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It is continuous medially with the lacrimal crest of the frontal strategy of maxilla. It presents a free posterior border, which types the lower boundary of the inferior orbital fissure. The medial margin of the orbital floor anteriorly presents a notch the nasolacrimal notch, which is transformed in to the higher opening of the nasolacrimal canal by articulation with lacrimal bone. It presents on the rounded margin which separates the orbital floor from the posterior floor. It leads to infraorbital canal which ends in infraorbital foramen on the anterior surface. The anterior and medial a part of this surface simply lateral to the nasolacrimal groove presents a small despair. It varieties the lateral wall of the nasal cavity and represents the bottom of the physique of maxilla. On the higher and posterior part of this floor presents maxillary hiatus which leads in to maxillary air sinus. Broken air cells (ethmoidal): Situated above the hiatus and completed by labyrinth of ethmoid and lacrimal bones. Behind the maxillary hiatus the medial floor presents a tough space which articulates with perpendicular plate of palatine bone. Fractures of the Zygoma or Zygomatic Arch the zygoma or zygomatic arch may be fractured by a blow to the side of the face. Although, it can happen as an isolated fracture, as from a blow from a clenched fist, it could be associated with multiple other fractures of the face, as often seen in automobile accidents. It arises from the junction of nasal floor and its alveolar process and joins with the palatine process fellow of reverse bone to form the anterior three-fourths of the onerous palate. Superior floor: It is easy and concave from side-to-side and forms main part of the ground of the nasal cavity. At the lateral area posteriorly it presents a groove for larger palatine vessels and nerve. Opposite the incisor enamel it presents a small depression, which along with the man of its reverse side varieties the incisive fossa. Posterior border: It is serrated for articulation with the horizontal plate of the palatine bone. It articulates above with the nasal margin of frontal bone, in entrance with nasal bone and behind with lacrimal bone. Lateral floor: Divided in to two areas anterior and posterior by anterior lacrimal crest. It tasks from the junction of anterior, posterior and orbital surfaces of the physique. Attachment: Origin of buccinator from posterior a part of outer floor up to the primary molar tooth. Maxillofacial fracture: Maxilla usually fractures because of huge facial trauma. Chance of leakage of cerebrospinal fluid (cerebrospinal rhinorrhea), which is secondary to fracture of the cribriform plate of ethmoid bone. Injury of the infraorbital nerve leads to anesthesia or paresthesia of the pores and skin of the cheek and upper gum. Blowout fracture of maxilla: A severe blow to the orbit might trigger the contents of orbital cavity to burst downwards through the ground of the orbit in to the maxillary air sinus. In this fracture a fraction of bone is depressed inward to compress or injure the brain 7. Linear skull fractures: It is the most common sort of skull fracture, but fracture line usually radiate away from it in two or more instructions. Although, a fracture might outcome some distance from the site of direct trauma the place the calvaria is thinner. Contrecoup or counterblow fracture: In this fracture no fracture happens on the level of impact however fracture occurs on the alternative facet of the skull. It could occur because of blow on the aspect of the top the place skinny bones forming the pterion ii. Due to fracture of the pterion the anterior division of the middle meningeal artery rupture which lies deep to the pterion iii. As a result hematoma occurs, which exert pressure on the underlying cerebral cortex iv. In a untreated case of rupture of middle meningeal artery could cause death in a quantity of hours. The anterior border of the two lamina of thyroid cartilage is fused from the each side to type what angle. It is a pocket like recess on the lateral wall of the larynx between the vestibular and vocal folds. It is a blind diverticulum from the higher a half of the sinus extends upwards between the vestibular folds and inside floor of the thyroid cartilage. It is a pair of mucous folds projected transversly in to the cavity of the larynx above the sinus of the larynx. It is a pair of mucous folds projected transversly in to the cavity of the larynx Q. Opposite the level of C3 to C6 vertebrae (In children and grownup female slightly higher). Length Breadth Anterior-posterior diameter Male 44 mm 43 mm 36 mm Female 36 mm 41 mm 26 mm Q. It is a hollow, muscular organ, consists of four chambers, situated within the middle mediastinum and covered by the pericardial sac, and acts as a central pumping organ of cardiovascular system. It is a conical projected part of the left ventricle which is directed downwards, forwards and to the left, situated on the left 5th intercostal house, half inch medial to the left midclavicular line. It is a notch on the inferior border of the guts, close to the apex of the guts. Near to it, anastomosis takes place between posterior interventricular branch of right and anterior inter ventricular branch of left coronary arteries. As the coronary vessels put on on the center seems ornamented, so the name becomes coronary vessels. During ventricular diastole as a end result of rest of myocardium, blood can flow through it. These are muscle fibers, arises from crista terminalis and spreads in the internal side of the anterior wall of the best atrium. Blood will move left to proper atrium because of pressure is more in the left atrium.

