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‫السالم عليكم و رحمة هللا و بركاته‬
Before we start…..
When we studied the cranial and facial bones we said that they will contribute
in forming things , for example they will form fossa such as anterior cranial
fossa or they will form a cavities such as the orbital cavity & nasal cavity . so
because they are intercalated , they are overimposed they contribute to form
so many things . that is why sometimes y might see a bone that is not
visualized from neither any surface of the skull& y see it will form things . for
example, ethmoid bone , y see that this bone contribute to forming part of the
anterior cranial fossa , it will form the part of the septum of the nose &part of
the lateral wall of the nose , sometimes y will be able to see the ethmoid bone
somewhere in the orbit.
The Dr advise us not to study the bones that are related to each other alone,
we must imagine the bones in a 3 D and study them in related to each other.
A Cavity that is almost round &have boarders & walls .
Bony cavities in which the eyes are firmly encased and cushioned by fatty
tissue
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Superior
(roof)
***Completely made by orbital plate ( horizontal
plate) of frontal bone .which is very thin plate and
is the continuation of the squamous part of the
frontal bone.(when we view the base of the skull
from the superior view y can see it)
***At supraorbital margin of the frontal bone there
are :
 Supraorbital foramen
 Supraorbital notch
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***Formed by :
inferior
a) Mostly by the orbital surface of maxilla
(floor)
b) The lateral & anterior small portion of the inferior
wall is made by the superior surface of the medial wall
of the zygomatic
***Formed by:
1) Greater wing of the sphenoid bone
2) Zygomatic process of the frontal bone
Lateral
wall
3) Orbital surface ( frontal process) of the zygomatic
bone
(( zygomatic bone: bulky triangular bone , the medial
wall of the zygomatic bone form the lateral wall of the
orbit))
*** formed by:
1) frontal process of the maxilla (extending upward forward)
2) Maxillary process of the frontal bone (extending downward backward)
Medial
wall
3) lacrimal bone ( has nothing to do with other bones)
4) lateral wall of the mass of the ethmoid bone
(ethmoid bone: has horizontal and perpendicular plates , from the horizontal plate
we have 2 masses come down )
***Note: the nasal bone is not considered as part of any wall of the orbit
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^^^Made by :
1) mostly by the greater wing of the sphenoid bone
2) small portion by visualized medial; part of the
lesser wing of the sphenoid bone
3) small part of the body of the sphenoid bone
posterior
wall
4) part of the maxilla
^^^have many openings:
 Optic canal: btw the lesser wing and the body
of the sphenoid bone
 Superior orbital fissure: btw the great wing and
the lesser wing of the sphenoid bone
 Inferior orbital fissure: btw the maxilla , the
zygomatic bone and the great wing of sphenoid
bone(these bones that mentioned never meet)
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The supra-orbital notch will hold the supra-orbital nerve , so this
nerve is very shallow and immediately btw the skin and bone.
If a patient come to the clinic, and they are in shock as people
believe because of some emotional stress, press on this notch ,and if
the patient feel pain this means that he is responding , so send to
home
*Most deep of the skull bones; lies between the sphenoid and nasal
bones.
*Forms most of the bony area between the nasal cavity and the orbits.
*Major markings include the cribriform plate, crista galli, perpendicular
plate, nasal conchae, and the ethmoid sinuses
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*Has one horizontal plate and one vertical(perpendicular ) plate .
* this part( A on the image above) is masked by overlapping of the horizontal
plate of frontal bone, so the frontal bone begins from here( B on the image
above), it will leave this area and this area and begins here and continue back
over as fused. So practically this part that y will see over here it is a gap that
is created within the horizontal portion o f the frontal bone and it pup up  ‫مش‬
‫فاهمة اصالو كتبت وراء الدكتور‬
*when we look from superior view we will see : A) crista galli B)
cribriform plate
perpendicular plate:
And this is the only participation
of the ethmoid bone in forming the
bones that form the anterior
cranial
*has two
parts:fossa
a) superior : called crista galli . it is visualized at the superior view of the base of the skull
b) inferior: real perpendicular plate. Form the superior part of the bony nasal septum.
