Ear

I. External Ear (Figure 8-56)

Consists of the auricle and the external acoustic meatus and receives sound waves.
A. Auricle
Consists of cartilage connected to the skull b ligaments and muscles and is covered b skin.
Funnels sound waves into the external auditor meatus.
!eceives sensor nerves from the auricular branch of the vagus and facial nerves and the
greater
auricular nerve" auriculotem#oral branch of the trigeminal nerve" and lesser occipital nerves.
!eceives blood from the su#erficial tem#oral and #osterior auricular arteries.
$as the following features%
Helix % the slightl curved rim of the auricle.
Antihelix % a broader curved eminence internal to the helix" which divides the auricle into an
outer sca#hoid fossa and the dee#er concha.
&.'()
Figure 8-56 *xternal" middle" and inner ear.
Concha % the dee# cavit in front of the antihelix.
Tragus % a small #ro+ection from the anterior #ortion of the external ear anterior to the concha
Loule % a structure made u# of areolar tissue and fat but no cartilage.
!. External acoustic "au#itor$% meatus
,s about ).5 cm long" extending from the concha to the tm#anic membrane.
,ts external one third is formed b cartilage" and the internal two thirds is formed b bone. -he
cartilaginous #ortion is wider than the bon #ortion and has numerous ceruminous glan#s that
#roduce earwax.
,s innervated b the auriculotem#oral branch of the trigeminal nerve and the auricular branch of
the vagus nerve" which is +oined b a branch of the facial nerve and the glossophar$ngeal
nerve.
!eceives blood from the su#erficial tem#oral" #osterior auricular" and maxillar arteries (a dee#
auricular branch).
C. T$mpanic memrane "ear#rum%
.ies obli/uel across the end of the meatus slo#ing mediall from #osterosu#eriorl to
anteroinferiorl0 thus" the anterior-inferior wall is longer than the #osterior-su#erior wall.
Consists of three la$ers % an outer (cutaneous)" an intermediate (fibrous)" and an inner (mucous)
laer.
$as a thickened fibrocartilaginous ring at the greater #art of its circumference" which is fixed in the
tm#anic sulcus at the inner end of the meatus.
$as a small triangular #ortion between the anterior and #osterior malleolar folds called the pars
flacci#a (deficient ring and lack of fibrous laer). -he remainder of the membrane is called the
pars tensa.
Contains the cone of light " which is a triangular reflection of light seen in the anterior-inferior
/uadrant.
Contains the most de#ressed center #oint of the concavit" called the umo (.atin for
12oeknob123).
Conducts sound waves to the middle ear.
&.'(4
,ts external (lateral) concave surface is covered b skin and is innervated b the auriculotem#oral
branch of the trigeminal nerve and the auricular branch of the vagus nerve. -he auricular branch
is +oined b branches of the glossophar$ngeal and facial nerves. -his surface is su##lied b the
dee# auricular arter of the maxillar arter.
,ts internal (medial) surface is covered b mucous membrane" is innervated b the tm#anic
branch
of the glossophar$ngeal nerve" and serves as an attachment for the handle of the malleus. -his
surface receives blood from the auricular branch of the occi#ital arter and the anterior tm#anic
arter.
II. Middle Ear (Figures 8-55 and 8-58)
Consists of the tm#anic cavit with its ossicles and is located within the #etrous #ortion of the
tem#oral bone.
-ransmits the sound waves from air to auditor ossicles and then to the inner ear.
A. T$mpanic "mi##le ear% cavit$
,ncludes the t$mpanic cavit$ proper (the s#ace internal to the tm#anic membrane) and the
epit$mpanic recess (the s#ace su#erior to the tm#anic membrane that contains the head of the
malleus and the bod of the incus).
Communicates anteriorl with the naso#harnx via the au#itor$ "eustachian% tue and #osteriorl
with the mastoi# air cells and the mastoi# antrum through the a#itus a# antrum.
,s traversed b the chorda tm#ani and lesser #etrosal nerve.
1. Boundaries of the tympanic cavity
&oof % tegmen tm#ani.
Floor % +ugular fossa.
Anterior % carotid canal.
Figure 8-5' 6iddle and inner ear.
&.'('
Figure 8-58 7ssicles of the middle ear and tm#anic membrane.
(osterior % mastoid air cells and mastoid antrum through the aditus ad antrum.
Lateral % tm#anic membrane.
)e#ial % lateral wall of the inner ear" #resenting the promontor$ formed b the basal turn of the
cochlea" the fenestra vestibuli "oval *in#o*% " the fenestra cochlea "roun# *in#o*% " and the
#rominence of the facial canal.
2. Oval window (fenestra vestibuli
,s #ushed back and forth b the foot#late of the sta#es and transmits the sonic virations of the
ossicles into the #erilm#h of the scala vestibuli in the inner ear.
!. "ound window (fenestra cochlea or tympani
,s closed b the secondar tm#anic (mucous) membrane of the middle ear and accommodates
the
#ressure waves transmitted to the #erilm#h of the scala tm#ani.
cc #.#1
+tits me#ia % is a condition of mi##le ear infection that ma be s#read from the
naso#harnx
through the auditor tube" causing tem#orar or #ermanent deafness.
&.'(5
!. )uscles
1. $tapedius muscle
,s the smallest of the s,eletal muscles in the human bod.
8rises from the #ramidal eminence" and its tendon emerges from the eminence.
,nserts on the neck of the sta#es.
,s innervated b a branch of the facial nerve.
&ulls the head of the sta#es #osteriorl" thereb tilting the base of the sta#es.
&revents (or reduces) excessive oscillation of the sta#es and thus #rotects the inner ear from
in+ur
from a loud noise.
,ts #aralsis results in h$peracusis.
2. %ensor tympani muscle
8rises from the cartilaginous #ortion of the auditor tube.
,nserts on the handle (manubrium) of the malleus.
,s innervated b the mandibular branch of the trigeminal nerve.
9raws the tm#anic membrane mediall and tightens it (in res#onse to loud noises)" thereb
increasing the tension and reducing the vibration of the tm#anic membrane.
cc #.#2
H$peracusis "h$peracusia% % is excessive acuteness of hearing " because of #aralsis of
the
sta#edius muscle (causing uninhibited movements of the sta#es)" resulting from a lesion of
the
facial nerve.
C. Au#itor$ ossicles
Consist of the malleus" incus" and sta#es.
Form a bridge b snovial +oints in the middle ear cavit" transmit sonic vibrations from the
tm#anic membrane to the inner ear" and am#lif the force.
1. Malleus (hammer
Consists of a head" neck" handle (manubrium)" and anterior and lateral #rocesses.
,ts rounded head articulates with the incus in the e#itm#anic recess.
,ts handle is fused to the medial surface of the tm#anic membrane and serves as an attachment
for the tensor t$mpani muscle.
2. Incus (anvil
Consists of a bod and two #rocesses (crura).
,ts long #rocess descends verticall" #arallel to the handle of the malleus" and articulates with the
sta#es.
