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Anatomy - NEETMDS- courses
NEET MDS Lessons
Anatomy

The Layers of the Pharyngeal Wall

  • The pharyngeal wall is composed of 5 layers. From internal to external, they are as follows.
  • Mucous membrane: this lines the pharynx and is continuous with all chambers with which it communicates.
  • Submucosa
  • Pharyngobasilar fascia: this is a fibrous layer that is attached to the skull.
  • Muscular layer: this is composed of inner longitudinal and outer circular parts.
  • Buccopharyngeal fascia: this is a loose connective tissue layer.
  • This fascia is continuous with the fascia covering the buccinator and pharyngeal muscle.
  • It contains the pharyngeal plexus of nerves and veins.

->The two parietal bones (L. paries, wall) form large parts of the walls of the calvaria.
->On the outside of these smooth convex bones, there are slight elevations near the centre called parietal eminences.
->The middle of the lateral surfaces of the parietal bones is crossed by two curved lines, the superior and inferior temporal lines.
->The superior temporal line indicates an attachment of the temporal fascia; the inferior temporal line marks the superior limit of the temporalis muscle.
->The parietal bones articulate with each other in the median plane at the sagittal suture. The medial plane of the body passes through the sagittal suture.
->The inverted V-shaped suture between the parietal bones and the occipital bones is called the lambdoid suture because of its resemblance to the letter lambda in the Greek alphabet.
->The point where the parietal and occipital bones join is a useful reference point called the lambda. It can be felt as a depression in some people.
->In addition to articulation with each other and the frontal and occipital bones, the parietal bones articulate with the temporal bones and the greater wings of the sphenoid bone.
->In foetal and infant skulls, the bones of the calvaria are separated by dense connective tissue membranes at sutures.
->The large fibrous area where several sutures meet are called fonticuli or fontanelles.
->The softness of these bones and looseness of their connections at these sutures enable the calvaria to undergo changes of shape during birth called molding. Within a day or so after birth, the shape of the infant’s calvaria returns to normal.
->The loose construction of the new-born calvaria also allows the skull to enlarge and undergo remodelling during infancy and childhood.

->Relationships between the various bones are constantly changing during the active growth period.
->The increase in the size of the cranium is greatest during the first 2 years, the period of most rapid postnatal growth of the brain.
->The cranium normally increases in capacity until about 15 or 16 years of age; thereafter the cranium usually increases only slightly in size as its bones thicken for 3 to 4 years.

 

The Paranasal Sinuses

  • These sinuses are air-filled extensions of the respiratory part of the nasal cavity.
  • They are in the following bones, frontal, ethmoid, sphenoid and the maxilla.

The Frontal Sinuses

  • These are located between the outer and inner tables of the frontal bone, posterior to the superciliary arches.

The Ethmoidal Sinuses

  • These comprise of several small cavities, called ethmoidal air cells, within the ethmoidal labyrinth (G. labyrinthos, a maze) of the lateral mass of the ethmoid bone.

The Sphenoidal Sinuses

  • These occupy a variable amount in the body of the sphenoid bone and may extend into the wings.

The Maxillary Sinuses

  • These are the largest pair of paranasal sinuses.
  • They are pyramidal-shaped cavities that may occupy the entire bodies of the maxillae.

​​​​​​​The Tongue

  • The tongue (L. lingua; G. glossa) is a highly mobile muscular organ that can vary greatly in shape.
  • It consists of three parts, a root, body, and tip.
  • The tongue is concerned with mastication, taste, deglutition (swallowing), articulation (speech), and oral cleansing.
  • Its main functions are squeezing food into the pharynx when swallowing, and forming words during speech.


-> Most of the facial skeleton is formed by nine bones: four paired (nasal, zygomatic, maxilla, and palatine) and one unpaired (mandible).
-> The calvaria of the new-born infant is large compared with the relatively small fascial skeleton.
-> This results from the small size of the jaws and the almost complete absence of the maxillary and other paranasal sinuses in the new-born skull.
-> These sinuses form large spaces in the adult facial skeleton. As the teeth and sinuses develop during infancy and childhood, the facial bones enlarge.
-> The growth of the maxillae between the ages of 6 and 12 years accounts for the vertical elongation of the child’s face.