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It is slender and elongated directed dorsolaterally, reaches near the posterolateral part of the spinal wire b. It is separated from the posterolateral sulcus by a slender band dorsolateral fasciculus of Lissauer c. The apex is roofed by a translucent mass of nerve tissue called substantia gelatinosa of Rolando, which receives the sensory enter of the dorsal nerve roots. A pair of lateral grey column: It is present in thoracic and lumbar regions of the spinal twine which is a lateral small projection between the anterior and posterior gray columns. The grey commissure: It connects the right and left halves of the spinal cord throughout the midline which is traversed by the central canal. The central canal communicates above with the fourth ventricle however beneath throughout the conus medullaris of the spinal wire broaden to type the terminal ventricle b. The central canal might continue in to the proximal a half of the filum terminale of about four to 5 mm c. Nuclei in Spinal Cord Nuclei in Anterior (Ventral) Gray Column or Horn the nuclei of anterior (ventral) column or horn are organized within the following groups: 1. Medial group: It is present in complete size of the spinal wire and innervates the axial musculature of the body. Lateral group: Present only in the region of cervical and lumbar enlargements of the spinal twine. Anterolateral/ventrolateral: Supply in case of upper limbs to the muscle tissue of the shoulder and arm and in case of lower limbs to the muscle tissue of the gluteal region and thigh ii. Posterolateral/dorsolateral: Supply in case of upper limbs to the muscle tissue of the forearm and in case of lower limbs to the muscles of the leg iii. Postposterolateral/retrodorsolateral: Supply in case of higher limbs the muscle tissue of the hand and in case of decrease limbs the muscular tissues of the foot. Central group: It is present only within the upper cervical segments that are represented by the phrenic and accent nuclei. Nuclei in Posterior (Dorsal) Gray Column or Horn Nuclei in posterior (dorsal) grey column or horn are arranged within the following teams: 1. Consists of skinny layer of cells (neurons) present superficial to the substantia gelatinosa b. Nucleus proprius: It lies simply deep to the substantia gelatinosa in complete extent of the spinal wire. It can be referred to as the thoracic nucleus, situated on the medial side of the base b. They are divided in to ten laminae and numbered from the tip of the posterior horn to the ventral horn. Sensory receptors the peripheral ends of the afferent nerve fibers receive impulses known as receptors. The white matter lies in the medial and ventral to the anterior grey columns forms the anterior funiculus. The white matter lies lateral to the anterior and posterior grey columns types the lateral funiculus. The white matter medial to the dorsal grey columns some essential descending tracts within the spinal twine. Pyramidal tracts Reticulospinal tract Tectospinal tract Vestibulospinal tract Olivospinal tract Rubrospinal tract Lateral corticospinal tract. Exteroceptors: these receives and responds to the stimuli from the external surroundings like ache, contact, pressure and temperature. Proprioceptor: these obtain and reply to the stimuli from the deep tissues like contraction of muscular tissues actions, position and strain associated to joints muscles contraction. Enteroceptor or interoceptors: these receives stimuli from the partitions of the viscera, gland bodies). Special Sense receptors these receive stimuli from the imaginative and prescient, listening to, scent and style. Zone of ischemic necrosis is often seen in T1 to T4 and L1 segments, because of meeting of various main arteries on this zones. The ligamentum denticulatum serves as a guide to the surgeons during cordoctomy operations. Commonest site of lumbar puncture is usually accomplished reverse the median plane between the Brain and Spinal Cord 561 4. Through the venous plexus the spread of an infection or metastasis to the vertebra from abdominal or thoracic organs takes place. Myelography: It is a radiographical examine which visualize the spinal twine and nerve roots by injecting a radiopaque distinction medium in to the subarachnoid house. The extradural causes are herniation of an intervertebral disk, tuberculosis in vertebrae, tumors of the vertebrae. Below the level of the lesion all twine features become depressed or lost and sensory impairment and a flaccid paralysis happen iii. In many of the circumstances the shock persists for less than 34 hours however in others it could persist for so lengthy as 1 to 4 weeks. Poliomyelitis: It is an acute viral an infection of the neurons of the anterior gray columns of the spinal twine and the motor nuclei of the cranial nerves. It is a disease of the central nervous system, inflicting demyelination of the ascending and descending tracts ii. Tabes dorsalis: It is caused by syphilis which causes destruction of nerve fibers on the point of entrance of the posterior root in to the spinal twine, especially in the decrease thoracic and lumbosacral regions. Cordotomy for relief of ache: Surgical reduction of pain used extensively in patients with terminal stage of most cancers, the place posterior root of a spinal nerve may be necessary to divide (may be several posterior roots) successfully severs the conduction of the ache in to central nervous system, in this patients deprives the opposite sensations in addition to pain. It is a nonelastic, thickest, hardest, dense and outermost layer of the meninges ii. The cranial dura mater is steady with the spinal dura mater on the foramen magnum. These two layers are fused together except the place they separate to enclose the venous sinuses. Endosteal layer: It is the endosteum of the inner surface of the cranium bones due to this fact there vertebral canal). The meningeal layer provides sheaths to the cranial nerves as they leaves via the cranial foramina 562 Human Anatomy for Students ii. The meningeal layer is continuous with the spinal dura mater across the margins of the foramen magnum iii. The meningeal layer of dura mater is folded inwards as 4 septa which partially divide the cranial cavity in to compartments which lodges totally different parts of the brain. Dural Processes the meningeal layer varieties 4 inward folds or projections they divide the cranial cavity in to intercommunicating compartments. Situation: In the median longitudinal fissure between the two cerebral hemispheres. Upper margin: Attached to the lips of the sagittal sulcus as far again as the interior occipital protuberance iv. Straight sinus: Along the line of attachment of the flax cerebri to the tentorium cerebelli. It is a crescentic tented shaped fold of dura mater, forming the roof of the posterior cranial fossa ii.

