myweb.fsu.edumyweb.fsu.edu/ls10f/Unit 2 disscetor bold words.doc · Web viewTHE THORAX Week #1 Day...

Clinical Anatomy Grant’s Dissector Notes (Summer 2009 and Summer 2010)

Melissa McDole

THE THORAXWeek #1

Day 1

Surface Anatomy—N 181

Clavicleo Sternoclavicular jointo Acromioclavicular joint

Acromion of scapula Jugular notch (suprasternal notch) Manubrium Sternal angle Body of sternum Xiphisternal junction Xiphoid process Seventh costal cartilage Costal margin Anterior axillary fold (lateral border of the pectoralis major muscle)

Skeleton of the Thorax

Thoracic vertebrae Rib

o Heado Neck o Tubercleo Costal margino Shaft (body)o Costal grooveo First rib

Highest, shortest, broadest, and most sharply curved rib Costal cartilage True ribs (1-7)

1


Melissa McDole

False ribs (8-10)--3 Floating ribs (11-12)--2 Sternum N186

o Jugular notch (suprasternal notch)o Manubriumo Sternal angleo Bodyo Xiphoid process

Scapula N185o Acromion o Coracoid process

Intercostal space and muscle

Intercostal space (dissect—space between 4 and 5 ribs)o External intercostal muscle N426

Elevates ribs below it Fibers are diagonal toward anterior midline as they

Descendo Internal intercostal muscle

Depresses rib above Fiber direction is perpendicular to fibers of external inter costal m.

o Innermost intercostal m.—N192 Same fiber direction and attachment and action

As the internal intercostal m. Serratus anterior Intercostal nerve Posterior intercostal artery and vein

o Intercostal nerves and vessels between internal intercostal muscle and innermost intercostal m.o Intercostal nerves and vessels supply the intercostal m., skin of thoracic wall, and parietal pleurao Order: veinartery nerve

Anterior intercostal branches of internal thoracic artery N189o Supply anterior end of intercostal space

2


Melissa McDole

Removal of the anterior thoracic wall

Costal parietal pleurao Attaches to thoracic wall

Right and left internal thoracic vessels Transversus thoracic m. N191

o Inferior attachment: on sternumo Superior attachment: costal cartilages 2 to 6o Depresses ribs

Internal thoracic artery and veinso Between the transversus thoracis m. and costal cartilages

Follow the internal thoracic artery inferiorly and find one:o Anterior intercostal branches

Posterior to the sixth or seventh costal cartilage, the internal thoracic artery divides into:o Superior epigastric arteryo Musculophrenic artery

3


Melissa McDole

Day 2

Lungs

Lungs in the thorax—N198

Three surfaces of lungo Costalo Mediastinalo Diaphragmatic

Oblique fissure(major fissure)—located on both lungso Separate lobes of lung

Right lungo Horizontal fissure (minor/transverse fissure)

Defines middle lobeo Three lobes

Superior lobe Lies anteriorly

Middle lobe Inferior lobe

Lies posteriorly Left lung

o Two lobes Superior lobe Inferior lobe

Apex (on each lung)o Arise as high as the neck of first rib

Pericardium4


Melissa McDole

o Contains the heart Root of the lung

o May be filled with clotted blood and pulmonary vessels Phrenic nerve Pericardiacophrenic vessels Vagus nerve—N230, 231

Removal of the lungs

When comparing two lungs note the following:o Right lung is shortero Right lung has greater volume than left lung

Borders of the lungo Anterioro Posterior o Inferior

Cardiac notcho On superior lobe of left lung, anterior to heart

Lingula on left lungo Inferior, medial portion of the superior lobe of the left lung

Contact impressions on mediastinal surface (right lung)—N 199o Cardiac impressiono Esophagus impressiono Arch of the azygos vein impressiono Superior vena cava impression

Contact impression on mediastinal surface (left lung)—N 199o Cardiac impressiono Aortic arch impressiono Thoracic aorta impression

Hilum of the lung—N208, 209o Main bronchuso Pulmonary artery

5


Melissa McDole

o Pulmonary veins In left lung—N203

o Superior lobar (secondary) bronchio Inferior lobar (secondary bronchio Segmental bronchi (9)

In right lung—o Superior lobar bronchi (eparterial bronchus)o Middle lobar bronchio Inferior lobar bronchio Segmental bronchi (10)

Bronchopulmonary segment Bronchial artery

Mediastinum

Mediastinum: region between two pleural cavities Boundaries of mediastinum:

o Superior boundary: superior thoracic apertureo Inferior boundary: diaphragmo Anterior boundary: sternumo Posterior boundary: bodies of vertebrae T1 to T12o Lateral boundaries: mediastinal parietal pleurae (left and right)

Sternal angle Plane of sternal angle-- marks level of:

o Superior border of pericardiumo Bifurcation of tracheao End of ascending aortao Beginning and end of arch of aortao Beginning of thoracic aorta

Superior mediastinum Inferior mediastinum—divided by pericardium into 3 parts

o Anterior mediastinum: between sternum and pericardium—may find thymus in childreno Middle mediastinum: contains pericardium, heart, and roots of great vessels

6


Melissa McDole

o Posterior mediastinum: posterior to pericardium and anterior to bodies of T5 to T12; contains structures that pass between neck, thorax, and abdomen

Four parts of mediastinum Mediastinal pleura—N230, 231 Pericardium Root of the lung Esophagus (right side) Thoracic aorta (left side) Costal pleura (on side of vertebral body) Endothoracic fascia

o Separates costal pleura from thoracic wall Phrenic nerves

o Innervate diaphragm Left and right pericardiacophrenic vessels

o Supply diaphragm

Middle mediastinum

Middle mediastinum Pericardium

o Sac enclosing the hearto Attached to central tendon of diaphragm

Heart Roots of great vessels

Heart in the thorax—N212

Superior vena cava Ascending aorta Arch of the aorta Pulmonary trunk Ligamentum arteriosum

o Connects the left pulmonary artery to the arch of the aorta Left vagus nerve

7


Melissa McDole

o Crosses left side of aortic arch Left recurrent laryngeal nerve Right atrium Right ventricle Left ventricle Borders of the heart

o Right border: formed by right atriumo Inferior border: formed by right ventricle and small part of left ventricleo Left border: formed by left ventricleo Superior border: formed by right and left atria and auricles

Apex of the hearto Part of left ventricleo Located deep to 5th intercostal space

Base of heart Parietal layer of serous pericardium

o Smooth shiny surface that lines inner pericardium Visceral layer of serous pericardium (epicardium)—N212 Pericardial cavity

o Potential space between parietal and visceral layers of serous pericardiumo Contains serous fluid that lubricates serous surfaces and allows free movement of heart while in pericardium

