OS 204: HUMAN BODY & MIND 3

HEAD and NECK

DISSECTION MANUAL
IMPORTANT! Read before dissecting. Texts in bold underlined prints serve as
checklist for dissection!
Unwrap the head and neck. Remove all traces of vaseline. Maintain the moisture and protective covering
of the head and neck, whenever possible after each dissection period.
With the use of sharp scissors and scalpel blade, shave off/cut the hair from the head. Clean off any dirt
or dried secretions from the head.

Fig 1. Face & Neck Incision Lines

Make incisions 2 &2c, cutting close to the margins of the lips, nostrils, eyelids & auricle. Reflect facial
skin to dissect the face, and flap back facial skin afterwards to protect facial structures.

THE FACE

1.

Reflect the skin following the facial incisions 2 and 2c as shown in figure 1 of the guide. You may
extend the incision up to the neck for ease of exposure. Cut close to the lip margins, nasal alae, eyelid
margins and around the auricles. The skin flaps are replaced over the face after dissection!

2.

Study from the book and atlas the muscles of facial expression. Note that they insert to the skin of the
face and their inserting fibers are necessarily in the process of skinning. Avoid cutting deeper than
required. The facial muscles are tender slips of fibers and at times, may be covered or included in a lot
of fatty layer which must be scraped off to visualize the fibers. Which are superficial and deep?

MUSCLES OF THE FACE (GRANTS)

3.

Study and analyze the arterial and venous system of the face. Verify the same in your cadaver.

4.

Know the theoretical and practical distribution of the trigeminal and facial cranial nerves. Verify
the facts in your cadaver. During dissection, preserve the branches and main stems of the arterial and
of the two cranial nerves. You may have to expose these by digging under the facial muscles, close to
the bones.

5.

Clean carefully the facial muscles with probe and curved forceps. Establish the organization of these
muscles according to: a. muscles of the forehead and the region of the eye; b. muscles associated with
the lips; c. muscles around the nose; and d. muscles associated with the ear.

6.

Clean the temporal fascia and note the zygomatic arch attachment of the galea aponeurotica and the
attachments of the temporal fascia. Its two layered form just above the zygomatic arch may be
demonstrated by a vertical incision into the fascia. To expose the whole fan of temporalis fibers,
remove the temporal fascia from the surface of the muscle and remove all the zygomatic arch (one side
only) forward of the articular eminence.

7.

Identify the buccal nerve and artery if they are found among the anterior fascicles of the temporalis.

THE SCALP

1.

Read on the scalp before scalping. Start scalping to expose the cranium and its overlying muscles and
fascia.Take special care in skinning the scalp. The skin is very thin and the subcutaneous tissue very
dense that the subdermal plane is not easy to follow, and nerves and vessels are readily severed.

2.

Study the layers of the scalp and note the importance or significance of each of the layers.

SAGITTAL SECTION OF SCALP (GRANTS)

3.

Remove the subcutaneous connective tissue, possibly in the same manner as the skin is reflected.
Display the epicranial muscles.

THE PAROTID GLAND

1.

Expose carefully the superficial portions and delineate the shape of the parotid gland. Study also the
character and attachments of the parotid fascia. Identify the parotid duct and note its course and
relation as well as its entry into the oral cavity. Dissect and identify the structures radiating from all
its borders.

2.

Dissect the facial nerve. Look for the main trunk as it exits from the stylomastoid foramen, about 1
cm below the mastoid process and 1 cm deep. Trace it as it enters the posterior border of the parotid
gland, divides into the upper temporofacial and lower cervicofacial divisions, and as it goes to the
face in five main areas. You will be removing the superficial lobe of the gland as you skeletonize the
facial branches. What muscles are innervated by the peripheral branches? What is the pes
anserinus?

3.

Study and vessels, both arterial and venous, that are closely related to the parotid gland. Trace their
origins and branchings.

THE INFRATEMPORAL FOSSA

1.

On the opposite side of the head, make a horizontal cut through the belly of the masseter up to the
mandible. Reflect the belly upwards, exposing the coronoid and condylar processes of the mandible,
exposing the temporomandibular joint. With a sharp chisel and mallet, make a horizontal cut across
the ramus of the mandible, cut the temporalis muscle attachments at the coronoid process.

2.

