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Đã hơn mười năm kể từ khi tôi đạt được học bổng của mình tại Phòng thí nghiệm Microneuroanatomy tại Đại học Florida. Lần đầu tiên tôi gặp Tiến sĩ Albert Rhoton tại cuộc họp lần thứ bảy của Hiệp hội Phẫu thuật Cơ sở Hộp sọ Nhật Bản, được tổ chức tại Hakata, Nhật Bản, vào năm 1995. Tôi sẽ không bao giờ quên rằng tôi đã ấn tượng sâu sắc như thế nào về những hình minh họa giải phẫu mà ông đã thể hiện tại cuộc họp đó. Như mọi bác sĩ giải phẫu thần kinh hiện nay đều biết, những hình ảnh của anh ấy mô tả chi tiết giải phẫu não tinh vi theo một cách độc đáo, và đó là điều mà tôi chưa từng thấy trước đây. Sau đó, từ tháng 9 năm 2003 đến tháng 8 năm 2004, tôi có cơ hội học giải phẫu đầu tại phòng thí nghiệm của anh ấy. Vào thời điểm đó, tôi là bác sĩ phẫu thuật thẩm mỹ được cấp chứng chỉ và bác sĩ giải phẫu thần kinh được cấp chứng chỉ ở Nhật Bản. Mặc dù tôi chỉ làm việc với tư cách là một bác sĩ phẫu thuật thẩm mỹ chứ không phải là một bác sĩ giải phẫu thần kinh, Tiến sĩ Rhoton đã hào phóng cho phép tôi nghiên cứu giải phẫu của vùng ngoại sọ tại phòng thí nghiệm của ông ấy. Đây là mối quan tâm lớn của tôi với tư cách là một bác sĩ phẫu thuật thẩm mỹ, và trong nghiên cứu của mình, tôi nhận thấy rằng phẩm chất của các mẫu vật giải phẫu rất khác nhau. Ví dụ, chất lượng tiêm silicon của vùng ngoại sọ khác với vùng nội sọ, và điều này khiến tôi lo ngại. May mắn thay, tại phòng thí nghiệm của Tiến sĩ Rhoton, tôi cuối cùng đã có thể lấy được một số mẫu vật tốt, trong đó silicon được tiêm gần như hoàn hảo vào vùng ngoại sọ. Phẫu thuật phục hồi khuôn mặt đã là công việc của cuộc đời tôi trong hơn 10 năm, và với cuốn sách này, Tiến sĩ Rhoton và tôi đã đặt mục tiêu là tạo ra một tập bản đồ giải phẫu dây thần kinh mặt được minh họa bằng các mẫu vật được mổ xẻ chính xác, tương tự như Pernkopf Anatomy được minh họa đẹp mắt. Tôi tin rằng một tập bản đồ giải phẫu bao gồm các mẫu vật dễ hiểu hơn một tập bản đồ có hình ảnh minh họa, ngay cả khi chúng được vẽ một cách tinh vi. Sự đánh giá của chúng ta về giải phẫu cơ bản của con người không phải lúc nào cũng đầy đủ và việc đánh giá lại toàn bộ tài liệu được bổ sung bằng các cuộc mổ xẻ tử thi chi tiết có thể dẫn đến những hiểu biết mới có thể làm thay đổi kỹ thuật phẫu thuật của chúng ta. Cuối cùng, tôi muốn bày tỏ sự cảm kích đối với sự kiên nhẫn của các con tôi, Aya, Satoshi, Akira và Jun, trong khi tôi đã đắm mình trong dự án và công việc khám chữa bệnh này. Tôi nghĩ cuốn sách này nên được dành tặng cho những người hiến tặng các mẫu vật được trưng bày bởi vì chỉ có sự tận tâm của họ mới có thể thực hiện được công việc này.
www.pdflobby.com www.pdflobby.com ffirs01.indd i 2/10/2015 1:41:03 PM www.pdflobby.com ffirs01.indd ii 2/10/2015 1:41:03 PM Atlas of the Facial Nerve and Related Structures Nobutaka Yoshioka, MD, PhD Director Department of Craniofacial Surgery and Plastic Surgery Tominaga Hospital Osaka, Japan Albert L Rhoton, Jr., MD R.D Keene Family Professor and Chairman Emeritus Department of Neurosurgery College of Medicine University of Florida Gainesville, Florida With 97 Illustrations Thieme New York • Stuttgart • Delhi • Rio de Janeiro www.pdflobby.com ffirs02.indd iii 2/10/2015 2:07:52 PM Thieme Medical Publishers, Inc 333 Seventh Ave New York, NY 10001 Executive Editor: Timothy Hiscock Managing Editor: Sarah Landis Editorial Assistant: Nikole Connors Senior Vice President, Editorial and Electronic Product Development: Cornelia Schulze Production Editor: Barbara A Chernow International Production Director: Andreas Schabert International Marketing Director: Fiona Henderson Director of Sales, North America: Mike Roseman International Sales Director: Louisa Turrell Vice President, Finance and Accounts: Sarah Vanderbilt President: Brian D Scanlan Compositor: Toppan Best-set Premedia Limited Library of Congress Cataloging-in-Publication Data Yoshioka, Nobutaka, author Atlas of the facial nerve and related structures / Nobutaka Yoshioka, Albert L Rhoton, Jr p ; cm Includes index ISBN 978-1-62623-171-9 (alk paper) I Rhoton, Albert L., 1932– , author II Title [DNLM: Facial Nerve—anatomy & histology—Atlases Head—anatomy & histology—Atlases Neck—anatomy & histology—Atlases WL 17] QP327 612.9’2078—dc23 2014044551 Important note: Medicine is an ever-changing science undergoing continual development Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book Such examination is particularly important with drugs thatare either rarely used or have been newly released on the market Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain Copyright ©2015 by Thieme Medical Publishers, Inc Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, customerservice@thieme.com Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, customerservice@thieme.de Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, customerservice@thieme.in Thieme Publishers Rio, Thieme Publicaỗừes Ltda Argentina Building 16th floor, Ala A, 228 Praia Botafogo Rio de Janeiro 22250-040 Brazil +55 21 3736-3631 Printed in China by Everbest Printing Ltd ISBN 978-1-62623-171-9 Also available as an e-book: eISBN 978-1-62623-172-6 54321 This book, including all parts thereof, is legally protected by copyright Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage www.pdflobby.com ffirs03.indd iv 2/10/2015 1:41:06 PM Contents Preface by Nobutaka Yoshioka vii Preface by Albert L Rhoton, Jr .ix Section I Intracranial Region and Skull 1 Intracranial Region Skull: External and Internal Views Orbit and Facial Bone 12 Section II Upper Facial and Midfacial Region 19 10 Upper Facial and Midfacial Region Overview 21 Forehead and Orbital Region 23 