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Questions and Answers
What do the external carotid arteries supply?
What do the external carotid arteries supply?
The face and scalp
Where do the internal carotid arteries ascend to?
Where do the internal carotid arteries ascend to?
The base of the skull
What do the middle cerebral arteries supply?
What do the middle cerebral arteries supply?
The lateral portions of the cerebrum
What structure unites the two anterior cerebral arteries?
What structure unites the two anterior cerebral arteries?
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What do the posterior cerebral arteries supply?
What do the posterior cerebral arteries supply?
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The middle cerebral arteries are considered part of the circle of Willis.
The middle cerebral arteries are considered part of the circle of Willis.
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What is located in the median plane between the falx cerebri and the calvarium?
What is located in the median plane between the falx cerebri and the calvarium?
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What is unique about the cervical vertebrae?
What is unique about the cervical vertebrae?
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The largest salivary glands are the ______ glands.
The largest salivary glands are the ______ glands.
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Which of the following structures is located within the cavernous sinus? (Select all that apply)
Which of the following structures is located within the cavernous sinus? (Select all that apply)
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What regions divide up the pharynx?
What regions divide up the pharynx?
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Which anatomical plane divides the body into cranial and caudal portions?
Which anatomical plane divides the body into cranial and caudal portions?
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What are the primary germ layers formed during human embryo development?
What are the primary germ layers formed during human embryo development?
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What is the function of the cranial bones?
What is the function of the cranial bones?
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The midcoronal plane divides the body into equal superior and inferior halves.
The midcoronal plane divides the body into equal superior and inferior halves.
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What does HCG stand for?
What does HCG stand for?
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The _______ bone is known for its bat-like appearance and contains the sella turcica.
The _______ bone is known for its bat-like appearance and contains the sella turcica.
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Which portion of the temporal bone houses the organs of hearing?
Which portion of the temporal bone houses the organs of hearing?
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Match the cranial bones with their characteristics:
Match the cranial bones with their characteristics:
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What do the maxillae form in the human skull?
What do the maxillae form in the human skull?
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The ethmoid bone is located between the orbits and forms the lateral walls of each orbit.
The ethmoid bone is located between the orbits and forms the lateral walls of each orbit.
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What are the main organs strictly belonging to the neck?
What are the main organs strictly belonging to the neck?
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At what cervical vertebra does the larynx begin?
At what cervical vertebra does the larynx begin?
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Which of the following cartilages are paired?
Which of the following cartilages are paired?
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What is the common name for the thyroid cartilage?
What is the common name for the thyroid cartilage?
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What is the largest endocrine gland in the body?
What is the largest endocrine gland in the body?
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What mineral is required by the thyroid gland to synthesize hormones?
What mineral is required by the thyroid gland to synthesize hormones?
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Where do the vertebral arteries originate?
Where do the vertebral arteries originate?
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What do the basilar arteries form when the vertebral arteries join?
What do the basilar arteries form when the vertebral arteries join?
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Where does the common carotid artery branch from?
Where does the common carotid artery branch from?
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What is the dilation at the division of the common carotid artery called?
What is the dilation at the division of the common carotid artery called?
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What are the major venous structures of the neck?
What are the major venous structures of the neck?
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Which vein is generally larger in most people: the right internal jugular or the left internal jugular?
Which vein is generally larger in most people: the right internal jugular or the left internal jugular?
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What is the primary function of the thyroid gland?
What is the primary function of the thyroid gland?
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The larynx functions solely as an air passageway.
The larynx functions solely as an air passageway.
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What are the nasal conchae?
What are the nasal conchae?
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Which bone forms the most inferior aspect of the nasal septum?
Which bone forms the most inferior aspect of the nasal septum?
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What is the function of the mandible?
What is the function of the mandible?
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The brain weighs exactly 3 pounds regardless of a person's body weight.
The brain weighs exactly 3 pounds regardless of a person's body weight.
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What do gyri and sulci represent in the brain?
What do gyri and sulci represent in the brain?
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What are the three layers of meninges?
What are the three layers of meninges?
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What does the term 'dura mater' mean?
What does the term 'dura mater' mean?
