Myofascial cone
The myofascial cone is a structure within the orbit involved in the movement and support of the globe, or more simply the eye. It also serves as the physical division between the intraconal and extraconal compartments, but the cone itself is included in the contents of the intraconal space 1.
Gross anatomy
The apex of the myofascial cone lies at the posterior aspect of the orbit, the orbital apex, taking origin from the annulus of Zinn from which it extends anteriorly as the four rectus muscles towards its base at the posterior section of the globe, covered in, and connected by the orbital fascia.
The organization of myofascial cone allows for the rotational movements of the globe to occur on a fixed axis 1. The space created by this complex arrangement of muscles and intervening connective tissue creates the intraconal space of about 30ml in volume, in contrast to the globe which is only 7ml 2.
Muscles
The annulus of Zinn is a fibrocartilagenous structure encircling the optic canal and the medial aspect of the superior orbital fissure. Along its circumference the highly vascular rectus muscles arise; notably, the lateral rectus arises from the largest portion of the annulus, and therefore is the longest muscle and has a more crescentic appearance than the origin of the medial rectus 1.
From the common origin of the ring, the rectus muscles continue as an apparently continuous muscular tube for a few millimeters before the muscle bellies can be appreciated separately 3. It is of clinical significance that the rectus muscles insert anteriorly, just beyond the coronal equator of the globe into the sclera; it is at this point the sclera is thinnest and should be inspected in suspected globe rupture.
Fascia
The periorbital fascia or periorbita is continuous with the loosely adherent periosteum of the bony orbit, reflects onto the optic nerve sheath and the extraocular muscles upon reaching the apex of the orbit. This fascia invests circumferentially into the perimysium of the extraocular muscles and extends between the lateral margins of the muscles to complete the conical structure of the myofascial cone.
Within the confines of this intraconal space lies the orbital fat, which is extensively occupied by fibrous septa that intervene between structures passing through the intraconal space. It is this septal arrangement that is implicated in the clinical findings of upgaze abnormalities resulting from orbital floor fractures 3. It should be noted that veins pass within the septal planes, and arteries pass indiscriminately, piercing the planes to reach their destinations 4.
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Anatomy: Head and neck
- skeleton of the head and neck
-
cranial vault
- scalp (mnemonic)
- fontanelle
-
sutures
- calvarial
- facial
- frontozygomatic suture
- frontomaxillary suture
- frontolacrimal suture
- frontonasal suture
- temporozygomatic suture
- zygomaticomaxillary suture
- parietotemporal suture (parietomastoid suture)
- occipitotemporal suture (occipitomastoid suture)
- sphenofrontal suture
- sphenozygomatic suture
- spheno-occipital suture (not a true suture)
- lacrimomaxillary suture
- nasomaxillary suture
- internasal suture
- basal/internal
- skull landmarks
- frontal bone
- temporal bone
- parietal bone
- occipital bone
- skull base (foramina)
-
facial bones
- midline single bones
- paired bilateral bones
- cervical spine
- hyoid bone
- laryngeal cartilages
-
cranial vault
- muscles of the head and neck
- muscles of the tongue (mnemonic)
- muscles of mastication
-
muscles of facial expression
- occipitalis muscle
- circumorbital and palpebral muscles
- nasal muscles
- buccolabial muscles
- elevators, retractors and evertors of the upper lip
- levator labii superioris alaeque nasalis muscle
- levator labii superioris muscle
- zygomaticus major muscle
- zygomaticus minor muscle
- malaris muscle
- levator anguli oris muscle
- risorius muscle
- depressors, retractors and evertors of the lower lip
- depressor labii inferioris muscle
- depressor anguli oris muscle
- mentalis muscle
- compound sphincter
- orbicularis oris muscle
- incisivus superior muscle
- incisivus inferior muscle
- muscle of mastication:
- elevators, retractors and evertors of the upper lip
- muscles of the middle ear
- orbital muscles
- muscles of the soft palate
- pharyngeal muscles
- suprahyoid muscles
- infrahyoid muscles
- intrinsic muscles of the larynx
- muscles of the neck
- accessory muscles of the neck
- deep cervical fascia
-
deep spaces of the neck
- anterior cervical space
- buccal space
- carotid space
- danger space
- deep cervical fascia
- infratemporal fossa
- masticator space
- parapharyngeal space
- stylomandibular tunnel
- parotid space
- pharyngeal (superficial) mucosal space
- perivertebral space
- posterior cervical space
- pterygopalatine fossa
- retropharyngeal space
- suprasternal space (of Burns)
- visceral space
- surgical triangles of the neck
- orbit
- ear
- paranasal sinuses
- nose
- oral cavity
- pharynx
- larynx
- viscera of the neck
- blood supply of the head and neck
-
arterial supply
-
common carotid artery
- carotid body
- carotid bifurcation
- subclavian artery
- variants
-
common carotid artery
- venous drainage
-
arterial supply
- innervation of the head and neck
-
cranial nerves
- olfactory nerve (CN I)
- optic nerve (CN II)
- oculomotor nerve (CN III)
- trochlear nerve (CN IV)
-
trigeminal nerve (CN V) (mnemonic)
- trigeminal ganglion
- ophthalmic division
- maxillary division
- mandibular division
- abducens nerve (CN VI)
- facial nerve (CN VII)
-
vestibulocochlear nerve (CN VIII)
- vestibular ganglion (Scarpa's ganglion)
- glossopharyngeal nerve (CN IX)
-
vagus nerve (CN X)
- superior laryngeal nerve
- recurrent laryngeal nerve (inferior laryngeal nerve)
- (spinal) accessory nerve (CN XI)
- hypoglossal nerve (CN XII)
- parasympathetic ganglia of the head and neck
- greater occipital nerve
- third occipital nerve
-
cervical plexus
- muscular branches
- longus capitis
- longus colli
- scalenes
- geniohyoid
- thyrohyoid
-
ansa cervicalis
- omohyoid (superior and inferior bellies separately)
- sternothyroid
- sternohyoid
- phrenic nerve
- contribution to the accessory nerve (CN XI)
- cutaneous branches
- muscular branches
- brachial plexus
- pharyngeal plexus
-
cranial nerves
- lymphatic drainage of the head and neck
- embryological development of the head and neck
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