Maxillary artery

*Beginning: Inside parotid, as larger of the 2 terminal branches of external carotid artery.
*Parts: 1st: Passes horizontally deep to mandible neck from its origin till lower border of lat. pterygoid 2nd: Passes superficial to lower head of lat. pterygoid.
3rd: Passes between 2 heads of lat. pterygoid, then through pterygomaxillary fissure reaching pterygopalatine fossa.
*Branches of 1st part:
Middle meningeal artery See below
Accessory meningeal artery Enters skull via foramen ovale, supplying dura mater.
Inferior alveolar artery Passes through mandibular foramen & canal, ending at mental foramen by dividing into incisive & mental branches. Supplies
lower teeth, lower lip & gives mylohyoid a.
Ant. tympanic artery Supplies tympanic cavity.
Deep auricular artery Supplies external auditory meatus.
nd
*Branches of 2 part: -Muscular arteries: For muscles of mastication -Buccal artery: To face.
rd
*Branches of 3 part:
Post. sup. alveolar artery Supplies upper molars & premolars.
Infraorbital artery Passes through inf. orbital fissure, infraorbital groove, infraorbital canal & infra-orbital foramen, it divides into palpebral,
nasal & labial branches. It gives ant. sup. alveolar artery supplying upper incisors & canine teeth.
Pharyngeal artery Supplies nasopharynx.
Artery of pterygoid canal Supplies nasopharynx.
Greater palatine artery Passes through greater palatine foramen to supply hard palate. Gives lesser palatine aa. supplying soft palate & palatine tonsil.
Sphenopalatine artery Passes through sphenopalatine foramen to supply nasal cavity.
Middle meningeal artery
*Beginning: Branch from 1 part maxillary artery.
st

*Course & end: Enters middle cranial fossa through foramen spinosum, then divides into ant. (reaching pterion) & post. terminal branches.
*Branches: 1- meningeal : to Dura mater 2-Skull bones & periostium 3-Trigeminal ganglion.
4-Tympanic: To tympanic cavity 5-Orbital: To orbit.
N.B.: It's injury leads to extradural hemorrhage.
Pterygoid venous plexus
*Site: Superficial & deep to lat. pterygoid. *Beginning: It receives tributaries corresponding to branches of maxillary a.
*End: Post. by forming maxillary v., which enters parotid & joins superficial temporal v. forming retromandibular v.
*Communications: With ant. facial v. via deep facial v., with cavernous sinus via emissary veins (foramen ovale & lacerum) & with inf. ophthalmic v.
via vein (inf. orbital fissure).
 Cavernous sinus
*Site & relations: On each side of body of sphenoid.
Above: I.C.A. Ant.: Apex of orbit & sup. orbital fissure.
Post.: Apex of petrous bone & trigeminal ganglion.
Med.: Body sphenoid, sphenoid sinus, pitutary gland Lat.: Temporal lobe uncus.

*Contents: Inside sinus: I.C.A & abducent n.

Embedded in lat. wall: Oculomotor, trochlear, ophthalmic & maxillary nn.

*Communications (tributaries):
Anteriorly Posteriorly Above Below Medially Others
Ophthalmic vv.: Sup. petrosal Superficial Emissary v. via foramen 2 inter- Pitutary
Connect it with sinus: Connects it middle ovale: Connects it with cavernous gland
ant. facial v. with transverse sinus. pterygoid plexus.
cerebral v. sinuses: veins.
Emissary vv. via foramen
Connect both
Inf. petrosal lacerum: Connect it with cavernous
Spheno- Central
sinus: Connects pterygoid & pharyngeal sinuses.
parietal sinus. it with I.J.V. plexuses. retinal v.
Emissary v. via carotid canal:
Connects it with pharyngeal
plexus or with I.J.V.
*Applied anatomy: Cavernous sinus thrombosis: Caused by transmission of infection from
dangerous area of face to cavernous sinus. It is characterized by fever & internal squint, eye
becomes congested & oedematous, later it bulges to outside -proptosis-.

