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Module 2.2 Flashcards

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1
Q

skeleton of the head

A

Cranium (Skull)

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2
Q

2 Parts of the Cranium

A
  1. Neurocranium

2. Viscerocranium

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3
Q
  • Cranial vault
  • Is the bony case of the brain plus the cranial meninges, proximal parts of cranial nerves and vasculature of the brain
  • encloses and protects the brain
A

Neurocranium

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4
Q

The neurocranium is formed by a series of 8 bones namely:

A
    • Sphenoidal
    • Temporal (2sets)
    • Occipital
    • Parietal (2 sets)
    • Frontal
    • Ethmoidal
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5
Q

The neurocranium is made up of:

A
  1. Calvaria or Skull Cap

2. Cranial Base or Basicranium

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6
Q

a dome like roof called the ___

A

calvaria or skullcap

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7
Q

a floor or cranial base called the ___

A

basicranium

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8
Q
  • facial skeleton
  • forms the anterior part of the cranium
  • consists of bones surrounding the orbits, nose and mouth
A

Viscerocranium

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9
Q

Viscerocranium is consists of 15 irregular bones namely

A 
A. 3 singular bones
-- Mandible
-- Ethmoid
-- Vomer
B. 6 bones as bilateral pairs
-- Lacrimal
-- Inferior nasal conchae
-- Maxillae
-- Palatine
-- Nasal
-- Zygomatic
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10
Q

In the anatomic position the inferior margin of the orbit and superior margin of the external acoustic meatus lie in the same horizontal plane

A

Orbitomeatal Plane or The Frankfort Horizontal Plane

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11
Q

Development of Cranium

A
    • bones of calvaria and cranial base develop by INTRAMEMBRANOUS OSSIFICATION and by ENDOCHONDRAL OSSIFICATION
    • at birth the bones of the calvaria are SMOOTH AND UNILAMINAR
    • disproportionately large; frontal and parietal eminences are prominent
    • facial aspect is small compared to calvaria
    • INCREASE IN SIZE OF CALVARIA is GREATEST during the FIRST 2 YRS. due to rapid brain development.
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12
Q

Development of Cranium

A
    • AT BIRTH the Frontal Bones consists of TWO HALVES; UNION begins in the 2ND YR.
    • halves of frontal bone are separated by frontal suture; obliterated by the 8th yr.
    • FRONTAL AND PARIETAL BONES ARE separated by the CORONAL SUTURE
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13
Q
    • remnant of frontal suture that persists
    • in the middle of the glabella
    • 8% of people
    • must not be interpreted as fracture in radiograph
A

Metopic Suture

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14
Q

Development of Cranium

A
    • intermaxillary suture separates the maxillae
  • -mandibular symphysis separates the mandible; halves of the mandible fuse early in the 2nd yr.
    • obliteration of sutures begin bet. ages 30 and 40 years on the internal surface and 10 years later on the external surface
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15
Q

Development of Cranium

A
    • no mastoid and styloid process in newborn; facial nerves are close to the surface and can be injured by forceps delivery
    • mastoid process forms during the 1st yr; SCM pulls on the petromastoid parts of temporal bones
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16
Q
  • diamond or star-shaped
  • bounded by frontal bone anteriorly and parietal bone posteriorly
  • 18 mos. no longer palpable
  • future site of bregma
A

Anterior Fontanelle

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17
Q
  • triangular
  • bounded by parietal bones anteriorly and occipital bone posteriorly
  • at junction of lambdoid and sagittal sutures; future site of lambda
  • no longer palpable at the end of 1st yr.
A

Posterior Fontanelle

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18
Q
  • temporal muscle overlies these fontanelles

- fuse during infancy

A

Sphenoid and Mastoid Fontanelles

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19
Q

palpation of fontanelles enables the physician to determine the:

A
    • progress of growth of frontal and parietal bones
    • degree of hydration (depressed fontanelle means dehydration)
    • level of intracranial pressure (bulging means increased pressure)
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20
Q

Rapid Growth of Face

A
    • coincides with the eruption of deciduous teeth
    • dento-alveolar development of the alveolar bone
    • associated with the increase in size of paranasal sinuses
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21
Q
    • premature closure of cranial sutures
    • 1 per 2000 births; unknown cause/genetic
    • more common in males usually does not affect brain development
A

Primary Craniosynostosis

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22
Q
    • premature closure of sagittal suture
    • anterior fontanelle is small or absent
    • long, narrow wedge-shaped cranium
A

Scaphocephaly

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23
Q
    • premature closure of the coronal or lambdoid suture on one side only
    • cranium is twisted and asymetrical
A

Plagiocephaly

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24
Q
    • premature closure of the coronal suture
    • high tower-like cranium
    • more common in females
A

