Aa Anatomy

GENERAL ANATOMY
Topic 1
OSTEOLOGY OF HEADIIIMIII
SHORT ESSAYS
0.1. Enumerate any four structures passing through foramen magnum.
Ans. The structures passing through the foramen magnum are as follows:
Through the anterior part:
1. Apical ligament of dens
2. Vertical brand of cruciate ligament
3. Membrane tectoria
Through the subarachnoid space:

I. Spinal accessory nerves
2. Vertebral arteries
3. Sympathetic plexus around the vertebral arteries
4. Posterior spinal arteries
5. Anterior spinal artery
Through the posterior part:

1. Lowest part of medulla oblongata
2. Three meninges
0.2. Give the attachments, nerve supply and actions of inferior constrictor muscles.
Ans.
The inferior constrictor muscle consists of two parts:
I. The thyropharyngeus
2. The cricopharyngeus
Their attachments arc as follows:

The thyropharyngeus arises from:
I. The oblique line on the lamina of the thyroid cartilage, including the inferior tubercle.
2. The inferior cornua of the thyroid cartilage.
The cricopharyngeus arises from the cricoid cartilage behind the origin of the cricothyroid
muscle. All the constrictors of the pharynx are inserted into a median raphe on the posterior
wall of the pharynx.
Nerve Supply
All muscles of the pharynx, except the stylopharyngeus are supplied by the motor fibres derived
from the cranial acces-sory nerve through the branches of the vagus. The inferior constrictor
receives an additional supply from the external and recurrent laryngeal nerves.
Action of Inferior Constrictor Muscles of Pharynx

The inferior constrictors of the pharynx bring about the third stage of deglutition or swallowing.
SHORT NOTES
0.1. Dens.
Ans.
I. Second cervical vertebra called axis is identified by the presence of the dens or odontoid
process. which is a strong. tooth-like process projecting upwards from the body.
2. The dens is usually believed to represent the centrum or body of the atlas, which has fused
with the centrum or body of the axis.
3. The superior surface of the body of cervical vertebra is fused with the dens and is encroached
upon on each side by the superior articular facets.
4. The dens articulates anteriorly with the anterior arch of the atlas, and posteriorly with the
transverse ligament of the atlas (Fig. 1A.1.1).
0.2. Maxilla.
Ans.
Maxilla is the second largest bone of the face. The whole of the upper jaw is formed by two
maxillae, and each maxilla contributes in the formation of face, nose, mouth, orbit, the
infratemporal and pterygopalatine fossac.
Features
Each maxilla has a body and four processes.
Body of maxilla
The body of maxilla is pyramidal in shape, with its base directed medially towards the lateral
wall of the nose and the apex is directed laterally towards the zygomatic process. It has four
surfaces and encloses a large cavity known as the maxillary sinus.
The four processes of maxilla are as follows:
I. The frontal
2. Zygomatic
3. Alveolar
e Palatine onnremes
0.3. Hyoid bone.

Ans. The hyoid bone is U-shaped and is situated in the anterior midline of the neck between the
chin and the thyroid cartilage (Fig. IA.1.2).
2. It develops from second and third branchial arches.
3. At rest, it lies at the level of the third cervical vertebra behind and the base of the mandible in
front.
4. The hyoid bone consists of a. the central part, called the body and b. two pairs of cornea, the
greater and the lesser.
5. It is suspended in position by muscles and ligaments. The hyoid bone provides attachment to
the floor of the mouth and to the tongue above, to the larynx below, and to the epiglottis and
pharynx behind.
0.4. Mastoid groove.

Ans. The mastoid part of the temporal bone lies just behind the external acoustic meatus. It is
continuous anterosuperiorly with the squamous temporal bone. A partially obliterated
squamomastoid suture may be visible just in front of and parallel to the roughened area of
muscular insertions known as mastoid groove.
0.5. Auditory tube.
Ans. The auditory tube connects the middle ear with the naso-pharynx anteriorly (Fig. IA.I.3).
The sulcus tube which is a groove between the posteromedial margin of the greater wing of the
sphenoid and the petrous temporal bone lodges the cartilaginous part of the auditory tube.
Posteriorly, the groove leads to the bony part of the auditory tube, which lies within the petrous
temporal bone.
0.6. Deep cervical fascia.

Ans.
Deep Cervical Fascia (Fascia Coil)
The deep fascia of the neck is condensed to form the following layers:
1. Investing layer
2. Preteacheal layer
3. Prevertebral layer
4. Carotid sheath
5. Buccopharyngeal fascia
6. Pharyngobasilar fascia.
Investing layer
It lies deep to the platysma muscle and surrounds the neck like a collar. It forms the roof of the
posterior triangle of the neck.
Pretracheal layer
The importance of this fascia is that it encloses and suspends the thyroid gland and forms its
false capsule. A fibrous band from this is attached to the cricoid cartilage known as ligament of
Berry.
Prevertebral layer
It lies in front of the pm-vertebral muscles, and forms the floor of the posterior triangle of the
neck.
Carotid sheath
It is a condensation of the fibroareolar tissue around the main vessels of the neck. These are the
common and internal carotid arteries and internal jugular vein and the vagus nerve.
Buccopharyngeal fascia
This fascia covers the superior constrictor muscle externally and extends on to the superficial
aspect of the buccinator muscle.
Pharyngobasilar fascia
This fascia is especially thickened between the upper border of. Superior constrictor and the
bare of the skull. It lies deep to the pharyngeal muscles.
0.7. Jugular foramen.

Or Name any four structures passing though jugular foramen.
Ans. The jugular foramen is large and elongated, placed at the posterior end of the
petro•occipital suture.
The jugular foramen transmits the following structures:
Through the anterior part
I. Inferior petrosal sinus
2. Meningeal branch of the ascending pharyngeal artery
Through the middle part

I. IX, X and XI cranial nerves
Through the posterior part

I. Internal jugular vein
2. Meningeal branch of the occipital artery.
The glossopharyngeal notch near the medial end of the jugular foramen lodges the inferior
ganglion of the glossopharyngeal nerve.
0.8. Foramen lacerum.

Ans. The foramen lacerum is a short, wide canal, I cm long. Its lower end is bounded
posterolaterally by the apex of the petrous temporal, medially by the basiocciput and the body
of the sphenoid, and anteriorly by the root of the pterygoid process and the greater wing of the
sphenoid bone.
The structures passing through the foramen lacerum arc as follows:
1. During life the lower part of the foramen is filled with cartilage,and no significant structure
passes through the whole length of the canal, except for the meninged branch of the ascending
pharyngeal artery and an emissary vein from the cavernous sinus.
2. The upper part of the foramen is traversed by the inter-nal carotid artery with venous and
sympathetic plexuses around it.
3. The nerve of the pterygoid canal, leaves the foramen by entering the pterygoid canal in the
anterior wall of the foramen lacerum.
0.9. Zygomatic arch.

Ans.
I. The zygomatic arch is formed by the temporal process of the zygomatic bone in anterior one-
third and the zygomatic process of the temporal bone in posterior two-thirds.
2. The arch is separated from the side of the skull by a gap.
3. The anterior end of the upper border is called the jugal point. The posterior end of the
zygoma is attached to the squamous temporal bone by anterior and posterior roots.
4. Two projections are visible in relation to these roots. One is articular tubercle or tubercle of
the root of zygoma at its lower border and the other one is the mandibular or articular fossa and
is known as postglenoid tubercle.
0.10. Superior orbital fissure.

Ans.
I. The superior orbital fissure is situated at the posterior part of thejunction between the roof
and lateral wall of the orbit.
2. It is an oblique, roughly triangular space bounded above by the lesser wing, below by the
greater wing and medially by the body of the sphenoid.
3. The lower border is marked by a small projection, which provides the attachment to the
common tendinous ring of Zinn. The ring divides the fissure into three parts.
0.11. Greater horn of hyoid.

Ans. Hyoid bone is a U-shaped bone suspended by stylohyoid ligaments and lies in front of the
neck between the base of mandible and the thyroid eminence (Fig. IA.I.2).
Hyoid bone has following parts
I. Body
2. Two greater cornua
3. Two lesser cornua.
Greater cornu or greater horn of hyoid bone projects backwards on each side as a long slender
process from the lateral ends of the body.
It possess:
two surfaces: upper and lower,
two borders: medial and lateral and
two ends: anterior and posterior.
Surfaces
Upper surface
Gives origin to
I. Middle constrictor muscle of pharynx medially
2. Hyoglossus muscle laterally.
Gives insertion to
I. Stylohyoid near the junction of greater combs with the body.
Gives attachment to
I. Fibrous loop anchoring the central tendon of diagastric-muscle to the hyoid bone.
Lower surface
It has no attachments.
Borders I. Medial border It gives attachment to thyrohyoid membrane.
Laremi horde, It gives insertion to thyrohyoid muscle anteriorly.
Ends I. Anterior end: It unites with the body by synchondrosis. 2. Posterior end: It ends in a
tubercle.
0.12. Surgical importance of pterion. Or Give the formation of pterion and Structures related
deep to It. Ans. I. The anterior part of the floor of temporal fosse is crossed by an H-shaped
suture where four bones; frontal, parietal, sphenoid and temporal adjoin each other. This area is
termed as the pterion. 2. It lies 4 cm above the midpoint of the zygomatic arch or 4 cm above the
zygoma and 2.5 cm behind the frontozygomatic suture. 3. The middle meningeal vein, the
anterior division of the middle meningcal artery and the stem of the lateral sulcus of the brain
lie deep to the pterion. 0.13. Name four arteries related to remus of mandible.
Or Give the four arteries related to remus of mandible. Ans. The four arteries related to ramus of
the mandible are as follows: I. Mental vessels 2. Inferior alveolar vessels 3. Mylohyoid vessels 4.
Masseteric vessels.
0.14. List out four structures passing through superior orbital fissure. Ans. Structures passing
through superior orbital fissure are as follows (Fig. IA.1.4): I. Superior and Inferior ophthalmic
vein 2. Latsiokil octve 3. Frontal nerve 4. Recurrent meningeal branch of ophthalmic artery 5.
Trochlear nerve 6. Oculomotor nerve 7. Nasociliary nerve 8. Abducent nerve.
0.15. Name the muscles attached to greater comua of hyoid bone.
Recurrent meningeal branch of ophthalmic artery Lacornai nerve Frontal name Superior
ophthalmic nerve tipper and lower divisions or ocutcmotor mom -Nasociliary nerve - Abducom
nerve - Inferior ophthalmic vein
'Troth
MVO
Lessor rang of sphcocid
Common tenomous ring i- - Body or sphenoid Superior Orbilal fiNSUre

Greater nine of sphenoid Fig. IA.I.4 Structures passing through superior orbital fissure.
Ans. The medial border of the greater combs provides attach-ment to the following muscles: I.
Thyrohyoid membrane 2. Stylohyoid muscle 3. Digsatric pulley. The lateral border of the greater
cornua provides insertion to: I. The thyrohyoid muscle 2. The investing fascia. 0.16. Structures
passing through foramen ovals. Ans. The foramen ovale is large and oval in shape. It is situated
posterolateral to the upper end of the posterior border of the lateral pterygoid plate. The
foramen ovale transmits the following: I. Mandibular nerve 2. The lesser petrosal nerve 3. The
accessory meningeal artery 4. An emissary vein connecting the cavernous sinus with the
pterygoid plexus of veins 5. The anterior trunk of the middle meningeal vein. 0.17. Structures
passing through anterior condylar canal.
Ans. I. The hypoglossal or anterior condylar canal pierces the bone anterosuperior to the
occipital condyle, and is directed laterally and slightly forwards. 2. It transmits the hypoglossal
nerve, the meningeal branch of ascending pharyngeal artery. and an emissary vein con-necting
the sigmoid sinus with the internal jugular vein. 0.18. Openings in the middle meatus of the
nose.
Ans.
The middle meatus of nose lies beneath the middle conchae engaging the structures like, the
ethmoidal bulla hiatus semilunaris and infundibulum. The openings in the middle meatus of
nose are as follows: I. The opening of the frontal air sinus in the anterior part of the hiatus
semilunaris. 2. The opening of the maxillary air sinus located in the posterior part of the hiatus
semilunaris. 3. The opening of the middle ethmoidal air sinus is present at the upper margin of
the bulls. 0.19. Give the attachments of pterygomandibular raphe and name the muscle attached
to it.
ns.
'1 he rterygomandibular raphe is attached immediately behini the third molar tooth in
continuation with the origin of the superior constrictor. 'I he muscles attached to it are as
follows: I. Superior constrictor muscle of pharynx 2. The buccinator muscle. 0.20. Ligaments
attached to the mandibular surface.
Ans. ligaments attached to the mandibular surface are as followx. I. Sphenomandibular ligament
2. Lateral ligament of temporomandibular joint. 0.21. Enumerate any four structures passing
through foremen magnum. Ans. The foramen magnum transmits the following structures: I.
Lowest part of medulla oblongata 2. Three meninges 3. Spinal accessory nerves 4. Vertebral
arteries.
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General Anatomy
0.22. Name the contents of pterygopalatlne fosse. Ans. Contents of pterygopalatine fossa are as
follows: I. Third part of the maxillary artery and its branches
2. Maxillary nerve and its two branches, zygomatic, and posterior superior alveolar. 3.
Pterygopalatine ganglion and its numerous branches containing fibres of the maxillary nerve
mixed with.
Topic 2
SCALP, TEMPLE AND FAill
LONG ESSAYS
0.1. Enumerate the layers of scalp. Give their blood supply, nerve supply and lymphatic
drainage. Ans. The scalp is made up of five layers: I. Skin 2. Superficial fascia 3. Deep fascia
(epicranial aponeurosis or gales aponcurotica) 4. Loose arcolar tissue 5. Pericranium. I. The skin
is thick and hairy outermost layer of the scalp. It is adherent to the epicranial aponeurosis
through the dense superficial fascia. It contains large number of se-baceous glands and is richly
supplied by blood vessels. 2. The superficial fascia is the second layer of scalp which is more
fibrous and dense in the centre than at the pe-riphery. It binds the skin to the adjacent
aponeurosis, and provides the proper medium for passage of vessels and nerves to the skin. 3.
The deep fascia, i.e. the epieranial aponeurosis or gales aponeurofice, is the third layer of scalp
which is freely movable on the pericranium along with the overlying adherent skin and fau-ia.
The occipitofrontalis muscle has two bellies, occipital and frontal, both of which are inserted
into the epicra-nial aponeurosis. Anteriorly, it receives the insertion of the frontalis, posteriorly
it receives the insertion of the occipitalis and is attached to the external occipital protuberance,
and to the highest nuchal lines in between the occipital bellies. On each side the aponeurosis is
attached to the superior temporal line, but sends down a thin expansion, which passes over the
temporal fascia and is attached to the zygomatic arch. 4. The fourth layer of the scalp is made up
of loose areolar tissue which extends anteriorly into the eyelids; posteri-orly to the highest and
superior nuchal lines and on each side to the superior temporal lines.
5. The pericranium is the fifth layer of the scalp and is loosely attached to the surface of the
bones, but is firmly adherent to their sutures where the sutural ligaments bind the pericranium
to the endocranium.
Arterial Supply of Scalp and Superficial Temporal Region The scalp has a rich blood supply (Fig.
1A.2.1) derived from both the internal and the external carotid arteries, the two systems
anastomeue over the temple. In front of the auricle, the scalp is supplied from before backwards
by the following: I. Supratrochlear 2. Supraorbital 3. Superficial temporal arteries. The first two
are branches of the ophthalmic artery, which is a branch of the internal carotid artery. The
superficial temporal is a branch of the external carotid artery. Behind the auricle, the scalp is
supplied from before backwards by the following: I. Posterior auricular 2. Occipital arteries.
Both are the branches of the external carotid artery.
Supratoehlear nerve Suoratrocivea artery Supra:ebbe nerve - Supraorbital adore
Zysemarieotempons
nerve Auncolorernporar nerve
Lesser OCCptal Greater Occlaital Occipital silo's nerve Third occipital nerve Ag. 111.2.1 Scalp
showing arsenal and nerve Supply.
Supra, al temporal artery Anna Posterior auricular artery

Lymphatic Drainage I. Preauricular or parotid lymph nodes This group of lymph nodes drains
the anterior part of the scalp. 2. Posterior auricular or mastoid and occipital lymph nodes: The
posterior part of the scalp drains in to this group of lymph nodes.
Nerve Supply Thr scalp and temple arc supplied by 10 nerves on each side. Out of these, five
nerves (four sensory and one motor) enter the scalp in front of the auricle. The remaining five
nerves (again four sensory and one motor) enter the scalp behind the auricle. Nerves of the
scalp end superficial temporal regions
I•
Front o; auricle Behind tip auricle
Sensory nerves 1. Supourcuharer 2. Sueraortillat Warier. 3. Zygmaticolemporte 4.

Aurieulotomporal nerve
Motor nerves 1. Temporal branch or facial noise
Sensory nerves 1. Posterior clivcion ce great auricur nerve (C2. CS), from ceevesn plexus 2.
Lesser occipital nerve (Ca from camera 0.04 a Greater occipital naive IC2), dorsal lama 4. Third
mutate/ nerve (C3).001581 tarn.
Motor nave I. Posterior atflpilar branch 01 laCial name
0.2. Describe the maxillary nerve under the follow-ing headings: origin, course, branches,
distribution and applied anatomy. Ans. The maxillary nerve is a sensory nerve originating from
ante. rior border of the trigeminal ganglion. It leaves the cranial cavity through the foramen
rotundum and enters the pterygo palatine fossa. It then enters the orbit through the inferior
orbital fissure. The nerve is accompanied by the infraorbital artery. The part of this nerve in the
floor of the orbit is called infraorbital nerve. In the floor of the orbit the nerve passes whin the
infree.rbitol canal. P. then passes through the infraorbital foramen and enters the face and
terminates by dividing into the following peripheral branch= 1. Inferior palpebral branch 2.
Lateral nasal branch 3. Superior labial branch. Branches of maxillary nerve in detail arc as
follows (Fig. IA.2.2): Within the cranial cavity:
Ag. 1A.2.2 Maxillary nerve and its branches.

It gives of meningeal branches to the dura mater of the middle cranial fosse. Within the
pterygopalatine fossa: I. Ganglionic branches to join pterygopalatine ganglion 2. Zygomatic
nerve: a. Zygomaticotemporal b. Zygomaticofacial 3. Posterior superior alveolar nerve Within
the floor of the orbit: 1. Middle superior alveolar nerve 2. Anterior superior alveolar nerve On
the faces 1. Inferior palpebral branch 2. Lateral nasal branch 3. Superior labial branch. The
posterior, middle and anterior superior alveolar nerves enter the maxilla, and they form the
superior dental plexus to supply the teeth of the upper jaw. Also they supply the maxillary air
sinus.
Ganglionic Branches 1. Sensations from the pharynx, nose, palate and orbit are carried by these
fibres. 2. It also receives seavtomotor fibres through the nerve of the pterygoid canal to supply
the lacrimal gland.
Zygomatic Nerve I. It is a branch of maxillary nerve. It enters the orbit, and divides into
zygomaticofacial and zygomaticotemporal branches. 2. Zygomaticofacial nerve passes through
the foramen of the zygomatic bone to supply skin of molar region.
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3. Zygornancotempond nerve enters the scalp and supplies the skin of the temporal region and
anterior quadrant of scalp. It carries parasympathetic fibres to the lacrimal nerve to supply
lacrimal gland.
Posterior Superior Aiveloar Nerve i. It enters the maxilla through an opening on the poste-rior
wall of maxilla. It supplies the mucous membrane of maxillary air sinus. It joins superior dental
plexus. 2. The posterior superior alveolar nerve via this plexus supplies the molar teeth of the
upper jaw and related guns of the maxilla.
The sensory root commences Irons the anterior border of the trigeminal ganglion. The motor
root of the mandibular nerve lies deep to the trigeminal ganglion.
Mandibular Nerve (Fig. 1A.2.3) Course 1. The two roots pass through the foramen ovate and
enter the infratemporal fossa. Just below the foramen ovak, the two roots unite to form the main
trunk of the man-dibular nerve.
Middle Superior Alveolar Nerve I. It is formed within the infraorbital canal, i.e. on the roof of
maxillary air sinus. 2. Its branches specifically supply the premolar teeth and sometimes join the
superior dental plexus.
Anterior Superior Alveolar Nerve I. It is a branch of infraorbital part of maxillary nerve, which
passes downwards into the anterior part of maxil-lary sinus. It divides into dental and nasal
branches. 2. the dental branch forms the superior dental plexus by joining posterior superior
and middk superior alveolar nerves. Through this plexus it supplies the incisor and canine teeth
of the upper jaw. The nasal branch supplies lower half of lateral wall of nose.
Palpebral Branches They supply skin of the lower eyelid and related conjunctiva.
Nasal Branches They supply the skin on the lateral side of external nose. Superior Labial
Branches They supply skin and mucous membrane of the lip and cheek.
Applied Anatomy During trigeminal neuralgia pain along the course of all branches of trigeminal
nerve including maxillary nerve. During cavernous sinus thrombosis, this nerve may be com-
pressed by blood dot. 0.3. Describe the course, branches and distdbu-lion of mandibular division
of trigeminal nerve. Ans. Mandibular nerve is the largest of the three divisions of the trigeminal
nerve. It is a mixed nerve carrying both sensory and motor roots.
motor root
say root Foramen wale
Nervous unmans
Tpa
Auncoloternporai rue,.
oto tampon
3. Masseterie
4. Buccal.
Branches from posterior division 1. tsI 2. Lingual 3. Inferior alveolar. Branches of mandibular
nerve and their distribution in detail are as follows:
Branches from the main trunk I. Nervous spinosus or meningeal branch: It enters the skull
through the foramen spinosum along with the middle meningeal artery and supplies the dun
mater of the middle cranial foss. 2. Nerve to medial pterygoid muscle: It supplies the medial
pterygoid muscle and then it en-ters the otic ganglion. Through this ganglion it supplies tensor
tympani and tensor yeti palatini muscles.
Lrgual nerve
Nerve le
Nrtaneld
---***) !alma/ elvuotar nerve
Mental nerve
Amelia ly of dgasutc Fig. IA.2.3 Mandibular nerve. Mpt, nerve to medial pterygoid: Mae
rnassetenc nerve: Temp. nerve to lemporalis and Let, nerve to lateral ptorygcid.
2. The main trunk is niedially related to the tensor veli pala-tini muscle and laterally related to
lateral ptcrygoid inns. dc. The otic ganglion is situated on the medial side of the nerve trunk.
After a short course, the trunk of the nerve divides into two divisions: (a) anterior and (b}
posterior.
Branches of Mandibular Nerve Branches from main trunk 1. Meningeal branch 2. Nerve to
medial pterygoid.
Branches from the anterior division 1. 'fhe anterior division is mainly motor, and it has some
sensory fibres. 2. The anterior division gives the following branches: a. Nerve to mustier It
crosses above the tendon of the lateral pterygoid muscle. It is accompanied by the artery to
masseter. It then passes through the mandibular notch. It supplies masseter muscle and
temporomandibular joint. b. Nerve to lateral pterygoid muscle: This branch enters the medial
surface of lateral pterygoid muscle. c. Nerve to temporalis (deep temporal nerves): They arc two
in number emerging from the upper border of the lateral pterygoid muscle and are
accompanied by deep temporal arteries. They supply deep surface of temporalis d. Buccal
nerve: It is sensory nerve which passes between the two heads of the lateral pterygoid
accompanied by the buccal artery. This nerve supplies the skin and mu-cosa of the check
Branches from anterior division I. Deep temporal 2. Lateral pterygoid
mandible and sphenomandibular ligaMent behind the tem-poromandibular joint, running
behind the superficial tem-poral vessels. It pierces the upper border of the parotid gland and
crosses the xygomatic arch and then it enters the tempo-ral to= (Fig. IA.2.4).
Flg.1A.2.4 Auriculotemporal nerve.
It gives the following branches: 1. Auricular branches to supply external ear 2. Temporal
branches to supply the skin of the temporal region 3. Glandular branches to supply the parotid
gland 4. Branch to the temporomandibular joint. 2. Inferior alveolar nerve (Fig. 1A.2.5) It is a
mixed nerve arising from posterior division of the mandibular nerve in the infratemporal fossa.
Course: It emerges below the lower border of the lateral ptcry-goid muscle accompanied by the
inferior alveolar artery and is situated posterior to lingual nerve. The nerve passes
I Lateral pterygoid muscle
tnterior *molar nerve inlorice alveolar artery
Branches from the posterior division The posterior division of the mandibular nerve is mainly
sensory and with few motor fibres, it gives rise to the follow-ing nerves: 1. Auriculotemporal
nerve This nerve has double roots of origin, which unite to form a single nerve which passes
backwards and lies deep to the lateral pterygoid muscle. Further, it passes between neck of
n
Inosive mow
Mental no.
Fig. IA2.5 Inferior alveolar nerve.
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downwards deep to the sphenomandibular ligament. it enters the mandibular foramen and
passes within the mandible. It supplies the pulp and periodontium of mandibular teeth. It
terminates within the mandible as: 1. Incisive nerve 2. Mental nerve-emerging through the
mental foramen. Branches of inferior alveolar nerve are as follows: I. Nerve to mylohyoid - this
nerve is given off before the inferior alveolar nerve enters the mandibular foramen. It pierces
the sphenomandibular ligament. It is accom-panied by artery to the mylohyoid and this nerve
termi-nates by supplying the anterior belly of the digastric and mylohyoid muscles. 2. Branches
to supply molar and premolar teeth and re-lated gum. These branches form inferior dental
plexus. 3. Incisive branch - it passes within the incisive canal supplying incisors and canine
teeth. 4. Mental branch - mental nerve emerges through the men-tal foramen and supplies soft
tissues of lower lip and chin. 3. Lingual nerve It arises within the infratemporal fossa from the
posterior division of the mandibular nerve. Course: it is joined by the chords tympani branch of
the fa-cial nerve within the infratemporal fosse and emerges along the lower border of the
lateral pterygoid muscle. It lies in front of the inferior alveolar nerve and vessels. The nerve is
superficially situated medial to the mandibular third molar covered only by the oral mucous
membrane. It then crosses the hyoglossus muscle and loops around the submandibular duct,
terminates by supplying the mucous membrane of the anterior two-thirds of the tongue.
Branches of lingual nerve are as follows: Branches to supply I. The mucous membrane of the
floor of the mouth 2. The gums of the mandible 3. The mucous membrane of the anterior two-
thirds of tongue. Communications of the lingual nerve It communicates with: I. Chorda tympani
nerve within the infratemporal fosse 2. Subnaandibular ganglkin and hypoglossal nerve, when it
lies on the hyoglossus 3. The ince. ins eiveniat strive 0.4. Describe the origin, course, relation
and branches of facial artery. Ans. The facial artery is the main artery of the face where it is
located within the muscles of facial expression. The artery is tortuous in its facial course.
Origin It originates from the external carotid artery just above the greater horn of the hyoid
bone within the carotid triangle.
Course It passes upwards and grooves the submandibular gland and then turns downwards
lateral to the submandibular gland and reaches the lower border of the mandible (Fig. IA.2.6). It
pierces the stylomandibular ligament.
angular artery
Lateral nasal angry
Sueonor label artery Neri0IWal artery
Submersed artery Tensile, angry Fara artery 1A.2.6 Course of facial artery.
I. It enters the face by winding around the base of the mandible, and by piercing the deep
cervical fascia, at the anteroinferior angle of the rnasseter muscle where it can he palpated and
is called 'anaesthetist's artery'. 2. First it runs upwards and forwards to a point 1.25 cm lateral
to the angle of the mouth.Then it ascends by the side of the nose up to the medial angle of the
eye, where it terminates by supplying the lacrimal sac; and by enestomosing with the dorsal
nasal branch of the ophthalmic anery. 3. The facial artery is very tortuous and lies between the
superficial and deep muscles of the face. Branches of the facial artery in the neck are as follows
(Fig. IA.2.7): 1. Ascending palatine artery 2. Tonsillar artery to supply the palatine tonsil 3.
Glandular branches to supply the submandibular gland and submandibular lymph glands 4.
Submental artery. Branches on the face are as follows: The anterior branches on the face we
large and named as follow. I. Inferior labial artery to supply the lower lip 2. Superior labial
artery to supply the upper lip and nose
Generai Anatomy,
Supracrbllal artery SupratrocNear artery

Transverse least artery Lateral meal artery Superior tablet artery Inferior labial artery
Fig. 1A.2.7 Branches of facial artery on the taco.
3. Lateral nasal artery 4. Muscular branches to the muscles of facial expression.
Applied Anatomy During injury of the face bleeding from the facial artery can be stopped by
compressing the artery against the lower border of mandible. In the lips branches of the facial
artery are found nearer to the mucous membrane than to the skin. Hence, injuries caused by the
teeth on the mucous membrane of the mouth may develop hidden hematomas. The labial
branches of the facial artery of both sides are communicating around the mouth. This
communication forms anastomosis between the external carotid arteries of both sides.
SHORT ESSAYS
0.1. Facial artery.
Or Origin, course, relation and branches of facial artery. Ans. Refer to the answer of Long Essay
Q. 4. 0.2. Buccinator muscle. Ans.
The buccinator muscle also known as trumpet muscle is the chief muscle of the cheek. This
muscle is covered by the buccopharyngeal fascia and buccal pad of fat. It is pierced by the
parotid duct opposite to maxillary second molar.
Origin 1. From lateral surface of alveolar processes of the maxilla and mandible at the level of
the third molar tooth 2. From anterior border of pterygomandibular raphe.
Insertion All the fibres converge at the angle of the mouth and fuse with the fibres of the
orbicularis oris.
Nerve Supply Beer al branch of the facial nerve supplies the buccinators muscle. Applied
Anatomy During the facial nerve injury, the paralysis of the buccinator muscle leads to inability
to blow the cheek.
Actions I. It compresses the cheek against the teeth thereby prevents the food accumulation
within the vestibule of the mouth during mastication and also helps in sucking. 2. It helps to
blow the cheek 0.3. Cutaneous innervation of face.
Or
Mention the sensory nerve supply to the face. Ans.
Sensory Nerve Supply of the Face I. The trigeminal nerve is the chief.sensory nerve of the face. 2.
The skin over the angle of the jaw and over the parotid gland is supplied by the great auricular
nerve (Cr. Cr). 3. The trigeminal nerve also supplies sensory innervations to eyeball, the oral
cavity, palate, cheeks, gums, teeth and anterior two.thirds of tongue and the supratentorial part
of the dura mater including that lining the anterior and middle cranial fossae. The follnwinp
hrenritec al ophthalmic rtivicinn of trigpmin.1 nerve supply scalp up to vertex, forehead, upper
eyelid, conjunctiva, small part of lower eyelid and root, dorsum and tip of nose: I.
Supratrochlear nerve 2. Supraorbital nerve 3. Lacrimal nerve 4. Infratrochlear nerve 5. External
nasal nerve.
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Maxillary division of trigeminal nerve I. Infraorbital nerve 2. Zygomaticofacial nerve 3.

Zygomaticotemporal nerve. These branches supply upper lip; side and ala of nose; most of the
lower eyelid; upper part of cheek and anterior part of temple.
Mandibular division of tripe:nine! nerve I. Auriculotemporal nerve 2. Buccal nave 3. Mental
nerve.
This division supplies lower lip; chin; lower part of check; lower jaw except over the angle;
upper two-thirds of lateral surface of auricle; and side of head.
Cervical plexus I. Anterior division of great auricular nerve (Ca, Cs) 2. Upper division of
transverse (anterior) cutaneous nerve of neck (On 0s). They supply the skin over the angle of
the jaw and over the parotid gland. Lower margin of the lower jaw. 0.4. Connections, course and
distribution of chorda tympani. Ans. In the vertical part of the facial canal, the chords tym-pani
nerve arises about 6 mm above the stylomastoid foramen and runs upwards and forwards in a
bony canal then enters the middle ear and runs forwards in close relation to the tympanic
membrane (Fig. I A.2.8). 2. It leaves the middle ear by passing through the petrotympenic
fissure, it then passes medial to the spine of the sphenoid and enters the infratemporal fosse
where it joins the lingual nerve through which it is distributed. 3. It carries preganglionic
secretomotor fibres to the sub-mandibular ganglion for supply of the submandibular
VII nerve (Facia) nerve) IX nerve Chorda tympani Lingual nenro---- Inferior alveola-
gengIon Manaibuior nerve Mt!!!!!!!!, Worst ',tavola Temporal Buccal Slybolossus
1011,111kr, -Gerecolossus
Flg. 1 A.2.8 Distribution of mandibular nerve ON.
and sublingual salivary glands and taste fibres from the anterior two.thirds of the tongue. 0.5.
Give a short account of parts, relation and nerve supply of lacrimal gland.
Ans. I. Lacrimal gland is a serous gland which is 'J' shaped, being indented by the tendon of the
levator palpebrae superioris muscle situated chiefly in the lacrimal fosse on the lateral part of
the roof of the bony orbit and partly on the upper eyelid. Small accessory lacrimal glands are
found in the conjunctival fornices. 2. The parts of lacrimal gland are as follows: a. A palpebral
part: smaller and superficial, lying within the eyelid b An orbital part: which is larger and
deeper. 3. About a dozen of its ducts pierce the conjunctiva of the upper lid and open into the
conjunctival sac near the superior fornix. Most of the ducts of the orbital part pass through the
palpebral part. 4. The gland is supplied by the lacrimal branch of the ophthalmic artery and by
the lacrimal nerve. The nerve has both sensory and secretomotor fibres. The course of
secretomotor fibres is as follows: Lacrimatry nuckus Nerves intermedius Gcniculatc ganglion
Greater petirosal nerve Nerve of pteirygoid canal Plerygopalline ganglion Relay Zygomatic and
zygoirtaticotemporal nerve Lacrimial nerve Lai-finial gland
The lacrimal fluid secreted by the lacrimal gland flows into the conjunctival sac where it
lubricates the front of the eye and the deep surface of the lids. Most 01 the fluid evaporates. The
rest is drained by the lacrimal canaliculi. When excessive, it overflows as tears.
General Anatomy
SHORT NOTES
0.1. Platysma. Ans. I. Platysma is one of the muscles of neck. 2. It originates from the upper parts
of pectoral and deltoid fasciae and fibres run upviards and medially. 3. Anterior fibres get
inserted to the base of the mandible and posterior fibres to the skin of the lower face and lip,
and may be continuous with the risorius. 4. Actions of platysma arc as follows: a. Releases
pressure of skin on the subjacent veins b. Depresses the mandible c- Pulls the angle of the
mouth downwards as in horror or surprise. 0.2. Buccinator. • Ans.
!hr....in:nor is the muscle of the cheek.
Origin I. Upper fibres, from maxilla opposite molar teeth 2. Lower fibres, from mandible,
opposite molar teeth 3. Middle fibres, from pterygomandibular raphe.
Insertion 1. Upper fibres, straight to the upper lip. 2. Lower fibres, straight to the lower lip. 3.
Middle fibres decussate before passing to the lips.
Actions I. Flattens cheek against gums and teeth. 2. Prevents accumulation of food in the
vestibule.
0.3. Bell's patsy. Ans.
Infranuclear lesions of the facial nerve are known as Bell's palsy. The features of Bell's palsy are
as follows: 1. The face becomes asymmetrical and is drawn up to the normal side. 2. The affected
side is motionless. 3. Wrinkles disappear from the forehead. 4. The eye cannot be closed. 5. Any
attempt to smile draws the mouth to normal side. 6. During mastication, food accumulates
between the teeth and the check. 7. Articulation of labials is impaired.
Q.4. Facial vein. Ans.
I. The facial vein is the largest vein of the face with no valves. 2. It begins as the angular vein at
the medial angle of the eye. 3. It is formed by the union of the supratrochlear and su-praorbital
veins. The angular vein continues as the facial vein, running downwards and backwards behind
the facial artery but with a straighter course. 4. ft crosses the anteroinferior angle of the
masseter, pierces the deep fascia, crosses the submandibular gland, and joins the anterior
division of the retromandibular vein below the angle of the mandible to form the common facial
vein. The latter drains into the internal jugular vein. 0.5. Facial artery. Ans. I. The facial artery
(facial part) is the chief artery of the face. It is a branch of the external carotid artery given off in
the carotid triangle just above the level of the tip of the greater comua of the hyoid bone. 2. In its
cervical course, it passes through the submandibu-lar region, and finally enters the face. 3. The
anterior branches on the face are as follows: a. Inferior labial to the lower lip. b. Superior labial -
a to the upper lip and the anteroin-ferior part of the nasal septum. c. Lateral nasal -a to the ale
and dorsum of the nose. d. The posterior branches are small and unnamed. 0.6. Orbicularls oculi.
Ans.
Orbicularis oculi is explained its Table IA.2. I.
Table 1A.2.1 Orbitularis oculi
IN=
1. Orbital Part of medial part palpebral age-meat and admin. ing bone 2. Faisonl Lateral pad of
pan medial palpebral ligament 3. Lela lacrimal fascia Upset and part and lacrimal bone lover
eyelids
Concentric rings return to the ooint of origin lateral palpe-bral raphe
Closes Ms tightly; protects eve from bright light Closes lids pen• fly; blinking Orates lacrimal
sac:supports the lower eyelid
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General Anatomy
0.7. Deep facial vein. Ans. I. Deep connections of the facial vein include a communi-cation
between the supraorbital and pterygoid plexus through the deep facial vein, which passes
backwards over the buccinator. 2. The facial vein communicates with the cavernous sinus
through that connections. 3. Infections from the face can spread in a retrograde direction and
cause thrombosis of the cavernous sinus. This is especially likely to occur in the presence of
infec-tion in the upper lip and in the lower part of the nose. 0.8. Palpebral ligament. Ans. The
palpebral fascia of the two lids forms the orbital septum. Its thickenings form tarsal plates of
tarsi in the lids and the palpebral ligaments at the angles. Q.9. Dangerous area of scalp. Ans.
Infections from the face can spread in a retrograde direction and cause thrombosis of the
cavernous sinus. This is likely to occur in the presence of infection in the upper lip and in the
lower part of the nose. This area is, therefore, called the dan-gerous area of the face (Fig. IA.2.9).
Fig. 1A29 Dangerous area of the lace.