Oral (mouth) cavity

Parts: Vestibule: Between teeth & gum (internally), cheeks & lips (externally).
Parotid duct opens in it opposite upper 2nd molar tooth.

Mouth cavity proper: Boundaries: Infront & sides; Teeth & gums.
Behind; Communicates with pharynx Above (roof); Hard & soft palate.
Below (floor); See table.

Ant. 2\3 of tongue with it’s Lower surface showing;

Frenulum linguae; Mucous fold with deep lingual v. & fimbriated ridge lat. to it.
Sublingual papilla: Elevation on side of frenulum, receiving submandibular duct orifice.
Sublingual fold: Elevation by sublingual gland, lat. to sublingual papilla, receiving sublingual ducts orifices.
Mylohyoid muscle , with its relations;
Below (superficial relations): Skin, fascia & platysma Superficial part submandibular gland.
Submandibular lymph nodes Ant. belly of digastric Submental vessels & lymph nodes.
 Above (deep relations): Muscles; Styloglossus, hyoglossus, genioglossus & geniohyoid.
Glands; Deep part of submandibular gland with its duct & sublingual gland.
Nerves; Lingual n. with submandibular ganglion & hypoglossal n.
Blood vessels; Lingual blood vessels .
N. supply of gum (gingiva):
Upper gingiva:
Outer surface; Ant., middle & post. sup. alveolar nerves (from maxillary &
infraorbital nerves).
Inner surface; Greater palatine & nasopalatine nerves ( from sphenopalatine ganglion).

Lower gingiva: Outer surface; Buccal & mental nerves (from mandibular & inf.
alveolar nerves).
Inner surface; Lingual n. (from mandibular n.).
Tongue
*Def.: Muscular mass enveloped by mucosa, with tip, root, margins & 2 surfaces.
*Surfaces:
Lower (ventral) surface Upper (dorsal) surface
It is smooth & related to mouth floor, shows: It is rough (lingual papillae) , divided by V-shaped groove
Frenulum linguae: Mucous fold (sulcus terminalis) into 2 parts;
ending by sublingual papillae. Anterior 2\3 (oral part) Posterior 1\3 (pharyngeal part)
-Lies in mouth cavity. -Lies in oropharynx.
-Directed upwards. -Directed backwards.
Deep lingual v.: On frenulum side. -Contains lingual papillae. -Contains lingual tonsil.
Fimbriated ridge: Lat. to deep lingual v. -2 sensory nerves; lingual &
chorda tympani. -One sensory n. ; glossopharyngeal
*Muscles:
Extrinsic muscles Intrinsic muscles
Styloglossus: From tip of styloid process, it retracts tongue. Sup. & inf. longitudinal.
Genioglossus: From upper genial tubercle, it protrudes tongue. Transverse & Vertical.
Palatoglossus: From palatine aponeurosis, it elevates tongue. They change shape of tongue.
Hyoglossus: From hyoid bone, it depresses tongue.
*N. supply:
Motor Sensory
All muscles are supplied by Anterior 2\3 Posterior 1\3 Root
hypoglossal n., except palato- Lingual n.; Glossopharyngeal n.; Internal laryngeal n.;
glossus by pharyngeal plexus For general sensation. For general & taste sensations. For general
(cranial root of accessory through Chorda tympani; sensation.
pharyngeal branch of vagus). For taste sensation.
*Blood supply:
Arterial supply Venous drainage
Deep artery of tongue (profunda linguae): Venae comitants of lingual a.: Form lingual v. which end in I.J.V.
Continuation of lingual a., Supplies
ant. part & tip.
2 dorsal lingual arteries: From 2nd Deep lingual v.: Extends back-wards on lower surface, to be joined by sub-
part lingual a., supplies post. part. lingual v. forming vena comitants of hypoglossal n., ending in lingual v.
*Lymph drainage: Ant. 2/3: Tip & frenulum; Submental lymph nodes.
Margins: Submandibular , jugulodigastric & jugulo-omohyoid nodes, on same side.
Central part: Submandibular , jugulodigastric & jugulo-omohyoid nodes, on both sides.
Post. 1/3: Jugulodigastric & jugulo-omohyoid nodes, on same side in case of
margins and on both sides in case of central part.

