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Review of Structures of the Head and Neck
Presented by:Dr. Joaquin masoud C. shaee
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Major features of the skull Mastoid process
Styloid process External auditory/acoustic meatus(ear opening)
Ear drum Hyoid bone Epiglottis Thryroid cartilage Cricoid cartilage
Tracheal rings
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Major features of the skull Zygomatic arch "
Ethmoid " Orbit "
Nasal aperture "
(choanae inside) "
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Muscles of Face
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You are responsible for muscles described in class Origin Insertion Action
Nerve - innervation (if given) Be able to recognize muscles in all diagrams of text
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The organization of the muscles of facial expression differs from that of muscles in most other regions of the body
There is no deep membranous fascia beneath the skin Instead, many small slips of muscle attached to the facial skeleton Insert directly into the skin
Facial muscles can cause movement of the facial skin that reflects emotions They are grouped mainly around the orifices of the face Dilators of the facial orifices and that the function of facial expression has
developed secondarily. Embryologically, they are derived from the mesenchyme of the second
branchial arch Innervated by the facial nerve Topographically and functionally the muscles of facial expression may be
subdivided into epicranial, circumorbital and palpebral, nasal, andbuccolabial groups
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Epicranius: occipitofrontalis
Circumorbital and palpebral group: orbicularis oculi, corrugatorsupercilii and levator palpebrae superioris
Nasal: comprises procerus, nasalis and depressor septi Buccolabial group of Muscles
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Epicranius consists of occipitofrontalis It consist of four thin, muscular quadrilateral parts two occipital and two frontal, connected by the epicranial aponeurosis Occipital part O: lateral two-thirds of the highest nuchal line of the occipital bone
and part of the mastoid part of the temporal bone I: Epicranial aponeurosis at coronal suture
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Each frontal part (frontalis) is adherent to the superficial fascia O: fibres blend with those of adjacent muscles - procerus, corrugator
supercilii and orbicularis oculi I : epicranial aponeurosis in front of the coronal suture
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Muscles of the Face
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The epicranial aponeurosis covers the upper part of the cranium and, with the epicranial muscle It forms a continuous bromuscular sheet extending from the occiput to
the eyebrows
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The circumorbital and palpebral group of muscles are orbicularisoculi, corrugator supercilii and levator palpebrae superioris
Orbicularis oculi is a broad, flat, elliptical muscle Surrounds the circumference of the orbit and spreads into the
regions of the eyelids, anterior temporal region, infraorbital cheekand superciliary region
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It has orbital, palpebral and lacrimal O: orbital part arises from the nasal component of the frontal bone, the fr
process of the maxilla, lacrimal crest andlacrimal bone I: upper orbital bres blend with the frontal part of occipitofrontalis and
corrugator supercilii. Many of them are inserted into the skin and subcutaneous tissue of the
eyebrow, constituting depressor supercili
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Orbicularis oculi
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Orbicularis oculi is supplied by temporal and zygomatic branches of the facinerve
Action: sphincter muscle of the eyelids and plays an important role in faciexpression and various ocular reexes
The orbital portion is usually activated under voluntary control
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Action: cooperates with orbicularis oculi, drawing the eyebrowsmedially and downwards to shield the eyes in bright sunlight
It is also involved in frowning.
The combined action of the two muscles produces mainly vertical wrinkles on the supranasal strip of the forehead
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The nasal muscle group comprises procerus, nasalis and depressor septi Procerus O: arises from a fascial aponeurosis covering the lower part of the nasal
bone and the upper part of the lateralnasal cartilage. I: into the skin over the lower part of the forehead between the eyebrows
Innervation: supplied by temporal and lower zygomatic branches from thefacial nerve
Actions: draws down the medial angle of the eyebrow and producestransverse wrinkles over the bridge of the nose.
It is active in frowning and 'concentration',
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Nasalis: divided in two parts Compressor Naris and Dilator Naris Compressor Naris O: Maxilla lateral to nasal notch I: at the bridge of nose through aponeurosis Action: Compress nasal aperture Dilator Naris O: Maxilla medial and below copressor I: cartilagnous ala nasi
Action: widening of ant. Nasal aperture Innervation: Buccal branch of facial N
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BUCCOLABIAL GROUP OF MUSCLES: include elevators,retractors and evertors of the upper lip
levator labii superioris alaeque nasi, levator labii superioris zygomaticus major and minor, levator anguli oris and risorius)
Depressors, retractors and evertors of the lower lip (depressor labiiinferioris, depressor anguli oris, and mentalis) Compound sphincter (orbicularis oris, incisivus superior andinferior), buccinator
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Levator labii superioris alaequae nasi O: Fronatal process of maxilla I: By two slips medial and lateral Medial slip inserted in great alar cartilage Lateral slip inserted in lateral part of upper lip with levator labi superioris a
orbicularis oris Innervation: zygomatic and buccal branches of the facial nerve Action The lateral slip raises and everts the upper lip The medial slip dilates the nostril
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Levator labii superioris O: from infraorbital margin I: upper lip between levator labi aleque nasi and zygomaticus minor Innervation: zygomatic and buccal branches of the facial N Actions: Levator labii superioris elevates and everts the upper lip
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Muscles of facial expression Zygomaticus
O: zygomatic bone
I: corners of mouth Action: smiling Nerve: facial / CN VII Buccal and zygomatic
M a j o r a n d M i n o r
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Mentalis O: Incisive fossa of mandible I: Skin of chin
Innervation : the mandibular branch of the facial nerve Actions raises the lower lip, wrinkling the skin of the chin it helps in protruding and everting the lower lip in drinking andalso in expressing doubt
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Depressor labii inferioris O: oblique line of mandible I: blend with opposite side and orbucularis oris Innervation by the mandibular branch of the facial nerve
Actions Depressor labii inferioris draws the lower lip downwards It contributes to the expressions of irony, sorrow, melancholy and
doubt.
