E101

Anatomical planes:
- sagittal
- coronal
- horizontal

Relationship & comparison
medial <> lateral
(dorsal) posterior <> anterior (ventral)
superior <> inferior
proximal <> distal
superficial <> deep


Upper limb


Bones:

shoulder girdle
- clavicle
- scapula: spine of scapula, acromion, suraspinous and infraspinous fossa, coracoid process,
scapular notch, glenoid cavity, supra- and infraglenoid tubercles, subscapular fossa
arm
- humerus: head, anatomical neck, greater & lesser tubercle, intertubercular (bicipital)
groove , surgical neck, deltoid tuberosity, spiral (radial) groove, trochlea, capitulum,
olecranon, olecranon & coronoid & radial fossae, medial and lateral epicondyles,
forearm
- radius: head (proximal end), distal end, radial tuberosity, styloid process,
- ulna: olecranon, coronoid process, trochlear & radial notch, ulnar tuberosity, head (distal
end), styloid process
hand
- carpal bones (8): proximal row: scaphoid, lunate, triquetrum, pisiform
distal row: trapezium, trapezoid, capitate, hamate

- metacarpals (5): base, shaft, head
- phalanges (14): base, shaft, head
THORACOAPPENDICULAR MUSCLES, SCAPULOHUMERAL MUSCLES.
SHOULDER JOINT AND ITS LIGAMENTS. MUSCLES OF THE ARM AND
SHOULDER. ROTATOR CUFF. ARMPIT.
Thoracoappendicular muscles:
-The first attachment bones of the thoracic cage; the second bones of the shoulder girdle or
humerus
-Allows movements predominantly at the scapulothoracic joint, but also at the shoulder joint
(especially intrinsic shoulder)
-Supplied by short branches of the brachial plexus
Anterior pectoralis minor and major, subclavius, serratus anterior m.
Posterior superficial (extrinsic shoulder) trapezius, latissimus dorsi m.
Posterior deep (extrinsic shoulder) levator scapulae m., rhomboids

Scapulohumeral muscles: (intrinsic shoulder) deltoid, teres major, rotator cuff muscles
Rotator cuff muscles (Supraspinatus, Infraspinatus, Teres minor, Subscapularis)

Joints of the upper limb
Sternoclavicular joint the only articulation between axial and upper appendicular skeleton
(articular disc; strength anterior and posterior ligaments as well as interclavicular and
costoclavicular ligaments)

Glenohumeral/shoulder joint (glenoid labrum; glenohumeral ligaments, coracohumeral ligament;
coracoacromial ligament); (flexion, extension, abduction, adduction, medial rotation, lateral
rotation)

Scapulothoracic joint (elevation-depression, protrusion-retrusion, external rotation-internal
rotation)

Arm
Anterior compartment (flexors of the arm and/or forearm) supplied by musculocutaneus n.:
biceps brachii, coracobrachialis, brachialis
Posterior compartment (extensors of the arm and/or forearm) supplied by radial n.:
triceps brachii, anconeus

Axilla
- pyramidal-like space between the upper thoracic wall and arm
- contains axillary blood vessels, brachial plexus and several groups of lymph nodes
- walls:
pectoralis minor and major (anterior);
subscapularis, teres major and latissimus dorsi (posterior);
serratus anterior (medial);
humerus (lateral)
traingular space (upper) : between teres minor m., teres major m., long head of triceps brachii m.
- contains circumflex scapular vessels

quadrangular space: between teres minor m., surgical neck of humerus, teres major m., long
head of triceps brachii
- contains posterior circumflex humeral vessels and axillary n.

traingular space (lower): shaft of humerus., inferior border of teres major m., long head of
triceps brachii m.contains circumflex scapular vessels
- contains deep brachial a., radial nerve
1
MUSCLES OF THE FOREARM, WRIST AND HAND. COMPARTMENTS OF THE
FOREARM. ELBOW JOINT AND ITS LIGAMENTS. PROXIMAL AND DISTAL
RADIOULNAR JOINT AND THEIR LIGAMENTS. CUBITAL FOSSA. WRIST AND HAND
JOINTS. CARPAL TUNNEL.

Muscles of the forearm:
Anterior compartment:
flexor-pronator compartment
acts at the elbow, wrist, and digits joints
supplied by median and ulnar nerve
Superficial group (attached predominantly to medial epicondyle of the humerus): pronator
teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum
superficialis m.
Deep group (attached to forearm bones): flexor digitorum profundus, flexor pollicis
longus, pronator quadratus m.
Posterior compartment:
extensor-supinator compartment
acts at the elbow, wrist, and digits joints
supplied by radial nerve
Superficial group (attached predominantly to lateral epicondyle of the humerus): extensor
carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris,
brachioradialis, extensor carpi radialis longus m.
Deep group (attached predominantly to forearm bones): supinator, abductor pollicis
longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis m.

Muscles of the hand
Compartments of the palm of the hand:
superficial: hypothenar (abductor digiti minimi, flexor digiti minimi brevis, opponens digiti
minimi, palmaris brevis m.), central (lumbricals), thenar (abductor pollicis brevis, flexor pollicis
brevis, opponens pollicis m.); deep: adductor pollicis m., interossei mm.

Anatomic snuffbox
Triangular depression between the tendons of: extensor pollicis longus m. and extensor pollicis
brevis m., (abductor pollicis longus m.)
scaphoid and trapezium bones form its floor
contains radial a.

Carpal tunnel:
Space between carpal bones (forming posterior, medial and lateral walls) and transverse carpal
ligament [flexor retinaculum between radial carpal eminence and ulnar carpal eminence]
(forming its anterior wall) containing the tendons of: flexor digitorum superficialis m., flexor
digitorum profundus m. and flexor pollicis longus m. along with the median n.

Cubital fossa
Triangular depression between the muscles of the arm and forearm, anterior to the elbow joint
Walls:
brachioradialis m. (lateral)
pronator teres m. (medial)
line connecting medial and lateral epicondyles of the humerus (upper border)
brachialis and supinator mm. (floor)
Contents (from lateral to medial): radial n., biceps brachii m. tendon, brachial a. and median n.

2

Elbow joint
Complex, consists of 3 joints with the common joint capasule:
humeroulnar joint (trochlea of humerus+trochlear notch of ulna)
humeroradial joint (capitulum of humerus+head of radius)
proximal radioulnar joint (head of radius+radial notch of ulna)

Ligaments of the elbow:
radial collateral ligament
ulnar collateral ligament
anular ligament of the radius

Other joints of the upper extremity:
distal radioulnar joint
radiocarpal (wrist) joint
intercarpal joints
midcarpal joint
carpometacarpal joints
metacarpophalangeal joints
interphalangeal joints

First carpometacarpal joint (of saddle type):
movements: in the plane of the palm (radial abduction adduction)
at the right angle to the plane of the palm (palmar abduction adduction)
opposition the composite movement




1
LONG AND SHORT BRANCHES OF THE BRACHIAL PLEXUS.
VESSELS OF THE UPPER LIMB.

LONG BRANCHES OF THE BRACHIAL PLEXUS:

MEDIAN N.
branches: anterior interosseus n.; common palmar digital nerves (3) proper palmar digital
nerves; injury carpal tunnel syndrome, hand of benediction, ape hand

ULNAR N.
branches: dorsal branch; palmar branch; deep branch; superficial branch common palmar
digital n. (1) proper palmar digital nn. (3); injury Funny bone sensation, claw hand

RADIAL N.
branches:
superficial branch (sensory) dorsal digital nerves of hand
inferior lateral brachial cutaneous n.
posterior brachial cutaneous n.
posterior antebrachial cutaneous n.
deep branch (motor) posterior interosseus n.
injury wrist drop

MUSCULOCUTANEOUS N.
branches: lateral antebrachial cutaneous n.

MEDIAL BRACHIAL CUTANEUS N.
MEDIAL ANTEBRACHIAL CUTANEUS N.

SHORT BRANCHES OF BRACHIAL PLEXUS:

dorsal scapular n.
long thoracic n.
suprascapular n.
nerve to subclavius
upper and lower subscapular nerves
thoracodorsal n.
lateral and medial pectoral nerves
axillary n. branches: superior lateral brachial cutaneous n.

VESSELS OF THE UPPER LIMB

SUBCLAVIAN A.
left a. originates directly from the aortic arch; right a. is a branch of brachiocephalic trunk
branches: subprascapular a., dorsal scapular a.

AXILLARY A.
central structure of the axilla; branches:
superior/supreme thoracic a.
thoracoacromial a. 4 branches: acromial, deltoid, pectoral and clavicular
lateral thoracic a.
subscapular a.
thoracodorsal a.
2
circumflex scapular a.
anterior humeral circumflex a.
posterior humeral circumflex a.

BRACHIAL A.
divides into the radial and ulnar arteries in cubital fossa, branches:
brofunda brachii/ deep brachial a.)
radial collateral a.
middle collateral a.
superior ulnar collateral a.
inferior ulnar collateral a.

RADIAL A.
accounts for the radial pulse ; runs through anatomical snuffbox; terminates as deep palmar arch
branches:
radial recurrent a.
superficial palmar branch
princeps pollicis a. thumb
radialis indicis a. lateral side of index

ULNAR A.
larger branch of brachial a.; branches:
ulnar recurrent a.
common interosseus a. anterior interosseus a., posterior interosseus a.
deep palmar branch

dorsal carpal rete (dorsal carpal arterial arch)
a vascular network over dorsal surface of the carpal joints
formed by dorsal carpal branches of ulnar a., radial a., and interossei arteries
branches: dorsal metacarpal arteries dorsal digital arteries

superficial palmar (arterial) arch
formed by ulnar a. and superficial palmar branch of radial a.
between palmar aponeurosis and tendons of flexor digitorum superficialis m.
branches: common palmar digital arteries (3) proper palmar digital arteries (6)

deep palmar (arterial) arch
formed by radial a. and deep palmar branch of ulnar a.
between metacarpal bones and tendons of flexor digitorum profundus m.
branches: palmar metacarpal atreries (3) join common palmar digital aa. from superficial arch

SUPERFICIAL VEINS
cephalic v.; basilic v.; median cubital v.

dorsal venous network of hand - a superficial network of veins on the dorsum of the hand emptying
into cephalic and basilic veins

DEEP VEINS follow arteries as venae comitantes (accompanying veins)

E207
Arteries and veins
aorta;
common iliac a.;
internal iliac a.;
anterior division
umbilical a.; superior vesical a.; obturator a.; inferior vesical a.;
internal pudendal a.; inferior gluteal a.;
posterior division
iliolumbar a.; lateral sacral a.; superior gluteal a.
external iliac a.;
femoral a.
superficial epigastric a.
superficial circumflex iliac a.
profunda femoris (deep femoral) a.
medial & lateral femoral circumflex artery
popliteal a.
posterior tibial a.
anterior tibial a.

inferior vena cava
common iliac v.
external iliac v.;
internal iliac v.;
femoral v.
popliteal v.

great saphenous v.; small saphenous v.
1
BONY PELVIS. ORIENTATION OF THE PELVIS. PELVIC JOINTS AND LIGAMENTS.