Soft palate
*Site.: Attached to hard palate post. border, hanging between nasopharynx & oropharynx.
*Muscles:
Muscle N. supply Action
Tensor palati All supplied by pharyngeal plexus Makes soft palate tense.
(cranial root of accessory via pharyngeal
Levator palati branch of vagus), except tensor palati by Elevates soft palate.
Palatoglossus mandibular n. (n. to med. pterygoid). Elevates tongue & closes oropharyngeal
isthmus.
Palatopharyngeus Elevates & shortens pharynx.
Musculus uvulae *Shortens uvula & prevents eversion.
*Elevates & retracts uvula.
*N. supply: -Motor; see above. -Sensory; lesser palatine & glossopharyngeal nn.

*Arterial supply: -Soft palate; *Lesser palatine (greater palatine a.)

*Ascending palatine (facial a.) *Ascending pharyngeal (E.C.A).

Pharynx
*Def.: Funnel tube, 5 inches, from skull base to C6 vertebra, becoming oeosphagus.

*Relations: -Post.wall; *Upper 6 cervical vertebrae

*Prevertebral muscles & fascia. *Retropharyngeal space.
-Ant. Wall; behind nasal, oral & laryngeal cavities.

*Muscles: A)Constrictors;
Muscle Origin Insertion N. supply Action
Sup. *Pterygoid hamulus. Median fibrous raphe Pharyngeal plexus Constriction
constrictor pharynx.
*Post. end mylohyoid line. (cranial root accessory
*Pterygomandibular raphe. through pharyngeal
Middle *Stylohyoid ligament. branch vagus).
constrictor
*Lesser & greater horns hyoid. N.B.: Inf. constrictor
Inf. receives additional
*Thyropharyngeus part Oblique
constrictor
line & inf. horn thyroid cartilage. supply, from recurrent
& external laryngeal nn.
*Cricopharyngeus part Cricoid side.
Gaps in lat. -1st gap (above sup. constrictor); *Tensor palati *Levator palati.
*Auditory tube *Ascending palatine a.
wall nd
-2 gap (between sup. & middle constrictors); *Stylopharyngeus muscle
*Glossopharyngeal n.
rd
-3 gap (between middle & inf. constrictors); *Sup. laryngeal a. *Internal laryngeal n.
-4th gap (below inf. constrictor); *Inf. laryngeal a. *Recurrent laryngeal n.

B)Non constrictors;
Muscle Origin Insertion N. supply Action
Stylopharyngeus Styloid base. pharynx wall All by pharyngeal Elevates
Palatopharyngeus Upper surface & post. border plexus (cranial root & shortens
thyroid cartilage pharynx, during
palatine aponeurosis. of accessory via
Salpingopharyngeus Tubal elevation. pharyngeal branch swallowing.
of vagus), except
stylopharyngeus
(glossopharyngeal n.)

*Cavity of pharynx (3 parts)

