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ANATOMIC SCIENCES

REVIEW
FACIAL VEINS
LYMPH

USC messed up the following questions:


1979 Q79 (all of these structures pass through the diaphragm)
1989 - The one about which is not a branch of Celiac or its branches. It says Left gastroepiploic, answer is inferior pancreaticoduodenal.
Questions I just didnt include:
1982 Q92

CELLS
- Components of cells
o Plasma MB:
Dynamic, selectively permeable MB enclosing the cytoplasm
Between cell wall & cytoplasm
Composition:
Lipids (phospholipids, cholesterol, glycolipids)
o Cholesterol increases mechanical stability; also decreases MB fluidity, but prevents freezing
o Increasing unsaturated FAs increases fluidity
Proteins (integral MB proteins & peripheral MB proteins)
o All transport proteins are integral MB proteins
One layer of charged lipids on either side of a layer of neutral lipids
Cell coat and microfilaments are attached to the cell membrane (golgi complex is not)
o Cell Wall:
Protects the cell from changes in osmotic pressure
Anchors flagellae
Maintains shape
o Fluid stuff:
Protoplasm:
Viscous, translucent, watery material that is a primary component of animal cells
Contains large % water & inorganic ions (K+, Ca2+, Mg2+, Na+) & naturally occurring organic compounds (e.g., proteins)
o Irritability
Property of protoplasm responsible for cell being sensitive to a stimulus
Nucleoplasm:
Protoplasm of the cell nucleus plays part in reproduction
Communicates with the cytoplasm by way of nuclear pores
o Molecules < 40kD can diffuse freely between nucleoplasm & cytoplasm thru the pores
Cytoplasm:
Protoplasm of the cell body that surrounds the nucleus, converts raw material into energy
Site of most synthesis activities
Contains cytosol (viscous, semitransparent fluid that is 70-90% water), organelles, and inclusions (metaplasm)
Metaplasm:
Name given to lifeless material stored in cytoplasm
EX: glycogen (an example of a cytoplasmic inclusion), fat deposits, pigment granulesincluding lipofuscin (yellowish-
brown substance that in quantity as cells age), and melanin (abundant in epidermis of skin & retina)
o Lipofuscin is the wear & tear pigment
o Microtubules:
Specialized type of filament composed of polymerized tubulin (protein)
Cylindrical hollow structures in the cytoplasm of all eukaryotic cells
Provide support and assist in cellular locomotion
Flagella and cilia
o Flagella:
Present in humans only in the spermatozoa
Core composed of microtubules
9 double circumferential microtubules and 2 single centrally located microtubules
Much longer than cilia
Move w/ an undulating snake-like motion
o Cilia:
Short, hair-like projection from the cell MB
Beat in coordinated waves
Core composed of microtubules
9 double circumferential microtubules and 2 single centrally located microtubules
9 + 2 arrangement of microtubules
o Similarities between Flagella and Cilia:
Nine sets of doublets, two singlets in center
Basal body
Essential to function of cilia and flagella
From the basal body, fibers project into the cytoplasm, possibly to anchor the basal body to the cell
Move by contraction of tubular proteins
o Axoneme:
Characteristic 9+2 pattern
Peripheral pairs share common wall of 2-3 protofilaments
Central pair of tubules are separated from one another and are enclosed w/in a central (single) sheath. Doublets and
central sheath linked by nexins
o CenTRIoles:
Nine sets of triplets
The microtubule organizing center of the cell
o Centrosomes:
Contain centrioles
o Microfilaments:
Much smaller than microtubules and have contactile and structure groups
Contractile is made up of
o Double-stranded helices of polymerized actin
o Actin and myosin
Structural is made up of
o Tonofilaments support the cell and provide attachments for Desmosomes, which anchor contigous cells, and
terminal webs , which anchor microvilli
What layer are they found in???? are they used in hemidesmosomes at the basal layer = stratum germ/basale,
Im going with Spinosum?
They are found in ALL layers except for corneum This test Sucks!
Involved in local movement, by sliding filament movement (as in muscle fiber microfilaments)
o Microvilli:
Think Microvillaments
Core of microfilaments
Intestines
Primary purpose is to increase functional surface area (not flagella or cilia)
o ***Hey: Microvilli have microfilaments; Cilia have microtubules dont screw it up!!!
o Stereocilia:
Long, nonmotile microvilli that cover the free surface of some of the pseudostratified columnar epithelium which
line the inside of the Epididymis
S for Sex and Stereocilia
Different from Cilia in that they are Nonmobile and have microvilli (microvillaments) NOT microtubules
Facilitate the passage of nutrients from the epithelium to the sperm by increasing the epitheliums surface area
Also present in the ductus (vas) deferens, which is also lined with pseudostratified epithelium
o Intermediate filaments:
Rope-like filaments that function in structural roles
o Barr body:
Sex chromatin body
Genetic activity of both X chromosines is essential only during the first weeks after conception
Later development only requires one functional X
Inactivated X chromosome appearing in dense chromatin mass attached to nuclear MB of normal female
Absent in normal males
If a male has a barr body, then he has Klinefelters (XXY)
Sex of embryo determined if Barr body presence as early as eight weeks
Important in recognition in epi cells because it tells us sex
o Cytoskeletal elements:
Form network of protein structures
o Nucleus
DNA is found principally in the nucleus
Feulgen Reaction test to distinguish beween DNA and RNA
Tells us what the Nucleus is FEUL full of
o Nucleolus:
Site of rRNA synthesis (not DNA, tRNA, or mRNA)
NOTE: rRNA is the most abundant RNA in the cell
NOT bound by a membrane (unlike nucleus, lysosome, mitochondrion, & pinocytotic vesicle)
o Ribosomes:
Site of protein synthesis
All protein synthesis begins on free polysomes
o Smooth ER (ribosomes are absent):
Steroid synthesis (vs. Protein Synthesis for RER)
The Q reads: Smooth ER predominates in steroid producing cells, but not in protein producing cells
Protein synthesis for use inside the cell
Intracellular transport
Detoxification reactions (hydroxylation & conjugation)
Glycogen degradation & gluconeogenesis (glucose-6-phosphatase is an integral MB protein of the SER)
Lipolysis begins in the SER
Production of bile salts (when in hepatocytes)
***Hepatocytes & steroid hormone producing cells of adrenal cortex are rich in SER
o Rough ER (ribosomes are attached):
Protein synthesis for use outside the cell aka, site of synthesis of secretory proteins
Also site of N-linked oligosaccharide addition to many proteins
Think Osteoblasts
Associated with RNA repeated again & again & again on tests (rRNA)
*Cytoplasmic RNA is localized in granular endoplasmic reticulum
Has regions that are smooth in appearance called transitional elements
***Mucus-secreting goblet cells & Ab-secreting plasma cells are rich in RER
Active cells characterized by an abundance of rough ER (fibroblasts, osteoblasts)
o Golgi apparatus:
Flat, membranous sacs or cisternae arranged in stacks (the stacks are called dicytosomes) w/ two poles
The cis face receives material
The trans face is for transportation function
Packages, stores, modifies & sorts products post-translational
Packages secretory material and forms lysosomes
Forms glycoproteins for extracellular use
Proteoglycan assembly from proteoglycan core proteins
Modifies N-oligosaccharides on asparagine
Adds O-oligosaccharides to serine & threonine residues (O-linked glycosylation)
Procollagen filaments formed here from polymerization of amino acids!!!!!
Polymerization of molecules into collagen fibrils occurs in the Golgi
o Lysosomes:
Cytoplasmic MB-bound vesicles containing glycoprotein hydrolytic enzymes that digest & destroy exogenous material
Lysosomes deal w/ biochemical breakdown & phagocytosis in the oral region
Are formed in the Golgi apparatus (they bleb off of it)
Are called to action when the cell produces too much proteins
o Peroxisomes:
Contain oxidases, enzymes capable of reducing oxygen to hydrogen peroxide and hydrogen peroxide to water
Bile acid synthesis occurs in peroxisomes
o Vacuoles:
Store & excrete various substances w/in the cytoplasm
o Glycosomes store sugar (found in liver)
o Mitochondria:
Threadlike structures w/in the cytoplasm that provide ATP
Similar to bacteria in shape & size
Reproduce by dividing (also like bacteria)
The most important organelle or component of a cell for oxidative processes = mitochondrion
Contain a double MB (inner & outer MBs)
Outer MB:
o Smooth, continuous, permeable
o Contains a lot of porin (integral MB protein that forms channels in the outer MB)
Inner MB:
o Impermeable to small ions (due to high content of cardiolipin)
o Enzymes for ETC & Oxidative Phos are embedded in the inner MB
Both mitochondria and nucleus have double-unit membrane (not lysosome, Golgi complex, or rough ER)
Maternal DNA Link
Contains cyclic DNA
Crista of the Mitochondria
Stores and provides more surface area for chemical reactions to occur (Protein NZs)
- Embryonically early cell types/forms:
o Mesenchymal cells (mesoblastic cells)
Potential to proliferate & differentiate into diverse types of cells
Form a loosely woven tissue called mesenchyme or embryonic CT
o Mesectoderm (ectomesenchyme)
Derived from ectoderm, especially from the neural crest in the very young embryo
The primary source of cranial connective tissue cells is the ectomesenchyme
o Neural crest cells:
Give rise to spinal ganglia (dorsal root ganglia) and the ganglia of the ANS
Give rise to neurolemma cells (Schwann cells), cells of the meninges that cover the brain and spinal cord, pigment cells
(Melanocytes), chromaffin cells of adrenal medulla and several skeletal and muscular components of head
o Fetus Blood Cells
Developing fetus blood cells are found in the red bone marrow, liver, spleen, and lymph nodes
- Important CellsFunction or Location
o Macrophagephagocytosis, defense against bacterial infection
Activated by gamma-IFN
Can function as APC
Kupffer cellliver
Dust cells/alveolar Macrophages-lungs
Langerhans- skin/dermis
Mesangial-kidneys
Microglia-CNS
Osteocytes-bone
Epitheloid- granuloma
Splenocytespleen
Histiocyteloose CT
o Mast Cellsmediators of inflammation on contact w/ antigen, same as Basophil in that it secretes Heparin & Histamine
Mediates allergic reaction involved in type I hypersensitivity reactions
o Schwannform myelin sheath around axons of PNS
Derived from neural crest cells
o Sertoliproduce testicular fluid (not testosterone)
o Leydigproduce testosterone
o Fibroblastproduces collagen and reticular fibers, most common cell of CT
o Osteoblastforms bone matrix and gives rise to osteocytes
o Sustentacular (supporting) cellinternal ear (organ of Corti), taste buds, olfactory epithelium. They are the taller cells on
the basement epithelium.
o Pyramidalcerebral cortex (cerebrum)
The pyramids contain upper motor neuron fibers only
o Endotheliallining blood and lymph vessels, endocardium inner layer
o Ependymallining brain ventricles and spinal cord
o Ganglionicin the ganglion of peripheral to CNS
o Globulartransitional epithelium (kidney, ureter, bladder) Transitional epithelium (also known as urothelium) is a type
of tissue consisting of multiple layers of epithelial cells which can contract and expand.
o Pricklestratum spinosum of epidermis
o Chromaffinadrenal medulla and paraganglia of Symp NS
o Purkinjecerebellar cortex (cerebellum)
o Claraterminal bronchioles, Clara cells are dome-shaped cells with short microvilli found in the small airways
(bronchioles) of the lungs.
o Goblet cellsmucous MBs of female reproductive tract, respiratory tract, and intestines
o InterstitialCT of ovary and testis
o Isletpancreas
o Juxtaglomerularrenal corpuscle of kidney
o Hepatocyteliver
- Cell replication:
o Chromosomes:
= DNA + protein (histones)
Appear as chromatin granules called chromatids, attached to centromeres when replicating
o Chromatin:
A complex of DNA & proteins (the proteins are either histone proteins or non-histone proteins)
Histone proteins:
o (+) charge-d proteins enriched w/ lysine & arginine
o Involved in DNA packaging
Non-histone proteins:
o Enzymes invovled in nuclear functions such as replication, transcription, & DNA repair
Is the cell component that is genetically continuous from one generation to the next (not nuclear membrane or golgi
complex)
o Euchromatin: (Eu means Good and Loose!!) Truly transcribed.
Loose form of DNA & transcriptionally active
o Heterochromatin:
Highly condensed & transcriptionally inactive
Almost the entire inactive X chromosome somatic cells in a woman is in this form
o Mitosis:
Splitting of nucleus & cytoplasmtwo diploid (daughter) cells w/ identical genetic constitutions
Keeps the same 2N (diploid) the Q reads: The diploid number of chromosomes is perpetuated in somatic cells by a
process of mitosis
M phase mitosis (karyokinesis) division of the nuclear parts of cell (no protein synthesis)
See Below (PMAT)
Cytokinesis division of the cytoplasm, accompanies mitosis
Interphase (inactive phase) period between one mitosis and the next
o G1 phase 1st growth phase
By far the most variable cycle period timewise among different types of cells
o S phase when DNA is replicated
o G2 phase 2nd growth phase
o
Four active phases:
Prophase
o Gradual coiling up of chromatin in nucleus
o Individualization of chromosomes, initiation of mitotic spindle w/ centriolar duplication
o Phosphorylation of the nuclear lamina during prophase initiates nuclear disassembly
Metaphase
o Disappearance of the nuclear envelope & nucleoli
o Chromosomes line up at the equatorial plate
o Spindle is complete
Anaphase
o The chromosomes split longitudinally and migrate to poles
o Beginning of cell division
Telophase
o Nucleolar restitution w/ nuclear envelope formation
o End of cell division
o # of chromosomes after telophase??? 46?? Only if youre counting PAIRS BEFORE Cytokinesis
Cytokinesis
o Splitting of the cytoplasm
o Occurs right after telophase
o NOT essential for Mitosis to occur
o Meiosis:
Gametes genetic material between homologus chromosomes is intermixed
Two divisions separated by a resting phase
Total of 4 daughter cells, each w/ the original # of chromosomes
Goes to Haploid

CONNECTIVE TISSUE

Types Description & Function Example


Epithelial tissue May be one or several layers thick; lower surface bound to a supportive Outer layer of skin, linings of GI tract,
basement MB of glycoprotein, mitotically active tissue; line all body urinary bladder, ducts and vessels; alveoli of
surfaces, cavities, and lumina and are adapted lungs; and covering of viscera and body
CT Proper Highly vascular (except cartilage); contain considerable intercellular Tendons and ligaments; cartilage and bone,
matrix; mitotically active tissue, support or bind other tissues and provide adipose, blood
metabolic needs
Muscle Limited mitotic activity; fibers are adapted to contract in response to Smooth, skeletal, and cardiac muscle
stimuli; movement of materials through the body, the movement of one
part of the body
Nervous tissue Limited mitotic activity; respond to impulses to and from all body organs Neurons and neuroglia

Classification of Connective Tissue


Connective tissue proper
Loose CT
Dense CT
Regular
Irregular
Specialized CT
Adipose tissue
Blood
Bone
Cartilage
Hematopoietic tissue
Lymphatic tissue
Embryonic CT
Mesenchyme
Mucous CT

CONNECTIVE TISSUE
- CT in general:
o Derived from mesenchyme (mesoderm). Almost all connective tissues (CT) originate from mesoderm; however, some CTs of the
head and neck region derive from neural crest ectoderm.
o Contains more intercellular material than cells
o Most common cells are the fibroblasts & macrophages
- CT Types:
o Dense CT provides tendons & ligaments w/ strong, flexible support; has high [fiber]
Dense regular:
Consists of tightly packed fibers arranged in consistant pattern EXs include tendons, ligaments, & aponeuroses
Dense irregular:
Consists of tightly packed fibers arranged in an inconsistent pattern
Found in dermis, submucosa of the GI tract, fibrous capsules, and deep fascia
o Loose CT (aka areolar CT) contains large spaces separating the fibers & cells, and contains a lot of intracellular fluid
- Collagen Types:
o Type I: most abundant found in dermis, bone, tendon, dentin, fibrous cartilage, fascias, late wound repair. The #1 (most
common) collagen is type I
o Type II: mainly in hyaline & elastic cartilage, vitreous body Type II for 2 eyes (get itthere are 2 Is.)
o Type III: major component of reticular fibers (in skin, BVs, uterus, granulation tissue) think three on the (BV)
o Type IV: found in basal lamina of basement MBs think four on the floor
o Type V: present in fetal MBs Type Five to come Alive
o Type X: epiphyseal plate
- Tendons/ligaments:
o Ligament band of CT (DRCT) that binds bone to bone
o Tendon band of CT (DRCT)that attaches bone to muscle
More specifically, it secures the muscle fascia to periosteum
Aponeurosis = a sheet-like tendon
o ***When a tendon or ligament attaches to bone, the attaching fibers are called Sharpeys fibers (its not just in teeth)
These are the periosteal collagen fibers that penetrate the bone matrix, binding the periosteum to bone
- Fasciculus
o A bound group of individual muscle fibers
o Fasciculi are the bundles of muscle fibers composing the muscle
- Fascia
o Each muscle is surrounded by fascia, which secures the muscle to a tendon
o Composed of dense regular CT (DRCT)
- Intercellular Junctions:
o Six major types of cell junctions in humans:
1) Tight junctions (zonula occludens)(Principle protein; occludins,claudins)
Greatest resistance to substances moving between cells
o Think Keep it tight so nothing gets through
2) Intermediate junctions (zonula adherens) (Principle protein;cathedrins,actin)
Belt-like connects two neighboring cells
3) Desmosomes (macula adherens) (Think macules are spots like macula of the eye or melanotic macule.) (Principle
protein; cathedrins)
Spot-like connects two neighboring cells
o Tonofibrils (tonofilaments) are found in the desmosome (spinosum???)
4) Hemidesmosomes intermediate filaments (Principle protein; integrin)
Spot-like connects plasma MB of an epithelial cell to the underlying basal lamina
o Epithelium anchored to the basal lamina and thus to the underlying CT
Common in stratified epithelium of skin and junctional epithelium of the epithelial attachment
Part of the oral cavity which is directly attached to the periosteum?? Hemidesmosomes to the CT
Bullous pemphigoid:
o Involves disruption of hemidesmosomes & consequent separation of the epithelium from the basal lamina
o Pemphigus: Autoimmunity against desmosomal attachments.

5) Focal contacts
Spot-like connects plasma MB of a fibroblast to the surrounding CT
o Points where actin filaments within the cell are attached to the basal lamina.
o These are dynamica and are important in migration of epithelial cells for wound repair.
6) Gap junctions (principle protein; connexin)
Specialized areas of cell MB connects neighboring cells
Communicating junctions
Organized collections of protein channels that allow ions/small molecules to passively traverse between connected cells
Separate from components of the junctional complex
Exist in all multicellular organisms and in almost all cell types
Some exceptions skeletal muscle (Because you want recruiting ability), RBCs, & freestanding cells such as circulating
lymphocytes
Miscellaneous
Adherens jxns provide strong mechanical attachements bw adjacent cells. They are built from transmembrane proteins
Cadherins and Catenins. Catenins are connected to actin filaments.
Note: One of the oncogenes frequently found with colon CA is mutated version of a protein that usually interacts with
catenins. Loss of functioning adherens may tumor metastasis.
EPITHELIAL TISSUE
- Classified according to cell shape & number/arrangement of cell layers
- Functions of Epithelium:
o Protection, absorption, excretion, and secretion, sensory, transport
- Types of Epithelium:
o Simple squamous epithelium:
Found where diffusion & filtration occur
Endothelium lining BVs & mesothelium lining body cavities
Alveoli of the lungs
o Simple cuboidal epithelium:
Collecting ducts, as well as proximal & distal tubules of the kidney
Thyroid follicles
Respiratory Bronchioles
o Simple columnar epithelium:
Specialized for secretion or absorption
Lines the majority of the GI system
Small & large intestine, gallbladder, & stomach (epi associated with the tubular part of the GI tract)
There is a distinct epithelium change between the esophagus and the stomach.
Uterine epithelium
Salivary gland striated ducts
o Stratified squamous epithelium:
Usually contains cuboidal cells in the deeper layers & squamous cells in the surface layer
This tissue is well adapted for abrasion and protection most resistant to trauma
Broadest classification of epithelium
Found on skin, linings of mouth, oropharynx, laryngopharynx, esophagus (usually not keratinized), anus, and vagina
When it thickens, rete pegs increase in size, and intercellular bridges become more evident
o Stratified cuboidal epithelium:
Ducts of the sweat glands
o Stratified columnar epithelium:
Large ducts of salivary glands
Male urethra
o Specialized EXs:
Pseudostratified ciliated columnar epithelium:
Respiratory Mucous MB of nasal cavity, paranasal sinuses, nasopharynx, trachea, & bronchial tree
o Not the lining of the respiratory bronchioles, which lose their cilia and change to cuboidal and then to
squamous
Parts of the male reproductive tract
Transitional epithelium
Stratified tissue that lines the urinary bladder, ureter, and upper part of the urethra
Contains dome-shaped superficial cells that change form when contracted or stretched
When epithelial cells specialize so that a free border is characterized with the presence of microvilli, then the cell possesses
either a striated or brush border (not pseudopoda or cilia)

Epithelium Cells Function


Simple Squamous Diffusion and filtration
Cuboidal Secretion, excretion, or absorption
Columnar Absorption, secretion, and protection
Pseudostratified Columnar Secretion and transport of particles out of air passages
Stratified Squamous Protection, prevents water loss
Cuboidal Protection and secretion
Columnar Protection
Special stratified: transitional Varies between cuboidal and squamous Permits expansion

- Functions of skin:
o Prevention of body dehydration
o Synthesis of Vit D
o Prevention of pathogen entry
o Regulation of body temperature
- Skin consists of two principle layers:
o Epidermis (outer) consists of stratified squamous epithelium
Develops from embryonic ectoderm
Avascular
Outer cells are dead, keratinized, & cornified
o SIDE BAR: Excessively thickened layer of the straum corneum composed of:
orthokeratin (hyperorthokeratosis): keratin layer without residual nuclei (Normal) and uneven surface (so you need ortho)
parakeratin (hyperparakeratosis): keratin layer with shrunken (pyknotic) residual nuclei (more even surface)
o In denture pt that continually wears them and eroded alveolar bone, the underlying alveolar mucosa is best described as gingival
mucosa becoming orthokeratinized mucosa
- Basement MB:
o Thin structure that attaches epithelium to underlying CT in contact w/ the dividing layer of cells
o Consists of glycoprotein from the epithelial cells and a meshwork of collagenous and reticular fibers from the underlying CT
o Type IV collagen
o Contains Hemidesmosomes
o Consists of:
Basal lamina develops from epithelial cells
Basal epithelial cells are most likely to be in mitosis
Reticular lamina develops from CT
o Lamina Lucida/Densa??????
o Dermis (inner) deeper, thicker layer of the skin
Consists of dense irregular CT
Develops from embryonic mesoderm
Contains
BVs & lymphatics
5 types of nerve endings
o (one Q reads: The dermis contains a wider variety of nerve endings than does the epidermis)
Desmosomes
Mitotic cells
Sebaceous glands
Associated with hair follicles and derived from ectoderm
Not found on palms of hands/soles of feet
Sweat/oil glands and hair follicles
Papillary layer of dermis:
Thin & less fibrous
Has projections (papillae) that extend up toward the epidermal layer (rete pegs)
Finely constructed, thin, loose CT
Contains fibroblasts, mast cells, & macrophages
Elastic fibers are abundant and provide the skin tone
Reticular layer of dermis:
Thick, fibrous, dense irregular CT
Continuous w/ the hypodermis
Reticular fibers are abundant (Type III)
Collagenous fibers & elastic fibers are also present
More fibers & fewer cells than in the papillary layer
o Tissue fluid reaches the epithelium in the skin through the ground substance of CT from capillaries
- Hypodermis:
o Subcutaneous layer found beneath the dermis that binds skin to underlying structures
Connects dermis w/ underlying fascia of muscle:
o Composed of loose areolar CT, adipose tissue and BVs & and lymphatics
Major site of fat deposition (50% of body fat)
The Q actually asks: Where is fat found? & the answer is NOT dermis; submucosa or CT layers are options, which
works for the hard palate (submucosa), but maybe not the skin???
Good blood supply
- Epidermis: (BG Stars Gives Lots of Charity)
o Outermost portion of skin develops from embryonic ectoderm
o 1) Stratum Basale (= Stratum Germinativum):
Least cytodifferentiated
Contains cuboidal or low columnar cells that exhibit lots of mitosis
Contains tonofibrils in the cytoplasm
Melanocytes are located here
Forms epithelial root sheath of hair follicle
o 2) Stratum Spinosum:
= prickle cell layer
Contains cells called Langerhans cells (unknown function perhaps immune response - APCs)
Malpighian layer denotes the stratum basale and stratum spinosum together
In the prickle cell layer of sulcular epi, the space in between cells is occupied by a small amount of tissue fluid, NOT
keratin or capillaries keratin is intracellular, capillaries dont reach here.
THICKEST LAYER??, except for Thick Skin
- The following 3 Layers are NOT present in NON-Keratinized Oral Epithelium
o 3) Stratum Granulosum:
Contain keratohyalin granules in the cytoplasm (not melanin or keratin granules)
o 4*) Stratum Lucidum:
Clear band of cells containing eleidin which is transformed into keratin as this layer becomes part of the stratum corneum
Most prominent in thick skin (palms & soles)
Absent in the thin skin and (orthokeratinized oral mucosa, which is thin skin)
NOT present in the oral cavity
o 5) Stratum Corneum:
Composed of closely packed dead cells filled w/ keratin
Thickest stratum corneum is found in the palm
Aka horny layer
- Some cells of epithelium
o Keratinocyte:
Cell type most common in epidermis of skin
Specialized to produce keratin (a protective protein)
Tonofibrils & desmosomes are especially well developed in keratinocytes
o Melanocytes: produce melanin
o Langerhans cells: antigen presenting cells, part of immune system
o Merkel cells: associated w/ nerve endings
o Inflammatory cells: lymphocytes, monocytes, neutrophils
- Cutaneous appendages: (see Kaplan in Integument chapter for all the details on these)
o Eccrine (merocrine) sweat glands
o Apocrine sweat glands
o Sebaceous glands
o Hairs
o Nails
- Oral epithelium:
o Some structures found in the oral mucous membrane:
Basal lamina, lamina propria, keratohyaline granules (deeply stained granules in cytoplasm), stratified squamous epithelium
o Covered w/ stratified squamous epithelium
Areas of oral stratified squamous keratinized: gingiva, hard palate (area of mechanical stress)
o Permeabilities of oral mucosa:
Sublingual > buccal > palatal
Is based on relative thickness & degree of keratinzation
EX: sublingual mucosa is relatively thin & non-keratizined and thin lamina propia (great for meds)
o Sublingual musosa is the thinnest epithelium of the oral cavity
o Oral cavity is highly acceptable for systemic drug delivery
Mucosa is relative permeable w/ a rich blood supply
Virtual lack of Langerhans cells makes the mucosa tolerant to potential allergens
Route also bypasses the first-pass-effect & avoids pre-systemic elimination in the GI tract
EX nitroglycerin tablets given sublingually for rapid absorption
NOTE: alveolar mucosa is similar to sublingual mucosa appears red due to the numerous BVs & thin epithelial covering
o CT of oral cavity (referred to as lamina propria):
Forms mechanical support & carries BVs & nerves
Two layers:
Papillary layer directly under epithelial layer, more cells, tone
Reticular layer dense, fibrous layer located under papillary layer
Oral mucosa of the cheek has a thinner lamina propria then the outer surface of the lip
o Submucosa:
Located between CT and muscle tissue
Present only in areas requiring a high degree of compressibility & flexibility (cheeks, soft palate)
Kaplan states that it is defined Submucosa, but immovable because it is tightly bound to underlying periosteum
The Anterior part contains much adipose tissue, and posterior part of the hard palate is full of glands
o NOTE: the most outstanding difference between the gingiva and the mucosa of the hard palate is the presence of glands
CARTILAGE/BONE
- Cartilage is avascular heals slowly after injury
- No calcium salts are present cartilage doesnt appear on x-rays
- Can support great weight, yet it is flexible & somewhat elastic
o Firmness of cartilage depends on:
Electrostatic bonds between collagen fibers & GAG side chains of matrix glycoproteins
Binding of water to the (-) charged proteoglycan complexes
- Cartilage has a preponderance of amorphous ground substance over fibers
- Chondrogenic cells = undifferentiated mesenchymal cells important to growth & development of cartilage
- Chondrocytes:
o Reside in depressions in matrix called Howships lacuna. (??I thought Howships lacunae are depressions formed by osteoclasts
resorbing bone).
o The only blood supply is provided by BVs entering cartilage through the perichondrium
o Secrete a hard, rubbery matrix around themselves
- Three subtypes:
o Hyaline
Most common type
Matrix contains many, closely packed, fine collagenous fibers
Has a capsule around the chondrocytes which represents the youngest layer of intercellular substance
Covers & protects bone
Precursor to bone in long bones, hyaline provides a region for bone to grow in length
Found where strong support & some flexibility are needed
Forms nearly all of fetal skeleton
May grow interstitially, where bone only can grow appositionally
In adults:
Articular cartilage smooth and slippery, it lines movable joints
Costal cartilages at the sternal ends of the ribs
Respiratory cartilages movable external nose and septum, larynx, trachea, and the bronchial walls
Auditory cartilages external auditory meatus and pharyngotympanic tube
Ground substance of hyaline cartilage is basophilic because it contains sulfated proteoglycans called
glycosaminoglycans
GAGs can readily bind & hold water allows tissue to assume a gelatinous nature resistant to compression and also
permit some degree of diffusion
Most abundant GAG is hyaluronic acid
o Fibrocartilage
Most closely resembles dense, irregular CT
Matrix contains dense collagenous fibers
Withstands tension & compression
Found in intervertebral discs (vertebra), knee joint, TMJ, & symphysis pubis
o Elastic
Matrix contains collagenous & elastic fibers
Similar to hyaline cartilage but the fibers are not as closely packed
More importantly, elastic cartilage contains many elastic fibers (elastin)
Forms the external ear (pinna) and is also found in the epiglottis, the auditory meatus, & larynx
- Tropocollagen
o Protein molecule in BOTH collagen and reticular fibers
- Perichondrium: is a layer of dense irregular connective tissue which surrounds the cartilage of developing bone.
o Consists of a fibrous outer layer (connective tissue MB) and a chondroblastic inner layer
o Very important to cartilage growth
- Cartilage growth:
o Interstitial chondrocytes divide w/in cartilage occurs in epiphyseal plates & articular cartilages. Bones lengthen thru
interstitial growth (at the cartilaginous epithelial plates interstitial growth could not occur anywhere but at the plates).
o Appositional where surface perichondrium lays down new layers results from differentiation of perichondrial cells. Bones
increase in girth thru appositional growth.
- Mineralization of Bone
o All of the following are contributors to the mineralization of bone:
Holes or pores in collagen fibers
Release of matrix vesicles by osteoblasts
Alkaline phosphatase activity in osteoblasts and matrix vesicles
Degradation of matrix pyrophosphate to release an inorganic phosphate group (is this what Alkaline phosphatase is
doing?)
NOT Release of acid phosphatase by osteocytes trapped in lacunae
- Bone growth:
o Appositional below the periosteum is a fibrous outer layer & a cellular inner layer of osteoblasts, which lay down bone
Because of bones rigid structure, interstitial growth is NOT possible
o Bone increases in size (width) by way of appositional growth by osteoblasts (Not interstitial)
o Do not confuse bone growth w/ bone formation
Bone forms by either endochondral ossification or intramembranous ossification
- Endochondral bone formation: (Think ENDO like long bones (files, etc.)
o Cartilage is precursor for bone in this type of growth
o The epiphyseal plate (disc) is a wedge of hyaline cartilage accounting for this increase
The plate is found between the epiphysis & diaphysis at each end of a bone
Cartilage cells of the epiphyseal plate form layers of compact bone tissue, adding to the bone length (by interstitial
growth in the cartilaginous epiphyseal plate)
The disc becomes inactive in most individuals by late teens/early 20s
o 1 ossification center near the middle of the diaphysis. Responsible for formation of diaphysis
o 2 ossification center in the epiphysis; forms later. Responsible for formation of epiphysis.
o Metaphysis the region between the 1 & 2 ossification centers. Growing zone of cartilage that separates the epiphysis and
diaphysis until adulthood.
o The Diaphysis shaft
o Here are the steps, all concise-like:
1) chondrocytes proliferate in epiphyseal plate
2) chondrocytes hypertrophy on diaphyseal side of the area
3) matrix calcifies
4) chondrocytes die
5) osteoblasts lay down layer of primary bone along the bone spicules
- Zones of the Epiphyseal Plate
o Zone of resting cartilage
Nearest to the epiphysis
Chondrocytes are disordered and are not dividing rapidly
o Zone of Proliferation
New cartilage is produced by interstitial growth
Multiple chondrocytes stack up forming columns
o Zone of Hypertrophy
Chondrocytes Mature and Enlarge Lacunae also appear swollen
More mature ones are at the diaphysis end and less mature are at the epiphysis end
o Zone of calcification
Thin layer of mineralized matrix
Death of hypertrophied chondrocytes occurs and the lacunae are invaded by blood vessels
Osteoblasts from the endosteum, travel with the connective tissue of blood vessels and aggregate on the calcified cartilage
surfaces
New bone matrix is deposited by appositional bone growth, then remodeled

o *The width of the epiphyseal plate remains constant because as the bone elongates, there is remodeling inside the metaphysis
o Bones fuse between 12 and 25 depending on bone and leave an epiphyseal line
o Plate closes at age 18?? 24??
- Bone Repair
o Blood Clot forms
o Bridging callus (A composite mass of tissue that forms at a fracture site to establish continuity between the bone ends; it is composed initially of uncalicifed fibrous tissue and
cartilage, and ultimately of bone.)forms
o Periosteal callus forms
o New endochondral bone forms
o NOT new osteons grown across the callus

EMBRYOLOGY
General Embryology
- Cleavage
o Begins w/in 24 hours of zygote formation
o With each division, the daughter cells (blastomeres) become smaller (no cell growth)
o Compaction begins w/ the 8-cell stage blastomeres flatten & are held together by tight junctions
o Morula by day 3 or 4, consists of the 16-32 cells, Solid Mass
The First solid ball of cells to form in the embryo
- Blastocyst formation
o Blastocele
Fluid begins to accumulate in the intercellular space & forms a central cavity known as the blastocele
o Blastocyst
In what stage do the cells start to have an inner cell mass? Blastocyst
Is the zygote, now free of its zona pellucida
Embryoblast inner cell mass projects into the cavity gives rise to the embryo proper
Which cells turn into the inner layer of the fetus? I think Embryoblast
Trophoblast outer cell mass forms outer epithelial layer gives rise to the fetal portion of the placenta
Think Troph i.e. has affinity to travel to uterine wall!
- st
1 Week: Implantation
o Begins by the end of the 1st week
o Upon implantation, the trophoblast produces hCG, a hormone that maintains the corpus luteum (which secretes
progesterone)
Excessive growth of the trophoblast results in hydatiform moles (hCG) which can fill the uterus and result in fetal
death
Also, the trophoblast can form the highly
malignant chorionepithelioma, a tumor of
the chorionic villi
o Ectopic pregnancy implantation outside the uterus
- 2nd Week: Bilaminar disc
o Epiblast primary ectoderm High columnar cells,
during 3rd week forms ectoderm and mesoderm
form the amniotic cavity On top
o Hypoblast primary endoderm Low cuboidal cells
contributes to primary yolk sac (or remaining
Blastocyst) On the bottom
- 3rd Week: Trilaminar disc
o Primitive streak
Linear thickening of the ectoderm cells
Defines the cephalocaudal axis of the embryo
Delimited rostrally by the primitive node
o Epiblast cells invaginate between epiblast & hypoblast forms the intraembryonic mesoderm
o Notochord formation: (Get your Honda acCORD on your 16th birth day)
Day 16 cells of the primitive streak migrate rostrally & form the tube-like notochordal process
The notochord is a rod-shaped body found in embryos of all vertebrates
Composed of cells derived from mesoderm and defines the primitive axis of the embryo
Found on the ventral surface of the neural tube
The notochord induces the the thickening of the ectoderm to form the neural plate
Turns in to the Nucleus Propulsus
o Neural plate begins to form
o Buccopharyngeal Membrane Ruptures
- What causes the infolding of the head thing in embryology?
o Neural cells growing OR branchial arch formation?? Im 100% sure its form neural cells growing!
- 4th 8th Weeks: Embryonic Period
o Week 4
For the 4 chambers of the heart begins to beat; upper/lower limb buds begin to form for the 4 limbs, and 4 Visible
Branchial Arches
Neural Plate
The neural plate increases in length as the primitive knot and primitive streak move caudally
Invagination of the neural plate at day 18 forms the neural groove
The edge of each fold is known as the neural crest
Neural tube is formed when the crests fuse, starting at the 4th somite region (neck) and proceeding in cephalic and caudal
directions
The cephalic end of the neural tube will eventually dilate to form the forebrain, midbrain, and hindbrain
o The spinal cord is formed from the remainder of the neural tube
Neural crest cells (Ectomesenchyme)
Form Posterior root ganglia, sensory ganglia of the cranial nerves, autonomic ganglia, meninges, Schwann cells,
suprarenal cells, and Melanocytes
Head and Tail Folds
The entoderm (endo) germ layer gives rise to the GI and depends on BOTH the cephalocaudal folding and the lateral
folding of the embryonic disc in a tubelike fashion
HEAD FOLD
Rapid longitudinal growth of the CNS causes the cephalic and caudal ends to bend and form head and tail folds
o As a result the brain comes to lie cranial to the cardiogenic area and septum transversum, which contributes to the
formation of the diaphragm.
o Part of the yolk sac becomes incorporated into the embryo as the foregut
This cavity opens into the midgut via the anterior intestinal portal and is bounded anteriorly by the
prochordal plate, which is known at this stage as the buccopharyngeal membrane
This membrane forms the back of the stomodeum and ruptures at the end of the 3rd week to establish
communication between the amniotic cavity and the primitive gut
TAIL FOLD
o Blah, blah
Lateral Folds
The continued growth of the somites causes the expanding lateral margins of the embryonic disc to bend ventrally,
forming lateral folds
o As a result, part of the yolk sac is taken into the embryo to form the midgut
o In addition, this folding constricts the initially wide communication between embryo and yolk sac to a narrow, long
vitelline duct, which eventually lies w/in the umbilical cord
What causes the infolding of the head thing in embryology?
Neural cells growing OR branchial arch formation?? Im 100% sure its form neural cells growing!
THIS is why I think the answer to the above yellow question is neural cells growth
rd th
o 3 -8 week fetus most susceptible to teratogens
o Ectodermal derivatives:
Surface ectoderm
Otic placode & lens placode
Epidermis
Hair & nails
Subcutaneous glands
Enamel
Anterior pituitary gland
Mammary glands
Hair, enamel, sweat glands & salivary glands are all derived from ectoderm (dentin is not)
Neuroectoderm:
Posterior pituitary gland
CNS neurons
Oligodendrocytes & astrocytes
Pineal gland
Neural crest:
ANS (e.g., autonomic ganglia)
Sensory ganglia of CNs
DRGs
Meninges
Schwann cells
Adrenal medulla (chromaffin cells)
Melanocytes
Odontoblasts
o Mesenchymal (mesodermal) derivatives:
CT (bone, cartilage)
Muscle
Dermis
Urogenital system
Adrenal cortex
Spleen
Serous MBs lining the pericardial, pleural & peritoneal cavities
o Endodermal derivatives:
GI system
Thyroid/parathyroids
Thymus
Lungs
Liver
Pancreas
Lining of respiratory tract, bladder & urethra
- 10th Week:
o Genitalia have M/F characteristics
Head & Neck Embryology
- Stomodeum = stomatodeum:
o Slight depression on the surface ectoderm
o Represents the primitive oral cavity
o Separated from primitive pharynx by buccopharyngeal MB (oropharyngeal MB)
Composed of ectoderm externally & endoderm internally (no mesoderm)
Covers the stomatodeum
Ruptures at 3 weeks (forming max palatal shelves)
o Prochordal Plate
Consists of the endoderm of the roof of the yolk sac and embryonic ectoderm
Does NOT contain mesoderm
- Branchial Arches = pharyngeal visceral arches
o General features:
A series of rounded mesodermal ridges on each side of head & neck of embryo at 4 weeks
Develop in the 4th week as neural crest cells that proliferate & migrate into the future head & neck region
By end of the 4th week, FOUR well-defined pairs of branchial arches are visible externally
o The 5th & 6th are small & cannot be seen on the embryo surface
Each branchial arch contains a cartilaginous bar or rod, a muscular component, an artery, & a nerve
1st-3rd arch play role in formation of face & oral cavity
1st arch develops into Mn & large part of Mx
1st, 2nd & 3rd arches play role in tongue development
Contain striated muscle, not from somites
Branchial arches (are SVE special because they are striated, but not developed from body wall or somites)

o From the above picture, the facial process indicated w/ the letter A gives rise to the secondary palate

o Cartilages of each arch:


1st arch cartilage (M: Meckels, Mandible, Malleus, Muscles of Mastication, Mylohyoid)
1st arch develops into Mn & large part of Mx
A model for the Mn but does not form any part of Mn
o What forms the Mn?? Intramembranous ossification of Meckels mmmmmmm
o Fate is dissolution with minor contribution to ossification
o Mandible forms before the maxilla.
o Both mandible (except for condyles) and maxilla are mostly formed by intramembranous ossification.
Closely related to development of the middle ear
o Ossifies to form the malleus & incus
All 8 muscles innervated by V3 (4 mastication, 2 tensors, anterior belly of digastric, and mylohyoid)
NOTE: CN V supplies the muscles derived from the 1st pair of branchial arches
2nd arch cartilage (Reicherts)
Closely related to development of the middle ear
o Ossifies to form the Stapes (Second Stapes)
Think S Second, Stapes, Styloid Process, Stylohyoid, Seven (VII)
Forms part of the hyoid bone
Also forms Styloid process of the temporal bone
Also forms the stylohyoid ligament
Stylohyoid muscle is from the 2nd arch
All facial expression muscles innervated by CN VII
3rd arch cartilage
Ossifies to form part of the hyoid bone
Stylopharyngeus muscle
Derivatives of the 3rd arch are innervated by CN IX
Think Pharynx: stylopharyngeus & glosspharyngeal nerve
4th & 6th arch cartilages:
Fuse to form laryngeal cartilages (except for the epiglottis)
All other pharyngeal and laryngeal muscles
XI via X:
o Spinal part of XI
Goes to SCM and trapezius
o Cranial part of XI
Joins X
Goes to pharyngeal muscles from vagal branches
Goes to laryngeal muscles via recurrent laryngeal
NOTE: CN XII provides GSE fibers derived from the Occipital somites, not any arches
4th arch:
o Most pharyngeal constrictors, Except Cricopharyngeus
o THE EXCEPTION Cricothyroid which you would think is the area of 6th arch
o Levator veli palatini
o Innervated by superior laryngeal branch of CN X
6th arch:
o All intrinsic laryngeal muscles (except cricothyroid) superior laryngeal branch of X
o The EXCEPTION Cricopharyngeus which you would think is the area of 4th arch
o Innervated by recurrent laryngeal branch of CN X
5th arch
Absent (short-lived or not developed)
o A little more about the arches: (yup, I know, I suck & youre pissed)
o 1st Arch:
Divides at 4 weeks embryonic development to form Mn & Mx processes
Mn (except condyles) & Mx are mostly formed by intramembranous ossification
Develops into two prominences or processes:
1) Mn process (larger) forms the Mn & lower lip
o Mn forms by merging of medial ends of Mn processes during the 4th week (Mn forms before Mx)
2) Mx process (smaller) forms the Mx, zygomatic bone, squamous part of the temporal bone, most of upper lip
o Mx forms by merging of Mx processes
o The upper lip is formed from the Mx processes and medial nasal processes
o The medial nasal process form the center of the nose and lateral nasal processes form the ala of the nose
o Maxillary teeth are developed from Arch I and a globular process
o NOTE: the intermaxillary arch is NOT a derivative of the 1st Arch
o The palatine shelf is a medial extension of the Mx process
o Lateral palatine processes of Mx process secondary palate (hard and soft palate)
o Primary Palate is formed by the medial nasal processes and join the secondary palate at the jxn of the nasopalatine
canal
o Lateral cleft lip results from failed fusion of Mx & medial nasal processes
May be unilateral or bilateral
o ***Cleft palate failure of fusion of the lateral palatine processes, nasal septum &/or median palatine process
Most common in Asians
Corners of the mouth
Formed by fusion of Mx & Mn processes
Tuberculum impar: (median tongue bud)
Median, triangular elevation which appears in the floor of pharynx just rostral to foramen cecum
Forms from 1st branchial arch
Gives first indication of tongue development in embryo at 4 weeks
Lateral lingual swellings (two distal tongue buds):
Develop on each side of median tongue bud
Elevations are the result of proliferation of mesenchyme of 1st arch
Swellings fuse to form the anterior 2/3 of tongue (mucosa and all)
o Delineated by circumvallate papilla??
Bifid tongue:
Results from lack of fusion of distal tongue buds (or lateral swellings)
Common in South American infants
o 2nd Arch:
Copula (helps to form posterior 1/3rd)
o 3rd Arch:
Posterior 1/3 of tongue is formed by two elevations: the copula (2nd arch) & the hypobranchial eminence (3rd arch)
- SIDE BAR:
o Bifid uvula:
Results from failure of complete fusion of palatine shelves

- Pharyngeal pouches: (NOT ARCHES)


o Paired evaginations of pharyngeal endoderm lining the inner aspects of the branchial arches in the neck region
NOTE: the parotid gland is NOT a derivative of a pharyngeal pouch
Messed up development of 3rd & 4th pouchesDiGeorge syndromeleads to T-cell deficiency & hypocalcemia

Pharyngeal Pouch Structures Derived


1st Tympanic MB, audtitory tube, and middle ear cavity, mastoid air cells
2nd Lymphatic nodules and palatine tonsils
3rd Inferior parathyroid gland, thymus gland (Hassalls Corpuscles)
4th Superior parathyroid gland, ultimobranchial body which gives rise to parafollicular cells (C cells)
of the thyroid gland (produce calcitonin)
5th Rudimentary structure, becomes part of the fourth pouch

- Vestibular lamina
o Separates lips & cheeks externally & the jaw structures internally in the developing embryo
o Outer lamina of the 2 epithelial lamina in embryo that separate the palate from the lip !!!!!
- Frontal nasal process (prominence):
o Produced by the growth of the forebrain
o Develops the forehead and nose
- Nasal placodes
o Thickened areas of specialized ectoderm that form on each side of the frontal nasal process
o Elevations form at the margin of these placodes
o What makes up the nose? Medial and lateral nasal processes
Two lateral nasal processes form the sides (alae) of the nose
Two medial nasal processes form the bridge of nose, nostrils, philtrum (upper lip), & primary palate (anterior to incisive
foramen)
o Philtrum
What forms the philtrum? Medial Nasal Processes with Maxillary processes
- Lips:
o Derived from Mn, Mx, & Medial Nasal processes
- Tongue:
o Derived from 1st, 2nd, and 3rd branchial arches
Anterior 2/3
1st Arch
Ectoderm (Mucosa)
Tuberculum impar
Lateral Lingual Swellings primary developmental source of mucosa of the anterior 2/3 of the tongue
Posterior 1/3
2nd and 3rd Arch
Endoderm
Copula (2nd)
Hypobranchial eminence (3rd)
Tongue NOT formed from macula
o At the jxn of the body and root of the tongue is:
Foramen Cecum
Lies at the base of the V of the sulcus terminalis
Sulcus Terminalis
V-shaped demarcation that separates anterior 2/3 from posterior 1/3
Circumvallate Papilla
NOT Lingual raphe
Remnant of thyroglossal duct.
o Taste in tongue:
All innervation is from the solitary nucleus
Anterior 2/3: CN VII
Posterior 1/3: CN IX
Extreme posterior and soft palate: CN X

ENDOCRINE SYSTEM
- Exocrine glands classified according to:
o 1) Type of secretion:

Mucous (water & mucin)buccal glands, glands of esophagus, cardiac & pyloric glands of stomach

Serous (enzymes)parotid, von Ebners glands (Serous ONLY), pancreas & uterine glands

Mixedsubmand. & sublingual glands, glands of nasal cavity, paranasal sinuses, nasopharynx, larynx, trachea, and bronchi
o 2) Mode of secretion:

Merocrineonly the cell secretory product is released from MB-bound secretory granules EX: pancreatic acinar cells

Apocrinesecretion of product plus small portion of cytoplasm EX: fat droplet secretion by mammary gland

Holocrineentire cell w/ secretory product EX: sebaceous glands of skin & nose (Think Hol = Whole)
o 3) Structure of duct system:

Unbranchedsimple glands EX: sweat glands

Branchedcompound glands EX: pancreas
o 4) Shape of secretory unit:

Tubularcylindrical lumen surrounded by secretory cells EX: sweat glands

Acinar (alveolar)dilated sac-like secretory unit EX: sebaceous & mammary glands

Tubuloacinar (tubuloalveolar)intermediate in shape or has tubular & alveolar secretory units EX: major salivary glands
o NOTE: Salivary, sweat, sebaceous, and von Ebner's glands are all exocrine glands
- Pituitary Gland (hypophysis cerebri):
o Master endocrine gland because it controls many other glands through release of tropic hormones

Tropic hormones = hormones that effect the activity of another endocrine gland
o Origin:

1) Upgrowth from ectoderm of the stomodeum roof of mouth (anterior pituitary, glandular portion from oral ectoderm)
Rathkes pouch diverticulum developing at 3 wks from the roof of stomodeum (primitive mouth) grows
toward brain
o The anterior lobe of the hypophysis develops from Rathkes pouch

2) Downgrowth from the neuroectoderm of diencephalonfloor of brain (posterior pituitary, nervous portion)
o Positioned in the sella turcica of the sphenoid bone directly above the sphenoid sinuses
o Structure:

Adenohypophysis = Anterior Pituitary
Pars tuberalis, pars distalis, and pars intermedia
Pars intermedia is an avascular zone lying between the lobes but is considered part of anterior pituitary
Pars intermedia & tuberalis have no proven function in mammals
NO innervation
Contains alpha & beta cells
Hypothalamic-hypophyseal portal blood system controls rls of anterior pituitary secretions. Does NOT
appear to have anything to do with posterior pituitary.

