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Anatomy

- The forehead is formed by the smooth, broad, convex plate of bone called the frontal squama.
- In foetal skulls, the halves of the frontal squama are divided by a metopic suture.
- In most people, the halves of the frontal bone begin to fuse during infancy and the suture between is usually not visible after 6 years of age.
- The frontal bone forms the thin roof of the orbits (eye sockets).
- Just superior to and parallel with each supraorbital margin is a bony ridge, the superciliary arch, which overlies the frontal sinus. This arch is more pronounced in males.
- Between these arches there is a gently, rounded, medial elevation called the gabella; this term derives from the Latin word glabellus meaning smooth and hairless. In most people, the skin over the gabella is hairless.
-The slight prominences of the forehead on each side, superior to the superciliary arches, are called frontal eminences (tubers).
- The supraorbital foramen (occasionally a notch), which transmits the supraorbital vessels and nerve is located in the medial part of the supraorbital margin.
- The frontal bone articulates with the two parietal bones at the coronal suture.
-It also articulates with the nasal bones at the frontonasal suture. At the point where this suture crosses the internasal suture in the medial plane, there is an anthropological landmark called the nasion . The depression is located at the root of the nose, where it joins the cranium.
- The frontal bone also articulates with the zygomatic, lacrimal, ethmoid, and sphenoid bones.
In about 8% of adult skulls, a remnant of the inferior part of the metopic (interfrontal) suture is visible. It may be mistaken in radiographs for a fracture line by inexperienced observers.
- The superciliary arches are relatively sharp ridges of bone and a blow to them may lacerate the skin and cause bleeding.
- Bruising of the skin over a superciliary arch causes tissue fluid and blood to accumulate in the surrounding connective tissue, which gravitates into the upper eyelid and around the eye. This results in swelling and a "black eye".
- Compression of the supraorbital nerve as it emerges from its foramen causes considerable pain, a fact that may be used by anaesthesiologists and anaesthetists to determine the depth of anaesthesia and by physicians attempting to arouse a moribund patient.

 

Mesodermal Origin

Muscles

Innervation

Somitomeres 1, 2

Superior, medial and ventral recti

Oculomotor (III)

Somitomere 3

Superior oblique

Trochlear (IV)

Somitomere 4

Jaw-closing muscles

Trigeminal (V)

Somitomere 5

Lateral rectus

Abducens (VI)

Somitomere 6

Jaw-opening and other 2nd arch muscles

Facial (VII)

Somitomere 7

Stylopharyngeus

Glossopharyngeal (IX)

Somites 1, 2

Intrinsic laryngeals

Vagus (X)

Somites 2-5

Tongue muscles

Hypoglossal (XII)

  •     Part of the axial skeleton; strong, flexible rod
        Supports the head
        Gives base to the ribs
        Encloses the spinal cord
        
    o    Vertebrae
        Consists of 34 bones composing the spinal column
    •    Cervical-7 bones
    •    Thoracic-12 bones
    •    Lumbar-5 bones
    •    Sacral- 5 bones.
    •    Coccygeal-4 to 5 bones

        In the adult the vertebrae of the sacral and coccygeal regions are united into two bones, the sacrum and me coccyx
        
    o    Curvatures-from a lateraI view there are four curves, alternately convex and concave ventrally
        Two convex curves are the cervical and lumbar
        Two concave curves are the thoracic and sacral

    o    Vertebra morphology

        Each vertebra differs in size and shape hut has similar components
        Body-central mass of bone
    •    Weight bearing
    •    Fonns anterior part of the vertebra
    •    Encloses the vertebral foramen
        Pedicles of the arch-two thick columns that extend backward from the body to meet with the laminae of the neural arch 

  •     Process (7)
    •    One spinous, two transverse, two superior articular, and two inferior articular
    o    Spinous process extends backward from the point of the union of thetwo laminae
    o    Transverse processes project laterally at either side from the junction of the lamina and the pedicle
    o    Articular processes arise near the junction of the pedicle and the lamina- superior processes project upward:inferior processes project downward
    •    Surfaces of the processes are smooth

    o    Inferior articular processes of the vertebra fit into the superior articular processes below
    o    Form true joints, but the contacts established serve to restrict movement

    Distinguishing features

    Cervical region- triangular shape

    •    All have foramina in the transverse process upper six transmit the vertebral artery
    •    Spinous processes are short
        o    C3 to C5 are bifurcated
        o    C7 is long-prominence felt at the back of the neck
    •    Have small bodies (except for C1 vertebra)
    •    C1 vertebra (atlas)
    o    No body
    o    Anterior and posterior arch and two lateral masses
    o    Superiorarticular processes articulate with the condyles of the occipital bone
    •    C2 vertebra (axis)-process on the upper surface of the body (dens) forms a pivot about which the axis rotates

    Thoracic region

    •    Presence of facets for articulation with the ribs (distinguishing feature)
    •    Processes are larger and heavier than those of the cervical region
    •    Spinous process is directed downward at a sharp angle
    •    Circular vertebral foramen

