THIEME Atlas of Anatomy Necl< and Internal Organs Michael Schuenke Erik Schulte Udo Schumacher Consulting Editors Lawrence M. Ross Edward D. Lamperti lllustr.uions by Markus Voll KarlWesker ~)Thieme ~Thieme Neck and Internal Organs THIEME Atlas of Anatomy Consulting Editors Lawrence M. Ross, M.D., Ph.D., Department of Neurobiology and Anatomy University ofTexas Medical School at Houston Edward D. Lamperti, Ph.D., Immune Disease Institute and Harvard Medical School Authors Michael Schuenke, M.D., Ph.D., Institute of Anatomy Christian Albrecht University Kiel Erik Schulte, M.D., Department of Anatomy and Cell Biology johannes Gutenberg University Udo Schumacher, M.D., FRCPath, CBiol, FIBiol, DSc, Institute of Anatomy II: Experimental Morphology Center for Experimental Medicine University Medical Center Hamburg·Eppendorf In collaboration with juergen Rude Illustrations by MarkusVoll Karl Wesker 962 Illustrations 78 Tables Thieme Stuttgart · New York Library of Congress Cotologlng-ln-Pub/ICXltkln Data Is available from the Important note: Medicine Is an ever-changing science undergoing publisher. continual development. Research and clinical exper1ence are continu ally expanding our knowledge, In particular our knowledge of proper This book Is an authorized and revised translation of the German treatment and dn.Jg therapy. Insofar as this book mentions any dosage edition published and copyrighted 2005 by Georg Thieme Verlag, or application, readers may rest assured that the authors, editors, and Stuttgart, Germany. Title of the German edition: Schuenke et al.: publishers have made every effort to ensure that such references are in Hals und lnnere Organe; Prometheus Lematlas der Anatomle. accordance with the rtate of knowledge at the time of production of the book. Nevertheless, this does not Involve, Imply, or express any guarantee Illustrators or responsibility on the part of the publishers In respect to any dosage Markus Voll, FDrstenfeldbruck, Germany: lnstn.Jctlons and forms of applications stated In the book. Every user Is Karl Wesker, Berlin, Germany (homepage: www.karlwesker.de) requested to examine cal'l!fully the manufacturers' leaflets accompa nying each drug and to check, If necessary In consultation with a phy Translator sician or specialist, whether the dosage schedules mentioned therein TerryTelger, Fort Worth, Texas, USA or the contralndlcatlons stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of applica tion used is entirely att he user's own risk and responsibility. The authors and publishers request every user to report to the publishers any dis crepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page. C corrected reprint 2010 Georg Thieme Verlag RiidigerstraBe14 D-70469 Stuttgart Germany http://www.thieme.de Thieme New York, 333 Seventh Avenue, New York, NY 10 001 , USA http:ffwww.thieme.com Typesetting byweyhing digital, Ostflldern-Kemnat Some of the product names, patents, and registered designs referred Printed in China by Everbest Printing Ltd, Hong Kong to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as pro Plus Version-includes online access to WinkingSkull.com PLUS prietary is not to be construed as a representation by the publisher that it is in the public domain. This book, including all parts thereof, is legally protected by copyright. Softcover Any use, exploitation, or commercialization outside the narrow limits ISBN 978-1 -60406-288-5 set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat repro Hardcover duction, copying, mimeographing, preparation of microfilms, and elec ISBN 978-1 -60406-294-6 tronic data processing and storage. 123456 Foreword Preface Our errthusiasm for the THIEME Atlas of Anatomy began when each As it started planning this Atlas, the publisher sought out the opinions of us, independently, saw preliminary material from this Atlas. Both and needs of students and lecturers in both the United States and of us corrtinue to be captivated by the new approach, the conceptual Europe. The goal was to find out what the "ideal" atlas of anatomy organization, and by the stunning quality and detail oft he images ofthe should be-ideal for students wanting to learn from the atlas, master Atlas. We were delighted by the ongoing opportunity provided by the the extensive amounts of infom1ation while on a busy dass schedule, editors at Thieme to cooperate with them in making this outstanding and, in the process, acquire sound, up-to-date knowledge. The result of resource available to our students and colleagues in North America. this work is this Atlas. The THIEME Atlas of Anatomy, unlike most other atlases, is a comprehensive educational tool that combines illustrations As consulting editors we were asked to review, for accuracy, the English with explanatory text and summarizing tables, introducing clinical edition of the THIEME Atlas ofA natomy. Our work involved a conversion applications throughout, and presenting anatomical concepts in a of nomenclature to tem1s in