Almost All Dissection Manual

Min Suk Chung, Beom Sun Chung

Department of Anatomy,Ajou University School of Medicine, Korea

Orientation

Anatomy is a very important subject in the field of medicine as it is the foundation of all the other studies. You will be able to ascertain almost everything in the lab from the textbook. You need a lab manual in order to quickly perform dissection and learn as much as you can from the anatomy lab. However, I think this simplified lab manual is more helpful to students than other published lab manuals.

This manual contains very simple diagrams to help you perform dissections, and you do not necessarily need to follow the instruction word by word. For example, it is suggested that you approach the specimen from various angles and dissect in many different ways when working on arms and legs which have bilateral symmetry. The goal of anatomy labs is to repeatedly see and understand the structures of the human body.

Under each picture, there is a list of structures that should be found during dissection. At the end of each chapter, you will find a list of structures that are to be studied. I hope you will be able to compare every structure from this manual to the actual specimen. Please bring this manual and a notebook to the lab. In case you cannot find a structure that you are supposed to, you should determine why. It is advised to memorize this manual before coming to the lab because it allows you more time to work on the body. If you are too cautious, you will not have enough time. Be moderately bold, but with a little bit of prudence.

I recommend students to dissect and feel the human body as much as possible. For example, it can be boring to separate skin from fascia sometimes; however you will become more familiar with the human body. Also, it is important to have relevant discussions with colleagues and professors beforehand and afterwards. These are keys to good grades and to becoming a great physician.

When performing dissections, always be courteous and thankful to the family of the deceased and those who donated their cadavers.

October 2, 2014

Min Suk Chung (Professor, PhD, MD) / dissect@ajou.ac.kr

Beom Sun Chung (Teaching Assistant, MD) / bschung@ajou.ac.kr

anatomy.co.kr

Department of Anatomy, Ajou University School of Medicine, 164 Worldcup-ro, Suwon, Republic of Korea / 443-380

1. Anatomy terms in this manual follow the TerminologiaAnatomica (Thieme, 1998).

2. The names of the cranial nerves are written in following abbreviations.

I = Olfactory nerveII = Optic nerveIII = Oculomotor nerveIV = Trochlear nerveV = Trigeminal nerveV1 = Ophthalmic nerveV2 = Maxillary nerveV3 = Mandibular nerveVI = Abducens nerveVII = Facial nerveVIII = Vestibulocochlear nerveIX = Glossopharyngeal nerveX = Vagus nerveXI = Accessory nerveXII = Hypoglossal nerve

3. Orientations of the head and methods of dissection are represented like below.

- Anterior view

- Posterior view

- Superior view

- Inferior view

- Right side view

- Oblique view

- Cut

- Reflect

- Remove

Contents

Chapter I. Dry bone................................................................................ 1

Chapter II. General principles of dissection............................................ 7

Chapter III. Back..................................................................................... 10

Chapter IV. Upper limb........................................................................... 16

Chapter V. Neck..................................................................................... 23

Chapter VI. Head.................................................................................... 27

Chapter VII. Thorax................................................................................ 37

Chapter VIII. Abdomen........................................................................... 45

Chapter IX. Pelvis & perineum................................................................ 53

Chapter X. Lower limb............................................................................ 57

Chapter I. Dry bone

1. Do not leave the lab with the dry bone. Do not write on the bone. Be careful not to break the bone.

2. Leave the lab after reorganizing bones like below.

CalvariaCranial base

Mandible

Vertebral column Clavicle Pelvic girdle or Hip bone1st rib Scapula Femur

Rib Humerus PatellaSternum Radius Tibia

Ulna FibulaBones of hand Bones of foot

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<Essential structures to identify in dry bone>

Touch and memorize the following bone structures from the dry bone. If the structure is marked with (surface), try to palpate them on your own body.

* SkullCalvariaCranial baseCranial cavityOuter tableDiploeInner tableGroove for superior sagittal sinusAnterior cranial fossaMiddle cranial fossaPosteriorcranial fossaClivusGroove for inferior petrosal sinusAnterior fontanelleOrbitSupraorbital marginInfraorbital marginSuperior orbital fissureInferior orbital fissureOptic canalChoanaNasolacrimal canalPterionTemporal fossaZygomatic arch (surface)Infratemporal fossaPterygopalatine fossaPterygomaxillary fissureJugular foramenForamen lacerumGreater palatine foramenIncisive foramenParietal bone

Groove for sigmoid sinusGroove for middle meningeal arterySuperior temporal lineInferior temporal lineParietal foramenSagittal suture

Frontal bone

Supraorbital notch (surface)Supraorbital foramenFrontal sinusCoronal suture

Occipital boneForamen magnumOccipital condyleCondylar canalHypoglossal canalExternal occipital protuberance (surface)Highest nuchal lineSuperior nuchal lineInferior nuchal lineInternal occipital protuberanceLambdoid suture

Sphenoid boneSellaturcicaHypophysial fossaPosteriorclinoid processSphenoid sinusLesser wingAnterior clinoid processGreater wingForamen rotundumForamen ovaleForamen spinosumLateral pterygoid plateMedial pterygoid plate

Temporal boneStyloid processMastoid process (surface)Carotid canalInternal acoustic meatusStylomastoid foramenExternal acoustic meatusZygomatic processMandibular fossaArticular tubercle

Auditory ossicleMalleus

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IncusStapes

Ethmoid boneCribriform plateCrista galliPerpendicular plateEthmoidal cellSuperior nasal conchaMiddle nasal concha

Inferior nasal conchaLacrimal boneNasal boneVomerMaxilla

Infraorbital foramenMaxillary sinusFrontal processZygomatic processPalatine processAlveolar processDental alveolus

Palatine bonePerpendicular plateHorizontal plateLesser palatine foramen

Zygomatic boneTemporal processFrontal process

MandibleBody of mandibleMental spineMylohyoid lineRamus of mandibleMandibular foramenLingula (surface) (need to put hand inside the oral cavity)Mandibular canalMental foramenMylohyoid grooveCoronoid processCondylar processHead of mandible (surface)Neck of mandible

Hyoid bone (surface) Body of hyoid bone Greater horn

Lesser horn* Vertebra

Vertebral columnCervical curvatureThoracic curvatureLumbar curvatureSacral curvatureVertebral canalVertebral bodyVertebral archPedicleLaminaVertebral foramenSuperior vertebral notchInferior vertebral notchIntervertebral foramenSpinous processTransverse processSuperior articular processInferior articular processCervical vertebra

Transverse foramenAtlas

Lateral massAnterior archPosteriorarchGroove for vertebral artery

AxisDens

Vertebraprominens (surface)Thoracic vertebra

Superior costal facetInferior costal facetTransverse costal facet

Lumbar vertebraSacrum

PromontoryAla of sacrumAuricular surfaceAnterior sacral foramenPosteriorsacral foramenMedian sacral crest (surface)Intermediate sacral crestLateral sacral crest

Sacral hornSacral hiatus (surface)

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Sacral canalCoccyx

* RibTrue ribFalse ribFloating rib

Head of ribNeck of ribBody of ribTubercle of ribCostal angleCostal grooveScalene tubercleGroove for subclavian arteryGroove for subclavian vein

Costal cartilage

* SternumManubrium of sternumJugular notch (surface)Clavicular notchSternal angle (surface)Body of sternumXiphoid processCostal notch

* Shoulder girdleClavicle

Sternal end (surface)Acromial end (surface)Conoid tubercle

ScapulaSubscapular fossaSpine of scapula (surface)Supraspinous fossaInfraspinous fossaAcromion (surface)Suprascapular notchGlenoid cavityCoracoid process (surface)

* HumerusHead of humerus (surface)Anatomical neck

Surgical neckGreater tubercleLesser tubercleIntertubercular grooveBody of humerusRadial grooveMedial supracondylar ridgeLateral supracondylar ridgeDeltoid tuberosityCapitulum of humerusTrochlea of humerusOlecranon fossaCoronoid fossaMedial epicondyle (surface)Lateral epicondyle (surface)

* RadiusHead of radius (surface)Neck of radiusBody of radiusRadial tuberosityInterosseous borderStyloid process (surface)Dorsal tubercle (surface)

* UlnaOlecranon (surface)Coronoid processTrochlear notchRadial notchInterosseous borderHead of ulna (surface)Styloid process (surface)

* Carpal boneScaphoid

Tubercle of scaphoid (surface)LunateTriquetrumPisiform (surface)Trapezium

Tubercle of trapezium (surface)TrapezoidCapitateHamate

Hook of hamate (surface)