Oblique pericardial sinus—N215 Transverse pericardial sinus

Day 3

Removal of the heart

ascending aorta pulmonary trunk superior vena cava inferior vena cava

8


Melissa McDole

four pulmonary veinso form boundary of oblique pericardial sinus

External features of the heart

Surface features—N214

External surfaces of heart—N214o Coronary (atrioventricular) sulcus: runs around heart, separates atria from ventricleso Anterior interventricular sulcus/posterior interventricular sulcus: indicate location of interventricular septum; join the

coronary sulcus at a right angleo Sternocostal (anterior) surface: formed by right ventricleo Diaphragmatic (interior) surface: formed by left ventricle and small part of right ventricleo Pulmonary (left) surface: formed by left ventricle; in contact with cardiac impression of left lungo Chambers of the heart

right atrium and right auricle right ventricle left ventricle left atrium and let auricle Superior view

aorta and aortic valve pulmonary trunk and pulmonary valve superior vena cava

Diaphragmatic surface Inferior vena cava Posterior interventricular sulcus

Cardiac veins—N216

Cardiac veinso Superficial to coronary arteries

Coronary arteries Coronary sinus

o On diaphragmatic surface9


Melissa McDole

o Located in coronary sulcus Great cardiac vein

o On sternocostal surface of heart Middle cardiac vein

o In posterior interventricular sulcus Small cardiac vein

o Courses along inferior border of heart Anterior cardiac veins

o Bridge atrioventricular sulcus between right atrium and right ventricleo Drain anterior wall of right ventricle directly into right atrium

Coronary arteries—N216

Aortic valve Right semilunar cusps Left semilunar cusps Posterior semilunar cusps Aortic sinus (right, left, posterior) Left aortic sinus

o Opening of the left coronary artery anterior interventricular branch (left anterior descending LAD artery)

follows great cardiac vein Circumflex branch

o Right coronary artery Opening at right aortic sinus Anterior right atrial branch

Sinuatrial nodal brancho Supplies sinuatrial node

Marginal branch Follows cardiac vein along inferior border of heart

Posterior interventricular branch Anastomoses with anterior interventricular branch of left coronary artery

Artery to the atrioventricular node

10


Melissa McDole

Internal features of the heart

o blood passes through the heart in the following order:o right atrium—N220

anterior wall of right atrium (interior of heart) pectinate muscles: horizontal ridges of muscle crista terminalis: vertical ridge of muscle that connects pectinate muscles

posterior wall of right atrium opening of superior vena cava opening and valve of inferior vena cava opening and valve of coronary sinus fossa ovalis

o derived from foramen ovale in fetus, blood from placenta is delivered to heart via IVC; oxygen rich blood and nutrients is

directed toward foramen ovale that allows passage to left atrium and out to the body without going to the lung

limbus fossa ovalis Conduction system of the heart: on walls of atria

Sinuatrial node (SA node) Atrioventricular node (AV node)

Right atrioventricular valveo right ventricle—N220

pulmonary valve anterior wall of right ventricle interventricular septum chordae tendineae opening of the right atrioventricular valve (tricuspid valve)

three cups:o anterioro septalo posterior

papillary muscles anterior

11


Melissa McDole

o largest septal

o very small and may be multiple posterior

Trabeculae carneae Septomarginal trabecula (moderator band) Opening of the pulmonary trunk Conus arteriosus (infundibulum)

Cone-shaped portion of right ventricle Inner wall is smooth

Pulmonary valve Three semilunar cusps (anterior, right, left)—N222 One fibrous nodule

o Help seal valve cusps and prevent backflow of blood during diastole Two lunules

o Help seal valve cusps and prevent backflow of blood during diastoleo left atrium—N221

four pulmonary veins arranged in pairs—two from right lung and two from left lung

valve of the foramen ovale on interatrial septum

opening into left auricle opening of left atrioventricular valve

o left ventricle—N221 aortic valve three semilunar valve cusps—N222

right left posterior

left atrioventricular valve (bicuspid valve, mitral valve) anterior cusp posterior cusp anterior papillary muscle posterior papillary muscle

12


Melissa McDole

chordae tendineae trabeculae carneae aortic valve right, left and posterior semilunar cusps

one nodule and two lunules muscular part of the interventricular septum membranous part of the interventricular septum coronary arteries aortic sinuses noncoronary cusp conducting system of the heart—N225

AV node AV bundle: two divisions

o Right bundle Stimulates ventricles to contract Carries impulses to anterior papillary muscle through septomarginal trabecula

o Leff bundle Stimulate ventricles to contract

Septomarginal trabecula

Week 2 Day 1

Boundaries of the superior mediastinumo Superior: superior thoracic apertureo Posterior: bodies of vertebrae T1 to T4o Anterior: manubrium of sternumo Lateral: mediastinal pleurae (left and right)o Inferior: plane of sternal angle

Thymus: fatty remnant posterior to the manubrium of sternum –N 212 Left brachiocephalic vein Right brachiocephalic vein Superior vena cava—where brachiocephalic veins meet—N230 Azygos vein: on right side of mediastinum

13


Melissa McDole

Arch of azygos vein: passes superior to root of right lung and drains into posterior surface of superior vena cava Right and left phrenic nerves

o Pass posterior to brachiocephalic veinso Run with pericardiacophrenic vessels o Enter superior surface of diaphragm

arch of the aorta—N231o begins and ends at level of sternal angleo three arteries branch from arch of aorta

brachiocephalic trunk left common carotid artery left subclavian artery

ligamentum arteriosumo connects arch of aorta to left pulmonary artery

left vagus nerve left recurrent laryngeal nerve right vagus nerve right recurrent laryngeal nerve

o loops around right subclavian artery trachea

o esophagus is posterior to trachea bifurcation of the trachea

o bifurcation occurs at the plane of the sternal angle to form the right and left main bronchus

right main bronchus has a larger diameter, is shorter and is more vertical tracheobronchial lymph nodes

o located around trachea near bifurcation tracheal rings carina

o special piece of tracheal cartilage

Posterior Mediastinum—N232

-structures are between the thorax and the abdomen; is posterior to pericardium

14


Melissa McDole

boundaries of posterior mediastinumo superior: plane of sternal angleo posterior: bodies of vertebrae T5 to T12o anterior: pericardiumo lateral: mediastinal pleura (left and right)o inferior: diaphragm

area of the oblique pericardial sinus esophagus thoracic aorta esophageal plexus of nerves

o innervates the inferior portion of the esophagus right vagus nerve left vagus nerve anterior and posterior vagal trunk

o found on inferior part of esophagus before it passes through diaphragmo innervate gastrointestinal tract

azygos vein posterior intercostal veins –N238 thoracic duct

o between azygos vein and the thoracic aortao to the left of azygos vein and is posterior to esophagus—N316

right posterior intercostal arteries hemiazygos vein

o where posterior intercostal veins drain into accessory hemiazygos vein

o where posterior intercostal veins drain into thoracic aorta esophageal arteries left bronchial arteries posterior intercostal arteries intercostal nerve—innermost intercostal muscle sympathetic trunk—N240

15


Melissa McDole

o has one sympathetic ganglion for each thoracic vertebral level rami communicantes (2) (white ramus communicans, gray ramus communicans)

o connect each intercostal nerve with its corresponding thoracic sympathetic gangliono white ramus communicans is more lateral

greater splanchnic nerve (on left and right) lesser splanchnic nerve least splanchnic nerve

THE HEAD AND NECK

Neck

Surface of the neck—N17

Atlas (C1)o Anterior arch and tubercleo Transverse process with transverse forameno Groove for vertebral arteryo Posterior arch and tubercleo Superior articular surface for occipital condyle

Axis (C2)o Denso Bodyo Transverse process with transverse foramen

16


Melissa McDole

o Laminao Spinous processo Superior articular facet for atlas

Vertebrae C3 to C7 Body Transverse process with transverse foramen Groove for spinal nerve Lamina Spinous process Vertebral prominens

Posterior triangle of the neck

--N35

Pharynx and esophaguso Superior part of digestive tract

Larynx and tracheao Superior parts of respiratory tract

Thyroid gland and parathyroid glands Visceral part of neck boundaries

o Posterior: cervical vertebraeo Posterolateral: the scalene muscleso Lateral: the sternocleidomastoid m.o Anterior: the infrahyoid mm

Carotid artery (internal carotid artery) Internal jugular vein Vagus nerve Carotid sheath

Posterior triangle of the neck—N26 Boundaries of posterior triangle:

Anterior: posterior border of sternocleidomastoid m. Posterior: anterior border of trapezius m.

