Dr Amirali.... HEAD and NECK

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[NeCk Location amp Boundaries I Objectives bull Surface Anatomy

bull lies between the upper part of thorax (inlet) and lower part of the skull e Division of Neck

Boundaries (a) Triangles of Neck amp Contents k- I ~y-vC

(i) Anterior - subdivisions- ~j ~ bull Posterior - cervical vertebrae (ii) Posterior - subdivisions -- vh~

I f eogt- f ~Nbgcentgtbull Posterolateral - scalene muscles (b) Divisions of Neck (cross section)

bull Lateral- sternocleidomastoid I (i) Anterior - Visceral ~

(ii) Posterior - Musculoskelet o Anterior - infrahyoid muscles

bull Clinical Correlation

Surface Anatomy Triangles of Neck Classification of Triangles of Neck Triangles of the neck can be grouped into

j Anterior Triangle bull Posterior Triangle

(f-nterior Triangle can be subdivided into (i) submandibular (ii) submental (iii) carotid (iv) muscular

J [1)Posterior Triangle can be subdivided into (i) Posterior (ii) omoclavicular (subclavian)---- ~------- ~-bull

I)

(2) Lateral to viscera is carotid sheath--- (c~otict~teryJ internal jup ular vein and vagus mrve) lt

-- z-===---- bull -~

~t (1) cervtcat-verfebral spine l (2) m uscles that move it J

- ~k

( I

o

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C

Divisions of Neck Lf I Neck Triangles amp Divisions ~~terior (visceral) --- The lateral side of the neck can be bull Posterior (musculoskeletal) -- divided into regions namely ~ ~--

I ~ Anterior Triang Ieterior part (1)~eraand I Posterior Triang Ie

( 5u5utt v 01) f1(

( Ant Part of Neck (Post Part 9f N~ck

(cervical spine) amp (v isceral )

muscles moving it (musculoskeletal)

I Trapezius ~ SternoCleidomasto i

Boundaries Anterior Triangle

bull Anterior the median line of the I

neck bull Posterior the anterioumiddot border of the sternocleidomastoid muscle

Superior Inferior border of the mandible

bull Superficial (roof) investing layer of the deep cervical fascia

bull Floor larynx and pharynx

~ i0~ - J Subdivision of Anterior Triangle

bull The anterior triangle is divided by the digastrics and omohyoid muscles into smaller triangles namely

~ubmandibular

~Carotid

y Submental

y Muscular

Subdivision of Posterior Triangle

bull The posterior triangle is further divided by the omohyoid muscles into smaller triangles namely

o Occipital triangle

Omoclavicular triangle ~~)

IBoundaries Posterior Triangle I J Anterior sternocleidomastoid muscle

posterior border

I Posterior the anterior border of trapezius muscle

I Inferior the middle 13 of the clavicle

I Superior (roof) investing layer of deep cervical fascia

I Floor muscles of the neck covered with paravertebral fascia

Transverse Section Neck J loves ling layer of deep

Anterior It cervical fascia

Recurrent laryngeal N

Tr~chea Prelraclie1fascia

~~77)lt ISynlPafhClictrunq

Trapezius m

Cervical vertebra

Posterior

(

~II(

- I Clinical Correlation

lIIIoveroentof Thyroici ~n Swaliowin~J

rl IPosterior Triangle Relationship INeck Anterior Division-Contents pr8vcr1obml tflscia

fOor) Poslcrior auricular v Cervical Viscera

e Pharynx and esophagus - superior part of digestive tract

If F~ci~1 v

bull Larynx and trachea - superior part J of the respiratory tract

J Sternotuidoshymastoid Illbull Thyroid gland and parathryoid

glands Clavicle

lif

( ( YJ (

C Clinical Correlation I gt Clinical Correlation J ~iflf~+~~~ i~rtl1l4~~r~~~~hiit~

- Clinical Correlation Clinical Correlation -J

if

ctaQl~~e6~useitj5iti~ullv~rJndmiddot r V~-vt A

~IJ~~L~ ~I~ 1 II~~U~ IIltO ~ middot r ~lt~r 19 j _~~_ _L_middot __ bull c

IIIIII~VJ 11 11 IIIiIll~ leealeilthen dire~re~ltinfclOlat ri~~iMi~ia~r middot middot~Dple middot~ifJ

middot M [

Mandible

~I ~ J5 c U L A R

T R I A N G L E

N E C K

I Contents Of Carotid Triangle ~~ bull Common carotid ~ t~ Ih ~ 1~ ~ fi- t- 7~1 aM4~A bh

h-plf nM dip~~ p~ i CA-s7UJ-t[

o Internal Jugular Vein ~

bull External carotid and its branches

bull Hypoglossal nerve

~--------------------~(Bones Cartilages Membranes Of Neck

Hyoid Bone at the angle between floor of the mouth and superior end of neck

Thyroid membrane is between the thyroidcartilage and hyoid bone

bull Thyroid cartilage in the anterior midline of neck

Cricoid cartilage is below the thyroid cartilage

i--fmiddot Cricothyroid ligament is between the thyroid cartilage and cricoid cartilage

bull First ring of Trachea between thee cricoid cartilage and superior part of thryroid

L2 Clinical Correlation 1- ~

~

~middot~1~~~~~middot~~~ ~~-~~~C~~ I~yenn ~ 1 ~ ft~~~7r~ middotdg7~~ Il

~~i tYiiaiiJjajjjl1ma~liliYrc1liSCihftJdff(~fR)Ahseti c~ iofn

o Branches of vagus nerve

bl

IExternal carotjdg middot1 Sl)perficial temporalMaxillara-----

6Posliliiorauricular a Facial a --------1 OcCipital a-----I

1

2 Ascending pharyngeala 1 Superior thyroid a

Pharyngeal branch t

Superiorlaryngeill nerve

Subclavian a

-=pok

c A R 0 T I D

A R T E R Y

B R A N C H E S

o F

(( Hypo~lossal n~re (XII) n (~ 1I ~ Cl 1ts ol C~fotid

Tri~n~I~middot~ ~ Ansa Cervicalis J R

[1- c

A E

bull Innervates~~ T I

~

bull This includes sternohyoid sternothyroid0 and omohyoid muscleN r s

H bull The~ss~erve carries the axon I

f from spinal N C1 and then

P branches off to sLpply Jhyrohyoid M

Internal jugular vein ~ ) I

Sternothyroid m

~ i )O~~

C Carotid Angiogram J A

8 7 R

~ o5 4 T3 Lingual a

I o

A R T E R Y

~ ~II ~ ~ ( f 1- middot i ff-1ew-tjJ ~ 1t ~-L_~l

J~~(

IC Contents of Submandibular Triangle I 11 I I Submandibuiar Gland - Relatio~sh]

bull Submandibular gland and its duct (blockage)

bull Facial artery

bull Facial vein

bull Stylohyoid muscle 0

bull Hypoglossal N (XII) Facial Ao

Int Carotid A

Submental Ao Ext Carotidbull Lymph nodes n d kr t5()w fAf- s-w~~ VI bull 0

0 ~ (NHtVr I Submandibular A Common Carotid A

IM Modlt - ~ 01-4~ 0 I _ HYpoglo~INo (XII) I fi) Jr-j~~ I 7~ a ~ - ----p~(j ~ kJclv -bj~ Q _ ~ J -vvh~

0

i~ t-J V(~ 11-1 f7w 6uq-~ -=-Jw-d(1 (~vt() )L J ~~ ~1i I f J~ d~1 o~ 1middottJr~O- N

I SUPerficial Submandibular Area IContents of Subment-I Tringle J anlerlor bel ly

$ An unpaired triangle L ClI-1~ 4-4--p 6 ~

e Submental lymph nodes

(1~ 1rt~~~ ~r

Siernolhyroid Anterior lugular vein (AJVI oJ

~(

[Contents Muscular Triangle 14 (

Clinical Correlation =l bull Infrahyoid muscles -

bull Thyroid gland v

bull Parathyroid glands

lt- M~lt (VvV- shy

t-f~r (r~ (~IN hiic~r JflfiA (r~) f1~ ~

l -~

[ Clinical Correlation ~ I f Clinical Correlatio~--~~J

t~ $lJpemiddotror 1 thy~odi vein Internal0 - c- - --=tb~ ~ 1 Thyroid ~Hexus junuarr l aJT ~ vJ Dfvepns v-cin (IJV)

-T-- ----- - -- - - Mkfdlei2 Interior UIlyroldshy

f artelf ~(y -A

mymid 2 A ~tThyrocervtcal t~riO( 0 piJ

Innlf thyroid 3f Y rJ( eiC1S ~

BrachiocephalLC Arch o~ aorta trunk

fn~ - 6 clcI-shy1ft ikc( rnJ 1~ -~ ~CP I~ ~~

( ( (

C Tracheotomy =J 1(13 Transverse Section (Tracheal Ring ill

Trachea LeHlobe of Ihyrold gland

Clr)jl(L~Ratt

0gt ~o

o~ )laquoj

r~middotmiddotflt7 In1emal ~itgtHar vein

Esophagtl$

Sl J1 j~- eft I1 ~ l 1t

Clinical Correlation ~ Clinical Correlation J bullf ~ ~

~ r Superior thyroid anery -Thyroid gJancl ~

5gt ~ j--_bull ___- ~ 10 I V JI _ Right~enll~~j ltgt~1 middotmiddotjF middot

+ ~ Wlt~ gt ~flj~~~g u1atienofca I ~middot ~~~~ UWi~~ysmat enciocrrl18

Tmiddotmiddot d - I V i

I~(

--

n-_ _ n OJ-n o l

-~ OJ tt_ o J

r--gt

C ( I~

v Cutaneous Nerve Distribution of Head amp Neck

imiddotrrigeminai Ni4~-bull 11 II bull ~vmiddotrr1-~r- middotmiddotv middot middot middot middot middotmiddotI~ v_

~~ ~i~~J -tmiddot ~ Y hlj~ry-f~tt~~~~optlth Maxill Mandi C23 causeS l toSS Off~

t)~ middotsensation ~tJr

-11 ~ I r-r$Ao partso(~Fac~-t

VOr(-lr~~ 711 Q-1 fNv-tmiddot- ()JV

Q- ftri4 rh 4e fu-~-gt UV [[r1ltj ~ (vy~N (cv5-)

