Anatomy

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PHARYNGEAL ARCHES ILIOLUMBAR LIGAMENT

ƒƒ The components of each pharyngeal arch include an aortic arch,
a specific cranial nerve, an associated muscle, and a cartilage
skeleton.
ƒƒ Strong band of connective tissue which extends from the
P
transverse process of L5 to the posterior iliac wing and iliac crest.
ƒƒ Major ligament at lumbosacral junction which helps in alignment
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ƒƒ M/s of the arches are s/by nerve of that arch. These nerves of L5 on the sacrum during various movements.
develop from neural crest cells. � It is one of three vertebro-pelvic ligaments responsible for

CELLS OF NEURAL CREST ORIGIN

stabilizing the lumbosacral spine. It does this along with the
sacrospinous and sacrotuberous ligaments. i
ƒƒ It has 2 parts:-
•• Upper part is attached to iliac crest and continuous with anterior
System Cell type
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layer of thoracolumbar fascia.
Nervous ƒƒ Sensory ganglia of CN 5,7,9,10 •• Lower part reaches posterior part of iliac fossa & blends with
System ƒƒ ANS (sympathetic and parasympathetic anterior sacroiliac ligament.
ganglia)
ƒƒ Intestinal nervous system/enteric plexuses
� This ligament is crucial in supporting the lower lumbar spine and
in providing anterior stability of sacroiliac joint.
E
(Aurbach's & Myenteric) � Iliolumbar syndrome, also known as iliac crest pain syndrome,
ƒƒ Neuroglial cells, olfactory ensheathing cells involves an inflammation or tear of the iliolumbar ligament
ƒƒ Schwann cells
GE
UMBILICAL CORD
Endocrine ƒƒ Adrenal medulla
ƒƒ Calcitonin-secreting C-cells S
ƒƒ Carotid body I-cells ƒƒ Develops from and contains remnants of the yolk sac and
allantois. It is formed by the 5th week of development,
Pigment cells ƒƒ Epidermal pigment cells (melanocytes)
Facial cartilage and ƒƒ Craniofacial cartilage and bones (Cranial
ƒƒ Cord is surrounded and supported by gelatinous tissue known U
as Wharton’s jelly, which is made up of mucopolysachharides
ED
bone vault except parietal bone)
at birth.
Sensory
Teeth
ƒƒ Inner ear, corneal endothelium and stroma
ƒƒ Dental papillae
ƒƒ Contains 2A+1V (Lt umbilical vein).
ƒƒ It contains one vein, which carries oxygenated, nutrient-rich
P
ƒƒ Odontoblast blood to the fetus from placenta.
Connective tissue ƒƒ smooth muscle, and adipose tissue of skin
of head and neck
ƒƒ Lt umbilical vein forms→ Ligamentum teres hepatis (Round
ligament of liver) P
ƒƒ Presence of single umbilical artery is associated with renal and
ƒƒ Connective tissue of meninges, salivary,
cardiac anomalies. Incidence is 1:100.
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lacrimal, thymus, thyroid, and pituitary

[N.B.: Left is left & right disappears at 4months of IUL and also
glands
remember that Lt is derived from Lt vein]
ƒƒ Connective tissue and smooth muscle in
arteries of aortic arch origin
SIBSON’S FASCIA E
SPECIAL VISCERAL EFFERENT FIBERS ƒƒ The suprapleural membrane is known as Sibson’s fascia.
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ƒƒ It partly separates the thorax from neck.

Special visceral efferent fibers (SVE) or Branchial efferent are the ƒƒ Triangular in shape.
efferent nerve fibers that provide motor innervation to the muscles ƒƒ Refers to a thickening of connective tissue ( endothoracic fascia)
of the branchial/pharyngeal arches in human.The only nerves
EX

