By

Dr G. E. Ebito
 The head is the superior part of the body
that is attached to the trunk by the neck.
 It houses the brain, and serves as the control
& communication center for the body.
 The head has special sensory receivers (eyes,
ears, mouth and nose), broadcast devices for
voice and expression, and portals for the
intake of food, water & O2, and the expulsion
of CO2.
 It is the site of our consciousness: ideas,
creativity, imagination, responses, decision
making and memory.
 The neck is the bridge between the head and
the rest of the body.
 It is located in between the mandible and the
clavicle, connecting the head directly to the
torso, and contains numerous vital structures.
 It contains some of the most complex and
intricate organs and tissues with essential
structure and function for normal physiology.
 Structures contained within the neck are
responsible for breathing, speaking,
swallowing, regulation of metabolism, support
and connection of the brain and cervical spine,
and circulatory and lymphatic inflow and
outflow from the head.
 Neck is the transitional part of the body
between the head superiorly and the trunk
inferiorly.
 It serves as a major conduit for structures
passing between them.
 The neck houses several vital organs and
structures such as the larynx, thyroid &
parathyroid glands, trachea, and esophagus.
 The head rests on the top part of the
vertebral column, with the skull joining at C1
(the 1st cervical vertebra known as the atlas).
 The head is divided into 14 regions, 8 of
which belong to the face.
 These regions are: Frontal, parietal, occipital,
temporal, auricular, mastoid, orbital,
infraorbital, buccal, parotid, zygomatic,
nasal, oral and mental regions.
 All of these 14 regions can be grouped into
either a neurocranial portion or
viscerocranial portion.
 With the exception of the auricular region,
which includes the external ear, the names
of the regions of the neurocranial portion of
the head correspond to the underlying bones
or bony features, and they are the frontal,
parietal, occipital, temporal and mastoid
regions.
 The remaining eight regions of the head
belong to the face and are grouped as
viscerocranial.
 This portion includes the facial region, which is
divided into five bilateral and three median
regions, and are named according to related
superficial features (oral and buccal regions),
deep soft tissue formations (parotid region),
and skeletal features (orbital, infraorbital, nasal,
zygomatic, and mental regions).
 The five bilateral regions are the orbital,
infraorbital, buccal, parotid and zygomatic
regions.
 The three median regions are named according
to features or structures lying along the midline
of the body and are the nasal, oral and mental
regions.
 Orbital region - eyeball, extraocular muscles,
eyelids, glabella, eyebrow, lacrimal glands and
bulbar conjunctiva.
 Temporal region - temporal & infratemporal
fossae, superior & inferior to the zygomatic
arch, respectively.
 Oral region - oral cavity, teeth, gingivae,
tongue, palate, and palatine tonsils.
 Nasal region - contains structures that are
important for smelling and breathing.
 Auricular region – the ear + auricle/ pinna &
EAM that collects & transmits sound to the
tympanic membrane.
 The head & neck skeleton forms the top part
of the axial skeleton.
 Head bones - the skull, hyoid bone, auditory
ossicles.
 Neck bones - cervical vertebrae (C1-7).
 The cranium (skull) is composed of 22 bones
and divided into two regions:
 Neurocranium (which protects the brain)
 Viscerocranium (which forms the face).
 The skull also supports tendinous muscle
attachments and allows neurovascular passage
between intracranial and extracranial
anatomy.
 The cranium (8 bones: frontal, 2-parietal, occipital,
2-temporal, sphenoid, ethmoid), and. the facial
bones (14 bones: 2-zygomatic, 2-maxillary, 2-
palatine, 2-nasal, 2-lacrimal, vomer, 2-inferior
conchae, mandible).
 Overlies the cranial bones; consists of 5 layers -
skin, connective tissue (dense), aponeurosis,
loose connective tissue and the periosteum.
 The three outermost layers move as one unit, with
the aponeurosis being a tendon-like structure
spanning between the frontalis and occipitalis
muscles.
 It is an anatomic region bordered anteriorly by the
human face, & laterally & posteriorly by the neck.
 Extends from the superior nuchal lines and
occipital turbulences to the supraorbital foramen.
 Receives rich arterial supply from ECA, & sensory
innervation from the trigeminal nerve, as well as
cervical nerves.
 The muscles of the head include the tongue,
muscles of facial expression, extra-ocular
muscles and muscles of mastication.
 Humans have well-developed muscles in the
face that permit a large variety of facial
expressions.
 The muscles are used to show surprise,
disgust, anger, fear, and other emotions;
they are an important means of nonverbal
communication.
 Muscles of facial expression include
frontalis, orbicularis oris, laris oculi,
buccinator, and zygomaticus.
 Frontalis: allows for forehead movement
 Orbicularis oris: allows for puckering of lips
 Orbicularis oculi: allows for closing of
eyelids and movement of tears away from
the surface of eye and into the nasal duct
system
 Buccinator: main muscle of the cheeks,
keeps food in the mouth and cheeks away
from teeth while masticating
 Zygomaticus: allows to pull angles of the
mouth up and away into a smile or laugh.
