Artery

Subclavian a.

flowchart LR subgraph first v & it & tt end subgraph second c end subgraph third d end s[Subclavian a.] s===>ax[axillary a.] s-->v[Vertebral a.] v--foramen magnum-->b[Basilar a.] s-->it[Internal thoracic a.] s-->tt[Thyrocervical trunk] s-->c[costal cervical trunk] c-->dc[Deep cervical a.] c-->hi[Highest intercostal] s--70%-->d[Dorsal scapular a.]

Info

Scalene m.
ant.,mid. scalene insertion at rib 1
post. scalene insertion at rib 2

Thyrocervical trunk

graph TB; a(thyrocervical trunk)-->b(TCA); b--30%-->d(dorsal scapular a.); a-->c(inf. thyroid a.); a-->e(suprascapular a.); a-->f(ascending cervical a.);

Axillary a.

Common carotid

carotid sheath
頸部無分支

External carotid

graph LR e[External carotid] e-->st[Sup.thyroid a.]-->|分支|sl[Sup. laryngeal a.] e--digastric下-->l[Lingual a.]-->舌 e--digastric上-->f[Facial a.] e-->ap[Ascending pharyngeal a.] e--沿著digastric深層-->o[Occipital a.] e-->a[Post. auricular a.] e-->m[Maxillary a.] e-->sp[Superficial temporal a.]--分支-->tf[Transverse facial a.] sp[Superficial temporal a.]--分支-->mt[Mid. temporal a.] subgraph 往後 ap o a end

lingual a.: hyoglossus m. 深層，digastric下

Info

由深而淺
lingual a. $\rightarrow$ hyoglossus m. $\rightarrow$ lingual v.&n.

Superficial temporal a.: 從耳前上穿出

Danger

Deep temporal a.

Facial a.

digastric上

graph LR 1[facial a.] 1-->2[sup. labial a.] 1-->3[inf. labial a.] 1-->4[angular a.] 4--supraobrital foramen-->11[supraorbital, supratrochlear a.] 10[facial a.]==submandibular gland 上==>1 10-->a[ascending palatine a.] 10-->t[tonsillar b.] 10--> s[Submental a.]

Ascending palatine a.

Styloglossus, Stylopharyngeus m. 之間，levator veli palatini m.附近分兩支：
支配軟顎
支配palatine tonsil, auditory tube

Maxillary a.

Mandibular part
Pterygoid part
Pterygopalatine part

Info

Maxillary a.通過pterygoid muscle淺層，穿入pterygopalatine fossa

First part

flowchart LR subgraph Brain mm[Middle meningeal a.] am[Accessory meningeal a.] end subgraph Mandibular ia[Inf. alveolar] end subgraph TMJ at[Ant. tympanic a.] ds[Deep auricular a.] end at & ds-->T[TMJ] am--foramen ovale-->5[CN V] mm--foramen spinosum-->bm[腦膜] ia--mental foramen-->Mental ia-->m[Mylohyoid a.] at--tympanic cavity-->tm[ tympanic membrane ]

Ant. tympanic a.: 進入 tympanic cavity，供應 tympanic membrane
Middle meningeal: 被Auriculotemporal n. 環繞

Second part

皆有(CN V₃)伴行，除了Buccal n.為sensory，其為motor

Ant./post. deep temporal a.
Buccal a.
Masseteric a.
Pterygoid a.

Third part

皆有sensory 伴行，穿入pterygopalatine fossa

flowchart LR psan[Post. sup. alveolar n.] io[Infraorbital a.] dp[Descending palatine a.] v[Vidian a.] ph[Pharyngeal a.] sp[Sphenopalatine a.] psa[Post. sup. alveolar a.] subgraph a[穿過 pterygomaxillary fissure] io & sp & v & ph & dp & psan end iof([infraorbital fissure]) sf([sphenopalatine foramen]) p([pterygoid canal]) pc([Palatine canal]) phc([pharyngeal canal]) pf([pterygomaxillary fissure]) v-->p dp-->pc pc-->|往前|gp[Greater palatine a.]-->hpl[Hard palate] pc-->|往後|lp[Lesser palatine a.]-->spl[Soft plate] sp-->sf-->n[Nose]-->ic[Incisive canal] psan-->pf-->mt io-->iof-->ee[Lacrimal g.] iof-->sa[ant./mid. sup. alveolar a.] ph-->phc psa--->mt[maxillary tuberosity]

Sphenopalatine a.: 最終分支，進入 Sphenopalatine foramen，支配鼻竇
Vidian a.: Vidian n.
maxillary tuberosity: on alveolar bone

Superior thyroid artery

Infrahyoid br.
Sup. laryngeal a.
SCM br.
Cricothryoid br.