containing SVE fibers are :-

ƒƒ The motor nucleus of trigeminal nerve (V) in upper pons.
extending over the cupola of the pleura and reinforcing it. It
covers lung’s apex. E
ƒƒ Morphologically it is regarded as the flattened tendon of scalenus
ƒƒ The nucleus of facial nerve (VII) in the lower part of the pons. minimus (pleuralis) muscle.
ƒƒ The nucleus ambiguus in medulla. It supplies
○○ Stylopharyngeus m/s through CN-IX and
ƒƒ Attaches to the internal border of the 1st rib and the transverse
processes of vertebra C7.
N
○○ Muscles of soft palate, the pharynx and the larynx through ƒƒ Injury to this fascia may result in herniation of the cervical pleura.
the vagus nerve (X) and the cranial part of accessory nerve
(collectively k/as vagoaccessory complex). T
These Updates are from Primes Supplement 2018
Anatomy
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COSTOCHONDRAL JOINT ANATOMY & HISTOLOGY OF HARD PALATE
ƒƒ Costochondral joint means the joint between the rib and its costal ƒƒ The hard palate forms the roof of the oral cavity. It lies posterior
P
cartilage. and medial to the alveolar process of the maxilla.
ƒƒ The first costal cartilage of both sides attach to the manubrium ƒƒ The bony structure is formed by the palatine processes of the
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sterni. At this joint, no movement is possible. maxilla and the horizontal plates of the palatine bones.
ƒƒ The second costal cartilage articulates with the body of sternum ƒƒ The hard palate is continuous with the soft palate posteriorly.
and the manubrium sterni by a synovial joint where movement ƒƒ Gross/ Macroscopic Features
is possible.
ƒƒ The third to seventh costal cartilages articulate with lateral border
○○ The hard palate is typically pale pink in colour and may have
an orange peel appearance d/to presence of minor salivary
i
of the body of sternum at mobile synovial joints. glands (more common posteriorly).
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ƒƒ Costal margin is formed by 8,9,10 costal cartilages articulating ƒƒ Microscopic Features
with each other. ○○ Lined with a keratinized stratified squamous epithelium,
ƒƒ Floating ribs are 11th and 12th ribs they do not articulate tightly bound to the underlying periosteum of the palatine
anteriorly. bone/maxilla.
○○ There is minimal submucosa, which becomes more prominent E
Costal Articulate with with Type posteriorly.
cartilages
NASMYTH’S MEMBRANE
1st Manubrium sterni Symphysis
GE
2nd cc Body of sternum Synovial joint ƒƒ Nasmyth’s membrane, aka primary enamel cuticle.
ƒƒ It is a thin membrane of tissue aka reduced enamel epithelium
S
3rd-7th cc Body of sternum Synovial joint (REE) produced by the ameloblast, that covers the tooth once it

6-10 th cc Each other at anterior borders Synovial joints

has erupted.
ƒƒ It protects enamel from resorption by cells of the dental sac and
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also secretes desmolytic enzymes for elimination of the dental
- All costal cartilages with ribs Costochondral
joints
sac, allowing fusion between reduced enamel epithelium and oral
epithelium. This process allows eruption of the tooth without P
bleeding.
DEVELOPMENT OF URETERIC BUD
ƒƒ The ureteric bud, also k/as the metanephrogenic diverticulum, is
ƒƒ Trapezius muscle is a unique triangular shape muscle. It
extends from occiput down to 12th thoracic vertebra.
P
a protrusion from the mesonephric duct during the development ƒƒ Sartorius → Strap like muscle.

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of the urogenital system.

TYPES OF SYNOVIAL JOINTS
NERVE INJURIES DURING LABOUR
ƒƒ Mother can sustain peroneal nerve injuries. We most often
Hinge
Interphalangeal
Pivot
Atlanto-
Condylar
Knee
Ellipsoid
Wrist joint,
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consider LL neuropathies in association with labour and delivery,
but UL injuries can be sustained as well. Neurologic injury can Joint of fingers axial Temporoma- Metacarpo
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occur during labour, spontaneous vaginal delivery, operative and toes Radioulnar ndibular phalangeal,
vaginal delivery, or C- section. Elbow Metatarso
○○ Lumbosacral plexus or trunk (L4-L5) injury can cause foot Ankle Phalangeal,
EX

drop.
○○ Injury to the LFCN (lateral femoral cutaneous nerve) causes
Atlanto-occipital
E
burning, pain, or numbness of the anterolateral thigh, known Saddle Plane Ball and socket
as meralgia paresthetica.
○○ Radial nerve injury has been reported with use of the birthing
Carpo – metacarpal
joint of thumb,
Intercarpal joint
Intertarsal joint
Shoulder joint
Hip joint N
bar when patients position their arms to rest on the bar directly Sternoclavicular Facet joint (between Talocalcaneo-
across the spiral groove of the humerus Calcaneo cuboid, the articular facet of navicular joint
joint between
malleus and incus
adjacent vertebra) Articulation between
incus and stapes
T
These Updates are from Primes Supplement 2018
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PERINEAL BODY Oculomotor Palsy

