Skull, Muscles of Face and Neck Final Version

THE SKULL
by PASA MD

INTRODUCTION
ANTERIOR ASPECT OF CRANIUM
LATERAL ASPECT OF CRANIUM
OCCIPITAL ASPECT OF CRANIUM
SUPERIOR ASPECT OF CRANIUM
EXTERNAL SURFACE OF CRANIAL BASE
INTERNAL SURFACE OF CRANIAL BASE

TABLE OF CONTENTS
INTRODUCTION
CRANIUM (SKULL)
skeleton of the head

2 Parts
Neurocranium
Viscerocranium

1. Neurocranium
Cranial vault

Is the bony case of
the brain plus the
cranial meninges,
proximal parts of
cranial nerves and
vasculature of the
brain

INTRODUCTION
The neurocranium is
formed by a series of
8 bones
Sphenoidal
Temporal (2sets)
Occipital
Parietal (2 sets)
Frontal
Ethmoidal

INTRODUCTION

The neurocranium is made up of:
Calvaria or Skull Cap
Cranial Base or Basicranium

INTRODUCTION

Has a dome like roof called the calvaria or skullcap

Calvaria (superior view)

Calvaria (inferior view)

FRONTAL
BONE

PARIETAL
BONE

PARIETAL
BONE

OCCIPITAL
BONE

INTRODUCTION

Has a floor or cranial base called the basicranium

Basicranium

INTRODUCTION
2. Viscerocranium
facial skeleton

forms the anterior part of the
cranium

consists of bones surrounding
the orbits, nose and mouth
Viscerocranium

INTRODUCTION
consists of 15 irregular bones
A. 3 singular bones
Mandible
Ethmoid
Vomer
B. 6 bones as bilateral pairs
Lacrimal
Inferior nasal conchae
Maxillae
Palatine
Nasal
Zygomatic

INTRODUCTION
Orbitomeatal Plane or The
Frankfort Horizontal Plane
In the anatomic position
the inferior margin of the
orbit and superior margin
of the external acoustic
meatus lie in the same
horizontal plane

Orbitomeatal Plane

INTRODUCTION
Development of Cranium
bones of calvaria and
cranial base develop
by intramembranous
ossification and by
endochondral ossification

at birth the bones of the
calvaria are smooth and
unilaminar

Cranium of Newborn

INTRODUCTION
disproportionately large;
frontal and parietal
eminences are prominent

facial aspect is small
compared to calvaria

increase in size of calvaria
is greatest during the first
2 yrs. due to rapid brain
development.

Cranium of Newborn

INTRODUCTION
at birth the frontal bones
consists of two halves; union
begins in the 2
nd
yr.
halves of frontal bone are
separated by frontal suture;
obliterated by the 8
th
yr.
frontal and parietal bones are
separated by the coronal
suture

INTRODUCTION
Cranium of Newborn

Metopic Suture
remnant of frontal suture
that persists
in the middle of the glabella
8% of people
must not be interpreted as
fracture in radiograph

Metopic Suture

INTRODUCTION
CLINICAL NOTES
intermaxillary suture
separates the maxillae

INTRODUCTION
Cranium of Newborn

mandibular symphysis
separates the mandible;
halves of the mandible
fuse early in the 2
nd
yr.

obliteration of sutures
begin bet. ages 30 and
40 years on the internal
surface and 10 years
later on the external
surface

INTRODUCTION
Cranium of Newborn

no mastoid and styloid
process in newborn; facial
nerves are close to the
surface and can be injured
by forceps delivery

mastoid process forms
during the 1
st
yr; SCM pulls
on the petromastoid parts
of temporal bones

Cranium of Newborn

INTRODUCTION
1. Anterior Fontanelle
-diamond or star-shaped
-bounded by frontal bone
anteriorly and parietal bone
posteriorly
-18 mos. no longer palpable
-future site of bregma

INTRODUCTION
2. Posterior Fontanelle
-triangular
-bounded by parietal
bones anteriorly and
occipital bone posteriorly
-at junction of lambdoid
and sagittal sutures;
future site of lambda
-no longer palpable at the
end of 1
st
yr.

INTRODUCTION
3. Sphenoid and Mastoid
Fontanelles
-temporal muscle overlies
these fontanelles
-fuse during infancy

INTRODUCTION
palpation of fontanelles
enables the physician to
determine the:
progress of growth of
frontal and parietal bones
degree of hydration
(depressed fontanelle
means dehydration)
level of intracranial
pressure (bulging means
increased pressure)

Fontanelles

INTRODUCTION
CLINICAL NOTES
Rapid Growth of Face
coincides with the eruption
of deciduous teeth

dento-alveolar development
of the alveolar bone

associated with the increase
in size of paranasal sinuses

Cranium of Newborn

INTRODUCTION
Primary Craniosynostosis
premature closure of
cranial sutures
1 per 2000 births
unknown cause/genetic
more common in males
usually does not affect
brain development

Craniocytosis
CLINICAL NOTES
INTRODUCTION
A. Scaphocephaly
premature closure of
sagittal suture

anterior fontanelle is
small or absent

long, narrow wedge-
shaped cranium

Scaphocephaly
CLINICAL NOTES
INTRODUCTION
B. Plagiocephaly
premature closure of the
coronal or lambdoid
suture on one side only

cranium is twisted and
asymetrical
Plagiocephaly
CLINICAL NOTES
INTRODUCTION
C.Oxycephaly/Turricephaly
premature closure of the
coronal suture

high tower-like cranium

more common in females
oxycephaly
CLINICAL NOTES
INTRODUCTION
The anterior aspect of
the cranium consists of:
Frontal Bone
Orbits
Nasal Region
Zygomatic Bone
Maxillae
Mandible