Tympanic artery

graph LR eca[ECA] apa[ Ascending Pharyngeal a.] ita[ Inf. tympanic a.] eca --> apa -->ita paa[ Post. auricular a.] sma[ Stylomastoid a.] eca --> paa --> sma --> pta[Post. tympanic a.] mma[Mid. meningeal a.] ma[Maxillary a.] ---> ata[Ant. tympanic a.] ma --> mma --> sta[Sup. tympanic a.] ica[ICA] ---> cta[Carotico tympanic a.]

SCM血液

上1/3

Occipital a.

中1/3

Sup. thyroid a.
Ext. carotid a.

下1/3

suprascapular a. (>80%)

Internal carotid a.

進入carotid canal 前無分支
CN X 伴行
Carotid canal入顱
carotid a. 夾 Stylopharyngeus m.(CN IX) , Styloglossus m. (CN XII)

Cerebral arterial circle

Ophthalmic a.

Dorsal nasal a.
Supratrochlear a.
- Ant./ Post. ethmoid a.
Supraorbital a.
Ciliary a.
Lacrimal a.

Vein

Info

subclavian vein 在ant. scalene m. 上方

graph TB scl[Subclavian v.] ej[EJV] sc[Suprascapular v.] aj[Ant. jugular v.] rm[Retromandibular v.] cb[communicating br.] bm[Submental v.] c[common facial v.] f[Facial v.] sc-->ej bm---aj aj-->ej cb-->aj rm===>ej rm-->c f-->c TCV-->ej ej==>scl sp[Superficial temporal v.]-->rm m[Maxillary v.]-->rm c-->cb cb---bm mt[Mid. temporal v.]-->sp

顱內

Nerve

Info

感覺神經 1, 2, 8
運動神經 3, 4, 6, 11, 12
副交感 3, 7, 9, 10

CN	Origin	foramen
I	嗅球	cribriform plate
II	Optic Chiasma	optic canal
III, IV	Midbrain	sup orbital fissure
V₁, VI	pons	sup orbital fissure
V₂		foramen rotundum
V₃		foramen ovale
VII		Internal coustic meatus
VIII	Pons, Medulla 之間	Internal coustic meatus
IX, X, XI	Medulla	jugular foramen
XII	Medulla	Hypoglossal canal

CN III, IV, VI

眼眶

CN III

Superior br.
- Motor
- sup. rectus m.
- levator palpebrae superioris m.
- sup. tarsal m.
Inferior br.
- Motor
- inf. rectus m.
- med. rectus m.
- inf. oblique m.
- Parasympathetic
- ciliary ganglion
  - sphincter pupillae m.(瞳孔括約肌)
  - ciliary m.(水晶體曲度)

injure

CN IV

Motor

Sup. oblique m.

injure

複視

CN VI

Lateral rectus m.

CN V1

Lacrimal n.
- lacrimal g.
Nasociliary n.
- Ant./ Post. ethmoid n.
  - 進入Ethmoid sinus
- Infratrochlear n.
- Long ciliary n.
  - 瞳孔擴張
Frontal n.
- Supratrochlear n.
- Supraorbital n.

CN V2

flowchart LR subgraph iof[Inferior Orbital fissure] MSA ASA i[Infraorbital n.]--> MSA & ASA end subgraph pf[Pterygopalatine Fossa] z[Zygomatic n.] gl[Pterygopalatine ganglion] PSA 22[CN V2]-->z & gl & PSA end z-->zf[Zygomaticofacial] & zt[Zygomaticotemporal] 2[CN V2]--->|foramen rotundum|22--->i

Post. sup. alveolar n.

穿過 pterygomaxillary fissure，支配上顎臼齒(molars)，除了第一大臼齒(mid. sup alveolar n.)

Warning

PSA a.
Alveolar bone

Infraorbital n.

感覺神經

Ant./Mid sup. alveolar n.
- 與動脈伴行
Sup. labial br.
Nasal br.

Pterygopalatine ganglion

位於pterygopalatine fossa

flowchart LR pg[Pterygopalatine ganglion] subgraph a[過Sphenopalatine foramen] nn[Nasopalatine n.] psn[Post. sup. nasal n.] end subgraph v[過Palatine canal] gp[Greater palatine n.] lp[Lesser palatine n.] end subgraph g[過Pharyngeal canal] ph[Pharyngeal n.] end pg-->nn-->spt[鼻中膈]-->if[Incisive canal] pg-->psn-->con[鼻甲] pg-->gp & lp & ph lp-->s[Soft palate] gp-->h[hard plate] pg-->pp[post. ganglionic Paresympathetic fiber]-->l[Lacrimal g.] click if "#alveolar-bone"

CN V3

Meningeal br.