Delineate the temporomandibular joint. Note the capsule and lateral ligament. Open the capsule
and study the inside anatomy and the type of joint. Then, remove the condylar head from the
glenoid fossa to disarticulate the lower jaw.

UPPER ARTICULAR CAVITY

ARTICULAR DISK
LATERAL PTERYGOID
MUSCLE

TMJ CAPSULE
LOWER ARTICULAR CAVITY

Remove the cut mandibular segment en bloc to expose the infratemporal fossa, taking care not to sever the
inferior alveolar nerves and vessels that enter the mandibular canal.

3.

Identify the medial and lateral pterygoid muscles, noting their origins and insertions.

4.

With a probe, dissect the internal maxillary artery coming from the external carotid, trace its course
up to its entry into the pterygomaxillary fissure. Study the branches and their destinations. You may
have to bluntly remove the external maxillary vein or the pterygoid plexus that sometimes envelope the
internal maxillary artery in the fossa. How is the artery related to the lateral pterygoid muscle? Trace
the maxillary artery branches that travel with the branches of the mandibular nerve.

The Maxillary Artery and Branches (Grants)

5.

Study the mandibular nerve by tracing it from under the foramen ovale, deep to the lateral pterygoid
muscle. Study the bigger branches: the inferior alveolar, lingual, auriculotemporal, the buccal
nerves, deep temporalis; take note of the branches of the maxillary artery that accompany them and
carry the same names.

6.

Identify the small chorda tympani nerve that joins the lingual nerve posteriorly.

7.

Try to look from the otic ganglion which may be found medial to the mandibular nerve, about 1 cm
under the foramen ovale.

8.

Review the maxillary vein which may have been destroyed earlier when you were looking for the
internal maxillary artery. What veins form the perygoid plexus?

REMOVAL OF THE CALVARIUM AND BRAIN

1.

With a saw, cut across the calvarium of the cadaver, about 1 cm level above the ears, across the frontal
bone, to the other ear and across the occiput. You may ask the technicians help for this. Do not cut
the dura.

2.

Remove the brain by inserting your fingertips downwards to the brain stem, up to the foramen
magnum, separating the dura from its bony bed. Cut at the brain stem level cleanly.

3.

Study the harvested brain, its gross structures and the attached cranial nerves.

SPLITTING THE SKULL AND UPPER NECK

1.

Using a sharp scalpel, first make your soft tissue cut about 1 cm lateral to the sagittal midline, from the
chin, up to the lips, nose, forehead, occiput to the back of the neck. With a saw, make your bony cuts
to split the skull into two almost equal halves. This procedure will bisect the head to make study of
the internal areas easier.

2.

Spread the halves of the skull and bisect the tongue and uvula with a sharp knife.

3.

Expose the larynx from above. Insert a knife between the vocal cords and cut the larynx in lateral
halves.

4.

Saw the cervical vertebrae as far as able to expose all the areas for clearer dissection.

THE EAR
1.

Remove the auricle from the head. Study its configuration. Note the external auditory canal, its
direction, shape, and length. Remove any dirt or debris from the canal to appreciate the tympanic
membrane. It is best to study the ear drum using an otoscope and examining a normal patients ear or
your classmates.

HELIX
SCAPHOID FOSSA
CRURA OF
ANTIHELIX

TRIANGULAR FOSSA

CRUS OF HELIX
TRAGUS

CONCHA
ANTIHELIX

ANTITRAGUS

LOBULE

2.

Strip the dura mater from the middle cranial fossa. Study the foramina and their contents, surface
landmarks and the prominences. A thin layer of bone , tegmen tympani, separates the middle cranial
fossa from the middle ear. With a chisel, chip away the tegmen to remove the roof of the middle ear
and expose its contents: the ossicles, muscles and nerves. Harvest the ossicles and place them neatly
inside a small canister. They will come in handy in the laboratory examination. Pass a probe through
the eustachian tube found on the anterior wall of the middle ear, and through the aditus that leads to
the mastoid antrum, posteriorly.

3.

Identify the arcuate eminence on the middle cranial fossa which marks the position of the anterior
semicircular canal. Study the internal acoustic canal and its contents: the cranial nerves 7 and 8.

4.

Chip away the roof over the semicircular canals and study their particular configuration. Try to delineate the membranous ducts from the bony labyrinth.