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Depressor anguli oris O: Mental tubercule and oblique line of mandible I: angle of mouth with orbicularis oris Innervation by the buccal and mandibular branches of the facial nerve
Actions Depressor anguli oris draws the angle of the mouth downwards and
laterally in opening the mouth and in expressing sadness
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Buccinator O: alveolar process of maxilla and mandible, anterior margin of
pterygomandibular raphe I: near modiolus at angle of mouth
Innervation : by the buccal branch of the facial nerve. Actions Buccinator compresses the cheek against the teeth and gums during
mastication, and assists the tongue in directing food between theteeth
When the cheeks have been distended with air, the buccinatorsexpel it between the lips, an activity important when playing windinstruments, accounting for the name of the muscle (Latin buccinator = trumpeter).
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Risorius O: Fascia of cheek I: underside of skin over modiolus
Innervation: supplied by buccal branches of the facial nerve Actions Risorius pulls the corner of the mouth laterally in numerous facial
activities, including grinning and laughing
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On each side of the face a number of muscles converge towards a focus just lateral to the buccal angle, where they interlace to form a dense,compact, mobile, bromuscular mass called the modiolus
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Human Anatomy, Frolich, Head/Neck I: Introductionthe Skull
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1. Frontal Sinus
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2. Maxillary Sinus3. Ethmoid Sinus4. Spenoid Sinus5. Sella Turcica6. Occipital Bone7. Mastoid Air Cells8. Floor of posterior fossa9. Anterior arch of C-110. Mandible11.Coronal Suture
10
9
1
2
3
4
5
6
7
8
11
LATERAL SINUS & SKULL
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1. Lat. & Med. ptyergoid
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3
2
4
6
plate2. Ethmoid Sinus3. Odontoid Process4. Sphenoid Sinus5. Foramen ovale6. Maxillary Sinus7. Mastoid air cells8. Ant arch of C-19. Margin of foramen
magnum10. Ext. auditory canal
79
1
5
8
10
BASE OF SKULL
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CT SKULL BASE
CAROTID CANAL
JUGULAR FORAMEN
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CT SKULL BASE
MANDIBULARCONDYLE
MASTOID AIR CELLS
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CT SKULL BASE
ZYGOMATIC ARCH
EXTERNALAUDITORY
CANAL
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CT SKULL BASE
CAROTID CANAL
MIDDLE EAR OSSICLES
MALLEUS
INCUS
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CT SKULL BASE
IACINTERNAL AUDITORY CANAL
CAROTID CANAL
OSSICLESMALLEUS
INCUS
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LATERALNECK1. Hard pallate2. Soft pallate3. Nasopharynx4. Oropharynx
12
3
4
AIRWAY
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1
2
3
4
AIRWAY1. Calcified tracheal
cartilage rings2. Hyoid bone3. Epiglottis4. Thyroid cartilage5. Cricoid cartilage
5
LATERAL VIEW OF NECK
SWALLOWINGSTUDY
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STUDY
1 2
3 4
Note hyoid bone moves anteriorly and superiorly with swallowing .
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5
2
3
6
4
ARTERIOGRAM
1. Internal CarotidArtery
2. Intracranial Carotid3. Maxillary Artery4. Occipital Artery5. External Carotid
Artery6. Common Carotid
Artery7. Facial Artery
17
CT SINUS
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1 1. Frontal Sinus
CT- SINUSAXIAL VIEW
Scans start superiorly and are shown going inferiorly
CT SINUS
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1. Ethmoid Sinus2. Sphenoid
Sinus3. Carotid canal
1
2
3
CT- SINUSAXIAL VIEW
CT- SINUS
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1. Maxillary Sinus
2. Med. & Lat.Pterygoid plate
3. Nasopharynx
4. Nasal septum
5. Inferior turbinate
1
23
4
5
CT- SINUSAXIAL VIEW
CT- SINUS
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1. Maxillary Sinus
2. Hard Palate
3. Mandible
4. Masseter muscle
3
2
1
3
4
4
AXIAL VIEW
CT- SINUS
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1. Fronto-nasalsuture
2. Frontal sinus3. Nasal bones
1
2
3
Coronal sections extending fromanterior to posterior
CT- SINUS
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1. Ethmoid sinus2. Inferior turbinate
3. Middle turbinate
1
2
3
CORONAL VIEW
CT- SINUS
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1. Maxillary
sinus2. Nasal
Septum
1
2
CT SINUSCORONAL VIEW
CT- SINUS
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1. Sphenoidsinus
2. Hard Palatte
1
2
CORONAL VIEW
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MASTOIDS
NASOPHARNYX
MAXILLA LT
EXTERNALAUDITORYMEATUS
MANDIBULARCONDYLE
SCAN LEVEL
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SCAN LEVEL
SUBCUTANEOUSFAT
SUBMANDIBULARGLAND
EPIGLOTTIS
STERNOCLEIOMASTOIDMUSCLE
LT
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SCAN LEVEL
THYROID CARTILAGE
CRICOIDCARTILAGE
JUGULARVEIN
COMMON CAROTIDARTERY
LT
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SCAN LEVEL
CLAVICLECLAVICLE
THYROIDGLAND
F A T
LT
TRACHEA ESOPHAGUS
l
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Cranial Nerves Special Sense Nerves
I,II,VIII Somatic Motor Nerves
EyeIII,IV,VI Tongue--XII
Rest of body nerves IX,X,XI
Face and jaws VII, V
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Head I: Skulla framework to hang on Overall organization of skull Base of the skullthe hard part
Developmental view Cranial nerves out (to targets )
Head II: Throat targets Head III: Special Sense targets Head IV: Cranial nerves in depth
Nerve targets in head
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Nerve targets in head SENSORYSpecial GeneralSmell skin Vision teethHearing eye
tongue
oral cavitynasal cavitymiddle earthroatmeninges
MOTORMuscles Glandseyes salivary
extrinsic sweatintrinsic lacrimal
jaws mucous
facial expressionlarynxtonguethroatear
Base of the skullcranial nerves out
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Base of the skull cranial nerves out Ethmoid (olfactory)