0.10. Epicranlal aponeurosia. Ans. I. The epicranial aponeurosis or gales aponcurotica is the
third layer of scalp and is freely movable on the pericra-nium along with the overlying and
adherent skin and fascia (Fig. IA.2.10). 2. Anteriorly, it receives the insertion of the frontalis pos-
teriorly, it receives the insertion of the occipitalis and it is attached to the external occipital
protuberance, and to the highest nuchal lines in between the occipital bellies. On each side the
aponeurosis is attached to the superior temporal line, but sends down a thin expansion, which
_-$uporliciallasas .000 01011r,,c,„_. WO' W4144„
EPlorrAal aPonotsosa -Loose connective tissue
^Porioraniten ova wear Fig. 1A.2-10 Layers of scalp.
passes over the temporal fascia and is attached to the zygomatic arch. 0.11. Palatine
aponeurosis.
Ans.
The posterior border of the hard palate provides attachment to the palatine aponeurosis. 0.12.
Nasolacrimal apparatus. Or Name the structures forming lacrimal apparatus. Ans. The
structures concerned with secretion and drainage of the lacrimal or tear fluid constitute the
lacrimal apparatus. It is made up of the following parts: 1. Lacrimal gland and its ducts 2.
Conjunctival sac 3. Lacrimal puncta and lacrimal canaliculi 4. Lacrimal sac S. Nasolacrimal duct.
0.13. Levator palpebrae superioris. Ans. Levator palpebrae superioris muscle is an eye opener
(or) dilator muscle.
Origin It originates from the following: I. Inferior surface of the lesser wing of the sphenoid bone
2. Orbital surface of the body of the sphenoid bone anterior to the optic foramen.
Insertion It expands towards the upper eyelid and divides into super-ficial and deep layers,
which are inserted to: I. Orbital septum and palpebral ligaments (medial and lateral) 2. Superior
tarsal plate 3. Skin of the upper eyelid. The smooth muscle fibres of the levator palpebrae
superioris is called as Muller's muscle.
The aponeurosis of this muscle divides the lacrimal gland into palpebral and orbital parts.
Nerve Supply I. Upper division of the oculomotor nerve. 2. Sympathetic fibres from T, segment
of the spinal cord supplies the smooth muscle fibres of the muscle.
Actions It elevates the upper eyelid. Applied Anatomy Paralysis of the muscle causes ptosis
(drooping of the upper eyelid). Paralysis of the smooth muscle fibres of this muscle causes
pseudoptosis (Homer's syndrome). 0.14. Name the cervical branches of facial artery. Ans.
The cervical branches of facial artery are as follows: I. Ascending palatine artery 2. Tonsillar
artery 3. Glandular branches 4. Submental artery.
0.15. Give the formation and termination of ante-rior facial vein.
Ans.
Facial (anterior facial) vein, corresponds in general, to the facial artery. The facial vein takes its
origin from the junction of the veins of the forehead and nose. Its upper part is termed the
angular vein and accompanies the angular artery. The angular vein receives the frontal vein, the
supraorbital vein and veins from the lower lid and from the bridge of the nose. From the inner
corner of the eye, the facial vein descends in a fairly straight line to the lower border of the
mandible.
Topic 3
LONG ESSAY
0.1. Describe the boundaries and contents of subclavian triangle. Ans. The subdavian triangle is
a small lower part of posterior triangle of neck- The posterior triangle is a space on the side of
the neck situated behind the sternodeidomastoid muscle (Fig. IA.3.1). The posterior triangle of
neck is subdivided by the inferior belly of the omohyoid into I. A larger upper part, called the
occipital triangle 2. A smaller lower part, called the supradavicular or the subclavian triangle.
Inescuius
stenextelclomastoid
Posterior Wangle (occipital pan) Superior holly of ornonyori Infenor belly of oniohyoid Poste.,
tosngio ISuCciavian part) -Clavicle
Flg. 1A.3.1 Posterior triangle of Iho neck
Boundaries Anterior posterior border of sternocleidomastoid Posterior anterior border of
trapezius Inferior or base: middle one-third of clavicle Apex lies on the superior nuchal line
where the trapezius and stemodeidomastoid meet.
Roof The roof is formed by the imresting layer of deep cervical fascia.
Floor The floor of the posterior triangle is formed by the preverte-bral layer of deep comical
fascia, covering the following muscles (Fig. IA.3.2): I. Splenies espies 2. Levator scapulae 3.
Scalenus medius and occasionally scalenus posterior. The contents of subclavian triangle are
listed in Table IA.3.1.
Nerves I. Three trunks of the brachial plexus emerge between the scalenus anterior and medius,
and carry the axillar•
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Trunks al bronchial plexus —See Imes ante.. —m es - Scalanus postenor — Subelavlan artery
&Abe:Wean von Fig. IA.3.2 Floor of the posterior triangle of neck.
Table 1A3.1 Contents of subclavlan triangle
Nerves
Lymph nodes
a. Three trunks of brachial plexus b. Nerves to serrates anterior (long thoracic, C5. CS. 57) c.
Nerves to subclavius (C5, C.6) d. Suprascapular nerves (C5. CS) A few members of the
supraclavicular chain
sheath around them (Fig. IA.3.3). The sheath contains the brachial plexus and the subdavian
artery. 2. The nerves to servants anterior (long thoracic, CS, C6, C7) arise by three roots. The
roots from C5 and C6 pierce the scalenus medius and join the root Cl. The nerve
passes over the serrates anterior in the medial wall of the axilla and gives branches to the
digitations of the muscle. 3. The nerve to the subclavius (C5, C6) descends in front of the
brachial plexus and the subclavian vessels, to reach the deep surface of the subclavius muscle.
As it runs near the lateral margin of the scalenus anterior, sometimes it gives off the accessory
phrenic nerve, which joins the phrenic nerve in front of the scalenus anterior. 4. The
supraseapular nerve (C5, C6) arises from the upper trunk of the brachial plexus and crosses the
lower pan of the posterior triangle. It passes backwards over the shoulder to reach the scapula.
It supplies the supraspi-flatus and infraspinatus muscles.
Vessels I. The subclavian artery passes behind the tendon of the scaknus anterior and the
subclavian vein passes in front of the tendon. 2. The suprascapular artery is a branch of the
thyrocervical trunk which passes laterally and backwards behind the clavicle. 3. The transverse
cervical artery is also a branch of the thyrocervical trunk. It crosses the scalenus anterior, the
phrenic nerve, and the upper trunks of the brachial plexus, the nerve to the subclavius, the
suprascapular nerve and the scalenus medius. At the anterior border of the levator scapulae it
divides into superficial and deep branches.
Lymph Nodes A few members of the supraclavicular chain.
A' .' 4:=> 4 r JAIPI'' is . . ._ Long trowie nerve i , . ' . • Ca

SuprescapAsr nerve DONS ecaplar naive
tea,. 10 aubCtavga
liketsibunaneous nowt
Pantry novo raw. mot '- aria nude, root d rm.]. gene
-----,U11001.1.CAPABI nerve NONat01ae99Veue dare --Lower .gegBovg: name Medal Neter.,
nerve NortAlgvlargekg nerve ol ego • rerm at forearm
Roden nerve
Radial nerve-Uner nerve
Flg. 1A.3.3 Brachial plexus
SHORT ESSAYS
0.1. Carotid sheath.
Or Brief account of carotid sheath and its contents. Or Formation, attachments, relation and
contents of carotid sheath.
Ans.
Carotid Sheath Carotid sheath is a condensation of the fibroareolar tissue around the main
vessels of the neck, namely (Fig. IA.3.4): I. The common carotid artery 2. Internal carotid artery
3. Internal jugular vein 4. The vagus nerve.
Ansa cervicats
Internal jugular vain Common carotid artery Vagus nerve
sympetnete mink Flg.1A.3.4 Carotid sheath with its contents (sectional view).
Platysms-External MT". van -
Relations I. The ansa cervicalis lies embedded in the anterior wall of the carotid sheath. 2. The
cervical sympathetic chain lies behind the sheath, attached to the presectebral fascia. 3. The
sheath is overlapped by the anterior border of the stet nocleidomastoid, and is fused to the first
three layers of the deep cervical fascia. 0.2. Describe torticollis. Ans. Torticollis or wryneck is a
deformity as a result of spasm or contracture of the muscles supplied by the spinal accessory
nerve, namely the sternodeidomastoid and trapezius. In this deformity the head is bent to one
side and the chin points to the opposite side. Depending on thecauses, there are many varieties
of tonicollis, as follows I. Rheumatic tortioollis,due to exposure to cold or draught 2. Reflex
tonicollis, due to inflamed or suppurating cervical lymph nodes, which irritate the spinal
accessory nerve 3. Congenital tortkollis, due to birth injury 4. Spasmodic torticollis, due to
central irritation. 0.3. General Investing layer of deep cervical fascia. Ans.
Deep Cervical Fascia (Fascia Coll) (Fig. 1A.3.5) The deep Lucia of the ;leek is condensed to form
the following layers I. Investing layer 2. Pretracheal layer 3. Prevertebral layer
Protrachool fascia z�Invesnng fascia ....• , • . Carctki sheath • ••••• • °°"11'74 Fused
provartebrel .-sud ise.sise Provertebral bacia
Trapexios
Lenges comics
Fig. 1A.3.5 Transverse section through the neck showing general investing fascia.
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4. Carotid sheath 5. Buccopharyngeal fascia 6. Pharyngobasilar fascia.
Investing Layer of Deep Cervical Fascia It lies deep to the platysma, and surrounds the neck like
a collar. It forms the roof the posterior triangk of the neck.
Attachments Superiorly 1. External occipital protuberance 2. Superior nuchal line 3. Mastoid
process 4. Base of the mandible. Between the angle of the mandible and the mastoid process, the
fascia splits to enclose the parotid gland.
Inferiorly I. Spine of scapula 2. Acromion process 3. Clavicle 4. Manubrium. The fascia splits to
enclose the suprasternal and supracla-vicular spaces. Posteriorly I. Ligamentum twelve 2. Spine
of the seventh cervical vertebra.
Anteriorly I. Symphysis menti 2. Hyoid bone. Both above and below the hyoid bone, it is
continuous with the fascia of the opposite side.
Other Features 1. The investing layer of deep cervical fascia splits to en-close the following
structures: a. Muscles--trapezius and stemocleidomastoid b. Salivary glands—parotid and
submandibular c. Spaces—suprasternal and supraclavicular. 2. it also forms pulleys to bind the
tendons of the digastric and omohyoid muscles. The suprasternal space contains: a. The sternal
heads of the right and left stemocleido-mastoid muscles b. The jugular venous arch c. A lymph
node d. The interclavindar ligament.
The supraclavicular space is traversed by: a. The external jugular vein b. The supraclavicular
nerves c. Cutaneous vessels, including lymphatics. 0.4. Give the attachments, nerve supply
actions of stemocieldomastold.
Ans.
and
The sternocleidomastoid and trapezius are large superficial muscles of the neck.
Attachments Attachmentsof stcmodeidomastoid areas shown in Pig. IA.3.1. Origin I. The sternal
head arises from the superolateral part of the front of the manubrium sterni. 2. The clavicular
head arises front the medial one-third of the superior surface of the clavicle. It passes deep to
the sternal head, and the two heads blend below the middle of the neck. Between the two heads
there is a small triangular depression of the lesser supraclavicular fossa, overlying the internal
jugular vein.
Insertion It is inserted (a) by a thick tendon into the lateral surface of the mastoid process, from
its tip to the superior border, and (b) by a thin aponcurosis into the lateral half of the superior
nuchal line of the occipital bone.
Nerve Supply I. The motor supply is by the spinal accessory nerve. 2. Proprioception by
branches from the ventral rami of C2.
Blood Supply Arterial supply one branch each from superior thyroid ar-tery and supra scapular
artery and two branches from the occipital artery. Veins follow the arteries.
Actions I. When one muscle contracts: a. It turns the chin to the opposite side. b. It can also tilt
the head towards the shoulder. 2. When both muscles contract together. a. They draw the head
forwards, as in eating and in lifting the head from a pillow. b. With the longus call, they flex the
neck against resistance. c. The reverse action in lowed inspiration.
Relations The sternocleidomastoid is enclosed in the investing layer of deep cervical fascia, and
pierced by the accessory nerve and by the four sternocleidomastoid arteries. It has the following
relations: 1. Superficial a. Skin b. Superficial fascia with platysma muscle c. Superficial lamina of
the deep cervical fascia cl. Paternal jugular vein e. Superficial cervical lymph nodes lying along
the vein f. Nerves i. Great auricular ii. Ihnsverse or anterior cutaneous iii. Medial supraclavicular
nerves g. The parotid gland overlaps the muscle. 2. Deep a. Bones and joints i. Mastoid process
above u. Sternoclavicular joint below b. Carotid sheath c. Muscles i. Sternohyoid ii.
Sternothyroid iii. Omohyoid iv. Three scalene v. Leveler scapulae vi. Splenitts capitis vii.
Longissimus capitis • viii. Posterior belly of digastric d. Arteries i. Common carotid ii. Internal
carotid iii. External carotid iv. Sternomastoid arteries two from the occipital artery, one from
the superior thyroid, one from the suprascapular v. Occipital vi. Subclavian vii. Suprascapular
viii. Ihnsverse cervical e. Veins L Internal jugular ii. Anterior jugular iii. Facial iv. Lingual E
Nerves i. Vagus ii. Accessory iii. Cervical ;dents tv. Upper part of brachial plexus
General ,.:.«.
v. Phrenic vi. Ansa cervicalis g. Lymph nodes i. Deep cervical. 0.5. Give the formation. course and
termination of external jugular vein. Ans. The external jugular vein hesdeep into the platysma
(Fig. IA.3.6). I. It is formed by the union of the posterior auricular vein with the posterior
division of the retromandibular vein. 2. It begins within the lower part of the parotid gland.
crosses the sternocleidomastoid obliquely, pierces the anteroinferior angle of the roof of the
posterior triangle, and opens into the subclavian vein. 3. Its tributaries are (a) the posterior
external jugular vein. (b) the transverse cervical vein; (c) the suprascapular vein and (d) the
anterior jugular vein. The oblique jugular vein connects the external jugular vein with the
internal jugular vein across the middle one-third of the anterior border of the
sternocleidomastoid.
Rg.1A.3.6 External jugular vein.
0.6. Boundaries and contents of posterior triangle. Ane. The posterior triangle is the space on
the side of the neck situated behind the stern.leidomastoid muscle (Fig. I A.3.1). The posterior
triangle is hounded: Anteriorly by: posterior border of sternocleidomastoid. Posteriorly by
anterior border of trapezius. Inferiorly or base by: middle one-third of clavicle. Apex lies on the
superior nuchal line where the trapezius and sternocleidomastoid meet (Table
O
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Table 1A.3.2 Contents of the Mterior litangle

11111111111111EMMINIMMIBMINSINKMAiiiiiii.a4MENIEN Nerves 1. Spinal accessory MVO 1.
Three trunks of brachial plexus 2. Nerve to serratus anterior (long thoracic. C5. CS. C7) 3. Nerve
to subctavius (C5,C6) 4. Suprascapular nerve (C5. C6)
2. Four cutaneous branches cervical plexus: a. Lesser occipital (C2) b. Great auricular (C2,C3) c.
Anterior cutaneous nerve d. Supaclavicular nerves (C3, C4) 3. Muscular branches: a. Two small
branches to the levator scapulae (C3. C4) b. Two small branches to the traperius (C3. C4) c.
Nerve of rhomboldeus (C5) 4. Upper part of the brachial plexus Vessels 1. Transverse cervical
artery and veln 2. Occipital artery
Lymph nodes
Along the posterior border of the sternocludomastoid, more in the lower part The
supreclawcular nodes and a few at the upper angle the occipital nodes
I. Third part of subcfavian artery and subciavian vein 2. Suprescapular artery and vein 3.
Commencement of transverse cervical artery and termination of the corresponding vein 4.
Lower part of external jugular vein A few members of the supraclavicular chain
SHORT NOTES
0.1. Occipital artery. Ans.
Occipital artery commences from the external carotid artery just above the greater horn of the
hyoid bone. It commences opposite to the commencement of the facial artery. Branches include
the following: I. Stemoeleidomastoid branches-upper and lower 2. Mastoid artery 3. Muscular
branches 4. Descending branch-superficial and deep branches 5. Meningeal branches-supply the
duns mater of the posterior cranial fosse 6. Branches to supply posterior surface of the auricle
and posterior quadrant of scalp. The terminal part of the artery supplies posterior quad-rant of
the scalp. 0.2. Cervical fascia.
Ans.
The deep cervical fascia of neck is condensed to form the following layers: t. Investing layer 2.
Pretracheal layer 3. Prevertebral layer 4. Carotid sheath
5. Buccopharyngeal fascia 6. Pharyngobasilar fascia. The applied anatomy of the deep cervical
fascia: I. Parotid swellings are very painful duc to the unyielding nature of the parotid fascia. 2.
The thyroid gland and all thyroid swellings move with deglutition because the thyroid is
attached to the larynx by the suspensory ligaments of Berry. 3. Division of the external jugular
vein in the supraclavicu-lar space may cause air embolism and consequent death because the
cut ends of the vein are prevented from retraction and closure by the fascia, attached firmly to
the vein.
0.3. Suprasternal apace. Ans. The investing layer encloses two fascia! spaces: I. Supraclavicular
space 2. gorraerernal ere, Near the lower part of the tnidlinc of the neck, the fascia splits to
enclose a space called suprasternal space (space of Burn's). Within the suprasternal space, the
following structures are present: I. Jugular venous arch communicating two anterior jugular
veins
2. Lymph node 3. Sternal origin of the steenocleidomastoid muscle 4. Intendavicular ligament 5.
Suprasternal ossicies. 0.4. Pretracheal fascia. Ms. I. Importance of this fascia is that it encloses
and suspends the thyroid gland and forms its false capsule. Superiorly it extends up to the hyoid
bone. Inferiorly it extends into the thorax and joins the fibrous pericardium. 2. Laterally, it fuses
with the carotid sheath and through this sheath it is continuous with the investing layer of deep
cervical fascia. 3. Medially, it divides and encloses the thyroid gland. It forms the false capsule
for the thyroid gland. 4. The posterior capsule of the thyroid is thin and hence enlargements of
the thyroid are directed posteriorly. 5. The pretracheal fascia invests the infrahyoid muscles.
This fascia is attached to the thyroid and cricoid carti-lages as the suspensory ligament of Berry.
This ligament binds the thyroid gland to the larynx. 0.5. External jugular vein. Or Formation of
external jugular vein. Ans. External jugular vein commences near the angle of the man-dible by
the union of the posterior division of retroman-dibular vein and posterior auricular vein. Its
course is as follows: I. It passes downwards within the superficial fascia and runs superficial to
the sternocleidomastoid. 2. It is accompanied by great auricular nerve and pierces the investing
layer of deep cervical fascia at the lower part of roof of the posterior triangle. 3. It terminates by
joining the subclavian vein, about 4 cm above clavicle. The vein is provided with valves. 4.
Tributaries of EJV are as follows: a. Suprascapular vein b. Transverse cervical vein c. Posterior
jugular vein d. Anterior jugular vein. Rarely, common facial vein may terminate in it. 0.6.
Contents of carotid sheath. Ans. Carotid sheath is a condensation of the fibroareolar tissue
around the main vessels of the neck namely: the common and internal carotid arteries and
internal jugular vein and the vagus nerve.
The carotid Acute endows the fioll.,wing: I. The internal carotid artery 2. Common carotid artery
3. Internal jugular vein 4. The vagus nerve. 0.7. Root value of brachial plexus. Ans. Brachial
plexus is a network of nerves to supply the upper limb.
Formation Ventral rami of C5, C6,C7, C8 and 'I', nerves join the plexus.
Branches Branches arc formed from root, trunk and cords.
Branch from the roots Nerve to join phrenic nerve (C5) 1. Dorsal scapular nerve or nerve to
rhomboids (C5) 2. Long thoracic nerve of Bell (nerve to serratus anterior (C5, C6, C7) 3. Nerve
to scalene muscles and longus colli muscles (CS, CO, C7, C8, T II.
Branches from the trunks The upper trunk gives the following: 1. Supraaeapular nerve (C5, C6)
2. Nerve to subclavius (C5, C6).
Branches from the cords I. Branches of lateral cord a. Lateral pectoral nerve (C5, C6, C7) b.
Musculocutaneous nerve (CS, C6, C7) c. Lateral root of median nerve (C5, C6, C7). 2. Branches of
medial cord a. Medial root of median nerve (C9T1) b. Medial pectoral nerve (C8T1) c. Medial
cutaneous nerve of forearm (C8TI) d. Medial cutaneous nerve of arm (C8T1) e. Ulnar nerve
(C8TI) (C7). 3. Branches of posterior cord a. Upper subscapular nerve (C5, C6) b. Thoracodorsal
nerve (C6, C7, C8) c. Lower suisscaputar nerve (t s. Lb) J. Axillary nerve (C5, C6) e. Radial nerve
(C5, C6, C7, CS TI).
0.8. Spinal part of accessory nerve.
Ans. I. Accessory nerve (XI cranial nerve) is a motor nerve. It has a cranial part and a spinal part.
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2. "Ilie spinal part emerges from the lateral surface of the upper five cervical segments of the
spinal cord.
COURSE Intracrenial course I. The spinal part has five mots. They unite to form spinal accessory,
it passes upwards into the foramen magnum and enters the posterior cranial fossa. 2. It then
passes laterally towards the jugular foramen. Within this foramen it unites with the cranial part.
At the lower part of the foramen it separates and leaves the jugular foramen.
Topic 4
Extracrenial course I. After emerging from jugular foramen it passes back-wards and laterally
deep to internal jugular vein. 2. It is accompanied by the sternocleidomastoid branch of the
occipital artery and passes deep into the posterior belly of dignstrk and sternocleidomastoid
and enters the posterior triangle. 3. It then passes deep into the trapezius muscle and termi-
nates by forming subtrapczial plexus by uniting with C3 and C4 nerves. This plexus supplies
trapezius muscle. 4. Muscular branches to the sternocleidomastoid and the trapezius are the
branches of the spinal part of accessory nerve.
LONG ESSAYS
0.1. Axillery nerve. Ana. Axillary nerve is one of the two large terminal branches of the posterior
cord of brachial plexus (Fig. 1A.4.1). The axillary nerve (C5, C6) supplies nothing in axifla, only
its name having been changed from circumflex to axillary.
Course From its origin, it passes backwards between subscapularis and trees major through the
quadrangular space where it
Supascoplat rams Swam( Iroo5mr. SuprosOnoW &man. loameol WW1,
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rorasnor citomilex htmOnleaery
ecepubs art .y .Li .4,110,0v0 Circurnilex Fig.1AA.1 AxIllary nerve Icircurrdatut nerve).
lies in contact with the surgical neck of the humerus, just below the capsule of the shoulder
joint.
Branches I. Muscular branches to supply the deltoid and mores minor muscles. 2. Articular
branch to supply the shoulder joint. 3, Cutaneous branch to supply the upper lateral cutaneous
nerve of arm. 4. Axillary nerve gives a branch to the shoulder joint and divides into:
Anterior branch It supplies deltoid, and a few terminal twigs pierce the muscle and Peach the
skin.
1
Posterior branch It gives off the motor nerve to woes minor, then winds around the posteroid
border of deltoid and becomes cutaneous nerve of the arm. It supplies a few of the posterior
fibres of deltoid.
Applied Anatomy I. The nerve may be injured during downward dislocation of shoulder joint. 2.
14 may be injured during fracture of surgical neck of humerus.
General Anatomy
3. Injury to the nerve paralyses the deltoid muscle. This causes fat shoulder. 4. Injection of drugs
like penicillin when wrongly injected may paralyse the nerve. 0.2. Mention boundaries of
suboccipital triangle. Describe the contents of triangle. Ans. The suboccipital triangle is a
muscular space situated deep in the suboccipital region.
Boundaries (Fig. IA.4.2)
Flg.1A.4.2 Boundaries of wboccipital triangle.
Superornediallr Rectos capitis posterior major muscle supplemented by the rectus capitis
posterior minor Superolatemllr Superior oblique muscle Interiorly: Inferior oblique muscle
Roof (Fig. 1A.4.3) Medially: Dense fibrous tissue covered by the semispinalis capitis
t—Longissimus capitis (i Flg.1A.4.3 Roof of suboccipital triangle.

Laterally: Longissimus capitis and occasionally the splenius capitis.
Floor I. Posterior arch of atlas 2. Posterior atlanto-occipital membrane. Suboccipital Muscles
Suboccipital muscles are described in Table IA.4.I. Contents of suboccipital triangle are as
follows: I. Dorsal ramus of nerve CI (suboccipital nerve) 2. Third part of vertebral artery 3.
Suboccipital plexus of veins. Dorsal Remus of First Cervical Nerve It emerges between the
posterior arch of the atlas and the vertebral artery, and soon gives rise to branches, which
supply the four suboccipital muscles and the semispinalis capitis. The nerve to the inferior
oblique gives off a commu-nicating branch to the greater occipital nerves. It crosses the
suboccipital triangle and pierces the semispinalis capitis and trapezius muscles to ramify on the
back of the head reaching up to the vertex. It supplies the semispinalis capitis in addition to the
scalp.
Table 1A.4.1 Suboccipital muscles: Origin, Insertion. nerve supply and actions Spine of axis
Lateral pan of the area Suboccipaid nerve 1. Mainly pastoral' ••• ink"41111 below tee inferior
nudol or dorsal ramus CI 2. Acting alone it turns the chin to the same side e a menthe. Mn two
motel. avIAMI mho. head
Rectos CalpidS posterior major
Rectos capitis posterior minor Obliques capitis Inferior or inferior oblique Obliques capitis
Inferrer or inferior oblique
Posterior medial part of the area below tubercle of atlas the inferior n uchal tine Transverse
process Lateral area between the of atlas nuchal lines
Spine of axis Transverse process of atlas
SuboccIpltal nerve or dorsal ramus CI Suboccipital nerve or dorsal ramus CI
1. Mainly postural 2. Extend the head 1. Mainly Postural 2. Extend the head 3. Rex the head
Laterally Suboccipaal nerve 1. Mainly postural or dorsal ramus CI 2. Turns chin to the same side
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CONTENTS OF THE VERTMEll

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Vertebral Artery (Fig. 1A.4.4) h is the first and largest branch of the first part of the subclavian
artery. Vertebral artery chiefly supplies to the brain, out of its four parts; only the third part
appears in the suboccipital triangle. This part appears at the foramen transversarium of the
atlas, grooves the atlas, and leaves the triangle by passing deep to the lateral edge of the
posterior atlanto-occipital membrane. Third part gives muscular branches to the muscles of the
suboccipital region.
Suboccipltal Plexus of Veins It lies in and around the suboccipital triangle and drains the I.
Muscular veins 2. Occipital veins 3. Internal vertebral venous plexus 4. Condylar emissary vein.
It itself drains into the deep cervical and vertebral plexus of veins.
Anterior oammarycaeng artery Lb— nor cerebral artery iti OphioddheIrnecio story cerebral
artery tenor charm:lel artery NA'steno, communicating artery 1 Poston. cerebral artery
Internal /•.,w_a si magnum F''''''oramedn'A"
Vertebral artery
Subciavian artery
Fig. 1A.4.4 The vertebral artery and ItS branches.
SHORT NOTES
0.1. Vertebral artery. Ans. I. Vertebral artery is the first branch of subclavian artery, and arises
from the upper convexity of the subclavian artery (Fig. IA.4.5). 2. Vertebral artery supplies the
visual area of the cerebrum, hindbrain, the spinal cord and suboccipital muscles.
GL—Posterior communicating artery --Postensr cerebral artery oerebelar ) _Iaterel Keene

artery Banshee of basfer artery Labyrkitlane antenor intena artery paenblinVerior artery ---
Cerebekar artery —Anterior spoel artery
V artery I — Pester, spinal artery • Flg.1A.4.5 The vertebral artery
It is divided into four parts according to its anatomical location as follows: First part: Dorsal
part of seventh intersegmental artery
Stroud pars: Procostal anastomosis Third part: Spinal branch of first cervical inter segmental
artery Fourth part Preneural anastomosis.
Commencement It commences from the first part of the subclavian artery and terminates at the
lower border of the pons where the arteries of both the sides unite to form the basilar artery.
Branches of Vertebral Artery First part Gives no branches. Second part Gives spinal branches to
supply the spinal cord. They enter the vertebral canal through the intervertebral foramen.
Third parr Gives muscular branches to the muscles of the suboccipital region. Fourth part Gives
the following branches: I. kleningeal branches 2. Posterior spinal artery 3. Anterior spinal artery
4. Posterior inferior cerebellar artery 5. Medullary branches to supply to medulla oblongata.
General Anatomy
0.2. Stylold process. Ans. "I he styloid process is a long, slender and pointed bony pro-cess
projecting downwards, forwards and slightly medially from the temporal bone. It descends
between the external and internal carotid arteries to reach the side of the pharynx. It is
interposed between the parotid gland laterally and the internal jugular vein medially.
Topic 5
0.3. Contents of suboccipital triangle.
Ans.
(omen's of suboccipital triangle are as follows: I. Third pan of vertebral artery 2. Dorsal ramus
of nerve Cl—suboccipital nerve 3. Suboccipital plexus of veins.
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0.1. Spinal dura meter. Ans.

Posterior sone' artery Denticulate ligament Anteror spinal artery_
Sutemchnoid space Pia male( Recurrent meningeei nerves
LONG ESSAYS
N.) Dula mate, Fig.1A.5.1 The section of spinal cord.
meter
I. Spinal dura mater is a thick, tough fibrous outermost meningeal membrane, which forms a
loose sheath around the spinal cord (Fig. IA.5.1). It is continuous with the meningeal layer of the
cerebral dura mater. 2. The spinal dens extends from the foramen magnum to the lower border
of the second sacral vertebra. 3. Thc dun: gkas tubular prolor.gat....ts the dorsalied ventral
nerve roots and to the spinal nerves as they pass through the intervertebral foramina.
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0.2. Subarachnold space. Ans. I. Subarachnoid space is a wide intraleptomeningeal space
between the pia and the arachnid, filled with cerebrospinal fluid (CSF) (Fig. IA.5.2). 2. It
surrounds the brain and spinal cord like a water cushion. 3. The spinal subarachnoid space is
wider than the space around the brain. It is widest below the lower end of the spinal cord where
it encloses the cauda equines. Lumbar puncture is usually done in the lower widest part of the
space, between third and fourth lumbar vertebrae.
nee•■••°."- Flg.1A.5.2 Subamehrod space.