PELVIS - bony ring formed by: 2 pelvic bones + sacrum and coccyx
- pelvis major / greater pelvis / false pelvis
- pelvis minor / lesser pelvis / true pelvis

linea terminalis boundary line between the greater and lesser pelvis, consists of: pubic
symphysis, pubic crest, pecten pubis, arcuate line and sacral promontory

Internal pelvic measurements (in women):
- measurements in the pelvic inlet (upper pelvic aperture) plane:
true (obstetric) conjugate the smallest AP dimension of lesser pelvis (11cm)
diagonal conjugate (12.5-13cm)
anatomical conjugate (11.5cm)
right (I) and left (II) oblique diameter (12cm)
transverse diameter of pelvic inlet (13cm)
- measurements in pelvic outlet (lower pelvic aperture) plane:
anteroposterior (conjugate) diameter of pelvic outlet (9(+2)cm)
transverse = interspinous diameter (11cm)

External pelvic measurements:
interspinous distance (25-26cm)
intercristal distance (28-29cm)
external conjugate (20-21cm)

gender-specific differences:
- female pelvis: larger and broader; inlet of almost oval shape; less distinct promontory and
wider alae of sacrum; larger distance between ischial tuberosities larger angle between
pubic arch
- male pelvis: taller, narrower and more massive; heart-shaped pelvic inlet; sacral
promontory shows a greater projection in pelvis; acute subpubic angle

PELVIC / HIP / COXAL BONE
- formed by 3 bones fused in acetabulum: ilium, pubis and ischium
- articulates with sacrum at sacroiliac joint
- obturator foramen formed by fusion of ischium and pubis, closed by obturator
membrane (except obturator canal)

SACRUM AND COCCYX
- parts of the vertebral column which form posterior part of pelvis
- (sacral) promontory anterior edge of the first sacral vertebra
- auricular surface of sacrum

sacroiliac joint
- irregular plane synovial joint between auricular surfaces of sacrum and ilium
- anterior, posterior and interosseus sacroiliac ligaments
pubic symphysis
- between adjacent surfaces of pubic bones in the median plane
- superior and inferior pubic ligaments
ligaments of the pelvic wall
2
- sacrospinous ligament
- sacrotuberous ligament
greater sciatic foramen
- upper one, between greater sciatic notch and sacrospinous ligament
lesser sciatic foramen
- lower one, between lesser sciatic notch, sacrotuberous and sacrospinous ligaments

ILIUM
- consists of body and ala of ilium/iliac wing
- arcuate line
- iliopubic eminence
- iliac fossa
- gluteal surface (external): anterior, posterior and inferior gluteal lines
- iliac crest: anterior superior and inferior iliac spines; posterior superior and inferior iliac
spines
- iliac tuberosity
- auricular surface of ilium

PUBIS
consists of the body and 2 rami (superior and inferior)
- pubic tubercle
- pubic crest
- pecten pubis
- obturator groove forms the upper margin of obturator canal
- symphyseal surface pubic symphysis

ISCHIUM
- body - joins the ilium and superior ramus of pubis
- ramus joins the inferior ramus of pubis
- ischial spine separates lesser and greater sciatic notch
- ischial tuberosity

ACETABULUM
- articular socket of the hip joint, formed by ilium, pubis and ischium
- acetabular notch
- acetabular fossa
- lunate surface
- acetabular rim; acetabular labrum

FEMUR
- head ( fovea capitis femoris) and neck
- greater and lesser trochanter; trochanteric fossa
- intertrochanteric crest (posterior); intertrochanteric line (anterior)
- gluteal tuberosity; pectineal line; linea aspera
- medial and lateral condyles; intercondylar fossa
- patellar surface; popliteal surface
- lateral and medial epicondyles (above adductor tubercle)

PATELLA
largest sesamoid bone, located within tendon of quadriceps femoris m.
3
- apex (facing downwards) and base
- anterior and posterior surface has two articular surfaces: medial and lateral (larger)

TIBIA
- weight-bearing medial bone of the leg
- medial and lateral condyle superior articular surfaces
- intercondylar eminence: medial and lateral intercondylar tubercles
- tibial tuberosity
- articular surface for head of fibula under lateral condyle
- soleal line
- medial malleolus = medial ankle malleolar groove
- inferior articular surface and articular surface of medial malleolus
- fibular notch

FIBULA
- head apex of head; articular surface of head
- lateral malleolus = lateral ankle malleolar fossa

TARSAL BONES
- 7 bones
- proximal group: talus, calcaneus
- distal group: medial, intermediate and lateral cuneiform bones, cuboid bone
- navicular bone intermediate tarsal bone

TALUS
- head, neck and body
- trochlea tali
- sulcus tali on the inferior side of the neck
- posterior, middle and anterior articular calcaneal surfaces
- articular surface for navicular bone
- lateral process

CALCANEUS
largest and strongest bone of the foot, forms the heel of the foot
- calcaneal tuberosity = heel
- calcaneal sulcus together with sulcus tali forms tarsal sinus
- sustentaculum tali shelf-like medial projection that supports talus
- posterior, middle and anterior talar articular surfaces
- articular surface for cuboid bone

METATARSAL BONES
- 5: base, shaft and head
- metatarsal I, II and III articulate with cuneiform bones
- metatarsal IV and V articulate with cuboid bone

1
SPINAL NERVE AND ITS RADICES AND RAMI. BRACHIAL PLEXUS.

Spinal nerve
posterior/dorsal root to dorsal horns of the spinal cord; contains axons of sensory (afferent) fibers
carries information to the CNS; at its distal end includes the spinal ganglion
anterior/ventral root to ventral horns of the spinal cord; contains motor (efferent) fibers; carries
information away from the CNS; both roots unite in intervertebral foramen to form the spinal nerve
posterior/dorsal ramus innervates deep back muscles and skin of the back
anterior/ventral ramus innervates muscles of the limbs and superficial muscles of the trunk and
skin areas over the limbs and anterior and lateral side of the trunk
meningeal ramus sensory, reenters the spinal canal
white ramus communicans carries myelinated fibers to sympathetic trunk ganglion
gray ramus communicans carries unmyelinated fibers from sympathetic ganglion to spinal n.

31 pairs of spinal nerves:
8 cervical (C1-C8)
12 thoracic (T1-T12)
5 lumbar (L1-L5)
5 sacral (S1-S5)
1 coccygeal (Co)

anterior rami of spinal nerves (except from rami of thoracic nerves) form somatic plexuses:
cervical plexus anterior rami of C1-C4 spinal nerves
brachial plexus - anterior rami of C5-C8 and T1 spinal nerves
lumbosacral plexus - anterior rami of T12, lumbar, sacral and coccygeal spinal nerves


2
Brachial plexus
Elements of structure:
5 roots (anterior rami of spinal nerves C5-T1) interscalene space
3 trunks (superior, middle, inferior) lateral to interscalene space, above clavicle
6 divisions (3 anterior, 3 posterior) posterior to clavicle
3 cords (lateral , medial, posterior) axilla
terminal branches (nerves) appendicular skeleton

Short branches of brachial plexus
- branches from the roots
dorsal scapular n. (C5)
long thoracic n. (C5-C7)
- branches from the superior trunk

nerves of supraclavicular part
of brachial plexus

suprascapular n. (C5-C6)
nerve to subclavius (C5)
- branches from the posterior cord
upper subscapular n. (C5-C6)
thoracodorsal n. (C7-C8)
lower subscapular n. (C5-C6)
axillary n. (C5-C6)
- branches from the lateral cord
lateral pectoral n. (C5-C7)
- branches from the medial cord
medial pectoral n. (C8-T1)

Long branches of brachial plexus
- branches from the lateral cord
musculocutaneus n. (C5-C7)
lateral root of median n. (C5-T1)
- branches from the posterior cord
radial n. (C5-T1)
- branches from the medial cord
medial root of median n. (C5-T1)
ulnar n. (C7-T1)
medial brachial cutaneus n. (C8-T1)
medial antebrachial cutaneus n. (C8-T1)



superior trunk injury Erb-Duchenne paralysis
inferior trunk injury Klumpkes paralysis
long thoracic n. injury winged scapula

nerves of infraclavicular part
of brachial plexus
1
HIP JOINT AND ITS LIGAMENTS. MUSCLES OF THE LOWER LIMB. GLUTEAL
REGION. ANTERIOR, MEDIAL AND POSTERIOR THIGH MUSCLES. FEMORAL
TRIANGLE.

Hip joint
multiaxial ball-and-socket synovial joint
between head of femur and lunate surface of acetabulum
- acetabular labrum
- transverse acetabular ligament
- ligament of head of femur
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament;

Common lacuna
gap between inguinal ligament and pelvic bone
divided by iliopectineal arch into 2 parts:
- vascular lacuna (femoral v., femoral a. [ femoral sheath], lymph nodes)
- muscular lacuna (iliopsoas m., femoral n.)

Femoral canal
canal for femoral hernia
contains: fat, areolar connective tissue, lymph nodes

Femoral ring
abdominal opening of femoral canal
located between inguinal ligament, femoral v., lacunar ligament and pectineal ligament

Saphenous hiatus (opening)
opening in fascia lata through which great saphenous v. drains into femoral v.
covered by cribriform fascia

Femoral triangle
triangular depression formed by muscles of upper thigh
inguinal ligament (superior border); adductor longus m. (medial border); sartorius m. (lateral
border); iliopsoas m., pectineus m. (floor); fascia lata, cribriform fascia (roof)
content: femoral n., femoral a., femoral v.,

Adductor canal
begins at apex of femoral triangle; ends in adductor hiatus
between adductor magnus m., adductor longus m. and vastus medialis m.
covered by vastoadductor membrane (fascia) and sartorius m.
content: femoral a., femoral v., saphenous n., descending genicular a., (n. to vastus medialis)

Adductor hiatus (hiatus tendineus)
aparture in tendon of adductor magnus m.
allows passage of femoral vessels from adductor canal into popliteal fossa



2
MUSCLES:

Gluteal Region
gluteus minimus m.
gluteus medius m.
gluteus maximus m.
tensor fasciae latae m.
piriformis m.
superior gemellus m.
obturator internus m.
inferior gemellus m.
quadratus femoris m.

Anterior Compartment of Thigh
iliacus m.
psoas major m.
psoas minor m.
sartorius m.
rectus femoris m.
vastus lateralis m.
vastus medialis m.
vastus intermedius m.

Medial Compartment of Thigh (adductors)
gracilis m.
adductor longus m.
adductor brevis m.
adductor magnus m.

obturator externus m.
pectineus m.


Posterior Compartment of Thigh (hamstrings)
biceps femoris m.
semitendinosus m.
semimembranosus m.

pes anserinus (goosefoot)

Trendelenburgs sign



iliotibial tract
iliopsoas m.
quadriceps femoris m. patellar ligament


1
POPLITEAL FOSSA. MUSCLES OF THE LEG AND FOOT. KNEE JOINT AND ITS
LIGAMENTS. TALOCRURAL JOINT. SURGICAL SUBTALAR JOINT.

POPLITEAL FOSSA
- diamond-shaped depression on back side of knee joint
- borders: biceps femoris m. (superolaterally); semitendinosus m. and semimembranosus m.
(superomedially); lateral head of gastrocnemius m., plantaris m. (inferolaterally); medial
head of gastrocnemius m. (inferomedially); popliteal fascia (roof); popliteal surface of
femur, oblique popliteal ligament, popliteus m. (floor)
- contents: popliteal a. and v., tibial n. and common peroneal n.; small saphenous v., medial
sural cutaneous n.

