The digastric (or biventer) line has been described and used to evaluate basilar invagination on frontal skull plain film and coronal recontructed CT image.
The digastric line is drawn between right and left digastric grooves. The tip of the odontoid process and atlanto-occipital joint normall...
The digastric muscle is composed of two bellies, anterior and posterior, connected by an intermediate round tendon. The two bellies of the muscle have different embryonic origins and hence are supplied by different cranial nerves.
anterior belly: digastric fossa on the deep sur...
The digastric triangle is one of the paired triangles in the anterior triangle of the neck. The triangles of the neck are surgically focussed, first described from early dissection-based anatomical studies which predated cross-sectional anatomical description based on imaging (see deep spaces of...
Dolan's lines are the collective name given to three lines described by Dolan and Jacoby 1 that aid in evaluating for maxillofacial fractures on an occipitomental skull radiograph. They are usually used as an adjunct to McGrigor-Campbell lines.
orbital line traces the inner margins of the later...
The term dolichoectasia means dilated and elongated. It is used to characterise arteries that have shown a significant deterioration of their tunica intima (and occasionally the tunica media), weakening the vessel walls and causing the artery to elongate and distend.
Dorello canal channels the abducens nerve (CN VI) from the pontine cistern to the cavernous sinus.
Dorello canal is found at the medial most end of the petrous ridge at the confluence of the inferior petrosal, basal, and cavernous sinuses.
The dorsal nasal artery, also known as the dorsonasal artery, is a terminal branch of the ophthalmic artery.
Arising as a terminal branch of the ophthalmic artery, the dorsal nasal artery exits the orbit after piercing the orbital septum above the medial canthal tendon (medial pa...
The dorsum sellae is the square shaped process of the sphenoid bone. It ascends superiorly from the posterior part of the sphenoid body to form the posterior wall of the sella turcica.
The dorsum sellae forms the posterior wall of the sella turcica, which houses the pi...
Thickening of the insertion of the lateral pterygoid muscle can mimic an anterior displaced temporomandibular disc. When both thickening of the inferior belly insertion and an anteriorly displaced disc are present, the two structures parallel each other; the so-called "double disc" sign.
The duct of Rivinus connects the sublingual gland to the floor of the mouth.
Despite its name, it is not a single duct, but numerous small ducts all of which open into the floor of the mouth and are collectively termed the duct of Rivinus.
The largest of these little ductules is the major duct...
The ducts of the salivary glands allow the passage of salivary juice from the glands to the oral cavity:
parotid duct (Stenson duct): connects the parotid gland to the buccal mucosa, adjacent to maxillary second molar
submandibular duct (Wharton duct): connects the submandibular gland to the f...
Dysphagia refers to subjective awareness of difficulty or obstruction during swallowing. It is a relatively common and increasingly prevalent clinical problem. Odynophagia is the medial term for painful swallowing.
Fluoroscopy is the mainstay of imaging assessment but manometry can help evaluat...
Eagle syndrome refers to symptomatic elongation of the styloid process or calcified stylohyoid ligament 1,2. It is often bilateral. In most cases, the cause is unknown; however, the condition is sometimes associated with disorders causing heterotopic calcification such as abnormal calcium/phosph...
The ear refers to the entire vestibulcochlear organ and is divided anatomically into:
Ectodermal dysplasia (ED) refers to a heterogeneous group of genetic disorders that cause abnormal ectoderm development. The effect is a non-progressive defect in the development of two or more tissues derived from embryonic ectoderm.
ED is rare with an estimated prevalence of 1:...
Ectopia lentis refers to subluxation or dislocation of the lens of the eye secondary to dysfunction or disruption of zonular fibres.
systemic and syndromic disorders
typically upwards and out
most common spontaneous cause 2
homocystinuria - ty...
An ectopic thyroid gland is one which is located in a location other than the normal position anterior to the laryngeal cartilages.
During embryological development, the thyroid gland migrates down from the foramen caecum at the posterior aspect of the tongue to its permanent location. This nor...
Endolymph is a one of two type of cochlear fluids, the other being perilymph. It is located in the scala media of the cochlea.
It is secreted by the stria vascularis (colloquially called 'battery of the cochlea') on the outer wall of the scala media.
It has a high level of potassium (K+) and g...
Endolymphatic sac tumours are very rare, locally invasive tumours of endolymphatic sac. Early detection of these tumours is critical, because early surgical intervention may prevent further hearing loss. Endolymphatic sac tumours do not metastasize but are highly locally aggressive.
