Undocumented thoughts about Weeks 2 and 3 lab objectives
9/7/99 W. Crone (303 FTZ, 629-7439, cronewil@hvcc.edu, www.hvcc.edu/academ/faculty/crone/index.html)
Included on this sheet are some thoughts to help you be oriented with the different lab objectives. Feel free to expand and elaborate for your own purposes--I'm not intending this to be exhaustive!
NB: for muscles: O-origin, I-insertion, N-enervation, A-action
- frontal b. (p. 185): in about 10% of population, there's a remnant of a frontal suture
- maxilla b.: Le Fort type I fracture horizontal through maxillae
- zygomatic b.: makes up orbital wall, anterior part of zygomatic arch; cheek prominence
- mandible b.: single bone
- anterior nasal aperture: (piriform aperatures); open up into nasal cavities
- nasion(nay-zee-on): middle of nasofrontal suture; nasal point (anthropologic)
- lacrimal b.: medial side of orbit, superior to maxilla; has fossa for lacrimal sac
- teeth, alveolar processes: (L. alveolus-little bowl, basin), sockets for teeth
- parietal b.: parietal b: (L. wall)
- coronal suture: between frontal and parietal b.
- sagittal suture: between parietal bb.
- bregma: junction of coronal/sagittal sutures; used in skull measurement
- occipital b.: contains foramen magnum
- external occipital protuberance: inion (in-ee-on) is the prominent midline point
- lambdoid suture: between occipital and parietal b.
- lambda: junction of lamboid/sagittal sutures; used in skull measurement
- vertex: most superior part of skull, near center of sagittal suture
- calvaria: cranial vault or brain case vs. the facial skeleton vs. the skullcap (calotte) used for removal
- mandible (body, ramus, angle, posterior border, articular condyle): horizontal body, two rami, angle the posterior body/ramus meeting spot, posterior border of ramus mental foramen
- mental foramen: in mandible, site of mental n. (branch of CN V3)
- temporomandibular joint (TMJ): modified hinge synovial joint w/ squamous part of temporal bone; typically, anterior dislocation, e.g., in yawning position
- temporal b. (mastoid and styloid process): temporal bone made of several different bones that fuse; mastoid air sacs develop postnatally
- external auditory meatus: (ear canal) and stylomastoid foramen: pathway for CN VII, vulnerable point for Bell's palsy
- zygomatic arch: temporal bone/zygomatic bone
- palpebral commissures (canthi) (p. 226): commissures unite the eyelids medially/laterally; epicanthal fold in Asians, Down's
- cornea: clear epithelium, nonvascularized, focusing element, RK (radial keratotomy) or other corrective surgeries.
- sclera: white, continuous with cornea; tough, protective
- iris: circular, pigmented diaphragm
- pupil: dark since seeing into pigmented posterior eye
- conjunctival sac: palpebral fissure the mouth of this sac made by bulbar/palpebral conjunctiva
- conjunctiva: bulbar conjunctiva covers sclera, with vessels (bloodshot eyes), palpebral (continuous) covers eyelid (anemia); conjunctivitis if inflamed.
- conjunctival fornix (ices, pl.): deep recess of the palpebral conjunctiva (L. vault)
- lacrimal papilla: small elevation, both superior and inferior: tears stem from suprerolateral glands and wash to there
- lacrimal punctum: small black pit on nasal end of eyelids, on top of papilla; to drain tears
- platysma m.: O: fascia over superior thoracic muscles, I: inferior mandibular border, N: CN VII (facial), A: depresses lower lip, tightens neck skin (human remnant of subcutaneous muscle that"quivers" flies away in cows).
- masseter m: O: zygomatic arch, I: ramus of mandible, N: CN V (trigeminal), A: elevates mandible
- parotid duct::(Stensen's duct), turns anterior and in front of masseter, penetrates buccinator to 2nd maxillary molar
- facial n. (VII): emerges from pons/medulla junction. Moves the face, tastes, salivates (sublingual, submandibular glands), cries. One-sided defect in Bell's palsy, since comes out in"tight fit" of stylomastoid foramen.
- parotid gland: Large salivary gland anterior/inferior to auricle. CN VII passes through it (but CN IX innervates it!). The gland swells up in mumps.
- buccinator m.: O: maxilla and mandible, I: orbicularis oris, N: facial n, A: compresses cheek, e.g., trumpet playing or chewing.
- facial a., v.: chief artery of face, arising from external carotid. Facial wounds bleed freely, heal quickly. Facial v. major drainage of face, drains into internal jugular. Has no valves, so concern if infection or thrombi of facial v get into cavernous sinus off of the dura mater (don't squeeze those boils!)
- zygomaticus major m.: O: zygomatic bone, I: superior corner of orbicularis oris, N: facial n, A: elevates corner of mouth (smile!)
- levator labii superioris m.: O: frontal process of maxilla, zygomatic bone, I: orbicularis oris and skin above lips, N: facial n, A: elevates upper lip
- orbicularis oris m.: O: fascia surrounding lips, I: mucous membranes of lips, N: facial n, A: compresses and protrudes (purses) lips. If Bell's palsy, then lots of drooling.