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General Anatomy
Topic 6
LONG ESSAYS
0.1. Enumerate dural venous sinus. Describe the cavernous sinus In detail.
Or Describe cavernous sinus and its relations. Or Classify dural venous sinuses. Describe In
detail the position, contents, tributaries and applied aspect of cavernous sinus. Ans.
Venous sinuses of dura mater are venous spaces the walls of which are formed by dura mater
(Fig. I A.6.1). They have an inner lining of endothelium. They are devoid of muscle and valves in
their walls. Venous sinuses receive venous blood from the brain, the meninges and bones of the
skull. Cerebrospinal fluid is poured into some of them.
kV.ar sag.. sinus Superior sepias' aims anuses I . . . s.. 40" 41141111, Superior peewee! sin. ,mold
sinus Straight VMS Confluence of sil3a soar :7:10s,., Great metal dilklire011,01:1::.A sinus Right
transverse TC,Pr.-IMP-ss.:€"1"" 'cavernous
vein
dial 11111), silos Ophthalmic vein ems Sigrnotd sinus Superior payouts.. Inferior pee'Oerel ei
Cavernous a
Ptelygois Nexus ea veins Flg. 110.1 Venous sinuses.
The pressure of blood in the cranial venous sinuses is kept constant as the sinuses communicate
with veins outside the skull through emissary veins. There are 23 venous sinuses, of which 8 are
paired and 7 are unpaired. A. Paired venous sinuses are as follows: There is one sinus each on
the right and left sides. I. Cavernous sinus 2. Superior petrosal sinus 3. Inferior petrosal sinus
4. Transverse sinus 5. Sigmoid sinus 6. Sphenoparietal sinus 7. Petrosguamous sinus 8. Middle
meningeal sinus/veins. B. Unpaired venous sinuses are as follows: They are median in position.
I. Superior sagittal sinus 2. Inferior sagittal sinus 3. Straight sinus 4. Occipital sinus 5. Anterior
intercavernous sinus 6. Posterior intercavernous sinus 7. Basilar plexus of veins.
Cavernous Sinuses Each cavernous sinus is a large venous space situated in the middle cranial
fosse, on either side of the body of the sphe-noid bone. Its interior part is divided into a number
of spaces or caverns by trabeculae. The trabeculae are muds less con-spicuous in the living than
in the dead. The floor of the sinus is formed by the endosteal dura mater. The lateral wall, roof
and medial wall are formed by the meningeal dura mater.
Meninges' layer oldies meter Endorhelhm Oculanolor nave fleshless nerve
Ochthalnoc nerve Seminary serve Mandibular nerve •
Hypophysis cerebrl Sphenoidal sinus Internal carotid may

aDducent nerve
Flg.1A.62 Coronet section of meddle cranial beset showing the relations of the cavernous sinus.
Relations (Fla. 1A.6.2) Structures outside the sinus are as follows: Superiorly. Optic tract, optic
chiasma, olfactory tract, internal carotid artery and anterior perforated substance Inferiorly:
Foramen lwerum and the junction of the body and greater wing of the sphenoid bone
1
Medially Hypophysis cerebri and sphenoidal air sinus Laterally: Temporal lobe with uncus
Anzeriorly Superior orbital fissure and the apex of the orbit Posteriorly. Apex of the petrous
temporal and the eras cerc-bri of the midbrain. Structures in the lateral wall of the sinus, from
above down-wards, are as follows: I. Ocvlomotor nerve: In the anterior part of the sinus, leaves
the sinus by passing through the superior orbital fissure. 2. Trochlear nerve: Enters the orbit
through the superior orbital fissure, in the anterior part of the sinus. 3. Ophthalmic nerve: It
divides into the lacrimal, frontal and nasociliary nerves its the anterior part of the sinus. 4.
Maxillary nerve: It leaves the sinus by passing through the foramen rotundum. 5. Trigeminal
ganglion: The ganglion and its dotal cave project into the posterior part of the lateral wall of the
sinus. Structurespassing through the centre of the sinus are as follows: I. Internal carotid artery
with the venous and sympathetic plexus 2. Abducent nerve, infaelateral to the internal carotid
artery. The structures in the lateral wall and in the centre of the sinus are separated from blood
by the endothelial lining. Tributaries or Incoming Channels From the orbit I. 'She superior
ophthalmic vein. 2. A branch of the inferior ophthalmic vein or sometimes the vein itself. 3. The
central vein of the retina may drain either into the superior ophthalmic vein or into the
cavernous sinus.
From the brain t. Superficial middle cerebral vein 2. Inferior cerebral veins from the temporal
lobe. From the meninges I. Sphenopazietal sinus. 2. The frontal trunk of the middle meningeal
vein may drain either into the pterygoid plexus through the fora-men ovate or into the
sphenoparietal or cavernous sinus. Draining Channels or Communications The cavernous sinus
drains into the following: I. The transverse sinus through the superior petrosal sinus. 2. The
internal jugular vein through the inferior petrosalsinus and through a plexus around the
internal carotid artery.
3. The pterygoid plexus of veins Omagh the emissary veins. 4. The facial vein through the
superior ophthalmic vein. 5. The right and left cavernous sinuses communicate with each other
through the anterior and posterior intercavernous sinuses and through the basilar plexus of
veins.
AU these communications are valveless, and blood can flow through them in either direction.
Applied Anatomy I. Thrombosis of the cavernous sinus may be caused by sepsis in the
dangerous area of the face, in the nasal cavities, and in the paranasal air sinuses. This gives rise
to the following symptoms: A. Nervous symptoms a. Serve pain in the forehead in the area of
distribution of the ophthalmic nerve b. Involvement of the third, fourth and sixth cranial nerves
resulting in paralysis of the muscles supplied. B. Venous symptoms Marked oedema of the
eyelids, cornea and root of the nose, with exophthaltnos due to congestion of the orbital veins. 2.
A communication between the cavernous sinus and the internal carotid artery may be produced
by had injury which results in the protrusion and pulsation of eyeball with each heartbeat
known as the pulsating exophthalmos. 0.2. Describe the pituitary gland in detail. Mention Its
blood supply, development and relation. Ans. The hypophysis cerebri or pituitary gland is a
small endo-crine gland situated in relation to the base of the brain. It is often called the master
of the endocrine orchestra because it produces a number of hormones that control the
secretions of many other endocrine glands of the body (Fig. IA.6.3). It lies in the hypophyseal
fossa or sena turcica or pituitary fosse, which is roofed by the diaphragms sense. The stalk of the
hypophysis cerebri pierces the diaphragms seise and is attached above to the floor of the third
ventricle. The gland is oval in shape and measures 8 mm anteropos-teriorly and 12 mm
transversely. It weighs about 500 me.
Relations Superiorly I. Diaphragms sell. 2. Optic chiasma 3. TUber citsereum 4. Infundibular
recess of the third ventricle.
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General Anatomy
Trs(ters nerve 1151 Abriosent nerve VII imamsl carotid artery Oculornotor nem Ise Rubs,' glen!
One maw. Isparagssa sass.
Grumman Nonous) rams OpnllyaMt 010540.5 011dgemnal rAnnaill,) Morass; divas. oltrigoolsol
POW MI Fig. 1A.6.3 Pituitary gland and Its relations.
Inferiorly 1. Irregular venous channels between the two layers of dura mater lining the floor of
the hypophyseal fossa 2. Hypophyseal fossa 3. Sphenoidal air sinus.
On each side The cavernous sinus with its contents.
Subdivisions The gland has two main parts: adenohypophysis and neuro-hypophysis, which
differ from each other embryologically, morphologically and functionally. The adenohypophysis
develops as an upward growth called the Rathke's pouch from the ectodermal roof of the
stomodetun. The neurohypophysis develops a downward growth from the floor of the
diencephalon and is connected to the hypo-thalamus neural pathways. Further subdivisions of
each part are given below.
Adenohypophyals (Fig: 1A.6.4) I. Anterior lobe or pars anterior, pars &stalls or pars glandu-lark
This is the largest part of the gland. 2. intermediate lobe or pars intermedia: This is in the form
of a thin strip that is separated from the anterior lobe by an intraglandular cleft, a remnant of
the lumen of Rethkes pouch. 3. Tatra! lobe or pars tuberalis: It is an upward extension of the
anterior lobe that surrounds and forms part of the infundibulum.
McKean eminence Infundbular recess of ewe ventricle \ Optic chissma
Para tuberalis — —
Marortary body r-- — Inrundibulum Pars posterior Pars warmer%
Pars anterior Fig. 1A.6.4 A sagttlal section of the hypophysis cerebri.
Neurohypophysis 1. Posterior lobe or neural lobe. pars posterior: It is smaller than the anterior
lobe and lies in the posterior concavity of the anterior lobe. 2. lnfindibular stem: It contains the
neural connections of the posterior lobe with the hypothalamus. 3. Median eminence of the
tuber cinerman: It is continuous with the infundibular stem.
Arterial Supply (Fig. 1A.6.5) The hypophysis cerebri is supplied by the following branches of the
internal carotid artery. 1. One superior hypophyseal artery on each side 2. One inferior
hypophyseal artery on each side. Each superior hypophyseal artery supplies: I. The ventral part
of the hypothalamus 2. The upper part of the infundibulum 3. The lower part of the
infundibulum through a separate long descending branch, called the in:bender artery. Each
inferior hypophyseal artery divides into medial and lateral branches, which join one another to
form an arterial
Capillary bans h medan eminence ,Su6' hYP'PhYs" end n nkmdsuum artery ,-.8 Portal vesse,o
VI77:4:1( e'///Tratecular artery to lower elfunalbulan Sh011 Pedal vessels
CapeSiy tufts a borer ingundibulurn AnitSlOrPOsis SorriOen SupartOr ass inferior hypSphySPal
allsolOS
Intoner hypOphysaar artery Flg. 1A.6.5 Arterial supply of the hypophysis carebris
ring around the posterior lobe. Branches from this ring sup-ply the posterior lobe and also
anastomose with branches from the superior hypophyseal artery. The anterior lobe or pars
distalis is supplied exclusively by portal vessels arising from capillary tufts formed by the su-
perior hypophyseal arteries.The long portal vessels drain the median eminence and the upper
infundibulum, and the short portal vessels drain the lower infundibulum. The por-tal vessels are
of great functional importance because they carry the hormone releasing factors from the
hypothalamus to the anterior lobe where they control the secretory cycles of different glandular
cells.
Venous Drainage Short veins emerge on the surface of the gland and drain into neighbouring
dural venous sinuses. The hormones pass out of the gland through the venous blood and are
carried to their target cells.
Histology and Hormones Anterior lobe 1. Chromophilic cells (50%) a. Acidophddalpha cells
(about 43% of cells) i. Somatotrophs: Secrete growth hormone (S111, C14)
ii. Mammorrophs (prolactin cells): Secrete lactogenic hormone. iii. Corticorrepbs, Secrete ACTH
b. Basophilsibeta cells (about 7% of cells) i. Thyrotrophs Secrete TSH u. Genedotroplic Secrete
FSH iii. Luteotrophn Secrete LH or ICSH 2. Chromophobic cells (50%) represent the
nonsecretory phase of the other cell types or their precursors.
Intermediate lobe It is made up of numerous basophil cells and chromophobe cells surrounding
masses of colloid material. It secretes the melanocytes stimulating hormone (MSH).
Posterior lobe It is composed of (a) a large number of non-myelinated fibres—
hypothalamohypophyseal tract and (b) modified neurological cells, called pituicytes. They have
many dendrites, which terminate on or near the sinusoids. The hormones related to the
posterior lobe are (a) vasopressin, (ADH) which acts on kidney tubules, and (b) oxytodn, which
promotes contraction of the uterine, and mammary smooth muscle Those hormones are
actually secreted by the hypothala-mus,from where theseare transported through the
hypothalamo-hypophyseal tract to the posterior lobe of the gland.
SHORT ESSAYS
Ten tort u m cerebelli. Ans. The tentorium cerebelli is a tent-shaped fold of dura mater, forming
the roof of the posterior cranial fossa. It separates the cerebellum from the occipital lobes of the
cerebrum and broadly divides the cranial cavity into supratentorial and infratentorial
compartments. The infratentorial compartment, in other words, is the posterior cranial fossa
containing the hindbrain and the lower part of the midbrain (Fig. IA.6.6). The tentorium
cerebelli has a free margin and an attached margin. The anterior free margin is U-shaped and
free. The ends of the 'U' are attached anteriorly to the anterior dinoid processes. This margin
bounds the tentorial notch, which is occupied by the midbrain and the anterior part of the supe-
rior vermin. The outer or attached margin is convex. Postero-laterally, it is attached to the lips of
the transverse, sold on the occipital bone and on the posteroinferior angle of the parietal bone.
Anterolaterally, it is attached to the superior border of the petrous temporal bone and to the
posterior
Oraphragma sortie covering hypophyseal fosse Optic nerve Infundbulum -- OCUIOMOtOr nerve
- Troentear nerve -- Great cerebral vein Saatchi sinus Superior srtmcoal 4AUS
-Antenor cinold process intornol carotid artery Aperture for oortomotor nerve, Aperture for
SOCNOar Parse Attached margin of tentorium cerebrei Forneeiorrgh .rof Attached margin of
atrium cerebelli Transverse sinus within layers of tenionum Opening of rtrporier sagas! anus
Fig. 1A.13.6 Tentorium coreb0111 soon from above.
clinoid processes. Along the attached margin there am the transverse and superior petrosal
venous sinuses. The trigeminal or MecicePs cave (Fig. 1A.6.7) is a recess of dura mater present
in relation to the attached margin of the tentorium. It is formed by evagination of the inferior
layer of the tentorium over the trigeminal impression on the petrous temporal bone. It contains
the trigeminal ganglion.
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Togerrunal ganglion
Superior petrosal sinus Tantalum combo%

----I-dilemma cave
Outer layer of dm motor Inner layer ol dura mater
Petrauc temporal tone Fig. 1A.6.7 Pa rasagatal section through the petrous temporal bone end
meninges to show the rormation of the trigeminal cave.
The free and attached margins of the tentorium cerebelli cross each other near the apex of the
petrous temporal bone. Anterior to the point of crossing there is a triangular area that forms the
posterior part of the roof of the cavernous sinus and is pierced by the third and fourth cranial
nerves. The tentorium cerebelli has two surfaces. The superior surface is convex and slopes to
either side from the median plane. The fate cerebri is attached to this surface, in the mid-line;
the straight sinus lies along the line of this attachment. The superior surface is related to the
occipital lobes of the cerebrum. The inferior surface is concave and fits the convex superior
surface of the cerebellum. The falx cerebri is attached to its posterior part. 0.2. Cavernous sinus.
Or
Cavernous sinus, its relations and tributaries. Ans. it. r In answer of Long Essays Q. 1. Q.3.
TrIgeminal ganglion In middle cranial fossa. Ans. This is the sensory ganglion of the fifth cranial
nerve. It is homologous with the dorsal nerve root ganglia of spinal nerves. All such ganglia are
made up of pseudounipolar nerve cells, with a T-shaped arrangement of their process one
process arises from the cell body which then divides into a central and a peripheral process. The
ganglion is crescentic or semilunar in shape, with its rnmanviry dirreseel antnmItterally. The
three divisions of tin. trigeminal nerve emerge from this convexity. The posterior concavity of
the ganglion receives the sensory root of the nerve.
Situation and Meningeel Flotations (Fig. 1A.6.8) The ganglion lies on the trigeminal impression,
on the ante-rior surface of the petrous temporal bone near its apex. It occupies a special space of
dura mater, called the trigeminat
Greater rag of sphenoid swanky news ..stantery nerve - - - - ........ r..,,' Ophthalmic nerve ...
internal carotid artery

„... .. .
•
Cavernous sinus
• Motor root and 'sonsorY root or trIgemnal ganglion Trigerninal ganglion ',Greater petrossf
nerve Middle morumeal artery 'Petroua temporal bone Sqvamous temporal bone Fig. 1A.6.8
Superior new of the middle cranial lossa showing some of ita contents.
or Methels rave. There are two layers of dun below the ganglion. The cave is lined by pia-
arachnoid so that the ganglion along with the motor root of the trigeminal nerve is surrounded
by CSF. The ganglion lies at a depth of about 5 cm from the preauricular point.
Relations
Medially: I. Internal carotid artery 2. Posterior part of cavernous sinus. Laterally: Middle
meningeal artery. Superiorly: Parahippocampal gyros. Inferiorly: 1. Motor root of trigeminal
nerve 2. Greater petrosal nerve 3. Apex of the petrous temporal bone 4. The foramen lacerum.
Associated Root and Branches The central processes of the ganglion cells form the large sensory
root of the trigeminal nerve, which is attached to pons at its junction with the middle cerebellar
peduncle. The peripheral processes of the ganglion cells form three divisions of the trigeminal
nerve, namely the ophthalmic, maxillary and mandibular.
The small motor root of the trigeminal nerve is attached to the ports superomedial of the
sensory root. It passes under the ganglion from its medial to the lateral side and joins the
mandibular nerve at the foramen *vale.
Blood Supply The ganglion is supplied by twigs from the (a) internal carotid, (b) middle
meningeal and accessory meningeal arteries and (c) by the meningeal branch of the ascending
pharyngeal artery.
SHORT NOTES
t.141£
Q.1. Fats cerebri. Ans.
the fait cerebri is a large sickle-shaped fold of dura mater occupying the median longitudinal
fissure between the two cerebral hemispheres (Fig. 1A.6.9): It has two ends: I. The anterior end
is narrow and is attached to the crista gall. 2. The posterior end is broad and is attached along
the median plane to the upper surface of the tentorium cerebelli.
The felt cerebri has two margins I. The upper margin is convex and is attached to the lips of the
sagittal sulcus. 2. The lower margin is concave and free. The fate cerebri has right and left
surfaces, each of which is related to the medial surface of the corresponding cerebral
hemisphere. Three important venous sinuses are present in relation to this fold. 'the superior
sagittal sinus lies along the upper margin; the inferior sagittal sinus lies along the !rawer mar
gin; and the straight sinus lies along the line of attachment of the falx to the tentorium cerebelli.
0.2. Meckel's cave. Ans.
The trigeminal or Merkel's cave is a recess of dura mater present in relation to the attached
margin of the tentorium
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cerebelli. It is formed by evagination of the inferior layer of the tentorium over the trigeminal
impression on the petrous temporal bone. It contains the trigeminal ganglion. 0.3. Emissary
vein. Ans.
Emissary veins connect the exuacranial veins with the intra-cranial venous sinuses to equalize
the pressure. Example: 1. The parietal emissary vein passes through the parietal foramen to the
superior sagittal sinus. 2. The mastoid emissary vein passes through the mastoid foramen to the
sigmoid sinus. Applied anatomy: Extracranial infections may spread through these veins to
intracranial venous sinuses. 0.4. Cavernous sinus. Ans. I. Each cavernous sinus is a large venous
space situated in the middle cranial fossa on either side of the body of the sphenoid bone. It is
about 2 cm long and 1 cm wide. 2. Its interior part is divided into a number of spaces or caverns
by trabeculae. 3. The floorof the sinus is formrdby thcendosteal dura mates 4. The lateral wall,
roof and medial wall are formed by the meningeal dun meter. 5. Anteriorly, the sinus extends up
to the medial end of the superior orbital fissure and posteriorly up to the apex of the petrous
temporal bone. 0.5.Tentotium cerebelli.
Ans.
The tentorium cerebelli is a tent-shaped fold of dura mater, forming the roof of the posterior
cranial fossa. It separates the cerebellum from the occipital !oh= of the cerebrum and broadly
divides the cranial cavity into supratentorial and infratentorial compartments. 0.6. Diaphragms
seitae. Ms. The diaphragms settee is a small circular, horizontal fold of dura mater forming the
roof of the hypophyseal fossa.
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Anteriorly, it is attached to the tubes:rill sel lac Posteri-orly, it is attached to the dorsum sellae.
On each side, it is continuous with the dun mater of the middle cranial fosse. The diaphragms
sellae has a central aperture through which the stalk of the hypophysis cerebri passes. 0.7.
Hypoglossal nerve. Ans. Hypoglossal nerve/cranial nerve XII, as the name implies is the nerve
supplying muscles of tongue (glossal means tongue) and is purely a motor nerve. Branches of
communication are as follows: 1. Vagus 2. Ventral ramus of first cervical nerve 3. Lingual nerve
superior cervical ganglion of sympathetic chain. Branches of distribution are as follows: 1. To
the three extrinsic muscles of tongue namdy stylo-glossus, genioglosus and hyoglossus and to
four intrinsic musom namely superior longitudinal, inferior longitudi-nal, transverse and
vertical muscles. 2. It carries fibres of ventral ramus of first cervical, which gets distributed as
meningeal branch, superior limb of ansa cervicslis, branch to thyrohyoid and geniohyoid
muscles.
Q.8. Superior sagittal sinus. Ans. The superior sagittal sinus occupies the upper convex, at-
tached margin of the falx cerebri (Fig. 1A.6.10). It begins anteriorly at the crisis gall by the union
of tiny meninges! veins. Here it communicates with the veins of the frontal sinus and
occasionally with the veins of the nose, through the foramen caecum. As the sinus runs upwards
and backwards, it becomes progressively larger in size. It is triangular in cross-section. It ends
near the internal occipi-tal protuberance by turning to one side, usually the right,
SWOON &Vet sinus soma*, aranalaross Corobre vein Cerebral arery
Arabroncel melee Pm meter
■ Entre:brat Seene (entential space) SalbararletOKI space

Fig. 1A.13.10 The superior sagetai sinus reross-sectional view).
and becomes continuous with the right transverse sinus. Sometimes the superior sagittal sinus
becomes continuous with the lel} transverse sinus. It generally communicates with the opposite
sinus. The junction of all these sinuses is called the confluence of sinuses. The superior sagittal
sinus receives the following tributaries: I. Superior cerebral veins 2. Parietal emissary veins 3.
Venous lacunae, usually three on each side 4. Occasionally, a vein from the nose opens into the
sinus when the foramen caecum is patent. 0.9. Middle meningeal artery. Ans.
Middle meningeal artery is a branch of the first part of the maxillary artery, given off in the
infratemporal fosse. It is transmitted through foramen spinosum. It supplies more of bone and
less of meninges. Middle meningeal artery supplies only small branches to the dura mater. It is
predominantly a periosteal arterysupplying bone and red bone marrow in the dipole. Within the
cranial cavity, it gives off the following: I. Ganglionic branches-to the trigeminal ganglion 2. A
petrosal branch-to the hiatus for the greater petrosal nerve 3. A superior tympanic branch-to
the tensor tympani 4. Temporal branches-to the temporal fosse 5. Anastomotic branch that
enters the orbit and anasto-moses with the lacrimal artery. • 0.10. Name four emissary veins.
Ans.
Emissary veins connect the extracranial veins with the intra-cranial venous sinuses to equalize
the pressure. Examples: 1. Parietal emissary vein 2. Mastoid emissary vein 3. Emissary vein-
passing through hypoglossal canal 4. Condylar emissary vein 5. Tao to three emissary veins
passing through foramen lacerum.
0.11. Confluence of dural venous sinus. Ans. Superior sagittal sinus begins anteriorly at the
crista galli by the union of tiny meninges] veins. Here it communicates with the veins of the
frontal sinus and occasionally with the veins of the nose, through the foramen caecurn. It ends
near the internal occipital protuberance by turn ing to one side, usually the right, and becomes
continuous with the right transverse sinus. Sometimes the superior sagittal sinus becomes
continuous with the let) transverse
Po's sinus. It generally communicates with the opposite sinus. The junction of all these sinuses
is called the confluence of sinuses. 0.12. Name any four tributaries of cavernous sinus. Ans.
Tributaries or incoming channels of cavernous sinus are as follows
From the orbit: t. The superior ophthalmic vein 2. A branch of the inferior ophthalmic vein or
sometimes the vein itself 3. The central vein of the retina. From the brain: 1. Superficial middle
cerebral vein 2. Inferior cerebral veins from the temporal lobe. From the meninges: 1.
Sphenoparietal sinui. 2. The frontal trunk of the middle meningeal vein may drain either into
the pterygoid plexus through the foramen ovate or into the sphenoperietal or cavernous sinus.
0.13. Mention the major openings in diaphragm. Ans. The diaphragm has three large openings
for the passage of structure between thorax and abdomen (Fig. 1A.6.11). The openings are as
follows 1. The aortic opening 2. The oesophageal opening 3. The vena canal foramen.
Werke' Wee cave Oesophagus Anna Ceiling tendon oI stelphnegni
Cava* el:ening (vertebra! I Tian
•Iftel 4%44
Mete hatue agoal Waive (vertebral level 'nos( (vertebral level TX) Flg.1A.6.11 The skaphragm.
General Anatomy
0.14. Name structures in the lateral wall of cavern-ous sinus.

Ans. Structures in the lateral wall of the sinus, from above downwards I. Oculomotor nerve 2.
Trochlear nerve 3. Ophthalmic nerve 4. Maxillary nerve 5. Trigcminal ganglion. 0.15. Name the
folds of dura mater present in the cranial cavity. Ans. At places, the meningeal layer of dura
mater is folded on it-self to form partitions that divide the cranial cavity into compartments that
lodge different parts of the brain. The folds are as follows: I. Falx cerebri 2. Tentorium cerebelli
3. Falx cerebelli 4. Diaphragms sellae. 0.16.111geminal ganglion In middle cranial fosse. Ans.
Trigeminal ganglion is the sensory ganglion of the fifth cranial nerve (Fig. 1A.6.12). It is
homologous with the dorsal nerve root ganglia of spinal nerves. All such ganglia are made up of
pseudounipolar nerve cells with a T-shaped arrangement of their process; one process arises
from the cell body which then divides into a central and a peripheral process. The ganglion is
crescentic or semilunar in shape, with its convexity directed anterolaterally. The three divisions
of the trigeminal nerve emerge from this convexity. The posterior concavity of the ganglion
receives the sensory root of the nerve.
011anevy bulb Or.br Nene (!r( Ocukom0101 rte. MO AD:lucent neve (VII Trochlear num OA
Miaow', nerves III oprartainec nerve lbj • textuary claret tv,I (Medea/at nerve Treeetnal
ganglion Vette nova Dell VentIttukeochleal nerve bbennebetYbee...t. Vagen nova IX)
Hypeglevnal nerve (XI]
'Neer-bre, nerve bt. Anbeenley rare pal
t A.6.12 The meddle cranial lasts shorans ingeminai gangton.
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Topic 7
CONTEr
LONG ESSAY
0.1. Write about origin, insertion nerve supply and action of muscles of eyeball. Ans. The
extraocular muscles are as follows:
Voluntary Muscles I. Four recti a. Superior rectos b. Inferior rectos c. Medial rectos cL Lateral
rectus 2. 'Bin obliqui a Superior oblique b. Inferior oblique 3. The levator palpebrae superioris
elevates the upper eyelid.
Involuntary Muscles 1. The superior tarsal muscle is the deeper portion of the levator palpebrae
superioris. It is inserted on the upper margin of the superior tarsus. It elevates the upper eyelid.
2. The inferior tarsal muscle extends from the fascial sheath of the inferior rectus and inferior
oblique to the lower margin of the inferior tarsus. It possibly depresses the lower eyelid. 3. The
orbital& bridges the inferior orbital fissure. Its action is uncertain.
The voluntary muscles are miniature ribbon muscles, having short tendons of origin and long
tendons of insertion.
Origin and Insertion of Voluntary Muscles Origin The four real arise from a common annular
tendon or tclidiooin iiag that is amulet] to the orbital surface of the apex of the orbit. The lateral
rectos has an additional small tendinous head, which arises from the orbital surface of the
greater wing of the sphenoid bone lateral to the tendinous ring. The superior oblique arises
from the body of the sphenoid. superomedial to the optic canal.
The inferior oblique arises from the orbital surface of the maxilla, lateral to the lacrimal groove.
The levator palpebrac superioris arises from the orbital surface of the sphenoid bone,
anterosuperior to the optic canal.
Insertion The recti are inserted into the sclera, a little posterior to the limbos. The tendon of the
superior oblique passes through a fibrocanilaginous pulley attached to the trochlear fosse of the
frontal bone. It is inserted into the sclera behind the equator to the eyeball, between the
superior rectos and the lateral rectus. The inferior oblique is fleshy throughout. It passes later-
ally, upwards and backwards below the inferior rectos and then deep to the lateral tutus. The
inferior oblique is inserted close to the superior oblique a little below and posterior to the latter.
The fat tendon of the levator splits into: a. Superior or voluntary lamella b. Inferior or
involuntary lamella. The superior lamella of the levator is inserted into the anterior surface of
the superior tarsus and into the skin of the upper eyelid. The inferior lamella is inserted into the
upper margin of the superior tarsus.
Nerve supply 1. The superior oblique is supplied by the IV cranial or trochkar nerve (SO4). 2.
The lateral rectus is supplied by the VI cranial or abducent nerve (LR6). 3. The remaining five
extraocular muscles—superior, inferior and medial recti; inferior oblique and levator palpebrae
superioris—are all supplied by the III cranial or oculomotor nerve.
Actions i. The movements of the eyeball are as follows: a. Around a transverse axis i. Upward
rotation or elevation (33°) ii. Downward rotation or depression (331 b. Around a vertical axis i.
Medial rotation or adduction (50°) ii. lateral rotation or abduction (501
c. Around an anteroposterior axis i. Intortion ii. Extortion The rotatory movements of the
eyeball upwards, downwards, medially or laterally are defined in terms of the direction of
movement of the centre of the pupil. The torsions are defined in terms of the direc-tion of
movement of the upper margin of the pupil at 12 o'clock position. d. The movements given
previously can take place in various combinations. 2. Actions of individual muscles are listed in
Table 1A.7.1. 3. Single or pure movements are produced by combined actions of muscles.
Similar actions get added together, while opposing actions cancel each other, enabling pure
movements. a. Upward rotation or elevation: By the superior rectos and the inferior oblique b.
Downward rotation or depression: By the inferior rectos and the superior oblique c. Medial
rotation or adduction: By the medical rectos, the superior rectus and the inferior rectus d.
Lateral rotation or abduction: By the lateral rectos, the superior oblique and the inferior oblique
e. Intortion: By the superior oblique and the superior rectus L Extortion: By the inferior oblique
and the inferior rectus.
Table 1A.21 Actions of Individual muscles
1. Superior oblique 2. Inferior oblique 3. Inferior rectos 4. Supertor cactus 5. Medal rectus 6.
Lateral recurs
Depression Adduction Imortion Elevation Adduction Extortion Elevation Adduction Intortion
Elevation Adduction Intortion Only adduction Only abduction
4. Combated movements of the eyes: The movements of the two eyes are harmoniously
coordinated and are called conjugate ocular movements. These movements are usually
horizontal or vertical, but oblique conjugate movements may also occur. The dissociated
movements of the two eyes arc called as disjunctive movements.
SHORT ESSAYS
0.1. Lateral rectus muscle of eyeball. Ans. There are four recti muscles of eyeball, namely: I.
Superior 2. Inferior 3. Medial 4. Lateral recti. The lateral rectus arises by two heads, one from
the upper and one from the lower aspect of the lateral part of the com-mon tendinous ring. The
following structures pass between the two origins of the lateral reams I. Upper and lower
division of the oculomotor nerve 2. Nisociliary nerve 3. Abducent nerve. From the origin, the
real muscles widen forwards to form the cone of muscles.
Insertion Lateral rectos is inserted to the corresponding surface of the sdera, behind the corneal
margin at 6.8 mm away from the corneal margin.
Nerve Supply The abducent nerve supplies the lateral teems.
Action The lateral rectos moves the cornea horizontally and laterally. 0.2. Positions, connections
and branches of ciliary ganglion. Ans. The ciliary ganglion is very small ganglion present in the
orbit. Topographically, the ganglion is related to nasociliary nerve, branch of ophthalmic
division of trigeminal nerve
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but functionally it is related to oculomotor nerve. This ganglion has no secretomotor fibres.
Roots It has three roots: 1. Sensory 2. Sympathetic 3. Motor. Only the motor root fibres relay to
supply the intraocular muscles. I. Sensory root is from the long ciliary nerve. 2. Sympathetic root
is by the long ciliary nerve from plexus around ophthalmic artery. 3. Motor root is from a branch
to inferior oblique muscle. These fibres arise from Edinger-Westphal nucleus, join oculomotor
nerve and leave it via the nerve to inferior oblique to be relayed in the ciliary ganglion.
Branches The ganglion gives 10-12 short ciliary nerves containing postganglionic fibres for the
supply of constrictor or sphinc-ter pupillae for narrowing the size of pupil and ciliaris muscle
for increasing the curvature of anterior surface of lens requited during accommodation of the
eye. 0.3. Boundaries and structures passing through superior orbital fissure.
Ans.
Superior orbital fissure communicates orbit and middle cranial fossa.
Boundaries Superior—lesser wing of sphenoid Inferior—greater wing of sphenoid Medial—
body of the sphenoid Lateral—frontal bone.
Structures Passing through the Superior Orbital Fissure
A common tendinous ring divides the fissure into three parts: I. Structures passing lateral to the
ring are as follows: a. Lacrimal nerve b. Frontal nerve c. Tinchlear nerve d. Superior ophthalmic
vein e. Recurrent branch of lacrimal artery. 2. Structures passing within the ring are as follows:
a. Upper division of oculomotor nerve b. Nasociliary nerve c. Lower division of the oculomotor
nerve d. Abducent nerve. 3. Structure passing medial to the ring:. a. Inferior ophthalmic vein.
SHORT NOTES
0.1. Ciliary ganglion. Ans. Ciliary ganglion is pinhead in size and is situated near the apex of
orbit. This ganglion is topographically related to trigeminal nerve, but functionally it is related
to oculomotor nerve.
Roots Motor Nerve to inferior oblique. Tins ts the parasympathetic root to supply sphincter
pupillae and ciliaris. I. Sensory—nasociliary nerve 2. Sympathetic—internal carotid plexus to
supply dilator pupillae.
Branches There are 15-20 short ciliary nerves.
0.2. Nasociliary nerve. Ans. Nasociliary nerve is one of the terminal branches of the oph-thalmic
division of the trigeminal nerve. It begins in the lateral wall of the anterior part of the cavernous
sinus. It enters the orbit through the middle part of the superior orbital fissure. The branches of
nasociliary nerve are as follows: I. A oammunicating branch to 11w ciliary ganglion 2. llvo or
three long ciliary nerves 3. The posterior edunoislai nerve 4. The infrarrochlear nerve 5. The
anterior ethmoidal nerve is the larger terminal branch of the nasociliary nerve. In the nasal
cavity, it lies deep to the nasal bone and gives off two internal nasal branches, and finally, it
emerges at the lower border of the nasal bone as the external nasal nerve, which supplies the
skin of the lower half of the nose.
0.3. Extraocular muscles. Ans. The extraocular muscles are as follows: I. Voluntary muscles 2.
Involuntary muscles.
Voluntary Muscles Voluntary muscles include the following: I. Four rah: (a) superior rectus, (b)
inferior rectus, (c) medial rectus and (d) lateral rectus 2. Twoobliqui: (a)superior oblique and
(b) inferior oblique 3. The levator palpebrae superioris. Involuntary Muscles I. The superior
tarsal must* is the deeper portion of the levator palpebree superioris. It is inserted on the upper
margin of the superior tarsus. It elevates the upper eyelid. 2. The inferior tarsal muscle extends
from the fascial sheath of the inferior resins and inferior oblique to the lower margin of the
inferior tarsus. It possibly depresses the lower eyelid. 3. The orbitalis bridges the inferior orbital
fissure. Its action is uncertain. 0.4. Oblique muscles of eyeball.
Ans.
Superior Oblique Muscle Origin Orbital surface of the body of the sphenoid above and me-dial to
optic foramen and inferior surface of lesser wing of the sphenoid bone. It is a rounded muscle
that gives rise to a tendon. The tendon winds round the fibrocartilaginous pulley-like trochlea
and expands and inserts on the superior rectus muscle.
Topic 8
Nerve Supply It is supplied by trochlear nerve.
Action Superior oblique muscle rotates the eyeball downwards and laterally. Inferior Oblique
Muscle Inferior oblique muscle originates from upper surface of floor of the orbit, lateral to the
lacrimal groove. and inserts into lateral surface of the sclera behind the equator.
Nerve Supply Inferior division of the oculomotor nerve.
Action Inferior oblique muscle rotates the cornea upwards and laterally: 0.6. Branches of
nesocillary nerve. Ans. The branches of nasoc ilia ry nerve are as follows: I. A communicating
branch to the sensory root of ciliary ganglion 2. Two or three long ciliary nerves, which supply
the eyeball 3. Posterior ethmoidal nerve 4. Infratrochlear nerve, which supplies medial portion
of the eyelids and conjunctiva 5. Anterior ethmoidal nerve, which divides into medial and lateral
nasal branches. 0.6. Actions of oblique muscles of eyeball. Ans. Actions of oblique muscles of
eyeball are as follows: I. Superior oblique muscle rotates the eyeball downwards and laterally. 2.
Inferior oblique muscle rotates the cornea upwards and laterally.
ANTERIOR TRIANGAMMI
LONG ESSAYS
0.1. Describe the origin, course, relations and branches of maxillary artery.
Ans.
The maxillary artery is the large terminal branch of the external carotid artery. It leaves EGA at
about right angle passing almost horizontally between the ramus of the mandible and the
sphenomandibular ligament. It has a
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General Anatomy
Deep temporal _ _ _ Pharyngeal artery Artery of prevygold cane Anima:r tympanic deep
auricular Superliciva temporal First pan of maxillary artery Masserene artery on rawer
pterygoid muscle Maisie rnaningeal Acoaesory meningeal Inferior alveolar Plerypad artery
Eiden.' carotid artery Brand, to rnylohyod Flg.1A.8.1 The maxillary artery and its relations.
•
Intraortilial artery SlalenOpalatine Third past of maxillary artery Posterior evertor alveolar
Greater palatine eranchea to maxillary sinus and uPper teeth Waddle superior shoder Second
pan of maxillary Aram Buccal artery
wide territory of distribution and supplies the following structures (Fig. 1A.8.1): 1. The external
and middle ears, and the auditory tube 2. The dura mater 3. The upper and lower jaws 4. The
muscles of the temporal and infratemporal regions 5. The nose and paranasal air sinuses 6. The
palate 7. The root of the pharynx.
Course and Relations In front of the ramus of the mandible, the artery passes up-wards across
the lower part of the lateral pterygoid crossing either superficial or deep to the lower had of this
muscle (Fig. IA.8.1). The maxillary artery is divided into three parts by the lateral pterygoid
muscle as follows (Fig. IA.8.2): I. The first (mandibular) part runs horizontally forwards, first
between the neck of the mandible and the spheno-mandibular ligament, below the
auriculotemporal
Anterior iympenic artery Deep aurivar artery Superecial temporal artery Maxillary artery
Massetedc artery
Saddle and accessory meningeal artery
nerve, and then along the lower border of the lateral pterygoid. 2. The second (pterygoid) part
runs upwards and forwards superficial to the lower head of the lateral pterygoid. 3. The third
(pterygopalatine) part passes between the two heads of the lateral pterygoid and through the
pterygo-maxillary fissure, to enter the pterygopalatine fossa where it lies in front of the
pterygopalatine ganglion.
Branches of First Part of the Maxillary Artery The first part of maxillary artery, i.e. when it
(Table IA.8.1) lies medial to the mandible, gives off the following branches: 1. The deep
auricular artery supplies the external acoustic meatus, the tympanic membrane and the
tempomman-dibular joint. 2. The anterior tympanic branch supplies the middle ear including
the medial surface of the tympanic membrane. 3. The middle meningeal artery is given off in the
infratem-poral fossa. It supplies only small branches to the dura
Deep temporal anon/
SpherlOpatatne artery Ad&Yel Ploniecid canal Pharyngeal artery Intraorbital artery Descending
palatine artery Pceleriar superior alveolar artery Buccal artery
Posterior auricular artery —
External carotid anary—f,:
Flg. IA.132 Maxillary artery and Its branches.
',forward artery Inferior alveolar artery Twig to Mara nerve
Rheohyred artery
1•"^— Table 1A.8.1 Branches of mandibular (list) part of the maxilary artery and their
distribution
Mallgar71.7=grerr maxillary artery transmitting (fleet P.M
Deco auricle artery Foramen m the Skin of the external acoustic. floor of the meatus, enter
surface external acoustic of tympanic membrane meatus Anterior tympanic Petrotympanic
Inner surlace of tympanic artery. Inner surface membrane Middle meningeal Foramen More of
bone and less of after/ spinosum meninges fifth and seventh nerves, middle ear, tenser tympani
Foramen ovate Main distribution is extracranial to pterygolds Mandibular Lower teeth and
mylohyoid muscle
Accessory meningeal artery Inferior alveolar artery
mater. It is predominantly a periostcal artery supplying the bone and red bone marrow in the
dipole. 4. The accessory meningeal artery enters the cranial cavity through the foramen ovale.
Apart from the meninges it supplies structures in the infratemporal fossa. S. The inferior
alveolar artery runs downwards and for-wards medial to the ramus of the mandible, enters the
mandibular canal in which it runs downwards and for-wards supplying teeth and surrounding
bone and then gives off a small branch through the mental foramen to anastomose with other
vessels on the face. Before enter-ing the mandibular canal, the artery gives off a lingual branch
to the tongue and a mylohyoid branch
BRANCHES OF SECOND PART OFTHE MAXILLARY ARTERY The second part of the maxillary
artery, while it is related to lateral pterygoid muscle, mainly gives off its so called muscular
branches (Table IA.8.2). The deep temporal brandies (anterior and posterior) ascend on doe
lateral aspect of the skull deep to the temporalis muscle. Brandies are also given to the
prerygoid muscles and to the masseter. A buccal brands supplies the buccinator muscle.
BRANCHES OF THIRD PART OF THE MAXILLARY ARTERY The third or the terminal part or the
pterygopalatine portion of the maxillary artery lies against the posterolateral aspect of the
maxilla and passes deep between the two heads of lateral pterygoid muscle to enter
pterygopalatine fossa where it gives off the following branches (Table IA.8.3): I. The posterior
superior alveolar artery arises just before the maxillary artery enters the pterygomaxillary
fissure. Descending on the posterior surface of the maxilla it gives off branches that enter canals
in the bone to supply the molar and premolar teeth, and the maxillary sinus. 2. The infraorbital
artery also arises just before the maxil-lary artery enters the pterygomaxillary fissure. Through
the inferior orbital fissure it enters the orbit and runs forwards in relation to the floor of the
orbit, first in the infraorbital groove and then in the infraorbital canal emerging on the face
through the infraorbital foramen. It gives off some orbital branches to the struc-tures in the
orbit and the anterior superior alveolar branches to the incisor and canine teeth. After emerg-
ing on the face, the infraorbital artery gives branches to the lacrimal sac, the nose and the upper
lip. The remaining branches of the third part arise within the pterygopalatine fossa. 3. The
grater palatine artery runs downwards in the greater palatine canal to emerge on the
posterolateral part of the hard palate through the greater palatine foramen. It then runs
forwards near the lateral margin of the palate to reach the incisive canal through which some
terminal
Table 1A 8.3 Branches of third part (pterygopalatine) of the maxillary artery
Posterior superior alveolar artery
Alveolar canals Upper molar and premolar in body of teeth and gums, maxillary manilla Sinus
Infraortatal artery Inferior orbital Lower orbital muscles, lacri-fissure may sac, maxillary sinus,
up-per incisors and canine teeth Greater palatine Solt palate. tonsil. palatine glakis muLOSa
appal pills Pharyngeal Root of nose and pharynx, (palatovaginal) auditory tube. sphenoidal
canal sinus Artery of Merygoid Herygoid canal Auditory tube. upper phar-canal you, middle ear
Sphenopalatine Sphenopalatine Lateral and medial walls of (terminal pan) foramen nose and
various air sinuses
Table 1A 8.2 The branches of second (Pterygoid) part of the maxillary artery
11111111.1.111111rai Deep temporal artery • Temporalls muscle • Plerygoiel artery

