black jack randall – Page 18 – Outlander Anatomy

February 3, 2015September 16, 2019

Anatomy Lesson 12: “Claire’s Neck – The Ivory Tower”

In Voyager, third of the Outlander books, Herself writes about a character named Dr. Joe Abernathy. As he examines some human bones, he softly sings to himself:

“Oh, de headbone connected to de…neckbone…de neckbone connected to de…backbone…Now hear…de word…of de Lawd!”

This spiritual song, composed by African-American author and songwriter James Weldon Johnson (1871–1938), provides a fitting introduction for today’s Anatomy Lesson #12: The Neck.

We need a model for our lesson on the neck and can ye think of a better one than bonny Claire? Here’s Claire drinking celebratory bubbly at the end of World War II; her ivory, blood-smeared neck rises from her torso as a long column of muscle, bone and sinew (Starz episode 101, Sassenach).

Definition: The neck is the body region between base of skull and top of sternum. The anatomical word for neck is cervix (Latin meaning neck), applying the neck region or neck of the uterus. For simplicity, I divide the neck into posterior and anterior compartments:

Posterior neck contains cervical vertebrae muscles, nerves, ligaments, etc.
Anterior neck compartment contains respiratory and gastrointestinal viscera (organs), important blood vessels, a bone and numerous muscles

Image A shows the chin angled toward the right acromion (Anatomy Lesson #2), thus lengthening the left side and shortening the right.

Image A

Posterior Neck: The posterior neck is supported by the cervical spine (see Anatomy Lesson #10 for thoracic, lumbar, sacral and coccygeal spine). The cervical vertebrae are numbered C1 – C7 and extend from base of skull to first thoracic (T1) vertebra (Image B – cervical spine, right side).

Image B illustrates C2 – T1 vertebrae. Anterior cylindrical bodies face right and posterior unpaired spinous processes point left. The spinous processes form midline knobs under the neck skin. These vertebrae form the cervical curvature, convex anteriorly and concave posteriorly, allowing for a springy and flexible neck that adjusts head position for optimal sight and hearing.

Although not shown in Image B, intervertebral (IV) discs separate vertebrae C2-C7.

Image B

Ligaments: Viewed in situ (Latin meaning in position), several strong ligaments bind cervical vertebrae to each other and the skull base (Image C, right side). An unpaired ligamentum nuchae extends from skull base to C7 spine anchoring the cervical vertebrae and providing partial origin for the trapezius muscles (Anatomy Lesson #3).

In the neck, ligamentum nuchae covers the spinous processes and is aligned with the median furrow, a midline groove running the length of the back (Anatomy Lesson #10). Known as the paddywhack in sheep and cattle, ligamentum nuchae helps support head weight in four-legged animals. Dried paddywhack is sold as dog treats as suggested by the 19^th century Welsh children’s song This Old Man:

“With a knick-knack paddywhack, give the dog a bone…”

C7 bears a long spinous process, the vertebra prominens, because in most people it is most prominent.

Try This: Palpate your own C7 spine: Crop chin to chest and palpate the big bony knob of vertebra prominens at the neck base.

Image C

Claire’s slender, swan-like neck bears a visible vertebra prominens (red arrow) as she cries at Castle Leoch (Starz ep 103, The Way Out). She just teased Jamie in the dinner hall about kissing Laoghaire. She is envious of their intimacy and she misses her hubby!

C3 – C7 Vertebrae: Cervical vertebrae C3 – C7 are similar to thoracic vertebrae (Anatomy Lesson #10) except they are smaller and have paired transverse foramina (holes) to transmit blood vessels to and from the brain (Image D). The bodies are smaller and oval. Spinous processes project posteriorly and most are bifid – forked – just like Claire’s life line! Understand that the spinal cord passes vertically through the vertebral foramina (pl.).

Image D

Atlas: C1 vertebra articulates with skull above and C2 vertebra below. C1 is also known as the atlas because it supports the head like Atlas of Greek mythology held up the celestial spheres. Its anatomy is also unique. Viewed from above (Image E), the odd atlas has neither body nor spinous process! Rather, it bears a small articular facet for the dens (see below) and a small posterior tubercle. Two peanut-shaped depressions (superior articular surfaces) articulate with two matching bulges (occipital condyles) of the skull base.

Try this: Nod your head up and down (as in “yes”). This sets up a rocking motion between atlas and occipital condyles of skull. No IV disc intervenes between C1 and occipital condyles base as it would be shredded with this motion.

Image E

Axis: C2 vertebra, the axis, is also an odd vertebra (Image F). It articulates above with C1 and below with C3 vertebrae. It has an elongated body topped by the tooth-shaped dens (odontoid process). A strong ligament holds the dens against the articular facet of C1.

Wonder why C2 has a dens but C1 has no body? No one knows, but some biologists hold that the dens was once the body of C1 but became part of C2 during evolution.

Try this: Move your head from side-to-side (as in “no”) and understand that the dens acts as a pivot point around which C1 and the head rotates.

Image F

Try This: Insert a clean finger in your mouth and push it all the way to the back of your throat (stop if you start to gag…); the dens lies deep to your finger. For this reason, radiographs of the dens are taken via an open mouth. Image G (red arrow) is an x-ray of a normal dens; it projects upward like a large tooth (hence the alternative name, odontoid process). You can perhaps see the lower teeth embedded in the mandible?

Image G

Dens and Hanging: The history of hanging is gruesome but pertinent. With the standard or long drop type of hanging, the condemned is suddenly dropped from a specified height. Weight of the plunging body plus a properly prepared and placed noose breaks the neck, meaning the dens snaps off C2 and is driven upward into the brainstem causing instantaneous death.

In The Fiery Cross, 5^th book of the Outlander series, Herself explains:

“My horse moved suddenly, dodging past a group of men, and I saw them, three stick-figures, dangling broken in the tree’s deep shadow. The hammer struck one final blow, and my heart shattered like ice. Too late.”

