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Head and Neck Anatomy

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Head and Neck Anatomy Anatomy Head and Neck Imaging Overview Before You Begin This module, intended for pre-clinical medical students, is part of the core anatomy teaching series. There should be no prerequisite knowledge necessary for medical students to successfully review and understand this module. Many of the additional module series in our website build off a strong understanding of human anatomy as it presents in imaging. Please refer back to these anatomy modules if you ever need to review. If material is repeated from another module, it will be outlined as this text is so that you are aware Introduction • The Head and Neck includes: • Skull and Cranial Cavity • Face and Scalp • Eyes and Orbits • Ears • Nasal Cavity and Pterygopalatine Fossa • Oral Cavity and Pharynx • Larynx • Neck • In this module, we will explore basic H&N anatomy identifiable with common imaging modalities Plain Film Radiographs Head and Neck Radiographs • Utilize ionizing radiation to capture images • Material density determines the degree of X-ray attenuation, and thus, appearance: Gas (Air) Fat Soft Tissue (Water) Bone Metal Basic Osteology Overview Skull Base Osteology * Coronal Suture Dorsum sellae Anterior clinoid Sella Turcica Palatine process Mastoid of maxilla air cells Hyoid * * * Sag. suture Crista galli Frontal sinus Lesser wing Greater wing Ethmoid air cells Mastoid Inf. Turbinate Dens Mandible ____ _____ __ _ _ _ __ __ ____ _ N = nasal V = vomer Frontal M= mandible bone S = sphenoid Frontal P = parietal sinus P T = temporal S T N Z V Maxilla M Sphenoid sinus Maxillary sinuses * Lesser wing Greater Frontal process of wing zygo. bone Maxillary sinus Zygomatic arch L. Mastoid * L. Maxillary sinus L. Coronoid process R. Condyle of mandible R. Angle of mandible Dens * * Mandible Nasopharynx Dens Soft Palate Atlas Oropharynx Axis Tongue C VI * * Intervert. foramen Trans. Process of C IV Spinous process Pedicle * * * Vestibular fold Laryngeal ventricle Vocal fold Trachea ________ ____ Optic canal Sphenoid sinus Rotundum Ovale Clivus Spinosum Lacerum IAM Occipital condyle Jugular foramen Lamdoidal suture Computed Tomography (CT) H&N CT • Utilizes ionizing Anterior radiation to produce cross- sectional images • Digital “windowing” can highlight Right Left specific tissues • Note the patient orientation shown to the left Posterior Muscles of the Head Muscles of the Neck First Cervical Vertebrae – Atlas Second Cervical Vertebrae - Axis Seventh Cervical Vertebrae CT Axial Series * Use airway, apices of lung, and scapula to estimate level on body. * IJV CC Sternohyoid SCM Vertebral Trapezius * Visceral compartment * Sternohyoid CC Vascular IJV SCM compartment Vertebral Levator Scapulae Trapezius Vertebral Follow Vessels of neck superiorly in axial CT: compartment CCA, IJV, Vert. art; then follow SCM, then trapezius Semispinalis * * Sternohyoid Common Facial Common Carotid EJV Vertebral SCM Levator Scapulae IJV Trapezius Semispinalis * Vertebral level:___ @C3/C4 * Hyoid External Carotid Internal Carotid EJV Vertebral SCM IJV Levator Scapulae Trapezius Semispinalis * * L. Masseter L. Parotid Post. Belly of gland Digastric m. L. Medial pterygoid Dens SCM Splenius * * L. Masseter L. Parotid gland L. Medial pterygoid Post. Belly of Digastric m. Splenius * * L. Temporalis L. Masseter L. Lateral Maxillary A. pterygoid Stylomastoid foramen L. Medial pterygoid * * L. Temporalis Coronoid process L. Masseter Pterygoid fovea L. Lateral pterygoid * * * L. Temporalis Coronoid process L. Masseter Foramen ovale TMJ L. Mastoid Air Cells * * ____ * Internal Carotid Eustachian tube EAC Cochlea Malleus IAC Vestibule Horizontal (post.) Auricle Semicircular c. * * Inferior rectus Temporalis * Medial and lateral check ligaments * Lateral rectus Optic nerve Temporalis * * Medial rectus Lens Ophthalmic artery Temporalis * * Superior oblique Superior rectus Temporalis CT Coronal Series * Utilize the spine, TMJ, bones of the face, and clavicles to assess depth of coronal image * * TMJ * * * Lateral pterygoid Nasopharynx Medial pterygoid * * R. Temporalis Pterygoid fossa R. Masseter SCM * Lesser wing Greater wing *Sphenoidal sinus Medial pterygoid attachment Ramus of mandible Pterygoid hamulus SCM * * * Ethmoidal air cells Inf. Orb. Mid. Turbinate fissure Inf. Turbinate * Medial rectus Superior rectus *Lateral rectus Optic nerve L. Temporalis Inferior rectus L. Masseter * Magnetic Resonance Imaging (MRI) MRI • Utilizes powerful magnetic fields and radio-frequency pulses to excite (usually hydrogen) atoms within tissues • The energy released by atoms as they return to baseline can be captured to produce an image • By varying parameters such as pulse frequency, image qualities can be modulated (i.e. T1 vs T2 weighted) • MRI can highlight structures that may not be apparent in CT imaging • MRIs are particularly apt when imaging soft tissues • As they do not rely on X-rays, MRI studies do not expose patients to radiation MRI – Axial Series * * L. Maxillary sinus Inf. concha Septum Nasopharynx R. Medial pterygoid m. Tens. Veli palatini m. L.Vertebral a. L. Masseter m. * * * Cochlea Vestibule Vestibulocochlear and Facial nerves Semi-circular canals * * Medial rectus * Lens Lat. rectus R. Optic nerve R. Internal carotid a. Basilar a. MRA and Angiography Vasculature of the Neck * * R. ICA R. ECA R. ICA R. CCA R. sup. Cerv. A. R. Vertebral A. Circle of Willis * * * Ant. Comm. A. Ant. Cer. A. Middle Cerebral a. Int. Carotid a. Basilar a. Vertebral a. * * Ant. Cer. A. Ant. Comm. A. Mid. Cer. A. Int. Car. A. Post. Comm. A. Basilar a. Post. Cer. A. Vertebral a. Arteries of the Face * * Superficial Temporal a. * Maxillary a. Mid. Meningeal a. Infraorbital a. Post. Auricular a. Occipital a. Asc. Facial a. Pharyngeal a. External Carotid a. Internal Lingual a. Carotid a. Superior Thyroid. a. * * * Superficial Temporal Middle Meningeal Occipital Maxillary Artery Facial Artery Internal Carotid Lingual Superior Thyroid * * Superficial Post. Auricular a. *Temporal a. Maxillary a. Occipital a. Internal Carotid a. Facial a. Lingual a. Superior Thyroid a. * * Superior sagittal * sinus Straight sinus Transverse sinus Sigmoid sinus IJV * * Superior sagittal sinus Great cerebral vein Straight sinus Trans. sinus Sigmoid sinus IJV’s END.
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