve)

Neurovasculature


Cephalic vein Posterior antebrachial cutaneous nerve (from radial nerve)


Basilic vein

Lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

terior branch nd Posterior branch of medial antebrachial cutaneous nerve Posterior

Accessory cephalic vein

Median basilic vein

Median cephalic vein

branch of medial antebrachial cutaneous nerve

Bicipital aponeurosis

Perforating veins

Note: In 70% of cases, a median cubital vein (tributary to basilic vein) replaces median cephalic and median basilic veins (see Plate 479). Superficial branch of radial nerve Palmar branch of median nerve Intercapitular veins

Accessory cephalic vein Posterior branch of lateral antebrachial cutaneous nerve (from musculocutaneous nerve)

Cephalic vein

Median antebrachial vein


Basilic vein

Cephalic vein Extensor retinaculum

Palmar branch of ulnar nerve Dorsal branch of ulnar nerve Palmar carpal ligament (continuous with extensor retinaculum) Palmar aponeurosis

Dorsal branch of ulnar ne

Dorsal metacarpal veins

Superficial branch of radial nerve Dorsal venous network

Intercapitular veins

Superficial transverse metacarpal ligament

Proper palmar digital nerves and palmar digital veins

Neurewaseu!ature

Dorsal digital nerves and veins

Plate 480

Cutaneous Innervation of Upper Limb



Supraclavicular nerves (from cervical plexu$-C3, 4)

MMm

Axillary nerve Superior lateral brachial cutaneous nerve (C5, 6)

Radial nerve Inferior lateral brachial cutaneous nerve (C5, 6)

Radial nerve Superficial branch (C6-8)

Median nerve Palmar branch and Palmar digital branches (C6-8)

Radial nerve Posterior brachial cutaneous nerve ( C 5 - 8 ) Inferior lateral cutaneous nerve Posterior antebrachial cutaneous nerve (C[5], 6 - 8 )

Intercostobrachial nerve (T2) and medial brachial cutaneous nerve (C8, T l / 2 )

Lateral antebrachial cutaneous nerve (C5, 6 [71) (terminal part of musculocutaneous nerve)

Medial antebrachial cutaneous nerve (C8, T1)

Axillary nerve Superior lateral brachial cutaneous nerve (C5, 6)

>

Ulnar nerve (C8, T l ) A Palmar branch

Dorsal branch and dorsal digital branches



Lateral antebrachial cutaneous nerve ( C 5 , 6 [7]) (terminal part of musculocutaneous nerve)

Radial nerve Superficial branch and dorsal digital branches ( C 6 - 8 )

Median nerve Proper palmar digital branches

Note: Division variable between ulnar and radial innervation on dorsum of hand and often aligns with middle of 3rd digit instead of 4th digit as shown

Meur©waseij!atiy]re

Dermatomes of Upper Limb

Note: (according to Keegan and Garrett) s h o w n as distinct segments. There is actually considerable overlap b e t w e e n adjacent dermatomes. An alternative d e r m a t o m e map is provided by Foerster (see references).

Posterior view

Neurovasculature

Plate 482


Deltopectoral node

Lateral axillary nodes (along axillary vein)

Basilic vein

Cubital nodes

Median cubital vein Vessels passing to dorsum of hand

Cephalic vein

Vessels passing to dorsum of hand

Vessels passing around w e b to dorsum of hand Vessels passing to dorsum of fingers

Note: Arrows indicate direction of drainage

Plate 483

Neurovasculafure

•r

-

mmm

Scans

Plate 484

Lower Limb 3

Topographic A n a t o m y Plate 485 mmmmMmm

485 Lower Limb

Hip and Thigh Plates 486-505

486 Hip (Coxai) Bone 487 Hip Joint 488

Hip Joint: Anteroposterior Radiograph

489

Femur

490 Bony Attachments of Muscles of Hip and Thigh: Anterior View 491 Bony Attachments of Muscles of Hip and Thigh: Posterior View 492 Muscles of Thigh: Anterior Views 493

Muscles of Thigh: Anterior Views (continued)

4 9 4 Muscles of Hip and Thigh: Lateral View 4 9 5 Muscles of Hip and Thigh: Posterior Views 496 Psoas and lliacus Muscles 4 9 7 Lumbosacral and Coccygeal Plexuses 498

Lumbar Plexus

4 9 9 Sacral and Coccygeal Plexuses 500 Arteries and Nerves of Thigh: Anterior Views 501 Arteries and Nerves of Thigh: Anterior Views (continued) 502 Arteries and Nerves of Thigh: Posterior View 503

Nerves of Hip and Buttock

5 0 4 Arteries of Femoral Head and Neck 505

Thigh: Serial Cross Sections


7

Lower Limb 5 2 7 Ligaments and Tendons of Ankle Plates

506-512

528 Ligaments and Tendons of Foot: Plantar View

5 0 6 Knee: Lateral and Medial Views

5 2 9 Tendon Sheaths of Ankle

507 Knee: Anterior Views

5 3 0 Muscles of Dorsum of Foot: Superficial Dissection

508 Knee: Interior

531 Dorsum of Foot: Deep Dissection

5 0 9 Knee: Cruciate and Collateral Ligaments

5 3 2 Sole of Foot: Superficial Dissection

5 1 0 Knee: Anteroposterior Radiograph

5 3 3 Muscles of Sole of Foot: First Layer

511 Knee: Posterior and Sagittal Views

5 3 4 Muscles of Sole of Foot: Second Layer

5 1 2 Arteries of Thigh and Knee: Schema

535 Muscles of Sole of Foot: Third Layer 5 3 6 Interosseous Muscles and Deep Arteries of Foot

Leg

5 3 7 Interosseous Muscles of Foot

Plates 513-522

5 1 3 Tibia and Fibula

Neurovasculature

5 1 4 Tibia and Fibula (continued)

Plates 538-546

515 Attachments of Muscles of Leg

5 3 8 Femoral Nerve and Lateral Femoral Cutaneous Nerve

5 1 6 Muscles of Leg (Superficial Dissection): Posterior View

539 Obturator Nerve

517 Muscles of Leg (Intermediate Dissection): Posterior View

5 4 0 Sciatic Nerve and Posterior Femoral Cutaneous Nerve

518 Muscles of Leg (Deep Dissection): Posterior View

541 Tibial Nerve

5 1 9 Muscles of Leg (Superficial Dissection): Anterior View

5 4 2 Common Fibular (Peroneal) Nerve

5 2 0 Muscles of Leg (Deep Dissection): Anterior View

543 Dermatomes of Lower Limb

521 Muscles of Leg: Lateral View

5 4 4 Superficial Nerves and Veins of Lower Limb: Anterior View

5 2 2 Leg: Cross Sections and Fascial Compartments

545 Superficial Nerves and Veins of Lower Limb: Posterior View

„

5 4 6 Lymph Vessels and Nodes of Lower Limb

Ankle and Foc&t Plates 523-537

Regional S c a n s

5 2 3 Bones of Foot

Plate 547

5 2 4 Bones of Foot (continued)

547 CT Angiograms of Arteries of the Lower Limb

525 Calcaneus 5 2 6 Ankle: Radiographs


Lower Limb Posterior view

Anterior view Iliac crest Iliac crest


Gluteus medius muscle -

Anterior superior iliac spine ^

Inguinal ligament

Tensor fasciae latae muscle-"

Sartorius muscle


Vastus lateralis muscle Rectus femoris muscle

Great saphenous vein

Semitendi nosus muscle —

lliotibial tract

Adductor / 1 magnus / muscle / Vastus medialis muscle

|

Gracilis tendon \ lliotibial tract

Fibularis (peroneus) longus muscle

Rectus femoris tendon (becoming part of quadriceps femoris tendon) Great saphenous Patella vein—-—

Biceps femoris muscle Long head — Short head

Patellar ligament Tibial tuberosity Great saphenous vein

Gastrocnemius muscle — Medial head ^ Lateral head

Tibialis anterior muscle Anterior border of tibia Calcaneal (Achilles) tendon ^

Lateral malleolus

Extensor digitorum longus tendons —

Small saphenous vein

Fibularis (peroneus) longus and brevis tendons

Medial malleolus Medial malleolus

Lateral malleolus

Plantar surface of foot —

Calcaneal tuberosity

Extensor hallucis longus tendon

Topographic Anatomy

Plate 485

Hip (Coxal) Bone See also Plates 248, 352, 353

Lateral view

Intermediate zone lum > Iliac crest Outer lip

Anterior Inferior Posterior

Gluteal lines

W i n g (ala) of ilium (gluteal surface)


terior superior iliac: spine Anterior inferior iliac spine

Posterior inferior iliac spine

Acetabulum Lunate surface Margin (limbus) of acetabulum Acetabular notch

Greater sciatic notch


Body of ilium Ischial spine

bic tubercle

Lesser sciatic notch Obturator crest

Body of ischium

Inferior pubic ramus Ischial tuberosity

Intermediate zone \ Inner lip (

Iliac crest

Iliac tuberosity

Ramus of ischium


Anterior superior iliac spine W i n g (ala) of ilium (iliac fossa)

ricular surface (for sacrum)

Anterior inferior iliac spine Arcuate line

Posteriorinferior iliac spine

Iliopubic eminence Superior pubic ramus

Greater sciatic notch


Ischial spine Body of ilium

Pubic tubercle

Lesser scialic notch Symphyseal surface

Body of ischium

Ilium Ischium Pubis

Obturator groove

Ischial tuberosity Ramus of ischium

Inferior pubic i

Medial view

Plate 486

Hip and Thigh

Erlip

J @ i M f

Anterior view liofemoral ligament (Y ligament of Bigelow) Iliopectineal bursa (over gap in ligaments)


bofemoral ligament Obturator crest



Greater trochanter

Posterior view Iliofemoral liagment Ischiofemoral ligament Zona orbicularis Greater trochanter Lesser trochanter

Ischial spine Ischial tuberosity

Intertrochanteric, line

Intertrochanteric crest

Joint opened: lateral view

Lesser trochanter

Anterior superior iliac spine Lunate (articular) surface of acetabulum

Anterior inferior iliac spine Iliopubic eminence Acetabular labrum (fibrocartilaginous)

Articular cartilage

Fat in acetabular fossa (covered by synovial membrane)

Greater trochanter

O b t u r a t o r artery Anterior branch Posterior branch Acetabular branch

Head of femur Neck of femur

Obturator membrane

Intertrochanteric line Ligament of head of femur (cut)

[34]op a r a d l

TfiogEfti

Ischial tuberosity Lesser trochanter

Plate 487

7

Hip Joints Anteroposterior Radiograph See also Plates 487, 489

A

Acetabulum

F

Femur

G

Greater trochanter

H

Head of femur

1

Ischium

IC


IL

Ilium

IT

Ischial tuberosity

I

Lesser trochanter

N O P

Plate 488

-

Neck O b t u r a t o r foramen Pubis (superior ramus)

Hip and Thigh

Femur

Anterior view

Posterior view Trochanteric fossa

Head

Greater trochanter

Greater trochanter

Head Fovea for ligament of head

Fovea for ligament of head

Ma ' /•:' Neck

Neck

Intertrochanteric crest Lesser trochanter

Calcar Lesser trochanter

Intertrochanteric line

Pectineal line Gluteal tuberosity

Linea aspera, \ |

Medial lip Lateral lip

Nutrient foramen Shaft (body)

Shaft (body) Line of attachment of border of synovial membrane

MV

Line of reflection of synovial membrane Line of attachment of fibrous capsule Line of reflection of fibrous capsule (unattached) Popliteal surface

Lateral epicondyle

Lateral epicondyle

Lateral condyle Lateral condyle

Hip and Thigh

Patellar surface

Intercondylar fossa

Plate 48®

Bony Affachmenfs of Muscles of Hip and Thigh: Anterior View

lliacus muscle

Origin of psoas major muscle from sides of vertebral bodies, intervertebral discs, and transverse processes (T12-L4)

Sartorius muse Rectus femoris muscle Pectineus muscle

Obturator internus and superior and inferior gemellus muscles

Adductor longus muscle

Piriformis muscle

Adductor brevis muscle

Gluteus minimus muscl Vastus lateralis muscl Iliopsoas muscle Vastus medialis muscl

Gracilis muscle Obturator externus muscle Adductor magnus muscle Quadratus femoris muscle

Vastus intermedins muscle

Origins Insertions

Articularis genus muscle Adductor magnus muscle

lliotibial tract Biceps femoris muscle Quadriceps femoris muscle (rectus femoris, vastus lateralis, vastus intermedins, and vastus medialis via patellar ligament)

Plate 490

Sartorius muscle Gracilis muscle

Pes anserinus

Semitendinosus muscle

Hip and Thigh

Bony Attachments of Muscles of Hip and Thigh: Posterior View

Gluteus medius muscle Gluteus minimus muscle Tensor fasciae latae muscle Gluteus maximus muscle

Sartorius muscle Rectus femoris muscle

Superior gemellus muscle

Obturator externus muscle

Inferior gemellus muscle


Quadratus femoris muscle



Iliopsoas muscle

Adductor magnus muscle Biceps femoris (long head) and semitendinosus muscles

Gluteus maximus muscle Vastus lateralis muscle Adductor magnus muscle Adductor brevis muscle Vastus intermedins muscle Biceps femoris muscle (short head)

Origins Insertions


Adductor magnus muscle Vastus lateralis muscle

Adductor magnus muscle

Plantaris muscle Gastrocnemius muscle (lateral head)

Gastrocnemius muscle (medial head)

Popliteus muscle

Semimembranosus muscle*

Popliteus muscle

Note: W i d l h of zone of attachments to posterior aspecl of femur (linea aspera) is greally exaggerated.

Hip and Thigh

Plate 491

Muscles of Thighs Anterior Views

Anterior superior iliac spine Anterior superior iliac spine

Hliacus muscle

us muscle (origin)

-Psoas major muscle


Gluteus medius muscle Inguinal ligament

Ligaments of hip joint

Pubic tubercle Iliopsoas muscle

Pectineus muscle

Tensor fasciae latae muscle Pectineus muscle Tensor fasciae latae muscle (origin Rectus femoris muscle (origin) Greater trochanter Iliopsoas muscle (cut) A d d u c t o r longus muscle Gracilis muscle

—

Sartorius muscle Rectus femoris muscle* — V a s t u s lateralis muscle" Vastus intermedius muscle* — V a s t u s medialis muscle lliotibial tract Rectus femoris tendon (becoming part of quadriceps femoris tendon) Lateral patellar retinaculum Patella Medial patellar retinaculum

Anteromedial intermuscular septum

Patellar ligament --Sartorius tendon Gracilis tendon Semitendinosus tendon Tibial tuberosity

Pes anserinus lliotibial tract {cut) Rectus femoris t e n d o n (cut) Quadriceps femoris tendon Patella Lateral patellar retinaculum Medial patellar retinaculum Head of fibula Patellar ligament Tibial tuberos'

Sartorius tendon

*Muscles of quadriceps femoris

Plate 492

Hip and Thigh

Muscles of Thigh: Anterior Views (continued)

Deep dissection

IRC PtPi Wmi^M


Superior ramus of pubis

A d d u c t o r longus muscle (cut and

reflected)

Ligaments of hip joint Greater trochanter of femur Iliopsoas muscle {cut)

Pubic tubercle

Pectineus muscle (cut and reflected)

Gracilis muscle (cut)

A d d u c t o r brevis muscle (cut and reflected)

O b t u r a t o r externus muscle

Vastus intermedins muscle


A d d u c t o r longus muscle (cut and reflected)

A d d u c t o r minimus part of A d d u c t o r magnus muscle

Femoral artery and'vein passing through hiatus of adductor magnus muscle

- O p e n i n g s for perforating branches of profunda femoris (deep femoral) artery

Vastus medialis muscle (cut) Rectus femoris t e n d o n (cut as it becomes pari of quadriceps tendon) Vastus lateralis muscle (cut)

T e n d o n of a d d u c t o r magnus muscle inserting on adductor tubercle on medial epicondyle of femur

Gracilis muscle (cut)

Lateral e p i c o n d y l e of femui Tibial collateral ligament Patella Lateral patellar retinaculum Fibular collateral ligament Head of fibula

M e d i a l patellar retinaculum

Sartorius tendon (cut)

Gracilis t e n d o n

Pes anserinus

Patellar ligament Tibial tuberosity

Hip and Thigh

Plate 493

7

Muscles of Hip and Thigh: Lateral View

External o b l i q u e muscle

Iliac crest


Gluteal aponeurosis over gluteus medius muscle

Sartorius muscle Gluteus maximus muscle

Tensor fasciae latae muscle

Rectus femoris muscle

Vastus lateralis muscle

lliotibial tract

Long head Biceps femoris muscle Short head

Lateral c o n d y l e of tibia and Gerdy's tubercle

Semimembranosus muscle Lateral patellar retinaculum Fibular collateral ligament Patella Plantaris muscle Extensor d i g i t o r u m longus muscle Gastrocnemius muscle (lateral head)

Head of fibula


Plate 494

Patellar ligament

Tibialis anterior muscle

Hip and Thigh

Muscles of Hip and Thighs Posterior Views For piriformis and obturator internus see also Plates 356, 357; For obturator externus see Plate 501

Superficial dissection

Deeper dissection Iliac crest Gluteal aponeurosis over Gluteus medius muscle Gluteus minimus muscle Gluteus maximus muscle Piriformis muscle Sciatic nerve Sacrospinous ligament Superior gemellus muscle Obturator internus muscle Inferior gemellus muscle Sacrotuberous ligament Quadratus femoris muscle Ischial tuberosity Semitendinosus muscle Greater trochanter Biceps femoris muscle (long head) Adductor minimus part of Adductor magnus muscle Semimembranosus muscle lliotibial tract Gracilis muscle Biceps femoris muscle Short head Long head Semimembranosus muscle Semitendinosus muscle Popliteal vessels and tibial nerve C o m m o n fibular (peroneal) nerve Plantaris muscle Gastrocnemius muscle Medial head Lateral head Sartorius muscle Popliteus muscle Tendinous arc Soleus muscle Plantaris tendon (cut)

Hip and Thigh

Plate 495

7

7 See also Plate 2 6 3

Quadratus l u m b o r u m muscle

12th rib

Ilioinguinal nerve

Origin of psoas major muscle from vertebral bodies, transverse processes, and intervertebral discs (Tl 2 - L 4 ) and origin of psoas minor muscle from vertebral bodies (Tl2, LI)

Psoas minor muscle

Lumbar plexus

Tra n sve rsu s abdo m i n is muscle [cut) Iliohypogastric nerve

Psoas major muscle Lumbosacral trunk Genitofemoral nerve Iliac crest


terior superior iliac spine

Iliacus muscle Femoral nerve

IJiopectineal bursa

Superior pubic r a m i Greater trochanter of fern ur

Iliofemoral ligament of hip joint (Y ligament of Bigelow)

Iliopsoas muscle passes backward to insertion on lesser trochanter

Shaft (body) of femur

Abductors (gluteus medius and minimus muscles)

Note: Arrows indicate direction of action of iliopsoas muscle.

Adductors

Plate 496

Hip and Thigh

Lumbosacral and Coccygeal Plexuses • H n H H H H H • H H B H H H n H H H H H H H H H H H H H n H n H H

Intercostal nerve

/.•v.

mm

Subcostal nerve (T12) Iliohypogastric nerve (T12, L I ) Ilioinguinal nerve (LI) To psoas major and psoas minor muscles

Anterior division Posterior division

Sympathetic trunk Rami communicantes

Genitofemoral nerve (LI, 2) Lateral femoral cutaneous nerve (L2, 3) Genital branch and Femoral branch of genitofemoral nerve

> Lumbar plexus

To psoas major and iliacus muscles Anterior branches and Lateral branches of subcostal and iliohypogastric nerves Lumbosacral trunk Nerve to quadratus femoris (and inferior gemellus) (L4. 5, SI) Nerve to obturator internus (and superior gemellus) (L5, SI, 2)

>• Sacral plexus

Superior gluteal nerve (L4, 5, SI) Nerve to piriformis (SI, 2) Obturator nerve (L2, 3, 4) Accessory obturator nerve (L3, 4) (inconstant) -

Coccygeal plexus

Inferior gluteal nerve (L5, SI, 2) Femoral nerve (L2, 3, 4)


Sciatic nerve-——

Perforating cutaneous nerve (S2, 3)

Posterior femorai cutaneous nerve (S1, 2,

Nerve to ievalor ani and coccygeus (S3,. 4)

Pudendal nerve (S2, 3, 4)

Perineal branch of 4th sacral nerve

Sciatic nerve

<

Anococcygeal nerves

C o m m o n fibular (peroneal) nerve (L4, 5, SI, 2) Tibial nerve (L4, 5, S1, 2, 3)

Hip and Thigh

Obturator nerve Inferior anal (rectal) nerve Posterior femoral cutcineous neive

Dorsal nerve of penis/clitoris p e r j n e a ( nerve and Posterior scrotal/iabial branche:

Plate 497

Lumbar Plexus mmmmmmmmmmmmmmmmmmmammmamm

Schema

Subcostal nerve (TI2)

\

White and gray rami communicantes Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve

>

Ventral rami of nerves

Lateral femoral cutaneous nerve Gravt rami communicantes Muscular branches to psoas and iliacus muscles Femoral nerve

J

Accessory obturator nerve (often Obturator nerve

A n t e r i o r division Posterior division

Lumbosacral trunk Diaphragm (cut) Subcostal nerve (T12) Sympathetic trunk Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve (cut) Lateral femoral cutaneous ne Femoral nerve Obturator nerve Psoas major muscle (cut) Lumbosacral trunks Inguinal ligament (Poupart's)

White and gray rami communicantes Subcostal nerve (TI2) Iliohypogastric nerve Ilioinguinal nerve Transversus abdominis muscle Quadratus lumborum muscle Psoas major muscle Gray rami communicantes G e n i to fern o r a I n er ve Iliacus muscle Lateral femoral cutaneous nerve Femoral nerve Genital branch and Femoral branch of g e n i t o fe m o ra I n e r ve Obturator nerve

Plate 493

Hip and Thigh

Sacral and Coccygeal Plexuses

Schema

Lumbosacral trunk

A n t e r i o r division Posterior division


Pelvic splanchnic nerves (parasympathetic to inferior hypogastric [pelvic) plexus)

Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis

Tibial nerve Sciatic nerve

Coccygeal nerve

C o m m o n fibul ai (peroneal) nei ve

Anococcygeal nerve Perineal branch of 4th sacral nerve Nerve to levator ani and coccygeus (ischiococcygeus) muscles

Nerve to quadratus femoris (and inferior gemellus Nerve to obturator internus (and superior gemellus)

Lumbosacral trunk Psoas major muscle Superior gluteal artery and nerve Obturator nerve lliacus muscle

Pudendal nerve Perforating cutaneous nerve

(J^*-

Posterior femoral cutaneous nerve

/x. i

Sympathetic trunk Gray rami communicantes Pelvic splanchnic nerves (cut) (parasympathetic to inferior hypogastric [pelvicl plexus)

Inferior gluteal artery Nerve to quadratus femoris Internal pudendal arter Nerve to obturator internus Pudendal nerve Obturator internus muscle Superior pubic ramus Piriformis muscle Coccygeus (ischiococcygeus) muscle Nerve to levator ani muscle Levator ani m Topography: medial and slightly anterior view of h e m i s e c t e d pelvis

Hip and Thigh

Sacral splanchnicnerves {cut) (sympathetic to inferior hypogastric [pelvic] plexus)

Plate 499

Arteries and Nerves of Thigh; Anterior Views See also Plate 5 3 8

Anterior superior iliac spineLateral femoral cutaneous nerve Inguinal ligament Iliopsoas muscle

Superficial dissections Tensor fasciae latae muscle {retracted) Gluteus minimus and medius muscles

Superficial circumflex iliac vessels Superficial epigastric vessels

Superficial and Deep external pudendal vessels


Femoral sheath

Pectineus muscle Profunda femoris (deep femoral) artery

Fascia lata (cut) Rectus femoris muscle Vastus lateralis muscle tensor fasciae latae muscle

Plate SCO

Profunda femoris (deep femoral) artery

Saphenous nerve

Femoral nerve, artery, and vein

Vastus medialis muscle

Femoral nerve, artery, and vein

A d d u c t o r canal (opened by removal of sartorius muscle)


Sartorius muscle

Iliopsoas muscle


Vastus lateralis muscie


Sartorius muscle (cut)

Pectineus muscle

Lateral circumflex femoral

Gracilis muscle

Lateral femoral cutaneous nerve {cut)

Saphenous nerve and saphenous branch of descending genicular artery Articular bra of descending genicular artery (emerges f r o m vastus medialis muscie) Patellar anastomosis Infrapatellar branch of Saphenous nerve

Nerve to vastus medialis muscle Adductor magnus muscle Anlerornedial intermuscular septum covers entrance of femoral vessels to popliteal fossa (adductor hiatus) Sartorius muscle (cut) Superior medial genicular artery (from popliteal artery) Inferior medial genicular artery (from popliteal artery)

Hip and Thigh

Arteries and Nerves of Thigh: Anterior Views (continued) m

See also Plates 5 3 8 , 5 3 9

Deep dissection External iliac artery and vein nguinal ligament (Poupart's)


Femoral artery and vein (cut)

Sartorius muscle (cut)

Pectineus muscle (cut)

Iliopsoas muscle O b t u r a t o r canal Tensor fasciae latae muscle {retracted) Gluteus medius and minimus muscles Femoral n Rectus femoris muscle (cut) Ascending, transverse and descending branches of Lateral circumflex femoral artery Medial circumflex femoral artery Pectineus muscle (cut) Profunda femoris (deep femoral) artery Perforating branches A d d u c t o r longus muscle (cut) Vastus lateralis muscle Vastus intermedius muscle Rectus femoris muscle (cut) Saphenous nerve A n t e r o m e d i a l intermuscular septum (opened) Vastus medialis muscle Quadriceps femoris t e n d o n Patella and patellar anastomosis Medial patellar retinaculum Patellar ligament

Hip and Thigh

O b t u r a t o r externus muscle A d d u c t o r longus muscle (cut) Anterior branch and osterior branch of o b t u r a t o r nerve Quadratus femoris muscle A d d u c t o r brevis muscle Branches of posterior branch of o b t u r a t o r nerve uctor magnus muscle Gracilis muscle Cutaneous branch of obturator nerve Femoral artery and vein (cut) Descending genicular artery rticular branch Saphenous branch A d d u c t o r hiatus Sartorius muscle (cut) uctor magnus t e n d o n uctor tubercle on medial e p i c o n d y l e of femur Superior medial genicular artery (from popliteal artery) Infrapatellar branch of Saphenous nerve Inferior medial genicular artery (from popliteal artery)

Plate 501

7

7

Arteries and Nerves of Thigh: Posterior View See also Plate 540

Deep dissection Iliac crest Superior clunial nerves Gluteus maximus muscle (cut) Medial clunial nerves Inferior gluteal artery and nerve

Gluteal aponeurosis and gluteus medius muscle (cut) Superior gluteal artery and nerve Gluteus minimus muscle Tensor fasciae latae muscle

Pudendal nerve Piriformis muscle Nerve to obturator internus (and superior gemellus)

Gluteus medius muscle (cut) Superior gemellus muscle

Posterior femoral cutaneous nerve-


Sacrotuberous ligament Ischial tuberosity Inferior clunial nerves (cut)

rator internus muscle Inferior gemellus muscle Gluteus maximus muscle (cut)

A d d u c t o r magnus muscle


Gracilis muscle

Medial circumflex femoral artery

Sciatic nerve Muscular branches of sciatic nerve Semilendinosus muscle

{retracted)

Semimembranosus muscle Sciatic nerve Articular branch A d d u c t o r hiatus Popliteal vein and a Superior medial genicular a Medial e p i c o n d y l e of femur Tibial nerve Gastrocnemius muscle (medial head) Medial sural cutaneous nerve Small saphenous vein

Plate 502

Vastus lateralis muscle and a iliotibial tract A d d u c t o r minimus part of adductor magnus muscle 1st perforating artery (from profunda femoris artery) A d d u c t o r magnus muscle 2nd and 3rd perforating arteries (from profunda femoris artery) 4th perforating artery (from profunda femoris artery) Long head (retracted) Short head

I \

Biceps femoris muscle

Superior lateral genicular artery C o m m o n fibular (peroneal) nerve Plantaris muscle Gastrocnemius muscle (lateral head) Lateral sural cutaneous nerve

Hip and Thigh

Gluteus maximus muscle {cut)

Iliac: crest A

i

Superior gluteal nerve Gluteus minimus muscle

Sciatic nerve

Piriformis muscle

Inferior gluteal nerve

Superior gemellus muscle

Posterior femoral cutaneous nerve-

AVvv'i Tensor fasciae latae muscle

Nerve to obturator interims (and superior gemellus)

Gluteus medius muscle (cut)

Pudendal nerve


Ischial spine Sacrospinous ligament

Nerve to quadratus femoris (and inferior gemellus) supplying articular branch to hip joint

Perforating cutaneous nerve Sacrotuberous ligament

l \JJtfSi

Inferior anal (rectal) nerve


pVSE


Dorsal nerve of penis

Inferior gemellus muscle

Perineal nerve


Posterior scrotal nerve

Gluteus maximus muscle (cut)

Perineal branches of posterior femoral cutaneous nerve

Sciatic nerve Ischial tuberosity Semitendinosus muscle

Posterior femoral cutaneous nerve Inferior clunial nerves

Biceps femoris muscle (long head) (covers semimembranosus muscle)

Hip and Thigh

POaiie S©3

Arteries of Femoral Head and Neck See also Plate 512

Anterior view

Posterior view Acetabular branch of obturator artery {often minute)

Superior Anterior Inferior >

Relinacular arteries (subsynovial)

Superior Posterior Inferior

Anastomosis between medial and lateral circumflex femoral ^ ^ arteries

Relinacular arteries (subsynovial) Anastomosis

Ischiofemoral ligament and joint capsule Medial circumflex femoral artery

Iliopsoas tendon

Iliofemoral (Y) ligament and joint capsule -


Ascending, ^ ^ Transverse, ^ Descending ^ ^ ^ branches of Lateral circumflex femoral artery —


Lateral circumflex femoral artery Nutrient artery of femur

Nutrient artery of femur

Anterior view in situ Coronal section


Acetabular labi um

Anastomosis

Ligaments and joint capsule v

Femoral artery

Lateral circumflex femoral artery ^ Ascending, Transverse, \ Descending \ branches

Synovial membrane Retinacular arteries \

Iliopsoas muscle

\\:\

Pectineus muscle

•• -

Acetabular branch

m

•\

•

:

w

Obturator artery

m


a

Epiphyseal plate Medial circumflex femoral artery

Profunda femoris (deep femoral) artery Medial circumflex femoral artery ""Îliopsoas tendon Lateral circumflex femoral artery

Femur of child: anterior view

Plate S©4

Hip and Thigh

Thigh: Serial Cross Sections

Sartorius muscle Profunda femoris (deep femoral) artery and vein Pectineus mu Iliopsoas muscle

Fascia lata Branches of femoral nerve Femoral artery and vein A d d u c t o r longus muscle Great saphenous vein


O b t u r a t o r nerve (anterior branch)

Vastus meclialis mu

A d d u c t o r brevis muscle

Lateral femoral cutaneous ne

Obturator nerve (posterior branch)

Vastus intermedius m Femur

Gracilis muscle

Vastus lateralis muscl

A d d u c t o r magnus muscle

Tensor fasciae latae m

Sciatic nerve

lliotibial tract



Semimembranosus muscle Semitendinosus muscle Biceps femoris muscle (long head)

Vastus medialis muscle Rectus femoris muscle

intermuscular septum of thigh

Vastus intermedius muscle Vastus lateralis muscle lliotibial tract Lateral intermuscular septum of thigh Biceps ( Short head femoris
( Long head

Semitendinosus muscle Semimembranosus muscle

Sartorius muscle Nerve to vastus meclialis muscle

j / V

in adductor

Saphenous nerve

/

canal

Femoral artery and vein ) Great saphenous vein A d d u c t o r longus muscle Gracilis muscle A d d u c t o r brevis muscle Profunda femoris (deep femoral) artery A d d u c t o r magnus muscle

Rectus femoris tendon Vastus intermedius muscle lliotibial tr

Sciatic nerve Vastus medialis muscle

Vastus lateralis muse Articularis genus muscle Lateral intermuscular septum of thigh Femur Biceps femoris muscle C o m m o n fibular (peroneal) nerve Tibial nerve

Hip and Thigh

Posterior intermuscular septum of thigh

Sartorius muscle Saphenous nerve and descending genicular artery Great saphenous vein Gracilis muscle uctor magnus tendon Popliteal vein and artery Semimembranosus muscle Semitendinosus muscle

Plate 505

Knee: Lateral and Medial Views

Lateral view


lliotibial tract Quadriceps femoris tendon

Biceps femoris \ L o n g h e a d muscle j short head Bursa deep to iliotibial tract

Patella

Fibular collateral ligament and bursa deep to it Lateral patellar retinaculum

Plantaris muscle Biceps femoris tendon and its inferior subtendinous bursa

Joint capsule of knee

C o m m o n fibular (peroneal) nerve

Patellar ligament

Head of fibula Gastrocnemius muscle

Tibial tuberosity

Soleus muscle Fibularis (peroneus) longus muscle


Medial view Sartorius muscle Vastus medialis muscle

Quadriceps femoris tendon

Gracilis muscle Tendon of semitendinosus muscle Semimembranosus muscle and tendon

Medial epicondyle of femur

Patella

Medial patellar retinaculum

Joint capsule

A d d u c t o r magnus tendon Parallel fibers

) Tit;jal , > collateral O b l i q u e fibers \ ligament Semimembranosus bursa Anserine bursa deep to Semitendinosus, racilis, and Sartorius tendons

Pes anserinus

Gastrocnemius muscle Tibial tuberosity Soleus muscle

Plate S@®

BCsne®

Knee: Anterior Views

Right knee in extension Femur

Vastus intermedius muscle

Articularis genus muscle



lliotibial tract

Rectus femoris t e n d o n ( b e c o m i n g quadriceps femoris tendon)

Lateral patellar retinaculum Lateral e p i c o n d y l e of f e m u r

Patella

Fibular collateral ligament and bu

Medial e p i c o n d y l e of femur

Biceps femoris t e n d o n and its inferior subtendinous bursa

M e d i a l patellar retinaculum

Broken line indicates bursa deep to iliotibial tract

Tibial collateral ligament Semitendinosus, Gracilis, and Sartorius tendons

Insertion of iliotibial tract to Gerdy's tubercle and oblique line of tibia C o m m o n fibular (peroneal) nerve

Pes anserinus

Anserine bursa

Head of fibula

M e d i a l condyle of tibia


Patellar ligament

Extensor d i g i t o r u m longus muse

Tibial tuberosity


Gastrocnemius muscle

Joint opened, knee slightly in flexion Femur Articularis genus muscle Synovial m e m b r a n e (cut edge)

Suprapatellar (synovial) bursa Cruciate ligaments (covered by synovial membrane)

Medial condyle of f e m u r

Lateral c o n d y l e of femur Origin of poplileus tendon (covered by synovial m e m b r a

Infrapatellar synovial fold

M e d i a l meniscus Subpopliteal recess Lateral meniscus Fibular collateral ligament

Alar folds (cut)

Infrapatellar fat pads (lined by synovial m e m b r a n e )

Head of fibula Suprapatellar (synovial) bursa (roof Patella (articular surface on posterior aspect)

Vastus medialis muscle (reflected

reflected)

inferiorly)

Vastus lateralis muscle (reflected inferiorly)

ECiraee

Plate S©7

7

Knee: Interior wmm

Inferior view Patellar ligament

lliotibial tract blended into lateral patellar retinaculum and capsu

Medial patellar retinaculum blended into joint capsule

Bursa

Suprapatellar synovial bursa

Subpopliteal

Synovial membrane (cut edge)

Popliteus tendon

Infrapatellar synovial fold

Fibular collateral ligament

Posterior cruciate ligament

Bursa

collateral ligament (superficial and deep parts)

Lateral condyle of femui

Medial condyle of femur

Anterior cruciate ligament

Oblique popliteal ligament

Arcuate popliteal ligament

Semimembranosus tendon

Superior view Semimembranosus tendon

Posterior meniscofemoral ligament

Oblique popliteal ligament

Arcuate popliteal ligament

Posterior cruciate ligament


Tibial collateral ligament (deep part bound to medial meniscus)

Bursa Popliteus tendon

Medial meniscus

Subpopliteal recess

Synovial membrane

Lateral meniscus

Superior articular surface of tibia (medial facet)

Superior articular surface of tibia (lateral facet)

Joint capsule

lliotibial tract blended into capsule


Infrapatellar fat pad

Patellar ligament

Anterior aspect A Superior view: ligaments and cartilage removed Attachment of posterior cruciate l i g a m e n t -

st

Intercondylar eminence Attachment of synovial membrane

Attachment of synovial membrane

Superior articular surface of tibia (medial facet)

Superior articular surface of tibia (lateral facet)

Attachment of anterior cruciate ligament

Attachments of horns of lateral meniscus Attachments of horns of medial men Anterior aspect

Plate 508

Knee

Knee: Cruciate and Collateral Ligaments

Right knee in flexion: anterior view Posterior cruciate ligament


Lateral condyle of femur (articular surface)

Medial condyle of femur (articular surface)

Medial meniscus

Popliteus tendon

Fibular collateral ligament —

Lateral meniscus

Medial condyle of tibia

mm Transverse ligament of kne

Right knee in extension: posterior view

Gerdy's tubercle

Posterior cruciate ligament Anterior cruciate ligament

Adductor tubercle on medial epicondyle of femur

Posterior meniscofemoral ligament Lateral condvle of femur (articular surface) /

Medial condyle of femur (articular surface)

Popliteus tendon Medial meniscus Fibular collateral ligament Tibial collateral ligament Lateral meniscus Head of fibula

faee

PDafe 509

7

7

Knee: Anteroposterior Radiograph

Plate 510

F

Fibula

FE

Femur

HF

Head of fibula

ICE

Intercondylar eminence

L

Lateral epicondyle

LCF

Lateral condyle of femur

LCT

Lateral condyle of tibia

M

Medial epicondyle

MCF

Medial condyle of femur

MCT

Medial condyle of tibia

P

Patella

T

Tibia

Knee: Posterior and Sagittal Views

Right knee: posterior view Femur (popliteal surface) A d d u c t o r magnus t e n d o n

A t t a c h m e n t of joint capsule

Medial head of gastrocnemius muscle and subtendinous bursa

Plantaris muscle Lateral head of gastrocnemius muscle and subtendinous bursa

Tibial collateral ligament Semimembranosus tendon

Fibular collateral ligament and its inferior Subtendinous bursa

O b l i q u e popliteal ligamen (tendinous expansion of semimembranosus muscle)

Biceps femoris t e n d o n and bursa beneath it

Semimembranosus bursa deep to t e n d o n ( b r o k e n

ate popliteal ligament (edge of capsule that arches over popliteus muscle)

Popliteus muscle

Head of fibula Posterior ligament of fibular head A t t a c h m e n t of joint capsule

Femur

Interosseous m e m b r a n e

Articularis genus muscle Quadriceps femoris t e n d o n Suprapatellar fat b o d y v

Lateral subtendinous bursa of gastrocnemius muscle

Suprapatellar (synovial) bursa

•

-

j,

vl^-

w m m m ^ -

Patella Subcutaneous prepatellar bursa Articular cavity Synovial m e m b r a n e

Synovial membrane

m ^ s & f r f r x * ^ Wm* " ^ t t

•Infrapatellar fat pad Subcutaneous infrapatellar bursa D e e p (subtendinous) infrapatellar bursa Lateral meniscus

Articular cartilages

Tibial tuberosity

A-;,

.

