Secti on IA

GENERAL ANATOMY

Topic 1 OSTEOLOGY OF HEAD AND NECK

SHORT ESSAYS
Q.1. Enumerate any four structures passing through
foramen magnum.

The structures passing through the foramen magnum are as The inferior constrictor muscle consists of two parts:
follows: The thyropharyngeus
Through the anterior part: The cricopharyngeus
Apical ligament of dens Their attachments are as follows:
Vertical brand of cruciate ligament The thyropharyngeus arises from:
Membrane tectoria The oblique line on the lamina of the thyroid cartilage,
Through the subarachnoid space: including the inferior tubercle.
Spinal accessory nerves The inferior cornua of the thyroid cartilage.
Vertebral arteries The cricopharyngeus arises from the cricoid cartilage
Sympathetic plexus around the vertebral arteries behind the origin of the cricothyroid muscle.
Posterior spinal arteries All the constrictors of the pharynx are inserted into a
Anterior spinal artery median raphe on the posterior wall of the pharynx.
Through the posterior part: Nerve Supply
Lowest part of medulla oblongata All muscles of the pharynx, except the stylopharyngeus
Three meninges are supplied by the motor fibres derived from the cranial
Q.2. Give the attachments, nerve supply and actions of accessory nerve through the branches of the vagus. The
inferior constrictor muscles. inferior constrictor receives an additional supply from
the external and recurrent laryngeal nerves.
Action of Inferior Constrictor Muscles of Pharynx
The inferior constrictors of the pharynx bring about the
third stage of deglutition or swallowing.

SHORT NOTES
Q.1. Dens. 1. Second cervical vertebra called axis is identified by the
presence of the dens or odontoid process, which is a strong,
tooth-like process projecting upwards from the body.
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The dens is usually believed to represent the centrum or
body of the atlas, which has fused with the centrum or
body of the axis.
The superior surface of the body of cervical vertebra is
fused with the dens and is encroached upon on each side
by the superior articular facets.
The dens articulates anteriorly with the anterior arch of
the atlas, and posteriorly with the transverse ligament of
the atlas (Fig. 1A.1.1).
Fig. 1A.1.1 Dens.
Q.2. Maxilla.
Maxilla is the second largest bone of the face. The whole
of the upper jaw is formed by two maxillae, and each
maxilla contributes in the formation of face, nose, mouth,
orbit, the infratemporal and pterygopalatine fossae.
Features
Each maxilla has a body and four processes.
Body of maxilla
The body of maxilla is pyramidal in shape, with its base
directed medially towards the lateral wall of the nose and
the apex is directed laterally towards the zygomatic
process. It has four surfaces and encloses a large cavity
known as the maxillary sinus.
The four processes of maxilla are as follows:
The frontal
Zygomatic
Alveolar 4. Palatine processes. Q.3. Hyoid bone.
The hyoid bone is U-shaped and is situated in the anterior
midline of the neck between the chin and the thyroid
cartilage (Fig. 1A.1.2).
Greater cornua
Lesser cornua
Body
Fig. 1A.1.2 Hyoidbone.
It develops from second and third branchial arches.
At rest, it lies at the level of the third cervical vertebra
behind and the base of the mandible in front.
The hyoid bone consists of
the central part, called the body and
two pairs of cornua, the greater and the lesser.
It is suspended in position by muscles and ligaments. The
hyoid bone provides attachment to the floor of the mouth
and to the tongue above, to the larynx below, and to the
epiglottis and pharynx behind. Q.4. Mastoid groove.
The mastoid part of the temporal bone lies just behind the
external acoustic meatus. It is continuous
anterosuperiorly with the squamous temporal bone. A
partially obliterated squamomastoid suture may be visible
just in front of and parallel to the roughened area of
muscular insertions known as mastoid groove.
Auditory tube.
The auditory tube connects the middle ear with the
nasopharynx anteriorly (Fig. 1A.1.3). The sulcus tube
which is a groove between the posteromedial margin of
the greater wing of the sphenoid and the petrous temporal
bone lodges the cartilaginous part of the auditory tube.
Posteriorly, the groove leads to the bony part of the
auditory tube, which lies within the petrous temporal
bone.
Aditus to antrum
Auditory tube Mastoid antrum
POSTERIOR
ANTERIOR
Middle ear Mastoid air cells
Mastoid process
Fig. 1A.1.3 Auditorytube.
Deep cervical fascia.
Deep Cervical Fascia (Fascia Coli)
The deep fascia of the neck is condensed to form the
following layers: 1. Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheath 5. Buccopharyngeal fascia
6. Pharyngobasilar fascia.
Investing layer
It lies deep to the platysma muscle and surrounds the
neck like a collar. It forms the roof of the posterior
triangle of the neck.
Pretracheal layer
The importance of this fascia is that it encloses and
suspends the thyroid gland and forms its false capsule. A
fibrous band from this is attached to the cricoid cartilage
known as ligament of Berry.
Prevertebral layer

It lies in front of the prevertebral muscles, and forms the
floor of the posterior triangle of the neck.
Carotid sheath
It is a condensation of the fibroareolar tissue around the
main vessels of the neck. These are the common and
internal carotid arteries and internal jugular vein and the
vagus nerve.
Buccopharyngeal fascia
This fascia covers the superior constrictor muscle
externally and extends on to the superficial aspect of the
buccinator muscle.
Pharyngobasilar fascia
This fascia is especially thickened between the upper
border of superior constrictor and the base of the skull. It
lies deep to the pharyngeal muscles. Q.7. Jugular
foramen.
Or
Name any four structures passing though jugular
foramen.
The jugular foramen is large and elongated, placed at the
posterior end of the petro-occipital suture. The jugular
foramen transmits the following structures:
Through the anterior part
Inferior petrosal sinus
Meningeal branch of the ascending pharyngeal artery
Through the middle part
1. IX, X and XI cranial nerves
Through the posterior part
Internal jugular vein
Meningeal branch of the occipital artery.
The glossopharyngeal notch near the medial end of the
jugular foramen lodges the inferior ganglion of the
glossopharyngeal nerve.
Q.8. Foramen lacerum.
The foramen lacerum is a short, wide canal, 1 cm long. Its
lower end is bounded posterolaterally by the apex of the
petrous temporal, medially by the basiocciput and the
body of the sphenoid, and anteriorly by the root of the
pterygoid process and the greater wing of the sphenoid
bone.
The structures passing through the foramen lacerum are
as follows:
During life the lower part of the foramen is filled with
cartilage, and no significant structure passes through the
whole length of the canal, except for the meningeal
branch of the ascending pharyngeal artery and an
emissary vein from the cavernous sinus.
The upper part of the foramen is traversed by the internal
carotid artery with venous and sympathetic plexuses
around it.
General Anatomy 5
The nerve of the pterygoid canal, leaves the foramen by
entering the pterygoid canal in the anterior wall of the
foramen lacerum.
Q.9. Zygomatic arch.
The zygomatic arch is formed by the temporal process of
the zygomatic bone in anterior one-third and the
zygomatic process of the temporal bone in posterior two-
thirds.
The arch is separated from the side of the skull by a gap.
The anterior end of the upper border is called the jugal
point. The posterior end of the zygoma is attached to the
squamous temporal bone by anterior and posterior roots.
Two projections are visible in relation to these roots. One
is articular tubercle or tubercle of the root of zygoma at
its lower border and the other one is the mandibular or
articular fossa and is known as postglenoid tubercle.
Q.10. Superior orbital fissure.
The superior orbital fissure is situated at the posterior part
of the junction between the roof and lateral wall of the
orbit.
It is an oblique, roughly triangular space bounded above
by the lesser wing, below by the greater wing and
medially by the body of the sphenoid.
The lower border is marked by a small projection, which
provides the attachment to the common tendinous ring of
Zinn. The ring divides the fissure into three parts. Q.11.
Greater horn of hyoid.
Hyoid bone is a U-shaped bone suspended by stylohyoid
ligaments and lies in front of the neck between the base
of mandible and the thyroid eminence (Fig. 1A.1.2).
Hyoid bone has following parts:
1. Body 2. Two greater cornua
3. Two lesser cornua.
Greater cornu or greater horn of hyoid bone projects
backwards on each side as a long slender process from
the lateral ends of the body.
It possess: two surfaces: upper and lower, two borders:
medial and lateral and two ends: anterior and posterior.
Surfaces
Upper surface
Gives origin to
Middle constrictor muscle of pharynx medially
Hyoglossus muscle laterally.
Gives insertion to
1. Stylohyoid near the junction of greater cornua with the
body.
Gives attachment to
1. Fibrous loop anchoring the central tendon of digastric
muscle to the hyoid bone.
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Lower surface
It has no attachments.
Borders
Medial border: It gives attachment to thyrohyoid
membrane.
Lateral border: It gives insertion to thyrohyoid muscle
anteriorly.
Ends
Anterior end: It unites with the body by synchondrosis.
Posterior end: It ends in a tubercle.
Q.12. Surgical importance of pterion.
Or
Give the formation of pterion and structures related
deep to it.
The anterior part of the floor of temporal fossa is crossed
by an H-shaped suture where four bones; frontal, parietal,
sphenoid and temporal adjoin each other. This area is
termed as the pterion.
It lies 4 cm above the midpoint of the zygomatic arch or 4
cm above the zygoma and 2.5 cm behind the
frontozygomatic suture.
The middle meningeal vein, the anterior division of the
middle meningeal artery and the stem of the lateral sulcus
of the brain lie deep to the pterion.
Q.13. Name four arteries related to ramus of
mandible.
Or
Give the four arteries related to ramus of mandible.
The four arteries related to ramus of the mandible are as
follows: 1. Mental vessels
Inferior alveolar vessels
Mylohyoid vessels 4. Masseteric vessels.
Q.14. List out four structures passing through
superior orbital fissure.
Structures passing through superior orbital fissure are as
follows (Fig. 1A.1.4):
Superior and Inferior ophthalmic vein
Lacrimal nerve
Frontal nerve
Recurrent meningeal branch of ophthalmic artery
Recurrent meningeal branch of ophthalmic artery
Lacrimal nerve
Frontal nerve
Superior ophthalmic nerve
Upper and lower divisions of oculomotor nerve
Nasociliary nerve
Abducent nerve
Inferior ophthalmic vein
Greater wing of sphenoid
Trochlear nerve Lesser wing of sphenoid
Fig. 1A.1.4 Structurespassingthroughsuperiororbitalfissure.
Trochlear nerve
Oculomotor nerve 7. Nasociliary nerve
8. Abducent nerve.
Q.15. Name the muscles attached to greater cornua
of hyoid bone.
The medial border of the greater cornua provides
attachment to the following muscles: 1. Thyrohyoid
membrane 2. Stylohyoid muscle
3. Digastric pulley.
The lateral border of the greater cornua provides insertion
to:
1. The thyrohyoid muscle 2. The investing fascia.
Q.16. Structures passing through foramen ovale.
The foramen ovale is large and oval in shape. It is
situated posterolateral to the upper end of the posterior
border of the lateral pterygoid plate.
The foramen ovale transmits the following:
Mandibular nerve
The lesser petrosal nerve
The accessory meningeal artery
An emissary vein connecting the cavernous sinus with the
pterygoid plexus of veins
The anterior trunk of the middle meningeal vein.
Q.17. Structures passing through anterior condylar
canal.
The hypoglossal or anterior condylar canal pierces the
bone anterosuperior to the occipital condyle, and is
directed laterally and slightly forwards.
It transmits the hypoglossal nerve, the meningeal branch
of ascending pharyngeal artery, and an emissary vein
connecting the sigmoid sinus with the internal jugular
vein. Q.18. Openings in the middle meatus of the
nose.
The middle meatus of nose lies beneath the middle
conchae engaging the structures like, the ethmoidal bulla
hiatus semilunaris and infundibulum.
The openings in the middle meatus of nose are as follows:
The opening of the frontal air sinus in the anterior part of
the hiatus semilunaris.
The
Common tendinous ring opening
of the
Body of sphenoid
Superior orbital fissure

maxillary air sinus located in the posterior part of the
hiatus semilunaris.
The opening of the middle ethmoidal air sinus is present
at the upper margin of the bulla.
Q.19. Give the attachments of pterygomandibular
raphe and name the muscle attached to it.
The pterygomandibular raphe is attached immediately
behind the third molar tooth in continuation with the
origin of the superior constrictor.
The muscles attached to it are as follows:
Superior constrictor muscle of pharynx
The buccinator muscle.
Q.20. Ligaments attached to the mandibular
surface.
Ligaments attached to the mandibular surface are as
follows:
Sphenomandibular ligament
Lateral ligament of temporomandibular joint.
Q.21. Enumerate any four structures passing
through foramen magnum.
The foramen magnum transmits the following structures:
Lowest part of medulla oblongata
Three meninges
Spinal accessory nerves
Vertebral arteries.
Q.22. Name the contents of pterygopalatine fossa. 2. Maxillary nerve and its two branches, zygomatic, and
posterior superior alveolar.
3. Pterygopalatine ganglion and its numerous branches Contents of pterygopalatine fossa are as follows: containing fibres
of the maxillary nerve mixed with.
1. Third part of the maxillary artery and its branches
Topic 2 SCALP, TEMPLE AND FACE
LONG ESSAYS
Q.1. Enumerate the layers of scalp. Give their blood
supply, nerve supply and lymphatic drainage.
The scalp is made up of five layers:
Skin
Superficial fascia
Deep fascia (epicranial aponeurosis or galea
aponeurotica) 4. Loose areolar tissue
5. Pericranium.
The skin is thick and hairy outermost layer of the scalp. It
is adherent to the epicranial aponeurosis through the
General Anatomy 5
dense superficial fascia. It contains large number of
sebaceous glands and is richly supplied by blood vessels.
The superficial fascia is the second layer of scalp which is
more fibrous and dense in the centre than at the
periphery. It binds the skin to the adjacent aponeurosis,
and provides the proper medium for passage of vessels
and nerves to the skin.
The deep fascia, i.e. the epicranial aponeurosis or galea
aponeurotica, is the third layer of scalp which is freely
movable on the pericranium along with the overlying
adherent skin and fascia.
The occipitofrontalis muscle has two bellies, occipital and
frontal, both of which are inserted into the epicranial
aponeurosis.
Anteriorly, it receives the insertion of the frontalis,
posteriorly it receives the insertion of the occipitalis and
is attached to the external occipital protuberance, and to
the highest nuchal lines in between the occipital bellies.
On each side the aponeurosis is attached to the superior
temporal line, but sends down a thin expansion, which
passes over the temporal fascia and is attached to the
zygomatic arch.
The fourth layer of the scalp is made up of loose areolar
tissue which extends anteriorly into the eyelids;
posteriorly to the highest and superior nuchal lines and on
each side to the superior temporal lines.
The pericranium is the fifth layer of the scalp and is
loosely attached to the surface of the bones, but is firmly
adherent to their sutures where the sutural ligaments bind
the pericranium to the endocranium.
Arterial Supply of Scalp and Superficial Temporal
Region
The scalp has a rich blood supply (Fig. 1A.2.1) derived
from both the internal and the external carotid arteries,
the two systems anastomose over the temple.
In front of the auricle, the scalp is supplied from before
backwards by the following:
Supratrochlear
Supraorbital
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Superficial temporal arteries.
The first two are branches of the ophthalmic artery, which
is a branch of the internal carotid artery. The superficial
temporal is a branch of the external carotid artery.
Behind the auricle, the scalp is supplied from before
backwards by the following: 1. Posterior auricular
2. Occipital arteries.
Both are the branches of the external carotid artery.
Supratrochlear nerve
Q.2. Describe the maxillary nerve under the
following headings: origin, course, branches,
distribution and applied anatomy.
The maxillary nerve is a sensory nerve originating from
anterior border of the trigeminal ganglion. It leaves the
cranial cavity through the foramen rotundum and enters
the pterygo palatine fossa. It then enters the orbit through
the inferior orbital fissure. The nerve is accompanied by
the infraorbital artery. The part of this nerve in the floor
of the orbit is called infraorbital nerve. In the floor of the
orbit the nerve passes within the infraorbital canal. It then

Zygomaticotemporal
nerve

Zygomatic nerve

Infraorbital Maxillary nerve

Third occipital nerve foramen
Pterygopalatine
Fig. 1A.2.1 Scalpshowingarterialandnervesupply.
Lymphatic Drainage
Preauricular or parotid lymph nodes: This group of Posterior
lymph nodes drains the anterior part of the scalp. superior
Anterior alveolar
Posterior auricular or mastoid and occipital lymph superior
nodes: The posterior part of the scalp drains in to this alveolar Superior
nerve
group of lymph nodes.
Nerve Supply
The scalp and temple are supplied by 10 nerves on each
passes through the infraorbital foramen and enters the
side. Out of these, five nerves (four sensory and one
face and terminates by dividing into the following
motor) enter the scalp in front of the auricle. The
peripheral branches:
remaining five nerves (again four sensory and one motor)
Inferior palpebral branch
enter the scalp behind the auricle.
Nerves of the scalp and Lateral nasal branch 3. Superior labial branch.
superficial temporal regions Branches of maxillary nerve in detail are as follows (Fig.
1A.2.2):
Within the cranial cavity:
Front of auricle Behind the auricle ganglion
nerve
dental plexus
Fig. 1A.2.2 Maxillarynerveanditsbranches.
Sensory nerves Motor nerves It gives of meningeal branches to the dura mater of the
1. Supratrochlear 1. Temporal branch
2. Supraorbital branches of facial nerve middle cranial fossa.
3. Zygomaticotemporal Within the pterygopalatine fossa:
4. Auriculotemporal nerve 1. Ganglionic branches to join pterygopalatine ganglion
2. Zygomatic nerve:
Sensory nerves Motor nerve Zygomaticotemporal
Posterior division of great auricular 1. Posterior auricular nerve
Zygomaticofacial 3. Posterior superior alveolar nerve
(C2, C3), from cervical plexus branch of facial Within the floor of the orbit:
Lesser occipital nerve (C2), nerve 1. Middle superior alveolar nerve 2. Anterior superior
from cervical plexus
alveolar nerve
Greater occipital nerve (C2), dorsal ramus
Third occipital nerve (C3), dorsal ramus On the face:
Inferior palpebral branch
Lateral nasal branch 3. Superior labial branch.
 General Anatomy 5

The posterior, middle and anterior superior alveolar During cavernous sinus thrombosis, this nerve may be
nerves enter the maxilla, and they form the superior compressed by blood clot.
dental plexus to supply the teeth of the upper jaw. Also Q.3. Describe the course, branches and distribution
they supply the maxillary air sinus. of mandibular division of trigeminal nerve.
Ganglionic Branches
Sensations from the pharynx, nose, palate and orbit are Mandibular nerve is the largest of the three divisions of
carried by these fibres. the trigeminal nerve. It is a mixed nerve carrying both
It also receives secretomotor fibres through the nerve of sensory and motor roots.
the pterygoid canal to supply the lacrimal gland. The sensory root commences from the anterior border of
Zygomatic Nerve the trigeminal ganglion. The motor root of the mandibular
It is a branch of maxillary nerve. It enters the orbit, and nerve lies deep to the trigeminal ganglion.
divides into zygomaticofacial and zygomaticotemporal Mandibular Nerve (Fig.1A.2.3)
branches. Course
Zygomaticofacial nerve passes through the foramen of the The two roots pass through the foramen ovale and enter
zygomatic bone to supply skin of malar region. the infratemporal fossa. Just below the foramen ovale, the
Zygomaticotemporal nerve enters the scalp and supplies two roots unite to form the main trunk of the mandibular
the skin of the temporal region and anterior quadrant of nerve.
scalp. It carries parasympathetic fibres to the lacrimal Motor root
Sensory root
nerve to supply lacrimal gland. Foramen ovale
Posterior Superior Alveloar Nerve Tpal
Nervous
It enters the maxilla through an opening on the posterior spinosus
Ttym
wall of maxilla. It supplies the mucous membrane of Mpt Otic ganglion
maxillary air sinus. It joins superior dental plexus. Auriculotemporal
nerve Mas
The posterior superior alveolar nerve via this plexus Tem Lpt
supplies the molar teeth of the upper jaw and related gum
of the maxilla.
Buccal nerve
Middle Superior Alveolar Nerve
It is formed within the infraorbital canal, i.e. on the roof Lingual nerve
of maxillary air sinus. Nerve to
Its branches specifically supply the premolar teeth and mylohyoid
sometimes join the superior dental plexus.
Inferior alveolar nerve
Anterior Superior Alveolar Nerve Mylohyoid
It is a branch of infraorbital part of maxillary nerve,
which passes downwards into the anterior part of Mental nerve
maxillary sinus. It divides into dental and nasal branches.
The dental branch forms the superior dental plexus by
joining posterior superior and middle superior alveolar Anterior belly
nerves. Through this plexus it supplies the incisor and of digastric
canine teeth of the upper jaw. The nasal branch supplies Fig. 1A.2.3 Mandibularnerve.Mpt,nervetomedialpterygoid;
lower half of lateral wall of nose. Mas, masseteric nerve; Temp, nerve to temporalis and Lpt,
nervetolateralpterygoid.
Palpebral Branches
They supply skin of the lower eyelid and related The main trunk is medially related to the tensor veli
conjunctiva. palatini muscle and laterally related to lateral pterygoid
Nasal Branches muscle. The otic ganglion is situated on the medial side
of the nerve trunk. After a short course, the trunk of the
They supply the skin on the lateral side of external nose.
nerve divides into two divisions: (a) anterior and (b)
Superior Labial Branches
posterior.
They supply skin and mucous membrane of the lip and
Branches of Mandibular Nerve
cheek.
Branches from main trunk
Applied Anatomy
1. Meningeal branch 2. Nerve to medial pterygoid.
During trigeminal neuralgia pain along the course of all
Branches from anterior division
branches of trigeminal nerve including maxillary nerve.
Deep temporal
Lateral pterygoid
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Masseteric
Buccal.
Branches from posterior division
Auriculotemporal
Lingual
Inferior alveolar.
Branches of mandibular nerve and their distribution in
detail are as follows:
Branches from the main trunk
Nervous spinosus or meningeal branch:
It enters the skull through the foramen spinosum along
with the middle meningeal artery and supplies the dura
mater of the middle cranial fossa.
Nerve to medial pterygoid muscle:
It supplies the medial pterygoid muscle and then it enters
the otic ganglion. Through this ganglion it supplies tensor
tympani and tensor veli palatini muscles.
Branches from the anterior division
The anterior division is mainly motor, and it has some
sensory fibres.
The anterior division gives the following branches:
Nerve to masseter:
It crosses above the tendon of the lateral pterygoid
muscle. It is accompanied by the artery to masseter. It
then passes through the mandibular notch. It supplies
masseter muscle and temporomandibular joint.
Nerve to lateral pterygoid muscle:
This branch enters the medial surface of lateral pterygoid
muscle.
Nerve to temporalis (deep temporal nerves):
They are two in number emerging from the upper border
of the lateral pterygoid muscle and are accompanied by
deep temporal arteries. They supply deep surface of
temporalis.
Buccal nerve:
It is sensory nerve which passes between the two heads of
the lateral pterygoid accompanied by the buccal artery.
This nerve supplies the skin and mucosa of the cheek.
Branches from the posterior division
The posterior division of the mandibular nerve is mainly
sensory and with few motor fibres, it gives rise to the
following nerves:
1. Auriculotemporal nerve
This nerve has double roots of origin, which unite to form
a single nerve which passes backwards and lies deep to
the lateral pterygoid muscle. Further, it passes between
neck of mandible and sphenomandibular ligament behind
the temporomandibular joint, running behind the
superficial temporal vessels. It pierces the upper border of
the parotid gland and crosses the zygomatic arch and then
it enters the temporal fossa (Fig. 1A.2.4).
Middle meningeal artery
Auriculotemporal
Mandibular nerve
nerve
Maxillary
artery
Inferior alveolar nerve
Lingual nerve
Fig. 1A.2.4 Auriculotemporalnerve.
It gives the following branches:
Auricular branches to supply external ear
Temporal branches to supply the skin of the temporal
region
Glandular branches to supply the parotid gland
Branch to the temporomandibular joint.
2. Inferior alveolar nerve (Fig. 1A.2.5)
It is a mixed nerve arising from posterior division of the
mandibular nerve in the infratemporal fossa.
Course: It emerges below the lower border of the lateral
pterygoid muscle accompanied by the inferior alveolar
artery and is situated posterior to lingual nerve. The nerve
passes
Lateral pterygoid muscle
Inferior alveolar nerve
Inferior alveolar artery
Incisive
nerve
Mental nerve
Fig. 1A.2.5 Inferioralveolarnerve.
downwards deep to the sphenomandibular ligament. It
enters the mandibular foramen and passes within the
mandible. It supplies the pulp and periodontium of
mandibular teeth.
It terminates within the mandible as:
Incisive nerve
Mental nerve—emerging through the mental foramen.
Branches of inferior alveolar nerve are as follows:
Nerve to mylohyoid — this nerve is given off before the
inferior alveolar nerve enters the mandibular foramen. It
pierces the sphenomandibular ligament. It is accompanied
 General Anatomy 5

by artery to the mylohyoid and this nerve terminates by

supplying the anterior belly of the digastric and
mylohyoid muscles.
Branches to supply molar and premolar teeth and related
gum. These branches form inferior dental plexus. Angular artery
Incisive branch — it passes within the incisive canal
supplying incisors and canine teeth.
Mental branch — mental nerve emerges through the Lateral nasal artery
mental foramen and supplies soft tissues of lower lip and
Ascending
chin. palatine Superior labial artery
3. Lingual nerve Inferior labial artery
It arises within the infratemporal fossa from the posterior External
carotid artery
division of the mandibular nerve. Submental artery
Course: It is joined by the chorda tympani branch of the Tonsillar artery
Facial artery
facial nerve within the infratemporal fossa and emerges
Fig. 1A.2.6 Courseoffacialartery.
along the lower border of the lateral pterygoid muscle. It
It enters the face by winding around the base of the
lies in front of the inferior alveolar nerve and vessels. The
mandible, and by piercing the deep cervical fascia, at the
nerve is superficially situated medial to the mandibular
anteroinferior angle of the masseter muscle where it can
third molar covered only by the oral mucous membrane.
be palpated and is called ‘anaesthetist’s artery’.
It then crosses the hyoglossus muscle and loops around
First it runs upwards and forwards to a point 1.25 cm
the submandibular duct, terminates by supplying the
lateral to the angle of the mouth. Then it ascends by the
mucous membrane of the anterior two-thirds of the
side of the nose up to the medial angle of the eye, where
tongue. Branches of lingual nerve are as follows:
it terminates by supplying the lacrimal sac; and by
Branches to supply
anastomosing with the dorsal nasal branch of the
The mucous membrane of the floor of the mouth
ophthalmic artery.
The gums of the mandible
The facial artery is very tortuous and lies between the
The mucous membrane of the anterior two-thirds of
superficial and deep muscles of the face.
tongue.
Branches of the facial artery in the neck are as follows
Communications of the lingual nerve
(Fig. 1A.2.7):
It communicates with:
Ascending palatine artery
Chorda tympani nerve within the infratemporal fossa
Tonsillar artery to supply the palatine tonsil
Submandibular ganglion and hypoglossal nerve, when it
Glandular branches to supply the submandibular gland
lies on the hyoglossus
and submandibular lymph glands
The inferior alveolar nerve rarely.
Submental artery.
Q.4. Describe the origin, course, relation and
Branches on the face are as follows:
branches of facial artery.
The anterior branches on the face are large and named as
The facial artery is the main artery of the face where it is
follows:
located within the muscles of facial expression. The
Inferior labial artery to supply the lower lip
artery is tortuous in its facial course.
Superior labial artery to supply the upper lip and nose
Origin
It originates from the external carotid artery just above
the greater horn of the hyoid bone within the carotid
triangle.
Course
It passes upwards and grooves the submandibular gland
and then turns downwards lateral to the submandibular
gland and reaches the lower border of the mandible (Fig.
1A.2.6). It pierces the stylomandibular ligament.
4 Quick Review Series: BDS 1st Year

3. Lateral nasal artery Supraorbital 4. Muscular branches to the muscles of facial The
expression. artery
Supratrochlear
Applied Anatomy artery
During injury of the face bleeding from the facial artery
Transverse
can be stopped by compressing the artery against the lower facial artery
border of mandible. In the lips branches of the facial artery
Lateral nasal
artery are found nearer to the mucous membrane than to the skin. Superior Hence,
injuries caused by the teeth on the mucous membrane labial artery of the mouth
may develop hidden hematomas. The labial Inferior labial branches of the facial artery of
both sides are communicating artery around the mouth. This communication forms
anastomosis
between the external carotid arteries of both sides.
Fig. 1A.2.7 Branchesoffacialarteryontheface.

SHORT ESSAYS

Q.1. Facial artery.
Or
Origin, course, relation and branches of facial artery.
Refer to the answer of Long Essay Q. 4. Q.2. Buccinator
muscle.
The buccinator muscle also known as trumpet muscle is
the chief muscle of the cheek. This muscle is covered by
the buccopharyngeal fascia and buccal pad of fat. It is
pierced by the parotid duct opposite to maxillary second
molar.
Origin
From lateral surface of alveolar processes of the maxilla
and mandible at the level of the third molar tooth
From anterior border of pterygomandibular raphe.
Insertion
All the fibres converge at the angle of the mouth and fuse
with the fibres of the orbicularis oris.
Nerve Supply
Buccal branch of the facial nerve supplies the buccinators
muscle.
Applied Anatomy
During the facial nerve injury, the paralysis of the
buccinator muscle leads to inability to blow the cheek.
Actions
It compresses the cheek against the teeth thereby prevents
the food accumulation within the vestibule of the mouth
during mastication and also helps in sucking.
It helps to blow the cheek.
Q.3. Cutaneous innervation of face. Or
Mention the sensory nerve supply to the face.
Sensory Nerve Supply of the Face
trigeminal nerve is the chief sensory nerve of the face.
The skin over the angle of the jaw and over the parotid
gland is supplied by the great auricular nerve (C2, C3).
The trigeminal nerve also supplies sensory innervations
to eyeball, the oral cavity, palate, cheeks, gums, teeth and
anterior two-thirds of tongue and the supratentorial part
of the dura mater including that lining the anterior and
middle cranial fossae.
The following branches of ophthalmic division of
trigeminal nerve supply scalp up to vertex, forehead,
upper eyelid, conjunctiva, small part of lower eyelid and
root, dorsum and tip of nose: 1. Supratrochlear nerve
Supraorbital nerve
Lacrimal nerve
Infratrochlear nerve
External nasal nerve.
Maxillary division of trigeminal nerve
Infraorbital nerve
Zygomaticofacial nerve 3. Zygomaticotemporal nerve.
These branches supply upper lip; side and ala of nose;
most of the lower eyelid; upper part of cheek and anterior
part of temple.
Mandibular division of trigeminal nerve
Auriculotemporal nerve
Buccal nerve 3. Mental nerve.
This division supplies lower lip; chin; lower part of
cheek; lower jaw except over the angle; upper two-thirds
of lateral surface of auricle; and side of head.
Cervical plexus
Anterior division of great auricular nerve (C2, C3)
Upper division of transverse (anterior) cutaneous nerve of
neck (C2, C3).
They supply the skin over the angle of the jaw and over
the parotid gland. Lower margin of the lower jaw.
 General Anatomy 5

Q.4. Connections, course and distribution of chorda

tympani.

In the vertical part of the facial canal, the chorda tympani

nerve arises about 6 mm above the stylomastoid foramen
and runs upwards and forwards in a bony canal then
enters the middle ear and runs forwards in close relation
to the tympanic membrane (Fig. 1A.2.8).
It leaves the middle ear by passing through the
petrotympanic fissure, it then passes medial to the spine
of the sphenoid and enters the infratemporal fossa where
it joins the lingual nerve through which it is distributed.
It carries preganglionic secretomotor fibres to the
submandibular ganglion for supply of the submandibular
and sublingual salivary glands and taste fibres from the
anterior two-thirds of the tongue.
Q.5. Give a short account of parts, relation and
nerve supply of lacrimal gland.

Lacrimal gland is a serous gland which is ‘ J’ shaped,

being indented by the tendon of the levator palpebrae
superioris muscle situated chiefly in the lacrimal fossa on
the lateral part of the roof of the bony orbit and partly on
the upper eyelid. Small accessory lacrimal glands are
found in the conjunctival fornices.
The parts of lacrimal gland are as follows:
A palpebral part: smaller and superficial, lying within the
eyelid
An orbital part: which is larger and deeper.
About a dozen of its ducts pierce the conjunctiva of the
upper lid and open into the conjunctival sac near the
superior fornix. Most of the ducts of the orbital part pass
through the palpebral part.
The gland is supplied by the lacrimal branch of the
ophthalmic artery and by the lacrimal nerve. The nerve
has both sensory and secretomotor fibres.
The course of secretomotor fibres is as follows:
Lacrimatory nucleus
Nerves intermedius
Geniculate ganglion
Greater petrosal nerve
Nerve of pterygoid canal
Pterygopalatine ganglion
Relay
Zygomatic and zygomaticotemporal nerve
4 Quick Review Series: BDS 1st Year

Lacrimal nerve
Lacrimal gland
Buccal
The lacrimal fluid secreted by the lacrimal gland flows into the
conjunctival sac where it lubricates the front of the eye and the
deep surface of the lids. Most of the fluid evaporates. The rest is
drained by the lacrimal canaliculi. Fig. 1A.2.8 Distributionof
mandibularnerve(V3). When excessive, it overflows as tears.

SHORT NOTES
Q.1. Platysma.
Platysma is one of the muscles of neck.
It originates from the upper parts of pectoral and deltoid
fasciae and fibres run upwards and medially.
Anterior fibres get inserted to the base of the mandible
and posterior fibres to the skin of the lower face and lip,
and may be continuous with the risorius.
Actions of platysma are as follows:
Releases pressure of skin on the subjacent veins
Depresses the mandible
Pulls the angle of the mouth downwards as in horror or
surprise.
Q.2. Buccinator.
The facial vein is the largest vein of the face with no
valves.
It begins as the angular vein at the medial angle of the
eye.
It is formed by the union of the supratrochlear and
supraorbital veins. The angular vein continues as the
facial vein, running downwards and backwards behind
the facial artery but with a straighter course.
It crosses the anteroinferior angle of the masseter, pierces
the deep fascia, crosses the submandibular gland, and
joins the anterior division of the retromandibular vein
below the angle of the mandible to form the common
facial vein. The latter drains into the internal jugular vein.
Q.5. Facial artery.