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Pressure on the cavernous sinus-leads to the bulging out of eyeball, rise in intracranial blood strain. Pressure on the third ventricle: It occurs because of a large tumor pressing on, causing rise in intracranial pressure. Infundibulum: It is a stalk that connects pars nervosa to the hypothalamus in the ground of the 3rd ventricle of the mind. The pars nervosa contains unmyelinated axons and their nerve endings approximately 100,000 neurosecretory neurons ii. Cell our bodies of the neurons lies in the supraoptic and paraventricular nuclei of the hypothalamus. These two hormones are carried along the axons and saved at their nerve endings in the pars nervosa as Herring bodies vi. From the Herring bodies the hormones are released in to the fenestrated capillaries by the hypothalamic impulses vii. The supraoptic nuclei are mainly accountable with vasopressin and paraventricular nuclei with oxytocin secretion viii. Other cells present in posterior pituitary are particularly fibroblast, mast cells and specialised glial cells referred to as pituicytes ix. Sternal head this head takes origin from the upper part of the anterior surface of manubrium sterni 2. Clavicular head this head originates from the superior surface of the medial one-third of clavicle. At the lateral surface of the mastoid means of temporal bone, from its apex to superior border 2. By an aponeurosis in to the lateral half of superior nuchal line of occipital bone. Relations this muscle is enclosed by the investing layer of deep cervical fascia, and pierced by accent nerve and 4 arteries supplying it. It is the deformity of the neck by which head is bent to the affected facet whereas the face turns to the opposite facet due to shortening of the sternocleidomastoid muscle ii. It is caused by troublesome labor which outcomes in hemorrhage happens in to the muscle and could additionally be detected as a small, rounded tumor during early weeks after delivery iii. Later this condition become develops in to a fibrotic mass which contracts and shortens the muscle. It results from repeated chornic contractions of the sternocleidomastoid maladjustment of pillows or psychogenic iii. Superomedial border: this border separates the medial surface from the superolateral surface. Inferolateral border: this border separates the inferior surface from the superolateral floor. This border separates the superolateral floor from the orbital floor of the frontal lobe i. Cerebrum has two cerebral hemispheres that are separated incompletely from one another by median longitudinal fissure ii. The two hemispheres related one another throughout median plane by the corpus callosum iii. Numerous nuclei, sulci and gyri enhance the floor space, with out rising the size of the cerebrum and offering for the neurons many times. Medial orbital border: this border separates the medial surface from the orbital surface. Medial occipital border: this border separates the medial surface from the tentorial surface. It begins from the anterior perforated substance, then extends forwards and laterally to reach the inferolateral border of the cerebral hemisphere ii. Here it divides in to three rami (posterior ramus, anterior horizontal and anterior ascending rami) which are unfold on the superolateral surface of the cerebral hemisphere. The Anterior Perforated Substance this depressed space is pierced by the central branches of the center cerebral artery. Boundaries of the Anterior Perforated Substance Anteriorly: By the olfactory trigone which is formed by the divergence of the olfactory tract in to medial and lateral olfactory striae. The Orbital Surface this floor is fashioned by the inferior floor of the frontal lobe and is slightly concave in nature. The gyrus rectus: Situation: It lies between the medial orbital border and the olfactory sulcus. This surface is shaped by the inferior surface of the temporal and occipital lobes which is convexo-concave antero-posteriorly ii. The anterior a part of this floor rests on the middle cranial fossa and the posterior part on the tentorium cerebelli. Sulci on the tentorial surface this surface presents two sulci which extends antero posteriorly and likewise the rhinal sulcus. This sulcus initiatives in to the inferior horn of the lateral ventricle producing an elevation generally identified as collateral eminence which forms the lateral a half of the ground of the inferior horn of the lateral ventricle c. It lies between the anterior finish of the parahippocampal gyrus and the curved temporal pole. Medially it communicates with the cingulate gyrus on the medial surface of the cerebral hemisphere via the isthmus. The medial occipitotemporal gyrus: It is medially restricted by the collateral and rhinal sulci and laterally by the occipitotemporal sulcus. The lateral occipitotemporal gyrus: It occupies lateral to the occipitotemporal sulcus. Posterior perforated substance which is pierced by the central branches of the posterior cerebral arteries. The medial Surface of the Cerebral Hemisphere Features section, the medial surface of the cerebral hemisphere is exposed which is flat and presents the following features. Longitudinal striae: these are two pairs of longitudinal fibers medial and lateral embedded within the substance of indusium griseum. Genu It is a bent and the anterior finish of the corpus callosum connecting the rostrum with the body or trunk. Body or trunk Extension: It extends from the genu infront, to the splenium behind. Inferior Surface It is concave from earlier than backwards and convex from side to side. On either facet of median plane-roof of the central part of the body of the lateral ventricle coated by ependyma c. Splenium: It is the thickest posterior end of the corpus callosum, which is continuous in front with the trunk. The fibers passing by way of the podium connecting the orbital surfaces of the two frontal lobes.