Masseteric artery Lateral and medial pterygoid muscles hlasseter muscle Buccinator muscle
Buccal artery
Greater palatine 011VI y Pharyngeal

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brandies enter the nasal cavity. Brandies of the artery supply the palate and gums. Within the
greater palatine canal it gives off the lesser palatine arteries that emerge on the palate through
the lesser palatine foramina and run backwards supplying the soft palate and tonsil. 4. The
pharyngeal branch runs backwards through pha-ryngeal or palatovaginal canal. It supplies part
of the nasopharynx, the auditory tube and the sphenoidal air sinus. 5. The artery of the
pterygoid canal runs backwards in the pterygoid canal and supplies the pharynx, the auditory
tube and the tympanic cavity. 6. The sphenopalatine artery passes medially through the
sphenopalatine foramen to enter the cavity of the nose. It gives off posterolateral nasal branches
to the lateral wall of the nose and to the paranasal air sinuses, and posterior scptal branches to
the nasal septum. 0.2. Describe the boundaries and contents of the carotid triangle of neck. Ans.
The boundaries of the carotid triangle are as follows (Fig. IA.8.3): Anternsuperiorly: Posterior
belly of the digastric muscle and the stylohyoid. Anteroinferiorly: Superior belly of the
omohyoid. . Posteriorly: Anterior border of thestemocleidomastoid muscle.
Roof I. Skin 2. Superficial fascia containing (a) the pLatysma, (b) the cervical branch of the facial
nerve and (c) the transverse cutaneous nerve of the neck 3. Investing layer of deep cervical
fascia.
Super.. carved triangle
Infena MOW triangle
Fig. 1A.8.3 The boundaries of the carotid Wangle.

Floor It is formed by the parts of (a) the thyrohyoid muade (b) the hyoglossus and (c) the
middle and inferior constrictors of the pharynx.
Carotid mangle Contents The contents of the carotid triangle areas follows (Pig. IA.8.4): 1.
Arteries a. The common carotid artery with the carotid sinus and the carotid body b. Internal
carotid artery c. The external carotid artery with its superior thyroid, lingual, facial, ascending
pharyngeal and occipital branches. 2. Wins a. The internal jugular vein b. The common facial
vein draining into the internal jugular vein c. A pharyngeal vein that may end either in the
internal jugular vein or in the common facial vein d. The lingual vein. 3. Nerves a. The vagus
running vertically downwards b. The superior laryngeal branch of the vagus, dividing into the
external and internal laryngeal nerves c. The spinal accessory nerve running backwards over
the internal jugular vein d. The hypoglossal nerve running forwards over the external and
internal carotid arteries e. The sympathetic chain runs vertically downwards posterior to the
carotid sheath. 4. Lymph nodes The deep cervical lymph nodes are situated along the in-ternal
jugular vein and include the jugulodigastric node below the posterior belly of the digastric and
the jugulo-omohyoid node above the inferior belly of the omohyoid.
External careed elegy Infernal mead artery .. ■ r Sosicis re:Case Pharyngestbrarce or sagas .....
„ till" C. --epharyneeer nerve - Hypog.assal nerve - ,- 4 I II imams; lanynerail nerve i5P 411
SoPer. evirOld one,/ ___ r EASAnat laryngeal nerve -- Stpcnor root et any, eon.. / r Arno cervcelis
Accessory nor. OtteArel alory Stpenor levyrgeal branch et vogps Paws nava
Werke roe< ol arca oemeans
Fig. 1A.8.4 The contents of the carotid triangle.
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0.
General Anatomy 43
SHORT ESSAYS
Q.t. Lingual artery. Ans. 1. Thc lingual artery arises from the external carotid artery opposite to
the tip of the greater cornu of the hyoid bone. 2. Id course is divided into three parts by the
hyoglossus muscle (Pig. 1A.8.5). a. The first part lies in the carotid triangle. It forms a
characteristic upward loop that permits free move-ments of the hyoid bone. h. Thc second part
lies deep to the hyoglossus along the upper border of hyoid bone. It is superficial to the middle
constrictor of the pharynx.
CN XII
MWOe constrictor
Deep lingual artery
Extenlel Card Gersohyad artery Hro910,... Sublingual blanch nerxa Fig.1A.8.5 The course of
lingual artery.
c. The third part is called the arteria profunda linguae or the deep lingual artery. It runs
upwards along the anterior border of the hyoglossus and then horizon-tally forwards on the
undersurface of the tongue as the fourth part. 3. In its vertical course, it lies between the
gcnioglossus medially and the inferior longitudinal muscle of the tongue laterally. The
horizontal part of the artery is accompanied by the lingual nerve. 0.2. External jugular vein. Ans.
The external jugular vein begins in the substance of parotid gland. It is formed by union of the
posterior auricular vein with the posterior division of the retromandibular vein. It begins within
the lower part of the parotid gland. crosses the sternocleidomastoid obliquely, pierces the
anteroinferior
angle of the roof of the posterior triangle and opens into the subclavian vein (Fig. IA.8.6). The
tributaries of external jugular vein are as follows: I. The posterior external jugular vein 2. The
transverse cervical vein 3. The suprascapular vein 4. The anterior jugular vein.
Fig. 1A.111.13 External jugular vein.

The oblique jugular vein connects the external jugular vein with the internal jugular vein across
the middle one-third of the anterior border of the stemodeidomastoid. The external jugular sew
usually terminates in the subcla. vian vcin,but sometimes it may end in the internal jugular vein.
The external jugular vein is examined to assess the venous pressure, as the right atrial pressure
is reflected in it because there are no traivvs in the entire course of this vein. 0.3. Give the
formation relations and branches of ansa cervical's.
Or Location, formation and distribution of ansa Cervi-calis.
Ans. Ansa ccrvicalis or awn hypogliwsi is a thin nerve loop that lies embedded in the anterior
wall of the carotid sheath over the lower part of the larynx (Fig. IA.8.7). It supplies the
infrahyoid muscles. Ansa ccrvicalis is formed by a superior and an inferior root. • Thc superior
root is the continuation of the descending branch of the hypoglossal nerve. • The inferior root or
descending cervical nerve is derived from second and third cervical spinal nerves.
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To muscles of tongue To genially.] To thyrehyoel-Superwit real el - ansa To superior toy of
omehydd To stomohyad To We.. belly Of Omontychd To 'tomorrow Fig. lit.8.2 Ansa cervicalis.
Hypoglossal mama A Ventral menus of Cl Cemmuticalion to hypoglossal manta Ventral rams of
C2 Vemrs mamas of C3
Inferior root of ansa cervleallS (dessemaing cerstailis)
The inferior root descends and winds around the internal jugular vein and then continues
anteroinferiorly to join the superior root in front of the common carotid artery. Distribution of
Ansa Cervicalis Distribution of ants cervicalis is as follows: I. Superior root: Supplies the
superior belly of the omohyoid. 2. Ansa rerviraliu Supplies the sternohyoid, sternothyroid and
the inferior belly of the omohyoid. 0.5. Name any four branches of external carotid artery given
In the carotid Mangle. Ans. The external carotid artery gives the following branches in the
carotid triangle (Fig. IA.8.8): 1. Superior thyroid 2. Lingual 3. Facial 4. Ascending pharyngeal 5.
Occipital branches.
Superior Thyroid Artery The superior thyroid artery arises from the external carotid artery just
below the level of the greater cornua of the hyoid bone. It runs downwards and forwards and
passes deep to the three long infrahyoid muscles to reach the upper pole of the lateral lobe of
the thyroid gland.
Eocene carotid emery Styloid peons intylnal carotid alter. II '', drlarVnG'real
btrichn'ol"viagneuTs - Mgicipfassa• name 11 ,e41 if Stamm tarynfiest nerve Superior thyroid
artery 1 il, .,..,,„0.„,..,,,,, s.,.,., mat of — 1 ir arise comically Ansa cenich
Accessory owe
-Culp-ear angry Wine or woe triangle Superior laryngeal breech of wags — Vests name rool of
ensa ovvicalis
Fig. IA.8.8 Branches of extornar carotid artery.
Apart hum its terminal branches to the thyroid gland, it gives one important branch, the
superior laryngeal artery, which pierces the thyrohyoid membrane in company with the
internal laryngeal nerve. The superior thyroid artery also gives a sternocleidomastoid brands to
that muscle and a cricothyroid branch that anastomoses with the artery of the opposite side in
front of the cricovocal membrane.
Lingual Artery The lingual artery arises from the external carotid artery op-posite the tip of the
greater comu of the hyoid bone. The hyoglossus muscle divides its course into three parts. The
first part lies in the carotid triangle. It loons a character-istic upward loop that permits free
movements of the hyoid bone. The second part lies deep to the hyoglossus along the upper
border of hyoid bone. It is superlidal to the middle constrictor of the pharynx. The third part is
called the arieria profinula linprae or the deep lingual artery that runs upwards along the
anterior border of the hyoglossus and then horizontally forwards on the undersurface of the
tongue as the fourth part. In its vertical course, it lies between the genioglossus medi-ally and
the inferior longitudinal muscle of the tongue laterally.
Facial Artery The facial artery or the external maxillary artery arises from the external carotid
just above the tip of the greater comb of the hyoid bone. It has two parts: I. The first part runs
upwards in the neck as cervical part. 2. The second part runs on the Face as facial part. The
cervical part of the facial artery gives off the following branches: I. Ascending palatine 2.
Tonsillar 3. Submental 4. Glandular branches for the submandibular salivary gland and lymph
nodes. The chief branches of artery on the face are the labial arteries: 1. Superior labial 2.
Inferior labial. The terminal portion of the facial artery is the angular artery. Occipital Artery
The occipital artery arises from the posterior surface of the external carotid artery, at about the
same level as the facial artery. Close to its origin it is crossed by the hypoglossal nerve. In the
carotid triangle, the artery gives two sterno-cleidomastoid branches. The upper branch
accompanies the accessory nerve, and the lower branch arises near the origin of the occipital
artery.
SHORT NOTES
0.L Lingual artery. Ans. The lingual artery arises from the external carotid artery opposite the
tip of the greater comu of the hyoid bone. It chiefly supplies the tongue. Its course is divided into
three parts by the hyoglossus muscle. The first part lies in the carotid triangle. It forms a
characteristic upward loop, which is crossed by the hypo-glossal nerve during surgical removal
of the tongue, the first part of the artery is ligated before it gives any branch to the tongue or
tonsil. 02. Ansa cervIcalls.
Ans. This is a thin nerve loop that lies embedded in the anterior wall of the carotid sheath over
the lower part of the larynx. It supplies the infrahyoid muscles. It is formed by a superior and an
inferior root. Superior root is derived from first cervical nerve, and the inferior root is derived
from second and third cervical spinal nerves. 0.3. Anterior jugular vein. Ans. This is a small vein,
beginning in the submental region below the chin. It descends in the superficial fascia about I
cm from the median plane. About 2.5 cm above the sternum, it pierces the investing layer of
deep fascia to enter the suprasternal space where it is connected to its fellow of the opposite
side by the jugular venous arch. The vein then turns laterally, runs deep to the
sternocleidomastoid just above the clavicle and ends in the external jugular vein at the posterior
border of the sternocleidomastoid. 0.4. Contents of the dlgastrie triangle.
Ans. Contents of anterior part of the digastric triangle are as follows: I. Structures superficial to
mylohyoid are as follows: a. Superficial part of the submandibular salivary gland. The facial vein
and the submandibular lymph nodes are superficial to it and the facial artery is deep to it. b.
Submental artery. c Mylohyoid nerve and vessels. 2. Structures superficial to the hyoglossus
seen without disturbing the mylohyond and the submandibular gland are (a) the
submandibular salivary gland, (b) the inter-mediate tendon of the digastric and the stylohyoid
and (c) the hypoglossal nerve.
Contents of posterior part of the triangle are as follows: I. Superficial structures are (a) lower
part of the parotid gland and (b) the external carotid artery before it enters the parotid gland. 2.
Deep structures, passing between the external and internal carotid arteries are (a) the
styloglossus, (b) the stylopharyngeus, (c) the glossopharyngeal nerve, (d) the pharyngeal
branch of the vagus nerve, (c) the styloid process and (f) a part of the parotid gland. 3. Deepest
structures include (a) the internal carotid artery, (b) the internal jugular vein and (c) the vagus
nerve.
0.5. Name branches of external carotid artery.
Ans. The external carotid artery gives off eight branches, which may be grouped as follows (Fig.
IA.8.9): 1. Anterior branches a. Superior thyroid b. Lingual c. Facial 2. Posterior branches a.
Occipital b. Posterior auricular 3. Medial branders a. Ascending pharyngeal 4. Terminal
branches a. Maxillary b Superficial temporal.
Pelletier
auricular artery
0.0.01 artery Doscemilng brans,
SupiefieS1 temporal artery Middle lomporal anew Transverse facial attory Maxillary artery
Ascending Debase branch Tonsils, btanch Facial artery Submeidal branch Unpall art,/
Sternoeleidornastore branch Ascending pharyngeal artery
internal motel Wm' External carotid anew Comman carofel artery Stemocleektnallcal _ wench
Superior Inyrod artery
Comma. carodO artery
Fig.1A.&9 External carotid artery and Its branches.
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General Anatomy
0.6. Mention the branches of lingual artery. Ans. Branches of three parts of lingual artery are as
follows: First part. Suprahyoid artery. Second put Dorsal lingual arteries to supply tongue, tonsil
and palate. Third pore Sublingual artery to supply sublingual salivary gland. This artery
communicates with submental artery. The lingual artery of both sides anastomose along the tip
of the tongue.
.0.7. Action and Insertion of posterior cricoaryte-nold muscle. Ans. Posterior cricoarytenoid is a
triangular muscle. It originates from the posterior surface of the lamina of the cricoid carti-lage.
Its fibres pass upwards and laterally and are inserted into posterior aspect of muscular process
of the arytenoid cartilage. Actions Posterior cricoarytenoids are the only muscles which abduct
the vocal cords.
Topic 9
PAROTID REGO"
LONG ESSAYS
0.1. Describe the gross anatomy of the parotid gland and add a note on nerve supply.
Or • Describe the relations, blood supply, nerve supply and applied anatomy of the parotid
gland.
Or Describe the external features, relations and nerve supply of the parotid gland. Ans.
There are three pairs of large salivary glands, namely I. Parotid gland 2. Submandibular gland 3.
Sublingual gland. The parotid gland is the largest of the salivary glands weighing about IS g. It is
situated below the external acoustic meatus, between the ramus of the mandible and the
sternockidomastoid muscle. The gland overlaps the masseter muscle anteriorly. The parotid
capsule is formed by the investigating layer of the deep cervical fascia. The fascia splits to
enclose the gland. The superficial lamina is thick and adherent to the gland. The deep lamina is
thin and is attached to the styloid process, the mandible and the tympanic plate. A thickened
portion of the deep lamina, extending between the styloid process and the mandible, forms the
stylornandibular ligament, which separates the parotid gland from the submandibular salivary
gland.
External Features of the Parotid Gland (Fig. 1A.9.1) The gland is pyramidal in shape. The apex of
the pyramid is directed downwards, and the base or superior surface forms the upper end of the
gland. • The four surfaces of the gland are as follows: 1. Superior (base of the pyramid) 2.
Superficial 3. Anteromedial 4. Posteromcdial. The surfaces are separated by three borders: I.
Anterior 2. Posterior 3. Medial. The apex overlaps the posterior belly of the digastric and the
adjoining part of the carotid triangle and the cervical branch of the facial nerve.
Auticukgranyeral n. and supedicial (endued vessels .*.5 du .,7,7,Loil..=1 _Buccal branches #

MEW. ransvorse racial a. Parotidduct Mesmer /Samna; mandbular Or. Subrnandlielar gland
Cervical br. Fig. 1A.G.1 External features ol the parotid gland.
Siernodousonsaste Fletromaraibular v Great auricular n.
The superior surface or base forms the upper end of the gland, which is small and concave,
where the temporal branches of the facial nerve, the superficial temporal vessels and the
auriculotemporal nerve traverse the parotid gland and cross the xygomatic arch
subcutaneously. The superficial surface is theoutersurfaceof the parotid gland and is covered
with skin and superficial fascia containing the anterior branches of the great auricular nerve.
The pm-auricular or superficial parotid lymph nodes may occur on its surface. Prom the
anterior edge of this superficial part, the parotid, the Stensen's duct passes forwards across the
masseter muscle. The anteromedial surface is grooved by the posterior border of the ramus of
the mandible. It is related to the masseur, the lateral surface of the temporomandibular joint,
the posterior border of the mandible, the medial pterygoid and the emerging branches of the
facial nerve. The posteromedial surface is related to (a) the mastoid process, with the
stemocleidomastoid and the posterior belly of the digastric and (b) the styloid process. The
external carotid artery enters the gland through this surface.
Borders The anterior border separates the superficial surface from the anteromedial surface
and extends from the anterior part of the superior surface to the apex. The following structures
emerge at the anterior border: 1. The parotid duct 2. Most of the terminal branches of the facial
nerve 3. The transverse facial vessels. The accessory parotid gland lies along the parotid duct
close to this border. The posterior border separates the superficial surface from the
posteromedial surface. It overlaps the stemocleido-mastoid muscle. The medial edge or border
separates the anteromedial surface from the posteromedial surface. It is related to the lateral
wall of the pharynx.
Tarnopol and roam= war.cr.as
Deep Structures of the Parotid Gland (Fig. 1A.9.2) 1. Arteries a. The external carotid artery
enters the gland through its posteromedial surface. b. The maxillary artery leaves the gland
through its anteromedial surface. c. The superficial temporal vessels emerge at the anterior part
of the superior surface. d. The posterior auricular artery may arise within the gland. 2. Veins:
The retromandibular vein is formed within the gland by the union of the superficial temporal
and maxillary veins. In the lower part of the gland, the vein divides into anterior and posterior
divisions that emerge at the apex (lower pole) of the gland.
Sdearlidal tereeral vessels Maxillary a $tykkid prose - Transv juguer v.
Auriculesomporai n
Facial n. SMohycid m.
Rellotnansabehar v Ext. jugular v. Occipital Ira. carob
Int jugUer v
Donee m. tt Styloaymd m. Ext. carotid a.
Flg.1A.9.2 Deep structures ol the parotid gland.
3. Nerves: The facial nerve enters the gland through the upper part of its posteromedial surface
and divides into its terminal branches within the gland and appear on the surface at the anterior
border. 4. Parotid lymph nodes.
Parotid Duct Parotid duct is about 5 cm long and emerges from the mid-dle of the anterior
border of the gland. It runs forwards and slightly downwards on the masseter. At the anterior
border of the masseter, it turns medially and pierces the buccal pad of fat and the buccinator
and opens into the vestibule of the mouth opposite the crown of the maxillary second molar
tooth.
Blood Supply The parotid gland is supplied by the external carotid artery and its branches. The
veins drain into the external jugular vein.
Nerve Supply I. Parasympathetic nerves are secretomotor. They reach the gland through the
auriculotemporal nerve. The pre-ganglionic fibres begin in the inferior salivatory nucleus; pass
through the glossopharyngeal nerve, its tympanic branch, the tympanic plexus and the lesser
petrosal nerve; and relay its the otic ganglion. The postganglionic fibres the passglatnhdrough
the auriculotemporal nerve and reach 2. Sympathetic nerves are vasomotor and are derived
from the plexus around the external carotid artery. 3. Sensory nerves to the gland come from
the auriculotem-poral nerve, but the sensory fibres of the great auricular nerve (C2) innervate
the parotid fascia.
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General Anatomy
Lymphatic Drainage Lymph drains first to the parotid nodes and from there to the upper deep
cervical nodes.
Applied Anatomy 1. Parotid swellings are very painful due to the unyielding nature of the
parotid fascia. 2. Mumps is an infectious disease of the salivary glands (usually the parotid)
caused by a specific virus. Viral parotitis or mumps characteristically does not sup-purate. Its
complications are orchitis and pancreatitis. 3. A parotid abscess may be caused by spread of
infection from the oral cavity. An abscess may also form due to suppuration of the parotid
lymph nodes draining an infected area. A parotid abscess is best drained by hori-zontal
incisions known as Hilton's method. 4. The facial nerve is preserved during parotidectomy; by
removing the gland in superficial and deep parts sepa-rately, the plane of cleavage is defined by
tracing the nerve from behind forwards. 5. Mixed parotid tumour is a slowly growing lobulated
pain-less tumour without any involvement of the facial nerve. Malignant change of such a
tumour is indicated by pain, rapid growth, fixity with hardness, involvement of the facial nerve
and enlargement of the cervical lymph nodes. 0.2. Describe the course of the facial nerve. Write
Its applied aspects.
Or Give an account on extracranial course relations and branches of the facial nerve. Add a note
on its applied anatomy.
Or Describe extracranial course of the facial nerve under the following headings: exit from
cranial cavity, course In neck and parotid gland, branches, distribution and applied aspects. Ans.
Facial nerve is the VII cranial nerve, which is the nerve of the second branchial arch.
Course and Relations I. The facial nerve is attached tn, the lateral surface of brainstem close to
caudal border of the pons by two roots, motor and sensory. 2. The sensory root is also called the
nernts intermedius. 3. The two roots run laterally and forwards, along with the eighth nerve to
reach the internal acoustic meatus. In the meatus, the motor root lies in a groove on the eighth
nerve, with the sensory root intervening. At the bottom
or fundus of the meatus, the two roots, sensory and motor fuse to form a single trunk, which lies
in the petrous temporal bone. 4. The course of the nerve can be divided within the canal into
three parts by two bends. a. The first part is directed laterally above the vestibule. b. The second
part runs backwards in relation to the medial wall of the middle ear, above the promontory. c.
The third part is directed vertically downwards be-hind the promontory. The sharp first bend is
also called the genu at the junction of the first and second parts. The geniculate ganglion of the
nerve is so called because it lies on the genu. The second bend is gradual and lies between the
promontory and the mastoid antrum. In its extracronial course, the facial nerve crosses the
lateral side of the base of the styloid process, enters the posteromedial surface of the parotid
gland, runs forwards through the gland and behind the neck of the mandible. It divides into its
five terminal branches, which emerge along the anterior border of the parotid gland. Branches
and distribution of the facial nerve are as follows (Fig. IA.9.3): 1. Within the facial canal a.
Greater petrosal nerve b. The nerve to the stapedius c. The chords tympani
LKAMBOry and 07.1/X■101 mivmor, nuclei leaden, ohm.% r.olrAnw Stntory root taunts nen.
Irearnal ao.4,10.Y GAM. petroxal
motor rodeos °enrolee gasgion
Lacrimal grand
Howe to sMDedus
Poston°, aulcutat POSIPISOf 01 qoatiC
TO flyi Cervical
tOrnolocituko gensfion SublInpal gland --Subteen:nous, fiend 14.0.1mandbular Fig. 1A.9.3
Distilbutlen of facial nerve branches.
2. 'the branches of facial nerve at its exit from the stylo-mastoid foramen a. Posterior auricular
b. Digastric c. Stylohyoid
3. Terminal branches within the parotid gland a. Temporal b. Zygomatic c. Buccal d. Marginal
mandibular e. Cervical 4. Communicating branches with adjacent cranial and spinal nerves A.
Branches of facial nerve within the facial canal a. Greater petrosal nerve is It is a branch of
nervus intcrmcdius and is known as the nerve of tear secretion. ii. The greater petrosal nerve
joins deep petrosal nerve near foramen lacerum and passes forwards through pterygoid canal
as nerve of pterygoid canal and emerges into pterygopalatine fossa and enters pterygopalatine
ganglion, where it relays secretomotor fibres. iii. The taste fibres and sympathetic fibres pass
through ganglion together with the sensory fibres of the maxillary nerve. is It is secretomotor to
glands of palate, pharynx and nose and has a few taste fibres for the scattered taste buds on the
oral surface of the palate. b. The nerve to the stapedius: It arises opposite the pyra-mid of the
middle ear and supplies the stapedius muscle. It damps excessive vibrations of the stapes
caused by high-pitched sounds. In paralysis of the muscle, even normal sounds appear too loud,
and it is known as hyperacusis. c. The ehorda tympani arises in the vertical part of the facial
canal about 6 mm above the stylomastoid foramen. It runs upwards and forwards in a bony
canal. It enters the middle ear and runs forwards in close relation to the tympanic membrane. It
leaves the middle ear by passing through the petrotym-panic fissure. It then passes medial to
the spine of the sphenoid and enters the infratemporal fossa. Chorda tympani joins the lingual
nerve through which it is distributed. It carries (a) preganglionic secretomotor fibres to the
submandibular ganglion for supply of the submandibular and sublingual salivary glands and
taste fibres from the anterior two-thirds of the tongue. B. The branches of facial nerve at its exit
from the scylomastaid foramen a. The posterior auricular nerve arises just below the
stylomastoid foramen. It ascends between the mastoid process and the external acoustic meatus
and supplies i. the auricularis posterior, ii the oocipitalis and the intrinsic muscles on the back of
the auricle.
b. The digastric branch arises dose to the posterior amine-larnaveandsuppliesthe posterior
belly of thedigastric. c. The stylohyoid branch, which may arise with digastric branch, supplies
the stylohyoid muscle. 3. Terminal branches within the parotid gland a. The temporal branches
cross the zygomatic arch and supply i. the auricularis anterior, ii. the auricularis superior, iii. the
intrinsic muscles on the lateral side of the ear, iv. the frontalis, v. the orbicularis oculi and vi. the
corrugator supercilii. b. The zygomatk branches run across the zygomatic bone and supply the
orbicularis oculi. c. The buccal branches are two in number. The upper buccal branch runs
above the parotid duct and the lower buccal branch below the duct. They supply muscles in that
vicinity. d. The marginal mandibular branch runs below the an-gle of the mandible deep to the
platysma. It crosses the body of the mandible and supplies muscles of the lower lip and chin. e.
The cervical brand; emerges from the apex of the parotid gland and runs downwards and
forwards in the neck to supply the platysma.
Applied Aspects of Facial Nerve The symptoms according to level of injury of facial nerve are
shown in Fig. IA.9.4. Symptoms according to level of injury of facial nerve I. A lesion higher up in
the facial canal, above the origin of the chords tympani causes facial paralysis, a loss of taste in
anterior part of the tongue.
!Memel maim means
2, 3, 4, 5 of above 3. 4. 5 of above—
Internal auditory meatus °articulate gantAlan Greater petraeal nor.,
Only 5 of above
Now to stapes...
Chorea lymPonl
Slytomastoki Ida en
Conical
Buccal
Fig. 1A.9.4 Level of injury of facial nerve and its symptoms.
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IIQuick Review Series: BDS 1st Year
2. A lesion still higher above the origin of the nerve to gapedius results in hyperacusis. These are
all lesions of the lower motor neuron (infranuclear). 3. A typical upper motor neuron lesion
(supranuclear) paralyses the lower part of the face but not the upper
(forehead and orbicularis oculi). The upper part of the facial nerve nucleus that innervates
upper musculature is supplied by the cerebral cortex of both sides whereas the lower part
which innervates lower face receives only contmlateral cortical fibres.
SHORT ESSAYS
0.1. Extrecranlal course of facial nerve. Ans. In its extracranial course, the facial nerve after
leaving the skull through the stylomastoid foramen crosses the lateral side of the base of the
styloid process and enters the postero-medial surface of the parotid gland, runs forwards
through the gland and divides into its five terminal branches that emerge along the anterior
border of the parotid gland.
Branches and Distribution I. Branches of facial nerve at its exit from the stylomas-toid foramen:
a. 'The posterior auricular nerve arises just below the stylomastoid foramen and supplies (a) the
aurkula-ris posterior, (b) the occipitalis and (c) the intrinsic muscles on the back of the auricle.
b. The digastric branch arises close to the posterior an-riadar nerve. It is short and supplies the
posterior belly of the digastric. c. The stylohyoid branch, which may arise with digastric branch,
is long and supplies the stylohyoid muscle. 2. Terminal branches within the parotid gland: a. The
temporal branches cross the zygomatic arch and supply (a) the auricularis anterior, (b) the
auricularis superior, (c) the intrinsic muscles on lateral side of the ear, (d) the frontalis, (e) the
orbicularis oculi and (f) the corrugator supercilii. b. The zygomatic branches run across the
zygomatic bone and supply the orbicularis oculi. c. The buccal branches are two in number. The
upper buccal branch runs above the parotid duct and the tower buccal branch .below the duct.
They supply muscles in that region. d. The marginal mandibular brand; runs below the angle of
the mandible deep to the platysma. It crosses the body of the mandible and supplies muscles of
the lower lip and chin. e. The cervical branch emerges from the apex of the parotid gland and
runs downwards and forwards in the neck to supply the platysma. 3. Communicating branches:
For effective coordination between the movements of the muscles of the first,
second and third branchial arches, the motor nerves of the three arches communicate with each
other. The fa-cial nerve also communicates with the sensory nerves distributed over its motor
territory. 0.2. Connections, course and distribution of chorda tympani. Ans. The chorda tympani
arises in the vertical part of the facial canal about 6 mm above the stylomastoid foramen. It runs
upwards and forwards in a bony canal and enters the middle ear and runs forwards in dose
relation to the tympanic membrane. It leaves the middle ear by passing through the
petrotympanic fissure. It then passes medial to the spine of the sphenoid and enters the
infratemporal fossa. Here, it joins the lingual nerve through which it is distributed. It carries (a)
preganglionic secretomotor fibres to the submandibular ganglion for supply of the
submandibular and sublingual salivary glands and (b) taste fibres from the anterior two-thirds
of the tongue. Q.3. Beginning, course, termination and relations of parotid duct Ans. Parotid duct
is thick walled and is about 5 cm long. It emerges from the middle of the anterior border of the
gland. It runs forwards and slightly downwards on the masseter. Here its relations are as
follows: Superiorly, I. Accessory parotid gland 2. Upper buccal branch of the facial nerve and the
trans-verse facial vessels.
Inferiorly, The lower buccal branch of the facial nerve. At the anterior border of the masseter, it
turns medially and pierces (a) the buccal pad of fat, (b) the bucoopharyn-pal fascia and (c) the
buccinator. The duct runs forwards for a short distance between the buccinator and the oral
mucosa. Finally, it turns medially and opens into the vestibule of the mouth opposite the max-
illary second molar tooth.
0.4. Describe structures passing through the pa-rotid gland.