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*Metacarpal boneBase of metacarpal boneBody of metacarpal boneHead of metacarpal bone (surface)

* PhalanxProximal phalanxMiddle phalanxDistal phalanx

Base of phalanxBody of phalanxHead of phalanx

* Pelvic girdle = Hip boneAcetabulumAcetabular notchAcetabular fossaLunate surfaceObturator foramenIlium

Arcuate lineIliac crest (surface)Iliac tubercle (surface)Anterior superior iliac spine (surface)Anterior inferior iliac spinePosteriorsuperior iliac spine (surface)Posterior inferior iliac spineGreater sciatic notchPosterior gluteal lineAnterior gluteal lineInferior gluteal lineIliac fossaAuricular surface

IschiumBody of ischiumRamus of ischiumIschial tuberosity (surface)Ischial spineLesser sciatic notch

PubisBody of pubisPubic crestPubic tubercle (surface)

Superior ramus of pubisPectineal lineInferior ramus of pubis

Pelvic inletLinea terminalisAnatomical conjugatePelvic outletGreater pelvisLesser pelvis

* FemurHead of femurFovea for ligament of headNeck of femurGreater trochanter (surface)Lesser trochanterIntertrochanteric lineIntertrochanteric crestBody of femurLinea asperaLateral lipMedial lipGluteal tuberosityMedial supracondylar lineLateral supracondylar lineMedial epicondyleMedial condyle (surface)Adductor tubercleLateral epicondyleLateral condyle (surface)Intercondylar fossaPatellar surface

* Patella (surface)

* TibiaMedial condyle (surface)Lateral condyle (surface)Intercondylar eminenceBody of tibiaTibial tuberosity (surface)Soleal lineInterosseous borderMedial malleolus (surface)

* Fibula

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Head of fibula (surface)Neck of fibulaBody of fibulaInterosseous borderLateral malleolus (surface)Malleolar fossa

* Tarsal boneTalus

Head of talusNeck of talusBody of talus

CalcaneusTalar shelf (surface)Calcaneal tuberosity (surface)

NavicularMedial cuneiformIntermediate cuneiformLateral cuneiformCuboid

* Metatarsal boneBase of metatarsal boneBody of metatarsal boneHead of metatarsal boneTuberosity of 5th metatarsal bone (surface)

* PhalanxProximal phalanxMiddle phalanxDistal phalanx

Base of phalanxBody of phalanxHead of phalanx

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Chapter II. General principles of dissection

1.Teacher prepares forceps, a handle of scalpel, a blade, a hook, scissors, a chisel, a hammer, a saw, nippers, a 1 mm thick soft wire, a pin, a disposable razor, a wooden prop, a scoop to poor preservative, a bucket to put under the table, a container to put a part of the cadaver, strings (red, blue, yellow, green), cloth, vinyl, a soap powder, a disinfectant, and disposable band-aids.

2. Students prepare rubber gloves, a mask, a towel, a soap, a chalk, and a water soluble pen.

3.In order to identify the number of the body, tie all the tags attatched to both arms and legs to the desk’s legs. Identify the age and the reason of death.

4. If the smell of cadaver fixative is too strong, spray water on the body. The cadaver fixative contains following chemicals:

Formalin 3 LEthanol (95%) 10 LPhenol 1 kgWater 22 L

5.Sufficiently cover the non-dissecting parts to prevent drying. (For example, when dissecting the back and the upper limbs, cover the head, neck, pelvis, perineum, torse and lower limbs with cloth.) Clean after each dissection lab. Spray enough cadaver conservative to keep the cadaver moist, and cover with vinyl. Cadaver conservative contains followings:

Formalin 1 LWater 100 L

6.Put removed parts of a cadaver during dissection (removed skin for example) into a container. Do not mix with other garbages or parts from a different cadaver. This will be cremated with the cadaver in a coffin.

7.Feel free to see and refer to useful materials such as a dry bone, a plastic model, and anatomical specimans. Put it back when you are done using it.

8.Do not leave the lab with a model or a specimen.

9.On each dissection stage, encircled “d” stands for dissection method.

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10.Skin: during skinning process, snip a shallow cut. Do not cut the muscle. Refer to the subcutaneous papilla while skinning. Keep the skin thin. Make holes on skin and pull to ease the skinning process.

When each lab is done, re-cover the skin to prevent drying or collect the removed skin in a container.

11. Subcutaneous tissue: after skinning, scratch the subcutaneous tissue with a hook and find cutaneous nerve and cutaneous vein

12. Muscle: remove the fascia that covers the muscle, tendon, and aponeurosis with a knife. It is better to remove the fascia in the muscle bundle direction. Also remove the intermuscular septum. The purpose of removing a fascia is to identify the border, origin and insertion of the muscle. After identifying the muscle, cut and fold the necessary muscle to see other structures inside (e.g. other muscle). Give a clean horizontal cut to a muscle belly near the origin and fold towards the insertion. The tendon should not be cut since it is hard to match and identify later. When cutting and folding the muscle, be cautious not to damage other muscle, nerve and artery. After folding the muscle, detach the fascia covering inside the muscle and identify the nerve and a located in the muscle Remove the vein located in the muscle

13. Blood vessel: because artery has a thicker wall and a smaller lumen compare to vein, there is almost no blood clot in a lumen which makes it appear white. Although artery appears white like nerve, unlike vein, artery has smooth muscle and elastic fiber on the wall. This allows artery to have a circular cross section.

14. Lymph node: check which region it belongs and then remove. Lymphatic vessel that connects lymph node can be hardly seen.

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15. Bone: use both chisel and hammer or saw or pincer to cut. Electric saws, electric drills, or osteotomes.

16. Variation does not have a trouble in functioning. Congenital malformation has problem in functioning. Congenital malformation can be used for case report. When you find one, reporight to teacher. Remove vein that accompany artery. When detaching vein, make sure a blood cloth inside does not contaminate the surrounding area. Do not detach a vein that does not accompany a, cutaneous vein, superior vena cava, pulmonary vein, azygos vein, and portal vein.

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Chapter III. Back

1.Skin of the back2.Trapezius & latissimus dorsi3.Rhomboid muscles4.Serratus posterior & erector spinae5.Splenius & transversospinalis6.Suboccipital triangle7.Deltoid muscle8.Muscles of scapula9.Laminectomy

10.Spinal cord

1.Skin of the back

ⓓ Skin the back. Do not make a deep cut. Keep skin thin during the process. The figure below is just an example. You don’t need to exactly follow it. Skinning process becomes easier if you poke a hole in the removed skin, insert your finger in the hole, and pull the skin. If you support the chest area with a wooden prop instead of the head, the head tilts due to gravity. Hence the skinning of the neck area becomes easier.

o Locate the medial branch and the lateral branch of posteriorramus and posteriorbranch of lateral cutaneous branch from the centre of the body respectively.

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2. Trapezius & latissimus dorsi

ⓓ Cut and fold the trapezius and latissimus dorsi muscle When you fold the latissimus dorsi, cut the origin of the muscle between 10th - 12th ribs and inferior angle of scapula. Be careful not to damage the serratus anterior when folding the latissimus dorsi.

o Notice that the nuchal ligament continues from under the 7th cervical vertebra to the supraspinous ligament.

o Notice that the thoracolumbar fascia is an aponeurosis of the latissimus dorsi and a fascia of the deep back muscle.

3. Rhomboid muscles

ⓓ Cut and reflect the rhomboid minor muscle and the rhomboid major muscle Be careful not to damage the dorsal scapular nerve inside.

4. Serratus posterior& erector spinae

ⓓ Cut and fold the serratus posteriorsuperior and the serratus posteriorinferior.

o Remove the posteriorlayer of the thoracolumbar fascia. Then divide the iliocostalis into the cervicis, thoracis, and lumborum. Divide the longissimus into the capitis, cervicis and thoracis. Insertion is the guideline of division.

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5. Splenius & transversospinalis

ⓓ Cut and fold the splenius capitis and the splenius cervicis.

o On one side, organize the iliocostalis, longissimus, and spinalis. On the other side, remove these muscles and organize the semispinalis, multifidus, rotatores.

o Remove a part of the external intercostal muscle and internal intercostal muscle Then locate the intercostal vein, artery, and nerve.

6. Suboccipital triangle

ⓓ Cut and fold the semispinalis capitis. Be careful not to damage the suboccipital triangle inside.

o From the suboccipital triangle, examine that suboccipital nerve which is a branch of 1st cervial nerve and that the vertebral artery is above 1st cervical vertebra.