The Nasal Bones 

-> These bones may be felt easily because they form the bridge of the nose.
-> The right and left nasal bones articulate with each other at the internasal suture.
-> They also articulate with the frontal bones, the maxillae, and the ethmoid bones.
-> The mobility of the anteroinferior portion of the nose, supported only by cartilages, serves as a partial protection against injure (e.g., a punch in the nose). However, a hard blow to the anterosuperior bony portion of the nose may fracture the nasal bones (broken nose).
-> Often the bones are displaced sideways and/or posteriorly.

The Maxillae 

-> The skeleton of the face between the mouth and the eyes is formed by the two maxillae.
-> They surround the anterior nasal apertures and are united in the medial plane at the intermaxillary suture to form the maxilla (upper jaw).
-> This suture is also visible in the hard palate, where the palatine processes of the maxillae unite.
-> Each adult maxilla consists of: a hollow body that contains a large maxillary sinus; a zygomatic process that articulates with its mate on the other side to form most of the hard palate; and alveolar processes that form sockets for the maxillary (upper) teeth.
-> The maxillae also articulate with the vomer, lacrimal, sphenoid, and palatine bones.
-> The body of the maxilla has a nasal surface that contributes to the lateral wall of the nasal cavity; an orbital surface that forms most of the floor of the orbit; an infratemporal surface that forms the anterior wall of the infratemporal fossa; and an anterior surface that faces partly anteriorly and partly anterolaterally and is covered buy facial muscles.
-> The relatively large infraorbital foramen, which faces inferomedially, is located about 1 cm inferior to the infraorbital margin; it transmits the infraorbital nerve and vessels.
-> The incisive fossa is a shallow concavity overlying the roots of the incisor teeth, just a shallow concavity overlying the roots of the incisor teeth, just inferior to the nasal cavity. This fossa is the injection site for anaesthesia of the maxillary incisor teeth.
-> If infected maxillary teeth are removed, the bone of the alveolar processes of the maxillae begins to be reabsorbed. As a result, the maxilla becomes smaller and the shape of the face changes.
-> Owing to absorption of the alveolar processes, there is a marked reduction in the height of the lower face, which produces deep creases in the facial skin that pass posteriorly from the corners of the mouth.


The Mandible 

-> This is a U-shaped bone and forms the skeleton of the lower jaw and the inferior part of the face. It is the largest and strongest facial bone.
-> The mandibular (lower) teeth project superiorly from their sockets in the alveolar processes.
-> The mandible (L. mandere, to masticate) consists of two parts: a horizontal part called the body, and two vertical oblong parts, called rami.
-> Each ramus ascends almost vertically from the posterior aspect of the body.
-> The superior part of the ramus has two processes: a posterior condylar process with a head or condyle and a neck, and a sharp anterior coronoid process.
-> The condylar process is separated from the coronoid process by the mandibular notch, which forms the concave superior border of the mandible.
-> Viewed from the superior aspect, the mandible is horseshoe-shaped, whereas each half is L-shaped when viewed laterally.
-> The rami and body meet posteriorly at the angle of the mandible.
-> Inferior to the second premolar tooth on each side of the mandible is a mental foramen (L. mentum, chin) for transmission of the mental vessels and the mental nerve.
-> In the anatomical position, the rami of the mandible are almost vertical, except in infants and in edentulous (toothless) adults.
-> On the internal aspect of the ramus, there is a large mandibular foramen.
-> It is the oblong entrance to the mandibular canal that transmits the inferior alveolar vessels and nerve to the roots of the mandibular teeth.
-> Branches of these vessels and the mental nerve emerge from the mandibular canal at the mental foramen.
-> Running inferiorly and slightly anteriorly on the internal surface of the mandible from the mandibular foramen is a small mylohyoid groove (sulcus), which indicates the course taken by the mylohyoid nerve and vessels.
-> These structures arise from the inferior alveolar nerve and vessels, just before they enter the mandibular foramen.
-> The internal surface of the mandible is divided into two areas by the mylohyoid line, which commences posterior to the third molar tooth. -> Just superior to the anterior end of the mylohyoid line are two small, sharp mental spines (genial tubercles), which serve as attachments for the genioglssus muscles.

