ffi&EpffiK

.t/

' Dr'- S. N. Kazi _.

, Associate ProlEili
Dr. D. Y. Patil N{edical College
for \\'omcn. Pimpri u
Phonc - 7420955, 7420556'
Email kaz.isn@vsni.net
 - IgL-t h>
ttirrt + R.rst t
.llEu -r la-!t1a
d*tr^rbe... - ..stn .5" -t sugariiat'^r SNK - Supcx
'co-qo"
a{Ak!ir'A^t
qo'- 'I?fi*
--' .t r"**''-
^nO*
S: 'l ypc ol Topic Pa8c
'\c Oucstion No.
'. s/N-l Coraco id process 5
a.: LAO_ I Manrmarl gland - -. .. .. LQ-(o*tr) 5
J.
^7 sn{-2 Lymphatic drainage of breast 6
S/N_3 DcvcloDmcnt of mamniarv pland l0
S/N_4 Pectoralis maior l0
6 SN.J 5 Clavipectoral Fascia s+r, F4e\dq(J;ll'bt) ll
LAQ_2 Axilla uQ{c.n'or)Jos,ttoq ) t2
8 LAO*3 Brachial nlexus rr^ l- ft€d/'cJ(cd{F .'{h}br t4
6)Li-n'aq,
9 --LAQ - 4 AX tary anery l7
){: S/N-6 Axillarv lymph lqdes _ 2I
11 SAQ I Lumbar Triangle 2l
12. S,N-7 Median cubital vein 2I
13. Snl 8 Deltoid 2,2

14. SAQ 2 Rotator cuff 23

.-15. SAQ_3 Ouadraneular'soace -
l6 sAQ -- 4 UDpcr triangular spacc 24
t7. SAQ_5 I-orver trianzular space
l8 LAQ_5 furillary nen,e 75
19. LAQ_6 Musculocutaneous nerve z6
t 20 I,AQ - 7 Rraclrial arlcry (fl,l,r'rc)
a
28
-r 2l LAO -- ri , l&trtfini ricrve JO
22 S,N.9 Applied anatomy of radial nerve 32
2j s/N - l0 Wrist drop
.24 LAO 9 Cubital frrssa u..fet',') t2
75. LAQ- r0 Ulnar rrtcq' l5
26. Snl-ti Anatomical snuff box 31
71 . s/N- 12 lilexor rct inaculu m i8
28. LAQ - I1 Mcd.ian ncrve r9
29. sn{ - r3 Applied anatomy of median nerve 40
30 s/N - 14 Carpa I trrn nel 4l
lt sn{ - ls Palnrar aponcurosis 42
32 S,4.1 - l('l Dorsal diqital expansion 43.
JJ, LAO 12 lntctossei 44
SN_I7 Lrr ntbrica ls 45
15. LAQ ll Superficial palmar arch 46
i6 LAQ _ I4 Dccp palrnar arch 48
31 LAQ - r5 .lJlnar ncrvc 49
]E sn{ -. 18 Pulp spacc 5l
l9 SN. 19 Palmar spaccs 5l
' i0. LAQ. I6 Shouldcr joint Lq - (ltari'02 ) 52
to"t ,o r)
\OTI- : LAQ = [,ong Ansrrcr (ctr'cl )
SAQ = Slron Ans\vcr Qlcslion
Qucsrron '
S'\ g (r.,..,ar)
= Slron Norcs l1i'co)iJ.,' oc) /.rr.. ?., ..,
ftY 'o2 )
 Wrist ioint (radio carpal)

CA e']<j'hl-\ "l s tt,'.v;at i \

Mi",r'L ta@L' ?'
s4
7',Y-f'd
a tu"ia) k eiir.txez & Trtx'u-a tvn
^u^.sja \_( I o.* ir^ )
t r!,, ( .cag.r *n .e pr* rd,n
a4
Kd''\T
\
,;X 4 Y d,L.Sdr'- ^
4 tlrt'y'u FVt-
I
uar<
wn7,1 J

NOTE ; t AQ = l-ong Artsrvcr Qucstiott

SAQ - Slron Att:rvct Oucstiorl
S/N = Shoa Notcs
 SNK - Supcx

Datc - 28-l I -2001.

S/N-I Coracoid Proccss:
A. lt
represents the ventral elpmen! of scapula and is homologus to the ischium of
hiobone -r-^^. -
R. It i:.a.lypc of affistic epiphysis. It gives anachmcnt to following muscle -
.roP"l)'
|-2.
Short head ol biccos and cg1ggg_lggbi-al is are attached to thc tip of coracord
- oroc.ess
U) pS"tofglg_lflnor ariscs fiom superior surface of coracoid process.
C lt givcs anachmcnt to lollowrng ligaments
.,^-C5l Coraco humcral lieameni r','hich exterids from lateral boidcr ol coracoid
>l' prbccss to anatomical neck ol humerous
b) Coram acromial arch - It is formed by coracoid and acromial process of
scapu la.
c) Coraco clavicular ligament - It is strong band bet*'een coracoid process anci
cl cular ligament. it consist of-
i) Coracoid part - It is an inverted cone shaped- Base is attached to the conoid
rubercle of clavicle.
ii) Trapezoid part.

n ApgUd drrr0mr{:- We,ight ir trunemrttod to tho medial Z3rd of claviele through

-'a----------:--- -
cg lale qgyt !q! 3ti-r[gasre!t.

, ffl,a-tDcscribc mammary gland under

L Gross,
2 Illood supply,
3 Ncrvc supply,
,i. Lymphatics and
5, Appticd anatomy,
Ans -
L Definition - It is a modified sweat gland, rudimentary in maie, well developeC in
lcmalc aftcr pubcny. ni twx're
2. Situation - Present in superficiat fa;cia cxcept tail^p*'*'hich pierccs dccp lascil ol
axilla through foramen ol Langer
A) Extent - !'erti y it ex'tencis from 2"d to 6\ribs
B) Horizontal - S ITOM er of sicrnum to
3. Type - Apocrine, lcrous, pgodifid tubulo - alveoiar gland-

S"rrrr,-."'\\
dnLtrlor -):\ 'PilSrerra-s
ortlirre ./ External
of bte6st

Muclo riturM dctp ro tlc brqrr.

4. Relations -
. - . A) . Superficial relations are - skiq superficial fascia
B) Deep relations are: a) Retro - mimmary space, b) Pectoral fascia.

Deep relations are mus

Area Muscles
I Superomedially r) Pectoraj is major
2 Superolaterally 7) Serratu s anterior
3 Lderomedially l) Extemal oblique
D) Structures deep to above muscles are - Subclavius, clavipectoral
pectoralis minor and suspensory ligament ofaxilla.
5 Structures -
,,
,. A) Skin consists ofnipple and areola.
a) Nipplg -It iiIlaERiiF?Escolouration of skin situated in the 4n intercostal
t ffiIt is pierced 6y 10-15 lactiferous ducts and contains smooth musclc
fibre.
b) &riola-- It is circular blackish discolouration around nipple. It contains plenty
-1
of modified sebaceous glands, which enlarges in pregnancy and are called
Flbg$Lcs_g! Mo$g9mgq. Thcy secrctc oily secrerion which lubricates and
: prevents cracktng ot thc skin over the nipple. it is devoid.ofhair and fat.
B) P_arenchyma - c9!!g!i_l-Da-ds
! a) Q]g4g.l.-pq'r - Consists of alveoli, lactilcrous dua a,.id lactiferous sinus,
which is tcrminal and dilatcd pan
' b) Fibrous stroma - Consists of fibrous sept4 which exlends from skin to the
r deep fascia and divides gland into l0 to l5 Iobes by ligament ofCooper.
c) Ilalry stroma lics berwe-en sdptum and glandular fan.
t "
$)Pofu
, -.L\:.d"""-**l-
s.,r.pfo{lrq\ i-o-.
,7tsro1q"{ *^" ;U$J si ,r,
& V'ar$q l"wr.
'* .ldq
J^t., J:
t--IJ]"
0{
iJ".'.o.H.J lJ..'*
,'.i
rge, ",^rn,i
h.ur
oi C. o[0.
l' ," aru,Xp-;b,rtl.o"rn 9*-
it."- t:-ra-& , *JrpI--,rr,
')
" or*l^ a -,VvG,
\l
.

5 Jh"
"*"l"nat Zbrr\ Lt odJL """4 Vq-utulor,
t) lnrernal rnammary anery
rntemal [ran9h,ol l"
anery _Qrang,hpl- l'- pat of (subclavian
{subclavia,r dnery)
r is rhe main
supply .lr
biood supply suppl,eslilffil frotrn''it,.
Ir suppl,esl*|ffi frrotf n'''t,. nrammary gland.
II) Superior thoracic,is brarich of part ol axillary artery supplies uppcr and
i"
medial quadrant of thc gland.
III) Acromio thoracic, branch ofaxillary arten, supplies upper lateral quadrant
IV)Lateral thoracic supplies lateral part olthe mammary gland.
..
b) Venous drainage -
I) Internal thoracic drains into- Subciavian vein
Il) -)
Acrorniothoracic
Il l) Superior thoracic
IV) lateral thoracic -
! ar"ins;nro a-iillary,rein
)
|

Nerve supply
a) Sensory and sympathetic -- 4 - to 6d intercostal ne.ve.
b) I iormonal control-
 . ---- fi Oai::iiJ:. s-:::..i:::'j -- 5J.'iil aai b:zaci:nc o: duc
Proga'-eroae s mulates - alveolar forrnation
--.Iff
p) Oestrogen & progesterone is Gfr-ndEIEGr thi formatioa of true (set' ' -'ry';

alvcoli durir.g pregnancy.

-Ia) P1ql4gqrr -
maintains lactatlon.
/) Oxytocin. - helps in ejection ofritk.
S/N-2 Lymphatic drainage of breast & appliul anatomy of lvmphatics

UwVv'ote-
d\*"7
cqn be
e^'l\ot^ zJ,
\ r,
vr'd' LL
2 k e^J* :'
\\> Ltr'.fu ndu
(rl 17nyhc,+:c: H+!tk nodca ;

/6Ps
\ \\r--ovrrY
\:f

Lyrnphli6 fro{! th. o'crviqs sli! of rnallrms-D, !is.-od

.^. iali)ilr-l:rr:r.
a) Il i:: onc ol' the comnon malignancy in icmales particularly in post
rn,:::rlpa-usal age.
b) )i ainrost spreads to the regional lymph node and to the opposite side.
c) lJ::r'l;, diagnosis
i:esbetter
grognosis
Lyrnpii nodcs - 75 oZ
lymphatic drains into
axill:rr y, nodes
- 20 % lymphatic
drains into intemal
manrnary nodes
- 5 % lymphatic
d ra ins lnto
postenor l,lrnpludoi frorr tl'c prrech)u11of lhc brc:st
intcrcostal nodcs
 SNK - Srrpcr

I- c LJralnage
Drai
A) l-ateral. Drains into anterior group of axillary lymphnode which drains
I ) Upper into central and ultimately drains into apical 1,,r'oup of axillary
2) Lower lymphnodes.
Particulars Superficial (exccpt skin over nipplc D ccp ( i'arenchyma +
. and areola) sk-lr, o',' rr r nipple and
ri-cola)
B) Medial
I ) Upper Drains into any of the lymp"h nodes Drains i':to either of
mentioned below :- lollori i:, :: otes :
l. parastemal group ol lymph I ) apir. ,rodes and
nodes on the same site (which 2) inil: r ,,i! manrmary
are situated along the internal iv nr, , rrodes.
mammary artery)
2. Opposite parastemal group of
lymph nodes.
3. Supraclavicular lymph nodes
present above the clavicle

2) Lower Drains into any ofthe lymph nodes r - I aF(nnu

mentioned Uef ow :- SrL r,ra* <J \c O CV'
! narastemal
|-- srouD of lvmoh
nodes on the same site (which
are situated along the intemal
mammary artery)
2. Opposite parasternal group cf
lymph nodes.
3. Drains into lymph node in the
rectus sheath - Liver - ovary -'
fl(rukenbere's tumor )
Nou,a days sirnpler nomenclature is adapted
A) I-ow nodes - Lcvel - I - below pectoralis minor muscle.
b) Medium nodes - Level - 2 - behind pectoralis minor musclr
c) I-{igh nodc - Level - 3 - above pectoralis minor muscle
D AppLied anatomy -
a) Applicd anatomy of lymphatics :-
-z I) Axillarv ty.p!449nop4!U is frequently due ro inlecrion :...i maliqnant
disease of mammary gland. The tumor is hard, regular and fi:rr,: i ) the deeper
structures in malignant tumor of mammarygland.
.!) Lymphatics from upper and lower mcdial quadrant go ro opposite side and
therelore a tumor arising from the medial hall ol marnrnary g,land is
dingerous.
.-ttl) Back door exit - malignant cells may penetrate pectoralis nrajor and goes to
Reiters lymph node, wlrich drain into apical group of arillan, lvrnplr nodes.
.-{V) Carcinoma usually arises from larc,er ductal epithcliLirn
1/) Suspcnsory ligaments ofCoopcr. are infiltrated bv nraliqnanr cclis and produce
dinrples overlyinq sk in
.

\)
 \
q a,r'

Icccsnn nitplc-r rnil :ppc:r on th milk

(B) Anomalies:-
a) Polymastia - +, supernumerary breast
b) Amastia -3. abse nce of breast
c) Athelia ----!'absence of nipple
d) Polythelia supemunerary nipples j ** &.af
SN-4pcctoralis -r
nlajoi-:
.

SWUuFrue" ur*r\e,,, co..,{* cq he{_+o \a_lJi

A. Ongin \ I
a) Ciavicular head - mediai % 01'antedor surlace of clavicle \nrq rJY .'
. Lr) Stemocosral J

J) From lareral pan of rr:cdor surlace cf stemum upr.o 6$ costal mlilage.

II; 2 ro 6u'cosial catrila3c
III) Aponeurosis olex-ternal oblique muscle
B Irr:cnion - by a flat b$*1u1lgl!Sn 15 cm Ierrglh)
into lateral
lnro lip ol
rarerat Llp biciffil I'groovc
oi blclpttat oor c ol
of ltumerus
irumerus in [] _
rn U - shaoed manner
No. A nterio r Ianrina Postcrio r Iamina
Thick and shorter Thin and lonqer
1 It receives 3layers olmusc)c fibres It receives fibres fionr
a) Superficial fibres arising lrom a) Front of sternunl
clavicle b) 2'd to 66 ribs
b) Middle fibres arising liorn c) 6$ costal cartilage
manubrium d)' Aponeurosis pf ex-remal oblique,u.461.
c) Deep fibres lrorn nrargin of % $- oLJonnen '
ste,.nunr and 2"d to 6u'rib a) and b) fibres are t*isted and lornrs the
artcrior axillary foid.

I0
 S).'li - Supcx

! ^rorn b,"t,
by mcdial pcctoral nerve ' after piercing pedoralis minor &
L._ Nen e su pply' -
lateral pcctoral nerve - aftcr piercing clavipectoral fascia
crt;
Acl ion :-
a) Clavicular fibrcs combincs with the anterior fibres of deltoid and bring about
flexion of shoulder jo int.
b) Sternal fibres combines with latissimus dorsi and bring about adduction and
mcdial rotation of shoulder joint.
c) It is also an accessory muscle of inspiration.
d) It is welldeveloped ln climbing and flying animals.
(qto.t-al,is vrn nof .

SAl.5 Clavif ectoral fascia :

li Introduction - Strong sheet of fascia extending from pectoialis nrinor to the
infcrior surface ofclavicle
2. Attachment
a) Medially - Fuses with acterior intercostal membrane ol upper 2 intercostal
spaces and attached to the first rib
b) Laterally - It is thick and ctense and attached to coracoid prccess.
c) Above - Above it splits to enclose subclavius and is attached to the lips of
the subclavian groove of clavicle. Its posterior layer mixes with axillary
sheath laterally and fuses with .deep cervical fascia of neck. It connects
ombhyoidlo clavicle.
d) Below - It splits to enclose pectoralis minor, and laterally ends into shon head
of biceps.

Cl!viPcaoral

Surpc,,rory laj!hllJ

3. Modificat ions -
a) Qo_5ig-coracoid liqarnenr- Ir is thickening ol fascia along lower border of
subclavius bctween coracoid process and first costo - chondral junction
b) Suspcnsory ligamcnt olaxilla is lascia below thc pectoralis minor
ll
 4- Stnritures gircing -
a) Passing insards
- D Thoraco - acronial artery exd i., l:anches o
i) Bones - clavicle, acromion pro6s
ii) Muscles - deltoid, and pectora.lis major
II) Lateral pectoral nen.e
b) Passing outwards
I) Cephalic vein
. II) Lymphatics from
. i) In&actavicular nodes and
ii) Mammary gland - to thc apical group olaxillary nodcs.
5. Action - It acts as suspensory ligament of axilla and maint:ins the dome of a;iilla.
6. Applied -
a) Malignant cells of breast may pierce clavipectoral fascia and go to Reiters
lymph node and to the apical group of lymph node. This is called back_door
exit.
--? 'd{rutq}d' 0r'fi4-'u0t '
,t-a-n-

LAQ-2 Describe axilla unde';

.l- Ecundries,
2. Content and
3. Apptied
Introductian - Axilla (armpit) It is a pyramidal shaped space present in the
upper part of arrq

Arill)q rr:. {l'rd fr l

T a: c.'ru of bra-hi!t ptcio.j

Po c{;o. ccrd of hrachilll plEruj

i. Boundaries -
A) Apcx is also called cewico-axillary cru.ral and is formed by
Mcdially - by outer border ol l"' rib
I-atcrally - by.superior border of sca,,lia
Antcriorly - by posterior border of clar.iclc

r2
 SNK - Su1r,.x

^l
€z \l.Pot
B) Basc - isYormcd by
a) Skin and -l Gom amcrior arillary fold (formcd b1'
"*tcrdir,g
pcclo.alis rmjor) to postcrior arillary fold (formcd bi
b) fascia F
Superficial
c) DccP fascia J latissimus doai)'

C)Walls .
a) @C!gl-1yall is formed by following structures .-
I) Superficial sl,ructure is pcctoralis major.
II) Deep structures are pcctoralis minor, subclavius, clavipectoral fascia, i' :i

. suspensory ligament ol a-tilla.

b) P-sgc!9ladl is formcd bY
' -l)-Su6-scapularismusclc
I! Teres major nrusclc
III)latissimus dorsi muscle
c) Qrerelsdlsformed by
I) Intemrbercular sulcus olthe shaft of humerus which contains long i,
of biceps brachii and
rl) Coracobrachialis and shorl hcad of biceps.
d) Medial uzll !s broad and formed by
I)
Upper 4 to 5 ribs & their intcrcostal muscles.
ttl Upper part ofserratus anterior covered by a strong fascia.
IlI) l-ong thotacic nerve
N) lntercostobrachial nerve, (T2)
2. Contents oI axilla:
e) Axiilary a,tery and its brarches;
B) Axillary vein and its tributaries
c) Cords of
brachial plexr-rs and their branches, long thoracic
intercosobrachial nerves;
t)) A;iillar), Iymph nodes and their affcrent and efferent connections;
rl,t A;iillary f:, 4 gt p\lx *uJu. i.
.,*'* 3. Applicd rp*- cl,. otlre_r c_o nh
ll ehl\rtdd c4. ^ye
A) Suppuration may occur
a) Supcrficial to peaoralis minor muscle - Here abscess app%rs at the
of arterior axiilary loid or in the deltopectoral groove,
b) Deep to pectoralis minor muscle - Here pus wrculd sun-ound vessels
nen'es and a-scend into neck or may track along the vessels in arm.
B) Axillary abscess is draincd by putting the knife at thc base of axilla miri
between anterior a,rd posterior axillary lold and nrove towards thoracic sir!
C) Relations ol vesscls are imporlant rvhile removing Iymph node in L,,c
nralignancy of breast.

., | ..-

ll
 LAQ-3 I)cscri bc brachirl
plexus.
- Ans. -
I. Dcfinition - Na',r,ork of nervc
fih'res present ar the juncrion of
neck and thorax supplying all
the structures of upper lirnb and
is lormed by ventral division of
antcrior primary raml of Cr, Cc,
Cr,' Ce, and Tr.

2 Brachial plexus may bc fixcd by

two ways
A) Prefixcd - when Ca root
joins with Cs, here Cq is
large T2 is often absent
B) Postfixed - When Tz
Forrrution ofth. brlc.hial plerEs.nd itt hrrochcs
root joins with Tr. Here
Cr root is absent. The
contribution by T1 is large-

J, Situation - Roots olbrachial plexus are situated betlveen scalani muscles

A) Trunk are present in thc lower part ofposterior triangle.
B) P-ivisions lie behind clavicle. Anterior division supplies all the muscle present
on the ventral part ol thorax and upper limb. Posterior division supplies
muscles present on dorsal part ofthorari and upper limb.
C) Cl$ gfejryig41l!_qxilla. The names of the cords are given depending upon
tbe relations ol the sccond part of axillary artery.
a) Cords enter above the ls part ofa-xillary artery.
b) Cords cmbrace 2nd part ofaxillarv artery.
c) Cords give branclles around 3'd pan oiaxilla,ry anery,.

4. Relations -
A) Supra clavicular part: Roots, trunks and brar,ches of trunls a-'e present above
the claviclc
B) Infra clavicular pan: Cords and branches ol coids are piesent belorv the
" cla'ziclc
-' f,tr"&o-hrQt(.
(\ I 5. Itr:rrrchc.s
i n'acn
'l
c'Lr oo A) 'firc ncrves arising lrom roots supply the muscles rvhich brings protraction and
retraction of shotrlder girdie i.e.
) Nervc lo rhomboids (dorsal scapular nene) (C5)
b) Ner-,rc to scrrarus anterior (long thoracic) (C..r.r)
-frunks
B) -
a) Suprascapular ncn,e (C5.C6)
I) Supplies - supraspinatus, inlrasPinatus
l,r
 SNK - Supcx

t\
,Nt
tr; Slroulder and acronr ioclavicular joint
lllr Scapu la " :';/ I
b) Ncrve to subclavius (C;,C6) - supplies subclavius muscle
i) Cords - Following arc thc branchcs from rcspective cords.
uNAR.
Later6l ror-,]] Medial r."r, Posterior ry+.p.,-,
a) btcral pectoral -. p) Uedial pectorat(Cr, 1,) a) Upper subscapular ( CS, C
nerue(C5 - C+) b) t!edial root ol mediary jepg 1 b) [,ower subscapular 7 )
b) Lateral root ol c) lledial cutaneo-us n..$.t6r l'l L(s, C )
. median ncrvc arnr ( L8, \\/ c) !'erve to lattissimu s-dorsi
j t-ateral ( Cs - C , Medial Postenor((t(t).
c) l\{uscuio cutancous d) Medial cutaneous nerve of d) Axillary n.*" C C" C" )
,
nerve (6s -C1) forearm L( a , \r )
c) Ulnar nerveC C+. C t.T,) c) Radial n"*df . -Cp T

Horncr's svndronre - It is due to involvement oF sympathetic nerve, which is

contributed by T1 It usually orcurs due to injury at the root ol
.r-1 brachial plexus.
\ Hypohydrosis (hypo -less,'hydrosis = sweating) Secretomotor fibers supplying
ro the sweat gland is through sympathetic nerves. l-
t'-r'
Opening ol eye is lost due to ptosis (drooping of the upper eyelid caused by
paralysis of involuntary part of the lcvator palpebrae superioris).
Robertsons pupil [construction of pupil] due to paralysis ol dilaror pupillae.
Unapposci action of this sphincter pupillae leads to constriction.
Narrowing of palpebral fissure.
Qlevation of Iorver eyelid.
Retraclion of e1,eLall. Eyeball is !ess prominei:t than normal lt is described but
not u,e Il exp Iaincd
Sinking of eveba li

"/)

Ii
 6. ied anatom
Particulars D iseasc , Muscles Paralysed Clinical featu rcs
i) Upper trunk Damaged Brachial plexus Sirould be Arm - i) hangs by the side
Treated Intelligently ii) adducted
Deltoid - postcrior cord iii; medially rotated
Bigeps, Bracllio"*adialis, foreirrm - EKended and
Braci--ralis - lateral corct pronared f
Suprasflatus, supinator (radial) | =-l
^1-_i I

Tercs major - upper and lowcr

Sub.scaptlar tteme,
Teres minor - lxillary nerve
Infra spinah:s - .lrprascapular trcrve
lri$l
lz' I
Nertes affected are
I.
Supra scapular: Supra spinalus,
Infra spinatus.
2- Musculocalatteous nerve: Biceps,
Brac h i al i s, and Coraco b rac h i al i s,
3. Axi llary neme

ii) Lower KIumpk es Iotrinsic muscles of hand i) Claw hand

tmnk paralysi Dorsal and palmar interossei, ii) I{orner's syndronre ^
I-urnbrical, i| ..$J.Znns"
*_-'l
(trN V Flexors ol r',,rist and finger. I c*,:-/r'
t

:h>:S ,$ .z
I

xl-
l.#'i
cc:-Qgg
: --:
\- '
---+Y!

iii) Nen e to Senatus alterior Winging ol scapula

serratus
an t erio r
iv) Lat eral l) Coraco brachiaiis, biceps. l) Midprone lorearnr
cord 2) All muscled supplied by median 2) Loss of flexion ol
ncrve cxcept thosc ofthe hand. forearm and rwisl.
i) Sensory loss on tlii
radial side ol lorearm.
v) Mediai I ) Claw hand
ll) Ulnarnerve
cord
I r1 ltcaiat root of mcdian ncrve 2) Sensory loss on the
I ulnar sidc ol forearnr
j and hand.

t6
 SNK - Supcx

SulElnvien 6rtery
AxiIiary arlery
i// t &racoid
, I 'Proces s

Firs t li ):
rib -r

( \. rG*.''s
t Brachial a.
Teres B3joc

Tlc cxr.ol rDd prru of lhc rillr.y r.n ty.

LAQ-4 Describe axillalf artery under followins heads

l) Origin,
2) Course and relation; ..., ''

, 3) Branches and
4) Applied anatomy.
Ans
Defioition - It is tbe artery ofaxilla.
1. Origin - It is continuation of third p-art_of subclaviaq. a4gt:,v. :

.,
i r. r /.!f?a
:Lrpii.l.-ir". -i ii,,, n:.-;.,i

,:\il.l jii iiier./

.t6
,,.-:.':,. ,,.r'i

ll.
. .. /<:- -.' ' .:..-.,_:-- \ - '.::i:::: r''. ::r:

Extent - It ext ends l'rom outer border of fi rst rib to lower border of teres rnajor.

2. Coursc and relations -

Axillay ancry is divided into three pans by pectoralis minor muscie
A) I" part - rncdial to pedo;alis minor
B) 2nd pan -.posterior to pectoralis minor
C) 3 rd part - lateral to peaoralis nrinor
Rclatio ns -

ll
 )

ts
 SNK - sutrc\

R !"ftlh/ 4 i^! 4 r+e)a

rp,5)b Ctg"Lv-d";"J;
d'
Part Anterio r Postcrior Medial Lateral
,i1 skin l) Medial cord of Axillarv vet n Lateral & posterior
'c
lif Su perficial brachial plexus cords ofbra6hial
fascia 2) Nerve to serratus p lexu s
anterior
iii) Platysma 3) Seiratus anterior
iv) Supra clavicular a) tubs
n eTves
yfieep fasc,a 5) Intercostal
fiP cctordis malor muscles
vii) Lateral pectoral nerve'i'
II 99ui" l) Posterior cord l) Medial I) t atcral cord

-2fSuperficial fascia 2) Subscapularis cord cf

'3)!eep fascia brachial 2) Co racob rachiali s
qy'y'Peaoralis major plexus
5) Pcctoralis minor 2) Medial
I pectordl'i'
Nerve
3) Axillary
vein
lll -r]Ky U coer sub_ \\o,
'i*prtu, _ rpr l) Medial $ l) Comcobmchialis
'
fascia n.ti" cutaneou s z) N"s.,,ro.,'-}"-.e-
"$(pprficial
r+,}crp tascra Lorvcr su[r- nerve of
6) tajg.'r r..94.! '
.p€ctoralis major Scapular arm *.rad.ralh '-
lled iai root of median Ncrve to lattissimus 2) Medial
blo
^lQ/'^
.nervc 'i, do rsi cutaneous 'CrJL-aje-i
Axillary ncrve ol forearm
Radial nen,e Ulnar 3 )
Nene
CIues -:
- h) A,ir\c!r \Qr/.'
\ ^nd
a) 2"" pan of,axillarl,aneq,is related to respecrive cords ot'brachial plexus.
b) 3'd part ol axillarl, aneD/ is related to branches ol respective cords ol
braclrial plexus.
c) Is part of axillary anery is related to lateral cord in respective position.
Mcdial and postcrior cnrds are clockwise rotated in 900 and occupies
pos it io n

I ["]'
tete'e! Ndo4t '/\'.!!4 fo,,t { T F9ll- A1
t{ ]-
MeAar'
[a/d,.l ^r^"1 - ura-l prt "{ U l.rJ
$4J"( {/ot ( tul)a NottL - A.t p"r .( fr p* n t

t,
3.Branclres -
Part Branchcs Coursc & relatio n Rem: rks
Superior thoiacic Runs cn upper bo:der of -Small brar,ci
pectoralis minoi- muscle -.{nastomos is rvitir
a) Internal thor:cic
b) Upper intercostal
-Supplies mammary gland
and pectoralis major,and
minor muscles
l) Thoraco-acromial -It pierces clavi pectoral -Supplies sternoclavicular
branch supplies to lascia jo int.
a) Bones - -[truns ori the upper
Llavlcle, border ol pectoralis
acromion minor
process of
scapula
b)
Muscles
pactoralies
major, deltoid.
2) Lateral thoracic Acconrpanies lovrer
bordcr of pcctoralis
minor
I ) Subscapular Largest brarch Anastonrosis witl!
- Circumflex Runs on lovrcr border Postcrior circunriex
scapular' of sr-rbscapularis hunreral
2) Antcrior circu mflex
humcral
- Ascending branch
3) Posterior circumfiex
humbral
l) Descending Anastomosis rviiir
i) lnfrascapular L Lateral thorar: :
ii) Small 2. Intercostal
branches 3. Decp branch , :'
2) Thoracodorsal transVersecei..'ical i

Variations -
a) AIa; thoracic branch - may arise fiom 2nd part of a-rillary artery
- supplics
I) zxillary pad of lar
II) lymph nodcs
' b) Last threc branches and profunda anery mayarise lrom comnron trunk.
c) I)osterior circumflex humeral anery may arise from profunda brachii
artery.
4. Applied anatomy
A) Axillary anery can bc cffectively compressed against the humerus.
B) Axillary ancry is likely to ruprure during reducrion of an old dislocated head
ol humcnrs
i0
 5,4,{-6 Axillary lymph nodcs:

LR|'ll ByJs of rh. rrili..

- These lymphnodes
Typc Situated AlTerent Efferent Drainini;."' .. --l
(Receives) (drains into) I

a) Antericr AJong lower lateral halfof Central a) Drains mnsi r"---]

border of breaS the lynplrai :.:.,i
pectorals minor breast I

,;l
I
b) Posterior Situated along Axillary tail Cenkal b) Dorsal piri r
subscapular trunk abovr
vessels iliac c..csr
_l
c) Lateral Situated 1) Upper Iimb Central c) Drains ent,r
posteromedial
to axillary vein
upper lirr''l:
-'
"'l
aCCO nip at 1

ceoh-alic r'.r.
d) Central Prescnt at the l) Anterior Apical d) From a), b), i"-1
base of axilla 2) Posterior

c) Apical Present in the

l) Lateral
Central 1) Subclavi an a) Drains
l
apcx of axilla trunk (a) Uppc, t:_)l
medial to 2) Thoracic (b) Manr;'
axillary vein duct glan,.l I

b) Axillary !r,, I
I
node
l
SAQ- I Lumbur Triangle:
is a musclrlar triangle presenr o the back aboye iliac cres!.
Il
L Boundaries -
A) A4edially: I.ateral border ol latis.sinus dorsi.
B) Larerally: Posterior border oJ external oblique.
C) Inferiorll,: I liac crest.
2. Applied - lt is a site of lunbar hernia.

2t
 S,N-7 l\{edian cubital vcin:
Itis a large communicating veiq u,hich shunts blood &om the ccphalic vein to thc basilic
vetn.
- 1. Origin - From ceptulic veirq which is present l" below bend ol elborv. It runs
obliquely up*'ard and medialty.
2. Fate - It cnds in basilic veiq l" above the medial epicondylc.
3. Relations - Superficial tg deep.
A) Median cubital vein.
B) Bicipital aponer:rosis.
: C) Brachial artery.
4. Tiibutary - Median vein of the forearm drains into deep vein tluough perlorator
vein.
5. Applied -
A) It is commonly used vein for withdrawal of blood for investigation anci
therap€ tic purposes (intra venous injectiorL intra venous fluid, blood).
B) This vein is fixed by perforator vein-

S/1.{-8 Deltoid:
A Definiti on- muscle in the shoulder r
Particulars Anterior Middle Posterior
S 1'non 1.rn ou s Claviorlar Acromial S pinal
i) Tvpe Long and parallel Multipennate long and Darallel
ii) R-alrge ol More Less More
movement
iii) Force of I-css More Les s
pull
iv) Origin A-nterior, upper surface of lateral border of lorver iip of crest ci
lateral l/3d of clavicle acromion soine of scaoula
v) Insertion Deltoid tuberosity on a V s haped impression extendrng on lateri ,

surface of middle of humerus

vi) Aaion 1) Antcrior fibres of deltoid Middlc 6bres r) Posterior fibrcs o:
and clavicular fibres of only brings deltoid combines
pectoralis major brings abduction of with lattissimus
flexion of shoulder joint shoulder joht dorsi ard bring
z) Antcrior fibres of deltoid lrom 15' to 90' enension of
and (a) stemal fibres ol shoulder joint.
pectora.lis major, 2) $pinous fibres of
(b) lattissimus dorsi Delroid +
(c) teres major
!r,-&aspinatus +
brings medial rotation of
shoulder joint.
feres minor
brings lateral
rotalion oi
should er ioint

22
 - SNK - Supc_\

B. Ncnc supply -.A-rillary ncn,e - Ci, C6 of posterior cord of brachial plexus.

C. Structurcs under cover ofdeltoid
a) Borres
l)Upperendofhumerus).uithgreaterandIesSeftuberosities,
Intertubcrcular sulcus,
Upper part of shaft and surgical neck of humerus.
II) Coracoid process of scapula.
b) Muscles -
I) i) Greatet tLlbercle - supraspinatus, inlraslinatus, teres minor
ii) Lesser tubercle - subs'.:apuiaris
Ii) Origin of coracobrachialis, shon head of biceps long head of biceps
. (supraglenoid tubercie) long head oftriceps, (infraglenoid tubercle) and iateral
' head or triceps (pcsterior aspecl of upper part of shaft of humerus)
c) Vessels - Antenor and posterior circumflex humeral.
d) Nen,e - Axillary.
e) Joints anC ligaments - Shoulder joint with ligaments and coracoacromial
iieame nts
it Bursae - Subacromial and subdeltoid bursae and bursae of shoulder joints.
D. Applied
a) Fracture ofsurgical neck olhumerus, causes lesion ofthe axillary nerr.,e, it results
ol paralysis of deltoid. This _affeas_ rl19- rngvement .of shoulder. joint specia.lly
abduction ftom I 5' to 90" ii affeaed.

SAQ-2 Rotator cuff

Ans -
Musatlolendinous aff of shoulder - This is
fbrous sheath _formed by Jour flatteryed
/ettdots namely.
Supraspinatus,
6\1t btlraspinatus,
'feres minor,
Subscapularis and lateral part
of capnle of .shoulde r joint.
Ftaturt's - a) Stts on ru1,cr()sirlr'.{
l') Sli.'.( r,' ,..::'s.1,. .'1 .tir.rrl.l.r
5
c) $tcadtes ltcad,[ hunrerus sltlu iirr jc'rr
e f n{ztis-t-tX gg Strurcthcns rhc cap.ntlc.
"c?i Applicd Dtslocoliott ol the .shoutder joint is I h. nru<ui(r<,'d:tu,ur r!ff ol rh< ,bo!U.:

ttrore comntottl), itt a dou'tu,ard direcliott. Because rotator utff is lrn

ittfe riorly.

2l
Sj Q-3 Ou a,i r a rtg u lar sp,lc'c.'
A. Bourtis:,-s:
a1 Abo;t I :_ =.:<: r:-:-.'r.!: s--d:
poslerior)
11 Subscaprlaris in
Jron t
'ci--'sile.
ll) Capnle of thc {..ii::..:-'
' shoulder joint qralr'entLrlar
III) 'feres minor
spr-:c i
b) Below - Teres najor --- Tric€ps
c) Medial - Long head of
lcrcs ArJor
t- .-'Irtcral
rhe lriceps tudial n. r proftrda , Iong
d) Lateral - Surgical neck brao\i i .rrcerv io
loier I Iid..uulBr spa.ee
hcads

of the huments
B. Struclures passing - Th< i.r..aG!!b' rP..B in th. '6?glrJ
a) Arillary nerve ..r;on. inck,dic6 th. qq"'lt'o€!l!. uPPcr
b) Posleior circttntflex ui:n€rrlrj :!d Lo*<. (ri:r3ullJ tPr6-

Il ume r-al_vesse ls
C Applicd - Fracture of turglcal ndck oJ humerus causes Iesion oJ aillary neme
Ieading to pualysis oI delroid muscle.

SAQ - 4 Upper triangular space:

''/A. Boundaries:
l+{edial - Teres minor
")
b) Laleral - ktng head of the triceps
,) I:tfarior - maior
Tere.s
d) Apex - [,ateral bordcr of scapula u,here leres major ond mirtor muscles
corNerse .

R. Slntctures 4zLssing :
Circtanfex scapular artery. .[t inlen-uDls the origin of lhe
leres minor and reaches the infraspinous fossa for atnslomosis wirh fie
srprascapular arlcrv.
C. Applicd anatomy-Blockage oJ circ-unflex scqtulcv artery leads lo loss of
collateral ciratlalion on the dorsal nrfuce of sccpula.

SAO - 5 Lower triangular space:

A Boundarie.s
a) Medially by long head of the rriceps
b) Laterally by slutft of lntme rus
c) Superiorly by teres major
B Stnrct ures passint
a) Iladial tterve
b) l)t ofunda braclrl lcssels
C Applied - [;rac!ure of niddle third of huments cLluses itiuryt to radial rrcn'e and
re.n Ils irt wrist drop.

)4
 St{I( - Supcx

LAQ-5 Describc axillary neryc under fonowing hcads

Root valuq course and rclation, branchcs and applicd anatomy
A. Introduction - Circumflex stout, nerye ofshoulder region which arises from posterior
cord of brachial plexus (ventral
rami of Cs and Cr).

B. Root va-luc - Ventral rami of Cs

. zt::'
and C,.

C.. Peculiaritics -
u) PJggCgL !'uIlgn of axillarl'
nerve bears pseudogangl ion
b) Axitlary nerve is the ideal
cxample of HiLloL-sJ-aw i.e
Nerve zupplylng thc ouscle
a$gg_ i! lheje]n!_sullller
t!g_&.14j!d__!kj_q_g"er_!he
joint.

D. Course and Relations :-

It arises from posterior cord
ofbrachial ptcxus. Post6riir cord lies posterior to second part of axillary artery.
Arillary nerve lies posterior to third part ofaxillary artery.
a) In axilla - It lies on lateral side ofradial nerve
b) In quadrangular space :- It divides into anterior and posterior division. -
c) Anterior division is accompanied by posterior circumflex humeral artery (branch
of 3- part ofaxillary artery)
- it runs deep to deltoid muscle and supplies deltoici and skin over its anterior
part ofdeltoid muscle
d) Posterior division zupplies teres minor which bears pseudo ganglicn. It also
suppiies posterior part ofdeltoid muscle.
- It pierces deep fascia to become lpper !,ateral O.rtaneous nerve of arm
E. Branches and d istribution
a) Muscular
I) Deltoid
II) 1'crcs minor
b) Ctrtaneous
- lpper !,atcral Cu[aneous nervc of arnr - supplies skin over postcrior
l) border of delroid and
li)upper part ollong head oftriceps
c) Articuiar branch to shoulderjoint
d) Vascular branch to posterior circumflex hunreral artery.

-F. Applicd Anatomy

a) Damagc to axillary ncrvc is caused by -

25
 i) Dislocalion oi si:ouider joint.
Il) Fracture ofsurgical neck ofhumerus
It resuls into following learures
[) Roundness ofshoulder is lost
lI) Greater tubercle of humerus becomes prominent
iII), Loss ofabduction
IQ Sensory loss over lower half of deltoid
b) Overhead abduction of shoulder joint is prevente/ by reflex inhibition of deltoid
through axillary nerve (Flilton's law)

LAQ-6 Describe musculocutancous nerve under foltorvins.hcads

' a) Rootvalug b) Coursc and distributiori, c) Applicd anatoiny
Ans. -
A. Definition - It is a branch of lateral cord of brachial plexus and is the motor nerve of
flexor compartment of arm and cutar@us nerve of forearm.

B. Root value - C5, Ce. and Cz

C. Course and relation - It arises from lateral cord ofbrachiat plexus.

t-atcral cord lies lateral ro rhe 2d part of axillary artery
lr4usculocutaneous nerves lies latera.l to 3d part ofaxillary artery.
It arises at lower border of peaoralis major
a) in a-xilla -
It lies lateral to third part ofaxillary artery and has following relations
Anteriorly - pectoralis niajor
Postericrly - subscapularis
il,iaedially - axillary artery
Laterally - coracobrachialis
- lt Ieaves axilla and enters front ofarm by piercing coracobrachiaiis
b) In arrn :-
ft runs downwards and laterally.
It passes between biceps and brachialis.
It pierces deep fascia and continuous as lateral cutaneous nerve of fore arn

)(,
 SNK - Supc-r

Coraooid process

.<-,Coracobrachialis

Brachiali6

- - ;Q Elborv ioint

6
li
Lateral antebrachial
cutaneous nerve
t,

M usc ulo-cutaneous nerve

D. Branchc-s and distribrrtion ;-

Muscular Cutaneous Articula r Nutrient branch l

to
i) Co racob rach ialis I-ateral cutaneous i) Elbou,joint Humeals
ii) Biccps brachii ncrvc ol forcarm ii) Shoulder joinr
iii) Brachialis supplics skin of iii) Superior
lateral srde of radioulnar joint
forearm
E. Va ria tio ns -
a) It rnay pass between biceps and brachialis without piercing coracobraclialis.
b) It nray givc or receivcs fibres fi-om mcdian ncrve.
Ir. Applied Anatomy
a) Occurrencc ofisolated lesion is rare.
b) Lesion occurs due to lracture oi neck of humerus.

2-1
 Nanrolc5.; -:m1.-r7cpi-" - r:-=kc ''i=-l:,-.:=.-r :: :l:.:::. :: :-:'- -"- :-: : :-1 ::
c)
of biceps brachii a::.j -to:zcob=*::d:s
d) Anesthesia on an'.e:ola:eral srface oi i: - -:.:::- Pa:: 3:-: :-*'_'--=: -:'
a&ryevated by elbo*' extension.
LAQ-7 Describc brachial artery under follorviog heads
a) Origin, b) Coursc and relation, c) Branchcs, d) Applied aoatomr'
Ans -
A. Definition It is artery of arm (i.e. supplying bone and muscles oi arm ) a,rd forms
- anzistomosis- around clborv joint.
Il. Peculiarities
a) It is superficial throughout il.s coursc
b) It is accompanied by
I) Veins - venae commitants (brachial veins)
Nerves
Artery Accompanying Nerve
Brachial Median
l. Profunda brachii Radial
Anterior descending Radial
2. Superior ulnar collateral Ulnar

,r ---- lntc{ ftr] s.ulur

f)iegram shorving nervr.s rel.tl<l lo

tlrtr brat:hial artery.

C. Origin - it is continuation ofaxillary artcry below the lower border ofteres major
D. Extent - It extends lronr lower border ofteres major to ncck ofradius
Il. Fatc -ltdivides inro tcrminal branches namcly
a) Radial
 SNK - Supcx

b) Uirar
Course and rclat.ions -
B) Posterior ':':.
l) Skin l) tnng "
head of tricepr'..--
2) Superficial fascia 2) Medial head of triceps
3) Deep fascia 3) Co racob rachiaJ is
4) Biceps brachii 4) Brachialis
5) Bicipital aponalros,s at thc
b ifurcation

C) l-atcr-dl - median nene D) It{ediai

(upper part) l) med.iai cut6n@us nene of

2) median nerve
G Branches -
a) Cutaneous - to skin over arm
b) Muscular - muscles of arm (Deltoid Biceps, Brachiaiis, Coracobrachialis)
c) Geoicular braaches - A-rtiorlar - shoulder joint
I)
Supcrior ulnar colJateral elbow joint )
II) lnfcrior ulnar collateral J
lV) Anastomotic branch to postedor cirqlmflex humeral artery
\0 Terminal branches - radial a.nd ulnararteries.

Teres MaJOr
-
8{achiJl Arl

grotunda Bech,i

SqD. Ulnar ColL.

InF. Utn3r' Co{1.

Radial Art Ulnar Arl.

M = MUSCULAR BRAXCH€5

Breotbcs od bracbial sr&r:t

H. Variations -
a) Frequcntly the brachial artery dividcs at higher leve).
b) Sometimes brachial artery descends towards medial epicondyle.
I Applied -

)9
 a r I 1 r:;::a::t:-t:' tri:. ::
r:r
n idc ie ;::l-.r
. .) B:acl::li .n-:. i: r:;:-:r: i. j_:.: .. --.. : :j:_-: .- r _-:-- : -..
Yo l!. rn:: - I-:::,r:i.; Jc;::: :::e :
cj BIood pressLrrc can be recordei by auscllring lie c.lisa:i::s oi::a:..::: ai:.r- .:
cubiral lossa
d) Blood can be collected lor blood gas analysis rhrough brachial a--,e1,

LAQ:A Describe radial nerve u ndcr follorving heads .:

' a) Root valuc, b) Coursc and relations, c) Applied anatomy. \'
Ans - ,,i
A Definition It is the iargest branch of posterior cord orbrachiar prcxrs. It is sensory
and motor nerve ofextensor compartment olarrq forearm and hand :,:ri: :
B.
- -

Root valuc - C5, Cr, Cz, Cs and Tr

C. Course and rclations :- It arises from
posterior cord of brachial plex.us. Subscapularis
Posterior cord Iies posterior to 2'd part of
o;illary*anc1y ar:d
- Radial ncrve- lics posteno. lo 3d parr Ie res F{{or

o f a-xi llary-aicry.

9..1'In lower part of axilla the nerve

passcs downwards and has following
relations i i
Anteriorly l- '-axillary artery,
pectoralis rnujor. Hcdc I hrad oi
Posleriorly - subscapularis, teres Ifi.eps
rnajor, Iatissimus dorsi
Mediallv . arilla,ry vein
.-l.aterally- coracobrachialis nuscle
It passcs through lqlygl
,. r!qSl1l{ space, and cnterslFe
radial groove along with
, prolunda brachii artery. R-adlal ncrvc (rr.artd froo bchind
. -lr.) lladial groovc It runs dor.wrwards
betu,een latcral and mcrlili hcad ol
tdceps r\t lorver end of rarJiar groove it pierces the rarerar inre'nuscular
scptu.i
,,"and entcrs into alterior cor).lpartment of arm.
r') cLrbital lbssa In cubitar rossa it passes berwccn brachialis and brachioradialis
and cxtcnsor carpi radiaiis longus and supplyilieie rnuscles
d) Forc-arrr - At thc level of raterar epicondyle it gives off posrcnor inrerosseous
branch rvhich Ieaves the lossa by picrcing supinator muscle ancj
enters back of
lo rt'-a r nr
c) I-land - In hand it continr:cs as supcrficial terminar branch and reaches dorsum of
hand and divide into 4-5 brarchcs

l0
 SNK - Supl

&l<iutk o
€,l1..!or
(2t91
r.{i.li l(

Irkc!r'
{ t- 1

lP)

Bra-ECicJ of thc radial usvc io

t-bc aro diagraoatic)
(

l) tsranches e)ln am
Particulars Mrrscular Cutaneous Joint
A) Above radial groove 7 I-ang head Posterior cutaneous Elbow
(med !a I grou p) t ) Triceps branch of arm
\ medial b.ead
B) Itthe groove Medial head i) l,ower lateral
@oii6rioi group) I ) Triceps
/ . cutaleous nerve of
lateral head atTn
2) A;rconeus
ii) Posterior cutaneous
branch of forearm
C) B-9toy rgdia] sr99vc *) Brachioi-e.d iaIs
(lateral group) 2) Exteasor carpi radialis
longus
3) Brachialis I
j

b) Forearnr - ln forearm it gives bianches to following muscles.

Suoerficial enor lnterosseous nerve

Superficial terminal branch ol N,fusclcs )
SJpinator
I
( cui an eou s)l t-iividii-i n t o j)
Anatornical snuff box
.,a) Digital and i)
Abducror pollicis longus
-b) ConnrL.rnicat ing ii)
Extensor pollicis brevis
. iii) Enensor pollicis longus
i-)--'Exrensor indices
4) Extcnsor digirorunr
.
4f Extcnsor digiti minimi

I
 SAi-9 Applicd -
lniurv
II to
o radial nerve
ll.cs ult
Site Cause
Motor Sensory

I tu:illa I)'-.--/
Saturdav niehr Exlensor muscles of Lnss of sensations
palsy arn\ forearm and of
p.,Crutchpalsy wrist are paralysed. l) Posterior

:i., , surface ofarm

',t
I
2) Dorsum oi
hand

2 lr{iddle of arm l) Fracture of shaft Pq54\'pis._qf e;gensors Loss of sensations

of humerus of forearm and wrist. ofdorsum ofhand.

2) Injeaion in radial
groove
Proximal part of Fracture of proximal Paralysis of exlensors
lorearm I /3d of raclius of rwist and hand
4 \\'rist joint Lesion of superficial Loss of sensation

radial nerve at wrist ol radial siCe of

dorsum of hand

S/N-10 Wrist drop:

ins. - Write points (l), (2), (3) only

, LAQ-9 Describe cubital fossa undcr

I. Bou nda rics,
2. Content and
3. Applied
n ns -
Cubital =,pcrtarning to c,bow
t)
 SM( - Supc)i

AI
i(
Brach i.s l is s-P lor

Thc floor of tbc cubitd for.r ir for6.d q 6.

brr.lirlL &d rupisio( .ol.Edc -(a) r<r{-s.
vicw ..od (B) cr.)'r ra.riodrl yic*-

A. comparision of popliteal and cubital fossa

Particulars. Ponliteal fcssa Cu bital fossa
S ite Present on posterior part of Present on anterior part of
knee joint eiborv joint
Su rface Flexor surface Flexor surface
S hapc Rhomboid Triangula-r

Bound:rrics
A) N4edial boundary * is fornted by la'.eral border of pronaior reres. I ' ,
R) i.-ateral boundary - is lornred by nedial border ofbraclrioradialis r ! --

C)) Roof - lormed by

a) S kin containing
I) Medial cutaneous nen,c of foreann
li) Lateral cutancolrs nerve of lorearm
Iil)- Medial cubitai vein rvlrich is
' lormed by
i) Cephalic vein
ii) Basilic vein
l) Superficial fascia
2) Decp lascia .
\\ Ibiu'$ih'-(
-i1^| -Ato\^or €{s
./J \ )..
 Brachialis
.\ ll Erachi:( a(terY
\FI Median nefve
Biceps
tcodc.t

Supirutor
Utrur arterY
0rachio
- radiatis Pronator t€res -
deep head
R ad ral Penator teres -
arterY Superficiat head

Cubitsl te55a-

D) FIoor - irruppe; part it is fiJrmed by lower part olbrachialis in lorver pan it is

formed by supinator
E) Base - is fonned by imaginary linejoining the medial and lateral epicondyle.
F) Apex - is forrned by meeting point of medial border ol b raciriorad ialis and
lateral border ol pronator teres.
G) Contents - liom medial to lateral are
Ulnar oerve
.ll€diau nelv€
',- Br-achiaL srtery

Radial n.
Bicctx telrCo.r
Fost - iflteros -

Srpirr!tor
Pronalor teaes
F-:dial n.
E.adiat a.