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Which layer of the meninges is delicate and resembles a cobweb?
Which layer of the meninges is delicate and resembles a cobweb?
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What is the primary function of the choroid plexus?
What is the primary function of the choroid plexus?
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What structure connects the two cerebral hemispheres?
What structure connects the two cerebral hemispheres?
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The _______ is known as the master gland of the body.
The _______ is known as the master gland of the body.
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Which cranial nerve is the largest?
Which cranial nerve is the largest?
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The vagus nerve (X) is responsible for the movement of the tongue.
The vagus nerve (X) is responsible for the movement of the tongue.
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What is the main function of the medulla oblongata?
What is the main function of the medulla oblongata?
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Which arteries supply blood to the brain?
Which arteries supply blood to the brain?
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Study Notes
Body Planes and Directional Terminology
- The body is divided into axial, coronal, sagittal, and oblique (orthogonal) planes for imaging purposes.
- Axial (transverse) plane: divides the body into superior (cranial) and inferior (caudal) portions. CT images are initially acquired in this plane.
- Coronal plane: separates the body into anterior (ventral) and posterior (dorsal) portions; the midcoronal plane divides into equal halves. Sometimes referred to as axillary or midaxillary.
- Sagittal plane: divides the body into right and left halves; midsagittal divides into equal halves.
- Oblique planes: run at a slant through the body.
- Directional terms include anterior/posterior, cranial/caudal, proximal/distal, dorsal/ventral, superior/inferior, medial/lateral, prone/supine.
Human Embryo Development
- Fertilization occurs in the fallopian tubes; the zygote implants in the uterine wall around day 21 of the menstrual cycle.
- Implantation takes about 7 days; the blastocyst secretes HCG (human chorionic gonadotropin).
- Primary germ layers (ectoderm, endoderm, mesoderm) form from the inner cell mass of the blastocyst; these layers give rise to all tissues and organs.
- Embryonic stage lasts six weeks (weeks 3-8). The embryonic period is from the beginning of week 3 through week 8.
- Ectoderm develops into epidermis, hair, nails, skin glands, lenses of eyes, tooth enamel, adrenal medulla, sensory receptor cells, and linings of oral/nasal cavities, vagina, and anus.
- The central nervous system develops from the ectoderm's neural plate (around day 18-20). The neural tube forms brain and spinal cord; the neural crest forms most of the peripheral nervous system. The cranial and caudal ends of the neural tube close around days 24 and 26 respectively.
- The neural tube differentiates into three primary vesicles (prosencephalon, mesencephalon, rhombencephalon), which further divide into five secondary vesicles (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon).
- Endoderm forms epithelium of the digestive tract, liver, pancreas, urinary bladder, urethra, respiratory tract, thyroid, parathyroid, and thymus glands.
- Mesoderm forms dermis, cardiac/skeletal/smooth muscles, connective tissue (cartilage and bone), blood vessel epithelium, joint cavity and serous membrane epithelium, kidneys, ureters, adrenal cortex, and reproductive system epithelium.
- Development after 26 weeks involves organ growth and maturation. Human pregnancy lasts approximately 40 weeks.
The Head and Neck: Cranial Bones
- Cranium (cranial vault) protects brain and pituitary gland.
- Scalp layers: skin, connective tissue, aponeurosis, loose connective tissue, periosteum (SCALP). Blood supply from external carotid artery.
- Skull: 22 bones connected by sutures (immovable joints).
- Eight cranial bones: one frontal, two parietal, two temporal, one ethmoid, one sphenoid, one occipital.
- Frontal bone forms forehead and superior orbit portions; contains frontal sinuses (usually visible radiographically by age 7).
- Parietal bones: most of the superior cranium and some lateral aspects; superior to temporal and posterior sphenoid bones.
- Temporal bones: inferior to parietal bones; form parts of lateral cranium and floor; contain squamous, mastoid, and petrous portions.
- Petrous portion: wedge-shaped, forms part of cranial base and houses hearing organs (external, middle, inner ear).
- Auditory ossicles (malleus, incus, stapes) located in the middle ear (tympanic cavity); transmit sound from tympanic membrane (eardrum) to oval window of inner ear.
