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Head & Neck

Cover Image for Head & Neck

Skull & Cranial Cavity

Identify the following structures:

  • Anterior Arch Of C1
  • Posterior Arch Of C1
  • Body Of C2
  • Dens
  • Mastoid Air Cells
  • Dorsum Sellae
  • Pituitary Fossa
  • Floor Of Anterior Cranial Fossa
  • Coronal Suture
  • Inner Table Of Calvarium
  • Outer Table Of Calvarium
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Lateral Skull Radiograph

Dissection Videos

Osteology of the Skull

Osteology and Anatomy Quiz

Quiz

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Flashcard Front
external acoustic meatus

Neck

Lateral Cervical Spine


Identify the following structures:

  • Anterior Arch Of C1
  • Posterior Arch Of C1
  • Dens
  • Body Of C2
  • Occipital Condyle
  • Spinous Process Of C2
  • Lateral Mass Of C4
  • Inferior Facet Of C4
  • Superior Facet Of C7
  • Pedicle Of C7
  • Facet Joint
  • Intervertebral Disc
  • Intervertebral Foramen
image-overlay-lateral-cervical-spine
Lateral Cervical Spine

Flexion and Extension of the Cervical Spine

These views are obtained with the patient performing maximal flexion and extension of their neck. They are used to assess alignment of the spine, and to look for ligamentous instability (ligament tears or laxity may result in vertebral bodies slipping forward or backward on each other).

flexion-psline
extension-psline

Note that the vertebral bodies remain aligned normally with movement, as is shown by the smooth, continuous posterior spinal line (green dashed line). Note the uniform widening of the interspinous spaces with flexion.

flexion-psline
extension-psline

AP Cervical Spine: Vertebral Bodies

Note the numbering of the vertebral bodies.

vertebral-body-numbers
AP Radiograph Cervical Spine

Odontoid View

This image is taken in an AP projection with the patient's mouth open.

Identify the following structures:

  • Odontoid Process (Dens)
  • Transverse Process C1
  • Lateral Masses Of C1
  • Spinous Process Of C2
  • Overlapping Occipital Bone
image-overlay-odontoid-view
Odontoid View

CT Cervical Spine

This images show the cervical spine from the C1/C2 level to the intervertebral disc.

Identify the following structures:

  • Odontoid Process (Dens)
  • Anterior Arch C1
  • Posterior Arch C1
  • Lateral Mass C1
  • Foramen Transversarium
  • Transverse Process C1
image-overlay-ct-cervical-c1-c2
CT Cervical Spine (C1/C2)

CT: Cervical Spine Sagittal & Coronal

These images are reformatted from a helical CT scan of the cervical spine. They are supplementary to axial images and are useful for evaluating alignment and joint spaces. Some fractures, such as compression fractures, are easier to identify on these images, as the loss of height is easier to appreciate.

Identify the following structures:

  • Anterior Arch Of C1
  • Posterior Arch Of C1
  • Dens
  • Body Of C2
  • Spinous Process C4
  • Intervertebral Disc
image-overlay-CT-cervical-spine-sagittal
CT: Cervical Spine, Sagittal Reformat

Axial CT

The following images are selected axial CTs of the neck; image 1 is the most superior, and image 6 the most inferior. These were obtained with contrast enhancement. Intravenous contrast helps to distinguish blood vessels from adjacent muscles and lymph nodes, by making them higher attenuation.

Identify the following structures:

  • Submandibular Gland
  • Epiglottis
  • Vallecula
  • Left Sternocleidomastoid
  • Platysma
  • Prevertebral Muscles
  • Right Internal Carotid Artery
  • Right Internal Jugular Vein
  • Right External Carotid Artery
  • Left External Jugular Vein
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Axial CT Neck (1)

Radiology Quiz

Quiz

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Flashcard Front
C3 vertebral body

Osteology Quiz

Quiz

1/9
Flashcard Front
anterior tubercle of atlas

Anatomy Quiz

Quiz

1/20

Afferent neurons from the carotid body and sinus travel in:

accessory nerve

ansa cervicalis

glossopharyngeal nerve

hypoglossal nerve

trigeminal nerve

Face & Scalp

Facial Nerve Dissection

Quiz

1/10

The skin of the chin is innervated by:

buccal nerve

infraorbital nerve

marginal mandibular nerve

mental nerve

supratrochlear nerve

Eye & Orbit

Imaging the eye and orbit

t2-ct-eye-orbit
T2 MRI and CT of the Orbit

Both CT and MRI are used to evaluate the contents of the orbit. When there is a history of trauma, CT is typically used since it is more sensitive for fractures of the bony margins of the orbits. On CT, when viewing soft tissue windows, the extraocular mucles, optic nerve and globe are visible, so limited assessment of these structures can also be made.

