Mosbys review for the nbde part i free download

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Whether you've loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. Quintessence Publishing USA. Paulo V. The chorda pathetic fibers from the carotid plexus tympani a branch from CN VII, con- before it enters the pterygoid canal. It taining parasympathetic fibers joins it emerges as the nerve of the pterygoid before it meets the submandibular gan- canal.

The nerve of the pterygoid canal glion, where it continues toward the continues toward the pterygopalatine fossa submandibular and sublingual glands. Auriculotemporal nerve: the auricu- toward the lacrimal gland along the zygo- lotemporal nerve travels posteriorly and matic nerve, a branch of CN V2 , and encircles the middle meningeal artery smaller glands in the nasal cavity, upper remaining posterior and medial to the pharynx, and palate Figure 1— It continues up toward the TMJ, 6.

Chorda tympani: the chorda tympani external ear, and temporal region, pass- branches from the facial nerve, carrying ing through the parotid gland and travel- both sensory fibers for taste and pregan- ing with the superficial temporal artery glionic parasympathetic fibers.

It exits and vein. Postganglionic parasympa- from of the temporal bone via the thetic nervous system fibers from the petrotympanic fissure and joins the lingual lesser petrosal branch, a branch from nerve a branch of CN V3 as it courses infe- CN IX, join the auriculotemporal nerve to riorly toward the submandibular ganglion the parotid gland.

Postganglionic parasym- F. CN VI: Abducens nerve pathetic fibers emerge from the ganglion 1. Motor distribution: lateral rectus muscle, submandibular glands see Figure 1— Sensory distribution: taste for the ante- rior two-thirds of the tongue. Temporal branch 2. Motor distribution: muscles of facial expression. Parasympathetic distribution: sublingual, submandibular, and lacrimal glands.

Anatomic pathway: the facial nerve enters the internal acoustic meatus, located in Zygomatic branch the temporal bone. In the bone, the facial nerve communicates with the geniculate CN VII ganglion and the chorda tympani nerve branches off.

The facial nerve then contin- Buccal branch ues and descends to exit the skull via the stylomastoid foramen. The auricular Mandibular branch nerve and nerves to the posterior belly of the digastric and stylohyoid muscles branch off before the facial nerve divides Cervical branch into five main branches: temporal, zygo- Figure 1— Facial nerve CN VII : motor branches to matic, buccal, mandibular, and cervical the muscles of facial expression.

Modified from branches Figure 1— Saunders, Nerve of the Lacrimal gland pterygoid canal. Deep petrosal n. Greater petrosal n. Pterygopalatine ganglion. Superior salivatory nucleus Pterygopalatine ganglion. Sublingual and Chorda tympani submandibular glands.

Submandibular ganglion Figure 1— It descends to the supe- 1. Foramen: internal auditory meatus. Sensory distribution: equilibrium, bal- the tympanic nerve of Jacobson or tym- ance, and hearing. Both ganglia I. CN IX: Glossopharyngeal nerve contain sensory and motor cell bodies.

The 1. Foramen: jugular foramen. Sensory distribution: posterior one-third inferiorly to provide sensory and motor of the tongue taste , pharynx, tonsils, function to the posterior tongue, middle middle ear, carotid sinus. Parasympathetic distribution: parotid carotid sinus. Parasympathetic pathway: the tympanic 4. It continues from there as ganglion.

They divide into external and the lesser petrosal nerve toward the otic internal laryngeal branches. The external laryngeal nerve provides nerve CN V3. Postganglionic parasympa- motor innervation to the cricothyroid thetic fibers emerge from the ganglion muscle and inferior pharyngeal con- and travel along the auriculotemporal strictor muscles.

The internal laryngeal nerve travels with Figure 1— CN X: vagus nerve through the thyrohyoid membrane to 1. Motor distribution with fibers from CN XI : membranes from the base of the tongue the laryngeal muscles phonation, swallow- to the vocal folds. The internal laryngeal ing , all muscles of the pharynx except the nerve also carries parasympathetic stylopharyngeus, and all muscles of the fibers. Recurrent laryngeal branches: the right 3.

Sensory distribution: posterior one third of recurrent laryngeal nerve ascends back to the tongue taste , heart, lungs, and the neck around the subclavian artery. The left recurrent laryngeal nerve passes 4. Parasympathetic distribution: heart, around the arch of the aorta or ligamen- lungs, abdominal organs. Anatomic pathway: the vagus nerve exits between the trachea and esophagus.

