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Fronto-Parieto-Occipital Region
Boundaries
➢ Anteriorly - supra-orbital margin
➢ Laterally - superior temporal line
➢ Posteriorly - superior nuchal line
Surface Anatomy
➢ Skin - thick and hairy with sebaceous glands
➢ Subcutaneous tissue - richly vascularized
➢ Epicranial aponeurosis - occipitofrontal muscle and aponeurosis
➢ Loose connective tissue
➢ Pericranium
➢ Skull - frontal squama, parietal bone and occipital squama
Neurovasculature
➢ Frontal - supratrochlear and supraorbital arteries, veins and nerves
➢ Temporal - superficial temporal artery and vein, auriculotemporal nerve
➢ Occipital - occipital artery and vein, major occipital nerve
➢ Retroauricular - Posterior auricular artery and vein, minor occipital nerve
Lymphatic Vasculature
➢ Parotid lymph nodes
➢ Occipital lymph nodes
➢ Retroauricular lymph nodes

Base of the Skull
➢

Inferior portion of neurocranium and viscerocranium except from mandible

It features
➢ Alveolar arch of maxillae (free border of alveolar process surrounding and
supporting maxillary teeth)
➢ Palatine process of maxillae
➢ Palatine bone
➢ Sphenoid bone
➢ Vomer bone
➢ Temporal bone
➢ Occipital bone
Hard palate is formed by:
➢ Anteriorly - palatal process of maxillae
➢ Posteriorly - horizontal plates of palatine bones
➢ The free posterior border of hard palate projects posteriorly in median plane as the
posterior nasal spine
➢ Posterior to central incisor teeth is the incisive foramen, a depression in the
midline of bony palate into which incisive canals open
➢ The right and left nasopalatine nerves pass from nose through a variable number of
incisive canals and foramina
➢ Posterolaterally are greater and lesser palatine foramina
➢ Superior to posterior edge of palate are 2 large openings: choanae (posterior nasal
apertures), which are separate by each other by the vomer, an unpaired bone that forms
a part of the bony nasal septum
Sphenoid
➢ Wedged between frontal, temporal and occipital bones
➢ Consists of a body and 3 pairs of processes: greater wings, lesser wings and
pterygoid processes
➢ Greater and lesser wings of sphenoid spread laterally from lateral aspects of body
of the bone
➢ The greater wings have orbital, temporal and infratemporal surfaces apparent in
facial, lateral and inferior views of exterior of cranium
➢ The pterygoid processes, consisting of lateral and medial pterygoid plates, extend
inferiorly on each side of sphenoid from junction of body and greater wings
➢ Groove for cartilaginous part of pharyngotympanic tube lies medial to spine of
sphenoid, inferior to junction of greater wing of sphenoid and petrous part of
temporal bone
➢ Depression in squamous part of temporal bone, called mandibular fossae,
accommodate the mandibular condyles when mouth is closed

Cranial base if formed posteriorly by occipital bone, which articulates with sphenoid
anteriorly
Occipital
➢ 4 parts of occipital bone are arranged around foramen magnum
➢ Major structures pass through this foramen are: spinal cord (where it becomes
continuous with medulla oblongata of the brain); the meninges of the brain and spinal
cord: the vertebral arteries: anterior and posterior spinal arteries; and the spinal
accessory nerve
➢ On lateral parts of occipital bone are 2 large protuberances, the occipital condyles, by
which the cranium articulates with vertebral column
Jugular foramen
➢ Large opening between occipital bone and petrous part of temporal bone
➢ Internal jugular vein and several cranial nerves emerge from the cranium
➢ The entrance to carotid canal for internal carotid artery is just anterior to jugular
foramen
Stylomastoid foramen
➢ Lies posterior to base of styloid process
➢ Transmits facial nerve and stylomastoid artery

Temporal and Mastoid Regions
Temporal Region
Boundaries
➢ Inferiorly - zygomatic arch
➢ Superiorly - superior temporal line
Surface Anatomy
➢ Skin - thin and hairy
➢ Subcutaneous tissue
➢ Superficial temporal artery, vein, zygomaticotemporal nerve and auriculotemporal
nerve
➢ Epicranial fascia
➢ Temporal fascia - 2 sheets - between them is the interfascial temporal space with fat
tissue
➢ Subaponeurotic tissue
➢ Temporal muscle - with deep temporal artery, vein, nerve
➢ Squama temporalis with medial meningeal artery
Mastoid Region
Boundaries
➢ Corresponds to the contour of the mastoid process
➢ Base faces upwards
Surface Anatomy
➢ Skin - thin and fixed
➢ Subcutaneous tissue - less prominent
➢ Posterior auricular muscle
➢ Posterior auricular artery and vein
➢ Fascia - Epicranial aponeurosis - thinner end portion
➢ Periosteum
➢ Trepanation triangle which is continuous with the sigmoid sinus and facial canal
➢ Bone with mastoid cells and mastoid antrum (communicates with the tympanic
cavity)

Infratemporal Region
➢

Irregularly shaped space deep and inferior to zygomatic arch, deep to the ramus of
the mandible and posterior to maxilla

Boundaries
➢ Laterally - ramus of the mandible
➢ Medially - lateral pterygoid plate
➢ Anteriorly - posterior aspect of maxilla
➢ Posteriorly - tympanic plate and mastoid and styloid process of temporal bone
➢ Superiorly - inferior surface of greater wing of sphenoid bone
➢ Inferiorly - where medial pterygoid muscle attaches to mandible near its angle
Contents
➢ Inferior part of temporalis muscle
➢ Lateral and medial pterygoid muscles
➢ Maxillary artery
➢ Pterygoid venous plexus
➢ Mandibular, inferior alveolar, lingual, buccal and chorda tympanic nerve and otic
ganglion