17


Melissa McDole

Inferior: middle one-third of clavicle Superficial (roof): superficial layer of the deep cervical fascia Deep (floor): muscles of neck covered by prevertebral fascia

Platysma m.o Superficial fasciao Covers lower part of posterior triangleo Attachments

Inferior: deltoid and pectoral region Superior: mandible, skin of cheek, angle of mouth, orbicularis oris m.

o Innervation facial nerve External jugular vein—N31

o Deep to platysma m.o Drain into the subclavian vein

Cervical plexuso Great auricular nerve

Crosses over superficial surface of sternocleidomastoid m. parallel to external jugular vein Innervates skin of lower part of ear and skin extending from the angle of the mandible to mastoid process

o Lesser occipital nerve Pass superiorly along border of sternocleidomastoid m. Supplies part of scalp immediately behind ear

o Transverse cervical n. Passes transversely across sternocleidomastoid m. and neck Supplies skin of anterior angle of neck May be removed with platysma m.

o Supraclavicular nerves Pass inferiorly to innervate skin of shoulder

Medial, intermediate, and lateral branches Accessory nerve (XI)

o Attach Superiorly to midpoint of posterior border of sternocleidomastoid m. Inferiorly to trapezius m.

o C3 and C4 branches join CN XI in posterior triangle and branches provide proprioceptive sensory innervationo Innervates: the sternocleidomastoid m and trapezius m.

18


Melissa McDole

Anterior triangle of the neck N28

Boundaries of anterior triangle of the necko Anterior: median line of the necko Posterior: anterior border of sternocleidomastoid m.o Superior: the inferior border of mandibleo Superficial (roof): superficial layer of deep cervical fasciao Deep(floor): larynx and pharynx

Triangle divided into smaller triangles Muscular, carotid, submandibular, and submental

Bones and cartilage—N29

Hyoid bone: at angle between the floor and mouth and superior end of the neck Thyrohyoid membrane: stretching between the thyroid cartilage and hyoid bone Thyroid cartilage: anterior midline of neck

Superficial fascia—N31

External jugular vein Retromandibular vein Posterior auricular vein Anterior jugular vein

Muscular triangle—N29

Muscular triangleo Infrahyoid muscles, thyroid gland, parathyroid glandso Boundaries of muscular triangle

Superolateral: superior belly of omohyoid m. Inferolateral: anterior border of sternocleidomastoid m. Medial: median plane of neck

Sternohyoid m.19


Melissa McDole

o Inferior attachment: sternumo Superior attachment: body of hyoid boneo Function: depresses hyoid bone

Superior belly of the omohyoid m.o Inferior: inferior border of hyoid boneo Superior: scapula near suprascapular notcho Depresses hyoid bone

Sternothyroid m.o Inferior: sternumo Superior: oblique line of thyroid cartilageo Depresses larynx

Thyrohyoid m.o Inferior: oblique line of the thyroid cartilageo Superior: hyoid boneo Elevates larynx

Ansa cerviciso Innervates four infrahyoid m.

N31

Laryngeal prominence Cricothyroid ligament Cricoid cartilage First trachea ring Isthmus of the thyroid gland

Submandibular triangle—N32

Submandibular triangle:o Submandibular gland, facial artery, facial vein, stylohyoid m. , part of hypoglossal nerve (XII), lymph nodeso Boundaries of submandibular triangle

Superior: inferior border of mandible Anteroinferior: anterior belly of the digastric m.

20


Melissa McDole

Posteroinferior: posterior belly of digastric m. Superficial (roof): superficial layer of deep cervical fascia Deep (floor): mylohyoid and hyoglossus m.

Mastoid process Styloid process Inner aspect of mandible—N15

o Digastric fossao Mylohyoid lineo Submandibular fossao Mylohyoid groove

Anterior and posterior bellies of the digastric m. Intermediate tendon Tendon of the stylohyoid muscle

o Attaches to the body of the hyoid bone o Innervated by facial nerve and elevates hyoid bone

Hypoglossal nerve (XII)o Passes deep to the posterior belly of digastric m.

Mylohyoid m.

Submental triangle—N31

Submental triangleo Submental lymph nodeso Boundaries of submental triangle

Right and left: anterior bellies of the right and left digastric mm. Inferior: hyoid bone Superficial(roof): superficial layer of deep cervical fascia Deep (floor): mylohyoid m.

Carotid triangle—N32

Carotid triangle

21


Melissa McDole

o Carotid arteries (common, internal, external), branches of the external carotid artery, part of hypoglossal n., branches of vagus n.

o Boundaries of carotid triangle Inferomedial: superior belly of the omohyoid m. Inferolateral: anterior border of the sternocleidomastoid m. Superior: posterior belly of the digastric muscle

Tip of the greater horn of the hyoid bone Nerve to the thyrohyoid m. –N32 Hypoglossal n. Superior root of the ansa cervicalis Inferior root of the ansa cervicalis Thyrohyoid membrane Internal branch of the superior laryngeal n. External branch of the superior laryngeal n. Superior laryngeal n. Cricothyroid m. Carotid sheath Internal jugular vein Common facial vein Superior thyroid vein Middle thyroid vein External carotid artery (6 branches)—N34

o Superior thyroid artery Superior laryngeal artery

o Lingual arteryo Facial arteryo Occipital arteryo Posterior auricular artery

Bifurcation of the common carotid artery Carotid sinus Carotid body Internal carotid artery Ascending pharyngeal artery Vagus nerve (X)

22


Melissa McDole

THYOID AND PARATHYROID GLANDSN74, 76

Cervical viscera contain the following structures:o Pharynxo Esophaguso Larynxo Tracheao Thyroid glando Parathyroid glands

Thyroid glando Located between C5 to T1o Touches near carotid sheath laterallyo Right and left lobes

Connected by isthmus (crosses anterior surface of tracheal rings 2 and 3)o Pyramidal lobe

Extends superiorly from isthmus Remnant of embryonic development

Superior thyroid arteryo Supplies thyroid glando Branch of external carotid artery