Note: from the superior view of the base of the skull, y can see just crista galli and cribriform plate
parts of the ethmoid bone and these two parts are the parts that participate in forming the anterior
cranial fossa.
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Horizontal plate :
*From the horizontal plate there are 2 masses, now this part( c in the image)
will contribute in forming the third posterior medial wall of the orbit ,
*In front of the lateral part of the masses there are lacrimal bones then ,
maxilla , frontal bone.
*the masses have sinuses, there are many sinuses, it has openings to the
nose .
*Ethmoid masses have protrusion ( superior and middle conchae( which are
shell like projections, form part of the lateral wall of the nasal cavity))
*Constructed of bone and hyaline cartilage.
* in the middle of the nose there is nasal septum , this septum is made by :
1)bone ( posteriorly):
^ real perpendicular plate of ethmoid bone( superiorly)
^ vomer(inferiorly)( it’s a triangular bone and it is a continue downward of
the perpendicular plate of ethmoid bone ).
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2) hyaline septal cartilage ( anteriorly)
Erode when we die ( the nasal septum in the skull of dead human body later
on has just 2 bones , no cartilage ).
*at both sides of the nasal septum , there is right and left parts of the nasal
cavity .
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roof
*very small
*formed by the cribriform plate of the ethmoid .
*has specialized mucous membrane ( olfactory mucosa)
* olfactory mucosa holds receptors for the smell , these receptors will continue
into post receptor fathers ,these post receptors will accumulate to form the
olfactory nerve , these olfactory nerves go into cribriform plate of ethmoid
bone and accumulate into an olfactory bulb ,that continue to olfactory tract
posteriorly into the nervous system .(post receptors>> olfactory nerve>>
olfactory bulb>> olfactory tract>> nervous system
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floor
*Formed by palatine process of the maxilla and palatine bone
*the maxilla has incisive foramen just posterior to the incisor teeth
medial wall
It is the nasal septum(mentioned above)
Lateral wall
*formed by :
1)the superior and middle conchae of the ethmoid bone
2)the inferior nasal conchae (note: it is not part of the ethmoid bone)
3) the perpendicular plate of palatine bone .
4) medial surface of the maxillary process
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*The perpendicular plate of ethmoid bone have ridges continue with the middle
and inferior conchae , these ridges has mucous accumulation
*Underneath each conchae there is invasination (grooves)( meatus):
1) superior meatus
2) middle meatus
3) inferior meatus
*The functions of these meatuses are:
1) increase contact of the air with the mucous membrane of the nose >>
warm the air
2) clean the air by holding the dust
3)sound pronunciation ( some people have shallow meatuses, because of
the thickness of the mucous membrane , if y want to hear their sound it is
in the record 16:30)(those people can be operated by increase the conchae
, so the meatus will be deeper.
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*Mucosa-lined, air-filled sacs
* found in five skull bones – the frontal( in the anterior aspect),
sphenoid(in the posterior aspect), ethmoid, and paired maxillary bones
*Air enters the paranasal sinuses from the nasal cavity and mucus
drains into the nasal cavity from the sinuses
*Lighten the skull and enhance the resonance of the voice .
* has openings, if they close because of infection , the sound will be
different .
*when somebody get infected >> the mucous membrane of the nose
and paranasal sinuses will be thickened & there will be edema within
this sinuses (increase the filling of these sinuses)>. The voice will be
affected(dullness of the voice) .
*some information about mucous membrane of the nose:
1) it is very sensitive
2)has many hair follicles
*the difference btw mastoid air cells and the sinuses??
Mastoid air cells : not opened into the nose
Sinuses: opened into the nose.
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*from wiki*
Humans possess four paired paranasal sinuses, divided into subgroups that
are named according to the bones within which the sinuses lie:




The maxillary sinuses, the largest of the paranasal sinuses, are under
the eyes, in the maxillary bones (open in the back of the semilunar
hiatus of the nose).