Ulnrr a.

Con!.1)ll of rhc cuti13l fclt!-

a) Median ncruc - passcs between 2 heads of pronator tercs

b) Brachial artery divides into 2 terminal branches in rhe cubital lbssa
narncly raciial and ulnar artery, radial artery passes throu.qh the aper ol
cubital lbssa arrri rrns superficially in the lorearnr
 SNi( - Sugrx

Ulnar artery is the larger artery runs deep to deep head ol pronator teres
c) Tcndon of biccps
d) Radial nerve divide into
I) Superficial and
11) Deep brarch
Decp branch gives posterior interosseous branch, which passes
through s!pinator and supplies all exlensor muscles of forearm.
Applicd -
a) Median cubital vein is the most fixed vein. Hence it is used for withdrawal of
. blood lor investigation purposes and sLa.'1ing intravenous fluid.
b) Brachial artery is auscultated for recording blood pressure.
c) Brachial artery is selectcd for withdrawing arterial blood lor blood gas analysis.
d) Supracondylar fracture of humerus resulls into ruptr-re of brachial artery, a,rd ends
into condition called Volkman's ischaemrc contracft're.
LAQ-l0 Describe ulnar artery r.rnder origir, fatq coursq relations,
branchcs:rnd ap plied aDatomy
,A.ns

Brach'ul Y€dia( epiconjyte

A. Definition - lt is the artery of arl -
medial side of forearm.
Ant- Utnar
B. Origin - It is largest terminal reiurrent ar t.
br anch of brachial artery rises
I cm below the bend of elbow.
Rad ia ( Post. U lnar
art. recu rrent ar t.
C Pcculiaritics - tt is
Commoil intei. art.
accompanied by - a) lnte r.
recurr. art.
,.,enae comitantes and
b) ulnar ncrwe in the distal Post. inter.
2/3'd of lorearm rt. tJLnar
a

D. Extcnt - [t cxtends clbow to

wrist joint. Ant. lnter.
ar t.
E. Course and relations -'
It passes dor',nrvard,
rnedially and Icaves cubital
lossa dccp to i:lnar hcad ol
Pa{ma r caro3l
Pronalor tercs and lies
bra nc h
between two ncrves,
larerally is mcclian and tlnrncht-r,rI ulnlr :rrltn.
rned ially is ulnar ncrvc
F. Rclat ion.s -
a) A ntcrior
 Upper half I-owcr half
l) Pronator tefes 1) Skin
2) Flcxor carpi radialis 2) Superficial fascia
3) Palmaris lougus 3) Deep fascia
4'; Flexor digitorum 4) Palmar antaneous
su p erfi cial i s branch ofulnar
5) Flexor carpi ulnaris nerve

'b) Posterior - Flexor digitorum profundus

- Pronator quadralus
c)
Iatcral - Flexor digitorum zuperficialis
d)
Medial - Flexor carpi ulnaris, ulnar newe
G. Branches -
a) Muscular - to all the muscles on medial side of forearm & hand
b) Cutanecus
c) Genicular branch -[) Elbow and
tr) Wrist joint
d) Newes - ulnar and median ' ,. - ,.
'' e) Nutrient - radius and uha
fl Comrnunicati-ng - I) Anterior and
tr)
Posterior carPal arch
- Superficial palmar arcL
g) Tenruaal ioterosseous branch - branch to interosseous membcane
b) Bra-nch to synovial sheath
G. Fatc - lJlnar artery lorms detp palmar arch in tie hand.
H. Applicd -
It is fclt lateral to flexor carpi ulnaris and above the p'rsiform bone.

L For c*sy rccalling rcurcmber interesting figure two.

a) One oltwo tenninal branch of brachial artery
b) Extcnds between fwo joint (elbow and wrist) Neck (ofradiLrs) to head (of:'::r:r)
c) Course benveen llvo nerves - median and ulnar
d) Rclations with two groups of muscles
l) Superficial and II) D"ep
e) I- res or trvo rnuscles
I) 13racliialis and II) Flexor digitomm prolundus
t) l3 rzurcires
- Tv,,o Bones - radius and ulna
- Tuo Resurrcnt
I) Anterior ulnar recrrrrent
iI) Posterior ulnar recurrcnt
- Branches {rticular - I) elbow joint tr) wrist joint
- Llranchcs Nerves - ulnar and median
- llra.nches larpal - arterior and posterior c.a,-pal
- Br anchcsto fland
Supcrficial paimar arch
Dccp palrnar arch
l6
 - Eranches to !nlcrosscous membrane
- Branchcs to grouP olmuscleS
* l) Supcrficial and II) DecP
S,t r-r r Anatomical snuff box:
n.*lt is depreised triangular area present on the lateral side of wrist and beconr.:
prominent when thumb fully extended.
B Boundary anC contents
Three tendons, thrQe bones and three struoures. (all - 3)
Lateralll' -'Tendon of abductor pollicis Iongrs
li4edially - Tendon olextensor pollicis brevis and exten5or pollicis longus'
(So three tendons form boundarics)
C. lFlocr
- lrom proximal to distal tkee bones; scaphoid, trapezium and base of fir=
nretacarpal bonc.
D. Corlcnts --three structures - lrom superficial to deep
i,) Cephalic vein (at the roof;
b) Superficial branch ofradial nerve
c) Radial anery.
E. Applied anatomy -
Fracture ol scaphoid rvili lead to painful demonstration of anatomic€l
.rruffbox

' I 2 Iit
s/N- r
ex o rc ti n a cu I u m - rr,3ffXfri 5,*t"ir!"'"i*ry5#
is thickened to form the eKensor retinacxlum
ilimtinsio[ lciri broa-d.'
''-

rc+! tr.r.ca!!,i rr!. l,r!us ;

\\ q
L.Rt, :l\L.crrPi lad brcvrs
1r! ;:*1. F,l I lo:':.. r\ ;
b fj.Le.se. dii:icnr: \ \
i-i.'i.i". i l.;, ',"i
rin.tL|'ltl.
t:rL. re i
,'* ',., i
F:t.carT). I
& :
u in:t is I \\'* ,1 C!
-:

UlLra : t
/Lrr - inloroq e. t L.( rcnsor Rsdius
ioCic is
?os t. intcros. n. tl
T.ins.rs kclion pAlioris( :bolt q.i.r
!io*in! rrmcr!..1 paeide d..p'h<(o th.
.r(cnto. .<tin..ultrn'

tl
 Proximall
Arttcrior border of radius belorv
Triouetral and oisiform bone.

Compartments - Reticulum sends septa rvhich are attachcd to the longitudinal ridgcs on
the radius ald forms six compartments. Tlte contents are from lateral to
medial. €? B
a) Abductor oollicis lonzus and cxtcnsor oollicis brevrs.
j
I b

c)
E*t .',.fi f lu'a i t ; rI o ngu. u-n'f, 6' .,ri r.
"nro, pollicis longus. ,",
Extensor on E,
d) Four tendons ofe).tensor digitonifir and tendon ofextensor indicis.
-,-o* e) Tendon of extensor digiti minimi. E Dfl
I f) Tendon oiextensor carpi ulnaris. Fcu

Applied - Extensor tendons keep all the tendons in position.

r-tEXO R FJJ-T t NIAc,u Lti
^^fascia connecting proximal and distal
.

A De{iuition - It is a stron_g [b1o9rs land ofdeep

carpal bones ofmedial and lateral side.
B. Gross
Particulars Proximal D istal
r) Attachment
a) ldcdially To pisilorm bone To hook of hamate
b) laterally To tubercle bf scaphoid To medial lip of groove
ol trapezium
2) Fate l) Antcbrachiai fascia I ) Palmar aponeurosis
2) Fascia covering flexor 2) Palmar lascia
dirlitorum superfi cialis

Ieun*,..^.',u-,,
{ bcr'.^
*,""
o. Me!q"
|

FIexor Rebnaculum
C. I(cla t io ns -
Particulars Supcrficial Dccp
l) Tendon l) Palmaris longus FDS- flexor digitorum superficialis -4
FDP- flexor digitorum profundus -4
FPL - flexor pollicis longus - I
FCR - flexor carpi radialis - I
2 ) Art crics I ) Ulnar anery
2) Superficial palmrr
branch of radial ancry
3) Nerve I ) UInar nervc Median
2) Palmar cutaneous
branch of ulnar ncrve
3) Palmar cutaneous
branch of median
4) Svnovial sheath For fldxor tendons
5 ) Bursae r) Radial bursa
2) Ulnar bursa
LAQ-1i Dcscribc median nertie under following_heads
a) Origin, 6f-ourse and rclations, c) Applied anatomy
t\ n\ -
A. Introduction - It is the nerve of musclc of forearm and thenar eminence and skin of
rne!1qi l[ge lncl[mrul?rs olltrsIan;j
B. Origin - lt is formed by medial and lateral root of median nerve.
Lateral root is the conilnuaiiori -o-i tlid iateraf cord of brachial plexus. The root
value olmedian nerve is C6, C7, C8 and TI.
C. Course and relations - Lateral root lies on lateral side and medial root lies on medial
sidc of 2"d part of axillary ai@
,, Mciliin
i', Mcdlan nerve rs is lormcd
lbrmcd on tlrc
latcral side of -ld pan of axillary
\ertcry.
:flrr nervc runs on lhe lateral sidc oL
Neac secord lumbn€l
brachial artery upto middic of arm ro
\
[,nbri., \
and crosies in flont anci goes Nc.\€ to fi{.r
\
mcdially and iies on mediai side ol
brachial artcry in thc lorver hallol
irr Ill
'l', ,- Mcdran ncrvc Ircs On rrrt..lral FIc, )r oorio\ b.cvis\
- /srdc ' I
of brachral ancrr rrr Al dqr.trr po,lE: b@3\. -.< ^
opooen' norbis -. - (J1/
the cubital fossa \ r.u,"- **r,on o,
MCdANFNC
It) pierccs pronator teres and L J
paSscs betwccn two heads
Distribution of me<Jian and r.rlnar nerves in rh3
ol pronator tcrcs. "
Medium ne r ve is separatcd fronr ulnar artery by deep head ol pronator
tcres
In lorearm it passes betwcen superficial and deep flexor! of fblgarm

.'l
I()
 ;i-l\ i, uc.o1npunicd [,y median, artery (branch of anlerior. interosseo.r:
' jL".y). \.4 \'y 4)\,ra tj rr 'J \- J'./' r,:J-' t-
In wrist - It passcs dcep to palmaris longus and lies bc3wccn fiexor digitorum
- :'- supemcralis and flexor carpi radialis. It passes tluough carpal tunnel and
ente.s t}re hand. It $ives lateral
'irit'medial
branch.
Beforc it divides into lateral and medial branch, it gives a recurdnt E
mirscular branclq which supplies.
4 Abduct'or polticis brevis
b) Opponens pollicis.
c) Superficial head offlexor pollicis brevis.
The tateral branch subdivides into th.rr9-p4lrnj!{ d-igital branchcs, which supply
, the skin ofboth sides ofthumb and radial side ofindex finger.
The branch to index finger provides a muscular brarch to first iumbrical.
The nredial branch zubdivides into two common palmar digital nerves. l-aterai
c-ommon digital nerve gives a branch to 2'd lumbnial.

S/N-13 Apptied anatomy

Ner\e can be studied in following heads.
-d iledrc.n ilqr{e-.
A. f.hj ury abovc elbow -
-' Cause oi injury supracondylar frachrre
- 9f the humerus

Position oi' hand Muscles naralvsed Testing of nerve

l) Unable to berd teminal Flexor pollicis longus Hold the proximal phalanx
phalyrr"x olthumb olthumb anci ask to flex the
terminal phalanx.
2) Forearm is kc:irt in zupine Pron lors Pronations ol the forearm
position
r) Hand is adducted Flexor carpi radialis
a) Middle fitLer rcmains
straight whii,:i making a
fist.
5) S igns ol bencCicrion index and middle fingers
r,i.dqn i..7c trct
can not be flexcd and thumb
can not be opposed

6) .,\pc thu rnb dclormity. Flexor pollicis brevis. Unabie to hold a paper
Opponens pollicis betwe'en thumb and index
Abductor pollicis brevis. finger
J J-''

40
 SNK - Supcx

(l I he marn causc ls c,
At wnsl. - 1'he on oI nerve ln tunncl -
Position of hand Muscles paralysed Testing of ncrve
Ape thumb deformity l) Flexor pollicis brevis. I) Counting ol fingers.
thumb adducted and 2) Opponens pollicis. 2) Index and middle finger
laterally rotated. 3) Abductor pollicis brevis. is lagging in flexing the
index finger while
makine a fist.

Carpal tunnel
A. Definition - It is a passage. formed !y concave palma! sufaces olcarpal bones,
situated in the lower part of antedor surface offorearm
B. Location - lt is located near wrist joint
C. Formation
a) Pillars
Particuiars Lateral Medial
Prorimal Scaphoid Pisiform
Distal TraDezium Hamate
b) . Anterior Flexor retinaculum
c) Posterior Palmar surlace ofcarpal bones

Cornmor rynodall | 7-Ftaor rcrin*irJ,:m

/t.:. \t^J-r.\=-),/ I .:. --y-TcrCon nf nqor

4 rcn.ron(.. f i )/,,\-:<4 i...:c / poltkir lonp'

C-rPit4c

TrRnsv€",r s.cl''on o{ thc clfPil tuand dtowing dispasition o{ th. flc-ror tcndod
rld tbcir ttrlo"lrl dl<edls

D, Relations -
a) n nterior ly - skin
- Palmaris longus tcndon
- Palmar cutancous branch ofulnar nerve
- Palmar cutaneous branch of median nerve
- Superficial palnrar branch ofradial artery
- L[nar ncrve
- [Jlnar vessels
b) Posteriorly palmar surface of carpal bone.
E. Contents - (from superficial to deep)
a) Flcxor digitorurn superficialis
4l
 br Fi:r:c: carpr red ialis
c) Flexor digitorum profundus
d) Flexor pollicis longus
e) Median neme
Iitadial and ulnar bursa
F. Applicd '
-zif Compt n oI mctlian ncrve in the carpal runnel gives rise to sensory and
cssio
.f(i - 'noror
symploms in the hand which constih:te the carpal lunncl syndrome
21 Aetiology - follorving are the causes lor carpal tunnel syndrome

(ii) Dislocation ofthe lunate

(iii)Old fracture of wrist.
II) So11 tissue pathology
(i) Tenosynovitis
.(ii)-A.cromegaly
(iii)Myxaedema
.
(iv)Obesity
, (v) Toxaemia of prepancy
Sex difference *-tt'-sually in femates
Age group - occurs betvreeri 401o'70 y,ezrs.
*
b) Clinical featurcs - Person gets
'-lfiit6nnincnt at-tlcks of paiq more in the niglt, It is refened to proximal
parl of foreamr. it may be relieved by dorsiflexion.
II)Wasting of thenar muscles namely
i) Flexor pollicis brevis.
ii) Opponens pollicis.
iii) Abductor pollicis brevis.
c) Trea.tment -
l) Pain is relieved by splinting ofthe wrist in slight dorsiflexion.
II)Division of flexor retirraculum may require ia severe cases

SA,i-15 Palmar aponcurosis:

It is a flattened tendon of palnraris iongus in the hand.
L Features -
A) Shape: triangular
I3) Apex: Blends rvith the flexor retinacLrlum.
C) Base: Directcd distally and divides into four slips opposite thc head of
nrclacarpals of the nrcdial lour fingers.
Each slip divides into two parts. Digital vessels, nerves and tendons of
lunrblicals 1;a-ss tlrrough the intervals between the slips. The palm is
dividcd into corrpanments by the slips arising fiom.lateral and medial
u rar grrrs of p;tlnrar a1roncurosis.
2,. Morphology - Phy logcrrctically represents degenerated tendon of Falmaris longus
i l:u n tiolrs
A) lt improvcs thc grip iry fixing the skin.
il) Il prolccts Lrrrdcrlyinli vcsscls and ncrves

47
 SNK - Su1rcr

.i. Applied - Dupultrcn contracture

A. Definition - It is inflammation of ulnar side of palmar aponeurosis. There is
thickcning and contraction ofthe aponeurosis.
,
B. Cause - It is due to fibrosis and shonening olthe palmar aponcurosis.
C. Features - Usually left hand is involved.
- It is more scvere toward the ulnar side.
- Thcre is progrcssivc {lexion ofthe fourth and fifth digits
- Therc is an involvement of proximal and middle phalanx because ol
insertion of palmar aponeurosis.
A high correlation cxists behveen Dupuytren cGntracture and
. coronary artery disease It is possibly as a result ol vasospasm
produced by the effect of referred pain on the sympatheric
innervation olthe vasculature within the Tr component ofulnar nerve
distribution

S/N-16 Dorsal digitai expansion:

A. Definition - [t is small aponeurosis formed by each eKensor tendon which covers the
dorsum of proximal phalanx and the sides of its base.

Do.sil digilrl crp.nsion

t) Shapc is t.ia aistatty
C Formation - tt is mai.ly lornre<r by exrensor digiiorum tendon and ii is a contributed
by interossei and Iumbrical musclcs
in little fingcr (fift1r digirl in addrrron ro above tendon it is formed bv
extcnsor digiti rninimi anrl
In indcx finger by cxtcnsor indicis
D Feal ures
a) Basc of dorsal digiral crpansiorr
I) It covers thc dorsal and colla(era{ aspccts ol'rne(acarpo_phalan.qcal joint
.n
 i-l) Extenslr tendoo is auachcd to the celtre ofbase of digitai cxpaasion.
III) It forms hood over head of metacarpal. It is morable distally and proximalll
with the flexion and extension of tle rtclacarpo-phalangeal joint.
t\) Each basal angle is anached to de€p transverse metacarpal ligament
b) I) Mareins - Margins 8re thi6k6nad lstorslly by inrcnion of tondon of lumbricale
. and interossei muscles.
Medially by interossei only.
tl) Wing tendons are of two types
i) Proximal wings - formed by dorsal and piiJmar intcrossei
''Itr) ii) Distal wings - formed by lumbricals.
Apex of cxpansion - At the distal end of proximal phalanx thc apcx oi the
expansion divided into three bands
They are l. one central and
2. Two collateral
Central band is inserted to the base ofmiddle phalaruc
Two collateral bands unite and finally are inserted into the dorsal aspect of tle
base of distal phalanx
E. Actions -
a) It keeps the extensor tendons in proper position in the midline.
b) Central band extends metacarpo-phalangeal joint.
Collatcnl bands are responsible for extension ofinterphzlangeal joints-

LAQ-12 Describe interossei (Inter - in befween, ossei - bone)

Ans -
A. Deflnition : These are the small muscles ofthe hand present in between metac€rpals
and are divided into palmar and dorsal intemssei. They are disassed on fbllo*ing

PaIiiculars I'almar intcross Dorsal interossei

Four iir number and are Four in number
bipennate.
interossei is All are ofuniform size.

They a,.e nvo in number.

middie fi
palmar ilterossei arise Join ing metacarpal.
from medial or ulnar s-rrfacc of
respective metacarpal.
Ttrird and ficunh palmar interossei
arise from lateral or radial snr{bce
of4s and 56 meta

44
 S\K - Supcx

Particulers Palmar and dorsal intcrossei

5) lnscnion Both arc inserted on
I ) Dorsal digital cxpansion

:2-'-*^ >,i;q*
v&lft'.AA[d#/
rrla. k Oo-:l nr..dd

Passes tlrrou
P:lrrar inter i are less than dorsal interossei,
1) Both are related posteriorly to deep transverse meta,:aTal
ligament
2) Radial artery passes between the gap produced by two heads of
lo dorsal interossei.
i) Proximal perferating arteries passeslet*""n1tt. g"p produced
bv trvo heads of znd. 3d. 46 dorsal interossei.
9) Actions I ) PAD - Palmar are adductor, DAB - Dorsal are abductor.
2) Both produce powerful flexion at nretacarpo-phalangeal joint
(M.P.) because their tendons are placed ventrally and distally
with respect to metacarpo-phalangeal joint.
l) They produce extension of interphalangeal joint. Both these
nrovcments are useful for oiecisiolr rvorl:
I0) Ncn e suopiv BoLh arc suoolied bv deeo brarch ofulnar ncne.

ffi
I I ) Testing Interossei can be tested in following ways.
I ) Dorsal interossei - By spreading the fingers agdinst resistance.
2) Palmar interossei - By holding a piece of paper betrveen the
firr"e's arrtl rcsting the y:p

SA,i-1 7 Lun.r b r-icir Is :

Thcsc arc rvorm Iike muscles and arisc lrom tendons of flexor
diqitonrrn prohr ndus
- 'lhe1,arc lour in numbers and are present on oalmar asoect.
- fhey are counted from lateral to medial.
- lo and 2'c lumbricals are unipinnare
- l'd and 4'l' Iumbricals are bipinnate
- Thcy aci as Iink muscles between deep flexors and extensors lendons
ol hand

Orrgirr - l'' and 2"r Iunrbricals arise lrom radial side ofprofundus tendon.

Ji
 flcxot .. ( Iexot
d i8i !oruz poltlcis
tqrgu3

I
I
I
I I

4rh ad
LlEd!'!c.. IE

Tlc crifr d t*l. hr*bricd otrdtr.

3d and qf lumbrica.ls arise betwetn neighbouting tendons of flexor

digitorum profundus.

lnsertion - They are inserted on dorsal surface of base ol middle and disial
phalanx through lateral border of digital expansion.

Action - fl,ey are flexors of metacarpo phalangeal joint and extens(::i '.i
i nt erp halangcal jo i nts.

Nerve supply -
Medial two lurnbricals are supplied by deep branch of ulna ,.:

and lateral two lumbricals by median newe.

Relation - They are dorsal to digital vessels and nerves.

Functiorr - Thcy produce up and do*n srrokes o[finger ior skilled rvork.

'l'esting ol'the nruscles is done by asking to hold a paper in betrveen thc finr-

I.AQ-13 Describe superficial palmar arch.

Ans -
A. Dcfinition - It is the arterial arch, Iies superficial to all the structurcs in thr r.,irnar
compar'tnlent

16
 .: can ix compa:ei s:lh circie of Willis present at base of brain and plantar
anerial arch in rhe foot
B. Arch is not

Sup€.ficial palme, a rch

Palms. me(aca.Pa
De€p Palma. a.crr
Deep branch of ulna r

FIexor rerlnacul!in

8!d,ar a.rery
\,
i-
-
The Drirrcioal an€ri,5 of thg oalm. Ttl€ arrow lndicat6 tllat th€ sui;'.rfici.l
paimar arch ts at the lev€l of the ext€td€d thumb.

C. Lo cation - part o corTesp o mar crease

D. Formr-tion -
a) N{edial l/3'd is formed by ulnar artery
b) Intemrediate l/ld is formed by superficial palmar branch olradial artery
c) Lateral l/i'd is fomred eirher by
I)
Arteria radialis indicis - artery olindex finger (branch olradial artery) or
II) Arteria princeps oollicis - arterv of thumb (branch oiradial artery')
LII) Median ar1ery (branch o[ anterior interosseous afterv which is a branch ol
common interosseous artery - ulnar artery).
E. Ilelotin.'t
a) .\rlcr.or - Falmaris brcvis
- Palnar aponcurosis
b) Posierior - Flexor digitorum super{icitlis
- Flexor dieitorum profundus
- Lumbricals
- Flexor diqiti minimi
- Digital branches of median nerve
i: Branchcs - Dieital branches are 4 in number - which suoolv mediai 3% fingers.
Out ofthcse lour digital branches lateral 3 digitai branches join deeo palnrar
arch by palmar metacamal aneries.
Aoolied -
It is one of the important anastomotic channels for effjcient blood supolv of
palm, in case olblockaqe of radial or ulnar arten,
L \Q-l{ Dcscribe dcep pnlmar arch.

S{porficiil p.lm.. rtn

O€.p br:rrcn of ulnl.

I hc Ddndml and€s oI lhc o.ll(l Th" arro"r lndal€s lhal t}l€ $per6ddl
pJm.lJ afth ls ed trl€ le,re.l o{ lbe edend€d dumb

A. Dcfinition - It is an arterial arch present deep to flexor tendons ofdigits.

B. Fornration - It is mainly formed by radial artery and completed on medial side by
deep palmar branch ofulnar artery.
C. l,ocation - Ii is presentat proKimal palmar crease
D. Arch is inco rnplete.
E. Relations -
a) Anterior -
I) Oblique head ofadductor pollicis
ll) Flexor tcndons of fingers
III) I-u rnb ricals
b) Posterior - slraft ol metacarpal and interossei
F Branchcs -
I ) Fron convcxity of arch 3 palmar mctacarpai arteries run distaily in 2'd, 3'd and 4'1'
sp accs.
Thcy supply mcdial 4 rnctacarpals, thcy terminate in finger cleft by joining
rvitir common digital branch of superficial palmar arch.
2) From dorsal side 3 pcrloratinq a.tcrics passes tkough medial 3 interosscous
spaccs to anastomoses rvith dorsal metacarpal aneries.
3) Frorn convcxity of arch, rccurrqlt branch to supply carpal boncs and to end in
palnrar carpal arch.
G. Applicd - One of the important anastomotic channels for eFFcicnt blood supply of
palm, in casc olblockage ofradial or ulnar artery.

4li
LAQ-I5 Describe ulnar uerve.
Ans -
A. Definition - Ulnar ncrve is also called 4usicia€+nerve becarse it supplies all
intrincic muscles olhand. It supplied forearm muscles and muscles ofhand. It carrres
cutaneous sensatioo from medial I% fingers.

B. e-It medral

q(
EP
Sut€.ficjal branch

AdCuclo( poniis

l"J.".'
Uinar nerve in hand with superficial and deep branches
rrse and rel:rtions
Course - Medial cord, iies
iies on meCial side of second part of axilialv
a-.tery.
Ulnar nerve iies medial to third part olaxillary artery
It also lies rncdial to brachial artery,
In middle of arm, it picrces
i
rnedial intermuscular septum along with superior ulnq{ c!!!4te.r. d a_49ry alLdenrers I
posterio_r compartlleg_qr-d it.!!gron
mctiat lprd oitriceps. and p^ortnina
rys4tal_gptloldJ!_e pfiumerus and is received by flexor carpi ulnaris and lies or
medialliganent of.e.lho:a-joint and rgsts,on
nr-edralside of the flq4gr:iigitorum grofundqs under thin blarket of flexor ca?i '
ulnaris in upper Z3d of lorearm and runs on
qt edialsid-e of ulnar ar-rery,
ln the trand it lies in lront olflexor retinaculum and divides rnto superficiai and
decp branch.

49
 Deer bran;h is accompanied by deep branch of ulnar artery and passes in berween
r.biir:ror ciigiti minimi and flexor digiti minimi then passes through
substancc of opponens digiti minimi.
Runs on lateral side ofhand and ends in graveyard made by adductor pollicis.

D. Branchcs
Particulars , Muscular Cutaneous Joint
Arm Elbow
Foreanm 1) Flexor carpi ulnaris
2) Flexor digitorum profundus (medial
Hand hal0
Palm - palmaris brevis Skin of hypothenar
Ilpothenar - l) Abduclor digiti minimi eminence and
brevis skin of medial one
2) Flexor digiti minimi ard half fingers
3) Opponens digiti minimi
Thenar - l) Adductor pouicis
2) Flexor pollicis brevis (deep
head)
lnterossei 4 palmar
4 dorsal
Lumbricals 2 medial

E. Applied -
a) Ulnar nervc is palpated as cord like structure behind medial epicondyle of
humerus. This is a diagnostic leature in leprosy.
b) Lllna-' nerve is damaged
I) At clbow joint due to
i) fiacture of medial epicondyle or compression in rubital tunnel. It results
into radial deviation of hand.
ii) pressure on the ulnar nerve as it passes along ulnar groove produces
"funny bone" symptoms - funny iensatiom along the hlpothenar surface
and little finger.
II. lJlnar nerve at rvrist joint is damaged by the compression of volar carpal
ligamcnt and palmaris brevis muscle.
- I{cre all intrinsic muscles of hand are paralysed resulting into [pical
claw ha nd
- Therc is hypcr exlension of metacarpo-phalangeal joints of the ring and
littlc finger and flexion of interphalangeal joint. This is because of
paralysis of intcrossei and lumbricals
- There is aiso sensory loss on medial I and % fingers
- There is loss oladduction ofthumb, as adductor pollicis is paralysed.

50
 sNK - Supcx

Sni-l8 Pulp space:

It is slacc betwccn palmar
skin and distal phalanges of all digits , T.l9 ol lk€dt
of hand
A. Situatioo - Distal to fibrous - - Pforlmd
ph.l!.tx
ol flexor tendon
sheath
B. Formation - Formed by fibrous
septa connecting
Skin to periosteum oldistal
phalynx.
C. Content -
ir) Subcrrtaneous fat Epiphysis a
b) Blood vesscl
l). Blood supply of terminal
phalynx
Middi. ph€{6nr -
- Distal 4/56 patt by digital - Oeo€ {6scJ.

arteries ploxinral l/5n part

by epiphyseal arterl'.
E. Applied Pulp 5p3ce cd a di8il Note thc pcltioo c{ artcrlcl to
a) Infeaion of pulp space, is rhe epiphyc: and dlaphpk dtre termlnal ptralaruc
called Whitlow, which is
associated with severe throbbing pain due to increased tension in spaces.
b) Infection is drained by lateral incision and breaking aii septa. In ncglected cases it
may lead to avascula-r necrosis ofterminal phalynx

S,0{-19 Palmar spaces:

lrns -
tnrennodi.t. <orp'ir.,1l ol p!.6.n
J Ro.,_J !,4r
L!i:i *rta
6l pokrur
, Th.r nrd.t
Fflt m.{!c.a!l
S!p.ficid p6kw.,.h
liir. bodd \
Fl.rd !..dw r \
F.rl1d oJ:o!w.cir
*1.di.l pdtrur toprum r \

Hypo&.@r liM€r.t

t^t'ffi m,id- --
\ l^{.F*'.r. Fld! ..eun
rwb@^.w. g€.
'o"JOqr.l
J,i JriliiiJiJii,ii
Transvcfle sedion i<.ori the h: (o ilr(R irj cocnpnmcrxr, and dre lo<atioo oa lorrc lprcej a( sor8kat impo{r..ce.

5l
 Particulars l\lid palmar I Thener
Aj Defir,ilion , Hollor'. space situ:ted on the inr.::' Hol:r.* spa:t :.::::e: ::.
I sidc ol r:l:r I outer side of Palm
B) Shape Triangular Tria ngular

C) Situation Inner side of palm Outer side of oalm

D) Boundaries
I ) Anterior i) Skin and palmar aponeurosis i) Skin asd palma:
ii) Flexor tendons of 3'd , aponeurosis
4s,56,fingers ii) Short muscles of thumb,
iiD 2'd , 3d , 4o' lumbricals exors pollicis brevis,
fl
opponens pollicis,
adductor pollicis,
iii) Flexor tendon of index
finger
iv) ls lumbrical
2) Posterior lascia covering interossei Transverse head of adductor
metac€rpal poUicis
3) Lateral intermediate pdmar septum Tendon of flexor pollicis
longus with radial bursa
lateral palmar septum
4) l'4edial rnedial paimar septum intermediate oa.lmar seotum
P:rrticulars I\{idpalmar Thenar

Ii) Drainage Incision in cithcr the 3'" or 4 In first rveb spacc postcriorly
web space 1

F) Com nru nication

Distally I:ascral shcatir of 3, 4d' lumbricals Fascial shea(h ol first
,,
Iocc-irslonalt), r. ] I l
lu nlDncal Ioccaslonally ^nd.

I)roximally The spacc is closed by the anachment ol ulnar bursa to the floor of
carpal tr,rnncl

l,AQ-16 Dcscribe shoulder joint (Glenohumeral ioint) unae.

Iigarncnts, movcmenti on"o --.'':l-;--'' -- -:':t--:-'.
Ans - "ppti")
A. llcfinition - Most mobile joint of upper extremity
Il. Classific,ation -
_ a) Structural - Sinrplc, ball and socket, multiaxial synovialjoint
b) Fu n ctiona I - Diarthrosis
C Boncs (aking part - I{rrnrerus and scapula
I) Arl iculating boncs -

52
 a) Humcrus - Head is covered by hyaline ca,tilage.
- lt is thick in the centre aJld thin at pe.iphery.
b) Scapula - glenoid cavity, covered by a hyaline cartilage.
E. Ligamcnts
a) Capsule
I) Attachment
i)
I{umerus - It is attached to anatomical neck of humerus.
ii) Scapula - It is atlached to paipheral margins o€ glenoid cavity including
supraglenold tubercle.
II) Deficient - It is dcficient in the region of lCtgiBLgsye for the passaee of
i\rr':.Jcn ..f 1..,..,,1 h...,..i ..i't,it:.':_ ii\ sr:.rri.r.l s\:::lr
iu) asccn.iing branch oiantcnol circum cx humcral artcq'
IX) Laxifi : lili la-r on the midiul iiae on.-"* Uelow the surgical neck of
irumerus.
;f\1 Strengthened - Ir is strengthened by ,c4gSrc1[ i..
) i) -sqpr4iEglqs, ii)-iqfr_aspinatu;, s ii t
I iii) g:res minqr& iv) Srrbscapularis
\! Capsule has two openings -
i) For long hsd of biceo rnuscle.
ii) Fcir subscapular bursa.
S;'novial membrane - It Iines irLner surface ofcaDsule and extends on lowers long
head ofbiceps, as tubular extension
-
c) Glenoid labrum Structurally it is fibrorcartilage in nature and triangrlar ilr_cross
seqtrQn. It is attachcd tq peripheral fr-a6rt id c'vity and te"dnn of biq)p
muscle.
I) It -d.gcpp41thq qvity of shoulder joint.
II) It proteEts th9_9dC9! oFthe articuiating surfaces.
iii) It pr_ovid_c!_tlrc qrslrren to head of humerus to roll as ball bearing.
.. d) (jlenohumeral ligament (It is condensation ofaotericr part ofcaosule)
It ls
is divided intoo3
Pa rticula rs From To
Superior band Supero-medial margin - Upper end of lesser tubercle
of glcncid c.avity
lvf.idd le band - Lower end of lesser tubercie
Inferior band - iower part ofanaromical neck
e) Coracohuineral liqament - Ir is thick band in the upper part of fibrous capsule lr
extend-s I'r'orn thc root ol coracoid process to neck of humerus.
'l'ransvcrsc humcral liganrcnt , i ,1 , -
- bndges gJeater and lesser tubercle "

5u
 F- \lovcmcnts
Action Il[uscle
l) Flexion t-- a)Ant;rioffi
b) Anterior fibres ofpectoralis major
E 2) Extension P a) Posterior fibres ofdeltoid with
L b) latissimus dorsi
A\ 3) Abduction >: l-15'lyplaspinatus.
'15-90" middle fibres ofdeltoid (acromial)
>A above 90" fibres ol serratus anterior attached to inferior
anglc of scapula.
4) Adduction IF Sternal fibres of pqEqqlis major,
A4 [.atissimus Corsi
5) Medial rotation l-ady, soldier and majors are medial rotator i.e. Muscles
rl 6. forming anterior boundary ol axilla, namely lattissumus
dorsi, subscapularis and 2 majors - fuectoralis major ard
'-Atqq*or
tercs malor) XbxoJ €1 lollo.z )
tr 6) Lateral rotation Spinous part of deltoid
!nfraspinatus
Teres minor
G. Relations
Superiorly -Coracoacromial arch
Sub-acromial bursa
S up rasp in atu s
Deltoid
InGriorly -[.ong head of triceps
Anteriorly-Subscapularis
Coracobrachiaiis
Short head of'biceps
Deltoid
Posteriorly- Dcitoid
Infiaspinan.ls
Teres minor - lateral rotator
Intracapsular- Tendon of long head of biceps
II. Blood Supply
a) Anterior circumllex humcral artery I
b) Postcrior circumflex humcral anery Branches o[axillary anery
!
c) Subscapuhr artcry
d) Suprascapular anery - branch oF'thyroccrvical trunk - branch ol l" ,;art ol
I

subclavian artcq,
L Nervc supply - I-lilton's law - Nerve supplying muscles acting on the i .rt aiso
supplies thc joint and skin over rhc joint.
a) Axillary nervc b) Muscu locutancous nerve c) Suprascapular ne; ,c
J. Applicd
a) Dislocation of shouldcr joint - It is most frequently dislocared joint in the bodv
duc to laxity ol capsule and the d isproportiooate area ol anicular surfaces. The
dislocation is rnost comnon inieriorly bccausc ollax capsule inlcriorly

51
 -
It is usueiiy'ocrurs rvhen arm is abducted.
Axillary nerve is usually injured.
b) Frozen shoulder - It is common condition due to adhesion berween rotator cuff
rnd humeral head rcsulting into painful movements.
c) Shoulder tip pain - Irritation ofdiaphragm causes referred pain to shoulder tip.

LAQ-17 Describc clbow joint unoe.

Classificatjon, rnovements, muscles bringing movcments and applicd
anatomy.
A n:;
A C Lassification
a) Stnrctural - compound, uniaxial, hinge type of synovial joint
b) Functional - Diadhrosis
B. Ilones taking Dan
a) Hume rus
b) Radius a.nd ulnar
C Articular structures
a) Superiorlv - caprtutum 3ld !f:q!lgt ry&.." Q! humerus
b) Inferiorly -
I) Upppr cu-@!q llltg3d*S{lqdiu s
U) Tlqchl-ear notch of ulna
D. Cubital Articulation - cnrxist of 3 ornts
Pa rliculars [Iu mero radial Ilumero ulnar Joint Superior radio ulir:r
Joint
I) llones Hurnerus and radius Humems and ulna Radius and ulna
2) Articular Ilead of radius r,..ith Trochlear notch ol ulna Circumference of head
surfacc capitulum of hun)- with trochlear surface of radius with osr;eo
enrs of humerus fibrous ring (arr,i rlar
dng)
3) -l ypc B:lJ--, a-qd__ja!!c t Sdcllg-qps of s)novial Pivot tt.oe of syno . ,al
t.vpc of sl novial joint joint
ioint
h l-i-qanents
a) Fibror,rs caosulc - It is altached to perioheral margin of articular surfacc of
lrumenrs, radiLrs and ulna
I) lncluding three lossae - coronoid. radial and olecranon
II) Excluding medial and iateral cpicondvle
Itl) It is thick mediallv. thick lareraliv.
'lhin antcriorly. thi n posteriorly
lV) lt merges rvith the annular ligament of superior radioulnar joint
b) Synovial membrane - lines inner surlace ofcapsule
. Jr n ntcnor Iigamcnr arrdl_ lormcd by
(1) l'ostcnor lrgamcnt
J thickcning of capsule of elbow joint and is thin
c) LJlnar collatcral liganrent shape is triangular
It cxtcnds superiorly lrom lorver pan of mcdial epicondyle
Inlcriorlv dividcs inlo .t bands

55
 process'
: :.:-1-i:: :ard is atl::i:c'j to me<iiai margin ofcoroooid
corono'rd process
and
il :-J"t band is anached between olecranonof olecrano.n process
iin p"i"int u*a is attached to media-l margin
n"ai"i -iiJ"tir-ti-iiit-; - it extend fiom fateral cPloondvl! or h*mcrur
annular ligament.

I -I?r!dod ot 8(.pt
Aekftt; .\ ( \Ut
-_fr
*:_N+NN-..
tudql N.t tt
/ / q7a, *,;,*o,,
-
r..Orryr

7N @E^- Utgt. PJ!,.\trgrt

?Z). cnatrr.. cxtcots s
-
772
^f(!l"Jt
Iricep5,

Relatioos of cltlo{ joitrt

F. Relations -
a) AnteriorlY I) Brachialis Stnictures are
II) Tendon ofbicePs contents ol cubital
III) Median nerve fossa.
I9 Brachial ertcry
b) Posteriorly - TricePs, anconeus
c) Medially - Ulnar nerve
Flexor carPi ulnaris and
Common flexors
d) Laterally - SuPinator
Extensor carPi radialis brevis
Common exlensors
C. I3looJ su 1, Pl1'
a collatelal anery | Branchcs of braclual a.-rery
) SLrPedor ulnal
b) lnferior ulnar collatcral allery J
c) n llterior descendirrg artcrl l i.lrancltes of profunda brachli artery
d; Postcrior desccnding aLcry )
e) Radial recunent aftery Brancltes of radial arlery
1) Interosseous recunenl anery l
anery
8) Anterior ulnar recurrent anerY I Branches of ulnar
It) I)ogtcrior ulnar recunent artcr Y ,
i'l Ne rvc su pply
a) Musculocutaneous ncrve
b) Radial nerve
c) Median nerve
d) Ulnar ncrvc

56
 Movcmcnts Muscle producing Movcment
r) Flexion l) Brachialis
2) Biceps
3) Brachioradialis
2) Enension l) Triceps
2) Alconeus
I Applied
a) Supracondylar fractures results into Volkrnan's ischaemic contracture.
b) Dislocation of joini is common poseriorly, It is associated with fracture of
coronoid process.
c) Effusion ofloiot o"*tt posteriorly because capsule is *eal:
d) Tennis clbow - pain and tenderness over lateral ePicondyle
Cause I) sprain ofradial collateral ligament
It) tearing ofthe fibres ofextensor carpi radialis brevis
III) i,nflammation of bursa
SAQ- 6 Carrying angle:
Ans -
A. Def nition - It is an c,ngle formed by arms with forearm when eibo* is fully extended
and Jorearm sapinaled
B- Cause - There are lwo reasons
d Medial flanse of trochlea is 6 mm lower thant lateral llatt
b) Olljgga oJ npeior utictlar surJace
C. diference - Carying angk is more infemale (becnuse of wider pelvis)
Sex
D. Function - Carrying angle b helpful in holding the object
E. Degree of cngle
a) It is ]$ "i41[11!!ygxtended elbow and sttpirnred forearnr
b) It is fuljlvJlexion a!1t/pronation oJJorearn.

rt!ryJladillcbG.un rrr rr.iG-! t

rn(;i€ i. d< tu 4 Fr .!
+< raliE r'f frrr!G;r

57
 L-{Q-iS Dcscribc radio ulnar joint under
ilrssification. nl ovcmen(s and m uscles bringing ou( the action
-,\ns- -
Particuiars crior r ld ioulnr r ioint
S u n Inferio r rad io ulna r joiet
I ) Typc .) Smrcnrral - Simple, uniaxial, pivot type of synovial joint.
b) Functional - Diarthrosis.
2) Artic,.: lar 1) Circumlerence ofthe head olradius l) Head olulna
surlace 2) OssoefibroLrs ring formed by 2) Ijlnar notch of radius
a) Radial notch of ulna
b) Annular liqament
3) Ligamcnt A) Annular uapsule -
a) Formation - 4/50'ofthe ring is a) Sunounds joint and
formed bv fibrous tissue. synovial membrane
- l/56 is f6rmed by bone. b) It is weak anteriorly
b) Shape B) Synovial membrane
i) In children - It is tubular projects upwards as a cu[-
ii) In adult - It is conical, de-sac known as reaessus
f/ wider in the upper part and sacciformis
narrower in the lower part c) Articular disc
c) Attachm-.int a) Structure is fibrocarti-
i) To the radius - upper and lage
lorver margins of b) Shape is triangular
circumference of head of c) Base is attached to
radius ulnar notch ofradius
ii) To the uina - anterior and d) Apexis attachedi tc
posterior margins of radial base and st1L,:iri
notch process ofulna.
d; lr with clbowjoint
is co:uinuous
e) It
blends externally with radial
collatcral ligament
B) Quadratc ligament
It crlcnds lrom neck ofrrdius tcr
radial not ch of ulna
1!)nctions at rypcrior ald inlenor radio ulnar ioint are pronation and i!t-l!3!!n
5) MLrsclcs bringing supination and pronation arc
)) Iliceps,
\ 2) Supinator,
\
. 3) Pronator tcres and
rd "v'.-
/
i+. I -____ 4) Pron4qr quadratus
Slorv supination with clborv cxlcnded is done by guoinator.
,c.$l
i! \ r'
Rapid supination with elbow flexed is done mainly by biceps

-\' t
i

,('t I Pronation is mainly brought by pronator quadratus and assisted by pronator teres ti,.rinq
rapid nrovcnlcnl and 3qainst rcsislance.
LAQ-19 Describe supination and pronation.
A. Dcfinition - Supination and pronation movements are mainly evolved for pickin-4 up
the tbod and into mouth
. Suniuation Pronation
l) tleftnltion
1) In anatomical posi- Palm faces forwards Palm faces backwards and
tion and thumb is placed thumb is placed medially
latcrally
2) In mid flexion of Palm fas€s Palm faccs downwards pnd
. elbow joint and thumb thumb is placed medially
laterally
2) Position of
*) Bone Radius is laterally ulna \p-djris ls-_gsrffogaig!]1'
is rnedialty and both are ulna is laerallv
kgot osrsllel to each
other
2) lnicrosscous Unsptalled Trvisted and spiralled
men.rbrane

")) Movement of bone Radius - plays active l) Head of radius rotata in

role atrd ul!9,_I9qaj-ss @_qqo osseous rins
inoie o?less fixeci'- .l 2) Lower end and articular
disc swing round ulnar
head
Ulna - it moves a variable
amount a-round a curved
course
s) Strength - Strength is greater Strensth is less
s) Posi'.ioa of axis - DrsDlaced medlallv n::rlg9d_1{9,"!y.
6) Situations in vrhich I) Tightening of nuts Loosenirrg of nuts
thesa movements are 2) Picking the food
used
d) Relation to gravity 4lttsayrtpcttqn Tol//3dsga\4Jy

B. Meclranism of Action
.z) Posrtion of forearm is semiflexed
b) !p9glryy":"*t_is roratory
e) E1olecltor picking up food and pu$ing into mourh.
d) -R14g_e,ql
movpqgls -
l) ln flexed elbow - 140 - 150"
2) In exlended elbow - 160"
',B) zLxis olRotation - head oCradius to apex ofarticular
disc ----} little finger
f) Homologous molgrnenls in lower limb - inversion and eversion
,c) Joints - Superior & inferior radio ulnar ioint
------i M u gc tr s "{
.-tc,rrrhHl-=*o"^
!._

)e l.ir-_,
rta p3
_:l^ l^
<r-Lr r]-Locll Ll'r
C. Applied
"a) In children head of radius is not developed as
compared to amular ligament hsnce subluxation of
superior radio ulnar joint, is common under age of 6 _

years.
b) Pronation and supination movenrcnts are used in
mechanicaljobs.
e.g. tightcning screw rvith screrv driver.
D. Axis -
Plane transversc
- lt is rcprcscnted as axis passing
Representatiorr
through centre ol head ol radius and apex of F?t&ft4d4!){srI&
a11icular disc

LAQ-20 Dcscribc \yrist joint (raclio carpal) under foriox.inghcads

a) classificatiorr, b) rclations, c) movements, d) mrrsclcs bringing
nlovern cn ts c) a pp licd ilnatonl),
r) CIassification
i) Structural - sinrplc, biaxial, cilipsoicl, synovialjoint
Ii.) Frr ncr iona lly - drenlrr.osis
b) Stnrctures :
l) Proxinralll,-i) distal articular sur{acc ofthe radius ard
ii) arricular disc of inlerior radio uinar joint
II) Distally - i) Scaphoid, lLrnarc, triquetral bone anJ
. ii) lntcrosseous ligamcnt
c) I-igaments . .'
I) Capsulc - i) Attachmcnt - Ir is attached close to the periphera.l margin of
proximal and distal articular surfaces including articular disc.
IIcad ol rrlna is excluded
ii) Variarion oFthickness - Ir is thin anreriorly and posteriorly

r)0
 and thick laterallY
iii) It blends with the palrnar and dorsal radio carpal ligaments.
II) Radial collateral ligament - It is thickening of lateral part of capsule and
extends from styloid process ofradius to the scaphoid and trepezium.
Itr) IJlnar cotlateral liganrent - It extends from styloid process of ulna to the
triquetral and pisiform bonc.

d) Arterial supply :
I) Palmar carpal arch and
tr) Dorsal carpal arch which is derived from
: i) Anterior interosscous
iD Posterior interosseous
iii) Anterior carpal (branch of radial and ulnar arteries)
iv) Posterior carpal ftranch of radial and ulnar arteries)
v) Recurrent branches ofdeep palmar arch.
e) Nerve supply :

I) Anterior interosseous nen e (brurch ol rnodian ner-ve)

II) Postedor interosseous nerve (branch of radial nerve)

l) Relations :

f) Front -
i) Proximal to flexor retinaculum (lateral to medial). They are an-anged
in tlrr€c groups.
I ) Superficial-Flexor carpi radials,
Palnraris longus,
Flexor carpi ulnaris

. 2) Intermediate - R.adial arte ry,

Median nerve,
Flexor digitorrrm zuperfi cialis
(tendon of middle and ring fioger is
arranged superficially and tendon of index
and little finger is arranged deep)
3) Deep - Fieror poliicis longus, anterior interosseous vessels and

- Flexor digitorunr profundus

ll) Behind - bencath extensor retiMculunr there are six osseofibrous
compartments. These are an-anged fiom laterai to medial as
i)
Abductor pollicis longus, cxtensor pollicis brevis,
ii) Exrensor carpi radials longus, extensor carpi radralis brevis,
iii) Extcnsor pollicis longus, tubercle ofLister
iv) Extcnsor digitorum and cxtcnsor indicis,
v) [.xlcnsor digiti minimi,
vi) Extensor carpi ulnaris

61
i\{ovcrnents P.angc of Main j oint Musclcs bringing Accessory I'f usdes
Niovenr cn t at which movments
movcmcnt
takes nlace
Flexion 85' mid carpal Flexor carpi radialis, Flexor digitorun superfi cialis,
and flexor carpi Flexor digitorum profu ndus,
rrlnaris Flexor pollicis longus,
Abduaor pollicis longus.
Ex.tcnsion 604 Radiocarpal Exlensor carpl Extensor digitorunt,
flilrist) radialis longus and Exlensor indicis,
brevis, Extensor pollicis longus,
Extcnsor carpi ulnaris Ext" -$or digiti rr,inimi-
Abduation 45u Midcarpal Abductor pollicis Flexor carpi radiglis,
lo ngus Extensor carpi radialis longus,
brevis
Adducrion 4sy P.adio Flexor carpi ulnaris
csrpai and eKensor carpi
ulnar
Circunrdrrc- Conrbination ol flexion, exlension, adduction an( abduction.
tion

h) Applicd .

l) Collcs lraclure (Dinner lork defonnity)

It is due to fal l on outstretched hand
- It involves distal end ofradius
- I{crc fracturc is tra,rsverse
- Force dispiaces the lower segmcnt upwards and backrvards and
- Distal articular surfacc is inclined posteriorly.
Il) Snriths lracture - It is rcverse of Colles fiacture
- lt is produced by lall on the back olhand
- I-lere distal fiagment is displaced fonvard and up*'ard.

S/h-'-20 First carpo metacarpal joint:

I '1 ypc-
A) Functionally: I)iarthrosis
ll) Structurally: Biaxial, saddle variety ofsynovial joint.
- Aniculei surlhccs
A) l)istll surfacc of trapezirrrn

67
 irl
:'t
'T6pic silj'riflaa-K; No Toplc \o
ln.:' \0.
l't,t,: ij
"'.
I'rrsc
)E
,f
tl
ili,
sAl.: ?:::t:iil (?F - Ns!1 ^ -L.-r
l;,,;J,ii$,',,,ilf,?llr,,ffi*
r25 | sti.z7
l:: submandibular 'tt '> ,'l
0anlliri
i,illJ'i;llf9i.-,r,a{d{,;\' ::t
t'-6ao'oc).'., i''l
'ii..,t
I- u: r :sl] p.oc!$./ 26 Ii[1],
| SN.23 r ducl
Thyroplossal
.: tr
UJI* 1 prcccss.S$ot{ff$Nl^Fts"" ioi : I ffitt da tg
t ,ptz Sryloid

Is\'30 lillHff*dq-"*'*gmt:i"tt€
srl-29

",gj'
sc,rp sAq qegolltr?.r*.E?{c;,a,) 12e

i;rutr;:i:ffi$U's#,'
- irr-lil:3, Uangelous i e r{o}e :
arqa or '
t{"lis ;l
,i-:: l'1iii,
i L".C :5 ffiffffi*"I"":gr*,"---
Cl.3!c pl:3.,'r!r]lnFtvi ?
,.t: g
-"'t
'i 1{!$<l't, Liiciinial3poa'erdj 'F SFq pGt+t^t l.slt.ll Rrcurenl laryngoal ncrvs .' 3

p *uq.{.Iriiliiffilyiilorepir*iorr.iir, I' r37

..sN.4Prelracheallasclal38|LA0.27Hyp00IossalnerveJl} |:uo-ze. ni&ssoryncrue{1..,,,, ,,1

ir' SN-s Ludwiosan0lna 139 | SN.34 Inlerior cervrcal syr'lalhelic 0an0l 01

.--SM-6
c$o lascia
"-^..^-:-.--;,---i-
Prevertebral 140 I| .-,,.
SN.35 Phrenicncrve ri.