Superior and middle thyroid veinso Tributary to internal jugular vein

Right and left inferior thyroid veinso Descend into thorax on anterior surface of tracheao Drain into right and left brachiocephalic vein (right thyroid vein drains into right brachiocephalic vein and visa versa)

Thyroidea ima artery (lowest)o Rare to find 2-12% found in populationo If present, enters thyroid gland inferiorly near midline

Recurrent laryngeal nerve

23


Melissa McDole

Parathyroid glandso Regulate calcium metabolism

ROOT OF THE NECK

N33

Root (base) or the necko Junction between the thorax and necko Superior to the superior thoracic aperture

Omohyoid muscleo Inferior and superior belly are joined by an intermediate tendon

External jugular veino Only tributary of the subclavian vein

Subclavian vein Internal jugular vein Brachiocephalic vein Subclavian artery—N33

o Branch of the brachiocephalic trunko Left subclavian artery is a branch of the aortic trunko Has 3 parts—reference point—anterior scalene muscleo First part: from its origin to the medial border of the anterior scalene m.

has three branches: (1) Vertebral artery: goes superiorly between anterior scalene m. and longus colli m.; passes into

transverse foramen of vertebra C6 (2) internal thoracic artery: arises from anteroinferior surface of subclavian a. and passes inferiorly to

supply anterior thoracic wall (3) thyrocervical trunk: arises from anterosuperior surface of subclavian a.; has 3 branches

o (1) Transverse cervical a.: crosses root of neck superior to clavicle and deep to omohyoid m.; supplies trapezius m.

o (2) Suprascapular a.: passes laterally and posteriorly to suprascapular notch; passes superior to the transverse scapular ligament; supplies supraspinatus and infraspinatus m.

24


Melissa McDole

o (3) inferior thyroid a.: passes medially toward thyroid gland; passes posterior to the cervical sympathetic trunk

Ascending cervical a.: is a branch of the inferior thyroid arteryo Second part: posterior to the anterior scalene m.: has one branch

Costocervical trunk: arises from the posterior surface of the subclavian a.; divides into 2 branches (1) Deep cervical a. (2) supreme intercostal a.: gives rise to posterior intercostal arteries 1 and 2

o Third part: between the lateral border of the anterior scalene m. and the lateral border of the first rib; has one branch Dorsal scapular a.

Passes between superior and middle trunks of brachial plexus; supplies muscles in the scapula; may arise from the transverse cervical artery instead of the subclavian a.

Thoracic duct: ascends from thorax into the neck; posterior to esophagus; joins the left subclavian vein and the left internal jugular v.—N206

Right lymphatic ducto Drains into the junction of the right subclavian and right internal jugular veins

Vagus nerve:--N32o In carotid sheath; goes into thorax; passes posterior to the root of the lung

Right laryngeal n.: given off by the right vagus n. Left laryngeal n.: given off by the left vagus n. Phrenic n.: crosses anteriorly to the anterior scalene m. Sympathetic trunk: (cervical portion; continuous with the thoracic sympathetic trunk) Muscles of the floor of the posterior cervical triangle:--N33

o Splenius capitis m.o Levator scapulae m.o Anterior, middle and posterior scalene mm.

Anterior and middle scalene mm. attach to the first rib Interscalene triangle: formed by the first rib and adjacent borders of the anterior and middle scalene mm.

o Components of triangle: Subclavian artery Roots of brachial plexus

At level of interscalene triangle Includes supraclavicular portion: roots, trunks, divisions

Subclavian vein Transverse cervical a.

25


Melissa McDole

Suprascapular s. Phrenic n.

HEAD

Skull

N2

Anterior view

Frontal boneo Glabellao Superciliary notcho Supraorbital notch (foramen)

Nasal bone Zygomatic bone Maxilla

o Frontal processo Infraorbital forameno Anterior nasal spineo Alveolar process

Nasal septum Mandible

o Alveolar processo Mental forameno Mental protuberance

Nasiono Junction between the frontal and nasal bones

Orbital margino Formed by 3 bones (frontal, maxillary, an zygomatic)

Anterior nasal aperture

26


Melissa McDole

o Bounded by nasal bones and maxillae

Lateral view of Skull—N4

Parietal boneo Superior temporal lineo Inferior temporal line

Frontal bone Sphenoid bone

o Greater wing Zygomatic bone

o Frontal processo Temporal process

Temporal boneo Squamous parto External acoustic meatuso Mastoid processo Zygomatic process

Occipital boneo External occipital protuberance

Sutureso Lambdoido Squamosalo Coronal

Pteriono Junction of the frontal bone, parietal bone, greater wing of sphenoid bone, and squamous part of temporal bone

Mandible—N15o Ramus

Cornoid process Mandibular notch Condylar process

Head (condyle) Neck

27


Melissa McDole

Angle Body Mental foramen Inferior border

Superior view of the skull—N7

Calvariao Skull cap formed by parts of the frontal, parietal, and occipital bones

Frontal (metopic) suture: between the ossification centers of the frontal bone Coronal suture: between frontal bone and two parietal bones Sagittal suture: between two parietal bones Bregma: point were sagittal and coronal sutures meet Lambdoid suture: between occipital bone and 2 parietal bones Lambda: point where sagittal and lambdoid sutures meet

FACE

Surface Anatomy

Vertex Supraorbital margin Nasal bones Alveolar process of maxilla Mental protuberance of the mandible Zygomatic arch Zygomatic bone Angle of the mandible

**The skin and face receives sensory innervation from three divisions/branches of trigeminal nerve (V); two cervical spinal nerves also provide sensory innervation

Ophthalmic division (V1): skin of the forehead, upper eyelids, and nose Maxillary division (V2): skin of lower eyelid, cheek, and upper lip Mandibular division (V3): skin of the lower face and part of the side of the head

28


Melissa McDole

Cervical spinal nerves 2 & 3: skin of the back of the head and area around the ear

**All muscles of facial expression receive motor innervation from facial nerve (VII)—N24

Superficial fascia of the face—N23

Platysma m. Masseter m.

o Used for mastication Parotid duct

o Drains into oral cavity

Facial nerve—N25

Parotid gland Facial nerve branches

o Temporal branch: crosses zygomatic archo Zygomatic branch: crosses zygomatic boneo Buccal branches: crosses the superficial surface of masseter m.o Mandibular branch: parallels the inferior margin of the mandibleo Cervical branch: crosses the angle of the mandible to enter the neck

Parotid plexus Masseter m. Buccal fat pad Buccinator m.

o Parotid duct pierces buccinator m.o Buccal branch of facial n.: crosses superficial surface of masseter m.; gives motor innervation to buccinator m.o Buccal n.: branch of mandibular division of trigeminal n. (V3)—from deep to masseter m.; gives sensory innervation to mucosa

and skin of cheek; provides no motor innervation

Facial artery and vein—N23

Facial artery

29


Melissa McDole

Inferior labial and superior labial aa. Angular a. Facial vein

Muscles around the orbital opening—N26

Orbicularis oculi m.o Innervated by the temporal and zygomatic branches of the facial n.

