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CLINICAL ANATOMY OF THE HEAD
Chovanec M1,2
1Department of Otorhinolaryngology, 3rd Medical Faculty,
University Hospital Kralovske Vinohrady2Institute of Anatomy, 1st Medical Faculty,
Charles University Prague
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frontal t.
glabella
frontozygomatic s.
supraorbital and supratrochelar i.
ant. lacrimal c., med. palp. ligament
infraorbital m., zygomaticomaxillar s.
supraorbital m.
ant. nasal sp., piriform ap.
infrazygomatic c.
alveolar juga
canine f.
mandibular ang.
body of mandible
mental prot.
mental tub.
Head – palpation
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frontal t.
supraorbital m.
zygomaticum bone
zygomatic arc
parietal t.
ext. occip crest
mandibular ramus
mandibular angle
infrazygomatic cr.
mental prot.
mental tub.
mastoid pr.
Head – palpation
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Arteries of the head
Bleeding - compression
facial a.
superf. temporal a.
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bleeding - compression
gret. palatine a.
inf. alveolar a. – alveolus
pterygoid v. plexus
Arteries of the head
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bleeding - ligation
lingual a.
(Pirogov´s tr. Béclard´s ang)
facial a.
(submandibular tr.)
maxillary a.
(infratemporal f.)
ext. carotid a.
(carotic tr.)
comon carotid a.
(arterial circle of Willis!)
comon carotid a.
(compression – carotic tr. - transv. pr. C6)
Arteries of the head
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skin incisionsarteries and nerves of the scalp1 - supratrochlear a.
2 - supraorbital a.
3 - superf. temporal a.
4 - post. auricular a.
5 - occipital a.
6 - tert. occipital n.
7 - great. occipitali n.
8 - lesser occiptal n.
9 -auriculotemporali n.
10 - zygomaticotemporali n.
11 - supraorbital n.
12 - supratrochlear n.
Arteries of the head
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microvascular reconstruction
(rect. abdominis free flap)
facial a.
ext. jugular v.
Arteries of the head
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Angiofibroma of nasopharynx
(sphenopalatine f.) maxillary a. -
angiography and embolization
CAVE:! anastomoses
ext. and int. carotid aa.
supratrochl. a./angular a.
vidian a.
Arteries of the head
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venous anastomoses (spread of infection)
facial v. ● supraobital/supratrochlear v. ●
sup. and inf. ophtalmic vv. ● cavernous s. ●
pterygoid v. pl. ● maxillary v. ●
retromandibular v. ● ext. palatine v. ● deep facial v. ●
superf. and med. temp. vv. ● parotid vv. ● transv. facial v.
Veins of the head
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Lymphatic drainage of the head
Lymph nodes of the head and neck(acc. toe Borovanský 1976)
1 - cervic. superf. LNs
2 – deep sup. cervical LNs
3 – occipital LNs
4 – retroauricular LNs
5 – preauricular LNs
6 – parotid LNs
7 – submandibular LNs
8 – deep inf. cervical LNs
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CN V/1
CN V/2
CN V/3
cervical pl.
gr. occipital n.
Sensitive inervation of the head
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Exit points of CN V
Ek - ektokonichion
Go - goniale
Is - incisale superius
Mor - medioorbitale
x – frontozygomatic s.
a – line of Černý
b – line - Mor a Go
c – line - Sn a Ek
n.V/1
n.V/2
n.V/3
Sensitive inervation of the head
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palpation
Sensitive inervation of the head
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Esencial neuralgia of CN V
neurovascular conflict of CN V and AICA
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Anestesia of the oral cavity
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Skin incisions in the face
skin relaxion lines and skin creases of the face
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External nose
collapse of the nasal valve
deviation of the external nose
(rhinoplasty)
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Nasal septum
deviation
septal haematoma
saddle nose deformity and
perforation
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Epistaxis
Little´s area
naso-nasopharyngeal pl. of Woodrof
ext. carotid a..
int. carotid a.
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- antrum Highmori
- birth
7x4x4 mm
- X-ray
4-5 mo
- bifasic growth
0-3 y & 7-12 y
- 18y: 34x33x23 mm
- topography
orbit – infraorbital n., a., v.
alveolar pr. – M1, M2, PM2, M3, C
pterygopalatine & infratemporal f.
MNM – ostium + acces. ostia
Maxillary sinus
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Caldwell Luc´s op. transmaxillary appr. to infratemporal f.
Maxillary sinus
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ostium of maxillary s. – nasolacrimal d.: 4-9 mm
Puncture of maxillary s.
