Video: Surface anatomy of the head and neck

Hey everyone! This is Nicole from Kenhub, and in this tutorial, we'll be looking at the surface anatomy landmarks of the head and neck.

Thankfully, we don’t see people walking around the streets looking like this. For clinicians, this means that we have to rely on the surface landmarks created by underlying structures in order to find our way around the body. Surface anatomy landmarks are anatomical features that can be seen or identified by the naked eye without dissection. Knowledge of these landmarks is essential for carrying out a range of tests and for finding the right spot to operate on during surgical procedures. Not to mention, they’re great to be aware of if you’re an artist.

In this tutorial, we’re going to be focusing specifically on the surface anatomy landmarks of the head and the neck. If you’d like to learn about the surface anatomy landmarks elsewhere in the body, be sure to check out our other tutorials which look in more detail at these. But for now, let’s dive right in to look at the surface anatomy landmarks of the head.

So, the most notable set of landmarks we can see on the head are the facial features – that is, the eyes, the ears, the nose, and the lips. The structure and appearance of the face is heavily influenced by the shape of the skull underneath so we’ll be looking simultaneously at the landmarks as they appear on the underlying skull using this image. No two faces are the same because no two skulls are the same.

The nose gets a lot of its shape and structure from the nasal cartilages which we can see here if we look beneath the surface. These derive a lot of their shape in turn from the nasal bones which form the bridge of the nose. If we take a look at the bones themselves, we can see that these only form a small part of the shape of the nose. Have a go at feeling this area on your own face. See if you can trace the nasal bones to their junction with the nasal cartilages. The nasal bones do a lot to influence the appearance of a person especially only taking up a relatively small portion of the nose itself. Nasal bones come in all shapes and sizes as we can see in the people around us.

The complete outline of the orbital margin can also easily be traced on either side of the nasal bones. In particular are the superciliary arches which can be clinically useful for us as they indicate the position of the frontal sinuses. These two arched elevations are prominent medially and can help us find the supraorbital notch or foramen which is where the supraorbital nerve passes through.

The next rather obvious landmark we have on the head is the outer portion of the two ears otherwise known as the auricle. These also come in all matter of shapes and sizes but generally have anatomy in common. For example, over here is the entrance to the middle and inner ear known as the external acoustic meatus. We can also see the outermost fold, the helix, and this inner fold, the antihelix. We also have a slightly smaller tragus and antitragus. And, of course, over here, is the lobule or the earlobe.

The next set of landmarks we can see highlighted here and making our model look like he’s sporting a bit of war paint our known as the zygomatic arches and give rise to the shape and structure of the cheeks. The zygomatic arch is actually formed by two bones – the zygomatic process of the temporal bone and the temporal process of the zygomatic bone. The zygomatic arches have a big influence on the appearance of the face and can be easily palpated.

Moving on up to the forehead, two landmarks here that are also easily palpable are these two rounded elevations on the frontal bone known as the frontal eminences. Jumping down to the lower part of the face, we have the jaw, which is formed by the part of the skull known as the mandible. Looking at the mandible itself, we can further divide it into three parts, all of which help to form the surface of your face. Firstly, we have the body of the mandible which forms the overall size and shape of the jaw, the mental protuberance which helps to form the shape of the chin, and the angle of the mandible which forms the angle of the jaw.

The mandible serves as an attachment point for the muscles of mastication – the chewing muscles. Two of which forms surface landmarks and can be easily palpated if you clench your teeth. The first of these is the masseter muscle, highlighted here, which along with the mandible helps to form the shape of the jaw. The second of these is the temporalis muscle which can also be palpated easily when clenching your teeth. This muscle fills the space made by the bones of the skull here to create the shape of the temple.

Moving on up to the cranium now, we can see the parietal bones, highlighted here in green. In the parietal bone, there’s a raised area in the center known as the parietal eminence. The parietal eminences are formed as a result of the external convexity of the parietal bones and help to form the overall shape of the head. Also visible on the lateral aspect of the head is the mastoid process of the temporal bone. This bony prominence serves as an attachment site for the sternocleidomastoid muscle and, as we can see in this image here, is located just behind the ear. This landmark is easily palpable, so have a feel for yourself.

If we hang on this image here for a second, we can see a landmark just here that is not as easily palpable as some of the others we’ve discussed in this tutorial but has a great deal of clinical relevance, making it worthwhile mentioning. Here we can see the point at which the mandible joins with the temporal bone to form the temporomandibular joint or TMJ for short. We can get another view of the TMJ on our original image of the skull highlighted in green just here and this synovial joint is where the mandible joins and articulates with the rest of the skull allowing us to open and close the mouth as well as move the jaw side to side. The TMJ can be palpated just in front of the ears when opening and closing the mouth. Problems with this joint are common so it’s important to be aware of.