The quote refers to the hanging of a character after sliding from the back of a horse. This type of hanging, known as short drop, results in a slow and agonizing death by strangulation because the body weight doesn’t drop far enough to break the dens! Had this character been hanged by long drop, the dens would likely have snapped from the body of C2 as shown in Image H (red arrow).

NOTE: I don’t have access to the medical history of the patient shown in Image H, so his/her fate is unknown. However, there are several types of dens fractures and treatment is possible.

I once had a medical student who fractured his dens in a skiing accident and survived! He was exceedingly careful when turning toward something or somebody: he rotated his upper torso and never rotated just his head for fear of dislodging the fractured dens.

Image H

Muscles: Viewed from the back, the cervical spine is overlaid with layers of muscles in the back and at the sides.

The paired trapezii (Anatomy Lesson #2, Anatomy Lesson #3 & Anatomy Lesson #10) form the most superficial layer (Image I – left side). These help extend, rotate and flex the neck.

Image I

Two pairs of intermediate neck muscles lie deep to trapezius: splenius capitis and semispinalis capitis (Image J – left side); these also flex, arch and rotate the neck.

Believe it or not, there are even more deep muscles of posterior neck but time requires us to move on. This lesson is rapidly becoming as long as a master’s thesis!

Image J

Three pair of muscles of the lateral neck are important. These are anterior, middle and posterior scalene muscles (Image K). These arise from the cervical vertebrae and insert on first or second ribs. Anterior and middle scalene lift the first rib and bend the neck towards the same side. Posterior scalene lifts the second rib and bends neck towards the same side. They all raise the ribs to increase the size of the thoracic cage and are thus secondary muscles of respiration.

Image K

Now, a question asked by many fans: why is Claire’s neck so long ( Starz episode 104, The Gathering)? It isn’t likely she has more than seven cervical vertebrae – an extremely rare variation! Two reasons likely account for her unusually elegant and swan-like neck.

First, the bodies of C2 – C7 vertebrae are probably a wee bit longer than most. Just a small additions to the lengths of each vertebrae and one’s overall neck length is enhanced!

Take for example the neck of an adult giraffe (Image L) which reaches 2 m (6.5’) in length even though this animal has only seven cervical vertebrae! Their neck length is achieved because each vertebral body can exceed 25.4 cm (10”) in height. Now, please dinna fash, I’m not suggesting Claire’s neck is like a giraffe’s! I use this extreme example to make the point.

Image L

The second reason for Claire’s long neck is because her trapezius muscles allow for a definitive angle between their slope and the column of her neck. This gives a looong profile to her ivory tower.

Here she weeps as a sick BJR relates the horrific account of Jamie’s scourging (red arrows – Starz episode 106, The Garrison Commander). Beautiful photography as we even see the reflection of a tear fallen on her left breast.

Now, compare and contrast Claire’s trapezii with Jamie’s which are super well-developed! His amazing trapezii slope downward from head and cervical spine to clavicles and scapulae (Anatomy Lesson #2) filling in the aforementioned angles. This widens the neck and effectively causes it to look shorter, but no less appealing. Make sense?

Anterior Neck: This region provides passage for pharynx (back of the throat), larynx (voice box), trachea (wind pipe) and esophagus (tube to stomach), viscera that will be left for later anatomy lessons.

We will, however, consider two superficial structures of the anterior neck. First, do you recall the paired platysmas in Anatomy Lesson #11? Each is a thin, flat subcutaneous muscle that pulls down the lower lip (green arrow) and webs the neck skin (red arrows).

Here’s Claire with platysmata (pl.) contracted as she tells Jamie that she had a wee bit too much of Colum’s rhenish (Starz episode 103, The Way Out). Och, she’s had waaay too much!

The second superficial structure of the anterior neck lies deep to each platysma; it is the external jugular vein. Each vein collects blood from its side of the face and empties it into a large vein at the base of the neck (Image M – black arrow).

Image M

Claire’s right external jugular vein (red arrow) shows vey well in this scene where she verbally spars with dirty Dougal (Starz episode 102, Castle Leoch)! She’s clearly pissed and for good reason – Dougal has her watched day and night by those hooligans, Rupert and Angus, thinking she’s an English spy! There are other scenes where this vein is apparent in both Claire and Jamie. Hope you watch for it!

Next, an important pair of muscles provides contour to the anterior neck. To understand them, we must first learn their bony attachments. The adult sternum (breastbone) is divided into three parts; the top part is the manubrium (Latin meaning handle). The other two parts will be left for a later lesson. At the top of the manubrium is a divot known as the jugular notch or suprasternal notch (Image N). The clavicles (Anatomy Lesson #2 & Anatomy Lesson #3) articulate with the manubrium at paired sternoclavicular joints (black arrow – right side).

Image N

The next image clearly shows Claire’s jugular notch (red arrow) as she watches a tense exchange between Colum and the wee tailor (Starz episode 103, The Way Out) who unfortunately misjudges the length of the laird’s standard frock coat!

Try this: Place fingers at the top of your sternum and feel the bony indent; this is your jugular notch.

Sternocleidomastoid Muscles: The large paired SCM provide anterior neck contour (Image O – right side). Each SCM has two heads: the sternal head takes origin from the manubrium, the clavicular head from the clavicle. The heads merge into one belly that inserts on the mastoid process, part of the skull (Anatomy Lesson #11).

Try this: Place your fingers in the jugular notch – drag chin towards your chest and feel a stout tendon on each side – the sternal head of each SCM!

Image O

Although his collar is a bit in the way, you can clearly see the sternal heads of both SCMs in BJR’s neck (Starz episode 106, The Garrison Commander) as he bellows at corporal milk sop to “kick her!” Nice guy, eh? Wouldna want to meet him in a dark alley. Hey, wait, we did meet him in a dark alley in Starz episode 108, Both Sides Now…or that was his 6^th times great grandson? Tcha, not much difference betwixt the two, at least in that episode!

The clavicular head of each SCM is thicker and wider than the sternal head creating a mound easily viewed in this image of Claire getting liquored up by Colum (Starz episode 102, Castle Leoch). Yep, a servant has just delivered a jug of his rhenish! Do ye also see the sternal heads of each SCM?