The Zygomatic Bones 

-> The prominences of the cheeks (L. mala), the anterolateral rims and much of the infraorbital margins of the orbits, are formed by the zygomatic bones (malar bones, cheekbones).
-> They articulate with the frontal, maxilla, sphenoid, and temporal bones.
-> The frontal process of the zygomatic bone passes superiorly, where it forms the lateral border of the orbit (eye socket) and articulates with the frontal bone at the lateral edge of the supraorbital margin.
-> The zygomatic bones articulate medially with the greater wings of the sphenoid bone. The site of their articulation may be observed on the lateral wall of the orbit.
-> On the anterolateral aspect of the zygomatic bone near the infraorbital margin is a small zygomaticofacial foramen for the nerve and vessels of the same name.
-> The posterior surface of the zygomatic bone near the base of its frontal process is pierced by a small zygomaticotemporal foramen for the nerve of the same name.
-> The zygomaticofacial and zygomaticotemporal nerves, leaving the orbit through the previously named foramina, enter the zygomatic bone through small zygomaticoorbital foramina that pierces it orbital surface.
-> The temporal process of the zygomatic bone unites with the zygomatic process of the temporal bone to form the zygomatic arch.
-> This arch can be easily palpated on the side of the head, posterior to the zygomatic prominence (malar eminence) at the inferior boundary of the temporal fossa (temple).
-> The zygomatic arches form one of the useful landmarks for determining the location of the pterion. These arches are especially prominent in emaciated persons.
-> A horizontal plane passing medially from the zygomatic arch separates the temporal fossa superiorly from the infratemporal fossa inferiorly.

Other Bones

There are several other, very important bones in the skull, including the palatine bone, ethmoid bone, vomer, inferior concha and the ossicles of the ear (malleus, incus and stapes). These, however, are covered to greater detail where they are relevant in the head (e.g., ethmoid bone with the orbit and nasal cavity).

 

Veins of the Face

The Supratrochlear Vein

  • This vessel begins on the forehead from a network of veins connected to the frontal tributaries of the superficial temporal vein.
  • It descends near the medial plane with its fellow on the other side.
  • These veins diverge near the orbits, each joining a supraorbital vein to form the facial vein near the medial canthus (angle of the eye).

 

The Supraorbital Vein

  • This vessel begins near the zygomatic process of the temporal bone.
  • It joins the tributaries of the superficial and middle temporal veins.
  • It passes medially and joins the supratrochlear vein to form the facial vein near the medial canthus.

 

The Facial Vein

  • This vein provides the major venous drainage of the face.
  • It begins at the medial canthus of the eye by the union of the supraorbital and supratrochlear veins.
  • It runs inferoposteriorly through the face, posterior to the facial artery, but takes a more superficial and straighter course than the artery.
  • Inferior to the margin of the mandible, the facial vein is joined by the anterior branch of the retromandibular vein.
  • The facial veins ends by draining into the internal jugular vein.

 

The Superficial Temporal Vein

  • This vein drains the forehead and scalp and receives tributaries from the veins of the temple and face.
  • In the region of the temporomandibular joint, this vein enters the parotid gland.

 

The Retromandibular Vein

  • The union of the superficial temporal and maxillary veins forms this vessel, posterior to the neck of the mandible.
  • It descends within the parotid gland, superficial to the external carotid artery but deep to the facial nerve.
  • It divides into an anterior branch that unites with the facial vein, and a posterior branch that joins the posterior auricular vein to form the external jugular vein.

Tongue 
Appears at 4th week.
Musculature derived from mesoderm of occipital somites.  Precursor muscles cells migrate to region of tongue and are innervated by general sensory efferent fibers of CN XII.
Mucosa derived from anterior endoderm lining arches 1-4; accordingly, innervation depends on arch derivation:
              Mucosa of anterior 2/3 of tongue comes from the first arch -> CN V
              Mucosa of posterior 1/3 of tongue comes from third and forth arch -> CN IX, X
Special taste of anterior 2/3 of tongue comes from CN VII.
Special taste of posterior 1/3 of tongue comes from CN X.
Tongue freed from floor of mouth by extensive degeneration of underlying tissue.  Midline frenulum continues to anchor tongue to floor of mouth.

Thyroid Gland

Develops as in growth of mucosal epithelium located in the midline of the tongue (at foramen cecum).  It descends along front of pharyngeal gut, but remains connected to tongue by thyrooglossal duct, which is obliterated later in development.  Thyroid gland descends to a point just caudal to laryngeal cartilages. 

Facial structures (general)

a) medial nasal prominence forms midline of nose, philtrum and primary palate
b) lateral nasal prominence forms alae of nose
c) maxillary prominence forms cheek region and lateral lip
d) clefts can form at inter-prominence fusion lines

Nose

At the time of anterior neural tube closure, mesenchyme around forebrain, frontonasal prominence (FNP), has smooth rounded extended contour.  Nasal placodes (thickening of surface ectoderm to become peripheral neural tissue) develop on frontolateral aspects of FNP.  Mesenchyme swells around nasal placode producing a medial and lateral nasal prominence (nasomedial and nasolateral processes).  These nasal prominences form the nose.