Buccinator is the muscle of the cheek.
Origin
Upper fibres, from maxilla opposite molar teeth
Lower fibres, from mandible, opposite molar teeth
Middle fibres, from pterygomandibular raphe.
Insertion
Upper fibres, straight to the upper lip.
Lower fibres, straight to the lower lip.
Middle fibres decussate before passing to the lips.
Actions
Flattens cheek against gums and teeth.
Prevents accumulation of food in the vestibule. Q.3.
Bell’s palsy.
The facial artery (facial part) is the chief artery of the
face. It is a branch of the external carotid artery given off
in the carotid triangle just above the level of the tip of the
greater cornua of the hyoid bone.
In its cervical course, it passes through the submandibular
region, and finally enters the face.
The anterior branches on the face are as follows:
Inferior labial n to the lower lip.
Superior labial n to the upper lip and the anteroinferior
part of the nasal septum.
Lateral nasal n to the ala and dorsum of the nose.
The posterior branches are small and unnamed. Q.6.
Orbicularis oculi.

Infranuclear lesions of the facial nerve are known as Orbicularis oculi is explained in Table 1A.2.1.
Bell’s palsy. The features of Bell’s palsy are as follows: Table 1A.2.1 Orbicularis oculi
The face becomes asymmetrical and is drawn up to the Muscle Origin Insertion Action
normal side. 1. Part of Concentric Closes lids
The affected side is motionless. Orbital medial rings tightly;
Wrinkles disappear from the forehead. part palpebral return to protects
ligament and the point eye from
The eye cannot be closed.
adjoining of origin bright light
Any attempt to smile draws the mouth to normal side. bone
During mastication, food accumulates between the teeth 2. Lateral part Lateral Closes lids
and the cheek. Palpebra of medial palpebral gently;
Articulation of labials is impaired. l part palpebral raphe blinking
Q.4. Facial vein. ligament
3. Lacrimal Upper and Dilates
Lacrimal fascia and lower lacrimal

part lacrimal bone eyelids sac;
supports
the lower
eyelid
Q.7. Deep facial vein.
Deep connections of the facial vein include a
communication between the supraorbital and pterygoid
plexus through the deep facial vein, which passes
backwards over the buccinator.
The facial vein communicates with the cavernous sinus
through these connections.
Infections from the face can spread in a retrograde
direction and cause thrombosis of the cavernous sinus.
This is especially likely to occur in the presence of
infection in the upper lip and in the lower part of the
nose. Q.8. Palpebral ligament.
The palpebral fascia of the two lids forms the orbital
septum. Its thickenings form tarsal plates of tarsi in the
lids and the palpebral ligaments at the angles.
Dangerous area of scalp.
Infections from the face can spread in a retrograde
direction and cause thrombosis of the cavernous sinus.
This is likely to occur in the presence of infection in the
upper lip and in the lower part of the nose. This area is,
therefore, called the dangerous area of the face (Fig.
1A.2.9).
Fig. 1A.2.9 Dangerousareaoftheface.
Epicranial aponeurosis.
The epicranial aponeurosis or galea aponeurotica is the
third layer of scalp and is freely movable on the
pericranium along with the overlying and adherent skin
and fascia (Fig. 1A.2.10).
Anteriorly, it receives the insertion of the frontalis;
posteriorly, it receives the insertion of the occipitalis and
it is attached to the external occipital protuberance, and to
the highest nuchal lines in between the occipital bellies.
On each side the aponeurosis is attached to the superior
temporal line, but sends down a thin expansion, which
General Anatomy 5
passes over the temporal fascia and is attached to the
zygomatic arch.
Q.11. Palatine aponeurosis.
The posterior border of the hard palate provides
attachment to the palatine aponeurosis. Q.12.
Nasolacrimal apparatus. Or
Name the structures forming lacrimal apparatus.
The structures concerned with secretion and drainage of
the lacrimal or tear fluid constitute the lacrimal apparatus.
It is made up of the following parts: 1. Lacrimal gland
and its ducts
Conjunctival sac
Lacrimal puncta and lacrimal canaliculi
Lacrimal sac
Nasolacrimal duct.
Q.13. Levator palpebrae superioris.
Levator palpebrae superioris muscle is an eye opener (or)
dilator muscle.
Origin
It originates from the following:
Inferior surface of the lesser wing of the sphenoid bone
Orbital surface of the body of the sphenoid bone anterior
to the optic foramen.
Insertion
It expands towards the upper eyelid and divides into
superficial and deep layers, which are inserted to:
Orbital septum and palpebral ligaments (medial and
lateral)
Superior tarsal plate 3. Skin of the upper eyelid.
The smooth muscle fibres of the levator palpebrae
superioris is called as Muller’s muscle.
The aponeurosis of this muscle divides the lacrimal gland
into palpebral and orbital parts.
Nerve Supply
Upper division of the oculomotor nerve.
Sympathetic fibres from T1 segment of the spinal cord
supplies the smooth muscle fibres of the muscle.
Actions
It elevates the upper eyelid.
Applied Anatomy
4 Quick Review Series: BDS 1st Year

Paralysis of the muscle causes ptosis (drooping of the

upper eyelid). Paralysis of the smooth muscle fibres of
this muscle causes pseudoptosis (Horner’s syndrome).
Q.14. Name the cervical branches of facial artery.

The cervical branches of facial artery are as follows:

Ascending palatine artery
Tonsillar artery
Glandular branches

Topic 3 SIDE OF THE

NECK
Submental artery.
Q.15. Give the formation and termination of anterior
facial vein.

Facial (anterior facial) vein, corresponds in general, to the

facial artery. The facial vein takes its origin from the
junction of the veins of the forehead and nose. Its upper part
is termed the angular vein and accompanies the angular
artery. The angular vein receives the frontal vein, the
supraorbital vein and veins from the lower lid and from the
bridge of the nose. From the inner corner of the eye, the
facial vein descends in a fairly straight line to the lower
border of the mandible.

LONG ESSAY
 General Anatomy 5

Q.1. Describe the boundaries and contents of

subclavian triangle.

The subclavian triangle is a small lower part of posterior

triangle of neck. The posterior triangle is a space on the
side of the neck situated behind the sternocleidomastoid
muscle (Fig. 1A.3.1). The posterior triangle of neck is
subdivided by the inferior belly of the omohyoid into 1.
A larger upper part, called the occipital triangle
2. A smaller lower part, called the supraclavicular or the
subclavian triangle.
Trapezius
Sternocleidomastoid
Posterior triangle (occipital
part) Superior belly of
omohyoid Inferior belly of
omohyoid
Posterior triangle
(Subclavian part)
Fig. 1A.3.1 Posteriortriangle
of theneck.
Clavicle Boundaries
Anterior: posterior border of sternocleidomastoid
Posterior: anterior border of trapezius
Inferior or base: middle one-third of clavicle
Apex: lies on the superior nuchal line where the trapezius
and sternocleidomastoid meet.
Roof
The roof is formed by the investing layer of deep cervical
fascia.
Floor
The floor of the posterior triangle is formed by the
prevertebral layer of deep cervical fascia, covering the
following muscles (Fig. 1A.3.2): 1. Splenius capitis
Levator scapulae
Scalenus medius and occasionally scalenus posterior.
The contents of subclavian triangle are listed in Table
1A.3.1.
Nerves
1. Three trunks of the brachial plexus emerge between
the scalenus anterior and medius, and carry the axillary
4 Quick Review Series: BDS 1st Year

passes over the serratus anterior in the medial wall of the axilla and gives branches to
the digitations of the muscle.
3. The nerve to the subclavius (C5, C6) descends in front
Splenius capitis of the brachial plexus and the subclavian vessels, to reach the deep
surface of the subclavius muscle. As it
Levator scapulae runs near the lateral margin of the scalenus anterior,
sometimes it gives off the accessory phrenic nerve, which joins the phrenic nerve in
front of the scalenus anterior.
Trunks of branchial plexus
4. The suprascapular nerve (C5, C6) arises from the upper
Scalenus anterior trunk of the brachial plexus and crosses the lower part
Scalenus posterior
Scalenus medius
of the posterior triangle. It passes backwards over the
shoulder to reach the scapula. It supplies the supraspi-
Subclavian artery
natus and infraspinatus muscles.
Subclavian vein
Fig. 1A.3.2 Flooroftheposteriortriangleofneck. Vessels
The subclavian artery passes behind the tendon of the scalenus anterior and the subclavian vein passes in front
Table 1A.3.1 Contents of subclavian triangle of the tendon.
Nerves a. Three trunks of brachial plexus The suprascapular artery is a branch of the thyrocervical trunk
b. Nerves to serratus anterior (long thoracic, which passes laterally and backwards behind the clavicle.
C5, C6, C7) The transverse cervical artery is also a branch of the
c. Nerves to subclavius (C5, C6) thyrocervical trunk. It crosses the scalenus anterior, the phrenic
d. Suprascapular nerves (C5, C6) nerve, and the upper trunks of the brachial plexus, the nerve to
Lymph A few members of the supraclavicular chain the subclavius, the suprascapular nerve and the scalenus medius.
nodes At the anterior border of sheath around them (Fig. 1A.3.3). The
sheath contains the levator scapulae it divides into superficial and
branches.
deep the brachial plexus and the subclavian artery.
2. The nerves to serratus anterior (long thoracic, C5, C6,
Lymph Nodes
C7) arise by three roots. The roots from C5 and C6 pierce the scalenus medius and join the root C7. The nerve A few
members of the supraclavicular chain.
Roots
Suprascapular nerve
Trunks Dorsal scapular nerve
C5

C6
Divisions
Nerve to subclavius
Cords and branches
C7
Long thoracic nerve
Lateral pectoral nerve
C8

T1

Musculocutaneous nerve Upper subscapular nerve

Nerve to latissimus dorsi
Lower subscapular nerve
Medial pectoral nerve
Axillary nerve Medial cutaneous nerve of arm
Medial cutaneous nerve of forearm
Lateral root
and medial root Radial nerve Ulnar nerve
of median nerve Median nerve

Fig. 1A.3.3 Brachialplexus.

 General Anatomy 5

SHORT ESSAYS
Q.1. Carotid sheath. The cervical sympathetic chain lies behind the sheath,
Or attached to the prevertebral fascia.
Brief account of carotid sheath and its contents. The sheath is overlapped by the anterior border of the
Or sternocleidomastoid, and is fused to the first three layers
Formation, attachments, relation and contents of of the deep cervical fascia. Q.2. Describe torticollis.
carotid sheath.
Torticollis or wryneck is a deformity as a result of spasm
Carotid Sheath or contracture of the muscles supplied by the spinal
Carotid sheath is a condensation of the fibroareolar tissue accessory nerve, namely the sternocleidomastoid and
around the main vessels of the neck, namely (Fig. trapezius. In this deformity the head is bent to one side
1A.3.4): and the chin points to the opposite side.
The common carotid artery Depending on the causes, there are many varieties of
Internal carotid artery 3. Internal jugular vein torticollis, as follows:
4. The vagus nerve. Rheumatic torticollis, due to exposure to cold or draught
Reflex torticollis, due to inflamed or suppurating cervical
lymph nodes, which irritate the spinal accessory nerve
Congenital torticollis, due to birth injury
Spasmodic torticollis, due to central irritation.
Q.3. General investing layer of deep cervical fascia.

Pretracheal fascia Deep

Investing fascia
Sternocleidomastoid
Trachea
Platysma Carotid sheath
External jugular vein Oesophagus
Fused prevertebral
and buccopharyngeal fasciae
Prevertebral fascia

Longus cervicis

Trapezius

Fig. 1A.3.5 Transversesectionthroughtheneckshowinggeneralinvestingfascia.

Ansa cervicalis
Internal jugular vein
Common carotid artery
Vagus nerve
Sympathetic trunk
Fig. 1A.3.4 Carotidsheathwithitscontents(sectionalview).
Relations
The ansa cervicalis lies embedded in the anterior wall of
the carotid sheath.
Cervical Fascia (Fascia Coli) (Fig.1A.3.5)
The deep fascia of the neck is condensed to form the
following layers:
Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheath 5. Buccopharyngeal fascia
6. Pharyngobasilar fascia.
Investing Layer of Deep Cervical Fascia
It lies deep to the platysma, and surrounds the neck like a
collar. It forms the roof the posterior triangle of the neck.
Attachments
Superiorly
External occipital protuberance
Superior nuchal line
Mastoid process 4. Base of the mandible.
4 Quick Review Series: BDS 1st Year

Between the angle of the mandible and the mastoid It is inserted (a) by a thick tendon into the lateral surface
process, the fascia splits to enclose the parotid gland. of the mastoid process, from its tip to the superior border,
Inferiorly and (b) by a thin aponeurosis into the lateral half of the
Spine of scapula superior nuchal line of the occipital bone.
Acromion process Nerve Supply
Clavicle The motor supply is by the spinal accessory nerve.
Manubrium. Proprioception by branches from the ventral rami of C2.
The fascia splits to enclose the suprasternal and Blood Supply
supraclavicular spaces. Arterial supply one branch each from superior thyroid
Posteriorly artery and supra scapular artery and two branches from
Ligamentum nuchae the occipital artery. Veins follow the arteries.
Spine of the seventh cervical vertebra. Actions
Anteriorly When one muscle contracts:
Symphysis menti It turns the chin to the opposite side.
Hyoid bone. It can also tilt the head towards the shoulder.
Both above and below the hyoid bone, it is continuous When both muscles contract together:
with the fascia of the opposite side. They draw the head forwards, as in eating and in lifting
Other Features the head from a pillow.
The investing layer of deep cervical fascia splits to With the longus colli, they flex the neck against
enclose the following structures: resistance.
Muscles—trapezius and sternocleidomastoid The reverse action in forced inspiration.
Salivary glands—parotid and submandibular Relations
Spaces—suprasternal and supraclavicular. The sternocleidomastoid is enclosed in the investing layer
It also forms pulleys to bind the tendons of the digastric of deep cervical fascia, and pierced by the accessory
and omohyoid muscles. The suprasternal space contains: nerve and by the four sternocleidomastoid arteries. It has
The sternal heads of the right and left sternocleido- the following relations:
mastoid muscles Superficial
The jugular venous arch Skin
A lymph node Superficial fascia with platysma muscle
The interclavicular ligament. Superficial lamina of the deep cervical fascia
The supraclavicular space is traversed by: a. The external External jugular vein
jugular vein Superficial cervical lymph nodes lying along the vein
The supraclavicular nerves Nerves
Cutaneous vessels, including lymphatics. i. Great auricular ii. Transverse or anterior cutaneous iii.
Q.4. Give the attachments, nerve supply and actions Medial supraclavicular nerves
of sternocleidomastoid. g. The parotid gland overlaps the muscle.
Deep
The sternocleidomastoid and trapezius are large a. Bones and joints
superficial muscles of the neck. i. Mastoid process above ii.
Attachments Sternoclavicular joint below
Attachments of sternocleidomastoid are as shown in Fig. Carotid sheath
1A.3.1. Muscles
Origin i. Sternohyoid ii. Sternothyroid iii.
The sternal head arises from the superolateral part of the Omohyoid iv. Three scalene
front of the manubrium sterni. v. Levator scapulae vi. Splenius capitis
The clavicular head arises from the medial one-third of vii. Longissimus capitis
the superior surface of the clavicle. It passes deep to the viii. Posterior belly of digastric
sternal head, and the two heads blend below the middle of d. Arteries
the neck. Between the two heads there is a small i. Common carotid ii. Internal carotid
triangular depression of the lesser supraclavicular fossa, iii. External carotid
overlying the internal jugular vein. Sternomastoid arteries two from the occipital artery, one
Insertion from the superior thyroid, one from the suprascapular
 General Anatomy 5

Occipital vi. Subclavian vii. Suprascapular jugular vein across the middle one-third of the anterior
viii. Transverse cervical border of the sternocleidomastoid.
Table 1A.3.2 Contents of the posterior triangle
Conten Occipital triangle Subclavian triangle
t
Nerves Spinal accessory nerve Three trunks of brachial plexus
Four cutaneous branches cervical plexus: Nerve to serratus anterior (long thoracic, C5, C6, C7)
Lesser occipital (C2) Nerve to subclavius (C5,C6)
Great auricular (C2,C3) Suprascapular nerve (C5, C6)
Anterior cutaneous nerve
Supraclavicular nerves (C3, C4) 3. Muscular
branches:
Two small branches to the levator scapulae (C3,
C4)
Two small branches to the trapezius (C3, C4)
Nerve of rhomboideus (C5)
4. Upper part of the brachial plexus
Vessel Transverse cervical artery and vein Third part of subclavian artery and subclavian vein
s Occipital artery Suprascapular artery and vein
Commencement of transverse cervical artery and
termination of the corresponding vein
Lower part of external jugular vein
Lymph Along the posterior border of the A few members of the supraclavicular chain
nodes sternocleidomastoid, more in the lower part, the
supraclavicular nodes and a few at the upper angle
the occipital nodes

SHORT NOTES
e. Veins Superficial Retromandibular vein
temporal vein
i. Internal jugular ii. Anterior jugular iii. Facial iv.
Lingual
f. Nerves
Vagus
Accessory iii. Cervical plexus iv. Upper part of brachial
plexus
Phrenic
Ansa cervicalis Common facial
g. Lymph nodes External
i. Deep cervical. jugular
vein Anterior jugular
Q.5. Give the formation, course and termination of vein
external jugular vein. vein
Fig. 1A.3.6 Externaljugularvein.
Q.6. Boundaries and contents of posterior triangle.
The external jugular vein lies deep into the platysma (Fig.
1A.3.6).
The posterior triangle is the space on the side of the neck
It is formed by the union of the posterior auricular vein
situated behind the sternocleidomastoid muscle (Fig.
with the posterior division of the retromandibular vein.
1A.3.1). The posterior triangle is bounded:
It begins within the lower part of the parotid gland,
Anteriorly by: posterior border of sternocleidomastoid.
crosses the sternocleidomastoid obliquely, pierces the
Posteriorly by: anterior border of trapezius.
anteroinferior angle of the roof of the posterior triangle,
Inferiorly or base by: middle one-third of clavicle.
and opens into the subclavian vein.
Apex lies on the superior nuchal line where the trapezius
Its tributaries are (a) the posterior external jugular vein,
and sternocleidomastoid meet (Table 1A.3.2).
(b) the transverse cervical vein; (c) the suprascapular vein
Q.1. Occipital artery.
and (d) the anterior jugular vein. The oblique jugular vein
connects the external jugular vein with the internal
4 Quick Review Series: BDS 1st Year
Occipital artery commences from the external carotid
artery just above the greater horn of the hyoid bone. It
commences opposite to the commencement of the facial
artery.
Branches include the following:
Sternocleidomastoid branches—upper and lower
Mastoid artery
Muscular branches
Descending branch—superficial and deep branches
Meningeal branches—supply the dura mater of the
posterior cranial fossa
Branches to supply posterior surface of the auricle and
posterior quadrant of scalp.
The terminal part of the artery supplies posterior quadrant
of the scalp.
Q.2. Cervical fascia.
The deep cervical fascia of neck is condensed to form the
following layers: 1. Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheath
Buccopharyngeal fascia
Pharyngobasilar fascia.
The applied anatomy of the deep cervical fascia:
Parotid swellings are very painful due to the unyielding
nature of the parotid fascia.
The thyroid gland and all thyroid swellings move with
deglutition because the thyroid is attached to the larynx
by the suspensory ligaments of Berry.
Division of the external jugular vein in the
supraclavicular space may cause air embolism and
consequent death because the cut ends of the vein are
prevented from retraction and closure by the fascia,
attached firmly to the vein.
Q.3. Suprasternal space.
The investing layer encloses two fascial spaces: 1.
Supraclavicular space
2. Suprasternal space.
Near the lower part of the midline of the neck, the fascia
splits to enclose a space called suprasternal space (space
of Burn’s).
Within the suprasternal space, the following structures are
present:
Jugular venous arch communicating two anterior jugular
veins
Lymph node
Sternal origin of the sternocleidomastoid muscle 4.
Interclavicular ligament
5. Suprasternal ossicles.
Q.4. Pretracheal fascia.
Importance of this fascia is that it encloses and suspends
the thyroid gland and forms its false capsule. Superiorly it
extends up to the hyoid bone. Inferiorly it extends into the
thorax and joins the fibrous pericardium.
Laterally, it fuses with the carotid sheath and through this
sheath it is continuous with the investing layer of deep
cervical fascia.
Medially, it divides and encloses the thyroid gland. It
forms the false capsule for the thyroid gland.
The posterior capsule of the thyroid is thin and hence
enlargements of the thyroid are directed posteriorly.
The pretracheal fascia invests the infrahyoid muscles.
This fascia is attached to the thyroid and cricoid
cartilages as the suspensory ligament of Berry. This
ligament binds the thyroid gland to the larynx. Q.5.
External jugular vein.
Or
Formation of external jugular vein.
External jugular vein commences near the angle of the
mandible by the union of the posterior division of
retromandibular vein and posterior auricular vein.
Its course is as follows:
It passes downwards within the superficial fascia and runs
superficial to the sternocleidomastoid.
It is accompanied by great auricular nerve and pierces the
investing layer of deep cervical fascia at the lower part of
roof of the posterior triangle.
It terminates by joining the subclavian vein, about 4 cm
above clavicle. The vein is provided with valves.
Tributaries of EJV are as follows:
Suprascapular vein
Transverse cervical vein
Posterior jugular vein
Anterior jugular vein.
Rarely, common facial vein may terminate in it. Q.6.
Contents of carotid sheath.
Carotid sheath is a condensation of the fibroareolar tissue
around the main vessels of the neck namely: the common
and internal carotid arteries and internal jugular vein and
the vagus nerve.
The carotid sheath encloses the following:
The internal carotid artery
Common carotid artery 3. Internal jugular vein
4. The vagus nerve.
Q.7. Root value of brachial plexus.
Brachial plexus is a network of nerves to supply the upper
limb.
Formation
 General Anatomy 5

Ventral rami of C5, C6, C7, C8 and T 1 nerves join the lower part of the foramen it separates and leaves the
plexus. jugular foramen.
Branches Extracranial course
Branches are formed from root, trunk and cords. After emerging from jugular foramen it passes backwards
Branch from the roots and laterally deep to internal jugular vein.
Nerve to join phrenic nerve (C5) It is accompanied by the sternocleidomastoid branch of
Dorsal scapular nerve or nerve to rhomboids (C5) the occipital artery and passes deep into the posterior
Long thoracic nerve of Bell (nerve to serratus anterior belly of digastric and sternocleidomastoid and enters the
(C5, C6, C7) posterior triangle.
Nerve to scalene muscles and longus colli muscles (C5, It then passes deep into the trapezius muscle and
C6, C7, C8, T1). terminates by forming subtrapezial plexus by uniting with
Branches from the trunks C3 and C4 nerves. This plexus supplies trapezius muscle.
The upper trunk gives the following: 1. Suprascapular Muscular branches to the sternocleidomastoid and the
nerve (C5, C6) trapezius are the branches of the spinal part of accessory

BACK OF THE NECK

Topic 4
LONG ESSAYS
2. Nerve to subclavius (C5, C6). nerve.
Branches from the cords
Branches of lateral cord
Lateral pectoral nerve (C5, C6, C7)
Musculocutaneous nerve (C5, C6, C7)
Lateral root of median nerve (C5, C6, C7).
Branches of medial cord
Medial root of median nerve (C9T1)
Medial pectoral nerve (C8T1)
Medial cutaneous nerve of forearm (C8T1)
Medial cutaneous nerve of arm (C8T1)
Ulnar nerve (C8T1) (C7).
Branches of posterior cord
Upper subscapular nerve (C5, C6)
Thoracodorsal nerve (C6, C7, C8)
Lower subscapular nerve (C5, C6)
Axillary nerve (C5, C6)
Radial nerve (C5, C6, C7, C8 T1).
Q.8. Spinal part of accessory nerve.

Accessory nerve (XI cranial nerve) is a motor nerve. It

has a cranial part and a spinal part.
The spinal part emerges from the lateral surface of the
upper five cervical segments of the spinal cord.
COURSE
Intracranial course
The spinal part has five roots. They unite to form spinal
accessory, it passes upwards into the foramen magnum
and enters the posterior cranial fossa.
It then passes laterally towards the jugular foramen.
Within this foramen it unites with the cranial part. At the
4 Quick Review Series: BDS 1st Year

Q.1. Axillary nerve.

Axillary nerve is one of the two large terminal branches

of the posterior cord of brachial plexus (Fig. 1A.4.1). The
axillary nerve (C5, C6) supplies nothing in axilla, only its
name having been changed from circumflex to axillary.
Course
From its origin, it passes backwards between
subscapularis and teres major through the quadrangular
space where it lies in contact with the surgical neck of the
humerus, just below the capsule of the shoulder joint. Fig. 1A.4.2 Boundariesofsuboccipitaltriangle.
Branches Superomedially: Rectus capitis posterior major muscle
Muscular branches to supply the deltoid and teres minor supplemented by the rectus capitis posterior minor
muscles. Superolaterally: Superior oblique muscle
Articular branch to supply the shoulder joint. Interiorly: Inferior oblique muscle
Cutaneous branch to supply the upper lateral cutaneous Roof(Fig.1A.4.3)
nerve of arm. Medially: Dense fibrous tissue covered by the
Axillary nerve gives a branch to the shoulder joint and
divides into:
Injury to the nerve paralyses the deltoid muscle. This causes

Suprascapular nerve
Anterior branch Posterior branch
It supplies deltoid, and It gives off the motor nerve to a few
terminal twigs teres minor, then winds around pierce the
muscle and the posteroid border of deltoid reach the skin. and
becomes cutaneous nerve
of the arm. It supplies a few of the posterior fi bres of deltoid.
Applied Anatomy
The nerve may be injured during downward dislocation of
shoulder joint.
It may be injured during fracture of surgical neck of Fig. 1A.4.1
Axillarynerve(circumflexnerve). humerus.

fat shoulder. semispinalis capitis

Injection of drugs like penicillin when wrongly injected
may paralyse the nerve.
Q.2. Mention boundaries of suboccipital triangle.
Describe the contents of triangle.
The suboccipital triangle is a muscular space situated
deep in the suboccipital region.
Boundaries(Fig.1A.4.2)
Sternocleidomastoid
Splenius capitis
Fig. 1A.4.3 Roofofsuboccipitaltriangle.
Laterally: Longissimus capitis and occasionally the
splenius capitis.
Floor
Posterior arch of atlas
Posterior atlanto-occipital membrane.
Suboccipital Muscles
Suboccipital muscles are described in Table 1A.4.1.
Contents of suboccipital triangle are as follows:
1. Dorsal ramus of nerve C1 (suboccipital nerve) 2.
Third part of vertebral artery 3. Suboccipital plexus of
veins.
Dorsal Ramus of First Cervical Nerve
 General Anatomy 5

It emerges between the posterior arch of the atlas and the

vertebral artery, and soon gives rise to branches, which
supply the four suboccipital muscles and the semispinalis
capitis. The nerve to the inferior oblique gives off a
communicating branch to the greater occipital nerves.
It crosses the suboccipital triangle and pierces the
semispinalis capitis and trapezius muscles to ramify on
the back of the head reaching up to the vertex. It supplies
the semispinalis capitis in addition to the scalp.
4 Quick Review Series: BDS 1st Year

Table 1A.4.1 Suboccipital muscles: Origin, insertion, nerve supply and actions
Muscle Origin Insertion Nerve supply Actions
Rectus capitis Spine of axis Lateral part of the Suboccipital Mainly postural
posterior area below the nerve or dorsal Acting alone it turns the chin to the same
major inferior nuchal line ramus CI side
Acting together the two muscles extend the
head
Rectus capitis Posterior medial part of the area below Suboccipital Mainly postural
posterior tubercle of atlas the inferior nuchal line nerve or dorsal Extend the head
minor ramus CI
Obliquus Transverse Lateral area Suboccipital Mainly postural
capitis process of between the nuchal nerve or dorsal Extend the head
inferior or atlas lines ramus CI Flex the head laterally
inferior
oblique
Obliquus Spine of axis Transverse process Suboccipital Mainly postural
capitis of atlas nerve or dorsal Turns chin to the same side
inferior or ramus CI
inferior
oblique Anterior communicating artery
Anterior cerebral artery
Vertebral Artery(Fig.1A.4.4) It is the first and largest branch of Ophthalmic artery the
first part of the
cerebral artery
Middle subclavian artery.
Anterior choroidal artery
Vertebral artery chiefly supplies to the brain, out of its four Posterior communicating artery
parts; only the third part appears in the suboccipital triangle.
Posterior cerebral artery
This part appears at the foramen transversarium of
the atlas, grooves the atlas, and leaves the triangle by passing carotid artery
Internal deep to the lateral edge of the posterior atlanto-occipital
membrane. Third part gives muscular branches to the
Foramenmagnum muscles of the suboccipital region.
Suboccipital Plexus of Veins
It lies in and around the suboccipital triangle and drains the: Vertebral artery
Muscular veins
Occipital veins
Internal vertebral venous plexus
Condylar emissary vein. Subclavian artery
It itself drains into the deep cervical and vertebral plexus
of veins. Fig. 1A.4.4 Thevertebralarteryanditsbranches.

SHORT NOTES
Q.1. Vertebral artery. Second part: Precostal anastomosis
Third part: Spinal branch of first cervical inter segmental
Vertebral artery is the first branch of subclavian artery, and artery
arises from the upper convexity of the subclavian artery (Fig. Fourth part: Preneural anastomosis.
1A.4.5). Commencement
Vertebral artery supplies the visual area of the cerebrum, It commences from the first part of the subclavian artery
hindbrain, the spinal cord and suboccipital muscles. and terminates at the lower border of the pons where the
arteries

Posterior communicating artery of both the sides unite to form the basilar artery.
Posterior cerebral artery
Superior cerebellar Branches of Vertebral Artery lateral pontine artery Branches of basilar artery
Labyrinthine First part: Gives no branches. anterior inferior artery
 General Anatomy 5

Cerebellar Second part: Gives spinal branches to supply the spinal cord. posterior inferior artery They enter the vertebral canal
through the intervertebral
Cerebellar artery foramen.
Anterior spinal artery
Vertebral artery Third part: Gives muscular branches to the muscles of the
suboccipital region. Posterior spinal artery
Fig. 1A.4.5 Thevertebralartery. Fourth part: Gives the following branches:
Meningeal branches
It is divided into four parts according to its anatomical
location as follows:
First part: Dorsal part of seventh intersegmental artery
Posterior spinal artery
Anterior spinal artery
Posterior inferior cerebellar artery
Medullary branches to supply to medulla oblongata.
4 Quick Review Series: BDS 1st Year

Q.2. Styloid process. Q.3. Contents of suboccipital triangle.

The styloid process is a long, slender and pointed bony
process projecting downwards, forwards and slightly
medially from the temporal bone. It descends between the
external and internal carotid arteries to reach the side of the
pharynx. It is interposed between the parotid gland laterally
and the internal jugular vein medially.
Contents of suboccipital triangle are as follows:
Third part of vertebral artery
Dorsal ramus of nerve C1—suboccipital nerve
Suboccipital plexus of veins.

Topic 5 CONTENTS OF THE VERTEBRAL CANAL

LONG ESSAYS

Q.1. Spinal dura mater. Q.2. Subarachnoid space.

1. Subarachnoid space is a wide intraleptomeningeal

space between the pia and the arachnoid, filled with cerebrospinal fluid (CSF) (Fig. 1A.5.2).