The frontal sinuses, superior to the eyes, in the frontal bone, which forms
the hard part of the forehead.
The ethmoidal sinuses, which are formed from several discrete air cells
within the ethmoid bone between the nose and the eyes.
The sphenoidal sinuses, in the sphenoid bone.
The paranasal air sinuses are lined with respiratory epithelium (ciliated
pseudostratified columnar epithelium).
sinus
maxillary
frontal
Sphenoidal
ethmoid
Anterior group
Site of drainage
Middle meatus through hiatus
semilunaris
Middle meatus via infundibulum
Sphenoethmoidal recess
Infundibulum and into middle
meatus
Middle group
Middle meatus on or above bulla
ethmoidalis
Posterior group
Superior meatus
Remember: there is nasolacrimal canal (canal btw the nose and lacrimal
bone).
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Notice in the above picture , the external and internal naris. And notice that
nasopharynx begins posteriorly to the internal naris .
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*has no connection with any other bone
*located btw muscles(place for muscle attachment)
*the most important functions of the muscles that are attached to the hyoid
bone:
1) elevate and depress the larynx
2)help in swallowing .
** called : the spine , backbone, spinal column
** makes up about two-fifths of the total height of the body
** consists of :
a) bones ( vertebrae( singular is vertebra))
b) connective tissue
** function:
1) surround and protect the nervous tissue of spinal cord
2) support the head
3)point of attachment for the ribs , pelvic girdle, muscles of the
back and upper limbs.
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the total # of vertebrae during early
development is 33. Then several vertebrae in
the sacral and coccygeal regions fuse . as a
result , the adult vertebral column typically
contains 26 vertebrae .
Vertebrae = 26
1
Cervical vertebrae =7
In the neck region…..
2
thoracic vertebrae =12
in the chest region (posterior to the
thoracic cavity…
3
Lumbar vertebrae =5
Support the lower back
4
Sacrum =1
Consist of 5 fused sacral vertebrae
5
Coccyx =1
Consist of 4 fused coccygeal vertebrae
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As y see we have curvature in the vertebral column in the adult , but
normally when y look at the intrauterine image y will see virgule shape ,
this virgula shape is the shape of vertebral column at all in the baby.
The virgule shape will continue until the age of 2 or3 months.
1) cervical curvature:
When y out the baby on the bed , he or she will elevate his , her head>>
this will create the cervical curvature, which is posterior concave
2) thoracic curvature:
When the baby crawl >> the crawling will create an anterior concave
thoracic curvature , and the shoulder will hold up ward .
3)Lumbar curvature:
When the baby walk >> a posterior concave lumbar curvature will be
formed.
4) sacral curvature:
Concave anteriorly
These curvatures will grows along with us .
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1)kyphosis: abnormal increase in thoracic curvature convexity &
prominent concavity, it is an erosion of anterior vertebral part( increase
concavity of thoracic region).
2)scoliosis: abnormal lateral curvature & rotation of the back (deviation to
left or right), crooked or curved back (appears between ages of 1015).(normally the vertebral column is aligned at midline, when this
alignment is deviated to the right or left this is what we call scoliosis)
3) lordosis: (hollow back) anterior rotation of pelvis, an abnormal
increase in lumber curvature, could be physiological (pregnancy) or
pathological(real lordosis), so both men & women can have lordosis.
( during pregnancy, the baby in the uterus create a force of drop at the
level of the abdomen>> this bring the lumbar region forward, and help
support axis of vertebral column has to be equal or distributed in a nice
way . it is occurs within the first semester of pregnancy . y have to tell
the pregnant women to do exercises , other wise( if the pregnant women
doesn’t do exercise or walk) the lordosis will become pathologic )
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*all vertebrae are typical except in two
regions:
1) cervical region ( first two vertebrae )
*Vertebrae are the same(arch& body), but
the difference from one region to another
can be in the prominence of the spinous
process, size of the body or the shape in
the vertebral canal.
