(BQ) Part 2 book Succinct concise anatomy for dental students with mCQs has contents: Nose and paranasal sinuses, cranial cavity, ventricular system, miscellaneous, histology, embryology, mandible, diencephalons, cerebellum,... and other contents.
17 Tongue Tongue is a mobile muscular organ present in the oral cavity For Personal Use Only Library Of School Of Dentistry.Tums Functions of Tongue Speech Taste Mastication Deglutition Development (See chapter 29, Embryology) Anatomical Features Tongue consists of two parts: • Oral part – Anterior 2/3rd • Pharyngeal part – Posterior 1/3rd – Conical in shape – Presents following features Tip Anterior end of the tongue and lies in contact with the incisor teeth Base Formed by the posterior 1/3rd of tongue Connected to the epiglottis by folds of mucous membrane • Median glossoepiglottic fold • Right lateral glossoepiglottic fold • Left lateral glossoepiglottic fold On either side of median fold is present a depression called vallecula Root Part of tongue attachéd to the floor of mouth Two Lateral Margin Present on either side of tongue Two surfaces: Dorsal Ventral / Inferior Dorsal surface of tongue • Convex on all sides • Divided into two by an inverted ‘V’ shaped sulcus, known as sulcus terminalis • Apex of sulcus is directed backward and is marked by a shallow depression called foramen cecum • Foramen cecum represents the site of embryological origin of thyroid gland • Two parts a Presulcal / Oral part - Constitute anterior 2/3rd of dorsal surface - Numerous papillae of different types are present b Postsulcul / Pharyngeal part - Large number of lymphoid follicles known as lingual tonsil are present - No papillae are present Dorsal surface of tangue as shown in Fig 17.1 Papillae of Tongue Five Types Vallate – Largest in diameter – 8-12 in number – Situated in front of sulcus terminalis Fungiform – Numerous rounded reddish elevation – Present near the tip and margins of the tongue For Personal Use Only Library Of School Of Dentistry.Tums 92 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 17.1: Dorsal surface of tongue Filiform – Most numerous – Covers most of the presulcul area – Impart a velvety appearance Foliaite – Present on the margin of tongue in front of sulcus terminalis Papillae simplex – These are not surface projection and can be seen in microscope Taste Buds • All papillae except filiform contains taste bud • Present at following site – Anterior 2/3rd of dorsum of tongue – Inferior surface of soft palate – Palatoglossal arch – Posterior surface of epiglottis – Posterior wall of oropharynx Four types of taste sensation: Salt Sweet Sour Bitter Features • • • • Frenulum linguae Lingual veins Plica fimbriata Sublingual papilla Muscles of Tongue • Tongue is divided into two symmetrical halves by a median fibrous septum • Each halves contains – – Four intrinsic muscle (alter the shape) – Four extrinsic muscle (alter the position) Ventral / Inferior Surface of tongue Does not contain papillae (Fig 17.2) Fig 17.2: Ventral surface of tongue Tongue 93 For Personal Use Only Library Of School Of Dentistry.Tums Table 17.1: Intrinsic muscles of tongue Intrinsic muscle • Superior longitudinal Origin Median septum Insertion Margin of tongue • Inferior longitudinal Posterior sides of the tongue Medial septum • Transverse linguae Median septum • Verticalis linguae Lamina propria of dorsum of Sides of tongue tongue Margins of tongue Action • Shorten the tongue • Make the dorsum concave • Shorten the tongue • Make the dorsum convex • Decrease the width of tongue and elongate it • Increases the width and flattens it Fig 17.3: Intrinsic muscles of tongue Table 17.2: Extrinsic muscles of tongue Extrinsic muscle Origin • Hyoglossus quadrilat- Greater cornua of hyoid eral shape bone Body of hyoid • Genioglossus (Bulk of Superior genial tubertongue) – Fan shaped cles or spine Insertion Action Sides of tongue between • Depresses the sides of the styloglossus and inferitongue or longitudinal muscles • Makes the dorsal surface convex Throughout the tongue • Protrude tongue tip from apex of root • Make the dorsum concave Body to hyoid • Prevents the tongue from falling back • Styloglossus – Elongated Tip of styloid process Along the entire length • Draw the tongue upwards and Stylomandibular liga- of side of tongue backwards ment • Antagonist to genioglossus • Palatoglossus Slender Oral surface of palatine Side of tongue at the • Pulls up the curve of tongue aponeurosis junction of its oral and • Approximates the palatoglospharyngeal part sal arches to decrease width of oropharyngeal isthmus Intrinsic Muscle Extrinsic Muscle See Table 17.1 and Figure 17.3 See Table 17.2 and Figure 17.4 For Personal Use Only Library Of School Of Dentistry.Tums 94 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 17.4: Extrinsic muscles of tongue Motor Supply • Internal laryngeal branch of superior laryngeal nerve: Convey taste sensation Somatomotor Arterial Supply • Hypoglossal nerve: Supplies all extrinsic and intrinsic muscles except palatoglossus muscle • Cranial part of accessory nerve through pharyngeal plexus Lingual artery, branch of external carotid artery – Chief artery Ascending palatine Tonsillar artery Secretomotor to Lingual Glands Venous Drainage • Preganglionic fibers : Arise in superior salivatory nucleus pass through submandibular ganglion via facial