Palpebral fissure (opening of eyelid)o Orbital part: surrounds orbital margin and closes eyelids tighto Palpebral part: thinner portion; within eyelids; blinks the eyelid

Muscles around the oral opening—N26

Levator labii superioris m.o Superior attachment: maxillao Inferior attachment: upper lipo Action: elevates upper lipo Innervation: zygomatic, buccal, mandibular branches of facial nn.

Zygomaticus major m.o Lateral attachment: zygomatic bone o Medial attachment: angle of moutho Action: draws angle of mouth superiorly and posteriorlyo Innervation: zygomatic, buccal, mandibular branches of facial nn.

Orbicularis oris m.o Medial attachment: maxilla, mandible, and skin in median planeo Lateral attachment: angle of the moutho Is the sphincter of the moutho Innervation: zygomatic, buccal, mandibular branches of facial nn.

Buccinator m.o proximal attachment: pterygomandibular raphe and lateral surfaces of alveolar processes of maxilla and mandibleo distal attachment: angle of moutho action: compresses cheek against molar teeth, keeping food on occlusal surface during chewing

30


Melissa McDole

o Innervation: zygomatic, buccal, mandibular branches of facial nn. Depressor anguli oris m.

o Inferior attachment: mandible o Superior attachment: angle of moutho Action: depresses corner of moutho Innervation: zygomatic, buccal, mandibular branches of facial nn.

Sensory nerves of the face—N24

Sensory Nerveso Supraorbital n.: branch of ophthalmic division of the trigeminal n. (V1) that passes through the supraorbital notch (foramen)o Infraorbital n.: branch of maxillary division of trigeminal n. (V2) that passes through infraorbital foramen

Innervates inferior eyelid, side of nose, upper lipo Mental n.: branch of mandibular division of trigeminal n. (V3) that passes through the mental foramen

Innervates lower lip and chin Mental foramen Mental n., artery, and vein

o Come from mental foramen

Skeleton of the parotid region

Temporal bone –N4o Mandibular fossao External acoustic meatuso Styloid processo Stylomastoid forameno Mastoid process

Mandible-N15o Heado Necko Angleo Ramus

Boundaries of parotid bed—N3431


Melissa McDole

o Posterior: mastoid process and posterior belly of digastric m.o Anterior: medial pterygoid m., ramus of mandible, and masseter m.o Medial: styloid process and associated m. (stylopharyngeus, styloglossus, stylohyoid)o Posterosuperior: floor of external acoustic meatus

N25

Parotid sheatho Contains parotid gland

Facial nerve Stylomastoid foramen Parotid duct Auriculotemporal n.

o Branch of mandibular division of trigeminal n. (V3)o Innervates skin of anterior side of ear and temporal regiono Delivers postganglionic parasympathetic nerve fibers from otic ganglion

External jugular vein Maxillary vein Superficial temporal vein Superficial temporal vein External carotid artery—N34

o Maxillary arteryo Superficial temporal artery

Superficial temporal arteryo Supplies lateral part of scalp

Posterior belly of digastric m. Stylohyoid m.

TEMPORAL REGION

**Temporal region has two fossae Temporal fossa: superior to zygomatic arch; contains temporalis m.

32


Melissa McDole

Infratemporal fossa: inferior to zygomatic arch; deep to ramus of mandible; contains medial and lateral pterygoid mm, branches of mandibular division of trigeminal n. (V3), and maxillary vessels and their branches

Skeleton of temporal region—N4

Superior and inferior temporal lines: on parietal bone Temporal fossa: formed by parts of 4 cranial bones: parietal, frontal, squamous part of temporal, and greater wing of sphenoid Zygomatic arch: formed by zygomatic process of zygomatic bone Mandibular fossa and articular tubercle: on temporal bone Lateral view of mandible—N15

o Heado Necko Mandibular notcho Coronoid processo Ramus angle

Internal surface of mandibleo Lingula: attaches sphenomandibular ligamento Mandibular foramen: for inferior alveolar nn and vesselso Mylohyoid groove: for mylohyoid n. and vessels

Lateral view of infratemporal fossa—N4o Pterygomaxillary fissure

Between lateral plate of pterygoid process and maxillao Inferior orbital fissure

Between greater wing of sphenoid bone and maxillao Infratemporal surface of maxillao Greater wing of sphenoid bone

Contains the foramen ovale and the foramen spinosumo Lateral plate of pterygoid process of sphenoid boneo Pterygopalatine fossa: at superior end of pterygomaxillary fissureo Sphenopalatine foramen: opening in medial wall of pterygopalatine fossa that enters nasal cavity

Boundaries of infratemporal fossao Lateral: ramus of mandible

33


Melissa McDole

o Anterior: infratemporal surface of maxillao Medial: lateral plate of pterygoid processo Roof: greater wing of sphenoid bone

Masseter muscle and removal of the zygomatic arch

Masseter m.o Superior attachment: inferior border of zygomatic archo Inferior attachment: lateral surface of ramus of mandibleo Elevates mandible (closes jaw) and protrudes mandibleo Innervation: masseteric branch of mandibular division of trigeminal nerve (V3)—N54

Temporal region—N54

Boundaries of temporal fossao Superior and posterior: superior temporal lineo Anterior: frontal and zygomatic boneso Inferior: zygomatic arch superficially and infratemporal crest of sphenoid bone deeplyo Superficial: temporal fascia

Temporalis (temporal) m.o Attached to deep surface of temporal fasciao Inferior attachment: coronoid process of mandibleo Muscle fibers of anterior portion are vertical (elevate mandible)o Muscle fibers of posterior portion are horizontal (retract mandible)

Infratemporal fossa—N40

Boundaries of intratemporal fossao Superior: zygomatic arch superficially, infratemporal crest of sphenoid bone deeplyo Anterior: alveolar border of maxillao Lateral: ramus of mandibleo Medial: lateral plate of pterygoid process

Inferior alveolar nerve and vessels34


Melissa McDole

o Nerve innervates mandibular teeth Mandibular canal Mental nerve

o Branch of inferior alveolar n.o Innervates chin and lower lip

lingual n.o innervates mucosa of anterior 2/3 of tongue and floor of oral cavity

maxillary artery—N40 has 15 branches—know 5 of 15 for nowo middle meningeal artery: passes through foramen spinosum; enters middle cranial fossa; supplies dura matero deep temporal arteries (anterior and posterior)o masseteric arteryo inferior alveolar a.o buccal a.: supply cheek

lateral pterygoid m.—N55o has 2 headso anterior attachment of superior head: infratemporal surface of greater wing of sphenoid boneo anterior attachment of inferior head: lateral surface of lateral plate of pterygoid processo posterior attachment: articular disc in capsule of temporomandibular joint and neck of mandibleo action: depress mandible (opens jaw)

medial pterygoid m.o proximal attach: maxilla and medial surface of lateral plate of pterygoid processo distal attach: inner surface of ramus of mandibleo elevates mandible (closes jaw)

inferior alveolar n. lingual n. chorda tympani pterygopalatine fossa posterior superior alveolar a.

