104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite 1

Johannes W.Rohen Chihiro Yokochi Elke Lütjen-Drecoll

Color of

A Photographic Study of the Human Body

Seventh Edition 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite 2

Coeditions in 20 Languages 104750_S_I_XII_Titelei_fertig:_ 22.01.2010 9:02 Uhr Seite 3

Johannes W.Rohen Chihiro Yokochi Elke Lütjen-Drecoll

Color Atlas of Anatomy

A Photographic Study of the Human Body

Seventh Edition

With 1211 Figures, 1117 in Color, and 94 Radiographs, CT and MRI Scans 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite IV

IV

Prof. Dr. med. Dr. med. h.c. Johannes W.Rohen Anatomisches Institut II der Universität Erlangen-Nürnberg Universitätsstraße 19, 91054 Erlangen, Germany

Chihiro Yokochi, M.D. Professor emeritus, Department of Anatomy Kanagawa Dental College, Yokosuka, Kanagawa, Japan Correspondence to: Prof. Chihiro Yokochi, c/o Igaku-Shoin Ltd., 1-28-23 Hongo, Bunkyo-ku Tokyo 113-8719, Japan

Prof. Dr. med. Elke Lütjen-Drecoll Anatomisches Institut II der Universität Erlangen-Nürnberg Universitätsstraße 19, 91054 Erlangen, Germany

With Collaboration of Kyung W.Chung, Ph.D. David Ross Boyd Professor & Vice Chairman Samuel Roberts Noble Foundation Presidential Professor Director, Advanced Human Anatomy University of Oklahoma, College of Medicine Department of Cell Biology

Copyright © DISCLAIMER Fourth Edition, 1998 Care has been taken to confirm the accuracy of the information present and Fifth Edition, 2002 to describe generally accepted practices. However, the authors, editors, and Sixth Edition, 2006 publisher are not responsible for errors or omissions or for any consequences Seventh Edition, 2011 by from application of the information in this book and make no warranty, Schattauer GmbH, expressed or implied, with respect to the currency, completeness, or accuracy Hölderlinstraße 3, 70174 Stuttgart, Germany; http://www.schattauer.de, and of the contents of the publication. Application of this information in a Lippincott Williams & Wilkins, a Wolters Kluwer business particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered 351 West Camden Street 530 Walnut Street absolute and universal recommendations. Baltimore, MD 21201 Philadelphia, PA 19106 The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the All rights reserved. This book is protected by copyright. No part of this book current recommendations and practice at the time of publication. However, may be reproduced or transmitted in any form or by any means, including as in view of ongoing research, changes in government regulations, and the photocopies or scanned-in or other electronic copies, or utilized by any constant flow of information relating to drug therapy and drug reactions, the information storage and retrieval system without written permission from reader is urged to check the package insert for each drug for any change in the copyright owner, except for brief quotations embodied in critical articles indications and dosage and for added warnings and precautions. This is and reviews. Materials appearing in this book prepared by individuals as particularly important when the recommended agent is a new or infrequently part of their official duties as U.S. government employees are not covered employed drug. by the above-mentioned copyright. To request permission, please contact Some drugs and medical devices presented in this publication have Food and Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, Drug Administration (FDA) clearance for limited use in restricted research via email at [email protected], or via website at lww.com (products settings. It is the responsibility of the health care provider to ascertain the and services). FDA status of each drug or device planned for use in their clinical practice.

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ISBN: 9781582558561 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite V