The higher soft tissue contrast of MRI results in better conspicuity of the soft tissue structures of the orbit, especially the globe. Compare the MRI and CT images shown.

MRI: Axial T1

The following are T1-weighted axial MRI images of the orbit (thin 2mm sections). The first image is the most inferior. Supsequent images are sequentially more superior. On T1 images, fat is high signal intensity (bright), fluid is low signal intensity (dark), and muscles and nerves are gray.

Identify the following structures:

  • Inferior Rectus
  • Eyeball (Globe)
  • Orbital Fat
  • Ethmoid Air Cells
image-overlay-t1-inferior-orbit
Axial T1-weighted MRI of the Orbit (1, most inferior)

MRI: Axial T2

On T2-weighted images, the high signal intensity fluid of the anterior and posterior chambers contrasts with the dark signal of the lens, making it very conspicuous. The air in the paranasal sinuses and air cells is dark.

Identify the following structures:

  • Medial Rectus
  • Lateral Rectus
  • Optic Nerve
  • Anterior Chamber
  • Vitreous Chamber
  • Lens
  • Orbital Fat
  • Sphenoid Sinus
  • Ethmoid Air Cells
image-overlay-t2-mid-orbit
Axial T2-weighted MRI, Mid Orbit

MRI: Coronal T1

This T1-weighted MRI is in the coronal plane just posterior to the globe (eyeball). The extraocular muscles, optic nerves, and superior opthalmic vein can be seen well in this image. Fat is bright, and muscles and nerves are gray.

Identify the following structures:

  • Left Optic Nerve
  • Medial Rectus
  • Inferior Rectus
  • Lateral Rectus
  • Superior Rectus
  • Levator Palpebrae Superioris
  • Superior Oblique
  • Ethmoid Air Cells
  • Maxillary Sinus
  • Orbital Fat
image-overlay-coronal-t1-orbit
Coronal T1-weighted MRI of the Orbit

CT: Coronal orbit

This is an IV contrast enhanced CT. The blood vessels are opacified with the iv contrast material, which makes them high attenuation. The orbital fat is dark gray, in contrast to the medium gray density of the extraocular muscles.

Identify the following structures:

  • Optic Nerve
  • Medial Rectus
  • Inferior Rectus
  • Lateral Rectus
  • Superior Rectus & Levator Palpebrae Superioris
  • Superior Oblique
  • Ophthalmic Artery
  • Orbital Fat
image-overlay-coronal-ct-orbit
Coronal CT of the Orbit

CT: Axial orbit

This CT is displayed in soft tissue window.

Identify the following structures:

  • Anterior Chamber
  • Lens
  • Vitreous Chamber
  • Medial Rectus
  • Lateral Rectus
  • Optic Nerve
  • Orbital Fat
  • Ethmoid Air Cells
  • Anterior Clinoid Process
image-overlay-axial-ct-orbit
Axial CT of the Orbit
Orbit Dissection, Superior Approach

Radiology Quiz

Quiz

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Flashcard Front
anterior chamber

Osteology Quiz

Quiz

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Flashcard Front
inferior orbital fissure

Anatomy Quiz

Quiz

1/10

Which of the following structures does not travel through the common tendinous ring?

abducens nerve

nasociliary nerve

oculomotor nerve

optic nerve

trochlear nerve

Ear

CT: Axial

This is a series of axial images of the head taken at the level of the petrous portion of the temporal bone and inner ear. The series moves from superior to inferior. The images are "windowed" to highlight osseous structures. Each axial image is only 1mm thick! This allows the fine structures of the inner ear to be displayed in detail.

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Axial CT Inner Ear (1)

CT: Coronal Ear

coronal-ct-ear
Coronal CT Inner Ear

This is a coronal CT image taken at the level of the petrous portion of the temporal bone and inner ear. The tympanic membrane is a very thin structure but can be faintly seen on this 1mm thick section.

Quiz

Quiz

1/10

Which of the following structures is correctly matched with its location in the middle ear cavity?

entrance to mastoid antrum – inferior wall (floor)

eustachian tube – anterior wall

jugular fossa – posterior wall

pyramidal eminence – medial wall

round window – lateral wall

Deep Face

CT: Axial

This is an axial CT of the face at the level of the lateral pterygoid muscle.