Oxycephaly/Turricephaly

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25
The anterior aspect of the cranium consists of:
- - Frontal Bone - -Orbits - - Nasal Region - - Zygomatic Bone - - Maxillae - - Mandible
26
- - squamous (flat)part - - forms the skeleton of the forehead - - articulates with nasal and zygomatic bones inferiorly - - articulates with lacrimal, ethmoid and sphenoids
Frontal Bone
27
Part of the Frontal Bone
- - the intersection of the frontal and nasal bones is the NASION - - the GLABELLA IS the smooth prominence superior to the root of the nose - - SUPRAORBITAL MARGIN is the angular boundary between the squamous and orbital parts - - SUPRAORBITAL FORAMEN at the supraorbital margin; for passage of supra-orbital nerve and vessels - - the SUPERCILIARY ARCH is a prominent ridge superior to the supraorbital margin and deep to the eyebrows; extends laterally on each side from the glabella
28
- - a blow to the sharp bony ridges may lacerate the skin and cause bleeding - - blood may accumulate in the superior eyelid and around the eye- black eye
Injury to Superciliary Arches
29
- - bilateral bony cavities - - resemble quadrangular pyramids - - contain and protect the eyeball and accessory visual structures
Orbits
30
Parts of the Orbits
- - SUPERIOR WALL (ROOF) -orbital part of horizontal bone; lesser wing of sphenoid - - MEDIAL WALL - orbital plate of ethmoid; plus frontal process of maxilla, lacrimal and sphenoid bones - - LATERAL WALL -frontal process of zygomatic bone; greater wing of sphenoid - - INFERIOR WALL (ORBITAL FLOOR) - maxilla and partly by zygomatic and palatine bones; demarcated from the lateral wall by the inferior orbital fissure - - FOSSA FOR THE LACRIMAL GLAND is the shallow depression in the orbital part of the frontal bone
31
- - cheek bones or malar bones; form prominences of cheeks - - lie on inferolateral sides of orbits and rests on maxillaearticulates with the frontal, sphenoid, maxillae and temporal bones
Zygomatic Bone
32
- - pierces the lateral aspect of the zygomatic bones | - - passage of zygomaticofacial nerve and vessels
zygomaticofacial foramen
33
Part of Nasal Region
PIRIFORM APERTURE - pear-shaped anterior nasal opening in the cranium; inferior to the nasal bones NASAL SEPTUM -divides the nasal cavity into right and left parts NASAL CONCHAE -curved bony plates on the lateral wall of each nasal cavity (appear like elongated seashells)
34
Nasal Septum is made up of:
- - Perpendicular plate of the ethmoid - - Vomer - - Cartilage of the Septum - - Crest of Maxillary Bone - - Crest of the Palatine bone
35
- - form upper jaw; form the infraorbital margins medially - - alveolar processes include the tooth sockets called alveoli - - supporting bone for maxillary teeth - -surround piriform aperture - - the two maxillae are united at the inter maxillary suture
Maxilla
36
Foramen found in the maxilla which is for the passage of infraorbital nerve and vessels
Infraorbital Foramen
37
Dr. Le Fort classified 3 variants of fractures of the | maxillae
- - Le Fort I Fracture - - Le Fort II Fracture - - Le Fort III Fracture
38
- horizontal fracture of the maxillae | - passing superior to the maxillary alveolar process crossing the bony nasal septum
Le Fort I Fracture
39
-passes from the posterolateral parts of the maxillary sinuses through the infra-orbital foramina lacrimals or ethmoids to bridge of nose
Le Fort II Fracture
40
- horizontal fracture - passes through the superior orbital fissures, ethmoid and nasal bones, extending to the greater wings of sphenoid and frontozygomatic sutures
Le Fort III Fracture
41
- - U-shaped bone - - alveolar process that support mandibular teeth - - consists of the body, angle and ramus - - mental foramina inferior to the 2nd premolar teeth; for mental nerves and vessels - - MENTAL PROTUBERANCE forming prominence of CHIN
Mandible
42
Fractures of the Mandible
- - FRACTURES OF THE NECK OF THE MANDIBLE are TRANSVERSE - - FRACTURES OF THE ANGLE OF THE MANDIBLE are usually OBLIQUE - - FRACTURES OF THE BODY OF MANDIBLE pass through socket of canine tooth
43
The lateral aspect of the cranium consists of:
- - Temporal Fossa - - Zygomatic Arch - - Ext. Acoustic Opening - - Mastoid Process - - Infratemporal Fossa - - Lateral aspects of maxilla and mandible
44
bounded by: - superiorly and posteriorly: by the superior temporal line and inferior temporal line - anteriorly: by frontal and zygomatic bones - inferiorly by zygomatic arch
Temporal Fossa
45
-- formed by the union of temporal process of zygomatic bone and zygomatic process of temporal bone
Zygomatic Arch
46
-- entrance to external acoustic meatus or canal
External Acoustic Opening
47
- - posteroinferior to the external acoustic opening | - - anteromedial is a pointed projection, the styloid process
Mastoid Process
48
- - inferior and deep to the zygomatic arch and mandible | - - posterior to maxilla
Infratemporal Fossa
49
-- is an H-shaped formation of sutures that unite the frontal, parietal, greater wing of sphenoid and temporal bones.
Pterion
50
- - hard blow to side of head life threatening because it lies over the anterior branches of middle meningeal vessels - - if untreated may lead to middle meningeal artery hemorrhage
Fracture of the Pterion
51
The occipital aspect is composed of the:
- - Occiput - - Parts of parietal bone - - Mastoid parts of temporal bone
52
-- the external protuberance of this bone is palpable in the median plane
Occipital Bone
53
most prominent point of the external occipital protuberance is the ___
Inion
54
Parts of the Occipital Bone
- - most prominent point of the external occipital protuberance is the INION - - the EXTERNAL OCCIPITAL CREST descends from the protuberance toward the foramen magnum - - the SUPERIOR NUCHAL LINE marks the superior limit of neck and extends laterally from each side of the protuberance - - the INFERIOR NUCHAL LINE is less distinct - -the LAMBDA indicates the junction of sagittal and lambdoid sutures - - ACCESSORY BONES OR SUTURAL BONES may be located at lambda or near the mastoid process
55
-- is somewhat oval in form and broadens posterolaterally at the parietal eminences
Superior aspect of the Cranium
56
Cranial Sutures
1. Coronal suture 2. Sagittal suture 3. Lamdoid suture
57
-- a suture that separates the frontal and parietal bones
Coronal Suture
58
-- a suture that separates the parietal bones
Sagittal suture
59
-- a suture that separates parietal and temporal bones from occipital bone
Lamdoid suture
60
Craniometric Points
BREGMA -- at junction of sagittal and coronal sutures VERTEX -- most superior point of the calvarianear the midpoint of the sagittal suture LAMBDA -- at junction of lambdoid and sagittal sutures
61
Parietal Landmarks
PARIETAL FORAMEN --located posteriorly in the parietal bone near the sagittal suture EMISSARY FORAMINA -- transmit emissary veins
62
- - also known as the Basicranium | - - inferior portion of neurocranium and viscerocranium minus the mandible
External Surface of Cranial Base
63
The external surface of the cranial base features:
- - Alveolar arch of maxillae - - Palatine process of maxillae - - Palatine - - Sphenoid - - Vomer - - Temporal bone - - Occipital bone
64
- - formed by palatal processes of maxillae anteriorly - - formed by horizontal plates of palatine bones posteriorly - - free posterior border projects as posterior nasal spine
Hard Palate
65
Foramens of the Hard Palate
A. INCISIVE FORAMEN -- posterior to central incisor teeth -- depression in the midline of bony palate into which the INCISIVE CANALS OPEN B. GREATER PALATINE FORAMEN -- medial to 3rd molar tooth -- Transmit: GREATER PALATINE NERVES AND VESSELS C. LESSER PALATINE FORAMEN -- posterior to greater palatine foramen -- Transmit: LESSER PALATINE NERVES AND VESSELS
66
- - two large openings superior to the posterior edge of the palate - - posterior nasal aperture - - separated from each other by the vomer
Choanae
67
- - trapezoidal in shape - - flat, unpaired bone - - forms a major part of the bony nasal septum
Vomer
68
- - wedged between the frontal, temporal and occipital bones - - unpaired bone that consists of: 1. Body 2. Greater wings and Lesser wings -spread laterally from the lateral aspects of the body of the sphenoid 3. Pterygoid processes
Sphenoid Bone
69
- - consists of lateral and medial plates | - - extend on each side of the sphenoid
Pterygoid Processes
70
-- the large opening in the basal part of the occipital bone
Foramen Magnum
71
- - large protuberances on the lateral parts of occipital bone - - where the CRANIUM ARTICULATES WITH THE VERTEBRAL COLUMN
Occipital Condyle
72
-- large opening between the occipital bone and petrous part of temporal bone
Jugular Foramen
73
- - anterior to the jugular foramen | - - ENTRANCE FOR THE INTERNAL CAROTID ARTERY
Carotid Canal
74
- - lies posterior to the base of the styloid process | - - TRANSMITS THE FACIAL NERVE AND STYLOMASTOID ARTERY
Stylomastoid Foramen
75
-- provide for muscle attachments
Mastoid Process
76
The internal surface of the cranial base has 3 large depressions namely:
1. Anterior Cranial Fossa 2. Middle Cranial Fossa 3. Posterior Cranial Fossa
77
-- formed by: frontal bone (anteriorly); ethmoid (middle); body and lesser wings of sphenoid (posteriorly) -- anterior and inferior parts of frontal lobe of brain occupy this area -- Posterior Boundaries: Posterior margins of the lesser wing of the sphenoid Anterior margin of the optic chiasmatic groove (sulcus) on the body of the sphenoid bone
Anterior Cranial Fossa
78
Parts of the Anterior Cranial Fossa
1. Orbital Parts of the Frontal Bone 2. Frontal Crest 3. Foramen Cecum 4. Crista Galli 5. Cribiform Plate of the Ethmoid 6. Anterior and Posterior Ethmoidal Foramen 7. Lesser Wing of Sphenoid 8. Sphenoidal Jugum