V Preface to the Seventh Edition

This new edition was revised and structured anew in different In the underlying seventh edition photographs of the surface ways. Each chapter is provided with an introductory front page anatomy of the human body were included again. We omitted to give an overview of the topics of the chapter and short marks and indications in order not to affect the quality of the descriptions. The whole introductory chapter “General Anatomy” pictures. was newly arranged and supported with introductory texts, thus Despite numerous additions and amendments the size of the facilitating students to better understand the complicated volume did not increase so that students both in preclinics and in “world” of gross anatomy. The large chapter 2 “ and ” clinics are offered an atlas easy to handle and cope with. was split into 5 sub-chapters with an introductory page each. While preparing this new edition, the authors were reminded of Furthermore, the drawings were revised and improved in many how precisely, beautifully, and admirably the human body is chapters and depicted more consistently. In most of the chapters constructed. If this book helps the student or medial doctor to new photographs taken from newly dissected specimens were appreciate the overwhelming beauty of the anatomical architecture incorporated. of tissues and organs in the human, then it greatly fulfils its task. The general structure and arrangement of the Atlas were main- Deep interest and admiration of the anatomical structures may tained. The chapters of regional anatomy are consequently create the “love for man”, which alone can be considered of placed behind the systematic descriptions of the anatomical primary importance for daily medical work. structures so that students can study – e.g. before dissecting an We would like to express our great gratitude to all coworkers extremity – the systematic anatomy of , joints, muscles, for their skilled work. Without their help the improvements of nerves and vessels. For studying the photographs of the specimens the Color Atlas of Anatomy would not have been possible. We the use of a magnifier might be helpful. The enormous plasticity of would also like to express our sincere thanks to those at the photos is surprising, especially at higher magnifications. Schattauer GmbH, Stuttgart, Germany, Lippincott, Williams & In many places new MRI and CT scans were added to give consi- Wilkins, Baltimore, Maryland, USA, and Igaku-Shoin, Tokyo, deration to the new imaging techniques which become more Japan, who always listened to our suggestions and invested and more important for the student in preclinics. We would like again a great deal of their effort into improving this book. to express our sincere thanks to Prof. Heuck, Munich, who provided us with the MRI scans.

Acknowledgements

We would like to express our great gratitude to all coworkers We would also like to express our many thanks to Prof. W. Bautz who helped to make the Color Atlas of Anatomy a success. We (Radiologisches Institut, University Erlangen-Nürnberg, Germany) are particularly indebted to those who dissected new specimens and Prof. A. Heuck (Radiologisches Zentrum, München-Pasing, with great skill and knowledge, particularly to Jeff Bryant (member Germany), who provided the newly included excellent CT and of our staff) and Dr. Martin Rexer (now Klinikum Fürth, Germany), MRI scans. who prepared most of the new specimens of the fifth, sixth and We are also greatly indebted to Mr. Hans Sommer (SOMSO Co., seventh edition. We would also like to thank Dr. K. Okamoto Coburg, Germany), who kindly provided a number of excellent (now Nagasaki, Japan), who dissected many excellent specimens of specimens. the fourth edition, also included in the fifth edition. Furthermore, Finally, we would like to express our great gratitude to our we are greatly indebted to Prof. W. Neuhuber and his coworkers photographer, Mr. Marco Gößwein, who contributed the very for their great efforts in supporting our work. excellent macrophotos. Excellent and untiring work was done by The specimens of the previous editions also depicted in this our secretaries, Mrs. Lisa Köhler and Elisabeth Wascher, and as volume were dissected with great skill and enthusiasm by Prof. well by our artists, Mr. Jörg Pekarsky and Mrs. Annette Gack, who Dr. S. Nagashima (now Nagasaki, Japan), Dr. Mutsuko Takahashi not only performed excellent new drawings but revised effectively (now Tokyo, Japan), Dr. Gabriele Lindner-Funk (Erlangen, Germany), the layout of the new edition. Dr. P. Landgraf (Erlangen, Germany), and Miss Rachel M. McDonnell Last but not least, we would like to express our sincere thanks to (now Dallas, Texas, USA). all scientists, students, and other coworkers, particularly to the We are greatly indebted to Prof. Kyung Won Chung, Ph.D., Director ones at the publishing companies themselves. of Medical Gross Anatomy, University of Oklahoma, USA, Dept. of Cell Biology, for his careful corrections of the proofs of the Erlangen, Germany; Spring 2010 J. W. Rohen new edition. C. Yokochi E. Lütjen-Drecoll 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite VI

