(DD13-14) Anatomic Sciences PDF

lymphatic system
Which of the following structures carry lymph into the node's subcapsular
sinus, through the cortical sinus and into the superficial cortex and paracortex?
efferent lymphatic vessels

afferent lymphatic vessels
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both afferent and efferent lymphatic vessels
neither afferent o r efferent lymphatic vessels
copyright Cl 20 13-2014 Dental Decks
ANATOMIC SCIENCES
afferent lymphatic vessels
Lymph nodes are small oval bodies enclosed in fibrous capsu les. Lymph nodes contain phagocytic co rtica l t issue (reticu lar t issue) adapted to fi lter lymph. Specialized
bands of connective tissue, ca lled trabeculae, divide the lymph node.
Afferent lymphatic vessels carry lymph into the node's subcapsular sinus, th rough
the cortical sinus and into t he superficial cortex and paracortex. Conversely, the lymph
may travel d irectly from the cortica l sinus into the medullary sinus. It is pri marily in
these cortices and the medullary sinus that t he lymph is cleansed by macrophages,
and antigens are presented and processed by lymphocytes, and plasma cells. The filtered lymph leaves t he node through the efferent lymphatic vessels, w hich merge
th rough t he concave hilum and t ransport the lymph into efferent collecting vessels,
which converge into larger vessels cal led lymph trunks (there are five major lymph
trunks in the body). The tho racic duct receives lymph from three out of the fou r quadrants of t he body; both lower quadrants and the upper left quadrant. The right lymphatic duct receives lymph only from t he upper right quadrant.
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Note: The thoracic duct receives lymph from three out of t he fou r quadrants of the
body; both lower quadrants and the upper left quadrant. The right lymphatic duct receives lymph only from the upper ri ght quadrant.
Important:
1. The afferent lymphatic vessels enter on the convex surface of the node.
2. There are fewer efferent vessels than afferent vessels associated w ith a node.
3. The spleen, thymus, palatine, and pharyngeal tonsils do not have numerous afferent vessels entering them as do lymph nodes.
4.The paracortex is dominated byT-cells.
Trabeculum
Postcapillary
(high ondotholial)
lary
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cortex
Lymph node s tructure. The bean-shaped lymph node has a hilum into which blood vessels enter, and from which efferent lymphatics emerge. It has an investing capsule. Afferent lymphatic vessels penetrate the convex surface of the gland and drain into the
subcapsular and medullary sinus system. The lymphoid parenchyma is subdivided into
cortex, paracortex and medulla. The most prom inent structures in the cortex are the lymphoid follicles.
11
(Reproduced wilh permission from Slcvcns. A. and Lowe J. H11mall Histology. cd 3. Elsev1er, Philndelpbia. 2005.)
Area draining to right

lymphatic duct
Area draining to
horacic duct
Right and left

venous angles
OeCp cervical
Right
lymphatic
duct
nodes
-------LM
vein
Central and -posterior
axillary
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nodes
Deep
lymphatic
vessels
Cubital
nodes
Lymphoid system. Pattern of lymphatic drainage. Except for right superior quadrant
of the body (pink), lymph ultimately drains into the left venous angle via the thoracic
duel. The right superior quadrant drains into the right venous angle, usually via a right
lymphatic duel. Lymph ty pically passes through several sets of lymph nodes, in a generally predictable order, before it enters the venous system.
1Al
Reproduced wilh penmssion (rom Moore KL. Daile)' AF. andAgurAMR. Cliiiicaii)'OrienteJAnatomy. cd 6. Wollcrs Kluwcr, Ballmtorc. 2010.
lymphatic system
Which of the following vessels are characterized by the presence of valves?
arterioles only
capil laries only
sinusoids only
veins only
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lymphatics only
lymphatics and capil laries

lymphatics and veins
ANATOMIC SCIENCES
lymphatics and veins

Primary lymphatic organs are responsible for the generation and selection of lymphocytes.
These are the thymus and bone marrow. Secondary lymphatic organs include the tonsils, spleen,
lymph nodes, appendix, which are responsible for the filtering component. There are also areas
of diffuse lymphoid tissue throughout the body including MALT, GALT, and SALT (mucosa-, gut' and bronchus-associated lymphoid tissue, respectively). GALT includes the tonsils and Peyer's
patches. The common component to all lymphatic tissues is the presence of lymphocytes.
Functions of the lymphatic system:
Returns tissue fluid to the bloodstream: when this fluid enters lymph capillaries, it is
called lymph. Lymph is returned to the venous system via two large lymph ducts, the
thoracic duct and the right lymphatic duct
Transports absorbed fats: within the villi in the small intestine, lymph capillaries,
called lacteals, transport the products of fat absorption away from the Gl tract and
eventually into the circulatory system through the thoracic duct
Provides immunological defenses against di sease-ca using agents: lymph filters
through lymph nodes, which filter out microorganisms (such as bacteria) and foreign
substances. Lymph nodes have also been shown to trap cancerous cells in the body.
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1. Lymph contains a liquid portion that resembles blood plasma, as well as white
blood cells (mostly lymphocytes) and a few red blood cells.
2. Lymph is absorbed from the tissue spaces by the lymphatic capillaries (which is a
system of closed tubes) and eventually returned to the venous circulation by the
lymphatic vessels, after lymph flows through the filtering system (lymph nodes).
3. In the upper limb, a hallmark of lymphatic vessels is that they follow the veins.
4.The lymphatic system does not have a central pump to move lymph throughout
the body. "Instead, the lymphatic system depends on the contractions of skeletal
muscles, the presence of valves in lymphatic vessels (similar to those in veins),
breathing, and simple gravity to move flu id throughout the
The Lymphatic System

Cervical lymph nodes
Thymus
Axillary lymph
nodes
Right lymphatic
duct
Spleen
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CiSterna chyli
Thoracic duct
21
lymphatic system
T cells are produced in the _ _ _.and mature in the _ _.
liver, thymus
bone marrow, liver
bone marrow, thymus
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lymph nodes, thymus
ANATOMIC SCIENCES
bone marrow, thymus

The thymus is a bilobed lymphoid organ positioned in the superior mediastinum in adult s, with the
inferio r part contained in the anterior med iastinum of child ren; it does not contain lymph nod ules o r
vessels.The main function of the thymus is to potentiat e immunocompetent T cells from t heir
immunoincompetent precursors. Add itionally, self-recognizing T cells are destroyed in the thymus. The
thymus is relatively large in newborns, conti nues to g row until puberty, at which point it undergoes
invol ution, being replaced by ad ipose tissue. Note: In the adult thymus, t he blood supply is isolated
from the parenchyma (which is the functioning portion of the gland as d istinguished from the connective
tissue o r stroma). This is sometimes referred to as the blood thymus barrier. In the child thymus, the
blood supply is not isolated from the parenchyma.
Hassall's corpuscles: are structures found in the med ulla of the human thymus, formed from
eosinophilic type VI epithelial reticular cells arranged concentrically. The function of Hassall's
corpuscles is currently unclear.

Digeorge syndrome: is a congenital d isease that is characterized by absent or underdeveloped thymus and parathyroid glands. It's typically caused by a deletion on the chromosome
numbered 22. Patients suffering from Digeorge have profound immunodeficiency due to a
lack ofT cells. No other immune cell populations are affected.
The spleen is formed by reticular and lymphatic tissue and is the largest lymph organ. The spleen lies
bet ween the fundus of the stomach and the d iaphragm. The spleen is purplish in color and varies in size
in d ifferent individuals. The spleen is slightly oval in shape with the hil um on the lower medial border. The
spleen is entirely covered by peritoneum, except at the hilum. It is enclosed in a fibroelastic capsule that
d ips into the organ, forming trabeculae, but trabeculae DO NOT d ivide the spleen into lobes/lobules. The
spleen also has no di stinct cortex or med ulla. The cellular material, consisting of lymphocytes and macrophages, is called splenic pulp, and it lies between the trabeculae. Supplied by the splenic artery, a branch
of the celiac artery.
The spleen is the largest single mass of lymphoid tissue in the body. The spleen can be considered as two
organs in one; it filters the blood and removes abnormal cell s (such as old and def ective red blood cells),
and it makes d isease -fighting components of the immune system (including antibodies and
lymphocytes). The body of the spleen appears red and pulpy, surrounded by a tough capsule. The red
pulp consist s of blood vessels (splenic sinusoids) interwoven with connective tissue (splenic cord s). The
red pulp filters the blood and removes old and defective b lood cells. It, along with the liver, are site of
erythropoiesis (blood formation) in the fetus and infant. The white pulp is inside the red pulp, and
consists of little lumps of lymphoid tissue. Antibod ies are made inside the white pulp.
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' -- - - - Thyroid gland
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Pericardium
I leart
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3AI
lymphatic system
Posterior 1/3 of the tongue drains into:
facial nodes
occipital nodes
submandibular nodes
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deep cervical nodes

submental nodes
jugulodigastric nodes
ANATOMIC SCIENCES
deep cervical nodes

The deep cervical lymph nodes are located along the length of the internal jugular vein on each
side of the neck, deep to the sternocleidomastoid muscle. The deep cervical nodes extend from
the base of the skull to the root of the neck, adjacent to the pharynx, esophagus, and trachea.
The deep cervical nodes are further classified as to their relationship to the sternocleidomastoid
muscle as being superior or inferior.
The deep cervical lymph nodes are responsible for the drainage of m ost of the circular
chain of nodes, and receive direct efferents from the sa livary and thyroid glands, the
posterior 1/3 of the tongue, the tonsils, the nose, the pharynx, and the larynx. All these
vessels join together to form the jugular lymph trunk. This vessel drains into either the
thoracic duct on the left, the right lymphatic duct on the right, or independently drains
into either the internal jugular, subclavian, or brachiocephalic veins.
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Some regional groups of lymph nodes:

Parotid lymph nodes - receive lymph from a strip of scalp above the parotid salivary
gland, from the anterior wall of the external auditory meatus, and from the lateral parts of
the eyelids and middle ear. The efferent lymph vessels drain into the deep cervical nodes.
Submandibular lymph nodes - located between the submandibular gland and the mandible; receive lymph from the front of the scalp, the nose, and adjacent cheek; the upper lip and
lower lip (except the center part}; the paranasal sinuses; the maxillary and mandibular teeth
(except the mandibular incisors); the anterior two-thirds of the tongue (except the tip); the
floor of the mouth and vestibule; and the gingiva. The efferent lymph vessels drain into the
deep cervical nodes.
Submental lymph nodes -located behind the chin and on the mylohyoid muscle; receive
lymph from the tip ofthe tongue, the floor of the mouth beneath the tip of the tong ue, the
mandibular incisor teeth and associated gingiva, the center part of the lower lip, and the
skin over the chin. The efferent lymph vessels drain into the su bmandibular and deep
cervical nodes.
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vein
Lymphatic drainage of face and scalp. A. Superficial drainage. A pericervical collar o f superficial lymph
nodes is formed at the j unction of the head and neck by the submental, submandibular, parotid, mastoid, and
occipital nodes. These nodes initially receive most of the lymph drainage from the face and scalp. B. Deep
drainage. All lymphatic vessels from the head and neck ultimately drain into the deep cervical lymph nodes,
either directly from the tissues or indirectly after pass ing through an outlying group o f nodes.
41
(Reproduced with pcnniS$ion from Moore KL, Daile)' Af. and Agur AMR. C/inicol/y Oriented AnaJOmy. ed 6. Wolters Kluwer. Ballimore.
20t0.)
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Lymphatic drainage of th e tongue a nd oral floor. A Left lateral view. B Anterior view.
The lymphatic drainage of the tongue and oral floor is mediated by submental and submandibular groups
o f lymph nodes that ultimately drain into the lymph nodes along the internal jugular vein. (A, j ugular
lymph nodes). Because the lymph nodes receive drainage from both the ipsilateral and contralateral sides
(B), tumor cells may become widely disseminated in this region (e.g., metastatic squamous cell carcinoma, especially on the lateral border of the tongue, frequently metastasizes to the opposite side).
4 AI
Reproduced with pe-rmission from Baker E.W. /lead tmd Neck Auatomr.ft,r Den/til
Thieme. New York. 20 I0.
lymphatic system
When antigen recognition occurs by a lymphocyte, B cells are activated and
migrate to which area oft he lymph node?
inner medullary region

medullary cords
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medullary sinuses
germinal centers
Irefer to card 1-1for illustration!
ANATOMIC SCIENCES
germinal centers
lymph nodes are small, round specialized dilations of lymphatic tissue that are permeated by
lymphatic channels. Their function is primarily to act as filters. They help to remove and dest roy
antigens that ci rculate in the blood and lymph. For this purpose, lymph nodes contain a lot of
macrophages. Lymphoid tissue in the nodes also produces antibodies and stores lymphocytes.
Note: The nodes generally occu r in clusters along the connecti ng lymphatic vessels pa rticularly in
t he armpits, the groin, the lower abdomen, and the sides of the neck.
Each lymph node is enclosed in a fibrous capsule with internal trabeculae (connective tissue)
supporting lymphoid tissue and lymph sinu ses.
The node consists of:
Outer (superficial) cortical region: contai ns separate masses of lymphoid tissue called
lymphoid follicles. Primary foll icles are not responding to antigen. They sta in uniformly.
Secondary follicles contain predominately B cells (lightly sta ining germinal centers) they are
active follicles responding to antigen and are a source of lymphocytes.
Paracortical region: is dominated by T cells. Bcells enter the node from the blood in this region
and quickly migrate to the superficia l cortex.
Inner medullary region: lymphoid tissue here is arranged in medullary cords,which are a
source of plasma cells (they secrete antibodies). Also contains medullary sinuses.
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lymph nodes can be classified as primary or secondary. Lymph from a part icular region drain s into
a pri mary node or regional nod e. Primary nodes, in turn, drain into a secondary node or central node.
Definitions:
Germinal centers: are sites within lymph nodes (also within lymph nod ules in peripheral lymph
t issues) where mature B lymphocytes rapidly proliferate, differentiate, mutate their antibodies
(through somatic hypermutation), and class switch their antibodies during a normal immune response to an infection.
Medullary cord is a portion of the medulla of the lymph node which conta ins lymphatic tissue
and project into the medullary sinus. B cells and plasma cells are the main cel l types fou nd in the
medullary cords.
lymphatic system
The lymph from the lower extremities drains into the:
left internal jugular vein

left subcl avian vein
junction of the left internal jugular and subclavian veins
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superior vena cava
junction of the right internal jugular and subclavian veins
Irefer to card 1 A-I, 2-1for illustration!
ANATOMIC SCIENCES
junction of the left inte rnal jug ular and subclavian veins
The thoracic duct is the main duct of the lymphatic system and is located in the
posterior mediastinum. It begins below in the abdomen as a dilated sac, the cisterna
chyli (at the level of the Tl 2 vertebra) and ascends through the tho racic cavity in front of
the spinal column (between the descending thoracic aorta [to its left) and the azygos vein
[to its right)). It is the common trunk of all the lymphatic vessels of the body, and drains
the lymph from the majority of the body (legs, abdomen, left side of head, left arm, and
left thorax). Note: The right lymphatic duct drains much less of the body lymph (only the
lymph from the right arm, right thorax, and right side of the head).
Important: The thoracic duct is approximately 40 em long and transports lymph from
the entire lower half of the body and left upper quadrant. It empti es into the left venous
angle bet ween the left internal jugular vein and the left subclavian vein (which is actually
the beginning of the left brachiocephalic vein). The right lymphatic duct is
approximately 1 em long and collects lymph from the right upper quadrant of the body
and empties into the right venous angle at the j unction of the right internal jugular vein
with the right subclavian vein (which is actuall y the b eginning of the right
brachiocephalic vein).
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1. The thoracic duct ascends through the aortic opening in the diaphragm, on
the right side of the descending aorta.
2. The thoracic duct contains valves and ascends between the aorta and the
azygos vein in the thorax.
3. The intercostal lymphatic vessels transport lymph fro m the left and right
intercostal spaces to the thoracic duct.
4. Mammary glands drain lymph into axillary lymph nodes.
5. Ki dneys drain lymph into lumbar lymph nodes.
6. Lungs and trachea drain lymph into hilar lymph nodes (which are located in
the hilum of the lung).
lymphatic system
Which of the following is NOT a function of the spleen?
removal of old or defective blood cel ls from blood

forming crypts that trap bacteria
storage of blood platelets
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storage of iron
ANATOMIC SCIENCES
forming crypts that trap bacteria

The spleen lies in the left hypochondriac region of the abdominal cavity between the fundus of
stomach and the diaphragm. The spleen is an ovoid organ roughly the size of a fist. The spleen
contains white and red pulp. The white pulp contains compact masses of lymphocytes
surrounding branches of the splenic artery. The red pulp consists of a network of blood-filled
sinusoid s, along with lymphocytes, macrophages, plasma cells, and monocytes (phagocytic white
blood cells).
There are three major functions of t he spleen, and these are handled by three different tissues
within the spleen:
Reticuloendothelial tissue: concerned with phagocytosis of erythrocytes and cell debris from
the bloodstream. This same tissue may produce foci of hemopoiesis when RBCs are needed.
Venous sinusoids: along with the power of the spleen to contract, provides a method for
expelling the conta ined blood to meet increased circulatory demands
White pulp: provid es lymphocytes and a source of plasma cells and hence antibodies for the
cellular and humoral specific immune defenses composed of nodules containing malpighian
corpuscles
Blood enters the spleen at the hilum through the splenic artery and is drained by the splenic
vein, which joins t he superior mesenteric vein to form the hepatic portal vein to the liver. The
nerves to the spleen accompany the splenic artery and are derived from the celiac plexus. Note:
Like the thymus, the spleen possesses only efferent lymphatic vessels.
Remember: Although the spleen does not develop from the primitive gut, as do the lungs, liver,
pancreas, gallbladder, stomach, esophagus, and intestines, it shares the blood supply of the foregut
which is supplied by the celiac trunk. The spleen develops from mesenchymal cells of the
mesentery attached to the pri mitive stomach.
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1. Infectious mononucleosis: is a common, acute, usually self-limited infectious disease

caused by the EBV, characterized by fever, membranous pharyngitis, lymph node and
splenic enlargement.
2. Asplenia: refers to the absence of normal spleen function and is associated with some
serious infection risks, especially encapsulated bacteria such as streptococcus pneumoniae, haemophilus influenzae and neisseria meningitidis.
Splenic vein
border
otch In superior
border
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Spleen-Visceral
view
stomach
Impression of the
colon (left colic flexure)
lymphatic system
Which of the following tonsil(s) is/are covered by nonkeratinized stratified
squamous epithelium?
Select all that apply.
lingual tonsils only

pharyngeal tonsil only
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palatine tonsils only
pharyngeal and palatine tonsils

lingual and palatine tonsi ls
all of the above
ANATOMIC SCIENCES
lingual and palatine tonsils

The tonsils are lymphatic organs that lie under t he su rface lining of the mouth and throat. They are considered part of the secondary immune system. They sit in the respiratory and alimentary tracts in
position to be exposed to inspired or ingested antigens from air or food. When sufficient antigen is p resent, this stimulates the 8 cells in the germinal zone of the lymphoid foll icle to d ifferentiate and produce
antibodies. The tonsils are involved in the production of mostly secretory lgA, which is transported to the
surface, providing local immune protection. There are three sets of tonsils, named accord ing to their
position.
The adenoids (pha ryngeal tonsil) are located on the posterior wall of the nasopharynx. They are at
their peak of development during childhood. They are surrounded partly by connective ti ssue and
partly by ciliated pseudostratified columnar epithelium (respiratory epithelium). They contain no
crypts.
The palatine tonsils are located on the posterolateral walls of the throat, one on each side. They
reach their maximum size during early child hood, but after puberty d iminish considerably in size.
These are the tonsils that are noticeably enlarged when a person suffers from a sore throat." They
contain many crypts, lymphoid follicles. but no sinuses. The palatine tonsils are surrounded partly by
connective tissue and partly by nonkeratinized stratified squamous epithelium.
Important point:The best way to d istinguish the palatine tonsil from the pharyngeal tonsil on the
histolog ic level is the t ype of epithelium associated with it .
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The lingual tonsils are smaller and more numerous. They are a collection of lymphoid foll icles on the
posterior po rtion of the dorsum of the tongue. Each has a single crypt. They are surrounded by nonkeratinized stratified squamous epithelium. Note: The th ree g roups of tonsil s are often referred to
as Waldeyer's Ring or the Tonsillar Ring.
Remember: Peyer's patches are similar in structure and function to the tonsils (Peyer's patches form
"intestinal tonsils"). Located in t he small intestine (specifically, the ileum}, t hey serve to destroy the
abundant bacteria, wh ich w ould otherwise th rive in the moist environment of the intestine. Note: Peyer's
patches and tonsils are considered subepithelial and non-encapsulated lymphoid tissues.
Tonsillectomy: is a su rgical procedure in which the tonsils are removed from either side of the tonsillar
fossa. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoid itis, obstructive sleep apnea, nasal airway obstruction, d iptheria carrier state, snoring, or peritonsillar
abscess. For children. the adenoids are removed at the same ti me, a proced ure called adenoidectomy.
Inferior
surface
of
tongue
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Apex
T he anterior free part constituting the maj ority of the mass of the tongue is the body. 111e posterior attached portion is the root. The anterior (two thirds) and posterior (third) parts of the dorsum of the tongue
are separated by the terminal sulcus (groove) and foramen cecum . Brackets, indicate parts of the dorsum
of the tongue and do not embrace specitic parts.
81
Reproduced Ytith llcrmission from Moore KL Oalley Af:. andAgur AMR. (1inico/ly OrimMI A11t11omy. c:d 6. Wolters Kluwer. Baltimore, 2010.
blood
In which of the following locations would one most likely find yellow bone
marrow in an adult?
diaphysis offemur
epiphysis of humerus
ribs
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crania l bones
vertebrae
ANATOMIC SCIENCES
diaphysis offemur
***Yellow marrow is found in the hollow center of the diaphysis (the long shaft of the
bone) known as the medullary cavity.
The bones are not solid structures. Cavities in the cranial bones, vertebrae, ribs, sternum, and the ends of long bones contain red bone marrow. This blood-forming tissue
produces erythrocytes, leukocytes, and thrombocytes with in bones by a process ca lled
hemopoiesis.
1. Before birth, the formed elements are also produced in a number of other
locations, including the yolk sac, liver, spleen, and lymph nodes.
2. Erythropoiesis refers specifically to the production of eryth rocytes.
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The red bone marrow contains precursor cel ls called hemocytoblasts (multipotent
stem cells) that g ive rise to all of the formed elements of the blood. The hemocytoblasts give rise to va ri ous comm itted progenitor cells, which give rise to the different
types of formed elements. For example, the eryth rocytes develop from proerythroblasts; the platelets develop from large cells cal led megakaryocytes.
When a ch ild is 7 years of age, yellow marrow begins to appear in the distal bones of
the limbs. This replacement of marrow gradually moves proximall y, so that by the time
the person becomes an adult, the red marrow is restricted to the bones of the skull,
the vertebral column, the tho racic cage, the girdle bones, and the head ofthe humerus
and femur.
***At birth, all bone marrow is red.
blood
Which of the following cells are agranulocytes?
basophils
eosinophils
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lymphocytes
monocytes
neutrophils
10
ANATOMIC SCIENCES
lymphocytes
monocytes
Formed
Element
Avg. No./mm3
Description
Biconcave, anuclcated cell
Erythrocytes
5 million
Platelets
150,000300,000 Small cellular fragments
LeukOC)'tes
.
.
.
Granulocytes:
Ncutrophils
Eosinophils
Basophils
Agranulocytes:
.
.
.
Monocytes
Hcmoslasis
10,000
5,400
Lobed nucleus, fine granules
Part of the immune system

(phagocytosis)
Lobed nucleus, red or yellow
35
Obscure nucleus, light purple
May phagocytize AbAg

complexes (active against parasites)
Release histamine, heparin, and
granules
serotonin
540
Kidneyshaped nucleus
Phagocytosis, differentiate into tissue

macrophages
Phagocytosis, secretion of cytokines
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275
granules
Ruffied membrane, cytoplasm

with vacuoles and vesicles
Macrophagcs
Lymphocytes
Function
Transport oxygen
2,750
Round nucleus, liulc cytoplasm Produce Abs, destroy specific target

cells
***Absolute neutrophil count measures cells per microliter. A risk of infection increases
dramatically w ith a reading of <500/ mm3, potentially following dental treatment and
should not receive dental care.
blood
Which of the following statements is NOT true regarding erythrocytes?
They:
are biconcave in shape

have an average lifespan of 30 days
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rely completely on anaerobic metabolism

have no nucleus
have no mitochondria
are disposed of by the spleen
11
ANATOMIC SCIENCES
have an average lifespan of 30 days

The process of erythrocyte production is called erythropoiesis. The hormone that stimulates
erythropoiesis is called erythropoietin, which is produced primarily by the kid neys. The average life span
of a red blood cell is 120 days.
Differentiation stages of erythroblast: Hemocytoblast -common myeloid progenitor- unipotent
stem cell - proerythroblast- basophilic erythroblast- polychromatophi lic erythroblast -normoblast
- reticulocyte- erythrocyte
Erythrocytes, or red blood cells, make up the largest population of blood cell s, numbering from 4.5 million
to 6 million per cubic millimeter of blood. Their principal function is to tran sport oxygen and carbon
dioxide. The hemog lobin molecules in erythrocytes combine with oxygen in the lungs to form
oxyhemoglobin. The oxygen is transported in this state to the tissues of the body. In the tissues, the
oxygen is released to d iffuse into the interstitial fluid. Within the tissues, carbon d ioxide is combined with
the hemoglobi n molecules to form carbaminohemoglobin, which is transported to the lungs.
Note: About 70% of carbon d ioxide, however, is transported by the b lood plasma as bica rbonate ions
(HCOj) one of the most important extracel lular buffers.
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Remember: (1) The proportion of erythrocytes in a sample of blood is called the hematocrit (usually
around 46% for males and 40% for females). (2) The precursor cell found in the red bone marrow that
gives rise to all of the formed elements of the blood is the hematocytoblast (these are p luripotent stem
cell s), which gives rise to various committed multipotent progenitor cells (aka Colony-forming cell s or
CFC), which then give rise to the different types of formed elements.
Note: Granulocyte Colony-stimulating factor (G-CSF) is the hormone that stimulates precursor cells in the
bone marrow to d ifferentiate into white blood cells (leukocytes).
1. Sickle cell anemia is an autosomal recessive genetic blood disorder in which the body produces abnormally shaped red blood cell s. The cells are shaped like a crescent or sickle. They don't
last as long as normal, round red blood cells, which leads to anemia. The sickle cell s also get stuck
in blood vessels, blocking blood flow. This can cause pai n and organ damage. Mutation is a hyd rophilic glutamic acid (polar) substitution with a hydrophobic amino acid valine.
2. Genetic deficiency of glucose-6-phosphate-dehydrogenase (G6PD) causes severe hemolytic
crisis in affected individuals secondary to decreased NADPH and the inabil it y of RBC's to maintain membrane integrity. It's induced by sulfa drugs, oxidants and fava beans.
blood
The formed elements of blood include all of the following EXCEPT one. Which
one is the EXCEPTION?
plasma
red blood cells
platelets
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white blood cells
12
ANATOMIC SCIENCES
plasma
BLOOD
LEUKOCYTES
8% of
body
weight
4 to 6 liters
Temp =
38"C
pH o f 7.35
To 7.45
--+
FORMED
ELEMENTS
VOLUME
(number per cubic mm)
Plas ma
55%
Leukocyt es
5-l 0 thousand
For med
Elements
4 5%
Platelets
150-300 thousand
--+
Neutrophils
60-70%
Lymphocytes
20-30%
Monocytes
2-6%
Eosinophils
1-4%
Basophils
0- 1%
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Erythrocytes
4 .3-5.8 million
Important: The mnemonic " Never Let M onkeys Eat Bananas" identifies the order of
abundance of leukocytes.
Note: The term leukocyte refers to all types of white blood cells as listed above, while
the term granulocyte refers only to those conta ining visible cytoplasmic granules. The
granulocytes are the neutrophils, eosinophils and basophils.
blood
Regarding the difference between plasma and serum, which of the following
statements is tru e?
serum is yellow; plasma has no color

serum conta ins antibodies; plasma does not
SAADDES
plasma contains clotting proteins; serum does not

plasma contains hemoglobin; serum does not
13
ANATOMIC SCIENCES
plasma contains clotting proteins; serum does not

Plasma is approximately 91% water; the other portion is made up of various
materials (see chart below). The porti on of the blood that is not plasma consists of
formed elements, which includes erythrocytes (red blood cells), leukocytes (white
blood cells), and cell fragments called platelets.
Note: Serum= blood plasma without fibrinogen (after coagulation)
BLOOD
8%of
body
weight
4 to 6 liters
Temp =
3sc
pH of7.35
To 7.45
PLASMA
(WEIGHT)
Albumins
55%
G lobulins
38%
Fibrinogen
7%
SAADDES
{
VOLUME
Plasma
55%
Formed
Elements
4 5%
P roteins
7%
Water
9 1%
Other Solutes
2.0%
Metabolic end products

Food materials
Respiratory gases
Hormones, etc.
Ions
Human seru m albumin is the most abundant protein in human blood plasma. It is produced in the liver. Albumin constitutes about half of the blood serum protein. It transports hormones, fatty acids, and other compounds, buffers pH, and maintains osmotic
pressure.
blood
Platelets are best described as:
megakaryocytes
cytoplasmic fragments
agranulocytes
SAADDES
immature leukocytes
lymphoid cells
14
ANATOMIC SCIENCES
cytoplasmic fragments
*** Although platelets are often classified as blood cells, platelets are actually
fragments of large bone marrow cells ca lled megakaryoc ytes.
Platelets are minute, irregularly shaped, disc-like cytoplasmic bodies found in blood
plasma that promote blood clotting and have no definite nucleus, no DNA, and no
hemoglobin.
Normal blood contains 150,000 to 300,000 platelets per cubic mm. Their life span is
7-10 days; they are removed in the spleen and the liver. Note: Thrombopoietin (a
g lycoprotein hormone) is produced by the kidney and liver. Thrombopoietin
stimulates precursor cells in the bone marrow to d ifferentiate into megakaryocytes.
Megakaryocytes give rise to platelets.
SAADDES
Remember: Platelets stop blood loss by form ing a platelet plug. This plug begins to
form when platelets are exposed to a rough surface. They contain many secretory
vesicles (granules), which contain chemicals that promote clotting. When platelets
adhere to collagen, they release ADP and other chemicals from their secretory
vesicles. Many of these chemicals, including ADP, induce changes in the platelet
surface that cause the surface to become 'sticky: As a result, additional platelets
adhere to the original platelets and form a "plug:'
Important: (1) Thromboxane A2 (TXA 2), p roduced by activated platelets, has
prothrombotic properties, stimulating activation of new platelets as well as
increasing platelet aggregation. (2) Prostacyclin (PGI 2) decreases platelet aggregation
and causes vasodilatation.
joints
Which of the following is CORRECT regarding the articular cartilages?
they are covered by d isks

most of them are covered by hyaline cartilage
SAADDES
they are covered by perichondrium

they are covered by periosteum
they are vascu lar
15
ANATOMIC SCIENCES
most of them are covered by hyaline cartilage

Synovial joint sare freely movable (diarthrodial), with movement limited only by joint surfaces, ligaments, muscles, or tendons.
They are characterized by four features:
1. Articular cartilage - a thin layer of hyaline cartilage that covers the smooth articular bone surfaces. This layer contains no blood vessels or nerves. Note: The temporomandibular joint contains fibrocartilage, not hyaline cart ilage.
2. Joint cavity- small fluid -filled space separating the ends of adjoining bones.
3. Articular (joint) capsule- double-layered; outer layer of fibrousconnective tissue that encloses
the joint.
4. Synovial membrane - prod uces synovial fluid. Found on both bu rsa and articular cartilage.
Note: Most joints of the body are synovial joints. They are classified functionally as diarthroses
(means freely movable). In addition to the features above, some synovial joints have articular discs
(TMJ and sternoclavicular joint). These discs consist of fibrocartilage. They divid e the cavity into two
separate cavities.
SAADDES
Synovial fluid is a clear, thick fluid secreted by the synovial membrane, which fills the joint capsule
and lubricatesthe articular cartilage at the ends of the articulating bones.
Supporting ligaments (capsular, extracapsular, and intracapsular ligaments) maintain the normal
position of the bones.
Ten percent of synovial joints have a washer-like structure between bone ends called the meniscus.
Its purpose is to absorb shock, to stabilize the joint, and to spread synovial fluid. The meniscus is
made out of fibrocartilage, but the meniscus also has no blood supply, no nerves, and no lymphatic channels. Biologically, the meniscus can't heal itself. The knee meniscus is the most famous
and most injured meniscus in the body.
Note: A bursa is a fluid-sac that is lined with a synovial membrane. The function of a bursa is toreduce friction. For example, a bursa may be located bet ween a tendon and a bone to reduce the frict ion of the tendon passing over the bone when the tendon's muscle contracts. Inflammation of the
lining of a bursa is referred to as bursitis.
Joint cavity
SAADDES
Str ucture of Synovial Joints
15 1
wilh permission from Patton KT, Thibodeau GA; Mosby's Hnndbook of Anatomy & Physiology. St. loUJs. 2000. Mosby.
joints
Which of the following joints is/are a synarthrosis?
temporomandibular joint
skull sutures
SAADDES
synovial joints
condyloid joints
16
ANATOMIC SCIENCES
skull sutures
Articu lations (joints) are the structures where bones connect. There are three main
classes of articulations based on the amount of motion they allow:
1. Synarthrosis - immovable joint (fibrous joint). Sutures found between the flat
bones of t he skull are of this type.
Note: Gomphosis is an example of a synarth rosis. It is t he joint that binds t he
teeth to the bony sockets (dental alveol i) in the mandible and maxilla.
2. Amphiarthrosis - slightly movable joint (cartilaginous joint). One example is the
symphysis pubis, where t he two os coxa bones join anteri orly.
SAADDES
3. Diarthrosis - freely movable joint (synovial joint).
Joints can also be classified based on the type of associated connective tissue:
Fibrous (joined by fibrous connective t issue) - two types: sutures (of skull) and
syndesmoses (between radius and ulna)
Cartilaginous (joined by fib rocartilage or hyal ine carti lage) - two types: synchondroses, which are joined by hya line ca rtilage (epiphyseal plates w ithin long
bones), and symphyses, w hich are joined by a plate of fi brocartilage (pubic symphysis)
Synovial (joint capsule containing a synovial membrane that secretes a synovial

fluid)- most joints, such as the temporomandibular joints, are synovial
joints
The spheno-occipital joint and epiphyseal cartilage plates are classified as
which of the following joints?
sutures
symphyses
SAADDES
synchondrosis
syndesmoses
17
ANATOMIC SCIENCES
synchondrosis
Joints are p laces of union between two or more bones. Joints are classified on the basis of their structural features into fibrous, cartilaginous, and synovial types.
Fibrous joints (synarthroses): are barely movable or non-movable and are found in t hese forms:
Sutures are connected by fibrous connective t issue and are found between the flat b ones of the skull.
Coronal suture: between frontal and parietal bones
Sagittal suture: between two parietal bones
lambdoid: between parietal and occipital bones
Bregma: intersection of coronal and sagittal sut ures, it's the site of anterior fontanelle In an infant
lambda: intersection of saginal and lambdoid sutures, It's the site of posterior fontanelle in an infant
Syndesmoses are connected by fibrous connective tissue and occur as the Inferior tibiofibular and tympanostapedial syndesmoses.
SAADDES
Cartilagi nous joints (amphiarthroses):
Synchondrosis (primary cartilaginous j oints) are united by hyaline cartilage and permit no movement b ut
growth in the length of the bone. These include epiphyseal cartilage plates and the first rib and sternum.
Symphyses (secondary cartilaginous j oints) are joined by a p late of fibrocartilage and are slightly movable
joints. These include the pubic symphysis and the intervertebral discs.
Synovial joints (diarthrodial joints):
Permit a great degree of free movement. They are characterized by four features: joi nt (synovial) cavity, articular cartilage, synovial membrane, and articular capsule. These joints are classified according to axes of
movement Into:
Gliding (plane): include those joints found in the carpal bones of t he wrist and the tarsal bones of the
ankle
Hinge: the elbow and knee joints are examples
Pivot found between atlas (Cl )and axis (C2)ofthe vertebral column
Ellipsoidal (condyloid): found between the distal surfaces of t he forearm bones (radius and uln a) and
the adjacent carpal bones
Saddle: found where the metacarpal of the thumb meets the trap ezium of the carpus (wrist)
Ball-and-socket (universal): allows almost all types of movements. Examples include t he shoulder j oint
and the hip joint.
Ball-and socket
joint
Carpal bones
Head of femur (ball)
SAADDES
Scaphoid bone
Ellipsoidal
(condyloid) joint
Ulna
Y'Y"'
Art icula tions- Ball-and-socket joint, Ellipsoidal joint, Gliding joint
17-1
Saddle joint
Humrus Hinge Joint
SAADDES
Trochlea
(of humerus) process
17AI
Articulations- Hinge joint, Pivot joint, Saddle joint
joints
The paramedics arrive at the scene of a minor motor vehicle collision. One
driver claims to have experienced whiplash and is having trouble shaking her
head in a "NO" motion. She is fine with nodding her head in a "YES" manner.
Which of the following joints allows maximum rotational movement of the
head about its vertical axis (saying "NO")?
intervertebral joint
SAADDES
atlantoaxial joint
atlanta-occipital joint
costovertebral joint
18
ANATOMIC SCIENCES
atlantoaxial joint
This joint is the synovial articulation between the inferior articulating facets of the
atlas (first cervical vertebra) and the superior articulating facets of the axis (second
cervical vertebra). The atlas and axis, or Cl and C2, do not have an intervertebral disc
nor an intervertebral fo ramen between them. Cl has two lateral masses (no vertebral
body) where it makes contact with the occiput and C2. The inferior articula r facets of
the Cl and the superior articula r facets of C2 form 2 joints, one on each side. There is
also a third joint formed by the dens, or odontoid process, of C2 and the interi or of the
anterior arch of Cl. This is the joint you use to shake your head as in saying "NO':
Note: The atlanto-occipital joint permits rocking or nodding movements of the

head as in saying "YES:' This joint is the synovial articulation between the superior
articu lating facets of the atlas (first cervica l vertebra) and the occipital condyles of the
skull.
SAADDES
joints
When someone is rotating the forearm with the palm turning outward, this
motion is termed as:
abduction
adduction
flexion
extension
pronation
SAADDES
supination
19
ANATOMIC SCIENCES
supination
Movement
D esc.ription
Exam ples
Flexion
Decreasing the inner angle of the

joint
Bending the elbow

Dropping the chin to the chest
Folding forward (flexion of spine)
Extension
Increasing the inner angle of the joint Back bend

Kicking leg back ( hip extension)
Abduction
Moving away from the midline o f

the body
Lifting leg to the side

Lifting anns up from sides into T position
Adduction
Moving towards the midline of the

body
Crossing one leg in front of the other

Crossing arm in front of torso or behind back
SAADDES
Lateral Flexion Side bending (neck/torso)
Dropping ear towards shoulder

Crescent Stretch (dropping one hand down
same s ide of body)
Rotating or pivoting around a long

axis
Twisting along s pinal column (seated twist)

T urning palms up and down
Pronation
Rotating the foreann with the palm

turning inward
Lifting ann then turning arm (like empty ing a

can o f soda)
S upination
Rotating the fore.ann with the palm

turning outward
Lifting ann then turning arm back (tuming

palms towards ceiling)
Evers ion
T urning the foot laterally resulting in Standing with the weight on the inner edge o f
the sole moving outward
the foot
Rotation
Protraction
Draw forward (shoulder)
Round shoulders forward "spreading" back
Retraction
Draw back (shoulders)
Squeezing shoulder blades together
urinary system
The ureter connects which of the following parts of the kidney to the urinary
bladder?
rena l papilla
rena l columns
rena l calyx
rena l pelvis
SAADDES
20
ANATOMIC SCIENCES
renal pelvis
The kidneys are located at the back of the abdomen, one on each side of the spine, at the
level of the lower ribs. They are a pair of reddish, bean -shaped organs that are highly
vascularized and perform the following functi ons of the urinary system: (1) forming urine
(2) maintaining homeostasis and (3) hormone secretion (i.e., erythropoietin and renin).
The kidneys are located on either side of the lumbar spine. They lie retroperitoneally
(external to the peritoneal lining of the abdominal cavity) in front of the muscles attached
to the vertebra l column.
Internal features of kidney:

Cortex - outer light-brown layer (glomeruli and proximal and distal convoluted tubules are located here). Site of blood filtration.
Medulla - inner dark-brown layer, contains cone-like structures called renal pyramids
that are separated by renal colu mns.
Renal columns - extensions of renal cortex.
Renal pelvis - a hollow inner structure that joins with the ureters (the tu bes that conduct urine to the bladder). Receives urine through the calyces.
Renal papilla - apex of pyramids, here the collecting ducts pour into minor calyces
Renal calyx - extension of the renal pelvis. Minor calyces unite to form major calyces, wh ich urine is emptied into.
SAADDES
1. The right kidney lies slightly lower than the left kidney due to the large
size of the right lobe of the liver.
2. Each kidney is surrounded by a fibrous renal capsule and is supported
by the adipose capsule.
3. Each kidney has an indentation, the hilum, on the medial border, through
wh ich the ureters, renal vessels, and nerves enter or leave.
4. Each kidney receives its blood supply from a renal artery, a branch of
the abdominal aorta.
Renal pyramid (medul
SAADDES
Renal column
2().1
Kidney- Coronal view of right kidney
urinary system
Name the following structures of the nephron in the order they are encountered from blood to urine.
(1) distal convoluted tubu le (2) bowman's capsule (3) collecting duct (4) g lomerulus
(5) loop of Henle (6) proximal convoluted tubule
2,4,6, 1 ,5,3
4,2,6,5, 1,3
6,2,4,5, 1,3
2,6,4,5, 1,3
SAADDES
21
copynght 0 20 132014 Dental Decks
ANATOMIC SCIENCES
4,2,6 ,5, 1,3

The subunit of a kid ney t hat pu rifies bl ood and maintains a saf e balance of solutes and w ater i s the
nephron; it i s t he functional unit of the human excretory syst em. About one m illion nephrons are in t he
cort ex of each kidney, and each one i s a l ong tubul e w i th a closed end, called the Bowman's capsule.
Component s of the nephron incl ude:
Renal corpuscle: whi ch consists of a glomerulus (network of parallel capi llari es) and a double-w alled
cup, t he Bowman's capsule whi ch surrounds t he glomerulus and collects filtrat e. The renal corpuscle
i s the site of filtration; this normally prod uces protein-free and cell-free filt rate that passes into the proximal convoluted t ubules.
The tubular portion: has four main regions. Filt rate from the Bowman's capsule first passes int o the
proximal convoluted tubule in the cortex. Here, glucose, am ino acids, met abolites, and electrolyt es are
reabsorbed from filtrat e and returned to circulation. Next, t he filtrate enters t he loop of Henle, first
through its descend ing lim b and t hen through its ascending lim b. Here, the filtrate is concent rated
through electrolyte exchange and reabsorption t o produce a hyperosmolar fl uid. Thi s loop ext ends deep
into the med ulla. From there. fluid enters t he distal convoluted tubule, also in the cortex. Here, sodium
i s reabsorbed under the influence of aldosterone. From the di stal convol uted t ubule. filt rate enters t he
collecting duct, which is the d istal end of the nephron. Thi s i s the site of final concent ration of filtrat e,
which then empti es into papillary d ucts deep w ithin t he med ulla.
SAADDES
Aft er filt ration, fl uid in the t ubulesofthe nephrons undergoes t wo more processes, both involving the peri tubular capillaries: tubular reabsorption and tubular secretion. Some bl ood i s not fil tered and passes into
the eff erent vessel s and peritubula r capilla ries. Many subst ances that are filtered are returned t o the peri tubular capillaries from t he tubules by reabsorption, oft en at high rat es (e.g., wat er, glucose, sod ium). Waste
p roducts are ret ained and empti ed into a collecti ng tubule, w hich i s d ischarged t o t he ureters.
Macula densa i s an area of closely packed specialized cells lini ng t he wall of the distal tubule. The cells of
the macula densa are sensit ive t o the concent rat ion of sodi um chl ori de in the d istal convol uted t ubul e. A
decrease in sod ium chloride concent ration ini tiat es a signal from the m acula densa t hat has t wo effect s: (1)
i t decreases resi st ance to blood flow in the afferent arterioles, which increases glomerular hydrost at ic pressure and helps ret urn glomerulus filtration rate (GFR) toward normal, and (2) it increases renin release from
the j uxtaglomerular cells of the afferent and efferent art erioles, which are the major storage sit es for renin.
Tubular and collecting system of the n ephron. 'f he

first pan of [he tubular system is the proximal lUbule,
which is a continuation of Bowman's capsule and ini
tially pursues a convoluted course (rhe pmximal convolured tubules). remaining close to the glome1ulus from
which it arise$.
The proximal mbule the-n straightens and descends coward the medulla (pmximal !Uraig/H luhu/es. or the Ihick
descending limb t?fthe loop of H enle). merging with a
thin-walled part of the tubular system (lhiu limb of rite
loop of Henle). n lis I'Uns down the co11ex, and rhen in
the medulla, toward the papillary tip (descending thin
limb). It dten loops back on itself (ascending rhin loop)
and re-enters the corcex. 1'he wall then become-S thicker,
formi ng the straight segment of rhe distal rubule {the
thick ascending limb of the Mop of Henle or Ihe diswl
!Uraighltubule).
SAADDES
In the cortex, close to the glomeruli. the distal mbule be.

comes convolmed (dislfll comoluted 1ubule). and emp.
ties into a collecting n1bule. which in turn empties imo a
co11ecting duc( lying within the medullary ray.
The collecting ducts descend imo the medulla whe.e a

number converge to produce large.diamere.r ducts in the
papillae (papillary ducts r>r ducts t?{Bellini).11lese ducts
open into the calyces at the tips of the papillae, the con.
centration of the openings producing a sieve. ! ike surface
appearance to the papillary tip (the area cribi'Osa).
21-1
Reproduced wilh
from Stevens, A. and Lowe J.
tJfP' ed 3. Ellievier. Philadclplua, 200S.
f1111t1a11
Histol
urinary system
Which of the following persists as the definitive (permanent) kidney?
pronephos
metanephros
mesonephros
SAADDES
none of the above
22
ANATOMIC SCIENCES
metanephros
The urinary system consists of the kidneys, the ureters, the urinary bladder, and the urethra. This
system filters the blood and maintains the volume and chem ical composition of the blood.
The kidneys are paired organs, which contain extensive vascularity and millions of nephrons within
the renal cortex and renal medulla. The kidneys fi lter blood and regulate the volume and
composition of body fluid s during the formation of uri ne.
Note: The development of the kidney proceeds th rough a series of successive phases, each marked
by the development of a more advanced kidney: the proneph ros, mesonephros, and metaneph ros.
The pronephros is the most immature form of kidney, while the metanephros is most developed.
The metanephros persists as the definitive adult kidney.
The ureters are long, slender, fibromuscular tubes that transport urine from the pelvisof the kidney
to the base of the urinary bladder. Because the left kidney is higher t han the right, the left ureter is
usually slightly longer than the right. The ureters are narrowest where they originate, at the renal
pelvis (ureteropelvic junction). Note: Filling of the bladder co nstricts the ureters at th e
ureterovesical junction, where they enter the bladder. Peristaltic waves, occurring about one to five
t imes each minute, move urine through the ureters.
Remember: In the female, the ureter descends posterior to the ovary and into the base broad ligament passing under the uterine artery "water under the bridg e.
SAADDES
The urinary bladder is a distensible sac that is situated in the pelvic cavity posterior to the
symphysis pubis. The urinary bladder is slightly lower in the female than in the male.lt concentrates
and serves as a reservoi r for urine, which the bladd er receives from the kidneys through the ureters
and discharges through the urethra.
Remember: Transitional epithelium is found lining the urinary bladder, and the cells of this tissue
are specialized to change shape in response to pressure. When the bladder is empty, these cells are
more or less cuboidal in shape, but as the bladder fills the cells become compressed and flattened.
The urethra is a fibromuscular tube that carries urine from the urinary bladder to the outside of the
body. In males, the urethra carries semen as well as urine. Note: The portion of the male urethra
t hat passes through the urogen ital diaphragm is called the membranous urethra.
SAADDES
22-1
Urinary System (m ale)
foramina
A 26-year-old female has been previously diagnosed with McCune-Albright
syndrome. There is bony fibrous dysplasia of the anterior cranial base leading
to the encasement and narrowing of the optic canal. Although her vision is
normal, there is concern that there will be compression of the optic nerve
and which of the following other structure(s)?
ophthalmic nerve (CN Vl)
SAADDES
cranial nerves Il l, IV, and VI

ophthalmic ar tery
ophthalmic veins
23
ANATOMIC SCIENCES
ophthalmic artery
The optic canal is located posteriorly in the lesser wing of the sphenoid. It communicates w ith the m iddle cran ial fossa. It transmits t he optic nerve and the ophthalmic
artery.
Bony Opening
Location (Bone)
Contents
Cribrifonn plate with foramina
Ethmoid
Hypoglossal canal
Occipital
Hypoglossal ner\e (CN XII)
Carotid canal
Temporal
Internal carotid artery
Maxilla and lacrimal
Nasolacrimal (tem) duct
Inferior orbital fissure
Sphenoid and maxilla
Infraorbital and zygomatic branches of maxillary nerve (V2), infraorbital artery, and part
of inferior ophthalmic vein
Superior orbital fissure
Sphenoid
Oculomotor (CN I II), trochlear (CN IV), and

abducens (VI) nerves; lacrimal, frontal and
nasoci liary branches of ophthalmic nerve
(VI); superior and inferior divisions of
ophthalmic vein; sympathetic fibers from
Optic canal and foramen
Sphenoid bone
Optic nerve (CN II) and ophthalmic artery
Stylomastoid foramen
Temporal
Facial nerve (CN VII)
Lacrimal canal
Olfactory nerves (CN I)
SAADDES
cavernous plexus
Frontal incisure
r---+- 7
Posterior
ethmoidal
foramen
Anterior
ethmoidal
foramen
- - Optic canal
SAADDES
Nasal bone
Lacrimal bone
Infraorbital
foramen
Right Orbit-Anterior View

23 1
Reproduced wilh permi.i>Sion from Shut nke M. Schulte E.. Schumacht'T U; /lead ami
Neck
Dental Medid11e: New Yort., 2010. Thieme Medica] Publishers.
foramina
A 62-year-old female visits the family physician with complaints of right-sided
hearing loss, ringing in the right ear (tinnitus), numbness over the right half
of her face, and dizziness. The physician diagnoses her with an acoustic
schwannoma that is occluding her right internal acoustic meatus. The internal
acoustic meatus pierces the posterior surface of the petrous part of the temporal bone. The internal acoustic meatus transmits which two structures?
SAADDES
trigeminal nerve (CN V) and facial nerve (CN VII)
facial nerve (CN VII) and vestibulocochlear nerve (CN VIII)

vestibulococh lear nerve (CN VI II) and vagus nerve (CN X)
trigeminal nerve (CN V) and vagus nerve (CN X)
24
ANATOMIC SCIENCES
facial nerve (CN VII) and vestibulocochlear nerve (CN VIII)
The vestibulocochlear nerve enters the internal acoustic meatus and remains within t he
temporal bone, to the coch lear duct (hearing}, semicircular ducts, and maculae (balance).
The fadal nerve enters the internal acoustic meatus, the facial canal in the temporal bone, and emerges
from the stylomastoid foramen. The stylomastoid foramen lies between the styloid and mastoid
processes of the temporal bone. Note: The facial nerve, upon entering the internal acoustic meatus also
gives rise to the chorda tympani branch (which is responsible for the parasympathetic innervation to the
submandibular and sublingual gland). It also provides sensory taste fibers for the anterior 2/3 of the tongue.
After the main trunk of the facial nerve exits from t he stylomastoid foramen, it enters into
t he substance of the parotid gland. It is here that it gives off five main branches that will supply
motor innervation to the muscles offacial expression.
SAADDES
Facial nerve branches mnemonic: "The Zebra Bi t My Cow"- From superior to inferior:
Temporal bra nch

Zygomatic branch
Buccal branch
Mandibular branch
Cervical branch
foramina
Which of the following foramina appears as a small round radiolucent area
on the mandibular premolar and can be confused with a periapical abscess if
not recognized correctly?
mandibular foramen
incisive foramen
SAADDES
mental foramen
foramen ovale
25
ANATOMIC SCIENCES
mental foramen
The mandibular foramen is located on the medial surface of the ramus of the
mandible just below the lingula, midway between the anterior and posterior borders
of the ramus. The foramen leads into the mandibular canal, which opens on the
lateral surface of the body of the mandible at the mental foramen.
Important: In relationship to the occlusal plane of the mandibular molars, the
mandibular foramen is located at or slightly above the occl usal plane and posterior to
the molars.
Note: The lingula is a tongue-shaped projection of bone that serves as the
attachment for the sphenomandibular ligament.
SAADDES
Remember: The inferior alveolar nerve (branch of V3), artery, and vein travel
through the mandibular foramen. At the mental foramen, the inferior alveolar nerve
ends by dividing into (1) the mental nerve, which exits the mental foramen and
supplies the skin of the mental region, mucous membrane and attached gingiva of
the ipsilateral mandibular anterior and premolar teeth and (2) the incisive branch
which continues coursing through the mandible and supplies the pulp chambers of
the anterior teeth and adjacent mucous membrane.
Mandibular
notch
Reproduced with
from Shue.nke M,
E.
U; Nt!tul and
Net:k An11tmny fi'r Dental
Mt!dicint!;
York. 20 I 0.
Head of
condyle
11-"o::::J-- - Pterygoid
Medic.al
fovea
SAADDES
Ramus of
mandible
Mental
Mental
foramen
Body of Oblique
mandible
line
Oblique left lateral view of the mandible. This view displays the coronoid process, the condylar
process, and the mandibular notch between them. The coronoid process is a site for muscular attachments, and the condylar process bears the head o f the mandible, which a1ticulates with the a1ticular disc
in the mandibular fossa o f the temporal bone.
2s- 1
foramina
Through which ofthe following foramina does the largest ofthe three (paired)
arteries that supplies the meninges pass?
foramen magnum
jugular foramen
SAADDES
foramen rotundum
foramen ovale
foramen spinosum
foramen lace rum
26
ANATOMIC SCIENCES
foramen spinosum- the artery i s the middle meningeal artery which i s the largest
of the th ree (paired) arteries w hich supply the m eninges, the others being the
anterior meningeal artery and t he posterior m eningeal artery
The jugular foramen lies between the lower border of the petrous part of the temporal bone
and the condylar pa rt of the occipital bone. The jugular foramen transmits the following
structures: inferior petrosal sinus, sigmoid sinus (becoming the internal jugular vein), the
posterior meningeal arterty (at th is point, still called the ascending pharyngeal artery) and the
glossopharyngeal, vagus, and accessory nerves.
Bony Opening
Contents
Location
(Bone)
Maxillary nerve (V-2)
Foramen rotundum
Sphenoid
Foramen ovalc
Sphenoid
Mandibular nerve (V-3)
Foramen magnum
Occip ital
Spinal cord, vertebral arteries, and "spinal rootsH of the

nerve
Foramen spinosum
Sphenoid
Middle meningeal artery
Mental foramen
Mandible
SAADDES
Greater palatine for.smcn Palatine
Mental nerve, artery a nd vein
Greater palatine nerve, artery, and vein
Lesser palatine foramen
Palatine
Lesser palatine nerve, artery, and vein
Incisive fOramen
Maxilla
Nasopalatine nerve and branches of the sphenopalatine

artery
Jugular fOramen
Occip ital and

temporal
Inferior petrosal sinus, sigmo id sinus (becoming the

internal jugular vein), posterior meningeal artery, and
glossopharyngeal, vagus and acccs.;;ory nerves
Remember: The accessory nerve (CN XI) enters the cranial cavity through the foramen magnum, where it immediately joins with the vagus nerve (CN X) and subsequently exits the cran ial
cavity through the jugular foramen.
Incisive
foramen
Palatine bone
Greater palatine
foramen
Lesser palatine
foramen
Infratemporal crest Scaphoid fossa

Sphenoidal foramen
Choana
Zygomatic bone,
temporal surface
Inferior orbital
fissure
Zygomatic
arch
Hamulus
Pharyngeal canal
Vomerovaglnal canal
Pharyngeal tubercle
SAADDES
Foramen ovale
Foramen splnosum Foramen laeerum - Petrotympanic fissure
Carotid canal
Jugular foramen
Stylomastoid foramen
Hypoglossal canal
Foramen magnum
Mandibular fossa
Occipital condyle
Mastoid process
Mast oid Incisure
Condylar canal
Mastoid foramen
Inferior nuchal
Superior nuchal line
26-1
._.1"'-- -EO><toornal occipital

Supreme nuchal line
The basal aspect of the skull
protuberance
Ethmoid bone,
cribrifonn plate
Frontal
crest
Frontal
sinus
Chiasmatic groove
Optic canal
Ethmoid bono.
crista galll
Anterior clinoid process
Frontal bone
Foramen ovate
Foramen spinosum
Arterial groove
fissure
Hypoglossal canal
lesser wing
Sphenoid bone,
greater wing
Sphenoid bone ,
SAADDES
Clivus
PetrCKH:e:ipital
Sphenoid bone.
Groove for sigmoid

sinus
hypophyseal fossa
Posterior clinoid
process
Temporal bone,
petrous part
Internal acoustic
meatus
Jugular foramen
Foramen magnum
Cerebellar fossa
lntomal occipital c rest

Internal occipital
protuberance
Cerebral fosaa
l nlerior of Ibe base of Ibe skull
foramina
The cranial nerves that supply motor innervations to the muscles that move
the eyeball all enter the orbit through a foramen that is between the:
lesser wing of sphenoid and fronta l bone

lesser wing of sphenoid and ethmoid bone
SAADDES
greater and lesser w ings of sphenoid bone
lesser wing of sphenoid, frontal and ethmoid bones
27
ANATOMIC SCIENCES
greater and lesser wings of sphenoid bone

The superior orbital fissure is located posteriorly between t he greater and lesser wings of the
sphenoid bone. The superior orbital fissure comm unicates with the middle cranial fossa.
It tran smits the: superior and inferior divisions of t he oculomotor nerve (CN Ill)
trochlear nerve (CN IV)
lacrimal, frontal, and nasociliary branches of t he ophthalmic nerve (CN Vl)
abducent nerve (CN VI)
superior and inferior d ivisions of t he ophthalmic vein
sympathetic fibers from the cavernous plexus
Bony Opening
Location (Bone)
Contents
SAADDES
Mandibular foramen Mandible
Inferior alveolar nerve, artery, and vein
Petrotympanic
fissure
Temporal
Chorda tympani nerve
Foramen lacerum
Sphenoid, occipital,
and temporal
Nerve of pterygoid canal (greater and deep

petrosal nerves), and artery of pterygoid canal
Supraorbital foramen
and canal
Frontal
Supraorbital nerve. artery. and vein
Infraorbital foramen Sphenoid and maxilla

and canal
Jnfr.sorbital nerve, artery, and vein
Pterygoid canal
Sphenoid
Area nerves and vessels
lntemal acoustic
meatus
Temporal
Facial and vestibulocochlear nerves
Extemal acoustic
meatus
Temporal
Opening to tympanic cavity
Frontal bone
Plerlon
Coronal suture
Squamous suture
Sphenoparietal suture
Sphenofrontal suture
Sphenosquamous
suture
Supraorbital
foramen
Sphenoid bone,
greater wing
Ethmoid bone
Nasal bone
Anterior nasal
spine
Maxilla
SAADDES
Mandible
Zygomatic
protuberance
bone
Mental foramen
Lateral 'iew of tbe skuU
Zygomatic
arch
External
glenoid acoustic
tubercle meatus
respiratory system
Which of the following terms means air in the chest?
hemothorax
pyothorax
pneumothorax
SAADDES
pulmothorax
pulmonary inflation
28
ANATOMIC SCIENCES
pneumothorax
A penetration wound of the chest wall can lead to a pneumothorax (air in the pleural cavity) or a
hemothorax (blood in the pleural cavity).ln both of these situations, the surface tension that binds
t he lungs to the chest wall is eliminated, and the lung will instantly shrink to the size of a tennis ball.
The lungs fill the pleural divisions of the thoracic cavity; they extend from the root of the neck to
the diaphragm. The lungs are the main component of the respiratory system; they distribute air and
exchange gases. The right and left lungs are separated by the mediastinum, which contains t he
heart, blood vessels, and other midline structures; fissures divide each lung into Jobes. Each
primary bronchus enters its respective lung at the hilus, an indentation on the mediastinal surface.
The bronchi and pu lmonary blood vessels are bound together by connective tissue to form the root
of the lung. The base, the inferior surface of the lung, rests on the diaphragm. The apex, the most
superior portion of the lung, projects above the clavicle.
SAADDES
Right lung:
Has three Jobes (superior, middle, and inferior) and three secondary (lobar) bronchi
Contains ten bronchial segments (corresponding to the t ertiary bronchi)
Usually receives one bronchial artery
Has a slightly larger ca pacity than the left lung
The azygos vein leaves an impression on the right lung as the vein arches over the root
Left lung:
Has two Jobes (superior and inferior) and two secondary (lobar) bronchi
Contains eight bronchial segments (corresponding to the tertiary bronchi)
Contains a cardiac notch (on its superior lobe), which is an indentation providing room for
the heart
Usually receives two bronchial arteries
Contains a lingula, which is a tongue-shaped portion of its superior lobe that corresponds to
the middle lobe of the right lung
Each lung is enclosed in a double-layered pleural sac. One layer is called the visceral pleura; t he
other is called the parietal pleura. Between t he two layers is the pleural cavity, which is filled with
serous fluid.
fissure
Inferior
lobe
Cardiac
notch
..._ __
notch
lobe
Inferior
lobe
Right lung
(B)
views
SAADDES
281
Costal surfaces of lungs. The lungs arc shown in isolation in antcrior(A) and lateral views (B), demonstrating lobes and fissures. C. The heart and lungs are s hown in situ.
Reproduced with permission from 1\>loorc KL. Dalley AF. and Agur AMR. Clinit<llfy Oriftu('({An(llonty. 00 6. Wolters Kluwer. Baltimore. 2010.
respiratory system
The ridge that marks the bifurcation of the trachea into the right and left primary bronchi is the:
carina
lingula
SAADDES
mediastinum
bronchial t ree
29
ANATOMIC SCIENCES
carina
The trachea connects the upper respiratory tract to the lower respiratory tract. It is about 9-1 5 em in length.
It is located in front of the esophagus and behi nd the thyroid g land in the neck. It is considered to be in the
superior and middle mediastinum. It is made up of 16-20 incomplete hyaline cartilaginous rings that are
open posteriorly. The trachea bifurcates into the right and left main stem bronchi at a location called the
carina, which is located at the level ofthe sternal angle (T4-T5). A series of ( -shaped rings of hyaline cartilage strengthen the trachea and prevent it from collapsing during inspiration. The trachea is lined with
ciliated pseudostr atified columnar epithelium and mucous-secreting goblet cells, which trap inhaled
debris. Ciliary action moves debris toward the oropharynx for removal by coughing.
The trachea branches off into t wo main bronchi, the left and right p rimary bronchi, which lead to the left
and right lung respectively. The right lung is larger and heavier than the left, but it is shorter and wider
because the right dome of the d iaph ragm is higher and the heart and pericardi um bulge more to the left .
The right and left mainstem bronchi branch from the trachea at different angles, the right more vertical
and more di rectly in line with the trachea, thus the right b ronchus is more likely to receive aspi rated
material. At this point in breathing, the air has been moistened, purified and warmed . Each bronchi enters
its lung and begins on a series of branches, called the bronchial or respiratory tree. The first of these
b ranches is the lobar (secondary) b ranch. On the left, there are t wo lo bar branches, while on the right,
there are three. Each lobar branches into one lobe. The next branch is called the segmental (tertiary)
b ranch. Each b ranch conti nues to branch into smaller and smaller b ronchioles. The final branch is called
the terminal bronchioles. These bronchio les are smaller than 0.5 mm in diameter. Each of these terminal
b ronchioles gives rise to several respiratory bronchioles. Note: The first few levels of bronchi are
supported by rings of cartilage. Branches after that are supported by irregularly shaped d iscs of cartilage,
while the latest levels of the tree have no support whatsoever.
SAADDES
Note: The right main bronchus divides into three lobar bronchi, and the left main bronchus divides
into two lobar bronchi. Each secondary or lobar bronchus serves one of the five lobes of the t wo lungs.
Each respiratory bronchiole subd ivides into several alveolar ducts, which end in clusters of small, thinwalled air spaces called alveoli. These cl usters of alveoli are called alveolar sacs and form the functional
unit of the lung.
primary bronchus
SAADDES
Bronchi in situ -Anterior view
29 1
respiratory system
Which of the following components of the respiratory system does NOT have
cilia?
tertiary bronchioles
primary bronchioles
SAADDES
alveo lar ducts
respiratory bronchioles
terminal bronchioles
30
ANATOMIC SCIENCES
alveolar ducts
Conducting bronchioles are smaller extensions of bronchi (little bronchi). Those devoid
of alveoli in their walls are nearer the hilum of the lung. These conducting passageways
deliver air to passageways that have alveoli. The last generations of conducting
bronchio les are called terminal bronchioles.
Respiratory bronchioles, continuing from terminal bronchioles, branch nearer to the

alveolar ducts and sacs and have occasional alveoli in their wall s. These bronchio les
capable of respiring are the first generation of passageways of the respiratory portion
of the bronchial tree.
Remember:
The conducting zone of the respiratory system is made u p of the nose, pharynx, lar-
SAADDES
ynx, t rachea, bronchi, bronch ioles, and termina l bronchioles; their functi on is to filter,
warm, and moisten air and conduct it into the lungs. It's also called the dead zone be cause there is no 0 2 exchange happens here.
The respiratory zone is the site of oxygen and carbon dioxide gas exchange, and is
composed of t he respiratory bronchioles, alveolar ducts, and alveoli.
Bronchioles are characterized by:

A diameter of one millimeter or less
An epithelium that progresses fro m ciliated pseudostratified columnar to simple
cuboidal (respiratory bronchioles)
Small bronchioles have non-ciliated bronchiolar epithelial cells (Clara ce lls) that
secrete a surface-active lipoprotein
Walls devoid of gland s in the underlying connective t issue
Woven bundles of smooth muscle to regu late t he bronchiolar diameter
Walls de void of cartilage (small diameter p revents them f rom collapsing at end of
expiration)
SAADDES
(A)
(B)
The Trachea, Bronchi, Bronchioles, and Alveoli

(A) The trachea and bronchi
(B) The termination of bronchioles into alveoli
30-1
respiratory system
Which of the following vessels supply blood to the bronchi?
pulmonary arteries
pulmonary veins
subclavian arteries
SAADDES
none of the above
Irefer to card 29-1, 30-1for illustration!
ANATOMIC SCIENCES
31
none of the above- the bronchial arteries supply blood to the bronchi
Each lung is shaped like a cone. It has a blunt apex, a concave base (that sits on the diaphragm), a
convex costal surface, and a concave mediastinal surface. At the middle of the mediastinal surface, the
hilum is located, which is a depression in which the bronchi, vessels, and nerves that form the root enter
and leave the lung.
The root of the lung contains the following structures:

Primary bronchus: the right and left bronchi arise from the trachea and carry air to the hilum of the
lung du ring inspiration and carry ai r from the lung during expi ration
A pulmonary artery: enters the hilum of each lung carrying oxygen-poor blood
Pulmonary vein(s): a superior and inferior pair for each lung leave the hilum carrying oxygen-rich
b lood
1. The small bronchial arteries (which are branches of the thoracic portion of the descending
aorta) also enter the hilum of each lung and deliver oxygen-rich blood to the tissues. The
bronchial arteries tend to follow the bronchial tree to the respiratory bronchioles where the
bronchial arteries anastomose with the pulmona ry vessels.
2. Branches of the vagus nerve pass behind the root of each lung to form the posterior pulmonary plexus.
SAADDES
Innervation of the lung: The lung is innervated by parasympathetic nerves via the vagus and sympathetic
nerves derived from the second to fourth thoracic sympathetic ganglia. These nerves form plexuses around
the hilus of the lung and give rise to intrapulmonary nerves accompanying the bronchial tree and blood
vessels. Both sympathetic and parasympathetic nerves to the lung contain efferent and afferent fibers.
Important: When foreign objects are aspirated into the trachea, they usually pass into the right primary
bronchus because it is larger, straighter, and shorter than the left. It is also in a more di rect li ne w i th the trachea (important in a dental cha ir because if a patient swallows an object it tends to lodge in the right
bronchus).
Tuberculosis seems to be more common in the right lung than the left due to the shorter right bronchus.
The reason that the disease is usually restricted to the apex of the lungs is due to the fact that venti lation/ perfusion ratio is high as the blood flow is reduced leading to higher alveolar P0 2 this provides a better environment for the obligate aerobes to g row.
respiratory system
Which of the following is NOT a part of the lower respiratory tract?
laryngopharynx
trachea
primary bronchus
SAADDES
alveolar duct
32
ANATOMIC SCIENCES
laryngopharynx
The mediastinum lies between the rig ht and left pleura in and near the median sagittal plane of the
chest. It extends from the stern um in front to the vertebral column behind, and contains all the thoracic viscera except the lungs. It may be divided for purposes of description into two parts:
An upper portion, above the upper level of the pericardium, which isnamed the superior mediastinum
A lower portion (inferior mediastinum) which is subdivided into three parts:
- that in front of the pericardium, the anterior mediastinum
-that containing the pericardium and its contents, the middle mediastinum
-a nd that behind the pericard ium, the posterior mediastinum
The respiratory system consists of the upper and lower respiratory tracts, the lungs, and the thoracic
cage. The respiratory system is designed to exchange the ca rbon dioxide accumulated in the blood
for oxygen in the airways, which enters the lungs as air from the surrounding atmosphere.
SAADDES
Blood travels continuously through t wo different circulations: the pulmonary and the systemic circu lations. The heart pumps deoxygenated blood from the veins of the systemic circulation into the
arteries of the pulmonary circulation. This blood is oxygenated by the lungs, and then flows back to
the heart to be pumped into the arteries of the systemic circu lation.
The structures of the upper respiratory tract include the nose, mouth, nasopharynx, oropharynx,
laryngopharynx, and larynx. Besides warming and humidifying inhaled air, these structures provide
for taste, smell, and the chewing and swallowing of food.
The lower respiratory tract structures are the trachea, bronchi, and lungs. Bronchi branch into bronchioles, which in turn branch into lobules. The lobule includes the terminal bronchioles and alveoli.
A mucous membrane containing hair-like cilia lines the lower tract. Functionally, the lower tract is
subdivided into conducting airways (the trachea and the primary, lobar, and segmental bronchi)
and alveoli, the sites of gas excha nge.
primary bronchus
SAADDES
Diaphragm
Respiratory System
Reproduced with perm1ssion from BaJTons Ant11omy fo1 :bh Card.;;:. Australia. 2009. Global Book l'ublshing.
32 1
respiratory system
All of the paranasal sinuses drain into one of the three meatuses (superior,
middle, and inferior) EXCEPT one. Which one is the EXCEPTION?
maxillary sinus
frontal sinus
SAADDES
ethmoidal sinus
sphenoidal sinus
33
ANATOMIC SCIENCES
sphenoidal sinus- which drains into sphenoethmoidal recess

Air enters through the nostrils (external nares) that lead to the vestibu les of the nose.
The bony roof of the nasal cavity is formed by the cribriform plate ofthe ethmoid bone.
The lateral walls have bony projections cal led conchae (superior, m iddle, and inferior),
wh ich are also referred to as the nasal tu rbinates. These conchae form shelves that have
spaces (or grooves) beneath them cal led meatuses (superior, middle, and inferior). All
of the paired paranasal sinuses drain into the nasal cavity by way of these meatuses
except for the sphenoidal sinus wh ich drains into the sphenoethmoidal recess. The nasolacrimal duct, which d rains tears from the surface of the eyes, also empties into the
nasal cavity by way of the inferior meatus. The floor is formed by the hard palate. The
nasal cavity opens posteri orly into the nasopharynx via funnel-like openings called the
choanae (posterior nares). The maxillary sinus drains into the m iddle meatus through
the semilunar hiatus.
SAADDES
1. The vestibules are lined w ith nonkeratinized stratified squamous epithelium.

2. The conchae of the nasal fossae are lined with pseudostratified ciliated
columnar epithelium.
3.The olfactory epithelium is very prominent in the upper medial portion of
the nasal cavity. Both olfactory and respiratory epithelium are cha racterized
as pseudostratified columnar epithel ium; olfactory epithelium is unique in
that it conta ins olfactory sensory cells.
4. The nasal cavity receives sensory innervation from the olfactory nerve fo r
smell and from the trigeminal nerve for other sensations. The nasal cavity's
blood supply is from branches of the ophthalmic and maxillary arteries.
SAADDES
Nasal
vestibule
Inferior
nasal
meatus
La teral Wall of Nose

33 1
Reproduced with pcnmssion from Atlll.1 ojH11man AlllJtiJmy: Springhouse:. 2001. Springhouse.
respiratory system
While ascending to 30,000 feet, the passengers on a commercial flight experience the sensation of their ears "popping:' The swallowing or yawning that
triggers this equalizes the pressure of the middle ear with the surrounding
atmosphere via the eustachian (auditory) tube. The pharyngeal opening for
this tube, along with the salpingopharyngeal fold, pharyngeal recess, and
pharyngeal tonsils (adenoids) are all located in the:
SAADDES
laryngopharynx
oropharynx
nasopharynx
none of the above
34
ANATOMIC SCIENCES
nasoph arynx
The ph arynx (the throat) is a t ube that serves as a passageway for the respiratory and digestive tracts. It extends from the mouth and nasal cavities to the larynx and esophagus.
The pharynx is divided into three regions:
1. Nasopharynx- is the most superior division of the pharynx. It is inferior to the sphe noid bone and li es at the level of the soft palate. The pharynx is lined with ciliated pseudostratified epithelium (respiratory epithelium). The nasopharynx has four open ings:
two auditory (eustachian) tubes: each opening out of a lateral wall and connecting
with the mi ddle ear (tympanic cavity)
two openings of the posterior nares (choanae)
Note: nasopharynx -location of the pharyngeal tonsils
SAADDES
The soft palate and uvula form the anterior wall of the nasopharynx. Note: The tensor veli
palatini and the levator veli palatini muscles prevent food from entering the nasopharynx.
2. Oropharynx - the middle division of the pharynx; is continuous w ith the posterior
oral cavity and is lined with stratified squamous epithelium. The oropharynx extends inferiorly from the soft pa late to the hyoid bone. The opening into the oropharynx from the
mouth is called the fauces. The lingual tonsils protrude into the oropharynx from the
oral cavity at the base of the tongue. The anterolateral walls of the oropharynx support
the palatine tonsils. It is a food and air pa ssageway.
3. La ryngopharynx- is the most inferior division of the pharynx; the laryngopharynx extends from the hyoid bone to the opening of the esophagus. The laryngopharynx is lined
w ith stratified squamous epitheliu m. extends from the oro pharynx above to the larynx
and esophagus. The laryngopharynx also serves as a passageway for food and air. Air
entering the laryngopharynx goes to the larynx while food goes to the esophagus.
Note: Food entering the larynx would be expelled by violent coughing.
Pharyngeal tonsil (adenoids)
Middle turbinate
SAADDES
Inferior turbinate
Vestibule
34-1
Pharynx
respiratory system
A women in Ethiopia who has a human papillomavirus infection, starts to
grow warts on her larynx and respiratory tract. In order to allow her to breathe
an emergency airway maybe established by opening into the trachea:
th rough the thyrohyoid membrane

between the thyroid and crico id cartilage
SAADDES
between thyroid cartilages
above the level of thyroid cartilage
35
ANATOMIC SCIENCES
between the thyroid and cricoid cartilage

An emergency tracheotomy (tracheostomy) is most easil y made by an incision
through the median cricothyroid ligament. This ligament runs from the cricoid ca rtilage
to the thyroid ca rtilage and is inferior to the space between the vocal cords (rima glottid is) w here aspirated objects usuall y get lodged. The tracheotomy allows for air to
pass between the lungs and the outside air. Important: The space entered is cal led
the cricothyroid space.
Important: A cricothyrotomy is preferabl e to tracheostomy for non-surgeons in

emergency respiratory obstructions. In t his procedure, an incision is made throug h
the skin and cricothyroid membrane for t he relief of acute respiratory obstruction.
SAADDES
Note: A tracheotomy (tracheostomy) is rarely performed and is limited to patients with

extensive laryngeal damage and infants w ith severe airway obstruction. Because of
the presence of major vascu lar structures (carotid arteries and internal jugular vein), t he
thyroid g land, nerves (recurrent laryngeal branch of the vagus nerve), the pleural cavities, and the esophagus, meticulous attention to anatomical detail has to be observed.
Laryngeal prominence (Adam's apple) is a protuberance that is formed by the angle
ofthe thyroid cartilage surround ing the larynx. This protuberance is more pronounced
in men.
respiratory system
Which of the following describes the function of the surfactant?
increases the surface area of the alveoli

reduces the attractive forces of 0 2 molecules and increases surface tension
reduces the cohesive force of H 20 molecules and lowers surface tension
SAADDES
increases the cohesive force of air molecules and raises surface tension
none of the above
36
ANATOMIC SCIENCES
reduces the cohesive force of H 20 molecules and lowers surface tension

Surfactant is a complex substance containing phospholipids and a number of apoproteins. This essential fluid is produced by the Type II alveolar cells, and lines the alveoli
and smallest bronchioles. Surfactant reduces surface tension throughout the lung,
thereby contributing to its general compliance. It is also important because it stabilizes the alveoli.
Neonatal respiratory distress syndrome (or respiratory d istress syndrome of newborn) is a syndrome in premature infants caused by developmental insufficiency of
surfactant production and structural immaturi ty in the lungs. It begins shortly after
birth and is manifest by tachypnea, tachyca rdia, chest wall retractions (recession), expiratory grunting, nasal fl aring and cyanosis during breathing efforts.
SAADDES
Cells of respiratory mucosa:

Clara cells are dome-shaped cells w ith short m icrovilli found in the small airways
(bronchioles) of the lungs. Clara cells are found in the ci liated simple epithelium.
These cells may secrete glycosaminoglycans to protect t he bronchiole lining.
Type I pneumocytes (simpl e squamous alveola r cells) are responsible for gas exchange in the alveoli and cover a majority of t he alveolar surface area (>95%).
Type II pneumocytes are granular and roughly cubo idal in shape. They cover a
much smaller surface area t han type I cells (<5%). Their function is t he production
and secretion of surfactant (the majority of which are d ipalm itoylphosphatidylcholine), a g roup of phospholipids t hat reduce the alveola r surface tension.
Alveolar macrophages (or dust cells) are type of macrophages found in the pulmonary alveolus, near t he pneumocytes, but separated from the wall. Dust cells are
another name for monocyte derivatives in the lungs that reside on respiratory surfaces and cl ean off particles such as dust or microorganisms.
arteries
The external carotid artery terminates within the parotid gland, just behind
the neck of the mandible, where the external carotid artery gives off two final
branches. Which of the following is one of those terminal branches?
superior thyroid artery

superficial temporal artery
SAADDES
posterior auricu lar artery

occipital artery
facial artery
m iddle meningeal artery
anterior ethmoidal artery

37
ANATOMIC SCIENCES

The external carotid artery suppli es st ructures w ith in the neck, face, and scalp, and also
supplies the maxilla and tongue. As with t he internal caroti d artery, the external carotid
artery begins at the upper border of the thyroid cartilage (i.e., at the termination of the
common carotid artery and t he carotid sheath). The external carotid artery terminates
w ith in the parotid gland, j ust behind the neck of the mandible, where the artery gives off
two fina l branches, the superficial temporal and the maxillary arteries. Note: At its
origin, where pu lsations can be felt, the external carotid artery lies within the carotid
triangle.
Branches of the external carotid artery (from inferior to superior):

Superior thyroid artery - su pp lies thyroid gland, gives off a branch to t he sternocleidomastoid muscle and superior laryngeal artery
Lingual artery- supp li es the tongue
Facial artery- supplies the face, including lips and the submandibular gland
Ascending pharyngeal artery - supplies the pharyngeal wall
Occipital artery- supplies the pharynx and suboccipital triangle
Posterior auricular artery - supp li es back of the scalp
Maxillary artery - terminal branch of external carotid, it gives off branches to the
mandible, and the middle meningeal artery before passing th rough the
pterygomaxillary fi ssure to enter the pterygopalatine fossa to supply t he maxilla
Superficial temporal artery- terminal branch of external caroti d, supplies skin over
frontal and temporal regions of scalp
SAADDES
Mnemonic of the external carotid artery b ranches (Egyptian one):

"Some American Lady Found Our Pyramids So M agnificent"
Important: The external carotid artery and its branches supp ly t he muscles of the neck
and face, thyroid gland, salivary glands, scalp, tongue, jaws, and teeth.
Parietal branch
1--
- - --+-l'':\--ofsuperficial
temporal artery
SAADDES
Reproduced With pt'nn1ssion from Fehrenbach MJ, Ht'1Ting SW: Jllu.flratetf Anatomy
and Neck. ed 1: St. Louis, 2007,
Saunders.
Pathway of the Superficial Temporal Artery
SAADDES
Pathway of the Facial Artery
37 A l
Rqwoduccd With pemliSlHOO (rom Fehrenbach MJ. Herring SW; 11/u:urated A11atmny o[tl1e Head and Neck, tNI J; St Louis. 2007. Saunders.
arteries
The Circle of Willis is formed by all of the following arteries EXCEPT one. Which
anterior communicating artery

posterior commun icating artery
SAADDES
anterior cerebral artery
superior cerebellar artery
38
ANATOMIC SCIENCES
superior cerebellar artery

Blood is supplied to the brain, face, and scalp via two major sets of vessels: the right and left
common carotid arteries and the right and left vertebral arteries. The right common carotid
arises from the brachiocephalic trunk, while the left common carotid arises from the aortic
arch directly. The common carotid lies within the carotid sheath and runs upwards in the neck to
the superior border of the thyroid cartilage. Here it divides into t wo pairs of blood vessels, the
external and internal carotid arteries. The external carotid arteries supply the face and scalp with
blood. The internal carotid arteries divide furt her in the middle cranial fossa into the anterior and
middle cerebral arteries, which supply blood to the anterior three-fifths of cerebrum, except for
parts of the temporal and occipital lobes. The vertebrobasilar arteries supply the posterior twofifthsof the cerebrum, part of the cerebellum, and the brain stem.
Remember:
Four major arteries, t he two vertebral and the two carotid, supply the brain with oxygenated
blood. The two vertebral arteries (which are branches of t he subclavians) converge to become
the basilar artery, which supplies the posterior brain.
The circle of Willis (also called the cerebral arterial circle) is formed by:
Terminal part of internal carotid artery (left and right)
Anterior cerebral artery (left and right)
Middle cerebral artery (left and right)
Posterior cerebral artery (branch of basilar artery) (left and right)
Anterior communicating artery
Posterior communicating artery
SAADDES
**"* This ci rcle of Willis forms an important means of collateral circulation in the event of
obstruction.
The internal carotid artery has no branches outside the skull and enters the skull through the
carotid canal. Insid e the skull, the internal carotid artery gives off the ophthalmic artery, which
supplies the optic nerve, eye, orbit, and scalp. The artery t erminates by passing through t he
cavernous sinus to join the c.ircle of Willis and supply the brain.
Anterior communicating
SAADDES
Arterial Blood Supply of Cerebral Hemispheres
38 1
Reproduced With pem1issum (rom Moore KL. Dalley AF. Agur AMR: Clinical Oriented Anatomy. eJ 6; Baltimore, 2010. Lippincott Williams
&Walkins.
right common
carotid artery
sternocleidomastoid
brachiocephalic
artery
right subclavian
artery
left subclavian
artery
SAADDES
aorta
clavicle
first rib
Origins from the heart of the arterial blood supply for the head and neck highlighting the pathways ofthe common carotid and subclavian arteries. Note the pathways
are different on the right and left sides of the body.
arteries
In carotid s inus syncope, the carotid sinus is overly sensitive to manual stimulation and can lead to loss of consciousness. Given this, which of the following statements is true?
it is stimulated by changes in blood pressure

it functions as a chemoreceptor
SAADDES
it is innervated by the facia l nerve
it is located at the termina l end of the external carotid artery

it communicates freely w ith the cavernous sinus
39
ANATOMIC SCIENCES
it is stimulated by changes in blood pressure

The carotid sinus is a localized dilation of the internal carotid artery at its origin, the common
carotid artery. The carotid sin us contains numerous baroreceptors, which function as a "sampling area" for many homeostatic mechanisms for maintaining blood pressure. The carotid sinus
baroreceptors are innervated by the sinus nerve of Hering, which is a branch of cranial nerve
IX (glossopharyngeal nerve).
The carotid body is a small cluster of chemoreceptors and supporting cells located near the bifurcation of the common carotid artery. The carotid body detects changes in the composition
of arterial blood flowing through it, mainly the partial pressure of oxygen, but also of carbon
dioxide. Furthermore, it is also sensitive to changes in pH and temperature.
SAADDES
The aortic body is one of several small clusters of chemoreceptors, baroreceptors, and supporting cells located along t he aortic arch. lt measures changes in blood pressure and the composition of arterial blood flowing past it, including the partial pressures of oxygen and carbon
dioxide and pH. The aortic body is innervated by cranial nerve X (vagus nerve).
The baroreflex or baroreceptor reflex is one of the body's homeostatic mechanisms for maintaining blood pressure. It provides a negative feedback loop in which an elevated blood pressure reflexively ca uses heart rate to decrease therefore causing blood pressure to decrease;
likewise, decreased blood pressure activates t he baroreflex, causing heart rate to increase t hus
ca using an increase in blood pressure. The system relies on specia lized neurons, known as
baroreceptors, in the aortic arch, carotid sinuses, and elsewhere to monitor changes in blood
pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated
by the autonomic nervous system.
Carotid sinus syndrome is a temporary loss of consciousness that sometimes accompanies
convulsive seizures because of the intensity of the carotid sinus reflex when pressure builds in
one or both carotid sinuses.
External carotid artery
SAADDES
Internal carotid
Pathway of the internal carotid artery after

branching off the common carotid artery
39 1
Rq woduccd With pemliSlHOO (rom Fehrenbach MJ. Herring SW; 11/u:urated A11atmny o[tl1e Head and Neck, eil J; St Louis. 2007. Saunders.
arteries
Which of the following branches of the internal carotid artery is most frequently implicated in a stroke?
ophthalmic artery
anteri or choro idal artery
SAADDES
middle cerebral artery
anteri or cerebral artery
Irefer to card 38-1for illustration)
ANATOMIC SCIENCES
40
middle cerebral art ery

The middle cerebral artery is the largest branch of the internal carotid. The artery
supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal
lobes, including the prim ary motor and sensory areas of the face, throat, hand, and arm
and in the dominant hemisphere, the areas for speech. The middle cerebral artery is the
artery most often occl uded in stroke.
Note: Small, deep penetrating arteries known as the lenticulost riate arteries branch
from the middle cerebral artery. These arteries are often called the "arteries of stroke"
because they are often involved in a stroke (also called a cerebrovascular accident).
The anterior cerebral artery is the smaller branch of the internal carotid artery that
supplies oxygenated b lood to most medial portions of the frontal lobes and superior
medial parietal lobes. The left and right anterior cerebral arteries are connected by the
anterior communicating artery (part of Circle of Willis).
SAADDES
Stroke warning signs:

Sudden weakness, paralysis, or numbness of the face, arm, and leg on one or both
sides of the body
Loss of speech or difficulty speaking or understanding speech
Dimness or loss of vis ion, particularly in only one eye
Unexplained dizziness (especially when associated w ith other neurologic symptoms),
unsteadiness, and sudden falls
Sudden severe headache and loss of consciousness
An int racranial berry aneurysm, also known as a saccular aneurysm, is a sac -l ike outpouching in a cerebral b lood vessel, which can seem berry-shaped, hence the name. Once
a berry aneurysm has formed it is likely to rupture, causing a stroke. Thus they are serious
medica l emergencies, and should be treated as soon as possible. Note: Berry aneurysms are
usually found in the region of the Circle of Willi s.
arteries
The sinusoids are most likely found in all of the following organs EXCEPT one.
Which one is the EXCEPTION?
spleen
bone marrow
cartilage
SAADDES
parathyroid g lands
41
ANATOMIC SCIENCES
cartilage
A sinusoid is a small blood vessel similar to a capillary but w it h a discontinuou s endothelium. Sinusoids are fou nd in the liver, lymphoid t issue, endocrine o rgans, and
hematopoietic organs such as the bone marrow and the spleen.
Sinusoids are highly permeable, having larger inter-cellular clefts, fewer t ight junctions,
and d iscont inuous endothelial cells (meaning t hat t he individual endothelial cells do
not overlap as in capillaries and are spread out). The level of permeability is such as to
allow small- and medium-sized proteins such as albumin to enter and leave the bloodstream. Some spaces are large enough for blood cel ls to pass. Oxygen, carbon dioxide,
nutri ents, proteins, and wastes are exchanged t hrough the t hin walls of t he sinusoids.
SAADDES
Sinusoids:
Have a large lumen (30 to 40 microns in d iameter) - ca pillaries have a small
lumen (average 8 microns in diameter)
Are wider and more irregular than capil laries
Have walls that consist partly of phagocytic cells
Form a part of t he reticuloendothelial system, wh ich is concerned chiefly with
phagocytosis and antibody formation
arteries
The most prominent functional component in the tunica media of large
arteries is the:
skeletal muscle cells

elastic fibers
SAADDES
smooth muscle cells

collagen fibers
42
copyright CI 201J..2014 Dental Decks
ANATOMIC SCIENCES
elastic fibers
***
Key: If the question referred to small arteries, the answer would have been
smooth muscle cells.
The wa lls of blood vessels are composed of the fo llowing tunics (layers):
1. Tunica intima - innermost layer, consists of a layer of simple squamous epithelium (called endothelium) and a th in connective-tissue basement membrane. The
endothelium of th is layer is the only layer present in vessels of all sizes.
Note: Atherosclerosis is the emergence of plaque between the basement membrane and the endothelial cells of the tunica intima.
SAADDES
2. Tunica media - middle layer, is usually very thick in arteries, and consists of
smooth muscle fibers mixed with elastic fibers. Increases or decreases lumen diameter; affects blood pressure.
3. Tunica adventitia - an outer layer of connective tissue, containing elastic and
collagenous fibers. The tunica adventitia of the larger vessels is infiltrated with a
system of tiny blood vessels ca lled vasa vasorum ("vessels of the vessels") that
nourish the more external tissues of the blood vessel wall.
Blood is carried away from the heart in large vessels ca lled arteries. These divide into
smaller arteries, and the smaller arteries divide into arterioles. Arteri oles divide into
microscopic capillaries (the exchange area of the system). The capillaries converge to
form vessels called venules, which join to form still larger vessels called vein s. Veins
return the blood to the heart.
Tunica Intima
.,.lli". - -oruernal olastJc
Tunica adventltJa
enous and elastic tissue
and vasa vasorum))
SAADDES
Muscular artery
large vein
vasa vasorum)
Muscular artery and large vein. Arteries have a more muscular wall, thus a much thicker tunica media
than the veins, and they have a greater amount of e lastic tissue. Conversely, the tunica adventitia of veins
are much thicker than those o f the arteries. The outermost layer is the tunica adventitia, composed of
fibroelastic connective tissue, whose vessels, the vasa vasorum, penetrate the outer regions of the tunica media, supplying its cells with
Remember: Veins, unlike arteries, may possess valves that
prevent the retlux of blood.
42 1
Rqwoduccd with pemtissuln (rom Gartner LP. Htntt JL; Color Atlcu
ed 5, Bnhimore. 200C), Lappincolt \Valhnms & Wtlkins.
arteries
The tunica media and adventitia are absent in which blood vessel type?
arteries
arterioles
capillaries
venu les
veins
SAADDES
43
ANATOMIC SCIENCES
capillaries
Through capi llary wa lls, which consist of a single layer of endothelial cells, blood and
tissue cells exchange gases and metabolites.
Capillaries are tiny blood vessels with extremely thin wa lls that consist of endothelium only; no tun ica media or adventitia is present. They join arteri oles and venules.
These blood vessels accommodate erythrocytes one at a time.
In certain structures (liver, spleen, bone marrow, and certa in g lands), the arterioles,
rather than connecting with capillaries, empty into blood vessels ca lled sinusoids.
They have very, very thin walls that conform to the space in wh ich they are located
(form irregula r tortuous tubes).
SAADDES
1. The velocity of blood flow is slowest in capillaries.