- auricle: the external ear, contains elastic cartilage for its springiness.
- external acoustic meatus: external ear canal, often with cerumen (wax) buildup.
- orbicularis oculi m.: O: bones of medial orbit, I: tissue of eyelid, N: facial n, A: closes eyelids. Important in preventing dry eye with blinking, and so concern of corneal ulcer with Bell's palsy
- skin of scalp:"S"(SCALP) typically (?) with hair
- superficial fascia:"C"(SCALP, connective tissue) subcutaneous tissue, tough and dense, with vessels, nerves running through it
- frontalis m.: O: galea aponeurotica, I: skin of eyebrow, N: facial n, A: elevates eyebrows and forehead
- occipitalis m., temporalis m.: occiptalis m.: O: occipital bone (nuchal line), I: galea aponeurotica, N: facial n, A: pull skin posteriorly and wrinkle posterior neck, move scalp backward. temporalis m.: O: temporal fossa, I: mandible, coronoid process, N: CN V (trigeminal); elevates mandible
- galea aponeurotica:"A"(SCALP) (epicranial aponeurosis), the aponeurosis between frontalis and occipitalis. When split, deep wounds gape open
- loose areolar tissue:"L"(SCALP) what separates the pericranium from the"SCA" layers of the scalp. A danger area for infections to spread, as it is loosely filled to allow frontalis/occipital movement.
- pericranium (periosteum):"P"(SCALP) what covers the bones of the cranial vault. During birth, may have cephalohematomas. Poor osteogenic properties, so need to have"fill ins" for adult defects.
- three divisions of trigeminal n: ophthalmic, maxillary, mandibular divisions: V1 ophthalmic, V2, maxillary, V3, mandibular. Maxillary (and mandibular) susceptible to trigeminal neuralgia (tic douloureux).
- six extrinsic m of eye: inferior and superior obliques, inferior, superior, lateral, and medial recti: CN III: medial rectus (adduct), superior rectus (elevate), inferior rectus (depress), inferior oblique (depends how hard it's tugged: up and out). CN IV: superior oblique (depends on how hard it's tugged: down and out). CN VI: lateral rectus (abduct).
- sclera: see above
- cornea: seeing double?
- choroid: vascular layer in posterior eye
- ciliary body: deep to the sclera-corneal junction, contains ciliary m. for lens tension, and for aqueous humor production
- iris: déjà vu all over again
- pupil:"window to your soul"
- retina: inner layer of posterior eye, contains rod and cone photoreceptors
- macula: retinal region for central vision, with fovea containing all cones. Macular degeneration in older individuals.
- optic n. (CN II): outgrowth from forebrain, responsible for sight
- optic disc:"blind spot" entrance of CN II to eyeball. Papilledema (swelling) from increased intracranial pressure
- aqueous humor: transparent, protein-containing fluid of anterior and posterior chambers
- vitreous humor: transparent, more gel-like substance in main ocular cavity posterior to lens
- lens: biconvex, focuses light onto retina. Cataracts, presbyopia seen with age.
- posterior triangle (of neck): SCM/trapezius/clavicle: CN XI, external jugular vein spotted here.
- sternocleidomastoid m.: SCM: O: sternum, clavicle, I: mastoid process, N: CN XI, A: turns head to side, flexes neck. Torticollis (wryneck): congenital thickening
- trapezius m.: the other big CN XI muscle, don't shrug it off.
- accessory n. (CN XI): the spinal root is the part responsible for SCM and trapezius m.
- clavicle.: collarbone, most frequently broken in the body
- platysma m.: seen above
- external jugular v.: drains most of the face and scalp on that side; crosses SCM in superficial fascia before joining subclavian vein.
- subclavius m.: small m. deep to clavicle, helps to anchor it and to protect subclavian vessels
- omohyoid m.:* Two bellied m. O: superior border of scapula, I: hyoid bone, N: ansa cervicalis (off of cervical plexus), A: depresses hyoid
- splenius capitis m.:* O: spinous processes of T1-6, I: occipital bone, mastoid process, N: cervical nerves (dorsal rami), A: extend head/neck, or if singly, can rotate to one side
- levator scapulae m.:* O: transverse processes of C1-4, I: superior margin of scapula, N: cervical nn., I: elevate scapula
- scalenus posterior m.:* O: transverse processes of C4-C6, I: rib #2, N: ventral rami of cervical n., A: flexes neck laterally, elevates second rib if necessary as acessory respiratory mm (other scalenes assist with forced inspiration as well).
- scalenus medius m.: O: transverse processes of C2-C7, I: first rib, N: ventral rami of cervical n., A: flexes neck lateally, elevates 1st rib in forced inspiration.
- scalenus anterior m.: O: similar to scalenus medius, except that origin is on the anterior transverse processes as vs. the posterior of the cervical transverse processes seen in scalenus medius.