VI Preface to the First Edition

Today there exist any number of good anatomic atlases. Conse- bones, for example, was not presented in a descriptive way, quently, the advent of a new work requires justification. We but rather through a series of figures revealing the mosaic of found three main reasons to undertake the publication of such a bones by adding one bone to another, so that ultimately the book. composition of skull bones can be more easily understood. First of all, most of the previous atlases contain mainly schematic Finally, the authors also considered the present situation in or semischematic drawings which often reflect reality only in a medical education. On one hand there is a universal lack of limited way; the third dimension, i.e., the spatial effect, is lacking. cadavers in many departments of anatomy, while on the other In contrast, the photo of the actual anatomic specimen has the hand there has been a considerable increase in the number of advantage of conveying the reality of the object with its propor- students almost everywhere. As a consequence, students do not tions and spatial dimensions in a more exact and realistic manner have access to sufficient illustrative material for their anatomic than the “idealized”, colored “nice” drawings of most previous studies. Of course, photos can never replace the immediate atlases. Furthermore, the photo of the human specimen corre- observation, but we think the use of a macroscopic photo instead sponds to the student’s observations and needs in the dissection of a painted, mostly idealized picture is more appropriate and is courses. Thus he has the advantage of immediate orientation by an improvement in anatomic study over drawings alone. photographic specimens while working with the cadaver. The majority of the specimens depicted in the atlas were prepared Secondly, some of the existing atlases are classified by systemic by the authors either in the Dept. of Anatomy in Erlangen, Germany, rather than regional aspects. As a result, the student needs several or in the Dept. of Anatomy, Kanagawa Dental College, Yokosuka, books each supplying the necessary facts for a certain region of Japan. The specimens of the chapter on the neck and those of the body. The present atlas, however, tries to portray macroscopic the demonstrating the dorsal branches of the spinal anatomy with regard to the regional and stratigraphic aspects of nerves were prepared by Dr. K. Schmidt with great skill and the object itself as realistically as possible. Hence it is an imme- enthusiasm. The specimens of the ligaments of the vertebral diate help during the dissection courses in the study of medical column were prepared by Dr. Th. Mokrusch, and a great number and dental anatomy. of specimens in the chapter of the upper and lower limb was very Another intention of the authors was to limit the subject to the carefully prepared by Dr. S. Nagashima, Kurume, Japan. essential and to offer it didactically in a way that is self-explana- Once again, our warmest thanks go out to all of our coworkers tory. To all regions of the body we added schematic drawings for their unselfish, devoted and highly qualified work. of the main tributaries of nerves and vessels, of the course and mechanism of the muscles, of the nomenclature of the various regions, etc. This will enhance the understanding of the details Erlangen, Germany; Spring 1983 J.W.Rohen seen in the photographs. The complicated architecture of the C.Yokochi 104750_S_I_XII_Titelei_fertig:_ 14.01.2010 14:45 Uhr Seite VII

VII Contents

1 General Anatomy 1 2 Head and Neck 19

Architectural Principles of the Human Body______1 2.1 Skull and Muscles of the Head ______19 Position of the Inner Organs, Palpaple Points, Bones of the Skull ______20 and Regional Lines ______2 Disarticulated Skull I ______24 Planes and Directions of the Body______4 Sphenoidal and Occipital Bones ______24 Osteology ______6 Temporal Bone ______26 Skeleton of the Human Body ______6 Frontal Bone ______28 Bone Structure ______8 Calvaria ______29 of the Bones ______9 Base of the Skull______30 Arthrology ______10 Skull of the Newborn ______35 Types of Joints ______10 Median Sections through the Skull ______36 Architecture of the Joint ______12 Disarticulated Skull II ______38 Myology ______13 Ethmoidal Bone ______38 Shapes of Muscles ______13 Ethmoidal and Palatine Bones______39 Structure of the Muscular System ______14 Palatine Bone and Maxilla ______40 Comparative Imaging of Skeletal Sphenoidal, Ethmoidal, and Palatine Bones ______43 and Muscular Structures in MRI and X-Ray ______15 Maxilla, Zygomatic Bone, and Bony Palate ______45 Organization of the Circulatory System ______16 Pterygopalatine Fossa and Orbit ______46 Organization of the Lymphatic System ______17 Orbit, and Nasal and Lacrimal Bones ______47 Organization of the Nervous System ______18 Bones of the Nasal Cavity ______48 Septum and of the Nose ______49 Maxilla and Mandible with Teeth ______50 Deciduous and Permanent Teeth ______51 Mandible and Dental Arch ______52 Ligaments of the Temporomandibular Joint ______53 Temporomandibular Joint ______54 Temporomandibular Joint and Masticatory Muscles __ 55 Masticatory Muscles ______56 Temporalis and Masseter Muscles ______56 Pterygoid Muscles ______57 Facial Muscles ______58 Supra- and Infrahyoid Muscles ______60 Section through the Cavities of the Head______62 Maxillary Artery ______63

2.2 Cranial Nerves______64 Brain and Cranial Nerves ______64 Trigeminal Nerve ______68 Facial Nerve ______70 Connection with the Brain Stem ______71 Nerves of the Orbit ______72 Base of the Skull with Cranial Nerves ______74 Regions of the Head ______76 Lateral Region ______76 Retromandibular Region ______80 Para- and Retropharyngeal Regions______83 104750_S_I_XII_Titelei_fertig:_ 14.01.2010 14:45 Uhr Seite VIII