- Inner ear (fluid-filled): vestibule (balance), semicircular canals (balance), cochlea (hearing). The round window allows for fluid shifts.
- Ethmoid bone: between orbits; forms medial orbital walls; contains perpendicular plate (part of nasal septum), superior/middle nasal conchae, and ethmoid sinuses (visible radiographically around age 3).
- Sphenoid bone: base of skull; anterior to temporal bones; "bat-like" shape; greater/lesser wings; sella turcica (houses pituitary gland); sphenoid sinuses (radiographically distinguishable after age 2).
- Occipital bone: posterior cranium and part of skull base; foramen magnum; occipital condyles (articulate with C1 vertebrae).
The Head and Neck: Facial Bones
- Facial skeleton: 14 bones.
- Maxillae: upper jaw; palatine processes (form hard palate); maxillary sinuses (largest paranasal sinuses; visible at birth, become more so at puberty).
- Palatine bones: posterior to maxillary palatine processes; form posterior hard palate.
- Zygomatic bones (zygomas): cheek prominences and lateral orbital borders; temporal processes (join with temporal bones to form zygomatic arches).
- Lacrimal bones: anteromedial orbital walls.
- Vomer: inferior aspect of nasal septum.
- Inferior nasal conchae: either side of nasal cavity; warm and moisten air. The superior and middle nasal conchae are part of the ethmoid bone.
- Mandible: lower jaw; rami (posterior); condyles and coronoid processes on rami; TMJ (temporomandibular joint).
Brain and Other Structures
- Brain: ~3 pounds (~2% body weight); smaller in women than men; gyri (folds) and sulci (furrows); more sulci/gyri generally correlates with higher intellectual capacity.
- Brain tissue: gray matter (unmyelinated fibers and nerve cell bodies) and white matter (myelinated nerve fibers). Neurons transmit impulses across synapses.
Brain Anatomy and Vasculature
- Synapses: Gray areas in brain images represent synaptic regions.
- Sulci and Gyri: CT images show brain sulci (furrows) and gyri (ridges) in transverse sections.
- Gray and White Matter: Cadaver brain sections clearly demonstrate gray and white matter distribution.
- Meninges: Three layers (dura mater, arachnoid, pia mater) protect the brain and separate it from the cranium.
- Dura Mater Extensions: Four dural folds compartmentalize the brain: falx cerebri, falx cerebelli, tentorium cerebelli, and diaphragma sellae.
- Falx Cerebri: Located within the longitudinal fissure, separating cerebral hemispheres. Visible on transverse CT scans.
- Tentorium Cerebelli: Separates cerebrum from cerebellum; visible on brain images.
- Arachnoid Layer: Middle meningeal layer; delicate, web-like structure with trabeculae creating the subarachnoid space containing CSF and major blood vessels. Also shows a subdural space.
- Pia Mater: Innermost meningeal layer; thin, vascular, adheres closely to the brain. Forms leptomeninges with arachnoid. Creates spaces containing CSF in sulci.
- Subarachnoid Cisterns: Spaces between arachnoid and pia mater containing significant CSF volume, especially near the brain base.
- Cerebellomedullary Cistern (Cisterna Magna): Between medulla oblongata and cerebellum; receives CSF from the foramen of Magendie; used for cisternal puncture if lumbar puncture is impossible.
- Pontine Cistern: Anterior to the pons; contains basilar artery; receives CSF from foramina of Luschka. Visible on transverse CT images.
- Cistern of the Lateral Sulcus: Between frontal and temporal lobes; contains middle cerebral artery.
- Interpeduncular Cistern: Contains the circle of Willis; between temporal lobes.
- Chiasmatic Cistern: Anterior and superior continuation of the interpeduncular cistern; associated with the optic chiasm.
- Cisterna Ambiens: Contains the great cerebral vein and pineal gland; located between the corpus callosum and cerebellum; also called superior cistern or quadrigeminal cistern.
- Pineal Gland: Frequently calcified in adult cranial imaging (CT, MRI, X-ray).