-! .- r-ro-o Poslerio r tria nole Notc

,,Sl'J./
Jl,t? sheathl-- Not(
Carotid shealhu- /
sflQNlta
1{ lr I sl'fs
SN.36 Scalenus anlctlo,
anlcrloi
142 | sno.z Anlerior lon0itudinalhganrenl .
'
i
.
'

' SA0-3 Greal au.icularnerve \,- 144 | SaO'A Posleriot lonoiludinallioament ?l

t sN-s stemocrcidomastoid (04.ht tst ut*' 1n4 | r-40-28 Alanlo-axial joinls '

n *il;:,
-(--0 c r':
subocc;uila'tria-sle 9Q\*ut Arral.to-n, ; riiai loinis ".{,r ?or.$d l-!q
"
ffO.z i;; i *:1:
tr:*:ffiy;ru ^.io(qroq) 146 sv:z rru;intTt;titl,S'jifir.
.:q |I Sn.:a "*x,
| LA0-8 arl€N
ve.lebra,
g*:'
lo4-il .; < a d.r,,rc6 sq- Noa
Patat' re

:| -{o;l
t40.9
::llll":ll'^,",.rp-:{F-"n:",-t :;l
:1"': i:ilX1fi::S+,.sslFrn',1t
-Si! Cavprnorrs ,' gAe'
RAA,
iru-,: ::""".:':.'tl,T"i '*
sinus
sro,-o' iro ,u'r,. ',9'
::: II ff,!' li::i:',,,,,,!n:"
ll:T-.:,,"]"flYe'ti":*:19*,,,'.,.(oh'"")
,51 | SN.39
r:l
t\.;iffiEtqk4.yii""i:l
I :y3:" Yi:11:*
,s', {olm.iz .^":"",ar*'-\
Aud(ory lube
,',.,rrrioru... 5R qsr.-&N5 (atb2)
:1

Siamordsrnus
/.3f,.12 Sismoid r55 Klelsclbach ilcn
0r K.rlscluacn -..\r -rd rs,.i4
a ",Ar? sinus
^ rToop^y's ce.cbtt
0 . \,/- l15 L5,n0.10
i.-19 l! Lilr,e
Litlle's 0R s areJ
a.ea
taleral'ua,'ol noqe . .SRq ttii"*]:il"-.],.,-,
s area

].uno.t '5b tla€-33 '-

- . q-d-11 Deveropnrenr
t&-1J n'vor.nn\'., hypophys.r
^r or ,r',1,,. ,
h..n^^h-c..o,o\, ii l*-F,r-
l-cx--an ;si.;; (r"l,.r; lar i.-";'l'
r,trritr,^,ir<i.'(':nt,'m^l;ir
vri:,-ra*l .-'3p
r;', ./-PA:'r' '"""""
: #i
I s{.16
m:{1:?,;'".,;*rstP$(o't'or) r:; -
- \ -
supelor orlirit trsst,rerir '61 st lz
l*fl
i:lldlliXll''ilis{r"g*r)co't.'"i,i*3'-
Igtonis
- Rima ' :L
:Ac'1 rylarcLrr,'mus.r,r, lhdorot" .'": L-o*o.ir l;rx :"-:"1q.-' frf;iilp;rn!,io"
t r3u.r. (icuromoror ne:u$;qggfat
i: ocutomoto, letbrb/lctoz ) lb: J
ne:,/eiit-{.{u!d4Al tstor.r{ldbz) .l sro-,rI L
L,'-umvJ
Umvi'rare pr!',. J€.
are p:rliritlr
- (4v,,'oqot^,) .i
39
SA0 3 'e: L >,/1u-'
(lo"';Cl sv-a: Iin oanic men,brJqc t .5. f)q
^.\tiv,
s^r.r; citiary !anotion-., "lf*.",t+:f -- "'- 'l;i ll rlo.io nl,oorr ea,.,' t nc {'ii'Hii'j.,i'r'
wlbc's s),nd'chre' -"'t-' r''x.r"iq
v.Lr4.h/;o! ,rv'!e
tAo-r3 Lochrearnerve'2: r*r I sru.aa iri,li"Ji.. ., rJ"l'" t''' -to:i'*
, ..Ao l,1 tooccert "ervi fu'^ .Ar.rl^. : I su.as cochcl
-- \r&i0-15 Oigaslri.lriintl4 'l t qnG(r. t. ,t. lusna6 lrisl phirynoerlarch / ,r,*).,:,
, j#;l' :1,',H':il1,iJd!^"*rv"* g.rg.
SM-19 linoualaflai'
W :[';i,::i,Tfii'flYHfi-'$;'4+*
r' II Sil.4q r"rJrynacalclell :'1
[,4eckc'ss Lrlilaqc .
:: LJK.20
--sN.zt Ansa
--SN.zl
-.5i1.21
ote o.r,,.
taclt arteryi-p-NgtL
V5+{-20 lacialanery
Hypoii6'ssr[..]0ts l'
Ansacervicalis(An3aHypo'oldsiltrlqlt,l1
iAn3a HvDo-olo-ssrNotf
cervicalis (An3a
-'f'f S\.50
r., , r._rruralirdlr- . aJ
o.6*,,,..r.1q^pe1;64r7.7,r,[
,' .lYb
. l?b I 5N.51
.ni
sru.m [,4ccrc
st.st [ourlh
carlilal
thrrynocni a,ch
and.ixll thJrynocni
tourlh and.ixlh arch r','
;I
j;
r, '$9;l' ,;l
,ii
;,'$9,1'
I
i:::ff:iili,:Hfff.f'$f#S:eil,tsr4'j[11,
\,-i,q0.18 Faci3lnervc g
i,AO-18 taciolnervc@ Lq r.o\+
fiili;;''l*""
;ffiil11h.ili,X;t'!+:;.'l.'"lc,.b4,ry,ilioli, 'evebrrec'lo*a'arc
;r:;;' i:::ff:iili,:#fff.f'$trf#S:eil,tsr,4'j['1, l,:1il1;:""
;'. | \.S'10.r:
iar. Crerr-L,r- ftor 'oU )
,.S'10.r: Ctl-L+-Gur"oq l'6a l
i;
t . SN-23 Lowermolor neoron lesione ^o!.+ isr II SN.53 Devclopnic0l ol lr.c 21,;.) i
.,S,N-24 Upper molor neurun lesion .

ffi.13 ,,Hlil.l?llll',1',',1,;"1{,;q.g,,.\6rrltb\)l
oo 'o! 3l:l:
o'"0"0''n'0""'
i|l I Sll.sl oevclopnrcrl ot lhymus ;\i/ l
'1,,,^ :
,"3.bn 'zs.ii *sot,enomandibutar lioamen\"4.' ' .rcI . i -iN.sz.. lnnt.na ..,0
zt::-lMusciesiiijnrstimri6n 7- ?- LhQ*.t
t-AQ* ilr{tld5"e
Sr1d\Y [1jsl*o
flijsl.io 'rietid u"ofr
riilio Niorx ?io
ii,iio,ilil,li,',,- ed"r,*,j";,*** ,,;
--r*0. zti-.it'iusctesr"f.jnrstimririn ai.ri31
-..-.r-.cip"l
.,., *,,!. i
-t*o -.,rr],?io

*:29- 9,i:s,'oji'i . .
..il o': '" ':"' ,tl I";j.;
.rxo.zzvsiaiiiri"ii".*':r"r;*,:,ti:.tf.:;i",';;
I 1 ' -- ,- r*1-\i
I
__;[o.t,or) . :

":;i-i*H.;;;6*""' \ fr#,;.**;t;;
,#*t{di"''?;
',

"';:; a k 4J il.+4i6
f.il..rF ,.) i-l', n-
L,n"t. .P F-- rX.l

(o"r-D
j. q':Ijr!^.!:.j !q{q." -'--
. I t'"ir!ftr!,lr.j
 Ap plicd a[[tonry;
A. fhc supranrcatal lrianglc corrcsponds s'ith of thc auriclc
ailgq'
B. At birth, masloid antrum is situated at about 3 mm dcep to t]lc supramcata
il
'd:1,

Suprameatai
triangle

External

*
Fig 3.2 : Boundafles ot sup.ameatat triangle.

Mastoid proccss .J.5c

(.Mar ls brcast, oid l\kc)
]l lo,tS" frorn r)1c lowcr pirrt ol lllusroid part of lcrlrt)orlL Il {b r)$ ll,,
r!tcrat.uwalt of-qf"i"ction
ll. (llc r astold
.
olch
bo11c,

t. Situation : Posteroinfo.rj.or part ol cxtcrnal acoustic mcatus

z. Dcvclopmcnii br$gjg"qlq ycar and is usually bcttcr dcveloi)cd rl nrcu thcn rn rvomcl.
J. Attachmcntl.:, Iollorr.rrg r.,..sc1,., rrr,. :rltrcl,c(l ti,,nl Lrclu c backrrrrr,l:
\al-t JJ\ r-!
A. Src rno c Ic r d o mts ro r,l
lr.
F rplcntus (apttls,
C!

C. Lorrgiss inrus caf,ir is

-..'.:'
.J. Ilcl:r(ioni:
A. lt is groo-\,cd ol (lri (1c.,) irsIccl l))'digirstric notcll lbr rhc origirr ot 0Jsrcrior-b.ll!. oa b
digasrric. Ilcdirl l(\ tl).r f01ch is e rroovc for tl)c occrpitll lrtcr\..
B. Slylonl!sloid for:rnr,'n *'lliclr rnrnsurils fitcitl nc c itnd slyl(rnli\sloid br;r:ich of postcrior
atrt rclrlitr atlcrv
5. Applicd ntt:rlottt) i Siltcc rastoicl proccss is not dcvcloPcd:rt hirt lr Ir
. .sc^ustic:nrcatus is sntrll. it rcsults.into cxDosurc pl1;frlciql ncrvc,;irll'fi
: : aariGggffauriig.i!plicarion of forctis afliin)i, ""Tf i

t-
'j Stornomastoid
i-
c^

LC Longissimus capilis

I rg l.l : lvl!scles allached 1o the rnastoid proccss

'a

ffiffiffi-EsH J,l;',' r,j"j:l' lnrn

er I
.i
--------
It $l.lr.lct
iJ n loflg, Rrd poirllcd borly proccss:r|is,:s liol)r lcntporal bonc. lt is dircclc(l downwards
ds and and
forrvards.
s' , l(f i

ir
,

i. Sitc: ir i.;r,c.ir.r l,r'... _j r:rrr.ri .ll(l ,ulcrnirl cilrotrLj ilrrcry. ',1 r1\F vct"t
'T-
-r'\ \ 'll

L 1\'\.l I
2. Rcl:rtiolls : 1,
A. \lcJr:rl'y lttcr,.r. J...i'r' \1.r.
Il, Lalcrrllv - pur('lid qlri (l ", i,':-1..''r"
\ 1r!e1 t\r'\
'

--1. Attichnlcnl\: Slylo.llossus

! t

Supcnor & middlc

Flg. 1.4: Attachrnents to styloid procoss.

128 Iicrrd, Ncck & Frcc
ta 6i t'3.1 r :: s ri,r ciiii6t
. Parts of stylold proccss St ruc( rr rc Ncrvc suppll'
At thc tip & anterior sutfoce' .lr1/r.rg/,rs.rrrs arrr.rc/c llll'poglossol (Xll)
|rledial surface Str,/r,,r,/rollrr.rt,,rrr nusc/c ] G os s o p h n q, u gc al
I ( l.\' )

Posierior surface Stvlohvoid nu.uclc Fdciol ncrtc ltll

lip oj a,i-gtd ppccss-t**i uteiol StS'Lonandibu I a4 I i gan c :t
,!i
StSl6ltyoid liganien1
r','il

Laycrs::- Q{:-s cAi.p i

A
-{j<.in;-Skin ls llrrrv and contairls plcnl)' o{- scIlccoLr; glands. Il is rrdlrcrcrrl I' iir': '
epicranial apolrcuro\is lhro!rgh thc dcnsc sulrcrficrrrl irscil, as i lhc pulrls nrri soi:i
B Conrrcctr'( liriLrL (..rocrficttl tr\:t,r) It r, \(] lJ.r,- ihJ c{'r'l: h nl('rtt "t ',1' ^ I

;E;df.;i;:.''..,
-..--.-'--rr''ll, rht ..rr r,s,.r. , ,,.,, ,r,r ,l-ii.iJui-r.il. li ..

"iX r* J.'.( ..,1r ccr.\- r,\\r'

C ...|pll9{!-!-L (r:rricr aponcurotrcu ,,r eprcrirr.r.rl rl)orrc,rrosis) : l-lris cottli,trrs
lfoccrp,torrortr. . nr,r "r Ir h' c.,'.i :r,J r'..1 lly. flrc ,'rL'pit.rl o,rlr', s
'Tibri' crrCiri.,t ..-itiir..l .r'. r h.. r rr..:l ,rl lrircs. tlrc Ilrl,rrr", i,c,ly ,r',.-
lr,-,1.,I-rtr..rr-c .l.r-
frcm cpicrar)rnl rponcurosis and r-r:rg.: \ rllr Ll)r proLcrus, corr'uqlloi sLrp,rlcilli rrrrd
orbicul:lris o(Lr|| I hc rlrrc.r:on of rl.e lil .'r, i. .r,1rqrn p '.1q11q111..l.
ir. I Uoqc ucglxr r, ..,, .-liiirr',,i. ':-te- '
a. Posteriorly lrorn highesr lncl supcrrol nLrchul lincs,
b I-it:r.rll.. r, , ..p:::,:: r:i i:.,r,ri i, . ,
c. A0tcriorly irrto tlrc oycil<1s. F lt S.
.,'
Tht /ort,rh /.r.r., r. ,,,, \, //,,,,./r j. . ../ ,/.rr4_tr,rrrr tt,,t ..1 tlt,t.1.,l1t "..
,nrccrior) rl.rs t:rycr r'-:rit,... rt,rr rt r ,.. .s ,r i , . if,fti ;,1ij.:fr:lli,
.,f --'
Tlrc blccding in rhis Ilycr rcsults irrLo l;lrck L:yr
L. ..'99!Lc-rq!"ul-ll-orl-pVrqstclt. lt is l,, e v Jll.rl.l]]-d kL LLrc \rrrl.rc. {)l rlrc l)(,]r irr(i r:i
firrrrly :dltcrcnr rn llrc sr.jlLrrc\. II.. I , ollcil.,l i rlris Lr)nr
u oc rly tnq bof e
'.rr'. trr. ,t l. .',

Skin
--
Enrissary
-- - Con eclivc llssLr{l
- Aroneu.osis
areolar Issue
- --Peri..anium
-Loose
Meningeal lay.r ol durirfi\i(e:
Layers ol llrc sca lp.
2. Blorrrl s rrlr 1r lr
n. Atlcri.rl suonlv:
Tnblc 1.2 :

ln front of arrriclc I Ii{hind thc iuilcli..

I a. Posrclior
,9:"ii',ll

Ophlhalmic artery
Supratrochlear vein \
Suoraorbilala4".v

Postci?, JUncula I vcin

Occrpllol - .. ----- oc.rprlnl vo n -'__-

lnlemaijugular vein
External
Fig. 3-6 i Arleral suliply anJ venous drainage ol scalp. , ' ,,. .

L) _\'-rroLrs -rirar grgc :

rr 1hc suprrrrochlcnr lcin.loins *,ith supirorbirirl ,,cin and drains into angular vein,
ll Lontir)ucs as facial vcin joins rvirtr ar:rcrior rirrisioi of rctrornandibular vein and
,rp,:rrr into conlrron facial vcirr*lriclr rlrrrns into irrtcrnil .iu3ulir vcin.
lr SrIrcrllcrirl lcrDporal vcin joins rvitir rrrilrLllirrl' r'crn irrrd clrains i lo rctromaodibular
vcrr. ll dividcs illro antcrior :rnd posirrror (li\.rtir)r)\. lhc rtrrcrior division joins
\\'rllt lllc llcilll vei[ fl d (lrilr)5 irrto LIrrn]nl jrr!ulilr vcin and postcrior. dlvlsion
corrtbirrcs with thc postcrior auricular t,:rn nn(l druins into cxtcrnaljugular.VCin. ..-i!.
c ()rcrfrl.rl vclll dralns iDlo
I SLlbocclPltal ecxous llcxus ,,vltich a:c conncclcd by crrrissary vcins or.
ll h\t! laI j ugu lrr vc.rr

)' 'J.,,il:','t 'tn"'.,-nly -lt'LgeminctI o.lcr1^€ o'irl il( bi<rne h{9,

lu Irr fronr ol auriclc: 'l
I SLlprilorbtlitl lnJ sLrpru tr,,Lltlc.rr br;rncllc\ 0l ,1'lrtllrlrrric clivis ioir
n,,.r. ( Y f-\
Il. Zygomaticotcmporal brauch ol zygulnilic 6qrlc rvhiclr is a branbh
Jivision of trrgcmir.rljen e. ( V2 \
lll n uriculotcnlporrl - rrrandibular div;sio o f ,!Ll1;c_!l !!t L f ! z|.
 b. Bchir;d l|c irLrir.lc O*tT C:rL,cO - Go 'tb
1.. I'ostcrror Llir nion of lrcat i ricular ncrvc. (Vctrtral rrnri of C,-{-, ) :

II. [-lsscr (t.ii]rlirl nctvc. Vcntral ranti of (Cr)

lll. Gclr.r (f!ilirirl rctvc - dorsal rurnus of C? ncrvc.
IV 'lltirtl (\ciIrtxl ncrvc - dcrsal ranrus C3 ncrvc.
B. Motor
n. ln fra::l :l :1.: :,;;i;l; Te,rrlurai brlrrch.of iaclal ncrvc supplics frontal bclty ol ,j-
occiDiro fronlirlir . "'l : . ..; :. ^. .' .t fi
' b. selrind ilrc .rLrriclc : Poitcrior auiicujir bran"li of facial rrcile srrlrplics occip!ml +i
belly of occipito frontalis.

Supralrochlear
F"".*-] @ r'{-.sF.
tI

Supraorb;i.i
, J,,

Zygomaticolenrtor.l
'1!,)rt , .L i)'.rr'-1, ol \.

Auricirlotemporal Vj

c"
/) ' Po.l, . i,.', rl rr

i
Cr I

Fig. 3 7 : Scnsory and molor supply ol lrrc :.li|

Applicd anntontl';
A. First laycr I Skin is thic| :rnd hairy. lt is tlrc cornrnon sitc ol scb'rcc,rrr, , ,.i
13. Sccond Iaycr' :
a. The blccdirrg irr sccLrrrd laycr is prclfusc. Tlris is bccrusc of t*o re.L., l
I. Thc scalp lrts riuh blood sLrpply (lrvc artclicr on ceclr sirlr:1.
ll. Tlrc lorr ,-cs\cli irrc frcvcnlc(1 Iro')r cor) ilrictLon bcclrrLsc tlrL rL.rll' ';! tlrr
blood vc.scls rLrc rrdhcrcnt to tltc .lcrisc colllactrvc tissuc.
b. Thc blccdiug crn bc intnrcdiatcly .rrrcslcd by corrrprcssing agairrst lrrud bor,: ir
cran iu m.
C. Third laycr : Tbc injury in anteropostcnor dircclion lrc:rls nrsr. 'l'hcrc is rr tlcl;ry ir thc
hcaling of thc lr0nsvcrsc injury. Bccausc llrc dircction ol' thc fibcrs ot rru\clrs is
anteropostc.ior.
Hcad. lic:i<f;lFa::€-- --:_,i--@1.3.
D. Fouflh.lsyer inrr :-
0 iia

c. Orbjqularis oculi lrrs ttrrce rr.rrr.

l. I Pplpcbral pirt clo\ci rhc c\c !cntly ns irtr sloop rnd I)lirlirc.
ll. lOlhiral parr clusc5 rlrc cyc tirrrrly ns h{pp! s durinl.j dust sto u.
Ill., Llcrimal part dil,rt( ; ri c lucrrreal s.rc. ^
I] iVl Lrsclc Ia.'{

l#i*.hd'T,ffi
i

a. Proccrus produccs ilarisr-.ir:sc r'.tliiiR J' i,, o *" ol-r)osc as in frorvning

b. Nasalis has (wo parls. ".,""..,'
I Transversc pafl call0(l Is crtrrrl;rcssor r:aris. ll conrprcsscs nisnl aDcrturc.
ll. Alar part callc(l (lilirtor rrrns Ir lilarcs thc artcrior nasrl nDcrlure in dccn
inspiration.
' ll". Deprcssor scpta dilatcs rntr:rior nasal apcrturc in rrrgcr.
Fronlatis _
---= orbicu ar s oc!tl
Coll !(lator suocrcilli-- ,,,,,._l**"^
",J.,
Levator labri supe.ioris
alaeque nesl
:ransvcrse part ol nasall5
Lcvalor labii suDerioris
Alar part ol n a s6lls
Zygomaticus mjnor Levalor anguli orls
zygoanaticus major Dcprossor scptl
'
Orbiculnris oris
Oopressor anguti oris
Bucclnaior
Depressor labii inlericris

Fi! 38; Mu6cos ol

Table 3.3 : Tho tabto shows mus;ies acllng *looo*nn. of tfre taco.
Op cn in gs --= Dll,.r* - -l
------...---1
a. Orbicularis Lcvotor pllpcbrac supcrioris I
f rurrrdLU!,!). u' y"r!l'L9
F =+.i- I

B. Lacrimal Lacr imalj-iis rt of.:6rbiiularir

oculi '

C. Antcrior 0, Alar part of nrsrlis, '

b: Depressor scpti.
c. Lcvator labii supcrioris a lr.cc,rr
nas i

I). Upl)cr lip l-cvator Iabii strncriorjs

Lcvalor Inhii su pcrioris nll.rLr,
nirsi
Zygonlnl icus rr]inor
l.cvirtor al]guli oris
n n{lc ol tnoulh l)cprcsso r a Iq LriL oIs iL 7-vgo Lnaliclrs rnll.jor.
I

)i
r t*.!"..'-:+e4';-44f5'9g$lf rlrclrr'.rrrlrl .',, r,c lo,.r,cc .s
:r. )fjr rnclc I urbrc,rlnrrs oflsios.-Ft:t'ill",r'.
b. Dilarors: ,h
L lirygr : Ilisolirs trj,rs ',' l:rrflrl
Ii -Sub-.rlrrncous
lstrli;r.ll-L;rr ,;,i
r. Zygonla(ictls ntajor dlarr,: tIc rrnllc ol-;roLrtll ul)\,lrli al(l lltaJlllv i:
lu rr,: h in g
r Zygorrlltticrrs rninor (lc!ir(,r. illrJ i\crls uppcr lip. 1,il
ilr l.cvirior llririi sLrncrior'is itlilcquc ltSt tlcvlrtcs arrtl cv. s tllc lri:j). r, ii,,
,lil. ... tllL. ri,).,1r rl .t,
Ill r\1r t{ile lrvrr I
I)r0rcs\or .uut.,l.',ris,lr.r'r. trrc :r'r''lc of rnouth dorr,ns,ald .lt
ii. Lcvator anguli oris ::l
iii I)cpr.:ssor labii inlcriors drrrvs rrn,11c ol rttorrllr dorvnrr;rrLl arr<l s,,nrr t
l:rtcrally ns in crprcssion ol ir,rrv i:
iv L.,cvxlor labii supcrioris clc!llc! rliJ it,
rv $Sg
j n{a,ri,,TT\ t,,i"rr"',.. rlr( t.,. , I l,t,
ii. llrrccinator Ilaticrrs rhc clrr.ck lrrrj iirrcrl)lv cxpcl\ tllc tir l)ct\\,ecn thc li:
\cI1'c suppll : I he tntrsclcs ol tlrc Ilrec irrc (lcvcl()l)cd lrol scco d pl|rryngcal arch a,)(i
rr.rvc oi lhc sccond pharyngcal lrclr is lireiul ncrrc Ilcrrcc all tltc ntrrsclcs arc supplir{:
i-uc iir I crvc. .$

'.

t-

oir{rf^Ir orir
I'rqrerl, frtieilrr'i ir Or l rCrius . .
 c "e-crce :eiAe€i -::e:
lllotor ncuron lcsio l-o\\(r qlr o trr r ncltron,lcslodl-ii:-
A, S vnnrt vnr e Suprl nuclcar I'ircial palsy. l. lnlrr rrrrcle.r fuci;rl palsy.'.-
I
c.g. l!cll r p.rlry , , -, 1.:.

b bl Ililorv, rlc liciil

,t, l.l r.a. t:rcr:rl nCrYc
Musclcs c. lpsilatcrll musclcs
prrrlyscd half of facc qrc face:rrc rr r rir
D. Clirica I d. Clinical fcaturcs on thc oppositc
fealu rcs sidc of lcsion. prralysis
I. -Facial
asymmerry
ll. inabiiitv of angle of mourli
to lltovc upwards
i- lll. 1-oss ol nosolabial fold Ill lrrrlrilrr\ to closc cyc.
lV niclU]l,il.ltlo ol lo('(l l lV ln:rl,ilirl Lrt lnglc of mouth
\'- llrc vcsribulc of llrc rlrourlr l() rrr(rvc rrl)\Y:rfds.
V. Dribb ling ol saliva V ot rr:rsolririal fold.
I-rrss
\/1. lrrnbiliry ro i 0atc lhc chcck Vl. Accrrnrrriuliol of food in thc
lalcftrllv vcst iLr(jlc ol ll)c nrouth.
VII I)r iLrb ling of slliva.
\/lll lnrt)ility to irrllatc thc
cllccl lirtc,illly.

Sensory ncrvc supl)ly 0f tllc l'ncc

Ophlhalmic--

Flg.3.9 i Scnsory ncrvc supply ol thc

134 l{cad. Ncck & Ir.r':,:

labio €holvs *r!flf/, n"*u the laco.

"uppry
Sourcc
Ophthnlnric
division ol r
Trigr rninal L
a
llcrvc -
;A. Uppcr lrp; I
B. Zygouaticofacial ncrvc v Sidc and ala of 'L
c. Zygom rticotcru pora I r\ lorvcr cyelid;
nbrvc uppcr-pa( of chcck:
and antcrior part of tcnrple.
Mandibular A. Auriculolclllpor^l ircrvc Lowcr lip; chin; lo*cr prrt of cirr', . 1:.
division of B. Buccal ncrvc ac, i
Lowcr jarv cxccpl o!cr llrc ilrrrlL '
trigcnrinal - -C, i',icntti lcrvc \lLqr,'er n,.tiiu; ,'ttF., l/1" .f I r' :. r,
iicive srr rfr cc of lLniclct rtnd siLlc ol Ir':r,

Cc rvicl I A Ar.tcrror rlivirirrr, ol Skin or,,:r tlrc lurlc ol tlrc.irL* AScL

picxus giclrt rLr r r llrr rr'.lrlc ovcr llic lJ.oli(l !.lirn(1.
(i z ,) r!ta
ll llt,trtr rll I_o*,cr nr.rrqirt of thc lorvrr iurr.
i:)ri!:n,)[)
ncrlr r,l rrt'cl
(C:,:r)

Drng.:rous alcil o f' fxce l

I troductioll : 'firc cIrtbolLrs irrisinr Iiorl (ltngcrous arcll of tlrc frrcc crr rsl;
corttlllic:rtior ol nr.,sclcs ut L.r:, rtl
Sitc: &'-"lr t s,\
A. Lbpcr liD.
Il. Scptrrrn of ll o sc.
C. ,tdjoinirrtr',irLi\ ol cllccks
-t- [i.cxsons fncilitatir]g rlrroltbLrs li)n))ijLL,)Jl
.\. nbscncc ol Jcclr firs..l, rrr r:r.c.
ll. Abscncc of vulr cs in iacirrl r ,.ir r Lrrl
C. Iracial vcin lics dirccrly orr t,Lci;rl rrrLLsclcs
(lontnrrrni.utirrrrs :
n. Dc0f irci:tl vcirr '- fucial vcrrr ; ltt,Jr.iqor(l vcrlous I)lcxus -; cavcrrr.,Lrs srnLL..
B. futgular r+in ,- s,,l^r;dr ol)lrrhalrni. \,,.ir -icar,^rnors sinus
nnr(om) : Tltc inlccliorr ol thc rllnqcrous arco of thc lucc lcirds to cuvcrnorri sii :

^,pPlicd
throntbosis. l_hc on'rbolus conrprcsscs cllni:rl ncrvcs plcscnt in iltc cirvcrnous slnrr.. .,,.i
results ilrto paralysis ol lhc nlusclcs ol lbc cycball.
.'ffi 3*i'5r'"1,'.',,',y''
3. crv c srrppl). rrnd
n-
rpparatus undei
BI
A

l. Co nr poncnts or parts;
Bland \ irir duqis
Tablo t.5 : table shows dctalls ol o.biril andi

a. Orbital
Siluatiof Mcdial surfacc of froIt:rl nroccss
of zygomatic bonc

Nc. of ducts

Func(ions , S-ff 'l tl,t:tS

L Mil ir)lxins l-ransfiurcnc\'(it
ll. Ilxprcsscs crlotrorr,
Ill. ,\cts rrs br,crcricidll.
IV Ilcrldcrs rtorrrisl:nrcrl lLr (,,::i1.,.
V. l(ccps tltc srrr{icc nrrrirt
ConjLrrrctiva:
lt (iross fc:rlLrrcs :

It is transpirrcnl ntLrcous fl"^r)ll)r r|, cor'crirtrl scl;rra attd lining tlrc inncr surfscc of
cyc I id
Conjunctivirl suc : lt is i l{)lLIlr,rl fll:\!c hcl\\'ccn c)'clid & cycball, consisis of
l. QI[ilrl plrl \\,lr ic lr i\ rrr (Nriir!t s itlr thc sclcr:r.
Lcvaroi ir,rlpcbrac

Lacrimi:l p!ncla (uP Per)

Superlor canallculus

Conjunctival eac

Lacdmal sac ir,

Flg. 3.11 : Lacrinrnl aptaralus

 'jil
llfi
iili
-
* Il pi t : II is higlrly
-$brrl
vnscular, adlrcrcrrr ru rarsill platc. l( lincs il': T
c vcJiili-.---
1il
l) Ncrrc sunl)l). :
')i
.1. Ophtlnlnric division crf lrigenrinrl ncrvc. :l
ll lvlurillrrl division of rrigcnriunl ucrve. \1
c. lllood sLrpplv : Palpcbrul branch of ophthalnic arlcD,. .i
C. I'iiici,r r"iilt l.,.rirrrrl carr licuii: ilach iacrinrai canaiiculus bcerns wlrh Duncrum.
- a. Lrngth o[ canaliculus;:" 10. mm. i:l : .j +. ' t.
',r' {.q
" t|' 'vih'[l - 2.tti' i" .l.Et
a
Horizontal - 8 mm c
ir. ll is liacd by slratificd squamous non-kcratinizcd cpithclirrr t
It opcns in thc lirtcral rvall of lacrirnal sac bchind nrcdill pllpc5;aL liganrcor. 1

D. Lacrinlal sac: I1 is rncmbranous palt continucs sitlr nirsolacrirrral duct. It is lrlilrj h

pouch urcasuring l2 x 5mnr.
Rclations of lrclinral sac : l

a. Antcli(rr:
i. iricciia i piipct)rrl ligrrncnl.
ll Orbicrrl:r ris oculi nrusclc.
b N,lcrlrally : l-rrcr irrul groolc.
c. l.-irlcrirll\': l-uerirrrrl flscitr and lacr'irrrul llrrl ol-orl)rcul:lr\ ocLrlL
E. Nasolacrirrrll rlrrr:t : lt is a nrcl]rbrirrroLLs pxssir!c ol l\ nrrr r, rg. lt rLIrs ftonr tir i ,, , :

end crl lrrclrrrr:rl :,re & opcrrs in thc ir lirior rircutLrs ol- ro\( llrc lo'.,.'cr cnd o{ rn! ',,r't
is gLriutlt'd hv .,,rlrc gf I!r1rg1, lt prcveIts bllckrr.rId llrrv,rt ll LrLl
L Dlood supplt : L.urlinr.rl brlnch oi ophthrlrrric lrtcrv.
3. Ncrvc srrppll :
A Scrtsoty : l-rcriir)ll brrnch of oplrtlrrlniic di(,isiou ol triscnrrrr:rl ncrtc.
ll S)'rrrj)ntllcllc:
tr. Pr'cgartgliortic llbcr's lrisc lront spirrrrl cLrrLl ('1 , ' '1 5 :t,::trerrt) 11l(l gocs lo :, :i'lr;,ri
ccr vicll syntperhctic gangiion.
b. P<lst glrnrliotric fii,crs arc thc plr\us urrrrrnd intcrrr;rt !.r,)lr(l ;rrlary lrt,i 'rr.rr,r',i
oplrthu lrrrie rrrtcr v
C. l)aIasv tp.rllretic crrc c:rr'r'ics s(crctol)t('i r ljbrr\.
a. l'rc-qirrrglrorrre Iil)crs :risr liorrrl:r.rrrrr,rtorl' rrLr.lerr: I'rr',:rr: ir llrc |()rrs l-\.r:: rj
lirci;rl rrcrrc+ t:rcnlcr pclrosirl rrurvc rnrl Jorrs rritlr ,lLci, jr.ri,rrrrl rrcfvc t, li.ir''
,r rel.rr'
b.
nctyc lo l)lcr!qoid cun:rl
-,-+ l)tct\g0l)ul;ttinc g:llrllioIl
Postganglionic libcrs [ry rtrrxillrrv r!:rrc - (z),t]irrrirtico r,;r1r,rlit -+ :,,r,
lucrinr;rl
- lacr rrr:ul ,.tl:trrd
{. Applicd a :rtor)l\':
A. *!3cpoaclgrjtis (l)(tLt|t) tcr\t) - il i\ lhl rr'II:rrrrr rrtr,rrr ol LLirr : i r:l.,.rrl
Il. lrtllallnlrtiorr ol lrcr nral siLc ts kno\!,rl rLr L c I i ' c r ' t i i rr rr,l l, ..cLrt. r! ilh l)irilr.
L r , L r 1)c'.1 ir'
and rcd ncss
C. Dlclygcll tce to 'lf) rs rcnrov:rl of l:r;rrnr,.l .r..
D l{crrtor.rl of pElprbr.rl prrl r} -qu.,l to ..r. r\lrr\'.rl ut enrrc .:1.:rrrl lree.rusu lllu (l::Lr:' ,l
lhc orbital part p!lsscs tl)rougll palpubrirl furt
E. Epiphora (Epiphora sLlddcn bursr) - ovcrllo\\, ol rclrs.
 to platysnla 6nd {urroutlds thc ncck likc'a collLrr,

Prevertebral layer -..-- O6sophagus

Trapezius
-
-
FLg. 3.12 : nveslin! layers of the deep cervical fascia.
l. Attrchnlcnts:
A. Supcrlrrrly
a. lirlcrnu I occil)rtill frot(rbcrilncc.
b. SLrpclior'nrcll.rl linc.
c. i\'lasloid Inrcr\s.
d. Ililsc ol rr:LriLrhic &
c. Il sl)lits to rriclosc pi\roli(l l)ct\ cc llrc i\rrql. cf nr.lr\'lil'lc ll,l rlr\r. l nroccss.
B lnlcriorly
a. Sfinc o1-scirt)Lrll.
b. Acro rrr rort proccss.
c. Clavic lc.
d. N'lanubriunr.
C Antcriorly
a. Syrnplrys is rlrcf ti
b. Ilyoici bonc.
c. Ol)liq!rr lirrc ol llryr{)id crrrLirgc.
2. Iic oI U rCt
A. - vrrrrr'
1'hickrtcss
a. Thici( ovcr plrolid glind, cailcd parolid fascia,
b. 1-hrck bct\\'ccn slyloid proccss lnd anglc ol'Inandiblc (stylomandibulirr ligamcnt).' ]

c. Thin on sLyloia proccss, rrrnrdiblc & tyrnpanic plate. j''ir'

'' ]

., lr'':':'- ir
 LL Magic of t!vo. S-.r .,f"
a. Encloscs 2 nlusclcs : Trapczius & stcmoclcidonlastoid,
b. llncloscs 2 gl nds I Purotid & subnrandibirlar.
c. Forms 2 lanrinac i Prclrachcfll & prcvcrtclrrll,
d. Forrlts roof of2 trianglcs :
L Antcrior &
ii. Postcrior.
c. Forms 2.spaccs dsuprastcmhl arid supiaclavicular. 4, C.. 4.:, {:, *.
f. Forms 2 structurds : Stylonialdi6irlar Iigrmint &-parotiddiiraslc.'rric'fasc'li.
g. Forms 2 sllngs : lntcrmcdiatc tcndon of digastric-&.ornohyoid.
3. Applicd onrtotlry :
A. Ludrvigs anginn:lt is a lr;3ntul!r srvclling duc to infcction in thc subru: r,rlar
region, lt is Iimitcd latcrally by two halves of mandiblc and postcriorly b), h)( |oxc.
This is bccausc ol thc attichmcnts of invcsti0g laycr of dccp ccnicll fr.scil to i)xsc
of rnandiblc and hyoici bonc.
l] Collar sliril itlr.ir't'.ir 'l lrr' rlct'r lr'rvi, :l! llrrro[ rrrrllt.r r,rr' 1h.,' sitr'r ,'l rr] I ., '.
ll\llll\,'r\ Ilri lrt rr,,,\,' i,\\t.\li\ .\\1,\ 1[r .t\'r'rrr t\ l\f rtt\l ll I'irtitr,rl,. , ,i,,1'
,'lr
lxs\'rrr r\ll(l lorl\\ rl]'\rll|lr] \l1t(lct tlla \ll1t.
( Nlurlll)\ : lltlcclr(\ \)l Iillolirl ltlrrnLI rs IurLrlrrl (lLl(. l() llli('k.t strorril l,r\cr\ rL)\"1 :1 !t.

a---r !-= J,:: \'-$T-

I l;:';lf.lli,!11 Prcl rnchcrl f:rscir _l
-l-lrc
condcnscd dccp lirscia in lio r ol'llncl,cil i:i clrllc(l prctrachcrl lascrl.
I. Attxchnlcnts :
A. Supcriorly I

a. lJyoid bonc irr tlic ilcdiarr planc.

b. Obliquc Irnc r)l'lltyroid crrtilxgc ltr(l
c. Cricoid cirtilltIc, n]orc latcrirlly
ll lnfcriorly:
Ilclorv tlrc tlt_,-r'oirl gllnrl rl t .lL):ci tlrc rllcrio' tltyroid vcins. lrussrr hri , rLj llrc
lrrach iocc lhr llc tcirrs rnJ linuli.,'lrl,:n,ls \'rllr rlrc arch ol tlrc iorliL.
( Orr cithcl sirlc rt lLrscs \\irir il)c ir()rl ol thc c,riolid shcalh dccf li) lirc ster)or)r' r,r:,i.
2 ()(ltcl fc^t rcs:
n. ()n citllcr sid. rt sclds a scplir \\|rclr corn0rrr lhc lllyroid glarid urrrl lbrrrs a .L,i,1iisory
lrq.\urent ol tlrc llrlr(lid ,tl:rn(l lrii ii .irllc(l lrgirlrcnl of Ilcrcy.
B. I'llc littilrncrlts rc xllirclrc.(; clricllv ro thc Lricoid crILilxgc r\rl(l nril)/ 0\tull( lLr (lrJ
llryroid cirtilirBc.
(. lt supporls tlrc tlr;'r'oirl trliflr(l i r,l (1, ri,,1 icr r .rrrl irrto tl)c rlrc(liN\tllrurrr
l). 'lltc clnsrrlc ()l tl)c llryror(l clrrrtl rs rc: . \\c, i. rlo rg lhc postcrior l)(,rdcr:; ol llrt l;,rL)rirl
lobcs. llcttcc lhc ll)yror(l giurrrl c.rrr crl,tru. l)l)stcliorJy ond conll)rcsli ocsolrirl,lL r artd
|roduccs d1'sphagrl
J. lirrnctions:
A. 'lhc fascia providcs a slippcrl sLrrlircc for lrcc ntovcnlcnts ol lhc ltacl L:rr ,lLrrirrr
srvallo$,ing
I). ll forms ncLrrova:;cullr shcrtlr to cnroiid vcsscl\.
 .:1.:-- r= -'

r---)
Symphys's menli

trvesling lascia

Pretrachgal tascia

Flg. 3.13 i Pretacfeal tirscl;r

t
I

^''!.o<- 1->Pos'eid
,\ pP licrl en:rtrrirrr: I
,. iL,L ,or\ lrlsrlg lronr ti)yroid gitnd l]1ovc \viti] dcglLrrrinrrrrLrI
lJ lllc itbsccs\ prcscnt in front of prc(rrchc:il lusci;r tlcsccrrLls rl Llrr :ilrpcrior nrcdiastinunr.
( lhc :rllsccss prcscnt bchiud lhc prc(atrcl\cirl irscia rlusL:cl(ls rn tltc supcrior rrrcdiastinunl,
1() ll)c I)os tc rio, ntcdirstinuln.

i[i'r,:,iil _r" drvigs angina J

lnlro(luction : lr is a ccliulitis o!- thc lloor ol-ll'c ntoutl\
Arrrtr) l\' : lt 1s litr tcd latcrally bi. trvo h:rlvcs ol rr:rrrrliblc rrntl Postcliorlv by hyoid bonc.
'lhrs rs bccurrsr
ot' tltc allachlncnts ol irrvcstirrq ll1'cr o1_ dL:cI ccrr'icrLl lrrscia lo thc basc
ol rrrrrtrlrbtc lr rd hycrrd bonc.
3 Silt : A sscllrrrg aIpclrs bclorv thc cliin lnd insidc thc rrrorrrlr. lr rs ileclr r,r rrryl,,hyoid,
4. (lau:;c : Ir is LrsLrallv sccondary ro caries of r|olar tootll
I

5 Or;rrrlrlicutiorrr : lt infccriot) sprcilds backwards, ir caLr:cs occlcrl.r ol qlolis. lt may rcsult

ir,ro ar,phyxir l

Al,l)licd aD:r(onrv : lllc absccss is drlincrl by a dccp incision bclorv thc rnnndiblc by
ilt!r(lrng thc rr)) lnltyotd musclc.
ffi]^..t"
It is a dccp fascia ol ncck. p.cscnr in front or anleriot 16 thg 6qrvicill vcItcbrrc. ------]
il lir|rr1' llrc
floor of thc postcrior trianglc of ,)ccl.
l. Attachmcnts :
A. Suoeriorlv : Il:l!^ r\f sL:,.!ll
O. inferiorty' enrgrlo,[{ongitudinat Jigamc.nr;ilf lbcdy.. of thir(i irnd Iotrrrlr tlr.racrc iili:
vertebrac. G' iI iir '.
C. Arlteriorly : Rctropharyngcal spacc.
D. Laterall; i Ccts l.; Cccp tc ii.:c.,,1r,
2. Fcstures i
A. Cervical ard t-.;;.:ir:.i :ler:.-s:s lic bcli:C the pievc.l.brxl fi s. ir.
B. It forms arill:rr-i s:::3ilr (Ce:'.i:c ari.l::,'
C. It Co:s !r,1: :ii.i: -..i:l:,:a:. :i -\. :...J veir.. This iia ii lf,o!c ::colr: lrss rr' frc': to
ciilate du:i:t i..a::aiaa \'::.ois :a:-:.:

Prevcrlcbral lit5ci3

Cervical vertebrac

F g 3 14 : Preve.lebral lrscia

l. St ructu rcs piclcin*:

n. Grcat auricular ncrr c
IJ. Lcsscr occipitrLl lcrrc. I L rrruncoLrs branclrcs ol ccIv ical plcxtts.
C. Transvcrsc ccrvicrl irnd
D- Supraclavicularlcrvcs. I
4. Ilclrtions:
A. Supcrficill
a. Acccssoly ncrvc
b. Lynph nodcs ol poslcrioI r.i llgle.
B. Dccp ;
a. Musclcs lorrrring lloor ol trirnglc.
b. Cervical plcxus.
c. Trunks of braclrr.rl plcxus.
d. Third part ol subclnvian arlcr).
 I-utictrrirs : .t iai'r;a i l:'. :.. -
caiolic sircaill dLrrirg nto!crult:. ,
(,. Al) l) lic d l lltorn) :
A. Thc it)sccss fornrcd brlr L r I thr ir rc vcrl c bral fascia travcl
nrediilstiiut]r uplo T3 - l'1.
ll Thc bsccs$ forlllcd inli(,rrt t,l pr cr urtctrrol
rhcn tlic posicrior .mcdias tinu nr.
irr,, .,.i;,.

i) Carotid sllcittll
It is a conrlcnsltion of dccp cc.vicnl filscra around carotid vessels and intcmal jugLlar
1. E:rtcnt : lt cxtcnds from blsc ot skull to thc arch of (hc sorta,
. r^--,aii^h

A. Antcrior wali is lbrnrccl b'.' prctruclrcll fascia.

B- Poslcrior rvnll is forrrrc<l hr' Ircvcrtcbrul frscir.
'lhlck[|'s! : ll ir tllick nroull(l .r]rery ir (l llri aroultd vcin to allow frcc cxpansion of vcin
durilt! lnc rcirsc(j vcnous rclunr

Rcll(ions:
A n ntc. iorl!, urrsa ccrvicitlrs r' prrrcrrr witlrin lltc w.lll or shcatlt.
IJ. Postcr rorlr', svnrFiltlrclic rr rr rl. L\ )rcscnt [tchinci lltc shcatlt.
). (io n (cn ts :

A. Inl('rnirl and contntoll clrotr!i lrlcrcs.

B. lnlcllill lulLrlar vc in.
C. Vagus ucr r c
,\pplicd :lrirt{,!Jr\ : lt is frcquerll., crqroscd in block disscction of thc ncck during surgical
rcnroval ol dccp ccrlicll lyrrrplr loJc:.

A€P
t
I

I
Corn ron carolid a rte /y
- lrrlcrnnl JU!ular ve in I

Vr0us ncrvc '- .-- I

I
ljt p;tlrrelrc lrunl
I

Flo, 1.15 (- r,olrd 3r'oarlr.

 llcad, Ncck & Facc.

Dcscribc postcrior trianglc

{ 1. Bou nd n rics 2. Roo I
4. Contcnts:rrrd 5. Ap p licd
'
t, Ilou ndnrics
A. Anlcriorly : Poslctior bordcr of stcnroclcido-rrastoid.
I]. Postcriorly : .Anterioribordcr of kapezius. ,*.r '4,, "r;d
C. Base : Middlc third of claviclc.
D. Apcx : Mecting point of sternoclcidomasroid anrl trrrpci:iLrs 0{ SlrPc or nuchal linn
z. Roof:
A. Skin.
B. Superficial fascia.
a t-..^-, i.. ^ ltlJ !l Ul U\!P
D, Roof is pierccd by -
a. Ncrvcs
L Lc:.cr,,'cc:prt.rl. <
ll. Crcnt luricrr llr,
lll. Trirrtsvcrsc clrt:ltcous rrcIvc ol nccl. F
l\'. SLrlr..cl.r 'c..l. r rr:r".
b. Vcins : llrtcrnirl .lLrgulur r'crr arrd rts (ribrL.r'rc:
c. Lynipll ! cssc ls

Subclavian lfiangle

' l',1iddle 1/3'' ol crav,clc

Fig 3.16 : Bou^df iJ\ ol a,lrcr.or .,r .J rr):rcr,or r.ianglc

 ---€aati .

:: :: . ::- :.!-

C. O:;:sr :::allv i.rl scn',!soin:irs

D. ScalcnLts mcdius;
L.. Scalcnus postcriori
F.

Trapozil.rs

I
V,
Semispinalis capitis

Scalerius a n l. rior

Fig. 3.17 : Floor and conlents of lhe poslcrlor l::rn!lc

Contcnts : litt .\li al {rccc.rjr/ y /rr'/ r'(\\,r,rr/ tlt< lltnph uorlcs-'ttt tltc r,t,c contents of the
,t)\!, t | ,t o titltrlt atttt olt orttct.' o,t il|1,',,,t o; inJtuttt o.[ r]t, l tt' i;tl llrnt
\1 ,. l.tLll,,r bclly ol ,'llr(rh)orJ
^ Ncr'., Srt
B. 4Bt
ir. :lcc{sory:tcr\'c_
b. lio()t\, trLrnks ol lachi:rl olcxus r d thcir banclrcs.
I N crvc to rhol]rboidcus.
Il Ncrvc to scrralus itIrlcrlor.
Ill Ncrvc {o subclavius.
l\t SLrprlscapular ncrvc.
c Ci lv ica l ncrvcs:
I Crcltcr occipital rrcrvc cllrcritcs fro l tlic apcx to p:rsr tr rr tlrr sculp.
ll Crcat ruricullr nc|vc.
lll I-csser occipital rrcrvc i
l\ -frrrsvcrsc ccrvical rcrvc ol ncck.
V Supraclavicularncrvc.
'l lrrrl and fourlh ccrvic0l ncrvcs supplying trapczius.
c.
il. ( ).arDi(ll artcry c tcrgcs il-ont thc apcx.
 b. Third palt of subclali:rn rrtcryi and branchcs of nrtcry.
6f subcluvirn nrtcry ':

[. Suprascopullr \ Branchcs of thyroccrvicrl

Il Transr,crsc ccrvic:rl J trunk (1" part ol' subclavirn)
Transvclsc ccrvicul rrtcry dividcs rnto nsccnding and dcsccnding br;rrrr lr ,rl
tlntcrior bordcr ol- r;lcrI]oclcidonlasloid.
c. Vcins : Extcrnrl jugulur vcin aId its tributarics. Sabclrvian vcin is lo$'cr dor(r, .r,rd
!tot intllld.d i rl,. lfi:rrrnlc.
d. Lvmoh nodcs -
'suprdbtoviiuhr' ! /. i E , j. -, ,i. '. :. -..1
' . t.- ivnrItr nddcs, arc pre-sent qlong thc postcrlor bordci "l i
-.-' ..; , sternornastoiu. ::
;
II. Occipitil lymph nodcs.
5. Applicd tnrtomy :
A. Lcft supraclavicular ' (Virc rrorv's) lynph nodcs arc cnlurgcd in ntclignnnc) .l r' ,

stomach and othcr ahdontinnl orgirns.

B, The pressuie in thc. cxtcual jLrgular vcin can be recurdcrl in thc .cctlr bcnl posiii. il
is increaseci in right sidcd ircari iaiiurc and-in the-obstruction of tltc sul)crior \'(llir , L.
C The,lqlLophgvnccal r!:c-ts\-rnr,y bc cxprcsscc! in thc iorvcr Plrr of llosrcri,lr rrr.L/ l

ffi c*3F;i.4y,.*.;-. -- ___

I
I

L Root valuc: Vc t(Ll r'u trL. L'1 C2 s: C3 (briurchcs lor ccrlical plcxrrs) (, i'
inlportant.
A largc lrunk pilssing ublr(ir!l. ,rpr.:rrrls ovcl slcrnoclc idorlrlr \to id.
2. Distribution :
A. Skin ovcr anSlc ol rrlrrr(lrhl(
B. Skin olcr parotid ,:lrrrrrl
C. Prrotid la sc iu
D. Skin of lhc lowL'r illd lltcr;rl slrlucc o1 car lobLric.
E. Skin ovcr rirlstoL(l rc{L{)l
3. Applicd anllonr! i lr Ls p.rll].rl,1r rLrrJ \'rsrlrlr thir:kcncd in tubcrculoi(l lcllros)

ffi=!,'u,rt1'r,I,1r,rr,!,!
Table 3.6 : Tljc lablc shows lhci /).1 ,,t afd nscrlio. ol rjillcrenl parts o{ slcrnoclciComrslord

i)rrticulilrs Oriti lnscrliorl

A. Sicrri,'oce ip,r;,t 't t,"Lc,,': t,,'u ii,iJ ,., rt -.,,;,,,,,,
I L, L,cL I .: I ,,t nl.r r,rl,r,Urlr rrrrclrrrI lilc ol occipital boirc
B. Stcfllonrastoid J \r'ir:[' r
N4as(oid proccss.
C. C lcidomastoid MaiLoid proccss.'
prrt rrl nrr:diirl
D. C lc idooccipitrlis J sur'itcc ol clirviclc. L.(cral - -td
2/J Ol- supcrlor
.
,_,__l_*,-
I nuchal linc of ecc ipita I brinc.
 ll(,rir:rili :

.j. S.rr::l:cr:, - 5Li:i. i::.r.iirit-

ll CLii.r:laoLr\ rca\.
I (r r e.rr urrrr,.:1.
ll. 'llltrrsvcrsc !rr\ t(.ll L\
I il. Mcdin I suprilcl:rri.colitr.

b. Vcin l Erterrnljnlulrr rcrl

B. DceP: 'F ii " ' ...,,,
t,t :
l rlr.l
Table 3.7 : The lable shows relalions of slcrnoclctdomasloid at dilleronl lsvels.