Anterior Aspect of Cranium

squamous (flat)part

forms the skeleton of the
forehead

articulates with nasal and
zygomatic bones inferiorly

articulates with lacrimal,
ethmoid and sphenoids
Frontal Bone

FRONTAL BONE
the intersection of the
frontal and nasal bones
is the nasion

the glabella is the smooth
prominence superior to the
root of the nose

FRONTAL BONE

Glabella

Nasion

supraorbital margin is the
angular boundary between
the squamous and orbital
parts

supraorbital foramen at the
supraorbital margin; for
passage of supra-orbital
nerve and vessels

FRONTAL BONE
Supra-orbital foramen
Supra-orbital margin

the superciliary arch is a
prominent ridge superior
to the supraorbital margin
and deep to the eyebrows;
extends laterally on each
side from the glabella
FRONTAL BONE

Injury to Superciliary Arches
a blow to the sharp bony
ridges may lacerate the
skin and cause bleeding

blood may accumulate in
the superior eyelid and
around the eye- black eye

CLINICAL NOTES
bilateral bony cavities

resemble quadrangular
pyramids

contain and protect the
eyeball and accessory
visual structures

Orbits

ORBITS

superior wall (roof)
-orbital part of horizontal bone
-lesser wing of sphenoid

medial wall
-orbital plate of ethmoid
-plus frontal process of maxilla,
lacrimal and sphenoid bones

Orbits

ORBITS
lateral wall
-frontal process of zygomatic
bone
-greater wing of sphenoid

Orbits

ORBITS

inferior wall (orbital floor)
-maxilla and partly by
zygomatic and palatine
bones
-demarcated from the
lateral wall by the inferior
orbital fissure

Orbits

ORBITS

fossa for the lacrimal gland is
the shallow depression in the
orbital part of the frontal bone

Orbits

ORBITS

cheek bones or malar
bones

form prominences of
cheeks

lie on inferolateral sides
of orbits and rests on
maxillae
Zygomatic Bone

ZYGOMATIC BONE

articulates with the frontal,
sphenoid, maxillae and
temporal bones

zygomaticofacial foramen
pierces the lateral aspect
of the zygomatic bones

passage of zygomaticofacial
nerve and vessels

Zygomaticofacial Foramen

ZYGOMATIC BONE

Piriform Aperture
-pear-shaped anterior nasal
opening in the cranium
-inferior to the nasal bones
Nasal Septum
-divides the nasal cavity
into right and left parts

Piriform Aperture
NASAL REGION
Nasal Conchae
-curved bony plates on the
lateral wall of each nasal
cavity
Nasal Septum and Nasal Conchae
NASAL REGION

form upper jaw; form the
infraorbital margins medially

alveolar processes include
the tooth sockets called
alveoli

supporting bone for maxillary
teeth

Maxillae

MAXILLAE

surround piriform aperture
the two maxillae are united
at the intermaxillary suture
articulates with zygomatic
bone
infraorbital foramen for
passage of infraorbital nerve
and vessels

Infraorbital Foramen

MAXILLAE

Fractures of the Maxillae
Dr. Le Fort classified 3
variants of fractures of the
maxillae
Le Fort I Fracture
Le Fort II Fracture
Le Fort III Fracture
Le Fort Fracture

CLINICAL NOTES
Le Fort I Fracture
-horizontal fracture of the
maxillae
-passing superior to the
maxillary alveolar process
crossing the bony nasal
septum
Le Fort I Fracture

CLINICAL NOTES

Le Fort II Fracture
-passes from the
posterolateral parts of the
maxillary sinuses through
the infra-orbital foramina
lacrimals or ethmoids to
bridge of nose

Le Fort II Fracture

CLINICAL NOTES
-horizontal fracture
-passes through the superior
orbital fissures, ethmoid and
nasal bones, extending to the
greater wings of sphenoid
and frontozygomatic sutures


CLINICAL NOTES

U-shaped bone

alveolar process that
support mandibular teeth

consists of the body,
angle and ramus
Mandible

MANDIBLE

mental foramina inferior to the
2
nd
premolar teeth; for mental
nerves and vessels

mental protuberance forming
prominence of chin
Mandible

MANDIBLE
CLINICAL NOTES
Fractures of the Mandible
fractures of the neck of the
mandible are transverse

fractures of the angle of
the mandible are usually
oblique

fractures of the body of
mandible pass through
socket of canine tooth
Mandibular Fracture

CLINICAL NOTES
The lateral aspect consists of:
Temporal Fossa
Zygomatic Arch
Ext. Acoustic Opening
Mastoid Process
Infratemporal Fossa
Lateral aspects of maxilla
and mandible

Lateral Aspect of Cranium


bounded by:
-superiorly and posteriorly:
by the superior temporal line
and inferior temporal line

-anteriorly: by frontal and
zygomatic bones

-inferiorly by zygomatic arch

Temporal Fossa

TEMPORAL FOSSA

formed by the union of
temporal process of
zygomatic bone and
zygomatic process of
temporal bone
Zygomatic Arch