GCmee

VCV

Vv'-yy. V

Sagittal section (lateral to midline of knee)

Plate 511

7

Arteries of Thigh and Knee: Schema

Superficial epigastric artery

Superficial circumflex iliac artery

Superficial external pudendal artery Femoral artery

O b t u r a t o r artery Deep external pudendal artery Medial circumflex femoral artery

Ascending branch, Transverse branch, Descending branch of Lateral circumflex femoral artery

Femoral artery

Muscular branches


Perforating branches

Femoral artery passing through a d d u c t o r hiatus Descending genicular artery Articular branch Saphenous branch

Superior medial genicular artery Superior lateral genicular a Popliteal artery

Patellar anastomosis

(phantom)

(phantom)

M i d d l e genicular artery

Inferior lateral genicular (partially in phantom)

Inferior medial genicular artery (partially in phantom)

Posterior tibial recurrent artery (phantom)

Anterior tibial recurrent artery

Circumflex fibular branch

Posterior tibial artery

Anterior tibial arter Interosseous m e m b r a n e

(phantom)

Fibular (peroneal) artery

(phantom)

•f-

Plate 512

Knee

Tibia and Fibula

Bones of right leg

Anterior intercondylar area

Anterior view

Posterior view



Lateral intercondylar tubercle

Medial intercondylar tubercle

Lateral condyle

Posterior intercondylar area

Medial intercondylar tubercle

Lateral intercondylar tubercle

Medial condyle

Apex, Head, Neck of fibula

Lateral condyle

Gerdy's tubercle (insertion of iliotibial tract)

Head, Neck fibu a

Oblique line

Groove for insertion of semimembranosus tendon

Tibial tuberosity Soleal lin^ Lateral surface

Lateral surface

Nutrientforamen

Anterior border

Anterior border

Interosseous border

Superior articular surfaces (medial and lateral facets)

Interosseous border

Interosseous border

Posterior surface

jfx

Posterior surface

Medial surface Medial surface

Medial border

Medial crest

Medial border Lateral surface

Tibia

Tibia

Fibula

Fibula

Posterior border Groove for tibialis posterior and flexor digitorum longus tendons Fibular notch Lateral malleolus

Articular facet of lateral malleolus

Leg

Medial malleolus

Inferior articular surface

Articular facet of medial malleolus

Medial malleolus

Articular facet of medial malleoli

Lateral malleolus

surface

Malleolar fossa of lateral malleolus

Plate 513

Tibia a n d Fibula ( c o n t i n u e d )

Anterior view w i t h ligament attachments lliotibial tract

Posterior ^ Anterior j


Cruciate ligaments

Anterior border-

Interosseous border Lateral surface

Posterior intercondylar area (origin of posterior cruciate ligament)

Head


Fibula

Tibia

Anterior ligament of fibular head

Head of fibula

Gerdy's tubercle

Posterior ligament of fibular head

bial collateral ieament

Biceps femoris tendon

Anterior ligament of fibular head

Superior view

Patellar ligament

ial tuberosity

Medial condyle

Lateral condyle Superior articular surface (lateral facet)


Medial ( Lateral (

Anterior intercondylar area (origin of anterior cruciate ligament)

Anterior border Interosseous border

Superior articular surface (medial facet) Intercondylar tubercles

Tibial tuberosity

Cross section Interosseous border

Lateral surface Anterior border


Medial surface

Interosseous border

Tibia Lateral surface

Anterior border

Medial border

Lateral surface Fibula

Tibia

Posterior surface

Fibula

Medial surface Medial crest

Posterior border

Posterior surface

Inferior view Anterior tibiofibular ligament

Anterior tibi-.; "ibular ligament

Lateral malleolus

Calcaneofibular ligament

Plate 514

Articular facet of lateral malleolu Fibula Medial malleolus Medial (deltoid) ligament of ankle

Malleolar fossa of lateral malleolus Posterior , tibiofibular ligament

Articular facet of medial malleolus Medial malleolus Tibia Inferior articular surface of tibia

L e g

A t t a c h m e n t s of M u s c l e s of Leg

Posterior view

Anterior view

Gastrocnemius muscle (medial head) lliotibial tract

Plantaris muscle Gastrocnemius muscle (lateral head) Popliteus muscle

Semimembranosus muscle Sartorius muscle Fibularis (peroneus) longus muscle

Extensor digitorum longus muscle

Gracilis muscle Semitendinosus muscle

Soleus muscle

Tibialis posterior muscle

anterior Flexor digitorum longus muscle

Extensor hallucis longus muscle

Fibularis (peroneus) tertius muscle

Popliteus muscle

Quadriceps femoris muscle via patellar ligament

muscle

Fibularis (peroneus) brevis muscle

Pes anserinus

Origins Insertions Note: Attachments of intrinsic muscles of foot not shown


Flexor hallucis longus muscle


Plantaris muscle

Soleus and gastrocnemius muscles via calcaneal (Achilles) tendon

Fibularis (peroneus) brevis muscle Tibialis anterior muscle

Fibularis (peroneus) tertius muscle




Leg


Flexor digitorum longus muscle

Plate S1S

Muscles of Leg (Superficial Dissection): Posterior View See also Plate 540

Semitendinosus muscle Semimembranosus muscle Gracilis muscle Popliteal artery and vein Sartorius muscle Superior medial genicular Gastrocnemius muscle (medial head) Nerve to soleus muscle

lliotibial tract Biceps femoris muscle nerve C o m m o n fibular (peroneal) nerve Superior lateral genicular artery Plantaris muscle astrocnemius muscle (lateral head) Lateral sural cutaneous nerve (cut) Medial sural cutaneous nerve (cut)



Soleus muscle

Soleus muscle

Plantaris tendon

Flexor digitorum longus tendon Tibialis posterior tendon Posterior tibial artery and vei Tibial nerve Medial malleolus Flexor hallucis longus tendon Flexor retinaculu Calcaneal branch of posterior tibial

Plate 516

Fibuiaris (peroneus) longus tendon Fibularis (peroneus) brevis tendon Calcaneal (Achilles) tendon Lateral malleolus Superior fibular (peroneal) retinaculum Fibular (peroneal) artery Calcaneal branches of fibular (peroneal) artery Calcaneal tuberosity

Leg

Muscles of Leg (Intermediate Dissection): Posterior View See also Plate 541

Adductor magnus t e n d o n Popliteal artery and vein

nerve C o m m o n fibular (peroneal) nerve (cut) Superior lateral genicular artery

Superior medial genicular artery Gastrocnemius muscle (medial head) (cut) Tibial collateral ligament Semimembranosus tendon (cut)

Lateral and medial sural cutaneous nerves (cut) Gastrocnemius muscle (lateral head) (cut) Fibular collateral ligamentBiceps femoris tendon (cut) Plantaris muscle

Inferior medial genicular artery Popliteus muscle Tendinous arch of Soleus muscle Plantaris tendon

Inferior lateral genicular artery Head of fibula m m o n fibular (peroneal) nerve (cut) Nerve to soleus muscle Fibularis (peroneus) longus muscle

V

Gastrocnemius muscle (cut)

Soleus muscle

Soleus muscle inserting into calcaneal (Achilles) tendon

Flexor digitorum longus tendon Tibialis posterior t e n d o n Posterior tibial artery and vein Tibial ne Medial malleol Flexor hallucis longus tendo Flexor retinaculum Calcaneal (Achilles) tendon Calcaneal branch of posterior tibial a. ,

Leg

Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis tendon Lateral malleolus Superior fibular (peroneal) retinaculum Fibular (peroneal) artery Calcaneal branches of fibular (peroneal) artery Calcaneal tuberosity

Plate 517

Muscles of Leg (Deep Dissection): Posterior View See also Plate 541

Superior medial genicular artery Gastrocnemius muscle (medial head) (cut) Sural (muscular) branches Popliteal artery and tibial nerve Tibial collateral ligament Semimembranosus t e n d o n (cu Inferior medial genicular arte

Superior lateral genicular artery Plantaris muscle [cut) Gastrocnemius muscle (lateral head) (cut) Fibular collateral ligament Biceps femoris t e n d o n (cut) Inferior lateral genicular artery of fibula C o m m o n fibular (peroneal) nerve

Popliteus muscle Posterior tibial recurrent artery Tendinous arch of soleus muscle

Posterior tibial artery

Flexor d i g i t o r u m longus muscle

eus muscle (cut and

reflected)

Anterior tibial artery


Tibial nerve Flexor hallucis longus muscle

(retracted)



Calcaneal (Achilles) t e n d o n (cut)

Interosseous m e m b r a n e

Flexor digitorum longus t e n d o n

Perforating branch \ C o m m u n i c a t i n g branch \

Tibialis posterior t e n d o n Medial malleolus and posterior medial malleolar branch of posterior tibial Flexor retinaculum M e d i a l calcaneal branches of posterior tibial artery and tibial nerve Tibialis posterior tendon Medial plantar artery and nerve Lateral plantar artery and nerve Flexor hallucis longus tendon 1 st metatarsal b o n e

Plate 518

of fibular (peroneal) artery

Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis t e n d o n Lateral malleolus and posterior lateral malleolar branch of fibular (peroneal) artery Superior fibular (peroneal) retinaculum Lateral calcaneal branch of fibular (peroneal) artery Lateral calcaneal branch of sural nerve Inferior fibular (peroneal) retinaculum Fibularis (peroneus) brevis t e n d o n Fibularis (peroneus) longus tendon Flexor d i g i t o r u m longus t e n d o n 5th metatarsal b o n e

Leg

Muscles of Leg (Superficial Dissection): Anterior View See also Plate 542

Vastus lateralis muscle Rectus femoris tendon (becomi quadriceps femoris tendon) lliotibial tract Superior lateral genicular artery Lateral patellar retinaculum Biceps femoris tendon Inferior lateral genicular C o m m o n fibular (peroneal) nerve Head of fibula

Vastus medialis muscle Patella Superior medial genicular artery bial collateral ligament Medial patellar retinaculum Inferior medial genicular artery Infrapatellar branch (cut) of Saphenous nerve (cut) Joint capsule Patellar ligament Insertion of sartorius muscle


Tibial tuberosity bia

Tibialis anterior muscle Gastrocnemius muscle Superficial fibular (peroneal) nerve (cut) Soleus muscle Fibularis (peroneus) brevis muscle



Fibula Superior extensor retinaculum

Medial malleolus

Lateral malleolus Inferior extensor retinaculum Extensor digitorum longus tendons Fibularis (peroneus) tertius tendon Extensor digitorum brevis tendons

ialis anterior tendon Medial branch of deep fibular (peroneal) nerve Extensor hallucis longus tendon Extensor hallucis brevis tendon Dorsal digital branches of deep fibular (peroneal) nerve

Dorsal digital nerves

Leg

Plate 519

7

Muscles of Leg (Deep Dissection): Anterior View See also Plate 542

Superior medial genicular artery

Superior lateral genicular artery

Quadriceps femoris t e n d o n


collateral ligament

Lateral patellar retinaculum

Medial patellar retinaculum

Iliotibial tract (cu Biceps femoris tendon (cut) Inferior lateral genicular a C o m m o n fibular (peroneal) nerve Head of fibula Fibularis (peroneus) longus muscle (cu Anterior tibial artery Extensor digitorum longus muscle (cu Superficial fibular (peroneal) nerve Deep fibular (peroneal) nerve Fibularis (peroneus) longus muscle

Infrapatellar branch of saphenous nerve (cut) Inferior medial genicular artery Saphenous nerve (cut) Patellar ligament Insertion of sartorius tendon Anterior tibial recurrent artery and recurrent branch of deep peroneal nerve Interosseous membrane ibialis anterior muscle (cut) Gastrocnemius muscle

Extensor digitorum longus muscle Fibularis (peroneus) brevis muscle and tendon

Soleus muscle Tibia Superficial fibular (peroneal) nerve (cut) Extensor hallucis longus muscle and tendon (cut)

Fibularis (peroneus) longus tendon Perforating branch of fibular (peroneal) artery Anterior lateral malleolar arte Lateral malleolus and arterial network Lateral tarsal artery and lateral branch of deep fibular (peroneal) Extensor digitorum brevis and extensor hallucis brevis muscles (cu Fibularis (peroneus) brevis tendon Posterior perforating branches from deep plantar arch

Interosseous membrane Anterior medial malleolar artery Medial malleolus and arterial network Dorsalis pedis artery ialis anterior tendon Medial tarsal artery Medial branch of deep fibular (peroneal) nerve Arcuate artery Deep plantar artery

Extensor digitorum longus tendons

Dorsal metatarsal arteries

Extensor digitorum brevis tendons (cu

Extensor hallucis longus tendon (cut)

Dorsal digital arteries Branches of proper plantar digital arteries and nerves

Plate 520

Extensor hallucis brevis tendon (cut) Dorsal digital branches of deep fibular (peroneal) nerve

Leg

Muscles of Leg: Lateral View See also Plate 542

Vastus lateralis muscle Biceps femoris muscle

Long head

lliotibial tract

Short head

Quadriceps femoris t e n d o n

Tendon

Superior lateral genicular artery Patella

Fibular collateral ligament Lateral patellar retinaculum C o m m o n fibular (peroneal) nerve

Lateral c o n d y l e of tibia Patellar ligament

Inferior lateral genicular artery

Tibial tuberosity Head of fibula


Soleus muscle

Extensor d i g i t o r u m longus muscle

Fibularis (peroneus) longus muscle and t e n d o n

Superficial fibular (peroneal) nerve (cut)

Extensor d i g i t o r u m longus t e n d o n Extensor hallucis longus muscle and t e n d o n

Fibularis (peroneus) brevis muscle and t e n d o n

Superior extensor retinaculum Inferior extensor retinaculum

Fibula

xtensor d i g i t o r u m brevis muscle

Lateral malleolus

Extensor hallucis longus t e n d o n

Calcaneal (Achilles) t e n d o n

Extensor d i g i t o r u m longus tendons

(Subtendinous) bursa of tendocalcaneus

Fibularis (peroneus) brevis t e n d o n

Superior fibular (peroneal) retinaculum

Fibularis (peroneus) tertius t e n d o n 5th metatarsal bone

Inferior fibular (peroneal) retinaculum ,

•>»

v >

Fibularis (peroneus) longus t e n d o n passing to sole o f f o o t

Leg

Plate 521

7

Leg: Cross Sections and Fascial Compartments

Deep fascia of leg (crural fascia)


Anterior compartment Extensor muscles Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis (peroneus) tertius Anterior tibial artery and veins Deep fibular (peroneal) nerve

Deep posterior c o m p a r t m e n t Deep flexor muscles Flexor digitorum longus Tibialis posterior Flexor hallucis longus Popliteus Posterior tibial artery and veins Tibial nerve Fibular (peroneal) artery and veins

Anterior intermuscular septum Lateral c o m p a r t m e n t Fibularis (peroneus) longus muscle Fibularis (peroneus) brevis muscle Superficial fibular (peroneal) nerve

intermuscular septum Superficial posterior c o m p a r t m e n t Superficial flexor muscles Soleus Gastrocnemius Plantaris (tendon)

Posterior intermuscular septum


Cross section just above middle of leg Tibialis anterior

Anterior tibial artery and'veins and deep fibular (peroneal) nerve

Extensor hallucis longus muscle a



Superficial fibular (peroneal) n

Great saphenous vein and saphenous nerve

Anterior intermuscular septum


Deep fascia of (crural fascia) Fibularis (peroneus) longus muscle

Flexor digitorum longus muscle Fibular (peroneal) artery and veins


Posterior tibial artery and veins and tibial nerve

Posterior intermuscular septum Fibu


Lateral sural cutaneous nerve


Transverse intermuscular septum

Plantaris tendon

Soleus muscle Gastrocnemius muscle (lateral head) Sural communicating branch of lateral sural cutaneous nerve

Plate 522

«*

Gastrocnemius muscle (medial head) Medial sural cutaneous nerve Small saphenous vein

Bones of Foot

Dorsal view Calcaneus Body Fibular (peroneal) trochlea Tarsal sinus Transverse tarsal joint

Lateral tubercle al tubercle Groove for tendon of flexor hallucis longus Trochlea

Metatarsal bones

>

Talus

Neck Head

Cuboid Tuberosity of 5th metatarsal bone

Posterior process

Navicular Tuberosity Lateral Intermediate Medial

C u n e i f o r m bones

Tarsometatarsal joint Base

Plantar view

Shaft (body)

Lateral tubercle

Phalanges Proximal

Head

Middle Distal

Medial tubercle

Talus

Base

Posterior process

Shaft (body)

Head

Head

Transverse tarsal joint

Base

Navicular Tuberosity

.uberosity C u n e i f o r m bones

Lateral Intermediate Medial

Calcaneus Tuberosity Medial process Lateral process Sustentaculum tali Groove for tendon of flexor hallucis longus Fibular (peroneal) trochlea Cuboid Tuberosity Groove for fibularis (peroneus) longus tendon Tuberosity of 5 th metatarsal bone

Tarsometatarsal joint Shaft (body) Metatarsal bones .,. f Medial Sesamoid bones j ^ ^

c

Proximal Phalanges -<

Head Base Shaft (body) Head Base Head Base Tuberosity

Middle Distal

Ankle and Foot

Plate 523

7

Bones of Foot (continued)

Lateral view Transverse tarsal joint

Head Talus

Navicular Intermediate

Trochlea


Lateral

Lateral process Tarsometatarsal joint

Posterior process

Metatarsal bones Tarsal sinus

Phalanges

Fibular (peroneal) trochlea Calcaneus

< Tuberosity Tuberosity of 5th metatarsal bone

Groove for fibularis (peroneus) longus tendon

/

Groove for fibularis I (peroneus) longus tendon

Medial view Transverse tarsal joint Navicular — Tuberosity C u n e i f o r m bones J

Intermediate Medial

Tarsometatarsal joint

Neck

Talus Head

Posterior process

Metatarsal bones

Tuberosity

Sesamoid bone

Groove for tendon of flexor hallucis longus

>

Calcaneus

Sustentaculum tali

Plate 524

Ankle and Foot

Calcaneus

Right f o o t

Posterior talar articular surface

Articular surface for cuboid bone

Anterior talar articular surface

Middle talar articular surface Anterior talar articular surface

Middle talar articular surface Articular surface for cuboid bone /

f" 1 1

Tuberosity Lateral process of tuberosity

^Fibular (peroneal) trochlea

Fibular (peroneal) trochlea

Sustentaculum tali

Groove for fibularis (peroneus) longus tendon Lateral view

Anterior talar articular surface

1


Calcaneal sulcus

M i d d l e talar articular surface

Tuberosity


Superior view

M i d d l e talar articular surface

Articular surface for c u b o i d bone

Tuberosity


Sustentaculum tali

Sustentaculum tali

Groove for tendon of flexor hallucis longus

Medial process of tuberositv

M e d i a l view

Fibula Interosseous membrane Posterior tibiofibular ligament

Medial (deltoid) ligament of ankle-

Posterior talocalcaneal ligament

Groove for tendon of flexor hallucis l o n g u s Medial process of tuberosity

Fibular (peroneal) trochlea j' r

Lateral process of tuberosity

Tuberosity Posterior view

Posterior talofibular ligament Calcaneofibular ligament Fibular (peroneal) tendons in inferior fibular (peroneal) retinaculum Critical Posterior view with ligaments

angle

^^-Ji

Functional relations of calcaneus

7

Ankle: Radiographs

Lateral view

c CB F HT LC N PT ST T TC TM TT

Anterior view F LM MM T TA

Fibula Lateral malleolus Medial malleolus Tibia Talus

Calcaneus Cuboid Fibula Head of talus Lateral cuneiform Navicular Posterior process of talus Sustentaculum tali of calcaneus Tibia Tuberosity of calcaneus Tuberosity of 5th metatarsal Trochlea of talus

Ligaments and Tendons of Ankle

Right foot: lateral view

i Posterior talofibular ligament ) Components of lateral Calcaneofibular ligament > (collateral) ligament Anterior talofibular ligament \ of ankle

Fibula Anterior and Posterior tibiofibular ligaments

Interosseous talocalcaneal ligament Dorsal talonavicular ligament Calcaneonavicular ligament

(

caneocuboid ligament

J

__ Blfurcate

h

âment

Dorsal cuboideonavicular ligament

Superior fibular (peroneal) retinaculum

Dorsal cuneonavicular ligaments Dorsal intercuneiform ligaments Dorsal tarsometatarsal ligaments

Calcaneal (Achilles) tendon (cut)

Inferior fibular (peroneal) retinaculum

Dorsal metatarsal ligaments

Lateral talocalcaneal ligament

Dorsal c u n e o c u b o i d ligament

Long plantar ligament

Cuboid bone

Fibularis (peroneus) longus

Dorsal calcaneocuboid ligament

Fibularis (peroneus) brevis Right foot: medial view

Posterior tibiotalar part Medial (deltoid) ligament of ankle )

Medial talocalcaneal ligament

Tibiocalcaneal part Tibionavicular part Anterior tibiotalar part

Posterior process of talus

Dorsal talonavicular ligament Posterior talocalcaneal igament

Navicular bone Dorsal cuneonavicular ligaments Medial cuneiform bone

Calcaneal (Achilles) tendon (cut)

Dorsal intercuneiform ligament Dorsal tarsometatarsal ligaments

u ...

1st metatarsal bone Tuberosity

ii i

^

J

j ,

•;

^yî

Tibialis anterior tendon Tibialis posterior tendon

„

Short plantar ligament Plantar calcaneonavicular (spring) ligament

Sustentaculum tali ^ L o n g plantar ligament

7

7

Ligaments and Tendons of Foot: Plantar View

Flexor digitorum longus tendon to 2nd toe [cut)

Distal phalanx of great toe

Flexor digitorum brevis tendon to 2nd toe (cut)

nterphalangeal (IP) joint

4th distal phalanx

Flexor hallucis longus tendon (cut)

4th middle phalanx

Proximal phalanx of great toe

Deep transverse metatarsal ligaments Metatarsophalangeal (MP) joint

5th proximal phalanx

Sesamoid bones

4th lumbrical tendon (cut)

A b d u c t o r hallucis and medial head of flexor hallucis brevis tendons (cut)

A b d u c t o r digiti minimi and flexor digiti minimi brevis tendons (cut)

Adductor hallucis and lateral head of flexor hallucis brevis tendons (cut)

Plantar ligaments (plates) Interosseous muscles (cut)

1 st metatarsal bone

5th metatarsal bone

Plantar tarsometatarsal ligaments

Plantar metatarsal ligaments

Medial cuneiform bone

Tuberosity of 5th metatarsal bone

Tibialis anterior tendon (cut)

Fibularis (peroneus) brevis tendon

Plantar cuneonavicular ligament

Cuboid bone

Plantar cuboideonavicular ligament

Fibularis (peroneus) longus t e n d o n

Tuberosity of navicular bone Plantar calcaneonavicular (spring) ligament

Tuberosity of cuboid bone Long plantar ligament

Tibialis posterior tendon

Plantar calcaneocuboid (short plantar) ligament

Flexor digitorum longus tendon (cut) Sustentaculum tali

Calcaneus

Flexor hallucis longus tendon (cut)

Medial process and Lateral process of Tuberosity of calcaneus

Posterior process of talus (medial and lateral tubercles)

Phalanges A

Joint capsule Metatarsal bone

Distal Capsules and ligaments of metatarsophalangeal a n d interphalangeal joints: lateral view


Plantar ligament (plate)

T e n d o n S t e a t i t e ©f

MotjEcB©

Lateral view

Soleus muscle



Superior extensor retinaculum /Tendinous sheath of tibialis anterior


Lateral malleolus and subcutaneous bursa

Calcaneal (Achilles) tendon

Inferior extensor retinaculum

C o m m o n tendinous sheath of fibularis (peroneus) longus and brevis

Tendinous sheath of extensor digitorum longus and fibularis (peroneal) tertius Tendinous sheath of extensor hallucis longus

Subcutaneous calcaneal bursa (Subtendinous) bursa of calcaneal tendon Superior and Inferior fibular (peroneal) retinacula Calcaneus Extensor digitorum brevis muscle

Fibularis (peroneus) longus tendon


M e d i a l view

Tibialis anterior tendon and sheath Tibia Sheath of tibialis posterior tendon Superior extensor retinaculum Medial malleolus and subcutaneous bursa Inferior extensor retinaculum Tibialis posterior tendon and sheath Tibialis anterior t e n d o n and sheath

Fibularis (peroneus) brevis tendon

Fibularis (peroneus) tertius tendon Tuberosity of 5th metatarsal bone

Calcaneal (Achilles) tendon Tendinous sheath of flexor digitorum longus Posterior tibial artery and tibial nerve Tendinous sheath of flexor hallucis longus Subcutaneous calcaneal bursa

Tendinous sheath of extensor hallucis longus

(Subtendinous) bursa of calcaneal tendon Flexor retinaculum Calcaneus Lateral plantar nerve Medial plantar nerve Tendinous sheath of flexor digitorum longus

A b d u c t o r hallucis muscle {cut) Plantar aponeurosis (cut) Flexor digitorum brevis muscle (cut)

7

Muscles of Dorsum of Foot: Superficial Dissection

Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) brevis muscle Fibularis (peroneus) longus tendo Extensor digitorum longus muscle and tendon Superior extensor retinaculum Fibula Perforating branch of fibular (peroneal) artery Lateral malleolus and anterior lateral malleolar artery Inferior extensor retinaculum Lateral tarsal artery and lateral branch of deep peroneal nerve (to muscles of dorsum of foot)

bialis anterior tendon Anterior tibial artery and deep fibular (peroneal) nerve Tibia Extensor hallucis longus tendon Tendinous sheath of extensor digitorum longus Medial malleolus Tendinous sheath of tibialis anterior Tendinous sheath of extensor hallucis longus terior medial malleolar artery Dorsalis pedis artery and medial branch of deep fibular (peroneal) nerve Medial tarsal artery

Fibularis (peroneus) brevis tendon Arcuate artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tend Extensor digitorum brevis and extensor hallucis brevis muscles Extensor digitorum longus tend Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Dorsal metatarsal arteries Dorsal digital arteries Dorsal branches of proper plantar digital arteries and nerves —

Deep plantar artery passing between heads of 1 st dorsal interosseous muscle to join deep plantar arch Extensor hallucis longus tendon Extensor expansions

Dorsal digital branches of deep fibular (peroneal) nerve

Dorsal digital branches of superficial fibular (peroneal) nerve

Dorsum of Foot: Deep Dissection

Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis muscle and tendon Extensor digitorum longus muscle and t e n d o n Fibula Perforating branch of fibular (peroneal) artery Anterior lateral malleolar artery Lateral malleol Lateral branch of deep peroneal nerve (to muscles of dorsum of foot) and lateral tarsal artery Fibularis (peroneus) longus tendon (cut)

Soleus muscle Tibialis anterior muscle and tendon bia nterior tibial artery and deep fibular (peroneal) nerve Extensor hallucis longus muscle and tendon terior medial malleolar artery Medial malleolus Dorsalis pedis artery Medial branch of deep fibular (peroneal) nerve Medial tarsal arteries Tuberosity of navicular bone /

Extensor digitorum brevis and extensor hallucis brevis muscles (cut) Fibularis (peroneus) brevis tendon (cu Fibularis (peroneus) tertius tendon (cut) A b d u c t o r digiti minimi muscle Dorsal metatarsal arteries

Arcuate artery Posterior perforating branches deep plantar arch Deep plantar artery to deep plantar arch uctor hallucis muscle Extensor hallucis longus tendon

Metatarsal bones Dorsal interosseous muscles Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Anterior perforating branches from plantar metatarsal arteries Dorsal digital arteries — Dorsal branches of proper plantar digital arteries and nerves

Extensor hallucis brevis tendon (cut) Extensor digitorum brevis tendons (cut) Extensor digitorum longus tendons (cut) Extensor expansions Dorsal digital branches of deep fibular (peroneal) nerve Dorsal digital branches of superficial fibular (peroneal) nerve

7

7

Sole of Foot: Superficial Dissection

Superficial transverse metatarsal ligaments-

Proper plantar digital arteries and nerves

Superficial branch of medial plantar artery

Transverse fasciculi

Digital slips of plantar aponeurosis

Lateral plantar fascia

Medial plantar fascia

Cutaneous branches of lateral plantar artery and nerve Cutaneous branches of medial plantar artery and nerve

Lateral band of plantar aponeurosis (calcaneometatarsal ligament)

Plantar aponeurosis

Medial calcaneal branches of tibial nerve and posterior tibial artery Tuberosity of calcaneus w i t h overlying fat pad (partially cut away)

Muscles of Sole of Foot: First Layer

Proper plantar digital branches of medial plantar nerve

Proper plantar digital branches of lateral plantar nerve Proper plantar digital arteries

C o m m o n plantar digital arteries from plantar metatarsal arteries

Lumbrical muscles Fibrous sheaths of flexor tendons

Flexor digitorum brevis overlying Flexor digitorum longus tendons

Superficial branch of medial plantar artery

Lateral head and Medial head of flexor hallucis brevis muscle

Flexor hallucis longus tendon Plantar metatarsal branch of lateral plantar artery

Abductor hallucis muscle and tendon

Flexor digitorum brevis muscle

Abductor digiti minimi muscle (deep to lateral plantar fascia)

Plantar aponeurosis (cut) Medial process and Lateral process of Tuberosity of calcaneus

Medial calcaneal branches of tibial nerve and posterior tibial artery

7

7

Muscles of Sole of Foot: Second Layer


Flexor digitorum longus tendons Proper plantar digital branches of lateral plantar nerve

Flexor digitorum brevis tendons Fibrous sheaths (opened) Sesamoid bones C o m m o n plantar digital nerves and arteries Lumbrical muscles

Flexor digiti minimi brevis muscle

Lateral head and Medial head of flexor hallucis brevis muscle Flexor hallucis longus tendon

Superficial branch and Deep branch of lateral plantar nerve

Lateral plantar nerve and artery

uctor hallucis tendon and muscle {cut) Flexor digitorum longus tendon

Superficial and deep branches of medial plantar artery Medial plantar artery and nerve

Quadratus plantae muscle

Tibialis posterior tendon Flexor hallucis longus tendon

Nerve to abductor digiti minimi mu (from lateral plantar nerve)

Posterior tibial artery and tibial nerve (dividing) Flexor retinaculum

Flexor digitorum brevis muscle and plantar aponeurosis (cut)

Lateral calcaneal nerve and artery (from sural nerve and fibular [peroneal] artery

A b d u c t o r hallucis muscle (cut) Medial calcaneal artery and nerve Tuberosity of calcaneus

Muscles of Sole of Fool: Third Layer


Proper plantar digital branches of lateral plantar nerve Proper plantar digital branch of superficial branch of medial plantar artery Anterior perforating arteries to dorsal metatarsal arteries Tendons of lumbrical muscles (cut) Sesamoid bones Flexor digitorum longus tendons

Transverse head and Oblique head of adductor hallucis muscle

Flexor d i g i t o r u m brevis tendons {cut)

Medial head and Lateral head of flexor hallucis brevis muscle

Flexor digiti minimi brevis muscle

Plantar metatarsal arteries

Superficial branches of medial plantar artery and nerve

Plantar interosseous muscles

Flexor hallucis longus t e n d o n (cut)

Superficial branch of lateral plantar nerve

A b d u c t o r hallucis muscle (cut)

Deep plantar arterial arch and deep branches of lateral plantar nerve

Deep branches of medial plantar artery and nerve

Tuberosity of 5th metatarsal b o n e

Flexor d i g i t o r u m longus t e n d o n (cut) Tibialis posterior t e n d o n

Peroneus brevis t e n d o n

Medial plantar artery and nerve

Peroneus longus t e n d o n and fibrous sheath

Flexor hallucis longus t e n d o n Quadratus plantae muscle (cut and slightly retracted)

Flexor retinaculum A b d u c t o r hallucis muscle (cut)

Lateral plantar artery and nerve A b d u c t o r digiti minimi muscle (cut) Lateral calcaneal artery and nerve Tuberosity of calcaneus

fljw . 5 i-

Flexor digitorum brevis muscle and plantar aponeurosis (cut) M e d i a l calcaneal artery and nerve

7

Interosseous Muscles and Deep Arteries of Foot

Dorsal view

Fibularis (peroneus) longus tendon (cut) Fibularis (peroneus) brevis tendon (cut) Cuboid bone Lateral tarsal artery Tuberosity of 5th metatarsal bone Fibularis (peroneus) tertius tendon (cut) Posterior perforating branches (from deep plantar arterial arch) Dorsal metatarsal arteries Extensor digitorum longus tendons (cu

Navicular bone Dorsalis pedis artery Medial tarsal artery Lateral ) Intermediate / Cuneiform bones Medial ) Dorsal tarsometatarsal ligaments Dorsal metatarsal ligaments artery Deep plantar artery passes to contribute to deep plantar arch interosseous muscles

Metatarsal bones

Extensor expansions Anterior perforating branches (from plantar metatarsal arteries)

Extensor hallucis longus tendon (cut) Extensor digitorum brevis and extensor hallucis brevis tendons (cut)

Dorsal digital arteries

Plantar view

Proper plantar digital arteries C o m m o n plantar digital arteries Lumbrical muscles (cut) Deep transverse metatarsal ligament and plantar ligaments (plates) Interosseous muscles

Plantar Dorsal

A b d u c t o r digiti minimi muscles Plantar metatarsal arteries Flexor digiti minimi brevis muscle Deep plantar arch Lateral plantar artery (cut) Tuberosity of 5th metatarsal bone Fibularis (peroneus) longus tendon Fibularis (peroneus) brevis tendon Tuberosity of cuboid bone Long plantar li Calcaneocuboid (short plantar) ligament

Flexor hallucis longus tendon (cut) Anterior perforating branches (to dorsal metatarsal arteries) Sesamoid bones Insertion of adductor hallucis and lateral head of flexor hallucis brevis muscles (cut) Insertion of abductor hallucis and medial head of flexor hallucis brevis muscles (cut) Medial origin of flexor hallucis brevis muscle (cut) Deep plantar artery (from dorsalis pedis artery) Posterior perforating branches (to dorsal metatarsal arteries) Plantar metatarsal ligaments (between bases of metatarsal bones) Medial cuneiform bone bialis anterior tendon (cut) Lateral origin of flexor hallucis brevis tendon (cut) berosity of navicular bone Tibialis posterior tendon (cut) Plantar calcaneonavicular (spring) ligament

Interosseous Muscles of Foot

Dorsal view

Cuboid Tuberosity of 5th metatarsal b o n e

Navicular

Lateral Intermediate > C u n e i f o r m bones Medial

Dorsal interosseous muscles (bipennate)

5th metatarsal b o n e

I Proximal phalanx Little \ (5th) < M i d d l e phalanx toe / ( Distal phalanx

1 st metatarsal b o n e

Proximal phalanx of great toe


Plantar view


Proximal phalanx of great toe Distal phalanx

Sesamoid bones

M i d d l e phalanx Proximal phalanx

1 st metatarsal b o n e Plantar interosseous muscles (unipennate)

5th metatarsal bo

Lateral / Intermediate / Medial \

Tuberosity of 5th metatarsal b o n e Cuboid

Navicular


7

Femoral Nerve and Lateral Femoral Cutaneous Nerve

Lateral femoral cutaneous nerve (L2, 3) Femoral nerve (12, 3, 4)

>

Lumbar plexus

O b t u r a t o r nerve Lumbosacral trunk lliacus muscle Psoas major muscle (lower pa Articular branch Sartorius muscle (cut and reflected) Pectineus muscle

Rectus femoris muscle (cut and reflected) Quadriceps femoris -< muscle

Vastus intermedius muscle


Anterior cutaneous branches of femoral nerve Sartorius muscle (cut and reflected)

Vastus meclialis muscle Vastus lateralis muscle

Saphenous nerve

Articularis genus muscle

Infrapatellar branch of saphenous nerve

Note: O n l y muscles innervated by femoral nerve shown

Medial crural cutaneous nerves (branches of saphenous nerve)


7

Obturator Nerve

Iliohypogastric nerve >• Lumbar plexus Ilioinguinal nerve

Genitofemoral nerve

Lumbosacral trunk


Femoral nerve Obturator externus muscle

Obturator nerve (L2, 3, 4)

Posterior branch

Articular branch A d d u c t o r brevis muscle Anterior branch

A d d u c t o r longus muscle (cut) \

A d d u c t o r magnus muscle (ischiocondylar, or hamstrings/' part supplied by sciatic [tibial! nerve)

Posterior branch

Cutaneous branch

V

I

Gracilis muscle

A

Articular branch to knee joint

i

/

A d d u c t o r hiatus

Note: Only muscles innervated by obturator nerve shown Cutaneous innervation

y / f>, L../ -

• ^ • ^ ^ • ' ' • • - . . . ^ i U

7

Sciatoe Merwe and Posterior Femoral ©MfameoMS Merwe

Posterior femoral cutaneous nerve (SI, 2 , 3 )

Greater sciatic foramen Inferior clunial nerves Sciatic nerve (L4, 5, SI, 2, 3)

Perineal branches

C o m m o n fibular (peroneal) division of sciatic nerve

Tibial division of sciatic nerve

Long head (cut) of biceps femoris muscle

Short head of biceps femoris muscle

Adductor magnus muscle (also partially supplied by obturator nerve)

^ , • Cutaneous innervation

Long head (cut) of biceps femoris muscle

Semitendinosus muscle

Semimembranosus muscle

Tibial nerve

Common fibular (peroneal) nerve

Articular branch


Articular branch

Plantaris muscle

Medial sural cutaneous nerve


Sural communicating branch


Sural nerve

Soleus muscle

Medial sural cutaneous nerve From sciatic nerve

Tibial nerve

Medial calcaneal branches

Medial and lateral plantar nerves

C o m m o n fibular (peroneal) nerve via lateral sural cutaneous nerve

Superficial fibular (peroneal) nerve Sural nerve

Lateral calcaneal branches

Lateral dorsal cutaneous nerve

Tibial nerve via medial calcaneal branches

Tibial Nerve

C o m m o n fibular (peroneal) nerve

Tibial nerve (L4, 5, SI, 2, 3)

Articular branch Lateral sural cutaneous nerve (cut)

Medial sural cutaneous nerve (cut)

Medial calcaneal branches (SI, 2)

Articular branches

Medial plantar nerve (L4, 5)

From tibial nerve

Plantaris muscle

Lateral plantar nerve (SI, 2)

Gastrocnemius muscle (cut)

Saphenous nerve (L3, 4) Sural nerve (SI, 2) via lateral calcaneal and lateral dorsal cutaneous branches

Nerve to popliteus muscle

Popliteus muscle

Interosseous nerve of leg

Cutaneous innervation of sole

Flexor retinaculum (cut)

Soleus muscle (cut partly retracted)

Flexor cli longus muscle

Tibialis posterior m


Sural nerve

Lateral calcaneal branch

Medial calcaneal branch

Flexor retinaculum (cut)

Lateral dorsal cutaneous nerve

Tibial nerve

Medial calcaneal branch Medial plantar nerve

Flexor d i g i t o r u m brevis muscle and nerve A b d u c t o r hallucis muscle and nerve Flexor hallucis brevis muscle and nerve 1st lumbrical muscle and nerve Common plantar digital nerves Proper plantar digital nerves

Lateral calcaneal branch of sural nerve Lateral plantar nerve

N e r v e to abductor digiti minimi muscle Quadratus plantae muscle and nerve A b d u c t o r digiti minimi muscle Deep branch to interosseous muscles, 2nd, 3rd, and 4th lumbrical muscles and A d d u c t o r hallucis muscle uperficial branch t o 4th interosseous muscle and Flexor digiti minimi brevis muscle

C o m m o n and Proper plantar digital nerves

Note: Articular branches not s h o w n

7

Common Fibular (Peroneal) Nerve W S V f i K y . ' - i W • sr.*


C o m m o n fibular (peroneal) nerve (phantom)


(phantom)

Articular branches Biceps femoris t e n d o n Recurrent articular nerve Common fibular nerve (L4, 5, SI, 2)

Extensor d i g i t o r u m longus muscle (cut)

Head of fibula Deep fibular (peroneal) nerve

Fibularis (peroneus) longus muscle (cu

bialis anterior muscle


Superficial fibular (peroneal) nerve

Branches of lateral sural cutaneous nerve


Extensor d i g i t o r u m longus muscle


Fibularis (peroneus) brevis muscle Lateral sural cutaneous nerve

Medial dorsal cutaneous nerve

Intermediate dorsal cutaneous nerve

Inferior extensor retinaculum (partially

cut)

Lateral dorsal cutaneous nerve (branch of sural nerve)

Superficial fibular (peroneal) nerve Lateral branch of deep fibular (peroneal) nerve to Extensor hallucis brevis and Extensor d i g i t o r u m brevis muscles Medial branch of deep fibular (peroneal) nerve

Deep fibular (peroneal) nerve

Sural nerve via lateral dorsal cutaneous branch

Dermatomes of Lower Limb

Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any t w o adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).

Autonomous sensory zones A

SI

Anterior

Posterior view

Segmental innervation of lower limb m o v e m e n t s

Knee

Extension

Dorsiflexion

Flexion

Foot

14, 5

Ankle Flexion

Extension

Plantar flexion

7

Superficial Nerves and Veins of Lower Limb: Anterior View

Lateral cutaneous branch of subcostal nerve Superficial epigastric vein Inguinal ligament (Poupart's) Superficial circumflex iliac vein Femoral branches of genitofemoral Lateral femoral cutaneous Saphenous opening (fossa ovalis) Fascia lata

Ilioinguinal nerve (scrotal branch) (usually passes through superficial inguinal ring) Genital branch of genitofemoral nerve Femoral vein uperficial external pudendal vein Accessory saphenous vein Great saphenous vein

Anterior cutaneous branches of femoral nerve Cutaneous branches of obturator nerve

Patellar nerve plexus

Branches of lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve Deep fascia of leg (crural fascia)

Infrapatellar branch of saphenous nerve

Saphenous nerve (terminal branch of femoral nerve)


Superficial fibular (peroneal) nerve Medial dorsal cutaneous branch Intermediate dorsal cutaneous branch

Small saphenous vein and lateral dorsal cutaneous nerve (from sural nerve) Lateral dorsal digital nerve and vein of 5th

Dorsal digital nerves

Dorsal venous arch

Dorsal digital nerve and vein of medial side of great toe Dorsal metatarsal veins Dorsal digital branch of deep fibular (peroneal) nerve Dorsal digital nerves and veins

Superficial Nerves and Veins of Lower Limb: Posterior View

Lateral cutaneous branch of iliohypogastric nerve Iliac crest Medial clunial nerves (from dorsal rami of S1, 2, 3)

Superior clunial nerves (from dorsal rami of LI, 2, 3) Inferior clunial nerves (from posterior femoral cutaneous nerve)

Perforating cutaneous nerve (from dorsal rami of SI, 2, 3)

Branches of posterior femoral cutaneous nerve

Branches of lateral femoral cutaneous nerve

Accessory saphenous vein

Branch of femoral cutaneous nerve Branch of cutaneous branch of femoral nerve

Terminal branches of posterior femoral cutaneous nerve


Lateral sural cutaneous nerve (from c o m m o n fibular [peroneal] nerve)

Small saphenous vein Sural c o m m u n i c a t i n g nerve Branches of saphenous nerve — Medial sural cutaneous nerve (from tibial nerve)

Sural nerve

Lateral calcaneal branches of sural nerve

Lateral dorsal cutaneous nerve (continuation of sural nerve)

Medial calcaneal branches of tibial nerve

Plantar cutaneous branches of medial plantar nerve

V mw&m^M

Plantar cutaneous branches of lateral plantar nerve

7

Lymph Vessels and Nodes of Lower Limb See also Plates 407, 408

Popliteal vein Popliteal lymph nodes

Cribriform fascia within saphenous opening

Horizontal group: Superolateral nodes Superomedial ^ nodes Vertical group: Inferior nodes

Superficial inguinal nodes

Fascia lata Great saphenous vein


Superficial lymph vessels

External iliac lymph nodes

Deep fascia of leg (crural fascia) Femoral nerve

Femoral ring Great saphenous vein



Ductus (vas) deferens Femoral sheath Femoral canal (opened) Femoral artery and vein


Deep inguinal lymph nodes

CT Angiograms of Arteries of the Lower Limb

8

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References

Plate 58

Plates 291, 2 9 2

Braus H. A n a t o m i e des M e n s c h e n . Berlin, Verlag von Julius

Elias H. Liver morphology. Biol Rev 1955; 30:263.

Springer, 1924.

. Origin a n d early d e v e l o p m e n t of the liver in various ver-

Plate 8 9

tebrates. A c t Hepat 1955;3:1.

Nishida S. The Structure of t h e Eye. New York, Elsevier NorthHolland, 1982.

L a c h m a n N, A c l a n d RD, Rosse C. Anatomical evidence for t h e absence of morphologically distinct cranial root of t h e a c c e s sory nerve in man. Clin Anat 2002; 15:4.

Injury, Trans

11th

. A re-examination of the structure of the mammalian liver: the hepatic lobule and its relation to the vascular and biliary system. A m J Anat 1949; 85:379. . A re-examination of the structure of t h e m a m m a l i a n liver:

Plates 164, 4 8 2 , 525, 5 4 3

parenchymal architecture. A m J Anat 1949; 84:311.

Foerster O. The d e r m a t o m e s in man. Brain 1933; 56:1. Garrett FD. The segmental distribution of t h e c u t a n e o u s nerves in the limbs of man. Anat Rec 1948; 102:409.

Plates 305, 3 0 8 Michels

NA.

Blood

Supply

and

Anatomy

of

the

Upper

A b d o m i n a l Organs, With a Descriptive Atlas. Philadelphia, J B

Keegan JJ. D e r m a t o m e hypalgesia with posterolateral herniation of lower cervical intervertebral disc. J Neurosurg

1947;

4:115.

Lippincott, 1955. Plate 3 2 6 T h o m a s MD. In The Ciba Collection of Medical Illustrations, Vol

Plate 172

3, Part II. Summit, NJ, CIBA, p 78.

Turnball IM. B l o o d y s u p p l y of t h e spinal cord. In Vinken PJ, GW

(eds):

Handbook

of

Clinical

Neurology,

XII.

A m s t e r d a m , North-Holland, 1972, p p 4 7 8 - 4 9 1 .

J a c k s o n CL, Huber JF. Correlated applied a n a t o m y of t h e bronchial tree and lungs with a system of nomenclature. Dis Chest 1943; 9:319.

Ikeda S, O n o Y, Miyazawa S, et al. Flexible b r o n c h o - f i b e r s c o p e . Otolaryngology (Tokyo) 1970; 42:855.

Plates 3 5 6 , 360, 365, 370, 378, 3 7 9 Oelrich T M . The striated urogenital sphincter muscle in the female. Anat Rec 1983; 205:223.

J a m e s TN. The internodal pathways of t h e human heart. Prog Cardiovas Dis 2001; 43:495.

ated urethral sphincter a n d radical prostatectomy: the apical

Plates 359, 361, 3 8 3 , 384 Oelrich T M . The urethral sphincter muscle in the male. A m J Anat 1980; 158:229.

Plates 253, 3 6 6 , 370, 3 8 3 Myers RP, King BF, Cahill DR. Deep perineal " s p a c e " as defined by magnetic resonance imaging. Presented at 14th Annual Session

Myers RP, Goellner JR, Cahill DR. Prostate shape, external stridissection. J Urol 1987; 138:543.

Plate 2 2 5

of t h e A m e r i c a n

Association

of

Clinical

Anatomists, Honolulu, HI, 1997. [Abstract: Clin Anat 1998;11].

Plate 4 0 3 Flocks RH, Kerr HD, Elkins HB, et al. Treatment of c a r c i n o m a of the prostate by interstitial radiation with radio-active gold (Au 198): a preliminary report. J Urol 1952; 68(2):510. Plate 4 8 2

Plate 282 DiDio LJA. Anatomo-Fisiologia d o Piloro ileo-ceco-colica Actas

S t o r m o n t TJ, Cahill DR, King BF, Myers RP. Fascias of the male

Plates 359, 361

Plate 2 0 3

Scientific

Plates 348, 361, 384, 396, 4 1 4 external genitalia and perineum. Clin Anat 1994; 7:115.

Plates 200, 201

homen.

of the liver. In Liver

Conference. N e w York, M a c y Foundation, 1953.

Plates 116, 117, 127

Bruyn

. Morphology

das

Primeiras

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no

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Argentinas de Gastroenterologia, Rosario, 1954. . Dados a n a t o m i c o s sobre o "piloro"

ileo-ceco-colico.

(Com observacao direta in vivo de "papila" ileo-ceco-colico.) [English summary]. Thesis, Fac M e d , Univ de Sao Paulo, 1952. Plate 290 Healey JE Jr, Schroy PC. A n a t o m y of t h e biliary d u c t within the human liver: analysis of the prevailing pattern of branchings a n d the major variations of t h e biliary ducts. Arch Surg 1953; 66:599. Healey JE Jr, Schroy PC, Sorensen RJ. The intrahepatic distribution of the hepatic artery in man. J Int Coll Surg 1953; 20:133.

Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec 1948; 102:409. Plate 5 4 3 Keegan JJ. Neurological interpretation of d e r m a t o m e hypalgesia with herniation of the lumbar intervertebral disc. J Bone Joint Surg 1944; 26:238. Last RJ. Innervation of the limbs. J Bone Joint Surg 1949; 31(B):452.

Index

References are to plate numbers. In most cases, structures are listed under singular nouns.

