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(BQ) Part 2 book Lippincott’s conciseillustrated anatomy: Head & neck has contents: Scalp and diploic and emissary veins, muscles of facial expression, parotid gland, facial nerve, and blood vessels of face, submandibular region, tongue and paralingual space,... and other contents.
173 SECTION Palate and Palatine Tonsil 2.18 I General Features of the Palate (Fig 2.18A) A Forms arched (dome-shaped) roof of mouth and floor of nasal cavities Separates oral cavity from nasal cavities and nasopharynx (part of pharynx superior to soft palate) Nasal surface covered by respiratory mucosa; oro- and nasopharyngeal surface by oral mucosa (heavy with glands) B parts Hard palate: immovable, anterior 2/3 Soft palate: movable in order to close off nasopharynx during swallowing or phonation C Sensory nerve supply: greater palatine nerve for sensory supply to gingivae and hard palate and lesser palatine nerve to soft palate; anteriormost part of hard palate receives sensory branches of nasopalatine D Motor nerve supply: all muscles of soft palate are supplied by vagus nerve (CN X) through pharyngeal plexus of nerves, except tensor veli palatini (supplied by CN V3) E Parasympathetic nerve supply Presynaptic fibers: in greater petrosal branch of facial nerve (CN VII), through nerve of pterygoid canal, to pterygopalatine ganglion Postsynaptic fibers: travel with sensory nerves to mucous glands of hard and soft palate F Arteries: descending palatine artery, a terminal branch of maxillary artery, sends lesser and greater palatine branches to supply soft and hard palate; ascending palatine branch of facial artery also helps G Veins: tributaries of pterygoid venous plexus II Hard Palate A Consists of palatine process of maxillary bones anteriorly and horizontal part of palatine bones B Covered by mucous membrane, which is immovably fixed to periosteum with no submucosa layer C Palatine glands: large mucous glands embedded in mucosa of posterior part of hard palate III Soft Palate A Location: moveable fibromuscular fold forming posterior projection from hard palate as far as posterior pharyngeal wall B Composition: skeletal muscles and aponeurosis covered by mucous membrane containing palatine glands Palatine aponeurosis: fibrous sheet extending posteriorly from caudal edge of palatine bone into soft palate to support and give attachment to muscles of that structure Tensor veli palatini: pulls lateral wall of auditory tube inferiorly, opening tube; innervated by branch of mandibular nerve (CN V3) Levator veli palatini: elevates soft palate to bring it into contact with posterior pharyngeal wall; innervated by branches of vagus nerve (CN X) Musculus uvulae: helps to close off nasopharynx from oropharynx; uvula: paired muscles beside midline are covered by mucous membrane and contains many mucous (palatine) glands in its submucosa; innervated by branches of vagus nerve (CN X) Palatoglossus muscle: within palatoglossal fold to sides of tongue; closes off opening of oropharynx by pulling tongue up and tensing palate innervated by branches of vagus nerve (CN X) Palatopharyngeus muscle: within palatopharyngeal fold in lateral wall of pharynx; lifts larynx during swallowing; innervated by branches of vagus nerve (CN X) Pansky_Chap02.indd 173 3/7/2013 8:14:29 PM 174 CHAPTER • Head IV Muscles of the Soft Palate (Fig 2.18B) Muscle Levator veli palatini Origin Petrous bone; medial wall of auditory tube Tensor veli palatini Lateral wall of auditory tube; scaphoid fossa; angular spine of sphenoid bone Musculus uvulae Palatopharyngeus Palatoglossus Insertion Decussate with fibers of other side and palatine aponeurosis Aponeurosis of palate after passing around pterygoid hamulus Action Raises soft palate during swallowing or phonation Tenses soft palate; opens auditory tube Nerve Pharyngeal plexus (CN X) Posterior nasal spine; palatine aponeurosis Hard palate and palatine aponeurosis Mucosa of uvula Raises and shortens uvula Pharyngeal plexus (CN X) Lateral posterior pharynx; posterior thyroid cartilage Pulls walls of pharynx superiorly, anteriorly and medially during swallowing, helps close nasopharynx Pharyngeal plexus (CN X) Anterior soft palate Dorsolateral tongue Raises posterior part of tongue and draws soft palate toward tongue Pharyngeal plexus (CN X) Trigeminal (CN V3) V Palatine Tonsil (Fig 2.18C) A Location Within tonsillar fossa (bed of palatine tonsil) posterior to palatoglossal fold and anterior to palatopharyngeal fold Not actually within oral cavity but in lateral wall of anteriormost portion of oropharynx; palatoglossal arch marks boundary between oral cavity and oropharynx (space between is called isthmus of fauces and palatoglossal and palatopharyngeal folds are called anterior and posterior pillars of fauces) B Features Covered by keratinized stratified squamous epithelium and substrate of lymphatic tissue (1–2 mm thick); surface has pit-like invaginations or tonsillar crypts; latter may be invaded by lymphocytes and granulocytes, desquamated cells, bacteria, etc and form whitish tonsillar thrombi Arteries a Ascending palatine and tonsillar branches of facial artery b Palatine branch of ascending pharyngeal artery c Tonsillar branches of dorsal lingual artery d Tonsillar branch of descending palatine artery Veins: tonsillar veins drain into pharyngeal plexus Lymph: to superior deep cervical nodes, especially jugulodigastric node Sensory nerves: branches of glossopharyngeal nerve (CN IX) and lesser palatine branch of maxillary nerve (CN V2) to upper portion VI Tonsillar Ring (Waldeyer’s) of Lymphatic Tissue A Said to “guard” openings into respiratory and digestive systems B Composed of lingual tonsil, palatine tonsils, and pharyngeal tonsil (adenoid) Pansky_Chap02.indd 174 3/7/2013 8:14:29 PM SECTION 2.18 • Palate and Palatine Tonsil Palatine process of maxilla 175 Nasopalatine nerve and septal branches of sphenoplatine vessels Horizontal part of palatine bone Greater palatine nerve and vessels Lesser palatine nerve and vessels Pterygoid hamulus Tensor veli palatini muscle Auditory tube Levator veli palatini muscle A Auditory tube cartilage Levator veli palatini muscle Salpingopharyngeus muscle Musculus uvulae Medial pterygoid plate Tensor veli palatini muscle and aponeurosis Palatine glands Musculus uvulae Palatopharyngeus muscle B Torus tubarius Pharyngeal tonsil Pharyngeal recess Torus levatorius Soft palate Palatoglossal fold Palatine tonsil Palatopharyngeal fold Lingual tonsil C Figure 2.18A–C. A Palate, Inferior View B Muscles of the Palate, Sagittal Section, Medial View C Palate, Sagittal Section, Medial View Pansky_Chap02.indd 175 3/7/2013 8:14:42 PM 176 CHAPTER • Head VII Clinical Considerations A Cleft lip (“harelip”): congenital anomaly; can occur independently or accompany cleft palate Seen in 1–2 per 300 live births; 60%–80% are male Usually affects upper lip; may be unilateral or bilateral and clefts vary from small notches in transitional lip and red border to cleft extending through lip into nose B Cleft palate: congenital anomaly in which midline fusion of palatine processes of maxillae or palatine bones fails to occur Cleft may also lie between premaxillary and maxillary portions of hard palate Permits air, liquids, or solids to pass from nose to mouth or vice versa, which can lead to sucking and swallowing problems in newborn and to speech difficulties in later years C Uranoplasty: repair of cleft in hard palate; congenital cleft palates may be repaired by using prominent mucoperiosteum on the inferior side of palate as a flap D Palatopharyngeal incompetency Occurs when soft palate does not extend far enough posterior to form good seal with pharynx Commonly associated with cleft palate and can cause problems with speech and swallowing E Jugulodigastric node: because of inaccessibility of posterior 1/3 of tongue and tonsil; sometimes 1st positive sign of carcinoma in these regions will be swelling of this node, sometimes called “main gland of tonsil” F Tonsils and adenoids Palatine tonsils are subject to infection as result of numerous crypts on their surface Tend to hypertrophy most commonly in childhood due to a general lymphatic hyperplasia; adenoid hypertrophy can block nasopharynx, creating problems in breathing Because of tremendous vascular supply of palatine tonsils, extreme care must be used in tonsillectomy