Neurohypophysis = Posterior Pituitary
Pituicytes Primary cell of posterior pituitary, fusiform cell closely related to neuroglia
Median eminence, infundibulum and pars nervosa
Infundibulum carries important nerve tracts from hypothalamus & substances to act on posterior pituitary
o The infundibular stalk contains the hypothalamic-hypophyseal tract, which carries axons to the posterior pituitary
Consists mainly of unmyelinated nerve fibers!!!
o Blood supply

From right & left superior and inferior hypophyseal

Sinusoidal blood arrangement (sinusoidal arrangement of BVs also found in Liver and Spleen)

Forms a rich vascular portal system
Portal has two capillary beds
***Three portal systems in the body:
o 1) Hepatic portal system 1st capillary bed in intestines & 2nd in the sinusoids of liver
o 2) Renal portal system 1st capillary bed in glomerulus & ????
o 3) Hypothalamus-Hypophyseal portal system 1st bed in HTh & 2nd in Anterior Pituitary

Carries the Releasing Hormones produced in the hypothalamus to the anterior pit and have them release further
hormones
o Synthesized peptide hormones:

Anterior Pituitary = pars distalis: FLAT PeG
The following tissues would be affected if the anterior lobe of the hypophysis were destroyed:
o Thyroid epithelium, zona fasciculata of adrenal gland, interstitial cells of testis, spermatogenic epithelium of testis

NOT adrenal medulla
Hormones released from:
o Alpha cells GH & Prolactin (regular hormones) Alpha for acidic or Eosionophilic pEg
o Beta cells FSH, LH, ACTH, TSH (all tropic hormones)
Sidenote: The hypophysis is characterized by an anterior lobe w/ alpha & beta cells
Follicle stimulating hormone (FSH):
o Development of graafian follicles & estrogens in the ovary
o Promotes spermatogenesis in males acts on sertoli cells to produce inhibin and androgen binding protein
Luteinizing hormone (LH):
o Stimulates formation of corpus luteum & progesterone secretion
o Stimulates interstitial cells (Leydig cells) of testes to secrete testosterone
Corticotropin (ACTH):
o Controls secretion of adrenocortical hormones (glucocorticoids), which affect glucose, protein, & fat metabolism
Thyroid stimulating hormone (TSH):
o Controls secretion of thyroxine by thyroid, uptake of iodine, and synthesis
**Melanin Stimulating Hormone (MSH) and Beta-Lipotropin
o Secreted from the pars intermedia
Prolactin (Lactotropin):
o Promotes mammary gland development & milk production, breast development

The mammary glands are under direct control from the hypophysis
o Triggered by rising estrogen levels
Growth hormone (GH) aka somatotropin:
o Growth in general; particularly skeletal system by stimulating aa uptake, protein synthesis, & CHO/fat breakdown
o Most plentiful of AP hormones
o Fusion of long bone epiphyses determines if excess GH will result in gigantism (children) or acromegaly (adults)
o Produced by acidophils in the anterior pituitary


Posterior Pituitary Neurohypophysis or pars nervosa:
Consists of unmyelinated nerve fibers
Consists of 100,000 axons of the supraoptic and paraventricular nuclei of hypothalamus
Secretes ADH & oxytocin
Hormones are synthesized in hypothalamus & transported in axons to the poster lobe for storage and secretion
o Transport occurs via hypothalamo-hypophyseal tract
Antidiuretic hormone (ADH) aka vasopressin:
o Controls rate of water excretion into urine
Oxytocin:
o Helps to deliver milk from glands in breasts to nipples during nursing
- Thyroid gland:
o H-shaped structure two parts joined by a thin isthmus

The isthmus runs in front of the trachea and contacts it posteriorly
o It has rings of epithelial cells surrounding a space filled with colloid
o Characterized by the fact that it functions as the controller of general body metabolism
o In adults, the site of origin is seen as the foramen cecum
o Blood supply

superior thyroid artery from external carotid, then branches to form the superior laryngeal and enters the thyrohyoid
membrane along with the internal branch of the superior laryngeal nerve from the vagus,)

inferior thyroid artery from thyrocervical trunk)

SIDENOTE: Vagus, has both the superior laryngeal nerve and the recurrent laryngeal nerve (BOTH do sensory and
muscle)
Pharyngeal branch Innervates the pharyngeal constrictors except the Cricopharyngeus (VI arch)

THINK Cricos are the ODD balls
Recurrent Laryngeal Sensory/PS: Everything from the folds down

MOTOR: All the motors of the Larynx except Cricothyroid (IV arch)
Superior Laryngeal Sensory/PS: (Internal branch) above the folds

MOTOR: (External branch) to the Cricothyroid
o Nerve supply glandular branches of cervical ganglia of sympathetic trunk
o Cell types:

Follicle cells:
Synthesize thryoglubulin (from tyrosine), which is stored in colloid of each follicle, and is a precursor to T3 & T4
When pituitary gland secretes thyrotropin, the colloid becomes active & thyroglobulin molecules are released and taken
back into the follicular cells where they become T3 & T4
Remain inactive at times of low thyroid homrone need can be activated when necessary for mobilization of colloid
found in thryroid
Colloid in the usual thyroid follicle stains acidophilic (PINK)
Metabolically active follicular colloid stains BASOPHILIC

Parafollicular cells: (C cells)
Produce calcitonin lowers calcium & phosphate levels in blood

Thyroglossal duct a narrow canal connecting the thyroid gland to the tongue during development
Disappears but persists as the foramen cecum

An upward extension of the thyroid gland could be a remnant of the thyroglossal duct, a pyramidal lobe, or a muscular slip

Cervical cysts in the midline of the neck is from Thyroglossal duct
- Parathyroid gland:
o Four glands two superior (superior thyroid artery from external carotid) and two inferior (inferior thyroid artery from
thryocervical trunk) pairs of glands on posterior (dorsum) of thyroid gland
o Develops from 3rd & 4th pharyngeal pouches
o Blood supply is mostly from inferior thyroid artery (with contribution from the superior thyroid artery to the superior glands
only)
o Controlled by blood levels of calcium NOT TSH
o Cell types:

Principal cells (chief cells) secrete PTH, have clear cytoplasm

Oxyphil cells (acid secreting cells) granules in cytoplasm, unknown function
o PTH:

Regulates calcium & phosphate metabolism

It is ESSENTIAL for LIFE

Innervention by superior cervical ganglion (sympathetic)

Low PTH leads to tetany & muscle weakness duel to lack of Ca2+
- Pineal gland:
o Located in the epithalamus of brain and releases the hormone melatonin
o Thought to play role in regulation of sleep-wake cycle, body temperature regulation, and appetite
- Adrenal gland:
o Aka suprarenal gland
o Embedded in adipose tissue above kidneys
o Adrenal Medulla:

Secretes Epi and Norepi

Secretion of Adrenal medulla is NOT ESSENTIAL FOR LIFE (unlike those of Parathyroids, Adrenal cortex, Anterior
pituitary, Pancreatic islets (Langerhans)

From neuroectoderm (neural crest cells which differentiate into medullary cells called chromaffin cells)
Same embryologic origin as sympathetic ganglia
So, chromaffin cells of adrenal medulla secrete catecholamine
So, the adrenal medulla is an endocrine gland of ectodermal origin in the abdomen

Is composed of many cells containing MB-bound osmiophilic granules

Has an intrinsic stroma consisting primarily of reticular fibers

NOT separated from the cortex by a capsule of collagen fibers
o Adrenal Cortex:

Outside to In: Zona GlomerulosaZona FasiculataZona Reticularis (GFR like Glomerular Filtration Rate)
Also outsidein: SaltSugarSex (aldosteroneglucocorticoidsandrogens) life gets sweeter

Each Zone of the cortex has endocrine cells:
Zona Glomerulosa
o Thin layer, clusters of cells beneath CT capsule
o Secretes mineralocorticoids, primarily aldosterone
Zona Fasiculata
o Thick middle layer, cells arranged in parallel columns that run at right angles to surface
o Secretes glucocorticoids, primarily cortisol; also small amounts of estrogenic & androgenic-like substances
Zona Reticularis
o Inner layer, cells arranged in interconnecting cords
o Secretes small amounts of cortisol & Dehydoropiandrosterone (DHEA)

Derived from the mesoderm
- Hormones that are ESSENTIAL FOR LIFE: parathyroid, adrenal cortex, anterior pituitary, pancreatic islets (Langerhans)
- Thymus:
o Major gland of immune system
o Two soft, pinkish-gray lobes lying in a bib-like fashion below the thyroid gland and above the heart

Encapsulated
o From 3rd branchial pouch
o Primary lymphoid organ (just like spleen, tonsils, lymph nodes, & Peyers Patches)
o Site of T-cell maturation
o Outer cortex contains primarily lymphocytes
o Inner medulla contains T-lymphocytes & Hassalls corpuscles (thought to be vestiges of epithelium unknown function)

Are Mature in the Medulla
o The thymus is the immune system organ most isolated from blood
o Master organ in immunogenesis in the young some believe it monitors total lymphoid system throughout life
o Requires zinc most critical involved in all aspects of immunity: Vit B6, Vit C, carbonic anhydrase, & others
o No afferent lymphatics of lymphatic nodules it makes mature T-cells, it doesnt collect them, so it only needs blood supply.
o Blood from the internal thoracic & inferior thyroid
o Innervated by vagus & phrenic nerves
o Has double embryologic origin:

Lymphocytes derived from hematopoietic stem cells (mesenchyme)

Hassalls corpuscles (epithelium) derived from endoderm of 3rd pharyngeal pouch
o Produces thymopoietin & thymosin

Both are thymic lymphopoeitic factors confer immunological competence on thymus-dependent cells & induce
lymphopoiesis

Also produces thymic humoral factor (THF) & thymic factor (TF)
Important in normal development of immune systemproliferation & maturation of T lymphocytes
- Pancreas:
o Has both exocrine & endocrine function
o Retroperitoneal organ, except for small portion of tail which lies in the lienorenal ligament
o Head & neck nestle in the curve of the duodenum; body is behind stomach; tail extends to spleen
o Characterized by groups of special cells scattered among glandular alveoli
o Endocrine (pancreatic islets Islets of Langerhans)

Endocrine glands secrete products (hormones) into interstitial fluid to diffuse into capillariesbloodstream

*Alpha cellsglucagon

*Beta cellsinsulin, carb metabs, most abundant (80% of cells)
Degeneration of Islets of Langerhans leads to diabetes mellitus

*Delta cellssomatostatin acts locally w/in islets of Langerhans to depress secretion of insulin & glucagon
o Exocrine (acini):

Exocrine glands secrete products into ducts, Trypsinogen

Centroacinar cellspancreatic juices lipases, carbohydrases & proteases (to digest fats, CHOs, & proteins)

Centroacinar cells are ONLY found in the Pancreas
o Duct of Wirsung:

Main excretory duct begins at tail & joins common bile duct to form hepatopancreatic ampulla (ampulla of Vater)
Ampulla opens into duodenum (into descending portion [2nd part] of duodenum)
o Accessory pancreatic duct (Santorinis duct) opens separately into duodenum (when present)
- Wolffian duct: (mesonephric duct) embryonic duct that develops in the male into the deferent duct, in the female it is obliterated
-
- SALIVARY GLANDS:

Major salivary glands are compound tubuloalveolar glands

Innervation
By way of General Visceral Efferents from both the salivatory nuclei & the lateral horns of the spinal cord
o Adenomere: part of developing salivary gland destined to become responsible for function

Composed of:
Intercalated ducts transport saliva to larger ducts
Striated ducts
o contain mitochondria for electrolyte & water transport; simple, low columnar epithelium
o Striations of salivary glands are related to a combo of foldings of basal cell MBs & radially arranged mitochondria
Glandular cells synthesize glycoproteins
o Serous demilunes:

A mucous tubuloalveolar secretory unit that contains lysozyme (degrades bacterial cell walls)

Serous demilune cells: associated w/ mucous acini of the sublingual & submandibular glands (Mixed serous)

Secrete into intercellular canaliculi, not into striated ducts
o Mucus cells:

Function to protect & lubricate for transportation

Characterized by large, clear secretory granules that occupy most of the cell & a flattened nucleus-containing, condensed
chromatin at cell base
o Serous cells:

Rounded euchromatic nucleus surrounded by rough ER in the basal third of the cell w/ zymogen granules (clearly visible &
easily stained secretory granules) at cell apex
NOTE: there is an abundance of zymogen granules in the apical cytoplasm (NOT ribosomes or mitochondria)
Apical granules in the parenchyma of the salivary gland cells represents secretion precursors

Serous cells are found in acinar cells of pancreas, parotid, gastric chief cells and intestinal paneth cells (found at base of vili
in intestines)
What is common among the pancreas and parotid? They both have serous secretory cells
o Ducts:

Parotid Stensons duct

Submandibular Whartons duct

Sublingual gland Rivian ducts (Bartholin duct -- See below)
o Parotid gland:

Largest salivary gland

PURELY SEROUS
High in amylase activity

Distinguished by having serous acini only, realtively long secretory ducts, and long intercalated ducts
No serous demilunes

Divided by Mn ramus into deep & superficial lobes

PS secretomotor from CN IX by way of lesser petrosal nerve, the otic ganglion, & auriculotemporal nerve (branch of V3)
Diminished salivation due to middle ear involvement most likely involves the lesser petrosal nerve

Lymphatics superior deep cervical nodes

Stensons duct crosses masseter m., pierces buccinator m. & opens into vestibule opposite Mx M2

Things that PASS through the Parotid Gland
Facial Nerve (NOT Artery OR Vein)
Retromandibular vein originates in parotid gland
External Carotid artery
Superficial temporal artery
Branches of the great auricular nerve
o Sensory loss in the skin overlying the parotid gland could be caused by damage to the great auricular nerve
(C2-3)

Surgical excision of the parotid gland endangers the facial nerve, auriculotemporal nerve, & external carotid artery
-
- Submandibular gland: (formerly submaxillary gland)

Mixed serous & mucous

Located in the submandibular triangle (digastric triangle)

Superficial part rests on mylohyoid muscle
To expose, you only need to cut the mucous membrane

Deep part is located around the posterior border of mylohyoid between the mylohyoid m. & hyoglossus m. p.567 ECA

Whartons duct
Arises from deep portion of gland & crosses lingual nerve in the region of the sublingual gland p. 565 ECA
Runs anteriorly immediately deep to the mylohyoid muscle
Terminates on the sublingual caruncle (papilla) adjacent to the base of the sublingual frenulum
o Sublingual caruncles are elevations that lie on either side of the lingual frenum

SIDENOTE: The lingual frenum is attached to the genioglossus

Facial artery enters the submandibular triangle deep to the posterior digastric & passes under to supply submandibular gland
Gives off submental branch as it emerges beneath the gland this is what actually supplies SM gland

PS secretomotor fibers leave CN VII in chorda tympani - which joins the lingual nerve SM ganglion.
Carries pre-G fibers to lingual nerve from which the submandibular ganglion is suspended
Fibers leave lingual nerve & synapse in ganglion w/ post-G
Also supply sublingual, lingual, von Ebners & inferior labial glands & glands of inferior portion of buccal mucosa

Post-G sympathetic fibers are from superior cervical ganglion
They gain access via the adventitia of the facial & lingual
o Submandibular & sublingual lymph drainage is to the deep cervical lymph nodes
o
o Sublingual gland:

Contains mostly mucous w/ some serous demilunes

Bartholins Duct major sublingual duct opens on sublingual papilla in floor of mouth (accompanies
submandibular duct)

Mylohyoid muscle supports the glands inferiorly

Innervated by PS of CN VII w/ chorda tympani from submandibular ganglion

Blood from sublingual artery (from lingual a. from external carotid a.)
o Von Ebners glands:

Located around the circumvallate papillae of the tongue

Function rinse food away from papilla after it has been tasted

PURELY SEROUS
o Parotid & Von Ebners are the only adult salivary glands that are purely serous
o Mucus-secreting glands

Palatine gland and Buccal glands (PURELY MUCOUS)

Submandibular (submax)

Sublingual NOT purely mucous has some serous demilunes in it.

Mucus of the trachea

Glands of the esophagus
NOT parotid gland or mucosa of ureter
- Parasympathetic innervation controlling salivation originated ONLY with VII and IX
- Fordyces Granule
o Aberrant sebaceous glands

GASTROINTESTINAL SYSTEM
- Divisions:
o Foregut esophagus, stomach, duodenum, liver, gallbaldder, pancreas
Celiac artery
o Midgut jejuno, ileum, cecum, ascending colon, transverse colon
Superior Mesenteric Artery
o Hindgut descending colon, sigmoid colon, superior 1/3 of rectum
Inferior Mesenteric Artery
- Peritoneum:
o Single sheet of simple squamous mesothelium that lines the abdominopelvic cavity and covers the abdominal and pelvic organs
o Parietal layer portion on the cavity wall
o Visceral layer portion on the organ
o Some of the organs are suspended from the body wall by a double fold of peritoneum called a mesentery
o Some organs are moved to or develop behind the peritoneum, hence retroperitoneal
- Intraperitoneal structures: (ITS GLASS J)
o Usually have a mesentery or peritoneum
ileum, transverse & sigmoid colon, gallbladder, liver, appendix, spleen, Stomach, and jejunum
- Retroperitoneal structures: (PADUA Is DARK)
o Organs do not have mesenteries
o Structures on posterior abdominal wall are retroperitoneal:
Think all Vertical Organs and the Pancreas
Duodenum, ascending & descending colon, rectum, kidney & ureters, pancreas, suprarenal glands, IVC, and abdominal aorta
NOT liver, spleen,
- Parts of the large intestine in sequential order alternate between intra- & retroperitoneal:
o Ascending colon (retro)transverse (intra)descending (retro)sigmoid (intra)rectum (retro)
Vagus nerve innervates ascending colon (but does not innervate the descending colon, sigmoid colon, rectum or anus)
- Esophagus:
o 10 inches, behind trachea in thorax, empties in cardiac portion of stomach through cardiac orifice
o Upper 1/3 has skeletal , Middle 1/3rd has skeletal + smooth muscle; lower 1/3 has smooth muscle only
What type of muscle is present in lower 1/3rd Smooth
Divided into 3 portions on basis of muscularis externa
o Receives blood from inferior thyroid artery, branches of descending thoracic aorta, and left gastric artery
o PS from esophageal branches of CN X
o Motor fibers from recurrent laryngeal of CN X & S innervation from esophageal plexus
- Abdomen divided into 9 regions by 4 imaginary planes (Hollywood Squares, Tic-tac-toe):
o 1 Epigastricmidline region above umbilical region (contains most of stomach)
2 Hypochondriacregion to R & L of epigastric region. Located beneath the cartilage of the rib cage (spleen here)
o 1 Umbilicallocated centrally, surrounds the umbilicus
2 Lumbarareas to the R & L of umbilical region
o 1 Hypogastric (pubic)midline region directly below the umbilical region
2 Iliac (inguinal)regions on R & L of hypogstric region
- Stomach:
o In upper part of abdomen, extending below the left costal margin into epigastric & umbilical regions, protected by lower ribs
o Connects w/ esophagus via cardiac sphincter & to small intestine via pyloric sphincter
The purpose of the Gastroesophageal sphincter is to prevent reflux of stomach contents
o 1.0 L capacity
o Receives blood from all 3 branches of celiac artery (L & R gastric, short gastric, and L & R gastroepiploic a.)
o Venous Drainage from the Portal vein & Splenic Vein
o Stomach regions:
Cardiaclies near junction of stomach & esophagus
Fundusenlarged portion above and left of esophageal opening into stomach
Bodymiddle or main portion of stomach
Pylorislower portion, lying near small intestines
o Rugae transient folds of the mucosa & submucosa present in an empty stomach but smoothen out in a distended stomach
o Gastric glands of stomach in the lamina propria:
Parietal (oxyntic)in fundus & body, secretes 0.16 M HCl and Gastric Intrinsic Factor
pH of stomach is <2, due to HCl secretion
Chief (zymogenic)in fundus & body, secretes pepsin
Enteroendocrinepresent throughout stomach; produce gastrin, serotonin??? (1989 Q26)
The G cell is an enteroendocrine cell that produce gastrin
o Lesser & greater omentum mesenteries that connect the stomach to other viscera (lesserliver; greatersmall intestines)
Greater Omentum
Connects transverse colon to the stomach
Lesser Omentum
A peritoneal fold connecting the lesser curvature of the stomach & the first part of the duodenum to the liver
Connects Liver to the stomach (L = L)
Contains the common bile duct, hepatic artery, & the portal vein
- Small intestine (D J I)
o Small intestine secrete:
Maltase, sucrase, lactase converts disaccs to monosaccs
Aminopeptidase & dipeptidase converts polypeptides to individual aa
Enterokinase converts trypsinogen to trypsin
o Small intestine mucosa:
Plicae circulares = tranverse folds of mucous MB increasing surface area of jejunum (aka valves of Kerckring)
Villi (numerous in entire small intestine, not in lg intestine) absorb via microvilli projections on the free surface of the
cells lining villi
Each villus consists of a lamina propria that has vessels, nerves, and lacteals
The central lacteal absorbs chylomicrons into the lymphatic circulation through junctional gaps
Epithelial cells lining villi:
Show surface modification known as the striated border (or brush border) -- microvilli
o Disaccharidases & dipeptidases carry out their activity at the striated (brush) border
o Lactose intolerance is caused by deficiency of the disaccharidase lactase
Goblet cellsmostly in the ileum (become more numerous as one proceeds distally along the small intestine)
Absorptive cellssimple columnar cells w/ microvilli
Villi, microvilli, brush border, and circular folds all increase surface area in small intestine (NOT rugae stomach)
Enteroendocrine cellssecrete enterogastrones (secretin & CCK) into bloodstream found in duodenum
Paneth cells(stain red) found at bases of villi of tubular intestinal glands (crypts of Lieberkuhn) & secrete digestive
enzymes, lysosymes (Pan for gold at the base of the villi)
o Duodenum:
One foot longshortest but widest in small intestine, horseshoe-shaped curves around head of pancreas
Brunners glands (submucosal glands) secrete alkaline mucus
Small, branched, coiled, tubular glands in submucosa that secrete alkaline mucus to neutralize gastric acid (histologically
differentiates stomach & duodenum)
Retroperitoneal in the latter parts
Receives common bile duct & pancreatic ducts at the ampulla of Vater (small rounded elevation in wall of duodenum)
Duct of Wirsung:
Main excretory duct begins at tail & joins common bile duct to form hepatopacreatic ampulla (ampulla of Vater)
o Ampulla opens into duodenum (in descending portion [2nd part] of duodenum)
Accessory pancreatic duct (Santorinis duct) opens separately into duodenum (when present)
Blood supply superior pancreaticoduodenal artery (arises from gastroduodenal artery & inferior pancreaticoduodenal
arising from superior mesenteric)
Pre-G PS are in dorsal motor nucleus of CN X
o Jejunum
Thicker muscular wall for more active peristalisis, mucosal inner lining of greater diameter for absorption
Greater diameter mucosal inner lining than ileum for better absorption.
Has more plicae circulares (valves of Kerckring) & more villi for absorption
Plicae circulares are most characteristic of the jejunum
Tall columnar epithelium (like the rest of the GI tract!!!)
o Ileum:
More mesenteric fat, more lymphoid tissue (Peyers patches), more complex vascularity, more goblet cells
Lymphoid tisse (Peyers Patches MALT for Ag presentation & secretory IgA) to handle waste and destroy bacteria
Preferred site for Vit B12 absorption
Ileocecal valve joins small & large intestines

Hormone Major activities Stimuli for release


Gastrin Stimulates gastric acid secretion Presence of peptides and amino acids in gastric
lumen. Distension of stomach
Cholecystokinin Stimulating secretion of pancreatic enzymes, and Presence of fatty acids and amino acids in the
contraction and emptying of the gall bladder small intestine
Secretin Stimulates secretion of water and bicarbonate from Acidic pH in the lumen of the small intestine
the pancreas and bile ducts
Gastric inhibitory polypeptide Inhibits gastric acid secretion (HCl) and motility Presence of fat and glucose in the small intestine
and potentiates release of insulin from beta cells
in response to elevated blood glucose
concentrations

- Large intestine:
o Three Parts:
1) Cecum vermiform appendix extends downward from cecum (appendix contains large amt of lymphoid tissue )
Infection at the vermiform appendix would spread by entering the bloodstream via the Brachiocephalic Vein - they must
be saying this because this is where the thoracic duct dumps lymph back into bloodstream.
2) Colon ascending (shortest), transverse, descending, & sigmoid
3) Rectum no teniae coli

o Teniae coli:
Three thick, longitudinal bands of smooth muscle fibers that extend the entire length of colon
Function for peristalsis
Shorter than the large intestine therefore cause it to form small pouches called Haustra
o Epiploic appendages (appendices epiploicae) small areas of fat-filled peritoneum lacking in the small intestine
o Function of large intestines (colon):
Remove water from material entering it
Water removed by absorption
Large intestines do not secrete enzymes into lumen
LACKS VILLI
o Colon epithelium:
Simple columnar w/ border of microvilli to increase surface area for absorption of water from lumen
Goblet cells lubricate dehydrating fecal mass w/ mucous
Crypts of Lieberkuhn (intestinal glandsin stomach they are called rugae) invade lamina propria (L for L) (not same
as goblet cells)
o SIDE BAR Lieberkuhn are in Lamina Propia, but Brunners are in Submucosa
No villa formed in large intestines (no surface area increase) Distinguishes it from Small Intestine
o Colon muscularis externa: inner circle smooth muscle layer
o Innervation
Vagus nerve supplies PS to ascending & transverse colon
Pelvic splanchnic nerves to descending & sigmoid colon w/ rectum & anus (Think where you get SPANCHED)
o Anal canal:
Rectal columns of Morgagni = vertical folds, produced by the infolding of the mucous MB around the submucosa
The columns is separated by furrow-like rectal sinuses, which end distally in small valve-like folds called anal valves
Sphincters:
Internal = smooth muscle; External = skeletal muscle
Epithelium (from valves to opening):
Simple cuboidalstratified cuboidalstratified squamouskeratinized stratified squamous
- Liver: (picture)
o Largest & most active organ, largest gland of the body
o Lies under right side of diaphragm
o Blood flow:
Blood supply hepatic artery & portal vein
The central hilus, or portal hepatis:
o Receives venous blood from the portal vein & arterial blood from the hepatic artery
o Also transmits the common bile duct
o ***Portal Triad = Portal vein + hepatic artery + bile ducts (sometimes lymph vessels)
The central vein lies outside the portal triangle
Blood eventually drains via the three hepatic veins into the IVC which is transported to heart
Esophageal veins serve as an important collateral circulatory unit to the hepatic portal system
Cirrhosis esophageal varices massive hemorrhage Death
o Sinusoids:
Irregular capillaries w/ round pores 100-200 nm in diameter. No basement MB
Allow macromolecules of plasma full access to the surface of liver cells through the space of Disse
o Autonomic nerve fibers from celiac plexus
o Divided into large right lobe & small left lobe by attachment of peritoneum of falciform ligament (PICTURE)
Right lobe of liver is further subdivided into quadrate lobe and caudate lobe by presence of gallbladder, fissure for
ligamentum teres (umbilical vein remnant), IVC, and fissure for ligamentum venosum
o Coronary ligaments attatch liver to underside of diaphragm
o Liver cells (hepatocytes):
Most versatile cell in body
Encircle a central vein and radiate outward
Produce & excrete bile, excrete bilirubin (major end product of hemoglobin decomposition)
Contain large number of mitochondria and smooth ER
Contain lots of glycogen clustered near SER
20-30 micron polyhedral eosinophilic cells
6 or more surfaces may either contact another cell to form gap jxns and bile caniliculi or form a free surface with microvilli
exposed to the perisinusoidal Space of Disse
Bile canaliculi
o Tubular spaces limited by the plasma membrane of several hepatocytes
o Form a network that progresses along the plates of the liver lobule in the direction of the portal canals
o At the periphery of the lobule, these ducts empty into the Herings canals, which are small ducts of cuboidal cells
o Then these ductules terminate in the cuboidal or columnar lined bile ducts, which go on to form the right and left
hepatic ducts, which together constitute the common hepatic duct
o BILE FLOW: Bile Canaliculi Bile ductules (Herings) Right and left hepatic ducts Common Hepatic
Duct
Produces prothrombin, fibrinogen, albumin etc.
Stores lipid and carbohydrates & vitamins
Converts lipids and amino acids into glucose via the enzymatic process of gluconeogenesis
Detoxifies and inactivates drugs by oxidation, methylation, and conjugation
Liver regeneration can be as much as 90% in about 2 weeks
Produce bile & excrete it, too
Does NOT deal w/ phagocytosis of particulate matter
Secrete bile into common hepatic duct, joined by short cystic duct of gallbladder to form common bile duct
Bile is conducted away from the liver and into the cystic duct by the common hepatic duct
o Kupffer cells:
Reticuloendothelial macrophages which line sinusoids of the liver
Function to filter bacteria or small foreign particles out of blood
Originate from the mononuclear phagocyte system
Remove bacteria and toxins entering blood through the intestinal capillaries.
Have vacuoles, lysosomes, and
granular ER

- Gallbladder:
o Pouch-like organ that stores &
concentrates bile by absorbing water
& salts (bile continuously produces in
liver)
o When small intestine is empty,
sphincter of ampulla (Oddi) constricts
forcing bile up the cystic duct to
gallbladder
With food
(particularly fats), CCK relaxes
ampulla for bile to mix w/ chyme
o Bile emulsifies neutral fats &
absorbs FAs, cholesterol, & certain
vitamins
o Gallbladder has Simple
Columnar Epithelium
o Gallbladder does NOT
contain a submucosa
Colon, stomach, jejunum, & duodenum do have a
submucosa present
o Receives blood from cystic artery of the right hepatic
artery
o Is innervated by vagal fibers from celiac plexus
o Lymph from gallbladder drains into a cystic lymph node,
then into the hepatic nodes and then into celiac nodes

SENSORY ORGANS
THE EYE:
- Eye Structure
o As if I were a ray of light, I would pass through:
Cornea
Anterior Chamber (filled with aqueous humor)
Pupil (made from the Iris which contains the sphincter muscles)
Lens (which is made more or less ovoid by the ciliary muscles in the ciliary bodies found at the periphery of the iris)
Vitreous body
Made of Type II Collagen Think type II for 2 eyeballs
3 Layers of back wall
Retina
o Rods (night visionuse your rod at night!) and Cones (C for Color)
o Continues all the way to just below the Ciliary Bodies
o Macula
Fovea centralis in the Macula
Avascular region that contains ONLY cones for most acute vision (What a perfect placeonly Cones)
Choroid
Sclera
o In other words, 3 layers to the eye
External Fibrous Layer
Sclera and Cornea
Middle Vascular Pigmented Layer
Uvea (consists of choroid, ciliary body, & iris)
Internal Neural Layer
Retina
- Lacrimal Apparatus
o Lacrimal glands
In a picture is located on the Lateral side
o Lacrimal ducts
o Lacrimal Canaliculi
o Lacrimal Sac
o Nasolacrimal Duct
Drains into the inferior nasal meatus behind the inferior nasal concha (I want my $50 dollars,..$50 dollars)
- Tears
o Under PS control by CN VII, which came to the Pterygopalatine ganglion via the Greater Petrosal nerve, then hopped a
ride on the zygomaticofacial branch of V2, then on the Lacrimal branch of V1 to the lacrimal gland
THE EAR:
- Ear consist of:
o External ear:
Receives sound waves
Auricle & external auditory canal
Lined w/ ceruminous glands produce cerumen (ear wax)
o Middle ear (tympanic cavity):
Air to bone conduction
Ossicles malleus (hammer) stapes (stirrup) and incus (anvil)
Two muscles stapedius muscle (smallest skeletal muscle in the body) & tensor tympani muscle
Medial wall oval & round windows
Lateral wall membrane
Middle ear communicates posteriorly w/ the mastoid air cells and the mastoid antrum through the aditus and antrum
Eustachian tube serves to equalize air pressures between the tympanic cavity (middle ear) & the nasopharynx
Middle ear infections (otitis media) are quite prevalent and may become extensive due to connection to both the mastoid air
cells and the nasopharynx by way of Eustachian tube
Pt is clinically deaf but a tuning fork on mastoid process causes hearing there is a problem of disarticulation of ossicles
NOT caused by a laceration of auriculotemporal, laceration of cn 8, or problem w stapedius muscle
o Inner ear:
Located in the Petrous Part of the Temporal Bone
Transmits to the nerves
Bony labyrinth
3 cavities: vestibule, semicircular canals, cochlea
Filled w/ perilymph (Na+ rich)
Membranous labyrinth
3 parts:
o Cochlear duct base of the cochlea = high frequency; apex = low frequency
o Saccule & utricle both contain maculae for sensing linear acceleration
o Semicircular canals contain ampullae for sensing angular acceleration
Filled w/ endolymph (K+ rich)
Hair cells are found in both the cochlear & vestibular apparatus

URINARY SYSTEM
- Urinary system:
o 2 kidneys, 2 ureters, 1 urinary bladder & 1 urethra
o Removes nitrogenous waste as urea from blood
Urea is produced when foods containing protein are broken down
o Lined w/ transitional epithelium
o Genital & urinary systems are supplied w/ PS fibers from pelvic splanchnic nerve
o Kidneys, ureters, & urinary bladder all located retroperitioneally (behind the peritoneum)
- Kidneys:
o Epithelium
Bladder and Ureters Transitional
Tubules Simple cuboidal
o Contain extensive vascularity & millions of nephrons w/in renal cortex & medulla
o Filter blood & regulate volume & composition of body fluids during urine formation
o Located retroperitoneally
Can be approached surgically w/o violating the continuity of the peritoneum (ovary, spleen, & gallbladder can not)
o Right kidney lies slightly lower than the left due to large size of the right lobe of liver
Right kidney is close to the Colon, Liver, and Duodenum (CLOSEST to Colon)
o Left kidney is in visceral contact anteriorly with the stomach
o Each is surrounded by a fibrous renal capsule & is supported by an adipose capsule
o Each has an indentation the hilum on its medial border through which the ureters, renal vessels, & nerves enter/leave
Point of entry/exit for renal artery, renal vein & ureter
o Divided into outer dark-brown renal cortex & inner light-brown renal medulla
o Derived from mesoderm of the intermediate cell mass 1994Q58
Intermediate cell mass into both kidneys & gonads
o Horseshoe kidney: when the inferior poles of both kidneys fuse
- Bloodflow through the kidney:
o Renal arteryinterlobar arcuate interlobular afferent arterioles
- Internal features of kidneys:
o Cortex outer layer (glomeruli are located here)
o Medulla inner layer, consists of renal pyramids separated by renal columns
2-3 pyramids may unite to form a papilla
o Renal columns found between pyramids; cortical tissue
o Renal papilla apex of pyramids; the collecting ducts pour into minor calyces here
A renal papilla projects directly into the minor calyx
o Minor calyces unite to form major calyces, which then unite to form renal pelvis
- Nephron:
o Functional unit of excretory system
Smallest unit of the kidney that makes urine
o Subunit of kidney that purifies blood & maintains safe balance of solutes & water
o >1 million nephrons per kidney
o Made up of a renal corpuscle, proximal convoluted tubule, loop of Henle, & distal convoluted tubule
Renal corpuscle aka Malpeeeeegian Corupuscle
Consists of a glomerulus (network of parallel capillaries) & the surrounding Bowmans capsule
Site of filtration (passage of plasma substances from glomerulus into Bowmans capsule)
o BP forces fluid into Bowmans capsule
Bowmans capsule has simple squamous epithelium (parietal layer)
Also has a visceral layer formed by podocytes
Where do you find podocytes? Glomerular epithelium
Between the layers is the urinary space
Renal tubule
Four regions:
o 1) Proximal convoluted tubule in cortex
o 2) Loop of Henle in medulla
Thin limb Simple squamous
Thick limb Simple cuboidal
o 3) Distal convoluted tubule in cortex
o 4) Collecting duct in medulla (Technically not in the nephron)
After filtration, the tubules handle tubular reabsorption & tubular secretion
o Water, glucose & sodium are reabsorbed into blood
o Waste products are retained & emptied into collecting tubuleureters
- Juxtaglomerular apparatus:
o JG cells
Modified smooth muscle of afferent arteriole
Secrete renin in response to low renal BP, low Na+, & high sympathetic tone
Renin converts circulating angiotensinogen into AT I, which is then converted into AT II by ACE
Also secrete erythropoietin
o Macula densa
Na+ sensor
Part of distal convoluted tubule
o Afferent arteriole
o Polkissen cells
- Ureters:
o Long, slender, muscular tubes that transport urine from renal pelvis to base of the urinary bladder
- Urethra:
o Fibro-muscular tube that carries urine from urinary bladder to outside of the body
o In males it carries semen as well as urine (if youre lucky)
- Urinary bladder:
o Distensible sac situated in pelvic cavity posterior to the symphysis pubis
o Slightly lower in females than in males
o Concentrates urine & serves as a reservoir
o Tonically Contracted
- Urine:
o Adults pass ~1.5 quarts of urine each day
o Volume of urine formed at night that formed during day
o Normal urine is sterile contains fluids, salts, & waste products, but is free of bacteria, viruses & fungi
o Bladder tissues are isolated from urine & toxic substances by a coating that discourages bacterial attachment & growth on walls