Now, see Claire in her bonny ribbon with both SCM tendons tensed? She is sooo pleased and relieved by Jamie’s clever handling of his scheming uncles at the Gathering (Starz episode 104); he is her patient, after all!

A comment about Claire’s SCM. Some folks have more than two SCM heads on each side. In Claire’s case, the inner pair of tendons (red arrow – right side) belongs to the sternal heads; the next pair (green arrow – her right side) belongs to her first set of clavicular heads. The wide tendon (aqua arrow – her left side) belongs to her second set of clavicular heads.

This doesn’t alter function – in my view, it makes her long neck even more splendid. The tendons look very bonny on her ivory tower enclosed like it is by a pert and lovely ribbon (kudos to Terry and team for the gorgeous costuming!). No one wears a neck ribbon quite like Claire! It is the best except, mayhap, when Jamie is taking it off? Snort!

Try This: Check out your own SCMs in a mirror. Do you have more than two heads?

The SCM performs three movements for us (other neck muscles assist with these movements). First, both sternal heads contract to arch the neck and depress (lower) the chin. Here you see Claire (Starz episode 102, Castle Leoch) contracting both sternal heads as Colum grills her about the proper pronunciation of Beauchamp and her distant famly from Compiègne, France.

The second function of SCM is turning the chin to look over one shoulder. This occurs when the clavicular head of only one side contracts. Again, we see Claire smile at Colum at the supper table afore he starts her grilling (Starz episode 102, Castle Leoch). Now, her left SCM muscle tendons are clearly visible because they are stretched. But, in fact, it is her right SCM that contracts to move her chin toward her right shoulder.

Try it yourself! You might also re-watch this entire scene to appreciate the array of gracious neck movements performed by our braw heroine!

The third movement occurs when both clavicular and sternal heads of one SCM contract to pull the same ear toward the shoulder. Here is Jamie (Starz episode 102, Castle Leoch) having his gunshot wound cleaned. How many times have we seen guys perform this neck movement? It seems a universal guy thing, but, I didn’t ken it was done in 1743 by 23 y. o. Scottish virgin! Yup, that’s both heads of his left SCM in action.

Next, the anterior neck compartment contains an unpaired bone (Image P – viewed from above). The U-shaped Hyoid bone is Greek meaning shaped like the letter upsilon, the 20^th letter of the Greek alphabet. In adults it measures roughly 2” (5 cm) side-to-side and front-to-back with a body and two cornua (Latin meaning horn). Unlike the other 205 human bones, the hyoid doesn’t articulate with any other bone!

Image P

The hyoid bone sits in a mostly horizontal orientation about a finger’s breadth below the bottom of the mandible (Anatomy Lesson #11) and at the level of C3 vertebra (Image Q). The hyoid is suspended in the neck by two strong ligaments attached to our styloid processes, a pair of gothic-looking bony spikes. Aye, our skulls really do have these wicked-looking projections!

OK. Let’s stop for a funny story: once a student asked me to examine his plastic skull model for accuracy. It looked fine until I turned it over and noticed it had no styloid processes! I voiced the observation and he responded that he had broken them off because he thought them to be leftovers from the modelling process! We got a good belly laugh over that one!

Image Q

Try this: Feel your own hyoid bone. Open thumb and index finger into a curved U and slip the opening over the front of your neck just below your jaw bone. Gently tighten your digits a wee bit and then cough or swallow. You should feel a hard bar move up and down on each side. This is the hyoid bone. If you push gently with your index finger your thumb feels the hyoid more easily on the contralateral (opposite) side. The hyoid is tucked so deeply under the mandible that it is rarely fractured except with compression during manual strangulation. Ugh!

Note: The hyoid bone appears in Diana’s 8th book Written in my Own Heart’s Blood but I will save that context for a later post. NO spoiler here!

A whopping nine pair of muscles attach to the hyoid. The thyroid cartilage (part of larynx) also hangs from it by a fibrous membrane. These muscles help control the tongue, floor of mouth, pharynx and larynx such that the hyoid plays important roles in breathing, speech, swallowing, chewing and coughing (Image R). Some muscles lift the hyoid forward or backward, others pull it down and forward or backward. Then there are combinations of movements between the muscles making for complex changes to throat, esophagus and airway. The arrows in Photo R indicate the directions the named muscle pull.

Image R

I won’t cover all nine pair of muscles attaching to the hyoid (only eight are listed in PhoImage R) because it is too much info. But, I will comment on the paired omohyoids. Each omohyoid (Image S – right muscle) has two bellies: an inferior belly arises from the scapula and ends at an intermediate tendon near the clavicle (Image S – black arrow) and a superior belly arises from the intermediate tendon and inserts on the hyoid. Although not shown in the image, the intermediate tendon is bound to the clavicle by fibrous tissue. As each omohyoid contracts, it pulls the hyoid bone downward and backward.

Image S

The omohyoid is rarely seen because it lies deeply. However, I saw this muscle in action during Starz episode 101, Sassenach. Now, I bet you watched this scene more than once but I encourage you to do it again. Here, Jamie has just chased Claire down (YES!). She spits “NO” ta his question: does she want him to pick her up and throw her over his shoulder (YES! erm…NO!). He says: “Well, then, I suppose that means yer comin’ wi’ me!” (oh YES, I mean NO!). Whew, gettin’ a wee bit dizzy here!

Now see the location of the red arrow on Jamie’s neck? Go back and watch this episode as he speaks the line about comin’ with him while keeping an eye peeled at the area indicated. Ye will see a bump rise and fall a couple of times. This is Jamie’s right omohyoid muscle contracting to depress his hyoid bone as he speaks. When I saw it, I nearly fell out of my chair! OMG it is bloody awesome! (Anatomists are a bit weird and easily entertained, ye ken?)

“Oh, de headbone connected to de…neckbone…

Let’s end this lesson with a final view of Claire’s magnificent ivory tower (not to mention Angus cleaning out a lug in the background)! Aye, she looks marvelous!