I. Olfactory Sphenoid (optic)
II. OpticIII. Oculomotor IV. Trochlear VI. Abducens
Temporal (otic)VII. Acoustic/Auditory/
Vestibulocochlear Face/Jaws
V. Trigeminal
VII. Facial Throat (rest of body)IX GlossopharyngealX. VagusXI. Spinal AccessoryXII. Hypoglosal
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Special Sense Nerves
Internal auditorymeatus (temporal)Inner ear VIII. Auditory
Optic canal(sphenoid)
RetinaII. Optic
Cribiform plate
(ethmoid)
Olfactory
epithelium
I. Olfactory
EXIT FROMCRANIAL CAVITY
TARGETNERVE
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Somatic Motor Nerves
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(eye muscles and tongue) EXIT CR. CAVITYTARGETNERVE
Hypoglossal canal(occipital)
Intrinsic, extrinsicmm. of tongue
XII. Hypoglossal
Sup.,med.,inf.rectus Inferior Oblique Levator palpebraesuperioris
III. Oculomotor (Also parasympatheticto ciliary mm, constrictor pupillae)
Lateral rectusVI. Abducens
Sup. Orbital fissure(sphenoid)
Superior oblique m.(with trochlea)
IV. Trochlear
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Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
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Rest of body nervesf f
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(all exit from jugular foramen)NERVE TARGET
X: Vagus Somatic motor to larynx/pharynx Parasympathetic to most of gut Taste to back posterior pharynx
XI: (Spinal)Accesory
Motor to traps,sternocleidomastoid
IX: Glosso-pharyngeal
Sensory to carotid body/sinus Taste to posterior tongue Sensory to ear opening/middle
ear Parotid salivary gland
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VII: Facial Nerve
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(exits cranial cavity with VIII--internal auditory meatus)
Facial muscles (ve branches fan out over face from stylomastoidforamen) Temporal Zygomatic Buccal Mandibular Cervical
chorda tympani (crosses interior ear drum to join V 3 ) Taste to anterior 2/3 of tongue Submandibular, sublingual salivary glands
Lacrimal glands
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V: Trigeminal (3 nerves in 1!)
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V: Trigeminal (3 nerves in 1!) V1. Ophthalmic
Exits with eye muscle group (superior orbital ssure, through orbit tosuperior orbital notch/foramina)
Sensory to forehead, nasal cavity V2. Maxillary
Exits foramen rotundum through wall of maxillary sinus to inferior orbiforamina)
Sensory to cheek, upper lip, teeth, nasal cavity V3. Mandibular
Exits foramen ovale to mandibular foramen to mental foramen
Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric Sensory to chin Sensory to tongue
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Cranial Nerve: Major Functions:I Olfactory smell
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II Optic vision
III Oculomotor eyelid and eyeball movement
IV Trochlear innervates superior obliqueturns eye downward and laterally
V Trigeminal chewingface & mouth touch & pain
VI Abducens turns eye laterally
VII Facial controls most facial expressionssecretion of tears & salivataste
VII Vestibulocochlear(auditory)
hearingequillibrium sensation
IX Glossopharyngeal tastesenses carotid blood pressure
X Vagus senses aortic blood pressureslows heart ratestimulates digestive organstaste
XI Spinal Accessory controls trapezius & sternocleidomastoidcontrols swallowing movements
XII Hypoglossal controls tongue movements
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When the tongue and face areaffected on the same side ashemiplegia the lesion must be abovethe XII and VII nucleus respectively
Important diagnostic rules
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Unilateral V, VII, and VIII Cerebellopontine angle lesion Unilateral III, IV, V and VI Cavernous sinus lesion Combined unilateral IX, X, and XI Jugular foramensyndrome
Combined bilateral X, XI, and XII LMN = bulbar palsy UMN = pseudobulbar palsy
Prominent involvement of eye muscle and facial weaknessesp when variable = myasthenia gravis
The most imp cause of brain disease in young age ismultiple sclerosis and in older age is vascular dis
Important diagnostic rules
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I. Olfactory The olfactory nerve has only a specialsensory component.
Special sensory (special afferent)-Functions in the special sense of smell orolfaction.
The olfactory system consists of theolfactory epithelium, bulbs and tractsalong with olfactory areas of the braincollectively known as the rhinencephalon.
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Functions of the Optic Nerve General Eyelids, orbital globe
Pupils Light reex, accomodation reex Acuity due to ocular, optic, or retinal abn. If reduced acuitycorrectable by pinhole then ocular
Fields Fundi
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v The right half of the retina receives stimuli from theleft visual eld.v The left half of the retina receives stimuli from theright half of the visual eld.v The upper half of the retina receives stimuli fromthe lower half of the visual eld.v The lower half of the retina receives stimuli fromthe upper half of the visual eld.
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III. Oculomotor A. Somatic motor (general somatic efferent)Supplies four of the six extraocular muscles of the eye and the levator palpebrae superioris muscle of the upper eyelid.
B. Visceral motor (general visceral efferent)Parasympathetic innervation of the constrictor pupillae and ciliary muscles.
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The somatic motor component of CN III
innervates the following four extraocularmuscles of the eyes:
Ipsilateral inferior rectus muscle
Ipsilateral inferior oblique muscle
Ipsilateral medial rectus muscle
Contralateral superior rectus muscle
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Lower motor neuron lesion of
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1. 1. Downward, abducted eye on the affectedside rectus muscles.2. Strabismus3. Ptosis (eyelid droop) on the affected side4. Dilation of the pupil on the affected side5. Loss of the accomodation reflex on the
affected side.