- Cerebrospinal Fluid (CSF): Produced by the choroid plexus; Composition: water, glucose, sodium chloride, and protein; changes in CSF constituents indicate disease.
- Choroid Plexus: Vascular structures in ventricles producing CSF through filtration and secretion; visible on axial CT images.
- Ventricles: Two lateral ventricles (separated by septum pellucidum), third ventricle, and fourth ventricle; CSF flows through the foramina of Monro, cerebral aqueduct, foramina of Luschka and the foramen of Magendie.
- Brain Regions: Cerebrum, diencephalon, brainstem, and cerebellum.
- Cerebrum: Largest brain region; divided into left and right hemispheres connected by the corpus callosum.
- Corpus Callosum: Genu, rostrum, body, and splenium; illustrated in provided diagrams.
- Longitudinal Fissure: Separates cerebral hemispheres; contains falx cerebri; deviation indicates "mass effect". Shown on axial CT images.
- Lobes of the Cerebrum: Frontal (personality, motor control), parietal (sensory), occipital (vision), temporal (hearing, smell, taste), insula (motor and sensory organ function).
- Fissures and Sulci: Gyri (folds), sulci (furrows), fissures (deeper grooves); longitudinal and sylvian (lateral) fissures. Sylvian fissure location detailed.
- Central Sulcus: Separates frontal and parietal lobes at precentral (motor) and postcentral (sensory) gyri. Parieto-occipital sulcus also exists.
- Cerebral Cortex: Surface layer of gray matter (1.5-5 mm thick); white matter below; basal ganglia interspersed.
- Diencephalon: Central midline structure; epithalamus, thalamus, hypothalamus (largest component).
- Thalamus: Gray matter mass; relay station for sensory pathways; forms ventricle walls. Epithalamus above, and hypothalamus below the third ventricle.
- Pituitary Gland: "Master gland"; regulates other glands; connected to the hypothalamus by the infundibulum. Shown on reformatted sagittal CT image.
- Brain Stem: Midbrain, pons, medulla oblongata.
- Midbrain: Between diencephalon and pons; quadrigeminal plate (colliculi) and cerebral peduncles.
- Cerebral Peduncles: Contain substantia nigra (role in Parkinson's disease; produces dopamine). Visible on CT images.
- Pons: Oval-shaped; fibers connecting cerebellum; basilar artery on anterior surface; illustrated in sagittal and axial views.
- Medulla Oblongata: Conical structure; fiber tracts; vital centers (heart rate, respiration, blood pressure). Contains pyramids and the median fissure.
- Cerebellum: Posterior cranial fossa; two hemispheres connected by the vermis; cerebellar cortex (gray matter), white matter; cerebellar tonsils; controls muscle tone and coordination.
- Cranial Nerves: 12 pairs; most originate from brainstem; numbered I-XII (Roman numerals); sensory, motor, or mixed functions; details of individual nerve functions included.
- Trigeminal Nerve (V): Largest cranial nerve.
- Vagus Nerve (X): Widest distribution; regulates heart rate, blood pressure, digestion, respiration.
- Arteries of the Brain: Internal carotid and vertebral arteries supply blood. External carotid arteries supply the face and scalp.
- Cerebral Arteries: Internal carotids form anterior and middle cerebral arteries via the Circle of Willis. Anterior cerebral arteries supply frontal and medial cerebral hemispheres; Middle cerebral arteries supply the lateral cerebrum; posterior cerebral arteries join the internal carotids.
- Vertebral Arteries: Branches of subclavian arteries; ascend through transverse foramina; join to form the basilar artery. Shown on axial CT.
- Basilar Artery: Travels over the pons; bifurcates into posterior cerebral arteries; site of common berry aneurysms. Shown in axial and reformatted sagittal CT. The posterior cerebral arteries supply the occipital lobes.
- Circle of Willis (COW): Formed from the internal carotids and basilar arteries; located in interpeduncular cistern; encloses optic chiasm and infundibulum. Shown on axial CT.
- Venous System: Dural sinuses, superficial cortical veins, deep cerebral veins. All drain into dural sinuses, then to internal jugular veins; lacks valves.