Endophthalmitis is a potentially sight-threatening condition that involves intraocular inflammation of any cause. It is distinguished from panopthalmitis in that is does not extend beyond the sclera. It is either infectious or noninfectious in aetiology, but in clinical practice, intraocular inf...
There is a short list of causes for enlarged extraocular muscles:
thyroid associated orbitopathy
amyloidosis (very rare) 2
Enophthalmos refers to the posterior displacement of the globe in the orbit. It implies that the globe itself is normal and is caused by either one or a combination of 1:
structural alterations in the bony orbit
orbital fat atrophy
Specific causes include 2:
orbital blowout fract...
The epiglottis is a leaf-shaped fibrocartilaginous structure that forms part of the supraglottic larynx and defines the division of the hypopharynx from the larynx.
The epiglottis projects posterosuperiorly from its stem-like base, which is attached to the thyroid cartilage. It ...
Epiglottitis is a life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds 1, which can lead to acute airway obstruction. Hence, treatment should be urgent and performed by appropriately trained individuals, e.g. instrumentation of the trachea should be perfor...
Epignathus is a term given to a very rare form of teratoid tumour that arises from the oropharyngeal region.
There may be a slight female predilection ref. The estimated incidence is ~ 1 in 35,000 to 200,000 births.
The tumour classically presents in utero ...
Epistaxis (nosebleed) is very common and has a broad differential diagnosis in clinical practice. In clinical practice, anterior epistaxis are mainly located in Kiesselbach's plexus and posterior epistaxis (5% of all epistaxis) in Woodruff's plexus.
Epistaxis is very common, with ...
The epitympanum, also known as the attic or epitympanic recess, is the most superior portion of the tympanic cavity. It is that portion of the tympanic cavity superior to the axial plane between the tip of the scutum and the tympanic segment of the facial nerve 1,3.
Posteriorly the epitympanum ...
Ethmocephaly refers to a rare type of midline cranio-facial anomaly that is characterised by the presence of extreme hypotelorism, arhinia and a midline proboscis.
holoprosencephaly 1,2: particularly alobar holoprosencephaly
The ethmoidal air cells (or less commonly, the ethmoidal sinuses) form one of the four pairs of paranasal sinuses. They are located within the single, midline ethmoid bone.
location: between the orbit and the nasal cavity, within the ethmoid labyrinth of the ethmoid bone
The ethmoid bone is a single midline facial bone that separates the nasal cavity from the brain and is located at the roof of the nose and between the orbits. It is a cubical shape and is relatively lightweight because of its spongy construction. It contributes to the anterior cranial fossa.
The ethmoid bulla, also known as bulla ethmoidalis, is the largest and most consistent air cell of the anterior ethmoid air cells.
It is located posterior to the frontal recess and enclosed laterally by the lamina papyracea. It forms the roof of the middle meatus.
It can be clas...
The ethmoid infundibulum is a curved cleft of the ethmoid bone which leads into the anterior portion of the hiatus semilunaris. It is bordered medially by the uncinate process and laterally by the orbital plate of the ethmoid. The infundibulum is often continuous with the frontal recess into whi...
The Eustachian tube, or more appropriately the pharyngotympanic tube, is the channel through which the tympanic cavity communicates with the nasopharynx. It is approximately 36 mm in length and is directed downward, forward, and medially, forming an angle of about 45 degrees with the sagittal pl...
Eustachian tube dysfunction (ETD) is considered by many to be the underlying cause of chronic otomastoiditis, although both the exact pathogenesis and role of ETD in chronic middle ear infections is unclear.
ETD is estimated to be present in ~1% of the adult population.
The external auditory canal (EAC) extends from the external auditory meatus (EAM) medially to the tympanic membrane.
The external auditory meatus (EAM) may either refer to the canal or the round lateral opening of the EAC.
The EAC is typically 2.5 cm in length and i...
External auditory canal atresia (EACA) is characterised by complete or incomplete bony atresia of the external auditory canal (EAC) and, especially when seen in the setting of an associated syndrome, a dysplastic auricle and an abnormal middle ear cavity.
The incidence is 1 in 10,...
External auditory canal cholesteatomas are uncommon locations for cholesteatomas, which are usually in the middle ear or petrous apex. When they occur lateral to the tympanic membrane, they are referred to as external auditory canal cholesteatomas.