)I Clinical Correlation II

1~ -~~tIk ~ lgtJnvJb ~ ~~~-7G j~ ~iO+(Y c~o~~~~1( i 4l ~ ~~-

~- I

S e n s 0

r V

N e r v e

F a c e

Surface Anatomy

~ -

Supraorbital ~ zygomatic margin ~ arch

Nasal bones f ~

-Zygomatlc cfreuroik bone (Z ~

Iveolar process of maxilla

Mental prolulJerante of mandible

ll )111 ~

v rnOD~(Qr1 h~~~M( )

Vz I c[)ltiaimic ner~e~ ) ~

r-----suptair6~filear 11

Inf(aJr9centIiI~Jlr n Igtc r==- Extorirnils~Ln

_l~

bull

J~l

ZvaomaticotemoDtal middotn

Supraorbilaln

Mandjbularherv~bullbull gtshy

Vr

( (I-(

)(J

IScalp Layers[ ~1~b i

The scalp consists of tlve layers that arefitm[y bound together

1 (Skin 2 ~oIlnective tissue - dense$ubputaneous ~~sue cont1in-v~t Je0~

(1lg th~espoundel$ and)uye~ ptt~esccllp CPCl)-fClJ ~ ryI ltC-) D~ 3 ~oneurosis (epi(W~Ulill(p~l1etJrpsis) - C0~ec~~ ~

J~Ilt~hs Itluscle taclliieQG1pltaJrs ll1Uscle ~ 4~Ose connective tis$ue permit)the ~Galp to move

over the calvaria 5 ~ticnUriui11 - the periosteumofthecrariihl bones

D- -gt W~ r~ v-VvA J 1f~~~ ~ - j)~r ~~

(~r1 l f Su-y ~Sr~17J)JltUgt -7 C~Mh~ CIinica I Co rre I a ti0 n I Ir-- n-s-o-ry-N-e-rv-e-amp-B-Io-o-d-S-u-p-p-Iy-O-f-S-ca-I-p-s-e

rm~~-

~~IBWOIiVtSSElS I I l 1 1 11ilt1 i( - )

~L ( ~ yen Vc~~~ ~v~

rj6 ~ -rtr tJwA

8fr

FrQllJ~ti~m~~~1e

CoiinecUve tissue 2 ~~APoncllrosiS 3 ~~ L()oseconneclivctissue 4

1~ Calvaria

6 v

tx~l) ~

tJ

5

lrJ1~ _ lt -11iIIIIIII

~

( ( 1 ~

[ Muscles of Face Platysma

-- ~ I JFrontal belly of _ (-i eN I

nerve

nerve

~v~11-Llaquo ~v(- f~u ~~~~J7 ) ~J bVl

-~ ~ ~- fttcJr1-( [fr- 0--lt0lt

Clinical Correlation

~

y S

c~

the -- 1

1- t~Nrgt-~J-t~

-

droopingiOT tfleuro affected ~side Cfin~(

gfY

( JH

[ Parotid Region 1

The wotid gbnd develops as an eYrlgjnarjojJ ofthcntamiddot1mucosa 1I1e1 ir occupies all avaihlhle space lr0lI1d the ramus of the Illltlndihlc

1

~ - gt bull -

~

J~iJA~

Ie ~J - rltJf-middotftlJ- ~t itj l J ~ L ( d~Oh-~utr~ -gt ~-)dr~Jt j VJ-=-_L- rrvZIvIv41a O~

-- ~~pa0 -)

Facial nerve (VII)

Zygomatic br

t~~( r)~~ OJ ~V r 0

~~~~~~eta~iprslip ~i E -t b r 1-1 ~r ~ I1 ~~i~B~t9tidqlinCl

BU~C(11 brs

MnndiDular br

Cervical br

1 bull c cI- --gt gt7CYr v1 ~J

Lateral Aspect of t-ace

T~--------~

J y

middotr )

TralSverse flt1clal a

Zygpmaticus major m

Cr1

)

- =

stornCldeidoma~()d m

(hd4i~~Xgt he-JJ~ Utv ~~ o~J~~ ~~JyP ~middotmiddot -VVmiddot middotmiddotmiddot)~middot----r~

J~Jlt ~f~~ -)-gtlaquo0)

(

( II(

~J (~ C Parotid Bed I Clinical Correlation

~sterior -ll1astoid process and posterior beJlyof the diW1S~ ~~ ~ ~ tric muscle ~~

~ dAl1 I fl dill s (Jl limerlOr - me liU pterygOtFllUSC e ramus 0 t Ie man J) C tff J ~lI1d masseter muscle ~ ~ - styloid process aud associated n1l1sdes (sty]opllil- () ~1gensislylogjoSStl9 andstylphyOld) -- t () craSH lerior - tlonrofdlcexternal acotl$ticmeatus

J ~ c-shy~ 0

~tf - f

(~

~

~fQ

Q ~ ~ Igtl I

~ bull ~IM tJI l1 tfUmiddot rJI

v ~h

~

)O j1ltCl-il(7 J (]Jitio- ~~rAv t7(Pv(t1 - shy ~ Splef19palatine artery M

Nerves lolempoflilism enterll)g pterygopalatine fossa

h i W AJr== Ner~er m ~ ~~ ~~t rI ~t1Y J bullbullbullbull__~ II ~~ ttu iJ1i N D

~v I B U A R

N E R V

a-g(e~~w oTt ----== I r _ptvlt- ~fiJf~-~ tJW4 5rv 1~ -tCfii2JJi P ~ J

( 4r

[ Clinical Correlation Temporomandibular Joint (Skeleton)

(~

e

[(b)--shy~j pound- -

Ramus

Muscles of TMJ

TM1

The lateral pterygoid

muscle mmiddotltl~~iN middotWi~~l -utpresses the

mandible (opens jaw)

acoustic meatus

r

C(Vt - - Styloid process

o

( ( H

L Muscles of Mastication

LQc

1 Temporal

2 Masseter Nerve supply Anterior trunk of mandibular

3 Lateral Pterygoid Nerve (eN v 3)

4 Medial Pterygoid ~ ~ lLvIJ f)

f (gtfJ (JJI r ~~ f-

l ( tr)shyA

[ Clinical Correlation - - ----- shy

I[J

L-i~gt _ J -l r----r+i1_~~---f~-~~~ cz-t (11shy

Cr-1JW_Major Lymph Nodes Head amp Neck

~~~

Tonsillar

OU9VIOd I9n(l$uumontof

- l1hvC r IIP7000i-of 1n000th 4pe)( of tO~9ue

~

08

I (H (


Dlffontl1 dignoI I SCalpinflaquoiCO rnycwKterial irfectlon

Mali9ha-n~eS SYJn nogj Iymphcmas

had ~I)d ned ~Jamcus Su~mndOgtUI~rmiddotnod Q~II (l(cinotm~ Drn oral cavity t~CJ

Dlff ~nUIdlagnoSlS Mon~ude09~lJIiJl~ respi~ Vir3ItgtCteJj31 infectiCO mycobaltlerial iofeaicn =illasma ct~iieg~lcriM detltal jjseJdb~ta

~allgn~6e$ Squall0n03ialId(gtcma of to~ head and 000 ljiiipncmasleukemias

I

Antarlor lt~rvl~oV Drain f3rynx teng orcpharynx llaquoior n

Dlrtntlol dfa

tl ~ 11JJIru ~ m-~-~ ~~W~_

~)~ (

~~~ ~ eJ)) l ~lAf

~~

---c~v~ sec S u brA-V ~j

Yrc OJJ~ d eve Ce cltcc)

-

S()b flQ -oLlo lJ ~ c~f ampJJI-OJMJ co ~ (- middotr J jI shy

lip posi c ~ v (el I

~ ~J f 1) 10 shy~ () -pc C ( tCtv (uJ Cl l

ccr I

j --C~((JAr~el( en (J(JfP (

f

C fronlal honc

B IIasal bOllc r shybull_ Sphenopalatine

foramen

~(fiJVJ u~t

d~G~ k r

linus

~idI~~Sr

PlerYLOid homI$

F Maxilla

QSI Palaline process Incisive canal

E ~t-

fltgt~ l- rltJ ( j ~(l evJd~

i~

0 j

-i Ii

~ a nict i ecviD J

~~)

f t ~

M

f G

~~~1 ~t

Dura mater

b~ n~~~~ I-ltA~ Ie nerve (VI

r-----~- I c hrnnlhnllld~11 rrlr llt

i -poundsa~ C i~ ~ I

oZ~v~gtA ~

Inferior meallJ$

t~~bullbull


) tc

(___ _ bull _____w_middot

1F i1 if l Sphenoidal Sinus and Pituita r~ J~ St ~

k ___~

J J

~(r

Horjlonlal plale l) l fpound ~y- ~ l~Ngt LA- A p~~ i C-tgt (V L -ij fgt n

I rLrJA I -r~ ~r~M

9ltrO~~ _OgtQlmiddotmI~_IICfyenllr~QW~IIWIO~ ~ ~ b

~f Pituitary Gland Relationship ~ ~ ~______bull______ __ bull ___~__-~~J il_ ~oampJW~middotlWIlt~~~~~~middotmiddot middot 1ft

~ _IC Clt - x- rMJ ) c0W f~ - n fcltVImiddot hi(

p fw ~~ CkI pJt OJ j~rien(jlwal JJifS

IhhpoundlVltro rf~r~j(~

(~ (~

Surgical aPPwaGIleNo1hemitultaryqland tal(e adVJ lit(J( 0

thefatthatth~sphen6idal simlsand nasal cavi ly provid(1 d f middot J JUJ- Jr v V

rectappro8ch

LA fItA-lt

~

cmiddotmiddot I

LJ - shy

Qgt-I bull

Ir- _-- -- ~~-l) rmiddot~middot=middot~--middotmiddot~=~~---_W~=-~ltO_~ ~

~ I

Question

~ Blood Supplyrt--- _~=_

~ultIgtI~~lt-__1

Internal carotid arteries gt~-ymiddot~J -oll JJlaJl islt ~drniH(d lU [lIe j)middotJsplldL (111

g

111 ~ (VCI( imiddotmiddot)dldmiddotlIs i CT eXlroillallioll 1fiLHl ill deg1 Inferior amp superior ------shyle-rn11 Cl01d n(r~ mjllry~im inrdf lbOmiddot L bullfmiddotimOIl~ hypophyseal arteries Pituitary Clan iuu -hiell of dll~ r(lnomiddotvjnt~ JlI~nc ould be lypj middot

reg The superior hypophyseal -gt ~~ ~gt-shy~J f(-ct~ rl fi~_rc t 0111 l 1J Ii d C fop middotcmiddot artery run down in the pituita - 11 n middottmiddot 1 middotC (tl~J~l rr - Jl middotmiddot~-~middot-7-J st3JR supplies anterior lobe middotV~

