1. THE SHEATH OF THE RECTUS muscle. LINEA ALBA. PRELUM ABDOMINALE. THE INGUINAL CANAL AND THE OTHER WEAK PLACES OF THE ABDOMINAL WALL

2. THE MUSCLES OF THE HEAD AND NECK.

3. THE TOPOGRAPHY AND FASCIAE OF THE HEAD AND NECK

 

Lesson є 9

 

Theme 1. THE SHEATH OF THE RECTUS muscle. LINEA ALBA. PRELUM ABDOMINALE. THE INGUINAL CANAL AND THE OTHER WEAK PLACES OF THE ABDOMINAL WALL

 

The Superficial Fascia.ЧThe superficial fascia of the abdomen consists, over the greater part of the abdominal wall, of a single layer containing a variable amount of fat; but near the groin it is easily divisible into two layers, between which are found the superficial vessels and nerves and the superficial inguinal lymph glands.

  The superficial layer (fascia of Camper) is thick, areolar in texture, and contains in its meshes a varying quantity of adipose tissue. Below, it passes over the inguinal ligament, and is continuous with the superficial fascia of the thigh. In the male, CamperТs fascia is continued over the penis and outer surface of the spermatic cord to the scrotum, where it helps to form the dartos. As it passes to the scrotum it changes its characteristics, becoming thin, destitute of adipose tissue, and of a pale reddish color, and in the scrotum it acquires some involuntary muscular fibers. From the scrotum it may be traced backward into continuity with the superficial fascia of the perineum. In the female, CamperТs fascia is continued from the abdomen into the labia majora.

ќписание: ќписание: rectus-abdominis

  The deep layer (fascia of Scarpa) is thinner and more membranous in character than the superficial, and contains a considerable quantity of yellow elastic fibers. It is loosely connected by areolar tissue to the aponeurosis of the Obliquus externus abdominis, but in the middle line it is more intimately adherent to the linea alba and to the symphysis pubis, and is prolonged on to the dorsum of the penis, forming the fundiform ligament; above, it is continuous with the superficial fascia over the rest of the trunk; below and laterally, it blends with the fascia lata of the thigh a little below the inguinal ligament; medially and below, it is continued over the penis and spermatic cord to the scrotum, where it helps to form the dartos. From the scrotum it may be traced backward into continuity with the deep layer of the superficial fascia of the perineum (fascia of Colles). In the female, it is continued into the labia majora and thence to the fascia of Colles.

ќписание: ќписание: rectus-sheath (1)

That portion of the aponeurosis which extends between the anterior superior iliac spine and the pubic tubercle is a thick band, folded inward, and continuous below with the fascia lata; it is called the inguinal ligament. The portion which is reflected from the inguinal ligament at the pubic tubercle is attached to the pectineal line and is called the lacunar ligament. From the point of attachment of the latter to the pectineal line, a few fibers pass upward and medialward, behind the medial crus of the subcutaneous inguinal ring, to the linea alba; they diverge as they ascend, and form a thin triangular fibrous band which is called the reflected inguinal ligament.

  In the aponeurosis of the Obliquus externus, immediately above the crest of the pubis, is a triangular opening, the subcutaneous inguinal ring, formed by a separation of the fibers of the aponeurosis in this situation.

  The following structures require further description, viz., the subcutaneous inguinal ring, the intercrural fibers and fascia, and the inguinal, lacunar, and reflected inguinal ligaments.

The Subcutaneous Inguinal Ring (annulus inguinalis subcutaneus; external abdominal ring) is an interval in the aponeurosis of the Obliquus externus, just above and lateral to the crest of the pubis. The aperture is oblique in direction, somewhat triangular in form, and corresponds with the course of the fibers of the aponeurosis. It usually measures from base to apex about 2.5 cm., and transversely about 1.25 cm. It is bounded below by the crest of the pubis; on either side by the margins of the opening in the aponeurosis, which are called the crura of the ring; and above, by a series of curved intercrural fibers. The inferior crus (external pillar) is the stronger and is formed by that portion of the inguinal ligament which is inserted into the pubic tubercle; it is curved so as to form a kind of groove, upon which, in the male, the spermatic cord rests. The superior crus (internal pillar) is a broad, thin, flat band, attached to the front of the symphysis pubis and interlacing with its fellow of the opposite side.

  The subcutaneous inguinal ring gives passage to the spermatic cord and ilioinguinal nerve in the male, and to the round ligament of the uterus and the ilioinguinal nerve in the female; it is much larger in men than in women, on account of the large size of the spermatic cord.

 

The Intercrural Fibers (fibræ intercrurales; intercolumnar fibers).ЧThe intercrural fibers are a series of curved tendinous fibers, which arch across the lower part of the aponeurosis of the Obliquus externus, describing curves with the convexities downward. They have received their name from stretching across between the two crura of the subcutaneous inguinal ring, and they are much thicker and stronger at the inferior crus, where they are connected to the inguinal ligament, than superiorly, where they are inserted into the linea alba. The intercrural fibers increase the strength of the lower part of the aponeurosis, and prevent the divergence of the crura from one another; they are more strongly developed in the male than in the female.

  As they pass across the subcutaneous inguinal ring, they are connected together by delicate fibrous tissue, forming a fascia, called the intercrural fascia. This intercrural fascia is continued down as a tubular prolongation around the spermatic cord and testis, and encloses them in a sheath; hence it is also called the external spermatic fascia. The subcutaneous inguinal ring is seen as a distinct aperture only after the intercrural fascia has been removed.