- Dural Sinuses: Superior and inferior sagittal sinuses, straight sinus, transverse sinus, sigmoid sinus, cavernous sinus, petrosal sinuses.
- Superior Sagittal Sinus: Median plane; between falx cerebri and cranial bones; triangular shape in images; illustrated in axial CT.
Inferior Sagittal Sinus
- Smaller than the superior sagittal sinus.
- Runs beneath the falx cerebri's free edge.
- Joins the great vein of Galen to form the straight sinus.
Straight Sinus
- Travels along the tentorium cerebelli to the occipital protuberance.
- Continues as the lateral sinus.
Confluence of Sinuses
- Common area where lateral sinuses originate from straight or superior sagittal sinuses.
- Located at the occipital protuberance.
Lateral Sinuses
- Branch into transverse and sigmoid sinuses.
Sigmoid Sinus
- Continuation of the transverse sinus.
- S-shaped path looping over petrous and mastoid parts of the jugular foramen.
- Continues as the internal jugular vein.
Cavernous Sinus
- Large venous sinus on each side of the sella turcica.
- Receives blood from ophthalmic and middle cerebral veins.
- Drained by small petrosal sinuses into the sigmoid sinus or jugular vein.
- Contains the internal carotid artery (enters via foramen lacerum, exits to subarachnoid space).
- Associated cranial nerves: Abducens (VI), Oculomotor (III), Trochlear (IV), and branches of Trigeminal (V).
Orbits
- Pyramid-shaped bony structures.
- Medial walls: Lacrimal bone, ethmoid and palatine bone orbital plates.
- Lateral walls: Zygomatic bones, greater sphenoid wing.
- Roof: Frontal bone orbital plates.
- Floor: Maxillae and part of zygomatic bones.
Bulbus Oculi (Eyeballs)
- Roughly spherical, 2-3 cm diameter.
- Three layers (tunics): Fibrous (external), vascular (middle), retinal (innermost).
- Optic nerve formed by ganglion cells, emerges posterior to optic disc.
- Optic nerves cross at the optic chiasm, then reach the occipital lobe (visual cortex).
Eye Muscles
- Six muscles inserted into the sclera: Medial, lateral, superior, and inferior rectus; superior and inferior obliques.
- Ophthalmic artery may be mistaken for an extraocular muscle on CT.
Salivary Glands
- Three pairs: Parotid, submandibular, sublingual.
- Secrete fluid to moisten food, contribute to taste, aid swallowing, and produce amylase.
Parotid Glands
- Largest, most superior salivary glands.
- Located between mastoid process and mandibular ramus.
- Stensen's duct drains into the oral cavity near the upper second molar.
Submandibular Glands
- Also called submaxillary glands.
- Palpable medial to the mandible's body and angle.
- Wharton's duct drains near the lingual frenulum.
Sublingual Glands
- Smallest, deepest salivary glands.
- Located in the mouth floor.
- Drain via Bartholin's duct and several Rivinus ducts, sometimes into Wharton's duct.
Pharynx
- Extends from skull base to C6 vertebra.
- 12 cm long, mucous membrane walls with constrictor muscles.
- Three parts: Nasopharynx, oropharynx, laryngopharynx.
Nasopharynx
- Posterior to nasal cavity (skull base to soft palate).
- Communicates with nasal cavity via choanae.
- Eustachian tubes open into lateral walls.
- Contains pharyngeal tonsil (posterior wall).
Oropharynx
- Posterior to mouth (soft palate to epiglottis).
- Palatine tonsils (lateral walls).
- Lingual tonsils (anterior walls).
Laryngopharynx
- Superior border of epiglottis to cricoid cartilage (C6).
- Lateral walls form piriform recesses around laryngeal opening.
- Retropharyngeal space (between vertebrae and pharyngeal musculature and fascia) allows movement for swallowing; infection can spread to mediastinum.
Cervical Vertebrae
- Convex anteriorly.
- Unique characteristics compared to other vertebrae.
Atlas (C1)
- Oval, ring-like; lacks body and spinous process.
- Lateral masses with articular facets for occipital condyles (nodding).