RETINACULA
superior extensor retinaculum - between fibula and tibia, proximal to ankles
inferior extensor retinaculum - Y-shaped band of deep fascia, between lateral surface of
calcaneus and medial surface of malleolus superiorly and navicular bone inferiorly
superior peroneal/fibular retinaculum - between lateral malleolus and calcaneus
inferior peroneal/fibular retinaculum - leateral side of calcaneus
flexor retinaculum - between medial malleolus and calcaneus

MUSCLES OF THE LEG:
anterior compartment of the leg (extensors/dorsiflexors of the foot): tibialis anterior m.,
extensor digitorum longus m., extensor hallucis longus m., peroneus/ fibularis tertius m.
lateral compartment of the leg (flexors and evertors of the foot): peroneus/fibularis longus
m., peroneus/fibularis brevis m.
posterior compartment of the leg - superficial layer (flexors/ plantarflexors of the foot
and knee): triceps surae m. = gastrocnemius m., soleus m. Achilles tendon (form calf of
the leg); plantaris m. (vestigial, often absent)
posterior compartment of the leg - deep layer (flexors of the foot and knee): popliteus m.,
tibialis posterior m., flexor digitorum longus m., flexor hallucis longus m.

MUSCLES OF THE FOOT:
dorsum of the foot: exensor hallucis brevis m., exensor digitorum brevis m.
sole of the foot: arranged in 4 layers:
1
st
: abductor hallucis m., flexor digitorum brevis m., abductor digiti minimi m.
2
nd
: quadratus plantae m. (additional flexor), lumbrical mm. (4)
3
rd
: flexor hallucis brevis m., adductor hallucis m. (transverse and oblique heads), flexor digiti
minimi brevis m.
4
th
: plantar interossei mm. (3), dorsal interossei mm. (4)

medial compartment muscles of the big toe
central compartment
lateral compartment muscles of the 5
th
finger

plantar aponeurosis spans from calcaneal tuberosity to fingers, protects sole of the foot
from injury

KNEE JOINT
- patella + condyles of femur + condyles of tibia
- biaxial joint: flexion/extension and lateral/medial rotation (in flexed position only)


2
- medial meniscus (larger one, C-shaped), lateralis meniscus (smaller, almost circular)
- menisci divide joint cavity into upper (flexion/extension) and lower part (rotation)
- intrinsic ligaments: transverse ligament of the knee; anterior cruciate ligament; posterior
cruciate ligament
- extrinsic ligaments: patellar ligament; tibial collateral ligament; fibular collateral
ligament; oblique popliteal ligament; arcuate popliteal ligament

- infrapatellar fatpad; infrapatellar synovial fold; suprapatellar bursa
- medial and lateral patellar retinacula aponeuroses of vastus medialis and lateralis mm.

ANKLE JOINT (TALOCRURAL JOINT)
- trochlea tali + inferior articulation surface of tibia + articulation surface of medial
malleolus + articulation surface of lateral malleolus
- hinge joint; movements: extension (dorsiflexion) and flexion (plantarflexion)
- ligaments:
lateral ligament 3 ligaments originating from lateral malleolus: anterior talofibular
ligament, posterior talofibular ligament, calcaneofibular ligament
medial (deltoid) ligament originates from medial malleolus and attaches to talus, calcaneus
and navicular bone

SUBTALAR JOINT
- talus + calcaneus + navicular bone
- ligaments:
interosseus talocalcaneal ligament (in tarsal sinus)
spring ligament (plantar calcaneo-navicular ligament)

resultant axis of the joint - from the lateral side of calcaneal tuberosity, through the head of
talus to the medial side of the foot

composed movements:
INVERSION: flexion + adduction + supination
EVERSION: extension + abduction + pronation
inversion medial side up / eversion lateral side up

TRANSVERSE TARSAL JOINT
- CHOPARTs joint surgical amputation of the foot
- between navicular and cuboid bones (distal side) and talus and calcaneus (proximal side)
- part of talocalcaneonavicular joint + calcaneocuboid joint

TARSOMETATARSAL JOINTS
- LISFRANC joints surgical amputation
- 3 synovial joints between tarsal and metatarsal bones

METATARSOPHALANGEAL JOINTS
- between heads of metatarsals and bases of proximal phalanges of toes

INTERPHALANGEAL JOINTS OF THE FOOT
- between phalanges of toes

1
LUMBOSACRAL PLEXUS AND ITS BRANCHES. NERVES OF THE LOWER
LIMB. VESSELS OF THE LOWER LIMB.

LUMBAR PLEXUS
ventral rami of L1 L4 spinal nerves + part T12
short branches psoas mm. and quadratus lumborum m.
long branches:
subcostal n. (T12)
iliohypogastric n. (L1)
- lateral cutaneus branch skin of hip and gluteal region
- anterior cutaneus branch skin above pubis
ilioinguinal n. (L1)
- anterior scrotal branches/anterior labial branches skin of scrotum/major pudendal labia
- femoral cutaneous branches upper medial part of the skin of the thigh
lateral femoral cutaneous n./ lateral cutaneous n. of the thigh (L2, L3)
skin on lateral side of the thigh
genitofemoral n. (L1, L2)
- genital branch (medial) enters inguinal canal scrotum/major pudendal labia
- femoral branch (lateral) to vascular lacuna skin over femoral triangle
obturator n. (L2-L4)
- anterior branch pectineus m., adductor longus and brevis mm. and gracilis m.,
terminates as the sensory branch skin of medial thigh
- posterior branch adductor magnus m.
femoral n. (L2-L4)
- numerous muscular branches iliopsoas m., quadriceps femoris m., sartorius m. and
partially pectineus m.
- sensory branches:
- anterior femoral cutaneous n. skin of anterior and medial side of the thigh
- saphenus n. skin on medial side of the leg and foot

SACRAL PLEXUS
ventral rami of spinal nerves L4 and L5 lumbosacral trunk, and S1 S5 + Co
short branches piriformis m., superior gemellus m., obturator internus m., inferior gemellus
m., quadratus femoris m.
long branches:
superior gluteal n. (L4 S1)
innervation gluteus medius and minimus muscles and tensor fasciae latae m.
injury: lack of abduction of the thigh, Trendelenburg sign + gluteal gait
inferior gluteal n. (L5 S2)
gluteus maximus m.
posterior femoral cutaneus n./ posterior cutaneous n. of the thigh (S1 S3)
innervation skin of the posterior thigh
- inferior clunial nn. skin of lower part of buttocks
- perineal branches skin of perineum
pudendal n. (S2 S4)
leaves the pelvis infrapiriform foramen, curves around ischial spine and runs back to pelvic
cavity lesser sciatic foramen
- inferior rectal nn.
- perineal branches
2
- dorsal n. of penis/clitoris
sciatic n. (L4 S3)
divides into tibial n. and common peroneal n.
innervation muscles of posterior compartment of the thigh and all the muscles of the leg
and foot
ischias / ischialgia inflammation of the sciatic n.
coccygeal n. (S5 - CO);

TIBIAL N.
- medial sural cutaneus n. joins communicating branch of lateral sural cutaneous n.
sural n.
- medial plantar n. common plantar digital branches proper plantar digital branches
- lateral plantar n. common plantar digital branches proper plantar digital branches;
innervation posterior muscles of the leg and muscles of sole of the foot, sensory: sole of
the foot, lateral margin of the foot, little toe

COMMON PERONEAL / FIBULAR N.
innervates short head of biceps femoris m.
- lateral sural cutaneus n.
- superficial peroneal / fibular n. peroneus longus and brevis mm.
- medial and intermediate dorsal cutaneous nn.
- deep peroneal / fibular n.
innervation muscles of anterior compartment of the leg and dorsal muscles of the foot
- lateral branch extensor hallucis brevis m., extensor digitorum bevis m.
- medial branch - skin on adjacent sides of I and II toes
injury: foot drop high-stepping gait

VESSELS OF THE LOWER LIMB.

COMMON ILIAC A.
terminal branch of abdominal aorta
divides into internal and external iliac a.

INTERNAL ILIAC A.
anterior division (mainly visceral):
[umbilical a. superior vesical a.; inferior vesical a.; middle rectal a.; vaginal a.; uterine a.;
internal pudendal a.]; obturator a.; inferior gluteal a.

posterior division (mainly to pelvic walls):
[iliolumbar a.; lateral sacral a.]; superior gluteal a.

EXTERNAL ILIAC A.
- inferior epigastric a.
- deep circumflex iliac a.
at a level of inguinal ligament becomes femoral a.

FEMORAL A.
vascular lacuna femoral triangle adductor canal adductor hiatus popliteal fossa
- superficial epigastric a.
- superficial circumflex iliac a.
3
- external pudendal arteries
- deep a. of the thigh (profunda femoris a.)
largest branch of femoral a. and major blood supply to the thigh
- lateral circumflex femoral a. ascending, transverse and descending branches
- medial circumflex femoral a. ascending, transverse, acetabular branches
- perforating arteries

POPLITEAL A.
continuation of femoral a. distal to adductor hiatus
divides into anterior and posterior tibial a.
5 genicular branches to knee joint:
- superior medial a. and lateral genicular a.
- inferior medial a. and lateral genicular a.
- middle genicular a.
2 sural arteries heads of gastrocnemius m.

Genicular anastomosis:
5 genicular arteries; descanding genicular a. (from femoral a.); descending branch of lateral
femoral circumflex a.; anterior recurrent branch of the anterior tibial a.

ANTERIOR TIBIAL A.
supplies anterior compartment of the leg
- dorsalis pedis a.
- lateral tarsal a.
- arcuate a. - gives off 2
nd
, 3
rd
and 4
th
dorsal metatarsal arteries dorsal digital arteries
passes to 1
st
interosseus space and divides into:
- deep plantar a. to the plantar arch at the sole
- 1
st
dorsal metatarsal a.

POSTERIOR TIBIAL A.
larger terminal branch of popliteal a.
supplies posterior and lateral compartments of the leg and most of the foot
- fibular a. lateral compartment
- medial plantar a. plantar digital arteries
- lateral plantar a. - arches medially and anastomoses with medial plantar a. to form deep
plantar arch 4 plantar metatarsal arteries




Thorax and back - Exercise 1


Vertebral column:
7 cervical, 12 thoracic, 5 lumbar vertebrae; sacrum + coccyx

Typical vertebra:
vertebral body, vertebral arch (spinous process, transverse processes, superior and inferior
articular processes), vertebral foramen, superior and inferior vertebral notch ( intervertebral
foramen)
Cervical vertebrae transverse foramen
C1 atlas anterior arch ( anterior tubercle, articular facet for dens of axis), posterior arch
( posterior tubercle)
C2 axis dens of axis
Thoracic vertebrae costal facets, transverse costal facets
Lumbar vertebrae costal (transverse) process, accessory process, mamillary process

Sacrum
base and apex, auricular surface, promontory, anterior and posterior sacral foramens, sacral
canal and hiatus, median, intermediate and lateral sacral crests

Ribs true, false and floating ribs
Typical rib head, neck, tubercle, body (shaft), groove
Rib I scalene tubercle, groove for the subclavian vein and artery
Rib II tuberosity for serratus anterior muscle

Sternum manubrium ( jugular notch, clavicular notches), sternal angle (of Louis), body
( costal notches), xiphoid process

Intervertebral disc annulus fibrosus, nucleus pulposus

Ligaments of the vertebral column
anterior and posterior longitudinal lig.
supraspinous lig. (ligamentum nuchae)
ligamenta flava, intertransverse ligg., interspinous ligg

Joints of the vertebral column

Atlanto-occipital joint:
occipital condyles + superior articular facets of the atlas

Atlantoaxial joint:
lateral atlantoaxial joints articular facets of the atlas and axis
median atlantoaxial joint dens of axis and anterior arch of the atlas
cruciform lig. ( transverse lig. of atlas + longitudinal lig.)