Facial Region
...
Zygomatic, Mental
and Buccal Regions
Infraorbital Region
Boundaries
➢ Superiorly - infraorbital margin
➢ Inferiorly - gingivobuccal fold
➢ Medially - nasolabial sulcus
➢ Laterally -zygomatic region
Surface Anatomy
➢ Skin - thin
➢ Subcutaneous tissue containing infraorbital (sensory) and buccal (motor nerves),
facial artery and vein
➢ Muscle layer - orbiculus oculi, caninus, levator labii superioris, levator superioris
alaeque nasi
➢ Canine fossa with infraorbital foramen (infraorbital artery, vein and nerve)
Mental Region
Boundaries
➢ Superiorly - gingivobuccal fold
➢ Inferiorly - mandibular base
Surface Anatomy
➢ Skin - thick and hairy with sebaceous glands
➢ Subcutaneous tissue - arranged in lobules with fibrous bundles or muscle bundles
➢ Muscle layer - depressor anguli oris, depressor labii inferioris, mentalis
➢ Facial artery (gives rise to the inferior labial artery), mental artery (branch of
mandibular artery) and vein, lymph nodes, mental nerve
➢ Mandible
Zygomatic Region
Boundaries
➢ Superiorly - boundaries of the zygomatic bone
Surface Anatomy
➢ Skin - thin
➢ Subcutaneous tissue
➢ Muscle layer - orbiculus oculi, zygomaticus major and minor
➢ Infraorbital nerve, zygomaticofacial nerve
➢ Zygomatic bone

Buccal Region
Boundaries - buccal tissue without bone
➢ Superior - zygomatic region and infraorbital region
➢ Inferior - mental region
➢ Anterior - oral angle
➢ Posterior - anterior border of masseter muscle
Surface Anatomy
➢ Skin - thick and hairy
➢ Subcutaneous tissue - well developed
➢ Buccal adipose body - fat pad
➢ Muscle layer - risorius
➢ Facial artery and vein
➢ Sensory innervation - buccal nerve, mental nerve and infraorbital nerve
➢ Motor innervation - buccal branch of facial nerve
➢ Muscle layer - buccinator, zygomaticus major and minor
➢ Buccal mucosa with parotid duct open opposite 2nd molar tooth

Orbital Region
Boundaries
➢ Superficial (palpebral) layer
➢ Deep layer - orbit
➢ Divided by orbital septum
Palpebral Layer - Surface Anatomy
➢ Palpebral skin - thin and fine; sebaceous glands, tarsal glands, ciliary glands
➢ Subcutaneous tissue - sparse, LCT, ophthalmic nerve, infraorbital nerve, angular
artery, superficial temporal artery
➢ Muscle layer - orbicularis oculi muscle
➢ Fibrous tissue layer - orbital septum, tarsal plate
➢ Conjunctiva - fornix
Lacrimal Pathways
➢ Superior and inferior lacrimal punt
➢ Canaliculi lacrimales à saccus lacrimalis
➢ M
...
The suprasternal space lies between these layers and contains the inferior
ends of the anterior jugular veins, jugular venous arch, fat and lymph nodes
Pretracheal layer
➢ Limited to anterior part of the neck
➢ Anteriorly – pretracheal fascia that crosses the neck, just posterior to the
infrahyoid muscles, and covers the trachea and the thyroid gland
➢ Laterally – fascia encloses the thyroid gland and more posteriorly is continuous
with fascia that surrounds oesophagus
➢ Posterior to the pharynx, pretracheal layer is referred to as buccopharyngeal
fascia and separates the pharynx from the prevertebral layer
➢ Extends from the hyoid, into the thorax, to blend with the fibrous pericardium of the
heart
➢ Includes a muscular part which encloses the infrahyoid muscles
➢ Includes a visceral part which encloses the thyroid gland, trachea, oesophagus and
is continuous superiorly and posteriorly with the buccopharyngeal fascia of the
pharynx
➢ Pretracheal fascia blends laterally with carotid sheath

Prevertebral layer
➢ Anteriorly as the fascia attaches to basilar part of occipital bone, area of jugular
foramen and the carotid canal,
➢ Laterally - attaching to mastoid process
➢ Posteriorly - along superiorly nuchal line ending at the external occipital
protuberance, where it associates with its partner from the opposite side
➢ Forms a tubular sheath for the vertebral column and its associated muscles (longus
colli and capitis, scalenes and deep cervical muscles) and also the sympathetic
trunk
➢ Superiorly it is fixed to the cranial base
➢ Inferiorly it is blended with endothoracic fascia
Carotid Sheath
➢ Fascia that extends from the cranial base to the root of the neck
➢ Blends anteriorly with the pretracheal fascia
➢ Blends posteriorly with the prevertebral layer
➢ Contains the common and internal carotid arteries, internal jugular vein, vagus
nerve, deep cervical lymph nodes, carotid sinus nerve, carotid plexuses
➢ Communicates with cranial cavity superiorly and mediastinum inferiorly

Submandibular Triangle
Boundaries
➢ Superiorly - base of mandible
➢ Inferior - bellies of digastric muscle
Contents
➢ Mylohyoid muscle
➢ Submandibular gland and duct
➢ Submandibular lymph nodes
➢ Facial artery and vein
➢ Submental artery and vein
➢ Mylohyoid nerve
It also contains Pirogovs Triangle
➢ Anteriorly - mylohyoid muscle
➢ Inferiorly - digastric muscle
➢ Superiorly - hypoglossal nerve
➢ Floor - hyoglossus muscle
Contains lingual artery and vein