As the skull via the jugular foramen at the they ascend, the nerves provide sensory medulla. It descends through the superior and parasympathetic innervation to and inferior ganglion of the vagus nerve, mucous membranes and structures up to giving off branches in the pharynx and the vocal cords.

The nerves then continue larynx. The vagus nerve descends and is as the inferior laryngeal nerves in the lar- accompanied by the carotid artery and ynx, providing motor innervation to all jugular vein within the carotid sheath as it the muscles of the larynx, except the enters the thoracic area. In the thorax, the cricothyroid muscle. A motor branch also right and left vagus nerves then give off the provides innervation to the inferior pha- right and left recurrent laryngeal nerves, ryngeal constrictor muscle.

CN XI: Accessory nerve into the neck. The two vagus nerves meet 1. Past the 2. Sensory distribution: sternocleidomas- diaphragm, the joined vagus nerves toid and trapezius muscles. Also joins esophageal plexus divide into the ante- with CN X in supplying motor function to rior and posterior vagal trunks. Pharyngeal branches: the pharyngeal cles.

Foramen: hypoglossal canal. Motor distribution: intrinsic muscles of 7. Superior laryngeal branches: branch from the tongue, genioglossus, hyoglossus, and the vagus nerve just below the inferior styloglossus muscles.

Inferior salivatory Otic ganglion nucleus. Scheme of parasympathetic nerve fibers of CN IX. Masticator space—includes four spaces: Spaces and cavities of the a. Temporal space head and neck 1 Location: between the temporalis Potential spaces, or fascial spaces, of the head muscle and its fascia. Odontogenic infections can b. Infratemporal space therefore spread to these areas. Spaces of the maxillary region the mandible and temporalis mus- 1. Vestibular space of the maxilla cle.

Medially, it is bordered by the a. Location: between the buccinator mus- lateral pterygoid plate and phar- cle and oral mucosa. It is inferior to the ynx. It is inferior to the greater wing alveolar process. Potential odontogenic source of infec- 2 Contents: maxillary artery and its tion: maxillary molars. Canine fossa branches, and the pterygoid plexus.

Location: positioned just posteriorly 3 Infections of the infratemporal and superiorly to the roots of the maxil- space are considered dangerous lary canines. It remains inferior to the due to the potential of spread of orbicularis oculi muscle, posterior to infection to the cavernous sinus via the levator muscles, and anterior to the the pterygoid plexus.

Potential odontogenic source of infec- infection: maxillary third molars tion: maxillary canines and first premo- and infectious anesthetic needles. Submasseteric space 3. Canine space 1 Location: between the masseter a. Location: situated within the superfi- muscle and mandibular ramus. It is 2 Potential odontogenic source of posterior to the orbicularis oris muscle infection: mandibular third molars and anterior to the levator anguli oris rare.

Communications: buccal space. Buccal space d. Pterygomandibular space a. Location: between the buccinator and 1 Location: between the medial masseter muscles. Consists of the buccal fat pad.

It is inferior to the lateral c. Communications: canine and pterygo- pterygoid muscle. Spaces of the mandibular region chorda tympani. Vestibular space of the mandible 3 This is the site for the inferior alve- a. Location: between the buccinator mus- olar nerve anesthetic block. It is inferior to the 4 Potential odontogenic source of alveolar process.

Potential odontogenic source of infec- third molars. Also consider infec- tion: mandibular posterior teeth and tious anesthetic needles. Submental space 2. Space of the body of the mandible a. Location: between the anterior bellies a. Location: between the body of the of the digastric muscles. It is superior mandible and its periosteum. Potential odontogenic source of infec- to the mylohyoid muscle. Contains the submental lymph nodes c. Communications: buccal, submental, and anterior jugular vein.

Potential odontogenic source of infec- and the vestibular space of the mandible. Note: Infection in this space geal constrictor muscle, to the thorax.

If the infec- b. Because odontogenic infections can tion spreads bilaterally to involve the quickly spread down this space into the sublingual and submandibular spaces, thorax, it is known as the danger space. For example, an untreated infection of a d. Communications: space of the body of mandibular incisor, with an apex above the mandible, submandibular and sub- the mylohyoid muscle, may spread lingual spaces. Location: between the mylohyoid and eral pharyngeal or parapharyngeal platysma muscle.

Pterygomandibular space muscles. Location: between the medial pterygoid b. Contains the submandibular lymph muscle and mandibular ramus. It is infe- nodes, submandibular salivary gland, rior to the lateral pterygoid muscle.