A Abdomen, 268 autonomic nerves and ganglia of, 318 axial CT images of, 350 bony framework of, 248 cross sections of at L3, 349 at L3, 4, 349 at L1-L2, 339 at T10, 293 at T12, 297, 331, 338 innervation of, 318 left lower quadrant of, 268 left upper quadrant of, 268 regions and planes of, 268 right lower quadrant of, 268 right upper quadrant of, 268 subcutaneous tissue of, 249 surface anatomy of, 247 viscera of, 269 Abdominal aortic plexus. See Intermesenteric plexus Abdominalis muscle, transversus, 362 Abdominal muscles, transversus, 363 aponeurosis of, 252 Abdominal wall anterior, 249, 265 arteries of, 255 deep dissection of, 251 intermediate dissection of, 250 internal view of, 253 nerves of, 257 superficial dissection of, 249 veins of, 255 arteries of, 263 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 median (sagittal) section of, 348 posterior arteries of, 264 internal view of, 263 lymph vessels and nodes of, 266 nerves of, 267 peritoneum of, 274 veins of, 265 posterolateral, 254 Abdominis aponeurosis, transversus, 252, 330, 349 Abdominis muscle aponeurosis of, 255, 330 rectus, 181, 188, 189, 192, 247, 250, 251, 258, 259, 293, 349, 351, 378 axial CT image of, 350 capsular branch of, 335 cross section of, 252 pelvic branch of, 335

Abdominis muscle (Continued) sheath of, 189 transversus, 25, 94, 96, 179, 189, 255, 257, 258, 263, 267, 329, 498 aponeurosis of, 252, 330, 349 tendon of origin of, 175, 176, 179 Abducent nerve (VI), 83, 84, 86, 114, 117, 118, 121 distribution of, 118 schema of, 118 Abducent nucleus, 116, 117, 121 Abductor digiti minimi muscle, 465, 470, 476, 533, 534, 536, 541 nerve to, 534 tendon of, 533 Abductor hallucis muscle, 533, 534, 535, 541 insertion of, 534, 536 Abductor hallucis nerve, 541 Abductor pollicis brevis muscle, 461, 465 Abductor pollicis longus muscle, 441, 444, 449, 451 area for, 439 Abductor pollicis longus tendon, 444, 469, 470 Aberrant ductule, 390 Accessory muscle bundle, 67 Accessory nerve (XI), 34, 114, 116, 117, 129, 177 cranial root of, 126, 127 schema of, 118, 127 spinal nucleus of, 116, 117 spinal roots of, 10, 118, 127 Accessory oculomotor nucleus, 116, 117, 121, 132 Acetabular fossa, 376, 487 fat in, 487 transverse section of, 376 Acetabular labrum, 352, 487 Acetabular ligament, transverse, 352, 487 Acetabular notch, 352, 486 Acetabulum, 352, 486 anteroposterior radiograph of, 488 articular surface of, 376 lunate surface of, 486 margin of, 352, 353, 486 radiograph of, 355 Achilles tendon. See Calcaneal (Achilles) tendon Acinus, 204 Acoustic artery, internal. See Labyrinthine artery Acoustic meatus external, 8, 13, 92, 93 auricular branch of vagus nerve to, 24 axial CT images of, 150 axial MR image of, 150 cartilaginous and osseous, 93 coronal oblique section of, 93 internal, 92, 97, 123 Acoustic opening, internal, 97 Acromial anastomosis, 427 Acromial angle, 420, 421 Acromial plexus, 427

Acromioclavicular joint, 423, 425 capsule of, 423 Acromioclavicular ligament, 423 Acromion, 27, 33, 185, 287, 418, 420, 421, 422, 423, 424, 425, 427, 429, 431, 432 anteroposterior radiograph of, 422 Adamkiewicz, artery of, 171 Adductor brevis muscle, 489, 493, 539 attachments of, 489, 491 Adductor canal, 500 Adductor hallucis muscle, 541 deep tibial nerve branch to, 541 insertion of, 536 oblique head of, 535 transverse head of, 535 Adductor hiatus, 539 femoral artery passing through, 512 Adductor longus muscle, 376, 489, 492, 493, 500, 505, 539 attachments of, 489, 491 innervation of, 540 transverse section of, 521 Adductor magnus muscle, 485, 489, 495, 500, 502, 505, 540 adductor minimus part of, 493 attachments of, 489, 491 hiatus of, 493 innervation of, 540 tendon of, 493 Adductor magnus tendon, 501, 506, 510, 511 Adductor muscles, thigh, 496 Adductor pollicis muscle, 462, 465, 476, 535 fascia over, 460, 462 Adductor tubercle, 489 Adenohypophysis, 140, 147, 148 cleft of, 147 Adnexa, 371 Afferent fibers, olfactory bulb, 119 Afferent nerves of mouth and pharynx, 62 of nose and sinuses, 210 of stomach and duodenum, 321 Agger nasi, 37, 38 Air, in colon, radiograph of, 355 Air cells, mastoid, axial MR image of, 150 Airway intrapulmonary, 204 to nasopharynx, 37 Airway reflexes, nerves initiating, 210 Ala, 8 lateral part of, 157 wing of, 157 Alar fibrofatty tissue, 36, 38 Alar fold, 507 Alar ligament, 22 Albini's nodules. See Fibrous (Albini's) nodule Alcock's canal. See Pudendal canal (Alcock's)

Alveolar artery anterior superior, 40 inferior, 40, 53, 60 lingual branch of, 69 mental branch of, 40, 69 middle superior, 40 posterior superior 40, 69 Alveolar duct, 204 opening of, 204 Alveolar nerve, 53, 55, 122, 131, 134 anterior superior, 45 nasal branch of, 42 inferior, 16, 40, 53, 55, 60, 131, 134 branch of, 40 entering mandibular foramen, 46 middle superior, 45 posterior superior, 44, 45 superior, 62, 71 Alveolar sac, 204 Alveolar vein inferior, 60, 70 posterior superior, 60, 70 Alveolus, 204 capillary bed in, 205 Amacrine cells, 120 Ampulla ear, 95, 96 semicircular, 92 of uterine tube, 372 Amygdaloid body, 110, 112, 119 thalamus and, 110 Anal canal, 393 anatomical, 393 arteries of, 398 beginning of, 376 beginning of, transverse section of, 357, 521 longitudinal muscle of, 356, 357 muscularis mucosae of, 393, 394 sagittal MR images of, 397 surgical, 393 veins of, 399 Anal columns, 393 Anal glands, 393 Anal nerve, inferior, 410, 411, 414, 496, 503 AnaS pit, 388 Anal sinus, 393 Anal sphincter muscle external, 356, 358, 360, 365 deep part of, 394, 395, 396 peripheral view of, 395 subcutaneous of, 391, 393, 395, 396 superficial part of, 391, 393, 394, 395 internal, 393, 394 Anal triangle, 380 Anal tubercle, 388 Anal valve, 393 Anal verge, 393 Anastomosis around elbow, 434 around scapula, 427 carotid-vertebral, 138 gastro-omental arterial, 272 in incisive canal, 40 obturator-pubic arterial, 259 paravertebral, 172 patellar, 500, 512 portacaval, 312 right-left, 138

Anastomosis (Continued) between septal sphenopalatine artery and greater palatine artery, 41, 138 subclavian-carotid, 138 subclavian-vertebral, 138 Anastomotic branch, 301 Anastomotic loop of ileal arteries, 280 of jejunal arteries, 280 of posterior spinal arteries, 171 of small intestinal veins, 310 of small intestine, 306 Anastomotic vein inferior, 102, 145 superior, 102 Anatomical snuffbox, 444 radial artery to, 469, 470 Anconeus muscle, 432, 444, 445, 477 nerve to, 432 origin of, 421 Angular artery, 23, 36, 68, 85, 138 Angular gyrus, 105 cerebral artery to, 141 cerebral branches to, 141, 142 Angular vein, 23, 70, 85 Ankle dorsiflexion and plantar flexion of, 543 lateral ligament of, 514 ligaments and tendons of, 514 ligaments of, 527 medial ligament of, 514 radiograph of, 526 tendons of, 527 Annular ligament of radius, 438 of trachea, 202 Anococcygeal body, 357, 378, 379, 395, 396 Anococcygeal nerve, 411, 412, 499 Anocufaneous line, 392, 393, 394 Anoderm, 393 Anorectal hiatus, 358 Anorectal junction, circular muscle layer of, 359 Anorectal line, 393 Anorectal musculature, 394 Ansa cervicalis, 31, 32, 128, 129 inferior root of, 32, 34, 71, 74, 128, 129 superior root of, 32, 34, 71, 74, 128, 129 ventral rami of, 128 Ansa of Galen, 80 Ansa subclavia, 130, 209, 226, 240 Anserine bursa, 506, 507 Antebrachial vein intermediate, 418, 479 median, 449 Anterior chamber, 81, 87, 88, 89, 90 endothelium of, 88 Anterolateral central arteries, 140, 141 Anteromedial central arteries, 140 Antihelix, 1, 93 crura of, 1, 93 Antitragus, 1, 93 Anulus fibrosus, 19, 155 Anum, fibrous septum of, 394 Anus, 360, 377, 380, 382, 388, 395 fetal, 388 transverse fibrous septum of, 393

Aorta, 207, 263, 324, 330, 342 abdominal, 27, 179, 195, 207, 225, 232, 270, 273, 274, 278, 298, 300, 301, 324, 327, 329, 330, 331, 332, 339, 341, 342, 363, 369, 398, 400, 401, 403, 412 cross section of, 338 arch of, 237, 244 ascending, 138, 215, 220, 223, 224, 225, 242, 245 axial CT images of, 242, 350 descending, 237, 242, 245, 246 thoracic, 194, 242 prenatal, 229 thoracic, 172, 297 cross section of, 297 descending, 172, 231, 241 esophageal branches of, 237 ureteric branch from, 341 Aortic arch. See Arch of aorta Aortic hiatus, 195 Aortic lymph node, lateral, 266, 343, 406 Aortic lymph nodes, 266 Aortic nerve, 228 Aorticorenal ganglion, 165, 167, 267, 318, 320, 321, 322, 324, 344, 345, 346, 409 celiac, 267 left, 318, 320, 323, 410, 415 right, 318, 320, 323 superior mesenteric, 267 Aortic plexus, 321, 322, 412 Aortic sinus, 223, 224 Aortic valve anatomy of, 223 semilunar cusps of, 221, 222, 223, 224, 225 left, 224 Apical foramen, 57 Apical ligament, of dens, 63, 65 Appendicular artery, 281, 306, 307, 322,323 Appendicular nodes, 317 Appendicular plexus, 322, 323 Appendicular vein, 311, 312 Appendix, 126 fibrous, 287 vermiform, 271, 281, 283, 284, 362, 363 aggregate lymphoid nodules of, 283 barium radiograph of, 283 circular muscle of, 283 fixed retrocecal, 283 orifice of, 282 serosa of, 283 submucosa of, 283 variations in position of, 283 Arachnoid, 102, 109 cerebral veins penetrating, 102 Arachnoid-dura interface, 102 Arachnoid granulation, 100, 102, 109 granular foveola for, 99 skull indentation for, 99 Arachnoid mater, 169 lumbar, 170 thoracic, 170 Arantius, body of, 223

Arch of aorta, 74, 75, 80, 138, 206, 210, 211,212,213,214,215,221,232, 233 groove for, 199 radiograph of, 213 Arcuate artery, 335, 337, 530, 531, 536 afferent glomerular arteriole from, 337 lymph vessels along, 343 Arcuate eminence, 9 Arcuate ligament dorsal radial metaphyseal, 455 lateral, 195, 263 medial, 195, 263 median, 195, 263 Arcuate line, 248, 251, 255, 259, 279, 348, 352, 353, 356, 486 section above, 252 section below, 252 Arcuate nucleus, 147 Arcuate popliteal ligament, 508, 511 Arcuate vein, 337 Arcus tendineous fasciae pelvis, 372 Areola, 182 Areolar gland, 182 Areolar tissue, 179, 251, 361, 471 in anterior closed space of finger, 471 Areolar venous plexus, 256 Arm. See also Forearm arteries of, 484 cutaneous nerves of, 479, 481 inferior lateral, 432, 477, 479, 481 medial, 257, 429, 432, 435, 473, 474, 479 ~ ' posterior, 432, 477, 479, 481 superior lateral, 432, 477, 478, 479, 481 deep artery of, 429, 432, 433, 434, 435 middle collateral branch of, 445 muscles of, 432 anterior views of, 430 deep layer of, 430, 432 posterior, 432 posterior view of, 432 superficial layer of, 430, 432 superior lateral, 432 neurovascular compartment of, 435 radial nerve in, 477 serial cross section of, 435 superficial veins of, 480 Arrector muscle, hair follicle, 167 Arteriae rectae, 307 Arteriogram, celiac, 303 Arteriole intralobular, 291 periportal, 291 portal, 291 Artery(ies). See also specific arteries of anterior abdominal wall, 255 of arm, 484 to brain, 136-137, 138, 141, 142 frontal view of, 141 lateral and medial views of, 142 colic, 308 of duodenum and head of pancreas, 301, 304 of esophagus, 237 of face, 23 of female pelvic organs, 400 of female pelvis, 403 of female perineum and uterus, 405 of femoral head, 504

Artery(ies) (Continued) of femoral head and neck, 504 of fingers, 471 of foot, 536 of foot, deep, 536 of hand, palmar view of, 466 of head, 23 of hip and thigh, 500-502 of hypothalamus and hypophysis, 148 intrarenal, 335 intrinsic distribution of, in spinal cord, 172 of large intestine, 307 of liver, 301 of liver, pancreas, duodenum, and spleen, 301, 305 of liver and gallbladder, variations in, 305 of male pelvis, 403 of male perineum, 405 of mammary gland, 183 to meninges, 136 of nasal cavity, 41 of neck, 504 of oral and pharyngeal regions, 69 of oral region, 69 of pancreas, 301 of posterior abdominal wall, 264 of posterior cranial fossa, 142, 143 of rectum and anal canal, 398 renal, 335 of scalp, 23 of spinal cord, 171 of spleen, 301 of stomach, liver, and spleen, 300 of testis, 401 of thigh anterior view of, 501 posterior view of, 502 of upper limb, 473 computed tomography of, 484 at wrist, 461 Articular cavity, 471 of finger, 471 Articular disc, 16, 243 Articularis genus muscle, 505, 507, 511, 538 attachment of, 489 Articular nerve great, 32 recurrent, 542 Articular process inferior, lumbar, 155 superior, lumbar, 155 Articular tubercle, 55 Aryepiglottic fold, 66, 67, 78 Aryepiglottic muscle, 78, 80 Arytenoid muscle oblique, 67, 78, 79, 80, 235 transverse, 63, 78, 79, 80, 235 action of, 79 Atlantoaxial joint, 19 lateral, 19 capsule of, 21 median, superior view of, 22 radiograph of, 17 Atlantooccipital joint capsule, 21, 22 Atlas (C1 j, 13, 17, 19, 22, 153, 160 anterior, 21 anterior arch of, 5, 17, 19, 37, 62, 137 anterior tubercle of, 19 dens of, articular facet for, 17 inferior view of, 17

Atlas (C1) (Continued) lateral mass of, 17 occipital condyle of, 17 posterior, 21 posterior arch of, 17, 18, 178 posterior tubercle of, 17, 175, 176 spinous process of, 18 superior articular facet for, 17 superior view of, 17 transverse foramen of, 17 transverse process of, 17, 21, 30, 39, 176 Atrioventricular bundle, 225 Atrioventricular node, 22, 218, 225 Atrioventricular valve left. See Mitral valve right. See Tricuspid valve Atrium, 224 internodal conduction pathways of, 225 left, 214, 215, 220, 221, 224, 246 auricle of, 212 oblique vein of, 214, 215, 216 section through, 221 right, 212, 213, 214, 215, 220, 223, 224, 241,246 opened, 220 radiograph of, 213 Auditory ossicles, 93 Auditory (pharyngotympanic, Eustachian) tube, 92, 93, 96, 125, 126 cartilage of, 47 cartilaginous part of, 52, 55, 64, 65, 67 groove for, 8 opening of, 37 pharyngeal opening of, 63, 64, 66, 125 Auerbach's plexus. See Myenteric (Auerbach's) plexus Auricle, 92, 97 concha of, 93 left, 212, 213, 215, 216, 224, 225 lobule of, 93 posteromedial surface of, 24 right, 93, 212, 214, 219, 220, 224 Auricular artery anterior, 23 deep, 40 posterior, 23, 34, 40, 100, 136, 138, 178 Auricularis anterior muscle, 26 Auricularis posterior muscle, 26 Auricularis superior muscle, 26 Auricular muscle, facial nerve branches to, 123 Auricular nerve, 122 anterior, 122 articular branch of, 122 great, 21, 22, 24, 32, 129, 177, 178 greater, 31 posterior, 25, 123 occipital branch of, 123 Auricular tubercle (of Darwin), 93 Auricular vein, posterior, 23, 70 Auriculotemporal nerve, 16, 24, 40, 55, 71, 122, 125, 134 Auscultation, triangle of, 152, 246, 424 precordial area of, 213 Autonomic ganglion, abdominal, 318 Autonomic nerves of abdomen, 318 in head, 131

Autonomic nerves (Continued) of nasal cavity. 44 to neck, 24 in thorax, 209 Autonomic nervous system schema of, 167 topography of, 167 Autonomic plexus, intrinsic, 326 Autonomic reflex pathways, 325 Axilla dissection of, 181 anterior view of, 429 dissection of, anterior view, 429 muscles of, 424 oblique parasagittal section of, 428 oblique parasagittal section of, 428 suspensory ligament of, 428 Axillary artery, 183, 189, 198, 200, 255, 427, 428, 429, 433, 434 acromial branch of, 434 anterior view of, 434 clavicular branch of, 434 computed tomography of, 484 deltoid branch of, 434 pectoral branch of, 434 posterior view of, 434 Axillary fold, 181 anterior, 181 posterior, 181 Axillary fossa, 243, 244, 245 Axillary lymph nodes, 428 along axillary vein, 484 apical, 184 brachial, 184 central, 184, 428 lateral, 483 along axillary vein, 483 parasagittal section of, 428 pectoral, 184, 428 subscapular, 184 Axillary nerve, 177, 425, 427, 429, 432, 476, 477, 481 superior lateral cutaneous nerve of arm from, 479 Axillary recess, 423 Axillary tail (of Spence), 182, 183 Axillary vein, 189, 198, 256, 428 intercostal tributaries to, 256 lymph nodes along, 483 Axis (02), 13, 17, 19, 22, 153 anterior view of, 153 body of, 17, 21 dens of, 5, 17, 37, 63 inferior articular process of, 17 interarticular part of, 17 left lateral view of, 153 pedicle of, 17 posterosuperior view of, 17 posterior articular facet of, 17 posterior lateral view of, 153 posterior tubercle of transverse process of, 30 spinous process of, 17, 174, 176 transverse process of, 30 Azygos vein, 17, 21, 153, 194, 206,.207, 209, 230, 241, 245, 246, 293, 331, 349 arch of, 230, 232, 244 axial CT images of, 242 groove for, 199

B Babinski's sign, 101 Back bones and ligaments of, 153-157 lumbar region, cross section of, 179 muscles of deep layer of, 176 axial CT images of, 350 intermediate layer of, 175 superficial layers of, 174 nerves of, 177. 179 surface anatomy of, 152 Bartholin's gland. See Vestibular gland, greater Basal nucleus, organization of, 110 Basal vein, 144, 145, 146 Basilar artery, 140, 141, 143, 171 axial MR image of, 150 Basilar membrane, 96 Basilar venous plexus, 103 Basilic vein, 418, 429, 449, 468, 480, 483, 484 intermediate, 480 Basivertebral vein, 137, 173 Biceps brachii muscle, 181, 418, 420, 429, 433, 435, 446, 447, 451 fascia over, 428 insertion of, 420 long head of, 424, 426, 428, 433, 435, 474 origin of, 420 tendon of, 243, 244, 245 short head of, 424, 428, 430, 433, 434, 435, 474 combined, 244 origin of, 420 tendon of, 425, 432, 433, 438, 446, 447 long head of, 423, 425, 430 short head of, 430 Biceps femoris muscle, 485, 489, 495, 503, 515 attachments of, 489, 515 long head of, 485, 494, 495, 540 attachments of, 491 short head of, 488, 494, 495, 540 attachments of, 491 tendon of, 506, 511, 514, 517, 520, 542 bursa of, 511 inferior subtendinous, 506, 507 long head of, 353 Bicipital aponeurosis, 430, 433. 446, 480 Bifurcate ligament, 527 Bigelow, Y ligament of, 487, 496 Bile canaliculus, 292 Bile duct, 126, 290, 291, 292 common, 167, 273, 274, 278, 279, 288, 294, 295, 297, 298, 300, 301, 304 cross section of, 338 hepatic ducts joining, 290 junction with duodenum, 295 extrahepatic, 294 union of pancreatic ducts and, 295 Bile ductule, 290 intralobular, 290 periportal, 290, 291, 292 Biliary tract innervation of, 327 intrahepatic, 292 Bipolar cells, 120

Bladder-prostate junction, 376 Blood circulation intrapulmonary, 205 postnatal, 229 prenatal, 229 Blood vessels, innervation of, 228 Bone(s) See also specific bones of abdomen, 248 of cranial base, 9 of elbow, 436 of foot, 523, 524 of forearm, 439 of hand, 474 of head, 2-16 of lower limb, 513, 524 of nasal cavity and paranasal cavity, at birth, 50 pelvic, 352-353 of right leg, 513 of thorax, 185 of wrist, 453, 456 Bowel loop, entering hernial sac, 261 Bowman's capsule, 336 Brachial anastomosis, around elbow, 433 Brachial artery, 27, 30, 31, 183, 193, 198, 206, 211, 230, 427, 429, 447 branches of, 433, 434 muscular branch, 433, 434 cords of, lateral, 428, 433 deep, 429 computed tomography of, 484 in situ, 433, 434 medial, 428, 433 posterior, 428 Brachial cutaneous nerve, superior Bateral, 177 Brachialis muscle, 420, 429, 430, 433, 435, 446, 447, 448 insertion of, 420, 438 origin of, 420, 421 Brachial plexus, 27, 30, 31, 32, 129, 160, 183, 189, 193, 198, 206, 211, 228, 230, 231, 232, 428, 429 anterior and posterior divisions of, 430 communication to, 129 cords of lateral, 428, 433 medial, 428 posterior, 428 medial, 428, 433 posterior, 428 roots of, 430 schema of, 430 terminal branches of, 430 trunks of, 430 Brachial vein, 429, 435 Brachiocephalic trunk, 33, 74, 75, 76, 136, 193, 206, 211, 212, 214, 232, 237, 243, 420 Brachiocephalic vein, 74, 208 groove for, 199 left, 70, 75, 137, 206, 211, 212, 230, 231, 243 right, 75, 137, 206, 210, 211, 212, 230, 243 Brachioradialis muscle, 418, 433, 444, 446, AA7 origin of, 420 Brachioradialis tendon, 448, 449

Brain, 48 arteries to, 136, 141, 142 frontal views of, 141 inferior views of, 139 lateral and medial views of, 142 schema of, 138 coronal section of, 108 deep veins of, 145 sagittal section of, in situ, 106 subependymal veins of, 146 ventricles of, 108 Brainstem anterior view of, 114 cranial nerve nuclei in, 116, 117 medial dissection of, 117 posterior phantom view of, 116 schema of, 117 sectioned, 107 Bregma, 7 Broad ligament, 389 anterior lamina of, 372 of female ureter, 340 mesometrium of, 371 mesosalpinx of, 369 posterior lamina of, 372 subdivisions and contents of, 372 uterine, 360, 362 Bronchial artery, 204, 205, 207 esophageal branch of, 207 inferior left, 207 left, 199, 231 esophageal branch of, 237 inferior, 237 superior, 237 right, 199, 207, 230, 237 superior left, 207 variations in, 207 Bronchial vein left, 207 right, 207 Bronchiole respiratory, 204, 205 terminal, 204, 205 Bronchomediastinal lymphatic trunk, 208 left, 266 right, 266 Bronchopulmonary lymph nodes, 199, 208, 230, 231 Bronchopulmonary segments, 200, 201 anterior view of, 200 lateral view of, 201 medial view of, 201 nomenclature for, 203 posterior view of, 200 Bronchus, 167, 202, 204, 234 anterior basal, 203 anteromedial basal, 203 apicoposterior, 203 elastic fibers of, 204 extrapulmonary, 202 inferior lobar, 202 intermediate, 202 intrapulmonary, 202, 204 lateral basal, 203 left, 203 axial CT images of, 242 left main branches of, 199, 206, 232, 233, 241 lingular, 202

Bronchus (Continued) major, 202 medial basal, 203 middle lobar, 202, 203 nomenclature of, 203 posterior basal, 203 right axial CT images of, 242 intermediate, 206 right main branches of, 207, 230, 245 smooth muscle of, 204 superior lobar, 202, 203, 206 Brunner's gland. See Duodenal glands Buccal artery, 40, 69 Buccal nerve, 24, 40, 46, 62, 71, 122 branches of, 25 Buccinator crest, 68 Buccinator lymph node, 72 Buccinator muscle, 15, 26, 48, 52, 54, 55, 60, 65, 68, 123 Buccopharyngeal fascia, 60, 63, 65 Buck's fascia. See Deep (Buck's) fascia Bulbar conjunctiva, 81, 87 Bulbospongiosus muscle, 358, 366, 370, 380, 381, 383, 404, 405, 417 bulb of vestibule of, 366 Bulbourethral (Cowper's) gland, 253, 361, 366, 383, 384, 389, 417 duct of, 383 opening of, 384, 385 perineal membrane and, 348 primordium of, 389 Bulging septum, 37 Bursa anserine, 506, 507 fibular collateral, 507 of hand, 462 iliopectineal, 496 infrapatellar, 511 patellar, 508 radial, 460 subdeltoid, 423 ulnar, 460 Buttock, nerves of, 503 c C1 spinal nerve, 127 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C2 spinal nerve, 127 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 C3 spinal nerve, 19 dorsal ramus of, 177 ventral ramus of, 32, 71, 177 C4 spinal nerve, 127 C5 spinal nerve, ventral ramus of, 32 C8 spinal nerve, 160 exit of, 161 C6 transverse process, 136 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19

C3 vertebra (Continued) tubercles of transverse process of anterior, 26 posterior, 26 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 posterior tubercle of, 18 posterosuperior view of, 17 C7 vertebra, 13, 153, 160 posterior tubercle of transverse process of, 30 spinous process of, 18, 152, 174, 175, 176, 424 superior view of, 18 Calcaneal artery lateral, 534, 535 medial, 534, 535 Calcaneal nerve lateral, 534, 535 medial, 534, 535 Calcaneal (Achilles) tendon, 485, 515, 516, 517, 518, 521, 527 soleus muscle insertion in, 515, 517 Calcaneocuboid ligament, 527, 536 dorsal, 527 plantar, 528 Calcaneofibular ligament, 514, 525, 527 Calcaneometatarsal ligament, 532 Calcaneonavicular ligament, 527 plantar, 527, 528, 536 Calcaneus, 524, 527, 528 anterior talar articular surface of, 525 body of, 523, 524, 525 dorsal view of, 523 fibular, 524 fibular trochlea of, 523 functional relations of, 525 groove for tendon of flexor hallucis longus, 523 lateral process, 523, 533 lateral view of, 525 medial process, 523 medial view of, 525 middle talar articular surface of, 525 plantar view of, 523 posterior talar articular surface of, 525 posterior view of, 525 radiograph of, 54 superior view of, 525 sustentaculum tali of, 523 trochlea of, 524 tuberosity of, 485, 488, 516, 517, 523, 533, 534, 535 radiograph of, 54 Calcar, 489 Calcar avis, 111, 112 Calcarine artery, 142, 143 Calcarine sulcus, 105, 106, 107, 111, 120 Callosomarginal artery, 141, 142 Calot, cystic node of, 315 Calot, triangle of, 301 Calvaria, 102 inferior view of, 7 superior view of, 7 Calyx, major, 339 Camper chiasm, 461 Camper's fascia, 348

Camper's (fatty) layer of subcutaneous tissue, 249, 361, 348, 378, 380 Canal of Schlemm. See Scleral venous sinus (canal of Schlemm) Canine teeth, 57 Capillary plexus, 148, 205 cortical, 337 medullary, 337 Capitate, 452, 453, 455, 456, 461 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 radiograph of, 457 Capitis muscle, rectus anterior, 32, 47, 73 anterior and lateral, nerves to, 129 lateral, nerves to, 129 lateralis, 30, 32 posterior major, 175, 176, 178 posterior minor, 175, 176, 178 Capitohamate ligament, 454, 455 Capitulym, 420, 436, 437 Capsular artery, 335 Capsular ligament, 423 of shoulder, 423 Capsular vein, 337 Capsule, internal, 141 Cardia, nodes around, 314 Cardiac nerve, cervical, 165 Cardiac notch, 236, 275 Cardiac orifice, 276 Cardiac plexus, 126, 165, 209, 226, 227, 240 Cardiac vein anterior, 216 of diaphragmatic surface, 216 great, 216 middle, 216 small, 216 of sternocostal surface, 216 Cardinal ligament, 360, 364, 370, 371, 372, 373 Caroticotympanic nerve, 123, 125 Carotid arterial arch, dorsal, 469 Carotid artery common, 23, 29, 31, 32, 33, 34, 71, 74, 75, 76, 100, 125, 128, 130, 133, 134, 136, 137, 198, 210, 232, 237 external, 28, 32, 34, 40, 59, 75, 76, 85, 86, 121, 123, 128, 130, 131 schema of, 34 internal, 10, 23, 28, 33, 34, 44, 47, 69, 71, 75, 76, 85, 86, 100, 123, 125, 130, 131, 132, 134, 138, 139, 140, 141, 142 caroticotympanic branch of, 138 groove for, 9 left common, 74, 80, 137, 193, 211, 214, 243 left internal, 142, 143 right common, 30, 80, 137, 193 right internal, 142 right lateral dissection of, 34 Carotid autonomic plexus, 10 Carotid body, 34, 125, 130, 210 Carotid canal, 10 external opening of, 8 for internal carotid artery, 11 for internal carotid nerve plexus, 9 Carotid groove, 9

Carotid nerve ( I X ) , 71 external, 165, 167 internal, 130, 131, 133, 165, 167 Carotid plexus, 86, 121, 131, 209, 226 common, 130, 131 external, 130, 133, 167 internal, 86, 123, 132, 165, 167 Carotid sheath, 28, 32 cranial nerves in, 60 Carotid sinus, 125, 130, 131, 210 Carotid vein, common, 70 Carpal arterial arch, dorsal, 469 Carpal articular surface, 439 Carpal bones, 452 in abduction, 453 in adduction, 453 anterior (palmar) view of, 452 posterior (dorsal) view of, 452 Carpal ligament palmar, 454, 460 transverse. See Flexor retinaculum Carpal tunnel, 461 palmar view of, 454 transverse cross section of, 461 Carpometacarpal joint, 455 articular capsule of, 454 capsule of first, 455 Carpometacarpal ligament dorsal, 455 palmar, 454 Carpotriquetral ligament, 454 Cartilage accessory nasal, 36 alar lateral and medial crus of, 36 major, 36, 38, 39 minor, 36 articular of elbow, 438 of finger, 471 of hip joint, 487 of knee, 511 arytenoid, 77, 78 muscular process of, 78 vocal process of, 78 auricular, 47 bronchial, 204 corniculate, 77 costal, 186, 248, 293, 419 cross section of, 196 eighth, -115 fifth, 194 fifth left, 241 of first rib, 243 second, 245 seventh, 198, 331 sixth, 424 cricoid, 20, 28, 29, 74, 77, 78, 196, 233, 234 arch of, 77 lamina of, 77, 78 longitudinal muscle bundle attached to, 234 posterolateral surface of, 234 prominence over lamina of, 66 of larynx, 77 septal, 39 septal nasal, 36 lateral process of, 38. 39

Cartilage (Continued) thyroid, 28, 29, 31, 74, 196, 202, 206, 233, 234, 235 lamina of, 77, 78 oblique line of, 29 superior horn of, 77 tracheal, 28, 202 Cartilage lamina, thyroid, 77 posterior border of, 67 Cauda equina, 160, 161, 170, 179, 339 in lumbar puncture, 162 Cauda equina artery, 171 Caudal mesonephric duct, residua off, 389 Caudate nucleus, 141 anterior vein of, 145, 146 body of, 108, 110 head of, 110, 111, 112, 145 posterior vein of, 145 terminal, 146 tail of, 108, 110, 112 thalamus and, 110 transverse veins of, 145, 146 Cavernous nerve, 166, 410, 412 Cavernous plexus, 121 Cavernous sinus, 85, 100, 104, 136, 140 coronal section through, 104 efferent hypophyseal vein to, 148 emissary vein communicating with, 70 superior view of, 104 Cecal artery, 323 anterior, 281, 306, 307 posterior, 281, 307 Cecal fold, 281, 362, 363 Cecal plexus, 323 Cecal vein anterior, 311, 312 posterior, 311, 312 Cecum,. 126, 269, 272, 281, 284, 362, 363 variations in posterior peritoneal attachment of, 281 vascular fold of, 281 Celiac ganglion, 44, 126, 165, 167, 168, 219, 267, 318, 320, 321, 323, 324, 325, 327, 328, 331, 345, 346, 409 Celiac lymph node, 266, 314, 315 Celiac plexus, 126, 165, 166, 240, 319, 320, 322, 323, 344, 345, 346, 410, 415 posterior vagal trunk to, 240 vagal branch to, 240 Celiac trunk, 165, 195, 206, 278, 298, 300, 305, 321, 324, 328, 329, 333 arteriogram of, 303 bifurcation of, 297 common origin of, 302 cross section of, 338 prenatal, 229 variations in, 302 Ceneus, apex of, 107 Central artery anterolateral, 141 anteromedial, 140 central, anterolateral, 143 posteromedial, 140 precentral, 141 Centra!! sulcus, 106

Central vein, 290, 291 of liver, 290, 291 Cephalic vein, 181, 188, 189, 256, 418, 424, 428, 429, 449, 468, 479, 480, 483, 484 accessory, 479, 480 intermediate, 480 Cerebellar artery anterior, 140 anterior inferior, 136, 138, 139, 140, 141, 143, 171 posterior, 141, 143 inferior, 143 posterior inferior, 141, 171 superior, 136, 138, 139, 140, 141, 143, 171 Cerebellar hemispheric vein, inferior, 144 Cerebellar notch anterior, 97 posterior, 97, 113 Cerebellar nucleus, 113 dentate, 113 emboliform, 113 fastigial, 113 globose, 113 Cerebellar peduncle inferior, 113, 144 inferior, superior, middle, 144 middle, 113, 114, 144 superior, 113, 114, 115,144 decussation of, 113 superior plane of, 113 Cerebellar tonsil, herniation of, 101 Cerebellar tonsillar artery, 143 Cerebellar vein hemispheric inferior, 151 precentral, 144 superior, 144 Cerebellomedullary cistern posterior, 109 vein of, 144 Cerebellum, 106, 111, 115, 146 anterior lobe of, 113 axial MR image of, 150 biventer lobe of, 113 dentate nucleus of, 115 flocculonodular lobe of, 113 flocculus of, 114 horizontal fissure of, 113 inferior fovea of, 115 inferior surface of, 113 lateral recess of, 115 lateral views of, 105 medial eminence of, 115 median sagittal section of, 115 parts of, 144 posterior lobe of, 113 posterior view of, 115 posterolateral fissure of, 107 sagittal MR image of, 149 secondary fissure of, 107 superior fovea of, 115 superior surface of, 113 tonsil of, 107, 115 Cerebral aqueduct, 106, 107, 108, 109, 146 Cerebral arterial circle (of Willis), 139,140

Cerebral artery anterior, 136, 138, 140, 141, 143 branches of, 141 left, 142 right, 142 terminal branches of, 142 communicating, 140 left anterior, 142 left middle, 142 middle, 136, 138, 140, 141, 143 branches of, 141 left, 142 temporal branches of, 141 posterior, 136, 138, 140, 141, 143, 171 branches to, 136, 138 right, 142, 143 temporal branches of, 143 terminal branches of, 142 right anterior, 142 temporal branches of, 143 posterior and anterior, 142 terminal branches of, 142 Cerebral crus, 107, 113, 114, 139, 145 Cerebral falx, 48 Cerebral fissure anterior, 143 longitudinal, 107, 143, 145 Cerebral hemisphere axial CT images of, 150 axial MR image of, 150 medial surface of, 106 Cerebral peduncle, 106, 115 Cerebral sulcus, lateral, 141 Cerebral vasculature, 136-138, 139-141, 143-144, 145-146 Cerebral veins anterior, 144, 145, 146 deep, 99 middle, 144, 145 great, 103, 104, 106, 115, 144, 145, 146 quadrigeminal cistern of, 109 inferior, 102, 104, 145 internal, 99, 108, 111, 144, 145, 146 lateral direct, 146 middle deep, 144, 145, 146 superficial, 145 penetrating subdural space, 99 superficial, 99, 102 middle, 99, 102, 104 superior, 102 opening of. 101 Cerebrospinal fluid, circulation of, 109 Cerebrum, 113 anterior lobe of, 113 biventer lobule of, 113 external capsule of, 110 flocculonodular lobe, 113 frontal pole of, 107 gyri of, 107 horizontal fissure of, 113 horizontal sections through, 110 inferior surface of, 113 inferior view of, 107 internal capsule of, 110 lateral views of, 105 medial view of, 106 medial views of, 106

occipital pole of, 107 posterior lobe of, 113

Cerebrum (Continued) posterolateral fissure of, 113 sulci of, 107 superior surface of, 113 superior vermis of, 113 temporal pole of, 107 tonsil of, 113 Cervical artery ascending, 33, 69, 71, 74, 75, 76, 136, 138, 171, 427 deep, 33, 136, 138, 171 superficial, 74, 75 transverse, 32, 69, 74, 75, 76, 138, 177, 427, 429 Cervical canal, 371 CervicaB cardiac nerve, 166, 209 inferior, 165, 226 middle, 165, 226 superior, 69, 71, 165, 226 sympathetic and vagal, 226 Cervical! curvature, 18, 153 Cervical enlargement, 161 Cervical ganglion middle, 165 superior, 165, 167 CervicaB nerve, 130-133, 134-135, 161 branches of, 25 superficial, 177 transverse, 24, 31, 71, 129 vertebrae and, 127, 161 Cervical plexus, 160, 177, 178, 481 ansa cervicalis of, 32, 128 branches from, 24 in situ, 32 schema of, 32, 129 supraclavicular nerves from, 479 Cervical spinal nerves, 160 C1, 160 exit of, 161 C2, dorsal ramus of, 177 C3, dorsal ramus of, 177 C4, dorsal ramus of, 177 C8, 160 exit of, 160 dorsal rami of, 24, 32, 177 medial branches of, 24 posterior cutaneous branches of, 178 Cervical sympathetic cardiac nerve inferior, 130, 226, 227 middle, 33, 130, 165, 226, 227 superior, 32, 60, 128, 130, 132, 133, 134, 165, 226, 227, 240 Cervical sympathetic ganglion, middle, 32, 60, 130, 131, 132, 133, 134, 167 Cervical sympathetic trunk, 131, 240 vertebral ganglion of, 240 Cervical vagal cardiac nerve inferior, 227 superior, 227 CervicaB vein deep, 137 left, 137 right, 137 right, deep, 137 superficial, 177 transverse, 70, 177

Cervical vertebrae. See also Atlas (C1); Axis (C2); specific vertebrae anterior view of, 17, 171 arteries of, 171 articular pillar of, 21 costal facets of, 21 external craniocervical ligaments of, 21 inferior aspect of, 18 lateral radiograph of, 21 number of, 161 right lateral view of, 21 superior aspect of, 18 superior view of, 18 upper, 17 Cervicis muscle, interspinals, 176 Cervicofacial nerve, 25 Cervicothoracic (stellate) ganglion, 13, 130, 165, 209, 226, 227, 240 esophageal and recurrent nerve branches from, 240 Cervix, 360, 364, 369, 370, 371, 372 external os of, 371 sagittal MR images of, 397 C5 spinal nerve, ventral ramus of, 32 C4 spinal nerve, 127 Cheek ligament, 83 Chest axial CT images of, 242 radiograph of, 213 Chest drainage tubes, placement of, 190 Chiasmatic cistern, 109 Chief cell, 276 Choana, 8, 13, 14, 37, 38, 39, 52, 55, 66, 67 Cholangiole, 292 Chordae tendineae, 220, 221, 223 Chorda tympani nerve, 62, 71, 93, 94, 122, 123, 124, 131, 133, 134, 135, 165 Choroid, 87, 89, 90 vascular arrangements within, 91 Choroidal artery anterior, 139, 140, 141, 143 posterior lateral, 139, 143 posterior medial, 139, 143 Choroid plexus, 111, 112, 145 of fourth ventricle, 106, 108, 109, 114, 115 of lateral ventricle, 108, 109, 110, 143, 145 of third ventricle, 106, 108, 109 Choroid vein, 91 bulb of, 91 Choroid vein, superior, 99, 145, 146 Ciliary artery anterior, 90, 91 recurrent branch of, 91 long posterior, 90, 91 posterior, 85 short, 91 short posterior, 90, 91 Ciliary body, 87, 90 blood vessels of, 90 fibers of, 88 orbicularis ciliaris of, 89 Ciliary ganglion, 45, 86, 121, 122, 131, 132, 165, 166, 168 nasociliary root of, 86, 131, 132 oculomotor root of, 132 parasympathetic root of, 86, 121

Ciliary ganglion (Continued) roots of, 131 schema of, 132 sensory root of, 86, 121, 122, 131 sympathetic root of, 86, 121, 132 Ciliary muscle, 87, 118, 121, 132 circular fibers of, 88 meridional fibers of, 88 Ciliary nerve long, 86, 121, 122, 131, 132 short, 86, 121, 122, 131, 132 Ciliary process, 87, 88, 89 Ciliary vein, anterior, 88, 90, 91 Cingular artery, 142 Cingulate gyrus, 106 isthmus of, 106, 107 Cingulate sulcus, 106 Circle of Willis. See Cerebral arterial circle (of Willis) Circular muscle, 326 Cisterna chyli, 266, 314, 318 lumbar lymph trunk to, 343 Claustrum, 110 Clavicle, 1, 26, 27, 28, 29, 31, 181, 182, 184, 186, 188, 189, 196, 197, 198, 213, 230, 231, 243, 418, 420, 421, 422, 423, 424, 425, 427, 428, 429 acromial end of, 419 acromial facet of, 419 anteroposterior radiograph of, 422 conoid tubercle of, 419 costoclavicular ligament impression on, 419 inferior surface of, 419 radiograph of, 422 right, 419 shaft body of, 419 sternal end of, 419 sternal facet of, 419 subclavian groove of, 419 superior surface of, 419 trapezoid line of, 419 Clavipectoral fascia, 428 pectoralis minor muscle invested by, 188 subclavius muscle invested by, 188 Clavipectoral fossa, 428 Clinoid process anterior, 9 coronal CT images of, 151 posterior, 9 Clitoris body of, 388 crus of, 360, 366, 370 deep artery of, 404 deep dorsal vein of, 356, 357, 360, 364, 365 dorsal artery of, 404 dorsal nerve of, 267, 413, 414 frenulum of, 377 glans of, 377, 388 prepuce of, 377 suspensory ligament of, 378, 379, 380 Clivus, 9 surface of, 22 Cloquet, node of, 266, 408 Clunial nerve inferior, 177, 411, 413, 503, 540, 545 medial, 177, 502, 545 superior, 177, 254, 502, 545 Coccygeal cornu, 157 Coccygeal ligament, 160, 161

Coccygeal nerve, 160, 161, 499 vertebrae and, 161 Coccygeal plexus, 499 schema of, 499 Coccygeus (ischiococcygeus) muscle, 263, 358, 359, 398, 402, 410, 411, 412 Coccyx, 153, 157, 160, 161, 248, 352, 353, 357, 376, 379, 391 anterior inferior view of, 157 posterior superior view of, 157 spinal nerves and, 161 tip of, 354, 357, 359, 376, 380, 382, 395 transverse process of, 157 Cochlea, 92, 95, 97 helicotrema of, 92, 96 osseous, 92, 96 section through, 92, 96 Cochlear aqueduct, 96 Cochlear cupula, 95 Cochlear ganglion, 124 Cochlear nerve, 92, 95, 96, 97 distribution of, 118 posteromedial view of, 95 Cochlear nucleus, anterior and posterior, 116, 117, 124 Cochlear recess, 95 Cochlear window. See Round window (cochlear) Cochleus, modiolus of, 96 Colic artery arc of Riolan between middle and left, 308 ascending branch of, 307, 398 descending branch of, 307, 398 left, 264, 307, 318, 323, 324, 340, 398 middle, 290, 298, 301, 306, 307, 318, 322, 323, 340, 348 absence of, 308 right, 306, 307, 308, 322, 323, 340 absence of, 308 variations of, 308 Colic flexure . left, 126, 269, 270, 271, 272, 275, 278, 284, 288, 298, 347 right, 269, 288, 297 Colic impression, 287 Colic lymph nodes left, 317 middle, 317 right, 317 Colic plexus left, 278, 284, 318, 323 middle, 322, 323 right, 275, 322, 323 Colic vein left, 311,312,313 middle, 298, 303, 311, 312 right, 311, 312, 313 Collateral artery middle, 432, 434, 435 radial, 434, 435 Collateral eminence, 111 Collateral ligament, 509 fibular, 493, 499 radial, 438 tibial, 493, 514 ulnar, 438 Collateral sulcus, 106 Collateral trigone, 111