Dura mater
Arachnoid mater
Pia mater
Subarachnoid space

Q.1. Enumerate dural venous sinus. Describe the Or

cavernous sinus in detail. Classify dural venous sinuses. Describe in detail the
Or position, contents, tributaries and applied aspect of
Describe cavernous sinus and its relations. cavernous sinus.
 General Anatomy 5

The lateral wall, roof and medial wall are formed by the
Venous sinuses of dura mater are venous spaces the walls meningeal dura mater.
of which are formed by dura mater (Fig. 1A.6.1). They Meningeal layer of dura mater
have an inner lining of endothelium. They are devoid of Endothelium
Hypophysis cerebri
Oculomotor nerve
muscle and valves in their walls.
Trochlear nerve
Venous sinuses receive venous blood from the brain, the
meninges and bones of the skull. Cerebrospinal fluid is Ophthalmic nerve Sphenoidal sinus
poured into some of them. Maxillary nerve
Mandibular nerve
Inferior sagittal sinus
Superior sagittal sinus Internal carotid artery
Sigmoid sinus Abducent nerve
Straight sinus Fig. 1A.6.2 Coronalsectionofmiddlecranialfossashowingthe
Superior petrosal sinus
Confluence of relationsofthecavernoussinus.
Basilar sinus
sinuses
Sphenoparietal
Relations(Fig.1A.6.2)
Great cerebral sinus Structures outside the sinus are as follows:
vein
Intercavernous Superiorly: Optic tract, optic chiasma, olfactory tract,
Right transverse sinus
internal carotid artery and anterior perforated substance
Sigmoid sinus Ophthalmic vein
Inferiorly: Foramen lacerum and the junction of the body
Superior petrosal sinus
Inferior petrosal sinus
and greater wing of the sphenoid bone
Cavernous sinus Medially: Hypophysis cerebri and sphenoidal air sinus
Pterygoid plexus of veins Laterally: Temporal lobe with uncus
sinus Anteriorly: Superior orbital fissure and the apex of the
Fig. 1A.6.1 Venoussinuses.
orbit
The pressure of blood in the cranial venous sinuses is
Posteriorly: Apex of the petrous temporal and the crus
kept constant as the sinuses communicate with veins
cerebri of the midbrain.
outside the skull through emissary veins.
Structures in the lateral wall of the sinus, from above
There are 23 venous sinuses, of which 8 are paired and 7
downwards, are as follows:
are unpaired.
Oculomotor nerve: In the anterior part of the sinus, leaves
A. Paired venous sinuses are as follows:
the sinus by passing through the superior orbital fissure.
There is one sinus each on the right and left sides.
Trochlear nerve: Enters the orbit through the superior
Cavernous sinus
orbital fissure, in the anterior part of the sinus.
Superior petrosal sinus
Ophthalmic nerve: It divides into the lacrimal, frontal and
Inferior petrosal sinus
nasociliary nerves in the anterior part of the sinus.
Transverse sinus
Maxillary nerve: It leaves the sinus by passing through
Sigmoid sinus
the foramen rotundum.
Sphenoparietal sinus
Trigeminal ganglion: The ganglion and its dural cave
Petrosquamous sinus project into the posterior part of the lateral wall of the
Middle meningeal sinus/veins. sinus.
B. Unpaired venous sinuses are as follows: Structures passing through the centre of the sinus are as
They are median in position. follows:
Superior sagittal sinus Internal carotid artery with the venous and sympathetic
Inferior sagittal sinus plexus
Straight sinus Abducent nerve, inferolateral to the internal carotid
Occipital sinus artery.
Anterior intercavernous sinus 6. Posterior intercavernous The structures in the lateral wall and in the centre of the
sinus sinus are separated from blood by the endothelial lining.
7. Basilar plexus of veins. Tributaries or Incoming Channels
Cavernous Sinuses From the orbit
Each cavernous sinus is a large venous space situated in The superior ophthalmic vein.
the middle cranial fossa, on either side of the body of the A branch of the inferior ophthalmic vein or sometimes the
sphenoid bone. Its interior part is divided into a number vein itself.
of spaces or caverns by trabeculae. The trabeculae are The central vein of the retina may drain either into the
much less conspicuous in the living than in the dead. The superior ophthalmic vein or into the cavernous sinus.
floor of the sinus is formed by the endosteal dura mater.
4 Quick Review Series: BDS 1st Year
From the brain
Superficial middle cerebral vein
Inferior cerebral veins from the temporal lobe.
From the meninges
Sphenoparietal sinus.
The frontal trunk of the middle meningeal vein may drain
either into the pterygoid plexus through the foramen
ovale or into the sphenoparietal or cavernous sinus.
Draining Channels or Communications
The cavernous sinus drains into the following:
The transverse sinus through the superior petrosal sinus.
The internal jugular vein through the inferior petrosal
sinus and through a plexus around the internal carotid
artery.
The pterygoid plexus of veins through the emissary veins.
The facial vein through the superior ophthalmic vein.
The right and left cavernous sinuses communicate with
each other through the anterior and posterior
intercavernous sinuses and through the basilar plexus of
veins.
All these communications are valveless, and blood can
flow through them in either direction.
Applied Anatomy
Thrombosis of the cavernous sinus may be caused by
sepsis in the dangerous area of the face, in the nasal
cavities, and in the paranasal air sinuses. This gives rise
to the following symptoms:
A. Nervous symptoms
Serve pain in the forehead in the area of distribution of
the ophthalmic nerve
Involvement of the third, fourth and sixth cranial
nerves resulting in paralysis of the muscles supplied.
B. Venous symptoms
Marked oedema of the eyelids, cornea and root of the
nose, with exophthalmos due to congestion of the orbital
veins.
A communication between the cavernous sinus and the
internal carotid artery may be produced by head injury
which results in the protrusion and pulsation of eyeball
with each heartbeat known as the pulsating
exophthalmos.
Q.2. Describe the pituitary gland in detail. Mention
its blood supply, development and relation.
The hypophysis cerebri or pituitary gland is a small
endocrine gland situated in relation to the base of the
brain. It is often called the master of the endocrine
orchestra because it produces a number of hormones that
control the secretions of many other endocrine glands of
the body (Fig. 1A.6.3).
It lies in the hypophyseal fossa or sella turcica or pituitary
fossa, which is roofed by the diaphragma sellae. The stalk
of the hypophysis cerebri pierces the diaphragma sellae
and is attached above to the floor of the third ventricle.
The gland is oval in shape and measures 8 mm
anteroposteriorly and 12 mm transversely. It weighs
about 500 mg.
Relations
Superiorly
Diaphragma sellae
Optic chiasma
Tuber cinereum
Infundibular recess of the third ventricle.
Trochlear nerve [IV]Abducent nerve [VI]
Cavernous (venous) sinus
Maxillary division of trigeminal nerve [V2]
Fig. 1A.6.3 Pituitaryglandanditsrelations.
Inferiorly
Irregular venous channels between the two layers of dura
mater lining the floor of the hypophyseal fossa
Hypophyseal fossa 3. Sphenoidal air sinus.
On each side
The cavernous sinus with its contents.
Subdivisions
The gland has two main parts: adenohypophysis and
neurohypophysis, which differ from each other
embryologically, morphologically and functionally.
The adenohypophysis develops as an upward growth
called the Rathke’s pouch from the ectodermal roof of the
stomodeum.
The neurohypophysis develops a downward growth from
the floor of the diencephalon and is connected to the
hypothalamus neural pathways. Further subdivisions of
each part are given below.
Adenohypophysis (Fig.1A.6.4)
Anterior lobe or pars anterior, pars distalis or pars
glandularis: This is the largest part of the gland.
Intermediate lobe or pars intermedia: This is in the form
of a thin strip that is separated from the anterior lobe by
an intraglandular cleft, a remnant of the lumen of
Rathke’s pouch.
 General Anatomy 5

Fig. 1A.6.5 Arterialsupplyofthehypophysiscerebri.

Median eminence ring around the posterior lobe. Branches from this ring
Infundibular recess of third ventricle
supply the posterior lobe and also anastomose with
branches from the superior hypophyseal artery.
The anterior lobe or pars distalis is supplied exclusively
by portal vessels arising from capillary tufts formed by
Mamillary body the superior hypophyseal arteries. The long portal vessels
Infundibulum drain the median eminence and the upper infundibulum,
Pars posterior and the short portal vessels drain the lower infundibulum.
The portal vessels are of great functional importance
Pars intermedia
because they carry the hormone releasing factors from the
Cleft hypothalamus to the anterior lobe where they control the
Pars anterior secretory cycles of different glandular cells.
Tuberal lobe or pars tuberalis: It is an upward extension Venous Drainage
of the anterior lobe that surrounds and forms part of the Short veins emerge on the surface of the gland and drain
infundibulum. into neighbouring dural venous sinuses. The hormones
Optic chiasma pass out of the gland through the venous blood and are
Pars tuberalis
Fig. 1A.6.4 Asagittalsectionofthehypophysiscerebri.
carried to their target cells.
Neurohypophysis Histology and Hormones Anterior lobe
Posterior lobe or neural lobe, pars posterior: It is smaller Chromophilic cells (50%)
than the anterior lobe and lies in the posterior concavity Acidophils/alpha cells (about 43% of cells)
of the anterior lobe. Somatotrophs: Secrete growth hormone (STH,
Infundibular stem: It contains the neural connections of GH)
the posterior lobe with the hypothalamus. Mammotrophs (prolactin cells): Secrete lactogenic
Median eminence of the tuber cinereum: It is continuous hormone.
with the infundibular stem. Corticotrophs: Secrete ACTH
Arterial Supply(Fig.1A.6.5) Basophils/beta cells (about 7% of cells)
The hypophysis cerebri is supplied by the following Thyrotrophs: Secrete TSH ii. Gonadotrophs: Secrete
branches of the internal carotid artery. FSH iii. Luteotrophs: Secrete LH or ICSH
One superior hypophyseal artery on each side Chromophobic cells (50%) represent the nonsecretory
One inferior hypophyseal artery on each side. phase of the other cell types or their precursors.
Each superior hypophyseal artery supplies: Intermediate lobe
The ventral part of the hypothalamus It is made up of numerous basophil cells and
The upper part of the infundibulum chromophobe cells surrounding masses of colloid
The lower part of the infundibulum through a separate material. It secretes the melanocytes stimulating hormone
long descending branch, called the trabecular artery. (MSH).
Each inferior hypophyseal artery divides into medial and Posterior lobe
lateral It is composed of (a) a large number of non-myelinated
and in infundibulum artery fibres—hypothalamo-hypophyseal tract and (b) modified
branches,
Long portal vessels which join neurological cells, called pituicytes. They have many
one another dendrites, which terminate on or near the sinusoids.
Short portal vessels to form an The hormones related to the posterior lobe are (a)
arterial vasopressin, (ADH) which acts on kidney tubules, and (b)
Capillary tufts oxytocin, which promotes contraction of the uterine, and
in median mammary smooth muscle. These hormones are actually
eminence secreted by the hypothalamus, from where these are
Superior
hypophyseal transported through the hypothalamohypophyseal tract to
Trabecular the posterior lobe of the gland.
artery to lower infundibulum
Capillary tufts in lower infundibulum Anastomosis between superior

SHORT ESSAYS
and inferior hypophyseal arteries
Inferior hypophyseal artery
4 Quick Review Series: BDS 1st Year
Q.1. Tentorium cerebelli.
The tentorium cerebelli is a tent-shaped fold of dura
mater, forming the roof of the posterior cranial fossa. It
separates the cerebellum from the occipital lobes of the
cerebrum and broadly divides the cranial cavity into
supratentorial and infratentorial compartments. The
infratentorial compartment, in other words, is the
posterior cranial fossa containing the hindbrain and the
lower part of the midbrain (Fig. 1A.6.6).
The tentorium cerebelli has a free margin and an attached
margin. The anterior free margin is U-shaped and free.
The ends of the ‘U’ are attached anteriorly to the anterior
clinoid processes. This margin bounds the tentorial notch,
which is occupied by the midbrain and the anterior part of
the superior vermis. The outer or attached margin is
convex. Posterolaterally, it is attached to the lips of the
transverse, sulci on the occipital bone and on the
posteroinferior angle of the parietal bone. Anterolaterally,
it is attached to the superior border of the petrous
temporal bone and to the posterior
Diaphragma sellae
covering hypophyseal fossa Anterior clinoid process
Optic nerve Internal carotid artery
Infundibulum Aperture for oculomotor nerve
Oculomotor nerve Aperture for trochlear nerve
Trochlear nerve Attached margin of
Great cerebral vein tentorium cerebelli
Straight sinus Free margin of
Superior petrosal tentorium cerebelli
sinus Attached margin of
tentorium cerebelli
Tentorium cerebelli Transverse sinus within
layers of tentorium
Opening of superior sagittal sinus
Fig. 1A.6.6 Tentoriumcerebelliseenfromabove.
clinoid processes. Along the attached margin there are the
transverse and superior petrosal venous sinuses. The
trigeminal or Meckel’s cave (Fig. 1A.6.7) is a recess of
dura mater present in relation to the attached margin of
the tentorium. It is formed by evagination of the inferior
layer of the tentorium over the trigeminal impression on
the petrous temporal bone. It contains the trigeminal
ganglion.
Trigeminal ganglion
Superior petrosal sinus
Tentorium cerebelli
Trigeminal cave
Outer layer of dura mater
Inner layer of dura mater
Fig. 1A.6.7 Parasagittal section through the petrous temporal
boneandmeningestoshowtheformationofthetrigeminalcave.
The free and attached margins of the tentorium cerebelli
cross each other near the apex of the petrous temporal
bone. Anterior to the point of crossing there is a
triangular area that forms the posterior part of the roof of
the cavernous sinus and is
pierced by the third and
fourth cranial nerves.
The tentorium cerebelli has
two surfaces. The superior
surface is convex and
slopes to either side from
the median plane. The falx
Petrous temporal bone cerebri is attached to this
surface, in the midline;
the straight sinus lies along the line of this attachment.
The superior surface is related to the occipital lobes of the
cerebrum. The inferior surface is concave and fits the
convex superior surface of the cerebellum. The falx
cerebri is attached to its posterior part.
Q.2. Cavernous sinus.
Or
Cavernous sinus, its relations and tributaries.
Refer to answer of Long Essays Q. 1.
Q.3. Trigeminal ganglion in middle cranial fossa.
This is the sensory ganglion of the fifth cranial nerve. It is
homologous with the dorsal nerve root ganglia of spinal
nerves. All such ganglia are made up of pseudounipolar
nerve cells, with a T-shaped arrangement of their process;
one process arises from the cell body which then divides
into a central and a peripheral process.
The ganglion is crescentic or semilunar in shape, with its
convexity directed anterolaterally. The three divisions of
the trigeminal nerve emerge from this convexity. The
posterior concavity of the ganglion receives the sensory
root of the nerve.
Situation and Meningeal Relations(Fig.1A.6.8)
The ganglion lies on the trigeminal impression, on the
anterior surface of the petrous temporal bone near its
apex. It occupies a special space of dura mater, called the
trigeminal
 General Anatomy 5

Greater wing of sphenoid Q.1. Falx cerebri.

Mandibular nerve
Maxillary nerve The falx cerebri is a large sickle-shaped fold of dura
Ophthalmic nerve mater occupying the median longitudinal fissure between
the two cerebral hemispheres (Fig. 1A.6.9).
Internal carotid artery
It has two ends:
The anterior end is narrow and is attached to the crista
galli.
The posterior end is broad and is attached along the
median plane to the upper surface of the tentorium
cerebelli.
Tentorium cerebelli

Tentorial notch Falx cerebri

Cavernous sinus

Motor root and

sensory root of Falx cerebelli
trigeminal ganglion Infundibulum
Trigeminal ganglion
Greater petrosal nerve
Tentorium cerebelli
Middle meningeal artery
Petrous temporal bone
Squamous temporal bone Diaphragma sellae
Fig. 1A.6.8 Superiorviewofthemiddlecranialfossashowing Fig. 1A.6.9 Falxcerebri.
someofitscontents.
cerebelli. It is formed by evagination of the inferior layer
or Meckel’s cave. There are two layers of dura below the
of the tentorium over the trigeminal impression on the
ganglion. The cave is lined by pia-arachnoid so that the
petrous temporal bone. It contains the trigeminal
ganglion along with the motor root of the trigeminal
ganglion. Q.3. Emissary vein.
nerve is surrounded by CSF. The ganglion lies at a depth
of about 5 cm from the preauricular point.
Emissary veins connect the extracranial veins with the
Relations
intracranial venous sinuses to equalize the pressure.
Medially:
Example:
1. Internal carotid artery 2. Posterior part of cavernous
The parietal emissary vein passes through the parietal
sinus.
foramen to the superior sagittal sinus.
Laterally: Middle meningeal artery.
The mastoid emissary vein passes through the mastoid
Superiorly: Parahippocampal gyrus.
foramen to the sigmoid sinus.
Inferiorly:
Applied anatomy: Extracranial infections may spread
Motor root of trigeminal nerve
through these veins to intracranial venous sinuses. Q.4.
Greater petrosal nerve
Cavernous sinus.
Apex of the petrous temporal bone
The foramen lacerum.
Each cavernous sinus is a large venous space situated in
Associated Root and Branches the middle cranial fossa on either side of the body of the
The central processes of the ganglion cells form the large sphenoid bone. It is about 2 cm long and 1 cm wide.
sensory root of the trigeminal nerve, which is attached to Its interior part is divided into a number of spaces or
pons at its junction with the middle cerebellar peduncle. caverns by trabeculae.
The peripheral processes of the ganglion cells form three The floor of the sinus is formed by the endosteal dura
divisions of the trigeminal nerve, namely the ophthalmic, mater.
maxillary and mandibular.
The small motor root of the trigeminal nerve is attached Blood Supply to the pons superomedial of the sensory root. It
passes under
The ganglion is supplied by twigs from the (a) internal carotid,
the ganglion from its medial to the lateral side and joins the
middle meningeal and accessory meningeal arteries and
mandibular nerve at the foramen ovale.
by the meningeal branch of the ascending pharyngeal artery.
SHORT NOTES
4 Quick Review Series: BDS 1st Year
The falx cerebri has two margins:
The upper margin is convex and is attached to the lips of
the sagittal sulcus.
The lower margin is concave and free.
The falx cerebri has right and left surfaces, each of which
is related to the medial surface of the corresponding
cerebral hemisphere.
Three important venous sinuses are present in relation to
this fold. The superior sagittal sinus lies along the upper
margin; the inferior sagittal sinus lies along the lower
margin; and the straight sinus lies along the line of
attachment of the falx to the tentorium cerebelli. Q.2.
Meckel’s cave.
The trigeminal or Meckel’s cave is a recess of dura mater
present in relation to the attached margin of the tentorium
The lateral wall, roof and medial wall are formed by the
meningeal dura mater.
Anteriorly, the sinus extends up to the medial end of the
superior orbital fissure and posteriorly up to the apex of
the petrous temporal bone. Q.5. Tentorium cerebelli.
The tentorium cerebelli is a tent-shaped fold of dura
mater, forming the roof of the posterior cranial fossa. It
separates the cerebellum from the occipital lobes of the
cerebrum and broadly divides the cranial cavity into
supratentorial and infratentorial compartments. Q.6.
Diaphragma sellae.
The diaphragma sellae is a small circular, horizontal fold
of dura mater forming the roof of the hypophyseal fossa.
Anteriorly, it is attached to the tuberculum sellae.
Posteriorly, it is attached to the dorsum sellae. On each
side, it is continuous with the dura mater of the middle
cranial fossa.
The diaphragma sellae has a central aperture through
which the stalk of the hypophysis cerebri passes. Q.7.
Hypoglossal nerve.
Hypoglossal nerve/cranial nerve XII, as the name implies
is the nerve supplying muscles of tongue (glossal means
tongue) and is purely a motor nerve.
Branches of communication are as follows:
Vagus
Ventral ramus of first cervical nerve
Lingual nerve superior cervical ganglion of sympathetic
chain.
Branches of distribution are as follows:
To the three extrinsic muscles of tongue namely
styloglossus, genioglossus and hyoglossus and to four
intrinsic muscles namely superior longitudinal, inferior
longitudinal, transverse and vertical muscles.
It carries fibres of ventral ramus of first cervical, which
gets distributed as meningeal branch, superior limb of
ansa cervicalis, branch to thyrohyoid and geniohyoid
muscles.
Q.8. Superior sagittal sinus.
The superior sagittal sinus occupies the upper convex,
attached margin of the falx cerebri (Fig. 1A.6.10).
It begins anteriorly at the crista galli by the union of tiny
meningeal veins. Here it communicates with the veins of
the frontal sinus and occasionally with the veins of the
nose, through the foramen caecum. As the sinus runs
upwards and backwards, it becomes progressively larger
in size. It is triangular in cross-section. It ends near the
internal occipital protuberance by turning to one side,
usually the right, and becomes continuous with the right
transverse sinus. Sometimes the superior sagittal sinus
becomes continuous with the left transverse sinus. It
generally communicates with the opposite sinus. The
junction of all these sinuses is called the confluence of
sinuses.
The superior sagittal sinus receives the following
tributaries:
Superior cerebral veins
Parietal emissary veins
Venous lacunae, usually three on each side
Occasionally, a vein from the nose opens into the sinus
when the foramen caecum is patent. Q.9. Middle
meningeal artery.
Middle meningeal artery is a branch of the first part of the
maxillary artery, given off in the infratemporal fossa. It is
transmitted through foramen spinosum. It supplies more
of bone and less of meninges. Middle meningeal artery
supplies only small branches to the dura mater. It is
predominantly a periosteal artery supplying bone and red
bone marrow in the dipole.
Within the cranial cavity, it gives off the following:
Ganglionic branches—to the trigeminal ganglion
A petrosal branch—to the hiatus for the greater petrosal
nerve
A superior tympanic branch—to the tensor tympani
Temporal branches—to the temporal fossa
Anastomotic branch that enters the orbit and anastomoses
with the lacrimal artery.
Q.10. Name four emissary veins.
Emissary veins connect the extracranial veins with the
intracranial venous sinuses to equalize the pressure.
Examples:
Parietal emissary vein
Mastoid emissary vein
 General Anatomy 5

Emissary vein—passing through hypoglossal canal sinus. It
Condylar emissary vein
Two to three emissary veins passing through foramen lacerum.
sagittal sinus becomes continuous with the left transverse
generally communicates with the opposite sinus. The
junction of all these sinuses is called the confluence of
sinuses.
Q.12. Name any four tributaries of cavernous sinus.
Tributaries or incoming channels of cavernous sinus are
as follows:
From the orbit:
The superior ophthalmic vein
A branch of the inferior ophthalmic vein or sometimes
the vein itself 3. The central vein of the retina.
From the brain:
1. Superficial middle cerebral vein 2. Inferior cerebral
veins from the temporal lobe.
From the meninges:
Sphenoparietal sinus.
The frontal trunk of the middle meningeal vein may drain
either into the pterygoid plexus through the foramen
ovale or into the sphenoparietal or cavernous sinus.
Q.13. Mention the major openings in diaphragm.
At places, the meningeal layer of dura mater is folded on
Superior sagittal sinus
Q.11. Confluence of dural venous sinus.
Superior sagittal sinus begins anteriorly at the crista galli
by the union of tiny meningeal veins. Here it
communicates with the veins of the frontal sinus and
occasionally with the veins of the nose, through the
foramen caecum.
It ends near the internal occipital protuberance by turning
to one side, usually the right, and becomes continuous with
the right transverse sinus. Sometimes the superior Fig.
1A.6.10 Thesuperiorsagittalsinus(cross-sectionalview).
itself to form partitions that divide the cranial cavity into
compartments that lodge different parts of the brain.
The folds are as follows:
Falx cerebri
Tentorium cerebelli
Falx cerebelli
Diaphragma sellae.
Q.16. Trigeminal ganglion in middle cranial fossa.
Trigeminal ganglion is the sensory ganglion of the fifth
cranial nerve (Fig. 1A.6.12). It is homologous with the
dorsal nerve root ganglia of spinal nerves. All such
ganglia are made up of pseudounipolar nerve cells with a
T-shaped arrangement of their process; one process arises
from the

The diaphragm has three large openings for the passage

of structure between thorax and abdomen (Fig. 1A.6.11).
The openings are as follows: 1. The aortic opening 2.
The oesophageal opening
The vena caval foramen.
Q.14. Name structures in the lateral wall of
cavernous sinus.

Structures in the lateral wall of the sinus, from above

downwards: 1. Oculomotor nerve
Trochlear nerve
Ophthalmic nerve
Maxillary nerve 5. Trigeminal ganglion.
Q.15. Name the folds of dura mater present in the
cranial cavity.
4 Quick Review Series: BDS 1st Year

cell body which then divides into a central and a peripheral process.
The ganglion is crescentic or semilunar in shape, with its convexity
directed anterolaterally. The three divisions of the trigeminal nerve
emerge from this convexity. The posterior concavity of the ganglion
receives the sensory root of the nerve.
Olfactory bulb Olfactory nerves [I]
Ophthalmic nerve [V1]
Optic Nerve [II]
Maxillary nerve [V2]
Mandibular nerve [V
Oculomotor nerve [III] ]
3

Abducent nerve [VI]Trigeminal ganglion

Trochlear nerve [IV]Facial nerve [VII]
Vestibulocochlear nerve
Glossopharyngeal nerve
Trigeminal nerve [V]
Vagus nerve [X]
Accessory nerve [XI] Hypoglossal
nerve [XI]
Fig. 1A.6.11 The diaphragm. Fig.
1A.6.12 Themiddlecranial fossashowing
trigeminalganglion.

Topic 7
CONTENTS OF THE ORBIT
LONG ESSAY
Q.1. Write about origin, insertion nerve supply and Origin and Insertion of Voluntary Muscles
action of muscles of eyeball. Origin
The four recti arise from a common annular tendon or
The extraocular muscles are as follows: tendinous ring that is attached to the orbital surface of the
Voluntary Muscles apex of the orbit.
Four recti The lateral rectus has an additional small tendinous head,
Superior rectus which arises from the orbital surface of the greater wing
Inferior rectus of the sphenoid bone lateral to the tendinous ring.
Medial rectus The superior oblique arises from the body of the
Lateral rectus sphenoid, superomedial to the optic canal.
Two obliqui The inferior oblique arises from the orbital surface of the
Superior oblique maxilla, lateral to the lacrimal groove.
Inferior oblique The levator palpebrae superioris arises from the orbital
The levator palpebrae superioris elevates the upper surface of the sphenoid bone, anterosuperior to the optic
eyelid. canal.
Involuntary Muscles Insertion
The superior tarsal muscle is the deeper portion of the The recti are inserted into the sclera, a little posterior to
levator palpebrae superioris. It is inserted on the upper the limbus.
margin of the superior tarsus. It elevates the upper eyelid. The tendon of the superior oblique passes through a
The inferior tarsal muscle extends from the fascial sheath fibrocartilaginous pulley attached to the trochlear fossa of
of the inferior rectus and inferior oblique to the lower the frontal bone. It is inserted into the sclera behind the
margin of the inferior tarsus. It possibly depresses the equator to the eyeball, between the superior rectus and the
lower eyelid. lateral rectus.
The orbitalis bridges the inferior orbital fissure. Its action The inferior oblique is fleshy throughout. It passes
is uncertain. laterally, upwards and backwards below the inferior
The voluntary muscles are miniature ribbon muscles, rectus and then deep to the lateral rectus. The inferior
having short tendons of origin and long tendons of oblique is inserted close to the superior oblique a little
insertion. below and posterior to the latter.
 General Anatomy 5

The fat tendon of the levator splits into: a. Superior or Muscle Action in primary position
voluntary lamella 1. Superior oblique Depression
b. Inferior or involuntary lamella. Adduction
The superior lamella of the levator is inserted into the
Intortion
anterior surface of the superior tarsus and into the skin of
2. Inferior oblique Elevation
the upper eyelid. The inferior lamella is inserted into the
upper margin of the superior tarsus. Adduction
Nerve supply Extortion
The superior oblique is supplied by the IV cranial or 3. Inferior rectus Elevation
trochlear nerve (SO4). Adduction
The lateral rectus is supplied by the VI cranial or Intortion
abducent nerve (LR6).
4. Superior rectus Elevation
The remaining five extraocular muscles—superior,
Adduction
inferior and medial recti; inferior oblique and levator
palpebrae superioris—are all supplied by the III cranial or Intortion
oculomotor nerve. 5. Medial rectus Only adduction
Actions 6. Lateral rectus Only abduction
The movements of the eyeball are as follows: Combined movements of the eyes: The movements of the
a. Around a transverse axis two eyes are harmoniously coordinated and are called
Upward rotation or elevation (33º) conjugate ocular movements. These movements are usually
Downward rotation or depression (33º) horizontal or vertical, but oblique conjugate movements
b. Around a vertical axis may also occur. The dissociated movements of the two eyes
i. Medial rotation or adduction (50º) ii. are called as disjunctive movements.
Lateral rotation or abduction (50º)
SHORT ESSAYS
c. Around an anteroposterior axis
Intortion
Extortion
The rotatory movements of the eyeball upwards,
downwards, medially or laterally are defined in terms of
the direction of movement of the centre of the pupil. The
tortions are defined in terms of the direction of movement
of the upper margin of the pupil at 12 o’clock position.
d. The movements given previously can take place in
various combinations.
Actions of individual muscles are listed in Table 1A.7.1.
Single or pure movements are produced by combined
actions of muscles. Similar actions get added together,
while opposing actions cancel each other, enabling pure
movements.
Upward rotation or elevation: By the superior rectus and
the inferior oblique
Downward rotation or depression: By the inferior rectus
and the superior oblique
Medial rotation or adduction: By the medical rectus, the
superior rectus and the inferior rectus
Lateral rotation or abduction: By the lateral rectus, the
superior oblique and the inferior oblique
Intortion: By the superior oblique and the superior rectus
Extortion: By the inferior oblique and the inferior rectus.
Table 1A.7.1 Actions of individual muscles
4 Quick Review Series: BDS 1st Year

Q.1. Lateral rectus muscle of eyeball. sphincter pupillae for narrowing the size of pupil and
ciliaris muscle for increasing the curvature of anterior
There are four recti muscles of eyeball, namely: surface of lens required during accommodation of the
Superior eye.
Inferior Q.3. Boundaries and structures passing through
Medial superior orbital fissure.
Lateral recti.
The lateral rectus arises by two heads, one from the upper Superior orbital fissure communicates orbit and middle
and one from the lower aspect of the lateral part of the cranial fossa.
common tendinous ring. Boundaries
The following structures pass between the two origins of Superior—lesser wing of sphenoid
the lateral rectus: Inferior—greater wing of sphenoid
1. Upper and lower division of the oculomotor nerve 2. Medial—body of the sphenoid Lateral—frontal bone.
Nasociliary nerve Structures Passing through the Superior Orbital
3. Abducent nerve. Fissure
From the origin, the recti muscles widen forwards to form A common tendinous ring divides the fissure into three
the cone of muscles. parts:
Insertion Structures passing lateral to the ring are as follows:
Lateral rectus is inserted to the corresponding surface of Lacrimal nerve
the sclera, behind the corneal margin at 6.8 mm away Frontal nerve
from the corneal margin. Trochlear nerve
Nerve Supply Superior ophthalmic vein
The abducent nerve supplies the lateral rectus. Recurrent branch of lacrimal artery.
Action Structures passing within the ring are as follows:
The lateral rectus moves the cornea horizontally and Upper division of oculomotor nerve
laterally. Nasociliary nerve
Q.2. Positions, connections and branches of ciliary Lower division of the oculomotor nerve
ganglion. Abducent nerve.
Structure passing medial to the ring:
The ciliary ganglion is very small ganglion present in the a. Inferior ophthalmic vein.
orbit. Topographically, the ganglion is related to
nasociliary nerve, branch of ophthalmic division of
SHORT NOTES
trigeminal nerve but functionally it is related to
oculomotor nerve. This ganglion has no secretomotor
fibres.
Roots
It has three roots:
Sensory
Sympathetic 3. Motor.
Only the motor root fibres relay to supply the intraocular
muscles.
Sensory root is from the long ciliary nerve.
Sympathetic root is by the long ciliary nerve from plexus
around ophthalmic artery.
Motor root is from a branch to inferior oblique muscle.
These fibres arise from Edinger–Westphal nucleus, join
oculomotor nerve and leave it via the nerve to inferior
oblique to be relayed in the ciliary ganglion.
Branches
The ganglion gives 10–12 short ciliary nerves containing
postganglionic fibres for the supply of constrictor or

Q.1. Ciliary ganglion.
Ciliary ganglion is pinhead in size and is situated near the
apex of orbit. This ganglion is topographically related to
trigeminal nerve, but functionally it is related to
oculomotor nerve.
Roots
Motor
Nerve to inferior oblique. This is the parasympathetic
root to supply sphincter pupillae and ciliaris.
Sensory—nasociliary nerve
Sympathetic—internal carotid plexus to supply dilator
pupillae.
Branches
There are 15–20 short ciliary nerves.
Q.2. Nasociliary nerve.
Nasociliary nerve is one of the terminal branches of the
ophthalmic division of the trigeminal nerve. It begins in
the lateral wall of the anterior part of the cavernous sinus.
It enters the orbit through the middle part of the superior
orbital fissure.
The branches of nasociliary nerve are as follows:
A communicating branch to the ciliary ganglion
Two or three long ciliary nerves
The posterior ethmoidal nerve
The infratrochlear nerve
The anterior ethmoidal nerve is the larger terminal branch
of the nasociliary nerve.
In the nasal cavity, it lies deep to the nasal bone and gives
off two internal nasal branches, and finally, it emerges at
the lower border of the nasal bone as the external nasal
nerve, which supplies the skin of the lower half of the
nose.
Q.3. Extraocular muscles.
The extraocular muscles are as follows:
1. Voluntary muscles 2. Involuntary muscles.
Voluntary Muscles
Voluntary muscles include the following:
1. Four recti: (a) superior rectus, (b) inferior rectus, (c)
medial rectus and (d) lateral rectus 2. Two obliqui: (a)
superior oblique and (b) inferior oblique
3. The levator palpebrae superioris.
Involuntary Muscles
The superior tarsal muscle is the deeper portion of the
levator palpebrae superioris. It is inserted on the upper
margin of the superior tarsus. It elevates the upper eyelid.
The inferior tarsal muscle extends from the fascial sheath
of the inferior rectus and inferior oblique to the lower
margin of the inferior tarsus. It possibly depresses the
lower eyelid.
General Anatomy 5
The orbitalis bridges the inferior orbital fissure. Its action
is uncertain.
Q.4. Oblique muscles of eyeball.
Superior Oblique Muscle
Origin
Orbital surface of the body of the sphenoid above and
medial to optic foramen and inferior surface of lesser
wing of the sphenoid bone.
It is a rounded muscle that gives rise to a tendon. The
tendon winds round the fibrocartilaginous pulley-like
trochlea and expands and inserts on the superior rectus
muscle.
Nerve Supply
It is supplied by trochlear nerve.
Action
Superior oblique muscle rotates the eyeball downwards
and laterally.
Inferior Oblique Muscle
Inferior oblique muscle originates from upper surface of
floor of the orbit, lateral to the lacrimal groove, and
inserts into lateral surface of the sclera behind the
equator.
Nerve Supply
Inferior division of the oculomotor nerve.
Action
Inferior oblique muscle rotates the cornea upwards and
laterally. Q.5. Branches of nasociliary nerve.
The branches of nasociliary nerve are as follows:
A communicating branch to the sensory root of ciliary
ganglion
Two or three long ciliary nerves, which supply the
eyeball
Posterior ethmoidal nerve
Infratrochlear nerve, which supplies medial portion of the
eyelids and conjunctiva
Anterior ethmoidal nerve, which divides into medial and
lateral nasal branches.
Q.6. Actions of oblique muscles of eyeball.
Actions of oblique muscles of eyeball are as follows:
Superior oblique muscle rotates the eyeball downwards
and laterally.
Inferior oblique muscle rotates the cornea upwards and
laterally.
4 Quick Review Series: BDS 1st Year

Topic 8 ANTERIOR TRIANGLE OF THE NECK

LONG ESSAYS
Q.1. Describe the origin, course, relations and The maxillary artery is the large terminal branch of the branches of
maxillary artery. external carotid artery. It leaves ECA at about right angle passing almost horizontally between the
ramus of the
mandible and the sphenomandibular ligament. It has a

Fig. 1A.8.1 Themaxillaryarteryanditsrelations.

wide territory of distribution and supplies the following The deep auricular artery supplies the external acoustic
structures (Fig. 1A.8.1): meatus, the tympanic membrane and the
The external and middle ears, and the auditory tube temporomandibular joint.
The dura mater The anterior tympanic branch supplies the middle ear
The upper and lower jaws including the medial surface of the tympanic membrane.
The muscles of the temporal and infratemporal regions
The nose and paranasal air sinuses
The palate
The root of the pharynx.
Course and Relations
In front of the ramus of the mandible, the artery passes
upwards across the lower part of the lateral pterygoid
crossing either superficial or deep to the lower head of
this muscle (Fig. 1A.8.1).
The maxillary artery is divided into three parts by the
lateral pterygoid muscle as follows (Fig. 1A.8.2):
The first (mandibular) part runs horizontally forwards,
first between the neck of the mandible and the
sphenomandibular ligament, below the auriculotemporal
nerve, and then along the lower border of the lateral
pterygoid.
The second (pterygoid) part runs upwards and forwards
superficial to the lower head of the lateral pterygoid.
The third (pterygopalatine) part passes between the two
heads of the lateral pterygoid and through the
pterygomaxillary fissure, to enter the pterygopalatine
fossa where it lies in front of the pterygopalatine
ganglion.
Branches of First Part of the Maxillary Artery
The first part of maxillary artery, i.e. when it (Table
1A.8.1) lies medial to the mandible, gives off the
following branches:
 General Anatomy 5