7. Deltoid muscle

ⓓ Cut and fold the deltoid muscle Be careful not to damage the axillary nerve.

o Fold the deltoid muscle Locate the subacromial bursa below the deltoid muscle and the acromion. The subacromial bursa is similar to a synovial membrane of a synovial joint.

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8. Muscles of scapula

ⓓ Cut and fold the supraspinatus and the infraspinatus. Be careful not to damage the suprascapular nerve inside.

o Locate the omohyoid muscle which is located at the upper corner of the scapula and its insertion is the hyoid bone.

o Remove the fascia of the serratus ant. located inside the scapula. Tear the serratus ant. with fingers and touch the subscapularis.

9. Laminectomy

ⓓ In order to perform laminectomy of a vertebral column, completely remove the deep back muscle, supraspinous ligament, and interspinous ligament Remove the spinous process and lamina, then transverse process and articular process. Completely expose the spinal ganglion in the intervertebral foramen. Be careful not to cut spinal nerve For some groups, do not cut and leave the suboccipital triangle. Remove the backside of the sacrum and locate all of the spinal nerve Cut the origin of the gluteus maximus from the sacrum. Vertically cut the back of the dura mater, spread it to both sides and pin it.

o Locate the ligamentum flavum attached to the front of a lamina.

o Remove a small portion of the pia mater from the spinal cord and the arachnoid mater. Examine if a pia mater is of the same tissue as the denticulate ligament and the terminal filum. Locate that the terminal filum is attached to the coccyx.

o Find spinal ganglions of the 1st thoracic nerve, 1st lumbar nerve and 1st sacral nerve. Tie them with a string.

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o Notice that the height of the medullary cone is 1st - 2nd lumbar vertebrae.

o Recognize that the 5th cervical - 1st thoracic nerves originate from the cervical enlargement and the 2nd lumbar - 3rd sacral nerves originate from the lumbosacral enlargement.

o Recognize that XI’s spinal root originates and inclines between 1st cervial nerve-5’s posteriorroot and denticulate ligament.

10. Spinal cord

ⓓ The posteriorroot and the anterior root meet and form a trunk of spinal nerve Cut both sides of this. Cut where the brain and the spinal cord meet. Cut vertebral artery as well. Remove the spinal cord.

o Vertically cut the front of dura mater. Spread it to both sides and find that its posterior root and anterior root look different.

o From a section between the brain and the spinal cord, differentiate gray matter (inside) and white matter (outside).

o Locate the posteriorlongitudinal ligament attached behind the vertebral body.

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<Essential structures to identify in back>

* MusclesTrapeziusLatissimus dorsi

Thoracolumbar fasciaLevator scapulaeRhomboid minorRhomboid majorSpleniusDeep back muscle

Erector spinaeTransversospinalis

Suboccipital triangleVertebral artery

* Spinal cordMeninges

Dura materArachnoid materSubarachnoid space

Cerebrospinal fluidPia mater

Cervical enlargementBrachial plexus

Lumbosacral enlargementLumbosacral plexus

Medullary coneSpinal nerve

1st - 8th cevical nerve1st - 12th thoracic nerve1st - 5th lumbar nerve1st - 5th sacral nerve

Cauda equina

* Scapular regionDeltoid muscleRotator cuff

SubscapularisSupraspinatusInfraspinatusTeres minor

Teres majorSerratus anterior

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Chapter IV. Upper limb

1. Skin of pectoral region2. Pectoralis muscle3. Brachial plexus & axillary artery4. Skin of arm, forearm & hand5. Triceps brachii6. Pronator teres7. Flexor digitorumsuperficialis8. Extensor carpi ulnaris9. Muscles & nerves of hand

10.Arteries of hand11.Shoulder joint12.Elbow joint

1. Skin of pectoral region

ⓓ Skin the pectoral region. Be very careful not to damage the platysma in the subcutaneous tissue. Fold the platysma upward. Do not skin the nipple and the areola. For a male cadaver, keep the nipple and the areola attached to the pectoralis major. For a female cadaver, keep the nipple, areola, and breast attached to the pectoralis major.

o Observe that the medial branch and the lateral branch of the anterior cutaneous branch, and the anterior branch of the lateral cutaneous branch are positioned from the centre respectively.

o From the breast of a female cadaver, differentiate the relatively white mammary gland and the relatively yellow subcutaneous tissue. Tie the lactiferous duct which connects the mammary gland and the nipple with a string.

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2. Pectoralis muscle

ⓓ Cut and fold the pectoralis major. Also cut the origin of the pectoralis major from the rectus sheath’s anterior layer.

o Find that the lateral pectoral nerve originates from the brachial plexus’s lateral cord and penetrates the costocoracoid membrane. Observe that the medial pectoral nerve originates from the medial cord and penetrates the pectoralis minor.

o See that the cephalic vein penetrates the deltopectoral triangle and goes into the axillary vein.

3. Brachial plexus & axillary artery

ⓓ Cut and fold the pectoralis minor.

o Locate the lateral cord and the medial cord of the brachial plexus by following the musculocutaneous nerve, median muscle and ulnar nerve towards the proximal of the cadaver.

o Using the pectoralis minor as a marker, divide the axillary artery into three sections. Examine the branches of each section.

o Notice that the branchial vein is an accompanying vein but the axillary vein is not an accompanying vein.

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4. Skin of arm, forearm & hand

ⓓ Skin all the uper limbs.

o Observe that the basilic vein penetrates the brachial fascia and goes into a border between the brachial vein and the axillary vein.

o Slice vertically and open the wall of the cutaneous veinfrom the upper limb. Observe that the venous valve has two valves.

o When removing the brachial fascia and the antebrachial fascia, keep the bicipitalaponeurosis to the biceps brachii.

o Notice that the musculocutaneous nerve controls the flexor muscle in the arm and the musculocutaneous nerve becomes the lateral antebrachial cutaneous nerve in the forearm.

o Observe that the pisiform is the sesamoid bone. located in the tendon of the flexor carpi ulnaris.

5. Triceps brachii

ⓓ Cut and reflect the long head and the lateral head of the triceps brachii along the radial groove of the humerus. Do not cut the medial head inside.

o Note that the radial nerve lies with the radial groove.

6. Pronator teres

ⓓ Cut and fold the pronator teres.

o The common interosseous artery emerges from the ulnar artery.

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7. Flexor Digitorum Superficialis

ⓓ Cut and fold the flexor digitorumsuperficialis. Also cut every origin of the humerus, radius, and ulna.

8. Extensor carpi ulnaris

ⓓ Cut and fold the origin of the extensor carpi ulnaris from the ulna.

o Examine the interosseous membrane.

9. Muscles & nerves of hand

ⓓ Cut and reflect the palmar aponeurosis. At this time, attach the palmaris brevis to the palmar aponeurosis. Detach the flexor retinaculum. Do not carelessly slice the tendons passing through the wrist; it will be harder to recognize the tendons. If you find the dissection of the hand difficuleft because of bent fingers, cut the muscle belly of the flexor digitorum profundus.

o Inside the flexor retinaculum, the synovial sheath wraps around the tendon. The synovial sheath also exists inside the extensor retinaculum and is similar to the synovial membrane of the synovial joint. In order to spot the synovial sheath easily, inject a dye into the synovial sheath before cutting the extensor retinaculum.

o From the fingers, cut the fibrous sheath that wraps the tendon of the flexor digitorum superficialis and the flexor digitorum profundus. Observe the insertion pointernal of the tendon.

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o Observe that the median nerve innervates from the 1st to 4th finger and the ulnar nerve innervates from the 4th to the 5th finger.

o Extract a nail and check how far the nail root reaches.

10. Artery of hand

ⓓ Cut and fold the abductor pollicis brevis.

o Observe that the superficial palmar branch of the radial artery and the ulnar artery form the superficial palmar arch. Inside the adductor pollicis, see that the deep palmar branch of the ulnar artery and the radial artery form the deep palmar arch.

11. Shoulder joint

ⓓ Cut and open the back of the shoulder joint capsule. (Do either the right or the left.)

o Feel the smoothness of the synovial membrane. The synovial fluid keeps the synovial membrane lubricated.

o Detach the articular cartilage and observe the articular surface of the bone.

o See that the glenoid labrum deepens the glenoid cavity. Observe that the long head of the biceps brachii goes through the shoulder joint cavity.

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12. Elbow joint

ⓓ Cut and open the front of the elbow joint capsule and the wrist joint capsule. (Do either the right or the left.)

o Observe the annular ligament that wraps the head of radius in the elbow joint.

o Around the wrist, observe the annular ligament that wraps the head of ulna and the articular disc between the head of ulna and the carpal bones.

