NEET MDS Lessons
Anatomy
The Medial Pterygoid Muscle
- This is a thick, quadrilateral muscle that also has two heads or origin.
- It embraces the inferior head of the lateral pterygoid muscle.
- It is located deep to the ramus of the mandible.
- Origin: deep head—medial surface of lateral pterygoid plate and pyramidal process of palatine bone, superficial head—tuberosity of maxilla.
- Insertion: medial surface of ramus of mandible, inferior to mandibular foramen.
- Innervation: mandibular nerve via medial pterygoid nerve.
- It helps to elevate the mandible and closes the jaws.
- Acting together, they help to protrude the mandible.
- Acting alone, it protrudes the side of the jaw.
- Acting alternately, they produce a grinding motion.
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.
Vessels of the Palate
- The palate has a rich blood supply from branches of the maxillary artery.
Classification
Epitheliums can be classified on appearance or on function
Classification based on appearance
- Simple - one layer of cells
- Pseudostratified - looks like more than one layer but is not
- Stratified - more than one layer of cells
Simple epitheliums
Simple squamous epithelium
Cells are flat with bulging or flat nuclei. Lines the insides of lung alveoli and certain ducts in the kidney
Forms serous membranes called mesothelium that line cavities like: pericardial , peritoneal, plural
Lines blood vessels - known as endothelium
Simple cuboidal epithelium
It appears square in cross section, Found in: - Ducts of salivary glands, Follicles of the thyroid gland, Pigment layer in the eye, Collecting ducts of the kidney, In the middle ear is ciliated type.
Simple columnar
- Lines the gastrointestinal tract from the stomach to the anal canal, Some columnar cells have a secretory function – stomach, peg cells in the oviduct, Some columnar cells have microvilli on their free border (striated border) – gall bladder, duodenum
- Microvilli increase the surface area for absorption
- Some columnar cells have cilia – oviduct, smaller bronchi
- Cilia transport particles
Pseudostratified
Appears as stratified epithelium but all cells are in contact with the basement membrane. Has a thick basement membrane. Different cell types make up this epithelium, Cells that can be found in this type of epithelium are:
- Columnar cells with cilia or microvilli.
- Basal cells that do not reach the surface.
- Goblet cells that secrete mucous.
- Found in the trachea, epididymus, ductus deferens and female urethra
Stratified epithelium
Classified according to the shape of the surface cells
Stratified squamous epithelium
Has a basal layer that varies from cuboidal to columnar cells that divide to form new cells. Two types are found:
Keratinized: Mostly forms a dry covering, The middle layers consists of cells that are forming- and filling up with keratin. The superficial cells form a tough non living layer of keratin, Keratin is a type of protein, The skin is of this type has thick skin - found on the hand palms and soles of the feet, thin skin - found on the rest of the body
Non-keratinized: Top layer of cells are living cells with nuclei Forms a wet covering, The middle layers are polyhedral, The surface layer consists of flat squamous cells
- Is found in: mouth, oesophagus, vagina
Stratified cuboidal epithelium
Found: - in the ducts of sweat glands
Stratified columnar epithelium
Found at the back of the eyelid (conjunctiva)
Transitional epithelium
- Sometimes the surface cells are squamous, sometimes cuboidal and sometimes columnar
- The superficial cells are called umbrella cells because they can open and close like umbrellas, when the epithelium stretch and shrink
- Umbrella cells can have 2 nuclei
- Found in the bladder and ureter
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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Ossification
- Intramembranous-found in the flat bones of the face
- Mesenchymal cells cluster and form strands
- Strands are cemented in a uniform network. Which is known as osteoid
- Calcium salts are deposited; osteoid is converted to bone
- Trabeculae are formed and make cancellous bone with open spaces known as marrow cavities
- Periosteum forms on the inner and outer surfaces of the ossification centers
- Surface bone becomes compact bone
- Endochondral-primary type of ossification In the human
Extrinsic Muscles of the Tongue (p. 746)
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 Palatoglossus Muscle
- Superior attachment: palatine aponeurosis.
- Inferior attachment: side of tongue.
- Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
- This muscle, covered by mucous membrane, forms the palatoglossal arch.
- The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.
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.