The middle meningeal artery is given off in the meningeal ovale extracranial to
infratemporal fossa. It supplies only small branches to the artery pterygoids
dura Inferior Mandibular Lower teeth and
Table 1A.8.1 Branches of mandibular (first) part of the alveolar artery mylohyoid muscle
maxillary artery and their distribution mater. It is predominantly a periosteal artery supplying
the bone and red bone marrow in the dipole.
The accessory meningeal artery enters the cranial cavity
through the foramen ovale. Apart from the meninges it
supplies structures in the infratemporal fossa.
The inferior alveolar artery runs downwards and
forwards medial to the ramus of the mandible, enters the
mandibular canal in which it runs downwards and
forwards supplying teeth and surrounding bone and then
gives off a small branch through the mental foramen to
anastomose with other vessels on the face. Before
entering the mandibular canal, the artery gives off a
lingual branch to the tongue and a mylohyoid branch
BRANCHES OF SECOND PART OF THE
MAXILLARY ARTERY
Masseteric artery
The
Deep temporal artery

Middle and accessory

meningeal artery
Sphenopalatine artery
Anterior tympanic artery Artery of pterygoid canal
Deep auricular artery Pharyngeal artery
Superficial temporal artery Infraorbital artery
Descending palatine artery
Maxillary artery
Posterior superior alveolar artery
Buccal artery

Posterior auricular artery Pterygoid artery

Inferior alveolar artery
Twig to lingual nerve
External carotid artery
Mylohyoid artery
Fig. 1A.8.2 Maxillaryarteryanditsbranches.
Branches of Foramen Distribution second part of the maxillary artery, while it is related to
maxillary transmitting lateral pterygoid muscle, mainly gives off its so called
artery (first muscular branches (Table 1A.8.2).
part)
Branch of maxillary artery Distribution
Deep auricle Foramen in Skin of the external
artery the floor of acoustic meatus, Deep temporal artery Temporalis muscle
the outer surface of Pterygoid artery Masseteric Lateral and medial
external tympanic membrane artery pterygoid muscles
acoustic Masseter muscle
meatus Buccal artery Buccinator muscle
Anterior Petrotympanic Inner surface of The deep temporal branches (anterior and posterior)
tympanic Inner surface tympanic membrane
ascend on the lateral aspect of the skull deep to the
artery
temporalis muscle. Branches are also given to the
Middle Foramen More of bone and
meningeal spinosum less of meninges fifth pterygoid muscles and to the masseter. A buccal branch
artery and seventh supplies the buccinator muscle.
nerves, middle ear, Table 1A 8.2 The branches of second (pterygoid) part of the
tenser tympani maxillary artery
Accessory Foramen Main distribution is
4 Quick Review Series: BDS 1st Year

BRANCHES OF THIRD PART OF THE middle ear

MAXILLARY ARTERY Sphenopalatin Sphenopalatine Lateral and medial
The third or the terminal part or the pterygopalatine e (terminal foramen walls of nose and
portion of the maxillary artery lies against the part) various air sinuses
posterolateral aspect of the maxilla and passes deep branches enter the nasal cavity. Branches of the artery
between the two heads of lateral pterygoid muscle to supply the palate and gums. Within the greater palatine
enter pterygopalatine fossa where it gives off the canal it gives off the lesser palatine arteries that emerge
following branches (Table 1A.8.3): on the palate through the lesser palatine foramina and run
The posterior superior alveolar artery arises just before backwards supplying the soft palate and tonsil.
the maxillary artery enters the pterygomaxillary fissure. The pharyngeal branch runs backwards through
Descending on the posterior surface of the maxilla it pharyngeal or palatovaginal canal. It supplies part of the
gives off branches that enter canals in the bone to supply nasopharynx, the auditory tube and the sphenoidal air
the molar and premolar teeth, and the maxillary sinus. sinus.
The infraorbital artery also arises just before the The artery of the pterygoid canal runs backwards in the
maxillary artery enters the pterygomaxillary fissure. pterygoid canal and supplies the pharynx, the auditory
Through the inferior orbital fissure it enters the orbit and tube and the tympanic cavity.
runs forwards in relation to the floor of the orbit, first in The sphenopalatine artery passes medially through the
the infraorbital groove and then in the infraorbital canal sphenopalatine foramen to enter the cavity of the nose. It
emerging on the face through the infraorbital foramen. It gives off posterolateral nasal branches to the lateral wall
gives off some orbital branches to the structures in the of the nose and to the paranasal air sinuses, and posterior
orbit and the anterior superior alveolar branches to the septal branches to the nasal septum.
incisor and canine teeth. After emerging on the face, the Q.2. Describe the boundaries and contents of the
infraorbital artery gives branches to the lacrimal sac, the carotid triangle of neck.
nose and the upper lip. The remaining branches of the
third part arise within the pterygopalatine fossa. The boundaries of the carotid triangle are as follows (Fig.
The greater palatine artery runs downwards in the greater 1A.8.3):
palatine canal to emerge on the posterolateral part of the Anterosuperiorly: Posterior belly of the digastric muscle
hard palate through the greater palatine foramen. It then and the stylohyoid.
runs forwards near the lateral margin of the palate to Anteroinferiorly: Superior belly of the omohyoid.
reach the incisive canal through which some terminal Posteriorly: Anterior border of the sternocleidomastoid
Table 1A 8.3 Branches of third part (pterygopalatine) of the muscle.
maxillary artery Roof
Branch of Foramen Distribution Skin
maxillary artery transmitting Superficial fascia containing (a) the platysma, (b) the
(third part)
cervical branch of the facial nerve and (c) the transverse
Posterior Alveolar canals Upper molar and cutaneous nerve of the neck
superior in body of premolar teeth and
alveolar artery maxilla gums, maxillary
Investing layer of deep cervical fascia.
sinus Floor
Infraorbital Inferior orbital Lower orbital It is formed by the parts of (a) the thyrohyoid muscle (b)
artery fissure muscles, lacrimal the hyoglossus and (c) the middle and inferior
sac, maxillary constrictors of the pharynx.
sinus, upper Carotid Triangle Contents
incisors and canine
The contents of the carotid triangle are as follows (Fig.
teeth
1A.8.4):
Greater Greater Soft palate, tonsil,
palatine artery palatine canal palatine
Arteries
glands mucosa The common carotid artery with the carotid sinus
upper gums and the carotid body
Pharyngeal Pharyngeal Root of nose and Internal carotid artery
(palatovaginal) pharynx, auditory The external carotid artery with its superior thyroid,
canal tube, sphenoidal lingual, facial, ascending pharyngeal and occipital
sinus
branches.
Artery of Pterygoid canal Auditory tube, Veins
pterygoid canal upper pharynx,
 General Anatomy 5

The internal jugular vein

The common facial vein draining into the internal jugular
vein
A pharyngeal vein that may end either in the internal
jugular vein or in the common facial vein
The lingual vein.
Nerves
The vagus running vertically downwards
The superior laryngeal branch of the vagus, dividing into
the external and internal laryngeal nerves
The spinal accessory nerve running backwards over the
internal jugular vein
The hypoglossal nerve running forwards over the external
and internal carotid arteries
The sympathetic chain runs vertically downwards
posterior to the carotid sheath.
Lymph nodes
The deep cervical lymph nodes are situated along the
internal jugular vein and include the jugulodigastric node
below the posterior belly of the digastric and the
juguloomohyoid node above the inferior belly of the
omohyoid.
4 Quick Review Series: BDS 1st Year

External carotid artery

Styloid process Accessory nerve
Internal carotid artery
Glossopharyngeal nerve Occipital artery
Pharyngeal branch of vagus
Outline of carotid triangle
Hypoglossal nerve
Superior laryngeal
branch of vagus
Internal laryngeal nerve
Vagus nerve External laryngeal nerve
Superior thyroid artery Inferior root of
Superior root of ansa cervicalis ansa cervicalis
Ansa cervicalis
Fig. 1A.8.3 The boundariesofthecarotid

triangle. Fig. 1A.8.4 Thecontentsofthecarotidtriangle.

SHORT ESSAYS
Q.1. Lingual artery.
The lingual artery arises from the external carotid artery
opposite to the tip of the greater cornu of the hyoid bone.
Its course is divided into three parts by the hyoglossus
muscle (Fig. 1A.8.5).
The first part lies in the carotid triangle. It forms a
characteristic upward loop that permits free movements
of the hyoid bone.
The second part lies deep to the hyoglossus along the
upper border of hyoid bone. It is superficial to the middle
constrictor of the pharynx.
auricular vein with the posterior division of the
retromandibular vein. It begins within the lower part of
the parotid gland, crosses the sternocleidomastoid
obliquely, pierces the anteroinferior angle of the roof of
the posterior triangle and opens into the subclavian vein
(Fig. 1A.8.6).
The tributaries of external jugular vein are as follows:
The posterior external jugular vein
The transverse cervical vein
The suprascapular vein 4. The anterior jugular vein.
Superficial Retromandibular vein
temporal vein

Common facial

External
jugular
vein Anterior jugular
vein
vein
Fig. 1A.8.6 Externaljugularvein.
CN The oblique jugular vein connects the external jugular
XII
vein with the internal jugular vein across the middle one-
Fig.1A.8.5 Thecourseoflingualartery.
The third part is called the arteria profunda linguae or the third of the anterior border of the sternocleidomastoid.
deep lingual artery. It runs upwards along the anterior The external jugular vein usually terminates in the
border of the hyoglossus and then horizontally forwards subclavian vein, but sometimes it may end in the internal
on the undersurface of the tongue as the fourth part. jugular vein.
In its vertical course, it lies between the genioglossus The external jugular vein is examined to assess the
medially and the inferior longitudinal muscle of the venous pressure, as the right atrial pressure is reflected in
tongue laterally. it because there are no valves in the entire course of this
The horizontal part of the artery is accompanied by the vein.
lingual nerve. Q.3. Give the formation relations and branches of
Q.2. External jugular vein. ansa cervicalis.
Or
The external jugular vein begins in the substance of Location, formation and distribution of ansa
parotid gland. It is formed by union of the posterior cervicalis.
 General Anatomy 5

Internal laryngeal nervebranch of vagus

External laryngeal nerve Vagus nerve
Ansa cervicalis or ansa hypoglossi is a thin nerve loop Superior thyroid arteryInferior root of
that lies embedded in the anterior wall of the carotid Superior root of ansa cervicalis ansa cervicalis
sheath over the lower part of the larynx (Fig. 1A.8.7). It Ansa cervicalis
Fig. 1A.8.8 Branchesofexternalcarotidartery.
supplies the infrahyoid muscles.
Apart from its terminal branches to the thyroid gland, it
Ansa cervicalis is formed by a superior and an inferior
gives one important branch, the superior laryngeal artery,
root.
which pierces the thyrohyoid membrane in company with
l The superior root is the continuation of the
the internal laryngeal nerve. The superior thyroid artery
descending branch of the hypoglossal nerve. l The
also gives a sternocleidomastoid branch to that muscle
inferior root or descending cervical nerve is derived from
and a cricothyroid branch that anastomoses with the
second and third cervical spinal nerves.
Hypoglossal nerve
artery of the opposite side in front of the cricovocal
Ventral ramus of C1 membrane.
Communication to hypoglossal nerve Lingual Artery
To muscles of tongue Ventral ramus of C2
The lingual artery arises from the external carotid artery
To geniohyoid Ventral ramus of C3
To thyrohyoid opposite the tip of the greater cornu of the hyoid bone.
Superior root of Inferior root of ansa cervicalis ansa cervicalis The hyoglossus muscle divides its course into three parts.
(descending cervicalis) The first part lies in the carotid triangle. It forms a
of omohyoid
To superior belly
To inferior belly of omohyoid characteristic upward loop that permits free movements
To sternothyroid
To sternohyoid of the hyoid bone.
Fig. 1A.8.7 Ansacervicalis. The second part lies deep to the hyoglossus along the
The inferior root descends and winds around the internal upper border of hyoid bone. It is superficial to the middle
jugular vein and then continues anteroinferiorly to join constrictor of the pharynx.
the superior root in front of the common carotid artery. The third part is called the arteria profunda linguae or the
Distribution of Ansa Cervicalis deep lingual artery that runs upwards along the anterior
Distribution of ansa cervicalis is as follows: border of the hyoglossus and then horizontally forwards
Superior root: Supplies the superior belly of the on the undersurface of the tongue as the fourth part.
omohyoid. In its vertical course, it lies between the genioglossus
Ansa cervicalis: Supplies the sternohyoid, sternothyroid medially and the inferior longitudinal muscle of the
and the inferior belly of the omohyoid. tongue laterally.
Q.5. Name any four branches of external carotid Facial Artery
artery given in the carotid triangle. The facial artery or the external maxillary artery arises
from the external carotid just above the tip of the greater
The external carotid artery gives the following branches cornu of the hyoid bone.
in the carotid triangle (Fig. 1A.8.8): It has two parts:
Superior thyroid The first part runs upwards in the neck as cervical part.
Lingual The second part runs on the face as facial part.
Facial 4. Ascending pharyngeal The cervical part of the facial artery gives off the
5. Occipital branches. following branches: 1. Ascending palatine
Superior Thyroid Artery Tonsillar
The superior thyroid artery arises from the external Submental
carotid artery just below the level of the greater cornua of Glandular branches for the submandibular salivary gland
the hyoid bone. It runs downwards and forwards and and lymph nodes.
passes deep to the three long infrahyoid muscles to reach The chief branches of artery on the face are the labial
the upper pole of the lateral lobe of the thyroid gland. arteries: 1. Superior labial
External carotid artery
Styloid process Accessory
2. Inferior labial.
nerve The terminal portion of the facial artery is the angular
Internal carotid artery artery.
Glossopharyngeal nerve Occipital
artery Occipital Artery
Pharyngeal branch of vagus The occipital artery arises from the posterior surface of
Outline of carotid triangle
Hypoglossal nerve
the external carotid artery, at about the same level as the
Superior facial artery. Close to its origin it is crossed by the
laryngeal
hypoglossal nerve. In the carotid triangle, the artery gives
4 Quick Review Series: BDS 1st Year

two sternocleidomastoid branches. The upper branch Superficial structures are (a) lower part of the parotid
accompanies the accessory nerve, and the lower branch gland and (b) the external carotid artery before it enters
arises near the origin of the occipital artery. the parotid gland.
Deep
SHORT NOTES
Q.1. Lingual artery. structures, passing between the external and internal
carotid arteries are (a) the styloglossus, (b) the
The lingual artery arises from the external carotid artery stylopharyngeus, (c) the glossopharyngeal nerve, (d) the
opposite the tip of the greater cornu of the hyoid bone. It pharyngeal branch of the vagus nerve, (e) the styloid
chiefly supplies the tongue. process and (f) a part of the parotid gland.
Its course is divided into three parts by the hyoglossus Deepest structures include (a) the internal carotid artery,
muscle. The first part lies in the carotid triangle. It forms (b) the internal jugular vein and (c) the vagus nerve.
a characteristic upward loop, which is crossed by the Q.5. Name branches of external carotid artery.
hypoglossal nerve during surgical removal of the tongue,
the first part of the artery is ligated before it gives any The external carotid artery gives off eight branches,
branch to the tongue or tonsil. which may be grouped as follows (Fig. 1A.8.9):
Q.2. Ansa cervicalis. Anterior branches
Superior thyroid
This is a thin nerve loop that lies embedded in the Lingual
anterior wall of the carotid sheath over the lower part of Facial
the larynx. It supplies the infrahyoid muscles. It is formed Posterior branches
by a superior and an inferior root. Superior root is derived Occipital
from first cervical nerve, and the inferior root is derived Posterior auricular
from second and third cervical spinal nerves. Q.3. Medial branches
Anterior jugular vein. Ascending pharyngeal
Terminal branches
This is a small vein, beginning in the submental region Maxillary
below the chin. It descends in the superficial fascia about Superficial temporal.
1 cm from the median plane. About 2.5 cm above the Superficial temporal
artery
sternum, it pierces the investing layer of deep fascia to Middle temporal
enter the suprasternal space where it is connected to its artery
fellow of the opposite side by the jugular venous arch. Transverse facial
artery
The vein then turns laterally, runs deep to the
Maxillary artery
sternocleidomastoid just above the clavicle and ends in Ascending palatine
the external jugular vein at the posterior border of the branch
sternocleidomastoid. Q.4. Contents of the digastric Tonsillar branch
Facial artery
triangle. Submental branch
Lingual artery
Contents of anterior part of the digastric triangle are as Superior thyroid
artery
follows: Common carotid
Structures superficial to mylohyoid are as follows: artery
Superficial part of the submandibular salivary gland. The Fig.1A.8.9
facial vein and the submandibular lymph nodes are Externalcarotid
arteryandits
superficial to it and the facial artery is deep to it.
branches.
Submental artery.
Q.6. Mention the branches of lingual artery.
Mylohyoid nerve and vessels.
Structures superficial to the hyoglossus seen without
Branches of three parts of lingual artery are as follows:
disturbing the mylohyoid and the submandibular gland
First part: Suprahyoid artery.
are (a) the submandibular salivary gland, (b) the
Second part: Dorsal lingual arteries to supply tongue,
intermediate tendon of the digastric and the stylohyoid
tonsil and palate.
and (c) the hypoglossal nerve.
Third part: Sublingual artery to supply sublingual
Contents of posterior part of the triangle are as follows:
salivary gland. This artery communicates with submental
 General Anatomy 5

artery. The lingual artery of both sides anastomose along

the tip of the tongue.
Q.7. Action and insertion of posterior cricoarytenoid
muscle.

Posterior cricoarytenoid is a triangular muscle. It

Topic 9 PAROTID
REGION
originates from the posterior surface of the lamina of the
cricoid cartilage. Its fibres pass upwards and laterally and
are inserted into posterior aspect of muscular process of
the arytenoid cartilage.
Actions
Posterior cricoarytenoids are the only muscles which abduct
the vocal cords.

LONG ESSAYS

4 Quick Review Series: BDS 1st Year
Q.1. Describe the gross anatomy of the parotid gland
and add a note on nerve supply. Or
Describe the relations, blood supply, nerve supply
and applied anatomy of the parotid gland. Or
Describe the external features, relations and nerve
supply of the parotid gland.
There are three pairs of large salivary glands, namely
Parotid gland
Submandibular gland
Sublingual gland.
The parotid gland is the largest of the salivary glands
weighing about 15 g. It is situated below the external
acoustic meatus, between the ramus of the mandible and
the sternocleidomastoid muscle. The gland overlaps the
masseter muscle anteriorly.
The parotid capsule is formed by the investigating layer of
the deep cervical fascia. The fascia splits to enclose the
gland. The superficial lamina is thick and adherent to the
gland. The deep lamina is thin and is attached to the
styloid process, the mandible and the tympanic plate. A
thickened portion of the deep lamina, extending between
the styloid process and the mandible, forms the
stylomandibular ligament, which separates the parotid
gland from the submandibular salivary gland.
External Features of the Parotid Gland (Fig.1A.9.1)
The gland is pyramidal in shape. The apex of the pyramid
is directed downwards, and the base or superior surface
forms the upper end of the gland.
The four surfaces of the gland are as follows:
Superior (base of the pyramid)
Superficial
Anteromedial
Posteromedial.
The surfaces are separated by three borders:
Anterior
Posterior
Medial.
The apex overlaps the posterior belly of the digastric and
the adjoining part of the carotid triangle and the cervical
branch of the facial nerve.
Sternocleidomastoid
Retromandibular v. Great auricular n.
Fig. 1A.9.1 Externalfeaturesoftheparotidgland.
The superior surface or base forms the upper end of the
gland, which is small and concave, where the temporal
branches of the facial nerve, the superficial temporal
vessels and the auriculotemporal nerve traverse the
parotid gland and cross the zygomatic arch
subcutaneously.
The superficial surface is the outer surface of the parotid
gland and is covered with skin and superficial fascia
containing the anterior branches of the great auricular
superficial temporal vessels
Temporal and
zygomatic branches
Transverse facial a.
Parotid duct
Buccal branches
nerve. The Masseter
Marginal mandibular br.
Submandibular gland
Cervical br.
preauricular or superficial parotid lymph nodes may occur
on its surface. From the anterior edge of this superficial
part, the parotid, the Stensen’s duct passes forwards
across the masseter muscle.
The anteromedial surface is grooved by the posterior
border of the ramus of the mandible. It is related to the
masseter, the lateral surface of the temporomandibular
joint, the posterior border of the mandible, the medial
pterygoid and the emerging branches of the facial nerve.
The posteromedial surface is related to (a) the mastoid
process, with the sternocleidomastoid and the posterior
belly of the digastric and (b) the styloid process. The
external carotid artery enters the gland through this
surface.
Borders
The anterior border separates the superficial surface from
the anteromedial surface and extends from the anterior
part of the superior surface to the apex.
The following structures emerge at the anterior border:
The parotid duct
Most of the terminal branches of the facial nerve
The transverse facial vessels.
The accessory parotid gland lies along the parotid duct
close to this border.
The posterior border separates the superficial surface from
the posteromedial surface. It overlaps the
sternocleidomastoid muscle.
The medial edge or border separates the anteromedial
surface from the posteromedial surface. It is related to the
lateral wall of the pharynx.
Deep Structures of the Parotid Gland (Fig.1A.9.2)
Arteries:
The external carotid artery enters the gland through its
posteromedial surface.
The maxillary artery leaves the gland through its
anteromedial surface.
The superficial temporal vessels emerge at the anterior
part of the superior surface.
The posterior auricular artery may arise within the gland.
Veins: The retromandibular vein is formed within the
gland by the union of the superficial temporal and
maxillary veins. In the lower part of the gland, the vein
divides into anterior and posterior divisions that emerge at
the apex (lower pole) of the gland.

Fig. 1A.9.2 Deepstructuresoftheparotidgland.
Nerves: The facial nerve enters the gland through the
upper part of its posteromedial surface and divides into its
terminal branches within the gland and appear on the
surface at the anterior border.
Parotid lymph nodes.
Parotid Duct
Parotid duct is about 5 cm long and emerges from the
middle of the anterior border of the gland. It runs forwards
and slightly downwards on the masseter. At the anterior
border of the masseter, it turns medially and pierces the
buccal pad of fat and the buccinator and opens into the
vestibule of the mouth opposite the crown of the maxillary
second molar tooth.
Blood Supply
The parotid gland is supplied by the external carotid artery
and its branches. The veins drain into the external jugular
vein.
Nerve Supply
Parasympathetic nerves are secretomotor. They reach the
gland through the auriculotemporal nerve. The
preganglionic fibres begin in the inferior salivatory
nucleus; pass through the glossopharyngeal nerve, its
tympanic branch, the tympanic plexus and the lesser
petrosal nerve; and relay in the otic ganglion. The
postganglionic fibres pass through the auriculotemporal
nerve and reach the gland.
Sympathetic nerves are vasomotor and are derived from
the plexus around the external carotid artery.
Sensory nerves to the gland come from the
auriculotemporal nerve, but the sensory fibres of the great
auricular nerve (C2) innervate the parotid fascia.
Lymphatic Drainage
Lymph drains first to the parotid nodes and from there to
the upper deep cervical nodes.
Applied Anatomy
General Anatomy 5
Parotid swellings are very painful due to the unyielding
nature of the parotid fascia.
Mumps is an infectious disease of the salivary glands
(usually the parotid) caused by a specific virus. Viral
parotitis or mumps characteristically does not suppurate.
Its complications are orchitis and pancreatitis.
A parotid abscess may be caused by spread of infection
from the oral cavity. An abscess may also form due to
suppuration of the parotid lymph nodes draining an
infected area. A parotid abscess is best drained by
horizontal incisions known as Hilton’s method.
The facial nerve is preserved during parotidectomy; by
removing the gland in superficial and deep parts
separately, the plane of cleavage is defined by tracing the
nerve from behind forwards.
Mixed parotid tumour is a slowly growing lobulated
painless tumour without any involvement of the facial
nerve. Malignant change of such a tumour is indicated by
pain, rapid growth, fixity with hardness, involvement of
the facial nerve and enlargement of the cervical lymph
nodes.
Q.2. Describe the course of the facial nerve. Write its
applied aspects.
Or
Give an account on extracranial course relations and
branches of the facial nerve. Add a note on its
applied anatomy.
Or
Describe extracranial course of the facial nerve
under the following headings: exit from cranial cavity,
course in neck and parotid gland, branches,
distribution and applied aspects.
Facial nerve is the VII cranial nerve, which is the nerve of
the second branchial arch.
Course and Relations
The facial nerve is attached to the lateral surface of
brainstem close to caudal border of the pons by two roots,
motor and sensory.
The sensory root is also called the nervus intermedius.
The two roots run laterally and forwards, along with the
eighth nerve to reach the internal acoustic meatus. In the
meatus, the motor root lies in a groove on the eighth
nerve, with the sensory root intervening. At the bottom
or fundus of the meatus, the two roots, sensory and motor
fuse to form a single trunk, which lies in the petrous
temporal bone.
The course of the nerve can be divided within the canal
into three parts by two bends.
The first part is directed laterally above the vestibule.
The second part runs backwards in relation to the medial
wall of the middle ear, above the promontory.
4 Quick Review Series: BDS 1st Year

The third part is directed vertically downwards behind the Greater petrosal nerve
promontory. It is a branch of nervus intermedius and is known as the
The sharp first bend is also called the genu at the junction nerve of tear secretion. ii. The greater petrosal nerve
of the first and second parts. The geniculate ganglion of joins deep petrosal nerve near foramen lacerum and
the nerve is so called because it lies on the genu. The passes forwards through pterygoid canal as nerve of
second bend is gradual and lies between the promontory pterygoid canal and emerges into pterygopalatine fossa
and the mastoid antrum. and enters pterygopalatine ganglion, where it relays
In its extracranial course, the facial nerve crosses the secretomotor fibres. iii. The taste fibres and sympathetic
lateral side of the base of the styloid process, enters the fibres pass through ganglion together with the sensory
posteromedial surface of the parotid gland, runs forwards fibres of the maxillary nerve. iv. It is secretomotor to
through the gland and behind the neck of the mandible. It glands of palate, pharynx and nose and has a few taste
divides into its five terminal branches, which emerge fibres for the scattered taste buds on the oral surface of the
along the anterior border of the parotid gland. palate.
Branches and distribution of the facial nerve are as The nerve to the stapedius: It arises opposite the pyramid
follows (Fig. 1A.9.3): of the middle ear and supplies the stapedius muscle. It
Within the facial canal damps excessive vibrations of the stapes caused by high-
Greater petrosal nerve pitched sounds. In paralysis of the muscle, even normal
The nerve to the stapedius sounds appear too loud, and it is known as hyperacusis.
The chorda tympani arises in the vertical part of the facial
canal about 6 mm above the stylomastoid foramen. It runs
Lacrimal nerve
upwards and forwards in a bony canal. It enters the middle
Sensory root
Internal auditory meatus Lacrimal gland ear and runs forwards in close relation to the tympanic
Motor nucleus Greater petrosal membrane. It leaves the middle ear by passing through the
Geniculate ganglion petrotympanic fissure. It then passes medial to the spine
of the sphenoid and enters the infratemporal fossa.
Deep petrosal
Chorda tympani joins the lingual nerve through which it is
Chorda tympani
Nerve to stapedius
distributed. It carries (a) preganglionic secretomotor fibres
Lingual nerve to the submandibular ganglion for supply of the
Stylomastoid foramen
submandibular and sublingual salivary glands and taste
Posterior auricular
l
Tongue fibres from the anterior two-thirds of the tongue.
Posterior belly ora
mp B. The branches of facial nerve at its exit from the
Te tic
Zygoma Submandibular
ganglion
stylomastoid foramen
Buc
cal
To stylohyoid Sublingual gland a. The posterior auricular nerve arises just below the
Submandibular gland
Cervical stylomastoid foramen. It ascends between the mastoid
Marginal mandibular
process and the external acoustic meatus and supplies
The chorda tympani the auricularis posterior, ii. the occipitalis and iii. the
Lacrimatory and superior salivatory nuclei
Nucleus of tractus solitarius intrinsic muscles on the back of the auricle.
of digastric The digastric branch arises close to the posterior
Fig. 1A.9.3 Distributionoffacialnervebranches. auricular nerve and supplies the posterior belly of the
The branches of facial nerve at its exit from the digastric.
stylomastoid foramen The stylohyoid branch, which may arise with digastric
Posterior auricular branch, supplies the stylohyoid muscle.
Digastric 3. Terminal branches within the parotid gland
Stylohyoid The temporal branches cross the zygomatic arch and
Terminal branches within the parotid gland supply
Temporal i. the auricularis anterior, ii. the auricularis superior, iii.
Zygomatic the intrinsic muscles on the lateral side of the ear, iv. the
Buccal frontalis,
Marginal mandibular v. the orbicularis oculi and vi. the corrugator
Cervical supercilii.
Communicating branches with adjacent cranial and spinal The zygomatic branches run across the zygomatic bone
nerves and supply the orbicularis oculi.
A. Branches of facial nerve within the facial canal
 General Anatomy 5

The buccal branches are two in number. The upper buccal The posterior auricular nerve arises just below the
branch runs above the parotid duct and the lower buccal stylomastoid foramen and supplies (a) the auricularis
branch below the duct. They supply muscles in that posterior, (b) the occipitalis and (c) the intrinsic muscles
vicinity. on the back of the auricle.
The marginal mandibular branch runs below the angle of The digastric branch arises close to the posterior
the mandible deep to the platysma. It crosses the body of auricular nerve. It is short and supplies the posterior belly
the mandible and supplies muscles of the lower lip and of the digastric.
chin. The stylohyoid branch, which may arise with digastric
The cervical branch emerges from the apex of the parotid branch, is long and supplies the stylohyoid muscle.
gland and runs downwards and forwards in the neck to Terminal branches within the parotid gland:
supply the platysma. The temporal branches cross the zygomatic arch and
Applied Aspects of Facial Nerve supply (a) the auricularis anterior, (b) the auricularis
The symptoms according to level of injury of facial nerve superior, (c) the intrinsic muscles on lateral side of the
are shown in Fig. 1A.9.4. ear, (d) the frontalis, (e) the orbicularis oculi and (f) the
Symptoms according to level of injury of facial nerve corrugator supercilii.
1. A lesion higher up in the facial canal, above the origin The zygomatic branches run across the zygomatic bone
of the chorda tympani causes facial paralysis, a loss of and supply the orbicularis oculi.
taste in anterior part of the tongue. The buccal branches are two in number. The upper buccal
Internal auditory meatus branch runs above the parotid duct and the lower buccal
Internal auditory Geniculate ganglion branch below the duct. They supply muscles in that
meatus Greater petrosal nerve region.
The marginal mandibular branch runs below the angle of
2, 3, 4, 5 of above Nerve to stapedius
the mandible deep to the platysma. It crosses the body of
3, 4, 5 of above the mandible and supplies muscles of the lower lip and
chin.
Chorda tympani
The cervical branch emerges from the apex of the parotid
Stylomastoid gland and runs downwards and forwards in the neck to
Temporal
Only 5
foramen supply the platysma.
of above
Zygomatic Communicating branches: For effective coordination
between the movements of the muscles of the first, second
Buccal
and third branchial arches, the motor nerves of the three
Cervical Marginal mandibular arches communicate with each other. The facial nerve also
Fig. 1A.9.4 Levelofinjuryoffacialnerveanditssymptoms. communicates with the sensory nerves distributed over its
A lesion still higher above the origin of the nerve to stapedius (forehead and orbicularis oculi). The upper part of
results in hyperacusis. These are all lesions of the lower motor the facial nerve nucleus that innervates upper
neuron (infranuclear). musculature is supplied by the cerebral cortex of both
A typical upper motor neuron lesion (supranuclear) paralyses the sides whereas the lower part which innervates lower
lower part of the face but not the upper face receives only contralateral cortical fibres.
SHORT ESSAYS
Q.1. Extracranial course of facial nerve. motor territory.
Connections, course and distribution of chorda
In its extracranial course, the facial nerve after leaving tympani.
the skull through the stylomastoid foramen crosses the
lateral side of the base of the styloid process and enters The chorda tympani arises in the vertical part of the facial
the posteromedial surface of the parotid gland, runs canal about 6 mm above the stylomastoid foramen. It runs
forwards through the gland and divides into its five upwards and forwards in a bony canal and enters the
terminal branches that emerge along the anterior border of middle ear and runs forwards in close relation to the
the parotid gland. tympanic membrane. It leaves the middle ear by passing
Branches and Distribution through the petrotympanic fissure. It then passes medial to
Branches of facial nerve at its exit from the stylomastoid the spine of the sphenoid and enters the infratemporal
foramen: fossa. Here, it joins the lingual nerve through which it is
distributed.
4 Quick Review Series: BDS 1st Year

It carries (a) preganglionic secretomotor fibres to the The third part is directed vertically downwards behind the
submandibular ganglion for supply of the submandibular promontory.
and sublingual salivary glands and (b) taste fibres from The first bend at the junction of the first and second parts is
the anterior two-thirds of the tongue. sharp. It lies over the anterosuperior part of the promontory
Beginning, course, termination and relations of and is also called the genu. The second bend is gradual, and
parotid duct. lies between the promontory and the mastoid antrum. The
facial nerve leaves the skull by passing through the
Parotid duct is thick walled and is about 5 cm long. It stylomastoid foramen.
emerges from the middle of the anterior border of the
gland. It runs forwards and slightly downwards on the
masseter. Here its relations are as follows:
Superiorly,
Accessory parotid gland
Upper buccal branch of the facial nerve and the transverse
facial vessels.
Inferiorly,
The lower buccal branch of the facial nerve.
At the anterior border of the masseter, it turns medially
and pierces (a) the buccal pad of fat, (b) the
buccopharyngeal fascia and (c) the buccinator.
The duct runs forwards for a short distance between the
buccinator and the oral mucosa. Finally, it turns medially
and opens into the vestibule of the mouth opposite the
maxillary second molar tooth.
Describe structures passing through the parotid
gland.
Or Structures passing through parotid gland.

Refer to the answer of Long Essays Q.1.

Intrapetrous part of facial nerve.