common usage and some organizational step-by-step sequence that allows for the integration of both system· changes to reflect pedagogical approaches in anatomy programs in by-system and topographical views. North America. This task was eased greatly by the dear organization of the original text. In all of this, we have tried diligerrtly to remain faithful Since the THIEME Atlas of Anatomy is based on a fresh approach to the to the irrtentions and insights of the original authors. underlying subject matter itself, it was necessary to create for it an errtirely new set of illustrations-a task that took eight years. Our goal We extend our special thanks to Brian R. MacPherson, Ph. D. for his timely was to provide illustrations that would compellingly demonstrate assistance in the role of a Consulting Editor during the emergency illness anatomical relations and concepts, revealing the underlying simplicity of one editor (LMR). of the logic and order of human anatomy without sacrifidng detail or aesthetics. We would like to thank the team at Thieme Medical Publishers who worked with us: Kelly Wright, Developmental Editor, and Cathrin E. With the THIEME Atlas of Anatomy, it was our intention to create an Schulz M.D., Executive Editor, for checking and correcting our work and atlas that would guide students in their initial study of anatomy, for their constarrt availability and encouragemerrt. stimulate their enthusiasm for this irrtriguing and vitally important subject, and provide a reliable reference for experienced students We would also like to extend our heartfelt thanks to Stefanie Langner, and professionals alike. Production Manager, for preparing this volume with care and speed. "Ify ou want to attuin the possible, you must atrempt the impossible" lawrence M. Ross, (Rabindranath Tagore). Edward D. lamperti Michael Schunke, Erik Schulte, Udo Schumacher, Markus Voll, and Karl Wesker Acknowledgments Rrst we wish to thank our families. This atlas is dedicated to them. We are grateful to Antje Biihl, who was there from the beginning as proj· ect assistant, working "behind the scenes" on numerous tasks such as We also thank Prof. Reinhard Gossrau, M.D., for his critical comments repeated proofreading and helping to arrange the figure labels. and suggestions. We are grateful to several colleagues who rendered valuable help in proofreading: Mrs. Gabriele Schiinke, Jakob Fay, M.D., We owe a great dept of thanks to Martin Spencker, Managing Director Ms. Claudia Diicker, Ms. Simin Rassouli, Ms. Heinke Teichmann, and Ms. of Educational Publications at Thieme, especially to his ability to make Sylvia Zilles. We are also grateful to Dr. julia jiims-Kuhnlre for helping quick and unconventional decisions when dealing with problems and with the figure labels. uncertainties. His openness to all the concerns of the authors and art· ists established conditions for a cooperative partnership. We extend spedal thanks to Stephanie Gay and Bert Sender, who com· posed the layouts. Their ability to arrange the text and illustrations on Without exception, our collaboration with the entire staff at Thieme facing pages for maximum clarity has contributed greatly to the quality Medical Publishers was consistently pleasant and cordial. Unfortunately of the Atlas. we do not have room to list everyone who helped in the publication of this atlas, and we must limit our acknowledgments to a few colleagues We particularly acknowledge the efforts of those who handled this proj· who made a particularly notable contribution: Rainer Zepf and Martin ect on the publishing side: Wal~ko for support in all technical matters; Susanne Tochtermann· Wenzel and Manfred Lehnert, representing all those who were involved jiirgen Liithje, M.D., Ph. D., executive editor at Thieme Medical Publish· in the production of the book; Almut Leopold for the Index; Marie-Luise ers, has "made the impossible possible." He not only reconciled the Kiirschner and her team for creating the cover design; to Birgit Carlsen wishes of the authors and artists with the demands of reality but also and Anne Dobler, representing all those who handled marketing, sales, managed to keep a team of five people working together for years on a and promotion. project whose goal was known to us from the beginning but whose full dimensions we came to appreciate only over time. He is deserving of The Authors our most sincere and heartfelt thanks. Sabine Bartl, developmental editor, became a touchstone for the au· thors in the best sense of the word. She was able to determine whether a beginning student, and thus one who is not (yet) a professional, could clearly appreciate the logic of the presentation. The authors are in· debted to her. Table of Contents Neck Overview and Muscles 4 Topographical Anatomy 1.1 The Neck: General Aspects ............................. 2 4.1 Surface Aniltomy and Triangles of the Neck .............. 42 1.2 Overview and Superficial Neck Muscles ................... 