Temporal Region 32 Superficial Structures in the Midfacial Region 38 Maxillary Region 49 Masseteric Region 56 Deep Structures in the Midfacial Region 61 Section III Lower Facial and Posterolateral Neck Region 79 11 12 13 14 Lower Facial Region 81 Oral Floor and Upper Neck Region 88 Posterior Neck and Occipital Region 91 Lateral Neck Region 102 Index 105 Note: Every figure shows the left side whenever the unilateral side is shown www.pdflobby.com ftoc.indd v 2/10/2015 6:23:02 PM www.pdflobby.com ftoc.indd vi 2/10/2015 1:41:08 PM Preface It has been more than ten years since I finished my fellowship at the Microneuroanatomy Laboratory at the University of Florida I first met Dr Albert Rhoton at the seventh meeting of the Japanese Society for Skull Base Surgery, held in Hakata, Japan, in 1995 I will never forget how deeply impressed I was by the anatomical illustrations he showed at that meeting As every neurosurgeon now knows, his images detail delicate brain anatomy in a unique way, and it was something that I had never seen before Then, from Septembr 2003 to August 2004, I had an opportunity to study head anatomy at his laboratory At that time, I was a board-certified plastic surgeon and a board-certified neurosurgeon in Japan Although I had been working exclusively as a plastic surgeon rather than as a neurosurgeon, Dr Rhoton generously allowed me to study the anatomy of the extracranial region at his laboratory This had been my major interest as a plastic surgeon, and I found in my research that the qualities of anatomical specimens varied greatly For example, the quality of silicon injection of the extracranial region differed from the intracranial region, and this concerned me Fortunately, at Dr Rhoton’s laboratory I was finally able to obtain some good specimens in which the silicon was almost perfectly injected into the extracranial region Facial reanimation surgery has been my life’s work for more than 10 years, and with this book, Dr Rhoton and I had as our goal the creation of an atlas of anatomy of the facial nerve illustrated with precisely dissected specimens, similar to the beautifully illustrated Pernkopf Anatomy I believe that an atlas of anatomy consisting of specimens is more understandable than one with illustrations, even if they are delicately drawn Our appreciation of basic human anatomy is not always complete, and a thorough reevaluation of the literature supplemented by detailed cadaver dissections can lead to new insights that may alter our surgical technique Finally, I want to express my appreciation for the patience of my children, Aya, Satoshi, Akira, and Jun, while I have been immersed in this project and clinical work I think this book should be dedicated to the donors of the specimens shown because only their devotion made this work possible Nobutaka Yoshioka, MD, PhD www.pdflobby.com fpref01.indd vii 2/10/2015 6:23:01 PM www.pdflobby.com fpref01.indd viii 2/10/2015 1:41:06 PM 98 III Lower Facial and Posterolateral Neck Region Temporalis m Superior nuchal line Digastric m Occipital a Inferior nuchal line Facial n Rectus capitis posterior minor m Superior oblique m Descending br of occipital a Rectus capitis posterior major m Inferior oblique m Ventral ramus of C2 Vertebral a Greater occipital n (dorsal ramus of C2) Levator scapulae m Fig 13.8 The posterior neck region The semispinalis capitis muscle has been reflected inferiorly The suboccipital triangle is a region bounded above and medially by the rectus capitis posterior major, above and laterally by the superior oblique, and below and laterally by the inferior oblique The floor of the triangle is formed by the posterior atlanto-occipital membrane and the posterior arch of the atlas The structures in the triangle are the terminal extradural segment of the vertebral artery and the first cervical nerve The C2 nerve emerges between the posterior arch of the atlas and the lamina of the axis where the spinal ganglion is located extradurally, medial to the inferior facet of C1 and the vertebral artery The nerve divides into a large dorsal and a smaller ventral ramus After passing below and supplying the inferior oblique muscle, the dorsal ramus divides into a large medial branch and a small lateral branch It is the medial branch that forms the greater occipital nerve The lateral branch sends filaments that innervate the splenius, longissimus, and semispinalis capitis, and is often joined by the corresponding branch from the C3 nerve The C2 ventral ramus courses between the vertebral arches and transverse processes of the atlas and axis and behind the vertebral artery Two branches of the C2 and C3 ventral rami, the lesser occipital and great auricular nerves, curve around the posterior border and ascend on the sternocleidomastoid muscle to supply the skin behind the ear www.pdflobby.com c13.indd 98 2/10/2015 1:40:55 PM 13 Posterior Neck and Occipital Region 99 Mastoid process Digastric m Superior oblique m Occipital a Descending br of occipital a Rectus capitis posterior major Dorsal ramus of C1 Vertebral venous plexus Facial n., Parotid gland Br to inferior oblique m Transverse process of atlas Ventral ramus of C2 Vertebral a Sternocleidomastoid m (reflected) Inferior oblique m Fig 13.9 The posterior neck region The innervation to the muscles from dorsal ramus of C1 is shown The C1, C2, and C3 nerves divide into dorsal and ventral rami The dorsal rami divide into medial and lateral branches that supply the skin and muscles of the posterior region of the neck The C1 nerve, called the suboccipital nerve, leaves the vertebral canal between the occipital bone and atlas and has a dorsal ramus that