79
- - the horizontal part of the frontal bone forms the roof of the orbit and the floor of the anterior cranial fossa - - forms the greatest part of the anterior cranial fossa - - surface show brain markings of orbital gyri
Orbital Parts of the Frontal Bone
80
-- median bony extension of the frontal bone
Frontal Crest
81
- - at the base of the frontal crest - - gives passage to vessels during fetal development - - insignificant postnatally - - contains the nasal emissary vein (1% of population)
Foramen Cecum
82
- - thick, median ridge posterior to foramen cecum - - projects superiorly from the ethmoid bone - - Latin –cock’s comb - - for the ATTACHEMENT OF THE FALX CEREBRI
Crista Galli
83
- - lie on each side of the crista galli - - supports the OLFACTORY BULBS - - means an anatomic structure pierced by many holes
Cribiform Plate of the Ethmoid
84
- - the TINY FORAMINA of this plate transmit the OLFACTORY NERVES (CN I) to the olfactory bulbs of the brain - - form the median aspect of the floor of the anterior cranial fossa - - separates the anterior fossa from the nasal cavity - - transmit the ANTERIOR AND POSTERIOR ETHMOIDAL ARTERY, VEIN AND NERVE
Cribiform Plate of the Ethmoid
85
- - contribute to the posterior aspect of the floor of the anterior cranial fossa - - separate the anterior cranial fossa from the orbits - - extending from __ are the ANTERIOR CLINOID PROCESS for the attachment of the free margin of the TENTORIUM CEREBELLI
Lesser Wing of Sphenoid
86
- -butterfly-shaped - - postero-inferior to the anterior cranial fossa - - has a central part, the sella turcica and depressed lateral parts on each side - - lateral parts support the temporal lobes of brain
Middle Cranial Fossa
87
The lateral parts of the fossa are formed by:
- - Greater wings of the sphenoid - - Squamous part of the temporal bone - - Petrous part of the temporal bone
88
Separated from the anterior cranial fossa by the ff:
SPENOIDAL CRESTS -- separates the anterior cranial fossa from the middle cranial fossa LATERALLY SPHENOIDAL LIMBUS -- separates the anterior cranial fossa from the middle cranial fossa CENTRALLY
89
- - saddle-like bony formation in middle cranial fossa - - surrounded by the anterior and posterior clinoid processes - - composed of 3 parts: 1. Tuberculum sellae 2. Hypophysial fossa 3. Dorsum sellae
Sella turcica
90
- - lies posterior to the cribriform plate - - connects the two lesser wings - - it also helps FORM the ROOF of the SPHENOID PARANASAL SINUS
Sphenoidal Jugum
91
- - is an unpaired bone in the center of the middle cranial fossa - -wedged in between the frontal and ethmoid bones anteriorly and the two temporal bones and the occipital bone posteriorly
Sphenoid Bone
92
- - median elevation | - - forms the posterior boundary of the prechiasmatic sulcus and anterior boundary of hypophysial fossa
Tuberculum sellae
93
- - median depression in the body of the sphenoid | - - accomodates the pituitary gland
Hypophysial fossa
94
- - square plate of bone - - forms the posterior boundary of the sella turcica - - superolateral angles make up the posterior clinoid process which gives attachment to the TENTORIUM CEREBELLI
Dorsum Sellae
95
-- transmits the: Optic nerve and Ophthalmic artery
Optic Canal
96
-- located between the greater and lesser wing of sphenoid -- opens anteriorly in the orbit -- transmits: >>Superior ophthalmic vein >>Lacrimal, frontal, nasociliary br. of ophthalmic nerve >>Oculomotor nerve >>Trochlear nerve >>Abducens nerve
Superior Orbital Fissure
97
- - located posterior to the medial end of the superior orbital fissure - - transmits: Maxillary nerve
Foramen Rotundum
98
- - large foramen postero-lateral to the foramen rotundum - - opens into the infratemporal fossa - - transmits: Mandibular nerve Accessory meningeal artery
Foramen Ovale
99
- - posterolateral to the foramen ovale - - opens into the infra temporal fossa - - transmits: Middle meningeal artery and vein; Meningeal branch of mandibular nerve
Foramen Spinosum
100
- - posterolateral to hypophysial foramen - - in life it is closed by a cartilage plate - - transmits: Meningeal arterial br.; Deep petrosal nerve; Small veins
Foramen Lacerum
101
- - lie on the anterosuperior surface of the petrous part of temporal bone - - extends laterally from the foramen lacerum - - contents: GREATER PETROSAL NERVE; PETROSAL BR. OF MIDDLE MENINGEAL ARTERY
Groove for the Greater and Lesser Petrosal Nerve
102
- - largest and deepest - - formed mostly by the occipital bone - - lodges the ff: CEREBELLUM, PONS AND MEDULLA OBLONGATA - - the dorsum sellae of the sphenoid marks its anterior boundary centrally - - petrous and mastoid parts of the temporal bones contributes its anterolateral walls.
Posterior Cranial Fossa
103
-- located in the center of the anterior part of the fossa leading to the foramen magnum
Clivus
104
-- bilateral concave impressions
Cerebellar Fossae
105
-- divides the posterior cranial fossa into large bilateral concave impressions
Internal Occipital Crest
106
--where the internal occipital crest ends
Internal Occipital Protuberance
107
- - located anterosuperior to the jugular foramen | - - transmits: FACIAL NERVE; VESTIBULOCHOCLEAR NERVE; LABIRINTHINE ARTERY
Internal Acoustic Meatus
108
-- located at the petrous ridge of the temporal bone --transmits: >>Meningeal br. of ascending pharyngeal and occipital a. >>Accessory nerve >>Sigmoid sinus >>Sup. bulb of int. jugular vein >>Inferior petrosal sinus >>Vagus nerve >>Glossopharyngeal nerve
Jugular Foramen
109
(Posterior Cranial Fossa) - - located superior to the anterolateral margin of the foramen magnum - - transmits: Hypoglossal nerve
Hypoglossal Canal
110
``` (Posterior Cranial Fossa) -- major structures passing through this large foramen are: >>Dural veins >>Ant./post. Spinal arteries >>Medulla and Meninges >>Spinal accessory n. >>Vertebral arteries ```
Foramen Magnum
111
Muscles Of Facial Expression 1
``` >>Occipitofrontalis >>Orbicularis Oculi >>Corrugator Supercilli >>Procerus Nasalis >>Levator Labii Superioris Alae Que Nasi >>Orbicularis Oris >>Levator Labii Superioris ```
112
Muscles Of Facial Expression 2
``` >>Zygomaticus Major And Minor >>Levator Anguli Oris >>Risorius >>Buccinator >>Depressor Anguli Oris >>Depressor Labii Inferioris >>Mentalis >>Platysma ```
113
Epicranial Muscle Group
Occipitofrontalis
114
- - flat digastric muscle - - (+) frontal and occipital bellies that share a common tendon the epicranial aponeurosis - - covers the dome of the skull from the highest nuchal lines to the eyebrows
Occipitofrontalis
115
Occipitofrontalis (Frontal Belly)
origin: EPICRANIAL APONEUROSIS insertion: SKIN AND SUBCUTANEOUS TISSUE OF EYEBROWS AND FOREHEAD
116
Occipitofrontalis (Occipital Belly)
origin: lateral 2/3 of SUPERIOR NUCHAL LINE insertion: EPICRANIAL APONEUROSIS
117
Occipitofrontalis (Vascular supply and Innervation)
Vascular Supply: supplied by the branches of the SUPERFICIAL TEMPORAL, OPHTHALMIC, POSTERIOR AURICULAR and OCCIPITAL ARTERIES Innervation: Occipital Part -- supplied by the POSTERIOR AURICULAR BRANCH OF THE FACIAL NERVE Frontal Part -- TEMPORAL BRANCHES of the FACIAL NERVE
118
Occipitofrontalis Frontal Belly (Action)
- - elevates eyebrows - - contraction of the frontal belly protracts the scalp - - transverse wrinkles across the forehead - - gives the face a surprised look
119
Occipitofrontalis Occipital Belly (Action)
- - contraction of the occipital belly retracts the scalp - - the occipital belly with bony attachments works as a synergist with the frontal belly - - retracts the scalp;increasing effectiveness of frontal belly
120
Circumorbital and Palpebral Muscle Group
Orbicularis Oculi | Corrugator Supercilli
121
- - borad, flat, elliptical muscles - - concentric circles around orbital margin - - closes eyelids and wrinkles forehead vertically - - assists in the flow of lacrimal fluid (tears)
Orbicularis Oculi (Orbital Part)
122
Orbicularis Oculi (Orbital Part) - Origin, Insertion and Action
``` origin: -- medial orbital margin -- medial palpebral ligament -- lacrimal bone insertion: -- skin around margin of orbit -- superior and inferior tarsal plates action: -- closes eyelids tightly(winking) -- closes eyelids and wrinkles forehead vertically -- assist in the flow of lacrimal fluid (tears) ```
123
- - concentric circles around the eyelids - -arises from the medial palpebral ligament, mainly from its superficial surface, and from the bone intermediately above and below the ligament - - the muscle fibers sweep across the eyelid interlacing at the lateral commissure to form the lateral palpebral raphe
Orbicularis Oculi (Palpebral Part)
124
Orbicularis Oculi (Palpebral Part)
origin: MEDIAL PALPEBRAL LIGAMENT insertion: LATERAL PALPEBRAL RAPHE action: -- closes eyelids gently -- the palpebral portion can be contracted voluntarily, to close the lids gently as in sleep, or reflexly, to close the lids protectively in blinking
125
Orbicularis Oculi (vascular supply and innervation)
vascular supply: supplied by branches of the FACIAL, SUPERFICIAL TEMPORAL, MAXILLARY and OPHTHALMIC ARTERIES innercation: supplied by TEMPORAL and ZYGOMATIC BRANCHES of the FACIAL NERVE
126
- - small pyramidal muscle - - located at the medial end of each eyebrow - -lying deep to the frontal part of occipitofrontalis and orbicularis occult, with which it is partially blended
Corrugator Supercilli
127
Corrugator Supercilli