The external acoustic canal i...
Exostosis of the external auditory canal (also known as surfer's ear), is a benign bony overgrowth of the bony external auditory canal brought about by exposure to cold wind and water combined.
broad-based or more focal circumferential bony overgrowth of the osseous exter...
External auditory canal osteomas are rare focal pedunculated bony overgrowths of the osseous external auditory canal.
solitary pedunculated bony overgrowth of the external auditory canal usually at the bony cartilaginous junction
large lesions may be associat...
The external carotid artery (ECA) is one of the two terminal branches of the common carotid artery. The other terminal branch is the internal carotid (ICA), which is somewhat larger than the ECA.
origin: bifurcation of the common carotid artery
course: under the submandibular gland an...
The external ear comprises the auricle (or pinna), the external auditory meatus, and the tympanic membrane (eardrum). The auricle concentrates and amplifies sound waves and funnels them through the outer acoustic pore into the external auditory meatus to the tympanic membrane.
The external jugular vein (EJV) drains the head, face, and part of the pectoral region.
Origin and course
The posterior division of the retromandibular vein and posterior auricular vein unite to form the external jugular vein at the angle of the mandible.
It courses inferiorly ...
A mnemonic to remember external jugular vein (formed by the retromandibular and posterior auricular veins) tributaries is:
P: posterior external jugular vein
A: anterior jugular vein
S: suprascapular vein
T: transverse cervical vein
The extraconal orbital compartment or extraconal space is the space within the orbit outside the musculofascial cone. The base of which is anterior and is formed by the orbital septum that surrounds the equator of the globe. The external sides are formed by the bones of the orbit and their perio...
Extraconal orbital lesions include lesions which arise from structures within the extraconal orbital space and those extending from adjacent structures into the orbits.
dermoid cyst: most common lesion in paediatrics
lacrimial gland lesions
Extracranial meningiomas, also known as primary extradural meningiomas or ectopic meningioma, are a rare location-specific type of meningioma that arise outside the dural covering of the brain and spinal cord. They are essentially extracranial tumours, most often occurring in the head and neck, ...
Extramedullary plasmacytoma is an uncommon plasma cell tumour that is composed of monoclonal plasma cells arranged in clusters or sheets. The rate of progression to multiple myeloma (MM) varies from 10% to 30%.
EMP occurs most commonly during the fourth through to seventh decades ...
An extramural air cell is one that is not contained within its named parent bone. So, the infraorbital ethmoidal air cells that lie within the maxilla rather than the ethmoidal bone are an example of extramural air cells.
A mnemonic to remember the order in which extraocular muscles are involved in thyroid-associated orbitopathy (TAO) is:
I: inferior rectus
M: medial rectus
S: superior rectus
L: lateral rectus
There is some debate about this however. Some claim superior rectu...
A mnemonic to remember the nerve supply to the extraocular muscles:
LR6SO4O3 (mock 'chemical formula')
The letters represent the extraocular muscles and numbers represent their respective cranial nerve supply:
LR6: lateral rectus, innervated by the 6th (abducens) nerve
The extra-ocular muscles are the six muscles that insert onto the eye and hence control eye movements:
superior rectus: elevation
superior oblique: intorsion
medial rectus: adduction
lateral rectus: abduction
inferior oblique: extorsion
inferior rectus: depression
The extrinsic muscles of the tongue are a group of 4 muscles of the tongue. They all arise outside the tongue, which is in comparison to the intrinsic muscles of the tongue which are entirely within the tongue with no external attachments. They act to alter the position of the tongue where as th...
The extrinsic muscles of the tongue can be remembered with the following mnemonic:
Paris St Germain's Hour
Paris St. Germain's Hour
Exudative retinitis, also known as retinal telangiectasis or Coats disease, is a rare congenital disease affecting the eyes and is a cause of leukocoria.
It occurs predominantly in young males, with the onset of symptoms generally appearing in the first decade of life with a peak ...
The eyelid covers the eye and is covered in front with loose skin and behind with adherent conjunctiva. The lower lid possesses very little mobility; lids are closed gently by palpebral fibres and forcefully by orbicularis oculi.
The eyelid comprises of a number of key featur...
Eye movements are a complex set of movements of the globe that are performed by the extra-ocular muscles that are grouped by the muscles that perform particular movements:
ocular internal rotators
ocular external rotators
Facial angiofibroma, also known as fibrous papule, is a fairly common skin lesion seen in males and females after puberty.