5.

Anteriorly, chip away the roof of the cochlea and study the snail-shaped structure of the organ.

6.

If available, study the pre-dissected temporal bones with the mastoid antrum, facial nerve and the middle ear exposed.

THE ORBIT AND EYEBALL

1.

Strip the periosteum from the floor of the anterior cranial fossa. Crack the orbital roof with a chisel.

Enlarge the opening with a forceps. Expose the orbital contents from above. Study the optic and
opthalmic nerves and their branches. Trace the extraocular muscles, their origins and insertions,
including the levator palpebrae superioris. Study the vessels, by removing some loose tissue and fat.
Where is the lacrimal gland?

2.

Over the face, note the surface landmarks. Study the orbicularis oculi muscle. Expose the lacrimal
gland by cutting through the supero-lateral part of the palpebra.

3.

Remove the eyeball by making a sharp circular cut over the margins of the orbit up to the bone. With
probe or your fingertips, separate the orbital contents from the bony orbit up to the apex, and cut
across the optic nerve, using a curved knife or blade. Study the extraocular and the levator palpebrae
superioris muscles, the optic nerve and other structures. Note the location of the lacrimal gland.

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4.

Study the bare bony orbital cavity, the orbital fissures and the structures that traverse them.

5.

Cut the eyeball longitudinally in the midline (in an anteroposterior direction), using a sharp blade.
Study its interior, its linings, the anterior and posterior chambers and their fluids, the lens and iris.
If available, fresh eyeballs from cows will make a good substitute for study.

THE NOSE AND PARANASAL SINUSES

1.

Upon splitting the skull, one half will exhibit the nasal septum side and the other the nasal cavity with
the lateral nasal wall exposed. Study the nasal septum first, its mucosa, nerves and vessels that run
over it. Strip the mucosa and expose the bony and cartilaginous parts of the septum. Locate the
nerves and vessels running across it.

2.

On the other side, study the lateral nasal wall. Not much dissection is needed. Identify the three turbi
nates; look for a supreme (fourth) turbinate, if there is. Also the meatuses, the choanae, and the ostia
of the paranasal sinuses. Locate the atrium, the vestibule and compare the three turbinates. Are they
equal in size and shape? The mucosa is vascular and gets easily congested in acute rhinitis.

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3.

Remove the medial shelves of the inferior and middle turbinates. On the middle meatus, identify the
semilunar hiatus, uncinate process, ethmoidal bulla, and the infundibulum where most of the ostia
of the sinuses empty. Pass a probe through these ostia to locate the sinuses. On the inferior inferior
meatus, look for the opening of the nasolacrimal duct, and use a probe to determine its direction
toward the orbit.

Look for the opening of the sphenoid sinus at the sphenoethmoidal recess and probe it. What are
the structures found on top, below and lateral to the sphenoid sinus?
4.

Locate the sphenopalatine foramen posterior to the middle turbinate and study the different branches
coming from the maxillary nerve that go to the nose. Identify the branches of the maxillary artery that
travel with the nerve and get the same names.

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5.

On one side of the face, remove the facial musculature over the anterior wall of the maxillary sinus.
Expose the maxillary antrum by gouging a hole into the sinus using a mallet and chisel. Study the
size and shape of the sinus. Where is the ostium located?

6.

From the medial orbital wall, note that the paper-thin lamina papyracea separates the orbit from the
ethmoidal air cells. Where do the ethmoidal air cells drain?

7.

Study the frontal sinus and the frontonasal ducts that empty towards the infundibulum. Are the
frontal sinuses always present? Are they always symmetrical?

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THE ORAL CAVITY

1.

Remove all dirt and debris from the oral cavity. Delineate the boundaries between the oral cavity
proper and the vestibule, between that and the oropharynx. What separates it from the nasal cavity?

2.

Study the tongue, its boundaries, from the base to the tip. What are the structures found on the floor
of the mouth? Where does the submandibular ducts empty? Locate the sublingual glands on each
side of the mouth floor. Note the various muscles that form the tongue, their origins and insertions.

Upper Lip
Upper Alveolar Ridge

Hard Palate

Retromolar Trigone
Buccal Mucosa
Oral Tongue
Floor of the Mouth

Lower Alveolar Ridge

Lower Lip

3.