( -_ bull -U J IJ ~ bull t _~ ri Ii n UCnlOT[(lWr Ijfrle The inferior hypophyseal artery Inl~gt~JIf i-o c c~~dIt III

rIC OplttilItHlil 1It1 middot V supplies posterior lobe BUT (flif Ic_~)r~~ does not pass through the Stimiddot~ ~ ~~ ( r in ~AaniLlny fll)W 10 lt) cI V - ---

L lr(nhl e1T TliiTe i The blood is drained from the pituitary by inferiorr~~v~-E- A ~rc-~Cfmiddoth-~ ) hypophyseal veins into the dural venous sinuses

C rl ~~ Q- t l ~~iJtwM k

c ~ tfif-i 11-sJ~~

l Meat

w~- ZL~~) l i Front1 sinus_- 050l-J- middot-~Jfo

CJ- --f ~ -__-_ Supelior concil2 (11 ---_ __ _---- Rod entering opening ---- - 01 Iroilial sinus

lb 1 ~ hmoid~1 uullil - LJ C ~

f _ 0 ~ Ope~ill9Qf nnlerior

W ethllloidal cells 0 H2 ~ Selllilunm hinilis ~ lllenor COIKlocI (111

Nasal veslibulela

Openin~1 of lIlaxiliMy S IlU~

2 ~ f)

r a -Jt- lt (gttl f j I ~ ) J~

tgtI cc(3- --n- ~ ~ 1middot

tufi4_

t~~~v~~~~-p~~~~~Ji middot~ middotmiddotuumiddot middot Cmiddot

~ Nasolacrimal Duct Opening lat Wan Nose a~gtUol~__IDIIII- __~ --cIlt~middot_ It_I-middot~_~~~ i r middot~

ttfJill~pound1lClS1SuplriDl l(1criln(l llxpIHa 1lc~I~~~~ ~I ( S I ~rJ j (ld lll 1 ldmittmiddotJ u) tLH he 5pl tt iln d PIILlC 11I11l Imiddotmiddot

i II ~ Sgt2imiddot(J~~ i~i l J1 i 11 j tb 11d ~-Llt cavi IY Ra diograplllC c shy laoima sac

1fl1lT1aIWfI r~v(ols l (JjcinCltiI in hb niJs1 Clmiddotmiddotty Tn h ich _l~ (lC fcmiddot1 ~(lw Pg IQrHion middot Uuld he GId ltCHlll

~

Nasolacrimal duel

-- ~~4~ h

~

and nuncUlo

Llcnmlt11 cima hculi

r- ---- 1 Nostr~ I

c~~~i~ ~~~t)block Ult hlHm of the mlxi IlXY sinus ramp Obstruction 1Ii-A (nl(F(I l)I(ltHllS

e v1IddlL meJllls v lacnnl(ll cIJunj l c surelk T m(((ll ~

D NaslJph)f ynx Inerior lacnnlill pll Ila

E SpbC11 )t(llnlOiidj f(~CC ~s

11

[=~aXiliary S~~~S -~~~~~~~~~~_ A 60 year lad res~~rustonef[iam+y-physician with a history 0- ted~~~6 days On itl Yi~ovvJexamination the p YSICian observed a swelling in the lower part of lateral wall of the nose She also informed the doctor that for the last 6 month she could not breath ~~~~J through her nose and she was tearing in the right eye fpr th~ same Eeriod Which of the folloWi~9structure ~ affected with this tumor A Sphenoidal sinus utb(f f~ v-t B Frontal sinus

V) ~~ ~f I

Lacrimal caniculi tooth Nasolacrimal duct ~

rJ

E Nostril - Nof~l~i~~~i~~~ft9i~~iP~~ ~r-w (tl~tJeNl~

lJtvlNIIII t~

f~ _~__~~___~_W___~_lt_~middot r-=~~-=~~~--=~~~-~~- wmiddotmiddot bullbull bull ( ~ II _J~illary Sinus amp Nasal Oral Cavity ~ r ~ ~ Maxillary Sinus Relationship

t~~__ ---~--~~~-- - ifl____ amp Orbit R~lationshiE~~u_~J O~

Superior (CAd- ~~~

opening Anti gravity directionhrhr5~ (l ~utlM ~middotll i -~Medial

--I eOo-r1--

ufeYlcr rshy3

~ l VV I - 0~ ______ -J (Jshy[ltvl ltI)

Mi(ltilc nasal conch o f n ~0 Il Infelior (IeI ~~ 11 shy

Nasal septuill V c) 0Y-O(J f L~~ ~~ ( t tlp futL J- () ~ UMI-- _ () ILh~ 51 __ _ ~- ~e ~ 0 - 1~ AAotA4- --- () v - II v- ~ o~

~ 10M ( ~tj IV 0 - - (j oJ-l ~ ()~0_ -~ 0 ~ ~o __- ~ cv ~ -a-~~ _ 0_ L

r--~-----OUIV _t _a _e1_ClN__~f~_ ij ~ -- - --~=-gt-~-

I Clinical Correlation ~ Question ~___ 111____ _ _ _~_~-a

~~=-_-=-=bull--=- _ -t

l 55 -yt-ar-o-ld lTlJle has ~1 conplJlu of middotL middot middotmiddot lk~ a - c~(~~ lld~illdilY WVHl pJiilL A dent~ l exmiddotuuinttllJl) (bull ( h [ lVIaxtllary SinUS t cJvip I

~I ) bnn[frnJ~~~i(lf of htf ttttlh L)uriru~ Cl1vc[Cll (~J jrJi 1 )[ 1 r When the ~ is in the umiql1 f)QSiiQO th0rntlxill~ry sinus ~ v hM-tM1 t ~ j r ~ ( 0 J bull 1 I tap[Hug on lts nflt ]ax) lt t h IL IltHI 1-11

cannot drain If iIlfeclioils of the 1axIUaIY SinUS perSISt ~o pro- J -v~J ~ middotmiddotmiddottt -1 -to1 t - I middot1 -i [ 1- ~ ~ nb l Ale I 1) he Vlit_ JLtl r[Iun- k H 1 [ mote drainage an opening IS surgically created through lhe InshyJfh]~ie~ i1-li middotb (J tho -r-GlT1dm lL dlli I [ r bull ~ 0 _ I J L t ~ I L J- - - _ - _ ~ _ ~erlor mearusnear the floor of the maxillilry ~ii1us Post Nasal Drip mo3C HkEl diq~losis~

1 Spnenni d siTflusji

n Anteri(1r th IntihiiJl Sliwsi [i

c Postgtrior l~thmojLJ Sili lsiTi ~

-- JJ ivldxiUJ ry ~ inuiill ~ copy~lotAJ

b middotrvc-L Front)l ~[JlllsilisJ

II

rJ~(

4 r1JaS~~~

( ( (rgt- ~middot~ -~~~f~oIJo~~1ltW(~mlt~UIwao~~~~~ ~ ~OmiddotH ~ olt bull bull

~~ ~ __uv_ i X-ra Skull OccipitC-M~rtta~~ne~ii __lt __ ~---~- ace ~ _- 1M _~__ S1t11 X-ray F-shyrv j4t ---~ bull~-Y)

J D CriSiS g~lIi

- - ___-10 Medi~1 lectlJS

EebaI1orbit 1shy(f)~ ~111I110i(]~~ $Inus

Middle concha4c

ta Mxillary OsliulIl jlddIO m01Iu4b

f~l l~h~lIl~)~~sectlQ~~middot InieriQr CQn(ll5arshy

~~~ tki$al scptum Inferior meausS b - -~-~--

C if bast of skull commu nication between nasal c~lIity I base of sku it

~)~ ~~ ~j

Separates till (2) leitea waH c~_Q~

~ 1 ~

j ~f[ ~ I ~~

f~ [ Question 1 fntcrior ~lI IlTloitl ~ll ~ni(J~It~ over 11 11 p iryq(J~O C~ l - 1 4 1 1 t r tmiddot I f ~ bull -1 1 rli I I 11 111 duIT fIJ ]1- 1U I Ij [

rj - -1([ ~l(ril t ~1fjLl plntj L middot oIYCICL[middotjmiddotlll(middotj middotmiddot [ ( I ~ rlbullbull bull bullbull I middot ~ M li l) ~ bullbull 1 r~ I )l (middottmiddotmiddot _ u_ L a _ l shy

iIJClil)f ~bfi(J middotqlmiddotL1LJ l) frdlun 0 ht orbit Orlilldl ~lniC ~f-- llh~ uuIJ mc~l lil h (o~md ilDf(lE(rh iu ~IJch (j pound~

8-Yo-v In( ~n] h)gting ~ra~~ )

6J - 04)1-ftmiddot t-JclvrcJ4A ~

I 1 A U immL~iIjU L A ~ ~ ~d~r- FrOntltll S~llus (J~ - r

(~ j ~ bull TJ - --r J-lt-j IJ vgtu-( ~~ LVijG lt11) 11 ~Hb

1) Nasa~ (aV11

L -1I~[)cij d illllS

~ ~ CS r

~ we) UI nj middoti

(tthmold Bone)

~ull

amp INJURY of Olfactory Bulb ~

~--

~

CC iedop

~~~ I j

i ~~ ~

~

Nasal Septum Nerve

~

InCisive canal

i -oO~7 + ~1gt1

Ioss of olfaction ( (inability to smell)

( (

~of0 U 0

~JJl

oxmiddot ~

~

Nasal Cavity -

1 I

-~ S~lyen g

(OV j J ~

f~S_

-7

~_ ---shy

ey) i JOyilfINrUIl1IIlI i bl1gbl ItJlc-nUb-opoundLdqJllltn1H I nnur Ikr hi os illv()lvcO In (mwuvclc colll1n He wJllt