Lower motor neuron lesion of Oculomotor nerve:
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IV. Trochlear NerveSomatic motor (general somatic efferent)Somatic motor innervates the superior oblique muscle
of the contralateral orbit.
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Extorsion (outward rotation) of the affected eye.
Vertical diplopia (double vision) due to the extortedeye. Weakness of downward gaze most noticeable onmedially-directed eye. This is often reported asdifculty in descending stairs.
IV Trochlear Nerve lesion
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V. Trigeminal Nerve
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VI. Abducent Nerve
Supplies the ipsilateral lateralrectus extraocular muscle
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1 Medially directed eye on the affected side dueVI Abducent Nerve lesion
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1. Medially directed eye on the affected side dueto the unopposed action of the medial rectus muscle.2. Inability to abduct the affected eye beyond themidline of gaze (up to approximately the midline, thesuperior and inferior oblique muscles can abduct the
eye).3. Strabismus - the inability to direct both eyes to thesame object. When asked to look at an object locatedlaterally to the side of the lesion, the patient's affected
eye will be unable to be abducted beyond the midlineof gaze. The opposite normal eye will be adducted toeffectively fixate on the object.
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4. Horizontal diplopia (double vision) due to the
strabismus.Patients may compensate by turning
their head so that the affected eye is focused on
an object and then moving the normal eye so asto xate on the object. CN VI paralysis is the most common isolatedpalsy due to the long peripheral course of thenerve.
Damage to the pontine lateral gaze center may result in conjugate paralysis of lateral gaze to the
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may result in conjugate paralysis of lateral gaze to theaffected side.This is indicated by an inability of the patient to xate on anobject placed laterally to the affected side. specically it is:
Inability to abduct the eye on the affected side pastapproximate midline gaze. Inability to adduct the eyeopposite the lesion past midline gaze.
The end result is that neither eye is moved to effectivelyxate on the target object.
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VII. Facial Nerve
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VIII. Vestibulocochlear Nerve
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IX. GlossopharyngealNerve
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X. Vagus Nerve
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Exam of Nerve IX and X Aah reex; uvula moves centrally If it moves to one side; Vagus lesion on the oppos side If it doesnt move, bilat palatal m paraesis Uvula moves on saying ahh but not on gag: IX palsy Gag reex: touch the post pharyngeal wall afferent : Nerve IX,
efferent: X
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XI. Accessory Nerve
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XII. Hypoglossal Nerve
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Special Senses Taste Smell Vision Hearing/Balance
TASTE: how does it work?
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Taste buds on tongue on fungiformpapillae (mushroom-likeprojections)
Each bud contains several celltypes in microvilli that projectthrough pore and chemically sensefood
Gustatory receptor cellscommunicate with cranial nerveaxon endings to transmit sensationto brain
Five taste sensations
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Sweetfront middle Sourmiddle sides Saltyfront side/tip
Bitter back umamiposterior
pharynx
CranialNerves of
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Nerves ofTaste
Anterior 2/3 tongue: VII (Facial)
Posterior 1/3 tongue: IX Glossopharyngeal)Pharynx: X (Vagus)
M&M, Fig. 16.2
Smell: How does it work?
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Olfactory epithelium in nasal cavity with specialolfactory receptor cells Receptor cells have endings that respond tounique proteins
Every odor has particular signature that triggers acertain combination of cells
Axons of receptor cells carry message back tobrain
Basal cells continually replace receptor cellsthey are only neurons that are continuously
replaced throughout life.
Olfactory epithelium just under cribiform plate(of ethmoid bone) in superior nasal epitheliumat midline
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Vision1. Movement of eyeextrinsic eye muscles and location in
orbit2. Support of eyelids, brows, lashes, tears, conjunctiva3. Lens and focusingstructures of eyeball and eye as optical
device4. Retina and photoreceptors
Movement of
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Movement ofeye
Extrinsic eye muscles
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Muscle " Movement " Nerve "Superioroblique "
Depresses eye,turns laterally "
IV (Trochlear) "
Lateral rectus " Turns laterally " VI (Abducens) "Medial rectus " Turns medially " III (Oculomotor) "
Superior rectus " Elevates " III (Oculomotor) "
Inferior rectus " Depresses eye " III (Oculomotor) "Inferior oblique " Elevates eye, turns
laterally "
III (Oculomotor) "
M&M, fig. 16.4
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Support/Maintenance of Eye b h d h ld f
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Eyebrows: shade, shield for perspiration Eyelids (palpebrae): skin-covered folds with tarsal
plates connective tissue inside Levator palpebrae superioris muscle opens eye (superior portion is smooth musc
why?)