ƒƒ Perineal body is a fibromuscular node present between the

P
urogenital opening and anal opening.
ƒƒ The levator ani muscle complex is consists of the pubococcygeus,
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puborectalis and iliococcygeus muscles. It is is the largest muscle
of the pelvic floor attached to perineal body and is a critical
component of the pelvic floor support.
ƒƒ The urethral ligaments and anterior vaginal wall provide a
hammock-like support and play an important role in maintaining
i
urinary continence in women. Therefore, a tear in the pubocervical
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fascia or periurethral ligament can lead to a cystocele, urethral
hypermobility, or urinary incontinence.

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Right
GE
Straight
S
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Left

Superior Oblique Palsy P

10 Muscles Inserted P
ƒƒ 2 transverse perinei superficialis & 2 Bulbo spongiosus in

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superficial stratum
ƒƒ 2 transverse perinei profundus & external sphincter & longitudinal
muscles of anal canal in middle stratum
ƒƒ 2 Levator ani (pubococcygeus and iliococcygeus) in deep stratum

6TH CRANIAL NERVE PALSY

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ƒƒ 6th cranial nerve (abducent nerve) palsy leads to abduction of the

eyeball as it supplies LR muscle. If the patient is asked to look at
the left side, concomitant palsy of the left lateral rectus leads to
EX

inability to move the left eyeball to the left side (abduction of left
eye), whereas the right eyeball moves normally. COLLAGEN TISSUE E
To Summarize
ƒƒ 6th nerve palsy – failure of lateral gaze
ƒƒ 3rd nerve palsy – eyeball down and out, dialted pupil, Ptosis
ƒƒ Loose connective tissue – loose arrangement of fibres. For
example areolar tissue, adipose tissue, myxomatous tissue and N
ƒƒ 4th nerve palsy – vertical diplopia on looking down – difficulty in reticular tissue.
ƒƒ Dense irregular connective tissue – Dense woven network
going downstairs, reading book
of collagenous fibres in a viscous matrix is also found in joint
capsules, muscle fascia and dermis of skin
T
These Updates are from Primes Supplement 2018
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ƒƒ Dense regular connective tissue – densely packed and arranged ƒƒ Genu –
in parallel. Found in tendon, ligaments. ○○ Curved anterior end of corpus callosum
○○ Forms the anterior boundary of anterior horn of lateral ventricle P
○○ Fibres from genu sweep forward on eitherside of frontal lobe
and form FORCEPS MINOR
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ƒƒ Rostrum
○○ Forms the floor of the anterior horn of lateral ventricle
○○ Fibres extend inferiorly to connect the orbital surface of two
frontal lobes
ƒƒ Trunk
i
○○ Fibres connect frontal and parietal lobe of two cerebral
hemisphere. Tapetum formed by fibres of trunk and splenium
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of corpus callosum which are not intersected by corona radiata.
Splenium is related to occipital cortex.

GE CREMASTERIC REFLEX E

MOVEMENTS OF JAW S
Action Muscle
Depression of Mandible ƒƒ Gravity: (Prime mover)
ƒƒ Lateral Pterygoid
U
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ƒƒ Assisted by
○○ Mylohyoid
○○ Geniohyoid
○○ Diagastrics
P
Elevation of Mandible ƒƒ Masseter—strong elevator
ƒƒ Temporalis
ƒƒ Medial pterygoid P
Protrusion of Mandible & side ƒƒ Medial pterygoid
to side movement (Helps in ƒƒ Lateral pterygoid
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chewing/grinding)
Retraction of Mandible ƒƒ Posterior fibers of temporalis

CORPUS CALLOSUM E
ƒƒ Afferent – stroking the inner side of thigh – fibers carried by

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femoral branch of genitofemoral nerve (L1-L2) & ilioinguinal

nerve.
ƒƒ Efferent – upward pulling of testes - carried by genital branch of
EX

genitofemoral nerve (L1-L2)

E
N
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These Updates are from Primes Supplement 2018