Collecting tubule, 336, 337 schema of, 337 Colles' fascia. See Superficial perineal (Colles') fascia Colliculus brachia of, 114 inferior, 106, 111 brachium of, 111 left, 144 superior, 106, 107, 111, 114, 115, 116, 132, 143, 144 brachium of, 111 left, 144 Colli muscle, nerves to, 129 Colon air in, radiograph of, 355 area for, 329 ascending, 126, 269, 272, 278, 284, 339, 349 axial CT images of, 350 cross section of, 338 site of, 274 circular muscle of, 282 descending, 167, 271, 278, 339, 342 area for, 329 cross section of, 338, 349 descending from left colic flexure, 297 from left colic flexure, 297 site of, 274 mucosa and musculature of, 284 nerve to, 410 right colic flexure of, 297 cross section of, 297 , sigmoid, 167, 168, 269, 271, 284, 391, 392, 393, 394, 412 looping to right side, 284 nerve to, 410 reflected, 271 variations in position of, 285 transverse, 269, 270, 273, 278, 284, 291, 294, 298, 299, 339 ascending to left colic flexure, 297 axial CT images of, 350 cross section of, 338 tributary from, 309 tributary from, 311 Commissure anterior, 106, 115, 146, 147 of fornix, 112 habenular, 106, 111 posterior, 106, 111, 388 Communicating artery anterior, 136, 138, 139, 140, 141, 142 posterior, 104, 136, 139, 140, 141, 142, 143 Communicating vein, 31, 137 Compressor urethra, female, 356 Compressor urethrae muscle, 367, 404 Compressor urethralis muscle, 370 Computed tomography (CT) abdominal, 350 of arteries of the arm, 484 of chest, 242 of head, 150 coronal images of, 151 of upper limb arteries, 484 Concha inferior, 14 nasal. See Nasal concha Conducting system, 225

Condylar canal, 11 Condylar emissary vein, 137 Condyle lateral, 489 medial, 489 Coneus, 106 C1 spinal nerve, 133 dorsal ramus of, 178 dorsal roots of, 114 exit of, 161 ventral ramus of, 71 ventral roots of, 114 C1 vertebra. See Atlas (C1) Conjunctiva, 91 bulbar, 81, 83, 88, 90 inferior palpebral, 81 palpebral, 83 superior palpebral, 81 Conjunctival artery, posterior, 91 Conjunctival fornix inferior, 81 superior, 81 Conjunctival vein, posterior, 91 Conjunctival vessels, 90, 91 Connective tissue of liver, 291 subserous, 326 Connective tissue sheath, 202 Conoid ligament, 425, 423 attachment of, 419 Conus arteriosus, 212, 218, 220, 222, 224 Conus elasticus, 78 Conus medullars, 160, 161, 170, 339 Convoluted tubule distal, 336 proximal, 336 Cooper's ligament. See Pectineal ligament (Cooper's) Coracoacromial ligament, 423, 425, 426, 430 Coracobrachialis muscle, 244, 245, 429, 430, 433, 435, 474 fascia over, 428 insertion of, 420 origin of. 420 Coracoclavicular ligament, 423 Coracohumeral ligament, 423 Coracoid process, 185, 189, 420, 421, 423, 425, 427, 428, 429, 433 anteroposterior radiograph of, 422 Cornea, 81, 83, 87, 88, 90, 91 Corneal limbus, 81 Corneoscleral junction, 81 Corniculate tubercle, 77 Coronal sulcus, 246, 385, 388 Coronal suture, 2, 5 Coronary artery anterior interventricular branch of, 219 diagonal branches of, 219 arteriographic views of, 218, 219 arterioventricular nodal branch of, 218 circumflex branch of, 219 atrioventricular branch of, 219 conus branch of, 218 of diaphragmatic surface, 216 interventricular septal branches of, 216, 217

Coronary artery (Continued) left, 216, 217, 219 anterior interventricular branch of, 216, 217, 219 circumflex branch of, 216, 217, 219 marginal branch of, 216, 217, 218 opening of, 224 posterior interventricular branch of, 218 posterior left ventricular branch of, 217 posterolateral branches of, 218, 219 right, 217, 218 atrial branch of, 216, 217 marginal branch of, 216, 217 opening of, 223 posterior interventricular branch of, 216, 217 posterolateral branches of, 216 sinuatrial nodal branch of, 216, 218 of sternocostal surface, 217 variations in, 217 Coronary ligament enclosing bare area of liver, 348 hepatorenal portion of, 287 of liver, 287 Coronary sinus, 214, 215, 216, 221, 233, 241 opening of, 220, 223 valve of, 220 Coronary sulcus, 214 Coronary vein, variations in, 217 Coronoid fossa, 420 Coronoid process, 15, 436, 443 radiograph of, 422 Corpora cavernosa, 382 Corpora quadrigemia, 107 Corpus albicans, 371 Corpus callosum, 106, 107, 108, 111, 141, 143 anterior, 145 cistern of, 109 dorsal vein of, 144, 146 genu of, 106, 107, 110, 112, 146 right dorsal branch to, 143 rostrum of, 106, 141 sagittal MR image of, 149 splenium of, 106, 107, 110, 112, 143, 144, 145, 146 sulcus of, 106 trunk of, 106, 141 Corpus cavernosum, 361, 382, 383, 385 sagittal MR images of, 371, 397 Corpus luteum, 371 Corpus spongiosum, 361, 366, 381, 382, 383 sagittal MR images of, 397 Corpus striatum, 110, 141 Corrugator cutis ani muscle, 393 Corrugator supercilii muscle, 25, 36, 123 Corti, organ of. See Spiral organ (of Corti) Cortical radiate artery, 335, 337 lymph vessels along, 343 Cortical radiate vein, 337 Costal facet inferior, 187 superior, 187 Costal groove, 186 Costal impression, 287

Costal pleural, 231, 232 Costocervical trunk, 33, 69, 136, 137, 138 Costochondral joint, 186 Costoclavicular ligament, 186, 419 attachment of, 419 Costocoracoid ligament, 188, 428 Costocoracoid membrane, 428 Costodiaphragmatic recess, 198, 230, 231, 293, 330, 332, 342, 349 right, 206 Cosfomediastinal space, 331 lateral, 198 superior, 198 Costovertebral joint, 243 left lateral view of, 187 right posterolateral view of, 187 transverse section of, 187 Cough receptor, 210 Cowper's gland. See Bulbourethral (Cowper's) gland Coxal bone. See Hip bone Cranial base bones of, 9 foramina of, 10, 11 inferior view of, 10 inferior view of, 8 Cranial fossa anterior, 9 middle, 9 posterior, 9 arteries of, 142, 143 veins of, 144 posterior veins of, 144 Cranial mesonephric (Gartner's) duct, 389 Cranial mesonephric tubule, 389 Cranial nerve, 116, 130-133, 134-135 in carotid sheath, 60 communicating branch of, 45 motor and sensory distribution of, 118 nuclei of medial dissection of, 117 posterior phantom view of, 116 schema of, 116 palsy of, 101 Cranial nuclei, in brainstem, schema of, 117 Craniocervical ligaments external anterior view of, 21 posterior view of, 21 right lateral view of, 21 internal, 22 Cremaster fascia, 250 Cremasteric artery, 255 Cremasteric muscle, 250, 251, 259, 261, 390 lateral origin of, 259 medial origin of, 259 Cremasteric vessels, 260, 401 Cribriform fascia, 546 Cribriform plate, 6, 9, 37, 39, 119 foramina of, 11 Cricoarytenoid muscle lateral, 78, 80 action of, 78, 79 posterior, 78, 80, 235 action of, 79

Cricopharyngeus muscle, 75, 76, 80, 233, 234, 235 Cricothyroid artery, 69 Cricothyroid joint, 77 pivot point of, 79 Cricothyroid ligament lateral, 77 median, 74, 77, 202 Cricothyroid muscle, 29, 68, 74, 78, 80, 126

action of, 79 oblique part of, 79 straight part of, 79 Crista galli, 3, 6, 9, 39 coronal CT images of, 151 Crista terminalis, 220, 225 Cross section of abdomen at L1-2, 339, 349 at L3, 349 at L3, 4, 349 at T10, 293 at T12, 297, 331, 338 of descending duodenum, 179 forearm, serial, 449 of gallbladder, 297 of scrotum, 390 of testis, 390 Cruciate ligament, 22, 507, 509 anterior, 508, 509, 514 attachment of, 508 origin of, 514 inferior longitudinal band of, 22 posterior, 514 attachment of, 514 superior longitudinal band of, 22 transverse, 22 C3 spinal nerve, 19, 127 dorsal ramus of, 178 ventral ramus of, 32, 71, 178 C2 spinal nerve, 133 dorsal ramus of, 177, 178 ventral ramus of, 32, 71, 177 Cubital fossa, 418 Cubital lymph nodes, 483, 484 Cubital node, 483 Cubital vein intermediate, 480 median, 418, 479, 483, 484 Cuboid bone, 523, 524, 527, 536, 537 articular surface for, 525 base of, 523 dorsal view of, 523 groove for fibularis longus tendon insertion, 523 plantar view of, 523 radiograph of, 54 shaft of, 523 tuberosity of, 523, 524, 528, 536 Cuboideonavicular ligament, plantar, 528 Culrnen, 113, 115, 144 Cuneate fasciculus, 114 Cuneate tubercle, 114 Cuneiform bone intermediate, 523, 536 lateral, 523, 536 radiograph of, 54 medial, 523, 524, 527, 536 plantar view of, 523

Cuneiform tubercle, 66, 67, 78 Cuneocuboid ligament, dorsal, 527 Cuneonavicular ligament dorsal, 527 plantar, 528 Cuneus, 106 apex of, 107 Cuspid teeth. See Teeth, canine Cutaneous nerve(s) antebrachial lateral, 469 dorsal, lower limb intermediate, 540, 541, 542 lateral, 542, 545 medial, 541, 542 femoral lateral, 409 posterior, 411 of forearm, medial, 469 of head, 24 lateral antebrachial, 447 lateral dorsal, 544 lateral femoral, 329, 499, 538, 539 medial antebrachial, 429, 432, 469 of neck, 24, 31 perforating, 411, 499 posterior antebrachial, 469 superior lateral brachial, 177 Cuticle, 471 C1 vertebra. See Atlas (C1) C2 vertebra. See Axis (C2) C3 vertebra, 13 inferior articular facet for, 19 tubercles of transverse process of anterior, 30 posterior, 30 C4 vertebra anterior tubercle of, 18 body of, 18 lamina of, 18 „

posterior tubercle of, 18 posterosuperior view of, 18 superior articular process of, 19 C7 vertebra, 13, 153, 160 posterior tubercle of transverse process of, 30 spinous process of, 18, 152, 174, 175, 176, 424 superior view of, 18 Cymfea, 93 Cystic artery, 294, 300, 301, 305 Cystic duct, 331 smooth part of, 294 spiral fold of, 294 variations in, 296 Cystic node (of Calot), 315 Cystic vein, typical arrangement off, 313 Cystohepatic triangle, 301 Cystourethrograms, male and female, 368

D Declive, 113 Deep (Buck's) fascia, 249, 250, 348, 361, 380, 381, 382, 383, 396, 401, 403, 405 intercavernous septum of, 382, 385

Deep palmar arch, 465 Deltoid muscle, 152, 174, 177, 188, 189, 243, 244, 245, 423, 428, 429 attachments of, 420 insertion of, 420, 421 origin of, 419, 420 Deltoid tuberosity, 420 Deltopectoral lymph node, 483, 484 Deltopectoral node, 483 Deltopectoral triangle, 247, 424 Denonvilliers' fascia. See Rectoprostatic (Denonvilliers') fascia Dens, 137 apical ligament of, 63, 65 of axis, 19, 37 posterior auricular facet of, 22 Dental plexus inferior, 122 superior, 122 Dental puBp, 57 Dentate gyrus, 106, 108, 111, 112, 119 Dentate nucleus, 108, 112, 119 Denticulate ligament, 169, 170 Dentinal tubules, 57 Dentine, 57 Depressor anguli oris muscle, 54 Depressor labii inferioris muscle, 26, 54, 123 Depressor septi nasi muscle, 36, 123 Dermatomes anterior, 482 levels of, 164 of lower limb, 543 posterior, 482 schematic demarcation of, 164 of upper limb anterior and posterior views of, 482 Descemet's membrane. See Posterior limiting lamina (Descemet's membrane) Diaphragm, 198, 206, 211, 215, 230, 233, 236, 237, 272, 273, 275, 286, 327, 329, 331, 342, 498 abdominal surface of, 195 area for, 330 caval opening for, 195, 263, 267 central tendon of, 263 right leaflet of, 194 costal part of, 195, 258 cross section of, 338 crura of, 179, 293, 338, 342 left, 263, 270, 297, 339 right, 263, 270, 293, 297, 331, 339 domes of, 213 left, 196, 197 right, 196, 197 lateral view of, 233 lumbar part of, 195 pelvic, 361 fascia of, 364 female, 356, 357 inferior and superior fascia of, 392 male, 358-359 superior fascia of, 360, 364, 365, 369, 394 phrenic nerves to, 193 slip of origin of, 349 sternal part of, 195 thoracic surface of, 193 Diaphragmatic constriction, 233

Diaphragmatic ligament, 389 Digastric fossa, 15 Digastric muscle, 29, 123 anterior belly of, 27, 28, 29, 31, 32, 34, 46, 53, 61, 68 intermediate tendon of, 59, 60 fibrous loop for, 59 phantom, 34 posterior belly of, 27, 28, 29, 32, 34, 40, 59, 73 nerve to, 25 Digastric tendon, intermediate, 59, 60 fibrous loop for, 28, 29, 53 Digital artery common, computed tomography of, 484 common palmar, 465 common plantar, 536 dorsal, 469, 471, 530, 536 nutrient branches of, 471 palmar common, 460 proper, 460 proper palmar, 460, 471 dorsal branches of, 471 proper plantar, 533, 535, 536 dorsal branches of, 530 Digital creases, 418 Digital nerves common palmar, 476 common plantar, 476, 541 dorsal, 468, 471, 475, 542, 544 lateral dorsal, 544 palmar to fourth and fifth fingers, 460 proper, 476 proper palmar, 460, 471, 476 dorsal branches of, 468 to thumb, 460 proper plantar, 535, 541 Digital vein dorsal, 468, 480, 544 Dilator pupillae muscle, 88, 121 DipBoe, 7 Diploic vein, 102 anterior temporal, 99 coronal dissection of, 99 frontal, 99 occipital, 99 posterior temporal, 99 Direct vein, lateral, 145, 146 Distal interphalangeal (DIP) joint, site off, 418 Distal medial striate artery (recurrent artery of Heubner), 140, 141, 142 Dorsalis pedis artery, 520, 530, 536 Dorsal ramus, spinal, 170, 258, 430 medial clunial nerves from, 545 perforating cutaneous nerves from, 545 Dorsal tubercle of radius (Lister's), 452 Dorsal venous arch, foot, 544 Dorsomedial nucleus, 147 Dorsum sellae, 9 Douglas, cul-de-sac of. See Rectouterine pouch (of Douglas) Ductus arteriosus obliterated, 229 prenatal, 229

Ductus choledochus. See Bile duct, common Ductus (vas) deferens, 259, 261, 340, 389, 390, 409, 546 ampulla of, 384 artery to, 255, 264, 340, 398, 401, 403 Ductus deferens plexus, 409, 415 Ductus plexus, 409 Ductus reuniens, 96 Ductus venosus obliterated, 229 prenatal, 229 Duodenal cap, 279 Duodenal flexure inferior, 279 superior, 279 Duodenal fold inferior, 278 superior, 270 Duodenal fossa inferior, 270 superior, 270 Duodenal glands, 279 Duodenal impression, 287 Duodenal papilla major, 279, 294, 295 minor, 279 Duodenal wall circular muscle layer of, 279 longitudinal muscle layer of, 279 submucosa of, 279 Duodenojejunal flexure, 270, 279, 342 Duodenojejunal junction, 179 Duodenum, 126, 248, 273, 275, 278, 288, 329, 340, 342 arteries of, 301, 304 ascending, 270, 278, 279 barium radiograph of, 279 circular muscle of, 277, 295 descending, 272, 279, 294 cross section of, 179 descending part of, 270 inferior part of, 270 in situ, 278 innervation of, 321 junction with common bile duct, 295 longitudinal fold of, 279 longitudinal muscle of, 277 mesentery root of, 278 mucosa of, 279 musculature of, 279 nerves of, 319, 320, 321 second-third parts of, 338 junction of, 339 submucosa of, 279 superior, 276, 278 cross section of, 297 superior part of, 294 superior (1st) part of, 297 suspensory ligament of, 270 suspensory muscle of, 270 veins of, 309 Dural sac in lumbar puncture, 162 sagittal MR images of, 397 termination of, 160, 161 Dural venous sinuses, 104 coronal section through, 104 sagittal section of, 103 superior view of, 104

Dura mater, 39, 91, 93, 96, 99, 100, 102, 109, 119, 137, 169 around bony and membranous labyrinths, 96 cerebral veins penetrating, 102 lumbar, 170 periosteal and meningeal layers of, 99 spinal, 160, 179 spinal arteries to, 172 of thoracic spine, 170 Dura-skull interface, 102

Ear, 93 bony and membranous labyrinths of, 95 external coronal oblique section of, 93 superolateral view of, 93 lobule of, 1 middle coronal oblique section of, 93 surface anatomy of, 1 Edinger-Westphal nucleus, 116, 117, 132 Efferent ductule, 389, 390 Efferent fiber, to olfactory bulb, 119 Ejaculatory duct, 376 beginning of, 384 openings of, 316, 384, 385 Elbow anastomoses around, 434 bones of, 436 ligaments of, 438 muscles of, 447-448 attachments of, 450, 451 radiographs of anteroposterior, 437 lateral, 437 Emissary vein, 99, 102 communicating with cavernous sinus, 70 condylar, 137 coronal dissection of, 99, 102 mastoid, 23, 99, 137 occipital, 99 parietal, 23, 94, 99 parietal foramen for, 7 of skull, 99 to superior sagittal sinus, 7 Endolymphatic duct, 11, 95 opening for, 97 in vestibular aqueduct, 96 Endolymphatic sac, 96 Endometrium, 371 Endopelvic fascia, 364 Ependyma, 108 Epicolic nodes, 317 Epicondyles lateral, 438, 440, 441, 442, 443, 489 radiograph of, 510 medial, 437, 440, 441, 442, 443, 447, 476, 489 Epicranial aponeurosis, 26, 178 Epicranius muscle frontal belly of, 26 occipital belly of, 26 Epididymal duct, 390 Epididymis, 390 appendix of, 389 body of, 390 head of, 390

Epididymis (Continued) sinus of, 390 tail of, 390 Epidural anesthesia, for lumbar puncture, 162 Epidural hematoma, 101 Epidural space fat in, 170 in lumbar puncture, 162 Epigastric artery superficial, 211, 511 superior, 188, 189, 192 Epigastric lymph nodes, inferior, 266 Epigastric region, 268 Epigastric vein inferior 251, 256, 265, 400 superficial, 247, 256, 265, 544 superior, 189, 256 Epigastric vessels inferior, 251, 259, 261, 349, 362, 363, 401, 403 superficial, 249, 500 superior, 331, 500 Epiglottis, 13, 58, 63, 66, 67, 76, 77, 78, 135, 233, 235 Epiphyseal plate, 504 Epiphysis, 471 nutrient arterial branch to, 471 Epiploic appendices. See Omental appendices Epiploic foramen, 331 Epiploic foramen. See Omental foramen Episcleral artery, 90 Episcleral space, 83, 87 Episcleral vein, 90, 91 segment of, 91 Epithelial cell, stomach surface, 276 Epithelial tag, 388 Epitympanic recess, 92, 93 Eponychium, 471 Epodphoron, 343 Epoophoron canal, 389 Erector spinae muscle, 152, 174, 175, 179, 180, 192, 243, 258, 293, 330, 331 Esophageal artery, 207 Esophageal hiatus, 195 Esophageal impression, 287 Esophageal junction, 236 Esophageal muscle, 202 circular, 75, 235, 236 longitudinal, 75, 235, 236 cricoesophageal tendon of, 235 Esophageal plexus, 126, 165, 166, 206, 209, 230, 231, 232, 241, 321 anterior, 240 posterior portion of, 240 sympathetic branches to, 209, 240 Esophageal prominence, pericardial, 215 Esophageal vein, 312, 313 Esophagogastric junction, 236 transverse section of, 293 Esophagus, 63, 68, 76, 126, 194, 204, 206, 207, 230, 231, 233, 240, 241, 243, 244, 245, 246, 263, 264, 270, 274, 323, 329, 332, 348 abdominal part of, 233, 237, 275 anterior view of, 240

Esophagus (Continued) arteries of, 237 common variations in, 237 bare area on ventral surface, 234 cervical part of, 237 circular muscle layer of, 234, 277 gradual slight muscular thickening of, 232 greater curvature of, 277 groove for, 199 in situ, 232 lateral view of, 233 longitudinal muscle layer of, 234, 277 lateral mass of, 234 mucosa of, 235, 236 junction with gastric mucosa, 276 musculature of, 239 nerves of, 240 opened posterior view of, 66 posterior view of, 240 pyloric part of, 277 recurrent arterial branch to, 195, 264 submucosa of, 235, 236 thoracic part of, 232, 237 topography and constrictions of, 233 zone of sparse muscles of, 234, 235 Ethmoidal artery anterior, 11, 85 meningeal branch of, 100 septal and meningeal branches of, 41 posterior, 11, 85, 100 septal and meningeal branches of, 41 Ethmoidal bulla, 37, 38 Ethmoidal cells, 48, 49, 83 anterior, 50 opening of, 37, 38 semilunar hiatus of, 37 middle, 50 opening of, 37, 38 posterior, 37, 38 opening of, 38 Ethmoidal foramen anterior, 2, 11, 12 posterior, 2, 11 Ethmoidal nerve anterior, 11, 43, 86, 121, 122 external nasal branches to, 24, 122 lateral internal nasal branches to, 42, 43 medial internal nasal branches to, 42 posterior, 11, 45, 86, 121, 122 Ethmoidal vein anterior, 122 posterior, 122 Ethmoid bone, 4, 6, 9, 38 anterior ethmoidal foramen of, 12 cribriform plate of, 37, 38, 39, 119 crista galli of, 39 middle nasal concha of, 2 nasal concha of, 38 orbital plate of, 2, 4, 12 perpendicular plate of, 2, 6, 39 uncinate process of, 38 Ethmoid sinus axial MR image of, 150 coronal CT images of, 151 Eustachian tube. See Auditory (pharyngotympanic, Eustachian) tube

Extensor carpi radialis brevis muscle, 418, 420, 444, 446, 477 groove for, 439 tendon of, 444, 445, 449, 469, 470 attachment of, 420 Extensor carpi radialis longus muscle, 432, 435, 441, 444, 445, 446, 449, 451, 477 groove for, 439 origin of, 439 tendon of, 444, 469, 470 Extensor carpi ulnaris muscle, 418, 420, 432, 441, 444, 449, 451, 477 tendon of, 444, 469, 470 ulnar origin of, 451, 470 Extensor digiti minimi muscle, 420, 441, 444, 450, 451 tendon of, 420, 441, 444, 449, 470 Extensor digitorum brevis muscle, 520, 521, 530, 531, 542 innervation of, 542 tendon of, 519, 520, 531, 536 Extensor digitorum longus muscle, 494, 519, 520, 522, 530, 531, 542 attachments of, 515 tendon of, 519, 520, 521, 530, 531, 536, 537 sheath of, 530 Extensor digitorum minimi tendon, 469 Extensor digitorum muscle, 432, 441, 449, 450, 477 central bands of, 451 CP

*

groove for, 439 lateral bands of, 451 tendon of, 418, 441, 444, 445, 449, 469, 470, 471 Extensor expansions, 536 tendinous slips to, 465 transverse fibers of, 470 Extensor hallucis brevis muscle, 520, 530, 542 innervation of, 542 tendon of, 519, 531, 536 Extensor hallucis longus muscle, 519, 520, 521, 522, 531 attachments of, 515 innervation of, 542 tendon of, 519, 520, 521, 530, 531, 536 sheath of, 530 Extensor indicis muscle, 441, 445, 449 groove for, 439 tendon of, 418, 441, 444, 469, 470 Extensor pollicis brevis muscle, 441, 443, 444, 445, 451 area for, 439 tendon of, 444, 469 Extensor pollicis longus muscle, 418, 441, 444, 449 groove for, 439 tendon of, 418, 444, 462, 468, 469 Extensor pollicis longus tendon, 444, 469, 470 Extensor retinaculum, 444, 446, 468, 469, 470, 530, 542 inferior, 530, 542 superior, 519, 521, 530

Extensor tendons, 420, 441, 444 common, of forearm, 420, 441, 444 in fingers, 464 of hand, 445 at wrist, 470 Extraocular muscles, sagittal MR image of, 149 Extraperitoneal fascia, 412 Extraperitoneal space, fibrofatty tissue of, 392 Eye, 168 anterior and posterior chambers of, 88 axial CT images of, 150 axial MR image of, 150 coronal CT images of, 151 external muscles of, 90 extrinsic muscles of, 84, 90 intrinsic arteries and veins of, 90 muscular artery and vein of, 90 vascular supply of, 91 Eyeball, 81 arteries and veins of, 85 choroid of vascular arrangements within, 91 tarsus of, 83 vascular supply of, 91 Eyelashes, 81 Eyelid, 81 arteries and veins of, 85 tarsus of, 83

Face arterial supply sources of, 19 muscles of. 123 sensory nerves of, 123 superficial arteries and veins of, 23 Facets, 246 Facial artery, 31, 32, 34, 36, 40, 60, 75, 85, 131, 133, 136, 138 lateral nasal alar branch of, 41 nasal septal branch of, 41 superior labial branch of, 41 tonsillar branch of, 64 transverse, 23, 34, 36, 69, 85 Facial canal, 124 prominence of, 93 Facial expression muscles, 26, 60 lateral view of, 26 Facial lymph node, 72 Facial muscles, 123 Facial nerve (VII), 11, 34, 40, 62, 71, 92, 104, 114, 116, 117, 122, 131, 133, 134, 135, 165, 166 branches of, 25, 168 buccal branches of, 123 cervical branches of, 123 communications to, 123, 125 distribution of, 118 geniculum (geniculate ganglion) of, 97, 123, 124, 125 intermediate, 133 internal genu of, 117 main trunk of, 25 marginal mandibular branch of, 30 motor nucleus of, 123 motor root of, 124 schema of, 118, 123, 134 in stylomastoid foramen, 94

Facial nerve (VII) (Continued) temporal branches of, 123 zygomatic branches of, 123 Facial nucleus, 116, 117 Facial plexus, 131 Facial vein, 23, 30, 32, 59, 60, 85 common trunk for, 23 deep, 23, 85 transverse, 23, 70 Falciform ligament, 252, 269, 274, 275, 305, 312, 331, 349 branch to, 255 of liver, 305 Fallopian tube. See Uterine (fallopian) tube Falx cerebelli, 144 Falx cerebri, 39, 102, 103, 141, 144 Fascia axillary, 428 anterior part of, 428 fenestrated, 428 brachial, 428 buccopharyngeal, 60, 63, 65 Camper's, 348, 361, 378 cervical investing layer of, 26, 28 muscles invested by, 188 pretracheal layer of, 28 clavicopectoral, 188 clavipectoral, 428 cremaster, 390 cremasteric, 250, 261 cribriform, in saphenous opening, 249 dartos, 390 deep (Buck's), 249, 250, 253, 348, 380, 381, 382, 383, 396, 401, 403, 405 deltoid, 26 diaphragmatic, 342 inferior, 348, 349 endopelvic, 364 extraperitoneal, 252, 261, 412 infradiaphragmatic, 236 infrahyoid, 28 of infrahyoid muscle, 428 infraspinatus, 174, 177 interosseous dorsal, 462 palmar, 462 infraspinous, 424 investing pectoralis minor muscle, 428 investing subclavius muscle, 428 latissimus dorsi, 428 of leg, 522, 546 obturator, 356, 369, 379, 402, 411 over obturator internus muscle, 365 obturator internus, 364, 392, 402, 411 of orbit and eyeball, 83 over adductor pollicis muscle, 460 paravesical endopelvic, 366 parotid, 26 pectoral, 182, 428 superficial and deep layers of, 428 of pectoralis minor muscle, 428 pelvic, 372 penile, 249 perineal, 356 deep, 355, 361, 370, 378, 381, 382, 383, 391, 396, 404, 405 deep transverse, 384 superficial, 348, 366, 370, 378, 380, 381, 395, 396, 404, 405, 411

Fascia (Continued) pharyngobasilar, 52, 73 plantar lateral, 532 medial, 532 posterior antebrachial, thickening of, 468 presacral, 348, 364, 396 pretracheal, 63 visceral layer of, 202 prevertebral, 60, 63, 65 pubocervical distal portion of, 372 horizontal portion of, 372 quadratus lumborum, 179 rectal, 348, 364, 378, 384, 391, 392, 393, 394, 396 rectoprostatic (Denonvilliers'), 348, 359, 361, 386, 391, 396 rectovesical, 384, 391, 396 renal, 339, 342, 347 anterior layer of, 179 Gerota's, 342 posterior layer of, 179, 342 sagittal section of, 342 transverse section of, 342 Scarpa's, 348, 361, 378 attachment of, 380 scrotal, 249 superficial, 395 serratus anterior, 428 Sibson's, 230 spermatic, 249, 250, 259, 261 external, 249, 250, 251, 257, 259, 260, 261, 361, 380, 390, 405 internal, 251, 261, 390 origin of, 260, 261 subclavius, 428 subserous, 412 superficial, 390 supradiaphragmatic, 236 temporal, 26, 54 deep layer of, 54 superficial layer of, 54 thoracolumbar, 174, 175, 176, 177, 330 anterior layer of, 176, 179 layers of, 179 middle layer of, 179 posterior layer of, 176, 179, 330 transversalis, 179, 252, 259, 261, 331 umbilical prevesical, 251, 252, 260, 348, 364, 365 uterine, 364 uterovaginal, 369, 370, 378 vaginal, 391 vesicle, 348, 361, 366, 369, 391, 396 Fascia lata, 250, 500, 544 attachment to Scarpa's layer, 249 of leg, 546 Fascial compartments, leg, 522 Fascial sheath of eyeball (Tenon's capsule), 83, 87 Fasciculus dorsal longitudinal, 147 medial longitudinal, 113 Fat of elbow, 438 epidural, 137, 170 infrapatellar, 507, 508, 511 of mammary gland, 182 in orbit, axial MR image of, 150 pararenal, 179, 339

Fat (Continued) perirenal, 179, 339, 342 retrobulbar, 83 of sole of foot, 532 suprapatellar, 511 Fat body, of ischioanal fossa, 376 Fat pad infrapatellar, 511 suprapatellar, 511 Fauces, 64 Female reproductive organs, innervation of, 415 Femoral artery, 250, 493, 500, 512, 546 circumflex ascending, 501, 512 descending, 501, 512 lateral, 500, 512 medial, 501, 502, 504, 512 transverse, 501, 512 deep, 493, 500, 512 muscular branches of, 512 Femoral canal, 546 lymph nodes in, 546 Femoral nerve, 160, 259, 267, 376, 409, 496, 498, 500, 538, 546 anterior cutaneous branches of, 409 branches of, 545 cutaneous, 545 anterior, 538, 544 lateral, 267, 329, 496, 498, 500, 544, 565 posterior, 160, 177, 503, 540, 545, 546 terminal branch of, 544 Femoral ring, 259, 262, 363, 364, 546 Femoral sheath, 250, 251, 262, 500, 546 Femoral vein, 250, 256, 376, 380, 493, 500, 505, 544, 546 Femoral vessels, 260, 401, 407 openings for, 263, 500 Femoris muscle, rectus, 376, 485, 489, 491, 492, 494, 500, 538 attachments of, 490, 491 origin of, 492 Femoris tendon, rectus, 485, 493, 505, 507, 519 Femur, 489, 511 adductor tubercle of, 489 anteroposterior radiograph of, 488 anterior view of, 489 calcar of, 489 of child, 504 fibrous capsule of, 489 gluteal tuberosity of, 489 greater trochanter of, 152, 489, 493 head of, 376, 487, 489 anteroposterior radiograph of, 488 arteries of, 504 fovea of ligament of, 489 radiograph of, 355 intercondylar fossa of, 489 intertrochanter crest of, 489 lateral condyle of, 489, 493, 510 lateral epicondyle of, 489 lesser trochanter of, 263, 489 ligament of head of, 487, 489 linea aspera of, 489 medial condyle of, 489 adductor magnus muscle insertion on, 493 adductor tubercle on, 493

Femur (Continued) neck of, 376 nutrient artery of, 504 nutrient foramen of, 489 patellar surface of, 489 pectinal line of, 489 popliteal surface of, 489, 511 posterior view of, 489 radiograph of, 355, 510 shaft of, 489, 496 Fibroelastic membranes, 234 Fibrous (Albini's) nodule, 223 Fibrous sheath, of sole of foot, 534 Fibrous trabecula, 147 Fibula, 513, 517, 530 at ankle, 525, 527, 531 anterior border of, 513 anterior intercondylar, 514 anterior view of, 513, 514 with ligament attachments, 514 apex of, 513, 514 cross section of, 514 head of, 492, 493, 494, 511, 513, 514, 515, 518, 520, 521, 542 anterior ligament of, 514 anteroposterior radiograph of, 510 posterior ligament of, 514 radiograph of, 510 interosseous border of, 513, 514 lateral condyle of, 514 lateral surface of, 513, 514 medial crest of, 514 medial surface of, 513 neck of, 513 posterior view of, 513 radiograph, of, 54, 510 superior articular surface of, 513 superior view of, 513 trochlea of, 522 Fibular artery, 512, 516, 517, 518, 522, 534 calcaneal branches of, 516, 517 circumflex, 512 communicating branch of, 518 perforating branch of, 518, 520, 530, 531 posterior lateral malleolar branch of, 518 Fibular collateral bursa, 507 Fibular collateral ligament, 506, 507, 508, 511, 514, 517, 520, 521 inferior subtendinous bursa of, 511 Fibularis brevis muscle, 530, 531, 542 attachments of, 515 innervation of, 542 tendon of, 485, 516, 517, 518, 520, 521, 527, 528, 530, 536 Fibularis brevis tendon, 530, 535 Fibularis longus muscle, 485, 494, 515, 517, 519, 521, 522, 542 attachments of, 515 innervation of, 542 tendon of, 485, 516, 517, 520, 521, 527, 528, 530, 531, 536 groove for, 524 to sole of foot, 521 Fibularis longus tendon, 536 Fibularis tertius muscle, 530 attachments of, 515 tendon of, 519, 521, 530, 531, 536

Fibular nerve articular branch of, 540, 541 common, 495, 499, 505, 506, 507, 508, 518, 519, 520, 521, 540, 541, 542, 544, 545 muscles innervated by, 542 deep, 520, 522, 542 dorsal digital branches of, 520, 530, 531, 544 dorsal digital branch of, 544 lateral branch of, 520, 542 medial branch of, 519, 520, 530, 531, 542 superficial, 519, 520, 521, 530, 542, 544 dorsal digital branches of, 530 intermediate dorsal cutaneous branch of, 544 medial dorsal cutaneous branch of, 544 Fibular notch, 513 Fibular retinaculum inferior, 518, 521, 525, 527 superior, 516, 517, 521, 527 Fibular tendon, 525 Fibular vein, 522 Filiform papillae, 58 Filum terminale externum, 160, 161 Filum terminale internum, 160, 161 Fimbriated fold, 51 Fingernail body of, 471 lunule of, 471 nailbed of, 471 Fingernail, body of, 471 Fingers, 418 arteries and nerves of, 471 arteries of, 471 bones of, 452 common names of, 418 cross section of, 471 cross section through, 471 distal anterior closed space of, 471 dorsum of lymph vessels passing to, 483 in extension, 464 extensor mechanism of, 471 extensor muscles of, 441 extensor tendons of, 464 fibrous septa of, 471 fibrous sheath, annular and cruciform parts of, 462 fibrous sheath of, 471 fifth palmar digital nerves to, 460 synovial tendinous sheath of, 460 in flexion, 464 flexor and extensor tendons in, 471 flexors of, 443 flexor tendons of, 464 fourth, palmar digital nerves to, 460 index, metacarpal of, radiograph of, 457 innervation of, 469 lateral view of, 464 lymph vessels passing through, 483 middle, middle phalanx of, 457 middle, sagittal section of, 453 muscle attachments of, 450 nerves of, 471 posterior (dorsal) view of, 464 ring, distal phalanx of, 457 sagittal section through, 453, 471

Fingers (Continued) septa of, 471 synovial flexor tendon sheaths of, 460 tendon sheaths of, 462 fibrous, 471 Flank left, 268 * right, 268 Flexor carpi radialis muscle, 420, 433, 442, 446 tendon of, 418, 420, 447, 448, 454, 460, 461 Flexor carpi radialis tendon, 447, 454 Flexor carpi ulnaris muscle, 418, 420, 444, 446, 447, 476 humeral origin of, 451 tendon of, 418, 420, 448, 449, 454, 461, 465 ulnar origin of, 451 Flexor carpi ulnaris tendon, 418, 454, 460, 465 Flexor digiti minimi brevis muscle, 465, 476, 533, 534, 536, 541 superficial tibial nerve branch to, 541 tendon of, 528 Flexor digitorum brevis muscle, 533, 534, 535 tendon of, 533, 534, 535 Flexor digitorum brevis nerve, 541 Flexor digitorum longus muscle, 515, 535, 541 innervation of, 541 tendon of, 513, 516, 517, 528, 533, 534, 535 Flexor digitorum profundus muscle medial part of, 476 tendon of, 460 Flexor digitorum superficialis muscle, 420, 443, 444, 446, 447, 448, 449, 450, 451, 474, 475, 476 humeroulnar head of, 420 origin of, 420 radial head of, 447, 448, 449, 450, 474 tendon of, 418, 420, 446, 449, 454, 461, 462, 474 Flexor digitorum superficialis tendon, 418, 454, 471 insertion of, 460 Flexor digitorum profundus muscle, 476 Flexor hallucis brevis muscle, 541 insertion of, 536 lateral head of, 533, 535 insertion of, 536 medial head of, 533, 534, 535 insertion of, 536 medial origin of, 536 tendon of adductor hallucis and lateral head of, 528 lateral origin of, 536 medial head of, 528 Flexor hallucis longus muscle, 541 attachment of, 515 innervation of, 541 tendon of, 516, 517, 518, 528, 533, 534, 535, 536 groove for, 523, 524, 525 on lalus, 523

Flexor muscles of fingers, 444 of forearm, superficial, 446 of leg deep, 522 superficial, 522 of wrist, 442 Flexor pollicis brevis muscle, 465 : 476 deep head of, 476 superficial head of, 476 Flexor pollicis longus muscle, 444, 446, 447, 448, 449, 450, 474 superficial head of, 443, 446 synovial tendinous sheath of, 460 tendinous sheath of, 460, 462 tendon of, 446, 448, 449, 454 in tendon sheath, 461, 462 ulnar head of, origin of, 420 Flexor pollicis longus tendon, 454 Flexor retinaculum, 447, 460, 461, 462, 465, 474, 516, 517, 534, 535, 541 removed, 454 transverse, 465 Flexor sheath, common, 460 Flexor tendons common, of forearm, 443, 446 in fingers, 464 profundus and superficialis, 462 at wrist, 461 Flexor tendon sheath common, 460 common ulnar, 462 fibrous, of sole of foot, 533 fibrous sheath over, annular and cruciform parts of, 460 of finger, 471 Flocculonodular lobe, 113 Flocculus, 113 Foliate papillae, 58, 135 Folium, 113, 115, 144 Follicle, 371 Fontalis muscle, 36 Fontanelle anterior, 12 mastoid, 12 posterior, 12 Foot arteries of, 536 bones of, 523, 524, 525 deep arteries of, 536 dorsal view of, 536 dorsum of deep dissection of, 530, 531 muscles of, 530 fibrous longus tendon passing to, 521 interosseous muscles of, 530, 536 inversion and eversion of, 543 lateral dorsal cutaneous nerve of, 530 ligaments and tendons of, 527 plantar view of, 528 plantar surface of, 485 plantar view of, 536 right lateral view of, 527 medial view of, 527 sole of muscles Of, 533, 534, 535 superficial dissection of, 532 tendons of, plantar view of, 528

Foramen lacerum, 8, 10 petrosal nerves of, 10 Foramen magnum, 8, 9, 11, 14, 58, 123, 127 Foramen of Luschka. See Lateral aperture (foramen of Luschka) Foramen of Magendie. See Median aperture (foramen of Magendie), 109 Foramen of Monro. See Interventricular foramen (of Monro) Foramen of Winslow. See Omental foramen (of Winslow) Foramen ovale, 4, 8, 11, 14, 45, 46 obliterated, 229 prenatal, 229 valve of, 221 Foramen rotundum, 11, 45 Foramen spinosum, 11, 14, 46 Foramen transversarium, 19 Forearm bones of, 439 cutaneous nerves of, 480 lateral, 435, 446, 447, 448, 449, 469, 473, 481 branches of, 479 posterior branch of : 480 deep muscle layer of anterior view of, 447 posterior view of, 445 distal, cross section of, 470 intermediate muscle layer of, anterior view of, 447 ligaments of, 438 medial, 429, 430, 433, 446, 469, 473, 479, 481, 474, 475 anterior branch of, 449, 480 posterior branch of, 480 muscles of, 440, 441, 442, 444, 446, 447 deep layer of, anterior view of, 448 muscular attachments of anterior view of, 450 posterior view of, 451 posterior, 432, 435, 449, 468, 469, 477, 479, 480, 481 pronated position of, 440 serial cross sections of, 449 superficial muscles of anterior view of, 446 posterior view of, 444 superficial veins of, 480 supinated position of, 440 Fornix, 106, 112, 147 body of, 106, 108, 112 columns of, 106, 110, 111, 112, 145 conjunctival, 81 crura of, 106, 110, 112, 143 schema of, 112 Fossa ovalis, 220, 544 limbus of, 220 Fovea centralis, 87, 90 Frenulum, 282 artery to, 59 of lower lip, 51 of tongue, 51, 61 of upper lip, 51 Frontal artery, 23 medial, 142 polar, 141, 142 Frontal artery, polar, 141, 142

Frontal bone, 9, 36, 38, 81, 82 glabella of, 4 nasal spine of, 38, 39 orbital part of, 2, 9 sinus of, 38, 39 squamous part of, 38, 39 supraorbital notch of, 4, 12 Frontal crest, 9 Frontal gyrus inferior, 105 medial, 106 middle, 105 superior, 105 Frontalis muscle, 36 Frontal lobe, 105 Frontal nerve, 83, 86, 121, 122 131 Frontal operculum, 105 Frontal pole, 105 sagittal MR image of, 149 Frontal sinus, 3, 5, 37, 38, 39, 48, 63 with frontal bone, 50 growth of, 50 Frontal sulcus inferior, 105 superior, 105 Frontobasal artery lateral, 141, 142 medial, 141, 142 Frontonasal canal infundibulum leading to, 38 opening of, 38 Frontonasal duct, 37 opening of, 49 Fundiform ligament, 249 of penis, 361 Fundus, of stomach, 293 Fungiform papilla, 58, 135

G Galea aponeurotica, 26, 102, 178 Galen, ansa of, 80 Galen, vein of. See Great cerebral vein (of Galen) Gallbladder, 126, 167, 196, 269, 272, 275, 294, 301, 331 arterial variations and collateral supply of, 305 body of, 294 cross section of, 297 fundus of, 294 gland orifices of, 294 infundibulum of, 294 innervation of, 168 joining hepatic duct, 294, 296 neck of, 294 Ganglion, basal nuclei of, 110 Ganglion cells, 120 Gartner's duct. See Cranial mesonephric (Gartner's) duct, 389 Gastric artery, 272, 300, 305, 318, 319, 320, 321 arteriogram of, 303 attached to lesser omentum, 274 esophageal branch of, 300 sympathetic fibers along, 240 left, 206, 237, 264, 300, 301, 306, 318, 319, 320, 321, 323, 331, 348, 349, 410 esophageal branch of, 237