Temporomandibular joint—N16

temporomandibular joint temporomandibular ligament

35


Melissa McDole

superior synovial cavity inferior synovial cavity

CRANIAL FOSSAE

Skeleton of the cranial base—N9

Skull findo Ethmoid bone

Crista galli Cribriform plate

o Frontal bone Orbital part

o Sphenoid bone Lesser wing Sphenoidal crest Superior orbital fissure Anterior clinoid process Sphenoidal limbus Optic canal Hypophyseal fossa Posterior clinoid process Greater wing

Foramen rotundum Foramen ovale Foramen spinosum

o Temporal bone Squamous part Petrous part

Superior border (petrous ridge) Groove for sigmoid sinus Internal acoustic meatus

o Occipital bone Clivus

36


Melissa McDole

Jugular foramen Hypoglossal canal Groove for the sigmoid sinus Foramen magnum Groove for the transverse sinus Internal occipital protuberance

Foramen lacerum Anterior cranial fossa Middle cranial fossa Posterior cranial fossa

Anterior Crania fossa—N104

Anterior cranial fossa: 3 boneso Sphenoid boneo Ethmoid boneo Orbital part of frontal bone

Olfactory nerve (I)

Middle cranial fossa—N104

Middle cranial fossa: containso temporal lobe of brain

middle meningeal artery foramen spinosum superior petrosal sinus optic nerve (II): passes through optic canal to enter orbit optic canal superior orbital fissure: where 4 cranial nerves pass through

o oculomotor nerve (III): o trochlear nerve (IV)o ophthalmic division of the trigeminal n. (V1)o abducent nerve (VI)

trigeminal nerve (V)37


Melissa McDole

o largest cranial n. trigeminal ganglion maxillary division of trigeminal nerve (V2) foramen rotundum mandibular division of trigeminal verve (V3) internal carotid artery carotid canal hypophyseal fossa sellar diaphragm (diaphragm sellae) anterior and posterior intercavernous sinuses—N104

Posterior cranial fossa—N104

facial nerve (VII) vestibulocochlear nerve (VIII) glossopharyngeal nerve (IX) vagus nerve (X) accessory nerve (XI) cervical root of accessory nerve hypoglossal nerve (XII) hypoglossal canal

pp. 220- 221—Forgot to do **

DURAL INFOLDINGS AND DURAL VENOUS SINUS

**The dural venous sinus collect venous drainage from brain and conduct it out of cranial cavity

Dural Infoldings—N103

cerebral falx (falx cerebri)o lies between the cerebral hemisphereso attached to crista galli, calvaria on both sides of groove for superior sagittal sinus, and cerebellar tentorium

cerebellar tentorium

38


Melissa McDole

o attached to clinoid process of sphenoid bone, superior border of petrous portion of temporal bone, and occipital bone on both sides of groove for transverse sinus

tentorial notcho opening in cerebellar tentorium o brainstem passes through ito between cerebral hemispheres and cerebellum

cerebellar falxo inferior to cerebellar tentorium in the midlineo attaches to occipital boneo between cerebellar hemispheres

Dural venous Sinuses—N104

superior sagittal sinuso begins near crista gallio ends near cerebellar tentoriumo drains into confluence of sinuses

inferior sagittal sinuso inferior margin of cerebral falxo from cerebellar tentorium and drains into straight sinuso smaller diameter than superior sagittal sinus

straight sinuso near line of junction of cerebral falx and cerebellar tentoriumo receives inferior sagittal sinus and great cerebral veino drains into confluence of sinus

transverse sinuseso carries venous blood from confluence of sinuses to sigmoid sinus

sigmoid sinuso begins at lateral end of transverse sinus and ends at jugular foramen

internal jugular veino formed by external surface of jugular foramen

From Atlas—N104o Sphenoparietal sinus

39


Melissa McDole

o Cavernous sinuso Superior petrosal sinuso Inferior petrosal sinuso Basilar plexus

PHARYNX

Pharyngeal wall—has 3 layers (from outside inward)o Buccopharyngeal fascia: adventia of pharynx that is continuous with connective tissue that covers buccinator m.o Muscular layer: has outer circular part and inner longitudinal parto Mucous membrane:

Muscles of the Pharyngeal Wall—N67

Inferior pharyngeal constrictor muscleo Anterior attachment: oblique line of thyroid cartilage and lateral surface of cricoid cartilageo Posterior attachment: is the pharyngeal raphe

Middle pharyngeal constrictor m.o Anterior attachment: greater horn of hyoid bone and inferior portion of stylohyoid ligament

40


Melissa McDole

o Posterior attachment: pharyngeal rapheo Inferior part is deep to inferior pharyngeal constrictor m.

Superior pharyngeal constrictor m.o Superior to middle pharyngeal constrictor m.o Anterior attachment: pterygomandibular rapheo Posterior attachment: pharyngeal raphe and pharyngeal tubercle of occipital boneo Inferior part is deep to middle pharyngeal constrictor m.

Pharyngobasilar fasciao Dense connective tissue membrane that attaches the superior edge of superior constrictor to base of the skull

Stylopharyngeus m.o Superior attachment: medial surface of styloid processo Inferior attachment: inner aspect of pharyngeal wall o Enters pharyngeal wall by passing between superior and middle pharyngeal constrictor m.o Innervated by glossopharyngeal n. (IX)—N71

Pharyngeal plexus of nerveso On posterolateral aspect of pharynxo Receives branches from

Glossopharyngeal n.—sensory to pharyngeal mucosa Vagus n.—motor to pharyngeal constrictor mm. Superior cervical sympathetic ganglion—vasomotor

Contents of carotid sheath Glossopharyngeal n. (IX)

o Passes between internal & external carotid aa as it approaches stylopharyngeus m. Vagus n. (X)

o Posterior to internal carotid a. and internal jugular vein in carotid sheatho Superior laryngeal n.o Pharyngeal branch of vagus n.

Hypoglossal n. (XII)o In submandibular triangleo Passes lateral to internal and external carotid aa.

Superior cervical sympathetic ganglion Sympathetic trunk

41


Melissa McDole

Bisection of the head On skull find

o Nasal bone, frontal boneo Cribriform plateo Body of sphenoid boneo Hard plateo Basilar part of occipital bone—foramen magnum

Internal Aspect of phaynx—N63

Parts of pharynx

Nasopharynxo Posterior to nose and superior to soft palateo Posterior nasal aperture (chonona)

Transition between nasal cavity and nasopharynx Two choanae are separated by nasal septum—N64 Opening of the pharyngotympanic tube (auditory tube, eustachian tube)

On lateral wall of nasopharynxo Torus tubaris

Cartilage of pharyngotympanic tube covered by mucosao Salpingopharyngeal fold

Extends from torus tubariuso Pharyngeal recess

Superior to torus tubariso Pharyngeal tonsil (adenoid)

In mucous membrane above pharyngeal recess**Adenoids: enlarged pharyngeal tonsils; obstruct flow of air from nose through nasopharynx, making mouth breathing necessary—Clinical correlation

Oropharynxo Posterior to oral cavityo Palatoglossal fold: dividing line separating oral cavity and oropharynxo Fauces: transitional region between right and left palatoglossal folds

42


Melissa McDole

o Palatopharyngeal fold Posterior to palatoglossal fold

o Palatine tonsil: between palatoglossal tongue and palatopharyngeal fold Laryngopharynx—N66

o Posterior to larynxo Extends from hyoid bone to lower border of cricoid cartilageo Epiglottis—midline of laryngopharynxo Inlet (aditus) of the larynx—midline of laryngopharynxo Piriform recess: lateral to midline

Borders: Medial: larynx Lateral: thyroid cartilage Posterior: inferior pharyngeal constrictor m.