,ts short #rocess extends hori:ontall backward to the fossa of the incus and #rovides the
attachment for the #osterior ligament of the incus.
!. $tapes (stirrup
Consists of a head and neck" two #rocesses (crura)" and a base (foot#late).
,ts neck #rovides insertion of the stape#ius muscle.
$as a hole through which the sta#edial arter is transmitted in the embro0 this hole is obturated
b
a thin membrane in the adult.
,ts base (foot#late) is attached b the annular ligament to the margin of the oval window (fenestra
vestibuli). 8bnormal ossification between the foot#late and the oval window (otosclerosis ) limits
the movement of the sta#es" causing deafness.
cc #.#!
+tosclerosis % is a condition of anormal one formation around the sta#es and the oval
window" limiting the movement of the sta#es and thus resulting in progressive con#uction
#eafness.
cc #.#&
Con#uctive #eafness % is hearing im#airment caused b a #efect of a soun#-con#ucting
apparatus such as the auditor meatus" eardrum" or ossicles.
-. Au#itor$ "phar$ngot$mpanic or eustachian% tue
Connects the middle ear to the naso#harnx.
&.'(6
8llows air to enter or leave the middle ear cavit and thus balances the #ressure in the middle ear
with atmos#heric #ressure" allowing free movement of the tm#anic membrane.
$as cartilaginous #ortion that remains closed exce#t during swallowing or awning.
,s o#ened b the simultaneous contraction of the tensor veli #alatini and sal#ingo#harngeus
muscles.
E. .ensor$ nerve an# loo# suppl$ to the mi##le ear
,s innervated b the t$mpanic branch of the glossophar$ngeal nerve" which forms the t$mpanic
plexus with caroticot$mpanic nerves from the internal carotid #lexus of sm#athetic fibers. -he
tm#anic nerve continues beond the #lexus as the lesser petrosal nerve" which transmits
#reganglionic #arasm#athetic fibers to the otic ganglion.
!eceives blood from the stlomastoid branch of the #osterior auricular arter and the anterior
tm#anic branch of the maxillar arter.
cc 8.85
/eural or sensorineural #eafness % is hearing im#airment because of a lesion of the
auditor
nerve or the central afferent neural #athwa.
III. Inner Ear (see Figure 8-55)
Consists of the acoustic apparatus " the cochlea housing the cochlear duct for auditor sense"
and
the vestiular apparatus " the vestibule housing the utricle and saccule" and the semicircular
canals housing the semicircular ducts for the sense of e/uilibrium.
,s the #lace where vibrations are transduced to s#ecific nerve im#ulses that are transmitted
through
the acoustic nerve to the central nervous sstem (C;<).
,s com#osed of the bon labrinth and the membranous labrinth.
A. !on$ la$rinth
Consists of three #arts% the vestibule" the three semicircular canals" and the cochlea" all of which
contain the peril$mph " in which the membranous labrinth is sus#ended.
-he vestiule is a cavit of the bon labrinth communicating with the cochlea anteriorl and the
semicircular canals #osteriorl.
-he on$ cochlea consists of two ad+acent ducts% (a) the u##er scala vestiuli " which begins in
the vestibule and receives the vibrations transmitted to the #erilm#h at the oval window0 and (b)
the lower scala t$mpani " which communicates with the scala vestibuli through the helicotrema at
the a#ex of the cochlea and ends at the round window" where the sound #ressure waves are
dissi#ated.
!. )emranous la$rinth
,s sus#ended in #erilm#h within the bon labrinth" is filled with en#ol$mph " and contains the
sensor organs.
$as com#arable #arts and arrangement as the bon labrinth.
,ts utricle and saccule are dilated membranous sacs in the vestibule and contain sense organs
called maculae " which detect linear acceleration of the head. -he macula of the utricle has a
hori:ontal orientation" and the macula of the saccule has a vertical orientation.
,ts semicircular #ucts consist of anterior (su#erior)" lateral" and #osterior ducts" and their dilated
ends are called ampullae " which detect rotational or angular acceleration.
,ts cochlear #uct "scala me#ia% is wedged between the scala vestibuli and scala tm#ani and
contains endolm#h and the s#iral organ of Corti " with rece#tor cells (hair cells) for auditor
stimuli (the sense of hearing).
cc 8.86
)01ni02re3s #isease "en#ol$mphatic or la$rinthine h$#rops% % is characteri:ed b a
loss of
alance "vertigo%4 tinnitus (ringing or bu::ing in the ears)" progressive hearing loss
resulting
from hdro#s of the endolm#hatic duct or edema of the labrinth (excessive amounts of
endolm#h that distort the membranous labrinth) or inflammation of the vestibular division of
the
vestibulocochlear nerve" and nausea and vomiting.
Lar$nx
I. Introduction
,s the organ of voice #roduction and the #art of the res#irator tract between the lower #art of the
#harnx and the trachea.
8cts as a compoun# sphincter to #revent the #assage of food or drink into the airwa in
swallowing and to close the rima glotti#is during the =alsalva maneuver (buildu# of air #ressure
during coughing" snee:ing" micturition" defecation" or #arturition).
!egulates the flow of air to and from the lungs for vocali:ation (#honation).
Forms a framework of cartilage for the attachment of ligaments and muscles.
cc #.'&
Lar$ngitis % is an inflammation of the mucous memrane of the lar$nx. ,t is characteri:ed
b
drness and soreness of the throat" hoarseness" cough" and ds#hagia.
II. (artila)es (Figure 8-5))
A. Th$roi# cartilage (see 9ee# ;eck and &revertebral !egion% ,.*.)
,s a single h$aline cartilage that forms a median elevation called the lar$ngeal prominence
"A#am3s apple% " which is #articularl a##arent in males.
$as an oli5ue line on the lateral surface of its lamina that gives attachment for the inferior
#harngeal constrictor" sternothroid" and throhoid muscles.
!. Cricoi# cartilage
,s a single h$aline cartilage that is sha#ed like a signet ring.
,s at the level of C=6 and articulates with the throid cartilage. ,ts lower border marks the end of
the #harnx and larnx.
&.'>5
Figure 8-56 Cartilages of the larnx.
C. Epiglottis
,s a single elastic cartilage.
,s a s#oon-sha#ed #late that lies behind the root of the tongue and forms the su#erior #art of the
anterior wall of the larnx.
,ts lower end is attached to the back of the throid cartilage.
cc 8.'5
Epiglottitis % is an inflammation or acute mucosal swelling of the e#iglottis" which ma cause
a
life-threatening airwa obstruction" es#eciall in children.
-. Ar$tenoi# cartilages
8re paire# elastic an# h$aline cartilages.
8re sha#ed liked #ramids" with bases that articulate with and rotate on the cricoid cartilage.
$ave vocal processes " which give attachment to the vocal ligament and vocalis muscle" and
muscular processes " which give attachment to the throartenoid muscle and the lateral and
#osterior cricoartenoid muscles.
