• Long bones (e.g.. femur and humerus)
• Short bones (e.g.. wrist and ankle bones)
• Flat bones (e.g.. ribs)
• Irregular bones (e.g.. vertebrae)

The Orbital Margin

• The frontal, maxillary and zygomatic bones contribute equally to the formation of the orbital margin.

• The supraorbital margin is composed entirely of the frontal bone.
• At the junction of its medial and middle thirds is the supraorbital foramen (sometimes a notch), which transmits the supraorbital nerves and vessels.

• The lateral orbital margin is formed almost entirely of the frontal process of the zygomatic bone.

• The infraorbital margin is formed by the zygomatic bone laterally and the maxilla medially.

• The medial orbital margin is formed superiorly by the frontal bone and inferiorly by the lacrimal crest of the frontal process of the maxilla.
• This margin is distinct in its inferior half only.

Appendicular Skeleton
Upper extremity
•    Shoulder-clavicle and scapula

Clavicle
    Articulates with the manubrium at the sternal end
    Articulates with the scapula at the lateral end
    Slender S-shaped bone that extends horizontally across the upper part of the thorax
    
Scapula

    Triangular bone with the base upward and the apex downward
    Lateral aspect contains the glenoid cavity that articulates with the head of the humerus
    Spine extends across the upper part of the posterior surface; expands laterally and
    forms the acromion (forms point of shoulder) 
    Coracoid process projects anteriorly from the upper part of the neck of the scapula
    
Arm (humerus)

Consists of a shaft (diaphysis) and two ends (epiphyses)
Proximal end has a head that articulates with the glenoid fossa of the scapula
Greater and lesser tubercles lie below the head

Intertubercular groove is located between them; long tendon of the biceps attaches here
Surgical neck is located below the tubercles

    o    Radial groove runs obliquely on the posterior surface; radial nerve is located here

    o    Deltoid muscles attaches in a V-shaped area in the middle of the shaft. called the deltoid tuberosity
    
Distal end has two projections. the medial and lateral epicondyles
Capitulum-articulates with the radius
Trochlea-articulates with the ulqa

Forearm

Radius
Lateral bone of the forearm
Radial tuberosity is located below the head on the medial side
Distal end is broad for articulation with the wrist: has a styloid process on its lateral side

Ulna

    Medial side of the forearm
    Conspicuous part of the elbow joint (olecranon)
    Curved surface that articulates with the trochlea of the humerus is the trochlearnotch
    Lateral ide is concave (radial notch); articulates with the head of the radius Distal end contains the styloid process 
    Distal end contains the styloid process

Hand

Carpal bones (8)
    Aranged in two rows of four
    Scaphoid. lunate. triquetral. and pisiform  proximal row); trapezium. trapezoid.
    capitate. and hamate (distal row)
    
Metacarpal bones (5)
    Framework of the hand
    Numbered 1 to 5 beginning on the lateral side
    
Phalanges (14)
    Fingers
     Three phalanges in each finger; two phalanges in the thumb

NEUROHISTOLOGY

The nervous system develops embryologically from ectoderm, which forms the neural plate

Successive growth and folding of the plate results in the formation of the primitive neural tube.

The neuroblasts in the wall of the tube differentiates into 3 cell types:

Neurons:  conduction of impulses

Neuroglial cells: connective tissue and support of CNS

Ependymal cells:  Lines the lumen of the tube.

   - Specialized neuro-ectodermal cells which lines the ventricles of the adult brain

                - Essentially also a neuroglial cell

Basic Unit = neuron

Exhibits irritability (excitability) and conductivity

A typical neurons consists of:

Cell body : Has nucleus (karyon) and surrounding cytoplasm (perikaryon) which contains organelles cell's vitality

Dendrites:  Several short processes

Axon:One large process

Terminates in twig like branches (telodendrons)

May also have collateral branches projecting along its course. These exit at nodes of Ranvier

Axon enveloped in a sheath, and together forms the nerve fiber

Classification:

May be done in different ways, i.e.

Functional = afferent, efferent, preganglionic, postganglionic, etc.

Morphological = shape, processes, etc

A typical morphological classification is as follows

a. Unipolar: Has one process only Not found in man

b. Bipolar (so-called ganglion cell):Has two processes Found in sensory systems, e.g. retina olfactory system

c. Multipolar: Has several process Most common in CNS

Cell bodies vary in shape, e.g.  stellate (star) , pyramidal

d. Pseudo-unipolar: Essentially bipolar neurons, but processes have swung around cb and fused with each other. They therefore enter and leave at one pole of the cell.

