NEET MDS Lessons
Anatomy
-> 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).
|
Pharyngeal Arch |
Arch Artery |
Cranial Nerve |
Skeletal elements |
Muscles |
|
1 |
Terminal Branch of maxillary artery |
Maxillary and mandibular division of trigemenial (V) |
Derived from arch cartilages (originating from neural crest): From maxillary cartilages: Alispenoid, incus From mandibular: Mackel’s cartilage, malleus
Upper portion of external ear (auricle) is derived from dorsal aspect of 1st pharyngeal arch.
Derived by direct ossification from arch dermal mesenchyme: Maxilla, zygomatic, squamous portion of temporal bone, mandible
|
Muscles of mastication (temporalis, masseter, and pterygoids), mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini (originate from cranial somitomere 4) |
|
2 |
Stapedius artery (embryologic) and cortiotympanic artery (adult) |
Facial nerve (VII) |
Stapes, styloid process, stylohyoid ligament, lesser horns and upper rim of hyoid (derived from the second arch cartilage; originate from neural crest).
Lower portion of external ear (auricle) is derived from 2nd pharyngeal arch. |
Muscles of facial expression (orbicularis oculi, orbicularis oris, auricularis, platysma, fronto-ooccipitalis, buccinator), posterior belly of digastric, stylohyoid, stapedius (originate from cranial somitomere 6) |
|
3 |
Common carotid artery, most of internal carotid |
Glossopharyngeal (IX) |
Lower rim and greater horn of hyoid (derived from the third arch cartilage; originate from neural crest cells) |
Sytlopharyngeus (originate from cranial somitomere 7) |
|
4 |
Left: Arch of aorta; Right: Right subclavian artery; Original sprouts of pulmonary arteries |
Superior laryngeal branch of vagus (X) |
Laryngeal cartilages (Derived from the 4th arch cartilage, originate from lateral plate mesoderm) |
Constrictors of pharynx, cricothyroid, levator veli palatine (originate from occipital somites 2-4) |
|
6 |
Ductus arteriosus; roots of definitive pulmonary arteries |
Recurrent laryngeal branch of vagus (X) |
Laryngeal cartilages (derived from the 6th-arch cartilage; originate from lateral plate mesoderm) |
Intrinsic muscles of larynx (originate from occipital somites 1 and 2) |
Intramembranous ossification
- Flat bones develop in this way (bones of the skull)
- This type of bone development takes place in mesenchymal tissue
- Mesenchymal cells condense to form a primary ossification centre (blastema)
- Some of the condensed mesenchymal cells change to osteoprogenitor cells
- Osteoprogenitor cells change into osteoblasts which start to deposit bone
- As the osteoblasts deposit bone some of them become trapped in lacunae in the bone and then change into osteocytes
- Osteoblasts lie on the surface of the newly formed bone
- As more and more bone is deposited more and more osteocytes are formed from mesenchymal cells
- The bone that is formed is called a spicule
- This process takes place in many places simultaneously
- The spicules fuse to form trabeculae
- Blood vessels grow into the spaces between the trabeculae
- Mesenchymal cells in the spaces give rise to hemopoetic tissue
- This type of bone development forms the first phase in endochondral development
- It is also responsible for the growth of short bones and the thickening of long bones
- Provides a rigid support system
- Protects delicate structures (e. g., the protection provided by the bones of the vertebral column to the spinal cord)
- Bones supply calcium to the blood; are involved In the formation of blood cells (hemopoiesis)
- Bones serve as the basis of attachment of muscles; form levers in the joint areas, aIlowing movement
The Auditory Tube
- This is a funnel-shaped tube connecting the nasopharynx to the tympanic cavity.
- Its wide end is towards the nasopharynx, where it opens posterior to the inferior meatus of the nasal cavity.
- The auditory tube is 3.5 to 4 cm long; its posterior 1/3 is bony and the other 2/3 is cartilaginous.
- It bony part lies in a groove on the inferior aspect of the base of the skull, between the petrous part of the temporal bone and the greater wing of the sphenoid bone.
- The function of the auditory tube is to equalise pressure of the middle ear with atmospheric pressure.
Histology
Histology is the study of tissues.
A tissue is a group of cells with similar structure and function plus the extracellular substances located between the cells.
There are four basic types of tissues:
- Epitheliums
- Connective tissue
- Muscle tissue
- Nervous tissue
Blood Supply to the Head and Neck
- Most arteries in the anterior cervical triangle arise from the common carotid artery or one of the branches of the external carotid artery.
- Most veins in the anterior cervical triangle are tributaries of the large internal jugular vein.
The Common Carotid Arteries
- The right common carotid artery begins at the bifurcation of the brachiocephalic trunk, posterior to the right sternoclavicular joint.
- The left common carotid artery begins arises from the arch of the aorta and ascends into the neck, posterior to the left sternoclavicular joint.