*start fromc3(cervical vertebrae#3)
*the first 2cervicalvertebrae is consider as
atypical(atlas and axis)
*sacrum and coccyx >> we don’t consider
them as atypical vertebrae bcs they are
fused 5 sacral vertebrae,4 coccygeal
vertebrae respectively.
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Parts of typical
vertebrae:
Body
(centrum)
*disc shaped, but rounded in the thoracic region
*weight-bearing region
*in the posterior aspect
Vertebral
arch
laminae
*in the anterior part of the vertebrae
*composed of pedicles and lamina that along with the
centrum encloses the vertebral foramen.
*the body continue anteriorly with a flat thing which is
lamina.
*has posterior connection with pedicle
Lamina: flat
pedicle
Spinous
process
*thick round connection btw arch and body
Pedicle:
round
2 lamina fuse together & project posterior and usually
downward, some are bifid which provide muscle
insertion( bifid means the end of it divided into2).
Just bifid in the cervical region
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Transverse
processes
*pedicle meets with lamina then projects posteriorly and
laterally
*for muscle attachment of the back.
In thoracic vertebrae these processes are present
with facets or demi-facet (demi-facet also
present on the body), facets exist on the apex of
the trans. process.
*in the cervical vertebrae there are vertebral artery foramen
through which vertebral artery pass.
Vertebral
foramen
Superior
and
inferior
articular
processes
Intervertebral
foramen
*make up the vertebral canal through which the spinal
cord passes.
* the pedicles and lamina along with the centrum encloses
the vertebral foramen.
*Protrude superiorly and inferiorly from the "pediclelamina"
junctions.
sacrum & coccyx bones.
they differ in orientation (laterally, anteriorly, more or
less lateral & anterior), so they differ from region to
another, to provide more movement according to that
region.
*lateral openings formed from notched areas on the
superior and inferior borders of adjacent pedicles.
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*Seven vertebrae (C1-C7) are the smallest & lightest vertebrae.
-C7 are distinguished with an
1) Oval body.
2) Long spinous processes.
3)Large and triangular vertebral foramina.
vertebral artery passes through.
inferior
Atypical cervical vertebrae
1) atlas(c1)
* it is nothing but a round arch.
Has no body and no spinous process.
Consists of anterior and posterior arches, they meet laterally
and form two lateral masses (masses are elongated more toward
lateral aspect).
The superior and inferior surface of lateral masses has articular
surfaces(depressions ) to articulate with the occipital condyles
and with the axis respectively
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Notice the anterior & posterior tubercle made by meeting of arches anteriorly &
posteriorly respectively
*Lateral to the lateral masses there are transverse processes, and it has transverse
foramen.
*atlanto-occipital joint
is an important joint, only flexion & extension movement occurs, where at the
rest of the joints in vertebrae such as (atlanto-axial, axial-c3), the movement is
rotation.
The superior articular facets are broad and divided into 2 facets separated by a
ridge, this ridge is important in the flex. & ext. maneuver. It will stop the posterior
sliding of condyles of the occipital bone on atlas.
The ridge will limit the movement anterior & posterior.
With age the flex. & ext. maneuver will be reduced; because the intervertebral
layer (hyaline cartilage) in the joint is eroded, it won't be moving like before,
exercise will help in keeping good movement.
The inferior articular facets are more rounded and more medially oriented to fit the
superior aspect of the axis.
On the anterior arch, notice the fovea dentis which is the facet for the dens,
odontoid ligament holds the dens to lateral borders of fovea dentis.
2) axis(c2)
The axis has a bod(very small), spine, and vertebral arches as do other cervical
vertebrae.
Unique to the axis is the dense or odontoid process which projects superiorly
from the body and is attached to the anterior surface of the arch of the atlas.
The dens is a pivot for the rotation of the atlas.
Transvers processes comes from similar masses (pedicles & lamina), they are
very small with transverse foramen where vertebral artery passes.