Gastric artery (Continued) right, 279, 294, 300, 305, 320, 321, 331 arteriogram of, 303 short, 300, 301, 305, 321 sympathetic fibers along esophageal branch of, 240 Gastric canal, 276 Gastric-esophageal mucosa junction, 276 Gastric folds, 236, 276 Gastric glands, 276 Gastric impression, 286 Gastric lymph drainage pathways, 314 Gastric lymph nodes, 314, 315 Gastric plexus, 410 left, 318, 319, 320, 322, 323 right, 319, 320, 322 Gastric vein left, 309, 310, 311, 312, 313 esophageal tributary of, 309 right, 309, 310, 311, 312, 313 short, 309, 311, 312, 313 Gastric vessels, short, 331 Gastrocnemius muscle, 506, 507, 516, 519, 520, 521, 522, 540, 541 innervation of, 541 lateral head of, 485, 494, 495, 511, 515, 516, 517, 518 attachments of, 491, 515 subcutaneous bursa of, 511 lateral subtendinous bursa of, 511 medial head of, 485, 491, 495, 502, 511, 517, 518, 522 attachments of, 491, 515 Gastrocolic ligament, 272 Gastroduodenal artery, 279, 294, 301, 304, 305, 306, 321, 322, 327 arteriogram of, 303 plexus on, 320 Gastroduodenal plexus, 320, 322, 327 Gastroepiploic artery, left, 301 Gastrolienal ligament. See Gastrosplenic ligament Gastro-omental arterial anastomosis, 272 Gastro-omental artery left, 300, 301, 305, 306, 321 plexus on, 319, 320 right, 272, 300, 305, 306, 321 origin of, 302 Gastro-omental lymph nodes left, 314 right, 314 Gastro-omental vein, 312 left, 309, 311, 312, 313, 314 right, 309, 311, 312, 313 Gastro-omental vessels attachment to greater omentum, 274 left, 299 Gastropancreatic fold, 272 Gastrophrenic ligament, 272, 329 Gastrosplenic ligament, 272, 273, 299, 331 short gastric vessels in, 299 Gemellus muscle inferior, 376, 495, 503 attachments of, 489, 491 nerve to, 503 superior, 495, 499, 503 attachments of, 489, 491

Genicular artery descending, 512 articular branch of, 500, 512 saphenous branch of, 500, 512 inferior lateral, 512, 517, 518, 519, 520 inferior medial, 500, 512 middle, 512 superior lateral, 502, 512, 516, 517, 519, 520, 521 superior medial, 51, 500, 501, 502, 512, 516, 518, 519, 520 Geniculate body lateral, 107, 110, 111, 114, 116, 120, 132, 143, 144, 145 of left thalamus, 143 medial, 107, 108, 110, 111, 114, 115, 139, 143, 144, 145 Geniculate nucleus left dorsal lateral, 120 right dorsal lateral, 120 Geniculum (geniculate ganglion), 116, 131, 135 of facial nerve, 97, 116, 125 site of, 124 Genioglossus muscle, 29, 32, 59, 60, 128, 129 superior mental spine for origin of, 52 Geniohyoid muscle, 29, 53, 59, 128, 129 Genital cord, 389 Genitalia, 388 external, 167 female, 377, 388 homologues of, 388 innervation of, 168 male, 388 internal female, 389 homologues of, 389 male, 389 lymph nodes and vessels of, 406, 407, 408 undifferentiated, 388 Genital tubercle epithelial tag of, 388 glans area of, 388 lateral part of, 388 Genitofemoral nerve, 329, 340, 496, 498, 539, 409 femoral branch of, 267, 409, 498, 544 genital branch of, 259, 261, 267, 409, 544 testicular vessels and genital branch of, 259, 261 Genu, of corpus callosum, 146 Gerdy's tubercle, 494, 513 Gerota's fascia. See Renal fascia, Gerota's Gimhernat's ligament. See Lacunar ligament (Gimbernat's) Gingiva epithelium of, 57 lamina propria of, 57 Gingival groove, 57 Glenohumeral joint, 423 Glenohumeral ligament inferior, 423 superior, 423 Glenoid cavity, 185, 423 Glenoid labrum, 423

Glisson's capsule. See Perivascular fibrous (Glisson's) capsule Globus pallidus, 108, 110, 539 Glomerular arteriole afferent, 336 efferent, 336 Glomerulus, 119, 136 Glossoepigloitic fold lateral, 58 median, 58 Glossopharyngeal nerve, 34, 114, 116, 117, 118, 123, 125, 126, 130, 131, 133, 135, 166 branch of, 168 carotid branch of, 34, 125, 126, 130, 131 inferior ganglion of, 125, 135 pharyngeal, tonsillar and lingual branches, 125 schema of, 118, 125, 134 tympanic branch of, 10 Gluteal aponeurosis, 330, 494, 495 over gluteus medius muscle, 174 Gluteal artery inferior, 341, 499 superior, 499 Gluteal fold, 152 Gluteal line anterior, 352, 486 right inferior, 352, 486 superior, 265, 311 Gluteal nerve inferior, 160, 499, 503 superior, 160, 499, 503 Gluteal tuberosity, 489 Gluteal vein inferior, 311 superior, 311 Gluteus maximus muscle, 152, 174, 177, 254, 330, 376, 381, 382, 395, 396, 410, 411, 413, 485, 494, 495, 502, 503, 504 attachments of, 491 Gluteus medius muscle, 152, 376, 492, 496, 500, 501, 502, 503 attachments of, 491 gluteal aponeurosis over, 330, 494, 495 Gluteus minimus muscle, 489, 495, 496, 500, 501, 502, 503 attachments of, 489, 491 tendon of, 376 Gonads, 389 male, descent of, 386 Gracile fasciculus, 114, 115 Gracile tubercle, 114, 115 Gracilis muscle, 489, 492, 493, 495, 500, 501, 502, 505, 506, 516 attachments of, 489, 515 innervation of, 540 Gracilis tendon, 485, 492, 493, 506, 507 Granular foveola, 99, 102 Granule cells, 119 Gray matter, 169 interomediolateral nucleus of, 44, 132, 134 lateral horn of, 170, 325, 346 spinal, 169 sympathetic preganglionic cell bodies in, 132 Great cerebral artery, quadrigeminal cistern of, 109

Great cerebral vein (of Galen), 103, 104, 106, 144, 145, 146 Groin left, 268 right, 268 Gubernaculum, 389, 415 Gum, 57 Gut. See also Viscera enteric plexus of, 325 prenatal, 229

Habenula, 110 Habenular commissure, 106, 111, 115 Habenular trigone, 111, 115 Hair cells (cochlear) inner, 96 outer, 96 Hamate, 452, 455, 456, 474 anterior (palmar) view of, 452 coronal section of, 455 hook of, 442, 452, 454, 456 radiograph of, 457 posterior (dorsal) view of, 452 radiograph of, 457 Hamulus, 8, 14, 38, 52 of spiral lamina, 95 Harad in abduction, 453 in adduction, 453 in anatomical position, 453 anterior (palmar) view of, 459, 465, 472 anterior view of, 460 arteries and nerves of, palmar view of, 466, 484 bones of, 456 bursae of, 462 cutaneous innervation of, 472, 476 deep digital crease of, 418 deep dorsal dissection of, 469 deeper palmar dissection of, 460 dorsal fascia of, 462 dorsal venous network of, 468, 483 dorsum of, 483 lymph vessels passing to, 483 in extension, 453 in flexion, 453 lymphatic pathway of, 468 lymph vessels passing to around web in, 483 dorsum of, 483 middle digital crease of, 418 muscles of, 465 intrinsic, 465 nerves of, palmar view of, 466 palmar dissection of deeper, 460 superficial, 459-460 palm of, 453 posterior (dorsal) view of, 465, 472 proximal digital crease of, 418 proximal palmar crease of, 418 radial dissection of, superficial, 467 radial longitudinal crease of, 418 radiograph of, anteroposterior, 457 septa between spaces of, 462 spaces and sheaths of, 462 spaces of, 462 superficial dorsal dissection of, 468

Hand (Continued) surface anatomy of, 418 tendon sheaths of, 462 Hartmann's pouch. See Infundibulum (Hartmann's pouch) Haustra, 284 Head. See also Brain; Skull; specific parts of head arteries of, 40-41 autonomic nerves in, 131 axial CT image of, 150 axial MR image of, 150 bones and ligaments of, 4-16 coronal CT images of, 151 cutaneous nerves of, 24 fauces of, 64 lymph vessels and nodes of, 72-73 mastication muscles of, 54-55 muscles of, 26 nasal region of, 36-37, 46-47, 48-49 nerves of, 24 oral region of, 50-61 sagittal MR image of, 149 surface anatomy of, 1 Heart, 126, 233 anterior exposure of, 212 apex of, 212, 213, 214, 246 atria, ventricles, and interventricular septum of, 224 base of posterior view of, 214 surface of, 214 conducting system of, 225 diaphragmatic surface of, 214 in diastole, 222 fibrous skeleton of, 222 inferior border of, 212 in situ, 211 innervation of, 227 innervation of, schema of, 227 left border of, 196 left side of, 225 membranous septum of, 221, 222 nerves of, 226 pericardial sac and, 282 right border of, 196 right side of, 225 in systole, 222 valves of, 222 Heiss, Hoops of, 367 Helicotrema, 92, 95, 96 Helix, 93 crus of, 93 Helvetius, collar of, 236, 277 Hemiazygos vein, 236, 245 accessory, 194. 207 Hemothorax, chest drainage tube placement in, 190 Henle's loop, 337 ascending limb of, 336 descending limb of, 336 proximal segment of, 336 thin segment of, 336 Hepatic artery, 297, 337 branches of, 290, 291, 292 common, 237, 264, 272, 279, 294, 300, 301, 305, 306, 318, 321, 327, 331, 349 arteriogram of, 303 cross section of, 297 effects of obstruction on, 305

Hepatic artery (Continued) intermediate, 301 left, 294, 300, 301, 305 middle, 305 origin of, 302 proper, 273, 278, 279, 288, 290, 294, 298, 301, 321, 330 arteriogram of, 303 bifurcation of, 331 to lesser omentum, 348 right, 294, 300, 301, 305 accessory, 302 origin of, 302 Hepatic duct, 290 aberrant, 294, 296 accessory, 296 common, 287, 289, 290, 294, 301, 331 left, 294 right, 294 variations in, 294, 296 Hepatic flexure. See Colic flexure, right Hepatic lymph nodes, 314, 315 Hepatic nerve plexus, 349 Hepatic plexus, 126, 319, 320, 322 anterior, 327 branches from, 319 to cardia, 320 pyloric, 126 vagal, 319 common, 318 posterior, 327 pyloric branch from, 126 vagal branch to, 319 Hepatic portal vein, 273, 278, 279, 288, 294, 298, 300, 301, 311, 312, 315, 331, 349 to lesser omentum, 348 prenatal, 229 tributaries of, 312 typical arrangement of, 313 variations of, 313 Hepatic vein, 194, 232, 265, 274, 287, 290, 309 prenatal, 229 Hepatoduodenal ligament, 272, 275, 278, 297 Hepatogastric ligament, 275, 288 Hepatogastric trunk, 302 Hepatomesenteric trunk, 302 Hepatopancreatic ampulla, 294 sphincter of, 295, 327 Hepatorenal recess (Morison's pouch), 331 Hering, canal of, 291, 292 Hering-Breuer reflex, receptors for, 210 Hernia inguinal indirect, 261 site of, 261 sliding, 236 Hernial sac, 261 neck of, 261 Herniated disc. See Lumbar disc herniation Hesselbach, triangle of. See Inguinal (Hesselbach's) triangle Heubner, recurrent artery of. See Distal medial striate artery (recurrent artery of Heubner) High intestinal vein, 313

Hip anteroposterior radiograph of, 488 arteries of, 500-502 bony attachments of anterior view of, 490 posterior view of, 491 flexion and extension of, 543 muscles of, 496 lateral view of, 494 posterior view of, 495 nerves of, 503 Hip bone auricular cartilage of, 487 lateral view of, 486 medial view of, 486 Hip joint anteroposterior radiograph of, 488 anterior view of, 487 capsule of, 504 iliofemoral ligament of, 496 lateral view of, 487 ligaments of, 492 posterior view of, 487 Hippocampal fimbria, 119 Hippocampal sulcus, 112 Hippocampus, 110, 111, 112 alveus of, 112 fimbria of, 106, 108, 111, 112 superior dissection of, 112 His, bundle of, 225 Horizontal cells, 120 Houston, valves of, 393 Humeral artery, circumflex anterior, 427, 429, 433, 434 posterior, 427, 429, 432, 433, 434 Humeral ligament, transverse, 423 Humeral vein, circumflex, 479 Humeroulnar head, 447 Humerus, 433, 436, 438 anatomical neck of, 420, 421 anteroposterior radiograph of, 422 anterior view of, 420 anteroposterior radiograph of, 422 capitulum of, 420, 436 common extension tendon of, 421 common flexor tendon of, 421 condyles of, 420, 436 coronoid fossa of, 420 greater tubercle of, 420, 421, 423, 432 crest of, 420 head of, -120 anteroposterior radiograph of, 422 infraglenoid tubercle of, 421 intertubercular sulcus of, 420 intertubercular tubercle of, 420 lateral epicondyle of, 420, 421, 436, 437, 438, 441, 442, 444, 448 lateral supracondylar ridge on, 420 lesser tubercle of, 420, 423 medial epicondyle of, 420, 421, 432, 433, 437, 440, 442, 444, 445, 446, 447, 476, 477 medial supracondylar ridge on, 420 olecranon fossa of, 421, 436, 437 olecranon of, 437 posterior view of, 421 radial fossa of, 420 radial groove of, 421 radiographs of, 437 right surgical neck of, 243

Humerus (Continued) shaft of, 244, 245 surgical neck of, 420 anteroposterior radiograph of, 422 trochlea of, 420, 437 ulnar nerve groove of, 421 Hyaloid canal, 87 Hydatid of Morgagni. See Vesicular appendix (hydatid of Morgagni) Hymen annular, 377 cribriform, 377 septate, 377 Hymenal caruncle, 370, 377 Hyoepiglottic ligament, 63, 77 Hyoglossus muscle, 34, 60 Hyoid bone, 27, 28, 29, 34, 59, 60, 61, 63, 65, 68, 74, 76, 77 body of, 13, 53 greater horn of, 13, 53, 75 lesser horn of, 13, 53 tip of greater horn of, 67, 75 Hyothenar muscle, 444, 476 Hypochondrium left, 268 right, 268 Hypogastric nerve, 165, 218, 324, 344, 345, 409, 410, 414, 415, 416 inferior, 324 left, 318, 323, 412 pelvic, 414 right, 318, 323, 412 superior, 345, 415 Hypogastric plexus inferior, 165, 166, 168, 323, 324, 344, 345, 409, 412, 499 parasympathetic branch from, 165 with periureteric loops, 344 right, 323 superior, 165, 318, 323, 324, 345, 409, 412 Hypogastric sheath, 364 Hypoglossal canal, 8, 10, 11 Hypoglossal nerve, 10, 32, 34, 114, 117, 129, 344 distribution of, 118 meningeal branch of, 128 schema of, 118, 128 vena comitans of, 59, 60, 70 Hypoglossal nucleus, 116, 128 Hypoglossal trigone, 115 Hypoglossus muscle, 27, 53, 74, 77, 128 dorsal lingual vein medial to, 70 Hypophyseal artery inferior, 140, 148 superior, 140, 148 Hypophyseal fossa, 5, 9 at birth, 50 Hypophyseal portal system primary plexus of, 148 secondary plexus of, 148 Hypophyseal portal vein long, 140, 148 short, 148 Hypophyseal vein, efferent, 140 to cavernous sinus, 148 Hypophysis, 106, 107, 147. See also Pituitary gland arteries and veins of, 148 Hypothalamic area, lateral, 135

Hypothalamic artery, 140 Hypothalamic sulcus, 106, 147 Hypothalamic vessels, 148 Hypothalamohypophyseal tract, 147 Hypothalamus, 108, 147, 324 arteries of, 148 nuclei of arcuate, 147 dorsomedial, 147 paraventricular, 147 posterior, 147 supraoptic, 147 ventromedial, 147 parasympathetic, 324 sympathetic, 324 Hypothenar eminence, 418 Hypothenar muscle, 446, 462, 476 Hysterosalpingogram, uterus, 373

Ileal artery, 306, 307 anastomotic loops of, 280 Ileal fold, 311, 313 Ileal orifice, 284 muscles fibers of, 282 papillary, 282 Ileal papilla, 282 Ileocecal fold, 281 Ileocecal junction, muscle fibers around,282 Ileocecal lips, 282 Ileocecal recess inferior, 281 superior, 281 Ileocecal region, 281, 282 Ileocolic artery, 281, 307, 322, 323, 340 colic branch of, 281, 306, 307 ileal branch of, 281, 306, 307 Ileocolic lymph nodes, 317 Ileocolic plexus, 322, 323 Ileocolic vein, 311, 312, 313 Ileum, 269, 282, 284, 339, 349 barium radiograph of, 280 circular muscle layer of, 280, 282 longitudinal muscle layer of, 280, 282 lymphoid nodules of, 280 mucosa of, 280 muscle fibers to, 282 musculature of, 280 serosa of, 280 submucosa of, 280 terminal, 271, 281, 282, 362, 363 Iliac artery circumflex ascending branch of, 255, 264 deep, 501, 512 superficial, 247, 512 common, 264, 274, 340, 341, 398, 400, 412 left, 318 axial CT images of, 350 right, 329 axial CT images of, 350 ureteric branch from, 341 external, 264, 274, 318, 329, 340, 398, 400, 402, 412, 501, 512 right, 329

Iliac artery (Continued) internal, 264, 307, 318, 329, 340, 341, 370, 398, 412 anterior division of, 400 posterior and anterior divisions of, 402 right, 323, 329 Iliac crest, 152, 174, 175, 176, 177, 247, 248, 254, 329, 330, 342, 351, 485, 486, 494, 495, 496, 502, 503, 545 inner lip of, 248, 352, 353 intermediate zone of, 248, 352, 353, 486 in lumbar puncture, 162 outer lip of, 248, 352, 353, 486 tuberculum of, 248, 352, 353, 486 upper lip of, 486 Iliac fossa, 352, 353, 363, 486 Iliac lymph nodes common, 266, 317, 343, 408 external, 266, 317, 343, 408, 546 lymphatic pathways to, 408 internal, 266, 317, 343, 408 lateral, 406 medial external, 406 Iliac plexus common, 412 external, 318, 412 internal, 318, 412 left common, 317 right internal, 323 Iliac spine anterior, 247, 248, 250, 486, 487, 492 anterior superior, 248, 249, 259, 263, 486, 487, 492, 493, 496, 500 posterior inferior, 486 posterior superior, 152, 352, 353, 486 Iliac tubercle, 353 Iliac tuberosity, 248 lliacus muscle, 263, 329, 376, 490, 496, 498, 499, 538 attachment of, 490 muscular branch of, 498 lliacus wing, male, 354 Iliac vein, superficial circumflex, 544 Iliac vessels circumflex deep, 364, 403 superficial, 249, 500 common, 271, 401, 412 external, 259, 260, 281, 311, 360, 361, 362, 364, 372, 392, 401, 403 internal, 311 superficial circumflex, 249 lliococcygeus muscle, 356, 357, 358, 359, 395 lliocostalis cervicis muscle, 175 lliocostalis lumborum muscle, 175 lliocostalis muscle, 175, 331 lliocostalis thoracis muscle, 175 Iliofemoral ligament, 487, 496 Iliohypogastric nerve, 160, 177, 267, 329, 409, 496, 498, 539 anterior branch of, 257 anterior cutaneous branch of, 257, 267, 410 genital branch of, 409 lateral cutaneous branch of, 545 schema of, 498

Ilioinguinal nerve, 160, 257, 260, 267, 329, 330, 340, 409, 414, 496, 498, 539, 540, 544 anterior labial branch of, 413 anterior scrotal branches of, 267, 409 schema of, 498 scrotal branches of, 267, 409, 544 Iliolumbar artery, 264, 341, 402 Iliolumbar ligament, 330, 353 iliolumbar vein, 330, 353 Iliopectineal bursa, 496 iliopectineal line, 353, 392 iliac part of, 358 pubic part of, 358 Iliopsoas muscle, 259, 376, 489, 492, 493, 500 attachments of, 489, 491, 496 Iliopsoas tendon^ 504 Iliopubic eminence, 248, 352, 486, 487 female, 354 Iliopubic tract, 259, 362, 363, 364 lliotibial tract, 485, 492, 494, 495, 502, 506, 507, 514, 515, 519, 520 bursa deep to, 506, 507 insertions of, 515 lateral patellar retinaculum and capsule and,508 Ilium arcuate line of, 356 articular surface of, 486 axial CT images of, 350 body of, 352, 486 gluteal surface of, 352 radiograph of, 355 anteroposterior radiograph of, 488 wing of, 248, 352, 358, 486 Incisive canal, 37, 38, 39, 43, 63 anastomosis in, 40 posterior septal branch of sphenopalatine and greater palatine arteries in, 41 Incisive fossa, 10, 14, 52, 56 Incisive papilla, 52 Incisor teeth, 56, 233 Incus, 89, 93, 96, 124 articular surface for, 93 body of, 93 lateral view of, 93 long limb of, 93 posterior ligament of, 94 short limb of, 93 superior ligament of, 94 Infant, mandible of, 15 Inferior anastomotic vein (of Labbe), 102, 145 Infraglenoid tubercle, 420, 421 Infrahyoid muscle, 29 action of, 29 fascia of, 28, 428 Infraorbital artery, 23, 36, 40, 81, 85 Infraorbital canal, 45 Infraorbital foramen, 12, 36 Infraorbital groove, 2 Infraorbital margin, 1 Infraorbital nerve (V2), 24, 36, 44, 81, 83, 121, 122 entering infraorbital canal, 45 internal nasal branches of, 122 superior alveolar branches of, 122 Infraorbital vein, 23, 70

Infrapatellar bursa deep, 511 subcutaneous, 511 Infrapatellar synovial fold, 507, 508 Infraspinatus fascia, 174, 177 Infraspinatus muscle, 152, 180, 244, 245, 424, 425, 427, 428, 432 fascia over, 174 insertion of, 421 origin of, 421 Infraspinatus tendon, 423, 425 infratemporal fossa, 4, 13 Infratrochiear nerve, 24, 36, 56, 81, 86, 122 from nasociliary nerve, 45 Infundibular nucleus, 147 Infundibular process, 147 capillary plexus of, 148 Infundibular recess, 108 Infundibular stem, 147 Infundibuium (Hartmann's pouch), 114, 140, 147, 294 body of, 114 fundus of, 114 neck of, 114 of uterine tube, 372 Inguinal canal, 260, 262 Inguinal falx, 250 conjoint tendon of, 250, 253, 259, 263 Inguinal foid, 389 Inguinal hernia indirect, 261 site of, 261 Inguinal ligament (Poupart's}, 247, 249, 250, 259, 263, 351, 356, 378, 380, 381, 407, 485, 492, 498, 500, 501, 544, 546 reflected, 250, 251, 259 Inguinal lymph nodes deep, 266, 406, 407, 408, 546 highest deep, 266, 408 horizontal, 266 inferior, 266 superficial, 266, 317, 406, 407, 408, 546 superficial inferior, 407 superolateral, 407 superomedial, 407 Inguinal region, 259 anterior view of, 259 posterior view of, 259 Inguinal ring deep, 251, 259, 261, 362, 363, 369, 386 site of, 274 superficial, 249, 259, 261, 386, 544 lateral and medial crus of, 259 Inguinal (Hesselbach's) triangle, 259 Insula, 105, 110, 141 central and circular sulci of, 105 limen of, 105, 141 short and long gyri of, 105 Inieralveolar septa, 15 Interarticular ligament, 187 Interarytenoid notch, 66 Interatrial septum, 220, 246 Intercalated lymph node, 73 Intercapitular vein, 468, 480 Intercarpal ligament, 455 Intercavenous sinus anterior, 103 superior, 103

Intercavernous septum, 382, 385 of deep fascia, 381 Interchondral joints, 186 Interclavicular ligament, 186, 419 Intercondylar area anterior, 513 posterior, 513 Intercondylar condyle, radiograph of, 510 Intercondylar eminence, 514 anteroposterior radiograph of, 510 Intercostal artery, 183, 192, 305 anterior, 192 first posterior, 33 lower, anastomosis with, 255 posterior, 171, 172, 188, 189, 230, 231 dorsal branch of, 172 lateral mammary and cutaneous branches of, 183, 192 second, 33 third right, 207, 237 supreme, 33, 136, 138 Intercostal lymph nodes, 266 Intercostal membrane external, 180, 189, 192, 258 internal, 180, 192, 230, 258 Intercostal muscle, 198, 243, 244, 245, 331 anterior cutaneous branch of, 180 external, 176, 188, 189, 192, 250, 258 external intercostal membranes anterior to, 189 innermost, 180, 192, 258 internal, 189, 192, 230, 231, 255, 258 lateral branch of, 188 medial branch of, 188 Intercostal nerve, 160, 170, 180, 189, 192, 331 abdominal portions of, 188 anterior, 258 anterior cutaneous branches of, 177, 188, 192, 257 collateral branch rejoining, 258 eighth, 209 first, 227, 430 lateral cutaneous branches of, 177, 188, 189, 192 lateral cutaneous branches to, 177, 188, 189, 257 posterior, 192, 230 seventh right, 321 sixth, 165, 209 third, 240 ventral ramus of, 180 Intercostal vein anterior, 256 left superior, 231 posterior, 230, 231 right superior, 230 Intercostal vessels, 331 Intercostobrachial muscle, 189 Intercostobrachial nerve, 189, 257, 429, 474, 479, 481 Intercrural fibers, 249, 259 Intercuneiform ligament, dorsal, 527 Interglobular space, 57 Intergluteal cleft, 152 Interlobar artery, 335, 337 lymph vessels along, 343 Interlobar lymph vessels, 208

Interlumborum cervicis muscle, 176 Intermaxillary suture, 36 Intermediate nerve, 104, 114, 118, 123, 124, 133, 135 Intermediolateral cell column, 346 Intermediolateral nucleus, 133, 134 Intermediolateral nucleus, preganglionic sympathetic cell bodies in, 132 Intermesenteric plexus, 267, 318, 322, 323, 324, 344, 345, 412 renal and upper ureteric branches from, 344 Intermetacarpal joint, 455 Intermuscular septum anterior, 522 anteromedial, 492, 500, 501 lateral, 430, 432, 435, 445, 448 of arm, 477 medial, 430, 432, 433, 445, 446, 447, 448 posterior, 522 transverse, 522 Intermuscular stroma, 326 Internal capsule, 108, 141 cleft for, 110 genu of, 110 retrolenticular part of, 110 Interosseous artery anterior, 434, 447 computed tomography of, 484 common, 434, 447, 448, 449 posterior, 434, 445, 448, 449 recurrent, 434, 445 termination of, 445 Interosseous intercarpal ligament, 455 Interosseous ligament, intercarpal, 455 Interosseous membrane, 439, 441, 443, 444, 454, 455, 511, 512, 517, 518, 520, 522, 525 Interosseous muscle, 528 deep tibial nerve to, 541 dorsal, 462, 465, 470, 476, 531, 536, 537 first, 445, 460, 465, 530 of foot, 536, 537 dorsal, 536 palmar, 465, 476 plantar, 535 plantar dorsal, 536 superficial tibial nerve branch to, 541 Interosseous nerve anterior, 448, 449, 475 of leg, 541 plantar, 537 posterior, 445, 449 Interosseous talocalcaneal ligament, 527 Interpectoral (Rotter's) lymph nodes, 184 Interpeduncular cistern, 109 Interphalangeal joint, 418 capsules and ligaments of, 528 Interphalangeal ligaments, 458 Iniersigmoid recess, 271, 340 Intersphincteric groove, 392, 393, 394 Interspinalis cervicis muscle, 176

Interspinous ligament lumbar, 176 lumbosacral, 177 Interspinous plane, 268 Intertendinous connection, hand, 470 Interthalamic adhesion, 106, 108, 110, 111, 146 Intertragic notch, 93 Interiransversarius muscle, lateral, 176 Intertransverse ligament, 187 Intertrochanteric crest, 487, 503 anteroposterior radiograph of, 488 Intertrochanteric line, 487, 489 Intertubercular plane, 268 Intertubercular tendon sheath, 423 Interureteric crest, 366 Interventricular foramen (of Monro), 106, 109, 111, 115, 145, 146 left, 108 Interventricular septum, 216, 220 muscular part of, 220, 223, 224, 225 Interventricular sulcus anterior, 246 posterior, 214, 215 Intervertebral disc, 19, 155. Intervertebral disc, 19, 155. See also specific vertebrae anulus fibrosis of, 155 lumbar, 157, 339 lumbosacral, 352 nucleus pulposus of, 155 sternal angle of, 245 Intervertebral disc space, 156 Intervertebral foramen, 19, 180 lower margin of, 154 lumbar, 155 radiograph of, 156 Intervertebral joint, 18 Intervertebral vein, 137, 173 Intestinal glands, 326 Intestinal lymphatic trunk, 316 Intestinal trunk, 266 Intestine, 167. See also Colon; Duodenum; Jejunum; Mesocolon circular muscle of, 326 intrinsic autonomic plexuses of, 326 large arteries of ; 307 innervation of, 324 lymph nodes vessels and nodes of, 317 mucosa and musculature of, 284 nerves of, 323, 324 schema of, 324 veins of, 311 longitudinal muscle of, 326 lumen of, 326 mesenteric relations of, 270, 271 mucosa of, 326 small, 126, 269, 322 area for, 329 arteries of, 306 innervation of, 324 lymph nodes of, 316 lymph vessels of, 316 mesentery of, 348 mucosa and musculature of, 280 nerves of, 322 schema of, 324

Intestine (Continued) small (Continued) veins of, 310 submucosa of, 326 Intraarticular ligament, 187 Intraculminate vein, 144 Intrahepatic biliary system, schema of, 292 Intralaminar nuclei, 111 Iniraparieial sulcus, 105 Intrapulmonary airway schema of, 204 Intrapulmonary blood circulation, 205 Infraspinatus tendon, 423 Intrinsic artery, of eye, 90 Intrinsic muscle action of, 79 of larynx, 78 of tongue, 128 Intrinsic nerve, pancreatic, 328 Intrinsic vein, of eye, 90 Iridocorneal angle, 87, 88, 90 trabecular meshwork and spaces of, 88 iris, 81, 87, 89, 90 arteries of, 91 folds of, 88 major arterial circle of, 88, 90, 91 minor arterial circle of, 88, 90, 91 veins of, 91 Irritant receptors, 210 Ischial spine, 248, 263, 411, 486, 487, 503 female, 354 radiograph of, 355 Ischial tuberosity, 248, 352, 353, 359, 378, 379, 381, 390, 395, 398, 486, 487, 502, 503 anteroposterior radiograph of, 488 female, 354 male, 354 radiograph of, 355 Ischioanal fossa, 366, 392 anterior recess of, 366, 370, 396 fat body of, 376, 380, 392 posterior communication between right and left, 396 posterior recess of, 396 preanal communication between right and left, 396 pus in, 396 roof of, 405 transverse fibrous septum of, 392, 394, 395 Ischiocavernous muscle, 360, 361, 370, 378, 379, 381, 382, 383, 391, 395, 404, 405 crus of, 366 Ischiococcygeus muscle, 263, 356, 357, 398, 402, 411, 412, 499 nerve to, 499 Ischiocondylar muscle, 540 Ischiofemoral ligament, 487 Ischiopubic ramus, 359, 361, 378, 379, 380, 382, 383, 384, 395 Ischium anteroposterior radiograph of, 488 body of, 486 radiograph of, 355 ramus of, 486

J Jaw. See also Mandible; Maxilla angle of, 1 closed, 16 slightly opened, 16 widely opened, 16 Jejunal artery, 306, 307 anastomotic loop of, 280 first, 302 plexus on, 3190 Jejunal vein, 311, 313 Jejunum, 269, 270, 271, 278, 279, 297, 298 barium radiograph of, 279, 280 circular muscle layer of, 280 cross section of, 297, 338 longitudinal muscle layer of, 280 lymphoid nodule of, 280 mucosa of, 280 musculature of, 280 submucosa of, 280 Jugular foramen, 103, 125, 126, 127 Jugular fossa, 8, 11 Jugular lymphatic trunk, 208 Jugular nerve, internal, 1,10 Jugular notch, 28, 181, 196 Jugular trunk, 72 left, 266 right, 266 Jugular vein anterior, 30, 74, 256 communication to, 70 termination of, 70 external, 23, 31, 74, 198, 206, 211, 256 internal, 23, 28, 29, 30, 31, 32, 34, 59, 74, 75, 76, 97, 128, 189, 198, 206, 211, 232, 256 inferior bulb of, 75 left, 137 right, 137 Jugulodigastric muscle, 73 Juguloomohyoid node, 73 Jugunra, 9

K Kerckring, valves of, 279, 280 Kidneys, 167, 179, 272, 278, 338 anterior surface of, 335 base pyramid of, 334 blood vessels in parenchyma of, 334, 337 blood vessels of, 332, 333, 347 cortex of, 334, 336, 337 cortical radiate arteries of, 335 fibrous capsule of, 334 hilum of, 334 inferior pole of, 334 in situ anterior views of, 329 posterior, 330 innervation of, 345 inner zone of, 336 interlobar arteries of, 335 lateral border of, 334 left, 98, 197, 273, 299, 329, 331, 340, 347 axial CT images of, 350 frontal section of, 329 superior pole of, 297

Kidneys (Continued) lymph vessels and nodes of, 343 major calices of, 334 medial border of, 334 medulla of, 334 minor calices of, 334 nerves of, 334 outer zone of, 336, 345 perforating radiate artery of, 335 posterior surface of, 335 prenatal, 229 renal column of, 334 renal cortex of, 338 renal papilla of, 334 retroperitoneal, 288 right, 197, 275, 298, 329, 330, 340, 342, 347 subscapular zone of, 336, 337 superior pole of, 272, 334 cross section of, 338 Knee anterior views of, 507, 508 anteroposterior radiograph of, 510 arteries of, 507 articular cavity of, 511 attachment of, 511 collateral ligaments of, 509 cruciate ligaments of, 509 in extension of, 507 in flexion, 509, 543 interior of, 508 joint capsule of, 506, 508, 519 lateral view of, 506 ligaments of, 508, 509 medial view of, 506 posterior view of, 511 right in extension, 507, 509 in flexion, 509 sagittal view of, 511 slightly in flexion, 507 Kohn, pores of, 204

L L4-5 disc herniation, 162 L5-S1 disc herniation, 162 L2 ganglion, 412 L1 spinal nerve, 160 ventral ramus of, 177 L1-3 spinal nerves, dorsal rami of, 254 L5 spinal nerve, 160, 412 anterior ramus of, 410 L1 vertebra, 153, 160 body of, 273 inferior articular process of, 156 spinous process of, 179 superior articular process of, 156 transverse process of, 338 L2 vertebra body of, 179 superior view of, 155 L3 vertebra body of, 156, 336, 337 pedicle of, 156 posterior view of, 155 spinous process of, 156 transverse proccss of, 156

L4 vertebra body of, 352 inferior vertebral notch of, 156 lamina of, 156 posterior view of, 155 spinous process of, 156 L5 vertebra, 153, 160 body of, 352 superior vertebral notch of, 156 Labbe vein. See Inferior anastomotic vein (of Labbe) Labial artery inferior, 69 posterior, 404 superior, 69 Labial nerve, posterior, 413, 414 Labial vein inferior, 70 superior, 70 Labioscrotal swelling, 388 Labium majus, 360, 365, 388 Labium minus, 360, 365, 388 Labyrinth bony, 95, 96 common limbs of, 95 right, 95 schema of, 96 superior projection of, right, 97 common membranous limb of, 95 membranous, 95, 96 right, 95 schema of, 96 orientation of in skull, 97 Labyrinthine artery, 140, 141, 143 internal, 143 left, 136 Lacrimal apparatus, 82 Lacrimal artery, 85 recurrent meningeal branch of, 100 Lacrimal bone, 2, 4, 6, 12, 38 at birth, 46 Lacrimal canaliculi, 82 Lacrimal caruncle, 81, 82 Lacrimal gland, 83, 85, 86, 133, 166, 167, 168 excretory ducts of, 82 orbital part of, 82 palpebral part of, 82 Lacrimal lake, 81, 82 Lacrimal nerve, 83, 86, 121, 122, 131 cutaneous branch of, 45 palpebral branch of, 82 Lacrimal papilla inferior, 81, 82 superior, 81, 82 Lacrimal sac, 81, 82 fossa for, 2, 4 Lactiferous duct, 182 Lactiferous sinus, 182 Lacuna lateral (venous), 99, 100 magna, 385 Lacunar ligament (Gimbernat's), 250, 251, 259, 263, 546 Laimer, area of- See V-shaped area (of Laimer), 234, 235 Lambda, 7 Lamina, lumbar, 155 Lamina affixa, 111 Lamina cribrosa, 87 Lamina terminalis, 106, 107, 147

Langerhans, islets of, 298 Laryngeal vein, superior, 235 Laryngeal artery recurrent right, 126 superior, 34, 69, 74, 75, 136 Laryngeal inlet, 63, 66, 235 Laryngeal nerve (X) external branch to, 74 inferior anomalous right, 80 anterior and posterior branches of, 80 left, 80 internal branch of, 75, 235 left, anterior and posterior branches of,

80

recurrent, 33, 71, 76, 130, 206, 209, 210, 211, 212, 226, 231, 232, 240 left, 74, 75, 76, 126, 193, 210, 211, 243, 244 right, 74, 75, 80, 226, 235, 240 superior, 75, 76, 80, 130, 131, 235 external branch of, 75, 80, 126 fold over internal branch of, 66 foramen for internal branch of, 78 internal branches of, 62, 65, 71, 74, 75, 76, 78, 80, 126 Laryngeal prominence, 77 Laryngopharyngeal sympathetic branch, 130 Laryngopharynx, 63 opened posterior view of, 66 Larynx, 135, 167, 168, 210 cartilage of, 77 innervation of, 168 intrinsic muscles of, 78 action of, 79 lateral dissection of, 78 median view of, 77 nerves of, 80 posterior view of, 77, 78 right lateral view of, 77, 78 sensory branches to, 80 superior view of, 80 Lateral aperture (foramen of Luschka), 109 Lateral funiculus, 115 Lateral rectus muscle, 84 Lateral rectus plane, 286 left, 268 right, 268 Lateral sulcus, 107 anterior, ascending, and posterior rami of, 105 Latissimus dorsa tendon, 244, 245 left, 244 Latissimus dorsi muscle, 152, 174, 177, 179, 180, 181, 188, 246, 249, 250, 258, 293, 424, 428, 433 costal origin of, digitations of, 254 fascia of, 428 insertion of, 420 small slip of origin of, 421 Leg anterior fascial compartment of, 522 anterior intermuscular septum of, 522 cross section of, 522 deep fascia of, 522, 544, 546 posterior compartment, 522 fascial compartments of, 522 lateral, 522 superior posterior, 522

Leg (Continued) innervation of, 538, 539 interosseous membrane, 522 interosseous nerve of, 541 medial cutaneous nerves of, 538 muscles of anterior view of, 519, 520 attachments of, 515 deep dissection of, 518, 520 lateral view of, 521 posterior view of, 516, 517 superficial dissection of, 516 posterior intermuscular septum of, 522 right, bones of, 513 surface anatomy of, 485 transverse intermuscular septum of, 522 Lens, 81, 88, 90 axial MR image of, 150 axis of, 88, 89 capsule of, 87, 88 cortex of, 87, 88 equator of, 87, 88 nucleus of, 88, 89 supporting structures of, 88, 89 suspensory ligament of, 87, 88 Lenticulostriate artery, 140, 141, 143 anterolateral central, 139 Lentiform nucleus, 108, 141 globus pallidus of, 110 putamen of, 110 thalamus and, 110 Lepiomeninges, 170 Lesser sac,331 Levator anguli oris muscle, 54, 123 Levator ani muscle, 263, 284, 312, 367, 376, 411, 499 fibers to anal canal longitudinal muscle from, 358 fibromuscular extensions of, 359 left, 356 levator plate of, 356, 357 medial border of, 359 nerves to, 267, 499 pelvic, 360 prerectal muscles from, 359 puborectalis part of, 391 tendinous arch of, 263, 356, 357, 358, 359, 364, 365, 370, 379, 392 Levator costae muscle, 176 Levatores costarum muscle brevis, 176 longus, 176 Levator labii superioris alaeque nasi muscle, 26, 54, 123 Levator labii superioris muscle, 26, 54, 123 Levator palpebrae superioris muscle, 81, 83, 84, 86, 121 coronal CT images of, 151 fascial sheath of, 83 insertion of, 81 Levator scapulae muscle, 27, 32, 174, 177, 189, 424, 427, 477 insertion of, 421 nerves to, 129 Levator veli palatini muscle, 47, 51, 55, 64, 65, 67, 68, 93, 126 interdigitaging fibers of, 52 Lieberkuhn, crypts of, 283 Lienogastric trunk, 302 Lienomesenteric trunk, 302

Ligamenta flava, 21 Ligaments. See also specific ligaments of abdominal wall and viscera, 348 of ankle, 527 of elbow, 438 of foot, plantar view of, 528 of knee, 508, 509 pelvic, 352-353, 372 of wrist, 454, 455 Ligamentum arteriosum, 206, 212, 221, 229, 231 node of, 208 prenatal, 229 Ligamentum flavum, in lumbar puncture, 162 Ligamentum nuchae, 21, 152 Ligamentum teres, 229, 288, 349 fissure for, 287 prenatal, 229 Ligamentum venosum, 229 fissure for, 287 prenatal, 229 Light, cone of, 93 Limen, of insula, 141 Limen nasi, 37 Linea alba, 181, 188, 247, 249, 250, 258, 259, 331 axial CT images of, 350 Linea aspera, 489 Linea terminalis, 157, 353, 364, 370 Lingual artery, 23, 32, 34, 59, 60, 69, 75, 133, 136, 138 deep, 51, 59 dorsal, 59 tonsillar branch of, 64 Lingual glands (serous glands of von Ebner), 58 Lingual gyrus, 106 Lingual nerve, 23, 40, 53, 55, 59, 60, 122, 123, 131, 133, 134, 135 deep, 51 Lingual tonsil, 58, 63, 64 Lingual vein common trunk for, 59 deep, 59, 70 dorsal, 59 Lingula, 15, 113, 115, 144, 199 bronchi to, 202 Lip frenulum of, 51 lower, 51 philtrum of, 51 tubercle of, superior, 1 upper, 51 Lister's tubercle. See Dorsal tubercle of radius (Lister's) Liver, 126, 196, 197, 272, 278, 293, 294, 297, 331, 339, 342, 347 anatomic lobes of, 289 anterior view of, 287 area for, 329 arterial variations and collateral supply of, 305 arteries of, 300, 301 bare area of, 329, 342 bed of, 287 caudate lobe of, 272, 288 central veins of, 290 coronary ligament of, 274 cross section of, 297, 338 distributing vein of, 291

Liver (Continued) duct distribution in, 289 falciform ligament of, 255 fibrous appendix of, 287 functional surgical segments of, 289 inferior border of, 268, 275 in situ, 288 inlet venula of, 291 innervation of, 168, 326 intrahepatic vascular and duct systems of, 290 intralobular arteriole of, 291 left lobe of, 269, 275, 288 left triangular ligament of, 274 ligaments of, 287, 312 lobes of, 289 low-power section of, 292 lymph pathways to, 184 normal lobular pattern of, 290 papillary process of, 287 parietal surface of, 289 periportal arteriole of, 291 perivascular fibrous capsule of, 290 portal arteriole of, 291 posterior lateral segment of, 289 posterior view of, 287 prenatal, 229 quadrate lobe of, 275 right lobe of, 269, 275, 288 axial CT images of, 350 round ligament of, 229, 256, 275, 349 segments of, 289 structure of, 29 sublobular lobes of, 290 surfaces of, 287 topography of, 286 variations in form of, 288 vascular system of, 290 veins of, 291 visceral peritoneum of, 331 visceral surface of, 287, 289 Liver plate cells, 290 Lobule (ear), 1 Locus ceruleus, 115 Longissimus capitis muscle, 175, 178 Longissimus cervicis muscle, 175 Longissimus erector spinae muscle, 349 Longissimus muscle, 175, 331 Longissimus thoracic muscle, 175 Longitudinal esophageal muscle, cricoid attachment of, 65, 67 Longitudinal intramuscular plexus, 326 Longitudinal ligament anterior, 63, 65, 179, 187, 263, 331, 348, 349, 353, 362, 363 posterior, 22 Longitudinal muscle conjoined, 392, 394 conjoined rectal, 393 of intestine, 326 rectal, 393 of tongue inferior, 60 superior, 60 Longus capitis muscle, 27, 30 nerves to, 129 Longus colli muscle, 30 Loops of Heiss, 367