2. A decrease in vessel diameter causes an increase in resistance to blood
flow.
Poiseuille's Law:
F=
81']1
In which F is the rate of blood flow, t.P is the pressure

difference between the ends of the vessel, r is the radius
of the vessel, 1 is the length of the vessel, and 11 is viscosity of the blood.
Note particularly in t his equation t hat t he rate of blood flow is directly proportional to
the fourth power of the radius of the vessel, w hich demonstrates once again t hat
the diameter of a blood vessel (which is equal to twice the radius) plays by fa r the
greatest role of all factors in determining the rate of blood flow t hrough a vessel.
SAADDES
Continuous Capillary
Fenestrated Capillary
Capillaries consist of a simple squamous epithelium rolled into

a narrow cylinder 8-10 p m in diameter. Continuous (somaHc)
capillaries have no fenestrae; material traverses the endothelia l cell in either direction via pinocytotic vesicles. Fenestrated (visceral) capillaries are characterized by the presence
of perforations, fenestrae, 60-80 p m in diameter, which may
or may not be bridged by a diaphragm. Sinusoidal capillaries have a large lumen (30-40 pm in diameter), possess numerous fenestrae, have discontinuous basal lamina, and lack
pinocytotic vesicles. Frequently, adjacent endothelial cells of
s inusoida l capillaries overlap one another in an incomplete
fashion.
Sinusoidal (Discontinuous) Capillary
Rqwoduccd with pemtissuln (rom Gartner LP. Htntt JL; Color Atltu
43- t
ed 5. Baltimore. 200C), L1ppincott \V1lhnms & \V1lkins.
arteries
The hepatic veins that drain the liver empty into the:
hepatic sinusoids
azygous vein
inferi or vena cava
SAADDES
inferi or vena cava and azygous veins

portal vein
44
ANATOMIC SCIENCES
inferio r vena cava
The hepatic artery brings oxygenated blood to the liver, while the hepatic portal
vein bri ngs food-laden blood from the abdominal viscera.
Remember: All the blood supplied to the liver from the hepatic arteri es and the porta l vein eventually d rains via the hepatic veins to the inferior vena cava.
Important: The most unusual aspect of hepatic circulation is that all the blood
supplied to the liver from the hepatic arteri es and the portal vein empties into the
same sinusoids (minute endothelial-lined passageways in the liver lobules), which
therefore contain a mixture of arterial and venous blood. The sinusoids of each lobule
empty into a common central vein. The common central vein of each lobule then
empties into one of th ree hepatic veins. These veins all empty into the inferior vena
cava, which transports the blood to the heart.
SAADDES
Remember: The portal triad is a distinctive arrangement in the liver. It is a component of the hepatic lobule and consists of the following structures:
Hepatic artery
Portal vein
Bile duct
SAADDES
H epatic ar chitecture - lobule and acinus. (A} Diagram showing the architecture of the liver and
the relationship between the vessels and ducts in the portal trdct, the sinusoids and the central veins.
44-1
Reproduced wilh pcnn ission from Stevens A. l.owt' J: Huma11
iN/ J.
Phaladdphaa. 200S. !!bevier.
Hepatic portal vein
Aorta
Hepatic artery
SAADDES
Central veins
The Pathway of Blood Through the Liver

44 A I
arteries
The greatest drop in blood pressure is seen at the transition from:
arterioles to capi llaries

arteries to arterioles
capillaries to venules
SAADDES
venu les to veins
45
ANATOMIC SCIENCES
arteries to arterioles
Important: The highest pressure of circulating blood is found in arteries, and gradually drops as the blood flows through the arterioles, capil laries, venules, and veins
(where it is the lowest). The g reatest drop in blood pressure occurs at the transition
from arteries to arterioles.
Arterioles are one of the blood vessels of the smallest branch of the arterial circulation. Blood flowing from the heart is pumped by the left ventricle to the aorta (largest
artery), which in turn branches into smaller arteries and final ly into arterioles. The
blood continues to flow through these arterioles into capi llaries, venules, and finally
veins, which return the blood to the heart.
SAADDES
Arterioles have a very small diameter (<0.5 mm), a small lumen, and a relatively
thick tunica media that is composed almost entirel y of smooth muscle, with little
elastic t issue. This smooth muscle constricts and dilates in response to neurochemical
stimuli, wh ich in turn changes the diameter of the arterioles. This causes profound
and rapid changes in peripheral resistance. This change in diameter of the arterioles regulates the flow of blood into the capillaries. Note: By affecting peripheral
resistance, arterioles directly affect arteria l blood pressure.
Primary function of each type of blood vessel:
- Arteries - transport blood away from the heart, generally have blood that is ri ch
in oxygen
-Arterioles- control blood pressure
-Capillaries- diffusion of nutrients/oxygen
-Veins- carry blood back to the heart, generally have blood that is low in oxygen
arteries
All of the following vessels supply blood to the tonsils EXCEPT one. Which
ascending pharyngea l artery

tonsil lar branch of facial artery
SAADDES
superior labial artery

dorsal lingual artery
Irefer to card 37 A-1for illustration I
ANATOMIC SCIENCES
46
superior labial artery

The facial artery supplies blood to t he face, tonsils, palate, labial g lands, and muscles of t he
lips. The facial artery also supplies the submandibular gland, the ala and dorsum of the nose,
and t he muscles of facial expression.
The facial artery originates in t he external carotid artery and gives off branches t hat supply
the neck and face. Branches of the facial art ery (cervical and facial portion) include:
Cervical portion:
Tonsillar - to the tonsils
Ascending palatine - ascends alongside the pharynx, to reach the base of the skull
Submental -to the area below the chin, the submandibular salivary glands and a
portion of the sublingual salivary glands
SAADDES
Facial portion:
Inferior labial -to t he lower lip
Superior labial - to the upper lip and vestibule of nose
Lateral na sal - to the lateral wall of the nose (outer side)
Angular - to the medial side of the eye. It is t he terminal branch of the facial artery
and can anastomose with t he dorsal nasal branch of the ophthalmic artery
Blood supply of palatine tonsils: Blood supply is provided by tonsillar branches of five arteries: the dorsal lingual artery (of t he lingual artery), ascending palatine artery (of the facial
artery), tonsillar branch (of the facial artery), ascending pharyngeal artery (of t he external
carotid artery), and t he lesser palatine artery (of the descending palatine artery). The tonsils
venous drainage is by t he peritonsillar plexus, which drain into t he lingual and pharyngeal
veins, which in turn drain into the internal jugular vein.
SAADDES
Pathway of the Facial Artery
37 A l
arteries
Which of the following arteries is found between the hyoglossus and
genioglossus muscles?
inferi or alveolar artery

posterior superior alveolar artery
SAADDES
lingual artery
infraorbital artery
facial artery
[refer to card 37 A-1for illustration]
ANATOMIC SCIENCES
47
lingual artery
The lingual artery arises from the anterior surface of the external carotid artery,
opposite the tip of the greater cornu of the hyoid bone. The lingual artery loops
upward and then passes deep to the posterior border of the hyoglossus muscle to
enter the submandibular region. The loop is crossed superficially by the hypoglossal
nerve. The loop supplies blood to the tongue, suprahyoid region, sublingual gland,
palatine tonsils, and floor of the mouth.
Important: In the o ral region, the lingual artery usually is found between the hyoglossus and genioglossus muscles.
SAADDES
Branches of the lingual artery include the suprahyoid, dorsal lingual, sublingual, and
deep lingual branches.
Note: The inferior alveolar vein, artery, and nerve along with the lingual nerve are
found in the space between the medial pterygoid muscle and the ramu s of the mandible
(pterygomandibular space).
Important: The injection site for the inferior alveolar nerve block is probed with a
cotton t ip applicator at the depth of the pterygomandibular space on the medial
surface of the ra mus. The needle is inserted into the tissues of the pterygomandibular space until the mandible is contacted. The needle is withdrawn 1 mm from the tissues to protect the peri osteum, and then the injection is administered.
arteries
If the palatal mucosa opposite to the maxillary first molar was lacerated and
bleeding occurred, which of the following arteries is most likely to be
involved?
greater palatine artery

descending palatine artery
SAADDES
nasopalatine artery
lesser palatine artery
m iddle superior alveo lar artery

posterior superi or alveolar artery
48
ANATOMIC SCIENCES
greater palatine artery

In t he pterygopalatine fossa, the maxillary artery gives rise to the descending
palatine artery, which travels to the palate throug h the pterygopa latine canal, which
then terminates in both the greater palatine artery and lesser palatine artery by
way of the greater and lesser palatine foramina to supply the hard and soft palates,
respectively.
The maxillary artery ends by becoming t he sphenopalatine artery, w hich supplies
the nasal cavity. The sphenopalatine artery gives rise to t he posterior lateral nasal
branches and septal branches, including a nasopalatine branch that accompanies
the nasopalatine nerve through the incisive foramen on the maxilla.
SAADDES
1. The greater palatine artery supplies the mucosa of the hard palate posterior to the maxillary canine.
2. Mucosa of the hard palate anterior to the maxillary can ine is supplied by
the nasopalatine artery.
3. The soft palate and tonsils are supplied by the lesser palatine artery.
Pterygopalatine
(opened)
SAADDES
Greater palatine
artery
Pathways of the greater palatine artery, lesser palatine artery,

and sphenopalatine artery
43-1
lateral posterior
nasal arteries
Posterior septal
branches
SAADDES
lesser palatine
artery
Greater palatine artery
S phenopalatine artery. Medial view of right nasa l wall and rig ht sp henopalatine artery. T he
sphenopa latine artery enters the nasal cavity through the sphenopalatine foramen. T he anterior portion of the nasa l septum contains a highly vascularized region (Kiesselbach's area), which is supplied by both the posterior septal branches of the sphenopalatine artery (external carotid artery)
and the anterior septa l branches of the anterior ethmoidal artery (internal carotid arte1y via ophthalmic artery). When severe nasopharyngea l bleeding occurs, it may be necessary to ligate the
maxi llary artery in the pterygopalatine fossa.
48AI
Reproduced wilh
from Shucnkc M. Schultc E, Schumacher U; Head and Neck Ana/Omyfor Vema/ MN/ici11e; New York, 1010,
Tlucmc Medical Publishers.
arteries
Examination of a patient with an ulcerative carcinoma of the posterior third
of the tongue revealed bleeding from the lesion and difficulty swallowing
(dysphagia). The bleeding was seen to be arterial; which of the following
arteries was involved?
deep lingual artery
SAADDES

tonsillar artery
sublingual artery
49
ANATOMIC SCIENCES

***The dorsal lingual artery runs on the superficial surface of the tongue - it is a branch of the
lingual artery that delivers blood to the posterior superficial tongue. So, this artery must be the
source of the hemorrhage.
The tongue is supplied by the lingual artery, the tonsillar branch of the facial artery, and the
ascending pharyngeal artery. The veins drain into the internal jug ular vein.
The lingual artery arises from the external carotid artery at the level of the tip of the greater
horn of the hyoid bone in the carotid triang le. Branches include:
Dorsal lingual: supplies the base and body of the tongue (posterior superficial tongue}
Suprahyoid: supplies the suprahyoid muscles
Sublingual: supplies the mylohyoid muscle, sublingual salivary gland, and mucous membranes of the floor of the mouth
Deep lingual (terminal branch}: supplies the apex of the tongue
SAADDES
Remember (information about the tongue}:

1. Motor innervation is from the hypoglossal nerve (CN XII} except for palatoglossus
muscle w hich is innervated by vagus nerve (CN X}.
2. Sensory innervation - lingual (branch of trigeminal CN V-3} supplies the anterior twothirds, glossopharyngeal (CN IX} supplies the posterior one-third (includ ing vallate papillae}, vagus (CN X} through the internal laryngeal nerve supplies the area near the epiglottis.
3. Ta ste- facial (CN VII} via chorda tympani supplies the anterior two-thirds; glossopharyngeal (CN IX} supplies the posterior one-third.
1. The tonsillar artery is a branch of the facial artery that also supplies blood to the
palatine tonsil.
2. The ascending pharyngeal artery is the smallest branch of the external carotid
artery. Branches include the pharyngeal and meningeal arteries.
3. The lingual artery and facial artery often arise from a common trunk of the external
carotid artery.
Maxillary artery
SAADDES
Facial artery
lingual
Pathway of the external carotid artery after branching off the common carotid artery
49-1
Rq'lroduccd With pc:m1issum (rom
MJ. Herring SW: 11/u.fll'ated A11atomy oftlle Head and Neck. ed J; St Louis. 2007. Saunders.
SAADDES
GG Genioglossus
MC Middle pharyngeal constrictor
SG Styloglossus
JiG Hyoglossus
l\1 Mandible
SLSublingual gland
Blood supply of th e ton gue. T he main artery to the tongue is the lingua l, a branch of the externa l
carotid artery. The dorsal lingual arteries provide blood supply to the root of the tongue and a branch
to the palatine tonsi l. T he deep lingual a11eries supply the body of the tongue. The sublingua l ar
teries provide blood supp ly to the floor of the mouth, includ ing the sublingua l g lands.
49AI
With pem1bts1on (rom Moore KL. Oalky AF. Agur AMR: Clinical Oritmted Anatomy. eJ 6: Baltimore. 20 10.lippinoou Williams
&Walkins.
arteries
During a boxing match a boxer got a blow on the lateral side of the skull,
immediately he fell unconscious for several seconds. He was asymptomatic
for the first 24 hours then he developed symptoms of elevated intracranial
pressure (headache, nausea and vomiting). Which of the following arteries is
most likely involved?
inferior alveolar artery
SAADDES
middle meningeal artery

infraorbital artery
deep temporal artery

middle cerebral artery
50
ANATOMIC SCIENCES
middle meningeal artery
The middle meningeal artery is typically the thi rd branch of the first part (retromandibular part) of the maxillary artery, one of the two terminal branches of the
external ca rotid artery. After branching off the maxillary artery in the infratemporal
fossa, it runs through the foramen spinosum to supply the dura mater (the outermost
meninges) and the ca lva ri a. The middle meningeal artery is the largest of the three
(paired) arteri es wh ich supply the meninges, the others being the anteri or meningeal
artery and the posterior meningeal artery.
In approximately half of subjects it branches into an accessory meningeal artery.
SAADDES
The anterior branch ofthe middle meningeal artery runs beneath the pteri on. It is vu lnerable to injury at th is point, where the skull is thin. Rupture of the artery may give
rise to an epidural hematoma. In the dry cranium, the middle meningeal, which runs
within the dura mater surrounding the brain, makes a deep indentation in the calvarium.
arteries
Which arteries supply the greater curvature of the stomach?
right gastric, left gastri c and short gastri c arteri es

right and left gastroepiploic arteries
right gastric, left gastroepiploic and short gastri c arteries
SAADDES
right gastroepiploic, left gastroepiploic and short gastric arteries
51
ANATOMIC SCIENCES
right gastroepiploic, left gastroepiploic and short gastric arteries

All of the arteri es that supply t he stomach are derived d irectly or indirectly from the celiac trunk (celiac
artery). The celiac artery takes its origin from t he abdominal aorta j ust below t he diaphragm at about
the level of t he twelfth thoracic vertebra. It is the artery that supplies t he foregut. The celiac artery is
surrounded by the celiac p lexus and lies behind t he lesser sac of peritoneum. The celiac artery has three
terminal branches: the splenic, left gastric, and the common hepatic arteries.
Splenic artery - the large splenic artery runs to the left in a wavy course along the upper border of the
pancreas and behind the stomach. On reaching the left kidney the artery enters the lienorenal ligament and
runs to the hilum of the spleen. It has the following branches:
I. Pancreatic bra nches
2. The left gastroepiploic artery
3. The short gastric arteri es
Left gastric artery - the small left gastric artery runs to the cardiac end of the stomach, gives off a few
esophageal branches, then turns to the right along the lesser curvature of the stomach. It anastomoses with
the right gastric artery.
SAADDES
Common hepatic artery - the medium-sized hepatic artery runs forward and to the right and then ascends
between the layers of the lesser omentum. At the porta hepatis it divides into right and left branches to
supply the corresponding lobes of the liver.
*** The common hepatic artery gives ri se to t he gastroduodenal artery, right gastric artery, and
hepatic artery proper (a.k.a. proper hepatic artery). The hepatic artery proper then g ives off a right
and left hepatic artery, w ith the cystic artery coming off of the right hepat ic artery.
Note: For purposes of description, the hepatic artery is sometimes d ivided into the common hepatic
artery, which extends from its origin to t he gastroduodenal b ranch, and the hepatic artery proper,
which is t he remai nder of the artery.
Arterial supply of the stomach:
The lesser curvature of the stomach is supplied by t he right gastric artery inferiorly, and the left gastric artery superiorly, which al so supplies the cardiac region.
The greater curvature is supplied by the right gastroepiploic artery inferiorly and t he left gastroepip loic
artery superi orly. The fundus of t he stomach, and also the upper portion of the g reater curvature, is supplied by the short gastri c artery which arises from splenic artery.
esophageal branches esophageal hiatus of diaphragm
SAADDES
gastroduodenal artery
superior pancreaticoduodenal artery
right gastroepiploic artery

51 1
Arteries that supply the stomach. Note that all of the arteries are derived from branches
of the celiac artery.
arteries
The internal thoracic artery ends in the sixth intercostal space by dividing
into the:
anterior and posterior intercostal arteries

subclavian and inferior epigastric arteries
SAADDES
superi or epigastri c and musculophrenic arteri es
52
ANATOMIC SCIENCES
superior epigastric and musculophrenic arteries

The internal thoracic artery supplies the anterior wall of the body from the clavicle to the umbilicus. It is a branch of the first part ofthe subclavian artery in the neck.
This artery descends vertically on the pleura behind the costal cartilages, just lateral
to the sternum, and ends in the sixth intercostal space by dividing into the superior
epigastric and musculophrenic arteries.
Branches of the internal thoracic artery include:
Anterior intercostal arteries that supply the upper six intercostal spaces.
Note: The anterior intercostal arteri es of the remaining lower spaces are branches
of the musculophrenic artery that itself is a branch of internal thoracic artery.
Perforating arteries, wh ich accompany the term inal branches of the corresponding intercostal nerves
The pericardiacophrenic artery, which accompanies the phrenic nerve and supplies the pericardium
Mediastinal arteries to the contents of the anterior mediastinum, fo r example,
the thymus gland
The superior epigastric artery, which enters the rectus sheath and supplies the
rectus muscle as far as the umbilicus
The musculophrenic artery, which runs around the costal margin of the
diaphragm and supplies the lower intercostal spaces and the d iaphragm
SAADDES
Note: The inferior epigastric artery, a branch of the external iliac artery,
anastomoses w ith the superior epigastric artery in the rectus sheath in the area of the
umbilicus.
Right common carotid artery
Left common carotid artery
Internal thoracic artery
SAADDES
Bronchial artery
Descendi ng thoracic aorta
Anterior i ntercoStal 3rtery
Superior epigastric artery

Subcostal artery
Ar teries of the t ho racic wall. The arteria l supply to the thoracic wall derives from the thomcic
am1a through the posterior intercostal and subcosta l arteries, from the axi llary artery, and from the
subclavian artery through the intemal thoracic and superior intercostal arteries.
52 1
Reproduced With pem1is!HOO (ro m Moore KL. Dalley AF. Agur AMR: C/inictd Oritmted Anatom)'. eJ 6: Baltimore. 2010.lippinoou Williams
&Walkins.
arteries
At what level does the abdominal aorta bifurcate into the common iliac
arteries and also gives rise to the middle sacral artery?
TlO
T12
T2
l4
l5
SAADDES
53
ANATOMIC SCIENCES
l4
The aorta is the main trunk of a series of vessels that convey the oxygenated blood to the tissues of the
body for their nutrition. The aorta commences at the upper part of the left ventricle, and after ascendi ng
for a short di stance, arches backward and to the left side, over the root of the left lung; the aorta then
descends within the thorax on the left side of the vertebral column, passes into t he abdominal cavity
through the aortic opening of the diaphragm in front of the twelfth thoracic vertebra(T12). The aorta
descend s behind the peritoneum on the anterior surface of the bod ies of the lumbar vertebrae. At the
level of the fourth lumbar vertebra (l4), the aorta divides into the two common iliac arteries. Just
p roximal to this terminal bifurcation is the median sacral artery, an unpaired parietal branch. Note: The
characteristic feature of the aorta is that it contains a lot of elastic fibers in its tunica media (middle
layer of blood vessel wall).
Anatomically, the aorta is traditionally d ivided into the ascendi ng aorta, the aortic arch, and the
descend ing aorta. The descending aorta is, in turn, subdivided into the t horacic aorta (that descends
within the chest) and the abdominal aorta (that descends withi n the abdomen).
Ascending aorta: a short vessel that starts at the aortic opening of the left ventricle. The only
branches of the ascending aorta are the right and left coronary arteries, which supply the heart
muscle.
SAADDES
Aortic arch: gives rise to th ree arterial branches: the brachiocephalic, the left common carotid,
and the left subclavian. These arteries furnish all of the blood to the head, neck, and upper limbs.
Descending aorta:
Thoracic portion (above the diaphragm): extends from T4 to T12 (lies in the posterio r
mediastinum). All of the arterial branches (posterior intercostal, subcostal arteries) from this part
are small. They supply the thorax and the diaphragm. Note: The bronchi receive blood from
branches of the thoracic aorta, termed bronchial arteries that are often found to show considerable
variations. Normally, there is one bronchial artery on the right side of the body and two bronchial arteries on the left. The right bronchial artery usually branches from the third posterior intercostal artery, while the left bronchial arteries (superior & inferior) split di rectly from the thoracic
aorta.
Abdominal portion(below the diaphragm): begins at the aortic hiatus in the d iaphragm and
extend s from T12 -l 4. Arteries from thi s area supply the abdomen and pelvic region as well as the
lower limbs. Arteries from this area supply the abdomen and pelvic region as well as the lower
limbs.
SAADDES
Inferior epigastric
Arteries of Posterior Abdominal \Vall - Branches of the Aorta

Branches of abdominal aorta
53 1
Reproduced With pem1issum (rom Moore KL. Dalley AF. Agur AMR: Clinical Oriented Anatomy. eJ 6; Baltimore, 2010. Lippincott Williams
&Walkins.
arteries
The blood supply of the mucosa of the nasal septum is derived mainly from
the:
facial artery
maxillary artery
SAADDES
inferi or alveola r artery

internal carotid artery
54
ANATOMIC SCIENCES
maxillary artery
The sphenopalatine artery, a branch ofthe maxillary artery, supplies most ofthe blood of
the nasal mucosa.
It enters by t he sphenopalatine foramen and sends branches to the posterior regions of t he
lateral wall and to the nasal septum.
After the greater palatine artery emerges from t he greater palatine foramen it courses
anteriorly and passes through the incisive foramen where it anastamoses with t he posterior
septal branch of the sphenopalatine artery to supply the anterior nasal septum.
The anterior and posterior ethmoidal arteries, branches of the ophthalmic artery, supply
t he anterosuperior part of the mucosa of the lateral wall of the nasal cavity and nasal septum.
Three branches of t he facial artery (superior labial, ascending palatine, and lateral nasal) also
supply t he anterior parts of t he nasal mucosa.
SAADDES
Remember:
1. The ophthalmic artery is a branch of the internal carotid artery.
2. The maxillary artery and the superficial temporal artery are the terminal branches
of the external carotid artery.
3. The pterygopalatine fossa is a cone-shaped paired depression deep to the infratemporal fossa. The pterygopalatine fossa is located between the pterygoid process
and the maxillary tuberosity, close to the apex of t he orbit. This fossa contains t he maxillary
artery and nerve and their branches arising here, including the infraorbital and sphenopalatine arteries, the maxillary division of t he trigeminal nerve and branches, and the pterygopalatine ganglion. The pterygopalatine fossa communicates laterally with the infratemporal
fossa through the pterygomaxillary fissure, medially wit h the nasal cavity throug h the
sphenopalatine foramen, superiorly with the skull through the foramen rotundum, and
anteriorly with the orbit through the inferior orbital fissure.
Anterior
ethmoidal
SAADDES
sphenopalatine
artery
Lateral wall of nasal cavity
Greater palatine artery
superior
labial artery
Nasal septum
Arterial supply of nasal cavity. An open-book view of the latera l and medial walls of the 1ight side
of the nasa l cav ity is shown. T he left '"page" shows the lateral wa ll of the nasal cavity. The
sphenopalatine artery (a branch of the maxillary) and the anterior ethmoida l artery (a branch of the
ophthalmic) are the most important m1eries to the nasal cavity. T he right "page" shows the nasal
septum. An anastomosis of four to five named arteries supplying the septum occurs in the anteroinferior portion of the nasal septum (Kiesselbacharea , shaded on picture), an area common ly
involved in chronic epistaxis (noseb leeds).
54-I
With
&W1lkins.
pem1bts1on (rom Moore KL. Dalley AF. Agur AMR: Clinical Oritmted Anatomy. eJ 6: Baltimore. 20 10.lippinoou Williams
arteries
The distal portion of the duodenum receives arterial supply from the inferior pancreaticoduodenal artery which branches from the:
celiac trunk
gastroduodenal artery
SAADDES
superior mesenteric artery

inferi or mesenteric artery
55
ANATOMIC SCIENCES

The duodenum proximal to the entry of the bile duct receives its arterial supply from the superior pancreaticoduodenal artery, a branch of the gastroduod enal artery which in turn branches from
the common hepatic artery which comes off the celiac trunk. The distal portion of the duod enum
receives its arterial supply from the inferior pancreaticoduodenal artery, which branches from the
superior mesenteric artery.
The arterial supply of the jejunum and ileum is from branches of the superior mesenteric artery.
The intestinal branches arise from the left side of the artery and run in the mesentery to reach the
gut. They anastomose with one another to form a series of arcades. The lowest part of the ileum is
also supplied by the ileocolic artery.
The large intestine extends f rom the ileum to the anu s. The large intestine is divided into the
cecum, the appendix, the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. The blood supply to these areas is as follows:
Cecum: the arterial blood supply is from the ant erior and posterior cecal arteries, which are
branches of the ileocolic artery, a branch of the superior mesenteric artery
Appendix: the arterial supply is by meansof the appendicular artery, a branch of the posterior
cecal artery
Ascending colon: the arterial blood supply is from the ileocolic and right colic branches of the
Transverse colon: the arterial blood supply of the proximal two-thirds is from the mid dle colic
artery, a branch of the superior mesenteric artery. The distal third is supplied by the left colic
artery, a branch of the inferior mesenteric artery
Descending colon: the arterial blood supply is f rom the left colic and sigmoid branches of the
inferior mesenteric artery
Sigmoid colon: the arterial blood supply is from the sigmoid branches of the inferior mesenteric artery
Note: The arterial blood supply to the rectum is from the superior, middle, and inferior rectal arteries. The superior rectal artery is a direct continuation of the inferior mesenteric artery. The mid dle
rectal artery is a small branch of the internal iliac artery. The inferior rectal artery is a branch of the
internal pudend al artery in the perineum. The arterial blood supply to the anus (anal canal) is from
the superior and inferior rectal arteries.
SAADDES
Inferior vena
Superior
pancreaticoduodenal
artery
SAADDES
idi""-li - - - - - -Joferior pancreaticoduodenal artery

l"i''F-- - - - - - S i u c,eri,o r mesenteric artery
artery
Duodenum
Duodenum, pancreas, and spleen. The duodenum, pancreas, and spleen and their blood
supply are revea led by removal of the stomach, transverse colon, and peritoneum.
55- 1
With pcm1issum (rom Moore KL. Dalley AF.Agur AMR: Clinical OrieJJted Anatomy. etf 6: Baltimore, 2010.lippinoou Williams
&Walkins.
arteries
All of the following are direct branches of the subclavian artery EXCEPT one.
Which one is the EXCEPTION?
internal t horacic artery

thyrocervica l artery
SAADDES
inferi or thyroid artery
dorsal scapular artery
56
ANATOMIC SCIENCES
inferior thyroid artery- which is a branch of the thyrocervical artery

The arch of the aorta is a continuat ion of the ascending aorta. The aortic arch lies behind the
manubrium sterni and arches upward, backward, and to the left in front of the trachea (its main
direction is backward). It then passes downward to the left of t he t rachea, and at the level of t he
sternal angle (T4) it becomes the descending or thoracic aorta.
Branches include:
The brachiocephalic artery is an extremely short artery and is the first branch from the aortic
arch. This artery passes upward and to the right of the trachea and divides into t he right
common carotid and right subclavian arteries behind the right sternoclavicular joint.
Remember: There are two (right and left) brachiocephalic veins but only one brachiocephalic
artery.
The left common carotid artery arises from the convex surface of the aortic arch on the left
side of the brachiocephalic artery. The left common carotid artery runs upward and to the left of
the trachea and enters the neck behind the left sternoclavicular joint.
The left subclavian artery arises from the aortic arch behind the left common carotid artery.
The left subclavian artery runs upward along the left side of the trachea and the esophagus to
enter the root of the neck. Thisartery arches over the apex of the left lung.
SAADDES
Subclavian artery branches are:

Vertebral artery
Internal thoracic artery: terminating in the superior epigastric artery and the musculophrenic
artery
Thyrocervical trunk: Very short. Divides into inferior thyroid artery, suprascapular artery and
transverse cervical artery
Costocervical trunk
Dorsal scapular artery
Mnemonic: These may be remembered by the mnemonic "VITamin C and o
Important:
1. The upper limbs are supplied by the subclavian arteries (both rig ht and left).
2. The head and neck are supplied by the right and left common carotid arteries.
SAADDES
anterior interventricular
artery
anterior cardiac vein

atrioventricular groove
apex
interventricular groove
Anterior surface ofthe heart and great blood vessels

Note the course of coronary arteries and cardiac veins.
56-I
arteries
All of the following statements concerning the common carotid arteries are
true EXCEPT one. Which one is the EXCEPTION?
the common carotid arteri es are the same in length

the common carotid arteri es d iffer in their mode of o rigin
SAADDES
the ri ght common carotid artery is a branch of the brachiocephalic trun k

the left common carotid artery is a branch of the aortic arch
[refer to card 38 A-1, 49-1for illustration)
ANATOMIC SCIENCES
57
the common carotid arteries are the same in length

The major arteries that supply the head and neck are the common carotid and subclavian arteries.
The origins from the heart of the common carotid and subclavian arteries that supply the head and
neck are different for the right and left sides of the body. For the right side of the body, the common
carotid and subclavian arteries are both bra nch es from the brachiocephalic artery. Th e
brachiocephalic artery is a direct branch of the aorta.
The common carotid artery is branchless and travels up the neck, lateral to the trachea and larynx,
to the upper border of the thyroid cartilage. The common carotid artery travels in a sheath deep to
the sternocleidomastoid muscle.This sheath also contains the internal jugular vein and the vagus
nerve. The common carotid artery ends by dividing into the internal and external carotid arteries at about the level of the larynx.
The internal carotid has no branches in the neck. The branches of the internal carotid artery
supply the structures inside the cran ial cavity. The internal carotid gives rise to t he ophthalmic
artery, the major blood supply of the orbit and eye, that enters the orbit through the optic
foramen (canal) with the optic nerve. The internal carotid ends by dividing into the anterior and
middle cerebral arteries that contribute to the great cerebral circle (of Willis).
SAADDES
The external carotid has eight branches that mainly supply head st ructures outside the
cran ial cavity. The branches are as follows:
Anterior branches:
Posterior branches:
1. Superior thyroid artery
1. Ascending pharyngeal artery
2. Occipital artery
2. Ling ual artery
3. Facia l artery
3. Posterior auricular artery
4. Superficial temporal artery
4. Maxillary artery
The subclavian artery arises lateral to the common carotid artery. The subclavian artery gives off
branches to supply both intracranial and extracranial structures, but its major destinat ion is the
upper extremity (arm).
Remember: On the left side of the body, the left common carotid and left subclavian arteries arise
from the arch of the aorta in the superior mediastinum.
right common
carotid artery
sternocleidomastoid
brachiocephalic
artery
right subclavian
artery
left subclavian
artery
SAADDES
aorta
clavicle
first rib
Origins from the heart of the arterial blood supply for the head and neck highlighting the pathways ofthe common carotid and subclavian arteries. Note the pathways
are different on the right and left sides of the body.
Maxillary artery
SAADDES
Facial artery
lingual
Pathway of the external carotid artery after branching off the common carotid artery
49-1
Rq'lroduccd With pc:m1issum (rom
MJ. Herring SW: 11/u.fll'ated A11atomy oftlle Head and Neck. ed J; St Louis. 2007. Saunders.
arteries
What is the major arterial origin supplying the mandibular anterior teeth?
mandibular artery
facial artery
vertebral artery
SAADDES
maxillary artery
[refer to card 49-1for illustration]
ANATOMIC SCIENCES
58
maxillary artery
\rtt.ri.tl Supph ol tht.
Artery
Source
CourSe
Exu rnal carotid artery
Maxillary
.tnd \t.mdihul.tr I t.t.th

Gives rise 10 3 branches that form a plexus 10 supply the maxillary a rch:
Anterior superior alwolar
Middle superior alveolar
Poste.rior superior alve.o lar

Giws rise 10 I branch that supplies the mandibular arth
Inferior a lveolar
Maxillary Tedh
Anterior superior alveolar
lnfrnorbilal anery
Arises afle-r the infraorbital artery
through the inferior
(of the maxillary artt.ry) orbital lis..o:ure and into the infraolb ital can al
Descends via the alveolar canals to supply pan oflht m.a:<illary arch
Supplits the maxillary sinus and the anterior lt.eth
SAADDES
M idd le superior a lve.olar
May or may not be pre.o:tnl

l fprts tn4 arises from the infraOfbital artel)' o f the maxillary
artery a Her il passes Lhrough the infe rior orbilal lis..o:ure and inlo
the infraolb iwl <:ana l
Descends via the a lvt.olar canals to supply the maxillary sinus
a nd the p lexus at the canine
lnfraoJbiM.I art<: I)'
superior a lveolar Third part of Lhe

llt.axillary a rtery
A r ises before the nt.axillary artery enterS the ptcrygopalaline

fossa
Enlcrs the infratemporul sudi'tce of the maxilla 10 supply the
maxilla')' sinus.. premolar s. and molarS
Mandibular T ctth
Inferior alveolar
FirSt part of the

maxillary a rtery
Orstends infe riorly following the inferior alveolar neTVe 10

e nter the mandibular forumen
Ttrminatts into the mental and incisive a11eries at the region
of the second pre mo lar
S upplies all of the mand ibular teelh
Menoal
Infe rior a lveolar artel)'
S upplies the labia l gingiva of the anterior Ieeth
Incisive
Infe rior a lveolar artel)'
S upplie s the anterior teeth
arteries
Parts and Branches of the Maxillary artery
c:o-
Branches
Deep auricular artOty
&ppPes extemal aeousiJc mealus, ext&roal
merri)mne, and lemporomandl:lular joint
Anterior tympanic
Sutli)NM in1&rrd
of tympanic membrane
110<f
Firat (man<libulat)
Proodmot (po<IO!Io<) 10 talorol

pterygoid muscle; runo horizon:aly,
(medial) to nod< ct condylar
Ml<ldto monlngool
artOty
En!EK'S cranial cavity via foramen spinoGum to iUPP'Y

bent, tOd bOI'Ie mal'rOW, duta mauw ol
lat4ral wal anct catvarla of neurocranium, trtgeminif
ganglion. facial nerve and geniculale gaf9ion,

1ympa:nic cavity. and tensor tympani musde
SAADDES
process: o1 mandible and lateral to
stylome.ndibu!ar ligament
artery
Adjacent (ouperficl81 or CIHp) to

18IORII pCctygold muscle: OISCOnds
obliQuely anterosuporiorfy. mediel
En1ers crenk\1cevMy vie foremen ovale; its

cistribution is mainly tetrac:rania11o muscles of
l"'fra..,mporallossa, sphenOid bOne. mandibUlar
neiVO, and otic ganglion
Inferior alveotar artery
Desoends to enter mandibular canal of m.andibte via

mandibUlar loramGn; supples mancl!blO, manclltx.Har
teeth, dlln, mylohyoid muid
M<wielericiU'tery
Traverses mandilnlar notch, suppty;ng tempofOmandbular ,k*tt and mas&etet muscte
Ooeplelllj)Of1lt
arteries
Anterior and poetoriot arteries asoend b01woen

tempotalis mueeto and bone of tempoml fossa,
supplying mainly muse..,
Pterygoid brrdl"
tnegoAorln -
"'M pterygo1c1 muscle
Buccal artery
59
copyright 0 20 13-1014 Dental Decks
Parts and Branches of the Maxillary artery !continued from front!

Pos&erior5l4>Eirior
alveol81'at1ef)'
lnfloa-otblalaf10oy
Descends oo ma:xlla's Infratemporal surface with

ol\'OOINcanalsiO oupply -lleoy
molar and promolar teeth,
gingiva., and
muc::ous membrane ol
Plus
Travertet lnteriof orbltalli$Sure, Wra-ortlital groove.
canal, and
supplies ini&tb' obliqll8 8f'd
rec::tus muades. facrirnal sac, maxillary canines and
Incisors Ieeth, mucous membrane of maxllaty slnu&.

and akin ot intra-orbital roQM)n ot taco
Distal {anlerorne<lal) to lateral
Thiod (plerygdd
palatl.-.)
Attetyolp18f}l101d
PasS85 pos:teriofty through p1e.rygold canal; supplies

M\.IIC()$3 of upper ph8irynx.
tube,
end tympanic ea,;ly
headS OIIOIO!al piOoygaklancl
""""'
thrOUgh porygomaxMta:ry fissure

IntO piOf\'l!OpolallnO ro.sa
Pharyngoal """""'
mucosa
ol nasaJpo!Otovaglnal""""'
roof, nasopharynx, sphOnOICfal aJr
Oeoeending polatine
11118')'
Doaeencls thfoo.l9h polot'no canol. dvidlno into

ond loSSM paltltino tiJ'IOriOSIO mucosa :lind
ol hard and eott palate
Sphenopoleflno
arteoy
Tet'lftnel btanQ\ ot me:xhl8.ry Mef'Y, traverses

&phenOpaaatin klram&l'l to sl4)ply walls and septum
ol nasal aMty; frorrl:al, ethmoidal, sphenoid, and
pteryoo'd muecle; passes between
SAADDES
ma>Oiruy $:nUGO$; and antcriOf"''nnOS't peJato
deep temporal branches

pharyngeal artery
artery of pterygoid canal
sphenopalatine
infra-orbital
maxillary- 3rd part
posterior superior
alveolar
middle superior
alveolar
anterior tympanic
SAADDES
lateral pterygoid
muscle
maxillary - 1st part
descending palatine
.......,_ __.;_;:.-., buccal branch
middle meningeal
external carotid
accessory meningeal
inferior alveolar
masseteric branch
pterygoid branch
Pnrts a nd Branches of Maxill ary Artery
59-1
arteries
Which of the following statements is TRUE regarding the left and right renal
arteries?
they both arise from the abdominal aorta below the superior mesenteric artery
the left renal artery is longer that the right renal artery
SAADDES
the right rena l artery is somewhat higher than the left rena l artery
the right rena l artery arises below the superior mesenteric artery, wh ile the left one
arises below the inferior mesenteric artery
60
<opyright o 2013-2014 C>ental Oe<ks
ANATOMIC SCIENCES
they both arise from the abdominal aorta below the superior mesenteric artery
The renal arteries normally arise off the side of the abd ominal aorta, immediately below
the superior mesenteric artery, and su pply the kidneys w ith blood. Each is directed across
the crus of the diaphragm, so as to form nearly a right angle with the aorta.
The renal arteries carry a large portion of total b lood flow to t he kidneys. Up to a th ird of
total cardiac output can pass t hrough the renal arteries to be filtered by the kidneys.
The arterial supply of the kidneys is variable and t here may be one or more renal arteries
supplying each kid ney. It is located above the renal vein. Supernumerary renal arteries (two
or more arteries to a single kidney) are the most common renovascu lar anomaly, occu rrence ranging from 25% to 40% of ki dneys.
SAADDES
Asymmetries between left and right renal artery:

Due to the position of the aorta, the inferior vena cava and the kidneys in the body, the
right renal artery is normally longer than the left renal artery.
The right passes behind the inferior vena cava, the right renal vein, t he head of the pancreas, and t he descending part of the duodenum.
The left is somewhat hi gher than t he right; it li es behind the left renal vein, t he body of
the pancreas and the splenic vein, and is crossed by t he inferior mesenteric vein.
1. As renal arteries pass into the kidneys, they branch into successively smaller
arteries: interlobar arteries - arcuate arteries- interlobular arteries - afferent
arterioles leading to the nephrons.
2. Venous blood is returned through a series of vessels that generally corres pond
to t he arterial pathways.
3. Urinary blad der is su pp lied by the vesicula r b ranches of t he internal iliac
arteries.
arteries
The subscapular artery which supplies the subscapularis muscle branches off
the:
subclavian artery
1st part of axillary artery
SAADDES
2nd part of axillary artery

3rd part of axillary artery
61
ANATOMIC SCIENCES
3rd part of axillary artery

The ax illary artery is the continuation of the subclavian artery into the axilla. The artery is
cl osely related to the cords of the brachial plexus and in fact the cords of the brachial plexus
are named according to their relation with the second part of the axillary artery; the posterior cord of the b rachial p lexus lies posterior to the second part of the axill ary artery, the
medial cord lies medial and the lateral cord lies lateral to it.
Origin and termination of axillary artery:

The axill ary artery begins at the lateral border of the fi rst rib as a continuation of the subclavian artery into the axilla. It terminates at the lower border of the teres major muscle
and then continues downward in the arm as the brachial artery. The axillary artery is often
referred to as having three parts, w ith these divisions based on its location relative to the
Pectoralis minor muscle, which is superficial to the artery.
SAADDES
Pa rts of the axillary arte ry:

First part - the part of the artery medial to pectoralis minor. It has one branch on ly;
superior thoracic artery (supreme thoracic artery)
Second part- the part of the artery that lies behind pectorali s minor. It has 2 branches;
thoracoacromial artery and lateral thoracic artery
Third part - the part of the artery lateral to pectoralis minor. It has 3 branches; subscapular artery, anterior humeral circumflex and posterior h umeral circumflex artery
Note: The brachial artery is cl osely related to the median nerve; in proximal regions, the median nerve is immediately lateral to the brachial artery. Distally, the median nerve crosses
the medial side of the brachial artery and lies anterior to the elbow j oint.
arteries
Which of the following statements is CORRECT regarding vertebral arteries?
inside the skull, the two vertebral arteri es join up to form the basilar artery
they arise from thyrocervica l trunk
they enter the skull th rough carotid canal
SAADDES
they pass through the t ransverse foram ina of all 7 cervical vertebrae
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ANATOMIC SCIENCES
inside the skull, the two vertebral arteries join up to form the basilar artery
The vertebral arteries are major arteries of the neck. They branch from the subclavian
arteri es and merge to form the single midline basilar artery in a complex called the
vertebrobasilar system, which supplies blood to the posterior part of the circle ofWillis
and thus significant portions of the brain.
The vertebral arteries arise from the subclavian arteries, one on each side of the body,
and then enter deep to the transverse process of the level of the 6th cervical vertebrae
(C6). They then proceed superiorly, in the transverse foramen of each cervical vertebra
until C1. This path is largely parallel to, but distinct from, the route of the ca rotid artery
ascending through the neck. At the C1 level the vertebral arteri es travel across the posterior arch of the atlas through the suboccipi ta l triang le before entering the foramen
magnum.
SAADDES
Inside the skull, the two vertebral arteri es join up to form the basilar artery at the base
of the medulla oblongata.
The basilar artery is the main blood supply to the brainstem and connects to the Circle of Willis to potentially supply the rest of the brain if there is compromise to one of
the carotids. At each cervical level, the vertebra l artery sends b ranches to the surrounding musculature via anterior spinal arteries.
Note: Branches of the vertebra l and basilar artery are responsible fo r circu lation to
cerebellum.
Vertebra Is give rise to: PICA (posterior inferi or cerebellar artery)
Basilar gives rise to: AICA (anterior inferi or cerebellar artery) and SCA (superior cerebellar artery)
bone
Which ofthe following structures provides attachment to falx cerebri?
cribriform plate
crista galli
lesser w ing of sphenoid
SAADDES
greater wing of sphenoid

corpus ca llosum
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ANATOMIC SCIENCES
crista galli
The viscerocranium (facial skeleton) consists of 15 irregular bones: 3 single bones
centered on or lying in the midline (mand ible, et hmoid, and vomer) and 6 bones
occurring as bilateral pa irs (maxill ae; inferior nasal conchae; and zygomatic, palati ne,
nasal, and lacrimal bones). Several bones of the cranium (frontal, temporal, sphenoid, and
ethmoid bones) are pneumatized bones, which contain air spaces, presu mably to
decrease their weight.
The ethmoid bone is exceedingly li ght and spongy, and cubical in shape; this bone is situated at the anterior part of the base of the cran ium, between the two orbits, at the roof
of the nose, and contributes to each of t hese cavities. The ethmoid bone consists of four
parts: a horizontal or cribriform plate, forming part of the base of t he cranium; a perpendicular plate, constituting part of t he nasal septum; and two lateral ma sses or
labyrinths.
SAADDES
Cribriform plate: Contains many olfactory foramina. The olfactory nerves pass
through t hese foramina. Note: Damage to t his area t ypically resu lts in the loss of sense
of smell.
Perpendicular plate: The crista galli is a midline proj ection from the perpendicular
p late that serves as an attachment for the falx cerebri.
Lateral masses (right and left) proj ect downward f rom t he cribriform plate. They
conta in t he ethmoid sinuses and the orbital plate of the ethmoid bone (lamina
papyracea). The lamina papyracea forms t he paper-thin medial wall of the orb it. The
superior and middle nasal conchae are scroll-like projections that extend medially from
the lateral masses into the nasal cavity.
Note: Each ethmoidal sinus is divided into anterior, middle, and posterior ethmoidal air
cells.
cribriform plate
-/
perpendicular
plate
orbital
plate
SAADDES
ethmoidal
sinuses
middle nasal
concha
Oblique lateral view of the ethmoid bone with its

perpendicular, cribriform, and orbital plates
63 1
crista galli
nasal bone
sphenoidal
sinus
superior nasal
concha
middle nasal
concha
..
sphenoid
bone
inferior nasal
concha
palatine bone
SAADDES
maxilla
. . . ., -
Lateral wa ll of the right nasal cavity with the ethmoid bone highlighted
63AI
bone
The hypophyseal fossa is located in a depression in the body of the sphenoid
bone; it houses which of the following structures?
hypothalamus
pituitary
cerebellum
SAADDES
hippocampus
corpus cal losum
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ANATOMIC SCIENCES
pituitary
The sphenoid bone is situated at the base of the skull in front of the temporal and basilar
part of the occipital bone. It somewhat resembles a bat with its w ings extended, and is
divi ded into a median portion or body, two great and t wo small w ings extending
outward from the sides of the body, and two pterygoid processes that p roject from the
bone below.
Hollow body: contains the sella turcica, which houses the pituitary gland and the
sphenoidal sinuses. Note: The sella tu rcica and the hypophyseal fossa should be
considered different entities, the latter being part of the former.
Greater wings: help to form the lateral wall of the orbit and the roof of the infratemporal fossa. Contain foramen rotundum: trans mits maxillary nerve (V-2), foramen
ovale: transmits mandibular nerve (V-3), and foramen spinosum: transmits the middle meningeal vessels and nerves to the tissues covering the brain.
Lesser (small) wings: help to form the roof of the orbit and the superior orbital fissure; contain the optic canal (o ptic foramen) that transmits the optic nerve (CN II) and
ophthalmic artery.
Pterygoid processes: one on either side, descend perpendicularly from the regions
where the bo dy and great w ings unite. Each process consists of a medial and a lateral
plate, the upper parts of wh ich are fused anteriorly; a vertical sulcus, the pterygopalatine groove, descends on the front of the line of fusion.
SAADDES
Remember: The lateral pterygoid p late provides the origin for both the lateral and the
medial pterygoid muscles. Medial surface of the lateral p late provides origin for the
medial pterygoid muscle, while the lateral surface of the lateral pterygoid plate p rovides
origin for the latera l pterygoid muscle.
*** Important: The
hamu lus is a process of the medial pterygoid plate of sphenoid

bone. It provides origin for the tensor veli palatini muscle.
bone
Flat bones of the skull, maxilla, major parts of the mandible and clavicles are
formed by:
endochondral ossification
subchondral ossification
SAADDES
intramembranous ossification
primary ossification
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ANATOMIC SCIENCES
intramembranous ossification
The first evidence of bone ossification (bone formation) occurs around the eighth week of prenatal
development. Bones develop either through endochondral ossification (going throug h a ca rtilaginous stage) or through intramembranous ossification (forming directly as bone). The dist inction
between endochondral and intramembranous formation rests on whether a carti lage model serves
as the precursor of the bone (endochondral ossification) or whether the bone is formed by a simpler
method, without the intervention of a cartilage precursor (intramembranous ossification).
Most bones are endochondral, meaning that they began as a hyaline cartilage model before they
ossify. This takes place within hyaline ca rtilage. This type of ossification is principally responsible for
the formation of the bones of the ba se of the skull, condyles of the mandible, short and long bones.
Bone replaces carti lage (osteocytes replace chondrocytes). The bones of the ext remities and those
parts of the axial skeleton that bear weight (e.g., vertebrae) develop by endochondral ossification.
SAADDES
Flat bones of the skull, the maxilla, and major parts of the mandible and clavicles are formed by
intramembranous ossification. Intramembranous ossification occu rs within a membranous, condensed plate of mesenchymal cells. At the initial site of ossification (ossification center) mesenchymal cells (osteoprogenitor cells) differentiate into osteoblasts. The osteoblasts begin to deposit the
organ ic bone matrix, the osteoid. The matrix separates osteoblasts, which, from now on, are located in lacunae within the matrix. The collagen fibers of the osteoid form a woven network without a
preferred orientation, and lamellae are not present at this stage. Because of the lack of a preferred
orientation of the collag en fibers in the matrix, this type of bone is also called woven bone. The
osteoid calcifies leading to the formation of primitive trabecular bone. Further deposition and calcification of osteoid at sites where compact bone is needed leads to the formation of primitive compact bone. Important points: (1 JIntramembranous ossification does not require the existence of
a cartilage bone model (2) In endochondral ossification, the cartilage does not transform into bone;
bone replace cartilage.
Remember: Once intramembranous bone is formed, it grows by appositional growth only
(growth by addition of new layerson those previously formed). Endochondral bone grows by both
appositional and interstitia l growth.
bone
During distalization of molars in bodily orthodontic movement, the alveolar
bone distal to the tooth must resorb, and the alveolar bone mesial to the
tooth must appositionally grow. In orthodontic movement, the alveolar
bone is being remodeled. This remodeling is a function of:
osteoclasts and osteoblasts
SAADDES
chondroblasts and osteoblasts

osteoblasts and osteocytes
chondrocytes and osteocytes
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ANATOMIC SCIENCES
osteoclasts and osteoblasts

Osteoclasts are cells t hat break down and remove exhausted bone tissue. Osteoblasts build
new bone tissue to repl ace this loss.
Osteoblasts are the principal bone-bu ilding cells; t hey synthesize collagenous fibers and
bone matrix, and promote mineralization d uring ossification. Once t his has been accomplished, the osteoblasts, which are trapped in their own matrix, develop into osteocytes t hat
maintain the bone t issue.
l .Osteoblasts are derived from mesenchyme (fibroblasts) and have a high RNA content and stain intensely with basic dyes.
2. Osteodasts (which are derived from stem cells in the bone marrow - the same
ones that prod uce monocytes and macroph ages) are large multinucleated cells
that contain lysosomes and phagocytic vacuoles. They are stimulated by PTH which
causes an increase in serum calcium.
Note: A Howship's lacuna is a small hollow created on the bone surface by osteoclastic activity.
3. Osteoid is newly formed organic bone matrix that has not undergone calcification. It is a specialized form of type I collagen surrounded by glycosam inoglycan gel.
This g el contains proteins possessing a high affinity for calcium binding.
SAADDES
*** Important: Osteoid differs from bone in that osteoid does not have a mineralized matri x.
It also has more water content th an the mature bone.
Remember: Bone is hard and resists com pression because of the mineralization of its
extracellular matrix. When bone matrix mineralizes, in organic hydroxya patite crystals
(primarily calcium phosphate) are deposited around the existing collagen fibrils, and the water
content of the matrix decreases. Bon e derives its fl exibility and tensile streng th from its
abundant collagen fibers.
bone
All are functions of the skeletal system EXCEPT one. Which one is the EXCEPTION?
lymph filtration
mineral storage
support
protection
SAADDES
body movement
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lymph filtration
Functions of the skeletal system:
Support: skeleton forms a rig id framework to which are attached the softer tissues and
organs of t he body.
Protection: the skull and vertebral column enclose t he CNS; the rib cage protects t he
heart, lungs, great vessels, liver, and spleen; and t he pelvic cavity supports the pelvic viscera.
Body movement: bones serve as anchoring attachments for most skeletal muscles. In this
capacity, the bones act as levers with t he joints functioning as pivots when muscles contract
to cause body movement.
Hemopoiesis: the red bone marrow of an adult produces red blood cells, white blood
cells, and platelets.
Mineral storage: the inorganic matrix of bone is composed primarily of the minerals
calcium and phosphorus. These minerals give bone its rigidity and account for approximately two-thirds of t he weight of bone. About 95% of the calcium and 90% of t he phosphorus within t he body are deposited in t he bones and teeth.
SAADDES
Bone exists in two forms: Compact (appears as a solid mass) and spongy or cancellous bone,
which consists of a branching network of trabeculae.
Important: The initiation of bone mineralization involves the following (1) Holes or pores in
collagen fibers. (2) The release of matrix vesicles by osteoblasts. (3) Alkaline phosphatase
activity in osteoblasts and matrix vesicles. (4 ) The degradation of matrix pyrophosphate to
release an inorganic phosphate group.
Fracture repair involves the following events: (1 ) Blood clot formation, (2) Bridging callus
formation, (3 ) Periosteal callus formation, and (4) New endochondral bone formation.
Pseudarthrosis (or "nonunions"): is a fracture t hat has not united in the stipulated time in
which such fractures usually unite and has no chance of union without intervention. There is
movement of a bone at the location of a fracture resulting from inadequate healing of the fract ure.
bone
At the temporomandibular joint (TMJ), hinge movements occur between
the:
condyle and articular eminence

articula r d isc and articu lar eminence
SAADDES
condyle and articular disc
articula r d isc and articu lar cavity

condyle and articular cavity
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ANATOMIC SCIENCES
condyl e and articular disc

The TMJ is a synovial joint w ith two articular cavities. Each cavity is responsible for a different movement at the joint. An articular disc sits between the condylar process of the
mandible on its inferior side and the mandibular fossa and articular eminence of the temporal bone on the superior side. This disc divides the joint into the two articular cavities,
w ith one cavity acting as a hinge component and the other cavity serving as a gliding
component. The lower part of the joint, between the condyle and the articu lar disc, is the
hinge component of the j oint. When the joint moves, this hinge component of the j oint
moves first, to initiate mandibular opening. The upper part of the joint, between the
articu lar disc and the mandibular fossa and articular eminence of the temporal bone, creates the gliding component. During joint movement, this gli ding cavity moves after the
hinge component to terminate mandibular opening.
SAADDES
1. The condyle of the mandible rests in the mandibular fossa (also called glenoid fossa) of the temporal bone. The fossa articulates w ith the condyle of the
mandible to form the TMJ.
2. The articular eminence forms the anterior boundary of the fossa and helps
maintain the mandib le in position. This area is the functional and articular port ion of the TMJ.
3. Separating the mandibular fossa from the tympanic p late posteriorly is the
squamotympanic fissure, through the medial end of which (petrotympanic fi ssure) the chorda tympani exits f rom the tympanic cavity.
4. The concave area between the mandibular condyle and coronoid process is
the mandibular notch (also known as the corono id notch). The mandibular
notch transmits arteries and nerves to the masseter muscle.
5. *** Important: The post erior slope of this eminence is lined by fibrous connective tissue.
bone
A patient comes into the orthodontist's office as referred to by his general
dentist. The orthodontist notes the patient's tongue thrusts and notes that
early treatment could prevent skeletal problems. Soft tissue development is
thought to encourage mandibular growth:
upward and forwa rd
SAADDES
upward and backward
downward and forwa rd
downward and backward
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ANATOMIC SCIENCES
downward and forward

The space between the jaws into wh ich the teeth erupt is generally considered to be
provided by growth at the mandibular cond yles (especially the molars). The
condyle is a major site of growth. Many arguments have been made about condyle
function in mandibular growth. Most authori ties agree that soft-tissue development
ca rries the mandible forward and downward, wh ile condylar growth fills in the
resultant space to maintain contact with the base of the skull.
The bone of the alveolar process exists only to support the teeth. If a tooth fails to
erupt, alveolar bone never forms in that area; and if a tooth is extracted, the alveolus
resorbs after the extraction until fina lly the alveolar ridge completely atrophies. The
position of the tooth, not the functional load placed on it, determines the shape of
the alveolar ridge.
SAADDES
Note: The long axes of the mandibular condyles intersect at the foramen magnum,
which indicates that these axes are d irected posteromedially.
bone
Which of the following structures does NOT form a portion of the lateral wall
of the nasal cavity?
maxilla
palatine bone
conchae
vomer
SAADDES
ethmoid bone
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ANATOMIC SCIENCES
vomer
The lateral walls are fo rmed primarily by the fronta l process of the maxilla,
perpendicular plate of the palatine bone, ethmoid bone, the superior, m iddle and
inferior conchae. The medial wall or nasal septum is fo rmed by the perpendicula r
plate of the ethmoid bone, the vomer bone, and the septal cartilage. The rest of
the framework of the nose consists of several plates of cartilage, specifically, the
lateral nasal cartilage and the g reater and lesser alar cartilage. The cartilage is held
together by fibrous connective tissue.
The nasal cavity opens on the face through the nostrils or nares and commun icates
with the nasopharynx th rough two posterior openings ca lled the choanae. The area
below each concha (superior, m iddle, and inferior) is referred to as a meatus.
SAADDES
The nasal cavity receives innervation from the olfactory nerve (CN I) and branches
of the trigeminal nerve (CN V). The nasal cavity blood supply is mainly from the
sphenopalatine branch of the maxillary artery.
Note: The nasopalatine nerve is a parasympathetic and sensory nerve that arises in
the pteryg opalatine ganglion, passes through the sphenopalatine foramen,
across the roof of the nasal cavity to the nasal septum, and obliquely downward to
and through the incisive canal, and innervates the glands and mucosa of the nasal
septum and the anterior part of the hard palate.
Important: The commun ication between the pterygopalatine fossa and the nasal
cavity is the sphenopalatine foramen. The sphenopalatine artery and the nasopalatine nerve extend through the sphenopalatine fo ramen.
nasal bones
frontal bone
ethmoW
bone
====t=-- lacrimal bones
sphenoid bone _ _..,._ ......,.
.---'--- sphenoid bone
SAADDES
zygomatic bone - -
zygomatic bone
Yomer
Cranium, facial (frontal) aspect
7().1
fronta I bone ...._....,..__..,....

superior concha
superior meatus
middle concha -"
frontal process__._ _...,..,
laaimal bone
Lateral and mcdoal (septal) walls of right
side of nasal cavity. The medial view
shows the right lateral wall of the nasal
cavity, and the lateral view shows the nasal
seplllm. The nasal septum has a hard
(bony) part located deeply ( posteriorly)
where it is protected and a son or mobile
pan located superficially (anteriorly)
mostly in the more vulnerable external
nose.
middle meatus
Inferior concha
Inferior meatus
SAADDES
palatine
process
of maxilla
Medial view right lateral

wall of nasal cavity
aista galfi
crest of
sphenoid
bone
septal
cartilage
vomer
nasal crest of
palatine bone
nasal crest
of maxilla
70A_.
Lateral view nasal septum
bone
A tubercle is:
a small, rounded process

a prominent elevated ridge or border of a bone
a large, rounded, roughened process
SAADDES
a sharp, slender, projecting process
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ANATOMIC SCIENCES
a small, rounded process

Surface Features of Bone (en largements and processes):
Process: the most generic term for bone projection that serves as a point for attachment of other structures. Example: Acro mion process of the scapula, transverse process of vertebrae and hamul ar process of the sphenoid bone.
Epicondyle: a p rojection or swelling on a condyle (or above, in some cases).
Example: Medial and lateral epicondyles of femur.
Spine: a sharp, slender projecting p rocess. Example: Spinous process of vertebrae,
spine of the scapul a.
Tubercle: a small, rounded process. Example: Greater and lesser tubercles of humerus.
Tuberosity: a large, rounded, roughened p rocess. Example: Ischial tuberosity of the
ischium.
Trochanter: a large b lunt p rojection for muscle attachments on the femur.
Example: Greater and lesser trochanters of the femu r.
Crest: a prominent elevated rid ge or border of a bone. Example: Iliac crest of the
ilium.
Linea (line): a small crest, usually somewhat straighter than a crest. Example: Li nea
aspera of femur.
Ramus: a major b ranch or division of the main bo dy of a bone. Th is may have its own
articulations or p rocesses. Example: The coronoid and condylar processes of the mandible are subdivisions of the ramus.
Neck: a slight narrowing of the body of the bone that supports the head.
Example: Necks of the humerus and femur.
Lamina: a very thin layer of bone. Example: The laminae of the vertebrae.
SAADDES
bone
The shaft of a long bone is capped on the end by spongy bone that is surrounded by compact bone. This is called the:
periosteum
diaphysis
endosteum
epiphysis
SAADDES
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ANATOMIC SCIENCES
epiphysis
Long bones have a tubular shaft, the diaphysis, and usually an epiphysis at each end. During the
growing phase, the diaphysis is separated from the epiphysis, by an epiphyseal cartilage. The part
of the diaphysis that liesadjacent to the epiphyseal carti lage iscalled the metaphysis. The shaft has
a central marrow cavity conta ining bone marrow. The outer part of the shaft is composed of
compact bone that is covered by a con nective ti ssue sheath, the periosteum.
A typical long bone includes the following structures:
Structure
Location and Function
Diaphysis
Bone shatl; consists of a cylindl'ical tube of du1able c.ompac[ bone.
Epiphysis
Caps diaphysis; consisu of spongy bone surrounded by compac[ bone;

contain...; red bone marrow for the producrion of red blood cells, white
blood cells. and plateleu.
SAADDES
Epiphyseal plate Between the epiphysis and the diaphysis; region of mitotic acth'ity
responsible for elongation of bone.
lvtedullary c.avity Centrally positioned spac.e within diaphysis; contain..o; fatty yellow bone-
Nutrient foramen Opening into diaphysis; provide..; site fo1 nurrient vessels to enter and
exit the medullary cavity.
Articular ca11ilage Caps e.ach epiphysis; c.omposed of hyaline ca11ilage; facilitates joint
moveme-nt.
Endosteum
Perioste um
l ines medullary c-avity; consists of suppo11ive dense regular c.onnective

tissue-.
Covers the surface of bone; con..o;ists of dense regular c.onnective issue-;
site for ligament- and tendon-muscle auachment and respon..o;ible for
diametric. bone growth.
Compact bone
Hard, outer layer of bone-tissue; covered by periosteum, serve-s for attachment of muscles, provides JU'Otection, and gives durable-strength to
the bone.
Cancellmu
(spottgy)
Porous, highly vascular, inne-r layer of bone dssue; m.akes the bone
lighter and provides spaces for red bone marrow where. blood cells are
produced.
epiphysis
red marrow cavities
medullary cavity
SAADDES
1rendosteum
diaphysis
- -
yellow marrow
periosteum
epiphysis
Longitudinal Section of the Tibia
bone
The hypophyseal fossa which houses the pituitary gland is located within
which of the following cranial fossae?
anteri or cranial fossa

middle cranial fossa
SAADDES
posterior crania l fossa
73
ANATOMIC SCIENCES
middle cranial fossa

The internal surface of the ba se of the skull consists of th ree cranial fossae, the anterior, middle,
and posterio r. They increase in size and depth from anterior to posterior. The anterior and
middle fossae are separated by t he lesser wing of t he sphenoid bone, and the middle and
posterior fossae are separated by the petrous pa rt of the temporal bone.
The anterior cran ial fossa is adapted for reception of the frontal lobes of the brain, and is
formed by portions of the frontal, ethmoid, and sph enoid bones. The crista galli, a midline
process of the ethmoid bone, gives attachment to the anterior end of the falx cerebri. On each
side of the crista galli are the grooved cribriform plates of the ethmoid bone, providing
numerous orifices for the delicate olfactory nerves from the nasal mucosa to synapse in the
olfactory bulbs.
SAADDES
The middle cranial fossa is composed of the body and great wings of t he sphenoid bone, the
squamous and petrous parts of the temporal bones and the frontal angles of the parietal
bones. This fossa is the"busiest of the cranial fossae. This fossa contain s laterally the temporal
lobes of the brain. This fossa contains the optic chiasma, optic canal, sella t urcica, and the
hypophyseal fossa that houses the pituitary gland. Within this fossa, the superior orbital fissure,
foramen rotundum, foramen ovale, foramen lacerum, and foramen spi nosum are found. In the
tem poral bone, t he hiatus for both the lesser and greater petrosal nerves are found. On t he
anterior surface of the petrous portion of the tempora l bone is the trigem inal impression,
which lodges the trigeminal ganglion (semilunar or gasserian) of the fifth nerve.
The posterior cranial fossa, the deepest of the fossae, houses the cerebellum, medulla, and
pons. Anteriorly, the posterior cranial fossa extends to t he apex of the petrous tempora l.
Posteriorly, it is enclosed by the occipital bone. laterally, portions of the squamous tempora l
and mastoid part of the temporal bone form its walls. It contains four important foramina, the
internal acou stic meatus (in the petrous pa rt of the tempora l bone), the j ugular foramen
(between the temporal and occipital bones), t he hypoglossal canal (in the occipital bone), and
the foramen magnum (a large median opening in the floor of the fossa, where the medulla
oblongata is continuous with the spinal cord).
bone
Treacher Collins syndrome is a rare genetic disorder that presents with many
craniofacial deformities. One of the characteristic traits is downward slanting eyes, which is caused by underdevelopment of the bone that forms the
substance of the cheek. Which bone is this that anchors many of the muscles
of mastication and facial expression?
ethmoid bone
SAADDES
zygomatic bone
occipital bone
sphenoid bone
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ANATOMIC SCIENCES
zygomatic bone - al so called the ch eek bone or malar bone

The zygomatic bone is situated at the upper and lateral part of the face: this bone
forms the prominence of the cheek, part of the lateral wall and floor of the orbit, and
parts of the tempo ral and infratemporal fossae. The zygomatic bone presents a malar
and a temporal surface; fou r processes, the frontosphenoidal, o rbital, maxillary, and
temporal; and four borders.
The zygomatic bone articulates with four bones: the frontal, sphenoidal, temporal
(to form the zygomatic arch), and maxilla. Above the zygomatic arch is the temporal
fossa, wh ich is filled w ith the tempora lis muscle. Attached to the lower margin of the
zygomatic arch is the masseter muscle. Note: The temporalis muscle passes medial
to the zygomatic arch before the muscle inserts into the coronoid process of the
mandible.
SAADDES
The temporal fossa is a shallow depression on the side of the cranium bounded by
the tempo ral lines and term inating below the level of the zygomatic arch. The
infratemporal crest of the greater w ing of the sphenoid bone separates the
temporal fossa from the infratemporal fossa below it.
SAADDES
temporal bone
Crnnium, lateral aspect
74-1
bone
Which of the following can be defined as a tube-like passage running
through a bone?
fovea
meatus
fossa
fissure
SAADDES
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ANATOMIC SCIENCES
meatus
Surface Features of Bone
Depressions:
Fissure (a sharp, deep groove): a sharp, narrow, cleft-like opening between the
parts of a bone that allows for the passage of bl ood vessels and nerves
Example: superior orbital fissure of the sphenoid.
Sulcus (a g roove, but shallower and a less abrupt cleft than a fissure): a shallow,
wide groove on the surface of a bone that allows for the passage of blood vessels,
nerves, an d tendons
Example: intertubercular sulcus of the humerus, alternately known as the bicipital g roove.
Incisure (notch): a deep indentation on the border of a bone
Example: greater sciatic incisure or notch of the os coxa.
Fovea: a small, very shallow depression
Example: fovea capitis on the head of the femu r accepts a ligament from t he hip
socket or acetabulum.
Fossa: a shallow depression. This may or may not be an articulating surface
Example (of articulating surface): g lenoid fossa of the scapula or mandibular
fossa of the temporal bone. Example (non-articulating surface) : subscapular
fossa.
SAADDES
Openings:
Foramen: an opening t hrough w hich blood vessels, nerves, or ligaments pass
Example: foramen magnum of the occipital bone, mental foramen of t he mandible.
Meatus (canal): a tu be-like passage running through a bone
Example: the acoustic meatus of the tempo ral bone.
bone
The ganglion that supplies the mucous membrane of the mouth and nose
with parasympathetic fibers is located in which of the following fossae?
pterygopalatine fossa
infratemporal fossa
SAADDES
temporal fossa
76
ANATOMIC SCIENCES
pterygopalatine fossa- the ganglion is pterygopalatine ganglion

Boundaries of Fossa<' ol the Skull
T empor al Fos.sa
In fratemporal Fossa
Pterygopalatine Fossa
Superior
Inferior cemporal line
Greater wing of sphenoid bone
Inferior stwfac.e of sphenoid bone body
Anterior
Frontal process of
zygomatic bone
Maxillary tubero.(jiry
Maxillary tuberosity
Medial
Surface of temporal
Lateral pterygoid plate
of Fossae
bone
Lateral
Zygomatic arch
Mandibular ramus and
11e1ygomaxillary fissure
zygomatic. arch
Inferior
SAADDES
Infratemporal crest of
No bony border
J>te.rygopalatine c.anal
No bony bo1der
l>tt.1ygoid process of sphenoid bone
sphe.noid bone
Post erior
Inferior cemporal line
\Iuscl<s. Blood\ <sscls. and :\er\l's ol r ossac of the Skull
Muscles
T emporal Fossa
Infratemporal Fossa
Temporalis muscle
Prerygoid muscles and lowe1 pan of
Pter ygopalatine Fossa
rempora1is muscle
Blood vessels Area blood vessels
Pcerygoid venous plexus and

maxillary a11ery (second J>OI'Iion)
and branches including middle
meningeal arre.ry, inferio1 alveolar
arte1y, and posterior superior
alveolar anery
Nenes
Mandibular nerve including inferior Prerygopalatine ganglion and

alveolar, buccal and lingual nerves maxillary nerve
as well a.s cho1da ()'lllpani and otic
ganglion
Area nerves
Maxillary artery (third portion)

and branches including
infraorbiral and .sphenopalatine
aneries
zygomatic arch
orbit----=:::
inferior
orbital fissure
SAADDES
lateral pterygoid
plate of the
sphenoid bone
maxillary tuberosity
pterygomaxillary
fissure
palatine
bone
Oblique lateral view ofthe base ofthe skull and the roof
ofthe pterygopalatine fossa and its boundaries
76-1
bone
The pterygopalatine fossa communicate laterally with infratemporal fossa
though which of the following?
sphenopalatine foramen
foramen rotundum
SAADDES
foramen lacerum
pterygomaxillary fissu re
inferi or orbital fissu re
Irefer to card 76-1for illustration]
ANATOMIC SCIENCES
77
pterygomaxillary fissure
The pterygopalatine fossa isa small triangular space behind and below the orbital cavity.
The pterygopalatine ganglion lies in the pterygopalatine fossa just below the maxillary nerve (V2). The pterygopalat ine ganglion receives preganglionic parasympathetic fibers from the facial
nerve by way of the greater petrosal nerve. The pterygopalatine ganglion sends postganglionic
parasympathetic fibers to the lacrimal gland and glands in the palate and the nose.
Note: The maxillary nerve (V2) and the pterygopalatine portion of the maxillary artery pass
t hrough the pterygopalati ne fossa.
The following passages connect the pterygopalatine fossa with other parts of the skull:
Connection- direction
Connection- direction
Orbit- anteriorly
Nasal cavity- medially
Oral cavity- inferiorly
Middle cranial fossa, foramen lacerum- posteriorly
Nasal cavity/nasopharynx- posteriorly
Infratemporal fossa- laterally)
Middle cranial fossa- posteriorly
SAADDES
Bony Opening
Location (Bone)
Contents
Sphenopalatine foramen
Sphenoid and palatine
Sphenopalatine artery and vein, nasopalatine nerve
Pterygoid canal
(vidian canal)
Sphenoid
Deep and greater petrosal nerves which fonn nerve

of pterygoid canal, area vessels
Ptcrygomaxillary
fissure
Sphenoid and maxilla
Posterior superior alveolar vein, artery and nerve,
Foramen rotundum
Sphenoid
IVhLxillary nerve (V2)
Inferior orbital fissure
Sphenoid and max illa
Infraorbital and zygomatic nerves, Infraorbital

artery. and ophthalmic vein
Pterygopalatine canal
(greater palatine canal)
Maxilla and palatine
Greater and lcs..o;cr palatine veins, arteries and
Pharyngeal canal
Sphenoid and palatine
maxillary artery
nerves
Pharyngeal branch of V-2
bone
Which ofthe following receives the opening ofthe nasolacrimal duct?
superi or meatus
middle meatus: ethmoidal bulla
middle meatus: Hiatus of semilunaris
SAADDES
sphenoethmoidal recess
inferior meatus
78
ANATOMIC SCIENCES
inferior m eatu s
The nasal conchae are three pairs of scroll-like, delicate shelves or projections, which
hang into the nasal cavity from the lateral walls. These projections assist in increasing
the surface area w ithin the nasal cavity for filtering, heating, and moistening the air.
The superior and middle conchae are part of the ethmoid bone; wh ile the inferior
concha is a separate bone (also called the inferior tu rbinate). The space below each
concha is referred to as a meatus.
Superior meatu s: lies below and lateral to the superior concha. The superior
meatus receives the openings of the posterior ethmoidal sinuses.
Middle meatus: lies below and lateral to the middle concha. The middle meatus
receives the openings of the frontal, maxillary, anterior, and middle ethmoidal sinuses. The middle ethmoidal sinuses drain onto the ethmoidal bulla (rounded
prominence on the lateral wall of the m iddle meatus). The anterior ethmoidal
sinuses d rain into the infundibulum (funnel-like structure that empties into a
groove called the hiatus semilunaris on the lateral wa ll of the m iddle meatus). The
frontal sinuses drain into the infundibulum or directly into the m iddle meatus. The
maxillary sinus d rains directly into the hiatus semilunaris; its opening (ostium) is
located near the top of the sinus.
Inferior meatus: lies below and lateral to the inferi or conchae. It receives the
opening of the nasolacrimal duct. The nasolacri mal duct drains lacri mal fluid from
the surface of the eye into the meatus for evaporation during respiration.
SAADDES
Note: Maxillary sinus cysts or neoplasms usually compress the nasolacri mal duct
leading to obstruction of this duct.
Sphenoethmoidal recess: is a small space posterior and superi or to the superior
concha into which the sphenoidal sinus opens.
superior nasal concha

middle nasal concha
sphenoidal sinus
pons
fourth ventricle
limen
SAADDES
medulla oblongata
nas.al vestibllle
atlas (Cl "'rtebra)
poslerior
oerebeUomedullary
cisttm
nasal hairs
(vibrissae)
Cl
a>is (C2 "'rteb<a)
--"""-- - spinal cord

pharyngeal opening of
tube
Lateral wall of nasal c.avity of rig ht half of head. The inferior and midd le conchae, curving medially and inferiorly from the lateral wall, divide the wa ll into three nearly equal parts and cover
the inferior and midd le meatus, respectively. The superior concha is small and anterior to the spheno idal sinus and the middle concha has an angled inferior border and ends inferior to the spheno ida l sinus. T he inferior concha has a sl ightly curved inferior border and ends inferi or to the
midd le concha.
78-1
nasion
nasal bones
bridge of
nose
middle nasal
conchae
SAADDES
Cranium, facial (frontal) aspect
78AI
bone
A prosthodontist designs his maxillary removable complete and partial
dentures to engage the hamular notch behind the maxillary tuberosities.
The hamulus is a small slender hook, which accommodates the action of the
tensor veli palatini. The hamulus is a component of which bone?
lateral pterygoid plate of sphenoid bone
SAADDES
medial pterygoid plate of sphenoid bone

maxilla
hori zontal p late of palatine bone
perpendicular p late of palatine bone
79
ANATOMIC SCIENCES
medial pterygoid plate of sphenoid bone