進入 foramen spinosum

Anterior division

支配咀嚼肌

Masseteric n.
Anterior and posterior deep temporal n.
Medial pterygoid n.
Lateral pterygoid n.
Buccal n.(Sensory)

Posterior division

Auriculotemporal n.
- 夾 mid. meningeal a.
- 走進 Digastric, Stylomastoid 之間
Lingual n.
- Chorda tympanic 匯入
Inf. alveolar n.
- Mental n.
  - 進入Mandibular foramen
  - Incisive n.
    - 下顎前牙感覺
Mylohyoid n. (Motor)

CN VII

Parotid plexus(支配表情肌)
- Temporal br.
- Zygomatic br.
- Buccal br.
- Marginal mandibular br.
- Cervical br.
Greater petrosal n.(Parasymphysis)
- Mucous g.
- Lacrimal g.
Stapedius n.
- 支配Stapedius m.
Chorda Tympanic n.(Parasymphysis)
- 支配前 $\frac{2}{3}$ 味覺
- Submandibular, Sublingual g.

flowchart LR 0[CN VII 顱內] 1((Geniculate ganglion)) c((Stylomastoid foramen)) pab[Post. auricular branch] nd[N. to digastric m.] ns[N. to stylohyoid m.] 0==>|Inter acoustic meatus|1 c-->pab fc==>c fc-->ct[Chorda tympanic]--Petrotympanic fissure-->l[Lingual n.] 1-->gp[Great petrosal n.]-->v[vidian n.] c-->ff[Parotid plexus] c-->nd & ns 1-->fc[Facial canal] click l "#posterior-division" click c "#temporal-bone"

Parotid plexus

Chorda tympanic

Great petrosal and Vidian

Lesser petrosal n.

CN VIII

Vestibular n. (平衡)
Cochlear n. (聽力)

CN IX

Motor

Stylopharyngeus m.
Lesser petrosal n.(Parasymphysis)
- 支配Parotid g.的副交感節前神經

Sensor

Tympanic n.
- 中耳、鼓膜內面、耳咽管(Eustachian)
Sinus n.

Terminal

Pharyngeal br.(with CN X)
- Mucosa of oropharynx
Tonsillar br.
- Palatine tonsil
Lingual br.
- 舌頭後1/3味覺、一般感覺

分隔ECA,ICA

CN X

Structure

common carotid a. 外側，蓋在 thyrocervical trunk 上
recurrent laryngeal n.沿 tracheoesophageal groove 攀升(就是食道和氣管中間)，接觸 medial thyroid gland，向內鑽到 inf. constrictor，進入 larynx，同時支配感覺與運動

Auricular br(腦內)
- Ext. acoustic meatus

所有 plato- 除了 Tensor veli palatini
- Palatoglossal m.
Pharyngeal br.
- Pharynx (除了 Stylopharyngeus)

Larynx

Sup. laryngeal n.
- Internal br.(Internal laryngeal n.)
  - Laryngopharynx
  - Larynx (Vocal fold 以上)
  - 舌根、Epiglottis 味覺
- External br.
  - Cricothyroid m.
Recurrent laryngeal n.
- 過Cricothyroid joint改叫Inf. laryngeal n.
- 支配所有軟骨間肌，除了 Cricothyroid m.
- 假聲摺以下的喉部黏膜感覺

recurrent laryngeal n.

left: arch of aorta
right: Subclavian a.

Sensor

CN XI

Spinal root(C₁-C₅)混合
向後支配SCM, Trapezius

CN XII

跨過ECA所有分支，除了Occipital a.
與Ansa cervicalis 混和
支配舌部肌肉

Cervical plexuses

graph TB b([運動]) c{{感覺}}

graph LR ansa([ansa cervicalis]); phrenic([phrenic n.]); tcn{{T. cervical n.}}; ga{{great auricular n.}}; sc{{supraclavicular n.}}; lo{{lesser occipital n.}}; c1-->ansa; c2-->ansa; c3-->ansa ansa--向上繞-->12[CN XII] c2 & c3-->cutaneous-->tcn & ga & lo c3 & c4-->sc-->p[穿出platysma] c3-->phrenic c4-->phrenic c5-->phrenic phrenic--ant. scalene m. 上方-->diaphragm[橫膈]