ZYGOMATIC ARCH

entrance to external
acoustic meatus or canal

External Acoustic Opening

EXTERNAL ACOUSTIC OPENING

posteroinferior to the
external acoustic opening

anteromedial is a pointed
projection, the styloid
process
Mastoid Process and Styloid Process

MASTOID PROCESS

inferior and deep to the
zygomatic arch and
mandible

posterior to maxilla
Infratemporal Fossa

INFRATEMPORAL FOSSA
note: the pterion is an H-shaped
formation of sutures that unite the
frontal, parietal, greater wing of
sphenoid and temporal bones.
Pterion

Fracture of the Pterion
hard blow to side of head

life threatening because it
ovelies anterior branches of
middle meningeal vessels

if untreated may lead to
middle meningeal artery
hemorrhage
Pterion

CLINICAL NOTES
The occipital aspect is
composed of the:
Occiput
Parts of parietal bone
Mastoid parts of temporal
bone

Occipital Aspect of Cranium


the external occipital
protuberance is palpable
in the median plane

most prominent point of
the external occipital
protuberance is the Inion

External Occipital Protuberance

OCCIPITAL BONE
the external occipital crest descends from the
protuberance toward the foramen magnum

External Occipital Crest and Foramen Magnum

OCCIPITAL BONE

the superior nuchal line
marks the superior limit
of neck and extends
laterally from each side
of the protuberance

the inferior nuchal line is
less distinct
Superior Nuchal Line

OCCIPITAL BONE

the lambda Indicates the
junction of sagittal and
lambdoid sutures

note: accessory bones or
sutural bones may be located
at lambda or near the
mastoid process

Lambda and Accessory Bones

OCCIPITAL BONE
The superior aspect is
somewhat oval in form
and broadens posterolaterally
at the parietal eminences

Superior Aspect of Cranium

Coronal suture
-separates the frontal
and parietal bones
Sagittal suture
-separates the parietal
bones
Lamdoid suture
-separates parietal and
temporal bones from
occipital bone

Sutures

CRANIAL SUTURES
Bregma
-at junction of sagittal
and coronal sutures
Vertex
-most superior point of
the calvarianear the
midpoint of the sagittal
suture
Bregma and Vertex

CRANIOMETRIC POINTS
Lambda
-at junction of lambdoid
and sagittal sutures
Lambda

CRANIOMETRIC POINTS
Parietal foramen
-located posteriorly in the
parietal bone near the
sagittal suture

Emissary foramina
-transmit emissary veins
Parietal Foramen

PARIETAL LANDMARKS
External Surface of Cranial Base
also known as the Basicranium

inferior portion of neurocranium
and viscerocranium minus the
mandible

External Surface of Cranial Base

the external surface of the
cranial base features
Alveolar arch of maxillae
Palatine process of maxillae
Palatine
Sphenoid
Vomer
Temporal bone
Occipital bone


formed by palatal processes
of maxillae anteriorly

formed by horizontal plates
of palatine bones posteriorly

free posterior border projects as
as posterior nasal spine

Hard Palate

HARD PALATE
A. Incisive Foramen
posterior to central
incisor teeth

depression in the
midline of bony palate
into which the incisive
canals open
Incisive Fossa and Greater Palatine Foramina

HARD PALATE
B.Greater Palatine Foramen
medial to 3
rd
molar tooth
transmit -greater palatine
nerves and vessels

C. Lesser Palatine Foramen
Posterior to greater
palatine foramen
Transmit-lesser palatine
nerves and vessels
Incisive Fossa and Greater Palatine Foramina

HARD PALATE

two large openings superior
to the posterior edge of the
palate

posterior nasal aperture

separated from each other
by the vomer
Choanae

CHOANAE

trapezoidal in shape

flat, unpaired bone

forms a major part of the
bony nasal septum
Vomer

VOMER

wedged between the frontal,
temporal and occipital bones
unpaired bone that consists of:
Body
Greater wings and Lesser
wings -spread laterally from
the lateral aspects of the
body of the sphenoid
pterygoid processes

Sphenoid Bone

SPHENOID BONE

Pterygoid Processes
-consists of lateral and
medial pterygoid plates
-extend on each side of
the sphenoid

Sphenoid Bone

SPHENOID BONE

the foramen magnum is
the large opening in the
basal part of the occipital
bone

Foramen Magnum

FORAMEN MAGNUM

large protuberances on the
lateral parts of occipital bone

where the cranium articulates
with the vertebral column

Occipital Condyles

OCCIPITAL CONDYLE

large opening between the
occipital bone and petrous
part of temporal bone

Jugular Foramen

JUGULAR FORAMEN

anterior to the jugular
foramen

entrance for the internal
carotid artery

Carotid Canal

CAROTID CANAL

lies posterior to the base
of the styloid process

transmits the facial nerve
and stylomastoid artery

Stylomastoid Foramen

STYLOMASTOID FORAMEN

provide for muscle
attachments

Mastoid Process

MASTOID PROCESS
The internal surface of the
cranial base has 3 large
depressions:
Anterior cranial fossa
Middle cranial fossa
Posterior cranial fossa

Cranial Fossa


formed by:
-frontal bone (anteriorly)
-ethmoid (middle)
-body and lesser wings of
sphenoid (posteriorly)

anterior and inferior parts
of frontal lobe of brain occupy
this area

Anterior Cranial Fossa

ANTERIOR CRANIAL FOSSA
A. Orbital Parts of the
Frontal Bone
the horizontal part of the
frontal bone forms the roof
of the orbit and the floor of
the anterior cranial fossa
forms the greatest part of
the anterior cranial fossa
surface show brain
markings of orbital gyri

