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

Innervation of the Skin

• Innervation of the skin is mainly through the three branches of the trigeminal nerve (CN V).
• Some skin over the angle of the mandible and anterior and posterior of the auricle is supplied by the great auricular nerve from the cervical plexus.
• Some cutaneous branches of the auricular branch of the facial nerve also supplies skin on both sides of the auricle.

• The trigeminal nerve is the general sensory nerve to the head, particularly the face, and is the motor nerve to the muscles of mastication.

The Ophthalmic Nerve

• This is the superior division of the trigeminal nerve, the smallest of the three branches and is wholly sensory.
• The ophthalmic nerve divides into three branches: the nasociliary, frontal and lacrimal just before entering the orbit through the superior orbital fissure.

• The nasociliary nerve supplies the tip of the nose through the external nasal branch of the anterior ethmoidal nerve.

• The frontal nerve is the direct continuation of CN V¹ and divides into two branches, the supraorbital and supratrochlear.
• The supratrochlear nerve supplies the middle part of the forehead.
• The supraorbital nerve supplies the lateral part and the front of the scalp.

• The lacrimal nerve, the smallest of the main ophthalmic branches, emerges over the superolateral orbital margin to supply the lacrimal gland and the lateral part of the upper eyelid.

The Maxillary Nerve

• This is the intermediate division of the trigeminal nerve.
• It has three cutaneous branches.

• The infraorbital nerve is the largest terminal branch of the maxillary nerve.
• It passes through the infraorbital foramen and breaks up into branches that supplies the skin on the lateral aspect of the nose, upper lip and lower eyelid.

• The zygomaticofacial nerve, a small branch of the maxillary, emerges from the zygomatic bone from a foramen with the same name.
• It supplies the skin over the zygomatic bone.

• The zygomaticotemporal nerve emerges from the zygomatic bone from foramen of the same name.
• It supplies the skin over the temporal region.

The Mandibular Nerve

• This is the inferior division of the trigeminal nerve.
• Of the three division of the trigeminal nerve, CN V³ is the only one that carries motor fibres (to the muscles of mastication).
• The main sensory branches of the mandibular nerve are the buccal, auriculotemporal, inferior alveolar and lingual nerves.

• The buccal nerve is a small branch of the mandibular that emerges from deep to the ramus of the mandible.
• It supplies the skin of the cheek over the buccinator muscle, the mucous membrane lining the cheek, and the buccal surface of the gingiva.

• The auriculotemporal nerve passes medially to the neck of the mandible and then turns superiorly, posterior to its head and anterior to the auricle. It then crosses over the root of the zygomatic process of the temporal bone, deep to the superficial temporal artery.

• It supplies the auricle, external acoustic meatus, tympanic membrane, and the skin in the temporal region.

• The inferior alveolar nerve is the large terminal branch of the posterior division of the mandibular nerve (the lingual nerve is the other terminal branch).
• It enters the mandible through the mandibular foramen to the mandibular canal. In the canal, it gives branches to the mandibular teeth.
• Opposite the mental foramen, this nerve divides into the mental nerve and the incisive nerve.
• The incisive nerve supplies the incisor teeth, the adjacent gingiva and the mucosa of the lower lip.
• The mental nerve emerges from the mental foramen and supplies the skin of the chin and the skin and mucous membrane of the lower lip and gingiva.

• The lingual nerve is the smaller terminal branch of the mandibular nerve.
• It supplies the general sensory fibres to the anterior two-thirds of the tongue, the floor of the mouth and the gingivae of the mandibular teeth.

Skeletal Muscle:  1-40 cm long fibres, 10- 60 µm thick, according to myoglobin content there are:

Red fibres: lots of myoglobin, many mitochondriam slow twitching - tire slowly

White fibres:  less myoglobin,  less mitochondria, fast twitching - tire quickly

Intermediate fibres:

mixture of 2 above

Most muscles have all three - in varying ratios

Structure of skeletal muscle:

Light Microscopy:  Many nuclei - 35/mm,  Nuclei are oval - situated peripheral,  Dark and light bands

Electron Microscopy: Two types of myofilaments

Actin

- 5,6 nm

 3 components:

 -actin monomers,  

 -tropomyosin - 7 actin molecules long

- troponin

 actin monomers form 2 threats that spiral

- tropomyosin - lie in the groove of the spiral

- troponin - attach every 40 nm

- one end attach to the Z line

- other end goes to the middle of the sarcomere

- Z line consists of á actinin

Myosin:

- 15 nm

- 1,6 µm long

- The molecule has a head and a tail

- tails are parallel

- heads project in a spiral

- in the middle is a thickening

- thin threats bind the myosin at thickening (M line)

Contraction:

A - band stays the same, I - band, H - bands become narrower

Myosin heads ratchet on the actin molecule

Sarcolemma: 9 nm thick,  invaginate to form T-tubule,

 myofibrils - attach to the sarcolemma

Sarcoplasmic Reticulum:

specialized smooth EPR,  Consists of T-tubules, terminal sisternae and sarcotubules

It is speculated that there are gap junctions between the T-tubule and terminal sisterna

An impulse is carried into the fiber by the T-tubule from where it goes to the rest of the sarcoplasmic reticulum

Connective tissue coverings of the muscle

Endomycium around fibres, perimycium around bundles and epimycium around the whole muscle

Blood vessels and nerves in CT

CT goes over into tendon or aponeurosis which attaches to the periosteum

Nerves:

The axon of a motor neuron branches and ends in motor end plates on the fiber

Specialized striated fibres called spindles (stretch receptors) form sensory receptors in muscles telling the brain how far the muscle has stretched

• This is the second cranial nerve (CN II) and is the nerve of sight.

The Walls of the Orbit

• Each orbit has four walls: superior (roof), medial, inferior (floor) and lateral.
• The medial walls of the orbit are almost parallel with each other and with the superior part of the nasal cavities separating them.
• The lateral walls are approximately at right angles to each other

The Superior Roof of the Orbit

• The superior wall or roof of the orbit is formed almost completely by the orbital plate of the frontal bone.
• Posteriorly, the superior wall is formed by the lesser wing of the sphenoid bone.

• The roof of the orbit is thin, translucent, and gently arched. This plate of bone separates the orbital cavity and the anterior cranial fossa.

• The optic canal is located in the posterior part of the roof.