Because of thin lateral wall behind which lie many major vessels, excision must be done with great care On lateral surface of palatine tonsil, fascia of superior pharyngeal constrictor muscle forms connective tissue capsule in which tonsil may be surgically entirely removed; large vessels and nerves in parapharyngeal space are separated from tonsil by superior constrictor, and are usually relatively protected during surgery G Nasopalatine block: nasopalatine nerves can be anesthetized by injecting anesthetic into incisive fossa in hard palate Needle inserted just posterior to incisive papilla; both nerves are anesthetized where they emerge from fossa Tissues affected are anterior hard palate and mucosa, lingual gingivae, and alveolar bone of anterior maxillary teeth Pansky_Chap02.indd 176 3/7/2013 8:14:43 PM 177 SECTION Nose, Nasal Cavity, and Paranasal Sinuses 2.19 I Nose and Nasal Cavity A Part of respiratory tract above hard palate; containing organ of smell B External nose Varies in size and shape, mainly due to differences in cartilages Pyramidal in shape; has a root (inferior to forehead) and an apex (at free end) Nostrils (nares): anterior openings separated by septum Coarse hairs (vibrissae) protect opening of nares and prevent foreign matter from entering nasal cavity Nose has lateral surfaces and dorsum a Superior part of dorsum is made up of nasal bones and is called the bridge of the nose b Lateral surfaces end inferiorly in a rounded portion, ala nasi Nose framework (Fig 2.19A,B) a Consists of bones superiorly and laterally (nasal bones on bridge and frontal process of maxillary bones), and cartilage and fatty tissue, inferiorly b Septal cartilage makes up approximately 1/2 of nasal septum and lateral cartilages are seen on either side of septal cartilage c Distal end of nose contains greater alar cartilage and several lesser alar cartilages, which provide rigid support for nasal alae (wings) and septum Frontal bone: Frontal sinus Nasal spine Nasal bone Sphenoid bone: Hypophyseal fossa Sphenoidal sinus Ethmoid bone: Crista galli Cribriform plate Perpendicular plate Vomer: Groove for nasopalatine nerve and sphenopalatine artery Septal cartilage Medial crus of major alar cartilage Maxilla: Anterior nasal spine Incisive canal Palatine process Alveolar process A Palatine bone: Horizontal plate Lesser palatine foramen Greater palatine foramen Figure 2.19A. A Bones of the Nasal Septum and Hard Palate Pansky_Chap02.indd 177 3/7/2013 8:14:50 PM 178 CHAPTER • Head Mucosa covering nasal septum Pharyngeal tonsil Choanae Torus tubarius Opening of auditory (pharyngotympanic) tube Hard palate: Palatine process of maxilla Horizontal plate of palatine bone Soft palate: Musculus uvulae Palatine glands B Figure 2.19B. B Mucous Membranes of the Nasal Septum and Hard Palate 7 Nerves a Muscles: branches of facial nerve (CN VII) b Sensory: infratrochlear nerve and external nasal branch of nasociliary branch of ophthalmic division of CN V to bridge of nose; nasal branches of infraorbital branch of maxillary division of CN V to sides of nose C Nasal cavity (Fig 2.19C,D) Lies below anterior cranial fossa and extends from nares anteriorly to posterior opening of nose, choanae, which lead into nasopharynx Filters, moistens, and warms air; functions as a resonator for speech Entrance into nasal cavity is called vestibule (enclosed laterally by alae of nose, medially by cartilaginous and connective tissue end of nasal septum, and lined by slightly modified facial skin) Limen nasi: curved mucosal ridge marking border to nasal cavity Stratified squamous epithelium of epidermis is continuous with pseudostratified, ciliated columnar (respiratory) epithelium at limen nasi Nasal septum: divides cavities a Anterior part: septal cartilage b Posterior part: bony nasal septum i Upper part: perpendicular plate of ethmoid bone ii Lower part: vomer plus crests of bone from maxillary and palatine c Covered by mucous membrane, of which an upper posterior part, just below cribriform plate of ethmoid, is olfactory Lateral wall of nasal cavity: exhibits shelves, conchae or turbinates, which are bony projections covered by mucous membrane and increase respiratory surface of nose; conchae cover spaces called inferior, middle, and superior nasal meatuses a Inferior concha: separate bone connected to maxilla; covers inferior meatus into which opens nasolacrimal duct from lacrimal sac, conducting tears into nasal cavity Pansky_Chap02.indd 178 3/7/2013 8:14:57 PM SECTION 2.19 • Nose, Nasal Cavity, and Paranasal Sinuses Cribriform plate 179 Frontal sinus Middle nasal concha Superior nasal concha Nasal bone Sphenopalatine foramen Lacrimal bone Sphenoidal sinus Frontal process of maxilla Medial pterygoid plate Perpendicular plate of palatine bone Inferior nasal concha Incisive canal Pterygoid hamulus (ghosted) Palatine foramina: Lesser Greater Palatine process of maxilla Horizontal plate of palatine bone C Middle nasal concha (cut) Opening of middle ethmoidal air cells Ethmoidal bulla Openings of anterior ethmoidal air cells in semilunar hiatus Lacrimal bone Uncinate process of ethmoid bone D Opening of maxillary sinus Inferior nasal concha Figure 2.19C,D. Bones of the Nasal Cavity C Lateral Wall D Detailed View, Lateral Wall Pansky_Chap02.indd 179 3/7/2013 8:15:10 PM 180 CHAPTER • Head b Middle concha: covers middle meatus i Bulla ethmoidalis: bulge formed by ethmoid air cells; middle ethmoidal air cells drain onto its eminence ii Uncinate process: thin process of ethmoid bone below bulla supporting mucous membrane forming semilunar hiatus iii Semilunar hiatus: groove anteroinferior to bulla ethmoidalis; receives ducts of nasal sinuses a) Frontal sinus: drains into highest portion of semilunar hiatus, called infundibulum b) Anterior ethmoidal air cells: several air cells drain into hiatus near its midpoint c) Maxillary sinus: drains into lowest portion of hiatus c Superior concha: small (1/2 length of middle concha and lies above posterior 1/2 of latter) and rounded with sphenoethmoidal recess above it and superior meatus below it; receives 1–2 openings from posterior ethmoidal air cells d Roof of nasal cavity: curved and narrow, except posteriorly where hollow body of sphenoid forms roof; formed, anterior to posterior, by nasal and frontal bones, cribriform plate of ethmoid, and body of sphenoid e Floor of nasal cavity: is wider than roof; formed by hard palate (palatine process of maxilla and horizontal process of palatine bone) Mucosa of nasal cavity: begins at border of nasal vestibule (Fig 2.19E,F) a Olfactory region i Mucosa is an area of approximately 10 cm2 and up to 100 micrometers thick with slightly brownish coloration and with olfactory chemoreceptors to form olfactory organ ii Covers superior concha, corresponding parts of roof of nasal cavity and nasal septum iii Thicker than respiratory mucosa iv Contains pseudostratified columnar epithelium with supporting and basal cells and olfactory cells (bipolar neurons with long, nonmotile cilia that respond to odoriferous substances and basal processes which form axons of olfactory nerves) v Lamina propria of this mucosa also contains serous olfactory glands a) Secretion of mixed glands moistens air and begins preliminary movement to pharynx by ciliary action of respiratory epithelium purification; any matter adhering to nasal secretion is moved to pharynx by ciliary action of respiratory epithelium b) Olfactory organ and sensory nerves of nasal mucosa control respiratory air for chemical impurities and can elicit “nasal reflex,” or sneeze b Respiratory region i Contains pseudostratified, ciliated columnar epithelium with goblet cells and cilia that beat toward pharynx ii Many seromucous nasal glands produce thin liquid secretion containing mucus iii Covers middle and inferior conchae and remaining parts of wall, together with mucosa of paranasal sinuses iv Most inspired air passes through region of middle and inferior meatuses Pansky_Chap02.indd 180 3/7/2013 8:15:11 PM SECTION 2.19 • Nose, Nasal Cavity, and Paranasal Sinuses Opening of sphenoidal sinus into sphenoethmoidal recess Sphenoidal sinus Nasal meatuses: Superior Middle Inferior 181 Nasal conchae: Superior Middle Inferior Olfactory bulb Frontal sinus Atrium Pharyngeal tonsil Limen nasi Pharyngeal recess Nasal vestibule Torus tubarius Opening of auditory (pharyngotympanic) tube Hard palate Soft palate