Carotid Triangle
Boundaries
➢ Anteriorly - superior belly of the omohyoid
➢ Posteriorly - anterior border of sternocleidomastoid
➢ Superiorly - posterior belly of digastric muscle
Contents
➢ Common carotid artery and branches
➢ Internal jugular vein and tributaries (facial, retromandibular and anterior jugular vein)
➢ Vagus nerve between the common carotid artery and internal jugular vein
➢ The above are enclosed in the carotid sheath
➢ Ansa cervicalis
➢ Cervical portion of the sympathetic trunk
➢ Cervicothoracic ganglion

Sternocleidomastoid Region
Boundaries
➢ Covered by sternocleidomastoid
Contents
➢ Skin - thin and movable
➢ Subcutaneous tissue with platysma, external jugular vein, cervical plexus
➢ Superficial lamina of cervical fascia
➢ Accessory nerve, sternocleidomastoid artery and nerve
➢ Sternocleidomastoid muscle
➢ Cervical neurovascular bundle
➢ Sternothyroid muscle
➢ Phrenic nerve
➢ Subclavian artery and thyrocervical trunk
Antescalene space
➢ Venous angle (thoracic duct)
➢ Vagus
➢ Common carotid artery
➢ Phrenic nerve
Interscalene space
➢ Subclavian artery and its branch the costocervical trunk
➢ Proximal portion of brachial plexus
Scaleno - vertebral triangle
➢ Subclavian artery and its branches - vertebral artery, thyrocervical artery and
internal thoracic artery)
➢ Vagus and phrenic nerve
➢ Lower part of sympathetic trunk
➢ Recurrent laryngeal nerve
➢ Cervicothoracic ganglion

Lateral Cervical Region
AKA posterior triangle of the neck
Boundaries
➢ Anteriorly - Posterior border of sternocleidomastoid muscle
➢ Posteriorly - Anterior border of trapezius
➢ Inferiorly - Clavicle
Contents
➢ Skin - thin and movable
➢ Subcutaneous tissue with posterior border of platysma, external jugular vein,
supraclavicular nerves, superficial cervical lymph nodes and deep lymph nodes
➢ Investing layer cervical fascia
➢ Loose connective tissue with Accessory nerve
➢ Pretracheal layer of cervical fascia (only in omoclavicular triangle)
➢ Superficial cervical artery and vein
➢ Suprascapular artery, vein and nerve
➢ Subclavian artery and vein – branches
➢ Brachial plexus (roots)

Infraclavicular Region
...
Provides a passageway for the
neurovascular structures that innervate the upper limb
Boundaries
➢ Apex - cervicoaxillary canal bounded by the 1st rib, clavicle and superior border of
scapula
➢ Base - formed by the concave skin, subcutaneous tissue and axillary fascia
...
The
anterior axillary fold is the most inferior part
➢ Posterior wall- formed by the subscapularis, teres major and latissimus dorsi
...
Pectoral region (region of mammary gland) - limited by inferior border of pectoralis
major muscle, superiorly it borders on the infraclavicular fossa
...
Presternal region - occupies an extreme medial position stretching from anterior
median line to parasternal line
...
Axillary region - includes axillary fossa
4
...
Also the inferior part of pectoral region
...
Anterior median line - runs on middle of sternum
2
...
Parasternal line - runs midway between sternum and medioclavicular line
4
...
AKA mammillary line
5
...
Posterior axillary line - corresponds to posterior axillary fold formed by anterior
borders of teres major and latissimus dorsi muscles
7
...
Scapular line - passes vertically through the inferior angle of the scapula
9
...
Posterior median line - runs on midline of the back along vertebral spinous
processes
Clavicles
➢ Lie subcutaneously, forming bony ridges at junction of thorax and neck
➢ Can be palpated easily throughout their length, especially where their medial ends
articulate with manubrium
Sternum
➢ Lies subcutaneously in anterior median line and is palpable throughout its length
Manubrium of sternum
➢ Lies at level of bodies of T3 and T4 vertebrae
➢ Anterior to arch of aorta
➢ Has a jugular notch that can be palpated between prominent sternal ends of
clavicles
➢ Has a sternal angle where it articulates with sternal body at level of T4-T5
intervertebral disc

Mediastinum
➢
➢
➢

Central compartment of the thoracic cavity between the two pleura
It contains the thoracic viscera
Extends from the superior thoracic aperture to the diaphragm

Parts
Superior Mediastinum - from superior thoracic aperture to thoracic plane/sternal angle/T4T5 vertebra
Contents
➢ Thymus
➢ Veins (both brachiocephalic trunks and superior vena cava)
➢ Arteries (arch of aorta and root of branches)
➢ Part of Vagus and Phrenic nerves, cardiac plexus
➢ Lower 2/3rd of Trachea (and related nerves)
➢ Upper ½ of the thoracic part of Oesophagus (and related nerves)
➢ Upper part of thoracic lymphatic duct
➢ Lymph glands
Inferior Mediastinum - from thoracic plane to diaphragm
...
Posterior Cervical Region
...
Nuchal region - unpaired region occupying the posterior (occipital) parts of the neck
2
...
Scapular region - corresponding to contours of scapula
4
...
Lumbar region - right and left, bounded by 12th rib above and by iliac crest below
6
...

Vertebral foramen stacked on one another to form a canal
...


Vertebral Foramen
➢ Refers to empty space enclosed by ring formed by neural arch and posterior aspect of
vertebral body
...