Identify the following structures:

  • Condylar Process Of Mandible
  • Lateral Pterygoid
  • Lateral Pterygoid Plate
  • Medial Pterygoid Plate
  • Coronoid Process Of Mandible
  • Temporalis
  • Maxillary Sinus
image-overlay-axial-ct-face-1
Axial CT of the Face (1)

Radiology Quiz

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Flashcard Front
temporalis muscle

Osteology Quiz

Quiz

1/10
Flashcard Front
condylar process of mandible

Anatomy Quiz

Quiz

1/10

Which nerve travels through foramen ovale to enter the deep part of the face (infratemporal fossa)?

facial nerve

inferior alveolar nerve

lingual nerve

mandibular nerve

maxillary nerve

Nasal Cavity

AP Sinuses

On AP view of the sinuses, the petrous ridge of the temporal bone and mastoid air cells overlap and partially obscure the lower orbits and maxillary sinuses. In order to better evaluate the maxillary sinuses, a special view (Waters) is obtained, shown in the next image.

Identify the following structures:

  • Inferior Concha (Turbinate)
  • Nasal Septum
  • Nasal Cavity
  • Maxillary Sinus
  • Ethmoid Sinus (Air Cells)
  • Frontal Sinus
  • Petrous Ridge Of Temporal Bone
  • Orbit
image-overlay-ap-skull-2
AP Radiograph of the Skull

Waters view of the sinus

A waters view is an AP view in which the patient flexes the neck and elevates the chin so that the x-ray beam passes obliquely through the facial structures, directed from caudal to cranial. In effect, this places the orbits and maxillary sinuses above the skull base structures and petrous ridge of the temporal bone, enabling them to be visualized better than on an AP view. This patient's frontal sinuses are very small (hypoplastic).

Identify the following structures:

  • Maxillary Sinus
  • Petrous Ridge Of Temporal Bone
  • Orbit
image-overlay-waters-2
Waters View

Lateral sinuses

Although all of the right and left sided structures are superimposed on the lateral view, it is the best projection to show the sphenoid sinuses, which are obscured by other bony structures on the AP and Waters views. This patient has hypoplastic (underdeveloped) frontal sinuses.

Identify the following structures:

  • Sphenoid Sinuses
  • Maxillary Sinuses
  • Nasal Bones
  • Hard Palate
  • Nasopharynx
  • Metallic Dental Fillings
image-overlay-lateral-radiograph-sinuses
Lateral Radiograph of the Skull

CT: Coronal nasal cavity

coronal-series-sinuses

The following images are four sequential coronal sections through the nasal cavity and paranasal sinuses. The first image is the most anterior and subsequent images are more posterior. Remember, when looking at coronal images, the patient's right side is depicted on the left side of the image.




Identify the following structures:

  • Nasal Septum
  • Frontal Sinus
  • Maxillary Sinus
  • Inferior Concha (Turbinate)
  • Middle Concha (Turbinate)
  • Nasolacrimal Duct
image-overlay-ct-coronal-nasal-cavity-1
Coronal CT Nasal Cavity (1)

CT: Sagittal midline

This is a 10mm thick reformatted CT image of the nasal cavity showing midline structures.

Identify the following structures:

  • Frontal Sinus
  • Sphenoid Sinus
  • Pituitary Fossa
  • Perpendicular Plate Of Ethmoid
  • Cribriform Plate (Of Ethmoid Bone)
  • Crisa Galli
  • Vomer
  • Nasal Bone
  • Cartilaginous Nasal Septum
  • Hard Palate
  • Nasopharynx
image-overlay-ct-sagittal-midline-nasal-sinuses
Midline Sagittal CT

CT: Axial head (pterygopalatine fossa)

This CT scan has been "windowed" (contrast adjusted) to highlight the bony structures. The pterygopalatine fossa (between the maxillary bone anteriorly and the root of the pterygoid process of the sphenoid bone posteriorly) can be appreciated.

Identify the following structures:

  • Zygomatic Arch
  • Maxillary Sinus
  • Pterygopalatine Fossa
  • Condyle Of Mandible
  • Foramen Ovale
  • Foramen Spinosum
  • Carotid Canal
image-overlay-ct=axial-pterygopalatine-fossa
Axial CT (level of pterygopalatine fossa)
Nasal Cavity Dissection

Radiology Quiz

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Flashcard Front
vomer

Anatomy Practice Questions

Quiz

1/10

Which of the following drains into the inferior meatus?

frontal sinus

maxillary sinus

middle ethmoid air cells

nasolacrimal duct

sphenoid sinus

Oral Cavity & Pharynx

The air filled pharynx and trachea are lucent on this lateral view of the soft tissues of the neck.