nerve, chorda tympani and lingual nerve • Postganglionic fibers : Conveyed via lingual nerve Superficial veins Deep vein of tongue – Principle vein Nerve Supply Vasomotor • Derived from the sympathetic plexus around lingual artery Sensory Supply • Lingual nerve: Receives general sensation from anterior 2/3rd of tongue • Chorda tympani: Receives taste sensation from anterior 2/3rd except form vallate papillae • Glossopharyngeal nerve: Conveys all sensation from posterior 1/3rd of tongue Lymphatic Drainage (Fig 17.5) Grouped into three: Tip and inferior surface of tongue—submental lymph nodes Anterior 2/3rd of dorsum of tongue—submandibular lymph nodes, and then to deep cervical lymph nodes Posterior 1/3rd of dorsum of tongue—upper deep cervical lymph nodes Clinical and Applied Anatomy Congenital anomalies of tongue can be: a Aglossia b Bifid tongue Tongue 95 For Personal Use Only Library Of School Of Dentistry.Tums Fig 17.5: Lymphatic drainage of tongue c Lingual thyroid d Tongue tie Previous Year Questions Describe tongue under following heads: a Musculature b Development c Histology of anterior 2/3rd of tongue Write sensory, gustatory and motor nerve supply of tongue Write short note on Describe tongue under following headings a Innervations b Blood supply c Lymphatic drainage Multiple Choice Questions Which cranial nerve carries the taste sensations from posterior 1/3rd of tongue: a Glossopharyngeal b Facial nerve c Trigeminal nerve d Vagus Taste sensation from anterior 2/3rd of tongue is carried by: a Hypoglossal nerve b Chorda tympani nerve c Glossopharyngeal nerve d Vagus nerve Answers (a) (b) (a) (a) (a) (d) Lymphatic vessels of tongue drain primarily into the: a Deep cervical nodes b Parotid nodes c Submental nodes d Submandibular nodes Taste buds are predominantly located in which papillae: a Circumvallate b Filiform c Fungiform d Foliate The papillae present on margins of tongue: a Fungiform b Filiform c Vallate d Foliate Muscles of tongue are supplied by: a Glossopharyngeal nerve b Lingual nerve c Chorda tympani d Hypoglossal nerve Main arterial supply to the tongue is: a Ascending palatine artery b Ascending pharyngeal artery c Lingual artery d Facial artery Hypoglossal nerve supplies to all the following muscle except: a Palatoglossus b Genioglossus c Hyoglossus d Styloglossus Safety muscle of tongue is: a Hyoglossus b Genioglossus c Palatoglossus d Styloglossus 10 Palsy of right genioglossus causes: a Deviation of tongue to right b Deviation of tongue to left c Deviation of soft palate to right d Deviation of soft palate to left (c) (a) (b) 10 (a) For Personal Use Only Library Of School Of Dentistry.Tums 18 Nose and Paranasal Sinuses Nose Nasal Cavity • Most proximal part of upper respiratory system • Lined by respiratory and olfactory epithelium • It consists of external nose and nasal cavity • Extends from nostrils in front of the posterior nasal apperture behind • Subdivided into two parts by nasal septum • Each nasal cavity presents with following boundaries External Nose Forms a pyramidal projection in the middle of the face Boundaries Features Very narrow Formed by cribriform plate of ethmoid bones Anterior part – formed by nasal bones Posterior part – formed by anterior sphenoid bones • Lined by olfactory epithelium Type or apex: Lower free end of nose Root: Forehead Dorsum: Rounded border between top and root of nose Nostrils / Nares: Two piriform shaped appertures present at broad lower part of nose Nerve Supply External nasal, infratrochlear and infraorbital nerve Skeleton of External Nose Formed by bones and cartilages: • Bony framework – Two nasal bone – forming bridge of nose – Frontal process of maxillae • Cartilaginous framework – main cartilage – Two lateral alar cartilages or superior nasal cartilage i One upper ii One lower – A single median septal cartilage – Two major alar cartilage/Inferior nasal cartilage Roof • • • • Floor • Horizontal • Formed by upper surface of hard palate Medial wall / Nasal septum • Formed by various bones and cartilages • It is osseocartilagenous partition between two halves of nasal cavity • Lined by mucous membrane Nasal cavity of nasal septum and nasal septum of arterial supply are shown in Figures 18.1 and 18.2 and Tables 18.1 and 18.2 Arterial Supply Septal branch of anterior ethmoid artery– Ophthalmic artery Septal branch of sphenopalatine artery–Maxillary artery Nose and Paranasal Sinuses 97 For Personal Use Only Library Of School Of Dentistry.Tums Fig 18.1: Nasal septum of nasal cavity Fig 18.2: Arterial supply of nasal septum Table 18.1: Nasal cavity of nasal septum Bony part • Vomer • Perpendicular plate of ethmoid • Nasal spine of frontal bone • Nasal crest of nasal bone • Sphenoidal crest / Rostrum • Palatine processes of maxilla • Horizontal plates of palatine bones Table 18.2: Nasal sepfum of arterial supply Cartilaginous part Bony part • Septal cartilage • Septal process of inferior nasal cartilage • Jacobson’s cartilage Anteriorly • Superior/lateral • Nasal nasal cartilage • Frontal process of maxilla • Inferior/major nasal • Lacrimal bone cartilage • Superior and middle con- • or tiny alar cartichae with Labyrinth of lage ethmoid • Inferior nasal conchae Posteriorly • Perpendicular plates of palatine • Medial pterygoid plate of sphenoid Lined by mucous membrane Cartilaginous part Lined by skin 98 SUCCINCT Concise