Intervertebral Foramen
➢ They are created on either side of vertebrae
➢ Allows for passage of nerve roots out from spinal canal along with spinal artery of
segmental artery, communicating veins, sinuvertebral nerves and transformaminal
ligaments
➢ Intervertebral foramen is bound by superior notch of adjacent vertebra, the inferior
notch of vertebra, the vertebral body and facet joints on transverse processes of
vertebra
Contents of Vertebral Canal
➢ Spinal Cord
➢ Meninges
➢ Spinal Nerve Roots
➢ Blood vessels supplying cord, meninges, vertebrae joints, muscles and ligaments
Meninges & Related Spaces
➢ 3 layers which cover spinal cord, nerve roots and brain
➢ It protects spinal cord and roots
Outermost layer – Dura Matter
➢ Resilient layer
➢ Bilaminour fibrous membrane

Middle layer – Arachnoid Matter
➢ Lays directly underneath dura matter
➢ Between dura and arachnoid = subdural space
➢ It consists of layers of connective tissue, is avascular and doesn’t receive any
innervation
Innermost layer – Pia Matter
➢ Arachnoid + Pia = Leptomeninges
➢ Pia matter is located underneath the sub-arachnoid space
➢ It is very thin and tightly adhered to surface of brain
➢ Highly vascularized, with blood vessels perforating through membrane to supply
underlying tissue
➢ Between pia matter and arachnoid matter is the subarachnoid space which contains
trabeculae and cerebrospinal fluid
Spinal Dura Matter
➢ Dura is made up of tough longitudinal collagen fibres interwoven with circular
elastic fibres
➢ External surface is rough and blends with loose connective tissue in epidural
space
➢ Internal surface, facing into subdural space is smooth and covered by a layer of
mesoepithelium
➢ Inferiorly, dural sac ends at sacral canal, usually at S2-S3 or sometimes S1
➢ Dura continues caudually as a fibrous thread named the filum terminalis externum,
coccygeal ligament, which blends with the posterior longitudinal ligament over
coccyx
➢ Dura is also attached to spaces in PLL
Epidural Space
➢ The epidural/ extradural space is a space outside the dura matter
➢ The nerve roots transverse the space as they extend into intervertebral foramen
➢ Space is occupied by loose connective tissue and fat
➢ Epidural space ends at the sacral hiatus, sealed by the posterior sacrococcygeal
ligament

Leptomeninges
➢ The pia and arachnoid are composed of loose connective tissue and separated
from one another by the subarachnoid space
➢ They are quite delicate membranes
➢ They are covered by a layer of mesothelium bathed by cerebrospinal fluid
➢ The arachnoid matter lines the entire dural sac and extends into the dural sleeves
➢ Trabeculae formed by this membrane in subarachnoid space facilitate CSF mixing
➢ Inferiorly, arachnoid lines dural sac within sacral canal and ends on termination of sac at
S2 level
...
Anterior Abdominal Wall
...

➢ Epigastrium - bounded by the midclavicular planes on the side and the subcostal plane
inferiorly, costal arch superiorly - contain stomach, liver, duodenum and pancreas
➢

Umbilical - bounded by the midclavicular planes on the side, subcostal plane superiorly
and the transtubercular plane inferiorly - contains small intestine, transverse colon,
duodenum, head of pancreas

➢

Hypogastric (pubic) - bounded by the midclavicular planes on the side, transtubercular
plane superiorly - contains sigmoid colon, small intestine, urinary bladder and uterus

➢

Right hypochondriac - lateral to the right midclavicular plane and the subcostal plane
inferiorly - contain right liver lobe and gallbladder

➢

Left hypochondriac - lateral to the right midclavicular plane and the subcostal plane
inferiorly - contain left liver lobe, stomach, spleen and left colic flexure

➢

Right lateral - lateral to the right midclavicular plane, subcostal plane superiorly, and the
transtubercular plane inferiorly - contain ascending colon and small intestine

➢

Left lateral - lateral to the left midclavicular plane, subcostal plane superiorly, and the
transtubercular plane inferiorly - contain descending colon and small intestine

➢

Right inguinal - lateral to the right midclavicular plane, the transtubercular plane
superiorly - contain cecum, vermiform appendix and small intestine

➢

Left inguinal - lateral to the left midclavicular plane, the transtubercular plane superiorly
- contain sigmoid colon and small intestine

Quadrants
Formed by the medial plane and the umbilical plane (passing through the umbilical region)
➢ Right upper quadrant
➢ Left upper quadrant
➢ Right lower quadrant
➢ Left lower quadrant
Midclavicular plane - from midpoint of clavicle to the midinguinal points
Subcostal plane - passing through inferior border of 10th costal cartilage

Transtubercular plane - passing through iliac tubercles
Anterolateral Abdominal Wall
Boundaries
➢ Superiorly - cartilages of 7-10th ribs and xiphoid process of sternum
➢ Inferiorly - inguinal ligament and superior margins of the pelvic girdle
Surface Anatomy
➢ Skin
➢ Superficial subcutaneous tissue (Camper fascia) with anterior cutaneous branches of
thoracoabdominal nerves (lateral to linea alba), superficial epigastric artery and vein
➢ Inferior to umbilicus, there is also a deep membranous layer (Scarpers fascia) which
continues as superior perineal fascia
...
Found
above midpoint of inguinal ligament parallel
...
This
opening contains intercrural fibres, which run perpendicular to the aponeurosis of
the external oblique and prevent the ring from widening
...
Ischioanal Fossa
Subcutaneous Division of the Pelvis
➢ Perineum is applied to the area of tissues between the anterior border of the anus
and the posterior border of the external genital organs (root of scrotum in males
and posterior margin of the pudendal cleft in females)
➢ Perineum is the region of the outlet of the true pelvis
➢ External genital organs, urethra and urogenital diaphragm are in urogenital region
...

