NEET MDS Lessons
Anatomy
- The tongue is divided into halves by a medial fibrous lingual septum that lies deep to the medial groove.
- In each half of the tongue there are four extrinsic and four intrinsic muscles.
- The lingual muscles are all supplied by the hypoglossal nerve (CN XII).
- The only exception is palatoglossus, which is supplied by the pharyngeal branch of the vagus nerve, via the pharyngeal plexus.
->The two parietal bones (L. paries, wall) form large parts of the walls of the calvaria.
->On the outside of these smooth convex bones, there are slight elevations near the centre called parietal eminences.
->The middle of the lateral surfaces of the parietal bones is crossed by two curved lines, the superior and inferior temporal lines.
->The superior temporal line indicates an attachment of the temporal fascia; the inferior temporal line marks the superior limit of the temporalis muscle.
->The parietal bones articulate with each other in the median plane at the sagittal suture. The medial plane of the body passes through the sagittal suture.
->The inverted V-shaped suture between the parietal bones and the occipital bones is called the lambdoid suture because of its resemblance to the letter lambda in the Greek alphabet.
->The point where the parietal and occipital bones join is a useful reference point called the lambda. It can be felt as a depression in some people.
->In addition to articulation with each other and the frontal and occipital bones, the parietal bones articulate with the temporal bones and the greater wings of the sphenoid bone.
->In foetal and infant skulls, the bones of the calvaria are separated by dense connective tissue membranes at sutures.
->The large fibrous area where several sutures meet are called fonticuli or fontanelles.
->The softness of these bones and looseness of their connections at these sutures enable the calvaria to undergo changes of shape during birth called molding. Within a day or so after birth, the shape of the infant’s calvaria returns to normal.
->The loose construction of the new-born calvaria also allows the skull to enlarge and undergo remodelling during infancy and childhood.
->Relationships between the various bones are constantly changing during the active growth period.
->The increase in the size of the cranium is greatest during the first 2 years, the period of most rapid postnatal growth of the brain.
->The cranium normally increases in capacity until about 15 or 16 years of age; thereafter the cranium usually increases only slightly in size as its bones thicken for 3 to 4 years.
Muscles of the Pharynx
- This consists of three constrictor muscles and three muscles that descend from the styloid process, the cartilaginous part of the auditory tube and the soft palate.
External Muscles of the Pharynx
- The paired superior, middle, and inferior constrictor muscles form the external circular part of the muscular layer of the wall.
- These muscles overlap each other and are arranged so that the superior one is innermost and the inferior one is outermost.
- These muscles contract involuntarily in a way that results in contraction taking place sequentially from the superior to inferior end of the pharynx.
- This action propels food into the oesophagus.
- All three constrictors of the pharynx are supplied by the pharyngeal plexus of nerves, which lies on the lateral wall of the pharynx, mainly on the middle constrictor of the pharynx.
- This plexus is formed by pharyngeal branches of the glossopharyngeal (CN IX) and vagus (CN X) nerves.
The Superior Constrictor Muscle
- Origin: pterygoid hamulus, pterygomandibular raphe, posterior end of the mylohyoid line of the mandible, and side of tongue.
- Insertion: median raphe of pharynx and pharyngeal tubercle.
- Innervation: though the pharyngeal plexus of nerves.
- The pterygomandibular raphe is the fibrous line of junction between the buccinator and superior constrictor muscles.
The Middle Constrictor Muscle
- Origin: stylohyoid ligament and greater and lesser horns of hyoid bone.
- Insertion: median raphe of pharynx.
- Innervation: through the pharyngeal plexus of nerves.
The Inferior Constrictor Muscle
- Origin: oblique line of thyroid cartilage and side of cricoid cartilage.
- Insertion: median raphe of pharynx.
- Innervation: through the pharyngeal plexus of nerves.
- The fibres arising from the cricoid cartilage are believed to act as a sphincter, preventing air from entering the oesophagus.
Gaps in the Pharyngeal Musculature
- The overlapping arrangement of the three constrictor muscles leaves 4 deficiencies or gaps in the pharyngeal musculature.