Frontal Bone as seen in the
Anterior Cranial Fossa

B. Frontal Crest
median bony extension
of the frontal bone

Frontal Crest

C. Foramen Cecum
at the base of the frontal
crest
gives passage to vessels
during fetal development
insignificant postnatally
contains the nasal
emissary vein (1% of
population)

Foramen Cecum

D. Crista Galli
thick, median ridge
posterior to foramen
cecum

projects superiorly from
the ethmoid bone

Latin cocks comb

Crista Galli

E. Cribriform plate of
the ethmoid
lie on each side of
the crista galli
the tiny foramina of
the cribriform plate
transmit the olfactory
nerves (CN I) to the
olfactory bulbs of the
brain

Cribriform Plate of the Ethmoid

Cribriform
Plate of the
Ethmoid

F. Anterior and Posterior
Ethmoidal Foramen
transmit the anterior and
posterior ethmoidal artery,
vein and nerve
Ethmoidal Foramen

Posterior
Ethmoidal
Foramen

G. Lesser Wing of Sphenoid
sphenoidal crest separates the
anterior cranial fossa from the
middle cranial fossa laterally

sphenoidal limbus separates
the anterior cranial fossa from
the middle cranial fossa
centrally

butterfly-shaped

postero-inferior to the
anterior cranial fossa

separated from the anterior
cranial fossa by the ff:
-spenoidal crests (laterally)
-sphenoidal limbus(centrally)

Middle Cranial Fossa

MIDDLE CRANIAL FOSSA

has a central part, the sella
turcica and depressed
lateral parts on each side

lateral parts support the
temporal lobes of brain

Middle Cranial Fossa

the lateral parts of the
fossa are formed by
Greater wings of the
sphenoid
Squamous part of
the temporal bone
Petrous part of the
temporal bone

A. Sella turcica
saddle-like bony
formation
surrounded by the
anterior and posterior
clinoid processes
composed of 3 parts:
Tuberculum sellae
Hypophysial fossa
Dorsum sellae

Sella Turcica

Tuberculum Sellae
-median elevation
-forms the posterior
boundary of the
prechiasmatic sulcus
and anterior boundary
of hypophysial fossa
Tuberculum Sella

Hypophysial Fossa
-median depression in the
body of the sphenoid
-accomodates the pituitary
gland

Hypophysial Fossa

Dorsum Sellae
-square plate of bone
-forms the posterior
boundary of the sella
turcica
-superolateral angles
make up the posterior
clinoid process

Dorsum Sellae

A. Optic Canal
transmits the:
Optic nerve
Ophthalmic artery

Optic Canal

B. Superior Orbital Fissure
-located between the
greater and lesser wing
of sphenoid
-opens anteriorly in the
orbit

Supraorbital Fissure

B. Superior Orbital Fissure
-transmits:
Superior ophthalmic vein
Lacrimal, frontal, nasociliary
br. of ophthalmic nerve
Oculomotor nerve
Trochlear nerve
Abducens nerve

Supraorbital Fissure

C. Foramen Rotundum
-located posterior to the
medial end of the
superior orbital fissure
-transmits:
Maxillary nerve

Foramen Rotundum

D. Foramen Ovale
-large foramen postero-lateral
to the foramen rotundum
-opens into the infratemporal
fossa

Foramen Ovale

-transmits:
Mandibular nerve
Accessory meningeal artery
E. Foramen Spinosum
-posterolateral to the
foramen ovale
-opens into the infra
temporal fossa
Foramen Spinosum

-transmits:
Middle meningeal
artery and vein
Meningeal branch of
mandibular nerve
F. Foramen Lacerum
-posterolateral to
hypophysial foramen
-in life it is closed by a
cartilage plate
-transmits:
Meningeal arterial br.
Deep petrosal nerve
Small veins

Foramen Lacerum

G. Groove for the Greater and
Lesser Petrosal Nerve
-lie on the anterosuperior
surface of the petrous part of
temporal bone
-extends laterally from the
foramen lacerum
-contents:
Greater petrosal nerve
Petrosal br. of middle meningeal
artery

largest and deepest
formed mostly by the
occipital bone
lodges the ff:
cerebellum
pons
medulla oblongata

Posterior Cranial Fossa

POSTERIOR CRANIAL FOSSA

the dorsum sellae of the
sphenoid marks its anterior
boundary centrally

petrous and mastoid parts
of the temporal bones
contributes its anterolateral
walls.

Posterior Cranial Fossa

A. Clivus
located in the center of
the anterior part of the
fossa leading to the
foramen magnum
clivus

B. Cerebellar Fossae
bilateral concave impressions

Cerebellar Fossae

C. Internal Occipital Crest
-divides the posterior cranial
fossa into large bilateral
concave impressions

D. Internal Occipital Protuberance
-where the internal occipital
crest ends
C
D
E. Jugular Foramen
-located at the petrous
ridge of the temporal bone
Jugular Foramen

-transmits:
Meningeal br. of ascending
pharyngeal and occipital a.
Accessory nerve
Sigmoid sinus
Sup. bulb of int. jugular vein
Inferior petrosal sinus
Vagus nerve
Glossopharyngeal nerve
E. Internal Acoustic Meatus
-located anterosuperior to
the jugular foramen
-transmits:
Facial nerve
Vestibulocochlear nerve
Labyrinthine artery