Or Structures passing through parotid gland. Ans. Refer to the answer of Long Essays Q.I. 0.5.
Intrapetrous part of facial nerve. Ans. 1. The two roots of the facial nerve sensory and motor,
fuse to form a single trunk at the bottom or fundus of the me-atus which lies in the petrous
temporal bone (Fig. IA.9.5).
Superior vestassar area Canal for facial nerve
Transverse Crest
Inferior veStbolar area
Foremen farigUlare Fig. IA.9.5 Features seen on the rondos of the left Internal acoustic meatus.
Doeraear area
General Anatomy
2. Within the canal, the course of the nerve can be divided into three parts by two bends (Fig.
IA.9.6). a. The first part is directed laterally above the vestibule. b. The second part runs
backwards in relation to the medial wall of the middle car, above the promontory. c. The third
part is directed vertically downwards behind the promontory. The first bend at the junction of
the first and second parts is sharp. It lies over the anterosuperior part of the promontory and is
also called the gees. The second bend is gradual, and lies between the promontory and the
mastoid antrum. The facial nerve leaves the skull by passing through the stylomastoid foramen.
Canal lof Ma& nerve Feat pan pefasirop latmelly oarreiralasurfaer morrsoicw &yore/Mad
foramen-,
second pert rust IfeCavarfle 444...-Adoo9 to froaatoicl smarten pyranea Third pad
tarn .0111WW03
Fig. 1A.9.6 Course of facial nerve.
SHORT NOTES
0.1. Parotid duct.
Or
Parotid duct opening. Ans.
Parotid duct is thick walled and is about 5 cm long. It emerges from the middle of the anterior
border of the gland. It runs forwards and slightly downwards on the masseter. It opens into the
vestibule of the mouth opposite the crown of the maxillary second molar tooth.
0.2. Facial nerve.
Ans. This is the seventh cranial nerve. It is the nerve of the second branchial arch. The facial
nerve leaves the skull by passing through the stylomastoid foramen and supplies motor
innervation to the muscles of face.
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0.3. Chorda tympani. Ans. The chorda tympani arises in the vertical part of the facial canal about
6 mm above the stylomastoid foramen. It leaves the middle ear by passing through the
pctrotympanic fissure. It then passes medial to the spine of the sphenoid and enters the
infratemporal fossa where it joins the lingual nerve through which it is distributed. It carries (a)
preganglionic secretomotor fibres to the submandibular ganglion for supply of the
submandibular and aosiol novel calively elands anal (h) taste fibres from the anterior two-
thirds of the tongue. 0.4. Nerve supply to parotid gland. Ans. I. The parasympathetic nerves are
secretomotor. They reach the gland through the auriculotemporal nerve. The preganglionic
fibres begin in the inferior salivatory
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nucleus: pass through the glossopharyngeal nerve, its tympanic branch, the tympanic plexus
and the lesser petrosal nerve and relay in the otic ganglion. The post-ganglionic fibres pass
through the aurkulotemporal nerve and reach the gland. 2. Sympathetic nerves are vasomotor
and are derived from the plexus around the external carotid artery. 3. The auriculotemporal
nerve supplies sensory nerves to the gland but the parotid fascia is innervated by the sensory
fibres of the great auricular nerve (C2). 0.5. Name the arteries seen In the substance of parotid
gland. Ans. I. The external carotid artery enters the gland through its posteromedial surface.
2. The maxillary artery leaves the gland through its an tern• medial surface. 3. The superficial
temporal vessels emerge at the anterior part of the superior surface. 4. The posterior auricular
artery may arise within the gland. 0.6. List the branches of facial nerve soon after its emergence
through the stylomastoid foramen. Ans. Branches of facial nerve at its exit from the
stylomastoid foramen are as follows: I. Posterior auricular 2. Digastric and 3. Stylohyoid.
Topic 10
TEMP,"INFRATEMPORAL
LONG ESSAYS
0.1. Name the muscles of mastication. Describe the origin, Insertion, nerve supply actions and
relations of any one of them.
Or
Describe the muscles of mastication under the following headings: names of the muscle attach-
ments, nerve supply and action.
Or
Name the muscles of mastication. Give their attachments, nerve supply and action.
Ans. The muscles of mastication are as follows: I. The masseur 2. The temporalis 3. The lateral
pterygoid 4. The medial pterygoid.
Masseter Muscle The masseter muscle is quadrilateral in shape and covers lateral surface of
ramus of mandible (Fig. IA.10.0.
//Lasseter muscle
Fig.1A.10.1 The masseter muscle.

Origin It has three layers: 1. Superficial layer arises from anterior two-third of lower border of
zygomatic arch and adjoining zygo-matk process of maxilla. 2. Middle layer arises from anterior
two-third of deep surface and posterior one-third of lower border of zygomatic arch.
General Anatomy . . , .
3. Deep layer arises from deep surface of zygomatic arch. Superficial fibres pass downwards and
backwards at 45°, middle and deep fibres pass vertically downwards.
Insertion I. Superficial layer is inserted into lower part of lateral surface of ramus of mandible. 2.
Middle layer is inserted into middle part of ramus. 3. Deep layer is inserted into upper part of
ramus and coronoid process of the mandible.
Nerve Supply The masseteric nerve, a branch of anterior division of man-dibular nerve, supplies
the masseter muscle.
Action It elevates mandible to close the mouth.
Temporalis Muscle Temporally muscle is a fan-shaped muscle, filling the temporal fosse (Fig.
IA.10.2). Origin The temporalis muscle arises from temporal fossa and tem-poral fascia. The
fibres converge and pass through gap deep to zygomatic arch.
Insertion Temporalis muscle inserts into margins and deep surface of coronoid process and
anterior border of ramus of mandible. Nerve supply Ttvo deep temporal branches from anterior
division of mandibular nerve.
Flg.1A.10.2 The temporalis muscle.

Action I. Elevates mandible. 2. Posterior fibres retract the protruded mandible. 3. Helps in side
to side grinding movements.
Lateral Pterygoid Muscle The lateral pterygoid muscle is a short, conical muscle and has upper
and lower heads (Fig. IA.10.3).
Lateral&Paw heap FoLywdlj Intense head Medial pterygoid Flg.1A.10.3 The lateral and medial
pterygoid muscles. Origin I. Upper head (small) arises from infratemporal surface and crest of
greater wing of sphenoid bone. 2. Lower head (larger) arises from lateral surface of lateral
ptcrygoid plate and the fibres run backwards and laterally and converge for insertion.
Lateral pterygaid plate
Insertion 1. Pterygoid fovea on the anterior surface of neck of mandible. 2. Anterior margin of
articular surface of temporoman-dibular joint. Insertion is posterotareral and at a slightly
higher level than origin.
Nerve supply A branch from anterior division of mandibular nerve. supplies the lateral
pterygoid muscle.
Action I. Along with suprahyoid muscles it helps in depressing the mandible to open the mouth.
2. Lateral and medial pterygoids protrude the mandible. 3. Left lateral pterygoid and right
medial ptcrygoid turn the chin to left side.
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Quick Review Series: BDS I st Year
Medial Pterygold Muscle The medial pterygoid muscle is quadrilateral in shape and has a small
superficial and a large deep head.
Origin i. Superficial head (small slip): From tuberosity of maxilla and adjoining bone. 2. Deep
head (quite large): From medial surface of lateral pterygoid plate and adjoining process of
palatine bone. The fibres run downwards, backwards and laterally.
Insertion Roughened area on the medial surface of angle and adjoin-ing ramus of mandible,
below and behind the mandibular foramen and mylohyoid groove.
Nerve supply Nerve to medial pterygoid, branch of main trunk of man-dibular nerve.
Action I. Elevates mandible. 2. Helps protrude the mandible. 3. Right medial pterygoid with left
lateral pterygoid turns the chin to left side. 0.2. Give an account of lateral pterygold muscle. Or
Describe lateral pterygoid muscle and its relations. Ans. The lateral pterygoid muscle is a short,
conical muscle and has upper and lower heads (Pig. IA.10.3).
Origin I. Upper head (small): Arises from infratemporal surface and crest of greater wing of
sphenoid bone. 2. Lower head (larger): Arises from lateral surface of lateral pterygoid plate and
the fibres run backwards and laterally and converge for insertion. Insertion I. Pterygoid
fovea'on the anterior surface of neck of the mandible 2. Anterior margin of articular surface of
temporoman-dibular joint. Inseition is posterolateral and at a slightly higher level than origin.
Nerve Supply A branch front anterior division of mandibular nerve.
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Action I. Depress mandible to open mouth, with suprahyoid muscle. 2. Lateral and medial
pterygoid muscles protrude the mandible. 3. Left lateral pterygoid and right medial ptcrygoid
turn the chin to left side as part of grinding movements.
Relations of Lateral Pterygold The lateral pterygoid may be regarded as the key muscle of this
region, and its relations are as follows: Superficially lateral pterygoid is related to she following:
I. Masseter 2. Ramus of the mandible 3. Tendon of the temporalis 4. The maxillary artery. Deep
relations of lateral pterygoid are as follows: 1. Mandibular nerve 2. Middle meningcal artery 3.
Sphenornandibttlar ligament. Deep head of the medial pierygoid structures emerging at the
lower border are as follows: 1. Lingual nerve 2. Inferior alveolar nerve.
Structures passing upwards deep to it are at follows: 1. The middle meningeal artery. Structures
passing through the gap between the um heads are as follows: 1. The maxillary artery enters the
gap 2. The buccal branch of the mandibular nerve comes out through the gap. Structure
surrounding the lateral pterygoid is as follows: I. The pterygoid plexus of veins. 0.3. Describe the
mandibular nerve under following headings: origin, roots fibres, its contents, termina-tion and
relations.
Or Describe the mandibular nerve under following headings: formation, course, relations,
branches and its distribution.
Or Give an account of origin, course, relations and branches of mandibular nerve. Add a note on
Its applied anatomy. Ans.
Mandibular nerve is the largest of the three divisions of the trigeminal nerve. It is the nerve of
the first bronchial arch
and supplies all structures derived from the mandibular of first branchial arch. It has both
sensory and motor fibres.
Origin, Course and Relations Mandibular nerve originates in the middle cranial fossa through a
large sensory root and a small motor root (Fig. 1A.10.4). The sensory root arises from the lateral
part of the trigeminal ganglion and leaves the cranial cavity through the foramen ovate. The
motor root lies deep to the trigeminal ganglion and to the sensory root. It also passes through
the foramen ovate to join the sensory root just below the foramen thus forming the main trunk.
The main trunk lies in the infratemporal fossa, on the tensor veli palatini, deep to the lateral
ptery-gold. After a short course, the main trunk divides into a small anterior trunk and a large
posterior trunk.
Lesser pal10144 Nerve to tensor tympani Aurladotemvor Chorda lyrroan eVenor alveolar
1.154enyold Fig. 1A.10.4 Mandibular nerve
Poetenor deep unposed Masseterle Anterior:ono temporal Lateral plarygeid sweat Medial
plarygdel
Lelgual
Submandtular 9anglen
Branches Branches from the main trunk Mcningeal branch or nervus spinosus It enters the skull
through the foramen spinosum with the middle meningeal artery and supplies the dura mater of
the middle cranial fossa.
Nerve to medial pterygoid Nerve to medial pterygoid arises close to the otic ganglion and
supplies the medial pterygoid from its deep surface. This nerve gives a motor root to the oft<
ganglion, which does not relay and supplies the tensor veld palatini and the tensor tympani
muscles. wenches from the enteric: t.-.:nk Buccal nerve Buccal nerve is the only sensory branch
of the anterior divi-sion of the mandibular nerve. It passes between the two heads of the lateral
pterygoid, runs downwards and for-wards, and supplies the skin and mucous membrane
related to the buccinator. It also supplies the labial aspect of gums of molar and premolar teeth.
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Masseteric nerve Masseteric nerve emerges at the upper border of the lateral pterygoid just in
front of the temporomandibular joint, passes laterally through the mandibular notch
accompany-ing the masseteric vessels and enters the deep surface of the masseur. It also
supplies the temporomandibular joint. Deep temporal nerves There are two deep temporal
nerves, anterior and posterior that pass between the skull and the lateral pterygoid and enter
the deep surface of the temporalis. The anterior nerve is often a branch of the buccal nerve. The
posterior nerve may arise in common with the masseteric nerve. Nerve to lateral pterygoid
Nerve to lateral pterygoid enters the deep surface of the muscle. It may be an independent
branch or may arise in common with the buccal nerve.
Branches from the posterior trunk Auriculotemporal nerve Auriculotemporal nerve arises by
two roots that run back-wards, encircle the middle meningeal artery and unite to form a single
trunk. Behind the neck of the mandible, it turns upwards and ascends on the temple behind the
super-ficial temporal vessels. 1. The auricular part of the nerve supplies the skin of the tragus
and the upper parts of the pinna, the external acoustic meatus and the tympanic membrane. 2.
The temporal part supplies the skin of the temple in addition. 3. The auriculotemporal nerve
also supplies the parotid gland (secretomotor and also sensory) and the tern. poromandibular
joint.
Lingual Nerve Lingual nerve is one of the two terminal brandies of the pos-terior division of the
mandibular nerve. It is sensory to the anterior twodhirds of the tongue and to the floor of the
mouth. The fibres of the chords tympani, a branch of facial nerve,which is secretomotor to the
submandibular and sublin-gual salivary glands and gustatory to the anterior two-thirds of the
tongue, are also distributed through the lingual nerve.
Gwseu and miatiOn6. It begins 1 cm below the skull. It runs first between the ten-sor veli
palatini and the lateral pterygoid and then between the lateral and medial pterygoid. About 2
cm below the skull it is joined by the chords tympani nerve. Emerging at the lower bonier of the
lateral pterygoid the nerve runs down-wards and forwards between the ramus of the mandible
and the medial pterygoid. Next, it lies in direct contact with the
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mandible, medial to the third molar tooth between the ori-gins of the superior constrictor and
the mylohyoid muscles. It soon leaves the gum and runs over the hyoglossus deep to the
mylohyoid. Finally, it lies on the surface of the genioglos-sus deep to the mylohyoid. Here it
winds around the sub-mandibular duct and divides into its terminal branches.
Inferior alveolar nerve Inferior alveolar nerve is the larger terminal brands of the posterior
division of the mandibular nerve. It runs vertically downwards lateral to the medial pterygoid
and to the sphe• nomandibular ligament. It enters the mandibular foramen and runs in the
mandibular canal accompanied by the infe-rior alveolar artery.
Branches I. The mylohyoid branch contains all the motor fibres of the posterior division. It
arises just before the inferior alveolar nerve enters the mandibular foramen, runs in the
mylohyoid groove and supplies the mylohyoid mus-cle and the anterior belly of the digastric. 2.
Within the mandibular canal the inferior alveolar nerve gives branches that supply the lower
teeth and gums. 3. The mental nerve emerges at the mental foramen and supplies the skin of the
chin, and the skin and mucous membrane of the lower lip. 4. The incisive branch supplies the
labial aspect of gums of canine and incisor teeth.
0.4. Describe origin, course relations and distribu-tion of lingual nerve. Ans.
Refer to the answer of Long Essays Q.3. Q.5. Mention boundaries and contents of infratem-poral
fosse.
Ms. The infratemporal fossa lies below the skull and behind the body of the maxilla and lateral
pterygoid plate. It communi-cates with the pterygopalatine fossa through the pterygo-maxillary
fissure.
• Boundaries
I. The roof is formed medially by the infratemporal surface of the greater wing of the sphenoid
and by a small part of the squamous temporal bone. Laterally, the roof is incomplete where the
infratemporal fosse communicates with the temporal fosse through the gap deep to the
zygomatic arch. The roof formed by greater wing is pierced by the foramen oval and by the
foramen spinosum. 2. The floor is open.
3. The medial wall is hum,' by the lateral pterygoid plate and the pyramidal process of the
palatine bone. 4. The lateral wall is formed by the ramus of the mandible. 5. The anterior wall is
formed by the infratemporal or posterior surface of the maxilla and by the medial sur-face of the
zygomatic bone. 6. The posterior wall is open.
Communications I. Superiorly-with cranial cavity 2. Inferiorly with-parapharyngeal space 3.
Medially with-pterygopalatine fossa. • The anterior and medial walk arc separated in their up-
per parts by the pterygomaxillary fissure through which the infratemporal fossa communicates
with the pterygopalatine fossa. The upper end of the pterygomaxillary fissure is con-tinuous
with the anterior part of the inferior orbital fissure through which the infratemporal fosse
communicates wide the orbit. Contents of infratemporal fossa are as follows: I. Mandibular
nerve and its branches 2. Maxillary artery and its branches 3. Maxillary vein and its tributaries
4. Chorda tympani nerve 5. Pterygoid plexus of veins 6. Muscles of mastication 7. Otic ganglion.
Q.B. Describe the movements of temporomandibu-lar joint and mention the muscles producing
these movements. What are the factors responsible for its stability?
Or Describe temporomandibular joint. Or Describe the articulating surfaces, ligaments and
movements of temporomandibular joint.
Or Describe the temporomandibular joint under the following headings: type of joint, articular
sur-faces, ligaments, nerve supply, movements and muscles producing movement.
Or Describe the temporomandibular joint under the following headings: articulating bones and
articu-lating surfaces, capsule, Infra-articular disc, liga-ments, movements with muscles
producing it and applied anatomy. Ans.
Temporornandibular joint (TMJ) is a synovial joint of ihc condylar variety.

Articular Surfaces The upper artrular surface is formed by: t. The articular eminence and 2.
Anterior part of the mandibular fosse. The inferior articular surface is formed by 1. The head of
the mandible: The articular surfaces are covered with fibrocartilage. The joint cavity is divided
into upper and lower parts by an intra.articular disc.
Ligaments The ligaments of TMJ arc as follows: I. The fibrous capsule 2. The lateral ligament 3.
The sphenomandibular ligament 4. The stytomandibular ligament. The fibrous capsule is
attached above the articular tuber-cle, the circumference of the mandibular fossa and the squa•
motympanic fissure; and below the neck of the mandible. The capsule is loose above the intro-
articular disc and tight below it. The synovial membrane lines the fibrous capsule and the neck
of the mandible. The lateral or temporomandibular ligament reinforces and strengthens the
lateral part of the capsular ligament. Its fibres arc directed downwards and backwards. It is
attached above the articular tubercle and below the posterolateral aspect of the neck of the
mandible. The sphenomandibular ligament is an accessory ligament. It is attached superiorly to
the spine of the sphenoid and inferiorly to the lingula of the mandibular foramen. It is a remnant
of the dorsal part of Meckel's cartilage. The stylornandibular ligament is another accessory liga-
ment of the joint. It is attached above to the lateral surface of the styloid process and below to
the angle and posterior border of the ramus of the mandible. It represents a thickened part of
the deep cervical fascia, which separates the parotid and submandibular salivary glands.
Articular Disc The articular disc is an oval fibrous plate that divides the joint into an upper and a
lower compartment. The upper compartment permits gliding movements, and the lower
rotatory as well as gliding movements. The disc has a cones-voconvex superior surface and a
concave inferior surface. The periphery of the disc is attached to the fibrous capsule. The disc is
composed of an anterior extension, anterior thick band, intermediate zone, posterior thick band
and bilamellar region. The disc represents the degenerated primitive insertion of lateral
pterygoid.
Relations Lateral: I. Skin and fasciae 2. Parotid gland 3. Temporal branches of the facial nerve.
Medial 1. The tympanic plate separates the joint from the internal carotid artery. 2. Spine of the
sphenoid, with the upper end of the sphe-nomandibular ligament. 3. The auriculotemporal and
chorda tympani nerves. 4. Middle meningeal artery.
Anterior: 1. Lateral pterygoid 2. Masseteric nerve and vessels.
Posterior: 1. The parotid gland separates the joint from the external auditory meatus 2.
Superficial temporal vessels 3. Auriculotemporal nerve. Superior: 1. Middle cranial fosse 2.
Middle meningeal vessels. lejirion Maxillary artery and vein.
Blood Supply Branches from superficial temporal and maxillary arteries. Veins follow the
arteries.
Nerve Supply Auriculotemporal nerve and masseteric nerve.
Movements The movements at the joint can be divided into those be-tween the upper articular
surface and the articular disc, i.e. meniscotemporal compartment and those between the disc
and the head of the mandible, i.e. meniscomandibular com-partment. Most movements occur
simultaneously at the right and left temporomandibular joints. In forward movement or
protraction of the mandible, the articular disc glides forwards over the upper articular sur-face,
the head of the mandible moving with it. The reversal of this movement is called retraction. In
slight opening of the mouth or depression of the mandi-bk, the head of the mandible moves on
the undersurfiree of the disc like a hinge. In wide opening of the mouth, this hinge-like
movement is followed by gliding of the disc and the head of the mandible, as in protraction. At
the end of this movement, the head comes to lie under thearticular tubercle. These movements
are reversed in closing the mouth or elevation of the mandible.
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Chewing movements involve side-to-side movements of the mandible. In these movements, the
head of right side glides forwards along with the disc as in protraction, but the head of the left
side merely rotates on a vertical axis. Asa result of this, the chin moves forwards and to left side
(the side on which no gliding hasoccurred). Alternate movements of this kind on the two sides
result in side-to-side movements of the jaw.
Muscles Producing Movements Depression is brought about mainly by the lateral pterygoid. The
digastric, geniohyoid and mylohyoid muscles help when the mouth is opened wide or against
resistance. During contraction, the lateral pterygoid rotates the head of the mandible and opens
the mouth. Dosing wide opening, it pulls the articular disc forwards. So movement occurs in
both the compartments. It is also done passively by gravity. Elevation is brought about by the
masseter, the tempora-Es and the medial pterygoid muscles of both sides. These are antigravity
muscles.
Protrusion is done by the lateral and medial pterygoids. Retraction is produced by the posterior
fibres of the tern-poralis. It may be resisted by the middle and deep fibres of the masseter, the
digastric and geniohyoid muscles. Lateral or side-to-side movements, e.g. turning the chin to left
side are produced by left lateral pterygoid and right medial pterygoid and vice versa.
Applied Anatomy I. Dislocation of mandible During excessive opening of the mouth, or during a
convulsion, the head of the mandi-ble of one or both sides may slip anteriorly into the in-
fratemporal fosse, as a result of which there is inability to close the mouth. 2. Derangement of
the articular disc may result from any injury, like overclosule or malocclusion. This gives rise to
clicking and pain during movements of the jaw. 3. In operations on the joint, the facial nerve
should be preserved with care.
SHORT ESSAYS
0.1. Articular disc. Ans.
Refer to the answer of Long Essays Q.6. 0.2. Buccinator muscle. Ans. Buccinator is the muscle of
the cheek.
Origin 1. Upper fibres, from maxilla opposite molar teeth 2. Lower fibres, from mandible
opposite molar teeth 3. Middle fibres, from pterygomandibular raphe.
Insertion I. Upper fibres, straight to the upper lip. 2. Lower fibres, straight to the lower lip. 3.
Middle fibres decussate before passing to the fins.
Actions 1. Flattens cheek against gums and teeth 2. Prevents accumulation of food in the
vestibule. 0.3. Inferior alveolar nerve. Ans. Refer to the answer of Long Essays Q.3.
0.4. Pterygopaiatine ganglion. Ans.
I. Pterygopalatine or sphenopalatine ganglion is the larg-est parasympathetic peripheral
ganglion that lies in the pterygopalatine fosse just below the maxillary nerve, in front of the
pterygoid canal and lateral to the spheno-palatine foramen (Pig. IA.10.5). 2. Topographically, it
is related to the maxillary nerve, but functionally it is connected to the facial nerve. 3. It serves
as a relay station for secretomotor fibres to the lacrimal gland and to the mucous glands of the
nose, the paranasal sinuses, the palate and pharynx.
Connections 1. The motor or parasympathetic root of the ganglion is formed by the nerve of the
pterygoid canal. It carries preganglionic fibres that arise from neurons present near the
superior salivatory and lacrimatory nuclei. and reach the ganglion. The fibres relay on the
ganglion, and postganglionic fibres arise to supply secretomotor nerves to the lacrimal gland
and to the mucous glands of the nose, the paranasal sinuses, the palate and the nesopharynx. 2.
The sympathetic root is also derived from the nerve of the pterygoid canal. It contains
postganglionic fibres arising in the superior cervical sympathetic pillion and passing through
the internal carotid plexus, the
-vs
General Anatomy
Leermai gland
Lacrimal nerve
Communicating beaten between zmornatic and Wilmal nerve
Zygomeoc nerve Maxitary nerve Foramen rottinclum Sphenopwatme toremen Pielygopelatna
ganglion
darnells)
Greater petrosal nerve
Nerve of pearygoio Deep petrosal nerve canal
Lessee oaken° nerve Greeter palatine nerve Plerygopalatine ganglion.
deep petrosal nerve and the nerve of the pterygoid canal to reach the ganglion. The fibres pass
through the gan-glion without relay and supply vasomotor nerves to the mucous membrane of
the nose, the paranasal sinuses, the palate and the nasopharynx. 3. The sensory root comes form
the maxillary nerve. Its fibres pass through the ganglion without relay. They emerge in the
following branches a. Orbital branches pass through the inferior orbital fis-sure and supply the
periosteum of the orbit and the orbitalis muscle. b. Palatine branches The greater or anterior
palatine nerve descends through the greater palatine canal and supplies the hard palate and the
lateral wall of the nose. The lesser or middle and posterior palatine nerves supply the soft palate
and the tonsil. c. Nasal branches enter the nasal cavity through the sphenopalatioe for-amen.
The lateral posterior supe-rior nasal nerve, about six in number, supply the posterior part of the
superior and middle conchae. The medial posterior superior nasal nerves, two or three in
number, supply the posterior part of the roof of the nose and of the nasal septum. The nasopala-
tine nerve descends up to the anterior part of the hard palate through the incisive for-amen. d.
The pharyngal branch passes through the palatine-vaginal canal and supplies the part of the
nasophar-ynx behind the auditory tube. e. Lacrimal branch: The postganglionic fibres pass back
into the maxillary nerve to leave through its zygo-snatic nerve and its xygomaticotemporal
branch, a communicating branch to lacrimal nerve to supply the secretomotor fibres to the
lacrimal gland.
0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.I.
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0.6. Styloid process of temporal bone. Ans. The styloid process with its attached structures is
called the styloid apparatus. The structures attached to the process are as follows: I. The
stylohyoid, styloglossus and stylopharyngeus muscles. 2. The stylohyoid and stylomandibular
ligaments. The five attachments resemble the reins of a chariot. I. The styloid process is a long,
slender and pointed bony process projecting downwards, forwards and slightly medially from
the temporal bone. 2. It descends between the external and internal carotid arteries to reach the
side of the pharynx. It is interposed between the parotid gland laterally and the internal jugular
vein medially. 3. The styloglossus muscle arises from the tip and adjacent part of the anterior
surface of the styloid process as well as from the upper end of the stylohyoid ligament. During
swallowing, it pulls the tongue upwards and backwards. 4. The stylopharyngeus muscle arises
from the medial sur-face of the base of the styloid process. Along with the glossopharyngeal
nerve it passes between the external and internal carotid arteries, enters the pharynx through
the gap between the superior and middle constrictors. it helps to lift the larynx during
swallowing and phonation. 5. The stylohyoid ligament extends front the tip of the styloid
process to the lesser cornu of the hyoid bone. 0.7. Attachments, relations, nerve supply and
action of lateral pterygold muscle. Or Give the attachment, relations and nerve supply of lateral
pterygoid muscle. Ans. Refer to the answer of Long Essays Q.2.
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SHORT NOTES
0.1. Lingual nerve. Ans. Lingual nerve is one of the two terminal brandies of the posterior
division of the mandibular nerve. It is sensory to the anterior two-thirds of the tongue and to
the floor of the mouth. The fibres of the chords tympani are also distributed
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0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.t. 0.6. Stylomandlbular
ligament. Ans.
2. The cavernous sinus through the emissary veins and 3. facial vein through the deep facial
vein. 0.9. Pterygomandibular raphe.
Ans. The pterygomandibular raphe is attached immediately behind the third molar tooth in
continuation with the origin of the superior constrictor muscle of the pharynx. It is formed by
the interdigitation of fibres from two muscles, namelybuccinator and superior pharyngeal
constrictors.
2. The anterior tympanic branch supplies the middle ear including the medial surface of the
tympanic membrane. 3. The middle meningeal artery supplies more of bone and less of
meninges, V and VII nerves, middle ear and tensor tympani. 4. The accessory meningeal artery
enters the cranial cavity through the foramen ovate. Apart from the meninges, it supplies
structures in the infratemporal fossa. 5. The inferior alveolar artery runs downwards and for-
wards medial to the ramus of the mandible to reach the mandibular foramen.
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SHORT NOTES
the floor of the mouth. The fibres of the chords tympani are also distributed through the lingual
nerve. 0.2. Jugular foramen. Ans. The jugular foramen is large and elongated, with its long axis
directed forwards and medially. it is placed at the posterior end of the pet ro-occupital suture.
The jugular foramen transmits the following structures: I. Through the anterior part a. Inferior
petrosal sinus b. Meningeal branch of the ascending pharyngeal artery 2. Through the middle
part IX, X and XI cranial nerves (glossopharyngeal, vagus and accessory nerves) 3. Through the
posterior part a. Internal jugular vein • b. Meningeal branch of the occipital artery. The
glossopharyngeal notch near the medial end of the jugular foramen lodges the inferior ganglion
of the glosso-pharyngeal nerve. Q.3. Audculotempond nerve. Ans.
This nerve has two roots of origin. Between the two roots the
0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.t. 0.6. Stylomandlbular
ligament. Ans. The stylomandibular ligament is an accessory ligament of the
temporomandibular joint. It represents a thickened part of the deep cervical fascia, which
separates the parotid and submandibular salivary glands. It is attached above to the lateral
surface of the styloid process and below to the angle and posterior border of the ramus of the
mandible. 0.7.TemporomandibUlar joint movements. Ans. Movements of temporomandibular
joint are: I. Depression 2. Elevation 3. Protraction 4. Retraction 5. Sick-to-side movement. The
articular disc divides the joint into two compart-ments, namely superior and inferior. I.
Elevation and depression: These movement occur in mainly the inferior compartment. The head
of mandible rotates on the articular disc. This movement occurs in the transverse axis. 2.
Prorraction and retraction: These movements occur mainly in the superior compartments. The
articular disc moves in anteroposterior direction up to the articular
tubercle and owners or the mannumiar ma.
2. The cavernous sinus through the emissary veins and 3. facial vein through the deep facial
the interdigitation of fibres from two muscles, namelybuccinator and superior pharyngeal
constrictors. 0.10. Name any four branches of first part of maxil-lary artery. Ms. The first part,
i.e. the mandibular part of maxillary artery runs horizontally forwards, first between the neck of
the mandible and the sphenomandibular ligament, below the suriculotemporal nerve, and then
along the lower border of the lateral pterygoid. Branches of the first part of the maxillary artery
are as follows: 1. The deep auricular artery supplies the external acoustic meatus, the tympanic
membrane and the temporoman-dibular joint.
Topic 11
General Anatomy
wards medial to the ramus of the mandible to reach the mandibular foramen. 0.11. Lateral
pterygoid plate.
Ans. 1. The lateral pterygoid plate is directed backwards and laterally. 2. It has medial and
lateral surfaces and a free posterior border. 3. The lateral surface forms the medial wall of the
infra-temporal fosza. 4. The lateral and medial surfaces give origin to pterygoid muscles. 5. The
posterior border sometimes has a projection called the pterygospinous process, which projects
towards the spine of the sphenoid.
SUBMANDIBULMINI
LONG ESSAYS
0.1. Write about the origin, insertion and relations Origin of mylohyoid muscle. The mylohyoid
muscle arises from mylohyoid line on the
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the floor of the mouth. The fibres of the chorda tympani are also distributed thrnIval, the linen,
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0.5. Muscles of mastication. Ans. Refer to the answer of Lung Essays Q.1. 0.6. Stylomandibular
ligament. Ans.
Oierlo on. Mensal spr8as sublingual fosse
Rashe
Flee poslenor Subrinandlbul rnanyn Body hyoid c"'"I'' 00'0 Fig. 1A. 11.1 Mylohyoid muscle.
Pardirl gland Power beer or dpentre sly/rboal External cartes opeolearetid
Fig. 1 A.11.2 Superlkial relations of mylohyoid muscle.