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<Essential structures to identify in upper limb>

* Pectoral regionMammary glandPectoralis majorPectoralis minor

* AxillaBrachial plexusLateral cord

Musculocutaneous nerveMedian nerve

Medial cordUlnar nerveMedian nerve

Posterior cordAxillary nerveRadial nerve

Axillary arteryLateral thoracic arterySubscapular arteryAnterior circumflex humeral arteryPosterior circumflex humeral artery

* Brachial arteryUlnar arteryRadial artery

* Cephalic veinAxillary vein

* Basilic veinBrachial vein

* ArmFlexor muscles - Musculocutaneous nerve

Biceps brachiiLong headShort headBicipital aponeurosis

CoracobrachialisBrachialis

Extensor muscle - Radial nerveTriceps brachii

Long head

Lateral headMedial head

* ForearmFlexor muscles - Median nerve,Ulnar nerve

Pronator teresFlexor carpi radialisPalmaris longusFlexor carpi ulnarisFlexor digitorum superficialisFlexor digitorum profundusFlexor pollicis longusPronator quadratus

Extensor muscles - Radial nerveSupinatorBrachioradialisExtensor carpi radialis brevisExtensor carpi radialis longusExtensor carpi ulnarisExtensor digitorumExtensor indicisExtensor digiti minimiAnatomical snuffbox

Abductor pollicis longusExtensor pollicis brevisExtensor pollicis longusRadial artery

* HandMuscles - Median nerve, Ulnar nerve

Abductor pollicis brevisFlexor pollicis brevisAdductor pollicisOpponens pollicisAbductor digiti minimiFlexor digiti minimi brevisOpponens digiti minimiLumbrical musclePalmar interosseusDorsal interosseus

Superficial palmar archUlnar arteryRadial artery

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Chapter V. Neck

1. Skin of neck2. Platysma3.Infrahyoid region4.Suprahyoid region5.Thyroid gland6.Larynx

1. Skin of neck

ⓓ Skin the neck. Be extremely careful not to damage the platysma muscle situated in the subcutaneous tissue.

2. Platysma

ⓓ Reflect the platysma. Take care not to damage the cutaneous nerve and the cutaneous vein inside the platysma.

o Observe that the retromandibular vein and the anterior jugular vein inseright into the external jugular vein. Observe the external jugular vein as it inserts into the subclavian vein.

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3. Infrahyoid region

ⓓ Cut and reflect the sternocleidomastoid muscle and the sternoclavicular joint capsule. Take care not to damage the ansa cervicalis placed inside the sternocleidomastoid muscle.

o Observe that the ansa cervicalis surrounds the internal jugular vein and that the nerves from the ansa cervicalis innervate the infrahyoid muscle.

o Look for the articular disc in the sternoclavicular joint Reflect the clavicle sideward.

o Starting from the anterior scalene muscle, divide the subclavian artery into three parts and look for the branches of the subclavian artery.

o Look for the pointernal where the left internal jugular vein and the left subclavian vein meet. Not only the tho-racic duct but also the jugular lymphatic trunk, subclavian lymphatic trunk, and broncho-mediastinal lymphatic trunk go into this pointernal of merge. You can remove other veins. But do not remove these veins and lymph ducts.

o Look for the trunk, division and cord of the brachial plexus. Also, look for the nerves that arise from these structures.

o Look for the cervical ganglion of the sympathetic trunk and the cervical nerves as they connect to the gray ramus communicans.

o Look for the right recurrent laryngeal nerve which curves around the subclavian artery and runs up to the larynx.

o Look for the 2nd, 3rd, and 4th cervical nerves which enter the XI innervating the trapezius muscle.

o Look for the branches of the XII which innervate the thyrohyoid muscle. These XII branches actually arise from the 1st cervical nerve.

- 24 -

4. Suprahyoid region

ⓓ Detach the superficial part of the submandibular gland Cut and reflect the mylohyoid muscle. If necessary, also cut and reflect the digastric muscle.

o Look for the branches of the lingual nerve which form the submandibular ganglion and innervate the submandibular gland after. These branches of the lingual nerve are actually called the chorda tympani.

5. Thyroid gland

ⓓ Cut and reflect the thyroid gland.

o Observe the isthmus of thyroid gland as it overlies the 2nd-4th tracheal cartilage.

o Look for the parathyroid gland Relatively, the thyroid gland is red and the parathyroid gland is yellow. However, it is practically difficuleft to distinguish between the two.

6. Larynx

ⓓ Cut out one side of the lamina of the thyroid cartilage and look for the superior and inferior laryngeal nerve in the larynx. Detach the whole larynx.

o Remove the mucous membrane of the vestibular fold and look for the vestibular ligament located at the lower corner of the quadrangular membrane. Remove the mucous membrane of the vocal fold and look for the vocal ligament located at the upper corner of the conus elasticus. Look for the vocalis that is a part of the thyroarytenoid muscle.

o Demonstrate the movement of the thyroid cartilage and the arytenoid cartilage using the intrinsic muscle of the larynx.

- 25 -

<Essential structures to identify in neck>

* MusclesPlatysma - Facial nerveSternocleidomastoid muscle - Accessory nerveSuprahyoid muscleInfrahyoid muscleAnterior scalene muscleMiddle scalene musclePosterior scalene muscle

* Common carotid arteryInternal carotid arteryExternal carotid artery

Superior thyroid arteryLingual arteryFacial artery

* Subclavian arteryVertebral arteryInternal thoracic artery

* Brachiocephalic veinInternal jugular vein

Thoracic ductSubclavian vein

External jugular vein

* Lingual nerveSubmadibular ganglion

Submadibular gland

* Hypoglossal nerve

* Cervical plexusAnsa cervicalisPhrenic nerve

* Brachial plexusSuperior trunkMiddle trunkInferior trunkAnterior divisionPosterior division

* Sympathetic trunkSuperior cervical ganglionMiddle cervical ganglionInferior cervical ganglion

* Vagus nerve

* Accessory nerve

* Thyroid glandParathyroid gland

* LarynxEpiglottic cartilageCricoid cartilageVocal cord

Thyroid cartilageArytenoid cartilage

Lateral cricoarytenoid muscleArytenoid muscleThyroarytenoid muscle

- 26 -

Chapter VI. Head

1. Skin of face2. Parotid gland3. Scalp4. Calvaria5. Superior sagittal sinus6. Dura mater7. Brain8. Temporomandibular joint9. Infratemporal fossa(Group A)

10. Oral cavity(Group B)11. Orbit12. Eyeball13. Middle & internal ear14. Sagittal section(Group A)15. Pharynx(Group B)

※ Split the class into Group A and B, and then share their findings.

1. Skin of face

ⓓ Remove the skin of the face. Take care not to damage the facial muscle of the subcutaneous tissue.

o Observe the facial muscle. After removing a part of the facial muscle, observe the parotid gland, masseter, and temporal muscle.

2. Parotid gland

ⓓ As you remove the superficial part of the parotid gland, find the five branches of the facial nerve(VII).

o Look for the external carotid artery and the retromandibular vein inside the parotid gland.

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3. Scalp

ⓓ Remove the scalp while taking care not to damage the epicranial aponeurosis.

o Observe the epicranial aponeurosis which lies between the frontalis and the occipitalis. Cut and unfold the epicranial aponeurosis and detach the loose connective tissue.

o Cut the origin of the temporal muscle from the calvaria and reflect downward.

4. Calvaria

ⓓ Remove the calvaria and posterior part of the occipital bone. To cut the skull bone without damaging the brain complete the following steps. Estimate the thickness of the calvaria using the thickness of dry bone. Consider the gravitational force pushing the brain downward (towards the lower calvaria). Using a saw, cut the outer table of the calvaria. Using a chisel and a hammer, cut out the inner table.

o Look for the Sharpey's fiber which binds the calvaria and the periosteal layer of the dura mater together.

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5. Superior sagittal sinus

ⓓ Make a vertical cut in the upper wall of the superior sagittal sinus and unfold.

o Observe that the arachnoid granulation of the superior sagittal sinus and the arachnoid mater are of the same tissue.

o Observe that the cerebral vein enters into the superior sagittal sinus.

6. Dura mater

ⓓ Make a cut in the dura mater along the transverse cut in the calvaria. Cut where the cerebral falx inserts into the crista galli and reflect. Cut where the cerebellar tentorium joins the temporal bone. Follow step 9 when cutting the tentorium cerebelli.