Internal Acoustic Meatus
F. Hypoglossal Canal
-located superior to the
anterolateral margin of
the foramen magnum
-transmits:
Hypoglossal nerve
Hypoglossal Canal

G. Foramen Magnum
major structures passing
through this large foramen
are:
Dural veins
Ant./post. Spinal arteries
Medulla and Meninges
Spinal accessory n.
Vertebral arteries

Foramen Magnum

END OF CHAPTER 1
MUSCLES OF FACIAL EXPRESSION
CHAPTER 2
OCCIPITOFRONTALIS
ORBICULARIS OCULI
CORRUGATOR SUPERCILLI
PROCERUS
NASALIS
LEVATOR LABII SUPERIORIS ALAE QUE NASI
ORBICULARIS ORIS
LEVATOR LABII SUPERIORIS

TABLE OF CONTENTS
ZYGOMATICUS MAJOR AND MINOR
LEVATOR ANGULI ORIS
RISORIUS
BUCCINATOR
DEPRESSOR ANGULI ORIS
DEPRESSOR LABII INFERIORIS
MENTALIS
PLATYSMA

TABLE OF CONTENTS
OCCIPITOFRONTALIS
flat digastric muscle

(+) frontal and occipital
bellies that share a
common tendon the
epicranial aponeurosis

OCCIPITOFRONTALIS (Frontal Belly)
ORIGIN

INSERTION
skin and subcutaneous
tissue of eyebrows and
forehead

OCCIPITOFRONTALIS (Frontal Belly)
ACTION
elevates eyebrows

contraction of the frontal
belly protracts the scalp

transverse wrinkles across
the forehead

gives the face a surprised
look
OCCIPITOFRONTALIS (Occipital Belly)
ORIGIN
lateral 2/3 of superior
nuchal line

INSERTION

ACTION
contraction of the occipital
belly retracts the scalp

the occipital belly with bony
attachments works as a
synergist with the frontal belly

retracts the scalp;increasing
effectiveness of frontal belly
OCCIPITOFRONTALIS (Occipital Belly)
ORBICULARIS OCULI (ORBITAL PART)
concentric circles around
orbital margin

closes eyelids and wrinkles
forehead vertically

assists in the flow of lacrimal
fluid (tears)

ORIGIN
medial orbital margin
medial palpebral ligament
lacrimal bone

INSERTION
skin around margin of orbit
superior and inferior tarsal
plates
ACTION
closes eyelids tightly(winking)
ORBICULARIS OCULI (PALPEBRAL PART)
concentric circles around
the eyelids

ORIGIN
medial palpebral ligament

INSERTION
lateral palpebral raphe
ACTION
closes eyelids gently
ORIGIN
Medial end of superciliary
arch

INSERTION
Skin superior to middle of
supraorbital margin and
superciliary arch
ACTION
Draws eyebrow medially
and inferiorly creating
vertical wrinkles above
the nose

Demonstrate concern or
worry
PROCERUS PLUS TRANSVERSE PART OF
NASALIS
ORIGIN
Fascia aponeurosis
covering nasal bone and
lateral nasal cartilage

INSERTION
Skin of inferior forehead
between eyebrows

ACTION
Depresses medial end of
eyebrow

Wrinkles skin over dorsum
of nose

Convey disdain or dislike

PROCERUS PLUS TRANSVERSE PART OF
NASALIS
ALAR PART OF NASALIS
ORIGIN
Maxilla

INSERTION
Ala of nose

ALAR PART OF NASALIS PLUS LEVATOR
LABII SUPERIORIS ALAEQUE NASII
ORIGIN
Frontal process of maxilla
(inferomedial margin of
the orbit)

INSERTION
Major alar cartilage

ACTION
Depresses ala laterally
dilating anterior nasal
aperture

Flaring nostrils during
anger or exertion

ALAR PART OF NASALIS PLUS LEVATOR
LABII SUPERIORIS ALAEQUE NASII

Encircles the mouth
within the lips

Control entry and exit
throught oral fissure

Important during speech
ORBICULARIS ORIS (ORAL SPHINCTER)
ORIGIN
Medial maxilla and
mandible
Deep surface of perioral
skin
Angle of mouth

INSERTION
Mucous membrane of
lips

ACTION
Closes oral fissure

Compresses and
protrudes lips (kissing)

Resists distention
(when blowing)

ORIGIN
Infraorbital margin (maxilla)

INSERTION
Skin of upper lip

ACTION
Part of dilators of mouth

Retract (elevate) / evert
upper lip

Deepen nasolabial sulcus
(sadness)

ZYGOMATICUS MINOR
ORIGIN
Anterior aspect of zygomatic
bone

INSERTION
Skin of upper lip

ZYGOMATICUS MINOR
ZYGOMATICUS MINOR
ACTION

Retract (elevate) or evert
upper lip

Deepen the nasolabial sulcus
(showing sadness)

ZYGOMATICUS MAJOR
ORIGIN
Lateral aspect of zygomatic
bone

INSERTION
Angle of mouth

ZYGOMATICUS MAJOR
ZYGOMATICUS MAJOR
ACTION

Elevates labial commissure
bilaterally to smile(happiness)

Unilaterally to sneer(disdain)

BUCCINATOR (CHEEK MUSCLE)

thin, flat rectangular

more closely related to
the buccal mucosa

fibers mingle medially
with orbicularis oris
ORIGIN
Mandible
Alveolar processes of
maxilla and mandible
Pterygomandibular raphe