The two roots of the facial nerve sensory and motor, fuse
to form a single trunk at the bottom or fundus of the
meatus which lies in the petrous temporal bone (Fig.
1A.9.5).
Within the canal, the course of the nerve can be divided
into three parts by two bends (Fig. 1A.9.6).
The first part is directed laterally above the vestibule.
The second part runs backwards in relation to the medial
wall of the middle ear, above the promontory.
Second part runs backwards Canal for facial nerve
Superior vestibular area Canal for facial nerve
Aditus to mastoid
antrum
Transverse crest First part passing laterally
Pyramid
Inferior vestibular area
Foramen Geniculate ganglion
singulare Cochlear area
Fig. 1A.9.5
Features seen on Promontory Third part runs downwards
the fundus of the left internal acousticmeatus.
Fig. 1A.9.6 Courseoffacialnerve.

SHORT NOTES Stylomastoid foramen

 General Anatomy 5

Q.1. Parotid duct. The auriculotemporal nerve supplies sensory nerves to

Or Parotid duct opening.
Parotid duct is thick walled and is about 5 cm long. It
emerges from the middle of the anterior border of the
gland. It runs forwards and slightly downwards on the
masseter. It opens into the vestibule of the mouth
opposite the crown of the maxillary second molar tooth.
Q.2. Facial nerve.
the gland but the parotid fascia is innervated by the
sensory fibres of the great auricular nerve (C2).
Q.5. Name the arteries seen in the substance of
parotid gland.
The external carotid artery enters the gland through its
posteromedial surface.
The maxillary artery leaves the gland through its

This is the
seventh Topic 10 TEMPORAL AND
cranial
nerve. It is INFRATEMPORAL FOSSA
the nerve of the second branchial arch. The facial nerve anteromedial surface.
leaves the skull by passing through the stylomastoid The superficial temporal vessels emerge at the anterior
foramen and supplies motor innervation to the muscles of part of the superior surface.
face. The posterior auricular artery may arise within the gland.

LONG ESSAYS

Q.3. Chorda tympani. Q.6. List the branches of facial nerve soon after its
emergence through the stylomastoid foramen.
The chorda tympani arises in the vertical part of the facial
canal about 6 mm above the stylomastoid foramen. It Branches of facial nerve at its exit from the stylomastoid
leaves the middle ear by passing through the foramen are as follows:
petrotympanic fissure. It then passes medial to the spine 1. Posterior auricular 2. Digastric and
of the sphenoid and enters the infratemporal fossa where 3. Stylohyoid.
it joins the lingual nerve through which it is distributed.
It carries (a) preganglionic secretomotor fibres to the
submandibular ganglion for supply of the submandibular
and sublingual salivary glands and (b) taste fibres from
the anterior two-thirds of the tongue.
Q.4. Nerve supply to parotid gland.

The parasympathetic nerves are secretomotor. They reach

the gland through the auriculotemporal nerve. The
preganglionic fibres begin in the inferior salivatory
nucleus; pass through the glossopharyngeal nerve, its
tympanic branch, the tympanic plexus and the lesser
petrosal nerve and relay in the otic ganglion. The
postganglionic fibres pass through the auriculotemporal
nerve and reach the gland.
Sympathetic nerves are vasomotor and are derived from
the plexus around the external carotid artery.
4 Quick Review Series: BDS 1st Year

Q.1. Name the muscles of mastication. Describe the
origin, insertion, nerve supply actions and relations of
any one of them. Or
Describe the muscles of mastication under the
following headings: names of the muscle
attachments, nerve supply and action. Or
Name the muscles of mastication. Give their
attachments, nerve supply and action.
The muscles of mastication are as follows:
The masseter
The temporalis
The lateral pterygoid 4. The medial pterygoid.
Masseter Muscle
The masseter muscle is quadrilateral in shape and covers
lateral surface of ramus of mandible (Fig. 1A.10.1).
Temporalis muscle is a fan-shaped muscle, filling the
temporal fossa (Fig. 1A.10.2).
Origin
The temporalis muscle arises from temporal fossa and
temporal fascia. The fibres converge and pass through
gap deep to zygomatic arch.
Insertion
Temporalis muscle inserts into margins and deep surface
of coronoid process and anterior border of ramus of
mandible.
Nerve supply
Two deep temporal branches from anterior division of
mandibular nerve.

Temporalis
muscle

Masseter
muscle

Fig. 1A.10.2 Thetemporalismuscle.

Action
Fig.1A.10.1 Themassetermuscle.
Elevates mandible.
Origin
Posterior fibres retract the protruded mandible.
It has three layers:
Helps in side to side grinding movements.
Superficial layer arises from anterior two-third of lower
Lateral Pterygoid Muscle
border of zygomatic arch and adjoining zygomatic
The lateral pterygoid muscle is a short, conical muscle
process of maxilla.
and has upper and lower heads (Fig. 1A.10.3).
Middle layer arises from anterior two-third of deep
surface and posterior one-third of lower border of
zygomatic arch.
Deep layer arises from deep surface of zygomatic arch.
Superficial fibres pass downwards and backwards at 45º,
middle and deep fibres pass vertically downwards.
Insertion
Superficial layer is inserted into lower part of lateral
surface of ramus of mandible. Lateral pterygoid
Lateral Superior head
Middle layer is inserted into middle part of ramus. pterygoid Inferior head
plate
Deep layer is inserted into upper part of ramus and Medial pterygoid
coronoid process of the mandible.
Nerve Supply
The masseteric nerve, a branch of anterior division of Fig. 1A.10.3 Thelateralandmedialpterygoidmuscles.
mandibular nerve, supplies the masseter muscle. Origin
Action Upper head (small) arises from infratemporal surface and
It elevates mandible to close the mouth. crest of greater wing of sphenoid bone.
Temporalis Muscle
 General Anatomy 5

Lower head (larger) arises from lateral surface of lateral
pterygoid plate and the fibres run backwards and laterally
and converge for insertion.
Insertion
Pterygoid fovea on the anterior surface of neck of
mandible.
Anterior margin of articular surface of
temporomandibular joint.
Insertion is posterolateral and at a slightly higher level
than origin.
Nerve supply
A branch from anterior division of mandibular nerve,
supplies the lateral pterygoid muscle.
Action
Along with suprahyoid muscles it helps in depressing the
mandible to open the mouth.
Lateral and medial pterygoids protrude the mandible.
Left lateral pterygoid and right medial pterygoid turn the
chin to left side.
Medial Pterygoid Muscle
The medial pterygoid muscle is quadrilateral in shape and
has a small superficial and a large deep head.
Origin
Superficial head (small slip): From tuberosity of maxilla
and adjoining bone.
Deep head (quite large): From medial surface of lateral
pterygoid plate and adjoining process of palatine bone.
The fibres run downwards, backwards and laterally.
Insertion
Roughened area on the medial surface of angle and
adjoining ramus of mandible, below and behind the
mandibular foramen and mylohyoid groove.
Nerve supply
Nerve to medial pterygoid, branch of main trunk of
mandibular nerve.
Action
Elevates mandible.
Helps protrude the mandible.
Right medial pterygoid with left lateral pterygoid turns
the chin to left side.
Q.2. Give an account of lateral pterygoid muscle. Or
Describe lateral pterygoid muscle and its relations.
The lateral pterygoid muscle is a short, conical muscle
and has upper and lower heads (Fig. 1A.10.3). Origin
Upper head (small): Arises from infratemporal surface
and crest of greater wing of sphenoid bone.
Lower head (larger): Arises from lateral surface of lateral
pterygoid plate and the fibres run backwards and laterally
and converge for insertion. Insertion
Pterygoid fovea on the anterior surface of neck of the
mandible
Anterior margin of articular surface of
temporomandibular joint.
Insertion is posterolateral and at a slightly higher level
than origin.
Nerve Supply
A branch from anterior division of mandibular nerve.
Action
Depress mandible to open mouth, with suprahyoid
muscle.
Lateral and medial pterygoid muscles protrude the
mandible.
Left lateral pterygoid and right medial pterygoid turn the
chin to left side as part of grinding movements.
Relations of Lateral Pterygoid
The lateral pterygoid may be regarded as the key muscle
of this region, and its relations are as follows:
Superficially lateral pterygoid is related to the following:
Masseter
Ramus of the mandible
Tendon of the temporalis
The maxillary artery.
Deep relations of lateral pterygoid are as follows:
Mandibular nerve
Middle meningeal artery 3. Sphenomandibular ligament.
Deep head of the medial pterygoid structures emerging at
the lower border are as follows:
Lingual nerve
Inferior alveolar nerve.
Structures passing upwards deep to it are as follows:
1. The middle meningeal artery.
Structures passing through the gap between the two
heads are as follows:
The maxillary artery enters the gap
The buccal branch of the mandibular nerve comes out
through the gap.
Structure surrounding the lateral pterygoid is as follows:
1. The pterygoid plexus of veins.
Q.3. Describe the mandibular nerve under following
headings: origin, roots fibres, its contents,
termination and relations.
Or
Describe the mandibular nerve under following
headings: formation, course, relations, branches
and its distribution.
Or
Give an account of origin, course, relations and
branches of mandibular nerve. Add a note on its
applied anatomy.
Mandibular nerve is the largest of the three divisions of
the trigeminal nerve. It is the nerve of the first branchial
arch and supplies all structures derived from the
4 Quick Review Series: BDS 1st Year

mandibular of first branchial arch. It has both sensory and

motor fibres.
Origin, Course and Relations
Mandibular nerve originates in the middle cranial fossa
through a large sensory root and a small motor root (Fig.
1A.10.4). The sensory root arises from the lateral part of
the trigeminal ganglion and leaves the cranial cavity
through the foramen ovale.
The motor root lies deep to the trigeminal ganglion and to
the sensory root. It also passes through the foramen ovale
to join the sensory root just below the foramen thus
forming the main trunk. The main trunk lies in the
infratemporal fossa, on the tensor veli palatini, deep to
the lateral pterygoid. After a short course, the main trunk
divides into a small anterior trunk and a large posterior
trunk.
Masseteric nerve
Masseteric nerve emerges at the upper border of the
lateral pterygoid just in front of the temporomandibular
joint, passes laterally through the mandibular notch
accompanying the masseteric vessels and enters the deep
surface of the masseter. It also supplies the
temporomandibular joint.
Deep temporal nerves
There are two deep temporal nerves, anterior and
posterior that pass between the skull and the lateral
pterygoid and enter the deep surface of the temporalis.
The anterior nerve is often a branch of the buccal nerve.
The posterior nerve may arise in common with the
masseteric nerve.
Nerve to lateral pterygoid
Nerve to lateral pterygoid enters the deep surface of the

Posterior deep temporal
Lesser petrosal Masseteric
Nerve to tensor tympani
Anterior deep temporal
Lateral pterygoid
Auriculotemporal Buccal
Chorda tympani Medial pterygoid
Lingual
Inferior alveolar
Mylohyoid Submandibular
ganglion
Fig. 1A.10.4 Mandibularnerve.
Branches
Branches from the main trunk
Meningeal branch or nervus spinosus
It enters the skull through the foramen spinosum with the
middle meningeal artery and supplies the dura mater of
the middle cranial fossa.
Nerve to medial pterygoid
Nerve to medial pterygoid arises close to the otic
ganglion and supplies the medial pterygoid from its deep
surface. This nerve gives a motor root to the otic
ganglion, which does not relay and supplies the tensor
veli palatini and the tensor tympani muscles.
Branches from the anterior trunk
Buccal nerve
Buccal nerve is the only sensory branch of the anterior
division of the mandibular nerve. It passes between the
two heads of the lateral pterygoid, runs downwards and
forwards, and supplies the skin and mucous membrane
related to the buccinator. It also supplies the labial aspect
of gums of molar and premolar teeth.
muscle. It may be an independent branch or may arise in
common with the buccal nerve.
Branches from the posterior trunk
Auriculotemporal nerve
Auriculotemporal nerve arises by two roots that run
backwards, encircle the middle meningeal artery and
unite to form a single trunk. Behind the neck of the
mandible, it turns upwards and ascends on the temple
behind the superficial temporal vessels.
The auricular part of the nerve supplies the skin of the
tragus and the upper parts of the pinna, the external
acoustic meatus and the tympanic membrane.
The temporal part supplies the skin of the temple in
addition.
The auriculotemporal nerve also supplies the parotid
gland (secretomotor and also sensory) and the
temporomandibular joint.
Lingual Nerve
Lingual nerve is one of the two terminal branches of the
posterior division of the mandibular nerve. It is sensory to
the anterior two-thirds of the tongue and to the floor of
the mouth. The fibres of the chorda tympani, a branch of
facial nerve, which is secretomotor to the submandibular
General Anatomy 5
and sublingual salivary glands and gustatory to the
anterior two-thirds of the tongue, are also distributed
through the lingual nerve.
Course and relations
It begins 1 cm below the skull. It runs first between the
tensor veli palatini and the lateral pterygoid and then
between the lateral and medial pterygoid. About 2 cm
below the skull it is joined by the chorda tympani nerve.
Emerging at the lower border of the lateral pterygoid the
nerve runs downwards and forwards between the ramus
of the mandible and the medial pterygoid. Next, it lies in
direct contact with the mandible, medial to the third
molar tooth between the origins of the superior
constrictor and the mylohyoid muscles. It soon leaves the
gum and runs over the hyoglossus deep to the mylohyoid.
Finally, it lies on the surface of the genioglossus deep to
the mylohyoid. Here it winds around the submandibular
duct and divides into its terminal branches.
Inferior alveolar nerve
Inferior alveolar nerve is the larger terminal branch of the
posterior division of the mandibular nerve. It runs
vertically downwards lateral to the medial pterygoid and
to the sphenomandibular ligament. It enters the
mandibular foramen and runs in the mandibular canal
accompanied by the inferior alveolar artery.
Branches
The mylohyoid branch contains all the motor fibres of the
posterior division. It arises just before the inferior
alveolar nerve enters the mandibular foramen, runs in the
mylohyoid groove and supplies the mylohyoid muscle
and the anterior belly of the digastric.
Within the mandibular canal the inferior alveolar nerve
gives branches that supply the lower teeth and gums.
The mental nerve emerges at the mental foramen and
supplies the skin of the chin, and the skin and mucous
membrane of the lower lip.
The incisive branch supplies the labial aspect of gums of
canine and incisor teeth.
Describe origin, course relations and distribu-tion of
lingual nerve.
Refer to the answer of Long Essays Q.3.
Mention boundaries and contents of infratem-poral
fossa.
The infratemporal fossa lies below the skull and behind
the body of the maxilla and lateral pterygoid plate. It
communicates with the pterygopalatine fossa through the
pterygomaxillary fissure.
Boundaries
The roof is formed medially by the infratemporal surface
of the greater wing of the sphenoid and by a small part of
4 Quick Review Series: BDS 1st Year
the squamous temporal bone. Laterally, the roof is
incomplete where the infratemporal fossa communicates
with the temporal fossa through the gap deep to the
zygomatic arch. The roof formed by greater wing is
pierced by the foramen ovale and by the foramen
spinosum.
The floor is open.
The medial wall is formed by the lateral pterygoid plate
and the pyramidal process of the palatine bone.
The lateral wall is formed by the ramus of the mandible.
The anterior wall is formed by the infratemporal or
posterior surface of the maxilla and by the medial surface
of the zygomatic bone.
The posterior wall is open.
Communications
1. Superiorly—with cranial cavity 2. Inferiorly with—
parapharyngeal space
3. Medially with—pterygopalatine fossa.
The anterior and medial walls are separated in their upper
parts by the pterygomaxillary fissure through which the
infratemporal fossa communicates with the
pterygopalatine fossa. The upper end of the
pterygomaxillary fissure is continuous with the anterior
part of the inferior orbital fissure through which the
infratemporal fossa communicates with the orbit.
Contents of infratemporal fossa are as follows:
Mandibular nerve and its branches
Maxillary artery and its branches
Maxillary vein and its tributaries
Chorda tympani nerve
Pterygoid plexus of veins 6. Muscles of mastication
7. Otic ganglion.
Q.6. Describe the movements of temporomandibular
joint and mention the muscles producing these
movements. What are the factors responsible for its
stability?
Or
Describe temporomandibular joint.
Or
Describe the articulating surfaces, ligaments and
movements of temporomandibular joint. Or
Describe the temporomandibular joint under the
following headings: type of joint, articular surfaces,
ligaments, nerve supply, movements and muscles
producing movement. Or
Describe the temporomandibular joint under the
following headings: articulating bones and
articulating surfaces, capsule, intra-articular disc,
ligaments, movements with muscles producing it
and applied anatomy.
Temporomandibular joint (TMJ) is a synovial joint of the
condylar variety.
Articular Surfaces
The upper articular surface is formed by:
1. The articular eminence and 2. Anterior part of the
mandibular fossa.
The inferior articular surface is formed by
1. The head of the mandible: The articular surfaces are
covered with fibrocartilage. The joint cavity is divided
into upper and lower parts by an intra-articular disc.
Ligaments
The ligaments of TMJ are as follows:
The fibrous capsule
The lateral ligament 3. The sphenomandibular ligament
4. The stylomandibular ligament.
The fibrous capsule is attached above the articular
tubercle, the circumference of the mandibular fossa and
the squamotympanic fissure; and below the neck of the
mandible. The capsule is loose above the intra-articular
disc and tight below it. The synovial membrane lines the
fibrous capsule and the neck of the mandible.
The lateral or temporomandibular ligament reinforces
and strengthens the lateral part of the capsular ligament.
Its fibres are directed downwards and backwards. It is
attached above the articular tubercle and below the
posterolateral aspect of the neck of the mandible.
The sphenomandibular ligament is an accessory ligament.
It is attached superiorly to the spine of the sphenoid and
inferiorly to the lingula of the mandibular foramen. It is a
remnant of the dorsal part of Meckel’s cartilage.
The stylomandibular ligament is another accessory
ligament of the joint. It is attached above to the lateral
surface of the styloid process and below to the angle and
posterior border of the ramus of the mandible.
It represents a thickened part of the deep cervical fascia,
which separates the parotid and submandibular salivary
glands.
Articular Disc
The articular disc is an oval fibrous plate that divides the
joint into an upper and a lower compartment. The upper
compartment permits gliding movements, and the lower
rotatory as well as gliding movements. The disc has a
concavoconvex superior surface and a concave inferior
surface. The periphery of the disc is attached to the
fibrous capsule.
The disc is composed of an anterior extension, anterior
thick band, intermediate zone, posterior thick band and
bilamellar region. The disc represents the degenerated
primitive insertion of lateral pterygoid.
Relations
Lateral:
Skin and fasciae

Parotid gland
Temporal branches of the facial nerve.
Medial:
The tympanic plate separates the joint from the internal
carotid artery.
Spine of the sphenoid, with the upper end of the
sphenomandibular ligament.
The auriculotemporal and chorda tympani nerves.
Middle meningeal artery.
Anterior:
1. Lateral pterygoid 2. Masseteric nerve and vessels.
Posterior:
1. The parotid gland separates the joint from the external
auditory meatus 2. Superficial temporal vessels
3. Auriculotemporal nerve.
Superior:
Middle cranial fossa
Middle meningeal vessels.
Inferior: Maxillary artery and vein.
Blood Supply
Branches from superficial temporal and maxillary
arteries. Veins follow the arteries.
Nerve Supply
Auriculotemporal nerve and masseteric nerve.
Movements
The movements at the joint can be divided into those
between the upper articular surface and the articular disc,
i.e. meniscotemporal compartment and those between the
disc and the head of the mandible, i.e.
meniscomandibular compartment. Most movements
occur simultaneously at the right and left
temporomandibular joints.
In forward movement or protraction of the mandible, the
articular disc glides forwards over the upper articular
surface, the head of the mandible moving with it. The
reversal of this movement is called retraction.
In slight opening of the mouth or depression of the
SHORT ESSAYS
mandible, the head of the mandible moves on the
undersurface of the disc like a hinge. In wide opening of
the mouth, this hinge-like movement is followed by
gliding of the disc and the head of the mandible, as in
protraction. At the end of this movement, the head comes
to lie under the articular tubercle. These movements are
reversed in closing the mouth or elevation of the
mandible.
Chewing movements involve side-to-side movements of
the mandible. In these movements, the head of right side
glides forwards along with the disc as in protraction, but
the head of the left side merely rotates on a vertical axis.
As a result of this, the chin moves forwards and to left
General Anatomy 5
side (the side on which no gliding has occurred).
Alternate movements of this kind on the two sides result
in side-to-side movements of the jaw.
Muscles Producing Movements
Depression is brought about mainly by the lateral
pterygoid.
The digastric, geniohyoid and mylohyoid muscles help
when the mouth is opened wide or against resistance.
During contraction, the lateral pterygoid rotates the head
of the mandible and opens the mouth. During wide
opening, it pulls the articular disc forwards. So movement
occurs in both the compartments. It is also done passively
by gravity.
Elevation is brought about by the masseter, the temporalis
and the medial pterygoid muscles of both sides. These are
antigravity muscles.
Protrusion is done by the lateral and medial pterygoids.
Retraction is produced by the posterior fibres of the
temporalis. It may be resisted by the middle and deep
fibres of the masseter, the digastric and geniohyoid
muscles.
Lateral or side-to-side movements, e.g. turning the chin to
left side are produced by left lateral pterygoid and right
medial pterygoid and vice versa.
Applied Anatomy
Dislocation of mandible: During excessive opening of the
mouth, or during a convulsion, the head of the mandible
of one or both sides may slip anteriorly into the
infratemporal fossa, as a result of which there is inability
to close the mouth.
Derangement of the articular disc may result from any
injury, like overclosure or malocclusion. This gives rise
to clicking and pain during movements of the jaw.
In operations on the joint, the facial nerve should be
preserved with care.
4 Quick Review Series: BDS 1st Year
Q.1. Articular disc.
Refer to the answer of Long Essays Q.6. Q.2.
canal
Fig. 1A.10.5 Pterygopalatineganglion.
Buccinator muscle.
Buccinator is the muscle of the cheek.
Origin
Upper fibres, from maxilla opposite molar teeth
Lower fibres, from mandible opposite molar teeth
Middle fibres, from pterygomandibular raphe.
Insertion
Upper fibres, straight to the upper lip.
Lower fibres, straight to the lower lip.
Middle fibres decussate before passing to the lips.
Actions
1. Flattens cheek against gums and teeth 2.
Prevents accumulation of food in the vestibule.
Q.3. Inferior alveolar nerve.
Refer to the answer of Long Essays Q.3.
Q.4. Pterygopalatine ganglion.
Pterygopalatine or sphenopalatine ganglion is the
largest parasympathetic peripheral ganglion that
lies in the pterygopalatine fossa just below the
maxillary nerve, in front of the pterygoid canal and
lateral to the sphenopalatine foramen (Fig.
1A.10.5).
Topographically, it is related to the maxillary
nerve, but functionally it is connected to the facial
nerve.
It serves as a relay station for secretomotor fibres to
the lacrimal gland and to the mucous glands of the
nose, the paranasal sinuses, the palate and pharynx.
Connections
The motor or parasympathetic root of the ganglion is
formed by the nerve of the pterygoid canal. It carries
preganglionic fibres that arise from neurons present near
the
superior salivatory and lacrimatory nuclei, and reach the
ganglion. The fibres relay on the ganglion, and
postganglionic fibres arise to supply secretomotor nerves
to the lacrimal gland and to the mucous glands of the
nose, the paranasal sinuses, the palate and the
nasopharynx.
The sympathetic root is also derived from the nerve of the
pterygoid canal. It contains postganglionic fibres arising in
the superior cervical sympathetic ganglion and passing
through the internal carotid plexus, the deep petrosal nerve
and the nerve of the pterygoid canal to reach the ganglion.
The fibres pass through the ganglion without relay and
supply vasomotor nerves to the mucous membrane of the
nose, the paranasal sinuses, the palate and the nasopharynx.
The sensory root comes form the maxillary nerve. Its fibres
pass through the ganglion without relay. They emerge in the
following branches:
Orbital branches pass through the inferior orbital fissure
and supply the periosteum of the orbit and the orbitalis
muscle.
Palatine branches: The greater or anterior palatine nerve
descends through the greater palatine canal and supplies
the hard palate and the lateral wall of the nose. The lesser
or middle and posterior palatine nerves supply the soft
palate and the tonsil.
Nasal branches enter the nasal cavity through the
sphenopalatine foramen. The lateral posterior superior
nasal nerve, about six in number, supply the posterior part
of the superior and middle conchae. The medial posterior
superior nasal nerves, two or three in number, supply the
posterior part of the roof of the nose and of the nasal
septum. The nasopalatine nerve descends up to the

SHORT NOTES
anterior part of the hard palate through the incisive
foramen.
The pharyngeal branch passes through the
palatinovaginal canal and supplies the part of the
nasopharynx behind the auditory tube.
Lacrimal branch: The postganglionic fibres pass
back into the maxillary nerve to leave through its
zygomatic nerve and its zygomaticotemporal
branch, a communicating branch to lacrimal nerve
to supply the secretomotor fibres to the lacrimal
gland. Q.5. Muscles of mastication.
Refer to the answer of Long Essays Q.1.
Q.6. Styloid process of temporal bone.
The styloid process with its attached structures is
called the styloid apparatus.
The structures attached to the process are as
follows:
The stylohyoid, styloglossus and stylopharyngeus
muscles.
The stylohyoid and stylomandibular ligaments.
The five attachments resemble the reins of a
chariot.
The styloid process is a long, slender and pointed
bony process projecting downwards, forwards and
slightly medially from the temporal bone.
It descends between the external and internal
carotid arteries to reach the side of the pharynx. It
is interposed between the parotid gland laterally
and the internal jugular vein medially.
The styloglossus muscle arises from the tip and
adjacent part of the anterior surface of the styloid
process as well as from the upper end of the
stylohyoid ligament. During swallowing, it pulls
the tongue upwards and backwards.
The stylopharyngeus muscle arises from the medial
surface of the base of the styloid process. Along
with the glossopharyngeal nerve it passes between
the external and internal carotid arteries, enters the
pharynx through the gap between the superior and
middle constrictors. It helps to lift the larynx
during swallowing and phonation.
The stylohyoid ligament extends from the tip of the
styloid process to the lesser cornu of the hyoid
bone.
Q.7. Attachments, relations, nerve supply and
action of lateral pterygoid muscle. Or
Give the attachment, relations and nerve
supply of lateral pterygoid muscle.
General Anatomy 5
Refer to
the
answer of Long Essays Q.2.
Q.1. Lingual nerve.
Lingual nerve is one of the two terminal branches of the
posterior division of the mandibular nerve. It is sensory to
the anterior two-thirds of the tongue and to the floor of
the mouth. The fibres of the chorda tympani are also
distributed through the lingual nerve. Q.2. Jugular
foramen.
The jugular foramen is large and elongated, with its long
axis directed forwards and medially. It is placed at the
posterior end of the petro-occupital suture.
The jugular foramen transmits the following structures:
Through the anterior part
Inferior petrosal sinus
Meningeal branch of the ascending pharyngeal artery
Through the middle part IX, X and XI cranial nerves
(glossopharyngeal, vagus and accessory nerves)
Through the posterior part
Internal jugular vein
Meningeal branch of the occipital artery.
The glossopharyngeal notch near the medial end of the
jugular foramen lodges the inferior ganglion of the
glossopharyngeal nerve.
Q.3. Auriculotemporal nerve.
This nerve has two roots of origin. Between the two roots
the middle meningeal artery passes. The two roots unite
to form a single nerve. It passes backwards and lies deep
to the lateral pterygoid muscle. It passes between the neck
of the mandible and sphenomandibular ligament. It
pierces the upper border of the parotid gland. It crosses
the zygomatic arch and then it enters the temporal fossa.
Branches
Auricular branches to supply external ear
Temporal branches to supply the skin of the temporal
region
Glandular branches to supply the parotid gland.
Branch to the temporomandibular joint Q.4. Inferior
alveolar nerve.
Refer to the answer of Long Essays Q.3.
Q.5. Muscles of mastication.
Refer to the answer of Long Essays Q.1. Q.6.
Stylomandibular ligament.
The stylomandibular ligament is an accessory ligament of
the temporomandibular joint. It represents a thickened
4 Quick Review Series: BDS 1st Year
part of the deep cervical fascia, which separates the
parotid and submandibular salivary glands. It is
attached above to the lateral surface of the styloid
process and below to the angle and posterior border
of the ramus of the mandible. Q.7.
Temporomandibular joint movements.
Movements of temporomandibular joint are:
Depression
Elevation
Protraction
Retraction
Side-to-side movement.
The articular disc divides the joint into two
compartments, namely superior and inferior.
Elevation and depression: These movements occur
in mainly the inferior compartment. The head of
mandible rotates on the articular disc. This
movement occurs in the transverse axis.
Protraction and retraction: These movements
occur mainly in the superior compartments. The
articular disc moves in anteroposterior direction up
to the articular tubercle and borders of the
mandibular fossa.
Side-to-side movement: Head of mandible and
articular disc of one side move forwards. But on
the opposite side the head of mandible does not
move forwards; instead it moves transversely.
Q.8. Pterygoid plexus of veins.
Pterygoid plexus of veins lies around and within
the lateral pterygoid muscle. The tributaries of the
plexus correspond to the branches of the maxillary
artery. The plexus is drained by the maxillary vein,
which begins at the posterior end of the plexus and
unites with the superficial temporal vein to form
the retromandibular vein.
The plexus communicates with
The inferior ophthalmic vein through the inferior
SUBMANDIBULAR REGION
Topic 11
LONG ESSAYS
orbital fissure,
The cavernous sinus through the emissary veins
and
The facial vein through the deep facial vein. Q. 9.
Pterygomandibular raphe.
The pterygomandibular raphe is attached immediately
behind the third molar tooth in continuation with the
origin of the superior constrictor muscle of the pharynx. It
is formed by the interdigitation of fibres from two
muscles, namely buccinator and superior pharyngeal
constrictors.
Q.10. Name any four branches of first part of
maxillary artery.
The first part, i.e. the mandibular part of maxillary artery
runs horizontally forwards, first between the neck of the
mandible and the sphenomandibular ligament, below the
auriculotemporal nerve, and then along the lower border
of the lateral pterygoid.
Branches of the first part of the maxillary artery are as
follows:
The deep auricular artery supplies the external acoustic
meatus, the tympanic membrane and the
temporomandibular joint.
The anterior tympanic branch supplies the middle ear
including the medial surface of the tympanic membrane.
The middle meningeal artery supplies more of bone and
less of meninges, V and VII nerves, middle ear and tensor
tympani.
The accessory meningeal artery enters the cranial cavity
through the foramen ovale. Apart from the meninges, it
supplies structures in the infratemporal fossa.
The inferior alveolar artery runs downwards and forwards
medial to the ramus of the mandible to reach the
mandibular foramen.
Q.11. Lateral pterygoid plate.
The lateral pterygoid plate is directed backwards and
laterally.
It has medial and lateral surfaces and a free posterior
border.
The lateral surface forms the medial wall of the
infratemporal fossa.
The lateral and medial surfaces give origin to pterygoid
muscles.
The posterior border sometimes has a projection called the
pterygospinous process, which projects towards the spine of
the sphenoid.
 General Anatomy 5

Q.1. Write about the origin, insertion and relations of

mylohyoid muscle.

The mylohyoid is a fat, triangular muscle belonging to the

suprahyoid group of muscles. Table 1A.11.1 gives an
account of mylohyoid muscle.
Table 1A.11.1 The mylohyoid muscle
Nerve
Origin Insertion supply Actions
Fig. 1A.11.2 Superficialrelationsofmylohyoidmuscle.
Mylohyoi 1. Nerve to 1. Elevates
d Anterior mylohyoi floor of mouth Deep or above the mylohyoid it is in contact with the
line of and d during first following (Fig. 1A.11.3):
mandible middle stage of a. Hyoglossus with its superficial relations, namely
fibres into deglutition i. The styloglossus ii. The lingual nerve iii. The
median submandibular ganglion iv. The deep part of the
raphe
submandibular salivary gland
2. 2. Helps in v. The submandibular duct vi. The
Posterior depression of
hypoglossal nerve vii. The vena comitants hypoglossi
fibres: mandible, and
body of elevation of b. The genioglossus with its superficial relations,
hyoid hyoid namely:
bone bone i. The sublingual salivary gland ii. The lingual nerve iii.
Origin The submandibular duct iv. The lingual artery
The mylohyoid muscle arises from mylohyoid line on the v. The hypoglossal nerve
inner surface of the mandible, as shown in Fig. 1A.11.1. Q.2. Describe submandibular gland. Add a note on
Insertion its innervation.
The mylohyoid muscle extends almost transversely
towards the midline where the anterior fibres insert with Submandibular salivary gland is one of the major salivary
the muscle on the other side into a median raphe. glands, situated in the anterior part of the digastric
The posteriormost fibres insert upon the body of the triangle. The gland is about the size of a walnut and is
hyoid bone, and the two muscles together form a roughly J-shaped. It is indented by the posterior border of
diaphragm below the geniohyoid muscle constituting the the mylohyoid which divides it into a large part
floor of the mouth, as shown in Fig. 1A. 11.1. superficial to the muscle that fills the digastric triangle
Superficial and deep relations of mylohyoid muscle are as and a small part lying deep to the muscle.
follows (Fig. 1A.11.2): Superficial Part
Superficially it is in contact with the following: It has three surfaces, namely
Anterior belly of the digastric Inferior
Superficial part of the submandibular salivary gland Lateral 3. Medial surfaces.
Mylohyoid nerve and vessels The gland is partially enclosed between two layers of
Submental branch of the facial artery. deep cervical fascia (Fig. 1A.11.4). The superficial layer
of fascia covers the inferior surface of the gland and is
attached to the base of the mandible. The deep layer
covers the medial surface of the gland and is attached to
the mylohyoid line of the mandible.
Superficially, the submandibular gland is crossed by the
facial vein and sometimes by the marginal mandibular
branch of the facial nerve. The large submandibular
lymph nodes lie along the superficial upper border of the
gland.

Fig. 1A. 11.1 Mylohyoidmuscle.