Before I close, I’d like to add a wee personal note at the request of a reader: I write my blog anonymously not because I have anything to hide but because I prefer to focus on Diana’s splendid books, the fabulous Starz Outlander series and fascinating human anatomy! I am a woman and a traditional one at that. If my blog encourages anyone, regardless of gender, to pursue an interest in science then I feel I have done my job. Namaste!

The deeply grateful,

Outlander Anatomist

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photo creds: Starz, Netter’s Atlas of Human
Anatomy, 4^th ed., Clinically Oriented Anatomy,
5^th ed., Hollingshead’s Textbook of
Anatomy, 5^th ed., www.teachmeanatomy.info, www.radiopedia.org,www.wikipedia.org, www.commons.wikimedia.org, www.medical-dictionary.thefreedictionary.com,

January 20, 2015March 10, 2020

Anatomy Lesson #11: “Jamie’s Face” or “Ye do it Face-to-Face?”

We humans communicate via written word, oral articulation, body language and facial expression.

Welcome to Anatomy Lesson #11 where we learn about muscles that give expression ta the face; it telegraphs more emotional content than perhaps any other body part (Image A) and it’s probably the main way the world recognizes each of us.

WARNING: if ye are a wee bit squeamish, this post contains drawings of the skull and facial muscles sans skin. But, if you concentrate on the science queasiness is usually replaced by the intellectual challenge of learning. I promise. Be brave!

Image A

This lesson starts and ends with Jamie. Why? Can you name an actor with a more expressive face? Frankly (no, not that Frank), I think our ruadh Jamie ranks up there with expressives such as Sir Anthony Hopkins and Sir Laurence Olivier. His range of facial expression is so great that there are times he looks like a different actor! Check the next image: at first glance, his gorgeous countenance appears serene but look again: it fair beams wi’ intelligence, determination, calculation and wit (Starz episode 4, The Gathering)!

And, I’ll be saying that Jamie is no afraid to use his muscles of facial expression if they yield keener insight into his emotional state – here as the warrior furiously fighting the Grants (Starz episode 8, Both Sides Now).

OK – on to the lesson!

Skull: Several skull bones provide attachments for muscles of facial expression (Image B). Please palpate (feel) these on your own skull: the bone of your forehead is the unpaired frontal bone; at the back of the skull is the unpaired occipital bone; the cheeks are mostly the paired zygomatic bones (Anatomy Lesson 8); the upper teeth are seated in paired maxillary bones; the lower teeth anchored into the unpaired mandible; the bridge of the nose is formed by paired nasal bones.

Try this: Grip the bridge of your nose wiggle it – normally, it doesn’t move. Now, work your fingers toward the tip until you feel bone give way to soft tissue – at this point the nasal bones are joined to nasal cartilages which you can easily wiggle.

Image B

The human face has 20+ pair of muscles of facial expression (Image C – not all muscles are shown). Little wonder that the face can display an astonishing range of emotion with more than 40 individual muscles plus working individually or in groups for combined effects!

Facial muscles vary considerably from person to person. Most are thin, flat and subcutaneous (just under the skin). Some attach to skull bones, or to the dermis of the skin (Anatomy Lesson 5 & Anatomy Lesson 6) or with other facial muscles. Thus, some have no bony attachments at all. As these muscles contract, the skin wrinkles at right angles to the direction of the muscles fibers, which over time gives rise to wrinkles. They also have strange names that are pronounced like they are spelled.

Image C

The muscles of facial expression develop from the same embryonic region and all are innervated by the paired facial nerves which arise from the brain (Image D).

Each facial nerve leaves the skull via a hole (foramen) just below the ear canal and breaks into 5 branches that supply the muscles of facial expression. (psst…The large bumpy orange mass at the side of the face is the right parotid (salivary) gland).

Image D

We anatomists love using devices and mnemonics to help us remember the myriad of names and details of the human body. It’s a mess of info you ken? Here is a fun one to recall the branches of the facial nerve (Image E); it’s a teaching device – not intended to intimidate the wee lassie. I like this acronym to recall the branches: To Zanzibar By Motor Car!

Image E

The paired facial nerves signal the muscles of facial expression to contract! If a facial nerve is compromised by injury, etc., then the facial muscles are paralyzed on the same side. This condition, known as Bell’s palsy, is demonstrated in the archival photo of a gentleman from the late 1800s (Image F). The right side of his face (on your left) has lost expression: he cannot close the eyelid, his mouth droops and his smile (nasolabial) fold is flattened.

Bell’s palsy is a difficult, debilitating and depressing condition because, as noted earlier, our face is how we face the world. To honor contributions by Scots to medical science (there are many) the syndrome bears the name of the man who first described it: Dr. Charles Bell (1774-1842) surgeon, anatomist and graduate of The University of Edinburgh. Pertinent to this topic and based on his anatomical knowledge, in 1806 Bell published “Essays on the Anatomy of Expression in Painting” for the instruction of artists.

Image F

Back to the muscles of facial expression!

For simplicity, I divide the face into five regions, naming their facial muscles and providing examples from Outlander cast members. Please ken that I canna cover all the muscles of facial expression nor all the cast for such a post would be way toooo long.

Region #1 – Forehead/Eyebrows: Four paired muscles act in this region but we will discuss only three pairs (Image G):

- Frontalis (black arrow),
- Occipitalis (blue arrow) and
- Corrugator supercilii (purple arrow)

NOTE: Skin overlying the corrugator supercilii (purple arrow) receives it own name, glabella, meaning smooth. At rest, the skin between the eyebrows is smooth unless the corrugator contracts and then it wrinkles.

Frontalis: Fibers of the frontalis muscles are oriented vertically from a connective tissue sheet overlying the skull (galea aponeurotica – grey in Image G) to the dermis o’ the eyebrows. Frontalis muscles raise the eyebrows and wrinkle the skin of the forehead as in asking a question or expressing concern.

Image G

Now, several of you have begged for Dougal in a lesson. So, here he is with both frontalis muscles contracted as he interrogates Claire (Starz episode 5, Rent).