- Inferior facets articulate with axis (C2).
Axis (C2)
- Odontoid process (dens) projects through atlas's vertebral foramen (side-to-side head movement).
Transverse Foramina
- Holes in cervical vertebrae's transverse processes.
- Passageway for vertebral arteries and other structures.
Spinous Processes
- Often bifid (forked), except C7 (vertebra prominens).
- C7 easily palpable.
Neck Muscles
- Divided into anterior and posterior triangles, based on sternocleidomastoid muscle.
Anterior Triangle Muscles
- Extend from sagittal plane to sternocleidomastoid's anterior border.
- Contribute to mouth floor.
- Base: Mandibular lower border; apex: Sternal manubrium.
- All attached to hyoid bone.
- Infrahyoid muscles (inferior to hyoid): Omohyoid, sternohyoid, sternothyroid, thyrohyoid.
- Suprahyoid muscles (superior to hyoid): Digastric, geniohyoid, mylohyoid, stylohyoid.
Carotid Sheath
- Contains carotid artery (common or internal), internal jugular vein, and vagus nerve.
Posterior Triangle Muscles
- Posterior to sternocleidomastoid, between its posterior border and trapezius.
- Base: Levator scapulae, anterior, middle, and posterior scalenes, splenius capitis.
- Apex: Sternocleidomastoid and trapezius junction.
Neck Organs
- Thyroid and parathyroid glands.
- Pharynx (continues from cranium/face).
- Larynx.
Larynx
- Air passageway and voice production organ.
- Starts at C3 (men), higher in women and children; ends at C6.
- Nine cartilages (three unpaired: thyroid, cricoid, epiglottic; three paired: arytenoid, corniculate, cuneiform).
- Thyroid and cricoid are hyaline cartilage; others elastic.
Thyroid Cartilage
- Largest laryngeal cartilage; "Adam's apple."
Thyroid Gland
- Largest endocrine gland.
- Two lobes connected by isthmus (across trachea's second and third rings).
- Lateral to inferior larynx and superior trachea; posterior to esophagus.
- Produces hormones regulating growth and metabolism (needs iodine).
Parathyroid Glands
- Two pairs, posterior and inferior to each thyroid lobe.
Major Neck Arteries
- Vertebral arteries: Originate from subclavian arteries, ascend through cervical transverse foramina (C6-C1), enter skull via foramen magnum, join to form basilar artery at pons.
- Carotid arteries: Right from brachiocephalic artery, left from aortic arch; ascend in carotid sheath; divide into internal and external at thyroid cartilage superior border; dilation at division is carotid sinus (blood pressure regulation).
Major Neck Veins
- Internal jugular veins: Drain dural sinuses (via sigmoid sinus), largest neck vessels, posterior to sternocleidomastoid, join subclavian veins to form brachiocephalic veins.
- External jugular veins: Two branches (anterior and posterior), drain face, neck, scalp into subclavian veins, then brachiocephalic veins, then superior vena cava.
CT Basics Module 8: Cross-Sectional Anatomy of Head and Neck
- Module covers anatomical planes, directional terminology, human embryo development, major head and neck structures, their functions, and location on schematic/CT images.
- Students should be able to identify anatomical planes in cross-sectional images.
- Covers human vascular system structures, 12 cranial nerves (distribution and function), and selected muscular structures.
- Jugular veins are visible on reformatted coronal CT images of the neck.
Recommended Reading
- Applegate E. The Sectional Anatomy Learning System: Concepts. 2nd ed. Philadelphia, PA: WB Saunders; 2002.
- Hofer. CT Teaching Manual: A Systematic Approach. 3rd ed. New York, NY; Thieme Publishers; 2007.
- Kelley L, Petersen C. Sectional Anatomy for Imaging Professionals. 2nd ed. St Louis, MO: Mosby Publishers; 2007.
- Madden M. Introduction to Sectional Anatomy. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2008.
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Test your knowledge on the anatomy of the carotid arteries and related structures. This quiz covers their function, location, and connections, as well as aspects of the pharynx and some unique characteristics of cervical vertebrae. Perfect for students of human anatomy and physiology.