Anatomy for Dental Students with MCQs Septal branch of greater palatine artery Septal branch of superior labial artery–Facial artery Venous Drainage • Veins form plexes in Litte’s area • Plexus drains anteriorly into facial vein • Posteriorly into plerygoid venous plexus For Personal Use Only Library Of School Of Dentistry.Tums Nerve Supply • Olfactory nerves – 5-20 in number of and supply olfactory zone • Internal nasal branch of anterior ethmoidal nerve – Anterosuperior part • Medial posterior superior alveolar nerve – Intermediate part • Nasopalatine nerve – Supply posterior part • Nasal branch of greater palatine nerve – Supply posterior part • Anterior superior alveolar – Antero inferior part • External nasal nerve, from anterior ethmoid – Lower mobile part Clinical and Applied Anatomy Kesselbach’s Plexus • Little’s area on the septum is a common site of bleeding or epistaxis • Pathological deviation of nasal septum is responsible for repeated attacks of common cold, allergic rhinitis, sinusitis, etc It requires surgical correction Lateral Wall of Nasal Cavity • Irregular • Present with three shelf—Life bony projection called conchae • Conchae increase the surface area of nose for effective air—conditioning of inspired air • It is also formed by bones and cartilages Features of Lateral Wall Conchae: Three curved bony projections directed downwards and medially from the lateral wall a Superior conchae – smallest – Part of ethmoi dal labyrinth b Middle conchae – Maximum no of openings – Part of ethmoidal labyrinth c Inferior concha – largest – Independent bone Meatuses: Passages present beneath the overhanging conchae: a Inferior meatus i Largest ii Lies below inferior nasal conchae b Middle meatus i Lies below middle nasal conchae ii Features - Ethmoidal bulla (rounded elevation) - Hiatus semilunaris (semicircular sulcus below ethmoidal bulla) - Infundibulum (short passage at the anterior end of middle meatus) c Superior meatus i Smalles ii Lies below superior concha Sphenoethmoidal recess: – Triangular depression, above and behind superior concha Atrium of middle meatus: – Shallow depression present in front of the middle meatus and above vestibule of nose Openings in the Lateral Wall of Nose (Table 18.3 and Fig 18.3) Table 18.3: Openings in the lateral wall of nose Site Sphenoethmoidal recess Sphenoidal air sinus Superior meatus Posterior ethmoidal air sinuses Middle meatus Middle ethmoidal air sinuses Frontal air sinus Anterior ethmoidal air sinus Maxillary air sinus Inferior meatus Nasolacrimal duct Subdivision of Lateral Wall • Anterior part: Presents vestibule, lined by skin containing hairs called as vibrissae • Middle part: Known as atrium of middle meatus • Posterior part: Presents conchae and meatus (space separating conchae) Openings Nose and Paranasal Sinuses 99 For Personal Use Only Library Of School Of Dentistry.Tums Fig 18.3: Openings in the lateral wall of nose Arterial Supply of Lateral Wall (Fig 18.4) Anterior ethmoidal artery—Anterosuperior quadrant Branches of facial artery—Anteroinferior quadrant Sphenopalatine artery—Posterosuperior quadrant Greater palatine artery—Posteroinferior quadrant Venous Supply Veins form a plexus which drains: Anteriorly—facial vein Middle—pterygoid plexus Posterior—Pharyngeal plexus Nerve Supply General sensory nerves – From trigeminal nerve – Anterior ethmoid nerve – Anterosuperior quadrant – Anterior superior alveolar nerve – Anteroinferior quadrant – Posterior superior lateral nasal branch – Posterior superior quadrant – Greater palatine nerve – Posterioinferior quadrant Special sensory nerves or olfactory nerve Supplies upper part of lateral wall just below cribriform plate Lymphatic Drainage • Anterior half: Submandibular node • Posterior half: Retropharyngeal and Upper deep cervical nodes Clinical or Applied Anatomy • Common cold/Rhinitis is the commonest infection of nose • Paranasal air sinuses may get infected, maxillary sinusitis is the commonest PARANASAL SINUSES (Fig 18.5) Fig 18.4: Arterial supply of lateral wall • These are all filled spaces within the bones around nasal cavity For Personal Use Only Library Of School Of Dentistry.Tums 100 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 18.5: Paranasal sinuses • Lined by mucous membrane, consisting of ciliated columnar epithelium • They communicate with nasal cavity through narrow channels Functions • Add humidity to inspired air Adjust temperature of inspired air Make the skull lighter Add resonance to the voice All paranasal sinuses are arranged in pairs except ethmoidal sinuses which are arranged in three groups • Paranasal sinuses are: – Frontal – Ethmoidal – Maxillary – Sphenoidal Maxillary Sinus/Antrum of Highmore (Fig 18.6) • • • • • Largest air sinus Present in the body of maxilla One on either side of the nasal cavity It drains into hiatus semilunaris of middle meatus Measurements Fig 18.6: Maxillary sinus – Vertical – 3.5 cm – Transverse – 2.5 cm – Anteroposterior – 3.25 cm Parts of maxillary sinus and their relations Pyramidal in shape: • Roof: Floor of orbit • Floor: Alveolar process of maxilla • Base: Nasal surface of body of maxilla • Apex: Extends into zygomatic process of maxilla • Anterior wall: Related to infraorbital plexus of nerves • Posterior wall: Forms anterior boundaries of infratemporal fossa 31 Miscellaneous Foramen (Table 31.1) For