NEET MDS Lessons
Anatomy
Muscles of the Soft Palate
The Levator Veli Palatini (Levator Palati)
- Superior attachment: cartilage of the auditory tube and petrous part of temporal bone.
- Inferior attachment: palatine aponeurosis.
- Innervation: pharyngeal branch of vagus via pharyngeal plexus.
- This cylindrical muscle runs inferoanteriorly, spreading out in the soft palate, where it attaches to the superior surface of the palatine aponeurosis.
- It elevates the soft palate, drawing it superiorly and posteriorly.
- It also opens the auditory tube to equalise air pressure in the middle ear and pharynx.
The Tensor Veli Palatini (Tensor Palati)
- Superior attachment: scaphoid fossa of medial pterygoid plate, spine of sphenoid bone, and cartilage of auditory tube.
- Inferior attachment: palatine aponeurosis.
- Innervation: medial pterygoid nerve (a branch of the mandibular nerve).
- This thin, triangular muscle passes inferiorly, and hooks around the hamulus of the medial pterygoid plate.
- It then inserts into the palatine aponeurosis.
- This muscle tenses the soft palate by using the hamulus as a pulley.
- It also pulls the membranous portion of the auditory tube open to equalise air pressure of the middle ear and pharynx.
The Palatoglossus Muscle
- Superior attachment: palatine aponeurosis.
- Inferior attachment: side of tongue.
- Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
- This muscle, covered by mucous membrane, forms the palatoglossal arch.
- The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.
The Palatopharyngeus Muscle
- Superior attachment: hard palate and palatine aponeurosis.
- Inferior attachment: lateral wall of pharynx.
- Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
- This thin, flat muscle is covered with mucous membrane to form the palatopharyngeal arch.
- It passes posteroinferiorly in this arch.
- This muscle tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly and medially during swallowing.
The Musculus Uvulae
- Superior attachment: posterior nasal spine and palatine aponeurosis.
- Inferior attachment: mucosa of uvula.
- Innervation: cranial part of accessory through the pharyngeal branch of vagus, via the pharyngeal plexus.
- It passes posteriorly on each side of the median plane and inserts into the mucosa of the uvula.
- When the muscle contracts, it shortens the uvula and pulls it superiorly.
-> This bone forms much of the base and posterior aspect of the skull.
-> It has a large opening called the foramen magnum, through which the cranial cavity communicates with the vertebral canal.
-> It is also where the spinal cord becomes continuous with the medulla (oblongata) of the brain stem.
-> The occipital bone is saucer-shaped and can be divided into four parts: a squamous part (squama), a basilar part (basioccipital part), and two lateral parts (condylar parts).
-> These four parts develop separately around the foramen magnum and unite at about the age of 6 years to form one bone.
-> On the inferior surfaces of the lateral parts of the occipital bone are occipital condyles, where the skull articulates with C1 vertebra (the atlas) at the atlanto-occipital joints.
-> The internal aspect of the squamous part of the occipital bone is divided into four fossae: the superior two for the occipital poles of the cerebral hemispheres, and the inferior two, called cerebellar fossae, for the cerebellar hemispheres.
Muscles Around the Mouth
- The sphincter of the mouth is orbicularis oris and the dilator muscles radiate outward from the lips like the spokes of a wheel.
Orbicularis Oris Muscle
- This muscle encircles the mouth and is the sphincter of the oral aperture
- This muscle (1) closes the lips, (2) protrudes them and (3) compresses them against the teeth.
- It plays an important role in articulation and mastication. Together with the buccinator muscle, it helps to hold the food between the teeth during mastication.
Zygomaticus Major Muscle
- It extends from the zygomatic bone to the angle of the mouth.
- It draws the corner of the moth superolaterally during smiling and laughing.
Zygomaticus Minor Muscle
- This is a narrow slip of muscle, and passes obliquely from the zygomatic bone to the orbicularis oris.
- It helps raise the upper lip when showing contempt or to deepen the nasolabial sulcus when showing sadness.
The Buccinator Muscle
- This is a thin, flat, rectangular muscle.
