NEET MDS Lessons
Anatomy
The Nasal Mucosa
- Mucosa lines the entire nasal cavities except for the vestibule of the nose.
- The nasal mucosa is firmly bound to the periosteum and perichondrium of the supporting structures of the nose.
- It is continuous with the adjoining cavities to which the nasal cavity communicates (e.g., the nasopharynx and paranasal sinuses).
- The inferior 2/3 of the nasal mucosa is called the respiratory area and air passing over this is warmed and moistened before it passes into the lungs.
- The superior 1/3 is called the olfactory area.
The Olfactory Area of Nasal Mucosa
- This area contains the peripheral organ of smell.
- Sniffing draws air into this area
- Olfactory receptor cells (from the olfactory nerve, CN I, are located in the mucosa of this area in the nose.
Nerves to the Respiratory Area of Nasal Mucosa
- The inferior 2/3 of the nasal mucosa are supplied chiefly by the trigeminal nerve (CN V).
- The mucous membrane of the nasal septum is supplied chiefly by the nasopalatine nerve, a branch of the maxillary nerve (CN V2).
- Its anterior portion is supplied by the anterior ethmoidal nerve (a branch of the nasociliary nerve) which is derived from the ophthalmic nerve (CN V1).
- The lateral walls of the nasal cavity are supplied by branches of the maxillary nerve (CN V2); the greater palatine nerve, and the anterior ethmoidal nerve.
Arteries of the Nasal Mucosa
- The blood supply of the mucosa of the nasal septum is derived mainly from the maxillary artery.
- The sphenopalatine artery, a branch of the maxillary, supplies most of the blood of the nasal mucosa.
- It enters by the sphenopalatine foramen and sends branches to the posterior regions of the lateral wall and to the nasal septum.
- The greater palatine artery, also a branch of the maxillary, passes through the incisive foramen to supply the nasal septum.
- The anterior and posterior ethmoidal arteries, branches of the ophthalmic artery, supply the anterosuperior part of the mucosa of the lateral wall of the nasal cavity and nasal septum.
- Three branches of the facial artery (superior labial, ascending palatine, and lateral nasal) also supply the anterior parts of the nasal mucosa.
Veins of the Nasal Mucosa
- The veins of the nasal mucosa form a venous network of plexus in the connective tissue of the nasal mucosa.
- Some of the veins open into the sphenopalatine vein and drain to the pterygoid plexus.
- Others join the facial and infraorbital veins.
- Some empty into the ophthalmic veins and drain into the cavernous sinus.
The Nasopharynx
- The nasal part of the pharynx has a respiratory function.
- It lies superior to the soft palate and is a posterior extension of the nasal cavity.
- The nose opens into the nasopharynx via to large posterior apertures called choanae.
- The roof and posterior wall of the nasopharynx form a continuous surface that lies inferior to the body of the sphenoid bone and the basilar part of the occipital bone.
- In the mucous membrane of the roof of the posterior wall of the nasopharynx is a collection of lymphoid tissue, known as the pharyngeal tonsil (commonly known as the adenoids).
- The pharyngeal orifice of the auditory tube is on the lateral wall of the nasopharynx, 1 to 1.5 cm posterior to the inferior concha, and level with the superior border of the palate.
- The orifice is directed inferiorly and has a hood-like tubal elevation over it called the torus of the auditory tube or the torus tubarius (L. torus, swelling).
- Extending inferiorly from the torus is a vertical fold of mucous membrane, known as the salpingopharyngeal fold.
- The collection of lymphoid tissue in the submucosa of the pharynx, posterior to the orifice of the auditory tube, is known as the tubal tonsil.
- Posterior to the torus and the salpingopharyngeal fold, there is a slit-like lateral projection of the pharynx called the pharyngeal recess.
- It extends laterally and posteriorly.
-> 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 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.
Extrinsic Muscles of the Tongue (p. 746)
The Genioglossus Muscle
- This is a bulky, fan-shaped muscle that contributes to most of the bulk of the tongue.
- It arises from a short tendon from the genial tubercle (mental spine) of the mandible.
- It fans out as it enters the tongue inferiorly and its fibres attach to the entire dorsum of the tongue.
- Its most inferior fibres insert into the body of the hyoid bone.
- The genioglossus muscle depresses the tongue and its posterior part protrudes it.
The Hyoglossus Muscle
- This is a thin, quadrilateral muscle.
- It arises from the body and greater horn of the hyoid bone and passes superoanteriorly to insert into the side and inferior aspect of the tongue.
- It depresses the tongue, pulling its sides inferiorly; it also aids in retrusion of the tongue.
The Styloglossus Muscle
- This small, short muscle arises from the anterior border of the styloid process near its tip and from the stylohyoid ligament.
- It passes inferoanteriorly to insert into the side and inferior aspect of the tongue.
- The styloglossus retrudes the tongue and curls its sides to create a trough during swallowing.
The Palatoglossus Muscle
- Superior attachment: palatine aponeurosis.
- Inferior attachment: side of tongue.
- Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
- This muscle, covered by mucous membrane, forms the palatoglossal arch.
- The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.
The Hard Palate
- The anterior bony part of the palate is formed by the palatine process of the maxillae and the horizontal plates of the palatine bones.
- Anteriorly and laterally, the hard palate is bounded by the alveolar processes and the gingivae.
- Posteriorly, the hard palate is continuous with the soft palate.
- The incisive foramen is the mouth of the incisive canal.
- This foramen is located posterior to the maxillary central incisor teeth.
- This foramen is the common opening for the right and left incisive canals.
- The incisive canal and foramen transmit the nasopalatine nerve and the terminal branches of the sphenopalatine artery.
- Medial to the third molar tooth, the greater palatine foramen pierces the lateral border of the bony palate.
- The greater palatine vessels and nerve emerge from this foramen and run anteriorly into two grooves on the palate.
- The lesser palatine foramen transmits the lesser palatine nerve and vessels.
- This runs to the soft palate and adjacent structures.
The Auditory Tube
- This is a funnel-shaped tube connecting the nasopharynx to the tympanic cavity.
- Its wide end is towards the nasopharynx, where it opens posterior to the inferior meatus of the nasal cavity.
- The auditory tube is 3.5 to 4 cm long; its posterior 1/3 is bony and the other 2/3 is cartilaginous.
- It bony part lies in a groove on the inferior aspect of the base of the skull, between the petrous part of the temporal bone and the greater wing of the sphenoid bone.
- The function of the auditory tube is to equalise pressure of the middle ear with atmospheric pressure.