Canthus (plural canthi): corner of eye Lacrimal caruncle makes eye sand at medial corner Epicanthal folds in many Asian people cover caruncle Tarsal glands make oil to slow drying
Eyelashciliary gland at hair follicleinfection is sty Eyelashestouch sensitive, thus blink
Support of Eye--conjunctiva
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Mucous membrane that coats inner surface ofeyelid (palpebral part) and then folds backonto surface of eye (ocular part)
Thin layer of connective tissue covered withstratied columnar epithelium
Very thin and transparent, showing blood vessels underneath (blood-shot eyes) Goblet cells in epithelium secrete mucous tokeep eyes moist
Vitamin A necessary for all epithelialsecretionslack leads to conjunctiva dryingupscaly eye
Support of eye--tearsM&M, fig. 16.5
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Lacrimal glandssuperficial/lateral in orbit,produce tears
Lacrimal duct (nasolacrimalduct) medial corner of eye carriestears to nasal cavity(frequently closed innewbornsopens by 1 yr usually)
Tears contain mucous,antibodies, lysozyme (anti-bacterial)
Eye as lens/optical device
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Light path: Cornea Anterior segment PupilLens Posterior segment Neural layer of retinaPigmented retina
Eye as optical device--structures Sclera (brous tunic): is tough connective tissue ball that forms outsid
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Sclera (brous tunic): is tough connective tissue ball that forms outsidof eyeball like box/case of camera Corresponds to dura mater of brain
Cornea: anterior transparent part of sclera (scratched cornea is typicalsports injury); begins focusing light
Choroid Internal to sclera/cornea Highly vascularized Darkly pigmented (for light absorption inside box)
Ciliary body: thick ring of tissue that encircles and holds lens Iris: colored part of eye between lens and cornea, attached at base to
ciliary body Pupil: opening in middle of iris Retina: sensory layer that responds to light and transmits visual signal to
brain
M&M, fig. 16.4
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Detail: Aperture and focus APERTURE
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Pupil changesshape due tointrinsic autonomicmuscles
Sympathetic: Dilator
pupillae (radial bers) Parasympathetic:sphinchter pupillae
FOCUS "" Ciliary muscles in ciliary body pull on lens to focus far away " Elasticity of lens brings back to close focus " Thus, with age, less elasticity, no close focus far-sighted "
M&M, fig. 16.8
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Detail: eye color Posterior part of iris always brown in color People with brown/black eyes with pigment throughout iris People with blue eyesrest of iris clear, brown pigment at
back appears blue after passing through iris/cornea
Details: Retina and photoreceptors Retina is outgrowth of brain Neurons have specialized receptors at end with photo pigment
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proteins (rhodopsins) Rod cells function in dim light, not color-tuned Cone cells have three types: blue, red, green In color blindness, gene for one type of rhodopsin is decient, usually red or
green Photoreceptors sit on pigmented layer of choroid. Pigment from
melanocytes--melanoma possible in retina!! Axons of photoreceptors pass on top or supercial to photoreceptor
region Axons congregate and leave retina at optic disc (blind spot)
Fovea centralis is in direct line with lens, where light is focused mostdirectly, and has intense cone cell population (low light night visionbest from side of eye)
Blood vessels supercial to photoreceptors (retina is good sight to checkfor small vessel disease in diabetes)
Retina andphotoreceptors
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p p
Ear/Hearing
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Outer Ear: auricle is elastic cartilage attached to dermis, gathers sound Middle ear: ear ossicles transmit and modulate sound Inner ear: cochlea, ampullae and semicircular canals sense sound and
equilibrium
M&M, fig. 16.17
Middle Ear External auditory canal ends at
tympanic membrane which vibratesagainst malleus on other side
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against malleus on other side
Inside middle ear chamber malleus incus stapes which vibrates on oval window of innerear
Muscles that inhibit vibration when
sound is too loud Tensor tympani m. (inserts on
malleus) Stapedius m. (inserts on stapes)
Inner Ear/Labyrinth
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Static equilibrium, linear motion Utricle, saccule are egg-shaped sacs in center (vestibule) of labyrinth
3-D motion, angular acceleration 3 semicircular canals for X,Y,Z planes
Sound vibrations Cochlea (snail)
M&M, fig. 16.20
Auditory Nerve (Acoustic) VIIIreceives stimulus from all to brain
Vestibular n.equilibriumCochlear n.hearing
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Throat/ Pharynx
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Overview: Sagittal view of nose/mouth/throat Nasal Cavity and Breathing Mouth and Chewing Throat and Swallowing Larynx and Singing
Sagittal Section Head Cranial cavity Brain/Spinal cord
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Vertebral bodies Epaxial muscles
Hard/soft palate Oral cavity Esophagus Trachea Epiglottis Naso- Oro-
Laringo-
pharynx "
Nose/Nasal Cavity and Breathing
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Nose/Nasal Cavity and BreathingFunction: Inlet for air to lung Warm/lter air
(mucous membranes onethmoid conchae )
Smell(nerve endings on nasalmembranes)
Conchae of Ethmod Bone
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Scroll-like bones Covered in mucous membrane for
Smell Filter air
W i
Sinuses All connected to nasal
cavity
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cavity All lined with mucous
membranes Cold/allergiesll with
mucous=sinusheadache
Maxillary " Ethmoid "
Frontal "
Sphenoid "
Mouth/Oral Cavity and ChewingFUNCTION "
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COMPONENTS Lips Cheeks
Palate Jaws and teeth Salivary glands
FUNCTION
Bite and chew food " Form words "
Taste "
Kiss "
Vestibulein front of teeth "Oral cavity properbehind teeth "
Lined by thickstratied squamousepithelium (almost
no keratin)"
LipsFUNCTION
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Close mouth Keep food in Make speech sounds Tactile
STRUCTURE Core of sphinchter-shape skeletal muscle
(orbicularis oris) Red margin transition from keratinized
skin to oral mucosa Red because clear color lets underlying vessels show through
No sweat or sebaceous glands, thusneeds to be wet (or lip balm)
CheeksFUNCTION
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FUNCTION Form side of moth
STRUCTURE Buccinator muscle
instrumental inswallowing, connects back
to pharyngeal constrictors
Palate Hard palate anterior
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Maxilla Palatine
Soft palate is posteriorextension, soft tissue
Palatoglossal arch
(palate to tongue) Palatopharyngeal arch
(palate to pharynx) Tonsils between arches Uvula???
Jaws
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FUNCTION
Hold teeth Occlude in chewing
STRUCTURE "
Upper jawmaxillary bone " Lower jaw--mandible "
Teeth Deciduous teeth milk
or baby teeth
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or baby teeth Emerge 6 mos. 2 yrs. Replaced by permanent
teeth 6-12 yrs. Wisdom teeth (3rd
molar) erupts 17-25 yrsor remains in jaw
Key to healthy teethand gums:
Flossing Visiting dentist
regularly (every 6mos.) and starting atyoung age (3-4 yrs.)