Lower limb- See also Leg arteries of, 500-502, 504 cutaneous innervation of, 487-489 dermatomes of, 543 lymph nodes and vessels of, 546 muscles of, 490-503 neurovasculature of, 538-546 segmental innervation of movements of, 543 superficial nerves and veins of, 544 anterior view of, 545 posterior view of, 545 surface anatomy of, 485 Lumbar artery? 171 fifth, 264 lower, anastomosis with, 255 right, 264 Lumbar curvature, 153 Lumbar disc herniation, 162 characteristic posture in, 161 clinical manifestations of, 161 left-sided lower, 161 level of and clinical features of, 161 surgical exposure of, 161 Lumbar disc protrusion, 161 Lumbar enlargement, 161 Lumbar ganglion, 167, 318 Lumbar lymphatic trunk to cisterna chyli and thoracic duct, 343 right and left, 316 Lumbar lymphatic trunk ganglion lower, 228 upper, 228 Lumbar lymph nodes, 266 Lumbar nerve, 161 Lumbar nucleus puiposus, herniated, 161 Lumbar plexus, 160, 496, 498, 538, 539 muscular branches from, 267 Lumbar puncture, 162 Lumbar region, 268 Lumbar spinal nerve, 161, 179 dorsal and ventrai roots of, 170 dorsal rami of, 177 origin of, 170 Lumbar triangle (of Petit), 152, 254 internal oblique muscle in, 174 Lumbar trunk ascending, 195, 263, 265, 332 left, 266 right, 266 Lumbar vein, ascending, 332 Lumbar vertebra anterior view of, 171 arteries of, 171 assembled, 153 body of, 153 cross section through, 170 dura mater of, 162 foramen of, 155 inferior articular process of, 155 inferior vertebral notch of, 155 intervertebral disc of, 155 lamina disc of, 155 left lateral view of, 155 mammillary process of, 155 muscles of, 179 pedicle, sectioned of, 179 posterior view of, 153 radiographs of, 156 spinous process of, 155

Lumbar vertebra (Continued) superior articular process of, 155 superior vertebral notch of, 155 superior view of, 155 transverse processes of, 248 transverse process of, 248 Lumbocostal ligament, 330 Lumbocostal triangle, 195 Lumborum muscle, interspinalis, 176 Lumbosacral articular surface, 157 Lumbosacral fascial sheath, 462 Lumbosacral trunk, 267, 496, 498, 499, 538, 539 Lumbosacral vertebrae inferior articular process of, 159 invertebral foramen of, 159 lamina of, 159 ligaments of, 159 ligamenturn flavum of, 159 pedicle of, 159 spinous process of, 159 superior articular process of, 159 transverse process of, 159 Lumbrical fascial sheath, 460 Lumbrical muscle, 465, 533, 534, 536 deep tibial nerve branch to, 541 in fascial sheaths, 460 first, 541 fourth, 460 in fascial sheath, 460 innervation of, 465, 541 schema of, 463 second, 460, 541 in fascial sheath, 460 tendons of, 535 third, 460 in fascial sheath, 460 third and fourth, 476, 541 Lumen, 326 Lunate, 376, 456, 487 anterior (palmar) view of, 452 area for, 439 . coronal section of, 455 posterior (dorsal) view of, 452 radiograph of, 457 Lunate sulcus, 105 Lungs, 167, 168, 170, 342 anterior border of, 196 anterior view of, 200 apex of, 196, 197 area for esophagus in, 196 area for trachea in, 196 bronchopulmonary segments of, 200, 201 cardiac impression of, 196 cardiac notch of, 196, 198 diaphragmatic surface of, 196 great vessels of, 206 groove for esophagus in, 196 hilum of, 196 horizontal fissure of, 196, 197, 198 inferior border of, 196 inferior iobe of, 198, 200 medial view of, 199 in situ, anterior view of, 198 left, 197, 211, 215, 243, 245 bronchopulmonary segments of, 200, 201 inferior lobe of, 201, 293 medial view of, 199

Lunate (Continued) oblique fissure of, 244 superior lobe of, 201, 242 left medial, 198 lingula of superior lobe of, 198 lobes of, 198 lymph nodes of, 208 lymph vessels and nodes of, 208 lymph vessels of, 208 medial view of, 198, 199 middle lobe of, 198, 200 oblique fissure of, 196, 197 right, 193, 196, 197, 198, 211, 243, 244, 245 bronchopulmonary segments of, 200, 201 inferior lobe of, 201, 293 medial view of, 199 middle lobe of, 201 superior lobe of, 201 root of, 193 spinal nerves to, 170 superior lobe of, 198, 200, 242 topography of anterior view of, 196 posterior view of, 197 Lunotriquetral ligament, 454 Lunula, 223 Luschka, foramen of, 19, 108, 109 Lymphatic drainage, from prostate gland, 408 Lymphatic duct, 208 Lymphatic pathway, hand, 468 Lymphatics apical collecting vessels, 73 basal collecting vessels, 73 central collecting vessels, 73 marginal collecting vessels, 73 Lymphatic trunk, 316 Lymph follicle, 58 of stomach, 276 Lymph nodes aortic, lateral, 266, 343, 406 axillary, 428 central, 428 pectoral (anterior), 428 bronchopulmonary, 199, 208, 230, 231 buccinator, 72 celiac, 266, 314, 315 cervical, 72, 73, 208 anterior deep, 72 anterior superficial, 72 deep lateral, 73 inferior deep, 72, 208 inferior deep lateral, 72 posterior lateral superficial, 72 superior deep lateral, 72 superior lateral superior, 72 transverse chain of, 72 colic, 317 of female pelvis and genitalia, 406 of female perineum, 407 gastro-omental, 314 of head and neck, 72 hepatic, 314 inguinal, 266 interpectoral, 184 of kidneys and urinary bladder, 343 of large intestine, 317 of lower limb, 546 of lung, 208

Lymph nodes (Continued) of male pelvis and genitalia, 408 of mammary gland, 184 mediastinal, 243 pancreatic, 315 pancreaticoduodenal, 315 paracolic, 317 * of pelvis and genitalia, 408 perianal, 317 of pharynx and tongue, 73 phrenic, 184, 266 of posterior abdominal wall, 266 pretracheal, 74 rectal, 317 sigmoid, 317 sinuatrial, 225 of small intestine, 316 splenic, 314 of stomach, 314 subclavian, 184 submandibular, 60, 73 submental, 73 subpyloric, 314 superior tracheobronchial, 244 suprapyloric, 314 tracheobronchial inferior, 245 of upper limb, 483 visceral, 266 Lymphoid nodule aggregate, 283 of ileum, 280 of jejunum, 280 Lymph vessels drainage routes of, 204 of female perineum, 407 of head and neck, 72 of kidneys and urinary bladder, 343 of large intestine, 317 of liver, 291 of lower limb, 546 of lung, 208 of male pelvis and genitalia, 408 of mammary gland, 184 of pelvis and genitalia, 408 of posterior abdominal wall, 266 of small intestine, 316 of stomach, 314 of trachea, 202 of upper limb, 483

M Macula, 90 fovea centralis in, 90 Macular arteriole inferior, 90 superior, 90 Macular zone, 120 Magendie, foramen of, 108 Magnetic resonance imaging (MRI) of head, 149, 150 pelvic, 397 Mallear fold anterior, 93 posterior, 93 Malleolar artery anterior lateral, 530 anterior medial, 530

Malleolus, 92 arterial network of, 520 lateral, 485, 513, 514, 520, 521, 530, 531 articular facet of, 513, 514 radiograph of, 54 medial, 485, 513, 514, 517, 518, 519, 530, 531 articular facets of, 514 radiograph of, 54 Malleus, 96 anterior process of, 93 handle of, 93 head of, 92, 93, 124 lateral process of, 93 lateral view of, 93 neck of. 93 superior ligament of, 93 Malpighian corpuscle, 336 Mammary gland anterolateral dissection of, 182 arteries of, 183 lobules of, 182 lymph vessels and nodes of, 184 sagittal section of, 182 subcutaneous tissue layer of, 182 suspensory ligaments of, 182 Mammillary body, 106, 107, 112, 114, 147 Mammillary process, lumbar, 155 Mammillothalamic fasciculus, 106 Mammillothalamac tract, 147 Mandible, 15 of adult anterolateral superior view of, 15 left posterior view of, 15 of aged persons, 15 alveolar part of, 15 angle of, 15 base of, 15 body of, 15, 27 condylar process of, 15 coronoid process of, 15 temporalis muscle insertion to, 54 head of, 15 of infant, 15 lingula of, 15 mental protuberance of, 15 mental spines of, 15 mental tubercle of, 15 neck of, 15 oblique line of, 15 pterygoid fovea of, 15 ramus of, 15, 25, 27 Mandibular canal, 60 Mandibular foramen, 15 inferior alveolar nerve entering, 46 Mandibular fossa, 4, 8, 12, 16 Mandibular lymph node, 72 Mandibular nerve (V3), 11, 24, 46, 86, 122, 125, 131, 133, 134, 135 anterior division of, 46 lateral view of, 46 marginal, 25, 31 medial view of, 46 meningeal branch of, 10, 86 motor root of, 46 posterior division of, 46 sensory root of, 46 Mandibular notch, 15 Manubriosternal joint, 186 Manubriosternal junction, 245

Manubriostemal synchondrosis, 419 Manubrium, 186, 198, 243, 244, 419 Marginal artery, 307, 323 of large intestine, 307 left, 216 Marginal plexus, 323 Marginal sulcus, 106 Marshall, ligament of, 221 Masseteric artery, 40, 54, 55 Masseteric nerve, 40, 54, 55, 122 Masseter muscle, 25, 27, 28, 47, 60, 61 axial CT image of, 150 axial MR image of, 150 deep part of, 54 insertion of, 54 superficial part of, 54 Mastication, muscles of, 54, 55 Mastoid angle, 9 Mastoid antrum, 94 Mastoid canaliculus, 10 Mastoid cells, 94 Mastoid emissary vein, 10, 137 Mastoid foramen, 10 Mastoid process, 14, 25, 27, 28, 29, 30, 34, 53, 59, 176 Maxilla, 2, 6, 38 alveolar process of, 2, 4, 6, 13, 38, 48 anterior nasal spine of, 2, 4, 6, 36, 38 at birth, 50 frontal process of, 2, 4, 36, 38, 81 incisive canal of, 6, 38, 40 incisive fossa of, 8 infraorbital foramen of, 2, 4, 12 infratemporal surface of, 4 maxillary sinus in, 50 medial palatine suture of, 8 nasal spine of, anterior, 36 nasal surface of, 6 orbital surface of, 2 palatine process of, 5, 6, 8, 14, 37, 38, 52, 56 tuberosity of, 4, 14 zygomatic process of, 2, 8 Maxillary artery, 16, 34, 40, 54, 71, 100, 131, 134 branches of, 40 Maxillary bone, 47 Maxillary nerve (V2), 45, 86, 121, 122, 131, 133, 134, 135 dental and gingival branches of, 45 meningeal branch of, 86, 122 nasal branch of, 122 pharyngeal branch of, 122 posterior superior lateral nasal branch of, 42, 43 Maxillary plexus, 131 Maxillary sinus, 3, 5, 44, 47, 48, 49 alveolar recess of, 48 axial MR image of, 150 coronal CT images of, 151 growth of, 50 infraorbital recess of, 48 mucous membrane of, 45 with opening into semilunar hiatus, 50 openings of, 37, 38, 48, 49, 50 postganglionic fibers to vessels and glands of, 44 sagittal MR image of, 149 zygomatic recess of, 48 Maxillary vein, 85 McBurney's point, 283

Medial rectus muscle, 83 Median aperture (foramen of Magendie), 109 Median nerve, 429, 433, 446, 447, 454, 460, 465, 474, 475 anterior interosseous part of, 476 anterior view of, 475 articular branch of, 475 branches to thenar and lumbrical muscles, 465 in carpal tunnel, 461 common palmar digital branches of, 460 communicating branch with ulnar nerve, 476 communicating with ulnar nerve, 475 to cutaneous innervation, 475 palmar branch of, 446, 447, 475, 481 palmar digital branches of, 473, 481 palmar view of, 475 posterior view of, 475 proper palmar digital branches of, 469 recurrent branch of, 474 to thenar muscles, 460 Median sulcus, dorsal, 115 Mediastinal lymph nodes, 184 anterior, pathway to, 184 posterior, 266 Mediastinum anterior lung area for, 194 cross section of, 241 fat pad in, 231 left lateral view of, 231 right lateral view of, 230 superior, great vessels of, 206 Medulla oblongata, 11, 106, 124, 134, 135, 168, 324, 345 axial MR image of, 150 cross section of, 124 lower part of, 135 nuclear layer of, 113 sagittal MR image of, 149 Medullary artery anterior segmental, 171, 172 posterior segmental, 171 Medullary lamina external, 111 internal, 111 Medullary (renal) lymph vessels, 343 Medullary vein anteromedian, 144 anterior segmental, 173 anteromedian, 144 posterior, 173 Medullary velum inferior, 106, 113 superior, 106, 113, 114, 115 Meibomian glands, 81 Meissner's plexus. See Submucous (Meissner's) plexus Membranous ampulla anterior, 95 lateral, 95 posterior, 95 Membranous septum atrioventricular part of, 222, 223, 225 interventricular part of, 223, 225 Meningeal artery, 99, 100 accessory, 11, 40, 100 anterior, 85 left middle, 136

Meningeal artery (Continued) middle, 40, 55, 99, 100, 102, 131, 138 posterior, 11 Meningeal nerve, 45 Meningeal plexus, middle, 131 Meningeal vein, middle, 102 Meningeal vessel grooves anterior, 9 middle, 6, 7, 9 posterior, 9 Meningeal vessels, middle, 10 Meninges, 10,136 arteries of, 99, 136 innervation of, 325 spinal, 102, 324, 325 superficial veins of, 102 veins of, 99 Meningohypophyseal trunk, 100 Meniscofemoral ligament, posterior, 508, 509 Meniscus, 455 lateral, 507, 508, 509, 511 horns of, 508 medial, 507, 508, 509 horns of, 508 Mental foramen, 2, 4, 15 Mentalis muscle, 26, 54, 123 Mental nerve, 24, 46, 71, 122 Mental protuberance, 1 Mesencephalic vein lateral, 144 posterior, 144, 146 Mesenteric artery inferior, 270, 278, 307, 308, 318, 323, 329, 332, 340, 341 superior, 179, 270, 281, 298, 301, 305, 306, 307, 308, 319, 321, 322, 328, 332, 339, 340, 342 common origin of, 302 relations of, 310 in root of mesentery, 270 Mesenteric ganglion, 126 inferior, 165, 167, 318, 323, 409 superior, 165, 167, 168, 267, 298, 318, 320, 322, 323, 324, 325, 328, 344, 345, 346, 409 Mesenteric lymph nodes, 315 inferior, 266, 317 superior, 266, 314, 317, 321 Mesentericoparietal recess, 179, 270, 271 Mesenteric plexus inferior, 165, 318, 323 superior, 165, 166, 318, 319, 320, 322, 328 Mesenteric vein inferior, 270, 298, 311, 312, 313, 315 superior, 179, 279, 306, 311, 312, 313, 338, 339, 342 cross section of, 338 relations of, 310 Mesenteric vessels, superior, 278, 349 Mesentery of ileum, 280 of jejunum, 280 peritoneal layers of, 326 root of, 270, 274, 278, 296, 298, 310, 340, 362, 363 superior mesenteric vein and, 310 of small intestine, 349

Mesoappendix, 281, 283, 322 Mesocolic taenia, 281, 282, 284 Mesocolon sigmoid, 271, 284, 307, 329, 340 attachment of, 274 transverse, 269, 270, 271, 272, 273, 278, 284, 307 attachment of, 298, 299 Mesometrium, 371 Mesonephric (wolffian) duct, 389 Mesonephric tubule vestigial, 390 Mesosalpinx, 369 laminae of, 372 Mesoihelial septum, 169 Mesovarium, 370 laminae of, 372 Metacarpal artery dorsal, 469, 530 palmar, 465 Metacarpal bone, 456 anterior (palmar) view of, 452 base of, 456 fifth, 444 base of, radiograph of, 457 head of, 456 posterior (dorsal) view of, 452 second, 445 shaft of, 456 third, 456 Metacarpal ligament deep transverse, 465 dorsal, 455 palmar, 465 superficial transverse, 480 Metacarpal vein, dorsal, 468 Metacarpophalangeal (MP) joint, 458 Metacarpophalangeal (MP) ligament, 458 Metaphyseal arcuate ligament, 455 Metaphysis, nutrient arterial branch to, 471 Metatarsal artery dorsal, 530, 535, 536 anterior perforating branches of, 535 posterior perforating branches of, 535 plantar, 535, 536 anterior perforating branches of, 535 Metatarsal bone, 523, 524, 536 base of, 523 fifth, 523 tuberosity of, 523, 530, 535, 536, 537 first, 523, 524, 537 fourth, 523 head of, 523 plantar view of, 523 second,523 shaft of, 523 third, 523 tuberosity of, 523, 524, 537 Metatarsal ligament deep transverse, 536 dorsal, 536 plantar, 528, 536 superficial transverse, 532 Metatarsal vein, dorsal, 544 Midbrain axial MR image of, 150 sagittal MR image of, 149

Midclavicular line left, 268 right, 268 Midline groove, 58 Midpalmar space, 460, 462 Minute arteries, of finger, 471 Mitral cell, 119 Mitral valve, 213, 225 anatomy of, 223 anterior cusp of, 222, 223, 224 commissural cusps of, 222 fibrous ring of, 222 leaflet of, 246 left fibrous ring of, 222 posterior cusp of, 222, 223, 224 Molar teeth first, 56 growth of, 50 second, 56 third, 56 Monro, foramen of- See Interventricular foramen (of Monro) Morgagni, hydatid of. See Vesicular appendix (hydalid of Margagni) Morison's pouch. See Hepatorenal recess (Morison's pouch) Mouth afferent innervation of, 62 floor of, 53 nerves of, 62 roof of, 52 anterior view of, 52 posterior view of, 52 Mucosa, intestinal, 279, 280 Mucous cell, stomach, 276 Mullerian duct. See Paramesonephric (mullerian) duct Multifidus muscle, 176 Muscles. See also specific muscles anorectal, 394 of arm anterior view of, 430 posterior view of, 432 of back, 174, 175, 176 deep layers of, 176 intermediate layers of, 175 superficial layers of, 174 of dorsum of foot, 530 of duodenum, 279 of esophagus, 234 extrinsic eye, 84 of face, 123 of facial expression, 26, 60 of foot, 536 of forearm, 440, 441, 446, 447, 448 of hand, 465 of hip and thigh, 492-493 lateral view of, 494 posterior view of, 495 innervated by femoral nerve, 538 innervated by obturator nerve, 540 of large intestine, 284 of larynx, 78 of leg anterior view of, 520 attachments of, 515 deep dissection of, 516, 520 posterior view of, 518 intermediate dissection of, 517 lateral view of, 521 posterior view of, 517

Muscles (Continued) superficial dissection of anterior view of, 518, 519 posterior view of, 516 of lower limb, 485 of mastication, 54, 55 of neck anterior view of, 28 lateral view of, 27 of pharynx, 65, 67, 68 lateral view of, 68 of rotator cuff, 425 of shoulder, 424 of small intestine, 280 of sole of foot first muscle layer of, 533 second muscle layer of, 534 third muscle layer of, 535 of stomach, 277 of thigh, 492-495 of tongue, 59, 60 of vermiform appendix, 283 Muscular artery, 90, 91 Muscularis mucosae, 276 of anal canal and rectum, 394 Muscular vein, 90 Musculocutaneous nerve, 429, 430, 433, 435, 447, 449, 474, 475, 480 terminal part of, 446, 469, 479, 482 Musculophrenic artery, 189, 198, 21 i, 215 Musculophrenic vein, 189, 256 Myelencephalon, 423. See also Medulla oblongata Myenteric (Auerbach's) plexus, 326 Mylohyoid groove, 15 Mylohyoid line, 15 Mylohyoid muscle, 27, 28, 29, 31, 32, 34, 53, 59, 60 median raphe between, 53 nerve to, 55, 60 Mylohyoid nerve, 16, 40, 46, 53, 122 Myometrium, 371

N Nail bed, 471 Nail matrix, 471 Nail root, 471 Nares anterior, 1 posterior, 14 Nasal artery dorsal, 23, 36, 40, 81, 85 external, 36 lateral, 36 Nasal bone, 1, 2, 4, 6, 12, 36, 38, 39 at birth, 50 Nasal cavity, 82, 83 arteries of, 41 autonomic innervation of, 44 bones of, at birth, 50 floor of, 37 growth of, 50 lateral wall of, 37, 38 medial wall of, 39 nerves of, 42-44 postganglionic fibers to vessels and glands of, 44 speculum view of, 37 Nasal cleft. See Intergluteal cleft

Nasal concha axial MR image of, 150 highest, 38 inferior, 37, 38, 82 coronal CT images of, 151 ethmoidal process of, 38 growth of, 50 sagittal MR image of, 149 middle, 2, 6, 37, 38, 48, 50, 82 growth of, 50 superior, 6, 37, 38 lower border of, 50 Nasalis muscle, 123 alar part of, 26, 76 transverse part of, 26, 36 Nasal meatus atrium of middle, 37 inferior, 37, 82 opening into, 50 middle, 37 atrium of, 37 opening into, 49 superior, 37, 50 Nasal nerve external, 36 inferior lateral, 131 posterior, 131, 133 posterior superior, 131 Nasal retinal arteriole inferior, 90 superior, 90 Nasal retinal venule inferior, 90 superior, 90 Nasal septum, 39, 41, 42, 47, 48, 63, 66 axial MR image of, 150 cartilage of, lateral process of, 38 coronal CT images of, 151 growth of, 48 Nasal slit, 11 Nasal spine anterior, 39 posterior, 39 Nasal vein dorsal, 23 external, 70 Nasal vestibule, 37, 39 Nasociliary nerve (V t ), 83, 86, 121, 122, 131, 132 infratrochlear nerve from, 45 Nasofrontal vein, 23, 85 Nasolabial lymph n c i e , 72 Nasolabial sulcus, 1 Nasolacrimal canal, opening of, 38 Nasolacrimal duct, 82 in nasooptic furrow, 50 opening of, 37, 82 Nasolacrimal foramen, at birth, 50 Nasooptic furrow, 50 Nasopalatine nerve (V 2 ), 10, 42, 43, 44, 62 communicating with greater palatine nerve, 42 passing to septum, 43 Nasopharynx, 92 airway to, 37 sagittal MR image of, 149 Navicular bone, 536, 537 plantar view of, 523 tuberosity of, 523, 524, 536 Navicular fossa, 361, 385

Neck arteries of, 33, 34, 39, 504 autonomic nerves in, 130 bony framework of, 13 cervical plexus in, 32 cutaneous nerves of, 24 fascial layers of, 28, 35 lymph nodes and vessels of, 72 muscles of, 27 anterior view of, 28 lateral view of, 27 nerves of, 24, 31, 71, 130 posterior triangle of, 174, 188 superficial veins and cutaneous nerves of, 23, 24, 31 surface anatomy of, 1 Nephron Henle's loop of, 337 schema of, 336 Nerves. See also specific nerves abdominal, 258 of abdominal wall, 267 of back, 177 to blood vessels, 228 cochlear fibers of, 96 cutaneous of arm and shoulder, 479 of forearm, 480 of head and neck, 224 of upper limb, 479, 481 of wrist and hand, 473 of esophagus, 240 of external genitalia, 409 of female pelvic viscera, 412 of female perineum and external genitalia, 413 of female reproductive organs, 415 of fingers, 471 of forearm, 480 of hand, 472 palmar view of, 466 of heart, 226, 227 of hip and buttock, 503 of kidneys and ureters, 344, 345 of large intestine, 323, 324 of larynx, 80 of liver and biliary tract, 327 of lower limb, 544, 545 of male external genitalia, 409 of male pelvic viscera, 410 of male perineum, 411 of mouth, 62 of nasal cavity, 42-44 of neck, 130 of pancreas, 328 of shoulder, 477 of small intestine, 322, 324 of spinal cord and vertebral column, 173 of stomach and duodenum, 319, 320 of suprarenal glands, 345, 346 of thigh, 500, 501, 540 of tracheobronchial tree, 210 of upper limb, 473 of urinary bladder, 344 of wrist, 461, 472 Neuroendocrine G cell, 276 Neurohypophysis, 140, 147, 148 Neuropathways, in parturition, 415 Neurovasculature of arm, 435 of lower limb, 538-546

Newborn, skull of, 12 Nipple, 181, 182 left, 196 right, 196 Nodose ganglion, 135 Nodule cerebellar, 144 inferior vermis, 113 Nose. See also Nasal cavity ala of, 1 anterolateral view of, 36 cross section of, 47 inferior view of, 36 lateral crus of, 36 medial crus of, 36 surface anatomy of, 1 Nostril, 1 Nuchal line inferior, 14 of skull, 174, 175, 176 Nucleus ambiguus, 117, 126 Nucleus pulposus, 155, 162 lumbar, 19 Nutrient artery, femoral, 504, 513 Nutrient foramen, 489, 513 0 Obex, 115 Oblique aponeurosis, 261 external, 250, 251, 260, 261, 349 internal, 253, 257 Oblique cord, 438, 439 Oblique fissure, 198 external, 188, 331 internal, 188, 189 of left lung, 244 Oblique muscle external, 174, 175, 177, 179, 182, 192, 247, 249, 250, 259, 263, 330, 424, 494 aponeurosis of, 250, 252, 259, 349 aponeurotic part of, 249 cross section of, 338 digitations of, 254 muscular part of, 249 inferior, 121 internal, 175, 179, 250, 259, 261, 263, 330 aponeurosis of, 252, 349 in lumbar triangle, 174 tendon of origin of, 179 superior, 83, 84, 86, 118, 121 Oblique popliteal ligament, 508 Oblique vein, left atrial, 214, 215, 221 Obliquus capitis inferior muscle, 175, 176, 178 Obliquus capitis superior muscle, 175, 176, 178 Obturator anastomotic vein, 265 Obturator anastomotic vessels, 262, 363 Obturator artery, 259, 264, 340, 369, 376, 398, 400, 402, 403, 410, 504, 512 acetabular branch of, 487 anterior branch of, 487 posterior branch of, 487 Obturator canal, 352, 358, 364, 365, 369, 402, 501 Obturator crest, 352, 486, 487

Obturator extemus muscle, 489, 493, 539 attachments of, 489, 491 Obturator foramen, 248 anteroposterior radiograph of, 488 radiograph of, 355 Obturator groove, 486 Obturator onternus muscle, 263, 376, 398, 411, 495, 499, 503 attachments of, 489, 491 nerve to, 499, 503 obturator fascia of, 364, 392, 402, 411 Obturator internus tendon, 359 Obturator lymph node, 406 Obturator membrane, 263, 352, 370, 487 Obturator nerve, 267, 340, 376, 498, 499, 538, 539, 540 accessory, 267, 498 articular branch of, 539 cutaneous branches of, 501, 544, 545 cutaneous branch of, 539 to knee joint, 539 posterior branch of, 539 Obturator-pubic arterial anastomosis, 259 Obturator vein, 311, 376 Obturator vessels, 259 right, 403 Occipital artery, 23, 34, 100, 178 descending branch of, 34 mastoid branch of, 100 medial, 142 CH

'

meningeal branch of, 23 occasional branch of, 11 sternocleidomastoid branch of, 34 Occipital bone, 4, 7, 8, 9, 1-2 basilar part of, 6, 8, 9, 22, 30, 37, 38, 39, 52, 65, 66, 67 clivus of, 22 condylar canal and fossa of, 8 condyle of, 9, 30, 128 external occipital crest of, 8 external occipital protuberance of, 4, 6, 8 foramen magnum of, 6 hypoglossal canal of, 6 inferior nuchal line of, 8 inferior petrosal sinus groove of, 6 internal occipital crest of, 9 internal occipital protuberance of, 9 jugular foramen of, 6 jugular process of, 30 pharyngeal tubercle of, 8, 63 superior nuchal line of, 83 transverse sinus groove of, 6 Occipital condyle, 9, 30, 128 Occipital crest, external, 14 Occipital lobe, 105 projection on, 120 Occipital lymph node, 72 Occipital nerve greater, 24, 177, 178 from C2 dorsal ramus, 129 lesser, 32, 129, 177, 178 third, 24, 177, 178 Occipital pole, 105 sagittal MR image of, 149 Occipital protuberance external, 14, 152 internal, 9

Occipital sinus, 103, 144 groove for, 9 Occipital sulcus, transverse, 105 Occipital vein, 23 internal, 146 O c c i p i t o f r o n t a l muscle frontal belly of, 123 occipital belly of, 123, 178 Occipitotemporal artery, 142 Occipitotemporal gyrus lateral, 106, 107 medial, 106, 107 Occipitotemporal sulcus, 106, 107 Oculomotor nerve (III), 84, 86, 101, 114, 116, 117, 166 branch of, 168 distribution of, 118 inferior branch of, 83, 86 inferior division of, 118, 121 schema of, 118 superior branch of, 83, 86 superior division of, 118, 121 Oculomotor nucleus, 116, 117, 121, 437, 438, 441, 444 accessory, 132 Odontoblast layer, 57 Olecranon, 436 Olfactory bulb, 107 cells of, 119 contralateral, 119 Olfactory cells, 119 Olfactory mucosa, 119 Olfactory nerve (I), 119 bundles of, 11 distribution of, 118 fibers of, 118, 119 schema of, 118, 119 Olfactory nucleus, anterior, 119 Olfactory stria lateral, 119 medial, 119 Olfactory sulcus, 107 Olfactory tract, 106, 107, 114 lateral nucleus of, 119 Olfactory trigone, 119 Olfactory tubercle, 119 Olive, 114, 117 Omental appendices, 272, 284 Omental arterial arch, 305 Omental artery, 305 Omental bursa, 272, 331 cross section of, 273 lesser sac of, 273 posterior wall of, 349 posterior wall of, parietal peritoneum on, 331 stomach reflected in, 272 superior recess of, 272, 274, 287 Omenta! foramen (of Winslow), 272, 273, 275, 288, 331 probe in, 272 Omental taenia, 281, 284 Omentum greater, 269, 271, 273, 284, 288, 339 anterior layers of, 294, 319 attachment of gastro-omental vessels to, 274 posterior layers of, 319 lesser, 273, 275, 288 anterior layer of, 319 attachment of gastric artery, 274

Omentum (Continued)'-:, blood vessels to right margin of, 348 posterior layer of, 319 right free margin of, 278, 279, 298 Omohyoid muscle, 29, 31, 34, 53, 189, 198, 420, 424, 428, 429 inferior belly of, 1, 27, 29, 31, 32, 128, 129, 427 invested by cervical fascia, 188 invested by fascia of infrahyoid muscle, 428 nerve to, 32, 71 31 origin of, 420 superior belly of, 27, 28, 29, 31, 32, 128, 129 Ophthalmic artery, 11, 23, 40, 83, 86, 132, 140, 143 continuation of, 85 muscular branch off, 85 supraorbital branch from, 69 supratrochlear branch from, 69 Ophthalmic nerve (VJ, 24, 45, 121, 122, 132, 133, 134, 135 external nasal branches of, 122 internal nasal branches of, 122 lacrimal, frontal, and nasociliary branches of, 11 tentorial branch of, 86, 122 Ophthalmic vein inferior, 85, 91 superior, 83, 85, 91 Opponens digiti minimi muscle, 465, 476 Opponens pollicis muscle, 461, 465, 475 Optic canal, 2, 6, 11, 83 Optic chiasm, 48, 104, 106, 107, 114, 140, 141, 145, 146, 147 Optic disc, 90 Optic nerve (II), 83, 86, 87, 90, 106, 107, 113, 132, 143, 144 coronal CT images of, 151 distribution of, 118 external sheath of, 91 internal sheath of, 91 vessels of, 91 outer sheath of, 32, 83, 87 sagittal MR image of, 149 in visual pathway, 120 Optic radiation, 120 Optic tract, 107, 108, 112, 114, 144 Oral cavity, 39, 48, 52-53, 63. See also Lip; Mouth; Teeth; specific parts of oral cavity coronal CT images of, 151 inspection of, 51 Oral region arteries of, 69 nerves of, 71 veins of, 70 Ora serrata, 87, 89, 90 Orbicularis ciliaris, 89 Orbicularis oculi muscle, 123 orbital part of, 26 palpebral part of, 26 Orbicularis oris muscle, 26, 36, 54, 81. 123 Orbiculus ciliaris, 89 Orbit arteries and veins of, 85 fascia of, 85

Orbit (Continued) fat in, 48, 83 axial MR image of, 150 growth of, 50 lateral dissection of, 49 medial wall of, 48 muscle attachments and nerves and vessels entering, 83 nerves of, 86 right, frontal, and slightly lateral view of, 2 Orbital fat body, 83 Orbital fissure inferior, 14, 83 superior, 83 Orbital gyrus, 107 Orbital muscle, 48 Orbital operculum, 105 Orbital septum, 81 Orbital sulcus, 107 Orbital surface, 2 Orbitofrental artery, 141, 142 lateral, 139 medial, 139 Oropharynx, 233 opened posterior view of, 66 Osfeomeatal unit, 37 Otic capsule, 96 anterolateral view of, 95 Otic ganglion, 55, 122, 123, 125, 131, 133, 134, 135, 168 schema of, 134 Oval window, 12, 95 base of stapes in, 92 fossa of, 94 stapes in, 93, 96 Ovarian artery, 341, 412 left, 329 right, 318, 322 ureteric branch from, 341 Ovarian plexus, 344, 412, 415 right, 318 Ovarian vein left, 311, 329, 332 right, 311, 332 Ovarian vessels, 332, 340, 362, 364, 404 left, 311 right, 311 tubal branches of, 404 Ovary, 340, 360, 362, 369, 370, 389, 410, 412, 415 ligament of, 360, 362, 369, 370, 371 right, 372 suspensory ligament of, 360, 362, 369, 370, 371, 372, 389, 400 ovarian vessels in, 364

P Pain pathway of, 325 referred, common areas of, 327 Palate growth of, 50 hard, 48, 63, 64 postsynaptic fibers to vessels and glands of, 44 soft, 37, 39, 51, 63, 64, 66 Palatine aponeurosis, 52 Palatine artery ascending, 40 greater, 52

Palatine artery (Continued) greater descending, 40 left, 40 lesser, 40 lesser left, 40 lesser right, 40 right, 40 Palatine bone, 39 at birth, 488 greater, 71 horizontal plate of, 14, 37, 38, 39, 52, 56 lesser, 71 lesser palatine foramen of, 39 nasal crest of, 39 orbital process of, 2, 38 perpendicular plate of, 38, 39 posterior nasal crest of, 39 posterior nasal spine of, 38 • pyramidal process of, 8, 12, 14 sphenoidal process of, 38 Palatine folds, transverse, 52 Palatine foramen greater, 8,11, 38, 56 lesser, 8, 11, 38, 39, 52, 56 Palatine gland, 52, 63, 64 Palatine nerve communicating with nasopalatine nerve, 42 descending, 133 greater, 11, 42, 43, 44, 45, 52, 62, 122, 131, 133 lesser, 42, 43, 45, 52, 62, 122, 131, 133 posterior inferior lateral nasal branch from, 42, 43 Palatine process, 14, 38, 52, 56 Palatine raphe, 52 Palatine suture median, 8 transverse, 8 Palatine tonsil, 51, 52, 58 Palatine vein, 70 external, 70 Palatine vessels, greater, 10 Palatoglossal arch, 51, 58 Palatoglossus muscle, 52, 58, 59, 64, 126 in palatoglossal arch, 60 Palatopharyngeal arch, 51, 58, 64, 66 Palatopharyngeal sphincter (Passavant's ridge), 65 Palatopharyngeus muscle, 52, 58, 59, 126, 235 Palmar aponeurosis, 442, 446, 454, 462, 480 reflected, 460 septa from, 460 Palmar arch, deep, 465 Palmar arterial arch deep, 465 superficial, 460 Palmar artery deep, computed tomography of, 484 superficial, computed tomography of, 484 Palmar carpal arterial arch, 465 Palmar carpal ligament, 446, 447, 454, 460 Palmar crease, proximal, 418

Palmar digital artery common, 462, 465 proper, 462, 471 Palmar digital nerve common, 476 proper palmar, 476 Palmaris brevis muscle, 476 Palmaris longus muscle, 442, 446, 448, 450, 475 Palmaris longus tendon, 418, 420, 446, 447, 454, 460 Palmar ligament, 471 Palmar venous arch, superficial, 460 Palpebral arterial arch, 85 Palpebral artery inferior lateral, 85 inferior medial, 85 lateral, 85 median, 85 superior lateral, 85 superior medial, 85 Palpebral conjunctiva, 81 Palpebral ligament lateral, 81 medial, 81, 83 Palpebral nerve, 24 Pampiniform plexus, 256 venous, 401, 403 Pancreas, 126, 167, 179, 273, 290, 297, 347 acini of, 298 anterior view of, 315 arteries of, 301 body of, 272 common areas of pain in, 328 cross section of, 297 head of, 272, 278, 279, 294, 298, 304, 338 arteries of, 304 in situ, 347 innervation of, 168, 328 lymph vessels and nodes of, 315 neck of, 298 posterior view of, 304, 315 tail of, 272, 298, 299, 329 artery to, 301 with uncinate process, 339 uncinate process of, 298 veins of, 309 Pancreatic artery dorsal, 300, 301, 305, 306 greater, 301 inferior, 301, 305, 306 Pancreatic duct, 294, 295, 298 accessory, 279, 298 principal, 279 sphincter of, 295 union of bile ducts and, 295 Pancreatic lymph nodes, superior, 314 left, 314 right, 314 Pancreatic notch, 298 Pancreaticoduodenal artery anastomosis of, 306 anterior superior, 272, 300, 301, 305, 306, 320, 321 inferior, 302, 305, 307, 322 anterior, 301, 306, 320, 321 common portion of, 306 plexus on, 319, 320, 322

Pancreaticoduodenal artery (Continued) inferior (Continued) posterior, 301, 306 posterior inferior, 301, 320, 321 posterior superior, 301, 305, 306, 320, 321 superior, 321 plexus on, 319 Pancreaticoduodenal lymph nodes, 315 Pancreaticoduodenal plexus, inferior, 322, 323 Pancreaticoduodenal vein anterior, 312 anterior inferior, 311 anterior superior, 311 inferior, 313 posterior, 312, 313 posterior inferior, 311 superior, 312 Pancreatic vein, 311, 313 dorsal or superior, 313 great, 313 Papilla muscle fibers to, 282 of teeth, 57 Papillary duct, 336 Papillary muscle anterior, 220, 223, 224,. 225 left anterior, 224 left posterior, 224 posterior, 220, 223, 225 right anterior, 224 right posterior, 224 septal, 220, 223, 224 Paracentral artery, 141, 142 Paracentral lobule, 106 Paracentral sulcus, 106 Paracolic gutter left, 271, 362, 363 right, 2 7 1 , 2 8 1 , 3 6 2 , 3 6 3 Paracolic lymph nodes, 317 Paradidymus, 389 Paraduodenal fossa, 270 Parahippocampal gyrus, 106, 107, 108, 119 Paramedian artery, 140 Paramesonephric (miillerian) duct, 389 Paramesonephric tubule, 389 Paranasal sinus age-related changes in, 50 bones of, at birth, 50 coronal section of, 48 cross section of, 47 horizontal section of, 48 lateral dissection of, 49 sagittal section of, 49 Pararectal fossa, 362, 363, 369 floor of, 392 Pararenal fat, 179 Parasternal lymph nodes, 184 Parasympathetic fibers postganglionic, 44 preganglionic, 44

Parasympathetic nerve, in tracheobronchial tree, 210 Parasympathetic nervous system schema of, 168 topography of, 166 Parathyroid gland, 76 inferior, 75, 76 * right lateral view of, 75, 76 superior, 75, 76 superior view of, 75, 76 Paratracheal lymph nodes left, 208 right, 208 Paraumbilical vein, 312 to round ligament of liver, 256 tributaries of, 256 Paraurethral (Skene's) glands, 389 primordium of, 389 Paraventricular nucleus, 147 Paravertebral anastomosis, 172 Paravesical fossa, 369 Parenchyma, blood vessels in, 337 Parietal artery, 141 anterior, 141, 142 anterior parietal, 142 posterior, 141, 142 Parietal bone, 2, 4, 6, 8, 9 tuber eminence of, 12 Parietal cells, 9, 276 Parietal emissary vein, 23 Parietal foramen, 7 Parietal limb, 220 Parietal lobe, 105 Parietal lobule inferior, 105 superior, 105 Parietal operculum, 105 Parietal pleura cervical, 196, 197, 230 costal, 194, 198, 206, 211, 230 left border of, 197 right border of, 197 diaphragmatic part of, 193, 194, 198, 206, 211 mediastinal part of, 193, 194, 198, 206, 211, 215, 230 Parietooccipital artery, 142, 143 Parietooccipital sulcus, 105, 106, 143 Parolfactory area, 106 Parotid duct, 25, 54, 55, 61, 69 Parotid gland, 25, 26, 27, 28, 31, 32, 55, 125, 134, 166, 167 accessory, 61 cholinergic and adrenergic synapses to serous, 61 horizontal section of, 25 Parotid lymph nodes deep, 72 superficial, 72 Parotid papilla, 51 Parotid space, 34 Pars distalis, 147 Pars flaccida, 93 Pars interarticularis, 155 Pars intermedia, 147 Pars tensa,93 Pars tuberalis, 147 Parturition, neuropathways in, 414

Passavant's ridge. See Palatopharyngeal sphincter (Passavant's ridge) Patella, 485, 492, 493, 494, 501, 507, 511, 519, 521 anteroposterior radiograph of, 510 radiograph of, 510 Patellar anastomosis, 500, 512 Patellar bursa, 508 Patellar capsule, iliotibial tract blended into, 508 Patellar ligament, 485, 489, 492, 493, 494, 508, 511, 514, 520, 521 Patellar nerve plexus, 544 Patellar retinaculum iliotibial tract blended into, 508 lateral, 492, 493, 507, 508, 519, 520 medial, 492, 493, 501, 506, 508, 519, 520 Pecten, 393 Pecten pubis, 248, 486 Pectinate ligament, 88 Pectinate line, 393 Pectinate muscle, 220 Pectineal ligament (Cooper's), 188, 250, 251, 259, 262, 263 Pectineal line, 248, 263, 352, 353, 486, 489, 505, 538 Pectineus muscle, 376, 489, 492, 493, 500, 538 attachments of, 489, 491 Pectoralis major muscle, 27, 28, 181, 182, 188, 192, 198, 243, 244, 245, 246, 247, 249, 250, 418, 419, 428 abdominal part of, 424 clavicular head of, 181 deep to pectoral fascia, 182 fascia of, 26, 428 insertion of, 420 origin of, 419 sternocostal head of, 424 tendon of, 433 Pectoralis minor muscle, 198, 243, 244, 245, 420, 428, 433 fascia of, 428 insertion of, 420 invested by clavicopectoral fascia, 188 Pectoralis minor tendon, 429, 430 Pectoralis muscle, 189 Pectoral nerve lateral, 188, 428, 430 medial, 188, 428, 429, 430 median, 428 Pedicle, lumbar, 155 Pelvic brim, 370 sacral part of, 157 Pelvic floor contents of, 354-366 female, 356 Pelvic foramina, radiograph of, 355 Pelvic inlet diameters of, 354 female, 354 male, 354 radiograph of, 355 Pelvic ligaments, 372 Pelvic organs, female, arteries and veins of, 400 Pelvic outlet anteroposterior diameter of, 35^ female, 354 transverse diameter of, 354

Pelvic plexus, 412 Pelvic scans, 397 Pelvic viscera female, 360, 369 nerves of, 412 male, 361 nerves of, 410 Pelvis, 351 anterior view of, 352 arcus tendineous fasciae, 372 bones and ligaments of, 352-353 false, 351, 362 female, 356 arteries and veins of, 402 contents of, 360 lymph nodes and vessels of, 407 radiograph of, 355 radiographs of, 355 sagittal MR images of, 397 structures in, 370-375 lateral view of, 352 linea terminalis of, 362, 364 male, 354 arteries and veins of, 401, 403, 405 contents of, 363, 387 lymph nodes and vessels of, 408 radiograph of, 355 radiographs of, 355 sagittal MR images of, 397 structures of, 380-387 surface anatomy of, 351 medial section of, 352 posterior view of, 352 renal, 339 sex differences of, 354 true, 352 viscera of, nerves of, 412 Penis body of, 351, 388 bulb of, 382, 383, 385 artery of, 383, 405 cavernous nerves of, 410, 412 crus of, 360, 366, 385 deep arteries of, 381, 383, 385, 404 deep dorsal vein of, 249 deep fascia of, 361, 380, 381, 382, 385, 387, 401, 403, 405 dorsal arteries of, 381, 383, 401 dorsal nerve of, 411 dorsal nerves of, 381, 383, 405, 409, 410, 411, 416, 503 dorsal veins of deep, 359, 361, 381, 383, 401, 403, 405 hiatus for, 358 superficial, 351, 381, 403 fetal development of, 388 frenulum of, 382 fundiform ligament of, 259, 361 glans, 351, 361, 382, 385, 388 corona of, 382 neck of, 382 sagittal MR images of, 397 internal pudendal artery of, 383 lateral superficial vein of, 381 raphe of, 388 section through body of, 381 skin of, 380, 381, 382, 387 superficial fascia of, 249, 250, 381, 382, 387 suspensory ligament of, 250, 361