Contains the inferior alveolar nerve c. Potential odontogenic source of infec- and artery, lingual nerve, and chorda tion: mandibular second and third tympani. This is the site for the inferior alveolar d. Communications: infratemporal, sub- nerve anesthetic block. Potential odontogenic source of infec- spaces. Sublingual space e. Communications: parapharyngeal space. Location: between the tongue and its intrinsic muscles and the mandible.

It is superior to the mylohyoid muscle and 1. Ear b. Contains the sublingual salivary gland, submandibular salivary gland duct, lin- A. Includes the auricle and external auditory c. Potential odontogenic source of infec- meatus Figure 1— The external auditory meatus external lars, and mesial roots of the first molars, ear and tympanic cavity middle ear presuming that the apices of these teeth are separated by the tympanic mem- lie above the mylohyoid line.

Communications: submental and sub- 3. Tympanic membrane eardrum mandibular spaces and the space of the a. Its external surface is covered by epi- body of the mandible.

Spaces of the neck sists of a mucous membrane. Parapharyngeal space b. It is transversed by the chorda tympani. Location: fascial space between the c. Transfers sound vibrations from air to pharynx and medial pterygoid muscle, auditory ossicles. Middle ear extends to the pterygomandibular 1. Three bones: malleus, incus, and stapes raphe anteriorly, and around the phar- see Figure 1— Loud sounds cause the tensor tympani b.

Communications: masticator, subman- which attaches to the malleus to con- dibular, retropharyngeal, and previs- tract, pulling the malleus and tympanic ceral spaces. Retropharyngeal space and prevent damage. Location: between the vertebral and C. Internal ear visceral fasciae, just posterior to the 1.

Cochlea pharynx. It extends from the base of the a. Senses hearing. Right ear: external, middle, and inner Auricle Incus Malleus Semicircular canals ear.

Cochlea Tympanic cavity Tensor tympani. Tympanic membrane. External Opening acoustic into meatus Auditory nasopharynx tube. Receptors hair cells for hearing are It is more convex than the sclera and located in the organ of Corti. This spiral sticks out as a small lump. Vascular coat the basilar membrane. Lies just behind the fibrous layer. Vestibule 2. Consists of the choroids, ciliary body, and a. Senses equilibrium. Consists of the utricle and saccule. The center opening of the iris is the pupil.

Semicircular canals—sense balance and The size of the pupil is controlled by two body position see Figure 1— Constrictor pupillae muscle—con- stricts the pupil. Dilator pupillae muscle—dilates the A. Fibrous layer pupil. It is innervated by sympathetic 1. Sclera—fibrous covering of the posterior fibers.

Retina 2. Cornea—transparent, avascular layer that 1. The inner lining of the eyeball. Photosensitive region. Cornea Anterior chamber Figure 1— Right eyeball: superior Posterior chamber view.

Scleral venous sinus Louis, Mosby, Ora serrata Rectus muscle. Includes area posterior to the ora ser- b Are less convergent, which gives rata. Optic disc c Three types of cones: red, 1 Where the optic nerve exits. This area c. Fovea centralis only contains cones and is the 1 Located approximately 2. Cells of the retina a. Epithelial cells 3 Photoreceptor membrane poten- 1 Comprise the pigment epithelium.

Photoreceptors—two types: amount of cyclic guanosine 1 Rods monophosphate cGMP is a For nondiscriminative vision released, causing sodium chan- low resolution. They are used nels to open. This causes depo- for seeing in the dark and larization of the photoreceptor detecting motion. This results in c The density of rods increases the closing of sodium channels, toward the periphery of the and the photoreceptor mem- eye. It decreases toward the brane hyperpolarizes.

Bipolar cells—synapse with rods and fovea centralis , where there cones. Ganglion cells—the axons of ganglion 2 Cones cells combine to form the optic nerve. Amacrine cells tion. They are also used for 1 Interneurons that connect bipolar color vision. May contribute. Rods converge small Cones read small signals signals, creating a larger directly—maximizing response in bipolar visual acuity i. Photoreceptors: convergence.

Bones 2 May also play a role in detecting motion. The skull f. Horizontal cells 1. There are a total of 22 cranial and facial 1 Interneurons that connect rods and bones in the skull Figure 1— Note: cones with each other and with some texts include the ossicles of the ears bipolar cells.