2. Deep or above the mylohyoid it is in contact with the following (Fig. IA.(1.3): a. Hyoglossus
with its superficial relations, namely i. The styloglossus ii. The lingual nerve iii. The
submandibular ganglion iv. The deep part of the submandibular salivary and v. The
submandibular duct vi. The hrowdossal nerve
2. The cavernous sinus through the emissary veins and 3. The facial vein through the deep facial
vein. 0. 9. Pterygomenclibular raphe.
the interdigitation of fibres from two muscles, namely buccinator and superior pharyngeal
constrictors.
b. The genioslossus with its superficial relations, namely: i. The sublingual salivary gland ii. The
lingual nerve iii. The submandibular duct iv. The lingual artery v. The hypoglossal nerve 0.2.
Describe submandibular gland. Add a note on its Innervation.
Ans.
Submandibular salivary gland is one of the major salivary glands, situated in the anterior part of
the digastric triangle. The gland is about the size of a walnut and is roughly J-shaped. It is
indented by the posterior border of the **hyoid which divides it into a large part superficial to
the muscle that fills the digastric triangle and a small part lying deep to the muscle.
Superficial Part It has three surfaces, namely I. Inferior 2. Lateral 3. Medial surfaces. The gland is
partially enclosed between two layers of deep cervical fascia (Fig. 1A.11.4). The superficial layer
of fascia covers the inferior surface of the gland and is attached to the base of the mandible. The
deep layer covers the medial surface of the gland and is attached to the mylohyoid line of the
mandible. Superficially, the submandibular gland is crossed by the facial vein and sometimes by
the marginal mandibular branch of the facial nerve. The lame cuhmendihular lymnh
MYlena'Old Ine Deep lof lascia,„\ asrona Submandibular gland ' Submandbulat lona
Mandibular canal
structures in the infratcmporal fossa. 5. The inferior alveolar artery runs downwards and for-
Greater corns* of hYad Base et mandible 'Superb al lamina of fascia Fig. IA.11.4 Cervical fascia
covonng submandexaar gland.
Deep Part This part is smaller in sire and lies deep to the mylohyoid and superficial to the
hyoglossus and the styloglossus. Poste-riorly it is continuous with the superficial part around
the posterior border of the mylohyoid. Anteriorly it extends up to the sublingual gland.
Relations Superficial or the inferior surface of submandibular gland is covered by the following:
I. Skin 2. Piatysma 3. Cervical branch of the facial nerve 4. Deep fascia 5. Facial vein 6.
Submandibular lymph nodes. The lateral surface is related to the following: I. The
submandibular fosse on the mandible 2. Insertion of the medial pterygoid 3. The facial artery.
The medial surface may be divided into three parts:
General Anatomy
In the terminal part of its course, the duct lies immediately below the mucosa of the floor of the
mouth and opens at the sublingual caruncle or papilla just lateral to the frenulum.
Blood Supply and Lymphatic Drainage The blood supply is through the facial artery. The veins
drain into the common facial or lingual vein. Lymph passes to submandibnlar lymph nodes (Fig.
Ita.11.5).
Nerve Supply Submandibular gland is supplied by branches from the sub-mandibular ganglion.
These brandies convey the following: 1. Secretomotor fibres 2. Sensory fibres from the lingual
nerve 3. Vasomotor sympathetic fibres from the plexus on the facial artery. The secretomotor
pathway begins in the superior salivary nucleus. Preganglionic fibres pass through the sensory
root of the facial nerve, the geniculate ganglion, the facial nerve, the chords tympani and the
lingual nerve to reads the sub-mandibular ganglion. Postgattglionic fibres emerge from the
ganglion and enter the submandibular gland. Sympathetic fibres from the superior cervical
ganglion reads this gland either by the way of other nerves or along thevessels. Stimulation of
parasympathetic fibres produces watery secretion from these glands, while the stimulation of
sympa-thetic fibres is said to produce a viscid one.
ma\ilkeRt w Istatypta sm WI
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the floor of the mouth. The fibres of the chords tympani are also distributed thenteth the Itneeet
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0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.t. 0.6. Stylomandibular
ligament. Ans.
constrictors.
SHORT ESSAYS
0.1. Otic ganglion. Ans. 1. Otic ganglion is a peripheral parasympathetic ganglion that relays
secretomotor fibres to the parotid gland (Fig. IA.1 I.6). 2. Topographically, it is related to the
mandibular nerve, but functionally it belongs to glossopharyngeal nerve.
&undone, ganglion
Mknor pmts.! nerve

Owe ganglion Atylcuistemperal nerve
Parotid
TYmbrinit nerve Glossopharynpeal nerve
Fig. 1A.11.8 The °tic ganglion.
3. Sire and location: It is 23 mm in size and is situated just below the foramen ovale in the
infratemporal fossa. It lies medial to the mandibular nerve and lateral to the tensor veil malatini
0.2. Submandibular ganglion. Ans. I. This is a parasympathetic peripheral ganglion. It is a relay
station for secretomotor fibres to the submandibu-lar and sublingual salivary glands. 2.
Topographically it is related to the lingual nerve, but functionally it is connected to the chords
tympani branch of the facial nerve. 3. The fusiform ganglion lies on the hyoglossus muscle just
above the deep part of the submandibular salivary gland, suspended from the lingual nerve by
two roots. 4. The motor or parasympathetic fibres pass from the lingual nerve to the ganglion
through the posterior root. These are prcganglionic fibres that arise in the superior salivatory
nucleus and pass through the facial nerve, the chords tympani and the lingual nerve to reach the
ganglion. The fibres relay in the ganglion. Postganglionic fibres for the submandibular gland
reach the gland through five or six brandies from the ganglion (Fig. 14.11.7). 5. Postganglionic
fibres for the sublingual and anterior lingual glands re-enter the lingual nerve through the
anterior root and travel to the gland through the distal part of the lingual nerve. 6. The
sympathetic fibres are derived from theplexus around the facial artery. It contains
postganglionic fibres arising in the superior cervical ganglion. They pass through sub.
mandibular ganglion without relay and supply vasomotor fibres to the submandibular and
sublingual glands. 7. Sensory fibres reach the ganglion through the lingual nerve.
tympanic membrane. 3. The middle meningcal artery supplies more of bone and less of
meninges, V and VII nerves, middle ear and tensor tympani. 4. The accessory tneningeal artery
structures in the infratcmporal fossa. 5. The inferior alveolar artery runs downwards and for.
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0.3. Give the origin, insertion and nerve supply of digastric muscle.
Ans. The digastric muscle is one of the suprahyoid muscles containing two bellies united by an
intermediate tendon
Amato, belly or dgasuic muscle mylohyold muscle Mg.1A.11.8 Name muscle (origin and
insertion).
(Fig. IA.)I.8). Anterior belly runs downwards and back-wards whereas the posterior belly runs
downwards and forwards. Table 1A.11.2 gives an account of digastric muscle.
Table 1A.112 Retails SI Monroe muscle
1. Anterior Both heads I. Ante,* 1. DePressee,;* belly from meet at the belly by mandible
digastrIcs intermediate nerve to when mouth it fosse of tendon that mylohyold opened widely
mandible perforates 2. Posterior or against 2. Posterior SH and is belly by resistance; it is belly
from held by Me facial nerve secondary to mastoid hyoid bone lateral oterygoid notch of 2.
Elevates hyoid temporal bone bone
SHORT NOTES
0.1. OtIc ganglion.
Ans.
It is a peripheral parasympathetic ganglion that relays sec-retomotor fibres to the parotid gland.
It is 23 mm in size and is situated just below the foramen ovate in the infra-temporal fossa.
Topographically, it is intimately related to the mandibular nerve, but functionally it belongs to
the
Function: Supports and elevates the floor of oral cavity and depresses mandible when hyoid
bone is fixed. 0.4. Hyoglossus muscle. Ans.
Hyoglossus is a muscle of tongue (Fig. IA.11.9). See Table IA.II.3 for details.
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the floor of the mouth. The fibres of the chords tympani are also distributed thrnnui.,
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0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.t. 0.6. Stylomandibular
ligament. Ans.
vein. 0. 9. Pterygomandibular raphe.
constrictors.
General Anatomy
meninges, V and VII nerves, middle ear and tensor tympani. 4. The accessory tneningeal artery
1111 Quick Review Series: SOS Ist Year
Table 1A.11.3 The hroMossus muscle
PrIpin • Insertion Nerve supply Actions Whoie length Side of tongue Hyooglossal illnesses of
greater between style- (XII) nerve tongue. flakes cornea and glosses and dorsum convex, lateral
past of inferrer long:- retracts the pro. body of hyoid tudinal muscle traded tongue bone: fibres
of tongue run upwards and fonrards
Q.5. Submandibular duct. Ans. Submandibular duct or Wharton's duct is a thin-wallas duct,
about 5cm long. It arises from the anterior end of the deep part of the gland and runs forwards
on the hyoglossus, between the lingual and hypoglossal nerves. At the anterior border of the
hyoglossus, the duct is crossed by the lingual nerve. It opens on the floor of the mouth, on the
summit of the sublingual papilla and at the side of the frenulum of the tongue. 0.6.
Submandibular lymph nodes. Ans.
Topic 12
The submandibular lymph nodes are larger and more numerous than the submental. They form
a chain of three to eight nodes situated largely along the upper border of the submandibular
gland. Some of these nodes are constant. The largest and the most constant node is close to the
point at which the facial artery crosses the mandible. It is known as the Stahr's lymph node.
These nodes receive the efferent vessels from the buccal and mandibular nodes, along the facial
vein and artery, and therefore, drain a large part of the face either directly or indirectly. 0.7.
Relations of hyoglossus muscle. Ans. Relations of hyoglossus muscle are as follows: I.
Superficial: Styloglossus, lingual nerve, submandibular ganglion, deep part of the
submandibular gland, sub-mandibular duct, hypoglossal nerve and veins accompa-nying it 2.
Deep: (a) Inferior longitudinal muscle of the tongue, (1)) genioglossus, (c) middle constrictor of
the pharynx, (d)glossopharynseal nerve, (e) stylohyoid ligament and (f) lingual artery.
DEEP STRUCTURESAIME
LONG ESSAY
0.1. Thyroid gland.
Or
Describe the thyroid gland. Add a note on blood supply and histology.
persists as the pyramidal lobe. The gland becomes functional during third month of
development.
Parts The gland consists of right and left lateral lobes that are joined to each other by the
isthmus. A third, pyramidal, lobe may project upwards from the isthmus or from one of the
lobes. Accessory thyroid glands arc sometimes found as small detached masses of thyroid tissue
in the vicinity of the lobes or above the isthmus.
Situation and Extent I. The gland lies against vertebrae C5, C6, C7 and TI, embracing the upper
part of the trachea. 2. Each lobe extends from the middle of the thyroid cartilage to the fourth or
fifth tracheal ring. 3. The isthmus extends from the second to the fourth tracheal ring.
Dimensions and Weight Each lobe measures about 5 cm X 2.5 cm X 2.5 cm, and the isthmus 1.2
can X 1.2 cm; the gland weighs roughly about 25 g. However, it is larger in females than in maks,
and further increases in size during menstruation and pregnancy.
Capsules of Thyroid (Fig. 1A.12.1) t. The peripheral condensation of the connective tissue of the
gland forms the true capsule. A dense capillary plexus is present deep to the true capsule; hence
the thyroid is removed along with the true capsule during operations to avoid haemorrhage. 2.
The false capsule is derived from the pretracheal layer of the deep cervical fascia. It is thin along
posterior border of the lobes, but thick on the inner surface of the gland
rifICEC n 1V11113. a JUJ,...aus y ii,uatcm w. fu•• yl,
Lobed thyroid gland Capsule -- /Suspenacay ligament of Barry '_Ascending branch ntense
thyroid anery &manor parathyroid -NWeak part of capsule Fig. 1A.12.1 Capssda of thyroid.
Thyroid Gland and its Relations (Fig. 1A.12.2) The lobes are conical in shape having the
following: 1. An Abase 2. e 3. Three surfaces, lateral, medial and posterolateral 4. Mao borders,
anterior and posterior. The apex is directed upwards and slightly laterally. It is limited
superiorly by the attachment of the sternothyroid to the oblique line of the thyroid cartilage.
The base is on level with the fourth or fifth tracheal ring. The lateral or superficial surface is
convex and is covered by (a) the stertrohyoid, (b) the superior belly of the omohy-oid, (c) the
sternothyroid and (d) the anterior border of the sternocleidomastoid. The medial surface is
related to (a) trachea and oesophagus, ()) inferior constrictor and cricothyroid and (c) external
laryngeal and recurrent laryngeal nerve. The posterolateral or posterior surface is related to the
carotid sheath and overlaps the common carotid artery. The anterior border is thin and is
related to the anterior branch of the superior thyroid artery. The posterior border is thick and
rounded and separates the medial and posterior surfaces. It is related to (a) the in-ferior thyroid
artery, (b) the anastomosis between superior and inferior thyroid arteries. M the parathyroid
elands and
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the floor of the mouth. The fibres of the chords tympani are also distributed tkrnoeh rho
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0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.1. 0.6. Stylomandibular
ligament. Ans.
General Anatomy
Ana. The pterygomaodibular raphe is attached immediately behind the third molar tooth in
constrictors.
structures in the infratcmporal fosse. 5. The inferior alveolar artery runs downwards and for.
Arterial Supply (Fig. 1A.12.3) The thyroid gland is supplied by the superior and inferior thyroid
arteries. The superior thyroid artery is a branch of the external carotid artery. At the upper pole
of the lobe, it divides into anterior and posterior branches. The anterior brands descends on the
anterior border of the lobe and con-tinues along the upper border of the isthmus to anastomose
with its fellow of the opposite side. The posterior branch de-scends on the posterior border of
the lobe and anastomoses with the ascending branch of the inferior thyroid artery. The inferior
thyroid artery is a brands of the thyrocervi-cal trunk that arises from the subclavian artery. It
reaches the lower pole of the gland and gives off branches to adjacent structures. The artery
divides into 4-5 glandular branches that pierce the fascia separately to reach the lower part of
the gland. One ascending branch anastomoses with the poste-rior branch of the superior
thyroid artery and supplies the parathyroid glands.
of Interionr9thyroWPthanery Scalenus anterior Vertebral vessels Inferior throat artery

Transverse cervical arteryer laryngeal nerve -44,Iyalli:Tri. 'yroce'P"nocal. enuory !mesa
Subclevian anon/ cervical
&perks thyroid artery and vein Middle thyroid vest
rocenrual trunk Lea vague nerve Loft recurrent Laryngeal nerve F19.10.124 Venous drainage of
thyroid gland.
The middle thyroid vein is a short, wide channel which emerges at the middle of the lobe and
soon enters the inter-nal jugular vein. The inferior thyroid veins emerge at the lower border of
the isthmus. They form a plexus in front of the trachea and drain into the left brachiocephalic
vein. A fourth thyroid vein (of Kosher) may emerge between the middle and inferior veins and
drain into the internal jugular vein.
Lymphatic Drainage Lymph from the upper part of the gland reaches the upper deep cervical
lymph nodes either directly or through the urelarmaeal nodes. Lymph from the tower neer of
she eland
drains to the lower deep cervical nodes directly and also through the pretracheal and
paratracheal nodes.
Applied Anatomy I. Remnants of the thyroglossal duct may form thyroglossal cysts or a
thyroglossal fistula. 2. Any swelling of the thyroid gland (goitre) moves with deglutiton. 3.
Hypothyroidism causes • cretinism in infants and my:oedema in adults.
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4. Benign tumours of the gland may displace and even compress neighbouring structures like
the carotid sheath, the trachea, etc. 5. Malignant growths tend to invade and erode neighbour-
ing structures. Pressure symptoms and nerve involve-ment are common in carcinoma of the
glands.
SHORT ESSAYS
0.1. Scalenus anterior muscle. Or Give the origin, insertion and superficial relations of scalenus
anterior muscle.
Ans. There are three scalene muscles: t. The scalenus anterior 2. The scalenus medius 3. The
scalenus posterior. The scalenus anterior is a key muscle of the lower part of the neck because
of its intimate relations to many important structures in this region. It is described in Table
IA.12.I. Relations of scalenus anterior are as follows (Pig. IA.12.5): Anteriorly, the muscle is
covered by sternocleidomastoid deep to this and on the scalenus anterior lie the following
structures:
Anteriorly: I. Phrenic nerve
Ansonor tubercle of transverse process
Sternocloidernastoid
Scolerus
anterior
Clavicle
Sutulavian vain First nb Second rib"
Transverse process or atlas

—Transverse process of axis
Lawlor scripuLae ra "rnedius Sisalenus fig Salons Posterkir . f tilh . 4 .4.1 A. Scapula 0/ Levier
trunks brachial plexus Sublavlen Wag
1119.1A.12.6 Relations of salons anterior muscle.
8. Subclavian vein 9. Branches of superior thyroid and supraseapubr arteries 1111 rtnr.ele
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the floor of the mouth. The fibres of the chords tympani are also distributed tkrnoeh rho
Roo., .......
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0.5. Muscles of mastication. Ans. Refer to the answer of Long Essays Q.1. 0.6. Stylomandibular
ligament. Ans.
General Anatomy
Ana. The pterygomaodibular raphe is attached immediately behind the third molar tooth in
constrictors.
structures in the infratcmporal fosse. 5. The inferior alveolar artery runs downwards and for.
Arterial Supply (Fig. 1A.12.3) The thyroid gland is supplied by the superior and inferior thyroid
arteries. The superior thyroid artery is a branch of the external carotid artery. At the upper pole
of the lobe, it divides into anterior and posterior branches. The anterior brands descends on the
anterior border of the lobe and con-tinues along the upper border of the isthmus to anastomose
with its fellow of the opposite side. The posterior branch de-scends on the posterior border of
the lobe and anastomoses with the ascending branch of the inferior thyroid artery. The inferior
thyroid artery is a brands of the thyrocervi-cal trunk that arises from the subclavian artery. It
reaches the lower pole of the gland and gives off branches to adjacent structures. The artery
divides into 4-5 glandular branches that pierce the fascia separately to reach the lower part of
the gland. One ascending branch anastomoses with the poste-rior branch of the superior
thyroid artery and supplies the parathyroid glands.
of Interionr9thyroWPthanery Scalenus anterior Vertebral vessels Inferior throat artery

Transverse cervical arteryer laryngeal nerve -44,Iyalli:Tri. 'yroce'P"nocal. enuory !mesa
Subclevian anon/ cervical
&perks thyroid artery and vein Middle thyroid vest
rocenrual trunk Lea vague nerve Loft recurrent Laryngeal nerve F19.10.124 Venous drainage of
thyroid gland.
The middle thyroid vein is a short, wide channel which emerges at the middle of the lobe and
soon enters the inter-nal jugular vein. The inferior thyroid veins emerge at the lower border of
the isthmus. They form a plexus in front of the trachea and drain into the left brachiocephalic
vein. A fourth thyroid vein (of Kosher) may emerge between the middle and inferior veins and
drain into the internal jugular vein.
Lymphatic Drainage Lymph from the upper part of the gland reaches the upper deep cervical
lymph nodes either directly or through the urelarmaeal nodes. Lymph from the tower neer of
she eland
drains to the lower deep cervical nodes directly and also through the pretracheal and
paratracheal nodes.
Applied Anatomy I. Remnants of the thyroglossal duct may form thyroglossal cysts or a
thyroglossal fistula. 2. Any swelling of the thyroid gland (goitre) moves with deglutiton. 3.
Hypothyroidism causes • cretinism in infants and my:oedema in adults.
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4. Benign tumours of the gland may displace and even compress neighbouring structures like
the carotid sheath, the trachea, etc. 5. Malignant growths tend to invade and erode neighbour-
ing structures. Pressure symptoms and nerve involve-ment are common in carcinoma of the
glands.
SHORT ESSAYS
0.1. Scalenus anterior muscle. Or Give the origin, insertion and superficial relations of scalenus
anterior muscle.
Ans. There are three scalene muscles: t. The scalenus anterior 2. The scalenus medius 3. The
scalenus posterior. The scalenus anterior is a key muscle of the lower part of the neck because
of its intimate relations to many important structures in this region. It is described in Table
IA.12.I. Relations of scalenus anterior are as follows (Pig. IA.12.5): Anteriorly, the muscle is
covered by sternocleidomastoid deep to this and on the scalenus anterior lie the following
structures:
Anteriorly: I. Phrenic nerve
Ansonor tubercle of transverse process
Sternocloidernastoid
Scolerus
anterior
Clavicle
Sutulavian vain First nb Second rib"
Transverse process or atlas

—Transverse process of axis
Lawlor scripuLae ra "rnedius Sisalenus fig Salons Posterkir . f tilh . 4 .4.1 A. Scapula 0/ Levier
trunks brachial plexus Sublavlen Wag
1119.1A.12.6 Relations of salons anterior muscle.
8. Subclavian vein 9. Branches of superior thyroid and supraseapubr arteries 1111 rtnr.ele
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continues along the upper border of the isthmus to anasto-Mese with its fellow of the opposite
side. The posterior branch descends on the posterior border of the lobe and anastomoses with
the ascending branch of the inferior thyroid artery. The inferior thyroid artery is a branch of the
thyrocervi-cal trunk which arises from the subclavian artery. It reaches the lower pole of the
gland and gives off branches to adja-cent structures. The artery divides into 4-5 glandular
branches which pierce the fascia separately to reach the lower part of the gland. One ascending
branch anastomoses with the posterior branch of the superior thyroid artery and supplies the
parathyroid glands. The superior thyroid artery supplies the upper one-third of the lobe and the
upper half of the isthmus and that the inferior thyroid artery supplies the lower two-thirds of
the lobe and the lower half of the isthmus. Sometimes, the thyroid is also supplied by the lowest
thy-roid artery (thyroidea iota artery) which arises from the brachiocephalk trunk or directly
from the arch of the aorta. Accessory thyroid arteries arising from tracheal and oe-sophageal
arteries also supply the thyroid. Venous Drainage The superior, middle and inferior thyroid
veins drain the thyroid gland. The superior thyroid vein which emerges at the upper pole ends
either in the internal jugular vein or in the common facial vein. The middle thyroid vein is a
short, wide channel which emerges at the middle of the lobe and soon enters the inter-nal
jugular vein. The inferior thyroid veins emerge at the lower border of the isthmus. They form a
plexus in front of the trachea, and drain into the left brachioccphalic vein.
A fourth thyroid vein (of Kosher) may emerge between the middle and inferior veins and drain
into the internal jugular vein. 0.3. Styloid process of temporal bone. Ans. The styloid process is a
long, slender and pointed bony pro-cess projecting downwards, fonvards and slightly medially
from the temporal bone (Fig, IA.12.6). It descends between the external and internal carotid
arteries to reach the side of the pharynx. It is interposed between the parotid gland later-ally
and the internal jugular vein medially. The styloid process with its attached structures is called
the styloid apparatus. The structures attached to the process are the stylohyoid, styloglossus
and stylopharyngeus muscles, and the stylohyoid and stylomandibular ligaments. The five
attachments resemble the reins of a chariot.
Flg.1A.12.6 Stylord process.

The apparatus is of diverse origin: The styloid process and the stylohyoid ligament and muscle
are derivatives of the second branchial arch, the stylopharyngeus is derived front the third arch
and the styloglossus from occipital myotomes.
SHORT NOTES
0.1. Oesophagus. Ans. The oesophagus is a muscular food passage, about 25 on in length. It is a
downward continuation of the pharynx begin--l^g a: he letvcr border of the t:ikoki taiiiilage mai
p.aes downwards behind the trachea, traverses the superior and pos-terior mediastinum of the
thorax and ends by opening into the cardiac end of the stomach in the abdomen (Fig. IA-12.7).
0.2. Thyroid gland. Ans. I. 'the thyroid gland is an endocrine gland, situated in the lower part of
the front and sides of the neck against
Airway Laryngeal Wet Emionis Vocal cads Thyroid caning° Grimm cartilva Trachea
11
-Laryngop,arynx War. mon Iistor muscle
—Oesophagus
Flg. 1A.12.7 Oesophagus.
vertebrae C5, C6, C7 and 'I'1 embracing the tapper part of the trachea. 2. On an average the
gland weighs about 25 g. 3. The gland consists of right and left lobes joined to each other by the
isthmus. A third, pyramidal, lobe may project upwards from the isthmus. Functions of thyroid
gland: I. Regulates the basal metabolic rate. 2. Stimulates somatic and psychic growth. 3. Plays
an important role in calcium 'metabolism. 0.3. Stylold process.
Ans. I. The styloid process is a long, slender and pointed bony process projecting downwards,
forwards and slightly medially from the temporal bone. 2. It descends between the external and
internal carotid arteries to reach the side of the pharynx. 3. It is interposed between the parotid
gland laterally and the internal jugular vein medially. Q.4. Accessory nerve. Ans. 1. Accessory
nerve is the XI cranial nerve. It has two roots, cranial and spinal. The cranial root is accessory to
the sagas and is distributed through the branches of the latter (Fig, IA.12.8). The spinal root has
a more inde-pendent course. 2. The cranial root is special visceral (bronchial) efferent, arises
from the lower part of the nucleus ambiguus and is distributed through the branches of the
vagus to the muscles of the palate, the pharynx, the larynx and possibly the heart.
Leveler scapulae Superficial branch of transverse cervical angry Accessory nerve (XI)
Rhomboid minor
Memo., majo.
Flg.1A.12.8 The accessory nerve (XI cranial nerve).
3. The spinal root is also special visceral efferent. It arises from a long spinal nucleus situated in
the lateral part of the anterior grey column of the spinal cord extending between segments Cl to
C5. Its fibres supply the sterno-cleidomastoid and the uapezius muscles. Thyroglossal duct. Ans.
1. The thyroid develops from a median endodermal thy-roid diverticulum which grows down in
front of the neck front the floor of the primitive pharynx. 2. The lower end of the diverticulum
enlarges to form the gland. The rest of the diverticulum remains narrow and is known as the
thyroglossal duct. 3. Most of the duct soon disappears; the position of the upper end Its marked
by the foramen caecum of the tongue. and the lower end often persists as the pyramidal lobe.
0.8. Stylohyold ligament. Ans. The stylohyoid ligament extends from the tip of the styloid
process to the lesser cornu of the hyoid bone. It is derived form second branchial arch. 0.7.
Recurrent laryngeal nerve. Or Recurrent laryngeal nerve of right side. Or Recurrent laryngeal
nerve in the neck. Ans. I. Right and left recurrent laryngeal nerves are the branches of vagus
nerve (Fig. 1A.12.9).
Fig. 1A.12.9 Recurrent laryngeal nerve.

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2. The right recurrent laryngeal nerve arises from the va-gue in front of the right subclavian. 3.
It supplies the following: a. All intrinsic muscles of the larynx, except the crko-thyroid. b.
Sensory nerves to the larynx below the level of the vocal cords. c. Cardiac branches to the deep
cardiac plexus. d. Branches to the trachea and oesophagus. e. To the inferior constrictor. 4. The
left recurrent laryngeal nerve arises form the ragas in the thorax. Rs distribution is similar to
that of the right nerve. 0.8. Jugulodigastric lymph node. Ana. The jugulodigastric node is a
member of the anterosuperior group of cervical lymph nodes. It lies below the posterior belly of
the digastric, between the angle of the mandible and the anterior border of the
sternocleidomastoid. It is the main node draining the tonsil 0.9. Isthmus of thyroid ligament.
Ans. I. The isthmus of thyroid connects the lower parts of the two lobes. 2. It has (A) Two
surfaces: a anterior surface and b. posterior surface: (8) Two borders: a. superior border and b.
inferior border. 3. The anterior surface is covered by a. the right and left sternothyroid and
sternohyoid muscles, b. the anterior jugular veins and c. fascia and skin. The posterior surface is
related to the second to fourth tracheal rings. 4. The upper border is related to the anastomosis
between the right and left superior thyroid arteries. 5. At the lower border, inferior thyroid
veins leave the gland. Occasionally. the isthmusis absent. 0.10. Blood supply of thyroid gland.
Ans. Thyroid gland is highly vascular. Arterial supply of thyroid gland is by the following: I.
Superior thyroid artery
2. Inferior thyroid artery 3. Arteria thynuidea knit
Superior Thyroid Artery Superior thyroid artery is the first branch of external carotid artery. It
divides into branches along the upper pole of the gland and supplies: I. Lobe of thyroid gland. 2.
A brands to anastomose with the artery of the opposite side. 3. A branch to supply lower part of
pyramidal lobe. Inferior Thyroid Artery Inferior thyroid artery is a branch of thyrocervical trunk
of subclavian artery. It passes deep to the common carotid artery and reaches the posterior
surface of the thyroid lobe. Arteries supplying trachea and oesophagus are also supplying the
thyroid gland. So when all thyroid arteries arc ligated, the gland gets its blood supply through
the tracheal and oesophageal arteries.
Arteria Thyroidea IMA (Neubauer's Artery) The artery is occasionally present. It usually arises
from the arch of aorta, rarely it may arise from the brachiocephalic artery. It runs upwards in
the midline of neck to the isthmus of the gland. 0.11. Formation of Internal jugular vein.
Or Formation and termination of internal jugular vein. Ans. Internal jugular vein is the largest
vein of the head and neck which drains venous blood from the brain and most struc-tures of the
head and neck. Development The anterior cardinal vein. Commencement The vein commences
at the lower border of the jugular foramen as the downward continuation of the sigmoid sinus.
Course It passes downwards and medially within the neck. It is found within the carotid sheath.
It teaches the level of medial end of the clavicle. Tc.r—tariaa: It cud. by joining the subclavian
vein to term the brachiocephalk vein behind medial end of the clavicle. 0.12. Name any four
structures related to medial surface of thyroid gland. Ans.
The medial surface of thyroid is related to the following: i. Two tubes, trachea and oesophagus.
2. Two muscles, inferior constrictor and cricothyroid. ;. Teo nerves. external laryngeal and
recurrent laryngeal. 0.13. Name any four structures attached to the styloid process.
Ans. The structures attached to the styloid process are as follows: 1. The stylohyoid,
styloglossus and stylopharyngeus muscles 2. The stylohyoid and stylomandibular ligaments.
Topic 13
PRONOUN=
SHORT ESSAY
0.1. Atlanto-occipital joint. Ans. I. Atlanto-occipital joint is a synovial joint of the ellipsoid
variety. It articulates above with the occipital condyles and below with the superior articular
facets of the atlas vertebra. 2. The ligaments of the atlanto-occipital joint are as follows: a The
fibrous capsule (capsular ligament) surrounds the joint. It is thick posterolaterally and thin
anteromedially. b. The anterior atlanto-occipital membrane extends from the anterior margin of
the foramen magnum above to the upper border of the anterior arch of the atlas below. laterally,
it is continuous with the anterior part of the capsular ligament, and anteriorly, it is strengthened
by the cordlike anterior longitudinal ligament. c. The posterior atlanto-occipital membrane
extends from the posterior margin of the foramen magnum above to the upper border of the
posterior arch of
the atlas below. Laterally. it is continuous with the posterior part of the capsular ligament.
Arterial and Nerve Supply The joint is supplied by the vertebral artery and by the first cervical
nerve. Movement= They are ellipsoid joints and permit move-ments around two axes. Flexion
and extension (nodding) occur around a transverse axis. Slight lateral flexion is permitted
around an anteroposterior axis. a. Flexion is brought about by the longus capitis and the rectos
capitis anterior muscles. b. Extension is done by the rectos capitis posterior major and minor,
the obliques capitis superior, the semispina-lis capitis and the upper part of the traperius. c.
Lateral bending is produced by the rectos capitis, the semispinalis capitis, the spknius capitis,
the sterno-cicidomastoid and the trapexius.
SHORT NOTES
0.1. Atlantoaxial Joint. Ans. Atiantoaxial joint consists of the following: 1. A pair of lateral
atlantoaxial joints between the inferior facets of the alias and the superior fie4ts of the ark..
These are plane joints. 2. A median atlantoaxial joint between the dens (odontoid process) and
the anterior arch and transverse ligament of the atlas. It is a pivot joint. The joint has two
separate synovial cavities—anterior and posterior.
3. Movement= The three joints exhibit rotatory move-ments that take place around a vertical
axis. The rotatory movements are brought about by the obliques capitis inferior, the rectos
capitis posterior major and the splenius capitis of one side, acting with the sternocleido-r.stoid
of the opposlie <Mc 0.2. Vertebral artery. Ans. Vertebral artery arises from the first part of the
subclavian artery and ends in the cranial cavity by supplying the brain.
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General Anatomy
AIR
It is one of the two principal arteries which supply the brain and is divided into four pares. It
supplies brain, spinal cord, the meninges, the surrounding muscles and bones Branches of
vertebral artery are as follows: I. In the nedc a. Cervical spinal branches b. Muscular branches to
deep muscles of the neck
Pm" 4. in the lower part the styloglossua and 5. the glossopharyngeal nerve. Still more laterally
there is facial artery with its tonsillar and ascending palatine branches. The internal carotid
artery is 2.5 ens posterolateral to the tonsil. The anterior bonier is related to the palatoglossal
arch with its muscle. 'rhe posterior border is related to the palatopharyngeal arch with its
muscle. The upper pole 4 related to the soft pal-ate, and the lower pole, to the tongue. The plies
triangularis is a triangular vestigial fold of mu-cous membrane covering the anteroinferior part
of the ton. sil.The plica semilunaris is a similar semilunar fold that may cross the upper part of
the tonsillar sinus. The intratousillar deft is the largest crypt of the tonsil. It is present in its
upper part. It is sotnetimes wrongly named the supratonsillar fosse. The mouth of the cleft is
semilunar in shape and parallel to the dorsum of the tongue. It repre-sents the internal opening
of the second pharyngeal pouch. A peritonsillar abscess or quinsy often begins in this deft.
2. Cranial branches a. Meningeal branches b. The posterior spinal artery c. The anterior spinal
artery d. The posterior inferior cerebellar artery e. Medullary arteries.
Topic 14
MOUTH AND
LONG ESSAYS
0.1. Describe anatomy of the palatine tonsil. Give Its surgical importance.
Or Give an account of the position, relations, blood supply and development of palatine tonsil.
Add a note on Its applied anatomy.
Or Give an account of the position, relations and blood supply of palatine tonsil. Add a note on
development. Ans. The palatine tonsil is an almond-shaped lymphoid tissue that occupies the
tonsillar fossa between the palatoglossal and palatopharyngeal arches visible through the
mouth (Fig. 1A.19.1). The palatine tonsil has-. • Two surfaces—medial and lateral, • Two
borders—anterior and posterior and • Two poles—upper and lower.
The medial surface is covered by stratified squamous epi-thelium continuous with that of the
mouth. It contains about 12-15 tonsillar crypts. The largest of these is called the intmtonsillar
deft. The lateral surface is covered by a sheet of fascia which forms the capsule of the tonsil. The
capsule is an extension of the pharyngobasilar fascia. It is only loosely attached to the muscular
wall of the pharynx, but anteroinferiorly the capsule is firmly adherent to the side of the
tongue.This firm attachment keeps the tonsil in place during swallowing. lust behind the firm
attachment, the tonsillar artery enters the tonsil by piercing the superior constrictor. The
palatine vein or external palatine or paratonsillar vein descends from the palate in the loose
areolar tissue on the lateral surface of the capsule, and crosses the tonsil before piercing the
wall of the pharynx. The vein may be injured during removal of the tonsil or tonsillectomy. The
bed of the tonsil is formed from by: 1. the pharyngobasilar fascia, 2. the superior constrictor and
palatopharyngeus muscles, I. the buccopharyngeal fascia,
Tours lobelias
Arterial Supply of Tonsil (Fig. 1A.14.2)
•
*kW
Lymphatic Drainage Lymphatics drain to the jugulodigastric node. Nerve supply:

Glossopharyngeal and lesser palatine nerves.
HIStolegy The palatine tonsil is situated at the oropharyngeal isthmus. Its oral aspect is covered
with stratified squamous non-keratinized epithelium, which dips into the underlying tissue to
form the crypts. The lymphocytes lie on the sides of the crypts in the form of nodules.
Development The epithelium over the tonsil develops from ventral part of second pharyngeal
pouch. The lymphocytes are mesodermal in origin. 0.2. Describe external features, muscles,
nerve supply and blood supply of soft palate. Ans. Soft palate is a movable, muscular fold,
suspended from the posterior border of the hard palate which separates the nasopharynx from
the oropharynx (Fig. 1A.14.3).
Supeatcia temporal
Omelet. estate.
Palatine tonsil Tonsillar branches
Ascending pharyngeal Asconcing pakten° Faciai. Ling.& — External carotid Fig. 1A.14.2 Arterial
supply of the palatine tonsil.
Caos•• mammal le.'