Salpingopalatine fold Tongue Salpingopharyngeal fold E Openings of ethmoidal air cells: Posterior Middle Anterior Opening of sphenoidal sinus Opening of frontonasal duct Semilunar hiatus Opening of maxillary sinus Opening of nasolacrimal duct F Ethmoidal bulla Figure 2.19E,F. E Lateral Wall of the Nasal Cavity F Lateral Wall of the Nasal Cavity, Conchae Removed Pansky_Chap02.indd 181 3/7/2013 8:15:26 PM 182 CHAPTER • Head II Paranasal Sinuses (Fig 2.19G–I) A Air-filled diverticula of nasal cavity B large paired sinuses and collection of air cells Frontal sinuses a Appear in approximately 7th year of life (may be earlier) b Lie posterior to superciliary arches between outer and inner tables of frontal bone, vary in size, are commonly asymmetrically formed c Both frontal sinuses are commonly separated by a septum, which is usually not straight d Open into anterosuperior end of semilunar hiatus at ethmoidal infundibulum via frontonasal duct Maxillary sinus a Appears in fetus at approximately 4th month of pregnancy b Very large in adults (largest paranasal sinus) c Related to orbit above; to molar and premolar teeth below; to lower 1/2 of nasal cavity medially; and posteriorly to pterygopalatine and infratemporal fossae d Drains at its superior end into semilunar hiatus of middle meatus e Deepest part of sinus lies above roots of 2nd premolar and 1st molar teeth; canine tooth is not usually topographically closely related f Infraorbital canal, with its infraorbital nerve (CN V2) and vessels, lies in its superior wall g Opening of sinus is poorly situated for good drainage because it lies near roof Sphenoidal sinuses a In sphenoid bone and separated from each other by asymmetric septum b Occur approximately 7th year of life c Nasal cavity and ethmoid air cells are anterior; layer of bone is posterior; nasopharynx and nasal cavity are inferior; brain, optic chiasma, intercavernous sinus, and hypophysis are superior; and laterally optic nerve, cavernous sinus, and its contents d Open into sphenoethmoidal recess of nasal cavity e Occasionally extends into basal part of occipital bone Ethmoidal air cells a Begin to form in fetus during 2nd 1/2 of pregnancy b Numerous, small, thin-walled sacs, which communicate with each other c Contained entirely in ethmoid labyrinth d Medially are superior and middle meatuses; laterally is orbit; anteriorly is frontal process of maxillary bone; and posteriorly is sphenoid sinus e Anterior air cells open into middle meatus into semilunar hiatus; middle set open into middle meatus on bulla ethmoidalis; posterior set open into superior meatus Pansky_Chap02.indd 182 3/7/2013 8:15:26 PM 356 Index Brain (Continued ) clinical considerations brain growth, 252 intracranial hematomas, 252 stroke, 252 white matter pathology, 252 cortex, 250 dural venous sinuses, 241 basilar, 242 cavernous, 242 clinical considerations, 244 confluence of, 240 diploic veins, 242 emissary veins, 242 inferior petrosal, 242 inferior sagittal, 240, 243 location, 240 occipital, 240 sigmoid, 240 sphenoparietal, 240 straight, 240 superior petrosal, 242 superior sagittal, 240, 243 transverse, 240, 244 features cerebral hemispheres, 249–250, 251 clinical considerations, 252 principal parts, 249, 251 forebrain, 250 head injuries and intracranial hemorrhage clinical considerations, 278, 279, 280, 281 epidural (extradural) hemorrhage, 276, 277 intracerebral hemorrhage, 278, 279 subarachnoid hemorrhage, 278 subdural hemorrhage, 276, 277 lateral view clinical considerations, 256 features, 256 lobes, 255–256 poles, 255, 257 primary auditory area, 256 primary motor cortex, 256 primary sensory cortex, 256 primary visual cortex, 256 principal fissures/sulci, 255 lobes frontal, 249 insula, 249 occipital, 249 parietal, 249 temporal, 249 medial view cerebral hemisphere, 258, 359 diencephalon, 258, 259 medulla oblongata, 258 midbrain, 258 pons and cerebellum, 258 medulla oblongata, 250 meninges arteries, 236 clinical considerations, 238–239 cranial, 234, 235 dural venous sinuses, 236 (see also Dural venous sinuses) Pansky_Index.indd 356 nerves, 238 partitions and shelves, dura, 236 veins, 238 midbrain, 250 occlusion, major arteries, 274, 275 pituitary gland (hypophysis) blood supply, 264 clinical considerations, 264 hormones and effects, 264 location, 263, 265 parts, 263, 265 relations, 263, 265 size, 263, 265 pons, 250 venous drainage clinical considerations, 244 deep veins, 242, 245 superficial (external) cerebral veins, 242, 245 ventricles features, 282, 283 fourth ventricle, 284 lateral, 282, 284, 285 third ventricle, 282, 284 Brainstem see Hindbrain Branchial cleft sinuses and cysts, 20 Branchial fistula, 22 Brodmann areas, 250 Bronchomediastinal lymph trunks, 46 Buccal nerve, 316 Buccopharyngeal fascia, Bulbus oculi see Eyeball, layers Bulla ethmoidalis, 180 C Calcitonin, 26 Calculus formation, 136 Caloric testing, 333 Canines, 158 Carotid body, 30 Carotid (neck) pulse, Carotid sheath, neck ansa cervicalis, 30 cervical sympathetic trunk clinical considerations, 38 composition, 36 ganglia, 36 location, 36 preganglionic fibers, origin, 36 clinical considerations carotid arteriography, 38 carotid endarterectomy, 38 carotid sinus hypersensitivity, 38 common carotid artery, 38 contents common carotid, 30 external carotid artery, 32 internal carotid artery, 32 internal jugular vein, 34 structure, 30 Carotid sinus, 32 Carotid triangle, 6, 16, 21 Cartilages larynx arytenoid, 62 corniculate, 62 cricoid, 62 cuneiform, 64 epiglottis, 62 thyroid, 62 triticeal, 62 Cataract, 206 Cavernous sinus clinical considerations, 248 contents and relations, 246, 247 location, 246, 247 venous communications, 246 Cementum, 160 Central venous catheterization, Cerebellum, 250 Cerebral compression, 256 Cerebral concussion, 256 Cerebral contusion, 256 Cerebral hemispheres basal view, 253, 253 cerebellum, 250 clinical considerations brain growth, 252 intracranial hematomas, 37 stroke, 252 white matter pathology, 252 cortex, 250 forebrain, 250 lobes, 249 medulla oblongata, 250 midbrain, 250 pons, 250 surface markings, 249 Cerebral lacerations, 256 Cerebrospinal fluid (CSF) circulation absorption, 286–287 choroid plexus, 286–287 clinical considerations CSF leakage, 290 during fractional pneumoencephalography, 291 hydrocephalus, 289, 290 lumbar puncture, 291 meningitis, 290 during radionuclide encephalography, 291 during ventriculography, 291 composition, 286 drainage, 286 formation, 286 function, 287 subarachnoid cisterns, 288–289 (see also Subarachnoid cisterns) subarachnoid space, 288 Cerebrovascular accident, 280 Cervical dystonia see Spasmotic torticollis Cervical spondylosis, 60 Cervical sympathetic trunk see also Trunks clinical considerations cervicothoracic ganglion block, 38 Horner’s syndrome, 38 hyperhidrosis, 38 Raynaud’s disease, 38 composition, 36 ganglia inferior cervical, 36 middle cervical, 36 superior cervical, 36 location, 36 preganglionic fibers, origin, 36 3/7/2013 7:04:04 PM Index Cervical triangles see Anterior cervical triangle; Posterior cervical triangle Cervical vertebral column articulations anterior longitudinal ligament, 52 atlanto-axial and atlanto-occipital joints, 51–52 ligamenta flava, 52 ligamentum nuchae, 52 posterior longitudinal ligament, 52 atlas, 51, 55 axis, 51, 55 cervical vertebrae 3–6, 51, 55 cervical vertebrae 7, 51 clinical considerations cervical root syndrome, 61 cervical spinal cord injury, 60 cervical spondylosis, 60 injury to/blockage of, arteries, 61 movements, 61 suboccipital puncture, 61 whiplash injury, 60 neurovascular structures arteries, 56 clinical considerations, 60–61 nerves, 56 veins, 58 prevertebral muscles longus capitis muscle, 52 longus colli muscle, 52 rectus capitis anterior muscle, 54 rectus capitis lateralis muscle, 54 surface, 52 suboccipital region muscles in, 54, 56 triangle, 54, 56 whiplash injury, 54 Chalazion, 192 Choked disc, 206 Cholesteatoma, 230 Chorda tympani, 228 Chronic traumatic encephalopathy, 256 Ciliary arteries, 208 Ciliary ganglion, 302, 305 Ciliary muscle, 205 Cleft lip, 176 Cleft palate, 176 Coated tongue, 172 Cochlea, 224 Cochlear duct, 226 Collateral circulation of brain, 272 Coloboma, 190 Color blindness, 214 Common ring tendon, 196, 199 Complete overbite, 162 Concha, 218 Conduction deafness, 230 Condyloid emissary veins see Emissary veins Conjunctivitis, 192 Contralateral homonymous hemianopia, 216 Contralateral homonymous hemianopsia, 