<its on the to# of the cricoid cartilage and rotates to change the o#ening of the vocal folds (the
rima glottidis).
E. Corniculate cartilages
8re paire# elastic cartilages that lie on the a#ices of the artenoid cartilages.
8re enclosed within the ar$epiglottic fol#s of mucous membrane.
F. Cuneiform cartilages
8re paire# elastic cartilages that lie in the are#iglottic folds anterior to the corniculate cartilages.
III. *i)aments of the *arynx
A. Th$roh$oi# memrane
*xtends from the throid cartilage to the medial surface of the hoid bone.
&.'>8
,ts middle (thicker) #art is called the mi##le th$roh$oi# ligament " and its lateral #ortion is
#ierced
b the internal larngeal nerve and the su#erior larngeal vessels.
cc 8.'6
Lar$ngotom$ % is an operative opening into the lar$nx through the cricothroid membrane
(cricothrotom)" through the throid cartilage (throtom)" or through the throhoid
membrane
(su#erior larngotom). ,t is #erformed when severe edema or an im#acted foreign bod calls
for
ra#id admission of air into the larnx and trachea.
!. Cricoth$roi# ligament
*xtends from the arch of the cricoid cartilage to the throid cartilage and the vocal #rocesses of
the
artenoid cartilages.
C. 7ocal ligament
*xtends from the #osterior surface of the throid cartilage to the vocal #rocess of the artenoid
cartilage.
,s considered the u##er border of the conus elasticus.
-. 7estiular "ventricular% ligament
*xtends from the throid cartilage to the anterior lateral surface of the artenoid cartilage.
E. Conus elasticus "cricovocal ligament%
,s the #aired lateral #ortion of the fibroelastic membrane that extends between the su#erior border
of the entire arch of the cricoid cartilage and the vocal ligaments.
,s formed b the cricothroid" median cricothroid" and vocal ligaments.
I+. (avities and ,olds (Figure 8-54)
-he larngeal cavit is divided into three #ortions b the vestibular and vocal folds% the vestibule"
ventricle" and infraglottic cavit.
A. 7estiule
*xtends from the larngeal inlet to the vestibular (ventricular) folds.
!. 7entricles
*xtend between the vestibular fold and the vocal fold.
C. 8nfraglottic cavit$
*xtends from the rima glottidis to the lower border of the cricoid cartilage.
Figure 8-59 ,nterior view of the larnx.
&.'>?
-. &ima glotti#is
,s the s#ace between the vocal folds and artenoid cartilages.
,s the narrowest #art of the larngeal cavit
cc 8.''
Lar$ngeal ostruction "cho,ing% % is caused b as#irated foods" which are usuall lodged at
the
rima glottidis. ,t can be released b com#ression of the abdomen to ex#el air from the lungs
and
thus dislodge the foods (e.g." the =alsalva maneuver).
7alsalva maneuver % is forcible exhalation effort against a closed airwa (a closed glottis"
nose"
or mouth)0 the resultant increase in intrathoracic #ressure im#edes venous return to the heart.
-his maneuver causes a tra##ing of blood in the great veins" #reventing it from entering the
right
atrium. -hen the breath is released" the intrathoracic #ressure dro#s" and the tra##ed blood is
/uickl #ro#elled through the heart" #roducing an increase in heart rate (tachcardia) and
blood
#ressure.
E. 7estiular fol#s "false vocal cor#s%
*xtend from the throid cartilage above the vocal ligament to the artenoid cartilage.
F. 7ocal fol#s "true vocal cor#s%
*xtend from the angle of the throid cartilage to the vocal #rocesses of the artenoid cartilages.
Contain the vocal ligament near their free margin and the vocalis muscle " which forms the bulk
of
the vocal fold.
8re im#ortant in voice pro#uction because the control the stream of air #assing through the rima
glottidis.
8lter the sha#e and si:e of the rima glotti#es b movement of the artenoids to facilitate
res#iration and #honation. (-he rima glottidis is wide during ins#iration and narrow and
wedgesha#ed
during ex#iration and sound #roduction.)
+. Muscles (Figure 8-5' - -able 8-(()
+I. Innervation (Figure 8-55)
A. &ecurrent lar$ngeal nerve
,nnervates all of the intrinsic muscles of the larnx exce#t the cricothroid" which is innervated b
the external larngeal branch of the su#erior larngeal branch of the vagus nerve.
<u##lies sensor innervation below the vocal cord.
$as a terminal #ortion above the lower border of the cricoid cartilage called the inferior lar$ngeal
nerve.
cc 8.'8
Lesion of the recurrent lar$ngeal nerve % could be #roduced during throidectom or
cricothrotom or b aortic aneursm and ma cause res#irator obstruction" hoarseness"
inabilit
to s#eak" and loss of sensation below the vocal cord.
!. .uperior lar$ngeal nerve
,s a branch of the vagus nerve and divides into the internal and external larngeal branches.
C. 8nternal lar$ngeal nerve
,nnervates the mucous membrane above the vocal cord and taste buds on the e#iglottis.
,s accom#anied b the su#erior larngeal arter and #ierces the throhoid membrane.
&.'((
Figure 8-55 ;erve su##l to the larnx.
cc 8.':
Lesion of the internal lar$ngeal nerve % results in loss of sensation above the vocal cord
and
loss of taste on the e#iglottis.
-. External lar$ngeal nerve
,nnervates the cricothroid and inferior #harngeal constrictor (crico#harngeus #art) muscles.
,s accom#anied b the su#erior throid arter.
cc 8.8;
Lesion of the external lar$ngeal nerve % ma occur during th$roi#ectom$ because the
nerve
accom#anies the su#erior throid arter. ,t causes paral$sis of the cricoth$roi# muscle "
resulting in #aralsis of the larngeal muscles and thus inabilit to lengthen the vocal cord and
loss of the tension of the vocal cord. <uch stresses to the vocal cord cause a fatigued voice
and a
weak hoarseness.
+ral Cavit$ an# (alate
I. Oral (avity (Figure 8-'))
,ts roof is formed b the palate " and its floor is formed b the tongue and the mucosa" su##orted
b the geniohoid and mlohoid muscles.
,ts lateral and anterior walls are formed b an outer flesh wall (cheeks and li#s) and an inner bon
wall (teeth and gums). (-he vestiule is between the walls" and the oral cavit$ proper is the area
inside the teeth and gums.)
II. .alate (Figure 8-'4)
Forms the roof of the mouth and the floor of the nasal cavit.
A. Har# palate
,s the anterior four fifths of the #alate and forms a on$ frame*or, covere# *ith a mucous
memrane between the nasal and oral cavities.
&.488
Figure 8-<6 7ral cavit.
Consists of the palatine processes of the maxillae and hori:ontal #lates of the #alatine bones.
Contains the incisive foramen in its median #lane anteriorl and the greater and lesser #alatine
foramina #osteriorl.
!eceives sensor innervation through the greater #alatine and naso#alatine nerves and blood
from
the greater #alatine arter.