origin: medial end of SUPERCILIARY ARCH insertion: SKIN superior to middle of SUPRAORBITAL MARGIN and SUPERCILIARY arch vascular suppy: SUPERFICIAL TEMPORAL and OPHTHALMIC ARTERIES innervation: TEMPORAL BRANCHES of the FACIAL NERVE action: -- draws eyebrow medially and inferiorly creating vertical wrinkles above nose -- demonstrate concern or worry -- involved in frowning
128
Nasal Muscle Group
- - Procerus | - - Nasalis (Transverse and Alar Part)
129
-- small pyramidal muscle that lies close to, and ins often partially blended with, the medial side of the frontal part of occipitofrontalis
Procerus
130
Procerus
origin: fascia aponeurosis covering nasal bone and lateral nasal cartilage insertion: skin of inferior forehead between eyebrows vascular supply: branches of the FACIAL ARTERY innervation: TEMPORAL and LOWER ZYGOMATIC branches from the FACIAL NERVE action: -- draws down the medial angle of the eyebrow -- produces transverse wrinkle over the bridge of the nose -- active in FROWNING and CONCENTRATION and helps to reduce the glare of bright sunlight
131
- - consists of traverse and alar - - TRANSVERSE PART ( COMPRESSOR NARIS) is attached to the maxilla above and lateral to the incisive fossa, and lateral to the alar part - - ALAR PART (PARS ALARIS OR DILATOR NARIS POSTERIOR) is attached to the maxilla above the lateral incisor and canine, lateral to bony attachment of depressor sept, and medial to the transverse part - - vascular supply: branches from FACIAL ARTERY and from infraorbital branch of the MAXILLARY ARTERY - - innervation: BUCCAL BRANCH of the FACIAL NERVE; ZYGOMATIC BRANCH of the FACIAL NERVE
Nasalis
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-- helps to produce the upper ridge of the philtrum
Nasalis (Alar Part)
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Nasalis (Alar Part)
origin: MAXILLA insertion: ALA of NOSE action: assist in widening the nares and in elongating the nose
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Action of Nasalis (Transverse Part)
compresses the nasal aperture at the junction of the vestibule and the nasal cavity
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Buccolabial Muscle Group
- - Levator Labii Superioris Alae Que Nasi - - Levator Labi Superioris - - Zygomaticus Major - - Zygomaticus Minor - - Levator Anguli Oris - - Depressor Labii Inferioris - - Depressor Anguli Oris - - Buccinator - - Orbicularis Oris - - Platysma - - Risorious
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Levator Labii Superioris Alae Que Nasi
origin: FRONTAL PROCESS of MAXILLA insertion: MAJOR ALAR CARTILAGE vascular supply: FACIAL ARTERY and the INFRAORBITAL BRANCH of the MAXILLARY ARTERY innervation: ZYGOMATIC and SUPERIOR BUCCAL branches of the FACIAL NERVE
137
Alar Part Of Nasalis Plus Levator Labii Superioris Alae que Nasii (Action)
- - Depresses ala laterally dilating anterior nasal aperture | - - Flaring nostrils during anger or exertion
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- - Encircles the mouth within the lips - - Control entry and exit throught oral fissure - - Important during speech
Orbicularis Oris (Oral Sphincter)
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Orbicularis Oris (Oral Sphincter)
origin: --medial maxilla and mandible -- deep surface of perioral skin -- angle of mouth insertion: mucous membrane of LIPS action: -- Closes oral fissure -- Compresses and protrudes lips (KISSING) --Resists distention (when blowing)
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Levator Labi Superioris
origin: Infraorbital margin (maxilla) insertion: skin of UPPER LIP vascular supply: FACIAL ARTERY and the infraorbital branch of the MAXILLARY ARTERY innervation: zygomatic buccal branches of FACIAL NERVE action: -- Part of dilators of mouth -- Retract (elevate) / evert upper lip -- Deepen nasolabial sulcus (sadness)
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Zygomaticus Minor
origin: anterior aspect of ZYGOMATIC BONE insertion: Skin of UPPER LIP vascular supply: superior labial branch of the FACIAL ARTERY innervation: zygomatic and buccal branches of the FACIAL NERVE action: -- Part of dilators of mouth -- Retract (elevate) or evert upper lip -- Deepen the nasolabial sulcus (showing sadness)
142
Zygomaticus Major
origin: lateral aspect of zygomatic bone insertion: angle of mouth vascular supply: superior labial branch of the facial artery innervation: zygomatic and buccal branches of the facial nerve action: -- part of dilators of mouth -- elevates labial commissure bilaterally to smile(happiness) -- unilaterally to sneer(disdain
143
- - thin, flat rectangular - - more closely related to the buccal mucosa - - fibers mingle medially with orbicularis oris - - latin word: trumpeter
Buccinator (Cheek Muscle)
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Buccinator (Cheek Muscle)
origin: -- mandible -- alveolar processes of maxilla and mandible -- pterygomandibular raphe insertion: angle of mouth orbicularis oris vascular supply: branches from facial artery and buccal branch or the maxillary artery innervation: buccal branch of the facial nerve action: -- presses cheeks against molar teeth -- works with tongue to keep food between occlusal surfaces and out of oral vestibule -- resists distention (when blowing)
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Levator Anguli Oris
origin: infra-orbital maxilla (canine fossa) insertion: angle of mouth vascular supply: superior labial branch of the facial artery and the infraorbital branch of the maxillary artery action: -- part of dilators of mouth --widens oral fissure (grinning or grimacing)
146
Risorius
origin: parotid fascia; buccal skin insertion: angle of mouth vascular supply: superior labial branch of the facial artery innervation: buccal branches of the facial nerve action: -- part of dilators of mouth -- depresses labial commissure bilaterally to frown (sadness)
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Depressor Anguli Oris
origin: anterolateral base of the mandible insertion: angle of mouth vascular supply: inferior branch of the facial artery and the mental branch of the maxillary artery innervation: buccal and mandibular branches of the facial nerve action: -- part of dilators of mouth -- depresses labial commissure bilaterally to frown (sadness)
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-- quadrilateral muscle that arises from the oblique line of the mandible, between the symphysis menti and the mental foramen --passes upwards and medially into the skin and mucosa of the lower lip, blending with its contralateral fellow and with orbicular Doris
Depressor Labii Inferioris
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Depressor Labii Inferioris
origin: platysma anterolateral; body of mandible insertion: skin of lower lip vascular supply: inferior labial branch of the facial artery and the mental branch of the maxillary artery innervation: mandibular branch of the facial nerve action: --part of dilators of mouth -- retracts (depresses) and/or everts lower lip (pouting, sadness)
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-- raise from the incisive fossa of the mandible descend to attach to the skin of the chin
Mentalis
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Mentalis
ORIGIN: Body of mandible (anterior to roots of inferior incisors) INSERTION: Skin of chin (mentolabial sulcus) VASCULAR SUPPLY: labial branch of the facial artery and the mental branch of the maxillary artery INNERVATION: mandibular branch of the facial nerve ACTION: -- Elevates and protrudes lower lip -- Elevates skin of chin (showing doubt)
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- - a broad sheet of muscle which arises from the fascia covering the upper part of pectorals major and deltoid - - its fiber cross the clavicle and ascend medially in the side of the neck
Platysma
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Platysma
ORIGIN: Subcutaneous tissue of infraclavicular and supraclavicular regions INSERTION: -- Base of mandible -- Skin of cheek and lower lip -- Angle of mouth -- Orbicularis oris VASCULAR SUPPLY: submittal branch of the facial artery and by the supra capsular artery INNERVATION: cervical branch of the Facial Nerve ACTION: -- it can draw down the lower lip and corners of the mouth in expression of horror or surprise -- Depresses mandible against resistance -- Tenses skin of inferior face and neck (tension and stress)
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-- injury to facial nerve (CN VII) -- paralysis of facial muscles on affected side result to: sad look when face is relaxed; markedly contorted smile; weakened lips affect speech; food accumulation
Bell's Palsy
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- - danger triangle of the face - triangular area from upper lip to bridge of nose - - inflammation of facial vein with secondary thrombus formation and pieces of an infected clot - - result from laceration of the nose by squeezing pimples
Thrombophlebitis of Facial Vein
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Cutaneous And Superficial Muscles Of The Neck
- - Platysma - - Sternocleidomastoid - - Trapezius
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- - (G. flat plate) - - Broad thin sheet of muscle - - Covers the anterolateral aspect of the neck - - Decussate over the chin and blend with facial muscles - - Inferiorly the fibers diverge - - Deep to this muscle are the extenal jugular vein and cutaneous nerves of the neck
Platysma
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Platysma
SUPERIOR ATTACHMENT: Inferior border of the mandible, skin and subcutaneous tissues of lower face INFERIOR ATTACHMENT: Fascia covering superior parts of pectoralis major and deltoid muscles INNERVATION: Cervical branch of facial nerve (CN VII) ACTION: Draws corners of mouth inferiorly and widens it (grimace/sadness/fright) -- Draws the skin of neck superiorly when teeth are clenched producing vertical skin ridges