—Dorsal linguae
Pharyngeal recesses Torus Sena5ele6
Saltangepheryngael foal Orepharyngeal isthmus Lague! torsi
• Tana luDaeue Sets WOO VatectiO0 (antanor to epiglottis) Palatine toned PalifloPhanP9.1e''
t0550 Laryngeal flier
Oaeophague
Pharyngeal tonsil Pharyngeal recess Torus lavaton. (kids ovanyIng !wafer yell peat/ a) Fold
overlying MialaPharYngoal sphincter S ea!nrp h a ris Palatine tonsil Palatophorrgool arch
(evetiles paletoPheantattoe muscle) Laryngeal net Trachea Oesettnagae
Nasal Cavity
Feereressessi reason of orrensmesal isthmus)

Tongue Lingual tonsils Valocola
Fig. IA.14.1 The palatine tonsil
Tonsil has rich blood supply derived from the following I. The facial artery (tonsillar branch) is
the main source of arterial supply of tonsiL 2. Other sources are as follows: a. Ascending
palatine branch of facial artery b. Dorsal lingual branches of the lingual artery c. Ascending
pharyngeal branch of the external carotid artery d. The greater palatine branch of the maxillary
artery.
Venous Drainage One or more veins leave from the lower part of the deep surface of the tonsil,
pierce the superior constrictor and join the palatine, pharyngeal or facial wins.
Fig. 1A.14.3 The soft palate
It has two surfaces, anterior and posterior. The anterior (oral) surface is concave and is marked
by a median raphe. The posterior surface is convex and is continuous with the floor of the nasal
cavity superiorly. It has two borders—superior and inferior. The superior border is attached to
the posterior border of the hard palate, blending on each side with the pharynx. The inferior
border is free and binds the pharyngeal isthmus; a conical projec-tion hanging from its middle is
called the uvula. From each side of the base of the uvula, two curved folds of mucous membrane
extend laterally and downwards. The anterior fold is called the palatoglossal arch or anterior
pillar of flumes. It contains the palatoglossus muscle and reaches the side of
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the tongue at the junction of oral and pharyngeal parts. This fold forms the lateral boundary of
the oropharyngeal isth-mus or isthmus of farces. The posterior fold is called the
palutopharyngeal arch or posterior pillar of fauns. It contains the palatopharyngeal muscle
andlorms the posterior bound-ary of the tonsillar fosse and merges inferiorly.with the lat-eral
all of the pharynx. The parts of soft palate are as follows: The palatine aponeurosis which is the
flattened tendon of the tensor veli palatini forms the fibrous basis of the palate. Near the median
plane the aponeurosis splits to enclose the museums uvulae. The levator veli palatini and the
palato-pharyngeus lie on the superior surface of the palatine apo-neurosis. The palatoglossus
lies on the inferior surface of the palatine aponeurosis. The muscles of the soft palate are as
follows: (Fig. IA.14.4): I. Tensor palati (tensor veil palatini) 2. Levator palati (levator veli
palatini) 3. Musculus uvulae 4. Palatoglossus 5. Palatopharyngeus. Muscles of the soft palate are
summarized in Table IA.14.1. Passavam's ridge: Some of the upper fibres of the palato-
pharyngeus pass circularly deep to the mucous membrane of the pharynx, and form a sphincter
internal to the superior constrictor. These fibres constitute Pa.ssavant's muscle which on
contraction raises a ridge called the Passavanes ridge on the posterior all of the nasopharynx.
When the soft palate is elevated it comes in contact with this ridge, the two together dosing the
pharyngeal isthmus between the nasopharynx and the oropharynx.
Table 1A.14.1 Summary of muscles of soft palate
Fig. 1A.14.4 Muscles of the soft palate.

Nerve Supply I. Motor nerves: All muscles of the soft palate except the tensor veli palatini are
supplied by the pharyngeal plexus. The fibres of this plexus are derived from the cranial part of
the accessory nerve through the vagus. The tensor yeli palatini is supplied by the mandibular
nerve. 2. General sensory nerves are derived from (a) the middle and posterior lesser palatine
nerves, the branches of the maxillary nerve and (b) from the glossopharyngeal nerve. 3. Special
sensory or gustatory nerves carrying taste sensa-tions from the oral surface arc contained in the
lesser palatine nerves. The fibres pass through the greater pe-trosal nerve to the geniculate
ganglion of the facial nerve and from there to the nucleus of the solitary tract.
MEM
Tensor yell 1. Lateral side of auditory tube palallni 2. Adorning part of the base of the skull
(greater wing and scaphold fosse of sphenoid bone)
Legator yell 1. Inferior aspect of auditory tube paraffin 2. Adjoining part of inferior surface of
wham temporal bone Musculus Posterior nasal spine and palatine uVutae aponeurom
Palatoglossus Oral surface of palatine aponeurosrs
Palatopharyn- 1 Anterior fascrculus pens 2. Posterior fasciculus
Muscle descends, and flattens out to form the pala-tine aponeurosis which Is attached to the
following: 1. Posterior border of hard palate 2. Inferior surface of palate behind the patentee
crest
Muscle is inserted into the upper surface of the palatine aponeurosis
Mucous membrane of uvula
Descends in the palatoglossal arch. to the side of the tongue at the junction of Isthmus its oral
and pharyngeal pails It is inserted into the folleuving-I. Posterior border of the lamina of Me
thyroid cartilage 2. Woe of tne pharynx and Its median rapine ,
1. Tightens the anterior pan soft palate 2. Equalizes air pressure ;:t between the middle ear and
the nasopharynx 1 Elevates soft palate and closeel the phaivngell isthmus 2. Opens the auditory
tube Puns uo the mum
Closes the oropharyngeal
• Shortens pharynx during Swallowing.
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4. Secreromotor nenrs are also contained in the lesser palatine nerves. They are derived from
the superior salivatory nucleus and travel through the greater petrosal nerve. Movements and
Functions of the Soft Palate The palate controls both the pharyngeal and the oropharyn. seal
isthmus. Through these movements the soft palate plays an important role in chewing,
swallowing, speech, coughing, sneezing, etc. A few specific roles are as follows: I. It isolates the
mouth from the oropharynx during chew-ing, so that breathing is unaffected. 2. It separates the
oropharynx from the nasopharynx dur-ing the second stage of swallowing, so that food does not
enter the nose. 3. By varying the degree of closure of the pharyngeal isth-mus, the quality of
voice can be modified and various consonants correctly pronounced. 4. During sneezing, the
blast of air is appropriately divided and directed through the nasal and oral cavities without
damaging the narrow nose. Similarly during coughing it directs air and sputum into the mouth
and not into the nose.
Blood Supply Arteries I. Greater palatine branch of maxillary artery. Ascending palatine branch
of facial artery. 2. Palatine branch of ascending pharyngeal artery.
Veins They pass to the pterygoid and tonsillar plexuses of veins. Lymphatics Lymphatics drain
into the upper deep cervical and retro-pharyngeal lymph nodes. Development of palate The
premaxilla or primitive is formed by the fusion of me-dial nasal folds; the rest of the palate is
formed by the shelf-like palatine processes of maxilla and horizontal plates of palatine bone.
Most of the palate gets ossified to form the hard palate. The unossificd posterior part of fused
palatal process forms the soft palate. Soft palate comprises epithelium, connective tissue and
muscles. Epithelium is from the ectoderm of maxillary process. The muscles are derived from
first, fourth and sixth bronchial arches and accordingly are innervated by 111,1m-fibular and
vagoacLc.or v complex.
SHORT ESSAYS
0.t Oropharynx. Ans. Oropharynx is the middle part of the pharynx situated behind the oral
cavity. Superiorly, it communicates with the nasopharynx through the pharyngeal or
nasopharyngeal isthmus. In front, it communicates with the oral cavity through the
oropharyngeal isthmus or isthmus of fames. Below, it opens into the laryngopharynx at the level
of the upper border of the epiglottis. Behind, it is supported by the body of the axis vertebra and
the upper part of the body of the third cervical vertebra. Its lateral all pres-ents the palatine
tonsil which lies in the tonsillar fossa. This fosse is bounded anteriorly by the palatoglossal arch,
and posteriorly by the pahtopharmeal arch The puterior wall of the oropharynx is formed
posteriorly by the supe-rior, middle and inferior constrictors of the pharynx (Fig. IA.14.5).
There are several aggregations of lymphoid tissue that constitute Waldeyer's lymphalk ring in
telation to the ore-pharyngeal isthmus. The most important aggregations are the right and left
palatine tonsils. Posteriorly and above, there is the pharyngeal tonsil; laterally and above, there
are
Flg.1A-14.5 Divisions of pharynx.

the tubal tonsils and inferiorly, there is the lingual tonsil over the posterior part of the dorsum
of the tongue. 0.2. Describe the features of the lateral wall of nasopharynx. Ans.

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The lateral wall of the nasopharynx presents the following features: I. The pharyngeal opening
of the auditory tube, at the level of the inferior nasal concha. 2. The tubal opening bounded by
the tubal elevation. 3. The salpingopharyngeal fold: A vertical fold of mucous membrane
running downwards from the posterior
General Anatomy
margin of the tuba! elevation and gradually fading on the side wall of the pharynx. 4. The levator
veil palatine. 5. Behind the tubal elevation, there is a narrow vertical slit that leads into the
pharyngeal recess or lateral recess, or fosse of Rosenmuller.
SHORT NOTES
0.1. Soft palate Ans. Soft palate is a movable, muscular fold, suspended from the posterior
border of the hard palate. It separates the nasopharynx from the oropharym, and is often looked
upon as traffic controller between the food and air passages. The soft palate has two surfaces—
anterior and posterior, and two borders—superior and inferior. 0.2. Nasopharynx. Ans. The
cavity of the pharynx is divided into: I. The nasal part, nasopharynx 2. The oral part, oropharynx
3. The laryngeal part, laryngopharynx. Nasal part of pharynx (nasopharynx) is the upper part of
the pharynx situated behind the nose, and above the lower border of theaall palate. It resembles
the nose both structurally as well as functionally; it is respiratory in function. Its walls are rigid
and non-collapsible, so that the air passage is kept patent. It is lined by ciliated columnar
epithelium. Its mucous mem-brane is supplied by the pharyngeal branch of pterygopalatine
ganglion suspended by maxillary branch of trigeminal nerve. 0.3. Palatine tonsil.
Ans.
The palatine tonsil occupies the tonsillar sinus or fossa be-tween the palatoglossal and
palatopharyngeal arches. It can be seen through the mouth. It is almond-shaped lymphoid tissue
collection and has two sulfases mcdial and lateral; two bor-ders, anterior and posterior and two
poles, upper and lower. 0.4. Muscles of soft palate. Ans. Muscles of the soft palate are as follows:
I. Tensor palati (tensor veli palatini) 2. Levator paled (levator veli palatini) 3. Musculus uvulae 4.
Palatoglossus 5. Palatopharyngeus.
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0.5. Tensor palatine muscle. Ans. Tensor veli palatini is a thin, triangular muscle. Origin I. Lateral
side of auditory tube. 2. Adjoining part of the base of the skull (greater wing and scaphoid fossa
of sphenoid bone).
Insertion Muscle descends, converges to form a delicate tendon which runs around the
pterygoid hamulus, passes through the origin of the buccinator, and flattens out to form the
palatine aponeurosis which is attached to: 1. Posterior border of hard palate. 2. Inferior surface
of palate behind the palatine crest.
Functions 3. Tightens the soft palate, chiefly the anterior part. 4. Opens the auditory tube to
equalize air pressure between the middle ear and the nasopharynx. 0.6. Pharyngobasilar fascia.
Ans. The pharyngobasilar fascia forms the bed of the tonsil. The posterior borer of medial
pterygoid plate gives attachment for pharyngobasilar fascia. 0.7. Pharyngotympanic tube.
Ans. Pharyngotympanic tube is the communicating passage between the middle ear and
nasopharynx and is directed downwards, forwards and medially. It balances the pressure inside
the middle ear with that of the external atmosphere. Length: About 3.6 cm long. In infants the
tube is shorter, wider and more horizontal. Diru-sian: Downwards, forwards and medially.
Aim Cartilaginous part, anterior two-third. Bony part, posterior one-third. The bony part
commences in the anterior wall of the middle ear and terminates at the junction of the
squamous and petrous part of the temporal bone. It is somewhat oval at cross-section. The
junction between the bony and cartilaginous part is known as the isthmus. 0.8. Lymphatic
drainage of tonsil. Ans. Lymphatics from the tonsil pass to the jugulodigastric node. 0.9.
Superior constrictor of pharynx. Ans.
Posfuon of palMoOoryngoal sphnctat on deep surInco or superior constwor
The muscular wall of the pharynx is formed mainly by the three pairs of constrictors superior,
middle and inferior. The superior constrictor takes origin from the following: I. Pterygoid
hamulus. 2. Pterygomandibular raphe. 3. Medial surface of the mandible at the posterior end of
the mylohyoid line, i.e. near the lower attachment of the pterygomandibular raphe. 4. Side of
posterior part of tongue. All the constrictors of the pharynx are inserted into a median raphe on
the posterior wall of the pharynx. 0.10. List the lymphatic nodules in Waldeyer's ring. Ans. In
relation to the oropharyngeal isthmus, there are several ag-gregations of lymphoid tissue that
constitute Waldeyer's lym-phatic ring. The most important aggregations are the right and left
palatine tonsils usually referred to simply as the tonsils. Pos-teriorly and above, there is the
pharyngeal tonsil; laterally and above, there arc the tubal tonsils, and inferiorly, there is the lin-
gual tonsil over the posterior part of the dorsum of the tongue. 0.11. Enumerate four relations of
constrictor muscle of pharynx. Ans. The three pairs of muscles of pharynx, namely, superior,
middle and inferior constrictors form the muscular wall of pharynx (Pig. IA.14.6). They are so
arranged that the inferior overlaps middle which in turn overlaps the superior. Relations of
constrictor muscles of pharynx are as follows: 1. Structures lying deep to the inferior border of
inferior constrictor are: a. Recurrent laryngeal nerve b. Inferior laryngeal vessels. 2. Structures
passing between the superior and middle constrictor are: a. Glossopharyngcal nerve b.
Stylopharyngeus muscle.
Flg.1A.14.6 Constrictor muscles of pharynx.
3. Structures passing between the middle and inferior con-strictor are: a. Internal laryngeal
nerve b. Superior laryngeal vessels. 4. Between the superior constrictor and the base of the
skull: a. Pharyngotympanic tube b. Levator veil palatini muscle c. Ascending palatine artery d.
Ascending pharyngeal artery. 0.12. Name the lateral relations of palatine tonsil.
Ans. The lateral surface of palatine tonsil is covered by a sheet of fascia which forms the capsule
of the tonsil which is an extension of the pharyngobasilar fascia (Fig. IA.14.7). Other structures
related to the lateral surface of palatine tonsil are as follows: I. The palatine vein or external
palatine or paratonsillar vein 2. Superior constrictor muscle of pharynx
Cartilaginous pan of Phagatgalraganla aOB nee. vet pelalini ramopnalyngoar Leveler veil NUM.
,,T*0 i" stAL Wien ►3, rel S ionoccoaninoeus
Superior constrictor Palatine lomil

Paratopharyngoal
Styropharyngom
made oonstrictor
rlierier tonslnctor
Fig. 1A.14.7 The palatine tonsil.
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3. Buccopharyngeal fascia 4. Facial artery 5. Ascending pharyngeal artery
6. Internal carotid artery 7. Glossopharyngeal nerve 8. Styloglossus and stylopharyngcus.
Topic 15
LONG ESSAYS
0.1. Describe the lateral wall of nasal cavity. Or Describe the features of the lateral wall of nose
In detail.
Or Describe the lateral wall of nose under following headings: bone formation features,
openings, blood supply and nerve supply. Ans. The lateral wall of the nose is irregular due to the
presence of three shelf-like bony projections called conchae, which increase the surface area of
the nose for effective air-conditioning of the inspired air (Fig. IAA 5.1). The lateral wall
separates the nose from: I. The orbit above, 2. The maxillary sinus below and 3. The lacrimal
groove and nasolacrimal canal in front. The lateral wall can be subdivided into three parts: I.
The vestibule: A small depressed area in the anterior part of lateral wall of nose which is lined
by modified skin containing short. stiff, curved hairs called vibrissae.
O,bal plats orbdual Rol
Orbital pate al ermoldal labydeb Perpendicular plate Rase cavities
Owlet pawky Crbrilorm pare Crete petit

PA (MN pra6s5 of muter, One Verner Fig. 1A.15.1 Corona) section through skull.
do ethmokies oats Bela elemottlalle
Undrete 0150515 Inlerior cone Pena
2. The atrium of the middle meatus: The middle part of lateral wall of nose. 3. The conchae: The
bony elevations in the posterior part. Spaces separating the conchae are called meatuses. The
skeleton of the lateral wall is partly bony, partly car-tilaginous, and partly made up of only soft
tissues as follows. The following bones make up the bony part of lateral wall of nose (Fig.
IA.15.2):
Frontal process of maxilla Leman& bone Stunner «Atha , betide meba 1 ' coUnonate process of
Lateral prOcoss 01 septet Carttege Itlajm War n11095 Minot afar Carbege
Medal pterypeld plate of enhonnia bone Perpendicular plate of palatine eerie Intoner concha
Flg. IA.15.2 Bones of the lateral wall of tne nasal cavity.
I. Nasal 2. Frontal process of maxilla 3. Lacrimal 4. Labyrinth of ethmoid with superior and
middle conchae 5. Inferior nasal concha 6. Perpendicular plate of the palatine bone (orbital +
sphenoidal processes) 7. Medial pterygoid plate. The cartilaginous part is formed by the
following; I. The superior nasal cartilage 2. The inferior nasal cartilage 3. Three or four small
cartilages of the ala. The circular lower part is formed by fibrofatty tissue cov-ered with skin.
Ceheraf Anatomy
--Conchae and Meatuses (Fig. 1A.15.3)
Superp concha Middle concha

Intoner concha Fig. 1A.15.3 'Ine lateral wall of the nose—conchae.
Opening el Phetyrogotympanic tube NaeOpharynx Soft palate
The nasal conchae are curved bony projections directed downwards and medially and are as
follows: 1. The inferior concha is an independent bone. 2. The middle concha is a projection
from the medial surface of the edunoidal labyrinth. 3. The superior concha is also a projection
from the medial surface of the ethmoidal labyrinth. This is the smallest concha situated just
above the posterior part of the middle concha. The passages beneath the overhanging conchae
arc known as meatuses of the nose. Each meatus communicates freely with the nasal cavity
proper (Fig. IA.15A). 1. The inferior meatus lies beneath the inferior concha, and is the largest of
the three meatus.. The nasolacrimal duct opens into it, the opening is guarded by the lacri-mal
fold, or Hasner's valve. 2. The middle meatus lies underneath the middle concha. It consists of
the following: a. A roundedelevation produced by the und.erlyingmickfie ethmoidal sinuses
known as the ethmoidal bulls. b. A deep semicircular sulcus below the bulls called the hiatus
semilunaris. c. A short passage at the anterior end of the hiatus known as the infundibulum.
!Monde:elm Wong act that drain, the frontal sinus 5115 M,10:1–r 0110,.d 0010
Opening 01 slaSclaCrIM01 duct
d. An opening of the frontal air sinus in the anterior part of the hiatus semilunaris. e. The
opening of the maxillary air sinus is located in the posterior part of the hiatus semilunaris. It is
often represented by two openings. The opening of the middle ethmoidal air sinus is present at
the upper margin of the bulls. 3. The superior meatus lies below the superior concha. This is the
shortest and shallowest of the three meatuses. It receives the openings of the posterior
ethmoidal air sinuses. The sphenoethmoidal recess is a triangular fossa just above the superior
concha. It receives the opening of the sphenoidal air sinus.
Arterial Supply of the Lateral Wall (Fig. 1A.15.5) I. The anterior ethmoidal artery assisted by the
posterior ethmoidal and facial arteries supplies the anterosuperior quadrant. 2. The
anteroinferior quadrant is supplied by branches from the facial and greater palatine arteries. 3.
The posternsuperior quadrant is supplied by the sphenopalatine artery. 4. The posteroinferior
quadrant is supplied by branches from the greater palatine artery. Venous Drainage (Fig.
1A.15.6) The veins form a plexus which drains anteriorly into the facial vein; posteriorly, into
the pharyngeal plexus of veins and from the middle part, to the pterygoid plexus of veins. Nerve
Supply (Fig. 1A.15.7) Both the general sensory and special sensory nerves supply the nasal
cavity. I. General sensory nerves derived from the following branches of trigeminal nerve are
distributed to whole of the lateral wall: a. The anterosuperior quadrant is supplied by the ante-
rior ethmoidal nerve branch of ophthalmic nerve.
Opening of =Idle etIoncidal cells onto bulls elhmodeld Opening to posterior ethrnaidal Its into
lateral we, of 'upon., meat., .1_ I /into sohenommoiciai recess openog of sphenoidal stress
Hiatus semilunans
Opening 01 maxillary sinus in root of hiatus serniltrouls
Fig. 1 A.15.4 The openings in the lateral wall of the nose.
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Anterior othmoidat artery Medic concha Peaterbrethrroidal artery Superior concha External
nasal anterior ' arteryfrom / SPhencoelaline artery ethrneidel
Ala, branch of
lateral nasal May
Lateral benches of sphenopalatlne artery
interior concha Greater palatine artery
Flg. 1A.15.5 Arterial supply of the nasal cavities.
Drainage to Drainage to plerygced Wm] min plexus in inlratemporal inane Fig. 1A.15.6 Venous
drainage of the nasal cavities.
External nasal branch of anterior othmeid
Antensr ethrnold 011actay bub Olfactory nerve pl Sphenopanune foramen
Interner nasal branches intmertna! norm

Posterior suporer lateral nasal nerves Nasal branch of intoner 1,11,10.11,1 wlverl,r nnnm
Rg.1A.15.7 Nerve supply of the nasal cavity.
b. The anteroinferior quadrant is supplied by the anterior superior alveolar nerve, brands of
auxiliary nerve, c. The posterosuperior quadrant is supplied by the poste-rior superior lateral
nasal branches from the pterygo-palatine ganglion suspended by the maxillary nerve.
d. The posterein (Crier quadrant is supplied by the anterior or greater palatine branch from the
pterygo-palatine ganglion suspended by the maxillary nerve. 2. Special sensory nerves or
olfactory nerves are distributed to the upper part of the lateral wall up to the superior concha.
Lymphatic Drainage (Fig. 1A.15.8) Lymphatics from the anterior half of the lateral wall pass to
the submandibular nodes, and from the posterior half, to the retropharyngeal and upper deep
cervical nodes.
Fig. IA.15.8 Lymphatic drainage of the nasal cavities.

0.2. Describe maxillary air sinus and its relation. Ans. The maxillary sinus is the largest of all the
paranasal sinuses locatedin the body of the maxilla (Figs 1A.15.9,1A.15.10).
Ethmoiclal sinuses Nasal septum Middle othrroidal emus Maxillary and Floor of noso
Upper tooth
1A.15.9 Corona' section through the nasal cavity and the maxillary sinuses.
Features of Maxillary Sinus The maxillary sinus is the first paranasal sinus to develop. I. The
maxillary sinus is pyramidal in shape, with its: a. Base: directed medially towards the lateral
wall of the nose
Anterior othrno sinuses Posterior eihrnoidal sinus

Sphenoidal sinus
Frontal air emus

tralltery sinus
Fig.1A.16.10 Location of paranasal sinuses in the lateral wall of the mdse.
b. Apex: directed laterally into the zygomatic process of the maxilla c. Roof formed by the floor
of the orbit d. Floon formed by the alveolar process of the maxilla. The floor lies about I cm
below the level of the floor of the nose. 2. The size of the sinus is variable, average
measurements are: height, 3.5 cm; width, 2.5 can and anteroposterior depth, 3.5 cm. 3. It opens
into the middle meatus of the nose in the lower part of the hiatus semilunaris, a second opening
is often present at the posterior end of the hiatus. Both openings are near to the roof than the
floor of the sinus. 4. The size of the opening is about 3-4 mm as it is over-lapped by the following
(a) from above, by the animate process of the ethmoid, and the descending part of the lacrimal
bone; (b) from below, by the inferior nasal concha and (c) from behind, by the perpendicular
plate of the palatine bone. It is still further reduced in size by the thick mucosa of the nose. 5.
Arterial supply: Facial, infraorbital and greater palatine arteries.
Nasal spine of frontal tone Nasal crest of nasal hale
6. Venous drainage: 1 he maxillary sinus drains in to the facial vein and the pterygoid plexus of
veins. 7. Lymphatic drainage: Into the submandibular nodes. S. Nerve supply. Infraorbital, and
anterior, middle and poste-rior superior alveolar nerves innervate the maxillary sinus. 0.3.
Describe gross anatomy of nasal septum.
Ans. Median osseocartilaginous partition between the two halves of the nasal cavity is known as
nasal septum. On either side, it is covered by mucous membrane and forms the medial wall of
both nasal cavities (Fig. IA.15.10. The bony part is formed almost entirely by: (a) the vomer, and
(b) the perpendicular plate of the ethmoid. Its margins receive contributions from the nasal
spine of the frontal bone, the rostrum of the sphenoid, and the nasal crests of the nasal, palatine
and maxillary bones. The cartilaginous part is formed by: (a) the septal cartilage and (b) the
septal processes of the inferior nasal cartilages. The cuticular part or lower end is formed by
fibrofany tissue covered by skin, The lower margin of the septum is called the columella. The
central part of nasal septum is rarely strictly median; it is usually defected to one or the other
side due to over-growth of one or more of the constituent parts. The septum has (a) four
borders, superior, inferior, anterior and posterior and (b) two surfaces, right and left. Arterial
Supply (Fig.1A.15.12) I. Anterosuperior part is supplied by the anterior ethmoidal artery. 2.
Anteroinferior part is supplied by the superior labial branch of facial artery. 3. PosteroinfcrMr
part is supplied by the sphenopalatine artery. 4. Posterior part is supplied by the posterior
ethmoidal artery.
Cronform dated ethmold Perpendicular pew 01 comma

Septet cartilage
Septa! process of interior resat cartilage
Comrade
Fig. 1A.15.11 The nasal septum.
Verner
rL,wIn,m N Vit.,.
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Swig branch of anteflor elhmoidal artery Septa! btanCh of POSterae ethmoidal artery
Septa! bream or
spreneswasno
"letessi, Tenernal part ol greater palatne artery Septet branch from nasal elegy from supador
labial elegy Fig. 1A.15.12 The arterial supply of nasal septum.
The vestibule of the nasal septum or its antcroinferior part contains anastomoses between the
septal ramus of the superior labial branch of the facial artery, branch of spheno. palatine artery
and of anterior ethmoidal artery which form a large capillary network called the Kiesselbach's
plexus.This is known as Little's area and is the common site of bleeding from the nose or
epistaxis.
Venous Drainage The veins form a plexus in the lower part of the septum or Little's area. The
plexus drains anteriorly into the facial vein, posteriorly through the sphenopalatine vein to
pterygoid venous plexus.
Nerve Supply (Fig. 1A.15.13) I. General sensory nerves, arising from trigeminal nerve, are
distributed to whole of the septum: a. The internal nasal branch of the anterior ethmoidal nerve
supplies the anterosuperior part of the septum. b. The nasopalatine branch of the
pterygopalatine ganglion supplies the posteroinferior part of the septum. c. The medial
posterior superior nasal branches of the pterygopalatine ganglion supplies the posterosu-perior
part. 2. Special sensory nerve or olfactory nerves are confined to the upper part or olfactory
area.
Lymphatic Drainage Posterior half of the nasal septum drains in to the retrophe. ryngeal and
deep cervical nodes, while the anterior half drains into the submandibular nodes.
anieriort="Ze'
Calseloty nerve pl—(taetal branches)
Nasopalaline nerve Fig. 1A.15.13 Nerve supply of the nasal septum.

SHORT ESSAYS
0.1. Nasal septum. Ans. Refer to the answer of Long Essays Q. 3. Q.2. Maxillary air sinus. Ans.
Refer to the answer of Long Essays Q.2.
Q.3. Give the boundaries, relations and applied anatomy of sphenoidal air sinus. Ans. Features of
sphenoidal air sinus are as follows (Fig. IA.15.14): I. The right and left sphenoidal sinuses are
located within the body of the sphenoid bone. They are separated by a septum. The two sinuses
are usually unequal in size. Each sinus opens into the sphenoethmoidsl recess of the
corresponding half of the nasal cavity.
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Menongeat lays, of ago ,no

Ocutornolor nerve - Trochlear nerve.-r,; Cavernous 1/laxilaty nerve Mandbular nerve
lypophyale Oefebd
Sphenoidal sinta
Infernal carotid Mery Abducenl nerve
Fig. 1A.1S.14 Sphenoidal sir sinuses.
2. Each onus is related superiorly to the optic chiasma and the hypophysis cerebri; and laterally,
to the internal carotid artery and the cavernous sinus. 3. Arterial supply: Posterior ethmoidal
and internal carotid arteries. 4. Venous drainage: The sphenoidal sinus drains into pterygoid
venous plexus and cavernous sinus. 5. Lymphatic drainage: To the retropharyngeal nodes. 6.
Nerve supply: Posterior ethmoidal nerve and orbital branches of the pterygopalatine ganglion
supply the sphenoidal sinus.
SHORT NOTES
0.1. Frontal sinus. Ans. Features of frontal sinus are as follows: 1. The frontal sinus lies in the
frontal bone. It extends upwards above the medial end of the eyebrow, and backwards into the
medial part of the roof of the orbit. 2. It opens into the middle meatus of nose at the anterior end
of the hiatus semilunaris either through the infun-dibulum or through the frontonasal duct. 0.2.
Nasal septum. Ans. The median osseocartilaginous partition between the two halves of the nasal
cavity is known as the nasal septum. On each side, it is covered by mucous membrane and forms
the medial wall of both nasal cavities. The bony part is formed almost entirely by: I. The vomer
2. The perpendicular plate of the ethmoid. The cartilaginous part is formed by: I. The septal
cartilage 2. The septet processes of the inferior nasal cartilages. The cuticular part or lower end
is formed by fibrofatty tissue covered by skin. The lower margin of the septum is called the
columella. The septum has: (a) four borders, superior, inferior, ante-rior and posterior and (b)
two surfaces, right and left. 0.9. Orbttal nerve. Ans. Orbital nerve is a branch of maxillary nerve.
The orbital branches pass through the inferior orbital fissure, and supply the periosteum of the
orbit and the orbitalis muscle.
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0.4. Maxillary sinus. Ans. The maxillary sinus is situated in the body of the nmsill, and is the
largest of all the paranasal sinuses. The maxillary sinus is pyramidal in shape, with its: 1. Base:
directed medially towards the lateral wall of the nose. 2. Apex. directed laterally into the
zygomatic process of the maxilla. 3. Roof formed by the floor of the orbit. 4. Floor formed by the
alveolar process of the maxilla. It opens into the middle meatus of the nose through ostium in
the lower part of the hiatus semilunaris. 0.5. Paranasal sinuses. Ans. Paranasal sinuses are air
filled spaces present within some bones around the nasal cavities. The sinuses are frontal,
maxil-lary, sphenoidal and ethmoidal. All of them open into the nasal cavity through its lateral
wall. The function of the sinuses is to make the skull lighter and add resonance to the voice. 0.6.
Sphenopalatine ganglion. Ans. Sphenopalatine or pterygopalatine is the largest parasympa-
thetic peripheral ganglion located in the ptcrygopalatine fosse just below the maxillary nerve, in
front of the pterygoid canal and lateral la the Thennpalarine foramen. It serves as a relay station
for secretomotor fibres to the lacrimal gland and to the mucous glands of the nose, the
paranasal sinuses, the palate and pharynx. Topographically, it is related to the maxillary nerve,
but rfulsocttciornploy rcamh.o connected to the facial nerve through its greater
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0.7. Blood supply of nasal septum. Ans. The arterial supply of nasal septum is as follows I.
Anterosuperior pan: supplied by the anterior ethmoidal artery. 2. Fbsteroinferior pars supplied
by the sphenopalatine artery. 3. Anteroinferior part: supplied by the superior labial branch of
facial artery. 4. Posterior patt supplied by the posterior ethmoidal artery. 5. The opening of the
maxillary air sinus is located in the posterior part of the hiatus semilunaris. 6. The opening of
the middleethmoidal air sinus is present at the upper margin of the bulla The anteroinferior
part or vestibule of the septum con-tains anastomoses between the septal ramus of the superior
labial branch of the facial artery, branch of sphenopalatine artery, and of anterior ethmoidal
artery which forms a large capillary network called the Kiesselbach's plexus. This is a common
site of bleeding from the nose or epistaxis, and is known as Little's area. 0.8. Middle meatus of
nose.
Ans. The middle meatus of nose lies underneath the middleconcha. It presents the following
features: 1. The ethmoidal bulla is a rounded elevation produced by the underlying middle
ethmoidal sinuses. 2. The hiatus semilunaris is a deep semicircular sulcus below the bulla.
Topic 16
3. The infundibulum is a short passage at the anterior end of the hiatus. 4. The opening of the
frontal air sinus is seen in the ante-rior part of the hiatus semilunaris. 0.9. Name the paranasal
sinus openings into middle meatus of the nose.
Or Mention the paranasal sinuses opening Into middle meatus of the nose.
Ans. The paranasal sinuses opening into middle meatus of the nose are as follows: I. Frontal
sinus 2. Maxillary sinus 3. Middle ethmoidal air sinus. 0.10. Name any four bony constituents of
nasal septum. Ans. The bony part of nasal septum is formed almost entirely by the following: I.
The vomer 2. The perpendicular plate of the ethmoid. Its margins receive contnbutions from the
following: I. The nasal spine of the frontal bone 2. The rostrum of the sphenoid 3. The nasal
crests of the nasal, palatine and maxillary bones.
SHORT ESSAYS
0.1. Vocal folds. Vocal cords. Location, attachments cords.
Or
nr and movements of vocal
Ans. Vocal cords are two folds of mucous membrane on each side in the laryngeal cavity (Fig.
IA.16.1). I. The upper fold is called the vestibular fold, and the lower fold is known as the vocal
fold. The vocal fold is
attached anteriorly to the middle of the angle of the thyroid cartilage on its posterior aspect and
posteriorly to the vocal process of the arytenoid. 2. The space between the vocal folds is called
rims glottidis (Fig. IA.16.2). It is limited posteriorly by an interaryte-noid fold of mucous
membrane. The rims glottides has an anterior intermembranous part (three-fifths) and a
posterior intercartilaginous part. 3. The rims is the narrowest part of the larynx. It is longer (23
mm) in males than in females (17 mm). 4. The vestibular and vocal folds divide the laryngeal
cavity into following three parts: a. The part above the vestibular fold is called the vestibule of
the larynx.
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EatOlcld.1 Arrepiglottic told