216 Contralateral quadranticvisual field defect, 216 Cornea, 202 Corneal pathology, 207 Corneal reflex, 207 Pansky_Index.indd 357 Corneoscleral junction, 202 Costocervical trunk, 46 Cranial meninges arachnoid mater, 234 covering, 234 dura mater, 234 pia mater, 234 Cranial nerve I see Olfactory nerve Cranial nerve II see Optic nerve Cranial nerve III see Oculomotor nerve Cranial nerve IV see Trochlear nerve Cranial nerve IX see Glossopharyngeal nerve Cranial nerve V see Trigeminal nerve Cranial nerve VI see Abducent nerve Cranial nerve VII see Facial nerve Cranial nerve VIII see Vestibulocochlear nerve Cranial nerve IX see Glossopharyngeal nerve Cranial nerve X see Vagus nerve Cranial nerve XI see Accessory nerve Cranial nerve XII see Hypoglossal nerve Cranial nerves abducent nerve clinical considerations, 322 features, 322 origin, course, and branches, 322, 323 accessory nerve clinical considerations, 342 features, 342 origin, course, and branches, 342, 343 components, classification general proprioception, 297 general somatic afferent, 296 general somatic efferent, 294 general visceral afferent, 296 general visceral efferent, 296 simple, 294 special somatic afferent, 296 special visceral afferent, 297 special visceral efferent, 294 summary, 297 facial nerve (see also Facial nerve) clinical considerations, 328–329 features, 324 origin, course, and branches, 324, 325, 326, 327 glossopharyngeal nerve clinical considerations, 336 features, 334 origin, course, and branches, 334, 335 hypoglossal nerve clinical considerations, 344 features, 344 origin, course, and branches, 344, 345 oculomotor nerve (see also Oculomotor nerve) clinical considerations, 304 features, 302 origin, course, and branches, 302, 304, 305 olfactory nerve clinical considerations, 298 features, 298 origin, course, and branches, 298, 299 optic nerve clinical considerations, 300 features, 300 357 origin, course, and branches, 300, 301 summary of, 292–294, 293, 294, 295 trigeminal nerve (see also Trigeminal nerve) clinical considerations, 320–321 divisions, 310, 311, 312, 313, 314, 315, 316, 317, 318, 319 features, 308 origin, course, and branches, 308, 309 trochlear nerve clinical considerations, 306 features, 306 origin, course, and branches, 306, 307 vagus nerve (see also Vagus nerve) clinical considerations, 340 features, 337 origin, course, and branches, 337–338, 339, 341 vestibulocochlear nerve (see also Vestibulocochlear nerve) clinical considerations, 332–333 features, 330 origin, course, and branches, 330, 331 Cranioschisis, 103 Cranium see Skull Cretinism, 28 Cricopharyngeus muscle, 81–82 Cricothyrotomy, 68 see also Larynx Crouzon’s syndrome, 103 Crown, 160 Cruciate/cruciform ligament, 51–52 Cryptophthalmos, 190 Cupula, 48 Cutaneous nerves, neck anterior rami, 14 clinical considerations, 14 posterior rami, 14 D Deafness, high tone, 231 Deciduous teeth, 158 Deep cervical fascia see Fascia, neck Deep temporal nerves, 316 Deglutition, 85 Dental caries, 162 Dentine, 160 Diabetic retinopathy, 214 Diaphragma sellae, 236 Diastemae, 158 Diencephalon see Forebrain Digastric muscle, 154 Dilatator pupillae muscle, 204, 205 Diphyodont, 158 Diploic veins, 242 Diplopia, 206 Distichiasis, 190 Dorsal scapular artery, 46 Ducts cochlear, 226 nasolacrimal, 190 parotid duct (Stensen’s), 133 right lymphatic, 46 thoracic, 46, 88 thyroglossal, 24, 29 Dura mater layers, 234 partitions and shelves, meningeal layer, 236 3/7/2013 7:04:04 PM 358 Index Dura mater (Continued ) diaphragma sellae, 236 falx cerebelli, 236 falx cerebri, 236 tentorium cerebelli, 236 Dural venous sinuses, 241 basilar, 242 cavernous, 242 clinical considerations childbirth injury, 244 subdural hematoma (bleed), 244 surgical hazard, 244 tumor cell metastasis, 244 confluence of, 240 inferior petrosal, 242 inferior sagittal, 240, 243 location, 240 meninges, 236 occipital, 240 sigmoid, 240 sphenoparietal, 240 straight, 240 superior petrosal, 242 superior sagittal, 240, 243 transverse, 240, 244 Dysarthria, 340 Dysgnathia, 162 Dysphonia, 340 E Ear auditory ossicles, 222, 223, 225 clinical considerations of auditory tube blockage, 231 cholesteatoma, 230 conduction deafness, 230 high tone deafness, 231 hyperacusis, 230 inner ear infections, 230 mastoid infections, 230 Meniere’s disease, 231 motion sickness, 231 myringotomy, 230 otic barotrauma, 231 otitis externa, 230 otitis media, 230 perceptive (sensorineural) deafness, 230 tears in tympanic membrane, 230 external ear auricle (pinna), 218 external auditory meatus, 218, 219, 220 general features, 218, 219 inner ear (labyrinth), 224, 226, 227, 229 membranous labyrinth, 226, 229 osseous labyrinth, 224 intrinsic muscles, 224 mechanism of hearing sound waves, 228 middle ear, 220, 221, 222 neurovasculature of middle and inner ear, 226, 228 sense organs, 226 spiral organ (of corti), 228 Ectopic thyroid tissue, 172 Ectropion, 190 Emissary veins, 123–124, 125, 126, 127, 242 Emmetropia, 206 Pansky_Index.indd 358 Enamel, 160 Entropion, 206 Epicanthus, 190 Epidural (extradural) hemorrhage, 276, 277 Epiphora, 192 Epitympanic recess, 220, 222 Equilibrium, sense organs for, 226 Erb’s point, neck, 14 Esotropia, 206 Eugnathia, 162 Exophthalmic toxic goiter, 28 Exophthalmos, 214 Exotropia, 206 External auditory meatus, 18, 219, 220 Eyeball clinical considerations accommodation, 206 ametropia, 206 artifical eye, 207 astigmatism, 206 cataract and presbyopia, 206 choked disc or papilledema, 206 corneal pathology, 207 corneal reflex, 207 diplopia, 206 emmetropia, 206 entropion, 206 esotropia and exotropia, 206 glaucoma, 206 hyperopia or hypermetropia, 206 Kayser-Fleischer ring, 207 myopia, 207 photophobia, 206 retinal detachment, 207 uveitis, 207 visual field, 206 divisions of, 205 general features, 202, 203 innervation of muscles, 205 layers cornea, 202 corneoscleral junction, 202 sclera, 202 refractive media, 205 Eyelids anomalies of, 190 clinical considerations, 190, 192, 198, 200 extraocular muscles, 196, 197, 198, 199 general features, 187, 189 lacrimal apparatus, 188, 190, 191 levator palpebrae superioris muscle, 188, 191 mechanical injuries, 192 muscles controlling levator palpebrae superioris muscle, 196 orbicularis oculi muscle, 196 neoplasms, 192 neurovasculature, 188 structure, 187, 189 F Face arteries of, 134 clinical considerations, 136–138 innervation, 133 lymphatic drainage, 134, 136 parotid gland general features, 133 location and relations, 133, 135 parotid duct (Stensen’s), 133 parotid fascia, 133 structures embedded in, 133–134, 135, 137 Facial artery, 32 Facial nerve branches chorda tympani, 326 greater petrosal nerve, 324, 325, 327 nerve to stapedius muscle, 326 nerve to posterior belly, 326 posterior auricular nerve, 326 clinical considerations Bell’s palsy, 328 hearing impairment, 328 hematoma, 328 lacerations/contusions, 328 paralysis, 329 testing of CN VII, 329 course, 324 features, 324 origin, 324, 325 Facial pain, 98 False vocal folds, 64 see also True vocal folds Falx cerebelli, 236 Falx cerebri, 236 Farsightedness see Hyperopia Fascia bulbi, 194 Fascia, neck clinical considerations, 10 deep cervical buccopharyngeal, carotid sheath, infrahyoid, pretracheal, prevertebral, superficial layer, visceral, pharyngobasilar, 81 skin and superficial, Fascial spaces parapharyngeal, 10, 89 pretracheal, 8, 10, 89 retropharyngeal, 10 suprasternal, 10 Foramina, 139 Forebrain basal ganglia, 250 brain basal view, 253, 254 diencephalon, 249 hypothalamus, 250 telencephalon, 249 thalamus, 250 Foster-Kennedy syndrome, 298 Fovea centralis, 204 Fracture of nose, 186 orbital, 194 Frenectomy, 172 Frey’s syndrome, 136, 352 Frontal bone, 92 Frontal emissary veins see Emissary veins Frontal nerve, 310 3/7/2013 7:04:04 PM Index G Gag reflex, 172 Ganglion cervicothoracic (stellate), 48 cervicothoracic ganglion block, 38 ciliary, 302, 305 inferior cervical, 36 middle cervical, 36 otic, 318 preganglionic fiber, 36 pterygopalatine, 314 stellate/cervicothoracic, 36 submandibular, 318 superior cervical, 36 Geniculocalcarine tracts see Optic radiations (geniculocalcarine tracts) Genioglossus muscles, 166 Geniohyoid muscle, 154 Geographic tongue, 172 Gingivitis, 162 Glaucoma, 206 Glossitis, 344 see also Hypoglossal nerve Glossopharyngeal nerve branches carotid sinus nerve, 334, 335, 336 lesser petrosal, 334 lingual branches, 334 nerve to stylopharyngeus, 334 pharyngeal branches, 334 tympanic, 334 clinical considerations, 336 course, 