- 29 -

7. Brain

ⓓ Slice the border of the brain and the spinal cord, and the vertebral artery using a scalpel to the back of the neck. Cut out the cranial nerve which connects the brain and the internal surface of cranial base, and internal catorid artery. Remove the brain. If possible, leave the cranial nerve, internal carotid artery, and vertebral artery on the brain for neuroanatomy lab exercise.

o Make a vertical incision on the dural venous sinus wall of the internal surface of cranial base, and observe. Think about which way the blood flows in the dural venous sinus.

o Peel off the cavernous sinus carefully and look for the III, IV, V1, V2, VI, and internal carotid artery that go through the cavernous sinus.

8. Temporomandibular joint

ⓓ Cut the zygomatic arch and reflect along with the masseter. Open the temporomandibular joint capsule.

o While examining the features of the articular disc and the articular surface in the temporomandibular joint, open the mouth wide.

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9. Infratemporal fossa(Group A)

ⓓ Cut the coronoid process and reflect along with the temporal muscle. From the ramus of mandible, remove the upper portion of the mandibular foramen. (The mandibular foramen can only be seen from the inside of ramus of mandible.) Take care not to disconnect the inferior alveolar nerve and the inferior alveolar artery.

o Observe the lateral pterygoid muscle and the medial pterygoid muscle. Understand the mechanism of these muscles.

o From the lateral pterygoid muscle, divide the maxillary artery into three parts. Look for the middle meningeal artery and the inferior alveolar artery which emerge from the maxillary artery.

o Observe that the V3 branches off to nerves that innervate the masticatory muscle, inferior alveolar nerve, and lingual nerve

o Look for the otic ganglion just below the foramen ovale.

10. Oral cavity(Group B)

ⓓ Detach the lateral pterygoid muscle, medial pterygoid muscle, and mylohyoid muscle from the mandible. Remove only the mandible from skull, but leave all the other structures on the body. Do not follow these steps on some cadavers. However, make sagittal section of the skull as step 15.

o Look for the submandibular gland which is located from the outside to the inside of the mylohyoid muscle. Also, look for the sublingual gland inside the mylohyoid muscle. Follow the ducts of each gland.

o Observe the filiform papilla, fungiform papilla, vallate papilla and foliate papilla of the tongue.

o Cut the tongue and observe the intrinsic muscle which stretches in three directions.

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11. Orbit

ⓓ Remove the upper wall of the orbit.

o The V1 gives off branches to nasociliary nerve, frontal nerve, and lacrimal nerve from the center. Observe the lacrimal gland.

o Consider which muscles these nerves(the III, IV, VI) innervate. Observe the ciliary ganglion which contracts the pupil.

12. Eyeball

ⓓ Cut and reflect the levator palpebrae superioris and the superior rectus.

o Remove only one eyeball. Observe the muscles that move the eyeball. From the cross section of the II, look for the central retinal artery which is a branch of the ophthalmic artery.

o Cut the eyeball, observe the ciliary body and the iris around the lens, and the optic disc of the retina.

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13. Middle & internal ear

ⓓ Gradually, remove the upper wall of the tympanic cavity and the internal ear. Estimate the location of the tympanic cavity and the internal ear by considering the vestibulocochlear nerve.

o Look for the auditory ossicle which is attached to the tympanic membrane. Also the VII’s branch, chorda tympani.

o Observe the mastoid cell, mastoid antrum, and auditory tube that joins the tympanic cavity.

o Observe the bony labyrinth (the cochlea, vestibule, and a part of semicircular canal) from the internal ear.

14. Sagittal section(Group A)

ⓓ Make sagittal section of the head. If the cut is too deviated from the median plane, the nasal concha can be damaged. Be careful.

o Observe the geniohyoid muscle and the genioglossus arise from the mental spine.

o Observe the palatine tonsils are located between the palatoglossal arch and the palatopharyngeal arch.

o Observe the torus tubarius extends to the salpingopharyngeal fold.

o Observe the three nasal meatus on the lateral wall of the nasal cavity, the sphenoethmoidal recess, and the paranasal sinuses that open separately.

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15. Pharynx (Group B)

ⓓ Remove the cervical vertebra which lies behind the pharynx and a part of the occipital bone. Do not remove the surroundings of the jugular foramen so that the IX and X are intact.

o Look for the anterior longitudinal ligament and the intervertebral disc of the cervical vertebra body.

o Observe the superior and the inferior ganglion of the IX and the X near the jugular foramen. Observe that the branches of the IX and the X innervate the pharynx.

o Observe the sup, middle, inferior pharyngeal constrictor, and the stylopharyngeus.

o Make a vertical cut in the posterior wall of the pharynx and unfold. Remove the mucous membrane of the pharynx and observe the levator veli palatini, the tensor veli palatini, and the palatopharyngeus.

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<Essential structures to identify in head>

* Facial muscle - Facial nerveOccipitofrontalisOrbicularis oculiLevator palpebrae superiorisCorrugator superciliiProcerusOrbicularis orisLevator labii superiorisDepressor labii inferiorisLevator anguli orisDepressor anguli orisZygomaticus majorZygomaticus minorRisoriusBuccinator

* Masticatory muscle - Mandibular nerveTemporalisMasseterMedial pterygoid muscleLateral pterygoid muscle

* External carotid arteryFacial arteryLingual arteryMaxillary arterySuperficial temporal artery

* Oral cavityHard palateSoft palatePalatoglossal archPalatopharyngeal arch

Palatine tonsil

* Nasal cavityNasal septumSuperior nasal conchaMiddle nasal conchaInferior nasal conchaSuperior nasal meatusMiddle nasal meatusInferior nasal meatusParanasal sinuses

Sphenoidal sinusFrontal sinusEthmoidal sinusMaxillary sinus

* EyeNasolacrimal ductExtraocular muscle

Superior rectusInferior rectusMedial rectusLateral rectusSuperior oblique muscleInferior oblique muscle

CorneaScleraIris

PupilLens

Ciliary bodyRetinaOptic nerveAqueous humorVitreous body

* EarAuricleExternal acoustic meatusTympanic membraneTympanic cavity

Auditory ossicleAuditory tubeCochlear ductUtricleSacculeSemicircular ductVestibulocochlear nerve

* BrainMeninges

Dura materArachnoid materSubarachnoid space

Cerebrospinal fluid

- 35 -

Pia materDural venous sinusInternal jugular veinInternal carotid arteryVertebral arteryCerebrumCerebellumBrainstemCranial nerve

Olfactory nerve (I)Optic nerve (II)Oculomotor nerve (III)Trochlear nerve (IV)Trigeminal nerve (V)

Ophthalmic nerve (V1)Maxillary nerve (V2)Mandibular nerve (V3)

Abducens nerve (VI)Facial nerve (VII)Vestibulocochlear nerve (VIII)Glossopharyngeal nerve (IX)Vagus nerve (X)Accessory nerve (XI)Hypoglossal nerve (XII)

* PharynxNasopharynxOropharynxLaryngopharynx

EsophagusSuperior constrictorMiddle constrictorInferior constrictorTorus tubariusEpiglottis

- 36 -

Chapter VII. Thorax

1. Intercostal space2. Anterior thoracic wall3. Pericardial cavity4. Right atrium5. Right ventricle6. Heart valves & coronary circulation7. Left atrium8. Left ventricle9. Pleural cavity

10. Lung

1. Intercostal space

ⓓ Cut the external intercostal muscle and the internal intercostal muscle and reflect.(The skin might have beenremoved in the pectoral region already.)

o Observe that the external intercostal muscle extends from the front to the external intercostal membrane. Observe that the internal intercostal muscle extend from the back to the internal intercostal membrane.

o Between the internal intercostal muscle and the innermost intercostal muscle, locate the intercostal vein, artery, and nerve in that order from the top to the bottom.

2. Anterior thoracic wall

ⓓ Cut out the anterior thoracic wall carefully not to damage the parietal pleura. You can also cut out the boundary of 1st - 10th ribs and the costal cartilage.

o Open between the costal cartilage of 2nd - 7th ribs and the sternum, and look for the synovial joint.

o From the anterior wall of the thorax, the internal thoracic artery gives off branches to the superior epigastric artery and the musculophrenic artery. The anterior intercostal artery emerges from the internal thoracic artery.

- 37 -

o Observe that the thymus is located posterior to the manubrium of sternum. The thymus of adults are almost all fat tissues.

o The ligamentum arteriosum is attached to the aortic arch and the left pulmonary artery. Discover how its location is related to the left recurrent laryngeal nerve.