Zygapophysial joints:
superior and inferior articular processes of next vertebrae

Curvatures of the vertebral column
primary thoracic, sacral kyphosis
secondary cervical, lumbar lordosis
Thorax and back - Exercise 2


Muscles of the back:

A:Superficial
trapeziusm.
latissimusdorsim.
rhomboidm.
levatorscapulaem.

Thoracolumbarfasciasuperficialanddeeplayer

B:Intermediate
serratusposteriorsuperiorm.
serratusposteriorinferiorm.

C:Deep
spleniuscapitism.
spleniuscervicism.
erectorspinae(iliocostalism.,longissimusm.,spinalism.)

Ligaments

anteriorlongitudinalligament
posteriorlongitudinalligament
ligamentumflavum
interspinousligament
supraspinousligament

Vertebral canal

Epiduralspace
Internalvertebralvenousplexus(anterior,posterior)
Spinalduramater
Spinalarachnoidmater
Subarachnoidspace
Spinalpiamaterdenticulateligament
Spinalcordconusmedullaris,caudaequina

Thorax and back Exercise 3 2008/09

Thoracic wall

Superficial group of the thorax muscles:
pectoralis major m. and pectoralis minor m.
serratus anterior m.

Muscles of thoracic wall:
external intercostal muscles
internal intercostal muscles
innermost intercostal muscles
subcostal muscles
transversus thoracis muscles

Fasciae of thoracic wall:
clavipectoral fascia
pectoral fascia
endothoracic fascia

Serous membrane:
parietal pleura cervical, costal, mediastinal, diphragmatic

Veins of the intercostal space:
superior, anterior and posterior intercostal veins
internal thoracic veins
azygos vein, hemiazygos vein, accessory hemiazygos vein

Arteries of the intercostal space:
supreme, anterior, posterior intercostals arteries . They are the branches of:
subclavian artery
internal thoracic artery musculophrenic a., superior epigastric a.
thoracic aorta

Nerves of the intercostal space:
intercostal nerves, subcostal n.

Breast:
nipple, areola, axillary tail of breast
lactiferous sinus, lactiferous duct
mammary gland, fat lobule, suspensory ligaments

lymphatics of the breast lecture !!!

Diaphragm:
central tendon
sternal, costal, lumbar parts
right and left crura
esophageal hiatus, aortic hiatus, vena caval foramen

Thorax and back Exercise 4 2008/09

1
External structure of the heart

Pericardium
fibrous pericardium
serous pericardium parietal layer, visceral layer (epicardium)

pericardial cavity

pericardial sinuses transverse pericardial sinus, oblique pericardial sinus

Orientation of the heart
apex and base
4 chambers: right atrium, right ventricle, left atrium, left ventricle
anterior (sternocostal) surface
inferior (diaphragmatic) surface
pulmonary surfaces

External sulci
coronary sulcus
anterior and posterior interventricular sulci

Coronary arteries
right coronary artery posterior interventricular branch
left coronary artery anterior interventricular branch, circumflex branch

Cardiac veins
coronary sinus and its tributaries
great cardiac vein
middle cardiac vein
small cardiac vein
oblique vein of the left atrium and posterior vein of the left ventricle
anterior cardiac veins
the smallest cardiac veins

Great vessels
pulmonary trunk pulmonary arteries

aorta:
ascending aorta
arch of aorta brachiocephalic a., left common carotid a., left subclavian a.
descending aorta (thoracic and abdominal parts)

brachiocephalic veins
superior vena cava
inferior vena cava



Internal structure of the heart. Heart conduction system.

Right atrium
right auricle
crista terminalis (sulcus terminalis)
pectinate muscles
fossa ovalis (remnant of the oval foramen)
opening of the coronary sinus
openings of SVC and IVC

Right ventricle
conus arteriosus (infundibulum)
trabeculae carneae
septomarginal trabecula (moderator band)
chordae tendineae (tendineus cords)
supraventricular crest
papillary muscles: anterior, posterior, septal

Left atrium
left auricle
pectinate muscles
openings of the pulmonary veins

Left ventricle
papillary muscles: anterior, posterior
chordae tendineae
trabeculae carneae

Interventricular septum
muscular part
membranous part

Fibrous skeleton of the heart
fibrous ring of: mitral valve, tricuspid valve, pulmonary trunk, aorta
right fibrous trigone
left fibrous trigone
membranous part of the interventricular septum

Heart valves
pulmonary valve semilunar cusps: anterior, right, left
aortic valve semilunar cusps: left, right, posterior
tricuspid (right atrioventricular) valve cusps: anterior, posterior, septal
bicuspid (left atrioventricular; mitral) valve cusps: anterior, posterior

Conducting system of the hart
sinoatrial node
atrioventricular node
atrioventricular bundle (bundle of His) right and left branch
Purkinje fibers

1
Lungs and autonomic system of the thorax

Trachea
tracheal cartilages, membranous wall, carina, bifurcation 2 main bronchi (primary bronchi)

Pleura
visceral pleura
parietal pleura costal, diaphragmatic, mediastinal and cervical part (cupula); pulmonary
ligament
pleural cavity costomediastinal recess, costodiaphragmatic recess

External structure of the lungs
hilum
root pulmonary artery and veins, main bronchus, bronchial vessels, nervous plexus,
lymphatic vessels

Right lung
inferior, middle and superior lobes; oblique fissure; horizontal fissure

Left lung
inferior and superior lobes; lingula; oblique fissure

Bronchopulmonary segments:

Right lung:
Superior lobe
I Apical
II Posterior
III Anterior
Middle lobe
IV Lateral
V Medial
Inferior lobe
VI Superior
VII Medial basal
VIII Anterior basal
IX Lateral basal
X Posterior basal
Left lung:
Superior lobe
I+II Apicoposterior
III Anterior
IV Superior lingular
V Inferior lingular
Inferior lobe
VI Superior
VII Medial basal *
VIII Anterior basal *
IX Lateral basal
X Posterior basal



/* check the lecture


Autonomic system of the thorax

Sympathetic division
white and gray communicating branches of
the thoracic spinal nerves
sympathetic trunk sympathetic ganglia,
interganglionic rami; stellate ganglion
greater, lesser and least thoracic splanchnic
nerve



Parasympathetic division
vagus nerve, recurrent laryngeal nerve,
esophageal plexus, anterior and posterior
vagal trunk
Divisions and contents of the mediastinum

Superior
thymus ( retrosternal fat pad, thymic remnant)
superior vena cava; brachiocephalic veins
aortic arch; brachiocephalic trunk; left common carotid artery; subclavian artery
trachea (thoracic part)
vagus nerves; left recurrent laryngeal nerve
cardiac nervous plexus
esophagus (thoracic part)
thoracic duct
phrenic nerves
lymph nodes

Anterior:
thymus (retrosternal fat pad, thymic remnant)
lymph nodes
fat tissue
sternopericardial ligaments

Middle:
heart with pericardium
ascending aorta
tracheal bifurcation and both main bronchi
pulmonary trunk; pulmonary arteries
pulmonary veins
superior vena cava; azygos vein (last portion)
pericardiophrenic arteries and veins
phrenic nerves

Posterior:
esophagus
vagus nerves; esophageal plexus
thoracic aorta
azygos and hemiazygos veins
thoracic duct
thoracic splanchnic nerves
lymph nodes





Diaphragm:
central tendon
sternal, costal, lumbar parts
right and left crura
esophageal hiatus, aortic hiatus, vena caval foramen

Abdomen and Pelvis 2008/09 - Exercise 1

Peritoneum and peritoneal cavity

General topography of abdominal viscera

GI tract:
abdominal part of the esophagus; stomach; small intestine: duodenum, jejunum, ileum; large
intestine: cecum, vermiform appendix, colon (ascending, transverse, descending, sigmoid),
rectum, anal canal;

spleen; pancreas; liver; gallbladder; kidneys; suprarenal glands

abdominal aorta; celiac trunk; superior mesenteric artery; inferior mesenteric artery; hepatic
portal vein


Development of the peritoneal cavity

foregut, midgut, hindgut
ventral and dorsal mesenteries

intraperitoneal structures vs retriperitoneal (primary, secondarily) organs


Peritoneum

parietal peritoneum
visceral peritoneum

falciform ligament
lesser omentum (hepatogastric ligament and hepatoduodenal ligament)
greater omentum
gastrophrenic ligament, gastrosplenic ligament, gastrocolic ligament,

mesentery proper (of the jejunum and ileum)
mesoappendix
transverse mesocolon
sigmoid mesocolon

Peritoneal cavity
greater sac
supracolic compartment
infracolic compartment
lesser sac (=omental bursa, epiploic bursa)
omental foramen (=epiploic foramen; foramen of Winslow)
superior recess
inferior recess
splenic recess
Female: rectouterine pouch (=Douglas cave), vesicouterine pouch,
Male: rectovesical pouch
Anterior abdominal wall. Inguinal canal. Hernias.

Anterior abdominal wall
Surface topography: 9 regions; 4 quadrants
Posterior abdominal wall, anterolateral abdominal wall
Superficial fascia: fatty layer - Campers fascia, membranous layer - Scarpas fascia
Muscles and aponeuroses: external oblique m., internal oblique m., transversus abominis m.
rectus sheath (anterior and posterior layer), linea alba, arcuate line, linea semilunaris
rectus abdominis m.(tendinous intersections), pyramidalis m.
transversalis fascia
extraperitoneal fascia
Vessels: superior epigastic a. and v., inferior epigastic a. and v., deep circumflex iliac a. and
v., superficial epigastric a. and v.

Umbilical folds:
Median contents: median umbilical ligament
Medial contents: chorda arteriae umbilicalis
Lateral contents: inferior epigastric vessels

Inguinal canal
Main contents: in men: spermatic cord, in women: round ligament of the uterus
deep inguinal ring, inguinal triangle (Hesselbachs triangle)
inguinal falx (conjoint tendon)
superficial inguinal ring: medial and lateral crus, intercrural fibers, reflected (reflex) ligament

Inguinal hernias
direct and indirect inguinal hernias

Ex 3
Stomach. Small and large intestine. Superior and inferior mesenteric
artery.
Gastrointestinal viscera.
Abdominal part of esophagus
Stomach
anterior and posterior wall
greater curvature, lesser curvature, cardiac and angular notches
regions: cardia, fundus, body, pylorus (pyloric antrum and pyloric canal)
cardiac opening, pyloric sphincter (forms pyloric orifice)
rugae

Small intestine
Duodenum:
Parts: superior (first), descending (second), horizontal (inferior, third), ascending (fourth)
greater duodenal papilla (common bile duct and main pancreatic duct- hepatopancreatic
ampulla), lesser duodenal papilla (accessory pancreatic duct), circular folds
duodenojejunal flexure, suspensory ligament (of Treitz)

Jejunum and ileum:
circular folds
in mesentery: windows, arterial arcades, vasa recta
ileocecal valve

Large intestine
Cecum with appendix
mesoappendix, McBurneys point

Colon:
ascending, transverse, descending, sigmoid
right (hepatic) colic flexure, left (splenic) colic flexure
transverse mesocolon, sigmoid mesocolon
taeniae coli (free, omental, mesocolic), haustra coli, epiploic (omental) appendices
semilunar folds

Rectum and anal canal


Superior and inferior mesenteric artery

Superior mesenteric artery: inferior pancreaticoduodenal a., middle colic a., right colic a.,
ileocolic a. (anterior cecal artery, appendicular artery)

Inferior mesenteric artery: left colic artery (ascending and descending branches), sigmoid
arteries, superior rectal artery
Exc 4
Liver and pancreas. Gallbladder and duct system for bile passage.
Spleen. Celiac trunk. Hepatic portal venous system and portal-caval
anastomoses.