- I knowits HOT.
TEETH

Comparison of Tooth Tissues


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ENAMEL:
Hardest tissue in body
Richest in calcium highly mineralized
Secreted by ameloblasts totally acellular
Enamel has no possibility of self-repair because its formative cells are lost once it is completely formed
Content:
96% inorganic minerals of calcium and phosphorous as hydroxyapatite (HA)
1% (or 2%) organic material (protein which is rich in proline)
3% water
Maturation of enamel is characterized by an increase in inorganic content & a decrease of BOTH water & organic material
Ectodermal origin (NOT ectomesenchymal)
ALL other tooth components are derived from ectomesenchyme
Enamel rod or prism:
Fundamental morphologic unit of enamel
Bound together by an interprismatic substance (interrod substance)
Each is formed in increments by a single ameloblast
At the time enamel matrix is first formed in a tooth, the nuclei of ameloblasts move to the non-secreting end of the
cell
Ameloblasts have short extensions towards the DEJ called Tomes process when they are in their Secretory stage
These Tomes processes give the ameloblasts at the DEJ a picket-fence appearance
The Tomes processes from the enamel are picketed with enamel spindles of the dentin (odontoblastic processes)
CAREFUL, Odonotblastic processes are Called Tomes FIBERS
During Calcification, Ameloblasts get their nutrients from the Stellate Intermedium
The interface between pre-ameloblasts and pre-odontoblasts is most like the interface between Epi and Dermis???
Rods begin at DEJ & extend to outer surface
Rods normally diverge radially away from the DEJ
Exception: in the cervical portion of primary teeth, the rods diverge toward the occlusal
Enamel rods converge toward the surface in the area of fissures although they are still diverging from the DEJ
5-12 million rods per crown
Rods increase in diameter (4 up to 8 microns) as they flare outward from DEJ
Oldest enamel in a fully erupted tooth is located at DEJ underlying a cusp or cingulum
Is a good thermal insulator
Organic matrix decreases as tooth matures and inorganic increases (F & Zn are minor constituents)
Optically clear in a demineralized histologic section of a adult tooth due to low organic (high inorganic) content
Extremely brittle, but very strong in compression can endure crushing pressure of ~100,000 psi
Coupled w/ dentin has cushioning property
Semitransluscent yellow to grayish-white
Selectively permeamble MB allows water & certain ions to pass via osmosis (Remember Bleaching!)
Crystals (Inorganic)
Have their long axes parallel to the rods in the bodies of the rods & deviating increasingly in their tails
Their tails are at the surface, heads at the DEJ

The degree of calcification in C, compared to that of D, islower


This would be opposite for a x-section of dentinal tubule

Fluoride Topical Application


Acid solubility of the surface enamel is reduced by fluoride
Enamel Caries
Are thought to penetrate along the route of the rod sheath
Hunter-Schreger bands: (Everyones TIGER hunting riffles are pointed in different directions)
Refers to alternating light & dark lines seen in dental enamel that begin at the DEJ & end before they reach enamel surface
They represent areas of enamel rods cut in cross-section dispersed between areas of rods cut longitudinally
Lines of Retzius: (Stria) (A) (Think Age Bands like a tree)
Artifacts in enamel (not found in dentin) created by incremental
steps of Ameloblasts
Analogous to Contour Lines of Owen in Dentin
Have increased organic content and are indicative of the rhythmic
variation in the calcification of the enamel matrix
They follow the appositional growth pattern
Neonatal line: 1985 Q87
One of the lines of Retzius is accentuated
Marks the division between enamel formed before & after
birth
Found in decidous teeth and cusps of permanent 1st
molars
Found in enamel of primary incisors, permanent
canines, and permanent 1st molars???
Found in dentin of permanent mandibular incisors and
permanent first molars??? (Check Calcification ages)
Perikymata: (Peri KY jelly) mata = Imbrication lines of Pickerill
Where lines of Retzius terminate on the tooth surface making a small valley traveling circumferentially around tooth
Ribbed surface of the tooth (for your pleasure)
Imbrication Lines of Pickerill:
Depression or grooves formed when growth rings (lines of Retzius) are incomplete at the enamel surface
Enamel tufts: (B)
Fan-shaped, hypocalcified structures of enamel rods that project from the DEJ into the enamel proper (unknown function)
Never found at the outer surface of enamel (perikymata, enamel matrix, & enamel lamellae are)
Enamel lamellae: (C)
Defects in the enamel resembling cracks or fractures which traverse the entire length of crown from surface to DEJ
Contain mostly organic material & may provide pathway for bacteria to enter
Hypomineralized structures extending from the DEJ to the surface of the enamel

A = Stria of Retzius; B = Enamel Tuft; C = Enamel Lamella; D = DEJ

Gnarled Enamel: (A) Below


Found most frequently in cusps, (pits and fissures?)
Wavy
Enamel spindles: (B?) Below
Careful, its not enamel, ITS a dentinal process
Elongated odontoblastic processes (hair-like) that traverse the DEJ
from the underlying odontoblasts
May serve as pain receptors
In a ground section of a permanent lateral incisor, the enamel spindle is
the first formed (other options were:
perikymata, gnarled enamel, granular
layer of Tomes)
Enamel spindle (dentin)
formation happens BEFORE
Granular layer of Tomes(mineute areas
of interglobular dentin subjacent to
cementum)
Serve as the counterparts to the
Picket-Fence DEJ from the odontoblast
side (Tomes processes from
ameloblastic side)

Primary Enamel Cuticle (aka Nasmyths MB) (Think Cellophane wrapping)


Delicate MB covering the crown of a newly erupted tooth
Produced by the ameloblast after it produces the enamel rods
Worn away by mastication and cleaning
Replaced by an organic deposit called the pellicle
Pellicle formed by salivary glycoproteins & invaded by bacteria to form plaque
**In a newly erupted tooth, the junction between the tooth surface and crevicular epi is a Basal lamina-like structure between
the enamel and the epithelium
Eruption:
During the early stage of eruption, the enamel matures
During eruption, the epithelial covering of the enamel unites with the oral epithelium and then degenerates

DENTIN:
Content:
70% inorganic (calcium hydroxyapetite), 20% organic (primarily Type I collagen), 10% water
More mineralized than regular bone, but less than enamel
The apatite crystal is oriented parallel to the collagen fibers in the dentin matrix (not parallel to dentinal tubules)???
Purposes of Dentin:
Nutritivekeeps organic components of the surround mineralized tissue supplied w/ moisture and nutrients
Sensoryextremes in temperature, pressure, or trauma to the dentin or pulp are perceived as pain
Pain originates in the pulp due to free nerve endings about the odontoblastic cells
*NOTE: in peripheral organs, the free nerve endings are receptors stimulated by pain (not touch, pressure,
temp)
Protectiveformation of reparative or secondary dentin
Theory of Pain
Hydrodynamic phenomena involving fluid influx into the tubules which then stimulate receptors in the pulp
Formation
Formed from the dental papilla (so is dental pulp)
Mesenchymal dental papilla adjacent to the IEE differentiates into odontoblasts
Main cell is the Odontoblast, derived from ectomesenchyme
Cell body is in the pulp cavity
**Ectomesenchyme is the primary source of cranial connective tissue
Odontoblasts begin dentin formation before enamel formation by the ameloblasts
During the last part of active eruption the odontoblasts are still functioning actively (ameloblasts are not)
Incremental lines of von Ebner (smaller versions of contour lines of Owen):
Lines in dentin that correspond to lines of Retzius in enamel. Run at right angles to dentinal tubules.
Also have a neonatal line which marks the transition between dentin formed before & after birth
Contour lines of Owen are larger than incremental lines of von Ebner and represent temporary disturbances in mineralization
of dentin. They are due to the incremental apposition of dentin.
Types:
Mantle dentin
The 1st formed portion of the dentin
The peripheral portion of dentin adjacent to enamel (DEJ) or cementum (CEJ), consisting mostly of coarse fibers
(Korffs fibers)
Circumpulpal dentin the remaining dentin
During the lifespan of a multirooted tooth, dentin forms most rapidly on the floor and roof of the pulp chamber
Peritubular dentin (AKA intratubular dentin):
Lines each dentinal tubule most mineralized dentin; more than intertubular dentin ( inorganic salt content)
Intertubular dentin: (in between tubules) main bulk of dentin.
Surrounds the peritubular dentin, less mineralized (has content of inorganic salts). More than 50% organic.
Interglobular dentin:
Imperfectly calcified matrix of dentin situated between the calcified globules near the periphery of the dentin
Primary dentin:
Dentin forming the initial tooth shape
Deposited before completion of the apical foramen
Secondary dentin:
Dentin formed after completion of the apical foramen
Formed at a slower rate than primary dentin as functional stresses are placed on a tooth
Does not contain cells (primary cementum & cancellous bone BOTH do)
A regular & somewhat uniform layer of dentin around the pulp cavity
Junction between 1 & 2 dentin is characterized by a sharp change in direction of dentinal tubules
Reparative dentin (Tertiary dentin):
Formed very rapidly in response to irritants such as attrition, abrasion, erosion, moderately advancing dental caries,
trauma
Forms at the pulp interface of the dentin in response to caries
Sclerotic dentin:
Results from aging & slowly advancing dental caries
The dentin tubules become calcified & obliterated, which blocks access of irritants to the pulp by way of tubules
Slide
Dentin tubules appear dark/black due to air when sectioning
Dentinal Tubules
Dentinal tubules are S-shaped in the crown due to crowding of the odontoblasts
Each dentinal tubule contains the cytoplasmic cells of an odontoblast
Primary curvatures of the dentinal tubules is LESS in root dentin than in crown dentin just memorize it
Tomes fibers: (AKA Odontoblastic Fiber) CAREFUL, Ameloblasts give off Tomes Processes
Long, slender, cytoplasmic extension arising from each odontoblast
Occupy the dentinal tubules
Dentin sensitivity is mediated by these fibers
Because of these fibers, odontoblasts are considered living tissue
Dead tracts:
Groups of dead, coagulated cytoplasmic processes of the dentinal tubules
Attributed to aging, caries, erosion, cavity preparation, or odontoblastic crowding
Shows up dark on ground section of tooth
A dead tract can form if odontoblastic processes disintegrate & leave open dentinal tubules
DEJ
Morphology of DEJ determined at the Bell stage
For whom, the BELL TOMES!
Interface between dentin & enamel
Where calcification of a tooth begins
Oldest dentin is next to DEJ

CEMENTUM:
Slightly softer & lighter in color (yellow) than dentin
Avascular and not innervated
Cementum is formed by cementoblasts from the PDL, as opposed to dentin which is formed from odontoblasts of the pulp
In order for cementum to form during root development, the epithelial root sheath (Hertwigs) must be fenestrated or
the continuity must be broken
Lines the apical foramen of a fully developed permanent tooth (Important for ENDO, dont perf the cementum)
Content:
50% inorganic (HA), 40% organic (collagen/protein), & 10% water
Similar to bone in the degree of mineralization
Collagen fibers formed from BOTH cementoblasts AND fibroblasts
Most closely resembles bone (more so than dentin) except there are no Haversian systems or BVs
Distinguished from enamel by presence of collagen fibers and the cellular component in mature tissue
Distinguished from dentin in that dentin was made by pulp cells and cementum by PDL cells
Similar to bone in that both contain cells in lacunae with canaliculi extending toward nutritional source
Secondary dentin does not contain cells
Cementum does NOT contain blood vessels
Important in orthodontics:
More resistant to resorption than alveolar bone, permitting orthodontic movement of teeth w/out root resorption
Two types of cementum (no functional difference)
Acellular cementum:
Usually predominates in the coronal 2/3 of the root. Thinnest at the CEJ
Cellular cementum: (Think C for laCunae)
Contains cementoblasts, inactive cementocytes, fibroblasts from the PDL, and cementoclasts
Occurs more frequently on the apical 1/3 of the root
Remember you need active Cementoblasts for attrition wear replacement
Usually the thickest to compensate for attritional wear of the occlusal/incisal surface & passive tooth eruption
Best diffrentiated from acellular cementum by the presence of lacunae (not by any functional difference)
Cementoid:
Peripheral layer of developing cementum (uncalcified)
Cementicles:
Calcified bodies sometimes found lying free w/in the PDL or fused w/ the cementum of the tooth
Primary cementum
Possesses lamellae (not lacunae, canaliculi, or cementocytes)
Functions:
Main function provides rough surface for attachment of Sharpeys fibers (PDL)
Compensates for loss of tooth surface due to occlusal wear by apical deposition of cementum throughout life (apposition of
apical cementum)
Protects the root surface from resorption during vertical eruption & tooth movement
Reparative function of cementum allows reattachment of CT following periodontal treatment
Replaces resorbed dentin or cementum
Pulp
Mature Pulp is composed of primarily Loose CT
25 yr old has pulp characterized as Loose CT
Anatomy
Derived from Dental Papilla (mesoderm)
After the tooth is formed, the dental papilla remains as the dental pulp
Coronal pulp
Located in the pulp chamber and pulp horns
Radicular pulp
Located in pulp canals
Apical foramen
Communicates w/ the PDL
Local resorption/deposition of cementum & local resorption of dentin may change the position/shape of apical foramen
Accessory canals
Extend from pulp canals through root dentin to PDL
Formed by a break in the (Hertwig) epithelial root sheath
Central Zone (pulp proper)lined peripherally by specialized odontogenic area which has these zones (inner to outer):
Pulpal core similar to cell-rich zone
Cell-rich zone contains fibroblasts (most abundant cell type in the pulp)
Cell-free zone (of Weil) Capillary and Nerve plexus (Plexus of Raschkow)
Odotoblastic layer contains odonotblasts and lies next to the predentin and mature dentin
Nerve Fibers
Principle types of nerves in the pulp are sympathetic & afferent fibers
Free nerve endings are only type of nerve ending (which is a specific receptor for pain). Therefore, the only type of
response the pulp can give is pain regardless of the stimuli (pressure, cold, heat).
Myelinated fibers = afferent
Unmyelinated fibers = vasomotor
Proprioceptors NOT found in pulp.
Age changes in pulp:
Decrease in:
Intercellular substance, water, & cells
Size of pulp cavity due to secondary &/or tertiary dentin
Number of reticulin fibers
Increase in:
Number of collagen fibers
Calcifications w/in pulp (called denticles or pulp stones)
Denticles:
True: complete w/ tubule and processes
False: amorphous in structure
Free: unattached to outer pulpal wall
Attached: attached at dentin-pulp interface
Pulp capping
More successful in young teeth because:
Apical foramen of a young pulp is large
Contains more cells
Is very vascular
Has fewer fibrous elements
More tissue fluid
Note: Young pulp lacks collateral circulation
Alveolar Process
Alveolar bone proper: (aka: cribriform plate or lamina dura) (SOCKET)
Part of alveolar process which immediately surrounds root of tooth & to which the fibers of PDL are attached
Has minute openings which provide passage for vascular nerve components
During growth and development of the alveolar process, osteoblasts, osteoclasts, and osteoid are present
Resorbs when subjected to pressure
What causes alveolar bone development?
Tooth Growth, w/o teeth it wont grow
Consists of:
1) Compact lamellar bone
2) A layer of bundle bone
Sharpeys fibers insert into this layer
Supporting alveolar bone:
Surrounds the alveolar bone proper & gives support to the socket
Consists of:
Cortical plate (compact lamellar bone)
Forms outer & inner plates of the alveolar processes
Thicker in Mn than Mx
Spongy bone (cancellated bone):
Fills in area between cortical plates of bone
This type of bone is not present in anterior region of mouth here the cortical plate is fused to the cribriform plate
This is also true over the radicular buccal bone of the maxillary posteriors
NOTE: Alveolar bone proper is the only essential part of the bone socket supporting alveolar bone is not always present
Mandible
Growth is appositional
Bone can only grow appositionally, but cartilage can grow appositionally or interstitially
Causes the formation of resting lines during growth of Mn
During active tooth eruption there is apposition of bone on all surfaces of the alveolar crest and on all walls of the bony socket???
The bone formed at the base of the socket is usually in the form of horizontal trabeculae
The best theory describing the force needed for active eruption is from the cells and fibers of the PDL pulling the tooth out
Permanent teeth move occlusally and buccally when erupting
Break in the mandible from a baseball at the mental foramen, which way will the muscles
pull the fragments
Large anterior and superior Small Inferior and Posterior
When you open your mouth, the buccal vestibule is squashed by the Coronoid process
Apical abscesses
Mn M2s & M3s have a marked tendency to produce cervical spread of infection most
rapidly
Attachment of muscles may determine the route that an infection will take, channeling the
infection into certain tissue spaces
Mandibular Teeth
Infections perforate below the buccinator
Swelling of the lower of the face
Infection will spread medially (lingually) from the Mn into the submandibular space & masticatory spaces
It pushes the tongue forward and upward
Further spread cervically may involve the visceral space and lead to edema of the vocal cords and airway obstruction
Molar abscess will reach the floor of the mouth by continuous spread until the lingual attachment of the mylohyoid m.
Swelling at the angle of the mandible is from the deflection of exudates from the mylohyoid m.
Tooth #32 is infectedinfection spreads to parotid, buccopharyngeal, & masseteric fascial spaces, NOT the temporal
In Hep C pt, Tooth #28 needs to be extractedWhich is a life-threatening sequelae of that txLudwigs Angina
Alpha delta fibers are responsible for sharp pain
Maxillary teeth
Perforate the bone above the buccinator attachment
Cause swelling of the upper of the face (which will eventually spread to the entire face)
Lingual spread
From infected Mn premolar or molar teeth into floor of mouth when above the level of attachment of the
mylohyoid m.
This is due to the mylohyoid line position relative to roots of premolars & molars search it in the Dental Anat file
Below the mylohyoid, it would drain into the submaxillary/submandibular space
Ludwigs Angina
Cellulitis, usually of odontogenic origin, bilaterally involving the submaxillary, sublingual, and submental spaces, resulting in
painful swelling of the floor of the mouth, elevation of the tongue, dysphasia, dysphonia, and (at times) compromise of the
airway hence the life-threatening part
Mesial Drift (or in mesial tilting during orthodontic movement):
Coronal half of the Mesial root wall shows resorption from osteoclastic activity
Coronal half of the Distal wall of the root shows deposition from osteoblastic activity
Similar situation: loosening & tightening of primary tooth before its lost
Alternate resorption (clasts) and apposition (blasts) of cementum and bone

TOOTH HISTOLOGY
First sign of tooth development (seen in histo sections) occurs in 6th week in utero (pictures)
Tooth development appears to be initiated by the mesenchymes inductive influence on the overlying ectoderm
In 6th week there is a thickening of the oral epithelium (derivative of the surface ectoderm)
These thickenings or U shaped bands are called the dental lamina and follow the curve of the primitive jaws (20)
At certain point on dental lamina, the ectodermal cells proliferate and produce swellings which become the enamel organ
Inside the depression of the enamel organ is an area of condensed mesenchyme becomes the dental papilla
Surrounding both the enamel organ and dental papilla is a capsule-like structure of mesenchyme called the dental sac
Enamel organ separates from the dental lamina AFTER the layer of dentin is deposited
Each tooth is the product of two tissues that interact during tooth development 1) oral epithelium & 2) underlying ectomesenchyme
The epithelium grows down into the underlying ectomesenchyme to form small areas of condensed mesenchyme, which become
tooth germs
Sequence of Tooth Histogenesis
The ectomesenchyme influences the oral epithelium to grow down into the ectomesenchyme
Elongation of inner enamel epithelium
This triggers the mesenchymal cells to differentiate into odontoblasts
Differentiation of odontoblasts
Deposition of first layer of dentin
Deposition of first layer of enamel
Deposition of root dentin and cementum
Stages of Histogenesis
Initiation (Bud Stage):
Initial interaction between oral epithelium and mesenchyme (ectomesenchyme), formation of dental lamina
Congenitally absence of teeth results from an interruption in this phase
Fused or geminated teeth occur during initiation and proliferation stages of tooth development
Proliferation (Cap stage):
Shape of tooth becomes evident, enamel organ is formed
Differentiation (Bell Stage):
Final shaping of tooth; cells differentiate into specific tissue-forming cells (amelo-, odonto-, cemento-, & fibroblasts) in
emanel organ
Histodifferentiation and mophodifferentiation occur during this stage
DEJ determined at this stage For whom the BELL TOMES
Forms the DEJ (the 1st structure formed by tooth but that remains in the fully developed tooth not IEE)
Apposition:
Cells that were differentiated into specific tissue forming cells begin to deposit the specific dental tissue
**Dentinogenesis imperfecta & amelogenesis imperfecta occur during histodifferntiation
Terms of Dentinogenesis
From Top of Diagram to bottom
Oral Epithelium
Epithelial layer on top
Dental Lamina
Stem connecting the Oral Epithelium to the Enamel Organ
Tooth Germ
Enamel Organ, Dental Papilla, Dental Sac (not successional lamina)
Enamel Organ
Derived from ectoderm
Gives rise to enamel and Hertwigs Root Sheath
4 Layers of Enamel Organ (not in order):
1) Outer enamel epithelium (OEE)
Outer cellular layer
Outlines the shape of future enamel organ
2) Inner enamel epithelium (IEE)
Innermost layer
Cells will become ameloblasts
Essential for the initiation of dentin formation (ameloblasts stimulate dentin formation)
1st formed in a partially erupted central incisor (among 1/2 cuticles, stellate reticulum, stratum intermedium)
3) Stratum Intermedium
Lateral to IEE
Essential to enamel formation (nutrients for the ameloblasts of IEE), but does not actually secrete the
enamel
Ameloblasts will only form enamel when stratum intermedium is present
4) Stellate Reticulum
Central core and fills bulk of organ
Contains lots of intercellular fluid (mucous type rich in albumin) which is lost prior to enamel deposition
Disturbances during morphodifferentiation of the enamel organ affect the shape of the tooth
IEE & OEE of enamel organ come together in the neck region and form Hertwigs root sheath
After enamel formation, all 4 layers become 1 and form the Reduced Enamel Epithelium
The reduced enamel epithelium & oral epithelium fuse to form the initial junctional epithelium
Very important in forming the dentogingival junction, where the enamel & epithelium meet as tooth erupts
This forms initial junctional epithelium (attached epithelium joining gingiva to tooth)
Dental Sac (aka Dental Follicle)
Derived from mesenchyme (derived from neural crest cells) NOT from oral epithelium
Gives rise to the cementum, PDL, and alveolar bone proper (aka attachment apparatus)
The embryonic precursor to cementoblasts
Surrounds the tooth germ (enamel organ/dental papilla)
Dental Papilla
Derived from mesenchyme (derived from neural crest cells)
Gives rise to the dentin and pulp
Triangular shaped inside the bell stage under the enamel organ
Peripheral cells of dental papilla differentiate into odontoblasts which produce predentin (calcifies to become dentin)
Center of dental papilla will become dental pulp
Epithelial Diaphragm
Multiple root formation follows unequal proliferation of the epithelial diaphragm okay
Hertwigs Epithelial Root Sheath
Sheath is formed by the joining of the IEE & OEE
After crown formation, the root sheath grows down
It shapes the root of the tooth & induces formation of root dentin (stimulates differentiation of odontoblasts)
Uniform growth of this sheath will result in the formation of a single rooted tooth
Medial outgrowths or evaginations of this sheath will produce multi-rooted teeth
???OLD TEST (1987) The # of roots formed is determined by the number of medial ingrowths of the cervical loop
Hertwigs epithelial root sheath is characterized by:
1) The formation of cell rests (rests of Malassez) in the PDL when the sheaths functions have been accomplished
2) The absence of stellate reticulum and a stratum intermedium
Cementogenesis:
After first root dentin is deposited, the cervical portion of Herwigs root sheath breaks down
This new dentin comes in contact w/ the dental sac
This communication stimulates cells fibroblast cells from the dental sac to differentiate into cementoblasts which
produce cementum
Accessory root canals are formed by a break or perforation in the rooth sheath BEFORE the root dentin is deposited
Epithelial Rests of Malassez
Are remnants of Hertwigs epithelial root sheath
Fate
Some degenerate and others calcify or become cementicles
Persistent rests can be found as groups of epithelial cells in the PDL
Continuity of Hertwigs epithelial rooth sheath must be broken in order for cementum to be deposited during tooth development
Tomes Granular Layer
Formed by odontoblasts that produce an organic matrix
Found in radicular dentin and lies just beneath the cementum
So, the granular layer (Tomes) makes the root dentin readily distinguished from crown dentin
**Interglobular dentin differs from Tomes granular layer in that interglobular dentin usually occurs a short distance
inside the DEJ and represents hypocalcified areas
Partial Anodontia (Hypodontia)
Radiograph of 10 year pt where 2 succedaneous teeth are missing

PDL & GINGIVA


PDL
0.2mm wide
Thickness depends on:
Age (decrease 0.1mm in old agedue to deposition of cementum & bone)
Stage of eruption
Function of the tooth
(PDL is thin and irregular principle fibers on teeth that lose their function)
Thicker in areas of tension than in areas of compression. (Think its getting stretched out, so it is going to be taller in
these areas.
Thickest in the Apical region of a tooth
Vital to the functional life of a tooth because it:
Contains nervous and vascular elements
Allows for physiologic movement of the tooth
Provides a cellular source for new cementurn and bone
Derived from the dental sac!!!!!
Connects cementum to alveolar bone
Contains remnants of Hertwigs root sheath (Rests of Malassezcalled cementicles when calcified)
Sharpeys Fibers terminal portion
Diameter greater on bone side vs. cementum
Only consist of Collagenous fibers, NOT reticular or elastic
Insert into Bundle Bone and Cementum
Function of PDL:
Physical
Attachment of tooth to bone via principal fibers
Formative
Formation of CT components by activities of CT cells (cemento-, fibro-, and osteoblasts)
Remodeling
By activities of CT cells (blast vs. clast of above cells)
Nutritive
Through BVs
Sensory
By CN V
Proprioceptive & tactile sensitivity
PDL and its hard tissue anchorage in terms of resisting occlusal force:
Anterior teeth have slight or no contact in the ICP
Occlusal table is < 60% of the overall faciolingual width of the tooth
Occlusal table of the tooth is generally at right angles to long axis
Crowns of Mn molars are 15-20 lingually inclined
Hence roots are positioned more facially for these teeth
Following loss of tooth function:
One may expect a reduction in width & loss of regular arrangement of principal fibers???
Like pulling a yarn taut???
PDL & nerves
2 Types
Free, unmyelinated endings convey PAIN thats cold test takes a long time to react
Encapsulated, myelinated convey PRESSURE Think fast jaw jerk reflex
PDL contains:
Cells
Osteoblasts, fibroblasts, Macrophages, Cementoblasts, etc.
BVs
Lymphatics
Extracellular substance of fibers (gingival and principal)
The principal fibrous elements of the PDL in adults is chiefly collagen
Ground substance
Mostly proteins and polysaccharides
Oxytalan fibers
Related to the microfibrillar component of elastic fibers
Run parallel to root surface
Gingival fibers (5) (picture)
General features:
Collagen fibers that provide support for the marginal gingival including the
interdental papilla
Found w/in the free gingiva.
Continuous w/ the CT fibers and are often considered part of the ligament (PDL)
Circumferential (circular) fibers (A)
Encircle the tooth around the most cervical part of the root
Insert into cementum & lamina propia of the free gingiva & alveolar crest
Resist rotational forces
Transseptal fibers (BELOW A)
Extend from tooth to tooth (cementum to cementum), coronal to alveolar crest
Are embedded into the cementum of adjacent teeth
Not on the facial and no attachment to the alveolar crest
Maintain dental arch integrity
Classified w/ principal fibers of PDL (AKA collagenous fibers).
Are included in the Interdental Ligament
Dentogingival fibers (B)
From the cementum apical to the epithelial attachment; course laterally & coronally
into gingival lamina propria
Dentoperiosteal fibers (C)
From the cervical cementum over the alveolar crest to the periosteum of the cortical plates of bone
Alveologingival fibers (D)
Insert in crest of alveolar process and spread out through the lamina propria into the free
gingiva

Principal Fibers of the PDL(5) (picture)
General features:
Composed of Type I collagen
Sometimes classified as belonging to general group of alveolodental fibers
Connect the cementum to the alveolar bone
Never found in contact w/ enamel
Alveolar crest fibers (B)
From cervical cementum to the alveolar crest
Function to counterbalance the occlusal forces on the more apical fibers and resist
lateral movement
Horizontal Fibers (C)
Perpendicular from alveolar bone to cementum
Resist lateral forces
Oblique fibers (33%) (D)
Most numerous
Insert into cementum and extend occlusally and obliquely into the alveolus
Resistant to forces along the long axis of the tooth (masticatory)
Found usually in middle 1/3 of root
Apical (E)
Offer initial resistance to tooth movement in occlusal direction
Interradicular fibers (F)
Only in multi-rooted teeth
Extend from cementum in furca are to bone w/in furca area
Gingival apparatus
Term used to describe the 5 gingival fiber types and the epithelial attachment
Gingival Ligament
Includes the dentogingival, alveologingival, and circumferential fibers

GINGIVA
The gingiva offers protection against bacterial invasion, the most important factor in this protection being that the surface
epithelium is highly impervious
Free Gingiva (aka marginal gingiva)
Collar of tissue that is not attached to the tooth or alveolar bone
1-3mm wide & forms the soft tissue wall of the gingival sulcus next to the tooth
Extends from free gingival groove to gingival margin
Structures:
Gingival Margin
1mm band of gingiva that forms immediate collar around the base of the tooth
Gingival Sulcus
Areas between the unattached gingiva and the tooth (where popcorn kernels go)
Above junctional epithelium (JE) continuous w/ JE, but structurally different
Epithelium is non-keratinized (same w/ gingival col)
Most vulnerable to inflammation
Healthy sulcus should NOT have rete pegs (rete pegs indicate inflammation)
Cells of the sulcular epi are joined TO EACH OTHER by desmosomes
Epithelial attachment (Junctional epithelium)
As supragingival plaque/calculus continues apically, it first would disrupt the attachment of the junctional epithelium
Joins the gingiva to the tooth
Inner layer of cells of JE attach gingiva to tooth
Cells of the epithelial cuff attach to enamel or cementum by means of hemidesmosomes
Internal basal lamina (**Basal lamina like structure)
Does NOT contain rete pegs as the superior apex of the free gingiva does
**Dentojunctional epithelium
Gingival epithelium that faces the tooth
Includes both Sulcular and Junctional
Interdental Papilla
Portion of the free gingiva that fills the IP embrasures below contact area
Consists of 2 papillae that are connected by the concave-shaped interdental col
Interdental col
Conforms to the shape of the contact area
Not present in teeth w/o contact
Non-keratinized
Blood vessels of the interdental papilla anastomose freely with BOTH periodontal & interalveolar vessels
Attached Gingiva
Part of the gingiva that is attached to the underlying periosteum of alveolar bone & to cementum by CT fibers & epithelial
attachment
NO submucosa
Present between the free gingiva & the more movable alveolar mucosa
Parakeratinized (with nuclear remnants in stratum corneum)
Masticatory Mucosa is Parakeratinized except with Dentures
Soft palate, skin of lips, floor of mouth & ventral tongue are NOT parakeratinized
Stippled
Extends from the mucogingival junction to free gingival groove
Mucogingival Junction
Separates the attached gingiva and the alveolar mucosa
Joins lining mucosa & masticatory mucosa
Free Gingival Groove
Separates the free gingiva from the attached gingiva
Is related to the arrangement of the supraalveolar fibers (not probe depth measurement, alveolar crest, or degree of PD health)
Oral Mucosa
Covers all oral surfaces except the teeth
2 Layers:
Stratified squamous epithelium
Keratinized
Nonkeratinized
Parakeratinized
Lamina Propria
CT that supports the epithelium
2 Layers
Papillary
Reticular
Attached to the periosteum or interposed over the submucosa (glands, BVs, nerves)
In the hard palate & gingiva, the lamina propria attaches directly to bone without an intervening submucosa
(not so for the soft palate)
Gingiva differs from alveolar mucosa in that it has high connective tissue papillae
Specialized Mucosa
Covers the dorsum of the tongue and taste buds
Non-keratinized (most of the dorsum of the tongue is keratinized, right?)
Masticatory Mucosa
Free gingiva, hard palate, attached gingiva, interdental gingiva
Keratinized
Beneath lies the lamina propria (dense, thick, firm CT containing collagenous fibers)
Lining or Reflective Mucosa
Inside of lips, cheek (buccal mucosa), vestibule, lateral surface of alveolar process, floor of the mouth, soft palate, ventral tongue
Thin, movable
Nonkeratinized, stratified squamous epi
Lamina Propia no glands in the lamina propria of the floor of the mouth
Submucosa
Periodontium
2 functional units:
Gingival unit
Free gingiva, attached gingiva, and alveolar mucosa
Attachment apparatus
Cementum, PDL, and alveolar bone proper

TMJ
TMJ
A diarthrodial joint that has a (fibrous CT- 1996 exam) (fibrocartilage -decks) on its articular surfaces (NOT hyaline)
Most diarthrodial joints are covered by hyaline cartilage
The articular surface of the condyle AND the posterior slope of the articular eminence have the same fibrous CT covering
Joint cavity is lined by a synovial MB & enclosed by a fibrous capsule
Divided into two compartments by an articular disc ALSO MADE OF FIBROCARTILAGE
The TMJ of a child contains Undifferentiated Mesenchyme cells, then Cartilage layer under the Fibrocartilage
TMJ Nutrients Hyaluronic acid of the Synovial fluid (produced by synovial membrane), feeding the articular cartilage
12 weeks condylar cartilage is present at the most superior aspect of the ramus
The condylar cartilage persists as the cartilage zone of the mature condyle, contributing to its adaptation potential
12 weeks The embryonic CT (Mesenchymal) between the growing condyle and temporal bone condenses to form the articular
disc
13 weeks Cavitation forms the lower joint compartment then the upper compartment
14 weeks Joint development complete
Structures
Articular Surface of temporal bone
Articular fossa (or glenoid fossa or mandibular fossa) concave
In older people is covered with Fibrous CT with Chondrocytes
In young adults the articular zone has
Articular zone of Fibrous CT
Proliferation zone of undifferentiated Mesenchymal cells UM
Cartilage zone
Articular Eminence convex
Is the anterior surface/boundary of the Mandibular (glenoid) fossa
42 yr old female with Hx of hyperPTHism, bilateral pain in TMJ, ears clogged and ringing
The region of the articular surface that is most likely missing is the Proliferative zone (I have no idea why!)
See 2001 Pilot Q 366
Condyle
Posterior aspect of the condyle is rounded & convex, whereas the anteroinferior aspect is concave
Posterior aspect of the condyle can be palpated by way of the external auditory meatus
Growth of the condyle allows for the space needed for erupting teeth
Condyle is broken through the pt. fovea?, there is no necrosis, what artery is supplying the tissue? Superficial
Temporal artery
Articular disc (meniscus)
Consists of fibrocartilagenous (Fibrocartilage) tissue, which resembles dense, irregular CT that may be associated w/
chondrocytes, capable of providing smooth articulating surface
Meniscus is a biconcave oval plate
Divides the joint into two spaces:
Superior joint space bounded by articular fossa & articular eminence
Sliding Motion occurs between the disks & articular eminences
Inferior joint space bounded below by the condyle
Rotational Motion
Meniscus varies in thickness, the thinner, central intermedia zone separates the thicker anterior & posterior bands
Posteriorly, the meniscus is continuous w/ the posterior attachment tissues called the bilaminar zone which is vascular,
innervated tissue that plays an important role in allowing the condyle to move forward
NOTE: the bilaminar zone is the most vascular portion of the articular disc (NOT the posterior band)
Posterior-inferior lamina of bilaminar zone has a very dense collection of elastic fibers (1999Q23 confirmed
JC?)
Retrodiscal Pad Area
Elastic fibers
Venous plexus well-vascularized structure of the TMJ
Collagen fibers
Loose connective tissue
NOT Hyaline Cartilage
Nonarticular surfaces of the TMJ are covered w/ synovium or periosteum (dont get clowned by the non part)
Articular capsule
Surrounds the joint
Attached above to the articular eminence (tubercle)
Attached at margins of the mandibular fossa & below the neck of the Mn
Synovial MB lines the capsule in the superior & inferior spaces of the joint Synovial MB also produces the synovial
fluid for the joint.
It does not cover the articular surfaces of articular discs
Innervated (all sensory, no motor) by the Auriculotemporal (posterior portion), the masseteric (anterior), and the
posterior deep temporal (anterior as well as temporalis m.) (ALL V3). (Think- information from the MAP)
Ligaments (picture)
Temporomandibular ligament
Is the only ligament that gives direct support to the capsule of the TMJ
Aka: lateral ligament
Runs from articular eminence to the Mn condyle
Provides lateral reinforcements for the capsule
Prevents posterior & inferior displacement of the condyle
Sphenomandibular & stylomandibular ligaments
Are considered accessory ligaments responsible for limiting Mn movement
Sphenomandibular ligament attached to the lingula of the Mn and the spine of the sphenoid bone
Most often ligament damaged in an IA nerve block (tested again & again)
Stylomandibular ligament attached at angle of the Mn
Muscles
Lateral pterygoid muscle:
Superior head:
Origin: Infratemporal surface of sphenoid bone
Insertion: TMJ capsule & articular disc
Inferior head:
Origin: Lateral surface of pterygoid plate
Insertion: Neck of the Mn condyle
Actions:
Protrude, depress (open), laterally move Mn
Innervation
Auriculotemporal nerve, Masseteric, and Posterior Deep Temporal in the capsule and around the periphery of the disc
NOTE: the auriculotemporal nerve carries pain, touch, temperature, & proprioceptive modalities to the TMJ
The TMJ, as w/ all joints, receives no motor innervation
The muscles that move the joint receive the motor innervations
Branchiometric motor fibers innervate the temporalis, pterygoids, anterior belly of digastric, mylohyoid, & tensors
Treatment
TMJ should be evaluated for tenderness and noise
The joint is palpated laterally (in front of the external auditory meatus) w/ the Mn in closed and open position
The joint is palpated posteriorly (through the external auditory meatus) w/ the Mn in closed and open position
Things to note:
Tenderness and sensitivity
Joint noises
Mn range of motion
Normal range of movement of adult Mn ~50 mm opening & ~10 mm protrusively & laterally
Magnetic resonance imaging (MRI):
Best imaging modality for identifying position of articular disc of the TMJ
Gold standard for soft tissue, especially the position of the articular disc
Utilizes magnetic field to alter energy levels of primarily the water molecules of soft tissue
Results in good visualization of various soft tissues, including articular disc
Major advantage of MRI is that there is no radiation involved
No harmful effects have been demonstrated
Panoramic, CT, & lateral transcranial radiographs are used to evaluate the bony structures of the TMJ
Problems
Dislocation (luxation)
May occur w/ one or both condyles
Relaxation of the supporting ligaments occasionally allows condyle to extend anteriorly beyond normal open position
May be manifested by true luxation that requires assistance for reduction
Or, it may be merely an overextended excursion anteriorly that is self-reducing (subluxation)
TMJ can only be dislocated anteriorly
Anteromedial most common direction in which the articular disc in the TMJ can be displaced
A click sound is usually demonstrated when this happens
Articular disc is seated on condyle & held in place by collateral ligaments (attached to medial & lateral poles of the condyles)
Muscle fibers from the lateral pterygoid muscle are attached to the anterior portion of the articular disc
Reduction of the dislocation
Is done by standing behind pt w/ thumbs inside mouth and the index fingers below chin
Thumbs depress the back of the jaw, and the chin is elevated by the index fingers
The head of the condyle will then slide back into the articular fossa
42 yr old female with Hx of hyperPTHism, bilateral pain in TMJ, ears clogged and ringing
The region of the articular surface that is most likely missing is the Proliferative zone (I have no idea why!)
Sounds
Click best describes sound associated w/ a disc displacement w/ reduction
Crepitation sound (crepitus) usually associated w/ a degenerative process (osteoarthritis) of the condyle
Dull thud usually associated w/ self-reducing subluxation of the condyle
Tinnitus ear ringing

BLOODaqui quede
- Fluids in general:
o Extracellular fluid (Na-142; K-4) vs intracellular (Na-10 K-140)
o Fluid: 50-60% of body weight

Intracellular fluid (w/in cells) = 35-40% of body weight

Extracellular fluid (outside the cells) = 15-20% of body weight
Blood plasma = 4-5% of body weight
Interstitial fluid = 11-15% of boby weight
o Transcellular fluids: 1-2 Liters; CSF, intraocular, synovial, pericardial, pleural, peritoneal
o Tissue (interstitial) fluid contains a small % of plasma proteins of low MW that pass through the capillary walls as a consequence
of hydrostatic pressure of blood. This fluid bathes the cells
- Blood
o 8% of total body weight
o Volume = 4-6 liters
o Temp = 38C
o pH = 7.35-7.45
- Blood composition
o 55% plasma:

91% water

7 % protein
Albumins 55%
Globulins 38%
Fibrinogen 7%

2% other solutes
Metabolic end products, food materials, respiratory gases, hormones, ions
o 45% formed elements:

1) Erythrocytes 4.3-5.8 million/mm3
Proerythroblast erythroblast normoblast reticulocyte erythrocyte
Biconcave, enucleated discs 7-8m in diameter
o Contain heme (an endogenous pigment)
o Biconcave shape increases surface area 20-30%
o High surface area : volume ratio
No MB-bound organelles
Energy source is glucose
o 90% from anaerobic metabolism degraded to lactate
o 10% from HMP shunt
Function = O2 & CO2 transport
o Oxyhemoglobin = hemoglobin molecule + O2
o Carbaminohemoglobin = hemoglobin + CO2 (~70% of CO2 is transported as bicarbonate ions)

Remember Carboxyhemoglobin is CO
RBC MB contains chloride-bicarbonate antiport allows transport of CO2 to lungs for elimination
Hematocrit = proportion of erythrocytes in a blood sample
o 46%, for males, 40% for females
Formed via erythropoiesis stimulated by erythropoietin produced in kidney
o In erythropoiesis, the cytoplasmic acidophilia increases (Duh, they become more red )
o In erythropoiesis, cells trend toward:

A progressively smaller size

A progressive loss of organelles

A progressive increase in cytoplasmic Hemoglobin concentration
Average life span = 120 days
o Normoblast is a developmental stage of the erythrocyte (not monocyte, lymphocyte, or eosinophil)
Shrink and crenate in hypertonic solution
Become ghost cells in hypotonic solution
Erythrocytosis = polycythemia = # of RBCs
Anisocytosis = varying sizes
Poikilocytosis = varying shapes

2) Platelets 250-400k/mm3
Cytoplasmic fragments of cells that promote clotting (as part of hemostasis)
o Thrombopoietin stimulates megakaryocytes to give rise to platelets
Minute, irregularly shaped, disk-like cytoplasmic bodies found in blood plasma
No nucleus, DNA or hemoglobin
Life span is 5-9 days removed in spleen & liver
Stop blood loss by forming a platelet plug
Contain secretory vesicles (granules), which release ADP & others chemicals when platelets adhere to collagen
o Induces changes that make platelet surface sticky
o Additional platelets adhere to original platelets to form plug
Thromboxane A directly promotes platelet Aggregation
o Where PGI inhibits Platelet grouping

3) Leukocytes 5-10k/mm3
Neutrophils 60-70% [of leukocytes] in a differential blood count
o More recent #s say 40-75%
o Lobed nucleus, fine granules
o Large, spherical azuriphilic 1 granules (lysosomes)

Contain hydrolytic enzymes, lysosyme, myeloperoxidase, & lactoferrin
o Function = phagocytosis (they love to ingest bacteria)
o Nucleus becomes more hyperchromatic during the development in the red bone marrow
o Neutrophils w/ > 5 lobes are called hypersegmented
Lymphocytes 20-30% (agranulocytes)
o Round nucleus, little cytoplasm
o Function = produce Ab, destroy specific target cells
o T cells:

Differentiate in the thymus

Account for 70-80% of circulating lymphocytes

Produces cell-mediated immunity

Interact w/ specific antigen, become sensitized & differentiate into several types of daughter cells:
Helper T cell (CD4)helps activate other T lymphocytes
Cytotoxic T cell (CD8)combines w/ Ag on surface of foreign cell causing lysis & cytokine release
Suppressor T cellsuppresses activation of immune system maintains hemostasis & tolerance to self
Memory T cellremains inactive until 2nd exposure to same Ag then reproduce to mount a faster
reaction
o Aka delayed hypersensitivity T cell
o B cells:

Differentiate in bone marrow

20-30% of circulating lymphocytes

Antibody immunity

Once activated by/sensitized to Agdaughter cells that either make Ab/s or become memory cells

Memory B cellsplasma cells (after 2nd exposure to Ag)

Can function as an APC via MHC Class II
o Plasma cells:

Differentiated from B-cells

Found mainly in bone marrow and CT; and sometimes blood

Off-center nucleus & clock-face chromatin distribution

Short 5-10 day life

Specific immunity
Aid in the immunologic defense of the body (NOT mast cells, neutrophils, giant cells)
Plasma cells (NOT T-cells or B-cells) produce most of the bodys Ab/s

Contain large amount of rough ER & well-developed Golgi apparatus (Same with Mucous secreting Goblets)

Are found in the inner medullary center of lymph nodes (aka Medullary Cords)
Monocytes 2-6% (agranulocytes)
o Kidney-shaped nucleus (Crescent Moon shaped)
o Differentiates into macrophages in tissues
o Function = phagocytosis
Eosinophils 1-4%
o Lobed nucleus, red or yellow granules
o Function = may phagocytize Ab-Ag complexes
o Contain histiminase, acid phosphatase, and aurosulfurnimase
Basophils 0-1%
o Obscured nucleus, purple granules
o Function = release histamine, heparin, serotonin, & SRS-A (slow reacting substance of anaphylaxis)
o Similar to mast cells w/ coarse cytoplasmic granules

Granules contain heparin (anticoagulant), histamine (vasodilator) and bradykinin, serotonin, & SRS-A (slow
reacting substance of anaphylaxis)

Heparin can prevent blood coagulation & can speed the removal of fat particles from blood after a fatty meal

Occur in most loose CT, especially along the path of BVs
o NOTE: serum = blood plasma w/o fibrinogen

- Bone marrow:
o Produces WBCs, RBCs & platelets by hematopoiesis
o Red marrow:

Cavities of cranial bone, vertebrae, ribs, sternum, & ends
of long bones

Prior to birth, other areas produce blood elements: liver,
spleen, lymph nodes

Hemacytoblasts (pluripotent stem cells):
So, the principal site of granulocytic hemopoiesis in the
adult human is red bone marrow
o Yellow marrow:

Found only in cancellous (spongy) tissue of certain bones:
Flat skull bones, ribs, sternum, vertebrae, portions of
ossa coxae & proximal epiphyses of humerus & femur

Minor location of fat storage

Blood vessel walls:


Tunica intima
Innermost layer
Consists of simple squamous epithelium (endothelium) and a thin CT basement MB
ONLY layer present in all vessels
In atherscletotic pt, this is the layer involved in the hypertrophy
Tunica Media
Middle Layer
Usually very thick in (smooth muscle w/ some elastic fibers). In Lg , elastic fibers are most prominent. In small , smooth
muscle is most prominent in this layer.
What keeps blood flowing during diastole energy stored in elastic fibers of
Tunica Externa (Adventitia)
Outer layer of CT w/ elastic & collagenous fibers
The tunica adventitia of the medium sized artery has mostly what? collagen and elastin
In larger vessels, infiltrated w/ tiny BVs called vasa vasorum (vessels of the vessels) that nourish external tissues of BV
wall

Highest BP found here


Greatest drop/change/gradient in BP is from the to the arterioles
There are more elastic membranes in a large artery than there are in a medium-sized artery
Arterioles
Very small diameter (<0.5mm)
Small lumen, thick tunica media almost entirely of smooth muscle, little elastic tissue
Has the greatest proportion of smooth muscle thickness when compared to the size of the lumen
Other choices: large (dont get clowned), capillaries, veins
Smooth muscle (fibers, with single, centrally-placed nuclei) dilation/constriction is caused by neurochemical stimuli & has
profound impact on peripheral resistance
Can empty in toSinusoids in certain tissues (liver, spleen, pituitary, adrenal, carotid body, pancreas, parathyroid not in
kidneys, they just have a portal system
Sinusoids are wider & more irregular than capillaries
Walls consist of phagocytic cells, from part of reticuloendothelial systemdeals w/ phagocytosis & Ab formation
Capillaries
Exchange occurs here
Endothelium only (no tunica media or adventitia)
Which is seen continuously throughout Circulatory system? ENDOTHELIUM
Constant lumen & complete endothelial lining (unlike sinusoids)
NO elastic fibers
One RBC at a time
Velocity of blood is slowest here
Aorta:
Tunica media is composed primarily of elastic fibers (distinguishing factor between aorta & )
Has four parts:
1) Ascending aorta:
Beginning portion, R & L coronary branch from it (to supply heart muscle)
Syphilis aneurysm occurs here
2) Arch of Aorta:
Gives rise to 3 Branches that supply all of the blood to the head, neck, and upper limbs:
Brachiocephalic
Extremely short
1st branch of aorta
At the neck it divides into the Right Common Carotid and right Subclavian artery
***Only 1 Brachiocephalic artery, BUT 2 Brachiocephalic veins Dont get clowned.
Left common carotid
Along w/ right common carotid, supplies head and neck
SEE BELOW
Left Subclavian
Along w/ right subclavian, supplies upper limbs
SEE BELOW
3) Thoracic portion:
From T4T12 (lies in the posterior mediastinum)
All of the arterial branches from this part are small See pps. 70, 116 of Essential Clinical Anatomy 2nd Ed. (ECA)
Posterior Intercostals
Supply intercostal, serratus anterior, and pectoral muscles
Anastomoses w/ Internal Thoracic (Subclavian) when it gives off the Anterior Cutaneous artery
At the mid-axillary line, give rise to Lateral Cutaneous artery
Subcostals
Supply the thorax & the diaphragm
Pericardial braches
Mediastinal branches
Esophageal branches
Bronchial branches
Superior Phrenic (at the level of the diaphragm)
4) Abdominal portion: (SEE BELOW)
Most common location for an atherosclerotic-induced aneurysm
From T12L4
Branches to:
(Unpaired)
Celiac Trunk
Superior Mesenteric
Inferior Mesenteric
NOTE: Spleen, stomach, pancreas & appendix are supplied by the 3 unpaired aortic branches (not
adrenals)
(Paired)
Suprarenal NOT From unpaired
Renal
If the renal artery is occluded, you are likely to get 2ndary HTN
Gonadal
Lumbar
Terminates w/ branching of:
Right Common Iliac
Left Common Iliac
Small Middle Sacral artery
Supply abdomen, pelvic region & lower limbs
Common Carotid: (FROM ABOVE)
Supplies head & neck
Branches into ICA & ECA at superior border of thyroid cartilage
Another Q: Branches at the level of C4 or the Hyoid bone
Carotid Sinus
Spindle-shaped dilation located at junction of ICA & ECA
Has baroreceptors for pressure when stimulated causes vasodilation, HR, & BP
Innervated by carotid sinus branch of CN IX (only 1 because its just a sinus, not a whole body)
Carotid sinus syndrome: temporary loss of consciousness accompanying convulsive seizures
Due to intensity of carotid sinus reflex when pressure builds in one or both carotid sinuses
Carotid body:
Lies posterior to the bifurcation of the Common Carotid
Innervated by CN IX & CN X (2 because its a whole body)
Sensitive to CO2 & O2 tension in blood
Carotid Sheath:
In it runs:
Common Carotid
Internal Jugular Vein
Vagus Nerve
NOT ansa cervicalis
NOT phrenic nerve
Branches of Common Carotid (2)
Internal Carotid: (3 Branches)
Inside the cranial cavity
Branches to:
Ophthalmic:
Supplies orbit & eye through optic foramen w/ optic nerve
Branches to:
Anterior ethmoidalSupplies the nasal cavity
Dorsal NasalAnastomoses w/ Angular branch (Facial)
Anterior Cerebral:
Great cerebral circle of Willis
Supplies:
Medial surfaces of hemispheres entire medial surface except a little bit from posterior cerebral artery. These
wrap around the top and get the superior and frontal pole surfaces as well
Anterior & superior portions of frontal & parietal lobes
Anterior portions of basal ganglia, internal capsule, corpus callosum
Middle Cerebral:
Great cerebral circle of Willis. The artery most often occluded in stroke.
Largest branch of ICA
Branches include Lenticulostriate
These are of Stroke (not the middle meningeal).
Thin-walled, frequently rupture to cause cerebral hemorrhage
Supply internal capsule, caudate, putamen. (is this why ppl often have ataxia with stroke??)
Supplies:
Lateral surface of the cerebral hemisphere primary motor and sensory areas of face, throat, hand and arm +
areas of speech in dominant hemisphere. Droop in face.
Posterior limb of the internal capsule & part of the basal ganglia
NOTE: Circle of Willis: (aka cerebral arterial circle)
Rupture of a vessel in the circle of Willis causes subarachnoid hemorrhage
The Basilar artery emits into 2 posterior cerebral (Basilar artery is formed by both vertebrals joining)
Then posterior cerebral emit posterior communicating artery
Then posterior communicating artery joins middle cerebral artery
Then middle cerebral artery emits anterior cerebral artery (Mid. cerebral is term. branch of int. carotid)
Finally anterior cerebral joined by anterior communicating artery
From Front to Back
Ant. CommunicatingAnt. CerebralMiddle CerebralPost. CommunicatingPost. CerebralBasilar
Anterior Communicating:
Most common circle of Willis aneurysm may cause visual field defects
Posterior Communicating:
Common area of aneurysm causes CN III palsy
The basilar & anterior communicating are the unpaired vessels of the Circle of Willis
Forms an important means of collateral circulation in case of obstruction
If the internal carotid is blocked, blood will still get to the brain via the vertebral /Basilar

NOTE: Stroke warning signs


Sudden weakness; paralysis; numbness of the face,
arm, & leg on one/both sides of body
Loss of speech or difficulty speaking or understanding
speech
Dimness or loss of vision, particularly in only one eye
Unexplained dizziness, unsteadiness, & sudden falls
Sudden severe headache & loss of consciousness
SIDENOTE: Branches of the Vertebral Artery (these have
nothing to do w/ the carotid )
Meningeal branches
Anterior & posterior spinal
Posterior inferior cerebellar (see diagram)
Medullary branches
Basilar artery:
Formed by the union of the two vertebral
Gives several insignificant (to Boards studying)
branches
Significant branches: Posterior cerebral
Supplies:
Occipital pole
Inferomedial temporal lobes
Subthalamic nucleus

External Carotid: (8 Branches)


From the level of the superior border of the thyroid cartilage (bifurcation of common carotid) to the neck of the Mn
into the parotid
Supplies the muscles of the neck, face, thyroid gland, salivary glands, scalp, tongue, jaws, and teeth
Branches from Inferior to Superior SALFO PMS (Some Angry Lady Figured Out PMS)
Superior thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial Temporal
Terminal Branches
Maxillary and Superficial Temporal the most superior branch
ANTERIOR BRANCHES: (4)
Superior Thyroid:
Supplies thyroid gland
Originates just below the level of the hyoid bones greater cornu
Branches to:
The SCM
Superior laryngeal artery
Pierces thyrohyoid MB w/ the internal laryngeal nerve (aka internal branch of superior laryngeal n.)
CAREFUL (the artery is the superior thyroid, but then turns into superior laryngeal, whereas the nerve is
internal branch of superior laryngeal, then internal and external branches)
Lingual:
Supplies tongue & floor of the mouth and tip of the tongue
Tongue also receives blood from Tonsillar branch (Facial) and Ascending Pharyngeal
Lingual artery does not follow the lingual nerve
Lingual artery does NOT pass between the medial pterygoid & the ramus of the Mn
Branches at the level of the tip of the greater horn of the hyoid bone in the carotid triangle
Passes Medial (deep) to the hyoglossus muscle and Superior to the Mylohyoid (Deep from the neck aspect)to enter
the oral cavity
So NOT between Hyoglossus and Mylohyoid
It passes between the Hyoglossus and the Genioglossus
Branches to:
Suprahyoid
Dorsal Lingual
Sublingual
Deep Lingual
The terminal branch that supplies the anterior 1/3 of the tongue (tip)
Ascends between the genioglossus and the inferior longitudinal muscles
If you pierce the tip of the tongue with a bur, you most likely hit the Deep Lingual Artery
Facial:
Supplies face, tonsils, palate, labial glands, muscles of lips, ala and dorsum of the nose, muscles of facial expression,
and submandibular gland
Branches to: (8)
Cervical: (4)
a) Tonsillarto tonsils & some supply to the tongue
b) Ascending Pharyngealto pharyngeal wall & some supply to the tongue?????
c) Glandularto submandibular gland
d) Submentalto area below chin
Facial portion: (4)
a) Inferior labialto the lower lip
b) Superior labialto the upper lip and vestibule of the nose
c) Lateral nasalto outer side of lateral nose (lateral wall)
c) Angularmedial side of eye
Terminal branch of facial artery
Anastomoses w/ the dorsal nasal branch of ophthalmic
Maxillary artery: (picture)
Supplies ALL teeth, muscles of mastication, hard/soft palate, and most of nasal cavity (NOT skin of forehead)
ethmoidal from ophthalmic gets some of the nasal cavity.
Branches from ECA at the posterior border of the Mn ramus
Terminal branch of ECA to region of infratemporal fossa and nasal cavity
Lateral pterygoid muscle divides maxillary artery into 3 parts:
1) Mandibular portion before muscle (DAM-AI)
Gives rise to branches supplying the tympanic cavity and membrane, dura, and mandibular teeth
Deep Auricularto external auditory meatus
Anterior Tympanicto eardrum
Middle Meningealto cranial cavity (damage to this artery results in epidural hematoma/hemorrhage)
Accessory Meningealto cranial cavity
Inferior Alveolarto chin & Mn teeth (runs along w/ vein & nerve and lingual nerve in the
pterygomandibular spacebetween the pterygoid muscle and the ramus of Mn (lingual artery does not)
3rd Branch of Mx artery???Other Answer was Middle Meningeal. ECA 2nd Ed says its middle
meningeal
IN Netters, they both come off at the same level!!! I hate this test
2) Pterygoid portion passing over/under muscle (ADPMB A Dr. Pepper Makes Bubbles
Gives rise to branches that supply the muscles of mastication
Anterior Temporal - ECA 2nd ed. Doesnt list this one in its breakdown.
Deep Temporal
Pterygoidmedial and lateral
Masseteric
Buccal
3) Pterygopalatine portion crossing muscle (SAD PIP SA(D))
Gives rise to branches that supply the max teeth, portions of the face, orbit, palate, and nasal cavity
Sphenopalatine
Terminal branch of maxillary artery
Enters the nasal cavity through the sphenopalatine foramen along w/ the nasopalatine branch of the
maxillary nerve
Principal artery to the nasal cavity, conchae, meatus, and paranasal sinuses
Damage results in epistaxis (nosebleed)
Nasopalatine (Comes off the Sphenopalatine- which came through the Sphenopalatine Formamen
with the Nasopalatine Nerve)
Comes through incisive foramen
Supplies anterior hard palate
Anastomoses w/ Greater Palatine artery of the Descending Palatine
Artery of the pterygoid canal
Descending palatinegreater and lesser palatine
Branches to:
Greater Palatine Arterypasses to the palate through the greater palatine foramen
Supplies mucosa of hard palate posterior to maxillary canine
A laceration of the palatal mucosa in the area of Mx M1 is most likely to damage the G. P. artery
Anastomoses w/ nasopalatine artery
Lesser Palatine ArterySupplies soft palate & tonsils after emerging from the lesser palatine foramen
Pharyngeal
Infraorbitalcanine and incisor, Part of the 3rd Part of the Maxillary Artery
Careful, the Infraorbital NERVE comes out from V2, but this is the artery
Posterior Superior Alveolar (Dental)maxillary molars and premolar
PSA is a direct branch off of Mx artery
Anterior and Middle Superior Alveolar??? Maxillary anteriors
POSTERIOR BRANCHES (4):
Ascending Pharyngeal
Supplies the pharyngeal constrictor muscles
Supplies the tongue
Occipital
Pharynx and suboccipital triangle
SCM
Hooks CN XII Landmark for finding XII
Posterior Auricular
Back of scalp
Superficial Temporal does supply the temporalis muscle (along w/ the maxillary artery)
Supplies the TMJ
Transverse Facial does NOT supply the temporalis (it branches off too early) it runs superficial to zygomatic
arch.
Subclavian (FROM ABOVE)
Divided in 3 parts by the scalene muscles PICTURE I couldnt find a good one
1st Part Medial o the scalene m.
Vertebral (foramen magnum)
FIRST BRANCH
**If internal carotid becomes blocked, blood still reaches the brain via the vertebral
Branches from vertebral artery found in section on circle of Willis
ThyroCERVical Trunk (3)
Suprascapular
Transverse cervical
Inferior thyroid
Internal Thoracic: (mammary)
Descends directly behind the 1st 6 costal cartilages, just lateral to the sternum
Branches to:
Upper Anterior Intercostalswhich anastomose w/ the Posterior Intercostals (Thoracic Aorta)
This network provides muscular branches to the intercostal, serratus anterior, and pectoral muscles
MusculophrenicSupplies the diaphragm and lower intercostal spaces anteriorly
Superior EpigastricEnters the rectus sheath and supplies rectus muscles are far as the umbilicus
***NOTE: The inferior epigastric artery (External Iliac) anastomes w/ the Superior Epigastric in the
rectus sheath in the area of umbilicus
2nd Part Behind the scalene m.
Costocervical (2):
Supreme intercostal (High Intercostal)
Deep cervical
3rd Part Lateral to the scalene m.
Dorsal Scapular:
Supplies the back

Axillary Artery
Continuation of the Subclavian
Begins at the 1st rib and ends at the margin of the teres major m., then turns into the Brachial artery (runs with Median Nerve),
then turns into the Radial and Ulnar at the Cubital fossa
Brachial Artery
Supplies the Posterior Compartment of the arm
Thoracodorsal
Supplies the latissimus dorsi m.
Divided into 3 Sections by the tendon of the pectoralis minor m.
1st Part (MEDIAL)
Supreme Thoracic artery
2nd Part (DEEP)
Thoraco-acromial artery
Lateral thoracic artery
3rd Part (LATERAL)
Subscapular artery
Posterior circumflex humeral artery
Anterior circumflex humeral artery

Abdominal portion of descending aorta: (FROM ABOVE)


From T12L4
Branches to:
(UNPAIRED) CSI
1) Celiac Trunk
Hepatic (Common) the common hepatic artery is a branch of the celiac artery
Liver, upper pancreas, duodenum, and gallbladder
Branches to:
Right Hepaticto right lobe of liver
Cysticto gall bladder
Left Hepatic
Right Gastriclesser curvature of the stomach (ALL Gastrics go to lesser curvature)
Gatroduodenalpancreas and duodenum
***[SEE Hepatic Circulation BELOW]
Left Gastriclesser curvature of the stomach and inferior part of the esophagus
Splenic spleen, stomach, and omentum
Branches to:
Left Gastroepiploicto greater curvature of the stomach (Epiploic appedanges of Greater omenum)
Short Gastricto ??lesser?? curvature of the stomach
**Stomach supplied by: R & L Gastric, Gastroepiploic & Short Gastric artery
2) Superior Mesentericsmall intestine (duodenum and jejunum), pancreas, cecum, ascending and transverse colons
Supplies the GI tract from the middle of the 2nd part of the duodenum to the distal 1/3 of the transverse colon
Supplies the right colic flexure
3) Inferior Mesenterictransverse, descending, & sigmoid colons and rectum
(PAIRED)
1) Suprarenaladrenal gland, Adrenals are not supplied by one of the 3 upaired branches
2) Renalkidneys
3) Gonadal
Testiculartestes
Ovarianovaries
4) Lumbarepaxial muscles of lumbar region
Terminates w/ branching of:
Right Common Iliac
Left Common Iliac
Small Middle Sacral

Cardiac Blood Supply


1st branch of the aorta is R/L coronary
Right Coronary
Supplies right atrium, most of right ventricle, diaphragmatic surface of the left ventricle, part of AV septum, SA node
(60% of the time), and AV node (80% of the time)
Posterior interventricular
Along with middle cardiac vein
Left Coronary
Supplies left atrium, most of left ventricle, some of the right ventricle, most of the IV septum, the SA node (40%), and
the AV node (20%)
Branches from the ascending aorta immediately above the anterior left cusp of the aortic valve
Anterior interventricular
Along with great cardiac vein
Necrosis on the anterior heart wall over both ventricles is likely due to occlusion of the ant.
interventricular a.
Circumflex branch
Coronary Sinus
Receives
Great, Middle, and Small Cardiac veins
Hepatic Circulation
Hepatic portal vein
Brings food-laden blood from the abdominal viscera
Formed by union of Superior Mesenteric Vein & Splenic Vein
Blood from liver eventually drains into the hepatic veins and then to IVC
**Liver has mixture of arterial (hepatic) and venous blood (portal)
Carries 2X as much blood as hepatic artery
Blood supply to nose:
Sphenopalatine branch of maxillary artery most important branch
Sphenopalatine branch is the terminal branch of the maxillary artery.
Anterior ethmoidal branch of ophthalmic artery to the dorsal nasal
Septal branch of superior labial branch of facial artery

VEINS
Veins vs. :
Less muscle, lower pressure, less elastic tissue, same general structure, larger diameter
>70% of blood is found in the venous system at any one time
Valves in veins of arms & legs prevent backflow
Veins & have pulse present, none in capillaries
Veins have larger tunica adventitia when compared to
Artery: Media is thickest layer
Vein: Adventitia is thickest layer
CapsVenulesVeinsVena Cava
Venules have very thin tunica adventitia
Larger veins have thicker tunica adventitia
Drainage from Brain to Right Atrium
Superficial region of head & neck drains into External Jugular Vein (EJV)
EJV empties into the Subclavian Vein (coming from the Axillary Vein of the shoulder)
Subclavian Vein joins the IJV (coming from the Sigmoid Sinus of the brain)
IJV & SCV join to form the Left Brachiocephalic Vein
The Left Brachiocephalic Vein then receives the Vertebral Vein from the posterior portion of the head
Left Brachiocephalic Vein meets the Right Brachiocephalic Vein to form the Superior Vena Cava Right Atrium
Veins (Individual Facts)
Superior Vena Cava (SVC):
Union of two Brachiocephalic Veins, has no valves, blood from head, neck, upper limbs, & chest; empties into Right Atrium
Inferior Vena Cava (IVC):
Larger than SVC
Guarded by a rudimentary non-functioning valve
When IVC gets slowly occluded, there are collateral routes through BOTH epigastric veins AND the total azygos
system
Brachiocephalic Veins:
Formed at the base of the neck from the joining of the IJV & SCV
Present on both sides of the neck
The R & L Brachiocephalics meet in the superior mediastinum to form SVC
Azygos vein (right side) joins the posterior aspect of the SVC just before it pierces the pericardium (thats why its
collateral circulation)
Infection of lower lip would first enter bloodstream at the Brachiocephalic Vein
Infection spreading via lymphatic system from the vermiform appendix first enters the bloodstream at the brachiocephalic
vein.
Internal jugular vein (IJV):
Begins at jugular foramen as a continuation of the Sigmoid Sinus
Descends in the carotid sheath
Descends behind sternoclavicular joint w/ SCV to form Brachiocephalic Vein
Drain the venous sinuses of the skull
External jugular (EJV):
Drains the skin, parotid, & muscles of the face & neck
Formed by union of the Posterior Auricular Vein & the posterior branch of the Retromandibular Vein
Crosses the SCM vertically, under the platysma, and ends in the SCV (DIFFERENT than Artery)
Subclavian Vein (SCV):
Continuation of the Axillary Vein at the inferior margin of the 1st rib
Passes medially to join the IJV to form Brachiocephalic Vein
Crosses 1st rib anterior to the anterior scalene muscle (Subclavian a. goes Posterior)
So does the Phrenic
Subclavian tributaries are:
EJV on the left side at the angle of its junction w/ IJV
Lymphatics from the Thoracic Duct
On the right side it receives the Right Lymphatic Duct at the same location
Axillary Vein:
Begins at the lower border of the teres major muscle as the continuation of the Basilic Vein
Located in the Deltopectoral Triangle
(Think ABCs) Axillary Vein is really the union of the Cephalic (radial side) & the Basilic (medial side formed after
the Median Cubital Vein shoots off of the Cephalic Vein)
Brachial Veindrains venous blood from deep antebrachial regions and brachial regions to Axillary Vein
Cephalic Veindrains venous from radial side to the antebrachium and brachium into Axillary Vein
Superiorly the vein passes between the deltoid and the pectoralis major muscles and enters the deltopectoral triangle
where it joins to be the axillary vein
Becomes the SCV as it ascends to the inferior margin of the 1st rib
Basilic + Cephalic = AxillarySubclavian (receives EJV)Subclavian + IJV (Jxn for thoracic duct = Brachiocephalic
Vertebral Vein:
Drains posterior portion of head
Then empties into the Left Brachiocephalic before it forms the Superior Vena Cava
Azygos Vein: (right side)
Drains posterior abdominal and thoracic body wall
Usually formed by union of the Right Ascending Lumbar & Right Subcostal Vein
Ascends through the aortic orifice of the diaphragm (A for A)
Lies in the posterior mediastinum & empties into the SVC at the junction of the 2 Brachiocephalic Veins
The Right Vagus nerve lies just posterior to the arch of the azygos
The Va-goose is most posterior
Azygos vein leaves an impression on the right lung as it arches over the root/hilum
Right Superior Intercostal Vein drains into Azygos vein.
NOTE: the 2nd, 3rd & 4th R posterior intercostal veins drain from the R superior intercostal vein into the azygos vein
Left Superior Intercostal Vein drains into the Left Brachiocephalic Vein at level of ????
Hemiazygos Vein: (left side)
Formed by union of the Left Ascending Lumbar Vein & Left Subcostal Vein
Empties into the Azygos Vein
Ascends on the left side of the vertebral body behind the thoracic aorta, receiving the lower four Posterior Intercostal Veins
Accessory Hemiazygos Vein:
Formed by union of 4th -8th Intercostal Veins
Empties into Azygos Vein, sometimes meets up with the Hemiazygos first then crosses and joins the azygos
Superficial Temporal Vein:
Drains the scalp & side of head
Descends anterior to the ear and plunges into the substances of the parotid gland
Maxillary Vein
Forms from the Pterygoid Plexus of Veins
Joins the Superficial Temporal Vein w/in the parotid gland to form the Retromandibular Vein
Retromandibular Vein: (Think Terminal Branches of Arterials)
Formed by union of Superficial Temporal & Maxillary vein w/in parotid
Divides at the angle of Mn into:
Anterior Branch joins Facial Vein to form Common Facial Vein, which then drains into the IJV
Posterior Branch joins Posterior Auricular Vein (occipital) from behind ear to form EJV
Veins of Cervical Triangle: Retromandibular Vein, EJV & IJV
Facial Vein
Begins as Angular Vein by the confluence of the Supraorbital and Supratrochlear Veins
Communicates w/ Superior Ophthalmic via the Supratrochlear and Supraorbital allowing infection from face to the Cranial
Dural Sinus
Drains directly into the IJV or joins the Anterior Branch of the Retromandibular Vein to form Common Facial Vein which
also enters IJV
The Facial Vein anastamoses w/ Retromandibular Vein below the border of the Mn & empties into the IJV, usually through
the Common Facial Vein
Angular Vein
Continues at the lower border of the orbital margin into the Facial Vein
Receives the Infraorbital and the Deep Facial Veins
Deep Facial Vein communicates between Facial Vein and the Pterygoid Plexus (which also becomes Max Vein)
Superior Ophthalmic Vein is a communication between the Facial Vein & Cavernous Sinus
Deep Facial Vein
Communication between the Facial Vein & Pterygoid Plexus
Superior Ophthalmic Vein
Communication between the Facial Vein & Cavernous Sinus
Inferior Ophthalmic Vein
Divides into two terminal branches
One to the Pterygoid Plexus
One to the Superior Ophthalmic Vein to the Cavernous Sinus
Pterygoid Plexus of Veins:
The pterygoid plexus is in between the temporal and pterygoid muscles
The pterygoid plexus and its tributaries are the venous parallel of the maxillary artery drains all correspondents to maxillary
artery.
Infection that spreads posterior to Mx sinus enters here
Terminates posteriorly in the Maxillary Vein
Terminates anteriorly in the Deep Facial Vein (drains into Facial Vein)
The pterygoid plexus drains into the retromandibular vein
Retromandibular splits into Anterior and Posterior divisions:
Anterior joins Facial Vein to form Common Facial Vein and then dumps into internal jugular vein
Posterior receives the posterior auricular veins and forms the external jugular vein, which then drains directly into the
subclavian vein
Direct communications: - DIMPsa
Deep Facial vein
Infraorbital vein
Maxillary vein
Posterior Superior Alveolar vein
NOT VertebralDuh!
Surrounds the maxillary artery occupying the infratemporal fossa associated w/ pterygoid muscles
Receives veins that correspond to the maxillary artery

Dural Venous Sinuses.


View is with the skull cap removed and the cranial cavity exposed.

A. Sphenoparietal
B. Intercavernous
C. Sigmoid
D. Occipital
E. Confluence
F. Basilar
G. Transverse
H. Superior Petrosal
I. Inferior Petrosal
J. Cavernous
K. Superior Sagittal

The Cavernous Sinuses:


Paired, irregularly shaped Venous Dural Sinuses
Created by drainage of Superior & Inferior Ophthalmic Veins, the
Cerebral Veins, & the Sphenoparietal Sinus
Located on either side of the sella turcica of sphenoid bone in middle
cranial fossa
Empty by way of Superior Petrosal Sinuses into the Transverse
Sinuses which become the Sigmoid Sinuses
The Sigmoid Sinuses then empty into the Jugular Foramen by
becoming the IJV
These veins do not have valves and so can also drain anteriorly into Ophthalmic Vein
Internal Carotid Artery and abducens (CN VI) nerve pass through the Cavernous Sinuses (CN VI is free-floating)
All of the others are embedded in lateral wall of the Cavernous Sinuses:
Oculomotor (CN III), Trochlear nerve (CN IV), Ophthalmic nerve (CN V1), Maxillary nerve (CN V2)
Think Caversnous s-EYE-nuses (III, IV, VI are eye movers, & V 1/V2 are above & below the eye on the face)
The Sinuses
Superior Sagittal
At the top of the falx cerebri
CSF flows into the arachnoid villi into the superior sagittal sinus
Inferior Sagittal
At the bottom of the falx cerebri
Straight sinus
When the great cerebral vein meets the inferior sagittal sinus, they form the straight sinus which takes them down to the
Confluence
Occipital
In the falx cerebelli
Confluence of sinuses
Where the Superior Sagittal, Straight, Occipital, and both Transverse Sinuses meet in the back
Transverse sinus
The 2 lateral sinuses that connect the Confluence to the Sigmoid Sinuses
Sigmoid
Connects to the Internal Jugular Vein via the jugular foramen of the skull
Also collects the Superior Petrosal Vein
Cavernous sinuses
Anterior and Posterior intercavernous sinuses surround the Infundibular stalk of pituitary
Drain the valveless ophthalamic & paranasal sinuses danger of infection
Sella turcica
Lies directly above the sphenoid sinuses
Middle cranial fossa
Diaphragma sellae
The tentorium cerebelli forms the roof of the posterior fossa
Danger triangle of face:
Covers the nose and maxilla and goes up to the region of the eye
Superficial veins communicate w/ the Dural Sinuses
Facial Vein has no valves and backflow of infection can get into the sinuses via the Deep Facial Vein (via Pterygoid Plexus) and
Superior Ophthalmic Vein (via Cavernous Sinus)
Veins of the Skull:
Veins of the brain are Direct tributaries to the Dural Sinuses (Cerebral Sinuses, or the sinuses of dura mater)
Various venous channels located in the dura mater and lined w/ endothelium
Emissary Veins: (THINK you have to go THROUGH the checkpoint to get to the COMMISSARY on BASE (of skull)
Valveless, connect the dural sinuses w/ the veins of scalp
Differently worded: emissary veins connect the venous sinuses of the dura mater w/ the extracranial veins
Diploic Veins:
Lie in channels in the diploe of the skull & communicate w/ Dural Sinuses, the veins of the scalp, and Meningeal Vein
Lie w/in the bone of the calverium and join as tributaries to the Emissary Vein
Portal Vein (aka: Hepatic Portal Vein):
Formed by the union of the Splenic and the Superior Mesenteric Veins
Tributaries are R & L Gastric Veins & the Cystic Vein
Passes:
Anterior to the epiploic foramen in the free edge of the lesser omentum
Epiploic foramen is bounded anteriorly by the free border of the lesser omentum
Greater peritoneal sac communicates with lesser peritoneal sac by means of the epiploic foramen
Posterior to the bile duct and the Proper Hepatic Artery
Ascends in front of IVC
Divides into R & L branches before entering liver
Carries 2x as much blood as the Hepatic Artery
Drains stomach, intestines, spleen, pancreas, and gallbladder
Drains into Hepatic Sinusoids, which then drains into the Center Vein
Here the blood travels through the hepatic portal system & makes it possible for the liver to perform many functions, (like
remove substances from blood, metabolize, detox)
After leaving liver, blood travels through Hepatic Vein to IVC
Splenic vein:
Drains spleen
Receives tributaries from:
Stomach = R & L Gastroepiploic Veins and R & L Gastric Veins
Pancreas = Pancreatic Vein
Gallbladder = Cystic Vein
Joins the Superior Mesenteric to form the Portal Vein
2 abdominal anastomeses
Superficial
Superficial epigastric to the Lateral thoracic (off of subclavian)
Deep
Inferior epigastric from the external iliac to the Internal thoracic
Superior Mesenteric drains:
Small intestine, cecum, and ascending & transverse colon
Joins Splenic Vein behind the neck of the pancreas to form the Portal Vein
Inferior Mesenteric:
Drains rectum, descending colon of the large intestine
Usually joins the Splenic Vein behind the neck of the pancreas
Fetal vessels and their remnants:
One Q reads: Ligamentous remnants of the fetal circulatory system persisting in the adult include the ligamentum venosum,
ligamentum arteriosum, ligamentum teres of the liver (not ligamentum nuchae or ligamentum teres of the uterus)
Umbilical Vein (1) Ligamentum teres (aka: Round ligament of the liver): (UV LighT)
Connects Placenta to liver, forms major portion of umbilical cord, nutrient-rich blood from placenta to fetus
Forms the round ligament of the liver after birth (ligamentum teres)
Umbilical (2)Medial Umbilical Ligaments: (U A MULe)
Arise from Internal Iliac associated w/ umbilical cord
Transports blood from fetus to placenta, becomes adult medial umbilical ligament
AllantoisMedian Umbilical Ligament
Ductus ArteriosusLigmentum Arteriosum: (Ductus) (PDA Pulm Art Duct ArtAorta)
Between pulmonary trunk (left pulmonary artery) & aortic arch to bypass pulmonary circuitry
R to L shunt, we dont care about pulmonary circ.
Does not carry fully oxygenated blood
Closes shortly after birth, atrophies, & becomes the ligamentum arteriosum
Ductus VenosusLigamentum Venosum (LDI Liver Ductus venosusInferior vena cava)
Only fetal vessel to carry O2-rich blood and nutrients. All others carry mixture of arterial and venous blood.
After Umbilical vein reaches the liver, then the Ductos venosus takes the blood to the IVC Right Atrium foramen ovale
Umblicial vein to the IVC (Just distal to where the bad blood was sent out in the iliac )
Foramen OvaleFossa Ovalis: (AOA Atrium foramen OvaleAtrium)
Opening between R & L atria to shunt blood passed the pulmonary circuitry, closes at birth and becomes the fossa ovalis, a
depression in the interatrial septum
Notochord Nucleus Pulposus
NOTE: The following are immediate changes that occur in the cardiovascular system at birth:
Closure of foramen ovale
Closure of the ductus venosus
Constriction of the ductus arteriosus
Constriction of the umbilical
Not closure of the interventricular foramen
Since were thinking about the umbilical cord:
Contains 2 umbilical de-O2d blood FROM fetus
Contains 1 umbilical vein O2d blood TO fetus (from placenta)

LYMPH SYSTEM
- Lymph
o Transparent, usually slightly yellow, often opalescent liquid found in lymphatic vessels
o Contains a liquid portion resembling plasma, as well as WBCs (mostly lymphocytes) & a few RBCs
o Absorbed from tissue spaces by lymphatic capillaries
o Flows through the filtering system (lymph nodes)
o Is eventually returned to venous circulation by lymphatic vessels
- Functions of Lymphatic System:
o 1) Collect & return tissue fluids back to bloodstream
Fluid entering lymph capillaries is called lymph
Fluid enters due to differing osmotic pressure across capillary MB
Lymph is returned to venous system via 1) thoracic duct & 2) right lymphatic duct
Lymphatic system depends on:
Skeletal muscle contraction, presence of valves in lymphatic vessels, breathing & gravity to move fluid
VS Veins
Walls of lymph vessels are thinner
Muscle layer is less developed
o 2) Transport absorbed fats
Lacteals transport fat products in small intestines from GI into circulatory system
Lacteals are lymph capillaries w/in villi of small intestine
o 3) Provide immunologic defense against disease-causing agents
Lymph filters through lymph nodes
Lymph nodes filter out microorganisms & foreign substances
- Basic framework of all lymphoid tissues (EXCEPT Thymus) is primarily reticular fibers and lesser amount of collagen fibers
- In the upper limb, the hallmark of lymph vessels is that they CONTAIN Valves Sean you got clowned
- Bone marrow is part of lymph system
- Chief characteristic of lymphatic organ is presence of lymphocyte
- Lymph nodes:
o Small, oval/round bodies of lymphatic tissue permeated by lymphatic channels
o Contains both afferent & efferent vessels (spleen, thymus, tonsils do not have
both)
Contains numerous afferent lymphatic channels (spleen, thymus,
palatine/pharyngeal tonsils do not)
The spleen, thymus, palatine & pharyngeal tonsils do not have numerous
afferent vessels entering them as do lymph nodes
o Primary function act as filters that remove & destroy Ag/s circulating in blood &
lymph
Contain a lot of macrophages
o Lymphoid tissue in nodes produces Ab/s & stores lymphocytes
o Generally occur in clusters, particularly in armpits, groin, lower abdomen, & sides
of neck
o Each node is enclosed in a fibrous capsules w/ internal trabeculae (CT) supporting
lymphoid tissue & lymph sinuses
Trabeculae are specialized bands of CT that divide the lymph node
o Outer cortical region:
Contains separate masses of lymphoid tissue (called germinal centers, nodules)
source of lymphocytes
NOTE: The germinal center of a lymph nodule represents the area of proliferation of lymphocytes
Also contains subscapular & cortical sinuses
Outer cortex B cells & nodules
Inner cortex T cells & NO nodules
o Inner medullary region:
Lymphoid tissue here is arranged in medullary cords source of plasma cells
Also contains medullary sinuses
- Travel of lymph through nodes:
o Afferent lymphatic vessels carry lymph into node vessels enter on convex surface of the node
Lymph is cleansed by macrophages, lymphocytes & plasma cells as it
circulates through cortical sinuses
o Efferent lymphatic vessels carry filtered lymph through the concave hilus
region into efferect collecting vessels
o Collecting vessels converge into larger vessels lymph trunks (five in the
body)
There are fewer efferents than afferents
o Lymph trunks empty into the thoracic duct or right lymphatic duct
Thoracic duct
Ascends between aorta and azygous vein
Drains most of the body
Empties into junction of the LEFT internal jugular & LEFT
subclavian veinsf (which becomes the L brachiocephalic v.)
Right lymphatic duct
Drains right side of head & neck, right upper limb, & right side of
thorax
Empties into junction of RIGHT internal jugular & RIGHT
subclavain vein
- Deep cervical lymph nodes:
o Eventually receive all lymph of head & neck
o Form a chain along the internal jugular vein, from skull to root of neck
o Efferent vessels join to form the jugular lymph trunk then drain to thoracic duct or right lymphatic duct
o Mandibular 3rd Molars initially???
o Carcinoma of the larynx would most likely affect? Deep cervical lymph nodes
- Parotid lymph nodes:
o Strip of scalp above parotid salivary glands
o Anterior wall of external auditory meatus
o Lateral parts of eye lids & middle ear
o **Drain into deep cervical lymph nodes
- Submandibular lymph nodes:
o Lymph from most of the dental and periodontal tissues drains initially into the submandibular lymph nodes
o Front of scalp
o Nose & adjacent cheek
o Upper & lower lips (except center part)
o Drain the Oral Cavity
o Mx & Mn teeth (except Mn incisors) (dont get clowned by infraorbital lymph node for drainage of Mx teeth)
o Anterior 2/3 of tongue (except the tip)
o Floor of mouth & vestibule & gingiva
o Angle of the mouth
o **Drain into deep cervical lymph nodes
- Submental lymph nodes:
o Tip of tongue
o Anterior floor of mouth (beneath tip of the tongue)
o Mn incisors & associated gingiva
o Center part of lower lip & skin over chin
NOT Mn molars, upper lip, lateral portion of lower lip
o **Drain into submandibular & deep cervical lymph nodes
- ***NOTE: The primary lymph nodes draining the mandible are the submandibular & submental nodes
- Thoracic duct:
o Conveys lymph from lower limbs, pelvic & abdominal cavities, left side of thorax, & left side of head, neck & left arm
o Begins below the abdomen as dilated sac the cisterna chyli
o Ascends through aortic opening in diaphragm, on the right side of the descending aorta
o Empties into junction of the left internal jugular & left subclavian veins
o Contains valves & ascends between the aorta & azygos vein in the thorax (Azy goose and Thoracic DUCK touch)
- Right lymphatic duct:
o Drains the right side of the head & neck, right upper limb, & right side of the thorax
o Empties into junction of the right internal jugular & right subclavian veins
- Spleen: (STUDY MORE!!!)
o Largest single mass of lymphoid tissue in body
o Ovoid organ ~size of a fist
o Develops from mesenchymal cells of the mesentery attached to primitive stomach Not from the gut.
o Found in closest relation to the inferior surface of the diaphragm
o Lies in left hypochondrium of abdominal cavity between stomach & diaphragm
o Important blood reservoir
o Filters blood ONLY (No afferent lymphatics)
o Phagocytosis of undesirable blood particles
o Manufactures mononuclear leukocytes
o White pulp
One card says: Contains lymphatic nodules & lymphocytes, like a lymph node
Another card: Contains compact masses of lymphocytes surrounding branches of the splenic artery
o Red pulp
Consists of a network of blood-filled sinusoids, along w/ lymphocytes, macrophages, plasma cells, monocytes & RBCs
Contains: splenic cords, numerous erythrocytes and blood vascular sinusoids
o PALS is the center zone of the spleen, surrounding the Central arteriole
*USMLE says: T cells are found in the PALS & the red pulp. B cells are found in follicles w/in the white pulp.
The B cells in the white pulp are analogous with the B cell outer cortical germinal centers in the lymph node
o Site of erythropoiesis in fetus & infant not in adults
Fetal erythropoiesis takes place in the Yolk sac, Liver, Spleen, Bone marrow (Young Liver Synthesizes Blood)
o Travel of blood through spleen:
Enters at the hilum through the splenic artery
Drained by the splenic vein joins lesser mesenteric vein to form hepatic portal vein to the liver w/ greater mesenteric vein
*Nerves to spleen accompany the splenic artery & are derived from the celiac plexus
- Thymus:
o Bilobed lymphoid organ located in the superior mediastinum has no lymphatics
o Main function to develop immature T-cells into immunocompetent T-cells
Tests new T cells for ability to recognize self-MHC molecules & self-epitopes these T cells are destroyed
o Thymus large in newborns, grows until puberty & then regresses in adults
o In the adult thymus blood supply is isolated from parenchyma blood thymus barriersupply is MOST isolated from the
parenchyma of the thymus (more than the other options: spleen, lymph node, Peyers patch, pharyngeal tonsil)
o In the childs thymus blood supply is NOT isolated from parenchyma
o Hassels corpuscle are characteristic of the thymus histologically
- Pharyngeal tonsils: Tonsils mainly produce SIgA.
o When inflamed, they are called adenoids
o Collection of lymphatic tissue located in posterior wall & roof of nasopharynx
o No lymph, sinuses or crypts
o Surrounded partly by CT & partly by epithelium, which forms deep infoldings (which arent crypts??)
o Characteristically covered by ciliated pseudostratified columnar
This is the distinguishing feature histologically from the palatine tonsils
- Palatine tonsils:
o Two masses of lymphoid tissue one mass on each side of oropharynx
o Reach maximum size during childhood & diminish considerably after puberty
o Contain many crypts & lymphoid follicles no sinuses
Think Crypts are in between your Arch CAVES
o Surrounded partly by CT and epithelium
o Found between palatoglossus and palatopharygeus
- Lingual tonsils:
o Found on posterior portion of dorsum of tongue
o Smaller & more numerous each has single crypt
- Peyers Patches:
o Follicular-associated epithelium
Enterocytes & M cells
o Germinal center
IgA positive B cells, CD4 T cells & APCs
o Intestinal tonsils, similar in structure & function to tonsils
o Located in the lamina propria & submucosa of the ileum
o Destroy bacteria
o No Goblet cells
o USMLE: M cells take up Ag. Stimulated B cells leave Peyers patch & travel thru lymph & blood to lamina propria of
intestine, where they differentiate into IgA-secreting plasma cells. The IgA is transported across the epithelium to deal w/
intraluminal Ag
- Peyers patches & tonsils considered subepithelial & nonencapsulated lymphoid tissue (not thymus, lymph nodes)
- Lymph from lungs, bronchi, and trachea drain into the mediastinal lymph nodes
- The spleen, thymus, & lymph nodes are similar in that they all contain lymphocytes
o Not all three filter blood, have a medulla and a cortex, serve as filters for tissue fluid, have afferent & efferent lymphatic vessels