334 features, 334 origin, 334, 335 Goiter, 5, 25, 28 Grave’s disease, 28 Greater palatine nerve, 312 Greater petrosal nerve, 226 Gums (gingivae), 160 Gyrus fusiform, 258 hippocampal, 348 postcentral, 249, 255 precentral, 249, 255 H Harelip see Cleft lip Head arteries of face, 134 blood vessels and nerves abducent nerve, 212 clinical considerations, 213–214 oculomotor nerve, 210 ophthalmic nerve, 210, 212 optic nerve, 210 of orbit, 208, 209, 210, 211, 212, 213, 213, 214 trochlear nerve, 210 bony orbit clinical considerations, 194 components, 193, 195 fascia of, 194 general features, 193, 195 cutaneous nerves of, 96–98, 99 clinical considerations, 98 spinal nerve branches, 96–97 trigeminal nerve branches, 97–98 Pansky_Index.indd 359 ear auditory ossicles, 222, 223, 225 clinical considerations, 228, 230–231 external ear, 218, 219, 220 general features, 218, 219 inner ear (labyrinth), 224, 226, 227, 229 intrinsic muscles, 224 mechanism of hearing sound waves, 228 middle ear, 220, 221, 222 neurovasculature of middle and inner ear, 226, 228 sense organs, 226 spiral organ (of corti), 228 eye, extrinsic muscles of clinical considerations, 198, 200 extraocular muscles, 196, 197, 198, 199 muscles controlling eyelids, 196, 197 eyeball structure clinical considerations, 206–207 divisions, 205 general features, 202, 203 innervation of muscles, 205 layers, 202, 203, 204 refractive media, 205 eyelid and lacrimal apparatus clinical considerations, 190, 192 general features, 187, 189 lacrimal apparatus, 188, 190, 191 levator palpebrae superioris muscle, 188, 191 neurovasculature, 188 structure, 187, 189 face arteries of, 134 clinical considerations, 136–138 lymphatic drainage of superficial structures, 134, 136 facial expression, muscles of clinical considerations, 130, 132 general features, 128, 129 groupings with principal actions, 128, 130, 131 infratemporal fossa clinical considerations, 150 mastication muscles, 141, 141–142, 143, 144 neurovasculature, 146, 148, 149, 150 temporomandibular joint, 145, 147 nose, nasal cavity, and paranasal sinuses clinical considerations, 186 nerves,vessels, and lymphatics, 184, 185 nose and nasal cavity, 177, 177, 178, 178, 179, 180 paranasal sinuses, 182, 183 oral cavity and teeth clinical considerations, 162–163 mouth, 156, 157 teeth and gums, general features of, 158 teeth, classification of, 158, 159 tooth structure, 160, 161 vessels and nerves, alveolar processes, and gingivae, 160, 161, 162 palate and palatine tonsil clinical considerations, 176 359 general features, 173, 175 hard palate, 173 muscles of soft palate, 174, 175 palatine tonsil, 174, 175 soft palate, 173 tonsillar ring, 174 paralingual space, 168, 169, 170 parotid gland facial nerve, and blood vessels of face, 133–134, 135, 136, 137, 137, 138 general features, 133 innervation, 133 location and relations, 133, 135 parotid duct, 133 parotid fascia, 133 structures embedded in, 133–134, 135, 137 scalp and diploic and emissary veins arteries of scalp, 123, 125 clinical considerations, 126 diploic veins, 124, 127 hair, 126 lymphatics of scalp, 124 nerves of scalp, 124, 127 structure, 123, 125 superficial veins, 123–124 skull anterior view, 105 basal view, 116, 117, 118 clinical considerations, 103–104 interior, 119, 120, 121, 122, 122 lateral view, 108, 109, 110, 111 neurocranium subdivisions, 100 ossification, 101, 102 subdivisions, 100 superior, posterior, and sagittal views, 112, 113, 114, 115 as a whole, 100 submandibular region clinical considerations, 154 muscles of, 154 and sublingual glands, 170, 171 submandibular triangle, 152, 153, 155 submental triangle, 154 superficial veins of, 96, 97 angular vein, 96 anterior jugular vein, 96 clinical considerations, 98 facial vein, 96 occipital vein, 96 posterior auricular vein, 96 retromandibular vein, 96 superficial temporal vein, 96 supraorbital vein, 96 supratrochlear vein, 96 surface anatomy clinical considerations, 94 palpable features, 92, 93, 95 vessels, surface topography, 93 viscera and sinuses, surface topography, 94 temporal, infratemporal, and pterygopalatine fossae clinical considerations, 140 general features, 139, 139–140 tongue clinical considerations, 171–172 features on dorsal surface of, 164, 165 3/7/2013 7:04:05 PM 360 Index Head (Continued) general features, 164 muscles, 166, 167, 168 neurovascular supply of, 165, 166 ventral or sublingual surface and floor of mouth, 164, 166 visual pathway clinical considerations, 216 summary, 215–216, 217 Head injuries and intracranial hemorrhage clinical considerations cerebral arteries, aneurysms, 278, 280, 281 cerebrovascular accident, 280 epidural (extradural) hemorrhage, 276, 277 intracerebral hemorrhage, 278, 279 subarachnoid hemorrhage, 278 subdural hemorrhage, 276, 277 Headache, 98 Hearing mechanism of, 228 Rinne test, 332 sense organs for, 226 Weber test, 332 Heimlich maneuver, 66 Helicotrema, 224 Hemianopia, contralateral homonymous, 216 Hemianopsia, contralateral homonymous, 216 Hering’s nerve, 30 Heterodont dentition, 158 High tone deafness, 231 Hindbrain brain basal view, 254 brainstem, 249 cerebellum, 249 medulla oblongata, 249 pons, 249 Hordeolum, 192 Horner’s syndrome, 38, 138, 214, 352 Hyaloid fossa, 205 Hydrocephalus, 103 Hyoglossus muscles, 168 Hyoid bone body, 18 features, 18 fracture, 22 greater horn, 2, 18 lesser horns, 18 ligaments and membrane attachments, 18 location, 18 muscle attachments, 18 stylohyoid ligament, 18 submental triangle, 6, 16 thyrohyoid membrane, 62 Hyperacusis, 230 Hyperhidrosis, 38 Hypermetropia, 206 Hyperopia, 206 Hyperthyroidism, 28 Hypoglossal nerve, 16, 166 branches, 344 clinical considerations, 344 course, 344, 345 Pansky_Index.indd 360 features, 344 origin, 344, 345 Hypophysis see Pituitary gland Hypothyroidism, 25, 28 I Incisors, 158 Incus, 222 Inferior alveolar nerve, 318 Infraorbital nerve, 314 Infratemporal fossa clinical considerations, 150 general features, 139, 139–140 muscles of mastication clinical considerations, 142, 144 general features, 141 muscle action, 142 special features, 141, 141–142 neurovasculature of lymphatics, 150 mandibular nerve, 146, 149 maxillary artery, 148, 151 otic ganglion, 148 pterygoid plexus, 150 temporomandibular joint, 145, 147 Inner ear (labyrinth), 224, 226, 227, 229 infections, 230 membranous labyrinth, 226, 229 osseous labyrinth, 224 Internal carotid artery, 266, 267, 268 cavernous part, 266 cerebral part anterior cerebral artery, 268, 269 anterior choroidal artery, 266, 268 anterior communicating artery, 268 middle cerebral artery, 268, 269 ophthalmic artery, 266 posterior communicating artery, 266 cervical part, 266 petrous portion, 266 Intertragic notch, 218 Interventricular foramina (of Monro), 282 Intracerebral hemorrhage, 278, 279 Intracranial hematomas, 252 Intrinsic muscles, ear, 224 Iris, 204 Island of Reil, 249 Isthmus, 24, 76 see also Thyroid gland J Jaw jerk, 320 Jugular foramen syndrome, 336 Jugulodigastric node, 176 K Kayser-Fleischer ring, 207 Kiesselbach’s area, 186 L Labial frenula, 156 Labyrinth see Inner ear (labyrinth) Lacrimal gland, 188 apparatus, (see Eyelid) artery, 208 nerve, 310, 311 sac, 190 Lacus lacrimalis, 190 Langer’s lines, Laryngeal prominence, 2, 62 Larynx arytenoid cartilage, 62 cartilages arytenoid, 62 corniculate, 62 cricoid, 62 cuneiform, 62 epiglottis, 62 thyroid, 62 clinical considerations bilateral vocal cord paralysis, 75 cricoid cartilage, 66 cricothyrotomy, 68 foreign bodies, laryngopharynx, 66 glottic edema, 75 laryngeal fractures, 68 laryngectomy, 68 laryngoscopy, 66 recurrent laryngeal nerve damage, 75 sexual dimorphism, 68 superior laryngeal nerve damage, 75 thyroidectomy, 75 valsalva maneuver, 75 vestibule, 66 epiglottis, 62 interior inferior border, 64 true vocal folds, 64 ventricle, 64 vestibule, 64 ligaments extrinsic, 64 intrinsic, 64 location and size, 62 lymphatic drainage, 74 muscles, 69, 69, 70 actions, 72–73 arytenoideus, 72 cricothyroid, 70 features, 70, 71 lateral cricoarytenoid, 70 posterior cricoarytenoid, 70 thyroarytenoid, 72 nerves, 73–74 synovial joints, 64 vessels, 74 Lateral cervical fistula, 78 Lateral geniculate body (LGN), 215 Lateral pterygoid, 142 Lateral view, brain clinical considerations, 256 features, 256 lobes, 255 poles, 255, 257 principal fissures/sulci, 255 Leptomeninges, 234 Lesser palatine nerve, 312 Ligaments alar, 52 anterior longitudinal, 52 cricotracheal, 48, 64 cruciate/cruciform, 51–52 extrinsic, 64 functions, 