Structure of individual tooth
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Jaw muscles
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Masseter, temporaliselevatemandible ( close jaw)
Medial pterygoidlateral (side-to-side) chewing
Lateral pterygoidtranslatesmandible anteriorly (part ofopening)
Digastric (not shown)depressesmandible ( opens jaw )
Chewing is circular motion
TongueFUNCTION Position food between teeth
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Position food between teeth Form words in speechSTRUCTURE Intrinsic muscles (allow for
shape change with bers in various directions)
Extrinsic musclesattachtongue to skeleton Genioglossus hyoglossus
Salivary glands Intrinsic all over
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Intrinsicall overmucous membranesof tongue, palate,lips, lining of cheek
Extrinsicsecretemore saliva wheneating (oranticipating) Parotid Submandibular sublingual
Saliva Moistens mouth Dissolves food to be tasted
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Dissolves food to be tasted Wets and binds food Contains amylase to start starch digestion
(saltine to sugar experiment)
Contains bicarbonate to neutralize cavity-causingacids produced by bacteria Contains anti-bacterial and anti-viral enzymes
and cyanide-like compound to kill harmful
micro-organisms Contains proteins that stimulate growth of
benecial bacteria in the mouth
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Descent of the larynx
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Larynx and SingingFUNCTION Channel air out of trachea Vibrate to produce sound for speech/songSTRUCTURES External skeleton or frame (cartilage) Internal vocal cords and associated muscles
Skeleton of larynx
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Cricothyroid ligament is usual site of emergencytracheotomy (feel on selfSURFACE ANATOMY)
M&M, Fig. 21.5
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Identify the three pharyngeal constrictor muscles and their anterior attachments to bony/cartilaginous structures. Identify the three small longitudinal muscles of the pharynx.
Buccinator
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Superior constrictor
Middle constrictor
Inferior constrictor
Pterygomandibularraphe
Stylopharyngeus
Cricopharyngeus
Superior constrictor
Middle constrictor
Inferior constrictor
Stylopharyngeus
Cricopharyngeus
Palatopharyngeus
Salpingopharyngeus
Identify the major cartilages of the larynx
Epiglottis
Hyoid
Hyoid
Epiglottis
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Anterior view Sagittal SectionPosterior view
Thyroid cart.Thyroid cart.
Cricoid cart.
Arytenoidcart.
Arytenoidcart.
Cricoid cart.
Vocal Cord
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Identify the role played by each of these muscles in the control of the controlof the size of the rima glottidis.
Arytenoid cart.Rima glottidis
Post. Crico-arytenoid Lat. Crico-arytenoid
Arytenoid cart
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Thyroid cart.
Aryepiglottic fold
Vocal cord
Arytenoideus
Vocal cord
Thyroid cart.
Rima glottidis
Actions of intrinsic laryngeal muscles
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Trace the course of nerves through the neck noting especially: the sensory and motor branchesof the cervical and brachial plexuses, their course and distribution in the neck and theirrelationship to major bony, muscular, or vascular landmarks in the region.
Great auricular n. Lesser occipital n.C1
Great auricular n.
Lesseroccipital
Hypoglossal n. (XII)
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Ansa cervicalis
Hypoglossal n. (XII)
Accessory n. (XI)
Phrenic n.
Vagus n. (X)
C5
C6
C7
C8
T1
Dorsal scapular n.
Nn. to longus colli and scalenes
Long thoracic n.
Suprascapular n.
C2
C3
C4
C5
Phrenic n.
occ p tan.
Transversecervicalnn.
Ansa cervicalis
Supraclavicular nn.Accessory n. (XI)
Trace the course of nerves through the neck noting especially: theextension of the upper part of the sympathetic trunk into the neck region.
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Sup. Cervical gang.
Cervicothoracicgang.
MiddleCervical gang.
Carotid plexus
Glossopharyngeal (IX)
Vagus (X)
C2
C1
C3
C4C5
C6C7
C8
Trace the flow of arterial blood from the aorta through the neck including vessels that passthrough the neck without branching and those that send branches to viscera and muscles of the neck.
Two main arteries are found in the neck: Subclavian and branches and Carotid
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Subclavian
Vertebral
Thyrocervical
Transversecervical
Deep cervical
Suprascapular
Ascendingcervical
Inf. thyroid
Ext. Carotid
Common carotid
Omohyoid
Digastric Lingual
Sup. thyroidSup. laryngeal
Int.carotid
Ext. carotid
Ascendingpharyngeal
Supercial temporal
Maxillary
Facial
Post.auricular
Trace the pathways for venous drainage from the neck into the brachialveins.
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Ext. jugularInt. jugular
Ant. jugular
Sup. thyroid
Middlethyroid
Inf. thyroid
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f c
facial view palatal view
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e
a = nasal septumb = inferior conchac = nasal fossad = anterior nasal spine
e = incisive foramenf = median palatalsuture
ba
d
c
facial view
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Nasal septum
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facial view
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Nasal fossa
facial view
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Anterior nasal spine
palatal view
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Incisive foramen
palatal view
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Median palatal suture
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Soft tissue of the nose
aa
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Red arrow points toperiapical lesion (post-endo).
b
e
db
Red arrows = lip line
d
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g
Red arrow = mesiodens(supernumerary tooth)
f
Blue arrow = chronic periapical periodontitis.Tooth # 9 is non-vital(trauma) and needs endo.
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Superior foramina of the nasopalatine canals (red arrows).These foramina lie in the oor of the nasal fossa. Thenasopalatine canals travel downward to join in the incisiveforamen.
b a
f
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d
The red arrows point to anincisive canal cyst; the orangearrow identies the root of tooth # 7.
All the incisors are non-vital andhave periapical lesions. The purplearrows point to external resorption;the blue arrow identies internalresorption.