Cranial bones: ethmoid 1 , frontal 1 , cells. No action b. Facial bones: inferior concha 2 , potential is created. Lens nasal 2 , palatine 2 , vomer 1 , The lens, by virtue of its shape, controls focus- zygoma 2.

The shape is con- c. Ossicles of the ears: malleus 2 , incus trolled by: 2 , stapes 2. Ciliary muscles. Contraction of these mus- 2.

Cranial sutures cles leads to relaxation of: a. Coronal suture—joins the frontal and a. Fibers that suspend the lens, allowing it parietal bones see Figure 1— Sagittal suture—joins the left and right vision. Stimulation of the parasympathetic c. Lambdoidal suture—joins the parietal nerve to the eye leads to contraction of and occipital bones Figure 1— Squamosal suture—joins the parietal tion for near vision.

Lateral view of the skull: cranial bones and sutures. Temporozygomatic suture—joins the c. The ethmoid bone houses the ethmoid zygomatic and temporal bones. Medial palatine suture—joins the left middle nasal conchae. Temporal bone g. Transverse palatine suture—joins the a. The temporal bone forms the lateral maxilla and palatine bones. It articulates with the 3. Sphenoid bone parietal, occipital, sphenoid, and zygo- a. The sphenoid bone is located along the matic bones and the mandible.

It articulates b. The temporal bone consists of three with all the cranial bones and four portions: facial bones: the maxilla, palatine 1 Squamous portion—includes the bones, vomer, and zygoma. The sphenoid bone consists of a body, bone. The inferior surface of the greater and lesser wings, and paired zygomatic process is the articular pterygoid processes.

Anterior to this fossa is the 1 The body contains the sphenoid articular eminence. This is where sinuses. Foramina include the stylo- part of the superior orbital fissure.

The space floor and anterior wall of the exter- between these two plates is the nal acoustic meatus. It is separated pterygoid fossa. Maxilla orbit, called the pterygopalatine a. The left and right maxilla fuse to form the fossa. The maxillae articulates with c. The sphenoid bone contains many the frontal, lacrimal, nasal, inferior nasal foramina and fissures. This includes concha, vomer, zygoma, sphenoid, eth- the foramen ovale, foramen rotundum moid, and palatine bones Figure 1— Each maxilla consists of a body and rior orbital fissure.

Sella turcica—a cradle at the center of alveolar, and palatine processes. Ethmoid bone sinuses. The ethmoid bone is also located along 2 The frontal process: the midline of the cranium.

It articu- a Contains an orbital surface that lates with the frontal, sphenoid, and is part of the inferior wall or lacrimal bones and the maxilla and floor of the orbit. Its structures include the cribriform rim with the lacrimal bone.

It becomes the infra- roof of the nasal cavity and is orbital canal and terminates at pierced by olfactory nerves. Frontal bone Ethmoid bone Nasal bone Lacrimal bone Infraorbital sulcus Frontal process of maxilla Inferior nasal concha Infraorbital foramen Zygomatic process of maxilla Body of maxilla Location of Vomer maxillary sinus Alveolar process Ramus of mandible of maxilla Alveolar process of mandible Mental foramen Body of mandible.

Anterior view of the skull: anterior aspect of the maxilla and mandible. A bony covered by a fibrous, tendinous prominence observed behind the sheet called the palatine aponeuro- upper third molar is known as the sis.

The midline forms a ridge that is maxillary tuberosity. Mandible to form the hard palate Figure 1— The mandible is a single bone that con- These two processes are separated sists of two vertical rami, a horizontal. Inferior view of the hard palate. Mandibular growth takes place in sev- 1— Cranial openings 2 The anterior border of the ramus 1. Cranial openings include foramina, canals, descends from the coronoid and meatus. A summary of important cranial openings 3 The horizontal portion of the is presented in Table 1— The orbit alveolar process, which contain the 1.

The orbit is the cavity in the skull that roots of the lower teeth. If an imagi- houses and safeguards the eyeball. The mandible provides many surface A summary of these bones is presented landmarks.

Bony openings of the orbit include the: landmarks include the mental pro- a. Optic canal—found at the apex of the tuberance, the mental foramen, the orbit. Inferior orbital fissure—separates the process, and the condyle Figure floor of the orbit from its lateral wall. Superior orbital fissure—lies between 2 From the medial aspect, important the greater and lesser wings of the landmarks include the mandibular sphenoid bone. The nasal cavity line and groove, the submandibular 1.