52 hyoepiglottic, 18, 64 intrinsic conus elasticus, 64 quadrangular membrane, 64 3/7/2013 7:04:05 PM Index lateral thyrohyoid, 62, 64 ligamenta flava, 52 ligamentum nuchae, 52 median cricothyroid, 64 median thyrohyoid, 62, 64 posterior longitudinal, 52 stylohyoid, 18 thyroid gland, vocal, 64 Light reflex, 214 Limen nasi, 178 Lingual artery, 32 Lingual nerve, 318 Lingual tonsil, 172 Lobes, brain frontal, 249, 255 insula, 249, 255, 257 occipital, 249, 255 parietal, 249, 255 temporal, 249, 255, 257 Lobule, external ear, 218 Longitudinal fissure, 249 Ludwig’s angina, 154 Lymph nodes carotid sheath, 34 head facial, 87 occipital, 86 parotid, 87 preauricular, 87 retroauricular, 87 jugulodigastric, 87 jugulo-omohyoid, 87 neck deep cervical, 87 submandibular, 87 submental, 87 superficial cervical, 87 parathyroid glands, 26 right lymphatic duct, 46 supraclavicular, 87 thoracic duct, 46 Lymphatic drainage clinical considerations, 88–89 face, 134, 136 head, 86 external ear, 86, 220 face, 86 lymph nodes, 86–87 scalp, 86 jugular lymph trunk, 88 neck lymph nodes, 87 thoracic and right, ducts, 88 M Macula lutea, 204 Malleus, 222 Mandible protrusion see Prognathism Mandibular nerves auriculotemporal nerve, 316 buccal nerve, 316 deep temporal nerves, 316 inferior alveolar nerve, 318 to lateral pterygoid muscle, 316 lingual nerve, 318 masseteric nerve, 316 to medial pterygoid muscle, 316 Pansky_Index.indd 361 origin, 314 otic ganglion, 318 submandibular ganglion, 318 Masseteric nerve, 316 Mastoid emissary veins see Emissary veins Mastoid infections, 230 Maxilla, 92 Maxillary artery, 32 Maxillary nerves greater palatine nerve, 312 infraorbital nerve, 314 lesser palatine nerve, 312 origin, 312, 313 pharyngeal nerve, 312 posterior superior alveolar nerve, 312 posterior superior lateral nasal nerve, 312 pterygopalatine ganglion, 314 pterygopalatine nerves, 312, 313 zygomatic nerve, 314 Medial pterygoid, 142 Medial view, brain cerebral hemisphere, 258, 259 diencephalon, 258, 259 medulla oblongata, 258 midbrain, 258 pons and cerebellum, 258 Medial (labyrinthic) wall, 222 Medulla oblongata, 249, 250, 258, 260 Membranous labyrinth, 226, 229 Meniere’s disease, 231 Meningeal artery, 208 Meninges arteries anterior meningeal, 236 middle meningeal, 236 posterior meningeal, 236 clinical considerations blunt head trauma, 239 bulging diaphragma sellae, 239 dural headaches, 239 injury, 239 meningiomas, 238 meningitis, 238 meningocele, 238 meningoencephalitis, 238 tentorial notch/incisure, 239 cranial arachnoid mater, 234 covering, 234 dura mater, 234 pia mater, 234 dural venous sinuses, 236 nerves, 238 partitions and shelves, dura diaphragma sellae, 236 falx cerebelli, 236 falx cerebri, 236 tentorium cerebelli, 236 veins, 238 Meningiomas, 238 Meningismus, 238 Meningitis, 238 Meningocele, 238 Meningoencephalitis, 238 Microcephaly, 103 Midbrain, 250 brain basal view, 253 361 connections with, 249 as mesencephalon, 249 Middle ear infection see Otitis media Miosis, 214 Modiolus, 224 Molars, 158 Motion sickness, 231 Mouth see Oral cavity Mumps, 136 Muscles anterior cervical triangle, 20 aryepiglottic, 72 attachments, hyoid bone, 18 ciliary, 205 controlling eyelids, 196, 197 cricopharyngeus, 81–82 digastric, 154 dilatator pupillae, 205 extraocular, 196, 197, 198, 199 extrinsic, eyes, 196, 197, 198, 199, 200, 200, 201 eye clinical considerations, 198, 200 extraocular muscles, 196, 197, 198, 199 muscles controlling eyelids, 196, 197 eyeball innervation, 205 facial expression clinical considerations, 130, 132 general features, 128, 129 groupings with principal actions, 128, 130, 131 genioglossus, 166 geniohyoid, 154 hyoglossus, 168 intrinsic, ear, 224 larynx, 69, 69, 70 (see also Larynx) actions, 72–73 arytenoideus, 72 cricothyroid, 70 features, 70, 71 lateral cricoarytenoid, 70 posterior cricoarytenoid, 70 thyroarytenoid, 72 lateral pterygoid, 316 laughter, 130 levator palpebrae superioris, 188, 191, 196 mastication, 141, 141–142, 143, 144 medial pterygoid, 316 mylohyoid, 154 obliquus capitis inferior, 54 orbicularis oculi, 196 palatoglossus, 168 pharynx, 79, 80, 81 (see also Pharynx) posterior cervical triangle, 39 prevertebral longus capitis muscle, 52 longus colli muscle, 52 rectus capitis anterior muscle, 54 rectus capitis lateralis muscle, 54 surface, 52 rectus capitis posterior minor, 54 of soft palate, 174, 175 sphincter pupillae, 205 stapedius, 224 sternocleidomastoid ansa cervicalis, 30 3/7/2013 7:04:05 PM 362 Index Muscles (Continued) branchial fistula, 22 carotid sheath, 30 carotid triangle, 16 central venous catheterization, cervical triangles, neck, anterior region, torticollis, 22 styloglossus, 168 stylohyoid, 154 submandibular region digastric muscle, 154 geniohyoid muscle, 154 mylohyoid muscle, 154 stylohyoid muscle, 154 suboccipital actions, 54 obliquus capitis inferior muscle, 54 obliquus capitis superior muscle, 54 rectus capitis posterior major muscle, 54 rectus capitis posterior minor muscle, 56 tensor tympani, 224 tongue, 166, 167, 168 of tongue, 166, 167, 168 Mydriasis, 214 Mylohyoid muscle, 154 Myopia, 206 Myringotomy, 230 Myxedema, 25 N Nasal bones, 92 Nasal cavity, 179 clinical considerations, 186 lateral wall, 178, 180 mucosa of, 180, 181 nasal septum, 178 nerves,vessels, and lymphatics of, 184, 185 blood supply of, 184, 185 general sensory nerves, 184 lymphatics of, 184 olfactory nerves, 184 veins of, 184 paranasal sinuses, 182, 183 ethmoidal air cells, 182 frontal sinuses, 182 maxillary sinus, 182 sphenoidal sinuses, 182 Nasociliary nerve, 310 Nasolacrimal duct, 190 Nasopalatine block, 176 Nasopharynx, 76 see also Pharynx Nearsightedness see Myopia Neck anterior triangle boundaries, 16 carotid, 16 clinical considerations, 20, 22 hyoid bone, 18 muscles, 20 muscular triangle, 20 submandibular triangle, 6, 16 submental triangle, 16 carotid sheath ansa cervicalis, 30 Pansky_Index.indd 362 clinical considerations, 38 contents, 30, 32, 33, 34, 35 structure, 30 cervical sympathetic trunk clinical considerations, 38 composition, 36 ganglia, 36 location, 36 preganglionic fibers, origin, 36 cervical triangles anterior triangle, posterior triangle, cervical vertebrae articulations, 51–52, 57 atlas, 51, 55 axis, 51, 55 cervical vertebrae 3–7, 51, 55 clinical considerations, 60–61 prevertebral muscles, 52, 54 suboccipital region, 54, 56, 60 cutaneous nerves anterior rami, 14 clinical considerations, 14 posterior rami, 14 fascia clinical considerations, 10 deep cervical, 8, skin and superficial, fascial spaces, 10 larynx arytenoid cartilage, 62 cartilages, 62 clinical considerations, 66, 68, 75 corniculate cartilage, 62 cricoid cartilage, 62 cuneiform cartilage, 64 epiglottis, 62 interior of, 64, 67 ligaments and joints, 64 location and size, 62 lymphatic drainage, 74 muscles, 69, 69, 70 nerves, 73–74 vessels, 74 lymphatics head, 86–87 neck, 87 parathyroid glands arteries, 26 clinical considerations, 29 location, 26 parts, 26 secretions, 26 tumors, 29 veins and lymphatics, 26 pharynx clinical considerations, 78, 85 deep fascial layer, 82 features of, 76, 77 muscles of, 79, 80, 81 neurovasculature, 82 parts, 76, 77, 78 submucosal layer, 81 wall, 81–82 posterior neck arteries, 56 clinical considerations, 60–61 nerves, 56 veins, 58 posterior triangle clinical considerations, 44 muscles within, 40 nerves within, 42, 43 occipital triangle, 39 omoclavicular (subclavian) triangle, 39 vessels within, 40, 41 root cervical esophagus, 50 cervical trachea, 48 clinical considerations, 50 cupula, 48 features of, 45, 45, 47 lymphatic vessels, 46 nerves at, 46, 48, 49 subclavian artery, 45–46 subclavian vein, 46 superficial veins anterior jugular, 12 clinical considerations, 14 common facial, 12 communicating vein (of Kocher), 12 external jugular, 11–12 location, 11 posterior auricular, 12 suprascapular, 12 transverse cervical, 12 surface anatomy clinical considerations, features, 2, 3, locations, thyroid gland arteries, 24 clinical considerations, 25, 28–29 location, 24 lymphatic drainage, 26 nerves, 26 relations, 24, 25 secretions, 26 veins, 24, 26 Nerve blocks, 98 Nerves accessory, 34, 42 auricular, 97 carotid sinus, 32 cranial (see Cranial nerves) cutaneous anterior rami, 14 posterior rami, 14 dorsal scapular, 46 facial, 226, 228 general sensory, 184 glossopharyngeal, 34 great auricular, 14, 42 greater occipital, 56 greater petrosal, 226 head abducent, 212 cutaneous nerves of, 96–98, 99 nerves of scalp, 124, 