Identify the following structures:

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
  • Larynx
  • Epiglottis
  • Soft Palate
  • Uvula
image-overlay-oral-cavity-pharynx-1
Lateral Radiograph - Oral Cavity & Pharynx (1)

CT: Sagittal Neck

This sagittal CT scan has been reformatted from a conventional helical (axial) CT of the neck. It is a midline sagittal view.

Identify the following structures:

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
  • Hard Palate
  • Soft Palate
  • Uvula
  • Oral Cavity
  • Epiglottis
image-overlay-ct-sagittal-neck-pharynx
Sagittal CT of the Neck

CT: Nasopharynx

The following images are axial, contrast enhanced CTs of the neck at the level of the nasopharynx. The first image is superior and the second more inferior.

Identify the following structures:

  • Nasopharynx
  • Pharyngeal Recess
  • Pharyngotympanic (Eustachian) Tube
  • Torus Tubarius
  • Choana
image-overlay-axial-ct-nasopharynx-1
Axial CT Nasopharynx (superior)

CT: Oropharynx

The following images are axial, contrast enhanced CTs of the neck at the level of the oropharynx. The first image is superior and the second more inferior.

Identify the following structures:

  • Oropharynx
  • Submandibular Gland
  • Sublingual Gland
  • Geniohyoid
  • Mylohyoid
  • Pharyngeal Constrictors
image-overlay-axial-ct-oropharynx-1
Axial CT Oropharynx (superior)

CT: Laryngopharynx

The following images are axial, contrast enhanced CTs of the neck taken just below the mandible, at the level of the laryngopharyx. The first image is superior and the second more inferior.

Identify the following structures:

  • Largyngopharynx
  • Epiglottis
  • Vallecula
  • Pharyngeal Constrictors
  • Hyoid Bone
image-overlay-axial-ct-laryngopharynx-1
Axial CT Laryngopharynx (superior)
Oral Cavity Dissection

Radiology Quiz

Quiz

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Flashcard Front
epiglottis

Anatomy Practice Questions: Oral Cavity

Quiz

1/10

Which of the following is found between the palatoglossal and palatopharyngeal arches?

choanae

palatine tonsil

pharyngeal recess

pharyngeal tonsil (adenoids)

torus tubarius

Anatomy Practice Questions: Pharynx

Quiz

1/7

The middle constrictor muscle arises from the:

cricoid cartilage

hamulus

hyoid bone

pterygomandibular raphe

thyroid cartilage

Larynx

CT: Sagittal Neck

This sagittal CT scan has been reformatted from a conventional helical (axial) CT of the neck. It is approximately a midline sagittal view.

Identify the following structures:

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
  • Epiglottis
  • Hyoid Bone
  • Laryngeal Vestibule
  • Thyroid Cartilage
  • Larynx
image-overlay-midline-sagittal-ct-neck-2
Midline Sagittal CT of the Neck

CT: Thyroid

The following images from a contrast enhanced neck CT are from just below the larynx. The first image is superior and second is more inferior.

Identify the following structures:

  • Trachea
  • Right Lobe Of Thyroid Gland
  • Left Lobe Of Thyroid Gland
  • Esophagus
image-overlay-ct-thyroid-1
Axial CT at level of Thyroid (superior)

CT: Upper Larynx

This contrast enhanced CT scan of the neck is at the level of the piriform fossa & aryepiglottic folds. The laryngopharyx is relatively flattened, not distended with air.

Identify the following structures:

  • Aryepiglottic Fold
  • Piriform Fossa
  • Larynx
  • Thyroid Cartilage
image-overlay-ct-upper-larynx
CT at level of Upper Larynx

CT: Mid Larynx

The following images from a contrast enhanced neck CT are from the mid-larynx, just below the glottis. The first image is superior and the second is more inferior. The arytenoid and corniculate cartilages are tough to differentiate from one another on a single axial image.

Identify the following structures:

  • Larynx
  • Arytenoid/corniculate Cartilage
  • Thyroid Cartilage
image-overlay-ct-mid-larynx-1
Axial CT at level of Mid Larynx (superior)

Radiology Quiz

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1/10
Flashcard Front
thyroid cartilage

Anatomy Practice Quiz

Quiz

1/10

During a thyroidectomy, the surgeon accidentally cuts the right recurrent laryngeal nerve in the tracheo-esophageal groove. Which of the following describes the expected result?

the accident has not affected the patient’s vocal cord function

the patient’s right vocal cord is completely paralyzed, and sensation is intact

the patient’s right vocal cord is completely paralyzed, and there is no sensation inferior to the glottis on the right side

the patient’s right vocal cord is partially paralyzed, and sensation is intact

the patient’s right vocal cord is partially paralyzed, and there is no sensation inferior to the glottis on the right side