- Various structures enter and leave the pharynx through these gaps.
- Superior to the superior constrictor muscle, the levator veli palatini muscle, the auditory tube, and the ascending palatine artery pass through a gap between the superior constrictor muscle and the skull.
- Superior to the superior border of the superior constrictor, the pharyngobasilar fascia blends with the buccopharyngeal fascia to form, with the mucous membrane, the thin wall of the pharyngeal recess.
- Between the superior and middle constrictor muscles, the gateway to the mouth, though which pass the stylopharyngeus muscle, the glossopharyngeal nerve (CN IX), and the stylohyoid ligament.
- Between the middle and inferior constrictor muscles, the internal laryngeal nerve and the superior laryngeal artery and vein pass to the larynx.
- Inferior to the inferior constrictor muscles, the recurrent laryngeal nerve and inferior laryngeal artery pass superiorly into the larynx.
->The sides and base of the skull are formed partly by these bones.
->Each bone consists of four morphologically distinct parts that fuse during development (squamous, petromastoid, and tympanic parts and the styloid process).
->The flat squamous part is external to the lateral surface of the temporal lobe of the brain.
->The petromastoid part encloses the internal ear and mastoid cells and forms part of the base of the skull.
->The tympanic part contains the bony passage from the auricle (external ear), called the external acoustic meatus. The petromastoid part also forms a portion of the bony wall of the tympanic cavity (middle ear). The meatus and tympanic cavity are concerned with the transmission of sound waves.
->The slender, pointed styloid process of the temporal bone gives attachment to certain ligaments and muscles (e.g., the stylohyoid muscle that elevates the hyoid bone).
->The temporal bone articulates at sutures with the parietal, occipital, sphenoid, and zygomatic bones.
->The zygomatic process of the temporal bone unites with the temporal process of the zygomatic bone to form the zygomatic arch. The zygomatic arches form the widest part of the face.
->The head of the mandible articulates with the mandibular fossa on the inferior surface of the zygomatic process of the temporal bone.
->Anterior to the mandibular fossa is the articular tubercle.
->Because the zygomatic arches are the widest parts of the face and are such prominent facial features, they are commonly fractured and depressed. A fracture of the temporal process of the zygomatic bone would likely involve the lateral wall of the orbit and could injure the eye.
-> This bone forms much of the base and posterior aspect of the skull.
-> It has a large opening called the foramen magnum, through which the cranial cavity communicates with the vertebral canal.
-> It is also where the spinal cord becomes continuous with the medulla (oblongata) of the brain stem.
-> The occipital bone is saucer-shaped and can be divided into four parts: a squamous part (squama), a basilar part (basioccipital part), and two lateral parts (condylar parts).
-> These four parts develop separately around the foramen magnum and unite at about the age of 6 years to form one bone.
-> On the inferior surfaces of the lateral parts of the occipital bone are occipital condyles, where the skull articulates with C1 vertebra (the atlas) at the atlanto-occipital joints.
-> The internal aspect of the squamous part of the occipital bone is divided into four fossae: the superior two for the occipital poles of the cerebral hemispheres, and the inferior two, called cerebellar fossae, for the cerebellar hemispheres.
The Salivary Glands
- There are three large, paired salivary glands: the parotid, submandibular, and sublingual glands.
- In addition to the main salivary glands, there are numerous small accessory salivary glands scattered over the palate, lips, cheeks, tonsils, and tongue.
The Temporomandibular Joint
- This articulation is a modified hinge type of synovial joint.
- The articular surfaces are: (1) the head or condyle of the mandible inferiorly and (2) the articular tubercle and the mandibular fossa of the squamous part of the temporal bone.
- An oval fibrocartilaginous articular disc divides the joint cavity into superior and inferior compartments. The disc is fused to the articular capsule surrounding the joint.
- The articular disc is more firmly bound to the mandible than to the temporal bone.
- Thus, when the head of the mandible slides anterior on the articular tubercle as the mouth is opened, the articular disc slides anteriorly against the posterior surface of the articular tubercle