Ansa cervicalis

Omohyoid
Sternohyoid
Sternothyroid
Geniohyoid
Thyrohyoid

Sup. cervical ganglion

支配carotid plexus, pharyngeal plexus

Gland

flowchart TB subgraph 7[CN VII] gp[Great petrosal n.] v[Vidian n.] ct[Chorda tympanic n.] end subgraph 9[CN IX] tp[tympanic plexus] lp[Lesser petrosal n.] end subgraph 52[CN V2] z end subgraph 53[CN V3] l[Lingual n.] end subgraph 54[CN V3] a[Auriculotemporal n. ] end subgraph 51[CN V1] lc end oga([Otic ganglion]) mga([Submandibular ganglion]) tp-->lp-->|foramen ovale|oga-->a--->p[(Parotid g.)] ct---->l-->mga-->lg[(Sublingual g.)] & mg[(Submandibular g.)] gp--> v-->|Foramen Lacerum, Pterygoid canal|pga([Pterygopalatine ganglion]) pga-->z[Zygomatic n.]-->lc[Lacrimal n.]-->ag[(Lacrimal g.)] pga---->mug[(Mucous g.)] click pga "#pterygopalatine-ganglion" click a "#posterior-division" click l "#posterior-division" click lp "#cn-ix" click ct "#chorda-tympanic-n" click z "#cn-v2" click lc "#cn-v1"

Muscle of Mastication

都是CN V₃支配

	Masseter		Temporalis	Medial pterygoid		Lateral pterygoid
	Superficial	Deep	-	Superficial	Deep	Upper	Lower
Origin	zygomatic arch		inferior temporal line temporal fascia	Maxillary tuberosity Pyramidal process of the palatine	Medial surface of lateral pterygoid plate	Greater wing	Lateral surface of lateral pterygoid plate
Insertion	Angle inferior and lateral ramus	Superolateral ramus Coronoid process	Coronoid process anterior border of ramus	Medial ramus angle		Articular disc capsule of the TMJ	Pterygoid fovea
Actions	Elevates Protrudes		Elevates Retrudes	Elevates Protrudes		Depresses Protrudes

Osteology

分類

顱骨(8)	顏面骨(14)
Occipital Ethmoid Frontal Temporal Parietal Sphenoid	vomer Mandible inf. nasal conchae nasal Maxilla Zygoma Lacrimal Palatine

再生三要件

Cell
Scaffold
Growth factors

一些單字

notch: 壓跡
eminence: 最凸點

骨頭

Frontal bone

Frontal sinus
Supraorbital notch/foramen
Glabella(眉間)
Lacrimal fossa

相鄰骨

Pr, S, L, N, E, Z, Mx

Parietal bone

Sagittal suture
Lambdoidal suture

相鄰骨

F, O, T, S, Pr’

Ethmoid bone

Cribriform plate
- Olfactory n. (CN I)
superior and middle Nasal concha

inferior Nasal concha

Sphenoid bone

pterygoid hamulus
Foramen rotundum
- CN V₂
Foramen ovale
- CN V₃
Foramen spinosum
- Mid. meningeal a.
Pterygoid canal
- vidian a./n.
Foramen lacerum (破裂孔)
Optic canal
- CN II
- Ophthalmic a.
Sup. orbital fissure
- Ophthalmic n.(CN V₁)/ v.
- CN III, IV, VI

相鄰骨

F, O, T, E, Pr, V, Z, Pl, Mx

上視圖

前視圖

後視圖

Temporal bone

Carotid canal
- ICA
Ext. acoustic meatus
Int. acoustic meatus
- CN VII, VIII
Jugular foramen
- int. jugular v.
- CN IX, X, XI
Stylomastoid foramen
- parotid plexus
Foramen lacerum
Petrotympanic fissure
- chorda tympanic
Zygomatic process
articular eminence

相鄰骨

Pr, O, S, M

Occipital bone

Hypoglossal canal
- CN XII
Foramen magnum
- Spinal cord
- Vertebral a.
- CN XI
Jugular foramen
Foramen lacerum

相鄰骨

Pr, T, S, C1

Vomer

Maxillary bone

four process
- frontal
- zygomatic
- palatine
- alveolar
Infraorbital fissure
- Infraorbital n./ a.

相鄰骨

F, Z, N, L, V, E, Pl, S, INC

骨折

Alveolar bone

Palatine process
Alveolar process
Maxillary tuberosity (智齒後)
- PSA foramen (a./ n.)
Incisive canal
- nasopalatine n. and vessel

Palatine bone

Greater palatine foramen
Lesser palatine foramen
Greater/ lesser palatine n.

Lacrimal bone

淚囊（lacrimal sac）

相鄰 lacrimal bone, maxillary bone

相鄰骨

F, Mx, E, INC

Mandible

Symphysis & Parasymphysis $\rightarrow$ Body $\rightarrow$ Ramus
Condylar process
Coronoid process
Mandibular foramen
- Mental n.
- 第一小臼齒下
Mental foramen
Lingula (小舌)
Mental spine (頦棘)
Sublingual g. $\rightarrow$ Mylohyoid line $\rightarrow$ Submandibular g.
Oblique line
- 7,8外
Antegonial notch
facial a./v.經過