4 Quick Review Series: BDS 1st Year

Lingual nerve The anterior part is related to the mylohyoid muscle,

nerve and vessels.
The middle part is related to the hyoglossus, styloglossus,
lingual nerve, submandibular ganglion and the
hypoglossal nerve.
The posterior part is related to the styloglossus,
stylohyoid ligament, glossopharyngeal nerve and the wall
of the

ganglion
Fig. 1A.11.3 Deeprelationsofmylohyoidmuscle.
pharynx.
Mylohyoid line Inferiorly it overlaps the stylohyoid and the posterior
Deep lamina Mandibular belly of the digastric.
of fascia canal
Submandibular Submandibular Duct (Wharton’s Duct)
gland Submandibular
fossa Wharton’s duct is a thin-walled duct, which is about 5 cm
Greater cornua of long and emerges at the anterior end of the deep part of
hyoid bone
Base of mandible the gland and runs forwards on the hyoglossus, between
Superficial lamina of fascia the lingual and hypoglossal nerves. The submandibular
Fig. 1A.11.4 Cervicalfasciacoveringsubmandibulargland. duct is in immediate contact with the sublingual gland,
Deep Part lying at first below and then medial to it and may receive
This part is smaller in size and lies deep to the mylohyoid a major sublingual duct (Bartholin’s duct) before it opens
and superficial to the hyoglossus and the styloglossus. into the mouth.
Posteriorly it is continuous with the superficial part In the terminal part of its course, the duct lies
around the posterior border of the mylohyoid. Anteriorly immediately below the mucosa of the floor of the mouth
it extends up to the sublingual gland. and opens at the sublingual caruncle or papilla just lateral
Relations to the frenulum.
Superficial or the inferior surface of submandibular gland Blood Supply and Lymphatic Drainage
is covered by the following: The blood supply is through the facial artery. The veins
Skin drain into the common facial or lingual vein. Lymph
Platysma passes to submandibular lymph nodes (Fig. 1A.11.5).
Cervical branch of the facial nerve Nerve Supply
Deep fascia Submandibular gland is supplied by branches from the
Facial vein submandibular ganglion.
Submandibular lymph nodes. These branches convey the following:
The lateral surface is related to the following: Secretomotor fibres
1. The submandibular fossa on the mandible 2. Insertion Sensory fibres from the lingual nerve
of the medial pterygoid Vasomotor sympathetic fibres from the plexus on the
3. The facial artery. facial artery.
The medial surface may be divided into three parts: The secretomotor pathway begins in the superior salivary
nucleus. Preganglionic fibres pass through the sensory
root of the facial nerve, the geniculate ganglion, the facial
 General Anatomy 5

nerve, the chorda tympani and the lingual nerve to reach

the submandibular ganglion. Postganglionic fibres
emerge from the ganglion and enter the submandibular
gland.
Sympathetic fibres from the superior cervical ganglion
reach this gland either by the way of other nerves or
along the vessels.
Stimulation of parasympathetic fibres produces watery
secretion from these glands, while the stimulation of
sympathetic fibres is said to produce a viscid one.
Medial pterygoid

Facial artery

Submandibular gland
Investing fascia
Anteroinferior part
of masseter

pterygoid Facial vein

Submandibular gland
Investing fascia
Medial
Fig. 1A.11.5 Vascularsupplyofsubmandibulargland.

SHORT ESSAYS
Q.1. Otic ganglion.

Otic ganglion is a peripheral parasympathetic ganglion

that relays secretomotor fibres to the parotid gland (Fig.
1A.11.6).
Topographically, it is related to the mandibular nerve, but
functionally it belongs to glossopharyngeal nerve.
Q.2. Submandibular ganglion.

This is a parasympathetic peripheral ganglion. It is a relay

station for secretomotor fibres to the submandibular and
sublingual salivary glands.
Topographically it is related to the lingual nerve, but
functionally it is connected to the chorda tympani
4 Quick Review Series: BDS 1st Year

Semilunar
ganglion
Minor petrosal
nerve Semilunar
Otic ganglion ganglion

Lingual nerve Lingual

Auriculotemporal
nerve

Tympanic nerve Chorda

Glossopharyngeal tympani
nerve
Sublingual Submandibular
gland ganglion
Parotid gland
Submandibular
Fig. 1A.11.6 Theoticganglion. gland
Size and location: It is 23 mm in size and is situated just arising in the superior cervical ganglion. They pass
below the foramen ovale in the infratemporal fossa. It lies through submandibular ganglion without relay and supply
medial to the mandibular nerve and lateral to the tensor vasomotor fibres to the submandibular and sublingual
veli palatini. glands. 7. Sensory fibres reach the ganglion through the
The motor or parasympathetic root is formed by the lesser lingual nerve.
petrosal nerve. The preganglionic fibres are derived from nerve
Facial nerve
the inferior salivary nucleus and pass through the IX
Fig. 1A.11.7 Submandibularganglionanditsbranches.
nerve, its tympanic branch, the tympanic plexus—the
Q.3. Give the origin, insertion and nerve supply of
lesser petrosal nerve—to reach the ganglion. The
digastric muscle.
postganglion or secretomotor fibres pass through the
auriculotemporal nerve to the parotid gland.
The digastric muscle is one of the suprahyoid muscles
The sympathetic root is derived from the plexus on the
containing two bellies united by an intermediate tendon
middle meningeal artery. It contains postganglionic fibres
arising in the superior cervical ganglion. The fibres pass
through the ganglion without relay and reach the parotid
gland via the auriculotemporal nerve. They are vasomotor
in function.
The sensory root comes from the auriculotemporal nerve
and is sensory to the parotid gland.
branch of the facial nerve.
The fusiform ganglion lies on the hyoglossus muscle just
above the deep part of the submandibular salivary gland,
suspended from the lingual nerve by two roots.
The motor or parasympathetic fibres pass from the lingual
digastric muscle Mylohyoid muscle
nerve to the ganglion through the posterior root. These Fig.1A.11.8 Digastricmuscle(originandinsertion).
are preganglionic fibres that arise in the superior (Fig. 1A.11.8). Anterior belly runs downwards and
salivatory nucleus and pass through the facial nerve, the backwards whereas the posterior belly runs downwards
chorda tympani and the lingual nerve to reach the and forwards. Table 1A.11.2 gives an account of digastric
ganglion. The fibres relay in the ganglion. Postganglionic muscle.
fibres for the submandibular gland reach the gland Table 1A.11.2 Details of digastric muscle
through five or six branches from the ganglion (Fig.
1A.11.7).
Postganglionic fibres for the sublingual and anterior
lingual glands re-enter the lingual nerve through the
anterior root and travel to the gland through the distal part
of the lingual nerve.
The sympathetic fibres are derived from the plexus
around the facial artery. It contains postganglionic fibres

SHORT NOTES
 General Anatomy 5

Origin Insertion Nerve Actions

supply
Anterior Both heads Anterior Depresses
belly meet at the belly by mandible
from intermediat nerve to when mouth
digastrics e tendon mylohyoid is opened
fossa of that Posterior widely or
mandible perforates belly by against
Posterior SH and is facial resistance; it
belly held by the nerve is secondary
from hyoid bone to lateral
mastoid pterygoid
notch of Elevates
temporal hyoid bone
bone
Otic ganglion. Fig. 1A.11.9 Hyoglossusmuscleanditsrelations.
Table 1A.11.3 The hyoglossus muscle
It is a peripheral parasympathetic ganglion that relays Origin Insertion Nerve Actions
supply
secretomotor fibres to the parotid gland. It is 23 mm in
Whole Side of Hypoglossa Depresses
size and is situated just below the foramen ovale in the
length of tongue l (XII) nerve tongue,
infratemporal fossa. Topographically, it is intimately greater between makes
related to the mandibular nerve, but functionally it cornua styloglossus dorsum
belongs to the glossopharyngeal nerve. and and inferior convex,
Digastric muscle. lateral longitudinal retracts the
part of muscle of protruded
body of tongue tongue
Refer to the answer of Short Essays Q.3. Q.3. Mylohyoid
hyoid
muscle. bone;
fibres run
Mylohyoid muscle is a fat, triangular muscle, and two upwards
mylohyoids from either side form the floor of the oral and
cavity. forwards
Origin: Mylohyoid line of mandible. Q.5. Submandibular duct.
Insertion: Median raphe and adjacent part of hyoid bone.
Innervation: Nerve to mylohyoid from the inferior Submandibular duct or Wharton’s duct is a thin-walled
alveolar branch of mandibular nerve (V3). duct, about 5 cm long. It arises from the anterior end of
Function: Supports and elevates the floor of oral cavity the deep part of the gland and runs forwards on the
and depresses mandible when hyoid bone is fixed. Q.4. hyoglossus, between the lingual and hypoglossal nerves.
Hyoglossus muscle. At the anterior border of the hyoglossus, the duct is
crossed by the lingual nerve. It opens on the floor of the
Hyoglossus is a muscle of tongue (Fig. 1A.11.9). See mouth, on the summit of the sublingual papilla and at the
Table 1A.11.3 for details. side of the frenulum of the tongue.
Q.6. Submandibular lymph nodes.

The submandibular lymph nodes are larger and more

numerous than the submental. They form a chain of three
to eight nodes situated largely along the upper border of
the submandibular gland.
Some of these nodes are constant. The largest and the
most constant node is close to the point at which the
facial artery crosses the mandible. It is known as the
Stahr’s lymph node.
These nodes receive the efferent vessels from the buccal
and mandibular nodes, along the facial vein and artery,
4 Quick Review Series: BDS 1st Year

and therefore, drain a large part of the face either directly

or indirectly.
Q.7. Relations of hyoglossus muscle.

Relations of hyoglossus muscle are as follows:

Superficial: Styloglossus, lingual nerve, submandibular
ganglion, deep part of the submandibular gland,
submandibular duct, hypoglossal nerve and veins
accompanying it
Deep: (a) Inferior longitudinal muscle of the tongue, (b)
genioglossus, (c) middle constrictor of the pharynx, (d)
glossopharyngeal nerve, (e) stylohyoid ligament and (f)
lingual artery.

DEEP STRUCTURES OF THE NECK

Topic 12
LONG ESSAY
 General Anatomy 5

Q.1. Thyroid gland.
Or
Describe thyroid gland under the following headings:
Coverings
Parts and relations
Blood supply
Applied aspect
Or
Describe anatomy of thyroid gland. Give its surgical
importance.
Or
Give an account of gross anatomy and histology of
thyroid gland. How is it developed?
Or
Describe the thyroid gland. Add a note on blood
supply and histology.
Or
Describe the thyroid gland under the following
headings: position and parts, relations, supply,
lymphatic drainage and development of gland.
The thyroid is an endocrine gland, situated below and
lateral to the thyroid cartilage.
Development
The thyroid develops from a median endodermal thyroid
diverticulum. The lower end of the diverticulum enlarges
to form the gland. The rest of the diverticulum remains
narrow and is known as the thyroglossal duct. Most of the
duct soon disappears. The position of the upper end is
marked by the foramen caecum of the tongue, and the
lower end often persists as the pyramidal lobe. The gland
becomes functional during third month of development.
Parts
The gland consists of right and left lateral lobes that are
joined to each other by the isthmus. A third, pyramidal,
lobe may project upwards from the isthmus or from one
of the lobes.
Accessory thyroid glands are sometimes found as small
detached masses of thyroid tissue in the vicinity of the
lobes or above the isthmus.
Situation and Extent
The gland lies against vertebrae C5, C6, C7 and T1,
embracing the upper part of the trachea.
Each lobe extends from the middle of the thyroid
cartilage to the fourth or fifth tracheal ring.
The isthmus extends from the second to the fourth
tracheal ring.
Dimensions and Weight
Each lobe measures about 5 cm 3 2.5 cm 3 2.5 cm, and
the isthmus 1.2 cm 3 1.2 cm; the gland weighs roughly
about 25 g. However, it is larger in females than in males,
and further increases in size during menstruation and
pregnancy.
Capsules of Thyroid(Fig.1A.12.1)
The peripheral condensation of the connective tissue of
the gland forms the true capsule. A dense capillary plexus
is present deep to the true capsule; hence the thyroid is
removed along with the true capsule during operations to
avoid haemorrhage.
The false capsule is derived from the pretracheal layer of
the deep cervical fascia. It is
Lobe of
thin along posterior border of
thyroid gland
the Capsule lobes, but thick on the
inner surface of the gland where
it forms a suspensory
ligament (of Berry), which
connects the lobe to the
cricoid cartilage
Suspensory ligament of Berry
Ascending branch
of inferior thyroid artery
Superior parathyroid
Weak part of capsule Fig. 1A.12.1 Capsuleofthyroid.
Thyroid Gland and its Relations (Fig.1A.12.2)
The lobes are conical in shape having the following:
An apex
A base
Three surfaces, lateral, medial and posterolateral
Two borders, anterior and posterior.
The apex is directed upwards and slightly laterally. It is
limited superiorly by the attachment of the sternothyroid
to the oblique line of the thyroid cartilage.
The base is on level with the fourth or fifth tracheal ring.
The lateral or superficial surface is convex and is covered
by (a) the sternohyoid, (b) the superior belly of the
omohyoid, (c) the sternothyroid and (d) the anterior
border of the sternocleidomastoid.
The medial surface is related to (a) trachea and
oesophagus, (b) inferior constrictor and cricothyroid and
(c) external laryngeal and recurrent laryngeal nerve.
The posterolateral or posterior surface is related to the
carotid sheath and overlaps the common carotid artery.
The anterior border is thin and is related to the anterior
branch of the superior thyroid artery.
4 Quick Review Series: BDS 1st Year

The posterior border is thick and rounded and separates the
medial and posterior surfaces. It is related to (a) the inferior
thyroid artery, (b) the anastomosis between superior and
inferior thyroid arteries, (c) the parathyroid glands and (d)
the thoracic duct only on the left side.
Arterial Supply (Fig.1A.12.3)
The thyroid gland is supplied by the superior and inferior
thyroid arteries. The superior thyroid artery is a branch of
the external carotid artery. At the upper pole of the lobe,
it divides into anterior and posterior branches. The
anterior branch descends on the anterior border of the
lobe and continues along the upper border of the isthmus
to anastomose with its fellow of the opposite side. The
posterior branch descends on the posterior border of the
lobe and anastomoses with the ascending branch of the
inferior thyroid artery.
The inferior thyroid artery is a branch of the thyrocervical
trunk that arises from the subclavian artery. It reaches the
Fig. 1A.12.3 Arterialsupplyofthyroidgland.
The superior thyroid artery supplies the upper one-third
of the lobe and the upper half of the isthmus and the
inferior thyroid artery supplies the lower two-thirds of the
lobe and the lower half of the isthmus.
Sometimes, the thyroid is also supplied by the lowest
thyroid artery (thyroidea ima artery) which arises from
the brachiocephalic trunk or directly from the arch of the
aorta. Accessory thyroid arteries arising from tracheal and
oesophageal arteries also supply the thyroid.
Venous Drainage(Fig.1A.12.4)
The superior, middle and inferior thyroid veins drain the
thyroid gland.
The superior thyroid vein which emerges at the upper
pole ends either in the internal jugular vein or in the
common facial vein.

Sternothyroid
Sternohyoid Recurrent laryngeal nerve
Sternocleidomastoid
False capsule
Omohyoid
True capsule
Trachea Position of
Thyroid gland ligament of Berry
Parathyroid gland
Common carotid artery
Carotid sheath
Internal jugular vein

Prevertebral fascia Oesophagus Vagus nerve

Sympathetic trunk
Fig. 1A.12.2 Thyroidglandanditsrelations.
lower pole of the gland and gives off branches to adjacent
structures. The artery divides into 4–5 glandular branches
that pierce the fascia separately to reach the lower part of
the gland. One ascending branch anastomoses with the
posterior branch of the superior thyroid artery and
supplies the parathyroid glands.
Superior thyroid
External artery
laryngeal nerve

Anterior
branch Posterior branch

Ascending branch
of inferior thyroid artery
Fig. 1A.12.4 Venousdrainageofthyroidgland.
Scalenus anterior
Anastomosing
Vertebral vessels The middle thyroid vein is a short, wide channel which
branch
Outline of
Inferior thyroid artery emerges at the middle of the lobe and soon enters the
thyroid gland Transverse internal jugular vein.
cervical artery The inferior thyroid veins emerge at the lower border of
Recurrent Suprascapular artery
laryngeal nerve Thyrocervical trunk
the isthmus. They form a plexus in front of the trachea
Middle and drain into the left brachiocephalic vein.
Subclavian artery
cervical ganglion
Carotid sheath
 General Anatomy 5

A fourth thyroid vein (of Kosher) may emerge between
the middle and inferior veins and drain into the internal
jugular vein.
Lymphatic Drainage
Lymph from the upper part of the gland reaches the upper
deep cervical lymph nodes either directly or through the
prelaryngeal nodes. Lymph from the lower part of the
gland drains to the lower deep cervical nodes directly and
also through the pretracheal and paratracheal nodes.
Nerve Supply
Nerves are derived mainly from the middle cervical
ganglion and partly also from the superior and inferior
cervical ganglia.
Histology and Function
The thyroid gland is made up of the following two types
of secretory cells.
The follicles of the gland are lined by follicular cells.
During active phase the lining of the follicles is columnar,
while in resting phase it is cuboidal. Follicles contain the
colloid in their lumina. Follicular cells secrete
Q.1. Scalenus anterior muscle. Or
Give the origin, insertion and superficial relations of
scalenus anterior muscle.
There are three scalene muscles:
The scalenus anterior
The scalenus medius 3. The scalenus posterior.
The scalenus anterior is a key muscle of the lower part of
the neck because of its intimate relations to many
important structures in this region. It is described in Table
1A.12.1.
Relations of scalenus anterior are as follows (Fig.
1A.12.5):
Anteriorly, the muscle is covered by sternocleidomastoid
deep to this and on the scalenus anterior lie the following
structures:
Anteriorly:
Phrenic nerve
Table 1A.12.1 The scalenus anterior muscle
triiodothyronine and tetraiodothyronine (thyroxin) which
stimulate basal metabolic rate and somatic and psychic
growth of the individual.
Parafollicular cells (C cells) are fewer and light cells lie
in between the follicles. They secrete thyrocalcitonin
which promotes deposition of calcium salts in skeletal
and other tissues and tends to produce hypocalcaemia.
Applied Anatomy
Remnants of the thyroglossal duct may form thyroglossal
cysts or a thyroglossal fistula.
Any swelling of the thyroid gland (goitre) moves with
deglutiton.
Hypothyroidism causes cretinism in infants and
myxedema in adults.
Benign tumours of the gland may displace and even
compress neighbouring structures like the carotid sheath,
the trachea, etc.
Malignant growths tend to invade and erode neighbouring
structures. Pressure symptoms and nerve involvement are
common in carcinoma of the glands.
Prevertebral fascia
Transverse cervical, suprascapular and ascending cervical
vessels
Lateral part of carotid sheath containing the internal
jugular vein
Descends cervicalis
Inferior belly of omohyoid
Anterior jugular vein
Scalenus
Clavicle vein
Fig. 1A.12.5 Relationsofscalenusanteriormuscle.
Subclavian vein
Branches of superior thyroid and suprascapular arteries
Clavicle.
Posteriorly:
1. Scalenus medius 2. Second part of subclavian artery
3. Roots of brachial plexus.
Lateral side:
1. Trunks of brachial plexus.

Transverse process of atlas

Transverse process of axis

SHORT ESSAYS
Anterior tubercle of
transverse process
Origin Insertion Levator
Innervation action
scapulae
From anterior Anterior
Sternocleidomastoid Anterolateral flexion of
tubercles rami of C4Scalenus
cervical spine
medius
transverse to C7 Rotates cervical spine
anterior
processes of to opposite side
Scalenus
cervical vertebrae posterior
Elevation of the first
C3 to C6 into rib during inspiration
scalene tubercle Scapula the neck
Stabilizes
Subclavian
Lower trunk of
First rib brachial plexus
Second rib Subclavian artery
4 Quick Review Series: BDS 1st Year

and adjoining ridge along with other

on the superior muscles
surface of the first
rib
Medial side:
Thyrocervical artery
Vertebral artery
Ascending cervical artery.
Q.2. Blood supply of thyroid gland.

The thyroid gland is supplied by the superior and inferior thyroid arteries. The superior thyroid artery is a branch of the
external carotid artery. At the upper pole of the lobe, it divides into anterior and posterior branches. The anterior branch
descends on the anterior border of the lobe and
continues along the upper border of the isthmus to The styloid process is a long, slender and pointed bony
anastomose with its fellow of the opposite side. The process projecting downwards, forwards and slightly
posterior branch descends on the posterior border of the medially from the temporal bone (Fig. 1A.12.6). It
lobe and anastomoses with the ascending branch of the descends between the external and internal carotid
inferior thyroid artery. arteries to reach the side of the pharynx. It is interposed
The inferior thyroid artery is a branch of the thyrocervical between the parotid gland laterally and the internal
trunk which arises from the subclavian artery. It reaches jugular vein medially.
the lower pole of the gland and gives off branches to The styloid process with its attached structures is called
adjacent structures. The artery divides into 4–5 glandular the styloid apparatus. The structures attached to the
branches which pierce the fascia separately to reach the process are the stylohyoid, styloglossus and
lower part of the gland. One ascending branch stylopharyngeus muscles, and the stylohyoid and
anastomoses with the posterior branch of the superior stylomandibular ligaments. The five attachments
thyroid artery and supplies the parathyroid glands. resemble the reins of a chariot.
The superior thyroid artery supplies the upper one-third Styloid process
Styloglossus
of the lobe and the upper half of the isthmus and that the
inferior thyroid artery supplies the lower two-thirds of the Stylohyoid
lobe and the lower half of the isthmus. Stylohyoid Stylopharyngeus
Sometimes, the thyroid is also supplied by the lowest ligament
thyroid artery (thyroidea ima artery) which arises from
Hyoid bone
the brachiocephalic trunk or directly from the arch of the Superior and
aorta. Accessory thyroid arteries arising from tracheal middle constrictors
and oesophageal arteries also supply the thyroid. Fig. 1A.12.6 Styloidprocess.
Venous Drainage The apparatus is of diverse origin:
The superior, middle and inferior thyroid veins drain the
thyroid gland.
The superior thyroid vein which emerges at the upper
pole ends either in the internal jugular vein or in the
common facial vein.
The middle thyroid vein is a short, wide channel which
emerges at the middle of the lobe and soon enters the
internal jugular vein.
The inferior thyroid veins emerge at the lower border of
the isthmus. They form a plexus in front of the trachea,
and drain into the left brachiocephalic vein.
A fourth thyroid vein (of Kosher) may emerge between
the middle and inferior veins and drain into the internal
jugular vein.
Q.3. Styloid process of temporal bone.
 General Anatomy 5

The styloid process and the stylohyoid ligament and muscle The spinal root is also special visceral efferent. It arises
are derivatives of the second branchial arch, the from a long spinal nucleus situated in the lateral part of
stylopharyngeus is derived from the third arch and the the anterior grey column of the spinal cord extending
styloglossus from occipital myotomes. between segments C1 to C5. Its fibres supply the
vertebrae C5, C6, C7 and T1 embracing the upper part of sternocleidomastoid and the trapezius muscles. Q.5.
the trachea. Thyroglossal duct.
SHORT NOTES
Q.1. Oesophagus.
Airway The oesophagus is a muscular food passage, about 25 cm in
Laryngeal inlet
length. It is a downward continuation of the pharynx begin- Epiglottis Laryngopharynx ning at the
lower border of the cricoid cartilage and passes Inferior
downwards behind the trachea, traverses the superior and pos- Vocal cords
muscle
constrictor terior mediastinum of the thorax and ends by opening into the
cardiac end of the stomach in the abdomen (Fig. 1A.12.7). Thyroid cartilage
Q.2. Thyroid gland. Cricoid cartilage Oesophagu s

1. The thyroid gland is an endocrine gland, situated in the

lower part of the front and sides of the neck against Fig. 1A.12.7
Oesophagus.

On an average the gland weighs about 25 g.

The gland consists of right and left lobes joined to each The thyroid develops from a median endodermal thyroid
other by the isthmus. A third, pyramidal, lobe may diverticulum which grows down in front of the neck from
project upwards from the isthmus. the floor of the primitive pharynx.
Functions of thyroid gland: The lower end of the diverticulum enlarges to form the
Regulates the basal metabolic rate. gland. The rest of the diverticulum remains narrow and is
Stimulates somatic and psychic growth. known as the thyroglossal duct.
Plays an important role in calcium metabolism. Q.3. Most of the duct soon disappears; the position of the
Styloid process. upper end is marked by the foramen caecum of the
tongue, and the lower end often persists as the pyramidal
The styloid process is a long, slender and pointed bony lobe. Q.6. Stylohyoid ligament.
process projecting downwards, forwards and slightly
medially from the temporal bone. The stylohyoid ligament extends from the tip of the
It descends between the external and internal carotid styloid process to the lesser cornu of the hyoid bone. It is
arteries to reach the side of the pharynx. derived form second branchial arch. Q.7. Recurrent
It is interposed between the parotid gland laterally and the laryngeal nerve. Or
internal jugular vein medially. Q.4. Accessory nerve. Recurrent laryngeal nerve of right side. Or
Recurrent laryngeal nerve in the neck.
Accessory nerve is the XI cranial nerve. It has two roots,
cranial and spinal. The cranial root is accessory to the
vagus and is distributed through the branches of the latter
(Fig. 1A.12.8). The spinal root has a more independent
course.
The cranial root is special visceral (branchial) efferent,
arises from the lower part of the nucleus ambiguus and is
distributed through the branches of the vagus to the
muscles of the palate, the pharynx, the larynx and
possibly the heart.
4 Quick Review Series: BDS 1st Year

Right and left recurrent laryngeal nerves are the branches of
vagus nerve (Fig. 1A.12.9).
The right recurrent laryngeal nerve arises from the vagus in
front of the right subclavian.
It supplies the following:
All intrinsic muscles of the larynx, except the
cricothyroid.
Sensory nerves to the larynx below the level of the vocal
cords.
Cardiac branches to the deep cardiac plexus.
Branches to the trachea and oesophagus.
To the inferior constrictor.
The left recurrent laryngeal nerve arises form the vagus in
the thorax. Its distribution is similar to that of the right
the right and left sternothyroid and sternohyoid
muscles,
the anterior jugular veins and
fascia and skin.
The posterior surface is related to the second to fourth
tracheal rings.
The upper border is related to the anastomosis between
the right and left superior thyroid arteries.
At the lower border, inferior thyroid veins leave the
gland.
Occasionally, the isthmus is absent.
Q.10. Blood supply of thyroid gland.
Thyroid gland is highly vascular.

trunk
Fig. 1A.12.8 Theaccessorynerve(XIcranialnerve). Fig. 1A.12.9 Recurrentlaryngealnerve.
nerve. Arterial supply of thyroid gland is by the following:
Jugulodigastric lymph node. Superior thyroid artery
Inferior thyroid artery
The jugulodigastric node is a member of the Arteria thyroidea ima.
anterosuperior group of cervical lymph nodes. It lies Superior Thyroid Artery
below the posterior belly of the digastric, between the Superior thyroid artery is the first branch of external
angle of the mandible and the anterior border of the carotid artery. It divides into branches along the upper
sternocleidomastoid. It is the main node draining the pole of the gland and supplies: 1. Lobe of thyroid gland.
tonsil. A branch to anastomose with the artery of the opposite
Isthmus of thyroid ligament. side.
A branch to supply lower part of pyramidal lobe.
1. The isthmus of thyroid connects the lower parts of the Inferior Thyroid Artery
two lobes. 2. It has Inferior thyroid artery is a branch of thyrocervical trunk
(A) Two surfaces: of subclavian artery. It passes deep to the common
anterior surface and carotid artery and reaches the posterior surface of the
posterior surface; (B) Two borders: thyroid lobe.
superior border and Arteries supplying trachea and oesophagus are also
inferior border. supplying the thyroid gland. So when all thyroid arteries
The anterior surface is covered by
 General Anatomy 5

styloid process. PREVERTEBRAL REGION

Topic 13
SHORT ESSAY

are ligated, the gland gets its blood supply through the The stylohyoid, styloglossus and stylopharyngeus
tracheal and oesophageal arteries. muscles
Arteria Thyroidea IMA (Neubauer’s Artery) The stylohyoid and stylomandibular ligaments.
This artery is occasionally present. It usually arises from
the arch of aorta, rarely it may arise from the
brachiocephalic artery. It runs upwards in the midline of
neck to the isthmus of the gland.
Q.11. Formation of internal jugular vein. Or
Formation and termination of internal jugular vein.

Internal jugular vein is the largest vein of the head and

neck which drains venous blood from the brain and most
structures of the head and neck. Development: The
anterior cardinal vein.
Commencement: The vein commences at the lower border
of the jugular foramen as the downward continuation of
the sigmoid sinus.
Course: It passes downwards and medially within the
neck. It is found within the carotid sheath. It reaches the
level of medial end of the clavicle.
Termination: It ends by joining the subclavian vein to
form the brachiocephalic vein behind medial end of the
clavicle.
Q.12. Name any four structures related to medial
surface of thyroid gland.

The medial surface of thyroid is related to the following:

Two tubes, trachea and oesophagus.
Two muscles, inferior constrictor and cricothyroid.
Two nerves, external laryngeal and recurrent laryngeal.
Q.13. Name any four structures attached to the
The structures attached to the styloid process are as
follows:
4 Quick Review Series: BDS 1st Year
Q.1. Atlanto-occipital joint.
Atlanto-occipital joint is a synovial joint of the ellipsoid
variety. It articulates above with the occipital condyles
and below with the superior articular facets of the atlas
vertebra.
The ligaments of the atlanto-occipital joint are as follows:
The fibrous capsule (capsular ligament) surrounds the
joint. It is thick posterolaterally and thin anteromedially.
The anterior atlanto-occipital membrane extends from the
anterior margin of the foramen magnum above to the
upper border of the anterior arch of the atlas below.
Laterally, it is continuous with the anterior part of the
capsular ligament, and anteriorly, it is strengthened by the
cordlike anterior longitudinal ligament.
The posterior atlanto-occipital membrane extends from
the posterior margin of the foramen magnum above to the
upper border of the posterior arch of the atlas below.
Q.1. Atlantoaxial joint.
Atlantoaxial joint consists of the following:
A pair of lateral atlantoaxial joints between the inferior
facets of the atlas and the superior facets of the axis.
These are plane joints.
A median atlantoaxial joint between the dens (odontoid
process) and the anterior arch and transverse ligament of
the atlas. It is a pivot joint. The joint has two separate
synovial cavities—anterior and posterior.
Movements: The three joints exhibit rotatory movements
that take place around a vertical axis. The rotatory
movements are brought about by the obliquus capitis
inferior, the rectus capitis posterior major and the
splenius capitis of one side, acting with the
sternocleidomastoid of the opposite side. Q.2. Vertebral
artery.
Vertebral artery arises from the first part of the
SHORT NOTES
subclavian artery and ends in the cranial cavity by
supplying the brain.
MOUTH AND PHARYNX
It is one of the two principal arteries which supply the brain
2. Cranial branches
and is divided into four parts. It supplies brain, spinal cord,
Meningeal branches
the meninges, the surrounding muscles and bones
Branches of vertebral artery are as follows:
1. In the neck
Cervical spinal branches
Muscular branches to deep muscles of the neck
Topic 14
LONG ESSAYS
Laterally, it is continuous with the posterior part of the
capsular ligament.
Arterial and Nerve Supply
The joint is supplied by the vertebral artery and by the
first cervical nerve.
Movements: They are ellipsoid joints and permit
movements around two axes. Flexion and extension
(nodding) occur around a transverse axis. Slight lateral
flexion is permitted around an anteroposterior axis.
Flexion is brought about by the longus capitis and the
rectus capitis anterior muscles.
Extension is done by the rectus capitis posterior major
and minor, the obliquus capitis superior, the semispinalis
capitis and the upper part of the trapezius.
Lateral bending is produced by the rectus capitis, the
semispinalis capitis, the splenius capitis, the
sternocleidomastoid and the trapezius.
Q.1. Describe anatomy of the palatine tonsil. Give its
surgical importance.
Or
Give an account of the position, relations, blood
supply and development of palatine tonsil. Add a
note on its applied anatomy. Or
Give an account of the position, relations and blood
supply of palatine tonsil. Add a note on
development.
The palatine tonsil is an almond-shaped lymphoid tissue
that occupies the tonsillar fossa between the palatoglossal
and palatopharyngeal arches visible through the mouth
(Fig. 1A.14.1).
The palatine tonsil has:
l Two surfaces—medial and lateral, l Two
borders—anterior and posterior and l Two poles—
upper and lower.
The medial surface is covered by stratified squamous
The posterior spinal artery
The anterior spinal artery
The posterior inferior cerebellar artery
Medullary arteries.
epithelium continuous with that of the mouth. It contains

about 12–15 tonsillar crypts. The largest of these is called
the intratonsillar cleft.
The lateral surface is covered by a sheet of fascia which
forms the capsule of the tonsil. The capsule is an
extension of the pharyngobasilar fascia. It is only loosely
attached to the muscular wall of the pharynx, but
anteroinferiorly the capsule is firmly adherent to the side
of the tongue. This firm attachment keeps the tonsil in
place during swallowing. Just behind the firm attachment,
the tonsillar artery enters the tonsil by piercing the
superior constrictor.
The palatine vein or external palatine or paratonsillar vein
descends from the palate in the loose areolar tissue on the
lateral surface of the capsule, and crosses the tonsil
before piercing the wall of the pharynx. The vein may be
Fig. 1A.14.1 Thepalatinetonsil
injured during removal of the tonsil or tonsillectomy.
The bed of the tonsil is formed from by:
the pharyngobasilar fascia,
the superior constrictor and palatopharyngeus muscles,
General Anatomy 5
the buccopharyngeal fascia,
in the lower part the styloglossus and
the glossopharyngeal nerve.
Still more laterally there is facial artery with its tonsillar
and ascending palatine branches. The internal carotid
artery is 2.5 cm posterolateral to the tonsil. The anterior
border is related to the palatoglossal arch with its muscle.
The posterior border is related to the palatopharyngeal
arch with its muscle. The upper pole is related to the soft
palate, and the lower pole, to the tongue.
The plica triangularis is a triangular vestigial fold of
mucous membrane covering the anteroinferior part of the
tonsil. The plica semilunaris is a similar semilunar fold
that may cross the upper part of the tonsillar sinus.
The intratonsillar cleft is the largest crypt of the tonsil. It
is
present
in its
upper
part. It
is
sometimes wrongly named the supratonsillar fossa. The
mouth of the cleft is semilunar in shape and parallel to the
dorsum of the tongue. It represents the internal opening
of the second pharyngeal pouch. A peritonsillar abscess
or quinsy often begins in this cleft.
Arterial Supply of Tonsil(Fig.1A.14.2)
Lymphatic Drainage
Lymphatics drain to the jugulodigastric node.
Nerve supply: Glossopharyngeal and lesser palatine
nerves.
Histology
The palatine tonsil is situated at the oropharyngeal
isthmus. Its oral aspect is covered with stratified
squamous non- keratinized epithelium, which dips into
the underlying tissue to form the crypts. The lymphocytes
lie on the sides of the crypts in the form of nodules.
Development
The epithelium over the tonsil develops from ventral part
of second pharyngeal pouch. The lymphocytes are
mesodermal in origin.
Q.2. Describe external features, muscles, nerve
supply and blood supply of soft palate.
4 Quick Review Series: BDS 1st Year

Soft palate is a movable, muscular fold, suspended from

the posterior border of the hard palate which separates the The
Maxillary nasopharynx from the oropharynx (Fig. 1A.14.3).
carotid
Fig. Superficial
temporal
Greater palatine

Palatine tonsil
Ascending
Tonsillar
pharyngeal
branches
Ascending
palatine
Facial Dorsal linguae
Lingual
External
1A.14.2 Arterialsupplyofthepalatinetonsil.
Fig. 1A.14.3 Thesoftpalate.

