Download Human Anatomy, Physiology, and Disease Processes

Gross Anatomy Review
for NBEO Part 1
Sunday, June 13, 2004
Christine Garhart, DVM, PhD
References:
Moore and Agur Essential Clinical Anatomy 2nd
ed. Chapters 9-10.
Sauerland Grant’s Dissector 12th ed. Chapter 7.
Moore and Dalley Clinically Oriented Anatomy
4th ed. Chapters I, 1, 2, 7, 8, and 9.
Additional references
• Fehrenbach and Herring Illustrated
Anatomy of the Head and Neck 2nd ed.
Chapters 6 and 10.
• Richard S.Snell Clinical Anatomy 7th ed.
Chapter 11.
Sample Questions
http://www.optometry.org/sample_items.htm
A 31-year-old female is deaf in her right ear and is
unable to close her right eye, but has no loss of
touch sensation on the right side of her face. The
MOST likely site of a single lesion that would
account for her symptoms is the:
a. superior orbital fissure
b. cavernous sinus
c. internal auditory meatus
d. stylomastoid foramen
e. crus cerebri
Sample Questions
http://www.optometry.org/sample_items.htm
The muscles of mastication are innervated by motor
neurons whose cell bodies are located in the:
a.
b.
c.
d.
dorsal motor nucleus of the vagus nerve
motor nucleus of the facial nerve
motor nucleus of the trigeminal nerve
salivatory nucleus
Nerves and vessels in the interior of the cranial base
Moore&Agur 10.2B
Cranial nerve VII and internal auditory meatus (right
ear viewed from above)
Snell 11.69A
Skeleton of the head and neck
• Cranium
– Neurocranium
• Calvaria (skull cap) bones: frontal, parietal, sphenoid,
temporal, occipital, ethmoid
• Cranial base-palatine bone in addition to above
– Face (viscerocranium)
• Lacrimal, vomer, maxilla, zygomatic, nasal, palatine,
mandible, inferior nasal conchae
• Cervical vertebrae
– C1 = atlas; C2 = axis; C3-C7 are typical vertebrae
Paranasal sinuses Moore&Dalley 7.71a
Divisions of trigeminal nerve (V) Sauerland 7.1
Muscles of the face
• More superficial (study handout)
– Orbicularis oculi, orbicularis oris, platysma,
frontal, occipital, auricular , zygomaticus,
risorius , depressor anguli oris, levator labii
superioris
• Deeper
– Levator anguli oris, depressor labii inferioris,
buccinator, corrugator supercilii, mentalis,
nasalis
Muscles of mastication
•
•
•
•
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
Attachments and actions of the muscles of
mastication
Snell 11-40 C
Vasculature of the face
• Arteries are branches of the external carotid artery
– Facial artery is major supply; crosses mandible anterior to masseter
and extends to medial canthus
– Superficial temporal artery ends in the scalp and gives rise to
transverse facial within the parotid gland
– Maxillary artery runs deep to the mandible.
• Venous drainage into jugular veins
– Facial vein from medial angle of eye to internal jugular
– Superficial temporal vein from scalp and forehead joins posterior
auricular forming the external jugular
Branches of the external carotid artery
Moore&Agur 8.26
Great vessels supplying and draining the head and
neck (arteries in red)
Fehrenbach&Herring 6-1
Venous drainage
of head: note
communication of
facial veins with
cavernous sinus
(red is internal
jugular vein)
Fehrenbach&
Herring 6-10
Lymphatic drainage of the neck and upper body
Fehrenbach& Herring 10-1
Nerves of the Face
• Trigeminal (CN V)
– Sensory (mainly) and motor to muscles of mastication
– 3 main divisions:
• 1. Ophthalmic - sensory
• 2. Maxillary- sensory
• 3. Mandibular- largely sensory and motor
– Trigeminal ganglion contains cell bodies of sensory
nerves
• Facial (CN VII)
– Motor to the muscles of the face
– 6 extracranial branches
• Temporal, zygomatic, buccal, mandibular, cervical, posterior
auricular
Posterior triangle
of the neck
Sauerland 7.46 A
Anterior triangles
of the neck
Sauerland 7.51
Pharynx
• The head contains the openings of both the alimentary and
respiratory tracts.
• They are separated by the palate (hard- bone and soft- a
soft tissue extension of the hard)
• Both tracts “merge/cross” in the pharynx.
– Nasopharynx- posterior to the nose and superior to the soft palate
– Oropharynx- posterior to the mouth (between the soft palate and
pharyngoepiglottic fold)
– Laryngopharynx- posterior to the pharynx
• During swallowing the soft palate acts as a valve to
prevent food from entering nasopharynx and the epiglottis
closes the larynx.
Midsagittal diagram of pharynx Moore 7.51
Number of lung lobes varies with species
Humans have 5 lobes Moore & Agur
Pleura
Moore
&
Agur
2.16a
Dual arterial blood supply to the
lungs
• Pulmonary
– Primary supply, large volume
– Deoxygenated blood from the RV
– Low pressure, elastic arteries
• Bronchial
– Branches from the aorta
– Supplies the pleura and airway walls
– Typical muscular arteries
Pulmonary blood supply to the lungs Moore & Agur
Bronchial
blood supply
from aorta to
the lungs
Moore &
Dalley 1.34 A
Venous drainage of the lung
• Pulmonary veins (4) into left ventricle
– Main return, large volume
– Oxygenated blood
• Bronchial veins
– Return some of the blood supplied by the bronchial arteries
– Azygos on right to vena cava
– Hemiazygos from the left to brachiocephalic vein
Lymphatic drainage of the lungs Moore &
Dalley fig. 1.35
Autonomic
nerve supply to
the lungs
Moore &
Dalley 1.36
Sympathetic trunks
• Begin at level of C1
• Three cervical sympathetic ganglia
– Superior-- at level of C1, C2
– Middle--at C6
– Inferior-- usually fuses with 1st thoracic ganglion
forming cervicothoracic or stellate.
• Cervical ganglia receive presynaptic fibers from
the superior thoracic spinal nerves and white rami
communicantes through the sympathetic trunk.
• From the ganglia fibers may pass to the ventral
rami of cervical nerves or form plexuses along
carotid and vertebral arteries.
Cervical sympathetic trunk and ganglia
Moore&Dalley 8.20 A
Horner’s Syndrome
• A sympathetic disturbance due to a lesion of a
sympathetic trunk in the neck.
• Signs:
– Pupillary constriction due to paralysis of the dilator
pupillae.
– Ptosis due to paralysis of smooth muscle mixed with
the striated muscle of the upper eyelid.
– Sinking in of eye may be due to paralysis of orbitalis m.
– Vasodilation and absence of sweating on the face and
neck due to lack of sympathetic nerve supply to glands
and vessels.