At origin I tn tlrc rnirtctlc i irscrtion ::,i'!!:

M usc Ies Stcrnohyoid, Scalcnus nrcdius, Splcnius
^,
capitis. 'l
Sternothyroid, Scalcrrus postcrior, Longus capiris, Dccp I
Omohyoid. Lcvator scilpLtlitc, Postcrior bcllv I of ncck
Splcnirrs capilis, of clignstric. ' J
lnfcrior bcliy ol oniLrltyorri
Antcrior.ju!Lrlir Conrnror c il () li(l irlcr\ nrlcry.
lvstn

Ccrvic:rI plrrus,
li reclt i:r I plcxrr.i.
X, XII rrcrrc
lnfcrtor ro0l rrJ lr tsir
ccr'.icrrlis.
Clands Thyroid, li'rr p lr rrodc.

Ncr'r'c sLrppl-r':
A. l!'1otor I Spinal root ol ltcccssorv crrc (\l - crnniill ncrvc).
13 I'roprioccptivc i Scconl arr(l lltrd rerrlr;rl ranti oi ccrviclrl .spirrlrl rr"r.,.

A Thc clricl ptirl)oso o' llte rrlLrsclc rs to I)rolritct tl)c llcitd (it is a corrrtrirrrrrrrrr o f
llcxion ol'ccrvicill \|rilL .1 rLl iixlcnsio oJ atlrrnto:rrial joint sinrultlncoLrslr
,.
B Ir.r cor,rtu<'rttttt ttlt\ tht lu.hl to\,ottl.t thc slntc tila rf shottlrlLr tutl rtrtns thc 1.

totton!: !hc oltltost tr, :ilt. face

'l'esting of tltc rnuscl(
:
A lltc trric is (u tc(l tu lrr( r'pposttc si(lc itl].rIlst rcsis(i tcc ond tlrc rr]L.s 1.. t onc sidc is
pr lpl, tcd
ll. Thc clrin ls bcnt do\\,^\\ur(ls to Icit tlrc sler.rr,,:lirdrrnrast.itl ol botlt sidcr .;

7. Applittl :r I' jr tonl.y :

\t
A. Congcrrjr;rl r,'rrrr,'lh t)rtrj'r$ (ljIicutl lIl)our, tlr]Juc p!tllil)tt ol tlre lre,r(l rrf tlrc bhby
ciluscs tcnriit[.a ol tllc llbcrs ol lltc stcntoclci(lorrrtsroid. .I'lic
subsoqrcrr llbrosir !td
contrlcturc is collc(l L(,nl'lutitfll torrrcoltj.
t. lbrticolir : lt i! (tuft; tit), t|r rvtllctr ttrc tre.rd is bc t to onc sidc ((o tlrc sidc of
'r
Itaralysis) a d tlrc L.hrr ,roiots to!viu(ls tllc opl\usirc s idc of lcsion.
l
 Slornoclcidonrasloid

Slernomastoid

Cngin and in€crlion o{ sl€rnocloidomrslold.

Bour,rlarics:
A. Supcrolatcrallv :Sul)crior obliqlrc cxtcnds l'ronr tlrc birck o{ lir(critl rnirss of lhc allirs lo
llrc latcral pxrr ol'occipitnl bonc bctrvccn sut'crior .rrr(i rr,tr.', r'Lrclr:rl lirrc.

5c[] rj,rna s cap lis

SLrperior cblique Grerrc. occip lsl nerv€
-
tlcclus cap t s posterror mrJloJ

Muscula. branch Rcclus citpLlrs Dos(crior malo'

\

Poslcfior.llilrlto-
occ 0 ll fi)c.rlbrane
p, ocess o{ a tlas

Dorsal ramus ol C1 --
LnteriOr ob|que rnusc tc S!pcno.
t
Lareral a--L-r Mo,l ,
Poslerior arch of allas I
+
Flg.3.19 I Bounda.ics and contonlr; ot l:. r s!l)occipital lI in Jritlc . tnlorjo. ._
 Sularoi)ra,lL.t,.\: -- - --
r licrrLrr r. i,ir ' l',r tcrir,r rn111y is badly narncd. It is not .\.crticrl.
nulci \r:ri.rr. ,rt rlrc hifid sJrinous proccss of thc sccond ccrlic:rl r
nllachc(l l0 lhc lrlcral part of arca bClolv, fcrior nuch r I
and ()lrrcs thc hcld to\\'itrd thc samc sidc.
b. Itcctus e.rpiris postcliqr
aihs.lI in-siiT'ii"iis n',
bc inscrtc<l inio tlic medial
extcnds lhc hcad.
C. Inlcriorly r. O-!!iqLrg caln1g_iqlagor is attachcd betwccn thc outcr surfacc of.
of thc axis ard back of (hc lateral mass of thc u1!T'tii,,
,,11
Floor : I rriir
A. Postcrior arch of lhc atlns and
B. Posterior al lrn(o-occipital nlcmbranc.
Roof : lt is lbrrrcd by scrrrispinalis capiris mcdially and !ongissinrLrs
Both rrttrscl:s ir.. i(pir.rt(.,l by dc sc fibrous tissuc. Thc Structutcs croj\i|lr:
A. Crcrlcr occipiill ncrvc rvhich crosscs infcro-mcdially,
B. Occilritul irt. \, \\1)icll crosscs strpcro-latcrrlly,
Contcnli :

A. _ihird pitrl ()l vcrlel)rrl 'trlcrv ruIs across thc flOOr of thc trinl1glc.
ll. Dorslrl rir rrti' o1 llriL ccr!icrl rrcrvc (Suboccipiiill ncrvc) ill(l itr rrrrrsrullr' branchcs
.:rncrrcr rlrro,r,.:ir tIc lloor ol' suboccipital trianglc.
c. Srrbocc ip itl I r crors p lcx Lrs.
D. Lynrphntic plrrus.
E. Fibrofartl'trssLrc
Ap licd rrlr(0nr\:
p
A. Ncck rrgirlrri is rrrrporrinr sign of1911tSI!. lt is duc (o sp:lsrl] ot c)ircnsor nlusclcs,
caLrscrl Lrr r rirtror oJ rcrvc roots]pi.c-nt in thc srrb-craclrnoi<l sp;rc,:.
l). ,!istcrarl I)rrrrrLr,.. L\ (lonc tllroLrgh sub-occipital trianglc ro oll:rcl CSF lrom
crstctrlil-rrl,rr., -l lrc |lccrllc is ir)tro(l ccd just :tbovc tllc spi c o1 .,, r, r lirrrvard and
Ltpr lrrl rl:r '. ,,1
(. l)ostcrior r.LrLrirl lr):,\r can bc:rpproacltcd (hrougil sub-occipilxl trirr:tlc.

(-i rca tcr occipital ncrvc

l. lrrtrr)duclion : Lrrrgc rrrctliirl branclt of rlorsal ramus ol Cr.
2. lloot v|lluc : l),)l:;rl lrnrlrs of Cr.
3. l)cculiarilics i IltickL,tt cuta Cats nt,n,c of botb,.
I)istril)Lrtion:
n. Scnsory .i,.rr ot si.rlp ov.:r posrcrior ll of cilr.
ll. Moror : Sc ',,rrrin;rt .: clpitrs.
5. (ioursc and rclitions:
A Crosscs srl.,recrfrr,r rri;trrllc
lJ. licrecr scrrrr.Din.rlr, ,r,piri, .t rr.rIczi,rs
 llcad, -Ncck:&, Facc

C. Runs on back of hctrd & rcrchcs vcllcr

(. Applicd nnntonrl : ln nrcnin-qitis nccL lir:rriirv causcJ dLrc to irritrlion ol ncn,c root.
": r!.t .

External jugular
l. Fornlction:. Dxtcrril .!ugular,.,cil rs ii,,,,,uLi b-y postclor drvision.-of trclroqlgn
' 'i ffit
postcrior auricular r'"i,'.
,;!i , t {.,, :{; i: I. i#:
2. Sltc : it bc!ins jusr bclow {iit nglc of llrc rnrn<1iblc or Nithin rhe.p0r!lid -:t' .
Bland,
3. Structurcs pierccd : ll picrccs the dtcp iusci:r irbovc thc claviclc.
1. Tcrmination : lt (i.xins ilto subclaviilr) r,cil lchintl claviclc.
5. Pcculiarity ; !t is ltai'idcd rr,/r./r |oA,es.
6. Applicd anatonrr' : lr rri(rc^( Cccp fascilL itiro!,c tltc claviclc to <lrnin irrlo $!rhcl,lvj | \.!in.
Ils. Iurnen i: hctJ .'l'cn hy rhc (lccl) txscrl \\,hlclt is atttchcd to i1s ulrrgirr. Ihc r,rr
uckcd irlo llrc lurrrcr of errcrrrl jrrlLrlur vcin during inspirttion
nrbolisnt rvhich is it lat:rl co[(lirion liioclLrc.,s a,,

s!pe' -rr
1l I 5unc.i Lernpo.al vcrn

-t-"""'- -rtl
,.*",
i llaxi,lary veln

\/)
\ i
- t\. f.lelronrnlJdibular vern

division ol relrom^nd bular voirl

- --_----qsl"llr"g:"
Poslpror c x terna l
ju!ul3r !cin

T rfsv'rjs.' ccrvrc:l vc in

S,rprnscapula. vein

S!bcla v rrl
Fi9.3.20:Etlcrn,rr

-lioirlbo'tc;Gb;;i :rl tcr'\' un(lcr

'---- - -- I

l. O rigil 2. lllunchcs rrrrd rlislr-illu(irrrr

3. I{clltions arrrl

t. Origin: It is a lilsr l,.rrrrrch ol' first prr t Lri sLrbcllvi:rrl ilr(arv. lt is thc lrt!csL blan L:h oi
lt is onc ()t llrc two princil);rl ;rrrL.r'ics of thc bIai
subciavian artcr\,.
In ir(l(liti(rrr. rt il l.i(r
 !lead. Ncck & -Frcc _

supplics spinal cord, mcningcs, surroundirg ntusci:s ::r: ::;.cs-

2. llrsnchcs nnd distribution : It is dividcd inlo four p:rrts
A. First Part is cervical and is horizontrl. lt cxlcnds lrorn thc origill to cntry into foramcn- '-
transvcrsariu m. It docsn't givc
-and irnpoltant branchcs.
B. Sccond part is veicbral is vcrticnl. lt c\tcnds frour sixtlt cervicrll vcrt
ssco!1d

c.

D. It cxtcnds tronr postcrior

givcs
a. Mcningcal braiclres, supply mcninges of postcrior crauial fossa.
b. Branches to.bJain And spinal cord.

\Fo,un,"n r,on.uu,.urtrn,

Third pad

Second pad
Scalonus snlerior
Filll p.11
Fkstnb

Lell subclavian artcry

Rrqht subclavian arlery

Fig. 3.21 : Vertebral artcry and its branches

I. Poslcrior spinnl ar(cry givcs rrvo irrrnchcs rvhiclt rlln on llltcrior and
postcrior to dorsxl rc,ot of spinal ncrvc.
II Antcaior spinrl lrtcry:lt ariscs firlnt tcrrrrirral plrt ul vcrtcb rl Lrrtcry and
urt itcs as i1 rlcsccnds rvith lcllorv of tlrc opp,rsitc sidc ro lbrrn alltcr ior nred
tru'rk. It sLrpplics nr,:dial parL of rncdullir irrcluding pyrrtrtid and h
nuc lci. ,l
Ill. Poslcrior inl!rior ccrcbral r!rtcry : It is tas! !ottuout drlct)'in llt(
largcs( brarlch of vcrtcLtral artcry. It rupplics
i. [-atcral p.rl of nrcdulla.
ii. Fourih vcntriclc by forrning cltoroid plcxus. .
iii. Inicrior vcrmis and inlcriolalcral surl'acc of ccrcbcllar hcnrisphcrci '' .
 A,,- The ,syrnplthctic plcxus of thc vcrtcbrsl artcry runs around thc l atcrv.
B. - Middle ccrvical ganglion lics arrtcromcdially.
C, I1{11ior ccrvicrl ginglion lics postcromcdially.
Applicd anatorrrl, i
'...,,
A;..lvlcdi3l mcdullarv syndromc: Thc lcsion of thc rnrccior spinul rrrtcr'y, is nranifosrrjrl by

senslbility ol' thc samc sidc of thc face and oppositc half of thc t,ocir'. Prrrlysis ol rhc
vocal cords, soft palate and plraryngeal musclcs of {hc ipiilarcral sidc.
C. Subclavian stcal syndromc : It tirkcs plscr !r obsriuctior: oi ih: sLrbcllvi:r;r :rrrcry
proxima! to ths crigiil ofnelicbrai ?ncry. Sornc amourit ol blco,.l is srol:r fl,r.r: rl'e
brain thrcusii iiie vcrisbrai arrcry oi thc oplositc sidc to iuii'rtlr,l .rollrliiril iiieLri,,r;,,1.

Luurbar pu nctu rc

L1
Sl.rn Duranr?1e.

lnlerspinous LrO.rmen( 2
0cc, far sc a SulJ:1 r i !:hn.i.i sr:1c^
Superiic,i ll icia {r

4
Supraspirous I jf :r,j il

Fig. 3.22 : Lunlbar punclure.

l. Introductiorr : lr rr perlornicd to obrlrn srrnpics ot ccrcbrospinll llrrirl for Ilbur:rl ,:).
a na lysis -

7. [.oc:l(ion : Spirrri r:ord cnds at lorvcr ltordcl of first lurlrtrar ,,,crtcblr Ilcrrcc lrrrrti,.rr'
punclurc is dorc lrc('.vccrr rlrird and foLrrrir lurnbar spinc. i
3. l,andnrark : A liri largcntial to thc l)ighcsl f'oints of (hc iliac crcsts i)asscs through tic
lcwcr bordcr ol rlrc lburth lunrbar vcrtcbrl o. thc intcrspncc bc(wccn thc fourrh arrrl lrliir
lumbar vcrlcbrir.
 I'roccdurc : Loail .r ' -. -
filtlr lunthnr vlrtci,n r': '.r
A. Skin.
B. I lrsciu
Supcrficia
C, Supraspinousligrrncrrt
D. lrtcrsi)inous Iigai:iii,: li,ir'..c::,:iic iiiii:C flav.il liSaiiicl;:j).
E. lEpidqifl Fptci;... ti:ll: ,li ,l li. li.;l r,'
f. ; Oufa'tna i;o.fiii,..i i. crrrcr rhc :Lrbrrachnoid spicc, '
' "' '

Applicd nnatomy:
A. Biochenical analysis of ccrcbrospinal fluid to diagnosc typc of mcningitis.
B. To diflcrcntiatc cxtradurll & subdural haemorrhage,
C. For cpidural and subdural anacsthcsia (spinal anacsthcsia).

di ffcr'6

Vcnous sinuscs lrc dcfi,rcrl us 0--r SINVS ARE

Splccs in (|c criniunr lrrrc,l by ctrtlothcliLll, prcscnl.
Irr L)r:l\vccrr 2l;rycrs,,l durir nlllrcr (crrdostcal & nrcnir)gcill) crccpl irrlcrior sagittal a]ld
stritiqlrt sinus rVlticlr rre irr Lrctrrccrr lNo rncningcal lrycrs.
Non cornprcssivc irr rr,rtLrc, rlcvrrid trl
Valrci rnd
Slnoolh nrusclc.
Absorbs ccrcbrospinal lluiri 1' .,rrrqh afachnoidal granulaticns
Rcccivcs valvclcss cnrissrry vc,,,,.rvltich
Equaliscs prcssrrr"- rvithin rrrd oLrt;ir;: thc skull,
CIrss ifi cat iorl :
Table 1.8 : Illc l.bie shows
?-".1i:9 _:l!
unpaircd sin use s.

I'.r ir I
.
Ijnprirc(l i

L lvl idd lc nrcningcal vcin Antcrior irtlc rcavc r rtolrs

2. SphcnopolictlI Poa(crior intcrcavoI.lr0us l
J. CavcrnoLrs Basilar vcrorrs plcxus
r4.
I
Su pcrior pc(rosul Occ ip ita I

:) PclrosclLru rrrous Strright

i 6. In fcrior pctroslrl Inicrior sagiltal
7. S igrnoiLl Supcrior sagittrl I

S 'l'rlrrsvcrs,: I

-J

Forntation:
A. Roof & larcral wall ; Mcningcal laycr of duramatcr.
 I lcad. Ncck & F

B. Floor : Endoslcxl la1,cr of durlrrr:rrcr.

C. Mcd ii I wall.
a. Mcningcll l.rycr of clurlnrrtcr \
b. llycr of duranrlrcr.
Endostcal
Rclxtions i
-The tabl€ shov/in9 relatrons or tlrc c:,vu,,,J!s s,nus.

l\{c d ia lly

La tc ra lly

Ericnt :
Al)cx ol orb il (o F lpcx of pclrous putt ol tcl|irrL brrrrc.

Superficial rniddte cerebrat vein

Superio( ot,hlhatmic vcin llcr ccrcbrat vcrn

Centrat vein ol re!ina
lnlerior ophthalrnic vejn

Sphcnoparietal sinus

Fil
Li,d.i,s men,nCear v!rn

H
ntrssary vcins
-- S!tcrrr pctro:irl ,,
E
. :l

.rJlcrt/Eord vencrjs ptcxus t-l - ..lct.t

lt:t,t...,t ,,

--

Faq. 3.23 j T!ib!laaics and oul!o,riq ctrannots of cavcrnous sinus

4. Contcnts: Truc contcnr is l.:loo<i

Olhcr. slructurcs arc scparalcd
bv l.ryc. nf
t\. .>ttuttrtt.ct p.t.tsitry tltlortgl, t1,.. tiut,, cn(lotllcrrunr
 : lut(t't l aoroii.l (rtet\'\lith srnpdthctia & tcnottt plctu.:t.
i' .lbdtrccnl ncrr? (bclo\y & Lat<'rol to intcrnal contid ortcry).
tl Siructurcs i11 thc latcral rvall
J
jLonr abovc dorvnNards

., lll'd - Oculornltor ncrvc

b lv'"l - tr;d;f,ic.,il"i.. #; *, {i i .' i,
.. vf.oit'it,itmicti.vis\orioTi;i$min:i.:.
:.
n
d V2 - Maxillary aivision oi iiigcminal.'
C, Incoming channcl - From $-a 3I}
Tabl6 3.10 : The tablo shows lncomlng v€lns to cavornous si,,l.rs.

a. Supcrficial middlc ccrcbral vcin.

b. Infcrior ccrcbral vcin.-.
lhnc a. Sphcnoparictalsinus.
b. Middlc mcningcrl vcin.
Ilvc biii r. Sr.rpcrior ophthl lnr ic vciu.
ir. ll lc lio r opIthrrlrnic vciu.
c Ccrlrll vcin of r'.:tirr;r

Anlerior perforaled substancc

Optic tracl Fl.o.

- lntc.rLal ..rrol d Jrlcry

- lcnrf,ori:l iobc
[t.inir]!cn a] er ol duramal€l

Hvpoirii. ri r cerc br r

a)(.r r.r' oLo.,rcrv,'

lr!{rr,iLi;,, fi,rv,l
l"lt]d:ll wall

Sphenoidrl r. sin!s. Oplrrlr.rlrnic norvc

-

,l

i
l;orJn r:n ovalq
I
1
I 'j
Foramon lfcc:!m
Fl0. 3,24 r 8ou^darics and cont6nlg ol the cn!ornous sin!s. !'
t
 Comrnunicntions:
Tablo 3.ll i Tho tablc showing oulgonq channets lrom cavcrnous sinus.
Il.cgion
A. Antcrior Iracial Srrpcrior ophthalnric vcin.
B. Posrcrior Transvcrsc. Srne.inr nnt rncil (in,,(
lnternal jugular vcln. Infciiorpctrosali'siaui:: i
Superior sagittrl 5l n us. upc;ficiai mid'dlc ;;rcb;al Ycirr
D. Infclior Ptcrygoid vcnous Enrissrry vcin passing through.
a. Foramcn ovalc.
b. Foramen laccrum.
c. Foramcn spinosum.
D, Opposite Cavcrnous s irr r rs. Artclioa inlcrcsycinous s ili.i s.
Pos(crior intctcavcrnous sinr)\
App licd a a(onl),:
A +Ig{t!)fl-glqfl1ll,, sr.r s is clLrsctl by scpric intccrions i0 tl\c (txnr.rc.(,u' ,)r
liicc. lhcsc ur,.., : r.c 6-i t Sf
l. U ppcr lip.
h. S rpt rrrr ot r)ojr .rj \' n. ! .. ....r c\
-- c. 2\djoitrilg lrrcu of cltcck ;rrrl ptrrlrrras:rl nir stnrrs.
Il. Thc clinical nl;tnilcsliltiols ol ih()rlt)osis irr cavcrloLrs sirrLrs lrrc
a. Scvcrc pain in cvc.
b. Ophtha lrnop lcgia.
c. Ocdcrra of cyclids.
d. Lxopltrhalnros.
C --,l1q1o- r19 rpll a!lt^!jyt llris is clust<l l)y rLrl)tlrrc of iotcrnnl cllroti(l r:,i.
'rcsulls into ','
n Lorr(l ) trrlic tl.lll
s s

b. [.Jrrilatcral p,r lsrrt ilc crLrlrlrtlr;rlrrro.

Supcrior slgitttl sinus

\/cnotts sintrs situutcd tl convcx lt)irrArl o'. I\\,o I:tycrs of itlx ccrcbrr.
I. li:ttcnt : Cris(t gilili lo iltcrnll ,,c,cipirrrl
l,rorubcrancc
2 coursc: Abovc thc lirfurncrr crrcirrrir, crrllii qrIi >rrrcr sr'frircc ol ionrirl sitrlLlliri
rrrtrgins oi l,lriclrl ln(l squtnr(Ju.i i,:r,r ,,1.oriipirul.
-r. Siz:
,: Il bcconrus progr.cssrvtlr lrirtcr :rs lt pl5\cr, baci:s.arci to nlcr,riri ,,
protubcralcc.
'1. l";l(c : Usually crrris irt rrghl trlrrrversc sLrrrrs.
5. Slrrpc : 'l rirrrg,.lur in , rlss-sccr,,,rr.
 Flg. 325 : €xlcnl and lcrminaLlon ol superior sagiltai sinus.
6. licaturcs : lnlcrior of thc sinus r'.r.sc|ts
A. Opcning of supcrior .crcb:nl ! ii:,s.
B. Opcnings of venous lncunlc rvhiclr rru usLrally tl)rcc in nurnbcr.
(Lacunirc Irc conrplicatcd n]csli\\'ork ol vcins in $,hich diploic altd nlJningcal vcins
opcn).
C. Projcction of :rircl)oord -r:,rrLrLrlr' \.
D. Nrlnrcrous fibrous stllr)(lr irt il{crior' illglc.
7. 'Il ib u rx rlcs :
A. Vcirrs Ironl nosc.
B. Srrpcrior ccrcbral vcin rvlriih rrrc ti {o l2 in nurnbcr and collccls blood fronl
n. Supcrolalcral and
b. Mcdial $urfacc of ccrcbnl lrcnrisplrcrc.
C. Diploic and ctnissary veirts tlrrrrLrllr vclr'.r., lacunac.
8. Conrnrrrnicntcs witlt :
A Vcins of sculp ttrrough pilrictll rrris\.r y vcr).
l] \rcins of nosc passing tliiough lirirnrcn cuccurr-
( Cirvcrnous sinus through.
ll. Supcrior {noslolr1olic vci (vr.:llr ol 'liolard).
b Supcrficial rniddlc ccrcbrrrl vcirr.
Al)l)iicd an,ltom)':
'l hrontlrosis :

Citusc inTu(tion ol scall) ilrl(l (liploc.

l{csult ^osc,
n. lncrcascd intricrilniill tcnsion I Duc to obstfirction to
)i I':rraplcgr:r (,luc to invol'crrclr of prraccntrll lobulc). I vcrroLrs drainagc
e. r'ortvulsiorrs duc lo conrnrcss,,rl ol rnotr,r arcf,. )

Sigmoid sinus
t. Introduc(ion : Vcnous clranncl in bctrvccn trvo folds of dura tnatcr (cndostcal and
mcringcal Iaycr) non cornprcssivc rrr rr,rturc lincrl by cndothclium prcscnl in cr.rium and
,..&t t4rr':a\
:
. i;.-. .. i.t :: _:
 , " l lc d, Ncck.&. face

..
2, Sltc : Postcrior ccmnirl lbssa on prrictal, tcnrforill occipiral i'L'r'r
^n(l
3. SIiapc: S siraJ'e.
.,.,. !'Ji,ri .,
to noritcrior cn0 ol J uAr rln r

7. Tributxrics : Connccts ro
A. Pcricrar:ial vcins by prssing lhrough urastoid & condylar Ibr':rrrcl
B. Ccrcbcllar vcin.
C. Intcrnal ar.rditorv vcin.
8. Applictl ,tniton!1 : !rl'cclilit: fr,':rn,posteiior crruiai rossa crrr rr;rch t() iilciir.ii irL,,.liir
vcin.

f
F,,,,,<-]--' ,,

J
Forn rcr) n)n9n!rn

liansvc( sL sinus
Ocop tJl srnus

Fig. 1.26 : Srg,nord s,nLrs

Dcscribe hypophysis ccrcbri undcr

I. Gross nntlonrv 2. Blrrocl srr1i1ll1 3. Ilistology
l._!ff4!r'!gtlAl. A pplicd annronry.

A. SilurlrJ I'rturlary 1ir:s:r of rirc body of spli-ltrid ironc

B. Shapc: Ovrrl
C. Sizc r 3 nrrr r tl rrrl
D. Wcighr I 00 nr!5
E. Rc lat ions
a. Srrpcr;or
I. Dilltlrrgnr,sclluc,
 ' '--i,..: -:
0 rrl - .,: '.
-. .ri:! al)xrt:a.i
c. L.ll..rl Clr crrr ou s sints
t. ilioo d suplrir I

A. Arterill srrlrplr':
lr SLrf, rir,r' l,lpoplryscal artcry. \ r.,...,,.,
b Infcr ror hypophyscal artery. J "'''
B. Vcnous Lllrinlgc : Short vcins cmcrgc on thc surfacc of g lxIld
ncigltborrrrg d ural vcnous sinuscs.

l. llistologl;
.J i ,. . ri:1ri J - of tllc gi:rnri. iL consisrs ol
eh.or oplrilic cclls (50%) thc cclls havc affiniry to colors.
^. L\ -.,1 ,1rt .l , f.rlplr:r c.:lls, abor,r 4i9,, of
ccll.1
ll ilrLsoIhils ibull cclls, about 77, :rl cclls)
[. ( hrorrLrlrlrol;ic cclls (50%,) thc cclll: (lo ]rot tirl.d color.
l] lrrtclurctii.Lr,: lobc:lt is rnil(lc !p ol rrurrrcr'orrs tr:rsoplrrl ccli, rr nrl clrrornoohobc cclls.
'l-Ircr'strr,rLrrrrl
co llo irl nltcrial

::.
:
l,j

Sasol)lr I ccll

- Chrornophobc ce ll

Sinu s. L.l

Fi!1. 3 27 : t.listoto!ly oi piluildry !ltand

C. lostcrior lobc lt coltsists of

a. Largc Irrrrrbcr of non myclinatcd ncrvc ljbcrs.
b. Modihcd ncuroglial cclls, callcd piruicyrcs.
 strffi t;;ril;;;,,------
"t i'' puJtlr5-iir:cbii
Ncct A trlc
9."."n,
A. clrronorogicar
n-cc iJr dcvcr
- ops ;rr'irr'
-

rrriLltJrc
=---
t'l
-

tltc lirrrrtlr rrcck

l
*c si,- . /-.-. o",oo.ri,.
Lcroocrnl. <';f trr tra ulcli rr,: ljfc
"-{iit"1r.r,
D. ;;;;*r"::r 'f' '" ',91,,oq",,n.
a. Rarhkc,s p,ri,;u , .i;^li . . r: i.:
orp'it;'i". pi..ro'Ijll1'T"l::fl ,rr srorrrodacur.r, ',. i'':
J:.'lt ruiu",,i"urun, of
ici r'. . , cpitIcliunl ,: i!:l
,.
" ijr,,.ft!",!P.iophvsis
.,.,11 , ,f.,,. djsrclis) and ,tj

,i*"&ll,l:"fr;!;l'n""'o/
,ljars posterior.
dicrrccpr'ro' L
givc risc,o *- rMp
li
:l
I .n...-^.,1r;.
" r, i ii;; ei l 'i
;
u
poucI
-c,"'1i,pi,".y, g'ij',].'J'"i l:il
-3i'.1i5,iil1,;,iiii.,J,."
'' .s,.,,\!, rI
;.i11,", -r rL o,,r !,ii,,d
,ir,J, r
Ir is i.r".,,,"r 1J,iii,,i:.i:ll::i,:,
ll 1
'].', ,,,. r,,,,,1 ,r,.
li::1",J1,,,;,,.11,:;i;,;.'
," J;:i:l,,llliil::.:tl:,::", ur J( r ,, c
c. i.,l,j:l:1,":
lJypcipl.s-i., ,1""
",nll,.'
nrn,'i'li,l,l].uun,,,,,,,,,,,,,,,
.s'alk
prcssurc & stro rv irrl ,lclr,.,..irrr

Dive jculum from

Euccopharyngcal
ne.: btanc
-';'

(
Fig. :. za. "!,!roprncnt
^- ol pjtuitary
a
 :::::, r\ at( c-Ja::-
:a=_i:=:-9€i-=; -:-_ 4
=:--,
,rppir"ii-fiFtoii-il:1:,.:1.:j-
A ljtiil.f .lyy9i,r giiis risc ro r$,o nrain rypc of symproms.
aE iGeninilrflfmptbins . duc to prcssurc ovcr tltc:sui.rounding jtructurcs.
b.- Spccific syntptoms: Pressurc ovcr opric chiisma causc" b'ilatcral hiroi
coulcs ncroulc-gnly ln 0dult & glgant

l. Intro ry of, upperl and Io '5i.thc musclcs ol

nnd
z. o.rgroi,''iii't;{#'"r ifi tcrminal branchcs oi extsnlll cllrotid !rtqry ilrising
substancc of pirotid glond at tha ncck of mondiblc,
.1. (loursc ; It is dividcd into thrcc parts by Iorvcr Ircad of lirtcral ptcrygoid usclc.
A. First part (Mandibular) : It is horizorrl l and lics uclor,. inicrior borclcr of latcral
pterygoid musclc. lt is bctwcc:t ncck o1' rnandiblc & sphcrrontlnclibullr ligamcnt.
Auriculotcmporal ncrve is rcl:rtcri lo lhc first purt of rrrrcrl,.
Il Sccond part (Ptcrygoid) itt is obliquc arrrl lics suPertrcirrl or dccp ro I{rcral ptcrygoid
nusclc.
C. Third part (Ptcrygopala( in c) : lr is horrzontal nnd lics bcrrvccn trvo lrcads of latcral
pterygoid muscle and decp to ptcrygo rixillnry fissuic.

Lateral t,terygoid m,i jcl.r

Anlarior lympanic srtory

Dcep auricula. artory

Superlrclal t6mporal

\ lVaxittary artory
Exlarnat carctld arloly
-
\i,oo," r'rcnin06al arlcry

Accesory mcnln0oal artoryi

I

lnlurior alvoolat artory.

Flg. 3.29 : 8ra_ches ol Ta" iarv d.1cry
 :i: l.:: !
.,. at
i ir: a;:: i -': . _:,:.

r l)::_ ... ,... - r.::aai - !;:i.iai :ir:i o.,ci c::cr suia::: ci l::ia...: ;:a:l
h Ii:trr. ,,,,..,i Jriar! , l).ts5rs thiougir orirdlbular canrl.
c. riairi.i 'irrl.rric altcry - sul)plics inncr surface of lyrnpalrc nrLnr'oralc. I
d. NiiCtlir rrrcrrrrr,scul nrr.ry..ni.rr tlrrough foramcn spinoiuur and supplics (l lrr:!: i{
ol'lllc n)i(ldlc crlnial fossa. :1.

c. /\cccssory rncningcal Artcry - cnlcrs.lhrough foronrCn ov0lc rrt{l supIlicS /1, ,,,,",, ' l'l
,', r', ,, r0"',, :' i 1 ; ' :
lr r., ' tt!"r",,,r,I"
|, r. , 'l,i"r
,,,',1, rl,'r l,rnrr.l,, b 1,, ||rirn,.lrn ol tllnitlr nllr,ll.
',,',1 4,
r I't'ryli r'l ri
lr. Ltc:p tcrrrr,,rrirl r/ \)' ,,:i
\ tJ r" 'a3,
c.
d. Bucrrl.
Missctrl!
?'
:
;f
C. Third part : Ilranclrcs of fhird pirt pass lhrough diffcrcnt foranrine rv[iclr cn;-,. ilto B
ptcrygopalatiIlc fi ssriic.
a. Posttirior'su'rcrror':rlrcollr ('
i
b. Infra - 1rl\rl.,l ,rrtcry. C{^'
t
:-
c. cr('llcr 1,'1,'t|Jr: r|tcr;.
tl. I)lrarl,rrgcrr I br:ruclrcs. '':;
l!
c. nrlcay ol l)tct\'!()ld ciltral. i.
I'. Sphcnop;rirrtrnc i
r\pplictl :rn:rtorrrr i
A. I lur,]cst ntcni|1llcill brltnch And clrrlreirlly i, ll. ' .ist I
N4iddlc ttrcrr r :.rrl [rrrrrch is
irnport:rrrt I'r. rr " . r'il).1\tllirr)
,llcry. :
U. It rrrr{ bc r.'rrr ,rr l,.,Llllrc ol llrc s\ull p!oduclng-cxtra-dural lr:rcllrirlr)ltil Jtt:!t , ,:lc:, -
lhcrltofoI''rc'll':i(crcblillc.l.j'\

i\lirltllt' ,rr*inll.,rl ,,' ler) f\i At

l=
Origin : liirst brirnt r o1 rlrc tilst pirrt oi rrrrrxillary arlcry in infralcnlporitl fossir
Ilclxlions : Slrl)cl] . rl r() sj)l)cnol i ldil)ulilr li!ialncr)1 altd dccp 1o lalctirl It,.,.: ,

It is :rccorrrplrrictl l,r
A Orvn plqurs 1)t r\]trljilll)qllc_ltcrvcs.
B N4 i!!l,c t4rLlr5irl rcr r, rr loyrrl lrie rrri
3. llrlnchcs:
A. Canglionic br;rrr.lrr,s ro trigc rirllrl glrrgiion. !-\
ll. I'ctrosa l blunc r

f. Supcrror t; rrrlr:rr', l,r.rrr' h

[). IcnipontL ltrunL i ,'1\
lt. /\ rlaslornos r),t l',Lircll
il. Cou rsc :
A. lt asccnds bct\\rrI t!!o r(rots ol auticLtlutcnlporel ncrvc.
ll. lt cntcr: tltc Iltrl(jla cr'unjirl lbsslr lllrougll loritnrcn spinosuln.
C. lt runs uprvartls ir d lbrrvirrds on grcatcr wing ot- sphcn<_,id bonc :rrrd
arttcrior' r t.l | . .:, r' ,1 r,. ill
 Middle mcningeal vessols

Foralnen srinc5um
f('tarfitn (ihl6

Mahdlbular

Maxillary arlery

Superlicial

v Exlernal carol | 211ery

Flg.3-30: Mlddlo meninEeal arlcry and ils branches.

l). n rrlc.ior division is .:loscly r!lirtcd lo ntolor iria ol. brain
li l'oslcrior division rLrrls br'.kr,lr,ls ur) slrlcrior tcnrpor'al sulcLrs of bmrrr and cnds at
l)ostcroir)ltrior rlngl0 ol o:rirclll bonc by divitling ilto i'rcntll lncl paricrirl blanclrcs.
5. z\ |) lrlicd xni onll, :
A l{ufturc ol-nriddlr rncnnrcirl irrtcry duc to injury (fool ball) lt prcrion causcs cxtra
dural hacn:orrhagc.
I]. Rupturc of antcrior clivisio of ruiddlc mcningcal artcry conlprcsscs. rno(or arca and
rcs u lls into contrill,rtcrlI lrcrrriplcgrl.
ct. Ittlpturc of postcrior (livisiorr ol" nliddlc nrcningcal trlcry rcslrlts into contralatcral
dcalircss-
l) l'lrc anlciior divrsron is i!l)t)rr)r!fl)c(l by mrking x holc at ptcrion (.1 cnr. abovc nridpoint
of zygorrrrric lrclr )

lr;i;il Superior orbital fissure

Iil)!) 3_'12 shows Ihe cor)tents of supcrioa orbilal lissurc..
l
I llt)pcr part
-/'.''
A Orbitrl brrnch of middlc meninocll ancrv (1" pan of mrrillrry ar.cry)
rrbovc thc r rng
+"- I1l,A.
s-. lp-r

2 Middlc Piirl
llll oLlqll tlrc flnl] ,\. Uppcr rfirrision oT oculomolor n"ru" -,- -
IJ. N.rsocrlrilty rrcrvc \. r
C. Gq cr di$isiorr ,if n.,ito,noro, u"ru" fi .
-
I), Abduccnt ncrvc
l. Lowcr mcdial ft,r rt
bclo\v thc ring In fcrior opltth alnr ic vcin
 .i:--:-. -:- -::: :-:.:-
c' c:- -: - : a:e?-

. Leval: - !r.-a:.ae s,:.,r.rrs

S!perior recius
Superior orbital fissurs
.d- Superio. obtique
Laldmal nelva-

Frontal

Trochleal norvo Dural shealh

Superior ophthalmic v€i Oplic nerve

Ophthalmic arler\
llc:cciliai,jr6.;c
Abducenl nerue lnfcrior
Lateral rectus

r,d",< I I

)Nrcd:r
I

J
F ig. 3.3 1 i Supcnor orbilal fissurc and ts cortenls

,). :.'.,:

l. A(t^cllmcnts : Extra ocular tuscics nrc

A. Voiuntary rnLrscles
a. l:oua rccli l
L SLrIc r ior rccrus. r
Jl. Jnlcrior rcctrs. 7
Ill. lr4cd rl I rcctus lIdJ
I\/. Lr icfa I rcctus ;
Origin of rccli : l.l)c rccti ntusclcs rrisc
front lllc rcsIc(:tivc positions ol. il for il!,ir
tcrrdinous rinlt. Tlrc Iinr] rs itrr.rclrcd
'I I)c tu if," sur1"c" ol-tlrc apc)i oI tlrc orl;rt
lirrcr.l rccrus hils in ",1r,,,1
,,,,,;ii ;,,,,;;,;",
.atJ<jitic,n.t
sur licc ol glcatcl rving .i. spltcrroitl - ' ""''' hcad. ,.,..trich arisos ,.ro.r r',:
lr,,;;,,
r)t. r.lrL(i i -l.ltc rccri ir,r lrscltod n)lo
_r1ir l 1(rr
,sr,-ri,,,r
(!,r I ; jrrrritr ,r- 1lr-. . lhc \ulcrr. a lilrlc posrerL,r
, ,2\.L 1.r,,..rr,., t" ..r..,r, . I rr.j .rj.(rtr. . .r,J
. \v] tt---fi" -5 6 7 r{
Mcdiirl rcctus : -i mnr berri'r,r rlrc ..clcr,. ,
lnfcrior rcctus I 6 ntn.) bclrind tlr- sclvr.,, urr14;,. ,u,,.,,on
Lalcral rcclLls :7 tnt bclrrnJ'hc sclcro -,,rrr..rl junctr.rrr. iuncrior,.
cor rre,rl
Supcriorrcctus:Smnr bcll rr: ll,c rcler,. c,,r.rrc:rl jurrcriorr.
 Il !,rrl, N..:\ N "'"
S!pcr or

Sclcro cornoal

Lateral rectus

Fig 3-32 i lnscrtL.n o{ rcct, nrusclc

l,.Lr,,,bliqLri :

Table 3.13 'TlrlI la)le shov?3 Origrn, rnsertron or lhc oblique nruscles ol (hc cyeball-
- i\ i ris.: lc 9.lsil, ] t \crtion .j
Supcr L'r Ilod),ol s plrcno id bonc, supcro 1] I'ostcrior sLrptlrrr lltcral quadraotli
loblierrc rucdiul to tlrc ol)iic cil :ll. , sclcrr ol tlrc cr,lrull l)cllind thc cqua
jtnt",iu, Orl)iLrl surfucc of nlirxilla. lirr0ril ] l)ostcrior ill1cflor lul.ral quadrant of:ill
l(, lilc Iiicrirr!l groovc. sclcr:r of tirc ercb;rll, bchind thc cquatoril
Lctatot ()lbr!rl sLrrfilcc oI lcsscr rvirrg ol' 'L Supclior Lrrrr,:llir :

palpcbllc thc splrcrt oici bonc. i AntcriL,r sIrircc oI lhc supcrior tarsus
strpcrior rs rr. Sli^ ' r, 'r1';'1r qy.116. i-.-
ll. lnicrior lrrn:: 1l: !
Uppcr nrrr,rin ol_ sLrl)crior tarsus. i-i; l,i;. :

Poslerior superLor lnleral

quadrant ol e)!5all

i
< --l---+',q: ,4' Optic canal

I
Lnlerior oblique
Poslcrior inforlor lalc ra I

Orb la sur{acc ol maxilla quadranl o{ eycbJll

Fjg- 3.33 : Orig n and insert o,l of the obl que m!5c c
 :or nx l.. ,-l ,
:. ls
b.
uf.tlrc I \e r c),clrd t,, i,
rr I
lrcll)i tn ilclrr..\sr,,r) L,l ,,. L

+
,^l T
\, I lnferioi
oblique
Superior
t..---
lt' \
reclus
l,
Srirr '
1'
I
Eleva lion Lrto., <_ I

I
I

tnli,rr
Abduction
Abduciion

Superior
lnferior
obiiq ue
recr,s

Fig.3.34 j Actio,
JU
'"t ano obl'qrc muscrcs
D. Musclc-s, brirrgirrg
tril.rirurrr
,,. ,,.,,," .,t
/\OoUctton: Alcclrrrl rc, rrrr \.rrpc,ii'r k(rus
b. A.bduc;ion
, l;;;,;i ,:.;li rrrlcrr".r ,\l)lr1 an(t irrtcrior rccrus.
c. Clevrrroj) . S,,fa,i,,; ;:,,,,1 rr rrrtl sLrpcr:o1 nh11,1 ,.
-r r)cprcss orr,,l,;;,;,,;.1:ll,,:l]i:,
c. lntortion: S uFt,ri,r r rcctur lll;:;;;,,,iii;l::"
f. Exrorrion rrir"ri"|" |'l.,lli irrrJ
nnd
suncrior obrrquc.
rn fcrior otrli(litc.
 .\ crt skpp-i) . : Aii ihe cxtra occtlur rLrt.ycles of tirc el,cball are stpplicd
e skppl.
t: cr]' c clccPl
Hi' so,'t superior obliqte, supplicd h), trochleer nertc (4rh cratiol
€--f Zn, htcra,l ,rct ,t supptictl hS' dhdrrcett cr|o (6th eru ld!
irkt ior obliqrc a d lcvalor palpebrae

4. Ap

position of ths eyoball for lostlng movomonts of tho

p"?"to^oru, ,rcrv!1,lcsi,,r l)ro,lrrccs Il(cr.il srrabisnrrrs .rrrrt rrc:rrty con)plcrc

u.
;qlr l!r !_fgr1q!r of iiic cy brll :,s lvcll ,r:_f-;; ii;Tl;;./c-li;i' In a<t,liti,,rr,
a
" ' ,hc '-'t-L
pupit is
-ilililcdlrnydnos '
JiS€.-f is), rnd rhcrc
ri,cr is
i.. Irss
t,ss rt
of aicoEn@119q_19hc1
ai--cc ri6dation r"h"* -.-
-s;
\>r Srl:lll:^j,
'nrOr"Er).
ncrud lcsion proa ,c-!y@-l_(d-;"-blc-tilonf*trcn Iooking do*rrvards.
Individuals wirlr diplolir usurlly cxpcricircc difficulty and apprchcnsion on dcsccnding
stn ircase.
-.
\)
D
*of a
fit-bduccnr
nervllcsion pr^,ltr.c r..citr.,l .rrs fcrosscd c),c(.) \\/,rrkn.s\ or paralysls
niIa.lc ciilscs.sqrrinr o, .riilll.:'i',r-\tr,b;s
ii i,li,,iiil6i11;" t,, . :!;.lcar io lor,k
in.diffcrcnt d irccrio;il)iil6iii i,,i,r:r l rvlrrLrr "),.. sidc of thc
r'ooirng to lhc oPl)osiic
lcsron 't-'u
f -!U.il1_. rs.(lr.r.,.r^rlrc.l by rrrrol xry. o'.ilf, rrr,,rcrrrcnrs of tlrc
'lul]]Iri..l
cyc5. llIS ls ,luc lo Inc ,n,.l rr.,tl, . I -::-(,rLjr .u5clc5. lr rrr.rV b,, i,Urcr vcstibular or
CCrCOCllar n oflr,.n

l. Funclional componcnts :
A. Sonratic cffcrcnt r: Musolcs ol cycball.
Il. Ccncral visccral effcrcnt It inncrvalcs c iliaris and sphinctcr pupillac nruscle.i
:

C. Ccncral somatic affcrcnr Carrics proprioccp(ive scnsatiOris frolu rusclcs to,

I

ppl
au lor.
1 N rrclci : .:,'!.. .i::i.
Tablc 3.15 : Tho lable shows nuclgl snd thoh distribution. /.
r::. i:!-r
^.

S.No. i Nuclcus I\tusclcs srr lllll ing

..\. lllaohc Supcrior tcctrrs-

Li. i Cludrt ccntrrl Lcvator PalPcbrac s!Pcrlotls
C.
..
I \/cntro nrcdiau
1'- -.-,r. -
Mcdial rcctus.
D. lr,tcriiic,.iiaic
;. *. i .lnfedor:i1c
=-- : inrcrior'.obllque.
.
;
tu s-.

r. I '1;;;;;l;i;;,r:
raiiigci rvcsiphal"t-:t : pbirictci 2uPillac, & ciliaris'
I
.

lnlorlor tsctus
Superior rectus lnl6rlor obliquo

Levalor palpcbrae
suoerioris

Caud.l ccntral 'r,. rius

lnlermcdia{c :'iLi::
n'.!
ventromcdian i,!al!:ijs
Dorsolaleral nuclcus
EdinOer WeslPhal nLlcleus

Fig 3 35 : Nuclei ol o.ulonr0lo. ne^'c'

L Cotrrrccl iorrs of rrrrclcrrs :

:\ '\licr!rll : ( arrlrrl ci)t)rlccli()ns
( rrcl)rrrI co,lc\ (xrci! 1.(;,3) > (lor()rril ril(liiiit
(icrtr of intc rnal crtostrlc OcLrlorlotor nLlcl:i
B l:1li: rr l l'criplrcral conncclrotls
ir. l.lusc lcs Jl cycbrll.
l). (:(rlll rcril l corrncctioni O-ffi l,( \1('
I I'tc(cctul nuclcus
ll (irrticorrLrclcrr (ri)cls o{ bollr sirlc!
IIi \lcd irr I longitudirrrrl burrdlc
l\/ ( lo
I t i c o b Ll b il r or lcctobulbirr traat
I

J. Or'ii{irr : rlc,rlorrotor lLrclcus. vrhi(:h lias it) 1l1c !r.\ tr1rLlr(r (rl ,:irl)cr l):rll of l))idl)rlin.
CouIsc :
A. lt,lra-ncurorral : Ocuto otor nuclcus --. -> lcglllclltum > rcd rltlclctls -.-- > nlcilial
piil-"f-iti6i"nria nigra and crnbrgcs otrl of i)rlinslcnl on rncdiirl sidc of ciirs c('r.i)ri
througl) oculotnotor sulcus.
 .i;-j.

. ' ,.-:- ..
.i,, J.iib(:L.ra ilttrf\,itrt,l Jrit5tcs olt lo
:.rrrri.r. sr\la ot po\lc or ..,r.lll))untc,lltj.! i cr! . ,t 1.r::..c, .rrrchnoid ntatcr
and lrr's in lrcc an<lnlrrc|,:rl rrrrrf!,in nl rcntr, r,,t c:r,:bsllr
lt. Larcral to ,: postcrior crrnoto p[pccss &
l,ur(crrur clinoi(l N picrccs
Ilr. :-.'"1 I)tcrccs lhc
thc rt..r.,
drrrr I..,rcr.
nrarcr.
rircrit \vi,rr {,T (i,r,,,roUi sinus,
;lll'Ji"",:]ll:
lcrr' filamcuts ?:l.t_9:_'::ld-:
from intcrnill csrotid 11.rhcartc
n,l
division
d;!i.'^^ ^. i.:^^.-:--,
of rrigcrninal ----
ncrvc. "un,,uu,,i."r"",uiih;
l\r Cilvernous sinus : Rclations frorn abovc dowIlwi!rds ;rrc
tlri|d and
oplrrhalnric and nraxillary (livision of tligcminal ncrvc
V. Ncrvc dividcs inlo up1,"i & lo*". division at anlcfior cll?l ,,f

/n t"
-;.,",., i I
.,..."....
l\\
'l
+

Superior cercbellar arlery

Inlervalbolwccn frce and fixod

it,;1;
I
margin ot lcnlorium
Cavernous
_; ]t
{t.( (
'' ./gc) Poslcrior ce.eb.at i'(cry

Superior orbrtal llssrrc

C |,r./
Fig. 3.36 : Coursc of ocutonrolor notuo

6. Rclatcd genglion : Crlirrry ganglion, a pcriphcr;rl p:rrasvrtrnnthctic qr,r)rtt jon

7. Distlibution:
A. Moror
a. lJppc r dir isron
J Ic! rr,,J l.rlncbrirc iunen\)ri\
ll SrrIrrror J cc{us
b. l.o',vcr drvisioo
I. l fcrior rcctLrr ii
ll. lnfcfior oblique
Ill. t\tcd ril I rcclUs
B Paras:'ntf'lthcr'q ln ciliary ganglion sunplics rplrincrcr ptrpilllc
lltrough tlrc br.rn.lr of .nfcrior obliquc.
rrrcl ciliaris musclc,
....._.1,.
'1
s. ifti'Jd:anatomy :
-A. Ilfra nuclcar parnlysis ol oculonrotor ncrvc rcsulLs inro S1 i\l'l'l,ll:l) i,,'

a- Loss of acco m nr ocll io n. t

5- Prosis.
c- Protrusion o{ cycbilll. I
i- l-creral squ in t.
' e- Etnbolus in cavcruous sinlis lli\i ir.1)(!!cc third lcrve pnrnlysis.
f- D iptopia.
g Dilatatiox-of pupil,4',*i,, .:i, ;;i, , i- . I . ..:i l
B- fa pamlyii! ot.b.,ild;lo'to; 'fi;r"c'; firicnr cannor look ripwardl, do\\'nwirds or rircdiali"
e- :lFftd ncrvc is usually affcctcd duo to syphilitic peri;rtcritis of oostcrior 6g1a!1ni ^trrl
' spcrior ccrcbcllar arlcrics as thc l]cr!c piisscs bctNccn thc ilrtcncs
D- Wcber's syndrornc.