Iii) wcaring n Jclmcl f1hyitllll e~minl1fi~lO ~hltgt~ cleRr fluid drfWing ft~ Ul~~$hOW fiaoiun or Ilw ~lpound-ltJfucllimQmJliJ~ Thi3 pUlicnU nl tJc~ ~ _ fJmmllkil-~ ollt)wiug Sitn-c

lA) lanilelt (WI HClJrin

__~~~nLC T ~QJlt~nN twc 1 if ro

( VU~~ 110111 Ihr pastcnor 0 If ~ of Ihe (OI1U

lWtl nne lhlrd f i MW~

Ill ~

ffi

rr I lovf- ~ ~lt tJ

~ ~ ~ Icf I 9t I ~J I~gtW

-----

Nasal Cavity - Blood Supply - ~pis~i --shy

amp1

e of its tributaries felt

( ( v~~m~__~~__~__~_WM -- r~1~ ~~-~ =~~

t ~ Pha~nx Divisions~ Question L __ _____~__~ 10lY __n __ J 7= =~~

~J -Lll-uld [illtl)l Id~ blUlUsJH ohe elnergcl)c~ ~ r~mi~~~eof$k~i-c~ kmiddotllji-middotWmiddotltgtlmiddotIii Ill Sj) Hj PmiddotImiddot middot~nlhflmiddotlll-middottmiddot1

bull cgt I _ _~ middotl-II~ ) j

I~ I r I- f n~-) I ~~~p(i1 jn rh~-arJ -ri-n)W5- is I( i ( ~Sf1

middot~IIh tor I-ittielt 1101 1IlVrVES 1~103Ih In1S10[T(cmiddote

)(i middotmiddotmiddot1 jhllh ~ ImiddotIH ff)llfl1Nfll ln i -Ilt D il d1 [x(Icilnt l3~Ctinmiddot anLi i1~ccJ1iding phdryngcaJ f

~~ ~~gt-

H Ps1trior sJvrior kcDlr [nd ltlCCCSCi i flTIilmiddotiJil

i ~~lC lm~rtl )rHlLh~ uJ lOS[(riO[ (thrloid)i Lflrl ~~ i yen pr1 [fllddlmiddot IItning~J

0) I ~ J-I iY~ IJD ~(IHal Ilrlnchr~ nf rh~Es~i~~ndsu bullf DIwrillLJltibial -=--- --- -- ~~ ~~~-

E DS(nlifnp Pli1Tbne -ll1o[ wmijjur hr31J(tt-l tJi (I)r plryngej

~~-_l__ 0IIII ~--~~~v~ rJw i~-=~ m ru~

I ~ ~ Question ~ harynx Retropharyngeal Space

_llLL _=rton__~gtmiddot ~--middot~~~middot _middotrmiddot It~Ilt___ JJ

gtM-old boy with a hlgh fever is bWLJgbt ~fI

the pedj~urkim Dl2c3 Pl ~iCd -eamiTlMion ~hp P~1-

lienL CorlpLttJ1S 0E P~pound-l In hb ear Hi clnroat app(a3 II~d dmi inlllmccl c(Ilfimling the diz(guoSrs oJ pbiJcyn fbs v~ti ch I) fIn follovrlng stru Ctur2S prNided ltl

to sprcmiddotad 10 thmiddot[ tyrnp3DIL

ca

Irrlraclll~nl (Isi

L CfIUdl)1

B In7(~rn1il acollstic fflealwmiddot

c_ fXIC1TI -Il lltcW~yen~I~ ~---=--- - c- ~ ~

U ~1Tr-l1(llv[TI)dn Ie HI [1~ I~ - ~

T~f-nFlt- i lfC~-- If 11 Ie I) oj middot ~I_

7 ~

lt~

( r (

Retropharyngeal Space amp Carotid Sheath Retropharyngeal Space Relationship

Illvesling layer or deep

cervical fascia

Tllyroid gland

------ Pharynx cw)l ( J

common emolid artery

J Intcrnnl jugular vein

Hyoid

Carolid shealh

Aelropllaryngeal space muslth~

Skin

Prove((cbrall~sclil Trapezius m Anterior Pharyn~ Pharyngeal mUScle)~coPhaeal fa~ Cervical verttbra posteriorfPivertebfalfasciaJongus coli Ant Longitudinallig

Body of vertebrae amp Intervertebral disc

~Lgtf~rltS~ ~lt- ltR

~t- ~~f~~ P bull zL pltV~~~

Pharynx Extent amp LayersQuestion A 32 year old man was admitted to th~

ER with EJdent Base of ~feriOr~bmderof

fever for 15 days He was unable to sWallow On cricoid cartilage 06) - - ~

examination the physician observed a lswelling in Wall has 3 layers outside to innermost layer

posterior wall of pharynx A CT scan rcentvealed that

swelling was a collection of pus In which of the ot-rT vfollowing was the pus collected - Buccopharyngeal fascI~

gt1 1 1 I bull A Retropubic space D~h) o~middot II

- Muscular lay~r bull B Retromammary space ~(f~f ~ eet7J bull C Sub arachnoid space r----- - - ---I

( D Retopharyngeal space ~ - Mucous membrane r

------- Sri

____

c ( l~1~___~~____~_~~-qe__ ~Aotbullcgt- ~~gt~- ~ l ~~~ctlr__~-ogtrrolU~~~_~__u~_~gt-_~~J _~~middot middotmiddot

Pharynx Wall Muscles r

Pharynx Pharyngeai P iex UJ1 ~ W _ft_wc=______~middot~~~_~___~~~~bullbull__~~ltJ ~6ltltI~______ ___~~~gtI ~~middot middot

location posterolateral of phawYTlix r nferior pharyngeal constrictor musd(-~

a~cuna~ ~j iAt10middote~ J (~ltVrO~vTIu-) ~eSbranChes fWVNHddie pharyngeal constrictor musde ltD

~(ugt~~ Glossopharyngeal nerve ~

J Superior pharyngeal constrictor rnuscle pharyngeal mucosa tA~~

eJl Vagus nerv~ pharyngecdCdossopharyngeai Nerve enters the pharynx constrictor muscles Q-ovJ~oltJo- ~)- s~~ ltJt l~hl(O(m the ~~2sectii~~anQjJ~lgQJe_~o[secttrL~~g and

amp-11v~6~~middot F eeurrent laryngea l nerve ilit~r~ the pharynx where r5peior ce~ical~ym~athetic gH1g i( rmiddoti ~ the Lrf~Ti9poundgD~~~r_~_~_~_~le joins the~~J~~Cg~l~ ICH~~~ C

1t C~)~ltC

Go - Ii f ~ 1~f~- - e~etVt~ laquo~ (4

~ CC -=-

~~ bull --~~I=~gt= ~~~ ~ ~ ~ -~~ mr_---~-t---~~-~~~~~rl

l ~~___ Musc I e_~ Of Pharnx lt ~_~ i Nerves amp Vessels Related To Pharyrn~ to- = _ ~___~~~__- Tmiddotmiddotmiddot

PhayngcalluDCCI

Cnrofii ~1n(cmuJu)ur~ill

~~hClljl

- -SympllllClictwri

(7 1 A ncurrcnrL1IVnorJ11IC1tS 13 ttiUIII IC(IIIICll t tII~jlIIIII I gtt c

I -~--

--

p yen( (

~~OLI~middot_~--_middot~Illl~ ~1~~~17~middotMIII~ middot~ middot ~

H I Clinical Correlation dA ~___~__~fIO-_Ibgtmiddot middot~u - middotmiddotmiddot-middot middotmiddot middotmiddot

q v AdenoidsN v t~ A iII -- Enlargedpharyngeai tonsils are called aclenoids_~ijg l_ i~i _(I L

struct the flow of atr from the iK)Se-through (if ~(JgJ~~~~ I A T

E making mouth breathing nKeSSaty -ILR L nlI or l onglluQrJI 1~~~~l l~

Hyoid tont bull

A i c-4I ICJ ) Qo-Af f3~r ~jC

I ~-~

du ~ 0fS Cr c~r~r ~ - (1)0 0 00

_~ltP I ~j -gt v-JU--b sJ-tL

~ iii shyAdlPAo-U)~

E ~ ~ 1 bull ~)B~~06t

WI

I I__ ___ _~- Jamp~~ 6l~

reD on til ill )I__~~ =I ~ ~I middot_ bull middot ~

i ~~~~~~-~-~-~-o-~~Ca~ty~-=-==~~~-~ ~ PharYnx Mucosal Fo~ds

i- -rl-lt ~ ~WIUIIIIIIQf~_--_ _ ______ _ __xre__lOd L __ _ _~_Wmiddot middotmiddotmiddotmiddot_middot __ __

)v~

~ AuM-~

f~ t~O-

L-_--___ PdgtT

-1---

_ CAr-

r~(~T)~3-( vl

eJo )Mmiddot _middot_~ - middot

----

( (j (

Question Muscles of Pharyngeal W~~~Ton~~~ __J

Cort lllgo of ~ ~ philryngotympanic lube

n 1] -year-otd bo i~~tfl$middotlQ l1el1 iPIIllineJ9nsi~~is ~~~~ Mcdial lllale of ptefygoid Droce$$c(Jn~i 11ed by ~m ot(L1lry~()JogiSt--gttVhiCh of t]ie 6]~OW ng palalinn~

(~n1ine~ 5 ulPph~~s unost of tbe bklDd ~o these tonslls ~d

ml1lf~ be prot~red rh~tJ its tonsHar Dmndl is dljllide

1 1 1r SCljjDQlng lJ1)IrTII2IeJ

RF~ - J~ J2Jj~S L~~ Cxc---~~ C Linguaraquo J~~- Cj ~ v-I~ 4l

Glossophalyngeal N

I) nll~scendiitg pillaHru G _ ~yV1 i (~ ~) amp ligation of Tonsillar A

E Superior thywid

~ ~

sVO~

(1-1cUtu ~~

Relationship Nerve and MuscleTonsil Bed Boundary St 10 lossus muscle IS attached to the styloidPalatine Tonsil lies in the interval between thE6 process and inser e in thetongue laterally

paltoglossal fold and palatopharyngeal fold

G~~~yp~sal nerve C0 ILshyBeh ind the paltoglossal mucosa is palatoglossal muscle This muscle elevates the tongue and

bull Action retracts and draws tongue superiorlydepresses the soft palate --~

~~ph~~g~ses between superior and Anterior palatoglossa fold ~ i ~on5trictor muscles to enter the t~_e ~

I ~- and innervates th~posterior 13 C the tongue and posterior mucosa 01 pharynx 11Merior ~ palatopharyngealfold

(I ~~Jtlj2 Recurrent farfngeal nerve enters the pharynx where the inferior

Latera ll y Styloglossus muscle amp glossopharypgeal constrictor muscle joins the esophagus nerve