Personal Use Only Library Of School Of Dentistry.Tums Table 31.1: Structures passing through foramen • Foramen Rotundum (ME) Maxillary nerve Emissary vein • Foramen Ovale (MALE) Mandibular nerve Accessory middle meningeal artery Lesser petrosal nerve Emissary vein • Foramen Spinosum (3 M) Middle meningeal artery Middle meningeal vein Meningeal branch of mandibular nerve (Nervus Spinosum) • Foramen Lacerum (MINE) Meningeal branch of ascending pharyngeal artery Internal carotid artery Nerve of pterygoid canal Emissary vein • Jugular Foramen – Anterior (IM) – Middle – Posterior (IM) Inferior petrosal sinus Meningeal branch of ascending pharyngeal artery IX, X, and XI cranial nerves Internal jugular vein Meningeal branch of occipital artery • Foramen Magnum – Anterior Part (MA) – Sub-arcanoid Space (VAS) – Posterior Part (LMT) Membrana Tectoria Apical ligament of dens Vertebral artery Anterior and posterior spinal arteries Spinal accessory nerve Lower part of medulla Meninges Tonsil of cerebellum RED NUCLEUS • Large ovoid mass of gray matter present on each side of midline • It is surrounded by fibers of superior cerebellar peduncle • mm in diameter • • • • Pink in color Contains iron pigment in its multipolar neuron Situated in tegmentum of the midbrain It consists of two portions Caudal part—contains large multipolar neuron Miscellaneous 169 Rostral part—contains small multipolar neuron Sensation carried: Non-discriminatory touch and pressure Functions • • • • Acts as an alternative route to pyramidal system Stimulates the flexor tone Inhibits the extensor tone Corticospinal tract helps in learning new movements while rubrospinal tract implement them Spinal COrd For Personal Use Only Library Of School Of Dentistry.Tums Spinothalamic Sensory Pathway • These are ascending and descending tracts (Table 31.2) • There are two pathways (Fig 31.1): Lateral spinothalemic tract Anterior spinothalemic tract Lateral Spinothalemic Pathway (Tract) Origin: Laminae I to IV of spinal gray matter Termination: Area 3,1,2 of cerebral cortex Crossing over: Fibers cross in the corresponding spinal segment anterior to spinal cord Sensation carried: Pain and temperature Anterior Spinothalamic Pathway (Tract) Origin: Laminae I to IV of spinal gray meter Termination: Joins with medial lemniscus in medulla Crossing over: Fibers cross to segment above spinal segment Fig 31.1: Anterior and lateral spinothalamic tract Table 31.2: Tracts of spinal cord Funiculus Ascending Tracts (Fig 31.2) Descending Tracts (Fig 31.3) Anterior 1. Anterior spinothalamic Anterior corticospinal Tectospinal Vestibulospinal Medial reticulospinal Lateral 2. Posteior spino-cerebellar 3. Anterior spino-cerebellar 4. Lateral spinothalamic 5. Dorsolateral tract of Lissauer Lateral corticospinal Rubrospinal Lateral reticulospinal Olivo spinal Posterior 6. Fasciculus gracilis or tract of gall 9. Fasciculus septomarginalis asciculus cuneatus or tract of Burdach F Fasciculus inter fasciculus For Personal Use Only Library Of School Of Dentistry.Tums 170 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 31.2: Ascending tract of spinal cord Fig 31.3: Descending tract of spinal cord Various types of neurons (Table 31.3) Table 31.3: Types of neuron According to polarity According to axon length According to shape of soma Size of soma nipolar: One process arises G U olgi Type-I: Long axons • Stellate shape from the body, e.g dorsal root which forms trads, e.g fas- • Fusiform shape ganglion ciculas gracilis • Basket shape Bipolar: two processes arises Golgi Type-II: Short axons, • Flask shape • Pyramidal shape from the body, e.g olfactory e.g present in gray matter mucosa Multipolar: More than two pro- A macrine: Numerous cesses arise from body, e.g maxi- processes without an axon, mum neuron of body e.g present in retina • Microneurons—7 mm length • Large neuron—12 mm of length Miscellaneous 171 OPTIC PATHWAY The nervous pathway which carries the retinal impulses to the visual center in cerebral cortex is called optic pathway (Flow chart 31.1) For Personal Use Only Library Of School Of Dentistry.Tums Flow chart 31.1: Course of Visual/Optic Pathway Optic nerve leaves eye through optic disc ↓ Medial fibers of each optic nerve cross midline ↓ They join the uncrossed lateral fibers of opposite side ↓ Optic chiasma ↓ Fibers runs towards lateral geniculation body ↓ Fibers pass through internal capsule ↓ Forms optic radiation ↓ Ends in visual cortex Applied Anatomy • Lesion of one optic nerve will cause total blindness in corresponding visual field • Lesion of optic tract/lateral geniculate body will cause homonymous hemianopia • Lesion of visual cortex will causes inferior or superior homonymous hemianopia BRACHIAL PLEXUS (Flow chart 31.2) • It is formed by interconnection of ventral primary rami of C5, C6, C7, C8 and T1 spinal nerves which supply upper limb • It is made up of roots, trunks and cords which are divided into cervical, supraclavicular and infraclavicular parts respectively – Roots: Formed by anterior primary rami of C5, C6, C7, C8 and T1 – Trunks i Upper trunk: Formed by joining of C5 and C6 roots ii Middle trunk: Formed by C7 roots iii Lower trunk: Formed by joining of C8 and T1 roots – Division: Each trunk divides into ventral and dorsal divisions – Cords i Lateral cord: Formed by union of ventral division of upper and middle trunks ii Medial