J
IstrE€ial:on-:-A--condition wiricir' includcs
i. Gpp<a-nrotor ncuron icsron ol cortico sniIi!l fai!a{ it) cn)s ccrcbri of tltc nridbIairl
2. L.+u':: ntotor r\cirron tc,iurr of tlrird nqrl.q. ,'rppl5rrr- tlrc nrusclcs of c)'cl)irll.
ir:ls,:lrs into
-, Contra lrr !'r:l I hcnriplcgirr lnrl
3- i:silatcral lrinllysis ol rlusclcs o1-crr5lll srLpirlicrl hl octtlo ttro tor rtctvc.

Ciliarl,ganglion
lairoduction : Cotlcctiou of ccll boclics ol prrrlsyrnpathctic narvc sulplyin!i slllittctcr
:i'iaili:c musclc situiltc(l al thc apcx o{ llrc orl)ir.
Size: Pin hcrd.
C..rnt.n( : Ccll bodics ol'multipolur ntirruir.
J, Sjiuarion I .\fc\ ol lltc otbit.
Rtlgrirrn:
:. ).1.di:rl1) : Opric lcrvc.
:i :.:::.rell).:l,ntcrrl cctrrs rnusclc.
r

6 C,:,!rr...tio ns i thrac roots i.

.:- l.|-r:al. {f iliil\v 1l\ittl)cl::) ,!-
j.I'rc!3Irgliorl litrrcs : lidingcr-\\rr.rl)lrrl rIclc[\ , lorvcr Lliri'roir It llrrr,l rr,,c -
ciliarr qllngli<t - [:ibrcs lrc rcl.r!cri
': J)osttlrt!li;nic IIL)rcs : rr! ,.,,ir.,i 1,, \l ()rt !rlL.uv rcrvc & sllfirl!
i c1'rrrrr^r-.r I rl|il, ! . I
!1. Cilrrrris rurrsclc.
i S:r,,'rr :t.\irsocrli:rr1 lrbrLs pasr tl)!ou!tlr cilLiUy qitnglion witlroul rcliry.
'. : :":r.rIlrcIic fibcrs p,'.s llriouglr ihc ci)rrrr.,,g,rnglion \\'i(hou( rcl;ry.
... I)lcSxn-rtlronic : Spirill nervc to sol)urror ccrvical synrp;tthclic glrrglion
f' l)osttlnslionic : llcxtrs irrrctnrl cirrotid artcry -----' sllorl cililry rr,lrvc
-----+ blood \,csscls ^round
of cy,:ball & sunply rhc musclc dilnror pupillac.
't. -)
Rranches: S ro l0 sltort ciliirr), cl!cs
 il)arasynpathotic)
Crliaris Edinger

S phin c(er

Cilary ganglion
Syrnpath€tic

Ophthalmic.

Cervicel syr,rpalhcl c

Fig. 3.37 : Crlrary Oantl on

s. I'rc:rliuritY i PoslgrIglicnic prrns)'rDpalltctic lll)rc\ i]lc nlvclioatad.

,. ,\ t)plicll :l il{orirl' : t'r.
r\ CorDplclc divisior of oculonrotor ncrvc is rrr:rrrrlistctl as
ru. I)Losis : Drooping ol cyclid. .

b Exlc11lirl sl|abisnrus : Duc to unopfosc(l ircrioll ol- lilicral rcc(us.

c. Dilittc(l lnd fixccl pupil.
d. Loss o{ lcconrrnodation.
c. Apparcnt protrusion ol cycball duc to llirccid paralysis of most qf ocular musclcs.
i. Diplopiu rvhcrc falsc inragc is highcr (l)i l rruc intagc. .-:-

B. Ncurosyphilis : Pcrinrtcrilis of postcrior ccrcLrral and supcrior ccrcbcllar nrtcrics will

rcsult into lcsion ol oculontotor ncrvc.
C. Wcbcr's synd.onrc : C:ontralirlcrnl lrcniplcLlrrr (!rpl)cr rnolor ccuron lcsion) ind ipsilatcral
plralysis cf rnLrsclcs sLrpplicd b;, oculonroror rcrvc.

undcr
r.;,i;
aiid;. i
I lrr lt c ( ion:t I conrponctlts:
r\ Srrrrrrtic cffcrcnt, for ntovcrncnt of tlrc cychrrll
ll ( irncral sr)ntiltic iiffcrcnl, lor proprioccplivc rtrpLrlscs lronr
thc
'I lrcrc
irrrpulscs lrc rcluycrl to ll\c nrcscnccph rlL': rrtrclcLrs of thc
.1. i\r'rlcrr\ : Tlrc trocltlcar nuclcus js silurtcd rt L lc vcntrollcdial of rhc ccntrll
1,r.t1r.r ol rhc ntidbriri0 nl ll)c lcvcl ol irrfcrior c(J icutos.
l,rul'sc:Utd d ist ril) u tio tr : :l
/\ 'lllc liochlcar ncruc cnrcrgcs fronr tlrc supcrior rncdullary vcluor ncar thc frcnulum
lrrst l)ulo!v thc infgrior c,)llicullls. l! it tltt t) l',' crcni.tl which cmerge!"ott
l,'t.\al U,rct oI tL, l,,,ttn:rcnt
 llc,rrl, Ncck,t.

,,,'/ -'-
//
Superior cerebellar arlery
Superior obliquc lnlerval betwbdn fre€ and Uxed I
[}r"'

v/
IA
y'' Sup(jnor orbilal fi ssure

Fig. 3.38 : CoLrrsc oi trochlcar uc^'c

B lt rvinrls rrrLrirLl ilLr sLrprrior' ccrcbcllar pc(lunclc ril(i lhc ccrcbrrrl pc,lrrr' i,r r,: !l,ovc
pons. It purre,r L)J1\acrr llrc postcrior ccrcbrlrl i'nd sllIcrior (.r(l)cllll: ritrics
irppcnr vcllrr.rll\ lri!:rirl Lo thc ccrcbrnl pcdul]( lc.
C. lL cnLcls the cl\'arn()us sirrrrs by picrcing thc poslcrior cor'ncr of its rr),)l )lclL 1l Iu
for\\nrils rf (lrc lir(:rirl ,,vrrll r>f tlrc cavcflrous sifLrs bcts,ccn llrr (jerrl,,Lriolor
ophthalrrric rrcrvcs lrr thc xnlcrior plt-t of thc sirrLrs it crosscs ovcr tlre thrrrl rr, r'r'r.
D. lt cntcrs thc orbil through 1hc latcral part of tlrc supcrior orbilrl 1l\s\ll.
E. In the orbir. it prrsscs ncdially abovc thc origiri of lcva(or Drrlpcl'ruc slt'.rioris
cnds by supplyrrrl llrc supcIior obliqtrc rnLrsclc throLrglr ils or'hitlrl sLL LrcL:
4. ApPlicd an:ltorr\ : \\ i,-r. (ltc lrocltlcilr ncrvc is dunrrrqcLi. rliploprL ,rLrLrrs lrt loo
dorvnrvards, visitrrr rs si glc, so !ong as lhc cycs I(,()k lbovc lhr lroIizorrt.rl ;rl,r,,

Dcscribe abducent nCrvc

l. Functionxl co mponcnts N rt clc r; r;

3. Corrrsc and distribution and Annlicrl

This is tlrc sixtll craliirl rrcrr'c. It supplics lhc llrlcrirl rcclLrs rrrusclc ol tltc crci,rl
l. Fullctionlrlco ll)o cnts :

A. Sotrtatic cl-lcrcrrt. lirr llticrul rrrorcrutnt of tltc e,cbull.

B Ccncritl sr)rrrirtic irll.rcrl. l,,r I)r,rl)r , ecpt tc rlirrrl... lr',Ln lltc lirtrr,rl r.(LL .lc.
'l_ltcsc itnpLrlscs rcrcll tlrc rncscrccplralic nuclcrrs ('l (hc Lrigcrlir)lrl n!.r\ i
2, Nuclcus : 'l hc lrbdrreclt rruclctrs is sitLlttcd in tlrc lowcr piut ol lllc I)1)r... ur I ll,)or
thc fourth vc trrclc, dcel) to tllc l'irciirl colliculrrs.
3. Coursc and distriblttiorl :
A. Thc ncrvc is atlachcd to thc loNr'r bordcr ot ll)c lons. oppo:iitc rlrc r rfcr ': r,l of
pyranlid (ot llrc itcdirlli)
 Optic nerv6 ioiobctlar artcry oblongala
Ciliary gan(
Laleral recl

Fig. 3.JS : Course.of abduccnt

no.v.o.
B. lt runs rrprvrrds. fonvards rr)(l latcrally
tlrrough,thc cistcnl
ro rr)c cnrcrior infcrior ccrcbcIrr a.cry; Lrs.rrry dorsnr
ro reaih ihc
C. I1 cnlcrs tllc ca!cr|oUs s ".""r,,:rloili,l.'l,,',rr
,,o,.u,,, ..iri"'nni ;;:.:r ,ll,iir::"i ,:"ll:
crosscs rr,c s.jJ)(.ur bor r(r
pcrrous
'r"i;;;;;i
:.;:iifi:i'"i,i,,1";:::::L ,ijili: ]il. ,,i]"
fctrosnllcrotdal litrnrc,rr..rrr.r ,cr,rhc ;,,,,. rr r.rs:ic, l\jr,..rrrr rhc
bcnds sherply iorrua,d,s.-.ln r1r"
rrcs tircrirr ro rl)c inrc.r:rr ."roria a"u",,,n,,, slrr\.rt Iirst it
"n"rf,ini ,r,"" i"?".Jii,ijl, ," ,,
p;;i,;,;,;;;;i;lorbiralrssurc
" l:r::;;fi",,ll",jlil:li;::i r,rc n,iddrc
r i:.i:: illil"",,'"l"il"li)'"1,i'n,l,ll
,1"-n,'i,ii"l::.","",.,,,, ,,,,,,"!,. ii
nL:rc ir
*,,c,s ,i,r i;cuiiii
rics

4. Applicd.nnrtortr-y : paralysis ol.rlrc

ab<jLrccnt ncrvc resulrs in:
n Nlcdial (rrt.r,rirl or c,,rr1crr,:rr) s.lrrrrr
lJ. Diptopi.r
rrrr.l

Describe d igastric
l. Boundar,ics
4. Contcrrtr :rnd.,.
Boundarics:
Antcrornfcriorly : Antcri,r, bcllv,,t
digr:;tric.
Postcroinfcriorly I)o:,tcr,,r. bcill ol diglslric and stylohyoid,
Supcriorly ( basc) r

A. Basc of rrranrliblc.
B. Lioc joining rhc auglc of thc
ntitndiblc to thc t;tstoid proccss.
Roof:
A. Skin
 lJ. Supcrficirl frrscia contains S-r3C
i\. Cutanco\rs Ycin (lributarics of c\tcr[al jugular vci ).
b. Cutlncous branclrcs of grlll auricular vcill.
c. Ccrr.ical brincll of facinl nt'rvc.
C. I)ccp lirscil cncloscs subntandiblrlar sIlivaly gltnd.
n

Poslefis: !c ) ol dLgaslric,:

-. --- H yoE loss u s

_> MrddLe and inferior

i.l.'!cf, n a .r'.j sale

llvoid bone
FIq.3.40 r Boundaries of Cigaslric lr,an!le-
liluor: Frorr) lntcrior to postcrior
.\ Nlvloltvord.
ll lJyo(lossus.
C. N'liddlc cofstrlclor ,:f phar;rrx
.1. C(inlcrlls:'nrcv urc strd icd ioio
,\ Antcrio: |];rri ol-tllc lriilnglc.
lu. Struclrrrcs supcr'liciel lo rrylol)\'oid.
I Srrbrrrrndibularsalivary glrnd (sLrPcrlrciul)
11. Subrnand ibu Iar lynrplr nodcs
lll S ubnrcntal urtcry-
l\/. lvlylohyoid vesscls & ncrvc.
V l;rcial vcin.
b. StrrrclLrrcs dccp to ntylohyoid : SLrbrrrtndibulrtr r;111'.;11y.qlaltil (dccp)
ll. I'ostcrior l)lrt of trilnglc.
TiiSir 3.16 : Thc table shows structur.rs r).,rr .l ilrc d trslric triangle

SLrptrfici:rl l)cup {S(\ l{'id) l)ccpcst

I'irrotid gll d n. Stylorrl 1,r occss rnirl curolid ilrtcrv
lr) lc
fixtcrna I carorid arrcry b. Styloglossus lrttcrnltl J ugtt lirr vcill
c. Stylophrr lvngcus X Vrgus ocrvc.
d. IX (glosso plraryngcn l)
c, X (plr,rry nllcal braoclr)
 I-lead, Ncck & l:lcc -1!€l',l:
5. .\l)PIic(l lrlrl(0rtr! I An infcction in tlrc sutrI1rln.iibLrllr rcqiorr rs tll ir0(l lo it trialgular, area6.
llourrrl.,! poslc.inrly b)' lhc hyoid honc; and 3nlcrolntcritll! on cuelr srtlc by rhe,rtwo hilvcs I'
ol rrrr|,lrhtrlrrr I'xsc This is so bcc:llrsc thc in\'csting IirYcr ot (lcrl) crr' ic,rl frscid ]is uitabhid "
-l'hc
ro rlr.r.i hoIcs rrirngular sNclling is crllcdJ]J{\gl:\: t|r lr rx ( ollccrion jofathc;puia:-
.*-., ,^,,..1,
11:r1 u .lr i1.,,,,...,,,,^,,,.,.,^.,1^
llrc I, :rrluc ups ards. :..:,+ n: a .

ndcr
,'i1 n.::" 31..,,
icd anato
Boundilrics i
A. SLrpcriorly : Postcrior bclly ofthc digastric musclc and rlrc styloi,yoid.
B. Anteroirrfc.iorly : Sulcrigr belly of rhc omohyoid.
C. l,-r.:criorll Antcrior boider of uppcr Ir:rlf of tlrc stcrrro'liiii,'i,.1 ii-,ii.tli.
_,_ _.. s:p-j:r.:
1\

Ai:eio,+P.srm,
lvliddle constriclor
i
I rr
',ijr

l1yo,a bone
Slcroocla dcrnastold

Tll:ohyoid

i,,;,o,r; r:.:::r,.rqe

lnlor or c.r.5lr r:1r,.

Flg. 3.41 : Bo!ndaries and {loor of caroL d ltuanglc

). Itr,(,1 :

n. S[1r.
Il SIlrcrlrciJl llsciu. lt contailrs
ir I)lit tysrrr ntLtsclc,
b Ccrvicll bfirnch of thc facial ncrvc aod
c Trilns\c:sc cutancous ncrvc of thc ncck.
C 1n\cstilg l:rlcr of dccp ccrvical ftrscia
-t. l:locr ll rs forrncrl by S..* tttf.
A !lyoqlossLr:
B. lnfcrior lnd nriddlc constrictors of pharynx
C. fhyrohyoiJ nrLrsclc.
 174 Ilcld. Ncck & l;rcc
'-:
'l
t+,4; + :contcnts :
...A,:,,Carotid shcath and ils contcnrs r
:,
4,,. Codrnton carotid tncrv.
b. lntcrniil clro id lrrcry.'
r

c: Inlcrntl jrrtrilrr !cin.

d. Vagus ncrvc. It is prcs;nr posLcrrnrcrJiallv.
B. Relations of cnr.rid \ll.at,r :

..
:- . i[.t..},. Posterioi wail : Symda-tlrctic trunk i *, "[
.;4..--Antcriorrvall.; Anslcerrrcr,lr..
.
::. ,lC.'f,.Extemal caroiii irtcry'inl'1,. ni.L i,". br:,nchcs :
:,..i .:i+zl*ii:n:ir.As cc n d in g pharyngcal arrc1,.
b, Superior rhyroid nrtcr)',
c. Liirgual irrcq,
' d. Facial artcry,
e. Occipital arrcry.
D. Carotid-body ard crrcri.i sinus.
E. - Triburriries of intcrnal jitfrilai vcin l
a. Pltaryngcal \ c l,
b. Lingurl vcin.
c. jl flcr.rl rcin.
Cont rrlu
F. Ncrvcs
'j: Virgus Ic.!c s irlr it. su;'irr '' .rJ\')!c:l ,, il,t. il.
. \ "b Spinri ;rlic. (.i) u(r'. c,
..() ,. Ilypoql ..,J r,rl, :
Ci Dccp cc,vrL.rl lr,1t\lr 1,r(lc{

a(e.y
OccLpital arrcry

sprn:l accc!s'j ,, r, r /11

L ino ua - Va!l u s

.- lJypoqloss.l f cr!L-
-
Ascendino pharyr\a.rrl
Superlor thyroid arlery Carord body t si,r! l
-
S!perior bclly oi omolryoid

Conr.non ca/otLd artcry--

nlernr lugUlri v! n

_ S(ernocleidonraslo d

A.r.ior

Fig. 1.42 Corllcnls ol ca.orid triangte.

 ,:;
-i

r.. Jrjii\itc,r b\ sucI pllpations.

ir:r.. r stiok.:nduccd tx tlre right

L Origin : It is onc of thc tcrminal branch of thc conrmorr carolid artery.

1. lixtcnt :From thc uppcr bordcr ofthyroid carrillgc ro thc ncck of mandibLc.
J. Br^nchcs : All thc branches of extcrnal carotid flrlcry lic abovc thc lcvcl of anglc o

uro"o,. I
t r no.ro,ior

l
I

Supcriicral lcmporal
Ascendin9 ph..yngcal a,1eay f-'

Postcrior aurrcular ir!lcry

Occiprtat artcry

lino!al artcry
Internal carotid artcry

li!t,,!rior thyroid artcry

Conrmon c.rrold J ery

Exlefirsl ca.olid a rtc ry

Fig. 3.43 : Brancho: ot crternal carotic, arlery

 llcnd, Ncck & Facc 'r

4. Coul-sc : Lr Iics rurcrior and rnedial to intcrnal carotid artcr) t,l ils oligilr' It passcs
iirc postcrior bcll) ol digastric arrd stylohyoid ntttsclc and crrl'.'ri Prrotid gland anl
iirto tcrrriinr I hrln:hcs.
5. Rclltiius :

A. Supcrlicial:
a In the carotid triangle. it is ovorlapDcd bv slcrnonrisloid and '.ir'is(ld
hypoglossal and lingual nervc,:and facial vcin.
b. tn^th'b iligastric triaiiglelir id'lrclatcd to posterior bclly of digdstriclsnd rlvlDli
nt!LScle.
c, ln palotid gland : Il is ovcrlappcd by rctromandibulir \ciil
B. Deep
a. Con'trictor muscles ol pharynx.
t b, Supcrior laryngeal ncrve & its two branchcs internal .trld c)itcrnal laryngc' r

c. I,iterr al cirotid drtely.-

Lingual a rterl'
o1-,:xtcrnrl caroli(l itrl, iY. .rriscs opPosil" lllc tip
grcntcr c()r ru ol hvoi(l bonc.
Corrr'sc:rrrrl Icl:rliorls : Ir is dividcd ir:to tlrrcc t)itrls lty lryor:lrrsrrLs rrltrsclc
A. Firsl prlrl (lirl('ral to ltyoglossLrs), cxtcrlds lronl cxlcrrriiL '.itrolr(i nllcr)' lo lllc tip
grcittcr c'irnLl ol_ lryoid borrc. It lbrlns uPNar(1 lool) l,) ir\(ri(l rLlPlLrl( lluling
Dro\ cnrcI]ls (rl' hyoid bonc.

t
A,rreirr<-f- + p,.,r','
---- Ilors,r

'r',pr ,i ,'l irrl .r,.

HyogLoss!s

Sub ingurl Jrlcry

Fig. 1.44 : Lin0ua arlcry ;rnd ils brarlchrr:;

 : (----i -
--

-lTf l":*,
,,."';: mJsclc :.-.d on rh: up;:r bordcr. of.trcn
a :- -) ---. ,::s sup:rlici2l to niid..jlc constrjclo:.
..-j..:.rrs a tJi.F, altelror bordcr of hlogtossus r]lrsclc.
lisuJ I aiicii.
1l It i., rlso cslled
3. Branclles:
A. First part : Suprahyojd artery,
Iin
C. Third,part : Sub.liri
:/*1 .i ,1 q"
4, Applied anato,nyr tn surgical i!
bcfore ir givcs ony rrrun.r,'io-iong'u.
o,

The
1.

2.

3, Cour.sc:lr is diviticd into ccrvical and

facial.
A lt rur,s s,.fclJ r., r.. suoc
; :ln:',1;',:"il::'':l;i":';p"",1';X1;;l ."lo,,t.ll ..:'Jli::,'.Ji,fj
;i:l:l;in ';; t:
tl:"\'., :t, ,r,..rr rnJ,butrr gtanC.
" llll cnr('rs rlrc lrrec by rvindi ng round bast of thc nandiblc
IJ.
rnscra .r rllc ju,ction or ,th.c ancl pirrccs dccp ccrvical
l.',er..' .i- .. ',i";:,;J,l,tu'.']tl' nnd body of mrndiLJlc. tr rtrrrs r.1,*..;1.1 nrtf an inch
'.
oJ.lrrlr.r'rrrr. 'lnd rsLcnds by rlrc sidc of rrosc r" L'l- ronroscs with

An!lulrr.r{crl

La(cral nasai bra n.ll

Superior tabial branctl
Tonsillar b.a nch
Ascending patat ne branch

lnleri.)r tati,a t)rn^.ri

Branch to subtrr.ndibular gland
Facral J.lory.-

Submenlsl 513n61, .'---

Fig. 3.45 : Faciat art6ry and
 \vounds ol focc b!ccd profuscly bul hcal quicklY
anastonl0srs.

Ansa (Ausn hvpogloss

,/rrso loop, cervicnl ncrvc
l. lntroduction : A loop lormcd b)' vcntrrI rrrrri ol ccrvical ncrvcs.
2. l:ornration: lL is lorrncd by first. sicond arr<l tlrir(l vc'ltral trrrrr of ccti'iclrl ncrr'cs

:1- Iloots:
A. SuPerior rool is formcd by first ccrvical rlctvc
B- Inferior rool is follned by second and lhird ccrvical ncrvc.
4. itclation : lt Iics on tlrc antcrior rvall ol crtrotiti sllcltrh
5. Distribution :
A. Sup.rlgr rool : Superlor bclly ol olnoIr-ul(1.
B. Ansa ccrvicalis I

a. Stcrnol)yoid, Hypoqlossal ne rvc

b. Sternothy,roid and
c. lnfcrior Lrclly o1' orrrohyoid. ---Conrmunlcrtion to 1)ypoqlo j.ii

lvluscles of longue

Thyrohyold
lnlL.rior rool o( ansa cert l:rriL'
Oe5cendens hypa0 ossr (sup.;ior root oI (dcscendens ceNicalis)
ansa cervlcalis)
Superior bcily oi ornohyod lr l,rrior be ly ol ornoh)n 4
-
Slernothyro d

Slernorryord

F is. 3.46 . Ansa cervicalis

 '. a:.: .i

D c_scribc\g/otid gland ul d c.r

1. )\{orphology 2. Rclrtions Blood suf Ir
4. Lylnphatics 5. Ncrvc sapplr D cr'clop m
?. llistology and 8. Applicd anltonr
t. i\'iorpiroiogy ; Ii is Iatgisi saiivary fianri.
A'wciaht:25'im.l1||i'J,l:]}'i;]]i":i:;'..:,
r. sha;c is tike"i( i'{vcftl'd dl*ntid'.
:

C. Covcring : Consists of infler truc capsulc, forrrrcd bv condcnsation

formcd by pcriphcral part of gland.
D. Outcr falsc capsulc : Formcd by invcsring laycr of dccp ccrr.ical fascia,
Prcsenting parts
a. Apex.
b. Basc.
c. Bor'dcrs: Anterior;.mcdial & posterior.
c;. Srrriiec. Supcrficiai, anteronredial and postcrorncdii\1.
2. Ilcl,rtions : Tablo 3..12 : The table shows relalLons of paro(id q and
Structu rc rclatcd Structurc crrrcrging
tSul)crficiil to dcc
Postcrior bclly of digastric a. Ccrvical branch of facisl nerve
b. ..\f(.rior aDd postcrior division
oi' rctrorrrandibula; vcin
a. Extcrnal acoustic mcatus lcmporal branch of faciai ncrvc
b. Postcricr part of TM joint t) Supcrficial tcnrpora I vein
l. S upcr licial lcnrporal artcry
ia Arrriculotcrrporal ncrvc
C. Surt'ace l. Skin rcat auricrrllr ncrvc sr-rpplying
a. SLrpcrficial ll.Superficial fascia I. Skin ovcr thc auglc of rnandiblc
IILPosterior fibrcs of platysma II I'rro tiC fl sc iir
lVSupcrficial group of lymph nod
tl. llasseter .- 4Nl
] II. Postcrior ramus of !!\ndiblc
IIL Ltdial orcrvcoid
IV Llaxillaiy artiry
t- 3 proccsses
c. Ijostcrorncdi:l L Mastoid ttoccss l. Au ricLr l.l:,, rfora I ncrvc
i. Sternoclcidomasroid tr i_.rclal irclrc
ii. Spicnius capitis I . Extcrrral carotid artcry
iii. Longissinius 6op,trs IV, Postcrior d ivis ion of
Slyloid ltoc... rnlnilibLrlrrr vcin.
i. Srylohyoid
ii. Stylopharyngcus
iii. Siyloglossus
IILTransversc [hocess ^f at las
Rcctlls capiris latcralis
 St ructu rc rcllted S t ructurc em c.gin g
(Snpcrflclnl lo d ccD)

I.
)ar+ti& d-rrrts i. Branchcs of facial ucrvc
Zi'goniitic brench
.) - Uppcr buccal brrnch il
- Lo,,\'ci bLr:cll Srancli
- lvfand ibrriar branch
ii. Trsirsvcise facial vcsscls
II: reio1iC E lanc and
^.c.essory
duct
t. Parotid ducr
I. S lc.n oc lcidonastoid Pe$ o-t-"..l.n1o, trr do
ll. Pcsicricr- auricuiar branch of "* r(ctd '\o
ii,ciai rerle. ?o* ctttqr[ul3r-r" v{ \r !L -
III Pos:crio r auricular vcsscls.
c. iVcdial Pharyir x

Carolld sheath
Exlsrnalcarotld anory
lnl6rnalJugula. ve n
R€lromandl6ular vsln Aurlculolenrporal nea,'o

Modialploiygoid rr^_a:: ol 3l:i r

,,..1tarsvorce
Rarnus ol msndible 3t- Reclus caPir s llrcralls
--<:1>^
&/
Massarar Slylohyoid
uaxtttataaa+-)z Post€rlor bolly ol Ciqaslrtc
Faclalno^c/ / N,laslold p.cc€ss

Anterlor bordor Sl€rnocloidomaslold

:,1.' Poslerlor bor/

F u'ai;! I'd!'e d'ru,'! 'drsuons,

",r Ir lJ,t
p
A. Artcrial: Bianchcs of cxtcrnal cntrtid a cr y
r
(E'
B. VcnoLrs: -ft ibutarics of cx(crnr I jLr3ular vc in
4, LJ,lrrp h r tic
A Aficrtl-ri lr'^'-t. -. - gr.ttn Itrrv : .
of lymph nodes.
:i .,..-.,,ryrnpiraric (l!ii ins lo j
,.,s 1ric group of dccp ccrvical lymph nodc,
 iicad, Neci Fac c

rr'crvc suppll
A. CIand

synlpathctic 8llnglion.
ii.
Postganglionic : Plexus around extcrnal cajoiid orlery.to parotid
B. Parotid fascia : Great auricuiar ncrvc.

Glossopharyn!6al

Mandibular n€rve
J!qular loramen

Tyrnpan c pls, us
lymp3nrc biancn ol
glossoph6ryngeal n€rvo
Foramen ov ale

Mlddle menlngeal
arl€ry Ollc g a ng llon

Skln ovor l5e Suo6rlor corvlcal

gion
Auriculotomporal norvo sympathollc gangllon
temporal ro

T[1 Jolnt

Parotld gla nd

Flq. 3.48 : N6rve supply ol parotld g and

6. Dc}cloptllcnt :
A, Ch.onoloBical agc : sixtir arrd scvcnth wcck of intrautcrinc lifc.
B. Germ layer : ll d€velops fronr cc(odcrrn.
C. Sitc : PrirnodlJl oral cavi:
 I{cad, Ncck &.Fsccl'
'.i?
Sourcc rlt tlcvclops as I firrrorv bc(rvccn rhc nrrnilibrLI., rlrc nraxillary ar;ha;;r r,,.
"ndinto {.'r
sitc ot
srtc of Irriurc ol ll)c rnourh.
Iiriurc anglc of conr\jii.d
ll)c groove is co
tnoulh. Tlrc srird tlrc tubq. Trr;
inro lhc Tirc blind 'ri "
ol llrc tubc brrrchcs ripidly in Ihc ot llr-. c!]cc'N. As rhc fuiion ot 'rii
sIirstn!tce
'
tlr,. .f ,

- nlirrdibulrr nrrd nitxrllrry arch likcs plicc. ir. ii,,crLir r gct shiftcd b0ck\r0rds l:rc :;
(l
crrd rvlrrch rcrnni s lrlic ir lubc !,-rit,rs lllc Jrirrotl(l (ir. L r\ (l tllc posrcrior cnd r:rlri li\
ul]dcrgocsbranchinglll3forntslllcglal]d|ll3rsl]l.sli1|j..'
l,1at la.y proces! Op../n! ol lh6

Fig. 3.49 : 0evelopmcnl o: plrolid gland.

Iliqtolo:] | eor",., Fc\rs+, & +^$A t3 Ar.'.i.J ,nF rr.y\s,L\
.i. ::.--.;:-.r-:- :lc - r.vcbl"r tiarrd 'Yr9t-11 .!r e!!}4uJ + tb% M!clt!)
B .\- r r:c r._cc b) scrol.s ccll:
c. i\iyocplrlr.irr.irr. cclls arc prcscnt. to-ct' o"ur ttle''s 1' t 6 el &at
f-..ter.co-lo-t

3lood vessol

sorous ac nus Adrpose tiss!c

r19. !,!0 | r1,!rorogy ur p.rrolr,J 9rrId
s. Apl)licd Inltonr\':
A. JlRtlJlli L,rlliunnriurol of parorid gl;rnd is vcri p.rrrtirl dr.lc ro unyiclding niri,r..
l,iiotrd i;'sc rif '.JtLUrllX_is vifirl infcclron of purotid rLl.Llrj, rvhich i5 usually bilat,jrrl .i
scll - lllnrtrng. l Icru ilrc no conrplrcrtions in etIirlrcn [rccarrsc gonads r:
dcvclopccl ir1 clrildrcn. If it occuis in adulr. thc collpitciltions arc oophoritis in l,r r

orchiris ir millc and p:tDcrcatitis iI bolh sc\cs.

C. t+ryrl;J Sl: i' J-.rincJ by rrtrrg rrurrsversc ir.- .. .,,r or.cr palot id glard ro;r.
rr)JUr) to tlrc i), jr.crr'-..
')I facral crvc (l!!oJULVi[S/fr
D. : lt is slorv cro,virrglbcriign 1;,,rlri.,,s lrrnrour and docs nrr'
H*\t#lt[u]{lrr 'L
; . llr,fil r'
%{aS;pg1pu.,',','1""1'
joins grcat
l'"1i lii}" l[ ;fi :J, I i'J:"'i i,,:' i.'' ,ld ,otpor
l[: l; a I rru, .
glnntl l,r r,
Lr
d.
rvith !uriculqr ncrvc,
" Thotc[orr: itinrulrlior ,,
of Stoul
Slllllulatlon or Ersur uurtcurar ncrvc. 'lhis
uurlcular ncfvc, I n's ri:su]|. sIqLFi^{ o^
tto \\,<rLti^4
rcsultr into .'t€ parollo
o^.Lre parotid g|lr'r(1
gllrtrl
li
l'\tu'ru-k z Sry\dAern4 . gnl0Ly.tr^l'o cts 8t KNi.k{t./',o
4 Xto""rdr"
 __r_._i;
Head, Ncck & Facc tl83
=TgilF
Parotid duct (Stenson's duct)
I- Introduction : It is thick rvollcd tubc, rvhich carrics scc.ction oi giand to vcstibul,
mouth,
Formrtlon : By union of t\vo vcrtical ducls (forni.d by ductulcs).
3. sr'c , of j
l,o*$ui[S. *fii SIiXS:i._$,ill r,,-: :.{,,, ..,,, ,-
4. Lcngttr:5,cm'i\i,ldth:B-'iiiri:..q.:,:'o'.
5. Coursc:
A. Bcgins - From middlc of anterior boider of parotid gland and
B, Runs pn masscter muscle, ..,
b. First bend : It directs medially at the eotcrior bordcr of nlirssctcr and
buccal pad of fat, buccophdiyngcal fcscia and buccinator musclc.
'c. Seron,i !,ierrd : it is-bciween-buccinator anci mucous mcmbranc
cavity.
d. Tlrird bcnd : It picrces mucous membrane and antcrs vcsii'Dijlc ol'nloutll.
B. Ends by opcning on the
-a. Suntnit of raised popilla.
b. Opposite the crovtt of upper second ntoldr loo(h.
c. lllitltilt vestibule of ntouth.
Anl6rlor border ol parolid g and

lluccopharyngeal pad of lal

flucccpharyngoal
Mass6lor rnu gclo

vv\./\^#- [4 ucous rnombrane

Opening !r rhe vcst bul€ of the mouth

Flg- 3.51 : Cturse ol parotid duct.
6. Struc(urc:
A. Outcr tlbroclilstlc coat and sniooth musclc.
,]t
lJ, lnncr l1rucous men]brane which is lined by stratificd cuboidal cpithcliLrnt. I
7. Illood Supply : A bta ch of cxtcrnll carotid orrcry.
1
ti. Vcnous Drnlnrgc : Vcir\s daain into cxtcrnal jugular vcin.
9. Lymphatlcs r Supcrlicial and dccp ccrvical group of lyrnph node.
r0. Ncrva supll), I Auriculotsnlpor[l nervc.
 thc rnaudibular and maxiilary aichcs 8t the sitc of fulutc :rr.qlc

rfa
:10n2
l'sc qn
licd anii
1. Furctional ccmponcnts I

Table 3.19 : The tabl6 shows lunctlonal compon€nts, nucleus and lunctlons ol faclal
norvo'

Functlonal conrponcnts Nuclcus ond its locotion Functlons

(n1u5clcs ol fircil\l
A, S pccidl vllcqrrl cfferenl Motor n!clcu3 s itu!ltcd lt Drdnchlrl nrclr
SaVD . BRANCHES lcwcr part of pons. cxprcss ion)
a. Mus:lcs of facial cxFrcstto't,
1-t ltratr = branchcs scalp and car.
c,lrcs = archcs b. Stapedius,
d iorsLric
c. Postcrior bcllY of dig
d. Stylohyoid.
-l I

B. G encral visccral cffercnt SLr pcrior salivarY

e,
f.
Buccinatol
Platysma
a. Secrcmotor fibcrs to sul:r;lr:di"
to
l I

CiVll - G lands ruclcus, localcd at guol .,,' rY

bular and sublingui I

io* cl prrt of pons g lands

Glands = salivar y arrd b. bcrS r,, i,rc
l-acrimalory n uc Ieu s, b, Sccrctoltlotor fibc
lrcritual glrtnds o vcrlappcd by supcrior lrcrinrrl gland. I
Sa livary nuclcus. l

S pccial v isccral Tastc s ensation fron it,t,.ll,

iln ..,al
S-YA! :-Ia$e of tonguc. I

_.1
D, Gencral somatic froni rh- I in I
a. C cncrol scnsation fr(
.nnl cLrr_';,m
of concha of externa I

nu clrrr s solitarius in thc b. Proprioccptivc scnsl'n,",ion5

nrcdu lla oblongata. Thc . muscles supplicd bY by thc " ,c.
I

ccll bodics of thesc fibcrs

arc locatcd in the I

__J
I
gcn icr,r latc ganglion of the
facial ncrvc.
 Hcad. Neck & FEce

?. Conncctlons :
A. Centrnl connection : Ccrebral cortc.i !ionr ircis 1, 6, 8.
B. Corticonuclcar fibres r Coronir rrdi:rtr ficru cf thc intcrr,al capsule,
3. Course ond rclrtlons :
A. lntra-neuronal :
s. Motor root qrises from motor |uclci of lacial ncrve, situatcd in d
; lt winds around abdlcpnt 0uclcLs xrd forDS fociall collicul[!,j
i- i neurobiotaxis. llls lieive fibcrs hnve a tendCnc!'irtoi ii'nigrate,
fronr which thcy reieivc thcir stimuli,
b. Sensory root (Nervus intermedius) formcd b),
l.Supcrior salivatory nucleus & iacrinratory nucleus.
II.
Nuclcus solitarius both roots emciges at thc junction of pons and
B. Extra-neuronsl i dividcd into 3 psrts
a. First part: It pssses through thc in I crnal aaoustic meatus
anterosuperior sngle of the mcdiai waii oi rire middle ear cnvitv
second part.
Itfor!ns8bu1gingatthcbcndcallcdgcniculatcganglion'
b. Second part : It runs horizontally backrvarcls along medial rvail of tyrnpanic cavity
l. It lies above pron1ontory and fcncslra Yetibuii and runs to thc.
Il. Posterior pan of medial s'rll
c. Third part ; Runs vcrticaLLy do\!r\varls throLrgh stylotnastoid foramcn.
C. Extia cranial r Turns antcriorly and pierccs thc oostcromcdial surfacc and elnerges ftom
antcronicdial surfacc of parotid gland
D. Tcrn]inates rn the parotid gland : by dividing i,ito tcrminatcs branches.

Branch to occlpltal

P ler-i,gop ala tin 6 petosa neNc

9an! on

'+ f':'"tlt ('t't'etrre

to srapsdlug

-r.{,-*J'--

Subm6ndlbular glano
!.!! r.r L I

ii.,'.
":..
) Flg 3.52 i Cou, ss and dlsirlbut on ol laclal n€rve.
 B ra nchcs I
A. lntracranial , ', =+=.+. ..
a. First p{rl : No brlrrrchis.
b. At thc junction of first rnd sceL'rr,l I)i l, grcatcr pclrosal ncrvc !riscs \\,hir1i clrlr),
sccrctornotor librcs lo thc Iicri rirl glr.nd, dccp pctros0l ncrvc lo plcryg(l; , cilr.r I
g6nglion r rclny >iyg6$roricotonlporal norvo-> loorltrnl J I,i\,1
c, nlcrygapnlntinc
sccol|o |'lll t :
. .1. Sympathc I ic: b rahches to middle lncniDgca
IL Branch to icsscr ictrosil ncrr.c by rvhich
ruru ParL: . ..- 1;.'i:{:1 .':
I. Srlpcdirl brrnch to stapcJi,r. r'rrough inr:ll canali.X.l
II. Clrorda tynpani joins lingual ncrvc ond carrics tastdfibres I lso
carrics secrctomolor fibrcs to subntandibular
IIL Comrrrunicoting .-r..,
lo vngus.
B. Extracraniai
Exlracranial i ,.,-,. ,..-i ... j'.J,, ''
.' fi , ,;-:.t,..
a, Postciior aurici.Ila; bianch. Il girrs communicating branch to 6r!c! ^-^". du,
^.,.1^,, i-,
t -ti,,i:
lcsser occipital. Ir dividcs inlo
I. Auricular branch, rvhich supplrcs auricularis postcrior.
ll. Occipital branch, rvhich sLrpplics occipital bclly of occipitofrontalis.
.b. Digastric
brirrclr supplrcs posrcir.,r ',rlly of ctigasrric.
c. ityloh) oid l'rarrclr supplrcs irylor'\' 'l rnLrsclc.
C. Tcrmindl branclrcs 1:1, )
a. TcmDoral
1l 'l'rontul trctty or occil),lofro.rl rtr\
II. Musclcs of c:rr
III Corrugarorsupcrcilir
b. !gornatic : Orhicularis ocrrti.
c llrrcc;r I

T1 Uppcr : (lo\!cr zygonla(ic).

i. Zygorn;rt rc nrajor.
ir Zvcontrr,u nrinur.
:... L cr:ttor llbrr srrperrori
ir Lcr aLor lrbii supcrioris rri,r,lLrac nasi.
\ l .\J.- \r t 1.,'r
ll l.i:.rc: :

r il iiac )t,r lo r.
r, Or'Jra|:lars o s
l.:., r':r..r: .:J -' s(.pplrc\ r'.^ ...!clls
a:i\ .., I

,.. , -ll. s rllC(Or i)air';ril .t'r::

of
Da:rrrrc L tlte pJio(r(l {lrr(l
i):ii :;),ri:.,
3
C. Lcsron in thc middlc crr
D TunroLrrs in tllc intcrnal acoLrslic trcalus.
,
u s c lc s Ipsilarcrrl rrrusclcs of tltc rr.lrolc facc arc
 iicrd. \cri .t l:rrcc :r,wl-l

Lorver rnotor ncuron lcsion -------:.i;n

-
l,csion of frcinl ncrvc dirr:rl io rt\'lonltstoid f0rrnrcn : TIrc lcsion of lacial
to vcrtical incisior ol rhc prrolid glrnd.
Lcsion of fucial ncrlc nt tllc s(ylonlxstoid forllnlcn : lt rcsults in IJcll's
palsy' is thc lorvrr nrotnr ncuron tyJ,c of frcirrl frrlsy -(pltt.ly_s.iL_ll
lt.occurs duc iq, intlanrqliriioq-i:gf ;faci0[ rii*c in:lihc...:t
"*grlllioll:.
stylomastoid for0nrcn. . irt i n' ? !i -r :r
'i'
Thc cxact causc is not k[o\vn, but it is thought to bc due to virfll i
inflamnrrtion and ocdcma of facial nervc tvith its conscqucnl comprcssion
canal. Pain of variable intcnsity bchind thc c0r prcccdes facial rvcakncss
ovcr a 48 hour pcriod.
Chnr0ctcristic featrrlcs (on rhc sidc of pnrnlysis)
A. Frcial asyolDrctry ; duc to unopposcd rction of musclcs of oopositc sidc
B-
o- Lois
Loss of
!r! rvrin!:lcs icrchcad : OUe
cn iCtCnCaO:
wrrnr:rcs Cn paralysts of
to paralysis
due tO OI lronlo-OccrPlralrs.
fronlo-occiDitaiis. :. -.8+::\=---.ii: )
C. lnrbiliry lo closc thc cyc (rvidc palpcbral fissurc) : duc to pnralysis oi orbicuiails.ticuii. '
D. Inability to nrovc th0 rnglc of thc nrouth up\vnrds and Iatcrally dLrri:rg laughing : duc to.'
prrillvsis of ,/) ionrilrcl, jr).ljor
ll- l.oss ol ilirsolli)r:ll lirrrorv : <lLrc to prralysis ol lcvaror lrbii sLrpcrioris rrlaqucnasi.
Ir Ac,:rrrrrrrlntiorr (rl lbad il lllc vcsribulc of thc nloutll i duc (o pilrnlysis ol tlrc buccinator.
C. l)r'ibblrng ol srllvir I duc to parillysis of orbicularis ciis.
H. lIibilily to inll.ilc thc clrcck propcrly : drrc to paral!sis of buccini\lor rnusclc,
Thc lcsion lr tlrc lcrticrl coursc of llrc facial ncrvc rvirhin thc nrastoli Lorrc rcsults in tl)c
loss ol lirstc scIsurro (\ I thc il tcrior two-tlrird of lltc tonguc on thc sidc of thc lcsion.
Tircrc is loss ol sccrctio liortt sirbrnrndiLular snlivary gland: howcvcr, lacritnation and thc
sl.rpcdrus rcllcx \,, rl.l hc rr,,rrrr,rl
4. A lcsioI in (lrc irr (l(Il( cirr icgt)tcnt of lhc ncivc (iynrl)nnic) docs nor rlltct lncrimation but
rcsulls iulo ipsilrrtcr:ri lrvpcrlcLrsis, loss of sccrctiorl oi subnrandibuhl gl:rntl orr rhc sidc and
loss o1'lirstc sclsr,l (jr) orj tlr. \illc sidc of thc lcsion.
5. A lcsrort rt or' Irorrrrrrrl (o rllc qcntcLrlillc ganglior: (tr:rtrsl:rbyriIthirrc) prorlLrccs diminishcd
Iacrin|rtiorr ol] tir. :iutlc sidc as rvcll its dis(urbincc ln {unc(iot) of llts olltcr branchcs.
AI_tcr rct;ncratron. rho pirrirsylnpalllctic sccrctot)totor fibcrs irrtcndcd Iir salivary glands
grow, and jout llrc sccIctornolor ljbcrs i tc dcd 1o supply tltc lacriLrral gl;rr<l; lhc nn(icipation
of lborl thcn prodLrecs lacri tlttr) . i stc d of sllivation (syndrorlrc oi crocorlilc tctrs). Thc
spccillc lc:ltr.irc ol llrs syndrotnc ls piraoxylntill lncrinlation dLrrrrrg carirrrg

l.H\-Jj..; 14:; .1 Un r )cr rrrotor ncrlron Icsion

Lcsion abovc thc lhci;rl ncrvc nLrclcrrs in lhc pons or tbovc involvcs corriconu.lc.lr fibcrs, Thc r

ntlin cuusc is lcsiorr irr rlrc irrtcrrrll c;rpsrrlc.

'lltc supranuclcar lcsions producc uppcr riolor ncuron lypc of paralysis. Illu rrrrsclcs onlyI of thc
i

j
lorvcr half of thc fircc iuc pirralyscd TItc nrrrsclcs of thc uppcr hall ,rl rlrc lacc arc normal j

bcacusc lhcy arc bilatclLlly inncrvatcd. +

l :
 Head- Ncck & Facc'
upper moto! ncuron lcsion : The.parie r is able to ltri le tlte skin ol his foteh
btt he is ot dble to pcfonn lhe-actio s ol lhe mrscles of lotcr lnlf of theface (as thcy
inreriation from the cetebrul hemi:phere hcnce paroll:t,l).

l. Boundnrlcr !
A. I(oof : I: is formcd bv
x. lnfraierrpo.al suiface of gieatci rvii.g ol sphcnoiC boirc it has following foramcn
fiom arte:icr to posltrior.
L Folancir o\'3!c rrhich transmits 6-r trt.t,le.
i. IlarCib,,tlar ncrve (V3).
il. ,.{cccssory meaingeal artery (a brancll of mrxillary :rrtcry).
::. I;ss:i-periosaFfl erve ("-branch-aFtympanic plcxus).
l

cavcrnous sirrrrs t" DLcr'ygrtict vcrrous

'i. iinrisirry-v€in-connccis
ll lrorenlcr spinosurn transmils OT 3 N'l
plcxus.

i IlrCdlc mcningcol artcry.

ii i\l id d lc Ilrcringcrl vcin.
iii. l\lcIingcal branch of nrandibul:rr ncr!c.
l, Sqrrrrrrtorrs pirl of lcnrOor0l bol)c,
lt. ^rreflor wull is lbr lcd by
.r l)ostctior surfacc of nraxilla.
lr lrr fcrior orbital fissurc.
( l',lcrlirl rvrll is fornrcd by
rr Lrtcral surlilcc of Iatcral ptcrygoid platc.
l' lcrrsor Pllati.
, SLrpcrior'constrictor.
,l l'{cry!lo urirxillflry fissurc.
'Supc.ior conitriclor

.-- Slyloid process of

(.rnrporal bofc
,. , ,l,rt lr'', ir,
'l
squamous ^arl ol
-. lcmporal bone

rI r,,rLr,,,r,, I'i,rv"
Ramrs of mandible
Fig. 3.53 : Boundrics ol inka temporal {os5,r
 )..:i a a::.
t, ?cs:.icr K a:i is forn.d by
e. St.vlcid process of tcmporal borrc.
b. Caiolid shcath.
E. Letcral *'all is formed by
a. Ramus of rnandiblc.

2.
ffi
'--l
a. lcmporalis.
b. Medial pterygoid.
c, Lateral pterygoid.
B.
Maxillary artcry and its branches
. D."-^L-. vr c-., ^--r
^a fuJr A- hr tr
PJ.L --9 tl-pr/1ryr,r
^ ^
l, !2 egp auncutar,
II. I nfcrior alvcolar,
III. A ntcrior tynrpanic,
lV L[ iddlc meningcal and
V. A cccssory meningcal.
b Br.rnrl,cs to musclcs oI rrre"trc.rti. .

L Massclric branch,
ll. Tcnrporal brrnch.
lll. Prcrygoid branch and
lV. Buccal branch.
C. l)tcrygoid vcnous plcxus.
I) i'lc I ycs :

it. llranchos of rnandibular division of rrigcnrinli rrcrvc.

l. Brancl)cs from ntain trunk.
i. Branch ro mcdial ptcrygoid.
ii. Mcningca I branch.
ll. Brrnchcs fronr antcrior trunk (mainly rrrotor)
i. Massctric b..rnch
ii. Brlnclr to latcral plcrygoid.
iii Dccp lcnlporal branch.
iv. Buccal branch.
Iir Brarrclrcs froltl iostcrior tru k.
i. Lingual brrnch
rr A rrricrrlotcrrrpol.r L
iii.
ln lerior alvcolar.
b ( lrortla tyntpani trervc
c. l)oslclior superior alvcolar branch of ntaxillary r)crvc.
Ii. Orngliorr : Otic ganSlion.
 comnlcx- condvlar; mrltiaxial, riddlc sh^lcd, ttylric.l syDn1'r11i

' i,.tc it.- t*:''Jlt :r' , +i * i" , '.,:.if,,

oncs: n[mely mbndiblc and tampotal bonc takc part 'iri ll'r. I
!.:;::r--formation of TM joint.
'. I, l.:Mandibular fossa on thc infcrior surface of thc sqLrarnous part of tcmp,' .
1

'i
. bonc.
It. Hcad of m,rndiblc.
b. Complex : Joint cavity is scparatcd by .articular disc into uppcr mcnisco tcnrn, r,l
lnwnr ma.i."^ -..riL"l"'
c. Condylar : Lcft and rigbt condvles of the hcad of mandiblc forms a iriion,l rr
articulation
d. Multiaxial : Protraction, rctraction, clcvation, dcprcssion anci sidc lrr .r.t!,
nlovcnrant
c. Saddle shapcd : SLrrlnccs irrc corvcx and cc,ncavc.
f Atypical synovirl : Thc irliculi. sLrrfaccs of thc hcrd oI nandib]c lnrl nrrrrrJii' Lrrr
fossa oI tcnroor;rl bonc arc nor covcrcd by- llynlinc cartiligc, but arc covcrcLl iry
fibro cartilagc- Iicrc collagcn librcs prcdor ilurc ilnd carlilrgc cc s lrc fcrv
B. Functionally I Diarrhrosis.
L Liganrcnts: Thc lignnrcnts can bc dividcd into
Anlerior lhick baid\ Inlermedrrte zonc
Anledor exlensioo Pos.lor ll':. r,.r''
Laleralpterygoid musc e -

Lalcral liqamelil C. p sLrLe

--
Spehenomandibula. liqamenl
B laminar regro.

Slylcid p.c'.,:'.j1

Slylo r.iandibular I ::]i_.

Fl3. 3 54: Articulir disc and igaments ol lemporomandibuta r joinl.