~

I d1 If t( --~sc=a~lp--=_1 I Scalp - Emissary Vein - Infection

gJ~~~~~9Ji~(1rl~~1gf~011~~~~1~1 centefebFfll ~~in

1 ~ ~ Gonnattivetissua 2 4 eMJ~ (t~ lt31 ~J~~~t~~~APoneurosis 3

0) ~~~ plooseConnective tissue 4~ 5 if~~ ericrahlum ~

i~ Calvaria S L A L cr 119-vHllUIU IlIlU middot81

UDj~middotf~b+oTmiddot1 ~ i

~~ii vlt lt~_ btw b~ t0

i4middot~e

cAVcM (~~~ Subarachnoid space (CSF)

(Vlef1~Clt) -7 [til Sf) ~h~ iJ~f~ll +u rwvvt (M~+~ ~II ~~trM-shy

Q-= ~~klt~tf (M IlJwf0 ---gt~~

[ Clinical Correlation Question A 5S-yeal-Dld mlD is aI(lm[Ued W tbi~ l~ttJier~truy

depawnent aner slipping 0]) wet prvement tind fa1H[)g Physjcll euroxaminatiKHl lievea]s (hal1l1e-pdlttlelll ha$ ahe~ matoma that formed in the ~~~~~ spreading to the area of tbe eyelWs Which ()n~ the fo]shybwirJg laycr$ is regardEdi as the danger zone

1sect~co~n~cti~ ~-1B Skm (r)CA~~

~oos~~~mnecUve-t-is~IP -- E Pericranium

I Ff~cj~HJ V~ ~~~J ~-IF

e Ccvo) ~- ~ ~-amp~~ q~

( U

8shy 1

L

bull JOe bullbull -

[MandiQle I HjiJeQIt~ process

_ Menlarfornmen -----shyMenial protuberance -----

~Anlerior nasal aperture

y

~(I

0~ ~)~ fJl ~vg

~ 0 f

ts 1oa1 w cA

SKUll latera~ V~ew

J

is (kt-1o-t-J

~hIJ pAll~~ ~ (Z~

pterion 4 Cranial Bones Junction amp Relation

to Middle Meningeal Artery (Ant Branch)~l~ middot1cmiddot~~~f~~~~~middotI~~ f ) ~7 ~~ ~)~

Itt

f

SaggitaJ suture

Occipital

Mtd~n4tt amp ~Us~4f~ui~~ ~

I

( (

l Calvaria (cranial cap) I Cranial Cavity 1 Artery grooves (impressions)

The inner part of cranium is known as cranial cavity

2 Arachnoid granulations The cranial cavity is divided into three cranial fossa

3 Venous sinus grooves

4 Diploie (spongy bone) 2 Middle cranial fossa centontains the 2 temporal

lobes af brain 5 Compact bone (inner)

3 Posterior cmiddot bull Hower and wider than 6 Compact bone (outer) e cranial fossa Contains occipital lobes

of the brain

~ 0

) ~

ltamp

~

~f t d ~ ~ Jt ~

~ r-J StA~ ~

Floor of Cranial Cavity amp R~lated Structure ------=~

gtx(middot ji~ cent~aVJ~filqQsect~

~(

~ i ~

( (

[ Question I ICranial Cavity and Cavern~us-Si-S]

A 5J~-yEar-Qtd moJe iLl ruraSDoo0d f~th art anC1l1 rvSilU (If Eheuro hasllAr ~rl~fV cliotie- to th~ --avelnous $lnttS- J

An ~JltHrlo[ approach w the sella turcica dlLOt

n~S~ll rl~1v[ty is peri(lrrned Tifmugh which of rhe Jo~shy

~O(1jrif]g fOi~~tcs rs th~ stmgoon roDst likely to enter tIle ClarltJi cavity

Ao C[lili)lrifonfJ p~ate YPj Jgt(

~ R CavemoUJiS sinus y C Frontail sinus gt~

l 0 ( ~D M ul~ us lJ ) ~~ ~al shy~ 1 ~ s f ij)UEHOWl snllUS

~

A Q -

I I j

-fJ

Cranial Cavity amp Cerebral Arterial Circle I Blood Supply - Brain ~--- ---I

ltr~ ~ An bull O ~ c(x1rii~if~tj~g~

~

c~~ Co

t

~ou--r~ I

I

1 i

f I bull I fI

Ittr

---

i

( NCI - Base SkLlDB (~ shy

Ol~tOllacor btJlb and

rYtrnI[ lfilet (I) __~-----1 ---------

~ ~ Ptc nerve (I)

--- ~ 1 b OPlic chiasm ______

~ _I Oculomotor norve(III) h

~~~~ )1 ____0 deg0 1 ~bull

~ -JTroChleartervltmiddot(IVd

~ Trigeminal ncrve (V) I 1l7 IAbducenl norvmiddot Ivn I Facmlllervc (VII)

~ LI~vusnerv~e~~)gt

ge middot Posterior Inforlor c~regell~r artery

VcrteliraJ artery --

ri-o ~

---x

CO Question A 49 year women presented with severe headaches and

c~-A CT scan revealed a tumor in the~ foramel-~examination the patient it was observed that the patient has no p_b_gIYngea~or ~a~ reflex Which of the following structures was affected

cf 0f cJte-fshy ~Iossopharyngeal nerve J- j

Vagus r fh C Accessory nerve s~ D Hypoglossal nerve -r(Yv~J cmiddot E TrQcbea-F-118rve--shy

~ II(

(

Question

Right l5eniohyoic]amplindtlnit middotoerviltal nerve

E Cantraiatera] ltliillgus and hypogtos~a1 ner~e~

Question -I An l1monscious- S7 year~old man ]8 transported

to the eme~ency dep$tment after falUn from a tree cr scan emiddotvaluatiorfi rev~als a f[acture of thecribpshy(arm p1ateVrhkh of the fonnJ~ling cO[1JdiishyHoJlJs 1iviU mC1s1 Ilk~ly be prn-eSElnt during the physkpoundl1 examination

A Entrapment of the eyeb8lH

~ Anosmia ~r--c Hyperacusis

00 TinnHus

E DMDnet1-S

( ( ( Clinical Correlation I

j

U ~t~~fnIP~ii f t--) ~hIj r ~~~ c

(~~ x c~ Y~ r -I Y C--c

PY 1 ~ t -~

~l (cr -- ~ l ~ - u jI

0~~

1 j4

Sase of Skull Relationship Int Carotid A Cavernous Sinus amp Abducent N

~

b I7i

(

Question A 55wyear-old IJ41n is a~ to the hospita

~l~l1Ll~ a compl~int ors~adach~~ _t l~u~lIt1Il p uocshytlilre reveaJis traces icC blood m tbercereOQSpJJJa] fnnid=-J

--shyVilh~iCh of the foUowing oonditiollshas JJilO$~ likely OC~ CtIrfed in thls patRqJt

Frltll(~11r~ ()f thfpPB80n wih llflstular injury

ruptured berrIf aneurysm~ Jeakage of branches of the- middle mcningeall ve1noilhin the tenlporal Ib01le

~ A tear of the ~-11rlbraM v(in t thp laquo1f1itrnf to the superior $agittai sinus

E Occlusion of th internal carQHd (lrtery by a dot geriampated in the Idt 3tdlliIll


J

( [ Clinical Correlation

I IBlood Supply - Brain (Sum-mary) I ~ -- shy

2

j

l~

Cranial Meninges Cranial Meninges ~ - - ( The dura mater has 2 surfaces Cranial meninges coverings coverrng the

brain There are 3 layers of meninge~ I~~1) ~riosteal~r outer surface in contact - CVi~M ~M~ P-YV ~ w ana _

(i) ~ mateythlck outer most fibrous ----2) ~yer inner surface adjacent to layer ( _ ~ ~ tfV ~ a ater

) JoVJ q--u (jJ- lWt~ I

(ii~achnoi~ater thin intermediate ~ Between these 2 layes is contained the layer us~ ~~~ venous sinus

(iii)~rnat delicate internal vascular J Between the archnoid m~ter a~d pi~ mater layer is the subarchnoid space In which Circulates

the CSF

t--jf

--)

( (

[ Dural Infoldings middot 1

peri steal layer and divi compartments

These infoldings nmit the-movements of the brain During vigrous shake and these include

(i)-Cerebral falx ~ ~ (ii) Cerebellar tentorium f o) V ------- shy

(iii)Cerebeliarfalx fdV~~ ~

(iv) Sellar diaphragm v ( (~h1i)J

L Dural Infoldings Dural Infoldings

-shy

p ~

Cerebellulll Medulln

~

(

Dur~1 Sinus ------1 )

Meninges - Coronal section

~1 Arachnoid granulations ~~ ~~sary va)

---3 Stnlighl

v Subaradll1oid

C(rebtal falx space (CSf)

( Posterior Aspect - Dura Mater Cerebral Veins Relationshi

~ r---1

(confluence of sinuses

Straight~ _ ~e Sinus

s~0 1(tgt lY

00lt( 1 ~O ~- ldbdu~~1

Hematdma~tr~ Tear ofc~rei5fal V

~ V

( __________- l

c-~- Clinical Correlation J Clinical Correlation( - ~

Subdural He~atoma

[-- -- Question I A 65middotyear-old male i5 admitted to the hospital

tllrf-~ weeks anef ltI small bump 01 his bead acrording to higt [larratlv~ He tuffered the accidental bump from a low-haFJging branch while drhing his tractor tluough tbe ~pple ordlard during harve5tij~ season DUlling pt1)$hr euroxlmimltuon the patient djspLays menta conmiddot IUfiioH and pCiOf physic~l toorclina dio ltlphic lxJcnlnation I~8]s lea[ltaqe from lt ~ rebr~eri_ Vel the fighl c01rebraJ he-mispheJ( F poe of bkedlngts (he patie-flt UWSl Hkey suffering

A Subaractmoid bleedtng

K Epiduraf hleeding C jr tracerebrJli bleeding into the brain paJeuroushy

thyma ~ SlIMlITiJlOf Pleootng E m~edirig Hue the cerebr~1 ventricular sy~tem

Periosteal Layer of Dura Mater amp Meningeal A shy

~ A Y