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The __ can be seen as a sheet of muscle by asking the patient to clench the jaws firmly.
Platysma
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- - Divides each side of the neck into anterior and lateral cervical region - - Broad strap-like muscle - - Has two heads a. Sternal Head b. Clavicular Head - - The two heads are separate inferiorly by a space called the lesser supraclavicular fossa
Sternocleidomastoid
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Sternocleidomastoid
SUPERIOR ATTACHMENT: -- Lateral surface of mastoid process of temporal bone -- Lateral half of superior nuchal line INFERIOR ATTACHMENT: -- Sternal head: anterior surface of manubrium of sternum -- Clavicular head: superior surface of medial third of clavicle INNERVATION: Spinal accessory nerve (CN XI, motor) C2 and C3 nerves (pain and proprioception)
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Sternocleidomastoid (Action)
ACTION - - Unilateral contraction: tilts head to same side and rotates it so face is turned superiorly toward the opposite side - - Bilateral contraction: (Flexion) Flexes cervical vertebrae so that the chin approaches the manubrium; Flexion also occur when lifting the head off the ground while lying supine protruding the chin while keeping the head level - - Bilateral contraction: Extension (especially for posterior fibers of the SCM) >> Extends neck at atlanto-occipital joints; elevating the chin
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How to test the Sternocleidomastoid?
- -The head is turned to the opposite side against resistance (hand against the chin) - - Normal when muscle is seen and palpated
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- - Large flat triangular muscle - muscle of neck - muscle of pectoral girdle - superficial muscle of back - - Covers the posterolateral aspect of the neck and thorax - - Attaches the pectoral girdle to the cranium and vertebral column
Trapezius
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Trapezius
ORIGIN: -- Medial third of superior nuchal line; External occipital protuberance; Nuchal ligament Spinous process (C7-T12); Lumbar and sacral spinous processes INSERTION: Lateral third of clavicle, acromion and spine of scapula INNERVATION: Spinal Accessory Nerve (CN XI; motor) C2 and C3 Nerves (pain and proprioception) ACTION: Elevates, retracts and rotates scapula superiorly -- Unilateral contraction - produces lateral flexion on the same side -- Bilateral contraction - extends the neck
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How to test the Trapezius
- - The shoulder is shrugged against resistance - - Normal when the superior border of the muscle is seen and palpated - - If the muscle is paralyzed the shoulder droops
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Suprahyoid Muscles
- - Mylohyoid - - Geniohyoid - - Stylohyoid - - Digastric
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- - Superior to the hyoid and connect it to the cranium - - These muscles constitute the substance of the floor of the mouth - - Support the hyoid in providing a base from which the tongue functions - - Elevate the hyoid and larynx in relation to swallowing and tone production
Suprahyoid Muscles
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Mylohyoid
ORIGIN: Mylohyoid line of mandible INSERTION: Mylohyoid raphe and body of hyoid INNERVATION: Nerve to mylohyoid, a branch of inferior alveolar nerve (from mandibular nerve, CN V3) ACTION: Elevates the following during swallowing and speaking: -- Hyoid -- Floor of mouth -- Tongue
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Geniohyoid
``` ORIGIN Inferior mental spine of mandible INSERTION: Body of hyoid INNERVATION: C1 via hypoglossal nerve ACTION: -- Pulls hyoid anterosuperiorly -- Shortens floor of mouth -- Widens pharynx ```
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Stylohyoid
ORIGIN: Styloid process of the temporal bone INSERTION: Body of hyoid INNERVATION: Stylohyoid branch of the preparotid facial nerve ACTION: Elevates and retracts hyoid; elongating the floor of the mouth
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-- Has two bellies joined by an intermediate tendon A. Anterior Digastric B. Posterior Digastric -- A fibrous sling connects the intermediate tendon to the body and greater horn of the hyoid
Digastric
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Digastric
ORIGIN: Anterior Belly: digastric fossa of mandible Posterior Belly: mastoid notch of temporal bone INSERTION: Intermediate tendon to body and greater horn of hyoid INNERVATION: Anterior Belly: nerve to mylohyoid, a branch of inferior alveolar nerve Posterior Belly: digastric (preparotid) branch of facial nerve ACTION: -- Working with infrahyoid muscles, depresses mandible against resistance -- Elevates and steadies hyoid during swallowing and speaking
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Infrahyoid Muscles
- - Sternohyoid - - Omohyoid - - Sternothyroid - - Thyrohyoid
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- - Often called “strap muscles” because of their ribbon like appearance - - Anchor the hyoid, sternum, clavicle and scapula - - Depress the hyoid during swallowing and speaking - - Work with the suprahyoid muscles to steady the hyoid providing a firm base for the tongue
Infrahyoid Muscles
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Infahyoid muscles are arranged in two planes namely
``` A. Superficial Plane - Sternohyoid - Omohyoid B. Deep Plane - Sternothyroid - Thyrohyoid ```
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Sternohyoid
ORIGIN: Manubrium of sternum and medial end of clavicle INSERTION: Body of hyoid INNERVATION: C1-C3 by a branch of ansa cervicalis ACTION: Depresses hyoid after elevation during swallowing
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-- Has two bellies united by an intermediate tendon A. Superior Belly B. Inferior Belly -- The fascial sling for the intermediate tendon connects to the clavicle
Omohyoid
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Omohyoid
ORIGIN: Superior border of scapula near suprascapular notch INSERTION: Inferior border of hyoid INNERVATION: C1-C3 by a branch of ansa cervicalis ACTION: Depresses, retracts and steadies hyoid
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-- covers the lateral lobes of the thyroid gland
Sternthyroid
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Sternothyroid
ORIGIN: Posterior surface of manubrium of sternum INSERTION: Oblique line of thyroid cartilage INNERVATION: C2 and C3 by a branch of ansa cervicalis ACTION: Depresses hyoid and larynx
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- - Appears to be the continuation of the sternothyroid muscle - - Runs superiorly from the oblique line of the thyroid cartilage to the hyoid
Thyrohyoid
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Thyrohyoid
ORIGIN: Oblique line of thyroid cartilage INSERTION: Inferior border of body and greater horn of hyoid INNERVATION: C1(via hypoglossal nerve-CN XII) ACTION: -- Depresses hyoid -- Elevates larynx
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-- Deep to prevertebral layer of deep cervical fascia -- Can be grouped to either: A. Anterior Vertebral Muscles -Longus colli -Longus capitis -Rectus capitis anterior -Anterior scalene B. Lateral Vertebral Muscles -Rectus capitis lateralis -Splenius capitis -Levator scapulae -Middle Scalene and Posterior Scalene
Prevertebral Muscle
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Longus colli
``` SUPERIOR ATTACHMENT anterior tubercle of C1 bodies of C1-C3 transverse processes of C3-C6 vertebrae INFERIOR ATTACHMENT bodies of C5-T3 transverse processes of C3-C5 vertebrae INNERVATION: Anterior rami of C2-C6 spinal nerves ACTION: Acting unilaterally: Flexes the neck with rotation (torsion) to opposite side ```
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Longus Capitis
SUPERIOR ATTACHMENT: Basilar part of occipital bone INFERIOR ATTACHMENT: Anterior tubercles of C3-C6 transverse processes INNERVATION: Anterior rami of C1-C3 spinal nerves ACTION: Flex head
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Rectus Capitis Anterior
SUPERIOR ATTACHMENT: Base of cranium, anterior to occipital condyle INFERIOR ATTACHMENT: Anterior surface of lateral mass of atlas C1 vertebra INNERVATION: Branches from loop between C1 and C2 spinal nerves ACTION: Flex head
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Anterior Scalene
SUPERIOR ATTACHMENT: Transverse processes of C3-C6 vertebrae INFERIOR ATTACHMENT: 1st rib INNERVATION: Cervical spinal nerves C4-C6 ACTION: Flex head
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Rectus Capitis Lateralis
SUPERIOR ATTACHMENT: jugular process of occipital bone INFERIOR ATTACHMENT: transverse process of atlas (C1 vertebra) INNERVATION: Branches from loop between C1 and C2 spinal nerves ACTION: Flexes head and helps stabilize it
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Splenus Capitis
SUPERIOR ATTACHMENT: Inferior half of nuchal ligament spinous processes of superior 6 thoracic vert. INFERIOR ATTACHMENT: lateral aspect of mastoid process lateral third of superior nuchal line INNERVATION: Posterior rami of middle cervical spinal nerves ACTION: -- laterally flexes and rotates head and neck to same side -- acting bilaterally, extends head and neck