The nasal cavity is divided into two parts and sublingual fossa, and the retro- by the nasal septum. Each side contains molar triangle Figure 1—22, B. The superior and middle. A Coronoid process Condylar process. Landmarks of the mandible. A, Medial view. B, Lateral view. TABLE 1— Superior meatus—opens into the pos- terior ethmoid sinus. Medial wall Ethmoid bone— c. Inferior meatus—communicates with orbital plate the nasolacrimal duct, which drains Superior- Lacrimal bone medial wall tears from the eye.

Inferior- Frontal bone— d. The sphenoid sinus directly communi- medial wall orbital plates cates with the nasal cavity. Maxilla—orbital plate e. Sphenopalatine foramen—opens into Lateral wall Zygomatic bone— Superior orbital the pterygopalatine fossa. Fossa Sphenoid bone— greater wing 1.

Pterygopalatine fossa Floor or Maxilla—orbital Inferior orbital fissure a. Boundaries and communications of the inferior wall plate pterygopalatine fossa are listed in Zygomatic bone Palatine bone— Table 1— Communicates with the infratemporal Apex Sphenoid bone— Optic canal fossa via the pterygomaxillary fissure.

Contents: branches of the maxillary artery, branches of the maxillary nerve CN V2 , and the pterygopalatine gan- glion. Infratemporal fossa The inferior conchae is a separate bone. Boundaries and communications of the 2. Between the conchae are small slit-like infratemporal fossa are listed in Table openings, or meatus, which allow commu- 1— Contents: branches of the mandibular paranasal sinuses or the nasolacrimal nerve CN V3 , the chorda tympani, the duct.

Roof Sphenoid bone — 3. Mouth —body a. Orbicularis oris—closes and protrudes Floor Pterygopalatine — upper and lower lips. Levator labii superioris—pulls lip up. Levator labii superioris alaque nasi— Posterior Sphenoid bone— Pterygoid canal, pulls lip up, flares nostrils. Mentalis—protrudes lower lip, tightens Medial Palatine bone— Nasal cavity via the chin.

Levator anguli oris—lifts the corner of foramen Lateral Pterygomaxillary Infratemporal fossa via the mouth. Zygomaticus major and minor—lift the fissure corner of the mouth. Muscles of mastication 1. There are four primary muscles of masti- cation, including the temporalis, the mas- seter, and the medial and lateral pterygoid muscles. Roof Sphenoid bone— Temporal fossa, b. The lateral pterygoid muscle is greater wing foramen ovale, involved in protrusion, depression, and foramen spinosum lateral excursion of the mandible.

Floor Open — Anterior Maxilla— Orbit via the inferior c. The origins and insertions of these tuberosity orbital fissure muscles are described in Table 1— Posterior Open — 2.

The hyoid muscles assist the muscles of Medial Sphenoid bone— Pterygopalatine fossa lateral pterygoid via pterygomaxillary mastication in retruding and depressing plate fissure the mandible. Lateral Mandible—ramus, — 3.

The muscles of mastication and hyoid coronoid process muscles are involved in coordinating mandibular movements Figure 1—23 : a. Closing the mouth 1 Temporalis—anterior vertical and artery, the pterygoid venous plexus, posterior fibers. Opening the mouth 1 Lateral pterygoid. Muscles of facial expression: major muscles a Infrahyoid muscles—these mus- and their actions. Eyes and eyebrows the digastric muscle will aid a. Epicranius occipitofrontalis muscle— in depressing and stabilizing raises the eyebrows and forehead.

Orbicularis oculi—closes the eyelid, suprahyoid muscles to help pull blinking. Corrugator—depresses the eyebrows. Face anterior belly of the digastric a. Buccinator muscle—compresses the muscle. Protrusion chewing.

Hyoid muscles 1. The hyoid muscles are divided into two Temporalis groups, depending on their location above or below the hyoid bone.

The suprahyoid muscles are superior Medial to the hyoid bone and include the ante- Lateral pterygoid rior and posterior digastric muscles, pterygoid the mylohyoid, geniohyoid, and stylo- hyoid.

The mylohyoid muscle forms the floor of the mouth. Masseter b. The infrahyoid muscles are inferior to Suprahyoid the hyoid bone and include the ster- Elevates mandible muscles nothyroid, sternohyoid, omohyoid, and Infrahyoid thyrohyoid. A summary of these mus- Depresses mandible muscles cles is presented in Table 1— Infrahyoid muscles Figure 1— Role of muscles of mastication and hyoid a. Innervation: cervical nerves C1—C3 muscles in mandibular movement.