Liver
surfaces: diaphragmatic and visceral

falciform ligament, coronary ligament, right and left triangular ligaments,
round ligament of liver (ligamentum teres hepatis),
fibrous appendix of liver, bare area

ligamentum venosum, fissure for ligamentum venosum; fissure for round ligament of liver, transverse
fissure (porta hepatis), fossa for the gallbladder

lobes: right, left, quadrate, caudate

VIII segments of liver

subphrenic recess, hepatorenal recess

Gallbladder and duct system for bile passage.
Gallbladder: fundus, body, neck

right and left hepatic ducts, common hepatic duct, cystic duct, common bile duct, hepatopancreatic
ampulla

Pancreas
head, uncinate process, neck, body, tail
main pancreatic duct (Wirsungs), accessory pancreatic duct (Santorinis)

Spleen
diaphragmatic and visceral surface, superior and inferior border, splenic hilum, upper and lower pole
impressions: gastric, renal, colic
gastrosplenic ligament, lienorenal ligament, phrenicosplenic ligament


Celiac trunk arteries
Celiac trunk: left gastric a., splenic a. (left gastroepiploic a.), common hepatic a. (gastroduodenal
a., proper hepatic a. and its branches: right and left hepatic arteries)
right gastric a., supraduodenal a., right gastroepiplioic a.

Hepatic portal venous system
hepatic portal vein: splenic v., superior mesenteric v.
inferior mesenteric v., jejunal and ileal vv

Porto-caval anastomoses.
Ex. 5
Autonomic nervous system in the abdomen. Topographical anatomy
of the abdomen: X-rays.

Sympathetic nervous system
abdominal part of the sympathetic trunk, lumbar ganglia
thoracic splanchnic nerves ( greater splanchnic n., lesser splanchnic n., least splanchnic n.),
lumbar splanchnic nerves,

Parasympathetic nervous system
vagus nerve (CN X), anterior and posterior vagal trunks

Abdominal prevertebral plexus and ganglia
celiac plexus
celiac ganglia, superior mesenteric ganglion, aorticorenal ganglia
intermesenteric (aortic) plexus
inferior mesenteric ganglion
renal plexus
superior hypogastric plexus
right and left hypogastric nerves
inferior hypogastric plexuses





E404
Liver

Anatomical division (4 lobes): right lobe (R), left lobe (L), quadrate lobe (Q), caudate lobe (C)

Ligaments:
-fixing the liver to the diaphragm, anterior and posterior abdominal wall: falciform ligament,
coronary ligament, right and left triangular ligament
-connecting the liver with gut: lesser omentum (hepatogastric ligament, hepatoduodenal
ligament)
-remnants of embryological structures: ligamentum teres hepatis (round hepatic ligament)
umbilical vein, ligamentum venosum ductus venosus

Diaphragmatic surface: falciform ligament
Visceral surface: H-like fissures pattern
fissure for ligamentum venosum (LV)
fissure for ligamentum teres hepatis (LT)
fossa for gallbladder (GB)
groove for inferior vena cava (IVC)
porta hepatis (portal vein, proper hepatic artery, hepatic ducts)

Functional division (8 segments [I-VIII]) on the basis of branching pattern of: proper hepatic
artery, hepatic ducts and portal vein








Biliary ducts and gallbladder
Gallbladder: Fundus Right and left hepatic ducts
Body
Neck
Cystic duct Common hepatic duct



Common bile duct
Pancreatic duct Pancreas


Hepatopancreatic ampulla
(major duodenal papilla with sphincter of Oddi)


Pancreas
head with uncinate process
neck
body
tail


Spleen
long axis along the left 10
th
rib (between 9
th
and 11
th
)
surfaces: diaphragmatic, gastric, renal, colic
gastrosplenic and phrenicolienal ligament


E406
Kidneys:
Capsules
-invested by fibrous renal capsule
-surrounded by fatty renal capsule (perirenal fat), enclosed within renal fascia (continuous
with the transversalis fascia);
outside of the renal fascia there is a fatty tissue constituting pararenal fat (continuous with the
subperitoneal tissue)

Relations
POSTERIOR:
-MUSCLES: diaphragm (and through it pleural cavity), psoas major, quadratus lumborum,
and transverse abdominis muscle,
-NERVES: subcostal nerve, iliohypogatric and ilioinguinal nerve cross diagonally posterior
surface

ANTERIOR:
left: stomach, spleen, pancreas, jejunum, descending colon
right: duodenum, liver, ascending colon

Hilum
renal vein, artery, and renal pelvis

Interior
medulla (renal pyramids) and cortex (outer part of the kidney also projecting into the
medullary region as renal columns)

Suprarenal glands:
Exterior:
together with the kidney surrounded by fatty capsule

Anterior relations:
Left: stomach
Right: liver

Supply:
3 arteries (branches of: inferior phrenic, abdominal aorta and renal aa.)
1 vein (left tributary of left renal v., right tributary of IVC)


Ureters:

Exterior:
extraperitoneal throughout their whole extent,

Interior:
three constrictions
at the junction with the pelvis,
entering pelvic inlet,
passing through the wall of bladder

Topography:
cross posteriorly testicular or ovarian vessels
cross anteriorly on the left side common iliac artery, whereas on the right side external iliac
artery
in males cross inferiorly deferens duct, whereas in females uterine artery

Bladder:

Exterior:
apex (pointed toward edge of the pubic symphysis)
fundus (mainly posterior wall)
neck (the lowest and the most fixed part of the bladder

resting in males on the prostate gland, whereas in females on the pelvic fascia

Relations in female:
posterior surface - anterior wall of the vagina and supravaginal part of the cervix
superior surface - vesico-uterine pouch
infero-lateral surfaces - fascia covering levator ani

Relations in male:
posterior surface rectum, seminal vesicles, deferent ducts
superior surface - sigmoid colon and ileum,
infero-lateral surfaces - fascia covering levator ani

Interior:
trigone its angles are formed by internal urethral orifice and ureteric orifices


Urethra:
Both sexes
involuntary internal sphincter
voluntary external sphincter

Female (additionally):
urethrovaginal sphincter
compressor urethrae

Parts (males only)
- preprostatic urethra = urethra in bladder neck
- prostatic urethra
the widest part, possessing crest seminal colliculus containing the
remnant of the vagina and the orifices of the ejaculatory ducts)
- membranous urethra
the shortest and the narrowest part,
- spongy urethra
the longest part, passing through the penile bulb and corpus spongiosum

Female urethra:
lies in the anterior wall of the vagina


Ex 8
Pelvic ca vit y: wa lls , mu s cles a nd fas cies . Per ineu m. Rect u m.

Pelvic cavit y

Review: Pelvis - bones , join t s , liga men t s , gender differen ces (s ee: lower limb )
Tr u e (=les s er ) a nd fa lse (=grea ter ) pelvis

Pelvi c in l et
Pelvic br im: pu bic symphys is , linea ter mina lis (pu bic cres t + pecten pu b is + ar cu a te line), ma rgin of
a la of t h e s a cr u m, s a cr a l pr omon tory

Pelvi c wa l ls
Bony: sa cr u m, coccyx, pelvic bon es in fer ior to th e lin ea ter min a lis
Mu scles : obtu r a t or in ter nu s m. , pir ifor mis m.
Liga men ts : s a cr osp in ou s liga men t, s acrot u berou s liga men t , a n ter ior s a cr oilia c liga men t

Aper t u res : obt u r a tor ca n a l, gr ea t er a nd les s er s cia t ic for a mina

Pelvi c ou t let
pu bic s ymph ys is , pu bic ar ch , is ch ia l t u ber os ity, s a cr otu ber ou s liga men t, coccyx

Pelvi c f l oor
Pelvic diap hr a gm: leva t or a n i m.(iliococcygeu s m. + p u bococcygeu s m. + pu bor ecta lis m.),
coccygeu s m. , s u per ior a nd in fer ior fa s cia of pelvic dia phr agm
Pu b ococcygeu s m.: pu bopros t a t icu s m. (=leva tor pr os t a te) or pu b ova gin a lis m. +
pu b oa na lis m.
Pu b orect a lis m. : per inea l flexu r e
tendin ou s ar ch , a nococcygea l liga men t (=a n ococcygea l b ody), u r ogen it a l h ia tu s

Per inea l membr a ne a nd deep per in ea l pou ch (=deep per inea l spa ce)

Per inea l bod y

Pelvi c f a s ci a
Membr a nou s pelvic fas cia : pa r iet a l (e. g. obt u r a t or , pir ifor mis ) a n d vis cer a l
En dopelvic fa scia

Per in eu m:
u rogen it a l tr ia n gle:
s u per ficia l per in ea l s pace,
a n a l tr ia n gle

Spa ces : retr op u bic (=preves ica l), pa r a ves ica l, retr orect a l (pr es acr a l)
Is ch ioa na l fos sa ( > an t er ior reces s ), p u den da l ca n a l

Rect u m
rect a l a mp u lla

An al ca n al:
a n a l colu mn s , pect in a t e line for med by a n a l va lves a n d a na l s in u s , a na l pecten , a n ocu t a neu s lin e
("wh ite line"), a na l aper t u r e
in tern a l a n a l s ph in ct er , extern a l a n a l s ph in ct er (deep, su per ficia l, su bcu t a neou s )

Ex 9 . Female genital organs
Internal female genital organs
ov a r i es
suspensory ligament of ovary, mesovarium, ligament of ovary
u t er in e t u b es ( =f a llo p ia n t u b es , s a lp in g es )
infundibulum (fimbriae, ovarian fimbria), ampulla, isthmus, uterine part
abdominal ostium, uterine ostium
mesosalpinx
u t er u s
anteversion, anteflexion
ligaments: round ligament of the uterus, broad ligament (mesometrium + mesosalpinx +mesovarium)
parametrium - contents

fundus
body: uterine cavity, uterine horn
isthmus
cervix (=neck): internal os, cervical canal, external os

perimetrium, myometrium, endometrium
vesicouterine pouch, rectouterine pouch
v a g i n a
vaginal vault, fornix (anterior, posterior and lateral parts), vaginal canal, anterior and posterior vaginal wall
hymen (or hymenal caruncles)



External female genital organs:

la bi a m a jo r a , anterior commisure, posterior commisure, pudendal fissure (cleft)
la bi a m i n o r a , prepuce (=foreskin) of clitoris, frenulum of clitoris

ves t i bu le : external urethral orifice, openings of the greater vestibular glands, paraurethral glands, vaginal orifice,

clit or is
body, glans, crus

Glands: bulb of vestibule, greater vestibular gland and duct, lesser vestibular glands


Perineal muscles of the female
superficial perineal muscles: superficial transverse perineal m., ischiocavernosus m., bulbospongiosus m.
Ex 10
Ma le gen it a l or ga n s .
I n t e r n a l ge n it a l or ga n s
Tes t is
tunica albuginea, septum
seminiferous tubule, straight tubule, rete testis (in mediastinum testis), efferent ductules

