NEET MDS Lessons
Anatomy
The Scalp
- The scalp consists of five layers of soft tissue.
- It extends from the superior nuchal line on the posterior aspect of the skull of the supraorbital margins.
- Laterally, the scalp extends into the temporal fossa to the level of the zygomatic arches.
Layers of the Scalp
- The scalp proper is composed of three fused layers. It is separated from the pericranium by loose connective tissue.
- Because of this potential areolar cleavage plane, the scalp is fairly mobile.
- Each letter of the word "S C A L P" serves as a memory key for one of the layers of the scalp: Skin, Connective Tissue, Aponeurosis Epicranialis, Loose Areolar Tissue and Pericranium.
Layer 1: Skin
- Hair covers the scalp in most people.
- The skin of the scalp is thin, especially in elderly people, except in the occipital region.
- The skin contains many sweat and sebaceous glands and hair follicles.
- The skin of the scalp has an abundant arterial supply and good venous and lymphatic drainage systems.
Layer 2: Connective Tissue
- This is a thick, subcutaneous layer of connective tissue and is richly vascularised and innervated.
- It attaches the skin to the third layer of the scalp.
- Fat is enclosed in lobules between the connective fibres.
Layer 3: Aponeurosis Epicranialis
- This is a strong membranous sheet that covers the superior aspect of the cranium.
- This aponeurosis is the membranous tendon of the fleshy bellies of the epicranius muscle.
- The epicranius muscle consists of four parts: two occipital bellies, occipitalis and two frontal bellies, frontalis that are connected by the epicranial aponeurosis.
Layer 4: Loose Areolar Tissue
- This is a subaponeurotic layer or areolar or loose connective tissue.
- It is somewhat like a sponge because it contains innumerable potential spaces that are capable of being distended by fluid.
- It is this layer that allows free movement of the scalp proper, composed of layers 1-3.
Layer 5: Pericranium
- This is a dense layer of specialised connective tissue.
- The pericranium is firmly attached to the bones by connective tissue fibres called Sharpey’s fibres, however, they can be fairly easily stripped from the cranial bones of living persons, except where they are continuous with the fibrous tissues of the cranial sutures.
Muscles Around the Eyelids
- The function of the eyelid (L. palpebrae) is to protect the eye from injury and excessive light. It also keeps the cornea moist.
The Orbicularis Oculi Muscle
- This is the sphincter muscle of the eye.
- Its fibres sweep in concentric circles around the orbital margin and eyelids.
- It narrows the eye and helps the flow of tears from the lacrimal sac.
- This muscle has 3 parts: (1) a thick orbital part for closing the eyes to protect then from light and dust; (2) a thin palpebral part for closing the eyelids lightly to keep the cornea from drying; and (3) a lacrimal part for drawing the eyelids and lacrimal punta medially.
- When all three parts of the orbicularis oculi contract, the eyes are firmly closed and the adjacent skin becomes wrinkled.
- The zygomatic branch of the facial nerve (CN VII) supplies it.
The Levator Palpebrae Superioris Muscle
- This muscle raises the upper eyelid to open the palpebral fissure.
- It is supplied by the oculomotor nerve (CN III).
Internal Ear
- Osseous labyrinth: a complex system of cavities in the substance of the petrous bone.
- Membranous labyrinth: filled with endolymph, bathed in perilymph.
Mesodermal Origin |
Muscles |
Innervation |
Somitomeres 1, 2 |
Superior, medial and ventral recti |
Oculomotor (III) |
Somitomere 3 |
Superior oblique |
Trochlear (IV) |
Somitomere 4 |
Jaw-closing muscles |
Trigeminal (V) |
Somitomere 5 |
Lateral rectus |
Abducens (VI) |
Somitomere 6 |
Jaw-opening and other 2nd arch muscles |
Facial (VII) |
Somitomere 7 |
Stylopharyngeus |
Glossopharyngeal (IX) |
Somites 1, 2 |
Intrinsic laryngeals |
Vagus (X) |
Somites 2-5 |
Tongue muscles |
Hypoglossal (XII) |
The Oropharynx
- The oral part of the pharynx has a digestive function.
- It is continuous with the oral cavity through the oropharyngeal isthmus.
- The oropharynx is bounded by the soft palate superiorly, the base of the tongue inferiorly, and the palatoglossal and palatopharyngeal arches laterally.