Major actions: 1 Assist the muscles of mastication in 2 Lateral pterygoid—inferior head. Retraction 2 Steady the hyoid bone and larynx 1 Temporalis—posterior fibers. Suprahyoid muscles a Suprahyoid muscles—espe- a. Innervation: refer to Table 1— Major actions: tric muscle. Lateral excursion 2 Raise the hyoid bone and larynx 1 Lateral pterygoid—on the non- when swallowing. Neck muscles of the direction of movement.

The muscles in the neck include the Note: an injured lateral pterygoid platysma, the sternocleidomastoid SCM , will cause the jaw to shift to the and the trapezius muscle. These muscles same side of the injury. Platysma—a thin layer of muscle found in acts as a stabilizer. Sternocleidomastoid a. The posterior trian- and gle can be divided into the occipital pectoralis Sternocleido- CN XI Clavicle and Mastoid and subclavian triangle.

Contraction of both SCMs will occipital scapula flex the neck. The carotid pulse can be felt at the and thoracic anterior-superior border of the SCM vertebral muscle, just posterior to the thyroid column cartilage. Neck triangles as viewed from the left side. Digastric Trapezius muscle Posterior cervical triangle Mylohyoid in submental triangle Omohyoid Carotid triangle Sternohyoid in muscular triangle.

Trapezius 2. Innvervation: refer to next page for inner- a. Action: contraction of the trapezius ele- vation of muscles of the pharynx. Muscles of the pharynx shrugging shoulders. The muscles of the pharynx include the E. Muscles of the soft palate superior, middle, and inferior constrictor 1. Muscles of the soft palate include the muscles; the stylopharyngeus; and the palatoglossus, palatopharyngeus, levator salpingopharyngeus. The major action of veli palatine, tensor veli palatine, and these muscles is to move the pharynx and uvula.

A summary of a. The palatoglossus forms the anterior their origins, insertions, and actions is tonsillar pillar. The palatopharyngeus forms the poste- 2. Innervation: rior tonsillar pillar and also closes off a.

Muscles of the soft palate and pharynx the nasopharynx and larynx during are all innervated via the pharyngeal swallowing. The tensor veli palatine wraps around lowing three exceptions: the lateral side of the pterygoid hamu- 1 Tensor veli palatine—innervated by lus and tenses the soft palate.

CN V3. A summary of these muscles is pre- 2 Stylopharyngeus—innervated by sented in Table 1— CN IX. It also raises the larynx mylohyoid line Middle constrictor Hyoid bone, stylohyoid ligament Inferior constrictor Thyroid and cricoid cartilages Stylopharyngeus Styloid process Thyroid cartilage, lateral Raise and dilates pharynx, helping food wall of the pharynx move through.

Surface anatomy Figure 1—25 : fibers. Dorsum of tongue—divided into two c. Sensory function: CN IX. Muscles of the larynx tongue, which lies relatively freely in the 1.

The muscles of the larynx include the oral cavity, and the posterior one third of cricothyroid, oblique and transverse ary- the tongue, which covers the oral cavity tenoids, thyroarytenoid, and the lateral and lies in the pharynx. A sum- 2. Sulcus terminalis—a V-shaped depression mary of these muscles and their actions is that divides the anterior two thirds from presented in Table 1— It is 2. Innervation: all muscles of the larynx are an embryologic remnant resulting from innervated by CN X via the recurrent the fusion between the first and second laryngeal nerve except the cricothyroid, pharyngeal arches.

Foramen cecum—a small pit located at nal laryngeal nerve. Area around epiglottis: CN X: general and special sensory. Filiform papillae. Dorsal aspect of the tongue: surface landmarks and sensory innervation. A summary 4. Lingual papillae—elevated structures of their origins, insertions, and actions is found on the surface of the tongue. There presented in Table 1— Innervation: a.

Filiform papillae a. Motor function: motor innervation for 1 Thin, pointy projections that com- all intrinsic and extrinsic muscles is prise the most numerous papillae from CN XII. Sensory function see Figure 1—25 : its characteristic rough texture. A loss of general and special sensation is filiform papillae results in glossitus.

Fungiform papillae 3 Area around the epiglottis: inner- 1 Round, red spots that are less vated by CN X via the internal numerous than filiform papillae. Vascular supply—the blood supply is from teristic mushroom shape. Circumvallate vallate papillae 1 The largest papillae and are 12 to 13 in number.