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the masses, the transverse process comes out before the pedicle, that when you
go down to C3 it is
pushed anteriorly & the pedicle is more posterior.
present the typical
aspect of any vertebra.
rocess is posterior & it is bifidic.
e 10 for labeled image (black background :/).
-occipital joint has limited movement due to the ridge on the
facets & the spinous processes all the way down in the cervical region.
Notes about the image:
(dens) of axis articulates within ring of atlas.
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the doctor pointed to all
the labeled parts
(he said x-rays are
important).
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how to know the thoracic vertebrae??
- The spinous process is long & inclined inferiorly, heart
shape body(has a mass , that is full of spongy bone).
- The transverse process has articular facets & the body
have demi facet so that 2 demi facets of adjacent
vertebrae forms one facet which articulate with the head
of rib. That’s why the rib takes the name of the above
vertebrae.
- Superior articular facets are lateral & posterior, the
inferior ones are medially & inferior.
- transverse process has articular facet >>hold the rib
>> help breathing
- when we rotate the hole vertebrae , the rotation occur
at the hip joint, not within the vertebral column . each
thoracic vertebrae has 2 superior & 2 inferior articular
processes ,
-spinal foramen:anterior to the pedicle and more or less
immediately underneath the transverse process.
Through which the spinal nerves exist from the spinal
cord.
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Spinous process is more shorter and more square in shape.
The bodies are more bulky than thoracic and cervical.
Page 27 of 41
the doctor pointed to all
the labeled parts
(he said x-rays are
important).
Why it is a lumbar
vertebrae??
the spinous processes are
more shorter
The body is more bulky
The intervertebral disc
appear as a gap btw the
vertebrae.
Page 28 of 41
*Below & above the 2 pedicles, there is a vertebral notch (sup & inf); it
makes the intervertebral foramen between 2 vertebrae which spinal
nerves exit from it.
*Usually (especially thoracic vertebrae) the transverse processes will
grow longer, they will incline inferiorly like the wings & this resembles
the ribs, it occurs mainly at the level of C7 (you can palpate it at the end
of your neck), we call it cervical rib , it will compress the nerve root
leading to difficulty in moving the upper extremities.
*The arm & fore arm muscles will be tired & will take their tiredness to
the shoulder muscle.
driving & desk sitting, we compress ourselves while sitting, then the
cervical rib will compress the nerve & you will have headache &
shoulder stiffness.
examine 2 things: blood pressure & x-ray of cervical region.
es go to muscles, so any compression will lead to defects in
movement skeletal muscles.
vertebrae.
by
naked eye, the measurement will indicate the age of compression on this
disc.
Definition : a Joint btw 2 bodies of the vertebrae
Page 29 of 41
*anterior and posterior longitudinal ligament( this
ligament hold bones together , allow them not to move in
the rotational movement, they will move bending left and
right. Notice that the posterior ligament is anterior to the
spinal cord>>> give protection
*Cushion-like pad composed of two parts
 Nucleus pulposus – inner gelatinous nucleus that gives the disc
its elasticity and compressibility
 Annulus fibrosus – thick membrane surrounds the nucleus
pulposus with a collar composed of collagen and Fibro cartilage.
Page 30 of 41
Sometimes, annulus fibrosus bulge or rupture leading to movement of
nucleus pulposus toward the edge, so it will exit the concentric layer of the
fibrous tissue, and that's what we call herniation.
Herniation varies in bulging, so bulging of annulus fibrosus can lead to
reduction in distance between 2 vertebrae; because you lose the power of
annulus fibrosus.
The whole vertebrae have longitudinal ligaments to hold them in place, but
they cannot help in preventing the herniation of the nucleus polposus.
Any degeneration of annulus fibrosus can lead to herniation(disc disease).
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btw the spinous process , there is inter-spinous ligament , that hold the
spinous process in the position,and prevent the rotational movement.
The Dr didn’t talk about the atlanto-occiputal joint and said we will take it later on.