cord: Formed by ventral division of lower trunk iii Posterior cord: Formed by union of dorsal division of all the three trunks Branches From Roots • • • • Dorsal scapular Long thoracic/nerve of bell Branches to join phrenic nerve Branches to longus coli and scalenus muscles From Upper Trunk • Nerve to subclavius • Suprascapular nerve From Lateral Cord (LML) • Lateral pectrol nerve • Musculo–cutaneous nerve • Lateral root of median nerve From Medial Cord (4 MU) • • • • • Medial pectoral nerve Medial cutaneous nerve of forearm Medial cutaneous nerve of arm Medial route of median nerve Ulnar nerve From Posterior Cord (RAT) • • • • • Upper subscapular Lower subscapular Radial nerve Axillary nerve Thoraco-dorsal nerve Clinical Anatomy • Injury to nerve of bell due to sudden pressure on shoulder leads to paralysis of serratus anterior muscle which causes winging of scapula 172 SUCCINCT Concise Anatomy for Dental Students with MCQs For Personal Use Only Library Of School Of Dentistry.Tums Flow chart 31.2: Brachial plexus • Erb’s Point: It is a point in upper trunk which is formed by joining of – C5 and C6 roots – Suprascapular nerve – Nerve to subclavius – Anterior and posterior division of upper trunk Erb’s Duchenne Palsy/Paralysis It occurs due to • Injury to the upper trunk of brachial plexus where these six nerves meet • Breech deliveries of babies • Prolonged abnormal posture during surgery It leads to sensory and motor loss on lateral side of forearm Clinical Signs • Upper limbs is by the side of body and adducted due to paralysis of deltoid, coracobrachialis and subclavius • Medially rotated due to paralysis of teres minor and infra spinatus muscle • Pronated due to paralysis of biceps muscle • This is known as Waiter Tip Hand Klumpke’s Paralysis • It results due to lesion involving the lower trunk (C8 and T1) • Caused by forceful upwards traction of arm – Motor loss—Hands assumes a characteristic deformity described as Claw hand Miscellaneous 173 For Personal Use Only Library Of School Of Dentistry.Tums Table 31.4: Classification of joints Structural Functional • Fibrous joint – Suture – Syndesmosis – Gomphosis • Synarthrosis • Skull type – Immovable, e.g.- fibrous joint – Immovable • Cartilaginous joint – Primary/synchondrosis – Secondary/symphysis • Amphiarthrosis – Slightly movable, e.g – cartilaginous joint • Vertebral type – Slightly movable • Synovial joint – Ball and socket – Saddle – Condylar – Hinge • Limb type – Freely movable, e.g snovial joints • Diarthrosis – Sensory loss—along the ulnar side of hand forearm and arm – Horner’s syndrome JOINTS It is a junction between two or more bones or cartilages (Table 31.4) Fibrous Joint • Bones are joined by fibrous tissue • Either immovable or permit a slight degree of movement • Following are the subtypes: Sutures • Present in skull • Immovable • According to shape of bony margins, it can be plane, serrate, denticulate, squamous, limbous types Syndesmosis • Bones are connected by interosseous ligament • For example, inferior tibiofibular joint Gomphosis (Peg and Socket joint) • For example, Tooth in its socket Region Synovial Joint (Table 31.5) • It consist of articular surfaces, which are formed by special variety of hyaline cartilage • Articular cartilage is wear resistant, low frictional and consists of fabricated surface and provide easy movement • It consists of fibrous capsule which completely encloses the joint • It is filled by synovial fluid Table 31.5: Classification of synovial joints and their movements Types of joint Movement A Plane type Gliding movement B Uniaxial joints – Hinge – Pivot Flexion and extension Rotation only C Biaxial joints – Condylar – Ellipsoid Flexion, extension, and limited rotation Flexion extension abduction, adduction and circumduction D Multiaxial joints – Saddle Flexion, extension, abduction, – Ball and socket adduction and conjunct rotation (spheroidal) Flexion, extension, abduction adduction circumduction and rotation 174 SUCCINCT Concise Anatomy for Dental Students with MCQs ARM Muscles (Table 31.6) For Personal Use Only Library Of School Of Dentistry.Tums Table 31.6: Muscle of arm Muscle and nerve supply Origin • Deltoids – By axillary nerve • Upper surface of lateral Deltoid tuberosity 1/3rd of clavicle – V Shape insertion on • Lateral border of acromian lateral aspect of humerus • Lower lip of spine of scapula • Abduction • Flexion • Extension - They act as shoulder joint • Biceps Brachii – Musculocutaneos nerve • Short head: Tip of coro- Posterior part of radial noid process tuberosity • Long head: Supraglenoid tubercle • Supination in semiflexed foramen • Flexor of elbow joint • Flexion of shoulder joint • Stabilization of shoulder joint • Triceps Brachii – Radial nerve • Long head – Infraglenoid tubercle of scapula • Lateral head – Oblique ridge of humerus • Medial head – Entire posterior surface of humerus • Extention of forearm • Acts at elbow joint Femoral Triangle • It is triangular depression below the inguinal ligament with apex directed below • Present in the upper 1/3rd of the front of thigh Boundaries • Apex: Meeting point of sartorius and adductor longus muscles • Base: Inguinal ligament • Medially: Adductor longus • Laterally: Sartorius • Floor: Iliacus Tendon of Psoas major Pectineus Adductor lougus • Roof: Fascia lata Superficial fascia Skin Insertion Posterior part of upper