127 nose, nasal cavity, and paranasal sinuses, 177, 177–178, 178, 179, 180, 181, 182, 183, 184, 185, 186 oculomotor, 210 ophthalmic, 210, 212 3/7/2013 7:04:05 PM Index optic, 210 spinal nerve branches, 96–97 trigeminal nerve branches, 97–98 trochlear, 210 head and neck, autonomics clinical considerations, 352 parasympathetics, 350, 351 sympathetics, 352, 353 hypoglossal, 16, 34, 166 larynx, 73–74 lesser occipital, 14, 42 long thoracic, 48 mandibular, 146, 149 meninges, 238 in nasal cavity, 178 occipital, 97 3rd occipital, 56 oculomotor, 210 olfactory, 184 ophthalmic abducent, 212 autonomic nerves of orbit, 212–213 frontal nerve, 210, 212 lacrimal nerve, 210 nasociliary nerve, 212 pharynx, 82 phrenic, 42 posterior neck, 56 within posterior triangle, 42, 43 recurrent laryngeal, 74 at root of neck, 46, 48, 49 to subclavius, 48 suboccipital, 56 superior laryngeal, 32, 70 supraclavicular, 14, 42, 46, 87 suprascapular, 48 transverse cervical, 14, 42 trigeminal (see Trigeminal nerve) vagus, neck, 34 vestibulocochlear, 226 Neuralgias, 98 Neurocranium ossification cartilaginous part (chondrocranium), 102 membranous part (desmocranium), 102 subdivisions of, 100 Neurohypophysis, 263, 264, 265 see also Pituitary gland Neurovasculature, see specific Night blindness, 214 Nose, fracture of, 186 see also Nasal cavity Nyctalopia, see Night blindness Nystagmus, 214 O Obstructive hydrocephalus, 290 Occipital artery, 32, 54, 58 Occipital bone, 92 Occipital nerve, 97 Occipital neuralgia, 98 Occipitalis tertius, 14 Occlusion abnormalities, 162 Occlusion, teeth, 158 Oculomotor nerve, 210 branches, 302, 303 ciliary ganglion, 302, 305 Pansky_Index.indd 363 clinical considerations eyeball reflexes, 304 lesions, 304 course, 302 features, 302 origin, 302 Olfactory nerve clinical considerations, 298 features, 298 origin, course, and branches, 298, 299 Olfactory region, 180 Ophthalmic nerves autonomic nerves of orbit, 212–213 frontal nerve, 210, 212, 310 lacrimal nerve, 210, 310, 311 nasociliary nerve, 212, 310 origin, 210, 308 Ophthalmic artery, 208 Optic disc, 204 Optic nerve, 210 branches, 300, 301 clinical considerations, 300 course, 300, 301 features, 300, 301 origin, 300, 301 Optic radiations (geniculocalcarine tracts), 215 Ora serrata, 204 Oral cavity, 156, 157 cheek, 156 clinical considerations, 163 gums, 160 lips, 156 oral vestibule, 156 teeth classification, 158, 159 general features of, 158 structure, 160, 161 vessels and nerves of, 160, 161, 162 Orbit blood vessels of, 208, 209, 210, 211 clinical considerations, 213–214 nerves of, 210, 212, 213, 213 abducent nerve (CN VI), 212 oculomotor nerve (CN III), 210 ophthalmic nerve (CN V1), 210, 212 optic nerve(CN II), 210 trochlear nerve (CN IV), 210 veins of, 208, 210 Oropharynx, 76, 78 Osseous labyrinth, 224 Osseous spiral lamina, 224 Otic barotrauma, 231 Otic ganglion, 318 Otitis externa, 230 Otitis media, 230 Ototic hydrocephalus, 290 Oxycephaly, 103 P Pachymenix see Dura mater Palate and palatine tonsil clinical considerations, 176 general features, 173, 175 hard palate, 173 muscles of soft palate, 174, 175 363 palatine tonsil, 174, 175 soft palate, 173 tonsillar ring, 174 Palatoglossus muscles, 168 Palatopharyngeal incompetency, 176 Papilledema see Choked disc Paralingual space, 168, 169, 170 Paranasal sinuses, 182, 183 ethmoidal air cells, 182 frontal sinuses, 182 maxillary sinus, 182 sphenoidal sinuses, 182 Parapharyngeal space, 10, 89 Parathormone, 26 Parathyroid glands clinical considerations, 29 location, 26 parts, 26 secretion, 26 during thyroidectomy, 29 tumors, 29 veins and lymphatics, 26 Parietal bone, 92 Parietal emissary veins see Emissary veins Parotid gland general features, 133 location and relations, 133, 135 parotid duct (Stensen’s), 133 parotid fascia, 133 Pars ceca, 204 Pars ciliaris, 204 Pars iridica, 204 Pars nervosa, 204 Pars pigmentosa, 204 Perceptive (sensorineural) deafness, 230 Periorbital eccymosis, 126 Permanent teeth, 158 Petrotympanic fissure, 222 Pharyngeal nerve, 312 Pharyngeal plexus, 82 Pharyngobasilar fascia, 81 Pharyngotympanic tube blockage see Auditory tube blockage Pharynx clinical considerations adenoiditis, 78 pharyngeal cysts, 78 pharyngeal fistula, 78 pharyngismus, 85 pharyngitis, 85 pharyngodynia, 85 pharyngomycosis, 85 pharyngoplegia, 85 pharyngostenosis, 85 posterior rhinoscopy, 78 retropharyngeal abscess, 78 swallowing (deglutition), 85 cricopharyngeus muscle, 81–82 deep fascial layer, 82 features of, 76, 77 muscles of, 79, 80, 81 neurovasculature artery, 82 lymph vessels, 82 nerves, 82 veins, 82 3/7/2013 7:04:05 PM 364 Index Pharynx (Continued) parts laryngopharynx, 78 nasopharynx, 76 oropharynx, 76, 78 pharyngobasilar fascia, 81 recesses, 82 soft palate, 82 wall, 81–82 Photophobia, 206 Photoreceptors, layers of, 204 Phrenic nerve, 42 Pia mater, 234 Pinna see Auricle (pinna) Pituitary gland blood supply, 264 clinical considerations, 264 hormones and effects, 264 location, 263, 265 parts adenohypophysis, 263, 265 median eminence, 263 neurohypophysis, 263, 265 relations, 263, 265 size, 263, 265 Plagiocephaly, 103 Pneumonia, aspiration, 22 Poles, 255, 257 Pons, 250 Posterior cervical triangle boundaries, 39 clinical considerations accessory nerve lesion, 44 cervical nerve block, 44 phrenic nerve lesion, 44 scalenus anticus syndrome, 44 Virchow’s node, 44 muscles within, 40, 40 nerves within, 42, 43 occipital triangle, 6, 39, 54 omoclavicular (subclavian) triangle, 6, 39 vessels within, 40, 41 Posterior ethmoidal artery, 208 Posterior neck see also Cervical vertebral column arteries deep cervical, 56 occipital, 58 vertebral, 56 clinical considerations, 60–61 nerves, 56 veins deep cervical, 58 suboccipital plexus, 58 vertebral, 58 Posterior rhinoscopy, 78 Posterior superior alveolar nerve, 312 Posterior superior lateral nasal nerve, 312 Posterior (mastoid) wall, 222 Posthemorrhagic hydrocephalus, 290 Premolars (bicuspids), 158 Presbyopia, 206, 214 Pretracheal space, 8, 10, 89 Prognathism, 162 Proptosis see Exophthalmos Prosencephalon see Forebrain Pterygopalatine fossa, 140 Pansky_Index.indd 364 Pterygopalatine ganglion, 314 Pterygopalatine nerves, 312, 313 Pulp cavity, 160 Pulsation, internal jugular vein, Punchdrunk syndrome see Chronic traumatic encephalopathy Pyramidal eminence, 222 R Ranula, 171 Raspberry tongue, 172 Raynaud’s disease, 38 Reflex dilation, 304 Respiratory region, 180 Retina, blockage of central vein and artery, 214 Retinal detachment, 207 Retinocolliculopulvinar-cortical pathway, 216 Retropharyngeal abscess, 78 Retropharyngeal space, 10 Rhinitis, 186 Rhinorrhea, 186 Rhombencephalon see Hindbrain Rima glottidis, 64 Rinne test, 332 Root(s) neck cervical esophagus, 50 cervical trachea, 48 clinical considerations, 50 cupula, 48 features, 45, 45, 47 lymphatic vessels, 46 nerves at, 46, 48, 49 subclavian artery, 45–46 subclavian vein, 46 tooth, 160 S Saccule, 226 Salivary fistulas, 136 Scalenus anticus syndrome, 44 Scalp and diploic and emissary veins arteries of scalp, 123, 125 clinical considerations, 126 diploic veins, 124, 127 hair, 126 lymphatics of scalp, 124 nerves of scalp, 124, 127 structure, 123, 125 superficial veins, 123–124 Scapha, auricle, 218 Scaphocephaly, 103 Sclera, 202 Sebaceous cysts, 126 Seborrheic keratosis, 192 Semicircular canals, 224 Semilunar hiatus, 180 Sense organs, ear, 226 Sensorineural deafness see Perceptive (sensorineural) deafness Sibson’s fascia, 8, 48 Skull anterior view bones, 105 clinical considerations, 106 general features, 105, 107 sutures, 106 basal view bones, 116, 118 clinical considerations, 118 foramina, 116, 118 general features, 116, 117 special features, 118 clinical considerations, 103–104 interior anterior cranial fossa, 119, 121 clinical considerations, 122 foramina, 119, 120, 121, 122, 122 inner aspect of calvaria, 120, 122 middle cranial fossa, 119 posterior cranial fossa, 119–120 lateral view bones, 105 general features, 105, 107 special features, 110, 111 sutures, 110, 111 median sagittal view, 114, 115 neurocranium subdivisions, 100 ossification, 101, 102 neurocranium, 102 viscerocranium, 102 subdivisions, 100 superior and posterior views bones, 112, 113 general features, 112, 113 sutures, 112 as a whole, 100 Spasmotic torticollis, 22 Sphincter pupillae muscle, 204, 205 Spina prominens, 51 Spinal anesthesia, 291 Spiral organ (of Corti), 228 Stapedius muscle, 224 Stapes, 222 Stellate/cervicothoracic ganglion, 36 Stereotaxic