is larger than the ventral ramus The dorsal ramus courses between the posterior arch of the atlas and the vertebral artery to reach the suboccipital triangle, where it sends branches to the rectus capitis posterior major and minor, the superior and inferior oblique, and the semispinalis capitis Occasionally, it has a cutaneous branch that accompanies the occipital artery to the scalp The C1 ventral ramus courses between the posterior arch of the atlas and the vertebral artery and passes forward, lateral to the lateral mass of the atlas and medial to the vertebral artery, and supplies the rectus capitis lateralis www.pdflobby.com c13.indd 99 2/10/2015 1:40:56 PM 100 III Lower Facial and Posterolateral Neck Region Temporal fascia Asterion Middle temporal a Posterior edge of external acoustic meatus Mastoid emissary v., Meningeal br of occipital a Posterior auricular v Digastric m Facial n Auricular br of posterior auricular a Occipital a (dissected from the groove) Posterior auricular a Superior oblique m Fig 13.10 Lateral view of the mastoid The posterior belly of the digastric muscle arises from the mastoid notch (digastric groove), which is on the inferior surface of the skull, medial to the mastoid process of the temporal bone The posterior belly is supplied by the digastric branch of facial nerve When the digastric muscle contracts, it acts to elevate the hyoid bone If the hyoid bone is being held in place (by the infrahyoid muscles), it will tend to depress the mandible (open the mouth) The stylomastoid foramen is at the anterior end of the digastric notch The asterion, defined as the junction among the lambdoid, parietomastoid, and occipitomastoid sutures, is used as a landmark for the transverse-sigmoid sinus junction www.pdflobby.com c13.indd 100 2/10/2015 1:40:57 PM 13 Posterior Neck and Occipital Region 101 Sigmoid sinus Mastoid segment Temporal br Digastric m Zygomatic br Transverse facial a Occipital a Auricular br of posterior auricular a Buccal br Zygomaticobuccal brs Transverse process of atlas Temporofacial division Cervicofacial division Greater occipital n Cervical br Marginal mandibular br Fig 13.11 The posterior neck region The superficial lobe of the parotid gland has been removed and mastoidectomy has been completed After emerging from the base of the skull at the stylomastoid foramen, the facial nerve gains access to the face by passing through the substance of the parotid gland The branches in the face include the posterior auricular nerve, the nerve to the digastric and stylohyoid muscles, and the temporal, zygomatic, buccal, marginal mandibular, and cervical branches The Inferior branches of the zygomatic branch usually form a zygomaticobuccal plexus with the buccal branches (see Fig 7.5) www.pdflobby.com c13.indd 101 2/10/2015 1:40:57 PM 14 Lateral Neck Region Lesser occipital n Prevertebral fascia Erb’s point Accessory n b Greater occipital n Posterior auricular v Lesser occipital n Splenius capitis m Sternocleidomastoid m Accessory n Great auricular n Supraclavicular n External jugular v Vagus n a Fig 14.1a,b (a) The lateral neck region (b) Posterolateral view of the posterior triangle The cervical plexus is a plexus of the ventral rami of the first four cervical spinal nerves, which are located from C1 to C4 in the cervical segment in the neck The branches of the cervical plexus emerge from the posterior triangle at Erb’s point, a point midway on the posterior border of the sternocleidomastoid The cervical plexus has two types of branches: cutaneous and muscular The cutaneous branches are the lesser occipital nerve (C2), the great auricular nerve (C2, 3), the transverse cervical nerve (C2, 3), and the supraclavicular nerves (C3, 4) The muscular branches are the ansa cervicalis, phrenic, and segmental The lesser occipital nerve arises from the lateral branch of the ventral ramus of the second cervical nerve (C2) It curves around the accessory nerve and ascends along the posterior border of the sternocleidomastoid, where pierces the deep fascia near the cranium to supply the skin over the lateral scalp and posterior surface of the auricle The great auricular and transverse cervical nerves only just enter the posterior triangle, turning sharply around the posterior border of the sternocleidomastoid muscle (Erb’s point) The supraclavicular nerves emerge from beneath the sternocleidomastoid and pass across and down the posterior triangle toward the clavicle The transverse cervical nerve supplies the skin anterolateral parts of the neck The supraclavicular nerves supplies the skin over the pectoralis major and deltoideus and upper and posterior parts of the shoulder The prevertebral fascia is prolonged downward and laterally behind the carotid vessels and in front of the scaleni and forms a sheath for the brachial nerves and subclavian vessels in the posterior triangle of the neck www.pdflobby.com c14.indd 102 2/10/2015 1:41:00 PM 14 Lateral Neck Region 103 Posterior auricular v Greater occipital n Temporal br Lesser occipital n Posterior auricular a Parotid gland Sternocleidomastoid m Splenius capitis m Accessory n Great auricular n External jugular v Transverse cervical n Supraclavicular n Internal jugular v Vagus n Fig 14.2 The lateral neck region The sternocleidomastoid muscle has been retracted anteriorly to show the cervical plexus The great auricular nerve is derived from the anterior rami of the C2 and C3 nerves It appears at the posterior border of the sternocleidomastoid muscle and passes forward and upward across the muscle to reach the angle of the mandible on and beneath the parotid fascia It supplies the skin overlying the mastoid