The left and right pterygoid processes project downward from near the junction of each of the g reater
wings within the body of the sphenoid bone. These processes run along the posterior portion of the nasal
passage toward the palate. Each process consists of a medial and a lateral pterygoid plate.
The lateral pterygoid plate provides the origin for both lateral and medial pterygoid muscles. The plate
also forms the medial wall of the infratemporal fossa. The medial pterygoid plate forms the posterior
limit of the lateral wall of the nasal cavity. The medial plate ends inferiorly as a hamulu s, a small, slender
hook that acts as a pulley for the tensor veli palatini (innervation: medial pterygoid nerve, CN V3) tendon
to change it s direction of pull from vertical to horizontal, thereby tensing the soft palate.
Pl'oce.s..-.es of Skull Skull Bones
Alveolar
Mandible
Associated Structures
Cl)nta ins roots of mand ibular teeth
Alveolar proces.o;
f\<la..;<illa
Contains roots of maxillary teeth
Coronoid
f>.<landible
P011ion of ramus
Frontal process:
Maxilla
Forms media l infraotbital ri i'H
SAADDES
Frontal
Fonns anterior lat.:-ral orbital wall
Sphe--noid
Anterior proce-s:s to sphenoid hone body
Greater
Sphe-noid
Poste-rolateral process: to sphenoid bone-. c.avity
Mastoid prol.'e-s:s
Temporal
Composed of mastoid air ce-lls
Maxillary proee-s:s
Zygomatic
Fonns infraorbital rim and potion of anterior lateral orbital \\'all
Palatine proces..o;
r-.<ta:<illa
Fonns anterior hard palate
Postglenoid process:
Temporal
Poste-rior to TMJ
Pterygoid proc.es..o;
Sphe-noid
Cl)nsiSL!; of medial and lateral pt.:-rygoid
wing
Styloid proces..o;
Temporal
Serves as auac-hme--nt fOr 1t1ustles and ligame-nu
T t -1\lpl)ral proces..o;
Zygomatic
P011ion of zygomatic arch
Zygomatic process
Fron1a.l
Lateral h) orbit
Zygomatic process
Ma:<illa
Fonns late-ral portion of infraorbital rim
Zygomatic process
Temporal
P011ion of zygomatic arch
greater wing of
sphenoid bone
infratemporal
crest
SAADDES
spine of sphenoid bone
hamulus of medial pterygoid plate
lateral pterygoid plate
Cutaway view of the lateral aspect of the upp er portion
of the skull with the sphenoid bone highlighted
79 1
bone
A young patient arrives in the physician's office with unexplained, persistent
symptoms. The patient has had bloody nasal discharge and painful oral
lesions. A chest x-ray reveals "coin
and labs reveal kidney failure.
Ultimately, the isolation of the AN CAs - lgG antibodies - yield a diagnosis of
Wegener's granulomatosis. The dentist who referred this patient to the
physician made a note of the necrotizing oral lesion that had perforated the
hard palate into the nasal cavity. The roof of the oral cavity is formed by the:
SAADDES
ethmoid and palatine bones

maxilla and nasal bones
maxilla and palatine bones

nasal and vomer bones
80
ANATOMIC SCIENCES
maxilla and palatine bones

***Specifically, the palatine processes of the maxilla and the horizontal plates of the
palatine bones.
The structure formed by th is union is the hard palate. The anterior two-thirds of the
hard palate is formed by the palatine processes of the maxilla, and t he posterior onethird is formed by the horizontal plates of the palatine bones. The hard palate forms not
only the roof of the oral cavity pro per but also the floor of the nasal cavity. It is covered
w ith a mucous membrane and beneath the mucosa are palatal salivary glands. The
greater (anterior) pa latine vein, artery, and nerve travel along the maxillary alveolar
processes anteriorly where they join the nasopalatine nerves and sphenopalatine artery
and vein, exiting the nasal cavity from the incisive foramen.
SAADDES
The soft palate is continuous w ith the hard pa late posteriorly and is "soft" because it does
not have a bony substrate but contains a tough fibrous connective tissue sheet, the
palatal aponeurosis, and is covered with a mucosa. Salivary glands are found in the underlying connective tissue. Posteriorly, the soft palate suspended in the oropharynx ends in
the midline uvula.
Remember: Most of the palatal muscles receive motor innervation from the pharyngeal
plexus of nerves. The tensor muscles of the palate (tensor veli palatin i) receive motor
branches from the mandibular division of the trigeminal nerve (CN V3). Sensory innervation is provided by the maxillary division of the t rigeminal nerve (CN V2). Arterial supply is from the descending palatine artery (a branch of the maxillary artery), which in turn
branches into the greater and lesser palatine arteries.
maxilla,
palatine process
groove for greater

palatine vessels
SAADDES
interpalatine
suture
palatine { horizontal plate

bone pyramidal process
vomer
Palate
bone
Most precisely, osteocytes are located in which of the following spaces?
canalicu li
lacunae
lamellae
trabeculae
SAADDES
81
ANATOMIC SCIENCES
lacunae
There are two types of bone tissue: compact and spongy. The names imply that the
two types of bone t issue d iffer in density, o r how tightly t he tissue is packed together. There are t hree types of cells t hat contribute to bone homeostasis. Osteoblasts are
bone-forming cells, osteoclasts resorb or break down bone, and osteocytes are
mature bone cells. An equilibrium between osteoblasts and osteocl asts maintains
bone tissue.
Compact bone consists of closely packed osteons or haversian systems. The haversian system consists of a central cana l ca lled the haversian canal, which is surrounded by concentri c rings (lamellae) of matrix. Between the rings of matrix, t he bone cells
(osteocytes) are located in spaces called lacunae. Small channels (canaliculi) radiate
from the lacunae to the haversian cana l to provide passageways through the hard
matrix, they provide oxygen and nutrients to the osteocytes. In compact bone, the
haversian systems are packed t ightly together to form what appears to be a solid
mass. The haversian canals contain blood vessels that are parallel to the long axis of
the bone. These blood vessels interconnect, by way of perforating cana ls, w ith vessels
on the surface of the bone.
SAADDES
Spongy (cancellous) bone is lighter and less dense than compact bone. Spongy bone
consists of plates (trabeculae) and bars of bone adjacent to small, irregular cavities
that conta in red bone marrow. The canalicu li connect to the adjacent cavities, instead
of a central haversian cana l, to receive their blood supply. It may appear that the t rabeculae are arranged in a haphazard manner, but they are organized to provide maximum strength similar to braces that are used to support a building. The trabecu lae of
spongy bone follow the lines of stress and can realign if the d irection of stress
changes.
trabeculae
SAADDES
t-::::1---'1.,..-
cancellous
(spongy) bone
haversian (central)
canals
volkmann's (transverse)
canals
medullary
marrow cavity
The longitudinal section oflong bone shows cancellous and compact bone
81-1
osteon
( Haversion system)
circumferential
lamellae
lacunae
containing
osteocytes
SAADDES
blood vessels
The magnified section of compact bone
bone
Which of the following is the largest bone of the pelvis?
ilium
ischium
pubis
SAADDES
82
ANATOMIC SCIENCES
ilium
The os coxa or hipbone is formed by the fusion of the ilium, ischium, and pubis on
each side of the pelvis. The os coxa articulates with t he sacrum at t he sacroiliac joint
to form the pelvic girdle. The two hip bones articulate with one another anteri orly at
the symphysis pubis.
The ilium is the uppermost and largest bone in the pelvis; the ilium possesses the
iliac crest, which ends in front at t he anterior superior iliac spine and behind at the
posterior superior iliac spine. The ilium possesses a large notch called the greater
sciatic notch.
The ischium is l-shaped with an upper thicker part (body) and a lower thinner
part(ramus). This part bears t he weight of the body w hen a person is in an upright,
seated position. Features incl ude ischial spine and ischial tuberosity. The obturator foramen is formed by the ramus of the ischium together with the pubis.
The pubis is divided into a body, a superior ramus, and an inferior ramus. The
bodies of the two pubic bones articulate w ith each other in the midline anteri orly
at the symphysis pubis. l ateral to the symphysis is the pubic tubercle. The inguinal ligament connects the pubic tubercle to the anteri or superior iliac spine.
SAADDES
Remember: The acetabulum is a cup-shaped cavity on the lateral side of the hip
bone that receives the head of the femur. It is formed superiorly by the ilium,
posteroinferiorly by the ischium, and anteromedially by the pubis.
Note: The sciatic nerve is t he largest single nerve in t he human body going from the
top of the leg to the foot on posteri or aspect.
Ilium
pubofemoral
llgament
SAADDES
intertrochanteric
line
Hip J oint - Anterior view

82-1
acetabular labrum
articular cavity
ligamentum teres
articular capsule greater

trochanter
SAADDES
Hip Joint- Frontal section
82AI
bone
The trachea divides into left and right main bronchi at the level of?
the upper part of sternum

the m id part of the body of the sternum
just above the xiphoid process
SAADDES
junction of manubrium and body of sternum
83
ANATOMIC SCIENCES
junction of manubrium and body of sternum- (sternal angle)

The sternum is made of three individual parts. The most superior part is the manubrium. The clavicle (collar bone) connects to the manubrium and the shoulder. lnferiortothe manubrium is the body of the sternum . The most inferior portion of the sternum is the xiphoid process.
Sternal angle: is formed by the junction of the manubrium and the body of the sternum. It marks the following:
approximate level of the 2nd pair of costal cartilages
approximately the beginning and end of the aortic arch
bifurcation of the trachea into the left and right main bronchi
boundary between the superior and inferior portion of the med iastinum
There are 24 ribs (12 pai rs). All ribs are attached posteriorly to the 12 thoracic vertebrae. The anterior portion of rib pair number one attach to the manubrium. Rib pairs number 2 through 7 have an anterior attachment to the body of the sternum. Rib pairs number 8 through 10 have an anterior attachment to the
cartilage of the rib above them. Rib pairs number 11 and 12 do not have an anterior attachment at all . The
ribs are d ivided into the following categories. Rib pairs number 1 through 7 are called true ribs, rib pairs
number 8 through 12 are false ribs and rib pairs number 11 and 12 are floating ribs.
SAADDES
Costal groove: is a groove between the ridge of the internal surface of the rib and the inferior border. It contains the intercostal vessels and intercostal nerve, the order of which (from superior to inferior) can be remembered w ith the mnemonic "VAN" which stands for Vein, Artery, Nerve, w hich means that the
intercostal nerve is most likely to be damaged in case of injury to that area because the nerve is least protected by the costal groove.
The vertebral column consists of 24 individual vertebrae, one sacrum (5 fused vertebrae), and one coccyx (3-5 fused vertebrae). The first seven vertebrae are called cervical vertebrae. These make up the bones
of our neck. The vertebrae in the thoracic reg ion are called the thoracic vertebrae. There are twelve of
those. Each one has a pai r of ribs attached to it . The last five vertebrae are the lumbar vertebrae.
Mnemonic: For the vertebrae, just remember the times people typically eat meals; 7am - breakfast - 7 cervical vertebrae, 12 pm - lunch - 12 thoracic vertebrae, 5pm - d inner - 5 1umbarvertebrae.
Note: The body of each vertebra develops from the caudal part of one sclerotome and cranial portion of
the next sclerotome, w hile the nucleus pulposus (central portion of the vertebral d isk) develops from the
notochord.
bone
Which of the following bones articulates with the capitulum of the humerus?
radius
acromion
ulna
scapula
cl avicle
SAADDES
84
ANATOMIC SCIENCES
radius
Clavicle: the clavicle connects to the manubrium of the sternum and the acromion of the scapula.
Scapula: is also called the shoulder blade. The glenoid cavity is the lateral edge of the scapula and is the
socket portion of the ball-and-socket j oint of the shoulder. The acromion of the scapula connect s to the clavicle.
Humerus: the head of the humerus fits into the glenoid cavity of the scapula. Lateral t o the head is the
g reater tubercle. At the inf erior (d istal) end of the humerus are two condyles. These have special names, the
lat eral condyle is the capitulum (which articulat es w ith the rad ius) and the med ial condyle is the trochlea
(w hich articulates w ith the ulna). Lateral to the capitulum is a rather large bump called the lateral epicondyle. Medial t o the trochlea is the medial epicondyle.There is a groove between the medial epicondyle
There is a nerve that
and the trochlea. when people hit this area. They say they've hit their ' funny
passes through that area, which is the ulnar nerve. On the ant erior side of the humerus, at the d istal end.
there is a depression called the coronoid fossa. On the opposi te side is a large depression called the olecr anon fossa.
SAADDES
Radius: there are two bones comprising the lower arm. The radius is the lateral bone and the ulna is the
medial bone. When the hand is in the supinate position, the radius and ulna are parallel t o each other. When
the hand is pronated, the radi us crosses over the ulna. The head of the radi us pivot s on the capitulum.
Ulna: the ulna has large bulge on the posterior side called the olecranon process. This is the elbow. Anterior to the olecranon process is a huge notch called the trochlear notch. The trochlear notch pivots on
the trochlea on the ulna.
M nemonics:
Elbow joint: rad ius vs. ulna ends CRAzy TULips
- Capitulum= RAdi us
- Trochlea= Ulna
Wrist: rad ial side vs. ulnar side
- Make a fist w ith your thumb in the air and say:RAQ!", your thumb is now pointing t o your RADi us
bone
Which of the following bones forms the major part of the lateral wall of the
orbit?
frontal bone
zygomatic bone
SAADDES
maxillary bone
sphenoid bone
85
ANATOMIC SCIENCES
zygomatic bone
The Walls of t he Orbit:
Each orbit has four walls: superior (roof), medial, inferior (Ooor) and lateral
The medial walls of the orb it are almost parallel with each other and w ith t he superior part of the nasal cavi ties separating them
The lateral walls are approximately at right angles to each other
The Superior Roof of the Orbit:
The superior wall or roof of the orbit Is formed almost completely by the orbital plate of the frontal bone
Posteriorly, the superior wall is formed by the lesser wing of the sphenoid bone
The roof of the orb it is thin, translucent, and gently arched. This plate of bone separates t he orbital cavity
and the anterior cranial fossa.
The optic canal is located in t he posterior part of the roof
The Medial Wall of the Orbit:
This wall is paper-thin and is formed by the orbital lamina or lamina papyracea of the ethmoid b one, along
with contributions from the frontal, lacrimal, and sphenoid b ones (papyraceus, "made of papyrus" or parchment paper).
There is a vertical lacrimal groove in t he medial wall, which is formed anteriorly by t he maxilla and posteriorly by the lacrimal b one
It forms a fossa for the lacrimal sac and the adjacent part of the nasolacrimal duct
Along the sut ure between the ethmoid and frontal b ones are two small foramina; t he anterior and posterior
ethmoidal foramina
These transmit nerves and vessels of the same name
SAADDES
The Inferior Wall ofthe Orbit

The thin inferior wall of t he orbit or the floor is formed mainly by the orb ital su rface of the maxilla and partly
by the zygomatic b one, and orb ital process of the palatine bone
The floor of the orbit forms the roof of the maxillary sinus
The floor is partly separated from the lateral wall of the orbit by t he inferior orb ital fissure
The Lateral Wall of the Orbit:
- This wail Is t hick, particularly its posterior part, which separates the orbit from t he middle cranial fossa
-The lateral wall is formed by the frontal p rocess of the zygomatic bone and the greater wing of the sphenoid
bone
-Anteriorly, t he lateral wall lies between t he orb it and the temporal fossa
- The lateral wall is partially separated from t he roof by the superior orbital fissure
cell
Kartagener syndrome is a hereditary syndrome; it's characterized by recurrent upper and lower respiratory tract infections. Dysfunction of which
organelle is responsible for this syndrome?
centriole
flagellum
vacuole
cilium
SAADDES
86
ANATOMIC SCIENCES
cilium
Flagella are present in the human body only in the spermatozoa. Flagella are similar
in structure to cilia but are much longer. The action of the flagellum produces movement
The cilium is a short, hair-like projection from the cell membrane. The coo rdinated
beating of many cilia produce organized movement.
The basic structure of flagella and cilia is the same. They resemble centrioles in having nine sets of microtubules arranged in a cylinder. But unlike centrioles, each set is
a doublet rather than a triplet of m icrotubules, and two singlets are present in the
center of the cylinder (9 + 2 arrangement). At the base of the cylinders of cil ia and flagella, w ithin the main portion of the cell, is a basal body. The basal body is essential
to the functioning of the cilia and flagella . From the basal body, fibers project into the
cytoplasm, possibly to anchor the basal body to the cell.
SAADDES
Note: Prokaryotic flagella are much thinner than eukaryotic flagella, and they Jack the
typical "9 + 2" arrangement of microtubules.
Both cilia and flagella usually function either by moving the cell or by moving liquids
or small particles across the surface of the cell. Flagella move with an undulating
snake-like motion. Cilia beat in coordinated waves. Both move by the contraction of
the tubu lar proteins conta ined with in them.
Kartagener syndrome (immotile cilia syndrome): is a hereditary syndrome; it's

characterized by recu rrent upper and lower respiratory tract infections; it's caused by
a defect in the action of the cilia.
cell
The inactive X chromosome in a female cell is called the _ _ _ _ which is
an example of _ _ __
pineal body, euchromatin

lateral body, heterochromatin
SAADDES
golgi body, euchromatin
barr body, heterochromatin
87
ANATOMIC SCIENCES
barr body, heterochromatin

In the female, the genetic activity of both X chromosomes is essential only during the
first few weeks after conception. Later development requ ires just one functional X
chromosome. The other X chromosome is inactivated and appears as a dense
chromatin mass ca lled the Barr body. This Barr body is attached to the nuclear
membrane in the cells of a normal fema le. In the cells of a normal male, who has only
one functiona l X ch romosome, the Barr body is absent.
Important: The Barr body's presence is the basis of sex determination tests (for
example, amniocentesis).
iJl
SAADDES
1. The sex of an embryo can be determined at about the eighth week.

2. Females have 45 active chromosomes and one inactive Barr body.
3. Barr body is also found in the cells of males with Kleinfelter syndrome
(XXY).
4. Barr body is an excellent example of Heterochromatin.
Heterochromatin: is highly condensed and t ranscriptionally inactive form of DNA.

Euchromatin: is extended and t ranscriptionally active form of DNA.
cell
In which cellular component are glycoproteins assembled for extracellular
use?
the Golgi apparatus

the endoplasmic reticulum
the nucl eus
SAADDES
the nucl eolus
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ANATOMIC SCIENCES
the Golgi apparatus

The function of the Golgi apparatus is two-fold: First, the modification of lipids and
proteins; Second, the storage and packaging of materials that will be exported from
the cell. The Golgi apparatus is often called t he "shipping department" of the cell.
The vesicles that pinch off from the Golgi apparatus move to t he cel l membrane, and
the material in the vesicle is released to t he outside of t he cell. Some of these
pinched-off vesicles also become lysosomes. Important: The Golgi apparatus is
where glycoproteins are assembled for extracellular use. N-linked glycosylations
are the most common and occur in the ER. 0 -linked glycosylations occur in the
golgi apparatus.
The Golgi apparatus (sometimes ca lled the Golgi body) is similar to endoplasmic reticulum (ER). It is composed of flat, membranous sacs, or cisternae, arranged in stacks
of parallel rows, one above the other, like pancakes. These stacks have two poles- the
convex cis face, w hich receives materials for processing, and the concave trans face,
oriented toward the cell membrane fo r transport. Between these two faces are several intermediate cisternae known as the medial face.
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1. These cisternae are located between the nucleus and t he secretory surface of a cell.
2. They package, store, and modify products that are secreted from the cell.
3. Procollagen filaments aggregate in the cisternae of Golgi apparatus.
Procollagen is fo rmed in the lumen of endoplasmic reticu lum by binding of
sugars with the amino acids that were previously polymerized on the ribosomes. Then it will move to the cis face of Golgi apparatus.
Lysosomes are cytoplasmic membrane-bound vesicles that contain a w ide variety of
glycoprotein hydrolytic enzymes that serve to digest and destroy exogenous material, such as bacteria.
utncelular spoce
.............._
Golci
'-.,. lraRSIIOrl
tesicle
Golgl
ER
G-- transiiOrl
tesicle
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Endoplasmic reticulum. Diagram above shows the relationship between ER <md Go lgi . The lumen
of the rough ER is continuous with the pelinuclear space and with the lumen of smooth ER, whereas
the Go lgi f01ms a separate membrane system. Communication between ER and Golgi is mediated
by sma ll vesicles ofER which break off, move through the cytosol and fuse with Golgi membrane.
The vesicles derived from RER are coated with a specific protein, COJ>TT, which targets them for
fusion with the Golgi.
88 1
cell
Which of the following is the distinctive array of microtubules in the core of
cilia and flagella composed of a central pair surrounded by a sheath of nine
doublet microtubules (characteristic "9 + 2" pattern)?
centriole
axoneme
tubulin
malleolus
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ANATOMIC SCIENCES
axoneme
An axoneme is the core scaffold of the eukaryotic cilia and flagella, which are projections from the cell made up
of mlcrotubules. Thus, the axoneme serves as the "skeleton" of these organelles, both giving support to the
structure and, in most cases, causing it to bend. Though distinctions of function and/or length may be made
between cilia and flagella, the internal structure of the axoneme is common to both.
The characteristic feature of the axoneme is its "9 + 2" arrangement of m icrotubules and associated proteins, as
shown in t he image below. Nine pairs of "doublet" mlcrotubules, a component of the cellular cytoskeleton,
form a ring around a "central pair" of single microtubules. Ciliary dynei n arms, the motor complexes that allow
the axoneme to bend, are anchored to these microtubules. The interactions between the ciliary dynei n proteins
and outer doublet microtubules generate force by sliding the doublets parallel to each other, which bends the
cilium and enables it to beat.
The radial spoke, a protein complex important in regulating the motion of the axoneme, Is also housed in the
axoneme; it projects from each set of outer doublets toward the central mlcrotubules. The radial spoke is a multiunit protein structure found in the axonemes of eukaryotic cilia and flagella. Nexln is a protelnous Inter-doublet
linkage that prevents microtubules in the outer layer of axonemes from movement with respect to each other.
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dyndn arms
ntxin lil'\kjng
protein
(tvery8G nm)
(evtry 24 nm)
radial
(Mry 29 nm)
Diagram of a cross-section of a cilium.The nine outer doublet

tubules are made of tubulin, whereas arms composed of the protein
dynein occur every 24 nm down the length of the cilium and interact with adjacent doublets as a "molecular motor to produce bendIng. links composed of another protein, nexin, are more widely
spaced (every 86 nm) and hold the mlcrotubules in position. Radial
spokes extend from each of the nine outer doublets toward a central pair of tubules at 29 nm Intervals, and the central sheath projections are present every 14 nm.
central pair
of mkrotubules
Note: Centrioles are cell organelles that constit ute the centrosome and thus aid in formation of the m itotic
spindle.
cell
Which ofthe following organelles have double membranes?
mitochondria
golgi apparatus
peroxisomes
centriole
nucleus
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nucleolus
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ANATOMIC SCIENCES
mitochondria
nucleus
Functions
Cdl Structure
Membranous:
Plastna membrane
Serves as a boundary of the c.cll, maintaining its integrity; protein mo lecules e mbedded
in pJasma membrane perform various functions
EndopJasmic reticulum
Ribosomes attached to roughER synthesize proteins that Jeave ceiJs via the Golgi
complex; smooth ER synthesize lipids incorporated in c.cll membranes, steroid
and certain carbohydrates used to fom1 glycoprotcins
Golgi apparatus
Composed of membranous s.acs;

carbohydrates, combines it with protein,
and packages the product as globules of g lycoprotein
Lysosomcs
Pcroxisomes
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A cell 's "digc$tivc system"
Contain enzymes that detoxify hannful substances. Cata]ase breaks down toxic
hydroge n peroxide into water and oxygen.
Mitochondria
Nucleus
Double membranous structure; catabolism; ATP synthe$is; a ceJI's ' 'power plant".
Mitochondria have their own cyclic. DNA which makes some prote in.'i that are used by
the mitochondria; this DNA is transmitted from th e mother to the fe tus.
Double membranous structure; houses the genetic code, which in tum dicta tes
protein
thereby playing an essential role in other cell activities, munely,
cell transport, m etabolism, and growth
Nonmembranous:
Ribosomes
Site of protein synthes is; a cell 's " protein factories"
Cytoskeleton
Acts as a framework to support the cell and its organelles; func tions in cell movement;
fom1s cell extension (microvilli, cilia, flagella)
Nucleolus
Plays an essential role in the fom1a tion o f ribosomes
cell
All of the following are considered as specialized types of macrophages
EXCEPT one, which one is the EXCEPTION?
kupffer cells
microglial cells
osteoclasts
SAADDES
langerhans cells
p lasma cells
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ANATOMIC SCIENCES
plasma cells
of Different Cells and Theil
Function
Primary Function
Cell
Plasma
Antibody synthesis (Immunoglobulins)
Mast
Mediators o f intlammation on contact with antigen
Schwann
Form myelin sheath around axons of the PNS
Sertoli
Produces testicular tluid

Produces testosterone
Leydig
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Fibroblas t
Produces collagen and reticular tibers
Os teoblast
Forms bone matrix, g ives rise to osteocytes
Odontoblast
Forms dentin
Ameloblast
Forms enamel
T (Lymphocytes)
Cell-mediated immunity
B (Lymphocytes)
Humoral immunity; Diflerentiate into plasma ce lls
Alpha (Pancreatic) Produce glucagon

Beta (Pancreatic)
Produces insulin
Langerhans
Antigen presenting cells (A PCs) located in the skin
Microglial
Special ized macrophages located in the nervous system
Kup ffer
Special ized macrophages located in the liver
Os teoclasis
Special ized macrophages located in the bone; bone resorption
cell
Which cell lines the lumen of the seminiferous tubules and secretes hormones, androgen binding proteins (ABPs) and other proteins that facilitate
spermatogenesis?
interstitial cells of Leydig

principal cells
sertoli cells
clara cel ls
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ANATOMIC SCIENCES
sertoli cells
Sertoli cell.s, together w ith a stratified layer of developing gametes comprise the cellular majority of the
seminiferous tubules. These cell s are responsible for secreting testicular fluid, and rogen bindi ng proteins
(ABPs) and hormones such as inhibi n; which regulates FSH secretion (sertoli cells are sensi tive t o FSH)..
Interstitial cells of Leydig are located in the loose vascular connective tissue surrounding the seminiferous tubules and are responsible for secreti ng testosterone.
ol Dilfcrcnt Cells and 'I heir
Cell
Locations
Primary Location
Sustentacular
Internal ear (organ of Corti). taste buds, olfactory epithelium
Pyramidal
Cerebral cortex (cerebrum)
Endothe lial
Lining blood and lymph vessels, endocardium (inner layer)
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Ependymal
Lining the brain ventricles and spina) cord
Sertoli
Seminiferous tubules of the testis
Ganglionic
In a ganglion peripheral to the CNS
Globular
Transitional epitheJium (kidney. water. bladder)
Prickle
Stratum spinosum of epideml is
Fibroblast
Most common cell of connective tissue
Chromaffin
Adrenal medulla and paravertebral ganglia of sympathetic nervous system
Purkinje
Cerebellar cortex (cerebellum)
Goblet
Mucous membranes of respiratory and intestinal tracts
Interstitial
Connective tissue of ovary and testis
Isle t
Pancreas
JuxtaglomeruJar
Renal corpuscle of kidney
Mesenchymal
Found between ectodeml and endodenn of embtyos
cell
Protein synthesis occurs in all of the following phases EXCEPT one. Which
G1 phase
S phase
G2 phase
M phase
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ANATOMIC SCIENCES
M phase
The cell cycle consists of interphase (including growth and synthesis) and mitosis.
Growth is the increase in cellular mass as the result of metabolism.
Synthesis is the replication of DNA in preparation for mitosis.
Mitosis is the splitting of the nucleus and cytoplasm that results in t wo diploid cells being formed .
The cell cycle can be further divided into:
Interphase: the interval between successive cell divisions duri ng which the cel l ismetabolizing
and the chromosomes are directing RNA synthesis.
It includes: 1. G phase - the first growth phase
1
2. S phase - DNA synthesis
3. G phase - the second growth phase
2
M phase- mitosis (also called karyokinesis), in th is phase both cell growth and protein
production stop. All of the cell's energy is focused on the complex and orderly division into two
similar daughter cells.
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Note: G0 phase - is a resting phase where the cell has left the cycle and has stopped dividing
Nuclear
Ohi1Sion
Cell di'lision
"
Morogrowth((a
hto.io
preporot 1on far
G1 DNA replicat ion
DNA reolicot ion ond

chromatid dupli cetl on
cell
The plasma membrane (cell membrane):
surrounds the cell wa ll and serves to protect t he cell from changes in osmotic pressure
is a polysacchari de-containing structure that functions in attachment to solid surfaces, preventing desiccation, and protection
SAADDES
is a non-permeable membrane enclosing t he cell wall
is a dynamic, selectively permeabl e membrane enclosing t he cytoplasm
94
copyright 0 201)..2014 Dental Decks
ANATOMIC SCIENCES
is a dynamic, selectively permeable membrane enclosing the cytoplasm
The plasma membrane (cell membrane) is a thin elastic structure 7.5 to 10 nanometers thick. It is
located between the cell wall and the cytoplasm. Normal cell membrane function is essential for
passive nutrient diffusion in and out of the cell, as well as for active (i.e., requiring energy) transport
across the membrane. The plasma membrane consists of a phospholipid bilayer containing integral
and peripheral proteins. This type of membrane is called a fluid mosaic and is found in both
prokaryotic and eukaryotic cells.
The cell wall surrounds the plasma membrane and serves to protect the cell f rom changes in
osmotic pressure, anchor flagella, maintain cell shape, and control the transport of molecules into
and out of the cell. Structures interior to the cell wall include the plasma membrane, the cytoplasm,
and cytoplasmic constituents such as DNA, ribosomes, and inclusions.
Remember: The mitochondria and nucleus are double membrane organelles. Mitochond ria are
the principal energy source of the cell (major site of ATP production) and are involved in all oxidative processes. They contain cyclic DNA.
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Integral
proteins
Note: Fatty acid s content of the lipids

form the interior hydrophobic tails of
plasma membrane. Remember "phobia
=fear" so hydrophobic means "water
fearing" that's why they arrange to the
inside away from water.
Peripheral proteins can be removed
with detergents and change in pH environment, however integral proteins cannot be purified w/o disruption of the cell
membrane structure.
Plasma membrane
cell
What type of cell in the dental papilla adjacent to the inner enamel epithelium differentiates into odontoblasts?
stellate reticular cel l

mesenchymal cel l
ameloblast
follicular cell
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ANATOMIC SCIENCES
mesenchymal cell - also called mesoblastic cells

These cells have the potential to proliferate and differentiate into diverse types of
cells (fibroblasts, chondroblasts, odontoblasts, and osteoblasts). Mesenchymal cells
form a loosely woven tissue called mesenchyme or embryonic connective tissue.
Important: The mesenchymal cells in the dental papilla adjacent to the inner enamel epithelium differentiate into odontoblasts, wh ich produce predentin that calcifies
to become dentin.
Mesectoderm (also ca lled ectomesenchyme) is that part of the mesenchyme deri ved
from ectoderm, especially from the neural crest in the very young embryo. Neural
crest cells give rise to spinal ganglia (dorsal root ganglia) and the ganglia of the
autonomic nervous system. These cells also g ive rise to neurolemma cells
(Schwann cells), cells of the meninges that cover the brain and spinal cord, pigment
cells (melanocytes), chromaffin cells of the adrenal medulla, and several skeletal and
muscular components of the head.
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Summary of Tooth Formation
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Dental papilla
Ectomesenchyme
from neural
crest
Dental follicle
95- 1
cell
On the playground at recess, a young girl is stung by a bee and immediately
breaks out in hives and starts gasping for air. The teacher grabs an epinephrine autoinjector from the first aid kit and is able to save the girl. What cells,
when bound by lgE, are responsible for this anaphylactic reaction?
mast cells
SAADDES
macrophages
platelets
kupffer cells
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ANATOMIC SCIENCES
mast cells
Mast cells are large cells with coarse metachromatic granules containing heparin
(anticoagulant), histamine (vasodilator), and other substances (i.e., chemotactic
facto rs, such as eosinophil chemotactic facto r of anaphylaxis and neutrophil
chemotactic factor). They occur in most loose connective t issue, especially along the
path of blood vessels. These cells act as mediators of inflammation on contact with
antigen. Note: Normally, mast cells are not found in circulation.
Both mast cells and basophils liberate heparin into the blood. Heparin can prevent
bl ood coagu lation as well as speed the removal of fat particles from the blood after a
fatty meal. They both also release histamine as well as smaller quantities of
bradykinin and serotonin. Note: It is mainly the mast cells in inflamed t issues that
release t hese substances during inflammation.
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The mast cells and basophils play an exceedingly important role in some types of
allergic reactions because t he type of antibody that causes allergic reactions (the lgE
type) has a special propensity to become attached to mast cells and basophils. The
reaction between antigen and antibody causes t he mast cell or basophil to rupture
and release exceedingly large quantities of histamine, bradykinin, serotonin,
heparin, SRS-A (slow-reacting substance of anaphylaxis), and a number of
lysosomal enzymes. This, in turn, causes local vascular and tissue reactions t hat
cause many, if not most, of t he allergic manifestations.
Note: Mast cells and basophils are deri ved from different precursors in bone marrow,
that's w hy they are considered separate cell types.
cell
A chromosome is maximally condensed chromatin wrapped around a protein
base of primarily:
hydroxyapatite
hya luronan
histones
haploid
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ANATOMIC SCIENCES
histones
Chromosomes are maximally condensed fo rm s of chromatin. Chromatin consists of
strands of DNA wound around a protein base of primarily histones and looks like a
beaded string under an electron microscope. Four histone proteins make up a
nucleosome core. This is the basic unit for which DNA is wrapped around.
Chromatin occurs in two forms: euchromatin (extended) and heterochromatin
(condensed). When a cell prepares to divide, the chromatin coils into compact
chromosomes.
Except in the gametes (germ cells), ch romosomes appear in pairs. One chromosome
from each pair comes from the male germ cell (sperm), the other from the female
germ cell (ovum).
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Normal human cel ls contain 23 pairs of chromosomes, which makes the diploid
number 46. The diploid number is the number of chromosomes of a normal cell. The
haploid number is the number of chromosomes in a gamete. Usually, the diploid
number is twice the haploid number. In these cells, 22 pairs are called homologous
ch romosomes or autosomes. These sets conta in genetic inform ation that controls the
same characteristics or functions. The 23rd pair are sex (X andY) chromosomes. The
composition of these chromosomes determi nes the person's sex - XX produces a
genetic female; XV, a genetic male.
Histones are positively charged basic proteins; they carry a highly positively charged
N-terminus with many lysine and arginine residues, their cha rge is positive because
they need to interact with DNA, which is negatively charged. Note: The basic amino
acids are arginine, lysine and histidine.
cell
Plasma cells are immediate derivations of which cell type?
CDS+ T cell
CD4+ T cell
B lymphocyte
neutrophil
eosinophil
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ANATOMIC SCIENCES
B lymphocyte
Plasma cells are further differentiated B cells that are very important in the product ion of antibod y. They are rarely found in the peripheral blood. They comprise from
0.2% to 2.8% of the bone marrow white cell count. Mature plasma cells are often oval
or fan shaped, measuring 8 to 15 1Jm. Their appearance (on light microscopy) is quite
characteristic: they have basophil cytoplasm and an eccentri c nucleus, in addition to
a pale zone in the cytoplasm that (on electron m icroscopy) conta ins an extensive
Golgi apparatus. They are found mainly in bone marrow and connective t issue. They
have a short lifetime of 5 to 10 days.
T cells (T lymphocytes or thymus-derived lymphocytes): produce cell-mediated
immunity. They account for 70% to 80% of circulating lymphocytes and become associated with the lymph nodes, spleen, and other lymphoid tissues. Upon interacting
with a specific antigen, T lymphocytes become sensitized and differentiate into several types of daughter cells. These include memory T cells, which remain inactive
until future exposure to the same antigen; killer T cell s, which combine w ith antigen
on the surface of the foreign cells, causing lysis of the foreign cells and the release of
cytokines; and different subsets of he Ip erT cells, which help activate other T lymphocytes. Note: HIV virus selectively infects T-helper cel ls or CD4+ T cells.
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B cell s (B lymphocytes, complete maturation in the bone marrow): produce antibodymediated immunity. They account for 20% to 30% of circu lating lymphocytes and like
T lymphocytes become associated w ith lymphoid organs (lymph nodes, spleen, etc.).
As B lymphocytes become sensitized to an antigen, mature B cel ls develop into plasma cells or become memory B cells. Memory B cells are formed specific to the antigen(s) encountered duri ng the primary immune response; able to live for a long time,
these cells can respond quickly upon second exposure to the antigen for wh ich they
are specific.
cell
Which ofthe following is a specialized macrophage located in the liver?
fibroblasts
hepatocyte
kupffer cell
erythrocyte
SAADDES
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ANATOMIC SCIENCES
kupffer cell
The liver's functional unit, the lobule, consists of p lates of hepatic cells, or
hepatocytes, that encircle a central vein and radiate outward. Separating the
hepatocyte plates from each other are sinusoids, the liver's capillary system.
Hepatocytes make up 60% to 80% of the cytoplasmic mass of the liver. These cells are
involved in protein synthesis, protein storage and transformation of carbohydrates,
synthesis of cholesterol, bile salts and phospholipids, and detoxification,
modification, and excretion of exogenous and endogenous substances. The
hepatocyte also initiates the formation and secretion of bile.
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Hepatocytes have abundant o rganelles that perform their numerous functions.

Smooth endoplasmic reticulum produces bile salts and detoxifies poisons.
Peroxisomes also detoxify poisons. Rough endoplasmic reticulum manufactures
membranes and secretory proteins. In certain leukocytes, the rough ER produces
antibodies. In pancreatic cells, the rough ER produces insulin. The Golgi apparatus
packages bile and other secretory products of t he cell. Glycosomes store sugar.
Finally, numerous mitochondria fuel cell activity.
Kupffer cells are reticu loendothelial macrophages, which line the sinusoids. They
function to remove bacteri a and toxins that have entered t he blood through the
intestinal capillaries. These cells have definite cytologic characteristics such as clear
vacuoles, lysosomes, and granular endoplasmic reticulum.
cell
Which of the following is the site of synthesis of rRNA and is NOT bound by a
membrane?
endoplasmic reticulum
ribosomes
SAADDES
golgi apparatus
nucleolus
plasma membrane
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ANATOMIC SCIENCES
nucleolus
The nucleolus is an oval body found inside the nucleus. The nucleolus consists of RNA and protein and is not bounded by a limiting membrane. The nucleolu s is the site of rRNA synthesis. Ribosomes are small particles consisting of rRNA and protein. They are commonly called
the "protein factories" of the cell. They are responsible for the process of translation, or taking the information from the DNA, encoding on RNA, and using it to create the proteins needed by the cell.
The endoplasmic reticulum is a membranous network through the cytoplasm. The endoplasmic reticulum is continuous with the cell and nuclear membranes.
There are two types of endoplasmic reticulum :
1. Smooth (ribosomes are absent)- steroid synthesis; intercellular transport; detoxification.
The SER in smooth and striated muscle cells is known as sarcoplasmic reticulum which is
responsible for storage and release of Ca2+.
2. Rough (ribosomes are attached) - synthesis of proteins for use o utside a cell (extracellular use).
SAADDES
1. The nucleus of a cell is surrounded by two membranes and contains DNA.

2. Active cells which synthesize large amounts of proteins (fibroblasts, osteoblasts,
plasma cell s, etc.) are characterized by an abundance of rough endoplasmic
reticulum.*** NBDE favorite question: The cytoplasm of osteoblasts appears to be
basophilic via normal H&E stain due to the presence of large amounts of rough
endoplasmic reticulum.
3. RNA and DNA can be distinguished from one another by the Feulgen reaction.
4. Any substance that is stained by the basic dye (appears blue or purple) is
considered to be basophilic, such as nucleus and rough endoplasmic reticulum,
because of their high content of DNA and RNA respectively.
5. Any substance that is stained by the acidic dye (appears pink or red) is considered
to be acidophilic, such as mitochondria and lysosomes.
cell
In which phase of mitosis do the chromosomes condense and become visible, the nuclear membrane breaks down, and the mitotic spindle apparatus
forms at opposite poles of the cell?
interphase
prophase
metaphase
anaphase
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telophase
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ANATOMIC SCIENCES
prophas e
Mitosis is the process of normal cell division. Mitosis occurs whenever body cells need to
produce more cell s for growth or for replacement and repair. The resu lt of mitosis is two
identical daughter cells w ith the same ch romosomal content as the parent cell. Mitosis
is part of the entire life span of the cell, also called the cell cycle. This entire cycle consists
of the following stages:
Interpha se: the interval between successive cell divisions during wh ich the cell is
metabolizing and the chromosomes are directing DNA synthesis. It includ es:
1. G phase: the fi rst growth phase
1
2. S phase: DNA synthesis

3. G phase: the second growth phase
2
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Mitosis can be divided into fou r principal stages:

Prophase: the chromoso mes condense and become visible, the nuclear membrane
breaks down, and the mitotic spindle apparatus forms at oppos ite poles of the cell.
Metaphase: the chromosomes align at the equatorial p late and are held in p lace by
microtubules attached to the mitotic spindle and to part of the centromere.
Anaphase: the cent rome res divide. Sister chromatids separate and move toward the
corresponding poles.
Telophase: daughter chromosomes arrive at the poles, and the mi crotubules disappear. The condensed chromatin expands, and the nuclear envelope reappears. The
cytoplasm divides (cytokinesis), and the cell membrane p inches inward, ultimately producing two daughter cell s.
Note: The mitotic spindle is made up of microtubules.
cell
All of the following statements regarding differences between meiosis and
mitosis are FALSE EXCEPT on e. Which one is th e EXCEPTION?
both require one division to complete the process

crossing over occurs in mitosis, it does not occur in meiosis
SAADDES
meiosis occurs in germ cel ls only
in m itosis the daughter cells have half the number of ch romosomes as the parent
cell (2n ton), wh ile in meiosis the daughter cells have the same number of ch romosomes as the parent cells (2n to 2n)
in meiosis the daughter cells have the same genetic information as the parent cell,
while in m itosis the daughter cells are genetically d ifferent from the parent cell
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ANATOMIC SCIENCES
meiosis occurs in germ cells only

Mitosis
Meiosis
Requires one division only to complete the
Requires two divi.i>ions 10 (.'.(Unplete. the process
<k'<CurS in all somatic cdls
O ceurS in germ
The. daughter
have the same number of
chromosomes as 1he parent cells (2n to 2n)
The daughter cdlo: have half Lhe number of

as 1he paren1ails (2n ton)
4 The. daughter cdlo; have the. same gent .lic

in formation as the parenl ce ll
Cro.o;sing over belween chromosomes dots not occur
only
4 The daughter cells art gentlicall> difftrtnt from

the parent <:.e ll
Cro.o:sing over belween chromosomes dots oceur
Phases of meiosis: There are t wo divisions in meiosis; the first d ivision is meiosis 1 and the second is
meiosis 2. The phases have the same names as those of mitosis. A number ind icates the division number
( 1st or 2nd): M eiosis 1: prophase 1, metaphase 1, anaphase 1, and telophase 1
M eiosis 2: prophase 2, metaphase 2, anaphase 2, and telophase 2
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In the first meiotic d ivision, the number of cells is doubled but the number of chromosomes is not. This
results in 1/ 2 as many chromosomes per cell. The second meiotic d ivision is like mitosis; the number of
chromosomes does not get reduced.
The events that occur during prophase of mitosis also occur during prophase I of meiosis. The chromosomes coil up, the nuclear membrane begi ns to d isinteg rate, and the centrosomes beg in moving apart.
Synapsis {joining) of homologous chromosomes produces tetrads (also called bivalents)
The two chromosomes may exchange fragments by a process called crossing over. When the chromosomes partially separate in late prophase, the areas w here crossing over occurred remain attached and
are referred to as chiasmata. They hold the chromosomes together until they separate during anaphase.
Metaphase 1:
Bivalents (tetrads) become aligned in the center of the cell and are attached to spindle fibers
Anaphase 1: begins when homologous chromosomes separate
Telophase 1: the nuclear envelope reforms and nucleoli reappear
Note: Interkinesis is similar to interphase except DNA synthesis does not occur. The events that occur
du ring meiosis II are similar to mitosis.
cell
Almost all human body cells have mitochondria EXCEPT one, which one is the
EXCEPTION?
fibroblasts
RBCs
osteoblasts
osteoclasts
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103
ANATOMIC SCIENCES
RBCs
Mitochondria (energy plants): the function of mitochondria is to yield ATP, it has two
membranes; outer and inner, the inner one contains many enzymes important for the
oxidative phosphorylation wh ich is an important process fo r yielding ATP. The inner
membrane also has a lot of infoldings ca lled cristae, they are responsible for increasing the inner surface area of mitochondria. The number of mitochondria and cristae is
proportional to the activity of the cell (e.g., kidney and ca rdiac cells requ ire a lot of energy so those cells possess high content of mitochondria).
Important: Mitochondria also have their own DNA which is maternally transmitted
hence; a female with a m itochondrial disorder will transmit it to all her offspring.
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1. Mature red blood cells have no m itochond ri a, so all of their energy needs
are supplied by anaerobic g lycolysis.
2. Striated duct cells of salivary glands have a lot of m itochondria arranged
in rows giving them a stri ated appearance. They need energy for actively
transpo rting ("pumping") ions.
3. Myoepithelial cells: these are non-secretory cells that are known to have
contractile properties in sweat glands and mammary glands.They are located
between the secretory cells and their basement membrane. They are derived from ectoderm.
gastrointestinal system
The main distinguishing feature of the jejunum is the presence of prominent:
brunner's glands
rugae
SAADDES
peyer's patches
ten iae coli
plicae circu lares
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ANATOMIC SCIENCES
plicae circulares - aka valves of Kerckring

The small intestine is the main site of absorption of digested food . The small intestine is specialized for
the completion of the d igestion processes and the subsequent absorption of the digested products. The
small intestine consists of three main segments: the duodenum, jej unum, and ileum.
Characteristic features of the small intestine include:
Intestinal villi. These are finger-like proj ections into the lumen (consisting of surface epi thelium and
underlying lamina propria).
The epithelium lining the lumen consists of a simple columnar epitheli um with goblet cells. The
apical surface of the absorptive epithelial cells has a "brush border" (resul ting from an orderly
arrangement of closely packed microvilli, which may number several hundred per absorptive cell). The
main function of the microvilli is to increase the surface area available for absorption.
The lamina propria of the small intestine is formed from loose connective tissue. This contains
blood vessels, nerves, and large lymphatic vessels (si te of absorption of lipids).
Intestinal glands. These are simple tubular glands that open to the intestinal lumen between the
base of the v illi . The intestinal g lands are sometimes called the crypts of Lieberkuhn. The crypts
secrete various enzymes, includ ing sucrase and maltase, along with enteropeptidase. Also, new epithelium is formed here. Secretory cells (Paneth cells) w ith large acidophilic granules are found at the base
of the intestinal g lands. The function of these secretory cells is still not fully understood, but it is known
that they secrete lysozyme, which has anti-bacterial properties.
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Important:
1. The main distinguishing f eature of the duodenum is the presence of glands in the submucosa. These
duodenal or Brunner's glands produce alkaline secretions to counteract the effects of gastric acids that
reach the duodenum. These glands also provide the necessary alkaline envi ronment for the functioning
of the exocrine pancreatic secretions.
2. The ileum is almost devoid of plicae ci rculares, however large accumulations of lymphatic tissue, both
nodular and dense, are found in the lamina propria. These can often be seen macroscopically as large
white patches and are commonly known as Peyer's patches occupied by M -cell s. The ileum is the preferred site for vitamin 812 absorption. Vitamin 812 is also known as cobalamin.
Remember: Pernicious anemia is an autoimmune disorder which attacks gastric parietal cells. These cells
secrete intrinsic factor which is integral for vi tamin B12 absorption.
DIGESTIVE SYSTEM
- -Stomach
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------Jejunum
_
Flexura of
transverse colon
- - Decending
colon
Ascending
colon Cecum_
----
AppendiX
.
- - - Rectum
. _ Anus
104-1
jejunum
plicae clc:utares
thick wall
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arterial arcades
smooth mucous
membrane
ilieum
thin wall
superior mesenteric
artery
fat
Some external and internal differences between the jejunum and ileum
104AI
A patient comes to the emergency room presenting with jaundice and
intense pain in the upper abdominal and between the shoulder blades. The
physician suspects choledocholithiasis that is caused by cholesterol stones
formed in which organ that stores and concentrates the bile.
appendix
gallbladder
liver
pancreas
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spleen
105
ANATOMIC SCIENCES
gallbladder
The gallbladder is a sac-shaped organ roughly 3 to 4 inches long. It is firmly attached to
the lower surface of the liver and lies on the right side of the abdomen j ust below the ribs
at the front. The gallbladder is joined by the cystic duct to the common hepatic duct to
form the common bile duct wh ich passes down through the head of pancreas to drain
into the ampulla of Vater. Just before the duct enters the duodenum, the co mmon bile
duct is j oined by the pancreatic duct.
Note: The gallbladder's lining is folded into rugae (similar to those in the stomach). The
middle layer consist s of smooth muscle fibers that contract to eject bile.
Bile is continuous ly produced by the liver and drains through the hepatic ducts and bile
duct to the duodenum. When the small intestine is empty of food, the sphincter (Oddi's
sphincter) of the hepatopancreatic ampulla (ampulla of Vater) constricts, and bile is
forced up the cystic duct to the gallbladder for storage.
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Important: Secreti on of the hormone cho lecystokinin after a fatty meal stimul ates gallbladder contraction and relaxation of Oddi's sphinct er, and the bile mixes with the chyme.
1.The sphincter (Oddi's sphincter) of the hepatopancreatic ampullaris is a circular muscle that surrounds the hepatopancreati c ampulla (ampulla of Vater).
2. The gallbladder does not contain a su bmucosa as do the stomach and intestines (both large and small).
3. Bile emul sifies neutral fats and absorbs fatty acids, cholesterol, and certain
vitamins.
4. The gallbladder receives blood from the cystic artery, a branch of the right
hepatic artery. The gallbladder is innervated by vagal fibers from the celiac
plexus. The lymph drains into a cysti c lymph node, then into the hepatic nodes,
and eventually into the celiac nodes.
Common HepJtic Duct
Common Bile Duct
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Duodenal Papilla
Duodenum
Pancreas, Duodenum and Gallbladder

105 1
The smooth muscle coat of the large intestine consists of three bands called
taeniae coli.
The walls of the large intestine have more villi than the small intestine.
both statements are t rue
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both statements are false
the first statement is true, the second is false
the first statement is fa lse, the second is true
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ANATOMIC SCIENCES

The large intestine consists of the colon and rectum. The colon Is composed of various parts: t he cecum, ascendi ng colon, transverse colon, descending colon, and sigmoid colon. The appendix is attached to the cecum. The
rectum is the second to last part of the digestive tract and leads into t he last part, t he anus.
The large Intesti ne Is comp osed of three parts:
1. Cecum: the beginning of the large intestine, bag-like structure that receives the ileum of the small intestine. The vermiform appendix is a narrow, blind tube that extends downward from t he cecum. It contains a
large amount of lymphoid tissue. Note: Because the appendix is a blind tract. it is frequently a site of inflammation (appendicitis).
2. Colon: parts of t he colon Include the ascending colon - the shortest part of the large intestine that
extends upward from the cecum on the right posterior abdominal wall. The t ransverse colon extends
across the upper abdomen where the colon bends downward along t he left posterior abdominal wall as the
descending colon. Low in the abdomen, the colon curves into the pelvis toward t he midline as the 5-shaped
sigmoid col on.
3. Rectum: extends from the sigmoid colon to the anus. It is straight and does not possess the taeniae coli
t hat are present in the rest of the large intestine. The rectum ends as the anal can al (3 - 4 em), which opens
to the exterior through t he anus. The anal canal is surrounded by t he internal and external sphincter m uscles
t hat control the expulsion of contents (bowel movements).
Important: Unlike those of the rest of the Gl tract, longitudinal muscles do not form a continuous layer
around the large intestine. Instead t hree bands of longitudinal muscle, called taeniae coli, run the length of
t he colon. Contractions gather the colon into bands (haustra), giving t he colon its puckered' appearance.
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,.
1. The large intestine lacks folds or villi. It is characterized by many tubular Intestinal glands with
large numbers of goblet cells. This is sometimes described as a glandular epithelium.
2. The large intestine is the site of water absorption (via columnar absorptive cells) and is also the site
of formation of t he feces. The secretions of the goblet cells provide lubrication for the luminal surfaces.
3. Abundant lymphatic t issue is common in the lamina propria (owing to the large bacterial populat ion i n the lumen of the large intestine).
4. Whereas t he circular smooth muscle layer is continuous, the longitudinal smooth muscle of the
muscularis is in the form of t hree thick bands, known as taeniae coli.
5. The anal region, unlike the rest of the large intestine, has a series of longitudinal folds, and the
epithelium becomes a stratified squamous epithelium.
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intestine
1-- E:I\Cirnal anal sphincter

(skeletal muscle)
Anus
anal sphincter
(smooth muscle)
Large intesti ne
106-1
Name the glands found in the submucosa of the duodenum that secrete an
alkaline mucus to protect the walls of the mucosa.
peyer's patches
glands of Kerckring
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hertwig's glands
brunner's g lands
crypts of Lieberkuhn
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ANATOMIC SCIENCES
brunner's glands
Brunner's glands (also called duodenal glands or submucosal glands) are small, bra nched, coiled,
tubu lar glands situated deeply in the submucosa of the duodenum. These glands make alkaline
material that act along with bile and pancreatic juice to neutralize the very acidic chyme entering
the duodenum throug h pylorus. They also help to achieve optimal PH for the activity of pancreatic
enzymes. Note: Histologically, it is possible to distinguish the duodenum from the stomach by the
presence of these submucosal glands.
Remember:
1. The duodenum is the first pa rt of the small intesti ne and measures around 12 inches in length.
The duodenum has a "C" shape, with the curvature of the"C encircling the head of the pancreas.
It is the shortest but widest part of the small intestine.
2. The interior of the duodenum has a folded surface, which increases the available surface area
for absorption of minerals (especially iron) and amino acids.
3. It is mostly retroperitoneal (lies behind the peritoneum). The exception is the first 2cm of the
first pa rt (ampulla, duodenal cap).
4. It receives the common bile duct and pancreatic duct at the duodenal papilla (which is a
small, rounded elevation in the wall of the duodenum).
5. The duodenum receives blood from the superior pancreaticoduodenal artery, a branch of
the gastroduodenal artery, and the inferior pancreaticoduodenal artery, a branch of the
superior mesenteric artery.
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Important: The sympathetic and parasympathetic divisions of the autonomic nervous system
control contraction of smooth muscles in the intestinal wall. (1) Sympathetic: The splanchnic
nerve passes through the celiac plexus. Postganglionic fibers innervate the small intestine.
Sympathetic stimulation slows motility of the small intestine. (2) Parasympathetic: The vagus
nerve supplies a vast distribution of parasympathetic fibers. Postganglionic fibers from t he celiac
plexus associated with the vagus nerve innervate the small intestine. Parasympathetic stimulation
of the small intestine causes increased motility. Note: The preganglionic parasympathetic neurons
to the duodenum are located in the dorsal motor nucleus of the vagus nerve.
At which level does the esophagus pierce the diaphragm?
C6
TS
TlO
T12
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ANATOMIC SCIENCES
T1 0- it begins at C6
The esophagus starts at t he lower border of t he 6th cervical vertebrae. It is a 10-inch
collapsible muscular tube t hat lies dorsal to the trachea and ventral to the vertebral column.
The esophagus extends from t he oropharynx anterior to the vertebral column, enters t he
mediastinum, leaves the thorax via t he esophageal hiatus (at T10) and joins the stomach. The
point where the esophagus ends and t he stomach begins is the esophagogastric junction.
The open ing through which the abdominal part of t he esophag us enters the cardiac portion
of t he stomach is called the cardiac orifice. Important: There is an abrupt change in the type
of surface epithelium at the junction of t he esophag us and stomach - from stratified
squamou s to simple columnar.
The esophageal wall contains four layers, as follows from the lumen outward:
Mucosa - epithelium, lamina propria, and glands
Submucosa -connective tissue, blood vessels, and glands
Muscularis (middle layer) - Proximal third of esophag us: striated muscle; Middle third of
esophag us: smooth and striated muscles; Distal third of esophagus: smooth muscle
Adventitia - connective tissue that merges with connective t issue of surrounding struct ures
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The esophagus receives blood from the inferior thyroid artery, from branches of the
descending thoracic aorta, and from branches of t he left ga stric artery.
"GERD" stands for gastroesophageal reflux disease, and "Barrett's esophagus" is the
metaplasia, or abnormal change, in the epithelium of the lower end of t he esophagus (gastric
or intestinal columnar epithelium replaces the normal stratified squamous epithelium of t he
esophag us) thought to be caused by chronic acid damage. Note: Strong association with
esophageal adenocarcinoma.
Remember: The esophag us receives parasympathetic fibers from the e sophageal branches
of the vagus nerve. The esophagus receives motor fibers from the recurrent laryngeal
branches of the vagus nerve and sympathetic innervation from the e sophageal plexus of
nerves.
The lateral surface of the stomach is called the:
lesser curvature
greater curvature
lesser omentum
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greater omentum
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greater curvature
The stomach is a collapsible, pouch-like structure about 10 inches long and capable of holding 2 to
4 quarts. Attached to the lower end of the esophagus, the stomach lies immediately inferior to the
diaphragm and extend s to the duodenal portion of the small intestine. The stomach lies in the left
upper quadrant of the abd ominal cavity.
The lat eral surface of the stomach is called the greater curvature; the medial surface, the lesser
curvature. The lesser omentum layer of the peritoneum extends around the stomach, and the
greater omentum is found along the greater curvature of the stomach. The interior of the stomach
is lined with rows of foldsor wrinkles, called rugae.
The stomach has four main regions:
1. Cardia: immediately distal to the gastroesophageal junction of the stomach and esophagus.
2. Fundus:enlarged portion distal to the cardia, lying above and to the left of the gastroesophageal opening.
3. Body: the mid dle or main port ion of the stomach, distal to the fundus and tapering in size.
4. Pylorus: the lower portion, between the body and the gastroduodenal j unction.
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The stomach has three layers of smooth muscle - the outer longitudinal, the middle circular, and t he
inner oblique muscles.
1. The maximum capacity of the stomach is about 3 to 4 liters.
2. The stomach receives blood from all three branches of t he celiac artery (celiac trunk) . The
left gastric artery supplies the lesser curvature of the fundus and the body of the stomach.
The right gastric artery is a loop that supplies the lesser curvature and then forms an
anastomosis wit h t he left gast ric artery. The left and right gastro-omental arteries supply
the greater curvat ure.
The mucosa of the stomach contains many gastric glands in the lamina propria:
Parietal (oxyntic) cells: located in fu ndus and body; secrete HCL and intrinsic factor
Zymogen ic (chief) cells: located in fu ndus and body; secrete pepsinogen
G cells: present throughout the stomach; produce gastrin
pyloric
sphincter
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greater
curvature
circular
muscle
layer
mucosa and
submucosa
Stomach - Internal view
Which ofthe following vessels does NOT supply blood to the liver?
hepatic veins
hepatic portal vein
common hepatic artery
celiac trun k
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ANATOMIC SCIENCES
hepatic veins
The liver receives blood from t wo sources: the hepatic artery proper, which is a branch of the
common hepatic artery, which in turn branches from the celiac trunk and the hepatic portal vein.
The hepatic artery proper supplies oxygenat ed blood from the aorta, while the hepatic portal vein
carries the products of digestion to the liver for processing. This blood eventually drains via the
hepatic veinsinto the inferior vena cava, which transports the blood to the heart. Note: The portal
triad consists of the: hepatic artery, portal vein and bile duct.
The liver is t he heaviest and most active internal organ in the body. Many of the liver's fu nctions are
vital for life. Normally reddish brown in color, the liver lies under the cover and protection of the
lower ribs on the right side of the abdomen. The liver has an upper (diaphragmat ic) surface and a
lower (visceral) surface; the two surfaces are separated at the front by a sharp inferior border. The
liver is attached to the diaphragm by the falciform, triangular, and coronary ligaments. The liver
is also joined to the stomach and duodenum by the lesser omentum (gastrohepatic omentum) and
hepatoduodenal ligaments respectively. The visceral surface of the liver is in contact with t he
gallbladder, the right kidney, part of the duodenum, the esophagus, the stomach, and the hepatic
flexure of the colon. The porta hepatis - the point where vessels and ducts enter and exit the liver
- lies on the ventral surface. The liver is divided into right, left, caud ate, and quadrate lobes.
Anatomically, the right lobe includes the caudate and quadrate lobes. The caudate lobe and t he
majorit y of the quadrate lobe are, however, funct ionally part of the left lobe, as they receive their
blood supply from the left hepatic artery and deliver their bile into the left hepatic duct.
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Bile is produced and excreted by hepatocytes (liver cells), which are the most versatile cells in t he
body. Bile is secreted by the liver into the common hepatic duct. A short cystic duct from t he
gallbladder joins the common hepatic duct to form the common bile duct, which transports the bile
inferiorly to the duodenum to help emulsify fat for digest ion. Note: Kupffer cells line the sinusoids
of the liver and function to filter bacteria and small foreign particles out of the blood.
Remember: The liver has digestive, metabolic, and regulatory functions; it schief digestive function
is producing bile, which acts as a fat emulsifier in the small intestine.
Note: The lesser omentum (gastrohepatic omentum) is the double layer of peritoneum that
extends from the liver to the lesser curvature of the stomach and the start of the duodenum.
coronary ligament
right lobe
of liver
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inferior border
Liver- Anterior view
110.1
left gastric artery
cystic artery
splenic artery
gastro
duodenal
artery
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Typical patterns of branching of celiac trunk and hepatic arteries

110AI
One significant difference between the jejunum and the ileum is that the ileum
characteristically contains more of which feature below?
plicae circu lares

brunner's g lands
taeniae coli
SAADDES
peyer's patches
villi
[refer to card 104 A-1for illustration )
ANATOMIC SCIENCES
111
peyer's patches
The ileum is characterized by extensive lymphoid tissue. Lymphoid cells aggregate to form Peyer's
patches.
Note: The jej unum has more plicae circulares (valves of Kerckring) and more villi.
The lower part of the ileum has no plicae circulares.
Comparison of the jejunum and ileum:
Jejunum (middle portion of the small intestine)- ext ends from the duodenum to t he ileum:
1. Thicker muscular wall for more active peristalsis.
2. Has a mucosal inner lining of greater diameter for absorption.
3. Has more (and larger) plicae circulares (valves of Kerckring) and more villi for greater
absorption.
4. Absorption of carbohydrates and proteins.
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Ileum (distal portion of the small intestine)- extends from the jejunum to the cecum:
1. More mesenteric fat.
2. More lymphoid tissue (Peyer's patches).
3. Blood supply is more complex.
4. More goblet cells, which secrete mucus.
5. Absorption of vitamin B12 and bile salts.
Remember:
1. Valves of Kerckring. The lining of the small intestine has permanent folds known as valves of
Kerckring or plicae circulares. These are most prominent in the jejunum. These folds, seen
macroscopically in transverse sections, consist of mucosa and submucosa.
2. 1ntestinal villi. These are finger-like projections into the lumen (consist ing of surface epithelium and underlying lamina propria).
*""*The epithelium lining the lumen consists of a simple columnar epithelium with goblet cells.
The apical surface of the absorptive epithelial cells has a "brush border" (resulting from an
orderly arrangement of closely-packed microvilli, which may number several hundred per
absorptive cell). The main function of the microvilli is to increase the surface area avai lable for
absorption.
Peristalsis for what organ is controlled by taeniae coli?
esophagus
stomach
large intestine
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small intestine
Irefer to card 106-1for illustration!
ANATOMIC SCIENCES
112
large intestine
Unlike those of the rest of the Gl tract, longitudinal muscles do not form a continuous
layer around the large intestine. Instead, th ree bands of longitudinal muscle, ca lled
taeniae coli, run the length of the colon. Contractions gather the colon into bands
(haustra), giving the colon its "puckered" appearance.
The major function of the large intestine (also called the colon) is the removal of
water from the material (chyme) entering it. Water is removed by absorption.
Unlike the small intestine, the large intestine does not secrete enzymes into its
lumen.
Histologic characteristics:
Epithelium: simple co lumnar w ith m icrovillus border to increase surface area for
absorption of water from the lumen. Mucus secreted by goblet cells lubri cates
dehydrating fecal mass. Intestinal g lands (crypts of Lieberkuhn) invade lamina
propria. The epithelium lacks villi.
Muscularis externa: inner circle consisting of a smooth muscle layer. Contains
the th ree bands of longitudinal muscle, called taeniae coli, for peri stalsis.
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Important: The vagus nerve supplies parasympathetic fibers to the ascending and
transverse colons, while the descending and sigmoid colon along wit h the rectum and
anus are supplied by the pelvic splanchnic nerves.
Hirschsprung's disease: is a congenital disease caused by the absence of the myenteric plexus (Auerbach and Meissner plexi). This leads to decreased parasympathetic
activity w hich results in decreased motility and obstruction of the intestine.
Which cells, located in the crypts of Lieberkiihn, secrete an antibacterial
enzyme that maintains the gastrointestinal barrier?
paneth cells
enteroendocrine cells
sertoli cells
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absorptive cells
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ANATOMIC SCIENCES
pane th ce lls
Characteristic feature s of the small intestine include:
Intestinal v illi. These are fi nger-like proj ections into the lumen (consisting of surface
epithelium and underlying lamina pro pria).
***The e pithelium lining the lumen consists of a simple co lumnar epithelium w ith
goblet cells. The apical surface of the absorptive epitheli al cell s has a "brush borde r"
(res ulting f rom an orderly arrangement of closely-packed microvilli, which may number
several hundred per absorptive cell). The main function of the microvilli is to increase
the surface area available for absorption.
*** The lamina propria of the small intestine is formed from loose connective t issue.
This conta ins b lood vessels, nerves, and large lymphatic vessels (site of absorption of
lipids).
Intestinal glands. These are simple tubular glands that open to the intestinal lumen
between the base of the villi. The intestinal glands are sometimes called the crypts of
Liebe rkuhn. Paneth ce lls are specialized secretory epithelial cell s located at the bases
of intestinal crypts (crypts of Lieberki.ihn). They are most common ly found in the ile um.
Their function is still not fully understood, but it is known that they secrete lysozyme,
which has anti-bacterial properties and helps maintain the gastrointestinal barrier.
Valves of Kerckring. The lining of the small intestine has permanent folds known as
valves of Kerckring or plicae circulare s. These are most prominent in the jejunum.
These folds, seen macroscopically in transverse sections, consist of mucosa and submucosa.
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Three types of e pithelial ce lls line the microvilli of the "brush borde r":
1. Goblet ce lls: secrete mucus, abundant in ile um.
2 Absorptive ce lls: participate in absorption, simple columnar cells.
3. Enteroe ndocrine cells: secrete enterogastrones (secretin and cholecystokin in) into
the blood - stream. Abund ant in the duodenum.
Which ofthe following cells are responsible for secreting glucagon?
alpha cells
beta cells
delta cells
gamma cells
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alpha cells
The pa ncreas is an elongated gland lying behind the stomach and in front of the aorta and
inferior vena cava. The large head of the pancreas is framed by the C-shaped loop of the duodenum. Extending to the left from the head region are the neck, body, and tail of the pancreas,
respectively. The tail meets the spleen on the left of the abdomen.
Note: Patients with cancer of the head of pancreas usually present with jaundice. The jaundice
develops because of t he blockage of the bile duct.
Pancreatic secretions are collected by t he main pancreatic duct (and accessory pancreatic
d uct), which, together with the bile duct, enters the duodenum at the hepatopancreatic
ampulla (ampulla of Vater).
The exocrine port ion is formed by secretory cells arranged in small sacs called acini, which
secrete d igestive enzymes called pancreatic juices into the intestine. The endocrine portion
consists of clusters of cells called pancreatic islets (islets of Langerhans), which are scattered
among the acini. These cells produce insu lin and glucagon, hormones that promote the cellular uptake of glucose and the breakdown of glycogen, respectively.
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1. Endocrine portion (secretes into bloodstream): takes the form of many small clu sters of
cells called Islets of Langerhans:
Alpha cells: secrete glucagon, which counters the action of insulin
Beta cells: secrete insulin, which promotes uptake and storage of glucose
Delta cells: secrete somatostatin
Gamma cells: secrete polypeptides
2. Exocrine portion (secret es throug h duct into d uodenum): secretes t he following
enzymes: pancreatic lipase, amylase, carboxypeptidase, elastase, and chymotrypsinogen.
Acinar cells: produce enzymes that d igest protein s, carbohydrates, and fats.
Trypsinogen is then converted to trypsin in t he small intestine.
Note: Cholecystokinin is produced by the duodenum and regulates pancreatic j uice secretion.
SAADDES
Pancreas, Duodenum, and Gallbladder
114-1
Which of the following provides parasympathetic stimulation to the sigmoid
colon?
vagus nerve
phrenic nerve
Tl-l2
52-54
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S2-S4
Divisions of gut tube:
Foregut: includes esophagus, stomach, liver, gallbladder, pancreas and proximal
part of duodenum (to the point of entry of common bile duct) as well as the spleen
(Note: that it is located in the foregut region, but is not a gut organ).
-Arterial supply: celiac trunk
-Venous drainage: hepatic portal system (via left gastric and splenic veins)
-Lymphatic drainage: celiac nodes
-Sympathetic innervation: thoracic splanchnic nerve synapsing in celiac plexus
-Parasympathetic innervation: vagus
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Midgut: incl udes distal part of duodenum, jejunum, ileum, cecum, appendix, ascend ing colon and two thirds of the transverse colon.
-Arterial supply: superi or mesenteri c artery
-Venous drainage: hepatic portal system (via superior mesenteric vein)
-Lymphatic drainage: superi or mesenteric nodes
- Sympathetic innerv ation: t horacic splanchnic nerve synapsing in superi or
mesenteric plexus
-Parasympathetic innervation: vagus
Hindgut: includes d istal one th ird of the t ransverse colon, descending colon, sigmoid colon and rectum.
-Arterial supply: inferior mesenteric artery
-Venous drainage: hepatic portal system (via inferior mesenteric vein)
-Lymphatic drainage: superi or and inferior mesenteric nodes
-Sympathetic innervation: inferior mesenteric plexus
-Parasympathetic innervation: 52-54
muscle
Which of the following triangles is bounded by the sternocleidomastoid, the
posterior belly of digastric and the superior belly of omohyoid muscle?
submental triangle
digastric tri angle
SAADDES
ca rotid triangle
muscular triangle
occipital tri angle
subclavian triangle
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ANATOMIC SCIENCES
carotid triangle
The neck is divided i nto triangles, the two most prominent b eing formed as the sternocleidomastoid crosses the
neck to form t he anterior and posterior triangles.
The anterior triangle is further subdivided by the anterior and p osterior bellies of t he digastrics and t he superior b elly of the omohyoid.
(1 ) Submental triangle:
(a) Boundaries: Anterior belly of digastric muscle, hyoid bone and the midline of t he neck
(b) Floor: Mylohyoid
(c) Contents (main): Submental lymph nodes, floor of the mouth
(2) Digastric (or submandibular) triangle:
(a) Boundaries: Anterior and posterior b ellies of digastric muscle and inferior border of the body of the
mandible
(b) Floor: Mylohyoid and hyoglossus
(c) Contents (main): Submandibular gland
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(3) Carotid triangle:

(a) Boun daries: Sternocleidomastoid, posterior belly of digastric and superior belly of omohyoid muscle
(b) Floor: Thyrohyoid, hyoglossus, and pharyngeal constrictors
(c) Contents (main): bifurcation of common carotid artery, i nternal jugular vein, vagus and hypoglossal nerve
(4) Muscular triangle:
(a) Boun daries: Superior belly of omohyoid, sternocleidomastoid and midline of the neck
(b) Floor: Sternohyoid and sternothyroid
(c) Contents (main): lnfrahyoid muscles, thyroid and parathyroid glands
The posterior triangle is subdivided by the Inferior belly of the omohyoid.
(1 ) Occipital Triangle:
(a) Boundaries: Sternocleidomastoid, trapezius, and inferior belly of omohyoid muscle
(b) Floor: Splenius capitis, levator scapulae, and t he middle and posterior scalenes
(c) Contents (main): Accessory nerve
(2) Subclavian {or supraclavicular) t riangle:
(a) Boundaries: Sternocleidomastoid, inferior belly of omohyoid muscle and clavicle
(b) Floor: 1st rib and serratus anterior
(c) Contents (main): Subclavian artery and vein, brachial plexus and supraclavicular nerves
anterior
cervical
region 1
submandibular
triangle
posterior
cervical
reglon
SAADDES
lesse< supraclavicular
fossa
lateral cervical regiOn
Cervical regions. 1. Anterior cervical region 2. Sternocleidomasto id region 3. Lateral cervical reu s-1
g ion 4. Posterior cervica I region
submandibular
triangle
sternocleidomastoid muscle - - - lateral cervical

region (lateral - -- cervical triangle)
SAADDES
digastric muscle
ante11or
trapezius
clavicle
lesser supraclavicular fossa
Muscle Dissection of the Neck - Right lateral view
muscle
Which of the following muscles assists in opening the pharyngeal orifice of
the auditory tube during swallowing?
stylopharyngeus
palatopharyngeus
SAADDES
salpingopharyngeus
117
ANATOMIC SCIENCES
salpingopharyngeus
Longitudinal \lnsclrs of the

Muscle
Origin
Insertion
II\
Action
Sty lopharyngeus
Sty loid process of temporal Latera] and posterior

bone
pharyngeal walls
Elevates the larynx and pharynx

during swallowing
Palatopharyngeus
Posterior bo rder of the hard Laryngopharynx and

palate and from the palatine thyroid cartilage
aponeurosis
Pulls the wall of the pharynx up

ward. Acting together, they pull
the palatopharyngeal arches
toward the midline
Salpingopharyngeus Lower part of the cartilage

of the a uditory tube
Fibers pass downward

and blend with the
palatopharyngeus
muscJc
Assists in elevating the pharyn.x,

it aJso assists in opening the
pharyngeal orifice o f the
auditory tube during swallowing
SAADDES
The musculature of the pharynx is comprised entirely of voluntary muscles. The

muscular arrangement is unique in t hat it is the only area in the alimentary tract
where a layer of longitudinal muscles is contained with in a layer of circula r muscles.
The external ci rcu lar layer includes t he superior, middle and inferior pharyngeal con
stric tors. The internal longitudinal layer includes the palatopharyngeus, sty
lopharyrngeus and the salpingopharyngeus.
Remember: All of the longitudinal muscles of the pharynx are innervated by the
vagus nerve via the pharyngeal plexus except the stylopharyngeus muscle which is
innervated by the glossopharyngea l nerve (CN IX).
muscle
Which ofthe following contains thick myosin filaments ONLY?
H zone
I band
A band
SAADDES
all of the above
118
ANATOMIC SCIENCES
H zone
Each skeletal muscle fiber is surrounded by a membrane, the sarcolemma. In the

muscle fiber's cytoplasm (sarcoplasm) are tiny myofibrils, arranged lengthwise. Each
myofibril consists of two types of finer fibers cal led filaments (thick myosin filaments
and th in actin fi laments). The filaments are stacked in compartments cal led
sarcomeres, the functional units of skeletal muscle. During muscle contraction, the
sarcomere shortens when thick and thin filaments slide over each other.
The striated pattern that is so characteristic of skeletal muscle directly resu lts from the
structure of the contractile units of the muscle. Each fiber of the muscle is striated and
made up of many myofibrils, which are also stri ated in the same pattern of alternating
dark and light bands called the A bands and I bands, respectively. In the center of
each A band is a lighter zone called the H zone; in the center of each I band is a dark,
thin line called the Z line. The portion of a myofibril between two Z lines constitutes
a single contractile unit termed a sarcomere. Each sarcomere is composed of two
sets of protein filaments. The thick myosin filaments are located in the A band. The
thin actin filaments are located primarily in the I bands but extend into the A
bands. The overlap of the actin and myosin filaments causes the dark coloration of
the A bands; actin's absence from the center of the A bands resu lts in the lighter H
zone of each A band. Note: The H zone conta ins thick filaments but no thin fi laments.
SAADDES
Note: The tension produced by a sarcomere depends on the number of actin-myosin

cross-bridges it forms. The number of cross bridges depends on the length of the sarcomere, because this determines how much overlap between myosin and actin filaments occurs. A bands do not change in length upon contraction. Only the H zone
and I bands change.
Relaxed
thick filament
H zone
Z line
I band
A band
SAADDES
Contracted
thin filament
sarcomere
Filament movem ent and muscle fiber shortening

A musc le fiber shortens when the thin fi laments move past the thick filaments toward the
center of the sarcomeres, a nd the Z lines a re drawn close together.
11111
muscle
The
tication?
is the most superficially located and strongest muscle of mas-
temporalis
medial pterygo id
SAADDES
lateral pterygoid
masseter
119
ANATOMIC SCIENCES
masseter
The masseter muscle originates from the lower border and medial surface of the zygomatic arch.
The muscles fibers run downward and backward to be attached to the lateral aspect of the ramus of
the mandible. It is the st rongest muscle of mastication, it will be enlarged in pat ient s with severe
clenching.
The medial pterygoid muscle consists of two heads; the bulk of the muscle arises as a deep head
from just above the medial surface of the lateral pterygoid plate, the smaller, superficial head
orig inates from the maxillary tuberosity and the pyramidal process of the palatine bone. This muscle
inserts on the medial surface of the angle and ramus of the mandible. The insertion joins the
masseter muscle to form a common tendinous sling (masseteric sling) which allows t he medial
pterygoid and masseter to be powerful elevators of the jaw. The angle of the mandible rests in this
sling. Note: The lingual nerve is located directly on the lateral surface of the medial pterygoid
muscle.
SAADDES
Important: The temporal is (mainly the anterior portion) helps the medial pterygoid and masseter
muscles elevate the mandible duri ng jaw closing (biting and chewing).
. 1. The superior origin of the lateral pterygoid muscle is from the infratemporal crest of
t he greater wing oft he sphenoid bone, and the inferior origin is from the lateral surface
of the lateral pterygoid plate of sphenoid bone. Both heads insert at the articular disc of
TMJ and neck of mandibular condyle.
2. Remember:
The mandible is protruded by t he action of both lat eral pterygoid muscles
One muscle causes lateral deviation of the mandible (shifts mandible to opposite
sid e)
3. All of the muscles of mastication are innervated by the mandibular division of the
trigeminal nerve.
Lateral
views
A. Lateral and medial pterygoid
SAADDES
B. Temporalls
_
---
___..,.....
C. Masseter and Temporalis
M uscles acting on the mandibleffl\1J
11.9-1
Temporo
mandibular
joint
Laternl ptel}tOid
Temporal
Masseter
Medial pterygoid
Posterior view of
viscerocranium
SAADDES
Anterolateral view
with head rotated
slightly to the left
119A I
Muscles acting on the mandible I TMJ
muscle
The anterior and posterior pillars of the fauces enclose which area of lymphoid tissue?
lingual tonsils
pharyngea l tonsils
SAADDES
palatine tonsils
peyer's patches
120
ANATOMIC SCIENCES
palatine tonsils
The palate is the roof ofthe oral cavity, consisting anteriorly of the bony hard palate and posteriorly of the soft palate. Transverse ridges, called palatal rugae, are located along the mucous membranes of the hard palate, where they serve as friction bands against which the tongue is placed during swallowing. The uvula is suspended from the soft palate. During swallowing, the soft palate and
uvula are drawn upward, closing the nasopharynx and preventing food and fluid from entering the
nasal cavity. The neurovascular bundle of the soft palate is the lesser palatine vein, artery, and nerve.
The pharyngeal plexus of nerves supplies the uvular area.
The fauces is a narrow passage from the mouth to the pharynx, situated between the soft palate
and the base of the tong ue; this is also called the isthmus of the fauces. On either side of the passage, two membranous folds, called the pillars of the fauces, enclose the palatine tonsils (consist
of predominantly lymphoid tissue).
SAADDES
The two arches formed by the anterior and posterior fold s of mucous membrane are:
The palatoglossal arch (glossopalatine arch, anterior pillar of fauces or anterior faucial pillar) on
either side runs downward, lateralward, and forward to the side of the base of the tongue, and is
formed by the projection of the pa latoglossus muscle with its covering mucous membrane.
The palatopharyngeal arch (pharyngopalatine arch, posterior pillar of fauces or posterior faucial pillar) is larger and projects farther toward the middle line than the anterior; it runs downward, lateral, and backward to the side of the pharynx, and is formed by the projection of the
palatopharyngeus muscle, covered by mucous membrane.
1. The palatal salivary glands are found beneath t he mucous membrane of the hard and
soft palate. They are mostly of the mucous type and contribute to the oral fluid.
2. Bifid uvula resu lts from failure of complete fusion of the palatine shelves. A unilaterally damaged pharyngeal plexus of nerves causes the uvula to deviate to the opposite side.
This is because t he uvular muscle shortens the uvula when it contracts and the muscle on
the intact side pulls the uvula toward that side.
Superior lip
Superior
labia l frenulum
Central incisor
Lateral incisor
Canine
Palatine
raphe
Hard palate
Premolars
Soft palate
Molars
Uvula
Oropharynx
Palatoglossal
arch
Palatopharyngeal
arch
SAADDES
Palatine tonsil
Tongue
Frenulum linguae
Duct of
submandibular gland
Molars
Sublingual
papilla
Premolars (biscuspids)
Gingivae (gums)
Canine (cuspid)
Lateral incisor
Inferior labial
frenulum
Inferior lip
Central incisor
120.1
muscle
Which of the following muscles are innervated by the axillary nerve?
pectoralis major
pectoralis m inor
teres major
teres m inor
deltoid
SAADDES
latissimus dorsi
121
ANATOMIC SCIENCES
deltoid
teres minor
Muscle
Nerve s upply
Action
Pectoralis major Medial and lateral pectoral

Adducts the arm and rotates it medially
nerves from medial and lateral cords of
brachial plexus
Pectoralis minor Medial pectoral nerve from medial
cord of brachial plexus
Pulls the s houlder downward and forward
Latissimus dorsi Thoracodorsal nerve from posterior

cord of brachial plexus
Extends, adducts, and medially

rotates the arm
Deltoid
Teres major
Teres minor
SAADDES
Axillary nerve (C5 and C6)
With the help of the supraspinatus muscle, it

abducts the upper limb at the shoulder joint
Lower subscapular nerve from

posterior cord of brachial plexus
Medially rotates and adducts the arm
Branch of axillary nerve
Laterally rotates the arm and stabilizes the

shoulder joint
Note: The axillary nerve is mixed. The motor branches innervate the deltoid and the
teres minor muscles.
teres minor
SAADDES
Rotator Cuff Muscles- Posterior view
121-1
trapezius
deltoid-pectoralis
major
SAADDES
pectoralis
minor
Superficial and Deep Muscles of
the Shoulder- Anterior view
121A I
muscle
All the following muscles are innervated by the same nerve that innervates
the muscles of mastication EXCEPT one, which one is the exception?
mylohyoid
tensor tympani
SAADDES
tensor veli palatini
anteri or belly of digastric
posterior belly of d igastric
[refer to card 119 A-1for illustration )
ANATOMIC SCIENCES
122
posterior bell y of digastric - which is innervated by the facial nerve