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It arises from the lateral cord or could arise from the anterior divisions of upper and middle trunks ii. It arises from the medial cord and arises behind the primary a half of the axillary artery ii. Lower subscapular nerve: It arises from the posterior twine and enter the lower a half of the subscapularis muscle. It arises from the posterior twine between the higher and lower subscapular nerves ii. It arises from the lateral twine of brachial plexus reverse the lower border of the pectoralis major ii. It pierces the coracobrachialis then descends laterally between the biceps and brachialis. The axillary and radial nerves are the terminal branches of the posterior wire arises behind the third part of axillary artery and lateral to the radial nerve, close to the lower border of subscapularis ii. Then the nerve curves backwards at the lower border of subscapularis together with the posterior circumflex humeral artery and passes through the quadrangular house. It crosses the axilla to the medial side of the arm, be a part of with a branch of the medial cutaneous nerve of the arm. It is the continuation of the subclavian artery, begins at the outer border of first rib b. It arises from the primary a half of the axillary artery near the lower border of subclavius Dissection 641 iii. It arises from the second a part of the axillary artery deep to the pectoralis minor b. It descends along the lateral border of the pectoralis minor to the lateral thoracic wall Subscapular artery: a. It is the biggest department of the axillary artery arising from the third a part of the axillary artery b. It arises from the lateral aspect of the third a half of the axillary artery at the decrease border of the subscapularis b. It runs horizontally deep to the coracobrachialis and brief head of biceps brachii to reach anterior to the surgical neck of the humerus. It arises from the third a half of the axillary artery on the decrease border of the subscapularis b. A longitudinal incision is given becoming a member of the midpoints of the above two transverse incisions. The basilic vein is identified alongside the medial aspect of the biceps brachii up to the middle of the arm where it pierces the deep fascia iii. Upper lateal cutaneous nerve of the arm: this is continuation of the posterior division of the axillary nerve iv. Medial cutaneous nerve of the arm: It pierces the deep fascia in the center of the arm. Medial cutaneous nerve of the forearm: It pierces the deep fascia with the basilic vein. Intercostobrachial nerve: It is the lateral cutaneous department of the second intercostal nerve. It enters the axilla and descends obliquely across the axilla communicates with the medial cutaneous nerve of the arm and then pierces the deep fascia below the axilla to provide the skin on the higher posteromedial a half of the arm. Now superficial fascia is incised and reflected like the skin-deep fascia is exposed: 1. Now reduce the deep fascia vertically on the anterior surface of the arm, and mirror the deep fascia to uncover the biceps brachii muscle 2. Now carry the biceps brachii muscle forwards and establish the musculocutaneous nerve in between the biceps brachii and brachialis three. The coracobrachialis muscle arises along with the brief head of biceps brachii from the tip of the coracoid course of and inserted in to the middle of the medial surface of the humerus 4. A transverse incision is given at the junction of upper onefourth and decrease threefourths of the front of the arm 642 Human Anatomy for Students. The radial nerve is accompanied by the profunda brachii artery which passes inferolaterally to the sulcus for the radial nerve on the posterior floor of humerus 7. The lower lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the arm come up from the radial nerve 8. The ulnar nerve, it passes backward by piercing the medial intermuscular septum near the center of the arm in to the posterior compartment of the arm 9. The median nerve and the brachial artery and vein present within the decrease onethird of the arm are inclined, forwards in front of the brachialis. An incision is given along the lateral onethird of the spinous strategy of the scapula which extends to the junction of the higher one fourth and lower threefourths of the arm ii. A vertical incision is given from the medial end of the first incision extending to the inferior angle of the scapula. Upper lateral cutaneous nerve of the arm arises from the posterior division of the axillary nerve b. The posterior divisions of the lateral cutaneous branches of the higher intercostal nerves. Now expose the triangular and quadrangular spaces which are bounded by the muscular tissues. Contents of the Triangular Space Circumflex scapular artery which is a branch of subscapular artery with the accompanying vein. Below Teres main Medially Long head of triceps brachii 644 Laterally Surgical neck of the humerus. Posterior circumflex humeral artery which is a branch of the third part of the axillary artery ii. Axillary nerve which is a branch of the posterior twine of the brachial plexus and divides in to anterior and posterior divisions. A longitudinal incision is given becoming a member of the centers of the previous two incisions. Reflect the pores and skin on both side, exposing the superficial fascia with the next structures. Incisions on Superficial Fascia Incision on superficial fascia is identical as that on pores and skin. A vein speaking the median cubital vein and deep vein, it pierced the deep fascia. Incisions on Deep Fascia Now, the deep fascia is incised and mirrored as like pores and skin. Steps of Dissection Position of the Body the physique shall be on supine position with elbow prolonged and forearm supinated. A transverse incision is given in entrance of the elbow between the 2 epicondyles of humerus ii. A transverse incision can be given on the junction of higher and middle onethird of infront of forearm Boundaries Medially Lateral border of pronator teres.

