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You are in Home >> Exams >> Mitchell Anaesthetic Notes

Head & neck anatomy

Created: 13/9/2006
Updated: 8/1/2007



  • Bones
    • External: nasal processes of frontal bones, nasal bones, frontal processes of maxillae
    • Internal: ethmoid, sphenoid, occipital, pterygoid, palatine, maxilla, conchae, vomer
  • Arteries
    • Facial: lateral nasal branch and others
    • Superior labial: septal and alar branches
    • Ophthalmic: dorsal nasal and anterior and posterior ethmoidal branches
    • Maxillary: nasal branch of infraorbital branch, sphenopalatine branch
  • Innervation
    • Special sensory
      • Smell (I) through cribriform plate
    • Sensory
      • External
        • V1 via anterior ethmoidal and external nasal branches of the nasociliary nerve to bridge and tip
        • V2 via nasal branches of infraorbital nerve
      • Internal
        • External nasal and infraorbital branches to vestibule
        • Septum: V1 anterior ethmoidal branch anterosuperiorly, V2 nasopalatine branch from pterygopalatine ganglion posteroinferiorly
        • Lateral wall: V1 anterior ethmoidal, V2 anterior superior alveolar branch, posterior and inferior nasal branches and greater palatine nerves from pterygopalatine ganglion
    • Motor: VII to muscles of facial expression


  • Innervation
    • Special sense
      • VII to palate via greater petrosal nerve
      • VII chorda tympani to lingual nerve supply anterior 2/3 of tongue
      • IX to posterior 1/3
    • Sensory
      • V2 and V3 via infraorbital, superior alveolar, nasopalatine, greater and lesser palatine, buccal, lingual, inferior alveolar and mental nerves
      • IX to posterior parts
    • Motor
      • VII to muscles of facial expression
      • V3 to tensor veli palatini and muscles of mastication
      • IX, X and XI via pharyngeal plexus to palatoglossus
      • XII to tongue and floor of mouth


  • Skeleton
    • Hyoid bone above, firmly attached by 3 thyrohyoid ligaments and thyrohyoid membrane
    • Three unpaired midline cartilages
      • Thyroid cartilage
        • Two laminae, fused in midline
        • Superior border attached to hyoid
        • Posterior borders attached to stylopharyngeus and palatopharyngeus
        • External surface attached to sternothyroid, thyrohyoid and inferior constrictor muscles
        • Inferior synovial joint with cricoid posteriorly and lateral and median cricothyroid ligaments
        • Internally attached to stem of epiglottis, vocal and vestibular ligaments and thyroarytenoid, thyroepiglottic and vocalis muscles
      • Cricoid cartilage
        • Complete ring of cartilage at level of C6
        • Attached to thyroid cartilage above
        • Inferior attachment to trachea
        • Posterior insertion of oesophageal muscle
        • Posterolateral origin of posterior cricoarytenoid muscle
        • Lateral and anterior origin of cricothyroid and inferior constrictor
        • Superior edge origin of lateral cricoarytenoid muscle and posteriorly articulation with arytenoid cartilages
      • Epiglottis
        • Leaf-shaped elastic cartilage
        • Inserts into thyroid cartilage
        • Anterior attachment to hyoepiglottic ligament
        • Median and lateral glossoepiglottic folds attach to tongue
        • Lateral aryepiglottic folds
    • Three paired cartilages
      • Arytenoids
        • Tetrahedral cartilages
        • Anterior vocal process attaches to vocal ligament
        • Lateral muscular process attaches to posterior and lateral cricoarytenoid muscles
        • Posterior surface attaches to transverse arytenoid muscle (to other arytenoid)
        • Anterolateral attachment to vocalis and thyroarytenoid muscle
        • Rotates to open or close vocal cords
      • Cuneiforms
      • Corniculates
        • Contained in aryepiglottic folds
  • Muscles
    • Extrinsic
      • Move the larynx
    • Intrinsic
      • Sphincter muscles
        • Transverse and oblique arytenoid, and aryepiglottic muscles bring the opening of the larynx closed
      • Muscles of vocal folds
        • Tensing of vocal cords by cricothyroid
        • Slackening of vocal folds by thyroarytenoid and vocalis muscles
        • Adduction of vocal folds by lateral cricoarytenoid and transverse arytenoid muscles
        • Abduction of vocal cords by posterior cricoarytenoid muscles
        • All supplied by recurrent laryngeal nerve except cricothyroid (external laryngeal nerve). Fibres from XI travelling in X.
  • Sensory innervation
    • X internal laryngeal nerve above vocal cords
    • X recurrent laryngeal nerve below vocal cords

Kindly provided by Dr James Mitchell from his pharmacodynamics series

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