ќписание: ќписание: inferiorepigastricartery

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The subcutaneous inguinal ring.

 

The Inguinal Ligament (ligamentum inguinale [Pouparti]; PoupartТs ligament) is the lower border of the aponeurosis of the Obliquus externus, and extends from the anterior superior iliac spine to the pubic tubercle. From this latter point it is reflected backward and lateralward to be attached to the pectineal line for about 1.25 cm., forming the lacunar ligament. Its general direction is convex downward toward the thigh, where it is continuous with the fascia lata. Its lateral half is rounded, and oblique in direction; its medial half gradually widens at its attachment to the pubis, is more horizontal in direction, and lies beneath the spermatic cord.

 

The Lacunar Ligament (ligamentum lacunare [Gimbernati]; GimbernatТs ligament) is that part of the aponeurosis of the Obliquus externus which is reflected backward and lateralward, and is attached to the pectineal line. It is about 1.25 cm. long, larger in the male than in the female, almost horizontal in direction in the erect posture, and of a triangular form with the base directed lateralward. Its base is concave, thin, and sharp, and forms the medial boundary of the femoral ring. Its apex corresponds to the pubic tubercle. Its posterior margin is attached to the pectineal line, and is continuous with the pectineal fascia. Its anterior margin is attached to the inguinal ligament. Its surfaces are directed upward and downward.

The Reflected Inguinal Ligament (ligamentum inguinale reflexum [Collesi]; triangular fascia).ЧThe reflected inguinal ligament is a layer of tendinous fibers of a triangular shape, formed by an expansion from the lacunar ligament and the inferior crus of the subcutaneous inguinal ring. It passes medialward behind the spermatic cord, and expands into a somewhat fan-shaped band, lying behind the superior crus of the subcutaneous inguinal ring, and in front of the inguinal aponeurotic falx, and interlaces with the ligament of the other side of the linea alba.

Ligament of Cooper.ЧThis is a strong fibrous band, which was first described by Sir Astley Cooper. It extends lateralward from the base of the lacunar ligament along the pectineal line, to which it is attached. It is strengthened by the pectineal fascia, and by a lateral expansion from the lower attachment of the linea alba (adminiculum lineæ albæ).

 

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The inguinal and lacunar ligaments.

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The interfoveolar ligament, seen from in front.

 

  The Rectus is enclosed in a sheath formed by the aponeuroses of the Obliqui and Transversus, which are arranged in the following manner. At the lateral margin of the Rectus, the aponeurosis of the Obliquus internus divides into two lamellæ, one of which passes in front of the Rectus, blending with the aponeurosis of the Obliquus externus, the other, behind it, blending with the aponeurosis of the Transversus, and these, joining again at the medial border of the Rectus, are inserted into the linea alba. This arrangement of the aponeurosis exists from the costal margin to midway between the umbilicus and symphysis pubis, where the posterior wall of the sheath ends in a thin curved margin, the linea semicircularis, the concavity of which is directed downward: below this level the aponeuroses of all three muscles pass in front of the Rectus. The Rectus, in the situation where its sheath is deficient below, is separated from the peritoneum by the transversalis fascia. Since the tendons of the Obliquus internus and Transversus only reach as high as the costal margin, it follows that above this level the sheath of the Rectus is deficient behind, the muscle resting directly on the cartilages of the ribs, and being covered merely by the tendon of the Obliquus externus.

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The Linea Alba.ЧThe linea alba is a tendinous raphé in the middle line of the abdomen, stretching between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the Recti, and is formed by the blending of the aponeuroses of the Obliqui and Transversi. It is narrow below, corresponding to the linear interval existing between the Recti; but broader above, where these muscles diverge from one another. At its lower end the linea alba has a double attachmentЧits superficial fibers passing in front of the medial heads of the Recti to the symphysis pubis, while its deeper fibers form a triangular lamella, attached behind the Recti to the posterior lip of the crest of the pubis, and named the adminiculum lineæ albæ. It presents apertures for the passage of vessels and nerves; the umbilicus, which in the fetus exists as an aperture and transmits the umbilical vessels, is closed in the adult.

 

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Diagram of a transverse section through the anterior abdomina wall, below the linea semicircularis.

 

 

The Lineæ Semilunares.ЧThe lineæ semilunares are two curved tendinous lines placed one on either side of the linea alba. Each corresponds with the lateral border of the Rectus, extends from the cartilage of the ninth rib to the pubic tubercle, and is formed by the aponeurosis of the Obliquus internus at its line of division to enclose the Rectus, reinforced in front by that of the Obliquus externus, and behind by that of the Transversus.

 

Actions.ЧWhen the pelvis and thorax are fixed, the abdominal muscles compress the abdominal viscera by constricting the cavity of the abdomen, in which action they are materially assisted by the descent of the diaphragm. By these means assistance is given in expelling the feces from the rectum, the urine from the bladder, the fetus from the uterus, and the contents of the stomach in vomiting.

ќписание: ќписание: rectus-sheath

  If the pelvis and vertebral column be fixed, these muscles compress the lower part of the thorax, materially assisting expiration. If the pelvis alone be fixed, the thorax is bent directly forward, when the muscles of both sides act; when the muscles of only one side contract, the trunk is bent toward that side and rotated toward the opposite side.