Tunica vaginalis: parietal layer, cavity, visceral layer

Ep id id ym is
head, body, tail
sinus of epididymis

Du ct u s d e fer en s (=vas deferens, =deferent duct): parts scrotal, funicular, inguinal, pelvic; Ampulla
Sem in a l ves icle s - Excr e t or y d u ct
Eja cu la t or y d u ct
Pr ost a t e
base, apex, surfaces: anterior, posterior, inferolateral
Lobes: anterior (=commisure, = isthmus), inferoposterior (=posterior), middle, right and left lateral lobes,
fibrous capsule
seminal colliculus: prostatic utricle, openings of ejaculatory ducts
prostatic sinus: openings of prostatic ducts

Bu lbou r et h r a l gla n d s

Muscles: ischiocavernosus m., bulbospongiosus m.
Ext er n a l gen it a l or ga n s
Pen is
root (two crura + bulb of penis), body, glans penis
corpora cavernosa separated by septum, corpus spongiosum, tunica albuginea, deep fascia of the penis (=Buck
fascia)

raphe of penis, corona of glans, neck of glans, glans penis, prepuce (=foreskin), frenulum of the prepuce
dorsal arteries of the penis, deep arteries of the penis, superficial and deep dorsal vein

suspensory ligament, fundiform ligament

Scr ot u m
skin + dartos fascia (-> with dartos m.)
raphe, scrotal sac, septum,

Sp er m a t ic cor d
ductus deferens + artery of the ductus deferens + testicular artery + pampiniform plexus of veins + cremasteric artery
and vein + genital branch of the genitofemoral n. + sympathetic and visceral afferent nerve fibers + lymphatics +
vestige of processus vaginalis

Coverings: external spermatic fascia (-> external oblique aponeurosis and its investing fascia), cremasteric fascia (->
internal oblique fascies), internal spermatic fascia (-> transversalis fascia)
cremasteric muscle in cremasteric fascia (-> internal oblique m.)


Please, read about mechanism of erection and ejaculation

E501
I. SKULL: 8 cranial bones (neurocranium) & 14 facial bones (facial skeleton)
II. BONES OF THE CRANIUM
- frontal bone (glabella)
- parietal bone
- temporal bone: squamous part, petrous part, mastoid part, tympanic part
- occipital bone: squamous part, basilar part, two lateral condylar parts
- sphenoid bone: body, greater and lesser wings, pterygoid precess
- ethmoid bone: cribriform plate, perpendicular plate & two masses enclosing ethmoid
air cells
III. SUTURES OF THE SKULL: coronal suture, saggital suture, squamous
(squamoparietal) suture, lambdoid suture
IV. FORAMEN IN THE LATERAL PART OF THE SKULL
- external acoustic (auditory) meatus
V. NEUROCRANIUM EXTERNAL ASPECT
A. lateral surface: infratemporal fossa & temporal fossa (zygomatic process of the
frontal bone & the frontal process of zygomatic bone, temporal line, zygomatic arch)
B. anterior surface: frontal bone with glabella
C. posterior surface: occipital bone with external occipital protuberance and crest
D. inferior surface (base of the skull): palatine process of maxilla; medial & lateral
pterygoid plate, pterygoid hamulus, pharyngeal tubercle, styloid process, occipital
condyle, mastoid process, groove for occipital artery
- greater palatine foramen greater palatine nerve & vessels
- lesser palatine foramen lesser palatine nerve & vessels
- foramen rotundum maxillary division of trigeminal nerve
- foramen ovale mandibular division of trigeminal nerve & accessory maningeal
artery
- foramen spinosum middle meningeal artery
- foramen lacerum - its closed by a plate of cartilage
- carotid canal internal carotid artery & sympathetic nerves (carotid plexus)
- jugular foramen glossopharyngeal, vagus, & spinal accessory nerves, and
beginning of internal jugular vein
- hypoglossal canal hypoglossal nerve and meningeal artery
- foramen magnum spinal cord, spinal accessory nerve, vertebral arteries, venous
plexus of vertebral canal , anterior & posterior spinal arteries
- condyloid foramen condyloid emissary vein
- mastoid foramen branch of occipital artery to dura mater and mastoid emissary
vein
- petrotympanic fissue chorda tympani & anterior tympanic artery
- stylomastoid foramen facial nerve
VI. CRANIAL FOSSAE
E. anterior cranial fossa (the roof of orbit): orbital part of frontal bone & lesser wing
of sphenoid bone
- crista galli
- anterior clinoid process
- cribriform plate olfactory nerves ; anterior and posterior ethmoidal foramina
anterior & posterior ethmoidal nerves, and veins
- foramen cecum small emissary vein from nasal mucosa to superior sagittal sinus

F. middle cranial fossa
- sella turcica (Turks saddle) of the sphenoid bone: tuberculum sellae, hypophyseal
fossa, jugum sphenoidale, clivus
- optic canal optic nerve, ophthalmic artery and central artery & vein of the retina
- superior orbital fissure oculomotor, trochlear & abducens nerves, ophtalamic
division of trigeminal nerve; ophtalamic veins
- foramen rotundum
- foramen ovale
- foramen spinosum
- foramen lacerum
- caroid canal
G. posterior cranial fossa
- internal auditory meatus facial and vestibulocochlear nerves; labyrinthine artery
- jugular foramen
- hypoglossal canal
- foramen magnum
- condyloid foramen
- mastoid foramen

I. BASE OF THE SKULL EXTERNAL ASPECT openings
- greater palatine foramen greater palatine nerve & vessels
- lesser palatine foramina lesser palatine nerves & vessels
- foramen rotundum maxillary division of trigeminal nerve
- foramen ovale mandibular division of trigeminal nerve
- foramen spinosum middle meningeal artery
- foramen lacerum - closed by a plate of cartilage pierced by major petrosal nerve
- carotid canal internal carotid artery & sympathetic nerves (carotid plexus)
- jugular foramen glossopharyngeal nerve, vagus nerve, accessory nerve,
beginning of internal jugular vein,
- hypoglossal canal hypoglossal nerve
- foramen magnum spinal cord, spinal roots of accessory nerve, vertebral arteries,
venous plexus of vertebral canal, anterior & posterior spinal arteries
- condyloid foramen condyloid emissary vein
- mastoid foramen mastoid emissary vein
- petrotympanic fissue chorda tympani
- stylomastoid foramen facial nerve


I. EXTERNAL EAR
A. auricle: helix, tragus, lobule
B. external acoustic (auditory) meatus: cartilaginous and bony portions
C. tympanic membrane (eardrum): pars Ilaccida, pars tensa

II. MIDDLE EAR /
TYMPANIC CAVITY
A. rooI: tegmen tympani
B. Iloor: jugular Iossa
C. anterior: carotid canal
D. posterior: mastoid air cells and mastoid antrum
E. lateral: tympanic membrane
F. medial: Ienestra cochlea / round window, promontory, Ienestra vestibuli / oval
window; prominence oI the Iacial canal, prominence oI the lateral semicircular
ducts

oval window is pushed back by the Iootplate oI the stapes
round window is closed by secondary tympanic membrane

AUDITORY OSSICLES: malleus (it has handle which is Iused to the medial surIace
oI the tympanic membrane); incus (anvil); stapes
MUSCLES: stapedius muscle, tensor tympani muscle

AUDITORY TUBE / EUSTACHIAN TUBE
MASTOID ANTRUM

III. INNER EAR
A. bony labyrinth: the vestibule; three semicircular canals; cochlea (with scala
vestibuli and scala tympani); perilymph
B. membranous labyrinth: utricle and saccule, three semicircular ducts, cochlear
duct (scala media); endolymph

IV. INNERVATION OF EAR
external ear: auriculotemporal nerve & vagus nerve
tympanic cavity tympanic plexus: tympanic nerve (Irom IX), caroticotympanic
nerves (Irom internal carotid plexus oI sympathetic Iibers)
inner ear: cochlear portion (Ior hearing) & vestibular portion (Ior equilibrium) oI CN
VIII

V. 22&31))(
external ear: superIicial temporal artery & branches oI the maxillary arteries
tympanic cavity: posterior auricular artery and branch oI maxillary artery
inner ear: labyrinth artery

VI. VESTIBULOCOCHLEAR NERVE
8 does not leave skull
- vestibular part: ampullae oI the semicircular ducts, the utricle & saccule
vestibular ganglion brain stem (equilibrium)
- cochlear part: organ oI Corti spiral ganglion brain stem (hearing)

E506
I. COATS OF THE EYEBALL
Outer Fibrous Layer of the Eyeball
1. sclera
2. cornea

Middle Vascular and Pigmented Layer of the Eyeball (Uvea)
1. choroid
2. ciliary body
3. iris

Inner Layer of the Eyeball (Retina)
1. outer pigmented layer
2. inner nervous layer
a. posterior three-fourths receives the visual light rays (photosensitive)
b. anterior one-fourth non-phototosensitive; constitutes inner lining of ciliary body and the
posterior portion of the iris
c. ora serrata junction between the photosensitive and non-photosensitive portions of the
retina
d. macula lutea oval yellowish area at the center of the posterior portion of the retina,
contains cones only
e. fovea centralis depression in the center of the macula lutea; contains only cones
area for most distinct vision
f. optic disc located about 3 mm medial to the macula lutea marks the point of exit of
the optic nerve fibers from the eyeball; pierced by the central artery of the retina (branch
of ophthalmic artery); no rods and cones blind spot

CONTENTS OF THE EYEBALL
Aqueous Humor
flow of aqueous humor: ciliary processes posterior chamber pupil anterior
chamber iridocorneal angle canal of Schlemm
Lens
Vitreous Body

REFRACTIVE MEDIA OF THE EYE
1. Cornea highest index of refraction
2. Aqueous Humor
3. Lens
4. Vitreous Body

THE RETINA

Photoreceptor Cells
1. rods
a. predominant type of photoreceptor in the periphery of the retina

b. very sensitive to light used for low levels of illumination form images without clear
details; used for night vision
c. not sensitive to colors
2. cones
a. responsible for sharp images and color vision

THE LIGHT REFLEX flashing a light in one eye results in the simultaneous constriction of
the pupil of the stimulated eye and the unstimulated eye
afferent limb optic nerve
efferent limb oculomotor nerve (parasympathetic component) to sphincter pupillae
muscle
direct light reflex pupillary constriction in the stimulated eye
consensual (indirect) light reflex pupillary constriction in the opposite, unstimulated eye

ACOMMODATION-CONVERGENCE REFLEX when the eyes are directed from a distant
to a near object, in order for the object in the visual field to remain in focus eyeballs move
medially, pupils constrict, and lenses thicken
afferent limb optic nerve
efferent limb oculomotor nerve to medial recti muscles and its parasympathetic
componment to the sphincter pupillae muscle and ciliary muscle








I. ORAL CAVITY: vestibule and oral cavity
- rooI palate
- Iloor tongue and mucosa
- lateral and anterior wall cheek and lips

II. PALATE: hard palate (palatine processes oI the maxillae and horizontal plates oI the
palatine bones) soIt plate (mucose, aponeurosis oI soIt palate, muscles, mucose)
- tensor veli palatini
- levator veli palatini
- palatoglossus
- palatopharyngeus
- musculus uvulae