➢ In anal region are the anal canal, rectum with the anus, external anal sphincter and
pelvic diaphragm
➢ The urogenital and pelvic diaphragm contribute to the formation of the floor of the
pelvis
Anatomical Relations
➢ Anteriorly – Lower border of pubic symphysis
➢ Posteriorly – Apex of coccyx
➢ Both sides – pubic, ischium and sacrotuberous ligaments
➢ Separated by thigh by perineofemoral fold
Perineal Region
➢ Forms floor of pelvis
➢ Subdivided into an anterior, small urogenital region and posterior, larger anal region
➢ A line slightly convex to the front connects the right and left ischial tuberosities, is
the boundary of these 2 regions
➢ A ridge of skin situated on medio-saggital line is called raphe of perineum divides
the skin into right and left halves
➢ Outlet of true pelvis is closed by muscles, fasciae, fat and skin
Pelvic Diaphragm
➢ Formed by the right and left levator ani muscles, right and left coccygeus muscles,
external anal sphincter muscle and fasciae
Muscles
Levator Ani
Triangular and consists of pubococcygeus and iliococcygeus muscles and together with the
fasciae forms a funnel-shaped muscular sheet which descends to anus
...
At level of perineal flexure of rectum, left and right pubococcygeus
muscles are inserted behind the rectum under the rectococcygeal muscle
...
It has 3 parts: deep (surrounds superior aspect of anal canal), superficial
(surrounds lower part of anal canal) and subcutaneous part (surrounds anal aperture)
➢ Posterior surface and apex of coccyx, anococcygeal body or in the skin
➢ Tendinous raphe of bulbospongiosus muscle and in skin of perineum
➢ Pudendal nerve (S2 and S3) and branches directly from S4
➢ Contraction of muscle compresses anus from the sides
Fascia of the Muscles of the True Pelvis
➢ Continuation of the intra-abdominal fascia and forms in cavity of the pelvis the
parietal and visceral fascia
Parietal Fascia
➢ Lines the walls of true pelvis in region of obturator, piriformis and coccygeus
muscles
➢ Arises superiorly from arcuate line and is fused with lower borders of pubis and
ischia
➢ Parietal fascia is thickened by levator ani muscle
➢ The thickened line of parietal fascia – tendinous arch of levator ani muscle; fascia
covering levator ani muscle
Visceral Fascia
➢ Where the superior fascia of the pelvic diaphragm approaches internal organs
(rectum and urinary bladder) – visceral pelvic fascia
➢ Origin of visceral fascia – tendinous arch of fascia of the pelvic muscles
➢ Visceral fascia envelops the bladder and rectum, in females also the vagina and in
males the prostate, seminal vesicles and the ampulla of vas deferens
➢ Rectovesical septum – separates rectum from prostate, seminal vesicles and
bladder
➢ Rectovaginal septum – separates rectum from vagina
➢ Visceral fascia arises superiorly form floor of peritoneal pouch which separates
these organs and terminates inferiorly on the floor of the pelvis, due to which it’s
also called peritoneo-perineal aponeurosis
Superior Fascia of Pelvic Diaphragm

➢

Fascia covering the superior surface of levator ani

Inferior Fascia of Pelvic Diaphragm
➢ Fascia covering the lower surface of levator ani
➢ It arises from tendinous arch of muscle
Ligaments
➢ Paired puboprostatic ligaments in males
➢ Paired pubovesical ligaments in females
➢ They arise on posterior surface of pubic symphysis and stretch backwards to
prostate and bladder in males and to urethra and bladder in females
Superficial Fascia of Perineum
➢ Most superficially located fascia of the perineal region which limits from below all the
structures of the anal and urogenital region
Ischiorectal Fossa
➢ Laterally – ischial tuberosity and fascia of obturator internus muscle
➢ Medially – inferior fascia of pelvic diaphragm
➢ Superiorly – origin of levator ani muscle
➢ Fossa is filled by ischiorectal pad of fat which transmits vessels and nerves in
fascial canal - pudendal canal
Superficial Perineal Pouch
➢ Bounded below by membranous layer of superficial fascia and above by urogenital
diaphragm
➢ Closed behind by fusion of its upper and lower walls
➢ Laterally, closed by attachment of membranous layer of superficial fascia and
urogenital diaphragm to margins of pubic arch
➢ Anteriorly, communicates freely with potential space lying between the superficial
fascia of the anterior abdominal wall and anterior abdominal muscles
Males
➢ Contains structures forming root of penis
➢ Bulbospongiosus and ischiocavernosus muscles
Females
➢ Contains structures forming root of clitoris
➢ Bulbospongiosus and ischiocavernosus muscles

Urogenital Diaphragm
➢ Musculofascial sheet which is situated in anterior part of true pelvis
➢ Upper surface – superior fascia of urogenital diaphragm
➢ Lower surface – inferior fascia of urogenital diaphragm/ perineal membrane
➢ In front of urethra and anterior border of diaphragm – transverse ligament of pelvis
➢ Free space between pubic symphysis, inferior pubic ligament and transverse
ligament transmits the deep dorsal vein of the penis/ deep vein of clitoris
➢ Superior and inferior fascia unite on posterior border of urogenital diaphragm to
form posterior boundary
➢ Superior fascia in males is fused with sheet of prostate
➢ Both fascia are fused with walls of urethra and in females with wall of vagina
Deep perineal space
➢ Between superior and inferior fascia of urogenital diaphragm
➢ Consists of 2 muscles; sphincter urethrae muscle anteriorly and deep transverse
perinei muscle posteriorly
...
It runs along the lateral intermuscular septum in a groove between lateral head of
triceps and brachialis or brachioradialis
Neurovascular bundle of the region becomes visible after dissection of the lateral head of the
triceps
...
It
then divides into medial collateral artery and radial collateral artery
Ulnar nerve pierces the medial intermuscular septum and passes groove for ulnar nerve
posterior to the medial epicondyle of the humerus
...