- Each common carotid artery ascends into the neck within the carotid sheath to the level of the superior border of the thyroid cartilage.
- Here it terminates by dividing into the internal and external carotid arteries.
The Internal Carotid Artery
- This is the direct continuation of the common carotid artery and it has no branches in the neck.
- It supplies structures inside the skull.
- The internal carotid arteries are two of the four main arteries that supply blood to the brain.
- Each artery arises from the common carotid at the level of the superior border of the thyroid cartilage.
- It then passes superiorly, almost in a vertical plane, to enter the carotid canal in the petrous part of the temporal bone.
- A plexus of sympathetic fibres accompany it.
- During its course through the neck, the internal carotid artery lies on the longus capitis muscle and the sympathetic trunk.
- The vagus nerve (CN X) lies posterolateral to it.
- The internal carotid artery enters the middle cranial fossa beside the dorsum sellae of the sphenoid bone.
- Within the cranial cavity, the internal carotid artery and its branches supply the hypophysis cerebri (pituitary gland), the orbit, and most of the supratentorial part of the brain.
The External Carotid Arteries
- This vessel begins at the bifurcation of the common carotid, at the level of the superior border of the thyroid cartilage.
- It supplies structures external to the skull.
- The external carotid artery runs posterosuperiorly to the region between the neck of the mandible and the lobule of the auricle.
- It terminates by dividing into two branches, the maxillary and superficial temporal arteries.
- The stems of most of the six branches of the external carotid artery are in the carotid triangle.
The Superior Thyroid Artery
- This is the most inferior of the 3 anterior branches of the external carotid.
- It arises close to the origin of the vessel, just inferior to the greater horn of the hyoid.
- The superior thyroid artery runs anteroinferiorly, deep to the infrahyoid muscles and gives off the superior laryngeal artery. This artery pierces the thyrohyoid membrane in company with the internal laryngeal nerve and supplies the larynx.
The Lingual Artery
- This arises from the external carotid artery as it lies on the middle constrictor muscle of the pharynx.
- It arches superoanteriorly, about 5 mm superior to the tip of the greater horn of the hyoid bone, and then passes deep to the hypoglossal nerve, the stylohyoid muscle, and the posterior belly of digastric muscle.
- It disappears deep to the hyoglossus muscle.
- At the anterior border of this muscle, it turns superiorly and ends by becoming the deep lingual artery.
The Facial Artery
- This arises from the carotid artery either, in common with the lingual artery, or immediately superior to it.
- In the neck the facial artery gives off its important tonsillar branch and branches to the palate and submandibular gland.
- The facial artery then passes superiorly under the cover of the digastric and stylohyoid muscles and the angle of the mandible.
- It loops anteriorly and enters a deep groove in the submandibular gland.
- The facial artery hooks around the inferior border of the mandible and enters the face. Here the pulsation of this artery can be felt (anterior to the masseter muscle).
The Ascending Pharyngeal Artery
- This is the 1st or 2nd branch of the external carotid artery.
- This small vessel ascends on the pharynx, deep to the internal carotid artery.
- It sends branches to the pharynx, prevertebral muscles, middle ear and meninges.
The Occipital Artery
- This arises from the posterior surface of the external carotid near the level of the facial artery.
- It passes posteriorly along the inferior border of the posterior belly of digastric.
- It ends in the posterior part of the scalp.
- During its course, it is superficial to the internal carotid artery and three cranial nerves (CN IX, CN X and CN XI).
The Posterior Auricular Artery
- This is a small posterior branch of the external carotid artery.
- It arises from it at the superior border of the posterior belly of the digastric muscle.
- It ascends posteriorly to the external acoustic meatus and supplies adjacent muscles, the parotid gland, the facial nerve, structures in the temporal bone, the auricle, and the scalp.
The Internal Jugular Vein
- This is usually the largest vein in the neck.
- The internal jugular vein drains blood from the brain and superficial parts of the face and neck.
- Its course corresponds to a line drawn from a point immediately inferior to the external acoustic meatus to the medial end of the clavicle.
- This large vein commences at the jugular foramen in the posterior cranial fossa, as the direct continuation of the sigmoid sinus.
- The dilation at its origin is called the superior bulb of the internal jugular vein.
- From here it runs inferiorly through the neck in the carotid sheath.
- The internal jugular vein leaves the anterior triangle of the neck by passing deep to the SCM muscle.
- Posterior to the sternal end of the clavicle, it unites with the subclavian vein to form the brachiocephalic vein.
- Near its termination is the inferior bulb of the jugular vein contains a bicuspid valve similar to that of the subclavian vein.
- The deep cervical lymph nodes lie along the course of the internal jugular vein, mostly lateral and posterior.
Tributaries of the Internal Jugular Vein
- This large vein is joined at its origin by the: inferior petrosal sinus, the facial, lingual, pharyngeal, superior and middle thyroid veins, and often the occipital vein.