NEET MDS Lessons
Anatomy
The Nasopharynx
- The nasal part of the pharynx has a respiratory function.
- It lies superior to the soft palate and is a posterior extension of the nasal cavity.
- The nose opens into the nasopharynx via to large posterior apertures called choanae.
- The roof and posterior wall of the nasopharynx form a continuous surface that lies inferior to the body of the sphenoid bone and the basilar part of the occipital bone.
- In the mucous membrane of the roof of the posterior wall of the nasopharynx is a collection of lymphoid tissue, known as the pharyngeal tonsil (commonly known as the adenoids).
- The pharyngeal orifice of the auditory tube is on the lateral wall of the nasopharynx, 1 to 1.5 cm posterior to the inferior concha, and level with the superior border of the palate.
- The orifice is directed inferiorly and has a hood-like tubal elevation over it called the torus of the auditory tube or the torus tubarius (L. torus, swelling).
- Extending inferiorly from the torus is a vertical fold of mucous membrane, known as the salpingopharyngeal fold.
- The collection of lymphoid tissue in the submucosa of the pharynx, posterior to the orifice of the auditory tube, is known as the tubal tonsil.
- Posterior to the torus and the salpingopharyngeal fold, there is a slit-like lateral projection of the pharynx called the pharyngeal recess.
- It extends laterally and posteriorly.
The Nose
- The nose is the superior part of the respiratory tract and contains the peripheral organ of smell.
- It is divided into right and left nasal cavities by the nasal septum.
- The nasal cavity is divided into the olfactory area and the respiratory area.
The Sublingual Glands
- These are the smallest of the three paired salivary glands and the most deeply situated.
- They are almond-shaped and lie in the floor of the mouth between the mandible and the genioglossus muscle.
- The paired glands unite to form a horseshoe-shaped glandular mass around the lingual frenulum.
- Numerous small ducts (10 to 12) open into the floor of the mouth.
- Sometimes one of the ducts opens into the submandibular duct.
- The nerves the accompany the submandibular and sublingual glands are derived from the lingual and chorda tympani nerves and from the sympathetic nerves.
- The parasympathetic secretomotor fibres are from the submandibular ganglion.
Walls of the Tympanic Cavity or Middle Ear
- This cavity is shaped like a narrow six-sided box that has convex medial and lateral walls.
- It has the shape of the biconcave lens in cross-section (like a red blood cell).
The Roof or Tegmental Wall
- This is formed by a thin plate of bone, called the tegmen tympani (L. tegmen, roof).
- It separates the tympanic cavity from the dura on the floor of middle cranial fossa.
- The tegmen tympani also covers the aditus ad antrum.
The Floor or Jugular Wall
- This wall is thicker than the roof.
- It separates the tympanic cavity from the superior bulb of the internal jugular vein. The internal jugular vein and the internal carotid artery diverge at the floor of the tympanic cavity.
- The tympanic nerve, a branch of the glossopharyngeal nerve (CN IX), passes through an aperture in the floor of the tympanic cavity and its branches form the tympanic plexus.
The Lateral or Membranous Wall
- This is formed almost entirely by the tympanic membrane.
- Superiorly it is formed by the lateral bony wall of the epitympanic recess.
- The handle of the malleus is incorporated in the tympanic membrane, and its head extends into the epitympanic recess.
The Medial or Labyrinthine Wall
- This separates the middle ear from the membranous labyrinth (semicircular ducts and cochlear duct) encased in the bony labyrinth.
- The medial wall of the tympanic cavity exhibits several important features.
- Centrally, opposite the tympanic membrane, there is a rounded promontory (L. eminence) formed by the first turn of the cochlea.
- The tympanic plexus of nerves, lying on the promontory, is formed by fibres of the facial and glossopharyngeal nerves.
- The medial wall of the tympanic cavity also has two small apertures or windows.
- The fenestra vestibuli (oval window) is closed by the base of the stapes, which is bound to its margins by an annular ligament.
- Through this window, vibrations of the stapes are transmitted to the perilymph window within the bony labyrinth of the inner ear.
- The fenestra cochleae (round window) is inferior to the fenestra vestibuli.
- This is closed by a second tympanic membrane.
The Posterior or Mastoid Wall
- This wall has several openings in it.
- In its superior part is the aditus ad antrum (mastoid antrum), which leads posteriorly from the epitympanic recess to the mastoid cells.
- Inferiorly is a pinpoint aperture on the apex of a tiny, hollow projection of bone, called the pyramidal eminence (pyramid).
- This eminence contains the stapedius muscle.
- Its aperture transmits the tendon of the stapedius, which enters the tympanic cavity and inserts into the stapes.
- Lateral to the pyramid, there is an aperture through which the chorda tympani nerve, a branch of the facial nerve (CN VII), enters the tympanic cavity.
The Anterior Wall or Carotid Wall
- This wall is a narrow as the medial and lateral walls converge anteriorly.
- There are two openings in the anterior wall.
- The superior opening communicates with a canal occupied by the tensor tympani muscle.
- Its tendon inserts into the handle of the malleus and keeps the tympanic membrane tense.
- Inferiorly, the tympanic cavity communicates with the nasopharynx through the auditory tube.
The Skeleton of the Nose
- The immovable bridge of the nose, the superior bony part of the nose, consists of the nasal bones, the frontal processes of the maxillae, and the nasal part of the frontal bones.
- The movable cartilaginous part consists of five main cartilages and a few smaller ones.
- The U-shaped alar nasal cartilages are free and movable.
- They dilate and constrict the external nares when the muscles acting on the external nose contract.
The Nasal Cavities
- The nasal cavities are entered through the anterior nares or nostrils.
- They open into the nasopharynx through the choanae.
The Roof and Floor of the Nasal Cavity
- The roof is curved and narrow, except at the posterior end.
- The floor is wider than the roof.
- It is formed from the palatine process of the maxilla and the horizontal plate of the palatine bone.
The Walls of the Nasal Cavity
- The medial wall is formed by the nasal septum; it is usually smooth.
- The lateral wall is uneven owing to the three longitudinal, scroll-shaped elevations, called the conchae (L. shells) or turbinates (L. shaped like a top).
- These elevations are called the superior, middle and inferior conchae according to their position.
- The superior and middle conchae are parts of the ethmoid bone, whereas the inferior conchae are separate bones.
- The inferior and middle conchae project medially and inferiorly, producing air passageways called the inferior and middle meatus (L. passage). Note: the plural of "meatus" is the same as the singular.
- The short superior conchae conceal the superior meatus.
- The space posterosuperior to the superior concha is called the sphenoethmoidal recess.
Muscles of the larynx
Extrinsic muscles
suprahyoid: raise larynx, depress mandible for swallowing
infrahyoid: lower larynx for swallowing
both stabilize hyoid for tongue movements
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.