Important: All of the muscles of mastication are innervated by the mandibular division
of the trigeminal nerve (V3) - (see note below). They receive b lood from the pterygoid
portion of the maxillary artery.
masseteric branch supplies the masseter
deep temporal branch supplies the temporal is
pterygoid branch suppli es both the medial and lateral pterygoids
Mastication is defined as the physical process of chewing food in preparation for swallowing and ultimately digestion. Four pairs of muscles in the mandible make chewing possible. These muscles can be grouped into t wo different functions. The first group incl udes
three pairs of muscles (masseter, temporali s, and medial pterygoids) that elevate the
mandible to close the mouth. The second group includes one pair of muscles (lateral
pterygoids) that wo rk to depress the mandib le (dro p the j aw), translate the jaw fro m side
to side, and protrude the mandible forward.
SAADDES
Note: There is one motor nucleus, a special visceral efferent (SVE) nucleus, associated
w ith the trigeminal nerve. It innervates the muscl es of the fi rst branchial arch, which consists mostly of the muscles of mastication. They also include the tensor tympani and several other small muscles. The nucleus is located in the mid pons at the level of attachment
of the trigeminal nerve to the brain stem. Fibers of the trigeminal motor nucleus emerge
as a separate motor root.
Remember: The muscles of mastication, mylohyoid, tensor tympani, tensor veli palatini
and anterior belly of digastric muscle are all derived from the first pharyngeal arch. This
w ill help you to remember the innervation of those muscles which is the mandibular
branch (V3) of the t rigeminal nerve (CN V).
muscle
All the muscles of the tongue are innervated by the hypoglossal nerve
EXCEPT one. Which one is the exception?
hyoglossus
styloglossus
SAADDES
palatoglossus
genioglossus
123
ANATOMIC SCIENCES
palatoglossus
The extrinsic muscles (geniog lossus, hyoglossus, styloglossus, and palatoglossus) anchor
the tongue to the skeleton (mandible, hyoid, and tempora l bones). These muscles control
the protrusion (genioglossus), retract ion (styloglossus), depression (hyoglossus and
genioglossus), and lateral movement (palatoglossus) of the tongue. Remember: All
extrinsic muscles end in - glossus (tongue) and begin w ith their site of orig in.
The intrinsic muscles lie entirely within the tongue itself. The fi bers of these muscles are
named according to the three spatial planes in which they run: longitudinal, transverse,
and vertical. When these fibers or muscles contract, they squeeze, fold, and curl the
tongue.
All of the muscles of the tongue, both intrinsic and extrinsic, except the palatoglossus
muscle, are innervated by t he hypoglossal nerve. The palatoglossus muscle is innervated by the pharyngeal plexus via the vagus nerve.
SAADDES
Note: The palatoglossus is a small ext rinsic muscle of the tongue that arises fro m the soft
palate and inserts in t he tongue. The palatoglossus acts to elevate the tongue.
The tongue receives its maj or blood supply from the lingual artery (which is a branch of
the external carotid artery). Note: The terminal part of the lingual artery, the deep lingual
artery, supplies the t ip of the tongue.
The veins drain into the internal jugular vein.
Remember: The trigeminal nerve provides the sensory input to the anterior two-thirds
of the tongue; while the glossopharyngeal nerve su pp li es the posterior one -th ird.
Note: The muscl es of the tongue are derived from myoblasts that mi grate from t he
myotomes of occipital somites. Connective t issue, lymphatics and blood vessels of the
tongue (and possibly some muscle fibers) are derived from t he pharyngeal arch mesenchyme.
muscle
Most of the muscles that act on the shoulder girdle and upper limb joints are
supplied by branches of the brachial plexus. Which of the following is NOT?
levator scapulae
rhomboid major
SAADDES
rhomboid m inor
trapezius
serratus anterior
pectoralis m inor
subclavius
124
ANATOMIC SCIENCES
trapezius- is innervated by the accessory nerve (CN XI)

\lusdcs ol th< l'cctoral Girdle
M uscle
Action
I nnervation
SerratllS anterior
Pulls scapula forward and downward
Long thoracic nerve, which

arises from roots C5, 6, and 7
of the brachial plexus
Pectoralis minor
Pulls the shoulder downward and forward
Medial pectoral nerve from

medial cord of brachial plexus
Subclavius
Depresses the clavicle and steadies this bone

during movements o f the shoulder girdle
Nerve to the subclavius from

the upper trunk of the brachia l
plexus
Suspends the shoulder girdle from the skull and the

vertebral column. T11e upper fibers elevate the
scapula. The middle fibers pull the scapula
medially. The lower fibers pull the medial border
of the scapula downward so that the glenoid cavity
faces upward and forward
Motor fibers from the spinal

part of the accessory nerve and
sensory fibers from the third
and fou rth cervical nerves
Levator scapulae
Raises the medial border of the scapula
Third and fourth cervical

nerves and from the dorsal
scapular ner\e (C5)
Rhomboid major
With the rhomboid minor and levator scapulae, it

elevates the medial border of the scapula and pulls
it medially
Dorsal scapular nerve (C5)
Rhomboid minor
With the rhomboid major and levator scapulae, it

elevates the medial border of the scapula and pulls
it medially
Dorsal scapular nerve (C5)
Trapezius
SAADDES
momboid minor
SAADDES
infraspinatus
latissimus dorsi
Superficial and Deep Muscles of the

Should er- Posterior view
124-1
muscle
A 16-year-old girl who is just about to have her junior prom comes crying
into the physician's office, but is lacrimating only from her right eye. The left
half of her face is also paralyzed. An oral exam reveals trauma to her buccal
mucosa where her teeth have bitten her cheek. Which muscle is responsible
for keeping mucous membranes out of the plane of occlusion and food out
ofthe buccal vestibule?
SAADDES
medial pterygoid
lateral pterygoid
buccinator
masseter
temporalis
125
ANATOMIC SCIENCES
buccinator
The buccinat or is one of the muscles of the cheeks and lips. On each side, the buccinator has a complex
origin from:
The maxilla along the alveolar process superior to alveolar margin horizontally between the anterior
border of the fi rst and third molars
The mandible along the oblique line of the mandible between the first and third molars
The pterygomandibular raphe: a thin, fibrous connection between the superior pharyngeal constrictor and the buccinator. The buccinator is the first muscle pierced when g iv ing a mandibular IAN
nerve block. - It inserts at orbicularis oris and skin at the angle of the mouth. It is traversed by the
parotid duct.
It is not a primary muscle of mastication - it does not move the jaw - and this is reflected in the buccinator's m otor innervation from the facial nerve. However, p roprioceptive fi bers are derived from the buccal
branch of the mandibular branch of the trigeminal nerve.
SAADDES
The facial muscles include: occipitofrontalis, t emporoparietali s muscle, procerus, nasalis muscl e, depressor septi nasi, orbicularis oculi, corrugator supercil ii, depressor supercilii, auricular muscles (anterior, superior, posterior), orbicularis o ris, depressor anguli o ris, risorius, zygomaticus major, zygomaticus minor, levator labii superioris, levator labii superioris alaeque nasi, depressor labi i inferioris, levato r anguli oris, buccinator and mentalis.
The platysma is innervated by the facial nerve. Although i t is mostly in the neck, due to its common
innervation it can sometimes also be considered a muscle of facial expression. The stylohyoid muscle,
stapedius and posterior belly of the digastric muscle are also innervated by the facial nerve, but are not
considered muscles of facial expression.
1. The facial and maxillary arteries supply blood to buccinator muscle.
2. Food accumulating in the vestibule might suggest that the buccinator is not working properly.
3. If the point of a needle ent ers the parotid g land during an inferior alveolar inj ection and
solution is deposited in the g land, the most likely result is paralysis of the buccinator muscle.
4. Damage to the facial nerve or i ts branches may cause weakness or pa ralysis of facial muscles called Bell's palsy.
5. Parotid duct travels over the masseter muscle and penetrates the buccinat or muscle to enter
the oral cavity. It opens into the mouth opposite the upper 2nd molar.
Temporal is
.....
Supr.wtrocnlear
_ .::....,_....- - Lateral polebral
ligament
SAADDES
/
Mental nen-e
MentaIs
125 1
Cutaneous branches of trigeminal nerve, muscles of facial expression, and eyelid
Fronta belly of
occipitofrontal
Procerus
Temporalis
Obicularis { orbital
oculi palpebral
SAADDES
Zygomaticus
major
Levator ongull
oris
Buccinator
Masse1er
Depressor
anguli oris
Depressor labU
inferioris
Mentalis
Muscles of facial expression
125AI
Epic:....,ial
apooeu10$1s
Frontal belly of
occipitofrontal
Temporolls
SAADDES
levator labii
superloris
---""7."---=
ObiaJiarls
Mentalis
Depressor
ancu11 oris
Platysma
Muscles of facial expression
muscle
All of the following muscles are responsible for elevating the mandible
EXCEPT one. Which one is the exception?
masseter
medial pterygoid
mylohyoid
temporalis
SAADDES
)refer to card 119 A-1for illustration )
ANATOMIC SCIENCES
126
mylohyoid
The temporal is muscle is a broad, fan-shaped muscle of mastication on each side of the head
that fills the temporal fossa, superior to the zygomatic arch. This muscle originates from the
entire temporal fossa. The tempora lis then passes med ially (downward and deep) to the zygomatic arch as a thick tendon before inserting on the coronoid process of the mandible.
. 1. The primary function of the anterior portion (fibers) of the temporal is muscle is
to elevate the mandible.
2. The posterior fibers retract the jaw and maintain the resting posit ion of closure of
the mout h.
Accessory depressors of the mandible: The depressor muscles of the mandible all have t he
hyoid bone in common as an attachment site. When the hyoid bone is immobi lized by a contraction of the muscles below it, the contraction of the depressor muscles located between the
hyoid bone and the mandible pulls the mandible downward (opens the mouth). The suprahyoid depressors of the mandible are the mylohyoid, geniohyoid, and digastric muscles.
Mylohyoid: The paired mylohyoid muscles are attached to the mylohyoid lines on the
internal surfaces of t he mandible, the right and left mylohyoid muscles join in the midline
to form the floor of the mouth, and the posterior end of this midline junction attaches to the
hyoid bone
Geniohyoid: The two geniohyoid muscles are found next to each other, on each side of
t he midline, directly on top of the mylohyoid muscles. The sites of attachment are the genial
t ubercle and the hyoid bone
Digastric Muscles: The digastric muscl e bu ndle is divided into an anterior belly and a posterior belly by a short tendon. This intermediate tendon passes through a loop of fibrous tissue secured to the body of the hyoid bone. The end of the anterior belly attaches to the
d igastric fovea and the posterior belly fastens onto the mastoid process of the tempora l
bone.
SAADDES
muscle
The action of which of the following muscles would be affected if the hamulus was fractured?
uvular
palatopharyngeus
SAADDES

palatoglossus
levator veli palatini
127
ANATOMIC SCIENCES

Five paired skeletal muscles ofthe soft palate:
1. Palatoglossus muscle: pulls the root of the tongue upward and backward. Both
muscles contracting together cause the palatoglossal arches to approach the midline, and thus the opening (oropharyngea l isthmus) between the oral pharynx and
the mouth is narrowed .
2. Palatopharyngeus muscl e: pulls the wal ls of the pharynx upward. Acting
together, the muscles pull the palatopharyngeal arches toward the midline.
3. Levator veli palatini muscle: ra ises the soft palate.
4. Tensor veli palatini muscle: the two muscles tighten the soft palate so that it
may be moved upward o r downward as a tense sheet. This muscle curves around
the pterygoid hamulus. Therefore, if the hamulus was fractured, the actions of
this muscle wou ld be affected. Both tensor and levator veli palatini muscles prevent food from enteri ng the nasal cavity by elevating the soft palate.
5. Uvular muscle: raises and shortens the uvula to help seal the oropharynx from
the nasopharynx.
SAADDES
Important: All the paired skeletal muscles of the soft palate are innervated by the
pharyngea l plexus except the tensor veli palatini, which is innervated by a branch
of the nerve to the medial pterygoid, which is a branch of the mandibular division
of the trigemina l nerve (V3).
1. The anteri or zone of the palatal submucosa contains fat, while the post'otcs erior zone contains mucous glands.
2. The salivary g lands of the hard palate are located in the posterolateral
zone. They arise from ectoderm and are separated by connective tissue
septa.
muscle
Which of the following travels with the esophagus through the esophageal
opening in the diaphragm?
aorta
tho racic duct
azygos vein
vagus nerve
SAADDES
right phrenic nerve
128
ANATOMIC SCIENCES
vagus nerve
*""" You can remember this because the vAGUS travels with the esophAGUS.
The diaph ragm is a flat muscle in a dome-like shape that separates the chest cavity from the abdominal cavity. The diaphragm is pierced by several structures that pass between t he two cavities. The
three largest of these structures are the esophagus, the aorta, and the inferior vena cava. The
central part of the diaphragm is the central tendon, which is fibrous rather than muscular. The
undersurface of the diaphragm forms the roof of the abdominal cavity, and lies over the stomach on
t he left and the liver on the right. Note: The diaphragm is higher on t he right side than the left,
allowing the liver to be tucked up under the bottom edge of the right rib cage.
When the diaph ragm contracts, it pulls down into the abdomen, thus creating a vacuum in t he chest
cavity that draws air into the lungs. Exhaling is done by contracting the muscles of the abdomen to
force the diaphragm upward when it is relaxed. During inspiration the diaphragm moves down,
increasing the volume in the thoracic cavity. During expiration the diaphragm moves up, decreasing t he volume in the thoracic cavity. The upper surface is in contact with the heart and lungs; the
lower surface contacts the liver, stomach, and spleen.
SAADDES
Important: The esophagus passes through the diaphragm, while the aorta, azygos vein, and thoracic duct pass posterior to it.
The diaphragm has three openings:
1. Aortic opening: transmits the aorta, the thoracic duct, and the azygos vein.
2. Esophageal opening: transmits the esophagus and right and left vagus nerves.
3. Caval opening: transmits the inferior vena cava and the right phrenic nerve.
Other respiratory muscles include the external, internal and innermost intercostals, subcostal, and
transversus thoracis. Th ese muscles are all innervated by the intercostal nerve while the
diaphragm is innervated by t he phrenic nerve.
Note: The phrenic nerve travels through the thorax between the pericardium and the pleura (in the
middle mediastinum).
INfldlbrr..tn
........
SAADDES
......
tbdomirvJ
tre.._
abdomlnsl
vtrttbrllatudlmt iJt
of clnphracm
Muscles of respiration
128-1
SAADDES
cardiac notch
apex of
the heart
6th db
lOth rib
Topography of th e lungs and mediastinum
128 AI
muscle
Which costal muscle can typically cross more than one intercostal space?
external intercostal
internal intercostal
innermost intercosta ls
subcostal
SAADDES
transverse thoracic
129
ANATOMIC SCIENCES
subcostal
The thorax contains vital structures that enable such functions as breathing to occur. Its
major muscles are the thoracic wall and upper limb muscles as well as the diaphragm.
Anterior thoracic w all muscles include:

External intercostal muscles: eleven on each side between the ribs. Pass from rib to
rib and run anteriorly and inferiorly (hands-in-pocket direction) at right angles to the
fibers of the internal and innermost muscles. Continue toward sternum as the external
intercostal membrane. They raise the ribs during inspiration.
Internal inte rcostal muscle s: eleven on each side between the ribs. Their fibers run
posteriorly and inferiorly. They continue toward the vertebral column as the internal
intercostal membrane. They depress the ribs during expiration.
Innermost intercostals: run in the same direction as internal intercostals but are separated from them by nerves and vessels. Action unknown but probably the same as
internal intercostals.
Subcostal muscles: originate on the inner surface of each rib near the costal angle
and insert on the inner surface of the first, second, or third rib below. They raise the
SAADDES
ribs during inspiration.

Transverse thoracic muscles: attach the posterior surface of the lower sternum to
the internal surface of costal cartilages 2 through 6. These muscles pull the ribs downward during expiration.
Re me mber: The diaphragm is the main muscle of inspiration. It is innervated by the
phre nic nerve. The intercostal muscles are mainly active during forced respiration.
During quiet breathing these muscles increase tonus, all owing for the thoracic wall to
remain rigid w ithout producing movement. These muscles are innervated by their corresponding intercostal ne rves.
SAADDES
Lateral View
Muscles of the thoracic wall
muscle
Name the molecule that lies along the surface ofF-actin and physically covers myosin binding sites during the resting state.
G-actin
tropomyosin
troponin
SAADDES
light meromyosin
heavy meromyosin
130
ANATOMIC SCIENCES
tropomyosin
The main contractile system of all muscular tissue is ba sed on the interactions of two proteins,
actin and myosin. The system of these proteins is sometimes called the actin-myosin contractile system.
Actin filaments (thin myofilaments, 5-8 nm in diameter) are composed of:
Actin: globula r actin (G-actin} molecules are arranged into double helical chains
called fibrous actin (F-acti n}
Tropomyosin: long, thread-like molecules, lie along the surface of F-actin stra nds and
physically cover myosin bind ing sites d uring the resting state. Upon release of calcium from
the sarcoplasmic reticulum, calcium binds to troponin C (calcium bi nding troponin). This
"unlocks" tropomyosin from actin, allowing it to move away from the binding g roove.
Myosin heads can now access the binding sites on actin. Once one myosin head binds, this
fully displaces tropomyosin and allows additional myosin heads to bind, initiating muscle
shortening and contraction. Once calcium is pumped o ut of the cytoplasm and calcium
levels return to normal, tropomyosin again bind s to actin, preventing myosin from binding.
Troponin: a small, oval-shaped molecule attached to each tropomyosin
SAADDES
Myosin filaments (thick myofilaments, 12-18 nm in diameter) are composed of:

Myosin, which ha s two components:
1. light meromyosin (LMM) makes up the rod-like backbone of myosin filaments.
2. Heavy meromyosin (HMM) forms the shorter g lobular lat era l cross-bridges, which link
to the binding sites on the actin molecules during contraction.
Skeletal muscle contracts when a stimulus from the nervous system excites the individual
muscle fibers. This starts a series of events that lead to interactions between the myosin (thick
filaments) and actin (thin filaments) of the sarcomeres of the fibers.
muscle
The right and left rectus abdominis muscles are entirely independent, being
separated by a connective structure called the:
pyramidalis
gubernaculum
linea alba
SAADDES
iliopectineal arch
131
ANATOMIC SCIENCES
linea alba
\lusdl'\ ul thl' \nit' I wr \hdunun.tl \\.til
M uscle
Action
Inner vation
External oblique
Supports abdominal c.oments; compresses abdominal Lower six thoracic nen'es and
c.ontents; assists in tle.xing and rotation of trunk.
iliohypogastric and ilioinguinal
Assists in forced expiration, micturition, defecation, nerves (ll)
parturition, and vomiting
Internal oblique
Same a.s a bo\'e

abdominal contents
Same as above
Same as above
abdominus
abdominis
Pyramidalis
(if present)
abdominal contents and flexes venebral

c.olumn; accessory muscle of expiration
Lower six thoracic nen1es
Tenses the. linea alba
Twelfth thoracic nerve.
SAADDES
1. As the spermatic cord (or round l igament of the uterus) passes under the
lower b order of the internal oblique, the sp ermatic cord carries with it some
of the m usc le fib ers that are ca lled the crema ster mu scle.
2. The posterior abdominal muscles include psoas major and minor
(innervated by the lumbar plexus), quadratu s lumborum (innervated by the
lumbar plexus), and the iliacus (innervated by the femoral nerve).
3. The linea alba is a tendinous ra phe that runs down the midline of the
abdomen in humans and other vertebrates. In human, linea alba runs fro m
xiphoid process to pubic symphysis. It is formed by the fusion of the
aponeuroses of the abdominal muscles, and it separates the left and right rectus
abdominis muscles.
SAADDES
Sup erficial Muscles of the Thorax and
Abdomen -Anterior view
Internal
intercostals
SAADDES
Transversus
abdominus
Internal
oblique
131AI
Deep Muscles of the Thorax and Ab domen - Anterior view
muscle
All of the following structures are located between the superior and middle
pharyngeal constrictors EXCEPT one. Which one is the EXCEPTION?
stylopharyngeus muscle
glossopharyngeal nerve
SAADDES
stylohyoid ligament
recu rrent laryngeal nerve
132
ANATOMIC SCIENCES
recurrent laryngeal nerve - is located inferior to inferior pharyngeal constrictor

The constrictor muscles of the pharynx are involved in the dig estive process, being responsible for
moving food down to the esophagus. The stylopharyngeus, along w ith the deeper muscles of the
palatopharyngeus and the salpingopharyngeus, are involved in elevat ing the larynx.
Muscle
Circular \lusclcs of the
nx
Origin
Inser tion
Action
Superior
constrictor
Medial pterygoid plate of the sphenoid bone Median pharyngeal raphe Cons trias
and the pterygomandibular raphe
upper pharynx
Middle
constrictor
Greater and lesser horns of hyoid;

stylohyoid ligament
Inferior
constrictor
Arch of cricoid and oblique line of thyroid

cartilages
Median pharyngeal raphe Constricts

lower pharynx
SAADDES
Median pharyngeal raphe ConstriCls

lower pharynx
1. All of the circular muscles (constrictors) are innervated by the pharyngeal plexus
which consists of a pharyngeal branch from the vagus and glossopharyngeal nerves as
well as a sympathetic branch from t he superior cervical gang lion.
2. The stylopharyngeus, palatopharyngeus, and salpingopharyngeus are all longitudinal
m uscles of the pharynx.
Along the lateral sides of the pharynx, you w ill find four gaps associated with the superior, middle
and inferior constrictors. Specific structures pass through each of these gap s.
Above the superior pharyngeal constrictor:

-auditory tube
- levator palatini muscle
-ascending palatine artery
Between the superior and middle constrictors:
-stylopharyngeus muscle
- glossopharyngeal nerve
-stylohyoid ligament
Between the middle and inferior constrictors:

- internal branch of the superior laryngeal nerve
- superior laryng eal artery
Below the inferior constrictor:
-recurrent laryngeal nerve
-inferior laryngeal artery
Superior
constrictor
SAADDES
Circular muscle
of esophagus
Longitudinal
muscle
esophagus
Muscles of the Pharynx- Posterior view
132-1
muscle
The connective tissue layer surrounding each individual muscle fiber is
called the:
perimysium
epimysium
SAADDES
endomysium
sarcolemma
133
ANATOMIC SCIENCES
endomysium
As an organ, skeletal muscle consists of several tissue types. Skeletal muscle fibers are long, threadlike cells that compose skeletal (striated) tissue. These cells have the ability to shorten their length
or contract.
Dense fibrous connective tissue (fascia) weaves through a skeletal muscle at several different levels.
The epimysium is the connective tissue layer that envelopes the entire skeletal muscle
The perimysium is a conti nuation of this outer fascia, dividing the interior of the muscle into
bundles of muscle cells. The bu ndle of cells surrounded by each perimysium is called a fasciculus.
Each of the three levels of fascia is interconnected, allowing vessels and nerves to reach individual
fibers and cells.
SAADDES
(surrounds
faseiC\IIi)
(surrounds
fibers)
(surrounds
entire muscle)
Cross section of skeletal muscle
Remember: The axon of a motor neuron is highly branched, and one motor neuron innervates
numerous muscle fibers. When a motor neuron transmit s an impulse, all of the fibers it innervates contract simultaneously.
Note: When muscles attach to tendons, the connective tissue surrounding the muscle continues
uninterrupted around the tendon. In the tendon, the collagen fibers unite at one end to the bone
or ot her struct ure that the tendon attaches to and at t he other end to the sarcolemma of t he muscle fiber.
muscle
At a picnic, the kids all decide to hang upside down on the monkey bars. One
daring kid decides that he will try to eat a grape while hanging upside down
and finds that he has no trouble doing this. Peristalsis and other similar
movements are produced by which type of muscle tissue?
smooth muscle tissue
SAADDES
striated muscle tissue

skeletal muscle t issue
cardiac muscle tissue
134
ANATOMIC SCIENCES
smooth muscle tissue

Smooth muscle tissue is located throughout the body, particularly with in the tunica
(walls) of hollow internal organs. The smooth muscle fibers are elongated and
spindle-shaped w ith a single nucleus. The myofibrils lack transverse striations.
They are responsible for involuntary movements of internal organs (e.g., peristalsis).
Types of smooth muscle:
Single-unit: have numerous gap junctions (electri ca l synapses) between adjacent fibers. These fibers contract spontaneously without nerve signals.
Examples include: the muscular tunica of the Gl tract, uterus, ureters, and arterioles.
Multi-unit: lack gap junctions and the individual fibers are autonomically innervated. Examples include: the ciliary muscle and the smooth muscle of the iris,
ductus deferens, and arteri es.
SAADDES
Skeletal muscle tissue attaches to the skeleton and is responsible for voluntary
body movement. It consists of many elongated, cylindrical cells, which are
multinucleated and have d istinct transverse striations consisting primarily of actin
and myosin proteins.
Remember: Each skeletal muscle fiber is innervated by an axon of a motor neuron
at a motor end plate (which is a large and complex terminal formation by which an
axon of a motor neuron establishes synaptic contact with a skeletal muscle).
muscle
A surgeon performing a thyroidectomy accidentally transects a nerve. The
patient then presents with hoarseness and difficulty breathing. There is a
loss of sensation below the vocal folds and loss of motor innervation to all of
the intrinsic muscles of the larynx except the cricothyroid muscle. Which
nerve was transected during the surgery?
recurrent laryngeal nerve
SAADDES
internal branch of superior laryngeal nerve
external branch of superior laryngeal nerve

accessory nerve
135
ANATOMIC SCIENCES

Note: Damage to this nerve (as a result of surgery or disease) can result in hoarseness
and d ifficulty breathing.
Intrinsic \lusclcs of the
Muscle
Cricothyroid
nx
Action
Stretches the vocal cords
Posterior cricoarytenoid
Maintains wide airways (for breathing)
TI1yroarytcnoid
Clos<" the vc,, tibule
Aryepiglottic
Clos<" the vc,, tibule
Transverse arytenoid
Contracts to close the airway posteriorly for speech
SAADDES
Lateral cricoarytenoid
Adducts the vocal cords
Thyr<>cpiglottic
Helps close
Vocalis
Shortens vocal cords, is the antagonist of the cricothyroid muscle
The vagus nerve provides sensory and motor innervation to the larynx:
1. The recurrent laryngea l nerve supplies all the intrinsic muscles except the
cricothyroid.
2.The cricothyroid muscle is supplied by the external branch of the superior laryngeal nerve.
3. Sensation above the vocal folds is supplied by the internal branch of the superior laryngeal nerve.
4. Sensation below the vocal folds is supplied by the recurrent laryngea l nerve.
5. The internal laryngeal nerve plays an important role in the cough reflex, which
keeps the interi or of the larynx free of the foreign material.
muscle
The axilla, or armpit, is a localized region of the body between the upper
humerus and thorax. It provides a passageway for the large, important
arteries, nerves, veins, and lymphatics that ensure that the upper limb
functions properly. The muscle that forms the bulk of the anterior axillary
fold is the:
latissimus dorsi
SAADDES
pectoralis major
subscapulari s
teres minor
teres major
136
ANATOMIC SCIENCES
pectoralis major
The axilla can be visualized as having a floor, an apex, and four walls (medial, lateral, anterior, and posterior).
The ape x is pointi ng toward the root of the neck. It is formed by the convergence of
the clavicle (anterior), the scapula (posterior), and the first rib (medially). All the nerves
and vessels of the upper limb pass through th is area.
The anterior axillary fold is made up of the pectoralis maj or and minor muscles
The posterior axillary fold is made up of the lati ssimus dorsi and teres maj or muscles
The base faces inferiorly and is formed by the skin and fascia of the concave axilla
(armpit)
The medial wall is formed by the upper four or five ribs and their intercostal muscles
and the serratus anterior muscle
The late ral w all is formed by the humerus (specifically, the coracobrach ialis and
biceps muscles in the bicipital groove of the humerus)
The posterior wall is formed by the subscapularis, teres major, and latissimus dorsi
muscles
The ante rior wall is formed by the pectoralis maj or, minor, and subclavius muscles
SAADDES
Contents of the axilla:
Axillary artery and its branches

Axilla ry vein and its tributari es
Infraclavicular part of the brachial plexus
Axilla ry lymph nodes and the associated lymphatics
The long thoracic and intercostobrachial nerve
Axilla ry fat and areolar tissue in which the other contents are embedded
muscle
All the infrahyoid muscles are innervated by the ansa cervicalis (Cl -3)
EXCEPT one. Which one is the EXCEPTION?
sternohyoid
sternothyroid
thyrohyoid
omohyoid
SAADDES
137
ANATOMIC SCIENCES
thyrohyoid - which is supplied by Cl via the hypoglossal nerve
Musd e
lnJtrtion
OriJ:in
Stcrnocleidomasto ld
Manubrium stcmi and medial

third of davidc
lnner,'a tion
Ac-tion
Two muscles acting

Spinal pan of accessory
Ma:oid proct."SS of
emporal bone and occipiwl together ext end head
nerve Cl nnd3
bone
und flex neck: one
muscle rotates head to
opposite sid e
r.n
Digastnc
(post..-rior and
antcnor bellies conncl"'cd by a tendon
a11achcd to the hyoid
bone)
i.,
0
a:
Mylohyoid
Ma:oid pn:K'css of temporal

bone
Digastric tOssa of the

mandible
Elevates the
hyoid
hdps de
Facial nerve (posterior

belly)
press and rcuact the
mandible
Ncn.c to myloh)oid. a
branch of the interior
_______________,____________
SAADDES
Mylohyoid line of body of
mandibk
Bod) of hyoid bone and

librous raphe
Elevates lloor of
Tri geminal (V-3) nerve
mouth and hyoid bone
or
mandible
____
temporal bon-e
Geniohyoid
lntCrior memul spine of mandiblc
Stctnoh)'Oid
Manubrium s terni and cluvide Body of the h)'Oid bone
Body of hyoid bone
Elevates hyoid bone or First cervical nerve viu the

depresses mandible
hypogtossal nerve
lkpn:sses the b)oid
Ansa ocrviealis (C 1.2. und
bone
l)
larynx
3}
______
thyroid ctutduge
lamina of thyroid canilage

iniC- Supcrior border of thc seupula
rior bellies
by a tendon)
hyoKI bone
Body of the h)<oid bone
hypogtossal nerve
the b)oid
ocrviealis (C I.l and
.,... ----..!...---,
Tltii)Oid
'lll)!ol<l
certolaet
stomooyold _ _ _ ___:
SAADDES
....;... ,...---- Sternoc:leldome""ld

ckWIUar tletd
Tbe suprahyoid and infra byoid muscles of th e nec k
liOiy
Omotl!tWillfetlo<
UH
muscle
Which of the following is NOT a characteristic of cardiac muscle?
multinuclear
intercalated discs
gap junctions
SAADDES
desmosomes
138
ANATOMIC SCIENCES
multinuclear
The heart is a functional syncytium (not to be confused w ith a true "syncytium"

in which all the cells are fused together, shari ng the same plasma membrane as
in skeletal muscle). In a functiona l syncytium, electri cal impulses propagate
freely between communicating cells via gap junctions, so that the myocardium
functions as a single contractile unit. This property allows rapid, synchronous
depolarization of the myocardium.
Like skeletal muscle fibers, cardiac muscle fibers contain myofilaments (contractile
units) and are striated with actin and myosin.
Cardiac muscle fibers contain large, oval centrally placed nuclei as well as strong, but
thin, unions between fibers ca lled intercalated discs. These intercalated d iscs
provide low resistance for current flow. In addition, cardiac muscle has relatively large
T-tubules and a less developed sarcoplasmic reticulum when compared to skeletal
muscle.
SAADDES
Important: Within the intercalated discs, desmosomes attach one cell to another
while gap junctions allow electrical impulses to spread from cell to cell.
Cardiac muscle fibers contract spontaneously without any nerve stimulus. They
respond to increased demand by increasing the size of the fiber; this is known as
compensatory hypertrophy.
Note: Skeletal and cardiac muscle fibers cannot mitotically divide, but certain
smooth muscle fibers can under hormonal influences (e.g., during pregnancy, the
smooth muscle fibers of the myometrium of the uterus increase in length, and new
cells are fo rmed).
muscle
A nervous dental student is performing the inferior alveolar nerve block for
the first time. His injection passes the ramus, but he thinks deposition of the
anesthetic will work. His patient complains that he can't "move his face" on
the side ofthe injection. Which gland did the dental student penetrate?
sublingual gland
SAADDES
submandibular gland
parotid gland
von Ebner's glands
139
ANATOMIC SCIENCES
parotid gland
If the needle mistakenly passes posteriorly at the level of the mandibular foramen, the needle w ill
penetrate the parotid gland, and the pat ient may develop paralysis of the muscles of facial
expression. If the tip of the needle is resting well below the mandibular foramen, you w ill be
penetrating the medial pterygoid muscle.
SAADDES
Correct needle penetration into the pterygomandibular space during an inferior alveolar block. If
the needle is inserted too far posteriorly, it may enter the parotid salivary gland containing the facial
nerve, causing a complication such as transient facial paralysis.
muscle
Biceps brachii is the major ____ of elbow joint, and ____ ofthe forearm.
flexor, pronator
flexor, supinator
SAADDES
extensor, pronator
extensor, supinator
pronator, supinator
140
ANATOMIC SCIENCES
flexor, supinator
Lateral head
Medial head
Brachialis
Coracobrachialis
Biceps brachii
Long head
Sho1t head
Infraglenoid tubercle
of scapula
Upper half of posterio
Olecranon process of
surface of shaft of
hume1us
u1na
Lower half of postel'ior surface of shaft of
hume1us
Radial nerve
the foreamt (extensor

ofrhe elbow joinT)
SAADDES
f ront of lowe.r half of

hume1us
process of
Supraglenoid tubercle
ofsc.apu1a
Coronoid process of
ulna
Musculocmaneous
nene
f lexo1 of elbow joint
Medial as pee' of shaft

of humerus
lvlusculocutaneous
nerve
Flexe.s the amt
of radius
l\tusculocutaneous Supinator of fore.ann and

nerve
nexor of elbow joint
Coracoid process of
scapula
Note: The radial nerve is most com monly i nj ured in a mid-humeral shaft fracture,
because this nerve runs in the rad ial (spiral) groove of the humerus. The biceps
brachii partici pates in flexion at both the glenohumeral and humeroulnar join ts.
pectoralis major
biceps brachli
SAADDES
brachioradialis
tendon of flex
carpi radialis
flexor digitorum - ---1-lfl.'superficialis
14().1
Superficial Muscles of the Upper Limb- Anterior view
muscle
Which of the following muscles originates from the medial surface of the
lateral pterygoid plate?
superficial head of the medial pterygoid

deep head of the medial pterygoid
SAADDES
lower head of the lateral pterygo id
upper head of the lateral pterygoid
Irefer to card 119 A-1for illustration I
ANATOMIC SCIENCES
141
deep head of the medial pterygoid
of \l:.htication
Muscle.
Temporalis
Origin
Bony t1oor ofu!mporal fossa
Insertion
Coronoid
Mandibular movements
of mandible The. anterior and supe1ior tibet's

elevate the mandib le
The-posterior fibers retract the

man dible
Me.dial pterygoid
lower border and medial surface

of the zygomatic arch
Late-ral aspect of the ramus of Ra ise-s (elevates) the mandible to

the mandible
occlude the. teeth in mastication
The s uperficial head arise-s from
Medial surface of the angle of Assists in rais ing (elevating) the
the-tube-rosity of the maxilla and
the mandible
man dible
Tile upper htad in.,.;e.rts into

the articular disc and fibrous
Lowtr heads: slight

of the- mandible (during jaw
opening)
One muscle: late-ral deviation of
the mandible (shift mandible lO
opposite side-)
Both muscles: J,rotrusion of the
mandible
SAADDES
the pyramidal process of thepalatine bone.
The deep he-ad arises from the
medial surfac.e of the lateral
pre.rygoid plate
Lateral pterygoid
(two heads)
The-upper head arises from the

infratemporal surfac.e of the
wing of the sphenoid
bone.
The-lower head arises fron'l the
lateral surface of the lateral
pterygoid plate
capsule of the TMJ
Tile lower head inse-11S into

the neck of condyle of the
mandible
Important: The muscles of mastication are innervated by the trigeminal nerve

(specifically, the mandibular division-V3).
muscle
A patient comes to the emergency room after boxing practice. He was hit
with an uppercut and heard a crack in his jaw joint. ACT scan shows a condylar fracture with damage to the articular disc. When the patient attempts
protrusion, the mandible markedly deviates to the left. Which muscle is
unable to contract?
left lateral pterygoid
SAADDES
right lateral pterygoid

left medial pterygoid
right medial pterygoid
142
ANATOMIC SCIENCES
left lateral pterygoid
The right and left pteryg oids acting together are the prime protractors of the
mandible. When one muscle is not function ing properl y, the contralateral muscle's
action is unopposed. The lack of the left lateral pterygoid trying to push the mandible
to the right allows the right muscle to move the mandible to the left. With this injury,
the mandible deviates toward the affected side. Similarly, because the muscle's insertion is d isrupted (disconnected from the body of the mandible) in the case of a
condylar fracture, the mandible will also deviate toward the affected side. The muscle is intact and can move the condyle when it contracts but not the body of the
mandible because of the fracture. The unopposed ri ght lateral pterygoid then
remains capable of displacing the mandible to the left.
SAADDES
Important: In addition to opening and protruding, the lateral pterygoids move the
mandible from side to side. For right lateral excursive movements, the left lateral
pterygoid muscle is the prime mover and vice versa.
Note: With a condylar neck fracture, muscle contractions might resu lt in
displacement of the injured condyle into the infratemporal fossa.
muscle
A 46-year-old woman comes into the dentist's office for a cleaning. He
notices that her tongue is slightly swollen, fiery red, and smooth. Her diet
history indicates that she has had a loss of appetite for quite some time and
that she has been feeling fatigued. A call to her physician indicates a history of iron deficiency anemia and associated glossitis. In glossitis, the smooth
nature is caused by a lack of which papillae that are the most numerous and
cover the anterior two-thirds of the tongue?
foliate
SAADDES
circumvallate
fung iform
filiform
143
ANATOMIC SCIENCES
filiform
The dorsum of the tongue is studded with papillae, of which there are four types:
Filiform: most numerous, small cones arranged in"V"-shaped rows paralleling the sulcus terminalis on the anterior two-thirds of the tongue. They are characterized by the absence of taste
buds and increased keratinization. They serve to grip food.
Fungiform: knob-like or mushroom-shaped projections, they are fou nd on the tip and sides of
the tong ue. These papillae are innervated by the facial nerve (VII).
Circumvallate (vallate): largest but fewest in number (7-12), they are arranged in an inverted
"V"-shaped row on t he back of t he tong ue. Associated with the ducts of Von Ebner's glands.
These papilla are innervated by the glossopharyngeal nerve (IX).
Foliate: found on lateral margins as 3 to 4 vertical folds. These taste buds are innervated by both
the facial nerve (VII - anterior papillae) and the glossopharyngeal nerve (IX- posterior papillae).
SAADDES
The receptors for the sense of taste (gustation) are located in taste buds on the surface of the
tong ue. The taste budsare associated with peg-like projections on the tongue mucosa called lingual
papillae. A taste bud contains a cluster of 40 to 60 gustatory cells, as well as many more supporting
cells. Each gustatory cell is innervat ed by a sensory neuron.
The tongue and the roof of the mouth contain most of the receptors for the taste nerve fibers in
branches of the facial, glossopharyngeal, and vagus nerves. Located on taste cells in the taste buds,
these receptors are stimulated by chemicals. They respond to fou r taste sensation s perceived by
specific areas on the tong ue: sweet: on the tip
bitter: on the back
sour: along the sides
salty: on the tip and sides
The underside of the tong ue is soft and kept very moist by salivary gland secretions. Beneath t he
tongue lie the open ings of the ducts from the sublingual and submandibular glands. The frenulum
forms the midline ridge on the lower surface of the tongue. The paired deep arteries and veins of
the tong ue lie on each side of this ridge.
Plummer-Vinson syndrome: presents as a triad of dysphagia (due to esophageal webs), glossitis,
and iron deficiency anemia. It most usually occurs in postmenopausal women.
ian glossoepiglottic fold
SAADDES
14)1
Tongue- Superior view
muscle
Which ofthe following muscles cells does NOT contain troponin?
skeletal muscl e cell

ca rdiac muscl e cell
smooth muscle cell
SAADDES
144
ANATOMIC SCIENCES
smooth muscle cell

Smooth muscle fibers are composed of uninucleate, spindle-shaped cells (f usiform
cells). They are much smaller than skeletal muscle fibers. The nuclei are situated in the
w idest part of each fiber. They do not possess T tubules, and their sarcoplasmi c reticulu m
is poorly develop ed. These muscle fibers do not possess reg ularly ordered myofibrils and
are therefore not striated. Their contraction process is slow and not subject to voluntary
control. Smooth muscle does not contain the protein troponin; instead calm odulin
(which takes on the regulatory role in smooth muscle), caldesmon and calponin are
sign ificant proteins expressed w ithin smooth muscle.
Skeletal muscle fibe rs are composed of bundles of very long, cylindrical,

multinucleated cells that possess regularly ordered myofibril s that are responsible for the
striated appearance of the cell. The nuclei are either slender ovoid or elongated and are
situated peripherally. They do contain transverse tubu les (T tubu les), and the
sarcoplasmic reticulum is very well-developed. Their contraction is quick, forcefu l, and
usually under voluntary control. The myofibrils (actin and myosin) are the contractile
element.
SAADDES
Remember: Cardiac muscle fi bers contain centrally placed nuclei as well as

intercalated discs (contain desmosomes and gap junctions), which represent j unctions
between cardiac muscle cells.
!.
>;-.,
1. The satellite cell is responsible for skeletal muscle regeneration.

2. Two T t ubules lie within a single skeletal muscle sarcomere.
3. 1n skeletal muscle, a triad refers to a T t ubule sandwiched between two dilated
cisternae of the sarcoplasmi c reticu lum.
4. Motor units consist of a motor neuron and all the muscle fibers it supplies.
5. The major reg ulatory proteins in muscle t issue are troponin and tropomyosin.
muscle
Skeletal muscle possesses a well developed sarcoplasmic reticulum. This
along with T tubules and terminal cisternae function in the release and
reuptake of:
sodium
phosphate
calcium
glucose
SAADDES
145
ANATOMIC SCIENCES
calcium
The sarcoplasmic reticulum is a network of tubules and sacs in skeletal muscles.
Th is network is analogous, but not identical, to the smooth endoplasmic reticulum
of other cell s.
Remember: The endopla smic reticulum is an extensive network of membraneenclosed tubules in the cytoplasm of cell s. This organelle is classified as granular or rough
surfaced when ribosomes are attached to the surface of the membrane and as agranular
or smooth surfaced when ribosomes are absent. The structure functions in the synthesis
of protein s and lipids and in the transport of these metabolites within the cell.
The cytoplasm of muscle cells is called sarcopla sm. The sarcoplasm of each skeletal
muscle fiber conta ins many parallel, thread-like struct ures called myofibrils. Each
myofibril is composed of smaller strands called myofilaments that contain the contractile
proteins, actin and myosin. The regular spatial organization of the contractile proteins
w ithin the myofibrils forms the cross banding. A network of membranous channels,
called the sarcoplasmic reticulum, extends throughout the sarcoplasm.
SAADDES
Note: It is mainly a great increase in the numbers of additional myofibrils (which is caused
by progressively greater numbers of both acti n and myosin filaments in the myofibrils)
that causes muscle fi bers to hypertro phy.
Important: The number of muscle fi bers does not increase; the size of each fiber
increases.
Note: Tro ponin C binds to ca2+ in ca rdiac and skeletal muscles, wh ile in smooth muscles
ca2+ binds to calmod ulin.
muscle
Which ofthe following muscles elevates and abducts the eyeball?
medial rectus
lateral rectus
superior rectus
SAADDES
inferi or rectus
superior oblique
inferi or oblique
146
ANATOMIC SCIENCES
inferior oblique
Extraocular 1\lusclcs
Muscle
Action
Innervation
Medial rectus
Adducts
CN III
Lateral rectus
Abducts
CNVI
Superior rectus
E levates, adducts, and med ia lly rotates
CN III
Inferior rectus
Depresses, adducts, and laterally rotates
CN III
Superior ob lique
Depresses abducts, and media lly rotates
CNIV
Inferior ob lique
E levates, abducts, and laterally rotates
CN III
SAADDES
Abducts the eyeball = moves the eyeball laterally = away from the nose
Adducts the eyeball = moves the eyeball med ially = toward the nose
Innervation of eyeball muscles mnemonic:
A good mnemonic to remember which muscles are innervated by what nerve is to paraphrase it as a molecular equation (LR6 S0 4 )]
Lateral Rectus - Cranial Nerve VI
Superior Oblique- Cranial Nerve IV
The rest of the muscles- Cranial Nerve Ill
Note: All extraocular muscles are supplied by the lateral and medial muscu lar branches of
the ophthalmic artery.
muscle
Rul<s of :\cnc
All muscles of: S upplied by:
lor \luscl< Groups

Exc.ept:
W hich is supplied by:
Pharynx
Pharyngeal plexus ( IX and X) Stylopharyngeus
Glossopharyngeal ( IX)
Larynx
Recurrent laryngeal
Cricothyroid
External branch of superior

laryngeal nerve
Tongue
Hypoglossal (XII)
Palatoglossus
Vagus (X)
Soft palate
lnfrahyoid
Eyeball
SAADDES
Pharyngeal plexus (IX and X) Tensor veli palatini
Nerve to medial pterygoid, a

branch of mandibular nerve
(V3)
Ansa cervicalis
Thyrohyoid
C I via hypoglossal nerve

(X II)
Oculomotor (Ill)
Lateral rectus
Superior oblique
Abducent (VI)
Trochlear (IV)
147
ANATOMIC SCIENCES
Comparison ul \lusdcs
Characteristics
Skeletal muscle
Cardiac muscle
Smooth muscle
Skeletal attachment
Yes
No
No
Striation
Yes
Yes
No
Sarcoplasmic reticulum
Extensive
lntennediate
Limited
Muscle fiber s hape.
Cylindrical
Branched
Fusifonn
Functional syncytium
No
Yes
Yes
Nucleus/fiber
Multiple
Single
Single
Sarcomere.
SAADDES
Regular
Regular
Absent
Z-line
Z-line
Dense bodies
Ca' binding protein
Troponin
Troponin
Calmodulin
Response to stimulus
Graded by recruitment
All-or-none
Changes in tone or rhythm
Electrical coupling
between fibers
Absent
Intercalated disk
and gap junctions
Gap junctions
Yes
Yes
Actin attached with
Sensitivity to extracellular No
Cal+
embryology
During the 4 'h week of embryonic development the tongue appears in the
form oftwo lateral lingual swellings and one medial swelling, the so-called:
fo ramen cecum
sulcus terminalis
SAADDES
tubercu lum impar
epiglottic swelling
143
ANATOMIC SCIENCES
tuberculum impar
During the 4" week of embryonic development t he tongue appears In the form of two lateral lingual swellings
and one medial swelling, the so-called tuberculum impar_These three swellings originate from the first
branchial arch. A second median swelling (the copula) is formed by mesoderm of the second, third, and
fourth arches. The lateral lingual tongue swellings overgrow the t uberculum impar and merge with each other,
forming the anterior two-thirds of the tongue.
The posterior third of the tongue originates from the second, t hird and fourth pharyngeal arches. The extreme
posterior part of the tongue Is derived from the fourth pharyngeal arch. The anterior two-thirds of the tongue
are separated from t he posterior third by a V-shaped groove called the terminal sulcus. The foramen cecum,
the remnant of t he proximal end of the t hyroglossal duct is located at the apex of the terminal sulcus.
Remember: The branchial arches are stacked bilateral swellings of tissue that appear inferior to the
stomodeum (primitive mouth) during t he fourth week of embryonic development. These branchial arches are
six pairs of U-shaped bars with a core mesenchyme which is formed by mesoderm and neural crest cells that
migrate to the neck region. The branchial arches are covered externally by ectodermal lined branchial clefts.
They are internally lined by endodermal lined branchial pouches. These arches support the lateral walls of the
primitive pharynx.
SAADDES
8
1. Bifid tongue is the result of lack of f usion of the distal tongue buds (or lateral swellings). This
seems to be common in South American infants.
2. Most tongue muscles develop from myoblasts originating in the occipital somites. Therefore, the
tongue musculature is innervated by t he hypoglossal nerve.
3. The f ifth branchial arch is so rudimentary that they are absent in humans or are included with the
fourth branchial arches.
Between the sixth and eighth weeks of prenatal development, the three major salivary glands begin as
epithelial proliferations, or buds, from the ectodermal lining of the primitive mouth (stomodeum). The rounded
terminal ends of these epithelial buds grow into the underlying mesenchyme, producing t he secretory cells, or
glandular acini, and the ductal system. The parotid glands appear early in the sixth week and are the first to
form. The submandibular glands appear late in the sixth week, and the sublingual glands appear in the eighth
week.
Parotid gland is derived from ectoderm.
Sublingual and submandibular salivary glands are derived from endoderm.
In some books the branchial (arches, pouches and clefts) are referred to as pharyngeal (arches,
pouches and clefts), "branchial=pharyngeal"
A: Tuberculum impar and

lateral lingual swellings and
their involvement in the
formation of the body of the
tongue .
SAADDES
1st branchial arch
2nd branchial arch
3rd branchial arch
4th-6th branchial arch
A: Copula and its ivolvement in

the fonnation of the base of the
tongue.
Lateral lingual swellings
Tuberclum
impar
Development of the Tongue

148-1
Reproduced with p..-nnission (rom Ba1h Balogh M. Fehrenbach MJ; IU!Nratcd Denta l Entbi)"Oiogy. Histology. and Anatomy. cd 2. St. LOUIS, 2006,
Saunders.
4
embryology
The cartilages of first and second branchial arches are derived from mesoderm.
The cartilages of the fourth through sixth branchial arches are derived from
neural crest cells.
SAADDES
both statements are fa lse
the fi rst statement is true, the second is fa lse

the first statement is false, the second is true
149
ANATOMIC SCIENCES

***The cartilages of first and second bra nchial arches are derived from neural crest cells. While
the cartilages of t he fourth-sixth branchial arches are derived from mesoderm.
Each pa ired branchial arch has its own developing cartilage, nerve, vascular, and muscular
components within each mesodermal core. These elements are of neural crest origin except
for the cartilages of the fourth through sixth branchial arches which are derived from
mesoderm.
Derivatives of the branchial arch cartilages:
First arch cartilage (Meckel's cartilage): is closely related to t he developi ng middle ear;
becomes ossified to form the malleus and incus of the middle ear, sphenomandibular
ligament, and portions of the sphenoid bone.
Note: Most of this cartilage di sappears as t he bony mandible forms by intramembranous
ossification lateral to and in close association with it, yet only some of Meckel's cartilage
makes a contribution to it. Its fate is said to be dissolution with minor contributions to
SAADDES
ossification .
Mandibulofacial Dysostosis: this developmental defect affects t he derivatives of the first

branchial arch .The patient usually exhibits micrognathia (small lower jaw), malar (zygomatic)
hypoplasia, deformity of the lower rim of the orbit and malformed external ear. These deformit ies clearly indicate problems with neura l crest cells migration of t he first branchial arch.
Second arch cartilage (Reichert's carti lage): is also closely related to t he developi ng
middle ear; becomes ossified to form the stapes of the middle ear, the styloid process of
the temporal bone, the stylohyoid ligament, the lesser cornu of the hyoid bone, and the
upper half of the body of hyoid bone.
Third arch cartilage: ossifies to form the g reater cornu of the hyoid bone and the
lower half of the body of the hyoid bone.
Fourth through sixth arch cartilage (laryngeal cartilages): forms the cartilages of t he
larynx (thyroid, cricoid, arytenoid, corniculate and cuneiform).
embryology
Failure offusion of which ofthefollowing will lead to cleft lip?
frontonasa l process; lateral nasal process

maxillary process; medial nasal process
lateral nasal process; medial nasal process
SAADDES
maxillary process; lateral nasal process
150
ANATOMIC SCIENCES
maxillary process; medial nasal process

Thus, the maxillary processe s contribute to the si des of t he upper lip, and t he two medial nasal processe s
cont ribute to the m iddle of t he upper lip. Fusi on of t hese processes to form t he upper lip i s completed during the sixth week of prenatal development, when t he g rooves between the processes are obliterat ed. The
maxillary processes on each side of t he developi ng face part ially fuse w ith t he mandibular arch t o form
t he labial commissures, or corners, of the mouth.
After format ion of the stomodeum (t he p rimitive mouth) but still w i thin the fourth week, t wo bulges of tissue appear inferior t o the primi tive mouth. t he two large mandibular processe s of t he first branchial arch .
The mandible forms as a result of the fusion of the right and left mandibular processes. The mand ible i s t he
first portion of t he face to form after t he creat ion of t he stomodeum.
The maxilla is formed primarily by merging of t he two smaller maxillary processes of t he fi rst branchial
arch. These maxillary processes al so form t he upper cheek regions and most of t he upper lip.
SAADDES
During t he fourth week. the frontonasal process (prominence) al so forms. It is a bulge of t issue in t he
upper facial area, at t he most cephal ic end of t he embryo. and i s t he cra nial boundary of t he stomodeum .
In the future, t he front onasal process gives rise to the upper face. w hich includes t he forehead. bridge of
nose, primary palate, nasal septum, and all structures related to t he medial nasal processes.
The nasal placodes fo rm in the anterior port ion of the frontonasal process, just superior to the stomodeum,
during the fourth week. These two buttonlike structures form as bilateral ectodermal thi ckenings that later
develop into olfactory cell s for the sensat ion of smell. The middle po rtion of the ti ssue growing around the
nasal placodes appears as two crescent-shaped swell ings and are called t he medial nasal processes, w hich
fuse to form t he m iddle portion of the nose from t he root to the apex and the center po rti on of the upper
lip and al so t he philtrum region. On the outer port ion of the nasal placodes, t here are al so t wo other crescent -shaped swellings. t he lateral nasal processes, whi ch w ill fo rm the alae. or sides of t he nose. Fusion
of t he lateral nasal, maxillary, and med ial nasal processes forms t he nares (nostril s).
Note: Partial unilateral and bilat eral cleft ing of t he lip results from the failure of t he maxillary and medial
nasal processes to fuse. Cl efts involving t he hard and soft palat e are the result of a lack of fusion among
t he lateral palatal processes. t he primary palate, and the nasal septum, depending on the degree; in other
words. failure of fusion of palatine shelves w ill lead to cleft palat e.
SAADDES
Frontal view
Lateral view
The adult face and its embryonic deriva tives of five facial processes: the single
frontonasal process and the paired ma xilla ry and mandibular processes.
150.1
Reproduced with p..-nnission (rom Bath-Balogh M. Fehrenbach MJ;

Saunders.
Demo/ EmhtJ'illogy. Histology. om/
ed 2. St Ll"'Uis. 2006.
Oropharyngeal
membrane
processes
Frontonasal
Stomodeum
SAADDES
Mandibular symphysis
Maxillary
process
Mandibular
arch
Third through fourth weeks of embryonic development - Frontal aspect

Disintegration of the oropharyngeal membrane enlarges the stomodeum of the embryo
and allows access between the primitive mouth and the primitive pharynx. The mandibular processes also fuse, forming the mandibular arch inferior to the enlarged stomodeum.
lSOA I
Reproduced wilh pem1ission (rom B.mh-Balogh M. Fehrenbach MJ; 11/u.ftraled Demal Emb'J'illogo,: Histology. am/
Saunders..
ed 2, SL Louis. 2006.
Medial nasal
process
Nasal pit
Lateral nasal
process
Medial nasal
processes
fusing with
Lateral nasal
process
SAADDES
other
Medial nasal
process
fusing with
maxillary
process
Nasolacrimal
groove
Philtrum
Philtrum
Upper lip
The development of the nose from the medial and latera l nasal processes
150 8-1
Reproduced wilh pem1ission (rom B.mh-Balogh M. Fehrenbach MJ; 11/u.ftraled Demal Emb'J'illogo,: Histology. am/
Saunders..
ed 2, SL Louis. 2006.
Developing brain
Nasal placodes
SAADDES
Site of otic placode
Developing heart
T he embryo at the fourth week of prenatal development.

The developing brain, face, and heart are noted.
150 C.l

Saunders.
ed 2. St Ll"'Uis. 2006.
embryology
During the fourth week of embryonic development, the first branchial arch
divides to form:
the two medial nasal processes

the mandibular and maxillary p rocesses
SAADDES
the two lateral nasal processes
the lateral and medial nasal processes
151
ANATOMIC SCIENCES
the mandibular and maxillary processes- also called maxillary

and mandibular prominences
The branchial arches are stacked bilateral swellings of tissue that appear inferior to
the stomodeum (primiti ve mouth) during the fou rth week of embryonic
development. These branchial arches are six pairs of U-shaped bars w ith a core
mesenchyme which is formed by mesoderm and neural crest cells that migrate to the
neck region. The branchial arches are covered externally by ectodermal li ned
branchial clefts. The arches are bordered medially by the pharynx, which is lined by
endoderm. Medially each of the branchial arches is separated by a pharyngeal
pouch. These pouches approach the corresponding branchial cleft. The
approximation of the ectoderm of the pharyngeal cleft w ith the endoderm of the
pharyngeal pouch forms the pharyngeal membrane. The grooves and pouches are
named (numbered) the same as the preceding arch.
SAADDES
After formation of the stomodeum (the primitive mouth) but still within the fou rth
week, two bulges of t issue appear inferior to the p ri mitive mouth, the two large
mandibular processes of the fi rst branchial arch.
Important: The mandible forms as a result of the fusion of the these two large
mandibular processes.
Note: The mandibular symphysis is a faint ridge in the midline on the surface of the
bony mandible where the mandible is formed by the fusion of the mandibular
processes.
The two smaller maxillary processes of the first branchial arch form the maxilla, the
upper cheek regions, and most of the upper lip.
embryology
The second branchial pouch gives rise to the:
eustachian tube
palatine tonsil
middle ear cavity
SAADDES
superi or parathyroid gland
152
ANATOMIC SCIENCES
palatine tonsil
Four well-defined pairs of pharyngeal pouches develop as endodermal evaginations from the lateral walls lining the pharynx. The pouches develop as balloon-like structures in a cran iocaudal sequence between the branchial arches.
Pharyngeal Pouch
First
Structures Derived From

Contributes to the formation of the tympanic m embrane (with first branchial groove).
auditory tube, tympanic ca,ity, mastoid antrum
Second
Palatine tonsils
Third
I nferior parathyroid glands (from the dorsal part) and th)mus gland (from the
ventral part)
Fourth
Fifth
--: .
SAADDES
Super ior par athyr oid glands (from the dorsal part)
Ultimobr anchial bodies which gives rise to C cells of the thyro id
1. Some books mention that there is fifth branchial pouch that fo rms the ultimobranchial bodies w hich gives ri se to C cells of the thyroid glands. Others consider the
fifth branchial pouch as a rudimentary pouch or a part of fourth branchial pouch which
gives rise to the ultimobranchial bodies and C cells.
2. C cell s of the thyroid are responsible for secreting calcitonin hormone.
3. The first brachial cleft forms the external auditory m eatus.
Digeorge syndrom e: congenital malformation ca used by underdevelopment of t hi rd and

fou rth bra nchial pouches lead ing to absence or hypoplasia of the parathyroid glands. The pat ients usually have congenital heart defects and compromised immunity.
embryology
The thyroid gland is first identifiable during the fourth week of gestation,
beginning as an endodermal invagination of the tongue at the site of:
tubercu lum impar

copula
SAADDES
terminal sulcus
fo ramen cecum
stomodeum
153
ANATOMIC SCIENCES
foramen cecum
The oral cavity (primitive mouth or stomodeum) appears as a shallow depression in the
em bryonic surface ectoderm.
This stomodeum (aka, stomatodeum) is limited in size by the first branchial arch, and in depth
by the oropharyngeal membrane (buccopharyngeal membrane). This temporary membra ne,
consisting of external ectoderm overlying endoderm, was formed during the third week of
prenatal development. The membrane also separates the stomodeum from the primitive
pharynx. The primitive pharynx is the cran ial portion of the foregut, the beginning of the future
d igestive tract.
The first event in t he development of the face, during the fourth week of prenatal development,
is di sintegration of the oropharyngeal membra ne. With this d isintegration of the membrane,
t he stomodeum is increased in depth, enlarging it.
SAADDES
In t he future, the stomodeum will give rise to t he oral cavity, which is lined by oral epithelium,
derived from ectoderm as a result of embryonic folding. The oral epithelium and underlying tissues will give rise to the teeth and associated structures.
Note: A plane passing through the right and left anterior pillars marks t he separation between
the oral cavity and oropharynx in the adult.
Thyroid gland: the initial site of thyroid gland lies between the copula and the tuberculum
impar which is called (foramen cecum), then it descends through thyroglossal duct to its permanent location below the thyroid cartilage in the neck.
Thyroglossal tract (duct): th is duct extends from foramen cecum on of tongue to the permanent location of thyroid g land below thyroid cartilage. This duct is supposed to close and d isappear after the descendent of thyroid into the neck, if it fails to close and disintegrate; portions
of this tract and remnants of thyroid tissue associated with it may persist at any point between
t he tongue and t he t hyroid. Thyroglossal d uct remnants are referred to as thyroglossal duct
cyst.
embryology
The primary palate or median palatal process is formed by the merging of the
frontonasal process with which other processes?
lateral nasal processes

medial nasal processes
SAADDES
maxillary processes
mandibular processes
154
ANATOMIC SCIENCES
medial nasal processes

The palate is formed from two separate embryonic structures: the primary palate and
the seconda ry palate. The palate is then completed during the 12th week of prenata l de velopment.
The palate is developed in three consecutive stages:

The formation of the primary palate
The formation of the secondary palate
The completion of the pa late
Primary palate formation : around the fifth week, the intermaxillary segment arises as
a result of fusion of the two medial nasal p rocesses and the frontonasal process within the
embryo. The intermaxillary segment gives rise to the primary palate. The prim ary palate
w ill form the p remaxillary portion of the maxilla (the anterior one-third of the final palate).
This small portion is anterior to the incisive foramen and will contain the maxillary incisors.
SAADDES
Secondary palate formation : around the sixth week, the b il ateral maxillary processes
give rise to two palatal shelves, or lateral palatine processes. These two palatal shelves
elongate and move medially towa rd each other, fusing to form the secondary palate. The
secondary palate w ill give rise to the posterior two -thirds of the hard palate, which will contain the maxillary canines and posterior teeth, posterior to the incisive foramen. The secondary palate also gives rise to the soft palate and its uvula.
Completion of the palate: To complete the palate, the secondary palate meets the posterior portion of the primary palate, and fuses together. These three processes are completely fused, forming the fi nal palate, both hard and soft portions, during the 12th week
of p renatal development.
A
Maxillary process
Maxillary process
.._-::::::::....1,---- --'ti Stomodeum

Palatal shelt-H----;;iDll/
Palatal shelf
SAADDES
B
Maxillary process
1+----.---.illt r--, l.'li:.---.----11f-- P alatal shelf

Stomodeum
mandible
The developing palate (highlighted). A: Palatal shelves form from the ma xillary
process deep on the inside of th e stomodeum. B: Palatal shelves grow in a horizontal direction toward each other, after " flipping" in a superior direction, to form th e
secondary palate.
154-1
R<'produccd \ltith penni$.iion (rom Ebtb-Balogh M. Fchrcnbacoh MJ;
Saunders.
Demal Emb'J'ology. Histology. om/
ed 2. St Louis. 2006.
Primary palate with

four incisor teeth
Secondary palate fonned from
fused palatal shelves with
canines and
SAADDES
Soft palate
The adult palate and its developmental portions
Reproduced \1,-ilh
Saunders.
from Ba1h-Balogh M, Fehrenbac-h MJ; 11/u.ftraled Demal EmhtJ'illogy. Histology. am/
ed 2. St. Louis. 2006.
embryology
All of the following muscles are derived from first branchial arch EXCEPT
one. Which one is the EXCEPTION?
tensor tympan i
anterior belly of digastric
temporalis
masseter
SAADDES

155
ANATOMIC SCIENCES

\1 ch .md Dt.J i' .1ti\ l' Structuns
Arch
Future
and .Muscles
Future Skeletal Structures and Ligaments.
Fistarch
I rigemjnal nerve (V1 and Y3l.
lvlalleu..o; and i ncus of middle ea1'. including anterior l igame.m
(mtmdibult1r)
muscles of masrication. mylohyoid

and anterior belly of digasttic,
[tnsor cympani. rt-ll$01' veli palatini
of the malleus, sphe-nomandibular ligament. and p011ion..o; of

the sphenoid bone
muscles
muscle. stylohyoid muscle
Stapes and po11ion..o; of malleus and incus of middle ear.

stylohyoid ligament, styloid process of the U!'ll\poral bone.
cornu of hyoid bone, upper portion of body of hyoid
bone
Third arch
neo:e
scylopharyngeal muscle
Grea[er comu of hyoid bone,lowe.r pot[ ion of body of hyoid

bone
Fourth arch
Superior Ja1yngeal branch of vagus Laryngeal car1ilages

pha1y ngeal cons1rictors,
levator veli 1,alatini and c-ric.othyroid
musc-le
Sixth arch
Recurre-nt laryngeal branch of

muscles of the
larynx except lhe cricothyroid
Second arch
(hyoid)
Eacialne.M. smpedius muscle-.

muscles of facial expression.
posre.rior belly of the digastric
SAADDES
Ph:uyngeal Arch
Laryngeal car1ilages
Structures Derived From
First
Mandible and maxilla, Meckel's cartilage, incus, malleus, sphenomalleo lar ligament,
sphenomandibular ligament
Second
Reicherts carti lage. styloid process. stylohyoid ligament, lesser comu and upper
part of hyoid bone and stap<',<
Third
Greater cornu and lower part of hyoid bone
Fourth through sixth Laryngeal cartilages
embryology
The nasal cavities are formed from which embryonic structure?
stomodeum
frontonasal process
intermaxillary segment
nasal pits
SAADDES
156
ANATOMIC SCIENCES
nasal pits
DeHlopment of the Face
Embr yonic Structure
Origin
Future Tissues
Stomodeum
Ectodennal depression enlarged

Oral cavity proper
by disintegration of oropharyngeal
membrane
Mandibular arch
(first branchial arch)
Fused mandibular proce.'ises

neural crest c.e lls
Lower lip, lower face, mandible with

associated tissues
Maxillary process(cs)
Superior and anterior swclling(s)

from mandibular a rch and neural
crest cells
M idfacc. Uppe r lip sides, cheeks,

secondary palate, posterior portion of
ma..xilla with associated tissues, zygomatic
bones, portion of temporal bones
Frontonasal process
Ectodcnnal tissue and neural crest

cells
Medial and late ral nasal processes
Nasal p its
SAADDES
Nasal p lacodes
Nasal cavities
Medial nasal process(cs)
Frontonasal process medial to

nasal pits
Middle o f nose, philtrum region,

intennaxillary segment
Jnte nnaxillary segment
Fused medial nasal processes
Anterior portion of maxilla with associated

tissues, primary palate
Late ral nasal proccss(cs)
Frontonasal process lateral to nasal Nasa] aJac

pits
NasoJacritnal cord
Nasolacrimal groove
Lacritnal sac, Nasolacrimal duc t
embryology
All of the following are neural crest cells derivatives EXCEPT one. Which one
is the EXCEPTION?
melanocytes
dorsal root ganglia
SAADDES
adrenal medulla
autonomic ganglia
adrenal cortex
schwann cells
sensory ganglia of crania l nerves
157
ANATOMIC SCIENCES
adrenal cortex- it is derived from mesoderm
Neural Crest Cell

Derivatives
Autonomic ganglia
Dorsal root ganglia
Leptomeninges (the pia
and arachnoid)
Schwann cells
Neuroectoderm
Derivatives
Neurohypophys is
(posterior pituitary)
Central Nervous
System
0 ligodendrocytes
Astrocytes
Pineal gland
Retina and optic
nerve
Surface Ectoderm
Derivatives
Adenohypophysis
(anterior pituitary
Epidermis
Hair
Nails
Inner ear
External ear
Lens of eye
Parotid gland
SAADDES
Adrena l medulla
Me lanocytes
Sensory cells of cranial
nerves
embryology
Which two ofthe following are NOT derived from endoderm?
lung
liver
gut tube derivatives
pancreas
spleen
SAADDES
thymus
dura mater
parathyroid g land
158
ANATOMIC SCIENCES
spleen
dura mater
Mesodermal
Endodermal
Derivatives
Heart
Gl tmct: foregut, midgut and hindgut
Blood
Lung
Dennis
Liver
Pancreas
Thymus
Thyroid
Parathyro id
Submandibular and sublingual glands
Middle car and auditory tube
Muscles
Vc$scls
Adrenal co rtex
Bone
Spleen
Kidney and ureter
SAADDES
Note: The dura mater is derived from neural crest cells of the ectoderm.
Fetal Circulation Derivathes
Fetus
Adult
Umbilical vein
Ligamentum teres
Umbilical arteries
Medial umbilical ligaments
Ductus arteriosus
Ligamentum artcriosum
Ductus venosus
Ligamentum vcnosum
For.uncn ovate
Fo.o;sa ovalis
Allantios
Urachus (medial umbilical ligament)
Notochord
Nucleus pulposus
heart
Which ofthe following arteries accompanies the great cardiac vein?
circumflex artery
anterior interventricular artery
posterior interventricular artery
SAADDES
right marginal artery
159
ANATOMIC SCIENCES
anterior interventricular artery

When viewed from the back (posterior view), t he most obvious structure lying in the coronary
sulcus is the coronary sinus. Thi s sinus receives most of the venous blood from the heart and
empties into the right atrium. Its tributaries are the small cardiac vein, middle cardiac vein,
and the great cardiac vein. There is a small vein that arises along the left side of the left atrium
j ust beneath the lower left pulmonary artery (called the oblique vein). This vein is a remnant of
the embryonic left superior vena cava.
The great cardiac vein: opens into the left extremity of the coronary sinus. This vein receives tributaries from the left atrium and both ventricles: one, the left marginal vein, is of
considerable size, and ascends along the left margin of the heart.
The small cardiac vein: opens into the rig ht extremity of the coronary sinus. This vein receives blood from the back of the right atrium and ventricle; the right marginal vein ascends
along the right margin of t he heart and joins the small cardiac vein in the coronary sinus, or
opens directly into the right atrium.
The middle cardiac vein: ends in t he coronary sinus near its right extremity.
The oblique vein: ends in the coronary sinus near its left extremity; thi s vein is continuous
above with t he ligament of the left vena cava.
SAADDES
The following cardiac veins do not end in t he coronary sin us:

The anterior cardiac veins: comprising three or four small vessels which collect blood from
the front of the right ventricle and open into the right atrium; the right marginal vein frequently opens into the right atrium, and is therefore sometimes regarded as belonging to t his
group.
The smallest cardiac veins (thebes ian veins): consisting of a number of minute veins which
arise in the muscular wall of the heart,; the majority open into the atria, but a few end in t he
ventricles.
Note: The anterior interventricular artery (left anterior descending artery), a branch of the
left coronary artery, accompanies the great cardiac vein. The posterior (or descending) interventricular artery, a branch of the right coronary artery, accompanies t he middle cardiac vein .
Coronary sinus
Right atrium
Great
cardiac vein
SAADDES
Inferior
vena cava
Small
cardiac
vein
Middle
cardiac
vein
Right
ventricle
159-1
Cardiac Veins- Posterior view
Arterial supply of the heart

Left coronary
artery
Right coronary
artery
Circumflex
artery
SAADDES
Posterior
interventricular
artery
Marginal
artery
159 A I
heart
Sympathetic stimulation will have which direct effect on the heart?
decreased automaticity
AV block
increased vaga l response
bradycardia
SAADDES
increased stroke volume
160
ANATOMIC SCIENCES
increased stroke volume

The strength and frequency of the heart beat are controlled by the autonomic nervous system. Both
parasympathetic and sympathetic parts of the autonomic nervous system are involved in the control of
the heart.
The heart also has an internal nervous system made up of the SA (sinoatrial node) and the AV (atrioventricular) node. The AV bundle (His) leaves the AV node near the lower part of the interatrial septum and
splits overt he upper part oft he interventricular septum into a left bundle branch and a right bundle branch.
The cardiac muscle is then supplied by branches of the two bund les.
Specialized cardiac muscle cells in the wall of the heart rapidly initiate or conduct an electrical impulse
throughout the myoca rdium. The signal is initiated by the sinoatrial (SA) node (pacemaker) and spreads
to the rest of the right atrial myocardium d irectly, to the left atrial myocardium by way of a bund le of interatrial conducting fibers, and to the atrioventricular (AV) node by way of three internodal bundles. The AV
node then initiates a signal that is conducted through the ventricular myocard ium by way of the atrioventricular bundle (bundle of His) and Purkinj e fibers.
SAADDES
Important: (1) The sinuatrial node is located at the j unction of the superior vena cava and the right
auricle; it's the most rapid ly depolarizing cardiac muscle tissue of the heart. This is why the SA node is
referred to as the "pacemaker" of the heart. (2) The AV node is an area of specialized tissue between the
atria and the ventricles of the heart, specifically in the posteroinf erior region of the interatrial septum near
the opening of the corona ry sinus, which conducts the normal electrical impulse from the atria to the
ventricles.
Remember: The conducting system of the heart is all modified ca rdiac muscle fibers and not nerves.
The sympathetic fibers arise from segments T2-T4 of the spinal cord and are d istributed through the midd le cervical and cervico-thoracic (or stellate) ganglia and the first four ganglia of the thoracic sympathetic
chain. The sympathetic fibers pass into the cardiac plexus and from there to the SA node and the cardiac
muscle. The effect of the sympathetic nerves at the SA node is an increase in heart rate. The effect on the
muscle is an increase in rise of pressure within the ventricle, thus increasing stroke volume.
The vagus nerve provides parasympathetic control to the heart. The effect of the vagus nerve at the SA
node is the opposite of the sympathetic nerves; it decreases the heart rate. The vagus nerve also decreases
the excitability of the junctional tissue around the AV node, and this resul ts in slower transmission.
Note: Strong vagal stimulation here may produce an AV block.
SAADDES
Right
Atrioventrfcular node
The Cardiac Conduction System
160-1
Reproduced wtth pcm1is!HOO (rom
BM. Stanton BA; Berne & LeV)'
ed tS: Philaddphia, 2008.. Elsc:vtcr.
heart
Which of the following is the correct conduction pathway through the heart?
SA node- ventricular muscle- AV node- His bundle- bundle branches- Purkinje fibers
-atri al muscle
SA node- atrial muscle- AV node- bundle branches- His bundle- Purkinje fibersventricular muscle
SAADDES
SA node- atrial muscle- AV node- His bundle- bundle branches- Purkinje fibersventricular muscle
SA node- Purkinje fibers- AV node- His bundle- bundle branches- atrial muscl eventricular muscle
161
ANATOMIC SCIENCES
SA node - atrial muscle- AV node- His bundle -bundle branches- Purkinje

fibers - ventricular muscle
The heart contains masses of nodal tissue, excitable tissue that conducts impulses and st imulates the
heartbeat intrinsically. This conduction system signals the heart to beat independently. It does not
require any external influences. The impulse to stimulate the heartbeat passes through the conduction system structures in this order: SA node - atrial muscle - AV node - His bundle - bundle
branches - Purkinje fibers - ventricular muscle
The SA node is in the wall of the right atrium, near the entrance of the superior vena cava. The SA
node typically depolarizes spontaneously at the rate of 60 to 100 times per minute, causing the atria
to contract. Impulses from the SA node pass to the atrioventricular node (AV node), atrioventricular
bundle (AV bu ndle, or bundle of His), and finally to the conduction myofibers(Purkinje fibers) within
the ventricular walls. Stimulation of the conduction myofibers causes the ventricles to contract simultaneously.
SAADDES
1. The rate of the discharge of the SA node set s the rhythm of the entire heart.
.fJ!ftes1 2. The rhythm originates frorn the SA node because the SA node depolarizes more fret i quently (60-100 beats per minute) than the AV node (4Q-60 beats per minute) and ven-
tricular conducting system (3Q-40 beats per minute) so t he AV node and ventricular
conducting system are captured by the sinus impulse and driven at 60-100 beats per
minute.
3.1n sinus rhythm, every P-wave is followed by a QRS complex, the R-R interval is regular, and the P-R interval is less than 0.2 seconds. A fast sinus rhythm, faster t han 100 beats
a minute, is known as sinus tachycardia while a slow rhythm, slower than 60 beats a
minute, is known as sinus bradycardia.
ECG Component
I' wa\'c
vent
Atrial depolarization
QRS
Ventricular depolarization
l)k
Impulse between SA and A V node (AV conduction)
T W1\'C
Ventricular t('polarizution
Qi
Ejcctton of blood
heart
The apex of the heart is located at the level of the:
th ird left intercosta l space

fourth left intercosta l space
fifth left intercosta l space
SAADDES
sixth left intercosta l space
162
ANATOMIC SCIENCES
fifth left intercostal space

The apex of the heart is formed by t he t ip of the left ventricle and islocated at the level of the fifth
left intercostal space.
The ventricles are larger and thicker walled than the atria. The right ventricle pumps blood to the
lungs. The left ventricle is larger and thicker walled than the right; it pu mpsblood through all other
vessels of the body.
Note: The ventricles receive blood from the atria.
Important: The left ventricle enlarges briefly in response to coarctation (constriction) of the aorta.
Remember: The heart functions as a double pu mp. The right side (right atri um) receives
deoxygenated blood from the systemic circuit via the superior and inferior venae cavae as well as
the coronary sinus. The bl ood then goes from the right atrium to the right ventricle via the right AV
valve. The right ventricle then pumps bl ood into the pulmonary circuit (via the pulmonary
semilunar valve, which allows blood to flow into the pulmonary arteries).
SAADDES
Note: Resistance to pulmonary blood flow in the lungs causes a strain on the right ventricle and
results in ventricular hypertrophy.
The left side [left atriu m) receives oxygenated blood from the lungs by way of the pulmonary
veins. This blood then flows through the left AV valve into the left ventricle. From the left ventricle,
blood passes through the aort ic valve and enters the arch of the aorta, which will deliver the blood
to the body's systemic circuits.
Remember: Most veins carry deoxygenated blood from the tissues back to the heart; exceptionsare
the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart.
Note: Heart failure may affect the right side, the left side, or bot h sides of the heart. The left sid e of
the heart receives blood rich in oxygen from the lung s and pumps it to the remainder of the body.
As the ability to pump blood forward from the left side of the heart is decreased, the remainder of the
body does not receive enough oxygen especially when exercising. This results in fatig ue. In addition, the pressure in the veinsof the lung increases, which may cause fl uid accumulation in the lung.
This result s in shortness of breath and pulmonary edema.
Brachlo<:ept>allc
artery
RJeM
pulmonary
artery
....
lelt Sllperior
Lett Inferior
SAADDES
vein
Right superior
pulmonary vein
Right inierlor
pulmonary vein
Anterior descending
branch of left coronary

artery
lett ventrtde
162-1
Heart -Anterior view
heart
Which of the following describes the function of the ductus arteriosus in the
fetus?
it shunts blood from the aorta to the pulmonary artery

it shunts blood from the pulmonary artery to the aorta
SAADDES
it shunts blood from the ri ght atrium to t he left atrium
it shunts blood from the umbilical vein to the inferi or vena cava
163
ANATOMIC SCIENCES
it shunts blood from the pulmonary artery to the aorta
The ligamentum arteriosum is a remnant of the ductus arteriosus in the fetus. The
ductus arteriosus is a normal feta l structure, allowing blood to bypass circulation to
the lungs (blood is shunted from the pulmonary artery to the aortic arch). Since the
fetus does not use his or her lungs (oxygen is provided through the mother's
placenta), flow from the right ventricle needs an outlet. The ductus provides this,
shunting flow from the left pulmonary artery to the aorta just beyond the origin of
the artery to the left subclavian artery. The high levels of oxygen that the ductus is
exposed to after birth causes the ductus to close in most cases within 24 hours. When
it does not close, it is termed a patent ductus arteriosus. After birth, the ductus
arteriosus becomes the ligamentum arteriosum, which connects the arch of the aorta
to the left pulmonary artery.
SAADDES
Remember: The fossa ovalis is a depression in the ri ght atrium of the heart, the
remnant of a thin fibrous sheet that covered the foramen ovale durin g fetal
development. During feta l development, the foramen ovale allows blood to pass
from the ri ght atrium to the left atrium, bypassing the nonfunctional feta l lungs while
the fetus obtains its oxygen from the placenta. Upon birth, the foramen ovale is
initially closed by the septum primum (valve of foramen ovale) as pressure in the left
atrium exceeds that in the right atrium. Eventually, the foramen ovale becomes
permanently closed with fibrous connective tissue and becomes the fossa oval is in
the adult.
Note: The atrial portion of the heart has relatively thin walls and is divided by the
atrial septum into the right and left atria. The ventricular portion of the heart has
thick wa lls and is divided by the ventricular septum into right and left ventricles.
Before Birth
After Birth
Right Atrium
Left Atrium
Right Atrium
Left Atrium
Higher pressure
Lower pressure
Lower pressure
Higher pressure
Septum secundum
Septum
secundum
SAADDES
Oval -----fossa
Oval
foramen
. - septum
primum
(valve of
oval
foramen)
Development of Features of Right Atrium
septum
primum
163-1
heart
A worker in the meat-processing industry comes down with an illness,
presenting with symptoms of fever, headache, and sore throat. A few days
later, he feels chest pain and has pink, frothy sputum. His physician states
that the worker has a viral infection caused by coxsackie B. This patient has inflammation of which layer of the heart?
epicard ium
myocardium
SAADDES
endocardium
pericardium
164
copyngh t 0 20 132014 Dental Decks
ANATOMIC SCIENCES
myocardium
Myocarditi s: is the inflammation of the muscular layer of the heart (myocardium)
Layers of the heart:
1. Internal or endocardium - Homologous with the tun ica intima of blood vessels.
Lines the surface of the heart chambers with a simple squamous endothelium and
underlying loose connective tissue contain ing small blood vessels.
2. Myocardium - Homologous with the tun ica media of blood vessels. Forms the
bulk of the heart mass and consists predominantly of card iac muscle cells arranged
in a spiral configuration. This spiral arrangement allows the heart to"wring"the blood
from the ventricles toward the aortic and pulmonary semilunar valves.
SAADDES
3. Pericardium - is the set of membranes around the heart (it is actually composed
of three layers of membranes). The innermost is the visceral pericardium, the middle is the parietal pericardium, and the outer one is the extra one, called the fibrous
pericardium. The inner two (visceral and parietal) are rather th in and delicate. The
outer one, the fibrous peri cardium, is tough. Important: The major sensory nerve to
the parietal pericardium is from branches of the phrenic nerve (C3-CS).
Important: The middle mediastinum is of the highest cl inical importance as it contains the pericardium and the heart and the immediately adjacent parts of the g reat arteries, phrenic nerves, main bronchi, and other structures in the root of the lungs.
heart
The left atrium and left ventricle receive their major arterial supply from
which artery?
anterior interventricu lar branch of the left coronary artery

circumflex branch of the left coronary artery
SAADDES
marginal branch of the ri ght coronary artery
posterior interventri cula r branch of the right coronary artery
165
ANATOMIC SCIENCES
circumflex branch of the left coronary artery