NOSE AND NASAL CAVITY

Skeleton of nasal cavity—N2

Nasal bone Lacrimal bone Maxilla

o Frontal processo Anterior nasal apertureo Anterior nasal spine

Nasal septum—bony part Middle nasal concha—part of ethmoid bone Inferior nasal concha N38 Ethmoid bone

o Cribriform plateo Superior nasal conchao Middle nasal concha

Lacrimal bone

43


Melissa McDole

Inferior nasal concha Maxilla

o Palatine processo Incisive canal

Sphenoid boneo Opening of sphenoidal sinuso Sphenoidal sinuso Bodyo Medial plate of pterygoid processo Lateral plate of pterygoid process

Palatine boneo Perpendicular plateo Horizontal plate

Sphenopalatine foramen

External nose—N36

Lateral nasal cartilage—gives shape to bridge of nose Septal cartilage—separates right and left nasal cavities and forms anterior part of nasal septum Ala cartilage—lateral to septal cartilage; gives shape to nostril

Nasal Cavity

Boundaries of nasal cavity:o Roof: bound by nasal septum and 3 bones: nasal bone, cribriform plate of ethmoid bone, and sphenoid boneo Floor: palatine process of maxilla and horizontal plate of palatine boneo Medial wall: nasal septumo Lateral wall: maxilla, lacrimal bone, ethmoid bone, inferior nasal concha, perpendicular plate of palatine bone

Nasal Septum—N39

Nasal septum Perpendicular plate of ethmoid bone

44


Melissa McDole

Vomer Septal cartilage In mucosa of nasal septum

o Nasopalatine nerve Pass via sphenopalatine foramen to incisive canal Innervate nasal septum Oral mucosa of hard palate

o Sphenopalatine a. Pass via sphenopalatine foramen to incisive canal Innervate nasal septum Oral mucosa of hard palate

o Olfactory area Mucosa near cribriform plate Extends down lateral wall of nasal cavity

Lateral wall of nasal cavity—N37

Lateral wall of nasal cavityo Sphenoethmoidal recess

Above superior concha Opening of sphenoidal sinus

o Superior conchao Superior meatus

Inferior to superior concha Opening of the posterior ethmoidal cells

o Middle concha Semilunar hiatus (hiatus semilunaris)

Ethmoidal bulla (bulla ethmoidalis)o Opening of middle ethmoidal cells

Opening of frontal sinus Opening of anterior ethmoidal cells Opening of maxillary sinus

o Middle meatus Inferior to middle concha

45


Melissa McDole

o Inferior concha Nasolacrimal duct

o Inferior meatus Inferior to inferior concha

o Vestibule Superior to nostril and anterior to inferior meatus

o Atrium Superior to vestibule and anterior to middle meatus

Sphenoidal sinus—N48o Inferior to hypophyseal fossa and pituitary glando Clinical correlation: can perform surgeries to pituitary gland via the sphenoid sinus

Ethmoidal cellso Between nasal cavity and orbit

Maxillary sinuso 3 sided pyramido Can hold up to 15 mL

Roof of maxillary sinus is floor of orbit and infraorbital n. innervates mucosa of sinus Floor of maxillary sinus is alveolar process of maxilla Opening of maxillary sinus is near roof Roots of maxillary teeth may project into maxillary sinus

o Clinical correlation Maxillary cannot drain with head upright, so if infection occurs, an opening can be created surgically via inferior meatus

near floor of maxillary sinus to promote drainage Roots of teeth project into maxillary sinus and are covered by mucosa; extraction of teeth (maxillary molar or pre molar

teeth) results in mucosa superior to root being torn and fistula may form between oral cavity and maxillary sinus

HARD PALATE AND SOFT PALATE

Hard palate—forms anterior 2/3 Soft palate—forms posterior 1/3

Skeleton of Palate—N8Skull—Inferior view

46


Melissa McDole

Maxillao Incisive forameno Alveolar processo Palatine process

Palatine boneo Horizontal plateo Greater palatine forameno Lesser palatine forameno Posterior nasal spine

Sphenoid boneo Halamus of medial plate of pterygoid processo Medial plate of pterygoid processo Lateral plate of pterygoid processo Scaphoid fossao Pterygoid canal

Infratemporal fossa—N4 Inferior orbital fissure Sphenopalatine foramen Pterygopalatine fossa Pterygomaxillary fissure

Soft palate—N64

Mucosal features of inner pharynxo Torus tubariuso Opening of pharyngotympanic tubeo Salpingopalatine foldo Torus Levatoriuso Salpingopharyngeal foldo Palatoglossal foldo Palatopharyngeal fold

Soft palateo Thickness due to palatine glands

47


Melissa McDole

o Strength due to palatine aponeurosiso Mobility due to muscles that attach to posterior 2/3

Palatopharyngeuso Superior attachment: hard palate and palatine aponeurosiso Inferior attachment: thyroid cartilage and pharyngeal wallo Function: elevate larynx during swallowingo Inner longitudinal muscle layer of pharynx

Salpingopharyngeus m.o Superior attachment: cartilage of pharyngotympanic tubeo Distal attachment: thyroid cartilage and pharyngeal wallo Function: elevate larynx during swallowingo Blends with palatopharyngeus m.o Inner longitudinal muscle layer of pharynx

Stylopharyngeus muscleo Enter pharynx between superior and middle pharyngeal constrictor mmo Lies anterior and parallel to the palatopharyngeus and salpingopharyngeus mm; all three blend near inferior ends

Pharyngobasilar fasciao encloses gap between the superior border of the superior pharyngeal constrictor m. and base of skull; following structures pass through

gap: pharyngotympanic tube (auditory tube)

connects nasopharynx to tympanic cavity part closest to pharynx is cartilaginous part closest to middle ear passes through temporal bone

levator veli palatine m. torus levatorius

o levator veli palatini m. superior attachment: cartilage of pharyngotympanic tube and adjacent part of temporal bone distal attachment: palatine aponeurosis function: elevate soft palate

medial plate of the pterygoid processo tensor veli palatini m.

lies lateral to medial plate superior attachment: scaphoid fossa

48


Melissa McDole

belly of muscle is between medial and lateral plates of pterygoid process tendon runs medially around hamulus of medial pterygoid process and forms palatine aponeurosis function: tenses soft palate

The five muscles of soft palate and pharynx are innervated by vagus nerve (X) vis pharyngeal plexus **o Salpingopharyngeus m.o Levator veli palatinio Palatoglossus m.o Palatopharyngeus m.o Musculus uvulae

The tensor veli palatini m. is innervated by mandibular n. CNV3 N52 Greater palatine n. and vessels

o Come from greater palatine foramen Nasopalatine n

o Supplies mucosa over the anterior part of hard palate Lesser palatine n.

o Posterior to greater palatine n.