  If the thorax be fixed, the muscles, acting together, draw the pelvis upward, as in climbing; or, acting singly, they draw the pelvis upward, and bend the vertebral column to one side or the other. The Recti, acting from below, depress the thorax, and consequently flex the vertebral column; when acting from above, they flex the pelvis upon the vertebral column. The Pyramidales are tensors of the linea alba.

 

The Transversalis Fascia.ЧThe transversalis fascia is a thin aponeurotic membrane which lies between the inner surface of the Transversus and the extraperitoneal fat. It forms part of the general layer of fascia lining the abdominal parietes, and is directly continuous with the iliac and pelvic fasciæ. In the inguinal region, the transversalis fascia is thick and dense in structure and is joined by fibers from the aponeurosis of the Transversus, but it becomes thin as it ascends to the diaphragm, and blends with the fascia covering the under surface of this muscle. Behind, it is lost in the fat which covers the posterior surfaces of the kidneys. Below, it has the following attachments: posteriorly, to the whole length of the iliac crest, between the attachments of the Transversus and Iliacus; between the anterior superior iliac spine and the femoral vessels it is connected to the posterior margin of the inguinal ligament, and is there continuous with the iliac fascia. Medial to the femoral vessels it is thin and attached to the pubis and pectineal line, behind the inguinal aponeurotic falx, with which it is united; it descends in front of the femoral vessels to form the anterior wall of the femoral sheath. Beneath the inguinal ligament it is strengthened by a band of fibrous tissue, which is only loosely connected to the ligament, and is specialized as the deep crural arch. The spermatic cord in the male and the round ligament of the uterus in the female pass through the transversalis fascia at a spot called the abdominal inguinal ring. This opening is not visible externally, since the transversalis fascia is prolonged on these structures as the infundibuliform fascia.

 

The Abdominal Inguinal Ring (annulus inguinalis abdominis; internal or deep abdominal ring).ЧThe abdominal inguinal ring is situated in the transversalis fascia, midway between the anterior superior iliac spine and the symphysis pubis, and about 1.25 cm. above the inguinal ligament. It is of an oval form, the long axis of the oval being vertical; it varies in size in different subjects, and is much larger in the male than in the female. It is bounded, above and laterally, by the arched lower margin of the Transversus; below and medially, by the inferior epigastric vessels. It transmits the spermatic cord in the male and the round ligament of the uterus in the female. From its circumference a thin funnel-shaped membrane, the infundibuliform fascia, is continued around the cord and testis, enclosing them in a distinct covering.

 

The Inguinal Canal (canalis inguinalis; spermatic canal).ЧThe inguinal canal contains the spermatic cord and the ilioinguinal nerve in the male, and the round ligament of the uterus and the ilioinguinal nerve in the female. It is an oblique canal about 4 cm. long, slanting downward and medialward, and placed parallel with and a little above the inguinal ligament; it extends from the abdominal inguinal ring to the subcutaneous inguinal ring. It is bounded, in front, by the integument and superficial fascia, by the aponeurosis of the Obliquus externus throughout its whole length, and by the Obliquus internus in its lateral third; behind, by the reflected inguinal ligament, the inguinal aponeurotic falx, the transversalis fascia, the extraperitoneal connective tissue and the peritoneum; above, by the arched fibers of Obliquus internus and Transversus abdominis; below, by the union of the transversalis fascia with the inguinal ligament, and at its medial end by the lacunar ligament.

Extraperitoneal Connective Tissue.ЧBetween the inner surface of the general layer of the fascia which lines the interior of the abdominal and pelvic cavities, and the peritoneum, there is a considerable amount of connective tissue, termed the extraperitoneal or subperitoneal connective tissue.

  The parietal portion lines the cavity in varying quantities in different situations. It is especially abundant on the posterior wall of the abdomen, and particularly around the kidneys, where it contains much fat. On the anterior wall of the abdomen, except in the public region, and on the lateral wall above the iliac crest, it is scanty, and here the transversalis fascia is more closely connected with the peritoneum. There is a considerable amount of extraperitoneal connective tissue in the pelvis.

  The visceral portion follows the course of the branches of the abdominal aorta between the layers of the mesenterics and other folds of peritoneum which connect the various viscera to the abdominal wall. The two portions are directly continuous with each other.

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The abdominal inguinal ring.

 

The Deep Crural Arch.ЧCurving over the external iliac vessels, at the spot where they become femoral, on the abdominal side of the inguinal ligaments and loosely connected with it, is a thickened band of fibers called the deep crural arch. It is apparently a thickening of the transversalis fascia joined laterally to the center of the lower margin of the inguinal ligament, and arching across the front of the femoral sheath to be inserted by a broad attachment into the pubic tubercle and pectineal line, behind the inguinal aponeurotic falx. In some subjects this structure is not very prominently marked, and not infrequently it is altogether wanting.

 

They differ some regions in abdomen:

In Epigastrium (upper floor) Ц

Right Hypochondriac Epigastric, Left Hypochondriac regions

In Mesogastrium (middle floor) Ц

Right Lateral, Umbilical and Left Lateral regions

In Hypogastrium (lower floor) Ц

Right Inguinal, Pubic and Left Inguinal regions

 
Fossae and folds on back surface of front abdominal wall

Back surface of front abdominal wall is covered by parietal sheet of peritoneum and carries unpaired median umbilical fold (plicae) and paired Ц medial and lateral umbilical folds (plicae). Medial umbilical fossa projected into superficial inguinal ring, which positioned between medial and lateral umbilical folds. Straight inguinal herniae can pass through this fossa. Lateral umbilical fossa placed laterally from lateral umbilical fold. It answers the deep inguinal ring and during pathologic cases can contain oblique inguinal herniae. There is supravesical fossa between median and medial umbilical folds.

