NEET MDS Lessons
Anatomy
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.
Muscles Around the Mouth
- The sphincter of the mouth is orbicularis oris and the dilator muscles radiate outward from the lips like the spokes of a wheel.
Orbicularis Oris Muscle
- This muscle encircles the mouth and is the sphincter of the oral aperture
- This muscle (1) closes the lips, (2) protrudes them and (3) compresses them against the teeth.
- It plays an important role in articulation and mastication. Together with the buccinator muscle, it helps to hold the food between the teeth during mastication.
Zygomaticus Major Muscle
- It extends from the zygomatic bone to the angle of the mouth.
- It draws the corner of the moth superolaterally during smiling and laughing.
Zygomaticus Minor Muscle
- This is a narrow slip of muscle, and passes obliquely from the zygomatic bone to the orbicularis oris.
- It helps raise the upper lip when showing contempt or to deepen the nasolabial sulcus when showing sadness.
The Buccinator Muscle
- This is a thin, flat, rectangular muscle.
- It is attached laterally to the alveolar processes of the maxilla and mandible, opposite the molar teeth and the pterygomandibular raphe.
- Medially, its fibres mingle with those of orbicularis oris.Innervation: the buccal branch of facial.
- It aids mastication and swallowing by pushing the cheeks against the molar teeth during chewing.
The Soft Palate
- This is the posterior curtain-like part, and has no bony support. It does, however, contain a membranous aponeurosis.
- The soft palate, or velum palatinum (L. velum, veil), is a movable, fibromuscular fold that is attached to the posterior edge of the hard palate.
- It extends posteroinferiorly to a curved free margin from which hangs a conical process, the uvula (L. uva, grape).
- The soft palate separates the nasopharynx superiorly and the oropharynx inferiorly.
- During swallowing the soft palate moves posteriorly against the wall of the pharynx, preventing the regurgitation of food into the nasal cavity.
- Laterally, the soft palate is continuous with the wall of the pharynx and is joined to the tongue and pharynx by the palatoglossal and palatopharyngeal folds.
- The soft palate is strengthened by the palatine aponeurosis, formed by the expanded tendon of the tensor veli palatini muscle.
- This aponeurosis attaches to the posterior margin of the hard palate.
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.
Geniohyoid Muscle
- Origin: Inferior genial tubercles of the mandible.
- Insertion: Anterior surface of the body of the hyoid bone.
- Nerve Supply: Branch of C1 through the hypoglossal nerve (CN XII).
- Arterial Supply: Sublingual branch of the lingual artery.
- Action: Elevates the hyoid bone and depresses the mandible.
The Palate
- The palate forms the arched roof of the mouth and the floor of the nasal cavities.
- The palate consists of two regions: the anterior 2/3 or bony part, called the hard palate, and the mobile posterior 1/3 or fibromuscular part, known as the soft palate.
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.
Genioglossus Muscle
- Origin: Mental spine of the mandible.
- Insertion: Dorsum of the tongue and hyoid bone.
- Nerve Supply: Hypoglossal nerve (CN XII).
- Arterial Supply: Sublingual and submental arteries.
- Action: Depresses and protrudes the tongue.