1-Nasopharynx 2-Oropharynx
Site: Behind nasal cavity. Site: Behind oral cavity.
Function: Respiratory. Function: Respiratory & digestive.
Extension: From base of skull to soft palate. Extension: From soft palate to epiglottis upper border.
Communications: Communications:
Ant.: With nasal cavity, via post. nasal opening. Ant.: With oral cavity, via oropharyngeal isthmus.
Inf.: With oropharynx, via pharyngeal isthmus. Sup.: With nasopharynx, via pharyngeal isthmus.
Lat.: With middle ear, via auditory tube. Inf.: With laryngopharynx.
Boundaries: Boundaries:
Roof: Sphenoid & occipital bones.
Floor: Soft palate.
Ant. wall: Nasal cavity.
Post. wall: Ant. arch of atlas. Ant. wall: Dorsum of pharyngeal part tongue.
Lat. wall: Shows; Post. wall: 2nd & 3rd cervical vertebrae.
-Opening of auditory tube; 1 cm behind inf. concha. Lat. wall: Shows; Palatine tonsil; it lies in tonsillar
fossa, between palatoglossal & palato-pharyngeal arches.
-Tubal elevation; above & behind opening of tube.
-Salpingopharyngeal fold; descends from tubal elevation.
-Pharyngeal recess; behind tubal elevation.
-Nasopharyngeal tonsil; at junction of roof & post.
wall, it starts to degenerate at age of 6-7 years.
If enlarged, it is called adenoid.
Palatine tonsil
*Def. & site: Lat. part of waldeyers ring, Lies in oropharynx Lat. wall (tonsillar fossa).
*Relations:
Above Below Ant. Post. Med. Lat.
Soft Dorsum of Palatoglossal arch. Palatopharyngeal arch. Superficial Deep surface;covered by
palate. pharyngeal surface; fibrous capsule, pharyngo-
part tongue. contains 12-15 basilar fascia & sup. constrictor
tonsillar crypts. (forming together tonsillar bed).
*Blood & nerve supply, lymph drainage:

Blood supply N. supply Lymph drainage

Arterial: Tonsillar branch; Jugulodigastric
Tosillar a. (main a.); from facial a. from glossopharyngeal n. node (upper deep
Ascending palatine a.: from facial a. Lesser palatine branches; cervical node).
Dorsal lingual a.a.; from 2nd part lingual a. From sphenopalatine ganglion.
Lesser palatine a.a.; from greater palatine a.
Ascending pharyngeal; from E.C.A.
Venous: Paratonsillar, pharyngeal or facial veins.
3-Laryngopharynx: From epiglottis (above) to lower border C6 vertebra (below).

*Arterial & n. supply of pharynx:

Arterial supply N. supply
-Ascending palatine (facial a.). Motor: Pharyngeal plexus, except stylopharyngeus by
glossopharyngeal n.
-Pharyngeal branch (maxillary a.).
Sensory: Nasopharynx: Sphenopalatine ganglion.
-Ascending pharyngeal (E.C.A). Oropharynx: Glossopharyngeal n.
Laryngopharynx: Internal laryngeal n.
N.B. Waldeyers ring, *Nasopharyngeal tonsil (sup.): At junction of roof & post.
wall nasopharynx *Lingual tonsil (inf.): On dorsum of post. 1\3 tongue.
*Palatine tonsil (lat.): On lat. wall oropharynx *Tubal tonsil (lat.): Around opening auditory tube.

Nasal cavity
a)Lat. wall; Shows 3 bony projections with highly vascular mucosa; nasal conchae
(sup.; smallest, middle & inf.; largest), space below each concha is nasal meatus,
while space above sup. concha is sphenoethmoidal recess. Middle meatus shows
rounded elevation (bulla ethmoidalis) bounded by curved groove (hiatus semilunaris).

*Openings in lat. wall:

Openings of paranasal sinuses Other openings
In sphenoethmoidal recess: Sphenoidal sinus.
In sup. meatus: Post. ethmoidal sinus. In inf. meatus:
Nasolacrimal duct.
In middle meatus: Behind sup. meatus:
Middle ethmoidal sinus; in bulla ethmoidalis. Spheno-palatine foramen.
Frontal sinus; in ethmoidal infundibulum, at ant. end of hiatus semilunaris.
Ant. ethmoidal sinus; in ethmoidal infundibulum or in ant. end of hiatus semilunaris.
Maxillary sinus; in post. end of hiatus semilunaris.
 b)Maxillary sinus
*Site: Largest, only present at birth, pyramidal & occupies body of maxilla.
*Relations:
Apex Base Roof Floor Ant. wall Post. wall
Towards Towards Floor of orbit Alveolar process of maxilla Subcutaneous, Pierced by post.
zygomatic nasal containing (2nd premolar & 1st molar), containing sup. alveolar n.
bone. cavity. infraorbital n. it’s damage during teeth extraction ant. sup. & vessels.
& vessels. leads to oroantral fistula. alveolar n.
& vessels.
*Opening: In upper part of base, in middle meatus at post. end of hiatus
semilunaris Its higher position makes drainage of any collection very hard.