BONE
- Function of bone:
o Support
o Protection
o Body movement
o Hemopoiesis
o Mineral storage
Inorganic bone matrix is composed primarily of minerals Ca & P
Give bone its rigidity & account for ~2/3 of its weight
95% of calcium & 90% of phosphorous in body is deposited in bone/teeth
In mineralization of bone inorganic material increases, water content decreases, but little change in collagen
Different than enamel
o Not fat storage
- Nutrition of bone reaches cells of compact bone via caniliculi, capillaries, & Volkmanns canals (not osseous matrix or lamellae)
- Bone formation:
o 1st evidence of bone ossification 8th week of prenatal development
o Endochondral ossification: (ENDO think long bones, condyles Long like FILES)
Most bones are endochondral derived
Begins as a hyaline cartilage model
Know Fxn of Hyaline Cartilage in bone growth
Calcified cartilage is replace by bone (dont get clowned: hyaline cartilage is not transformed into bone)
Bone replaces cartilage osteocytes replace chondrocytes
Short & long bones (bones of extremities & weight bearing bones)
Mandibular condyles
The list includes ethmoid, sphenoid, & temporal bones
Cranial Base portions of the occipital, sphenoid, temporal, and ethmoid
o Intramembranous:
Bone formed directly no cartilage precursor
Takes place w/in MBs of CT
Flat bones of skull (cranial vault) & face (e.g., nasal bone), & clavicle
Mandible (except condyles), Maxilla
In ORTHO tx, the type of new alveolar bone formation is intramembranous
Contributes to growth of short bones & thickening of long bones
Involves transformation of osteoblasts to osteocytes
o Once formed, bone grows by appositional growth
o A disturbance in cartilage formation in a fetus results in deformities of the axial skeleton and the base of the skull
- Bones grow NOT formed by
o Appositional
- Cells of bone formation & resorption:
o Osteoblasts:
Synthesize collagenous fibers, bone matrix & promote mineralization during ossification
Become trapped in their own matrix & develop into osteocytes
Derived from mesenchyme (fibroblasts)
Have high RNA content & stain intensely with basic dyes (blue)
o Osteoclasts:
Large, multinucleated Giant Cells containing lysosomes & phagocytic vacuoles
Reversal Lines:
o Seen on the Cribiform plate (aka alveolar bone proper) of the alveolar process
o Indicates cessation of osteoclastic activity
Originates from Mononuclear-phagocyte family (MONOCYTE)
Form Howships Lacunae
o Osteoid:
Newly formed organic bone matrix that has not undergone calcification
Differs from bone in that it has no mineralized matrix
o Osteocytes:
Maintain the bone tissue
- Bone properties:
o Hard due to calcification of extracellular matrix
o Elastic due to presence of organic fibers
o Strong due to collagenous fibrils
- Bone components:
o Diaphysis
Cylindrical shaft of durable compact bone
o Epiphysis
Caps diaphysis
Location of secondary ossification center
Spongy bone surrounded by compact bone
Contains red bone marrow
Erythropoiesis takes place mainly in the epiphysis says Sean
o Epiphyseal plate
Between epiphysis & diaphysis
Region of mitotic activity responsible for elongation of bone
o Medullary cavity
Centrally positioned space w/in diaphysis
Contains fatty yellow bone marrow (everywhere else)
NOTE: Red marrow = Blood cell formation
Cranial, vertebrate, ribs, sternum, epiphysis of long bones
o Nutrient foramen
Opening into diaphysis
Provides site for nutrient vessels to enter/exit medullary cavity
o Articular cartilage
Hyaline cartilage caps of each epiphysis
Facilitates joint movement
o Endosteum
Lines medullary cavity
Consists of supportive dense regular CT
o Periosteum
Dense regular CT covering surface of bone
Site for ligament & tendon-muscle attachment
Responsible for diametric bone growth
Has an outer fibrous layer and an inner osteogenic layer
o Compact bone (Lamellar)
Hard, outer layer of bone tissue
Covered by periosteum
Serves for muscle attachment
Provides protection & gives durable strength to bone
The component of bone tissue that gives a bone tensile strength is the collagenous fibrils of matrix
Consists of:
Matrix of compact bone is collagen plus salts of calcium & phosphorus
Osteocytes bone cells
Osteon a cylinder of compact bone composed of concentric lamellae (HENCE, lamellar or compact bone)
o The oldest lamella of the osteon is the most central lamella
o Osteon canals are oriented parallel to the predominant direction of force like when you stand on an aluminum can
Lacunae depressions in the matrix where an osteocyte is located
Lamellae circular layers of osteocytes located in lacunae
Canaliculi processes connecting lacunae each
canaliculus resembles a miniature canal
Haversian canal central canal around which
concentric lamellae are located
o Contains BVs & nerves that serve the osteocytes
o Exchange of substances between central canals
& osteocytes occurs along canaliculi
Haversian system = Haversian canal + surrounding
structures
o Repeating system is found in compact bone of
diaphyses of long bones
Volkmanns canal = connects 2 Harversian canals
o Cancellous (spongy or trabecular)
Porous, highly vascular, inner layer of bone tissue branching network of trabeculae
Makes bone lighter & provides spaces for marrow
Seen as spicules or trabeculae
o Immature bone (woven bone, nonlamellar bone, or bundle bone)
Laid down fast
Bundle bone receives the Sharpeys fibers in the alveolar bone proper
- Surface features of bone:
o Fissure
Sharp, narrow, cleft-like opening (groove) between parts of a bone that allows passage of BVs & nerves
o Sulcus
Shallow, wide groove on bone surface that allows passage of BVs, nerves, tendons
A shallower & less abrupt cleft/groove than a fissure
o Incisure (notch)
Deep indentation on the border of a bone
o Fovea
Small, very shallow depression
o Fossa
Shallow depression may or may not be an articulationg surface (e.g., glenoid fossa & subscapular fossa, respectively)
o Foramen
Opening through which BVs, nerves, or ligaments pass
o Meatus (canal)
Tube-like passage running through a bone
o Process
Bone projection that serves for attachment of other structures
o Epicondyle
Projection or swelling on a condyle
o Spine
Sharp, slender projecting process
o Tubercle
Small, rounded process
o Tuberosity
Large, rounded, roughened process
o Trochanter
Large blunt projection for muscle attachments on femur
o Crest
Prominent elevated right or border of a bone
o Linea (line)
Small crest, usually somewhat straighter than a crest
o Ramus
Major branch or division of the main body of a bone
o Neck
Slight narrowing of the body of bone that supports the head
o Lamina
Very thin layer of bone
- Unpaired bones ethmoid, frontal, occipital, & sphenoid
- Ethmoid bone:
o Sieve-like bone at base of skull, behind bridge of nose
o Straddles mid-sagittal plane & aids to connect the cranial skeleton to the facial skeleton
o Each sinus divided into anterior, middle & posterior air ethmoidal cells
o Horizontal plate (cribriform plate)
Perforated (olfactory foramina) on either side of crista galli for passage of olfactory nerve bundles
Crista galli sharp, upward, midline projection for attachment of falx cerebri
o Lateral masses (right & left)
Project downward from horizontal plate
Contain ethmoid sinuses & lamina orbitalis (lamina papyracea located in the orbital medial wall)
The thinnest portion of the orbit is the Medial wall
The roof of the orbit is made from the Frontal bone
Superior & middle conchae are curved plates of bone that form the medial surfaces of the lateral masses
o Perpendicular plate
Downward projection from midline on the undersurface of horizontal plate
Forms upper portion of the nasal septum
- Sphenoid bone:
o Single bone that runs through the mid-sagittal plane
o Aids in connecting cranial skeleton to facial skeleton
o Consists of a hollow body & 3 pairs of projections:
Hollow body
Contains the sella turcica (houses pituitary gland) & sphenoid sinuses
Greater wing forms lateral wall of orbit & roof of the infratemporal fossa
Foramina in greater wing provide access to both pterygopalatine & infratemporal fossa
o Foramen rotundum transmits maxillary nerve V2 .
o Foramen ovale transmits V3 and lesser petrosal nerve.
o Foramen spinosum transmits middle meningeal vessels & nerves to tissue covering brain
Lesser wing helps to form superior orbital fissure & roof of orbit
Contains optic canal (optic foramen) & ophthalmic artery
Superior Orbital Fissure
Located between greater and lesser wings of the sphenoid
o Left & right pterygoid processes
Project downward from near junction of each of the greater wings w/in body of sphenoid bone
Run along posterior portion of nasal passage
Each proccess consists of a medial & lateral pterygoid plate
Lateral pterygoid plate
o Provides origin for both lateral & medial pterygoid muscles
Medial pterygoid originates from medial surface
Inferior head of lateral pterygoid originates from the lateral surface
o ***Forms medial wall of infratemporal fossa
Medial pterygoid plate
o Forms posterior limit of lateral wall of nasal cavity
o Ends inferiorly as the hamulus (haMElus) for Medial
Hamulus = small, slender hook acting as a pulley for tensor veli palatine tendon (from vertical to horizontal)
What is located directly behind Mx 3rd Molar?? Hamular notch, or Mx tuberosity Its gotta be!
- TMJ components:
o Mandibular fossa
Oval depression in inferior surface of base of zygomatic process of the temporal bone
Articulates w/ condyle of Mn to form TMJ
o Articular eminence
Rounded bar of bone forming the anterior part of the Mn fossa
Posterior slope of eminence is lined by fibrous CT
o TMJ cavity
Divided into upper & lower compartment by articular disc
Upper disc glides forward on articular tubercle - translation
Lower condyle rotates beneath the disc like a hinge hinge action
- Alveolar bone:
o Exists only to support teeth if tooth never erupts, it never forms if tooth is extracted, alveolus resorbs
o In children, it increases in height & length to accommodate developing dentition
o Position of tooth, not the functional load placed on it, determines the shape of the alveolar ridge
o Alternate loosening and tightening of primary tooth about to shed is from alternate resorption and apposition of cementum and
bone
o The primary mineral component of alveolar bone in the periodontium is Hydroxyapatite
- Mandibular condyles:
o Provides space for erupting molars
o Major site of growth
Soft tissue development carries the Mn forward & downward
Condylar growth fills in the resultant space to maintain contact w/ the base of the skull
o Long axes of Mn condyles intersect at foramen magnum, which indicates that axes are directed posteromedially
o Growth at the mandibular condyles provides the space between the jaws into which the teeth erupt
- Hard palate:
o Anterior 2/3 formed by palatine processes of maxilla
o Posterior 1/3 by the horizontal plates of palatine bones
o The portion of hard palate located directly posterior to the Mx central is derived from the medial nasal processes
o Forms the roof of the oral caviy & floor of nasal cavity
If you over-implanted Teeth #710, you would penetrate the nasal cavity
o Covered w/ a mucous MB beneath these are palatal salivary glands
o Submucosa of anterolateral is characterized by adipose tissue, where posterolateral contains nests of mucous salivary
glands
- Roof of the oral cavity formed by the maxilla & the palatine bones; specifically the palatine processes of the maxilla & horizontal
plates of the palatine bones. Same as the floor of the nasal cavity
- Soft palate:
o Posterior to & continuous w/ hard palate
o Contains
Lamina propia of loose fibrous CT
Tough fibrous CT sheet the palatal aponeurosis
Salivary acini deep to the mucous membrane
Shallow, blunt rete pegs
o Posteriorly, soft palate is suspended in the oropharynx ends in the midline uvula
o Most palatal muscles receive innervation from pharygeal nerve plexus
o Motor branchers of CN V3 to tensor mucles of palate
o Sensory innervation provided by CN V2
- Nasal cavity:
o Bridge of nose is formed by two nasal bones
o Lateral walls formed by superior, middle, & inferior conchae
o Bony floor formed by palatine process of Mx & horizontal plate of palatine bone
o Roof formed by nasal, frontal, body of sphenoid & cribiform plate of ethmoid
o Medial wall or nasal septum formed by the perpendicular plate of ethmoid bone, vomer bone, & septal cartilage
o The rest of the framework for bone consists of several cartilage plates
Specifically, the lateral nasal cartilage and greater & lesser ala cartilage
These are held together by fibrous CT
o Opens on face through nares
o Communicates w/ nasopharynx through choanae (posterior openings of nasal cavity to nasopharynx)
o Nasal conchae:
Three pairs of scroll-like delicate shelves or projections, which hang into nasal cavity from lateral walls
Increase surface area w/in nasal cavity & expose the olfactory nerve to inhaled odors
Superior & middle conchae part of ethmoid bone
Inferior conchae separate bone (aka inferior turbinates)
o Meatus of the Conchae: Plate 525 (Clemente)
Space below & lateral to each concha
Superior meatus
Receives openings of the posterior ethmoidal sinuses
Middle meatus
Receives the openings of: 4 things: (FAMM)
o Frontal sinus drains into infundibulum of middle meatus
o Middle ethmoidal sinuses drain onto ethmoidal bulla (rounded prominence on lateral wall of middle meatus)
o Anterior ethmoidal & maxillary sinuses drain into middle meatus via the hiatus semilunaris
Hiatus semiluminares groove on lateral wall continuous w/ the infundibulum
NOTE: the maxillary sinus must drain upwards against gravity makes maxillary sinus infections hard to treat
Inferior meatus:
Receives the opening of nasolacrimal duct drains lacrimal fluid from eye surface of into meatus for evaporation
- Cranial fossae:
o Anterior cranial fossa
Formed by frontal & ethmoid bones. (Lesser wings of sphenoid bone too ECA 2nd ed. pps 504-5)
Contains:
Frontal lobes of cerebrum
Cribriform plate
Foramen cecum (contains emissary vein in fetal life)
Crista galli
o Middle cranial fossa
Formed by sphenoid, temporal, & parietal bones
Contains:
Temporal lobes of cerebrum
Hypophysis cerebri (pituitary gland)
Optic & carotid canal (ECA puts optic in the anterior fossa. Clemente and BRS list them hereyou decide.)
Superior orbital fissure
Trigeminal impression for trigeminal ganglion
Separates the middle ear cavity & sphenoid sinus
Which foramen is not in the middle cranial fossa Jugular
o Posterior cranial fossa
Formed by occipital & temporal bones
Contains:
Occipital lobes
Cerebellum, pons, & medulla oblongata
Internal auditory meatus
Jugular, condyloid, & mastoid foramen
Foramen magnum
Hypoglossal canal
o Petrous portion of the temporal bone:
Forms the floor of the middle cranial fossa
Separates the middle cranial fossa from the posterior cranial fossa
- Zygomatic bone
o NOT part of the calvarium, because it comes from the 1st Branchial arch
o Aka cheekbone, malar bone or zygoma
o Forms prominence of cheek & part of the lateral wall & floor of the orbital cavity
o NOT part of the calvarium (Temporal, Occipital, Parietal, Frontal all are)
o Anteriorly articulates w/ maxilla
o Posteriorly articulates w/ zygomatic process of temporal bone to form the zygomatic arch
- Temporal fossa
o Shallow depression on side of cranium bounded by temporal lines
o Terminating below level of zygomatic arch
o Area above zygomatic arch, filled w/ temporalis muscle
o Lower margin is masseter muscle
- Infratemporal fossa
o Communicates w/ pterygopalatine fossa via pterygomaxillary fissure (IN, UP, BACK Just like PSA block)
o Other openings communicating w/ the infratemporal fossa: foramen ovale, foramen spinosum (not foramen rotundum)
o Lies posterior to maxilla, between pharynx & ramus of mandible, below infratemporal crest of greater wing of sphenoid bone
o Boundaries of Infratemporal fossa:
Anterior wall posterior surface of maxilla
Posterior wall tympanic part & styloid process of temporal bone
Medial wall lateral pterygoid plate of the sphenoid bone
Lateral wall ramus of the mandible
Roof infratemporal surface of greater wing of sphenoid bone
Contains foramen ovale transmits V3
Floor point where medial pterygoid muscle inserts into medial aspect of the Mn near the angle
o CONTENTS of infratemporal fossa: lots of Qs on this stuff
See 1999Q04 I dont like this one
Temporalis muscle (lower portion)
Temporalis muscle passes medial to the zygomatic arch & inserts into coronoid process
Medial & lateral pterygoid muscles
Between them runs the:
o IA nerve and artery
o Lingual nerve
NOT the nerve to the masseter
Maxillary artery & most branches (including middle meningeal artery)
MAJOR artery of the infratemporal fossa
Pterygoid plexus of veins
Mandibular nerve & branches including lingual nerve
Chorda tympani
Otic ganglion (PS ganglion associated w/ glossopharyngeal nerve)
Sphenomandibular ligament
o In a fractured condyle, muscular contractions may result in displacement of the condyle into the infratemporal fossa
- *Temporal & infratemporal fossae communicate w/ each other deep to zygomatic arch
- Infratemporal crest of greater wing of sphenoid bone
o Separates the temporal fossa from the infratemporal fossa below it
- Pterygopalatine fossa (Think Sphenopalatine Fossa)
o Communicates laterally w/ infratemporal fossa by way of pterygopalatine fissure
o Formed by the sphenoid, palatine, and maxillary bones (not temporal)
o Pterygopalatine ganglion:
Lies in the pterygopalatine fossa just below CN V2
Receives preG PS fibers from facial nerve by way of greater petrosal nerve
Also receives PostG Sympathetic fibers via the deep petrosal
Sends postG PS fibers to lacrimal gland & glands in palate & nose (NOT to parotid gland)
o CN V2 & pterygopalatine portion of maxillary artery pass through the fossa
- Pterygopalatine fissure communicates:
o 1) Medially w/ nasal cavity through sphenopalatine foramen
The Sphenopalatine formaen connets the pterygopalatine fossa with the nasal cavity
o 2) Posteriorly through pterygoid canal
o 3) Posteriorly w/ the cranial cavity through the foramen rotundum
o 4) Posteriorly w/ the pharynx through the pharyngeal canal
o 5) Anteriorly w/ orbit through the inferior orbital fissure
o 6) Inferiorly w/ the Greater Palatine canal to the mouth
NO communication with Facial Canal
- Chest
o Ribs
True 1-7
False 8-12
Floating 11-12
Articulate with the spine at the superior articular process of same number and inferior facet for one number lower (higher on
the spine) in a synovial joint and are surrounded by a radiate ligament
When the arched shaft of the ribs is elevated, transverse diameter of the pleural cavity is increased
o Sternum
Sternal angle
The bottom of the sternal shield
Used to locate 2nd rib
Level of the branching of the trachea (where it passes behind the aortic arch)
Same plane as T5
Body of sternum articulates directly w/ manubrium & xiphoid process (not clavicle, 1st rib, 11th rib)
- Hip bone
o Formed by fusion of ileum, ischium, pubis
o Articulates w/ the sacrum at sacroiliac joint to form pelvic girdle
o Two hip bones articulate w/ one another anteriorly at the symphsysis pubis
o Ilium:
Upper flattened part of hipbone
Iliac crest ends in front at anterior superior iliac spine & behind at posterior superior ilac spine
Greater sciatic notch a large notch call
o Ischium:
L-shaped w/ upper thicker part (body) & lower thinner part (ramus)
Bears weight of body when person is upright & seated
Ischial spine & ischial tuberosity
Obturator foramen formed by ramus & pubis
o Pubis:
Body, superior ramus, & inferior ramus
Bodies of the two pubic bones articulate in the midline at symphysis pubis
Medial to symphysis is pubic tubercle
Inguinal ligament connects the pubic tubercle to anterior superior iliac spine
o Acetabulum:
Cup-shaped cavity on lateral side of hip bone
Receives the head of femur
Formed superiorly by ilium, posteroinferiorly by ischium & anteromedially by pubis

JOINTS
- Three main classes of joints (articulations):
o Synarthroses:
Immovable joints (fibrous joints) EX: sutures
In a newborn, intervals between bones in the middle of the cranial base is Hyaline cartilage (see spheno-occipital15 lines)
o Diarthroses:
Freely movable joints (synovial joints)
Aneural & avascular
Covered in hyaline cartilage or fibrocartilage (TMJ)
o Amphiarthroses:
Slightly movable articulations in which the contiguous bony surfaces are either connected by broad, flattened disks of
fibrocartilage or are united by interosseous ligaments (cartilaginous joints) EX: pubic symphysis, vertebrates
- Joints can also be calssified based on the associated CT type:
o Fibrousjoined by fibrous CT
1) Sutures
2) Syndesmoses between radius & ulna
3) Gomphosis tooth socket
o Cartilaginousjoined by fibrocartilage or hyaline cartilage
1) Synchondroses epiphyseal plates w/in long bones. Permit no movement but the growth within bone.
NOTE: The spheno-occipital synchondrosis in the midline of the cranial base of a newborn consists of hyaline
cartilage
2) Symphysis mental symphsis. Symphysies are joined by a plate of fibrocartilage and are slightly movable jts. Pubic
symphysis and intervertebral discs are example.
o *Synovialjoint capsule containg a synovial MB that secretes a synovial fluid
Lined with either Hyaline cartilage or fibrocartilage
Most joints are synovial such as TMJ
- *Synovial joints:
o Freely movable (diarthrodial) joints
o Limited by one joint surface, ligaments, muscles, or tendons
o Have 5 distinguishing features:
1) Articular cartilage:
Thin layer of hyaline cartilage that covers the smooth articular surfaces
Contains no BVs or nerves
NOTE: TMJ contains fibrocartilage not hyaline cartilage
2) Synovial (joint) cavity:
Small fluid-filled space separation the ends of adjoining bones
3) Articular capsule:
Double-layered capsule
o Outer layer fibrous CT encloses the joint.
o Inner layer thin, vascular synovial MB (because it needs blood supply to produce synovia)
4) Synovial MB:
Secretes clear, thick fluid Synovial fluid
Provides nutrition
Fills joint capsule & lubricates articular cartilage at the articulations
5) Supporting ligaments:
Capsular, extracapsular, & intracapsular ligaments
Maintain normal bone positioning
o Some synovial joints have articular discs (i.e., TMJ & sternoclavicular joint) that divide the cavity into two separate cavities
- Bursa:
o Fluid filled sac lined w/ a synovial MB
o Function = reduce friction
o May be located between tendon & bone to reduce friction during muscle contraction
o Bursitis inflammation of lining of a bursa
o Subacromial bursa
Large synovial membrane which is adherent to undersurface of coracoacromial ligament, acromion, & deltoid laterally, &
floor is adherent to rotator cuff & greater tuberosity;
It envelops proximal humerus, & facilitates gliding of proximal humerus under coracoacromial arch
- Atlanto-axial joint:
o Allows for maximum rotational movement of head about its vertical axis
o Synovial articulation between:
1) the inferior & articulating facets of the atlas (1st cervical vertebra)
2) the superior articulating facets of the axis (2nd cervical vertebra)
o Movement of head in saying NO
- Atlanto-occipital joint:
o Synovial articulation between:
1) the superior articulating facets of the atlas
2) the occipital condyles of the skull
o Pemits rocking & nodding movement in saying YES

MUSCLE

- Muscle fibers:
o Sarcoplasm cytoplasm of muscle cells
Contains many parallel, threadlike structures called myofibrils
o Myofibrils
Large, multinucleated skeletal muscle cells
Each is comprised of smaller strands called myofilaments that contain contractile proteins: actin & myosin
An increase in #s of additional myofibrils causes muscle fibers to hypertrophy
This is caused by progressively greater numbers of both actin & myosin filaments in the myofibrils
The # of muscle fibers does not increase, the size of each fiber increases
I Band
Gets smaller with contraction
Only Actin
o Z line
Separates adjacent sarcomeres
Where the T tubules lie
Desmin is also found at the Z lines
It aligns adjacent myofibrils in the myocyte, giving muscle its striated appearance
A Band (A for Alpha Male -- myosin, meaning it makes everyone come to it)
Doesnt change size with contraction
Both actin, but Myosin dictates borders this is because myosin (thick) is only present in the A Band
o H zone (Think HOT zone, where the ACTIoN is coming)
Gets smaller with contraction
Only Myosin
o M line
o Sarcomere: (see figure)
Repeating contractile unit in the myofibril
Each sarcomere is enclosed between two Z lines (Think End of the alphabet)
Characterized by dark & light striations due to the arrangement of thick (myosin) & think (actin) filaments
Dark bands = A bands (anisotropic)
Contain myosin filaments throughout
o In normal light microscopy of striated muscle, the dark portion of the striation is caused by the presence of myosin
Outer regions contain both actin & myosin
H band central area of A band w/o actin/myosin overlap
Light bands = I bands (isotropic)
Bisected by dark Z lines, where actin filaments of adjacent sarcomeres join
o Sarcoplasmic reticulum:
Network of membranous channels, tubules & sacs in skeletal muscles
Analogous to endoplasmic reticulum of other cells
Extends throughout the sarcoplasm
The organelles that releases & sequesters/stores Ca2+ during muscle contraction & relaxation
o Fibrous CT covering of muscle:
Epimysium:
The CT layer enveloping the entire skeletal muscle
Perimysium:
Continuation of the outer fascia, dividing the interior of the muscle into bundles of muscle cells
Fasciculus = bundle of cells surrounded by each perimysium
Endomysium:
The CT layer surrounding each muscle fiber
What immediately covers myofibrils?
o Endomysium or Sarcolemma?????
The 3 levels of fascia are interconnected, allowing vessels & nerves to reach individual fibers & cells
o Muscle-tendon junction
The union is made by a continuity of CT sheaths of the muscle with those of the tendon
- Motor unit
o Def: alpha motor neuron + muscle fibers it innervates
o Axon of motor unit is highly branchedone motor neuron innervates numerous muscle fibers
o When a motor neuron transmits an impulse, all fibers it innervates contract simultaneously
- Muscle contraction
o Tension develops because of interaction between actin & myosin filaments (see figure)
o Actin filaments (thin myofilaments, 5-8 nm diameter); composed of:
Actin globular actin (G-actin) molecules are arranged into double spherical chains called fibrous actin (F-actin)
*Tropomyosin (Like ROPE-Omyosin)long, threadlike molecules, lie along surface of F-actin strands & physically cover
actin binding sites during resting state
*Troponin (LIKE TRIP, i.e. tripped the SWITCH) a small oval-shaped molecule attached to each tropomyosin
o Myosin Filaments: (thick myofilaments, 12-18 nm diameter); composed of:
Light meromyosin (LMM) makes up rod-like backbone of myosin filaments
Heavy meromyosin (HMM) forms shorter globular lateral cross-bridges, which link to actin binding sites during
contraction
- Smooth muscle:
o Responsible for involuntary movements of internal organs
o Much smaller than skeletal muscle fibers
o Composed of uninucleate, elongated, spindle-shaped cells (fusiform cells)
Do not possess regularly ordered myofibrils & are therefore NOT striated (myofibrils lack transverse striations)
Nuclei are found in the widest part of each fiber
o Do NOT possess T-tubules & sarcoplasmic reticulum is poorly developed
o Contraction process is slow & not subject to voluntary control

o Types of Smooth muscle


Single unit
Has numerous gap junctions (electrical synapses) between adjacent fibers
These fibers contract spontaneously
EX muscular tunica of GI tract, uterus, ureters, & arterioles
Multi-unit
Lacks gap junctions
Individual fibers are autonomically innervated
EX: ciliary muscle & smooth muscle of iris, ductus deferens &
- Skeletal muscle:
o Responsible for voluntary body movement
o Composed of bundles of very long, cylindrical, multinucleated cells
Possess regularly ordered myofibrils responsible for striated appearance (myofibrils have distinct transverse striations)
Striations consist primarily of actin & myosin proteins
Each fiber is innervated by an axon & motor neuron at a motor end plate
o Enlarges with prolonged activity as result of increase in sarcoplasm and in the number of myofibrils of existing muscle fibers
Not from differentiation of myoblasts or mitotic division of muscle fibers
o Nuclei are either slender ovoid or elongated & are situated peripherally
Only skeletal muscle has peripherally located nuclei
o Contain transverse tubules (T-tubules -- at the Z line) & the sarcoplasmic reticulum is very well developed
o Contraction is quick, forceful, & usually under voluntary control
o Myofibrils (actin & myosin) are the contractile element
o Triad consists of terminal cisternae and fingerlike invagination of sarcolemma
- Cardiac muscle fibers:
o Make up thick, middle layer of heart known as the myocardium
o Have larger T-tubules & less-developed sarcoplasmic reticulum as compared to skeletal fibers
o Short, branched, & single or binucleated
o Have more mitochondria between myofibrils; richer in myoglobin than most skeletal muscles
o Contain large, oval, centrally placed nuclei
o Characteristic feature presence of intercalated discs
Strong, thin unions between fibers
Provide low resistance for current flow
Within the discs, desmosomes attach cells & gap junctions allow electrical impulses to spread from cell to cell
o Can contract spontaneously w/o nerve stimulation
o Respond to increased demand by increasing fiber size known as compensatory hypertrophy

HEAD/NECK MUSCLES

Muscles of Anterior Neck


Muscle Origin Insertion Action Innervation
SCM Sternum; clavicle Mastoid process of Turns head to side; flexes Accessory nerve
temporal bone neck & head
Digastric Inferior border of mandible; Hyoid bone (sling) Opens jaw; Ant belly (V3)
mastoid groove elevated hyoid bone Post belly (VII)
Does move the mandible
(opens) BUT is NOT a
muscle of mastication
Mylohyoid Mylohyoid line of mandible Median raphe Elevates hyoid bone & Trigeminal V3
(Know how to ** the mylohyoid ridge/line is floor of mouth
pick out of a located on the body of the NOTE: in the submental
diagram) mandible region, the mylohyoid is
**The mylohyoid is the muscle the 1st muscle to be
responsible for displacing penetrated from the skin
denture when extended too far NOT involved in
inferiorly mastication!!
Stylohyoid Styloid process of temporal Body of the hyoid Elevates & retracts hyoid Facial N
bone bone
Hyoglossus Body and greater horn of hyoid Lateral and dorsal tongue Raises the hyoid, retracts Hypoglossal n.
bone the tongue to the
LATERAL FLOOR
Sternohyoid Manubrium Body of hyoid Depresses hyoid Ansa cervicalis
Thyrohyoid Thyroid cartilage Greater cornu of hyoid Depresses hyoid; C1 via hypoglossal n.
bone elevates thyroid cart.
Omohyoid Superior border of scapula Clavicle; body of hyoid Depresses hyoid Ansa cervicalis
bone

- Only 3 muscles Depress the Hyoid TOS, Thyrohyoid, Omohyoid, and Sternohyoid
- Superficial Muscles of the Neck???
o SCM
o Platysma
o Sternohyoid
o Maybe Splenius Muscles???
- Muscles of the Deep Neck
o Often called the lateral vertebral muscles
o Form a large portion of the floor of the posterior cervical triangle

Muscles of Deep Neck


Muscle Origin Insertion Action Innervation
Longus Capitus Anterior Tubercles of Basilar portion of the Flexes the neck C1-C3 ventral rami
C3-C6 vertebral occipital bone **In front of the cervical
transverse processes vertebrae and are often
called prevertebral ms.
Longus Colli Bodies of T1-T3, bodies Anterior tubercle of the Flexes the neck (weakly), C2-C6 ventral rami
of C4-7, and transverse atlas (C1), bodies of C2- and slightly rotates and
processes of C3-C6 4, and transverse laterally bends the neck
processes of C5-C6
Scalenes Anterior: Anterior Anterior: Scalene Anterior and Middle: Anterior: C5-C7 ventral
tubercles of transverse tubercle of 1st rib Elevate the 1st rib, when rami
processes of C3-C6 the 1st rib is fixed, they
Middle: Superior surface flex the neck forward and Middle: C3-C8 ventral
Middle: Posterior of 1st rib laterally rotate it to the rami
tubercles of the opposite side
transverse processes of Posterior: External Posterior: C6-C8 ventral
C2-C7 border of 2nd rib Posterior: Raises the 2nd rami
rib and flexes and
Posterior: Posterior slightly rotates the neck
tubercles of the
transverse processes of
C4-C6

- Suboccipital Triangle
o Deep in the triangle passes the vertebral artery and the Suboccipital nerve (aka dorsal ramus of C1)
o Posterior Neck/Head Nerves
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
Great auricular nerve (cervical plexus C2,3)
Lesser occipital nerve (cervical plexus C2,3)
Least occipital nerve (dorsal ramus of C3 spinal nerve)
Suboccipital nerve (aka dorsal ramus of C1)

Muscles of Suboccipital Triangle


Muscle Origin Insertion Action Innervation
Rectus Capitus Posterior Arises from the tubercle Medial part of the Extends the head Suboccipital nerve (aka
Minor of the posterior arch of inferior nuchal line dorsal ramus of C1)
the atlas
Rectus Capitus Posterior Arises from the spinous Lateral portion of the Extends head and rotates Suboccipital nerve (aka
Major process of the axis inferior nuchal line it to the same side dorsal ramus of C1)
Obliquus Capitus From the transverse Occipital bone between Extends the head and Suboccipital nerve (aka
Superior process of the atlas the superior and inferior bends it laterally dorsal ramus of C1)
nuchal lines
Obliquus Capitus Inferior Spinous process of the Inferior and dorsal Rotates the atlas, turning Suboccipital nerve (aka
atlas portions of the transverse the face towards the dorsal ramus of C1)
process of the atlas same side

Location & Contents of the Triangles of


the Neck
Triangle Boundaries Contents
Anterior SCM (sternocleidomastoid) muscle, medial Four lesser triangles, salivary glands,
line of neck, inferior border of mandible larynx, trachea, thyroid glands, various
vessels & nerves.
Carotid (Superior) SCM, posterior digastric, & omohyoid Carotid , internal jugular vein, vagus nerve,
muscle CN XII (where the IJV originates from)
Superior border is the posterior digastric
Submandibular (Digastric, Submaxillary) Digastric muscle, inferior border of Salivary glands, CN XII
mandible
***NOTE: mylohyoid makes up the floor
Submental Digastric, hyoid bone (only unpaired Muscles of the floor of the mouth, salivary
triangle of neck) glands & ducts
Muscular (or inferior carotid) Omotracheal SCM & omohyoid muscles, midline of neck Larynx, trachea, thyroid gland, carotid
sheath
Posterior (THINK Os) SCM & trapezius muscles; clavicle Floor: Medial and Posterior Scalenes,
THE SCM divides the anterior and posterior Splenius capitus, Levator scapulae, Nerves
triangles & vessels, Anterior belly of Omohyoid
(NOT sternohyoid)
Occipital SCM, trapezius, & omohyoid muscles Cervical plexus, accessory nerve
Omoclavicular (Subclavian) SCM, & omohyoid muscles, clavicle Brachial plexus, Subclavian artery

- Triangles
o Anterior Triangle
Submental
Digastric
Carotid
Muscular
o Posterior Triangle
Occipital and Omoclavicular
o CN XII (Hypoglossal) travels from the Carotid triangle into the Mandibular triangle
Muscles that pass:
Medial scalene
Splenius capitis
Levator scapulae
- Hyoid Bone
o Attached by muscles or ligaments to the mandible, clavicle, and tongue
- Sternocleidomastoid (SCM)
o Origin
2 heads of origin
Sternal head arises from the anterior surface of the manubrium of the sternum
Clavicular head arises from the superior surface of the medial third of the clavicle
o ***Clavicle is first bone to calcify and is the most commonly broken
o Insertion
To the lateral surface of the mastoid process and the lateral half of the superior nuchal line
o Action
Tilts head to one side, flexes the neck, rotates the neck so the face points superiorly to the opposite side, both together flex the
neck
o Innervation
Spinal root of XI (and C2, C3)
Only Traps are also innervated by XI
o Sternocleidomastoid separates the anterior & posterior triangles of the neck
- Platysma
o Innervated by CN VII

Muscle of Mastication
Muscle Origin Insertion Action
Temporalis Floor of the temporal bone Coronoid process of Mn Elevates & retracts Mn
Masseter Zygomatic arch Lateral ramus of the Mn Elevates Mn to occlude teeth
Medial pterygoid Medial surface of the Lateral Medial surface of angle of Mn Elevates Mn & moves Mn
pterygoid plate & tuberosity of Mx & laterally
pyramidal process of palatine bone
Lateral pterygoid Superior head: Greater wing of the Superior head: Articular disc & capsule Opens, protrudes, & moves Mn
sphenoid bone Inferior head: Condylar neck of Mn laterally
Inferior head: Lateral surface of
lateral pterygoid plate
- Muscles of mastication
o Two groups based on function:
Masseter, temporalis, medial pterygoid elevate Mn to close mouth
In the temporalis, most elevation is from the anterior fibers, but the posterior fibers do contribute to elevation of Mn
Lateral pterygoid depresses Mn to open mouth, translates jaw (side-to-side) & protrudes Mn
What about mylohyoid as an elevator of Mn see 2000 Q01
Kaplan says mylohyoid also depresses the Mn (bad Q!!!)
o All receive blood supply from pterygoid portion of the Mx artery
o Innervated by trigeminal nerve (V3)
o Masseter & medial pterygoid form sling around angle of Mn
Superificial head of masseter inserts on lateral surface of angle & medial pterygoid inserts on medial surface of angle
Primary closing muscles provide lateral stabilization of Mn
Both muscles exert similar forces upon Mn
Nerve to the masseter passes through the mandibular notch, BUT does not reach the muscle by passing through the
mandibular foramen
o Medial pterygoid muscle:
The lingual nerve, inferior alveolar nerve, & IA artery all pass between medial pterygoid & Mn ramus (not lingual artery) I
think the point of this Q is to test whether or not you know that the Lingual A. and N. take different paths.
If needle lies below mandibular foramen during IA block, it will pierce the Medial Pterygoid muscle
A diffuse swelling at the angle of the Mn & lateral neck of the condyle constrains the following muscle (NOT the medial
pterygoids)
Digastric, mylohyoid, lateral pterygoid, geniohyoid
o Lateral pterygoid muscle:
Condylar fracture or injury to lateral pterygoid results in deviation toward affected side
Damage to the articular disc of TMJ would result in paralysis of the lateral pterygoid muscle, which inserts on the articular
disc, joint capsule, & neck of the Mn. The patient would be unable to open his/her mouth
o Temporalis muscle:
Fan-shaped muscle originating from 1) the bony floor of the temporal fossa & 2) the deep surface of the temporal fascia
Inserts on the coronoid process of the mandible & the anterior border of the ramus of the mandible
Anterior & superior fibers elevate Mn; posterior fibers retract Mn (these fibers also contribute to elevation of Mn)
Primary function of the temporalis muscle is to elevate & retrude the Mn
Innervated by deep temporal nerves (branches of V3)
Arterial supply by the maxillary & superficial temporal
Passes medially (downward & deep) to zygomatic arch as a thick tendon before inserting
Posterior fibers retract Mn & maintain resting position of closure of mouth
o In a double vertical fracture at the mental foramina, muscle action will cause the small fragment to move inferiorly &
posteriorly. This probably has something to do with the Digastric muscle that attaches to the anterior mandible.
- Buccinator muscle:
o Does not move the jaw
o Innervated by CN VII
o Complex origin:
Maxilla along alveolar process superior to alveolar margin between 1st & 3rd molars
Mandible along oblique line of Mn between 1st & 3rd molars
Pterygomaxillary ligament
Pterygomandibular raphe thin, fibrous band running from the hamulus of the medial pterygoid plate down to the Mn
(Along with Superior pharyngeal constrictor)
Marks the posterior border of the vestibular side of the cheek (posterior border of buccinator)
Connects the buccinator and the superior pharyngeal constrictor
o Inserts:
Orbiuclaris oris & skin at angle of mouth
o Pierced by the parotid duct
o Proprioceptive fibers are derived from the buccal branch of V3
o Muscle innervation from the buccal branch of VII
o Actions:
Assists with mastication but NOT innervated by V3
Move boluses of food out of vestibules & back towards molar teeth
Tense the cheeks during blowing & whistling
Assist w/ closure of mouth
o Blood supply facial & maxillary
- IA nerve block injection
o Needle passes through mucous MB & buccinator muscle & lies lateral to medial pterygoid
o If needle passes posteriorly at level of Mn foramen penetrates parotid facial paralysis
o If needle passes well below Mn foramen penetrate medial pterygoid

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- Palatine aponeurosisMuscles of Tongue
o All muscles of tongue are innervated by CN XII (except palatoglossus muscle pharyngeal plexus [CN XI via X])
Damage to what CN leads to movement of the tongue toward the side of the damage? CN XII
o Blood supply lingual artery; venous drainage into internal jugular vein
o Extrinsic muscles:
Anchor tongue to skeleton
Control protrusion, retraction, & lateral movements of tongue
Genioglossus, Hyoglossus, Styloglossus, Palatoglossus (Decks say Palato IS an extrinsic, Netters doesntGo with Decks)
Lingual nerve, hypoglossal nerve, & submandibular duct are all superficial to the hyoglossus (lingual artery is not)
o Intrinsic muscles:
Lie entirely w/in tongue itself
Named according to spatial plane: longitudinal, transverse, vertical
Fibers contract to squeeze, fold, & curl the tongue
- NOTE the Exceptions C1 via XII Genioglossus (should be just XII) for the extrinsic tongue muscles
Thyrohyoid (should be just ansa cervicalis) for the strap muscles
Geniohyoid!!
- Taste buds:
o Associated w/ peg-like projections on the tongue mucosa called lingual papillae
o Contain a cluster of 40-60 gustatory cells as well as many more supporting cells
o Each gustatory cell is innervated by a sensory neuron
o Have a turnover rate of 30 days, and are located on ventral and dorsum of the tongue??
o Kinds of Lingual papilla:
Filiform: (think MILI, like Millions)
Most numerous, small cones arranged in V-shaped rows paralleling the sulcus terminalis on anterior 2/3 of tongue
Characterized by absence of taste buds & increased keratinzation (DONT Taste, just like MILI didnt sing)
o Filiform papillae are the lingual papillae with the thickest keratin (think Mili Vanilli wore lots of Makeup)
Fungiform:, FUNGUS are on the Tip and SIDES
Mushroom-shaped, found on tip & sides of tongue
Most likely to be damaged by a tongue laceration
Taste buds innervated by CN VII
Circumvallate:
Largest but fewest in number (7-12), arranged in an inverted V-shaped row on back of tongue
Associated w/ ducts of Von Ebners glands
Have many taste buds, which are innervated by CN IX
Foliate:
Found on lateral margins as 3-4 vertical folds
Taste buds innervated by both CN VII & CN IX
Where are the taste buds found on the dorsum of the tongue?