Occipitalis: The paired occipitalis muscles (Image G 🤞🏻) are oriented vertically from the occipital bone to the galea aponeurotica. When they contract, forehead skin is pulled backward.

As Claire causes kissus interruptus, Jamie contracts his occipitalis muscles and his forehead and scalp are pulled backward (Starz episode 7, The Wedding)! Watch the episode again (as if you need an excuse) to see his occipitalis muscles in action and you’ll ken what I mean.

Claire, what a tease! (psst…Jamie, if the lass willna do her duty, in the interest of science I’m sure there are plenty of others willing to step in…just sayin’!)

Corrugator supercili: Fibers of the paired corrugator supercilii are oriented diagonally from the frontal bone to the dermis between the eyebrows (Image G 🤞🏻). As they contract the brows “knit” together creating vertical wrinkles between the eyebrows as in worry, frown or puzzlement. Here, Claire watches as Geordie nears death at the tynchal (Starz episode 4, The Gathering).

Q: Now, here’s a more complicated facial expression: Jamie watches a foul redcoat deserter assault Claire (Starz episode 8, Both Sides Now). Which muscles of his forehead are contracted?

A: Well, turns out both frontalis and corrugator supercilli muscles contract to reflect terror, despair or helplessness. Jamie looks to be in agony here. Good job if you named either muscle!

Region #2, Eyelids: One pair of facial muscles operates the eyelids, the orbicularis oculi (Image H – black arrow).

Orbicularis oculi are paired elliptical muscles attaching to frontal and maxillary bones and to a fibrous band at the inner corner of each eyelid.

- Orbital loops of each orbicularis oculus rise to the brows, reach the temple and overlay the zygomatic bone.
- Palpebral loops extend into the upper and lower eyelids.

Contraction of orbicularis oculi close the eyelids to varying degrees. (NOTE: the eyelids are opened by muscles that do not belong to muscles of facial expression.)

Image H

Here is a funny scene from Starz episode 5, Rent: Dougal is telling the Highlanders about auld granny Mary asking her husband what he was thinking “when ye first saw me nipples!”

Note the crow’s feet at the corner of his right eye (L not visible)? These are caused by contraction of each orbicularis oculus muscle – here in an expression of mirth. Dougal is so into his story that he drools! It happens quickly, but you can see a wee sliver of saliva after it drops from his mouth (red arrow). Verra funny!

In the same episode Jamie tells Claire: “Dinna worry – trees are safe, Sassenach” (much safer than Uncle Dougal. Aye?).

Here only the orbicularis oculi of his lower eyelids are contracted giving him the Fraser cat’s eyes and broad cheekbones that Herself attributes to Jamie.

Here’s Claire’s with her eyelids closed because the palpebral parts of her orbicularis oculi muscles are fully contracted. She’s just told Jamie that his dirk is too long and heavy for her (Starz episode 8, Both Sides Now). Snort! Rupert replies that the lassies say that to him all the time so Claire gives him a look of mild disgust. Naughty Rupert!

Region #3, Upper Lip: A whopping five pair of muscles operate the upper lip (Image I)! We’ll cover four of the pairs:

- zygomaticus major (purple arrow),
- levator labii superioris alaeque nasii (green arrow) and
- rizorius (blue arrow).
- orbicularis oris (black arrows) operates both upper and lower lips

Image I

Zygomaticus major: Zygomaticus major reaches from the zygomatic bone to the corner of the lips. Its contraction pulls the corners upward as in a smile. Jamie shows a good one here (Starz episode 5, Rent).

Claire has just declared that Angus can “kiss her bloody English ass.” Jamie canna help but grin – she’s a spirited lass and he likes her potty mouth. Hey, hey, did you also ken that he has cheek dimples? Too cute!

Levator labii superioris alaeque nasi (LLSAN): The LLSAN muscles have the longest name of the 600+ skeletal muscles of the human body but they are small. The name is Latin for “lifter o the upper lip and wing of the nose”.

Each muscle arises from the maxillary bone and divides into two slips – one to the upper lip and the other to a nostril. In plain English, the lip-slip lifts the lip into a snarl and has been tagged “The Elvis Muscle”. Well, Rupert beat Elvis out by two centuries when he snarls at Claire “Horse, my cock” (Starz episode 4, The Gathering)! Yep, that’s his right LLSAN muscle contracting.

The other slip of LLSAN flares the nostril (red arrow). It’s quick but here Jamie flares his nostrils as he tells Claire he reckons they will be riding all that night and the next one too (Starz episode 1, Sassenach)! There is a better one of his flaring nostrils but I’ll be saving that for a later lesson!

Risorius: Rizorius muscles reaches from the parotid glands (Image I 🤞🏻) to the corner of the lips. As they contract, the mouth pulls into a grim, flat smile – here, Jamie kens just how pissed Claire is about the marriage contract (Starz episode 6, The Garrison Commander)!

Orbicularis oris: Orbicularis oris circles the mouth but isn’t a sphincter; it is a complex of four interlacing quadrants of muscle that contract to:

Close the mouth
Pucker the lips
kiss
Play brass instruments
Spit

See it in action here as Jamie warns Claire that he will brook no dissent from her – aye, she is coming with him (Starz episode 1, Sassenach)! If she willna walk then he will pick her up and throw her over his shoulder! Does she want him to do that? Her mouth says no, but her heart says, oh aye!

And here is Claire’s orbicularis oris muscle getting into the act as she puckers up and spits in the face of BJR (Starz episode 1,Sassenach)! Doesna matter if he does look like Frank, the smart lass wants nothing to do with this bloody bastard!

Region #4, Lower Lip: The lower lip has 5 paired muscles that activate it. The lower lip is also moved by the unpaired orbicularis oris but it has already been discussed above 🤞🏻. We will cover four (Images J & K):

- mentalis (green)
- depressor anguli oris (purple arrow)
- platysma (blue arrows)
- depressor labii inferioris (see Image K)

Image J

Mentalis: Mentalis muscles contract to pucker the chin skin. See Mrs. Fitz (red arrow) asking God to bless Claire for saving her nephew, Tammas Baxter (Starz episode 3, The Way Out).