process, lower part of the auricle, the parotid region, and the angle of the mandible The great auricular nerve and sural nerve are the most commonly selected nerves for facial nerve grafting, but only to 10 cm of the great auricular nerve can be harvested safely, which limits its use in extensive repairs Disadvantages include a sensory deficit of the earlobe when using the great auricular nerve The accessory nerve also emerges from sternocleidomastoid muscle into the posterior triangle The accessory nerve is found approximately 1cm above Erb’s point It runs obliquely downward on the levator scapulae muscle to enter trapezius The external jugular vein lies on the lateral surface of the sternocleidomastoid muscle It arises by the confluence of the posterior branch of the retromandibular vein and posterior auricular vein It drains into the subclavian vein or internal jugular vein (see Fig 11.2) www.pdflobby.com c14.indd 103 2/10/2015 1:41:00 PM www.pdflobby.com c14.indd 104 2/10/2015 1:41:01 PM Index A Abducens nerve, 11 Accessory meningeal artery, 4, 63, 66 Accessory nerve, 7, 22, 67, 69, 70, 77, 78, 89, 90, 94, 95, 96, 102, 103 Alar cartilage, 45, 48 Alveolar canals, 73 Anastomatic artery, 92 Angular artery, 46, 83 Angular vein, 45, 81 Ansa cervicalis, 90, 102 upper root, 89 Anterior clinoid process, 11 Anterior deep temporal artery, 62 Anterior deep temporal nerve, 62 Anterior ethmoidal artery, 48 Anterior ethmoidal foramen, 13 Anterior ethmoidal groove, 13 Anterior ethmoidal nerve, 26, 48 Anterior inferior cerebellar artery, Anterior lacrimal crest, 13 Anterior nasal spine, 14 Anterior semicircular canal, 3, 4, Anterior superior alveolar artery, 49 Anterior superior alveolar nerve, 49 Anterior trunk, 66 Anterior tympanic artery, 63 Arnold’s nerve, 7, 8, 93 Articular disc, 63, 65 Articular tubercle, 8, Ascending palatine artery, 53, 54, 68, 69, 70, 71 Ascending pharyngeal artery, 76, 78, 89 meningeal branch, Asterion, 10, 96, 100 Atlas, transverse process, 67, 68, 70, 76, 96, 97, 99, 101 Auditory tube See Eustachian tube Auricular cartilages, lateral view, 93 Auriculotemporal nerve, 22, 23, 32, 34, 40, 44, 55, 58, 59, 61, 63, 65, 66, 68, 69, 71, 72, 77, 81, 86 B Buccal artery, 65, 66, 86 lingual branch, 63 Buccal branches, of facial nerve, 39, 40, 41, 42, 43, 44 Buccal fat pad, 56, 57, 58, 60 buccal extension, 59 pterygoid extension, 59 temporal (deep temporal) extension, 59 Buccal nerve, 49, 62, 63, 65, 66, 69, 71, 72, 73, 75, 86 Buccinator muscle, 17, 21, 22, 39, 41, 54, 56, 60, 63, 66, 75, 81, 82, 83, 85, 86, 87 attachment, 65, 68 in facial region, 42 as modiolus component muscle, 81 C Calvarial bones, Canine eminence, 16 Canine fossa, 16 Carotid artery See also External carotid artery; Internal carotid artery in posterior neck region, 95 Carotid canal, 7, 8, 78 Carotid groove, 11 Cervical branch, 39, 43 Cervical (C1) nerve dorsal ramus, 99 ventral ramus, 99 Cervical (C2) nerve dorsal ramus, 98, 99 ventral ramus, 98, 99 Cervical (C3) nerve, 98 dorsal ramus, 99 ventral ramus, 99 Cervical nerve(s), dorsi rami, 91 Cervical plexus, 89, 102, 103 Cervicofacial division, 42, 43, 90, 101 Choana, 15 Chorda tympani, 3, 4, 5, 70, 71, 76, 77 with sphenoid bone spine removed, 76, 77, 78 Clinoidectomy, anterior, Cochlea, opened, Columellar artery, 45, 47, 48, 87 Common carotid artery, 89 Common facial nerve, 88 Common facial vein, 55, 85, 87, 90 Communicating branches, of facial nerve, in midfacial region, 41, 44 Condylar canal, 8, 10 Condylar head, 17, 18 Condylar neck, 17, 18 Condylar process, 9, 44, 58 Contralateral artery, 92 Coronoid process, 9, 14, 17, 18, 58 Corrugator supercilii muscle, 16, 22, 25, 42, 45, 46, 81 Cranial nerve IX, 76 Cranial nerve X, 76 Cranial nerve XI, 76 Craniotomy frontotemporal, facial nerve temporal branch in, 37 suboccipital, 90 Cranium, 92 Cribiform plate, 13 foramina, 11 superior view, 13 Crista galli, 11, 13 D Deep auricular artery, 63, 67 Deep facial nerve, 68, 69, 85 Deep facial vein, 63, 64, 65 Deep petrosal nerve, 75 Deep temporal artery, 61, 63, 64, 65, 66, 67, 68, 69, 71, 72, 73, 74, 77 Deep temporal fat pad, 59 Deep temporal nerve, 49, 54, 61, 63, 64, 65, 66, 68, 69, 71, 72, 73 Deep temporal vein, 61 Depressor anguli oris muscle, 17, 22, 39, 81, 82, 83, 84, 85, 87 attachments, 84 defected upward, 84 as modiolus component muscle, 81 Depressor labii inferioris muscle, 17, 22, 81, 82, 84 Depressor septi muscle, 16, 42, 47, 48 attachments, 48 Descending palatine artery, 52 Digastric groove (mastoid notch), 10, 100 with digastric muscle posterior belly detached, 90 Digastric muscle, 5, 6, 8, 77, 84, 95, 96, 97, 98, 99, 100, 101 anterior belly, 71, 84, 87, 88 in facial reanimation, 56 posterior belly, 5, 43, 60, 85, 87, 88, 90, 100 detached from digastric groove, 90 Digastric ridge, 5, 77 Dorsal nasal artery, 26, 46 Dorsum sellae, 11 E Emissary foramen, Emissary vein, Endolymphatic sac, Erb’s point, 102, 103 www.pdflobby.com bindex.indd 105 2/10/2015 6:22:45 PM 106 Index Ethmoid bone, superior view, 13 Ethmoid sinus, 51, 52 Eustachian tube, 4, 7, 8, 54, 71, 74 bony part, 71 cartilaginous part, 7, 71 opened, 78 External acoustic meatus, 4, 8, 9, 10, 69, 74 opened, posterior edge, 100 External carotid artery branches, 89 in lower facial region, 87 in masseteric region, 58 in midfacial region, 60, 63, 65, 66, 68, 69, 74, 76 reflected, 76 in temporal region, 34 External jugular vein, 39, 55, 81, 82, 102, 103 External nasal artery, 48, 49 External nasal nerve, 48, 49 External nasal vein, 45, 48 External oblique line, 17 External occipital crest, 10 External occipital protuberance (inion), 10, 91 F Face lateral oblique view, 81 lateral view, 21, 22 