~~~~

~(C~~5 f ~JQ)n~FJng~n1 middotartoryoiKJ-vofn

lateral venous lacuna

f~

Pqtllrinr--4shylH


SupraOdJ1tal ver -l41f]1iilihlltm_

~r ~ FaClalv0in

(

Clinical Correlation --

BloodcoUection between the dura materandcavari~

reJi~~J~~~

r Clinical Correlation

If

lbV ~

1barachnoid ~ hemorrage

~ArtM l) r~1

ater (subarachnoid spac~) V ~

(

Cmiddot~ Clinical Correlation Question I - J J -~ ~Z~r~middotkmiddot

f kigtL 1 [ ~iifi~ri~If)tliltHq m~5tltltl1f

~l bull yenl~ ) ~ ~

middotmiddotimiddotmiddotmiddotmiddot J 2

1 middot Ai1ast0EHGsgg~b~tWg~o~ttljl~tatigll~ryq I bull ~ bull bull _- ~ bull ~ shy - - _ J ~gt _

) 1

Clinical Correlation ---- I[ Dura - Nerve supply ] bull The innerva Jons_of-the-dumiddotFaigpredommiddotina~

supplied by 3_divisions of eN v (TRIGERMINAL

bull The sensory endings are numerous in the DURA along each side of the SUPERIOR SAGGITAL SINUS and in the CEREBELLAR TENTORIUM then they are in the floor of the cranium

~Therefore pain arising fro 0 eadache) is generally REFERRED TO ~s supplied by cervical nerve or division of the TRIGERMINAL LAYER ~

--- folit

it ~6-yedr-o~d boy isadmiut--d ~o the h(~9pdlal ImiddotiiLh f~Il~[ confused m~nlaJ state and ruowsiness Dmlng physical examinatiolJ -it Is notiEXt tbBt the boy suffers from s--~n~diOjogiC examinataon reveals cav~ ernous sJtluts rmnbQSiS Vllkh of the foliowiflJgroutes (If poundntry r~yemrulS sinvs tlQuld m()~i likely be respollsibleoif Ule inrfretuon dlnd tbromboftfs

A CUotid artery 0Pe - ~-B Mastoid emlssai1jr vein

~Mladl~ menhgeal ~ln~ry 0 ~phthahnilC ern

R P(1rietat enJi$$Jiry vein

Comparison of Spinal and Cranial Meninges

Spine Cranial

Extra Dural Present Periosteal layer Space adherent to the

skull bone

Extra dural Fat and Potential space for space venous plexus Epi Dural

Hematoma

Dura splits Accommodates into periosteal sinus Divides and meningeal Cranial cavity by layer infoldings of dura

[ Clinical Correlation middot ti~~-gt

f ~

(

[ Clinical Correlation

~~t~ IO~SI-~ -i~~~~ 01 VNtrN ~~ I- bull -h-- _ ~~ l~l~Veurort7~

~ ~ML

t ~ r)

~ ~

~ ~~

( L-ww (1

I

3 IVApound~(~--II Y

(

7

~

J (- ----------Qu-~ion ]

1J-~~~C~f~Q~ fPe ~etc hrOrocepoalus Radiograpnilc Cxaminltlthm re1eal~

A 2-month-ojd female iniant is 11ospltaJized ~vith

- ~rol tv ~n)SPliila fllld beoJeeil~(JImPJ(J~blain aJ)d J

J G~vC~

crYtRUrionsWiU most Illietv l~d to this lype of dirtica~

IIYifer1ying bones of the 5l~un Vbhil of th~ flOUtVrmg ltz

v-I)- ~picttlrei tvL t 0 -- -1

yshy~ A L(wk oJ filtratioIl thWllgt rnuhnoid glanuia-IP

tions Et Ocdus]llltlof ceuroJ-ehral aquedlilct (of SyhiDls) 0cX~ Uf j--7 LYYshyc BlociltaSe of the toE3rtliina of Luscwa

~ r-ltj Q~L~ 6vV---- I0+ Cougental abser~oe oI the [Olf8lmen of Mijgendie

E CtO5me of tblit imelventrlcular foramfna 011 If MOilro

(oG ~c

~~ ~ V rgtC) -- (VV ~ ~ _

(Ier- ~

IV-

Ci- ~o(

V ~

~

cf (0( ~ O V

)eYcc)

lt00shy~

(c I Eye Muscles Anferioramp Posterior View Movement of Orbit ~_J

ltL(i

Ocular Muscle

Medial Rectus

Infereior Rectus

Lateral Rectus

Superior rectus

Primary amp Secondary middotmiddot

Actions

ytTJ

eN Innervation

Oculomotor (III)

Oculomotor (III)

Abducent (VI)

Oculomotor (Ill)

(Yc

SuperiorObliq ue Trochlear (IV) nl_ d~~ jppound

Inferior Oblique Oculomofor (III)

ftAll~WJ~t~ilf~~(~~~~~~~~ I Opposite istrue for the inferior pole

lt

IEy~ ~tef~lampNerve sup-pij siiPf1 oibit~t ffirtcrYV

~Su(i~iiorr~~lUs m V

LatoraII1lCIUS V Jilusclcmiddot tlI Whe~ntral retinal artery

gets occluded there j ~ -shy~b ~ complete 10S$ Of visi~ u inthat eyeEXCEEI_tll-a-t--

the fovea is not affected middotPoslcrlorditary-arterics bull shy

~1L~M ~

I

( ( f 11L Questi~n [ EyeneVeJ1)~~S orajnage-]

l3 middot y~~rmiddotold rnate pat[(Hllt visits the oiJJJtpatient cJiltk vvtith a comp~aint ()f progiess~ve pEiiinie-s5 loss of vj~IfTl RadlOltl-~mp~it ~xan~inati()n]ieveuroals thromPQph1eshybitit of tilc G~~fern(lus sJi1t1lS Tjlro~lf)hihich 01 the ()]- lowtng SUUOUIpound-S mlCSi[ a stliMmbus pass to cause the ~Y InI)~(j)m~ i(~f ~ f44s patknt

L St~b81r(ldmoid stiltaiCeuro- c

entrallftltery c1 the leUna~ _ ~J) vt-

C CenlJal ve~]~ of the rdhl~l CT o

D- p~~~- c ~I J ~(It ~ 111 I if ~rbull r ~Ii n i bull bull middotlri~dJ) ~dnb-t)

[~~~~~~s~ Sinus~Aibdiucep)t jMierve 1 ~~ fA-U ~ )I ~ lIhf1iClf

~~~ZY ) ( ~~

-middot- -middot=1 ~ ~- lt J Oculo~oio~ miNe (UI ~ middot~- i~ 1 ~( ~n l

) ~

I

r

nerJC V I) -iy I lJo~~

rii1axll~JY IlCflle (V21 If ~~~~~I

~(

I ~y- ~

tJ

lOJltlOIDltalgt4JEn(

~ 3~

fOn[orvnOta ~~ omiddoth~~51( lt f ~~P9P pc~uS Wt~

s-

I

A6~-yearQhl w)ma~n is ~dmitted to the hoopit~r willI ~~gl1~Or ~verholm a[Q~~tlnrQmbio8us Radiographk eXrlml~~tvn r~~~rmiddota middot~1)~~ 0[ tbelntem~~I~ itiifl~ l(I~Dwittfi1J1h~ b~er1l-9 s nis During P~~uysshy~i6iiniJI~lj~a~~b~fr~~~oijl~gt~)~leJ~fsltt~emect to Seuro~ if nery~ cfmtn~5SJqn llaS OOCUTI~t~jnn t~~~ ~~eFft~ lt OllS SlIlUS y

A~hlabiljt~to~yenzetIo~niard and mEmiddotdiaily on tlteaf~cte() ~sldt

~co~ S7P~~~ffihhe ~ ~or ptlpeurobrap~e S~~e~~t~ta~~1~~~(~~m1id~tI0n imd tOllS of

~it~~iCofi$l C(~nltal ~ipithiterlfp~~ ahductlon_oJ tbggpE

4l7

( -ttFr

Clinica1Correlation

Abducent Nervegttesion - ~ -

~0) yen~y(109lt-

JJ) YJ q c yU t (Z- ~ ~

QJc ~ v-lti tXZv~igtPV ~ v

0C)1 Qj~

middotmiddotI-middotmiddotmiddotmiddot- I ii I ~ lt~ Cmiddot bullnlCaorrea aIf)fiI CUn11cttJlreOfrrelation ( middotr I I - ~

(0amp ~ ~ ~

1 ~

C()l1lplete()ctulor11otor Nerve Paralysis

(sf

- 2

nil innervates (a) Inf Oblique (10) Kectus(SR) Cc)Inf Rectus (IR) Cd) Medial Rectus (MR)

~ 1t9 $fL~~

( ( ( ~rr

Visual Defects~~ndj~etherlemiddot or lesionsis (are ~ore to~ pticchiasm

(t

Field of Vision

~o V ~ Damage before the optic chiasm causes loss of vision in the ~~ visual field ofthe same side only ------------shy ~ J Damage at the chiasm causes loss of vision laterally in both () 1t1 visual fields bitemporal hemianopia (D) ~ p~ ~ (L

Damage afterthe chiasm causes loss of vision on one side (~but affecting bpth visual fields th~ visual field affected Is locatedori tti~ opposite side of thelesl~m

~ +~ Visual cortex (f ~

Lt~

hshy-10

Horner~sSY4I1~~tomie Sympathetic cerlical lrunRlnterruDtio n

3

4

~MIy~v~~~ ( ~~J ( ArtJ)to) fo~

~

1 area

~~ pltV--

brilandibwal duct - on the sublingual

AAl1g)l~ ~eiris -s-een on either s ide of the Fnnulum 7h( ~ rr)middot~~~11~ -----

I (

( ( ~1 Cmiddot ~Imiddot 1middotR c - [ Tonguel)orsam lknigtJa ~egloniaLtlU

~ --

~

~

t _

IIJI ~

-v E

J

middot0 middot bull Imiddotemiddotmiddot middotmiddot M Sn Ie s amp Aie lI1emiddot S- mimI1I Ti frIg~i bull ~ middot U~ i I ~t PVi c- tlit-middott-- Y

The lingual amp glossopharynge~ lerve suppli~s mucosa of anterior 23 an~ posterior 13 pf~t_orl9J~ respectively wi~h general sensation and taste fibers Tlle chorda tympam supplies ant 2[3 shy( Intrinsic muscles of tongue include ( c 1) Transverse ~) Superior (3) Inferior 4) Longtitudinal fibers

bull Extrinsic muscles of the tO~gue

1) Styloglossus (2) genioglomiddotSsus (3hyoglossus ~ ~ --- ---- shy

bull Both this group of muscles are innerVated by Hypoglssal nerve (XII)

rO ~liIinll middot middot ~~middotmiddotmiddot Umiddot middotsmiddotcmiddotIemiddots1 bull ~ rJ~~~J middot I~I I~ 1

j II ~J- 7~ _~ ((~v-lt)- AJYI 1 ~wbv

J I ( -1-

~-- r~4 (1 ~ 0 ~~ ljgt ~

~ to

( r TO nmiddotnu ~ i yen gt_ O~ AI~ ee d It~~A~ e Supply bull ~ r -1iI It~ ~~P~~~middot middotmiddotmiddot~ ~ I ~~middot ~ v [miftiCaICerrelation

1 gtgt~ bull

~vr

Extrinsic muscles of Tongue

I facts ~b()uttarynx~

bull AnterierrThyroid eiland Posterior Pharynx J

bull laterally Rt~amp~~ar~tid Sheath and its Contents J - -~--~

c lfhas ~ va~ve(~lottis with 2 functions

~~) 9~~r~~Urg airway ~ b) Plloltabon

J TWo setsofgtMtiscles j a)If1trJr1sic~1trql ~()ttis ~rE~~~ihsicentCQf1~t~I p~()~iti9nin neck (infra amp

suprahyoid -~Ud stYloparyngeus)

bull L~C~~iqnlJetwee~6

---u7

middotfmiddot~~~-~~~~ J 1middot middotC~~ ~t(~middotmiddot ~~j ~Ymiddotffiwj

~middotfA2nulIIi

c -11-I

S A U

[ L-o-c-a-ti-o-n-o-f--La-r-y-n-x-middot- -] middot n-N--e-ck-R

middot - bull R Ti3$~~~~ V F Irit~~~k taJiJjl0d f Et A A C G~~

EE eteJili1gamptl1~chea

~ ~~i~ri~ft~~~d~Vmiddot bull 0A

yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V

Neck QqAe~ middotq~rtiI~ges ampMembra nes sa evgt lt I bull

the anterior midline of neck ~

eri~Qid eamiddot cti~~S ibelowthe thyroid cartilage

[

(

-L-a-middot in-x--R-e-lla-t-i0-fl-s-h-ip----r( (

ry-middotmiddot - i i i ~ r

Larflx Cat~jI~~rfjJ e$(amp Membranes

1lf+UiMIJ fhlHIt

Allmontarymiddotlavor shy

-suPolionhYloiditoCh IEsopjagUsr ilt ft~~~~tyry fRyer

~middotThvrold gld

C~pSUlo a~d ltopla 01 lhyioidglMd

- ------------- Larynx 111tra~j~ Mytscles

l

c ~

CUniqd COl1relation =J _ - r shy

A 25 yearoJdWqhtcentiji o~defgoes~tracheal intubation beci1~$e6flthcentst~itjjtiriessu$tainedbyroad traffic a~i~~1lt~ iih~ siz(i6f~~flijiiQJLtube is limited by the ciialttete[lQfLth~iairwcaYfw1i ith of which of-the- fl1bwiflgrh~v~I middot _

middotCliiCod grtil~ amp H~ a ~mlcent~~ rjngdf~~dilagearound trachea The riilgs qfthcent~taa~beajllt1f~rior to cricoid cartilage have agclppQ$~~rioJ1ly andare 6shaped