 

 

 

ѕодпись: Right Lateralѕодпись: Left   Lateral

 

 

 

 

 

 

 

 

Theme 2. THE MUSCLES OF THE HEAD AND NECK

 

The Fasciæ and Muscles of the Head. a. The Muscles of the Scalp

 

Epicranius

The Skin of the Scalp.ЧThis is thicker than in any other part of the body. It is intimately adherent to the superficial fascia, which attaches it firmly to the underlying aponeurosis and muscle. Movements of the muscle move the skin. The hair follicles are very closely set together, and extend throughout the whole thickness of the skin. It also contains a number of sebaceous glands.

 

The superficial fascia in the cranial region is a firm, dense, fibro-fatty layer, intimately adherent to the integument, and to the Epicranius and its tendinous aponeurosis; it is continuous, behind, with the superficial fascia at the back of the neck; and, laterally, is continued over the temporal fascia. It contains between its layers the superficial vessels and nerves and much granular fat.

  The Epicranius (Occipitofrontalis) is a broad, musculofibrous layer, which covers the whole of one side of the vertex of the skull, from the occipital bone to the eyebrow. It consists of two parts, the Occipitalis and the Frontalis, connected by an intervening tendinous aponeurosis, the galea aponeurotica.

  The Occipitalis, thin and quadrilateral in form, arises by tendinous fibers from the lateral two-thirds of the superior nuchal line of the occipital bone, and from the mastoid part of the temporal. It ends in the galea aponeurotica.

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Muscles of the head, face, and neck.

 

  The Frontalis is thin, of a quadrilateral form, and intimately adherent to the superficial fascia. It is broader than the Occipitalis and its fibers are longer and paler in color. It has no bony attachments. Its medial fibers are continuous with those of the Procerus; its immediate fibers blend with the Corrugator and Orbicularis oculi; and its lateral fibers are also blended with the latter muscle over the zygomatic process of the frontal bone. From these attachments the fibers are directed upward, and join the galea aponeurotica below the coronal suture. The medial margins of the Frontales are joined together for some distance above the root of the nose; but between the Occipitales there is a considerable, though variable, interval, occupied by the galea aponeurotica.

  The galea aponeurotica (epicranial aponeurosis) covers the upper part of the cranium; behind, it is attached, in the interval between its union with the Occipitales, to the external occipital protuberance and highest nuchal lines of the occipital bone; in front, it forms a short and narrow prolongation between its union with the Frontales. On either side it gives origin to the Auriculares anterior and superior; in this situation it loses its aponeurotic character, and is continued over the temporal fascia to the zygomatic arch as a layer of laminated areolar tissue. It is closely connected to the integument by the firm, dense, fibro-fatty layer which forms the superficial fascia of the scalp: it is attached to the pericranium by loose cellular tissue, which allows the aponeurosis, carrying with it the integument to move through a considerable distance.

 

Variations.ЧBoth Frontalis and Occipitalis vary considerably in size and in extent of attachment; either may be absent; fusion of Frontalis to skin has been noted.

 

Nerves.ЧThe Frontalis is supplied by the temporal branches of the facial nerve, and the Occipitalis by the posterior auricular branch of the same nerve.

 Actions.ЧThe Frontales raise the eyebrows and the skin over the root of the nose, and at the same time draw the scalp forward, throwing the integument of the forehead into transverse wrinkles. The Occipitales draw the scalp backward. By bringing alternately into action the Frontales and Occipitales the entire scalp may be moved forward and backward. In the ordinary action of the muscles, the eyebrows are elevated, and at the same time the aponeurosis is fixed by the Occipitales, thus giving to the face the expression of surprise; if the action be exaggerated, the eyebrows are still further raised, and the skin of the forehead thrown into transverse wrinkles, as in the expression of fright or horror.

  A thin muscular slip, the Transversus nuchæ, is present in a considerable proportion (25 per cent.) of cases; it arises from the external occipital protuberance or from the superior nuchal line, either superficial or deep to the Trapezius; it is frequently inserted with the Auricularis posterior, but may join the posterior edge of the Sternocleidomastoideus.

 

Muscles of the Head subdivided into

Mastication and Facial Expression (mimetic) groups

 

Muscles of Mastication

Masseter

Х Origin:

Х Superficial: 1.zygomatic process of the maxilla 2.inferior border of zygomatic arch

Х Intermediate: inner surface of zygomatic arch Х Deep: posterior aspect of inferior border of zygomatic arch

Х Insertion:

Х Superficial: 1.angle of mandible 2.lateral surface of mandibular ramus

Х Intermediate: ramus of mandible Х Deep: 1.superior ramus of mandible 2.coronoid process of mandible

Х Action: 1.closes the lower jaw (clenches the teeth) 2.may deviate mandible to opposite side of contraction

Х Blood: masseteric arteryХ Nerve: masseteric nerve

ќписание: ќписание: muscles-involved-in-mastication

Medial pterygoid

Х Origin:

1.medial surface of lateral pterygoid plate of the sphenoid 2.palatine bone 3.pterygoid fossa

Х Insertion:

1.inner surface of mandibular ramus 2.angle of the mandible

Х Action:

1.closes the lower jaw (clenches the teeth) 2.can protrude the mandible in combination with the lateral pterygoid

Х Blood: medial pterygoid artery Х Nerve: medial pterygoid nerve

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Lateral pterygoid

Х Origin:

1.Superior head: lateral surface of the greater wing of the sphenoid 2.Inferior head: lateral surface of the lateral pterygoid plate

Х Insert together:

1.neck of the mandibular condyle 2.articular disk of the TMJ

Х Action:

1.deviates mandible to side opposite of contraction (during chewing) 2.opens mouth by protruding mandible (inferior head) 3.closes the mandible (superior head)

Х Blood: lateral pterygoid artery Х Nerve: lateral pterygoid nerve

ќписание: ќписание: Muscles_of_mastication_2

Temporalis

Х Origin:

Х Temporal fossa

Х Insertion: coronoid process of the mandible

Х Action:

1.closes the lower jaw (clenches the teeth) 2.retraction, pulles back

ќписание: ќписание: image382

Muscles of Facial Expression (mimetic muscles) have such peculiarities:

1.                Originate in bones of face and insert into skin

2.                Do not throw over joints

3.                Do not have proper fasciae (exception is buccinator muscle)

4.                Placed round natural orifices of the face (eyes, nostrils, ears and mouth)

5.                They have an antagonists Ц elastic skin

 

Muscles of Facial Expression (mimetic)

 

Orbicularis oculi

Х Origin:

1.orbital portion: nasal process of frontal bone 2.palpebral portion: palpebral ligament 3.lacrimal portion: lacrimal crest of lacrimal bone

Х Insertion: circumferentially around orbit meeting in palpebral raphe

Х Action: powerfully closes the eye Х Blood: ophthalmic artery Х Nerve: zygomatic branch of facial nerve

Corrugator supercilii

Х Origin: frontal bone just above the nose Х Insertion: skin of the medial portion of the eyebrows Х Action: draws the eyebrows downward and medially Х Blood: ophthalmic artery Х Nerve: zygomatic branch of facial nerve

Orbicularis oris

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Scheme showing arrangement of fibers of Orbicularis oris.

ќписание: ќписание: Muscles_tete3_full_en

Х Origin:

1.alveolar border of maxilla 2.lateral to midline of mandible

Х Insertion:

1.circumferentially around mouth 2.blends with other muscles

Х Action:

1.closes the lips 2.protrudes the lips

Х Blood: facial artery Х Nerve: buccal branch of facial nerve

 

Levator labii superioris

Х Action: 1.elevates the upper lip 2.flares the nostrils

 

Zygomaticus minor

Х Action: elevates the upper lip

 

Zygomaticus major

Х Action: lifts and draws back the angle(s) of the mouth (as in smiling)

 

Risorius (may be absent)

Х Action: draws the mouth laterally (as in smiling)

 

Levator anguli oris

Х Action: lifts the angle(s) of the mouth (as in smiling)

 

Buccinator

Х Action: compresses the cheek(s)

 

Depressor anguli oris

Х Action: lowers the angle(s) of the mouth (as in frowning)

 

Depressor labii inferioris

Х Action: draws the lower lip downward and laterally

 

Epicranial Musculature

 

Occipitalis (2 bellies)

Х Origin:

1.lateral 2/3 of superior nuchal line 2.external occipital protuberance

Х Insertion: galea aponeurosis, over the occipital bone Х Action: draws back the scalp to raise the eyebrows and wrinkle the brow Х Blood: occipital artery Х Nerve: posterior auricular branch of facial nerve

 

Frontalis (2 bellies)

Х Origin: galea aponeurosis, anterior to the vertex Х Insertion: skin above the nose and eyes Х Action: draws back the scalp to raise the eyebrows and wrinkle the brow Х Blood: ophthalmic artery Х Nerve: temporal branch of facial nerve

 

Anterior, posterior and superior auricularis muscles

Х Action: draws the auricle

 

There are parotid fascia, masseteric fascia and boccopharyngeal fascia in head region.

Regions of head: frontal, parietal, occipital, temporal, auditory, mastoid and facial regions. Facial area has orbital, infraorbital, parotidomasseteric, zygomatic, nasal, oral and mental regions.

ќписание: ќписание: Muscles_of_mastication_4

 

 

ќписание: ќписание: Muscles_of_mastication_2

 

Neck Musculature

Subdivides into superficial and deep groups

 

Superficial Neck Musculature

Platysma

Х Origin: subcutaneous skin over delto-pectoral region Х Insertion: invests in the skin widely over the mandible Х Action: 1.depress mandible and lower lip 2.tenses the skin over the lower neck

Х Blood: superficial vessels of the neck Х Nerve: cervical branch of facial nerve (VII cranial)

 

Sternocleidomastoid

Х Origin: (two heads)

1.manubrium of sternum 2.medial portion of clavicle

Х Insertion: mastoid process of temporal bone Х Action:

1.rotates to side opposite of contraction 2.laterally flexes to the contracted side 3.bilaterally flexes the neck

Х Blood:

1.occipital artery 2.superior thyroid artery

Х Nerve:

1.motor: spinal accessory (XI cranial) 2.sensory: ventral rami of C2,(C3)

1. Stylohyoid

Х Origin: styloid process of temporal bone Х Insertion: lateral margin of hyoid (near greater horn) Х Action:

1.pulls the hyoid superiorly & posteriorly during swallowing 2.fixes the hyoid bone for infrahyoid action

Х Blood: facial & occipital artery Х Nerve: facial nerve (VII cranial)

2. Digastric

Х Attachments:

1.post belly: mastoid process of temporal bone 2.anterior belly: digastric fossa of internal mandible

