The Orbital Margin

• The frontal, maxillary and zygomatic bones contribute equally to the formation of the orbital margin.

• The supraorbital margin is composed entirely of the frontal bone.
• At the junction of its medial and middle thirds is the supraorbital foramen (sometimes a notch), which transmits the supraorbital nerves and vessels.

• The lateral orbital margin is formed almost entirely of the frontal process of the zygomatic bone.

• The infraorbital margin is formed by the zygomatic bone laterally and the maxilla medially.

• The medial orbital margin is formed superiorly by the frontal bone and inferiorly by the lacrimal crest of the frontal process of the maxilla.
• This margin is distinct in its inferior half only.

Sternum

o    Forms the medial part of the anterior chest wall
o    Manubrium (upper part)-clavicle and first rib articulate with the manubrium .
o    Body (middle blade)-second and tenth ribs articulate with the body via the costal cartilages
o    Xiphoid (blunt cartilaginous tip)

Ribs (12 pairs)

o    Each rib articulates with both the body and the transverse process of its corresponding
o    thoracic vertebra
o    The second to ninth ribs articulate with the body of the vertebra above'
o    Ribs curve outward, forward, and then downward
o    Anteriorly, each of the first seven ribs joins a costal cartilage that attaches to the sternum
o    Next three ribs (eighth to tenth) join the cartilage of the rib above
o    Eleventh and twelfth ribs do not attach to the sternum; are called "floating ribs"

The Middle Ear

• This part of the ear is in a narrow cavity in the petrous part of the temporal bone.
• It contains air, three auditory ossicles, a nerve and two small muscles.
• The middle ear is separated from the external acoustic meatus by the tympanic membrane.

• This cavity includes the tympanic cavity proper, the space directly internal to the tympanic membrane, and the epitympanic recess, the space superior to it.

• The middle ear is connected anteriorly with the nasopharynx by the auditory tube.
• Posterosuperiorly, the tympanic cavity connects with the mastoid cells through the aditus ad antrum (mastoid antrum).
• The tympanic cavity is lined with mucous membrane that is continuous with the mucous membrane of the auditory tube, mastoid cells, and aditus ad antrum.

Contents of the Tympanic Cavity or Middle Ear

• This cavity contains the auditory ossicles (malleus, incus and stapes); the stapedius and tensor tympani muscles; the chorda tympani nerve (a branch of the facial nerve, CN VII); and the tympanic plexus of nerves.

Blood Supply to the Head and Neck

• Most arteries in the anterior cervical triangle arise from the common carotid artery or one of the branches of the external carotid artery.
• Most veins in the anterior cervical triangle are tributaries of the large internal jugular vein.

The Common Carotid Arteries

• The right common carotid artery begins at the bifurcation of the brachiocephalic trunk, posterior to the right sternoclavicular joint.
• The left common carotid artery begins arises from the arch of the aorta and ascends into the neck, posterior to the left sternoclavicular joint.

• Each common carotid artery ascends into the neck within the carotid sheath to the level of the superior border of the thyroid cartilage.
• Here it terminates by dividing into the internal and external carotid arteries. 

The Internal Carotid Artery

• This is the direct continuation of the common carotid artery and it has no branches in the neck.
• It supplies structures inside the skull.
• The internal carotid arteries are two of the four main arteries that supply blood to the brain.

• Each artery arises from the common carotid at the level of the superior border of the thyroid cartilage.
• It then passes superiorly, almost in a vertical plane, to enter the carotid canal in the petrous part of the temporal bone.

• A plexus of sympathetic fibres accompany it.

• During its course through the neck, the internal carotid artery lies on the longus capitis muscle and the sympathetic trunk.
• The vagus nerve (CN X) lies posterolateral to it.

• The internal carotid artery enters the middle cranial fossa beside the dorsum sellae of the sphenoid bone.
• Within the cranial cavity, the internal carotid artery and its branches supply the hypophysis cerebri (pituitary gland), the orbit, and most of the supratentorial part of the brain. 

The External Carotid Arteries 

• This vessel begins at the bifurcation of the common carotid, at the level of the superior border of the thyroid cartilage.
• It supplies structures external to the skull.

• The external carotid artery runs posterosuperiorly to the region between the neck of the mandible and the lobule of the auricle.
• It terminates by dividing into two branches, the maxillary and superficial temporal arteries.
• The stems of most of the six branches of the external carotid artery are in the carotid triangle. 

The Superior Thyroid Artery

• This is the most inferior of the 3 anterior branches of the external carotid.
• It arises close to the origin of the vessel, just inferior to the greater horn of the hyoid.
• The superior thyroid artery runs anteroinferiorly, deep to the infrahyoid muscles and gives off the superior laryngeal artery. This artery pierces the thyrohyoid membrane in company with the internal laryngeal nerve and supplies the larynx.