~~~~~~i~iUS-=- bull Vestihijlar folds - bull Vocalcords __

~ ~ ~

( ( 1t Ve5ampe5and Nerves of Larynx

is r- ~~ ~ --middot ~Ii middot

7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv

(2) Lateral to viscera is carotid sheath--- (c~otict~teryJ internal jup ular vein and vagus mrve) lt

-- z-===---- bull -~

~t (1) cervtcat-verfebral spine l (2) m uscles that move it J

- ~k

( I

o

tf( (

C

Divisions of Neck Lf I Neck Triangles amp Divisions ~~terior (visceral) --- The lateral side of the neck can be bull Posterior (musculoskeletal) -- divided into regions namely ~ ~--

I ~ Anterior Triang Ieterior part (1)~eraand I Posterior Triang Ie

( 5u5utt v 01) f1(

( Ant Part of Neck (Post Part 9f N~ck

(cervical spine) amp (v isceral )

muscles moving it (musculoskeletal)

I Trapezius ~ SternoCleidomasto i

Boundaries Anterior Triangle

bull Anterior the median line of the I

neck bull Posterior the anterioumiddot border of the sternocleidomastoid muscle

Superior Inferior border of the mandible

bull Superficial (roof) investing layer of the deep cervical fascia

bull Floor larynx and pharynx



~ubmandibular

~Carotid

y Submental

y Muscular






posterior border










Trapezius m

Cervical vertebra

Posterior

(

~II(






If F~ci~1 v



glands Clavicle

lif

( ( YJ (



if




middot M [

Mandible

~I ~ J5 c U L A R

T R I A N G L E

N E C K














~




bl



1


Pharyngeal branch t


Subclavian a

-=pok

c A R 0 T I D

A R T E R Y

B R A N C H E S

o F



[1- c

A E


~






Sternothyroid m

~ i )O~~


8 7 R

~ o5 4 T3 Lingual a

I o

A R T E R Y


J~~(



bull Facial artery

bull Facial vein



Int Carotid A




0





(1~ 1rt~~~ ~r


~(





lt- M~lt (VvV- shy


l -~




f artelf ~(y -A





( ( (



Clr)jl(L~Ratt

0gt ~o

o~ )laquoj


Esophagtl$







I~(

--

n-_ _ n OJ-n o l

-~ OJ tt_ o J

r--gt

C ( I~










~- I

S e n s 0

r V

N e r v e

F a c e

Surface Anatomy

~ -


Nasal bones f ~




ll )111 ~





_l~

bull

J~l


Supraorbilaln


Vr

( (I-(

)(J







D- -gt W~ r~ v-VvA J 1f~~~ ~ - j)~r ~~


rm~~-


~L ( ~ yen Vc~~~ ~v~

rj6 ~ -rtr tJwA

8fr

FrQllJ~ti~m~~~1e


1~ Calvaria

6 v

tx~l) ~

tJ

5


~

( ( 1 ~



nerve

nerve


-~ ~ ~- fttcJr1-( [fr- 0--lt0lt


~

y S

c~

the -- 1

1- t~Nrgt-~J-t~

-


gfY

( JH

[ Parotid Region 1


1

~ - gt bull -

~

J~iJA~


-- ~~pa0 -)

Facial nerve (VII)

Zygomatic br

t~~( r)~~ OJ ~V r 0


BU~C(11 brs

MnndiDular br

Cervical br



T~--------~

J y

middotr )


Zygpmaticus major m

Cr1

)

- =




(

( II(




J ~ c-shy~ 0

~tf - f

(~

~

~fQ

Q ~ ~ Igtl I


v ~h

~




~v I B U A R

N E R V


( 4r


(~

e


Ramus

Muscles of TMJ

TM1




acoustic meatus

r


o

( ( H


LQc

1 Temporal





l ( tr)shyA


I[J



~~~

Tonsillar



~

08

I (H (







I


Dlrtntlol dfa

tl ~ 11JJIru ~ m-~-~ ~~W~_

~)~ (

~~~ ~ eJ)) l ~lAf

~~



-




ccr I


f

C fronlal honc


foramen

~(fiJVJ u~t

d~G~ k r

linus

~idI~~Sr

PlerYLOid homI$

F Maxilla


E ~t-


i~

0 j

-i Ii

~ a nict i ecviD J

~~)

f t ~

M

f G

~~~1 ~t

Dura mater




oZ~v~gtA ~

Inferior meallJ$

t~~bullbull


) tc



k ___~

J J

~(r


I rLrJA I -r~ ~r~M






(~ (~



rectappro8ch

LA fItA-lt

~

cmiddotmiddot I

LJ - shy

Qgt-I bull


~ I

Question


~ultIgtI~~lt-__1


g







c ~ tfif-i 11-sJ~~

l Meat






Nasal veslibulela


2 ~ f)



tufi4_






~

Nasolacrimal duel

-- ~~4~ h

~

and nuncUlo


r- ---- 1 Nostr~ I





11


V) ~~ ~f I


rJ


lJtvlNIIII t~



Superior (CAd- ~~~


--I eOo-r1--

ufeYlcr rshy3




~ 10M ( ~tj IV 0 - - (j oJ-l ~ ()~0_ -~ 0 ~ ~o __- ~ cv ~ -a-~~ _ 0_ L



~~=-_-=-=bull--=- _ -t









II

rJ~(

4 r1JaS~~~



J D CriSiS g~lIi



Middle concha4c





~)~ ~~ ~j


~ 1 ~

j ~f[ ~ I ~~








1) Nasa~ (aV11


~ ~ CS r

~ we) UI nj middoti

(tthmold Bone)

~ull


~--

~

CC iedop

