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Anatomy

 
Anterior 2/3 of tongue Posterior 1/3 of tongue
Motor Innervation All muscles by hypoglossal nerve (CN XII) except palatoglossus muscle (by the pharyngeal plexus)
General Sensory Innervation
Lingual nerve (branch of mandibular nerve CN V3) Glossopharyngeal nerve (CN IX)
Special Sensory Innervation
Chorda tympani nerve (branch of facial nerve) Glossopharyngeal nerve (CN IX)

The Laryngopharynx

  • The laryngeal part of the pharynx lies posterior to the larynx.
  • It extends from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it narrows to become continuous with the oesophagus.
  • Posteriorly, the laryngopharynx is related to the bodies of C4 to C6 vertebrae.
  • Its posterior and lateral walls are formed by the middle and inferior constrictor muscles, with the palatopharyngeus and stylopharyngeus internally.
  • The laryngopharynx communicates with the larynx through the aditus or inlet of the larynx.
  • The piriform recess is a small, pear-shaped depression of the laryngopharyngeal cavity on each side of the inlet of the larynx.

The Medial Wall of the Orbit 

  • This wall is paper-thin and is formed by the orbital lamina or lamina papyracea of the ethmoid bone, along with contributions from the frontal, lacrimal, and sphenoid bones (L. papyraceus, "made of papyrus" or parchment paper).
  • There is a vertical lacrimal groove in the medial wall, which is formed anteriorly by the maxilla and posteriorly by the lacrimal bone.
  • It forms a fossa for the lacrimal sac and the adjacent part of the nasolacrimal duct.
  • Along the suture between the ethmoid and frontal bones are two small foramina; the anterior and posterior ethmoidal foramina.
  • These transmit nerves and vessels of the same name.

Mylohyoid Muscle

  • Origin: Mylohyoid line of the mandible.
  • Insertion: Median raphe and body of the hyoid bone.
  • Nerve Supply: Nerve to mylohyoid (branch of the trigeminal nerve, CN V3).
  • Arterial Supply: Sublingual branch of the lingual artery and submental branch of the facial artery.
  • Action: Elevates the hyoid bone, base of the tongue, and floor of the mouth; depresses the mandible.

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.

Eye 

At week 4, two depressions are evident on each of the forebrain hemispheres.  As the anterior neural fold closes, the optic pits elongate to form the optic vesicles.  The optic vesicles remain connected to the forebrain by optic stalks. 
The invagination of the optic vesicles forms a bilayered optic cup.  The bilayered cup becomes the dual layered retina (neural and pigmented layer)
Surface ectoderm forms the lens placode, which invaginates with the optic cup.
The optic stalk is deficient ventrally to contain choroids fissure to allow blood vessels into the eye (hyaloid artery).  The artery feeds the growing lens, but will its distal portion will eventually degenerate such that the adult lens receives no hyaloid vasculature.
At the 7th week, the choroids fissure closes and walls fuse as the retinal nerve get bigger.
The anterior rim of the optic vesicles forms the retina and iris.  The iris is an outgrowth of the distal edge of the retina.
Optic vesicles induces/maintains the development of the lens vesicle, which forms the definitive lens.  Following separation of the lens vesicle from the surface ectoderm, the cornea develops in the anterior 1/5th of the eye.
The lens and retina are surrounded by mesenchyme which forms a tough connective tissue, the sclera, that is continuous with the dura mater around the optic nerve.  
Iridopupillary membrane forms to separate the anterior and posterior chambers of the eye.  The membrane breaks down to allow for the pupil
Mesenchyme surrounding the forming eye forms musculature (ciliary muscles and pupillary muscles – from somitomeres 1 and 2; innervated by CN III), supportive connective tissue elements and vasculature.


Eyelids

Formed by an outgrowth of ectoderm that is fused at its midline in the 2nd trimester, but later reopen.

- The forehead is formed by the smooth, broad, convex plate of bone called the frontal squama.
- In foetal skulls, the halves of the frontal squama are divided by a metopic suture.
- In most people, the halves of the frontal bone begin to fuse during infancy and the suture between is usually not visible after 6 years of age.
- The frontal bone forms the thin roof of the orbits (eye sockets).
- Just superior to and parallel with each supraorbital margin is a bony ridge, the superciliary arch, which overlies the frontal sinus. This arch is more pronounced in males.
- Between these arches there is a gently, rounded, medial elevation called the gabella; this term derives from the Latin word glabellus meaning smooth and hairless. In most people, the skin over the gabella is hairless.
-The slight prominences of the forehead on each side, superior to the superciliary arches, are called frontal eminences (tubers).
- The supraorbital foramen (occasionally a notch), which transmits the supraorbital vessels and nerve is located in the medial part of the supraorbital margin.
- The frontal bone articulates with the two parietal bones at the coronal suture.
-It also articulates with the nasal bones at the frontonasal suture. At the point where this suture crosses the internasal suture in the medial plane, there is an anthropological landmark called the nasion . The depression is located at the root of the nose, where it joins the cranium.
- The frontal bone also articulates with the zygomatic, lacrimal, ethmoid, and sphenoid bones.
In about 8% of adult skulls, a remnant of the inferior part of the metopic (interfrontal) suture is visible. It may be mistaken in radiographs for a fracture line by inexperienced observers.
- The superciliary arches are relatively sharp ridges of bone and a blow to them may lacerate the skin and cause bleeding.
- Bruising of the skin over a superciliary arch causes tissue fluid and blood to accumulate in the surrounding connective tissue, which gravitates into the upper eyelid and around the eye. This results in swelling and a "black eye".
- Compression of the supraorbital nerve as it emerges from its foramen causes considerable pain, a fact that may be used by anaesthesiologists and anaesthetists to determine the depth of anaesthesia and by physicians attempting to arouse a moribund patient.

 

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