Just so you understand, the lips are everted by other muscles. Mrs. Fitz adores Claire. She would have the Miracle Worker sit for a portrait if it were up to her!

Depressor anguli oris: Depressor anguli oris muscles pass from the mandible to the orbicularis oris muscle (Image J). As they contract, the lower lip is drawn down; Claire contracts both of hers to demonstrate disgust at the British treatment of the Scots (Starz episode 6, The Garrison Commander). Her outspoken words place her in the hands of BJR!

Platysma: Each platysma is a long, thin flat muscle that begins in the dermis near the 2^nd rib, passes over the jaw and ends in the dermis near the lower lip; it has no bony connections and is sometimes listed as a muscle o’ the neck (Photo J).

Have ye noticed how a horse can quiver its skin to rid itself of flies? It has a pair of muscle equivalent to the human platysma. As our platysmas contract, they pull down the lower lips and wrinkle the skin of the neck conveying the expression of a grimace.

Here we see Jamie with his platysmas contracted (red arrows) after he hoists Dougal over his shoulder because his uncle was playing dirty shinty (Starz episode 4, The Gathering)!

Depressor labii inferioris: The fifth and last pair of lower lip muscles is depressor labii superioris, green in Image K. This muscle extends from mandible to dermis of lower lip. As its name implies, it pulls down on the lower lip. Couldn’t find a good Outlander example so the drawing must do.

Image K

Region #5, Cheek: Each facial cheek contains one muscle, the buccinator (Photo L – black arrows); it hides deep to risorius muscles. Each muscle starts near the back of the jaw and blends wi’ the orbicularis oris. It’s known as the bugler’s muscle fer guid reason; try this, fill yer mouth wi’ air and push out yer cheeks. The bulging cheeks contain the buccinators. Now, draw yer cheeks inward ta blow out the air; ye just contracted yer buccinators. Congrats!

Image L

Here, Jamie’s right buccinator (green arrow – canna see the left one) is expanded as he contemplates one of a bazillion questions thrown at him.

That brings our lesson on the muscles of facial expression to a close.

but, here is something to contemplate…. in case you think that animals cannot have facial expression take a wee keek at these next four images (Starz episode 5, Rent).

In this scene, Rupert has just told the Highlanders how he was stuck between hairlip Chrissie and sweaty Nettie trying to decide which one to swive first. Sassy-lassie Claire declares that she believes his left hand is jealous of his right! This brazen comment is followed by a moment of tension where everyone, especially Jamie, awaits Rupert’s Response (sounds like the title of a book – Aye?). Jamie gets the joke right away.

Takes a few seconds but then the other Highlanders get her joke! Jamie’s zygomatic majors are contracted here in a big old grin! Then, Brimstone gets the joke!

Brimstone is really getting into it along with Jamie!

BTW did you notice the beautiful cutwork on Brimstone’s bridle? Dinna know who did the leather work but it’s almost as lovely as Claire’s wardrobe which Mrs. Fitz puts together sometime between supper after the boar hunt and first light the next day as they head off to collect the rents! (That Mrs. Fitz sure is a miracle worker herself). I figure the covered wagon they take is to carry Claire’s wardrobe – it would put a queen to shame!

And finally, the full horse laugh from Brimstone. Och, ye are a witty one, Claire!

Now I promised you that I would begin and end with Jamie. I have pondered how it is that he has such an expressive face. Here are my ideas:

He has more muscles of facial expression than most folk! Aye, it happens and I have seen examples in the dissection lab.
His facial muscles are more highly innervated giving greater control over them.
He is a keen observer of human emotional nuance and highly intuitive which allows him to feel his way through a character more than most actors.
His emotional intelligence derives from some combination of the above.

Whatever the explanation, we viewers are the lucky beneficiaries of his acting skills. So, thank ye Jamie!

Here’s a terrific example from Starz episode 3, The Way Out as Claire unties Jamie’s stock to check his gunshot wound: with little more than sideward glance, a slight narrowing of the eyelids and a wee tug of the lips, Jamie conveys extreme discomfort and smoldering UST! Och, if ye dinna know what it means, check www.urbandictionary.com!

I hope ye enjoyed learning about the verra important muscles of facial expression, especially Jamie’s!

And for those who are new to my blog, a note of explanation: I follow the convention of using character’s names rather than actor’s names. This gives the cast at least one degree of separation and a wee modicum of respect as I dissect their bodies with words! I hope you all understand!

The deeply grateful,

Outlander Anatomist

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Image credits: Sony/Starz, Netter’s Atlas of Human Anatomy, 4^th ed., Clinically Oriented Anatomy, 5^th ed., Hollingshead’s Textbook of Anatomy, 5^th ed., www.kenhub.com, www.Wikipedia.org

January 7, 2015December 1, 2019

Anatomy Lesson 10: “Jamie’s Back!”

Anatomy Lesson #10: The Back.

Happy New Year to all of you! I’m a wee bit late posting this because I just returned from my trip to Fraser’s Ridge country. It was a verra beautiful region. I can see why Jamie and Claire made their home there.

Welcome to all newcomers and thanks to all those returning to learn about Anatomy Lesson #10: The Back. Because our red-haired hero is so utterly braw, I will use many images of Jamie to teach this verra important topic.

Claire first sees Jamie’s back in Starz episode 102, Castle Leoch, as she removes the blanket to clean his gunshot wound. Herself writes in Outlander book:

“I had finished the bandaging and stood quiet behind him, a hand resting on his good shoulder… His upper back was covered with a crisscross of faded white lines. He had been savagely flogged, and more than once. There were small lines of silvery scar tissue in some spots, where the welts had crossed, and irregular patches where several blows had struck the same spot, flaying off skin and gouging the muscle beneath.”

Then says Jamie:

“Lobsterbacks. Flogged me twice in the space of a week. They’d ha’ done it twice the same day, I expect, were they not afraid of killing me. No joy in flogging a dead man.”