VIII Contents

2 Head and Neck

2.3 Brain and Sensory Organs______84 2.4 Oral and Nasal Cavities ______143 Position of Brain and Great Sensory Organs______84 Position of Oral and Nasal Cavities ______143 Scalp and Meninges ______85 Nasal Cavity ______144 Meninges ______86 Paranasal Sinuses ______144 Dura Mater and Dural Venous Sinuses ______86 Nerves and Arteries ______146 Dura Mater ______88 Sections through the Nasal and Oral Cavities ______148 Pia Mater and Arachnoid ______89 Oral Cavity ______150 Brain ______90 Muscles ______150 Median Sections ______90 Submandibular Triangle ______152 Arteries and Veins ______92 Salivary Glands ______153 Arteries ______93 Arteries and the Arterial Circle of Willis ______98 Cerebrum ______99 2.5 Neck and Organs of the Neck ______154 Cerebellum______102 Organization and Regions of the Neck ______154 Dissections ______104 Muscles of the Neck ______156 Limbic System ______107 Larynx ______158 Hypothalamus ______108 Cartilages and Hyoid Bone ______158 Subcortical Nuclei ______109 Muscles ______160 Ventricular System ______112 Vocal Ligament ______161 Brain Stem ______114 Nerves ______162 Coronal and Cross Sections______116 Larynx and Oral Cavity ______163 Horizontal Sections ______118 Pharynx ______164 Auditory and Vestibular Apparatus ______122 Muscles ______166 Temporal Bone ______125 Vessels of the Head and Neck ______168 Middle Ear ______126 Arteries ______168 Auditory Ossicles ______128 Arteries and Veins ______170 Internal Ear ______129 Veins ______171 Auditory Pathway and Areas ______131 Lymph Vessels and Nodes ______172 Visual Apparatus and Orbit ______132 Regions of the Neck ______174 Eyeball ______133 Anterior Region ______174 Vessels of the Eye ______134 Lateral Region ______178 Extra-ocular Muscles ______135 Cervical and Brachial Plexuses ______186 Visual Pathway and Areas ______137 Layers of the Orbit ______140 Lacrimal Apparatus and Lids ______142 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite IX

Contents IX

3 Trunk 187 4 Thoracic Organs 243

Segmental Structure of the Trunk ______187 Position of the Thoracic Organs ______243 Skeleton ______188 Respiratory System ______246 Vertebrae ______190 Bronchial Tree ______246 and ______192 Projections of Lungs and Pleura ______248 Vertebral Joints ______195 Lungs ______249 Costovertebral Joints and Intercostal Muscles ______196 Bronchopulmonary Segments ______250 Costovertebral Joints ______197 Heart ______252 Ligaments ______198 Myocardium ______257 Joints Connecting to the Head ______200 Valves ______258 Vertebral Column of the Neck ______203 Function ______260 Surface Anatomy of the Anterior Body ______204 Conducting System ______261 Female ______204 Arteries and Veins ______262 Male ______205 Regional Anatomy of the Thoracic Organs ______264 Thoracic Wall ______206 Thymus ______266 Thoracic and Abdominal Walls ______209 Heart ______268 Vessels and Nerves ______214 Pericardium ______272 Inguinal Region ______217 Epicardium ______273 Male ______217 Posterior Mediastinum ______274 Female ______220 Mediastinal Organs ______274 Back ______221 Posterior and Superior Mediastinum ______281 Muscles ______221 Mediastinal Organs ______281 Nerves ______226 Diaphragm ______282 Vertebral Canal and Spinal Cord ______230 Coronal Sections through the Thorax ______284 Nuchal Region ______234 Horizontal Sections through the Thorax ______286 Fetal Circulatory System ______288 Mammary Gland ______290 104750_S_I_XII_Titelei_fertig:_ 05.01.2010 12:36 Uhr Seite X