The arteria l blood supply of the heart is provided by the ri ght and left coronary arteries, which ari se from the ascending aorta immediately above the aortic valve. The coronary arteries and their major branches are distributed over the surface of the heart,
lying within subepica rdial connective tissue.
The ri ght coronary artery arises from the anterior aortic sinus of the ascending aorta
and runs fo rward between the pulmonary trunk and the right auri cle. This artery gives
rise to an important branch immediately after leaving the ascending aorta. This is the
anterior right atrial branch, which gives ri se to the important sinoatrial nodal artery. This artery supplies the SA node or pacemaker of the heart. The right coronary artery continues in the coronary sulcus, giving off a marginal branch, which supplies
the right ventricle. Finally, the ri ght coronary artery gives rise to the posterior interventricular branch (posterior descending artery), which supplies both ventricles, and
then anastomoses with the circumflex artery from the left coronary artery.
SAADDES
The left coronary artery, wh ich is usually larger than the ri ght coronary artery, ari ses
from the left posterior aortic sinus oft he ascending aorta and passes forward between
the pulmonary t runk and the left auricle. It supplies the major part of the heart, includ ing the greater part of the left atrium, left ventricle, and ventricu lar septum. lt then
enters the atri oventri cu lar groove and divides into an anterior interventricular
branch (descending branch) and a circumflex branch.
Important: (1) Coronary arteri es receive the majori ty of their blood flow during ventricu lar relaxation, or diastole, when the left ventricle is filling with blood (2) The anterior interventricular artery is the one most often involved in coronary occlusions
and is often the one that is bypassed in bypass card iac surgery.
Ascending tract
Arch of aorta
Site of SA Node
Right coronary
artery (RCA) Within
coronary sulcus
A ...-"'!k---,,_)111 terior Interventricular
branch of LCA
Atrioventricular
(AV) nodal branch
of RCA
Right marginal
branch of RCA
SAADDES
(A) Anterior view
Left pulmonary artery

Left coronary
artery (LCA)
Posterior interventricular
branch within posterior
interventricular groove
Coronary arteries. A.B. In the

most common pattern of distribution, the RCA anastomoses
ch of aorta
with the circumflex br.lnch of
Superior vena the LCA (anastomoses are not
cava (SVC)
shown) after the RCA has
Sinuatrial (SA)
.
.
.
.
g1ven nse to the postenor mnodal branch
o_f_
RCA
tcrventricular (IV) artery.
.,, - - , - -Fiight pumonary

veins
Anterior
interventricular
branch of LCA
(B) Posterolnferior view
Rcprodutcd wuh
&om
Moon- KL
A Aaw- AMR;
Clmica/ Ot'ttmed Anotonn, 6; Sal
tunorc, 1010. Lipptnoon William!' &
WiUans.
Circumflex branch of LCA

Anteri or
Left coronary artery
AV nodal artery
Anterior
SAADDES
Septal bra nches
......_Apex of heart
Arteries of the interventri cular septum (IVS) are shown . The RCA branch to the AV node
is the first of many septa l branches of the posterior IV artery. The septal branches of the anterior interventricular branch of the LCA supply the anterior two th irds of the IVS. Because the
AV bundle and bundle branches are centrally placed in and on the IVS, the LCA typically provides the most blood to this conducti ng tissue.
16S A I
Reproduced wath pcmtission !rom Moore Kl. Oallcy AF, Ag.urAMR: Clinical Oriented
& Walkins.
ed 6: Baltmtorc. 2010.lippincou Willinms
heart
Which ofthe following does NOT empty directly into the right atrium?
azygous vein
inferior vena cava
superior vena cava
SAADDES
corona ry sinus
166
ANATOMIC SCIENCES
azygous vein
The coronary sinus lies in the posterior part of the coronary sulcus (atrioventricular
groove) and opens in the right atrium between the opening of the inferi or vena cava
and the right atrioventricular orifice, its opening being guarded by a semilunar valve
(Thebesian va lve).
The superior vena cava opens into the upper part of the right atrium. The superior
vena cava returns the blood from the upper half of the body.
The inferior vena cava (larger than the superior vena cava) opens into the lower part
of the right atrium. The inferior vena cava returns the blood from the lower half of the
body.
SAADDES
Flow of the blood through the heart:

1. Entering the right atrium are the coronary sinus and the superi or and inferior
venae cavae ca rrying deoxygenated blood from the systemic circuit.
2. Upon contraction of the right atrium, blood passes through the ri ght AV valve
to the right ventricle.
3. Upon contraction of the right ventricle, blood leaves to pass to the right and
left lungs via the pulmonary arteries.
4. Blood gases are exchanged in the lung, and oxygenated blood returns via
pulmonary veins to the left atrium.
5. Upon contraction of the left atrium, blood passes through the left AV valve to
the left ventricle.
6. Upon contraction of the left ventricle, oxygenated blood passes through the
aortic valve to the systemic circuit via the aorta and its branches.
heart
A patient with a "heart-valve problem" comes into the dental clinic for
periodontal therapy. She says that her old periodontist always gave her
antibiotics before treatment, and insisting that the dentist hear the problem,
she places the stethoscope in the left fifth intercostal space medial to the nipple line. Which heart valve is best heard over the apex of the heart?
t ri cuspid valve
m itral valve
SAADDES
pulmonary valve
aortic valve
167
ANATOMIC SCIENCES
mitral val ve (bicuspid val ve)

The four va lves of the heart are designed to allow one-way flow only of blood. Their function
is to prevent backflow into the releasing chamber.
The four heart va lves work in pairs in tandem:
During ventricular systole, the ventricles of the heart contract, and the pulmonary and
aortic va lves open to allow blood to be pumped into t he pulmonary and general circulatory systems, respectively, while the mitral and tricuspid valves remain closed.
During ventricular diastole, the aortic and pulmonary valves close, while the atrioventricular valves (the mitral and tricuspid valves) open to allow blood to pass from the atria to the
ventricl es.
1. The atrioventricular val ves - the mitral and t ricuspid valves- separate the atrium
and ventricle on t he left and right sides of the heart respectively.
2. The aortic and pulmonary valves are said to be semilunar valves, because each
consists of three half-moon-shaped valve cusps that are attached to t he inside wall of
the aortic and pu lmonary arteries.
3. The apex of the heart lies in the left fifth intercostal space med ial to the nipple line,
about 9 em from the midline. This location is useful for determining t he left border of
the heart and for auscultation of the mitral (bicuspid) valve.
4. The tricuspid va lve is best heard over the right half of the lower end of the body
of the sternum.
5. The pulmona ry va lve is best heard over the second left intercostal space.
6. The aortic va lve is best heard over the second right intercostal space.
SAADDES
Htarl sound
Fir..l (S I)
Produttd by:
of AV valves (mitral and tricuspid)
Second (S2)
Closure of semilunar valves (aortic and pulmonary)
Third (S3)
Rapid ventricular filling
fourth (S4}
Atrial contradion
pulmonary valve
SAADDES
chordae tendineae
167-1
Heart Valves - Ventricular diastole
pulmonary valve
SAADDES
mitral valve
167 A l
Heart Valves - Ventricular systole
heart
A 1 0-year-old girl comes into the physician suffering from rheumatic fever.
She is presenting with aortic valve stenosis, which is causing her dizziness
and syncopal episodes. In the healthy heart, after ventricular systole, the aortic valve:
prevents reflux of blood into the right ventricle
SAADDES
prevents reflux of blood into the right atrium

prevents reflux of blood into the left atrium
prevents reflux of blood into the left ventricle
168
ANATOMIC SCIENCES
prevents reflux of blood into the left ventricle

There are four valves that keep blood flowing in one direction through the heart:
The right and left atrioventricular valves -separate the atrium and ventricle on t he left
and rig ht sides of the heart, respectively.
- Tricuspid valve or right AV valve- guards t he right atrioventricular orifice; consists of
three cusps. This valve controls the flow of blood through the right AV opening.
Note: Thin bu t strong fibrous cords of the chordae tendineae attach the cusps of t his
valve to t he papillary muscles of t he right ventricl e.
-The mitral valve or left AV valve -guards the left atrioventricular orifice; consists of two
cusps. Chordae tendineae attach t hese cusps to papillary muscles of the left ventricle.
Important: Overdistension of the valves of the atrioventricular orifices of the heart is prevented by t he papillary muscles and the trabeculae carneae (muscle ridges and bulges lining the
right ventricle of the heart).
SAADDES
The semilunar valves:

- Pulmonary valve - guards the pulmonary orifice (between the right ventricle and the
pu lmonary artery); con sists of three semilunar cusps.
- Aortic valve - guards the aortic orifice; consists of three semilunar cusps. Note: When
this valve is closed it prevents backflow of blood into the left ventricle.
*** Important: There are no chordae tendineae or papillary muscles associated with these
valve cusps. Pa pillary muscles are found only in the ventricles of the heart.
Major Jones Criteria for Diagnosing Rheumatic Fever:
Migratory polyarthritis: a tempora ry migrating inflammation of the large joints
Carditis: inflammation of heart muscle (myocarditis) and may affect endocardium and pericard ium too
Subcutaneous nodules: containing Aschoff bodies
Sydenham chorea: involuntary ra pid movements ofthe extremities
Erythema marginatum: a long standing reddi sh rash distributes in a"bathing suit" pattern
heart
Which of the following structures prevent the AV valves from everting (or
being blown out) back into the atria during ventricular contraction?
crista terminal is and papillary muscles

chordae tendineae and papillary muscles
SAADDES
pectinate muscles and papillary muscles
chordae tendineae and pectinate muscles
169
ANATOMIC SCIENCES
chordae tendineae and papillary muscles

Remember: Papillary muscles are cone-shaped muscles that term inate in the
tend inous cords (chordae tendineae) that attach to the cusps of the atri oventri cula r
valves (tricuspid and mitral va lve). Papillary muscles are found only in the ventricles
of the heart. The papillary muscles do not help the va lves to close. Instead, these
muscles prevent the cusps from being everted (or being blown out) back into the
atri um during ventricular contraction. Mitral valve prolapse is a prevalent heart
cond ition and dysfunction of these papillary muscles. It can predispose a patient to
infective endocarditis.
SAADDES
The pectinate muscles are prominent ridges of atrial myocardium located on the
inner surfaces of much of the right atrium and of both auricles (which are small
con ical pouches projecting from the upper anterior portion of each atrium).
The crista terminal is is a vertical muscular ridge that runs along the right atrial wall
from the opening of the superior vena cava to the inferi or vena cava. The crista
termina lis provides the origin for the pectinate muscles.
Note: The crista terminalis represents the junction between the sinus venosus and
the heart in the developing embryo. It is represented on the external surface of the
heart by a vertica l groove cal led the sulcus terminalis.
Important: The SA node is located in the right atrium at the junction of the crista
terminalis near the opening of the superior vena cava.
heart
The diaphragmatic surface ofthe heart is formed by:
right atrium and right ventri cle

right atrium and both ventri cles
left ventricle only
SAADDES
right ventricle only

both ventricles
170
ANATOMIC SCIENCES
both ventricles
The adult heart is a hollow, fo ur-chambered muscular organ that is about the size of a
closed fist. About two-thirds of the heart's mass is to the left of the body midline. The heart
and its pericardium make up t he content s of the middle mediasti num. The pericardium is
a tough double-walled fi brous membranous sac t hat surrounds the heart. The outer wall
of the sac is called the parietal pericardium; the inner wall of the sac is called the vi sceral
pericardium (epicard ium). The parietal and visceral pericardia are continuous. This continuity takes p lace at the points where t he maj or blood vessels enter and leave the heart. In
between t hese wall s is the pe ricardia! cavity, which contains se rou s fluid t hat min imizes
friction as the heart beats.
The anterior surface of the heart is also known as the sternocostal surface. The anterior
surface shows part s of each of the four chambe rs of the heart:
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Right atrium (RA)

Left atrium (LA)
are small and located toward t he superior region of the heart

and are separated by the th in, muscular interatrial sept um.
Right ventricle (RV) }

Left ventricle (LV)
are larger and are located at the apex of the heart and are
separated by the thick, muscular interventricu lar septum.
Three borde rs of the he art:

Right border: made up of the right atrium
Inferior border: made up of right atrium, right ventricle, and left ventricle
Left border: made up of the left vent ricle
The left and right ventricles make up the diaphragmatic surface of the heart. This part
rests on the fibrous part of the diaph ragm.
The left atrium makes up the so -called base of the heart. When the body is in the supine
position (lying on its back), the heart rests on its base, and the apex of the heart (the t ip of
the left ventricle) projects up and to the left and fits into a depression on the diaphragm.
endocrine system
The pituitary gland is composed of two distinct tissue types. These tissue
types have their embryonic origin in what layer(s)?
ectoderm
mesoderm
endoderm
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ectoderm and mesoderm

ectoderm and endoderm
all of the above
171
ANATOMIC SCIENCES
ectoderm
The pituitary gland (also called the hypophysis) is no larger than a pea (weighs only
0.5 gram), and rests in the sella turcica, a depression in the sphenoidal bone at the
base of the b rain. The p ituitary connects with the hypothalamus via the
infundibulum, through which this gland receives chemical and neural stimuli.
The pituitary gland is often referred to as the "master endocrine gland" because it
controls so many other glands. It does this through the action of tropic hormones hormones that affect the activity of another endocrine gland. For this reason, the
pituitary gland is essential for life.
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The pituitary develops from two different sources: an upgrowth from the ectoderm
of the stomodeum and a downgrowth from the neuroectoderm of the
diencephalon, in other words, an upgrowth from the roof of the mouth and a
down growth from the floor of the brain.
This double origin explains why the pituitary gland is composed of two completely
different types oftissue. The adenohypophysis (glandular portion) arises from the oral
ectoderm, and the neurohypophysis (nervous portion) originates from the
neuroectoderm.
During the developmental stage (about the third week), a diverticulum called
Rathke's pouch ari ses from the roof of the stomodeum (primitive mouth) and grows
toward the brain. As this pouch approaches the developing neurohypophysis
(posterior lobe), its attachment with the mouth is lost. The pouch then goes on to
form the portion of the pituitary gland known as the adenohypophysis {ant erior
lobe).
The Pituitary Gland
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HUMAN BRAIN -SIDE VIEW
Corpus
Callosum
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171 A l
endocrine system
Diabetes insipidus is characterized by the secretion of large amounts of
dilute urine because of a deficiency in antidiuretic hormone. Antidiuretic
hormone is secreted from the:
anterior pituitary
posterior pituitary
SAADDES
adrenal medulla
adrenal cortex
thyroid
kidney
172
ANATOMIC SCIENCES
posterior pituitary
The pituitary has two main regions. The larger region, the anterior pituitary (adenohypophysis), p roduces at least six hormones:
Mnemonic- GPA 8-FLAT - yH, f,rolactin from Acidophil s.

ESH, J.H, ACTH, I SH.
1. Growth hormone (GH)- pro motes growth in general, particularly the skeletal system.
2. Corticotropin (ACTH)- controls the secretion of adrenocortical hormones, which in
turn affect the metabolism of glucose, proteins, and fat.
3. Thyroid-stimulating hormone (TSH) - controls the secretion of thyroxine by the thyroid gland.
4. Prolactin- promotes mamm ary gland development and milk production.
5. Follicle-stimulating hormones (FSH) - stimulates growth of Graafian follicles in the
ovary and promotes spermatogenesis in the male.
6. Luteinizing hormone (LH)- stimulates secretion of sex hormones by the ovary and
testis.
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The posterior pituitary, which makes up about 25% of the gland, serves as a storage area
for:
1. ADH (antidiuretic hormone or vaso pressin)- controls the rate of water reabsorpt ion in
the kidneys.
2. Oxytocin - has a number of functions, many of which are associated with labor and delivery and nursing mothers. During labor, oxytocin facilitates rapid and efficient delivery, and after b irth, the hormone promotes milk production in nursing mothers.
Note: ADH and oxytocin are produced in the hypothalamus and transported in axons to
the posterior lobe of the hypophysis for storage and secretion.
Hypothalamus:
SAADDES
ADH
Kidney
OT
Mammary
glands
17N
endocrine system
A SO-year-old female was diagnosed with anaplastic thyroid cancer and
underwent aggressive surgery to remove most of the thyroid. Unfortunately,
the surgeon also excised the parathyroid glands. Which oft he following could
result from the excision of the parathyroid glands?
strengthening of muscles
SAADDES
weaken ing of bones

muscle convu lsions
decalcification of bones
173
ANATOMIC SCIENCES
muscle convulsions
***A deficiency of PTH can lead to tetany, muscle weakness due to a lack of available calcium
in t he blood.
The body's smallest known endocrine glands, the parathyroid glands are small, pea-like organs
embedded beneath the posterior surface of the thyroid gland. Most people have four of them.
Working together as a single gland, the parathyroid gland s produce parathyroid hormone.
Parathyroid hormone is the most important regulator of calcium and phosphorus concentration
in extracellular fluid. It finds its maj or target cells in bone and kidney. These glands are essential for life.
Each parathyroid gland has a fibrous tissue capsule and two types of cells:
Chief cells - produce parathyroid hormone, which acts to raise the concentration of calcium in t he blood and reduce the concentration of phosphate ions
Oxyphil cells - function is undetermined
SAADDES
They receive innervation from t he postganglionic sympathetic fibers of the superior cervical
ganglion. The superior pair receives its blood supply from the superior thyroid artery (from ext ernal carotid) and the inferior pa ir from the inferior thyroid artery (from thyrocervical trunk).
Note: The thyrocervical trunk is short and thick and arises from the first portion of the subclavian artery close to the med ial border of the scalenus anterior. This trunk divides almost immediately in to the fo llowing three branches: inferior thyroid, suprascapular, and transverse
cervical (or superficial cervical) arteries.
1. These glands develop from the third and fourth pharyngeal pouches.
' 2.The tiny pineal gland lies at the back of the third ventricle of t he bra in. This
gland produces the hormone melatonin. This hormone is thought to play a number
of roles in humans, including the regulation of t he sleep-wake cycle, body
temperature regulation, and appetite.
SAADDES
Pharyngeal
muscles
Thyroid
Esopllagus
17].1
Parathyroid Glands
endocrine system
The innervation to the parotid gland and its sheath comes from all of the following nerves EXCEPT one. Which one is the EXCEPTION?
auriculotemporal nerve
great auricular nerve
facial nerve
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174
ANATOMIC SCIENCES
facial nerve
The parotid gland is the largest of the salivary glands and is a purely serous gland. It is
situated below the external auditory meatus and lies in a deep hollow behind the
ramus of the mandible and in front of the sternocleidomastoid. Th is gland is divided into
deep and su perficial lobes (which enclose the facial nerve). Therefore, a porti on of the
parotid lies superficial to the mandibular ramus, and another portion lies deep.
The parotid gland is drained by Stensen's duct, wh ich crosses the ma sseter muscle and
pierces the buccinator muscle to open into the vestibule of the mouth opposite the
maxillary second molar.
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The parotid sheath and overlying skin are innervated by the auriculotemporal nerve
(branch of V3) and the great auricular nerve (C2, C3 fro m cervical plexus).
Parasympathetic secretomotor fibers fro m the inferior sa livatory nucleus of the
glossopharyngeal nerve supply the parotid gland. The nerve fibers pass to the otic
ganglion via the tympanic branch of the glossopharyngeal nerve and the lesser petrosal
nerve. Postganglionic para sympathetic fibers reach the parotid g land via the
auriculotemporal nerve (branch V-3), which lies in contact with the deep surface of the
gland. Sympathetic innervati on originates from the external carotid nerve plexus.
Note: Although the terminal branches of the facial nerve (CN VII) pass through the gland,
they do not participate in its innervation.
The external carotid artery and its terminal branches within the gland, namely the
superficial temporal and the maxillary arteries, supply the parotid gland. The lymphatic
vessels drain into the parotid lymph nodes and the deep cervical lymph nodes.
Accessory
Parotid parotid
Masseter
g
SAADDES
Submandibular gland
Facial
Internal jugular vein
vein
Salivary Glands- Lateral view
174-1
endocrine system
The part of a developing salivary gland destined to become responsible for
its functioning is called the:
nephron
fo llicle
adenomere
lobule
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175
ANATOMIC SCIENCES
adenomere - it is the functional unit in salivary gland s

Exocrine glands are struct urally and functionally subdivided by septa, plate-like invaginations of their connective tissue ca psules. Th is arrangement app li es mainly to the pancreas
and salivary glands.
1. Lobes are the largest of the subunits and are separated by connective t issue septa.
2. Lobules are subunits of the lobes and are separated by thin extensions of the septa.
3. Adenomeres are secretory subunits of lobul es. Adeno meres consist of all the secre tory cells that release their p roducts into a single intralobu lar duct.
4. Acini (or alveoli) are smaller secretory subunits. Each acinus is a spheric collection of
secretory cells surround ing the b lind-ended termination of a single intercalated duct.
An adenomere is composed of:
Intercalated ducts - are lined by low cu boidal cell s found in intercalated duct s
Striated ducts - conta in a lot of mitochondria responsible for electrolyte and water
transport during secretion. Simple, low columnar epithelium line these ducts.
Glandular cells- synt hesize glycoproteins
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The salivary glands are divided into 2 groups:

Major
1. Parotid gland - p urely serous gland
2. Submandibular (submaxillary) gland - mixed serous and mucous gland with
serous predominating
3. Sublingual gland- mixed serous and mucous gland with mucous predominating
Minor are located on the:
1. Lips
2. Cheek
3. Tongue- von Ebner's glands are associated w ith circ umva llate papill a. They are
purely serous.
4. Hard palate
The Salivary Glands
SAADDESI
Parotid duct
Parotid g land
- - --
Sublingual g land -
...,.
Submandibular
\_
Sub ma nd ibular g land _ /
175 1
endocrine system
A death-row inmate who was notorious for aggressive and hyperactive
behavior is complaining of abdominal pain. Hospital tests reveal bilateral
tumors that are secreting excessive catecholamines. Which of the following
glands is involved?
anterior pituitary
SAADDES
pancreatic islets (Langerhans)

adrenal medulla
parathyroids
adrenal cortex
176
ANATOMIC SCIENCES
adrenal medulla
Stimulation of the adrenal medulla causes the release of large quantities of epinephrine and
norepinephrine. The same effects are also caused by direct sympathetic stimulation, except
the effects last longer when the medulla secretes the hormones. With or without one or t he
other (medulla or sympathetic nerves), the organs would still be stimulated. In other words, the
medulla functions in a manner similar to postganglionic sympathetic cells.
The two adrenal glands (also called suprarenal glands) are flattened, somewhat triangularshaped endocrine glands resting upon t he superior poles of each kidney at t he back of the abdomen. Each gland has an outer part, t he cortex, and a core, the medulla.
The adrenal cortex produces t hree main types of hormones:
Glucocorticoid s: whi ch are produced and released under t he control of adrenocorticotrophic hormone (ACTH) from the pituitary, influences t he metabolism of fat, protein, and
carbohydrates, promoting the breakdown of protein and the release of fat and sugars into the
bloodstream
Mineralocorticoids: enhance sodium reabsorption in the collecting duct of the kidneys
Sex steroids
SAADDES
The adrenal medulla contains many modified nerve cells, which produce and release about
80% epinephrine (adrenaline) and 20% norepinephrine (noradrenaline). These hormones are
released in bursts during emergency situations or accompanying intense emotion. They act to
increase the strength and rate of heart contractions, ra ise the blood sugar level, elevate t he
blood pressure, and increase breathing.
Important: The adrenal medulla develops from neuroectoderm, while the adrenal cortex develops from mesoderm.
Note: Neuroectoderm is a specia lized group of cell s that d ifferentiate from the ectoderm.
Neural crest cell s are a specialized group of cells developed from neuroectoderm that
migrate from the crests of the neural folds and disperse to specific sites within the mesenchyme.
They also influence a special type of mesenchyme, t he ectomesenchyme, to form dental tissues.
Adrenal
gland
Kidney (left)
SAADDES
176-1
Adrenal Gland - Coronal view of left adrenal gland
Adrenal cortex:
Zona glomerulosa
Zona fasciculata
Zona reticularis
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The Adrenal Gland
176A-1
endocrine system
The portion of the pituitary gland that does NOT arise from the hypothalamus is the:
neurohypophysis
pars nervosa
SAADDES
adenohypophysis
infundibulum
177
ANATOMIC SCIENCES
adenohypophysis
Remember: The posterior lobe (i.e., neurohypophysis, pars nervosa), the
infundibulum and the pituitary stalk all arise from the hypothalamus. The
neurohypophysis contains axons from the neurosecretory cel ls of the hypothalamus.
The anterior lobe (adenohypophysis) is formed from an invagination of the
pharyngeal epithelium (Rathke's pouch)- thus, the epithelial nature of its cells.
Important:
1. The anterior pituitary or adenohypophysis is a classica l g land composed predominantly of cells that secrete protein hormones.
2. The posterior pituitary or neurohypophysis is not rea lly an endocri ne g land;
rather, it is largely a collection of axonal projections from the hypothalamus t hat term inate behind the anterior pitu ita ry gland. It also forms the so-called pituitary stalk,
which appears to suspend the anterior gland from the hypothalamus.
SAADDES
The tropic hormones (FSH, LH, ACTH, and TSH) are hormones that affect the activity
of another endocrine gland. Releasing or inhibiting hormones produced by the
hypothalamus control t hese hormones of the anteri or pituita ry. Prolactin and
growth hormone (GH) are also made in the anterior pituita ry. These two hormones
are not considered to be tropic hormones.
Secretory cells of the anterior pituitary are categorized into two g roups, according to
their staining properties.
Acidophils (acidic stain): secrete GH, and prolactin
Basophils (basic stain): secrete TSH, FSH, LH, and ACTH
endocrine system
Exocrine glands include all of the following EXCEPT one. Which one is the
EXCEPTION?
sweat glands
the prostate gland
SAADDES
bile-producing glands of the liver

the pituitary gland
lacri mal g lands
gastric glands
178
ANATOMIC SCIENCES
the pituitary gland

Exocrine glands are glands whose secretions pass into a system of ducts that lead ultimately
to the exterior of the body. So the inner surface of the gland s and the ducts that drain them
are topologically continuous with the exterior of the body (the skin}. Endocrine glands, in
contrast, secrete their products, hormones, directly into the blood rather than through a duct.
Classification of exocrine glands:
Type of secretion
1. Mucous (secrete mucus= water + mucin}- buccal glands, glands of the esophagus,
cardiac and pyloric g lands of the stomach
2. Serous (enzymes}- parotid gland, von Ebner glands, pancreas and uterine glands
3. Mixed (mucous and serous}- submandibular and sublingual salivary glands, glands
of the nasal cavity, para nasal sinuses, nasopharynx, larynx, trachea, and bronchi
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Mode of secretion
1. Merocrine - only cell secretory product released from membrane bound secretory
granules- pancreatic acinar cells
2. Apocrine- secretion of product plus small portion of cytoplasm- fat droplet secretion
by mammary glands
3. Holocrine- entire cell with secretory product- sebaceous glands of skin and nose
Structure of duct system
1. Unbranched -"simple" glands- sweat glands
2. Branched - "compound" gland s- pancreas
Shape of secretory unit
1. Tubular - cylindrical lumen surrounded by secretory cells- sweat glands
2. Acinar (alveolar}- dilated sac-like secretory unit- sebaceous and mammary glands
3.Tubuloacinar (tubuloalveolar} - intermediate in shape or having both tubular and
alveolar secretory units- major salivary glands
Cllmti((A/
sard.illtd
Skinswfou
SAADDES
Exocrine gland
sttrd<dintubl.,J
Endocrine gland
178-1
endocrine system
A young girl presents to the physician with a large, round face, a "buffalo
hump:' and central obesity. She also has a history of hypertension and
insulin resistance as a result of increased cortisol. Which anterior pituitary
hormone controls the production and secretion of cortisol?
follicle-stimulating hormone (FSH)
SAADDES
luteinizing hormone (LH)
adrenocorticotropic hormone (ACTH)

thyroid-stimulating hormone (TSH)
corticotropin-releasing hormone (CRH)
179
ANATOMIC SCIENCES
adrenocorticotropic hormone (ACTH) - also called corticotropin

Adrenocorticotropic hormone, as its name implies, stimulates the adrenal cortex.
More specifically, this hormone stimulates secretion of g lucocorticoids such as
cortisol, and has little contro l over secretion of aldosterone, the other major steroid
hormone from the adrenal cortex.
ACTH is secreted from the anteri or pi tuitary in response to corticotropin-releasing
hormone (CRH) from the hypothalamus. Corticotropin-releasing hormone is secreted
in response to many types of stress, which makes sense in view of the "stress management" functions of glucocorticoids. Corticotropin-releasing hormone itself is inhibited
by glucocorticoids making it part of a classical negative feed back loop.
SAADDES
Follicle-stimulating hormone (FSH):
In females, FSH initiates ovari an fo llicle development and secretion of estrogens

in t he ovaries
In males, FSH stimulates sperm production in the testes (spermatogenesis)
Luteinizing hormone (LH):
In females, LH stimulates secretion of estrogen by ovarian cells to result in ovulation and stimulates formation of t he corpus luteum and secretion of progesterone
In males, LH stimulates the interstitial cells of Ieydig in the testes to secrete
testosterone
Thyroid-stimulating hormone (TSH) regu lates t hyroid gland activities, uptake of
iodine, and synthesis and release of thyroid hormones.
Hypothalamus
SAADDES
Gonad
.......
J.....
..
179 1
The hypothalamic pituitary axes
endocrine system
A pancreatic cancer patient has a tumor that presses on the ampulla of Vater.
This has been causing him Gl problems because the tumor obstructs the
common bile duct and the main excretory duct of the pancreas which is
known as:
wharton's duct
SAADDES
the duct of Wirsung

bartholin 's duct
wolffian duct
Stenson's duct
180
ANATOMIC SCIENCES
the duct of Wirsung

The pancreas is a retroperitoneal organ located post erior t o the stomach on t he posterio r abdominal
wall. The pancreas's large head is framed by the ( -shaped loop of the d uodenum, while the t ail touches
the spleen. The pancreas plays a role in both the digestive and endocrine systems. The pancreas is covered
in a tissue capsule that partitions the gland into lobules.
Endocri ne portion (islets of Langerhans - endocrine cell s of pancreas):
Alpha cells - secrete glucagon, which counters the action of insulin
Beta cells - secrete insulin, which helps carbohydrate metabolism
Delta cells - secrete somatostatin, which acts locally w i thin the islets of langerhans themsel ves to
depress the secretion of both insulin and glucagon
Important: The degeneration of the islet s of Langerhans lead s to diabetes mellitus.
Exocrine portion:
Acinar cells (pancreatic exocrine cells) - these cells are fi lled w ith secretory granules containing the
d igestive enzymes (mainly try psin, chymotrypsin, pancreatic lipase, and amylase) that are secreted
into the lumen of the acinus.
SAADDES
Remember: Pancreatic secretions contain bicarbonate ions and are alkaline in order to neutralize the acid ic
chyme that the stomach churns out. Bicarbonat e secretions are stimulat ed by secretion produced in the
duodenum.
The endocrine function of the pancreas is concerned w ith both foodstuff release during f asting and foodstuff storage aft er meals. The two pancreatic hormones responsible for these functions are glucagon and
insulin, respectively. These t wo hormones are produced in special cell t ypes w ithin many tiny spherical
clumps of pancreatic tissue, which are known as the pancreatic islets or the islets of Langerhans. Wi thin
the islets of Langerhans, the alpha cells secrete glucagon, which elevat es blood sugar; beta cells secrete
insulin, which affects the metabolism of f ats, proteins, and carbohydrates; and delta cells secrete somatostatin, which can inhibit the release of both glucagon and insulin.
Two ducts that may be associated w i th the pancreas:
1. The main pancreatic duct (duct of Wirsung) - begins at the tail and j oins the common bile d uct t o
form the hepatopancreati c ampulla (ampulla of Vater) before opening into the d uodenum. This ampulla
d ischarges bile and pancreatic enzymes into the descending portion (second part) of the duodenum.
2. The accessory pancreatic duct (Santorini's duct) - w hen present opens separately into the duodenum.
endocrine system
On a patient's panoramic radiograph, the dentist notices a small, well-defined
radiolucency that sits inferior to the mandibular canal. The dentist performs a
sialogram that rules out a true cyst and makes the working diagnosis a static bone
cavity (Stafne bone cyst). Which of the following salivary glands creates the
depression in bone that radiographically gives the above appearance?
sublingual g land
SAADDES
von Ebner's g lands
submaxillary gland
parotid g land
[refer to card 174-1, 175-1for illustration]
ANATOMIC SCIENCES
181
submaxillary gland
The submandibular gland weighs half the weight of the parotid. This gland isoften referred to as the
submaxillary gland. This gland lies in the submandibular triangle formed by the anterior and
posterior bellies of the digastric muscle and the inferior margin of the mandible. The gland is
positioned medial and inferior to the mandibular ramus partly superior and partly inferior to the
base of the posterior half of the mandible. The gland forms a u shape around the posterior border
of the mylohyoid muscle, which divides the submandibular gland into a superf icial and deep lobe.
The deep lobe comprises the majority of the gland. The glandular elements are a mixt ure of serous
(mostly) and mucous acini with some serous demilunes. As is the case with the parotid gland, the
submandibular gland is invested in its own capsule, which is also continuous with the superficial
layer of deep cervical fascia. Important: The marginal mandibular branch of the facial nerve
courses superficial to the submandibular gland and deep to the platysma.
SAADDES
The submandibular duct (Wharton's duct) arises from the deep portion of the gland and crosses
the lingual nerve in the region of the sublingual gland to terminate on the sublingual caruncle
(papilla) adjacent to the base of the sublingual frenulum. When the sublingual duct (Bart holin's
duct) is present, it usually terminates on or near the sublingual caruncle also. Important: The
lingual nerve wraps around Wharton's duct, starting lateral and ending medial to the duct, while
CN XII (the hypoglossal nerve) parallels the submandibular duct, running j ust inferior to it.
Blood supply: The blood supply is from the facial and lingual arteries. The facial artery forms a
groove in the deep part of the gland, and then curves up around the inferior margin of the mandible
to supply the face. The veins drain into the facial and lingual veins. The lymph vessels drain into the
submandibular and deep cervical lymph nodes.
Innervation: Parasympathetic secretomotor fibers from the superior salivatory nucleus of the
facial nerve. The nerve fibers pass to the submandibular ganglion via the chorda tympani nerve
and the lingual nerve. Postganglionic parasympathetic fibers pass to the gland via the lingual
nerve. Postganglionic sympathetic fibers reach the gland as a plexus of nerves around the facial
and lingual arteries.
endocrine system
The thymus is a prominent feature of the middle mediastinum during infancy
and childhood.
The thymus is the central control organ for the immune system.
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182
ANATOMIC SCIENCES
the f irst statement is fal se, the second is true

The thymus is a prominent feature of the superior mediastinum during infancy and
childhood. The thymus plays an important role in the development and maintenance of
the immune system. As puberty is reached, the thymus begins to diminish in relative size.
By adulthood, it is usually replaced by adipose tissue and is often scarcely recognizable;
however, it continues to produce T lymphocytes.
While the thymus is part of the endocrine system, the thymus's primary functi on is that of
a lymph organ. The thymus is the central control organ for the immune system.
Lymphocytes originate from hemocytoblasts (stem cell s) in red bone marrow. Those that
enter the thymus mature and develop into activated T lymphocytes (i.e., able to respond
to antigens encountered elsewhere in the body). They then divide into two groups:
Those that re-enter the blood; these are transported to developing secondary
lymphoid ti ssues, such as lymph nodes and spleen
Those that remain in the thymus gland and are the source of future generations of T
lymphocytes
SAADDES
Many nutrients function as important cofactors in the manufacture, secretion, and

function of thymic hormones. Zinc, vitamin B& and vitamin Care perhaps the most critical.
Zinc is perhaps the most critical mineral involved in thymus gland function and thymus
hormone action. Zinc is involved in virtually every aspect of immunity.
1. The thymus has no afferent lymphati cs or lymphatic nodules.
2. Other lymphoid organs originate exclusively from mesenchyme, whereas
the thymus has a double embryologic origin. The lymphocytes are derived
from hematopoietic stem cel ls (mesenchyme), wh ile Hassall's corpuscles
(epithelium) are derived from endoderm of the third pharyngeal pouch.
3. The arteries supplying the thymus are derived from the internal mammary,
superior thyroid, and inferior t hyroid arteries. It is innervated by the vagus
nerve.
endocrine system
Mature lymphocytes constantly travel through the blood to the lymphoid organs and then back to the blood. This constant recirculation insures that the
body is continuously monitored for invading substances. The major areas of
antigen contact and lymphocyte activation are the secondary lymphoid organs. These include all of the following EXCEPT one. Which one is the EXCEPTION?
spleen
SAADDES
lymph nodes
thymus gland
tonsils
mucosal associated lymphoid tissue (MALT)
183
ANATOMIC SCIENCES
thymus gland
The thymus gland is a primary lymphoid organ (along with the bone marrow) that
consist s of two lobes surrounded by a th in layer of connective t issue. The thymus gland is
located deep to the sternum in the superior media stinum. This gland consists of an
outer cortex that is primarily lymphocytes. The inner medulla also conta ins lymphocytes
and Hassall's corpuscles. These corpuscles are thought to be vestiges of epithelium; their
function is unknown.
Important: This organ appears to be t he ma ster organ in immunogenesis in the young
and is believed by some (but not all) to monitor the total lymphoid system throughout
life.
SAADDES
Remember: The p rimary function of the thymus is the process ing and maturation of spe ciallymphocytes (white b lood cells) called T lymphocytes orT cell s, which play a central
role in cell-mediated immunity. T lymphocytes migrate from the bone marrow to the thymus, where they mature and differentiate until activated. While in the thymus, the lymphocytes do not respond to pathogens and foreign agents. After the lymphocytes have
matured, they enter the b lood and go to other lymphatic organs, where the lymphocytes
help p rovide defense against disease. The thymus also produces a hormone, thymosin,
which stimulates t he maturation of lymphocytes in ot her lymphatic organs.
1. The thymus gland also produces thymic lymphopoietic factor (TLF), wh ich
confers immunological competence on t hymus -dependent cell s and induces
lymphopoiesis.
2. Defects in chromoso me 22 (cause of most cases of DiGeorge syndrome) may
cause a ba by's thymus gland to be smaller than normal (hypoplastic). In some
cases, children wit h DiGeorge syndrome don't have a thymus gland at all.
3. MALT ranges from loose clusters of lymphoid cell s in the intestinal lamina propria,
to more complex organizations as in the Peyer's Patches, tonsils, and appendix.
Right common
carotid artery
Left common
carotid artery
Right
subclavian
artery
SAADDES
Left
brachiocephalic
vein
Internal
Internal thoracic
thoracic artery
Inferior vein
thyroid
vein
183-1
Sup erior mediastinum - Sup erficial dissection
The Endocrine System

Pineal gland
Hypothalamus
Pituitary gland
U f--- --- Thyroid gland

Thymus
SAADDES
Testes
(male)
Ovaries
(female)
' - - - --
--
183
A I
endocrine system
All of the following contain mucus-secreting cells EXCEPT one. Which one is
the EXCEPTION?
submandibular g lands
sublingual glands
SAADDES
parotid glands
glands of the esophagus

mucosa of the trachea
184
ANATOMIC SCIENCES
parotid glands- these glands are completely serous

Both the major and minor salivary glandsare composed of both epithelium and connective tissue.
Epithelial cells both line the duct system and produce the saliva. Connect ive tissue surrounds the epithelium, protecting and supporting the gland.The connective tissue of the gland is divided into the
capsule, which surrounds the outer portion of the entire gland, and septa. Each septum helps divide
the inner portion of the gland into larger lobes and smaller lobules.
Epithelial cells that produce saliva are called secretory cells. The two types of secretory cells are classified as either mucous or serous cells. Secretory cells are found in a group, or acinus (plural, acini),
which resembles a cluster of grapes. Each acinus consists of a single layer of cuboidal cells, epi thelial
cells surrounding a lumen, a central opening where the saliva is deposited after being produced by
the secretory cells.
The three forms of acini are classified in terms of the type of epithelial cell present and the secretory
product being produced.
SAADDES
Serous Acini:
Composed of serous cells producing a serous secretory product; are generally spherical with
a narrow lumen
Serous cells contain large amounts of RER, free ri bosomes, a prominent Golgi complex, and
numerous protein-rich, membrane-bound vesicles called secretory granules. In cells that produce digestive enzymes, these vesicles are called zymogen granules
Mucous Acini:
Composed of mucous cells producing a mucoussecretory product; are usually more tubular wi th a wider lumen
Most mucous cells conta in large numbers of mucinogenic granules in their apical cytoplasm
Mixed Acini:
Have both mucous cells surrounding the lumen and a serous demilune or cap of serous
cells superficial to the group of mucou ssecretory cells
These caps, or serous demilunes, secrete into the highly convoluted intercellular space, between the mucous cells.*** They are associated with the mixed acini of the sublingual and
submandibular glandsas well as the glands of the esophagusand trachea.
endocrine system
Calcitonin is secreted by the:
thyroid gland
parathyroid g land
adrenal glands
SAADDES
thymus gland
185
ANATOMIC SCIENCES
thyroid gland
The largest of the endocrine glands, the thyroid g land consists of two lobes, the right
and left, which are joined across by a thin band cal led the isthmus. The thyroid gland
is an "H"-shaped structure located anterior to the upper part of the trachea near its
junction with the larynx.
Thyroid epithelial cells, the cel ls responsible for synthesis of thyroid hormone, are
arranged in spheres ca lled thyroid follicles. These follicles are filled w ith colloid. Colloid is composed of thyroglobulin and iodine and is the storage form of the thyroid
hormones T3 and T4.
Note: Thyroid hormone is composed of two different substances: thyroxine (also
ca lled T4, or tetraiodothyron ine) and triiodothyronine (T3). Thyroid hormone has
several functions, the main one being to determine the metabolic rate of body tissues.
SAADDES
Important: The production of thyroid hormone is under the control of thyroid-stimulating hormone (TSH), wh ich is released from the pituitary gland. Overproduction
ofTSH can lead to Graves' disea se.
In addition to thyro id epithelial cells, the thyroid gland houses one other important
endocrine cel l. Nestled in spaces between thyroid follicles are parafollicular or C cells,
which secrete the hormone calcitonin. Calciton in acts to reduce blood ca lcium, opposing the effects of parathyroid hormone (PTH).
Note: The thyroglossal duct is a narrow cana l that connects the thyroid g land to the
tongue during development. This duct d isappears soon after development of the
gland. In the adult, the proximal end ofthe duct persists as the foramen cecum of the
tongue.
Thyroid gland
SAADDES
Thyroid cartilage
Anterior
Anterior
Posterior
Posterior
185 1
endocrine system
Hospital tests on a patient identify a tumor in the hypophysis that is excessively secreting growth hormone. Given that the patient is a 4-year-old male,
what is the expected outcome if no treatment is performed?
pituitary gigantism
acromegaly
SAADDES
pituitary dwarfism
achondroplasia
186
ANATOMIC SCIENCES
pituitary g iganti sm
The amount of growth hormone secreted by the anterior p ituitary gland can have a
dramatic effect on bone development:
Pituitary gigantism - tumor prior to adolescence, excessive GH delays ossification of

epiphyseal cartilage (non-fusion of epiphyses)
Acromegaly- tumor after adolescence, excess GH secreted after epiphyseal cartilages
have been replaced by bone (fusion of epiphyses)
Pituitary dwarfism- GH deficiency resulting in early replacement of epiphyseal cartilages by bone
Important point: The deciding factor in whether gigantism or acromegaly will occur when
there is over secretion of growth hormone by the pituitary gland is whet her the epiphyses
of the long bones have fused with the shaft or not.
SAADDES
Two lobes of the pituitary gland (hypophysis cerebri):

1. Posterior lobe - unmyelinated nerve fibers, secretes ADH and oxytocin.
2. Anterior lobe - pars distalis is the anterior part of the adenohypophysis that is the
major secretory part of the gland.
Alpha cells (acidophil s; stain strongly w ith acid dyes)

1. Somatotrophs - secrete GH
2. Lactotrophs - secrete prolactin
Beta ce lls (baso phils; stain strongly with basic dyes)

1. Corticotrophs - secrete ACTH
2. Gonadotrophs - secrete FSH and LH
3. Thyrotrophs - secrete TSH
*** The pars intermedia and tuberalis have no proven function in mammals.
endocrine system
The arterial blood supply of the adrenal glands comes from 3 sources, with
branches arising from the inferior phrenic artery, the renal artery, and the
aorta.
Venous drainage flows directly into the inferior vena cava on the right side
and into the left renal vein on the left side.
SAADDES

the first statement is fa lse, the second is t rue
Irefer to card 176 A-1for illustration)
ANATOMIC SCIENCES
187
both statements are true

The adrenal glands are small, yellowish organs that rest on the upper poles of t he kidneys in
t he back of the abdomen. The right adrenal gland is pyramidal, whereas t he left one is more
crescentic, extending toward the hilum of the kidney.
Each adrenal gland is composed of 2 distinct parts: the adrenal cortex and the adrenal medulla.
The cortex is divided into 3 zones. From exterior to interior, these are t he zona glomerulosa, t he
zona fasciculata, and the zona reticularis.
Zona Glomerulosa: is t he outer layer of the adrenal cortex. This layer is responsible for making mineralocorticoids. Mineralocorticoids help the body regulate salt and fluid levels, and
maintain normal blood circulation. Aldosterone is the most important mineralocorticoid
made by the adrenal glands.
SAADDES
Zona Fasciculata: this middle layer of t he adrenal cortex produces glucocorticoids. Glucocorticoids regulate sugar levels, maintain normal blood pressure, and help you respond to
stress and illness. Cortisol is t he most important glucocorticoid made by t he adrenal glands.
Zona Reticularis: is the innermost layer of the adrenal cortex. This layer is responsible for
producing androgens (male hormones). Androgens play an important role in the development of the genitals and the development of sexual characteristics such as armpit hair, genital hair, and adul t-type body odor. They also help to speed up growth. Both males and
females normally produce androgens. The androgens produced in greatest q uantity by the
adrenal cortex are "dehydroepiandrosterone (DEHA) and androstenedione. A portion of
these hormones is then made into "testosterone'; which is the most potent androgen.
Remember: The medulla of the adrenal gland rea lly is modified nervous ti ssue and functions in a m anner simil ar to postganglionic sympathetic cells - stimulati on of the adrenal
medulla causes t he release of large quantities of epinephrine and norepinephrine. The
sa m e effects are also caused by d irect sympatheti c stimulat ion, except the effects last
longer when the m edulla secretes t he hormones. With o r without one or the other (med ulla
o r sympathetic nerves), the o rgans would still be stimulated.
endocrine system
Meibomian glands (or tarsal glands) are sebaceous glands located at the rim
of the eyelid that function to protect the eyes from drying out. Meibomian
glands, release the entire secretory cell. This type of gland is referred to as:
merocrine
apocrine
holocrine
endocrine
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ANATOMIC SCIENCES
holocrine
Exocrine glands have a duct throug h which t heir product (sweat, saliva, digestive enzymes, etc.) is
released. Exocrine glands within the integumentary system include sebaceous glands (which are
associated with hair follicles and are derived from ectoderm), sweat glands, and mammary gland s.
Within the digestive system, exocrine glands include the salivary glands, gastric glands within the
stomach, and the exocri ne portion of the pancreas.
SAADDES
Mammary glands, certain sweat
glands
Holocrine Accumulate their secretions in each cell's cytoplasm Sebaceous

and release the v.1lole cell into the duct. This destroys
the cell, which is
cell.
of skin
Endocrine glands secrete their prod ucts (hormones) into the interstitial fluid surrounding the
secretory cells from which they diffuse into capillaries to be carried away by the blood. Endocrine
glands constitute th e endocrine system and include the hypothalamus, pituitary, thyroid,
parathyroid, thymus, adrenal, and pineal glands as well as the gonads and the islets of Langerhans
(endocrine cells of the pancreas).
The major salivary glands (parotid, submandibular, and sublingual) are classified as compound
tubuloalveolar glands. They deliver their salivary secretions into the mouth by way of large
excretory ducts (Stensen's, Wharton's, and the numerous small Rivinu s's ducts) respectively.
Remember: The parotid gland and von Ebner's glands are the only adult salivary glands that are
purely serous.
endocrine system
Which salivary gland(s) can have either numerous small ducts that open onto
the floor of the mouth or a single main excretory duct (Bartholin's duct)?
submandibular gland
parotid g land
SAADDES
sublingual gland
von Ebner g lands
[refer to card 174-1, 175-1for illustration]
ANATOMIC SCIENCES
189
sublingual gland
The sublingual gland is the smallest of the three main salivary glands. It contains both
serous and mucous (with serous demilunes) acini, the latter predominating. It is located
beneath the oral mucosa in the fl oor of the mouth between the mandible on one side and
the genioglossus and hyoglossus muscles on the other side. The sublingual gland sits on
the mylohyoid muscle. Unlike the submandibular gland, wh ich drains via one large duct,
the sublingual gland drains via approximately 12-20 small ducts (R ivinus's ducts) along
the sublingual fold along the fl oor of the mouth.
The sublingual gland is innervated by parasympathetic secretomotor fibers fro m
superior salivato ry nucleus of the facial nerve. The nerve fibers pass to the
submandibular ganglion via the chorda tympani nerve and the lingual nerve.
Postganglionic parasympathetic fibers pass to the gland via the lingual nerve.
Postganglionic sympathetic fibers reach the gland as a plexus of nerves around the facial
and lingual arteries.
SAADDES
The blood su pply is from the sublingual branch of the lingual artery and from the
submental branch of the facial artery.
Important:
The veins drain into the facial and lingual veins. The lymph vessels drain into the
submandibular and deep cervical lymph nodes.
Sometimes the numerous sublingual ducts (12 to 20 in number) join to form a single
main excretory duct (Bartholin's duct) that usually empties into the submandibular
duct.
Note: von Ebner's glands are located around the circu mvallate papilla of the tongue.
Their main function is to rinse the food away from the papilla after the food has been
tasted by the taste buds. These glands are purely serous.
endocrine system
Which portal venous system is critical for proper endocrine function?
hypophyseal
rena l
hepatic
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190
ANATOMIC SCIENCES
hypophyseal
A portal venous system occurs when a capillary bed d rains into another capillary bed
through veins. Both capil lary beds and the blood vessels that connect the beds are
considered part ofthe portal venous system. They are relatively uncommon as the majority of capil lary beds drain into the heart, not into another capillary bed. Porta l venous
systems are considered venous because the blood vessels that join the two capillary
beds are either veins or venules. Examples of such systems include the hepatic portal
system, the hypophyseal portal system, and the renal porta l system.
Blood supply to the pituitary g land is from the right and left superior hypophyseal arteri es and from the ri ght and left inferior hypophyseal arteries, wh ich are branches of
the internal ca rotid artery. These form the rich vascula r hypophyseal portal system.
This system of blood vessels links the hypothalamus and the anteri or pituitary. This
system allows endocrine communication between the two structures. The veins drain
into the intercavernous sinuses.
SAADDES
Important: The neurohypophysis contains abundant axons whose cell bodies are located mainly in the supraoptic and paraventricular nucl ei of the hypothalamus.
of Origin and
of Pituitary Gland
Oral ectoderm
(from roof ofstomodeum)
Adenohypophysis
(glandular portion)
Pars dista lis

Pars tubera lis
Pars intem1edia
} Anterior lobe
Neuroectoderm
(from .floor ofdiencephalon)
Neurohypophysis
(nerve portion)
Pars nervosa
Infundibulum
} Posterior lobe
endocrine system
A pathologist receives a salivary tissue biopsy of what the dentist believes is
pleomorphic adenoma. However, the dentist forgot to mention the site of the
biopsy. The pathologist identifies certain histological structures that would
indicate that this sample is not from the parotid gland. What structures can
be seen in histologic examination of the submandibular and sublingual
glands but NOT in the adult parotid gland?
SAADDES
myoepithelial cells
serous cells
interca lated ducts

serous demilunes
striated ducts
191
ANATOMIC SCIENCES
se rous demilunes
Important: Secretory cell s are found in a group, or acinus (plural, acini), which resembles
a cluster of grapes. There are three forms of acini: serous, mucous, and mixed.
Mixed acini: these glands have both serous and mucous cell s.
-The mucous cells form tubul es, but their ends are capped by serous cells that secrete
between the mucous cells' intercellul ar space. These serous ca ps on mucous cells are
called serous demilunes.
Approximately 10% of submandibular gland s conta in serous demilunes, but these
glands are predominantly serous acini, which constitute 90% of the gland.
The sublingual gland contains serous demilunes amid its predominant mucous cell
population. Serous cells are present exclusively on demilunes of mucous tubules.
SAADDES
Note: The key point is that the parotid gland and the von Ebner's glands are purely
serous and do not contain any mucous or mixed acini.
These demilune cell s secrete mucus that contains the enzyme lysozyme that degrades
the cell walls of bacteria. In this way, lysozyme confers antimicrobial activity to mucus.
Remember: All of the major salivary glands (parotid, submandibular, and sublingual) are
classified as compound tubuloalveolar gland s. This means that their ducts branch
repeatedly (compound) and their secretory portions are tubular and composed of small
sacs called alveoli or acini.
Myoepithe lial ce lls (or basket cells): are contractile cells that lie between the basement
membrane and the plasma membrane of the secretory cell s. They are also found in the
proximal part of the duct system. Myoepithelial cell s possess many actin -conta in ing microfilaments, which sq ueeze on the secretory cells and move their products toward the excretory ducts.
endocrine system
Thyroid epithelial cells (follicular cells) which are responsible for the synthesis ofthyroid hormone are arranged in spheres called thyroid follicles.
These follicles are filled with colloid.
SAADDES
192
ANATOMIC SCIENCES

Colloid is composed of thyroglobulin and iodine and is the storage form of the thyroid hormones T3 (iodothyronine) and T4 (thyroxine or tetraiodothyronine).
When the pituitary gland secretes thyrotropin, the colloid becomes active, and
thyroglobul in molecules are released and taken back into the foll icula r cells by
endocytosis, where the molecules are broken down into thyroid hormones,
thyroxine (T4) and triiodothyronine (T3).
Note: The T3 and T4 are collectively referred to as the thyroid horm ones.
These horm ones then pass out of the foll icular cells and enter the bloodstream. Within
the bloodstream, almost all of the thyroid hormones are bound to plasma proteins
such as thyroid-binding globulin (TBG).
SAADDES
The thyroid normally produces about 10% T3 and 90% T4.1n the t issues, however, much
of the T4 is converted to T3, wh ich is the major active form of the thyroid hormones at
the cellula r level.
Follicular cells remain inactive at times of low thyroid hormone need and can be
activated when it is necessary for the mobilization of colloid found w ithin the thyroid
follicle. Note: Metabolically inactive follicu lar colloid will stain acidophilic (stains
strongly w ith acid stains) while metabolically active follicular colloid w ill stain
basophilic (stains strongly with basic stains).
endocrine system
After being seen by a neurologist, a patient is diagnosed with a pituitary
adenoma. As the neoplasm increases in size, it will most likely affect which
cranial nerve?
CNI
CN II
CN Ill
CN IV
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193
ANATOMIC SCIENCES
CN II
Pituitary adenom as are tu m ors that can affect vision, sometimes caus ing vision loss. As
they grow in size, p ituitary adenomas can put pressure on important structures in the body,
such as the optic nerve. Putting pressure on the optic nerve may cause blindness.
The sella turcica (literally Turkish saddle) is a saddle-shaped depression in the sphenoid bone
at the base of the skull. The seat of the saddle is known as the hypophyseal fossa which holds
the pituitary g land (hypophysis cerebri).located anteriorly to the hypophyseal fossa is the tuberculum sellae. Completing the formation of the saddle posteriorly is the dorsum sellae.The
dorsum sellae is terminated laterally by the posterior clinoid processes.
1.The crista galli is a sharp upward projection of the ethmoid bone in the mi dline,
for the attachment of the falx cerebri.
2. The cribriform plate consists of perforated areas on either side of the crista
galli. It transmits olfactory nerve b undles.
3. The infratemporal fossa lies inferior to the tem poral fossa and the infratemporal crest on the greater w ing of the sphenoid bone.
4. The floor of the sella turcica is also the roof of the sphenoid sinus.
SAADDES
Important points to remember concerning the pituitary gland:

1. Blood supply is from the right and left superior hypophyseal arteries and from the
right and left inferior hypophyseal arteries, wh ich are b ranches of the internal carotid
artery. These form the rich vascular hypophyseal portal system.
2. The anterior pituitary or adenohypophysis is a classical gland composed predo minantly of cell s that secrete p rotein hormones.
3. The posterior pituitary or neurohypophysis is not really an organ but an extension of
t he hypothalam us. The posterior pituitary is co mposed largely of the axons of hypo thalamic neurons that extend downward as a large bundle beh ind the anterior pituitary.
The posterior p ituitary also forms the so -called pituitary stalk (infund ibulum) which appears to suspend the anterior gland from the hypothalamus.
endocrine system
Oxytocin and vasopressin are synthesized in the hypothalamus and are transported to the pituitary gland for storage by way of:
myelinated nerve fibers

both myelinated and unmyelinated nerve fibers
SAADDES
unmyelinated nerve fibers
194
ANATOMIC SCIENCES
unmyelinated nerve fibers
As opposed to the anterior lobe (adenohypophysis), which presents epithelial

characteristics, the posteri or lobe (neurohypophysis) consists of about 100,000
unmyelinated axons of secretory nerve cells, the cell bodies of which are housed in
the supraoptic and paraventri cular nuclei of the hypothalamus. The secretory
products (oxytocin and vasopressin [ADH]) are t ransported down the axons and
stored in the axon terminals, known as Herring bodies, in the neurohypophysis.
Herring bodies are in cl ose contact with capillari es, allowing the hormones to be
released into the bloodstream when needed. Thus, oxytocin and vasopressin are
synthesized in the hypothalamus and stored in and released by the
neurohypophysis (specifically, the pars nervosa).
SAADDES
Important: The hypothalamo-hypophyseal portal tract refers to the way in which

secretions by the anterior pituitary are controlled by hormones called
hypothalamic releasing and inhibiting factors. These factors are secreted within
the hypothalamus itself and then conducted to the anteri or pituitary through the rich
vascular hypophyseal portal system. This system of blood vessels links the
hypothalamus and the anterior pituitary. This system allows endocrine
communication between the two structures.
Note: Prolactin is unique among the pituitary hormones in that it is under tonic inhibitory control by the hypothalamus. Transection ofthe pituitary stalk therefore resu lts
in an increase in the production of prolactin, but a decrease in all other pituitary hormones. Prolactin inhibitory factor is none other than the neurotransmitter dopamine,
which is secreted by the hypothalamic tuberoinfundibular neurons.
nervous system
Which of the following tracts is responsible for coordinating eye and head
movements?
tectospinal t ract
rubrospina l tract
SAADDES
vestibulospinal tract
reticu lospinal tract
195
ANATOMIC SCIENCES
tectospinal tract
Tracts descending to the spinal cord are concerned with voluntary motor function, muscle tone, reflexes and equilibrium, visceral innervation, and modulation of ascending sensory signals. Universally regarded as the single most important tract concerned w ith skilled
vo luntary activity, the corticospinal t ract originates from pyrami d-shaped cell s in the premotor, primary motor, and primary sensory cortex.
\l.1jol DcsccndinJ! 1 r.1ds of the Spin.1l ( 01 d
Name
Function
Location
Origin
Termination
L<ueral conicospinal
Voluntary movement,
lateral white columns
t>.<fotor areas or ce-rebral
lateral or anterior
cone-:< opposite side- from

tract location in cord
gray c.olumtt.(!
(or crossed pyramidal) c.omracrion of individual

or small gtoups of muscle$
SAADDES
Anterior corticospinal Same as lateral conicospi- Anterior whi[e columns ?>.lotor cortex bul on same lateral or anterior
nat except mainly muscles
side as location in cord
gray c.olumns
of same side
(or d irec[ pyramidal}
lateral or ante-ior
g.rayc.olum.n..o;
Larenl reticulospinal
Mainly facilitato1y inOuence on motOI' neuron..o; to

skeletal muscles
rvtedial reticulospinal
to.'lainly inhibiory intlue.nce on motOI' neuron..o; to

skeletal muscles
Anterior whie columns Relicular fbnn.alion,

mainly the medulla
Rubi'OSJ,inal
Coordination of body
movement and posnll'e
Red nucleus (of midbrain) lateral or anterior

g.rayc.olum.n..o;
Vestibulo..o;pinal
Mediates the-influenc.es of lateral white columns

the ve..o;tibular end organ
and he cerebellum upon
e-xten..o;or muscle [One
Lateral vestibular nucleus lateral or ante-ior

g.rayc.olum.n..o;
Tectospinal ract
(c.olliculospinal tract)
Coordination of head.
neck and eye movements
Reticular fbnn.arion, mid-
brain, pon..o;, and medulla
Anterior whie columns Midbrain tec.rum
lateral or anterior
g.rayc.olum.n..o;
Rexed laminae of
g.rayc.olumn
Fasciculus gracilis........_ ',

Fasciculus
Posterior spinocerebellar._
SAADDES
''
Anterior
spinocerebellar
''
''
''
''
'A
Anterior
spinothalamic
The major ascending (sensory) tracts, shown on ly on the left here, are highlighted. The major
descending (motor) tracts, shown on ly on the right, are highlighted. The broken line indicates
the anterior/posterior orientation angle.
195 1
Reproduced w1th permission from l'auon KT.
GA: Miuby.f Handbook ofAnaiM I)' &
St. Louis, 2000. Mm;by.
nervous system
A 56-year-old male patient with ty pe II diabetes comes into the emergency
room with a painful blistering skin rash localized over the left side of his forehead. The localized area of skin with sensory innervation from a single nerve root
ofthe spinal cord is called what?
fa scicui us
dermatome
spindle
bundle
SAADDES
196
ANATOMIC SCIENCES
dermatome
Dermatomes are t he areas of skin supplied by a single spinal nerve; however, there is usually
some overlap between adjacent dermatomes. Each of the 31 segments of the spinal cord gives
rise to a pair of spinal nerves, which carry messages into and out of the CNS. These spinal nerves
branch into and service part icular areas of the body. Ultimately, each nerve ends up innervati ng a
different region of the skin, called a dermatome, with the exception of spinal nerve Cl , which
does not play a role in dermatomes.
Peripheral nerve innervation of the skin (cutaneous innervat ion) usually forms a different pattern
from spinal nerve skin innervation (dermatome) because the ventral primary divisions of spinal
nerves form plexuses. This allows multiple spinal nerves to constitute a peripheral nerve. For exam
pie, the musculocutaneous nerve is composed of ventral primary divisions of spinal nerves CS, C6,
and C7. When the cutaneous port ion of the nerve reaches the skin of the lateral foramen, the
branches from each of the spinal nerves supply their respective dermatomes. Key point to remem
ber: The pattern of distribution of the peripheral nerve (musculocutaneous) is different from the
dermatome pattern.
SAADDES
Important: Cranial nerve dermatomes do not have any overlap (are not innervated by more t han
one nerve) whereas spinal nerve dermatomes overlap each other by SO% as insurance again st
anesthesia of a dermatome. The loss of t he overlap requires the loss of innervation to three
adjacent dermatomes to produce anesthesia in the middle dermatome. For example, all three of
the dorsal roots or intercostal nerves of T4, TS, and T6 woul d have to be severed or damaged to
create anesthesia in dermatome TS. Severing a peripheral nerve produces a different pattern of
anesthesia on the skin. Note: This is diagnosed by the neurologist to determine if the lesion is in a
spinal nerve or a peri pheral nerve.
Remember: Referred pain is caused when the sensory fibers from an internal organ enter t he spinal
cord in the same root as fibers from a dermatome. The brain is poor at interpreting visceral pain and
instead interprets it as pain from the somatic area of the dermatome. So pain in the heart is often
interpreted as pain in the left arm or shoulder, pain in the diaphragm is interpreted as along the left
clavicle and neck, and the "stitch in your side" you sometimes feel when running is pain in the liver
as it s vessels vasoconstrict.
SAADDES
196-1
Dermatome distribution of spinal nerves. A, The front of the body's surface. B, The back
of the body's surface.
nervous system
Wernicke's area is located within which cerebral lobe?
parietal lobe
occipital lobe
temporal lobe
frontal lobe
SAADDES
197
ANATOMIC SCIENCES
temporal lobe
The cerebrum or cortex (the extensive outer layer of gray matter of the cerebral hemispheres) is the largest part of the human brain, associated w ith higher brain function
such as thought and action. The cerebral cortex is divided into four sections, called
" lobes": the frontal lobe, pari etal lobe, occipital lobe, and tempora l lobe.
Note: (1) The limbic system, often referred to as the "emotional brain; is found buried
within the cerebrum. (2) Basal nuclei are gray matter stru ctures deep within each cerebral hemisphere that help to control skeletal muscle activity.
3. Somesthetic area
2. Motor area
Controls th in m uscles of th e body {fingers.
mouth, feet, eye...
Receives sensations, tempetature and pain

sensations from the body
SAADDES
Cootdinates movements
Controls speech (articulation of words}
Parietal lobe (3)
Frontal lobe (1,2)
Occipital lobe (4)
3. Prefrontal area
-Elaborates the th inking
4. Visual area
process
Detects visual signals
Plan ning of complex move-
ments
Temporal lobe (5,6,7)

S. Auditory area
- Detects au ditory signals
7. Short-term memory area

- Stores shotHefm memory (that
lasts for a few seconds)
6. Wernicke's area
-Interprets the significance of sentences as they
are heard and wrinen
Parietal Lobe
Frontal Lobe
Occipital
Lobe
SAADDES
Temporal
Lobe
Medulla Oblongata
Spinal Cord
197-1
Lobes of the Brain - Lateral view
Median section of the brain

Central
sulcus
Corpus
callosum
SAADDES
Lateral
ventricle
Thalamus
Occipital
lobe
Hypothalamus
Midbrain / /
/
Temporal lobe
Pons
Medulla oblongata
Cerebellum
Spinal cord
197 A l
The Basal Nuclei
Lateral ventricle
SAADDES
Putamen
-+l,__,_o.,.L.----Jo+- Globus pallidus
Third ventricle
Thalamus
197 B l
PARIETAL LOBE
behaviour
Intelligence
memory
movement
intelligE>.,ce
language
reading
sensation
SAADDES
TEMPORAL LOBE
beh I!LJr
h anng
poeeh
CEREBELLUM
balance
coor dination
VISiOn
mt
ry
BRAIN STEH
bloCid pre ou-- P
brcathmg
consciOusness
heartbeat
swallowing
197 C-1
nervous system
Which structural component of a neuron sends impulses away from the cell
body?
neuroglial cell
perikaryon
dendrite
axon
SAADDES
198
ANATOMIC SCIENCES
axon
Nervous tissue is composed of two types of cells:
1. Neurons - transm it nerve impulses.
2. Neuroglial cells (glial cells) - are non-conducting "support cells" of nervous
tissue. Examples include astrocytes, attached to the outside of a capil lary blood
vessel in the brain, phagocytic microglial cells, and ciliated ependymal cells that
form a sheath that usually lines flu id cavities in t he ventricu lar system of the brain.
Structure of a neuron:
Cell body (perikaryon)- contains the nucleus and most of the cytoplasm. Located
mostly in the centra l nervous system as clusters called nuclei, some found in the
peripheral nervous system as groups cal led ganglia.
Dendrites - neuronal processes that send the impulse towa rd the cell body. There
may be one or many dendrites per cell. Some neurons Jack dendrites.
Axon (nerve fiber) - neuronal process that sends t he impulse away from the cell
body.
SAADDES
***If the axon is covered with a fatty substance called myelin, t he axon is referred to
as a myelinated fiber. If there is no myelinated cover, then the axon is referred to as
an unmyelinated fiber.
Neurons are classified according to structure (based on t he number of processes t hat
extend from the cell body): bipolar, unipolar, or multipolar (most common). They are
also classified accord ing to function: motor (efferent), sensory (afferent), o r
interneurons (which lie between sensory and motor neurons in the CNS).
Note: Whether or not someone feels different stimuli (pain, temperature, pressure, etc.)
is determined by t he specific nerve fiber stimulated.
A multipolar neuron (Ex. spinal motor neuron)
SAADDES
Initial
y-
segment
D11ect1on of
NodeofRanvier
signal transmission
""'"'"'""-::---
198-1
Types of Neurons
Multlpopar neurons
Pur1<inje cell
Dendrites
Axon
SAADDES
Bipolar neurons
Retinal neuron
Anaxonic neuron
198A I
Dendrites
nervous system
A 14-year-old female patient presents to the physician with hyperpigmented
lesions (cafe-au-fait spots), hamartomas of the iris (Lisch nodules), and
axillary freckling (Crowe's sign). The patient had previously been diagnosed
with neurofibromatosis, but is now complaining of generalized pain and
tingling. The physician discovers multiple neurilemmomas, classifying the
disease as a form of neurofibromatosis. Neurilemmomas are a neoplasm of
myelin producing cells in the peripheral nervous system known as?
astrocyte
SAADDES
oligodendrocyte
schwann cell
m icroglial cell
satellite cell
199
ANATOMIC SCIENCES
schwann cell - also called neurolemmocyte or neurolemma cell
Schwann cells in the peripheral nervous system serve as supportive, nutritive, and
service facil ities for neurons. The gaps in the myelin sheath that occur between
adjacent Schwann cells are called nodes of Ranvier, and serve as points along the
neuron for generating a signal. Signals jumping from node to node t ravel hundreds
of times faster than signals traveling along the surface ofthe axon (known as saltatory
conduction). This allows your brain to communicate w ith you r toes in a few
thousandths of a second.
Note: There are no Schwann cells in the CNS (central nervous system); the myelin
sheath (in the CNS) is formed by the processes of the oligodendrocytes.
SAADDES
Remember: The neural crest is a band of neuroectodermal cells that lie dorsolateral
to the developing spinal cord, where they separate into clusters of cells (neural crest
cells) that develop into dorsal root ganglion cells, autonomic ganglion cells,
chromaffin cells of the adrenal medulla, neurolemma cel ls (Schwann cells),
integumentary pigment cells (melanocytes), and the leptomeninges (pia mater
and arachnoid mater), wh ile the dura mater is derived from mesoderm.
Important: Microglial cells are the resident immune cells of the central nervous
system. Their function resembles that of tissue macrophages.
nervous system
Which of the following ascending tracts of the spinal cord function to
carry pain and temperature sensory information to the thalamus?
lateral spinothalamic tract

anteri or spinothalamic tract
SAADDES
fasciculus gracilis
fasciculus cuneatus
spinocerebellar t ract
ANATOMIC SCIENCES
200
lateral spinothalamic tract

The white matter of the spinal cord contains tracts that travel up and down the cord. Many of these
tracts travel to and from the brain to provide sensory input to t he brain, or bri ng motor stimuli from
the brain to control effectors. Ascending tracts, those t hat travel toward the brain are sensory,
descending tracts that travel away from the brain are motor.
\srl'ndinj;! I rach of lhl' Spin.tl Curd
Name
Function
Lateral spinothalamic
Pain, temperamre, and crude Lateral white columns

wuch of opposite side
Location
Origin
Termination
Posterior gmy column l'halamus

of opposite side
Anterior spinothalamic Crude rouch and pressure
Anterio1 white colum.ns Posterior gmy column l'halamus

of opposite side
Fasciculus gracilis and Discriminating touch and

pressure sensations
("'ostel'ior white columns Spinal ganglia ofsame Medulla
cuneatus
SAADDES
Anterior and posterior

spinocerebe.llar
Unconscious kinesthe$ia
side
Lateral white columns
Antel'io1 or JX>Steriol'
gray column
Cerebellum
Note: Axons of cells within nucleusgracilisand nucleus cuneatus cross as internal arcuate fibers and
form the medial lemniscus. The medial lemniscus is thus a large ascending bundle of heavily myelinated axons (fast conducting) whose cell bodies lie in the contralateral nucleusgracilis and nucl eus
cuneatus.The medial lemniscuspasses rostrally through the medulla, pons and midbrain to terminate
in the vent ral posterolateral (VPL) nucleus of the thalamus. Cells in the VPL then send their axons to
t he postcentral gyrus (somatosensory cortex) of the cerebral cortex.
Note: For most tracts, the name will indicate if it is a motor or sensory tract. Most sensory tracts names
begin with spino, indicating origin in the spinal cord, and their names end with the pa rt of the bra in
where the tract leads. For example, the spinothalamic tract travels from the spinal cord to the thalamus. Tracts whose names begin wit h a part of the brain are motor. For example, t he corticospinal
tract begins with fibers leaving the cerebral cortex and travels down toward motor neurons in the
cord .
Fasciculus gracilis........_ ',

Fasciculus
Posterior spinocerebellar._
SAADDES
''
Anterior
spinocerebellar
''
''
''
''
'A
Anterior
spinothalamic
The major ascending (sensory) tracts, shown on ly on the left here, are highlighted. The major
descending (motor) tracts, shown on ly on the right, are highlighted. The broken line indicates
the anterior/posterior orientation angle.
195 1
Reproduced w1th permission from l'auon KT.
GA: Miuby.f Handbook ofAnaiM I)' &
nervous system
Which of the following spinal nerve structures is exclusively composed of
sensory fibers?
ventral root
dorsal root
ventral ram i
dorsal ram i
SAADDES
201
ANATOMIC SCIENCES
dorsal root
The spinal cord is the connection center for the reflexes as well as the afferent (sensory) and efferent (motor)
pathways for most of the body below the head and neck. The spinal cord begins at the brainstem and ends
at about the second lumbar vertebra. The sensory, motor, and interneurons are found in specific parts of
the spinal cord and nea rby structures. Sensory neurons have their cell bodies in the spinal (dorsal root)
ganglion . Their axons travel through the dorsal root into the g ray matter of the cord. Within the gray matter are interneurons w i th which the sensory neurons may connect. Al so located in the gray matter are the
motor neurons whose axons travel out of the cord through the ventral root. The wh it e matter surrounds
the gray matter. It contains the spinal tracts that ascend and descend the spinal cord.
At 31 places along the spinal cord, the dorsal and ventral roots come together to form spinal nerves. Spinal
nerves contain both sensory and motor fibers, as do most nerves. Spinal nerves are given numbers that ind icate the portion of the vert ebral column in which the nerves ari se. There are 8 cervical (C 1-C8), 12 thoracics (T1-T1 2), 5 lumbar (L1-L5), 5 sacral (S1-S5), and 1 coccygeal nerve. Nerve ( 1 arises between t he
cranium and atlas (1st cervical vertebra), and (8 ari ses between the 7th cervical and 1st thoracic vertebra.
All the others arise below the respective vertebra orformer vertebra in the case of the sacrum.
SAADDES
Spinal nerves divide into b ranches called rami. Ventral primary rami exit anteriorly, and dorsal primary rami,
posteri orly.
A nerve pl exus i s a network of adj acent spinal nerves that join t ogether. The name of each plexus describes
the area its nerves supply. The maj or nerve plexuses and areas they supply are:
cervical: head, neck, shoulders, d iaphragm
brachial: upper limbs, and some neck and shoulder muscles
lu mbar: part of the abdominal wall, lower limbs, and external mal e genitalia
sacral: perineum, buttocks, and most of the lower limbs
pudendal: external f emal e genitalia
Sensory impulses travel along the sensory (afferent, or ascending) neural pathways to the sensory cortex in the parietal lobe of the brain where they are interpreted. Motor impulses travel from the brain to the
muscles along t he motor (efferent, or descending) pathways. These impul ses orig inate in the motor cortex of the frontal lobe and travel along upper motor neurons to t he peripheral nervous system. Upper
motor neurons originate in t he brain and form two major systems, the pyramidal and extrapyramidal
systems.
Ventral root
Spinal nerve
SAADDES
""'- ventral ramus
2011
Anatomy of a Nerve
Spinal nerve
Blood vessels
SAADDES
Unmyelinated
nerve fiber
Myelinated
nerve fiber
Endoneurium
Cross section
201 A-1
nervous system
A student dozing off in class is unexpectedly called on by the professor to
answer a question. Not knowing the answer, the hair on the back of the
student's neck stands up, his pupils dilate, and his heart starts to race. This
fight-or-flight response is controlled by the:
somatic nervous system
SAADDES
autonomic nervous system

central nervous system
sensory nervous system
202
ANATOMIC SCIENCES
autonomic n er vou s system

The central nervous syst em includes the brain and spinal cord. The peripheral nervous
syst em consists of all body nerves. Motor neuron pathways are of two types: somatic
(skeletal) and autonomic (smooth muscl e, cardiac muscle, and glands). The autonomic system is subdivided into the sympathetic and parasympat hetic systems.
The PNS consists of all nervous structures located outside the CNS. The PNS includes the
cran ial nerves, arising fro m the inferior aspect of the brain, and the spinal nerves, arising
from the spinal cord. The PNS is divided functionally into afferent (sensory) and efferent
(motor) divisions.
The afferent division of the PNS includes somatic sensory neurons which carry impulses to the CNS from the skin, fascia, and j oints, along w ith visceral sensory n eurons,
which carry impulses from the viscera of the body (hunger pangs, b lood pressure) to the
CNS
The efferent division of the PNS is divided into the somatic (voluntary) and autonomic (involuntary) nervous system
SAADDES
Comparison of the Somatic and Autonomic Nen ous

Feature
Soma tic
stems
Autonomic
Effectors
Skeletal muscle
Glands, smooth muscle, cardiac muscle
Control
Usually volumary
Usually involuntary
Efferent pathways
One nerve fiber from CNS Two nerve fibers from CNS to effector;
to effector; no ganglia
synapse at a ganglion
Neurotransmitters
Acetylcholine (Ach)
Ach and norepinephrine (N)
Effect on target cells
Always excitable
Excitatory or inhibitory
Effect of denervation Flaccid paralysis
Denervation hypersensitivity
SAADDES
Divisions of the Nervous System
2021
nervous system
Which ofthe following separates the occipital lobe and the cerebellum?
fa lx cerebri
fa lx cerebelli
tentorium cerebell i
SAADDES
corpus ca llosum
203
ANATOMIC SCIENCES
tentorium cerebelli
The meninges are t hree concentric protective membranes surrounding the brain and spinal cord (the CNS).
1. Dura mater- the outermost t ough fibrous layer that li nes t he skull and forms fold s, or reflections,
t hat descend into the brain fissures and prov ide stabi lity.
The dural folds are t he following:
Falx cerebri -lies in the longit ud inal fissure and separates t he cerebral hemispheres
Tentorium cere belli - sepa rat es the occipi tal l obe of t he cerebrum and t he cerebellum
Falx cere belli - separates t he two lobes of the cerebell um
2. Arachnoid mater - i s a fragile network of collagen and elastin fibers w ith a cobweb-like appearance.
The arachnoid membrane has moderate vascularit y and lies bet ween t he dura mat er and t he pia mat er.
3. Pia mater- innermost membrane, i t i s an extremely t hin membrane made up of collagen and elast ic fi bers cont aining many bl ood vessel s. The pi a mater ad heres closely to the brain and spinal cord .
SAADDES
** *These are the struct ures involved in meningiti s, an inflammation of t he meninges, w hich, if severe, may
become encephaliti s (an inflammation of the bra in).
The subarachnoid space, filled w ith cerebrospinal fluid, separat es t he arachnoid membrane and t he pia
m ater. In addit ion, t he meningeal area has two pot ential spaces:
Epidural space- over t he dura mat er; becomes a real space in the presence of pathology, such as accumul ation of blood from a torn meningeal artery (an epid ural hemat oma)
Subdural space - a closed space w ith no egress bet ween t he dura mater and the arachnoid memb rane; often the site of hemorrhage aft er head trauma
Note: In t he ventricles of t he b rain, the pia mater and ependymal cells contribute to t he formation of t he
choroid plexuses. It i s these pl exuses t hat regulate t he intravent ri cular pressure by secretion of cereb rospinal fl uid .
Typt of Meningealllemorrhage
Associated Vessel
l!ptdural
Middle meningeal artery
Subdural
Bridging vein
Subamchno1d
C1rd c o( Wdhs (berry aneurysm)
Choroid
plexus (CSF
production)
Monro
Skull
Pia mater
SAADDES
space
Fourth
ventricle
space
203-1
Meninges and Ventricles of the Brain
The meninges of the brain
SAADDES I
Skull
Superior sagittal sinus
Dura
mater
Arachnoid mater
Subarachnoid
space
Pia mater
Brain
Z03A I
nervous system
Which of the following cranial nerves arise in the pons?

trigeminal nerve (CN V)
SAADDES
abducens nerve (CN VI)

facial nerve (CN VII)
204
ANATOMIC SCIENCES
trigeminal nerve (CN V)

*..,.The olfactory, optic, oculomotor and troch lear cranial nerves are located in the anterior portion
of the brain. The trigemina l, abducens, and facial nerves arise in the pons. The vestibulocochlear nerve
arises in the inner ear and goes to the pons. The glossopharyngeal, vagus, accessory and hypoglossal nerves are attached to the medulla oblongata.
The brain stem, which is continuous with the spinal cord below, consists of the midbrain, pons, and
medulla. Passing th rough the brain stem are ascending pathways carrying sensory information from
the spinal cord to the brain, and descending pathways, carrying motor commands down to the spinal
cord. Centers in the brain stem regulate many vital functions, including heartbeat, respirat ion, and
blood pressure.
SAADDES
The midbrain connects dorsally with the cerebellum. The midbrain relays motor signals from
the cerebral cortex to the pons, and sensory transmission in the opposite direction, from the spinal
cord to the thalamus. The substantia nigra in the midbrain helps to control movement. Lesions
of the substantia cause Parkinson's disease.
The pons lies below the midbrain and connects the cerebellum with the cerebrum. The pons
also links the midbrain to the medulla oblongata.lt is involved with motor activity of the body
and organs. In addition to housing one of the brain respiratory centers, the pons acts as a pathway
for conduction tracts between brain centers and the spinal cord, and serves as the exit point for
cranial nerve V.
The medulla oblongata is the most inferior portion of the brain stem and isa small, cone-shaped
structure that joins the spinal cord at the level of the foramen magnum. The medulla oblongata
functions primari ly as a relay station for the crossing of motor tracts between the spinal cord and
the brain. The medulla oblongata also contai ns mechanisms for controlling reflex activities such
as coughing, gagging, swallowing, and vomiting. The medulla oblongata also contains a central
core of gray matter called the reticular formation. This area is involved in regulat ing sleep and
arousal (via reticular activating center) and in pain perception, and includes vital centers that regulate breathing and heart activity.
HUMAN BRAIN
SAADDES
callosum
ellum
204 1
nervous system
Which of the following meningeal structures is a ring-shaped fold that allows
the passage of the infundibulum of the pituitary gland?
tentori um cerebelli
falx cerebri
falx cerebelli
SAADDES
diaphragma sellae
205
ANATOMIC SCIENCES
diaphragma sellae
The dura mater is the outermost tough fibrous layer that lines the skull and fo rms
folds, or reflections, that descend into the brain's fissu res and provide stabili ty. The dura
mater is composed of two layers. The periosteal layer adheres tightly to the inner surface of the cranium, and the meningeal layer forms partitions (folds or reflections)
that descend into the brain's fissures and provide stabili ty.
The dural folds are the following:
Two vertical folds:
Falx cerebri - lies in the longitudinal fissure and separates the cerebral
hemispheres. Contains inferior and superior sagittal sinuses.
Falx cerebelli - separates the two lobes of the cerebellum. Contains occipital
sinus.
SAADDES
A horizontal fold:
Tentorium cerebelli - separates the cerebrum and the cerebellum. Contains
the straight, transverse, and superior petrosal sinuses.
The dural venous sinuses are spaces between the periosteal and meningeal
layers of the dura. The sinuses conta in venous blood that originates for the most part
from the brain or cran ial cavity. The sinuses contain an endothelial lining that is
continuous into the veins that are connected to the sinuses. There are no valves in
the sinuses or in the veins that are connected to the sinuses. The vast majori ty of the
venous blood in the sinuses drains from the cranium via the internal jugular vein.
Note: The diaphragma sellae is a ring-shaped fold of dura mater covering the sella turcica, and contain ing an aperture for passage of the infundibulum ofthe pituitary gland.
SAADDES
Stra'ight
sinus
Dural reflections (large shaded areas toward inside) and dural sinuses (small shaded
areas on peripheral) after removal of the brain. T he sigmoid sinus of the right side
is seen through the tentorial incisura.