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The red arrows point to the soft tissue of the nose. Thegreen arrows identify the lip line.
Maxillary Cuspid
a
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a = oor of nasal fossa
b = maxillary sinus
c = lateral fossa
d = nose
d
c
b
a a
facial view
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a = oor of nasal fossab = maxillary sinusc = lateral fossa
(a & b form inverted Y)
cb
c
b
facial view
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Floor of nasal fossa (red arrows) and anterior border of maxillary sinus (blue arrows), forming the inverted(upside down) Y.
facial view
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Lateral fossa. The radiolucency results from adepression above and posterior to the lateral incisor. Tohelp rule out pathology, look for an intact lamina durasurrounding the adjacent teeth.
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Soft tissue of the noseRed arrows point to nasolabial fold. Alsonote the inverted Y.
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The maxillary sinussurrounds the root of thecanine, which may bemisinterpreted as pathology.
The white arrows indicate theoor of the nasal fossa. Themaxillary sinus (red arrows) haspneumatized between the 2 nd premolar and rst molar
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a b c
Maxillary Premolar
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a = malar process
b = sinus septum
c = sinus recess
d = maxillary sinus
d
b b
facial view
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a = malar process
b = sinus recessc = sinus septumd = maxillary sinus
a c d dca
facial view
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Malar (zygomatic) process. U or j-shapedradiopacity, often superimposed over the roots of themolars, especially when using the bisecting-angletechnique. The red arrows dene the lower border of the zygomatic bone.
facial view
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Sinus septum. This septum is composed of folds of cortical bone that arise from the oor and walls of the
maxillary sinus, extending several millimeters into thesinus. In rare cases, the septum completely divides thesinus into separate compartments.
facial view
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Sinus recess. Increased area of radiolucency causedby outpocketing (localized expansion) of sinus wall.If superimposed over roots, may mimic pathology.
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Pneumatization. Expansion of sinus wall intosurrounding bone, usually in areas where teethhave been lost prematurely. Increases with age.
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g
d
efacial view
e
g
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a
f
a = maxillary tuberosity* e = zygoma (dotted lines)b = coronoid process f = maxillary sinusc = hamular process g = sinus recessd = pterygoid plates
* image of impacted third molar superimposed
c
b
d
b
ac f
facial view
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Maxillary Tuberosity. The rounded elevation locatedat the posterior aspect of both sides of the maxilla.Aids in the retention of dentures.
facial view
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Coronoid process. A mandibular structure sometimesseen on the maxillary molar periapical lm when usingthe bisecting angle technique with nger retention (Themouth is opened wide, moving the coronoid down andforward). Note the supernumerary molar.
facial view
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Hamular process (white arrows) and pterygoid plates(purple arrows). The hamular process is an extension of the
medial pterygoid plate of the sphenoid bone, positioned just posterior to the maxillary tuberosity.
facial view
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Zygomatic (malar) bone/process/arch. Thezygomatic bone (white/black arrows) starts in the
anterior aspect with the zygomatic process (bluearrow), which has a U-shape. The zygomaticbone extends posteriorly into the zygomatic arch(green arrow).
facial view
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Maxillary sinus. As seen in the above lm, the oor of the maxillarysinus ows around the roots of the maxillary molars and premolars.The walls of the sinus may become very thin. As a result, sinusitis mayput pressure on the superior alveolar nerves resulting in apparent
tooth pain, even though the tooth is perfectly healthy. Note coronoidprocess (green arrow), zygomatic bone (blue arrow), sinus septum(yellow arrow) and neurovascular canal (orange arrows).
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The maxillary sinus is evidentanterior to the second molar(black arrows) but it disappearsposteriorly due to thesuperimposition of the zygomatic
bone. The orange arrows identify amucous retention cyst (retentionpseudocyst) within the sinus.
This lm shows the coronoidprocess (green arrow) and adistomolar (blue arrow) that haserupted ahead of the thirdmolar (red arrow). A
distomolar is a supernumerarytooth that erupts distal(posterior) to the other molars.
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The zygomatic process (green arrows) is a prominent U-shaped radiopacity. Normally the zygomatic bone posterior tothis is very dense and radiopaque. In this patient, however, themaxillary sinus has expanded into the zygomatic bone andmakes the area more radiolucent (red arrows). The coronoidprocess (orange arrow), the pterygoid plates (blue arrows) andthe maxillary tuberosity (pink arrows) are also identied.
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This lm shows the expansion of the borders of the maxillarysinus through pneumatization (red arrows). This expansionincreases with age and it may be accelerated as a result of chronicsinus infections. It is most commonly seen when the rst molar isextracted prematurely, as in the lm at right (the second and thirdmolars have migrated anteriorly to close the space). The coronoidprocess is seen in the lower left-hand corner of each lm. Thegreen arrow identies a sinus recess. Note the two distomolars inlm at right (blue arrows).
li l f
Mandibular Incisor
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a. lingual foramen
b. genial tubercles
c. mental ridge
d. mental fossa
a b c
d
facial viewlingual view
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b = genial tubercles
a = lingual foramen c = mental ridge
d = mental fossa
ab
cd
lingual view
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Lingual foramen. Radiolucent hole in center of genial tubercles. Lingual nutrient vessels pass throughthis foramen.
lingual view
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Genial tubercles. Radiopaque area in the midline, midwaybetween the inferior border of the mandible and the apices of the incisors. Serve as attachments for the genioglossus andgeniohyoid muscles. May have radiolucent hole in center(lingual foramen), but not on this lm. Note double rootedcanine (red arrows).
facial view
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Mental ridge. These represent the raised portions of the mentalprotuberance on either side of the midline. More commonlyseen when using the bisecting angle technique, when the x-raybeam is directed at an upward angle through the ridges.
facial view
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Mental fossa. This represents a depression on the labialaspect of the mandible overlying the roots of the incisors.The resulting radiolucency may be mistaken forpathology.