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Levator Scapulae
SUPERIOR ATTACHMENT: Posterior tubercle of transverse processes C2-C6 vertebrae INFERIOR ATTACHMENT: Superior part of medial border of scapula INNERVATION: Dorsal scapular nerve C5 and cervical spinal nerves C3 and C4 ACTION: Downward rotation of scapula and tilts its glenoid cavity inferiorly by rotating scapula
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Middle Scalene
SUPERIOR ATTACHMENT posterior tubercles of transverse processes C5-C7 vertebrae INFERIOR ATTACHMENT Superior surface of 1st rib; posterior to groove for subclavian artery INNERVATION: Anterior rami of cervical spinal nerves ACTION: -- Flexes neck laterally -- Elevates 1st rib during forced inspiration
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Posterior Scalene
SUPERIOR ATTACHMENT: posterior tubercles of transverse processes of C5-C7 INFERIOR ATTACHMENT: external border of 2nd rib INNERVATION: Anterior rami of cervical spinal nerves C7 and C8 ACTION: Flexes neck laterally Elevates 2nd rib during forced inspiration
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Temporal fossa boundaries:
- - Posterior and superior: temporal lines - - Anterior: frontal and zygomatic bones - - Lateral: zygomatic arch - - Inferior: infratemporal crest
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The floor of the temporal of the temporal fossa is formed by parts of the bones that form the pterion namely:
1. Frontal 2. Parietal 3. Temporal 4. Greater wing of Sphenoid
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-- fan-shaped muscle arises from the bony for and overlying the temporal fascia which form the roof of the temporal fossa
Temporalis muscle
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-- is an irregularly shaped space deep and inferior to the zygomatic arch, deep to the rams of the mandible, and posterior to the maxilla
Infratemporal Fossa
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The boundaries of the infra temporal fossa are as follows:
1. Lateral - Ramus of mandible 2. Medial - lateral pterygoid plate 3. Anterior - Maxilla 4. Posterior- Tympanic plate; Mastoid process; Styloid process 5. Superior - Greater wing of Sphenoid 6. Inferior - mandible near the angle
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Contents of the Infratemporal Fossa
1. Muscles 2. Arteries 3. Veins 4. Nerves
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Muscles of the Infratemporal Fossa
- - Temporalis - - Lateral Pterygoid - - Medial Pterygoid
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Temporalis
ORIGIN: Temporal Fossa INSERTION: Coronoid process and Anterior border of Ramus INNERVATION: Anterior trunk of mandibular nerve (CN V3) via Deep temporals branches ACTION: Elevates mandible, closing jaws; posterior, more horizontal fibers are primary retractors of mandible
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Lateral Pterygoid
ORIGIN: -- greater wing of sphenoid -- lateral pterygoid plate INSERTION: Condylar process of the mandible INNERVATION: Anterior trunk of mandibular nerve (CN V3) via lateral pterygoid nerve ACTION: -- bilateral: protracts mandible and depress chin -- unilateral: swing jaw toward contralateral side -- produces lateral chewing movement
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Medial Pterygoid
ORIGIN: Two heads embraces the Inferior head of L Pterygoid INSERTION: Medial surface of Mandible near the angle INNERVATION: Anterior trunk of mandibular nerve (CN V3) via medial pterygoid nerve ACTION: -- acts synergistically with the masseter to elevate the mandible -- alternate unilateral activity produces smaller grinding movements
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Muscle of Mastication
- Temporalis -- Munches or Closes the Jaw - Medial Pterygoid -- Munches or Closes the Jaw - Masseter -- Munches or Closes the Jaw - Lateral Pterygoid --Lowers the jaw
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Masseter
ORIGIN: Zygomatic arch INSERTION: Lateral surface of ramus coronoid INNERVATION: Anterior trunk of mandibular nerve (CN V3) via masseteric nerve ACTION: elevates mandible; closing jaws; superficial fibers make limited contribution to protrusion of the mandible
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Infratemporal fossa (Arteries) - - branch of external carotid artery - - arises posterior to the neck of the mandible - - divided into 3 parts by the Lateral Pterygoid
Maxillary Artery
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-- deep to the neck of mandibular condyle -- Branches: >> Deep auricular >> Anterior Tympanic >> Middle Meningeal >> Accessory Meningeal >> Inferior Aveolar
Maxillary Artery (First Part -- Mandibular)
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-- passes superficial or deep to the lateral pterygoid muscle -- Branches: >> Deep temporal >> Pterygoid >> Masseteric >> Buccal
Maxillary Artery (Second Part -- Pterygoid)
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-- disappears through the pterygomaxillary fissure -- enters the pterygopalatine fossa -- Branches: >> Inferior orbital >> Posterior superior alveolar/ Dental >> Descending palatine >> Artery of the pterygoid canal >> Pharyngeal >> Sphenopalatine
Maxillary Artery (Third Part -- Pterygopalatine)
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- Partly between the temporal and pterygoid muscles - Connected to the facial vein by the cavernous sinus
Infratemporal Fossa Contents: Veins
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Nerves (Infratemporal Fossa) - - largest branch of the trigeminal nerve - - Descends through the foramen ovale into the IT fossa - - Supply the muscles of mastication
Mandibular Nerve
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Nerves (Infratemporal Fossa) - - Encircles the middle meningeal artery - - Largest branch passes posteriorly - - Sensory to auricle and temple - - Parasympathetic secretomotor to the parotid
Auricolotemporal Nerve
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Nerves (Infratemporal Fossa) -- enters the mouth between medial pterygoid, ramus of the mandible passes under the cover of the oral mucosa inferior to the third molar
Lingual Nerve
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Nerves (Infratemporal Fossa) - - Runs anteriorly on the buccinator muscle - - Piercing but not supplying - - Supplies the mucous membrane of the cheek and posterior part of the buccal surface of the gingiva
Buccal Nerve
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Nerves (Infratemporal Fossa) - - A branch of the Facial Nerve - - Carries taste fibers to the anterior 2/3 of the tongue - - Joins the lingual nerve in the IT fossa - - Secretomotor to the submandibularand sublingual glands
Chorda tympani
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Nerves (Infratemporal Fossa) - - Inferior to the foramen ovale - - Medial to the mandibular nerve - - Posterior to the medial pterygoid muscle - - Parasympathetic functions
Otic ganglion
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- - Mandere - to masticate - - U-shaped bone - - Largest and strongest bone of the Face - - Composed of two symmetrical halves - -Parts: 1. Body - horizontal part 2. Rami - vertical part; have 2 processes 3. Angle
Mandible
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- - Posterior | - - Head and neck articulates w/ mandibular fossa of the temporal bone
Condylar Process
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- - Between Coronoid and Condylar processes | - - Transmit nerves and vessels to the masseter
Mandibular notch
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- - Located in the inner aspect of the ramus - - Entrance to the mandibular canal - - Transmit the inferior alveolar nerve and vessels
Mandibular foramen
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(Mandibular foramen) | -- thin tonguelike projection of bone overlapping the foramen
Lingula
222
(Mandibular foramen) - - small groove that runs inferiorly and anteriorly - - contains the mylohyoid nerve and artery
Mylohyoid groove
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- - Divides the internal surface of the mandible into 2 areas - - Origin of the Mylohyoid muscle
Mylohyoid line
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- - located superior to anterior end of mylohyoid line | - - origin of genioglossus
Mental spine
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Genioglossus
ORIGIN: superior mental spine on posterior surface of symphesis menti INSERTION: Central mass of tongue and mucous membrane NERVE: Hypoglossal Nerve (XII) ACTION: Protracts tongue
226
(NEWBORN) -- fibrous tissue joint in the median plane that unites the 2 halves of the mandible 1ST YR- begin to fuse 2nd YR- completely fused
Symphysis Menti
227
Fractures of the mandible
-- occur on opposite sides of the mandible >> Coronoid process - single >> Neck - transverse, may be associated with dislocation of the Temporomandibular joint on the same side >> Angle – oblique, may involve the socket of the 3rd molar tooth >> Body – pass through the socket of the canine tooth
228
-- a hinge and gliding joint and is the most constantly used joint in the body
Temporomandibular Joint
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Temporomandibular joint: Normal VS Abnormal
Normal closed position -- Jawbone is separated from skull by a soft disk that acts as a cushion when you chew, speak or swallow Normal Open Position -- Disk stay in place when jaw is in use Abnormal -- Disk is pulled forward when jaw is in use, causing the bone structures to grind together
230