surface of olecranon process of ulna • • • • • • Actions Femoral vein and its tributaries Femoral nerve and its branches Fibro fatty tissue Femoral branch of genitofemoral nerve Part of lateral femoral cutaneous nerve Deep inguinal lymph node BLOOD SUPPLY OF BONE (Fig 31.4) Bone is supplied by four sets of blood vessels as Nutrient artery—supplies to bone marrow and inner 2/3rd of cortex Metaphyseal artery/Juxta epithelia artery—arise from anastomosis around the joint Epiphyseal artery—derived from periarticular vascular arcades found on non articular bone surface Periosteal artery—main artery which supplies to short bone It supplies the harversian system in outer 1/3rd of cortex Contents (6F PD) BLOOD SUPPLY OF HEART • Femoral sheath • Femoral arteries and its branches Arterial Supply—By two coronary arteries from ascending aorta Both runs in coronary sulcus Miscellaneous 175 SYNDROMES For Personal Use Only Library Of School Of Dentistry.Tums Turner’s Syndrome – Monosomy of X chromosome is seen – Karyotype 45, X0 – Patient is female with no Y chromosomes and present with following features a Short stature b Webbing of neck c Underdeveloped breast d Rudimentary ovaries e Majority are infertile f Primary or secretary amenorrhea Down’s Syndrome/Mongolism/Triosomy 21 – It usually follows fertilization of gametes out of which one has two chromosome 21 – It can also occur due to translocation Fig 31.4: Blood supply of bone a Right Coronary Artery - Smaller than left - Arises from anterior aortic sinus - Supplies right atrium, ventricle, i.e major part of right ventricle and smaller part of left ventricle and whole system of heart except left branch of AV bundle b Left Coronary Artery - Arises from left posterior aortic sinus - Supplies to left atrium - Ventricle (major part of left and small part of right ventricle) - Left branch of AV bundle Venous Supply Heart is mainly supplied by veins a Coronary Sinus - Longest vein of heart - Receive tributaries as - Great cardiac vein - Middle cardiac vein - Small cardiac vein - Posterior vein of left ventricle - Oblique vein of left atrium of Marshall’s - Right marginal vein b Anterior Cardiac Vein c Venae Cordis Minimi Clinical Features • • • • • • • Mental retardation Short stature Brachy cephaly Protruding tongue Small ears and flat occiput Flat nasal bridge Males are inferile and female have reduced fertility Risk Factors • Advancing maternal age • Familial history • Radiation injuries Klinefelter’s Syndrome – Trisomy of sex chromosome – Karyotype is 47, XXY – Patient is male Clinical Features • • • • • • • Mild developmental delay Behavioral immaturity Small testes Dysgenesis of seminiferous tubules Gynecomastia Poor musculature Infertile For Personal Use Only Library Of School Of Dentistry.Tums 176 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 31.5: Functional unit of lung BRONCHO-PULMONARY SEGMENTS • It is the independent functional unit of lung (Fig 31.5) • Made up of a tertiary branches with its branchial tree accompanied by an independent branch from pulmonary artery, venous drainage is inter segmental • Each lung has ten broncho-pulmonary segment Anatomical Features Shape - Wedge Apex - Towards tertiary branches Base - Towards lung surface Principal branches of lung ↓ Divides into upper and lower end ↓ Subdivides to form 10 segmental bronchi on each side (Table 31.7) Clinical Anatomy • Apical segment of lower lobe of right lung is commonest site of aspiration lung abscess and aspiration pneumonia (Mendelson’s Syndrome) • Posterior segment if right upper lobe is commonest site of tuberculosis Table 31.7: Ten broncho-pulmonary segments Lobe Right Lung Segments Left Lung Segments Upper Apical Posterior Anterior Apical Posterior Anterior Upper lingual Lower lingual Middle Medial Lateral Lower Apical Medial basal Anterior basal Lateral basal Posterior basal Apical Medial basal Anterior basal Lateral basal Posterior basal • Anterior segment of upper lobe is most frequent site of origin of carcinoma LMPHATIC DRAINAGE OF BREAST • Female mammary gland is a modified sweat gland which lies in the superficial fascia in pectoral region • Right gland may be larger and lower than left • Lymphaytic drainage of breast has a deep and superficial part (Fig 31.6) Miscellaneous 177 • Parenchyma is drained by vessels present in interlobular connective tissue and walls of lactiferous ducts – 75% drain into maxillary nodes – 20% drain into parasternal nodes – 5% drain into posterior intercostal nodes Superficial Part For Personal Use Only Library Of School Of Dentistry.Tums Fig 31.6: Lymph nodes draining breast Deep Part • Drains parenchyma, nipple and areola • Areola and nipple are drained by subreolar plexus of sappey • Drains overlying skin except areola and nipple • Outer part drains into axillary nodes • Inner part drains into parasternal groups of lymph nodes • This communicates with the opposite parasternal nodes • Upper part drains into supraclavicular group of lymph nodes • Lower part drains into subdiaphragmatic nodes • They communicates with sub-peritoneal plexus of lymphatic For Personal Use Only Library Of School Of Dentistry.Tums Bibliography 10 11 12 BD Chaurasia Handbook of General Anatomy (3rd edn) BD Chaurasia’s Human Anatomy (4th edn), volume 1-Upper Limb and Thorax BD Chaurasia’s Human Anatomy (4th edn), volume 2-Lower Limb, Abdomen