Introduction and surface anatomy
The head and neck contain the structures that are the most significant to the practice of dental surgery. These regions are not as easy to study from dissection as other areas because an ‘onion skin’ approach has to be adopted. Layers are dissected from the most superficial subcutaneous structures to the deepest internal structures, the brain, and spinal cord; structures that appear at one level may not show up again until the dissection has advanced to much deeper layers. It is important to have a general understanding of the structures forming the head and neck to build up a coherent picture of their relationship to each other. The skull is the structural basis of the head. The skull comprises the cranium, formed from 27 bones joined together by fibrous joints known as sutures, and the separate mandible that articulates with the cranium at the temporomandibular joints (TMJ). The skull houses and protects the brain in the cranial cavity. It also protects other delicate structures vital for the reception of the special senses; the orbital cavities contain the eyes and dense bones in the cranial base house the internal ears. The entrance to the respiratory tract is the bony and cartilaginous nasal cavity; it can also be accessed together with the gastrointestinal tract through the oral cavity between the cranium and mandible. The major skeletal component of the neck is the cervical part of the vertebral column formed by seven vertebrae. The lower five cervical vertebrae conform to the general pattern of vertebrae outlined in Section 10.1.1, but the upper two cervical vertebrae are specialized; the atlas articulates with the underside of the skull for nodding movements and the second vertebra, the axis, articulates with the atlas for shaking movements of the head. The hyoid bone in the upper anterior neck and the laryngeal cartilages below it form the laryngeal skeleton. There are several important muscle groups in the head. The muscles of facial expression are small superficial muscles beneath the skin of the face; they alter facial expression in response to emotion, but also play a part in chewing, swallowing, and speech.