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Ethmoidal sinuses
- aterior (AE) and posterior (PE)
- basal lamel – „ground lamela“
- AE: middle nas. meatus
birth: 2x4x2 mm
18 y: 20x22x10 mm
- PE: sup. nas. meatus
18 y: 20x20x10 mm
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bullous concha
frontal bulla Hallers´s cellOnodi´s cell
Ethmoidal sinuses
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- X-ray: 2 y
- frontal bone invasion: 5 y
- adolescence: 17x28x27 mm
- unilateral aplasia: 7% (4-15%)
- ant. and post. lamina: diploe, ant./post. = 2/1
- topography: ant. cranial fossa, orbit
Frontal sinus
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Sphenoid sinus
- pneumatisation after 3rd y, 7th y: sella turcica
- 18 y: 23x20x17 mm
- ev. invasion of: gr. wings of sph. bone, clivus,
pterygoid pr., palatine bone
- topography: sella turcica, CN II, int. carotid a.
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endoscopic transsphenoidal appr.
pituitary surgery
CN II decompression
other skull base pathologies
Sphenoid sinus
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Complications of sinustis
Orbital: orbitocelulitis, abscess, neuritis of CN II
Intracranial:
meningitis
empyema
abscess
trombosis of cavernous s.
Cranial: osteomyelitis
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semilunar hiatus
uncinate proces
ethmoidal bulla
maxillary ostium
accesory osstia
nasofrontal duct
ant. ethm. cells
sphenoethm. recess
Lateral nasal wall
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Ostiomeatal complex
mucociliar clearance
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FESS – Functional endoscopic endonasal surgery
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Clefts
5 td 6 td
9 td7 td
facial clefts
clefts of lip, jaw, palate
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External ear development
Treacher Collins syn.
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External auditory canal atresia
BAHABone Anchored Hearing Aid
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External auditory canal
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External otitisApopilosebaceous unit
External auditory canal
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Fissurae of Santorini
ca of ext. auditory canal
ca of parotid gland
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External auditory canal
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Ear lobe
otohematoma
„cauliflower ear“
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Otoscopy
Cholestetaoma
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Otoscopy
ac. middle aer infection paracentesis
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Complications of middle ear infection
Temporal
mastoiditis
subperiostal abscess
CN VII paresis
labyrintitis
petrositis
Intracranial
meningitis
subdural empyema
epidural abscess
brain abscess
trombofelbitis of sigmoid s.
hydrocephalus
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Rehabilitation of deafness
cochlear implant
auditory brainstem i.
auditory midbrain i.
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Mandibular fractures
architecture of cancellous bone
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Midface fractures
bony pillars Le Fort I, II, III
fr. of nasomaxillary complex fr. of zygomaticomaxillary complex
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Blow-out fracture
inf. rectus m.
infraorbital n., a., v.
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Skull base fractures
„racoon eyes“
CSF-leak
1 - transv. fr.of ant. cr. base
2 - transv. fr. of middle cr. base
3 - fr. encircl. f. magnum
4 - fr. of temporal bone
5 - longitudinal fr. of post. cr. base
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Fr. of temporal bone
transversal
longitudinal
transversal
longitudinal
„battle sign“
CSF-leak
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Epidural hematoma
middle meningeal a.
ant. and post. meningeal aa.
diploic vv.
CT
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Transcranial approaches
trephination craniotomy
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Subdural hematoma
bridging vv.CT
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Subarachnoidal hematoma
trauma
aneurysm
AV malformation
aneurysm - clipping
aneurysm - coiling
CT
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Intracerebral hematoma
CT
CT
hemocephalus
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Hydrocephalus
comunicating (meningitis)
non-comunicating (CPA TU)
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Fontanels
orientation - child delivery
hydrocephalus
dehydratation
transcranial US
puncture
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Intracranial hypertension
intracranial herniation
conuses
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CN II
amaurosis
bitemp. heteronym.
hemianopsia
contralat. homonym.
hemianopsia
contralat. homonym.
quadrontopsia inf.
contralat. homonym.
quadrontopsia sup.
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CN III, IV, VI
CN IV palsy
CN VI palsy
CN III palsy
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Horner´s syndroma
Sympathetic trunk lesion
miosis
ptosis
enoftalmos
hemifacial anhydrosis
schwannoma of sympathetic tr. – postop
cong. Horner´s syn.
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Exoftalmos and proptosis
thyroid ophtalmopathy
granulocytar sarcoma
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CN VII
cong. CN. VII palsyperif. paresesis of CN VII (CPA lesion)
Somatomotorická
Sensorická
Visceromotorická
Chuťová
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CN VIII
fundus of right int. auditory meatus
right CPA
hypacusis
tinnitus
perif. vestibular syndroma
nystagmus
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CN IX, X, XI
palsy of CN XIpalsy of CN IX
palsy of CN X
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CN XII
schwannoma of left CN XII
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Tongue inervation
bitter
sour
salty
sweet
CN X
CN IX
CN V
CN X
CN IX
CN V/CNVII
sensitivitytaste
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Major salivary glands
sialographyparotid gl.
submand. gl
sialoendoscopy
sialolithiasis
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Parotid gland
superf. parotidectomy
metastasis to parotid LNs
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THANK YOU FOR YOUR ATTENTION
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