Temporomandibular Joint Disorder
1. Trauma - - Bruxism - the involuntary or habitual grinding of the teeth, typically during sleep - - Teeth Loss 2. Arthritis - - Degenerative - - Rheumatoid
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Borders of Abdominal wall
Superiorly-diaphragm Inferiorly-pelvic inlet Anteriorly * above-lower part of T-cage * below-rectus abdominis, ext & int oblique, transversus abdand fasciae Posteriorly-lumbar vertebrae * Lateral-12th ribs, upper bony pelvis, psoas, quadratus lumborum, aponeurosis transv abdomen
232
Subdivisions of Abdomen
- - Anterior wall - - Right lateral wall - - Left lateral wall - - Posterior wall
233
Surface anatomy of the Abdomen
Landmarks: - - Costal arches - - Umbilicus - - Iliac crest - - Symphysis pubis - - Inguinal fold - - Linea alba
234
Layers of the Abdomen
1. Skin -- loose except umbilicus - Lines of tension = transverse (transverse incision less obvious scar) 2. Fascia 3. Muscles - - 4 paired: 3 flat; 1 straplike - - Strengthens abdominal wall - - Decreases risk of protrusion of viscera
235
- - fibrous raphe by decussation of 3 abd muscles - - midline, fr xyphoid to symphysis pubis - - few blood vessels - - incision thru it has less bleeding
Linea alba
236
Layers of Facsia
a. Superficial Fascia 1. Superficial fatty=CAMPER’s - - blood vessels/nerves ramify - - represented by Dartos musclein the scrotum - - Panniculus adiposus 2. Deep membranous = SCARPA’s - - attached to linea alba - - equivalent to Colles’ fasciain the perineum b. Deep Fascia – very thin
237
-- Most superficial Free inferior margin = inguinal ligament (POUPART’S LIGAMENT) LACUNAR LIGAMENT (GIMBERNAT’S) -- reflected downward, backward and lateral COOPER’S LIGAMENT - Lateral
External Oblique
238
- - Interdigitate w/ serratus anterior and latissimus dorsi - - Obliquely downward and medially - - Form aponeurosis
External Oblique
239
-- triangular defect above & medial to pubic tubercle
Superficial inguinal ring
240
- - Deep to external oblique - - Upward and medial - - Aponeurotic fibers of int oblique and transversus abdominis = conjoint tendon - - Form aponeurosis w/c splits to form rectus sheath - - The lower fibers forms the CREMASTER MUSCLE in the scrotum
Internal Oblique
241
- - Innermost - - Flat - - Ends in aponeurosis - - Contribute to conjoint tendon
Transversus Abdominis
242
- - On either side of linea alba - - Segmented = tendinous intersections - - Lateral borders convex = linea semilunaris
Rectus Abdominis
243
- - Not always present | - - Tenses linea alba
Pyramidals
244
External Oblique
``` ORIGIN: 5-12th ribs INSERTION: Linea, Iliac crest pubic tubercle ACTION: -- compress/support abdominal viscera -- flex/rotate trunch ```
245
Internal Oblique
``` ORIGIN: TL fascia iliac crest INSERTION: 10-12th rib linea alba ACTION: -- compress/support abdominal viscera -- flex/rotate trunk ```
246
Transversus Abdominis
ORIGIN: 7-12th costal catilage TLf, IC, IL INSERTION: Linea pubic crest ACTION: Compress/support abdominal viscera
247
Rectus Abdominis
ORIGIN: Pubic symphysis; pubic cres INSERTION: Xyphoid 5-7 costal cartilage ACTION: flex trunk; compress abdominal viscera
248
Contents of the Rectus Sheath
- - Pyramidalis - - Superior and inferior epigastric vessels - - Nerves that supply rectus and transversus abdominis
249
- - Lines the transversus abdominis muscle - - Continuous with diaphragmatic fascia, iliacus fascia, and pelvic fascia - - Forms the femoral sheathfor the femoral vessels of the lower ext. - - Endo-abdominal fascia
Transversalis Fascia
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Lies between the transversalis fascia and perotoneum
Properitoneal fat pad
251
Internal lining of the abdomen
Parietal Peritoneum
252
Other structures of the Abdomen
- - Median umbilical vein - - Lateral umbilical vein - - Ligamentum teres hepatis
253
Functions of 3 Flat Anterior Abdominal Muscles
1. Support abdominal contents during sitting and standing 2. Muscle girdle that exerts pressure on abdominal contents Contraction = generates increased intraabdominal pressure for: expulsion of air [cough/ sneeze] ; bearing down -defecate/urinate/parturition 3. Approximate rib cage to pelvis 4. Stabilize vertebral column by raising IAP.
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Nerve Supply (Abdomen)
-- Ventral rami of T6-12, L1 spinal nerves -- Sensory -- End as anterior cutaneous branches w/c emerge thru anterior rectus sheath (Numbness of abdominal incision) -- 2 branches of ventral ramus of L1 nerve 1] iliohypogastric –medial location; skin over inguinal location 2] ilioinguinal –anterior location; skin over superomedial thigh
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Blood Supply (Abdomen)
1. Thoracic and abdominal aorta 2. Superior epigastric artery -terminal branch of internal thoracic artery; Supplies the Rectus abdominis 3. Inferior epigastric artery - branch of external iliac artery; Rectus abdominis
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Venous Drainage (Abdomen)
1. Superior Vena Cava - superior epigastric vein - intercostal vein - subcostal vein 2. Inferior Vena Cava - inferior epigastric vein - deep circumflex iliac vein - lumbar vein - thoracoepigastric vein
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-- connect network of veins through the umbilicus and along the ligamentum teres to the portal vein (portal-systemic venous anastomosis)
Paraumbilical veins
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- - distended subcutaneous veins radiating from umbilicus | - - Seen in portal hypertension
Caput Medusae
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Lymphatics (Abdomen)
1. Axillary nodes – above umbilicus | 2. Inguinal nodes – below umbilicus
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-- Forms a triangle -- Boundaries Inferior –inguinal ligament Superior –horizontal line ASIS to lateral margin of rectus Medial –lateral margin of rectus
The Inguinal Region
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- - Oblique path thru inguino-abdominal region - - 4 –5 cm - - Entrance: abdominal deep inginal ring - - Exit: superficial inguinal ring - - Connects extraperitoneal space of abdomen to scrotum or labia major - - Newborn-deep ring almost directly posterior from superficial ring
Inguinal Canal
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Wall of Inguinal Canal
Floor– inguinal and lacunar lig Roof – arched fibers of int obl + transv and Anterior – ext obl aponeurosis Posterior– transversalis fascia + conjoint tendon
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Types of Abdominal Hernia
1. Inguinal a) direct, b) indirect 2. Femoral 3. Umbilical 4. Epigastric 5. Incisional hernia 6. Spigelian hernia-Linea semilunaris 7. Petit’s triangle hernia-ext oblique, lat dorsi, iliac crest 8. Internal hernia 9. Littre’s hernia
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– protrusion of a structure, viscus or organ from the cavity where it belongs - -Parts: 1. Orifice 2. sac 3. content
Hernia
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(Type of Hernia) - - Leaves abd cavity lateral to inferior epigastric vessels - - Common in males - - Passes thru patent processus vaginalis
Indirect inguinal hernia
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- - hernia that is common in R side - - Common in children & young adult - - Neck is narrow - - May extend to scrotum
Indirect inguinal hernia
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- - a type of hernia where it protrudes anteriorly thru posterior wall of inguinal canal - - Leaves abd cavity medialto inf epigastric vessels - - Due to weakening of anterior abd muscles and transversalis facia - - Due to repeated inc. IAP(Intraabdominal Pressure) like coughing, straining - - Common in elders; Neck is wide; Rare in women
Direct inguinal hernia
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- - a type of hernia that lies below and lateral to pubic tubercle - - More common in women - - Passes through the femoral canal
Femoral Hernia
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Type of Umbilical Hernia | exomphalos - failure of midgut to return to the abdominal cavity in fetal life. With membrane
Omphalocoele
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Type of Umbilical Hernia | -- weakness in scar of umbilicus
Acquired infantile
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Type of Umbilical Hernia - paraumbilical hernia. - does not protrude through umbilical scar but linea alba
Acquired adult
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Type of Umbilical Hernia | - Defect through anterior abdominal wall which abdominal content freely protrude
Gastroschisis
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-- Hernia located at the midline epigastric area
Epigastric Hernia
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-- Hernia as a result non-closure of previous incision after surgery
Incisional Hernia
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-- Hernia located in the linea semilunaris
Spigelian Hernia
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-- Hernia from the inferior lumbar triangle
Petit’s Hernia
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-- Hernia of the superior lumbar triangle
Grynfeltt’s Hernia
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-- Hernia located intra-abdominally
Internal Hernia
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-- Hernia wherein only one part of the wall protrudes out into the sac
Littre’s Hernia
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Division of Abdominal Wall (4 Quadrants)