INSERTION
Angle of mouth
Orbicularis oris
ACTION
Presses cheeks against
molar teeth
Works with tongue to
keep food between
occlusal surfaces and
out of oral vestibule
Resists distention (when
blowing)
LEVATOR ANGULI ORIS
ORIGIN
Infra-orbital maxilla
(canine fossa)

INSERTION
Angle of mouth

LEVATOR ANGULI ORIS
ACTION

Widens oral fissure
(grinning or grimacing)

RISORIUS
ORIGIN
Parotid fascia
Buccal skin

INSERTION
Angle of mouth

RISORIUS
ACTION

Depresses labial commissure
bilaterally to frown (sadness)

ORIGIN
Anterolateral base of the
mandible

INSERTION
Angle of mouth

ACTION

Depresses labial commissure
bilaterally to frown (sadness)

ORIGIN
Platysma
Anterolateral body
of mandible

INSERTION
Skin of lower lip

ORIGIN
Platysma
Anterolateral body
of mandible

INSERTION
Skin of lower lip

ACTION

Retracts (depresses)
and/or everts lower lip
(pouting, sadness)

MENTALIS
ORIGIN
Body of mandible
(anterior to roots of
inferior incisors)

INSERTION
Skin of chin (mentolabial
sulcus)

MENTALIS
ACTION
Elevates and protrudes lower
lip

Elevates skin of chin
(showing doubt)

PLATYSMA
ORIGIN
Subcutaneous tissue of
infraclavicular and
supraclavicular regions
INSERTION
Base of mandible
Skin of cheek and lower
lip
Angle of mouth
Orbicularis oris

PLATYSMA
ACTION
Depresses mandible
against resistance

Tenses skin of inferior
face and neck
(tension and stress)

CLINICAL NOTES
BELL PALSY
injury to facial nerve
(CN VII)
paralysis of facial
muscles on affected
side result to:
sad look when face is
relaxed
markedly contorted smile
weakened lips affect
speech
food accumulation
CLINICAL NOTES
Thrombophlebitis of Facial Vein
danger triangle of the face
-triangular area from upper lip to
bridge of nose
inflammation of facial vein with
secondary thrombus formation
and pieces of an infected clot
result from laceration of the nose
by squeezing pimples
END OF CHAPTER 2
CHAPTER 3

MUSCLES OF THE NECK
CUTANEOUS AND SUPERFICIAL MUSCLES OF NECK
MUSCLES OF THE ANTERIOR CERVICAL REGION
PREVERTEBRAL MUSCLES
LATERAL VERTEBRAL MUSCLES

TABLE OF CONTENTS
CUTANEOUS AND SUPERFICIAL
MUSCLES OF THE NECK

PLATYSMA
STERNOCLEIDOMASTOID
TRAPEZIUS
PLATYSMA

(G. flat plate)

Broad thin sheet of
muscle

Covers the anterolateral
aspect of the neck

PLATYSMA

Decussate over the chin
and blend with facial
muscles

Inferiorly the fibers
diverge

Deep to the platysma
are the extenal jugular
vein and cutaneous
nerves of the neck

PLATYSMA
SUPERIOR ATTACHMENT
Inferior border of the
mandible, skin and
subcutaneous tissues of
lower face

INFERIOR ATTACHMENT
Fascia covering superior
parts of pectoralis major
and deltoid muscles
PLATYSMA
INNERVATION
Cervical branch of facial
nerve (CN VII)

note: refer to netter-facial
nerve schema
PLATYSMA
ACTION
Draws corners of mouth
inferiorly and widens it
(grimace/sadness/fright)

PLATYSMA
ACTION
Draws the skin of neck
superiorly when teeth
are clenched producing
vertical skin ridges

PLATYSMA
TESTING THE PLATYSMA
The platysma can be seen
as a sheet of muscle by
asking the patient to
clench the jaws firmly.
STERNOCLEIDOMASTOID
Divides each side of the
neck into anterior and
lateral cervical region

Broad strap-like muscle

Has two heads
a. Sternal Head
b. Clavicular Head

STERNOCLEIDOMASTOID

Has two heads
a. Sternal Head
b. Clavicular Head

The two heads are
separate inferiorly by a
space called the lesser
supraclavicular fossa

STERNOCLEIDOMASTOID
SUPERIOR ATTACHMENT
Lateral surface of mastoid
process of temporal bone

Lateral half of superior
nuchal line

STERNOCLEIDOMASTOID
INFERIOR ATTACHMENT
Sternal head:
anterior surface of
manubrium of sternum

Clavicular head:
superior surface of medial
third of clavicle

STERNOCLEIDOMASTOID
INNERVATION
Spinal accessory nerve
(CN XI, motor)
C2 and C3 nerves
(pain and proprioception)

note: refer to netter
-accessory nerve schema
STERNOCLEIDOMASTOID
ACTION
Unilateral contraction:
tilts head to same side
and rotates it so face is
turned superiorly toward
the opposite side

STERNOCLEIDOMASTOID
ACTION
Bilateral contraction: Flexion
Flexes cervical vertebrae so
that the chin approaches the
manubrium

Flexion of the Neck
STERNOCLEIDOMASTOID
ACTION
Bilateral contraction: Flexion
Flexion also occur when
lifting the head off the
ground while lying supine
protruding the chin while
keeping the head level
Lifting head off the ground
STERNOCLEIDOMASTOID
ACTION
Bilateral contraction:
Extension
(especially for posterior
fibers of the SCM)