!. .oft palate
,s a firomuscular fol# extending from the #osterior border of the hard #alate and makes u# one
fifth of the #alate.
6oves #osteriorl against the #harngeal wall to close the oro#harngeal (faucial) isthmus when
swallowing or s#eaking.
,s continuous with the palatoglossal and palatophar$ngeal fol#s .
!eceives blood from the greater and lesser #alatine arteries of the descending #alatine arter of
the maxillar arter" the ascending #alatine arter of the facial arter" and the #alatine branch of
the ascending #harngeal arter.
!eceives sensor innervation through the lesser #alatine nerves and receives skeletal motor
innervation from the vagus nerve. 8 lesion of the vagus nerve deviates the uvula to the o##osite
side.
cc 8.56
Lesion of the vagus nerve % causes deviation of the uvula toward the o##osite side of the
lesion
on #honation because of #aralsis of the musclus uvulae. -his muscle is innervated b the
vagus
nerve and elevates the uvula.
C. )uscles of the palate (-able 8-8)
III. %on)ue (Figure 8-'' - see Figure 8-'4)
,s attached b muscles to the hoid bone" mandible" stloid #rocess" #alate" and #harnx.
,s divided b a =-sha#ed sulcus terminalis into two #arts12@an anterior two thirds and a #osterior
one third12@which differ develo#mentall" structurall" and in innervation.
&.4?>
Figure 8-<< -ongue.
-he foramen cecum is located at the a#ex of the 12oe=123 and indicates the site of origin of the
embronic th$roglossal #uct.
cc #./'
Tongue-tie "an,$loglossia% % is an anormal shortness of frenulum linguae " resulting in
limitation of its movement and thus a severe s#eech im#ediment. ,t can be corrected
surgicall b
cutting the frenulum.
A. Lingual papillae
8re small" ni##le-sha#ed #ro+ections on the anterior two thirds of the dorsum of the tongue.
8re divided into the vallate" fungiform" filiform" and foliate #a#illae.
1. +allate papillae
8re arranged in the form of a =>oe7=>? in front of the sulcus terminalis.
8re studded with numerous taste buds and are innervated b the glosso#harngeal nerve.
2. ,un)iform papillae
8re mushroom-sha#ed #ro+ections with red heads and are scattered on the sides and the a#ex of
the tongue.
!. ,iliform papillae
8re numerous" slender" conical #ro+ections that are arranged in rows #arallel to the sulcus
terminalis.
&. ,oliate papillae
8re found in certain animals but are rudimentar in humans.
!. Lingual tonsil
,s the collection of no#ular masses of l$mphoi# follicles on the #osterior one third of the dorsum
of the tongue.
C. Lingual innervation
-he extrinsic and intrinsic muscles of the tongue are innervated b the h$poglossal nerve exce#t
for the #alatoglossus" which is innervated b the vagus nerve. 8 lesion of the h#oglossal nerve
deviates the tongue toward the in+ured side.
-he anterior two thirds of the tongue receives general sensor innervation from the lingual nerve
and taste sensation from the chor#a t$mpani.
-he #osterior one third of the tongue and the vallate #a#illae receive both general and taste
innervation from the glossophar$ngeal nerve.
-he e#iglottic region of the tongue and the e#iglottis receive both general and taste innervation
from the internal lar$ngeal ranch of the vagus nerve.
-. Lingual arter$
8rises from the external carotid arter at the level of the ti# of the greater horn of the hoid bone in
the carotid triangle.
&asses dee# to the hoglossus and lies on the middle #harngeal constrictor muscle.
Aives rise to the su#rahoid" dorsal lingual" and sublingual arteries and terminates as the #eep
lingual arter$ " which ascends between the genioglossus and inferior longitudinal muscles.
E. )uscles of the tongue (-able 8-?)
+. $alivary 0lands (see Figure 8-'5)
A. .uman#iular glan#
,s ensheathed b the investing laer of the dee# cervical fascia and lies in the suman#iular
triangle.
,ts su#erficial #ortion is situated su#erficial to the mlohoid muscle.
,ts dee# #ortion is located between the hoglossus and stloglossus muscles mediall and the
mlohoid muscle laterall and between the lingual nerve above and the h#oglossal nerve below.
@harton3s #uct arises from the dee# #ortion and runs forward between the mlohoid and the
hoglossus" where it runs medial to and then su#erior to the lingual nerve. ,t then runs between the
sublingual gland and the genioglossus and em#ties at the summit of the sublingual #a#illa
(caruncle) at the side of the frenulum of the tongue.
,s innervated b #arasm#athetic secretomotor fibers from the facial nerve" which run in the
chorda
tm#ani and in the lingual nerve and sna#se in the submandibular ganglion.
.ulingual glan#
,s located in the floor of the mouth between the mucous membrane above and the mlohoid
muscle below.
<urrounds the terminal #ortion of the submandibular duct.
*m#ties mostl into the floor of the mouth along the sublingual fold b () short ducts" some of
which enter the submandibular duct.
,s su##lied b #ostganglionic #arasm#athetic (secretomotor) fibers from the submandibular
ganglion either directl or through the lingual nerve.
cc 8.5:
Lu#*ig3s angina % is an acute infection of the submandibular s#ace with secondar
involvement of
the sublingual and submental s#aces" usuall resulting from a dental infection in the
mandibular
molar area or a #enetrating in+ur of the floor of the mouth. <m#toms include #ainful swelling
of
the floor of the mouth" elevation of the tongue" ds#hagia (difficult in swallowing)" ds#honia
(im#airment of voice #roduction)" edema of the glottis" fever" and ra#id breathing.
(har$nx an# Tonsils
I. .harynx (Figure 8-'6 - see Figure 8-'4)
,s a funnel-shape# firomuscular tube that extends from the base of the skull to the inferior
border of the cricoid cartilage.
Conducts food to the eso#hagus and air to the larnx and lungs.
II. $ubdivisions of the .harynx
A. /asophar$nx
,s situated behind the nasal cavit above the soft #alate and communicates with the nasal cavities
through the nasal choanae.
Contains the phar$ngeal tonsils in its #osterior wall.
,s connected with the tm#anic cavit through the au#itor$ "eustachian% tue " which e/uali:es
air
#ressure on both sides of the tm#anic membrane.
!. +rophar$nx
*xtends between the soft #alate above and the su#erior border of the e#iglottis below and
communicates with the mouth through the oro#harngeal isthmus.
Contains the palatine tonsils " which are lodged in the tonsillar fossae and are bounded b the
#alatoglossal and #alato#harngeal folds.
&.4?5
Figure 8-<6 &harnx.
cc 8.6A
(har$ngeal tumors % ma irritate the glosso#harngeal and vagus nerves. &ain that occurs
while
swallowing is referred to the ear because these nerves contribute sensor innervation to the
external ear.
cc 8.66
Heimlich maneuver % is designed to ex#el an obstructing bolus of food from the throat of a
choking victim b wra##ing our arms around the victimBs waist from behind and #lacing a fist
with
one hand and gras#ing it with the other on the abdomen between the navel and the costal
margin
and forcefull #ressing into the abdomen with a /uick inward and u#ward thrust to dislodge
the
obstruction.