205 1
Reproduct'd with pe1mission from Kicman. JA: BanS 111e H11mtm
Sy.ftem. eJ 9. Bnllimorc:. 2009. Lippincon Willinms & Wilkms.
nervous system
The diencephalon lies beneath the cerebral hemispheres and contains which
of the following?
thalamus
pons
medulla
SAADDES
hypothalamus
206
ANATOMIC SCIENCES
thalamus
hypothalamus
The brain lies within the cranial cavity of the skull and is made up of billions of nerve cells (neurons)
and supporting cells (glia). Neuronal cell bodies group together as gray matter, and their processes
group together as white matter.
The brain can be divided into four main parts: the cerebrum, diencephalon, brain stem, and cerebellum.
The cerebrum is the largest part of t he brain and consists of t he four paired lobes with the two
cerebral hemispheres, connected by a mass of white matter called the corpus callosum. The
cerebrum accounts for about 80% of the brain's mass and is concerned with higher functions, including perception of sensory impulses, instig ation of voluntary movement, memory, thought,
and reasoning. There are two layers of the cerebrum:
-The cerebral cortex is the thin, wrinkled gray matter covering each hemisphere
-The cerebral medulla is a thicker core of white matter
SAADDES
The diencephalon lies beneath the cerebral hemispheres and has two main structu res- the thalamus and the hypothalamus. The walnut-sized thalamus is a large mass of gray matter that lies
on either side of the third ventricle. The thalamus is a great relay station on the afferent sensory
pathway to the cerebral cortex. The tiny hypothalamus forms the lower part of the lateral wall
and floor of the third ventricle. The hypothalamus exerts an influence on a wid e range of body
functions.
The cerebellum is attached to the brain and feat ures a highly fold ed surface.lt is important in
the control of movement and balance.
The brainstem is the lower extension of the bra in where it connects to the spinal cord. It consists
of the midbrain, pons, and medulla.
Remember - Each portion of the brain consists basically of three areas:
1. Gray matter - composed primarily of unmyelinated nerve cell bodies
2. White matter - composed basically of myelinated nerve fibers
3. Ventricles - spaces filled with cerebrospinal fluid
Corpus callosum
Hypothalamus
SAADDES
Brain stem
Brain - Sagittal view

206 1
Reprodud with penniss1on from Barron :1 AJJau,ny Flash Cartl1. Australia. 2009. Global Book Publis hing.
nervous system
Which type of neuroglial cells form myelin in the CNS?
astrocytes
oligodendrocytes
m icroglia
SAADDES
ependymal cel ls
207
ANATOMIC SCIENCES
oligodendrocytes
Neuroglial cells, t he other major cell type in neural tissue, provide struct ural integrity to the nervous
system and fu nctional support that enables neurons to perform. Neuroglia do not typically have
synapses at their surface. Classically neuroglial cells are described as existing only in the central
nervous system (brain and spinal cord). Cells in the PNS that support neurons include Schwann
cells and satellite cells. Note: With the exception of microglia, which derive from mesoderm, all
neuroglia derive from ectoderm.
Cell
St ructure
Function
CNS
.
.
.
.
.
Astrocytes
Many processes attached to their

cell body
Provide s tmctural
Oligodendrocytes
S maller cell bodies than

a'itrocytes and relatively fewer
proc.esses leaving the cell body
Form m yelin sheaths around axons in

the CNS
Microglia
S mallest cell bodies a mong the.

neuroglia
Main phagocytic cell and antigenl>resenting cells in the CNS
Ependymal cells
Columnar cells with ciliated free.

surfaces
Line most of the ventricular system of

the CNS
Choroidal cells
Modified ependymal cells
Form the inner layer of the choroid

l.,lexu.s. Secrete cerebros pinal fluid
into the ventricles
S mall, flattened cells
Support cell
SAADDES
P NS
.
.
S atellite. cells
in ganglia within
the PNS
Schwann cells
Flattened cells arranged in series

around axon.s
F orm m yelin within the PNS
1. Schwann cells in the PNS myelinate a single axon

2. Oligodendrocytes in the CNS myelinate many (50+) axons
nervous system
Cell bodies of preganglionic sympathetic fibers to the head are located in the:
superior and m iddle cervical ganglia

lateral gray horns of segments Tl to T4 of the spinal cord
anterior gray horns of segments Tl to T4 of the spinal cord
SAADDES
lateral gray horns of segments 52 to 54 of the spinal cord
208
ANATOMIC SCIENCES
lateral gray horns of segments T1 to T4 of the spinal cord

The autonomic nervous system runs bodily functions w ithout our awareness or control. It is the mot or system to visceral organs. It is d ivided into t wo systems:
Sympathetic (thoracolumbar) d ivision:
- "Fight, fright, or flight"
- Derived from thoracic and lumbar spi nal nerves (T1 -L2)
Preganglionic neuron s (myeli nated): relatively short
- Cell bod ies are located in the int ermediolateral g ray column of thoracic and lumbar vertebrae
- The axons of preganglionic neurons exit ventral root into the w hite ramus communication then
they synapse w ith postganglionic axons in peripheral ganglion at the same level or another level
- Neurotransmi tter is acetylcholi ne
Postganglionic axons (unmyeli nated): relatively long
- Cell bodies in peripheral ganglia extend t o v isceral organs
- Distribution is w idespread
-Neurotransmi tter is norepi neph rine except for adrenal med ulla and sweat glands
SAADDES
Parasympathetic (cra nial-sacral) d iv ision:

-"rest and d igest
- Derived from cranial and sacral nerves - CN Ill, VII, IX, and X; 52-54
Preganglionic neurons (myelinated): relatively long
-Synapse w ith postganglionic axons in ganglia close t o organs

-Neurotransmi tter is acetylcholi ne
Postganglionic axons (unmyelinated): relatively short
-Neurotransmi tter is acetylcholi ne
- Distribution is more specific and less d iffuse than sympathetic
Sympathetic vs. Parasympathetic
Most organs have dual innervation
In general, the actions of one system oppose those of the other
Both divisions are cooperative in salivary g lands
Predominant tone is parasympatheti c in m ost organs
Sympathetic tone exists solely in adrenal med ulla, sweat glands, piloerector muscles of skin, and many
b lood vessels
Sympathetic d istribution t ends to be more diffuse w hereas parasympathetic is more specific
nervous system
The lateral ventricles communicate with each other by:
the two foramina of Luschka

the interventricular foramen
the cerebral aqueduct
SAADDES
septum pellucidum
the foramen of Magendie
209
ANATOMIC SCIENCES
septum pellucidum
There are four ventricles in the brain. They connect with each other, the central canal of the
spinal cord, and the subarachnoid space surrounding the brain and spinal co rd. The ventricles contain cerebrospinal flui d, wh ich acts as a shock absorber, cush ioning t he b rain
from mechanical forces.
The right and left lateral ventricles are in the right and left cerebral hemispheres, respectively. They co mmunicate w ith each other by the septum pellucid urn. They also communicate with the narrow third ventricle in the d iencephalon through a sm all open ing, the
interventricular foramen (foramen of Monro). The third ventricle is continuous w ith the
fourth ventricle via the cerebral aqueduct (also call ed the aqueduct of Sylvius) that traverses the midbra in. The fourth ventricle is located dorsal to the pons and medulla, and ven tral to the cerebellu m. A single median aperture (foram en of Magendie) and a pair of
lateral apertures (foramina of Luschka) provide communication between the fourth ventricle and the subarachno id space.
SAADDES
Cerebrospinal fluid is produced mainly by a structure call ed the choroid plexus in the
lateral, third and fourth ventricles. CSF flows from the lateral ventricle to the th ird ventricle
through the interventricular foramen (also called the foramen of Monro). The th ird ventricle and the fourth ventricl e are connected to each other by the cerebral aqueduct (also
called the aqueduct of Sylvius). CSF then flows into the subarachno id space through the
foramina of Luschka (there are two of these) and the foramen of Magendie (only one of
these).
Note: Absorption of the CSF into the bloodstream takes p lace in the superior sagittal sinus
through structures called arachnoid granulations (arachnoid villi). When the CSF pressure
is greater than the venous pressure, CSF w ill flow into the b loodstream. However, the arachnoid villi act as "one way valves"- if the CSF pressure is less than the venous pressure, the
arachnoid villi will NOT let b lood pass into the ventricul ar system.
Lateral
...
space
Posterior horn
SAADDES
Third
Cerebral aqueduct
Fourth ventricle
Brain Ventricles - Sagittal view

Reprodud with penniss1on from Barron :1 AJJau,ny Flash Cartl1. Australia. 2009. Global Book Publis hing.
2091
nervous system
The spinal cord terminates at the:
conus medullari s
subarachnoid space
filum term inale
SAADDES
arachnoid space
cauda equina
central canal
210
ANATOMIC SCIENCES
conus m e dullaris
The spinal cord ends in the adult as a constriction called the conus medullaris around ll
(ll to l 2). The dura and arachnoid, however, continue down to level 52, where the
arachnoid fuses with the filum terminale. Thus, a needle inserted between the spines at
L3, l4, or lS will enter the subarachnoid space, which is filled with cerebros pinal fluid,
w ithout injuring the spinal cord.
Cauda equina is a bundle of nerves occupying the spinal column below the spinal cord in
most vertebrates that consists of nerve roots and rootl et s attached to the spinal cord. It
serves the legs.
Cerebrospinal fluid (CSF) is a colorless, thin fluid found in the ventricles of the brain, the
subarachnoid space, and the central canal of the spinal cord. CSF is produced mainly by a
structure called the choroid plexu s in the lateral, th ird and fourth ventricles. CSF escapes
the ventricular system of the brain through the three fora mina of the fourth ventricle and
so enters the subarachnoid space. CSF now circulates both upward over the surfaces of
the cerebral hemispheres and downward around the spinal cord. The subarachnoid space
extends down as far as the second sacral vertebra. Eventually, the flu id enters the
bloodstream by passing into the arachnoid villi and diffusing through their walls.
SAADDES
1. The choroid plexuses regulate the intraventricular pressure by secretion of

cerebrospinal flui d.
2. The cerebrospinal fluid, along with the bony and ligamentous walls of the
vertebral canal, protects the spinal cord from injury.
3. Ependymal cell s are cells that make up the lining membrane of the ventricles
of the brain and of the central canal of the spinal cord. They are also present in
the choro id plexus of the central nervous system and participate in the
production of cerebrospinal fluid.
Supraspinous ligament
Interspinous ligament
CSF in lumbar cistern
Extradural (epidural)
space
SAADDES
lumbar spinal puncture

for spinal anesthesia
-.....1-'111'..-..,..J
llt-- --1
Spinous process of l4
lumbar injection for

epidural anesthesia
Extradural space In sacral canal
Lumbar Spinal Pun cture

Rcproc:b:cd vrmh pnmlSSIOil from MOOR KL lniiC') Af. Apr AMR; Chn1tal Onmtcd Amtomy. cd 6: lblluno".2010. Larruacou Wtllums
&.W1Ikau.
nervous system
The dorsal root ganglion is a collection of cell bodies for afferent nerve fibers
(mostly sensory) that exists just outside of the spinal cord.
There is no ventral root ganglion because the motor efferent fibers have their
cell bodies in the ventral horns (anterior portion of the grey matter) of the
spinal cord.
SAADDES
the first statement is true, the second is fa lse

the first statement is fa lse, the second is t rue
211
ANATOMIC SCIENCES

The spinal cord extends from the base of the skull to a point above two-thi rds of the way down the back.
running through the vertebral canal.
Wi thin the spinal cord, the H-shaped mass of gray matter is divided into horns, which consi st mainly of
neu ronal cell bodies and an intermediate zone.
Posterior (dorsal) horns: are specialized to process sensory information such as touch, pain. and
joint sensation, and to relay this information to the brain
Anterior (ventral) horns: contain motor neurons. which transmit messages out to the muscles
via spinal nerves
Note: In the devel oping nervous system, the basal plate is the region of the neuraltube ventral to the sulcus limitans. It extends from the rostral mesencephalon to the end of the spinal cord and contains primarily motor neurons, w hereas neurons found in the alar plate are primarily associated wi th sensory functions.
Dorsal root ganglia (or spinal ganglion): is a nodul e on a dorsal root that contains cell bod ies of neurons
in afferent spinal nerves. The axons of dorsal root ganglion neurons are known as afferents.ln the peripheral nervous system, afferents refer to the axons that relay sensory information into the central nervous
system (i.e. the brain and the spinal cord). These neurons are of the pseud o-unipolar type, meaning they
have an axon w ith two branches that act as a single axon, often referred to as a d istal p rocess and a proximal process.
SAADDES
Upper motor neurons (UMNs): are motor neurons that originate in the motor region of the cerebral cortex or the brain stem and ca rry motor information down to the final common pathway. that is, any motor
neurons that are not directly responsible for stimulating the target m uscle. The main effector neurons for
voluntary movement lie w ithin layer V of the primary motor cortex and are called Betz cells. The cell bodies ofthese neurons are some of the largest in the b rain, approaching nearly 100
d iameter.
Lower motor neurons (LM Ns): are the motor neurons connecting the brainstem and spinal cord to muscle fibers. bringing the nerve impul ses from the upper motor neurons o ut to the muscles. A l ow er motor
neu ron's axon terminates on an effect or (muscle). l ow er motor neurons are classified based on the type of
muscle fiber they innervate:
Alpha motor neurons innervate extrafusal muscle fibers. the most numerous type of muscle fiber and
the one involved in muscle contraction.
Gamma motor neurons innervate intrafusal muscle fibers, w hich together w it h sensory afferents compose muscle sp indles. These are part of the system for sensing body position (propriocepti on).
Spinothalamic
SAADDES
Posterior ramus of
spinal nerve
Schwann
cell
Dura mater
Spinal Cord - Cross-Section view

Rcrrodud wnh
from
6 Anato"n Flash Canh. AusttaLLL 2009. Global Book Pubhshm&.
211-1
nervous system
In the peripheral nervous system, which fibers carry impulses to smooth and
cardiac muscle as well as to glands?
somatic afferent fibers

visceral afferent fibers
SAADDES
somatic efferent fibers

visceral efferent fibers
212
ANATOMIC SCIENCES
visceral efferent fibers

Functionally. the fibers of peripheral nerves may either be somatic or visceral and also either sensory
(afferent) or motor (efferent).
There are four types of fibers:
1. Somatic sensory (afferent) fibers carry impulses from cutaneous and proprioceptive receptors.
2. Visceral sensory (afferent) f ibers carry impulses from the viscera.
3. Somatic motor (efferent) fibers carry impulses to skeletal muscle.
4. Visceral motor (efferent) fibers carry impulses to smooth and card iac muscle and to glands.
Somatic motor vs. Visceral motor:
Somati c motor neurons are di rected from cortical levels to skeletal muscles and are voluntary
Visceral motor neurons are d irected from the hypothalamus and midbrain and are involuntary, but
have input from the cortex and thalamus
Somatic lower motor neurons are in the ventral horn of gray matter and the neurotransmitter at
skeletal muscle is acetylcholine
Visceral motor neurons come from cranial nerves or the intermediolateral gray horn, involve t wo neurons, and the neurotransmitter is either acetylcholine or norepinephrine at either card iac muscle, smooth
muscle, or g lands
SAADDES
(
of
Origin in CNS
' ' mpalhllll ant.l Paras\ mpalhllll On l'!oiUR'!o
Symparhttit
Ftatur\
Location of ganglia
(CN Ill, VII. IX. and X; S 2-S4)
ganglia adjacent to Tcmlinal ganglia near or wrthin targcc
spinal column and prcvertebrol

ganglia an1crior to rt
Fiber lengths
Parasympalhetic
T horacolumbnr (T IL2)
organs
Shon prcganghonic
Long pregang lionic
Long postganglionic
Shon postganglionic
Mmunal {about I :2)
Neuronal divergcne<
Extensive (about 1:17)
EO.ttcs on system
Ol)cn
Prcganghonic
neurotransmitter
Acykhohne
and general
More local and spiftc

Acylcbolanc
Postganglionic
Noradrenaline
ncurotransmincr
glands and adrenal medulla)
for sweat
Parasympathetic System
Constricts pupils
Stimulates flow
of saliva
Constricts bronchi
Slows
SAADDES
and secretion
Stimulates bile
release
Contracts bladder
2121
Sympathetic System
Dilates pupils
Inhibits salivation
Relaxes bronchi
Accelerates heartbeat
SAADDES
Inhibits peristalsis
and secretion
Stimulates glucose
production and release
Inhibits bladder contraction

Stimulates orgasm
212AI
nervous system
The ciliary, pterygopalatine, submandibular, and otic ganglia are all:
sympathetic ganglia
parasympathetic ganglia
both sympathetic and parasympathetic ganglia
SAADDES
neither sympathetic nor parasympathetic ganglia
213
ANATOMIC SCIENCES
parasympathetic ganglia
Parasympathet ic ganglia are the autonomic ganglia ofthe pa rasympathetic nervous system. M ost are small
t erminal ganglia or intramural ganglia, so named because they lie near or w ithin the organs they innervat e.
Parasympathetic ganglia:
CN Ill = Ciliary ganglion- eye - cil iary muscl e (accommodati on of l ens), sphincter pupillae muscle
(m i osi s of pupil)
CN VII= Pterygopalatine ganglion- lacrimal g land, oral and nasal mucosa; submandibular ganglion- subli ngual and submandibular salivary glands
CN IX= Otic ganglion- parotid salivary gla nd
CN X= Term inal ganglia that innervate organs in thorax and abdomen
S2-S4 = term inal ganglia that innervat e large int estine, rectum, genitalia, uret ers, and urinary bladder
*** Neurotransmitter is acetylcholine at pre- and postganglionic synapses.
SAADDES
Sympathetic ganglia : organized int o t wo chains that run parallel to and on either side of the spinal cord .
Paravertebral ganglia: lie on each side of the vertebrae and are connected to form the sympathetic
chain or t runk. There are usually 21 o r 23 pairs of t hese ganglia: 3 in the cervical region, 12 in t he t horaci c region, 4 in t he lumbar region, 4 in the sacral regi on, and a single, unpaired ganglion lying in front
of the coccyx called the ganglion im par.
Cervical ganglia- superior, middle or inferior cervical ganglion
Thoracic, lumbar and sacral ganglia
Prevertebral (or preaort ic) ganglia: provide axons t hat are di stributed w ith t he three major gastrointestinal arteries arising from the aorta
Celiac ganglion
Superior and inferior mesenteric ganglion
Inferior hypogastric ganglion
* "* Neurotransmitter is norepinephrine (NE), except on adrenal medulla where it is acetylcholine.
White ramus and gray ramus communicans:
White ramus communicans: all sympathetic preganglionic neurons enter t he paravertebral ganglion chain v ia the w hite ra mus communicans. They are whit e because the nerves are myelinated.
Gray ramus communicans: carry unmyelinated postganglionic sympathetic nerves to peripheral
organs. They are g ray because they are unmyelinated.
nervous system
Neurulation is the stage of organogenesis in vertebrate embryos, during
which the neural tube is transformed into the primitive structures that will
later develop into the central nervous system. When does the neurulation
begin?
1 " week
3'd week
S'h week
7'hweek
SAADDES
214
ANATOMIC SCIENCES
3'dweek
Duri ng the latter part of the third week of prenatal development the central nervous system begins
to develop in the embryo. Many steps occur during th is week to form the beginn ing of the spinal
cord and brain.
First, a specialized group of cells differentiates from the ectoderm. These cells are the neuroectoderm, and they are localized to the neural plate of the embryo. The neural plate is a band of cells that
extends the length of the embryo, from the cephalic end to the caudal end. This plate undergoes further growth and thickening, which cause the plate to deepen and invaginate centrally, forming the
neural groove. Near the end of the third week, the neural groove deepens further and is surrounded
by the neural folds. As further growth of the neuroectoderm occurs, the neural folds meet superior
to the neural groove, and a neural tube is formed during the fourth week. The neural tube undergoes
fusion at its most superior portion and forms the future spinal cord as well as other neural tissues.
SAADDES
Important: During the third week, another specialized group of cells, the neural crest cells,
develop from the neuroectoderm. These cells migrate from the crests of the neural folds and
disperse within the mesenchyme. These migrated cel ls are involved in the development of many
face and neck structures, such as the branchial arches.
Note: These neural crest cells are essential in the development of the face, neck, and oral tissues.
Remember: The growth of neural tissue during the fourt h week of prenatal development causes
folding of the embryonic disc into an embryo, establishing for the first time the human axis and placing tissues in their proper positions for furt her embryonic development.
Neurulation: is the stage of organogenesis in vertebrate embryos, during which the neural tube is
transformed into the primitive structures that will later develop into the central nervous system.
Neurulation begins in the third week with the folding of the ectoderm lying above the notochord,
forming an indentation along the back of the embryo. Th is indentation is called the neural groove.
Neural tube defects: Closure of the neural tube occurs in the middle, and then moves anteriorly and
posteriorly. Failure to close the neural tube anteriorly results in anencephaly, a condition characterized by forebrain and skull degeneration, which is always fatal. Failure to close the posterior tube is
known as spina bifida, which in its most severe form is characterized by failure to form the neural
plate.
nervous system
An endodontist is performing root canal therapy on his anxious dental
patient. His anesthesia has been successful throughout the access preparation, cleaning, and shaping. Just before he starts to obturate, he sticks a paper
point in the first canal to dry it out. The patient jumps up in pain from the stimulus. Which type of primary afferent fiber carries information related to sharp
pain and temperature?
SAADDES
A-a lpha fibers

A-beta fibers
A-delta fibers
C-nerve fibers
215
ANATOMIC SCIENCES
A-delta fibers
Primary afferent axons are the nerve fibers connected to the different types of
receptors in the skin, muscle, and internal organs. These pri mary afferent axons come
in different diameters and can be divided into different groups based on their size.
Here, in order of decreasing size, are the different nerve fiber groups: A-alpha, Abeta, A-delta, and C-nerve fibers. A-a lpha, A-beta, and A-delta nerve fibers are
insulated with myelin. C-nerve fibers are unmyelinated. The th ickness of the nerve
fiber is correlated to the speed with wh ich information travels in it - the thicker the
nerve fiber, the faster information travels in it.
Important:
A-alpha nerve fibers ca rry information related to proprioception (muscle sense)
A-beta nerve fibers carry information related to touch
A-delta nerve fibers carry information related to pain and temperature
C-nerve fibers carry information related to pain, temperature, and itch
SAADDES
Autonomic neurotransmitters:
All autonomic preganglionic synapses have Ach as the neurotransmitter (nicotinic receptors)
All postganglionic parasympathetic synapses have Ach as the neurotransmitter
(muscari nic receptors)
Most postganglionic sympathetic synapses have NE as the neurotransmitter
(adrenergic receptors)
Sympathetic preganglionic neurotransmitter at adrenal medulla is Ach (nicotinic receptor) - release of epinephri ne and norepinephrine (80/20)
Sympathetic postganglionic neurotransmitter at sweat glands is Ach (muscarinic receptors)
nervous system
Which ofthe following cells is the only excitatory cell in the cerebellum?
basket cells
stellate cells
granule cells
SAADDES
purkinje cells
golgi cells
216
ANATOMIC SCIENCES
granule cells
The term cerebellum literally means "little brain. It is located dorsal to the brainstem and is connected to the brainstem by 3 pa irs of cerebellar peduncles.
Functions:
1. Coordination oft he movement: the cerebellum controls the timing and pattern of muscle activat ion during movement
2. Maintenance of equilibrium (in conjugation with the vestibular system)
3. Regulation of muscle tone: modulates spinal and brain stem mechanisms involved in postural
control.
Dysfunction:
1. Ataxia: a disturbance t hat alters the direction and extent of voluntary movements; abnormal
gait and uncoordinated movements
2. Dysmetria: altered range of motion (misj udge distance)
3. 1ntention tremor: oscillating motion, especially of head during movement
4. Vestibular signs: nystagmus, head ti lt
SAADDES
The cerebellar cortex has three layers:

1. Molecular layer: most superficial, consisting of axons of granule cells (parallel fibers) and basket and stellate cells
2. Purkinje layer: middle layer consisting of a single layer of large neuronal cell bodies (Purkinje
cells)
3. Granular layer: deepest layer (next to white matter) consisting of small neurons called granule
cells
Cell types of the cerebellar cortex:
1. Purkinje cells: the only output neuron from the cortex utilizes GABA to inhibit neurons in deep
cerebellar nuclei
2. Granule Cells: intrinsic cells of cerebellar cortex; use glutamate as an excitatory transmitter; excites Purkinje cells via axonal branches called "parallel fibers
3. Basket Cells: inhibitory interneuron; utilizes GABA to inhibit Purkinje cells
nerve
Preganglionic parasympathetic fibers reach the otic ganglia through
which of the following nerves?
greater petrosal nerve

lesser petrosal nerve
SAADDES
mandibular branch of t ri geminal nerve

vagus nerve
217
ANATOMIC SCIENCES
lesser petrosal nerve

The glossopharyngeal nerve is a mixed nerve (motor and sensory), wh ich originates fro m
the anterior surface of the medulla oblongata along with the vagus nerve (CN X) and
spinal accessory nerve (CN XI). The glossopharyngeal nerve passes laterally in the
posterior cranial fossa and leaves the skull through the jugular foramen to su pply
sensation to the pharynx and posterior third of the tongue. The cell bodies of these
sensory neurons are located in the superior and inferior ganglia of this nerve. The
glossopharyngeal nerve then descends through the upper part of the neck along w ith the
internal jugular vein and internal carotid artery to reach the posterior border of the
stylopharyngeus muscle of the pharynx to which the nerve su pplies somatic motor
fibers.
SAADDES
The otic ganglion is a small parasympathetic ganglion that is functionally associated w ith
the glossopharyngeal nerve. The otic ganglion is located immediately below the
foramen ovale in the infrate mporal fossa. The otic ganglion is one of four
parasympathetic ganglia of the head and neck. (the others are the submandibular
ganglion, pterygopalatine ganglion, and ciliary ganglion). The tympanic and lesser
petrosal branches of the glossopharyngeal nerve supply preganglionic
parasympathetic secretomotor fibers to the otic ganglion. Here the fibers synapse,
and the postganglionic fibers leave t he ganglion and join the auriculotemporal nerve.
As the auriculotemporal nerve passes the paroti d gland, postganglionics leave the nerve
to enter the su bstance of the gland.
Important: Terminal ganglia receive pregang lionic fibers from the parasympathetic
division. The following cranial nerves also contain preganglionic para sympathetic
fi bers: oculomotor (ciliary ganglion), facial (pterygopalatine and submandibular
ganglia), and vagus (small terminal ganglia).
Note: The vagus nerve (CN X) provides the efferent (motor) limb of the gag reflex,
whereas the glossopharyngeal nerve (CN IX) provides the afferent limb.
Rootlets of glossopharyngeal nerve
uperior and inferior sensory ganglia

salivary
gland
SAADDES
ganglion
Common carotid artery
Pharyngeal branch
Distribution of the Glossopharyngeal Nen 'e

217-1
nerve
Your most recent patient presents to your office complaining of severe pain
in his jaws around the temporomandibular (TMJ) joint. He chews three
packs of gum a day, and his wife tells him he grinds his teeth at night. What
nerve provides major sensory innervation to the TMJ?
masseteric nerve
SAADDES
218
ANATOMIC SCIENCES
The auriculotemporal nerve ari ses from the posteri or division of the mandibular
nerve (V3). The auriculotempora l nerve supplies the posterior portion of the TMJ.
The nerve to the masseter (masseteric nerve), also a branch of V3, carries a few
sensory fibers to the anterior portion of the TMJ. The deep temporal nerves (anterior,
middle, and posterior branches) innervate the temporalis muscle and ca rry a few fibers
to the anterior portion of the TMJ as well.
1. Pain impulses from a patient's fractured condylar neck are carried by the
auriculotemporal nerve.
2. Pain (TMJ patient) is transm itted in the capsule and periphery of the disc
by the auriculotemporal nerve.
3. The auriculotemporal nerve carries some secretory fibers from the otic ganglion to the parotid sali vary g land.
4. The TMJ, as is the case w ith all joints, receives no motor innervation. The
muscles that move the joint receive the motor innervation.
S. lts arterial blood supply is provided by the superficial temporal and maxillary branches of the external carotid artery.
SAADDES
SAADDES
Medial pterygoid
Zygomatic branch
of facial nerve
Nen'es of the Temporomandibular Region

218 1
Rcprodud with pennission from Alfo.t of H11man Anatomy: Springhouse, 2001, Springhouse.
nerve
When walking to his car late at night, a professor hears footsteps behind
him. His sympathetic response results in dilated pupils, a dry mouth, and
constriction of blood vessels in his face resulting in an ashen look. The
sympathetic response for the head and neck is mediated by cell bodies
located in the:
superior cervical ganglion
SAADDES
middle cervical ganglion
inferi or cervica l ganglion

ganglion impar
219
ANATOMIC SCIENCES
superior cervical ganglion

Paravertebral sympathetic ganglia lie on each side of the vertebrae and are connected to form the
sympathetic chain or trunk.There are usually 21 or 23 pairsof these ganglia: 3 in the cervical region,
12 in the thoracic region, 4 in the lumbar region, 4 in the sacral region, and a single, unpaired ganglion lying in front of the coccyx called the ganglion impar.
Sympathetic ganglia:
1. Cervical ganglia
Superior cervical ganglion: the uppermost and largest, stretching from the level of C1 to
t he level of C2 or C3. This ganglion lies between the internal carotid artery and the internal
jugular vein. The superior cervical ganglion innervates viscera of the head.
Middle cervical ganglion: small, located at the level of the cricoid cartilage. Th is ganglion
is related to the loop of the inferior thyroid artery. Innervates viscera of the neck, thorax (i.e., t he
bronchi and heart), and upper limb.
Inferior cervical ganglion: occurs at the C7 vertebral level. Most commonly is fused to the
first thoracic sympathetic ganglion to form a stellate ganglion. Innervates viscera of the neck,
thorax (i.e., the bronchi and heart), and upper limb.
2. Thoracic chain ganglia: send postganglionic fibers to the entire gastrointestinal tract up to the
upper colon
3. Lumbar and sacral ganglia: send postganglionic sympathetic fibers to the digestive tract below
the upper colon, including the rectum, and to the smooth muscle and gland sof t he bladder, and
external genitalia.
Horner's syndrome: is the combination of droopin g of the eyelid (ptosis) and constriction of the
pupil (miosis), sometimes accompanied by decreased sweating of the face on the same side; redness
of the conjunctiva of the eye is often also present.
SAADDES
Important:
The gray rami connect the sympathet ic tru nk to every spinal nerve. The white rami are limited to the spinal cord segments between T1 and L2.
The cell bodies of the visceral efferent fibers in visceral branches of the sympathetic trunk are
located in the intermediolateral cell column (or lateral horn) of the spinal cord; the cell bodies
of visceral afferent fibers are located in the dorsal root ganglia.
Proj ections of
sympathetic
nervous system
Sympathetic
nervous system
Parasympathetic
nervous syst em
..
Eye
:J
Lacrimal and
salivary
- -superior
cervical ganglion
\,.
ng
:;<,lddle
Blood vessels [
Sweat glands
Smooth muscle
SAADDES
- .
-
T12
Thoracic
L1
lumbar
':.5
51
Sacral
lrf.-Reproductive
or gans
chain
Schematic showing t he sympath etic and parasympath etic pathways. Sympathetic pathways are
shown on left and par asympathetic pathways on right. Preganglionics are shown in darker shades
and postganglionics in lighter shades.
219 1
with penniss1on (rom Koeppen BM, Stanton BA: Berne & levy Physiology. cd 6: l'hiladelpbin. 2008. Elscvacr.
nerve
Which of the following trigeminal nuclei is involved with the proprioception
oftheface?
spinal nucleus
masticatory nucleus
SAADDES
mesencephalic nucleus
ch ief nucleus
220
ANATOMIC SCIENCES
mesencephalic nucleus
The axons of the neurons enter the pons t hroug h t he sensory root and terminate in one of t he
three nuclei of the trigeminal sensory nuclear complex.
Mesencephalic nucleus is involved with proprioception of the face, t hat is, the feeling of
position of the muscles. Unlike many nuclei within the CNS, the mesencephalic nucleus
contains no chemical synapses but is electrically coupled. Instead, neurons of this nucleus
are pseudounipolar cells receiving proprioceptive information from the mandible, and
sending projections to the motor trigeminal nucleus to mediate monosynaptic jaw j erk
reflexes. It is also the only structure in the CNS to contain the cell bodies of primary afferent
neurons, which are usually contained within ganglia (like the trigeminal ganglion).
Main sensory nucleu s (or"chief nucleus" or "pontine nucleus") is a group of second order
neurons w hi ch have cell bodies in the dorsal Pons. It receives information about
discriminative sensation and light touch of t he face as well as conscious proprioception of
t he jaw via first order neurons of CN V. Most of the sensory information crosses the midline
and travels to the contralateral ventral posteromedial (VPM) of the thalamus via the Ventral
trigeminothalamic tract. However, information of the oral cavity travels to the ipsilateral
Ventral Posteromedial (VPM) of the t halamus via the dorsal trigeminothalamic tract.
SAADDES
Spinal nucleus (mediates pain and temperature from t he head and neck) can be divided
into three regions along its length; the region closest to the mout h is called subnucleu s
orali s, the middle region is called subnucleus interpolaris, and t he region closest to the
tail is called subnucleus caudal is. The pain fibers actually synapse in subnucleus caudal is.
The trigem inal motor nucleus contains motor neurons t hat innervate muscles of t he first
branchial arch. This nucleus is located in the mid-pons.
Nucleus
Funcliora
1- Mt'St'aocphahc
Propriocepttoa of thc titoc
2- Moin sensory
0 JscrimintJti\'C' touch oflhc foce
3- Spinal
Painftemtlcraturc of the face
Supplies muscles
1st branchial arch
nerve
Preganglionic parasympathetic axons are associated with all oft he following
cranial nerves EXCEPT one. Which one is the EXCEPTION?
oculomotor
facia l
t ri geminal
SAADDES
glossopharyngeal
vagus
221
ANATOMIC SCIENCES
trigeminal
There are four paired ganglia which supply all p arasympathetic innervation to the head and neck. They are
the ciliary ganglion, pterygopalatine g anglion, submand ibular ganglion, and the otic ganglion.
Each has th ree roots entering the ganglion and a variable number of exiting branches:
The motor root carries presynaptic para sympathetic nerve fibers that terminate in t he ganglion by
synapsing with the postsynaptic fibers that travel to target organs
The sympathetic root carries postsynaptic sympathetic fibers that traverse the gang lion without
synap sing
The sensory root carries general sensory fibers that also do not synap se in the ganglion
Some ganglia also carry special sensory fibers for taste.
P .tr.ts\ mpalhlltc Ganglia
Ganglion
Ciliary
Pte-rygopalatine
S ubmandibular
Location
Fibers
Posterior part o f the orbit

on Lhe late.rnl side o f the
optic nerve
Prtgang.lionk p a nuympMhC't ic fib ers from the oculomotor nen e

P(t!ltganglionic pa rasympalhdic ObC'n l lcavc ga nglion in the short
ciliary nen es
Sympathetic libt.n fro m the internal carotid plc:xu.'>
Ouply plac.e-d in the.

pterygopalatine fos.<>a
Prt'ganglionk !lterttllmutor fib ers a rise in the lacrimal nudeu.'> o f the

facial nerve
Pn!ltgangllonic pan sympalht.'t.ic fi bC"n reach Lhe maxillary nerve by
one o f its ganglionic branches- these reach the- lacrimal gland: others
run in the palatine and nasal nerves to the palatine and rw.sal glands
S ympathetic libt.n reach the ganglion via the internal ca rotid plexus
S ituatcxl on Lhe late.rnl

surface of the hyoglossus
Prtgang_lionk p anuympathr tic ftb trs reach the ganglion from the
supe rior salivatory nut leu.'> u fthe fac ial nen'e via the chorda tympani a nd
lingual ner\'es
Pn!ltg_anglionic parasympatht.'tic libr n pass to the submandibular
gland. to which they are secretomotor. O ther secretomotor fi bers pass to
the sublingual gland
S ympalht.'tic libcn are v.a.'>omotor to the blood ves.'>ds o f the gland.'>
SAADDES
muscle
Otic
Situated j ust below the

foramen ovale and is
medial to the mandibular
p anuympathr tic ftb trs originate in the

inferior salivatory nuc leus u fthe glossopharyngeal nerve
Pt't!llg_anglionic pa rasympalht.'tic Obr n lca.:e the ganglion and join the
auriculotemporal nerve. fibers arc secretomotor to the parutjd gland
nerve
Which of the following cranial nerves is the only nerve that emerges from the
dorsal aspect ofthe brainstem?
t rochlear nerve (CN IV)

SAADDES
oculomotor nerve (CN Ill)

optic nerve (CN II)
222
ANATOMIC SCIENCES

The oculomotor nerve (CN Ill), trochlear nerve (CN IV), and abducens nerve (CN VI) all exit the
cranium through the superior orbital fissure. They innervate the extrinsic ocular muscles,
resulting in movements of the eyeball.
The trochlear nerve (CN IV) supplies the superior oblique muscle (the muscle that turns the
eyeball inferiorly and laterally), and the abducens nerve (CN VI) supplies the lateral rectus of the
eye. Note: The trochlear nerve is the smallest cranial nerve and the only cranial nerve that
emerges from the dorsal (back) aspect of the brain stem and innervates contralateral structures.
The oculomotor nerve supplies the following extraocular muscles: medial, superior, and inferior
recti; inferior oblique; and levator palpebrae superioris. The oculomotor nerve sends
preganglionic parasympathetic fibers to the ciliary ganglion. The postganglionic fibers leave the
ganglion in the short ciliary nerves to supply the sphincter pupillae and the ciliary muscle.
Note: In most cases, ptosis is caused by either a weakness of the levator muscle (muscle that raises
the lid), or a problem with the oculomotor nerve.
SAADDES
Edinger-Westphal nucleus: it contains the parasympathetic ganglionic cells, whose efferent axons
in the oculomotor nerve travel to the ciliary ganglion in the orbits where they are relayed to postganglionic neurons, whose fibers innervate the pupillary sph incter in the anterior eye. The nucleus is
located posterior to the oculomotor nucleus and is also known as t he accessory oculomotor nucleus.
The pupillary light reflex: is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retina of the eye, thereby assisting in adaptat ion to various levels of darkness and light, in addition to retinal sensitivity. Greater intensity light causes t he
pupil to become smaller (all owing less light in), whereas lower intensity light causes the pupil to become larger (allowing more light in). Thu s, the pupillary light reflex regulates the intensity of light
enteri ng the eye. The optic nerve, or more precisely, the photosensitive ganglion cells through the
reti nohypothalamic tract, is responsible for the afferent limb of the pupillary reflex - it senses the incoming light. The oculomotor nerve is responsible for the efferent limb of the pupillary reflex- it
drives the muscles that constrict the pupil.
nerve
The splanchnic nerves (greater, lesser, and least) arise from the:
cervica l sympathetic ganglion (chain)

tho racic sympathetic ganglion (chain)
lumbar sympathetic ganglion (chain)
SAADDES
sacral sympathetic ganglion (chain)
223
ANATOMIC SCIENCES
thoracic sympathetic ganglion (chain)

Remember: Paravertebral sympathetic ganglia lie on each side of the vertebrae
and are connected to form the sympathetic chain or trunk. These nerves ari se from
thoracic ganglia (TS- T12). Note: They all pass th rough the d iaphragm.
The preganglionic sympathetic fibers may pass th rough the paravertebral ganglia
on the thoracic part of the sympathetic trunk without synapsing to term inate in the
prevertebra l ganglia. These myelinated fibers form the splanchnic nerves, of which
there are th ree:
1. Greater- formed from sympathetic fibers from TS- T9. The nerve passes through
the crura of the diaphragm to end in the celiac ganglion.
2. Lesser - formed from sympathetic fibers from TlO - Tll. The nerve passes through
the diaphragm with the greater to end in the aorticorenal ganglion.
3. Least- ari ses from the last thoracic ganglion, and, piercing the d iaphragm, ends
in the renal plexus.
SAADDES
Important: Thoracic splanchnic nerves (specifically the greater splanchnic nerve) to

the celiac plexus consist primarily of preganglionic vi sceral efferent fibers. The
postganglionic fibers arise from the excitor cells in the celiac plexus and are
distributed to the smooth muscle and glands of the viscera.
nerve
Which ofthe following nerves penetrates the cricothyroid membrane?

facial nerve
SAADDES
accessory nerve
internal laryngeal nerve
224
ANATOMIC SCIENCES

Both recurrent laryngeal nerves pass deep to the lower margin of the inferior constrictor
muscle to innervate the intrinsic muscles of the larynx responsible for controlling the
movements of the vocal folds.
The right recurrent laryngeal nerve innervates:
All of the muscles of the larynx, except the cricothyroid, which is supplied by the external laryngeal branch of the superior laryngeal nerve
The mucous membrane of the larynx below the vocal fold s
The mucous membra ne of the upper part of the trachea
Note: This nerve comes in contact with the thyroid gland and comes into close relationship
with the inferior thyroid artery
SAADDES
The left recurrent laryngeal nerve innervates:
The same muscles and mucous membranes as the right recurrent laryngeal, except on the
left side
*** The right recurrent laryngeal nerve splits from the right vag us before entering the
superior mediastinum at the level of the right subclavian artery. The nerve hooks posteriorly
around the right subclavian artery and also ascends in the groove between the esophagus and
trachea.
***The left vagus gives rise to the left recurrent laryngeal nerve.
1. Recurrent laryngeal. nerves are vulnerable during thyroid surgery. If one is damaged
..")1iiS'1 the q uality of voiCe w1ll be affected resulting 1n hoarseness (rough vo1ce).
2. The recurrent laryngeal nerve penetrates the cricothyroid membra ne from behind
of the cricothyroid joint.
3. The left laryngeal nerve, which is longer, branches from the vagus nerve to loop
under the arch of the aorta, posterior to the ligamentum arteriosum before ascending.
On the other hand, the right branch loops around the rig ht subclavian artery.

Right recurrent laryngeal nerve - --1Inferior cardiac
""Tl
Pulmonary
Esophageal plexus
SAADDES
Cellae ganglion and plexus
Superior mesenteric
Pyloric
Renal
Hepatic flexure
to small and largo Intestine
224-1
Vagus Nerve Distribution

-.h. pennw.on &om A tillS of HffMIIfl A ..aro.r.; Spnngl:lottsc. 1001. $prulgbouK
nerve
The hypoglossal nerve travels from the carotid triangle into the
submandibular triangle of the neck.
This nerve is a motor nerve supplying all of the intrinsic and extrinsic
muscles of the tongue, except the palatoglossus, which is supplied by the
facial nerve.
SAADDES
the first statement is t rue, the second is false
225
ANATOMIC SCIENCES
The hypoglossal nerve leaves the skull through the hypoglossal canal medial to the
ca rotid cana l and jugular foramen. Note: The jugular foramen allows for the exit of
the spinal accessory nerve from the cran ial cavity. Soon after the hypoglossal nerve
leaves the skull through the hypoglossal canal, it is joined by Cl and C2 fibers from
the cervical plexus. Important: The hypoglossal nerve travels from the carotid
triangle into the submandibular t riangle of the neck. This nerve is a motor nerve
supplying all of the intrinsic and extrinsic muscles of the tongue, except the
palatoglossus, which is supplied by the vagus nerve.
Lesions of the hypoglossal nerve:
Unilateral lesions of the hypoglossal nerve result in the deviation of the protruded tongue toward the affected side. This is due to the lack of function of the genioglossus muscle on the diseased side.
Injury of the hypoglossal nerve eventually produces paralysis and atrophy of
the tongue on the affected side with the tongue deviated to the affected side.
Dysarthria (inability to articulate) may also be found.
SAADDES
Important: If the genioglossus muscle is paralyzed, the tongue has a tendency to

fall back and obstruct the oropharyngeal airway with ri sk of suffocation.
SAADDES
Hypoglossal Nerve- Cranial Nerve XII
Supplies th e muscles of the tongue
Reproduced wilh pcnn ission from Spenc-e AP, Mason EB: Huma11 Anammyaml
2251
ed 4; St Paul. 19'1)2. Wesl Publislung Company.
nerve
After depositing enough lidocaine 2% to anesthetize the nerve entering
the mandibular foramen, a dental student removes the needle to approximately half the depth of the initial target, whereupon another bolus of anesthetic is deposited. What nerve is most likely anesthetized by the second
bolus?
hypoglossal nerve
SAADDES
long buccal nerve
inferi or alveola r nerve

lingual nerve
226
ANATOMIC SCIENCES
lingual nerve
The lingual nerve is a branch of the mandibular division (V3) of the tri geminal
nerve. It supplies general sensation for the anterior two -thirds of the tongue, the
floor of the mouth, and mandibular lingual gingiva. Note: The submandibular duct
has an intimate relation with t he lingual nerve, which crosses it twice.
The lingual nerve descends deep to t he lateral pterygoid muscl e, where the nerve is
joined by the chorda tympani (branch of the facial nerve), w hich conveys the
preganglionic parasympathetic fibers to the submandibular ganglion and taste
fibers from the anterior two-thirds of t he tongue.
Important: If you cut t he lingual nerve after its junction w ith t he chorda tympani, t he
tongue would have a loss of taste and tactile sense to the anterior two-thirds.
SAADDES
1. The chorda tympani emerges from a small canal in the posterior wa ll of

the tympanic cavity (petrotympanic fissure) after crossing t he medial
surface of the tympanic membrane. It joins the lingual nerve in t he
infratemporal fossa .
2. The chorda tympani nerve conveys general visceral efferent fibers
(motor fibers) of the parasympathetic d ivision of the autonomic nervous
system to the submandibular ganglion. It also carries special visceral
afferent fibers for taste.
SAADDES
The pathway of the posterior trunk ofthe mandibular
nerve ofthe trigeminal nerve is highligh ted
226 1
with pcnn is..-.ion from Fchrcnbach MJ, Hcning SW; llluslriltcd Anatomy of the Head and Ncl' k. cd 3; St. Louis. 2007. Saunders.
on of
Lateral pterygid nerve

Lateral pterygoid--::..-..-...::---;
muscle
Buccal nerve - l ' - -- --l'lllllif-:
SAADDES
horda tympani nerve

In petrotympanic
fissure
Masseteric nerve
The pathway of the anterior tr unk of th e mandibular

nerve of the trigeminal nerve is high lighted
226AI
with pcnn is..-.ion from Fchrcnbach MJ, Hcning SW; llluslriltcd Anatomy of the Head and Ncl'k. cd 3; St. Louis. 2007. Saunders.
nerve
The lesser petrosal nerve carries preganglionic parasympathetic fibers to
which of the following ganglia?
otic ganglia
geniculate ganglia
SAADDES
submandibular ganglia
sublingual ganglia
ANATOMIC SCIENCES
227
otic ganglia
The glossopharyngeal nerve innervates the stylopharyngeus muscle (via the

muscular branch). It is the only muscle that is supplied by this nerve. This muscle is a
landmark for locating the glossopharyngea l nerve because as the nerve enters the
pharyngea l wall, it curves posteriorly around the lateral margin of this muscle.
In addit ion to the somatic motor innervation of the stylopharyngeus, the
glossopharyngea l nerve supplies preganglionic parasympathetic motor fibers to the
otic ganglion. These fibers synapse with the postganglionic fibers in the ganglion to
supply the parotid gland.
SAADDES
The preganglionic nerves leave the glossopharyngeal nerve as the tympanic nerve,
which enters the middle ear cavity and participates in the formation of the tympanic
plexus. The tympanic nerve reforms as the lesser petrosal nerve, leaves the cranial
cavity through the fo ramen ovale, and enters the otic ganglion. Postganglionics are
ca rried by the auri culotemporal nerve (V3) to the parotid gland.
Visceral sensory branches of the glossopharyngeal nerve:
Lingual branches - are two in number; one supplies the vallate papillae and the
mucous membrane covering the base of the tongue; the other supplies the
mucous membrane and foll icula r g lands of the posterior one-third of the
tongue, and commun icates with the lingual nerve.
Pharyngeal - d istributed to the mucous membrane of the pharynx. Is the
sensory limb of the gag reflex.
Carotid sinus nerve - to ca rotid sinus (baroreceptor) and carotid body
(chemoreceptor)
Rootlets of glossopharyngeal nerve
uperior and inferior sensory ganglia

salivary
gland
SAADDES
ganglion
Common carotid artery
Pharyngeal branch
Distribution of the Glossopharyngeal Nen 'e

217-1
nerve
The cervical plexus consists of anterior rami from Cl - C4; some ofthese fibers
reach the hyoid muscles by running concurrently with which cranial nerve?
phrenic nerve
vagus nerve
SAADDES
spinal accessory nerve
hypoglossal nerve
228
ANATOMIC SCIENCES
hypoglossal nerve
Adjacent ventral rami will form complex interwoven networks of nerve fibers (axons} known as
a nerve plexus. Four plexuses - cervical, brachial, lumbar, & sacral emerging from each plexus
will be specifically named peripheral nerves, which will contain fibers from multiple spi nal cord
levels.
1. Cervical plexus (C 1-C4} - provides cutaneous innervation to the skin of the neck, shoulder, and upper anterior chest wall as well as motor innervation to the infrahyoid (strap} muscles and geniohyoid muscle. The major nerve branches are:
Ansa cervical is (C 1-C3}: supplies infra hyoid muscles except for thyrohyoid which is supplied by C1 only
Phrenic nerve (C3-CS}: supplies t he d iaphragm
Great auricular nerve (C2 and C3}: It provides sensory innervation for the ski n over
pa rotid gland and mastoid process, and both surfaces of the outer ear
SAADDES
2. Brachial plexus (CS-CS and T1} - formed in the posterior triangle of the neck, the brach ial
plexus extend s into the axilla, supplying nerves to the upper limb.
It has three cords:
posterior - axillary and radial nerves are main branches
lateral - musculocutaneous nerve is main branch
medial - ulnar nerve is main branch
Note: The median nerve forms its two heads (medial and latera l} from the medial and
lateral cords.
3. Lumbar plexus (L1-L4}- formed in the psoas major muscl e, the lumba r plexus supplies
the lower abdomen and parts of the lower limb. Main branches are the femoral and obturator nerves.
4. Sacral plexus (L4-LS and Sl -54} - lies in t he posterior pelvic wall in front of
the piriformis muscle. The sacral plexus supplies the lower back, pelvis, and parts of
t he thigh, leg, and foot. The main branch is the sciatic (largest nerve in t he body).
The Cervical Plexus
SAADDES
Hypoglossal nerve (XII) ------
- -- Lesser occipital nerve
---------
Cl
---.,;:..,r#- - Great auricular nerve
22111
Phrenic nerve
The Brachial Plexus
cs
(6
C7
(8
Tl
SAADDES
Musculocutaneous
nerve
\- !:...._- - - +
Radial nerve
228 A l
Anterior divisions
-
The Lumbar Plexus
Posteriordivisions
T12
Iliohypogastric nerve
L1
Ilioinguinal nerve
Genitofemoral nerve
SAADDES
lateral femora l
cutaneous nerve
Obturator nerve
Femoral nerve
228
nerve
The branch of the trigeminal nerve that innervates the midface, palate and
paranasal sinuses exits the cranial cavity through which structure?
superior orbital fissu re

optic cana l
SAADDES
fo ramen rotundum
pterygomaxillary fissu re
fo ramen ovale
229
ANATOMIC SCIENCES
foramen rotundum -the nerve is the maxillary nerve

The ophthalmic division (V1) enters the orbit through the superior orbital fissure and provides
sensory innervation to the eyeball, t ip of the nose, skin over the upper eyelid, and skin of the face
above the eye. Branches include the lacri mal, frontal, nasociliary, supraorbital, supratrochlear,
infratrochlear, and ext ernal nasal nerves. Note: The skin of the lower eyelid is supplied by branches
of the infrat rochlear at the medial angle, the rest is supplied by branches of the infraorbital nerve of
t he maxillary division (V2).
l .During a sinus attack, painful sensation from the ethmoid cells is carried in the
nasociliary nerve.
2. The ophthalmic nerve is purely sensory.
3. The ophthalmic nerve is often infected with the herpes zoster virus, whereas
involvement of the lower two divisions is rare.
SAADDES
The maxillary division (V2) passes through the foramen rotundum and provides sensory
innervation to the midface (below the eye and above the upper lip), palate, paranasal sinuses, and
t he maxillary teeth.
1. The tickling sensation felt in the nasal cavity j ust prior to a sneeze is carried by the
maxillary division of trigeminal. Branches include the infraorbital, zygomaticofacial,
and zygomaticotemporal nerves.
2. The maxillary nerve is purely sensory.
3. 1t's most frequent ly affected by tic doulourex (trigeminal neuralgia).
Sensory innervation of mandibular division (V3) is to the skin of the cheek, the skin of the
mandible, and the lower lip and side of the head. Sensory in nervation also includes the TMJ,
mandibular teeth, the mucous membranes of the cheek, the floor of the mouth, and the anterior
part of the tongue. Branches include the mental, buccal, and auriculotemporal nerves.
Important: The t rigeminal nerve contains no parasympathetic component at its origin. The
nerves branches are used by the ocul omotor, facial, and glossopharyngeal nerves to distribute their
preganglionic parasympathetics fibers to the parasympathetic head ganglia.
Trigeminal
nerve
SAADDES
Maxillary nerve
(V2)
\
The general pathway of th e trigeminal or fifth cranial ner ve
and its motor and sensory roots and three divisions
2291
Reproduced wilh pcnn ission from fehrenbach MJ, Hcning SW;
AIWI<ml)' of the Head and Neck. ed J: St. Louis.. 2007. Saund<'rs.
SAADDES
\
The pathway of the ma xillary nerve ofthe trigeminal nerve is highlighted
229 A l
Rqlroduccd wuh pem1issuln from
MJ. Herring SW; 11/u:urated Anatomy of tl1e Nead and Neck, f'(l J; St Louis. 2007. Saunders.
nerve
The mylohyoid nerve is derived from the inferior alveolar nerve just before
it enters the mandibular foramen. The mylohyoid nerve descends in a
groove on the deep surface of the ramus of the mandible, to supply the
mylohyoid and what other muscle?
anteri or d igastric
geniohyoid
stylohyoid
SAADDES
genioglossus
230
ANATOMIC SCIENCES
anterior digastric
Function of mylohyoid: elevates hyoid bone, base of tongue, and floor of mouth. The
mylohyoid line, which gives origin to the mylohyoid, is found on the body of the
mandible. The sublingual gland is located superior to the mylohyoid muscle. When film is
placed for a periapical view of the mandibular molars, it is the mylohyoid muscle that get s
in the way if it is not relaxed. Important: Swelling at the angle of the mandible and the
lateral neck is often the result of deflection of exudates by the mylohyoid muscle.
Suprahyoid mu scles:
- Digastric mu scles
- Anterior belly: innervated by nerve to the mylohyoid, which is a branch of the
mandibular division of the trigeminal nerve
-Posterior belly: innervated by the facial nerve
SAADDES
- Mylohyoid muscle: innervated by nerve to the mylohyoid, wh ich is a branch of the

mandibular division of the trigeminal nerve
- Geniohyoid muscle: innervated by the first cervical nerve through the hypoglossal
nerve
- Stylohyoid: innervated by the facial nerve
lnfrahyoid muscles:
- Omohyoid muscle: innervated by ansa cervical is - Cl, 2, and 3
- Sternohyoid muscle: innervated by ansa cervicalis- Cl , 2, and 3
- Sternothyroid muscle: innervated by ansa cervical is - Cl, 2, and 3
- Thyrohyoid muscle: innervated by the first cervical nerve, which accompanies the
hypoglossal nerve to the su prahyoid region, and then branches from it to reach the
thyrohyoid muscle
Remember: The mylohyoid nerve arises from the inferior alveolar nerve, a branch of the
mandibular division (V3) of the trigeminal nerve (V).
nerve
Which of the following nerves innervates the medial rectus muscle of the
eyeball?
optic
olfactory
oculomotor
trochlear
abducens
SAADDES
ophthalmic (Vl)
231
ANATOMIC SCIENCES
oculomotor
Nerve
Site of Exit from Skull
Component
OlfactOC')'(CNI)
Clibntbrm plmc of ethmoid bon-e Spial 5tnsory

(special afferent)
Optic(CN IJ)
Oplic foramen
(kulo motor(CN Ill) SUt)Crior orbJtal ti.ssurc
Troc-hlcar(CN IV)
Supcrior orbltal ti.ssurc
Abducens {CN VI)
Superior orbnal ti.ssurc
Spial 5ensory
(special nffcrent)
Function
Sense of smell
Conveys visual
infom1auon from the re-tina
Somatic motor
Supplies four of the six
(general somatic cfiercnt) extraocular muscles of1bc
eye and the levator palpebrae
supcrioris musdc of the
uppcrcychd
Vi.sral motor
Par.-.sympathctlC inncrvalion
(gencrnl vise<ral
of the constrictor pupillae

nnd dha1y muscles
Somatic motor
lnmr\'atcsth<: supcnor
SAADDES
(general somatic cfrcn-nt) obhqu(' musc-le
Somatic motor
lnncrvatc:stbc I:Jtcrul rc<:tus
(gcnc-ml somatic efferent) musdc
Remember: The abducens (CN VI) nerve innervates the lateral rectus muscle of the eye. The lateral
rectus muscle is responsible for lateral gaze (its contraction causes the eye to be abducted). A lesion
of this nerve results in medial strabismus (cross-eyed) and diplopia (double vision).
Note: Every cranial nerve that innervates the eye (CN Ill, IV, Vl, VI) passes through the superior orbital fissure except for the opt ic nerve which goes th rough the optic foramen .
The corneal reflex, also known as the blink reflex, isan involuntary blinking ofthe eyelid selicited by
stimulation of the cornea (such as by touching or by a foreign body), or bright light, though could result from any peripheral stimulus. Stimulation should elicit both a direct and consensua l response
(response of the opposite eye). The reflex consumes a rapid rate of 0.1 second. The evolutionary purpose of this reflex is to protect the eyes from foreign bodies and bright lights (the latter known as the
optical reflex). The reflex is mediated by:
The nasociliary branch of the ophtha lmic branch (Vl) of the 5th cran ial nerve (trigeminal nerve)
sensing t he stimulus on the cornea, lid, or conjunctiva (i.e., it is the afferent).
The 7th cranial nerve (facial nerve) initiating the motor response (i.e., it is the efferent).
Oculomotor Nerve
SuperiL rectus
SAADDES
Inferior oblique
Medial rectus
Oculomotor
nerve (Ill)
2311
SAADDES
Olfactory Nerve- Cranial Nerve I
231AI
Rcproduc.:>ed with pennission from Spence AP. Ma.mn I!B: liuman Am'IIOmy tmd PIJy.fiolfJg)'. ed 4: St. Paul. 1992. Wcsl Publ11ihing Company.
SAADDES
Optic Nerve- Cranial Nerve II
231 B l
Reproduoc-d with
from Sp.:ncc AP. i\1la.wn I::B: Human A11atomy tmd
ed 4: St. Paul. 1992. Wcs1 Publ1shing Company.
' "'---jf
.
oblique
muscle
orbital
fissure
Trochlear Nerve - Cranial Nerve IV
SAADDES
Abducens
nerve
231 C l
Reproduoc-d with pennission from Spence AP. Mason EB:
AJJatomy tmd PIJ.}'.fiology. ed 4: St. Ptml. 1992. Wcs1 Publ1shing Company.
nerve
The principal types of nerves found in the dental pulp are:
parasympathetic and efferent fibers

sympathetic and afferent fibers
sympathetic and efferent fibers
SAADDES
parasympathetic and afferent fibers
232
ANATOMIC SCIENCES
sympathetic and afferent fibers

The sensory nerve fibers in the dental pulp originate in the trigeminal ganglion and
are categorized, from smallest to largest d iameter, into (-fibers, A-delta, and some Abeta fibers. On the other hand, postganglionic sympathetic nerve fibers originate in
the superior cervical ganglion. A-delta fibers are myelinated low-threshold mechanoreceptors and are responsible for the so-called "first pain signal:' (-fibers are unmyelinated, high-threshold fibers. They are termed poly-nodal because they respond
to several types of stimuli such as mechanica l, chemical, or thermal stimulation of the
pulp. (-fibers most likely mediate the sensation of "second pain:' Note: The pulp conta ins both myelinated and unmyelinated nerve fibers.
SAADDES
Tooth pulp consists of a loose type of connective t issue. Its main components are thin
col lagen fibers arranged asymmetrica ll y p lus a ground substance containing glycosaminoglycans. Tooth pulp is a highly innervated and vascu larized t issue. Numerous fibroblasts are present. Surrounding the pulp and separating it from the dentin are
the odontoblasts.
Important: Pain originates in the pulp due to free nerve endings (afferent fibers),
which are the only type of nerve endings found in the pulp and are specific receptors
for pain. Rega rdless of the source of stimulation (heat, cold, and pressure), the only response will be pain. Note: Vasomotor sympathetic fibers are thought to end on blood
vessels.
Functions ofthe pulp:
1. Nutritive - very rich blood supply that surrounds the odontoblasts.
2. Formative - peri pheral layer of pulp cells g ives rise to the odontoblasts that form
dentin.
3. Sensory - free nerve endings that make contact w ith the odontoblasts.
nerve
Which ofthe following cranial nerves has visceral sensory innervation?
tri geminal nerve

facial nerve
vagus nerve
SAADDES
hypoglossal nerve
ANATOMIC SCIENCES
233
vagus nerve
The vagus nerve is a mixed nerve that leaves the brain from the medulla and passes out of the
cranial cavity through the jugular foramen. The vag us nerve descends in the neck in the
carotid sheath behind the internal and common carotid arteries and the internal jugular vein.
Both right and left vagal trunks pass through the posterior mediastinum on the esophagus
and enter the abdominal cavity with the esophagus. The vagus nerves supply the viscera of the
neck, thorax, and abdomen to the left colic (splenic) flexure of the large intestine. The vagus
nerve consists of the following components:
\
Cr.mi.ll '\crH \.
Function
Component
Somatic (Branchial) Motor
l,ropriocepthe
To dte soft palate; pharynx; intrinsic laryngeal muscles (phonation); and a

nominal exrrinsic tongue muscle. the palawg1ossus, which is actually a
palatine muscle based on its derivation and innervation
SAADDES
(l,arasympathetic) Motor
To rhe muscle..; lis ted above
To dtoracic and abdominal viscera
Somatic (General) Sensory
From the infe-rior pharynx, and lal')'llX
Vbceral Sensory
r-rom the thomcic and abdominal organs
Taste and Somatic (General) Sensation
r-rom the I'OOt of the tongue and taste buds on the epiglonis. Branches of the
internal laryngeal ne-l've (a bmnch of CN X} supply a small area. mostly

somatic (ge.neml) sensory but also some special sensation (taste)
1. The abdominal viscera below the left colic flexure and the pelvic and genitalia
are supplied with preganglionic parasympathetic fibers from the pelvic splanchnic
nerves.
2. The pharyngeal plexus of nerves contains both motor and sensory components.
The motor nerves are believed to come from the vagus nerve.
3. The vagus nerve forms the efferent limb of the gag reflex.

Right recurrent laryngeal nerve - --1Inferior cardiac
""Tl
Pulmonary
Esophageal plexus
SAADDES
Cellae ganglion and plexus
Superior mesenteric
Pyloric
Renal
Hepatic flexure
to small and largo Intestine
224-1
Vagus Nerve Distribution

-.h. pennw.on &om A tillS of HffMIIfl A ..aro.r.; Spnngl:lottsc. 1001. $prulgbouK
nerve
Which ofthe following is a component ofthe optic disc or papilla?
central artery
cones
sensory efferent fibers
SAADDES
myelinated nerve fibers

oculomotor nerve
234
ANATOMIC SCIENCES
central artery
The optic disc (also called the optic papilla) is the small blind spot on the surface of
the retina, located about 3 mm to the nasal side of the macula. The optic d isc is the
only part of the retina that contains no photoreceptors (rods or cones). The d isc
consists of unmyelinated axons of ganglion cells exiting the retina to form the optic
nerve. These fibers become myelinated po sterior to the optic d isc and are
accompanied by the central artery and vein of the retina.
The optic nerve has only a special sensory component. Special sensory conveys
vi sual information from the retina (special afferent). Visual information enters the
eye in the form of photons of light that are converted to electrical signals in the retina.
These signals are ca rried via the optic nerves, chiasma, and tract to the lateral
geniculate nucleus of each thalamus and then to the visual centers of the brain for
interpretation.
SAADDES
Remember: After exiting the eye at the optic disc, the two optic nerves (one from
each eye) meet at the optic chia sma. It is here that the axons from the medial (nasal)
half of each retina cross to the opposite side, wh ile those from the lateral half of
each retina remain on the same side. From the optic chiasma, axons that perceive the
left visual field form the right optic tract. These optic t ract fibers synapse in the lateral
geniculate nuclei with geniculocalcarine fibers (optic radiations) that terminate on
the banks of the ca lcarine sulcus in the primary visual cortex (Brodmann's area 17) of
the occipital lobe. Thus, the right visual field is interpreted in the left hemisphere of
the brain and vice versa.
Note: The central artery of the retina, a branch of the ophthalmic artery, pierces the
optic nerve and gains access to the retina by emerging from the center of the optic
d isc.
The Visual Projection Pathway
SAADDES
Opdcchlil5m
nudeus
U.C:.ral
nucleus ofthe
thalamus
Superior
colliculus
Left
2l41
nerve
Which of the following ganglia receives fibers from the motor, sensory, and
parasympathetic components of the facial nerve and sends fibers that will
innervate the lacrimal, submandibular, and sublingual glands?
the semilunar ganglion

the geniculate ganglion
SAADDES
the otic ganglion
the ciliary ganglion
235
ANATOMIC SCIENCES
the geniculate ganglion

The geniculate ganglion is an L-shaped collection of fibers and sensory neurons of the facial nerve
located in the facial canal of the head. The geniculate ganglion receives fibers from the motor, sensory, and parasympathetic components of the facial nerve and sends fibers that will innervate the
lacrimal glands, submandibular gland s, sublingual glands, tongue (anterior two-thirds), palate, pharynx, external auditory meatus, stapedius, posterior belly of the digastric muscle, stylohyoid muscle,
and muscles of facial expression.
Sensory and parasympathetic inputs are carried into the geniculate ganglion via the nervus intermedius. Motor fibers are carried via the facial nerve proper. The greater petrosal nerve, which carries sensory fibers as well as preganglionic parasympathetic fibers, emerges from the anterior
aspect of the ganglion.
Important branches of the intrapetrous part of the facial nerve:
The greater petrosal nerve arises from the facial nerve at the geniculate ganglion. The nerve
contains preganglionic parasympathetic fibers that pass to the pterygopalati ne ganglion and are
there relayed through the zygomatic and lacrimal nerves to the lacrimal gland; other postganglion ic fibers pass through the nasal and pa latine nerves to the glands of the mucou s membrane
of the nose and pa late. The nerve also contain s many taste fibers from the mucous membrane of
the palate. The nerve emerges on the superior surface of the petrous part of the temporal bone
and runs forward to enter the foramen lacerum. It is here joined by the deep petrosal nerve
from the sympathetic plexus on the internal carotid artery and forms the nerve to the pterygoid
canal (vidian nerve). This passes forward and enters the pterygopalatine fossa, where it ends in the
pterygopalatine ganglion. Note: The loss of lacrimation (dry eye) can be due to an injury to the
greater petrosal nerve.
The nerve to the stapedius arises from the facial nerve to supply the stapedius muscle.
The chorda tympani arises from the facial nerve ju st above the stylomastoid foramen. The nerve
leaves the tympanic cavity through the petrotympanic fissure and enters the infratemporal fossa,
where the nerve joins the lingual nerve. The chorda t ympani contains many taste fibers from
the mucous membrane covering the anterior two-thirds of the tongue, and the floor of the mouth.
The nerve also contains preganglionic parasympathetic secretomotor fibers that reach the submandibular ganglion and are there relayed to t he submandibular and sublingual salivary glands.
SAADDES
nerve
The left optic tract contains:
fibers from the left eye only

fibers from the right eye only
fibers from the nasal half of the left eye and temporal half of the right eye
SAADDES
fibers from the temporal half of the left eye and nasal half of the right eye
236
ANATOMIC SCIENCES
fibers from the temporal half of the left eye and nasal half of the right eye
The optic nerve (CN II) ari ses from axons of ganglion cells of the retina, which
converge at the optic disc. The optic nerve leaves the orbital cavity by passing
through the optic foramen (also called optic canal) of the sphenoid bone with the
ophthalmic artery and then enters the cran ial cavity. The nerves on both sides join
one another to form the optic chia sma. Here, the nerve fibers that ari se from the
medial (nasal) half of each retina cross the midline and enter the optic tract of the
opposite side; the fibers from the lateral (temporal) half of each retina pass posteriorly
in the optic tract of the same side.
The optic tract emerges from the posterolateral angle of the optic ch iasma and passes
backward around the lateral side of the m idbrain to reach the lateral geniculate body.
SAADDES
Remember: The optic nerves carry impulses associated with vision. Like the
olfactory nerves, the optic nerves are entirely sensory. The optic nerves are actually
brain tracts rather than true nerves, since the optic nerves are formed from
outgrowths of the embryonic d iencephalon.
Note:The optic nerve fibers originating from the nasal halves of the retina cross in the
optic ch iasm. The fibers from the temporal halves do not cross but continue on the ipsilateral side. Hence, the ri ght tract contains the fibers from the temporal half of the
right eye and from the nasal half of the left eye. The left tract contains fibers from the
temporal half of the left eye and from the nasal half of the ri ght eye.
nerve
Which statement concerning the left vagus nerve is FALSE?
it can be cut on the lower part of the esophagus to reduce gastric secretion (termed
a vagotomy)
it forms the anterior vagal trunk at the lower part of the esophagus
SAADDES
it passes in front of the left subclavian artery as it enters the tho rax
it conta ins parasympathetic postganglionic fibers
it contributes to the anterior esophageal plexus
ANATOMIC SCIENCES
237
it contains parasympathetic postganglionic fibers
*** This is false; the vagus nerve carries para sympathetic preganglionic fibers to the
t horacic and abdominal viscera.
The left vagus nerve enters the thorax in front of t he left subclavian artery and behind the
left brachiocephalic vein. The nerve then crosses t he left side of t he aortic arch and is itself
crossed by t he left ph renic nerve. The left vagus nerve passes behind the root of the left lung,
forms the pulmonary plexus, and continues to form the esophageal plexus. The left vagus
nerve enters the abdomen in front of the esophagus through the esophageal hiatus of the
diaphragm as the anterior vagal trunk (reaches t he anterior surface of the stomach).
Note: The vagus nerves lose their identity in the esophageal plexus. At the lower end of the
esophagu s, branches of the plexus reunite to form an anterior vagal trunk (anterior gastric
nerve), which can be cut (vagotomy) to reduce gastric secretion.
SAADDES
The right vagus nerve crosses the anterior surface of the right subclavian artery and enters
t he thorax posterior to the right brachiocephalic vein, lateral to the trachea, and just
posterior to the arch of the azygos vein. The nerve passes posterior to the root of the right lung,
contributing to the pulmonary plexus. The nerve also contribu tes to t he esophageal plexus.
The nerve enters the abdomen behind the esophagus through the esophageal hiatus of the
diaphragm as the posterior vagal trunk (reaches the posterior surface of the stomach).
The Vagus Nerve (CN X)- General Functions:
Motor to and sensory from the larynx
Motor to pa latoglossus muscle
Motor to all of the muscles of the pharynx except the stylopha ryngeus (from CN IX) and all
muscles of t he soft palate except the tensor veli palatini (from mandibular d ivision of CN V)
Conveys taste from area around epiglottis
Sensory from external auditory meatus
Afferent from viscera above left (splenic) colic flexure
Parasympathetic to the lungs, heart, stomach, and myenteric plexus
nerve
Which of the following nerves penetrates the thyrohyoid membrane?
faciaI nerve
accessory nerve
SAADDES
238
ANATOMIC SCIENCES

The vagus nerve possesses two sensory ganglia:
1. Superior ganglion - lies on nerve within the jugular foramen
2. Inferior ganglion - lies on nerve just below the j ugular foramen
Branches that arise from the superior ganglion:
Meningeal - supplies dura mater
Auricular - supplies auricle, external auditory meatus
Branches that arise from the inferior ganglion:
Pharyngeal - forms pharyngeal plexus, supplies all of the muscles of the pharynx, except the
stylopharyngeus muscle (innervated by glossopharyngeal nerve) and all of the muscles of t he
soft palate, except the tensor veli palatin i (innervated by mandibular nerve, V3).
*"'*It joins branches from the glossopharyngeal nerve and the sympathetic trunk, to form the
pharyngeal plexus.
Superior laryngeal - divides into:
- Internal laryngeal - ravels with superior laryngeal artery and pierces the thyrohyoid
membrane. Supplies mucous membranes of the larynx above the vocal folds.
- External laryngeal - travels with superior thyroid artery and supplies the cricothyroid
muscle.
SAADDES
*"'* Remember: The recurrent laryngeal nerve penetrates t he cricothyroid membrane from behind
of the cricothyroid joint
Nucleus ambiguus: is located in t he ventrolateral medulla in it s upper half. It is a column of motor
neurons that sends its axons to the cranial nerves IX (glossopharyngeal), X (vagus) and XI (accessory)
through its caudal port ion. The X is important and the IX is insignificant (since it only supplies motor
innervation to stylopharyngeus).
The somatic motor part of vagus nerve axons comes from nucleus ambiguus and it innervates the
soft palat e (including uvula), pharynx, larynx and upper esophagus.
A unilateral lesion in nucleus ambiguu s will produce ipsilateral paralysis of soft palate, deviation of
t he uvula away from t he lesioned side, nasal regurgitation (soft palate), hoarseness (larynx) and dysphagia (pharynx and upper esophagus).
nerve
Which cranial nerve supplies the derivatives ofthe hyoid arch?
glossopharyngeal
tri geminal
vagus
facial
SAADDES
239
ANATOMIC SCIENCES
facial
Branchial \rch and Ocrh ath l '
Future Nerves and Muscles
Arch
Future Skeletal Structures and Ligaments
of
Malleus and incus of middle ca1. including antetior ligament
mastica1ion, mylohyoid and anterior of the malleus, sphenomandibular ligament, and portions of
belly of digastric, tt-n..o;or tympani.
the sphenoid bone
tensor veli palatine
First ar('h (mumbbulor) Trige-minal nerve-.
Second arch (hymd)
Third arch
Stapes and portions of malleu..o; and incus of middle ear,

stylohyoid ligament. styloid proces..o; of the
bone,
Glossopharyngeal nerve,
s1ylopharynge.al 1nuscle
Grea1er c.ornu of hyoid bone, lower por'lion of body of hyoid

bone
Supe-ril)r laryngeal branch and recurrenl laryngeal branc.h of vagus

nerve, levator veli palatini muscle$,
pharyngeal conslrklors. intin..o;ic
mlLo;cles of the larynx
Laryngeal cartilages
Je.sser ('ornu of hyoid bone. upper portion ofbodyofhyoid

bone
SAADDES
Fourth through sixth
arch
Facial nerve-. stapediu.o; nl lt..o;c le,

.nu..o;de$ of facial cxpre$Sion,
posterior bdly of the diga..o;tric
mu..o;cle. stylohyl)id muscle
Note: The cranial nerves that innervate the derivatives ofthe branchial arches (CNV, VII,
IX and X) are the only mixed CNs, the rest are either sensory or motor nerves.
Note: The trigeminal, facia l, glossopharyngeal, and vagus nerves are said to be
branchiomeric (non-somitic) in origin because they originate from the branchial
arches.
Important: The ophthalmic nerve (CN Vl) i s not considered branchiomeric. It does
not innervate branchial arch derivatives. Instead, it innervates structures derived from
the paraxial mesoderm found in the frontonasa l process of the developing embryo.
nerve
A lesion of the facial nerve just after it exits from the stylomastoid foramen
would result in:
an ipsilateral loss oftaste to the anterior tongue

a decrease in saliva production in the floor of the mouth
SAADDES
a sensory loss to the tongue
an ipsilateral paralysis offacial muscles
a contra lateral paralysis of facial muscles
240
ANATOMIC SCIENCES
an ipsilateral paralysis of facial muscles

The facial nerve is the nerve of facial expression. The facial nerve is a mixed nerve containing both
sensory and motor components. It emerges from the brainstem between the pons and the medulla, and
controls the muscles of facial expression, and taste to the anterior two-thirds of the tongue.
The facial nerve's main function is motor control of most of the facial muscles and muscles of the inner ear.
This nerve also supplies parasympathetic fibers to the submandibular g land and sublingual glands via
the chorda tympani nerve and the submandibular ganglion, and to the lacrimal gland via the
pterygopalatine ganglion. In addition, the nerve receives taste sensations from the anterior two-thirds
of the tongue. The facial nerve has four components with distinct functions:
f. .td.tl -
Component
Cr.uu.tl :\lJH \II
Function
SAADDES
Somatic (Branchial) Motor
As the nerve of the 2nd pharyngeal arch, it supplies striated muscles derived
from its mesodenn, mainly the muscles of facial
and auricular
muscle$. It also supplies the. posterior be.llies of the digastric, stylohyoid,
muscles.
and
Visceral (Parasympathetic)
Provides
parasympathetic fi bers to the pterygopalatine ganglion
for innervation ofr he lacrimal
and to the submand ibular ganglion for
The ptery
innervation of the sublingual and submandibular salivary
gopalatine ganglion is associa1ed with the maxillary ne.rve (CN V2). which
distribute$ its
fi bers. where.as the submandibular ganglion is
associate.d with the mandibular nerve (CN V3).
Somatic (General) Sen,sory
Some fi bers from the geniculate ganglion supply a small area of rhe. skin o f
the concha of the auricle, close 10 external acous1ic me.atus
Special Sensory (fa.ste)
Fibers carrie.d by the chorda tympani join the lingual nerve 10 convey taste
sensa1ion from the anterior two 1hirds of the longue and soft palate
Key point: Branchial motor fibers constitute the largest portion of the facial nerve. The remaining three
components are bound in a d istinct fascial sheath from the branchial motor fibers. Collectively, these
three components are referred to as the nervus intermedius.
SAADDES
Postganglionic
parasympathetic
neurons
gland
Facial Nerve- Cranial Nerve VII

(A) Sensory and parasympathetic Neurons
(B) Somatic Motor Branches
240 I
Reproduced wilh pcnn ission from Spenc-e AP, Mason EB: Huma11 Anammyaml
ed 4; St Paul. 19'1)2. Wesl Publislung Company.
nerve
The spinal part of accessory nerve enters the skull through
and
then it joins the cranial root. Together they leave the skull through the
ca rotid canal, jugular foramen

ca rotid canal, foramen magnum
SAADDES
jugular fo ramen, foramen magnum
foramen magnum, jugular foramen
241
ANATOMIC SCIENCES
foramen magnum, jugular foramen

The accessory nerve is a nerve that controls specific muscles of the neck. As a part of
it is traditiona ll y believed to originate in the brain, it is considered a crania l nerve. Based
on its location relative to other such nerves, it's designated the eleventh of twelve cranial nerves, and is thus abbreviated CN XI.
It is purely motor and has two roots, cranial and spinal. The spinal root arises from anterior horn cel ls of the upper 5 cervica l segments, and it enters the skull th rough foramen magnum, these fibers are joined by the crania l root which arises from the caudal
part of the nucleus ambiguus and together they leave the skull th rough the jugular
foramen with the vagus.
SAADDES
In the jugular foramen the crania l root fibers join the vagus to be d istributed along
w ith fibers of the vagus to the pharynx and larynx. This part of nerve cannot be tested
separately. The spinal part supplies the sternocleidomastoid and trapezius muscle.
Note: A patient exhibiting accessory nerve paralysis would have difficulty turning their
head to the left or ri ght, and shrugging their shoulders.
SAADDES
Accessory Nerve- Cranial Ner ve XI
\Vith cranial and spinal portions separated
with pcrmis..-.ion from Spcacx AI', Mason EB: Httma11 AntiiMIJ' Ond
241 1
ed 4; St Paul. 1992. Wesl Publit>lung Company.
nerve
Which ofthe following nerves innervates the lower lip?
mental nerve
incisive branch of IAN
facial nerve
SAADDES
lingual nerve
242
ANATOMIC SCIENCES
mental ner ve
llmtn.ltwn of tht O r al< ,l\lt\
Ntn't
Supplies the Following Areas
O rigin
Lingual
Mandibular nerYe (V3)
C horda ()rmpani
Facial neiVe (VII)
General sensation of anterior 2/3 of the tongue, lingual gingiva of lower

ili'Ch
Glossopha1y ngeal
General and caste sensation ofthe posterior 1/3 of the tongue (including
the vallate papillae)
Taste sensation ofthe base of the tongue and e-piglottis
Vagus
Inferior alveola
nerve
Incisive
Me-mal
Taste sensation ofanterior2/3 of the tongue (except for the vallate

papillae)
Mandibular nerve (V3)
Lower premolar and molar tee[h and buccal surfaces; in the molar region
SAADDES
Inferior alveolar ne-rve.
Lower ame-rio1 teeth
Inferior alveolar ne-rve.
Amerio aspect.; of the chin and lower lip as well as the buccal gingivae
of the mand1bula1 anterior tee.th and premolars
Bucc.al
Mandibular nerve (V3)
Buccal surfaces in the molar region
Posterior superior
alveolar
Maxillary nerve (V2)
Upper molar teeth (except for the mesiobucc-al root of the lirst molar)
and buccal surfaces in the molar region
Middle superior
alveolar
Upper premolar teeth, mesiobuccal root of upper first molar and bucc.al
surt3ces in upper p1emola1 region
Anterior superio1
alveolar
Upper aJlterior teeth and bucc.al surfaces in upper anterior teeth
Greater palarine
Pterygopalatine ganglion l'alatal side of upper [eeth (except in incis.al area)
Nasopalatine
Pterygopalatine ganglion l'alatal side of upper amerior teedl (incisal area)
Jnfrao1bital
Upper lip
nerve
Which of the following nerves is derived from both the medial and lateral
cords ofthe brachial plexus?
musculocutaneous
axillary
ulnar
median
SAADDES
radial
243
ANATOMIC SCIENCES
median
The brachial plexus is a somatic nerve p lexus formed by intercommunications among the ventral rami of the
lower four cervical nerves (CS-C8) and the first thoracic nerve (Tl ). The plexus is responsib le for the motor Innervation to all of the muscles of the upper limb with the exception of the trapezius and levator scapula. it supplies
all of t he cutaneou s innervation of the upper limb w ith t he exception of an area near the axilla (armpit) which is
supplied by the i ntercostobrachial nerve.
Formation of the Brachial Plexus:
A. Roots: The ventral rami of spinal nerves CS to T1 are referred to as the roots of p lexus
B. Trunks Shortly after emerging from the intervertebral foramina, these 5 roots unite to form t hree trunks:
-The ventral rami of CS and C6 unite to form t he upper trunk
-The ventral ramus of C7 continues as the m iddle trunk
-The ventral rami ofC8 andTl unite to form the lower trunk
C. Divisions Each trunk splits i nto an anterior division and a posterior division
SAADDES
The anterior divisions usually supply Oexor muscles

The posterior divisions usually supply extensor muscles
D. Cords The anterior divisions of upper and middle trunks unite to form the lateral cord
The anterior division of t he lower trunk forms the medial cord
All3 posterior divisions from each of the 3 trunks all uni te to form the posterior cord
The cords are named according to t heir position relative to the axillary artery
E. Termin al branches
Musculocutaneous nerve: is derived from t he lateral cord; this nerve innervates the m uscles in the Oexor
compartment of t he arm; it carries sensation from the lateral (radial) side of the forearm
Ulnar n erve: is derived from the medial cord; it supplies motor innervation main ly to intrinsic m uscles of
the hand; it carries sensory innervation from the medial (ulnar) 1 & digits (the 5th
of the 4th digits)
Median nerve: is derived from both the lateral and medial cords; it supplies motor in nervation to most of
flexor muscles in t he forearm and intrinsic muscles of the t humb; it carries sensory innervation from the lateral (radial) 3 & digits (the thumb and first 2 and
Axillary nerve: is derived from the posterior cord; it supplies motor innervat ion to deltoid and teres minor
muscles only; it carries sensory innervation from the skin just below the point of the shoulder
Radial nerve: is also derived from posterior cord; called great extensor nerve because it innervates the
extensor muscles of the elbow, wrist and fingers; it carries sensory innervation from the skin on t he dorsum
of t he hand on the radial side
v,
v,
nerve
Which sensory receptor is most sensitive to linear acceleration?
cri sta
utricle
saccule
macula
SAADDES
organ of corti
244
ANATOMIC SCIENCES
macula
Vestibulocochlear nerve (CN VIII)
Functions: Special sensory (special somatic afferent) that is, special sensations of
hearing and equilibri um.
Nuclei: Four vestibular nuclei are located at the junction of the pons and medulla
in the lateral part of the floor of the 4th ventri cle; two coch lear nuclei are in the
medulla.
The vestibulocochlear nerve (CN VIII) emerges from the junction of the pons and
medulla and enters the internal acoustic meatus. Here it separates into the vestibula r
and cochlea r nerves.
SAADDES
The vestibular nerve is concerned w ith equilibrium. It is composed of the central

processes of bipolar neurons in the vestibular ganglion; the peripheral processes of
the neurons extend to the maculae ofthe utricle and saccule (sensitive to the line of linear acceleration relative to the position of the head) and to the ampullae of the semici rcu lar ducts (sensitive to rotational acceleration).
The cochlear nerve is concerned with hearing. It is composed of the central processes
of bipolar neurons in the spinal ganglion; the peripheral processes of the neurons extend to the spiral organ.
Organ of Corti (spira l organ): The t rue organ of hearing, a spiral structure w ithin the
cochlea contain ing hair cells that are stimulated by sound vibrations. The hair cells convert the vibrations into nerve impulses that are transm itted by the cochlear portion of
the eighth cranial nerve to the brain.
Ampulla
Semicircular
ducts
Vestibular
ganglion
Internal
auditory
meatus
Vestibular
nerve
SAADDES
auditory
meatus
Vestibulocochlear Ner ve- Cr anial Ner ve VIII

Showing the vestibular nerve that supplies the vestibule and
ampullae and the cochlear nerve that supplies the cochlea.
body cavities and regions

Which of the following organs is retroperitoneal?
stomach
kidneys
liver
gallbladder
SAADDES
inferi or vena cava

spleen
245
ANATOMIC SCIENCES
kidneys
inferior vena cava
Abdominal cavity: the maj or part of the abdominopelv ic cavity, bounded by the thoracic diaphragm and
the pelvic inlet . The abdominal cavity includes both the peritoneal cavity and the retroperitoneal space.
Peritoneal cavity: that part of the abdomen surrounded by peritoneum. This is a pot ential space between the pa rietal and visceral layers of perit oneum
Retroperitoneal space: the area behi nd (post erior to) the peritoneum. Retroperitoneal organs are locat ed in this space
Abdominal contents:
Peri toneum: a thin, serous membrane lining the wall s of the abdominal and pelvic cavities and clothing the abdominal and pelvic v iscera. The peritoneum can be regarded as a "balloon into which o rgans
are pressed into from the outside. The peritoneum has visceral and parietal layers, just like the pleural cavity.
Parietal peritoneum: lines the w alls of the abdominal and pelvic cavities
Visceral peritoneum: covers the organs
** *The potential space between the t wo layers, which is in effect the inside space of the balloon, is
called the peritoneal cavity.
SAADDES
The peritoneal cavity can be divided into two parts:

Greater sac: is the main component of the peritoneal cavity and extends from the diaphragm down
t o the pelvis
Lesser sac: is smaller and lies behind the stomach
* ** The t wo sacs are in free communication wi th one another through an oval w indow call ed the
opening of the lesser sac, or the epiploic foramen.
The terms intraperitoneal and retroperitoneal are used to describe the relationship of various o rgans to
the peritoneal covering. An organ is said to be intraperitoneal when i t is almost tot ally covered w ith visceral perit oneum. The following organs are considered t o be intraperitoneal: the stomach, jej unum, ileum,
spleen, transverse colon, liver, and gallbladder. Retroperitoneal organs are those that lie behind the perit oneum and are only part ially covered w i th visceral peritoneum. The fo llowing organs or structures are
considered t o be retroperitoneal: the aort a, inf erior vena cava, kid neys, adrenal g lands, pancreas, uret ers,
most of the duodenum, and the ascendi ng and descending parts of the colon.
Note: Mesenteries are two-layered fold s of peritoneum connecting parts of the int estines to the posterio r
abdominal wall. These folds permit blood, lymph vessels, and nerves t o reach the viscera.