Triangles of the neck 2 Arrangement: in a row parallel and The SCM divides each side of the neck into ante- just anterior to the sulcus terminalis. Anterior triangle d. Foliate papillae 1. Borders: anterior margin of the SCM, mid- 1 Vertical folds found posteriorly on line of the neck, and inferior border of the the side of the tongue. Subdivisions: e. Note about taste buds: taste buds con- tain neuroepithelial taste cells. They can discriminate five taste sensations: salty, sweet, sour, bitter, and the recently described umami taste taste TABLE 1— Intrinsic muscles of the tongue—muscles found entirely within the tongue.

Their main function is to change Styloglossus Styloid process Tongue Retracts the shape of the tongue. Extrinsic muscles of the tongue—there sides of are three extrinsic muscles of the tongue, tongue including the genioglossus, styloglossus, Hyoglossus Greater horn Tongue Depresses and body of tongue and hyoglossus Note: some texts also hyoid bone include the palatoglossus.

Submandibular digastric triangles artery and its branches C3, C4 , branches 1 Borders: upper margin of the ante- of the cervical plexus, CN XI, suprascapu- rior and posterior bellies of the lar artery and vein, nerves to the upper digastric muscle, inferior border of limb and muscles of the triangle floor, the mandible. It is subdivided by the omohyoid muscle muscles. Subclavian supraclavicular triangle nerve, and nerve to the mylohyoid 1 Borders: inferior border of the infe- muscle. Submental triangle one-third of the clavicle, and poste- 1 Borders: between the right and left rior border of the SCM.

Occipital triangle c. Muscular triangles 1 Borders: superior border of the 1 Borders: inferior border of the inferior belly of the omohyoid, pos- superior belly of the omohyoid terior border of the SCM, and the muscle, anterior border of the SCM, anterior border of the trapezius. The axilla is a space described as a pyramid, d. Carotid triangles with a base composed of the skin and superficial 1 Borders: superior border of the fascia of the armpit.

The apex rises to the level of superior belly of the omohyoid the mid-clavicle. It contains the nerves and blood muscle, inferior border of the pos- vessels supplying the upper limbs. Axilla and the anterior border of the SCM. Boundaries: the axilla is bounded by three 2 Floor: inferior pharyngeal constric- skeletal and muscular walls. Anterior wall 3 Contents: common carotid artery 1 Contains the clavicle superiorly which bifurcates near the upper and the pectoralis major and pec- border of the thyroid cartilage and toralis minor muscles.

Medial wall vein and its tributaries, vagus nerve 1 The lateral thoracic wall covered CN X including external and inter- by the serratus anterior muscle.

Posterior triangle 2 The teres major and latissimus 1. Borders: posterior border of the SCM, dorsi muscles contribute to the anterior border of the trapezius and the inferior aspect of the posterior wall. Contents: 2. Floor: splenius capitis, levator scapulae, a. The axilla contains portions of the: posterior and middle scalene muscles.

Contents: external jugular and subclavian 2 Axillary artery. The axillary sheath encloses the artery, c A suprascapular superior border. Axillary lymph nodes receiving lymph fossae for muscle attachments.

Shoulders and upper extremities b The infraspinous fossa below Limbs develop from outgrowths of the axial the spine. The upper limb develops from body wall 4 The acromion articulates with the segments of the lower four cervical and first tho- clavicle at the acromioclavicular racic levels.

Muscle, nerve, blood vessels, and joint. The suprascapular notch, on lymphatic drainage arise concomitantly. The the superior border of the spine, is upper limb has four skeletal components: shoul- the site of transmission of the der girdle, arm, forearm, and hand. Additional suprascapular nerve and vessels. The shoulder girdle consists of the superolateral border. The scapula is a broad, flat, thin, trian- base of the coracoid process, artic- gular-shaped bone Figure 1— The clavicle is an S-shaped bone com- b An axillary lateral border facing monly known as the collarbone Figure the axilla.

Coracoid process Spine of scapula Suprascapular notch Supraspinous fossa Glenoid fossa. Infraspinous Subscapular fossa fossa.

Vertebral Axillary border border Vertebral border. Inferior angle Figure 1— Right scapula. Posterior view left and anterior view right. Lateral curvature Figure 1— Right clavicle. Supe- rior view top and inferior view bottom. Medial curvature Lateral end Medial end with acromion with sternum. For attachment of For attachment of costoclavicular ligament acromioclavicular ligament. The arm consists of the humerus bone articulates with the radius of the Figure 1— The humerus is the only bone of the 9 The lateral epicondyle above the arm.