     Lumbar region
     
    •    Large and heavy bodies
    •    Four transverse lines separate the bodies of the vertebrae on the pelvic surface
    •    Triangular shape-fitted between the  halves of the pelvis
    •    Four pairs of dorsal sacral foramina communicate with four pairs of pelvic sacral foramina

    Sacral vertebrae 
    •    Five (sometimes six) vertebrae are fused in the adult to form the sacrum
    •    The sacrum articulates above with L5, laterally with the hip bones, and inferiorly with the coccyx.
    •    It has a roughly triangular appearance with a pelvic and dorsal surface, a lateral mass on each side, and a base and apex.
    •    An anesthetic for the spinal nerves may be injected extradurally through the sacral hiatus (caudal analgesia)
    •    The sacral canal (which contains the dura, cauda equina, and filum terminale) extends from the base to the sacral hiatus. 
    •    The apex of the sacrum may be fused with the coccyx.


    Coccygeal vertebrae

    •    Four to five modular pieces fused together
    •    Triangular shape with the base above and the apex below

    F Defects

    •    Lordosis-exaggerated lumbar concavity
    •    Scoliosis-lateral curvature of any region
    •    Kyphosis-exaggerated convexity in the thoracic region

 

MUSCLE

Types:

Skeletal (voluntary)
Cardiac (involuntary)
Smooth (involuntary)

The Auditory Ossicles

The Malleus

  • Its superior part, the head, lies in the epitympanic recess.
  • The head articulates with the incus.
  • The neck, lies against the flaccid part of the tympanic membrane.
  • The chorda tympani nerve crosses the medial surface of the neck of the malleus.
  • The handle of the malleus (L. hammer) is embedded in the tympanic membrane and moves with it.
  • The tendon of the tensor tympani muscle inserts into the handle.

The Incus

  • Its large body lies in the epitympanic recess where it articulates with the head of the malleus.
  • The long process of the incus (L. an anvil) articulates with the stapes.
  • The short process is connected by a ligament to the posterior wall of the tympanic cavity.

The Stapes

  • The base (footplate) of the stapes (L. a stirrup), the smallest ossicle, fits into the fenestra vestibuli or oval window on the medial wall of the tympanic cavity.

Functions of the Auditory Ossicles

  • The auditory ossicles increase the force but decrease the amplitude of the vibrations transmitted from the tympanic membrane.

Nerves of the Face

Innervation of the Muscles of Facial Expression

The Facial Nerve (CN VII)

 

  • The seventh cranial nerve supplies the superficial muscle of the neck (platysma), the muscles of facial expression, the auricular muscles and the scalp muscles.
  • CN VII is the sole motor supply to the muscles of facial expression.
  • The facial nerve emerges from the skull though the stylomastoid foramen.
  • Almost immediately, it enters the parotid gland. It runs superficially in this gland before giving rise to its five terminal branches: temporal, zygomatic, buccal, marginal mandibular, and cervical.
  • These nerve emerge from the superior, anterior and inferior margins of the gland and spread out like the abducted digits of the hand to supply the muscles of facial expression.
  • The temporal branches of CN VII cross the zygomatic arch to supply all the superficial facial muscles superior to it, including the orbital and forehead muscles.
  • The zygomatic branch of CN VII passes transversely over the zygomatic bone to supply the muscles in the zygomatic, orbital and infraorbital regions.
  • The buccal branches of CN VII pass horizontally, external to the masseter muscle, to supply the buccinator and the muscles of the upper lip.
  • The marginal mandibular branch of CN VII supplies the muscles of the lower lip and chin.
  • The cervical branch of CN VII supplies the platysma and the superficial muscles of the neck.

Intrinsic Muscles of the Tongue

The Superior Longitudinal Muscle of the Tongue

  • The muscle forms a thin layer deep to the mucous membrane on the dorsum of the tongue, running from its tip to its root.
  • It arises from the submucosal fibrous layer and the lingual septum and inserts mainly into the mucous membrane.
  • This muscle curls the tip and sides of the tongue superiorly, making the dorsum of the tongue concave.

 

The Inferior Longitudinal Muscle of the Tongue

  • This muscle consists of a narrow band close to the inferior surface of the tongue.
  • It extends from the tip to the root of the tongue.
  • Some of its fibres attach to the hyoid bone.
  • This muscle curls the tip of the tongue inferiorly, making the dorsum of the tongue convex.

 

The Transverse Muscle of the Tongue

  • This muscle lies deep to the superior longitudinal muscle.
  • It arises from the fibrous lingual septum and runs lateral to its right and left margins.
  • Its fibres are inserted into the submucosal fibrous tissue.
  • The transverse muscle narrows and increases the height of the tongue.

 

The Vertical Muscle of the Tongue

  • This muscle runs inferolaterally from the dorsum of the tongue.
  • It flattens and broadens the tongue.
  • Acting with the transverse muscle, it increases the length of the tongue.

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