and Pelvis BD Chaurasia’s Human Anatomy (4th edn), volume 3-Head, Neck and Brain GP Pal Textbook of Histology (1st edn) Gowri Shankar Dentest (2nd edn) Inderbir Singh, GP Pal Human Embroyology (7th edn) Inderbir Singh Textbook of Anatomy with Color Atlas (3rd edn) volume 3-Head, Neck and Brain Inderbir Singh Textbook of Human Histology (4th edn) Krishna Garg, Indira Bahl, Mohini Kaul Textbook of Histology Color Atlas (4th edn) Mahindra Kumar Anand Human Anatomy for Dental Student (1st edn) Satheesh Kumar K, Swapna M Dental Pulse (4th edn) Index Page numbers followed by f refer to figure and t refer to table For Personal Use Only Library Of School Of Dentistry.Tums A Accessory muscle of mastication 28 thyroid arteries 71 Acoustic meatus 113 Action of extraocular muscles of eyeball 13f longitudinal muscles 106 Amygdaloid body 147f Angle of mandible 149 Ansa cervicalis 56, 56f Anterior and lateral spinothalamic tract 169f and posterior aspect of larynx 110f spinothalamic pathway 169 Aponeurosis Arcuate fibers 139 Arm muscles 174 Arterial supply of dura mater 119 face 6f lateral wall 99, 99f nasal septum 97f palatine tonsil 81f thyroid gland 71f Artery 107, 108, 114 Articular disc 26 surfaces 26, 83, 84 Arytenoid cartilages 111 Ascending tract of spinal cord 170f Atlantoaxial joints 83 Atlanto-occipital joints 83 Attachment of cranial nerve to brainstem 129f styloid process 67f Auditory tube 108 B Basal ganglia 146f, 147 Bell’s palsy Blood supply of bone 174, 175f brain 142 face heart 174 Body of mandible 148 Bony labyrinth 116 orbit 12 Boundaries of orbit 12 parotid gland 30f posterior triangle 41f submental triangle 49f Brachial plexus 171, 172 Brachiocephalic vein 61, 62f Branches of cervical plexus 65f circle of Willis 142, 142t common carotid artery 51 external carotid artery 52, 53f facial nerve internal carotid artery 54f subclavian artery 60f Branchial apparatus 152 arches 152f clefts and pouches 152f Bronchopulmonary segments 176 Buccopharyngeal fascia 41, 105f Bulbar fascia 14 C Capsules of parotid gland 31 submandibular gland 35, 35f thyroid gland 70 Carotid body 52 sheath 40, 41f sinus 51 triangle 49 Cartilages of larynx 110 Cavity of larynx 111 Cerebellar syndrome 135 Cerebral hemisphere 136, 136f, 139f of inferior surface 138t of medial surface 138t Cerebrospinal fluid 123, 124f Cervical part of sympathetic truck 62, 64f pleura 64, 66, 66f Ciliary ganglion 15, 17f Circle of Willis 142, 143 Circumvallate papilla 163f Classification of paired and unpaired sinuses 120t Cleft palate 154 Common carotid artery 50 Communication of sinuses 122t Components of articular disc 26f cerebral peduncle 132f lacrimal apparatus 11 Conjunctiva 11 Conjunctival sac 11 Connections of cerebellum 135 otic ganglion 23f Connective tissue 1, 161 Constitution of larynx 110 Constrictors muscles of pharynx 105 of pharynx 106t Contents of carotid triangle 50f digastric triangle 49f orbit 13 posterior triangle 42, 42f Continuation of axillary vein 61 Corniculate cartilages 111 Corpus callosum 140, 141t striatum 147 180 SUCCINCT Concise Anatomy for Dental Students with MCQs Costocervical trunk 61 Cricoid cartilage 111 Cuneiform cartilages 111 For Personal Use Only Library Of School Of Dentistry.Tums D Dangerous area of face 7f layer of scalp Deep branches 65 cervical fascia 39 lymph nodes 78, 79t Descendens hypoglossi 56 Descending cervical nerve 56 tract of spinal cord 170f Development of anterior lobe 157 different parts of face 151 face 150, 151f fibroareolar stroma 156 masculature of tongue 156 mouth 155, 155f mucous membrane 156 palate 154, 154f pituitary gland 157, 157f posterior lobe 157 teeth 87 thyroid gland 156, 156f tongue 155, 156f tonsils 157 tooth 157, 158f Diaphragma sellae 119 Digastric triangle 48 Division of cerebellum 134 posterior triangle 41 Dorsal scapular artery 61 surface of tongue 91, 92f E Ear ossicles 115, 116f Epiglottis 111 Epithelial lining of larynx 111 Erb’s duchenne palsy/paralysis 172 Eruption of decidous teeth 87, 87t permanent teeth 87, 87t teeth 87 Eustachian tube 108 External auditory 113 carotid artery 52 ear 113 jugular vein 55 nose 96 Extraocular muscle of eyeball 13 Extrinsic muscle 93 of tongue 93t, 94f F Facial muscles nerve 7, 31, 32f palsy sheath of eyeball 14 vein Falx cerebri 118 Fascia colli 39f Features of superficial cervical 79t Femoral triangle 174 Fibrous capsule 26 joint 173 Floor of fourth ventricle 127, 128f Folds of meningeal dura mater 118, 118f Formation of circle of Willis 143f Frontal lobe 136 Functional areas of cerebral cortex 139 unit of lung 176f Functions of cerebral hemisphere 138, 138t CSF 124 thalamus 145 tongue 91 Fungiform and filiform papilla 163f G Ganglia 63 Gomphosis 86, 173 Gray matter of cerebellum 135 H Hard palate 88 Horner’s syndrome 63 Hyaline cartilage 165, 165f Hyoglossus muscle 36 Hypophysis cerebri 122, 163 Hypothalamo-hypophyseal portal system 123 Hypothalamus 146 I Inferior ophthalmic vein 17 orbital fissure 12 root 56 surface of cerebral hemisphere 138 thyroid artery 71 Infrahyoid muscles 51 Internal capsule 140 carotid arteries 52, 142 ear 116 jugular vein 54, 55f mammary artery 60 maxillary artery 24, 24f thoracic artery 60 Intracranial course of facial nerve 9f Intrinsic muscle 93 of larynx 111 of tongue 93f, 93t Involuntary extraocular muscles 13 Isthmus 70 K Kesselbach’s plexus 98 Kidney 166, 166f Klumpke’s paralysis 