Mouth 

Stomadeum (primitive oral cavity) forms between frontonasal prominence and first pharyngeal arch.  The first pharyngeal arch forms the dorsal maxillary prominence and ventral mandibular prominence.  The maxillary prominence will merge with medial nasal prominences, pushing them closer to cause fusion.  Fused medial nasal prominences will form midline of nose and midline of upper lip (philtrum) and primary palate (first 4 teeth).

Nasolacrimal structures

Maxillary and lateral nasal prominences are separated by deep furrow, the nasolacrimal groove.  Ectoderm in floor of groove forms epithelial cord, which detaches from overlying ectoderm.  The epithelial cord canalizes to form the nasolacrimal duct.  The upper end of the duct widens to form the lacrimal sac.  After detachment of the cord, the maxillary and lateral nasal prominences merge with each other, resulting in the formation of a nasolacrimal duct that runs from the medial corner of the eye to the inferior meatus of the nasal cavity.  
The maxillary prominences enlarge to form the cheeks and maxillae.
The lateral nasal prominences form the alae of the nose.

Secondary (hard) palate

Main part of definitive palate formed by two palatine shelves derived from intraoral bilateral extensions of the maxillary prominences.  These appear at the 6th week.  They are directed obliquely downward on each side of the tongue; they move down when mandible gets bigger.  
At the seventh week, they ascend to attain a horizontal position, then fuse to form the secondary palate.  At the time the palatine shelves fuse, the nasal septum (an outgrowth of median tissue of the frontonasal prominence) grows down and joins the cephalic aspect of the newly formed palate
Anteriorly, shelves fuse with triangular primary palate.  The incisive foramen marks the midline between the primary and secondary palate.

External Ear

The auricle is derived from 6 auricular hillocks (mesenchymal proliferations) along the dorsal aspect of arches 1 (top of ear) and 2 (bottom of ear).  These fuse to form the definitive auricle.  At the mandible grows, the ear is pushed upward and backward from its initial horizontal position on the neck.
The EAM is derived from the 1st pharyngeal arch.  
The eardrum (tympanic membrane) is composed of 3 layers of cells: 1) ectodermal epithelial lining of bottom of EAM; 2) endodermal epithelium lining of tympanic cavity; 3) intermediate layer of connective tissue.
The eardrum is composed of multiple cell layers because it represents the first pharyngeal membrane, and thus lies at the junction of the first pharyngeal pouch and cleft.

Middle Ear

The middle ear consists of an auditory tube (from the 1st pharyngeal pouch, along with tympanic cavity) and the ossicles (from pharyngeal arches 1 and 2 cartilage).  
The first arch cartilage forms the malleus and incus.  The tensor tympani (muscle of the malleus) is derived from the fourth somitomere (associated with the first arch) and is therefore innervated by CN V.
The second arch cartilage forms the stapes.  The stapedius (muscles of the stapes) is derived from the sixth somitomere (associated with the second arch) and is therefore innervated by CN VII.
The ossicles are initially embedded in mesenchyme, but in the 8th month, the mesenchyme degenerates and an endodermal epithelial lining of the tympanic cavity envelops the ossicles and connects them to the wall of the cavity in a mesentery-like fashion.


Inner Ear

The inner ear is derived thickening of surface ectoderm on both sides of the hindbrain (otic placodes).  The placodes invaginate to form otic vesicles (otocytes).  The vesicles then divide into ventral and dorsal components.
The ventral component forms the saccule and cochlear duct.
The dorsal component forms the utricle and semicircular canals and endolymphatic duct.


Cochlear Duct

Derived from an outgrowth of the saccule during the 6th week.  The outgrowth penetrates the surrounding mesenchyme in a spiral fashion.  The surrounding mesenchyme forms the cartilage and undergoes vacuolization.
The scala vestibule and scale tympani form and surround the cochlear duct.  They are filled with periplymp to receive mechanical vibrations of ossicles. The mechanical stimuli activates sensory (ciliary) cells in the cochlear duct.  

Semicircular canals

The utricle is initially three flattened outpocketings, which lose the central core.  From this three semicircular canals are forms, each at 90 degree angles from one another.  Sensory cells arise in the ampulla at one end of each canal, in the utricle and saccule. 

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