*Vessels & nerves related:

In roof In ant. wall In lat. wall In post. wall Behind sinus
Infraorbital n. Ant. sup. alveolar Middle sup. alveolar Post. sup. alveolar Greater palatine n.
& vessels. n. & vessels. n. & vessels. n. & vessels & vessels

Facial (7th cranial) N.

Course Branches (10)
-Inside skull; it enters petrous bone via A)On middle ear; 3 branches:
internal auditory meatus, passing on middle *Greater superficial petrosal. *N. to stapedius.
ear to leave skull via stylo-mastoid foramen. *Chorda tympani:- Join lingual n. deep to lat. pterygoid.
-Outside skull; it enters parotid gland & -Supplies .Taste, to ant. 2\3 tongue. .Parasympathetic, to
divides into 5 terminal branches. submandibular & sublingual glands.
B)Just outside skull; 2 branches:
*Post. auricular, to occipital belly of occipitofrontalis.
*Branch to post. belly digastric & stylohyoid.
C)In face (parotid gland); 5 terminal branches:
*Temporal *Zygomatic *Buccal
*Mandibular *Cervical (supply muscles of scalp, face & platysma)

Cervical fascia
1-Investing deep fascia:
*Post.: It splits to surround trapezius & forms post. triangle roof.
*Lat. & ant.: It splits again to surround sternomastoid, then forms ant. triangle
roof to become continuous with corresponding fascia of opposite side.

*Sup.: Attached to sup. nuchal line, mastoid process & lower border of mandible.
It splits to enclose parotid gland (parotid fascia).

*Inf.: Attached to acromion, clavicle & manubrium.

2-Prevertebral fascia 3-Pretracheal fascia 4-Carotid sheath.

 Sternomastoid muscle
(Landmark between ant. & post. triangles)
*Origin: *Sternal head; manubrium sterni *Clavicular head; med. 1\3 clavicle.
*Insertion: Lat. surface mastoid process & sup. nuchal line.

*N. supply: *Motor; spinal root accessory n. *Sensory; C2,3.

*Action: *One muscle; bends head to same side & rotates face to opposite side.
*Two muscles; flexes neck.

Relations:-Spinal root accessory n.; pierces muscle at junction of upper & middle 1/3.
-Superficially; *Skin & fascia *Parotid gland. *E.J.V & post.
auricular vessels *Great auricular n. & transverse cutaneous n. of neck.

-Deeply; *Carotid sheath (C.C.A, I.C.A, I.J.V & vagus n.)

*Deep cervical L.N. *Cervical plexus *8 muscles
(3 muscles of post. triangle floor, 3 infrahyoid, scalenus ant. & post. belly digastric
*1st & 2nd parts subclavian a. *Thyroid gland lobe.

Anterior triangle
*Boundaries: *Above; Mandible lower border.
*Ant.; Neck mid line *Post.; Sternomastoid ant. border.
.*Divisions: By digastric & sup. belly omohyoid muscles, it is divided into 3 1\2 triangles;

1)Submental triangle
*Contents: Submental vv. & L.N.’s
2)Digastric triangle
*Boundaries: *Above; Mandible lower border *Below & infront; ant. belly digastric.
*Below & behind; post. belly digastric & stylohyoid muscles.
*Roof: Skin, superficial fascia & deep fascia Floor: Mylohyoid & hyoglossus.

*Contents:
Glands Vessels Nerves
*Submandibular gland; *Facial a.; ascends on submandibular gland post. *N. to mylohyoid;
with sub-mandibular L.N. border then deep to it, it gives submental branch. *Hypoglossal n.
*Parotid gland (lower part). *Ant. facial v.; descends superficial to submandibular gland.