Perforated substance, 114 anterior, 107, 114, 119 posterior, 107, 114 Perforating artery, 501 anteromedial central, 140 posteromedial, 140 radiate, 335 from thigh, 512 Perforating artery, radiate, 335 Perforating cutaneous nerve, 411, 413 of hip, 503 of lower limb, 545 sacral, 499 Perforating vein, 337 of arm, 479 of forearm, 480 Per hippocampus, 112 Perianal skin, 394 sweat glands and hair in, 393 Perianal space, 392, 393, 396 Perianal tissues, 388 Perianal venous plexus external, 392 internal, 392 Pericallosal artery, 141, 142 posterior, 143 Pericardiacophrenic artery, 194, 206, 211, 230, 241, 255 left, 193 right, 193 Pericardiacophrenic vein, 194, 206, 211, 212, 230, 231, 241 Pericardiacophrenic vessels, 215 Pericardial reflection, 214, 220 Pericardial sac anterior view of, 215 left lateral view of, 215 Pericardial sinus oblique, 215, 246 transverse, 215, 220 Pericardial sinus, transverse, 212 Pericardium, 211, 215, 233 bare area of, 196 diaphragmatic part of, 215 fibrous, 198, 230 line of fusion to diaphragm, 211 over right atrium, 230 mediastinal part of, 194 reflection of, 214, 220, 221 at site of great vessels reflection, 212 sternocostal part of, 215 Perichoroidal space, 87, 88 Pericranium, 102 Periformis muscle, 490 Periglandular plexus, 326 Periglomerular cells, 119 Perimuscular rectal venous plexus, 311 Perineal artery, 370, 403, 404, 405 transverse, 405 Perineal body, 359, 361, 365, 378, 380, 381, 382, 383, 384, 391, 395, 403, 404, 405 Perineal compartment, superficial, 396 Perineal flexure, 376 Perineal ligament, transverse, 356, 358, 361, 364, 380, 383, 405 Perineal lymph vessels, 317

Perineal membrane, 263, 358, 365, 366, 380, 381, 383, 391, 404, 405, 411, 413 left, 354 Perineal muscle deep fascia of, 356 deep transverse, 356, 360, 361, 381, 383, 404 superficial transverse, 356, 380, 381, 382, 391, 404, 405 Perineal nerve, 410, 411, 413, 503 deep, 411, 413, 530 lateral branch of, 530, 531 deep branches of, 411 in males, 411 posterior scrotal and labial branches of, 499 in pudendal canal, 392 superficial, 411, 413 superficial branches of, 411 Perineal raphe, 388 Perineal space male, 383 superficial, 361, 370, 378, 404, 405 Perineal vein, 405 Perineopelvic spaces, 396 Perineum, 347 abscess in, 396 female, 360, 377, 395 arteries and veins of, 404 deep, 379 lymph vessels and nodes of, 407 nerves of, 413 structures of, 371-375 superficial dissection of, 378 interdigitating fibers to, 357 male, 361 arteries and veins of, 405 deeper dissection of, 381 frontal section, anterior view of, 383 nerves of, 411 structures of, 380-387 superficial dissection of, 380 surface anatomy of, 351 Periodontium, 57 Periorbita, 83 Periosteum alveolar, 57 mandibular or maxillary, 57 Periportal space, 291 Perirenal fat, 179, 342 Perisinusoidal spaces, 291 Peritoneal fold hepatic artery in, 272 testicular vessels in, 363 Peritoneum, 179, 236, 252, 261, 284, 322, 329, 342, 412 female, 365, 366, 378, 400, 412 inferior, 415 potential spaces of, 364 forming pararectal fossa floor, 392 male, 361, 366 inferior extent of, 415 parietal, 271, 273, 331, 348, 362, 363, 373 of anterior abdominal wall, 348 on omental bursa posterior wall, 331 phrenic nerve to, 327 of posterior abdominal wall, 274 visceral, 273, 326 Perivascular fibrous (Glisson's) capsule, 290

Peroneal nerve, deep, 530 Peroneus brevis tendon, 535 Peroneus longus tendon, 535 fibrous sheath of, 535 Pes anserinus, 489, 492, 493 attachments of, 489, 515 Pes hippocampus, 111, 112 Petrosal ganglion, 131, 135 Petrosal nerve deep, 123, 125, 131, 133 greater, 86, 123, 124, 125, 131, 133, 135 groove for, 9, 97 hiatus for, 11 lesser, 86, 93, 122, 123, 125, 134 groove for, 9 hiatus for, 11 Petrosal sinus inferior, 11, 103 groove for, 6, 9 superior, 97, 103 groove for, 9 Petrosal vein, 144 draining to petrosal sinus, 144 Petrosquamous fissure, 12 Petrotympanic fissure, 11 Peyer's patches, 280 Phalanx, 524 distal, 456, 471 cross section of, 471 of great toe, 537 ulnar nerve innervation of, 476 dorsal, 523 fourth, base of, radiograph of, 457 middle, 456, 471, 523 radiograph of, 457 ulnar nerve innervation of, 476 plantar view of, 523 proximal, 456, 523 of great toe, 537 radiograph of, 457 of ring finger, distal, radiograph of, 457 of thumb, distal, radiograph of, 457 tuberosity of, 523 Pharyngeal aponeurosis, 235 Pharyngeal artery, 40 ascending, 11, 34, 40, 69, 136, 138 meningeal branches of, 100 pharyngeal branch of, 64 posterior meningeal branch of, 136 tonsillar branch of, 64 Pharyngeal constrictor muscle glossopharyngeal part of, 59 inferior, 27, 75, 76, 80, 126, 233, 234 cricopharyngeus part of, 233, 234 middle, 27, 59, 75, 126, 235 superior, 40, 52, 55, 59, 69, 75, 126, 235 glossopharyngeal part of, 59, 65 Pharyngeal muscle, longitudinal, 235 Pharyngeal nerve, 133 Pharyngeal plexus, 62, 71, 125, 126, 130, 131 Pharyngeal raphe, 37, 60, 63, 65, 67, 75, 76, 234 Pharyngeal recess, 37, 47, 64, 66 Pharyngeal region arteries of, 69 nerves of, 71 veins of, 70 Pharyngeal tonsil, 37, 63, 64, 66, 67 Pharyngeal tubercle, 64, 65, 67

Pharyngobasilar fascia, 52 Pharyngobasilar fossa, 59 Pharyngoepiglottic fold, 235 fibers to, 65 Pharyngoesophageal junction, 235 Pharyngotympanic tube. See Auditory (pharyngotympanic, Eustachian) tube Pharynx afferent innervation of, 62 arteries of, 69 lymphatic drainage of, 73 lymph nodes and vessels of, 73 median section of, 63 muscles of lateral view of, 68 median (sagittal) section of, 65 partially opened posterior view of, 67 nerves of, 62 opened posterior view of, 66 posterior view of, 75 posterior wall of, 51 veins of, 71 Philtrum, 1 Phrenic artery inferior, 237, 305, 318, 333, 347 left inferior, 272, 300, 319, 320, 332, 333 recurrent branch of, 300 sympathetic fibers along, 240 right inferior, 300, 319, 320,333, 346 Phrenic ganglion, 320, 327 Phrenic lymph nodes, inferior, 184, 266 Phrenic nerve, 30, 32, 74, 129, 130, 189, 193, 198, 206, 210, 211, 226, 230, 243, 429 anterior, 195, 321 efferent and afferent fibers of, 193 left, 193, 194, 215, 346 nerve to, 430 pericardial branch of, 193 phrenicoabdominal branches of, 193 right, 193, 194, 215, 244, 318, 327, 346 Phrenicocolic ligament, 272 Phrenic plexus, 410 inferior, 318 left inferior, 319, 320, 323, 346 right inferior, 319, 320, 323, 346 Phrenic vein inferior, 320 left inferior, 320 Phrenoesophageal ligament, 236 Pia-arachnoid mater, 91 Pial plexus, 171 arterial, 173 peripheral branches from, 173 venous, 173 Pia mater, 91, 99, 102 overlying spinal cord, 169 thoracic, 170 Pigment cells, 120 Pillar cells, 94, 120 Pineal body, 106, 110, 111, 114 Pineal recess, 108 Piriform fossa, 233 Piriformis muscle, 263, 411, 489, 495, 503 nerve to, 499 Piriform lobe, 119

Pisiform, 442, 446, 447, 454, 456, 460, 465 radiograph of, 457 Pituitary gland, 107, 147 anterior lobe of, 140, 147, 148 posterior lobe of, 148 posterior lobe of, 140, 147 sagittal MR image of, 149 in sella turcica, 37 Pituitary stalk, 147 Plantar aponeurosis, 533, 534, 535 digital slips of, 535 lateral band of, 535 Plantar arterial arch, deep, 531, 536 posterior penetrating branches from, 520, 536 Plantar artery deep, 530, 535, 536 lateral, 535, 536 cutaneous branches of, 535 medial, 534 cutaneous branches of, 534, 535 deep branches of, 534 superficial branch of, 533, 534, 535 posterior perforating branches of, 536 Plantar calcaneonavicular ligament, 536 Plantar digital artery, common, 534 Plantar digital nerve, common, 534, 541 Plantar interosseous muscle, 537 Plantaris muscle, 494, 495, 511, 515, 540, 541 attachments of, 491, 515 innervation of, 541 Plantaris tendon, 495, 516, 517, 522 Plantar ligament, 536 long, 528, 536 short, 527 Plantar nerve lateral, 534, 535, 540, 541 cutaneous branches of, 535 deep branches of, 535 plantar cutaneous branches of, 545 proper plantar digital branches of, 533, 534, 535 superficial branch of, 535 medial, 534, 540 deep branch of, 534, 535 plantar cutaneous branches of, 535, 545 proper plantar digital branches of, 533, 534, 535 superficial branch of, 534 Platysma muscle, 26, 28, 60, 124 Pleura, 331 abdominal, 349 cupula of, 74 mediastinal, 194 parietal, 206 spinal nerves of, 170 thoracic, 170 visceral, 205 Pleural cavity costodiaphragmatic recess of, 196, 197, 330, 331 left costodiaphragmatic recess of, 104, 206 left costomediastinal recess of, 194 right costodiaphragmatic recess of, 194 Pleural reflection, 196 Plica semilunaris, 81, 82

Pneumothorax, chest drainage tube placement in, 190 Pons, 106, 114, 134, 135 axial MR image of, 150 sagittal MR image of, 149 Pontine artery, 140, 141, 143 Pontine taste area, 135 Pontine vein lateral, 144 transverse, 144 Pontomesencephalic vein, anterior, 144 Popliteal artery, 512 Popliteal fossa, 485 Popliteal ligament, arcuate, 511 Popliteal ligament, oblique, 511 Popliteal lymph nodes, 546 Popliteal surface, 489 Popliteal vein, 546 Popliteal vessels, 495 Popliteus muscle, 491, 511, 515, 541 attachments of515, 541 nerve to, 541 Popliteus tendon, 508, 510 origin of, 507 Pores of Kohn, 204 Portacaval anastomosis, 312 Porta hepatis, 287 Portal space, limiting plate of, 291, 292 Portal triad, 273, 278, 290, 297, 298 cross section of, 273 Portal vein, 297 branch of, 291, 292 cross section of, 297, 338 Postanal space deep, 396 superficial, 396 Postcaval lymph nodes, lateral, 343 Postcentral gyrus, 105 Postcentral sulcus, 105 Posterior chamber, 81, 87, 88, 90 Posterior limiting lamina (Descemet's membrane), 88 Posteromedial central artery, 140 Postganglionic sympathetic fibers, 346 ciliary ganglion, 132 female reproductive organ innervation, 415 male reproductive organ innervation, 416 urinary bladder and lower ureter innervation, 417 Postlunate fissure, 113 Poupart's ligament. See Inguinal ligament (Poupart's) Preaortic lymph nodes, 317, 408 Precaval lymph nodes, lateral, 343 Prececal lymph nodes, 317 Precentral gyrus, 105 Precentral sulcus, 105 Prechiasmatic groove, 9 Preculminate vein, 144 Precuneal artery, 142 Precuneus, 106 Prefrontal artery, 141 Preganglionic sympathetic cell body, 44, 132

Preganglionic sympathetic fibers, 346 ciliary ganglion, 132 female reproductive organ innervation, 415 male reproductive organ innervation, 416 urinary bladder and lower ureter innervation, 417 Premolars, 56, 57 Preoccipital notch, 105 Prepatellar bursa, subcutaneous, 511 Prepontine cistern, 109 Prepuce, 388 of clitoris, 388 of penis, 361 site of, 388 site of future origin of, 388 Preputial gland, opening of, 382 Prepyloric vein, 311 Prerectal muscle fibers (of Luschka), 359 Presacral space, 364, 396 Presymphyseal node, 408 Pretracheal lymph node, 74 Prevertebral anastomosis, 172 Prevertebral muscle, 30 Prevesical lymph node, lateral, 343 Prevesical lymph plexus, 408 Prevesical plexus, 408 Princeps pollicis artery, computed tomography of, 484 Procerus muscle, 26, 36, 123 Profunda brachii artery, 429 Profundus flexor tendon, in common flexor sheath, 460 Promontorial lymph nodes, 343, 408 Promontory, 92, 93 Pronator quadratus muscle, 440, 448, 449, 450, 465, 475 Pronator teres muscle, 420, 433, 440, 446, 447 humeral head of, 420, 447, 450, 474, 475 origin of, 420 ulnar head of, 350, 420, 447, 448, 475 origin of, 420 Prostate gland, 167, 384 arterial supply of, 403 capsule of, 361, 366, 384 fibromuscular stroma of, 384 hyperplastic lateral lobe of, 403 hyperplastic middle lobe of, 403 inferolateral lobe of, 384 inferoposterior lobe of, 384 • innervation of, 168 isthmus lobe of, 384 lymphatic drainage from, 408 median lobe of, 384 primordium of, 389 with prostatic urethra, 376 sagittal MR images of, 397 skeletal muscle band of, 384 sphincter urethrae muscle ascending anterior aspect of, 359 Prostatic duct, openings of, 384, 385 Prostatic plexus, 165, 344, 416 Prostatic sinus, 384, 385 Prostatic urticle, 389 Prostatic vein, right, 31 I Prostatic venous plexus, 403

Proximal interphalangeal (PIP) Joint, 418 Psoas major fascia, 342 Psoas major muscle, 179, 267, 278, 329, 339, 342, 492, 496, 498, 499 area for, 330 articular branch of, 538 fascia of, 179, 342 lower part of, 538 origin of, 489, 496 Psoas minor muscle, 263, 496 origin of, 496 Psoas muscle, 376, 496 axial CT images of, 350 muscular branch of, 498 Psoas tendon,376 Pterion, 4 Pterygoid artery lateral, 40 medial, 40 Pterygoid canal artery of, 40 nerve of, 122, 123, 125, 131, 133, 135 Pterygoid fossa, posterior view of, 14 Pterygoid fovea, 15 Pterygoid hamulus, 4, 38, 46, 52, 55, 64, 65, 68 at birth, 50 Pterygoid muscle lateral, 40, 54, 55 axial MR image of, 150 medial, 15, 25, 40, 52, 55 nerve to, 71 Pterygoid nerve lateral, 46, 122 medial, 46, 122 Pterygoid plate lateral, 13, 47, 55, 68 medial, 52, 55, 64, 65 hamulus of, 13 Pterygoid plexus, 70, 85 deep facial nerve from, 23 Pterygoid process, 6, 8 hamulus of, 12, 13, 14 lateral plate of, 4, 12, 13, 14, 38, 39, 50 medial plate of, 12, 13, 14, 38, 39, 50 of palatine bone, 13 plates of, 6 Pterygomandibular raphe, 15, 40, 52, 55, 65, 68 Pierygomaxillary fissure, 4 Pterygopalatine fossa, 4, 13, 14, 40, 44, 49 Pterygopalatine ganglion, 122, 123, 125, 131, 133, 135, 166, 168 ganglionic branches of, 45 in pterygopalatine fossa, 44 schema of, 133 Pubic arch, 248 female, 354 male, 354 Pubic bone, 348, 357, 383 Pubic crest, 259, 376 Pubic hypogastric region, 268 Pubic ligament, inferior, 248, 356, 359, 360, 364, 365, 378, 383 Pubic ramus inferior, 248, 486 superior, 248, 486, 496, 499

Pubic symphysis, 247, 259, 263 female, 354 male, 354 radiograph of, 355 sagittal MR images of, 397 superior portion of, 376 Pubic tubercle, 247, 250, 263, 486, 492, 493 Pubic vein, 265 Pubis anteroposterior radiograph of, 488 body of, 376 radiograph of, 355 superior ramus of. 488, 493 symphyseal surface of, 412 Pubocervical fascia, 372 Pubococcygeus muscle, 357, 358, 359, 360 Pubofemoral ligament, 487 Puboprostatic ligament, lateral, 366 Puborectalis muscle, 356, 357, 358, 359, 376, 398 left, 356 Pubovesical ligament lateral, 364, 365 medial, 364, 365 Pudendal artery deep external, 512 internal, 341, 376, 499 superficial external, 512 Pudendal canal (Alcock's), 392, 411 internal pudendal artery in, 402, 404 internal pudendal vein in, 399 pudendal nerve in, 413 Pudendal canal, left internal pudendal vein in, 311 Pudendal cleft, 377 Pudendal nerve, 160, 267, 410, 411, 412, 415, 416, 417, 499, 500, 503 block of, 413 internal, 392 Pudendal vein external, 256, 265 internal, 376 left internal, 311 right internal, 311 superficial external, 544 Pudendal vessels deep external, 401 internal, 392 superficial, 500 superficial external, 401 Pudendal vessels, superficial, 249 Pudendum, 377 Pulmonary artery, 213 axial CT images of, 242 left, 206, 213, 214, 231, 245 prenatal, 229 radiograph of, 213 right, 205, 206, 210, 214, 220, 230, 245 prenatal, 229 Pulmonary ligament, 199, 208, 230, 231 Pulmonary Bymph nodes, 208 Pulmonary plexus, 126, 165, 166, 168, 210 anterior, 209 posterior, 209

Pulmonary trunk, 206, 212, 215, 220, 224, 225 bifurcation of, 215 outflow to, 224 prenatal, 229 Pulmonary valve, 213, 220, 222, 225 semilunar cusps of, 220, 222 Pulmonary vein left, 205, 206, 215, 221, 224, 231 inferior, 214, 241 prenatal, 229 superior, 214 right, 206, 215, 225, 230 inferior, 214, 220, 246 prenatal, 229 superior, 212, 214, 220, 224 Pulvinar, 110, 111, 143, 144, 145 left, 144 right, 144 of thalamus, 114 Pupil, 81 dilator muscle of, 88, 121, 132 muscles of, 132 sphincter muscle of, 88, 121, 132 Pupillae muscle dilator, 121 sphincter, 121 Purkinje fibers, 225 subendocardial branches of, 225 Putamen, 108 Pyloric antrum, 275 barium radiograph of, 279 Pyloric canal, 297 cross section of, 297 Pyloric gland, 276 Pyloric lymph nodes, 315 Pyloric orifice, 276, 279 Pylorus, 275, 276, 278, 297 barium radiograph of, 279 cross section of, 297 Pyramid, 114, 144 decussation of, 114 inferior vermis, 113 of vermis of cerebellum, 115 Pyramidalis muscle, 250, 260 Pyramidal process, 8, 12, 14 Q Quadrangular lobule, 113 Quadrangular space, posterior circumflex humeral artery in, 427 Quadratus femoris muscle, 492, 493, 495, 503, 511, 538 attachments of, 489, 491, 515 nerve to, 499, 503 Quadratus lumborum muscle, 176, 179, 263, 267, 329, 342, 496, 498 area for, 330 fascia of, 179 Quadratus plantae muscle, 534, 535, 541 Quadratus plantae nerve, 541 Quadriceps femoris muscle, 538 attachment of, 490 patellar ligament of, 515 Quadriceps femoris tendon, 485, 492, 501, 506, 511, 520, 521 Quadriceps tendon, 493

Quadrigeminal cistern, 109 Quadrigeminal plate, 115

R Radial artery, 433, 445, 446, 447, 448, 449, 454, 460, 461, 465, 474 in anatomical snuffbox, 469, 470 computed tomography of, 484 palmar carpal branch of, 448, 465 superficial palmar branch of, 454, 460, 465 Radial bursa, 460, 462 Radial collateral artery, 434 Radial collateral ligament, 454, 455 Radial nerve, 429, 430, 432, 435, 447, 448, 474, 475, 477 in arm, 477 branch of, 469 communicating branch of, 468 deep branch of, 445, 447, 449, 474 dorsal digital branch of, 473, 481 inferior lateral, 481 posterior cutaneous, 469, 473, 481 superficial branch of, 444, 447, 449, 468, 469, 473, 474, 480, 481 dorsal digital branch of, 469 Radial recurrent artery, 433, 434, 447 Radial styloid process, 452 Radiate artery, perforating, 335 Radiate capitate ligament, 454 Radiate ligament, 187 Radiate sternocostal ligament, 186 Radicular artery anterior, 172 posterior, 172, 173 Radicular vein, 173 Radiocarpal joint, 453, 455 Radiocarpal ligament dorsal, 455 palmar, 454 radiocapitate part of, 454 radioscapholunate part of, 454 Radiograph of ankle, 526 barium of ileum, 279 of jejunum, 279 of long vermiform appendix, 283 of stomach, duodenum, and proximal jejunum, 279 of cervical vertebrae, 18 of chest, 213 of elbow, 437 of female pelvis, 355 of hand, 457 of hip joint, 488 of knee, 510 lateral, of skull, 5 of lumbar vertebrae anteroposterior, 156 lateral, 156 of male and female pelvis, 355 of male pelvis, 355 pelvic female, 355 male, 355 of shoulder, 422 of wrist and hand, 457

Radiolunate ligament long, 454 palmar, 454 short, 454 Radioscaphocapitate ligament, 454 Radioulnar joint, distal, 455 Radioulnar ligament dorsal, 455 palmar, 454 Radius, 436, 438, 439, 440, 442, 443, 465 annular ligament of, 438 anterior branch of, 439 anterior (palmar) view of, 452 anterior surface of, 439 coronal section of, 439, 455 cross section of, 470 dorsal tubercle of, 452 head of, 439 right, 439 interosseous border of, 439 neck of, 437, 439 posterior cutaneous and inferior lateral cutaneous nerves of arm from, 479 posterior (dorsal) view of, 452 radiograph of, 437 rotators of, 440 tuberosity of, 437, 439 ulnar notch of, 439 Rami communicantes gray, 130, 132, 133, 134, 165, 167, 169, 170, 180, 196, 209, 230, 240, 258, 267, 318, 324, 325, 327, 344, 412, 498, 499 white, 130, 132, 133, 134, 165, 167, 169, 180, 196, 209, 230, 240, 258, 267, 318, 321, 324, 325, 345, 398, 412, 499 Rathke's pouch, vestigial remnant of, 50 Rectal artery inferior, 307, 398, 402, 403, 404, 405 middle, 264, 307, 323, 341, 364, 398, 400, 402, 403 superior, 264, 307, 318, 323, 324, 340, 364, 398, 400, 410 bifurcation of, 307 branch of, 307 Rectal lymph nodes, 317 middle, 317 superior, 31 / Rectal nerve inferior, 411, 503 superior, 503 Rectal plexus, 323, 344, 412 communication between internal and perimuscular, 399 middle, 323 superior, 318, 323 Rectal vein inferior, 312 left, tributaries of, 311 left middle, 311 left superior, 312 middle, 312 right, tributaries of, 311 right inferior, 311 right middle, 311 right superior, 312 superior, 311 bifurcation of, 399

Rectal venous plexus communication between internal and external, 399 external, 311, 393, 394, 399 internal, 393, 394, 399 perimuscular, 399 Rectal vessels, superior, 274 Rectineal ligament, 259 Rectocervical space, 369 Rectococcygeus muscle, 263 Rectoperinealis muscle, 262 Rectoprostatic (Denonvilliers') fascia, 348, 359, 361, 386, 391, 396 Rectosigmoid artery, 307, 323, 398 Rectosigmoid junction, 284, 391, 393, 394 Rectosigmoid plexus, 323 Rectosigmoid vein, 311, 312, 399 Rectourethralis superior muscle, 359 Rectouterine fold, 369 Rectouterine ligament, 369 Rectouterine pouch (of Douglas), 360, 362, 369, 371 f 391 Rectovaginal space, 364, 369 Rectovesical pouch, 348, 361, 391 Rectovesical space prerectal, 396 retroprostatic, 396 retrovesical, 396 Rectum, 263, 271, 284, 329, 356, 357, 361, 363, 364, 365, 378, 384, 391, 393, 400, 412 anal canal and, 393 arteries of, 398 circular muscle layer of, 393, 394 in situ, 391 female, 328, 396 male, 328, 396 innervation of, 168 ischioanal fossae of, 392 longitudinal muscle layer of, 393, 394 lymphatic pathway along, 408 marginal artery of, 398 muscularis mucosae of, 394 sagittal MR images of, 397 termination of, 376 transverse folds of, 393 veins of, 399 Rectus abdominis muscle, 189, 331 sagittal MR images of, 397 Rectus capitis anterior muscle, 73 Rectus capitis muscle. See Capitis muscle, rectus Rectus capitis posterior major muscle, 175, 176, 178 Rectus capitis posterior minor, 175, 176, 178 Rectus femoralis tendon, 492 origin of, 492 Rectus femoris tendon, 485 Rectus muscle inferior, 83, 84, 121, 151 lateral, 83, 84, 86, 121, 151 axial MR image of, 150 tendon of, 87 medial, axial MR image of, 150 superior, 83, 84, 86, 91, 121 tendon of, 91

Rectus sheath, 83, 189, 249, 250, 349 anterior layer of, 188, 250, 252, 259, 424 cross section of, 252 posterior layer of, 251, 252, 257, 259 Red nucleus, 107, 116, 117 Reil, island of- See Insula Renal artery, 335, 341, 345 anterior branch of, 335 in situ, 332 left, 323, 329, 339, 347 posterior branch of, 335 right, 318, 321, 329 ureteric branch of, 335, 336 variations in, 333 Renal column (of Bertin), 337 Renal corpuscle cortical, 336 juxtamedullary, 336 Renal cortex, 336, 337, 346 Renal ganglion, 344, 345 left, 346 right, 346 Renal fascia, 339, 342, 347 anterior layer of, 179 Gerota's, 342, 347 posterior layer of, 179, 342 sagittal section of, 342 transverse section of, 342 Renal medulla, 336, 337 preganglionic fibers and, 346 Renal papilla, 336 Renal parenchyma, 334 Renal plexus, 344, 345 left, 323, 346 right, 318, 346 Renal segment arteries of, 335 vascular, 335 Renal sinus, 337 fat in, 334 perirenal fat of, 337 Renal vein, 341 in situ, 332 left, 329, 333 double, 333 entering inferior vena cava, 339 multiple, 333 right, 265, 329, 332, 339 Reproductive organs, male, innervation of, 415 Respiratory bronchiole, 204 Rete testis, area of, 390 Reticular nucleus, 111 Retina, 91 ciliary part of, 87, 88 iridial part of, 88 non-pigmented areas of, 91 optic part of, 87, 89 pigmented areas of, 91 projection on, 120 structure of, 120 Retinacular artery, 504 subsynovial, 504 Retinal artery, 90 central, 85, 87, 90, 91 Retinal vein, 90 central, 87, 91 Retinal vessels, right, 90 Retrobulbar fat, 83 Retrocecal recess, 271, 281

Retromandibular vein, 23, 31, 59, 85 anterior, 61, 70 common trunk for, 59, 61, 70 posterior, 61, 70 Retroperitoneal artery, 331 Retropharyngeal lymph nodes, 73 Retropubic (prevesical) space (of Retzius), 48, 348, 364, 396 fat in, 251 Retropubic venous plexus, 365 Retropyloric lymph nodes, 314 Retrotonsillar fissure, 113 Retrotonsillar vein inferior, 144 superior, 144 Retzius, cave of, 348 Retzius space. See Retropubic (prevesical) space (of Retzius) Rhinal sulcus, 106, 107 Rhomboid major fossa, 114 Rhomboid major muscle, 174, 177, 180, 192, 243, 245, 424 insertion of, 421 Rhomboid minor muscle, 174, 177, 424, 477 insertion of, 421 Rhomboid muscle, 244 Ribs, 186, 244, 245 angle of, 185, 186 axial CT images of, 242, 350 body of, 185 eighth, 241, 349 eleventh, 330 false, 185 first, 94, 160, 186, 196, 197, 211, 230, 419, 429 costal cartilage of, 243 groove for, 199 synchondrosis of, 419 floating, 185 head of, 185, 186 interarticular ligament of, 187 middle, 186 neck of, 185, 186, 194 ninth, 299 second, 182, 185, 419 left, 186 seventh, head of, 246 sixth, 182 true, 185 tubercle, 185, 18G twelfth, 160, 174, 195, 342, 349 projection of, 330 Riolan, arc of, 308 Risorius muscle, 26, 123 Rod cells, 94, 120 Rods, 120 Rolando, sulcal artery of, 142 Rolando, sulcus of, 105, 106 Rosenmuller, node of, 266 Rosenthal, vein of, 144, 145, 146 Rotator cuff muscles, 425 Rotatores cervicis muscle brevis, 176 longus, 176 Round ligament, 372 of liver, 288, 312 of uterus, 389 Round window (cochlear), 92, 95 closed by secondary tympanic membrane, 96 fossa of, 93

51 spinal nerve, 160, 410 anterior ramus of, 414 52 spinal nerve, 160 Saccule, 92, 95, 96, 124 Sacral artery * lateral, 171, 264, 341, 398, 402, 403 median, 307, 341, 364, 398, 402 Sacral canal, 157, 358 Sacral cornu, 157 Sacral crest intermediate, 157 lateral, 157 median, 157, 352, 357 Sacral curvature, 153 Sacral foramen anterior, 157, 353, 358 fourth posterior, 357 posterior, 157, 353 radiograph of, 156 Sacral ganglion, 167, 318 Sacral hiatus, 157 Sacral lymph nodes lateral, 266, 408 middle, 266, 408 Sacral nerve, 161 perineal branch of, 499 vertebrae and, 161 Sacral parasympathetic outflow, 165 Sacral plexus, 160, 177, 267, 344, 345, 415, 416, 499 left, 318 right, 323 Sacral promontory, 157, 248, 412 Sacral sympathetic trunk left, 412 right, 412 Sacral vein, median, 311 Sacrogenital fold, 340 Sacroiliac joint, 358 female, 354 radiograph of, 355 Sacrospinous ligament, 159, 352, 353, 357, 359, 410, 495, 503 Sacrotuberous ligament, 357, 376, 379, 395, 402, 410, 411, 495, 502, 503 Sacrouterine ligament, 364 Sacrum (S1-5), 152, 160 ala of, radiograph of, 355 anterior view of, 153, 171 apex of, 157 arteries of, 171 articular facet for, 155 articular surface of, 157, 486 base of, 157 coronal section through, 157 dorsal surface of, 157 facets of superior articular process, 157 left lateral view of, 153 medial sagittal section of, 157 pelvic surface of, 157 posterior view of, 153 promontory of, 157, 248, 412 radiograph of, 355 sacral crest of, 157 sacral tuberosity of, 157 sagittal MR images of, 397 spinal nerves and, 161

Sacrum (S1-5) (Continued) superior articular process of, 157 transverse ridges of, 157 Sagittal sinus inferior, 103, 145, 146 superior, 99, 100, 102, 103, 106, 109, 144, 145 axial MR image of, 150 Sagittal suture, 7, 12 Sagittal vein, inferior, 144 Salivary glands, 61 frontal section of, 51, 60 horizontal section of, 51, 60 lingual minor, 51 molar minor, 52 sublingual, 51, 60 submandibular, 51. 60 Salivatory nucleus inferior, 116, 117, 125, 134 superior, 116, 117, 123, 133 Salpingopharyngeus muscle, 126 Saphenous nerve, 500, 538, 544 branches of, 538, 545 infrapatellar branch of, 500, 538 Saphenous opening, 250, 544 cribriform fascia in, 249 Saphenous vein accessory, 544, 546 great, 250, 485, 544, 545, 546 small. 485, 544, 545 Sartorius muscle, 376 Sartorius muscle, 485, 492, 495, 499, 500, 538 attachments of, 490, 491, 515 Sartorius tendon, 492, 493 Scala tympani, 92, 95, 96 Scala vestibuli, 91, 95, 96 Scalene muscle anterior, 27, 30, 32, 74, 186, 189, 193, 198, 206, 211, 230, 427, 429 slips of origin of, 30 middle, 27, 30, 32, 69, 70, 186, 189 nerves to, 129 nerves to, 129, 430 posterior, 27, 30, 186, 189, 232 slips of origin of, 30 Scalp epicranial aponeurosis of, 26 skin and subcutaneous tissue of, 26 superficial arteries and veins of, 23 Scapha, 93 Scaphocapitate ligament, 454 Scaphoid bone, 456 anterior (palmar) view of, 452 area for, 439 coronal section of, 455 posterior (dorsal) view of, 452 tubercle of, 452, 454, 456 Scaphoid fossa, 93 Scapholunate ligament, 455 Scaphotrapeziotrapezoid, 454 Scapula, 29, 180, 185, 192, 243, 244, 245 acromion of, 185 anastomoses around, 427 anterior view of, 420, 427 axillary artery and anastomoses around, 427 body of, 428 coracoid process of, 213 glenoid cavity of, 420 anteroposterior radiograph of, 422

Scapula (Continued) inferior angle of, 152, 246, 420 infraglenoid tubercle of, 420 infraspinous fossa of, 185 lateral border of, 420 anteroposterior radiograph of, 422 medial border of, 152, 420 neck of, 420 posterior view of, 421, 427 spine of, 152, 174, 177, 185, 197, 213, 424, 427, 428 anteroposterior radiograph of, 422 subscapular fossa of, 185 superior angle of, 420 superior border of, 420, 425 suprascapular notch of, 184 supraspinous fossa of, 421 Scapular artery circumflex, 427, 429, 430, 434 dorsal, 32, 137, 427, 429 Scapular ligament, superior transverse, 423, 425, 427 Scapular nerve, dorsal, 429, 477 Scapulohumeral dissection anterior view of, 426 lateral view of, 426 posterior view of, 426 Scarpa's (membranous) layer, 249, 380 fascia latae attachment to, 249 Schlemm's canal. See Scleral venous sinus (canal of Schlemm) Sciatic foramen greater, 352, 353, 357, 540 lesser, 352, 353, 357 Sciatic nerve, 160, 495, 499, 503, 539, 540 articular branch of, 502 branches of, 499, 540 common fibular division of, 499, 540 left, 376 muscles innervated by, 540 right, 376 tibial division of, 499, 540 Sciatic notch greater, 248, 486 lesser, 248, 486 Sclera, 81, 83, 87, 88, 91 bulbar conjunctiva, 81 lamina cribosa of, 87 Scleral spur, 8 / Scleral venous sinus (canal of Schlemm), 87, 88, 90, 91 veins draining, 91 Scrotal artery, posterior, 403, 406 Scrotal ligament, 389 Scrotal nerve anterior, 409 posterior, 411, 503 Scrotal nerve, posterior, 410, 411, 503 Scrotal vein, anterior, 256 Scrotum, 351, 388 cross section through, 390 skin of, 390 superficial fascia of, 249 Sebaceous gland, 81 Segmental artery anterior inferior, 335 anterior superior, 335 inferior superior, 335

Segmental artery (Continued) posterior, 335 superior, 335 Segmental medullary artery anterior, 171, 172 major anterior, 171 posterior, 171 Segmental medullary vein, 173 Sella turcica, 6, 9, 39 hypophysis in, 37 Semicircular canal anterior, 95, 96, 97 axial MR image of, 150 lateral, 95, 96, 97 plane of, 97 posterior, 95, 96, 97 prominence of, 92 Semicircular duct, 92 ampulla of, 92, 124 anterior, 95, 96 lateral, 95, 97, 124 posterior, 96T 97, 124 superior, ampulla of, 124 Semilunar fold, 284 Semilunar hiatus, 37, 38 with anterior ethmoidal cell openings, 38 at birth, 50 Semilunar line, 247 left, 268 right, 268 Semilunar lobule inferior, 113 posterior, 113 Semilunar plane, 286 Semilunar vale, nodule of, 223 Semimembranous bursa, 511 Semimembranous muscle, 494, 495, 540 attachments of, 491 tendinous expansion of, 511 Semimembranous tendon, 506, 508, 511, 518 groove for insertion of, 513 Seminal colliculus, 366, 384 Seminal vesicle, 361, 363, 384, 389, 391 Seminiferous tubule, 390 Semispinalis capitis muscle, 174, 175, 176, 178, 424 in posterior triangle of neck, 178 Semispinalis cervicis muscle, 178 Semispinalis thoracis muscle, 176 Semitendinosus muscle, 489, 495, 503, 515, 540 attachments of, 489, 491 Semitendinosus tendon, 492, 493, 506, 507 Sensory cortex, 135 Septal artery branches, 40 Septomarginal trabecula, moderate band of, 220, 224, 225 Septum, 205 Septum pellucidum, 106, 108, 110, 111, 112, 141, 143, 145, 147 anterior vein of, 145, 146 posterior veins of, 146 Serosa of ileum, 280 jejunal, 280 of spleen, 299 of vermiform appendix, 283

Serous glands of von Ebner. See Lingual glands (serous glands of von Ebner) Serratus anterior muscle, 174, 180, 181, 182, 186, 192, 243, 245, 246, 247, 249, 250, 258, 418, 420, 424 digitations of, 186, 188, 189 fascia of, 428 insertion of, 420 Serratus posterior inferior muscle, 175, 179, 254, 330 Serratus posterior muscle, 174 Serratus posterior superior muscle, 174, 175 Sesamoid bone, 456, 524, 534, 535, 536, 537 lateral, 523 medial, 523 plantar view of, 523 Shoulder anterior view of, 423, 474, 479 anteroposterior radiograph of, 422 capsule of, 432 coronal section of, 423 cutaneous nerves of, 479 glenohumeral joint, 423 lateral view of, 423 muscles of, 424 nerves of, 429-430 posterior, 477 posterior, nerves of, 477 posterior view of, 479 superficial veins of, 479 Sigmoid artery, 323, 340 Sigmoid lymph nodes, 317 Sigmoid plexus, 323 Sigmoid sinus, 11, 97, 103 groove for, 6, 9 Sigmoid vein, 311, 312 Sigmoid vessels, attachment of, 274 Sinuatrial lymph nodes, 225 SinuatriaB nodal artery, 216, 218, 225 Sinuses confluence of, 144, 145 axial MR image of, 150 frontal, 37, 38 maxillary, opening of, 37 paranasal, 47-50 sphenoidal, 37, 38 opening of, 37, 38 straight, 144 transverse, 145 transverse left, 144 Sinusoid, 290, 291, 292 Skene's glands. See Paraurethral (Skene's) glands Skin over rectus sheath, 252 perianal, 393, 394 SkuflB anterior view of, 2 anteroposterior radiograph of, 3 base of, 66, 160, 161 diploic and emissary veins of, 99 fracture of, 101 horizontal section through, 104 labyrinth orientation in, 97 lateral view of, 4 midsagittal section of, 6 of newborn, 12 skin of, 102 superior nuchal line of, 174, 175, 176

Soleal line, 513 Sole (foot) cutaneous innervation of, 541 muscle layers of, 532, 533, 535 Soleus muscle, 506, 516, 517, 520, 521, 522, 540 attachments of, 515 innervation of, 541 insertion of, 517 nerve to, 516, 517 tendinous arch of, 495, 517 Solitary tract nucleus, 116, 117, 123, 125, 126, 135, 345 Sound reception, pathway of, 92 Spermatic cord, 260, 261, 376 cremasteric fascia on, 260 cremasteric muscle of, 257 ductus deferens in, 255 external spermatic fascia of, 249, 257, 259 external spermatic fascia on, 249 external spermatic fascia over, 405 internal spermatic fascia on, 262 Sphenoethmoidal recess, 37, 38 Sphenoidal fontanelle, 12 Sphenoidal sinus, 6, 37, 38, 39, 48, 49, 63, 64, 83 axial MR image of, 150 within bony shell, 50 coronal CT images of, 151 opening of, 6, 37, 38, 49 sagittal MR image of, 149 Sphenoid bone, 9, 38 body of, 6, 9, 50 carotid groove of, 9 clivus of, 9 foramen ovale of, 9 foramen spinosum off, 8 greater wing of, 2, 3, 4, 5, 8, 9, 151 orbital surface of, 2 infratemporal crest of, 4 lesser wing of, 2, 3, 6, 9 orbital surface of, 2 pterygoid hamulus of, 6 pterygoid process of, 4, 8, 12, 38 lateral plate of, 39 medial plate of, 39 sphenoidal sinus of, 38 spine of, 14 Sphenoid emissary foramen, 11 Sphenomandibular ligament, 40, 55 Sphenooccipital synchondrosis, 63 Sphenopalatine artery, 40, 41, 69 posterior lateral nasal branch of, 40 posterior septal branch of, 40 Sphenopalatine foramen, 4, 6, 13, 14, 38, 40, 42 Sphenopalatine vessels, 11 Sphenoparietal sinus, 103, 145 Sphincter muscle external, 367 external anal, 284, 288, 388, 395 internal, 367 of pupil, 132 Sphincter of ampulla, variations in, 295 Sphincter urethrae, 396 Sphincter urethrae muscle, 356, 359, 361, 365, 366, 378, 379, 383, 384, 385, 403, 416

Sphincter urethrovaginalis muscle, 366, 370, 378, 379 Spinal artery anterior, 11, 141, 171, 172 anastomotic loops to, 171 posterior, 11, 172 anastomotic loops to, 171 * left, 143, 172 right, 172 Spinal cord, 243, 244 arteries of, 171 intrinsic distribution of, 172 ascending fibers of, 416 axial CT images of, 242 central canal of, 108, 109 descending fibers of, 416 descending tracts in, 108 in situ, 160 sacral, 324 sagittal MR image of, 149 schema of, 167, 346 thoracic, 134, 210, 327, 328 thoracic part of, 132 thoracolumbar, 324 veins of, 173 Spinal dura mater, 160 Spinal ganglion, dorsal, 170 Spinalis cervicis muscle, 175 Spinalis cervicis muscle, 175 Spinalis erector muscle, 349 Spinalis muscle, 175, 331 Spinalis thoracis muscle, 175 Spinal membranes, 169 Spinal meninges, 325 Spinal nerve, 258 anterior cutaneous branch of, 180 cervical, 127, 160 collateral branch of, 258 dorsal branch of, 258 dorsal ramus of, 169, 170 groove for, 19 intervertebral foramen for, 18 lumbar, 179 meningeal branch of, 258, 325 origin of, 170, 258 recurrent meningeal branches of, 170 recurrent meningeal branches of, 170 segmental medullary branches of, 138 to skin vessels and glands, 325 thoracic, 180, 258 ventral ramus of, 169, 258 Spinal nerve roots anterior, 321 anterior view of, 169 dorsal, 114, 169 filaments of, 160 posterior view of, 169 relation to vertebrae, 161 ventral, 114, 170, 180, 321 Spinal nerve trunk, 258 Spinal perivascular plexus, 322 Spinal sensory ganglion, 258, 321, 324, 327 anterior cutaneous fibers of, 258 ascending fibers of, 345 communicating branch of, 258 descending fibers of, 345 dorsal root of, 180, 325, 327, 328, 345 lateral cutaneous branch of, 258 ventral root of, 258