Study the hard and soft palate, the tonsillar pillars, the tonsils, and the teeth? How many teeth are
there in the adults? Over the vestibule, what marks the location of the opening of the Stensens duct?

4.

Take note of the muscles that form the soft palate. Look for the hamulus of the pterygoid plate. What
muscle hooks over it?

THE PHARYNX

1.

Study the walls of the nasopharynx. Look for the opening of the eustachian tube, the torus
tubarius, the Rosenmullers fossa and the pharyngeal recess. Are there adenoids present in your
cadaver?

2.

The oropharyngeal walls are continuous with those of the hypo- and naso-pharynx. What separates
oro from the hypo and the naso. Look for the Passavants ridges, if there are.

3. The hypopharynx ends at the cricopharyngeus level. Note the larynx abuts into it, but is not part of it.

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Study the laryngeal inlet from the superior aspect of the hypopharynx, using textbook pictures and
the cadaver.

Nasal Septum
Opening of Eustachian Tube
Nasopharynx
Superior Surface of Soft Palate
Uvula
Palatine Tonsil

Oropharynx

Base of Tongue
Epiglottis

Pyriform Sinus

Hypopharynx

Postcricoid Region

Cervical Esophagus

THE LARYNX

1.

It is best to study the laryngeal framework and structures first with the use of laryngeal models and
Atlas pictures, before dissecting this area. Study the different cartilages forming the framework, the
ligaments connecting them, the muscles that move the cartilages and tbe corresponding muscular
actions. Study the laryngeal cavity, the folds inside, including the innervation of the muscles.

2.

Be familiar with the appearance of the larynx as seen from above (as in direct laryngospic view),
noting the epiglottis, aryepiglottic folds, arytenoids, the esophageal inlet, pyriform sinuses and the
vallecullae (pill pockets).

3.

Remove the larynx from its bed. Cut the strap muscles attached to the larynx anteriorly. Resect the
Trachea at the level of the second tracheal ring. Separate the trachea from the anterior wall of the esophagus carefully using a sharp knife, in a cephalad direction, up to the pharynx. Superiorly, cut the
thyrohyoid membrane which connects the larynx to the hyoid bone, and continue cutting downwards
through the pharyngeal wall to connect with the lower incision. The superior and inferior
neurovascular bundles of the larynx will have to be cut, but identify them. The distal portion of the
recurrent laryngeal nerves on both sides of the trachea and larynx must be identified and preserved.
You have just done a total laryngectomy procedure!

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4.

With the larynx in hand, study the external landmarks and the extrinsic muscles of the larynx, like
the cricoarytenoids, cricothyroideus, arytenoideus and the rest.

5.

Strip off the extrinsic muscles from the larynx at the area of the cricoid and arytenoid to visualize the
underlying cartilages, like those mentioned and the cuneiform, corniculate, etc.

6.

Study the laryngeal inlet. What compose it, what is its shape and orientation as regards the
hypopharynx. Try to move the vocal cords with a probe. What is the rima glottis?

7.

With a sharp knife, cut the larynx longitudinally in the posterior midline, downwards. Note the
location of the true and false cords, ventricle, vestibule and subglottic space.

8.

Review the venous and arterial supply of the larynx, its lymphatic drainage and innervation.

THE ANTERIOR AND POSTERIOR NECKS: SUPERFICIAL FASCIA

1.

Expose the neck using incisions 1, 2 and 2c (refer to figure 1). Incision 1 is made along the clavicles
onto the shoulders and the back on the suprascapular line. Incision 2c is a midventral incision from the
manubrium sterni to the mentum. Incision 2 starts from the manubrium sterni, carried up to the angle
of the mandible just inferior to the external ear, on both sides of the neck.

2.

The superficial fascia of the neck is not reflected in a large flap, as in the trunk wall, because muscles
are embedded in the fascia. These muscles form a layerthe Panniculus Carnosuswhich is
rudimentary in man, but which may be active in some individuals.

3.

Identify the platysma muscle lying within the superficial fascia. Make out the borders of this muscle.
Do you see the inferior part of this muscle on the chest wall? At the lower end of the muscle, where it
extends over the clavicle, the platysma can be seen as having a layer of superficial fascia on the deep
surface. In reflecting the muscle, it is very important to include this deep layer of fascia.