A 15-year-old patient comes into the emergency room with diffuse abdominal pain, loss of appetite, and a fever. On palpation of the lower right abdomen he feels pain, and even greater rebound pain when the pressure is
released. The diagnosis is appendicitis. The appendix is located in which abdominal region?
umbilical
epigastri c
hypogastric
SAADDES
lumbar
hypochondriac
iliac
246
ANATOMIC SCIENCES
Iliac
I ht:" :\uu.
Right Hypochondriac
liW I'
Gallbladder
Small intesrine
Ascending colon
Transverse colon
Righ[ kidney
Right Lumbar
Epigastric
Esophagus
Stomach
liver
Pancreas
SJ)Ieen
Small imesaine
Tran..werse colon
Right and lef[ adre11als
Right and Jef[ kidneys
Right and Jef[ ure[ers
Umbilical
Left Hypochondriac
S[omach
Liver (tip)
Pancreas (tail)
Splee1l
Small intestine
T1ansve1'Se colon
Desc.ending c.olon
Ld l kidney
Left Lumbar
SAADDES
Liveo (tip)
Gallbladder
Small inte;aine
Ascending c.o lon
Righ[ kidney
Right Iliac
Small intestine
Appendix
Cecum and
ascending colon
Right ovary (female-s)
Righ[ fallopian n1be
Stomach
Pancreas
Small imesaine
Tran..werse colon
Right and lef[ kidneys
Right and Jef[ ure[t-rs
Cisre-rna chylii
Hypogastric
Small inte$tine
Sigmoid c.olon
Rectum
Right and Je_f[ ure[e-rs
Urina1y bladde-r
Female
Uten1.s
Right and Jef[ ovaries
Right and Je-f[ fallopian mbes
)1ale
Vas deferen..o;
Seminal vesicles
Prostate
Small intesrine
Desc-ending colon
Ldl kidney (tip)
Left Iliac
Small intesrine
Desc-ending c.olon
Sigmoid colon
Ld! oval) (female)
Left fallopian tube (female)
SAADDES
Ab dominal Regions- Anterior view
Reproduced with pcnmssion from Atlas of Human
Springhouse. 2001. Springhouse.
246 I

In an elderly adult, the thymus is mostly atrophied, and the remains lie in the
superior mediastinum. In a pubescent boy, the thymus is at its largest, with an
average mass of 35 grams. When it is this size, the thymus will be present in
which other division ofthe mediastinum?
anterior mediastinum
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middle mediastinum
posterior mediastinum
247
ANATOMIC SCIENCES
anterior mediastinum
The tho racic cavity is surrounded by the ri bs and chest muscles. It's subdivided into
the pleural cavities, each of wh ich contains a lung, and the mediastinum, wh ich conta ins the heart, large vessels of the heart, trachea, esophagus, thymus, lymph nodes,
and other blood vessels and nerves. The mediastinum is further d ivided into fou r areas.
Li sted below are some of the major structures conta ined w ithin the different regions.
(It is not with in the scope of these ca rds to list all of the contents of the mediastina).
Note: Some structures overlap into d ifferent areas.
Superior mediastinum: arch of the aorta, left and ri ght subclavian arteries and
veins, ri ght and left common ca rotid arteri es, right and left internal jugular veins,
right and left brachiocephalic veins, brachiocephalic artery, upper half of the superi or vena cava, right and left primary bronchus, trachea, esophagus, thoracic duct,
thymus, the phrenic nerves, vagus nerves, ca rdiac plexus of nerves, and left recurrent
laryngeal nerve.
Inferior mediastinum: region d irectly below the superi or mediastinum. This is
subdivided into three regions: anterior, middle, and posteri or.
1. Anterior mediastinum: lymph nodes, branches of internal thoracic artery; in
children, conta ins the inferior part of the thymus gland.
2. Middle mediastinum: peri ca rdium, heart and adjacent great vessels, the
phrenic nerves, and the main bronchi.
3. Posterior mediastinum: thoracic aorta, thoracic duct, esophagus, trachea, right
and left main bronchus, brachiocephalic artery, left common carotid artery, left
subclavian artery, arch of aorta, esophageal plexus (branches of vagus and
splanchnic nerves), sympathetic chain ganglia, azygos and hemiazygos veins, and
many lymph nodes.
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Middle
mediastinum
Superior-L
mediastinum
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Posterior
mediastinum
2471
Mediasti num - Subdivisions

The diaphragm is located in the:
pelvic cavity
t horacic cavity
abdominal cavity
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vertebral cavity
243
ANATOMIC SCIENCES
thoracic cavity
Body cavities are spaces within the body that contain the internal organs. The dorsal (posterior)
and ventral (anterior) cavities are the two major closed cavities.
Dorsal cavity is subd ivided into two cavities:
1. Cranial cavity (skull}: encases the bra in
2. Vertebral cavity (also called the spinal or vertebra l canal}: is formed by portions of the
bones (vertebrae) that form the spine. It encloses the spinal cord.
*** These two cavities commun icate through the fora men magnum. These cavities are
lined by meninges. The fluid in t hese cavities is called cerebrospinal fluid.
Ventral cavity: is subd ivided into two cavities:
1. The thoracic cavity, is surrounded by the ribs and chest muscles. The thoracic cavity is
subdivided into:
Pleural cavities (right and left): each of which contains a lung and the mediastinum,
which contains the heart, large vessels of the heart, trachea, esophagus, thymus, lymph
nodes, and other blood vessels and nerves
Remember: The med iastinum is further divided into four areas: the middle, the anterior, posterior, and superior areas.
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Pericardia! cavity: between the visceral and parietal layers ofthe serous pericardium,
contains a thin film of fluid
2. Abdominopelvic cavity, which has two reg ions:

Abdominal cavity: contains the stomach, intestines, spleen, liver, and other internal
organs
Pelvic cavity: inferior to the abdominal cavity, contains bladder, some reproductive
structures (""" See below), and the rectum
*** In the male: the paired ductus deferens and seminal vesicle and the unpaired
prostate. ln the female : the paired ovaries and the unpaired uterus.
***The two cavities (thoracic and abdominopelvic) commun icate through an opening in the
d iaphragm called the hiatus.
cavity
Dorsal
cavity
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Ventral
cavity
Abdominopelvic
cavity
- - - - --+-'
Body CaYitics
248-1
The dorsal cavity, in t he posterior region of the body, is divided into the cranial caYity and the
Yer tebr al canal (Yer tebr al c.a vity). The Yentral cavity, in the anterior region, is divided into the
thoracic and abdominopeiYic cavities.
miscellaneous
Extracellular fluid comprises _ _ _ of the amount of total body water.
25%
33%
50%
66%
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249
ANATOMIC SCIENCES
33%
The body's water is effectively compartmentalized into several major divisions.
Intracellular fluid (ICF) comprises two-thirds of the body's water
-If your body is 60% water by weight, ICF is two-thirds of that, or 40% of your total weight.
-The ICF is primarily a solution of potassium and organic anions, proteins, etc. (Cellular Soup!).
-The cell membranes and cellular metabolism control the constituents of this ICF.
- ICF is not homogeneous in the body. ICF representsa conglomeration of fluids from all the different cells.
Extracellular fluid (ECF) is the remaining one-third of the body's water
- ECF is about 20% of your weight.
-The ECF is pri marily a NaCI and NaHC03 solution.
- The ECF is further subd ivided into three subcompartments:
Interstitial Fluid (ISF) surroundst he cells, but does not circulate. It comprises about threequarters of the ECF.
Plasma circulates as the extracellular component of blood. It makes up about one-q uarter
ofthe ECF.
Transcellular fluid is a set of fluid s that are outside of the normal compartments. These 12 1iters of fluid make up the CSF, digestive juices, mucus, etc.
Note: The epidermis of t he skin obtains nourishment by diffusion of tissue fluid from capillary beds
located in the dermis. Th is tissue fluid (also called interstitial fluid) conta ins a small percentage of
plasma proteins of low molecu lar weight that pass through the capillary walls as a consequence of
the hydrostatic pressure of the blood. This fluid bathes the cells.
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Inner ear fluids:

Perilymph is an extracellular fluid located within the cochlea (part of the ear) in two of its th ree
compartments: the scala tympani and scala vestibule. The ion ic composition of peri lymph is comparable to that of plasma and cerebrospinal flu id. The major cation in peri lymph is sodium.
Endolymph is the fluid contained in the membranous labyrinth of the inner ear. The main cation
of this unique extracellular fluid is potassium, which is secreted from the stria vascularis. The high
potassium content of the endolymph means that potassium, not sodium, is ca rried as the depolarizing electrical current in the hair cel l.
miscellaneous
All of the following are anatomic structures of the auricle EXCEPT one. Which
tragus
helix
antrum
concha
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250
ANATOMIC SCIENCES
antrum
External ear: consists of the auricle (pi nna) and the external auditory canal. This part receives
sound waves. The auricle consists of cartilaginous ant ihelix, crux of the helix, lobule, t ragus,
and concha. The external auditory canal is a narrow chamber measuring about 1 inch long.
This canal connects the auricle with t he tympanic membrane in the middle ear.
Middle ear (tympanic cavity): an air-filled cavity within the petrous part of the temporal
bone. The middle ear contains three small bones or ossicles, th e malleus (hammer), stapes
(stirrup), and incus (anvil) that transmit sound. Lin ed with mucosa, the middle ear is bounded
laterally by the tympanic membrane and medially by t he oval and round windows. Also contains two muscles - the stapedius muscle, which is the smallest of the skeletal muscles in t he
body, and the tensor tympani muscle. The tympanic membrane, consisting of layers of skin,
fibrous tissue, and mucou s membrane, transmits sound vibrations to the internal ear.
Inner ear: consists of cl osed, fluid-filled spaces within t he temporal bone. The inner ear is a
bony labyrinth, which includes three connected structures - the vestibule, the semicircular canals, and the cochlea. These structures are lined with a serous membrane that forms t he
membranous labyrinth. A fluid called perilym ph fills the space between t he bony labyri nth
and the membranous labyrinth. Note: Within the cochlea lies the cochlear d uct, a triangular,
membranous structu re housing the organ of Corti. The receptor organ for hearing, the organ
of Corti t ransm its sound to the cochlear branch of the acoustic (CN VIII) nerve.
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Clinical considerations: Middle ear infections (otitis media) are quite prevalent and may
become extensive d ue to connections between the tympanic cavity and both the mastoid air
cells and the nasoph arynx. Note: Streptococcus pneumoniae is the most frequent microbe
causing otitis media.
The auditory tube eq ualizes air pressure on either side of the tympanic membrane. The
middle ear communicates posteriorly with the mastoid air cells and the mastoid antrum
th rough the aditus ad antrum.
External ear
I Auricle
(Not to scale)
Middle ear
Inner ear
(pinna)
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Auditory
ossicles
External, Middle, and Inner Ears

(Note: anatomic stmctures not draw11 to scale)
25().1
miscellaneous
Which of the following helps the lens change its shape to better focus light to
the retina?
neural retina
pupil
iris
ciliary body
conjunctiva
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ANATOMIC SCIENCES
ciliary body
Parts oft he eye: Eye Anatomy consists of many intricate partsof the eye.lt involves parts that allow
light refraction, maintaining the shape of the eye, light conversion and much more.
Cornea:The cornea is the dome shape outer covering of the eye. The cornea is where most of the
focusing of light occurs. It consists of many layers including the epithelium which is the tough
outer layer that regenerates fairly quickly. The epithelium is usually removed or cut duri ng many
refractive procedures where the cornea is reshaped to focus light better.
Sclera: The sclera is the outer white part of the eye that you can see. It provides protection and
st ructure for the inner parts of the eye.
Conjunctiva and lacrimal glands: The conjunctiva is a mucus layer that keeps the eye moist Infections to this area are known as the popular "Pink Eye." Lacrimal glands are found on the outer
part of each eye and are producersof tears.
Vitreous humor and aqueous Humor:The vitreous humor is a gel-like substance in the back
part of the eyeball which provides the shape of the eyeball. The aqueous humor is the watery region in the front of the eye ball. It is separated into two regions, the anterior chamber in front of
the iris and the posterior chamber behind it. The canal of Schlemm drains water in thi sregion and
is sometimes blocked off leading to the disease known as glaucoma or other complications.
Iris and pupil: The pupil is the dark, black circle of the eye. It contracts with brightness and expands during darkness allowing light to be better transmitted. The iris is the colored part of the
eye.This coloring is due to pigment cells in tissue in the iris. The iris contains the sphincter pupillae, a muscle used to narrow the pupil, and the dilator pupillae, a muscle used to widen the pupil.
Lens: The lens is a clear layer behind the pu pil that does j ust what a regular lens does. The lens
main purpose is to focus light by changing its shape. The ciliary body are muscles attached to the
lens that help the lens change its shape to better focuslight to the reti na.
Retina: The retina is the inner most layer of sensitive tissue. When light is transmitted here images can clearly be transmitted to the brain.The retina consists of many layers including layersof
rods and cones. Many cells in the reti na transform light into chemical and electrical energy that is
transferred to optic nerves. The back center of the retina contains the macula. The Macula is a
highly sensitive part of the retina. It is responsible for our detailed vision. The center of the macula iscalled the fovea which has a major role in detailed perception. When there isdamage to the
macula, we are unable to see fi ner details.
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reproductive system
The ovaries are homologous with the testes in the male.
Each ovary lies in a shallow depression, named the ovarian fossa, on the
lateral wall of the pelvis; this fossa is bounded above by the external iliac
vessels, in front by the obliterated umbilical artery, and behind by the ureter.
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the first statement is fa lse, t he second is true
252
ANATOMIC SCIENCES
both statement are true

The ovaries are elliptical organs, situated close to the side wall s of the pelvis, and are supported by the
broad ligament of the uterus. All the ovary's blood and lymphatic vessels, and nerves enter at the hilum .
Beneath its surface epithelium is a cortex that encloses the medulla at its core. The bulk of the ovary is
the supporting structure called the stroma . Note: The main function of the ovaries is to produce mature
ova.
The cortex contains ova at d ifferent stages of development The ova begin as primordial oocytes, su rrounded by a layer of flat cells called granulosa cells. At puberty, the granulosa cells begin to multiply and
form the multilayered theca interna that secretes androgens (in response to LH) that are the precursors of
estrogens. Note: Granulosa cell s have aromatase that converts the androgens produced by the theca interna into the necessary estrogens. The surrounding stromal cells form the theca externa.
A split appears in the theca interna and expands to form a fluid-tilled cavity that pushes the oocyte to one
side; the foll icle is now a Graafian follicle.
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Ovulation takes place in the midd le of each menstrual cycle- a Graafian follicle ruptures to release its
ovum, which enters the uterine tube. The empty follicle tills with blood and regresses into a corpus luteum.
If the ovum is fertilized, the corpus luteum will persist and continue secreting progesterone to maintain
pregnancy. If not, the corpus luteum shrinks into a small mass of collagenous tissue- the corpus albicans.
1. Meiosis, the process by which gametes are formed, can also be called gametogenesis, literally
"creation of gametes. The specific type of meiosis that forms sperm is called spermatogenesis,
while the formation of egg cells, or ova, is called oogenesis. The most important thing you need
to remember about both processes is that they occur through meiosis.
2. Just like spermatogenesis, oogenesis involves the formation of haplo id cells from an original
diploid cell, called a primary oocyte, through meiosis. The female ovaries contain the primary
oocytes. There are two maj or differences between the male and female production of gametes.
First of all, oogenesis only leads to the production of one final ovum, or egg cell, from each
primary oocyte (in contrast to the four sperm that are generated from every spermatogonium).
Of the four daughter cell s that are produced when the primary oocyte divides meiotically, three
come out much smaller than the fourth. These smaller cells, called polar bodies, eventually
disintegrate, leaving only the larger ovum as the fi nal product of oogenesis. The production of
one egg cell via oogenesis normally occurs only once a month, from puberty to menopause.
Female Reproductive System

Uterus
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2521
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Corpu$
luteum
Normal Ovary
252A I
reproductive system
Consider the following structures:
1. Spongy urethra 2. Ductus deferens 3. Prostatic urethra 4. Epididymis
Name the path that sperm travels upon ejaculation.
1, 2, 3, 4
2, 4, 1, 3
4, 2, 1, 3
4, 2, 3, 1
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253
ANATOMIC SCIENCES
4,2, 3, 1 (epididymis, ductus deferens, prostatic urethra, spongy urethra)

Sperm is formed in the testes and then passes along the ductus deferens, which joins the duct
of the seminal vesicle to form t he ejaculatory duct. During ejaculation, the sperm combines
with secretions from t he prostate gland and seminal vesicles to form t he seminal fluid.
The testes are two oval organs contained in the scrotum; t he right one is usually higher than
the left by nearly a half inch. The testis is capped by the epididymis. The epididymis is a
tortuous, (-shaped, cord-like tube about 20 feet long located in the scrotum. The t ube
emerges from the tail as the ductus (vas) deferens. The ductus deferens and its surrounding
vessels and nerves form the spermatic cord, which runs upward to t he level of the pubic
tubercle of the pubic bone, passes through the inguinal canal, and t hen turns sharply to enter
t he pelvic cavity. The d uctus deferens then heads toward t he back of the prostate gland, where
t he ductus deferens expands into an ampulla and joins the duct of the seminal vesicle to form
t he ejaculatory duct. The ejaculatory duct penetrates t he prostate gland to open into t he
prostatic urethra. After leaving t he prostate gland, the urethra runs t hroug h the muscles of
t he urogenital diaphragm, and enters the penis.
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. 1. The ejaculatory duct is one of the two passageways that carry semen from t he
: ' prostate gland to the urethra. The oviduct (fallopian tube) is one of a pair of d ucts
opening at one end into t he uterus and at the other end into the peritoneal cavity,
over t he ovary. Each t ube serves as a passage through which an ovum is carried to
the uterus and throug h which spermatozoa move out toward the ovary.
2. Stereocilia are long, nonmotile microvilli that cover the free surfaces of some of
the pseudostratified columnar epithelium that lines the inside of t he epididymis.
Stereocilia serve to facilitate the passage of nutrients from the epithelium to t he
sperm by increasing the epithelium's surface area.
Note: Stereocilia are also present in the ductus (vas) deferens, which is also lined
with pseudostratified columnar epithelium.
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MALE REPRODUCTIVE TRACT
Male Urinary
Bladder and
Urethra
Ureter
Urinary
bladder
Trigone - - - -
Prostatic--- --+-.. "+----Prostate

urethra
gland
Bulbourethral
gland
urethra
SAADDES
Penile
urethra
External-----....
urethral orifice
Vas deferens
Epididymis
Testis
Scrotum
253 A l
reproductive system
Cooper's ligaments are fibrous bands attached to musculature and function to
support:
each testis
each ovary
SAADDES
each body of the epididymis

each breast
254
ANATOMIC SCIENCES
each breast
The mammary glands (breasts) are located on either side of the anterior chest wall over the
greater pectoral and the anterior serratus muscles. These glands are specialized accessory
glands that secrete milk. They are formed from many small tubules grouped into a lobule.
Several lobules constitute a lobe, each of which has an interlobular duct. Many of these ducts
combine to form a lactiferous duct, which terminates at the nipple. The nipple is present on
each breast as a centrally located pigmented area of erectile tissue ringed by an areola that's
darker than the adjacent tissue.
The arterial supply of th e breast is from perforating branches of the internal thoracic artery
and the intercostal arteries. The axillary artery also supplies the gland via its lateral thoracic
and thoracoacromial branches.
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Several chains of lymph nodes drain different areas of the breast and axilla. The node chains and
the areas they drain are as follows:
pectoral- most of the breast and anterior chest
brachial- most of the arm
subscapular- posterior chest wall and part of the arm
midaxillary- pectoral, brachial, and subscapular nodes
internal mammary nodes- mammary lobes
..
1. Breast cancer causes dimpling ("peau d'orange") of the overlying skin and nipple
_;,.Y
retraction.
' 2.The suspensory ligaments (Cooper's ligaments) are strong, fibrous processes that
run from the dermis of the skin to the deep layer of superficial fascia through the
breast.
3. 1mportant: Mammary, sweat, lacrimal, and salivary glands contain a special type of
smooth muscle cell called myoepithelial cells (star-shaped). These cells have
processes that spiral around some of the secretory cells of these glands. The
contraction of these processes forces the secretion of the glands toward the ducts.
reproductive system
The inguinal canal is an oblique passage through the lower part of the
anterior abdominal wall and is present in both males and females. In
females its primary content is the round ligament of the uterus. In males,
which of the following structures does NOT pass through the inguinal canal?
spermatic cord
SAADDES
ductus deferens
testicula r veins
ejaculatory duct
lymph vessels
255
ANATOMIC SCIENCES
ejaculatory duct
The inguinal canal all ows structures of the spermatic cord to pass to and from the testi s
to the abd omen in the male. In the female, the smaller canal permits the passage of the
round ligament of the uterus from t he uterus to the labium majus. Note: In both sexes,
the canal also transmits the ilioinguinal nerve.
The spermatic cord is a collection of struct ures t hat traverse t he inguinal canal and pass
to and from the testi s. The spermatic cord is covered w ith three concentric layers of fascia
derived f rom t he layers of the anterior abdominal wall, and begins at the deep inguinal
ring lateral to t he inferior epigast ric artery and ends at the testi s.
Structures of the spermatic cord:
Ductus (vas) deferens - it is a cord -li ke structure; it conveys sperm from the
epididymis to the ejaculatory duct, which is a passageway formed by the union of
the deferent duct (vas deferens) and the excretory duct of the seminal vesicle. The
ej aculatory duct opens into the prostatic urethra.
Testicular artery - branch of the abdominal aorta; supplies mainly the testis and
the epididymi s.
Testicular vein s - an extensive venous plexus, the pampiniform plexus, leaves the
posterior border of t he testis. As the plexus ascends, it becomes reduced in size into a
sing le testicular vein. This runs up on the posterior abdominal wall and drains into the
left renal vein on the left side, and into the inferior vena cava on the right side.
Testicular lymph vessels - ascend through the inguinal canal and pass up over the
posterior abdominal wall to reach the lumbar lymph nodes on the side of the aorta at
the level of the fi rst lumbar vertebra.
Autonomic nerves- sympathetic fibers run with the testicu lar artery from the renal
or aorti c sympathetic plexuses. Afferent sensory nerves accompany the efferent
sympathet ic fibers.
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reproductive system
Cystitis is a term that refers to urinary bladder inflammation. It is most commonly caused by a urinary tract infection. It affects females more than males.
This is mainly due to the difference in length of the:
ureter
urethra
SAADDES
theca intern a
fa llopian tube
rena l pelvis
256
copyngh t 0 20132014 Dental Decks
ANATOMIC SCIENCES
urethra
The urethra is a tube that conveys urine from the urinary bladder to the outside of the body. The
wall of the urethra is lined with mucous membranes and contains a relatively thick layer of smooth
muscle tissue.lt also contains numerous mucous glands, called "urethral glands," that secrete mucus
into the urethral canal.
The urethra being shorter in the female (about 4 em long) than it is in the male (about 20 em long)
subjects the female to more frequent bladder infections. Because the male urethra travels in the
penis, the male urethra is longer than the female urethra. This requires an invading organism to travel
a greater distance to gain access to the urinary bladder. Eliminating urine by the male tend s to flush
the urethra before an invading organism can reach the urinary bladder.
if':': , 1. The female urethra opens into the vestibule bet ween the clitoris and the vagina.
2. In the male, the urethra also conveys semen from the reproductive organs during ejaculat ion.The male urethra is divided into three parts:
-prostatic: it is the wid est and most dilatable portion of the urethra
- membranous: it is the shortest and least dilatable portion of the urethra
-penile: it is the long est and narrowest portion; bulbourethral glands open into it
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3. The ureter isa paired passageway that transports the urine from the kidney to the uri nary
bladder for concentrat ion and storage until the urine is voided.
Important: The accessory gland s, which produce most of the semen, include the:
The seminal vesicles are paired sacs at the base of the bladder.
The bulbourethral glands (Cowper's gland s), also paired, are located inferior to the prostate
gland.
The prostate gland is shaped like an inverted pyramid and lies under the bladder, with the apex
pointing downward. Emerging from the neck of the bladder, the urethra runs vertically through
the prostate gland, and exits just in front of the apex. The prostate gland has two major groups of
glands: -periurethral glands: are in the central zone surrounding the urethra
- main glands: are in the peri pheral zone
*'** All the gland sopen into the prostatic urethra and secrete the enzyme acid phosphatase, fibrinolysin, and some proteins. Prostatic secretion makes up about 25% of semen.
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..- - - - - Spongy (penile) urethra
.-- - - - Erectile t issue of penis
u,;..;....--External urethral orifice
Comparison of Male & Female Urethra
256-1
reproductive system
Where does the fertilization of an oocyte occur?
vagina
ovary
peritoneum
ampulla
uterus
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257
ANATOMIC SCIENCES
ampulla
Organ
"' unction
Ovaries
Produces ova (female germ cells) and female sex honnones (e.o;trogen.s and progesrerone)
Uterine mbes
(fallopian lube.<)
Receive the ovum from the ovary and provide a site where feni lization of rhe ovum can take
place. Tlle tube$ sene as a conduit along which the spermatozoa travel to reach the ovum.
Utems
Serves as a site for the reception, rele.ntion, and nutrition ofthe fertilized ovum
Vagina
Not only is the fe-male ge-nital canal but also serves as lhe excntory duct fOI' the menstmal flow
and fomts pan of the birth canal
Labia majora
Form margins of pudendal cleft; enclose and protect the other external re-productive organs
Labia minora
Clitoris
Vestibular glands
l\hnunary glands
Bartholins gland-:
Form margins of vestibule; protect openings of vagina and urethra
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Provides feeling of pleasure during stimulation
Secrere lubricating fluid into the vestibule and vaginal opening during coitus
J)roduce and secrere milk fo1 nourishment of an infant
1'hey secrete mucus to lubricare the vagina and are homologous to bulbourethral glands in males
Fallopian tubes are the two long, t hin t ubes that connect to a woman's uterus (one on each side).
The other ends of the tubes flare open wi th several long fringes, called fimbriae, on the end. After
ovulation, these fimbriae beat back and forth to help guide the egg into the fallopian tube. Once inside t he tube, tiny hairs called cilia push the egg along and toward the uterus. Fertilization typically
occurs in the fallopian tube if the egg encountersa sperm. There are fou r parts of the fallopian tube
from the ovary to the uterus:
The fimbriae
Infundibulum
Ampulla- where the ovum is fertil ized
Isthmus
Mons pubice
Clitoris
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Labia minc1ra-------..
Labia
Vagina
Anus
External genita lia- Female
reproductive system
The two tubes on the top side of the penis are called the:
th e erectile tissue
spongy tu bes
corpus cavernosum
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co rpus spongiosum
urethra
[refer to card 253-1, 253 A-1for illustration)
ANATOMIC SCIENCES
258
corpus cavernosum
Or:,:a nsul tlu.: \LIIc Hxpruducll\c '\slun
Organ
Function
Tesoes(2)
Produce spcnn and testosterone (male sex hormone)
Scr01um
Portion ofthe St"minal d u<:t in which Sperm m.aturc and an: stort.d
Epididymis (2)
Ductus (vas) deferens (2) Transport spenn during ej aculation upward inside the spenn.ati<: cord 10 the urelhrn
Produces st.men, the Huid thai carrie-s spt.nn; this fluid helps protect spcnn from the vagina's
acidity during cj ac ulalion
gland
Seminal
(2 pair)
Secrete the majori1)' of the Ruid (alkaline and rich in fru<:IO!ic) in semen
Bulbourethral glands
(Cowpers g land)
Seatle fluid that lubricate.<: urdhra and end of penis
EjaculatOI)' docts ( 2)
Receive spenn and additives to pn)duce seminal lluid: run through the prostale and o pen into the
urtthrn
Penis
Male sexual organ that
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both urine and spcnn
The penis is the male sex organ, reach ing its full size during puberty. In addition to its sexual function, the penis acts as a conduit for urine to leave the body. The penis is made of several parts:
Glans (head) of the penis: In uncircumcised men, the glans is covered with pink, moist tissue
called mucosa. Covering the glans is the foreskin (prepuce). In circumcised men, the foreskin is
surgically removed and the mucosa on the glans transforms into dry skin.
Corpus cavernosum: Two columns of tissue running along the sides of the penis. Blood fills this
tissue to cause an erection.
Corpus spongiosum: A column of sponge-like tissue running along the front of the penis and
ending at the glans penis; it fills with blood during an erection, keeping the urethra -which runs
through it - open.
The urethra runs through the corpus spongiosum, conducti ng urine out of the body.
reproductive system
When sperm cells are formed, they migrate in an immature state to the long,
narrow structure attached to the back of each testicle called the:
vas deferens
prostate
rete testis
SAADDES
seminal vesicles
epididymis
259
ANATOMIC SCIENCES
epididymis
The t estes (sing ular: testis) are paired structures that are suspended within the scrotum in
the male. They produce sp ermatozoa and sex hormones (and rogens). Sperm are
prod uced in the seminiferous tubules and stored outside the testis in the epididymis
until ej aculated. Androgens, the most important one being testosterone, are synthesized
and secreted into the b loodstream by interstitial cells (of Leydig) found in the interstitium
of the testis between the seminiferous tu bules. Testosterone is respons ib le for growth and
maintenance of male sexual characteristics and for sperm production.
The ovaries are ellipt ical organs, situated close to the side wall s of the pelvis, and are
supported by the broad ligament of the uteru s. All of the ovary's blood and lymphatic
vessels, and nerves enter at the hilum. Beneath its surface epithelium is a cortex that
encloses the medulla at its core. The bu lk of the ovary is the supporting structure called
the stroma. Note: The main function of the ovaries is to p roduce mature ova. The ovaries
also produce steroid hormones estrogen and progesterone.
SAADDES
Estrogen - promotes the development and maintenance of female sexual characteristics and the proper sequence of events in the female reproductive cycle (menstrual
cycle)
Progesterone - maintains (along w ith estrogen) the lining of the uterus necessary
for successful pregnancy
Remember: Ovulation takes p lace in the middle of each menstrual cycle - a Graafian
follicle ruptures to release its ovu m, which enters the uterine tube. The empty follicle fill s
w ith blood and regresses into a corpu s luteum. If the ovum is fertilized, the corpus
luteum w ill persist and continue secreting progesterone to maintain p regnancy. If not,
the corpus luteum shrinks into a small mass of co llagenous t issue- the corpus albicans.
Corona radiata
I
I
Midpiece
Tail
SAADDES
Endpfece
Egg cytoplasm
Spermatozoon
Ovum
259-1
f emale O vary. Showing ovulntioo step
SAADDES
I
Hormonal control of ovulation
periodontium
Surrounding the gingival portion ofthe root of each tooth is a specialized epithelium known as the:
connective t issue attachment

periodontal ligament attachment
SAADDES
junctional epithelium
external basal lamina
260
ANATOMIC SCIENCES
The dentogingival epithelium is the junction between the tooth surface and t he gingival
tissues. Together, t he sulcular epithelium and junctional epithelium form the
dentogingival junctional tissues. They are composed of nonkeratinized stratified
squamous epithelium.
Sulcular epithelium (also called crevicular epithelium) - stands away from the tooth,
creating a gingival sulcus, or space that is filled with gingival fluid or crevicular fluid.
Junctional epithelium - a deeper extension of the sulcular epithelium, the junctional
epithelium beg ins at the base of the sulcus. This epi thelium is a collar like band of stratified
sq uamous epithelium that is firmly attached to the tooth surface by way of an epithelial
attachment. At the epithelium's beginning, it is approximately 15 to 30 cell layers t hick,
and at its apical end, the epithelium is only a few cell layers thick. The j unctional epithelium
consists of two layers: a basal layer and suprabasallayer.
SAADDES
Important: The superficial, or supra basal, epithelial cells of the j unctional epit helium provide
t he hemidesmosomes and an internal basal lamina t hat create the epithelial attachment.
The epithelial attachment is very strong in a healthy state, acting as a type of seal between the
soft gingival t issues and the hard t issue surface.
***In ideal gingival health, the junctional epithelium is located entirely on enamel above t he
cementoenamel junction.
Note: Histologically, the best way to distingui sh the free gingiva from the epithelial
attachment (junctional epithelium) is the fact that the epithelium of the epithelial attachment
does not contain rete pegs or connective tissue papillae and the free gingiva does. Rete
pegs are epithelial projections that extend into the gingival connective t issue. Connective
tissue papillae are connective tissue projections that extend into t he overlying epithelium.
periodontium
Which of the following gingival fibers extend between the cementum of
approximating teeth?
circula r fibers
dentogingival fibers
SAADDES
transsepta l fibers
alveo logingival fibers
dentoperiosteal fibers
261
ANATOMIC SCIENCES
transseptal fibers
Although not strictly part of the POL, other groups of collagen fibers are associated with
maintaining the functional integrity of the periodontium. These groups are found in the lamina propria of the gingiva and collectively form the gingival ligament. Five groups of fiber
bundles compose the ligament:
Circular group - this fiber subgroup of the gingival fiber group is located in the lamina
propria of the marginal gingiva. The circular ligament encircles the tooth and helps maintain
gingival integrity.
Dentogingival group - this fiber subgroup ofthe gingival fiber group inserts in the cementum on the root, apical to the epithelial attachment, and extends into the lamina propria
of the marginal gingiva. Thu s, this ligament has only one mineralized attachment to the
cementum. The dentogingival ligament works with the circular ligament to maintain gingival integrity.
Alveologingival group - this fiber subgroup of the gingival fiber group extends from the
alveolar crest of the alveolar bone proper and radiates coronally into the overlying lamina
propria of the marginal gingiva. These fibers may possibly help to attach the gingiva to the
alveolar bone because of their one mineralized attachment to bone.
Dentoperiosteal group - this fiber subgroup of the gingival fiber group courses from the
cementum, near the cementoenamel junction, across the alveolar crest. These fibers possibly anchor the tooth to the bone and protect the deeper periodontal ligament.
Transseptal group - this fiber subgroup of the gingival fiber group are located interproximally and form horizontal bu ndles that extend between the cementum of approximating
teeth into which they are embedded. They lie in the area between the epithelium at the
base of the gingival sulcus and the crest of the interdental bone and are sometimes classified with the principal fibers of the periodontal ligament.
SAADDES
Note: Some histologists consider the gingival ligament to be part of the principal fibers (also
called the alveolodentalligament) of the POL.
SAADDES
c
group
261-1
Alveolar bone
The arrangement of the principal tiber groups within the periodontium. A, Principal tiber groups. B,
Fiber groups of the gingival ligament. C, Gingival ligament fibers as seen interproximally re lated to the
gingival col.
ReprodllC.'cd with permission from Nand A: Te11 CmeS Orallii.mJ!og)' IXIell1pment. Structure. a11d Fmu:tion: St.
LOU IS,
200!), Elsevier.
periodontium
The mucosa found on the hard palate is known as:
lining mucosa
masticatory mucosa
specialized mucosa
SAADDES
none of the above
262
ANATOMIC SCIENCES
masticatory mucosa
The oral mucosa is composed of two layers:
1. Stratified squamous epithelium, which may be nonkeratinized, parakeratinized, or orthokeratinized dependi ng upon its location.
2. Lamina propria (connective tissue), which supports the epithelium. Subd ivided into t wo layers
(papillary and dense). It may be attached to the periosteum of the alveolar bone or interposed over
the submucosa (the submucosa contains glands, blood vessels, and nerves).
I' pn ol Oral
Region
Type
lining mucosa Buccal mucosa. labial

mucosa, alveolar
mu<:()Jt.il, floor of the
mouth, ve.ntraltonguc
Central Clinical
Apptarance
Gtnl'nd Microscopic
ApJ)l'aranct'
Softe.r texture. m<>ist

l>Urface. a nd ability to
Thin non ktratinlzed l>lratifitd
squamous epithe-lium, few rete

l>lretch and be compressed, pegs. thin lamina propria
SAADDES
acting a.s a cushion
surfac.e, and soil pklle
Ma.sticaiOry
mucosa
Free gingiva. attached Rubbery iiurfac.: texture

and re-siliency, serving a..::
finn base
Ktratini:ttd epithelium, many
Oo.-salt<>ngue-surfac:.e Associated with lingual

papillae
tv1o.stly keratinized. Note: The

fi liform and circumvallate
papillae arc ke-ratinized, but Lhc
fung,ifonn and fo liate papillae
art nonke.r.uinizcd
gingiva. interdenta l
rete pe-gs, thick lamina propria
gingiva. hard palate-,

and dorsal surface of
tongue
Specialized
mucosa
Remember:
1. The crevicular (sulcular) epithelium and gingival col are nonkeratinized gingival ti ssues. The g ingival col is the interdental depression in the gingiva, between the buccal and lingual papillae.
2. The lining of a healthy sulcus is composed of nonkerati nized epithelial tissues with no rete pegs. The
presence of rete pegs is indicative of the presence of inflammation.
3. The junction of the li ning mucosa with the masticatory mucosa is the mucogingival junction.
Note: A basement membrane is located bet ween the oral epithelium and the connective tissue. The
basement membrane is composed of two layers - basal and reticular lamina.
periodontium
Scaling and root planning are periodontal treatments that can remove calculus and also stimulate the gingiva. Usually, a periodontist waits four to six
weeks after a scaling and root planning procedure for reevaluation of therapy. This allows healing of the connective tissue by what main cellular component of the gingival connective tissue?
osteoblast
odontoblast
fibroblast
SAADDES
ameloblast
263
ANATOMIC SCIENCES
fibroblast
All forms of epithelium, whether associated with lining, masticatory, or specialized mucosa, have a lamina propria deep to the basement membrane. The lamina propria,
like all forms of connective tissue proper, has two layers: papillary and dense.
The lamina propria is densely collagenous with a system of collagen fiber bundles
ca lled the gingival fibers (gingiva l ligament). These fibers brace the marginal gingiva
against the tooth, provide the rigidity necessary to withstand the mechanical insults
of mastication, and unite the free marginal gingiva with the cementum of the root
and adjacent attached gingiva. These fibers are continuous with the periodontal
ligament. The POL is also considered to be connective tissue. It surrounds the root
and connects it w ith the alveolar bone by its principal fibers (alveolodental
ligament), which are also collagenous fibers.
SAADDES
The most common cell in the lamina propri a, like all types of connective tissue proper,
is the fibroblast . The fibroblast is responsible fo r the synthesis and secretion of
collagen as well as other proteins. Therefore, fibroblasts are responsible for healing of
the gingiva following surgery or disease processes. Other cells present in the lamina
propria in smaller numbers are the wh ite blood cells such as PMNs, mast cells,
macro phages, and lymphocytes.
Note: The gingival apparatus is a term used to describe the gingival ligament
(or g roups) and the epithelial attachment.
periodontium
Which structure below is NOT a derivative of the dental follicle?
pulp
cementum
periodontal ligament
SAADDES
alveolar bone
[refer to card 95-1, for illustration I
ANATOMIC SCIENCES
264
pulp
The dental follicle (aka, dental sac), is responsible for the development of the supporting structures of the tooth. This includes the cementum, periodontal ligament
(PDL), and the alveolar bone. The pulp is a derivation of the dental papilla.
The peri odontal ligament is that part of the periodontium that provides for the attachment of the teeth to the surrounding alveo lar bone by way of the cementum. The
PDL appears as the periodontal space on rad iographs (0.2 mm average w idth), a
radiolucent area between the radiopaque lamina dura of the alveolar bone proper and
the radiopaque cementum.
The PDL is an organized fibrous connective tissue that also maintains the gingiva in
proper relationship to the teeth. In addition, the PDL transmits occl usal fo rces from the
teeth to the bone, allowing fo r a small amount of movement and acting as a shock absorber for the soft tissue structures around the teeth, such as the nerves and blood
vessels.
SAADDES
1. The PDL becomes very thin and loses the regular arrangement of its
fiber when a tooth loses its function (hypofunction). This also occurs in
areas of tension as opposed to areas of compression. Teeth in hyperfunction have an increased POL w idth.
2. Unlike other connective tissues of the periodontium, the PDL does not
show the changes related to aging, although the PDL can undergo d rastic
changes as a result of periodontal disease.
3. Remnants of Hertwig's epithelial root sheath found in the PDL of a functional tooth are called epithelial rests of Malassez. These groups of epithelial cel ls may become m ineralized in the mature periodontal ligament forming cementicles. Note: Peri apical and radicula r cysts derive their cyst linings
from the rests of Malassez.
periodontium
Which periodontal ligament fiber group mainly resists movements of a tooth
in an occlusal direction?
alveolar crest group

horizontal group
apical group
SAADDES
interradicu lar group

oblique group
Irefer to card 261 -1for illustration]
ANATOMIC SCIENCES
265
apical group
The principal fibers of the POL are primarily composed of bundles of type I collagen fibrils. These fibers
connect the cementum t o the alveolar bone. The main principal fiber g roup is the alveolodental
ligament, which consists of five fiber groups:
Alveolodentalligament:
The alveolar crest group of the alveolodentalligament: originates in the alveolar crest of the alveolar
bone proper and fans out to insert into the cervical cementum at various angles. The function of this
group is to resist tilting, intrusive, extrusive, and rotational forces.
The apical (periapical) group of the alveolodental ligament: rad iates from the apical region of the
cementum to insert into the surrounding alveola r bone proper. The function of this g roup is to resist
extrusive forces, which try to pull the tooth outward (in an occlusal d irection), and rotational forces.
The oblique group of the alveolodentalligament: the most numerous of the fiber groups and covers
the apical two-thirds of the root. This group originat es in the alveolar bone proper and extends apically
to insert more apically into the cementum in an oblique manner. The function of this group is to resist
intrusive forces, which try to push the t ooth inward, as well as rotational forces.
The horizontal group of the alveolodental ligament: originates in the alveolar bone proper apical t o
i ts alveolar crest and inserts into the cementum horizontally. The function of this group is to resist tilti ng
forces, which work to force the tip either mesially, d istally, lingually, or facially, and to resist rotational
forces.
The interradicular group of the alveolodentalligament: found only between the roots of mul ti rooted
teeth (furcation area). Run from the cementum into bone, forming the crest of the interradicular
septum. The function of this g roup is to work together w ith the alveolar crest and apical groups to resist
intrusive, extrusive, tilting, and rotational forces.
SAADDES
Note: Another principal fiber other than the alveolodentalligament is the interdental ligament, o r
transseptalligament. This fiber group (called transseptal fibers) inserts mesially or interdentally into the
cervical cementum of neighboring teeth over the alveolar crest of the alveolar bone proper. Thus, the fibers
travel from cementum to cementum without any bony attachment. The function of this group is to resist
rotational forces and thus hold the teeth in interproximal contact.
Important: The ends of the principal fibers, which are embedded into the cementum and alveolar bone,
are called Sharpey's fibers.
periodontium
Which ofthe following is the most common cell found in the POL?
cementoblasts
undifferentiated mesenchymal cells
osteoblasts
fibroblasts
SAADDES
266
ANATOMIC SCIENCES
fibroblasts
Contents of the POL
Fibroblasts: like all connective tissues, they are t he most common cell
Cementoblasts and cementoclasts
Osteoblasts and osteoclasts
Macrophages, mast cells, and eosinophils
Undifferentiated mesenchymal cells
Ground substance: proteoglycans, glycosaminoglycans, glycoproteins, and water
Functions of the POL:
Support: provides attachment of the tooth to the alveolar bone
Formative: contain s cells responsible for formation of the periodontium
Nutritive: contains a vascular network providing nutrients to its cells
Sensory: contains afferent nerve fibers responsible for pain, pressure, and proprioception
Remodeling: contains cells responsible for remodeling of the periodontium
SAADDES
Important: Orthodontic treatment is possible because the POL continuously responds and
changes as the result of the functional requirements imposed upon the POL by externally
applied forces.
The POL has a vascular supply (arises from the maxillary artery), lymphatics (drain to the submandibular lymph nodes except for the mandibular incisors which drain to t he submental
lymph nodes), and a nerve supply, which enter the apical foramen of the tooth to supply the
pulp.
Two types of nerves are found within the POL
1. One type is afferent, or sensory, which is myelinated and transmits sensation.
2. The other type is autonomic sympathetic, which regulates the blood vessels.
Two types of nerve endings are found in the POL:
1. Free nerve endings; convey pain.
2. Encapsulated nerve endings; convey pressure.
tissue
Which of the following epithelia lines the endothelium of the aorta and the
mesothelium ofthe peritoneal cavity?
simple squamous epithelium

stratified columnar epithelium
SAADDES
stratified cuboidal
transitional epithelium
267
ANATOMIC SCIENCES

Simple squamous epithelium- single layer of thi n, flat cells; functions in gas exchange; li nes blood vessels and various membranes:
Endotheli um lining the card iovascular system( e.g., the aorta)
Epithelium lining the alveoli in lungs
Mesothelium li ning body cavi ties and coats organs of these cavities
Simple cuboidal epithelium- single layer of cube-shaped cell s; carries on secretion and absorption:
Epithelium li ning collecting ducts, proximal, and d istal tubules of the kidney
Epithelium li ning thyroid follicles
Simple columnar epithelium - elongated cells; functions in prot ection. secretion and absorption:
Lini ng of the small and large intestine, the gallbladder, and the stomach
Uterine epi thelium
Saliva ry gland striated ducts
Internal lini ng of the maj ority of the tubular gastrointestinal tract
Stratified squamous epithelium- composed of many layers of cell s; prot ects underlying cell s from
environment al fluctuations:
Epidermis of the ski n (keratinized)
Lini ng of the esophagus (usually not keratinized)
Stratified cuboidal epithelium- composed of many layers of cube-shaped cell s:
Ducts of the sweat gland s
Stratified columnar epithelium- composed of many layers of elongated cells:
La rge duct s of salivary g lands
Male urethra
SAADDES
Specialized epithelium :
- Pseudostratified columnar epithelium- elongated cells atop one another w ith nuclei located at
two or more levels w ithin cells; may have cilia that function t o m ove fl uid s past the cells:
Lining of the upper respi ratory tract
-Transitional epithelium - specialized to undergo distension; helps prevent urinary fluid s from d if fusing outwards:
Bladder
Ureter
Lining of parts of the male reproductive system
Simple squamous
Simple cuboidal
Simple columnar with microvilli
SAADDES
.L
.......____
Slratified squamous
__
Transilional
___,
Pseudostratified columnar with
cilia and microvilli
Epithelia
26J.I
tissue
Which of the following cell layers of the epidermis contains keratohyalin
granules?
stratum corneum
stratum lucidum
SAADDES
stratum granulosum
stratum spinosum
stratum basale
268
ANATOMIC SCIENCES
stratum g ranulo sum

The skin is co mposed of three primary layers, the epidermi s, dermis and hypodermi s. The
epidermis is the outer, thinner portion of the skin. The epidermis is avascular. It develops
from embryonic ectoderm. The epidermis consists of five layers; they receive their nutrients f rom blood vessels in the dermis. From innermost to outermost, they are:
l.Stratum basale (germinativum) - deepest layer; cuboidal to columnar cells; site of continuous cellul ar reproduction. M elanocytes, which produce melanin, are located here.
The cells of this layer are the least differentiated of all epidermis cell layers.
2. Stratum spinosum - next deepest layer; contains cell s call ed Langerhans cell s; con tains nerve cells.
3. Stratum granulosum - three to five rows of fl at cells; these cell s have basophilic keratohyalin granules.
4.Stratum lucidum- only in the th ick skin of the palm s and soles; consists of clear, flat,
dead cells.
5. Stratum corneum - outermost layer of epidermi s; 25 to 30 rows of flat, dead cells filled
w ith keratin; continuously shed and replaced.
SAADDES
Note:The bottom layer, the stratum basale, has cell s that are shaped like columns. In this
layer, the cells divide and push already form ed cells into higher layers. As the cells m ove into
the higher layers, the cells flatten and eventually die. The to p layer of the epidermis, the
stratum corneum, is m ade of dead, fl at skin cell s that shed about every two weeks.
Important: There are th ree types of specialized cell s in the epidermis. M elanocytes p ro duce pigm ent (melanin), Langerhans cells are the frontline defense of the immune system
in the skin, and keratinocytes produce keratin (a protective p rotein). They are the most
common cell types in the epidermi s of the skin. Note: Tonofi bril s (fibrill ar structural p ro teins) and desmosom es are especially well developed in keratinocytes.
Mnemonic: B.ad
yet J.eg C.ramps. This is an acronym for the layers of the skin
from the innermost to the outermost layer.
Structure of the Epidermis

' -- - -- - Dead keratinocytes,
those on the surface ftake off
OLO
SAADDES
Melanocyte
YOUNG
Dividing keratinocyte (stem cell)
Tactile cell
---
--
Sensory nerve ending

268-1
Epidermis:
Stratum corneum
Stratum lucidum
Pain receptor
(free nerve
endings)
Sweat duct
Stratum basale
Touch
receptor
SAADDES
Nerve
Dermis
Reticular
Capillary
Sweat
gland
Subcutaneous
fatty tissue
Vein
Pressure
receptor
Artery
tissue
What is the main difference between parakeratinized and orthokeratinized
epithelium?
parakeratinized epithelium has keratohya lin granules

parakeratinized epithelium has nuclei
SAADDES
parakeratinized epithelium has more prominent RER

parakeratinized epithelium are rich in mitochondria
269
ANATOMIC SCIENCES
para keratinized epithe lium has nuclei

This stratified squamous epithelium acts as a mechanical barrier and protects the underlying
tissues. There are three types found within the oral cavity:
1. Nonkeratinized (most common) - selective barrier, acts as a cushion. Cells do not contain
keratin. Is associated with lining mucosa (i.e., buccal and labial mucosa, mucosa lining the floor
of the mouth, ventral surface of the tongue, and the soft palate)
2. Orthokeratinized (least common) -associated with mast icatory mucosa (i.e., hard palate and
the attached gingiva, also the lingual papillae on the dorsal surface of the tongue)
3. Parakeratinized - associated with masticatory mucosa (i.e., attached gingiva, in higher levels
than orthokeratinization, and the tong ue's dorsal surface)
Note: The main difference bet ween para keratinized epithelium and orthokeratinized epithelium
is in the cells of the keratin layer. In parakeratinized epithelium, the superficial layer is stil l being shed
or lost, but these cells of the keratin layer conta in not only kerati n but also nuclei, unlike those of orthokeratinized epithelium.
SAADDES
Other cell types (ot her than keratinocytes) found in the oral epithelium:
Epithelial cells - form a cohesive sheet that resists physical forces and serves as a ba rrier
to infection
Melanocytes - synthesize melanin
Langerhans cells - antigen presenting cells, pa rt of immune system
Granstein cells- antig en presenting cells, part of immune system
Merkel cells- associated with sensory nerve endings
White blood cells - PMNs are the most commonly occurring
All forms of epithelium (whether associated with lining, masticatory, or specialized mucosa) have a
lamina propria (connective tissue proper) deep to the basement membrane. It supports the
epithelium and is subdivided into two layers (papillary and dense). It may be attached to the
periosteum of the alveolar bone or interposed over the submucosa (the submucosa contains
glands, blood vessels, and nerves).
Note: A basement membrane is located between the oral epithelium and the connective tissue.
The basement membrane is composed of two layers - basal and reticular lamina.
tissue
Which type of collagen is found mainly in dentin and bone?
type I
type II
type Ill
type IV
SAADDES
270
ANATOMIC SCIENCES
type I
*** 90% of the collag en in the body is in types I, II, Ill, and IV. Type I is associated w ith (bONE),
and is the principle fiber of the POL. Type II is associated w ith cartilage (carTWOilage). Type Ill is
associated w ith reticular fibers (reTHREEicular). Type IV is associated with the floor (FOUR) or
t he ba sement membrane.
The basement membrane is a thin, acellular structure always located between any form of epitheliu m and its underlying connective t issue. The ba sement membrane con sists of two layers:
The basal lamina (produced by the epithelial cells): superficial portion of t he basement
membrane. Consists of two layers microscopically:
-The lamina Iucida: clear layer, closer to the epithelium
-The lamina densa: dense layer, closer to the connective tissue
SAADDES
The reticular lamina: this layer is a thin layer composed of type Ill collagen fibers as well
as reticular fibers produced and secreted by the underlying connective tissue.
Attachment mechanisms are also part of t he basement membrane. These involve hemidesmosomes w ith their attachment plaques, tonofilaments from the epithelium, and the anchoring
collagen fibers from the connective t issue.
Important: Keloid is a result of an overgrowth of granulation tissue (collagen type Ill) at the site
of a healed skin injury which is t hen slowly replaced by collagen type I.
1. Every t hird amino acid in collagen is glycine; other amino acids t hat are important
in collagen structure are proline, hydroxyproline and hyd roxylysine.
2. Vitamin C is requ ired for hydroxylation reactions of proline and lysine to hydroxyproline and hydroxylysine respectively. Deficiency of vitamin C will cause incomplete
hydroxylation of these amino acids; this causes scurvy which is characterized by poor
wound healing and gum bleeding.
3. Lysyl oxidase is an extracellular enzyme w hich plays an important role in procollagen crosslinking.
tissue
Which of the following epithelial tissues is most often specialized for diffusion and filtration?
simple co lumnar epithelium

stratified cuboida l epithelium
SAADDES

pseudostratified epithelium
ANATOMIC SCIENCES
271

Simple epithelium has only a single layer of cells, all contacting the basal lamina.
Stratified epithelium has two or more layers, with only the deeper layer contacting
the basal lamina.
Pseudo stratified epithelium appears multilayered, but is actually only a single layer
with all of the cells touching the basal lamina. The positioning of the nuclei within the
individual columna r cel ls causes this illusion.
of Different 1
Epitheli um
Simple
Stratified
..
of Epithelium
Cells
Function (s)
Squamous
Cuboidal
Columnar
Diffusion and filtration

Secretion or absorption
Absorption and secretion
Squamous
Cuboidal
Columnar
Protection; prevents water loss

Protection and secretion
Protection
SAADDES
Spec ialized:
Transitional
Pseudostratified
Varies between cuboidal and squamous Specialized to undergo distens ion

Columnar cells atop one another with
May have cilia that function to move
nuclei located at two more levels within fluids past the cells
cells
Simple squamous
Simple cuboidal
Simple columnar with microvilli
SAADDES
.L
.......____
Slratified squamous
__
Transilional
___,
Pseudostratified columnar with
cilia and microvilli
Epithelia
26J.I
tissue
Which of the following cells is the most abundant cell type found in
connective tissues?
osteoblast
chond roblast
mast cell
fibroblast
macrophage
SAADDES
272
ANATOMIC SCIENCES
fibrobla st
Pnrtl.'lp.tl Kinds ol
Type
llsSUl'S
Types/Examples
Description and Function
.
.
Epithelial
tissues
May be one (simple) or several (stratified) layers Two types:

thick; lower surface bound to a supportive
Surface epithelium covers the
basement
mitotically active tissue;
outside of the body and lines
avascular; covers the surface of the body and line
internal organs
the various body cavities, ducts and vessels
Glandular epithelium
Connective
tissues
Highly vascular (except for cartilage); contains

considerable intercellular matrix; mitotically
active tissue; used for support (bones and
cartilage), for anachment of other tissues
(tendons, ligaments, and fascia), or for other
specialized functions (such as blood)
Tendons and ligaments; cartilage and

bone, adipose tissue, blood
..
..
.
..
.
Types of connective tissue proper:

Areolar
Dense (regular)
Elastic
Reticular
Adipose
SAADDES
Muscular
tissues
Limited mitotic activity; composed of

specialized cells that are capable of contracting
and thereby decreasing in length; these tissues
move the skeleton, propel the blood throughout
the body, and aid in digestion by moving food
through the digestive tract
Nervous
tissues
Limited mitotic
throughout the body
transmit messages
Three types:
Smooth
Cardiac
Skeletal
Form brain, spinal cord, and nerves;

consist largely of cells (neurons)
with long protoplasmic extensions
Note: Fibroblasts are the most abundant cells of the connective tissue.
tissue
Intervertebral discs are made up of:
elastic cartilage
periosteum
fibrocartilage
SAADDES
hyaline ca rti lage
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ANATOMIC SCIENCES
fibrocartilage
Cartilage isa type of dense, fibrous connective tissue, which supports and shapes various struct ures.
It also cushions and absorbs shocks. Cartilage is composed of cells called chondrocytes that are dispersed in a firm, gel-like ground substance, called the matrix.These cells reside in depressions in the
matrix, called lacunae. Cartilage contains no blood vessels, and nutrients are diffused through the
matrix. Cartilage is found in the joints, the rib cage, the ear, the nose, and the throat and between intervertebral discs. Note: The only blood supply to cartilage is provided by blood vessels that enter the
cartilage through the perichondrium.
Important: The exception to the rule that cartilage is always covered by a perichondrium is the articular cartilage at a synovial joint.
There are three subtypes based on the composition of the matrix:
1. Hyaline cart ilage- has a high proportion of matrix and fine collagenous fibers. Throughout
childhood and adolescence, hyaline cartilage plays an important part in the growth in length of
long bones (epiphyseal plates are composed of hyaline cart ilage). Covers the articular surfaces
of nearly all synovial joints. It is incapable of repair when fractured.
Note: Type II collagen makes up 40% of this cartilage's dry weight.
2. Fibrocartilage - has a large number of collagen fibers embedded in a small amount of matrix.
Fibrocartilage is found in the discs within joints (e.g., the TMJ, intervertebral discs, sternoclavicular joint, and knee joint) and on the articular surfaces of the clavicle and mandible. Fibrocartilage is formed mainly by collagen type I.
3. Elastic carti lage- similar to hyaline cartilage, except elastic cartilage possesses large numbers
of elastic fibers embedded in the matrix. Elastic cartilage is very flexible and is found in the auricle of the ear, the external auditory meatus, the auditory tube, and the epiglottis. Elastic cartilage is composed of elastic fibers and collagen type II.
SAADDES
1. Carti lage is a precursor to endochondral bone.

2.The matrix is mainly composed of proteoglycans, which consist of glycosaminoglycans
and core protein. The most common types are chondroitin sulfate and keratan sulfate.
3. The perichond rium is very important in the growth of cartilage.
4. No calcium salts are present and, therefore, cartilage does not appear on x-rays.
tissue
All of the following bones are formed completely by intramembranous ossification EXCEPT one. Which one is the EXCEPTION?
clavicles
mandible
maxilla
frontal bone
SAADDES
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ANATOMIC SCIENCES
mandible- the cond yles are formed b y endochondral ossification

Endochondral ossifi cation begins with points in the cartilage called "primary
ossification centers:' They mostly appear during fetal development, though a few short
bones begin their primary ossification after birth. They are responsible for the formation
of the diaphyses of long bones, short bones, and certain parts of irregular bones.
"Secondary ossification" occurs after birth, and forms the epiphyses of long bones and
the extremities of irregular and flat bones. The diaphyses and the epiphyses of long bones
remain separated by a growing zone of cartilage (the metaphysis) until the child reaches
adulthood (18 to 25 years of age), whereupon the cartilage ossifies, fusing the two
together. Note: Heterotopic ossification is the formation of bone outside the skeleton
and is seen in diseases such as myositis ossificans.
SAADDES
Long bones increase in length during growth and development. The epiphyseal plat e
(disc) is a wedge of hyaline cartilage accounting for th is increase. Th is plate is found be tween the epiphysis (bulbous end) and diaphysis (tubular shaft) at each end of the bone.
The cartilage cells of the epiphyseal plate form layers of compact bone tissue, adding to the
length of the bone (interstitial growth). This disc becomes inactive in most individuals by
the late teens or early twenties.
Note: Hyaline cartilage does not calcify and become bone; rather, it calcifies and is re placed by bone.
Remember: Bone formation or development occurs by two methods:
1. Intramembranous ossifi cation mainly occurs during formation of the flat bones of
the skull; the bone is formed from mesenchyme tissue.
2. Endochondral ossification occurs in long bones, such as limbs; the bone is formed
from cartilage.
Reproduced with permission from Stevens A. Lowe

Chondroblasts
Early perichondrium
Hmn(m
ed J. Philadelphia. 2005. Elsevier.
Periosteum
SAADDES
Primitive
Developing
Developi ng
mesenchyme cartilage model bone collar
Primary (diaphyseal)
ossification center
Prenatal long bone development (endochondral ossification)

A. Chondroblasts develop in primitive mesenchyme and form an early perichondrium and cartilage model.
B. The developing cartilage model assumes the shape of the bone 10 be formed, and a surrounding peric hondrium becomes identifiable.
C. At the mids haft of the diaphysis the perichondrium becomes a periosteum through the development of
osteoprogenitor cells and osteoblasts, the osteoblasts producing a collar of bone by intramembranous ossification.
D. Blood vessels grow through the periosteum and bone collar, carrying osteoprogenitor cells within them.
These establish a primary (or diaphyseal) ossification center in the center o f the diaphysis.
E. Bony trabeculae spread out fro m the primary ossification center to occupy the entire diaphysis, linking
up with the previously formed bone collar. which now forms the cortical bone of the diaphysis. At this stage
the terminal club-shaped epiphyses are still composed of cartilage.
F. At about tem1 (the precise time varies between long bones). secondary or epiphyseal ossification centers
are established in the center of each epiphysis by the ingrowth along with blood vessels of mesenchymal cells
which become osteoprogenitor cells and osteoblasts.
z741
tissue
A patient in the dental clinic states in his medical history that he has heart
disease and occasionally takes nitroglycerin for his pain. During treatment,
the patient clutches his chest and frantically points to his jacket pocket. The
dentist obtains the nitroglycerin bottle from his jacket, removes one tablet,
and places it:
on the soft palate
SAADDES
on the gingiva
on the oral vestibule
on the floo r of the mouth

on the buccal tissue
any of the above
275
ANATOMIC SCIENCES
on the floor of the mouth

Note: The reason of the ease of diffusion is because the epidermis and lamina propria
is thin in the floor of the mouth.
In general, the permeability of the oral mucosa is as follows, from most permeable to
least: sublingual > buccal mucosa > palatal mucosa. This ranked order is based on
the relative thickness and degree of keratinization of those tissues. The sublingual
mucosa is thin and nonkeratinized. The buccal mucosa is thicker than the
sublingual mucosa and is also nonkeratinized. The hard palatal mucosa is thicker
still, with a thick keratinized layer.
Important point: The oral cavity is highly acceptable for systemic drug delivery. The
mucosa is relatively permeable with a rich blood supply, and the virtual lack of
Langerhans cells makes the mucosa tolerant of potential allergens. This route also
bypasses the fi rst pass effect and avoids pre-systemic elimination in the Gl tract.
Example: Nitrog lycerin tablets are given sublingually for rapid absorption.
SAADDES
Remember: The oral mucosa is composed of an outermost layer of stratified

squamous epithelium. Below this lies a basement membrane, a lamina propria
(connective t issue proper) fol lowed in most cases by the submucosa as the
innermost layer. The compos ition of the epithelium varies depending on the site
in the oral cavity. The mucosa of areas subjected to mechanical stress (the gingiva and
hard palate) is keratinized (specifically, orthokeratinized). The mucosa of the soft
palate, the sublingual, and the buccal regions, however, is not keratinized.
Note: Alveolar mucosa is very similar to sublingual mucosa in that it, too,
appears red due to the numerous b lood vessels and the thin epithelial covering.
Fordyce spots (ectopic sebaceous glands) are yellowish small papules that are sometimes found on the buccal mucosa or on the vermilion border of the lips.
tissue
Which of the following is the principle component of ground substance of
the cartilage?
fibroblasts
collagen fibers
SAADDES
reticula r fibers
chondroitin sulfate
276
ANATOMIC SCIENCES
chondroitin sulfate
Cartilage and bone are specialized forms of connective tissue. They contain cells which produce
fibers and ground substance. Together, the fibers and g round substance compri se the organic
matrix. The principal constituents of ground substance are proteoglycans, which consist of prot ein combined with complex carbohyd rates such as chondroitin sulfate and keratan sulfate.
These carbohydrates are called glycosaminoglycans, usually abbreviated GAGs.
The GAGs radiate from the protein core like the brist les of a bottle brush. The principal GAGs of
cartilage are chondroitin sulfate and keratan sulfate. Another matrix com ponent is
hyaluronic acid, a gelatinous mucopolysaccharide. The hyaluronic acid acts as a sort of
cement to bi nd the proteoglycans together into large aggreg ates.
Note: All GAGs are sulfated and have a protein core except hyaluronic acid.
SAADDES
Important: Because of the chemical nature and organization of t he glycosaminoglycans, t he

ground substance can readily bind and hol d water, which allows the t issue to assume a
gelatinous nature that can resist compression and permit some degree of d iffusion through
the matrix.
Note: Chondrocytes produce all t he components of cartilage: the matrix material and t he fibers
as well.
Hyaline cartilage forms nearly all of the fetal skeleton. In the adult, the rem nants are:
Articular cartilage - smooth and slippery, it lines movabl e joints
Costal cartilages - at the sternal ends of t he ribs
Respiratory cartilages - movable external nose and septum, larynx, trachea, and bronchial walls
Stl'ucture
Function
Collagen fibers
Provide tensile. strength
Elastic fibers
Provide elasticity
Ground substance
Provide
strenglh
tissue
At the gymnastics center, a 22-year-old male doing flips on the trampoline
lands incorrectly on his ankle and dislocates it. In the emergency room, the
physician provides traction to correctly relocate the ankle. The patient is told
that although there are no fractures the bands of fibrous connective tissue
that connect bone to bone are almost definitely torn. These bands are called:
tendons
bursae
ligaments
SAADDES
menisci
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ANATOMIC SCIENCES
ligaments
Ligaments are dense, strong, flexible bands of fibrous connective tissue that tie bones
to other bones. Ligaments that connect the joint ends of bones either limit or facilitate movement. Ligaments also provide stability.
Tendons are strong, flexible bands of fibrous connective t issue that attach muscles to
the fibrous membrane that covers bones (periosteum). Tendons move bones when
skeletal muscles contract.
Important: When a t endon or ligament is attached to the bone, the attaching fibers
are called Sharpey's fibers. They are periosteal col lagen fibers that penetrate the bone
matrix, binding the periosteum to the bone.
SAADDES
Remember: The periodont al ligament contains collagen fibers that are inserted on
one side in the cementum and on the other side in alveolar bone. The ends of these collagen fibers are Sharpey's fibers.
Bursae are small, synovial, fluid-fil led sacs located around joints at friction points
between tendons, ligaments, and bones. Bursae act as cushions.
. 1. A fasciculus is a bound g roup of individual muscle fibers. The fasciculi are
..JJ the bundles of muscle fibers composing a muscle. In turn, each muscle is sur-
lid
rounded by a connective t issue ca lled fa scia.

2. The fascia secures the muscle to a tendon. lt attaches the muscles to nearby
bones by blending with the periosteum of these bones.
3. An aponeurosis is a sheetlike tendon.
4. Menisci are crescent-shaped interradicula r fibroca rti lages in certain joints,
including the knee.
tissue
Which type of connective tissue is most commonly observed in ligaments
and tendons?
loose connective tissue

dense irregula r connective tissue
SAADDES
dense regular connective tissue

elastic connective tissue
278
ANATOMIC SCIENCES
dense regular connective tissue

Connective t i ssue derives from mesenchyme (mesoderm). Compared w ith epithelium, connective t issue
i s usually composed of f ewer cells spaced further apart and containing larger amounts of matrix between
the cells (except in adipose connective t issue). The most common cell i s the fibroblast. Other cells found
in connective tissue include migrated white blood cells such as macrophages (histiocytes), basophi ls
(mast cells), lymphocytes (including plasma cells), and neutrophils (PM Ns).
Essential components of connective tissue are:
Ground substance (proteog lycans to w hich GAGs are attached and glycoproteins)
Fibers (collagen, elasti c, and reticular fibers)
Cells
Connective ti ssue can be classified into:
1. Connective ti ssue proper:

Loose (areolar): consists predominantly of cells or matrix in an irregular or loose arrangement and
few fibers. Serves as padd ing for t he deeper portions of the body
Dense: w hich provides structu ral support, has g reater fiber (protein) concentration, few cells
and less g round substance and is t ightly packed . Dense is further subdivided into:
SAADDES
Dense regular connective t issue: has a regular arrangement of tightly packed, strong, parallel
collagen fibers w ith few fibroblast cells. This t issue includes tendons, ligaments, aponeuroses
and cornea.
Dense irregular connective t issue: has t ightly packed, strong collagen fibers arranged in an
inconsistent or irregular pattern. This t issue is found in the dermi s, submucosa of Gl tract, organ capsules, deep fascia, periosteum and peri chondrium .
2. Special connective tissue:

Elastic connective ti ssue: consist predominantly of elastic fibers. It's found in large arteries (aorta),
vocal cords and between t he arches of the vertebrae (ligamenta flava).
Adipose connective tissue: i t consists mainly of adipocytes. This t issue has d iminished access by
antibiotics and leukocytes because of the poor blood supply.
Reticular connective tissue: it consists mainly of reticular fibers (collagen type Ill). Reti cular connective tissue is found around t he liver, the kidney, the endocrine g lands, t he spleen, and lymph
nodes, as well as in bone marrow.
3. Supportive connective tissue: Bone and cartilage
tissue
The greatest resistance to the movement of the molecules between cells is
mainly achieved by which of the following intercellular junctions?
desmosomes
hemidesmosomes
SAADDES
adherens junctions
gap junctions
zonu la occludens
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ANATOMIC SCIENCES
zonula occludens
Bricks in a build ing must be stuck together and also tied somehow to the foundation. Similarly, cells
within tissues and organs must be anchored to one another and attached to components of the extracellular matrix. Cells have developed several types of intercellular junctions to serve these funct ions, and in each case, anchoring proteins extend th rough the plasma membrane to link cytoskeletal
proteins in one cell to cytoskeletal proteins in neighboring cells as well as to proteins in the extracellular matrix.
An intercellular junction bet ween cells isa desmosome.The desmosome appears to be disc-shaped
and can be likened to a spot weld."
Another type of intercellular j unction is a hemidesmosome, which involves an attachment of a cell
to an adjacent noncellular surface. Important: This type of attachment is present with the gingival
epithelium that attaches to the tooth surface (called the junctional epithelium of the epithelial
attachment) as well as in that which occurs between nails and nail beds.
Note: The clinical cond ition known as bullous pemphigoid involves the disru ption of
hemidesmosomes and consequent separation of the epithelium from the basal lamina.
SAADDES
Another type of intercellular j unction is what is called an adherens junction (also called zonula adherens). These junctions share the characteristic of anchoring cells throug h their cytoplasmic actin
fi laments.There is considerable morphologic diversity among adherens junctions. Those that tie cells
to one another are seen as isolated st reaks or spots, or as bands that completely encircle the cell. The
band-type of adherens junctions is associated with bu ndles of actin filaments that also encircle the
cell just below the plasma membrane. Spot-like adherens junctions help cells adhere to the extracellular matrix. Adherens junctions are thought to part icipate in folding and bending of epithelial
cell sheets.
Tight junctions (zonu la occludens): are formed by fusion of the outer leafletsof apposed cell membranes on the lateral cell surfaces, just beneat h apical poles. They form barrier to permeability, or a
seal around the cell.
Gap junctions: are small channels that form direct intercellular connections throug h which small
molecules and ions can flow. Each gap junction is formed by two hemichannels or (connexons).
tissue
In contrast to tight and adherens junctions, gap junctions do NOT seal
membranes together, nor do they restrict the passage of material between
membranes.
Gap junctions allow electrical and metabolic coupling among cells so that
signals initiated in one cell can readily propagate to neighboring cells.
SAADDES
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ANATOMIC SCIENCES
both statement s are true
In contrast to t ight and adherens junctions, gap junctions do not sea l memb ranes to gether, nor do they restrict the passage of material between membranes. Rather, gap junctions are composed of arrays of small channels that permit small molecules to shuttle from
one cell to another and thus directly link the interior of adjacent cells. Most Importantly,
gap junctions allow electrical and metabolic coupli ng among cells so that signals initiated
in one cell can readily p ropagate to neighboring cells.
Gap junctions are p roteinaceous tubes some 1.5-2 nm in diameter. These tubes allow
materia l to pass from one cell to the next without having to pass through the p lasma
membranes of the cells. Dissolved substances such as ions o r glucose can pass through
the gap junctions. They a re formed by transmembrane proteins called connexins.
SAADDES
Functionally, there a re three gro ups of cell junctions:

1. Occluding junctions - which join the plasma membranes of adjacent cells tightly
together.
2. Anchoring junctions- which physically connect adjacent cells and their cytoskeletons, but leave a space separating the plasma membranes.
3. Communicating junctions - which permit the passage of chemi cal and e lectrical
signals between the joined cells. Ga p junctions belong to this group.
Such specialized cell junctions a re found in many tissues th roughout the body, but are especia lly abundant in epithelial tissues, where some cell junctions are organ ized into
groups called junctional complexes.
Three d istinct components of a junctional complex:
A tight junction
An intermediate junction
A desmosome
***All of which are associated with the p lasma membranes of adjacent cells.
tissue
Where would you expect to find the fewest matrix-embedded elastic fibers?
nasal cartilage
epiglottis
auricle
SAADDES
eustachian tube
281
ANATOMIC SCIENCES
nasal cartilage
Remember: Elastic cartilage is similar to hyaline ca rtilage, except elastic cartilage possesses large numbers of elastic fibers embedded in matrix. Elastic cartilage is very flexible and is found in the auricle ofthe ear, the external auditory meatus, the auditory
tube, and the epiglottis. Nasal ca rtilage consists of hyaline cartilage.
Cartilage can develop or grow in size in two different ways:
1.Interstitial growth - is growth from deep with in the t issue by t he m itosis of each
chondrocyte, producing a large number of daughter cells within a single lacuna,
each of which secretes more matrix, thus expanding the tissue.
2. Appositional grow th - is layered g rowth on t he outside of the tissue from an
outer layer of chondrobl asts w ithin perichondrium.
SAADDES
Growth of bone:
Appositional growth - or layered formation of bone along its peri phery, is accomplished by the osteoblasts, wh ich later become entrapped as osteocytes. Because of its rigid structure and t he infrequent ability of osteocytes to d ivide,
interstitial growth in bones is not possible.
*** Do not confuse bone growth w ith bone formation or development. Bone forms
by either endochondral ossification or intramembranous ossification.
Remember:
Endochondral ossification: increases bone length by continued interstitial
growth of cartilage w hich is then replaced by bone
Appositional growth: increases bone girth by apposition of new bone subperiostea lly
tissue
Which layer of skin is mainly composed of areolar connective tissue and adipose tissue?
epiderm is
hypodermis
dermis
SAADDES
ANATOMIC SCIENCES
282
hypodermis - aka, the subdermis

The integumentary system consists of the skin and its many derivatives (hair, glands, nails, and
sensory receptors). The skin is composed of many t issues structurally j oined for specific funct ions.
Structure of skin:
The outer epidermi s: which consists of stratified squamous epithelium. It develops from
embryonic ectoderm. The outer epidermis is avascular. The principal cell of t he epidermis is
called a keratinocyte.
The inner dermis: thicker portion of t he skin; composed of connective tissue with collagenous and elastic fi bers for toughness. The inner dermis develops from embryonic mesoderm
and contain s blood vessels, nerves, glands, and hair follicles. It is a strong, stretchable layer
t hat essentially holds t he body together. The inner dermis has two main regions:
papillary layer: upper dermal region
reticular layer: lower dermal layer
SAADDES
***The subdermis (hypodermis) is the layer of tissue directly underneath the dermis. The subdermis is mainly composed of areolar (loose) connective tissue and adipose tissue. Physiological functions of the subdermis include insulation, storage of energy, and aid in the anchoring
of the skin . The subderm is also cushions t he un derlying body for extra protection again st
trauma.
The skin also contains several other relevant structures, including the following:
Basement membrane: collagenous membrane between the epidermis and dermis t hat
holds them together
Meissner's corpu scle: oval body in t he dermis, thought to participate in tactile sensation
Ruffini's corpuscle: oval capsule containing the ends of sensory fibers in t he dermal papillae. It's sensitive to skin stretch, and contributes to the kinesthetic sense of and control of finger position and movement. It is believed to be useful for monitoring slippage of obj ects
along the surface of the skin, allowing modulation of grip on an obj ect.
Structure of the Epidermis

' -- - -- - Dead keratinocytes,
those on the surface ftake off
OLO
SAADDES
Melanocyte
YOUNG
Dividing keratinocyte (stem cell)
Tactile cell
---
--
Sensory nerve ending

268-1
tissue
When we look at our fingers, we can see fingerprints. Which of the following
layers of skin are we looking at in order to see the fingerprints?
papillary layer of the dermis

stratum corneum of the epidermis
SAADDES
reticula r layer of the dermis
stratum lucidum of the epidermis
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ANATOMIC SCIENCES
papillary layer of the dermis

The dermis is the thicker portion oft he skin. The dermis is composed of connective ti ssue w ith collagenous
and elastic fibers for toughness. The dermis develops from embryonic mesoderm and cont ains blood vessels, nerves. glands, and hair fo ll icles. The dermis is a strong, stret chable layer that essentially holds the
body together. The dermis has two main regions:
1. Papillary layer: thin and less fibrous; has prima ry and secondary dermal ridges (aka, ret e pegs).
that extend up t owa rd the epidermal layer. Epidermal ridges are the interdigi tations of the epidermis
w ith these dermal ridges. This layer contains the blood vessels that supply the overlying epidermis.
The layer contains fibroblasts, mast cells, and macrophages.
2. Reticular layer: thick and fibrou s, and is continuous w ith the hypodermis. Blood vessels from the
hypodermis pass through this layer. It contains more reticular fibers and fewer cells than the papillary
layer. This layer consists of an interwoven meshwork of dense irregular connective tissue.
Characteristics of the subdermis (hypodermis) that connects the dermis w ith the underlying fascia of
muscles: Composed primarily of loose (areolar) connective tissue
M ajor site of fat deposition (50% of body fat)
Has good blood supply
SAADDES
Function s ofthe skin:

Vitamin D prod uction
Excretion v ia sweat gland s
Sensation of touch. pain and pressure
Prot ection against physical and chemical stresses

Hemostatic regulation of body t emperature
Note: Arteriovenous shunt s are found in the skin and are innervated by sympathetic vasoconstrictor fibers.
Skin appendages:
Cutaneous glands
-Sebaceou s glands: they produce oil which is a lubricant for skin which keeps skin soft and moist
- Sweat glands:
Eccrine: they are the most numerous
Apocrine: found mostly in armpits and geni tal areas
Hair: produced by hair foll icle w hich are made of hard keratinized epithelial cells
Arr ector pili: smooth muscles that pull hairs straight
Nail: mod ified stratum corneum and heavily keratinized
tooth components
A 17-year-old man falls down and chips the incisal edge of his maxillary central incisor, reducing the length of the crown. The dentist informs him that the
tooth may erupt a little to compensate for the loss. Which of the following
structures will be deposited in the apex of the tooth when the tooth continues to erupt?
cementum
bundle bone
dentin
SAADDES
pulp
enamel
peri odontal ligament
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ANATOMIC SCIENCES
cementum
Cementum is t he bone-like mineralized tissue covering the anatomical roots of teeth. The
primary function of cementum is to attach Sharpey's fibers. It has the following
characteristics:
Slightly softer and lighter in color (yellow) than dent in
Formed by cementoblasts from the POL, as opposed to dentin, which is formed from
odontoblasts of the pulp. It develops from the dental follicle (a.k.a., dental sac)
Most closely resembles bone (more so than dentin). except there are no haversian systems or blood vessels; it is avascular
Mature cementum is by composition 45-50% mineralized inorganic material (mainly
calcium hydroxyapatite). and 50% organic material, namely collagen and noncollagenous
matrix protein
The organic portion is primarily composed of collagen and protein
Has no nerve innervation
Thickest at the tooth's apex and thinnest at the CEJ at the cervix of the tooth
Important in orthodontics. Cementum is more resistant to resorption than alveolar
bone, permitting orthodont ic movement of teeth without root resorption.
SAADDES
Two types of cementum (functionally t here is no d ifference):

1. Acellular (sometimes called primary cement um): consists of the first layers of cementum
deposited at the DCJ; acellular cement um is formed at a slow rate and contain s no embedded cementocytes, usually predominate on the coronal two-thirds of the root. Thinnest
at the CEJ.
2. Cellular (sometimes called secondary cementum): consists of t he last layers of cementum
deposited over t he acellular cementum; cellular cement um is formed at a faster rate than
acellular cement um and contains embedded cementoblasts. Cellular cement um occurs
more frequently on the apical third of t he root. Cellular cement um is usually the thickest to
compensate for occlusal/incisal wear and passive eruption of t he tooth.
Note: The composition of bone is roughly 50% inorganic, 25% collagen, and 25% water.
tooth components
Intertubular dentin is formed in peripheral parts oft he mineralized dentin inside the walls of dentin tubules.
Peritubular dentin is highly mineralized and it also contains little collagen.
SAADDES
285
ANATOMIC SCIENCES
the first statement is false, the second is t rue

pt's ul Dl'nhn
Type
Location/Chronology
Description
fomted in peripheral parto; of the

mineralized dentin inside the walls of
dentin. mbules
Highly mineralized and ir also contains litde collagen
lntertubuhw
Fomted by odomoblasrs through

predentin mineralization berv.een che
tubule..o;
Dense collagen matrix
Mantle
Outemtosr layer of primary de min
f irst dentin fomted. slightly

mineralized than
other laye1s of the primary dentin (i.e. circumpu1pal}
Circumpulpal
laye around outer pulpal wall
De.ntin fomted after mantle dentin
f'eritubular
(intratubular)
Primary
Secondary
SAADDES
Teniary
(eparmive or
reactionary dentin)
More mineralized than secondat'y

Fomted nlpidly during cooth
fomtation. It outlines the pulp chamber
and constitutes the main pan of the
dentin mass
fomted after completion of the apical
foramen; fonns slower than. primary
Less mineralized than primary
Fomted as a re$uh of injury
IITegula pattern of tubule$
Remember: Each dentina l tubule contains the cytoplasm ic cell process (Tomes' fiber) of an
odontoblast.
Important: Odontoblasts secrete the organic components of the dentin matrix. The fibrous matrix
is mostly type I collagen.
Note: Dead tracts consist of groups of empty tubules due to the death of the odontoblasts whose
processes formerly filled the tubules. These tracts have been attributed to the aging process of the
dentinal tissue. They may also be caused by caries, erosion, cavity preparation, or odontoblastic
crowd ing.
tooth components
Which of the following areas of the pulp is also known as the "zone of Wei I?"
fibroblastic layer
odontoblastic layer
cell-rich zone
SAADDES
cell-free zone
286
ANATOMIC SCIENCES
cell -free zone

The pulp is the innermost tissue of the tooth. The pulp is formed from the central cells of the
dental papilla.
Anatomy of the pulp:
Coronal pulp: located in t he pulp chamber and forms pulp horns
Radicular pulp: located in the pulp canals (root portion of tooth)
Apical foramen: communicates with the POL
*** Accessory canals may also be associated with the pulp. Remember: These form when
Hertwig's epithelial root sheath encounters a blood vessel during root formation. Root
structure then forms around the vessel, forming the accessory canal.
SAADDES
Architecture of the pulp:

The peripheral aspect of dental pulp, referred to as the odontogenic zone, differentiates
into a layer of dentin-forming odontoblasts. lmmediately subjacent to the odontoblast layer
is the cell-fre.e zone (of Wei I). This reg ion contains numerous bu ndles of reticular (Korff's)
fibers. These fibers pass from the central pulp region, across the cell-free zone and between
t he odontoblasts, their distal ends incorporated into t he matrix of t he dentin layer. Numerous capillaries and nerves are also found in this zone.
Ju st under the cell-free zone is the cell-rich zone containing numerous fibroblasts, t he
predominant cell type of pulp. Since odontoblasts themselves are incapable of cell division,
any dental procedure that relies on the formation of new dentin after destruction of odontoblasts, depends on the d ifferentiation of new odontoblasts from these multipotential cells
of the pu lp. Lymphocytes, plasma cells and eosinophils are other cell types also common in
dental pulp.
Med ial to the cell-rich zone is the deep pulp cavity that contains subodontoblastic plexus
of Raschkow.
SAADDES
Cellric h
zone
Odontoblastic layer
Schem atic representation of th e cells bordering the pulp. rER, Rough endoplasmic reticulum
286-1
ReprodllC.'cd with permission from Nand A: Te11 CmeS Orallii.mJ!og)' IXIell1pment. Structure. a11d Fmu:tion: St. L OUIS, 200!), Elsevier.
tooth components
All of the following are stages of amelogenesis EXCEPT one. Which one is the
EXCEPTION?
presecretory
secretory
transitional
SAADDES
morphogenic
maturation
post-maturational
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ANATOMIC SCIENCES
morphogenic
Amelogenesis is the process of enamel matrix formation t hat occurs during the appositional
stage of tooth development. Enamel matrix is produced by ameloblast cells. These cells are
columnar cells that differentiate during t he bell stage in the crown area. The enamel matrix is
secreted from each ameloblast from its Tomes' process. Tomes' process is t he secretory surface
of t he ameloblast that faces the dentinoenamel junction (DEJ). Enamel matrix is first formed
in the incisal/occlusal portion of the future crown near the forming DEJ.
Important: The DEJ is the interface between the dentin and enamel. The DEJ is the remnant
of the onset of enamel formation. During amelogenesis, ameloblasts enter t heir first
formative state after t he first layer of dentin is formed. They secrete enamel matrix as they
retreat away from the DEJ. This matrix then mineralizes.
SAADDES
Remember: Enamel is produced in a rhythmic fashion.
Important: The odontoblasts beg in dentin formation (dentinogenesis) immediately before

enamel formation by the ameloblasts. Dentinogenesis begins with the odontoblasts laying
down a dentin matrix or predentin, moving from the DEJ inward toward the pulp. The most
recently formed layer of dentin is always adjacent to t he pulpal surface. Note: Predentin or
dentin matrix is a mesenchymal product consisting of nonmineralized collagen fibers.
These odontoblasts are induced by the newly formed ameloblasts to produce predentin in layers, moving away from the DEJ.
1. The DEJ is also t he area at which calcification of a tooth begins.
2. The morphology of the DEJ is determined at the bell stage.
3. The oldest enamel in a fully erupted molar is located at the DEJ underlying a
cusp.
4. Research has shown that in order for ameloblasts to form enamel, cells from the
stratum intermedium must be present.
tooth components
Pulpal involvement of a carious lesion in a young child is much more likely
because:
caries progress faster in primary teeth

caries can enter primary teeth from the enlarged apical foramen
SAADDES
the pulp chamber is larger in primary teeth compa red to permanent teeth
reparative dentin is not as functional in primary teeth as it is in permanent teeth
288
ANATOMIC SCIENCES
the pulp chamber is larger in p rimary t eeth compared to p ermanent teeth

The den tal pulp is a connective tissue, and thus has all of the components of such a t issue: intercellular sub stance, tissue Ould. cells, lymphatics, vascular system, nerves, and fibers (mainly collagen and some reticular fib ers).
Cells found in the pulp:
Fibroblasts: most numerous
Odon tobl asts: only cell bodies are located in the p ulp
Undifferentiat ed mesenchymal cells
Lymphocytes, plasma cells and eosinophils
Several large nerves enter the apical foramen of each molar and premolar w ith single ones entering the anterior
teeth. A young premolar may have as many as 700 myelinated and 2,000 unmyelinated axons entering t he apex.
These nerves have two primary modalit ies:
1. Aut onomic Nerve Fibers. Only sympathetic autonomic fibers are found in the p ulp. These fibers extend
from the neurons whose cell bodies are fou nd in the superior cervical ganglion at the base of the skull. They
are unmyelinated fibers and travel with the blood vessels. They innervate the smooth m uscle cells of the arterioles and therefore function i n regulation of blood Oow in the capillary network.
2. Afferent (Sensory) Fibers. These arise from the maxillary and mandibular branches of t he fifth cranial nerve
(trigeminal). They are predominantl y myelin ated fibers and may terminate in the central pulp. From t his region some will send out small individual fibers that form the subodontoblastic plexus (of Raschkow) just under
the odontoblast layer.
SAADDES
In addition to being the formative organ of the dentin, the p ulp also has the following functions:
Nut ritive: the pulp keeps the organic components of the surrounding m ineralized tissue supplied with
moisture and nutrients
Sen.s ory: extremes in temperature, pressure, or trauma to the dentin or pulp are perceived as pain
Protective: the formation of reparative or tertiary dentin (by the odontoblasts)
Important clinical information:
Pulp capping is more successful in young teeth because:
The apical foramen of a young pulp is large
The young pulp contains more cells (odontoblastic)
The young pulp is very vascul ar
The young pulp has fewer fibrous elements
The young pulp has more tissue fluid
"*" The young pulp l acks a collateral circulation
tooth components
The main function of cementum is to:
maintain the w idth of the PDL

supply nutrition to the pulp
stimulate formation of dentin
SAADDES
attach sharpey's fibers
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ANATOMIC SCIENCES
attach sharpey's fibers
Cementum is composed of a mineralized fibrous matrix and cells (cementocytes).

