Cardiac Muscle

Fibres anastomose through cross bridges

Fibres are short, connected end to end at intercalated discs, also striated,  contract automatically

Light microscopic Structure:

Short fibres connected at intercalated disks,  85 - 100 µm long,  15 µm

same bands as in skeletal muscle,  1 or 2 nuclei - oval and central,  in perinuclear area is a sarcoplasmic reticulum, intercalated discs lie at the Z line

Electron microscopic structure:

 Between myofibrils lie the mitochondria,  2,5 µm long mitochondria,  dense cristae

and are as long as the sarcomere, fibres have more glycogen than skeletal muscle fibres

myofilaments, actin and myosin are the same as in skeletal muscle,  the sarcoplasmic reticulum differs in that there is no terminal sisterna. The sarcotubules end in little feet that

sit on the T-tubule

Intercalated Disc:

on Z lines,  fibres interdigitate,

 3 types of junctions in the disc

Transverse Part:

zonula adherens

desmosomes

Lateral Part:

Gap junctions (nexus) - for impulse transfer

Mechanism of Contraction:

slide - ratchet like in skeletal muscle, certain fibres are modified for conduction,  Impulses spread from cell to cell through gap junctions,  Purkinje cells are found in the AV bundle

they have less myofibrils,  lots of glycogen and intercalated discs

Connective tissue coverings:

Only endomycium in cardiac muscle,  Blood vessels, lymph vessels and nerves lie in the endomycium

The Medial Wall of the Orbit 

• This wall is paper-thin and is formed by the orbital lamina or lamina papyracea of the ethmoid bone, along with contributions from the frontal, lacrimal, and sphenoid bones (L. papyraceus, "made of papyrus" or parchment paper).

• There is a vertical lacrimal groove in the medial wall, which is formed anteriorly by the maxilla and posteriorly by the lacrimal bone.
• It forms a fossa for the lacrimal sac and the adjacent part of the nasolacrimal duct.

• Along the suture between the ethmoid and frontal bones are two small foramina; the anterior and posterior ethmoidal foramina.
• These transmit nerves and vessels of the same name.

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.

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.

• 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 bone

  Bursae
  •    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
   

NEUROHISTOLOGY

The nervous system develops embryologically from ectoderm, which forms the neural plate

Successive growth and folding of the plate results in the formation of the primitive neural tube.

The neuroblasts in the wall of the tube differentiates into 3 cell types:

Neurons:  conduction of impulses

Neuroglial cells: connective tissue and support of CNS

Ependymal cells:  Lines the lumen of the tube.

   - Specialized neuro-ectodermal cells which lines the ventricles of the adult brain

                - Essentially also a neuroglial cell

Basic Unit = neuron

Exhibits irritability (excitability) and conductivity

A typical neurons consists of:

Cell body : Has nucleus (karyon) and surrounding cytoplasm (perikaryon) which contains organelles cell's vitality

Dendrites:  Several short processes

Axon:One large process

Terminates in twig like branches (telodendrons)

May also have collateral branches projecting along its course. These exit at nodes of Ranvier

Axon enveloped in a sheath, and together forms the nerve fiber

Classification:

May be done in different ways, i.e.

Functional = afferent, efferent, preganglionic, postganglionic, etc.

Morphological = shape, processes, etc

A typical morphological classification is as follows

a. Unipolar: Has one process only Not found in man

b. Bipolar (so-called ganglion cell):Has two processes Found in sensory systems, e.g. retina olfactory system

c. Multipolar: Has several process Most common in CNS

Cell bodies vary in shape, e.g.  stellate (star) , pyramidal

d. Pseudo-unipolar: Essentially bipolar neurons, but processes have swung around cb and fused with each other. They therefore enter and leave at one pole of the cell.

Typical neuron:

- Has 2 or more dendrites

Close to the cb the cytoplasm of dendrites has Nissl granules as well as mitochondria

Only one axon Arises from axon hillock, Devoid of Nissl granules, Encased in myelin sheath

No additional covering except for occasional foot processes of neuroglial cells

May branch at right angles

Branches at a node of Ranvier is known as a collateral

Ends of axons break up into tree-like branches, known as telodendria

Axons may be short (Golgi Type II) e.g. internuncial long (Golgi Type I) e.g. pyramidal neuron

Nucleus Central position Large and spherical

Chromatin is extended and thus not seen in LM. This allows the nucleolus to be prominent

Cytoplasm (perikaryon)

Surrounds nucleus  May be large or small, shape may be round, oval, flattened, pyramidal, etc

Contains aggregates Nissl granules(Bodies) which is also sometimes referred to as rhomboid flakes

aggregation of membranes and cisternae of rough endoplasmic reticulum (RER)

numerous ribosomes and polyribosomes scattered between cisternae

(Polyribosome = aggregate of free ribosomes clumped together)

responsible for ongoing synthesis of new cytoplasm and cytoplasmic substances

needed for conduction of impulses

highly active in cell protein synthesis

resultant loss of power to divide which is characteristic of neurons

- Golgi network surrounding nucleus (seen in EM only)

- Fibrils made up of:

- neurofilaments

- microtubules

Tubules involved in:

1. plasmic transport

2. maintenance of cell shape

3. essential for growth and elongation of axons and dendrites

Neurofilament:

1. provide skeletal framework

2. maintenance of cell shape

3. possible role in axonal transport

(Axonal [axoplasmic; plasmic] transport may be antero- or retrograde. Anterograde transport via neurotubules is fast and moves neurotransmitters. Retrograde transport is slow and is the reason why viruses and bacteria can attack and destroy cell bodies. E.g. polio in the ventral columns and syphilis in the dorsal columns).