C. Lar$ngophar$nx "h$pophar$nx%
*xtends from the u##er border of the e#iglottis to the lower border of the cricoid cartilage.
Contains the piriform recesses " one on each side of the o#ening of the larnx" in which
swallowed
foreign bodies ma be lodged.
III. Innervation and Blood $upply of the .harynx (Figure 8-'5)
A. (har$ngeal plexus
.ies on the mi##le phar$ngeal constrictor.
,s formed b the phar$ngeal ranches of the glosso#harngeal and vagus nerves and the
sm#athetic branches from the su#erior cervical ganglion.
,ts vagal ranch innervates all of the muscles of the #harnx with the exce#tion of the
stlo#harngeus"
which is su##lied b the glosso#harngeal nerve.
,ts glosso#harngeal com#onent su##lies sensor fibers to the #harngeal mucosa.
!. Arteries of the phar$nx
8re the ascending #harngeal arter ascending #alatine branch of the facial arter descending
#alatine arteries" #harngeal branches of the maxillar arter" and branches of the su#erior and
inferior throid arteries.
&.4?6
Figure 8-<' ;erve su##l to the #harnx.
I+. Muscles of the .harynx (Figures 8-'8 and 8-'? - -able 8-(>)
+. $wallowin) (1e)lutition
,s an act of transferring a food bolus from the mouth through the #harnx and eso#hagus into the
stomach.
A . -he olus of foo# is #ushed back b elevating the tongue b the stloglossus into the fauces"
which
is the #assage from the mouth to the oro#harnx.
! . -he palatoglossus an# palatophar$ngeus muscles contract to s/uee:e the bolus backward
into the
oro#harnx. -he tensor veli #alatini and levator veli #alatini muscles elevate the soft #alate and
uvula to
close the entrance into the naso#harnx.
C . -he *alls of the phar$nx are raised b the #alato#harngeus" stlo#harngeus" and
sal#ingo#harngeus
muscles to receive the food. -he su#rahoid muscles elevate the hoid bone and the
larnx to close the o#ening into the larnx" thus #assing the bolus over the e#iglottis and
#reventing the
food from entering the res#irator #assagewas.
- . -he serial contraction of the su#erior" middle" and inferior #harngeal constrictor muscles
moves the
food through the oro#harnx and the larngo#harnx into the eso#hagus" where it is #ro#elled b
#eristalsis into the stomach.
+I. %onsils
A. (har$ngeal tonsil
,s found in the #osterior wall and roof of the naso#harnx and is called an adenoid when enlarged.
cc 8.69
A#enoi# % is h#ertro#h or enlargement of the phar$ngeal tonsils that obstructs #assage
of air
from the nasal cavities through the choanae into the naso#harnx and thus causes difficult in
nasal breathing and #honation. ,t ma block the #harngeal orifices of the auditor tube"
causing
hearing im#airment. -he infection ma s#read from the naso#harnx through the auditor
tube to
the middle ear cavit" causing otitis media" which ma result in deafness.
!. (alatine tonsil
.ies on each side of the oro#harnx in an interval between the #alatoglossal and #alato#harngeal
folds.
!eceives blood from the ascending #alatine and tonsillar branches of the facial arter" the
descending #alatine branch of the maxillar arter" a #alatine branch of the ascending #harngeal
arter" and the dorsal lingual branches of the lingual arter.
,s innervated b branches of the glosso#harngeal nerve and the lesser #alatine branch of the
maxillar nerve.
cc 8.6<
(alatine tonsillectom$ % is surgical removal of a #alatine tonsil. 9uring tonsillectom" the
glosso#harngeal nerve ma be in+ured" causing loss of general sensation and taste
sensation of
the #osterior one third of the tongue. ,t ma cause much bleeding because the #alatine tonsils
are
highl vascular. <evere hemorrhage ma occur usuall from the tonsillar branch of the facial
arter
and #alatine branches of the ascending #harngeal and maxillar arteries or #aratonsillar
veins.
Buins$ "peritonsillar ascess% % is a #ainful #us-filled inflammation of the tonsils and
surrounding tissues. ,t is caused b a s#reading infection in the tissues surrounding the
inflamed
tonsils or develo#s as a com#lication of tonsillitis" #rimaril in adolescents and oung adults.
-he
soft #alate and uvula are edematous and dis#laced toward the unaffected side. <m#toms
include
sore throat" fever" ds#hasia (im#airment of s#eech)" and trismus (motor disturbance of the
trigeminal nerve" es#eciall s#asm of the muscles of mastication with difficult in o#ening the
mouth). 8lthough it can be life threatening" it can be treated with antibiotics" surgical
as#iration"
or tonsillectom.
C. Tual "eustachian% tonsil
,s a collection of lm#hoid nodules near the #harngeal o#ening of the auditor tube.
-. Lingual tonsil
,s a collection of lm#hoid follicles on the #osterior #ortion of the dorsum of the tongue.
&.4??
E. @al#e$er3s tonsillar ring
,s a tonsillar ring of lm#hoid tissue at the oro#harngeal isthmus" formed b the lingual" #alatine
(faucial)" tubal (eustachian)" and #harngeal tonsil.
+II. ,ascia and $pace of the .harynx (see Figure 8-8)
A. &etrophar$ngeal space
,s a potential space between the bucco#harngeal fascia and the #revertebral fascia" extending
from the base of the skull to the su#erior mediastinum.
&ermits movement of the #harnx" larnx" trachea" and eso#hagus during swallowing.
!. (har$ngoasilar fascia
Forms the sumucosa of the phar$nx and blends with the #eriosteum of the base of the skull.
.ies internal to the muscular coat of the #harnx0 these muscles are covered externall b the
bucco#harngeal fascia.
/asal Cavit$ an# (aranasal .inuses
I. 2asal (avity (Figure 8-5> - see Figure 8-'4)
7#ens on the face through the anterior nasal a#ertures "nares4 or nostrils% and communicates
with
the naso#harnx through a #osterior o#ening" the choanae.
$as a slight dilatation inside the a#erture of each nostril" the vestiule " which is lined largel with
skin containing hair" sebaceous glands" and sweat glands.
A. &oof
,s formed b the nasal" frontal" ethmoid "cririform plate% " and s#henoid (bod) bones. -he
cribriform #late transmits the olfactor nerves.
Figure 8-5; ;asal cavit.
&.'>(
!. Floor
,s formed b the #alatine #rocess of the maxilla and the hori:ontal #late of the #alatine bone.
Contains the incisive foramen " which transmits the naso#alatine nerve and terminal branches of
the s#heno#alatine arter.
C. )e#ial *all "nasal septum%
,s formed #rimaril b the #er#endicular #late of the ethmoid bone" vomer" and se#tal cartilage.