Х both bellies meet and attach at the lateral aspect of body of hyoid by a pulley tendon Х Action:

 

ќписание: ќписание: image385

 

 

Suprahyoid group

 

1.open mouth by depressing mandible 2.fixes hyoid bone for infrahyoid action

Х Blood: branches of the external carotid Х Nerve:

1.posterior belly: facial nerve (VII cranial) 2.anterior belly: mylohyoid nerve

ќписание: ќписание: image386

3. Mylohyoid

Х Origin: inner surface of mandible off the mylohyoid line Х Insertion:

1.body of hyoid 2.along midline at mylohyoid raphe

Х Action:

1.elevates the hyoid bone 2.raises floor of mouth (for swallowing) 3.depresses mandible when hyoid is fixed

Х Blood: lingual artery Х Nerve: mylohyoid nerve (branch of mandibular division, V3 cranial)

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4. Geniohyoid

Х Origin: inner surface of the mandible

Х Insertion: body of hyoid (paired muscles)

Х Action:

1.pulles the tongue 2.depress the mandible 3.works with mylohyoid

Х Blood: lingual artery Х Nerve:

 

Infrahyoid group

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1. Sternohyoid

Х Origin:

1.posterior aspect of manubrium 2.sternal end of clavicle

Х Insertion: body of hyoid Х Action:

1.depresses hyoid & larynx 2.acts eccentrically with the suprahyoid muscles to provide them a stable base

Х Blood:

1.inferior thyroid artery (primary) 2.superior thyroid artery

Х Nerve:

1.upper portions: superior root of ansa cervicalis, C2 2.lower portions: inferior root of ansa cervicalis, C2,3

 

2. Omohyoid

Х Attachments:

1.superior belly: hyoid bone (lateral to sternohyoid) 2.inferior belly: superior scapular border (medial to suprascapular notch)

Х both bellies meet at the clavicle & are held to the clavicle by a pulley tendon Х Action:

1.depresses hyoid & larynx 2.acts eccentrically with the suprahyoid muscles to provide them a stable base

Х Blood:

1.inferior thyroid artery (primary) 2.superior thyroid artery

Х Nerve:

1.upper portions: superior root of ansa cervicalis, C2 2.lower portions: inferior root of ansa cervicalis, C2,3

 

3. Sternothyroid

Х Origin: posterior aspect of manubrium Х Insertion: oblique line of thyroid cartilage Х Action:

1.depresses hyoid & larynx 2.acts eccentrically with the suprahyoid muscles to provide them a stable base

Х Blood:

1.inferior thyroid artery (primary) 2.superior thyroid artery

Х Nerve:

1.upper portions: superior root of ansa cervicalis, C2 2.lower portions: inferior root of ansa cervicalis, C2,3

 

4. Thyrohyoid

Х Origin: oblique line of thyroid cartilage Х Insertion: body of hyoid Х Action:

1.depresses hyoid 2.may assist in larynx elevation

Х Blood:

1.inferior thyroid artery (primary) 2.superior thyroid artery

Х Nerve:

1.upper portions: superior root of ansa cervicalis, C2 2.lower portions: inferior root of ansa cervicalis, C2,3

 

 

Deep Neck Muscles have lateral, medial groups

 

Deep Lateral Neck Musculature

Anterior scalene

Х Attachment A: anterior tubercles of transverse processes of C3-C6 Х Attachment B: 1st rib Х Action:

if transverse process fixed: 1.elevates the ribs for respiration

if ribs fixed: 2.rotates to side opposite of contraction 3.laterally flexes to the contracted side 4.bilaterally flexes the neck

Х Blood: inferior thyroid artery (branch of the thyrocervical trunk) Х Nerve: ventral rami C3-C6

 

Middle scalene

Х Attachment A: transverse processes of all cervical vertebrae Х Attachment B: 1st rib (behind anterior scalene) Х Action:

if transverse process fixed: 1.elevates the ribs for respiration

if ribs fixed: 2.rotates to side opposite of contraction 3.laterally flexes to the contracted side 4.bilaterally flexes the neck

Х Blood: ascending cervical artery Х Nerve: ventral rami C3-C8

Posterior scalene

Х Attachment A: posterior tubercles of transverse processes of C5 & C6 Х Attachment B: 2nd and/or 3rd rib Х Action:

if transverse process fixed: 1.elevates the ribs for respiration

if ribs fixed: 2.rotates to side opposite of contraction 3.laterally flexes to the contracted side 4.bilaterally flexes the neck

Х Blood: ascending cervical artery Х Nerve: ventral rami C5-C7

Longus colli

ХOrigin: lower anterior vertebral bodies and transverse processes Х Insertion: anterior vertebral bodies and transverse processes several segments above Х Action: flexes the head and neck Х Blood: muscular branches of the aorta Х Nerve: ventral rami C2-C6

Longus capitis

Х Origin: upper anterior vertebral bodies and transverse processes Х Insertion: anterior vertebral bodies and transverse processes several segments above Х Action: flexes the head and neck Х Blood: muscular branches of the aorta Х Nerve: ventral rami C1-C3

 

Rectus capitis anterior

Х Origin: anterior base of the transverse process of the atlas Х Insertion: occipital bone anterior to foramen magnum Х Action: flexes the head Х Blood: muscular branches of the aorta Х Nerve: ventral rami C2,3