sensory innervation, 11 Facial artery, 21, 22 bifurcation, 46 cut, 47 inferior labial branch, 83 in lower facial region, 81, 82, 83, 84, 85, 87, 90 in midfacial region, 39, 40, 68 in oral floor, 88 relationship to facial vein, 87 superior labial branch, 83 in upper neck region, 89, 90 Facial bone, 12–18 Facial expression, Facial nerve, 4, 34, 35, 81 branch to digastric and stylohyoid muscles, 90 buccal branches, 82, 101 cervical branches, 81, 82, 101 course of, digastric branch, 100 exit site, extratemporal segment, 3, intracranial (pontine or cisternal) segment, intraparotid branches, 42 intratemporal segment, landmark for branches of, 44 in lower facial region, 86 marginal mandibular branch, 22, 43, 82, 84, 85, 101 in masseteric region, 55, 57, 58, 59, 60 in mastoid region, 100 in midfacial region, 63, 65, 66, 67, 68, 69, 70, 71, 74, 77, 78 reflected posteriorly, 76 motor fibers, pontine segment, in posterior neck region, 95, 96, 97, 98, 99 sensory nerve fibers, temporal branches, 24, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 101, 103 trunk main, 90 posterior, 66 structures adjacent to, 76–78 upper branches, 40 in upper neck region, 89 venous valves, 45 vertical part, zygomatic branches, 38, 39, 40, 41, 42, 44, 101 zygomaticobuccal branches, 38, 39, 75, 83, 87 Facial nerve grafting, 103 Facial region lower, 81–87, 90 with depressor anguli oris muscle removed, 84 with lips removed, 87 with opened mandibular canal, 85 with platysma muscle removed, 84 upper, overview, 21–22 Facial reinnervation surgery, 39, 56 hypoglossal muscle in, 76 masseteric nerve in, 58 Facial vein, 22, 39, 81 in lower facial region, 82, 83, 84, 87 in lower neck region, 90 in masseteric region, 58 in midfacial region, 40, 41, 46, 48, 63 in oral floor, 88 relationship to facial artery, 87 in upper neck region, 90 Foramen ovale, 3, 7, 11, 15, 62 Foramen rotundum, 6, 11, 13, 14, 52 Foramen spinosum, 7, Forehead, 23–26 Frontal bone, nasal part, 16 Frontal crest, 11 Frontalis muscle, 21, 22, 23, 24, 32, 33, 81 frontal belly, 23 reflected inferiorly, 25 separated from orbicularis oculi muscle, 24 Frontal nerve, 26 Frontal notch, 13, 16 Frontomaxillary suture, 12, 16 Frontonasal suture, 12, 16 Frontotemporal region, 23, 24 Frontozygomatic suture, 9, 12, 61 G Galea aponeurotica, 21, 22, 23, 91 Galeal layer, 23 Ganglionic branches, 52 Geniculate ganglion, 4, 61 Geniohyoid muscle, 88 Gingiva maxillary, 50, 51 palatal, 53 Glossopharyngeal nerve, 7, 8, 70, 72, 76, 78, 89 branches, 3, Great auricular artery, 97 Great auricular nerve, 22, 39, 43, 81, 93, 102, 103 Greater occipital nerve, 22, 82, 93, 94, 95, 96, 101, 102, 103 lateral branch, 91, 94 medial branch, 91, 94 Greater palatine artery, 51, 53, 54, 72, 73, 74 Greater palatine canal, 53 Greater palatine foramen, 15, 74 Greater palatine nerve, 15, 51, 52, 54, 74 Greater petrosal nerve, 3, 4, 75 H Hyoid bone, 100 Hypoglossal canal, Hypoglossal-facial nerve side-to-end anastomosis, Hypoglossal nerve, 68, 70, 76, 78, 89, 97 Hypoglossus muscle, 88 I Incisive artery, 53 Incisive fossa, 16, 17 and canal, 15 Incus, 77 short process, Inferior alveolar artery, 63, 66, 68, 69, 71, 74, 84, 85, 87, 88 reflected, 72 Inferior alveolar nerve, 54, 63, 65, 66, 67, 68, 69, 71, 73, 74, 84, 85, 87, 88 mylohyoid branch, 85 reflected, 72 Inferior alveolar vein, 66, 68, 69, 71, 84, 85, 88 Inferior joint space, midfacial region, 63 Inferior labial artery, 83, 84, 85, 87 Inferior nuchal line, 10, 98 Inferior oblique muscle, 75, 97, 98, 99 Inferior ophthalmic vein, 75 www.pdflobby.com bindex.indd 106 2/10/2015 1:39:20 PM Index Inferior orbital fissure, 12, 13, 16, 64, 75 lateral part, 73 Inferior orbital fossa, Inferior palpebral artery, 45 Inferior palpebral branch, 42 Inferior petrosal sinus, Infrahyoid muscles, 100 Infraorbital artery, 41, 45, 47, 49, 50, 51, 52, 63, 64, 65, 66, 68, 69, 72, 74, 75 Infraorbital foramen, 15, 16 Infraorbital nerve, 12, 14, 39, 41, 45, 47, 48, 49, 50, 51, 52, 64, 65, 66, 68, 69, 72, 75, 87 inferior palpebral branch, 38, 41 Infraorbital sulcus (groove), 12, 13 Infraorbital vein, 40, 45 Infratemporal crest, 8, 66, 68 Infratemporal fossa, 8, 63–74, 86 with accessory ligaments of the temporomandibular ligament, 67 anterior wall, 66 with coronoid process removed, 63 with drilled mandibular fossa, 69 with elevated mandibular nerve, 72 with elevated tensor veli palatini muscle, 70 with fractured pterygoid plate, 74 inferior boundary, 66 inferior orbital fissure in, 64 with lateral pterygoid muscle removed, 65 with mandible removed, 68 with mandibular condyle removed, 65 with maxillary artery elevated, 73 with medial pterygoid muscle removed, 68 medial wall, 66 osseous boundaries, with pterygoid plexus removed, 66 roof, 66 with temporalis muscle removed, 63 with tensor veli palatini muscle removed, 71 Infratrochlear nerve, 26 Inion (external occipital protuberance), 10, 91 Interfascial fat pad, 34 Intermaxillary suture, 14 Internal acoustic meatus, roof, Internal carotid artery, 4, 6, 7, 61, 68, 72, 76, 89 Internal carotid plexus, sympathetic filaments from, 11 Internal jugular vein displaced laterally, 89 in lateral neck region, 103 in lower facial region, 87, 90 in midfacial region, 7, 55, 67, 68, 69, 70, 71, 76 in posterior neck region, 95 in upper neck region, 89, 90 Internasal suture, 12 Intracranial region, 3–6 Intrajugular process, Intraorbital nerve, 46 J Jacobson’s nerve See Glossopharyngeal nerve Joint capsule, 60 Jugular bulb, Jugular foramen, 7, 8, 76, 78 L Lacrimal artery, 26 Lacrimal fossa, 12, 13, 14 Lacrimal gland, Lacrimal nerve, 26 Lambdoid suture, 10 Laryngopharynx, sensory innervation, 76 Lateral cartilage, upper, 48 Lateral