- interscalene triangle: between anterior and medial scalene: brachial plexus and subclavian artery pass through here
- subclavian a., v.: artery coming of interscalene triangle, vein anterior to scalenus anterior
- brachial plexus: coming out of interscalene triangle
- phrenic n.:"C 3,4,5, gotta breathe to stay alive"; see it here closely on top of scalenus anterior
- axillary a.: continuation of subclavian artery, with boundaries from lateral edge of 1st rib to distal margin of teres major muscle.
- anterior triangle (neck): SCM, mandible, neck midline are boundaries. Carotid sheath of carotid artery, jugular vein, and vagus nerve in here, as well as hyoid muscles and thryoid/parathyroid glands.
- pharynx: both digestive/respiratory functions; boundaries from oral and nasal cavities to past the cranial base to about C6, with portions of naso-, oro-, and laryngopharynx
- esophagus: continues from lower laryngopharynx
- larynx: voice box for phonation
- trachea: in superior mediastinum, supported by cartilaginous C rings
- thyroid gland: two lobes connected by an isthmus, around the trachea
- hyoid b.: U-shaped, can be fractured in (manual) strangulation
- thyroid cartilage: that piece of cartilage which includes #123. Functions as protection as well as connection point for vocal folds.
- laryngeal prominence: in males, prominent, so called Adam's apple
- cricoid cartilage: inferior to thyroid cartilage (most inferior of all the laryngeal cartilages)
- arytenoid cartilage: paired, attachment for vocal cords
- cricothyroid membrane: between thyroid and cricoid cartilages; possible site for emergency airway access
- common carotid a.: off of aortic arch
- external carotid a.: blood supply to face and visceral neck
- internal carotid a.: drainage of brain from dural sinuses dilation in proximal internal carotid artery near carotid bifurcation that acts as baroreceptor (pressure sensation)
- internal jugular v.: main drainage from dural sinuses
- carotid sheath: connective tissue that covers carotid a., internal jugular v., and CN X in neck
- vagus n. (CN X): runs in carotid sheath on both right and left sides
- external jugular v.: drainage of face and scalp, can notice venous pressure waves in it, as per Bates
- infrahyoid mm.: stabilize hyoid and help to draw it inferiorly
- sternohyoid m.: O: sternum, I: hyoid, N: cervical n (C1), A: lowers hyoid
- sternothyroid m.: O: sternum, I: thyroid cartilage, N: cervical n (C2, 3), A: lowers larynx
- thyrohyoid m.: O: hyoid bone I: thyroid cartilage, N: cervical n (C1), A: raises larynx
- first tracheal ring: inferior to cricoid cartilage
- isthmus of thyroid: midline connection between two thyroid lobes
- greater horn of hyoid b.: large posterior projection; developed from 3rd brachial arch.
- superior thyroid a.: large branch off of external carotid artery
- carotid sinus and carotid body*
- submandibular triangle: defined by mandible and digastric m bellies. Salivary glands and some lymph nodes here
- submandibular gland: around the posterior edge of mylohyoid muscle (lateral inferior mandible)
- digastric m.: Two-bellied mm that connect off of hyoid bone. Anterior belly O: from posterior belly, I: mandible, N: CN V. Posterior belly O: mastoid process, I: anterior belly, N: CN VII, A: elevate hyoid, depress mandible.
- stylohyoid m.: O: styloid process, I: lesser horn of hyoid bone, N: CN VII, A: elevates and retracts hyoid
- mylohyoid m.: O: body of mandible, I: midline, N: CN V, A: elevates floor of mouth
- left, right recurrent laryngeal nn.:* are branches of vagus n. to larynx supplying almost all of the intrinsic laryngeal muscles
- parathyroid glands:* supply parathyroid hormone (PTH) to raise blood calcium levels, small and pinkish brown, hard to find
- middle pharyngeal constrictor m.: innervated by CN X and CN XI (cranial root), for constriction while swallowing
- inferior pharyngeal constrictor m.: innervated by CN X and CN XI (cranial root), for constriction while swallowing
- interior pharynx: internal spaces of pharynx
- nasopharynx: respiratory function; superior to soft palate
- orifice of auditory tube: (eustachian tube) laterally positioned in nasopharynx
- pharyngeal tonsil: also known as adenoids when enlarged. If swollen, they obstruct the nasopharynx, which leads to mouth breathing ("adenoid facies").
- oropharynx: digestive function; from soft palate to epiglottis
- palatine tonsil: the tonsils we're all familiar with, on either side of oropharynx
- laryngopharynx: from epiglottis to level of lower cricoid cartilage, where it joins up with esophagus
- piriform recess: in laryngopharynx, inferior to epiglottis, a possible lodging place for fishbones
- rima glottidis: defined by true vocal cords, a common spot for that overly large piece of steak to lodge
- vestibular folds: the false vocal cord folds that are superior to true vocal cords, help to close larynx during swallowing to prevent food entry
- vocal folds: true vocal cords
- epiglottis: guards the opening into the larynx, marks its upper surface; epiglottitis a medical emergency
- vallecula: depressions between median and lateral glossoepiglottic folds. Targets for laryngoscope blade during intubation.
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