I wish I could work off a blank canvas of Jamie’s back before it was scarred by that mad bastard Randall! Fact is we have only a brief and limited glimpse at Lallybroch (Starz episode 102, Castle Leoch) as Black Jack administers his first whipping of our brave hero. Ugh!

Now, take a wee gander at Jamie’s back after the first blow. The blue arrows mark welts or wheals! Our Starz Jamie has verra fair skin and these swellings appear to be real. Wheals are typically initiated by an allergic response or tough handling such as pressure, blows or friction. Mayhap Jamie was handled a wee bit roughly during this scene?

Back: Now, in anatomy, the human back is defined as the large area from the base of the head to the tail bone (Photo A). It is widest at the shoulders, narrows at the rib cage and ends as a “V” between the buttocks. The topographical (surface) anatomy of a well-muscled back displays a mess of lumps, bumps and valleys created by underlying muscles, etc.

The two black arrows in Photo A mark a prominent vertical midline groove, the posterior median furrow. You should also understand that for protection, back skin is thicker and has fewer nerve endings than, for example, belly or chest skin. It is also an area that we cannot typically see or touch without aid of mirrors, photos, or yoga practices. Namaste!

Photo A

Now, sans the skin, let’s take a peek at the superficial structures creating back contour (Photo B). The paired trapezius muscles (Anatomy Lesson #3) cover the upper back. You recall they take origin (begin) from bones of the skull and spine but they insert (end) on clavicle and scapula; acting together or separately, they these bones. Latissimus dorsi muscles cover the lower back. They also take origin from bones of the back but insert on and move the humeral bones (Anatomy lesson #2). Gluteus maximus and Gluteus medius (Anatomy lesson #1) muscles appear to be part of the back but they form most of the buttocks and belong to the lower limbs. The V-shaped depression at the base of the spine (white area) is the thoracolumbar fascia flanked by the gluteal muscles and iliac crests. The thoracolumbar fascia is a strong sheet of collagen that gives origin to back and abdominal muscles (cover in a later post). The iliac crest forms the top of each hip bone. The vertical midline groove (see Photo A) is created by the spine as it adheres to the dermis of the skin (Anatomy Lesson #5 & Anatomy Lesson #6).

Photo B

Removal of the superficial back muscles exposes the deeper erector spinae muscles (Photo C). They attach to the spine and ribs. In the physically fit, they are visible as thick longitudinal columns of muscle flanking each side of the spine. Their function is to arch or extend and rotate the spine (see below). Again, although seemingly part of the back, the buttocks and their gluteal muscles are actually parts of the lower limbs.

Photo C

The length of the back is determined by the spine or vertebral column which extends from the base of the skull to the tail bone (green in Photo D).

Photo D

The vertebral column forms the bony central axis of the back (Photo E). Five regions are identified from the cephalic end (Greek meaning head) to the caudal end (Latin meaning tail): cervical, thoracic, lumbar, sacral and coccygeal. There are 7 cervical (C 1-C7), 12 thoracic (T1-T12), 5 lumbar (L1-L5), 5 sacral (S1-S5) and 4 coccygeal (Co 1-Co4) for a total of 33 vertebrae (Photo E).

Photo E

A typical vertebra (some are atypical) shows the following main features (photo F): a spinous process that projects posteriorly and provides ligament and muscle attachments; a cylindrical body that is flanked top and bottom by intervertebral (IV) discs; paired transverse processes (black arrows) that provide for muscle and ligament attachments; and a hole known as a vertebral foramen.

Photo F

The vertebrae of an intact spine are aligned and held in check by numerous powerful ligaments, connective tissue bands that link bone to bone (Photo G – don’t fash about their names).

Photo G

This arrangement makes the vertebral column strong, flexible and springy! It also allows for a considerable amount of movement including lateral (side bending) flexion, twisting (rotation), and anterior (forward) flexion (Photo H):

Photo H

And, for spinal extension (Photo I):

Photo I

Vertebral alignment also converts individual vertebral foramina into a vertebral canal that houses and protects the spinal cord. Photo J is a schematic of the spinal cord inside the vertebral canal (only a few vertebrae are numbered). The colored coded regions give rise to spinal nerves issuing in pairs from cervical, thoracic, lumbar, sacral and coccygeal levels of the spinal cord; the nerves supply structures of the neck, trunk, upper limbs and lower limbs.

Photo J

The thoracic vertebrae are unusual in that they are directly anchored to the ribs and indirectly to the sternum (breast bone). This arrangement provides great stability and allows anterior flexion but little other movement (Photo K). Ribs in the image below are numbered but the thoracic vertebrae are not. Know that T1 vertebra articulates with the 1^st pair of ribs and so on.

Photo K

Here’s an interestin’ tidbit: as bipedal humans, our spines transform during life. With infants, the entire spine is flexed anteriorly (Photo L – purple line).

Photo L

As we lift our heads, sit up and walk, four alternating curvatures develop that are readily apparent in the adult spine. The cervical and lumbar vertebrae curve posteriorly – the thoracic and sacral vertebrae curve anteriorly (Photo M – spine viewed from the left side).

Photo M

Take a deep breath and enjoy this image o’ Jamie’s back: ye can clearly see his thoracic and lumbar curvatures as well as the deep midline groove flanked by impressive columns of his erector spinae muscles (Starz episode 105, Rent). And, thank ye verra much but from now on, he’ll be mending his own shirt – since his tender Uncle Dougal keeps tearing it off in front of strangers! He doesn’t care if the lad wears rags from now on!

Now, Claire who makes love to Jamie with her eyes (and other stuff too) throughout all the Outlander books, observes that Jamie’s back is “as straight as an alder sapling.” She doesna mean that he lacks the four curvatures; she means that he holds his back upright and erect…good muscle tone, aye? Here’s a great example of Jamie’s back while playing with the fillies (Starz episode 2, Castle Leoch). Snort!

And, och, while giving the Watch the slip (Starz episode 5, Rent)!

