Hip

Constitutes the pelvic girdle
United with the vertebral column
Union of three parts that is marked by a cup shaped cavity (acetabulum) Ilium
•    Prominence of the hip
•    Superior border is the crest
•    Anterosuperior spine-projection at the anterior tip of the crest
•    Corresponding projections on the posterior part are the posterosuperior and posteroinferior iliac spines
•    Greater sciatic notch-located beneath the posterior part
•    Most is a smooth concavity (iliac fossa)
•    Posteriorly it is rough and articulates with the sacrum in the formation of the sacroiliac joint

Pubic bone

Anterior part of the innominate bone
Symphysis pubic-joining of the two pubic bones at the midline
Body and two rami 
•    Body forms one fifth of the acetabulum
•    Superior ramis extends from the body to the median plane: superior border forms the pubic crest
•    Inferior ramus extends downward and meets with the ischium
•    Pubic arch is formed by the inferior rami of both pubic hones

Ischium
    Forms the lower and back part of the innominate bone
    Body
•    Forms two fifths of the accrabulum
•    Ischial tuberosiry-supports the body in a sitting position
•    Ramus-passes upward to join the inferior ramus of rhe pubis; known as rhe obturator foramen

Pelvis

Fanned by the right and left hip bones, sacrum, and coccyx

Greater pelvis

o    Bounded by the ilia and lower lumbar vertebrae
o    Gives support to the abdominal viscera

Lesser pelvis

o    Brim of the pelvis corresponds to the sacral promontory
o    Inferior outlet is bounded by the tip of the coccyx, ischial tuberosities, and inferior rami of the pubic bones

Female pelvis

o    Shows adaptations related to functions as a birth canal Wide outlet
o    Angle of the pubic arch is obtuse

Male pelvis

o    Shows adaptations that contribute to power and speed
o    Heart-shaped outlet
o    Angle of the pubic arch is acute

Thigh

Femur-longest and strongest bone of the body
Proximal end has a rounded head that articulates with the acetabulum
Constricted portion-the neck
Greater and lesser trochanters
Slightly arched shaft; is concave posteriorly
o    Linea aspera-strengthened by this prominent ridge
o    Site of attachment for several muscles
Distal end has two condyles separated on the posterior side by the intercondyloid notch

Knee cap

Patella-sesamoid bone
Embedded in the tendon of the quadriceps muscle
Articulates with the femur

Leg

Tibia-medial bone
o    Proximal end has two condyles that articulate with the femur
o    Triangular shaft

    Anterior-shin
    Posterior-soleal line
    Distal-medial malleolus that articulates with the latus to form the ankle joint
Fibula-lateral bone
o    Articulates with the lateral condyle of the tibia but does not enter the knee joint
o    Distal end projects as the lateral malleolus

Ankle, foot, and toes

Adapted for supporting weight but similar in structure to the hand

Talus

o    Occupies the uppennost and central position in the tarsus
o    Distributes the body weight from the tibia above to the other tarsal bones
Calcaneus (heel)-Iocated beneath the talus
Navicular-located in front of the talus on the medial side; articulates with three cuneifonn bones distally
Cuboid-lies along the lateral border of the navicular bone

Metatarsals
o    First, second, and third p1etatarsals lie in front of the three cuneifonn bones
o    (2) Fourth and fifth metatarsals lie in front of the cuboid bone

Phalanges

o    Distal to the metatarsals
o    (2) Two in the great toe; three in each of the other four toes .

Longitudinal arches in the foot (2)

o    Lateral-fonned by the calcaneus, talus, cuboid, and fourth and fifth metatarsal bones
o    Medial-fonned by the calcaneus, talus, navicular, cuneifonn, and first, second, and third metatarsal bones

Transverse arches-formed by the tarsal and metatarsal bones

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.

Levator Palpebrae Superioris Muscles

• This is a thin, triangular muscle that elevates the upper eyelid.
• It is continuously active except during sleeping and when the eye is closing.

• Origin: roof of orbit, anterior to the optic canal.
• Insertion: this muscle fans out into a wide aponeurosis that inserts into the skin of the upper eyelid. The inferior part of the aponeurosis contains some smooth muscle fibres that insert into the tarsal plate.
• Innervation: the superior fibres are innervated by the oculomotor nerve (CN III), and the smooth muscle component is innervated by fibres of the cervical sympathetic trunk and the internal carotid plexus.