- It extends from the soft palate to the superior border of the epiglottis.
The Palatine Tonsils
- These are usually referred to as "the tonsils".
- They are collections of lymphoid tissue the lie on each side of the oropharynx in the triangular interval between the palatine arches.
- The palatine tonsils vary in size from person to person.
- In children, the palatine tonsils tend to be large, whereas in older persons they are usual small and inconspicuous.
- The visible part of the tonsil is no guide to its actual size because much of it may be hidden by the tongue and buried in the soft palate.
->The two parietal bones (L. paries, wall) form large parts of the walls of the calvaria.
->On the outside of these smooth convex bones, there are slight elevations near the centre called parietal eminences.
->The middle of the lateral surfaces of the parietal bones is crossed by two curved lines, the superior and inferior temporal lines.
->The superior temporal line indicates an attachment of the temporal fascia; the inferior temporal line marks the superior limit of the temporalis muscle.
->The parietal bones articulate with each other in the median plane at the sagittal suture. The medial plane of the body passes through the sagittal suture.
->The inverted V-shaped suture between the parietal bones and the occipital bones is called the lambdoid suture because of its resemblance to the letter lambda in the Greek alphabet.
->The point where the parietal and occipital bones join is a useful reference point called the lambda. It can be felt as a depression in some people.
->In addition to articulation with each other and the frontal and occipital bones, the parietal bones articulate with the temporal bones and the greater wings of the sphenoid bone.
->In foetal and infant skulls, the bones of the calvaria are separated by dense connective tissue membranes at sutures.
->The large fibrous area where several sutures meet are called fonticuli or fontanelles.
->The softness of these bones and looseness of their connections at these sutures enable the calvaria to undergo changes of shape during birth called molding. Within a day or so after birth, the shape of the infant’s calvaria returns to normal.
->The loose construction of the new-born calvaria also allows the skull to enlarge and undergo remodelling during infancy and childhood.
->Relationships between the various bones are constantly changing during the active growth period.
->The increase in the size of the cranium is greatest during the first 2 years, the period of most rapid postnatal growth of the brain.
->The cranium normally increases in capacity until about 15 or 16 years of age; thereafter the cranium usually increases only slightly in size as its bones thicken for 3 to 4 years.
- The forehead is formed by the smooth, broad, convex plate of bone called the frontal squama.
- In foetal skulls, the halves of the frontal squama are divided by a metopic suture.
- In most people, the halves of the frontal bone begin to fuse during infancy and the suture between is usually not visible after 6 years of age.
- The frontal bone forms the thin roof of the orbits (eye sockets).
- Just superior to and parallel with each supraorbital margin is a bony ridge, the superciliary arch, which overlies the frontal sinus. This arch is more pronounced in males.
- Between these arches there is a gently, rounded, medial elevation called the gabella; this term derives from the Latin word glabellus meaning smooth and hairless. In most people, the skin over the gabella is hairless.
-The slight prominences of the forehead on each side, superior to the superciliary arches, are called frontal eminences (tubers).
- The supraorbital foramen (occasionally a notch), which transmits the supraorbital vessels and nerve is located in the medial part of the supraorbital margin.
- The frontal bone articulates with the two parietal bones at the coronal suture.
-It also articulates with the nasal bones at the frontonasal suture. At the point where this suture crosses the internasal suture in the medial plane, there is an anthropological landmark called the nasion . The depression is located at the root of the nose, where it joins the cranium.
- The frontal bone also articulates with the zygomatic, lacrimal, ethmoid, and sphenoid bones.
In about 8% of adult skulls, a remnant of the inferior part of the metopic (interfrontal) suture is visible. It may be mistaken in radiographs for a fracture line by inexperienced observers.
- The superciliary arches are relatively sharp ridges of bone and a blow to them may lacerate the skin and cause bleeding.
- Bruising of the skin over a superciliary arch causes tissue fluid and blood to accumulate in the surrounding connective tissue, which gravitates into the upper eyelid and around the eye. This results in swelling and a "black eye".
- Compression of the supraorbital nerve as it emerges from its foramen causes considerable pain, a fact that may be used by anaesthesiologists and anaesthetists to determine the depth of anaesthesia and by physicians attempting to arouse a moribund patient.