 Hcad. Ncck & Face

.\ ,\lr in lrgomcnrs
.,lt
' ^ L Fibrous capsulc
Aflachmcnrs
i. Abovc:

t.
ll. r

III. Pcculiariti
i.
It is lax and strong.'
ii.
It gives to latcral pterygoid musclc.
b. Articular di:c :.lt\is oval in shapc and- fibio--carl ilaec in harurc.
I. Morphologically it rcprcscnrs !rtc:.c! plcrygoid -.riuscic.
IL It is atrrchcd
i. Anlcriorly nctr tllc IlcJd of rrrrndrillc
rr tcrrphcrllly ro tlrc iusicjc oi rlrc filrr.rs ...;,i.rlc.
lll. I'ar(s:
i Antcrior cxtcnsion.
i. n rrrcrior lhicli band.
rrr Intc:rrrcdirlc th rn pal t.
iv.
I'osrcrior rh rck band
v
Pustcrior bilrntrnrr nxlcns ion
lV. Variarion in thickncss: It is tlrick pcriphcrally,rrntj tltin irr lhc ccnrcr.
V. Pcculiarity : Civcs attachmcnr to lateral ptcrl:goi<1 mLrsclc.
Vl Funclionally it divi,lcs lhc jornr crvity i,,ro ,,11,., lnci lu*.cl cornparrmcnt.
i. Thc niovcncnt in thc uppcr aunrp.r,n,.ni is gliding.
ii. Thc rrrovcnicnt in thc lorvcr is rorator.y ,,u giiAlngi
. l r'cr:rl I \l lrjJn)cnt
I lr rs .r \tour band of fibroLs tissuc.
il It co\.crs liltcral aspcct of capsrrlc arrrl strcngtircrrs it
JIJ lt c\rcr,ds lronr rubcrclc of root of rygnn," io ncck of rlrc ltirn(liblc.
lV. lt tigltrcns in rctraction and prorractiori and rclaxcs in rllc rcst position.
d. Sl,novialrncnrbranc
I lr lrncs lhc nbrous clpsulc abovc a.<i bcros trrc rlisc bLrt docs not covet rbc
,irsc
ll. It lincs non articular surfacc of arliculnring boncs.
lll ln ncrv born, cvcn thc articular surfoc"s u."",ovcrcd by synov,al nrcnrbranc.
-B7,,,AcccssoD, Ir Jtrm(nt
\'z .r Spl.cnornrnrlrbulirr :

ligemcnr :
I lntroduction : Ii is an acccssory ligamcnr ol- lcrnporo,nil,lJrbul:rr yoint, *flicn
lics on a dccp planc away lrom fibrous capsulc
ll n tlJ.lrntcntj Arjscs from sprlc oI sphcnoij bolc to thc lirrgula
ol.mandiblc.
b. Srylonllndibular ligamcnr ::
Srylorrrandibular
I. It is a spccialized band of dccp ccrvical fascia. ]

,, ani adjaccnt .nrcridr aspcct or sryloid pr99c!! Io

lhc anglc of !:-T,ll:
lL^.:,:l:1":. mandiblc "p:*
ar,d postcrio. bordcr.
lll. lt is considcrcd only acccssory ro thc joint and of unccrr.in funcrion.
 Ilcad, Ncck & Fa

N'loYcnrcnts and nrusclcs bringlng nlo\'.nrcnts :

Thcrc arc tllrcc scts of riirndibular ltlo!cmcrts i\l rlr. I'\l irillrr llrcsc ilrc
A. Dcprcssion rnd clcvntiorr.
t. D cp rcs sio n is trtroduccrl rroinlt 1,t t),t Ltr',,t1 I't(i.tgoil. ]'hc digilstric,
gcniohy'oid and nlyloll),oid rDusclcs lrrlir \, lrcr rlrr ,,lltlr is opcncd rvidc -or agc
against rcsistancc.
.b, -Elcva[ion is produccd by thc rirss.-::r rr': tcrrlorrlis, and thc
. pre ry!-oid inrus clls bf borfi srdes.
B. Sidc to side movcmcnl (gliding noYcrncr:lt
Latcral or side to sidc nrovcmcI:1s ]ic li.:r::r.l l,r ll:: :r:cr.r;rl anJ latcral ptcri'8oids
each siCc acring altematcly.
C. Protraction and rctraction.
a. Protrusion is donc by rhc larcral (prrrcipilly' its i fcrior hcad) and mcdial
pteq goids.
b. r! tI: .iupcralis. lt
Rctraction is produccd b1, tlrc nosterio' ,lhcrs mry bc rcsistcd'
b; thc r"iddlc and dccp fibcrs of th: r:.r:..,rlji, ii,( ,ligastric anC gcrioiryoid
ntu ic Ics

t. Ilclations:
A. Lalcra I ;

I Sl in arrJ f:rsci,r,
b. Pirolid gllnd irod
c. Tcrnporal branchcs of facial ncrvc
I{ Mc,liil : {
l. Tynrprnrc plitc of tcrnnolill boric.
b. Spinc of sphcnoi(l; anJ sphcnornrndibLrlrrr lrg;rrtcrtl. i
c. Auriculotcruporll lnd clrordr tynipirri ncrvc rrr(l
d. Middlc nrcn ingcal aitcry.
..!i rs r(l,t,ij
A. Auriculo tcnrpor rr r:rvc, n branclr of p()\tcri()r (ii.'iriorr rri r:rrrdibulirr ncrvtr.
Il l!4 ssclcric ncrvc, u branclr ol tlic nrrl(libuliu rdrrc
6. r\pplied u ilt(,mv i
.A. For*on! li.slocurion is contuoucst Jor ol litplt;trnLnr
v \\/ith thc moulh opcn, lhc condylcs arc in thc ;r{icLllrr cL'rncndc and suddcn r i,rl,:rrcc,
cvcn nrLtscular spasn) (r convulsi\'c vu\\'r))- lli.it rlistlrrcc rrrrc or i)oll] tcrrrporoirrilll(Jil)ulllr
joint.
l\. /l larior dislocatian rt,tltl_t' octut.t Lit tltr rl\'ttult)ut i.< 1ttr:;rtn ritltortt rt' i); lt is
casily rcduccC, tllc joiIlt is lcss strirlc bccrLLrsc thc irrcrcasccl clcvillioll ,'l lhc
cdcntuious mandiblc pcrutlncrrlly clongxlcs lrrlcrlll llglrllcrll.
(;. Tllc rcduclion of tlrc TM joint is cusily rrelri:r'ctl Lry prcssIl]g (lowl1 on thc rrroii Lccth
witlr tlrunrbs placcrl in tlrc r)touth. an(l itt rlrd sirnrc littrc pushing llrc clrin ul)\\.ti,l r d
backrvard. 'l'hc dorvnward prcssu.c on lllc rnolur tccth ovcrco!ncs rhc tcnsior ',l thc
tcnrporalis aod massctar rnusclcs which irrc in sl)irsrn: urrd thc uprr'ard irnd brr, Liv:rrd
prcssurc on thc chin helps thc hciLd ol nlilndjblc to put i to o.iginal posilion
L). fhe grcat srie gth of tha latcral tenrporontottdibular ligantattt prcvcnts !he heui ,,i the
nrantlible lton passittg bacln' arc! and.ftat(:tuting !he t)\npa ic plale \\'hcn.r .sd\'('rt /,,i.,r,
ftlis on the chin.
E fhc articular disc of thc tcmpororrandibular joinl rnay bcconrc pnrtinll)' dotAclrc(J ' rr!
 Hcad, Ncck.& f :,cc

rcscrlhe nl .of
:n;'origin
idn '. & ,", :E:I
Tablo 3.21 Ths lablo orlgin. iris€rtion and
[{usclc l. I 3.^c
A. Massetcr: a. Supc;nciil Dorl and thc rL!r to
It hls thrcc -I? Antcrior lwo-third of inacrt into thaf'laicral clos c l thc noul 11 i|lr (l
parts. lo$'er bordcr of surfncc of ramus of clcnchcs thc I cct lr
zygomatic ilrcll. nrandiblc.
ll. Zygonratic Drocess 0i.
mox illa.
i-,l b. lntcr!l1cdiatc Ira! t:
Mi<iciie third oi'
zygomatic irclr.
c. Dccp prr t: N!.(lirl
surfacc ol zr gornlrrrc
arch.
I). 1'cnrporaiis: Wholc ol thc tcrr|,rlrl Nlurn inscrtion is on a. Uppcr urLi ;.:rr. ror
fossa bclwcci i l.r)or thc anrcrior and fibc rs clcr',rr. tlr c
lcnrporal linc unJ pos{crior bordcr of nrand iblc.
infnrtcmporaI cr,::L of tltc c<-rronoid proccss. b. l'ostcrior lrbcrs
ol spI croid rctract lhc rlrlr1rIrl)lLl

Lir tcl nI a. Supcrior lrcirtl irriscs ir. l'tcryjloid fovca on a. lt is irr(tislr(r .,1)lo
ptcrygoid: 1'r o nt infrulcrrrltorrrl tlrc anterior surfacc for thc llcLiv! | rirg
It has surlicc and crcsl o1 lllc ol lhc ncck ol titc oi ll)c n)o ull).
t!vo llcads. grClltCr \vrn': o1' nr a ndib lc. b. Bot!: ptcr ygo ,r :rri
s phcno id bo nc b Articular disc of togclhcr, Irol il lllc
b. Inl'crior lrc.ril ;l isc s N1 joinr rnindiblc
fr{'rl lirtcr il l :Lrr'1ircr ol c ( pstrlc of 'l Vl
rL c. Ilotll tlrc |L (ls
ll tcnr l finryll,'r(l lrlrtL cofit rcl irl!r rli , ,lo
proCrrcc sirI : .rlc
tl]()\rcl]i{.,111! Llrc
rn and ib lc.
D. M cd ial Supcr 1rc irr I lrtrrrl: ir. Iiough arcaon thc a. lrlovcs tlrc r, :lrlc
ptcryrloid: L fuboros itv ol rllrrillu rncdial surfaoc of u prvarcl, lirrr', r .in<l
It lrls trvo IL Pyrant id;r l rlrrccss ,rl- rrglc of nrandiblc. nlc d irI lly .iir1. ::iL:s
hcads. pal:rtinc bo rc. b Adjoining part of lhc dioth.
Dccp hc;td: thc ramus of b. lt is a gtctt it!t:
L Mcdial srul-:rcc rf rn anclib lc.
latcral ptcr'r,gortl ollrrc c. A.ca bclow and c. Both thc i)i- 'iris
ll. Ptc:ygoid li)ssa. bchind the COntract irllcr Lr. , . 1(J

rnandibular forarncn. produce srrlcl, Litlc

nlovclllc ls ,: Lllc
mandiblc
 Tefrp rr,rl lossa
ZyOomalic arch

tulcdial surlaco

fla. 3.56 ^:t ,.hmi.r, L; :emporilt,s musct6.

.1. Ncllc srr1r1rl1 . ,'lll !l)f nusclcs of nastication ort' srrpplitl l,r lttattchts from anlcridr
lntnl o/ I t ttct vc ctccl)t nedial c't.rqoid ttlticlt i.r .,t,1ttlitrl ll' ltronch fron nain
t t r rt t t t I t t r r Irt

tr Lllrl I'r' I'r:1,1(ltDUlllr t)rrvc

D,_qsqrl!_c.
1;..'. Origi
3:;,''Bi:iri
i. Otigin : 'l his ncrvc ariscs frour trigcntinil. thc fihh crrrr,ll rrcrlc
l. C(,uIsr rn(l rcl:rlions : lt bcgins in tlrc rrriddlc cri iill li)ssr lr\' l:U!lc sc sory root ond n
s'tlitll rrtolor rool. lloth thc roots joir just bcforc cnrc rrrq irrro tbrarncn ovalc. It
crrlcr!cs llriorrtlr 1_<rrantcn ovlrlc lts il ntixc(l ncrvc 'l jtc ||r t trrrrrk lics in thc
irrlrltc trporll l(rssrt. ,^llcr ir shorl corrrsc, lhc nllill trLlltli drvirll.i rrrtr' :,ntcrior and postcrior
rlrvisiorr
l. llr':Urclrr\:
,,\ lrrorrr tl)c lrlri lnrrk
ir i\'1cr)irr!lcrll branch supplics d!rrilrtralcr of tltc rrriddlc cr]rrr,rl li,rsl.
r \'rv.. r,. rh, rncLjirl prcrlgoi,l s'rp,,irc,
I Nlod irl prcrygoid nrusclc,
ll. 'lcnsor palati musclc and
ll I 'l crrsor tvlnpuni Itusclc.
lI l:r,,rlt tlrc rrrrtcrioi trunk : lt is marnly rnotor cxccpl Lruccirl LrrL rclr, rvlrich is scnlbry.,
it. Nlrlssctcric ncrvc suppllcs massr-.tcr musclc Crril 1 M lorLrt '4

b Dccp tcmporal suppiics rcmporalis n)usclc. i t

c. Nclvc to itr" latcrai pterygoid supplics Iltcral prcrygoi(l ruusclc. ! '
d. lluccal ncrvc supplics thc skin and rnucous nrcntbrnrrc rclrlc(l lo buccinator.i
(-. lrr)rr thc portcrior trunk I lt is ltluinly scusory cxccpt itcrvc lo nlylollyoid, whlch is
lnotor.
i 'i
 'Auriculotcnrporal ncrvc dividci lnlo
I; Auricular"firt sulptidi. itrc
' i. St in if ttrc-irogus.
-- ii. Uppcr part of pina.
iii. Extcrnal acoustic mcatus,
iv. Tympariic ni6ni6ranc,
II.
rll. Arti
a
Iv: Pari
.-,:
Lr:rgual.:; ;: ,-r';1',ich -_;.:-
lnrcrioa ralr'!ol:r
Infcrior aLveo;3a ''.;ilch q:\'es
eir es
L -r-eic ic ::., :olr:. oii
l!. 1,1::::l ::-. :

Branch (o nredial
Branch to 1e^sor tympani
Branch lo lenso. palati

Lareral pterygoid branch

Euccal branch

ln{enor alveolar ncNc

t
.
^" .--]- -. ",
, ,
I

Fig. 3 58 : llandibular ncNe efid ris branches.

d. Ap p lied anat.)nry:
A A lcsion at lhc lirrarrtcrr or,;rlc involvcs nrrrrrlrblrlrrr norvc illd r'csrrl(s in plr.rr.illl(.,
along tlrc rr;an<lible, tirc lowcr (mandibulur) {ccrh irnd'll)c siclc ol facc. ihclc is rri..,
paralysis ol-I]lusclcs ol rDastication arrd loss oijirv-jcrk rcllix :rs rhis ncrvc supplii:
both aflcrcnt and ctlcrcnr limbs for rhc jarv jcrk rclci.
D. Mnndibulirr ncLrralgiu : 'fhc pain tlong thc dislrib!rion of rrrirndibular divisiorr rl
lrigco'rinal ncrvc is cnllcd nraudibrrlaI ncurdlgitl. ll is oftcI diflicult to trcitt. lltis ii
trcatcd by divisio of tllq scnsory roor ol trigcrninal ncrvc.
C. 'llrc ntotor pan of rrrrrrclibullr is tc6rcd l)y rsliing t:lc g0ticnt lo clcnclr thc tccth.
 & ia::

4nglion
Ir is collcction of.-ccllbodics;o f parasymfirrhcric ncrvc !upplying
p..riplrcral part of craniunr.
A. Topographically it is rclatcd to thc nrlrdibular ncrvc.
B. Functionallj it is rclatcd to glossopharyngcal ncrvc.

J.
..1 : ".

D. Mcdially: Tensor palati.

E. Latcrally: Mandibular nervc.
4. Conncctions :
A. Parasympathctic or motor root -r:!_.ti:1+:':'=1.
a. Prcganglionic: Infcrior salivary luclcus - glc'ssopharyngc-"1 ncrvc-..ri.brmpanic--
branch of gtossopharyngcal rrcrvc - forrtts tynrplnic plcxus.alorig,:wi.th
clrolicotyrnpanic branch of intcrnrl carotid 0rtcty - a lcsscr pctros i lianih is
givcn 'passcs lhrotlSl) forsnlctl oYlllc - olic SitrlBlioll _ rcllly.
b. Postgnnglionic . auriculotcurpor:rl ncrvc - parotid gland.

Glossopharyngcal nerve

Mandibular nerve
....---
-l- Jugular foramen
\\
Tympanic branch of
glossoplra.yf goal nolvo

Skrn ove. the

te nporai .e9ion

Flg. 3.59 : Conncclrons ol olic oan0lion,

 I lcad, Ncck & Fa,..c I
'rl. ,

B. Sensory : Auriculotcnlporal ilcrvc p:rsscs ihrouglt olic gr0glion \yilhout intcrnlpting.

C. Sympathctic :
a. Preganglionic : spinrl ncr!c " supcrirrr ccrvicrl syrtlplrlhctic ganglion,
b. Postganglionic : plcxus arolil(i crl,.r'rrll curoritl llrci)..
5. Branchcs :
A. Au(iculotcmporal ncwc to parotid glrr),i
B. Nerve to mcdial .pteryAord pass ,trrirrot, rtr. nri. o'rndrio,.. xr:..'! s,.:fpl), rhc
.. a. Tensor,palatirand, . n.. ;. !i.'il
' b. .Tcnrbiiii,nipdiii. r': ,,, i. : r '. :..: ;'t
C. The.-otic. ganglion is connected to thc clrorda typmpani ncrve and thc ncr.vc
" pterygoid canal. This communicalinr chilncl possibly iorms an altcrnatc .outc of
taste pathlvay from thc antcrior tr(o rhird oI rrunk to thc gcnicutatc ganglion of
facial ncrvc.
6. Applicd anstomy : Injury to the nuriculotcmporat ncrvc manifcsts in thc loss
salivo.

l. Morp hology I
This is a laigc salivary gland siruarcd irr Ilrc irnlcrior part of digilstric triilnglc. It c,\iqnds
uplo stylomandilJultr Ir!:.lntcDt.
A. Dr-yfiet--Th1-fF"ia - ai"io"a Uy rtr',loltyorri nrLrsc lc ilto q)
a. Largc supcrficial plrt and 'vt
b. Srnnll dccp p.r lL. '.t . (:
'.]rto
3. Ends : Ir.p_rcs11.1;_1ly43ads
3. Anlcrror;rr,l
b. Postcrior.
C. Prcscdsjrrcc-su r lircc s :

L lnfcrior,,
b. Latcral &
c. Mcdial.
2. Rclations :
A. Supcrficial parr :
a. Rclation to infcrior surflcc ..
35, r. Skin,
ll. Supcrfici.rl irirrr.
I I, lll.
{) y lv
Plarysma,
DccP fisci., 1
,,^ V Colrrrnorr lacl.rl vcrn,
L\- VL Ccrvical branch of facul ncrr,..
VII. Submandi5ular lymph nodc.
b. Rclation to latcial surlacc :
i/. S L Submandibul;rr fossa of mandrblc.
(1 tl
,1,
I

';Lr.t;r',.t.; -{..i.- l:' - 'f',^:'-'l'^ J

I {1,
 t, I

j I 1': -':
llirr:j'.:'
' ":'' ll. Mcdial ptcrygoid musclc and MecLcruC oVt^)lc\
,:.._.-_:

. ill.
' c.
Flcial artcq,.
{.a, i.i0 ,tL[
McdqlSurl4c is cxtcnsivc rnri dividcd into 3 oarts:
t lb41s!,",1
'AMMlY5
i. t,,lylohloid ntusclcs,
ii. Mylohyoid vcsscls,
i ii. Mylohyoid ncrvc and

. r:r.,!:!.r..r
. rir. r:r':: ' l

s.
5,
p.
of pharynx and fl
linguai artcry. z il
Submandibular duct
Supcrrlclil .- DooP
I

Superfcialparl ol m
submandibulat gland -llyoqlossus

Tonguo

part ol rrtrnirndibular

Fig 3.60 : Suparficial and deep part ol submrndibuta. gtand.

B. Dccp Part :
a. Latcrally : Mylohyoicl. a
b. Mcdially : ll),oglossus and styloglossus
3. urooo supply ti
Blood , a ..).!
A. n rtcrirl supply : I:lcr;rl errcry. .. . \/6c\ L .
B. Vcnous arnincgc:Conrnror facial or Iirgual vcirr. tp i-A..
[,1,,^.r''o'..
Lyrrphatic drrina,tc : Subrnrrrrdrbulrr lyrnph rrodcs. i r.^q,Jt 'Cun
5nop1y , fc-A'l r-tPQl+(+l
e"iYltl Paliclr L c /"-
/v- il
tt \
'
5. Ncrvc supply fou
A ., S.{9sE!,"1-!bjjl . Arisc. tronr supcrior salilatory nucleus.
II I i

a. I'rcganglionic fibcrs p.rss rhrough facial ncrirc, qcnicUlnlc _ git.6gli!n, ; i ;

tympani and rhc lingual ncrvc ro rJach lubmin-diEnl"r-"*of ion.'- - - -Cho(d_a

b. I63ilanglion fibiEliiid from gangtion and cnrcr subi"nZibular gland. -.
_ Scnsory
B. fibrcs rcach thc ganglion through lingual ncrvc,
 Subrn3odib!lar ganglion

Facial arlery Supc.;or syn\Dclhcti.-

gang iion
Submandibular aland
Fig. 3.61 i Nerve supply ol suDmandibular gland.
6. ,tpplicd Anxt,Jnr\' :
A. Tltc submandibrLllr qllrrd is cxciscr! by an incision onc inclt l)clo..r' lrc rulgii I 1,1-
jaw Sincc thc rrrr rLiibLLlul branclr of frcill ncrvc is closcly rclatcd.
B. Thc sccrction ,rl_ rlrc suLrrrrandibuiar gl:lnd is -nrorc viscus, hcrrcc thc 11\.r i(lar1,j{: ,)t
calcuii is urorc rorrrrol ir lllc subntan(libula. gland_
C. A stonc jn thc rh r n rl b u lir r duct (\\'harton's dLrc() cotr hc I)irlpirlc,i birnlrLraill
s r r ir i

lhc floor of tllc rtourlt illd c:rn c\rcn bc sccn if sufficicntly lrrlc.

S u lr nr l rr tl i lr rr Ix r'rrgll ll glion l

.41-.-- I

I Intr0dLlctio : ll is r Lrillr(tr()n ol ccii l:orlics prcscll in iltc coLlsc (r1 i,r':rs.,_lri;r ril) , .
ncrvc supplyilg thc subrrr:rl(lil)ulirr lrrd suLrlirrgLral gland.
A ll is topogrirfltic,rll\ .{)rlt,t.tLr(j ro liIr1rIrl crvc_
ll. lt is functioniLll) rolr)cclr(j to llrcilrl lcrvc
2. Cross:
A. Shapc : fxsiforrl
tj. Siluiltion : Ol: lr.,,r:1,'r'Lrs rrrnclc.
C Relations :

n. SLrpcrior: l-irr .lr,e rc

b. lnfcriorly : l)Jii, l.irt ol sul,rn,rnrlrirL iur gland.
I). Conncctions
a. l)trasyI]]patlrct re
L ProB(n0lirrric lll)pur I Supqriol rflllv6lory rltrolcus . lilcilrl ,rclvc _ cllol\lir
tyntpani j,rins rvith lingttitl ttcrvc - submandibular ganglion - rclay.
IL PostgnnglioIric flbrcs : Llnnarrccl branchcs - to sut)rnandiL)ulilr or sul)LilLtirrl
gland.
 Lingualnerve

Chorda

! i,:

Lingual arlery

Submandib!lar
gland Fac al arlery
S,Jbin3ndibulal.

Hyoid bonc

Fig. 3.62 : Subma.rdtb,rtar gangjion

h. S Yntfa thclic fibrcs:

l. I'rcgenglionic fibcr,; nrisc lront:spinll rlrr\cs - sut)crior ccrvical sympathctic
,.tanglion - fibcrs rclay in rlrc gunglion.
Il. I)ostganglionic fibcrs forrn tllc plc\us uror rr(j .\lcnritl crrolid artcry _ (lingual
artcry) rhc fibcrs do no rclay.
c. Scnsory : Lingual ncrvc, branch of submaudibLrliu rrcrvc
D. B.irrlchcs : Fivc to six branchcs:ntcr thc subrnan(lrLLrlir gllnd, sublingual and antcrio.
lirtLrrl gland.

andj u nrlcr

(7Jr.rr c,o.r slriclrl. r'rrlcs fonn)

L (; ross :
A. Siluution :

l. Il is situatcd in front of C5, 6, 7 and T, vcrtchr:rc

b l:lch Iobc cxtcnds frorn obliqrrc linc ol lhyroi(l .irrl lrqc lo rhc sixtlt tracheai ring.
c Jllc istllntus cxtcllds front tlrc sccond lo lhc llr ,l Lr.rtlrc,rl rrrrg.
l]. l)irrreIsrons and wcight :
n. l:lch Iobc mcasures 2" X 1,, X l',.
b. llrc isthntus mcasurcs %,' x %,.
c. Wcight: About 25 ,]ms.
C- Capsu lcs I

a. 'lruc capsulc I It is condcn.ation of .ur.r'ccrrvc tissuc of gland,.

b. ljrlsc capsulc : Il is condcns.rrion lcriphcril
 L\ lP conrparc rhc
tii
of lo'l t borrc

I :h

ls

o,_orroh),oid arrd

Supc.ror iaryngeat ncrvc

Hyoid bone

lnlcr'ral taryngeal nerue

Thyrohyotd membrane
Exlernal laryngeaj ncrve

Thyroh)roid c€rlitagc
lnfcfi or conslriclo. ntuscla

Cricoihtroid nrLrscle C .i r! ol tobe ot tfrr.oid gtrrjd

Cricoid cartita0c

Outline ol isrtrlnus ot Ocsoltr:r0U:;

lhyroid 9la nd --
RccLrrrcn( hryngcal nerve
Trncho.r

Fig. 3.63 : Structurcs rslalcd

to mcdia and tatcra/ surlrca
o, ry.oid O and
 Stomothyold

; Falss r

Stsmomaslold l.Tgo "

Sup€no.

Prgverl6bmllascla

Oesophagus

Flg. 3.64 : Rclations at lhc lovel o{ 1lr" lslhunrus ol tlrc lhyrold Qland.

IL Mcdial
i. Musclcs :

- lnfcrior corrrtrictor and

- Cricothyroid.
ii. lubcs :
- Trachca and
- Ocsophagus.
iii. Ncn cs :
- Extcrl)il 3.11(l
- Rccurrcnt lrrrvnli;al.
lll. Postcrolatctal i Ci!roti(l slrcirllr
b. Iiclatiors to bordcr
l. rltcrior : Supcrior tlryrord rtcry (lntcrior broncll).
ll. I'ostcrior:l)aratllyroi(l glrnd is tnrpottlnt structurc. l'lA
i. lnfcrior tl)yro id ilrlciy.
ll JI)orJ r. J.'r I rr\ or' I(ll rlil
iii. lnastornosis bct'vccn supcrior & irrlcrior (hyroid artcry.
G. BIood Supply:
r. Artcrial : S-.r t'; \
l. 1{crior rt)'roitl trttrt It supplics hlootl to the najor port of lhe thyroid
gland i.e. (Two thinl ol lartral loltcs unl hulf of tltc istltnus). lt is a branch of
ii,yroc"ni"ol tru,rk (i brarrclr of subclirviirn aricry) pcnctraics dccp leurf4cc of
:".1,r,i> gl.rnd and ahastonloscs rvirh dcsccnding branch of supcrior thyroid{iancry on
postcrior bordcr of tlry roid Ellnd 1/ ir closel.t relatcd to rcc rrrcntl laryngeo L,

ir"rvt ncu, tltc glanl It supplics I i

i. Lowcr two-third ol lobc ol'lhc gland and 1

ii. Lowcr hqlf ol istlluus ::il, . ;
Il. Supcrior lhyroid artcry (n branch of cxtcr al carotid) dcsccnds
 thyroid gland irnd divi(l.s rttlr'r itntcrior and postcrior branch. rvhich dcsccttd:
along rntcaior irntl postrr i,tr bord,:r 'fhc tntcrior brilllch ilnilstouloscs \villl
arlcry of oppositc sirlr ,r r :LrpcIior boldcr ol islllrnus l)ostctior brirn'l
anastouroscs Nitl\ iufcr;,)i llrvroi(i Irtcry on poslcrior bordcr. /t ir c/rrr' l
relaled vitlt attcrntl lut ,':r:,,t! ,rclrt lt supplics
i. Uppcr onc-tliird of rlr. !1rr(l rrd
ii. Uppcr half of isthrrus
Exte.nal carolic

External laryngcal nc.ve

Vagus nerve
Cornmon carclid a|1sry

'-ln{e.ior lhyrokl irterY

SubclaviJn a(cr '

Fiq. 3.65 : Arlcfa supply of lhyioid gland

IIL Thyroid inrr : lt cithcr ;rrisrs liom brachioccphalic lrunk or irrch ol ir"rliL
!t suppli':s isrlrnrus cf thy-roi<l g!: tl.
lV. NuutcroLr.s :rcccssory thyroid irrlcrics, br rlchc) o,l_ ocsopllagclrl ilrld lr;lcllcirj
artcrics. TIlcsc brilrchcs supply'(llc glilod fronl tllc lllc(liill ot tlcc;t surfltcc
b. Vcnous Dritinirgc : fltc vcins ol lhc lhyroid glarld lbrnt plcxrrs rvltich is silrrrrt':'i
dccp to thc clfrsulc rllrd d in rrs lirllou's
L Supcrior lh!'roid v,:in i ll dr:rios ir)to lIltcrr)rl lugullr vcirt.
Il. Middlc th) roid vcin : lt dlains irrlo inlcrnrl jirgular vcin.
lll. Infcrior lhvroid vcin: Il drrrirr; irrto lcll brurrcltioccplralic vcirr
Superior lhyro d ro n

Internal JUgulir v!irr

l.r'lrddle lhyrorl "e n

lnleftor ihyroid ve,n

Subclavlan vein
Ersclriocephalic vcin

Superior vcne

Fi9.3.66: Venous drainagc ol lhyroid 9land.

 H.1:, \.:i .:

H. Lynrpharrc Drcrn:ge :Thcy are arrangc,i iIto

8. Uppc. group : Prclaryngcal and jugL:io digasrric.
b- Lorlcr group : Prc(rrcllcal groul llong rc;urrcnt laryngcll n,.-rrc.
I. Ncrvc srrppiy : 1hcy arc dcrivcd
a. l.'!ainly fronr nriddlc ccrvical synrprrtrcric ganglion.
b. Panly by supcrior and infcrior-syirplthcric gr-nglion.

Folliclos

Fig. 3.67 : Hisrotogy ot lhyro d gtand.

A. Lrrnrcn of fotliclcs, slrorvs colloid rDntcriit.

n. Folliclur rrrc lrnu(t l)y cr,tr,r.l.rl .l'lttrollunr.
C. Thcrc nrc clclr or lrglrr cclls calicd paralbllicLrlar cclls rvlriclt prorlLrcc cirlcironin.
U. ll)cy irrc f,olyh, Jr:r1 \\'rtll ,)vitl, ccccntric jl clci.
E. Thcy flrc nrcscnt bctwcc,t lblliculnr ccll!i jlnd lic on [ln5cnlcnr trlltl,r|lllc.
3. Dcvclopntcnt : '
A. Chronologrc,rl gc Il (lcvcli)ps in thc fourth tvcck of intrautcrinc Irlc.
IJ. C.crrn lrycr : lt rJcvclops frorn cndodcrnr divcrticulutn, thc lhyro
!ilossirl (jIct.
l. )ltc I loor ol tllc phlrrynx bchind tllc lul)crculunt lntnilr of (llc (lcvclotrilJ: lonquc.
U- Sourccs : lt,Jcvclops a\. mcdian thyroilt divcrticutunt c\tcndrnt fr,,,,i ti,-,,,,nJn
to lhyroid carlilagc. Thc disral prrr bccorncs bifi(l rvirhin rvlriclr rhc a".r .li"iacs"uccum
scr ics of doublc ccllular plaics. Tbc duct Jisupncers, rr\ ccFhirlic
inlo'a
p.rlg,r-;i u
loramcn cJccum anJ its crudrl cnd occasionally fonns thc pyrtmj(lirl Iot)c. ",,,f I I
Anornalics
E. Anornalics I O---r ITi\ I t
a, lnconlplclc dasccnt of rhyroid lllyroid 8tand.
i !l::lllll.:::
b, f.sccnr
Iliyrogloss:rlducr.
gland,
I I
c. ,Lhyroglossol cyst.
d, Agcncsrs of rlryroid gland.
 -r *.,:- i:-= rii ar :1: _
Applicd snstqmi. : .
A: (}i f1i 'Drrii;g tlry&i.lccr,n!, irleriir 'titj,roia arrcn sltouhl lte liel strol'lront thc
gland to
Bland lo aioid
avoid injiry'to Ion'noaal i"trn ot',1t ,,1,r,
rccutent ig-114e91i"49j,,
iniury lo rcarrrcrrt i,,, tht'roid
trutrior art"^,ihouk!
tt,yrii,l nicn, ,"
oull f,e
' ' ried ,rcar.the gland ro dtdiffillGlltlic cri,,rrnt Lt,t.u!:t,tt nirte.

slporfc,ar Doc{r
I .

Sle.nothyroid
Exl6mal 16ryn0orl nodo

gland

Flg. 3.68 : Atlachments ol stcrnothyroid musct6 showing prcvcnlron of

upward enlargentent ol thyroid 9tand.

R Thyroid gland is cncloscd in rlrc prctrachcal fascia, rvhich is atrachcd to tltc tracllct lrn(i
larylx. Tlrc pos(crior wall of thc larynx is thc a0lcrior rvall of pharynx. During
dcglutimtion, thc pharynx nrovcs, so that larynx also nrovcs. Hcncc, srvcliings urising
lrorn thyroid glr d !lso movc. fltlJ ls a i lor!on! diogrortic fcatuta ro
'.:{::::.'.1:::t:::!!:Xs;y!!!L
Srf crures t thc nia linc. !o1L-1\ly!-ara,u! iut s'.'atting a,isi !: lront othu
C. Thc upwqrd cnlargcrlcnt of rhyroid gland is p.cvcllrcd l)y s.(JltoA,yrall rnusclc (s ir is
!ttlchcd to obliquc llnc ol' tllyrord curlilirc{.//,ix(c ..1/ ,/r,r rr!c//irt,r ol tL oiJ rl tkl
'
eularge 2---:

D. A ddnat1!9t1t13y/t.
crpsulc is lrcscnl dccf' truc capsulc l{cncc drrring ihyroidccton)y, truc
ru
capsulc is:rlso rcrrovcd llorrg rvrrh thc thyroid glantl, to avoid blccding
[. P,rrtirl tLyrordcclorny is nrclcrrcJ ovcr total th),roidcctotDy, to avoid posropc|lritc
1ii6ocatm.--Usr'nfpo,r. iio, p"., of both lobcs o{ thyroid glrnds arc lcit to rr oid
hypopararhyroidisr).
displrccnrcnt a|<J cornprcssion of ncighb0,rIg
arc chlracrcrrztd by
-E:jgl-lryT
Cj-Ylligjalt-S Tj rs of thyroid giand arc characrcriilcrl by invasion and crosiorr r.rl'
ncrghUonng slrucl rcs nar)1cly rccUrrcnt Isrl gc l ncrvc.

Thyroglossal
t. Intioduction: A duct cxtcllding frotn {hc foranren caccunt of tonguc to thyloid primord ium.
It rs prcscnt in
cmbryonic lifc. lt is formcd by cndodcrm of third and founh pharyngcal
archcs.
 Fatc : Disral part usually di{Tercntiatcs t" tLrrlI pyrlmidal lobc and
iemainder part oblitcratcs.

-lon9ue -+-,t'
--)

,rl* i

Thyrold 0land ,.ii.1..

.,'11.
Fl!, 3,60 r thyroglDdrAldu6r.
Chr,rnologicnl ege i At sevenrh wcck ol irtra Lrrcrinc iife.
Applicd ana(omy : l'crsistcncc of fragrncnt oi' th),rc!lossal duct
cysts or fistula.
Itcfcr thc Fig of thyroglossal cl,sr.

l. Aetiology i lt results from pcrsistcncc of a porrio:t ol'a Ill),roglossal d,rct.

2. Incldcncc : It is thc commoncrt congcnltil ntrL,Il.rly.
3. Sitc : Bclow thc lcvcl of h1,oid bonc.
4. Agc I Ir l! ovldont ih lllo ln!o loon! Frcrunrrbl\.u.ic:tur.u llrc li,l iIl] Licco ics $eclctory.
5, Clin ical rnanifcstation :
A. It prcscnts as a swclling alonS llrc coLrasc oI dLrcl.
B. Thcrc is rcoccurrcncc of thyrcglossal cysl il lllc,.ri).rlc ol thc lltyroglossal duct is not
rc rno vcd,

Tong ue

S,rporlo{
Thyroglussal

Thyroid

Fls 3.69A
 l{cad,

Parathvroid gland
Thcsc arc trvo pairs (supcrior rrrrrl rrl-rrror) Lrl snrlll cndocriuc glanris.
1. Sltc : On postcrior border-1r,.-.rr ol i:1cri\l lobc of rhyroid glrnd. llrcy rrL: 1r ..
the crtpsule of tlryroid gLrrrr.l

2, Gross :
A. Wcight : 50 n1g. cacll
i B, Dimensic'ns : 6-x i x i:r:::. :

L rosluon :

a. Su:::i_- : rrr:. . . -.: .. :r.:c cli-l3nl in posilion and lics rt tl'i:,r 1.11,

postc::c: :::::r : .,r:::l lcl-_l oi th).roid gland. it lics insidc tlrc trii. i rl
C)15:. :. :aj :::..-. . :.:-.1 :,.,,C.
b. The i:ricrior para(ir\rord glrnd is vcnrral to thc recurrcnt laryngc.,L ,,,,
position of inferior pararhyroid gland is variablc. lt may bc :
L --QutSidc-,th,r- iaisc capsuie of thlroid gland aird a,bcyc llr. irl,rri rr 'r

il rt c ry.
IL -Within-thc. lulsc capsulc of thyroid glaud rnd bclorv thc inlcrr,'r
rc:lr lllc t'\\. ,r. 1,. ,,1 t',yr.l,l Iobc.
lll. Within tlrc sLLLr!lin(:(' ol'lhc lhyroid Ilir](l ncnr iLs poslrrior i)or(lci

t\
ir l.',
Superior parathyroid gland

Recurr€nl laryngeal n

i
lnferior thyroid artcry

Truc capsule - -
rj

inlcro-prrJl-yoog.-d s )
Supcrior

I
ft

Fi! 3.70 i Pos t oni of lllc pa.alhyru,,i .r ,-

'"1
 . , .Subclavian ariery .:,!:--=-'-: I
I

Introduction : It is thc main of uppcr linrb and srrpplics considcrablc pirt of neck
and brain. - ^rlcry
Origin : On (hc right sidc it ariscs frorr !q.:rcl{occphalic rnrnk. On tlr! Icfl sidc it ariscs
fionr arch of aorta.
3, Extcnt : I1 cxtcnds front ,talnoclr\_icall.rr .Jnrrrr ro or.ttc, bor!i.r of first rib.
4. Coursc nnd rcl^iions : TIrc irrtcry is dividcd i to tilrcc p:rts by scalcrrus antcrior musclc.

lnferior thyrord ancry Sc, anus anlcnor

Traosversc ccrvical anery

Suprl sczputar artery
Coslo cervical trunk
Thyroccrvrcaltrunk aa
Fi.sl rib
Dorsat scaputar irlery i!
Righl subclavian
arlery Lell subclavlan.rrlcrv
.n
,n

FIS I 71 . SuL- a, dn anary ond its branchos

 ;..:- : -.'.. .-1:::
-_+-::f-
First parr of subclavian artcri'is:;ncdiai;';b;nd lart is postcrior and third part
scalcnus antcrior musclc.
5. Ilranchcs: C-'r' \,tT C D
A. First parr ;
a. Vcrtcb.al arlery.
b Intcrnal thoracic artcry.
!h;';occrvical lr.rak -hich dilidcc intc : €--: SIT
r. >uprascapulari, &,, lL. 4.i.. +., :i:, -.;:
IL ln ferior'itryrold; !f'-i' i---? ;-
Ill. Iransvcrsc cervicitl .-l- , .4- . ji:.: l:
B. Sccond prn : !ostocenical aiiery.
C. Tlrird pan : porsal scapular ancry.
6. App i c d I n a t o m y :_S$9.byr,a!_rlg!_€yAqt4g!e rakcs placc in obstruction of the subckr
I
r
artery proximal ro the origTn of virrcf,rai-arrcry, Somc amount of blood is stolcn frorir
biain through rh. \'cncbral artcry cf the cppositc siCc i:: ordcr to pro'..id: -ccll-
circulation to the affccrcd ann. This.may result in ischacmic ncuroio[ical synrptoms.

Internal jugular vein -t i,r'\(/

dircct conrinuation of signroiC sinL_rs.

Iixtcnt : It crrcrrds from jugullrr foramcn to srcrtrxl cnd oi clrviclc lL joins thc sLrbelr.. iin
vcin to lbrnr brichio.cphatic vcin.
Tril-rutarlcs:
A. Pharyng:al vc ir,
B. Supcrior thyroid vc in,
C, Middlc thyroid vcin,
D. I.ingual vc in,
E. Contmon flcral v"in and
F. In fcrior pctrosal sinus.

-8,
Asccndrng pharynqer , r"t^
a
Lingual vo in

Superior thyroid vo n

Flg. 3.72 . lnlerna jugular vcin and iLs tabutaries

 Hcrd, Ncck &

Rslatlons:
A. Postcriorly : The rclation arc fronr abovc ctorvnrvartls
a. Rectus capitis latcralis.
b. Trarsversc proccss ol atlas.
c. Levator scapulae.
d. Scalcnus mcdius and ccrvical plexus,of rcrr,cs.
c. . Scalenss antcrior;bnd phrcdic ncrvc- :. . rlll
'ir, fi, .rrh4giqliviiililtiiqi ino ni5t part or. vcncbral I lit anery..
'" g. ' 'Firil pi'rt ciftuttliviirn drtlryi
B, Anicioletcrallv :-;- -
a. It is crossed by supcrior bclly of omolryoid and postcrior bclly of
_ b. Bclow the omohyoid : Srcrnohyoid and stcrnothyioid.
C, Mcdialiy :
a. Conmon carotid artery.
b. Vagus newe.
4. Applicd an{tcntv :
A. Thc intcrn.i jugular vein is acccssiL:lc decp ro thc suplirclaviculrr fossa. thii iein is'
tuscd for rccording venous pulsc prcssurc.
il Io (hc congestive cardiac fcilurc thr i tcrnll jugrrl,rr \, r' r\ r,,\l rlilrrrc'J vcin.
C. Thc dccp ccrvical lymph nodcs llc o thr rrrtcrrr.rl J.... l.,r v^ltl

ncrvc:undcl :
2. Coursc anC
Applicd arratom
I):l rD t ico lr) tili t!tnI'jlnil

Tablo 3 22 .
.The
rable shows tg".ti""rl!91rr"ljl!s &_tho flnctions of thc g ossopharynoeat norv€.
I
I unclion:ll conll)oncn(s I Frrncfi,r,i,
A. Ccncra I sonlrtic affcrcnt. f) r iD, toLlch and tcntpcratLrrc frorr poslcrior one-third
of tonguc, tonsil, soft palarc & oral parl of pharynx.
Spec ir I !isccral affcrcnr SvAd 'fnstc scnsations fronr tlic circuntvitllatc
papillae and
postcrior onc-third pa.t of tonguc.
C. Gcncral visccral affcrcnt Front baro-rcccptor and chcmo-rcccptor of thc carotid
Scnsat io n body and crrotid sinus.
D. Brrnchi-rl cffcrcnr (socciirl Motor to stylopharyn!cus
r 15."' 31 ,:JJ"r"n1;. SaVD'
E. cenc;1r.";itr.; Sccrelo'nolor fibcrs to prrrotid glancl
CiVti G lan(t(

2. Coursc qnd rclstions: 'fhc ncrvc ariscs by I to 4 filamcnts frorn postcro tatcral
lulcu's of
mcdulla obloogala. Thc ncrvc lgrycs the s1,..:l by prssing through nriddlc part. of jugulsr
foramcn, anterior to thc l0't ana il'' cnn.,l ncrvcs. It has a scparalc dural
shcath. - '
4. Applicd qnatorlry i
A. Thc glossoiharyngcal ncrvc is Lcstcd eiinicalll by'
a. Tickling the postcrior wirll ol fl:r.,nr. Thcrc is loss of
tnusclc in thc lcsioll oI qlossoplrrrl\ rrgcal ncrvc.
b. Testing scnsations frorn p,,siciror r.r:'llrird of tcngue.
B, Isolatcd lcsion of glossopharynLcrl lcrrc is almost unLnown.-

1. origtn:
-nry'r ::l:=::-'
,f. recute laD,ngcol nen,t otises frcDr vagus nerve iit.tlr" iic[,
B. Lqft recutent laryngeal uertc arises from the vagus nem|-ii the'lhat.ji'
2. Coursc and rclations: Is slightly diffcrent for the right and left-recunent
A. Right iccurrcr,i laryngcal ncr\c.
a. It is present in front oJ tlte subclavian orler), a d \einds il.
b. It runs uprvards and mcdially bchind thc subclavian and common
and rcach trachco-ocsoplr;[rcil I groovc.
c. ir1 tlrc uppcr pflrl olgroo!c, it is rclitcd to thc infcribr thyroid artcry.

s,
^I

Trachea Vagus narve L+R I

Oesophagus
+
I
Recuarent laryngeal nerve lnferior thyroid arlery

SLrbclavian a rlery
n rch of lh,. aorln

Fi9.3.74 : Co,,;,., ol.ccurrcnl hryngeal ncrve

rl. lhc ncrvc pnsscs rlccp 1t) loNcr Lro(lcr of infcrior cons(rictor. Il cnlcrs thc larynx
bch intl cricothyroici jo int
ll Lcll rcLurrcnt laryngcal rrcrvi
l. It c()sscs llrc lcft sidc o rrrch ol-thc .;otta.
b. lt loops atoknd !itt' !it:,r't!(ntunt /ut,'riasuu anl teachcs lltc I t ocheo -oesoPhagc al

c. Il ijo!s not havc to fir\\

l. l)i,tr illlrtio : lt :upplrcs
n. ll irtrir)sic musclcs o, lar1'nr e:rccpt cricothyroid. ,i
ll Scnso.y rtcrvcs of thc llryrx belorv tlrc lcvcl of vocal cords. i l

(l 'l'ltcrc arc four cardiac branchcs lrorrr thc right rnd lcft rccurrcr)t lcryngcal ncr'{b. Thcsc
arc nvo superior and trvo inlcrior. Our of rhc four cardiac brancllcs thc Icft inferior
branch gocs to supcrficial cardiac plcxus. Thc threc cardiac branches join.tbc;dccp .
curtlrac plcxus. a -: .-rEt:l
- r',1h8! t :
 D. Branchcs lo trrchcr and ocsophagus and
E. To thc inJi ,' ..'r.stlcror.
4. Applicd nn!ltonr\' :
A. Irritation oi- tlrc rc!ilr.cnt laryngcal ncrvc by cnl0rgcd l1'ntph r'',r1,:s in clriidrcn
producc a pcrsrstcll cough.
B. Recuncnt larl'ngcrl ncrvcs may bc injurcd in thyroid surgcry or conlprcssc(j
groving tunlor, norlic ancurysm or lrolr othcr causcs..
: !i' .1c; If 6qly onc'rccuncnt laryngeal rlcrvc;ls ,piraiy,1pa, ;thc'Fffccrgd vocal
the parsmcdiirn position and the v6cal iord on tlie nonnxl sidc
phonation.
D. If both rccurrcnt laryngcal nervcs arc paralyzcd, tlic vocal cortls rcnrain
paranedian position (in betwecn abducrion and adduction). 'lhis rcsrrlrs irr
a, Loss of phonation,
b. Dyspnoca (dillrculty in breathing), and rcspiratory stridor.

3 :riiessor)' ricrye undci

l. Functio0nal conlponcnts 2. :Coursc and r,rlfltions
3. Brarichcs & 4. Apnlicd lnltonl\'.
1. Functional contponc (s I ll hts t\vo roots, cralliil and spinal.
A. Cranial root rs spccirl visccrnl cffcrcnt. lr ariscs fronr nrrclcLrr urririrlu..rs. lr i:
distributcd rlrIorrlr pharyngcal plcxus, 1o rhc
a. Musclcs of palatc,
b. Musclcs of pharynx and
c. Musclcs ul Lrrr rrr.
B Spinal root is also spccirl visceral effcrcrlt. It ariscs froot spinll ;rrrelL,rrs plL:scnl in rhe
anterior grc) c rrLrl'rrr li rhc spi ll cold, cxtc diug fronr C, lo (. r,!,trjr,j t l(j !lbcrs
supply
a. Stcr'noclc idrr rrrustoid.
b. Trapczius

2. Cou rsc :rnd distril)Lrtion :

A. Cranial root
a. lt crtrcrgcs b) 4 to 5 roollc(s, cllilcllcd to l)ostcrolatcrnl sr.rlcrL;0i rlr,: r;rcLirrLllL
b. lt r'-rrs vith ninth ilnd tct)ll) cranial ncrvc and thc spinli ir..csli()..r r.:r\'.t and
rcachcs lltc jLrgrrlar forantcn.
c. In thc juqLrler lor:rrncn, thc craniitl root unitcs rvitlr thc :ilrLn,rl ro,-rt rrrri rrgain
scparatcs itnd l)itsscs out scpilrltcly.
d. Jhc crrrri:tl roo(, finrll) fLrscs rvitlr tllc vil!us ncrvc and disLr i,urq; to Llrc:r'rlrcLcs
of pharyrr r und lurvnr.
B. Spinal root
a. It ariscs lrorrr rppcr fivc scglrcnt ol sprrrlrl corcl.
b. ln thc vcrtcbral canill, (l)c fila11cnts unitc to fornl a sinLllL: trunk arrrl c 1rr., lhc
craniufi lllrougl) forarncrr nragnunr.
c. It runs along with cranial root oI acccssorJ and joinj in tltc j Lr rtu lar l'orrr:rlr and
again scparatcs and concs out scparatcly.
 .d. It dcscends-vertically,. between the internal jugular vcin and intcrnal
e. It rcachcs a point-midway bctwccn thc anglc of thc mandiblc
proccss.
f. It runs dorvnrvords and backward; superficial to intemal jugulJr vctn, aid
stcrnomastJid..
g. lt picrccs thc antcrior border of itecnomastoid dt'thc j

l.!r 1,r-rr sllrsrr. Ll

i:r - It leaves-l
and eods by supplying it.'

Cranlal rool ol acc6ssory

Spinal rool ol acc6s3ory

Jugular {oramen
lnlodor polrosal slnu s
lnlcrnal lugular voln
Ttansvsrse proc€ss ol allas
Stylold p.ocess
Occlpital arlery

Stylohyoid

L€6s€r 6!ric!Lar n 0rva

Po5lcrior bclly o{ digastrlc

Tranczirrs --.
-- Stcrn o cle do{rlastold

Flq. 3.75 : Co!rso irlrd .lislribution ol ircccsso'y oorvo

llr'urtchcs:
A Crarriltl root supplics :

a. M usc lcs of palatc,

h MLrsclcs of pharynx and
c. MLrsclc:r of larynx.
ll. .Spi'ral root supplics:
.r Slcrlo lc rdo rrrlsroid
r, Ir,.t r/ .\
'L AIl'lir(l I ll(odry:
A- 'lhc acccssory ncrvc is tcstcd clinicaliy ;
a. lly asking thc paticnt to shrug his sirouldcrs (trapezius) agrinst
conrparing thc powcr oo thc two sidcs; and
 )j3:,C &-i

:. i s:..-or'r13sloid)

Thc
a. Thc facc is tumcd towards:I1i€-lide'bf irijury.
b. Therc is an inability to thc :houldcr towrrrds t|c sidc of rlur:
paralysis of trapezius
C. The - pus. accumulstcd , ne8
sternomastoid,ilbpl
acccssory ncrvc.. :
. i.rr r- r;q-+--: t: 'i:

Futrctional conrponents : Somatic ef.f_ircnt suppiics muscics ol tonguc.