Longitudinal Muscles of Pharynx


Muscle Origin Insertion Action
Stylopharyngeus Styloid process Posterior and superior margins of Thyroid Elevates pharynx & larynx
cartilage & muscles of pharynx
(Passes between the superior and middle
pharyngeal constrictors)
Palatopharyngeus Hard palate; aponeurosis of soft palate Thyroid cartilage & muscles of pharynx Elevates pharynx
Salpingopharyngeus Cartilage of auditory tube Muscles of pharynx Elevates nasopharynx??,
opens auditory tube
- Stylopharyngues innervated by the glossopharyngeal nerve (the other two are innervated by CN XI via X -- pharyngeal plexus)
- Soft palate:
o Blood supply lesser palatine artery/vein
o All muscles of soft palate (except one) are innervated by CN IX & X (pharyngeal plexus)
Exception: tensor veli palati m. innervated by nerve to the medial pterygoid, a branch of V3
o Anterior zone of the palatal submucosa contains fat
o Posterior zone contains mucous glands
o Attached inferolaterally to tongue by the glossopalatine archs (Palatoglossal arch?)
o Connected to lateral wall of pharynx by the pharyngopalatine arches (Palatopharyngeal arch)
o Palatal salivary glands found beneath mucous MB of the hard & soft palate (mostly mucous)
o Five paired skeletal muscles of the soft palate:
1) Palatoglossus closes oropharyngeal isthmus
2) Palatopharyngeus
Elevates pharynx
Contraction during swallowing causes a fold in the posterior wall of the pharynx
3) Levator veli palati
Elevates soft palate during swallowing & yawning
Innervated by X (XI via X)
Extrinsic muscle of the soft palate
Inserts in a palatine aponeurosis
From cartilage of Eustachian tube and petrous portion of temporal bone to the palatine aponeurosis of soft palate
4) Tensor veli palati
Tenses palate & opens mouth of the auditory tube during swallowing & yawning
Curves around the hamulus (if hamulus is fractured, actions of this muscle are affected)
From the scaphoid fossa of the medial pterygoid plate, spine of the sphenoid bone, and cartilage of Eustachian tube to
the palatine aponeurosis of the soft palate
Innervated by V3
5) Uvular raises & shortens the uvula to help seal oropharynx from nasopharynx
o Uvula suspended from the soft palate
Innervated by pharyngeal nerve plexus
Unilateral nerve damage causes uvula to deviate to the opposite side (THE ODD BALL in that rule)
When uvular muscle contracts, the muscle on the intact side pulls the uvula toward that side
Bifid uvula:
Results from failure of complete fusion of palatine shelves
- Pharyngeal Constrictors (Circular Muscles)
o Superior Pharyngeal constrictor
From pterygoid hamulus, pterygomandibular raphe, posterior portion of the mylohyoid line and side of the tongue
All attach to the median raphe of the pharynx and the pharyngeal tubercle of the occipital bone
Constricts the wall of the upper pharynx during swallowing
Innervated by X
Lateral wall of the Oropharynx
Behind the Mandible
Superior and Middle Constrictors are split by CN IX (glossopharyngeal) and the Stylopharyngeus muscle - See pp
636 ECA 2nd Ed.
o Middle Pharyngeal Constrictor
From the stylohyoid ligament and the greater & lesser horns of the hyoid bone to the median raphe of the pharynx
Constricts during swallowing
Innervated by X
Behind the Hyoid bone
o Inferior Pharyngeal Constrictor
Arises from the oblique line of the thyroid cartilage and side of cricoid cartilage to the median raphe of the pharynx
Constricts during swallowing
Innervated by X
Behind the Thyroid and Cricoid cartilages
The lower end is referred to as the cricopharyngeal muscle, which is continuous with the esophageal muscle fibers
Circular Muscles of Pharynx
Muscle Origin Insertion Action
Superior constrictor Medial pterygoid plate, pterygoid hamulus, Median raphe & pharyngeal Constricts upper pharynx
pterygoimandibular raphe; mylohyoid line of mandible, tubercle of skull
side of tongue
Middle constrictor Greater & lesser horns of hyoid; stylohyoid ligament Median raphe Constricts lower pharynx
Inferior constrictor Arch of cricoid & oblique line of thyroid cartilages Median raphe of pharynx Constricts lower pharynx

- Styloid Process Muscles


o Stylohyoid
Innervated by VII
Perforated near its insertion at the hyoid bone by the tendon of the 2 bellies of the digastric bone
Elevates and retracts the hyoid bone that elongates the floor of the mouth
o Stylopharyngeus
Innervated by IX (only muscle IX hooks up)
Passes between superior and middle constrictors
Elevates the larynx and pharynx during swallowing and speaking
o Styloglossus
Innervated by XII
Some fibers interdigitate with hyoglossus muscle
Elevates and retracts the tongue during swallowing
One of the 4 Extrinsic muscles of the tongue
- Fauces
o Anterior pillars form the glossopalatine arch (aka palatoglossal arch)
The arch attaches the soft palate laterally to the tongue
Within the arch palatoglossus muscle elevates tongue & narrows the isthmus of the fauces
o Posterior pillars form the pharyngopalatine arch (aka palatopharyngeal arch)
The arch attaches the soft palate to the lateral wall of the pharynx
Within the arch palatopharyngues muscle elevates pharynx, helps close nasopharynx, narrows the isthmus of the fauces,
& aids in swallowing
o Palatine tonsils:
Consist predominantly of lymphoid tissue
Found between the two arches in an area called the isthmus of the fauces
- Retropharyngeal or Prevertebral space
o Lateral boundary at level of oropharynx is the carotid sheath (not pterygomand. raphe, medial pterygoid, or stylopharyngeus m)
o NOTE: retropharyngeal space lies between buccopharyngeal fascia & prevertebral fascia
Infection can spread from pharynx to mediastinum
- Strap Muscles (Infrahyoid Muscles)
o Depressors of larynx & hyoid after they have been drawn up w/ pharynx to swallow (deglutition)
o Lie between deep fascia & visceral fascia over the thyroid gland, trachea, & esophagus
o Innervated by ansa cervicalis (aka cervical plexus) from C1,2,3 (except thyrohyoid C1 fibers via CN XII)
o Sternothyroid
o Sternohyoid
o Thyrohyoid ***Boards ? said it WAS innervated by ansa cervicalis, and Geniohyoid was only one not
Anatomy notes say Infrahyoids, EXCEPT thyrohyoid (C1 via CN XII)
Maybe that one Q thinks that C1 (via CN XII) counts as part of ansa cervicalis
o Omohyoid
MuscleOriginInsertionActionInnervationSternohyoidManubrium of the sternumBody of the hyoidDepresses the hyoid after
swallowingC1, C2, C3
(ansa cervicalis)SternothyroidPosterior surface of the manubrium of the sternumOblique line of the thyroid cartilageDepresses the larynx
after swallowingC2, C3
(ansa cervicalis)OmohyoidInferior Belly: Superior border of the scapula near the suprascapular notch
* Then goes through a fibrous attachment of the clavicleSuperior Belly: Inferior border of the hyoid boneDepress the hyoid bone after the
bone has been elevated. Retracts and steadies the boneC1, C2, C3
(ansa cervicalis)Thyrohyoid
**Does not raise the hyoid (its infrahyoid, baby!)Oblique line of the lamina of the thyroid cartilageInferior border of the body and the
greater horn of the hyoid Depresses the hyoid bone and if the hyoid is fixed, draws the thyroid cartilage superiorlyC1 via XII
(also to the Geniohyoid, and to the Genioglossus)
- Suprahyoid muscles:
o Raise the hyoid during swallowing
o Assist lateral pterygoid in depressing Mn
o Assists posterior fibers of temporalis in retraction of Mn
MuscleOriginInsertionActionInnervationDigastricPosterior Belly (Longest): Mastoid notch of the temporal bone
Anterior Belly: Digastric fossa of the mandibleBoth bellies end in an intermediate tendon that perforates the stylohyoid muscles and is
connected to the horn of the hyoidElevates the hyoid and helps lateral pterygoids open the mouth by depressing the mandibleAnterior
Belly: V3 (Mylohyoid n. branch)
Posterior Belly: VII
(SAME AS Stylohyoid)StylohyoidStyloid processBody of the hyoid
(Perforated by the digastric intermediate tendon)Elevates and retracts the hyoid to elongate the floor of the mouthVIIMylohyoid

**If fall on nail in submental region, first muscle penetratedMylohyoid line of mandibleMedian fibrous raphe and the body of the hyoid
boneElevates hyoid and raises floor of mouth during swallowing, pushes tongue upward or forward
**Can help depress the mandible or open the mouth
**Sublingual gland is located superior to the mylohyoid muscle
Mylohyoid n. branch (V3)GeniohyoidMental spine (Genial tubercles)Body of the hyoidElevates and draws the hyoid forward shortening
the floor of the mouth
When hyoid is fixed, also helps retract and depress the mandibleC1 via XII
(also to the Thyrohyoid)

**C1 Ventral primary ramus contributes to the superior root of the ansa cervicalis, which then jumps on XII to get to the geniohyoid
(thyrohyoid also)
- Muscles of the Larynx
o ALL (but the cricothyroid) of the intrinsic muscles of the larynx receive their innervation from the inferior (recurrent) laryngeal
nerve (of CN X)
o Posterior cricoarytenoid
Helps maintain a wide airway through the larynx
MuscleOriginInsertionActionInnervationCricothyroidAnteriolateral part of cricoid cartilageInferior aspect and inferior horn of the thyroid
cartilageStretches and tenses vocal cordsExternal branch of superior laryngeal nerve of X
(**Superior laryngeal continues as internal branch that pierces thyrohyoid membrane and does sensory above the vocal cords)Posterior
CricoarytenoidPosterior surface of the laminae of the cricoid cartilageAttaches to the muscular process of the arytenoid cartilageONLY
muscle that ABDUCTS the vocal folds and widens the rima glottidis (space between the vocal folds)Recurrent laryngeal nerve of the
vagus (Inferior Laryngeal)Oblique ArytenoidsArytenoid cartilagesAttach to opposite arytenoid cartilage
**(Some fibers continue superiorly as the Aryepiglottic muscle)Close the inlet of the larynx by adducting the rima glottidisRecurrent
laryngeal nerve of the vagus (Inferior)Transverse ArytenoidArytenoid cartilagesAttach to opposite arytenoid cartilageClose the inlet of
the larynx by adducting the rima glottidisRecurrent laryngeal nerve of the vagus (Inferior)Aryepiglottic Recurrent laryngeal nerve of the
vagus (Inferior)ThyroepiglotticRecurrent laryngeal nerve of the vagus (Inferior)ThyroarytenoidRecurrent laryngeal nerve of the vagus
(Inferior)Lateral CricoarytenoidRecurrent laryngeal nerve of the vagus (Inferior)Vocalis
- Pulls on the True and changes pitchDerived from the Thyroaryteniod muscle **Located in the vocal folds themselvesRecurrent
laryngeal nerve of the vagus (Inferior)ALSO in the Larynx
o Conus Elasticus
Most superior portion is thickened and forms the vocal ligament
o Vocal Ligament
- The cricoid cartilage is cut twice in a sagittal plane (splits the body in left and right halves)
o Provides a backstop when doing automatic tracheotomy
o The thyroid cartilage, arytenoid cartilage, epiglottis & 2nd tracheal cartilages would not be cut twice

UPPER LIMB MUSCLES


- Axilla
o Boundaries: (Pyramid)
Medial wall upper 4-5 ribs & their intercostal muscles, and the serratus anterior muscle
Lateral wall humerus (specifically the coracobrachialis & bicep muscles in the biciptial groove)
Posterior wall scapula, subscapularis, teres major, & latissimus dorsi muscles
Anterior wall pectoris major, minor, & subclavius muscles
Base axillary fascia or skin
o Contents:
Axillary vessels
Branches of the brachial plexus
Both heads of the biceps brachii
Coracobrachialis
Muscles of the Axilla
Muscle Nerve Innervation Action
Pectoris major Medial & lateral pectoral nerve from brachial plexus Flexes, adducts, & medially rotates arm
Pectoris minor Medial pectoral nerve Depresses the scapula
Latissiums dorsi Thoracodorsal nerve from brachial plexus Adduct, extends & medially rotates the arm
Deltoid Axillary nerve (C5-C6) Abducts arm, post. Fibers extend & anterior fibers flex
Teres major Lower subscapular nerve from brachial plexus Adducts, extends & medially rotates the arm
Teres minor Branch of Axillary nerve Rotates the arm laterally

Muscles of the Shoulder


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Muscle of the Arm


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Scapula (coracoid process & supraglenoid tubercle)

- Radial nerve is most commonly injured in a mid-humeral shaft


fracture, because it runs in the radial (spiral) groove of the
humerus
- Coracoid Process
o A break would affect the biceps brachii and the pectoralis
minor muscles (Pec major inserts into arm)
- And one more factoid:
o The pronator quadratus m. is the primary pronator of the
forearm (assisted by the pronator teres m.)

- Triangle of auscultation
o Bounded by the upper border of the latissimus dorsi, the
lower border of the trapezius, & the medial margin of the
scapula
o Site where breathing sounds can be heard most clearly
o Floor is formed by the rhomboid major

ABDOMINAL & PELVIC MUSCLES

Muscles of Anterior Abdominal Wall -- (TIRE from Deep to Super)


Muscle Origin Insertion Action Innervation
Transversus abdominis Compresses abdomen Lower intercostal,
iliohypogastric &
ilioinguinal nerves
Internal abdominal Lateral half of the Inferior borders of the Compresses abdomen; lateral Lower intercostals (T7-
oblique inguinal ligament, the cartilages of the last 3 rotation, acting alone it bends T11), subcostal (T12)
iliac crest, and the to 4 ribs, the linea alba, the vertebral column laterally iliohypogastric, &
**Along with the thoracolumbar fascia pubic crest, and and rotates it to bring the ilioinguinal nerves (L1)
aponeuroses of the pectineal line shoulder of the opposite side
transverses, forms the forward
conjoint tendon **Nerves of the anterior
abdominal wall lie
immediately deep to this
muscle
Rectus abdominis 2 tendons Attaches to the 5th, 6th, Flexes vertebral column, Lower intercostal nerves
Lateral attaches to the and 7th ribs and the tenses abdomninal wall, and (T7-T11), and the subcostal
pubic crest xiphoid process depresses the ribs nerve (T12)
**Linea alba splits the Medial interlaces with
muscle and 3 the tendon of the
tendinous bands opposite side to arise
horizontally (6 pack) from the pubic
symphysis
External abdominal Fleshy digitations fro Attaches to the anterior Compresses abdomen; lateral Lower intercostal nerves
oblique the external surface and half of the iliac crest, rotation, acting alone it bends (T7-T11)
inferior borders of anterior superior iliac the vertebral column laterally
lower 8 ribs spine, and into a broad and rotates it to bring the
aponeurosis along a line shoulder of the same side
from the 9th costal forward
cartilage to the anterior
superior iliac spine.
The aponeurosis inserts
into the midline linea
alba

- Cremaster muscle
o Arises from the middle of the inguinal ligament and is a continuation of the internal abdominal oblique muscle
o Draws testes upward
o Innervated by the genital branch of the genitofemoral nerve (L1 and L2)
o After passing through the inguinal ring, the muscle fibers of the cremaster form a series of loops making up the cremaster fascia
which surrounds the spermatic cord
- Posterior abdominal muscles:
o Psoas major & minor innervated by lumbar plexus
o Quadratus lumborum
From the transverse process of L3-5, the iliolumbar ligament, and the iliac crest to the lower border of the last rib and the
transverse processes of L1-3 vertebrae
Flexes the lumbar vertebral column, fixes the 12th rib during inspiration
Innervated by lumbar plexus (Subcostal nerve T12 and L1-3)
Above the muscle, the diaphragm forms the lateral arcuate ligament
o Iliacus innervated by femoral nerve
o Dorsal rami innervate erector spinae muscles
- Respiratory muscles:
o Diaphragm, internal & external intercostals, subcostals, & transverses thoracic
Diaphragm is innervated by phrenic nerve; the others are all innervated by intercostal nerves
o Diaphragm:
Muscle mostly responsible for quiet breathing
Flat muscle in a dome-like shape that separates chest & abdominal cavities
Arises from the xiphoid process, lower 6 costal cartilages and a lumbar portion (L1-L3)
Then the muscles converge and insert into the central tendon
o The tendon is drawn downward and forward during inspiration
Inhaling contraction of diaphragm pulls down on chest (via the central tendon), drawing in air via pressure differences
The vertical dimension of the thoracic cavity is increased chiefly by contraction of the diaphragm
Exhaling contraction of abdominal forces the relaxed diaphragm upwards
Upper surface contacts heart & lungs; Lower surface contacts liver, stomach, & spleen
Innervated by the Phrenic nerve (C3, 4, 5keep the diaphragm alive)
Travels through the thorax between pericardium & pleura
o The phrenic nerve is the nerve lying in close relation to the surface of the pericardial sac (not the vagus nerve)
Right phrenic travels anteriorly to bronchial root and does NOT leave an impression (azygos v. does)
Phrenic nerve Sends off branches to innervate the parietal pericardium
Is in direct contact in the neck with the Infrahyoid fascia
Inability to move the diaphragm is associated with a total section of the spinal cord at C2
Phrenic nerve passes anterior to which muscle Anterior scalene
Has three openings:
Caval opening (T8)
o IVC
o Right phrenic nerve
Esophageal opening (T10)
o Esophagus
o R & L vagus nerves
Aortic opening (T12)
o Aorta
o Azygos vein
o Thoracic duct
MNEMONIC: I 8 10 EGGs AAT 12
o I = IVC T8; T10 EG = esophagus, G vaGus or (10 for CN X); A = Aorta, Azygos, T = Thoracic duct
T12
o External intercostals: (Girls gone wild Externs lifting up their shirt!)
From rib to rib in a shoulder to belly button direction hands in pocket
Pass from rib to rib & run at right angles to fibers of the intenal & innermost muscles
Continue toward sternum as the anterior intercostal MB
Active during inspiration and elevate the ribs
Innervated by the intercostal nerve, i.e. between 4th and 5th rib is the 4th intercostal space, so innervated by the 4th intercostal
nerve meaning there are only 11 intercostal nerve
o Internal intercostals:
Right angle to External intercostals
Eleven on each side between ribs
From rib to rib in a sternum to pants pocket direction
Continue toward vertebral column as the posterior intercostal MB
The upper portions (upper 4 to 5 intercostal muscles) elevate the ribs
The lateral and posterior muscles, where fibers run more obliquely depress the ribs and are active during expiration
Innervated by intercostal nerves
o Innermost intercostals:
Run is same direction as internal intercostals but are separated from them by nerves & vessels
Thought to elevate the ribs
Innervated by the intercostal nerves
o Transversus thoracis:
From posterior surface of the lower portion of the body of the sternum and xiphoid process to the inner surface of costal
cartilages 2-6
Depress the ribs
Innervated by the intercostal nerves
- Muscles of Inspiration
o SCM Accessory muscle Christopher Reeves used this to breathe.
o Scalenes (Ant, Middle, Post) Accessory muscle
o External intercostals
o Interchondral part of internal intercostals
o Diaphragm
- Muscles of Expiration
o Internal intercostals (except interchondral part)
o Abdominals (TIRE Transversus abdominis, Internal oblique, Rectus abdominis, External oblique)
NOTE : the nerves of the anterior abdominal wall lie between transversus abdominis & internal oblique muscles
- Active Inspiration
o Diaphragm descends
o Rib joints are active
o Lateral diameter of thorax increases

LOWER LIMB MUSCLES


- Quadriceps femoris group
o Rectus femoris:
Crosses the hip & knee joints
Flexes thigh at hip & extends leg at knee
o Vastus lateralis, intermedius & medialis
All extend leg at knee
- Muscles of the thigh posterior group
o All three:
Flex the leg & extend the thigh
Innervated by tibial nerve
o Biceps femoris
o Semitendinousus
o Semimembranous
- Muscles of the thigh anterior group
o Sartorius
Flexes leg & thigh
Abducts thigh
- Femoral triangle:
o Contains the femoral V.A.N.
- Unhappy triad: MCL, meniscus, & ACL

NERVOUS SYSTEM
- Embryology:
o Neural PlateNeural Tube
Prominent growth of neural tissue causes folding of the embryo during the 4th week of development
This gives it a C-shaped curvature
Neural plate forms by Day 19 in the dorsal midline of the embryo
A rostrocaudal groove appears on the midline & invaginates as the lateral borders rise to form the neural folds
The neural folds begins to move together & fuse, converting the neural plate into a neural tube
The Notochord induces ectoderm to form neuroectoderm, hence promoting formation of the neural plate
The Prochordal Plate (Buccopharngeal) and the cloacal plate only have 2 layers epi and hypoderm
o Neural Tube
The neural tube develops into the CNS
Initially the neural tube is separated from the surface ectoderm by neural crest cells
Caudal end develops into the spinal cord
Basal plates motor part of CNS
Alar plates sensory part of CNS Alar does Afferents.
Rostral end develops into the brain
3 parts: rhombencephalon, mesencephalon, prosencephalon
o Neural crest:
Band of neuroectodermal cells that lies dorsolateral to developing spinal cord
Clusters of cells (neural crest cells) develop into: DRG (dorsal root ganglion) cells, spinal autonomic ganglion cells,
chromaffin cells, neurolemma cells (Schwann cells), integumentary pigment cells (melanocytes), & meningeal covering of
brain & spinal cord
- Nervous tissue has two classes of cells:
O 1) Neurons: nerve cells
Transmit nerve impulses
Basic unit of the nervous system activities of the system are carried out it at the neuron level
O 2) Neuroglial cells: nerve glue
Provide support & nourishment for neurons
- 1) Neurons:
O Structure
Cell body (perikaryon)
Contains nucleus & most of the cytoplasm
Located mostly in the CNS as clusters called nuclei some found in periphery as ganglia
When the cell body is destroyed all of its fibers degenerate and die
Synthesizes axoplasm that is needed for increasing axon length
Contains Nissl bodies (rough ER); not found in axon or axon hillock
Dendrites
Process that send the impulse toward the cell body
May be one or many dendrites some neurons lack dendrites
Axon (nerve fiber)
Process that send the impulse away from the cell body
Only one axon per neuron
O Classified according to:
1) Structure (by number of processes)
Bipolar or Unipolar or Multipolar (most common)
2) Function
Motor or Sensory or Mixed
O Myelination
Myelin formed by Schwann cells in PNS & oligodendrocytes in CNS
Node of Ranvier is junction between two Schwann cells
O Neurolemma
The outermost portion of a nerve fiber (Dont call the myelin sheath the outer!!!!)
The nucleated layer of Schwann cells that surrounds the myelin sheath
So, from inside out: axis cylindermyelin sheathneurolemma
O Motor Neurons
Babinski Sign
In adults, a positive Babinski sign means damage to upper motor neurons
In newborns, a positive sign is normal
- 2) Neuroglia:
O Non-neuronal tissue of CNS that performs supportive & other ancillary functions
O Composed of various types of cells collectively called neuroglial or glial cells
O With the exception of the microglia, which derives from mesoderm, all other neuroglia cells form from ectoderm
Neuroglia
Cells that support neurons Structure Function
CNS
Astrocytes Stellate w/ numerous processes Form structural support between capillaries &
neurons w/in CNS, Blood Brain Barrier
Oligodendrocytes Similar to astrocytes but w/ shorter & fewer Form myelin in CNS, guide development of neurons
processes w/in CNS myelinates multiple CNS axons
Microglia Minute cells w/ few short processes Phagocytize pathogens & cellular debris w/in CNS.
Mesodermal origin (M for M, others are from Act like macrophages which also derive from
Ectoderm) mesoderm.
Ependymal Columnar cells that may have ciliated free surface Line ventricles & central canal w/in CNS where
CSF is circulated by ciliary motion
PNS
Satellite cells Small, flattened cells Support ganglia w/in PNS
Schwann cells Flattened cells arranged in series around axons or Form myelin w/in PNS only myelinates 1 axon
dendrites Promote axonal regeneration

- Spinal cord:
O Cylindrical, occupies ~ upper 2/3 of vertebral canal, & is enveloped by the meninges
O Centrally located gray matter & peripherally located white matter
O Ends at ~L1 in adults & at ~L3 in young children
Dura & arachnoid continue to S2 where arachnoids fuses w/ filum terminale (after fusion it is called the coccygeal ligament)
O Main areas of spinal cord:
Gray matter
H-shaped, centrally located, consists of nerve cell bodies & unmyelinated nerve fibers
Gray commissure center of the H connects two paired posterior (dorsal) horns & anterior (ventral) horns
Anterior hornmotor
O Cell bodies of somatic motor system lie w/in the ventral horn
O Cell body of a motor neuron in a spinal reflex arc is located in anterior gray column (ventral horn) of the spinal cord
O Patellar (knee-jerk) reflex: L4
O Biceps reflex: C5
O Triceps reflex: C7
O Achilles reflesx: S1
Lateral hornautonomic
Posterior hornsensory
Central canal:
w/in gray commissure & filled w/ CSF
White matter:
Composed primarily of myelinated axons (because its fatty)
Surrounds gray matter
O Fasciculus gracilus legs (Think Graceful legs and straight down)
O Fasciculus cuneatus arms
- Spinal taps
O Lumbar puncture needle inserted in space between L3-L4 (or between
L4-L5)
Needle enters subarachnoid space which is filled w/ CSF (pia is
not pierced)
O CSF can be aspirated most safely by inserting the needle between L3 &
L4 since the spinal cord usually does not extend below L2
- Spinal nerves:
O 31 pairs; all spinal nerves are mixed made up of ventral & dorsal roots
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
The cauda equina consists of the roots of the lumbar & sacral
spinal nerves
O Ventral and Dorsal roots leave the spinal cord, immediately join to form
the Spinal Nerve, then 3 branches, 1 to sympathetic chain ganglion, 1 to
the Ventral Rami (i.e. intercostals), 1 to Dorsal Rami (i.e. intrinsic
muscles of the back)
Then the anterior rami can branch to form Lateral and Anterior cutaneous branches
The intercostals nerves course between the innermost and the inner intercostal muscles
Intercostals (somatic nerves) are connected to the sympathetic chain ganglia via the rami communicantes
Like how the greater splanchnic nerve comes from rami communicantes from T5-9
O Ventral roots
Contain axons of motor neurons (also ANS stuff)
Cell bodies located in spinal cord
Upon exit, become anterior rami (mixed) supply body wall & limbs
In cervical, brachial, lumbar, & sacral regions the anterior rami of the spinal nerves unite to form plexuses
O These plexuses give rise to other nerves for distribution to muscle, skin, etc.
O Dorsal roots
Contain axons of sensory neurons
Cell bodies located outside spinal cord in dorsal root ganglia
Upon exit, become posterior rami (mixed) supply skin & deep back muscles
O Hey, if youre confused, look at a picture somewhere

- Spinal Cord tracts


o Columns of white matter w/in spinal cord that conduct impulses to CNS (ascending) & away from CNS (descending)
SPINAL CORD TRACTS
Ascending tracts Function
Anterior spinothalamic Conducts sensory impulses for touch & pressure
Lateral spinothalamic (side of lateral horn) Conducts pain & temperature impulses
Fasciculus gracilis (back in the midline) & fasciculus cuneatus Conducts sensory impulses from skin, muscle, tendons, & joins;
(back offset) (THINK GRACEFUL LEGS) also touch localization (conscious proprioception)
Posterior spinocerebellar (back corners) Conducts sensory impulses from one side of body to same side of
cerebellum for subconscious proprioception
Descending Tracts Function
Anterior corticospinal (Front Midline) Conducts motor impulses from cerebrum to spinal nerves &
outward through anterior horn for coordinated movement
Lateral corticospinal (Just next to dorsal horn, inside Post. Conducts motor impulses from hemisphere to spinal nerves through
Spinocer.) anterior horns for coordinated movments
Tectospinal (Front offset) (Night at the Roxbury TECHNO head Conducts motor impulses to cells of anterior horns & eventually to
shake) muscles that move the head
Rubrospinal (In lateral grooves, in front of lat. Corticosp.) Conduct motor impulses concerned w/ muscle tone & posture
Vestibulospinal (Front really offset) Regulate body tone & posture (equilibrium) in response to
movements of head
Anterior & medial reticulospinal & lateral reticuloalspinal Control muscle tone & sweat gland activity

- Meninges
O Three protective tissue layers covering CNS
O The structures involved in meningitis (inflammation of meninges) if severe can become encephalitis (inflammation of brain)
O Dura mater:
Outermost MB a fused, double layer of tough fibrous CT
Layers separate to form venous sinuses in the cranial cavity
Endosteal layer adheres tightly to inner surface of the cranium
Meningeal layer forms partitions (folds) that extend between regions of the brain
O Arachnoid:
Delicate middle MB adheres to dura mater but is separated from pia mater by subarachnoid space contains CSF
O Pia mater
Innermost MB delicate vascular MB of loose CT adheres closely to brain & spinal cord
- Outside the skull: SCALP
O Skin, CT, Aponeurosis, Loose CT, Pericranium
- Cerebrospinal fluid
O Clear, colorless fluid formed by the choroid plexuses w/in the lateral, 3rd & 4th ventricles
O Produced by filtration, primarily from tufts of capillaries that protrude into all four ventricles
Ependymal cells also produce CSF they line the ventricles, central canal of spinal cord, & choroid plexuses
O Fluid enters the subarachnoid space through three foramina of the 4th ventricle
O Choroid plexuses regulate intraventricular pressure by secretion & absorption of CSF
O CSF along w/ ligamentous walls of vertebral canal protect spinal cord from injury
- Dura mater (continued):
O Two vertical folds
Falx cerebelli separates hemispheres of cerebellum; contains occipital sinus
Falx cerebri separates the cerebral hemispheres; contains inferior & superior sagittal sinuses
O Two horizontal folds
1) Tentorium cerebelli
Separates occipital lobes from the cerebellum
Contains straight, transverse, & superior petrosal sinuses (NOT inferior petrosal sinus)
2) Diaphragma sellae
Forms roof of sella turcica; a small central opening allows passage of infundibular stalk of the pituitary
- BRAIN
o Blood-brain barrier (BBB):
Protected by the CIA:
Choroid plexus epithelium
Intracerebral capillary endothelium
Arachnoid
Glucose & amino acids cross by carrier-mediated transport mechanism
L-dopa used to treat Parkinsons, since dopamine does not cross the BBB
o Consists of several regions: TDMMMS
Forebrain (prosencephalon)
Telencephalon & diencephalon derive from the
forebrain
Midbrain (mesencephalon)
Hindbrain (rhombencephalon)
Metencephalon and Myelencephalon derive from
the Hindbrain
o Each portion of brain consists basically of three areas:
Gray matter composed primarily of unmyelinated
nerve cell bodies
White matter composed basically of myelinated nerve
fibers
Ventricles spaces filled w/ CSF
o Cerebrum:
Located w/in telencephalon & is the higher forebrain
Consists of five paired lobes w/in two convoluted
cerebral hemispheres (connected by corpus callosum)
Accounts for 80% of brains mass
Deals w/ higher functions perception of sensory
impulses, instigation of voluntary movement, memory,
thought, reasoning
Two layers of cerebrum:
Cerebral medulla thickened core of white matter
Cerebral cortex thin, wrinkled gray matter covering each hemisphere
o Diencephalon:
Major autonomic region of forebrain almost completely surrounded by cerebral hemispheres of the telencephalon
Chief components thalamus, hypothalamus, epithalamus, & pituitary gland (just posterior pituitary)
The 3rd ventricle forms a midplane cavity w/in the diencephalon
o Hypothalamus:
Is the inferior portion of the diencephalon & forms roof & ventrolateral walls of the 3rd ventricle
Endocrine control
Regulates hormone synthesis in anterior pituitary
Synthesizes & releases oxytocin & ADH water/salt balance\
ADH supraoptic nucleus; Oxytocin paraventricular nucleus -- (Think LOW oxygen when you PARAshute)
Regulation of ANS
Temperature control (anterior hypothalamus think A/C: Anterior = Cooling)
Eating behaviors
Lesions of ventromedial HThobesity
Lesions of lateral HThsevere aphagia
Lesions of supraoptic nucleidiabetes insipidus (polydipsia & polyuria result from deficient ADH)
Sexual maturation & childbirth
o Thalamus:
Thalamic nuclei:
DOESNT regulate Breathing Medulla Ob does
Lateral Geniculate nucleus visual
Medial Geniculate nucleus auditory (PUT your fingers in your ears
POINT MEDIALLY)
Ventral posterior nucleus sensory
o Medial part body senses
o Lateral part facial sensation
Ventral anterior/lateral nuclei motor

o A Lateral Ventricle
o B Corpus callosum
o Identify the thalamus in the sketch above: C
o D Internal Capsule
o E Basal Ganglia (Caudate, Putamen, Pallidum, Substantia Nigra, Nucleus accumbens, Subthalamic Nucleus)

o Most of the fibers ascending or descending to the cerebral cortex transverse the internal capsule
The fiber tracts passing from the thalamus to the cortex are found in the internal capsule

o Four ventricles:
NOTE: formation of the brain begins w/ differentiation of the cephalic
end of the hollow neural tube
Hollow spaces persist as ventricles w/in the brain
1&2) Two lateral ventricles
Hollow C-shaped spaces w/in right & left cerebral hemispheres
Large mass of gray matter that bulges into the floor and lateral
aspect of the ventricle is the caudate nucleus
3) Third ventricle
Forms a median cavity w/in the diencephalon (forebrain)
4) Fourth ventricle:
Located in the metencephalon (hindbrain).
Contains two openings in its walls called Lateral apertures
(foramina of Luschka)
Contains a single opening in its roof called Medial aperture
(foramen of Magendie)
The apertures connect the ventricular system w/ the subarachnoid space
After circulating throughout the subarachnoid space, CSF is returned to the circulatory system by filtration
through arachnoid villi (villi protrude mainly into the venous drainage sinuses of the cranial cavity) into the
Superior Sagittal sinus
Two interventricular foramina of Monro oval openings which provide communication between the third & lateral
ventricles
The cerebral aqueduct in the midbrain connects the third & fourth ventricles
Obstruction of the cerebral aqueduct causes enlargement of the two lateral & third ventricles (not the fourth)
Referred to as a non-communicating hydrocephalus which means lateral ventricles are not in communication w/
subarachnoid space
o Excessive CSF in the ventricles
o Substantia Nigra (Black people are DOPE
Uses dopamine as predominant neurotransmitter for S.N. (not for olivary nucleus or lateral reticular nucleus)
o Cerebellum
Consists of the vermis (medial) & two cerebellar hemispheres
External anatomy:
Each hemisphere has an anterior lobe, posterior lobe, & flocculonodular lobe
Internal anatomy:
Cerebellar cortex
o 3 layers (think MPG): Medullary, Purkinje, Granular
Arbor vitae
o Subcortical white matter
Cerebellar nuclei
Circuitry:
Mossy fibers = excitatory fibers from the spinal cord, pons, & vestibular nuclei
Climbing fibers = excitatory fibers from the inferior olive nucleus
Golgi cells = fibers receiving input from mossy fibers & parallel fibers of the granule cells
Purkinje fibers = fibers receiving input from the climbing & parallel fibers AND inhibitory input from basket cells
Each granule cell sends its axon into the molecular layer, giving off collaterals at 90 angles = parallel fibers
o The granule cell axons stimulate the distal dentrites for the Purkinje cells & Golgi cells
o Purkinje fibers are the final common pathway for cortical output
They can stimulate OR can send a single axon through the granular layer & arbor vitae to inhibit the deep nuclei
Common symptoms of cerebellar dysfunction
Ataxia, Dysmetria, Nystagmus, Hypotonia, Intention tremor
- Cerebral cortex:
o Extensive outer layer of gray matter of cerebral hemispheres
o Cerebral lobes function primarily in voluntary movement, higher intellectual processes & personality (w/ the limbic system)
o NOTE: basal nuclei gray matter structures deep w/in each cerebral hemisphere help control muscle activity

Area of Cerebral Cortex Function


Precentral gyrus of frontal lobe Motor area (initiates voluntary contractions of skeletal muscle
EX Highly skilled, discrete hand movements depend on activity of the precentral
gyrus
Postcentral gyrus of parietal lobe Sensory area (receives sensory info regarding temperature, touch, pain, proprioception)
(Think Dorsal meaning Sensory) Concerned with recognition of painful stimulus from the teeth
**Sensations from Left face and Teeth are interpreted in the Right Parietal Lobe
Medial surface of the occipital lobe Visual area visual center of the cerebral cortex is found here
Parietal lobe (near base of postcentral gyrus) Taste area
Temporal lobe (transverse temporal gyri) Hearing area the primary auditory complex is found here
Frontal lobe (Higher intellectual functions)
(Unable to Plan or Organize Behaviors)
(Lacks Self-Discipline)
(Anti-social Behavior) PHINEAS GAGE
Parietal lobe Somatic associated area (Integration & interpretation center)
Temporal lobe (Medial surface) Smell

- Limbic system:
o Includes brain structures involved in emotion, motivation, & emotional association w/ memory
o Responsible for 5 Fs:
Feeding, Fighting, Feeling, Flight, & Sex (Ha, Ha) (as quoted from USMLE)
- Gate Theory of Pain (outdated???)
o A controller system modulates sensory input so that there is a selective and integrative action occurring before impulses reach the
first synapse for onward transmission.
The gate controller in this system is the substantia gelatinosa
Jello would fit through the gate
- BRAINSTEM
o Picture: ID cross section of : pons, midbrain, medulla oblongata, spinal cord
o Corticobulbar tract
The fibers which separate from the corticospinal tract as it descends through the pons & medulla oblongata
Fibers of this tract innervate the motor nuclei CN V, CN VII, CN XII (perhaps also the nucleus ambiguus)

- 1) Which CN contralateral innvervation? CN 12 (also the upper part of 7 to the forehead, and most texts also say 2)
o I think it could be 5, 7 upper, 12 (& even nulceus ambiguus)
- 2) What CN crosses corticobulbar? 12
o Same answer
- 3) Which tract of the corticobulbar only innervates to the contralateral side of the face?
o I say its 7 lower
o Hypoglossal n. (not sure)

http://sprojects.mmi.mcgill.ca/cns/histo/systems/motor/main.htm - for explanations


Also see lab on desktop for explanation
CN XII receives bilateral innervation
CN V does, too
CN VII lower is only contralateral
N. ambiguus receives bilateral

- BRAINSTEM
O Lower extension of brain where it connect to spinal cord
O Neurological functions located in the brainstem include those necessary for survival
Breathing, digestion, HR, BP
O Most cranial nerves come from brainstem
O Motor nuclei are medial to sensory nuclei
O Pathway for all fiber tracts passing up & down between peripheral nerves & spinal cord to higher brain
O Midbrain:
Nerve pathway of cerebral hemispheres
Contains auditory & visual reflex centers
O Pons:
Bridge-like structure which links different parts of brain
Serves as a relay staion from medulla to higher cortical structures
of brain
O Medulla oblongata:
Relay station for the crossing of motor tracts between spinal cord
& brain
If the spinal tract of CN V were sectioned at the level of
the caudal medulla, PAIN from the ipsilateral side of the
face would be most affected
Contains respiratory, vasomotor, & cardiac centers
Has many mechanisms for controlling reflex activities (e.g.,
coughing, gagging, swallowing & vomiting)
Medial lemniscus
Large ascending bundle of fibers, composed of 2nd order
neurons, carrying proprioception & discriminatory touch
sensations to the conscious levels
O
- BRAINSTEM NUCLEI:
O LOOK UP CROSS SECTIONS OF MIDBRAIN, PONS, AND
MEDULLA
ORIGIN OF CNS
BRAIN (2)
O I
O II
MIDBRAIN (2)
O III
O IV Only CN from Dorsal Brainstem
PONS (4)
O V (remember Spinal N. of V is from Medulla)
O VI
O VII
O VIII
MEDULLA (4 5* if you count Spinal of V)
O IX
O X
O XI
O XII
O CN III
Oculomotor
GSE fibers to all extraocular muscles except the superior oblique (trochlear nerve) and the lateral oblique (Abducens
nerve)
Edinger-Westphal Nucleus
PreG parasym fibers, which give rise to GVE fibers with terminate on cells in the ciliary gaglion
Lesions
Ptosis, Eye looks down and out causing double vision, Mydriasis, and loss of accommodation
In cross section of the nerve, the parasym fibers surround the somatomotor
O CN IV
Trochlear nuclei
located near central gray matter of the lower midbrain at the level of the inferior colliculi
Located on the Dorsal side of the brain only nerve that comes from the back of the brainstem.
Lesions
Double vision on looking downward and awy from the affected side
O CN V:
Sensations from the Left face and teeth are interpreted in the Right Parietal lobe
Touch receptors are most numerous per unit area in the tip of the tongue
Motor nucleus of V:
*Sends SVE (special visceral efferent) fibers to muscles of mastication
Lower motor neuron control of the muscles of mastication is by way of the Motor nucleus of V
Monosynaptic jaw closing reflexes might be disrupted in Motor nucleus of V
Just medial to the Main Sensory Nucleus
Fibers are SVE and supply the 8 muscles of V3
Joins sensory nuclear complex fibers to become Trigeminal Nerve
Trigeminal sensory nuclear complex:
Axons enter the pons through sensory root & terminate in 1 of 3 nuclei of trigeminal sensory nuclear complex:
1) Mesencephalic nucleus: (MeS for Muscle Spindle and Phalic for P-DaLic)
O Mediates proprioception (ex. Musclespindle) from the face
O Primary sensory neurons of mechanoreceptors in the PDL not in the main sensory nucleus of TG.
O Cell bodies of the proprioceptive 1st order neurons are found in mesencephalic nucleus (not trigeminal ganglion)
O Mediates Jaw jerk reflex Only nucleus in the CNS that receives proprioceptive inputs from muscle
spindles
O Only example in which the primary sensory cell bodies reside within the CNS instead of in ganglia
2) Main sensory nucleus: (The Main role of V is sensation)
O Discriminative touch of face
O Mediates general sensation (ex. Touch)
O **All sensory information from the face fibers cross and ascend in the ventral TTT (Trigeminalthalamic Tract) to
the VPM - M for your ugly Mug
From the rest of the body it goes to the VPL
3) Spinal trigeminal nucleus of V: (SPAINAL Spine pain/temp in lateral cord)
O Mediates pain & temperature from head & neck (Oral Cavity)
O Mx bone fracture next to central incisornociception terminates centrally in spinal subnucleus caudalis of V
O If the spinal tract of the fifth cranial nerve were sectioned at the level of the caudal medulla, PAIN from the face
would be most affected
O The primary sensory neurons' nucleus of termination for pain from a Mx M2 is the spinal nucleus of V
O The descending tract (down to the spinal nucleus) of V contains axons of primary sensory neurons
O Fibers then cross and ascend in the ventral TTT (trigeminothalamic) tract to the VPM as well
O Lesions
Sensory deficits Loss of tactile, Proprioceptive, pain sensation, temperature, etc.
Motor deficits From lower motor neuron involvement involving the muscles of mastication
Temporalis and masseter causes weak jaw closure
Pterygoid weak jaw opening (probably just the lateral pterygoid lesion would do this)