Tonsil has rich blood supply derived from the following:
The facial artery (tonsillar branch) is the main source of
arterial supply of tonsil.
Other sources are as follows:
Ascending palatine branch of facial artery
Dorsal lingual branches of the lingual artery
Ascending pharyngeal branch of the external carotid
artery
The greater palatine branch of the maxillary artery.
Venous Drainage
One or more veins leave from the lower part of the deep
surface of the tonsil, pierce the superior constrictor and
join the palatine, pharyngeal or facial veins.
It has two surfaces, anterior and posterior. The anterior
(oral) surface is concave and is marked by a median
raphe. The posterior surface is convex and is continuous
with the floor of the nasal cavity superiorly.
It has two borders—superior and inferior. The superior
border is attached to the posterior border of the hard
palate, blending on each side with the pharynx. The
inferior border is free and binds the pharyngeal isthmus; a
conical projection hanging from its middle is called the
uvula. From each side of the base of the uvula, two
curved folds of mucous membrane extend laterally and
downwards. The anterior fold is called the palatoglossal
arch or anterior pillar of fauces. It contains the
palatoglossus muscle and reaches the side of the tongue at
the junction of oral and pharyngeal parts. This fold forms
the lateral boundary of the oropharyngeal isthmus or
isthmus of fauces. The posterior fold is called the
palatopharyngeal arch or posterior pillar of fauces. It
contains the palatopharyngeal muscle and forms the
posterior boundary of the tonsillar fossa and merges
inferiorly with the lateral wall of the pharynx.
parts of soft palate are as follows:
The palatine aponeurosis which is the flattened tendon of
the tensor veli palatini forms the fibrous basis of the
palate. Near the median plane the aponeurosis splits to
enclose the musculus uvulae. The levator veli palatini and
the palatopharyngeus lie on the superior surface of the
palatine aponeurosis. The palatoglossus lies on the
inferior surface of the palatine aponeurosis.
The muscles of the soft palate are as follows: (Fig.
1A.14.4):
Tensor palati (tensor veli palatini)
Levator palati (levator veli palatini)
Musculus uvulae
Palatoglossus 5. Palatopharyngeus.
Muscles of the soft palate are
summarized in
Table 1A.14.1.
Passavant’s ridge: Some of the upper fibres of the
palatopharyngeus pass circularly deep to the mucous
membrane of the pharynx, and form a sphincter internal
to the superior constrictor. These fibres constitute
Passavant’s muscle which on contraction raises a ridge
called the Passavant’s ridge on the posterior wall of the
nasopharynx. When the soft palate is elevated it comes in
contact with this ridge, the two together closing the
pharyngeal isthmus between the nasopharynx and the
oropharynx.
 General Anatomy 5

Table 1A.14.1 Summary of muscles of soft palate salivatory nucleus and travel through the greater petrosal
Muscle Origin Insertion Actions
Tensor veli Lateral side of auditory tube Muscle descends, and flattens out to Tightens the anterior part
palatini Adjoining part of the base of form the palatine aponeurosis which is soft palate
the skull (greater wing and attached to the following: Equalizes air pressure
scaphoid fossa of sphenoid Posterior border of hard palate between the middle ear
bone) Inferior surface of palate behind the and the nasopharynx
palatine crest
Levator veli Inferior aspect of auditory Muscle is inserted into the upper surface Elevates soft palate and
palatini tube of the palatine aponeurosis closes the pharyngeal
Adjoining part of inferior isthmus
surface of petrous temporal Opens the auditory tube
bone
Musculus uvulae Posterior nasal spine and Mucous membrane of uvula Pulls up the uvula
palatine aponeurosis
Palatoglossus Oral surface of palatine Descends in the palatoglossal arch, to Closes the oropharyngeal
aponeurosis the side of the tongue at the junction of
isthmus its oral and pharyngeal parts
Palatopharyngeu Anterior fasciculus It is inserted into the following: Shortens pharynx during
s Posterior fasciculus Posterior border of the lamina of the swallowing
thyroid cartilage
Wall of the pharynx and its median raphe
nerve.
Movements and Functions of the Soft Palate
The palate controls both the pharyngeal and the
oropharyngeal isthmus. Through these movements the
soft palate plays an important role in chewing,
swallowing, speech, coughing, sneezing, etc.
A few specific roles are as follows:
It isolates the mouth from the oropharynx during
chewing, so that breathing is unaffected.
It separates the oropharynx from the nasopharynx during
the second stage of swallowing, so that food does not
enter the nose.
By varying the degree of closure of the pharyngeal
isthmus, the quality of voice can be modified and various
Fig. 1A.14.4 Musclesofthesoftpalate. consonants correctly pronounced.
Nerve Supply During sneezing, the blast of air is appropriately divided
Motor nerves: All muscles of the soft palate except the and directed through the nasal and oral cavities without
tensor veli palatini are supplied by the pharyngeal plexus. damaging the narrow nose. Similarly during coughing it
The fibres of this plexus are derived from the cranial part directs air and sputum into the mouth and not into the
of the accessory nerve through the vagus. The tensor veli nose.
palatini is supplied by the mandibular nerve. Blood Supply
General sensory nerves are derived from (a) the middle Arteries
and posterior lesser palatine nerves, the branches of the Greater palatine branch of maxillary artery. Ascending
maxillary nerve and (b) from the glossopharyngeal nerve. palatine branch of facial artery.
Special sensory or gustatory nerves carrying taste Palatine branch of ascending pharyngeal artery.
sensations from the oral surface are contained in the Veins
lesser palatine nerves. The fibres pass through the greater They pass to the pterygoid and tonsillar plexuses of veins.
petrosal nerve to the geniculate ganglion of the facial Lymphatics
nerve and from there to the nucleus of the solitary tract. Lymphatics drain into the upper deep cervical and
Secretomotor nerves are also contained in the lesser retropharyngeal lymph nodes.
palatine nerves. They are derived from the superior Development of palate
4 Quick Review Series: BDS 1st Year
The premaxilla or primitive is formed by the fusion of
medial nasal folds; the rest of the palate is formed by the
shelflike palatine processes of maxilla and horizontal
plates of palatine bone. Most of the palate gets ossified to
form the hard palate. The unossified posterior part of
fused palatal process forms the soft palate.
SHORT ESSAYS
Q.1. Oropharynx.
Oropharynx is the middle part of the pharynx situated
behind the oral cavity. Superiorly, it communicates with
the nasopharynx through the pharyngeal or
nasopharyngeal isthmus. In front, it communicates with
the oral cavity through the oropharyngeal isthmus or
isthmus of fauces. Below, it opens into the
laryngopharynx at the level of the upper border of the
epiglottis. Behind, it is supported by the body of the axis
vertebra and the upper part of the body of the third
cervical vertebra. Its lateral wall presents the palatine
tonsil which lies in the tonsillar fossa. This fossa is
bounded anteriorly by the palatoglossal arch, and
posteriorly by the palatopharyngeal arch. The posterior
SHORT NOTES
wall of the oropharynx is formed posteriorly by the
superior, middle and inferior constrictors of the pharynx
(Fig. 1A.14.5).
There are several aggregations of lymphoid tissue that
constitute Waldeyer’s lymphatic ring in relation to the
oropharyngeal isthmus. The most important aggregations
are the right and left palatine tonsils. Posteriorly and
above, there is the pharyngeal tonsil; laterally and above,
there are
Q.1. Soft palate
Soft palate is a movable, muscular fold, suspended from
the posterior border of the hard palate. It separates the
nasopharynx from the oropharynx, and is often looked
upon as traffic controller between the food and air
passages.
The soft palate has two surfaces—anterior and posterior,
and two borders—superior and inferior. Q.2.
Nasopharynx.
Soft palate comprises epithelium, connective tissue and
muscles. Epithelium is from the ectoderm of maxillary
process. The muscles are derived from first, fourth and sixth
branchial arches and accordingly are innervated by
mandibular and vagoaccessory complex.
Fig. 1A.14.5 Divisionsofpharynx.
the tubal tonsils and inferiorly, there is the lingual tonsil
over the posterior part of the dorsum of the tongue.
Q.2. Describe the features of the lateral wall of
nasopharynx.
The lateral wall of the nasopharynx presents the
following features:
The pharyngeal opening of the auditory tube, at the level
of the inferior nasal concha.
The tubal opening bounded by the tubal elevation.
The salpingopharyngeal fold: A vertical fold of mucous
membrane running downwards from the posterior margin
of the tubal elevation and gradually fading on the side
wall of the pharynx.
The levator veli palatine.
Behind the tubal elevation, there is a narrow vertical slit that
leads into the pharyngeal recess or lateral recess, or fossa of
Rosenmuller.
The cavity of the pharynx is divided into:
The nasal part, nasopharynx
The oral part, oropharynx 3. The laryngeal part,
laryngopharynx.
Nasal part of pharynx (nasopharynx) is the upper part of
the pharynx situated behind the nose, and above the lower
border of the soft palate. It resembles the nose both
structurally as well as functionally; it is respiratory in
function. Its walls are rigid and non-collapsible, so that
the air passage is kept patent. It is lined by ciliated

columnar epithelium. Its mucous membrane is supplied
by the pharyngeal branch of pterygopalatine ganglion
suspended by maxillary branch of trigeminal nerve. Q.3.
Palatine tonsil.
The palatine tonsil occupies the tonsillar sinus or fossa
between the palatoglossal and palatopharyngeal arches. It
can be seen through the mouth. It is almond-shaped
lymphoid tissue collection and has two surfaces medial
and lateral; two borders, anterior and posterior and two
poles, upper and lower. Q.4. Muscles of soft palate.
Muscles of the soft palate are as follows:
Tensor palati (tensor veli palatini)
Levator palati (levator veli palatini)
Musculus uvulae
Palatoglossus
Palatopharyngeus.
Q.5. Tensor palatine muscle.
Tensor veli palatini is a thin, triangular muscle.
Origin
Lateral side of auditory tube.
Adjoining part of the base of the skull (greater wing and
scaphoid fossa of sphenoid bone).
Insertion
Muscle descends, converges to form a delicate tendon
which runs around the pterygoid hamulus, passes through
the origin of the buccinator, and flattens out to form the
palatine aponeurosis which is attached to:
Posterior border of hard palate.
Inferior surface of palate behind the palatine crest.
Functions
Tightens the soft palate, chiefly the anterior part.
Opens the auditory tube to equalize air pressure between
the middle ear and the nasopharynx. Q.6.
Pharyngobasilar fascia.
The pharyngobasilar fascia forms the bed of the tonsil.
The posterior borer of medial pterygoid plate gives
attachment for pharyngobasilar fascia.
Q.7. Pharyngotympanic tube.
Pharyngotympanic tube is the communicating passage
between the middle ear and nasopharynx and is directed
downwards, forwards and medially. It balances the
pressure inside the middle ear with that of the external
atmosphere.
Length: About 3.6 cm long. In infants the tube is shorter,
wider and more horizontal.
Direction: Downwards, forwards and medially.
General Anatomy 5
Parts: Cartilaginous part, anterior two-third. Bony part,
posterior one-third.
The bony part commences in the anterior wall of the
middle ear and terminates at the junction of the squamous
and petrous part of the temporal bone. It is somewhat
oval at cross-section. The junction between the bony and
cartilaginous part is known as the isthmus. Q.8.
Lymphatic drainage of tonsil.
Lymphatics from the tonsil pass to the jugulodigastric
node. Q.9. Superior constrictor of pharynx.
The muscular wall of the pharynx is formed mainly by
the three pairs of constrictors superior, middle and
inferior.
The superior constrictor takes origin from the following:
Pterygoid hamulus.
Pterygomandibular raphe.
Medial surface of the mandible at the posterior end of the
mylohyoid line, i.e. near the lower attachment of the
pterygomandibular raphe.
Side of posterior part of tongue.
All the constrictors of the pharynx are inserted into a
median raphe on the posterior wall of the pharynx.
List the lymphatic nodules in Waldeyer’s ring.
In relation to the oropharyngeal isthmus, there are several
aggregations of lymphoid tissue that constitute
Waldeyer’s lymphatic ring. The most important
aggregations are the right and left palatine tonsils usually
referred to simply as the tonsils. Posteriorly and above,
there is the pharyngeal tonsil; laterally and above, there
are the tubal tonsils, and inferiorly, there is the lingual
tonsil over the posterior part of the dorsum of the tongue.
Enumerate four relations of constrictor muscle of
pharynx.
The three pairs of muscles of pharynx, namely, superior,
middle and inferior constrictors form the muscular wall
of pharynx (Fig. 1A.14.6). They are so arranged that the
inferior overlaps middle which in turn overlaps the
superior.
Relations of constrictor muscles of pharynx are as
follows:
Structures lying deep to the inferior border of inferior
constrictor are:
Recurrent laryngeal nerve
Inferior laryngeal vessels.
Structures passing between the superior and middle
constrictor are:
Glossopharyngeal nerve
Stylopharyngeus muscle.
Position of palatopharyngeal sphincter on deep surface of superior
constrictor
4 Quick Review Series: BDS 1st Year

Superior constrictor Middle Describe the features of the lateral wall of nose in
constrictor
Inferior constrictor
detail.
Oesophagus Or
Fig. 1A.14.6 Constrictor Describe the lateral wall of nose under following
musclesofpharynx. headings: bone formation features, openings, blood
Structures passing supply and nerve supply.
between the middle and
inferior constrictor are: The lateral wall of the nose is irregular due to the
Internal laryngeal nerve presence of three shelf-like bony projections called
Superior laryngeal vessels. conchae, which increase the surface area of the nose for
Between the superior constrictor and the base of the skull: effective air-conditioning of the inspired air (Fig.
Pharyngotympanic tube 1A.15.1).
Levator veli palatini muscle The lateral wall separates the nose from:
Ascending palatine artery The orbit above,
Ascending pharyngeal artery. The maxillary sinus below and
Q.12. Name the lateral relations of palatine tonsil. The lacrimal groove and nasolacrimal canal in front.
The lateral wall can be subdivided into three parts:
The lateral surface of palatine tonsil is covered by a sheet The vestibule: A small depressed area in the anterior part
of fascia which forms the capsule of the tonsil which is an of lateral wall of nose which is lined by modified skin
extension of the pharyngobasilar fascia (Fig. 1A.14.7). containing short, stiff, curved hairs called vibrissae.
Other structures related to the lateral surface of palatine Cranial cavity
Orbital plate Cribriform plate Crista galli
tonsil are as follows: of frontal
The palatine vein or external palatine or paratonsillar vein bone
Middle
Superior constrictor muscle of pharynx Orbital plate
Orbit Orbit
ethmoidal
Cartilaginous part of of ethmoidal cells
labyrinth
Bulla
Perpendicular ethmoidalis
plate

Nasal cavities
Maxillary
Maxillary
sinus
sinus
Uncinate
process
Inferior concha bone
Oral cavity
Palatine process of
maxillary bone Vomer

Fig. 1A.15.1 Coronalsectionthroughskull.

The atrium of the middle meatus: The middle part of
lateral wall of nose.
The conchae: The bony elevations in the posterior part.
Spaces separating the conchae are called meatuses.
The skeleton of the lateral wall is partly bony, partly
cartilaginous, and partly made up of only soft tissues as
Palatine follows.
tonsil The following bones make up the bony part of lateral wall
Fig. 1A.14.7 The
Buccopharyngeal fascia
Facial artery NOSE AND PARANASAL
Internal carotid artery
Glossopharyngeal nerve SINUSES
Ascending pharyngeal artery Styloglossus and stylopharyngeus.

Topic 15
LONG ESSAYS
palatinetonsil. of nose (Fig. 1A.15.2):
Q.1. Describe the lateral wall of nasal cavity. Or

Fig. 1A.15.2 Bonesofthelateralwallofthenasalcavity.
Nasal
Frontal process of maxilla
Lacrimal
Labyrinth of ethmoid with superior and middle conchae
Inferior nasal concha
Perpendicular plate of the palatine bone (orbital 1
sphenoidal processes)
Medial pterygoid plate.
The cartilaginous part is formed by the following:
The superior nasal cartilage
The inferior nasal cartilage
Three or four small cartilages of the ala.
The circular lower part is formed by fibrofatty tissue
covered with skin.
Conchae and Meatuses (Fig.1A.15.3)
Fig. 1A.15.3 Thelateralwallofthenose—conchae.
The nasal conchae are curved bony projections directed
downwards and medially and are as follows: 1. The
inferior concha is an independent bone.
The middle concha is a projection from the medial
surface of the ethmoidal labyrinth.
The superior concha is also a projection from the medial
surface of the ethmoidal labyrinth. This is the smallest
concha situated just above the posterior part of the middle
concha.
The passages beneath the overhanging conchae are
known as meatuses of the nose. Each meatus
communicates freely with the nasal cavity proper (Fig.
1A.15.4).
The inferior meatus lies beneath the inferior concha, and
is the largest of the three meatuses. The nasolacrimal duct
General Anatomy 5
opens into it, the opening is guarded by the lacrimal fold,
or Hasner’s valve.
The middle meatus lies underneath the middle concha. It
consists of the following:
A rounded elevation produced by the underlying middle
ethmoidal sinuses known as the ethmoidal bulla.
A deep semicircular sulcus below the bulla called the
hiatus semilunaris.
A short passage at the anterior end of the hiatus
known as the infundibulum.
Infundibulum opening of frontonasal duct that drains the frontal sinus
and anterior ethmoid cells
Opening of nasolacrimal duct
An opening of the frontal air sinus in the anterior part of
the hiatus semilunaris.
The opening of the maxillary air sinus is located in the
posterior part of the hiatus semilunaris. It is often
represented by two openings.
The opening of the middle ethmoidal air sinus is present
at the upper margin of the bulla.
The superior meatus lies below the superior concha.
This is the shortest and shallowest of the three meatuses.
It receives the openings of the posterior ethmoidal air
sinuses.
The sphenoethmoidal recess is a triangular fossa just
above the superior concha. It receives the opening of the
sphenoidal air sinus.
Arterial Supply of the Lateral Wall (Fig.1A.15.5)
The anterior ethmoidal artery assisted by the posterior
ethmoidal and facial arteries supplies the anterosuperior
quadrant.
The anteroinferior quadrant is supplied by branches from
the facial and greater palatine arteries.
The posterosuperior quadrant is supplied by the
sphenopalatine artery.
The posteroinferior quadrant is supplied by branches
from the greater palatine artery.
Venous Drainage(Fig.1A.15.6)
The veins form a plexus which drains anteriorly into the
facial vein; posteriorly, into the pharyngeal plexus of
veins and from the middle part, to the pterygoid plexus of
veins.
Nerve Supply (Fig.1A.15.7)
Both the general sensory and special sensory nerves
supply the nasal cavity.
General sensory nerves derived from the following
branches of trigeminal nerve are distributed to whole of
the lateral wall:
4 Quick Review Series: BDS 1st Year
The anterosuperior quadrant is supplied by the anterior
ethmoidal nerve branch of ophthalmic nerve.
Fig. 1A.15.4 Theopeningsinthelateralwallofthenose.
Lat
eral branches of
Fig. 1A.15.5 Arterialsupplyofthenasalcavities.
Drainage to Drainage to pterygoid facial vein plexus in infratemporal
fossa Fig. 1A.15.6 Venousdrainageofthenasalcavities.
of infraorbital nerve superior alveolar nerve
Fig. 1A.15.7 Nervesupplyofthenasalcavity.
The anteroinferior quadrant is supplied by the anterior
superior alveolar nerve, branch of maxillary nerve.
The posterosuperior quadrant is supplied by the posterior
superior lateral nasal branches from the pterygopalatine
ganglion suspended by the maxillary nerve.
The posteroinferior quadrant is supplied by the anterior or
greater palatine branch from the pterygopalatine ganglion
suspended by the maxillary nerve.
Special sensory nerves or olfactory nerves are distributed
to the upper part of the lateral wall up to the superior
concha.
Lymphatic Drainage (Fig.1A.15.8)
Lymphatics from the anterior half of the lateral wall pass
to the submandibular nodes, and from the posterior half,
to the retropharyngeal and upper deep cervical nodes.
Deep cervical
Retropharyngeal and
 General Anatomy 5

The size of the sinus is variable, average measurements

are: height, 3.5 cm; width, 2.5 cm and anteroposterior
depth, 3.5 cm.
It opens into the middle meatus of the nose in the lower
part of the hiatus semilunaris, a second opening is often
present at the posterior end of the hiatus. Both openings
are near to the roof than the floor of the sinus.
The size of the opening is about 3–4 mm as it is
overlapped by the following:
(a) from above, by the uncinate process of the ethmoid,
and the descending part of the lacrimal bone; (b) from
below, by the inferior nasal concha and (c) from behind,
by the perpendicular plate of the palatine bone. It is still
further reduced in size by the thick mucosa of the nose.
Fig. 1A.15.8 Lymphaticdrainageofthenasalcavities. Arterial supply: Facial, infraorbital and greater palatine
Q.2. Describe maxillary air sinus and its relation. arteries.
Venous drainage: The maxillary sinus drains in to the
The maxillary sinus is the largest of all the paranasal facial vein and the pterygoid plexus of veins.
sinuses located in the body of the maxilla (Figs Lymphatic drainage: Into the submandibular nodes.
1A.15.9,1A.15.10). Nerve supply: Infraorbital, and anterior, middle and
Floor of anterior cranial fossa posterior superior alveolar nerves innervate the maxillary
OrbitEthmoidal sinuses Superior sinus.
conchaNasal septum
Middle conchaMiddle ethmoidal
Q.3. Describe gross anatomy of nasal septum.
sinus
Maxillary hiatus
Maxillary sinus Median osseocartilaginous partition between the two
Inferior conchaFloor of nose halves of the nasal cavity is known as nasal septum. On
Upper tooth either side, it is covered by mucous membrane and forms
Palate forming roof of mouth
the medial wall of both nasal cavities (Fig. 1A.15.11).
Fig. 1A.15.9 Coronalsectionthroughthenasalcavityandthe
maxillarysinuses.
The bony part is formed almost entirely by: (a) the
Features of Maxillary Sinus vomer, and (b) the perpendicular plate of the ethmoid. Its
The maxillary sinus is the first paranasal sinus to develop. margins receive contributions from the nasal spine of the
The maxillary sinus is pyramidal in shape, with its: frontal bone, the rostrum of the sphenoid, and the nasal
Base: directed medially towards the lateral wall of the crests of the nasal, palatine and maxillary bones.
nose The cartilaginous part is formed by: (a) the septal
Anterior ethmoidal cartilage and (b) the septal processes of the inferior nasal
sinuses
Frontal air sinus
cartilages.
Posterior ethmoidal sinus The cuticular part or lower end is formed by fibrofatty
tissue covered by skin, The lower margin of the septum is
Sphenoidal sinus called the columella.
Maxillary sinus
The central part of nasal septum is rarely strictly median;
it is usually defected to one or the other side due to
overgrowth of one or more of the constituent parts.
The septum has (a) four borders, superior, inferior,
anterior and posterior and (b) two surfaces, right and left.
Arterial Supply (Fig.1A.15.12)
Fig. 1A.15.10 Locationofparanasalsinusesinthelateralwall of Anterosuperior part is supplied by the anterior ethmoidal
thenose.
artery.
Apex: directed laterally into the zygomatic process of
Anteroinferior part is supplied by the superior labial
the maxilla branch of facial artery.
Roof: formed by the floor of the orbit Posteroinferior part is supplied by the sphenopalatine
Floor: formed by the alveolar process of the maxilla. The artery.
floor lies about 1 cm below the level of the floor of the
nose.
4 Quick Review Series: BDS 1st Year
Posterior part is supplied by the posterior ethmoidal artery.
Nasal spine of frontal bone
Nasal crest of nasal bone
Septal cartilage
Septal process of inferior nasal cartilage
Columella
Fig. 1A.15.11 Thenasalseptum.
Fig. 1A.15.12 Thearterialsupplyofnasalseptum.
The vestibule of the nasal septum or its anteroinferior part
contains anastomoses between the septal ramus of the
superior labial branch of the facial artery, branch of
sphenopalatine artery and of anterior ethmoidal artery
which form a large capillary network called the
Kiesselbach’s plexus. This is known as Little’s area and
is the common site of bleeding from the nose or epistaxis.
Venous Drainage
The veins form a plexus in the lower part of the septum or
Little’s area. The plexus drains anteriorly into the facial
vein, posteriorly through the sphenopalatine vein to
pterygoid venous plexus.
Nerve Supply (Fig.1A.15.13)
General sensory nerves, arising from trigeminal nerve,
are distributed to whole of the septum:
The internal nasal branch of the anterior ethmoidal nerve
supplies the anterosuperior part of the septum.
The
Cribriform plate of ethmoid
Perpendicular plate of ethmoid
Rostrum of sphenoid
Vomer
nasopalatine branch of the pterygopalatine ganglion
supplies the posteroinferior part of the septum.
The medial posterior superior nasal branches of the
pterygopalatine ganglion supplies the posterosuperior
part.
Special sensory nerve or olfactory nerves are confined to
the upper part or olfactory area.
Lymphatic Drainage
Posterior half of the nasal septum drains in to the
retropharyngeal and deep cervical nodes, while the
anterior half drains into the submandibular nodes.
 General Anatomy 5

Fig. 1A.15.13 Nervesupplyofthenasalseptum.

SHORT ESSAYS
Q.1. Nasal septum. Q.3. Give the boundaries, relations and applied anatomy of sphenoidal air sinus.

Refer to the answer of Long Essays Q. 3.

Features of sphenoidal air sinus are as follows (Fig. 1A.15.14):
Q.2. Maxillary air sinus. 1. The right and left sphenoidal sinuses are located within the body of the sphenoid bone.
They are separated by a
septum. The two sinuses are usually unequal in size.
Each sinus opens into the sphenoethmoidal recess of the
Refer to the answer of Long Essays Q. 2. corresponding half of the nasal cavity.
Meningeal layer of dura mater
2. Each sinus is related superiorly to the optic chiasma and the hypophysis cerebri; and laterally, to the internal
Oculomotor nerve Hypophysis cerebri
Trochlear nerve carotid artery and the cavernous sinus.
Cavernous sinus 3. Arterial supply: Posterior ethmoidal and internal carotid
Maxillary nerve Sphenoidal sinus arteries.
Mandibular nerve 4. Venous drainage: The sphenoidal sinus drains into
pterygoid venous plexus andcarotid
Internal cavernous
artery sinus.
Abducent nerve 5. Lymphatic drainage: To the retropharyngeal nodes.
Fig. 1A.15.14 Sphenoidalairsinuses. 6. Nerve supply: Posterior ethmoidal nerve and orbital
branches of the pterygopalatine ganglion supply the sphenoidal sinus.
SHORT NOTES
Q.1. Frontal sinus. The bony part is formed almost entirely by:
The vomer
Features of frontal sinus are as follows: The perpendicular plate of the ethmoid.
The frontal sinus lies in the frontal bone. It extends The cartilaginous part is formed by:
upwards above the medial end of the eyebrow, and The septal cartilage
backwards into the medial part of the roof of the orbit. The septal processes of the inferior nasal cartilages.
It opens into the middle meatus of nose at the anterior end The cuticular part or lower end is formed by fibrofatty
of the hiatus semilunaris either through the infundibulum tissue covered by skin.
or through the frontonasal duct. Q.2. Nasal septum. The lower margin of the septum is called the columella.
The septum has: (a) four borders, superior, inferior,
The median osseocartilaginous partition between the two anterior and posterior and (b) two surfaces, right and left.
halves of the nasal cavity is known as the nasal septum. Q.3. Orbital nerve.
On each side, it is covered by mucous membrane and
forms the medial wall of both nasal cavities.
4 Quick Review Series: BDS 1st Year
Orbital nerve is a branch of maxillary nerve. The orbital
branches pass through the inferior orbital fissure, and
supply the periosteum of the orbit and the orbitalis
muscle.
Q.4. Maxillary sinus.
The maxillary sinus is situated in the body of the maxilla,
and is the largest of all the paranasal sinuses.
The maxillary sinus is pyramidal in shape, with its:
Base: directed medially towards the lateral wall of the
nose.
Apex: directed laterally into the zygomatic process of the
maxilla.
Roof: formed by the floor of the orbit.
Floor: formed by the alveolar process of the maxilla.
It opens into the middle meatus of the nose through
ostium in the lower part of the hiatus semilunaris. Q.5.
Paranasal sinuses.
Paranasal sinuses are air filled spaces present within some
bones around the nasal cavities. The sinuses are frontal,
maxillary, sphenoidal and ethmoidal. All of them open
into the nasal cavity through its lateral wall. The function
of the sinuses is to make the skull lighter and add
resonance to the voice. Q.6. Sphenopalatine ganglion.
Sphenopalatine or pterygopalatine is the largest
parasympathetic peripheral ganglion located in the
pterygopalatine fossa just below the maxillary nerve, in
front of the pterygoid canal and lateral to the
sphenopalatine foramen.
It serves as a relay station for secretomotor fibres to the
lacrimal gland and to the mucous glands of the nose, the
paranasal sinuses, the palate and pharynx.
Topographically, it is related to the maxillary nerve, but
functionally it is connected to the facial nerve through its
greater petrosal branch.
Q.7. Blood supply of nasal septum.
The arterial supply of nasal septum is as follows:
Anterosuperior part: supplied by the anterior ethmoidal
artery.
Posteroinferior part: supplied by the sphenopalatine
artery.
Anteroinferior part: supplied by the superior labial
branch of facial artery.
Posterior part: supplied by the posterior ethmoidal artery.
The opening of the maxillary air sinus is located in the
posterior part of the hiatus semilunaris.
The opening of the middle ethmoidal air sinus is present
at the upper margin of the bulla.
The anteroinferior part or vestibule of the septum
contains anastomoses between the septal ramus of the
superior labial branch of the facial artery, branch of
sphenopalatine artery, and of anterior ethmoidal artery
which forms a large capillary network called the
Kiesselbach’s plexus. This is a common site of bleeding
from the nose or epistaxis, and is known as Little’s area.
Q.8. Middle meatus of nose.
The middle meatus of nose lies underneath the middle
concha.
It presents the following features:
The ethmoidal bulla is a rounded elevation produced by
the underlying middle ethmoidal sinuses.
The hiatus semilunaris is a deep semicircular sulcus
below the bulla.
The infundibulum is a short passage at the anterior end of
the hiatus.
The opening of the frontal air sinus is seen in the anterior
part of the hiatus semilunaris.
Q.9. Name the paranasal sinus openings into middle
meatus of the nose.
Or
Mention the paranasal sinuses opening into middle
meatus of the nose.
The paranasal sinuses opening into middle meatus of the
nose are as follows: 1. Frontal sinus
Maxillary sinus
Middle ethmoidal air sinus.
Q.10. Name any four bony constituents of nasal
septum.
The bony part of nasal septum is formed almost entirely
by the following:
The vomer
The perpendicular plate of the ethmoid.
Its margins receive contributions from the following:
The nasal spine of the frontal bone
The rostrum of the sphenoid
 General Anatomy 5

The nasal crests of the nasal, palatine and maxillary bones.

Q.1. Vocal folds. cartilage on its posterior aspect and posteriorly to the
Or Vocal cords. vocal process of the arytenoid.
Or The space between the vocal folds is called rima glottidis

LARYNX
Topic 16
SHORT ESSAYS
Location, attachments and movements of vocal (Fig. 1A.16.2). It is limited posteriorly by an
cords. interarytenoid fold of mucous membrane. The rima
glottides has an anterior intermembranous part (three-
Vocal cords are two folds of mucous membrane on each fifths) and a posterior intercartilaginous part.
side in the laryngeal cavity (Fig. 1A.16.1). The rima is the narrowest part of the larynx. It is longer
The upper fold is called the vestibular fold, and the lower (23 mm) in males than in females (17 mm).
fold is known as the vocal fold. The vocal fold is attached The vestibular and vocal folds divide the laryngeal cavity
anteriorly to the middle of the angle of the thyroid into following three parts:
The part above the vestibular fold is called the vestibule
of the larynx.
The part between the vestibular and vocal folds is called the
sinus or ventricle of the larynx.
The part below the vocal folds is called the infraglottic part.
Movements of Vocal Folds
Movements of the vocal folds affect the shape and size of
the rima glottidis.
During quiet breathing or at rest, the intermembranous part
of the rima is triangular, and the intercartilaginous part is
quadrangular.
The glottis is reduced by the adduction of the vocal folds
during phonation or speech.
During forced inspiration, both parts of the rima are
triangular, so that the entire rima is lozenge-shaped; the
vocal folds are fully abducted.
The intermembranous part of the rima glottidis is closed,
but the intercartilaginous part is widely opened Fig. 1A.16.1
Coronalsectionthroughlarynx. during whispering.
A B
Fig. 1A.16.2 (A)Superiorveiwthroughlaryngealinlet.(B)Superiorviewthroughlarynx.
4 Quick Review Series: BDS 1st Year

SHORT NOTES
Q.1. Vocal folds.
Epiglottis
Refer to the answer of Short Essays Q.1.
Q.2. Rima glottidis. Vestibular foldVocal fold
Aryepiglottic foldRima glottidisRima vestibuli
The space between the right and left vocal folds is the Cuneiform tubercle rima glottides (Fig. 1A.16.3). It
is limited posteriorly by Corniculate tubercle Interarytenoid fold an interarytenoid fold of mucous
membrane. The rima Fig. 1A.16.3 Sectionalviewoflarynxshowingrimaglottidis.
glottidis has an anterior intermembranous part (three- The lower parts of the anterior borders of the right and
fifths) and a posterior intercartilaginous part. The rima is left laminae fuse to form a median projection called the
the narrowest part of the larynx. It is longer (23 mm) in laryngeal prominence. The upper part of the anterior
males than in females (17 mm). borders do not meet. They are separated by the thyroid
Q.3. Cricoid cartilage. notch.
A ring-shaped cartilage which encircles the larynx below The posterior borders are free and are prolonged upwards
the thyroid cartilage is known as the cricoid cartilage and downwards as the superior and inferior cornua or
(Fig. 1A.16.4). horns. The superior cornua is connected with the greater
It is thicker and stronger than the thyroid cartilage and cornua of the hyoid bone by the lateral thyrohyoid
has a narrow anterior part called the arch and a broad ligament. The inferior cornua articulates with the cricoid
posterior part, called the lamina. cartilage to form the cricothyroid joint.
The lamina projects upwards behind the thyroid cartilage, The inferior border of the thyroid cartilage is convex in
and articulates superiorly with the arytenoid cartilages. front and concave behind. In the median plane, it is
The inferior cornua of the thyroid cartilage articulates connected to the cricoid cartilage by the conus elasticus.
with the side of the cricoid cartilage at the junction of the Q.5. Thyrohyoid membrane.
arch and lamina. The thyrohyoid membrane is a fibroelastic ligament that
The anterior borders approach each other at an angle of
about 90° in the male and about 120° in the female.
Facet for spans
Cricoid Lamina articulation with
cartilage Arch arytenoid cartilage
Facet for
Airway articulation with
inferior horn of thyroid cartilage
Trachea
Fig. 1A.16.4 Cricoid
cartilage (anterolateralview).
Q.4. Thyroid cartilage.