,s also formed b #rocesses of the #alatine" maxillar" frontal" s#henoid" and nasal bones.
cc 8.65
-eviation of the nasal septum % ma obstruct the nasal airwa and block the o#enings of
the
#aranasal sinuses.
-. Lateral *all
,s formed b the su#erior and middle conchae of the ethmoid bone and the inferior concha.
,s also formed b the nasal bone" frontal #rocess and nasal surface of the maxilla" lacrimal bone"
#er#endicular #late of the #alatine bone" and medial #tergoid #late of the s#henoid bone.
Contains the following structures and their o#enings%
.phenoethmoi#al recess % o#ening of the s#henoid sinus.
.uperior meatus % o#ening of the #osterior ethmoidal air cells.
)i##le meatus % o#ening of the frontal sinus into the infundibulum" o#enings of the middle
ethmoidal air cells on the ethmoi#al ulla " and o#enings of the anterior ethmoidal air cells
and maxillar sinus in the hiatus semilunaris.
8nferior meatus % o#ening of the nasolacrimal #uct.
.phenopalatine foramen % o#ening into the #tergo#alatine fossa0 transmits the
s#heno#alatine arter and naso#alatine nerve.
cc 8.66
/asal pol$p % is an inflammator$ pol$p that develo#s from the mucosa of the #aranasal
sinus"
which #ro+ects into the nasal cavit and ma fill the naso#harnx. -he most common cause of
nasal #ol#s is allergic rhinitis. Cortisone or nasal steroid s#ras slow #ol# growth or will
shrink
them down tem#oraril. ,f medical treatment fails" endosco#ic sinus surger is #erformed to
remove the #ol#s (#ol#ectom).
&unn$ nose % is caused b tears draining into the inferior nasal meatus through the
nasolacrimal
duct. ,t is also associated with the common cold" ha fever" flu" and allerg" which ma cause
drainage from the #aranasal sinus directl into the nasal cavit.
&hinoplast$ % is a t#e of #lastic surger that changes the sha#e or si:e of the nose.
II. $ubdivisions and Mucous Membranes
A. 7estiule
,s the dilated #art inside the nostril that is bound b the alar cartilages and lined b skin with hairs.
!. &espirator$ region
Consists of the lower two thirds of the nasal cavit.
Carms" moistens" and cleans incoming air with its mucous membrane.
C. +lfactor$ region
Consists of the su#erior nasal concha and the u##er one third of the nasal se#tum.
,s innervated b olfactor nerves" which conve the sense of smell from the olfactor cells and
enter the cranial cavit through the cribriform #late of the ethmoid bone to end in the olfactor bulb.
III. Blood $upply to the 2asal (avity
7ccurs via the following routes%
&.'>)
A . -he lateral nasal ranches of the anterior and #osterior ethmoidal arteries of the
o#hthalmic arter.
! . -he posterior lateral nasal and #osterior se#tal branches of the s#heno#alatine arter of
the maxillar arter.
C . -he greater palatine ranch (its terminal branch reaches the lower #art of the nasal
se#tum through the incisive canal) of the descending #alatine arter of the maxillar arter.
- . -he septal ranch of the su#erior labial arter of the facial arter and the lateral nasal
branch of the facial arter.
cc #.3'
C Epistaxis % is a noselee# resulting from ru#ture of the s#heno#alatine arter. ;osebleed
occurs from nose #icking" which tears the veins in the vestibule of the nose. ,t also occurs
from
the anterior nasal se#tum (DiesselbachBs area)" where branches of the s#heno#alatine (from
maxillar)" greater #alatine (from maxillar)" anterior ethmoidal (from o#hthalmic)" and
su#erior
labial (from facial) arteries converge.
I+. 2erve $upply to the 2asal (avity
A. .7A "smell% sensation is su##lied b the olfactor nerves for the olfactor area.
!. D.A sensation is su##lied b the anterior ethmoidal branch of the o#hthalmic nerve0 the
naso#alatine" #osterior-su#erior" and #osterior-inferior lateral nasal branches of the maxillar nerve
via
the #tergo#alatine ganglion0 and the anterior-su#erior alveolar branch of the infraorbital nerve.
cc #.3#
.neeEe % is an involuntar$4 su##en4 violent " and au#ile expulsion of air through the
mouth
and nose. -he afferent limb of the reflex is carried b branches of the maxillar nerve" which
conve general sensation from the nasal cavit and #alate" and the efferent limb is medicated
b
the vagus nerve.
+. .aranasal $inuses (Figure 8-5( - see Figures 8-45 and 8-'4)
Consist of the ethmoidal" frontal" maxillar" and s#henoidal sinuses.
8re involved in a reduction of weight and resonance for voice.
A. Ethmoi#al sinus
Consists of numerous ethmoi#al air cells " which are numerous small cavities within the
ethmoi#al
la$rinth between the orbit and the nasal cavit.
,ts infection ma erode through the thin orbital #late of the ethmoid bone (lamina #a#racea) into
the orbit.
Can be subdivided into the following grou#s%
(osterior ethmoi#al air cells " which drain into the su#erior nasal meatus.
)i##le ethmoi#al air cells " which drain into the summit of the ethmoidal bulla of the middle
nasal meatus.
Anterior ethmoi#al air cells " which drain into the anterior as#ect of the hiatus semilunaris in
the middle nasal meatus.
cc 8.6:
Ethmoi#al sinusitis % is an inflammation in the ethmoidal sinuses that ma erode the medial
wall
of the orbit" causing an orbital cellulitis that ma s#read to the cranial cavit.
&.'>4
Figure 8-5A 7#enings of the #aranasal sinuses.
!. Frontal sinus
.ies in the frontal one and o#ens into the hiatus semilunaris of the middle nasal meatus b wa
of the frontonasal duct (or infundibulum).
,s innervated b the su#raorbital branch of the o#hthalmic nerve.
cc 8.';
Frontal sinusitis % is an inflammation in the frontal sinus that ma erode the thin bone of the
anterior cranial fossa" #roducing meningitis or brain abscess.
C. )axillar$ sinus
,s the largest of the #aranasal air sinuses and is the onl #aranasal sinus that ma be #resent at
birth.
.ies in the maxilla on each side" lateral to the lateral wall of the nasal cavit and inferior to the
floor of the orbit" and drains into the #osterior as#ect of the hiatus semilunaris in the middle nasal
meatus.
cc 8.'A
)axillar$ sinusitis % mimics the clinical signs of maxillar tooth abscess0 in most cases" it is
related to an infected tooth. ,nfection ma s#read from the maxillar sinus to the u##er teeth
and
irritate the nerves to these teeth" causing toothache. ,t ma be confused with toothache
because
onl a thin laer of bone se#arates the roots of the maxillar teeth from the sinus cavit.
-. .phenoi#al sinus
,s contained within the bod of the sphenoi# one.
7#ens into the sphenoethmoi#al recess of the nasal cavit.
,s innervated b branches from the maxillar nerve and b the #osterior ethmoidal branch of the
nasociliar nerve.