O CN VI
Abducens nucleus
Located in the lower pons, ventral to the
floor of the fourth ventricle near the
midline
Provides GSE to the lateral rectus muscle
Lesions
Paralysis causes lateral rectus palsy, leading
to medial deviation of the affected eye and
diplopia
O CN VII
Main Motor Nucleus
To all the muscles of facial expression
NOTE the upper face receives bilateral
innervation BUT the lower face receives
contralateral innervation
REFER TO Bells PALSY
Superior Salivatory nucleus
Located posterolateral to the motor nucleus of VII
One group of fibers enters the superficial (greater) petrosal nerve and terminates in the ptergopalatine ganglion
Lacrimal glands
Another group of fibers travels in the chorda tympani nerve to reach the submandibular gangion Submandbular and
Sublingual glands (Greater goes to Ganglion)
Gustatory nucleus (Nucleus Solitarius) actually VII, IX, and X
Solitary tract gives rise to the geniculate ganglion
The rostral portion of the nucleus of the solitary tract receives all the SVA fibers for taste, which pass in the seventh,
ninth, and tenth CNs
The facial receives all the anterior 2/3rds of the tone
The taste afferents in the facial nerve arise from cells in the geniculate gangion
Lesions
Flaccid paralysis of muscle of facial expression (upper and lower face)
Loss of corneal reflex (efferent limb)
Hyperacusis (due to stapedius muscle) paralysis
Loss of taste from anterior 2/3rds means lesion is proximal to the sytlomastoid foramen since the chorda tympani
joins the facial nerve in the middle ear
Bells Palsy
O Lower motor neuron damage = ipsilateral problems
O *Facial nerve:
LMN lesion:
Affects BOTH upper & lower face
Causes an IPSILATERAL flaccid paralysis of facial musculature
A pt has a lower facial paralysis, where is the damage facial nerve in the facial canal!!!
O NOT after it leaves the stylomastoid foramen
Hyperactive Spastic Paralysis
Hypoactive Fasciculations, Atrophy, Flaccid Paralysis (Like in ALS)
UMN lesion:
Affects ONLY lower face
Most commonly affects CONTRALATERAL face below the eyeball
Rt sided lower face paralysis caused by Contralateral (left side) Cerebrocortical damage
O CN VIII
Vestibular Nuclei
Sensory from the Crista ampullaris of the semicircular canals and the maculae of the utricle and saccule
Cochlear Nuclei:
Input from the Organ of Corti, Spiral Ganglion
O CN IX
Glossopharyngeal nuclei
SVE fibers from the rostral nucleus amibiguus and supply the stylopharyngeus muscle
GVA fibers to the nucleus solitarius and supply the baroreceptors of the carotid sinus
SVA fibers carrying taste sensation from the posterior 1/3rd of the tongue and terminate in the nucleus Solitarius (aka
gustatory nucleus)
GSA Fibers supplying the posterior tongue and pharynx carry the sensory limb of the Gag reflex
O The motor limb of this reflex is carried by fivers from the nucleus ambiguous, which exits via the vagus nerve
O Lesion
Up CN IX results in unilateral ipsilateral loss of gag reflex
Down CN X results in bilateral loss of gag reflex
Inferior Salivatory
PS nerve fibers to the Otic ganglion via Lesser petrosal nerve hitchhikes on V3 (auriculotemporal) to the Parotid
Gland
O CN X
Main Motor Nucleus
(aka the vagal part of the nucleus ambiguous)
Located in the anterior portion of the reticular formation and extends throughout the medulla
Sends motor fibers through the
Dorsal Motor Nucleus
Located in the floor of the 4th ventricle and ventral to sulcus limitans
PreG PS fibers distributed to the PostG neurons supplying the viscera of the thorax and abdomen
Nucleus Solitarius (aka Gustatory nucleus) VII, IX, and X
GVA fibers from the larynx, esophagus, and baroreceptors in the aortic arch and visceral abdominal/thoracic viscera
SVA fibers from epiglottis taste buds (present in newborns)
Nucleus Ambiguus
Sends SVE fibers to larynx, pharynx all the XI via X crap
Lesions
Weakness of the palate, loss of gag, and nasal speech occurs and possibly nasal regurgitation of food
Bilateral lesions of the vagus leads to paralysis of the pharynx and larynx death from asphyxiation
Paralysis of an ipsilateal vocal cord may occur, because the recurrent laryngeal nerve supplies all of the laryngeal
muscles, except the cricothyroid, which is supplied by the superior laryngeal nerve
In a nut shell
Nucleus solitarius = sensory (taste, gut distension, etc) VII, IX, X
Nucleus ambiguus = motor (pharynx, larynx, upper esophagus) IX, X, XI
O Dorsal motor nucleus (parasympathetic) (to heart, lungs, upper GI) X only
Baroreceptors
O From IX Carotid Sinus
O From X Aortic Arch
Each CN has a nucleus of its own name, EXCEPT:
O I/II/VIII special sense only
O IX/X these share nucleus ambiguous
O VII/IX/X share nucleus solitarius (aka gustatory nucleus)
O XI arises from cervical spinal cord only called a CN because it sneaks up & exits skull w/ IX & X
O CN XI
Spinal accessory nerve (not nucleus):
*Sends SVE fibers to SCM & trapezoid
XI via X explanation
O Cranial root fibers originate from the caudal nucleus ambiguous to supply the intrinsic muscles of the the larynx
O The fibers join CN X and finally reach the intrinsic laryngeal muscles through recurrenet laryngeal nerve
Lesions
Paralysis of the SCM (difficulty in turning head) and Trapezius (shoulder droop)
O CN XII
Hypoglossal Nucleus
Located near the midline below the floor of the 4th ventricle in the caudal medulla
GSE fibers to intrinsic muscles of the tongue, genioglossus, hyoglossus, and Styloglossus
Lesions
Ipsilateral paralysis deviation TOWARD
O UMN Unilateral Tongue weakness W/O atrophy
Bilaterally innervated upper, so NO atrophy
O LMN Unilateral Tongue weakness W/ atrophy (e.g. from tonsillectomy damaging CN XII)
- Anatomic Divisions of Nervous System
o CNS
Brain & spinal cord
Control center of nervous system
Receives sensory input from PNS & formulates responses
o PNS
12 pairs of cranial nerves
31 pairs of spinal nerves 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, & 1 coccygeal
Afferent division:
Somatic sensory neurons carry impulses from skin, fascia & joints
Visceral sensory neurons carry impulses from viscera of body (hunger pangs, BP)
Efferent division:
Somatic (voluntary) somatic motor neurons carry impulses to skeletal muscles
Autonomic (involuntary) visceral motor neurons transmit impulses to smooth & cardiac muscles & glands
o Sympathetic & Parasympathetic
o See next section
- Autonomic Nervous System
o Innervation to organs not usually under voluntary control
o Cardiac muscle, smooth muscle, visceral organs/glands
o Preganglionic neurons
Cell bodies are in CNS
Synapse in autonomic ganglia
Parasymp originate in cranial nerves & craniosacral region
PreG PS fibers have their cell bodies in association w/ the nuclei of certain cranial nerves & in the anterolateral cell
column of the grey substance of S2-4, A for AL, as
Preganglionic PS nerve fibers to the urinary bladder have their cell bodies in the spinal cord at the S2,3,4 level
Symp originate in thoracolumbar (T1-L3) region
PreG S fibers to the head/neck have their cell bodies in the intermediolateral horns of the thoracic spinal cord
PostG S fibers to the head have their cell bodies in the cervical ganglia
o Postganglionic neurons
Cell bodies in autonomic ganglia
Synapse on effector organs
o SYMPATHETIC DIVISION:
Prepares body for intense physical activity in emergencies (fight or flight) through adrenergic effects
HR increases & blood glucose rises
Blood is diverted to skeletal muscles
Pupils & bronchioles dilate
Adrenal medulla releases Epi & NE
Preganglionic fibers
Release ACh
Carried by white rami
Postganglionic fibers
Release NE (except for BVs in skeletal muscles & sweat glands)
Carried by gray rami
***Synapse in paravertebral or prevertebral ganglia
o PARASYMPATHETIC DIVISION:
Conserves energy (rest & digest)
Decrease HR
Papillary & bronchiolar constriction
No effect on adrenal medulla
Maintains normality of body functions
Preganglionic & postganglionic fibers release ACh
o Synapses between neurons are made in autonomic ganglia
PS NS ganglia located in or near effector organs
Symp NS ganglia located in the paravertebral chain
o NOTE: Most organs are innervated by both PS & Symp NS

- Cranial Sutures
o Coronal Suture
Separates Frontal bone from BOTH Parietal Bones
o Sagittal Suture
Separates BOTH Parietal Bones
o Lambdoid Suture
Separates BOTH Parietal Bones from Occipital Bone
o Squamous Suture
Separates A Parietal Bone from the Temporal Bone

- FORAMINA:

o Anterior Cranial Fossa: I


Cribriform plate perforations
Located in ethmoid bone
Contains olfactory nerves (CN I)
o Middle Cranial Fossa: II-VI
Optic Canal CN II (optic nerve), ophthalamic artery, central
retinal vein (within optic nerve)
Superior Orbital Fissure CN III, IV, V1, VI, superior
ophthalamic vein NOT ophthalamic artery
Between the slit light openings between lesser & greater
wings of sphenoid bone
Foramen rotundum in sphenoid bone carries maxillary
nerve (V2)
Inferior orbital fissure carries the maxillary nerve (V2)
AFTER IT HAS EXITED THE BRAIN
Foramen ovale in sphenoid bone carries mandibular nerve (V3) & the lesser petrosal nerve and accessory meningeal
artery
Think: for CN V, its Standing Room Only (S. R. O.)
Spinosum middle meningeal artery
Foramen spinosum in sphenoid bone carries middle meningeal artery & vein
o Posterior Cranial Fossa: VII-XII
Internal Auditory Meatus CN VII, VIII
Canal running through petrous portion of the temporal bone
CN VII enters meatus & emerges from stylomastoid foramen between styloid & mastoid processes of temporal bone
o Gives off five branches in the parotid gland supplies motor innervation to muscles of facial expression
o Anesthetic in parotid (during Mn block) paralyzes muscles of facial expression
o Gives chorda tympani branch thru the petrotympanic fissure
CN VIII enters meatus, then remains w/in temporal bone
o Nerve fibers to cochlear duct (hearing), semicircular ducts & maculae (balance)
Jugular Foramen CN IX, X, XI, internal jugular vein (Found in the Posterior Cranial Fossa)
Passage between the petrous potion of the temporal bone and the jugular process of the occipital
Hypoglossal Canal CN XII
Foramen magnum in occipital bone contains medulla oblongata, vertebral , & spinal accessory nerve, Medulla Oblongata

o Mandibular foramen:
Location:
Above the occlusal plane & posterior to the Mn molars
On medial surface of ramus just below the lingula, midway between the anterior & posterior borders of the ramus
Lateral to the medial pterygoid muscle
Leads into Mn canal which opens into mental foramen below PM2
NOTE: incisive canal a continuation of the Mn canal beyond the mental foramen & below incisor teeth
NOTE: lingula bony projection that serves as the attachment for the sphenomandibular ligament
Contains inferior alverolar nerve, artery & vein
IA nerve ends at mental foramen by dividing into:
o 1) mental nerve supplies skin & mucous MB of mental region
o 2) incisive branch supplies pulp chambers of anterior teeth & adacent mucous MB
o Other foramina:
Carotid canal
Located in temporal bone
Contains internal carotid artery & sympathetic nerves (carotid plexus)
Nasolacrimal canal
Located in lacrimal bone/maxilla
Contains nasolacrimal duct
Foramen cecum in frontal & ethmoid bones contains emissary vein in fetal life
Sphenopalatine foramen sphenopalatine artery/vein & nasopalatine nerve
Pterygoid canal deep & greater petrosal nerves (these form the nerve of the pterygoid canal)
Pterygomaxillary fissure PSA artery/vein/nerve & maxillary artery
Pterygopalatine canal greater & lesser palatine artery/vein/nerve
Pharyngeal canal pharyngeal branch of V2
Greater palatine foramen in the palatine carries greater palatine nerve, artery & vein
Lesser palatine foramen carries lesser palatine nerve artery & vein
Stylomastoid foramen in temporal bone carries facial nerve
Mental foramen in mandible carries mental nerve, artery & vein
Petrotympanic fissure in temporal bone carries chorda tympani & anterior tympanic artery
Fracture involving petrotympanic fissure would affect the chorda tympani
Foramen lacerum in temporal & sphenoid bones carries artery of the pterygoid canal, greater & deep petrosal nerves
(through the occluded cartilage)
Supraorbital foramen in frontal bone carries supraorbital nerve artery & vein
Infraorbital foramen in sphenoid & maxilla carries infraorbital nerve (V2), artery, & vein
Incisive foramen in maxilla carries nasopalatine nerve

http://en.wikipedia.org/wiki/Cranial_nerves#Thirteen_cranial_nerves.3F
CN CN Name Nuclei Site of exit from skull Functions (M= motor; S = sensory)
#
I Olfactory Anterior Olfactory Cribiform plate (ethmoid S = smell
bone)
II Optic Lateral Geniculate Optic foramen S = vision
III Oculomotor Edinger-Westphal Superior orbital fissure M = levator palpebrae superioris, medial,
Occulomotor superior, inferior, inferior oblique, ciliary m. (lens),
sphincter m. (pupil)
IV Trochlear Trochlear Superior orbital fissure M = superior oblique m.
V Trigeminal Mesencephalic, Main
V1 Ophthalmic Sensory, Spinal, and Superior orbital fissure S = cornea, skin of nose, forehead, scalp
V2 Maxillary Trigeminal Motor Foramen rotundum S = nasal cavity, palate, Mx teeth, skin of cheek,
upper lip
V3 Mandibular Foramen ovale S = tongue, Mn teeth, Mn, skin of chin, floor of
mouth, TMJ
M = mastication mm., tensors, anterior digastric, &
mylohyoid
VI Abducens Abducens Superior orbital fissure M = lateral rectus m.
VII Facial Facial, Solitarius Internal auditory meatus S = taste (anterior 2/3)
(Gustatory), Salivatory M = facial expression mm., lacrimation, salivation
VIII Vestibulocochlear Vestibular, Cochlear Internal auditory meatus S = hearing, balance
IX Glossopharyngeal Ambiguus, Inferior Jugular foramen M = stylopharyngeus muscle (Only muscle it gets)
Salivatory, Solitarius S = taste (posterior 1/3), pharynx, middle ear,
carotid sinuses
X Vagus Ambiguus, Solitarius, Jugular foramen M = muscles of pharynx & larynx (Ambiguus)
Dorsal Motor M = smooth m. of thoracic & abdominal organs
(Dorsal motor)
S = taste (epiglottis) (Solitarius)
S = thoracic & abdominal organs (viscera)
XI Accessory Ambiguus, Spinal Jugular foramen M = trapezius m. & SCM m.
Accessory
XII Hypoglossal Hypoglossal Hypoglossal canal M = intrinsic & extrinsic tongue mm.

Parasympathetic Nuclei & Ganglia by Cranial Nerve


Cranial Nerve Nucleus Ganglion Effector
CN III Edinger-Westphal N. Ciliary G. Pupillary sphincter m. meiosis
Ciliary m. accomodation
CN VII Superior Salivatory N. Pterygopalatine G. Lacrimal gland & nasal cavity/nose secretion
Submandibular G. Submandibular & sublingual glands secretion
CN IX Inferior Salivatory N. Otic G. Parotid gland secretion
CN X Dorsal Motor N. of Vagus *None* Viscera of thorax & abdomen

Autonomic Ganglia PS & Symp fibers


Ganglion Location PS Fibers Symp Fibers Chief Distribution
Ciliary Lateral to optic n. PreG: CN III (inferior division) Internal carotid plexus PS Ciliary m. &
PostG: Short ciliary nn. sphincter pupillae
Symp Dilator pupillae
& tarsal mm.
Pterygopalatine Pterygopalatine fossa PreG: CN VII, greater petrosal n., & Internal carotid plexus Lacrimal gland & glands
nerve of pterygoid canal Deep petrosal n. in palate & nose
PostG: Branches of V2,then V1
Submandibular On hyoglossus m. PreG: CN VII (Chorda tympani) Plexus on facial artery Submandibular &
PostG: Lingual n. sublingual glands
Otic Below foramen ovale PreG: CN IX & lesser petrosal n. Plexus on middle Parotid gland
PostG: Auriculotemporal n. meningeal artery

CRANIAL NERVES
- CN V, VII, IX, X are branchiomeric (nonsomitic) in origin because they originate from the branchial arches
- Olfactory (CN I)
o Exits Cribiform plate of ethmoid bone
o Enters nasal canal for smell
o Fracture of the cribiform plate typically results in loss of sense of smell
- Optic nerves (CN II)
o Arise from axons of the ganglion cells of the retina which converge at the optic disk
o Optic foramen (optic canal):
Area where nerve enters the cranial cavity through the sphenoid bone
o Optic disc (aka optic papilla):
Area where optic nerve exits eye
Made up of nerve cells
Small blind spot on surface of the retina no rods or cones
Located ~3mm to nasal side of the macula
Only part of retina which contains no photoreceptors
Optic tracts consists of axons from ganglion cells
Consists of axons of ganglion cells exiting the retina to form the optic nerve
The axons are accompanied by the central artery & vein of the retina
o After exiting eyes, optic nerves meet at the optic chiasm (in the floor of the diencephalon)
o From optic chiasm, axons that perceive the left visual field form the right optic tract & vice-versa
Fibers that arise from the nasal hemiretinas decussate & contribute to the contralateral optic tract
o Optic nerve fibers from the nasal side cross the midline and enter the optic tract of the other side by way of the optic chiasma
Fibers arising from the temporal hemiretinas remain ipsilateral
Optic tract fibers synapse in the lateral geniculate nuclei w/ geniculocalcarine fibers (optic radiations) that terminate on the
banks of the calcarine sulcus in the primary visual cortex (Brodmanns area 17) of the occipital lobe
So, the right visual field is interpreted in the left hemisphere of the brain & vice versa
o Central artery of the retina (branch of ophthalmic artery), pierces the optic nerve & gains access to the retina by emerging
from the center of the optic disc
- Oculomotor nerve (CN III)
o Supplies: medial, superior, & inferior recti; inferior oblique; & levator palpebrae superioris
o Sends pregangl fibers to ciliary ganglion
o Post gang fibers leave the ganglion in the short ciliary nerves to supply the sphincter pupillae & the ciliary muscle
- Oculomotor nerve (CN III), trochlear nerve (CN IV) & abducens nerve (CN VI) and ophthalmic (V div 1) all exit the cranium through
the superior orbital fissure. They innervate the extrinsic ocular muscles, resulting in movement of the eyeball
- Trochlear nerve (CN IV):
o Supplies the superior oblique muscle
o Smallest cranial nerve
o Only cranial nerve that emerges from dorsal aspect of the brainstem
- Trigeminal nerve (CN V):
o Exits inferolateral PONS as a sensory & motor root
o Largest of 12 cranial nerves
o Larger sensory root enters the trigeminal (semilunar, gasserian) ganglion in the middle cranial foss, Embeds in Meckels CAVE
o Three sensory divisions of the nerve arise from the ganglion & leave the cranial cavity through foramina in the sphenoid bone
o Smaller motor root passes under the ganglion & joins the mandibular division as it exists through the foramen ovale
- Semilunar ganglion (aka trigeminal or gasserian ganglion)
o Large, flattened, sensory ganglion of the trigeminal nerve
o Lies close to cavernous sinus in the middle cranial fossa
o Ophthalmic division (V1):
Enters orbit through superior orbital fissure
Sensory innervation to eyeball, tip of nose, skin on face above eyes
Three branches: lacrimal, frontal, & nasociliary
o Maxillary division (V2):
Passes through foramen rotundum
Sensory innervation to midface (below eyes & above upper lip), palate, paranasal sinuses, & maxillary teeth
o Mandibular division (V3):
Exits cranial cavity through foramen ovale
Motor innervation to tensor veli palatine, tensor tympani, muscles of mastication, and anterior belly of digastric & mylohyoid
Has no PS component at its origin:
Sensory innervation to:
Skin on Lower face, skin of mandible, lower lip & side of the head
TMJ (Auriculotemporal, and Masseteric and Posterior Deep Temporal), mandibular teeth, mucous MBs of cheek,
floor of mouth, & anterior part of the tongue
Lingual nerve branch of V3:
Descends deep to lateral pterygoid muscle, where it is joined by chorda tympani (branch of CN VII) which conveys
pregang PS fibers to submandibular ganglion & taste fibers from anterior 2/3 of tongue
Supplies general sensation for anterior 2/3 of tongue, floor of mouth, & mandibular lingual gingiva
Submandibular duct has an intimate relation to the lingual nerve, which crosses it twice
Is directly on the lateral surface of the medial pterygoid muscle
If you cut lingual nerve after its junction w/ chorda tympani, pt loses taste & tactile sense to anterior 2/3 of tongue
Nerve to Masseter:
Passes through mandibular notch to enter muscle on medial surface
Also a branch of V3
Carries a few sensory fibers to the anterior portion of the TMJ
Anterior portion of TMJ also supplied by branches of the posterior deep temporal nerve (branch of V3)
Auriculotemporal nerve:
Arises from posterior division of V3
Provides posterior sensory innervation to TMJ
o Pain (TMJ pt) is transmitted in the capsule & periphery of the disk by the auriculotemporal nerve
Pain from a fractured mandible
The joint only sends sensory information it does not receive motor innervation (the muscles do, duh!)
Carries some secretory fibers from the otic ganglion to the parotid gland (from CN IX)
Referred pain from the TMJ to skin over the parotid region & side of head is based on the distribution of the
auriculotemporal n.
- TMJ
o Innervated by: (Think of the nerves as a MAP of the TMJ)
Nerve to the masseter (anterior portion) V3
Auriculotemporal (Primary) V3
Posterior deep temporal nerve (anterior portion) V3
- CN III, VII, IX use branches of CN V to distribute their preganglionic PS to the PS head ganglia
- Abducens (CN VI):
o Supplies the lateral rectus of the eye
o NOT found within the walls of the cavernous sinus (III, IV, V1, and V2 are) actually within the C sinus itself.
- Facial nerve (CN VII):
o Contains sensory neurons that originate from taste buds on anterior 2/3 of tongue
The cell bodies are located in the geniculate ganglion, which lie in the facial canal, in the inner ear
o Associated with the second pharyngeal arch
o Innervates the facial muscles w/ motor fibers
o Supplies the Mimetic muscles (LIKE a MIME, facial expression)
o Lacrimal gland & salivary glands w/ PS fibers
o Anterior tongue w/ taste fibers
o Originates in the pons
o Traverses the facial canal of the temporal bone & exits the stylomastoid foramen
o Also contains PS fibers to sublingual & submandibular glands (via submandibular ganglion)
o Facial nerve function:
Motor innervation:
Muscles of facial expression
Posterior belly of digastric muscle & stylohyoid muscle after CN VII emerges from stylomastoid foramen
Stapedius muscle w/in the middle ear
Damage just after it left stylomastoid foramen would cause loss of innervation to facial muscles (orbicularis oculi m.)
Which structure innervates the orbicularis oculi? Temporal and zygomatic branches of CN VII
Sensory: proprioceptive innervation: from the same muscles listed for motor innervation
Secretomotor: PS innervation. Secretion of tears from the lacrimal gland & salivation from the sublingual & submandibular
glands
Special sensory: taste impulses (sweet sensation) from the taste
buds on the anterior 2/3 of tongue, floor of mouth, & palate
o Bells Palsy
Damage to the facial nerve or its branches may cause weakness
or paralysis of facial muscles
Peripheral ipsilateral facial paralysis
Inability to close eye on affected side
Complete destruction of the facial nucleus itself OR its
branchial efferent fibers (facial nerve proper) paralyzes all
ipsilateral facial muscles
Upper motor neuron Can wrinkle forehead (Inability to
smile he can still wrinkle forehead because upper face gets
innervation from the BOTH sides of the brain (See Pic)
Lower motor neuron lesion (i.e. Facial Nucleus Destruction)
Complete facial paralysis (Inability to smile OR
wrinkle forehead)
- PS innervation controlling salivation originate in facial
& glossopharyngeal nerves
- Chorda tympani
o Emerges from a small canal in posterior wall of
tympanic cavity & crosses medial surface of
tympanic MB
o Joins lingual nerve in the infratemporal fossa
- Geniculate ganglion:
o Located w/in the facial canal (petrous portion of
temporal bones)
o Contains sensory neurons via chorda tympani of CN
VII (innervates taste buds on anterior 2/3 of tongue)
o Greater petrosal nerve:
Parasymp secretomotor branch of CN VII and general visceral afferent fibers
No sympathetic fibers or general somatic efferents
Also described as the parasympathetic root of the pterygopalatine ganglion
Arises from the geniculate ganglion
Carries PS preG fibers to pterygopalatine ganglion
Exits cranial cavity through foramen lacerum
Enters pterygoid canal after joining w/ deep petrosal nerve to form the nerve of the pterygoid canal
o Deep petrosal nerve is carrying postG S from the superior cervical ganglion
o Both form the nerve of the pterygoid canal (Vidians)
In pterygopalatine fossa, the nerve of the pterygoid canal terminates in the pterygopalatine ganglion
PS pre-ganglionics from greater petrosal nerve synapse w/ post-ganglionics here
S (already post-ganglionics) just pass on through the ganglion w/out synapsing
Post-ganglionic autonomics distributed to lacrimal gland & glands of mucous MB of nasal cavity, pharynx, & palate
Also transmits taste centrally from palate through palatine nerves
These taste fibers also necessarily pass through the pterygopalatine ganglion & nerve of the pterygoid canal to
reach the greater petrosal nerve on their way to the tractus & nucleus solitarius in the pons
o Lesser petrosal nerve:
Pregang PS to the otic ganglion parotid gland (via auriculotemporal nerve V3)
NOTE: the postG PS cell bodies to the parotid gland are found in the otic ganglion
Stimulation of lesser petrosal nerve causes secretion by parotid gland
Tympanic & lesser petrosal branches of CN IX supply preganglionic PS secretomotor fibers to the otic ganglion
o Preganglionic fibers leave CN IX as the tympanic nerve (SEE MIDDLE PIC)
Tympanic nerve enters middle ear cavity & participates in formation of the tympanic plexus (on the medial
Wall), where chorda tympani runs from posterior wall across lateral wall (aka medial surface of Tympanic MB)
o It reforms as the lesser petrosal nerve, leaves cranial cavity through foramen ovale, & enters otic ganglion
Diminshed salivary gland production from the parotid due to MIDDLE EAR damage has most likely affected the Lesser
Petrosal Nerve (NOT the auriculotemporal)
- Glossopharyngeal nerve (CN IX):
o Originates from anterior surface of the medulla oblongata along w/ CN X & CN XI
o Passes laterally in posterior cranial fossa & leaves skull through the jugular foramen
o Splits the Superior and Middle Constrictors to enter the oral cavity
o Supplies sensation (including pain) to pharynx & posterior 1/3 of tongue
o Innervates derivatives of the 3rd branchial arch
o Innervates stylopharyngeus muscle (the only muscle supplied by CN IX)
Landmark for locating CN IX as CN IX enters pharyngeal wall, it curves posterior around the lateral margin of the
muscle
o Cell bodies of these sensory neurons are located in Superior & Inferior ganglia of this nerve
Cell bodies of pain fibers in CN IX are found in the superior ganglion of CN IX
o Descends through upper part of neck along w/ internal jugular vein & internal carotid artery
Reaches posterior border of the stylopharyngeus muscle supplies it w/ somatic motor fibers
o Caries 1 afferent neurons that cause the gag reflex (innervates mucous MBs of the fauces)
o ***NOTE: CN III, VII, IX, & X all carry pre-gang PS fibers
o Visceral sensory branches of CN IX:
Lingual
Terminal branch of CN IX to posterior 1/3 of tongue conveying general sensation & taste to circumvallate papillae
Also carries some secretomotor fibers to the glands
Pharyngeal
Distributed to mucous MB of the pharynx sensory limb of the gag reflex
Carotid sinus nerve
To carotid sinus (baroreceptor) & carotid body (chemoreceptor)
o Remember Sinus gets it from IX, but the whole BODY gets it from IX and X, aortic arch only from X
- Otic ganglion:
o Pregang PS cell bodies originate in the Inferior Salivatory nucleus
o Small PS ganglion, functionally associated w/ CN IX
o Situated below foramen ovale; medial to V3
o Tympanic & lesser petrosal branches of CN IX supply preganglionic PS secretomotor fibers to the otic ganglion
Preganglionic fibers leave CN IX as the tympanic nerve
Tympanic nerve enters middle ear cavity & participates in formation of the tympanic plexus
It reforms as the lesser petrosal nerve, leaves cranial cavity through foramen ovale, & enters otic ganglion
o Postgang PS fibers leave the ganglion & join the auriculotemporal nervejump off at the parotid gland
- Vagus Nerve (CN X):
o Leaves brain from medulla & exits cranial cavity through jugular foramen
o Contains PS pre-ganglionic fibers to thoracic & abdominal viscera
o Descends in neck in the carotid sheath behind the internal & common carotid & internal jugular vein
o Both R & L Va-Goose trunks pass through posterior mediastinum on the esophagus & enter abdominal cavity w/ the esophagus
o In the lower thorax, the esophageal branches of the right vagus branches are found mainly on the posterior esophagus
Just make the right hand turn on the wheel the left vagus goes to the anterior
o Supplies viscera of neck, thorax, & abdomen to the left colic (splenic) flexure of large intestine
Abdominal viscera below left colic flexure, & pelvis & genitalia supplied w/ pregang PS fibers from pelvic splanchinc
nerves
o Vasomotor sympathetic fibers are thought to end on BVs
o Possesses Two Sensory Ganglia:
Superior ganglion (lies on nerve w/in jugular foramen)
Meningeal supplies dura mater
Auricular supplies auricle, external auditory meatus
Inferior ganglion (lies on nerve just below the jugular foramen)
Pharyngeal
o Forms pharyngeal plexus
o Supplies:
Pharyngeal muscles, except stylopharyngeus (CN IX)
Soft palate muscles, except tensor veli palati (V3)
Superior laryngeal, divides into:
o 1) Internal laryngeal travels w/ superior laryngeal artery & pierces thyrohyoid MB
Supplies mucous MB of larynx above vocal folds
o 2) External laryngeal travels w/ superior thyroid artery & supplies cricothyroid muscle
o Sensory Portion of CN X:
Somatic sensory fibers to skin of the ear
Cell bodies in the superior ganglion of CN X (somatic sensory nucleus)
Axons enter spinal tract & nucleus of CN V
Visceral sensory fibers to pharynx, larynx, & thoracic & abdominal viscera to the left colic flexure (hunger pangs)
Cell bodies in inferior ganglion of CN X (visceral sensory nucleus)
Axons enter tractus & nucleus solitarius
Visceral sensory fibers to epiglottis (taste)
Cell bodies in inferior ganglion
Axons enter tractus & nucleus solitarius
o Motor Portion of CN X:
Branchiomeric motor fibers to skeletal muscle derived from visceral arch muscle in larynx, upper esophagus & pharynx
Cell bodies of these motor neurons are in nucleus ambgiuus
Visceral motor fibers to smooth muscles & glands of the organs of the neck, thorax, & abdomen
These are the PS preganglionic fibers w/ cell bodies in dorsal motor nucleus of vagus
o One Q asked about the preG PS fibers of the duodenum these are found in the dorsal motor nucleus of
vagus
o Left vagus nerve:
Enters thorax in front of the left subclavain artery & behind the left brachiocephalic vein
Then crosses left side of the aortic arch & is itself crossed by the left phrenic nerve
Then passes behind the left lung, forms the pulmonary plexus, & continues to form the esophageal plexus
Enters abdomen in front of the esophagus through the esophageal hiatus of the diaphragm as the anterior vagal trunk
o Right vagus nerve:
Crosses anterior surface of the right subclavian artery & enters thorax posterolateral to the brachiocephalic trunk,
lateral to the trachea, & medial (& just posterior) to the azygos vein
Passes posterior to root of the lung, contributing to the pulmonary plexus
Contributes to the esophageal plexus
Enters abdomen behind the esophagus through the esophageal hiatus of the diaphragm as the posterior vagal trunk
o R&L vagus nerves lose their identity in the esophageal plexus
At lower end of the esophagus, branches of the plexus reunite to form the anterior vagal trunk (anterior gastric nerve)
Anterior vagal trunk can be cut (vagotomy) to reduce gastric secretion
o Right recurrent laryngeal nerve
Arises from right vagus nerve in neck
Hooks around subclavian artery & passes up/backwards behind artery & ascends in groove between trachea & esophagus
(tracheoesophageal groove) (Plate 554 Clementes)
Innervates:
All muscles of the larynx (except cricothyroid supplied by external laryngeal branch of superior laryngeal nerve)
o The external laryngeal branch runs with superior thyroid artery to the cricothyroid
Mucous MB of larynx below the vocal folds
Mucous MB of upper part of the trachea
Comes in contact w/ thyroid gland & comes into close relationship w/ inferior thyroid artery
o Left recurrent laryngeal nerve
Crosses arch of the aorta, hooks around ligamentum arteriosum, & ascends in groove between trachea & esophagus
Arises from left vagus
Innervates:
Same muscles as right recurrent, but on left side
o A few cardiac branches arise from CN X & enter cardiac plexus
When BP goes up, then these branches increase firing
These are pre-gang PS nerves
Innervate heart mucle & conducting system (SA node, etc.)
- Accessory Nerve (CN XI):
o Innervation to the SCM and Trapezius
- Hypoglossal Nerve (CN XII):
o Motor nerve supplying all intrinsic & extrinsic muscles of the tongue (except palatoglossus CN X and Genioglossus C1 via XII)
o Leaves skull through hypoglossal canal medial to carotid canal & jugular foramen
o Passes above hyoid bone on the lateral surface of hyoglossus muscle deep to the mylohyoid muscle (Between Hyoglossus and
mylohyoid) pp 565 ECA 2nd ed.
o Landmark Loops around occipital artery(Clemente 444)& passes between the external carotid artery & internal jugular
vein
o Soon after it leaves the skull through the hypoglossal canal. it is joined by C1 fibers from cervical plexus
TO then supply Genioglossus, Geniohyoid, Thyrohyoid
o Unilateral lesions result in deviation of protruded tongue toward the affected side due to lack of function on diseased side
o LMN Injury of CN XII eventually produces paralysis & atrophy of tongue on affected side w/ tongue deviated to the affected side
Dysarthria (inability to articulate) may also be found
o NOTE: if genioglossus muscle is paralyzed, tongue has tendency to fall back & obstruct oropharyngeal airway suffocation risk
- Cranial Nerve lesions:
o CN V (motor) jaw deviates TOWARD side of lesion
o CN X uvula deviates AWAY from side of lesion
o CN XI head turns TOWARD side of lesion
o CN XII tongue deviates TOWARD side of lesion
**************************************************************************
- Sympathetic ganglia:
o Sympathetic trunks two long chains of symp ganglia on either side of vertebral column that extend from base of skull to coccyx
Damage to the sympathetic trunk causes Horners Syndrome
Lie close to vertebral column & end below by joining to form a single ganglion the ganglion impar (unpaired)
Sympathetic ganglia are located at intervals on each sympathetic trunk alongside vertebral column
Generally there are 3 cervical, 12 thoracic, 4 lumbar, & 4 sacral
Gray rami connect sympathetic trunk to every spinal nerve
White rami are limited to the spinal cord segments between T1 & L2
Cell bodies of visceral efferent fibers (in visceral branches of the sympathetic trunk) located in lateral horn of spinal cord
(Intermediolateral cell column).
Cell bodies of visceral afferent fibers located in dorsal root ganglia
o Sympathetic nerves (Splanchics) arise from thoracic sympathetic ganglia (T5-T12) they all pass through diaphragm
o PreG Symp fibers may pass through ganglia on thoracic part of sympathetic trunk w/out synapsing
These myelinated fibers form the splanchnic nerves:
Greater symp fibers from T5-T9 pierce diaphragm & synapse w/ excitor cells in the ganglia of celiac plexus
o Nerves consist primarily of preganglionic visceral efferent fibers
o The thoracic splanchnic nerves to the celiac ganglion consist predominantly of preG visceral efferents
o PostG fibers arise from excitor cells in celiac plexus & are distributed to smooth muscle & glands of viscera
o Travels just posterior to the azygos vein
Lesser symp fibers from T10-T11 pierce diaphragm & synapse w/ excitor cells in aorticorenal ganglion
Least symp fibers from T12 pierce diaphragm & synapse w/ excitor cells in ganglia of the aorticorenal plexus
The fibers from the thoracic splanchnics (T5-12) and the lumbar splanchnics synapse largely in 3 ganglia:
1) Celiac ganglion
2) Superior Mesenteric ganglion
3) Inferior Mesenteric ganglion
o Some nerve fibers go even more inferior to the superior hypogastric plexus to provide sympathetic innervation to the
pelvic viscera
o NOTE: PS innervation of the upper 2/3 of the abdominal viscera comes via the vagus nerve which goes through the celiac plexus
w/o synapsing like the sympathetics do
The remaining inferior portions come by way of the parasympathetics from S2, S3, S4 via pelvic splanchnics
o Cervical Ganglia:
Sympathetic innervation to head & neck structures is distributed via the blood vessels (NOT CN III, VII, IX, X)
Superior cervical ganglion
Uppermost & largest lies between internal carotid artery & internal jugular vein
Most of postG sympathetic fibers that go to head region have their cell bodies located here
o EX: The postG sympathetic fibers to the vessels of the SM gland arise from cells in the superior cervical ganglion
o This is where the preG and postG sympathetic fibers of the cervical region synapse
o Cell bodies of sympathetic fibers in the nerve of the pterygoid canal come from the superior cervical ganglion
o Postganglionic sym cell bodies that provide innervation to the submandibular gland is located in superior cervical
ganglion
Some fibers go to the upper 3 to 4 cervical nerves
Middle cervical ganglion
Fibers to the cervical nerves C5 & C6
Small, located at level of cricoid cartilage
Related to the loop of the inferior thyroid artery
Inferior cervical ganglion
Fibers to spinal nerves C7, C8, & T1
Most commonly fused to first thoracic sympathetic ganglion to form a stellate ganglion
- Cervical plexus:
o Cervical nerves C1-C4 contribute motor fibers to plexus
o Motor nerves are branches of ansa cervicalis (loop formed by C1-C3)
o Positioned deep on side of the neck, lateral to the 1st four cervical vertebrae
o An important branch of each cervical plexus is the phrenic nerve (C3-C5) supplies diaphragm
o Provides cutaneous innervation to skin of the neck, shoulder & upper anterior chest
Supraclavicular nerves innervate skin over the shoulder
Transverse cervical nerve provides sensory innervation to anterior/lateral parts of the neck
o Provides motor innervation to infrahyoid (strap) muscles (except for the thyrohyoidC1 via XII & to the geniohyoid muscle)
o Gives rise to the first 2 of 3 roots contributing to the phrenic nerve that innervates the diaphragm (C3, 4, 5)

- Brachial plexus (C5-T1)


o Formed in posterior triangle of the neck
o Extends into axilla, supplying nerves to the upper limb
o Axillary sheath contains the Cords of the brachial plexus and
the axillary artery and vein (NOT subclavian artery???)
Sheet music contains Cords
o Think Randy Travis Drinks Cold Beer
o Roots Trunks Divisions Cords Branches
(Question: What is terminal portion of brachial plexus
called?)
o 5 Roots
o 3 Trunks:
Superior C 5,6
Middle C 7
Inferior C8, T1
o Each splits into anterior and posterior division
o 3 Cords:
Lateral C5,6,7 From Superior and Middle Roots
Lateral pectoral nerve C5,6,7
Musculocutaneous nerve C 5,6,7
**Median nerve (forms from the medial & lateral cords) C5-T1

Posterior C5,6,7,8,T1 From All 3 Roots


Axillary nerve C5,6
Radial nerves C5-T1

Medial (C8, T1) From Inferior


Medial pectoral nerve C8,T1
Ulnar nerve C8,T1 ulnar nerve is a terminal branch of the medial cord
o Ulnar nerve is most sensitive at the elbow (not wrist, hands) think funny bone
**Median nerve (forms from the medial & lateral cords) C5-T1
o Brachial artery runs adjacent to and parallel with the median nerve in the arm
o Branches
Think from Back to front to Medial ARMMU
o Anteriors
**Arm & Forearm Flexors
Musculocutaneous biceps, brachialis,
coracobrachialis mm.
Median forearm flexors, thenar mm., radial lumbricals
Ulnar Ulnar flexors, adductor pollicis, hypothenar
mm., interossei, lumbricals 4-5
o Posteriors
**Arm & Forearm Extensors (posterior of the arm/forearm)
Radial both arm & forearm extensors
o (triceps, brachioradialis, supinator, extensors of
wrist/fingers)
o Hand
Thenar muscles:
Opponens pollicis, Abductor pollicis brevis, Flexor
pollicis brevis
Innervated by the median nerve (dont get clowned by
the radial nerve)
Numbness of Forefinger and thumb caused by
damage to the Median nerve
Hypothenar muscles: (all are ____ digiti minimi)
One Half LOAF One and half Lumbricals,
Opponens d.m., Abductor d.m., Flexor d.m.
Innervated by Ulnar nerve
The lateral two lumbricals are also innervated by the median
nerve
The rest of the intrinsic muscles of the hand are innervated
by the ulnar nerve (i.e. interosseoi)

- Lumbar plexus: L1-L4


o Formed in psoas muscle
o Supplies lower abdomen & parts of the lower limb
o Main branches are the femoral & obturator nerves
- Sacral plexus: L4-L5 & S1-S4
o Lies in posterior pelvic wall in front of piriformis muscle
o Supplies lower back, pelvic, & parts of thigh, leg, & foot
o Main branches are the sciatic (largest nerve in body), gluteal, &
pelvic splanchnic nerves
- Dermatome:
o Area of skin supplied by a single spinal nerve
o *Supplied by either cranial or spinal nerves
o Cranial nerves
All 3 divisions of CN V supply the skin of face, anterior scalp (V1) & ear (V3)
The ear receives additional innervation from CN VII, IX, & X
All but one of the spinal nerves anterior & posterior primary divisions innervate the remaining dermatomes of the body
The greater occipital nerve (C2) supplies posterior scalp because C1 usually does not supply a dermatome
No overlapping innervation of cranial dermatomes
o Spinal (peripheral) nerve innervation of the skin (cutaneous innervation):
Usually differs from cranial nerve skin innervation because ventral primary divisions of spinal nerves form plexuses
Allows multiple spinal nerves to constitute a peripheral nerve
o EX: C5-C7 form the musculocutaenous nerve
Spinal nerve dermatomes overlap 50%
Must anesthetize T4-T6 to block feeling in T5 dermatome

Functional Components of Nerves


Spinal Nerves
***Only contain 4 of 7 functional components (just the General, not Special components)
Efferent
GVE smooth muscle, cardiac muscle, glands
PreG S: C8L2 w/ cell bodies located in the intermediolateral nucleus
PreG PS: S2S4 w/ cell bodies located lamina VII (analagous to the intermediolateral nucleus)
GSE skeletal muscle arise from alpha & gamma motor neurons of lamina IX (anterior horn)
Afferent (all arise from DRGs)
GVA sensory info from the viscera (although technically not a part of the ANS)
GSA exteroceptive & proprioceptive sensation
Exteroceptive touch, pain, temp
Proprioceptive joints, muscle, tendons, fascia
Cranial Nerves
Afferent
GSA see above
*SSA Vision, Hearing & Equilibrium
GVA see above
*SVA Olfaction & Taste (Southern Virginia is OuT there!!!)
Special visceral afferent fibers for taste are conveyed in VII, IX, & X
Efferent
GSE skeletal muscle from myotomes
GVE PreG PS (no Symp): CN III, VII, IX, X
*SVE (Brachial Arches)
CN V mastication from motor nucleus of V
CN VII facial expression from facial nucleus
CN IX & X larynx, pharynx from nucleus ambiguus
CN XI trapezoid (lift shoulders), SCM (turn head)