3. Pericardial cavity

ⓓ Cut and unfold the parietal layer of the fibrous pericardium and the serous pericardium. Use hands if the parietal layer is adhered to the visceral layer. This adhesion is also common in the pleura and the peritoneum. Use hands to separate two layers.

o Reach into the pericardial cavity with your hand, and feel the opening of the transverse pericardial sinus and the closed oblique pericardial sinus.

o Remove a part of the visceral layer of the serous pericardium. Confirm that the visceral layer is the epicardium.

4. Right atrium

ⓓ Cut the right atrium wall and open.

o Observe the coarse area (inside the right auricle) because of the pectinate muscle Look for the openings of the superior vena cava, inferior vena cava, and coronary sinus where the walls are smooth. The boundary between these two parts is the terminal crest.

o Push the oval fossa towards the left atrium to see if the right atrium and the left atrium are connected. If connected, the atrial septal defect is suspected.

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5. Right ventricle

ⓓ Cut and open the right ventricle wall.

o Observe that the trabeculae carneae is coarse, and the conus arteriosus is smooth.

o The tendinous cord holds the tricuspid valve so that the tricuspid valve does not flip backward when the right ventricle contracts.

6. Heart valves & coronary circulation

ⓓ Detach the heart from the body.

o The boundaries of the atria and the ventricles are called the coronary sulcus and the interventricular sulcus. Follow the coronary artery and the cardiac vein in those sulcus.

o Observe the locations and the features of the four valves. Look for the right and the left aortic sinus that arose due to the aortic valve. Observe the right and the left coronary artery emerge from here.

- 39 -

7. Left atrium

ⓓ Cut and open the left atrium wall.

o Alike the right atrium, observe the pectinate muscle inside the left auricle.

8. Left ventricle

ⓓ Cut the left ventricle wall and open.

o Observe that the left ventricle wall is thicker than the right ventricle wall. However, the chambers are of the similar size.

o Observe that the mitral valve has two cusps, and for that reason, it also has two papillary muscle.

o Peel off the very thin layer of the endocardium of the left ventricle. Observe the left bundle of the atrioventricular bundle which is located between the endocardium and the myocardium. Follow the atrioventricular bundle backward and find the atrioventricular node located in the lower back area of the interatrial septum.

- 40 -

9. Pleural cavity

ⓓ Cut and open the parietal pleura wall.

o Put your hand inside the pleural cavity. Confirm that the root of lung and the pulmonary ligament are the maximum you can reach.

o Put your hand into the costodiaphragmatic recess and the costomediastinal recess. Confirm that the parietal pleura is bigger than the lung.

10. Lung

ⓓ Cut out the root of lung, and detach the lung from the body.

o Observe that the parietal pleura is tightly adhered to the diaphragm.

o Look for black dots in the lung. These are caused by smoking and pollution, and called the pneumoconiosis.

o Observe that the visceral pleura folds into the fissure, but the parietal pleura doesn’t.

o At the hilum of lung, a pulmonary artery is located above and two pulmonary vein are located below. The bronchus is located behind. Around the bronchus is supplied by the bronchial artery.

o Dissect the lung and find all the segmental bronchi. Confirm that all the pulmonary artery follow the segmental bronchi, and all the pulmonary vein lie between the segments.

o See the alveolus, which is 0.2mm in diameter, with naked eyes.

- 41 -

o Confirm that the carina of trachea is at the same level with the sternal angle. The two primary bronchi from the carina of trachea have different appearance.

o Observe the azygos vein, hemiazygos vein, and accessory hemiazygos vein entering the superior vena cava.

o The thoracic duct enters where the left internal jugular vein and the left subclavian vein meet.

o Observe the thoracic ganglion located in the sympathetic trunk, the gray and the white ramus communicans connecting the spinal nerve, arise of the greater splanchnic nerve from the 5th to the 9th thoracic ganglion.

o The X forms the esophageal plexus. It then becomes the anterior and posteriorvagal trunk then goes to the stomach.

o Look for the aortic arch, left bronchus, and esophageal hiatus of the diaphragm. They all press against the esophagus.

o Remove the wall of the esophagus and see that it consists of the adventitia, outer longitudinal layer and inner circular layer of muscular layer, submucosa and mucosa.

o Peel off the fascia of the diaphragm, and distinguish the muscle belly and the central tendon.

- 42 -

<Essential structures to identify in thorax>

* Thoracic wallIntercostal muscleIntercostal nerveIntercostal arteryIntercostal vein

* Thoracic cavityMediastinumThymusEsophagusSympathetic trunk

Sympathetic ganglionGreater splanchnic nerveLesser splanchnic nerve

* Vagus nerve

* Azygos vein

* Hemiazygos vein

* Accessory hemiazygos vein

* Thoracic duct

* DiaphragmCaval openingEsophageal hiatusAortic hiatus

* HeartParietal pericardiumVisceral pericardiumPericardial cavityRight atrium

Superior vena cavaBrachiocephalic vein

Inferior vena cavaCoronary sinus

Great cardiac veinMiddle cardiac veinSmall cardiac veinPectinate muscle

Right ventricle

Trabeculae carneaePapillary muscleTendinous cordTricuspid valvePulmonary valvePulmonary trunk

Left atriumPulmonary veinInteratrial septum

Left ventricleMitral valveInterventricular septumAortic valveAtrioventricular bundleAscending aorta

Right coronary arteryPosterior interventricular branch

Left coronary arteryCircumflex branchAnterior interventricular branch

* ArteryAortic arch

Brachiocephalic trunkCommon carotid arterySubclavian artery

Thoracic aorta

* LungParietal pleuraVisceral pleuraPleural cavityRight lung

Oblique fissureHorizontal fissureSuperior lobeMiddle lobeInferior lobe

Left lungOblique fissureSuperior lobeInferior lobe

Pulmonary arteryPulmonary vein

- 43 -

* TracheaBronchus

Lobar bronchusSegmental bronchus

BronchioleAlveolus

- 44 -

Chapter VIII. Abdomen

1. Skin of abdomen2. External oblique muscle3. Scrotum (1) & round ligament of uterus4. Scrotum (2)5. Internal oblique muscle6. Rectus abdominis (1)7. Rectus abdominis (2)8. Peritoneum & mesentery9. Abdominal organs

10. Stomach & intestine

1. Skin of abdomen

ⓓ Peel off the skin of the anterolateral abdominal wall. Leave the umbilicus attached to the inner tissue. If working on a male cadaver, take care not to damage the external spermatic fascia and the superficial inguinal ring of the pubic tubercle.

o See that the subcutaneous tissue under the umbilicus consists of a thin fatty layer and a deep membranous layer.

o See the branches of the cutaneous nerve, the thoracoabdominal nerve.

o See that the superficial inguinal ring is an opening on the aponeurosis of the external oblique muscle. If working on a male body, see that aponeurosis of the external oblique muscle connects to the external spermatic fascia.

2. External oblique muscle

ⓓ Cut and reflect the external oblique muscle.

o Observe the internal oblique muscle and the aponeurosis of the transversus abdominis meet to form the inguinal falx.

- 45 -

3. Scrotum (1) & round ligament of uterus

ⓓ In a male cadaver, cut and expose each layer of the scrotum.

o See the dartos muscle under the subcutaneous tissue of the scrotum.

o Confirm that the cremaster is a continuation of the internal oblique muscle.

o Look for the ductus deferens, testicular artery, and pampiniform plexus in the spermatic cord.

o In a female cadaver, see that the round ligament of uterus passes through the superficial inguinal ring and goes into the labia majora..

4. Scrotum (2)

ⓓ In a male cadaver, cut and open the parietal layer of the tunica vaginalis.

o Touch to feel that the tunica vaginalis and the peritoneum are of the same tissue.

o Find the epididymis and the efferent ductule. Cut the testis and look for the rete testis and the seminiferous tubule.

- 46 -

5. Internal oblique muscle

ⓓ Cut and reflect the internal oblique muscle.

o Confirm that the thoracoabdominal nerve is located between the internal oblique muscle and the transversus abdominis.

o Slightly reflect the transversus abdominis. Find the deep inguinal ring which is a hole of the transversalis fascia.

6. Rectus abdominis (1)

ⓓ Cut and reflect the anterior layer of the rectus sheath. At this time, also cut where the anterior layer of the rectus sheath and the tendinous intersection fuse.

o Find the superior and inferior epigastric artery inside the rectus abdominis.

- 47 -

7. Rectus abdominis (2)

ⓓ Cut and reflect the rectus abdominis.

o Find the relationship between the rectus sheath, external oblique muscle, internal oblique muscle and aponeurosis of transversus abdominis. Explain the arcuate line.