Extends neck at atlanto-
occipital joints; elevating
the chin

STERNOCLEIDOMASTOID
TESTING THE SCM
The head is turned to the
opposite side against
resistance (hand against
the chin)

Normal when muscle is
seen and palpated
Large flat triangular muscle
-muscle of neck
-muscle of pectoral girdle
-superficial muscle of back

Covers the posterolateral
aspect of the neck and thorax

Attaches the pectoral girdle to
the cranium and vertebral
column

TRAPEZIUS
TRAPEZIUS
ORIGIN
Medial third of
superior nuchal line
External occipital
protuberance
Nuchal ligament
Spinous process (C7-
T12)
Lumbar and sacral
spinous processes

TRAPEZIUS
INSERTION
Lateral third of clavicle,
acromion and spine of
scapula

TRAPEZIUS
INNERVATION
Spinal Accessory Nerve
(CN XI; motor)
C2 and C3 Nerves
(pain and proprioception)
note: refer to netter
-accessory nerve schema
TRAPEZIUS
ACTION
Elevates, retracts and
rotates scapula superiorly
TRAPEZIUS
ACTION
Unilateral contraction:
-produces lateral flexion
on the same side

Bilateral contraction:
-extends the neck
Lateral Flexion on same side
TRAPEZIUS
TESTING THE TRAPEZIUS
The shoulder is shrugged
against resistance

Normal when the superior
border of the muscle is
seen and palpated

If the muscle is paralyzed
the shoulder droops

MUSCLES OF THE ANTERIOR
CERVICAL REGION

SUPRAHYOID MUSCLES
MYLOHYOID
GENIOHYOID
STYLOHYOID
DIGASTRIC
SUPRAHYOID MUSCLES
Superior to the hyoid and connect it to the cranium

These muscles constitute the substance of the
floor of the mouth

Support the hyoid in providing a base from which
the tongue functions

Elevate the hyoid and larynx in relation to
swallowing and tone production

MYLOHYOID
ORIGIN
Mylohyoid line of mandible

INSERTION
Mylohyoid raphe and body
of hyoid

Note:refer to netter
-Mandible and Floor of Mouth

MYLOHYOID
INNERVATION
Nerve to mylohyoid, a
branch of inferior alveolar
nerve (from mandibular
nerve, CN V3)

Note: refer to netter
-nerves of oral and pharyngeal
regions

MYLOHYOID
ACTION
Elevates the following during
swallowing and speaking:
Hyoid
Floor of mouth
Tongue

GENIOHYOID
ORIGIN
Inferior mental spine of
mandible

INSERTION
Body of hyoid

-tongue and mandible
GENIOHYOID
INNERVATION
C1 via hypoglossal nerve

-Hypoglossal nerve schema

GENIOHYOID
ACTION
Pulls hyoid anterosuperiorly

Shortens floor of mouth

Widens pharynx

STYLOHYOID
ORIGIN
Styloid process of the
temporal bone

INSERTION
Body of hyoid
STYLOHYOID

INNERVATION
Stylohyoid branch of the
preparotid facial nerve

-Facial nerve schema

STYLOHYOID
ACTION
Elevates and retracts hyoid;
elongating the floor of the
mouth

Has two bellies joined by
an intermediate tendon
A. Anterior Digastric
B. Posterior Digastric

A fibrous sling connects
the intermediate tendon to
the body and greater horn
of the hyoid

DIGASTRIC
DIGASTRIC
ORIGIN
Anterior Belly: digastric
fossa of mandible
Posterior Belly: mastoid
notch of temporal bone

INSERTION
Intermediate tendon to
body and greater horn of
hyoid
DIGASTRIC

INNERVATION
Anterior Belly: nerve to
mylohyoid, a branch of
inferior alveolar nerve

Posterior Belly: digastric
(preparotid) branch of
facial nerve
DIGASTRIC
ACTION
Working with infrahyoid muscles,
depresses mandible against
resistance

Elevates and steadies hyoid
during swallowing and speaking

MUSCLES OF THE ANTERIOR
CERVICAL REGION

INFRAHYOID MUSCLES
STERNOHYOID
OMOHYOID
STERNOTHYROID
THYROHYOID
INFRAHYOID MUSCLES
Often called strap muscles because of their
ribbon like appearance

Anchor the hyoid, sternum, clavicle and scapula

Depress the hyoid during swallowing and speaking

Work with the suprahyoid muscles to steady the
hyoid providing a firm base for the tongue

INFRAHYOID MUSCLES
Arranged in two planes
A. Superficial Plane
-Sternohyoid
-Omohyoid
B. Deep Plane
-sternothyroid
-thyrohyoid

STERNOHYOID
ORIGIN
Manubrium of sternum and
medial end of clavicle

INSERTION
Body of hyoid
STERNOHYOID

INNERVATION
C1-C3 by a branch of
ansa cervicalis

to see the ansa cervicalis

STERNOHYOID
ACTION
Depresses hyoid after
elevation during swallowing
Has two bellies united by
an intermediate tendon
A. Superior Belly
B. Inferior Belly

The fascial sling for the
intermediate tendon
connects to the clavicle

OMOHYOID
OMOHYOID
ORIGIN
Superior border of scapula
near suprascapular notch

INSERTION
Inferior border of hyoid
OMOHYOID
INNERVATION
C1-C3 by a branch of
ansa cervicalis