 The muscles of facial expression are located
within the subcutaneous tissue of the face. They
originate from bone or fascia and insert onto
the skin.
 As they contract, the muscles pull on the skin to
exert their effects.
 These muscles all develop from the 2nd
pharyngeal arch.
 As they migrate from the arch, they take their
nerve supply with them. As such, they are all
innervated by branches of the facial nerve.
 The facial muscles can broadly be categorised
into three groups – orbital, nasal and oral.
 The muscles of mastication are associated with
movements of the jaw (temporomandibular joint).
 There are four muscles:
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
 Muscles of mastication develop from the 1st
pharyngeal arch.
 They are innervated by mandibular nerve, a
branch of trigeminal nerve (CN V).
 There are more than 20 neck muscles, extending
from the base of the skull and jaw down to your
shoulder blades and collarbone.
 These muscles support and stabilize the head, neck
and the upper part of the spine.
 They help to move the head in different directions
and assist with chewing, swallowing and breathing.
 Two major triangles in the neck - anterior &
posterior (with sub-division into additional
triangles & anatomic areas).
 Anterior triangle is surrounded inferiorly by the
sternal notch & clavicle, laterally by the
Sternocleidomastoid, and medially by the
trachea, thyroid, and cricoid cartilages.
 The anterior triangle is subdivided into 4
smaller segments (triangles) –
 Submental
 Submandibular
 Carotid
 Muscular triangles.
 Submental (suprahyoid) triangle contains the
mylohyoid muscle as its floor, and bounded by
hyoid bone inferiorly, midline of the neck medially
and the anterior belly of the Digastric posteriorly.
 Submandibular (submaxillary) triangle is
superiorly bordered by the mandible, and by the
anterior & posterior bellies of the Digastric.
 Carotid (superior carotid) triangle is bordered
posteriorly by Sternocleidomastoid, anteriorly by
Omohyoid, and superiorly by Stylohyoid &
posterior belly of Digastric; The thyrohyoid,
hyoglossus, middle pharyngeal constrictor, and
inferior pharyngeal constrictor muscles form the
floor of the carotid triangle.
 Muscular (inferior carotid) triangle is bordered
medially by the midline of the neck, superiorly
by the superior belly of the Omohyoid, and
posteriorly by the Sternocleidomastoid.
 Posterior triangle is bordered posteriorly by the
trapezius muscle, anteriorly by
Sternocleidomastoid, and inferiorly by the
clavicle.
 The posterior triangle is divided into the
occipital triangle and subclavian triangle by the
inferior belly of the Omohyoid muscle.
 The neck also has several layers of fascia, but
the two main divisions are superficial and deep
fascia.
 Superficial cervical fascia extends from the head
down to the thorax and axillae. In the neck, it
contains the superficial lymph nodes, cutaneous
nerves, external and anterior jugular veins, and
the platysma muscle. It is arranged loosely to
allow for neck movement.
 Deep cervical fascia subdivides into the
superficial layer of deep cervical fascia, the
middle layer of deep cervical fascia, and the
deep layer of deep cervical fascia.
 The superficial layer of deep cervical fascia
(investing layer) lies between the muscles of the
neck and the superficial cervical fascia,
encircling the Sternocleidomastoid & Trapezius.
 Attaches inferiorly to the scapula, clavicle, and
manubrium.
 Superiorly, it attaches to the mandible, mastoid
process, superior nuchal line, and external
occipital protuberance.
 The middle layer of deep cervical fascia
(pretracheal layer) runs from the mediastinum
inferiorly to the skull base superiorly.
 Has a muscular and visceral division.
 Pretracheal layer has a muscular and visceral
division.
 Muscular division encloses the strap muscles,
sternohyoid, sternothyroid, omohyoid, and
thyrohyoid muscles.
 Visceral division encloses the larynx, pharynx,
esophagus, thyroid, parathyroid glands, trachea,
and recurrent laryngeal nerve.
 The deep layer of deep cervical fascia
(prevertebral layer) runs from the skull base to the
mediastinum. Its two divisions are the alar and
prevertebral layers. These layers surround the
deep muscles of the neck and the cervical
vertebrae, forming part of the retropharyngeal
space.
 Embryology
 Many important neurovascular and
musculoskeletal structures in the neck are
embryologically derived from the pharyngeal
arches.
 Blood Supply and Lymphatics
 The major blood vessels of the neck are
confined within the carotid sheath; these are the
common carotid artery, the internal carotid
artery, and the internal jugular vein.
 Many lymph nodes exist in the neck, with the
majority located along the course of the internal
jugular vein.
 Nerves
 The cervical ganglia are a trio of sympathetic
nervous system ganglia that lie alongside the
vertebral column.
 Superior cervical ganglion lies at the C2/C3
intervertebral level
 Middle cervical ganglion lies at the C6/C7
intervertebral level
 Inferior cervical ganglion is fused with the first
thoracic ganglion to create the stellate ganglion
at the C7/T1 intervertebral level.