- It is attached laterally to the alveolar processes of the maxilla and mandible, opposite the molar teeth and the pterygomandibular raphe.
- Medially, its fibres mingle with those of orbicularis oris.Innervation: the buccal branch of facial.
- It aids mastication and swallowing by pushing the cheeks against the molar teeth during chewing.
Intrinsic muscles
all innervated by recurrent laryngeal nerve except cricothyroid: external laryngeal nerve
adductors of vocal folds: bring folds together at midline
Transverse and oblique arytenoids: pull arytenoids together
Lateral cricoartenoids: spin and slide arytenoids up
only one abductor of vocal folds
Posterior cricoarytenoids—down and up
adjustors of shape and tension of vocal folds
Cricothyroid muscle
o superficial to lateral cricoarytenoid
o tenses vocal folds by tilting thyroid cartilage forward and sliding forward
Thyroartenoid and vocalis muscles
o vocalis: sometimes treated as medial most fibers of thyroartenoid muscle
o different fiber directions
lateral: adduct
medial: change shape of folds
control voice by bring bringing together different parts of folds
o as move from epithelium to vocalis muscle, fold becomes stiffer
o near connections, vocal folds are stiffer
o vocal fold: complex, multilayered vibrator
The Meatus of the Nose
Sphenopalatine Recess
- This space is posterosuperior to the superior concha.
- The sphenoidal sinus opens into this recess.
Superior Meatus
- This is a narrow passageway between the superior and middle nasal conchae.
- The posterior ethmoidal sinuses open into it by one or more orifices.
Middle Meatus
- This is longer and wider than the superior one.
- The anterosuperior part of this meatus lead into a funnel-shaped opening, called the infundibulum, through which the frontonasal duct leads to the frontal sinus.
- There is one duct for each frontal sinus and since there may be several, there may be several frontonasal ducts.
- When the middle concha is removed, rounded elevation called the ethmoidal bulla (L. bubble), is visible
- The middle ethmoidal air cells open on the surface of the ethmoidal bulla.
- Inferior to this bulla is a semicircular groove called the hiatus semilunaris.
- The frontal sinus opens into this hiatus anterosuperiorly.
- Near the hiatus are the openings of the anterior ethmoid air cells.
- The maxillary sinus also opens into the middle meatus.
Inferior Meatus
- This is a horizontal passage, inferolateral to the inferior nasal concha.
- The nasolacrimal duct opens into the anterior part of this meatus.
- Usually, the orifice of this duct is wide and circular.
The Middle Ear
- This part of the ear is in a narrow cavity in the petrous part of the temporal bone.
- It contains air, three auditory ossicles, a nerve and two small muscles.
- The middle ear is separated from the external acoustic meatus by the tympanic membrane.
- This cavity includes the tympanic cavity proper, the space directly internal to the tympanic membrane, and the epitympanic recess, the space superior to it.
- The middle ear is connected anteriorly with the nasopharynx by the auditory tube.
- Posterosuperiorly, the tympanic cavity connects with the mastoid cells through the aditus ad antrum (mastoid antrum).
- The tympanic cavity is lined with mucous membrane that is continuous with the mucous membrane of the auditory tube, mastoid cells, and aditus ad antrum.
Contents of the Tympanic Cavity or Middle Ear
- This cavity contains the auditory ossicles (malleus, incus and stapes); the stapedius and tensor tympani muscles; the chorda tympani nerve (a branch of the facial nerve, CN VII); and the tympanic plexus of nerves.
The Orbital Margin
- The frontal, maxillary and zygomatic bones contribute equally to the formation of the orbital margin.
- The supraorbital margin is composed entirely of the frontal bone.
- At the junction of its medial and middle thirds is the supraorbital foramen (sometimes a notch), which transmits the supraorbital nerves and vessels.
- The lateral orbital margin is formed almost entirely of the frontal process of the zygomatic bone.
- The infraorbital margin is formed by the zygomatic bone laterally and the maxilla medially.
- The medial orbital margin is formed superiorly by the frontal bone and inferiorly by the lacrimal crest of the frontal process of the maxilla.
- This margin is distinct in its inferior half only.