surgery, skull, 104 Sternocleidomastoid (SCM) muscle ansa cervicalis, 30 branchial fistula, 22 carotid sheath, 30 carotid triangle, 16 central venous catheterization, cervical triangles, neck, anterior region, torticollis, 22 Strabismus, 214 Stroke, 252 Styloglossus muscles, 168 Stylohyoid muscle, 154 Subarachnoid cisterns anterior cerebellopontine, 288 chiasmatic, 288 cistern of lateral cerebral fossa, 288 crural, 288 interpeduncular, 288 medullary, 288 pontine, 288 definition, 288 intercommunicating, 288–289 posterior pericallosal, 288 posterior cerebellomedullary cistern (cisterna magna), 288 3/7/2013 7:04:05 PM Index quadrigeminal, 288 superior (cerebellar), 288 Subarachnoid hemorrhage, 278, 279 Subclavian artery branches, 46 origin, 45, 47 parts, 45 relations, 45 Subclavian steal syndrome, 50, 273 Subclavian vein, 46 Subdural hematoma (bleed), 244 Subdural hemorrhage, 276, 277 Submandibular ganglion, 318 Submandibular region clinical considerations, 154 muscles of, 154 submandibular triangle, 152, 153, 155 submental triangle, 154 Suboccipital muscles actions, 54 obliquus capitis inferior muscle, 54 obliquus capitis superior muscle, 54 rectus capitis posterior major muscle, 54 rectus capitis posterior minor muscle, 56 Suboccipital plexus, posterior neck, 58 Suboccipital triangle, 59 1st cervical nerve, 54 greater occipital nerve, 56 obliquus capitis inferior muscle, 54 obliquus capitis superior, 54 plexus of veins, 58 rectus capitis posterior major, 54 rectus capitis posterior minor muscle, 56 vertebral artery, 54 Sulcus, 249 central, 249, 255 lateral, 255 postcentral, 255 precentral, 255 Superficial veins, neck anterior jugular, 12 clinical considerations, 14 common facial, 12 communicating vein (of Kocher), 12 external jugular, 11–12 location, 11 posterior auricular, 12 suprascapular, 12 transverse cervical, 12 Supernumerary teeth, 163 Suppurative infections in sinuses, 186 Suprahyoid muscles see Muscles, of submandibular region Supraorbital artery, 208 Suprapleural membrane see Sibson’s fascia Suprasternal space, 10 Supratrochlear artery, 208 Synovial joints, 64 T Tears in tympanic membrane, 230 Telencephalon see Forebrain Temporal bone, 92 Temporal fossa, 139, 139–140 Tensor tympani, auditory tube and canal for, 222, 223 Tensor tympani muscle, 224 Tentorial notch, 236 Pansky_Index.indd 365 Tentorium cerebelli, 236 Thoracic outlet syndrome, 44 Thyrocervical trunk, 46 Thyroglossal cysts, 172 Thyroglossal duct, 24, 29 Thyrohyoid membrane, 62 Thyroid gland arteries, 24 clinical considerations, 25, 28–29 cretinism, 28 goiter, 26 Grave’s disease, 28 hyperthyroidism, 28 hypothyroidism, 25, 28 location, 24 lymphatic drainage, 26 nerves, 26 parathyroid tumors, 29 relations, 24, 25 secretions, 26 suspensory ligaments, thyroglossal duct cyst, 29 thyroidectomy, 29 veins, 24 Thyroidea ima, 24 Thyroidectomy, 29 Tongue anomalies and variations, 172 clinical considerations, 171–172 dorsal surface features of, 164, 165 general features, 164 muscles of, 166, 167, 168 neurovascular supply of, 165, 166 ventral or sublingual surface and floor of mouth, 164, 166 Tonsillar ring, 76, 174 Torticollis, 22 Tracheostomies, 50 Tracheotomy, 50 Tragus, 218 Transient ischemic attacks (TIAs), 273 Trigeminal nerve branches, 308, 309 mandibular division (CN V3), 98 maxillary division (CN V2), 98 ophthalmic division (CN V1), 98 clinical considerations herpes zoster virus infection, 320 lesion, 320 testing of, 320–321 trigeminal neuralgia (tic douloureux), 320 course, 308 divisions, 310, 311, 312, 313, 314, 315, 316, 317, 318, 319 features, 308 mandibular auriculotemporal nerve, 316 buccal nerve, 316 deep temporal nerves, 316 inferior alveolar nerve, 318 to lateral pterygoid muscle, 316 lingual nerve, 318 masseteric nerve, 316 to medial pterygoid muscle, 316 origin, 314 otic ganglion, 318 submandibular ganglion, 318 365 maxillary greater palatine nerve, 312 infraorbital nerve, 314 lesser palatine nerve, 312 origin, 312, 313 pharyngeal nerve, 312 posterior superior alveolar nerve, 312 posterior superior lateral nasal nerve, 312 pterygopalatine ganglion, 314 pterygopalatine nerves, 312, 313 zygomatic nerve, 314 ophthalmic frontal nerve, 310 lacrimal nerve, 310, 311 nasociliary nerve, 310 origin, 310 origin, 308, 309 Trigeminal neuralgia, 137–138 Trochlear nerve, 210 branches, 306 clinical considerations, 306 course, 306 features, 306 origin, 306, 307 paralysis, 214 True vocal folds, 64 see also Vocal cord Trunks bronchomediastinal lymph, 46 cervical sympathetic clinical considerations, 38 composition, 36 ganglia, 36 location, 36 preganglionic fibers, origin, 36 costocervical, 46 jugular lymph, 88 lower, 48 middle, 48 thyrocervical, 46 upper, 48 Tympanic cavity, 220 Tympanic membrane, 220 Tympanic plexus, 228 U Uncinate process, 180 Uranoplasty, 176 Utricle, 226 Uveitis, 207 V Vagus nerve branches anterior vagal trunk, 338 auricular, 338 esophageal plexus, 338 meningeal, 338 pharyngeal, 338 posterior vagal trunk, 338 pulmonary and bronchial branches, 338 recurrent laryngeal nerves, 338 superior and inferior cervical cardiac, 338 superior laryngeal nerve, 338 thoracic cardiac branches, 338 3/7/2013 7:04:05 PM 366 Index Vagus nerve (Continued) clinical considerations auricular branch irritations, 340 lesions, 340 course, 337, 339, 341 features, 337 origin, 337 Veins anterior jugular, 12 cerebellar, 244 common facial, 12 communicating, 12 condyloid emissary veins (see Emissary veins) deep cervical, 58 diploic, 124, 127, 242 emissary, 123–124, 125, 126, 127, 242 external jugular, 11–12 frontal emissary (see Emissary veins) great cerebral, 242 head angular vein, 96 anterior jugular vein, 96 clinical considerations, 98 facial vein, 96 occipital vein, 96 posterior auricular vein, 96 retromandibular vein, 96 superficial temporal vein, 96 superficial veins, 96, 97 supraorbital vein, 96 supratrochlear vein, 96 hypophyseal portal veins, 264 inferior cerebral, 242 inferior thyroid, 24 internal jugular, 4, 5, 34 lateral hypophyseal, 264 mastoid emissary (see Emissary veins) Pansky_Index.indd 366 meninges, 238 middle cerebral, 242 nerves,vessels, and lymphatics, 184 of orbit, 208, 210 parathyroid glands, 26 parietal emissary (see Emissary veins) posterior auricular, 12 posterior neck, 58 retromandibular, 12 subclavian, 46 superficial, 12, 123–124 superior and middle thyroid, 24 superior cerebral, 242, 245 suprascapular, 12 transverse cervical, 12 vertebral, 58 Venous drainage clinical considerations, 244 deep veins, 242 superficial (external) cerebral veins, 242, 245 Venous lacunae, 240, 243 Venous plexuses, 124 Ventricles, brain features, 282, 283 fourth ventricle, 284 lateral, 282, 284, 285 third ventricle, 282, 284 Vermis, 250 Vertebral artery branches anterior spinal artery, 270 posterior inferior cerebellar artery, 270 posterior spinal arteries, 268, 270 course, 268, 269 stenosis/occlusion, 273 Vestibule, 224 false vocal folds, 64 laryngeal inlet, 64 quadrangular membrane, 64 Vestibulocochlear nerve, 226 branches, 330 clinical considerations acoustic neuroma, 333 conduction tests, 332 lesions, 333 vestibular function tests, 332–333 course, 330, 331 features, 330 origin, 330, 331 Virchow’s node, 44 Viscerocranium, 102 Visual pathway clinical considerations, 216 summary, 215–216, 217 Vitreous body, 205 Vitreous chamber, 205 Vocal cord bilateral vocal cord paralysis, 75 false vocal folds, 64 form, 75 rima glottidis, 64 true vocal folds, 64 vocal ligament, 64 W Waldeyer’s ring see Tonsillar ring Weber test, 332 Wens see Sebaceous cysts Whiplash injury, 54, 60 White matter pathology, 252 Z Zygomatic bone, 92 Zygomatic nerve, 314 3/7/2013 7:04:06 PM Pansky_Index.indd 367 3/7/2013 7:04:06 PM Pansky_Index.indd 368 3/7/2013 7:04:06 PM Pansky_Index.indd 369 3/7/2013 7:04:06 PM Pansky_Index.indd 370 3/7/2013 7:04:06 PM ... Figure 2. 22E. E Orbit and Extrinsic Muscles of the Eye, Magnetic Resonance Image, Coronal View Pansky_Chap 02. indd 20 0 3/7 /20 13 8:18:01 PM SECTION 2. 22 • Extrinsic Muscles of the Eye 20 1 Eyeball... Figure 2. 22F,G. F Extrinsic Muscles of the Eye, Superior View G Orbit and Extrinsic Muscles of the Eye, Computed Tomography Image, Transverse View Pansky_Chap 02. indd 20 1 3/7 /20 13 8:18:13 PM 20 2 SECTION... Infraorbital foramen B Figure 2. 21A,B. Bony Orbit A Surface Relations, Anterior View B Anterior View Pansky_Chap 02. indd 195 3/7 /20 13 8:17:08 PM 196 SECTION 2. 22 Extrinsic Muscles of the Eye