- - R Upper Quadrant/RUQ - - LUQ - - R Lower Quadrant/RLQ - - LLQ
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Division of Abdominal Wall - 9 Regions
- - Epigastric - - R /L hypochondrium - - R / L Lumbar - - Umbilical - - R/ L Iliac - - Hypogastric
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Division of Abdominal Wall -- Planes
Planes for regional division Subcostal – thru costal margins Transtubercular – thru iliac tubercles Plane for quadrant division Transumbilical – thru umb.
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Surgical Incisions (Abdomen) - Midline incision
1. Xiphoid-pubic 2. Supraumbilical 3. Infraumbilical
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Surgical Incisions (Abdomen) - Longitudinal
- - Paramedian - lateral to the median plane - - Pararectus - - Transrectus
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Surgical Incisions -- Transverse
1. Supraumbilical -- above the umbilical line 2. Rockey-Davis - for appendectomy 3. Pfannenstiel - bikini incision
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Surgical Incisions (Abdomen) - Oblique incision
1. Kocher’s 2. Gibson’s 3. McBurney’s 4. Lumbotomy
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Surgical Incisions (Abdomen) - Other incisions
1. Chevron | 2. Hockey stick
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Abdominal Surgical Incisions
1. Midline –done rapidly; no blood vessels cut (less bleeding); incise at linea alba; entry for trauma 2. Paramedian –lateral to midline; encounter bleeding; entry for complicated appendicitis 3. Suprapubic – above pubic symphysis; below arcuate line; entry for pelvic organs, cesarian section 4. Subcostal –below ribs [costal margin]; cut thru rectus muscle; bleeds [cut sup epig vessels]; entry for gallbladder[R]/spleen[L] 5. McBurney –oblique at R lower area; cut thru all flat muscles; entry for appendicitis
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Posterior Abdominal Wall is composed of:
1. Bones–Lumbar vertb., Sacrum , Ilium 2. Muscles–Diaphragm, Psoas, Iliacus, Quadratus lumborum 3. Fascia–Iliac, Quadratus lumborum, Thoracolumbar 4. Blood vessels 5. Nerves–Lumbosacral plexus 6. Fats 7. Lymph nodes
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Muscles of the Posterior Abdominal Wall
* Diaphragm * Quadratus lumborum * Psoas major * Psoas minor * Iliacus
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Psoas Major
thick, fusiform ; “ muscle of the loin” ORIGIN: Transverse processes of the lumbar vertb; sides of bodies of T12 –L5 INSERTION: Lesser trochanter of femur ACTION: Flexes the vertb. Column, flexes the hip NERVE SUPPLY: L2L3L4
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Iliacus
–large, triangular on the lateral side of Psoas major ORIGIN: Superior 2/3 of iliac fossa; ala of sacrum; sacroiliac ligament INSERTION: Lesser trochanter of femur ACTION: Flexes thigh and stabilizes hip joint, flexes the trunk NERVE SUPPLY: Femoral nerve (L2L3L4)
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Quadratus lumborum
ORIGIN: Inferior border of 12thrib; tips of lumbar transverse processes INSERTION: Iliolumbar ligament; Iliac crest ACTION: Extends and Laterally flexes the vertb. Column NERVE SUPPLY: Ventral branches of T12 and L1 –L4
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- - Body is massive and kidney shaped - - Intervertebral disc is thicker than other region - - Wedge-shaped-responsible for normal lordosis
Lumbar Vertebrae
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- - Head has single facet - - Anterior end is pointed - - Has a small costal cartilage
Twelfth pair of Ribs
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Ventral Primary Divisions Of The Lumbar, Sacral And The Coccygeal Nerves
- - lumbar and sacral plexusessupply the lower limb | - - sacral nerves supply: the perineum (pudendal plexus) and the coccygeal region (coccygeal plexus)
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- - ventral primary divisions of 1st three and greater part of the 4th lumbar nerves - (+)contributions fr the 12th thoracic nerve - - situated on either sides of the post. abd’l wall dorsal to the psoasor ventral to the transverse processes of the vertebrae
Lumbar plexus
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Branches Of The Lumbar Plexus
- - ilioinguinal - - iliohypogastric - - genitofemoral- supply the caudal part of the parieties of the abd’l wall - - lateral femoral cutaneous - - accessory obturator - - obturator - - femoral - supply the anterior thigh and medial part of the leg
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The Largest Branches Of The Lumbar Plexus
1. Obturator 2. Femoral 3. Lumbosacral Trunk
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course: lateral border of psoas major, crosses quadratus and pierces post part of transversalis abddivides into: 1. lateral cutaneous br 2. anterior cutaneous br 3. muscular branches to int obliqueand transversus abdominis
Iliohypogastric
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course: similar to the hypogastric but caudal to it areas of distribution: 1. skin over proximal and medial thigh,r oot of penis and scrotum, mons pubis and labia majora 2. muscular branches to the I.O. and transversus abdclinical
ilioinguinal nerve
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``` -- Superior lumbar triangle (Grynfeltt-Lesshaft triangle) Borders superior: 12th rib lateral: Internal oblique medial: Quadratus lumborum ```
Hernia of the Back
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``` Inferior lumbar triangle (Petit’s Triangle) Borders -lateral: external oblique -medial: latissimus dorsi -inferior: iliac crest ```
Hernia of the Back
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– has no diagnostic value on patients suspected of having neurologic disease - - technique is insensitive and nonspecific - - Abnormalities seen rarely provide sufficient information for patient’s management - - Shows bone density changes in some metabolic and pathologic conditions
Plain skull radiography
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– technique of choice for the initial diagnostic evaluation of most patients with neurologic disease
CT Scan / MRI
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- - PA view with 15 degree tilt of the tube caudally | - - Permits visualization of orbital structures: superior orbital fissures; sphenoid wings and frontal sinuses
Caldwell’s X-Ray Projection
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- - AP view with a 30 degree tilt of the tube caudally | - - Visualizes: occipital bone; mandibular condyles and mastoids
Towne’s View
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What We Look For In A Routine Skull Radiograph
- - Check all calcifications, such as may be found in the dura, the falx cerebri, pineal gland, choroid plexuses, petroclinoid ligament and the habenular commissure - - Carefully define the sella turcica, its anterior and posterior clinoid processes and tuberculum sellae - - The petrous ridges, orbits, sphenoid ridges, temporal bones and facial bones are carefully studied bilaterally
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What To Study On Lateral Skull Views
``` Blood Vessel Markings - pattern of the blood vessels grooves should be observed closely on lateral view - Middle Meningeal Artery (MMA) - Diploic Veins Sutures ```
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- - Lateral view shows an oval shaped central depression in the sphenoid bone - - It contains the pituitary gland - - Normal measurement are 16 to 17 mm in the AP diameter
Sella Turcica
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-- Right mandible clearly showing right ramus, angle and alveolar margins of the mandible
Right Oblique X-Ray View Of Mandible
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Layers of the abdominal wall in Midline incision:
skin>>fascia (camper's and scarpa's)>>linea alba>>transversalis fascia>> extraperitoneal fat>>peritoneum
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Layers of the abdominal wall in Paramedian Incision
- - skin, fascia (camper's and scarpa's) and the anterior rectus sheath are incised - - The anterior rectus muscle is freed from the anterior sheath and retracted laterally. - - The posterior rectus sheath (if above the arcuate line) or transversalis fascia (if below the arcuate line), extraperitoneal fat and peritoneum are then excised allowing entry to the abdominal cavity.
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Layers of the abdomen in Transverse Incision
skin, fascia, anterior rectus sheath, rectus muscle (+/- internal oblique, depending on the length of the incision), transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum. The medial aspect of this incision will be through the layers just like as in the midline incision.
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Layers of the abdominal wall in Subcostal Incision
Skin, rectus sheath, rectus muscle, internal oblique, trasnversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.
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Layers of the abdominal wall in McBurney's Incision
skin, fascia, internal oblique medially and external oblique laterally, transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.
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Layers of the abdominal wall in Pfannenstiel incision
skin, fascia, anterior rectus sheath, rectus muscle, transversalis fascia, extraperitoneal fat, perineum.

Anatomy (10 decks)

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