-Cervical plexus schema to
see the ansa cervicalis
OMOHYOID
ACTION
Depresses, retracts and
steadies hyoid
Wider than the sternohyoid

Covers the lateral lobes of
the thyroid gland
STERNOTHYROID
STERNOTHYROID
ORIGIN
Posterior surface of
manubrium of sternum

INSERTION
Oblique line of thyroid
cartilage
STERNOTHYROID
INNERVATION
C2 and C3 by a branch of
ansa cervicalis

STERNOTHYROID
ACTION
Depresses hyoid and larynx
Appears to be the
continuation of the
sternothyroid muscle

Runs superiorly from
the oblique line of the
thyroid cartilage to the
hyoid
THYROHYOID
THYROHYOID
ORIGIN
Oblique line of thyroid
cartilage

INSERTION
Inferior border of body
and greater horn of hyoid
THYROHYOID

INNERVATION
C1(via hypoglossal nerve-CN XII)


THYROHYOID
ACTION
Depresses hyoid

Elevates larynx

LONGUS COLLI
LONGUS CAPITIS
RECTUS CAPITIS ANTERIOR
RECTUS CAPITIS LATERALIS
SPLENIUS CAPITIS
LEVATOR SCAPULAE
ANTERIOR SCALENE
MIDDLE SCALENE
POSTERIOR SCALENE
Deep to prevertebral layer of deep cervical fascia
Can be grouped to either:
A. Anterior Vertebral Muscles
-Longus colli
-Longus capitis
-Rectus capitis anterior
-Anterior scalene
B. Lateral Vertebral Muscles
-Rectus capitis lateralis
-Splenius capitis
-Levator scapulae
-Middle Scalene and Posterior Scalene

LONGUS COLLI
SUPERIOR ATTACHMENT
anterior tubercle of C1
bodies of C1-C3
transverse processes of
C3-C6 vertebrae
INFERIOR ATTACHMENT
bodies of C5-T3
C3-C5 vertebrae

LONGUS COLLI

INNERVATION
Anterior rami of C2-C6
spinal nerves

-cervical plexus in situ

LONGUS COLLI
ACTION
Acting unilaterally:
Flexes the neck with
rotation (torsion) to
opposite side
LONGUS CAPITIS
SUPERIOR ATTACHMENT
Basilar part of occipital
bone

INFERIOR ATTACHMENT
Anterior tubercles of C3-
C6 transverse processes

LONGUS CAPITIS
INNERVATION
Anterior rami of C1-C3
spinal nerves
-Cervical plexus in situ

ACTION
Flex head

SUPERIOR ATTACHMENT
Base of cranium, anterior
to occipital condyle

INFERIOR ATTACHMENT
Anterior surface of lateral
mass of atlas C1 vertebra

INNERVATION
Branches from loop
between C1 and C2
spinal nerves

ACTION
Flex head

ANTERIOR SCALENE
SUPERIOR ATTACHMENT
Transverse processes of
C3-C6 vertebrae

INFERIOR ATTACHMENT
1
st
rib

ANTERIOR SCALENE
INNERVATION
Cervical spinal
nerves C4-C6

ACTION
Flex head

SUPERIOR ATTACHMENT
jugular process of occipital
bone

INFERIOR ATTACHMENT
transverse process of atlas
(C1 vertebra)

INNERVATION
Branches from loop
between C1 and C2
spinal nerves

ACTION
Flexes head and helps
stabilize it

SPLENIUS CAPITIS
SUPERIOR ATTACHMENT
Inferior half of nuchal
ligament
spinous processes of
superior 6 thoracic vert.
INFERIOR ATTACHMENT
lateral aspect of mastoid
process
lateral third of superior
nuchal line

SPLENIUS CAPITIS
ACTION
laterally flexes and rotates
head and neck to same side

acting bilaterally, extends
head and neck

LEVATOR SCAPULAE
SUPERIOR ATTACHMENT
Posterior tubercle of
transverse processes
C2-C6 vertebrae

INFERIOR ATTACHMENT
Superior part of medial
border of scapula

LEVATOR SCAPULAE
INNERVATION
Dorsal scapular nerve C5
and cervical spinal nerves
C3 and C4

ACTION
Downward rotation of
scapula and tilts its
glenoid cavity inferiorly
by rotating scapula

MIDDLE SCALENE
SUPERIOR ATTACHMENT
posterior tubercles of
transverse processes
C5-C7 vertebrae

INFERIOR ATTACHMENT
Superior surface of 1
st
rib;
posterior to groove for
subclavian artery

MIDDLE SCALENE
INNERVATION
Anterior rami of cervical
spinal nerves

ACTION
Flexes neck laterally

Elevates 1
st
rib during
forced inspiration

POSTERIOR SCALENE
SUPERIOR ATTACHMENT
posterior tubercles of
C5-C7

INFERIOR ATTACHMENT
external border of 2
nd
rib
POSTERIOR SCALENE
INNERVATION
Anterior rami of cervical
spinal nerves C7 and C8

ACTION
Flexes neck laterally

Elevates 2
nd
rib during
forced inspiration
REFERENCES

1. Clinically Oriented
Anatomy
By Keith Moore
2. Clinical Anatomy by
Regions
By Richard Snell, MD
3. Atlas of Human Anatomy
By Frank Netter, MD
4. World Wide Web

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