國考毒瘤

肌肉接點

Hyoid bone

眼眶

腦洞們

Buttress

傳導力量

Sutures

Coronal
Sagittal
Lambdoidal(人字)
Squamosal(鱗)
Temporozygomatic
Median palatine
Transverse palatine

發育年表

2y
- 額骨融合
4y
- 枕骨軟骨融合
16-20y
- Sphenoid, Occipital 融合

Lymphatic system

總圖

Nodes

flowchart LR aa([Ant. auricular]) pa([Post. auricular]) p([parotid]) o([Occipital]) idc([Inf. deep cervical]) sc([Superficial cervical]) sm([Submandibular node]) smt([Submental]) rp([Retropharyngeal]) subgraph sdc[Sup. deep cervical] jd([Jugulodigastric]) jo([Jugulo-omohyoid]) end sc-->sdc aa--> p pa-->sdc sm-->sdc sdc-->idc o -->idc rp-->jd smt-->jo p-->jd

Lingual Lymphatic nodes

病灶

Groups

Level I: the submental group (Ia), and the
submandibular group (Ib).
Level II: the upper jugular lymph nodes

level IIa – CN XI 前
level IIb – CN XI 後

Level III: the middle jugular lymph nodes
Level IV: the lower jugular lymph nodes
Level V: all lymph nodes contained within the posterior triangle
Level VI: lymph nodes of the anterior (central) neck compartment

Tip

清除 I, II, III

Nasal cavity

flowchart LR sm([Submandibular]) rp([Retropharyngeal]) subgraph Nasal nasal[鼻腔] f & e & m sp[Sphenoid Sinus] end nasal--前1/3-->sm nasal--後2/3-->rp f[Frontal Sinus]-->sm e[Ethmoid Sinus]--Ant./Mid. -->sm e--Post. -->rp m[Maxillary Sinus]-->sm sp-->rp

Oral cavity

flowchart LR sdc([Sup. deep cervical]) sm([Submandibular node]) smt([Submental]) rp([Retropharyngeal]) rp-->sdc subgraph Oral gums hp[Hard palate] sp[Soft plate] Tonsil[Palatine tonsil] Floor end gums-->sm hp--Ant. -->sm hp--Post. -->sdc sp-->rp & sdc Floor--->sdc Floor--Ant. -->smt Floor--Post. -->sm Tonsil-->sdc

Tongue

flowchart LR jo([Jugulo-omohyoid]) smt([Submental]) sm([Submandibular node]) sdc([Sup. deep cervical]) Apical-->jo & smt Central-->sdc & smt & sm Marginal-->smt & sdc Basal -->sdc

Tonsil

Waldeyer’s tonsillar ring

flowchart LR rp([Retropharyngeal]) jd([Jugulodigastric]) idc([Inf. deep cervical]) pa[Palatine tonsil] ph[Pharyngeal tonsil] lp[Laryngeal pharynx] o[Oropharynx tonsil] ue[Upper esophagus] pa & o -->jd ph-->rp lp & ue -->idc

Face

Maxillary
Buccinator
Supramadibular

Larynx

用vocal fold 分，上,下分別到SDC, IDC

Thyroid

跟著Sup./ Inf. thyroid a.走，分別到SDC, IDC

Nose

Bone

Frontal (nasal process)
Maxilla (frontal process)
Nasal

Cartilage

Septal
Lateral nasal
Alar

Artery

Ophthalmic a.

Dorsal nasal a.
External nasal a.

Infraorbital a.

Nasal br.

Superior labial a

Septal a.
Alar a.

Nerve

Ant. ethmoid n.
- Int./ Ext. nasal n.
  - 鼻內/ 外感覺
Nasociliary br.
Infraorbital n.
- Nasal br.

Nose cavity

Hypophyseal fossa

腦下垂體在這

Nasal septum (鼻中膈)

nasal sepal cartilage
perpendicular plate of ethmoid
vomer

Nerve

Olfactory n. (CN I)

Ophthalmic n.

Anterior ethmoid n.
- 中下鼻甲前測一般感覺

Maxillary n.

Infraorbital n.
Pterygopalatine ganglion
- Post. inf. nasal Br. of Greater palatine n.
- Nasopalatine n.
  - 走在鼻中隔
  - 穿過 Incisive canal
- Post. lat./med. sup. nasal n.

Artery

Ant./ Post. ethmoid a.
- 供應鼻中隔
Sup. labial a.
- Septal br.
Maxillary a.
- Sphenopalatine a.
  - to Incisive canal
- Greater palatine a.