Anterior and Posterior Regions of Elbow
Cubital Fossa
➢ Depression on the anterior aspect of the elbow
➢ A space filled with a variable amount of fat anterior to the most distal part of the
humerus and elbow joint
Boundaries of Cubital Fossa
➢ Superiorly - imaginary line connecting medial and lateral epicondyles
➢ Medially - mass of flexor muscles of forearm arising from the common flexor
attachment on the medial epicondyle; most superficially, the pronator teres
➢ Laterally - mass of extensor muscles of forearm arising from lateral epicondyle and
supra-epicondylar ridge; most superficially, the brachioradialis
Floor - brachialis and supinator muscles of arm and forearm
Roof - continuity of brachial and antebrachial fascia reinforced by bicipital aponeurosis,
subcutaneous tissue and skin
Contents
➢ Terminal part of brachial artery and commencement of its terminal branches, radial
and ulnar arteries
...

➢ (Deep) accompanying veins of arteries
➢ Biceps brachii tendon
➢ Median nerve
➢ Radial nerve, deep between muscles forming lateral boundary of fossa
➢ Superficially, in the subcutaneous tissue overlying cubital fossa; medial cubital vein
and medial and lateral cutaneous nerves of forearm
Anconeus
➢ Small, triangular muscle on posterolateral aspect of the elbow
➢ Anconeus helps triceps extend forearm and tenses capsule of elbow joint
➢ Abducts ulna during pronation of the forearm

Anterior Region of Forearm
Superficial Layer
Borders
➢ Superiorly - transverse line, 3cm superior to elbow
➢ Inferiorly - transverse line between radial and ulnar carpal projections
➢ Medially - vertical line between medial epicondyle of humerus and ulnar carpal
projection
➢ Laterally - vertical line between lateral epicondyle of humerus and radial carpal
projection
Inferior part of the region that extends between carpal projects - anterior carpal region
Veins
➢ Cephalic vein occurs in superior third of forearm
➢ Basilic vein ascends along medial side of forearm
➢ Both veins are connected through anastomoses that are also drained by median
antebrachial vein
Nerves
➢ Terminal branches of lateral cutaneous nerve of forearm and medial cutaneous
nerve of forearm enter region superiorly
➢ Palmar cutaneous branch of median nerve becomes apparent in inferior third of
forearm
Middle Layer
➢ Anterior region - neurovascular bundles that are situated in lateral, medial and deep
groove of forearm
Lateral Groove
➢ Bounded laterally - brachioradialis, medially - pronator teres and flexor carpi radialis;
contains radial artery
➢ Radial artery gives rise to superficial palmar branch superior to flexor retinaculum before
it turns dorsally and runs under tendon of brachialis to snuffbox
➢ Superficial branch of radial nerve accompanies radial artery laterally
Median Groove
➢ Medial groove of forearm is bounded laterally - flexor digitorum superficialis, medially flexor carpi ulnaris; contains ulnar artery (lies in superior third of the region between both
heads of flexor digitorum superficialis)
➢ Ulnar nerve lies on medial side of ulnar artery - it descends along flexor carpi ulnaris and
gives off dorsal branch and superficial branch
➢ Ulnar nerve and ulnar artery pass ulnar canal (Guyon canal) and continue into palm of
hand

Median nerve becomes superficial in inferior third of the forearm - situated between flexor carpi
radialis and palmaris longus/ flexor digitorum superficialis
...

Deep Layer
➢ Deep groove of forearm becomes apparent after dissection of superficial flexor muscles
➢ It contains median nerve, that lies posterior to flexor digitorum superficialis and anterior
to flexor digitorum profundus in upper 2/3rd of region
➢ Anterior interosseous nerve and anterior interosseous artery form deepest neurovascular
bundle - they descend immediately anterior to interosseous membrane and are situated
in groove between flexor pollicis longus and flexor digitorum profundus

Posterior Region of Forearm
Superficial Layer
Borders
➢ Superiorly - transverse line, 3cm inferior to olecranon
➢ Inferiorly - transverse line between radial and ulnar styloid processes
➢ Laterally and medially - vertical lines between medial and lateral epicondyles of
humerus and the ulnar and radial styloid processes
Posterior cutaneous nerve of forearm enters region superiorly and divides into several
branches
Superficial branch of radial nerve enters inferior 1/3rd of the region after passing between
brachioradialis and radius - it’s accompanied by cephalic vein that ascends and curves
around lateral margin of forearm entering anterior region
Dorsal branch of ulnar nerve occurs at medial side of the region - it’s accompanied by
beginning of basilic vein
Deep Layer
➢ Becomes apparent after elevation of extensor digitorum
It contains small neurovascular bundle that consists of:
➢ Posterior interosseous artery - passes superior opening of interosseous
membrane, descends between superficial and deep layers of extensor muscles and
ends in periarticular arterial anastomoses of carpal region
➢ Deep branch of radial nerve - enters region by piercing supinator and divides into
several motor branches
...

Nerves and Arteries
➢ 3 common palmar digital arteries derive from superficial palmar arch divide
proximal to metacarpal heads into the proper palmar digital arteries for supply of
2nd to 5th finger
➢ Arteries are accompanied by proper palmar digital nerves
➢ At the lateral (radial) side of the 2nd finger occur the radial proper palmar digital
artery of 2nd finger and the ulnar proper palmar digital nerve of 2nd finger
➢ Arteries and nerves run along the lateral (radial) and medial (ulnar) sides of the
fibrous digital sheath up to the distal phalanges
➢ Superficial to the palmar aponeurosis lie the terminal branches of the palmar
cutaneous branch of median nerve