The ENTIRE Cranial Nerve MAP


CN I (Olfactory Nerve)
Special Visceral Afferent
Enter/exit cribriform plate
Conveys information from olfactory epithelium

CN II (Optic Nerve)
Special Somatic Afferent (Special Visceral Afferent according to Moore pg. 644)
Enter/exit optic canal
Conveys information from retina

CN III (Occulomotor Nerve)


Part 1 - General Somatic Efferent
Enter/exit superior orbital fissure within annulus tendinus

Superior Division
Innervates superior rectus muscle
Innervates levator palpebrae superioris muscle

Inferior Division
Innervates inferior rectus muscle
Innervates medial rectus muscle
Innervates inferior oblique muscle

Part 2 General Visceral Efferent (PARASYMPATHETIC PART)


Carries preganglionic parasympathetic fibers along inferior division to ciliary ganglion
Fibers synapse in ciliary ganglion
Short ciliary nerves carry postganglionic parasympathetic fibers from ciliary ganglion to innervate sphincter of pupil and
ciliaris muscle
Ciliary ganglion also carries 1) postganglionic sympathetic fibers along short ciliary nerves to blood vessels of eyeball and
the tarsals, 2) Afferent fibers from nasociliary nerve (CN5 V1)

CN IV (Trochlear Nerve)
General Somatic Efferent
Enter/exit superior orbital fissure
Innervates superior oblique muscle

CN V (Trigeminal Nerve)
Exits the PONS
V1 (Opthalmic Nerve)
General Somatic Afferent
Enter/exit superior orbital fissure
Sensory nerve with 3 main branches

Frontal Nerve (Branch 1)


Enter/exit superior orbital fissure above annulus tendinus

Supraorbital Nerve
Exit supraorbital foramen
Innervates frontal sinus, conjunctiva upper eyelid, skin of forehead

Supratrochlear Nerve
Exit on medial side of supraorbital nerve
Innervates skin in middle of forehead to hairline

Nasociliary Nerve (Branch 2)


Enter/exit superior orbital fissure within annulus tendinus

Infratrochlear Nerve
Exits of medial wall of orbit above upper eyelid
Innervates skin and conjunctiva of upper eyelid

Anterior Ethmoid Nerve


Courses w/ anterior ethmoid artery (ophthalmic artery) through anterior ethmoid foramen
Innervates anterior ethmoid sinuses and anterosuperior part of nasal mucosa on both septum and lateral wall of
nasal cavity
Terminal branch is External Nasal Nerve, innervates skin on dorsum and tip of nose

Posterior Ethmoid Nerve


Courses w/ posterior ethmoid artery (ophthalmic artery) through posterior ethmoid foramen
Innervates posterior ethmoid sinuses and sphenoid sinuses

Long Ciliary Nerves (2)


Innervates (sensory to) iris, cornea, and ciliary body
Carry postganglionic sympathetic fibers to the dilator of the pupil
Sensory Root to Ciliary Ganglion
Sensory fibers to eyeball from nasociliary nerve pass through ciliary ganglion and course w/ short ciliary nerves
(CN 3)

Lacrimal Nerve (Branch 3)


Enter/exit superior orbital fissure above annulus tendinus
Gland is in the outer lateral side
Courses forward in lateral part of orbit to the lacrimal gland
Carries postganglionic parasympathetic fibers (secretomotor) from pterygopalatine ganglion via zygomaticotemproal
nerve (CN5 V2) from greater petrosal nerve (CN7)
[CN V1 via CN V2 via CN7]
Carries postganglionic sympathetic fibers (vasoconstrictive) from pterygopalatine ganglion via zygomaticotemproal
nerve (CN5 V2) from deep petrosal nerve (Superior Cervical Ganglion)
[CN V1 via CN V2 via Superior Cervical Ganglion]

V2 (Maxillary Nerve)
General Somatic Afferent
Enter/exit foramen rotundum then runs anterolaterally through pterygopalatine fossa
If anesthesia was injected into the pterygopalatine fossa, then V2 would be anesthetized
Within fossa gives rise to 3 branches:

Zygomatic Nerve (Branch 1)


Arises in floor of orbit through inferior orbital fissure
Innervates skin over zygomatic arch and anterior temporal region
Best described as sensory branches of maxillary division of V
Gives rise to 2 terminal braches:

Zygomaticofacial Nerve
Exit zygomaticofacial foramen

Zygomaticotemporal Nerve
Exit zygomaticotemporal foramen
Carries postganglionic parasympathetic fibers (secretomotor) to lacrimal nerve (CN5 V1) from pterygopalatine
ganglion via zygomaticotemporal nerve (CN5 V2) from greater petrosal nerve (CN7)
[CN5 V1 via CN5 V2 via CN7]
Carries postganglionic sympathetic fibers (vasoconstrictive) to lacrimal nerve (CN5 V1) from pterygopalatine
ganglion via zygomaticotemporal nerve (CN5 V2) from deep petrosal nerve (Superior Cervical Ganglion)
[CN5 V1 via CN5 V2 via Superior Cervical Ganglion]

Ganglionic Branches (2) Supporting Pterygopalatine Ganglion (Branch 2 and 3)


Convey general sensory fibers from maxillary nerve that pass through ganglion
(Note: all the braches of the pterygopalatine ganglion are mixed nerves with General Somatic Afferent fibers from the
maxillary nerve, and General Visceral Efferent fibers from the nerve of the pterygoid canal [see below])
Pterygopalatine ganglion gives off numerous braches:

Greater Palatine Nerve


Innervates gingivae, mucous membranes, glands of hard palate

Lesser Palatine Nerve


Innervates gingivae, mucous membranes, glands of soft palate

Nasopalatine Nerve
Courses through sphenopalatine foramen along posterior half nasal septum (along with the Sphenopalatine artery)
NOTE: The spenopalatine foramen is the hole on the MEDIAL wall of the pterygopalatine fossa
In other words it is the direct connection with the nasal region and the Ganglion region of V2
Innervates mucosa in this region then dives down through incisive canal
Innervates mucous membranes and gland of anterior part of hard palate
Nerve of the Pterygoid Canal
General Visceral Efferent
Carries preganglionic parasympathetic fibers from CN7 via greater petrosal nerve, these are secretomotor to mucosa
and glands and synapse in ganglion
Carries postganglionic sympathetic fibers from Superior Cervical Ganglion via deep petrosal nerve, these are
vasoconstrictive to mucosa and glands, do not synapse

Posterior Superior Lateral Nasal Nerve


Innervates mucosa on superior half of lateral wall of nasal septum

Posterior Inferior Lateral Nasal Nerve


Innervates mucosa on inferior half of lateral wall of nasal septum

Maxillary nerve then leaves pterygopalatine fossa through inferior orbital fissure
Henceforth it is known as the Infraorbital nerve (CAREFUL, youre still in bones)

Infraorbital nerve
It then gives rise to 3 large sensory branches:
Innervates the upper lip

Posterior Superior Alveolar Nerve


Sensory innervation to maxillary molars
Doesnt get MB of M1

Middle Superior Alveolar Nerve


Sensory innervation to maxillary molars and premolars

Anterior Superior Alveolar Nerve


Sensory innervation to premolars, a branch dives through the incisive canal and emerges as the Incisive Nerve to supply
the maxillary canines and incisors
(Note: nasopalatine nerve also courses through incisive canal)

Maxillary Nerve then continues along floor or orbit through infraorbital sulcus
It dives down through the infraorbital canal and emerges through the infraorbital foramen and serves to innervate
(sensory to) the skin of the cheek, lower lid, lateral side of nose and upper lip
Superior labial branches (skin over cheek and upper lip)

V3 (Mandibular Nerve)
Mixed nerve w/ General Somatic Afferent (sensory) and Special Visceral Efferent fibers (motor)
Enter/exit foramen ovale and enters infratemporal fossa
Divides into anterior and posterior trunks
Anterior trunk gives rise to:

Long Buccal Nerve


Innervates skin and mucosa of the cheek, vestibule, and buccal gingiva adjacent to 2nd and 3rd molars
Pain from Swelling of the gingiva would be transmitted via the Buccal nerve

Branches to Four of the Muscles of Mastication


Motor nerve to Masseter, Temporalis, Medial Pterygoid, Lateral Pterygoid muscles

Branches to Additional Muscles (not sure if these branches from anterior trunk)
Motor nerve to anterior belly of the digastric (accessory muscle of mastication), tensor veli palatini, tensor tympani, and the
mylohyoid

(Note: muscles of mastication and innervation derived from 1st pharyngeal gill arch)

Posterior trunk gives rise to:

Auriculotemporal Nerve
Passes between neck of mandible and external acoustic meatus
Innervates skin anterior to ear and posterior temporal region
Pain from fractured mandible
Carries postganglionic PS fibers (secretomotor) from otic ganglion to the parotid salivary gland, these general visceral
efferent fibers come to the otic ganglion via the lesser petrosal nerve (preganglionic parasympathethic) from CN 9 (see
below)
Marker: middle meningeal artery passes between branches that make up auriculotemporal nerve Plate 479
(Clementes Atlas)

Inferior Alveolar Nerve


Enters mandibular foramen
Sensory innervation to mandibular teeth

Mental Nerve
Terminal branch of mandibular nerve
Exits through mental foramen
Innervates skin of chin, lower lip, mucosa of lower lip
Pt with dentures has caused pain in the inner vestibule or something which nerve was irritated Mental

Nerve of the Mylohyoid


Runs along the mylohyoid groove
Motor nerve to Mylohyoid muscle (accessory muscle of mastication)

Lingual Nerve
Enters mouth between medial pterygoid and ramus of mandible inferior to 3rd molar
Sensory innervation to anterior 2/3 of the tongue, floor of the mouth, lingual gingiva
Carries Special Visceral Afferent fibers via Chorda Tympani:

Chorda Tympani
Special Visceral Afferen(taste), General Visceral Efferent (salivary gland)
Branch of CN VII, passes through middle ear over tympanic membrane
Joins lingual nerve in infratemporal fossa
Carries taste fibers to anterior 2/3 of the tongue
Carries preganglionic parasympathetic fibers (secretomotor) to submandibular ganglion for the submandibular and
sublingual salivary glands

CN VI (Abducens Nerve)
General Somatic Efferent
Enter/exit superior orbital fissure
Innervates lateral rectus muscle
What muscles Abducts the eye? Abducens (Abductens)
Paralysis of lateral rectus muscle causes interference with? Abduction of the eye

CN VII (Facial Nerve)


Motor and sensory nerve, see Moore pgs. 658-660 (sensory for taste and from part of the external ear (Concha of auricle).
Supplies the Mimetic muscles (muscles of facial expression)
Consists of two roots
Smaller root has taste (Special Visceral Afferent), parasympathetic (General Visceral Efferent) and sensory (General Somatic
Afferent) fibers
Larger root carries motor fibers to muscles from 2nd pharyngeal arch (Special Visceral Efferent)
Nerve enters internal acoustic meatus
Within facial canal it gives rise to:

Greater Petrosal Nerve


(General Visceral Efferent)
Carries preganglionic parasympathetic fibers to pterygopalatine ganglion
Joins the deep petrosal nerve as it passes through cartilage of foramen lacerum
(Note: These two nerves form the nerve of the pterygoid canal)
After synapse, postganglionic parasympathetic fibers innervate lacrimal gland (See Above), and mucous glands of nasal
cavity, palate, upper pharynx

Nerve to Stapedius
(Special Visceral Efferent)
Innervates stapedius muscle in middle ear
Prevents excess movement of the stapes

Chorda Tympani Nerve


Passes through middle ear over tympanic membrane
Joins lingual nerve in infratemporal fossa
Carries taste fibers to anterior 2/3 of the tongue (Special Visceral Afferent)
Carries preganglionic parasympathetic fibers (secretomotor) to submandibular ganglion for the submandibular and sublingual
salivary glands (General Visceral Efferent)
(Note: Sensory fibers (General Somatic Afferent) to concha of auricle of external ear arise here)

Larger motor root (Special Visceral Efferent) exits stylomastoid foramen


Gives off motor braches to occipitalis and auricular muscles (via Posterior Auricular Branch)
Gives off motor branches to posterior belly of the digastric and stylohyoid muscles
Pierces parotid gland
Gives off five terminal motor branches to muscles of facial expression: (TZBMC)
Two Zebras Broke My Coccyx

Temporal Branch
Zygomatic Branch
Buccal Branch
Mandibular Branch
Cervical Branch

CN VIII (Vestibulocochlear Nerve)


Special Somatic Afferent (Special Visceral Afferent according to Moore pg. 644)
Enter/exit internal acoustic meatus
Conveys equilibrium, balance (Vestibular fibers) and hearing (Cochlear fibers) information from inner ear

CN IX (Glossopharyngeal Nerve)
Motor (General Visceral Efferent and Special Visceral Efferent) and sensory (General Somatic Afferent and Special Visceral
Afferent) nerve, see Moore pgs. 662-663
From Inferior Salivatory Nucleus
Goes to tympanic plexus as tympanic nerve, then turns into lesser petrosal nerve (carrying Pregang PS to the otic ganglion,
which then sends Postgang PS to the parotid via the auriculotemporal (V3)
Enter/exit jugular foramen
Gives off two small branches:

Tympanic Nerve
Courses through middle ear
Forms tympanic plexus on promontory of middle ear
Provides sensory innervation (General Somatic Afferent) to the internal surface of the tympanic membrane
Clogged ears from pressure on the auditory tubes is sensed via CN IX (dont get clowned by vestibulocochlear)
Reforms as the lesser petrosal nerve
Carries preganglionic parasympathetic fibers (General Visceral Efferent) to the otic ganglion to supply the parotid gland via
the auriculotemporal nerve (CN5V3) (See Above)

Carotid Branch
Special Visceral Afferent
Provides baroreceptor innervation to the carotid sinus

Follows and gives motor innervation (Special Visceral Efferent) to Stylopharyngeus muscle (derived from 3rd pharyngeal arch)
Gives of Pharyngeal Branch to Pharyngeal Plexus of nerves (CN9 and CN10), this gives sensory innervation (General Somatic
Afferent) to the oropharynx
Passes b/w superior and middle constrictor muscles to reach oropharynx
Gives of two branches:

Tonsilar Branch
General Somatic Afferent
Provides sensory innervation to the palatine tonsil

Lingual Branch
Provides general sensory innervation (General Somatic Afferent) to posterior third of tongue
Provides taste fibers (Special Visceral Afferent) to posterior third of tongue

CN10 (Vagus Nerve)


Motor and sensory nerve, see Moore pgs. 664-666
Enter/exit jugular foramen
Joins with cranial root of CN11
Enters carotid sheath and continues to root of the neck
Gives off multiple branches:

Pharyngeal Branch
Innervation to pharyngeal constrictor muscles (Special Visceral Efferent), except cricopharyngeus, and pharyngeal
longitudinal muscles, except stylopharyngeus (Note: pharyngeal muscles derived form 4 th through 6th pharyngeal arches)
Provides general sensory innervation (General Somatic Afferent) to laryngopharynx
(Note: motor innervation is really cranial root CN11 via CN10)

Superior Laryngeal Nerve


Divides into two terminal nerves:

Internal Laryngeal Nerve


Sensory (General Somatic Afferent) to root of tongue to vocal folds
Carries preganglionic parasympathetic (General Visceral Efferent) to mucous membrane in same area

External Laryngeal Nerve


Motor innervation (Special Visceral Efferent) to the cricothyroid muscle (ONLY laryngeal m. not done by
recurrent)

Recurrent Laryngeal Nerves


Sensory (General Somatic Afferent) and parasympathetic (General Visceral Efferent) to laryngeal mucous membrane from
vocal folds down
Motor innervation (Special Visceral Efferent) to muscles of larynx and cricopharyngeus muscle, Except Cricothyroid

Cardiac Branches
Provides sensory (General Visceral Afferent) and preganglionic parasympathetic fibers to heart

Passes through superior thoracic aperture into thorax


Provides sensory (General Visceral Afferent) and preganglionic parasympathetic (General Visceral Efferent) innervation to organs
of thorax
Passes through esophageal hiatus as anterior and posterior vagal trunks
Provides sensory (General Visceral Afferent) and preganglionic parasympathetic (General Visceral Efferent) innervation or
organs of abdomen as far as left colic flexure

CN11 (Accessory Nerve)


Enter/exit jugular foramen
Motor nerve with many branches, see Moore pgs. 666-667

CN12 (Hypoglossal Nerve)


Enter/exit hypoglossal canal
Motor nerve with many branches, see Moore pgs. 667-669

HEART
A review of the principle body cavities:
Posterior (dorsal) cavity
Cranial cavity contains brain
Spinal cavity contains spinal cord
The two cavities communicate through foramen magnum
The cavities are lined by meninges
Anterior (ventral) cavity
Thoracic cavity:
Pericardial cavity surrounds heart
Pleural cavity (R & L) each surrounds a lung
The portion between the two pleural cavities is called the mediastinum (the heart & pericardial cavity are located
here)
Abdominal cavity:
Abdominal cavity contains the stomach, spleen, liver, gallbladder, pancreas, and small/large intestines
Pelvic cavity contains the rectum and urinary bladder
In the male, also the paried ductus deferens & seminal vesicle and prostate gland
In the female, also the paired ovaries & the uterus

Superior mediastinum:

Aortic arch w/ its branches, R & L brachiocephalic veins, upper of SVC, trachea, esophagus, thoracic duct, thymus,
phrenic nerve, vagus nerve, cardiac nerve, & left recurrent laryngeal nerve
Inferior mediastinum: (T4 to T12)
1) Anterior mediastinum
Part of the thymus gland
Some lymph nodes
Branches of the internal thoracic artery
2) Middle mediastinum
Pericardium & Heart
Phrenic nerves & its accompanying vessels
3) Posterior mediastinum
Think of the 5 birds in the back of the thoracic cage:
Va-goose, Esopha-goose, Azy-goose, Hemiazy-goose& Thoracic duck
Descending (thoracic) aorta
Thoracic duct
Esophagus
Azygos system of veins (including hemiazygos vein)
Vagus nerves on the esophagus
Splanchnic nerves
Many lymph nodes
Sympathetic chain ganglia (sympathetic trunks)
NOT phrenic nerves - thats middle mediastinum
Cross Section at T8 of the Posterior Mediastinum
From Back to Front
Vertebra
Splanchnic
Azygos vein
Thoracic duct (off-center to right)
Descending aorta (off-center to left)
Esophagus
Vagus Nerve around esophagus
Trachea (but here its already bisected into bronchi)
HEART general info:
Size of a closed fist
Located in the middle mediastinum
Two thirds of hearts mass is to the left of body midline
The developing Heart is anterior to the notochord (It delineates the posterior part of the heart..
Surrounded by the Pericardium
Inner is the Visceral Pericardium (epicardium)
Outer is the Parietal Pericardium
Visceral and parietal pericardia are continuous at the veins & entering & leaving the heart
Serous fluid fills in between to minimized friction went the heart beats
Close relation laterally to the phrenic nerves (which innervate the parietal pericardium)
The apex fits into a depression in the diaphragm
Chambers of the Heart
2 Atria
Separated by thin, muscular interatrial septum
Fossa Ovalis
Shallow depression
Site of foramen ovale in the fetus, which permitted blood flow from atrium to atrium, bypassing pulm circ.
The foramen eventually becomes closed with fibrous CT and becomes fossa
Valve of foramen ovale lies in the medial wall of the left atrium
Anulis ovalis forms the upper margin of the fossa
2 Ventricles
Separated by thick, muscular interventricular septum
Apex of the heart located at level of the 5th intercostal space (left); Apex is formed by Left ventricle only.
Enlarge due to coarctation (constriction) from the aorta
Left ventricle is thicker
Layers of the heart:
Internal endocardium:
Homologous with the tunica intima of the blood vessles
Lines the surface with simple squamous endothelium and underlying loose CT with small blood vessels
Myocardium:
Homologous to the tunica media
Bulk of heart mass with cardiac muscle cells arranged in the spiral configuration
Allows heart to wring blood from the ventricles toward aortic and semilunar valves
Right and left coronary supply myocardium, come from ascending aorta
Epicardium or pericardium:
Serous membrane
Externally, it is covered by simple squamous epithelium supported by thin layer of CT
The adipose tissue that surrounds the heart accumulates in this layer
Cardiac muscle:
Makes up myocardium
Intercalated discs to form a functional network
DOES NOT contract voluntarily
Fibers are separate cellular units, which dont contain many nuclei
Respond to increase demands by increasing fiber size (compensatory hypertrophy)
Pectinate muscles:
Located on the inner surface of the right atrium
They are prominent ridges of atrial myocardium in right atrium and both auricles (which are small conical pouches projecting
from the upper anterior portion of each atrium)
Crista terminalis:
Vertical muscular ridge that runs along the right atrial wall from the opening of the SVC to the IVC.
Provides origin of the pectinate muscle.
Represents junction btw the sinus venosus and the heart in the developing embryo
The line of junction between the primitive sinus venosus and the auricle
Also represented on the external surface of heart by the vertical groove called the sulcus terminalis
SA node is located in the crista terminalis near opening of SVC
Papillary muscles:
Cone-shaped muscles that terminate in tendinous cords (chordae tendineae that attach to the cusps of the AV valves)
Papillary muscles do not help the valves to close
Help prevent the cusps from being everted or blown out into the atrium during ventricular contraction
Chordae tendinae do the same thing
Sinus Venarum
Smooth portion of the right atrium
Develops from embryonic sinus venosus
Receives blood from sup. and inf. vena cavae, coronary sinus, and anterior cardiac veins
Separated from muscular portion by the Crista terminalis
Septomarginal Trabecula
Band of trabeculae carneae connect the interventricular septum to the base of the anterior papillary muscle
Contraction of this muscle prevents over distention of the ventricle
Interventricular Septum
Largely muscular, except for superior aspect, which is a small membranous portion that is common site for
ventricular septal defects
Ligamentum Arteriosum
Remanants of Ductus Arteriosum (fetal bypass of pulm. circ)
Connects Aortic arch to Pulmonary Veins
Left Recurrent Laryngeal hooks around it
Valves: (TPMA Tee Pee My Ace)
Tricuspid
best heard over the right half of the lower end of the body of the sternum
Anterior, Septal, Posterior cusps
Pulmonary
valve best heard over the second left intercostal space, just lateral to sternum
NO chordae tendinae or papillary muscles
Anterior, Right, and Left Semilunar cusps
More Anterior than Aortic Valve (Remember that because it has an Anterior Cusp, where Aortic has Posterior)
Mitral valve (bicuspid)
best heard over apex of heart, (Left 5th intercostal space at the mid clavicular line)
Only valve of the 4 that has 2 cusps
Posterior and Anterior Cusps
Aortic valve
best heard over the second right intercostal space, just lateral to the sternum
NO chordae tendinae or papillary muscles
Left, Right, and Posterior Semilunar cusps. (Aortic has posterior, Pulmonary has Anterior each has A & P)
Blood Flow
The cardiac veins lie superficial to the
These all empty into the right atrium:
Coronary sinus
Largest venous pathway
Opens into the right atrium
Most of the cardiac veins empty here, except for anterior cardiac veins, which empty directly into the right
atrium
Superior Vena Cava
Opens into the upper part of the right atrium
Returns blood from upper half of the body
Inferior Vena Cava
Larger than Superior VC
Opens into the lower part of the right atrium
Blood from lower half
Anterior Cardiac Veins THINK ARTRIA
Cardiac VEIN
Empty direct into R atrium
Then blood goes through the Tricuspid valve into the
R ventricle then through Pulmonary valve and goes to
pulmonary /circulation
Blood gas exchange occurs and is return to heart via
pulmonary veins
Increased resistance to pulmonary blood flow in
the lungs would cause a strain on the right
ventricle
Enters left atrium, passes through Mitral valve to left
ventricle, and out the aortic valve to the rest of the
body
After entering the aorta, immediately the blood can
leave the aorta through the right and left coronary ,
sending blood right back to the heart
This does NOT happen during contraction of left ventricle
Coronary fill during diastole
Obstruction of either artery can lead to anoxia to the heart, resulting in MI, spasms, or death
The small and middle cardiac veins return blood from the myocardial capillaries to the Coronary Sinus
Small comes from right
Middle from back
The anterior interventricular artery accompanies the great cardiac vein
The posterior interventricular artery accompanies the middle cardiac vein
**Thrombosis in coronary sinus might cause dilation in small, great, oblique, and middle cardiac veins, but NOT THE
ANTERIOR cardiac vein
Anterior cardiac vein drains directly into the right atrium whereas all others drain into the coronary sinus.

Impulse-conducting system of heart:


Consists of specialized cardiac muscle (which contain modified cardiac muscle fibers THESE ARE NOT NERVES) present in
the SA node, the AV node, and the Bundle of His (including the Purkinje fibers)
Fibers capable of depolarizing more rapidly than regular fibers, but are weakly contracting
The Sinoatrial node (SA node):
Located in the crista terminalis at the junction of the superior vena cava and the right auricle is the most rapidly
depolarizing (Pacemaker)
Depolarizes spontaneously at 70 to 80 per minute
The conduction system of heart is all modified cardiac muscle fibers and NOT NERVES
Innervation to the heart is by the Vagus nerve and sympathetic nerves
SA Node Atria AV Node AV Bundle Purkinje fibers
Parasympathetic fibers from the vagus slow the heart where the sympathetic fibers from the sympathetic trunk speed up the
heart beat
Usually (60% of the time) receives blood supply from the right coronary artery (AV node supplied by RCA, too)
Pericardial sac
With heart removed, look for the Transverse pericardial sinus (under the pulmonary trunk)
Also oblique pericardial sinus, is a cul-de-sac behind the heart

RESPIRATORY SYSTEM
The Respiratory System:
Has two major partsa branching, tree-like set of hollow tubes (the conducting airways) and very thin-walled pouches (the
alveoli) at the ends of these tubes
Cartilaginous rings found in the main bronchi
Left lung has a smaller capacity than the right
Alveoli form the functional unit of the lung
Assists in vocalization and olfaction
Consists of the nasal cavity , pharynx, larynx, trachea, and the bronchi, bronchioles, and alveoli within the lungs
Lungs
Developed from an outpocketing of the gut tube (so did liver, pancreas, & gallbladder not spleen)
Pair of resp organs that lie within the thoracic cavity and are separated by the mediastinum
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 small bronchial also enter the hilum of each lung and deliver oxygen rich blood to the tissues
They tend to follow the bronchial tree to the respiratory bronchioles where they anastomose with the pulmonary vessels
Branches of the vagus nerve also pass the hilum of each lung
Innervation is by what? - the Vagus nerve and sympathetic chain ganglia nerves
Right lung:
Has 3 lobes (superior, middle, and inferior) and three secondary (lobar) bronchi
Contains ten bronchial segments (tertiary bronchi)
Usually receives one bronchial artery
Slightly larger capacity than the left lung
More common to aspirate foreign bodies into the Right lung (less acute angle)
Left Lung:
Has 2 lobes (superior and inferior) and two secondary (lobar) bronchi separated by an oblique fissure
Two lobes because the heart takes up too much space for a third lobe
Contains eight bronchial segments (tertiary bronchi)
Contains a cardiac notch on its superior lobe
VERY ODD Usually receives two bronchial (Where Right only gets 1, eventhough 3 lobes)
Contains a lingulaa tongue-shaped portion of its superior lobe that corresponds to the middle lobe of the right lung.
A stab wound creating a pneumothorax on the left side would result in the collapse of the left lung only
Hilum
Pulmonary Veins usually anterior and inferior
Pulmonary are then Anterosuperior
Brochus usually most posterior
Structure of the Lung:
Each lung is enclosed in a double-layers sac called the pleura
One layer is called the visceral pleura, the other is called the parietal pleura
Between the two layers is the pleural cavity, which is filled with serous fluid
Root of the lung major structures found therein:
1) Primary bronchusarise from trachea and carry air to the hilum
Part of the conducting division of the respiratory system = pulmonary conduction system
2) Pulmonary arteryenters the hilum of each lung carrying oxygen poor blood
3) Pulmonary veinssuperior and inferior pair for each lung leave the hilum carrying oxygen rich blood
Top to Bottom:
Trachea:
Tube that begins below the cricoid cartilage (C6) of larynx and splits at the level of the sternal angle (T5) [about the same
level where the trachea passes behind the aortic arch] where it divides at the carina into primary bronchi (right and left
primary or mainstem bronchus, which lead to each lung and are part of the pulmonary conduction system
Two main bronchi branches divide into five lobar bronchi (secondary bronchi):
Right main bronchus divides into three lobar bronchi
Straighter, shorter, and larger than the left primary bronchus
It is also in a more direct line with the trachea (important in dental chair because if patient swallows an object it
tends to lodge in the right bronchus)
Left main bronchus divides into two lobar bronchi
Each secondary or lobar bronchus serves one of the five lobes of the two lungs
Secondary bronchi branch into tertiary bronchi (segmental bronchi) which continue to divide deeper in the lungs
into tiny bronchioles, which subdivide many times, forming terminal bronchioles
Each of these terminal bronchioles gives rise to several respiratory bronchioles
Each respiratory bronchiole subdivides into several alveolar ducts, which end in clusters of small, thin-
walled air sacs called alveoli
These alveoli open into a common chamber called alveolar sac, which forms the lungs functional unit
Bronchus
Differs from a bronchiole by possessing cartilage plates & pseudostratified columnar epi
Main support provided by Hyaline Cartilage
Bronchioles
Characterized by:
Diameter < 1mm
Epithelium that progresses from ciliated pseudostratified columnar to simple cuboidal (respiratory bronchioles )
Small bronchioles have non-ciliated bronchiolar epithelial cells (Clara cells) that secrete GAGs that protect the lining
No glands, no hyalinecartilage, no lymphatic nodules
Smaller diameter prevents them from collapsing at end of expiration
Scattered goblet cells
Abundant smooth muscle to regulate the bronchiolar diameter
Variation of the size of the lumen of the bronchiole during inspiration and expiration is caused primarily by smooth
muscle and elastic fibers
Contraction is from parasymp stimulation
*Conduction bronchioles
Smaller extensions of bronchi (little bronchi)
Those devoid of alveoli in their walls are nearer the hilum of the lung
*Terminal bronchioles
Lined by low columnar epithelium
*Respiratory bronchioles
Continues to progress to low simple cuboidal
Continuing from terminal bronchioles, branch nearer the alveolar ducts and sacs and have occasionally alveoli in their walls
These bronchioles capable of respiring are the first generation of passageways of the respiratory portion of the bronchial tree
As air passes from the trachea into the lungs, the respiratory bronchiole is the 1st structure in which gaseous exchange through
the wall of an alveolus may occur
In proceeding from the bronchus to the respiratory bronchiole, there is a decrease in cartilage and an increase in
elastic fibers
In proceeding from the trachea to a respiratory bronchiole, the following structural changes occur:
Decrease in goblet cells, decrease in ciliated cells, total loss of cartilage from the walls
Not a progressive change from stratified squamous to cuboidal epithelial lining (from Columnar to cuboidal)
As you go down respiratory tract what is the last thing to go
Smooth muscle??? See physio book
Cells
Type I Pneumocyte
Account for 97% of alveolar lining
Extremely thin (as thin as 25 nm)
Provide minimal barrier to facilitate diffusion of gas
Type II Pneumocyte (GREAT cells)
Account for 3% of alveolar surface
Produce/secrete surfactant (a lecithin)
Phosphlipid-containing substance that reduces surface tension
Pharynx (throat) tube
Serves as passageway for respiratory and digestive tracts. Extends from mouth and nasal cavities to the larynx and esophagus.
Has three regions:
Nasopharynx:
Contains the eustachian canal (connects the nasopharynx to middle ear), salpingopharygeal fold, pharyngeal recess, &
pharyngeal tonsils (called adenoids when inflamed), (not piriform recess) Which is on either side of eipiglottis
Lies above the soft palate and is continuous with the nasal passage
Lies directly behind the nasal cavities or choanae
The pharyngeal tonsils may become inflamed & block the choanae, causing pt to become a mouth breather
The tensor veli palatine and the levator veli palatine muscles prevent food from entering the nasopharynx
The uvular muscle does, too, but it wasnt an answer option
Oropharynx:
Extends from the plane passing through the anterior pillars to the beginnings of the laryngopharynx
It communicates with the oral cavity through the isthmus of the fauces
Oral part of the Pharynx communicates directly with the Nasopharynx and the Laryngopharynx
Receives food from mouth and air from nasopharynx
Contains palatine and lingual tonsils
Between the soft palate and the epiglottis
Laryngopharynx (also hypopharynx):
Extends from the oropharynx (tip of the epiglottis and inferior)
The SUBGLOTTIS receives sensory innervation from the Superior Laryngeal Nerve
Serves as a passageway for food and air
Air entering the laryngopharynx goes to the larynx while food goes to the esophagus
Food entering the larynx would be expelled by violent coughing
Swallowing
Food moves from oropharynx , prompting soft palate to rise and seal off the nasopharynx.
Epiglottis bends downward while the laryngeal apparatus moves upward, closing off the laryngeal inlet (Aditus)
Bolus of food cascades around the epiglottis and passes through the piriform fossae (recesses) on either side to enter the
esophagus
We swallow 2000 times a day
Mostly done during the daytime, NOT eating
Nose:
What makes up the nose? Medial and lateral nasal processes
Air enters through nostrils (external nares) lead to the vestibules of the nose
The bony roof of the nasal cavity is formed by the cribiform plate of the ethmoid bone
The lateral walls have bony projections called conchae that form shelves which have spaces beneath them called meatuses
The paranasal sinuses
(maxillary, frontal, ethmoidal, and sphenoidal) drain into the nasal cavity by way of these meatuses
The nasal bone does NOT contain paranasal sinuses
Maxillary is the Largest Paranasal sinus
NOTE: Sphenoidal sinus doesnt drain into any of the meatuses
The nasolacrimal ductdrains tears from surface of eyes, also empties into the nasal cavity by way of the inferior meatus
The floor is formed by the hard palate
Nasal cavity & oral cavity are connected by the incisive foramen??? (other options: gr. pal. & less. pal)
The nasal cavity opens posteriorly into the nasopharynx via a funnel-like opening called the choanae (posterior nares)
Epithelium:
Vestibules are lined with nonkeratinized stratified squamous epithelium
Conchae of the nasal fossae and the sinuses are lined with pseudostratified ciliated columnar epithelium
The cell of the maxillary sinus is pseudostratified ciliated columnar epithelium
The specialized columnar epithelium is very prominent in the upper medial portion of the nasal cavity
The nasal cavity receives sensory innervation from the olfactory nerve for smell and from the trigeminal nerve for other
sensations
Nasal cavities lined with specialized columnar epithelium (called olfactory epithelium)
Blood supply is from the branches of the ophthalmic and maxillary
Emergency tracheotomy:
Tracheotomy allows for air to pass between the lungs and the outside air
Done in the cricothyroid space (between thyroid and cricoid cartilage) or through the median cricothyroid ligament
Most easily made by an incision through the median cricoid cartilage to the thyroid cartilage and is inferior to the space between
the vocal cords (rima glottides) where aspirated objects usually get lodged
If you cut below the cricoid cartilage you will damage the trachea
What type of epithelium is covering the vocal folds???
Upper vocal folds (FALSE folds) Psuedostratified
Lower vocal folds (TRUE folds) Nonkeratinized stratified squamous

REPRODUCTIVE SYSTEM..FALTA
Organs of the Female Reproductive System
Ovaries
Are almond-shaped organs located on either side of the uterus, but vary with age.
Round, smooth, and pink at birth
Grow larger, flatten and turn grayish by puberty
During childbearing years take on almond shape and rough, pitted surface
After menopause, they shrink and turn white
Produce ova and steroid hormones:
Estrogenstimulates the development of the female sex organs, the breast, and various secondary sexual characteristics
Progesteronestimulates secretion of uterine milk by the uterine endometrial glands; also promote development of the
secretory apparatus of the breasts
Purpose of ovaries is to produce mature ova
Oogoniaserve as source of oocytes
1 oocytes begin meiosis I during fetal life & complete meiosis I just prior to ovulation
During the in between year, meiosis I is arrested in prophase
Meiosis II is arrested in METaphase until fertilization (until the egg has MET a sperm)
Just prior to ovulation the preovulatory follicle produces and secretes large amounts of Estrogen
Primordal folliclescontaining oocytes in their sexually mature ovary are stimulated to develop by secretion of FSH from the
anterior lobe of the pituitary
Primary follicles (in first meiotic division) become secondary follicles with the formation of the antrum (cavity)
Fully mature Graafian follicles containing secondary oocytes (in second meiotic division) release the egg into the abdominal
cavity under the influence of LH to be swept into the ostium of the Fallopian tube (uterine tube, oviduct) to be fertilized and
subsequently implanted in the uterus or discarded if not fertilized
During maturation of the egg, four daughter cells are produced, one of which is the large fertilizable ovum, while the others
are small, rudimentary ova known as polar bodies or polocytes.
Zona pellucida is associated with a oocyte in a mature follicle
Atretric Follicles
A follicle that degenerates before coming to maturity; great numbers of such atretic follicles occur in the ovary before
puberty; in the sexually mature woman, several are formed each month
Corpus luteum
Endocrine body that secretes progesterone and is formed in the ovary at the site of a ruptured ovarian (Graafian) follicle
immediately after ovulation.
If pregnancy does not occur, the corpus luteum regresses to a mass of scar tissue (corpus albicans) which eventually disappears.
If pregnancy does occurcorpus luteum persists for several months until the placenta matures enough to produce the hormones
Develops directly from the cells remaining in the remnants of the preovulatory follicle after ovulation
In the ovary:
Progesterone production is primarily by the corpora lutea
Uterine/Fallopian Tubes
Convey secondary oocyte toward the uterus
Site of fertilization (Especially the Ampulla)
Convey developing embryo to uterus
Uterus
The uterine cavity is roughly triangular in shape and compressed in an anteroposteriorly
Site of implantation
Blastocyst usually occurs in the upper portion of the uterine cavity
Protects and sustains life of embryo and fetus during pregnancy
Active role in parturition
Source of menses
Round ligament of the uterus normally found in the inguinal canal of the female.
It is a fibromusuclar band attached to the uterus on either side in front of and below the openings of the fallopian tube. It
passes through the inguinal canal to the labia majora
Vagina
Conveys uterine secretions to outside of the body
Receives erect penis and semen during coitus and ejaculation
Passage for fetus during parturition
Path of menstrual flow to outside
Mammary Glands
Produces and secretes milk for nourishment of an infant
Lie in the superficial fascia not the deep fascia.
Are actually a modified sweat gland
Contain myoepithelial cells (aka basket cells) (star-shaped)have processes that spiral around some of the secretory cells
of these glands
Contraction forces the secretion of the glands toward the ducts
Located in the spaces between the basement membrane and secretory cell!!!!!
The breast receives arterial blood through branches of the lateral thoracic (branch of the axillary artery) and internal thoracic
Coopers ligaments support breastsare strong, fibrous processes that run from the dermis of the skin to the deep layer of
superficial fascia through the breast
Nipple usually lies at the level of the fourth intercostal space
Breast cancer causes dimpling of the overlying skin and nipple retraction
Most of the lymph from the mammary glands goes to the axillary lymph nodes
Organs of the Male Reproductive System
Testis
Testis produce spermatozoa and secret sex hormones
They are firm, mobile organ lying within the scrotum
Each develops retroperitoneally and descends into the scrotum about time of birth
Seminiferous tubules
Sperm are produced in the seminiferous tubules and stored outside the testis in the epididymis until ejaculated
Meiosis occurs here (it does NOT occur in the ductus epididymis, stratum germanitivum, or ovarian germinal epi)
Lining consists of a complex stratified epithelium
Contain two cell types:
Sertoli cells
Produce spermatozoa
Form the blood-testes barrier with tight junctions connecting each cell
Spermatogenic cells germ cells found between Sertoli cells
The development of germ cells depends on pituitary FSH & testicular testosterone
Interstitial cells
Produce and secrete male sex hormones
Androgens, the most important one being testosterone, are synthesized and secreted into the blood stream by interstitial
cells (of Leydig) found in the interstitium of the testis between the seminiferous tubules
Testosterone is required for development of the testes and secondary sex characteristics and initiation and maintenance of
sperm production and secondary sex characteristics.
Epididymis
One found on each testis
Epididymis displays stereocilia
It is a tortuous, C-shaped, cordlike tube located in the scrotum
Tube emerges from the tail as the vas deferens, which enters the spermatic cord
Provides storage space for the spermatozoa and allows them to mature
Carries sperm from the seminiferous tubules of the testis to the vas deferens
Ductus Deferens (Vas)
Store spermatozoa
Conveys sperm from the epididymis to the ejaculatory duct
Cordlike structure
Contains Stereocilia also
Ejaculatory Duct
Receive spermatozoa and additives to produce seminal fluid
Passageway formed by the union of the deferent duct (vas deferens) and the excretory duct of the seminal vesicle
The ejaculatory duct opens into the prostatic urethra
Speaking of ejaculation: just think, Point & Shoot = Parasympathetic for erection, Sympathetic for emission
Seminal Vesicles
Secrete alkaline fluid containing nutrients and prostaglandins
Prostate Gland
Secretes alkaline fluid that helps neutralize acidic seminal fluid and enhance motility of spermatozoa
Scrotum
Encloses and protects testes
Penis
Conveys urine and seminal fluid to outside of the body
Sperm development:
Spermatogenesis occurs in Seminiferous tubules
Spermatogonium1 spermatocyte2 spermatocyteSpermatid
Diploid, 2NDiploid, 4NHaploid, 2NHaploid, N
Organs that produce semen:
Seminal vesiclespaired sacs at the base of the bladder
Bulbourethral gland (Cowpers gland)paired located inferior to the prostate
Prostate glandunder the bladder and surrounds the urethra. Continually secretes prostatic fluid, a thin, milky, alkaline fluid.
Copora amylacea are present in the alveoli of this gland
Inguinal canal:
It transmits the spermatic cord in males and the round ligament of the uterus in females; as well as the ilioinguinal nerve in both
sexes
It begins at the deep inguinal ring and extends to the superficial inguinal ring
It is much larger in males than in females:
The anterior wall is formed by aponeuroses of the external oblique and partially by the internal oblique muscle
Passes:
Cremaster muscle
Testicular artery
Internal spermatic fascia
Pampiniform plexus of vein
NOT the epidiymis (that would be down in the scrotum)
Spermatic Cord
Covered by 3 concentric layers of fascia derived from the layers of the anterior abdominal wall
Internal and external spermatic fascia
Cremasteric fascia (cremaster muscle and fascia)
Spermatic cord contents:
Testicular artery: branch of the abdominal aorta; supplies mainly the testis and cremaster muscle
Testicular veins: pampiniform plexus forms testicular veins; drains into the left renal vein on the left side and into the inferior
vena cava on the right side
Urethra
Passageway for urine between the urinary bladder and the outside
of the body
Female urethra
4 cm
Females have more frequent bladder infections
Opens into the vestibule between the clitoris and the vagina
Male urethra
20 cm because it travels in the penis
Ureter
Paired passageway which transports the urine from the kidney to
the urinary bladder for concentration and storage until voided
Reproductive Anatomy
See Kaplan pp. 515-521 for all the details

Hyoglossus and Mylohyoid Relationships


Lingual Nerve, Hypoglossal nerve, Submandibular Duct
SubMan duct and lingual nerve cross 2 x
ALL superficial (Lateral) to the Hyoglossus
ALL deep (medial) to the Mylohyoid
Lingual Artery
Deep to BOTH (Medial)
Which nerve does NOT follow its artery???
Lingual nerve
External Carotid
What nerve follows the external carotid??
Great Auricular Nerve???