Typical neuron:

- Has 2 or more dendrites

Close to the cb the cytoplasm of dendrites has Nissl granules as well as mitochondria

Only one axon Arises from axon hillock, Devoid of Nissl granules, Encased in myelin sheath

No additional covering except for occasional foot processes of neuroglial cells

May branch at right angles

Branches at a node of Ranvier is known as a collateral

Ends of axons break up into tree-like branches, known as telodendria

Axons may be short (Golgi Type II) e.g. internuncial long (Golgi Type I) e.g. pyramidal neuron

Nucleus Central position Large and spherical

Chromatin is extended and thus not seen in LM. This allows the nucleolus to be prominent

Cytoplasm (perikaryon)

Surrounds nucleus  May be large or small, shape may be round, oval, flattened, pyramidal, etc

Contains aggregates Nissl granules(Bodies) which is also sometimes referred to as rhomboid flakes

aggregation of membranes and cisternae of rough endoplasmic reticulum (RER)

numerous ribosomes and polyribosomes scattered between cisternae

(Polyribosome = aggregate of free ribosomes clumped together)

responsible for ongoing synthesis of new cytoplasm and cytoplasmic substances

needed for conduction of impulses

highly active in cell protein synthesis

resultant loss of power to divide which is characteristic of neurons

- Golgi network surrounding nucleus (seen in EM only)

- Fibrils made up of:

- neurofilaments

- microtubules

Tubules involved in:

1. plasmic transport

2. maintenance of cell shape

3. essential for growth and elongation of axons and dendrites

Neurofilament:

1. provide skeletal framework

2. maintenance of cell shape

3. possible role in axonal transport

(Axonal [axoplasmic; plasmic] transport may be antero- or retrograde. Anterograde transport via neurotubules is fast and moves neurotransmitters. Retrograde transport is slow and is the reason why viruses and bacteria can attack and destroy cell bodies. E.g. polio in the ventral columns and syphilis in the dorsal columns).

- Numerous mitochondria

- Neurons lack ability to store glycogen and are dependent for energy on circulating glucose

Impulses are conducted in one direction only

Dendrites conduct towards the cb

Axons conduct away from cb

Synapses:

- Neurons interconnect by way of synapses

- Normally the telodendria of an axon synapse with the dendrites of a succeeding axon

axo-dendritic synapse

This is usually excitatory

- Other types of synapses are:

 axo-axonic

May be excitatory and/or inhibitory

axo-somatic

May be excitatory and/or inhibitory

 dendrodendritic

Usually inhibitory

- Synapses are not tight junctions but maintain a narrow space the so-called synaptic cleft

- The end of an telodendron is usually enlarged (bouton) and contains many synaptic vesicles,

mitochondrion, etc. Its edge that takes part in the synapse is known as the postsynaptic membrane and no

vesicles are seen in this area

- Synapses may be chemical (as above) or electrical as in the ANS supplying smooth muscle cells subjacent to adjacent fibres

Gray and White Matter of Spinal Cord:

- Gray matter contains:

- cb's (somas) of neurons

- neuroglial cells

- White matter contains:

- vast number of axons

- no cb's

- colour of white matter due to myelin that ensheathes axons

Myelin:

- Non-viable fatty material contains phospholipids, cholesterol and some proteins

- Soluble and not seen in H&E-sections because it has become dissolved in the process, thus leaving empty spaces around the axons

- Osmium tetroxide (OsO4) fixes myelin and makes it visible by staining it black. Seen as concentric rings in cross section

- Myelin sheath (neurolemma) is formed by two types of cells

- Within the CNS by Oligodendrocytes

- On the peripheral neurons system by Schwann cells

- Sheath is formed by being wrapped around the axon in a circular fashion by both types of cells

Neuroglial Cells:

- Forms roughly 40% of CNS volume

- May function as: 1. support

2. nurture ("feeding")

3. maintain

Types of glial cells:

Oligodendrocytes:

- Small dark stained dense nucleus

- Analogue of Schwann cell in peripheral nervous system

- Has several processes which forms internodal segments of several fibres (one cell ensheathes more than one axon)

- Provides myelin sheaths in CNS

- Role in nurturing (feeding) of cells

Astrocytes:

Protoplasmic astrocytes:

- found in gray matter

- round cell body

- large oval nucleus with prominent nucleolus

- large thick processes

- processes are short but profusely branched

- perivascular and perineurial foot processes

- sometimes referred to as mossy fibres

Fibrous Astrocytes:

- found in white matter

- polymorphic cells body

- large oval nucleus

- long thin processes

Microglia:

- Neural macrophages

- smallest of the glial cells

- intense dark stained nucleus

- conspicuously fine processes which has numerous short branches

Cerebral Cortex:

Consists of six layers which are best observed in the cortex of the hippocampus

From superficial to deep:

- Molecular layer:

- Has few cells and many fibres of underlying cells

- Outer granular layer:

- Many small nerve cells

- Pyramidal layer:

- Pyramidally-shaped cells bodies

- Inner granular layer:

- Smaller cells and nerve fibres

- Internal (inner) pyramidal layer:

- Pyramidal cells bodies

- Very large in the motor cortex and known as Betz-cells

- Polymorphic layer:

- Cells with many shapes

Cerebellar Cortex:

Consists of three layers

Connections are mainly inhibitory

From superficial to deep

- Outer molecular layer:

- Few cells and many fibres

- Purkinje layer:

- Huge flask-shaped cells that are arranged next to one another

- Inner granular layer:

- Many small nerve cells

Motor endplate:

Seen in periphery on striated muscle fibres

- known as boutons

- has no continuous myelin covering from the Schwann cells

- passes through perimysium of muscle fiber to "synapse"

- multiple synaptic gutter (fold) in sarcoplasma of muscle fiber beneath bouton

- contains numerous synaptic vesicles and mitochondria

Ganglia:

- Sensory Ganglia:

(e.g. trigeminal nerve, ganglia and dorsal root ganglia)

- No synapse (trophic unit)

- pseudo-unipolar neurons

- centrally located nucleus

- spherical smooth border

- conspicuous axon hillock

- Surrounded by cuboidal satellite cells (Schwann cells)

- Covered by spindle shaped capsular cells of delicate collagen which forms the endoneurium

- Visceral and Motor Ganglia (Sympathetic and Parasympathetic):

- Synapse present

- Ratio of preganglionic: postganglionic fibres

1. Sympathetic 1:30

Therefore excitatory and catabolic

2. Parasympathetic 1:2

Therefore anabolic

Except in Meissner and Auerbach's plexuses where ratio is 1:1000 '2 because of parasympathetic component's involvement in digestion

- Preganglionic axons are myelinated (e.g. white communicating rami)

- Postganglionic axon are non-myelinated (e.g. gray communicating rami)

- small multipolar cell body

- excentrally located nucleus

- Inconspicuous axon hillock

- satellite cells few or absent

- few capsular cells

The Scalp

• The scalp consists of five layers of soft tissue.
• It extends from the superior nuchal line on the posterior aspect of the skull of the supraorbital margins.
• Laterally, the scalp extends into the temporal fossa to the level of the zygomatic arches.

Layers of the Scalp

• The scalp proper is composed of three fused layers. It is separated from the pericranium by loose connective tissue.
• Because of this potential areolar cleavage plane, the scalp is fairly mobile.
• Each letter of the word "S C A L P" serves as a memory key for one of the layers of the scalp: Skin, Connective Tissue, Aponeurosis Epicranialis, Loose Areolar Tissue and Pericranium.

Layer 1: Skin

• Hair covers the scalp in most people.
• The skin of the scalp is thin, especially in elderly people, except in the occipital region.
• The skin contains many sweat and sebaceous glands and hair follicles.
• The skin of the scalp has an abundant arterial supply and good venous and lymphatic drainage systems.

Layer 2: Connective Tissue

• This is a thick, subcutaneous layer of connective tissue and is richly vascularised and innervated.
• It attaches the skin to the third layer of the scalp.
• Fat is enclosed in lobules between the connective fibres.

Layer 3: Aponeurosis Epicranialis

• This is a strong membranous sheet that covers the superior aspect of the cranium.
• This aponeurosis is the membranous tendon of the fleshy bellies of the epicranius muscle.

• The epicranius muscle consists of four parts: two occipital bellies, occipitalis and two frontal bellies, frontalis that are connected by the epicranial aponeurosis. 

Layer 4: Loose Areolar Tissue

• This is a subaponeurotic layer or areolar or loose connective tissue.
• It is somewhat like a sponge because it contains innumerable potential spaces that are capable of being distended by fluid.
• It is this layer that allows free movement of the scalp proper, composed of layers 1-3.

Layer 5: Pericranium

• This is a dense layer of specialised connective tissue.
• The pericranium is firmly attached to the bones by connective tissue fibres called Sharpey’s fibres, however, they can be fairly easily stripped from the cranial bones of living persons, except where they are continuous with the fibrous tissues of the cranial sutures.

• Bones begin to form during the eighth week of embryomic life in the fibrous membranes (intramembranous ossification) and hyaline cartilage (endochondral ossification)