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They run through the lower elements of the hamstring muscles and higher parts of the calf muscular tissues b. They run by curving spherical proximal to both the condyles of femur to reach the front of the knee joint c. The medial superior genicular artery runs deep to the semimembranosus and semitendinosus muscle tissue, proximal to the medial head of the gastrocnemius and deep to tendon of the adductor magnus muscles d. It is small artery arises from the popliteal artery near the posterior heart of the knee joint b. Medial inferior genicular artery: It lies deep to the medial head of gastrocnemius. Tibial nerve is the larger terminal branch of the sciatic nerve begins at the junction of middle and lower onethird of the thigh ii. The nerve within the higher a part of the popliteal fossa lies lateral to the popliteal artery, in the center crosses the artery posteriorly (here the popliteal vein lies intervene between popliteal artery and the tibial nerve) then in the lower half it lies medial to the popliteal artery iii. Then the nerve descends within the groove between the 2 heads of gastrocnemius, accompanies with a cutaneous artery. The nerve to soleus runs between the lateral head of gastrocnemius and plantaris to reach the superficial floor of the soleus. Superior medial genicular nerve: Passes above the medial condyle of the femur deep to the muscles ii. Middle genicular nerve: Pierces the posterior a part of the capsule of the knee joint iii. Inferior medial genicular nerve: Passes infero medially on the higher border of the popliteus then forwards beneath the medial condyle of the tibia. It is smaller terminal branch of the sciatic nerve begins at the junction of the middle and lower onethird of the thigh ii. It passes by way of the medial border of the biceps femoris to the back of the fibular head iii. Then the nerve curve around the neck of the fibula to flip forwards and passes between the fibular neck and higher fibers of the peroneus longus muscle where it divides in to superficial and deep peroneal nerves. Sural speaking nerve: It arises from the upper a part of the popliteal fossa, descends on the posterolateral aspect of the calf and joins with the sural nerve. Lateral cutaneous nerve of the calf: It arises from the widespread peroneal nerve in the popliteal fossa. It pierces the deep fascia over the lateral head of the gastrocnemius and descends to the lateral floor of the upper half of the leg. Genicular Branch of the Obturator Nerve It arises from the posterior division of the obturator nerve by piercing the distal a half of the adductor magnus reaches within the popliteal fossa then supply the knee joint. It fashioned by the union of anterior and posterior tibial veins near the decrease border of the popliteus muscle ii. This vein ascends along the medial side of the popliteal artery in the decrease a half of the popliteal fossa then within the middle it crosses posterior to the artery, in the upper a part of the popliteal fossa the vein lies lateral to the artery iii. Its tributaries correspond with the popliteal artery in addition the quick saphenous vein drain in to it. Dissection 671 Steps of Disseciton Position of Body Body might be in prone place. Another transverse incision is given along the roots of toes throughout metatarsophalangeal joints iii. Reflect the skin and expose the superficial fascia Structures present within the superficial fascia: 1. Medial calcaneal nerve (branch of tibial nerve) and medial calcaneal vessels distributed in the area of heel. Branches of medial and lateral plantar nerves and vessels distributed within the higher a half of the sole. Now the superficial fascia is cut and reflects like pores and skin and plantar aponeurosis is exposed. During removing of plantar aponeurosis avoid damage to the plantar digital nerves and vessels, which lies just deep to the distal part of the aponeurosis. Medial plantar nerve and vessels current in the medial intermuscular furrow between the abductor hallucis and flexor digitorum brevis. Lateral plantar nerve and vessels present in lateral intermuscular furrow between abductor digiti minimi and flexor digitorum brevis. Medial plantar artery lies medial to the medial plantar nerve and lateral plantar artery lies lateral to the lateral plantar nerve. Now minimize the flexor digitorum brevis in the center then mirror it forwards and backwards. Flexor digitorum longus with the flexor accessorius (lateral and medial heads) and lumbrical muscle tissue (four). The long plantar ligament in between lateral and medial heads of flexor accessorius 4. Remove the abductor digiti minimi from its origin and expose the lateral head of flexor accessorius 5. Trace one of many tendons of flexor digitorum longus by way of its fibrous flexor sheath to its insertion and one of many medial two lumbricals to the proximal phalanx and sometimes to their extensor expansions 6. Now the flexor tendons are drawn aside and oblique part of the adductor hallucis separate. Plantar arterial arch fashioned by the lateral plantar artery and arteria dorsalis pedis ii. The association of the muscles is an inside round layer and outer longitudinal layer c. Contraction of the muscularis mucosae is liable for the motion and folding of mucosa. This layer consists of clean muscle (except within the upper a part of the esophagus the place this layer comprise striated muscle fibers) which might be divided in to two sublayers: � the internal layer is circular and outer layer is longitudinal. Description of the Features Mucous Membrane It consists of three layers: Epithelium a. The epithelium differs throughout the gastrointestinal tract depending on the precise functions of each a part of the tube b. The epithelium has three principal functionsprotection, absorption and secretion c. The epithelium is columnar or throughout the size of the tube (except, the esophagus and decrease a part of the anal canal) both absorptive or secretory d. The epithelium of the esophagus and decrease part of the anal canal for the protecting operate. Serous Layer this layer is serous membrane (visceral layer of peritoneum) consists of simple squamous epithelium called mesothelium and small quantity of connective tissue mendacity deep to the mesothelium. Parietal or oxyntic cells: these secretes hydrochloric acid and a gastric intrinsic issue d. This region belongs to part of the abdomen close to the esophageal orifice of the stomach ii. A change of epithelium from stratified squamous of the esophagus to simple columnar epithelium in the abdomen T. Rest of the features (layers) is identical as that of common features of the gastrointestinal tract.