8. Peritoneum & mesentery

ⓓ Cut and reflect the transversus abdominis and the parietal peritoneum. At first, cut a small portion of the parietal peritoneum. Find the round ligament of liver which connects the umbilicus and the portal vein. Find the median and medial umbilical ligament below the umbilicus. Take care not to damage these structures when cutting the parietal peritoneum.

o Find whether or not the transversalis fascia and the parietal peritoneum can be distinguished from the extraperitoneal fascia, the adipose tissue. (Normally these cannot be distinguished.)

o Touch the falciform ligament, coronary ligament, and lesser omentum to determine the form of the visceral peritoneum attached to the liver.

o Rip the lesser omentum. Put one hand into the omental bursa. Using both hands, touch the omental foramen, gastrosplenic ligament and splenorenal ligament Detach the adhesion part of the gastrocolic ligament with hands to enlarge the omental bursa.

- 48 -

o Detach the fusion fascia of the ascending colon and the descending colon with hands. Make them into an intraperitoneal organ.

9. Abdominal organs

ⓓ Detach the liver from the body.

o Cut and spread the wall of the gallbladder and the cystic duct attached to the liver. Examine the inside.

o See that the ligamentum venosum connects the portal vein and the inferior vena cava. Then discuss the fetal circulation.

o Dissect the liver and observe that the common hepatic duct, proper hepatic artery, and portal vein branch out and supply two lobes. The rt, intermediate, and left hepatic vein which enter the inferior vena cava lie between two areas.

o See which branch of the celiac trunk goes to which mesentery.

o Peel off one layer of peritoneum from the mesentery of the small intestine and the large intestine. Find the branches of the superior and the inferior mesenteric artery. To do this, remove the superior and the inferior mesenteric vein.

- 49 -

o (One can only guess this in reality) Observe that the branches of the celiac trunk and the superior mesenteric artery connect at the descending part of duodenum (anastomosis). See that the branches of the superior and the inferior mesenteric artery connect at the transverse colon.

o Observe that the appendicular artery, and a branch of the ileocolic artery are originated from the superior mesenteric artery, exists in the appendix.

o Detach the front part of the pancreas. Find the relationship between the accessory pancreatic duct, pancreatic duct, common bile duct and the hepatopancreatic ampulla. Cut and open the descending part wall of the duodenum. Observe that the hepatopancreatic ampulla opens into the major duodenal papilla.

o Confirm that the peritoneum covering the spleen is easily removable but the fibrous capsule inside is not easily removable due to the splenic trabecula.

o Remove the wall of the stomach and see the outer longitudinal muscle, middle circular muscle, and inner oblique muscle.

o Remove the wall of the large intestine and see the relationship between the tenia coli and the outer longitudinal muscle.

o See that the celiac ganglion connects with the greater splanchnic nerve. See that the celiac plexus, superior mesenteric plexus, inferior mesenteric plexus, superior hypogastric plexus and hypogastric nerve link.

o Cut the suprarenal gland Distinguish the relatively white cortex and the relatively black medulla.

o Remove a small part of the anterior kidney and see the pathway for urine.

o Confirm that the end of the common iliac artery pushes the ureter.

o Look for the caval opening which can be found at the central tendon of the diaphragm. Also, find the esophageal hiatus and the aortic hiatus from the muscle belly.

o Observe that the intestinal lymphatic trunk and the lumbar lymphatic trunk enters the chyle cistern. If necessary, remove the abdominal aorta and find them.

o Cut out the psoas major, and observe that the femoral nerve and the obturator nerve emerge from the 2nd - 4th lumbar nerves.

- 50 -

10. Stomach & intestine

ⓓ If interested, a group can take out the gut from the stomach to the sigmoid colon. Cut vertically, open and then remove the food inside the gut. Use sink and paper towel when removing the food.

o Observe that there are vertical gastric folds in the stomach, and transverse circular folds in the small intestine.

o Understand that the digestion and absorption in the jejunum are more active than in the ileum by considering their appearance.

o See if there is an ileal diverticulum located 50 cm apart from the ileocecal valve facing the umbilicus. There is a 1-2% chance of the ileal diverticulum.

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<Essential structures to identify in abdomen>

* Anterolateral abdominal wallRectus abdominis

Rectus sheathTendinous intersectionsLinea alba

External oblique muscleInternal oblique muscleTransverse abdominal muscle

* ScrotumTestisEpididymisDuctus deference

Spermatic cordInguinal canal

* Abdominal cavityParietal peritoneumVisceral peritoneumPeritoneal cavityIntraperitoneal organ

MesenteryRetroperitoneal organ

* StomachLongitudinal foldCardiaPylorus

* Small intestineCircular foldDuodenumJejunumIleum

* Large intestineTenia coliHaustrumOmental appendixCecumAppendixAscending colonTransverse colon

Descending colonSigmoid colonRectum

* LiverPortal vein

Superior mesenteric veinSplenic veinInferior mesenteric vein

Hepatic arteryHepatic ductHepatic vein

Inferior vena cava

* GallbladderCystic ductCommon bile duct

* PancreasPancreatic duct

* Spleen

* KidneyRenal cortexRenal pyramidMinor calyxMajor calyxRenal pelvisUreter

* Posterior abdominal wallAbdominal aortaCeliac trunk

Celiac ganglionSuperior mesenteric arteryInferior mesenteric arteryQuadratus lumborumPsoas majorIliacus

- 52 -

Chapter IX. Pelvis & perineum

1. Peritoneal cavity in pelvis2. Arteries & nerves in gluteal region3. Pelvic organs

1. Peritoneal cavity in pelvis

ⓓ The pelvis also has the peritoneal cavity. From a male cadaver, touch the rectovesical pouch. From a female cadaver, touch the vesicouterine pouch. For a female cadaver, put one hand in the rectouterine pouch and the other hand in the back of the vaginal fornix to feel the thin boundary.

o For a female cadaver, see that the mesosalpinx and the mesovarium continue to the mesometrium and that the round ligament of uterus originates from the uterus and goes into the deep inguinal ring.

o For a female cadaver, insert a wire into the uterine tube and check if the peritoneal cavity and the uterine cavity are connected. Also check how far the ovary is from the fimbria.

2. Arteries & nerves in gluteal region

ⓓ Cut and reflect the origin of the left gluteus maximus. Be careful not to disconnect the inferior gluteal nerve and the inferior gluteal artery which innervate the gluteus maximus.

- 53 -

3. Pelvic organs

ⓓ Cut the intervertebral disc of the 4th - 5th lumbar vertebrae located at the level of the iliac crest. In order to divide the whole body into the upper and the lower body, cut out the structures that connect the abdominal cavity and the pelvic cavity. While cutting the border of the sigmoid colon and the rectum, tie them well with a string to prevent the food inside from leaking out. Cut the left sacroiliac jointernal and the pubic symphysis. Detach the left pelvic wall and the left leg. For this, cut the structure that connects the pelvic wall and the pelvic cavity. For some cadavers, do the median section instead of this method.

o Observe the nucleus pulposus and the anulus fibrosus that form the intervertebral disc.

o Put one hand in the pelvis and the other hand in the ischioanal fossa of the perineum. Feel the pelvic diaphragm which is the boundary of the pelvis and the perineum.

o The tendinous arch which is the origin of levator ani lies from the pubic symphysis to the ischial spine.

o See that the piriformis passes the greater sciatic foramen and reaches the gluteal region while the obturator internus passes the lesser sciatic foramen and reaches the gluteal region.

o Recognize that the superficial transverse perineal muscle and the external anal sphincter are on the same layer as the ischiocavernosus and the bulbospongiosus.

o Detach the white and tough perineal membrane and observe the deep transverse perineal muscle and the external urethral sphincter that form the urogenital diaphragm. From a male cadaver, see the bulbourethral gland in the urogenital diaphragm.

o See that the both sides of the sympathetic trunk meet to form the ganglion impar. See that the sacral ganglion and the anterior ramus of the sacral nerve link to the gray ramus communicans.

o See that the sciatic nerve originates from 4th lumbar - 3rd sacral nerves.

o Observe that the pudendal nerve originates from the 2nd - 4th sacral nerves and follows the internal pudendal artery. Observe that the inferior rectal nerve originates from the pudendal nerve and then the perineal nerve and the dorsal nerve of penis branch off. (in case of female, dorsal nerve of clitoris).