1. The thyroid cartilage is

V-shaped in cross-section. It consists of right and left
laminae. Each lamina is roughly quadrilateral (Fig.
1A.16.5). notch Inferior thyroid tubercle
between the superior margin of the thyroid cartilage
Lateral thyroid ligaments
below and the hyoid bone above (Fig. 1A.16.6).
Left lamina Triticeal cartilage Aperture for nerve and
Superior Superior Thyrohyoid membrane
thyroid notch horn Median thyrohyoid
Fig. 1A.16.6 Extrinsicligamentsoflarynx.
Superior
thyroid tubercle
Median thyrohyoid ligament—is the midline thickening
of membrane.
Oblique line Lateral thyrohyoid ligament—is the thickening of the
Laryngeal
prominence Inferior horn posterior border of the membrane. l Structures
Facet for cricoid
Inferior thyroid (Medial surface of horn
) piercing thyrohyoid membrane are: l Superior
Fig. 1A.16.5 Thyroidcartilage(anterolateralview).
 General Anatomy 5

laryngeal arteries l Internal laryngeal nerve. Q.6. The skeleton or cartilages of larynx are as follows:
Cricothyroid muscle. The larynx contains nine cartilages, of which three are
The cricothyroid muscle is the only intrinsic muscle unpaired and three are paired. The paired cartilages of
outside the larynx, lying on its external aspect (Fig. larynx are:
1A.16.7). Arytenoid
It originates from the lower border and lateral surface of Corniculate
cricoid and its fibres pass backwards and upwards to Cuneiform.
cornua and lower border of thyroid cartilage. Give boundaries of rima glottidis.

The space between the right and left vocal folds is the
rima glottidis; it is limited posteriorly by an
interarytenoid fold of mucous membrane. The rima has
an anterior intermembranous part (three-fifths) and a
posterior intercartilaginous part. The rima is the
Vocal ligament narrowest part of the larynx. It is longer (23 mm) in
males than in females (17 mm).
Name the intrinsic muscles of larynx.
Cricothyroid ligament
Median cricothyroid ligament
Fig. 1A.16.7 Cricothyroidmuscle.
The intrinsic muscles of larynx are as follows (Fig.
Actions: Tense the vocal cords and act as an adductor of 1A.16.9A and B): 1. Cricothyroid
the vocal cords. Posterior cricoarytenoid (triangular muscle)
Q.7. Nerve supply of larynx. Or Name sensory nerve Lateral cricoarytenoid
supply of larynx. Transverse arytenoid (unpaired muscle) 5. Oblique
arytenoid and aryepiglotticus 6. Thyroarytenoid and
Nerve Supply of Laryngeal Muscles (Fig.1A.16.8) thyroepiglottic.
All intrinsic muscles of the larynx are supplied by the Origin and insertion of posterior cricoaryte-noid
recurrent laryngeal nerve except for the cricothyroid muscle.
which is supplied by the
external laryngeal nerve. The posterior cricoarytenoid muscle originates from the
Inferior vagal ganglion posterior surface of the lamina of cricoid and its fibres run
Superior laryngeal nerve upwards and laterally and are inserted into the muscular
Right vagus nerveInternal laryngeal process of arytenoid muscle.
nerve
Give the

A B
Fig. 1A.16.9A and B Intrinsicmusclesoflarynx.
External laryngeal nerve attachments, nerve supply and actions of inferior
ThyrohyoidLeft vagus nerve membrane constrictor muscle.
Cricothyroid muscle
Left recurrent
Right recurrent
Inferior constrictor muscle originates from:
laryngeal nervelaryngeal nerveTrachea
Fig. 1A.16.8 Nervesupplyoflarynx. Thyroid cartilage (oblique line and inferior horn)
Q.8. Paired cartilages of larynx.
4 Quick Review Series: BDS 1st Year
Cricoid cartilage Inferior constrictor muscle inserts into
pharyngeal raphe. Parts of the inferior constrictor are: a.
Thyropharyngeus
b. Cricopharyngeus.
The dehiscence of Killian is a weak area between these
two parts.
Nerve supply: Pharyngeal plexus of nerves.
Q.1. Describe surface features of dorsum of the
tongue. How do you connect its epithelial innervation
to its development?
Or
Describe anatomy of tongue. Add a note on its
development.
The tongue is situated in the floor of the mouth. It has an
oral part that lies in the mouth, and a pharyngeal part that
lies in the pharynx. The oral and pharyngeal parts are
TONGUE
Topic 17
LONG ESSAYS
separated by a V-shaped sulcus terminalis (Fig. 1A.17.1).
The functions of tongue are taste, speech, mastication and
deglutition.
Oral part
(anterior two-thirds)
Geniohyoid muscle
Fig. 1A.17.1 Paramediansagittalsectionofthetongue.
The tongue has following external features:
Root
Tip
Body.
The root of the tongue is attached to the mandible and
soft palate above, and to the hyoid bone below. In
between the two bones, it is related to the geniohyoid and
mylohyoid muscles.
The tip of the tongue forms the anterior free end which, at
rest, lies behind the upper incisor teeth. The body of the
tongue has (a) a curved upper surface or dorsum and (b)
an inferior surface.
Action of the constrictors of the pharynx: During
deglutition, they contract and cause peristaltic movement
in the pharynx.
Thyropharyngeus has propulsive function whereas the
cricopharyngeus has a sphincteric function.
Cricopharyngeal part relaxes during the contractions of the
thyropharyngeal part.
The dorsum of the tongue is divided into (a) an oral part
or anterior two-thirds and (b) a pharyngeal part or
posterior one-third, by a faint V-shaped groove, the sulcus
terminalis.
The inferior surface is covered with a smooth mucous
membrane, which shows a median fold called the
frenulum linguae. On either side of the frenulum there is
a prominence produced by the deep lingual veins. More
laterally there is a fold called the plica fimbriata (Fig.
1A.17.2).
The oral or papillary part of the tongue is placed on the
floor of the mouth. Its margins are free and in contact
with the gums and teeth. The superior surface of the oral
part shows a median furrow and is covered with papillae
which make it rough.
The pharyngeal or lymphoid part of the tongue lies
behind the palatoglossal arches and the sulcus terminalis.
Its posterior surface called the base of the tongue, forms
the anterior wall of the pharynx. The mucous membrane
is devoid of papillae, but has many lymphoid follicles that
collectively constitute the lingual tonsil. Mucous glands
are also present.
Tip of tongue turned up
Plica fimbriata Frenulum
Deep lingual vein
Orifice of Sublingual fold
submandibular on floor of mouth
duct on
sublingual papilla
Fig. 1A.17.2 Theinferiorsurfaceofthetongueandthefloorof the
mouth.
The posteriormost part of the tongue is connected to the
epiglottis by three folds of mucous membrane. These are
 General Anatomy 5

the median glossoepiglottic fold and the right and left Table 1A.17.1 Nerve supply of tongue
lateral glossoepiglottic folds. On either side of the median Nerve Anterior Posterior one-third Posterior
fold there is a depression called the vallecula. supply two- of tongue most part
of thirds of or
Papillae of the tongue are projections of mucous
tongue tongue vallecula
membrane or corium which impart the characteristic
Sensory Lingual Glossopharyngeal, Internal
roughness to anterior two-thirds of the tongue.
taste chorda glossopharyngeal laryngeal
There are three types of papillae on the tongue (Fig. tympani, including the branch of
1A.17.3): except vallate vagus
The vallate or circumvallate papillae are situated vallate Internal
immediately in front of the sulcus terminalis and are papillae laryngeal
about 8–12 in number. They are large in size 1–2 mm in branch of
vagus
diameter. Each papilla is a cylindrical projection
papillae
surrounded by a circular sulcus, and its walls are raised
above the surface. Q.2. Give an account of musculature of tongue and
its development. Write briefly about lymphatic
The fungi form papillae are numerous near the tip and
drainage of tongue.
margins of the tongue, but some of them are also
scattered over the dorsum. They are distinguished by their
bright red colour. The tongue is a muscular organ. A middle fibrous septum
divides the tongue into right and left halves. Each half
contains four intrinsic and four extrinsic muscles (Fig.
1A.17.4):
Intrinsic muscles:
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Extrinsic muscles:
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus.
Intrinsic Muscles of the Tongue
The intrinsic muscles occupy the upper part of the tongue,
Oral and are attached to the submucous fibrous layer and to the
Foramen
Vallate papillae median fibrous septum. They alter the shape of the
caecum Fig. 1A.17.3 Papillaeofthetongue. tongue.
The filiform papillae or conical papillae cover the
presulcal area of the dorsum of the tongue, and give it a
characteristic velvety appearance. They are the smallest
and most numerous of the lingual papillae. Each is
pointed and covered with keratin.
Development of Tongue
Epithelium
Anterior two-thirds: From two lingual swellings and one
tuberculum impar, which arise from the first branchial
arch. It is supplied by lingual nerve (posttrematic) and
chorda tympani (pretrematic).
Posterior one-third: From cranial part of the
hypobranchial eminence, i.e. from the third arch.
Therefore, it is supplied by the glossopharyngeal nerve.
Posterior most part develops from the fourth arch.
Therefore, it is supplied by the vagus nerve (Table
1A.17.1).
4 Quick Review Series: BDS 1st Year
Fig. 1A.17.4 Themusculatureoftongue.
The superior longitudinal muscle lies beneath the mucous
membrane. It shortens the tongue and makes its dorsum
concave.
The inferior longitudinal muscle is a narrow band lying
close to the inferior surface of the tongue between the
genioglossus and the hyoglossus. It shortens the tongue and
makes its dorsum convex.
The transverse muscle extends from the median septum to
the margins. It makes the tongue narrow and elongated.
The vertical muscle is found at the borders of the anterior
part of the tongue. It makes the tongue broad and
flattened.
Extrinsic Muscles of the Tongue
The extrinsic muscles connect the tongue to the
following:
Mandible via genioglossus
Hyoid bone through hyoglossus 3. Styloid process via
styloglossus
4. The palate via palatoglossus.
Genioglossus is a fan-shaped muscle which forms the
main bulk of the tongue. It arises from the upper genial
tubercle of the mandible. From here the fibres fan out and
run backwards. The upper fibres are inserted into the tip,
the middle fibres into the dorsum, and the lower fibres
into the hyoid bone. The upper fibres retract the tip, the
middle fibres depress the tongue, and the lower fibres pull
the posterior part of the tongue forwards and thus
protrude the tongue from the mouth.
This muscle if paralysed will fall back on the oropharynx
and block the air passage.
SHORT ESSAYS
Q.1. Nerve supply of tongue.palatoglossus is supplied by the cranial root of the
accessory nerve through the pharyngeal plexus.
Nerve supply of the tongue is as follows: Sensory Nerves
Motor Nerves 1. The lingual nerve is the nerve of general sensation and the chorda tympani is the nerve of taste for the
1. All the intrinsic and extrinsic muscles except the pala- anterior two-thirds of the tongue except vallate toglossus are
supplied by the hypoglossal nerve. The papillae.
The tip
of the
tongue
drains
bilaterally to the submental nodes.
The right and left halves of the remaining part of the
anterior two-thirds of the tongue drain unilaterally to the
submandibular nodes. A few central lymphatic drain
bilaterally to the same nodes.
The posterior one-third of the tongue drains bilaterally to
the jugulo-omohyoid nodes; these are known as the lymph
nodes of the tongue.
The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the tongue
including the circumvallate papillae.
The posterior most part of the tongue is supplied by the
vagus nerve through the internal laryngeal branch (Table
1A.17.1).
Q.2. Lymphatic drainage of tongue. Or
Lymph vessels and lymph nodes draining lymph
from tongue.
Lymphatic Drainage (Fig.1A.17.5)
The tip of the tongue drains bilaterally to the submental
nodes.
The right and left halves of the remaining part of the
anterior two-thirds of the tongue drain unilaterally to the
submandibular nodes. A few central lymphatics drain
bilaterally to the same nodes.
The posterior one-third of the tongue drains bilaterally to
the jugulo-omohyoid nodes; these are known as the
lymph nodes of the tongue (Fig. 1A.17.5).
Venous Drainage
The arrangement of the vena comitantes/veins of the
tongue is variable. Two venae comitantes accompany the
 General Anatomy 5

lingual artery, and one vena comitantes accompanies the Motor nerves
hypoglossal nerve. The deep lingual vein is the largest All the intrinsic and extrinsic muscles except the
and principal vein of the tongue. It is visible on the palatoglossus are supplied by the hypoglossal nerve. The
inferior surface of the tongue. These veins unite at the palatoglossus supplies to the cranial root of the accessory
posterior border of the hyoglossus to form the lingual nerve through the pharyngeal plexus.
vein, which ends either in the common facial vein or in Sensory nerves
the internal jugular vein. The lingual nerve is the nerve of general sensation and
Innervation or Nerve Supply of the Tongue the chorda tympani is the nerve of taste sensation for the
(Fig.1A.17.6) anterior two-thirds of the tongue except vallate papillae.
Anterior 2/3 of tongue Posterior 1/3 of tongue Fig. 1A.17.5 Lymphaticdrainage.
The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the tongue
including the circumvallated papillae.
The posteriormost part of the tongue is supplied by the
Submental nodes vagus nerve through the internal laryngeal branch.
Jugulo-omohyoid
lymph nodes
Submandibular nodes
Omohyoid muscle
Internal jugular vein
Q.3. Describe in detail about blood supply and innervation of tongue.

Arterial supply of tongue is chiefly derived from the lingual artery, a branch of the external carotid artery. The root of the
tongue is also supplied by the tonsillar and ascending pharyngeal arteries. Fig. 1A.17.6 Vascularandnervesupplyoftongue.
SHORT NOTES
Q.1. Lingual nerve supply. ganglion, (d) deep part of the submandibular gland, (e)
submandibular duct, (f) hypoglossal nerve and (g) veins
The lingual nerve is the nerve of general sensation for the
anterior two-thirds of the tongue.
Q.2. Lymphatic drainage of tongue.

Lymphatic drainage of tongue is as follows:

The tip of the tongue drains bilaterally to the submental

EAR
Topic 18
SHORT ESSAY
nodes.
The right and left halves of the remaining part of the
anterior two-thirds of the tongue drain unilaterally to the
submandibular nodes. A few central lymphatics drain
bilaterally to the same nodes. accompanying it.
The posterior one-third of the tongue drains bilaterally to Deep relations of hyoglossus muscle are (a) inferior
the jugulo-omohyoid nodes; these are known as the longitudinal muscle of the tongue, (b) genioglossus, (c)
lymph nodes of the tongue. middle constrictor of the pharynx, (d) glossopharyngeal
Q.3. Relations of hyoglossus muscle. nerve, (e) stylohyoid ligament and (f) lingual artery.
Structures passing deep to posterior border of hyoglossus,
from the above downwards include (a) glossopharyngeal
Superficial relations of hyoglossus muscle are (a)
nerve, (b) stylohyoid ligament and (c) lingual artery.
styloglossus, (b) lingual nerve, (c) submandibular
4 Quick Review Series: BDS 1st Year

Q.1. Give the position, nerve supply and development body of incus
of tympanic membrane.

Tympanic membrane is a thin, translucent partition Head,

anterior process and
between the external acoustic meatus and the middle ear.
handle of malleus
It is oval in shape, measuring 9 mm 3 10 mm which is
placed obliquely at an angle of 55° with the floor of the
meatus and faces downwards, forwards and laterally. Pars tensa
The tympanic membrane has outer and inner surfaces.
The outer surface of the membrane is lined by thin skin
Chorda tympani
and is concave (Fig. 1A.18.1). The inner surface provides
attachment to the handle of the mallets, which extends up
to its centre. The inner surface is convex (Fig. 1A.18.2).
Fig. 1A.18.2 Innersurfaceofthelefttympanicmembrane.
The point of maximum convexity lies at the tip of the
The tympanic membrane is composed of the following
handle of the malleus and is called the umbo. The
three layers (Fig. 1A.18.3):
membrane is thickened at its circumference, which is
The outer cuticular layer of skin.
fixed to the tympanic sulcus of the temporal bone on the
The middle fibrous layer made up of superficial radiating
tympanic plate.
fibres.
Superiorly, the sulcus is deficient, and the membrane is
The deep circular fibres, which are minimal at the centre
attached to the tympanic notch. From the ends of the
and maximal at the periphery.
notch two bands, the anterior and posterior malleolar
The fibrous layer is replaced by loose areolar tissue in the
folds are prolonged to the lateral process of the malleus.
Anterior malleolar fold
pars flaccid. The inner mucous layer is lined by a low
Pars flaccida ciliated columnar epithelium. Blood Supply
The outer surface is supplied by the deep auricular branch
Posterior
malleolar fold of the maxillary artery.
Middle ear The inner surface is
Position of handle supplied by the
of malleus anterior tympanic
Pars tensa branch of the maxillary
(outer surface
) Umbo
artery and by the
posterior tympanic
branch of the posterior
Fig. 1A.18.1 Outersurfaceofthelefttympanicmembrane. auricular artery.
The greater part of the tympanic membrane is tightly Head of malleus
Lateral process and handle
stretched and is called the pars tense, the part between the
of malleus
two-malleolar folds is loose and is called the pars flaccid. External acoustic meatus
The pars flaccid is crossed internally by the chorda Cuticular layer of tympanic
tympani. This part is more liable to rupture than the pars Fibrous layer membrane
Mucous layer Fig. 1A.18.3 Tympanic
tense. The membrane is held tense by the inward pull of
the tensor tympani muscle, which is inserted into the membraneasseeninsection.
upper end of the handle of the malleus. Venous Drainage
Short process and Veins from the outer surface drain into the external
jugular vein. The veins from inner surface drain into the
transverse sinus and into the venous plexus around the
auditory tube.
Lymphatic Drainage
Lymphatics pass to the preauricular and retropharyngeal
lymph nodes.
Nerve Supply
Outer surface: The anteroinferior part is supplied by the
auriculotemporal nerve, and the posterosuperior part by
the auricular branch for the vagus nerve.

Inner surface: This is supplied by the tympanic branch of
the glossopharyngeal nerve through the tympanic plexus.
Q.1. Tympanic membrane.
A thin, translucent partition between the external acoustic
meatus and the middle ear is known as tympanic
SHORT NOTES
membrane. It is oval in shape, measuring 9 mm 3 10 mm.
It is placed obliquely at an angle of 55° with the floor of
the meatus. It faces downwards, forwards and laterally.
Q.2. External acoustic meatus.
EYEBALL
Topic 19
SHORT ESSAYS
Q.1. Give the development of retina.
The retina is derived from the layers of the optic cup
which is divisible into a larger posterior part that becomes
thick, and forms the retina proper (optical part of retina);
and an anterior part that remains thin and forms an
epithelial covering for the ciliary body and iris (ciliary
and radial parts of retina).
The outer wall of the posterior part of the optic cup
remains thin. Its cells form the pigmented layers of the
retina.
The inner wall of the cup differentiates into matrix cell,
mantle and marginal layers as in the neural sheath.
After giving origin to the cells of the mantle layers, the
cells of the matrix layers form the rods and cones, the
cells of the mantle layers form the bipolar cells, the
ganglion cells and other neurons of the retina and also the
supporting elements.
The axons of the ganglion cells grow into the marginal
layers to form the layers of nerve fibres. Then fibres grow
into the optic stalk by passing through the coordinal
fissure. The optic stalk is then converted into the optic
nerve. Q.2. Lateral rectus muscle of eyeball.
General Anatomy 5
The external ear consists of: (a) the auricle or pinna and
(b) the external acoustic meatus. The external auditory
meatus conducts sound waves from the concha to the
tympanic membrane.
The meatus or canal is S-shaped and about 24 mm long,
of which the medial two-thirds or 16 mm is bony, and the
There are four rectus muscles namely (Fig. 1A.19.1):
Superior rectus
Inferior rectus
Medial rectus 4. Lateral rectus.
Levator palpebrae superioris
These muscles originate from the common tendinous
ring, which is situated around the superior, medial and
inferior borders of the optic foramen.
Origin
The lateral rectus muscle arises from lateral part of
common tendinous ring by two heads, one from the upper
and one from the lower aspect of the lateral part of the
common tendinous ring.
Between the two origins of the lateral rectus following
structures are passing:
1. Upper and lower division of the oculomotor nerve 2.
Nasociliary nerve
3. Abducent nerve.
From the origin, the rectus muscles widen forwards to
form the cone of muscles.
Insertion
Lateral rectus is inserted to the anterior half of the eyeball
laterally.
4 Quick Review Series: BDS 1st Year

Nerve Supply The lateral rectus moves the cornea horizontally and
The lateral rectus is supplied by the abducent nerve. laterally.
Action Function
Abduction of eyeball.
Fig. 1A.19.1 Rectusmusclesofeyeball.

SHORT NOTES
Q.1. Short ciliary Actions of oblique muscles of eyeball are as follows:
nerve. 1. Contraction of superior oblique directs the pupil down
and out.
Sensory root Contraction of inferior oblique directs the pupil up and
Nasociliary nerve
Long ciliary nerve out.
The functions of superior oblique muscle are depression,
Sympathetic abduction and medial rotation of eyeball.
root
The functions of inferior oblique muscle are elevation,
Parasympathetic abduction and lateral rotation of eyeball. Q.3. Fascial
(motor) root
Ciliary sheath of eyeball.
ganglion
Oculomotor nerve [III] Short ciliary nerve The fascial sheath of the eyeball (bulbar sheath) is a layer
Sensory fibres of fascia that encloses a major part of the eyeball (Fig.
Sympathetic fibres
Parasymp
1A.19.4). The eyeball can freely move within this sheath.
athetic preganglionic fibres The sheath gives off a number of expansions:
Parasympathetic postganglionic fibres Fig. 1A.19.2 Shortciliary 1. A tabular sheath 2. The medial check ligament 3. The
nerve. lateral check ligament.
The postganglionic parasympathetic fibres from ciliary Facial sheath of eyeball or bulbar fascia is firmly attached
ganglion are distributed to the eyeball through short posteriorly, to the sclera around the point of entrance of
ciliary nerves and they innervate the sphincter pupillae the optic nerve into the eyeball; anteriorly, to the sclera
and ciliary muscles (Fig. 1A.19.2). near the edge of the cornea; additionally, as the muscles
The ciliary ganglion gives 10–12 short ciliary nerves approach the eyeball, the investing fascia surrounding
containing postganglionic fibres for the supply of each muscle blends with the fascial sheath of the eyeball
constrictor or sphincter pupillae for narrowing the size of as the muscles pass through and continue to their point of
pupil and ciliaris muscle for increasing the curvature of attachment.
anterior surface of lens required during accommodation A specialized lower part of the fascial sheath of the
of the eye. eyeball is called the suspensory ligament of the eye or the
Q.2. Actions of oblique muscles of eyeball. suspensory ligament of Lockwood, it supports the
eyeball.
The oblique muscles of eyeball are in the superior and
inferior parts of the orbit (Fig. 1A.19.3).

Fig. 1A.19.4 Thefascialsheathoftheeyeball.

Inferior rectus
Fig. 1A.19.3 Obliquemusclesofeyeball.
 General Anatomy 5

REGIONAL ANATOMY OF NECK

Topic 20
LONG ESSAY
Q.1. Cervical sympathetic chain.

The cervical part of the sympathetic trunk is located on

each side of the cervical part of the vertebral column,
behind the carotid sheath and in front of the prevertebral
fascia (Fig. 1A.20.1). It is connected to each cervical
spinal nerve by a gray ramus communic There are no
white rami communications in the cervical ganglion
region.

Fig. 1A.20.1 Cervicalpartofthesympathetictrunk.

Cervical sympathetic chain is related:
Anteriorly to
Internal carotid artery
Common carotid artery
Carotid sheath
Inferior thyroid artery
Posteriorly to
Prevertebral fascia
Longus capitis and cervicis muscles
2 Transverse processes of the lower six cervical
vertebrae.
Ganglia
Along the course of the sympathetic trunk in the cervical
region three ganglia, i.e. superior, middle and inferior
cervical ganglia, are usually described.
1. Superior cervical ganglion
This is the largest of the three ganglia. It is spindle-
shaped, and about 2.5 cm long. It is located just below the
skull, opposite the second and third cervical vertebrae. It
4 Quick Review Series: BDS 1st Year

is formed by the fusion of the upper four cervical ganglia. Injury to cervical sympathetic trunk produces Horner’s
It marks the superior extent of sympathetic trunk. syndrome, which is characterized by the following: a.
Its branches pass to the following: Ptosis (i.e. drooping of the upper eyelid)
The internal and external carotid arteries forming Miosis (i.e. constriction of the pupil)
plexuses around these vessels. Anhydrosis (i.e. loss of sweating on that side of the face)
Cervical spinal nerves C1 to C4 through gray rami Enophthalmos (i.e. retraction of the eyeball)
communicantes.
The pharyngeal branches take part in the formation of the
pharyngeal plexus.
The heart as superior cardiac nerves: the left superior
cervical cardiac branch goes to the superficial cardiac
plexus while the right branch goes to the deep cardiac
plexus.
2. Middle cervical ganglion
It is the second ganglion inferior to the superior cervical
ganglion along the course of the sympathetic trunk. The
middle cervical ganglion is very small and encountered at
about the level of cervical vertebra C6. Branches from
this ganglion pass to the following:
Cervical spinal nerves C5 and C6 through gray rami
communicantes.
The heart as middle cardiac nerves which is the largest of
the sympathetic cardiac branches. It goes to the deep
cardiac plexus.
Tracheal and oesophageal branches.
Thyroid branches accompany the inferior thyroid artery
to the thyroid gland. They also supply the parathyroid
glands.
3. Inferior cervical ganglion
At the lower end of the cervical part of the sympathetic
trunk the inferior cervical ganglion is formed by the
fusion of the seventh and eighth cervical ganglia, which
becomes very large when it combines with the first
thoracic ganglion and forms the cervicothoracic ganglion
(stellate ganglion). The inferior cervical ganglion is
situated anterior to the neck of first rib and the transverse
process of cervical vertebra C7, and posterior to the first
part of the subclavian artery and the origin of the
vertebral artery. Branches from this ganglion pass to the
following:
Spinal nerves C7 to T1 through gray rami communicantes
The vertebral artery, forming a plexus associated with
this vessel
The heart as inferior cardiac nerves.
This ganglion also receives white rami communicantes
from thoracic spinal nerve T1 and, occasionally, from T2.
Clinical Anatomy
The head and neck are supplied by sympathetic nerves
arising from the upper four thoracic segments of the
spinal cord. Most of these preganglionic fibres pass
through the stellate ganglion to relay in the superior
cervical ganglion.
 General Anatomy 5

Loss of the ciliospinal reflex (i.e. pinching the skin on the

nape of the neck) does not produce dilatation of the pupil
which normally takes place.
Q.1. Describe superolateral surface of cerebrum. The inferolateral border
The cerebrum is made up of two cerebral hemispheres The medial orbital border 4. The medial occipital border.
which are incompletely separated from each other by the Three poles
median longitudinal fissure. Frontal pole, at the anterior end
BRAIN
The two hemispheres are connected to each other across the Occipital pole, at the posterior end
median plane by the corpus callosum. Each hemisphere Temporal pole, at the anterior end of the temporal lobe.
Topic 21
contains a cavity, called the lateral ventricle.
Each cerebral hemisphere has the following external
Each cerebral hemisphere is divided into four lobes:
Frontal
LONG
features: ESSAY Parietal
Three
Fig. surfaces
1A.21.1 Superolateralsurfaceofcerebrum. Occipital 4. Temporal.
The superolateral surface The lobes are best appreciated on the superolateral surface
The medial surface 3. The inferior surface. as in Figure 1A.21.1.
Four borders
1. The superomedial border

Central sulcus Superomedial border

Posterior ramus
of lateral sulcus
Parieto-occipital sulcus

Frontal Parietal
lobe lobe

Occipital
Temporal lobe
lobe Occipital Pole
Frontal pole
Preoccipital notch

Temporal pole
Inferolateral border
4 Quick Review Series: BDS 1st Year

Sulci and gyri of superolateral surface are as follows (Fig.
1A.21.2):
The lateral sulcus (fissure of Sylvius): The lateral sulcus
is a deep fissure that separates the frontal and temporal
lobes on the under surface of the brain and continues onto
the lateral surface and passes backwards, above the
temporal lobe.
Central sulcus: It is an oblique sulcus passing up from
just behind the opercula to indent the superior border of
the hemisphere just behind the midpoint. It is the only
Precentral sulcus
Superior frontal sulcus
Inferior frontal sulcus
The inferior parietal lobule is invaded by the posterior
ramus of the lateral sulcus, and of the superior and
inferior temporal gyri which divide the inferior parietal
lobule into anterior, middle and posterior parts. The
anterior part is called the supramarginal gyrus, and the
middle part is called the angular gyrus.
The superior and inferior temporal sulci divide the
temporal lobe into superior, middle and inferior temporal
gyri.
The occipital lobe is further subdivided by the following
Central sulcus
Postcentral gyrus
Postcentral sulcus
Superior parietal lobule
Inferior parietal lobule

Arcus parieto-occipital
Parieto-occipital sulcus
Superior gyrus
Middle gyrus Intraparietal sulcus
Inferior frontal gyrus Transverse occipital sulcus

Superior occipital gyrus

Lunate sulcus
Anterior ascending
Postcalcarine sulcus
anterior horizontal
Lateral occipital sulcus
and posterior rami of lateral sulcus
Inferior occipital gyrus
Inferior temporal sulcus
Superior temporal sulcus
Superior temporal gyrus Inferior temporal gyrus
Middle temporal gyrus
long sulcus to pass over on to the medial surface of the sulci:
hemisphere and it separates frontal and parietal lobes. The lateral occipital sulcus divides this lobe into the
The frontal lobe is further divided by the following sulci: superior and inferior occipital gyri.
The precentral sulcus runs parallel to the central sulcus, a The lunate sulcus separates these gyri from the occipital
little in front of it. The precentral gyrus lies between the pole.
two sulci. The area around the parieto-occipital sulcus is the arcus
The area in front of the precentral sulcus is divided into parieto-occipitalis. It is separated from the superior
superior, middle and inferior frontal gyri by the superior occipital gyrus by the transverse occipital sulcus.
and inferior frontal sulci. The summary of sulci and gyri of the cerebrum on
The anterior horizontal and anterior ascending rami of the superolateral surface is as follows:
lateral sulcus subdivide the inferior frontal gyrus into Frontal lobe:
three parts (pars orbitalis, pars triangularis and pars Sulci precentral l Superior frontal l Inferior frontal
opercularis). Gyri precentral
The parietal lobe is further subdivided by the following Superior frontal l Middle frontal » Inferior frontal
sulci: Parietal lobe:
The postcentral sulcus runs parallel to the central sulcus, Sulci postcentral » Intraparietal
a little behind it. The postcentral gyrus lies between the Gyri postcentral
two sulci. Superior parietal lobule l Inferior parietal lobule
The area behind the postcentral gyrus is divided into the which is divided into three parts: (a) the anterior,
superior and inferior parietal lobules by the intraparietal supramarginal; (b) the middle, angular and (c) the
sulcus. posterior, over the end of interior temporal sulcus.
Precentral gyrus
Fig. 1A.21.2 Sulciandgyriofsuprolateralsurface.
Temporal lobe: l Lunate
 General Anatomy 5

Sulci superior temporal l Superior and inferior polar

Inferior temporal b. Gyri arcus parieto-occipitalis
Gyri superior temporal, with three transverse l Superior occipital
temporal gyri middle temporal l Inferior l Inferior occipital l Gyrus
temporal descendens.
4. Occipital lobe:
a. Sulci transverse occipital l Lateral occipital

SHORT NOTE
Q.1. Central sulcus. and occipital poles. It runs on the superolateral surface
obliquely downwards and forwards and ends a little
above
the posterior ramus of the lateral sulcus.
The central sulcus
begins at
superomedial border
the
MISCELLANEOUS
of the hemisphere a
little behind the midpoint between the frontal

Topic 22
SHORT ESSAYS
Q.1. Radicular artery. attachments. Before union with the shaft, an epiphysis is
supplied from the circulus vasculosus of the joint.
The radicular arteries are derived from various parent Veins are numerous and large in the cancellous red
vessels depending on the levels like spinal branches of marrow bones (e.g. the basivertebral veins) and run with
the vertebral, ascending cervical, deep cervical, the arteries in Volkmann’s canals in compact bone.
intercostals, lumbar and sacral arteries.
As fetal growth proceeds most of the radicular arteries
disappear, those that remain form anastomoses with the
anterior and posterior spinal arteries, and are commonly
known as booster or feeder vessels. The largest of the
feeder vessels is arteria radicularis magna (of
Adamkiewicz).
Many of these radicular branches are small and end by
supplying the nerve roots. A few of them, which are
large, contribute blood to the spinal arteries.
One of the anterior radicular branches is very large and is
called the arteria reticularis magna. Its position is
variable. This artery may be responsible for supplying
blood to as much as the lower two-thirds of the spinal
cord.
The radicular arteries make important contributions to
reinforce the longitudinal trunks.
Q.2. Blood supply of long bone.

Bone is a type of dense connective tissue. In the adult the

nutrient artery of the shaft of a long bone usually supplies
little more than the marrow.
The compact bone of the shaft and the cancellous bone of
the ends are supplied by branches from the periosteum,
especially numerous beneath muscular and ligamentous
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