They represents a focal vascular and collagen growth.
This lesion is usually solitary and located on the nose skin, measuring 1-5 mm.
There is no hereditary p...
The facial artery is one of the branches of the external carotid artery and supplies blood to the structures of the face.
origin: branch of the external carotid artery a little above the level of the lingual artery, in the carotid triangle of the neck
course: passes deep to the poster...
The facial bones comprise a set of bones that make up the face:
inferior nasal concha
zygoma (zygomatic bone)
Where these bones join each other, sutures occur.
The facial-cavernous anastomoses are the communications of the facial and deep facial veins with the cavernous sinus.
At the medial canthus of the eye there is a communication with the ophthalmic veins, which drain into the cavernous sinus. Blood from the frontal scalp normally f...
Facial clefts comprise of a wide spectrum of pathologies that result from failure of fusion in the facial region during the embryonic/early fetal period. The result is a gap in the fetal face. These clefts can affect the lip, philtrum, alveolus, and hard and soft palate to varying degrees.
Facial fractures are commonly caused by blunt or penetrating trauma at moderate or high levels of force. Such injuries may be sustained during a fall, physical assault, motor vehicle collision, or gunshot wound. The facial bones are thin and relatively fragile making them susceptible to injury.
The facial muscles enable facial expression and serve as sphincters and dilators of the orifices of the face. These muscles differ from those of other regions in the body as there is no fascia deep to the skin of the face; many of the facial muscles insert directly into the skin 1.
The facial nerve is one of the key cranial nerves with a complex and broad range of functions.
Although at first glance it is the motor nerve of facial expression which begins as a trunk and emerges from the parotid gland as five branches (see facial nerve branches mnemonic), it has taste and p...
There are many mnemonics to recall the branches of the facial nerve (superior to inferior) as they exit the anterior border of the parotid gland. Examples include:
Tall Zulus Bear Many Children
Two Zulus Bit My Cat
Two Zebras Bit My Coccyx
Ten Zebras Buggered My Car
To Zanzibar By Motor Car...
Facial palsy refers to the neurological syndrome of facial paralysis. It can result from a broad range of physiological insults to the facial nerve or its central nervous system origins. The most common causes of this is Bell palsy.
While facial palsy refers to the clinical presen...
The facial vein (previously known as the anterior facial vein) is the continuation of the angular vein and joins the anterior branch of the retromandibular vein to form the common facial vein 1-3.
At the level of the lower margin of the orbit, the angular vein becomes the facial ...
Factitious hyperthyroidism or thyrotoxicosis factitia refers to precipitation of thyrotoxicosis due to exogenous ingestion of thyroid hormone (e.g. levothyroxine). It has been rarely associated with myocardial ischaemia 2.
The hypervascularity which is seen wi...
The falciform crescent (or crista falciformis) is a horizontal ridge that divides the internal acoustic meatus into superior and inferior portions.
The facial nerve and superior vestibular nerve (SVN) travel in the superior portion of the IAM with the facial nerve anterior to the SVN ...
The Fallopian (facial) canal refers to a bony canal through which the facial nerve traverses the petrous temporal bone, from the internal acoustic meatus to the stylomastoid foramen.
It is, for those of you fond of trivia, the longest bony canal through which a nerve passes. It is also responsi...
The false vocal cords (vestibular folds, ventricular folds) are paired shelf-like structures located within the supraglottic larynx that divide the vestibule above from the ventricle below.
The vestibular ligaments are the ligamentous component of the false vocal cords and const...
Familial medullary thyroid carcinoma (FMTC) is a genetic disorder closely related multiple endocrine neoplasia type IIa (MEN2a) and multiple endocrine neoplasia type IIa (MEN2b). It is characterised by the development of medullary thyroid cancer.
FMTC is the result of mutations in the RET (re...
Fatty nodal metaplasia in the neck occurs as a result of chronic inflammation or radiotherapy 3. The normal fatty nodal hilum enlarges, such that the lymph node appears cystic. However, its center is of fatty density. There is no surrounding stranding, and the node otherwise looks normal.
Faulty fetal packing, also known as congenital vault depression, is a congenital concave depression of the skull in a newborn.
Occurs in 1 in 10,000 births 1.