A)Suprahyoid muscles
Muscle Geniohyoid Digastric Mylohyoid (diaphragma oris) Stylohyoid
Origin Lower genial tubercle. *Ant. belly; digastric fossa. Mylohyoid line. Post. surface
*Post. belly; digastric of styloid.
(mastoid) notch.
 Insertion Hyoid body. Intermediate tendon. *Ant. & middle fiberS; Hyoid bone.
mylohyoid raphe.
*Post. fibers; hyoid body.
N. supply C1 via hypoglossal n. *Ant. belly; n. to mylohyoid
N. to mylohyoid (mandibular n.). Facial n.
(mandibular n.).
*Post. belly; facial n.
Action Elevation of hyoid Elevation of hyoid in Elevation of hyoid bone & Elevation of
in swallowing or swallowing or depression mouth floor in swallowing hyoid bone
depression of mandible. of mandible . or depression of mandible. in swallowing.
Relations *Superficially:-Skin & fascia -Submandibular gland -Ant. belly digastric muscle.
of -Facial a. & its submental branch -N. to mylohyoid -Submental L.N.
mylohyoid
*Deeply: -Hyoglossus.
-Lat. to hyoglossus; styloglossus, lingual n. & submandibular ganglion, deep part
submandibular gland & its duct, hypoglossal n. & its vena comitants, suprahyoid a.
-Ant. to hyoglossus; geniohyoid, genioglossus, sublingual gland, 3rd part lingual a. & its
sublingual branch.

B)Extrinsic muscles of tongue

Muscle Styloglossus Palatoglossus Genioglossus Hyoglossus

Origin Styloid tip. Lower surface Upper genial tubercle. Hyoid body &
palatine aponeurosis. greater horn.
Insertion Tongue side. Side of post. *Upper & middle fibers; Post. 1\2 of tongue side.
part tongue. Tongue ventral surface.
*Lower. fibers; Hyoid body.
N. supply Hypoglossal n. pharyngeal plexus Hypoglossal n. Hypoglossal n.
(cranial root of
accessory through
pharyngeal branch vagus).
Action Retracts & Elevates tongue *One muscle; protrudes Depresses post. 1\2
elevates tongue. & closes oro- tongue to opposite side. tongue against mouth
pharyngeal isthmus. * Both muscles; floor.
-Protrudes tongue forwards.
-Depresses tongue central part.
-Prevents tongue from
falling backwards.
Relations of *Superficially (lat.): Styloglossus, lingual n. & submandibular ganglion, deep part
hyoglossus
submandibular gland & its duct, hypoglossal n. & its vena comitants, suprahyoid a.
* Anteriorly: Geniohyoid, genioglossus, sublingual gland, 3rd part lingual a. & its sublingual branch.
*Posteriorly: Middle constrictor muscle pharynx, stylohyoid ligament, glossopharyngeal
n., stylopharyngeus & 1st part lingual a.
*Deeply (med.): Middle constrictor muscle pharynx, stylohyoid ligament,
glossopharyngeal n., genioglossus & 2nd part lingual a. with its 2 dorsal lingual branches.
 C)Submandibular salivary gland
A)Superficial part: In submandibular fossa of mandible, wedged between it & mylohyoid,
extending: -Above; to mylohyoid line -Below; to intermediate tendon digastric.
-Infront; to mental foramen -Behind; to mandible angle.

Surfaces & relations;

Inferolateral Lateral Medial
-Skin, superficial & deep fascia. -Submandibular fossa. -Ant.: Mylohyoid with n. to mylohyoid & submental a.
-Submandibular L.N. -Med. pterygoid. -Intermediate: Hyoglossus with structures on it.
-Ant. facial v. -Facial a.(between -Post.: Styloglossus, stylohyoid ligament & glossopharyngeal n.
-Cervical branch facial n. gland & med. pterygoid).

B)Deep part: Deep to mylohyoid, on hyoglossus lat. surface, with lingual n.

above & hypoglossal n. below. Superficial & deep parts are continuous
around mylohyoid post. Border.