ligament, 55, 56, 57, 58, 60 Lateral nasal artery, 39, 41, 45, 46, 47, 48, 81, 83, 85, 87 alar arcade from, 45 communication with external nasal artery, 48 Lateral nasal wall, 48 Lateral neck region, 102–103 posterior triangle posterolateral view, 102 with sternocleidomastoid muscle retracted, 103 Lateral pterygoid muscle, 18, 52, 56, 75, 85, 87 lower head, 63, 64 pterygoid head, 65 upper head, 62, 63, 64 Lateral pterygoid plate, 8, 49, 65, 68, 69, 71, 73 Lateral semicircular canal, 4, Lesser occipital nerve, 22, 82, 91, 93, 94, 95, 102, 103 Lesser palatine artery, 53, 54 Lesser palatine foramen, 15, 74 Lesser palatine nerve, 15, 52, 74 Lesser petrosal nerve, 3, 72 Levator anguli oris muscle, 16, 22, 39, 40, 41, 42, 45, 46, 47, 48, 81, 83, 85 as modiolus component muscle, 81 Levator labii muscles, attachments, 47 Levator labii superioris alaeque nasi muscle, 45, 47, 48 Levator labii superioris muscle, 16, 21, 22, 39, 40, 41, 42, 45, 46, 47, 81 Levator palatini muscle, 78 Levator palpebrae superioris muscle, 26 Levator scapulae muscle, 76, 96, 98 107 Levator veli palatini muscle, 54, 70, 71, 72, 76 Lingual artery, 89 Lingual nerve, 54, 63, 65, 66, 68, 69, 70, 71, 73, 74, 76, 78, 85, 87, 88, 89 branch to medial pterygoid muscle, 72 Lingula, 18 Longissimus capitis muscle, 5, 96 reflected inferiorly, 97 M Malleus, handle, 77 Mandible, 87, 89, 100 anterior view, 17 ascending ramus, 86 cut, 66, 67 muscles, partially removed, 63, 88 posterolateral view, 18 upper border of ramus, 58 Mandibular angle, 82 Mandibular canal, opened, 84, 85 Mandibular condyle, 10, 55, 58, 63, 85 Mandibular foramen, 18, 85 Mandibular fossa, 8, 66, 68, 69 opened, 4, 72, 77 Mandibular nerve, 4, 6, 11, 62, 69, 76 anterior trunk, 69 motor division, posterior trunk, 69 Mandibular notch, 9, 39, 58 Marginal mandibular branch, of facial nerve, 8, 22, 43, 84, 85, 101 Masseteric artery, 56, 57, 86 Masseteric fascia, 39, 41, 81, 82 opened, 82 Masseteric nerve, 54, 56, 57, 59, 60, 62, 66, 68, 72, 73, 86 intraoperative landmarks, 58 reflected, 63, 64, 71 Masseteric region, 55–60 with deep temporal fat pad removed, 60 with facial nerve branches removed, 55 with parotid gland removed, 55 with zygomatic arch removed, 59 Masseteric vein, 56 Masseter muscle, 6, 18, 34, 44, 50, 51, 55, 90 deep part, 57, 58 for facial reanimation, 56 with fascia, 22 middle part, 56, 57, 58 reflected, 57 reflected, 86 downward, 58 inferiorly, 86 upward, 65 www.pdflobby.com bindex.indd 107 2/10/2015 1:39:20 PM 108 Index Masseter muscle (cont.) superficial part, 58 attachment, 56, 57 reflected, 56 without fascia, 42 Mastication, muscles of, 6, 56 Mastoid after mastoidectomy, lateral view, 100 Mastoid antrum, Mastoidectomy, 101 mastoid after, Mastoid emissary vein, 96, 100 Mastoid foramen, 10, 96 Mastoid notch (digastric groove), 10, 100 with digastric muscle posterior belly detached, 90 Mastoid process, 5, 8, 9, 10, 84, 95, 96, 97, 99 Mastoid segment, 101 Mastoid tip, 67, 69, 76 Maxilla with anterior wall removed, 50 anteroinferior view, 14 frontal process, 16 with posterior and medial walls opened, 51 Maxillary artery, 49, 52, 54, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 78, 85 pterygoid segment, 86 pterygopalatine segment, 52 segments, 63 Maxillary bone, 49 palatine process, 15 Maxillary nerve, 4, 6, 11, 51 infraorbital branch, 14 zygomaticotemporal branch, 26 Maxillary ostium, 50, 51 Maxillary region, 49–54 with mimetic muscles removed, 49 with veins removed, 52 Maxillary sinus orifice, 75 posterior wall, 50 Maxillary tuberosity, 49, 73 Maxillary vein, 64, 65, 66, 67 Meckel’s cave, Medial palpebral ligament, 16, 45 Medial pterygoid muscle, 18, 56, 65, 66, 69, 73, 85 superficial head, 63 Median palatine suture, 15 Meningo-orbital (lacrimal) foramen, 6, 12, 13 Mental artery, 84, 85, 87 Mental foramen, 16, 17 Mentalis muscle, 17, 22, 81, 82, 84, 87 Mental nerve, 17, 84, 85, 87 Mental protuberance, 16, 17 Mental tubercle, 17 Mental vein, 84, 85, 87 Middle cranial fossa, 78 Middle deep temporal nerve, 62 Middle ear, innervation, Middle fossa, 3, dura, superior view, 61 without bone, 62 Middle meningeal artery, 3, 4, 62, 63, 66, 68, 69, 71, 72, 76, 78 groove for, 11 orbital branch to lacrimal artery, Middle nasal concha, 14 Middle superior alveolar nerve, 49, 52 Middle temporal artery, 36, 55, 60, 61, 100 groove for, Middle temporal vein, 35, 36, 37, 55, 57, 58, 59, 60 Midfacial region deep structures, 61–78 overview, 21–22 superficial structures, 38–48 Mimetic muscles, 21, 22, 45 deep seated, 41 modiolus, 22, 81, 83 Minor salivary gland, 63 Modiolus, 22, 81, 83 Mylohyoid groove, 18 Mylohyoid line, 18 Mylohyoid muscle, 6, 84, 88 Mylohyoid nerve, 68, 70, 71, 84, 87, 89 N Nasal bone, 13, 14, 49 Nasalis muscle, 16, 42, 46, 48 alar part, 47 attachments, 48 transverse part, 46, 47 Nasal septum, 14 posterior edge, 54 Nasociliary nerve, 26 Nasolacrimal duct, 50, 51 Nasolacrimal torus, 50, 51 Nasomaxillary suture, 16, 49 Nasopalatine nerve, 15, 52, 53 Nasopharynx, 74 Neck posterior triangle, 102 upper region, 89–90 Nervus intermedius, 4, 5, 77 Neurovascular bundle, 61 Nuchal ligament, attachment site, 10 O Occipital artery, 5, 10, 22, 43, 60, 67, 68, 69, 70, 71, 77, 90, 92, 93, 94, 95, 96, 97, 98, 99, 101 cut, 76 anastomosis in scalp, 92 ascending branch, 91, 97 descending branch, 91, 96, 97, 98, 99 dissected from the groove, 100 meningeal branch, 5, 7, 96, 100 sternocleidomastoid branch, 90, 94 transverse (cutaneous) branch, 91, 96 Occipital condyle, 7, 8, 9, 10 Occipital groove, 10 Occipitalis muscle, 21, 22, 91, 93 bellies, 91 Occipital region, 91–101 Occipitofrontalis muscle, 23 Occipitomastoid suture, 10 Oculomotor nerve, 6, 11 