Paranasal sinuses

鼻旁竇，濕潤呼吸的空氣

	Artery/ Nerve
Frontal	Ophthalmic br./ division
Maxillary	Maxillary br./ division
Ethmoid	Ophthalmic br. Maxillary br.
Sphenoid	Ophthalmic br. Maxillary br.

flowchart LR sr[Sphenoethmoidal recess] s[Sup. meatus] m[Mid. meatus] i[Inf. meatus] ss[Sphenoid s.]--->sr pse[Post.ethmoid s.]--->s aes[Ant. ethmoid s.]--->m mse[Mid. ethmoid s.]--->m ms[Maxillary s.]--->m fs[Frontal s.]-->ei[ethmoidal infundibulum]-->m

Frontal sinus

神經皆CN V₁

Anterior ethmoid a.
Supraorbital a./n.
Supratrochlear (滑車上) a./n.

Maxillary sinus

來自Maxillary a. 3rd Part, Maxillary division

Ant./mid. sup. alveolar a./n.
Post. sup. alveolar a./n.

Ethmoid sinus

ethmoid bulla

Mid. ethmoid sinus 開口

Ant. ethmoid a./n.
Post. ethmoid a./n.
Post. lateral nasal a./n.

Sphenoid sinus

Post. ethmoid a./n.
Post. lateral nasal a./n.

Ear

TMJ

Supply

artery

Anterior:
- Masseteric a.
Posterior:
- Sup. temporal a. (TMJ br. )
- Ant. tympanic a.
- Deep auricular a.

Vein

Superficial Temporal
Maxillary
Pterygoid plexus

Nerve

Auriculotemporal(Sensor)
Masseteric br. of the mandibular n. (Sensor)
Post. deep temporal nerve

Join capsule

Articular eminence 到 articular fossa

Joint disk

分成 Ant. band(2mm), Central intermediate zone(1mm),
Post. band(3mm)
Dense fiber CT，無神經血管
Lower division 連到 condylar neck 的 lat.,med. poles
Upper division 連到 Temporal bone 的 postglenoid process

collateral ligament

retrodiskal tissues

有神經血管，分秘 Synovial fluid 到 Synovial cavity

Superior retrodiskal lamina:elastic fibers,接到 tympanic plate,限制平行移動
Inferior retrodiskal lamina:Collagen fibers,將 disc 接到 condyle,限制旋轉移動

Ligament

Temporomandibular ligaments
- Inner horizontal protion
  限制向後
- Outer horizontal protion
  限制旋轉、平移
Stylomandibular ligaments
Sphenomandibular ligaments

Info

Stylomandibular ligament 分隔 parotid ,submandibular g.

JAW movement

旋轉: 下顎離上門牙2.5cm
平移: disc-condyle complex 沿 articular eminence 滑動,可再往前張開約 1.5 公分

movement

Alveolar process

Alveolus of maxillary central incisor
Interdental septum
Interradicular septa
Alveolar eminence

Dehiscence & Fenestration

Sharpey’s fiber

牙齒與齒槽之間，包含縱向 principal fiber(Sharpey’s fiber) 連接牙齒與齒槽骨

區分process

上門齒

側門牙根較靠近鼻腔底

上犬齒

唇側齒槽薄
顎板比小臼齒厚

上臼齒

Maxillary sinus下
大臼齒牙根分內外

下門、犬齒

alveolar process 薄

下臼齒

alveolar process 厚
5 在 mental fossa上方
6, 7, 8有 Oblique line
6, 7 多牙根一前一後，distal 可能多個
8 在Submandibular fossa 上

區分上下顎

下顎Cortical plate 厚，越後面越厚
下頷管

Info

cortical plate: 皮質骨，X-ray 下白色
Sponge bone: X-ray 下黑色

Tip

上顎可浸潤麻醉，因為cortical plate薄

舌頭

Structure

Terminal sulcus(terminalis)分前後

Papillae

Filiform

最多
無 taste buds

Fungiform

前側
CN VII

Foliate

舌邊緣
CN VII, CN IX

Circumvallate

後側
CN IX

Nerve

運動

CN XII

感覺

根部 taste/ general sense
- Vagus n.
後 $\frac{1}{3}$ $\frac{1}{3}$ taste/ general sense
- Glossopharyngeal n.
前 $\frac{2}{3}$ $\frac{2}{3}$
- Taste: Chorda tympanic
- General sense: Lingual n

Hyoglossus m. 外側

Lingual n.
Hypoglossal n.
Submandibular duct

Artery

Lingual a.

Genioglossus m., Hyoglossus m.之間

Deep lingual a.
Sublingual a.
- 會合 Submental a. (Facial a. 分支)

Muscle

Extrinsic muscles

Motor:CN XII

移動舌頭

Genioglossus(makes bulk of the tongue)
Hyoglossus
Styloglossus

Motor:CN X (Pharyngeal plexus)

Palatoglossus

Intrinsic muscles

Motor:CN XII

改變舌頭形狀

Sup. longitudinal
Inf. longitudinal
Transverse
Vertical

Oral cavity

上顎

maxilla
- Palatal process
palatine
- Palatal process
Incisive foramen
- Nasopalatine n.
- Sphenopalatine a.
Greater/ Lesser palatine n./a.