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It helps to introduction a catheter in to the tube along the nasal cavity for the intubation of the pharyngotympanic tube. It is a vertically downwards fold of mucosa from the posterior margin of the tubal elevation ii. It extends downwards and forwards from the anterosuperior angle of the tubal elevation to the soft palate ii. The levator veli palatini muscle, produces this elevation on the mucosa instantly below the tubal opening. Tubal tonsils: It is a small mass of lymphoid tissue within the mucosa simply posterior to the opening of auditory tube (on each side). It is mucous lined slender vertical slit behind the tubal elevation on the lateral wall ii. It extends between the levator veli palatini with auditory tube and prevertebral muscle tissue. Vertebral Level Opposite the physique of 2nd and higher a part of 3rd cervical vertebrae. Boundaries of Oropharynx Above Communicates with the nasopharynx through the pharyngeal isthmus. Boundaries of Oropharyngeal Isthmus Above By the taste bud Below By the dorsal surface of the posterior onethird of the tongue On both sides By the palatoglossal arch containing the corres ponding muscle. Functions It is closed during swallowing to stop regurgi tation of meals from pharynx to the mouth cavity. It is a paired mucous folds masking the palatoglossal muscular tissues separated from mouth ii. It is located one on both sides of the oro pharynx between the palatoglossal and palatopharyngeal arches lodges the palatine tonsil. Lateral wall or flooring: By the superior constrictor and styloglossus muscular tissues lined internally by the pharyngobasilar fascia. Situated bilaterally within the oropharynx throughout the tonsillar sinus or fossa between the palatoglossal and palatopharyngeal arches. In the lateral walls Presence of piriform fossa: A deep depressed space lined by mucous membrane lies on both sides of the inlet of the larynx. Submucous coat: It is thickened in the upper part to type the pharyngobasilar fascia. Pterygoid hamulus and adjoining posterior margin of the medial pterygoid plate (sometimes) ii. Highest fibers: Passes upwards, backwards and medially then inserted in to pharyngeal tubercle, on the basilar part of the occipital bone. Lower fibers: Passes obliquely downwards, backwards and medially then inserted in to the median raphe. Insertion: Around the upper end of esophagus remaining continuous with the same fibers of the other muscle. Through the gap between the decrease border of superior and higher border of middle constrictors. Palatopharyngeus Origin this muscle arises by two fasciculi anterior and posterior both arises from upper floor of palatine aponeurosis. Insertion After forming a single sheet inserted in to the posterior border of thyroid cartilage. Stylopharyngeus Origin From the medial side of the bottom of the styloid strategy of mandible. As a conjoint sheet to the posterior border of the lamina of thyroid cartilage ii. Few fibers inserted posteriorly with the same fibers of the alternative facet across the median fibrous raphe. Salpingopharyngeus Origin Inferior part of the cartilage of the auditory tube close to the pharyngeal opening. It is located on the posterior wall of the pharynx the place the decrease part of the thyropharyngeus is a single sheet of muscle, not overlapped internally by the superior and middle constrictors iii. Veins type a plexus which additionally obtain blood from taste bud and prevertebral region ii. Communicates with pterygoid venous plexus above and finish in the inside jugular vein. Pharyngeal plexus: It lies on center constrictor Head, Neck and Face 405 It is shaped by the following nerves: i. The pharyngeal branch of vagus (motor) carrying fibers from the cranial a half of accent nerve ii. The motor fibers derived from the cranial part of accessory nerve by way of the branches of the vagus. They provide all muscular tissues of pharynx except stylopharyngeus which is provided by the glossopharyngeal nerve iii. The inferior constrictor has further provide from the external and recurrent laryngeal nerves. Nasopharynx: It is equipped by the pterygopalatine ganglion, carrying fibers of the maxillary nerve ii. During articulation of speech of all phrases besides m, n, g (nasal tone) when partial closure is important iv. Simultaneous elevation of soppy palate by levator veli palatini and tensor veli palatini iii. Boundaries Anteriorly Anterior median airplane of neck extending from the symphysis menti to the suprasternal notch. Important Regions of Pharynx Pharyngeal Isthmus this is the opening of communication between nasopharynx above and oropharynx beneath. Muscular triangle Carotid triangle Digastric or submandibular triangle Submental triangle. Boundaries and Contents of each Subdivisions of Anterior Triangle Muscular triangle Boundaries Anteriorly Anterior median plane of neck from hyoid bone to the suprasternal notch. Posteroinferiorly Anterior border of the lower a half of the sternocleidomastoid muscle. Carotid Triangle Boundaries Anterosuperiorly Posterior stomach of digastric and stylohyoid muscular tissues. Common carotid artery and its bifurcation exterior and inside carotid arteries with carotid sinus and carotid body ii. Superior laryngeal nerve department of the vagus nerve divides in to inside and external laryngeal nerves g. Investing layer of deep cervical fascia splitt ing to enclose the submandibular salivary gland. Carotid sheath containing inside carotid artery, internal jugular vein and vagus nerve. Deep cervical lymph nodes lies along the inner jugular vein which includes jugulodigastric group beneath the posterior belly of digastric and juguloomohyoid group above the superior stomach of omohyoid c.