III. TONGUE:
1. Lingual papillae: vallate papillae, IungiIorm papillae, IiliIorm papillae, Ioliate
papillae
Innervation: motoring hypoglossal; sensory lingual nerve; taste chorda
tympani, glossopharyngeal nerve, vagus nerve
!"#"
a) extrinsic styloglossus, hyoglossus, genioglossus, palatoglossus
$%
& Blood supply: lingual artery with sublingual and deep lingual artery

IV. TEETH: incisors (2), canines, premolars (2), molars (3)

V. TONSILS (Waldeyer`s ring): pharyngeal tonsil, palatine tonsil, tubal tonsil, lingual tonsil

VI. SALIVARY GLANDS
1. submandibular gland: with Wharton`s duct empties at the sublingual papilla
2. sublingual gland: empties by about 10 short ducts at the sublingual papilla

VII. MANDIBULAR NERVE (V3) - it`s branches are divided into anterior and posterior
group
- provides sensory Iibers to cranial dura mater oI posterior part oI the middle Iossa
& anterior part oI the posterior Iossa
- anterior group (nerves innervating mainly muscles oI mastication): masseteric,
deep temporal, medial pterygoid & lateral pterygoid; buccal nerves
- posterior group: auriculotemporal, lingual & inIerior alveolar nerves

VIII. HYPOGLOSSAL NERVE
innervating all intrinsic and extrinsic muscles oI tongue (except palatoglossus)
- carries Iibers Irom C1 to supply geniohyoid and thyrohyoid muscles

EXTERNAL NOSE
- bones: nasal bones & Irontal processes
- cartilages: two lateral cartilages, two alar cartilages & septal cartilage

NASAL SEPTUM: perpendicular plate oI ethmoid, vomer, septal cartilage

NASAL CAVITIES: have 4 walls: rooI; Iloor, medial (nasal septum) & lateral (with
nasal conchae); entered anteriorly through nares, opens posteriorly into the nasopharynx
through the choanae

NASAL CONCHAE (superior, middle and inIerior) divide the nasal cavity into Iour
parts: sphenoethmoidal recess, superior meatus, middle meatus & inIerior meatus
sphenoethmoidal recess sphenoidal sinus
superior meatus posterior ethmoidal sinus
middle meatus (with semilunar hiatus and ethmoidal bulla) Irontal sinus, maxillary
sinus & anterior ethmoidal sinuses
inIerior meatus nasolacrimal duct

VASCULATURE OF THE NASAL CAVITY
external nose superior labial artery and lateral nasal branches oI the Iacial artery
Iloor oI nose cavity greater palatine artery
rooI and lateral wall oI nose cavity anterior & posterior ethmoidal arteries,
sphenopalatine artery
medial wall oI nose cavity anterior & posterior ethmoidal arteries; sphenopalatine
artery

VI. INNERVATION OF THE NASAL CAVITY
Nerve I (olfactory nerve)
special sensory nerve special sense oI smell is distributed to the nasal mucosa
superior to the level oI the superior concha on both the lateral wall and the nasal
septum
- the cell bodies in the mucosa oI the rooI oI the nasal cavity
- it`s Iibers (which pass through the Ioramina in the cribriIorm plate) Iorm olIactory
nerve
- on the cribriIorm plate is situated olIactory bulb where are the body oI the mitral cells
(it 2
nd
neuron oI the olIactory pathway)
- axon oI these cells Iorm olIactory tract which enters the olIactory cortex

Maxillary nerve (V2) supplies most oI nasal cavities (except oI superior / anterior
part oI cavity which is supplied by anterior ethmoidal nerve a branch oI V1).
Branches oI V2 supplying nasal cavity origin Irom the pterygopalatine ganglion
(except anterior part oI cavity supplying by branch oI inIraorbital nerve)

VII Pterygopalatine fossa space between pterygoid process oI sphenoid bone (posteriorly)
and maxilla (anteriorly), medial wall is Iormed by vertical plate oI the palatine bone, the rooI
iI Iormed by greater wing oI the sphenoid bone and the Iloor is Iormed by the palatine bone

the pterygopalatine Iossa communicates:
1. with orbit cavity through inIerior orbital Iissure
2. with inIratemporal Iossa through pterygomaxillary Iissure

3. with nasal cavity through sphenopalatine Ioramen
4. with middle cranial Iossa through Ioramen rotundum
5. with base oI skull through pterygoid canal
6. with oral cavity through greater palatine canal and Ioramen

contents oI the pterygopalanine Iossa
1. maxillary nerve & its branches
2. nerve oI the pterygoid canal
3. pterygopalatine ganglion
4. pterygopalatine part oI the maxillary artery & its branches

VIII. Maxillary nerve
- enters pterygopalatine Iossa through Ioramen rotundum
- it has three branches: zygomatic nerve, inIraorbital nerve and two pterygopalatine
nerves
5. zygomatic nerve gives zygomaticoIrontalis and zygomaticotemporalis nerves, this
nerve also convey parasympathetic Iibers to the lacrimal gland
6. posterior-superior alveolar nerves
7. inIraorbital nerve gives middle- and anterior- superior alveolar nerves
8. two pterygopalatine nerves pterygopalatine ganglion

Pterygopalatine ganglion:

- greater petrosal nerve
- deep petrosal nerve
- pterygopalatine nerves (V2)















nerve oI pterygoid
canal
- greater and lesser palatine nerve
- orbital branches
- pharyngeal nerve
- posterior-superior nasal branches (with nasopalatine nerve)
piriform aperture
carotid canal
condylar canal
hypoglossal canal
musculotubal canal
nasolacrimal canal
optic canal
major and minor palatine canal
pterygoid canal
inferior orbital fissure
superior orbital fissure
petrosquamous fissure
petrotympanic fissure
foramen incisivum
supraorbital foramen
jugular foramen
foramen lacerum
foramen magnum
mastoid foramen
foramen ovale
parietal foramen
foramen rotundum
sphenopalatine foramen
foramen spinosum
stylomastoid foramen
cribriform foramina
internal and external acoustic opening
crista galli
lesser wing of sphenoid
greater wing of sphenoid
petrous part of temporal bone
trigeminal impression
mastoid process
stylomastoid process
sella turcica
occipital condyle
groove for transverse sinus
groove for sigmoid sinus
groove for superior and inferior petrosal
sinus
groove for superior sagittal sinus
hard palate

Falx cerebri
Sellar diaphragm
Falx cerebelli
Tentorium cerebelli

Epidural space
Middle meningeal artery
Trigeminal cave

Sphenoparietal sinus
Cavernous sinus
Superior petrosal sinus
Inferior petrosal sinus
Sigmoid sinus
Transverse sinus
Straight sinus
Superior sagittal sinus
Inferior sagittal sinus

Internal carotid a.
Ophthalmic a.
Vertebral a
Trigeminal ganglion

In openings inside the cranial cavity:
CN II
CN III
CN IV
CN V
1

CN V
2

CN V
3

CN VI
CN XII
E505
I. ORBITAL CONTENTS.
- eyeball
- muscles of eye movement
- optic nerve
- oculomotor nerve
- trochlear nerve
- abducens nerve
- ophthalmic nerve: lacrimal nerve, frontal nerve, nasociliary nerve
- ophthalmic artery: central artery of the retina, long & short posterior ciliary arteries, lacrimal
artery, muscular branches, medial palpebral arteries, supraorbital artery, supratrochlear artery,
anterior & posterior ethmoidal arteries
- ophthalmic veins: superior & inferior
- lacrimal gland
- lacrimal sac
II.
III. MUSCLES OF THE ORBIT
- superior rectus
- inferior rectus
- medial rectus
- lateral rectus
- superior oblique
- levator palpebrae superioris
-
- inferior oblique
IV. INNERVATION OF THE ORBIT
1. optic nerve
2. oculomotor neve
3. trochlear nerve
4. ophthalmic nerve
5. abducens nerve

V. NERVES III, IV & VI
-N. III its divided into superior division (which innervates the superior rectus & levator
palpebrae superioris muscles) and inferior division (which innervates medial rectus, inferior rectus
& inferior oblique muscles, it has also fibers to ciliary ganglion)
- N. IV innervates superior oblique muscle
- N. VI - innervates lateral rectus muscle

VI. NERVE OPHTHALMIC (V1)
- its 1
st
branch of the trigeminal nerve
- its divided into three branches: lacrimal nerve (for lacrimal gland and the skin of the upper
eyelid), frontal nerve (divides into supraorbital nerve which supplies the scalp, forehead,
frontal sinus & upper eyelid; and supratrochlear nerve which supplies the scalp, forehead &
upper eyelid), nasociliary nerve (it has 6 branches 1. a communicating branch to the ciliary
ganglion; 2. short ciliary nerves which carry autonomic fibers to ciliary body & iris; 3. long
ciliary nerves which carry autonomic fibers to dilation pupillae; 4. posterior ethmoidal nerve to
the sphenoidal and posterior ethmoidal sinuses; 5. anterior ethmoidal nerve to the anterior
ethmoidal air cells, septum and lateral walls of the nasal cavity as well as the skin of the tip of
the nose; 6. infratrochlear nerve which innervates eyelids, skin of nose and lacrimal sac

VII. CILIARY GANGLION
- it receives three types of innervations: sensory, parasympathetic and sympathetic
- sensory innervations from ophthalmic nerve (via communicating branch)
- parasympathetic innervations from oculomotor nerve
origins on the common
tendinous ring
- sympathetic innervations from internal carotid plexus
- it sends parasympathetic fibers to the sphincter pupillae and cilliary muscle via the short
ciliary nerves
- it sends sympathetic fibers to the dilator pupillae via long ciliary nerves

IX. VASCULATURE OF THE ORBIT.
ophthalmic artery is a branch of the internal carotid artery:
- central artery of the retina is an end artery (it has no branches) so its occlusion results in blindness
- long posterior ciliary arteries supply ciliary body and iris
- short posterior ciliary arteries supply choroid
- lacrimal artery it give rise to two lateral palpebral arteries
- muscular branches supply orbital muscles as well as iris via anterior ciliary arteries
- supraorbital artery supplies forehead, the scalp and the frontal sinus
- supratrochlear artery - supplies forehead and the scalp
- anterior ethmoidal arteries supplies anterior ethmoidal air cells, frontal sinus & nasal cavity
- posterior ethmoidal arteries - supplies posterior ethmoidal air cells and sphenoid sinus

ophthalmic veins:
- superior ophthalmic vein is formed near the roof of orbit cavity by the union of the
supratrochlear, supraorbiral & angular vein; receives also inferior ophthalamic vein; it terminates
in the cavernous sinus
- inferior ophthalmic vein begins by the union of small vein in the floor of orbit; communicates
with the pterygoid venous plexus

X. LACRIMAL APPARATUS
- lacrimal gland
- lacrimal canaliculi
- lacrimal sac
- nasolacrimal duct

I. MUSCLES OF THE FACE
- m. occipitofrontalis
- m. orbicularis oculi: orbital, palpebral and lacrimal parts
- m. orbicularis oris
- m. buccinator
- platysma

- masseter muscle
- temporalis muscle
- lateral and medial pterygoid muscles

II. SCALP
1. skin
2. connective tissue: larger blood vessels, scalp grapes
3. aponeurosis epicranialis (galea aponeurotica)
4. loose connective tissue: subaponeurotic space
5. pericranium: periosteum

III. TEMPOROMANDIBULAR JOINT
- synovial joint, mandibular fossa, articular tubercle
- head of mandible
- synovial cavities
- articular disk