Olfactory nerve, 13 Ophthalmic artery, 26 frontal nerve branch, 26 lacrimal nerve branch, 6, 26 nasociliary nerve branch, 26 Ophthalmic nerve, 4, 6, 11 Ophthalmic veins, 11 Optic canal, 11, 12, 13 opened, Optic nerve, 26 with dura, Optic strut, 13 Oral commissure, 83 Oral floor, from the side, 88 Orbicularis oculi muscle, 16, 22, 33, 38, 39, 40, 41, 42, 45, 46, 47, 48, 81, 83 function, 83 as modiolus component muscle, 81 reflected, 38, 55, 57 upper, 32, 41 Orbicularis oris muscle, 17, 22, 39, 41, 81, 82, 84 upper, 39 Orbit, 12–16, 50, 51 anterior view, 12 anteromedial view, 13 superior view, 26 Orbital floor, 50 Orbitalis (Müller’s) muscle, 64 Orbital region, 23–26 Orbital septum, 45 Oropharynx, sensory innervation, 76 Otic ganglion, 3, 72 P Palatal region, 53–54 Palatine aponeurosis, 53, 54 Palatine artery, ascending, 89 Palatine bone, 15 Palatoglossus muscle, 70 www.pdflobby.com bindex.indd 108 2/10/2015 1:39:20 PM Index Parietal bone, Parietal foramen, 92 Parietomastoid suture, 10 Parotid duct, 22 in lower facial region, 85, 86, 87 in masseteric region, 55, 60 cut and reflected, 56, 57 reflected, 58 in midfacial region, 39, 40, 41, 42, 63 relationship with buccinator muscle, 85 Parotid gland, 22 buccal branch, 81 deep lobe, 42 in lateral neck region, 103 in midfacial region, 44 in posterior neck region, 93, 99 with substance removed, 44 with superficial lobe removed, 42, 101 tail, 82 in temporal region, 33, 34, 42 Periauricular muscle, 21 Pericranial vein, 25 Pericranium, 91 Petrotympanic (squamotympanic) fissure, 5, 7, 69, 77 Pharyngeal plexus, 76, 89 Phrenic muscle, 102 Piriform (anterior nasal) aperture, 16 Pituitary fossa (sella turcica), 11 Platysma muscle, 17, 22, 81, 84, 87 attachments, 84 Posterior alveolar canals, 73 Posterior atlanto-occipital membrane, 98 Posterior auricular artery, 22, 69, 70, 81, 90, 91, 95, 100 branches anastomosis in scalp, 92 auricular branch, 5, 43, 89, 94, 95, 96, 100, 101 occipital branch, 43, 93, 94 perforating artery from, 93 Posterior auricular muscle, 22, 93 Posterior auricular nerve, 8, 22, 77, 91, 93, 102, 103 Posterior auricular vein, 22, 82, 93, 94, 95, 103 Posterior circular artery, 68 Posterior deep temporal nerve, 62 Posterior ethmoidal foramen, 13 Posterior ethmoidal groove, 13 Posterior ethmoidal nerve, 26 Posterior fossa dura, Posterior lacrimal crest, 13 Posterior nasal spine, 15 Posterior neck region, 91–101 with galea and occipitalis muscle removed, 94 with longissimus capitis muscle reflected inferiorly, 97 with parotid gland superficial lobe removed, 101 with semispinalis muscle reflected inferiorly, 98 with skin and galea removed, 91 with splenius capitis muscle reflected medially, 96 with sternocleidomastoid muscle reflected laterally, 95 with trapezius muscle reflected medially, 96 Posterior semicircular canal, 3, Posterior superior alveolar artery, 52, 63, 64, 65, 66, 69, 73, 75, 85 Posterior superior alveolar nerve, 52, 63, 64, 65, 66, 69, 73, 75, 85 dental branch, 73 gingival branch, 73 Posterior superior alveolar vein, 63, 64 Premasseteric artery, 39, 81, 82 Prevertebral fascia, 102 Procerus muscle, 16, 21, 42, 45, 46, 81 Pterion, Pterygoid canal artery of, 52 nerve of, 75 vein of, 75 Pterygoid fovea, 18 Pterygoid hamulus, 8, 15, 53, 54 Pterygoid muscle, Pterygoid plate, 52 fractured, 74 Pterygoid venous plexus, 45 deep component, 65 Pterygomandibular raphe (ligament), 67, 68 Pterygomaxillary fissure, 73, 74 Pterygopalatine fossa, 14, 52, 74, 75 Pterygopalatine ganglion, 34, 51, 52, 74, 75 R Rectus capitis lateralis muscle, 69, 76 Rectus capitis posterior major muscle, 97, 98, 99 Rectus capitis posterior minor muscle, 97, 98 Retromandibular vein, 34, 36, 42, 43, 44, 55, 57, 58, 59, 60, 65, 85, 90 anterior branch, 82, 90 posterior branch, 82, 103 Retromolar fossa, 17, 86 Risorius muscle, 21 as modiolus component muscle, 81 S Salpingopharyneus muscle, 71 Scalp, from above, 92 109 Segmental muscle, 102 Sella turcica (pituitary fossa), 11 Semicircular canals, 61, 77 Semispinalis capitis muscle, 94, 95, 97 Sensation, facial nerve-based, Sentinel vein, 34, 35, 37 Septal artery, 45, 46, 47, 48, 87 Sigmoid sinus, 5, 7, 77, 101 Skull from above, 92 anterior view, 16 anteroinferior view, 14 external and internal views, 7–11 lateral view, 9, 73 posterolateral view, 10 Skull base anterior (internal surface), 11 external surface, middle (internal surface), 11 Soft palate, 68 Sphenofrontal suture, 12 Sphenoidal ridge, 11 Sphenoid bone, greater wing, 9, 11, 12 lesser wing, 11 scaphoid fossa, 54 spine, with spine removed, 69 Sphenoid sinus, 51, 52 mucosa, Sphenomandibular ligament, 66, 67 Sphenopalatine artery, 51, 52 Sphenopalatine foramen, 14 Sphenopetrosal suture, Sphenozygomatic nerve, 12 Spinal accessory nerve, 76 Splenius capitis muscle, 5, 22, 91, 93, 94, 95, 96, 97, 102, 103 Stapedius muscle, Stapes incus, Sternocleidomastoid muscle, 5, 22, 39, 76, 81, 82, 91, 93, 94, 97, 102, 103 anterior triangle, 94 cut and reflected, 89 posterior triangle, 94 reflected, 90, 95, 99 laterally, 95 medially, 96 retracted anteriorly, 103 Styloglossus muscle, 68, 89 Stylohyoid ligament, cut, 74 Stylohyoid muscle, 60, 90 Styloid process, 66, 69, 77 cut, 7, 8, 76, 78 Stylomandibular ligament, 67, 89 Stylomastoid artery, 76, 78, 89 branch to digastric muscle, 69 foramen, Stylomastoid foramen, 7, 8, 100 www.pdflobby.com bindex.indd 109 2/10/2015 1:39:20 PM 110 Index Stylopharyngeus muscle, 68, 70, 89 Subclavian vein, 103 Subgaleal fat pad, 32, 33, 37 reflected, 34 Sublingual artery, 88 Sublingual fossa, 18 Sublingual gland, 3, 18 ducts, 88 Submandibular fossa, 18 Submandibular ganglion, 5, 88 Submandibular gland, 3, 85, 87, 88, 90 Submental