Cheek

Parotid papilla
- 上顎第二大臼齒外
pterygomandibular raphe
- pterygomandibular space 邊界

Floor

Sublingual papilla (caruncle)
- Submandibular g. 開口

gums

角化牙齦
- 硬顎內側都是角化牙齦
Mucogingival (藍線)

Salivary g.

Parotid	Submandibular	Sublingual
serous	mostly serious	almost mucous

Parotid g.

Minor salivary g.

Pharynx

Structure

Nasopharynx

Sensor:CN V

Opening of Pharyngotympanic tube (auditory tube, Eustachian tube)
- 前:Salpingopalatine fold
- 後:Torus tubarius $\rightarrow$ Salpingopharyngeal fold
Pharyngeal tonsil

Pharyngotympanic tube

- 通過 Temporal bone - 後2/3是軟骨

Oropharynx

Sensor:CN IX

由外而內

Palatoglossal fold(arch)
Palatine tonsil
Palatopharyngeal fold(arch)
- 分隔口腔與口咽(fauces)

Laryngopharynx

Sensor:CN X

Epiglottis
Choana 後鼻孔
Piriform recess
- (medial) larynx;
- (lateral) thyroid cartilage
- (posterior) Inf. pharyngeal constrictor m.

Muscle

外部

pharyngeal constrictor
- CN X (Pharyngeal plexus) 控制
- 環狀肌肉
外內

Sup Pterygomandibular raphe pharyngeal raphe

Mid Hyoid bone 的 greater horn,
Sup. pharyngeal constrictor

Inf Thyroid cartilage 的 oblique line,
Cricoid cartilage
Stylopharyngeus
- 穿入Sup. Mid. pharyngeal constrictor之間
- CN IX 支配

	外	內
Sup	Pterygomandibular raphe	pharyngeal raphe
Mid	Hyoid bone 的 greater horn, Sup. pharyngeal constrictor
Inf	Thyroid cartilage 的 oblique line, Cricoid cartilage

內部

Vagus 支配

Palatoglossus m
- palatoglossal fold 下
- Palatine aponeurosis $\rightarrow$ lateral side of tongue
Palatopharyngeus m
- palatopharyngeus fold下
- Hard palate and palatine aponeurosis $\rightarrow$ Thyroid cartilage and pharyngeal wall
- salpingopharyngeus m.會合
Salpingopharyngeus m.
- salpingopharyngeal fold下
- Cartilage of pharyngotympanic tube(耳咽管軟骨) $\rightarrow$ thyroid cartilage and pharyngeal wall
Levator veli palatine m.
- From Scaphoid fossa

V₃支配

Tensor veli palatini m.
- 增加軟顎強度
- 打開耳咽管
- 繞過 pterygoid process

藍圈: Pharyngotympanic tube
綠: Tensor veli palatini m.

Nerve

Pharyngeal plexus

CN IX
- 主要 Sensor
- Stylopharyngeus m.
CN X
- 主要 Motor
- Sup. laryngeal n.
CN XI
- Motor

Others

Recurrent laryngeal branch of the vagus
- Part of Inf. constrictor m.
Pharyngeal n.
- Sensor of nasopharynx & the auditory tube
CV V₃
- Tensor veli palatini

Artery

From Ext. carotid a.

Ascending pharyngeal
- stylopharyngeus
- constrictor m.
- palatine tonsil
- soft palate
Sup. thyroid a.
- 穿過 Inf. constrictor m.
- Thyroid gland

From Facial a.

Ascending palatine
- Sup. constrictor m.
- Soft palate
Tonsillar a.
- Sup. constrictor m.
- palatine tonsil

Others

Pharyngeal a.
- Superior portion of the nasopharynx
- Auditory tube
Pharyngeal br. of Inf. thyroid a.

Larynx

Muscle

關閉 Epiglotticus

Thyroepiglotticus m
Aryepiglotticus

Vocal fold

Motor: Recurrent laryngeal n.

Arytenoid m.
- Transverse fiber / Oblique fiber
- Vocal fold adduction
Post. cricoarytenoid
- Vocal fold abduction
Lateral cricoarytenoid m.
- Vocal fold adduction
Thyroarytenoid m.
- Arytenoid cartilage 往前

Motor: External laryngeal n.

Cricothyroid m.

假聲帶:Vestibular Fold

Nerve

Sup. laryngeal n.
- Internal br.(Internal laryngeal n.)
  - Sensor
  - 穿過 Thyrohyoid ligament
- External br.
  - Motor
Recurrent laryngeal n.
- Inf. laryngeal a.伴行
- 過Cricothyroid joint改叫Inf. laryngeal n.