The Lingual Artery

• This arises from the external carotid artery as it lies on the middle constrictor muscle of the pharynx.
• It arches superoanteriorly, about 5 mm superior to the tip of the greater horn of the hyoid bone, and then passes deep to the hypoglossal nerve, the stylohyoid muscle, and the posterior belly of digastric muscle.

• It disappears deep to the hyoglossus muscle.
• At the anterior border of this muscle, it turns superiorly and ends by becoming the deep lingual artery.

The Facial Artery

• This arises from the carotid artery either, in common with the lingual artery, or immediately superior to it.
• In the neck the facial artery gives off its important tonsillar branch and branches to the palate and submandibular gland.
• The facial artery then passes superiorly under the cover of the digastric and stylohyoid muscles and the angle of the mandible.

• It loops anteriorly and enters a deep groove in the submandibular gland.

• The facial artery hooks around the inferior border of the mandible and enters the face. Here the pulsation of this artery can be felt (anterior to the masseter muscle).

The Ascending Pharyngeal Artery

• This is the 1^st or 2^nd branch of the external carotid artery.
• This small vessel ascends on the pharynx, deep to the internal carotid artery.
• It sends branches to the pharynx, prevertebral muscles, middle ear and meninges.

The Occipital Artery

• This arises from the posterior surface of the external carotid near the level of the facial artery.
• It passes posteriorly along the inferior border of the posterior belly of digastric.
• It ends in the posterior part of the scalp.
• During its course, it is superficial to the internal carotid artery and three cranial nerves (CN IX, CN X and CN XI).

The Posterior Auricular Artery

• This is a small posterior branch of the external carotid artery.
• It arises from it at the superior border of the posterior belly of the digastric muscle.
• It ascends posteriorly to the external acoustic meatus and supplies adjacent muscles, the parotid gland, the facial nerve, structures in the temporal bone, the auricle, and the scalp. 

The Internal Jugular Vein

• This is usually the largest vein in the neck.
• The internal jugular vein drains blood from the brain and superficial parts of the face and neck.
• Its course corresponds to a line drawn from a point immediately inferior to the external acoustic meatus to the medial end of the clavicle.

• This large vein commences at the jugular foramen in the posterior cranial fossa, as the direct continuation of the sigmoid sinus.

• The dilation at its origin is called the superior bulb of the internal jugular vein.
• From here it runs inferiorly through the neck in the carotid sheath.

• The internal jugular vein leaves the anterior triangle of the neck by passing deep to the SCM muscle.
• Posterior to the sternal end of the clavicle, it unites with the subclavian vein to form the brachiocephalic vein.
• Near its termination is the inferior bulb of the jugular vein contains a bicuspid valve similar to that of the subclavian vein.

• The deep cervical lymph nodes lie along the course of the internal jugular vein, mostly lateral and posterior.

Tributaries of the Internal Jugular Vein

• This large vein is joined at its origin by the: inferior petrosal sinus, the facial, lingual, pharyngeal, superior and middle thyroid veins, and often the occipital vein.

The Temporomandibular Joint

• This articulation is a modified hinge type of synovial joint.
• The articular surfaces are: (1) the head or condyle of the mandible inferiorly and (2) the articular tubercle and the mandibular fossa of the squamous part of the temporal bone.

• An oval fibrocartilaginous articular disc divides the joint cavity into superior and inferior compartments. The disc is fused to the articular capsule surrounding the joint.

• The articular disc is more firmly bound to the mandible than to the temporal bone.

• Thus, when the head of the mandible slides anterior on the articular tubercle as the mouth is opened, the articular disc slides anteriorly against the posterior surface of the articular tubercle

The Paranasal Sinuses

• These sinuses are air-filled extensions of the respiratory part of the nasal cavity.
• They are in the following bones, frontal, ethmoid, sphenoid and the maxilla.

The Frontal Sinuses

• These are located between the outer and inner tables of the frontal bone, posterior to the superciliary arches.

The Ethmoidal Sinuses

• These comprise of several small cavities, called ethmoidal air cells, within the ethmoidal labyrinth (G. labyrinthos, a maze) of the lateral mass of the ethmoid bone.

The Sphenoidal Sinuses

• These occupy a variable amount in the body of the sphenoid bone and may extend into the wings.

The Maxillary Sinuses

• These are the largest pair of paranasal sinuses.
• They are pyramidal-shaped cavities that may occupy the entire bodies of the maxillae.