4.

Locate the anterior, external, and posterior jugular veins and trace their course as far as possible
without any dissection. Carefully remove the superficial fascia over the platysma, at the same time
identifying all nerves which are encountered. The platysma ends inferiorly in an irregular and jagged
line.

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5.

Reflect the cutaneous nerves of the neck together with the platysma and its fascia. The veins
encountered must be preserved as much as possible. Lift the muscle until you see the three groups of
supraclavicular nerves and the cervical cutaneous nerves. Do not dectach them from the fascia.
Follow the course of the nerves until they pass underneath the sternomastoid, and look in this place for
another cutaneous nervethe great auricularwhich passes in a superior direction over the
sternomastoid. Look also for the lesser occipital nerve.

6.

Identify the cervical branch of the facial nerve reaching the underside of the platysma. Expose
completely the more proximal portions of the sensory nerves encountered, and the anterior and
external jugular veins.

THE DEEP CERVICAL FASCIA & TRIANGLES OF THE NECK

1.

Study the two big triangles of the neck using both the bony and soft tissue landmarks. Identify and
define the boundaries and contents of the triangles. The surgical neck is studied first in this manner.

3.

Organize your knowledge of the deep cervical fascia in terms of lamination, attachments, relations
and compartmentalization in the neck. What is the superficial layer or investing layer? What are the
fasciae of the infrahyoid muscle? The pretracheal fascia or layer? The prevertebral layer? The
bucco-pharyneal fascia? The carotid fascia and sheath?

Cross Section of Neck

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3. Observe the strap muscles of the neck vis--vis the superficial layer of the sternohyoid, omohyoid
and the deeper layer of the sternothyroid muscles. What compose the strap muscles.
4.

Study the two bellies and intermediate tendon of the omohyoid muscle. Analyze the attachment of the
intermediate tendon. Note the nerves reaching these muscles and free them toward the carotid sheath.
Transect this to reach the thyroid gland.

Omohyoid muscle,
Superior belly
Omohyoid muscle,
Inferior belly

THE SUBMANDIBULAR REGION

1.

Define the boundaries of the submandibular triangle. In the subcutaneous tissue, disclose the great
auricular nerve and the submental vein, including their communications.

2.

Observe the facial vein crossing the triangle and terminating in the internal jugular vein. Look for the
marginal mandibular branch of the facial nerve curving through the upper part of the triangle to the
face, and identify the cervical branch passing inferiorly to the platysma.

3.

Study and delineate the submandibular gland, its superficial and deep relations to the mylohyoid
muscle. Disclose also the lymph nodes and the facial artery grooving the upper surface of the gland.

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5.

Clean the digastric muscle and the mylohyoid muscle and their corresponding nerves. Cut the mylohyoid at the raphe and from the hyoid bone and reflect it upward. Then observe and note the relations
of the a) deep portion of the submandibular gland; b) submandibular duct; c) lingual nerve; d)
submandibular ganglion; e) hypogossal nerve; and f) vena commitans nervi hypoglossi.

6.

Delineate the sublingual gland. Disclose the duct or ducts. Observe its relations to the neighboring
structures.

7.

Identify and clean the hyoglossus muscle from origin to insertion. Note the lingual artery deep to it
in the inferior portion of the submandibular triangle.

7. Trace the stylohyoid and posterior belly of the digastric to their insertions. Clean the styloglossus
muscle. Identify all its nerves.
8.

Identify and analyze all the branches of the carotid system of arteries.

STERNOCLEIDOMASTOID MUSCLE
1.

Disclose the muscle by opening the fascial sheath. Observe the origin and insertion. Study the innervation best seen from the posterior triangle. What is the nerve point? Trace all its nerves. Is the
accessory nerve part of the nerve complex? What arteries supply the muscle?

2.

Delineate the superficial branches of the cervical plexus emerging along the posterior border of the
sternomastoid below the accessory nerve and trace them.

3.

Trace the lesser occipital, great auricular, transverse cervical and the supraclavicular nerves.

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THE CAROTID SHEATH AND RELATIONS

1.

Transect the sternomastoid and observe the carotid sheath. Trace the muscular nerves to the infrahyoid
muscles toward this sheath. Identify the ansa cervicalis and its loop (the superior ramus to the
hypoglossal nerve and the inferior ramus to the cervical plexus roots).