-he #ituitar gland lies above this sinus and can be reached b the transsphenoi#al approach "
which follows the nasal se#tum through the bod of the s#henoid. Care must be taken not to
damage the cavernous sinus and the internal carotid arter.
.phenoi#al si nusitis % is an infection in the s#henoidal sinus that ma s#read" ma come
from
the nasal cavit or from the naso#harnx" and ma erode the sinus walls to reach the
cavernous
sinuses" #ituitar gland" o#tic nerve" or brainstem. Close relationshi#s of the s#henoidal sinus
with
other surrounding structures are clinicall im#ortant because of #otential in+ur during #ituitar
surger and the #ossible s#read of infection to other structures.
Chapter .ummar$
/ec,
-he posterior cervical triangle is bounded b the tra#e:ius" sternocleidomastoid" and
clavicle and is subdivided b the #osterior bell of the omohoid into the occi#ital and
subclavian triangles. ,t contains the s#inal accessor nerve0 external +ugular vein0 cervical
#lexus0 roots and trunks of the brachial #lexus0 and subclavian" transverse cervical" and
su#rasca#ular arteries.
-he anterior cervical triangle is bounded b the sternocleidomastoid" mandible" and midline
of the neck and is subdivided b the digastric anterior and #osterior bellies and anterior bell
of the omohoid into the submandibular" carotid" muscular" and submental triangles.
-he accessor$ nerve runs on the levator sca#ulae" dee# to the tra#e:ius" and innervates the
tra#e:ius and sternocleidomastoid muscles. -he su#erficial (cutaneous) branches of the
cervical #lexus include the great auricular" transverse cervical" su#raclavicular" and lesser
occi#ital nerves. -he dee# branches of the cervical #lexus consist of the ansa cervicalis"
which su##lies the infrahoid or stra# muscles" and the #hrenic nerve" which runs on the
scalenus anterior and enters the thorax to su##l the dia#hragm.
-he #osterior bell of the #igastric an# st$loh$oi# muscles are innervated b the facial
nerve" whereas the anterior bell of the digastric and mlohoid muscles are innervated b
the trigeminal nerve. -he geniohoid and throhoid muscles are innervated b C( through
the h#oglossal nerve.
-eep .tructures of the /ec,
-he trachea begins at the inferior border of the cricoid cartilage and ends b bifurcating into
the #rimar bronchi at the level of sternal angle. ,t is ke#t o#en b a series of C-sha#ed
haline cartilages.
-he esophagus is a muscular tube extending from the #harnx to the stomach. ,t contains
smooth muscles innervated b sm#athetic nerve fibers from the sm#athetic trunk and
branchiomeric
skeletal muscles innervated b <=* fibers from the recurrent larngeal nerves.
-he th$roi# glan# is an endocrine gland that secretes the hormones throxine and
throcalcitonin" which regulate metabolic rate. -he isthmus overlies the second to the third or
the second to the fourth tracheal rings.
-he parath$roi# glan#s are two su#erior and two inferior (four to six) small endocrine
glands" which secrete #arathroid hormone for calcium metabolism. ,f there is no secretion of
#arathroid hormone" fetal tetan is #roduced.
-he caroti# sheath contains the common and internal carotid arteries" internal +ugular vein"
and vagus nerve. ,t does not contain the sm#athetic trunk" which lies #osterior to the carotid
sheath and is embedded in the #revertebral fascia.
-he common caroti# arter$ arises from the brachioce#halic trunk on the right and from the
aortic arch on the left. ,t divides into the internal and external carotid arteries at the level of
the u##er border of the throid cartilage. -he internal carotid arter has no named branch in
the neck" and the external carotid arter has numerous branches such as the su#erior
throid" ascending #harngeal" occi#ital" lingual" facial" #osterior auricular" maxillar" and
su#erficial tem#oral arteries. -he caroti# o#$ lies at the bifurcation of the common carotid
arter and serves as a chemorece#tor. -he caroti# sinus lies at the origin of the internal
carotid arter and functions as a #ressorece#tor or barorece#tor. -he carotid bod and
carotid sinus are innervated b the carotid sinus nerve of the vagus nerve and the nerve to
the carotid bod from the glosso#harngeal nerve.
Face an# .calp
6uscles of facial expression are innervated b the facial nerve" and the cutaneous
sensation is su##lied b the trigeminal nerve. -he face receives arterial loo# from the
facial arter" which gives rise to the inferior labial" su#erior labial" and lateral nasal branches
and ends as the angular arter. -he facial vein has the corres#onding branches of the facial
arter" drains into the internal +ugular vein" and communicates with the #tergoid venous
#lexus b wa of the dee# facial vein.
-he scalp consists of the skin" connective tissue" a#oneurosis" loose connective tissue" and
#ericranium (#eriosteum)0 receives sensor innervation from branches of the o#hthalmic"
maxillar" and mandibular nerves and the lesser" greater" and third occi#ital nerves0 and
receives blood from branches of the internal and external carotid arteries. -he loose
connective tissue laer is known as a dangerous laer and communicates with cranial dural
venous sinuses b wa of the emissar veins.
8nfratemporal Fossa
-he infraorital fossa contains muscles of mastication" the mandibular nerve and its
branches" and the maxillar arter and its branches.
-he muscles of mastication are innervated b the mandibular branch of the trigeminal
nerve. -he lateral #tergoid o#ens the +aw" and other muscles close the +aw. -he mandible
can be #rotruded b the lateral and medial #tergoid muscles" whereas it can be retracted b
the tem#oralis and masseter muscles.
-he maxillar$ arter$ gives rise to the dee# auricular" anterior tm#anic" inferior alveolar"
dee# tem#oral" middle meningeal (muscles of mastication)" and buccal branches in the
infratem#oral fossa. -he middle meningeal arter #asses between two roots of the
auriculotem#oral nerve and enters the cranial cavit through the foramen ovale. -he inferior
alveolar arter enters the mandibular canal and su##lies the lower teeth and chin.
-he man#iular nerve gives off inferior alveolar" lingual" buccal" dee# tem#oral" and other
muscular branches. -he lingual nerve is +oined b the chorda tm#ani" which carries the
#reganglionic #arasm#athetic fibers to the submandibular ganglion and taste fibers to the
anterior two thirds of the tongue. -he inferior alveolar nerve gives off the mlohoid nerve"
which su##lies the anterior bell of the digastric and mlohoid muscles.
-he paroti# glan# secretes a large amount of water saliva (which contains en:mes) b
#arasm#athetic stimulation and a small amount of viscus saliva in res#onse to sm#athetic
stimulation. -he saliva enters the vestibule o##osite the site of the u##er second molar tooth
b wa of the #arotid duct.
Cranial Cavit$
-he anterior cranial cavit$ contains numerous foramina that transmit nerves0 blood vessels0
and other structures including the foramen cecum (emissar vein to su#erior sagittal sinus)"
foramina of cribriform #late (olfactor nerve)" #osterior ethmoidal foramen (#osterior
ethmoidal nerve and vessels)" and o#tic canal (o#tic nerve and o#hthalmic arter).
