NEET MDS Lessons
Anatomy
The Orbital Vessels
- The orbital contents are supplied chiefly by the ophthalmic artery.
- The infraorbital artery, the continuation of the maxillary, also contributes blood to this region.
- Venous drainage is through the superior orbital fissure to enter the cavernous sinus.
The Ophthalmic Artery
- This artery arises from the internal carotid artery as it emerges from the cavernous sinus.
- It passes through the optic foramen within the dural sheath of the optic nerve and runs anteriorly, close to the superomedial wall of the orbit.
The Central Artery of the Retina
- This is the one of the smallest but most important branches of the ophthalmic artery.
- It arises inferior to the optic nerve until it approaches the eyeball.
- It then pierces the optic nerve and runs within it to emerge through the optic disc.
- The central artery of the retina spreads over the internal surface of the retina and supplies it.
The Ophthalmic Veins
The Superior Ophthalmic Vein
- The superior ophthalmic vein anastomoses with the facial vein.
- It has no valves and blood can flow in either direction.
- It crosses superior to the optic nerve, passes through the superior orbital fissure and ends in the cavernous sinus.
The Inferior Ophthalmic Vein
- This begins as a plexus on the floor of the orbit.
- It communicates with the inferior orbital fissure with the pterygoid plexus, crosses inferior to the optic nerve, and ends in either the superior ophthalmic vein or the cavernous sinus.
Connective Tissue
Functions of Connective tissue:
→ joins together other tissues
→ supporting framework for the body (bone)
→ fat stores energy
→ blood transports substances
Connective tissue is usually characterized by large amounts of extracellular materials that separate cells from each other, whereas epithelial tissue is mostly cells with very little extracellular material. The extracellular substance of connective tissue consists of protein fibers which are embedded in ground substance containing tissue fluid.
Fibers in connective tissue can be divided into three types:
→ Collagen fibers are the most abundant protein fibers in the body.
→ Elastic fibers are made of elastin and have the ability to recoil to original shape.
→ Reticular fibers are very fine collagen fibers that join connective tissues to other tissues.
Connective tissue cells are named according to their functions:
→ Blast cells produce the matrix of connective tissues
→ Cyte cells maintains the matrix of connective tissues
→ Clast cells breaks down the matrix for remodeling (found in bone)
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 Lateral Wall of the Orbit
- This wall is thick, particularly its posterior part, which separates the orbit from the middle cranial fossa.
- The lateral wall is formed by the frontal process of the zygomatic bone and the greater wing of the sphenoid bone.
- Anteriorly, the lateral wall lies between the orbit and the temporal fossa.
- The lateral wall is partially separated from the roof by the superior orbital fissure.
Nerves of the Palate
- The sensory nerves of the palate, which are branches of the pterygopalatine ganglion, are the greater and lesser palatine nerves.
- They accompany the arteries through the greater and lesser palatine foramina, respectively.
- The greater palatine nerve supplies the gingivae, mucous membrane, and glands of the hard palate.
- The lesser palatine nerve supplies the soft palate.
- Another branch of the pterygopalatine ganglion, the nasopalatine nerve, emerges from the incisive foramen and supplies the mucous membrane of the anterior part of the hard palate.
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.
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.