Coursc and rclation\: It ariscs from sntcrolatcral sLrlcrrs of nrcciullr oblongata. Tlrc rrcrvc
Icnvcs thc skull through hypoglossal canal.
Extracranial coursc:
A. l'hc nerve first Iics iccp to thc intcrnal jugul:rr \,cilr rr)(l (lcsccllds bctrvccn irr(,rir;tl
jLrgular vcin arid thc intcrlrJl carotid ar(cry.
B. It is prcscnt dccp to t lrc
a Parotid gland,
b. Thc styloid proccss,
c. Tlrc postcrior bclly df thc digastric ancl

Hypoglossal nerve -

Exlernal carotid a11e.y

HyoJlossus nruscle ---

Submandibular aa nqlion
Lingual nerve lrlernal carolid arlc r y

GenihYoid

---
Flg. 3.76 : Courss and d siribution of hyi,.)Olossal norvo.
branchcs containing Cl nervc but through twclfth ncrvc.
a. Mcningeal branch.
b. Ansa ccrvicalls.
c. Branches to lhyrohyoid and geniohyoid.
1. ,\ppllcd-arrtonly :
A. iiypogiossai ncrvc is testcd clinically by isking thc piticnt ro protrudc his tonguc.
l\. Lcsion of the hypoglossol ncn)e prcduc(.t purolt'sis of tlta tangue to lhc side of lcsio .
1'hc position ofthe tonguc indicatc sidc of rhc lcsion.
C. lf thc lcsion is infra nnclcirr thcrc is gradurl atroohy on tlrc sidc of lcsior.

l. Introd ction : lt is a sympaLhctic ganglion lrcscnt on thc latcral sidc ol vcricbral coluntn.

sympalheiic gangllon

ramus ol Cl

Ansa subclaviu9=--
lnforior cerVical
sympathetic gangllon

Anl,rrior prima.J
.rmus ot C! i I
I

Subclavlan
i
I
I

F19.3,77 : Inlero -orvical sympath€iic ganglion.

 Hcad, Ncck & Ia:c

2. Gross anatomy :
A, Situation : Ccrvical rcirorr i|l front of ncck of first rib and t.ansvcrsc pro:.:is of
' '' siuenth vcrtcbra".
"crvical l'
- B., Fomlatiofl : By fusion of sc,cnth and eighlh ccrvicsl ganglir rt C7 vcncbtir iorms

.l .r::r:::jl:llot. ganglion witir T, gangiion

3. Rclqtlons :
j.'r!r1:A.!-A-itiii(
iancr,l |i".
:,Eighth. cgrvical. spiAaf qcr_y.qi,l
:"Ih-irdjpan of vc riebra I i' -
branchcs:

the heart by dccp cardiac plexus.

rami comnrunicants Are givcn to thc vcntral rami of ntivcs

5. Applied arrtouy :
Iiorner's si'ndromc : It is dLrc ro involvcrlcnt of synlpathctic ncrvc, rvhich is contIibLrtcrl l'y 'f,.
It usuall;,-occurs duc to in.jur,r, al thc .oot of braclrirl plcxus.
fr lloRNE[i l hc lctlcrs of th" ruoid "llorncr" givc lhc ir)forrrrllL{)Lr irbout
clinical rranilcstations ol Horncr's syltdromc.
l. I-[ypohydrosis (/r-rlo lcss, /r.,/rori.r srvcrting) is duc to invollcmcnt o{' :r\ frll.lllrctic
ncrvcs, rvlrich arisc fronr llrst thoraclc ncrvc. Thcsc arc sccrctornotoa fil)crs sLrl)l,l)'ru I llrc
sweat glanCs of ihc skin ol rlic face nnd forchcad.
2. Qening of eyc is iost cluc to ptosis (drooping of the upper cyclid). it i:; crrrrcd by
paralysis of Mullcrs nrusclc (snooth rnuscle of lcvator palpcbrac supcrioris). ir lrr, t it is
pscudo ptosis.
Argyil Bobcrtson pupil Iconsrrrcrcd ounil] duc to paral),srs of dilator pupilllc(LrnopIoscd
action of sphinctcr pupillxc
4. N.:rrcrving ot p:rlpcLJ'i. ti-. r:
Llcvrtion ot lowcr cyc, i,l
6. Bctraction of cycball. (SrrrrIcn :ycb,rlll Ir]olrl)tllirlDtus rs (lrc ro llrvol!,c0rcrL ol orLrl,llis
m usc lc.

1. Origir : It is mainly lbrnrcd fron C4, rvith unimportant contributioil fronr C3 rrnd (. ii is
onc of thc rnost iorporlanl ncrvr ill rltc body, tlrc only nrotoI supply !o its own irlll of
diaplrragrn. It also supplics pcritoncurn, plcura and pcricardium.
2. Coursc and rclations:
A. Thc ncrvc is formed at ihc Iatcral bordcr oi scalcnus antcrior, at thc lcvcl ol L)i't)cr
bordcr of llryroid ctrrr'lgc.
B. It runs down\!erds on llrc anrcrior'surlacc oI scalcr]us rtcrior.
"crtically
 C. Thc ncrvc lics dccp to
a. Prevcncbral fascia.
b. Infcrior belly of ornohyoid.
c. Transvcrsc ccr\,ical or Icry.
d. Suprascapularartcry.

Phr6nic nerve

Omohyold

Taansvease cervical

Supra scapular:
jugular veln
Thyrocerv cal lrunk subclavian v€ln
subclavian 6r10ry
Righlsubclavian
arlery

Arch ol lh€ aorla

Fig. l-78 : Phren c nerve and its rclatjcns

Branchcs:
A. M^ror irrdncltcs
Dia,t.tr.3n Plrrcnic ncrv r. I n,rirr rrrornr ro tllc draphrlgr'.
B Scnsory brrnchcs ')crvc {
a. CcnLru f;rrt of d.lpit...\.r) I
b. ?lrLrr;r.
c. lcricardiunt lnd
d. I'crtorrcurl.
Applicd injrtunr\:
o t.,
llt^""
occauscl1:,:?': ll:.i"" yri
ol frcssUrc llOrrr
rnjurcd by pcncrraring woun<js
..rliL,n..)t (r. .or( tn thc mcdiaSlinurn
of thc ncck or damaged
_
B l/ phrntc tttrrt ts ,l . t 't t. !t]., .\r,\,tlandrng half of thc dtophragm
l,:::.:1.,,,,, ,!,.!,-, 1:,:,r,,,
r o1 .,1,c ,tiapt.rag,1-",ir t) Lt,i",t'",(t pu.rhed up will bc
ptto thc
utota.\ u)' thc I'otttitc ,)t,,t,, tt)t l pr(x!rr! As a rcsult, thc lot,er libe ol th,e luig on
thar t t ntt.1 cotttpse.

Scalenus antcrior
It is a decp musclc of sidcof ncck.
1. Origln :Anlcrior tuberclcs of transvcrse proccsscs of typical ccrvical
fou nh, fifth and sixth ccrvical vcrrebrac).
.
 iicad, NccL.&-Facri

1. thc rn!rcr bordcr oi lirii arl)

3. l.. c r\,c suppl\- \'aiiaai of founh, llfilr and sixlh ccrlicll rrcrvc.
4. Rcln'tio s : It is a kcy musclc of thc lowcr part of ncck bccausc of its il1tinlatc iclations
to many important Structurcs,
,A..Antcrior '

b. Arterics
[, Trnnsverseccrvicol,
lI. Suprascapular and
ilI. Asccnding cervical.
Ve ins
L Intcnlal jugular vein and'
Il. Subclavian vein.
d. Musclcs
L Stcrnoclcido mastoid and
ll. lnfcrior bclly of onrohyoid.
c. Bonc : Clavicle
B. i'ostcrior :
a. llrachiol plcxus (lorvcr trunk).
b SLrbclrvian artcry sccond part.
c. l)cc1t ccrvical artcry,
cl. Supcrior intcrcostal artcry.

Phrenic ne e
Scx rnirs inlcrior

Omohyoid muscle

Transverse cervical
\..--.tt,nro.. oucr

Supra scapular -....'-_

Thyrocerv cal kunk

Righl subclavian
adery

Flg. 3.79 : Scalenus anlcrior and ,15 roLal ons

c. Mcdially:
a. I"irst part of subclavian ilrtcry.
b. Infcrior thyroid ancry.
c. Syrnpathctic lrunk.
D. Latcrally :
a. Third part of subclavian artery.
b. Trunks of brnchial plcrus
 Neck Facc

of ccrvical-spinc.
spine to oppositc sidc.
dur ing inspiration.

At(achnrcnt i [t 'is attachcd to upplr 8nd

lowcr bordcrs of snieriorturfecc,of-bodies ---
of all vcrlcl'rae
atlanlo occlpital
2. Ex(cnt : lt c)ilclds from antcrior surlacc cf
trppcr srcral vcrtcbrn lo antcrior tub,.:tclc ot lubcrcle second
cervical
sccortd cc rv icirl vcrtcLra.
3. \/rrix(io ir thiclincss : lt is triangulir ln
sltap,:, uppcl part is narrow, lowci par( is
brord.
4. Tcrnririation ', It coutittues ds a,ttcrtor
alla lo occiliral neutbronc.
BoC), c{ I ji :t^cfn; vertebra
F19.3.80 : An!erior longjludinal liEamenl

Postirior lo ngitirO irr al I iga nr

Il is attncl)c(l to tlrc upl)cr aud lorvcr bordcr of thc postcrior srrrfrcc ol- bodics of all
vcrlcbrac
Iixlent : Il cx(cllds froni thc hody of lrrst sacrrl t,-, titc lorrct borrlcr o1- l)od) of sccond
ccrvica I vcrtcbru.
t. 'I'crnriDxtion : lr <ottritttttt as Dtcnbr0na t.,ttt)rta nb.)\ ? sccottl cat t tc'tl verttltru
.t, Itcla{ lo n s I

. A,0lcrior ljasrycrtcbral vcnorrs plcxLts,

ll. I'osrcr r,rr Sl)i irl c{)rd wrtlr rrrcrtingcs.
\/orlorlon rlriclinrss i [Jl]pcr pnrt is broad arrd hits unifornr rvidth, Iuwcr Irrt is
'l'ypcs of nbcrs :

A. Supcrficiirl lrbcrs : Tlicy join 3

3. Dccp fil,crs:They mcrgc witlr
 r-l::d, Ncck &.F

A.Transvcrsc liganrcnt of ntlas: It cxlends Capsula; liganrcnr:

bcttvecr thc two t(rbcrclcs on tllc a. Thcy arc lcosc. l'hc laxilv
nrcdial sidc of Iatcrrl rrr:rssc" of allas.
- Apical liglnrcnts of tLc fibrous capsulc
lJ. : lr connccrs rhc tip pcnrrits lonvard or
ofthc dcns to thc dorsil surface of back*,ard gliding
basilar parr of occinrrrl bonc
nlOvCmcllts du ring
C..\i:r ligrrncnr: rota{ion of tltc atlas.
a. Il cxtcnds fornr ,.rpp,j;
irait ol lircral b. They irc .ttachcd to llrc
surlicc of thc dcn\ tu tIc nrcdill periphcral rnargin of
surfacc oi co dylcs.
anicular surfacc_
b Thcsc ;r rc rtrong liq.,n,.ut,
c. Exccssivc strcrchrnLl of thc
c. Thcy :rrc srrct.lrcll ,lurirr,, crron lLbrous c;r psu Ic r. frcr..rrll.l
and rclurcd tjurirrt crtcnsrc,r,.
d Thcy clrcck crccssivc rotari,,rr
by cu rvalurcs of arricr.rlar
s urfr ccs.

Movc41sn15 and n)usclcs LrinEilg nlovcnrcut\

ntovcnrcnls and rric nl.ric ,rro,..,l \,.rric.r.
: Mo!,cn)cnts at itll lltrcc joints er,: rotirtof),
.r .rrrs. Tlrc i.l,,r'io,,,,r .r prrur .rorr(l w'icll
lhc allrs, rolatcs 1c.r.y,nt tl,. .kull rvith
itt. ll r:l c.rilcd NO ntovcnrcnr.
A. Ipsilarcrij
a. Obliqus capiris inlcrior.
b. Rcctus capitrs postcrior rl;rlor .rrr,t rrrirnr
c. Lon gissirn u: r aniris
rl. Sp lcn ius c.rn:rrs
B. t nntr;rlat4ral Str.rnoclcrdurrr.r.r,rirl
i
5. Apl) Iicd a atonly : -
Dcrtll by lrlnging rrr.ry bc Lluc r,
'ii,li,ii",il,o,.""o"J";lll:,::.,1,::,,iI,,:l t,ti
::rnr"lll;:"r::",:i ,i ;,: i lli,,il",,ll,",l,,, l,
l.;;
 anil
anatonl\'.
l. Classllication ; r

A. Structural :Simple, c.rndy,ar,

B. Functional : Dianhrosis
There is no inten'erlebral disc rr ll:: 3rlrnro-occipital joint, u'hich
cxtensivc rangc ol flexicl and c icnsrorl
2. Llgaments I
A. Flbrout clprulc I
., A rclrod to porlpllcr0l urargln ol rrricular surfacc,
!. I, is thick posterolarcrally, rhir erd lccsc airrc.onedially.
_ Svncli:l
B, mcmbranc : Intcrnaliy ir lirrc: rlie fibrous capsulc.
C. Antcrior atlanto-occipital ntcnrirrarrc :

a. ll connccts thc cntcrior arclt ol rlliis \\,itlt tl\c aItcrior nrargin of forancn magnum.
b. Latcrllly it continucs with thc irrrrcrior part of clpsular liga:rncnt.
c. Antcriorly it is srrcngrlrc cd l)y tlrc :rrrtcrior lo gitudinal liganrcnr.
d. It prcvints exccssivc nrovcnrcrrts.
D. Posterior atlanto-occipital urcntbranc :
a. It cxtends fronr postcrior nra,-gin ol lirrilrncn nragnum to thc postcrior arch cf
b. Latcrally it continucs as lltc postcrior prrt of capsular ligt|ncnt.
Membra a

"T','"', Uppe. band

R,qht.t---+--'Lort ligament

J Apical ligament

Occipital condylo

Odonioid process Alar ligamont

of axis
Lateral mass of atlas

Accessory atlanto
axial ligament lioam€nt

ii:;

Flg. 3.81 : Ligamenls of atlanto occipilat and atlanto axial jolnt.

 3.1 florcrri:rts anr :::-:s:l:s Lrii:i:1S rirovcmcnt5:
as YEJ rT.Oi c:_ -' a

. A. Flcxion:
a, Longus cap;t is.
,-,]. . b.' RectLrs capitis antcrior.
:r- - c. Sternoclcidonrastoid.
.,.!

. t:iiT :':-'".b. Rectus cnpitis postcrior

ii'" ' ' obliqus capitis.
. ; d. Scmispioalis capitis.
c. SplcniLrs capitis.
f. Longissinruscapitis.
g, lrapczius.
C. Latcral flcrion :

a-. Sernonra-st,.tid (Acting lnilaterrlly).

u. vs"9er !.,tii,rr

4. App licd qltttonry :

A. The atlantolxirrl rcgion of thc ccrvic:rl spinc cnn bc vrsLralrzcd rn tfrrrsoral

anteropostcrior radiographs.
Il. Thc transor;rl rorrtc is also utilizcd in srrrSical approlrchcs to this rcgron. rvirh Lrgr*'rrrd
rctraction ol thc soli palil(c and divisicn of thc postcrior rval! of thc phrrynr.

Apex of pet.ous pad

of temporal bone
_ t
',<--+L,jn
Tensor palali
I
Levalor pa al Sprfo of
- splrcriold tonc

Pterygoid
hamLrlus Latcraiplcrygord
pla(e

Palatne aponcuro$is

Musculu: uwlae -
Dorsum of longue

Fi9.3.82 : Nlusclcs ol soll palate.

.-tlcadiNcck & Facc

Tho labl6 shows origin. inssrtion 6nd acilon o( musclo!

Mu scles Origir Inscrtlon-- '

]
a. Latcrnl sidc of Inscrtior, is in the
cuditorl'tLrbc. fornr of a sponcurosis:
b. Adjoilring farr of lhc wl)ich is attachcd'to:r :l
"r-basc of thc skull
irltdtlarii iingf&ic
scaphoid fossa of
sphcnoid bonc)
thc palatiric.bre!t.:

a. Infcrior aspcct of Upper surface ofl-1.._.

a.:Elevates soft pal
auditory rubc. palatinc aponcurosis. I rnC clos'a: t
b. Adjoining part of
infcrio r su r facc of I b. Opcns thc iudit
pclrous fart of I tubc, Iikc rhc lcnsor
tcnlfollll bollc.

C. Musctrlus I)ostcrirr rrlsa l spinc. Mucous nrcn,branc ofl Pulls ul llrc u!rrljr.
u\ru Iac Palutinc rponcurosis.

D. Palatoglossus Oral su r[ircc ol palatinc Sidc of thc (onguc atl Elcvatcs thc blsc of thc
apcncuros is. tllc juncticn of lntcrior I tongllc ind closcs thc
trvo-third and postarior I oro.pharyngcal isthmus.
on c-l h ird.

.ntcrior llsciculus : I)os(crior bordcr of Pulls up tlrc rvall of tlrc

l:rohr poslcrior tlrc lamina Lof pharl,nx r rrd slrortcns it
borcicr ol lr ir r(l l)llatc thyroid cartilngc. d uring s rv a llo*,r g
r'r -

Poslcrior {rrsciculLrs : Wirll of thc pharynx

Frorrt prlittinc and its rrcrlian
aponcrrrosis. raphc.

Ncrvc sup11ly I
A. Motor : lll nu.tclt,.t oJ- thc ;;oft palate are supplicd bS, phar;,ngastl p!cxts exccp!
ttL,rt'cs
tcnsor r) ldti, which i\ stpl)lt.l b)' the naudibulor nerye. The ltibers c,f tltis plcxus are
dcrivccl fron thc crortiul part oI the occc,rso\t ncn,e (tltrough thc vagus).
B. Gcncral scnsory ncr\ cs :rrc dcr , cd fronr
a. Lcssc. palatinc nc.vcs, w lrich arc branchcs of thc
pterygopalatinc ganglion) and from rhc
b. C lossoplra ryngc:r I rrcrvc. I
C. Spccial scnsory (gustatorv) ncrvc : Thc fi5crs rravcl through thc grcarcr pcrrosrl nchc i
- geniculatc canalion of rhc
aeniculate ganglion rltc trci:rl nrrclerr< of rh.
fuciaL nerve - nuclcus the <^l;i'ru
solitary ir,.t
tract.
D. Sccrctomotor ncrves : Lcsscr palatinc ncrvcs. Thcy are dcrivcd from tll(. sutcriqr _

salivatory nuclcus and travcl through thc grcatcr pctlosal ucrvc.

 \\'aldc1'cr's rin g

Il is 3+----.\.'\.!.--
rinc ol'subnrucosrl lvnrDhoid tissuc \\lrcl) bcginning
glslrn nfcsl tnal lract,
r
--

l. Fornlation :
A. Inlront and bclorv : Lingual tonsil.

cervical lymph nodc rvhich togcther constitutc thc "cxtcrnal ring of Waldcycr".
liunctions;
A. lt filtcrs tissu'e fluid coming from inncr surfacc of oral cavity.
B. It prevcnts the entry of organisnl from outsidc and tircrcby acting as a gua.d
C. It scrvcs as thc first linc of dcfcncc & pro(ccts thc body against ingsL':,i
inspircd bactcrir b1' prodLrcing antibodics agilinst such invading organistrrr'
the tonsil itself bccomes infectcd, it bccorlcs a source for.thc spread of infcctiorr

Tubal lonsll
I

t
@ R,ghr--'
I
rri

/ Pharyngeal ron si

Lingual ton s il

Fig. 3.63 : Waldeycr's ring.

:1. pplicd nttonry:
A. Waldcycr's ring lbrrns a srrc'rrg d.lcns0 systcrrr to 0_tfl_crll-$q -\!Icad-_ql ir1!rrlr" I
the orll and nasal cavitics into tllc lowcr rcspirltirry tract consisting ol lrrr'',rrr, rr
bronclr i and lungs
Il 'l hc lynrphatrc ring lrclps ,n d,-lcnsivc rruL:lranisnt ol rltc rcspiratory rId irl;jl
'irom
sys:cns by dcstroying rlic cniry olliicioirigrri-sns rhc cxtcrnal cnvirolrnrlit.
C. In prcantibiotic cra : Dnlargenrcnr of thc lyrnphoid folliclc in thc Waldcycr's li:rg
to block tlrc'rg*s5r1-Jtor\ rrr^'
 colIcction of lymploid tissuc
Tonsillar sinus
betweell palatoglossal
:2 cms.

nsccnding palatinc
a rtcry.
errl tolsillar branchcs. ,-

B. B.,,,rllj,,
il rltcrior l
Lr. Postcrior

p:,lE su,oerior constrictor

lrne a-. re fy

TonsrlJar arlcry Caps ule

Slyloglossus
nruscle

Slylopha.ynoau.
Paratonsillat
vejo
Palatoph rryngeus

Eucco pharyngeal
/a scia

F1s.3.84 : Rolations
of tonsil.
-t ir
 Effi i"pir.-
'-A.=Aitcriel ' :

- -' a. Main sourcc i Inferior tonsillor branch of focial ortcO'. lt c lcrs the tonsil ft
laleral sutlacc.
' ! b. Additional sourccs :
i:r '.'"-:i.*.: -,Anterior tonsillar, a branch of lingual artcry.

Oo!oondlno Palutino
branoh ol mnrlllfirv '
Palatopharyngl}al arch

Dalatino

Anlerior tonsillar -
arlo ry

Llngual arlory ---

lnlcrior tcnsrllar ---- Faciai . rriiry
ertory

Fig. 3.85 ; Arterial supply ol lonsil.

B. Vcnous drurrrrrqc:
a. lnto tllc plraryo.lcll vcrrrLrs plcx rrs.
b. Princip;rl rllu irrrrqc is by' tIc tonsillnr vci0, tributary of tltc littgttll r',:rI
4. Nervc suppll' : Clossopharyngcal ncn,c.
5_ Dcvclopincnt:
A. Chronologicul rrgc : Ir dcvclops in thc lburtI wcqk of inllnutcrilrc lilt.
B. Ccrm laycr : Thc cnr-ll-qliun dcvclopi .frorn ll)c cnlodcrlll of t[c sccorr,i
pouch _and rcrrraining slruc!_u,-rcs front thc loc{l rncscnchynlill tiss\lc'
C. Sourcc lt dcvclr'ps l'r,rrr vcntral part of thc sccottd phnrytrgcrrl :"rlch.
cndodcrrnal cclls proiilcratc oLrlwards as solid buds -which arc subscqucrrll)' , irn al
fonn tonsill::r pits ---r<i-cryp-ts Lymphocytcs ci(llcr (lcvclop fron tncsotlcrn
aic@s irr floir crrcullting l) rrpl)otytcs.
D. Sitc : On thc lrtcrirl sidc of ;rdult oral cavity.
6. llistology : It is lyrnphoiiJ orgar consists of
A. Stratified squanrou:i noo-kcratinlzcd cpithclium,
B. With crypts,
 ' ' C. Fibrous capsulc on thc outcr s idc iu)(l
D. Lyniphoid tissuc - (D iffusc and ll,rrrplr rtotlulql.

Lymphatic
nodule

F 3 LBI l1]5lolorlY otluits

?. Applicd anatoury :
t.

n _!E!gc(;gL fronr rlrc irttrctcd 111115ii cxtcnl, ro rhc middlc car, bccausc borh arc
supplrcd by llrc AIosroDIraryrrg..rl rr"rvc.
B- The crosulc or'thc tonsrl is rr'r,*,:rl llLr inLo.sillcct,)r'y. bccausc it is attachcd {0
dccp surlacc of thc tocsil and rrrcrrrls t,' It,tnr 5q,,-i;1i-l--,,.Ifj.
on! lu c ts nc.vcs and vcsscls
C. Aftcr tonsillccionry all clots
'rr ,,4 ,t'rrrsrllrp fossir rc rcrrro!cd lo prcvcnt flrc
intcrfcrcrrcc of rctraction ol'blood vcsscls Such rcmoval of clots is rlso do.c in utcr!l
altcr dclivcry to prcvcnt posl I)irrlLrrrr h;rcrllorrlligc
D lQgl.r{i.rs pcrirorr{r. ,r.,U-! \s

D escrib c
7'
'pharynx trndcr
Parts '"'
3. lVJuscles.of pharylrr
5. Ncrve suppll, rnd
Parts : It is a rvidc, nruscular tubc 5i1n11gq1 bclrind q1,"
nosc, tllouth and llrynx.
into lhrcc parts :
A.,Nasophary X,
B. Oropharynx and
C. Laryngopharynx.
 :t::€ 3.2i --: ::: s--*! : "i-: az's a' '+ ='+'.- '
'.

Partlculers ) rsophrrl nr O:o;:rrr.,:r L:rrvngopharynr

Bchind nosc. rr.j "r.rl c:, :,
Bch

b. Extcnt : I Basc of skutl (body Soft prlatc to uppcr U pp:r l-rordcr of cpiglo(ii tai
nf cphcooid) to soft border of cpigloris. lor,.cr [rordcr of criLr.'i
Dalrte. cirriiirgc.
Irrfcriorly',iiiitli

nasopharynx &
Ill.Bclow lvith
laryngopharynx.
d. Ncrvc suppiy Pharyngcal branches I Ninth and tcnthlNinth Ilnd tcnth ncryc.
of ptgrygopi.latinc I
irerve.
ganeli"n I

o. Rclations :
x. Antcrio. Posterior nasal C)ral caYitv. l. lnlct ol'larynx,
apcraturc_ ll. Postcrior surfacc ol' cr ic,rid
IIL Arytcnoid c r rt ila !lc.
b. I'ostelior B ody of sphcnoid llody ol- sccond rncl Irou r(l) an(l fiilh ccr! ical
bo nc. lllird ccrlicll vurlcbrrc.
vcrlcbtilc.
c. Latcral Opcning of auditory Tonsillar fossa I'yr iforrrr lbssa
rva ll tu bc.
I L i n i n giCiliared colun)nar Stratificd sqrranrousls t r l l iiic rt squnnrout
cpithclirrrn : I r:pithclium. n o,L k c ril t in is c tll rronlcrutirrisctl cpiLltcliurn
I
cpithcliunr. l

g. Function : I'assagc for airLI'assa3c for air andil';rssai:c lirr lirod.

(Rcspi.atory funcrion). I food.

2. Structurcs of pltrrln\ :
A. Mucosa.
B. Suborucosu.
C. Pharyngobrsilar fascia : Fibrous slrcct filling (hc girp crrc-ndi g lloflt basc o{ skLrll
uppcr margin of supcrior constrictor nrusclc.
D. Muscula r coat:
a. Outcr circular nruscle consisls ol-
I. Strpcriorconstrictor.
Il. Middlc constricror
III lrrfcrior constrictor.
b. Inncr longiludinal laycr consists oI
I. Srylopharyngcus.
II. Salphingopharyngeus.
III. Palatopharyngcus.
 Modlan rapho

z4i-.,
i?i itf,;
'Cod6t.lalor
L6n
laryng€al
:a;;9gg9rior Iarynseal €
conslr,clor "

-lnlerlor
lnlorior l,tryngcrl arlory ----: : ..
Recurrent laryngcal neave

Fig. 3.87 : Pharynx opcned fiom lront showing conslriclo. musctes

of pharynx and slrLrctures passing between ihem.

3. l\lusclcs of phulrtrr :rrc Ccscribcrl rs r;trrcr !o gitudinal and outcr cir.culur.

A Thc circulur rrrLrsclcs of pharynx arc dcscribcd as follows:
r. Origin
J Sulrciior cot\strictor :
i. I'rcr ygopll.ryngcus :
I'osrcrior bordcr of rucdial ptcr,)g(.id platc and
lrcrygo id hantulus.
ii ltLrcco nlrirryr)gcrrs : I'lcrygorlandibular.apltc.
ir. \,1ylo-plrrrrylgcus I Postcrior cnd ol mylohyoid lirrc ol lrrrndiblc.
iv Olossoplrurvngcus I Sidc of tong!ic_
il. lvliddlc coltslriclor:
i. (jho dro,phirryngcus :
- Lorvcr parr of srylohyoid lrgamcnr and
- Lcsscr cornu of hyoid bonc.
ii Cc|rtopharyngcus : [Jppcr bordcr of grca(cr cornu of hi'oid bone.
I ll. Infcrror constrictor:
i Ilryro-pharyngcus (pronrl'sivc prrrl) i
. Iror)r obliquc ljnc ol tlryroid cartilagc and
-l'hc
tcndinous band across thc cricothyroid nrusclc.
ii. Crico-pharvngcus (splrinctcr part : from sidc of thc cricoid)
b. lnscction:
l. P harylgcal tutlcrclc and

II. Mcdirn pha.yngcal raphc.

B. Longitudinal rtrusclcs of pharynx a.c dcscribcd in following tablc :
 ' '--,'.:=
T!ble 3.26 : The tablo sho$s crigin and In3erlion ot longitudlnal muscles ol pharyni.

Blood supply :
A. Arterial:
a. Ascending pharyngcal branch ol cxtcrntl carotid srtcry.
b. Asccnding palatinc I I rarrcl of facial.
c. Tonsillar artcri, J
d. Dorsal Iingual : Branch of lrrgLr:r
c. Crcatcr palatinc : Blrrrch ol nlilrr ilr\'.
Venous drainagc : Fornt a plcrrrs t lriclr rlreirrs jurular and
Lyrnphatic drlinagc:
a. Rctrol, hary,ngcal and
b. Dccp ccrvical g16n p ol_lyrf l)lr rro{lcs
Ncrvc supply of phrrr nr : lltlryrrgc,rl plcxrrs rr'hiclr is lbrrrcd tty
A. Scrsory ;

a. Gcncral : PllarVngcal branclr,rl .!los:;oJ)ltitvngcal nqavc.

b. Spccial : l'astc fibrcs IhroLrqlr irrtcfltitl laryngcal ncrvc, a branclt ,.f sul)cr ior
laryngcll ncrvc, brlnch rrf \'iL(Lrs ncr vc.
B. Motcr :
. a. Sonratornolor i Pharyngctl bllLIcll ol vlg,ts - chic fl y Itoior.
b. Sccrctomotor i Fl'urcs trorn 4rcltcr pclr'os;tl t)cf!c
c. Vasomotor: Pharyngcal brlnclt rrl sLrpcrior ccrv icr I s),nlpltllctic grngliol.
6. Ap plicd anatonr.,' :
A. Dysphagia : Difficulry in srvirllorvrrrr
B. Killian'sdchisccncc.

.i
Iiillia ns dchisccncr:
ccn Pirfl of poslcrioa \v;ril ol-phirrvl]r bclwccl] lowcr plrt ol' vocirl fo lds and I
ls wcak and is nol covcrccl by tlrc nrusclc. This wcak arca is callcd Killians f.
I
dchisccncc. I

Pharyngcal-divcrticula lrc ol rhc tlclrisccncc.-fhc alratonlical colrtributing

forntcd by ourporclrilg
factor for this condition is thc ncLlrortrLrscLriar irrcoordinatio ol tirc two pa rts ol-inlcrior
constrictor. Thc propulsivc rhyropharyngcLrs is sLrpplicd by pharyngeal plcxus an<i splr inctcric
ctlcopharyngcus by rccurrcnr I.rryngcrl nclc.
.
 Thyropharyngeus..
-

Cricopharyngeus

Fig. 3.88 : Killian's -dehis..nce.

Auditory
l. Introduction : It is a funncl slrirpcd lubc whiclr connccts rniddlc car cavity to nasopltarynx-
L. Cross r

A. Lcnglh;16 nrrll. A.,,rI .h{rd

ch d

Anlc.ior
Middlc car
Cavily
Pha.yngotympa

.l
:j

Nasopharynx Antoaor

Flg.3.B9: Pharyngotympanic lubo in adult and chlld.

.t
I
'i
 H.d,l'l :&.i::iii
Parts Parts.
Tab lo 3.27 | labl6 shows bony and csdllageoou! parl:ol oudllory .:-

':'
:i

Middlc ear

Bclorv : Tympanic platc of'

Medially:Carotid canal.

3. Agc diffcrcncc:
Table 3.28 : The table shows dilfa.ence ol auditory lube in child and adull
child
I'rIticulrrs Arlrrlt
A. Lcr)glh (in rtrirl)
I b( 7:i 36
S rra i ght
Il. I'crs ition Obliquc
C. IJoLrv pllrl Nluch sllortcr Onc-third
D 'fLrbal clcllrion I)rcscnt

4. Blood suppll':
A. N4ickilc mcningc;,1 ilrr.ry (rrJ\illlr\ irt(':\ ).
I). Asccnling plrtIr'LrIc.rL ,rrcr\ (c\lcrr.l .:i:olid artcry)
5. Vc ous Drainagc : I'l.ir{oi(l ,, enous plc\us
6. n'crve supply: Tyrirlirni. IlcrLrs lilrnrcd
A.. Tynrpanic ol ll,rrsolrlr.rryngcrl n.._1c, r scnsor) rrcr\/c.
brarrclr
B. lynrpanic branclrcr llorrr plcxus arourtd rrlcrnxl carolid itrtcry, il syr))Pirlllclic rlcrvc
1. IiuDcliolrs:
A- Maintains cqutlihr rrrrr ol lir prcssurc o: eitlrcr sidc oi trrnprrrric tltcltrbr.'irc for propcr
vibration oI ntlr
sou
[]. lncrcascd prcssurc irr rrrrlrlic clr lirrccs i:a nuditory tubc to ol)ctl r!'ith l clrr:1.

8. Applicd nnatonrv :
A. In childrcn, inlccti,rrr ol orll cavrly. n-'-sal citvily or phrrrl'nr trstrally s1rr,;rds trr tlre
nriddlc car bccaLrsc irLrclrtor'! tubc is shou rn lcngtlt and ltorizcntai in positic,n
B. Somctimcs tube i! blockcd duc lo inllrrrrration oI tubal tonsil.
 Ncck & Facc

Dcscribc nasal
l. Fo rrna tio n
3. A*crr,c s rip p l1'

It is usually do,iatcd to onc sr,lc rrrrl c:rclr nasal cavity somcwhat

l. Formption : Parlly h.., h:,rrrs urd prrtly' b1' carrilagc.
A. Bonv Drn is,l ,! l\
l
^ ! ,

aJ v"ihty tirmc,l r,v 4 t, rr 11 rl i.

I. Vomer: Bcl,,r i:nd bchind
IL lcrpcedicul:r J-..,:c of crhmoid.

0
Seplal cartilaOe
-

seplal process ol - -
major alar cartilage

Palatal process
maxilla --.--
Fig.3.90: Bones forming nasal seplum.

b. ACcCs5Ory bLr nc \ irr.

L Nasal spinc ol ffoltirl.
ll, Crcsl 0nd r(Jstrrrrrr of sphcnoid.
IIL I'illnl illc Jrrl.i,:"ss ul.rrrirrilla.
lV. llorizontrl pr11 ot borh lrlirlinc.
B. Cartilaginorrs pirrt is lirrrrtcil bv:
. i,. S(pl:ll c:lltrlirrc
_ b. Scptal proccss ol irrl.crior nlsal clrtilagc.
C. Curicular plrt is lblrrrcd Lry libro iirtty tissic.
2. I3lood suppll :
A. n rtcriai supply i
a. Antcrosupcrior I)nfl I)y
L n tcrior cll)rr)oi(l;tl irrlcr\,, a b[lt]cll of oplrtlralntic arrcry
ll. Supcrior labiul, rL b|rr clr of t.ocilll nrrcry.
b. l,osrcroinfcrior plrr by spllc o _ pal tinc aricry.
B. Vcrrous dr,irragc :

a parr clrains by supcrior ophthalrnic vcrn, u.lrrclr ofcns into

1\ol,crosuf,:,rlor
cavcrnous slnus.
b. Posteroinfcrior pilrl driiins into ptcrygoid vcnous
Dlc>.us.
c. U-.rcr pnrt of rhc jcprulr dririn; inro-inlcrior .c,Jbrol uc,..
 'Sphencp3latino ar1ory

'0

Septal bra
Su pP rio r abial a rlc ry

Flq. 3.91 : Arlerial supply of n3saL seplum.

,1. Lorvcr mobilc prrt of ..:cptunl drains into f.rcill vcin rt'hich drains into irl(crrl:tl
jugular vcin. An inlcction from IIlis prrl ,ril) c\tc r(i rlto clvcrnous sinus viu
I. Dccp facial vcin and
Il. Ptcrygoid vcnous plexus.
-fhis bclongs to dnngcrous arca
of facc.

lnferior ceturbral vein

Cavcrnous sinu s
Ophthalm c vein

Facial veiil Sphenopalalinc v.irl

Ple.ygold vc nou s plexus

Fig.3.92:Venous drainagc oi nasal scpturn

 c. Lyrlphatic drainagc :
a. Antcrior half : To thc submandibular nodes.
b. Postcrior hslf : To thc rctropharyngcal and

n6.vgs

r- lnternal nassl branch '

anlerlor cthmoldal

Nasooaletins

Fi9.3.93 : Nerve supply ol nasal

3. Ncrr e srrppll :
A. Ccncral scnsory ncrvcs.
n. Antcrosupcrior : Antcrior cthmoidal ncrvc
b. I'osrcroinfcrior part : Nasopalaiinc branch
B. Spccinl scnsoty ncrvcs arc ollactory ncrvcs.
4. Ap p lic(l :rnrtorny :
y'.. Dcviation o1'nlsal scptunr ntay bc duc to cartiltgc or bonc. ll nray bc duc io
a. I)ostnatal traurna (ntost conrnron causc).
b. CongcrrrtaI nrllfornratio:r.
Erccssivc na:al dcviatiorr produccs unilatcrrl na\irl obslructio and is trcatcd by
subnr,rcnrrs rcscctiou of thc scotum fSMI{}.
lJ. Lrllla \ lrrcrr or Kicssclblctr's arca.

Introduction : It is an arca on aItcro infcrior part of nasal scprunr. lhc nosc blceding is
rclativcly cornllon bccausc nasal rnrrcosa is highly vascular. Tirc rlild cpistax,\-results from nose
pricking rvirich tc.rs thc vcins in thc vcstibulc.
Thc profusc blccding occurs duc lo nrpturc of onc of thc follorvilg lrLcrics
A. Scptal branch antcrior cthnroidal (Ophthalmic). :

B.- Scptal branch of thc supcrior Iabial artcry, a briinch oi facial. I

C. Scptal branch of sphcnopalarinc (Maxillary artcry) and

D. Scptal brnnch of grcatcr palatino (Maxillary artcry),
Tltc anastonosis formcd by thesc artcrics is calied ..Klcssclbrch's plcxus". Evcn o
affccting this nrca cxn cflusc prgfugc blcodihg.
 Scptal branch of sphcnoprlltinc arrcry is longcs( and torluo\rs. l( is :rlso callcd ai ,.,rr.i
nisc blccdlngq or -rllirioloIis(,s lrtcr\,.'.
Suddcn and scvcrcnlsll blcccling in clrt.'rly hypcrtcr:sivc piltic t I)iry [),., duc to ruflL!l (' of
-iiG;;;in1;F;iiG;;,rc- lnd lllircb) lcrfornts naturc's safct), proccdurc to rcducc
venous communicntion r

u,c.

Sphonopal.tinc

Supsrior labial artery

Little's srea
Greater palatine arlery

Flg. f.94 : Litlle s irca

Formation:
n
1.
nonffiirtlili,,..T
'Nnsat uY*"i* \ (o{-l
a.
b. Ft.,,ilill proccss of rrr;rr.rllu.
c. Lacrinral
d. Ethnr.rid: Supcrior conch:r antj midcllc concha. int'i"'m "{ lld/-b
c. lnlirior nasi,l concha. i. -,ar-" 1""'
.'
\ i I)crpcn<licul.rr plltc ol pnlilr jc boni.
'S*",-,'*c.i'

Nasal bone bone

Fronlal process ol ma^l --Lairimal
Superior nasal ca.tilagc Superior co;r,rir i

[-'liddle conch.r
lnforior nasal cartitage

Alar ca.lilage,- Perpcndicula. i,l;tr4

ol palatino bonrl
Plerygoi,l
;i9.3.95: Bones and ca(itages lorming lhe laleral wa ot no,Sloto
 Canilaginous part.is formcd by
' a. Upp-cr, Iorver nasal cartilagc rnd
b. Alar carlilogc.
C, Cuticular fart is formcd by fibro-i'rtty lissuc.

2. Fc&turcs :
A. The cpithel rval! is as fo

eral wiil
a. Supcrior concha : A projcction of cthmoid bonc. This is srdallest'
abovc thc middle conclia. It cncloscs a spacc callcd supcrior
b, - Middlc concha : A p.ojcction of etlrmoid bone. It cncloscs middlc
Infcrior concha is indepcridcnt.bone. It cncloscs infcrior mcatus.
V(U{}'t Af >-',"k1111u,1a, ar'.lr r{54AJ-a'{ tr,,.,tax, e--,J -^" n . L,ir,L aJJ i"'
- T:b:r-3:?3: Ti,s iairio shows irliportanl strirctures o.esenl iri ltie 'ur'::^
laloral wall ot nose.,uaJ

Sitc S tructu rc
Sphcnocthnroidal rcccss. Sphcnoiclll air sinus.
II Supcrior mcatus, Poslcrior clirnro i(ll I air sinus.
Il t. Middlc mcarrrs Middlc cthnroidal air sinus.
Ethnloid^l bulla : Roundcd clcvrtion produccd
by uppcr rnargin of cthnroidal bulla.
i. IJiatLrs scrrrilunaris dccp scnricircular sulcus
bclorv thc bulla.
- At antcrior cncl. Frontal air sirrrs
Middlc part. n ntcrior ctllnloi(lrl air sinus.
Pos(crior crrd. Mi,xillary air sinus.
lV. In fcrior nrcatLr s Naso lacriorll duct.

,,{. Opening ol middlo othomoldal 3it sinus

I
rn/ <-+oslenor
^,ir, I Opening of sphenoldal air sinus
T Opening of posterior othmoidal
aia slnus
()tr)ning ol fronlal air sinus
Openlng ot anterior
othomoidal air sinus
,,trjniriU of nasolacdmat duct
(- ----.: --=:\

--7
Flg. 3.96 | Openines in the latoral wall of nose.
 Blood suppl] :
A. r\rtc rial :

Tablo 3.30 : The tablc shows srterial supply ol lat6rgl vrall of noso.

art6ry Sphcr\opaiailne-onc.,.- .

Superior alvcolar arlery

G,cilar palaline aiery

Flg 3 97 i A(erial supply ol lateral v/rll o{ oose

B. Vcno,r\,ir.l r,r,!c
a. Arrtciior vcirts fornt a plcxus and drailts into flcial vcin.
b. Poslcflo. r'cins drain into pharyngcal plcxus of vctn;
.. lvlid(llc p.r( drains into ptcrygoid plcxLrs of vcins

irl.j r: i,oid vcnous PLexus

Fac r \t r ------

^^"*,+,'-
Fig. 3.98 : VenoLis drainagc of lateral v/all ol l]olie

C. Lympha tic dlairragc :

a. i,nterior lralf drains into submandibr,rlar lyrnptt rrodcs
b. Postcrior half drains into rctropharyngcrl and dccp ccrvicai iyrrrph nodcs
.1. Nerve supply:
A. Spccial scnsory ncrvc : Olfactory (l).
B. Gcneral sensory : lrigcnrinal (V).
 t
<--l--.-)Pc'srid Poslgrior su
I nasal neryo -_

Anlerlor elhmoidal nerve

Gr€aler palatino
lnlerior suPerior alveolar

Fiq. 3.9e : Nerve suppty

"1_],",i;=i, I":l,o"t "","
!. Applied aneton)\' :. !, ., fL i;:? ,.
A. Cornolon cold iJ tlrc conln)oncst virsl infcction of nosc.
B. Paranasal xir sinus nlay gcr inlcctcd fiom the infection of nosc.,l-/ e". ,.ot'l'
C. Hypertrophy of mucosa ovcr the inferioi nasal concha is a common lcaturc of allergic
watcr d ischlrgc. .,..
,_.r air , i :: ,...

Maxillary air sin us (antrum of I{ighmo rc)

l, Introduction : l-argcst and inrportant paranasal air sinus presclt in maxil ir, lincd by ciliated
cpith eliu m.

lmportincc:
A. It hclps in conditioniug of thc air by adding humidity.
B. It acts as rcsorrating chambcr rbr production of sounds.
C. ll increasc.; lhc quality oi voicc (timbcr).
D. lt reduccs rhc tucigl'r if rhc skuli.
Cross anatomy:
A. Shapc rs pyranrrdal.
a. Basc is lbrrncd by nasal surface of body ol-maxilla and lbrrrs lrrtcral wrll of nosc.
b. Apex : Torvards thu zygornrric borrc.
-lJ Boundarics :
a. Supeuor rvall or roof : Orbiral surfacc of maxilla.
b. Inferior wall or floor : Alveolar surface of maxiLla.
c Anterior wall : Antcrior surlace of maxilla.
d. Postcrior q'ell I Poatorlor rurfacc of maxllla.
 : 2.5 cnl

ritc of palatinc bonc.

gland.
'-- _-_=:i-:a'r' _ l
,i,-4. i--: t is 0icscnt on.the,basc, closc ro thc roof of thc oral cavity. Maxillary air
:. ' ii)
middlc mcatus by tw-o opcnings.
-ii rprcsent-
in lowcr prrt of hiatrrs semilunaris TIic opcning is at hi
1S

of hiatus.

Opening of maxill3ry sinus

.'Middle meatus

Maxlllary s lnus

Hard palale

Fig. 3.100 : Max lla.y alr sinus

5. Dcvclopmcni : Dcvclopcd fro l splillrrrq of rrrdrillll. It is firsl l)nr0nrs0l rrir sinll!
dcvclop. It dcvclops in tllc fourrlr rironrh of i lra ur.Jrinc lifc. Ir grorvs rrpidly durirrg 6-
ycars and rcach full sizc afrcr tlrc cr!ption ol itll pcrnl:rncnr tcctll.
6. Blood auppl)':
A. Artcrial supply :
a. .Infraorbital artcry (Maxillary ancry).
b. Crcatcr palatinc artcry (Maxillrrry ar(cry).
c. Postciior supcrior alvcolar artcr!. (Maxilla.y ancry).
B. Vcndr,rs drainagc :
-a. ,i,Infracrbital vcin drains into anr:Lilrrr vcin.
b. .llGrcatcr palatioc vcin drains inr"o prcrygoid tcnous plcxus.
iiirli:
'.1
 7.

8. Lynrphatic
9. Applied Iymph node.

: B. It csn:bc
S : ff:' ;;-:61ijiiff ffi T':1f ,,."i U- lll;, l"; ;l**-'
I

E,
:ildi:ii;ri,"$xn{.;{:s$1ff
"'ii:'ii"
:]ffi t::r;ft :'mn:
;;,
",",, ""; l;.." J
r. n
"::i
"i, :lij:',:i ^.0
n n.
t rr'" "1","
op.ning tn tlrc miaalc
'n""iirn,r] rlilill't"'"t''
or =-riciius,filn:
'""",.'"'r'l:s."::,h.
, ill',il:1.''#:iii::i:i! l'iilli"n''il;,,i^*'i'-r'"'a'"i*,i inro rr,c nasar
"F;J;-

ffi;ffi*inffi
t,t.ort'ction , t, i.
rurygopalatinc
l)f.---

_]__._{ ganglion
),'ilrL\ r,rc\c,rr "l
.".,..i,llillil,"li;'ipltcral,parasynrpart,c( ic slnslior
I
l'l'il,ii:;:;I,;:,,?'ll,ilini,"{l"ii1;i'.il:;r:l"li"jjl: ,.," l:,i;t;t::l;
,*,i
,fl;ll:ll;ll,;;;"11, 'iY.'llli,'"",1'i."iii,i,,il,'lf,;;,,;,;
tr ts a collcction ol ccll
l,l:, of craoium.
2. ll;,,,,'""1'"''.'''""r "'r'".1i,i:i"l""t*;,lffitili,.:r"r;;i'i;,:,,'
(.;ross: rl c r vc).
A. SrtLtittio I I,tcrv,,^
lJ. ll, J.rrr,,ns . '6uPilal,nc fossx.
ir Mcdritllv p!.
t, l.rrcrrrlli' "'oryt'gc.rl arrcry.
i S,'1,c,,or . v,.".if ", 1"'tctygr.rid crnri.
,1. J'us,. riorlv . _^lllJI) ncrvc.
. rcr'.go rd canrl
t. L() r(tion\ :
n. I'ir':l.yntpJtllctic l,*

i;-"Tfi l,."t:" rronr racrinrarory n,rcrcus

::,i:"xi!"t
,,,,",n"1 ."."n,i16"on - Freatcr pctrosill (pons) fac ia I
q lficry) - netve ""ru; ; ;:;".," pctiosa I
ncrvc
rclry to p,a,ygo,.t ."on"ll - Pleryt
 b. Illaxillary nervc - zygonlntic branclt - zygom
branch to lacrimal ncrvc.
B. ncrvc passcs through ptcrygopalatinc grnglion

dMslon
ol lifih norvo
GreaterpcL'c$l'norv-_
Geniculale gan0lioh

ganglion
Supcrior synrPallrcirc
ganglion
rnlernal
carolld artery

Fi9.3.101 : Plcrygopalatine ganglion.

Branchcs: Thcy rrc viriually dcrivcd frorn maxillary ncr..'c.

A. Orbital branch supplics :

a. Orbitalis rrusc!c,
b. Mucous nrcmbranc of spllcnoid and
c. Mucous rrcmbranc of postcrior clhmoidal sinus.
B. Pa latinc :

a- Grcllcr pillxtirtc nclvc rvhich supplics mucotls rncnlbrnllc of latcrlrl s':rll oi losr:
b. Lesscr pctrosnl Ilcrvc - nruco!rs tltcmbranc of soft pallto antl pllllinc t<lrlsii
C- Nasal branchcs :

a. Postcrior sLrpcrior latcral nlsal.

b. Mcdial nasal
5. Ap plicd lnatony :
- A- lt is callcd ganglion of hay fcvcr and produccs rrrnning of nosc and cycs.
B. Injcction of alcohol is occasionally cnrploycd irr intracl0blc cascs of rllcrgic rltinitis.

l. Formation : Larynx is formed by paircd and unpaircd ca.tilagcs. Thcy arc

A. unpaircd : Thyroid, cricoid, cpiglotis.
B. P_aircd : Arytenoid, comiculatc, cunciform carlilagcs.
 +.)

,ii

ts

ifi oi.'.i riil'iirtiiilil, diiUiSi6idbi -l6t

Itrr. - rriad':rq, rtri.x I
iM'ris
fiiilliil,,6+
.-...1-.........---
".:!t
Muscular proccss
.
df
;fi cartilagc; .. 'i;
Arch of cricoid ca'g!i[e;.!i':- lnfCririt"'horn or$iwi6
,x cartilogc; ".' itaft!
d. -Thyroarytenoid -Dcep--sui.'aci of ihy;o i d Latcral surlace ol ary-tcnoid.
cartilagc, cartilagc.
e.'lhyrocpiglotticus .--' Thyroarytcnoid cartilagc. Epiglottis.
f. Obliquc arytcnoid Muscular proccss of o nc. Apcx of othcr arytcnoid
irrytencid cflrtilngc. cnrtilrilc.
Voc a lis l'ostcrior surfacc of thyroid Vocal proccss of aryrenoid
cartilagc in nridlinc. cartiligc.
_
h. Transvcrsc arytcnoid l)ostcrior surfacc of arytcnoid Postcrior surfacc of other sidc
ca rtilagc of onc sidc.

i. Arycpigloticus Muscular process of Epiglottis

aiyicnoiil cartilagc.
3. Actions of musclcs :
A. Acling on rlrc vecal cords
a. Abductor : Postcrior cricoarytcnoid, abductor of vocal cords.
Epiglotlis

Thyroepiglotticus Aryspiqlotlicus
Thyroarylcnoideus
lnledor
Vocalis
Apical proccss
Thyfoid carli a!€ Ary,tonoid carlilag;

Musculal
lcrico tt yroia Laleral

Post€rlor
Vocal p.ocess of
arytenoid cartilago
 lll. Oblique arytcnoid.-:
c. Tensor of the vocal folds
d. Rala'idr'bf
B, /

.a

exlcrna .ncrvc

L Cricothyroid dcvclops from fourth, pharyngcal arch thcrcforc supplicd by ncrve-

of fourth arch i.c. cxtcmal laryngcal ncrvc, branch oi supcrior laryngcal.
ll. Rortlnini|lg |l.lu.clOr rl€velOn,:.1 frot]r Aixtll . , ,t ,lt1,1 hdlrac ruFttllod by norv* of
sixth pharyngcal arclr Lr. icctrrrcrrr l:rr'y rrgcul rrcrvc
.- b Functional corrclation :
Thc cricothyroid muscle acts as a tuoing fork. It fi.s1, rcccivcs impulses nnd sitrts
vibrating. Thc rcnraining musclcs rcccivc i.npulsc rvlrich Itcln in producing voicc.
5. Applic(l llnfltomy :
A. Exarninationof larynx is callcd laryllioscopy.
B._L!Ln{itis is inflammarion of liryril-6iiii in conruroo cold. Thc ss.clling of vocal
cords is rarc in acutc laryngitis.
Thc laryngitis is thc infl3rnmntion of thc lt.t0cous nlcnlbranc of thc larynx. Thc vocal
cords do not srvcll duc to follorving reasons:
il. Thc vocal cords arc lincd by stratificd squanrous cpirltcliunt (rcmcmbcr that rcst of
thc larynx is line by pscudostrutificd ciliatcd colurnnrr cpirhcliunl).
b. Thc ntrtcous nlcmbrtnc is llrntly il(tachcd to ihLr vocill ligonrcnts,
c. There is no submucous tls$uc rld gl0nd$ ovcr tlrc vocallords.
For thc samc rcoson thc vocal cord.s appcnr fcarly wl)itc in color.
C. Damaqc to intcnlal laryngcal ncrvc piot!Lrccs .rri;rcsrhcsli\ (loss of scnsation in.
supraglottic part of larynx). Thcrcforc foreign bo,lf EIi Gfi-cnrcr. Forcign bodics can
rcadiiy cntcr thc larynx if intcrnal laryngcal ncrvc is damagcd.
D. Drnragc.to cxtcrnal lar',ngcal ncrvc carrscs_pgallsiLoJ .c1c_qr-lrj41d Lulc_b. It rrsLrlts
luro wulkncss of phorrltion.
D. Whcn both rccr.rrrer,t laryngeal ncrvcs arc injurcC.vogal,corcis li9
!!_9g419!r 19111i9,1

l. Introduction : Narrowest antcroposterior clcft, or sptcc of laryngcal cavity, lincd by

stratified squamous nonkeratinized epithelium (rvitlrour srrbmucous coat).
Attachntcnt:
A. Antcriorly : Thc nriddlc of anglc of thyroid canilagc.

