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Anatomy

Nerve Supply of the Muscles of the Orbit (pp. 715-6)

  • Three cranial nerves supply the muscles of the eyeball; the oculomotor (CN III), trochlear (CN IV) and abducent (CN IV) nerves.
  • All three enter the orbit via the superior orbital fissure.
  • The trochlear nerve supplies the superior oblique muscle.
  • The abducent nerve supplies the lateral rectus muscle.
  • The oculomotor nerve supplies everything else.
  • A mnemonic that is used is this formula for this strange sulfate: SO4(LR6)3

Smooth Muscle

Light microscopic Structure:

cells - long - spindle shaped,  nucleus lies in the widest widest part of the fiber,  when the fiber contract the nucleus become folded, 30 - 200 µm long,between fibres lie endomycium

Electron microscopic structure:

 Mitochondria, ribosomes, golgi, rough EPR, myofilaments are present but no sarcomeres and no Z lines,thin filaments - actin and tropomyosin (7nm), thick filaments - myosin (17nmØ)

- intermediate filaments (10 nm)

- actin and myosin overlap more than in skeletal muscle and can therefore contract more

 A rudimentary sacroplasmic reticulum is present in the form of invaginations on the surface called caveolae , So there are no T-tubules,  Cells communicate through gap junctions.

Dense bodies

Filaments are attached to dense bodies which take the place of the Z line in skeletal muscle

There are two types of dense bodies - cytoplasmic and membrane

contains a percentage actinin (like the Z line)

dense bodies transmit contractile force to adjacent fibres

 

Arrangement:

Fibres can be single or in groups, normally arranged in sheaths,  In the GIT are 2 or 3 layers

Nerve supply:

2 types:

Where it is arranged in layers a few fibres are innervated together

impulse spread through the gap junctions between fibres (slow contraction)

In the iris and the vas deferens each fiber is individually supplied (quick contraction)

The Pharynx

  • The pharynx is the continuation of the digestive system from the oral cavity.
  • It is a funnel-shaped fibromuscular tube that is the common route for both food and air.
  • The pharynx is located posterior to the nasal and oral cavities, and the larynx.
  • For the convenience of description, the pharynx is divided into three parts: (1) the nasopharynx, posterior to the nose and superior to the soft palate; (2) the oropharynx, posterior to the mouth; and (3) the laryngopharynx, posterior to the larynx.
  • The pharynx is about 15 cm long.
  • It extends from the base of the skull to the inferior border of the cricoid cartilage anteriorly, and to the inferior border of C6 vertebra posteriorly.
  • It is widest (about 5 cm) opposite the hyoid bone and narrowest (about 1.5) at its inferior end, where it is continuous with the oesophagus.
  • The posterior wall of the pharynx lies against the prevertebral fascia, with the potential retropharyngeal space between them.

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.

The Temporomandibular Joint

  • This articulation is a modified hinge type of synovial joint.
  • The articular surfaces are: (1) the head or condyle of the mandible inferiorly and (2) the articular tubercle and the mandibular fossa of the squamous part of the temporal bone.
  • An oval fibrocartilaginous articular disc divides the joint cavity into superior and inferior compartments. The disc is fused to the articular capsule surrounding the joint.
  • The articular disc is more firmly bound to the mandible than to the temporal bone.
  • Thus, when the head of the mandible slides anterior on the articular tubercle as the mouth is opened, the articular disc slides anteriorly against the posterior surface of the articular tubercle

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.

Muscles of the Tongue

  • The tongue is divided into halves by a medial fibrous lingual septum that lies deep to the medial groove.
  • In each half of the tongue there are four extrinsic and four intrinsic muscles.
  • The lingual muscles are all supplied by the hypoglossal nerve (CN XII).
  • The only exception is palatoglossus, which is supplied by the pharyngeal branch of the vagus nerve, via the pharyngeal plexus.

 

Extrinsic Muscles of the Tongue

The Genioglossus Muscle

  • This is a bulky, fan-shaped muscle that contributes to most of the bulk of the tongue.
  • It arises from a short tendon from the genial tubercle (mental spine) of the mandible.
  • It fans out as it enters the tongue inferiorly and its fibres attach to the entire dorsum of the tongue.
  • Its most inferior fibres insert into the body of the hyoid bone.
  • The genioglossus muscle depresses the tongue and its posterior part protrudes it.

 

The Hyoglossus Muscle

  • This is a thin, quadrilateral muscle.
  • It arises from the body and greater horn of the hyoid bone and passes superoanteriorly to insert into the side and inferior aspect of the tongue.
  • It depresses the tongue, pulling its sides inferiorly; it also aids in retrusion of the tongue.

 

The Styloglossus Muscle

  • This small, short muscle arises from the anterior border of the styloid process near its tip and from the stylohyoid ligament.
  • It passes inferoanteriorly to insert into the side and inferior aspect of the tongue.
  • The styloglossus retrudes the tongue and curls its sides to create a trough during swallowing. 

 

The Palatopharyngeus Muscle

  • Superior attachment: hard palate and palatine aponeurosis.
  • Inferior attachment: lateral wall of pharynx.
  • Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
  • This thin, flat muscle is covered with mucous membrane to form the palatopharyngeal arch.
  • It passes posteroinferiorly in this arch.
  • This muscle tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly and medially during swallowing. 

Intrinsic Muscles of the Tongue

The Superior Longitudinal Muscle of the Tongue

  • The muscle forms a thin layer deep to the mucous membrane on the dorsum of the tongue, running from its tip to its root.
  • It arises from the submucosal fibrous layer and the lingual septum and inserts mainly into the mucous membrane.
  • This muscle curls the tip and sides of the tongue superiorly, making the dorsum of the tongue concave.

 

The Inferior Longitudinal Muscle of the Tongue

  • This muscle consists of a narrow band close to the inferior surface of the tongue.
  • It extends from the tip to the root of the tongue.
  • Some of its fibres attach to the hyoid bone.
  • This muscle curls the tip of the tongue inferiorly, making the dorsum of the tongue convex.

The Transverse Muscle of the Tongue

  • This muscle lies deep to the superior longitudinal muscle.
  • It arises from the fibrous lingual septum and runs lateral to its right and left margins.
  • Its fibres are inserted into the submucosal fibrous tissue.
  • The transverse muscle narrows and increases the height of the tongue.

The Vertical Muscle of the Tongue

  • This muscle runs inferolaterally from the dorsum of the tongue.
  • It flattens and broadens the tongue.
  • Acting with the transverse muscle, it increases the length of the tongue.

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