Hypothenar Eminence
➢ Thin fascia covers palmaris brevis
➢ At its inferior margin becomes ulnar proper palmar artery for 5th finger and ulnar
proper palmar nerve for 5th finger
Middle Layer
Thenar Eminence
➢ Superficial branch of radial artery passes proximal aspect of the region
➢ From median nerve arises strong recurrent branch that runs to thenar muscles
➢ More distally, median nerve gives off the radial proper palmar digital nerve of thumb
and the ulnar proper palmar digital nerve of thumb
➢ Immediately inferior to transverse head of the adductor pollicis occurs division of the
princeps pollicis artery into ulnar proper palmar artery of the thumb and radial
proper palmary artery of 2nd finger
Midpalmar (Mesothenar)
➢ Deep to palmar aponeurosis - superficial palmar arch; formed by anastomoses of
superficial branch of ulnar artery and thinner superficial branch of radial artery and
gives off distal common palmar digital arteries for supply of 2nd to 5th finger

➢

➢

Median nerve passes carpal canal under flexor retinaculum - divides into 3 common
palmar digital nerves that subdivide in the middle of the palm into proper palmar
digital nerves for 2nd - 4th finger
3rd common palmar digital nerve has an anastomoses with 4th common palmar
digital nerve that derives from superficial branch of ulnar nerve

Hypothenar Eminence
➢ Ulnar artery divides immediately after passing ulnar canal
➢ Deep branch of ulnar artery disappears between flexor digiti minimi and abductor
digiti minimi
➢ Superficial branch of ulnar artery gives rise to ulnar palmar proper artery for 5th
finger and then turns medially into superficial palmar arch
➢ Ulnar nerve parallels medially the ulnar artery and divides into deep branch of ulnar
nerve and superficial branch of ulnar nerve
➢ Superficial branch of ulnar nerve gives off ulnar palmar proper nerve for 5th finger and
common palmar nerve for 4th- 5th finger
Deep Layer
➢ Deep palmar arch lies at level of the base of the metacarpals, 2cm proximal to superficial
palmar arch - formed by anastomoses of deep palmar branch of radial artery with deep
palmar branch of ulnar artery
➢ From deep palmar arch arise palmar metacarpal arteries
➢ Princeps pollicis artery lies at border between thenar and mesothenar - it supplies with its
branches the thumb and lateral side of 2nd finger
➢ Deep branch of ulnar nerve accompanies the deep palmar arch and gives off branches

Dorsum Of The Hand
Boundaries
➢ Superiorly - line between radial and ulnar styloid processes
➢ Inferiorly - carpo -metacarpal joints
Surface Anatomy
➢ Skin
➢ Subcutaneous tissue with dorsal digital veins draining into the dorsal metacarpal
veins which unite to form the dorsal venous network, superficial branch of the radial
nerve passing over the snuffbox and extensor retinaculum and dorsal branch of
ulnar nerve
➢ Dorsal fascia and extensor retinaculum
➢ Extensor digitorum, digiti minimi and indicis, extensor pollicis longus and brevis
➢ Dorsal metacarpal arteries which are branches of the dorsal carpal arch
➢ Dorsal digital artery of thumb which is a branch of the radial artery
➢ Muscles and bones
Anatomical Snuffbox
➢ Medial - tendon of extensor pollicis longus
➢ Lateral - tendon of the extensor pollicis brevis and abductor pollicis longus
➢ Proximally - styloid process of radius
➢ Floor - scaphoid and trapezium
Contents
➢ Radial artery
➢ Superficial branch of radial nerve
➢ Cephalic vein

Digits of Hand
14 phalanges, 3 in each finger and 2 in the thumb
➢ Each has a head, shaft and proximal base
➢ Palmar surface is flat but slightly concave anteriorly in long axis
➢ Bases of proximal phalanges carry concave, oval facets adapted to metacarpal
heads - their own heads are smoothly groove like pulley and encroach more on to the
palmar surfaces
➢ The bases of the middle phalanges carry 2 concave facets separated by a smooth
ridge, conforming to heads of proximal phalanges
➢ Bases of distal phalanges are adapted to pulley-like heads of middle phalanges
➢ Heads of distal phalanges are non-articular and carry a rough, crescentic palmary
tuberosity, to which pulps of fingertips are attached
Ligaments and Muscles
➢ Articular ligaments and muscles are attached to phalanges
➢ Tendon of flexor digitorum profundus is attached to palmar aspect of base of
phalanx and tendon of extensor digitorum to its dorsal surface
➢ Tendon of flexor digitorum superficialis and its fibrous sheath are attached to sides
of the middle phalanx and a part of extensor digitorum is attached to base dorsally
➢ Fibrous flexor sheath is attached to sides of a proximal phalanx, part of
corresponding dorsal interosseous is attached to its base laterally and anterior
dorsal interosseous is attached medially
Phalanges of little finger and thumb differ:
➢ Abductor and flexor digiti minimi are attached to medial side of base of the
proximal phalanx of little finger
➢ Tendon of extensor pollicis brevis and oblique head of adductor pollicis (dorsally)
and oblique and transverse heads of adductor pollicis, are sometimes conjoined with
first palmar interosseous (medially) are attached to base of proximal phalanx of
thumb

Gluteal Region
Boundaries
➢ Superiorly - level of iliac crests
➢ Inferiorly - gluteal fold
➢ Laterally - line through anterior superior iliac spine
➢ Medially - intergluteal cleft
Surface Anatomy
➢ Skin
➢ Subcutaneous tissue with cutaneous superior, medial and inferior cluneal nerves
➢ Gluteal fascia
➢ Gluteal muscles
➢ Gluteal bursa
➢ Superior gluteal artery, vein, nerve (passing through greater sciatic foramen superior
to piriformis muscle)
➢ Inferior gluteal artery, vein, nerve / sciatic nerve, inferior cluneal nerve (passing
through greater sciatic foramen inferior to piriformis muscle)
➢ Internal pudendal artery and nerve (emerging from the greater sciatic foramen and
passing through lesser sciatic foramen to enter pudendal canal