*Submandibular duct: 5 cm long, arising from med. surface of superficial

part, running along deep part, then between mylohyoid & hyoglossus, with
lingual n. (above) & hypoglossal n. (below). Lingual n. hooks around (double
crosses) the duct, then continues between sublingual gland & genioglossus, to open
on sublingual papilla on side of tongue frenulum.
N.B.; -Stone in submandibular duct is more common than that of parotid duct;
*Secretion is thick & viscid *Duct drains against gravity.
*Duct opens in mouth floor, any food particle may enter it, forming stone nucleus.
-Patient complains of submandibular swelling, increasing in size during meals
& returns to normal size inbetween meals.

*Arterial supply: Glandular branches of facial a.

*N. supply: Through submandibular ganglion; -Sensory: Lingual
-Sympathetic: Plexus around facial a. -Parasympathetic: Chorda tympani.

D)Sublingual salivary gland

*Shape & site: Almond, 3 cm, on genioglossus, raising sublingual fold.

*Relations: -Above; sublingual fold -Below; mylohyoid. -Lat.; sublingual fossa.

-Med.; genioglossus with submandibular duct & lingual n. inbetween.

*Sublingual ducts: 8-12 ducts, opening in sublingual fold, few open in submandibular duct.
*Arterial supply: Sublingual & submental arteries.
*N. supply: Through submandibular ganglion; -Sensory: Lingual
-Sympathetic: Plexus around lingual a. -Parasympathetic: Chorda tympani.
 E)Submandibular ganglion
*Site: Parasympathetic ganglion, suspended from lingual n. on hyoglossus lat. surface.
*Roots:
*Sensory; Lingual n., traverses ganglion without relay.
*Sympathetic; Plexus around facial & lingual aa., traverses ganglion without relay.
*Parasympathetic; Chorda tympani, relays in ganglion.
*Branches: Supply submandibular & sublingual salivary glands.
3-Muscular triangle
*Boundaries:*Infront; neck midline.
*Above & behind; sup. belly omohyoid *Below & behind; ant. border sternomastoid.

*Floor: Thyroid & cricoid cartilages, thyrohyoid membrane.

*Contents: -3 infrahyoid musles (Sternohyoid, sternothyroid & thyrohyoid).
-Structures in median region neck, below hyoid bone.

4-Carotid triangle
*Boundaries: *Behind; Sternomastoid *Above & infront; post. belly
digastric & stylohyoid *Below & infront; sup. belly omohyoid.
*Roof: Skin, superficial fascia & deep fascia.

*Floor: Pharynx & hyoglossus.

*Contents:
A)Blood vessels B)Nerves
Arteries; *Hypoglossal n.;
*Common carotid a. (C.C.A): divides at upper border thyroid cartilage (disc crosses I.C.A, E.C.A &
between C3 & C4), into internal (I.C.A) & external (E.C.A) carotids. lingual a.
*E.C.A: Anteromedial to I.C.A, outside carotid sheath, gives 5 branches in triangle *Glossopharyngeal n.
-Sup. thyroid a.; runs downwards -Lingual a.; runs forwards -Facial a.; runs upwards.
*Spinal root accessory n.
-Occipital a.; runs backwards -Ascending pharyngeal; runs med. to I.C.A. *Vagus n. with it’s
*I.C.A: Posterolateral to E.C.A, inside carotid sheath, gives no branches in neck. internal & external
Veins; sup. thyroid, lingual & common facial veins, ending in I.J.V. laryngeal branches.
Carotid sheath; -Tube of deep fascia from skull base to neck root, investing big
vessels & nerves of neck except E.C.A. *Sympathetic chain.
-Contents: *C.C.A & I.C.A (med.) *I.J.V (lat.). *Ansa cervicalis.
*Lower 4 cranial nerves (in upper part), vagus n. (in lower part).
*Sympathetic chain (in post. wall), ansa cervicalis (in ant. wall). C)Deep cervical L.N.
(along I.J.V)

.
a)External carotid artery (E.C.A)
*Origin: At upper border thyroid cartilage, from C.C.A.
 *Course: Anteromedial to I.C.A, outside carotid sheath.