- Numerous mitochondria

- Neurons lack ability to store glycogen and are dependent for energy on circulating glucose

Impulses are conducted in one direction only

Dendrites conduct towards the cb

Axons conduct away from cb

Synapses:

- Neurons interconnect by way of synapses

- Normally the telodendria of an axon synapse with the dendrites of a succeeding axon

axo-dendritic synapse

This is usually excitatory

- Other types of synapses are:

 axo-axonic

May be excitatory and/or inhibitory

axo-somatic

May be excitatory and/or inhibitory

 dendrodendritic

Usually inhibitory

- Synapses are not tight junctions but maintain a narrow space the so-called synaptic cleft

- The end of an telodendron is usually enlarged (bouton) and contains many synaptic vesicles,

mitochondrion, etc. Its edge that takes part in the synapse is known as the postsynaptic membrane and no

vesicles are seen in this area

- Synapses may be chemical (as above) or electrical as in the ANS supplying smooth muscle cells subjacent to adjacent fibres

Gray and White Matter of Spinal Cord:

- Gray matter contains:

- cb's (somas) of neurons

- neuroglial cells

- White matter contains:

- vast number of axons

- no cb's

- colour of white matter due to myelin that ensheathes axons

Myelin:

- Non-viable fatty material contains phospholipids, cholesterol and some proteins

- Soluble and not seen in H&E-sections because it has become dissolved in the process, thus leaving empty spaces around the axons

- Osmium tetroxide (OsO4) fixes myelin and makes it visible by staining it black. Seen as concentric rings in cross section

- Myelin sheath (neurolemma) is formed by two types of cells

- Within the CNS by Oligodendrocytes

- On the peripheral neurons system by Schwann cells

- Sheath is formed by being wrapped around the axon in a circular fashion by both types of cells

Neuroglial Cells:

- Forms roughly 40% of CNS volume

- May function as: 1. support

2. nurture ("feeding")

3. maintain

Types of glial cells:

Oligodendrocytes:

- Small dark stained dense nucleus

- Analogue of Schwann cell in peripheral nervous system

- Has several processes which forms internodal segments of several fibres (one cell ensheathes more than one axon)

- Provides myelin sheaths in CNS

- Role in nurturing (feeding) of cells

Astrocytes:

Protoplasmic astrocytes:

- found in gray matter

- round cell body

- large oval nucleus with prominent nucleolus

- large thick processes

- processes are short but profusely branched

- perivascular and perineurial foot processes

- sometimes referred to as mossy fibres

Fibrous Astrocytes:

- found in white matter

- polymorphic cells body

- large oval nucleus

- long thin processes

Microglia:

- Neural macrophages

- smallest of the glial cells

- intense dark stained nucleus

- conspicuously fine processes which has numerous short branches

Cerebral Cortex:

Consists of six layers which are best observed in the cortex of the hippocampus

From superficial to deep:

- Molecular layer:

- Has few cells and many fibres of underlying cells

- Outer granular layer:

- Many small nerve cells

- Pyramidal layer:

- Pyramidally-shaped cells bodies

- Inner granular layer:

- Smaller cells and nerve fibres

- Internal (inner) pyramidal layer:

- Pyramidal cells bodies

- Very large in the motor cortex and known as Betz-cells

- Polymorphic layer:

- Cells with many shapes

Cerebellar Cortex:

Consists of three layers

Connections are mainly inhibitory

From superficial to deep

- Outer molecular layer:

- Few cells and many fibres

- Purkinje layer:

- Huge flask-shaped cells that are arranged next to one another

- Inner granular layer:

- Many small nerve cells

Motor endplate:

Seen in periphery on striated muscle fibres

- known as boutons

- has no continuous myelin covering from the Schwann cells

- passes through perimysium of muscle fiber to "synapse"

- multiple synaptic gutter (fold) in sarcoplasma of muscle fiber beneath bouton

- contains numerous synaptic vesicles and mitochondria

Ganglia:

- Sensory Ganglia:

(e.g. trigeminal nerve, ganglia and dorsal root ganglia)

- No synapse (trophic unit)

- pseudo-unipolar neurons

- centrally located nucleus

- spherical smooth border

- conspicuous axon hillock

- Surrounded by cuboidal satellite cells (Schwann cells)

- Covered by spindle shaped capsular cells of delicate collagen which forms the endoneurium

- Visceral and Motor Ganglia (Sympathetic and Parasympathetic):

- Synapse present

- Ratio of preganglionic: postganglionic fibres

1. Sympathetic 1:30

Therefore excitatory and catabolic

2. Parasympathetic 1:2

Therefore anabolic

Except in Meissner and Auerbach's plexuses where ratio is 1:1000 '2 because of parasympathetic component's involvement in digestion

- Preganglionic axons are myelinated (e.g. white communicating rami)

- Postganglionic axon are non-myelinated (e.g. gray communicating rami)

- small multipolar cell body

- excentrally located nucleus

- Inconspicuous axon hillock

- satellite cells few or absent

- few capsular cells