Illnesses involving the Levator Palpebrae Superioris

• In third nerve palsy, the upper eyelid droops (ptosis) and cannot be raised voluntarily.
• This results from damage to the oculomotor nerve (CN III), which supplies this muscle.

• If the cervical sympathetic trunk is interrupted, the smooth muscle component of the levator palpebrae superioris is paralysed and also causes ptosis.
• This is part of Horner's syndrome.

The Rectus Muscles

• There are four rectus muscles (L. rectus, straight), superior, inferior, medial and lateral.

• These arise from a tough tendinous cuff, called the common tendinous ring, which surrounds the optic canal and the junction of the superior and inferior orbital fissures.
• From their common origin, these muscles run anteriorly, close to the walls of the orbit, and attach to the eyeball just posterior to the sclerocorneal junction.

• The medial and lateral rectus muscles attach to the medial and lateral sides of the eyeball respectively, on the horizontal axis.
• However, the superior rectus attaches to the anterosuperior aspect of the medial side of the eyeball while the inferior rectus attaches to the anteroinferior aspect of the medial side of the eye.

The Oblique Muscles

The Superior Oblique Muscle

• This muscle arises from the body of the sphenoid bone, superomedial to the common tendinous ring.
• It passes anteriorly, superior and medial to the superior and medial rectus muscles.
• It ends as a round tendon that runs through a pulley-like loop called the trochlea (L. pulley).
• After passing though the trochlea, the tendon of the superior oblique turns posterolaterally and inserts into the sclera at the posterosuperior aspect of the lateral side of the eyeball.

The Inferior Oblique Muscle

• This muscle arises from the maxilla in the floor of the orbit.
• It passes laterally and posteriorly, inferior to the inferior rectus muscle.
• It inserts into the sclera at the posteroinferior aspect of the lateral side of the eyeball.

• Skull 
  Cranium
  o    Superior portion formed by the frontal. parietal, and occipital bones
  o    Lateral portions formed by the temporal and sphenoid bones
  o    Cranial base formed by the temporal. sphenoid, and ethmoid bones
  o    Fontanels-soft spots in which ossification is incomplete at birth

  Frontal bone
  o    Forms the forehead
  o    Contains the frontal sinuses
  o    Forms the roof of the orbits
  o    Union with the parietal bones forms the coronal suture

  Parietal bones
  o    Union with the occipital bone forms the lambdoid suture
  o    Union with the temporal bone forms the squamous suture
  o    Union with the sphenoid bone forms the coronal suture

  Temporal bones
  o    Contains the external auditory meatus and middle and inner ear structures
  o    Squamous portion-above the meatus: zygomatic process-articulates with the zygoma
  o    to form the zygomatic arch 

  •    Petrous portion
  o    Contains organs of hearing and equilibrium 
  o    Prominent elevation on the floor of the cranium

  •    Mastoid portion
  o    Protuberance behind the ear

  o    Mastoid process
  •    Glenoid fossa-articulates with the condyle on the mandible
  •    Styloid process-anterior to the mastoid process; several neck muscles attach here
  •    Stylomastoid foramen-located between the styloid and mastoid processes; facial nerve emerges through this opening
  •    Jugular foramen-located between the petrous portion and the occipital bone: cranial nerves IX. X, and XI exit
   

The Lips

• These are mobile muscular folds that surround the mouth, the entrance of the oral cavity.

• The lips (L. labia) are covered externally by skin and internally by mucous membrane.
• In between these are layers of muscles, especially the orbicularis oris muscle.

• The upper and lower lips are attached to the gingivae in the median plane by raised folds of mucous membrane, called the labial frenula.

Sensory Nerves of the Lips

• The sensory nerves of the upper and lower lips are from the infraorbital and mental nerves, which are branches of the maxillary (CN V²) and mandibular (CN V³) nerves.

Superior Constrictor Muscle

• Origin: Hamulus, pterygo-mandibular raphe, and mylohyoid line of the mandible.
• Insertion: Median raphe of the pharynx.
• Nerve Supply: Vagus nerve via the pharyngeal plexus.
• Arterial Supply: Ascending pharyngeal artery, ascending palatine artery, tonsillar branch of the facial artery, and dorsal branch of the lingual artery.
• Action: Constricts the wall of the pharynx during swallowing.