*Termination: Inside parotid gland, dividing into maxillary & superficial temporal aa.
*Branches:
3 from ant. aspect; 2 from post. aspect; 1 from med. aspect; 2 terminals; maxillary &
sup. thyroid, lingual & facial post. auricular & occipital ascending pharyngeal superficial temporal.

Artery
Lingual a. Facial a.
Origin E.C.A, opposite greater horn hyoid. E.C.A, above greater horn hyoid.
Course Divided by hyoglossus, into 3 parts; Divided into 2 parts;

*1st part: From origin to post. border hyoglossus, *Facial part (in face); see head.
making S-shaped loop, lying on middle constrictor &
*Cervical part (in neck);
crossed by hypoglossal n.
-Ascends deep to post. belly digastric,
*2 part: Runs deep to hyoglossus.
nd

entering digastric triangle & grooving post.

*3rd part: -Ascends along ant. border hyoglossus, border sub-mandibular gland.
crossed by lingual n. & submandibular duct. -Deep to mandible, it runs between gland & med.
-Enters tongue as deep a. of tongue supplying pterygoid, reaching mandible lower border
ant. part & both lingual aa. anastomose. to enter face at masseter anteroinf. angle.
Branches *1 part: Suprahyoid a.; runs above hyoid. *Facial part: See head.
st

*2 part: 2 dorsal lingual arteries; supply

nd
*Cervical part:
post. part tongue & palatine tonsil. -Tonsillar a.; supply palatine tonsil (main a.).
*3 part: Sublingual a.; supplies sublingual gland. -Ascending palatine;; supply pharynx, soft
rd

. palate & palatine tonsil.

-Glandular; supplies submandibular gland.
-Submental a. (largest branch); supplies
surrounding muscles.
B)Internal Jugular vein (I.J.V)

*Origin: At jugular foramen, as continuation of sigmoid sinus.

*Course: Descends inside carotid sheath, lat. to I.C.A, C.C.A & vagus n.

*Termination: Behind clavicle med. end, joining subclavian v., forming brachiocephalic v.

*Tributaries: *Inf. petrosal sinus *Pharyngeal veins *Common facial v.

*Lingual v. *Sup. thyroid v. *Middle thyroid v.

Lymph nodes of head & neck

A)Superficial group: *Vertical ; along external & anterior jugular veins.
*Circular; at junction of head & neck:
 Submental Submandibular Buccal Partoid Mastoid Occipital
-In submental -On submandibular gland. -On buccinator. -Superficial & deep. -On -On
triangle. -Drain most of teeth -Drain cheek. -Drain lat. part mastoid occipital
-Drain lower & gums, tongue sides, of scalp & face, process. bone.
incisors & gum, mouth floor, palatine middle ear, -Drain -Drain
tip & frenulum tonsils, submandibular upper molars. back of back
tongue, mouth floor. & sublingual glands, nose. scalp & of scalp.
auricle.
B)Deep group: 2 vertical;

Deep cervical lymph nodes Deep cervical lymph nodes in median region
at side neck
Along I.J.V, deep to sterno-
mastoid, divded by intermediate
tendon omohyoid, into 2 groups;
Upper deep Lower deep Retro- Infrahyoid Prelaryngeal Pretracheal Paratracheal
cervical cervical pharyngeal
*Contain *Contain *Behind *Infront of *Infront of *Infront of *On trachea
important important pharynx. thyrohyoid cricothyroid trachea, side, along
node (jugulo- node (jugulo- *Drain membrane, membrane. along inf. recurrent
digastric), at omohyoid), pharynx. below hyoid *Drain larynx thyroid veins. laryngeal n.
point of at point of *Drain larynx. & thyroid. *Drain trachea *Drain trachea,
crossing crossing & thyroid. oesophagus
between I.J.V between I.J.V & thyroid.
& post. belly & inf. belly
digastric. omohyoid.
*Drain tongue *Drain tongue.
& tonsil.
Deep cervical lymph nodes, receive lymph from all superficial & deep nodes of head & neck. Their efferent
vessels collect in jugular lymph trunk, which joins Rt. lymph duct (on Rt. side) & thoracic duct (on Lt. side).