The Nose

• The nose is the superior part of the respiratory tract and contains the peripheral organ of smell.
• It is divided into right and left nasal cavities by the nasal septum.
• The nasal cavity is divided into the olfactory area and the respiratory area.

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.

Levator Palpebrae Superioris Muscles

• This is a thin, triangular muscle that elevates the upper eyelid.
• It is continuously active except during sleeping and when the eye is closing.

• Origin: roof of orbit, anterior to the optic canal.
• Insertion: this muscle fans out into a wide aponeurosis that inserts into the skin of the upper eyelid. The inferior part of the aponeurosis contains some smooth muscle fibres that insert into the tarsal plate.
• Innervation: the superior fibres are innervated by the oculomotor nerve (CN III), and the smooth muscle component is innervated by fibres of the cervical sympathetic trunk and the internal carotid plexus.

Illnesses involving the Levator Palpebrae Superioris

• In third nerve palsy, the upper eyelid droops (ptosis) and cannot be raised voluntarily.
• This results from damage to the oculomotor nerve (CN III), which supplies this muscle.

• If the cervical sympathetic trunk is interrupted, the smooth muscle component of the levator palpebrae superioris is paralysed and also causes ptosis.
• This is part of Horner's syndrome.

The Rectus Muscles

• There are four rectus muscles (L. rectus, straight), superior, inferior, medial and lateral.

• These arise from a tough tendinous cuff, called the common tendinous ring, which surrounds the optic canal and the junction of the superior and inferior orbital fissures.
• From their common origin, these muscles run anteriorly, close to the walls of the orbit, and attach to the eyeball just posterior to the sclerocorneal junction.

• The medial and lateral rectus muscles attach to the medial and lateral sides of the eyeball respectively, on the horizontal axis.
• However, the superior rectus attaches to the anterosuperior aspect of the medial side of the eyeball while the inferior rectus attaches to the anteroinferior aspect of the medial side of the eye.

The Oblique Muscles

The Superior Oblique Muscle

• This muscle arises from the body of the sphenoid bone, superomedial to the common tendinous ring.
• It passes anteriorly, superior and medial to the superior and medial rectus muscles.
• It ends as a round tendon that runs through a pulley-like loop called the trochlea (L. pulley).
• After passing though the trochlea, the tendon of the superior oblique turns posterolaterally and inserts into the sclera at the posterosuperior aspect of the lateral side of the eyeball.

The Inferior Oblique Muscle

• This muscle arises from the maxilla in the floor of the orbit.
• It passes laterally and posteriorly, inferior to the inferior rectus muscle.
• It inserts into the sclera at the posteroinferior aspect of the lateral side of the eyeball.

The Submandibular Glands

• Each of these U-shaped salivary glands is about the size of a thumb and lies along the body of the mandible.
• It is partly superior and partly inferior to the posterior 1/2 of the base of the mandible.
• It is partly superficial and partly deep to the mylohyoid muscle.

• The submandibular duct arises from the portion of the gland that lies between the mylohyoid and hyoglossus muscle.

• The duct passes deep and then superficial to the lingual nerve.
• It opens by one to three orifices on a small sublingual papilla beside the lingual frenulum.

• The submandibular gland is supplied by parasympathetic, secretomotor fibres from the submandibular ganglion (preganglionic fibres from the chorda tympani via the lingual nerve).

Innervation of the Pharynx

• The motor and most of the sensory supply of the pharynx is derived from the pharyngeal plexus of nerves on the surface of the pharynx.
• The plexus is formed by pharyngeal branches of the vagus (CN X) and glossopharyngeal (CN IX) nerves, and by sympathetic branches for the superior cervical ganglion.

• The motor fibres in the pharyngeal plexus are derived from the cranial root of accessory nerve (CN XI), and are carried by the vagus nerve to all muscles of the pharynx and soft palate.
• The exceptions are stylopharyngeus (supplied by CN IX) and the tensor veli palatini (supplied by CN V3).