4 4.2 Posterior Cervical Triangle ............................ 44 1.3 Suprahyoid and lnfrahyoid Muscles ....................... 6 4.3 Anterior CervicaiTriangle ............................. 46 1.4 Prevertebral and Lateral (Deep) Neck Muscles ............. 8 4.4 Deep Lilteral Cervicill Region, Caracotid Triangle, and Thorilcic Inlet ................................... 48 4.5 Posterior Cervical and Occipital Regions ................ 50 2 Arteries 4.6 Cross-sectional Anatomy of the Neck 2.1 Arteries ............................................ 10 fromtheT1/T2toC6/C7Levels ...................... 52 2.2 Veins .............................................. 12 4.7 Cross-sectional Anatomy at the Level 2.3 Lymphatic System ................................... 14 oftheC5/ C6Vertebral Bodies ......................... 54 2.4 Overview of the Nervous System in the Neck and the Distribution of Spinal Nerve Branches ............ 16 2.5 Cranial Nerves and Autonomic Nervous System in the Neck ........................................... 18 3 Cervical VIscera 3.1 Embryology ........................................ 20 3.2 Thyroid Gland and Parathyroid Glands ...........•....... 22 3.3 Larynx: Location, Shape, and Laryngeal Cartilages ............. 24 3.4 Internal Features and Neurovasculilr Structures ......... 26 3.5 Muscles ............................................ 28 3.6 Topographical ilnd Clinical Anatomy .................. 30 3.3 Pharynx: Muscles ........................................... 32 3.8 SurfaceAnatomyofthe Mucosa and its Connections with the Skull .......................... 34 3.9 Topographical Anatomy ilnd lnnerviltion ............... 36 3.10 Neurovilscular Structures in the Parapharyngeal Space .. 38 3.11 The Parapharyngeal Space ilnd Its Clinical Significance .. 40 IX Table ofC ontents Thorax Spaces 3 Blood vessel 1.1 Overview oft he Thoracic Skeleton and its Landmarks ..... 58 3.1 Thoracic Aorta ....................................... 114 1.2 Divisions of the Thoracic Cavity and Mediastinum ......... 60 3.2 Vena Cava and Azygos System ........................ 116 1.3 Overview oft he Mediastinum .......................... 62 3.3 Arteries and Veins oft he Esophagus .................... 118 1.4 Contents of the Mediastinum ........................... 64 3.4 Pulmonary Arteries and Veins ......................... 120 1.5 Pericardium .......................................... 66 3.5 Bronchial and Diaphragmatic Arteries and Veins ......... 122 1.6 Pleural Cavity ......................................... 68 3.6 Coronary Vessels (Coronary Arteries and Cardiac Veins): Topography ......................................... 124 2 Organs 3.7 Coronary Vessels: Distribution oft he Coronary Arteries ... 126 2.1 Esophagus: Location, Divisions, and Special Features .............. 70 4 Lymphatics System 2.2 Location and Wall Structure .......................... 72 4.1 OverviewofThoracic Lymphatic Trunks and Pathways .... 128 2.3 Inlet and Outlet, Opening and Closure ................. 74 4.2 Overview of the Lymph Nodes ......................... 130 2.4 Trachea: Thoracic Location and Relations ................ 76 4.3 The Thymus ......................................... 132 2.5 Lung: 4.4 Lymphatic Drainage of the Esophagus .................. 134 Thoracic Location and Relations ...................... 78 4.5 Lymphatic Drainage of the Trachea, Bronchial Tree, 2.6 Shape and Structure ................................. 80 and Lungs ........................................... 136 2.7 Trachea and Bronchial Tree: 4.6 Lymphatic Drainage of the Diaphragm, Heart, Shape and Structure ...............•................... 82 and Pericardium ..................................... 138 2.8 Lung: Segmentation ...................................... 84 2.9 Functional Structure ofthe Bronchial Tree ............. 86 5 Nervous System 2.10 Functional Structure ofthe Vascular Tree .............. 88 5.1 OverviewofThoracic Innervation ••..••.••.•••..••..••. 140 2.11 Diaphragm ........................................... 90 5.2 Innervation of the Esophagus, Trachea, 2.12 Respiratory Mechanics ................................. 92 and BronchiaiTree ................................... 142 2.13 Prenatal and Postnatal Circulation ...................... 94 5.3 Innervation of the Heart .............................. 144 2.14 Heart: 5.4 Innervation of the Pericardium and Diaphragm .......... 146 Anterior View. ...................................... 96 2.15 Lateral and Superior Views ........................... 98 2.16 Shape and Structure ................................ 100 2.17 MuscularStructure(Myocardium) .................... 102 2.18 Atria and Ventricles ................................ 104 2.19 Overview of the Cardiac Valves; the Atrioventricular Valves .......................... 106 2.20 Semilunar Valves and Sites for Auscultating the Cardiac Valves ................... 108 2.21 Impulse Formation and Conduction System ........... 110 2.22 Mechanical Action of the Heart ........................ 112 X