The fibrous matrix consists of both Sharpey's fibers and intri nsic nonperiosteal
fibers. Sharpey's fibers are the termina l portions of t he principal fibers of the POL
(alveolodental ligament) that are each partially inserted into t he outer part of the
cementum at 90 degrees, or a right angle, to the cementa! surface, as well as the
alveolar bone on their other end.
Remember: Cementum is the bone-like mineralized tissue coveri ng t he anatomical
roots of teeth. The two basic types are acellular and cellular.
Other functions of cementum incl ude the following:
Compensates for t he loss of tooth surface due to occl usal wea r by apical deposition of cementum th roughout life
Protects the root surface from resorption duri ng vertical eruption and tooth
movement
SAADDES
f;?y
1. Histologically, cementum differs from enamel in the fol lowing ways:

Cementum has collagen fi bers
Cementum has cellular components in the mature tissue
2. Cementoid is t he peripheral layer of developing cementum t hat is laid
down by cementoblasts undergoing cementogenesis. Cementoid is uncalcified or immature.
3. When t he cementoid reaches t he fu ll th ickness needed, the cementoid surrounding the cementocytes becomes ca lcified or matured and is then considered cementum.
4. Cementocytes are cementoblasts entrapped by t he cementum they produce.
tooth components
An irritating or painful response to cold, hot or pressure stimuli is usually
caused by sensitivity of which oral tissue?
dentin
cementum
pulp
enamel
SAADDES
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ANATOMIC SCIENCES
dentin
Cump.trisun ol lhl 0l'IIlalllard
Enamel
Dentin
Cementum
Dental papilla
Type of tissue
Epithelial
Connective tissue Connective tissue
Connective tissue
Inorganic levels
96%
70%
65%
60"1.
Organic levels; water

levels
1%;3%
20"1.; 10%
23%; 12%
25%; 15%
Mesodenn
SAADDES
Incremental lines
Fonnative cells
Dental sac
Alveolar Bone
Enamel organ
Embryological
background
Lines of Retzius
Imbrication lines
of von Ebner
Arrest and reversal Arrest and reversal

lines
lines
Ameloblasts
Odontoblasts
Cementoblasts
Osteoblasrs
Odontoclasts
Odontoclasts
Cementoclasts
Osteoclasts
Tissue fonnation after None
Possible
Possible
Possible
Vascularity
None
None
None
Present
Innervation
None
Present
None
Present
Resorptive cells
tooth components
Generally, as the dental pulp ages, the number of cells _ _ _, and the number of collagen fibers _ _ _.
decreases, decreases
decreases, increases
SAADDES
increases, decreases
increases, increases
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ANATOMIC SCIENCES
decreases, increases
Important: As the dental pulp ages, the following changes take place:
Decreased: - intercellular substance, water. and cells
"**Major decrease in the number of und ifferentiated mesenchymal cells
- size of the pulp cavity due to the addition of secondary or tertiary dentin
Increased: - number of collagen fibers
- calcifications within the pulp (called denticles or pulp stones)
Important point: As the pulp ages, it becomes more fibrotic, leading to a reduction in the regenerative capacity of the pulp.
Remember:
1. The only type of nerve end ing found in the pulp is the free nerve ending, which is a specific
receptor for pain. These pain receptors are located in the plexus of Raschkow. Regard less of the
source of stimulation (heat, cold, pressure), the only response will be pain.
2. The pulp contains both myelinated (mostly) and unmyelinated nerve fi bers. They are afferent and
sympathetic.
3. The myelinated fibers are the axons of sensory or afferent neurons that are located in the dentinal
tubules in dentin.
4. The unmyelinated fibers are sympathetic and associated with the blood vessels.
SAADDES
Note: Proprioceptors (which respond to stimul i regarding movement) are not found in the pulp.
Pulp stones: are nodular calcified bodies having an organic matrix and they occur frequently in relation to
the coronal pulp. There are two types of pulp stones, true and false, and both variants of pulp stones can
be either"free"within the pulpal mass or they may be "attached" to the dentinal wall.
True pulp stones: are composed predominantly of dentin and have dentinal tubules. They may have
an outer layer of predentin and are often located adjacent to odontoblast cells
False pulp stones: are composed of concentric layers of calcified material with no tubular structures
According to their location in the dental pulp, stones can be classified as:
Free pulp stones: are su rrounded on all sides by pulpal tissue and are not attached to the dentinal wall
Attached pulp stones: are those, which are attached to the dentinal wall of the pulp chamber
Embedded pulp stones: pulp stones that are surrounded by reactionary or secondary dentin
tooth components
Which ofthe following has the least amount of collagen?
bone
dentin
enamel
cementum
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292
copynght 0 20132014 Dental Decks
ANATOMIC SCIENCES
enamel
Enamel is the hardest calcified tissue in the h uman body and the richest in calcium.
Enamel is highly mineralized and is totally acellular. It cons ists of approximately 96%
inorganic material (primarily calciu m and phosphorus as hydroxyapatit e), 1% organic
material, and 3% water. Enamel is of ectodermal origin. The organ ic matrix consists
main ly of protein, which is rich in proline.
The fundamental morpholog ic unit of enamel is the enamel rod or prism which is bound
together by an interprismatic substance (interred substance). Each is formed in
increments by a single enamel-forming cell, the ameloblast . Most enamel rods extend
the w idth of the enamel f rom the DEJ to the outer enamel surface. Consequently, each
enamel rod is oriented somewhat perpendicular to the DEJ and the outer enamel surface.
The specific shape of the enamel rod is dictated by the To mes' process of the ameloblast.
In most cases, each enamel rod is cylindrical in the longitudinal section. In most areas of
enamel, the enamel rod is about 4 micrometers in diameter. Note: The oldest enamel in a
fu lly erupted tooth is located at the DEJ underlying a cusp or cingulum.
SAADDES
Other important facts about enamel:

It has no power of regeneration -the ameloblasts lose their functional ability when
the crown of the tooth has been completed
It has no power of metaboli sm
It has no mean s of combating bacterial invasion - the susceptibility of the mineral
component to dissolution in an acid environment is the basis for dental decay
It has no nerve supply
It is a good thermal insulator
The acid solubility of the surface enamel is reduced by fl uoride (this is the basis for
the topical application of fluorides in dental caries prevention)
tooth components
All of the following age changes in enamel are true EXCEPT one. Which one is
the EXCEPTION?
attrition
d iscoloration
SAADDES
flatten ing of grooves and fissu res

modifications in the surface layer
increased permeability
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ANATOMIC SCIENCES
increased permeability
Enamel is a nonvital tissue that is incapable of regeneration . With age, enamel becomes
progressively worn in regions of masticatory attrition. Wea r facets increasingly are
pronounced in older persons, and in some cases substantial portions of the crown
(enamel and dentin) become eroded. Other characteristics of aging enamel include
discoloration, reduced permeability, and modifications in the surface layer.
Note: Linked to these changes is an apparent reduction in the incidence of caries.
Teeth darken with age. Whether th is darkening is caused by a change in the structure of
enamel is debatable. Although darkening cou ld be caused by the addition of organ ic material to enamel from the environment, darkening also may be caused by a deepening of
dentin color (the layer becomes thicker w ith age) seen through the progressively th inning
layer of translucent enamel.
SAADDES
No doubt exists that enamel beco mes less permeable w ith age. Young enamel behaves as
a semipermeable membrane, permitting t he slow passage of water and substances of small
molecular size through pores between the crystals. With age the pores diminish as the crystals acquire more ions and as the surface increases in size.
The surface layer of enamel reflects most prominently the changes w ithin thi s tissue. During aging, the composition of the surface layer changes as ionic exchange w ith the oral environment occurs. In particular, a prog ressive increase in the fluoride content affects the
surface layer (and that, incidentally, can be achieved by topical application).
tooth components
Enamel tufts and lamellae may be likened to geologic faults and have no
known clinical significance.
The striae of Retzius often extend from the DEJ to the outer surface of enamel,
where they end in shallow furrows known as perikymata.
SAADDES
the fi rst statement is true, the second is fa lse

the fi rst statement is false, the second is true
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ANATOMIC SCIENCES

Enamel tufts are fan-shaped, hypocalcified st ructures of enamel rods that
proj ect from the dentinoenamel junction into the enamel proper. They are found
in t he inner one-th ird of enamel and represent areas of less mineralization.
Enamel tufts are an anomaly of crystallization and seem to have no clinical
importance.
Enamel spindles represent short dentinal t ubul es near the DEJ. They result
f rom odontoblasts that crossed the basement membrane before it mineralized
into the DEJ. These dentinal tubul es become trapped during the apposition of
enamel matrix, and enamel becomes mineralized around t hem. They may serve
as pain receptors.
Enamel lamellae are part ially ca lcified vertical defects in the enamel
resembling cracks or fractures that traverse the entire length of the crown fro m
the surface to the DEJ. They are narrower and longer than enamel tufts. Enamel
lamellae are an anomaly of crystallization and seem to have no cl inical
importance.
Over the cus ps of teeth the enamel rods appear twisted around each other in a
seemingly complex arrangement known as gnarled enamel.
As a toot h erupts, it is covered by a pellicle consisting of debris from the enamel
organ that is lost rapidly.
Salivary pellicle, a nearly ubiquitous organic deposit on the surface of the
teeth, always reappears shortly af ter teet h have been polished. Dental p laque
forms read ily on the pellicle, especially in more p rotected areas of the dentition.
SAADDES
Hunter-Schreger bands are an opt ical phenomenon produced by changes in direction

between adjacent groups of enamel rods. The bands are seen most clearly in longitudinal
ground sections viewed by reflected light and are found in t he inner two thirds of the
enamel.
tooth components
You would expect to see all ofthe following in dentin EXCEPT one. Which one
is the EXCEPTION?
incremental lines of von Ebner

contou r lines of Owen
SAADDES
striae of Retzius
g ranular layer ofTomes
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ANATOMIC SCIENCES
striae of Retzius
The incremental (or imbrication) lines of von Ebner in dentin can be likened to the
growth rings or incremental lines of Retzius in enamel. The incremental lines of von
Ebner show the incremental nature of dentin apposition and run at right angle to the
dentinal tubules.
The contour lines of Owen are a number of adjoining parallel imbrication lines that are
present in stained dentin. These contou r lines demonstrate a disturbance in body metabolism that affects the odontoblasts by altering their formation efforts. These contour
lines appear together as a series of dark bands.
Tomes' granular layer is most often found in the peri pheral portion of the dentin beneath the root's cementum adjacent to the DCJ (dentinocemental junction). This area
only looks granular because of its spotty microscopic appearance. The cause of the
change in th is region of dentin is unknown.
SAADDES
1. Enamel fo rmation begins at the future cusp and spreads down the cusp
,., slope. As the ameloblasts retreat in incremental steps, the ameloblasts create
an artifact in the enamel called the lines of Retzius (a.k.a. striae of Retzius).
2. One of the lines of Retzius is accentuated and is more obvious than the others. It is the neonatal line that marks the d ivision between enamel formed
before birth and that which is produced after birth- this neonatal line is found
in all deciduous teeth and in the larger cusps of the permanent first molars.
tooth components
The organic phase of dentin is about 90% collagen, mainly type _ _ with
small amounts of types _ _ .
I, II and IV
I, Ill and V
Ill, I and IV
IV, I and Ill
SAADDES
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ANATOMIC SCIENCES
I, Ill and V
Dentin is the specialized connective tissue that makes up the bulk of the tooth,
extending for almost its entire length. Dentin is hard, elastic, 70% inorganic, 20%
organic, and 10% water. The inorganic component consists of mainly calcium
hydroxyapatite w ith the chem ical formula of Ca 10(P0 4) 6(0H) 2. This ca lcium
hydroxyapatite is similar to that found in higher percentages in enamel and in lower
percentages in bone and cementum. Smaller amounts of other minerals, such as
carbonate and fluori de, are also present.
The organic phase of dentin is about 90% collagen (mainly type I w ith small amounts
of types Ill and V) with fractional inclusions of va ri ous non co llagenous matrix proteins
and lipids.
SAADDES
1. Unlike enamel, wh ich is acellular, dentin has a cellular component that

is reta ined after its fo rmation by odontoblasts.
2. Dentin and pulp tissue are both formed by the dental papilla. Pulp tissue
is a loose, very vascular, and non-calcified connective tissue while dentin is
avascular and a calcified tissue.
3. The main cell type in dentin is the odontoblast, which is derived from
ectomesenchyme.
4. Dentin is softer than enamel but slightly harder than bone. Dentin is more
flexible (lower modulus of elasticity) than enamel. Dentin's compressive
strength is much higher than its tensile strength.
5. Dentin is more mineralized than cementum or bone but less mineralized
than enamel. Morphologically and chem ically, dentin has many cha racteristics in common w ith bone.
tooth components
In orthodontic tooth movement, bone remodeling is forced. The bands,
wires, or appliances put pressure on one side of the tooth and adjacent
alveolar bone, creating a zone of _ _ in the POL This leads to bone _ _.
On the opposite side of the tooth and bone, a _ _ zone develops in the POL
and causes the
of bone.
tension, deposition, compression, resorption
SAADDES
compression, resorption, tension, deposition
compression, deposition, tension, resorption

tension, resorption, compression, deposition
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ANATOMIC SCIENCES
compression, resorption, tension, deposition
Orthodontic movement of teeth always causes remodeling of the alveolar bone

proper to accommodate movement of the teeth. Important: The new alveolar bone
deposited duri ng orthodontic t reatment is best described as intramembranous.
Remember:
Osteoblasts (derived from mesenchyme, i.e., fibroblasts) are bone-forming cells
that secrete the collagen and minerals needed to lay down new bone in their
vicinity.
Osteoblasts that have been t rapped in the osteoid produced by other surround ing
osteoblasts are called osteocytes Osteocytes maintain bones, play a role in
contro lling the extracellular concentration of ca lcium and phosphate, and are
directly stimulated by ca lciton in and inhibited by PTH (parathyroid hormone).
Osteoclasts (which are deri ved from stem cells in the bone marrow - the same
ones that produce monocytes and macrophages) are bone-resorbing cel ls. They
are essential partners for bone modeling and remodeling. Their resorptive activity
allows the permanent renewing of bone and regulates ca lcium homeostasis.
SAADDES
1. A similar situation is the alternate loosening and tightening of a deciduous

S'j tooth before it is lost. This is caused by the alternate resorption (cementa, ' clasts, osteoclasts) and apposition (cementoblasts, osteoblasts) of cementum and bone.
2. During active tooth eruption, there is apposition of bone on all surfaces
of the alveolar crest and on all walls of the bony socket.
Remember: Permanent teeth move occlusally and facially when erupting.
tooth components
Apical abscesses of which teeth have a marked tendency to produce cervical
spread of infection most rapidly?
mandibular central and lateral incisors

mandibular canine and first premolar
SAADDES
maxillary first and second molars
mandibular second and third molars
298
ANATOMIC SCIENCES
mandibular second and third molars

Certain anatomic features determine to a large extent the actual direction that infection may
take. The attachment of muscles may determine the route that an infection will take,
channeling the infection into certain tissue spaces.
lctth
Clinical Presentation of lesion

Maxillary vestibule
( hmc.1l Present.1t10n ol \bsccsscs and l-1stul.lc
Teeth Most Commonly Involved

Maxillary central and lateral incisor
Maxillary canine (i f root is short and inferior to levator a nguJi oris)
Maxillary premolars
Maxillary molars (if buccal roots are short and inferior to buccinator)
SAADDES
Penetration of nasal floor
Maxillary central incisor
Nasolabial skin region
Maxillary canine (i f root is long and superior to levator anguli oris)
Palate
Maxillary late ral incisor

Maxillary premolars (lingual root)
Maxillary molars (palatal root)
Perforation into maxillary sinus Maxillary molars (if buc.cal roots a re long)
Buccal skin surface
Maxillary molars (if buccal roots a re superior to buccinator)
Mandibular vestibule
Mandibular incisors (if roots are short a nd superior to mentalis)

Mandibular canines a nd premolars (if root.-. are short and superior to depressors)
Mandibular fi rst and second molars (if roots are short a nd superior to buccinator)
Submental skin region
Mandibular incisors (if roots are long and inferior to mentalis)
Sublingual region
Mandibular fi rs t molar (if lingual root is short a nd superior to mylohyoid)

Mandibular second molar (if lingual root is short and supe rior to mylohyoid)
Submandibular skin region
Mandibular second molar (if lingual root is long and infe rior to mylohyoid)
Mandibular third molars (i f roots are infe rior to mylohyoid)
tooth components
The bone directly lining the socket (inner aspect of the alveolar bone) specifically is referred to as:
bundle bone
cancellous bone
osteoid
SAADDES
trabecu lar bone
299
ANATOMIC SCIENCES
bundle bone
The al veolar process is that bone of the jaws conta ining the sockets (alveoli) for the
teeth. The alveolar process consists of an outer (buccal and lingual) cortical plate, a
central spongiosa, and bone lining the alveolus (alveolar bone). The cortica l plate
and alveo lar bone meet at the alveolar crest (usually 1.5 to 2 mm below the level of
the cementoenamel junction on the tooth it surrounds). Alveola r bone comprises inner
and out components; it is perforated by many foramina, wh ich transmit nerve and vessels; thus sometimes is referred to as the cribriform plate. Rad iographically, alveolar
bone also is referred to as the lamina dura because of an increased radiopacity.
The bone d irectly lining the socket (inner aspect of alveolar bone) specifical ly is referred to as bundle bone. Embedded with in th is bone are the extrinsic collagen fiber
bundles of the POL, which, as in cellula r cementum, are mineralized only at their periphery. Bundle bone thus provides attachment for the POL fiber bundles that insert
into it.
SAADDES
The cortical plate consists of surface layers of lamellar bone supported by compact
haversian system bone of va ri able th ickness. The cortical plate is generally thinner in
the maxilla and thickest on the buccal aspect of mandibular premolars and molars. The
trabecular (or spongy) bone occupying the centra l part of the alveolar process also
consists of bone d isposed in lamellae w ith haversian systems occurring in the large
trabecu lae.
Trabecular bone is absent in the region of the anterior teeth, and in th is case, the cortica l plate and alveolar bone are fused together. The important part of this complex in
terms of tooth support is the bundle bone.
tooth components
A newly erupted tooth has a membranous covering. It is derived from which
structure?
peri kymata
dental papilla
SAADDES
dental follicle
oral epithelium
gubernaculum
300
ANATOMIC SCIENCES
oral epithelium
Also known as Nasmyth's membrane, the secondary enamel cuticle is the th in membrane covering newly erupted teeth. It is a remnant of the reduced enamel epithelium, and is ectodermally derived. It is produced by the ameloblast cell after it produces
the enamel rods. The secondary enamel cuticle consists of two extremely thin layers
(the inner one clear and structureless, the outer one cellular), covering the entire crown
of newly erupted teeth and subsequently abraded by mastication; the cuticle is evident m icroscopically as an amorphous material between the attachment epithelium
and the tooth. This cuticle is worn away by mastication and cleaning. Nasmyth's membrane is replaced by an organic deposit called the pellicle, wh ich is formed by salivary
proteins. It is this pellicle that is invaded by bacteria to form bacterial plaque that, if
not removed, w ill cause dental caries and periodontal disease.
SAADDES
Note: The primary enamel cuticle is the organic matrix responsible for binding the epithelium to the tooth during development.
Gaburnaculal canal: is a small canal located between the permanent tooth germ and
the apex ofthe deciduous tooth, containing remnants of dental lamina and connective
tissue.
Remember: Enamel is incapable of repairing itself once it is destroyed (unlike
dentin). After the ameloblasts are finished w ith both enamel apposition and maturation, they become part of the reduced enamel epithelium, along with the other portions of the compressed enamel organ. The reduced enamel epithelium fuses with the
oral mucosa, creating a cana l to allow the enamel cusp tip to erupt through the oral
mucosa into the oral cavity. Unfortunately, the ameloblasts are lost forever as the
fused t issues d isintegrate during tooth eruption, preventing any further enamel apposition.
tooth components
Dentin is considered a living tissue because of odontoblastic cell processes
known as:
triacetate fiber
Tomes' fiber
tag fiber
Korff's fiber
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ANATOMIC SCIENCES
Tomes' fiber
These odontoblastic processes (Tomes' fibers) occupy the dentinal tubules. There is
one per odontoblast.
It is because of these odontoblastic cell processes that dentin is considered a living
tissue, with the capability to react to different stimuli and produce secondary,
sclerotic, and/or repa rative dentin.
Dentin sensitivity is not well understood. One theory is that Tomes' fibers are
receptors and t ransmit an impulse to pulpal nerves. The preferred theory is that fluid
movement within the tubules, in response to a stimulus, t ri ggers the pulpal nerves.
Remember: The odontoblasts begin dentin formation (dentinogenesis)
immediately before enamel formation by the ameloblasts. Dentinogenesis begins
with the odontoblasts laying down a dentin matrix or predentin, moving from the
DEJ inward toward the pulp. The most recently formed layer of dentin is al ways
adjacent to the pulpal surface. Note: Predentin or dentin matrix is a mesenchymal
product consisting of nonmineralized collagen fibers.
SAADDES
Remember: Amelogenesis is the process of enamel matrix formation that occurs

during the appositional stage of tooth development. Enamel matrix is produced by
ameloblast cells. These cells are columnar cells that d ifferentiate duri ng the
apposition stage in the crown area. The enamel matrix is secreted from each
ameloblast by its Tomes' process. Tomes' process is the secretory surface of the
ameloblast that faces the dentinoenamel junction (DEJ).
1. The cell body of the odontoblast lies in the pulp cavity.

' 2. The dentinal tubules are S-shaped (curvature) in the crown due to
overcrowding of odontoblasts. This curvature of the tubules decreases in
root dentin.
tooth components
Secondary dentin is produced in reaction to various stimuli, such as
attrition, caries, or a restorative dental procedure.
Tertiary dentin is produced only by those cells directly affected by the
stimulus.
SAADDES

the first statement is false, the second is true
302
ANATOMIC SCIENCES
the first statement is fal se, the second is true

Tertiary dentin (also referred to as reactive or repa rative dentin) is produced in
reaction to various stimuli, such as attri tion, caries, or a restorative dental procedure.
Unlike pri mary or secondary dentin that forms along the entire pulp-dentin border,
tertiary dentin is produced only by those cells d irectly affected by the stimulus.
Tertiary dentin is subclassified as reactionary or reparative dentin, the former
deposited by preexisting odontoblasts and the latter by newly d ifferentiated
odontoblast-like cells.
Primary dentin is the dentin formed in a tooth before the completion of the apical
foramen of the root. Primary dentin is characterized by a regula r pattern of tubules.
Secondary dentin is the dentin that is formed after completion of the apical
foramen. Secondary dentin is formed at a slower rate than pri mary dentin and is less
mineralized. Secondary dentin is a regu lar and somewhat uniform layer of dentin
around the pulp cavity. Secondary dentin is made by the odontoblastic layer that
lines the dentin-pulp interface.
SAADDES
Note: The junction between pri mary and secondary dentin is characterized by a
sharp change in the direction of dentinal tubules.
When dentin is damaged, usually by the chronic injury of ca ri es, odontoblastic

processes d ie or retract, leaving empty dentinal tubules. Areas w ith empty dentinal
tubules are called dead tracts and appear as dark areas in ground sections of tooth.
With t ime, these dead t racts can become completely filled calcified material
(sclerotic dentin). This region is called blind tracts and appears white in sections of
ground tooth. The adaptive advantage of blind tracts is the sealing off of the dentinal
tubules to prevent bacteri a from entering the pulp cavity. Clinically, this sclerotic
dentin appears dark, smooth, and shiny.
tooth development
The dental lamina, a thickening of the oral epithelium that produces the
swellings of the enamel organs, is first seen histologically around the:
second week in utero

sixth week in utero
SAADDES
tenth week in utero
fourth month in utero
Irefer to AS card 303-1, 308 B-1, 308 C-1for illustration I
ANATOMIC SCIENCES
303
sixth week in utero
By the third week after conception, the primitive mouth (stomodeum) has formed.
Over the next few weeks, the tongue, jaws, and palate develop. During the sixth to
seventh weeks, formation of the teeth commences, and by eight weeks, all of the
primary (deciduous) incisors, can ines, and molars are discernible.
Tooth development appears to be initiated by the mesenchyme's inductive influence
on the overlying ectoderm. Early in the sixth week, there appears to be a thicken ing of
the oral epithelium (which is a derivative of the surface ectoderm). These thickenings
or U-shaped bands are ca lled the dental lamina and fo llow the curve of the pri mitive
jaws.
SAADDES
At certa in points on the dental lamina, the ectodermal cells proliferate and produce
swellings that become the enamel organ. Inside the depression of the enamel organ,
an area of condensed mesenchyme becomes t he dental papilla. Surrounding both
the enamel organ and dental papilla is a capsule-like structure of mesenchyme called
the dental sac.
Note: The enamel organ separates from the dental lamina after the first layer of dentin
is deposited.
Remember: Each tooth is t he product of two t issues that interact duri ng tooth
development, the oral epithelium and the underlying ectomesenchyme. The oral
epithelium grows down into the underlying ectomesenchyme and forms small areas
of condensed mesenchyme, w hich become tooth germs.
SAADDES
The bud stage of tooth development seen in
coronal section (A) and sagittal section (B)
Reproduced with p..-rmission from Nand A: Tell CtJte's Oral Hi.11tdOJ;JIXrelnpntent, Stmcmre. tmd Function: St. Lou1s.
303 1
Elsevier.
Primordium of the
Successional
dental lamina
SAADDES
The cap stage of tooth development, w hich involves prol iferation a nd differentiation,
forming the tooth germ, the primordium of a primary tooth. Note the components of the
tooth germ: the enamel organ, dental papilla, a nd dental sac. Also note that the developing primordium of the permanent succedaneous tooth lingua l to the primary tooth gem1
is in the bud s tage.
303AI
Reproduced with pcrmission from Bath Balogh M.

2006. Saunders.
4
MJ: 1/llt$/Yated Dental
Hi:aology. and
ed 1. St Louis.
SAADDES
Early Bud Stage of Tooth Development
The enamel organ seems to be divided by the enamel cord
303 Bl
Reproduced with permission from Nand A: 1l!tJ CmeS Oral Hi.mdogJ Dervdi1J>ment, Strocture. tmd Function: St. LOUIS,
Elsevier.
tooth development
When enamel maturation is completed, the ameloblast layer and the adjacent papillary layer regress and together constitute the:
cervical loop
epithelial root sheath
SAADDES
reduced enamel epithelium

304
ANATOMIC SCIENCES
When enamel is ful ly mature, the ameloblast layer and the adjacent papillary layer
reg ress and together constitute the reduced enamel epithelium that covers the
tooth through eruption. The ameloblasts stop modulating, reduce their size, and
assume a cuboidal appearance. This epithelium, although no longer involved in the
secretion and maturation of enamel, continues to cover it and has a protective
function.
Important: The reduced enamel epithelium remains until the tooth erupts. As the
tooth passes through the oral epithelium, the part of the reduced enamel
epithelium situated incisally is destroyed, whereas that found more cervically
interacts with the oral epithelium to form the junctional epithelium.
SAADDES
Remember: The junctional epithelium (or epithelial attachment) attaches the

gingival t issues to the tooth using hemidesmosomes. The apical extent of the
junctional epithelium is usually the cementoenamel junction.
II
Oute r enamel epithelium ]-Compressed to

Stellate reticulum
Stratum intermedium
Ameloblasts
fonn reduced
enamel
epithelium
SAADDES
The reduced enamel epithelium is produced after the completion of enamel apposition when the enamel organ under goes compression of its many layers on the enamel
surface.
304-1
Reproduced \1,-ilh
Saunders.
Connective
tissue
SAADDES
Stages in the process of tooth eruption. A: Oral cavity before the eruption process begins. Reduced
enamel epithelium covers the newly fonned enamel. B: f usion o f the reduced enamel epithel ium with
the oral epithelium. C: Disintegration o f the central fused tissue, leaving a tunnel for tooth movement.
0: Coronal fused tissues peel back from the crown during eruption, leaving the initial j unctional epithelium near the cementoenamel j unction.
304A-I
R<'produccd \ltith p<'nni$.iion (rom Ebtb-Balogh M. Fchrcnbacoh MJ;
Saunders.
ed 2. St Louis. 2006.
tooth development
Epithelial cells of the inner and outer epithelium proliferate from the cervical
loop of the enamel organ to form a double layer of cells known as:
dental lamina
dental papilla
SAADDES
Hertwig's epithelial root sheath
305
ANATOMIC SCIENCES
Hertwig's epithelial root sheath
The structure responsible for root development is the cervical loop. The cervical loop is the
most cervical portion of the enamel organ, a bilayer rim that consists of on ly inner and outer
enamel epithelium of the enamel organ. The cervical loop begins to grow deeper into t he surrounding mesenchyme of the dental sac, elongating and moving away from the newly completed crown area to enclose more of the dental papilla t issue and form Hertwig's epithelial
root sheath (HERS).
Hertwig's sheath is an epithelial diaphragm that is derived from the inner and outer enamel
epithelium of the enamel organ. After crown formation, the root sheath grows down and
shapes the root of the tooth and induces formation of root dentin. Uniform growth of this
sheath will resul t in the formation of a single-rooted tooth, while medial outgrowths or
evaginations of t his sheath will produce multi-rooted teeth.
SAADDES
After the first root dentin is deposited, t he cervical portion of Hertwig's epithelial root sheath
breaks down, and this new dentin comes in contact with the dental sac. This communication
stimulates cells to differentiate into cementoblasts that produce cementum. This process is
called cementogenesis.
Accessory canals, defined as a co mmunication between the p ulp t issue and t he
periodontal ligam ent other than t hrough the root apex, are the result of a localized failure
in the fo rmati on of Hertwig's sheath during embryonic stages of tooth formati on. This
leads to a failure in odontoblastic differentiati on and denti n formati on and event ually to
the form ation of the accessory canal.
An enamel pearl is a non-neoplastic excrescence of enamel where ena mel is not supposed
to be, such as on a root surface. They are fo und usually in the area between roots, which is
called a fu rcation, of molars. Enamel pearls are not comm on in teet h with a single root. The
m ost com m on location of an enamel p earl is the fu rcation areas of the maxillary and
mandibular third m olar roots. The enamel pearls are form ed essentially from the Hertwig's
epit helial root sheath.
Enamel
' ftl
Dentin
Stellato
reticulum
Outer enamel
oplthollum
Ameloblasts
Pulp
lntermedlum
SAADDES
Dental sac
Inner enamel
epithelium
Stratum
lntermedlum
Inner
enamel
epithelium
Hartwig's
epithelial
root
L - - - - 1 - - - - - - - - - J sheath
enamel
epithelium
Stagr.s in root development. A: Cervical loop of a primary tooth, which is composed of the most
cervical portion of the enamel organ and is responsible for root development. B: Hertwig's epithelial root sheath is formed fiom elongation of the cervical loop, which is responsible for the
shape of the root (or roots) and the induction of root dentin.
30S.I
Saunders.
ed 2. StLouis. 2006.
tooth development
Tooth development is dependent on a series of sequential cellular
interactions between epithelial and mesenchymal components of the tooth
germ.
Once the ectomesenchyme influences the oral epithelium to grow down into
the ectomesenchyme and become a tooth germ, the histogenesis of a tooth
occurs.
SAADDES

306
ANATOMIC SCIENCES

Inner enamel epithelium cells continue their d ifferentiation into ameloblasts that produce organic matrix against the newly formed dentinal surface. Almost immediately, thi s organic matrix mineralizes and becomes t he initial enamel layer of the crown. Thus although enamel
protein secretion occurs before mantle dentin is visible on the crown, these proteins do not assemble as a layer until dentin is formed. The enamel-forming cells, the ameloblasts, move away
from the dentin, leaving behind an ever-i ncreasing thickness of enamel.
For these events to take place normally, d ifferentiating odontoblasts must receive signals from
d ifferentiating ameloblasts (inner enamel epithelium), and vice versa- an example of reciprocal induction.
Usual events in the histogenesis of a tooth:
SAADDES
1. Elongation of the inner enamel epithelial cells of the enamel organ; thi s influences mesenchymal cells on the periphery of the dental pa pilla to d ifferentiate into odontoblasts (#2
below)
2. Differentiation of odontoblasts
3. Deposition of the first layer of dentin
4. Deposition of the first layer of enamel
Tooth development is dependent on a series of sequential cellular interactions between
epithelial and mesenchymal components of the tooth germ . Once the ectomesenchyme
influences the oral epith elium to grow down into the ectomesenchyme and become a tooth
germ, the above events occur.
Remember: Histogenesis means the formation and development of the tissues of the
body, in this case t he tooth.
1. Some texts include the deposition of root dentin and cementum as #5 in t he
histogenesis of a tooth.
2. Korff's fibers is a name given to the rope-like grouping of fibers in the periphery
of the pu lp that seem to have something to do with the formation of dentin matrix.
tooth development
Which ofthe following forms the middle part ofthe enamel organ?
outer enamel epithelium

inner enamel epithelium
stratum intermedium
SAADDES
stellate reticu lum
307
ANATOMIC SCIENCES
stellate reticulum
Four layers of the enamel organ:
1. Outer enamel epithelium (OEE): the outer cellular layer of the enamel organ
(very th in). This layer outlines the shape of the future developing enamel organ.
2. Inner enamel epithelium (lEE): the innermost cellu lar layer of the enamel organ
(very th in). The cells in th is layer w ill become ameloblasts and produce enamel.
3. Stratum intermedium: this area lies immediately lateral to the inner enamel
epithelium (thicker than both the OEE and lEE). This layer of cells seems to be
essential to enamel formation (prepares nutrients for the ameloblasts of the lEE).
SAADDES
4. Stellate reticulum: this area is the central core and fills the bulk of the enamel
organ. This layer contains a lot of intercellular fluid (mucus-type fluid ri ch in albumin) that is lost just before enamel deposition.
Remember: After enamel formation is completed, all of the above structures of the
enamel organ become one and fo rm the reduced enamel epithelium. This is
important in the formation of the dentogingival junction, which is an area where
the enamel and epithelium come together as the tooth erupts into the mouth. This
forms the initial junctional epithelium (or epithelial attachment), which later
migrates down the tooth to assume its normal position.
tooth development
Put the following developmental stages of a tooth in the correct sequence:
(1) Bell stage (2) Bud stage (3) Cap stage
1,2,3
3,2, 1
2,3,1
2, 1,3
SAADDES
]refer to AS card 308 B-1, 308 C-1for illustration]
ANATOMIC SCIENCES
308
2,3, 1
Deve lopmental stages of a tooth:

1. Initiation (sixth to seventh weeks): ectoderm lining stomodeum gives rise to oral
epithelium and then to dental lamina, adj acent to deeper ectomesenchyme, wh ich is influenced by the neural crest cell s. Induction is the main process involved. Congenital absence of teeth (anodontia) and su pernumerary teeth resu lt from an interruption in this
phase.
2. Bud stage (eighth week): growth of dental lamina into b ud that penetrates growing
ectomesenchyme. Proliferation is the main process involved.
3. Cap stage (n inth to tenth weeks): enamel organ forms into a cap, surro unding the
mass of t he dental papilla from the ectomesenchyme and surrounded by the mass of the
dental sac also from the ectomesenchyme, thus forming the tooth germ. Proliferation,
differentiation, and morphogenesis are the main processes involved. Dens in dente, gemination, fusion, and tubercle formation occur during this phase.
4. Bell stage (eleventh to twelfth weeks): final shaping of tooth, cell s differentiate into
specific tissue forming cell s (a meloblasts, odontoblasts, cementoblasts, and fibroblasts) in
the enamel organ. Histodifferentiation and morphodifferentiation are the main
processes involved. Macrodontia/microdontia occur during t his stage.
5. Apposition (varies per tooth): cells that were differentiated into specific tissue -forming
cells begin to deposit the specific dental tissues (enamel, dentin, cementum, and pulp).
Enamel dysplasia, concrescence, and the form ation of enamel pearls occ ur during th is
stage.
6. Calcification (varies per toot h): mineralization
7. Eruption (varies per tooth)
8. Attrition (varies per tooth)
SAADDES
Note: Dentinogenesis imperfecta and amelogenesis imperfecta occur during histodifferentiation (Bell st age).
Bell stage of tooth development. T he

dental lam ina is disintegrating, so the
tooth now continues its development divorced fiom the oral epithelium. T he
crown pattern of the tooth has been established by folding of the inner enamel
epithelium. This folding has reduced the
amount of stellate reticulum over the future cusp tip. Dentin and enamel have
begun to fmm at the crest of the folded
inner enamel epithelium.
SAADDES
3081
SAADDES
Stratum intermedium
Inner enamel epithelium
Central cells of the dental papilla

enamel epithelium
The bell stage of tooth development, which ex hibits d ifferentiation of the too th
germ to its fim hest extent. Note the enamel organ and the dental papilla have differentiated into various layers in preparation for the apposition of enamel and
dentin.
Reproduced \1,-ilh
Saunders.
308AI
Stages in Tooth Development

Stageffi me Span*
Micr oscopic
Appearance
Hlltlation stage/sixth to
seveth weeks
Main Processes
Involved
Induction
Description
Ectodenn lining stomedeum gives
rise to oral epithelium and rhen to
dental lamina. adjacent w deeper
ec1omese.nchyme, which is influenced by the neural crest cells.
Both tissues are separated by a
SAADDES
baseme-n t membrane.
Bud srage/e.ighth week
P-roliferation
Growth of dental lamina into bud

that peneuates growing ectomesenchyme.
Cap stage/ninth to renth

weeks
Proliferation, difTe.rentiation, morphogenesis
Enamel organ fo nns into cap, surrounding mass of de.ntal papilla

from the e.crome.o;endtyme and surrounded by mass of dental sac also
from the eccomesenchyme. Fonnation of the rooth gel'llt.
* Note that these are approximate prenatal time spans for the development of the primary dentition

Saunders.
ed 2. StLouis. 2006.
Sta ges in Tooth development

Sta geffi me Span*
Bell stage/eleventh
Microscopic
Appearance
[0
twelfth weeks
P-roliferation, ditTerentia.
tion, morphogenesis
Description
Differentiation of enamel organ
into bell with four cell types and
dental papilla into two cell rypes.
SAADDES
Apposition stage/ varies

per tooth
Main Processes
Involved
Maturation stage/ varies

per tooth
Induction. prolifermion
De.ntal tissue..; secreted as marix in

successive layers.
Maturation
Dental tissues fully mineralize [ 0

their mature levels.
* Note that these are approximate prenatal time spans for the development of the primary dentiti on
308 C.l

Saunders.
ed 2. St Ll"'Uis. 2006.
tooth development
In adults the epithelial cell rests of Malassez persist next to the root surface
within the periodontal ligament.
Although apparently functionless, they are the source of the epithelial lining
of dental cysts that develop in reaction to inflammation of the periodontal
ligament.
SAADDES
the fi rst statement is fa lse, the second is t rue
[refer to card 305-1for illustration]
ANATOMIC SCIENCES
309

The epithelial rests of Malassez are remnants of Hertwig's epithelial root sheath and
can be found as groups of epithelial cells in the periodontal ligament. Some rests
degenerate; others become ca lcified (form cementicles). Although apparently
functionless, they are the source of the epithelial lining of dental cysts that develop in
reaction to inflammation of the periodontal ligament.
Remember: The purpose of Hertwig's epithelia l root sheath is to shape of the root
(or roots) and induce dentin formation (by stimulating the differentiation of
odontoblasts) in the root area so that it is continuous with coronal dentin. After this
root dentin is deposited, the cervical portion of the root sheath breaks down, and this
new dentin comes in contact with the dental sac. This contact stimulates cells from
the dental sac to d ifferentiate into cells that wil l produce cementum, the PDL, and the
alveolar bone proper.
SAADDES
Important: The continu ity of Hertwig's epithelial root sheath must be broken in
order for cementum to be deposited during tooth development (cementogenesis).
Hert wig's epithelial root sheath is cha racterized by:
The formation of cell rest s (rests of Malassez) in the PDL when the sheaths functions have been accomplished
The absence of a stellate reticulum and a stratum intermedium (it consists of inner and outer enamel epithelium only)
Remember: The structure responsible for root development is the cervical loop, which
is the most cervical portion of the enamel organ.
tooth development
Histologically, the dentin of the root is distinguished from the dentin of the
crown by the presence of:
incremental lines of Retzius

rete pegs
SAADDES
granular layer ofTomes

sharpey's fibers
310
ANATOMIC SCIENCES
granular layer of Tomes
When root dentin is viewed under transmitted light in ground sections (and only in
ground sections), a granular-appeari ng area, the granular layer of Tomes, can be
seen just below the surface of the dentin where the root is covered by cementum. A
progressive increase in so-called granules occurs from the cementoenamel junction
to the apex of the tooth. This area only looks granular because of its spotty microscopic appearance. The cause of the change in this region of dentin is unknown. The most
recent interpretation relates this layer to a special arrangement of collagen and noncollagenous matrix proteins at the interface between dentin and cementum.
1. Globular dentin: refers to areas of both pri mary and secondary mineralization in dentin.
2. Interglobular dentin: is the term used to describe areas of unmineralized
or hypo mineralized dentin where globular zones of m ineralization (calcospherites) have failed to fuse into a homogeneous mass within mature dentin.
It is seen most frequently in the circumpulpa l dentin just below the mantle
dentin, where the pattern of mineralization is largely globular.
SAADDES
tooth development
Which ofthe following products is NOT ectodermal in origin?
enamel
hertwig's epithelial root sheath
pulp
ameloblasts
SAADDES
[refer to AS card 95-1for illustration)
ANATOMIC SCIENCES
311
pulp
Components of the tooth germ (aka, dental organ):
1. Enamel organ, wh ich is formed from oral epithelium, wh ich is derived from
ectoderm. The enamel organ has four distinct cel l layers:
1. Outer enamel epithelium
2. Inner enamel epithelium
3. Stratum intermedium
4. Stellate reticulum
*** The enamel organ wil l give rise to enamel and will eventually form Hertwig's
epithelial root sheath (HERS).
SAADDES
2. Dental follicle (a.k.a., sac), wh ich is formed from mesenchyme (ectomesenchyme), wh ich is derived from neural crest cells. The dental follicle surrounds the
developing tooth germ and wi ll give rise to the supporting t issues of the tooth (i.e.,
cementum, the PDL, and the alveolar bone proper).
3. Dental papilla, which is also formed from mesenchyme (ectomesenchyme),
which is derived from neural crest cells. The dental papilla w ill g ive rise to the
dentin and dental pulp.
Note: The outer layers of cells differentiate into the odontoblasts (dentin-fo rmin g
cells).
SAADDES
Beginning of histodifferentiation within the enam el
organ forming the stellate reticulum. The peripheral
cells are differentiating into the inner and outer enamel
ep ithelia.
3111
Reproduced with permission from Nand A: Te11 CateS Oral Hi.fltH08J' !Jn-elnpment, Structure. and FunNion: St. Lou1s. 200M. EJscvier.
SAADDES
Dental papilla
Dental follicle
Cap stage of tooth d c,clo pmcnt. T he epithelia l enamel

organ sits over a ball of ectomesenchyma l ce lls, the dental
papilla that extends around the rim of the enamel o rgan to
form the dental follicle
Reproduced with p..-rmission from Nand A: Ten CtJte's Oral Hi.11tdOJ;JIXrell1pntent, Stmcmre. tmd Function: St. Lou1s.
311A I
Elsevier.
Summary of Tooth Formation
SAADDES
Dental papilla
Ectomesenchyme
from neural
crest
Dental follicle
95- 1
veins
The portal vein is about 2 inches long and is formed behind the neck of the
pancreas by the union of the:
left gastric and the left colic veins

appendicular and the inferior mesenteric veins
SAADDES
superior mesenteric and the splenic veins

right gastri c and the ri ght col ic veins
312
ANATOMIC SCIENCES
superior mesenteric and the splenic veins
The portal vein (most commonly referred to as the hepatic portal vein) is a major vein t hat
d rains blood from t he abdominal part of the gastrointestinal tract from the lower t hird of t he
esophagus to halfway down the anal canal; the portal vein also drains blood from the spleen,
pancreas, and gallbladder. The portal vein enters the liver and breaks up into sinusoids, from
which blood passes into the hepatic veins t hat join the inferior vena cava. The portal vein is
formed behind the neck of the pancreas by the union of the superior mesenteric and t he
splenic veins. The portal vein ascends to the right, behind t he first part of the d uodenum, and
enters t he lesser omentum. The portal vein t hen runs upward in front of the opening into the
lesser sac to t he porta hepatis, where it d ivides into rig ht and left branches, before entering the
liver.
SAADDES
Almost all of the blood coming from the d igestive system drains into a special venous
circulation called the portal circulation. Thi s is because it contains all t he nutrients and toxins
that have been absorbed along the digestive tract from ingested food. Before these absorbed
substances can go into the systemic circulat ion, the portal circulation must be filtered first to
remove or"detoxify"them. This filtering and detoxification are functions of the liver.
The tributaries of the portal vein are the:
Splenic vein: joins the superior mesenteric vein to form the portal vein
Inferior mesenteric vein: is joined by t he splenic vein, which drains the accessory digestive
organs of the pancreas and spleen, as well as part of the stomach
Superior mesenteric vein: joins the splen ic vein to form the portal vein
Gastric veins, which d rain t he upper pa rt of the stomach, and t he cystic vein, which drains
t he gallbladder, also d rains into the right branch of the portal vein
Note: Once blood d elivered by the hepatic portal system has filtered t hrough the liver, the
blood is returned to the heart via the inferior vena cava.
Important: The portal vein carries twice as much blood as the hepatic artery.
Hepatic portal vein

ncreatic veins
SAADDES
Hepatic Portal Circulation
312 1
Reproduced With permission (rom l'auon KT. Thibodcnu GA: Miuby.i" Handbook ofAnaltml)' &
veins
The right posterior intercostal vein drains blood into:
azygos vein
hemiazygos vein
accessory hemiazygos vein
SAADDES
none of the above
313
ANATOMIC SCIENCES
azygos vein
The azygos venous system con sists of the azygos vein, the hemiazygos vein (vena azygos
minor inferior), and the accessory hemiazygos vein (vena azygos minor superior). They drain
blood from the posterior pa rts of the intercostal spaces, the posterior abdominal wall, the
pericardium, the diaphragm, the bronchi, and the esophag us.
The origin of the azygos vein is variable. It is often formed by the union of the right ascending lumbar vein and the right subcostal vein.The azygos vein ascends through the aortic opening in the diaph ragm on the right side of the aorta to the level of the fifth thoracic vertebra.
Here the vein arches forward above the root of the right lung to empty into the posterio r surface of the superior vena cava. Note: The azygos vein leaves an impression on the right lung
as the vein arches over the root. The azygos vein has numerous tributaries that include the eight
lower intercostal veins, the right superior intercostal vein, the superior and inferior hemiazygos veins, and numerous mediastinal veins.
SAADDES
An intercostal vein runs alongside each intercostal artery. Each side ha s eleven posterior intercostal veins and one subcostal vein. Most posterior intercostal veins empty into the azygos venous system, which in turn empties into the superior vena cava at the fourth thoracic vertebra.
The superior vena cava contains all of the venous blood from the head and neck and both
upper limbs and is formed by the union of the two brachiocephalic veins. It pa sses
downward to end in the right atrium of the heart. The azygous vein joins the posterior aspect
of the superior vena cava ju st before it enters the pericardium. Note: The inferior vena cava
pierces the central tendon of the diaphragm opposite the eighth thoracic vertebra and almost
immed iately enters the lowest part of the right atrium with venous blood from the lower pa rt
of the body.
Remember: The right brachiocephalic vein is formed at the root of the neck by the union of
the right subclavian and the right internal jugular veins. The left brachiocephalic vein has
a similar origin. It passes obliquely downward and to the right behind the manubrium sterni
and in front of the large branches of the aortic arch . It joins the right brachiocephalic vein to
form the superior vena cava.
Right intercostal vein
SAADDES
Anterior intercosltaL--,
vein
Thoracic \Vall Veins -Anterior view

ReproduCX'd wilh pt'nnission from Alias o(H11mOtl Anatoot)': Springhouse. 2001, Springhoust'.
313-1
veins
The subclavian vein is located anterior to the:
scalenus anterior muscle

scalenus middle muscle
scalenus posterior muscle
SAADDES
none of the above
314
ANATOMIC SCIENCES
scal e nus ante rio r muscle

The subclavian veins are two large veins, one on either side of the body. Each subclavian
vein begins at the outer border of the first rib as a continuation of the axillary vein. At the
medial border of the scalenus anterior, the vein j oins the internal jugular vein to form
the brachiocephalic vein. Important: The subclavian vein crosses the first rib anterior to
the sca lenus anterior muscle.
The external jugular ve in lies in the superficial fascia deep to the platysma. The vein
passes downward from the reg ion of the angle of the mandible to the middle of the
clavicle. This vein perforates the deep fascia j ust above the clavicle and drains into the
subclavian vein.
1. The subclavian vein follows the subclavian artery. The vein passes anterior to
the sca lenus anterior muscle, while the artery passes posterior to that muscle.
'. 2. The thoracic duct usually drains into the junction of the left internal jugular
and subclavian veins.
3. The brachial vein drains venous blood from deep antebrachial regions and
brachial regions into the axillary vein.
4. The cephalic vein drains venous blood fro m the radial side to the antebrachium and brachium into the axillary vein.
5. Brachiocephalic vein either of two veins (right and left) formed by the union
of the internal jugular and subclavian veins.
6. The superior vena cava is a large vein formed by the union of the two brachioce phalic veins; this vein has no valves. It receives blood from the head, neck,
upper limbs, and chest and empties into the right atrium of the heart.
7. The inferior vena cava (larger than the superior vena cava) opens into the
lower part of the right atrium; the inferior vena cava is guarded by a rudimentary,
non-functi oning valve. The inferior vena cava returns blood to the heart from the
lower half of the body.
SAADDES
External jugular vein

Brachiocephalic vein
vein
-
Superior vena cava
Brachial
Median cubital vein
SAADDES
Palmar venous arch
iliac vein
I\--Sn1all saphenous vein
Dorsal venous arch

314-1
Major Veins of the Circulatory System
veins
Oxygenated blood leaves the placenta and enters the fetus through the:
foramen ovale
ductus venosus
umbilical arteries
SAADDES
ductus arteriosum
umbilical vein
315
ANATOMIC SCIENCES
umbilical vein
Blood leaves the placenta and enters the fetus t hroug h the umbilical vein. It is the only fetal
vessel to carry blood that is rich in oxygen and nutrients. All of the other vessels carry a
mixture of arterial and veno us b lood. After circulating in the fetus, t he blood returns to
the placenta through t he umbilical arteries.
Structure
Location
Ductus venosus
Fate in the Newborn
of the umbilical cod
the placenta
Venous shunt w ithin the
Transports oxygenated
blood directly into the
inferior vena c.ava
Fomt..o; the ligamentum venosum, a

fibrous cord in the live1
A shunt to bypass the
Closes at birth and becomes the fos.<;a

O\'aJis, a depression in the inte-ratrial
liver to COJHleC[ wich the

inferior vena cava
Foramen ovale
Function
the round ligamelll (also knov.n

Connecrs the placenta to the Transports nutrient-rich
forms a major J>OI'tion oxygenated blood from as the ligamentum teres) of che liver
Umbilical ' 'tin
SAADDES
Opening between the right
and left atl'ia
pulmonary circulatory
system
septum
Closes sho11ly after birth. atrophies,

and become$ the ligamentum
arteriosum
Ductus arterio.sum
Between the pulmonary

tmnk and the ao11ic arch
A shunt to bypass the

pulmonary circulatory
system
Umbilical arteries
Arise$ from internal i1iac

arteries: associated with the
umbilic.al co1d
r ranspons blood from Atrophy to become the me-dial

the fen1s to the placenta umbilical ligaments
The medial umbilical ligament should not be confused wit h the median umbilical
ligament, a different structure that represents the remnant of the embryonic urachus.
The paired umbilical arteries arise from the iliac arteries. They supply deoxygenated
fetal blood to the placenta.
FETAL CIRCULATION
SAADDES
3151
vein
veins
The exchange of gases in the lungs takes place between the alveoli and the:
bronchial arteries
pulmonary veins
pulmonary arteri es
capillaries
SAADDES
316
ANATOMIC SCIENCES
capillaries
Unlike the arteries and veins, capillaries are very thin and fragile. The capillaries are actually
only one epithelial cell thick. They are so thin that blood cells can only pass through them in
single file. The exchange of oxygen and carbon dioxide takes place through the thin capillary
wall.
Arteries and veins run parallel throughout the body with a web-like network of capillaries,
embedded in tissue, connecting them. The arterioles pass their oxygen-rich blood to the
capillaries, which allow the exchange of gases within the tissue. The capillaries then pass their
waste-rich blood to the venules for transport back to the heart.
( ump.lnson uf \
\rtl'nrs..n1d CapJII:.uil'!li
Arteries
Capillaries
Veins
SAADDES
Blood direction
From heart
Join arterioles to venules
To heart
Thin elastic
Muscle layer
Thick elastic
None
Semilunar valves
None
None
Present
Pressure
High with pulse
Less, no pulse
Very low with pulse
Oxygen concentration
Oxygenated
Mixture
Deoxygenated
Differences in blood pressure are reflected in vessel structure:

Arteries: thick, muscular walls to accommodate the flow of blood at high speeds and pressures
Arterioles: thinner walls that constrict or dilate as needed to control blood flow to the capillaries.*** Remember: The greatest blood pressure drop occurs across the arterioles.
Capillaries: walls composed of only a single layer of endothelial cells
Venules: receive blood from capillaries; wall s thinner than those of arterioles
Veins: thinner walls but larger diameters than arteries; maintain low blood pressure required for return to heart
SAADDES
Capillary bed
316-1
Capillaries
SAADDES
Smooth muscle cells
Smooth muscle cells

316 A I
veins
All of the following nerves are embedded in the lateral wall of the cavernous
sinuses EXCEPT one. Which one is the EXCEPTION?

ophthalmic nerve (CN Vl )
SAADDES
oculomotor nerve (CN Il l)

maxillary nerve (CN V2)
mandibular nerve (CN V3)
317
ANATOMIC SCIENCES
mandibular nerve (CN V3)

The two cavernous sinu ses are large veins lying w ith in the skull cavity, immediately
behind each eye socket and on either side of the pituitary gland. They connect with the
veins of the face and those of the brain. These sinuses empty by way of the superior
pet rosal sinuses into the transverse sinuses that continue as the sigmoid sinuses. The
sigmoid sinuses end at the jugular foramen by becoming the internal jugular vein s.
These sinuses are also emptied by the inferior petrosal sinuses that drain into the
internal j ugular veins. Because the veins of the head do not have valves, b lood from the
cavernous sinuses can also drain anteriorly into the ophthalmic veins.
The cavernous sinus is an important structure because of its location and its contents. This
sinus carries in its lateral wa ll the th ird crania l (oculomotor) nerve, the fourth cranial
(trochlear) nerve, and parts 1 (the ophthalmic nerve) and 2 (the maxill ary nerve) of the fifth
cranial (trigeminal) nerve.
SAADDES
Remember: The internal carotid artery and the abducens nerve (CN VI) pass through
the sinus.
1. A cavernous sinus thrombosis can be caused from an odontogenic infection
' that communicates with the cavernous sinus through the ophtha lmic veins.
2. The cavernous sinus syndrome is characterized by edema of the eyelids and
the conj unctivae of the eyes and paralysis of the cranial nerves that course
through the cavernous sinus.
3. The orbital cavity is drained by the superior and inferior ophthalmic veins.
The superior ophthalmic vein commun icates in front w ith the facial vein. The
inferior opht halmic vein communicates through the inferior orbital fissure w ith
the pterygoid venous p lexus. Both veins pass backward through the superior
orbital fi ssure and drain into the cavernous sinus.
Superior
Supraorbital trochlear
Cavernous
Maxillary
Superficial
temporal
SAADDES
vein
Common
facial
vein
Veins of the head: overview. The superticial veins of the head communicate w ith each other and w ith
the dural s inuses via the deep veins of the head (pterygoid plexus and cavemous sinus). The pterygoid
plexus connects the facial vein and the retromandibular vein (via the deep facial vein and maxillary vein,
respectively). 1l1e cavernous sinus connects the facial vein to the sigmoid sinus (via the ophthalmic veins
and the petrosal sinuses, respectively).
317-1
Reproduced wilh pcnnission from Shu<'nkc M. Schullc E. ScbunUlch U: Head and Noc:k Anatomy for lknttll
Thiem<' Medical Publish<'rs.
New York, 2010.
veins
Which oft he following veins are found within the marrow spaces oft he skull?
cerebral venules
diploic veins
emissary veins
SAADDES
brachiocephalic veins
318
ANATOMIC SCIENCES
diploic veins
The dural sinuses are large, endothelium-lined venous channels situated between the
two layers of dura mater, the peri osteal and t he meningeal layers. The dural sinuses
are devoid of va lves and are part of t he venous system ofthe dura mater. Major cranial
sinuses include a postero-superior group, at the upper and back part of the skull
(such as superior sagittal, inferior sagittal, straight, transverse, and occipital) and an
antero-inferior group, at the base of the skull (such as cavernous, petrosal, and basilar plexus).
Important: The veins of the brain are direct tributari es of the dural venous sinuses.
SAADDES
1. The emissary veins, w hich are valveless, connect the dural venous sinuses
w ith the veins of the scalp.
2. An emissary vein, found in the foramen ovale, is a means of
commun ication between t he pterygoid plexus and t he cavernous sinus.
3. The diploic veins are found in the skull, and drain the diploic space. This is
found in the bones of t he vault of the skull, and is the marrow-containing
area of cancellous bone between the inner and outer layers of compact bone.
The diploic veins drain th is area into the dural venous sinuses.
4. The internal jugular vein begins in the jugular foramen as a continuation
of the sigmoid sinus. This vein descends in the carotid sheath and ends in
the brachiocephalic vein. It receives blood from the brain, face, and the
neck.
5. Generally, the veins of the head and neck do not have valves.
vein
SAADDES
sinus
Dural Sinuses of th e Dura Mater
318-1
pmus.noo from
Ci111t.ti Atl.uo(ANJ/Oifll.
II ; Pbdaddphta. 200S. Upptni;on\\IIIWI'IJ& \\llkaos.
veins
Which of the following veins join within the parotid gland to form the retro mandibular vein?
the facia l and maxillary veins

the facia l and superficial temporal veins
SAADDES
the maxillary and superficial temporal veins

the facia l and mandibular veins
319
ANATOMIC SCIENCES
the maxillary and superficial temporal veins

The facial veins, coursing with or parallel to the facial arteries, are valveless veins that provide the primary superficial drainage of the face. Tri butaries of the facial vein include the deep facial vein,
which drains the pterygoid venous plexus of the infratemporal fossa.
The facial vein is a continuation of the angular vein past the inferior margin of the orbit. Inferior to
the margin of the mandible, the facial vein is joined by the anterior (communicating) branch of the
retromandibular vein.The facial vein drains directly or indirectly into the internal jugular vein opposite or inferior to the level of the hyoid bone. Note: The angular vein commu nicates with the superior ophtha lmic vein throug h the nasofrontal vein, thus establishing an important anastomosis
bet ween the anterior facial vein and the cavernous sinus.
1. The pterygoid venous plexus is a venous network associated with the pterygoid
muscles. Its posterior end is drained by the maxillary vein. The following venous channels
have direct connections with the pterygoid venous plexus - the maxillary, deep facial,
infraorbital, and posterior superior alveolar veins.
2. The maxillary vein is a short vessel that drains the posterior end of the pterygoid
venous plexus. This vein runs backward with the maxillary artery on the medial side of the
neck of the mandible and joins the superficial temporal vein within the parotid gland,
to form the retromandibular vein.
3. The retromandibular vein runs posterior to the ramus of the mandible within the
substance of the parotid gland, superficial to the external carotid artery and deep to the
facial nerve. As it emerges from the inferior pole of the parotid gland, it divides into an
anterior branch that unites with the facial vein and a posterior branch that joins the
posterior auricular vein inferior to the parotid gland to form the external jugular vein.
This vein passes inferior and superficially in the neck to empty into the subclavian vein.
4. Remember: The internal jugular vein descend s through the neck within the ca rotid
sheath and unit es behind the sternoclavicular joint with the subclavian vein to form the
brachiocephalic vein. The brachiocephalic veins (right and left) unite in the superior
mediastinum to form the superior vena cava, which return s blood to the right atri um of
the heart.
SAADDES
Parietal tributary of s uperficial

temporal vein
Superior and Inferior
ophthalmic veins
Superficial temporal vein
Middle temporal vein

Pterygoid venous plexus
External nasal vein
SAADDES
Superior labial vein
Subclavian vein
Lateral view
Veins of tb e Face and Scalp

Reproduced With
&W1Lions.
from
KL. Dallcy AF.Ag_ur AMR. Cltf11'4 al Odr ntedAnatmff), ed 6:
:WIO. L!ppuK'ott Wdhams
veins
Which of the following are considered to be primary resistance vessels?
large arteries
arterioles
capillaries
large veins
venu les
SAADDES
320
ANATOMIC SCIENCES
arterioles
Special feat ures Thick. diste.nsible walls;

large radii
FunctiOn$
Passageway from heart to
Highly
Thin walle-d. large
wdl
innervated walls.
small radii
art"a
Rdativdy thin. nexiblt walls;
total <.-ross-sectional large radii
Passageway 10 heart from

Primary resistance
Blood and tissue
ves..o:d s; dettnnine
tissue.s; blood n:servoir
exchange
distribution of cardiac- gases and
output
metabolites;join
arterioles to venules
SAADDES
tissues; prt-S..'>urc rcst.rvoir
Remember:
1. Veins have thinner walls than a rteries but have larger diameters because of the
low blood pressures required fo r venous return to the heart.
2. Valves in the veins of the neck, arms, and legs preve nt venous backfl ow.
3. Important: With the exce ption of the pulmonary vessels and certain fetal vessels,
arteries transport oxyge nated blood, and veins transport deoxygenated blood.
4. Venules continue from capillaries and merge to form veins.
5. Blood volum e is not evenly distributed among the different types of vessels. Due to
the expanda ble properties of veins, a vein will stretch about eight times mo re than an
artery of corresponding size. At rest, the venous syste m thus contains about 65 to 70
percent of total blood volu me, with the heart, a rteries, and ca pillaries containing 30
to 35 percent of total blood volume.
veins
At the level of the inferior border of the 1st right costal cartilage, the brachiocephalic veins unite to form the:
external jugular vein

internal jugular vein
SAADDES
retromandibular vein
superi or vena cava
subcl avian vein
tho racic duct
321
ANATOMIC SCIENCES
superior vena cava

The t wo largest veins in the body are the superior and inferi or vena cavae, which d rain into the heart from
above and below, respectively. The great veins of the neck are all derivatives from the superi or vena cava .
The superior vena cava is a large, yet short vein that returns blood from all structures superior to the d iaph ragm, except the lungs and heart . It passes inferiorly and ends at the level of the 3rd intercostal cartilage, where it ent ers the right atrium of the heart.
There are three main veins in the neck, the external, anterior, and internal jugular veins.
The external jugular vein (EJV) begins near the angle of the mand ible (just inf erior to the auricle) by
the union of the posterio r d iv ision of the retromandibular vein w ith the posterior auricular vein. It descend s to the inferior part of the lateral cervical region and t erminates in the subclavian vein. It drains
most of the scalp and side of the face.
Most veins in the anterior cervical region are tribut aries of the internal jugular vein (IJV), typically the
largest vein in the neck. The internal j ugular vein d rains blood from the brain, anterior face, cervical v iscera, and deep muscles of the neck. It commences at the jugular foramen in the posterior cranial fossa
as the d irect continuation of the sigmoid sinus. Note: Posterior to the sternal end of the clavicle, the IJV
merges w ith the subclavian vein to form the brachiocephalic vein.
The anterior jugular vein (AJV) is usually the smallest of the j ugular veins. The AJV typically arises
near the hyoid from the confluence of the superficial submandibular veins. At the root oft he neck, the
AJV turns laterally, posterior t o t he sternocleidomastoid muscle, and opens into the termination of the
EJV o r into the subclavian vein. Note: Superior t o the manubrium, the right and left AJVs commonly
unit e across the midline to form the jugular venous arch in the suprasternal space.
SAADDES
1. The brachial, basilic, and cephalic veins drain the upper li mbs; these veins d rain into the axillary vein. The axillary vein end s at the lateral border of the 1st rib, where it becomes the subclavi an vein.
2. The femoral vein d rains the lower limb, becoming the external iliac vein as it enters the trunk,
w here the vein is j oined by the internal iliac vein from the pelvis to become the common iliac
vein.
3. The inferior vena cava begins anterior to the LS vertebra by the union of the common iliac
veins.
4. The left suprarenal vein and left gonadal vein drain int o the left renal vein. The left renal vein
then drains into the inf erior vena cava. In contrast, the right suprarenal vein and gonadal vein
d rai n d irectly into inferior vena cava.
SAADDES
1--lif---C>mmunicating branch
vein {IJV)
Subclavian vein
Superficial veins of the neck. The s uperficial tem1>0ral and maxillary veins merge, fanning the retromandibular vein, the posterior division of which unites with the posterior auricular vein to form the EJV.
The facial vein receives the anterior division o f the rehomandibular vein before emptying into the internal
jugular vein, deep to the SCM. The anterior jugular veins may lie superficial or deep to the investing
layer of the deep cervical fascia.
321 1
wath pcm1ission (rom Moore KL. Dalley Af. Ag_ur AMR: Clinia1l Oriented
&Walkins.
t!(/6: Balt1morc. 2010. lippinoou Williams
External acoustic meatus
Superior }
T hyroid vein
SAADDES
Pltr--f--- - -Middlo
Left brachiocephalic vein

Sternoclavicular joint
Superior vena cava
Internal jugular vein. The IJV is the main venous structure in the neck. It originates as a continuation
o f the S-shaped sigmoid (dural venous) sinus. As it descends in the neck, it is contained in the carotid
sheath. It terminates at the Tl vertebral level, su1>erior to the stemoclavicular joint, by uniting w ith the
subclavian vein to form the brachiocephalic vein. A large valve near its termination prevents re flux of
blood into the vein.
321A I
Reproduced wath pcm1ission from Moore KL. Onllcy AF, Agu.rAMR: ClinictJI Oriented
&Walkins.
e(/6: Bahm1orc. 2010.lippinoou Willinms
veins
Because the facial vein and its tributaries have no valves extracranial infections arising within an area bounded by the bridge of the nose and the angles of the mouth (danger triangle of the face) will reach which of the
following sinuses?
cavernous sinus
SAADDES
sigmoid sinus
inferior petrosal sinus
superior petrosal sinus
322
ANATOMIC SCIENCES
cavernous sinus
The superior ophthalmic vein communicates in front with the angular vein. The inferior
ophthalmic vein communicates th rough the inferior orbital fissure with the pterygoid
venous plexus. Bot h veins pass backward through the superior orbital fissure and drain
into the cavernous sinus.
***The facial vein has no valves, and a backflow can cause an infection to get into the
dural sinuses, through the deep facial vein (wh ich drains the pterygoid venous p lexus
of the infratempora l fossa) and the superior ophthalmic vein (via the cavernous sinus).
Important: Danger triangle of the face - a triang le exist s t hat approximately covers the
nose and maxilla and goes up to t he region bet ween the eyes. Th is is an area in wh ich
superficial veins co mmunicate with the dural sinuses.
SAADDES
Anastomoses to remember:
1. Deep facial vein is a communication between the facial vein and the pterygoid
venous plexu s.
2. Superior ophthalmic vein communicates anteriorly w ith t he angular vein, thus
establishes an important anastomosis between the anterior facial vein (a direct continuation of t he angular vein) and the cavernous sinus.
The venous drainage of the su perficial parts of the scalp is th rough the accompanying veins
of the scalp arteries, the supraorbital and supratrochlear veins. The superficial temporal veins and posterior auricular veins drain the scalp anterior and posterior to the auricles, res pectively. The posterior auricular vein often receives a mastoid emissary vein
from the sigmoid sinus, a dural venous sinus. The occipital veins drain the occipital region
of the scalp. Venous drainage of deep part s of the sca lp in t he temporal region is through
deep temporal veins, which are tributaries of the pterygoid venous p lexus.
veins
Which dural venous sinus lies in the convex attached border of the falx
cerebri?
cavernous sinus
transverse sinus
SAADDES
superior sagittal sinus

straight sinus
323
ANATOMIC SCIENCES
superior sagittal sinus

The dural venous sinuses are endothelial-lined spaces between t he periosteal and meningeal layers of
the dura. La rge veins from the surface ofthe brain empty into these sinuses and most of t he blood from the
brain ulti mately d rains through them into the internal jugular veins.
The superior sagittal sinus lies in the convex attached border oft he falx cerebri. lt begins at the crista galli
and ends near the internal occipital protuberance at the confluence of sinuses.
Note: Arachnoid granulations are found in t he superior sagittal sinus. They are responsible for reabsorbing CSF into the venous circulation.
Confluence of the sinuses is the connecti ng point of the superior sagittal sinus, straight sinus, and occipi tal sinus. It is found deep to the occipital p rotuberance of t he skull. Blood arriving at this point then
proceeds to d rain into the left and right transverse sinuses.
The inferior sagittal sinus is much smaller than the superior sagittal sinus. It runs in t he inferior concave
f ree border of the falx cerebri and ends in the straight sinus.
The straight sinus is formed by the union of the inferior sagittal sinus w ith t he great cerebral vein. It runs
inferoposteriorly along the li ne of attachment of the falx cerebri to t he tentorium cerebell i, where it joins
the confluence of sinuses.
The cavernous sinu ses are found on either side of the body of the sphenoid bone in middle cranial fossae. These sinuses receive b lood from t he sphenoparietal sinuses that are l ocated underneath the f ree
edges of t he lesser w ings of t he sphenoid bone. Blood al so d rains into t he cavernous sinuses via the superior and inferior ophthalmic veins. The cavernous sinuses d rai n posteroinferiorlyth rough t he superi or and
inferio r petrosal sinuses and emissary veins to the basilar and pterygoid plexuses.
The superior petrosal sinu ses are l ocated in t he edge of t he tentorium cerebelli on t he ri dge of t he
petrous part of the temporal bone. These sinuses d rai n into t he transverse sinuses.
The inferior petrosal sinuses are found at the base of the pet rous part of the temporal bone in the posterior cranial fossae w here these sinuses empty into t he internal j ugular vein.
The basilar sinus interconnects w ith inferi or petrosal sinuses and t he internal vertebral pl exus.
The transverse sinuses extend laterally from the confluence of sinuses in the tentorium cerebelli. The
transverse sinuses t ravel ventrally to become the sigmoid sinuses of each side.
The sigmoid sinuses bend into an $-shaped curve and continue into the internal j ugular vein through the
jugular foramen.
The occipital sinus is located in t he posteri or attached border of the falx cerebelli . This sinus communicates superiorly with the confluence of sinuses and inferiorly w ith t he internal vertebral pl exus.
SAADDES
SAADDES
Dural infoldings and dural venous sinuses. Venous sinuses of the dura mater and their communications are demonstrated.
323 1
Reproduced wath pcm1is.sion (rom Moore KL. Dnllcy AF, AgurAMR: Cli11ical Oriented
& Walkins.
ed 6; Balumorc. 2010.lippincou Willituns
veins
All of the following are characteristic features of veins EXCEPT one. Which
muscular tun ica media

thick tunica adventitia
SAADDES
larger lumen
valves
vasa vasorum
324
ANATOMIC SCIENCES
mu scular tunica media

***Veins have a thin tunica med ia with few muscle fibers.
Characteristics
Arteries
Large (e.lastic arterie$)
Small (muscular
Arterioles
Capillaries
Venules
Veins
Vel'y thick tunica media that contain a lot o f elastic fibers and some
smooth muscle fibe rs
Tunica media
fi bers
of almost entire.ly smooth muscle cells with few
Small vesse.ls (diameter < 0.5 mm), smaH lumen, thicker tunica media
with a lot of smooth muscle fibers
Small vesse.ls (0.0 I d iamete.r). walls have. endotheliallayel' only
SAADDES
Small vesse.ls; walls have. endothelium and very thin tunica adventitia;
larger venules have thicker tunica adventitia
Thin tunica media with few smooth muscle
thick tunica adventitia
with little elastic

larger lumen and thinner walls than the arteries
they
some contain valve-$ and vas.a
(nutrient blood
vesse.ls that supply the walls o f large veins)
Remember:
1. Arteries and veins (and lymphatics) have three coats or tunicae - tunica intim a, tunica
media, and tunica adventitia.
2. Arteries have both elastic and muscle fibers in their walls, which allow them to pro pel
blood throughout the cardiovascular system.
3. Vein s have thinner wall s than arteries and a re d istinguished by valves, which p revent
the backflow of blood.
4. As simple endothelial tubes, capillaries are the smallest blood vessels and provide the
linkage between the smallest arteries (arterioles) and veins (venules).
5. Veins a re more compliant than arteries which means they a re more capable of adopting their lum en size with changes in blood volum e inside their lum en.

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lymphatic system

efferent lymphatic vessels

both afferent and efferent lymphatic vessels

neither afferent o r efferent lymphatic vessels

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afferent lymphatic vessels

Area draining to right

Right and left

lymphatics and capil laries

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lymphatics and veins

The Lymphatic System

lymph nodes, thymus

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bone marrow, thymus

' -- - - - Thyroid gland

deep cervical nodes

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deep cervical nodes

Some regional groups of lymph nodes:

Thieme. New York. 20 I0.

inner medullary region

Irefer to card 1-1for illustration!

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left internal jugular vein

superior vena cava

junction of the right internal jugular and subclavian veins

Irefer to card 1 A-I, 2-1for illustration!

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removal of old or defective blood cel ls from blood

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forming crypts that trap bacteria

1. Infectious mononucleosis: is a common, acute, usually self-limited infectious disease

lingual tonsils only

palatine tonsils only

pharyngeal and palatine tonsils

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lingual and palatine tonsils

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150,000300,000 Small cellular fragments

Lobed nucleus, fine granules

Part of the immune system

Lobed nucleus, red or yellow

Obscure nucleus, light purple

May phagocytize AbAg

Phagocytosis, differentiate into tissue

Ruffied membrane, cytoplasm

Round nucleus, liulc cytoplasm Produce Abs, destroy specific target

are biconcave in shape

rely completely on anaerobic metabolism

are disposed of by the spleen

have an average lifespan of 30 days

white blood cells

(number per cubic mm)

serum is yellow; plasma has no color

plasma contains clotting proteins; serum does not

plasma contains clotting proteins; serum does not

Metabolic end products

they are covered by d isks

they are covered by perichondrium

most of them are covered by hyaline cartilage

3. Diarthrosis - freely movable joint (synovial joint).

Synovial (joint capsule containing a synovial membrane that secretes a synovial