This appearance is due to external compression on the skull from 1,2:
fetal limb or twin
Febrile infection-related epilepsy syndrome (FIRES) is a severe postinfectious neurological disorder that presents with status epilepticus in a previously normal child (or less commonly adult) after a febrile illness.
FIRES has received several names in the literature:
A fetal goitre is an enlargement of the thyroid gland in utero. It can occur with either hyper- or hypothyroidism (and in isolated cases of euthyroidism 8).
The mechanism depends on whether the underlying cause is hyper- or hypothyroidism.
maternal Graves disease with...
First branchial cleft cysts are a type of branchial cleft anomaly. They are uncommon and represent only ~7% of all branchial cleft cysts.
They are usually diagnosed in middle-aged women 3-4.
Their presentation can in the form of 3:
asymptomatic, e.g. inci...
The fissula ante fenestram (FAF), also known as the cochlear cleft, is a small connective tissue-filled cleft located where the tendon of the tensor tympani muscle turns laterally toward the malleus. It is situated immediately anterior to the oval window, and posterior to the cochleariform proce...
The fistula test is used when examining a patient with recurrent vertigo.
A finger is abruptly applied to the external meatus which causes a pulse of air-transmitted pressure. If nystagmus is induced in association with vertigo, it indicates bony destruction within the inner ear e.g. cholesteat...
Floating teeth is the description given to the appearances on imaging of teeth that appear to be floating as a result of alveolar bone destruction around their roots.
They are uncommonly encountered, with a wide differential diagnosis - albeit that the underlying cause ...
The floor of mouth is an oral cavity subsite and is a common location of oral cavity squamous cell carcinoma.
The floor of mouth is a U-shaped space extends (and includes) from the oral cavity mucosa superiorly, and the mylohyoid muscle sling 2,3.
superiorly: oral ...
Florid cemento-osseous dysplasia is a sub type of cemento-osseous dysplasia. It is a rare condition presenting in the jaw refers to a group of fibro-osseous (cemental) exuberant lesions with multi-quadrant involvement.
There maybe an increased female predilection and tends to be ...
Focal calvarial thinning can result from a number of causes. They include:
bilateral thinning of the parietal bones (normal variant) most common
mega cisterna magna
peripherally located tumors (e.g. oligodendroglioma)
Follicular thyroid adenoma is a commonly found benign neoplasm of the thyroid consisting of differentiated follicular cells. It cannot be differentiated from follicular carcinoma on cytologic, sonographic or clinical features alone 1.
Follicular thyroid adenoma is more commonly fo...
Follicular thyroid carcinoma (FTC) is the second most frequent malignancy of the thyroid gland after papillary cancer and accounts for ≈10-20% of all thyroid neoplasms.
It typically occurs in women and in an older age group than papillary (i.e. 40-60 years of age).
The foramen caecum represents a primitive tract between the anterior cranial fossa and the nasal space. It is located along the anterior cranial fossa, anterior to the cribriform plate of the ethmoid bone and posterior to the frontal bone, within the frontoethmoidal suture. It lies at a variable...
Foramen caecum can refer to a number of different anatomical structures:
foramen caecum (tongue)
foramen caecum (anterior cranial fossa)
The foramen lacerum is a triangular opening located in the middle cranial fossa anterior to the petrous apex, which forms its posterior border. Its anterior border is formed by the body of the sphenoid bone at the junction of greater wing and pterygoid process and medial border is formed by the ...
A mnemonic to remember foramen ovale contents is:
O: otic ganglion (inferior)
V: V3 cranial nerve (mandibular division of the trigeminal nerve)
A: accessory meningeal artery
L: lesser petrosal nerve
E: emissary veins
Foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the caverno...
The foramen rotundum is located in the middle cranial fossa, inferomedial to the superior orbital fissure at the base of greater wing of the sphenoid bone. Its medial border is formed by lateral wall of sphenoid sinus. It runs downwards and laterally in an oblique path and joins the middle crani...
The foramen singulare, also known as the singular foramen, is a small opening at the posteroinferior aspect of the fundus of internal auditory canal (IAC) 2,3. It carries the singular or posterior ampullary nerve, a branch of the inferior vestibular nerve which carries afferent information from ...
The foramen tympanicum (also known as foramen of Huschke) is an anatomical variation in the external acoustic canal (EAC), where a bony defect connects the EAC to the temporomandibular joint (TMJ).
Various studies have reported on the occurrence of a foramen tympanicum in the asym...