The forearm consists of the radius and shaft meets the upper portion of the ulna Figure 1— Greater tubercle Greater tubercle Lesser tubercle Intertubercular sulcus Anatomical neck.

Surgical neck. Lateral supracondylar Medial supracondylar Lateral supracondylar ridge ridge ridge. Coronoid fossa Olecranon fossa. Lateral epicondyle Medial epicondyle Lateral epicondyle. Trochlea Figure 1— Right humerus. Anterior aspect left and posterior aspect right.

The radius is lateral to the ulna when in 1 The trochlear notch on the proxi- the anatomical position with palms fac- mal end of the ulna curves around ing forward or in the supine position.

The wrist and hand consist of carpal pointed, distal portion of the radius. Carpal bones sion on the inferomedial aspect of 1 There are eight short, cuboidal the radius, serves as the articula- carpal bones in the wrist, each tion with the distal end of the ulna.

The ulna is lateral to the radius when in row with four bones in each row. Ulnar notch. Medial styloid Lateral styloid process Lateral styloid process process Figure 1— Ulna and radius of right forearm. Anterior view left and posterior view right. Metacarpal bones 2 The pectoralis minor muscle is a 1 These bones form the skeleton of small, triangular muscle arising the palm of the hand; each base from the anterior chest wall deep to articulates superiorly with the distal the pectoralis major muscle and row of carpals and inferiorly with inserting on the coracoid process the phalanges.

Phalanges a Protracts, depresses, and rotates 1 Each finger has three phalanges: the scapula laterally. Muscles are grouped by region: pectoral, 3 The subclavius is a small muscle superficial back, shoulder, arm, forearm, located below the clavicle.

Pectoral Figure 1— Deltoid Pectoralis major clavicular head. Pectoralis major sternal head. Pectoralis minor Biceps brachii short head-cut Subscapularis. Biceps brachii long head-cut Latissimus dorsi.

Coracobrachialis Serratus anterior Brachialis. B Figure 1— Muscles of pectoral region and anterior right arm. A, Superficial. B, Deep. Superficial back Figure 1—31, Table 1— Teres major Triceps brachii b Supplied mainly by CN XI with a Long head small supply from branches of Latissimus dorsi Lateral head the cervical plexus of nerves in Medial head the neck. Levator scapulae 4 The major and minor rhomboid Rhomboid major muscles originate from the verte- Infraspinatus brae to insert into the vertebral Rhomboid minor Teres minor border of the scapula.

Triceps brachii a Retracts and medially rotates Long head the scapula. Latissimus dorsi Lateral head b Supplied by the dorsal scapular Medial head nerve. Shoulder see Figures 1—30 and 1—31, Table 1— B a Anterior fibers flex and medially Figure 1— Posterior muscles of the right shoulder rotate the posterior fibers, and and arm.

TABLE Upper fibers Cranial nerve XI: and cervical spines Clavicle: superior lateral third elevate scapula spinal accessory Ligamentum nuchae 2. Middle fibers spines retract scapula Skull: superior nuchal 4. Rotates laterally line and inion glenoid fossa points up Latissimus dorsi Vertebrae: spines Humerus: floor of 1.

Adducts arm Thoracodorsal nerve of T6 to T12 intertubercular sulcus 2. Extends arm Os coxae: iliac crest 3. Rotates arm Lumbodorsal fascia medially Ribs: lower three to four Levator scapulae Vertebrae: transverse Scapula: superior aspect 1. Elevates scapula Dorsal scapular processes of C1 to 4 of vertebral border 2. Rotates scapula medially glenoid fossa down Rhomboids Vertebrae: spinous Scapula: vertebral border 1. Retracts scapula Dorsal scapular processes of C7 to T5 2.

Rotates scapula medially glenoid fossa down. Louis, Mosby, , Table 9—2, p. APR, Anterior primary rami. Abducts arm Axillary lateral third tuberosity 2. Flexes arm Scapula: acromion 3. Rotates arm medially and spine anterior fibers 4. Extends arm posterior fibers 5. Rotates arm laterally posterior fibers Teres major Scapula: inferior angle Humerus: medial 1.

Extends arm Lower subscapular lip of intertubercular 2. Medially rotates arm sulcus 3.