Slide (22-27 ) the dr didn’t talk about them
 Consists of five fused vertebrae (S1-S5), which shape the posterior
wall of the pelvis
 It articulates with L5 superiorly by the only two superior processes,
 and with the auricular surfaces of the ilium part of the hip bones to
complete the pelvic girdle
 Upper anterior aspect of the body protrose anteriorly, create the
concavity of sacrum convexity

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Parts of the sacrum:
*transverse lines: site where the bodies of the vertebrae joined
*ala: fused transverse processes(here the transverse processes are more bulk
and tortious compared with the thoracic one)
*the posterior aspect of ala articulate with the ilium of the hip
* at the inferior part of the median crest divided into two right and left
processes
* Dorsal sacral foramina continuated to the anterior sacral foramina(they are
lateral to the bodies).
Page 33 of 41
4 bones fused together and articulate directly with S5
* Fractures of the vertebra , could be :
-Fragmented & nonfragmented
-Complete & incomplete
*distance between the broken vertebrae and the adjacent one above or below will be minimized.
- 1. Disk Herniation : complete or incomplete bulging
- 2. Degeneration : degenerative changes in the structure of the annulus fibrosis .
Page 34 of 41
Page 35 of 41
 the ribs will adhere with their heads into the lateral
aspect of demi-facets ;that present on the superior and inferior
boarders of the body of T-vertebrae.
 12 ribs
* 1-7 ribs : articulate directly with the sternum my coastal
cartilages
*Atypical rib -> first rib ; the atypicality is due to it's
orientation only ,horizontal instead of vertical as the others
* False ribs (8-12) -> normal ribs but they never reach the
sternum
-> (8-10) ; adhere to the 7th cartilages
-> (11-12) ; Floating ribs , they don't articulate with any thing
interiorly .
* All ribs are incomplete bones ; because they need cartilages to
connect with lateral boarder of sternum .

-
RIBS , each one has :
Head; articulate with T-vertebrae .
Neck
Tubercle ; articulate with transverse process
Page 36 of 41
 All Ribs have lateral and medial surfaces . and superior
(rounded) and inferior boarders. Inferior boarder has
 All Ribs have lateral and medial surfaces . and superior
(rounded) and inferior boarders. Inferior boarder has
subcoastal groove ; where intercoastal vein,artery and nerve
passes. When we need to make a puncture it should be at the
superior not inferior boarder.
 The movement of thorax will be only at the anterior aspect
(during respiration) by action of cartilages. But posterior part
will never move ;because it linked by ligaments to the
vertebrae.
Page 37 of 41
 3 parts :
-upper : manubrium
- middle : sternal body
- lower : Xiphoid process
-> between manubrium and body we have Sternal(lewis) angle , that
very important clinically ; because you can count the ribs from the
second rib legation . and the surface anatomy of the thorax is very
important ; because when we need to test any thing inside the
thorax or want to make any puncture we need firstly to count the
ribs
Page 38 of 41
*manubrium : square shape part has superior and inferior articular
boarders .
-> on superior boarder we have Jugular notch , that very important ,
because any puncture of the Trachea will begin at this notch .
-> when any thing close the larynx , we can make a puncture inside
the trachea at this point , because the trachea lies directly under
the skin of this region . -> after making this puncture the patient
will respire normally .
Page 39 of 41
‫‪Notes:‬‬
‫‪Y have to go to the slides and study them with this sheet‬‬
‫اعتذر على التاخر بالتفريغ لكن لكل شخص ظروفه التي تحكمه ‪...‬‬
‫اعذروني عن اي خطا بالتفريغ و في حال وجد ضعوه من فضلكم في الكوركشن زون‬
‫"ال يوجد انتحار ابشع من الحياة بدون هدف و بدون تح ٍد و انجاز و بدون صياغة التاريخ ! هذه ليست‬
‫حياة و انما اهدار لالكسجين على كوكب االرض!!"‬
‫شكر خاص لعنود البستنجي‬
‫اختكم‪ :‬عرين بني عيسى‬
‫‪Page 40 of 41‬‬