172 L Lacrimal apparatus 11, 11f gland 11 pancta and canaliculis 11 sac 11 Laryngopharynx 104 Lateral atlantoaxial joints 84 geniculate body 146 spinothalemic pathway 169 ventricles 126 wall of nasal cavity 98 Layers of cheek 86 scalp 2f Ligaments 26, 83, 84 For Personal Use Only Library Of School Of Dentistry.Tums Index 181 of atlanto-occipital joint 83f of eye 15f of pinna 113 of TMJ 27f Ligamentum nuchae 45, 45f Lingual glands 94 Lips 85 and cheeks 85 Longitudinal muscles of pharynx 106, 106t Loose areaolar tissue Lymph nodes 163, 164f draining breast 177f of head and neck 78f, 78f Lymphatic drainage 2, 7, 32, 36, 71, 81, 94, 99, 101, 107, 108, 112, 113, of breast 176 of tongue 95f M Mandibular nerve 21, 22f Maxillary artery 24 nerve 20 sinus 100, 100f Medial geniculate body 146 surface of cerebral hemisphere 138 Median atlantoaxial joints 84 Medulla oblongata 129 Mid brain 131 Middle ear 115 Mixed salivary gland 162f Motor supply of face 8f Movements of joints 83t TMJ 27t Mucous salivary gland 161f Muscles of back 45 facial expression 4, 5f mastication 28 middle ear 116 orbit 13 pharynx 106t pinna 113 side 44 soft palate 89f tongue 92 Muscular branches 66 triangle 50 N Nasal cavity 96 of nasal septum 97t septum of arterial supply 97t nasal cavity 97f Nasolacrimal duct 12 Nasopharynx 103 Nerve and blood supply of scalp 3f of neck 62 supply of dura mater 119 face larynx 111 pharynx 107 submandibular gland 36f Nuclear origin 7, 15, 19 Nuclei of cerebellum 135f thalamus 145 O Oblique of eyeball muscles 14f Occipital lobe 137 Oculomotor nerve 15, 16f Openings in lateral wall of nose 98, 99f vestibule of mouth 85 Ophthalmic artery 16 nerve 19 veins 17 Optic pathway 171 Oral cavity 85 Oropharyngeal isthmus 104 Oropharynx 104 P Paired cartilage 111 sinuses 120 Palatine tonsil 80, 162, 163f Pancreas 163, 165f Papillae of tongue 91 Paranasal sinuses 99, 100f, 101, 101t Parathyroid glands 72 Paravertebral muscles 75, 76f, 77t Parietal lobe 137 Parotid duct 32 gland 30, 31, 31t, 32 Parts of cerebellum 134, 134f corpus callosum 141f ear 114f internal capsule 140t, 141f maxillary artery 24t lateral ventricle 126, 126f maxillary sinus 100 pharynx 103, 103f submandibular gland 34f third ventricle 126 tooth 87f vertebral artery 60f Passavant’s ridge 106 Peg and socket joint 173 Pharyngeal arches 152 Pharyngobasilar fascia 41 Pituitary gland 122, 163, 164f Posterior triangle 41 Pretracheal fascia 40 Prevertebral fascia 40 muscles 75, 75f, 76t Pseudostratified epithelium 160, 160f Pterygopalatine ganglion 20, 20f Pyramidal lobe 70 R Ramus of mandible 149 Relations of auditory tube 108f cavernous sinus 121f hyoglossus muscle 38f internal and external jugular vein 61f capsule 141f palatine tonsil 80f submandibular gland 35f thyroid gland 70f Retromandibular vein 6, 32 S Salivary glands 30, 36, 161 Scalenovertebral triangle 75 Scalenus anterior muscles 58 Scalp Secretion of CSF 124 For Personal Use Only Library Of School Of Dentistry.Tums 182 SUCCINCT Concise Anatomy for Dental Students with MCQs Sensory supply of face 7f Serous salivary gland 161f Simple epithelium 160 Situation of parathyroid gland 72f thyroid gland 69f Skeleton of external nose 96 Soft palate 88 Sphenomandibular ligament 27 Sphenopalatine ganglion 20 Spinal cord 169 Spinothalamic sensory pathway 169 Spiral organ of corti 116 Spleen 165f Sternoclavicular joint 60 Structure of ducts and acini 162f Styloid apparatus 66 process 66 Stylomandibular ligament 27 Subclavian artery 58, 58f, 60f, 61 steal syndrome 60 vein 61 Subcutaneous tissue Subdivisions of anterior triangle 48 lateral wall 98 hypophysis cerebri 123f, 123t Sublingual salivary gland 36 Submandibular duct 35 ganglion 21 salivary gland 34 Submental triangle 48 Suboccipital muscles 47 triangle 46 Subsections of TMJ 28t Sulci 136, 138 Sulcus 86 Superficial cervical lymph nodes 79 fascia 1, 4, 39 Superior ophthalmic vein 17 orbital fissure 12 root 56 thyroid artery 71 Suprahyoid muscles 36 Syndesmosis 173 Synovial joint 173 T Taste buds 92 Temporal lobe 137 Temporomandibular joint 26 ligament 26 Tentorium cerebelli 118, 119f Terminal ventricle of spinal cord 128 Thymus 81, 166, 166f Thyrocervical trunk 61 Thyroid cartilage 110 gland 69, 163, 164f Trachea 72, 165, 165f Transitional epithelium 160, 161f Tributaries of brachiocephalic vein 62t cavernous sinus 121, 122f internal jugular vein 54 Trigeminal ganglion 19 nerve 19 neuralgia 21 Tympanic membrane 114f U Unpaired cartilage 110 sinuses 120 V Vein 107, 108, 114 accompany arteries supply of face 6f Venous drainage of brain 142 brainstem 143 cerebellum 143 cerebral hemisphere 142 Ventral surface of tongue 92f Vertebral arteries 59, 60, 142 Vessels of orbit 16 Vestibule of oral cavity 86f W Waldeyer’s lymphatic ring 79, 80f Wharton’s duct 35 White matter of cerebrum 139 ... membrane For Personal Use Only Library Of School Of Dentistry.Tums 114 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 21 .1: Parts of ear It consists of two parts Cartilaginous part. .. folds: Recurrent laryngeal nerve 1 12 SUCCINCT Concise Anatomy for Dental Students with MCQs For Personal Use Only Library Of School Of Dentistry.Tums Table 20 .1: Intrinsic muscles of the larynx.. .For Personal Use Only Library Of School Of Dentistry.Tums 92 SUCCINCT Concise Anatomy for Dental Students with MCQs Fig 17.1: Dorsal surface of tongue Filiform – Most numerous