artery, 68, 84, 85, 87, 88, 89 Submental region, cutaneous innervation, 71 Suboccipital muscles, 97 Suboccipital nerve See Cervical (C1) nerve Suboccipital triangle, 98, 99 Subzygomatic fossa, 55 Superficial (interfascial) fat pad, 34, 35, 37 Superficial musculoaponeurotic system (SMAS), 21 Superficial temporal artery, 22, 32, 33, 34, 35, 36, 40, 42, 43, 44, 55, 57, 58, 59, 60, 61, 63, 65, 66, 68, 69, 70, 71, 74, 77, 81, 85 frontal branch, 22, 23, 24, 33, 81 parietal branch, 22, 81, 92 Superficial temporal fascia, 21 Superficial temporal vein, 22, 32, 33, 34, 35, 36, 40, 42, 55, 57, 58, 59, 60, 81 Superior alveolar nerves, 73 Superior auricular artery, 32, 34 Superior auricular muscle, 22, 32, 33, 81 Superior constrictor muscle, 68 Superior joint space, 63, 65 Superior labial artery, 46, 48, 83, 85, 87 Superior laryngeal nerve, 89 Superior nuchal line, 91, 97, 98 Superior oblique muscle, 26, 90, 97, 98, 99, 100 Superior ophthalmic vein, 26 Superior orbital fissure, 6, 11, 12, 13, 16 lateral edge, Superior palpebral artery, 45 Superior petrosal sinus, Superior pharyngeal constrictor muscle, 68, 70, 76 Superior rectus muscle, 26 Superior temporal line, Superior thyroid artery, 89, 90 Superior tympanic artery, 3, Supraclavicular nerve, 102, 103 Supramastoid crest, 8, Suprameatal spine (Henle), Suprameatal triangle, Supraorbital artery, 25, 26 branches anastomosis in scalp, 92 communicating branch, 24 deep branches, 24, 25 superficial branches, 23, 24 Supraorbital foramen, 13, 14, 16 Supraorbital nerve, 13, 23 branches lateral (deep) branch, 23, 24, 25 medial (superficial) branch, 23, 25 to skin (cut), 25 Supraorbital region, 25 medial view, 25 Supraorbital vein, 23, 25, 45, 81 Supratrochlear artery, 25, 26 branches anastomosis in scalp, 92 deep branch, 25 superficial branches, 23 Supratrochlear nerve, 23, 25 Supratrochlear vein, 25, 45, 81 T Tegmen tympani, Temporal bone, 9, 36 tympanic part, Temporal branches, of facial nerve, 24, 32, 33, 34, 35, 36, 37, 38, 40, 41, 42, 101, 103 Temporal branches, of the facial nerve, 38, 39, 40, 41, 42 Temporal crest, 18 Temporal fascia, 24, 37, 100 deep layer, 35, 37 removed, 36 reflected anteriorly, 34 superficial layer, 34, 35, 37 reflected upward, 34 Temporal fossa, superior view, 61 Temporalis muscle, 18, 36, 37, 55, 56, 58, 60, 62, 94, 95 for facial reanimation, 56 fascia of See Temporal fascia reflected, 61 tendon, 58, 59, 75, 86 Temporal muscle, Temporal region, 32–37, 34, 36, 37 fat pads See Deep fat pad; Subgaleal fat pad; Superficial fat pad with temporoparietal fascia reflected, 34, 35 Temporofacial division, 42, 43, 90, 101 Temporomandibular joint, 55, 63 Temporomandibular ligament, 9, 55 accessory ligaments, 67 Temporoparietal fascia, 21, 23, 24, 32, 37, 81 reflected, 34 Tendinous arch, 91, 93 Tensor tympani membrane, Tensor tympani muscle, 4, 6, 61 Tensor veli alatini muscle, Tensor veli palatini muscle, 54, 68, 69, 70, 75, 77 branch to medial pterygoid muscle, 73 Tongue, innervation of, 3, 76 Tonsillar artery, 68 Tragal pointer (cartilage), 43 Transparent deep fat pad, 35 Transparent superficial fat pad, 34 Transverse cervical nerve, 82, 102, 103 Transverse facial artery, 22, 32, 34, 35, 38, 39, 40, 41, 44, 55, 81 Transverse facial nerve, 38, 42 Transverse palatine suture, 15 Transverse-sigmoid sinus junction, 100 Transverse supraorbital vein, 45 Trapezius muscle, 91, 94, 95, 97 reflected medially, 96 Trigeminal (gasserian or semilunar) ganglion, 3, 4, Trigeminal nerve, 4, 6, 44 infraorbital branch, 12 mandibular division, 6, 11 maxillary division, 6, 11 ophthalmic division, 6, 11 zygomatic branch, 12 Trochlear nerve, 6, 11, 26 Tuberculum sellae, 11 Tympanic cavity, Tympanomastoid fissure, Tympanomastoid suture, 9, 70, 77 drop-off point, U Upper neck region, 89–90 V Vaginal process, 7, 8, 72, 78 Vagus nerve, 7, 70, 76, 89, 102, 103 auricular (mastoid) branch, pharyngeal branch, 78 Vertebral artery, 98, 99 Vertebral venous plexus, 99 Vestibulocochlear nerve, 3, Vidian canal See Pterygoid canal Vomer bone, 8, 15 Z Zygomatic arch, 14, 34, 35, 36, 55, 56, 57, 58, 62 root, 61 Zygomatic bone, 9, 49 Zygomatic branches, of facial nerve, 38, 39, 40, 41, 42, 44, 101 Zygomatic minor muscle, 81 Zygomatic nerve, 12, 52 branches, 12, 61 Zygomaticobuccal branches, of facial nerve, 38, 39, 41, 44, 46, 75, 83, 87 www.pdflobby.com bindex.indd 110 2/10/2015 1:39:20 PM Index Zygomaticobuccal nerve, 38, 75 Zygomaticobuccal plexus, 42, 101 Zygomaticofacial foramen, 9, 13, 49 Zygomaticofacial nerve, 12, 38, 49, 61, 63, 64 Zygomaticomaxillary suture, 49 Zygomatico-orbital artery, 22, 23, 32, 40, 81 Zygomatico-orbital foramen, 12 Zygomaticotemporal foramen, 61 Zygomaticotemporal nerve, 12, 26, 34, 35, 36, 55, 61 Zygomaticotemporal suture, 55 111 Zygomaticulotemporal nerve, 60 Zygomaticus major muscle, 16, 21, 22, 34, 38, 39, 40, 41, 42, 44, 46, 55, 56, 57, 58, 81, 83, 85, 86 as modiolus component muscle, 81 Zygomaticus minor muscle, 16, 41, 42, 46 www.pdflobby.com bindex.indd 111 2/10/2015 1:39:20 PM www.pdflobby.com bindex.indd 112 2/10/2015 1:39:20 PM ... (lacrimal gland, submandibular gland, and sublingual gland; see Fig 5.9a and Fig 12.1) The facial nerve emerges from the brainstem at the junction of the pons and medulla The course of the facial nerve. .. facial nerve segment and the lateral canal The zygomaticofacial nerve is a sensory nerve of the cheek and one of the two branches of the zygomatic nerve that originated from the maxillary nerve. .. lesser wings of the sphenoid at the junction of the roof and lateral wall of the orbit It transmits the oculomotor nerve, the trochlear nerve, and the sympathetic filaments from the internal