Let’s move on now to the posterior aspect of the head where we can see the most prominent landmark – the external occipital protuberance. This serves as an attachment site for the trapezius muscle and is easily palpable in most individuals. More importantly, it can be used as a useful landmark to help you find the next three landmarks which are known as the nuchal lines. These are three curved horizontal protrusions that can be palpated in most individuals. See if you can feel for them on your own head. These three ridges serve as the attachment points for several muscles in the neck.

The highest nuchal line might not be visible in all individuals. It serves as the origin for the epicranius muscle and epicranial aponeurosis. The next nuchal line is the superior nuchal line. Despite its name, this line is situated inferiorly to the highest nuchal line and it serves as the point of origin for the trapezius muscle, the sternocleidomastoid muscle, and the splenius capitis muscle. The final and most inferiorly situated of the three nuchal lines is, not surprisingly, the inferior nuchal line. The semispinalis capitis muscle inserts just above this line.

So now that we’ve looked at some of the major surface anatomy landmarks of the head, let’s move on down to look at the landmarks of the neck.

When we look at the neck anteriorly, we can see and palpate a lump just here which is formed by the underlying laryngeal cartilages. A prominent structure visible in post pubescent males is the laryngeal prominence of the thyroid cartilage and is more commonly known as the Adam’s apple. The thyroid cartilage and the cricoid cartilage, while less prominent, are palpable in females as well as males.

Two more landmarks that are easy to spot on most people are the forms of the sternocleidomastoid muscles which are highlighted just here. The sternocleidomastoid muscle lies very superficially, meaning that it has significant influence on the surface form of the neck. When this muscle is contracted, the sternal head stand out as the sharply defined ridge with the slight v-shaped depression appearing between the two heads.

Let’s turn our model around and have a look at another prominent landmark of the neck, the final landmark we’ll be covering today, which is the superior portion of the trapezius muscle. The trapezius muscle is a very large muscle that extends all the way down the back. Its superior border roughly forms the shape of a triangle and can be especially prominent in muscular individuals.

Alright, before we conclude the tutorial, let’s quickly run through the landmarks that we’ve covered.

First, we looked at the landmarks of the face specifically starting with the nasal cartilages which form the most prominent portion of the nose. The nasal cartilage is connected to the nasal bone, the shape of which has a significant effect on the shape of the nose and the appearance of the face as a whole. Tracing laterally from the nasal bone, we can palpate the superciliary arches which is where we can also find the supraorbital notch where the supraorbital nerve passes through.

Next, we looked at the outer part of the ear known as the auricle. Some useful landmarks of the auricle include the external acoustic meatus which is the entrance to the middle and inner ear as well as the helix, the antihelix, the tragus, and the antitragus as well as the lobule or ear lobe. Forming the structure of the cheeks, we next have the zygomatic arches or the cheek bones. The zygomatic arches are formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone.

Looking at the forehead, we can palpate two raised areas known as the frontal eminences. Moving down to the lower portion of the face, we can palpate the landmarks formed by the mandible, which can be divided into the body of the mandible which forms the majority of the structure of the jaw, the mental protuberance which helps to form the chin, and the angle of the mandible which can be easily felt just anteriorly to the ear. Also helping to form the shape of the face and jaw are two of the muscles of mastication which are the masseter highlighted here and the temporalis just here – both of these muscles can be easily palpated when the jaw is clenched.

Looking laterally at the head, we can trace a rounded elevation marking the center of each of the two parietal bones of the skull. This is known as the parietal eminence. Just inferiorly to the parietal eminence is the mastoid process which is easy to see and to palpate. This bony prominence serves as one of the attachment sites for the sternocleidomastoid muscle and can be felt just behind the ear. Located just anteriorly to the mastoid process is the clinically important temporomandibular joint or the TMJ which is the synovial articulation between the mandible and the temporal bone and this joint can be best felt when the jaw is opened and closed.

We then looked at the external occipital protuberance which is one of the attachment sites for the trapezius muscle before moving to talk about the nuchal lines, which include the highest nuchal line, the superior nuchal line, and the inferior nuchal line, all of which serve as the attachment points for various muscles and ligaments of the neck and can vary in palpability between individuals.

We then moved on to examine the surface anatomy landmarks of the neck, the first of which being that caused by the underlying laryngeal cartilages. In males, this is the laryngeal prominence or the Adam’s apple and the thyroid and cricoid cartilages also feature in females as well as males. The two sternocleidomastoid muscles also contribute significantly to the overall form of the neck while finally we saw that the superior portion of the large trapezius muscle also helps to form the shape of the neck.

That concludes this tutorial on the surface anatomy landmarks of the head and the neck. If you’d like to know more about surface anatomy, be sure to check out our other tutorials looking at the limbs and the trunk in more detail.

See you next time.