X Contents

5 Abdominal Organs 291 6 Retroperitoneal Organs 323

Position of the Abdominal Organs ______291 Position of the Urinary Organs ______323 Anterior Abdominal Wall ______293 Sections through the Retroperitoneal Region ______325 Stomach ______294 Kidney ______326 Pancreas and Bile Ducts ______296 Arteries ______328 Liver ______298 Arteries and Veins ______329 Spleen ______300 Retroperitoneal Region ______330 Upper Abdominal Organs ______301 Urinary System ______330 Vessels of the Abdominal Organs ______302 Lymph Vessels and Nodes ______332 Superior Mesenteric Vessels ______302 Vessels and Nerves ______333 Portal Circulation ______303 Autonomic Nervous System______334 Superior Mesenteric Artery ______304 Male Urogenital System______336 Inferior Mesenteric Artery ______305 Male Genital Organs (isolated) ______337 Dissection of the Abdominal Organs ______306 Male External Genital Organs ______340 Mesenteric Arteries ______308 Penis ______342 Mesentery ______310 Male Internal Genital Organs ______343 Upper Abdominal Organs ______311 Testis and Epididymis ______343 Posterior Abdominal Wall ______316 Accessory Glands ______344 Pancreas and Bile Ducts ______316 Pelvic Cavity in the Male ______345 Duodenum, Pancreas, and Spleen ______317 Coronal Sections ______345 Root of the Mesentery and Peritoneal Recesses ____ 318 Vessels of the Pelvic Organs ______346 Horizontal Sections through the Abdominal Cavity __ 320 Abdominal Aorta ______348 Midsagittal Sections through the Abdominal Cavity __ 322 Vessels and Nerves of the Pelvic Organs ______349 Urogenital and Pelvic Diaphragms in the Male ______350 Female Urogenital System ______354 Female Genital Organs (isolated) ______356 Female Internal Genital Organs______358 Uterus and Related Organs ______359 Arteries and Lymph Vessels ______360 Female External Genital Organs ______361 Urogenital Diaphragm and External Genital Organs in the Female ______363 Pelvic Cavity in the Female ______366 Coronal and Horizontal Sections ______367 104750_S_I_XII_Titelei_fertig:_ 14.01.2010 14:46 Uhr Seite XI

Contents XI

7 Upper Limb 368 8 Lower Limb 432

Skeleton of the Shoulder Girdle and Thorax ______368 Skeleton of the Pelvic Girdle and Lower Limb ______432 Scapula ______371 Bones of the Pelvis ______433 Skeleton of the Shoulder Girdle and Humerus ______372 Skeleton of the Pelvis ______435 Humerus ______373 Bones of the Hip Joint ______438 Skeleton of the Forearm ______374 Femur ______439 Skeleton of the Forearm and Hand ______375 Skeleton of the Leg ______440 Skeleton of the Hand ______376 Bones of the Knee Joint ______441 Joints and Ligaments of the Shoulder ______378 Skeleton of the Foot ______442 Ligaments of the Elbow Joint ______379 Ligaments of the Pelvis and Hip Joint ______444 Ligaments of the Hand and Wrist ______380 Knee Joint ______446 Muscles of the Shoulder and Arm ______382 Ligaments of the Knee Joint ______447 Dorsal Muscles ______382 Joints of the Ankle ______449 Pectoral Muscles ______384 Ligaments of the Foot ______450 Muscles of the Arm ______386 Muscles of the Thigh ______452 Muscles of the Forearm and Hand ______388 Adductor Muscles ______452 Flexor Muscles ______388 Gluteal Muscles ______454 Extensor Muscles ______392 Flexor Muscles ______455 Muscles of the Hand ______394 Muscles of the Leg ______457 Arteries ______396 Flexor Muscles ______457 Veins ______398 Muscles of the Leg and Foot ______458 Nerves ______399 Deep Flexor Muscles ______460 Surface Anatomy of the Upper Limb ______401 Extensor Muscles ______462 Posterior and Lateral Aspects ______401 Muscles of the Foot ______463 Anterior Aspect ______402 Arteries ______466 Neck and Shoulder ______403 Veins ______468 Shoulder ______404 Nerves ______470 Posterior Region ______404 Lumbosacral Plexus ______471 Anterior Region ______406 Lumbar Part of the Vertebral Canal and Spinal Cord __ 472 Shoulder and Arm ______408 Spinal Cord with Intercostal Nerves ______474 Axillary Region ______410 Spinal Cord and Lumbar Plexus ______475 Brachial Plexus ______413 Surface Anatomy of the Lower Limb ______476 Arm ______414 Posterior Aspect ______476 Cubital Region ______416 Anterior Aspect ______477 Forearm and Hand ______420 Thigh ______478 Posterior Region ______420 Anterior Region ______478 Anterior Region ______422 Gluteal Region ______482 Hand ______424 Thigh ______484 Posterior Region ______424 Posterior Region ______484 Anterior Region ______426 Knee and Popliteal Fossa ______486 Sections through the Upper Limb ______430 Crural Region ______489 Crural Region and Foot ______492 Coronal Sections through the Foot ______495 Sections through the Lower Limb ______496 Foot ______498 Posterior Region ______498 Anterior Region ______500

Index ______503