: Ti,g tablo shows dllloaonce

lntc. - cartilaginous
parl
-->/:.
Poslorior
a) Rima glo(idis in quiet breathing crico - aMenoid
-
b)Rima glottidis in Iullinrp!ralion (Oiamond shapody
{Enlarged triangular)

Laleralcnco ' aMenoid

Rima gloltidis in Rima glo$dis in

high-pitched voice whisperin0 voice.
x Fig. 3.103 : Exlrinsic muscles ot tongue_

Ncrvc Supply : All muscles of larynx are supplicd by rccuircnt Iaryngcal

ncrvc) cxcept cricothyroid, which is supplied, by eitcirial laryngcal o
laryngeal, branch of vagus ncrve).
 ;-Y6osvorius

n \r
t
r,,<----.1---), L4n

J
Fl9, 3.104 i tntrinsic m!sctos ot ronoUs.
fable :
3.321 Tho tabte
-_- o;iir; -
[
M usc lc

a. Supcrior Poslcrior part oI mcdin

longitudiual fibrous scptunr.
b. I n f c r i o r Postcrior Dart of \i,lc
iongitudinnl lo n guc. ^
c. Transvcrsus n fi_brnus
-Y:d]i _scfrunr :t9j :ll:r:e-::* Rcduccs thc \vi('th.
d. Vcrticalis Lanrina nrulrrr;r I
o l j Sidcs of ron8uc.
dorsdiri,rf rorrqrrc Itcd uccs tlrc thickrc :]
of tongrrc,
_l

Slylohyoid ligamenl

'
flg, S.10! I E{rlnslc muscles of tonguo.
"ail-
 rabro r.st i rF la6jish;;!;.;.Ein;riiiu,uon
una o"r;on ot exlrlnslc

c. Chon d rog loss s:

r..r I. Lcssct cornu
Dctach ed oarr o fJ Sidc of rongr,c.
hyoid
of tltc hyoglossus II. Pa bone-.
rt of body of'
hyoid bonc
;. s,/"sbr,; fin of styloia nio....
and srylonranjrbut,.,. Sidc of ronguc.
ligamcnt.
c. Palatoglossus
", ,-f; urosls.
IJ n;
pa la inc
Sidc of tongLrc.
Elcvation
t
of tonguc.
Blood supply:
Arrcrinl supJrly:
^. a. L^ingual
,aflcry (chicf !irlcry
tonguc throuolr oI lorrqLrc), br_anch of cxtcrnal carotid
I pr ofundr" linjurl lrrcrv a ncry supplics
ll. ll { lrJr Jics or.rl r)ilrl of tongLrc.
u
L t.icralDorsal Iingu,rl rrr"ry I.lt supplrcs
(J. Jrtcry IhrouAll. plrrryngc.rl prrt of
tonguc
t ,/\sccndlt)g palnlinc.
I l oDstlar branch

JUpcrlt( Lrl r.r ltyr_rglo:sus.

b. Distribution
c. strucrurcsu""orpiilid l.lypoglossal
Tip and un,tcr su.f"l][ffi
Drains into ""-"-&t
 L.vnlp h3ii. draineg.:
A. Pcruirarilics:
a. Do nci accompany.thc blood vcsscls,
b. Tip of thc tonguc prcscnts riclicit I1'rrrplr drainagc arrd
c, Lyurphatic in the postcrior onc third of tonguc drains
d. Llrnphatic of thc tongue ultimalc]y drains inro ju
thcy arc callcd lymph nodcs of tongue.
Lymphatic isists ol followinc.sets-
i r r;i i' t *-rlF*r
Ta6l. a-a7 : The tabil c dislir'aqo of thb"ionriUb.

' Submandibular node

-. Jugulbdignstric
Ai:lcrior 2/3" lymphatics of .. Jugulo ontohyoid
tonguc iil front of vallatc_Ilpillac.
IV Dorsal Posterior l/3'"

Mandible

Submenlal

SLrbmandibular n(jdes

Jugulodigaskic ceNic€l nodes

.11

lnror^al l!9ur!. voln

, Fig.3.106 : Lynrphalc d a nro! ol tongue
Applicd anatonry of lynrphatic :

a. Malignancy in lhc tip and poslcnor o:rc third ol tongua rs nrorc dangcrous sincc rt
drains bilatcrally.
b. Lymplr vcsscls picrciirg mylolrvord urc oltcrr closcly rclirlcd io llrc pcriosicrjnr
mandrblc accounling carly sprcitd.to thc l)onc
4. Ncrvc supply of to nguc :
A-M
*:944gqE1- All _lhc cxlrrnsrc & tntrrnsrc rrrrrsclcs 'l toI11uc arc suPplicd r'l !

'.
,,'^\. hypogloss ncrvc (ncrvc of ocsrpll:rl ll)yotofllc) cxi, pl pa lrloglos$uc which kl
supplicd by pharyngcal plcxLrs.
',.-Y
 dcrivcd from supcrior salivary nuclcus

T!blo 3.38 : Tho tabte shows

Li rl'p ual ,

mandibular (rrilerhinal):;
Ncrvc of first
pharyngcal arch.
Chorda tympani (facial) lGtossopharyngcal (tX) Vagus
prctrcir.atic nerve (ofJncrvc, a ncrvc (9
of rhird fo url h a!
arch) arch. a rch).
i;?1,1 ij:li".^*" lpharyngcar

L Circumvallatc Clossopharyngcal ncrvc, ncrvc of

third pharyrrgcll arclr:
Irungifornr [-ittgurl rrcrvc (branch of nrandibLrlar ncrvc]
fililo rn and

Spcc al scn salions

Goneral sensations

lg. 3.107 : Sensory nerve supply ol tongu€. iL

itil
lapillac of tr.rrrguc - projcction
j.'" rissuc I dcrn)ar corc of cpithelir,rm causcd by projcctrons of ii
subcpiihc
Tonsuc,;;;; lial
"^onn::l
/\. r_rrcumvrllalc DJ oillac ). tuii";;;;;,n]ir"l,'i,,
B. Filifornr ano hrngiform prpillac arc
dcscribcd as foll,rrrs:
 str

-are-dcvciopc<i from ucciniral nyctcr:";3.

q. 5ite.1 Floor of thc pl"ri." 1.uri.,*i"i io ;icaiair ilry ro id <iivcrticuium.
D. Sourccs :
a. Musclcs: AII thc rnusclcs oi ronguc arc dcvciopcd froll occipiral ntyotonlc cxccpt --
palatoglossus. Thc ninc ol rhe occipitrl nryotomc is hypogLossal (trvcllilr c rirn ial
ncrvc). l{encc all rhc ntursclc;;rc supplicct by hypoglossal rrcrvc.
b, f,lucous membranc: Ir is d.:r.loped lionr crrCoicrni of rhc floor of pharyr\ .rrrd is
subdir rdc4 roro
l. Anlcrior two ihird rs dc..clopcd frorD :
i. Fusion of a pzv oi lirrgual srvclling arising front pouch of thc first
brenchial arch and
ii. Tubcrculum ifip!.t \it,tpar unpaircd) a nridlinc srvclling ariscs fronl first
pouch anJ givcs a !'cry littlc conlribution. Thc post trcnatic ncr!c ol llrst
, arch is linquul ncr..c irnd pac-trcnlntlc ncrvc of sccond arctr is cl)orda
tvmpani ncn.e.
IL I,ostcrior orc third i5 ric;clepgcl frurn cranial part of hypobrarrchiil c rr)cllcc,
rvhich is forrned bi iusion ol- rlrir(l aod four(h bracliill nrch,:s oll1,. 'l-ltc
cntincncc ii diri<lcri bi r lrl|l\vcrsc Uroovc into criuri l ln(l clrrr(Ltl l)url. lllc
ncrve ol rlrir4 arch is gl,;ssopharynllcol ncrvc, ncr!c ol lburth nrclj is stll)crior
laryngcal ncrvc rnd th( ncrvc of th! si\th !rclr is rccurrc t l ryIlgcnl llcrvc
c Fibrous sronrir I ljlr,r'l rcrsrls rrn<l Iyr)r)rlirlics lrc dir,cloncrl frorn nrcsotlcr'rrr ol
thc cdjaccnr rrclrc s
d. Papillac :
L Formcd by thickcning of cpirhclium (Jl (iorsunr of ronltuc.
IL Fungiform and filifornr prrpilluc dcvclop in ultc.ior rrio-rlrrnl crf rongrrc.
IIl. Circumvallntc ndpiltic dc!clr)p t pos{crior ot)c-tllird lront sccond arch. It 1.cis
submcrgcd by the orcrArorvrh ol rlrrd arclr and tlrcsc papillac occul)y tl)c
antcrior wall of sulcus lc.rninalis Ilc cc tl)c), rrrc sLrpplicd by glossopharl,rrlqcal
ncrvc ( lXth ncrtc)
Anomalics:
a. Ankyloglossia :
l. Ankyloglossia s!pc.ior : Tonguc is il(lhcrcnl to p0latc.
 c. Macroglossia ; Too largc tonguc.
App licd rnatorny:
A. Injirry to thc hypoglossal r)crvc proiluccs n ysis of lhc
sidc of rfre lision,jlnfianuclcar lcsion 3li
Supra nucJg,er.lcsioi{prgUucesl pafalls*'witl
B. ln unconsaious patient, thc mourh may fall back nnd
bc prevcnlcd by'kceiing the tonguc on onc sidc or pu Iing thc longue.
C. _9€l!aq.a--9[1$-&!€ge is quitc conrmon. It is bclt cr trcatcd by radio
s u rgc rY.

l. Prpillrc su;:cundcd by trcnch.

Sizc : 2 :rnl pinhcad sizc.
.1, Nunrl,ot. i .Abo[l l0 to 12.
.t. Sitrxtior : Singlc row in front of sulcus lclrninalis
lr conlirins tastc buds, prescnl on latcral ival ol papill.
6. 'lrstc l)uds : Thcy contain lhrcc typcs of cclls.
A Cusrilcry ccll or bipolar cclls.
B. SLrstcrtacular or supporting cclls
C Il rsal cclls

Circunrvallale papillae -.

Flg. 3.1C8 : CL.cumvall.lr r,iic,li3c.

ynlpanic nlcnlbftlnc
L Gross freturcs I It is a thin, transluccnr partitiofl bc(wccn (hc circrrill rnLl rhc middlc car.
It is ov:rl irr shapc,'mcasuring 9 x I0 mrn. lt is placcd obliqLrcly lr rrr rnglc of 551wirh rtrc :

floor of thc ncatus. lt has outer and inncr surfacc. | :

A. Outcr surlacc : Covcred by lhin skin.

B. lnncr surfacc : Providcs attacl,mcnt to lhc handlc of mallcus. Tl)c poinr of miximus
convc^ity lics at rl)c level of rrl is crllcfurghg
I i.a . :
 Dei

slilcc silunlcd brlrvrc:l

bonc. ,-.; 't'
cauc in sh'rpi:.

ot : l5 nrrtr.
c. -:rTransvcrsc :'
.,. "-'ll.
I. ' Roof : 6 rnm.
':-' tc'ntii :' i rn'.
i :* i III. Floor : 4 mm.
'. Communicalion :

a. Antcriorly : NasopIer;'rr1 ilri.iilir i!.liic.) i.ilj..

b. Postcriorly: Masloid uirt.rri rir,j eri ccli,; ti r.r,r1,lr r,,lilr,r i, :Lrl(rulll.
D. Boundarics :

a. Roof or tcgnrcr'iirl \\'.rli :i.:r:rr.,l.i r'lr lio rL rl il I c .rlrrr:r

b. Floor or.jugLrlar \! rll
I. Scparatcs nriddlc r, r il ri .rlr.rior Lrrlir ,r1 r:r. rrl t.r r lrr l vc in.
Il. i:ornrcd by;rgLrl,r ti'r'., ,'t i.irrJ).rll i( r:L'.
c. Artcrior \':'ll or c.rr :

I. It is coostrict.J.
IL Consisls of lhrcc l.rir
i. Up|cr Pilrt lLi:i r\ 'ilf.il lo. f.ir.r r i,'t.ii,. i

rt. lrlrriJlc prrrt ' : .: : .. . .r . ..

iii. Lorrcr piir( lii:rri ilrr i,,,.,t:rrr.r r..;.j ,.1 ,. rril :. : ri

- l:,rrcstra vostjbuti
T€nsor tynip.rnr

Lesscr potosal ne.vc

- '_ rlrrvo to slapodius
Pharyngolympanic

I -ar,..rdn lympanl
I t
"',c,ua
coctrlaae I

clD .:opharynooat norvo

rl
lnlcriral carolid anery l,(cinaljugulatveh
1

Fl0. 1,110:Nliddlcorrslrr!,,i,q..)_-? llc'rr. l'r'..ri )',,,r,stcr .,r iiri.1 rrcJatwall

 ' '
scptunr bctlvccrt clrrllrl lrrl (cllrl'l r) lrir,\rri ell (l ;lrl;i'
lll. Thar" is a
tubc.'
d- Postcrior \villi cr lnistoiJ *lll : liclrrc:rc'rlrr 1o ilo\,'irr g lllllurci frcini':

downrvards.:
L Sup{rlorly l Adillll l(t trrrtrro rl 'rrt r"rr
Il. Foisr incudis : Deprcsi''rrt Ir''t i tiLr'
'' lll. iyr,rrni.3 (p,"jccrioit) Ai:c;i oi irri'i irl'l iii:l'i'15.ll oi)jirirlg
siaoedius.. . ,i ,t ,
I tV.; ii.i"i'to'pyramid:Posririor cin:\lrculris f : cl -r'jl r)'!nl r'1
'e. Lateral or ntcmbranous rvall.
L scParatcs ntiddlc car ftonr crtcrrllrl cltt
ll. Formcd lrrinly bY:
i. TYmPanic nrcmbrallc.
ii. Pirtiy by squlmotts patt of lcorlrrrrirl ir'rl:
Itl. Ncar thc tynrpanic nctcil thcfc irtc (\\o xl'rrrl rirs -
i. PctrotYlnPonic fisin: c
ii. Antcrior clnllicttltis li)l rlr')rrlir l\Lr'r"rrr' lr lr' rr rLrLr I rl crrr' lt
I Mcdial or lilbyrintlrinc n'tlt ' ii "1,'r""" ' L" l' l': e

fcltturcs :
firllorving
I. I'rontontoi;'plodLlccLl i)) llrsl lr:rr) . r i ! .l Lrll
ll FcncsrrJ rcstibuli ll)\Ji o:)r'lrir:i
lll.I'rontincncc rrl llci:ri rI rll
lV._Fcncstrl cochlcll cll(l\ 1lr (irl r 1\:rli'::lr ": t: ' 's
l I c'ondirry
ntcnrbrattc.
V. SinLrs tyntpitni dcprcssrorr irclrrrr'l II:''tI:'t:tt ': '

Contcnts:

B. Bollc : Ear ossiclcs tllrntclv rllriliu: ilr:ir' rrr I ': '

e. Vcsscls, rvlliclr suppll' lrnd drli t rliJ'l : - rr

D. Musclcs : Tctrsor ty ttrpl'rtr ilrl.: rl ':l r ''

l;. Lignnlerltrt ol'cnr ,' s.1.1"
I,. Tyiupurrrc car iry pr.,lrcr 1.,(. .,. I . .

O. tpitynrpanic rcccss lbovc lvllllilrl' lllrrrrrrlir r'

3. Blood supply:
A. Artcrial supply :

a. Largc a rtcr ic s

I. Atttcrior t)'lllp''iic (l)riLrlill ol llr'r) t l

Il.Pust".io,LYlnPillrici.iilil.|]l.::
artcry.
b. Sr)lall arlerics
L supcrior Lvrrtplnic (rni'l'1lc rrtctrirtrr 'L rrrr : '

ll. lnlcrior lylr\Dallic (asccr)dirr8 l)lriir) '1:' l)

lll. lvnrn:rrric brlllch (artcr! of pLir'r" r ''
Ciroricory'rrprrrric brurr!rr ol lC/\'
lV,
Pctrosal brdncll of middlc nrr:nitr!lcrtl rrtict '
V,
B, Vcnous drainagc : Vr':ins from nliddlc clrr (lr'riri r'li(:
a. Supcrior Pctrcsal sinus.
b, ltcrYgoid Plcxus .'f rcirt
 Ncck & Facc

Ncrlc suppll ; Tynrprrric ploius lrrrrle,l b,'

A. Tynrpaqic branch of glossoplrrrl,ng,:rl rcrr ci l{
B. Carolicotl,ntpnnic ncrvc (plcrus rrroLllri l(l \i '-*
Allplicd :lnitorry : Throirt infcctiols corrrirr,rl),sprc.L.l r,, LiL rrricldlc
"",,,foouii'U
tuLc. \\'hich arc [Iorc cor])rnou in childrcr. Il ,:liiltlrcrr rlrc trrbc is small
Tltc pus ntay bc dischargcd into onc ol ilrc lillorvirU coLr:rc:,

C. :-May. crode thc;floor & sprcad do\\'n\\'irrd irr)d crrrs.J tlr r orn!osis of
D.'-May causc ni-ri!1did ol.riccss.
E, Fracturc of middlc crarriai fosse cil clr',ri. i'lucJrDit tl)rrrLr'tir tllc car

orgrn Corti
t I nttodtlction
2. Gross : lt is localcd on birsilur nrcrrrlrrirrri: r,l c,,lrle;rr ,l rc

l. Illcao!cl,ltlc $trttctur'(, r ( o sists r)l lollrj!!.:1, r rl::

A. Bisilul nrcrl)branc r li\(alLls lrollr Lr:iic\r.. r ii rrl .,rrrr::r
consists of co lluir cu ll l)rcr

vestrbulilr nrenrbrane
hak c.l.-

lviembrana leclor a

t-,

'lunnclol Co.1i l.
5p ral !rr,)|cn ol cochlear n.r,'c Basllar nrtniJi,, r,

H€nson's co l5
lnner rod cells

Ouler rod ceils

B. llods of Corti : Enclosc turncl o' Corl:. li.e rl:l.r I' oi r ), r : ls follows
Tablo 3.41 : Thc tabra shows deta s of nnor:)f.1 .Lrr,r rrll
I'n r(iculr rs Iurrcr rorls (t.illar) i Ou(cr rods (pi
Sirrglc S irl nlc
60 Lr0 .10 00
 o.:n's s,c,lo.ilil.

i ="-+*t.r-CqF-Tr&nsfcrs vil)raiioo into ncrvc intpLtlsc goiug tr) c(,cir cirr lcr\ c.
..l-tr-itir:{.].!,Therc..hqir
hrir cclls
erllr arc .liui.i^.t .i.,^
rr" divicicC i,,,..,. rrrJ
inro irrucr -,,,r orir-.r i..:. . -il..
^,,,... 1....t ,,r
l!:h iuiia rabr€ shows dola ts ot rnnor and o!ro. rr:,,: cur s

i 1"|l.t_Ig:9]]t'__ 9,'j.j,.!,ircclls..lljl
Mddial'iri iuncr r'dd of Corri i Ourcr tii outcr rod o f.'Cdrh
'i h rcc to lbLir

:010l i

Cllil.Lri..rl I
--l
/1.11(r'r,l .s ci .r\ cllcrcnl I
' .- lNervc suppl;,
a t. ilu t\l (cra I -

ir:2 r:L,r' ,'lir.rri r:lclcus

lFunction r\r.,ditolr

Thcsc inncr hair cclls ar'c srrlrIort,.ii lrl lrlrrr tLlrturL i trir:j i:1,, cr ,

Outcr :upporring c, lls ol llcrr:cl

Mcrnb.ana tcctorilr : Ccllrrirrorri i|.Itl:riLri. J()r Dr(jlrL lr1)r I I :r .l .,

Tonotopic locl Irs rri,,.r

Ilightorrcs : l-orvcr llrr't of ()rjtilt ol lorti
Low toncs : Uppcr part oi_ r:r,il) oi a orti

Cochlca
I. Cochlca : SIrcll ol srruLl. Shlpc I eonr:ri, l! lL::Lr,
) Locxtion : Antcrior ro tllc vcslrSl lc.
A. AI;3x rs tu\!ir:d\ .r,::{:,r.r'1.. . 1 : iri rrrirlr:l ,. l{lr) i.,.
Il. Base is ill tlrc :l,,rr ,,' rrr(r ' .' ,. ra.rl,r: i. j. r L:,..1 i\ ,(.lr ! r ,ttfC,
3. Dinlcnsion:
A. From blsc to apcr i urnr
B. Width 9lrm (ar brLsc).
4. Strrrcttrrc :
A. Ccntral Lrony urL, \l0tlroi,:. I :,. .tnrr,.i rir r. I I :lrl ir|tr{I:r,i
bony cirnirl is dl,,iri,,j illo irr,{ .l:r : .l;r:i. .r: : ; .r: i i
a. Scalr ntcdrr (..)cIlcir \l,t.t) i I r , t:,r.r.1..
i .r:r:
,
r. , ,r 1 ir..
L llasillrr:l,trirlrrairc llltL:l rLr!,c...r,r,..r: .l :r: :,
ll. Vcs(ibul.ri ol Ilcissrr:r'; i)1.:ii )ir.r .
lll. Outcr rvall ol-coclrlcl li-i ircr.vc:rr
lV Thc apcx of lllc cochlcl is birrrLl It
 caC, Ncck
Li
2:,
\/. Sl)iral orgit) ol (-'orii lics ol lr .r . i iir.iriri:rJr.
. b. Scall vestibuli:
l. Clrrll itl.:ovc sc:rilr nllrliu
Il. Cornnrunicittcs l itlr
i. Bony vcslibulc ilt Ij:r,c,

5. Opcnings rt basal tur! of borry cochlcr :

A. Or rl
rvirrdorv : Occu;):.rl L j :jr : ; ::::. :

B. Round ,rr irrLior,, : Closr; L., sc.. r. : .: , r

C. Coclrlclr c rr:rliculu.i , , ,.,,,,,, .,,, ,.. .

Short notes cr.r ilrni:ry ology

Iiirst phli.r,ngc:rI
First pharyngcal arch is also crlluo ru LrrLliirrl.r rr..
Tablo 3.43 : Thc table shows dcllri'1 .,us ol L: I I,ri.r ' l

hlusclcs r:l rrrlll Nct t'( & Artcr]'

l. Tcnrporrlis 1 Nctvc ot llrsl
I
2. L:rtrrxl lltqrIgoi(t phr rS,ngcal nrch is
I lrtur.l., ,t lliul(libu lar ncrvc,
l. Ntcrlixl t,tcr! x"i(l I r11 '{ri(.rr: ri r trrlnch ol'
.t. Masscrcr ) trigcnrinal nctvc
5. Mylo h vo id
lfilth crnnial
llc l\'! )
6. Antcrior bcll.\, 0t di!lstIi( il
't. Tcn !ior tytnl) ,trtcrr' of thc first l
it n i
p lruryngcal arch
!l- Tcnsor piltti nrostly disappcars,
l):Il ol th isartcry
lor nr s nraxillary
,l, (cry.
 'lit.
.-**i.
<\ A ''.,,'

\ ...,'
r',

f:
h

( i'rii ,4

"n
ilj
1\

S"r
Sccond phn rvllgcll I
Tltc rvord "sccottd" andthc clcrivrtivcs ol thcscc,r,Lj
Tablo 3.44 | Thc l.lotc sl.o,vl dcfivat,v(,! o, scco...i rt.,._..
n I'c lr

rrr.rrvle., rrrclr
_l
I.rir.irvitlrthclcttcr"S"
1 ,
Skclctrl clcnrcrrt l.i,':ur, rrt ilrtcf\
ll. Srapcdirrs. lA. Stapcs. Srvlrrlry,, it LltrL.rr: L f LrrL, ol' sccond
12. Stylolryoia. I g. $tyloid prrrccss ol I,iir rr Il!tci,l arch is
J3. Postcrior bcllv ot' tcmporrl bo nc. Ir,rrI.rI lcrvc (scvcntlr
I discstric. ]c. S:nallc r cornu o{i cr;rir,l rctrc).
14. Occ ipito fronr:rlr,. i hyoid bonc i

15. Musclcs of car t) Supcrior sLIlucc o1'

I

.\ r' t c lY,o f
6. Musclqs of f acirl; body of hy,,iLl borrc ,sccu,r_dJ
Irrr i n!cirl ilrcll nl(\stly
cxprcssiol. ] | ,( r:15 cXc(.pr J(,rl
7. Plutysnra. ii, r\ Ll l) rrl rvlticlr li,rrrrs I

!r . 1l rl llrl0r]'
]

Muscles ol lhe scalp

[4usc]es ol lhe exlernal ear

Musclcs ol f:rc'al e),press/or)

)
Slapcdius
i
Buaclnatcr
glyiohyold / t
<--l--r,
ri

Poslerior bo ly ot didastrjc
'
r,,,,, rd, rur
I
PlatyBrna
( *
I &
s
I
F19.3.113 : l,{uscl.s ouv.iloircg rrD l l:ij1 trr.rryirliji,t nrctr. .:l

''
 & Facc -

sraeesll]\
A :l)1c.i iroac5S:l

{li)lo:rioi(J liOxrncnt
Smallor cornr ot hyold bon;
- Suporioi part of )
F".+':l''r'f 1.'+1 '.4
i i i$,:'

: Skclclalclsmcnls and liOa'narlj ol sucoi,d plr3ryr tcol arch,

Pir aryngc:r i po tr ciics

Endodcrrtt of caclr phrryngcll rrr.lr rs c;rli.,l pir,r,r.l: Ll lLr.r; I ,ril rrr ing flrc tltc Strucltrr i i

givcn by thc rcspcctitc pouchcs

., Tablo 3.45 : The trblc shows d.r,ri)tvel ol i)rrrr)f(;!r r),,.-l Ll

Dorsal cnd

Flg.3.115: Tubolynr;)anic r€ccss l.\ ll)

l:ij ,.1 1i I r J.)ngoal poycll,:.i_.
I :11..-1.
 .,^Antorior
I
R,ch!<_F> Le,r
I
poYrerio,
Ltnguat swelling (l &

Tonsit
( )

Thymus
( lll ) L)
o",,,ur,oio nr,,n.
f f$o'io'

n"'o'nt'o'o n'n"u
fnf;';'
Fig.3.117 r,r r.rrr, i,t t)r ,lr, lr, l) r;ir....

PharyngcrI clcft
;j::i",rl of pharyrrgcal rrch is crticd
clcl
- ei'.r-rti. ,"'",,,",.,1 ', u,.,,..
i:::i,:l:l app"n. on ,r": n..i',,"i ,,,.,,.
l)'^"],j"t.
of ca r. sccon(J .r.r,l
r ir ,r I li) pilll.l
'
St:ond arch dcvclops ru,ter
rh:rr rlr... rerr,.r.rr
.r rc llcs , I. t:i: 1,,1 :l r:(t (itilr
.\,,specc is crcrtcd irr
bcrrlcerr o
r.:rltcd,rs ccrvicar .i,;;.
;,;i"::.,:l::1.'iil:.il]:] ',:,it, i r,) ir i, r -, I
ll i! \\ ijjc
tt..iucs caudal to thc ,,,.ri.1 , ..-rJ,l rrr:lr l :c:, sirlr
iriljri ;rr.r Ilr: rl.oorh
,r,r.r

Fig. 3.118 :Pr,:r).:,r)cll ctr llr

 s
i-lcai, Ncci. & Facc -
S
..,lffiT.tt l\{eckcl's cartilrgc 4iart-;
t. Dcllni(iott : Skclctal clcrllcrll ol iiri ltr.,l p,.i,;.-' ' ;:rrr'lr'oLrllr
'- l\'fccl:cl'sclrtilagc.
i;2. Dr(cnd : It cxtcnds tiortt tho tl*'clopirrg olii r.r;'r' i' (' rr'1r) LirLLllr Fronl
,-l
tt:13,.-:- l.tcrlvatltcs : follo|iirg.arc. dlc slrilcturcs !i\'.1 i)' .liil.lcrri 1r:rrls of M-c I

i.-'{'r' t'''r*'tlf;frlj; rile tar,rc,r,c,*'",,,.'. -,,.',.,,,"neu.:'

fv
I

'': ln"^"r r\. Irr.t:; ..:.i . , ,i

i l -'-
Intcrmcdiatc I A AI)t.llr,r lil'irrl)rrri ol r'rllcLls
, I"'-:-'-- |1' s1'l' ) :'iILr " r' ' )r ':: '.I.fi,." -
, ';t1.
'',.,..,-..'
Vcntral I A. IJrd! 01 lr1:,r'(1rl i' rr r'l la
'I

-,,,',1
[ffi-ffI([--
l;l?tY\--:i' :'i-.-11
Fo u.tt,
_ _
sirllr ltlr:tr r t)'-,; I il Icll
l. i\lrrsclcs: Gt\..rss of le l.
,\. C lico lr v rt.r irl
t

l]. Constrictor of pharyrrr.

C. lntrilsic nrusclcs of lar;'rt.i
D. Siriutcd nrusclc ol' ocsolhigrt
Sl(0lclxl clcnrctlt: Thc foLrrLir irnti rrrr.'i: r,i :, . I rL r.r lr " r"llrtr rrrrrl givc follol irr
ciri I i{gcs;
A. ]'hyroid,
l]. Crico itl.
C ,,\ r) rcrrorrl,
[) ( ornicrrlrtr rrrrtl
l: ( Lrtc ili,r'nt
3. N c rlcs r

A. Nc[vc ol rhc fourlll lrL.Lrrnre Lr :,:rlr i. .r.r -:rr I lr ".,1 i .:!c, a l)rilnch of villlLr
nc rv c,
B. Ncrvc ol tlrc sixlh plr.:r',rr5c;ri .rr,l j:, ir.::rLr: i.r:';'-l I r:'rLc li llranCh Of vagrr:
Cf! C.
4.
A. l:ourtll ilrcll
a. Right s rdc I:ornrs tltc ll\))irr il i,.rrL ol i ,il :rib.i.Lri Lit I i.r')'.
:

;b. Lcft si<lc : Arch of thc ror Lr

B. Sixth arch.
:a Ventral part :Fornrs 1tu lrtr oit;,rv lrr tti;.
b. Do.sal ps.t :
Right s idc : DLrctus ilr{cri(i\rrs " lLiil; (i -.ilrlrrill:! irtlll fornls ligoni'cntu nr
artcriosurn.
i
','li
. ri. i''
 )- Co.,ric!lclo

Cun,rilorrr

' 'r.i'i ,!ir.t

Crico I
F1g.3.11-o: Skel6[al elements dovolopod lro.1 l\' & \'l lrr thirr]rrq{jJl ircrr,rs

l. Chronological agc : l:rghth wcck of illrirLltcriuc lilcl

2. Ccrnt laycr : N.1cso(lcrrrr of phlryngcul urcIcs.
3. Sitc : At rhc pirlriti\c ulrl c.rvity.
4, Sourccs : lt consists of r\\'o l)rrts
A. Primitivc piLlat0 ii an irrca in lro r ol incisirr lossr. lr
mcdial nitsitl proccss & raxillary proccss.
B. Pcrmancnt pallic lics bcirinci 1,rrrili,,.r ;rrl.ir. ., I i
palatinc proccss ol [rorh nraxilllc in nri.ilirc. iiif :i:i .r L

pCrnlanC l l)rlillcs tlri:c plitcc itr ir \.' sl:lrircJ . I r: r:. t

bcforc blckr;r:,lr

f
i
Righl< ) r rrr
|
J

|---

C l,: ft
la0 nt.,

i\
.l

+ffiu*j-
1,.1.:.i:d!..,. '"r
j-'. 'i -
 I Facc

..:
C.,\ntcrior tlrrcc-fourth of plr, .:. - : :'.r ., .
D. Postcrior onc-forirtlr j
:
scplum and hangs ls soft pl r : .a

5. Anonralics :
A. Clcft palste.
B. Clcft lip.

1 't
Introductlon i Clcfl palatc: I'n!g:l
Dalatc ond vrrics in dcorcc of sc'c:.:,
:
l First dcgrcc : Bifid uvulrr.
2. Sccond dcgrce : Ununilcd DrlrrllL
3. Third dcgrcc : Ununitcd p;rlaLui oI orc ridc of prcmaxilla.- ' t$i.
4. Fourth dcgrcc : Is rirc. l.Jrlrrri. :.,llr , I r i i. .:,s :rrri clrli on both sidcs of prcfiiaxillr.
'::
- ,:l -
-E,,
Pt ).Nn ----/'r- :--

Secondary
pal.rle

, rl r.rL .Leil ;)iilalc

,ar:

3i[d uvula '. r i

''
l\/
rr r..,ll n.LLrl.l Clotl ol soft Palrl t

(! ii, oxrcndin0 ln lo hard fir ',

ii.li:rl r,,,r )1r ,,Ciltrr,L'j.

rA
.;
Clcft
Duc to lil ilu rc
 Ilc d, Ncck & FaccF

;J:
a

Unilal6ral c.loft lip B,Lr.,,il')

:rfir r.ir
,..@ *l ' tt' I

l' ( )
tl I

\1r/',
Modian clcil I p llar,r ;Lp
""-J-t/
L c,!,,rf c C iLp

l. Cltronologicil :rgc : Fiftlr Irrontl) ol'ir)lLrulcrinc I ji' t'.,

2. Gcrnr lrycr :
A. Uppcr lip : Ectodcrnr nnd urcsoclcrrrr.
B. Lowcr lip : Ectodcrnr and nrcsodcnrr
C. Chcck and vcstibulc of nroutlt: Ictodcrrrr ol rrivt,rl.rr, r rrt,r:t,.
3. Sourccs ; It dcvclops frcnr five proccsscs
A Unpaircd frontonasal proccss rvhicll aqltirt lb rl. lll!,i:i : illlil iillarrrL llil\rLl P'occris
R. Paircd nrr:iillary pr r)ccrrci
C. Paircd mandibul;rr proccsscs.
Abovc proccsses contributc for thc lirrnrrrt on L,l 1L,ii, \ irr:t i LL.lt.r.:
a. Lntcral pilrl ol nra)iilltLr)'ptocess Ltii. l,) iiLl. .L r.,rt,rl r::r1rc; I1r
b. lr'lcdian nasrl ptoccss givc risc to PiriltrtLLr',,1 1.1'; r lip.
Fronto nasal procc ss

o,ffiqo
Otl.t.tD.., rtr,ilL r

lied iin f:, .lL lir rc rr:

Olobular ptogosE
Flg, 3,123 | Devel3prnent of lic,l
 Hcad,-Nc:k & Fa;c .,- ..
-
a.' ltar:isiti
!ro..rt gi'"
l. Anomalics :.trlost of tlia anonraliri
proccsscs, s hich for;ns fucc,
A. Facial clc{i or nasolubial furro\r' : jt ir..lr.' ro lirilurc ol lirsion
proccss a rrd thc maxillary proccss. It nr:ry lc rrri utcral or bila
' is sbscnt in this ononrrly.
u,: IrcLiia{. ol ,latcrol.
uf Irtsior 'of rlgltt unrl

-
b. Latcrnl harclip : It is lc11, conrnrcn a:t-l ciLrc tn !ailurc of nar.r I
- proccss and nrrxilllry,proccss.
c. Vcrl rarcly lhcrc nra),bc irilurc ol f:ijiri (,1 rriircji5uiur urchcs & rcsuui'iinto sfiit
lorvcr Iip.
-:..]'l:
C. Macroslonta or rvidc oocnilg ,:rl ih,: rrr,rri:. Il ir.,iu': to li!ilurc or lcsscf-lcgrcc oi
fusion bll,r'ccl r:i:::itlt:il,r' ::r.l r,.r.,....,r . . r .:...
D. i,licrosi,,.,r.i (srlr,rii ,,rii i.sr.rlI - jr i, r.. ':.:. l.) c1-ccssrv. lLr:liort ol maxillary ilr,l
ntandibulilr prcccsscs
E. Othcr rnrc rr)ortlrlics ircr, oi r,.5r rr,1) i)( ,. r(rl
n, I'roho'icis I n .)Iirr{Irr' irI I'r!'t(rl,r,tr (,1 r, . l,r " r tir! i,'tlr,'r,(l
t). Clclops:[.usion (,1 1\\'o !\(]rlLlS

[)cvclr.rllrrrcnt t It t'lrt tis

Chronologicxl
Agc cllat)gcs
A. lt is lrrilcr ut lrirth.
il. lt contrnrLL,rrsly ilcrcrL.:r liii IL:lrr.rii'.
C. y',f{cr lrLrbcrty it urrtlc l,rc:, rrlilirLr,,.
2. Ccrnt l:rt'c r- :

A. llessal s i,rr'|trsclc: r. :..ei.rtr':,1 ti.)r:l Lr' ,.r'i::i.rl .i:i,:i tir. ll.rrri ;.lrurr,nqcul pou:i .
B. l-yrtrlllror,l i \suir i rlt r I 'Icrl lr,, r) ni(i r:(t:| ,,1 Ll tir,rrl jr rirrrIl,.,ll irrcll.
3. Sltc r lirlrril,\L ltll{r),lr'.
4. Soutccs : ll Ls \cr), clojrl\ uss(rciiL:cJ \vll r (lti ni(l(ri l)lllrlllvl()r(l glrtntl. lt gcts scp:rir.tcC
frorrt thc irrfcrr,rr p:rrillll\'r,r1Ll rtltrrrrl rs tltc lll ,'|t r.ri1|r)ji:t -l llrs ts rliviclctl into
A. 'l'lrinrtcr lr,rrtrorr rvlticlr liirlt:r Il)j ccr-t icrl l rrl , l_ tlt: tltr.rrl:s
B. llro:rtiur' i','r'iion is Jrr':.lrtl irrt.r l\!o l).rl:, .\i,:-:) r icr:i i to ilrorirx irld lorms tll,rrr.i,
Pir .

Thcsc rrvo 1,.':

fo rnrcd.
5. Anonr:rlics : o ,,
/\. Abrrorrrul \rtc is lltc !(iIrIL L) eIr illof f iri ,)I LIj,r:r\.s lt llrirf rcrrraitt along thc cou.]c
ol'dtvcloi\llrc|lt.
B, Corvlqtl l).lrr oI tl\c ltr\]1trs tlrr', $,i( 1r.1,:r.L!rrc.l & g vc risc tr) Lrcocssory thy'rirlo tturrr.,.
i r"1
 r.':-eia i Thc conrponcnts ol'rlrc cyc iur,l rutc dcrir cJ as lbllorr s :

- A. Forcbrain vcsiclc gi'cs risc ro

. r'': , ' ar : Rctina and
'.""
' _..b. Opric ncrvc.
. .: B.' Surfacc ccrodcrm.civcs risc to :
,: i{i+ei a,l,er Thc :epidiii,irtsl'qf il-e .cyet ios.
'i. ;.i.:7"1"b;
Lacrimal gland Bnd ducts,
;*i:::a:'i- : corijunciivil sac.
..... . d. Canaliculi ond sac.
',-:: : c; Comcal cpirhcliurn.
. . f. The lcns.
.iC;" Neurectodcrm givcs risc ro:
I 8. --Su_bstaI.ltia propria of corrrcr.
b, Sclera.
c. Choroid.
d. Ciliary body.
c, l ris.
2. Anomalies :

A. Colobonrr (d.lccl) : l)clccrrvc il(i.r r. ol opLLi lrssLr'f, rrl( .\'Ll(i,)LLrc.1:]l .icIlrrcrll

B, Thu causcs ol coltgcnilxl cllrlrit llLi bc :

a. Ilercditlry or by
b. lnfccticrn of rubcll:r r ir L;'
c. Astigntatistn : Faul11, cLrrr'trtLfc )l !LrillciL or ie tr Ito,1Lt:r: : , : li
- irrir( i , rrr

D. Rarc anonralics arc

a. Aph::kia I Abscncc ol lcrri.
b. Anoplttltrlml.; n br.r. c 't rr.
c. Cyclopi. : lrlcdiancvc.
ti. Aniridia i Absc!)cc ol-i r.
c. Svnoplrthalrni : Irrrsrrrrr ol c,..,
f. Mlc. ( l)lllullnrrjs I .. .:).:r,. ..

Short rrotes orr Ilistolog5.

ffim- c".'*r -- _-
- I

l. It forms antcrior onc-sixth ol {hc ouicr aort ol (\.i):Ll, CL,:fc., is riin:t)uic t irr.irL:\r
follow;lg rcaso rr s.
A. Rcgular arrrngcmcnl ol tibcrs.
B, Rcfractivc indcx ol-gro.rrrd subslur.u r, ld ill)-r r ti r..L rr
C. Thickncss of cach fibril is lcss thr:r r',.r.,.c lcr:.r1, trj ti,tl.r
D, Crilical Icvcl of rvatcr is rrrlinrainc I !1,. ucrir,.. .o.o:t)ir!)Lr
d Pccu orltics I Comca has
I ril A. No blood vcsccls
llll(i'1'b. No lvmnhrtics anrl
nl.n'".i"c rupply. Nc,u..' i,.c nun.,,,)rlrr,,r(,1

ffi
 Larc15 ; 1i;1" e:c iivc ia_..:, -: : l
F=.'
A. anterio: E;;ti.cliur:r ; .lr:::::.
l;:.: _
cpithclium!.
a. Thc dccpcr cclls arc colllnn:l .r::,: r..... r ,. ll
h. Thc supcrficial cclls lrc \qrrirl,,,... .,r. .... r.
c. Thc cclls rcst on litrcrr b,rscrr....,r ..,....., ,..
d. Thq cclls ncvcr kcrslir)isc.
9. _-h r froLr rrerr v !r !l;,,1,r. lL(,r((
allclioi lirritirli Ircnrl'iiIi, )

lrBnspilrcltt rrl]d horl]oLtct)o!s l]icIii)tu0c,

c. It contains coltagen fibcrs ti,hich irlc pr.,JLrc..<l ir! sitbstiinti0 proPna.
Conncctivc tissuc propcr . 1sLrb"r..r,i.., 1r"j, ,..
a. This is thc main substrlcc of conlir.
b. ,lt is prescnt dccp to Llo\\,utilli's lrcrnbrirrr.:.
c, it is i modificd,'trons1.r,rcnt. Il.ltt'r(,r . .. .. i.\ ri. r.j.
ussu^c conrlrns !lir):. r,,ii,,.:.j, iri rr: . irrr.rining conrcai spit6s.:,i::
:. i.,':^::lil:",]Ic
ii litiiiniiis - 2)il lrll]cll.la i|),i l:ir,,r r li r(r
-iru
containing sulphatcd g il c o s u rl j r,r .: ., i
:Lr.J\, cLrrlrctlcd il ground
. .l),,/t..1 i,, dr^,,nd .!,tar"
substBncc
.

f.
1

Thc collagcn fibcrs arc ,ri.lr,pc ti rrtrr::r, rr , :r r r.. l

g. Arritngcn)cnt of fibcrs ts !!r\ rc!tLrl.ll
lr. Fil'crs \l'ithirr onc lrrrrcli,,: ir. 1 ,, , .,.,1 .r. rl ol)rusc anglc Lo
lhosc ol'fil)cis of a<ljrrr:c Lr lrLrrrcl 1....
ll contains Ilbrobl!sl wll (lr x r-. r,.ll,rrr L r li ,r I i.r r .rr,. :rlso t lllccl as lcratocyrc.;
or COrnctl CorpusclCs ()i aL)l0eoj\ Lr\.
D. Dcscctnct's ntcr)tbranc I (-J'r ur IrtLs,_.rrrcnt Lli:L].rr.r: .

:1. lt ls lorrn(..1 Lry horrr,,. -.I j.,.,.: .r,.,:.:r.r.

h. irlctttbrrrrc i,rclks lt :lrc i|.:irliti !): llrc t, t:i.. |.i.) llL)las \\i .ll lbnn inncr rvsll
of
sinus vcnous sclcrt.
c. Thc sp0ccs hcl\,cct tllc... rr,r5,:cr:.r .- .,r I . I ,l,r,. c. ot r i,locoritcrl anglc.
r

D, l.lrrdorrrcrrunr of iltcrior clliIl)i)ar

a. It is bltlrco Lr1 lr,1ucuLr. l: ..,,.. Il lr,1 rr lrc LiLrrr :ls r)anlcd.
lr ll ls linc(l hl los crrl'. L -; . .

c. lt is lrrl,r;.tc,l li.r rr. r,t , r. , ....

A.lerjor cp thetrun ___

Elowm6n'g mernbtane

Connectivo liss Lr e

Descemet's membrane
I

Endolhelium of anterioi - -l al(ono{i or low

chamber c!boidalc6lls
Fi(i.3.12{:C,[..j.r
 ..'.j r

*.1.i
Iletin:r

,er of r0ds Srtd corr,:s :

Rods and c6nc! irc lirht
- rcicnrors
Tti. .onit it.fon'a ,^ +-- .rur:
a. Acu ity of vision.
b. Brightncss of lisror.
c. e olor visiou.
' Rods rcspond to Cirrr i lirt.
'Outer linliting mcnrbrrrrr : Corrllrrs llrtcrrl lrroc ess of radial
Outcr nucl.':lr lelcr : . :.. r.r r' ..i.,r of rctls anrl.cLrnc:r
proccss of ncLrrons.
5. Outcr I)lc\ilorr) lilt'rr
Pigmcn( c r,lL liy€r

Layar ol rods & conr:

Outer limitino .ncrr1brane

Outor nuclc.i layor
iNucLel o{ rods & con.!)

Outcr plorifonr lr yc,

C', ; 6 G, :a(aA /-, (:' (:t a a: .l'' ()

lnncr nuct".r' r,, i , i ,' -; () Oat (, O
i.t r:, e)
G,

o Otc)a. e
C)
(;)

-J- .:r -// \ --- lnncr ploriforn\ lrlrr

l,-- \__/, :- -
-_-\
Ganglion cell layer
-- Layc. ol optlc nor\! ii
i: a.33l;5ri.lLl,i.
1i5 :

Inncr nuclcrrr laycr: It L riir ir.

A. (lcil boLliirs attd ttLrL.. L I 1) ir,,, i.. .r.:. L
.i(..)n(j,,a(jca f:Lr:rr0: ol- visL.ol prtl;r|r,r)
B. A ssociut ion ncurons
a. llorizontal cclls
b. Arnacrirrc cclls
C. Supporting cclls (l\.1r: i.r's !rl \l
 aa
"aa-\"a" "a*
7. Inncr plcxifonn l:r1cr : Cort:rirr, .,,.. .. .: i-,
of association cclls qr flnucrirt -rll::
8. Gnnglion ccll l:ll'cr : Corlrri), ,:li l, .i .: irfc
' cclls with pron)incl)t nisscl granrlcr 'li:r r ...'r. ,1 r thc

9. Optic ner!c ls)'cr : Contains (,lrli! rr(r.' 1.1:r't. ,Lr .l

I0. Inncr !inriting orcnrDranc i I lir \urlil,re lr.r1r1: r,a\i lir'.'ar ls t)lro\\'n
-,.insinualc betwbcn rods a;d ggncs. I( l)rc\'c]lrs dillirjLrr oll liUht: l(
... retina ind lipr'citnd'ii uisil r..i ',' r" ,1..1 ','; ; ,t; ., i',"ii . ui, ol M;uii L
Eyclid

Skatined squimous
epilhelium
Blood vcsseis
wi
-.'-1
i

Ciliary (sv/e3tJ
g ands

E.v.i:.'.r,
I L',1 I 121
Fcaturcs:
l. Both thc sLlrluccs ol thc c1'clid irr, rL..(l l)\
A Skirl ol llrc c\. '(i ,s lrrrt'l br
U. Mucou. rr,crtri.rtlrtrc (tl tl\c c\ " I .l'il al .lrll
2. Skelcton is lbrrncd ltl' n trlrlss,)l lrirrL)L 'I|i | ;:iiI:LJ':' r i ) 1.,1r

3. Fat cclls rrrc abscnl in thc subcprt)rci;r, r.rrrr'iL'lr\r 1:\'r'i

4. Arrcctor pilrrullt tnusclc is ^b)cDl ril { lr lrir l
5. n cccssory Iacr'imal glrLrrrls ilrr: l)r( 'rrl
gland.'lhcv otc scrous irl nrlrrrc.
Tarsal glunds (Mciborrrrrrrr glrrrrcl; : I r. ir rr1 trr ir:.rr.rr I ii ,l

?. Moll's gland : Thcsc nrc fl]odificd s\ci I

illrr:r,i,
E' clands of Zciss : Thcsc irrc scbacc"Lr'
 'Sclcroicolncril j uir ctio rr

ff
:j iii. Dcep
Dcep'IIalrc cd c c IIs.
III. At sclera junction : Strllificti stlLr.rirrous
r.r v, ;i ;;;;; comcal
i'_..
r Jiiii"i ri"" ii'ii,'r Ji' :;i,';; JJ'J'
b.. Borvman's membrnnc clrrngcs ir,r, sui :1,irl.:lr..l r,r.,.: . r l::icctlvc .

''c.. Collaqenous bundlcs of tl:c s.lcrr iui.l;ilr-' ( ir(c:rv riil. thosc of

:lcl bccomc pirallll r!itlt c::.1: .):.1.: ::. j l:.- j ur]]cs homo
irl Slii:!r!lli.
d I)ostcrior lip fornrs:r l)rojcc(ir)!t :irlg,: r:r rrirclr tlrc
e. l)cscc0ts Incntbrillc (clt)tir)lL(,r ir:lL, it.i[]cri.ll:r r):.
krt rtrvn ls
I ol llorrtarr'.r'hiclt rrr. l:r..1 t), iL:i.ir.t,Lir,t . .i
Spitcer
Ii. l lr,r:c spuccs r:orl]:|rrrriculr. r']t I ritr rL:r cri ,: ctr. Lt I !.\!
lll Ttc,c irrc sc\'.' .l : .t.rll ; l j ., :L ,l1lc1,\r nnd latct:.I
to tr'ilbccrrlar Lrtf\ll\\,ofk. ltLr.- -.r..1 .:.c r,. ., . i(elloDs of,a cirCulilr
crrtnl knog,tt rrr tlte c.rl:.i ,rl Scl,L.r:i .\ttici, il. rLlLilcl to rhc bbrdci ci'
crrtrrct. l'his currtl contnitrlrclrlrr r. i, ir rcr : .te-:.rrr,.l is trsuallv fillrJ
rr'illr cicar aqucoir:, itLrltlr :.: '

T:iJle 3.47 : Ttrc l.Jbie sltows scl!ro co tcr ui.l...

C:rrrui of SchlcmriL

, i, ti]lt

l, ;::Ll l