~~~ I j

i ~~ ~

~

Nasal Septum Nerve

~

InCisive canal

i -oO~7 + ~1gt1


( (

~of0 U 0

~JJl

oxmiddot ~

~

Nasal Cavity -

1 I

-~ S~lyen g

(OV j J ~

f~S_

-7

~_ ---shy







Ill ~

ffi

rr I lovf- ~ ~lt tJ


-----


amp1


( ( v~~m~__~~__~__~_WM -- r~1~ ~~-~ =~~







~~ ~~gt-





~~-_l__ 0IIII ~--~~~v~ rJw i~-=~ m ru~







ca

Irrlraclll~nl (Isi

L CfIUdl)1





7 ~

lt~

( r (



cervical fascia

Tllyroid gland




Hyoid

Carolid shealh


Skin














------- Sri

____










1t C~)~ltC


~ CC -=-

~~ bull --~~I=~gt= ~~~ ~ ~ ~ -~~ mr_---~-t---~~-~~~~~rl


PhayngcalluDCCI


~~hClljl

- -SympllllClictwri


I -~--

--

p yen( (






Hyoid tont bull


I ~-~

du ~ 0fS Cr c~r~r ~ - (1)0 0 00


~ iii shyAdlPAo-U)~

E ~ ~ 1 bull ~)B~~06t

WI

I I__ ___ _~- Jamp~~ 6l~




)v~

~ AuM-~

f~ t~O-

L-_--___ PdgtT

-1---

_ CAr-

r~(~T)~3-( vl


----

( (j (








Glossophalyngeal N


E Superior thywid

~ ~

sVO~

(1-1cUtu ~~









~








i4middot~e









e Ccvo) ~- ~ ~-amp~~ q~

( U

8shy 1

L

bull JOe bullbull -




y

~(I

0~ ~)~ fJl ~vg

~ 0 f

ts 1oa1 w cA

SKUll latera~ V~ew

J

is (kt-1o-t-J

~hIJ pAll~~ ~ (Z~



Itt

f

SaggitaJ suture

Occipital


I

( (








of the brain

~ 0

) ~

ltamp

~

~f t d ~ ~ Jt ~

~ r-J StA~ ~



~(

~ i ~

( (









~

A Q -

I I j

-fJ



~

c~~ Co

t

~ou--r~ I

I

1 i

f I bull I fI

Ittr

---

i



rYtrnI[ lfilet (I) __~-----1 ---------

~ ~ Ptc nerve (I)



~~~~ )1 ____0 deg0 1 ~bull



~ LI~vusnerv~e~~)gt



ri-o ~

---x





~ II(

(

Question







00 TinnHus

E DMDnet1-S


j


(~~ x c~ Y~ r -I Y C--c

PY 1 ~ t -~

~l (cr -- ~ l ~ - u jI

0~~

1 j4


~

b I7i

(









J



2

j

l~







the CSF

t--jf

--)

( (








-shy

p ~


~

(

Dur~1 Sinus ------1 )



---3 Stnlighl

v Subaradll1oid



~ r---1



s~0 1(tgt lY

00lt( 1 ~O ~- ldbdu~~1


~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

(



reJi~~J~~~


If

lbV ~


~ArtM l) r~1


(



~l bull yenl~ ) ~ ~



) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

t ~ r)

~ ~

~ ~~

( L-ww (1

I

3 IVApound~(~--II Y

(

7

~

J (- ----------Qu-~ion ]




J G~vC~








(oG ~c

~~ ~ V rgtC) -- (VV ~ ~ _

(Ier- ~

IV-

Ci- ~o(

V ~

~

cf (0( ~ O V

)eYcc)

lt00shy~


ltL(i

Ocular Muscle

Medial Rectus

Infereior Rectus

Lateral Rectus

Superior rectus


Actions

ytTJ

eN Innervation

Oculomotor (III)

Oculomotor (III)

Abducent (VI)

Oculomotor (Ill)

(Yc




lt






~1L~M ~

I








~~~ZY ) ( ~~


) ~

I

r



~(

I ~y- ~

tJ


~ 3~


s-

I





4l7

( -ttFr

Clinica1Correlation


~0) yen~y(109lt-



0C)1 Qj~


(0amp ~ ~ ~

1 ~


(sf

- 2


~ 1t9 $fL~~

( ( ( ~rr


(t

Field of Vision




Lt~

hshy-10


3

4


~

1 area

~~ pltV--



I (


~ --

~

~

t _

IIJI ~

-v E

J







j II ~J- 7~ _~ ((~v-lt)- AJYI 1 ~wbv

J I ( -1-

~-- r~4 (1 ~ 0 ~~ ljgt ~

~ to


1 gtgt~ bull

~vr










---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



~middotThvrold gld



l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv



~ubmandibular

~Carotid

y Submental

y Muscular






posterior border










Trapezius m

Cervical vertebra

Posterior

(

~II(






If F~ci~1 v



glands Clavicle

lif

( ( YJ (



if




middot M [

Mandible

~I ~ J5 c U L A R

T R I A N G L E

N E C K














~




bl



1


Pharyngeal branch t


Subclavian a

-=pok

c A R 0 T I D

A R T E R Y

B R A N C H E S

o F



[1- c

A E


~






Sternothyroid m

~ i )O~~


8 7 R

~ o5 4 T3 Lingual a

I o

A R T E R Y


J~~(



bull Facial artery

bull Facial vein



Int Carotid A




0





(1~ 1rt~~~ ~r


~(





lt- M~lt (VvV- shy


l -~




f artelf ~(y -A





( ( (



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Question







00 TinnHus

E DMDnet1-S


j


(~~ x c~ Y~ r -I Y C--c

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the CSF

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s~0 1(tgt lY

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~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

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reJi~~J~~~


If

lbV ~


~ArtM l) r~1


(



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--- folit






Spine Cranial


skull bone


Hematoma



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(



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J (- ----------Qu-~ion ]




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Infereior Rectus

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Actions

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yenVIii~ ~ F411N T

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Question







00 TinnHus

E DMDnet1-S


j


(~~ x c~ Y~ r -I Y C--c

PY 1 ~ t -~

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1 j4


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b I7i

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the CSF

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(

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~ A Y

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f~

Pqtllrinr--4shylH



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reJi~~J~~~


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lbV ~


~ArtM l) r~1


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) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



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Infereior Rectus

Lateral Rectus

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Actions

ytTJ

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Oculomotor (III)

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Oculomotor (Ill)

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~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

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M U S C U L A R

T R I A N G L E

N E C

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K I Submandibular

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(




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~~~~ )1 ____0 deg0 1 ~bull



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~ II(

(

Question







00 TinnHus

E DMDnet1-S


j


(~~ x c~ Y~ r -I Y C--c

PY 1 ~ t -~

~l (cr -- ~ l ~ - u jI

0~~

1 j4


~

b I7i

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J



2

j

l~







the CSF

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( (








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(

Dur~1 Sinus ------1 )



---3 Stnlighl

v Subaradll1oid



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s~0 1(tgt lY

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~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

(



reJi~~J~~~


If

lbV ~


~ArtM l) r~1


(



~l bull yenl~ ) ~ ~



) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

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Infereior Rectus

Lateral Rectus

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Actions

ytTJ

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Abducent (VI)

Oculomotor (Ill)

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~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

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K I Submandibular

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[

(




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l

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~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



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reJi~~J~~~


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~l bull yenl~ ) ~ ~



) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

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( L-ww (1

I

3 IVApound~(~--II Y

(

7

~

J (- ----------Qu-~ion ]




J G~vC~








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Lateral Rectus

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---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

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[

(




1lf+UiMIJ fhlHIt



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l

c ~





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7- A

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s~0 1(tgt lY

00lt( 1 ~O ~- ldbdu~~1


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( __________- l


Subdural He~atoma







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~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

(



reJi~~J~~~


If

lbV ~


~ArtM l) r~1


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) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

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3 IVApound~(~--II Y

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7

~

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Lateral Rectus

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Actions

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Oculomotor (Ill)

(Yc




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~vr










---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



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l

c ~





~ ~ ~



7- A

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r ~ut

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( rr ( of

1 bullbull

Jb--Yv

--)

( (








-shy

p ~


~

(

Dur~1 Sinus ------1 )



---3 Stnlighl

v Subaradll1oid



~ r---1



s~0 1(tgt lY

00lt( 1 ~O ~- ldbdu~~1


~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

(



reJi~~J~~~


If

lbV ~


~ArtM l) r~1


(



~l bull yenl~ ) ~ ~



) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

t ~ r)

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~ ~~

( L-ww (1

I

3 IVApound~(~--II Y

(

7

~

J (- ----------Qu-~ion ]




J G~vC~








(oG ~c

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IV-

Ci- ~o(

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~

cf (0( ~ O V

)eYcc)

lt00shy~


ltL(i

Ocular Muscle

Medial Rectus

Infereior Rectus

Lateral Rectus

Superior rectus


Actions

ytTJ

eN Innervation

Oculomotor (III)

Oculomotor (III)

Abducent (VI)

Oculomotor (Ill)

(Yc




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I








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J







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J I ( -1-

~-- r~4 (1 ~ 0 ~~ ljgt ~

~ to


1 gtgt~ bull

~vr










---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



~middotThvrold gld



l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv

(

Dur~1 Sinus ------1 )



---3 Stnlighl

v Subaradll1oid



~ r---1



s~0 1(tgt lY

00lt( 1 ~O ~- ldbdu~~1


~ V

( __________- l


Subdural He~atoma







~ A Y

~~~~



f~

Pqtllrinr--4shylH



~r ~ FaClalv0in

(



reJi~~J~~~


If

lbV ~


~ArtM l) r~1


(



~l bull yenl~ ) ~ ~



) 1





--- folit






Spine Cranial


skull bone


Hematoma



f ~

(



~ ~ML

t ~ r)

~ ~

~ ~~

( L-ww (1

I

3 IVApound~(~--II Y

(

7

~

J (- ----------Qu-~ion ]




J G~vC~








(oG ~c

~~ ~ V rgtC) -- (VV ~ ~ _

(Ier- ~

IV-

Ci- ~o(

V ~

~

cf (0( ~ O V

)eYcc)

lt00shy~


ltL(i

Ocular Muscle

Medial Rectus

Infereior Rectus

Lateral Rectus

Superior rectus


Actions

ytTJ

eN Innervation

Oculomotor (III)

Oculomotor (III)

Abducent (VI)

Oculomotor (Ill)

(Yc




lt






~1L~M ~

I








~~~ZY ) ( ~~


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I

r



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I ~y- ~

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s-

I





4l7

( -ttFr

Clinica1Correlation


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hshy-10


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4


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J







j II ~J- 7~ _~ ((~v-lt)- AJYI 1 ~wbv

J I ( -1-

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~ to


1 gtgt~ bull

~vr










---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



~middotThvrold gld



l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv

( __________- l


Subdural He~atoma







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~~~~



f~

Pqtllrinr--4shylH



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S A U





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c -11-I

S A U





yenVIii~ ~ F411N T

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c -11-I

S A U





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M U S C U L A R

T R I A N G L E

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K I Submandibular

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c -11-I

S A U





yenVIii~ ~ F411N T

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M U S C U L A R

T R I A N G L E

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c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

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K I Submandibular

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(




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c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

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---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

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~ D

K I Submandibular

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~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

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(




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~vr










---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




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(




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---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




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l

c ~





~ ~ ~



7- A

~

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r ~ut

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( rr ( of

1 bullbull

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---u7


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



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l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

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( rr ( of

1 bullbull

Jb--Yv


~middotfA2nulIIi

c -11-I

S A U





yenVIii~ ~ F411N T

L0 AM RY Y

M U S C U L A R

T R I A N G L E

N E C

~ D

K I Submandibular

Xio V




[

(




1lf+UiMIJ fhlHIt



~middotThvrold gld



l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv

[

(




1lf+UiMIJ fhlHIt



~middotThvrold gld



l

c ~





~ ~ ~



7- A

~

D~P_

r ~ut

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( rr ( of

1 bullbull

Jb--Yv



7- A

~

D~P_

r ~ut

-If

( rr ( of

1 bullbull

Jb--Yv

( rr ( of

1 bullbull

Jb--Yv

Documents

Dr Amirali.... HEAD and NECK