Rectus capitis lateralis

Х Origin: transverse process of the atlas Х Insertion: jugular process of the occipital bone Х Action: bends the head laterally Х Blood: muscular branches of the aorta Х Nerve: ventral rami C2,3

ќписание: ќписание: image387

 

Neck prevertebral deep Musculature

 

Theme 3. THE TOPOGRAPHY AND FASCIAE OF THE HEAD AND NECK

Topography of the neck

Neck has follow regions:

Anterior region is bordered overhead by lower margin of mandible, from below by sternum, from one side Ц by the sternocleidomastoid muscle. Median line of the neck divides anterior region into right and left anterior triangles. There are some areas in each triangle:

1.                Submandibular trigone bordered by lower margin of mandible and both bellies of digastric muscle

2.                There is lingual trigone of Pyrohov in Submandibular triangle that bordered by back margin of mylohyoid muscle, tendon of posterior belly of digastric muscle and hypoglossal nerve. There is lingual artery in this triangle.

3.                Carotid trigone bordered by posterior belly of digastric muscle, superior belly of omohyoid, anterior margin of the sternocleidomastoid and linea alba of the neck.

4.                Muscular (omotracheal) trigone bordered by superior belly of omohyoid, anterior margin of the sternocleidomastoid and linea alba of the neck.

5.                Mental trigone bordered by anterior bellies of both digastric muscles, hyoid bone and mandible.

 

The Fascia Colli (deep cervical fascia) lies under cover of the Platysma, and invests the neck; it also forms sheaths for the carotid vessels, and for the structures situated in front of the vertebral column.

  The investing portion of the fascia is attached behind to the ligamentum nuchæ and to the spinous process of the seventh cervical vertebra. It forms a thin investment to the Trapezius, and at the anterior border of this muscle is continued forward as a rather loose areolar layer, covering the posterior triangle of the neck, to the posterior border of the Sternocleidomastoideus, where it begins to assume the appearance of a fascial membrane. Along the hinder edge of the Sternocleidomastoideus it divides to enclose the muscle, and at the anterior margin again forms a single lamella, which covers the anterior triangle of the neck, and reaches forward to the middle line, where it is continuous with the corresponding part from the opposite side of the neck. In the middle line of the neck it is attached to the symphysis menti and the body of the hyoid bone.

  Above, the fascia is attached to the superior nuchal line of the occipital, to the mastoid process of the temporal, and to the whole length of the inferior border of the body of the mandible. Opposite the angle of the mandible the fascia is very strong, and binds the anterior edge of the Sternocleidomastoideus firmly to that bone. Between the mandible and the mastoid process it ensheathes the parotid glandЧthe layer which covers the gland extends upward under the name of the parotideomasseteric fascia and is fixed to the zygomatic arch. From the part which passes under the parotid gland a strong band extends upward to the styloid process, forming the stylomandibular ligament. Two other bands may be defined: the sphenomandibular (page 297) and the pterygospinous ligaments. The pterygospinous ligament stretches from the upper part of the posterior border of the lateral pterygoid plate to the spinous process of the sphenoid. It occasionally ossifies, and in such cases, between its upper border and the base of the skull, a foramen is formed which transmits the branches of the mandibular nerve to the muscles of mastication.

  Below, the fascia is attached to the acromion, the clavicle, and the manubrium sterni. Some little distance above the last it splits into two layers, superficial and deep. The former is attached to the anterior border of the manubrium, the latter to its posterior border and to the interclavicular ligament. Between these two layers is a slit-like interval, the suprasternal space (space of Burns); it contains a small quantity of areolar tissue, the lower portions of the anterior jugular veins and their transverse connecting branch, the sternal heads of the Sternocleidomastoidei, and sometimes a lymph gland.

  The fascia which lines the deep surface of the Sternocleidomastoideus gives off the following processes: (1) A process envelops the tendon at the Omohyoideus, and binds it down to the sternum and first costal cartilage. (2) A strong sheath, the carotid sheath, encloses the carotid artery, internal jugular vein, and vagus nerve. (3) The prevertebral fascia extends medialward behind the carotid vessels, where it assists in forming their sheath, and passes in front of the prevertebral muscles. It forms the posterior limit of a fibrous compartment, which contains the larynx and trachea, the thyroid gland, and the pharynx and esophagus. The prevertebral fascia is fixed above to the base of the skull, and below is continued into the thorax in front of the Longus colli muscles. Parallel to the carotid sheath and along its medial aspect the prevertebral fascia gives off a thin lamina, the buccopharyngeal fascia, which closely invests the Constrictor muscles of the pharynx, and is continued forward from the Constrictor pharyngis superior on to the Buccinator. It is attached to the prevertebral layer by loose connective tissue only, and thus an easily distended space, the retropharyngeal space, is found between them. This space is limited above by the base of the skull, while below it extends behind the esophagus into the posterior mediastinal cavity of the thorax. The prevertebral fascia is prolonged downward and lateralward 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; it is continued under the clavicle as the axillary sheath and is attached to the deep surface of the coracoclavicular fascia. Immediately above and behind the clavicle an areolar space exists between the investing layer and the sheath of the subclavian vessels, and in this space are found the lower part of the external jugular vein, the descending clavicular nerves, the transverse scapular and transverse cervical vessels, and the inferior belly of the Omohyoideus muscle. This space is limited below by the fusion of the coracoclavicular fascia with the anterior wall of the axillary sheath. (4) The pretrachial fascia extends medially in front of the carotid vessels, and assists in forming the carotid sheath. It is continued behind the depressor muscles of the hyoid bone, and, after enveloping the thyroid gland, is prolonged in front of the trachea to meet the corresponding layer of the opposite side.

