NEET MDS Lessons
Anatomy
Endochondral ossification
- A cartilage model exists
- Through intramembraneous ossification in the perichondrium a collar of bone forms around the middle part of the cartilage model
- The perichondrium change to a periostium
- The bone collar cuts off the nutrient and oxygen supply to the chondrocytes in the cartilage model
- The chondrocytes then increase in size and resorb the surrounding cartilage matrix until only thin vertical septae of matrix are left over
- These thin plates then calcify after which the chondrocytes die
- The osteoclasts make holes in the bone collar through which blood vessels can now enter the cavities left behind by the chondrocytes
- With the blood vessels osteoprogenitor cells enter the tissue
- They position themselves on the calcified cartilage septae, change into osteoblasts and start to deposit bone to form trabeculae
- In the mean time the periosteum is depositing bone on the outside of the bone collar making it thicker and thicker
- The trabeculae,consisting of a core of calcified cartilage with bone deposited on top of it, are eventually resorbed by osteoclasts to form the marrow cavity
- The area where this happens is the primary ossification centre and lies in what is called the diaphysis (shaft)
- This process spreads in two directions towards the two ends of the bone the epiphysis
- In the two ends (heads) of the bone a similar process takes place
- A secondary ossification centre develops from where ossification spreads radially
- Here no bone collar forms
- The outer layer of the original cartilage remains behind to form the articulating cartilage
- Between the primary and the secondary ossification centers two epiphyseal cartilage plates remain
- This is where the bone grows in length
- From the epiphyseal cartilage plate towards the diaphysis a number of zones can be identified:
Resting zone of cartilage
Hyaline cartilage
Proliferation zone
Chondrocytes divide to form columns of cells that mature.
Hypertrophic cartilage zone
Chondrocytes become larger, accumulate glycogen, resorb the surrounding matrix so that only thin septae of cartilage remain
Calcification and degeneration zone
The thin septae of cartilage become calcified.
The calsified septae cut off the nutrient supply to the chondrocytes so subsequently they die.
Ossification zone.
Osteoclasts make openings in the bone collar through which blood vessels then invade the spaces left vacant by the chondrocytes that died.
Osteoprogenitor cells come in with the blood and position themselves on the calcified cartilage
septae, change into osteoblasts and start to deposit bone.
When osteoblasts become trapped in bone they change to osteocytes.
Growth and remodeling of bone
Long bones become longer because of growth at the epiphyseal plates
They become wider because of bone formed by the periosteum
The marrow cavity becomes bigger because of resorbtion by the osteoclasts
Fracture repair
When bone is fractured a blood clot forms
Macrophages then remove the clot, remaining osteocytes and damaged bone matrix
The periosteum and endosteum produce osteoprogenitor cells that form a cellular tissue in the fracture area
Intramembranous and endochondral ossification then take place in this area forming trabeculae.
Trabeculae connect the two ends of the broken bone to form a callus
Remodelling then takes place to restore the bone as it was
Joints
The capsule of a joint seals off the articular cavity,
The capsule has two layers
fibrous (outer)
synovial (inner)
The synovial layer is lined by squamous or cuboidal epithelial cells, Under this layer is a layer of loose or dense CT, The lining cells consists of two types:
- A cells
- B cells
They secrete the synovial fluid
They are different stages of the same cell, They are also phagocytic., The articular cartilage has fibres that run perpendicular to the bone and then turn to run parallel to the surface
- Provides a rigid support system
- Protects delicate structures (e. g., the protection provided by the bones of the vertebral column to the spinal cord)
- Bones supply calcium to the blood; are involved In the formation of blood cells (hemopoiesis)
- Bones serve as the basis of attachment of muscles; form levers in the joint areas, aIlowing movement
Innervation of the Skin
- Innervation of the skin is mainly through the three branches of the trigeminal nerve (CN V).
- Some skin over the angle of the mandible and anterior and posterior of the auricle is supplied by the great auricular nerve from the cervical plexus.
- Some cutaneous branches of the auricular branch of the facial nerve also supplies skin on both sides of the auricle.
- The trigeminal nerve is the general sensory nerve to the head, particularly the face, and is the motor nerve to the muscles of mastication.
The Ophthalmic Nerve
- This is the superior division of the trigeminal nerve, the smallest of the three branches and is wholly sensory.
- The ophthalmic nerve divides into three branches: the nasociliary, frontal and lacrimal just before entering the orbit through the superior orbital fissure.
- The nasociliary nerve supplies the tip of the nose through the external nasal branch of the anterior ethmoidal nerve.
- The frontal nerve is the direct continuation of CN V1 and divides into two branches, the supraorbital and supratrochlear.
- The supratrochlear nerve supplies the middle part of the forehead.
- The supraorbital nerve supplies the lateral part and the front of the scalp.