Tonsillar bed—N64

Palatine tonsilo Located in tonsillar bed

Boundaries Anterior—palatoglossal fold Posterior—palatopharyngeal fold Lateral—superior pharyngeal constrictor m.

Crypts Palatoglossus m.

o Superior attachment: palatine aponeurosiso Inferior attachment: lateral side of tongueo Function: elevates tongue; depresses soft palate

Glossopharyngeal nerve (IX)o Passes between superior and middle pharyngeal constrictor mm to enter tonsillar bed

49


Melissa McDole

o Innervates mucosa of posterior 1/3 of tongue and posterior wall of pharynx

Sphenopalatine foramen and pterygopalatine fossa—N42

Sphenopalatine artery—N41o Posterior lateral nasal artery: lateral to nasal wallo Posterior septal branch: to nasal septum

Sphenopalatine foramen Greater palatine n.—greater palatine canal Lesser palatine n.—greater palatine canal Descending palatine artery—greater palatine canal

o One of the terminal branches of the maxillary arteryo Divides to give rise to the

Greater palatine a. Lesser palatine a.

Pterygopalatine gangliono Location for synapse of preganglionic axons of facial n. that course first to greater petrosal n. and then to pterygoid canalo Postganglionic fibers go with branches of maxillary division of trigeminal n.o Stimulates secretion from mucosa of nasal cavity, paranasal sinuses, nasopharynx, roof of mouth, and soft palate, lacrimal gland

Nerve of the pterygoid canalo Enters pterygopalatine fossa posteriorlyo Passes anterior toward pterygopalatine gangliono Has preganglionic parasympathetic axons from greater petrosal n. and postganglionic sympathetic axons from deep petrosal n.

Infratemporal fossa—N69o Maxillary a.—passes deeply toward pterygomaxillary fissure to give rise to:

Sphenopalatine a.—passes through pterygopalatine fossa and then through sphenopalatine foramen to enter nasal cavity Descending palatine a.—enters greater palatine canal Infraorbital a.—passes through inferior orbital fissure to enter infraorbital canal and emerge on face at infraorbital

forameno Maxillary division of trigeminal n.—courses from foramen rotundum to inferior orbital fissure; passes through pterygopalatine

fossa and gives off pterygopalatine branches that form greater and lesser palatine nerves

50


Melissa McDole

ORAL REGION

Oral regiono Oral vestibule: bounded externally by lips and cheeks and internally by teeth and gumso Oral cavity proper: area between alveolar arches and teeth; largest content of oral cavity proper is the tongue

Surface anatomy of the oral vestibule—N51

Maxillao Alveolar processo Anterior surface (above the alveolar process)o Infratemporal surface

Mandibleo Alveolar processo Coronoid process and the tendon of the temporalis m.

Masseter m.o Can be palpated when the teeth are clenched

Communication between the oral vestibule and the oral cavity propero Posterior to the third molar tooth

Frenulum Opening of the parotid duct

o Located lateral to the second maxillary molar tooth

Surface anatomy of the oral cavity proper

Borders of your oral cavity Lateral and anterior: teeth and gums Superior: the hard palate Inferior: mucosa covering tongue and sublingual area

51


Melissa McDole

Posterior: palatoglossal folds (right and left)

In your oral cavity Tongue

o Bodyo Apex

o Median sulcus Sublingual area

o Frenulum of the tongue (sublingual frenulum)o Sublingual fold (pica sublingualis)o Sublingual caruncleo Opening of the submandibular duct: on the sublingual caruncleo Deep lingual veins: on either side of frenulum of tongue

Tongue—N58

Tongueo Root—posterior 1/3o Body—anterior 2/3o Apexo Dorsum

Terminal sulcus (sulcus terminalis)—divides anterior 2/3 of tongue from posterior 1/3 Lingual tonsil—posterior to terminal sulcus Foramen cecum—in midline at point o terminal sulcus Lingual papillae—four types: vallate, filiform, fungiform, and foliate

Body of the tongueo Lies horizontal in the oral cavity

Root of the tongueo Is more verticalo Lower part of anterior boundary of the oropharynxo Structures include:

Median glossoepiglottic fold: midline fold of mucosa between the dorsum of the tongue and the epiglottis

52


Melissa McDole

Lateral glossoepiglottic fold: between the dorsum of the tongue and the lateral border of the epiglottis Epiglottic vallecula: depression between median and lateral glossoepiglottic folds

Bisection of the mandible and floor of the mouth

Mylohyoid mm. Geniohyoid m.

o Deep to mylohyoido Anterior attachment: inferior mental spine of the mandibleo Posterior attachment: body of hyoid boneo Function: pulls hyoid bone anteriorly

Sublingual region—N51

Genioglossus m.o Anterior attachment: superior mental spine of the mandibleo Posterior attachment: hyoid bone and the tongueo Function: protrudes the tongueo Innervate: hypoglossal nerve (XII)o Clinical correlation

Lack of function of the genioglossus m is a result of hypoglossal n. dysfunction; the tongue cannot protrude in the midline; the functional side of the tongue protrudes normally and the side with the dysfunctional nerve protrudes less or not at all; when testing for hypoglossal n. lesions, the protruded tongue deviates toward the side of the nerve lesion

Frenulum of the tongue Sublingual fold Sublingual caruncle Opening of the submandibular duct Sublingual gland

o Deep to mucosao Rests on mylohyoid m.o Has about 12 short ducts that drain along the summit of the sublingual fold

Submandibular ducto Opens at the sublingual caruncle

53


Melissa McDole

Deep part of the submandibular glando On deep side of mylohyoid m.

Lingual n.o Passes lateral, inferior, and medial to the submandibular ducto Has several branches that supply the mucosa of the anterior 2/3 of the tongue with general sensation and taste fibers—N61

Submandibular gangliono Near the third mandibular molar tootho Below the lingual n.

Hypoglossal n. (XII)o Passes between the submandibular gland and the hypoglossal m.o Both the hypoglossal n. and the lingual n. pass between the hypoglossus m and the mylohyoid m. to enter the sublingual regiono Hypoglossal n. passes inferior to the lingual n.

Hypoglossus m.o Deep to the mylohyoido Inferior attachment: body and greater horn of the hyoid boneo Superior attachment: lateral side of the tongueo Function: depresses and retracts tongue

Styloglossus m.—N59o Proximal attachment: styloid process o Distal attachment: lateral side of the tongueo Function: draws tongue superiorly

Intrinsic mm of the tongue—N60o Verticalo Transverseo Superior longitudinalo Inferior longitudinal groups of fibers

Lingual artery—from external carotid arteryo Passes medial to the hypoglossal m.—name becomes deep lingual artery

The intrinsic mm of the tongue and three extrinsic mm of the tongue (styloglossus, genioglossus, and hypoglossus) are innervated by the hypoglossal n. (XII)

54

myweb.fsu.edumyweb.fsu.edu/ls10f/Unit 2 disscetor bold words.doc · Web viewTHE THORAX Week #1 Day...

Documents

Transcript of myweb.fsu.edumyweb.fsu.edu/ls10f/Unit 2 disscetor bold words.doc · Web viewTHE THORAX Week #1 Day...