Spinal tract, 125, 126 trigeminal nerve and, 116, 117 Spinal vein anterior, 144, 173 posterior, 144, 173 Spinous process lumbar, 155 radiograph of, 156 thoracic, 154 Spiral ganglion, 96 Spiral lamina hamulus of, 95 osseous, 95, 96 Spiral ligament, 96 Spiral organ (of Corti), 92, 96 Splanchnic nerve abdominopelvic, 228, 324, 325 cardiopulmonary, 228 first lumbar, 323 fourth lumbar, 318 greater thoracic, 167, 209, 230, 240, 258, 263, 267, 320, 324, 327, 409 left, 194, 318, 321, 323, 327, 328, 346 right, 194, 240, 318, 320, 321, 327, 328, 346 least thoracic, 209, 263, 267, 320, 322, 323, 324, 325, 344, 345, 409 left, 323, 346 right, 318, 320, 346 lesser thoracic, 165, 167, 209, 258, 263, 267, 318, 320, 321, 322, 324, 325, 345, 409 left, 318, 319, 323, 346 right, 346 lumbar, 160, 165, 318, 345, 409, 412 left first, 346 right first, 346 second, 344 upper, 415 pelvic, 166, 168, 323, 344, 345, 412, 499 sacral, 165, 273, 344, 412, 499 thoracic, 346 Spleen, 196, 197, 272, 273, 288, 290, 293, 297, 331, 347, 349 anterior extremity of, 299 area for, 329 arteries of, 300, 301 axial CT images of, 350 colic impression of, 299 cross section of, 297, 299, 338 diaphragmatic surface of, 299 fibrous capsule of, 299 gastric impression of, 299 hilum of, 299 in situ, 299, 347 posterior extremity of, 299 pulp of, 299 renal impression of, 299 serosa of, 299 superior border of, 299 veins of, 309 visceral surface of, 299 Splenic artery, 237, 278, 297, 298, 299, 300, 301, 305, 306, 318, 319, 320, 321, 327, 328 arteriogram of, 303 left, 264 origin of, 302 pancreas and, 274 splenic branches of, 300

Splenic capitis muscle, 174, 175, 178, 424 Splenic cervicis muscle, 175, 178 Splenic flexure, 269, 271. See also Colic flexure, left Splenic lymph nodes, 314, 315 Splenic plexus, 318, 319, 320 Splenic pulp, 299 Splenic trabeculae, 299 Splenic vein, 273, 297, 299, 303, 306, 311, 312, 313, 315 cross section of, 338 Splenic vessels, 274, 348, 349 Splenium, of corpus callosum, 143, 145 Splenius capitis muscle, 174, 178, 424 in posterior triangle of neck, 178 Splenius cervicis muscle, 178 Splenius muscle, 27 Splenorenal ligament, 272, 299, 329 with splenic vessels, 331 Squamous suture, 12 S1 spinal nerve, 160 S5 spinal nerve, 160 Stapes, 92, 93 anterior limb of, 93 base of, 92, 93 footplate of, 93 head of, 93 limbs of, 92 in oval window, 96 posterior limb of, 93 Stapius muscle nerve to, 123 tendon of, 93 Stellate ganglion. See Cervicothoracic ganglion Stellate veins, 334 Sternal angle, 245 Sternalis muscle, inconstant, 188 Sternoclavicular joint, 196 articular cavities of, 419 articular disc of, 419 transverse section of, 243 Sternoclavicular ligament, anterior, 419 Sternocleidomastoid artery branch, 34 Sternocleidomastoid lymph node, 72 Sternocleidomastoid muscle, 27, 31, 32, 34, 73, 74, 127, 129, 174, 178, 188, 198, 247, 419, 424, 429 accessory nerve to, 127 clavicular head of, 27, 28, 181, 247 medial margin of, 74 origin of, 419 sternal head of, 27, 28, 181, 247 Sternocostal articulations, 186 Sternocostal joint, 419 Sternocostal ligament, 186 intraarticular, 186 radiate, 186, 419 Sternocostal triangle, 195 Sternohyoid muscle, 27, 28, 29, 31, 32, 53, 128, 129, 189, 198 invested by cervical fascia, 188 nerve to, 71 origin of, 419

Sternothyroid muscle, 27, 28, 29, 31, 32, 128, 129, 198 nerve to, 71 Sternum, 26, 29, 180, 194, 233, 246, 424 angle of, 185 axial CT images of, 242 body of, 181, 185, 247, 248 head of, 181 jugular notch of, 185 manubrium of, 27, 28, 185 xiphoid process of, 181, 184, 185, 247 Stomach, 167, 215, 237, 269, 273, 276, 294, 297, 298, 331 angular notch of, 275 area for, 329 arteries of, 300 atonic, 275 axial CT images of, 350 body of, 275, 279 cardiac parts of, 233, 236, 277 cardiac zone of, 276 chief cells of, 276 circular muscle layer of, 236 cross section of, 297 fundus of, 233, 236, 275, 293 barium radiograph of, 279 vagal branch to, 240 gastric zone of, 276 greater curvature of, 275 hypertonic, 275 hypotonic, 275 in situ, 275 innervation of, 321 lesser curvature of, 275 posterior vagal branch to, 240 longitudinal muscle layer of, 236, 277 lymph follicle of, 276 lymph vessels and nodes of, 314 mucosa of, 276 mucous cells of, 276 muscularis mucosae of, 276 musculature of, 236, 277 nerves of, 319, 320 oblique muscle layer of, 236 orthotonic, 275 posterior surface of, 272 reflected, 272 submucosa of, 276 surface epithelial cells of, 276 variations in position and contour of, 275 veins of, 309 zigzag line of, 236 Straight artery, 307 branch of, 326 of ileum, 280 of jejunum, 280 Straight gyrus, 107 Straight sinus, 144, 146 in tentorium cerebelli, 103 Strap muscle, 118 Stratified squamous epithelium, tongue,58 Stretch receptors, 210 Stretch reflex pathway, 325 Stria medullaris, 106 Striate artery, distal medial, 140, 141, 142 Stria terminalis, 108, 111, 112 Striatum, 110 Styloglossus muscle, 27, 32, 59, 60, 128

Stylohyoid ligament, 13, 59, 64, 65, 68 Stylohyoid muscle, 27, 28, 29, 34, 40, 59, 60, 61, 67, 68, 123 nerve to, 25 Styloid process, 14, 27, 29, 30, 34, 53, 59 radial, 439 ulnar, 439 Stylomandibular ligament, 15 Stylomastoid foramen, 25, 123, 125 Stylopharyngeus muscle, 59, 65, 68, 125, 126, 235 Subacromial bursa, 423 Subaponeurotic space, 468 Subarachnoid space, 87, 99, 102, 109 in lumbar puncture, 162 thoracic, 170 Subcallosal area, 106, 119 Subcallosal gyrus, 106 Subclavian artery, 30, 32, 74, 76, 130, 171, 183, 189, 198, 206, 211, 237, 427 anomalous, 80 grooves for, 186 left, 75, 80, 137, 193, 243 right, 75, 126, 137, 193, 230 anterior dissection of, 33 oblique schematic view of, 33 Subclavian lymphatic trunk, 208 Subclavian lymph node, 184 Subclavian trunk left, 266 right, 266 Subclavian vein, 30, 32, 74, 189, 198, 206, 211 grooves for, 186 left, 75, 137, 186 right, 75, 137, 230 Subclavius muscle, 186, 189, 230, 419, 428, 429 fascia investing, 428 fascia of, 428 insertion of, 419invested by clavicopectoral fascia, 188 nerve to, 430 Subcostal artery, 264 lower anastomoses with, 255 Subcostal muscle, 258 Subcostal nerve, 160, 267, 409, 498 lateral cutaneous branch of, 267 lateral femoral cutaneous branch of, 544 right, 329 Subcostal plane, 268 Subcostal vein, 498 Subcutaneous bursa, 511 Subcutaneous olecranon bursa, 438 Subcutaneous space, dorsal hand, 462 Subcutaneous tissue of abdomen, 249, 252 Camper's and Scarpa's layers of, 249 deep membranous, 380, 381 fatty layer of, 348, 361, 378 superficial, 380 of mammary gland, 182 membranous, 348, 361, 378 of rectus sheath, 252. Subdeltoid bursa, 423 Subdural hematoma, site of, 101 Subendocardial branch, 225 Subependymal vein, 146

Subhiatai fat ring, 236 Sublingual artery, 59, 61 Sublingual caruncle, 51 with openings of submandibular ducts, 51 Sublingual duct, 51 openings of, 61 Sublingual fold, 51 with openings of sublingual ducts, 51 Sublingual fossa, 15 Sublingual gland, 51, 53, 61, 123, 133, 167 mucous, 61 Sublingual nerve, 46 Sublobular vein, 290, 291 Submandibular duct, 51, 53, 59, 60 Submandibular fossa, 15 Submandibular ganglion, 59, 122, 123, 131, 133, 166, 168 schema for, 133 Submandibular giand, 27, 28, 31, 32, 53, 123, 133, 166, 167 mucous, 61 serous, 61 Submandibular lymph nodes, 73 Submental artery, 40 Submental vein, 70 Submucosa of intestine, 326 of stomach, 277 of vermiform appendix, 283 Submucosal gland, 326 Submucosal plexus, 326 Submucous (Meissner's) plexus, 326 Submucous space, 392 internal rectal venous plexus in, 393 perianal, 396 Suboccipital nerve, 21, 178 Suboccipital triangle, 178 Subparotid node, 72 Subpleural capillary, 205 Subpleural lymphatic plexus, 208 Subpopliteal recess, 507, 508 Subpubic angle, radiograph of, 355 Subpyloric lymph nodes, 314 Subscapular artery, 427, 434 computed tomography of, 484 Subscapular fossa, 185 Subscapularis muscle? 180, 192, 243, 244, 245, 425, 428, 433 insertion of, 420 origin of, 420 subtendinous bursa of, 423 Subscapularis tendinous muscle openings of, 423 position of, 423 Subscapularis tendon, 423, 425 Subscapular nerve lower, 429, 430, 477 upper, 429, 430 Subserous fascia, 412 Subserous plexus, 326 Substantia nigra, 107 Subtendinous bursa, 511 Subtrapezial plexus, 177 Subungual space, 471 Sulcal artery, 141 central, 141, 142 postcentral, 142 precentrai, 141 prefrontal, 142

Sulcal vein anterior, 173 posterior, 173 Sulcus dorsal median, mesothelial septum in, 169 hippocarnpal, 112 hypothalamic, 147 intraparietal, 105 occipital transverse, 105 occipitotemporal, 107 olfactory, 107 Sulcus limitans, 115 Sulcus terminalis, 214 Superciliary arch, 1 Superficialis flexor tendon, in common tendon sheath, 460 Superficial perineal (Colles9) fascia, 358, 361, 366, 370, 378, 380, 411 attachment of, 380 Supinator artery, 447 Supinator muscle, 420, 440 insertion of, 420 origin of, 420 Supraclavicular nerve, 24, 31 intermediate, 129, 479 lateral, 129, 479 medial, 129, 479 Supracondylar ridge, 436 Supraduodenal artery, 300, 301, 306 Supraglenoid tubercle, 420 Suprahyoid artery, 59 Suprahyoid muscle, action of, 29 Supramarginal gyrus, 105 Supraoptic nucleus, 147 Supraopticohypophyseal tract, 147 Supraoptic recess, 106, 108 Supraorbital artery, 23, 36, 40, 81, 85 Supraorbital nerve, 24, 36, 81, 122 branches of, 86 medial and lateral branches of, 86 Supraorbital notch, 1 foramen, 2 Supraorbital vein, 23, 70, 85 Suprapatellar synovial bursa, 511 Suprapineal recess, 108 Suprapleural membrane, 230 cervical, 231 Suprapyloric lymph nodes, 314 Suprarenal gland, 197, 278, 298, 299, 329, 340, 342 arteries and veins of, 332, 333 cross section of, 347 dissection of, 346 in situ, 332 left, 197, 272, 297, 329, 331, 338, 346 nerves of, 344, 346 dissection of, 346 right, 197, 297, 329, 346 schema of, 346 dissection of, 346 Suprarenal impression, 287 Suprarenal-phrenic vein anastomosis, 265 Suprarenal plexus left, 323 right, 318 Suprarenal vein, 333, 347 inferior, 347 middle, 347 right, 332, 338

Suprascapular artery, 32, 74, 75, 76, 427, 429 infraspinous branch of, 427 Suprascapular nerve, 429 Suprascapular notch, 184, 185, 420, 421, 423, 427 Suprascapular vein, 70 Supraspinatus ligament, 179 Supraspinatus muscle, 177, 423, 427 428, 428 insertion of, 420 origin of, 420 Supraspinatus tendon, 423, 425 Suprasternal space, 28 Supratrochlear artery, 23, 40, 81, 85 Supratrochlear crest, 220, 224 Supratrochlear nerve, 81, 122 Supratrochlear vein, 23, 24, 85 Sural cutaneous nerve articular branches of, 541, 542 communicating branch of, 540 lateral, 540, 541, 542, 545 branches of, 544 communicating branch of, 545 medial, 540, 541, 545 Sural nerve, 534, 540, 541, 545 lateral calcaneal branch of, 541 medial calcaneal branch of, 541 via lateral calcaneal and lateral dorsal cutaneous branches, 541 Sustentaculum tali, 523, 524 Sweat gland, 9, 167 Sylvius, sulcus of, 141 Sympathetic ganglion, 409 lumbar, 170 superior cervical, 130, 132 superior ganglion, 125, 128, 131, 133, 134,210, 226 thoracic, 209 thoracic, third, 240 Sympathetic nervous system general topography of, 165 schema of, 167 Sympathetic trunk, 125, 133, 192, 210, 230, 258, 263, 267, 290, 324, 325, 327, 344, 409, 412, 499 cervical, 165 ganglia of, 321, 325, 344, 345 ganglion of, first thoracic, 132 left, 194, 318, 324, 346 left lumbar, 323 right, 194, 318, 328, 331, 346 sacral, 323 left, 412 right, 412 thoracic, 240 thoracic ganglia of, 321 Synovial cavities, 22, 187 Synovial membrane, 423, 471 attachment of to femur, 511 of hip joint, 487

T T1 spinal nerve, 132, 133, 134, 160 T2 spinal nerve, 133, 133 T7 spinal nerve, 414 lateral cutaneous branch of, 254 medial cutaneous branch of, 254

T10 spinal nerve, 410 T11 spinal nerve, 414 T12 spinal nerve, 160 ventral ramus of, 254 T10 ventral ramus, 345, 410 T1 vertebra, 13, 153, 160 spinous process of, 197 T4 vertebra, 230 T6 vertebra lateral view of, 154 superior view of, 154 T8 vertebra, 241 T10 vertebra, 241 T12 vertebra, 153, 160 body of, 349 lateral view of, 154 spinous process of, 152, 174, 175, 177 Taenia free, 271, 281, 282 mesocolic, 281, 282, 284 omental, 281, 284 Talofibular Bigament anterior, 514 posterior, 514 Talus dorsal view of, 523 head of, 523, 524 lateral tubercle of, 523 medial tubercle of, 523 neck of, 523, 524 plantar view of, 523 posterior process of, 523 groove for tendon of flexor hallucis longus, 523 lateral tubercle, 523 medial tubercle, 523 trochlea of, 523, 524 Tarsal artery lateral, 530, 536 medial, 530, 536 Tarsal gland, 81 openings of, 81 Tarsal joint, transverse, 523 Tarsal sinus, 523, 524 Tarsometatarsal joint, 523 Tarsometatarsal ligament, dorsal, 536 Tarsus of eyelid, 81 inferior, 81 superior, 81 Taste buds, 58 section of, 58 Taste pathways, 135 Tectal plate, 106 Tectorial membrane, 22, 96 deeper part of, 22 Tectospinal tract, 132 Teeth apical foramina of, 57 canine, 57 cement of, 57 crown of, 57 deciduous, 56 dentinal tubules of, 57 dentine of, 57 enamel of, 57 incisors, 56, 57, 233 interglobular spaces between, 57 interproximal spaces between, 57 labiobuccal view of, 57

Teeth (Continued) molar first, 56 growth of, 50 second, 56 third, 56 molars, 56, 57 neck of, 57 nerves to, 57 odontoblast layer of, 57 papilla of, 57 permanent, 56, 57 left lower, 57 left upper, 57 lower, 56 upper, 56 premolars, 56, 57 root canals of, 57 roots of, 57 Tegmen tympani, 92, 93 Tela choroideae, 108, 111, 145 Temporal artery deep, 99 anterior, 40 posterior, 40 posterior, 40 middle, 23, 99 parietal branch of, 23 polar, 142 superficial, 23, 34, 40, 99, 100, 134 frontal branch of, 23, 85 Temporal bone, 9 petrous part of, 9, 97 squamous part of, 997 Temporal fossa, hematoma of, 101 Temporal gyrus inferior, 105, 107 middle, 105 superior, 105 Temporalis muscle, 54 axial MR image of, 150 insertion of, 15, 54 nerves to, 122 Temporal lobe, 105, 107, 141 axial MR image of, 150 hematoma of, 101 herniation of, 101 Temporal nerve branches of, 122 deep, 122 anterior, 40 posterior, 40 schema of, 122 Temporal sulcus inferior, 107 Temporal vein deep, 99 middle, 23, 99 superficial, 99 branches of, 23, 99 frontal and parietal branches of, 99 tributary of, 102 Temporomandibular joint articular disc of, 54, 55 lateral ligament of, 40 Tendinous intersection, 83 : 84, 86, 121, 181, 247 Tenon's capsule. See Fascial sheath of eyeball (Tenon's capsule)

Tensor fasciae latae muscle, 36, 485, 492, 494, 503 attachments of, 491 origin of, 492 Tensor tympani muscle, 93 tendon of, 93 Tensor tympani nerve, 122 Tensor veli papatini muscle, 52, 93, 122 tendon of, 52 Tensor veli papatini nerve, 55 Tentorium cerebelli, 86, 101, 103, 144, 145 sagittal MR image of, 149 straight sinus in, 106 Teres major muscle, 152, 174, 177, 180, 244, 245, 424, 427, 428, 433 insertion of, 420 lower margin of, 434 Teres minor muscle, 174, 177, 243, 244, 245, 423, 424, 425, 427, 428 Terminal sulcus, 58 Testicular artery, 387, 403, 409, 416 left, 329, 332 right, 332 Testicular plexus, 409, 416 right, 318 Testicular vein, 311, 329, 332 right, 311, 322 Testicular vessels, 340, 363 left, 332 lymphatic pathways along, 408 in spermatic cord, 401 Testis, 361, 386, 389, 390, 416 appendix of, 387, 389 arteries and veins of, 401 cross section of, 390 cross section through, 390 descent of, 386 external spermatic fascia over, 405 lobules of, 390 lymphatic pathways from, 408 pathways from, 408 sagittal MR images of, 397 schema of, 390 septa of, 390 tunica albuginea of, 390 visceral layer over, 387 Thalamic vein, superior, 146 Thalamogeniculate artery, 143 Thalamoperforating artery, 140, 143 Thalamostriate vein inferior, 144, 146 posterior part of, 146 superior, 108, 111, 145, 146 Thalamotuberal artery, 140 Thalamus, 106, 108, 110, 112, 114, 145, 147, 324 left, 144 geniculate bodies of, 143 nuclei of, 111 pulvinars of, 107, 111, 143, 145 sagittal MR image of, 149 schema of, 111 stria medullaris of, 106 stria terminalis of, 111 ventral posteromedial nucleus of, 135 Thecal sac, sagittal MR images of, 397 Thenar eminence, 418

Thenar muscle, 446, 460 innervation of, 460 supplied by median nerve, 476 Thenar space,462 dorsal extension of, 460 Thigh anterior cutaneous nerve of, 545 arteries of, 500, 501, 512 bony attachments of anterior view of, 490 posterior view of, 491 cutaneous innervation of, 538, 540 lateral cutaneous nerve of, 538 muscles of anterior views of, 491, 493 lateral views of, 494 posterior views of, 495 nerves of, 500, 501, 538, 540 anterior view of, 501 posterior view of, 502 serial cross sections of, 505 Thoracentesis, 190 Thoracic aortic plexus, 209 Thoracic artery anterior intercostal branches of, 189 internal, 189, 198, 206, 211, 237, 244, 245, 246, 305 perforating arteries of, 188 lateral, 183, 188, 189, 427, 434 left, 193, 194 perforating branches of, 183 right, 193, 230 superior, 189, 427, 429, 434 Thoracic cardiac nerve, 193, 209 Thoracic constriction, 233 Thoracic duct, 189, 194, 198, 206, 209, 211, 244, 245, 246, 263, 266, 293, 318 Thoracic ganglion, 167 Thoracic muscle, transversus, 194 Thoracic nerve, 161 dorsal ramus of, 192 long, 188, 189, 192 Thoracic spinal nerve, 133 dorsal root of, 133 ventral root of, 133 Thoracic sympathetic nerves, 130 Thoracic vein internal, 189, 198, 244, 245, 246 left, 194 right, 194 Thoracic vertebrae, 21 anterior view of, 171 arteries of, 171 cross section through, 170 Thoracic visceral nerves, 165 Thoracic wall anterior, 188-189 Thoracis muscle, transversus, 189 Thoracoabdominal nerve, cutaneous branch of, 188 Thoracoacromial artery, 424, 427, 428 acromial branch of, 424, 427, 429 clavicular branch of, 424, 427, 429 deltoid branch of, 424, 427, 429 pectoral branch of, 424, 427, 429 Thoracodorsal artery, 427, 434 Thoracoepigastric vein, 249

Thorax autonomic nerves in, 209 bony framework of, 185 cross sections of, 246 at T3-4 disc level, 244 at T4-5 disc level, 245 at T7 disc level, 246 at T3 lower level, 243 surface anatomy of, 181 Thumb distal phalanx of, 457 innervation of, 460 proper palmar digital nerves of, 460 Thymus, 211, 230, 244 Thyroarytenoid muscle, 78, 79, 80 Thyrocervical trunk, 32, 74, 75, 76, 237, 427 right, 137 Thyroepiglottic ligament, 77 Thyroepiglottic muscle, 80 Thyrohyoid membrane, 29, 74, 77, 235 Thyrohyoid muscle, 27, 28, 29, 31, 32, 53, 128, 129 Thyroid artery inferior, 32, 74, 76, 427 esophageal branch of, 237 superior, 31, 32, 34, 74, 75, 76 superior laryngeal branch of, 34 Thyroid gland, 29, 31, 196, 198, 206 anterior view of, 74 articular surface of, 78, 80 fibrous capsule of, 76 isthmus of, 74 posterior view of, 75 pyramidal lobe of, 74 right lobe of, 74, 75, 76 Thyroid notch, superior, 77 Thyroid vein inferior, 74, 75, 198 middle, 74 superior, 31, 74 Tibia, 511, 530 anterior border of, 485, 513, 514 anterior view of, 513 with posterior ligament attachments, 513 cross section of, 514 inferior articular surface of, 513, 514 interosseous border of, 513, 514 lateral condyle of, 494, 510, 513 lateral surface of, 513, 514 medial border of, 513, 514 medial condyle of, 513, 514 medial surface of, 513, 514 oblique line of, 513 posterior surface ofr 514 posterior view of, 513 radiograph of, 510 superior articular surface of, 514 superior view of, 514 tuberosity of, 492, 493, 511, 513, 514 Tibial artery anterior, 512, 530 posterior, 512, 534 medial calcaneal branch of, 533, 535 posterior medial malleolar branch of, 534 Tibial collateral ligament, 511

Tibialis anterior tendon, 485, 494, 536, 542 attachment of, 515 tendinous sheath of, 530 tendon of, 530 Tibialis posterior muscle, 534, 541 attachment of, 515 tendon of, 535, 536 Tibial nerve, 495, 540, 541 articular branches of, 540 lateral plantar, 541 medial calcaneal branch of, 533, 535, 540, 541, 545 medial plantar, 541 muscles innervated by, 541 posterior, 534 Tibiofibular ligament anterior, 514 posterior, 514 Toe fifth distal, middle, and proximal phalanxes of, 537 vein of, 544 great distal phalanx of, 537 medial side of, 544 proximal phalanx of, 537 Tongue, 37, 39, 59, 125 apex of, 58 body of, 58 crypt of, 58 dorsum of, 58 frenulum of, 51 frontal section of, 60 horizontal section of, 60 inferior longitudinal muscle of, 128 intrinsic muscles of, 128 lateral view of, 59 lymphatic drainage of, 73 lymph vessels and nodes of, 73 muscles of, 59, 60 vertical and transverse., 60 posterior, 125 root of, 58, 235 sagittal MR image of, 149 salivary glands and, 60 schematic stereogram of, 58 superior longitudinal muscle of, 128 taste anterior of, 125 Tonsil, palatine, 58 Tonsillar artery, 40 Torus tubarius, 37, 39 Trabecula, 148 artery of ; 148 Trabeculae carneae, 220 Trachea, 29, 74, 75, 77, 126, 168, 196, 198, 202, 211,213, 230, 234, 237, 243, 244 arteries of, 202 bifurcation of axial CT images of, 242 cartilage of, 28, 202 cross section through, 202 elastic fibers of, 202 epithelium of, 202 mucosa of posterior wall of, 202 nerve of, 202 Trachealis muscle, 202 Tracheobronchial lymph nodes, 244 inferior, 245

Tracheobronchial nodes, 266 Tracheobronchial tree, innervation of, 210 Transpyloric plane, 268 Transverse process, lumbar, 19, 179 Transverse process, lumbar, 155 Transverse sinus, 97, 103 groove for, 9 left, 144 Transversospinalis muscle, 243 Transversus abdominis muscle, 180, 192, 261 Transversus thoracis muscle, 180, 192 Trapeziocapitate ligament, 454, 455 Trapeziotrapezoid ligament, 455 Trapezium, 456 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 tubercle of, 452, 454, 456 Trapezius muscle, 27, 29, 127, 129, 152, 174, 177, 180, 188, 189, 192, 244, 246, 247, 418, 419, 420, 428 : 429 insertion of, 420 Trapezoid bone, 456 anterior (palmar) view of, 452 coronal section of, 455 posterior (dorsal) view of, 452 Trapezoid ligament, 423 Treitz, ligament of, 270 Triangle of auscultation, 152, 246, 424 Triangle of Petit. See Lumbar triangle (of Petit) Triangular fossa, 93 Triceps brachii muscle, 152, 429, 444, 446 lateral head of, 152, 181, 245, 418, 424, 427 long head of, 152, 243, 244, 418, 420, 424, 427, 433 tendon of, 152, 438 Tricuspid valve anatomy of, 223 anterior cusp of, 222, 223, 224 orifice of, 246 posterior of, 222, 223, 224 right fibrous ring of, 222, 225 septal cusp of, 222, 223, 224 Trigeminal ganglion of, 86, 116, 117, 132, 133, 134, 135 Trigeminal impression, 9 Trigeminal nerve, 24, 97, 114, 116, 117, 122, 133, 134, 135, 144 ganglion of, 131 maxillary division of, 24 mesencephalic nucleus of, 116, 117 motor nucleus of, 116, 117, 122, 135 motor root of, 131 ophthalmic division of, 24 parotid branches of, 122 principle sensory nucleus of, 116, 122 schema of, 122 sensory nucleus of, 117 sensory root of, 118, 131 spinal nucleus of, 116. 117, 122, 125, 126 spinal tract of, 117, 126 superficial branches of, 122

Trigeminal nucleus, 122 Trigone collateral, 111 habenular, 111 left fibrous, 222 right fibrous, 222 of urinary bladder, 361, 365, 366, 385 Triquetrocapitate ligament, 454 Triquetrohamate ligament, 454, 455 Triquetrum bone, 456 anterior (palmar) view of, 452 posterior (dorsal) view of, 452 Trochanter greater, 248, 376, 485, 487, 489, 492, 495, 496, 503 anteroposterior radiograph of, 488 radiograph of, 355 lesser radiograph of, 355 Trochlea, 420 Trochlear nerve (IV), 83, 84, 86, 114, 116, 121 schema of, 186 Trochlear nucleus, 117 Tuber cinereum, 106, 107, 114 median eminence of, 147 Tuberculum sellae, 9 Tuberohypophyseal tract, 147 Tufted cell, 119 Tunica albuginea, 390 Tunica vaginalis parietal layer of, 390 visceral layer of, 390 Turbinates, 37 Tympanic artery, anterior, 40 Tympanic canaliculus, 10 Tympanic cavity, 92, 93, 96, 124, 125 Tympanic membrane, 92, 93, 96 right, 93 Tympanic nerve, 93, 123, 125, 134 Tympanic plexus, 93, 123, 125, 132, 134 tubal branch of, 125

y Ulna, 436, 438, 439, 440, 441, 442, 443, 454, 465 anterior border of, 436 anterior (palmar) view of, 452 anterior surface of, 436 coronal section of, 455 coronoid process of, 437 dorsal tubercle of, 436 interosseous border of, 436 • lateral surface of, 429, 436 olecranon of, 418, 444 posterior border of, 436, 439 posterior (dorsal) view of, 452 posterior surface of, 436, 439 radial notch of, 436 radiograph of, 437 tuberosity of, 436, 439 Ulnar artery, 433, 434, 446, 447, 454, 460, 465 anterior recurrent, 447 computed tomography of, 484 deep palmar branch of, 447, 454, 460, 465 dorsal carpal branch of, 469 palmar carpal branch of, 465 with venae comitantes and ulnar nerve, 460

Ulnar bursa, 460 Ulnar collateral artery inferior, 433, 434 superior, 433, 434, 444 Ulnar nerve, 429, 433, 444, 446, 447, 454, 460, 465, 476 anterior view of, 476 articular branch of, 476 communicating branch of, 468 communicating branch with median nerve, 476 communicating with median nerve, 476 in cutaneous innervation, 476 to cutaneous innervation, 476 deep branch, 476 deep branch of, 447, 454, 465, 476 dorsal branches of to dorsum of middle and distal phalanges, 476 dorsal branch of, 444, 446, 468, 469, 476 dorsal digital branches of, 469 groove for, 436 inconstant contribution of, 476 muscles innervated by, 476 palmar branch of, 447, 476 palmar view of, 476 posterior (dorsal) view of, 476 posterior view of, 476 proper palmar digital branches of, 469 superficial branch of, 447, 460, 476 Ulnar recurrent artery anterior, 434 posterior, 434, 444 Ulnar styloid process, 452 Ulnocapitate ligament, 454 Ulnolunate ligament, 454 Ulnotriquetral ligament, 40, 454 Umbilical artery, 340, 341, 396 distal, "402 obliterated, 372 occluded part of, 229, 362, 363, 364, 400, 403 patent part of, 400, 402, 403 prenatal, 229 Umbilical ligament medial, 229, 259, 341, 401, 402, 403 median, 340, 364, 365, 400, 403, 409 Umbilical region, 268 Umbilical vein obliterated, 288 Umbilicus, 247, 305, 312 Umbo, 93, 96 Umbrical muscle fourth, 476 third, 476 Uncal vein, 145 Uncinate process, 19, 37, 38, 339 Uncovertebral joints, 19 Uncus, 106, 107, 119 Upper limb anterior view of, 418, 473 arteries of, 473 computed tomography of, 484 lymph nodes of, 483 lymph vessels and nodes of, 483 lymph vessels of, 483 nerves of, 473 posterior view of, 418 surface anatomy of, 418

Ureter, 271, 334, 341, 362, 363, 364, 365, 366, 391, 400, 402, 403, 410, 412 arteries of, 341 diagonal course of, 340 female, 340 left, 340 male, 340 nerves of, 344, 345 retroperitoneal, 340 right, 318, 329, 340, 372 upper, innervation of, 345 Ureteral plexus, right, 318 Ureteric fold, 362, 363, 369 Ureteric nerve, middle, 344 Ureteric orifice, 384 left, 366 right, 366 Ureteric plexus, 410 Ureieropelvic junction, 339 Urethra, 263, 367, 372, 389 beginning of, 376 cavernous, 368, 385 bulbous portion of, 371 pendulous portion of, 371 in children, 368 female, 356, 357, 360, 361, 389 frontal section, anterior view of, 379 schematic reconstruction of, 379 male, 381, 383 floor of, 385 hiatus for, 358 roof of, 385 membranous, 368, 385, 408 lymphatic pathway from, 408' musculofascial extensions to, 357 prostatic, 366, 368, 376, 384, 385 spongy, buibous portion of, 366 Urethral artery, 384, 405 Urethral crest, 384 Urethral fold, 388 partly fused, 388 Urethral gland, 380, 385 lacunae and openings of, 379 Urethral lacuna, 385 Urethral meatus, external, 361 Urethral orifice, 388 external, 360, 377, 379, 382, 385, 388 female external, 395 Urethral raphe, 388 Urethral sphincter, internal, 366, 367, 384, 385 Urethrovaginal sphincter, 367 Urinary bladder, 167, 269, 323, 329, 340, 367, 412 apex of, 361, 365 arteries of, 341 body of, 361, 365, 366 fascia of, 361, 364 female, 366 fundus of, 361, 365, 366 innervation of, 168, 417 interior of, 376 lateral ligament of, 364 lymph vessels and nodes of, 343 male, 366 mucosa of, 340 neck of, 362, 365, 366 nerves of, 344 orientation and supports of, 365 sagittal MR images of, 397 trigone of, 361, 365, 366, 385

Urinary bladder (Continued) ureteric orifice of, 366 uvula of, 366, 385 voiding cystourethrography of, 368 Urogenital fold, 388 Urogenital groove, 388 Urogenital hiatus, 367 Urogenital sinus, 389 Urogenital triangle, 380 Urticle, 92, 95, 96, 124 Uterine artery, 340, 341, 372 cardinal ligament with, 364 vaginal branches of, 404 Uterine ostium, 371 Uterine (fallopian) tube, 360, 362, 369, 370, 389, 400, 412, 415 abdominal ostium of, 371 ampulla of, 371, 372 fimbriae of, 371, 372 folds of, 371 infundibulum of, 371, 372 isthmus of, 371 uterine part of, 371 Uterine vein, 404 superior, 399 Uterine venous plexus, 399 Uterine vessels, 360, 361, 371 ovarian branches of, 372 Uterosacral fold, 362, 392 Uierosacral ligament, 360, 371, 372, 373 Uterovaginal venous plexus, 412 Uterovesical pouch, 372 Uterus, 370, 380, 388, 389, 400, 412 age changes and muscle pattern of, 373 anteflexion of, 377 arteries and veins of, 404 body of, 360, 371 cervix of, 360, 364, 369, 370, 371 degrees of retroversion of, 377 external os of, 371 frontal section of, 371 fundus of, 360, 362, 365, 369, 371 internal os of, 371 retracted, 412 round ligament of, 340, 389 sagittal MR images of, 397 U-V junction, 372 Uvula, 51 of urinary bladder, 366, 385 Uvular muscle, 52 V Vagal cardiac nerve, 130 Vagal fibers, 126 Vagal nucleus, dorsal, 116 Vagal trunk, 263, 321, 322, 323, 328 anterior, 126, 166, 209, 318, 319, 320, 321, 327, 344, 346 anterior gastric branch of, 319 celiac branches of, 216 celiac branch of, 319, 320, 321, 322 gastric branches of, 126 hepatic branch of, 126, 319, 320, 323, 327 celiac branches of, 320

Vagal trunk (Continued) posterior, 166, 318, 320, 321, 322, 323, 327, 328, 344, 346 branch to celiac plexus, 240 celiac branches of, 216, 319, 320, 321, 322 posterior gastric branch of, 320, 328 Vagina, 367 horizontal portion of, 372 musculofascial extensions to, 356 sagittal MR images of, 397 supporting structures of, 370 upper four-fifths of, 389 vertical portion of, 372 vestibule of, 370, 377 Vaginal artery, 340 Vaginal fornix, 371 anterior part of, 360 posterior part of, 360 Vaginal orifice, 388 Vaginal vein, 398 Vaginal venous plexus, 398 Vaginal vestibule, 389 artery of bulb of, 370 bulb of, 370, 404 artery to, 404 Vaginal! wall, 370, 373 Vagus nerve (X), 32, 34, 74, 75, 76, 114, 116, 117, 118, 125, 126, 127, 130, 131, 135, 206, 209, 210, 211, 325, 345 auricular branch of, 10, 24, 126 cardiac branch of, 209 celiac branch of, 321 cervical cardiac branch of inferior, 126 superior, 126 cholinergic, 210 communicating branch of, 126 communication to, 32 distribution of, 118 inferior ganglion of, 126, 127, 128, 135 left, 243, 244 meningeal branch of, 126 nucleus of, 324 pharyngeal branch of, 125, 126, 130 posterior nucleus of, 116, 117, 126, 324, 345 pulmonary plexus branch of, 209 right, 75, 80, 193, 226, 230 schema of, 118, 126 superior cervical cardiac branch of, 130, 131 superior ganglion of, 126, 127 thoracic cardiac branch of, 126, 226 Vallate papillae, 58, 135 Vallecula, 58 Vane comitantes, 59, 60 Vasa rectae spuria, 337 Vasa rectae vera, 337 Vastus intermedius muscle, 489, 493, 507, 538 attachments of, 489, 491 Vastus lateralis muscle, 485, 489, 491, 492, 493, 494, 500, 507, 538 attachments of, 489, 491 Vastus medialis muscle, 485, 489, 492, 493, 500, 538 attachments of, 489, 491, 538 nerve to, 500

Vater ampulla of, 294 major duodenal papilla of, 294 Vein brain, 146 of brain, 145 of forearm, 480 of hypophysis, 148 of hypothalamus, 148 of large intestine, 311 of pancreas, 309 of posterior cranial fossa, 144 of small intestine, 309 of spleen, 309 superficial, of lower limb, 545 of suprarenal glands, 347 vertebral, 137 Velum inferior medullary, 113 superior medullary, 113 Vena cava inferior, 179, 194, 206, 209, 213, 215, 220, 225, 230, 272, 273, 278, 293, 297, 298, 330, 331, 333, 339, 342, 347, 412 axial CT images of, 242, 350 cross section of, 297, 338 opening for, 223 persistent left, 333 right renal vein entering, 339 valve of, 220 superior, 74, 75, 206, 211, 213, 215, 220, 224, 225, 230, 244, 245, 246 axial CT images of, 242 prenatal, 229 Venae comitantes, 460 Venous arch, dorsal, 544 Venous plexus, 372 vertebral, 10 Ventral ramus, 170, 193 in situ, 160 Ventricle (cerebral) choroid plexus of, 109 fourth, 113, 115, 144, 146 axial MR image of, 150 choroid plexus of, 106, 114 lateral and median apertures of, 146 median sagittal section of, 114, 115 outline of, 143 posterior view of, 115 rhomboid fossa of, 114 sagittal MR image of, 149 vein of lateral recess of, 144 lateral, 108, 110, 146 choroid plexus, 109 choroid plexus of, 99, 108, 110, 143, 145 lateral vein of, 146 occipital horn of, 110, 111, 146 right, occipital horn of, 143 sagittal MR image of, 149 temporal horn of, 108, 111, 146 veins of, 146 left lateral, 108 aperture of, 108 central part of, 108 frontal horn of, 108 occipital horn of, 108 phantom view of, 108 temporal horn of, 108

Ventricle (cerebral) (Continued) right lateral, 108 third, 106, 108, 110, 111, 146 choroid plexus of, 106, 108 tela choroideae of, 108, 111, 145 Ventricle (heart) left, 213, 214, 221, 224, 246 axial CT images of, 242 posterior vein of, 216 posterior wall of, 221 right, 214, 215, 224, 246 axial CT images of, 242 opened, 220 Ventricular vein hippocampal, 146 inferior, 146 Ventromedial nucleus, 147 Venuiae rectae, 337 Vermian artery inferior, 143 superior, 143 Vermian vein inferior, 144 superior, 144, 146 Vermis, 113 inferior, 113 nodule of, 113 pyramid of, 113 tuber of, 113 uvula of, 113 superior, 113 central lobule of, 113 culmen of, 113 declive of, 113 folium of, 113 lingula of, 113 tuber of, 115 uvula of, 115 Vertebra. See also specific vertebrae body of, axial CT images of, 242, 350 lumbar, 155 radiographs of, 156 relation to spinal nerves, 161 spinous process of, axial CT images of, 242 thoracic, 154 Vertebral artery, 10, 21, 32, 75, 76, 100, 130, 140, 141, 171, 178, 226, 237 anterior meningeal branch of, 143 atlantic part of, 178 left, 143 meningeal branches of, 10 posterior meningeal branch of, 100, 143 right, 143 venus plexus of, 137 Vertebral body, 19 articular facets for, 186 fourth thoracic, 230 lumbar, 155 Vertebral canal, lumbar, 155 Vertebral column anterior view of, 153 left lateral view of, 153 posterior view of, 153 veins of, 137 Vertebral ganglion, 130, 226 Vertebral notch inferior, lumbar, 155 superior, lumbar, 155 Vertebral plexus, 130

Vertebral vein, 137 anterior, 137 Vertebral venous plexus, 137 external, 173 internal, 170, 173 Vertebra prominens, 19, 21 Vesical artery inferior, 340 ureteric branches of, 340 superior, 340, 341 ureteric branches of, 341 Vesical fold, transverse, 372 Vesical plexus, 323, 344, 412 Vesical vein right, 311 superior, 265, 399 Vesical venous plexus, 366, 403 in retropubic space, 361 Vesical vessels, lymphatic pathway along, 408 Vesicocervical fascial fibers, 364 Vesicocervical space, 364 Vesicosacral fold, 363 Vesicouterine pouch, 372 Vesicovaginal pouch, 362, 365, 391 Vesicovaginal space, 364 Vesicular appendix (hydatid of Morgagni), 371, 389 Vesicular vein, inferior, 399 Vestibular aqueduct endolymphatic duct in, 96 external opening of, 97 Vestibular area, 115 Vestibular fossa, 377 Vestibular ganglion, 95 Vestibular gland, 389 greater, 389', 404 opening of, 377 primordium of, 389 Vestibular membrane, 96 Vestibular nerve, 95, 97, 124 inferior, 95, 97, 124 superior, 95, 124 Vestibular nuclei, 117 Vestibular nucleus, 116, 124 diagrammatic, 124 Vestibular (oval) window, 95 Vestibule, 95, 389 cochlear recess of, 92, 95 elliptical recess of, 95 spherical recess of, 95 Vestibulocochlear nerve, 117 Vestibulocochlear nerve (VIII), 92, 95, 97, 114, 116, 131 schema of, 116, 118, 124 Vestigial mesonephric tubule, 390 Vidian nerve, 122 Viscera abdominal, 269 median sagittal section of, 348 pelvic female, 360 male, 361 nerves of, 412 vasculature of, 300-315 Visceral lymph nodes celiac, 266 inferior mesenteric, 266 superior mesenteric, 266 Visceral nerve, thoracic, 165 Visceral pleura, 205

Visual fields, overlapping, 120 Visual pathway, 120 Vitreous body, 87 Vitreous chamber, 90 coronal CT images of, 151 Vocalis muscle, 78, 80 action of, 79 Vocal ligament, 77, 78 abduction of, 79 adduction of, 79 lengthening of, 79 shortening of, 79 Voiding cystourethrograms, male and female, 368 Vomer, 39 Vomerine groove, 39 Vorticose vein, 85, 90, 91 anterior tributaries of, 91 bulb of, 91 posterior tributaries of, 91 suprachoroidal tributaries of, 91 V-shaped area (of Laimer), 234, 235 Vulva, 377

w White matter, spinal, 169 Willis, circle of. See Cerebral arterial circle (of Willis) Winslow, foramen of- See Omental foramen (of Winslow)

Wolffian duct. See Mesonephric (wolffian) duct) Wrist anterior (palmar) view of, 472 anterior view of, 460 arteries of, 461 articular disc of, 455 bones of, 456 coronal section of, 455 cross section, transverse, 461 cutaneous innervation of, 472 deep dorsal dissection of, 469 deeper palmar dissection of, 460 extensor muscles of, 441 extensor tendons at, 470 flexor muscles of, 442 flexor tendons, arteries, and nerves at, 461 ligaments of, 454, 455 movements of, 453 nerves at, 461 palmar dissection, deeper, 460 posterior (dorsal) view of, 455, 470, 472 radial dissection, superficial, 467 radiograph of, anteroposterior, 457 sagittal section of, 453 superficial dorsal dissection of, 468 superficial palmar dissection of, 459 tendons of, 461

Xiphoid process, 185, 191, 196, 198, 247, 248, 249, 285, 286, 293, 297, 298 cross section of, 297

Z Zigzag (Z) line, 236 Zona orbicularis, 487 Zonular fibers, 87, 88, 89, 90 Zygapophyseal (facet) joint, 246 C2-3, 19, 21, 22 capsule of, 21, 22 C3-4, 21 Zygomatic arch, 14, 54, 151 Zygomatic bone, 81 Zygomatic nerve, 121 Zygomaticofacial artery, 23 Zygomaticofacial nerve, 24, 122 Zygomaticofacial vein, 23 Zygomaticotemporal artery, 23 Zygomaticotemporal nerve, 24, 122 Zygomaticotemporal vein, 23 Zygomaticus major muscle, 26, 54, 123 Zygomaticus minor muscle, 26, 54, 123

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