Anterior Region Of The Thigh
Boundaries
➢ Superiorly - inguinal ligament
➢ Inferiorly - knee joint
➢ Laterally - line between anterior superior iliac spine and lateral condyle
➢ Medially - posterior margin of gracilis
Surface Anatomy
➢ Skin - hairy in males
➢ Subcutaneous tissue with fat, anterior cutaneous branches of femoral nerve and the
lateral cutaneous nerve of the thigh, great saphenous vein, superficial inguinal
lymph nodes at the saphenous opening that accompany the great saphenous vein
➢ Deep fascia - fascia lata which contains the saphenous opening
Saphenous Opening
➢ 3
...
75cm gap in the fascia lata inferior to the medial part of inguinal ligament
➢ Medial margin is smooth
➢ Inferior, superior and lateral margin is sharp - the falciform margin
➢ Covered by a membranous cribriform fascia
➢ Into the saphenous opening is passing the great saphenous vein, lymphatic vessels
from the superficial inguinal lymph nodes, superficial circumflex artery and vein,
superficial epigastric artery and vein, external pudendal artery and vein, femoral
branch of the genitofemoral nerve
Femoral Triangle - Subfascial space
➢ Superiorly - inguinal ligament
➢ Laterally - sartorius
➢ Medially - adductor longus
➢ Floor - iliopsoas and pectineus
➢ Roof - Fascia lata, subcutaneous tissue and skin
Through the subinguinal space there are two compartments, in which structures pass through,
by the iliopectineal arch
➢ Muscular lacuna - (lateral to arch) - contains the iliopsoas muscle and femoral nerve
➢ Vascular lacuna - (medial to arch) - contains the femoral sheath (femoral artery and
branches- lateral compartment, femoral vein and tributaries - intermediate
compartment compartment) and lymphatic vessels/nodes

Femoral Canal
➢ Anteriorly - inguinal ligament
➢ Posteriorly - superior ramus of pubis
➢ Medially - lacunar ligament
➢ Laterally - vertical septum
➢ Base - oval femoral ring
Contents
➢ Connective tissue, lymphatic vessels
Adductor Canal
Long, narrow passageway in the middle third of the thigh
...
Superior Extensor Retinaculum - strong, broad band of deep fascia, passing from
fibula to tibia, proximal to malleoli
2
...
Forms a strong loop around tendons of fibularis
tertius and extensor digitorum muscles
Muscles of Anterior Compartment of Leg
➢ Tibialis anterior
➢ Extensor digitorum longus
➢ Extensor halluces longus
➢ Fibularis tertius

Posterior Region of Leg
➢
➢
➢
➢

Planarflexor compartment
Largest leg compartment
Divided into superficial and deep subcompartments by transverse intermuscular
septum
Tibial nerve and posterior tibial and fibular vessels supply both parts of posterior
compartment but run in deep subcompartment (anterior) to transverse
intermuscular septum

Superficial Subcompartment
➢ Least confined area
Deep Subcompartment
➢ Bounded by 2 leg bones and interosseous membrane that binds them together
➢ Tightly confined
➢ Tapers as muscles it contains become tendinous
➢ Transverse intermuscular septum ends as reinforcing transverse fibers that
extend between tip of medial malleolus and calcaneus to form flexor retinaculum
➢ Retinaculum is subdivided deeply, forming separate compartments for each tendon of
deep muscle group, as well as for tibial nerve and posterior tibial artery as they bend
around medial malleolus
Superficial Muscle Group
➢ Gastronemius
➢ Soleus
➢ Plantaris
Deep Muscle Group
➢ Popliteus
➢ Flexor hallucis longus
➢ Flexor digitorum longus
➢ Tibialis posterior
Cruropopliteal Canal - passes between anterior surface of soleus muscle and deep
muscles of posterior group on the leg
➢ Anteriorly - popliteus muscle
➢ Posteriorly - tendinous arch of soleus muscle

Plantar Region
➢
➢
➢
➢

Deep fascia of the dorsum of the foot is thin where it is continuous proximally with the
inferior extensor retinaculum
Over the lateral and posterior aspects of the foot, the deep fascia is continuous with
the plantar fascia, the deep fascia of the sole
Plantar fascia has a thick central part and weaker medial and lateral parts
Plantar fascia holds parts of the foot together, helps protect the sole from injury
and helps to support the longitudinal arches of the foot

Plantar Aponeurosis
➢ Thick, central part of the plantar fascia forms the strong plantar aponeurosis,
longitudinally arranged bundles of dense fibrous connective tissue investing the central
plantar muscles
➢ It resembles the palmar aponeurosis of the palm of the hand but it is tougher,
denser and elongated
➢ Arises posteriorly from the calcaneus and functions like a superficial ligament
➢ Distally, the longitudinal bundles of collagen fibres of the aponeurosis divide into 5
bands that become continuous with the fibrous digital sheaths that enclose the flexor
tendons that pass to the toes
➢ At the anterior end of the sole, inferior to the heads of the metatarsals, the
aponeurosis is reinforced by transverse fibres forming the superficial transverse
metatarsal ligament
In the midfoot and forefoot, vertical intermuscular septa extend deeply (superiorly) from the
margins of the plantar aponeurosis toward the 1st and 5th metatarsals, forming 3
compartments of the sole:
1
...
Central compartment of the sole
➢ Covered superficially by the dense plantar aponeurosis
➢ Flexor digitorum brevis
➢ Tendons of flexor hallucis longus and flexor digitorum longus
➢ Muscles associated with the latter, quadratus plantae and lumbricals and adductor
hallucis
➢ Lateral plantar nerve and vessels

3
...
It contains metatarsals, the dorsal and plantar
interosseous muscles and the deep plantar and metatarsal vessels
...
It contains
extensors hallucis brevis and extensor digitorum brevis and neurovascular structures of the
dorsum of the foot

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