And one of my personal favorites where Jamie strides away from Claire after telling her that it is he who is virgin (Starz episode 106 The Garrison Commander)! One of them better ken what they’re doing! That put a wee gleam in Claire’s eye!

Now back ta anatomy. Another interesting tidbit about the vertebral column: at birth, the wedge-shaped sacrum consists of five separate vertebrae. Fusion begins in adolescence and ends about 30+ years explaining why the adult sacrum is counted as five vertebrae. Also, the sides of the sacrum articulate (form a joint) with each hip bone at the sacroiliac (SI) joints (Photo N – red arrows) to create a rigid pelvis. The purple arrows mark bilateral bony elevations o’ the hip bones known as the posterior superior iliac spines (PSIS).

Photo N

The PSIS are also sites where the dermis adheres to underlying bone forming the so-called dimples of Venus (Photo O):

Photo O

Although the dimples appear in countless nude images, it turns out they aren’t just beauty marks; they are superficial and easily used for bone marrow aspirations (Photo P).

Photo P

Hold on to your chair! Claire shows her dimples of Venus in this scene from Starz episode 107, The Wedding (red arrows)! Here, Claire guides Jamie’s hands to her hips and he starts to put his right fingers over her left dimple! Gasp, I think I just stopped breathing – need CPR STAT!

I cannot find any images of Jamie’s dimples of Venus but, aye, he’s got ‘em. It is just that they are absorbed into paired grooves where his lumbosacral fascia meets his very well-developed gluteus maximus and medius muscles (see Anatomy Lesson #1)! His butt muscles are so powerful that they create a groove on each side of the sacrum (Starz episode 105, Rent). Mmhm!

Now, this lesson must visit Jamie’s scourging by the Mad Man of Fort William! It breaks my heart to watch this episode (Starz episode 106, The Garrison Commander), but it is needful to understand. The harsh treatment of Jamie is not only a personal tragedy but is a harbinger of the approaching battle of Culloden and the subsequent crushing by the Redcoats of the Highlander way of life. You ken that Jamie had already received 100 lashes for trying to escape afore BJR decides he‘s due 100 more! The first strike of the whip causes the blood to flow freely because BJR is using the infamous Cat ‘o Nine Tails with lead weights at the tips! He means to bleed Jamie to the bone (You understand that if he had actually done so, Jamie would have been disabled or perhaps dead?)

Ye can see why Jamie dubs him that “mad bastard Randall.” Just take a keek at Randall’s face and eyes. This is hard work, right? And just in case you didn’t notice, the blurry figure in the background is Black Brian, Jamie’s father, so named because of the color of his hair whereas BJR is named for the color of his soul!

By the end, Jamie’s back looks like haggis. Little wonder he could barely sit astride a horse after his friends made shift to rescue him!

Herself provides another intimate appraisal of Jamie’s back in the Outlander book. Here, Jamie removes his shirt in Claire’s surgery after leaving Gwyllyn’s performance. The dressing is chaffing him and he asks her to remove it. Claire observes:

“He sat patiently, not moving as I circled behind him and inspected his back…I was appalled…The scars covered his entire back from shoulders to waist. While many had faded to little more than thin white lines, the worst formed thick silver wedges, cutting across the smooth muscles. I thought with some regret that it must have been quite a beautiful back at one time. His skin was fair and fresh, and the lines of bone and muscle were still solid and graceful, the shoulders flat and square-set and the backbone a smooth, straight groove cut deep between the rounded columns of muscle that rose on either side of it…I tried not to imagine the muscular arms raised…ropes cutting into wrists, the coppery head pressed hard against the post in agony…Involuntarily, I reached out, as though I might heal him with a touch and erase the marks with my fingers. He sighed deeply, but didn’t move as I traced the deep scars, one by one, as though to show him the extent of the damage he couldn’t see.“

Now, I must confess, this post wasn’t much fun because of its grim topic but history teaches us important lessons. During the Napoleonic Wars (1803-1815), soldiers in the British Army could receive up to 1,200 lashes, a number that could permanently disable or kill a man. The US followed a similar code and neither country abolished scourging until the late 19^th century – a blot on both nations to be sure as scourging is intended to demean, humiliate and permanently scar its victims.

Flogging was also used during the US slavery period. The next photo taken at Baton Rouge in 1863 shows the back of Gordon (Photo Q), a scourged slave. His scars are pronounced because of keloid formation.

Photo Q

Lastly, let’s consider the importance of the back, the single largest canvas of the human body. It is the basis for many sayings focused on this area of vulnerability giving rise to idioms such as: “your back is against the wall”, “stab one in the back”, “friends have one’s back”, “watch one’s back” and “back off”. The back is also a symbol of strength and hard work, as in “back to work”, “strong back” and “put your back into it”. Indeed, the practice of showing explicitness on the back has been practiced for centuries through clothing, no clothing, art, tattoos and, in Jamie’s case, flogging.

The back can also be used to telegraph emotion. In the next image, Claire has just snubbed Jamie (Starz episode 105, Rent) because he said her face plainly showed that she was thinking of running like she tried at the gathering. Well, she did ask, but Jamie doesn’t like the brush off so he flaps his plaid over his back in annoyance. It’s very funny! See Claire “back” there? She just slipped into her tent. Darn woman…doesn’t know what’s billowing behind her back!

OK, that’s it for the back. Next time I will post on a lighter topic…like Claire, I promise!

The deeply grateful,

Outlander Anatomist

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Photo Credits: Netter’s Atlas of Human Anatomy 4^th ed., Netter’s Atlas of Human Embryology, 1^st edition, Hollingshead’s Textbook of Anatomy, 5^th ed., Starz, ainsleyjason.wordpress.com, www.sportsmed.or.nz, www.Radiopaedia.org, www.wikihow.com, www.Wikipedia.org, www.massgeneral.org, www.faculty.washington.edu, www.wikipedia.com, www.momarock.wordpress.com, www.imueos.wordpress.com, www.forums.hardwarezone.com.sq, www.pedsoncologyeducation.com, www.stemcelldoc.wordpress.com, www.hercampus.com, www.prevention.com