IV. ARTERIES AND VEINS OF THE FACE AND SCULP
- facial artery (arises from external carotid artery): submental artery, inferior labial
artery, superior labial artery, angular artery
- transverse facial artery
- maxillary artery
- superficial temporal artery
- posterior auricular artery
- occipital artery
- supraorbital & supratrochlear arteries (branch of internal carotid artery)

- facial vein: angular & deep facial vein
- retromandibular vein
- common facial vein
- posterior auricular vein

V. NERVE OF FACE AND SCALP
1. Facial nerve CN VII
- greater petrosal nerve, stapedius nerve, chorda tympani
- temporal, zygomatic, buccal, marginal of mandible & cervical branches, posterior
auricular nerve, branch to digastric & stylohoid muscleses
2. Trigeminal nerve CN V
- ophthalmic division
- maxillary division
- mandibular division
3. Nerves from cervical plexus - sensory nerves
- great auricular nerve
muscles of
facial
expression
muscles of
mastication

VI. PAROTID GLAND
- in the retromandibular space
- is innervated by parasympathetic (secretomotor) fibers of lesser petrosal nerve
(glossopharyngeal nerve CN IX)
- the parotid duct
VII. LYMPHATICS
- superfacial lymph nodes of head: submental, submandibular, buccal, facial,
occipital, retroauricular, parotid and superficial cervical nodes
- deep lymph nodes of the head
ANATOMY OF THE PARAPHARYNGEAL SPACE
The parapharyngeal space forms an inverted pyramid with its base at the skull and
its apex at the greater cornu of the hyoid bone.
The fascial margins of the parapharyngeal space are complex, comprising different
layers of the deep cervical fascia. As it curves around the lateral side of the
pharyngeal mucosal space, the middle layer of the deep cervical fascia forms the
medial fascial margin. The lateral fascial margin is formed by the medial slip of the
superficial layer of the deep cervical fascia as it curves around the deep border of the
masticator and parotid spaces. Posteriorly, the parapharyngeal space fascia is made
up of the anterior part of the carotid sheath, formed by the fusion of all three layers of
the deep cervical fascia.
Extending from the medial pterygoid plate to the styloid process, the tensor veli
palatini and its fascia divide the parapharyngeal space into pre- and post-styloid
spaces.
- The post-styloid compartment contains cranial nerves IXXII:
the glossopharyngeal nerve (CN IX),
the vagus nerve (CN X),
the accessory or spinal nerve (CN XI),
and the hypoglossal nerve (CN XII), as well as
the internal carotid artery,
the internal jugular vein with adjacent superior and inferior deep cervical lymph
nodes
the cervical division of the sympathetic trunk,.
- The prestyloid compartment, bound anteriorly by both the medial pterygoid
muscle and the mandible, contains fat, minor or ectopic salivary glands, the
internal maxillary artery, and the branches of V3 (ie, the mandibular branch of the
trigeminal nerve).

NAMEOFTHETRIANGLE
ORTHEREGIONINTHE
NECK

CONTENTS
Sternocleidomastoidregion

1. Sternocleidomastoidmuscle
2. Superiorpartofexternaljugularvein
3. GreatAuricularNerve
4. TransverseCervicalNerve

LesserSupraclavicularFossa
(b/wcostal&sternaheadofSCMmuscle)

1. InferiorpartofInternalJugularVein

PosteriorCervicalTriangle

1. TrapeziusMuscle
2. CutaneousBranchesofPosteriorRamiof
SpinalNerves
3. SuboccipitalTriangleliesdeepto
superiorpartofthisregion

LateralCervicalTriangle
(PosteriorTriangleofNeck)

*Borders:anteriorlyposteriorborderofSCM
muscle,posteriorlyanteriorborderoftrapezius
muscle,inferiorlybymiddlethirdofclavicle,
apexwhereSCMandTrapeziusmeetonthe
SuperiorNuchalLine,roofbytheInvestingLayer
ofDeepCervicalFascia,andafloorbythe
SpleniusCapitisMuscle,LevatorScapulae
Muscle,MiddleScaleneMuscle,andPosterior
ScaleneMusclescoveredbytheprevertebral
layerofdeepcervicalfascia)

Dividedinto:
1. OccipitalTriangle
2. Subclavian(Omoclavicular)Triangle

byinferiorbellyofOmohyoidMuscle!!!!!!!

OccipitalTriangle

1. AccessoryNerve(CNXI)
2. UpperpartofBrachialPlexus
3. NervousPointoftheNeck
4. OccipitalArtery
5. PartofExternalJugularVein
6. PosteriorBranchesofCervicalPlexusof
Nerves
7. CervicalArtery
8. CervicalLymphNode

Omoclavicular(Subclavian
Triangle)

1. ThirdpartofSubclavianArtery
2. LowerPartofBrachialPlexus
3. ExternalJugularVein(externally)
4. SubclavianVein(deep)
5. SuprascapularArtery
6. SupraclavicularLymphNodes

AnteriorTriangleofNeck
*Borders:anteriorlybymedianlineoftheneck,
posteriorlybyanteriorborderofSCMMuscle,
superiorlybyinferiorborderofMandible,apex
atjugularnotchofManubrium;Roofby
SuperficialCervicalFasciawithPlatysmaMuscle
andfloorbyPharynx,Larynx,andThyroidGland

Submandibular(Digastric)
Triangle
*Borders:byinferiorborderofmandible,andby
anteriorandposteriorbeliesofdigastrics
muscle;floorbymylohyoidmuscle,hypoglossus
muscle,andmiddlepharyngealconstrictor
muscle

1. SubmandibularGland
2. HypoglossalNerve(CNXII)
3. FacialArtery
4. LingualArtery
5. SubmandibularLymphNodes
6. NerveotMylohoidMuscle(fromV3)
7. FacialVein
8. SubmentalArtery(fromFacialArtery)
notinsubmentaltriangle!!!

SubmentalTriangle
*Borders:Inferiorlybybodyofhyoidbone,
laterallybyrightandleftanteriorbelliesof
digastricsmuscles,floorby2mylohyoidmuscles,
apexatmandibularsymphysis,andbaseformed
byhyoidbone

1. SubmentalLymphNodes
2. SmallVeinsthatunitetoformAnterior
JugularVein

CarotidTriangle
*Borders:superiorbellyofOmohyoidMuscle
anteriorly,posteriorbellyofdigastricsMuscle
superiorly,andanteriorborderofSCMmuscle
posteriorly

1. CommonCarotidArtery
2. ExternalCarotidArtery
3. HypoglossalNerve(CNXII)
4. InternalCarotidArtery
5. LingualArtery
6. CarotidSinus
7. CarotidBody
8. VagusNerve
9. SuperiorRootofAnsaCervicalis
10. AccessoryNerve(CNXI)
11. ThyroidGland
12. Larynx
13. Pharynx
14. DeepCervicalLymphodex
15. BranchesofCervicalPlexus
16. CervicalSympatheticTrunk
17. SuperiorThyroidArtery

MuscularTriangle
*Borders:superiorbellyofomohyoidmuscle,
anteriorborderofSCMmuscle,andthemedian
planeofneck

1. ThyroidGland
2. InfrahyoidMuscles
3. Larynx
4. Trachea
5. SternothyroidMuscle
6. SternohyoidMuscle
7. ParathyroidGland

For ami na i n t he Sk ul l and t hei r Cont ent s

Name of t he Openi ng St r uc t ur es Tr aver si ng t he

Openi ng

1. Cribriformplate Olfactorynerves

1. ForamenCecum

Occasionalsmallnasalemissaryvein(fromnasalmucosa
tosuperiorsagittalsinus)in1%ofpopulationaccording
toMoore

2. AnteriorEthmoidalForamen

Anteriorethmoidalnervesandvessels
3. PosteriorEthmoidalForamen Posteriorethmoidalnervesandvessels

4. OpticCanal* OpticNerve(CNII)
Opthalmicartery
Centralarteryandveinoftheretina

5. SuperiorOrbitalFissure*
lateralpart
LacrimalNerve(V1)
FrontalNerve(V1)
TrochlearNerve(CNIV)
SuperiorOpthalmicVein

6. SuperiorOrbitalFissure*
medialpart
NasociliaryNerve(V1)
AbducensNerve(CNVI)
Sup.BranchofOculomotorNerve(CNIII)
Inf.BranchofOculomotorNerve(CNIII)

7. ForamenRotundum*

MaxillaryNerve(V2)
8. ForamenOvale*

MandibularNerve(V3)
AccessoryMeningealArtery
OccassionalyLesserPetrosalNerve

9. ForamenSpinosum* MiddleMeningealArteryandVein
MeningealBranchofMandibularNerve

10. ForamenLacerum*

Nothingpassesthroughthisforamen(buttheupperpart
istraversedbyinternalcarotidarteryandgreaterand
deeppetrosalnervesenroutetothepterygoidcanal)
Mooresaysthatinternalcarotidarteryandits
accompanyingsympatheticandvenousplexusespass
horizontallyacrosstheareaoftheforamenwhichis
closedbycartilageduringlife.

11. CarotidCanal* Internalcarotidartery

CarotidPlexus ofSympatheticNerves
CavernousSinus

12. Hiatusoffacialcanal* GreaterPetrosalNerve

13. InternalAuditoryMeatus FacialNerve(CNVII)

VestibulocochlearNerve(CNVIII)
LabirynthArtery

14. JugularForamen
anteriorpart
InferiorPetrosalSinus
GlossopharyngealNerve(CNIX)

15. JugularForamen
posteriorpart
VagusNerve(CNX)
AccessoryNerve(CNXI)
InternalJugularVein
PosteriorMeningealArtery

16. HypoglossalCanal HypoglossalNerve

17. ForamenMagnum SpinalCord(orMedullaOblongata)

Meninges
SpinalAccessoryNerve(CNXI)
VertebralArteries
VenousPlexusofVertebralCanal
AnteriorSpinalArteries
PosteriorSpinalArteries

18. CondyloidForamen(not
mentionedinclass)

CondyloidEmissaryVein(thatpassesfromsigmoidsinus
tovertebralveinsinneck)
MeningealBranchofAscendingPharyngealArtery

19. MastoidForamen(not
mentionedinclass)
MeningealBranchofOccipitalArtery(toduramater)
MastoidEmissaryVein

20. ZygomaticofacialForamen ZygomaticofacialNerve

21. SupraorbitalNotchorForamen SupraorbitalNerveandVessels

22. InfraorbitalForamen InfraorbitalNerveandVessels

23. MentalForamen MentalNerveandVessels

24. PetrotympanicFissure Chordatympani

Oftenanteriortympanicartery

25. StylomastoidForamen FacialNerve(CNVII)

26. IncisiveCanal NasopalatineNerve

TerminalPartofSphenopalatineorofGreaterPalatine
Vessels
27. GreaterPalatineForamen GreaterPalatineNerveandVessels

28. LesserPalatineForamen LesserPalatineNerveandVessels

29. PalatineCanal DescendingPalatineVessels

GreaterPalatineNerve
LesserPalatineNerve

30. PterygoidCanal NerveofPterygoidCanal(VidianNerve)

*(thiscanalrunsfromanteriorwallofforamenlacerum
tothepterygopalatinefossa)
31. SphenopalatineForamen SphenopalatineVessels
NasopalatineNerve

32. GranularFoveole Littlepitsintheskullforarachnoidgranulations

33. DigitateImpressions FoundininternalSkullfordifferentpartsofbrain

34. ExternalOpeningofVestibular
Aqueduct

EndolymphaticDuct