Vestibule Laryngeal venteclo Infraglottic space Cricoid arch
Laryngeal soma,
Middle pad of cavity Vestibular tad (mucosa overtying vestibular !pommel)
Vocal told mucosa overlying vocal ftgantent
Trachea
1A.111.1 Gotonai section through larynx.
General Anatomy
b. The part between the vestibular and vocal folds is called the sinus or ventricle of the larynx. c.
The part below the vocal folds is called the infraglottic part. Movements of Vocal Folds
Movements of the vocal folds affect the shape and size of the rime glottidis. I. During quiet
breathing or at rest, the intermembranous part of the rim is triangular, and the
intercartilaginous part is quadrangular. 2. The glottis is reduced by the adduction of the vocal
folds during phonation or speech. 3. During forced inspiration, both parts of the rima are
triangular, so that the entire rims is lozenge-shaped; the vocal folds arc fully abducted. 4. The
intermembranous part of the rima glottidis is dosed, but the interstrtilaginous part is widely
opened during whispering.
Ouedrangatar membrane
Vestibule, tigament
Free
is
Vocal ligament
Cricothyrcid *gement Muscutar process of eiyeano4 Vocal process of eryionoia
A Fig.1A.16.2 (A) Supollor veto/ through laryngeal inlet. (B) Superior view through larynx.
SHORT NOTES
0.1. Vocal folds. Ans. Refer to the answer of Short Essays Q.I. 0.2. Rime glottidis. Ans. The space
between the right and left vocal folds is the rima glottides (Fig. 1A.16.3). It is limited posteriorly
by an interarytenoid fold of mucous membrane. The rima
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Eptglotbs
Vocal told _ Vestebular fold Atyclagtattic Iola

Cuneiform luborcte Comiculato tubercle
- NMI ...Mai Rime glotedle
Intorarytenokl fold
Fig. 1A.16.3 Sectional view of larynx showing rime glotticlis.
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glottidis has an anterior intermembranous part (three-fifths) and a posterior intercartilaginous

part. The rime is the narrowest part of the larynx. It is longer (23 mm) in males than in females
(17 mm). Q.3. Cricoid cartilage. Ans. 1. A ring-shaped cartilage which encircles the larynx below
the thyroid cartilage is known as the cricoid cartilage (Fig. 1A.16.4). 2. It is thicker and stronger
than the thyroid cartilage and has a narrow anterior part called the arch and a broad posterior
part, called the lamina. 3. The lamina projects upwards behind the thyroid cartilage,' and
articulates superiorly with the arytenoid cartilages. The inferior cornua of the thyroid cartilage
articulates with the side of the cricoid cartilage at the junction of We arch and lamina.
cdoco Lamina cxduge t Aron Trachea
Facet for arteulation wan arytenoid cartilage, Facet fcw articulation ell intense horn Of thyroid
cartilage
Fig. 1A.16.4 Check' cartilage (anterolatoral view).
0.4. Thyroid cartilage. Ans. I. The thyroid cartilage is V-shaped in cross-section. It consists of
right and left laminae. Each lamina is roughly quadrilateral (Fig. 1A.16.5).
Left lamina Soreder thyroid notc•
Laryngeal prominence inter*, thyroid notch
Lateral throw Igarnonts laTa
Suponor horn
&verb, thyroid loberole
OWN. One Intoner horn Facet Or cricoid Medial surface ol horn) Interior thyroid tubercle
F1/41.1A.16.5 Thyroid carblage (anterolaterai view).
—="1111 2. The anterior borders approach each other at an angle of about 90P in the male and
about 1200 in the female. 3. The lower parts of the anterior borders of the right and left laminae
fuse to forma median projection called the bryn. gcal prominence. The upper part of the anterior
borders do not meet. They am separated by the thyroid notch. 4. The posterior borders are free
and are prolonged upwards and downwards as the superior and inferior cornua or horns. The
superior cornua is connected with the greater cornua of the hyoid bone by the lateral
thyrohyoid ligament. The inferior comua articulates with the cricoid cartilage to form the
cricothyroid joint. 5. The inferior border of the thyroid cartilage is convex in front and concave
behind. In the median plane, it is con-nected to the cricoid cartilage by the corms elasticus.
0.5.Thyrohyoid membrane.
Ana. The thyrohyoid membrane is a fibroelastic ligament that spans between the superior
margin of the thyroid cartilage below and the hyoid bone above (Fig. IA.16.6).
Flg.IA.16.13 Extrinsic ligarnentS of larynx. I. Median thyrohyoid ligament—is the midline thick •
g of membrane. 2. Lateral thyrohyoid ligament—is the thickening of the posterior border of the
membrane. • Structures piercing thyrohyoid membrane are • Superior laryngeal arteries •
Internal laryngeal nerve. 0.6. Cricothyroid muscle. Ans. The cricothyroid miracle is the only
intrinsic muscle outside the larynx, lying un its external aspect (Fig. IA.16.7). It originates from
the lower border and lateral surface of cricoid and its fibres pass backwards and upwards to
cornua and lower border of thyroid cartilage.
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Vocal ligament
Crloctrwract ligament Sedan crwellwroicl ligament Fig. 1A.16.7 Cricothyroid muscle.
Actions: Tense the vocal cords and act as an adductor of the vocal cords. 0.7. Nerve supply of
larynx. Or Name sensory nerve supply of larynx. Ans.
Nerve Supply of Laryngeal Muscles (Fig. 1A.16.8) All intrinsic muscles of the larynx are supplied
by the recur-rent laryngeal nerve except for the cricothyroid which is supplied by the external
laryngeal nerve.
Net vague nerve ThrohyO.d me rorano
Superior laryrpeu nerve

Internal laryngeal nerve External laryngeal nerve -Loft yaws nerve
CriCOlhYreld muscle Right recurrent laryngeal nerve
Loh recurrent laryngeal nerve Tract.
Flg. 1A.16.8 Nerve Sup* of larynx.
A
0.8. Paired cartilages of larynx.
Ans. The skeleton or cartilages of larynx are as follows: The larynx contains nine cartilages, of
which three are un-paired and three are paired. The paired cartilages of larynx are: 1. Arytenoid
2. Comiculate 3. Cuneiform.
0.9. Give boundaries of rime glottidis.
Ans. The space between the right and left vocal folds is the rime glottidis; it is limited
posteriorly by an interarytenoid fold of mucous membrane. The rims has an anterior
intermembra-nous part (three-fifths) and a posterior intercartilaginous part. The rims is the
narrowest part of the larynx. It is longer (23 mm) in males than in females (17 mm). Q.10. Name
the intrinsic muscles of larynx.
Ans. The intrinsic muscles of larynx are as follows (Fig. 1A.16.9A and B): I. Cricothyroid 2.
Posterior cricoarytenoid (triangular muscle) 3. Lateral cricoarytenoid 4. Ihnsverse arytenoid
(unpaired muscle) 5. Oblique arytenoid and aryepiglotticu$ 6. Thyroarytonoid and
thyroepiglottic. 0.11. Origin and insertion of posterior cricoaryte-noid muscle.
Ans. The posterior cricoarytenoid muscle originates from the posterior surface of the lamina of
cricoid and its fibres run upwards and laterally and are inserted into the muscular process of
arytenoid muscle.
Transverse arytenwci Oblique antenna POStencw cc:warp:mord
Rime glottal• vaa, ligernents
Lateral Cridoerytenold
Fig. tA.16.9A and 13 Inmnsic muscles of larynx.
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0.12. Give the attachments, nerve supply and actions of inferior constrictor muscle. Ans. Inferior
constrictor muscle originates from: I. Thyroid cartilage (oblique line and inferior horn) 2.
Cricoid cartilage Inferior constrictor muscle inserts into pharyngeal raphe. Parts of the inferior
constrictor are: a. Thyropharyngeus b. Cricopharyngeus.
Topic 17
The dehiscence of Killian is a weak area between thew two parts. Nerve supply: Pharyngeal
plexus of nerves. Action of the constriaors of the pharynx During deglutition, they contract and
cause peristaltic movement in the pharynx. Thyropharyngeus has propulsive function whereas
the cricopharyngeus has a sphincteric function. Crioopharyn-geal part relaxes during the
contractions of the thyropha-ryngeal part.
LONG ESSAYS
0.1. Describe surface features of dorsum of the 3. tongue. How do you connect Its epithelial
innerva-tion to hs development?
Or Describe anatomy of tongue. Add a note on its development Ans. I. The tongue is situated in
the floor of the mouth. It has an oral part that lies in the mouth, and a pharyngeal part that lies
in the pharynx. The oral and pharyngeal parts are separated by a V-shaped sukus terminalis
(Fig. 1A.17.1). 2. The functions of tongue are taste, speech, mastication and deglutition.
Oral pan (anteriot tworghtlebt)
Inferior surface Mandible

tetwonat sulous Pharyngeal pan (pawnor One-third) Root of longue
tepid bone ktorionycomasete GenWhyold muscle Fig. 1A.17.1 Paramecian stoner section of the
tongue.
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4.
5.
6.
The tongue has following external features: a. Root b. Tip c. Body. The root of the tongue is
attached to the mandible and soft palate above, and to the hyoid bone below. In between the
two bones, it is related to the geniohyoid and mylohyoid muscles. The tip of the tongue forms
the anterior free end which, at rest, lies behind the upper incisor teeth. The hotly of the tongue
has (a) a curved upper surface or dorsum and (b) an inferior surface. The dorsum of the tongue
is divided into (a) an oral part or anterior two-thirds and (b) a pharyngeal part or posterior one-
third, by a faint V.shaped groove, the micas terminalis. The inferior surface is covered with a
smooth mucous membrane, which shows a median fold called the frenulum linguae. On either
side of the frenulum there is a promi-nence produced by the deep lingual veins. More laterally
there is a fold called the pile/ tfimbriata (Fig. IA.17.2). The oral or papillary part of the tongue is
placed on the floor of the mouth. Its margins are free and in contact with the gums and teeth.
The superior surface of the oral part shows a median furrow and is envenni with papillae which
make it rough. The pharyngeal or lymphoid part of the tongue lies behind the palatoglossal
arches and the sulcus terminalis. Its posterior surface called the base of the tongue, forms the
anterior wall of the pharynx. The mucous membrane is devoid of papillae, but has many
lymphoid follicles that collectively constitute the lingual tonsil. Mucous glands are also present.
Tip of tongue turned up

Plies fintbriagt
Frenutum
Orop lingual vow
Curios of suronaneemar duct en sitangual pantie Fig. 1A.17.2 The inferior surface of the tongue
and the floor of :Ito mouth.
tiKSuWtoldIngest told on Poor of mouth
7. The posteriormost part of the tongue is connected to the epiglottis by three folds of mucous
membrane. These are the median glossoepiglottic fold and the right and left lateral
glossoepiglottic folds. On either side of the median fold there is a depression called the vallecula.
8. Papillae of the tongue are projections of mucous mem-brane or corium which impart the
characteristic rough-ness to anterior two-thirds of the tongue. There are three types of papillae
on the tongue (Fig. 1A.17.3): I. The vallate or &nomad/ate papillae arc situated imme-diately in
front of the sulcus terminalis and are about 8-12 in number. They are large in size 1-2 mm in
diameter. Each papilla is a cylindrical projection surrounded by a circular sulcus, and its walls
are raised above the surface. 2. The fungi form papillae are numerous near the tip and margins
of the tongue, but some of them are also scat-tered over the dorsum. They are distinguished by
their bright red colour.
Funglferm papillae
Oral vestibule
—Foliate
FrIclorm papillae
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Orefnann
papelas
'femme! memo Pharyngeal part Pf longue °allele papillae Foramen ateuum
Fig. 1A.17.3 Papillae et the tongue.
3.11.1in/or/a papillae or conical papillae cover the presul cal arcs of the dorsum of the tongue,
and give it a char-acteristic velvety appearance. They are the smallest and most numerous of the
lingual papillae. Each is pointed and covered with keratin.
Development of Tongue Epithelium 1. Anterior two-thirds: From two lingual swellings and one
tuberculum impar, which arise from the first bronchial arch. It is supplied by lingual nerve
(posttrematic) and chords tympani (pretremati• 2. Posterior one-third: From cranial part of the
hypobraro chial eminence, i.e. from the third arch. Therefore, it is supplied by the
glossopharyngeal nerve. 3. Posterior most part develops from the fourth arch.There-fore, it is
supplied by the vagus nerve (Table 1A.17.1).
Table 14.17.1 Nerve supply of tongue
17niaTer'''Firaferior supply of two-thirds one-third of Posterior most tongue of tongue tongue
part or valrocula Sensory Lingual Glossopharyn. Internal laryngeal taste Cherda Wm- Beal.
glossa- branch of vagus pant, except pharyngeal Internal laryngeal satiate papillae including the
branch of sages satiate papillae
0.2. Give an account of musculature of tongue and its development. Write briefly about
lymphatic drainage of tongue. Ans. The tongue is a muscular organ. A middle fibrous septum
divides the tongue into right and left halves. Each half contains four intrinsic and four extrinsic
muscles (Fig. 1A.17.4): 1. Intrinsic muscles a. Superior longitudinal b. Inferior longitudinal c.
Tronsverse d. Vertical 2. Extrinsic muscles: a. Genioglossus b. Ilycgl-c. Styloglossus d.
Palatoglossus.
Inbinelc Muscles of the Tongue The intrinsic muscles occupy the upper part of the tongue, and
are attached to the submucous fibrous layer and to the median fibrous septum. They alter the
shape of the tongue.
A
V
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• Series: 8DS 1st Year
t=s
13enroarea
SlyloolOSSu
Hypogkesus — Gement:sees Fig. 1A.17.4 The musculature of tongue.
Somme —longitudinal vertices TranSVerde
friend. iongitutInal
Septum
1. The superior longitudinal muscle lies beneath the mucous membrane. It shortens the tongue
and makes its dorsum concave. 2. The inferior longitudinal muscle is a narrow band lying close
to the inferior surface of the tongue between the genioglossus and the hyoglossus. It shortens
the tongue and makes its dorsum convex. 3. The transverse made extends from the median
septum to the margins. It makes the tongue narrow and elongated. 4. The vertical muscle is
found at the borders of the anterior part of the tongue. it makes the tongue broad and flattened.
Extrinsic Muscles of the Tongue The extrinsic muscles connect the tongue to the hallowing: I.
Mandible via genioglossus 2. Hyoid bone through hyoglossus 3. Styloid process via styloglossus
4. The palate via palatoglossus.
_intrinsic muscles
—Septum
Genioglossus is a fan-shaped muscle which forms the main bulk of the tongue. It arises from the
upper genial tubercle of the mandible. From here the fibres fan out and run backwards. The
upper fibres are inserted into the tip, the middle fibres into the dorsum, and the lower fibres
into the hyoid bone. The upper fibres retract the tip, the middle fibres depress the tongue, and
the lower fibres pull the posterior part of the tongue forwards and thus protrude the tongue
from the mouth. This muscle if paralysed will fall back on the oropharynx and block the air
passage. 1. The tip of the tongue drains bilaterally to the submental nodes. 2. The right and left
halves of the remaining part of the anterior two-thirds of the tongue drain unilaterally to the
submandibular nodes. A few central lymphatic drain bilaterally to the same nodes. 3. The
posterior one-third of the tongue drains bilaterally to the jugulo-omohyoid nodes; these are
known as the lymph nodes of the tongue.
SHORT ESSAYS
0.1. Nerve supply of tongue. Ans. Nerve supply of the tongue is as follows:
Motor Nerves I. All the intrinsic and extrinsic muscles except the pala-toglosius are supplied by
the hypoglossal nerve. The
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palatoglossus is supplied by the cranial root of the accessory nerve through the pharyngeal
plexus. Sensory Nerves I. The lingual nerve is the nerve of general sensation and the chords
tympani is the nerve of taste for the anterior two-thirds of the tongue except vallate papillae.
2. The gMssopharyngeal nerve is the nerve for both general sensation and taste for the posterior
one-third of the tongue including the circumvallatc papillae. 3. The posterior most part of the
tongue is supplied by the vagus nerve through the internal laryngeal branch (Table IA.17.1). 0.2.
Lymphatic drainage of tongue. Or Lymph vessels and lymph nodes draining lymph from tongue.
Ans.
Lymphatic Drainage (Fig. 1A.17.5) 1. The tip of the tongue drains bilaterally to the submental
nodes. 2. The right and left halves of the remaining part of the anterior two-thirds of the tongue
drain unilaterally to the submandibular nodes. A few central lymphatics drain bilaterally to the
same nodes. 3. The posterior one-third of the tongue drains bilaterally to the jugulo-omohyoid
nodes; these are known as the lymph nodes of the tongue (Pig. IA.17.5).
Anterior 2,3 Of longue Posterior V3 of tongue
Subrnenial metes I .1=rdontycid Sulanendibular no \ Omohyold muscle internal jugular vein Fig.
1A.17.5 Lymphatic drainage.
0.3. Describe In detail about blood supply and Innervation of tongue. Ans. Arterial supply of
tongue is chiefly derived from the lingual arterys a branch of the external carotid artery. The
root of the tongue is also supplied by the tonsillar and ascending pharyngeal arteries.
Venous Drainage The arrangement of the vena comitantes/veins of the tongue is variable. Two
venac comitantes accompany the lingual artery, and one vena comitantes accompanies the
hypoglos-sal nerve. The deep lingual vein is the largest and principal vein of the tongue. It is
visible on the inferior surface of the tongue. These veins unite at the posterior border of the
hyoglossus to form the lingual vein, which ends either in the common facial rein or in the
internal jugular vein. Innervation or Nerve Supply of the Tongue (Fig. 1A.17.6) Motor nerves All
the intrinsic and extrinsic muscles except the palatoglos-sus are supplied by the hypoglossal
nerve. The palatoglossus supplies to the cranial root of the accessory nerve through the
pharyngeal plexus.
Sensory nerves I. The lingual nerve is the nerve of general sensation and the chords tympani is
the nerve of taste sensation for the anterior two-thirds of the tongue except vallate papillae. 2.
The glossopharyngeal nerve is the nerve for both general sensation and taste for the posterior
one-third of the tongue including the circumvallated papillae. 3. The posteriormost part of the
tongue is supplied by the vagus nerve through the internal laryngeal branch.
Lingual nerve (from IV,D
Chortle tympani GrossetaharYegoel prom mo nerve Pxl wypeniosew nerve pag
Occipital artery
8yorrosaus Dorsal lingual vein Deep lingual rein Undue! artery
Common casokl artetv Internet Jugular van Stenodeltomesteki branCh of ccdphat artery Fig.
1A.17.8 Vascular and nerve supply of tongue.
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SHORT NOTES
Q.1. Ungual nerve supply. Ans. The lingual nerve is the nerve of general sensation for the
anterior two-thirds of the tongue. 0.2. Lymphatic drainage of tongue. Ans. Lymphatic drainage
of tongue is as follows: I. The tip of the tongue drains bilaterally to the submental nodes. 2. The
right and left halves of the remaining part of the anterior two-thirds of the tongue drain
unilaterally to the submandibular nodes. A few central lymphatics drain bilaterally to the same
nodes. 3. The posterior one-third of the tongue drains bilaterally to the jugulo-omohyoid nodes;
these are known as the lymph nodes of the tongue.
Topic 18
0.3. Relations of hyoglossus muscle. Ans. Superficial relations of hyoglossus muscle arc (a)
styloglossus, (b) lingual nerve, (c) submandibular ganglion, (d) deep part of the submandibular
gland, (c) submandibular duct, (0 hypoglossal nerve and (g) veins accompanying it. Deep
relations of hyoglossus muscle are (a) inferior lon-gitudinal muscle of the tongue, (b)
genioglossus, (c) middle constrictor of the pharynx, (d) glossopharyngeal nerve, (c) stylohyoid
ligament and (1) lingual artery. Structures passing deep to posterior border of hyoglossus, from
the above downwards include (a) glossopharyngeal nerve, (b) stylohyoid ligament and (c)
lingual artery.
IIIIIIIII
SHORT ESSAY
0.1. Give the position, nerve supply and development of tympanic membrane. Ans. I. Tympanic
membrane is a thin, translucent partition between the external acoustic meatus and the middle
ear. 2. It is oval in shape, measuring 9 mm X 10 mm which is placed obliquely at an angle of 55°
with the floor of the meatus and faces downwards, forwards and laterally. 3. The tympanic
membrane has outer and inner surfaces. The outer surface of the membrane is lined by thin skin
and is concave (Fig. 1A.18.1). The inner surface provides attachment to the handle of the
mallets, which extends up to its centre.Tbe inner surface is convex (Fig. IA.18.2). 4. The point of
maximum convexity lies at the tip of the handle of the malkus and is called the umber The mem-
brane is thickened at its circumference, which is fixed to the tympanic sulcus of the temporal
bone on the tym-panic plate. 5. Superiody, the sulcus is deficient, and the membrane is attached
to the tympanic notch. From the ends of the notch two hands, the anterior and posterior
malleolar folds arc prolonged to the lateral process of the mallet*.
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Antericc rmaeolar fold Pare naCcida
Pesten°, malleotar told

Position cd handle of malteds
Pars tense (outer surface)
Fig. 1A.18.1 Outer surface of the lett tympanic membrane.
6. The greater part of the tympanic membrane is tightly stretched and is called the pars tease,
the part between the two-malleolar folds is loose and is called the pars flaccid. The pars flaccid
is crossed internally by the chords tym-pani. This part is more liable to rupture than the pars
tense. The membrane is held tense by the inward pull of the tensor tympani muscle, which is
inserted into the upper end of the handle of the malleus.
General Anatomy
Shen process and body of Incas
Flg. 1A.1112 Inner surface of the left tympanic membrane.

The tympanic membrane is composed of the following three layers (Fig. 1A.18.3). a. The outer
cuticular layer of skin. b. The middle fibrous layer made up of superficial radiat-ing fibres. c. The
deep circular fibres, which arc minimal at the centre and maximal at the periphery. The fibrous
layer is replaced by loose areolar tissue in the pars flaccid. The inner mucous layer is lined by a
low ciliated columnar epithelium. Blood Supply I. The outer surface is supplied by the deep
auricular branch of the maxillary artery. 2. The inner surface is supplied by the anterior
tympanic branch of the maxillary artery and by the posterior tym-panic branch of the posterior
auricular artery.
Inddle ear
limbo
Head of 'maces
Lateral process and handle of mallows
arouses water Cuticular layer of tympanic membrane
Romps layer raucous layer Fig. 1A.18.3 Tympanic membrane as seen in section.
Sign In
Venous Drainage. Veins from the outer surface drain into the external jugular vein. The veins
from inner surface drain into the transverse sinus and into the venous plexus around the
auditory tube.
Lymphatic Drainage Lymphatics pass to the preauricular and retropharyngcal lymph nodes.
Nerve Supply I. Outer surface. The anteroinferior part is supplied by the aurictdotemporal
nerve, and the posterosuperior part by the auricular branch for the vague nerve. 2. inner
surface: This is supplied by the tympanic branch of the glossopharyngeal nerve through the
tympanic plexus.
SHORT NOTES
0.1. Tympanic membrane. Ans. A !H. •renducent parthinn between the external acoustic meatus
and the middle ear is known as tympanic mem-brane. It is oval its shape, measuring 9 mm X 10
mm. It is placed obliquely at an angle of 555 with the floor of the meatus. It faces downwards,
forwards and laterally. Q.2. External acoustic meatus.
Ans. The external ear consists of (a) the auricle or pinna and (b) the external acoustic meatus.
The external auditory me-atus conducts 3.1,14 waves (tuns the concha to the tympanic
membrane. The meatus or canal is S-shaped and about 24 mm long, of which the medial two-
thirds or 16 mm is bony, and the lateral one-third or 8 mm is cartilaginous.
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SHORT ESSAYS
0.1. Give the development of retina. Ans. 1. The retina is derived from the layers of the optic cup
which is divisible into a larger posterior part that be-comes thick, and forms the retina proper
(optical part of retina); and an anterior part that remains thin and forms an epithelial covering
for the ciliary body and iris (ciliary and radial parts of retina). 2. The outer wall of the posterior
part of the optic cup re-mains thin. Its cells form the pigmented layers of the retina. 3. The inner
wall of the cup differentiates into matrix cell, mantle and marginal layers as in the neural sheath.
4. After giving origin to the cells of the mantle layers, the cells of the matrix layers form the rods
awl cones, the cells of the mantle layers form the bipolar cells, the ganglion cells and other
neurons of the retina and also the supporting elements. 5. The axons of the ganglion cells grow
into the marginal layers to form the layers of nerve fibres. Then fibres gross into the optic stalk
by passing through the coordinal Bs. sure. The optic stalk is then converted into the optic nerve.
0.2. Lateral rectus muscle of eyeball.
Ans. There are four rectus muscles namely (Fig. 1A.19.1): I. Superior rectus 2. Inferior rectos 3.
Medial rectos 4. Lateral rectos.
Levaser palpobree superloris
Superior oblique
▪ Superior moos Medial tea
I hese muscles originate from the common tendinous ring, which is situated around the
superior, medial and infe nor borders of the optic foramen.
Origin The lateral roams muscle arises from lateral part of common tendinous ring by two
heads, one from the upper and one from the loweraspect of the lateral part of thecommon
tendinous ring. Between the two origins of the lateral rectos following structures are passing: 1.
Upper and lower division of the oculomotor nerve 2. Nasociliary nerve 3. Abducent nerve.
From the origin, the rectus muscles widen forwards to form the cone of muscles.
Insertion Lateral rectos is inserted to the anterior half of the eyeball laterally. Nerve Supply The
lateral rectus is supplied by the abducent nerve.
Action The lateral rectus moves the cornea horizontally and laterally. Function Abduction of
eyeball.
!aeries. cella.
Literal room Inferior rectos F10. IA.19.1 Rectos muscles of eyeball.
General Anatomy
SHORT NOTES
0.1. Short ciliary nerve. Ans.
Ciliary ganglion Oculomotor nerve PIO Short cilary nerve - SenSOry fibres - Sympathetic ttires
Perasyncethebc pregangionic fibres - Parasympathetic postgangOonic fibres Fig. 1A.19.2 Short
ciliary nerve.
The postganglionie parasympathetic fibres from dliary gan-glion are distributed to the eyeball
through short ciliary nerves and they innervate the sphincter pupillae and ciliary muscles (Fig.
IA.19.2). The ciliary ganglion gives 10-12 short ciliary nerves con-taining postganglionic fibres
for the supply of constrictor or sphincter pupillae for narrowing the size of pupil and ciliaris
muscle for increasing the curvature of anterior surface of lens required during accommodation
of the eye. 0.2. Actions of oblique muscles of eyeball. Ans. The oblique muscles of eyeball are in
the superior and inferior parts of the orbit (Fig. IA.19.3).
Leveret patoebrae superions .4 Stamm, rect.•mewl Ns
Superior °heave
Inledor Oblique utanro recNS inferior mortis Flg. 1 A.19.3 Oblique muscles of eyeball.
Actions of oblique muscles of eyeball are as follows: I. Contraction of superior oblique directs
the pupil down and out. 2. Contraction of inferior oblique directs the pupil up and out 3. The
functions of superior oblique muscle are depression, abduction and medial rotation of eyeball.
4. The functions of inferior oblique muscle are elevation. abduction and lateral rotation of
eyeball. 0.3. Fasclal sheath of eyeball.
Ans.
The fascia! sheath of the eyeball (bulbar sheath) is a layer of fascia that encloses a major part of
the eyeball (Fig. 1A.19.4). The eyeball can freely move within this sheath. 'the sheath gives off a
number of expansions: 1. A tabular sheath 2. The medial check ligament 3. The lateral check
ligament. Facial sheath of eyeball or bulbar fascia is firmly attached posteriorly, to the sclera
around the point of entrance of the optic nerve into the eyeball; anteriorly, to the sclera near the
edge of the cornea; additionally, as the muscles approach the eyeball, the investing fascia
surrounding each muscle blends with the fascia! sheath of the eyeball as the muscles pass
through and continue to their point of attachment. A specialized lower part of the fascia] sheath
of the eyeball is called the suspensory ligament of the eye or the suspensory ligament of
Lockwood, it supports the eyeball.
Fig. 1A.19.4 The WW1 sheath of the eyeball.

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Topic 20
REGIONAL ANATOMY OF
LONG ESSAY
Q.1. Cervical sympathetic chain. Ans. The cervical part of the sympathetic trunk is located on
each side of the cervical part of the vertebral column, behind the carotid sheath and in front of
the prevertebral fascia (Fig. IA.20.1). It is connected to each cervical spinal nerve by a gray
ramus communicans. There arc no white rani communications in the cervical ganglion region.
Flg.1A.20.1 Cervical part of the sympathetic hunk.
Cervical sympathetic chain is related: I. Anteriorly fO a. Internal carotid artery b. Common

carotid artery c. Carotid sheath d. Inferior thyroid artery 2. Posteriorly to a. Prevertebral fascia
b. Longus capitis and cervicis muscles 2 Transverse processes of the lower six cervical
vertebrae. Ganglia Along the course of the sympathetic trunk in the cervical region three
ganglia, i.e. superior, middle and inferior cervical ganglia, are usually described.
I. Superior cervical ganglion This is the largest of the three ganglia. It is spindle-shaped, and
about 2.5 cm long. It is located just below the skull, opposite the second and third cervical
vertebrae. It is formed by the fusion of the upper four cervical ganglia. It marks the superior
extent of sympathetic trunk. Its branches pass to the following: a. The internal and external
carotid arteries forming plex-uses around these vessels. b. Cervical spinal nerves Cl to C4
through gray rami com-municantes. c. The pharyngeal branches take part in the formation of
the pharyngeal plexus. d. The heart as superior cardiac nerves: the left superior cer-vical cardiac
branch goes to the superficial cardiac plexus whik the right branch goes to the deep cardiac
plexus. 2. Middle cervical ganglion It is the second ganglion inferior to the superior cervical
ganglion along the course of the sympathetic trunk. The middle cervical ganglion is very small
and encountered at about the level of cervical vertebra C6. Branches from this ganglion pass to
the following: a. Cervical spinal nerves C5 and C6 through gray rami comtnunicentes. b. The
heart as middle cardiac nerves which is the largest of the sympathetic cardiac branches. It goes
to the deep cardiac plexus. c. Tracheal and oesophageal branches. iL Thyroid branches
accompany the inferior thyroid artery to the thyroid gland.They also supply the parathymid
glands. 3. Inferior cervical ganglion At the lower end of the cervical part of the sympathetic
trunk the inferior cervical ganglion is formed by the fusion of thc seventh and eighth cervical
ganglia, which becomes very large when it combines with the first thoracic ganglion and forms
the cervicothonkic ganglion (stellate ganglion). The inferior cervical ganglion is situated
anterior to the neck of first rib and the transverse process of cervical vertebra C7, and posterior
to the first part of the subclavian artery and thc origin of the ver-tebral artery. Branches from
this ganglion pass to the following: a. Spinal nerves C7 to T1 through gray rami communicanks
b. The vertebral artery, forming a plexus associated with this vessel c. The heart as inferior
cardiac nerves.
This ganglion also receives white rami communicantes from thoracic spinal nerve TI and,
occasionally, from T2.
Clinical Anatomy I. The head and neck are supplied by sympathetic nerves arising from the
upper four thoracic segments of the spinal cord. Most of these preganglionic fibres pass through
the stellate ganglion to relay in the superior cervical ganglion.
Topic 21
General AVIV
2. Injury to cervical sympathetic trunk produces Homers syndrome, which is characterized by

the following: a. Ptosis (i.e. drooping of the upper eyelid) b. Miosis (i.e. constriction of the pupil)
c. Anhydrosis (i.e.loss of sweating on that side of the face) d. Enophthalmos (i.e. retraction of the
eyeball) e. Loss of the ciliospinal reflex (i.e. pinching the skin on the nape of the neck) dots not
produce dilatation of the pupil which normally takes place.
LONG ESSAY
0.1. Describe superolateral surface of cerebrum. Ans. I. The cerebrum is made up of two cerebral
hemispheres which are incompletely separated from each other by the median longitudinal
fissure. 2. The two hemispheres are connected to each other across the median plane by the
corpus callosum. Each hemi-sphere contains a cavity, called the lateral ventricle. Each cerebral
hemisphere has the following external features: Three surfaces I. The superolateral surface 2.
The medial surface 3. The inferior surface. Four borders I. The superomedial border
2. The infrrolateral border 3. The medial orbital border 4. The medial occipital border. Three
poles 1. Frontal pole, at the anterior end 2. Occipital pole, at the posterior end 3. Temporal pole,
at the anterior end of the temporal lobe. Each cerebral hemisphere is divided into four lobes: I.
Frontal 2. Parietal 3. Occipital 4. Temporal. The lobes are best appreciated on the superolateral
surface as in Figure IA.21.1.
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Aa Anatomy

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GENERAL ANATOMY

Through the subarachnoid space:

Through the posterior part:

Their attachments arc as follows:

Action of Inferior Constrictor Muscles of Pharynx

0.3. Hyoid bone.

0.4. Mastoid groove.

0.6. Deep cervical fascia.

0.7. Jugular foramen.

Through the middle part

Through the posterior part

0.8. Foramen lacerum.

0.9. Zygomatic arch.

0.10. Superior orbital fissure.

0.11. Greater horn of hyoid.

Common tenomous ring i- - Body or sphenoid Superior Orbilal fiNSUre

20:04 efilj Unti . ig AA 11-02-2022 16°C /\ =i ENG

Supra, al temporal artery Anna Posterior auricular artery

Sensory nerves 1. Supourcuharer 2. Sueraortillat Warier. 3. Zygmaticolemporte 4.

Ag. 1A.2.2 Maxillary nerve and its branches.

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say root Foramen wale

---***) !alma/ elvuotar nerve

Flg.1A.2.4 Auriculotemporal nerve.

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Quick Review Series: 1305 1st Year

Supracrbllal artery SupratrocNear artery

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Maxillary division of trigeminal nerve I. Infraorbital nerve 2. Zygomaticofacial nerve 3.

gengIon Manaibuior nerve Mt!!!!!!!!, Worst ',tavola Temporal Buccal Slybolossus

Quick Review Series: 1313S IM Year

Fig. 1A29 Dangerous area of the lace.

A' .' 4:=> 4 r JAIPI'' is . . ._ Long trowie nerve i , . ' . • Ca

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Jyotsna Rao - QRS x

Table 1A.3.2 Contents of the Mterior litangle

To 001Iokt sIon 00 Wont pan or &Tog

Flg.1A.4.2 Boundaries of wboccipital triangle.

t—Longissimus capitis (i Flg.1A.4.3 Roof of suboccipital triangle.

CONTENTS OF THE VERTMEll

Quit* Review Series: SOS 155 Year

GL—Posterior communicating artery --Postensr cerebral artery oerebelar ) _Iaterel Keene

0.1. Spinal dura meter. Ans.

nee•■••°."- Flg.1A.5.2 Subamehrod space.

Hypophysis cerebrl Sphenoidal sinus Internal carotid may

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Superior petrosal sinus Tantalum combo%

internal carotid artery

Quick Review Series: BDS 1st Year

■ Entre:brat Seene (entential space) SalbararletOKI space

0.14. Name structures in the lateral wall of cavern-ous sinus.

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11111111.1.111111rai Deep temporal artery • Temporalls muscle • Plerygoiel artery

Greater palatine 011VI y Pharyngeal

Fig. 1A.8.3 The boundaries of the carotid Wangle.

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Fig. 1A.111.13 External jugular vein.

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