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Sacral Cornu i At the perimeters of the sacral hiatus two small tubercles seems downwards and forwards called sacral cornu ii. It is shaped by the fused transverse processes and the costal components of the sacral vertebrae. The higher wider part bears auricular floor (ear shaped) for articulation with the ilium forming sacroiliac joint. Piriformis arises from bars between first and second, second and third, third and fourth foramina. Erector spinae: U shaped origin over the spinous and transverse tubercles and passing above fourth sacral foramina. Inferiorly the canal opens on the sacral hiatus, which communicates via the intervertebral foramina, with the pelvic (anterior) and dorsal (posterior) sacral foramina. It is bounded in front by the bodies of the sacral vertebrae and behind and sides by the fused laminae and the spinous processes. Lateral Surface Behind the auricular floor the rough pitted area gives attachment interosseous sacroiliac ligament. Origin of gluteus maximus Structures associated to ala of the sacrum: From medial to lateral: a. Cauda equina Filum terminale Spinal meninges Subdural and subarachnoid spaces, which ends on the stage of second sacral vertebra. As the cervical and lumbar areas of the vertebral column having free actions happen, due to this fact these regions are frequent sites of disabling pain ii. Low again ache most commonly occurs typically in the third by way of 6th many years of life iv. Back generally injured in competitive sports and in industrial and automobile accidents v. Some indications of fracture of the vertebral column, ache in back but unable to transfer the limbs indicating fracture of the vertebral column. Variations in the vertebrae: Variations in the quantity vertebrae could also be clinically important. Variation in variety of vertebrae are affected by intercourse race and developmental components (genetic and environmental) ii. About 5% individuals variations occur in thoracic, lumbar, sacral and coccygeal vertebrae vi. When number of lumbar vertebrae is more than 5 a compensatory decrease of thoracic vertebrae. Atrophy of the skeletal tissues Following are the abnormal curvature within the vertebral column: i. Kyphosis or humpback or hunch again Feature the irregular increase in thoracic curvature, as a end result of the vertebral column curves posteriorly. Cause Due to erosion of the anterior a part of one or more vertebrae which is a result of osteoporosis. Diameter of the Thoracic Vertebrae Anteroposterior diameter of the thorax is increased. Lordosis or hollow back or sway again Features In this condition the abnormal enhance of lumbar curvature when the lumbar a half of vertebral column abnormally anteriorly curved. It occurs due to an anterior rotation of the pelvis in which the upper a half of the sacrum tilts antero-inferiorly b. This irregular curvature is commonly related to weak point of the trunk musculature particularly the antero-lataral belly muscle tissue. During being pregnant ladies develop a temporary lordosis and will cause low again ache which may disappears soon after childbirth d. Obesity in each sexes can produced lordosis with low again pain as a result of the increase weight of the belly contents, which can be corrected by lack of weight iii. It is an abnormal lateral curvature of the vertebral column, accompanied by rotation of the vertebrae b. When bending over, the ribs protrude on the aspect of the elevated convexity Causes a. Kyphoscoliosis (sometimes present)-It is a mixed conditions of kyphosis and scoliosis in which irregular antero-posterior diameter causes extreme restriction of the thorax and lung expansion. In this procedure the anesthetic agent is injected in to epidural area of sacral canal by way of hiatus or by way of the posterior sacral foramina (transacral anesthesia) b. The sacral hiatus may be positioned between the sacral cornua and inferior to the 4th sacral spinous process c. The anesthetic agent spreads superiorly and epidurally where it acts on the S2 via the coccygeal spinal nerves within the cauda equina d. The top to which anesthetic agent reach is managed by the quantity injected and the position of the affected person. Lumbarization of S1 vertebra: In some people the S1 vertebra is extra or less separated from the sacrum and is partly or completely fused with L5 vertebra iii. When L5 is sacralized, the L5/S1 level is powerful and the L4/L5 stage degenerates often producing ache. This defect is hid by skin, however its place is usually indentified by a tuft of hair ii. It is a extreme sort of spina bifida caused by improper nearer of the neural tube throughout embryonic life b. The spina bifida cystica associated with meningocele (herniation of the meninges) and/or meningomyelocele (herniation of the spinal cord) d. In sever conditions of meningomyelocele neurological symptoms develop like paralysis of the limbs, impairment of the bladder and bowel controls 7. It is a condition of herniation or protrusion of the nucleus pulposus (a gelatinous central mass of the intervetibral disc) in to or by way of the annulus fibrosus (a fibrocartilage forming the periphery of the intervertebral disc). About 95% of the lumbar disc herniation occur between the L4 and L5 or L5 and S1 degree c. In young person the intervertebral disc are so strong (as water content of their nuclei pulposi is excessive up to 90%) therefore the vertebrae typically fracture when fall before the disc rupture d. In old aged persons their nuclei pulposi turn out to be thinner as a result of dehydration and degeneration, as a result their intervertebral discs turn into decrease in height (thickness) which is accountable. Chronic pain brought on by compression of spinal nerve roots by the herniated disc is referred to the realm equipped by that nerve. It is an acute mid and low back pain extending downwards along the posterolateral facet of the thigh and leg ii. It is commonly outcomes from postero-lateral herniation of a lumbar intervertebral disc between the L5 and S1 level that impacts the S1 element of the sciatic nerve iii. It is ache in the decrease a half of the back and hip extending again of the thigh in to the leg ii.