ќписание: ќписание: image384
Section of the neck at about the level of the sixth cervical vertebra.

Showing the arrangement of the fascia coli.

 

Above, it is fixed to the hyoid bone, while below it is carried downward in front of the trachea and large vessels at the root of the neck, and ultimately blends with the fibrous pericardium. This layer is fused on either side with the prevertebral fascia, and with it completes the compartment containing the larynx and trachea, the thyroid gland, and the pharynx and esophagus.  

   

Variations.ЧThe Sternocleidomastoideus varies much in the extent of its origin from the clavicle: in some cases the clavicular head may be as narrow as the sternal; in others it may be as much as 7.5 cm. in breadth. When the clavicular origin is broad, it is occasionally subdivided into several slips, separated by narrow intervals. More rarely, the adjoining margins of the Sternocleidomastoideus and Trapezius have been found in contact. The Supraclavicularis muscle arises from the manubrium behind the Sternocleidomastoideus and passes behind the Sternocleidomastoideus to the upper surface of the clavicle.

 

Triangles of the Neck.ЧThis muscle divides the quadrilateral area of the side of the neck into two triangles, an anterior and a posterior. The boundaries of the anterior triangle are, in front, the median line of the neck; above, the lower border of the body of the mandible, and an imaginary line drawn from the angle of the mandible to the Sternocleidomastoideus; behind, the anterior border of the Sternocleidomastoideus. The apex of the triangle is at the upper border of the sternum. The boundaries of the posterior triangle are, in front, the posterior border of the Sternocleidomastoideus; below, the middle third of the clavicle; behind, the anterior margin of the Trapezius. The apex corresponds with the meeting of the Sternocleidomastoideus and Trapezius on the occipital bone. The anatomy of these triangles will be more fully described with that of the vessels of the neck (p. 562).

 

Nerves.ЧThe Sternocleidomastoideus is supplied by the accessory nerve and branches from the anterior divisions of the second and third cervical nerves.

 

Actions.ЧWhen only one Sternocleidomastoideus acts, it draws the head toward the shoulder of the same side, assisted by the Splenius and the Obliquus capitis inferior of the opposite side. At the same time it rotates the head so as to carry the face toward the opposite side. Acting together from their sternoclavicular attachments the muscles will flex the cervical part of the vertebral column. If the head be fixed, the two muscles assist in elevating the thorax in forced inspiration.

 

Sternocleidomastoid region answers the projection of the same name muscle.

Lateral region of the neck is bordered by back margin of the sternocleido-mastoid, anterior margin of the trapezius muscle and upper margin of clavicle. There are follow areas in this region:

1.                Omo-trapezial trigone is bordered by back margin of the sternocleidomastoid, lower belly of omohyoid and anterior margin of the trapezius muscles.

2.                Omo-clavicular (greater supraclavicular) trigone of neck is bordered by back margin of the sternocleidomastoid, lower belly of omohyoid and upper margin of the clavicle.

Posterior region answers the projection of the trapezius muscle.

Cervical fascia

According V.M.Shevkunenko there are 5 cervical fasciae:

I - superficial cervical fascia envelops the platizma

Proper cervical fascia has two sheets:

II - superficial lamina of the proper cervical fasciae starts from front surface of the sternum and clavicle, lower margin of mandible and attaches the spinous processes of the cervical vertebrae. It forms the sheath for sternocleidomastoid and trapezius muscles.

III - deep lamina of the proper cervical fasciae starts from back surface of the sternum and clavicle and attaches to the hyoid bone from sides bordered by omohyoid muscles. This fascia forms linea alba of neck and the sheath for infrahyoid muscles.

Suprasternal interaponeurotic space made up between superficial and deep lamina of the proper cervical fasciae. It contains jugular venous arch and fat tissue. Suprasternal space connects with lateral recesses located behind the lower part of sternocleidomastoid muscle.

s.

 

According international nomenclature (PNA)

there are 3 laminae of cervical fasciae:

IV - internal cervical fascia subdivides into parietal and visceral sheets. Parietal lamina envelopes all organs of neck together and visceral Ц each organ separately. Previsceral space positioned between parietal and visceral laminae and contains adipose tissue, lymphatic nodes, and nerves and communicates with anterior mediastinum. Pretracheal space located before trachea between parietal and visceral sheet

V - prevertebral fascia envelops all deep cervical muscles forming their sheathes. Retropharyngeal space made up between V fascia and parietal lamina of IV fasciae. Retrovisceral space positioned between internal cervical and prevertebral fasciae and contains adipose tissue and continues into posterior mediastinum.

 

1.                Superficial lamina meets the superficial lamina of the proper cervical fasciae according V.M.Shevkunenko and contains the suprasternal space.

2.                Pretracheal lamina meets the deep lamina of the proper cervical fasciae according V.M.Shevkunenko and forms carotid sheath.

3.                Prevertebral lamina meets the same fasciae according V.M.Shevkunenko.

 

Interscalenum space positioned between anterior and middle scalene muscles where subclavian artery passes. Anterscalenum space located in front of scalene muscles where subclavian vein passes.

Deep lamina of the proper cervical fasciae (V.M.Shevkunenko) associating infrahyoid muscles forms omoclavicular aponeurosis or cervical sail (Rishe). Cervical sail assists to drain superficial veins of neck that spliced with it.

 

Prepared by

Reminetskyy B.Y.