- The lacrimal nerve, the smallest of the main ophthalmic branches, emerges over the superolateral orbital margin to supply the lacrimal gland and the lateral part of the upper eyelid.
The Maxillary Nerve
- This is the intermediate division of the trigeminal nerve.
- It has three cutaneous branches.
- The infraorbital nerve is the largest terminal branch of the maxillary nerve.
- It passes through the infraorbital foramen and breaks up into branches that supplies the skin on the lateral aspect of the nose, upper lip and lower eyelid.
- The zygomaticofacial nerve, a small branch of the maxillary, emerges from the zygomatic bone from a foramen with the same name.
- It supplies the skin over the zygomatic bone.
- The zygomaticotemporal nerve emerges from the zygomatic bone from foramen of the same name.
- It supplies the skin over the temporal region.
The Mandibular Nerve
- This is the inferior division of the trigeminal nerve.
- Of the three division of the trigeminal nerve, CN V3 is the only one that carries motor fibres (to the muscles of mastication).
- The main sensory branches of the mandibular nerve are the buccal, auriculotemporal, inferior alveolar and lingual nerves.
- The buccal nerve is a small branch of the mandibular that emerges from deep to the ramus of the mandible.
- It supplies the skin of the cheek over the buccinator muscle, the mucous membrane lining the cheek, and the buccal surface of the gingiva.
- The auriculotemporal nerve passes medially to the neck of the mandible and then turns superiorly, posterior to its head and anterior to the auricle. It then crosses over the root of the zygomatic process of the temporal bone, deep to the superficial temporal artery.
- It supplies the auricle, external acoustic meatus, tympanic membrane, and the skin in the temporal region.
- The inferior alveolar nerve is the large terminal branch of the posterior division of the mandibular nerve (the lingual nerve is the other terminal branch).
- It enters the mandible through the mandibular foramen to the mandibular canal. In the canal, it gives branches to the mandibular teeth.
- Opposite the mental foramen, this nerve divides into the mental nerve and the incisive nerve.
- The incisive nerve supplies the incisor teeth, the adjacent gingiva and the mucosa of the lower lip.
- The mental nerve emerges from the mental foramen and supplies the skin of the chin and the skin and mucous membrane of the lower lip and gingiva.
- The lingual nerve is the smaller terminal branch of the mandibular nerve.
- It supplies the general sensory fibres to the anterior two-thirds of the tongue, the floor of the mouth and the gingivae of the mandibular teeth.
Histology
Histology is the study of tissues.
A tissue is a group of cells with similar structure and function plus the extracellular substances located between the cells.
There are four basic types of tissues:
- Epitheliums
- Connective tissue
- Muscle tissue
- Nervous tissue
-
Articulations
Classified according to their structure, composition,and movability
• Fibrous joints-surfaces of bones almost in direct contact with limited movement
o Syndesmosis-two bones united by interosseous ligaments
o Sutures-serrated margins of bones united by a thin layer of fibrous tissue
o Gomphosis-insertion of a cone-shaped process into a socket• Cartilaginous joints-no joint cavity and contiguous bones united by cartilage
o Synchondrosis-ends of two bones approximated by hyaline cartilage
o Symphyses-approximating bone surfaces connected by fibrocartilage• Synovial joints-approximating bone surfaces covered with cartilage; may be separated by a disk; attached by ligaments
o Hinge-permits motion in one plane only
o Pivot-permits rotary movement in which a ring rotates around a central axis
o Saddle-opposing surfaces are convexconcave. allowing great freedom of motion
o Ball and socket - capable of movement in an infinite number of axes; rounded head of one bone moves in a cuplike cavity of the approximating boneBursae
• Sacs filled with synovial fluid that are present where tendons rub against bone or where skjn rubs across bone
• Some bursae communicate with a joint cavity
• Prominent bursae found at the elbow. hip, and knee'Movements
• Gliding
o Simplest kind of motion in a joint
o Movement on a joint that does not involve any angular or rotary motions
• Flexion-decreases the angle formed by the union of two bones
• Extension-increases the angle formed by the union of two bones
• Abduction-occurs by moving part of the appendicular skeleton away from the median plane of the body
• Adduction-occurs by moving part of the appendicular skeleton toward the median plane of the body
• Circumduction
o Occurs in ball-and-socket joints
o Circumscribes the conic space of one bone by the other bone
• Rotation-turning on an axis without being displaced from that axis
The Articular Capsule
- The capsule of this joint is loose.
- The thin fibrous capsule is attached to the margins of the articular area on the temporal bone and around the neck of the mandible.
Stylohyoid Muscle
- Origin: Posterior border of the styloid process of the temporal bone.
- Insertion: Body of the hyoid bone at the junction with the greater horn.
- Nerve Supply: Facial nerve (CN VII).
- Arterial Supply: Muscular branches of the facial artery and muscular branches of the occipital artery.
- Action: Elevates the hyoid bone and base of the tongue.