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The needle should introduce through the lesser supraclavicular triangle (between the sternal and clavicular heads of the sternocleidomastoid) upward and inward direction to avoid puncture of the pleural sac. The internal jugular vein acts as a information for surgeons throughout excision of the deep cervical limb nodes vii. Sometimes inside jugular vein might required ligature to prevent spread of septic emboli from contaminated middle ear viii. For recording stress in the right atrium, the right inner jugular vein is used due to this vein lies in a similar line with the right brachiocephalic vein, superior vena cava and the best atrium. The articular surfaces are lined by the fibrocartilage however an intraarticular disk divided the joint cavity in to upper and lower components. The higher part allows gliding movements and decrease part rotator and gliding movements vi. Below To the lateral surface and the posterior border of the neck of the mandible. Stylomandibular Ligament Attachments Above To the apex and adjoining anterior facet of the styloid strategy of the temporal bone. Movements Depression Muscles concerned Lateral pterygoid in opposition to resistance of either side of a. Retraction Muscles involved Temporalis (posterior fibers) assisted by the center and deep elements of either side: 448 a. In this place, the mandible remains depressed and the individual is unable to close their mouth iv. The reduction could be corrected by manipulation by giving strain of thumbs on the lower molar tooth and pushing the jaw backwards. Temporomandibular joint arthritis: this joint may infected by degenerative arthritis which may trigger dental malocclusion and joint clicking (crepitus) sound because of detached articular disk with pain throughout movements of jaw. The strong lateral temporomandibular ligament prevents dislocation of head of the mandible backwards and fracture of the tympanic plate when a extreme blow falls on the chin. The head of the mandible occasionally dislocated forward caused by any sudden violence or during yawning due to sudden contraction of lateral pterygoid muscle tissue ii. Epicranial aponeurosis or galea aponeurotica along with occipitofrontalis muscle iv. It is attached to the epicranial aponeurosis or galea aponeurotica through the dense superficial fascia. Posteriorly To the exterior occipital protuberance, and the superior nuchal strains. It is freely mobile on the pericranium together with the overlying adherent skin and fascia Attachments Anteriorly: It is connected to the insertion of the frontalis. Posteriorly: It is hooked up to the insertion of the occipitalis and also hooked up to the external occipital protuberance and to the very best nuchal lines. It is thin and continuous with the temporal fascia and attached to the zygomatic arch. Pericranium It is the periosteum of cranial bones and varieties the fifth layer of the scalp. Attachments: It is loosely connected to the surfaces of the cranial bones and firmly attached to the sutures of the bones. Out of ten nerves, five nerves enter the scalp anterior to the auricle and remaining five nerves enter the scalp behind to the auricle. Posterior branch of great auricular nerve (sensory) from C2 and C3 of the cervical plexus b. Danger area (layer) of scalp: the layer of subaponeurotic loose areolar tissue (4th layer) is known as hazard area of scalp. Any an infection in this layer spreads quickly and may infect dural sinuses via the communicating emissary veins ii. Accumulation of blood due to any damage with out producing much localized swelling. The subcutaneous tissue of scalp (superficial fascia) consists of dense fibrofatty tissue which prevents the retraction of blood vessels ii. It occurs because of bleeding in to the loose areolar tissue (fourth) layer of the scalp after a blow on the cranium ii. The blood gravitates progressively deep to the frontalis muscle and appears first in the upper eyelid and then the lower eyelid after few days. It occurs due to obstructions of the ducts of the sebaceous glands related to hair follicles of the scalp ii. Infection of scalp usually stays localized and is often painful, due to ample fibrous tissue in the subcutaneous layer Occasionally, the infection may unfold by the emissary veins, which are valveless, to the cranium bone inflicting osteomyelitis 7. A partially indifferent scalp is relapsed with cheap chance of therapeutic if considered one of its vessels remain intact. The free areolar tissue layer is recognized as hazard area of the scalp as a end result of pus or blood spreads simply in this layer 452 Human Anatomy for Students ii. Infection on this layer can infect the intracranial constructions like mind and meninges through the emissary veins that move by way of the parietal foramina of the calvaria iii. Infections (with fluid, blood or pus) can also enter the eyelids and the root of the nose as a result of the frontalis muscle attached in to the pores and skin and subcutaneous tissue of the brow not to the bone, therefore could produce black eye, most of the blood enters the higher eyelid but some may enter the decrease eyelid. Scalp lacerations are the most typical sort of head accidents throughout vehicular or industrial accidents ii. These injuries are bleed profusely because the arteries coming into through the periphery of the scalp bleed from both ends as a end result of ample anastomosis iii. The epicranial aponeurosis is essential because of its power, which prevents gaping of the skin in a superficial laceration, as a outcome of the margins of the laceration are held together by this aponeurosis ii. In a deep scalp laceration when epicranial aponeurosis is break up or lacerated along the coronal airplane the deep scalp wounds gape extensively because of the pull of the frontal and occipital heads of the occipitofrontalis muscle anteriorly and posteriorly respectively 12. Sadness: anguli oris and zygomaticus minor by producing depth of naso-labial sulcus and Short Notes on Head, Neck and Face 453. Grief: Depressor anguli oris by miserable the angle of mouth assisted by platysma. Anger: Dilator naris and depressor septi by producing dilatation of anterior nasal aperture and depressing the cellular a part of nasal septum. Frowning: Corrugator supercilii by producing vertical wrinkles of brow and procerus producing wrinkles across the foundation of the nostril. Surprise, horror, and fright: By frontalis elevating the eyebrows and horizontal wrinkles of brow. Whistling: Buccinator by mingle medially with these of the orbicularis oris and by contraction of orbicularis oris. Nerve Supply of Face Motor Nerve the facial nerve itself is the motor nerve of the face (except the masseter). Human Anatomy for Students Features Carotid sheath is thick and dense over the arteries and nerve however skinny over the vein. Posteriorly the cervical part of the sympathetic chain, closely attached to the prevertebral fascia. The vagus nerve Here the artery lies medially, vein laterally and nerve between and behind them.


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