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o Observe that the superior gluteal artery originates from the posterior branches of the internal iliac artery, and the inferior gluteal artery, umbilical artery, obturator artery, internal pudendal artery and uterine artery from the anterior branches.

o In a female cadaver, observe the anastomosis of the ovarian artery and the uterine artery.

o Cut and open the wall of the urinary bladder. Observe the vesical trigone and the ureteric orifice. See that the ureteric orifice is tilted by inserting a wire.

o From a male cadaver, cut the wall of the ductus deferens, seminal vesicle, and ejaculatory duct. Find that their lumen are connected.

o From a male cadaver, detach the prostate in front of the prostatic urethra. Observe the prostatic utricle in the seminal colliculus.

o From a male cadaver, skin the penis. Split the two corpora cavernosa and the one corpus spongiosum. Cut the corpus spongiosum vertically and open to find the urethra.

o From a female cadaver, detach the wall of the uterus. Observe the lumen of the cervix and the body of the uterus.

o From a female cadaver, see that the crus of clitoris and the bulb of vestibule is spongy tissue. Observe the greater vestibular gland behind the bulb of vestibule.

o Cut the rectum and posterior wall of anal canal vertically and open to pull out the food inside. From the section of the anal canal, observe the external anal sphincter which is relatively red and the internal anal sphincter which is relatively white. Observe that the internal anal sphincter and the inner circular muscle of the rectum connect.

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<Essential structures to identify in pelvis & perineum>

* Pelvic wallPiriformis

Greater sciatic foramenObturator internus

Lesser sciatic foramenPelvic diaphragm

Levator aniCoccygeus

* Lumbosacral plexusFemoral nerveObturator nerveSuperior gluteal nerveInferior gluteal nerveSciatic nervePudendal nerve

* Internal iliac arteryObturator arterySuperior gluteal arteryInferior gluteal arteryUmbilical artery

* External iliac artery

* Male urogenital systemUreterUrinary bladder

DetrusorInternal urethral sphincter

Prostatic urethraProstate

Membranous urethraExternal urethral sphincter

Spongy urethraCorpus spongiosum

PenisCorpus cavernosum

Ductus deferensSeminal vesicleEjaculatory duct

* Female genital system

OvaryUterine tubeUterus

BodyCervixUterine cavity

Vagina

* Digestive systemRectumAnal canal

Anal columnPectinate lineExternal anal sphincterInternal anal sphincter

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Chapter X. Lower Limb

1. Skin of lower limb2. Rectus femoris3. Pectineus& adductor longus4. Gluteus medius5. Gastrocnemius6. Soleus7. Leg & ankle8. Plantar aponeurosis9. 1st layer of sole

10. 2nd layer of sole11. 3rd & 4th layers of sole12. Hip joint13. Knee & ankle joint

1. Skin of lower limb

ⓓ Remove the skin of the lower limb including the toes.

o The fixative might have been injected to the cadavers through the femoral artery. Cut and remove the string.

o Observe that the great saphenous vein passes the medial malleolus anteriorly, penetrates the saphenous opening, and enters the femoral vein. Also, the small saphenous vein passes the lateral malleolus posteriorly and enters the popliteal vein. Find the perforating vein.

o Remove the fascia lata except the iliotibial tract.

o From the femoral triangle, there are femoral vein, artery, and nerve respectively from posterior to anterior.

o Put your finger inside the peritoneal cavity, and through the femoral ring to the femoral canal. While doing this, confirm that the femoral ring is situated lateral to the lacunar ligament, and anterior to the pectineal line. (Femoral hernia is a condition caused by protrusion of small intestine through the femoral ring to the femoral canal.)

2. Rectus femoris

ⓓ Cut and reflect the rectus femoris.

o Observe that the adductor canal is located lateral to the sartorius, medial to the vastus medialis, and the adductor canal ends with the adductor hiatus. The opening of the adductor magnus is the adductor hiatus.

3. Pectineus & adductor longus

ⓓ Cut and reflect the pectineus and the adductor longus.

o The medial and lateral femoral circumflex artery emerge from the deep femoral artery which lies inside the adductor longus.

o Recognize that the obturator externus and the obturator internus have the same function by examining the appearance.

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4. Gluteus medius

ⓓ Cut and reflect the gluteus medius. Be careful not to cut off the superior gluteal nerve that supplies the gluteus medius, the gluteus minimus, and superior gluteal artery.

o Observe at which position the sciatic nerve branches into to the tibial nerve and the common fibular nerve.

5. Gastrocnemius & soleus

ⓓ Cut and reflect the gastrocnemius.

6. Soleus

ⓓ Cut and reflect the soleus.

7. Leg & ankle

ⓓ From the posteriorcompartment of leg, situated are the tibialis post, flexor digitorum longus, and flexor hallucis longus, in that order from the inside.

o Clean and remove the three retinaculums of the ankle. Inside the retinaculums, the synovial sheath wraps around the tendon.

o Cut the fibularis longus. See that the common fibular nerve is being divided to the superficial fibular nerve and the deep fibular nerve.

o Observe that the popliteal artery branches out to the anterior tibial artery and the posteriortibial artery. The fibular artery originates from the posteriortibial artery.

o Find that the dorsalis pedis artery divides into the arcuate artery and the deep plantar artery.

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8. Plantar aponeurosis

ⓓ Remove the plantar aponeurosis.

9. 1st layer of sole

ⓓ Cut and reflect the flexor digitorum brevis and the abductor hallucis.

10. 2nd layer of sole

ⓓ Cut and reflect the quadratus plantae and the flexor digitorum longus.

o See that the posteriortibial artery divides into the medial and the lateral plantar artery. Confirm that the lateral plantar artery and the deep plantar artery meet to form the plantar arch.

11. 3rd & 4th layers of sole

ⓓ Cut and reflect the oblique head of the adductor hallucis and the flexor hallucis brevis.

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12. Hip joint

ⓓ Cut and open the hip joint capsule. (Do either the right or the left.)

o Observe that the acetabular labrum deepens the acetabulum. Also, the ligament of head of femur attaches to the transverse acetabular ligament.

13. Knee & ankle joint

ⓓ Cut and reflect the quadriceps femoris to see the knee joint. (Do either the right or the left.)

o Examine the form of the tibial and the fibular collateral ligament and the anterior and the posteriorcruciate ligament. Determine the functions of these structures by considering their appearance.

o The medial meniscus is oval. The lateral meniscus is circular. Find the narrow articular cavity under the meniscus.

o Observe the movement of the patella while bending the knee. Remove the thick articular cartilage of the patella.

o Move the ankle jointernal and see the following actions: It requires the joints above the talus for dorsiflexion and plantar flexion. It requires the joints below the talus for inversion and eversion.

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<Essential structures to identify in lower limb>

* Cutaneous veinsGreat saphenous vein

Femoral veinLesser saphenous vein

Popliteal vein

* ThighAnterior region - Femoral nerve

Tensor fasciae latae muscleFascia lata

Iliotibial tractQuadriceps femoris

Patellar ligamentRectus femorisVastus lateralisVastus medisVastus intermedius

Femoral triangleInguinal ligamentSartoriusAdductor longusFemoral nerveFemoral arteryFemoral vein

Medial region - Obturator nerveGracilisAdductor longusAdductor brevisAdductor magnus

Posterior region - Sciatic nerveSemitendinosusSemimembranosusBiceps femorisLong headShort head

Gluteal region - Superior gluteal nerve, Inferior gluteal nerve

Gluteus maximusGluteus mediusGluteus minimus

Femoral arteryDeep femoral artery

Medial circumflex femoral artery

Lateral circumflex femoral artery

Popliteal arteryAnterior tibial arteryPosterior tibial artery

Fibular artery

* LegAnterior region - Deep fibular nerve

Tibialis anteriorExtensor hallucis longusExtensor hallucis brevisExtensor digitorum longusExtensor digitorum brevisFibularis tertius

Lateral region - Superficial fibular nerve

Fibularis longusFibularis brevis

Posterior region - Tibial nerveCalcaneal tendon

GastrocnemiusPlantarisSoleus

Flexor hallucis longusFlexor digitorum longusTibialis posterior

* Sole - Medial plantar nerve, Lateral plantar nerve

First layerPlantar aponeurosisFlexor digitorum brevisAbductor hallucisAbductor digiti minimi

Second layerFlexor digitorum longusQuadratus plantaeLumbrical muscle

Third layerFlexor hallucis longusFlexor hallucis brevisAdductor hallucisFlexor digiti minimi brevis

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Fourth layerPlantar interosseusDorsal interosseus

Dorsalis pedis arteryMedial plantar artery

Lateral plantar artery

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Almost All Dissection Manual in academic article

Chung BS, Chung MS: Free manual of the cadaver dissection modifiable by other anatomists. Anat Sci Int 90(3): 201-202, 2015. 6.

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