2.

Open the carotid sheath and observe the details of the internal jugular vein, carotid artery and the
vagus nerve in between and posterior to the two vessels.

3.

Locate the sympathetic trunk medial to the sheath, in front of or within the prevertebral fascia.

4.

Follow the carotid artery upward to its bifurcation. Do the same for the jugular vein and check all its
tributaries as far as possible.

5.

Identify the external carotid artery and trace it as far as possible. Look for the cardiac nerves,
branches of the vagus and the sympathetic nerve running along or in the sheath.

6.

Look for the deep cervical lymph nodes along the internal jugular vein. Review its subgroups.

7.

Identify the thoracic duct emptying into the junction of the internal jugular and subclavian veins on
the left side of the neck. Note its arch and its course as far as its disappearance behind the esophagus.
Trace the right main lymphatic duct, the counterpart of the thoracic duct on the right neck.

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Esophagus
Trachea
Phrenic Nerve
Internal Jugular Vein
Brachial Plexus

Thoracic Duct

Subclavian Vein

8.

Identify the thyrocervical trunk of the subclavian artery. Look for the transverse cervical artery
running along and laterally through the posterior triangle and the suprascapular artery approaching
the clavicles.

9.

Identify the inferior thyroid artery and note the middle cervical ganglion of the sympathetic in
relation to the arch. Look for the ascending cervical artery.

10. Identify the phrenic nerve on the surface of the anterior scalene muscle behind the prevertebral fascia.
Trace the nerve to its origin.
11. Observe and analyze the formation of the brachiocephalic trunk behind the sternoclavicular joint and
also the beginning of the subclavian artery.

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12. Observe in detail the course and relations of the vagus and phrenic nerves and the sympathetic
trunk as they pass from above into the chest.
13. Identify the cervicothoracic ganglion of the trunk and also the ansa subclavia. Disclose fully the
origin and course of the recurrent laryngeal nerve.
14. Delineate and analyze the floor of the posterior triangle noting especially the scalene muscles in
relation to the nerves and vessels of the triangle. Observe the levator scapulae and splenius capitis and
their innervation. Note the course and relations of the vertebral artery.

THE THYROID GLANDS AND PARATHYROIDS

1.

Study the fascial investment and relations of the thyroid gland. Examine the lobes and isthmus of the
pyramidal lobe.

2.

Delineate the superior and inferior thyroid arteries and then the superior, middle and inferior
thyroid veins.

3.

Identify and trace the internal and external branches of the superior laryngeal nerve from the vagus.
Note their relations with the superior thyroid artery.

4.

Cut vertically through the isthmus and observe the fascial band attaching the gland to the cricoid
cartilage.

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5.

Identify the recurrent laryngeal nerve at the side of the trachea. Trace this upward as it goes under
the cricopharyngeus muscle, noting its relation to the thyroid gland and to the inferior thyroid vessels.

6.

Locate the parathyroid glands. Look for them within the posterior sheath of the thyroid gland. How
many are there? Name the blood supply.

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REFERENCES
1. UPCM Gross Anatomy 201 Laboratory Dissection Manual (1994)
2. Hollinshead, Anatomy for Surgeons, The Head & Neck, Vol 1, 3rd edition, 1982
3. Romanes, Cunninghams Manual of Practical Anatomy, Vol 3: Head & Neck &
Brain, 15th edition, 1986
4. Sauerland, Grants Dissector, 10th edition, 1991
5. Netter, Atlas of Human Anatomy, 2nd edition
6. Moses, Atlas of Clinical Gross Anatomy, 1st edition, 2005
7. Drake, Grays Anatomy for Students, 1st edition, 2005
8. Patel & Shah, TNM Staging of Cancer of Head & Neck: Striving for Uniformity
Among Diversity, CA Cancer J Clinic 2005, 55: 242-258
9. Buyton, Deep Neck Space Infection, UTMB, Dept of Otolaryngology, 2005
10. Ghorayeb, Surgical Anatomy in Head & Neck, Houston, Texas.
http://www.ghorayeb.com
11. Head & Neck Anatomy, http://www.instantanatomy.net
OooOOOOooo

JACOB S. MATUBIS, MD
Revised 05/08

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