 Ansa cervicalis, a part of the cervical plexus, is
embedded in the carotid sheath anterior to the
internal jugular vein, in the carotid triangle.
 Sympathetic & parasympathetic innervation to the
head and neck.
 3 branches of the trigeminal nerve - ophthalmic,
maxillary and mandibular.
 The sympathetic innervation (for ‘flight or fight
response) begins in the spinal cord.
 Nerve fibres exit the spinal cord and enter the
sympathetic chain, which is composed of superior,
middle and inferior cervical ganglion.
 The parasympathetic innervation (for ‘rest and
digest’) to the head and neck originates from 4
nuclei, located in the brainstem - ciliary, otic,
pterygopalatine and submandibular.
 Meaning of tongue = "glosso" (Gk) & "lingual"
(Latin).
 A muscular structure located on the floor of the
oral cavity.
 The tongue is a specialized skeletal muscle that
is specially adapted for the activities of speech,
chewing, developing gustatory sense (taste) and
swallowing.
 It is the primary taste organ and plays a key role
in the initial phases of swallowing.
 The tongue contains two sets of muscles, the
intrinsic- involved with shape of tongue, and
the extrinsic- involved with tongue movement.
 It is attached to the hyoid bone.
 The intrinsic muscles originate and attach to
other structures within the tongue.
 There are four paired intrinsic muscles of the
tongue and are named by the direction in which
they travel – the superior longitudinal, inferior
longitudinal, transverse and vertical muscles of
the tongue.
 The motor innervation to the intrinsic muscles
of the tongue is via hypoglossal nerve (CN XII).
 The extrinsic muscles of
the tongue originate
from structures outside
the tongue and insert
onto it.
 They are innervated by
the hypoglossal nerve –
with the exception of the
palatoglossus, which is
innervated by the vagus
nerve.
 Genioglossus
 Hyoglossus
 Styloglossus
 Palatoglossus
 The brain, cervical portion of spinal cord, ears,
eyes, nose & sinuses, salivary glands, & oral cavity.
 Cranial nerves & cervical spinal nerves.
 Nasal cavity drains secretions from the 4 pairs of
paranasal sinuses (frontal, sphenoid, ethmoid &
maxillary), the airspaces within skull bones that
function in humidifying the inspired air.
 Oral cavity marks the start of GIT, with 3 major
functions of digestion, communication and
breathing.
 Salivary glands consist of 3 pairs of exocrine glands
- parotid, submandibular & sublingual glands.
 The tonsils are collections of lymphatic tissue
located within the pharynx.
 They collectively form a ringed arrangement, known
as Waldeyer’s ring:
 Pharyngeal tonsil
 Tubal tonsils (x2)
 Palatine tonsils (x2)
 Lingual tonsil
 The tonsils are classified as mucosa-associated
lymphoid tissue (MALT), and contain T cells, B cells
and macrophages.
 They have an important role in fighting infection –
the first line of defence against pathogens entering
through the nasopharynx or oropharynx.
 Key facts about head and neck anatomy
Skull Comprised of 22 bones: (Frontal bone, parietal bones
(2), occipital bone, temporal bones (2), sphenoid bone,
ethmoid bone, maxillae (2), inferior nasal conchae (2),
lacrimal bones (2), nasal bones (2), palatine bones (2),
vomer, zygomatic bones (2), mandible
Nose Composed of nasal cartilages and nasal bones, anterior
to nasal cavity
Arteries: facial, sphenopalatine, greater palatine, and
ophthalmic arteries
Nerves: olfactory nerve (CN I), ophthalmic nerve (CN
V1), maxillary nerve (CN V2)
 Key facts about head and neck anatomy
Eye Consists of ocular bulbs (eyeballs) with associated
extraocular muscles located in orbits
Main artery: ophthalmic artery
Main nerves: optic nerve (CN II), oculomotor
nerve (CN III), trochlear nerve (CN IV), trigeminal
nerve (CN V), and abducens nerve (CN VI)
Ear Comprised of outer, middle and inner ears
Main arteries: external carotid, maxillary, and basilar
arteries
Main nerves: facial nerve (CN VII) and
vestibulocochlear nerve (CN VIII)
 Key facts about head and neck anatomy
Mouth/ Consists of teeth, tongue, hard and soft palates, uvula
oral and tonsils, oropharynx
cavity Main arteries: descending palatine, facial, lingual, and
maxillary arteries
Main nerves: maxillary nerve (CN V2), mandibular
nerve(CN V3), vagus nerve (CN X), hypoglossal nerve
(CN XII), and facial nerve(CN VII)
Neck Contains hyoid bone, thyroid gland, parathyroid
glands, pharynx and larynx; externally divided into
triangles, internally divided into compartments
Main arteries: Common carotid, external carotid,
internal carotid and facial arteries
Main nerves: Cervical plexus