Neck

Triangle

Muscle

舌骨上

肌肉	神經支配
Mylohyoid	CN V₃
Digastric	Ant. belly: CN V₃ Post. belly: CN VII
Stylohyoid	CN VII
Geniohyoid	C₁

舌骨下

肌肉	神經支配
Omohyoid	Ansa cervicalis
Sternohyoid
Sternothyroid
Thyrohyoid m.	C₁

Others

肌肉	神經支配
Trapezius	CN XI
SCM	CN XI

Fasciae

Superficial fascia

表情肌
Platysma

Deep fascia

Head

Temporal fascia
- Temporal arch以上
Masseteric-parotid fascia
- Temporal arch以上
- 連到investing fascia
Buccopharyngeal fascial
- 連到investing fascia
Pterygoid fascia
- Pterygoid m. 外

Neck

Investing fascia
- 最外層
Carotid fascia
Visceral fascia
- 食道呼吸道
Vertebral facial

Space

flowchart TB v[Vestibular space] c[Canine space] b[Buccal space] p[Pterygomandibular space] pd[Parotid space] pp[Parapharyngeal space] sm[Submandibular space] ms[Masticator space] smt[Submental space] click v "#vestibular-space" click c "#canine-space-maxilla" click b "#buccal-space" click p "#pterygomandibular-space" click pd "#parotid-space" c---b b---p pd---pp ms---sm ms---pp sm---smt

Vestibular space

of Maxilla
of Mandible

Canine space (Maxilla)

Nasolabial sulcus

Buccal space

Buccal fat pad
Parotid duct
Facial a.

Parotid space

Parotid g.
Facial n.
ECA
Retromandibular v.

Masticator space

Temporal space

Temporalis m.分隔

Superficial temporal space
Deep temporal space

Infratemporal space

Zygomatic arch 以下

外側
- Temporalis
內側
- Pterygoid plate
Maxillary a.

Pterygomandibular space

Med. pterygoid m.外

Inf. alveolar a./ v./ n.
Lingual n.

Submassetric space

Submental & Submandibular space

Submental

Digastric, Hyoid bone, Mandibular symphysis 為界
Superficial cervical fascia為底，Mylohyoid m. 為頂

Sublingual space

Lingual n./a.
Hypoglossal n.

Cervical spaces

Previsceral space

Parapharyngeal space

顱底到舌骨
倒錐型
Glossopharyngeal n.
Hypoglossal n.
Deep cervical lymphatic node

Retropharyngeal space

Dangerous space
Sup. pharyngeal constrictor m.後

Perivertebral & Paravertebral space

Infratemporal fossa

血管

Maxillary a.

Nerve

CN V₃
CN V₂
Chorda tympanic
Lesser petrosal n.

Pterygopalatine Fossa

Pterygomaxillary fissure

$\rightarrow$ Infratemporal fossa

PSA n.
Maxillary a.
Variable network of veins into the pterygoid plexus

Sphenopalatine foramen

$\rightarrow$ Nasal cavity

Nasopalatine n.
Post. sup. nasal n.
Sphenopalatine vessels

Inferior Orbital fissure

$\rightarrow$ Orbit

Infraorbital n. (CNV₂)
Zygomatic n. (CNV₂)
Infraorbital vessels
Inferior ophthalmic v.

Palatine canal

$\rightarrow$ Hard & soft palate (Oral cavity)

Greater palatine n. and vessels
Lesser palatine n. and vessels

Foramen Rotundum

$\rightarrow$ Middle cranial fossa

CN V₂出顱

Pterygoid canal

$\rightarrow$ Foramen lacerum (破裂孔)

Vidian n.
Vidian a.

Pharyngeal canal

$\rightarrow$ Nasopharynx

Pharyngeal n.
Pharyngeal vessels

Pterygopalatine ganglion

Greater/lesser palatine n.
Nasopalatine n.
Post. sup. nasal n.
Pharyngeal n.

Temporal fossa

Artery

Superficial temporal a.
Middle temporal a.
Anterior & Posterior deep temporal a.

Vein

Superficial temporal:
- Anterior to the Superficial temporal a.
- Joins the maxillary v. to form the
retromandibular v.
Middle temporal:
- Arises deep within the temporalis m. and fascia
- Joins the superficial temporal v. immediately before it passes inferior to the root of the zygomatic arch
Anterior & Posterior deep temporal:
- Drain into the pterygoid plexus of veins
- Also communicate with the middle temporal v.
Maxillary: *
- A short branch formed by a confluence of the pterygoid plexus of veins
- Joins the superficial temporal v. to form the retromandibular v.

Nerve

CN V₃
- Auriculotemporal n.
- Ant. & Post. deep temporal n.
Temporal br. (CN VII)