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The radiolucent area abovecorresponds to the location of themental fossa. However, this slide
represents chronic periapicalperiodontitis; these teeth arenon-vital, due to trauma.
The orange arrows aboveidentify nutrient canals. Theyare most often seen in older
persons with thin bone, and inthose with high blood pressureor advanced periodontitis.
Mandibular Canine
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a b
a = mental ridgeb = genial tubercles/
lingual foramenc = mental foramen
c
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facial view
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Mental ridge. The raised portions of the mentalprotuberance, sloping downward and backward fromthe midline.
lingual view
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Lingual foramen/genial tubercles. (Seedescription under mandibular incisor above).
facial view
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The red arrows identify the mandibular canal andthe blue arrow points to the mental foramen.
Mandibular Premolar
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a = mylohyoid ridgeb = mandibular canalc = submandibular gland fossad = mental foramen
facial view lingual view
ad
d b
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c
b = mandibular canald = mental foramen
a = mylohyoid ridge(internal oblique)
c = submandibular glandfossa
c
add b
lingual view
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Mylohyoid (internal oblique) ridge. This radiopaque ridgeis the attachment for the mylohyoid muscle. The ridgeruns downward and forward from the third molar regionto the area of the premolars.
facial view
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Mandibular canal. (Inferior alveolar canal). Runsdownward from the mandibular foramen to the mentalforamen, passing close to the roots of the molars. Moreeasily seen in the molar periapical.
lingual view
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Submandibular gland fossa. The depression below themylohyoid ridge where the submandibular gland is
located. More obvious in the molar periapical lm.
facial view
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Mental foramen. Usually located midway between theupper and lower borders of the body of the mandible, in
the area of the premolars. May mimic pathology if superimposed over the apex of one of the premolars.
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The mental foramen (bluearrow) is adjacent to aperiapical lesion associated withtooth # 21 (red arrow). There isslight external resorption on #21.
The green arrow points to themental foramen. The yellow arrowidenties a periapical lesion on # 30.Note the overextension of the silverpoint in the distal root, the
perforation of the mesial root andthe amalgam protruding throughthe perforation from the pulpchamber.
Mandibular Molar
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a = external oblique ridge
b = mylohyoid ridgec = mandibular canald = submandibular gland fossa
facial view lingual view
b
a
b
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b
c
b
a = external oblique ridgec = mandibular canal
b = mylohyoid ridged = submandibular gland
fossa
dd
ab
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c
dd
a = external oblique ridge
b = mylohyoid ridgec = mandibular canald = submandibular gland fossa
facial view
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External oblique ridge. A continuation of the anteriorborder of the ramus, passing downward and forward onthe buccal side of the mandible. It appears as a distinct
radiopaque line which usually ends anteriorly in the areaof the rst molar. Serves as an attachment of thebuccinator muscle. (The red arrows point to the mylohyoidridge).
lingual view
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Mylohyoid ridge (internal oblique). Located on the lingualsurface of the mandible, extending from the third molar
area to the premolar region. Serves as the attachment of the mylohyoid muscle.
facial view
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Mandibular (inferior alveolar) canal. Arises at the mandibularforamen on the lingual side of the ramus and passes downwardand forward, moving from the lingual side of the mandible in thethird molar region to the buccal side of the mandible in thepremolar region. Contains the inferior alveolar nerve andvessels.
lingual view
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Submandibular gland fossa. A depression on the lingualside of the mandible below the mylohyoid ridge. Thesubmandibular gland is located in this region. Due to thethinness of bone, the trabecular pattern of the bone is very
sparse and results in the area being very radiolucent. Thefact that it occurs bilaterally helps to differentiate it frompathology.
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The external oblique ridge (red arrows) and themylohyoid ridge (blue arrows) usually run parallel witheach other, with the external oblique ridge always beinghigher on the lm.
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The mandibular canal (red arrows identify inferior border of canal) usually runs very close to the roots of the molars, especially the third molar. This can be a problem whenextracting these teeth. Note the extreme dilaceration (curving) of the roots of the third molar (green arrow) in the lm at left. Thelm at right shows kissing impactions located at the superiorborder of the canal.
Slide # 1
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A. The red arrows identify the ?
Slide # 1
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A. Floor of nasal cavity
Slide # 2
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A. The red arrow points to the ?
B. The white arrows identify the ?C. The blue arrow points to the ?
D. The yellow arrow identifies the ?
Slide # 2
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A. Coronoid processB. B. Maxillary sinus
(pneumatized into maxillarytuberosity)
C. Sinus septumD. Zygomatic process
Slide # 3
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A. The small radioluceny identified bythe green arrow is the ?
Slide # 3
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A. Lingual foramen
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Slide # 4
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A. Mylohyoid ridgeB. Submandibular gland fossa
Slide # 5
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A. The yellow arrows point to the ?
B. The red arrows identify the ?
Slide # 5
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A. Zygomatic processB. Maxillary sinus
Slide # 6
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A. The red arrow points to the ?
B. The orange arrow points to the ?
C. The blue arrows point to theradiolucent line known as the ?
Slide # 6
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A. Inferior concha
B. Nasal septumC. Median palatal suture
Slide # 7
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A. The red arrows point to the ?
Slide # 7
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A. Mental ridge
Slide # 8
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A. The red arrows identify the ?B. What is the name of the radiolucent
area surrounding the canal?
Slide # 8
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A. Mandibular canalB. Submandibular gland fossa
References
-Netter atlas of human anatomy-Netter neuro-anatomy-Netter anatomy of head and neck
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-Greys anatomy-Snells Human anatomy-Robbinss anatomy and pathology
-Contemporary oral and maxillofacial surgeryO l di l i i l d i i
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