-he mi##le cranial fossa contains the su#erior orbital fissure (C;s ,,," ,=" =4" and =, and
o#hthalmic vein)" foramen rotundum (maxillar nerve)" foramen ovale (mandibular nerve"
accessor meningeal arter" and lesser #etrosal nerve)" foramen s#inosum (middle
meningeal vessels and meningeal branch of mandibular nerve)" foramen lacerum (u##er #art%
internal carotid arter and #lexus)" hiatus of canal of lesser #etrosal nerve" and hiatus of
canal of greater #etrosal nerve.
-he posterior cranial fossa contains the internal acoustic meatus (facial nerve"
vestibulocochlear nerve" and labrinthine arter)" mastoid foramen (emissar vein)" +ugular
foramen (C;s ,E" E" and E, and internal +ugular vein)" condlar canal (emissar vein)"
h#oglossal canal (C; E,,)" and foramen magnum (medulla oblongata" meninges" vertebral
arteries" s#inal roots of C; E,).
Cranial /erves
+lfactor$ nerve (<=8" smell).
+ptic nerve (<<8" vision).
+culomotor4 trochlear " and a#ucens nerves (A<*" muscles of ee movement" <7' " .!6 "
and !emainder4 ).
Trigeminal nerve (A<8" skin on face0 <=*" muscles of mastication and tensor veli #alatini"
tensor tm#ani" mlohoid" and digastric anterior bell muscles).
Facial nerve (<=*" muscles of facial ex#ression0 <=8" taste on anterior two thirds of tongue0
A=*" #arasm#athetic nerve to submandibular and #tergo#alatine ganglia0 A=8" mucous
membrane on #alate0 A<8" external ear).
7estiulocochlear nerve (<<8" hearing and balance).
Dlossophar$ngeal nerve (<=*" stlo#harngeus muscle0 <=8" taste on #osterior one third of
tongue0 A=*0 #arasm#athetic nerve to otic ganglion0 A=8" #osterior one third of tongue0
A<8" external ear).
7agus nerve (<=*" muscles of #alate" #harnx" and larnx0 <=8" taste on e#iglottis0 A=*"
#arasm#athetic nerve to smooth muscles" glands" heart" and muscles in the thorax and
abdomen0 A=8" mucous membrane of the #harnx" larnx" middle ear cavit" and thoracic
and abdominal viscera0 A<8" external ear).
Accessor$ nerve (<=*" tra#e:ius and sternocleidomastoid) and h$poglossal nerve (A<*"
muscles of tongue movement).
&eflex Arcs
-he o#tic nerve mediates the afferent limb of the pupillar$ light reflex " whereas
#arasm#athetic fibers in the oculomotor nerve mediate the efferent limb.
-he o#hthalmic nerve mediates the afferent limb of the corneal "lin,% reflex b wa of the
nasociliar branch" whereas the facial nerve mediates the efferent limb.
-he maxillar nerve mediates the afferent limb of the sneeEe reflex (irritation of the nasal
mucosa)" and the vagus nerve mediates the efferent limb.
-he mandibular nerve mediates the afferent and efferent limbs of the Fa* Fer, reflex.
-he glosso#harngeal nerve (#harngeal branch) mediates the afferent limb of the gag
"phar$ngeal% reflex " and the vagus nerve mediates the efferent limb.
-he vagus nerve mediates the afferent and efferent limbs of the cough reflex (irritation of
the bronchial mucosa).
8ntracranial -ural 7enous .inuses
6ost veins of the brain drain into the intracranial dural venous sinuses.
-he superior sagittal sinus lies in the midline along the convex border of the falx cerebri
between the cerebral hemis#heres.
-he inferior sagittal sinus lies in the free edge of the falx cerebri and is +oined b the great
cerebral vein of Aalen to form the straight sinus.
-he superior sagittal4 straight4 an# occipital "in the falx cereelli% sinuses +oin at the
confluence" which is drained b the transverse sinuses.
-he transverse sinus drains into the sigmoid sinus" which becomes the internal +ugular vein.
-he cavernous sinus is located on each side of the sella turcica0 communicates with the
o#hthalmic vein" #tergoid venous #lexus" and facial vein0 and contains the abducens nerve
and internal carotid arter in the middle and the oculomotor" trochlear" o#hthalmic" and
maxillar nerves in the lateral wall.
+rit
-he optic canal is formed b two roots of the lesser wing of s#henoid and transmits the o#tic
nerve and o#hthalmic arter. -he su#erior orbital fissure is formed b the lesser and greater
wings of the s#henoid bone0 transmits the oculomotor" trochlear" abducens" and o#hthalmic
nerves and o#hthalmic vein. -he inferior orbital fissure lies between the greater wing and
maxilla and transmits the infraorbital nerve and vessels.
)uscles of e$e movement are the levator #al#ebrae su#erioris" inferior obli/ue" and
su#erior" middle" and inferior rectus muscles" which are innervated b the oculomotor nerve0
the lateral rectus muscle is innervated b the abducens nerve0 and the su#erior obli/ue is
innervated b the trochlear nerve.
-he ophthalmic nerve divides into the lacrimal" frontal (which divides into the su#raorbital
and su#ratrochlear branches)" and nasociliar nerves. -he nasociliar nerve gives off a
communicating branch to the ciliar ganglion and the long ciliar nerve" which contains
sm#athetic #ostganglionic fibers" and serves as afferent limb of the corneal blink reflex arc.
&arasm#athetic nerves su##l the ciliar muscle and the s#hincter #u#illae muscle" and
sm#athetic nerves su##l the dilator #u#illae muscle.
-he ophthalmic arter$ arises from the internal carotid arter and su##lies structures in the
orbit and eeball. -he o#hthalmic veins communicate with the cavernous sinus and the
#tergoid venous #lexus.
+ral Cavit$
-he #alate consists of the hard #alate and soft #alate. 6uscles of the #alate (#alatoglossus"
#alato#harngeus" muscular uvulae" levator veli #alatine" and tensor veli #alatine) are
innervated b the vagus nerve" exce#t the tensor veli #alatini" which is innervated b the
trigeminal nerve.
/erves
-he maxillar teeth are innervated b the su#erior alveolar nerve" and the mandibular
teeth are innervated b the inferior alveolar nerve.
-he outer (buccal) surface of the maxillar gingiva is innervated b the su#erior alveolar
and infraorbital nerves" whereas the inner (lingual) surface is innervated b the greater
#alatine and naso#alatine nerves.
-he outer (buccal) surface of the mandibular gingiva is innervated b the buccal and
mental nerves" whereas the inner (lingual) surface is innervated b the lingual nerves.
)uscles of the tongue are innervated b the h#oglossal nerve exce#t the #alatoglossus"
which is innervated b the vagus nerve. -he anterior two thirds of the tongue is innervated b
the lingual nerve for general sensation and b chorda tm#ani of the facial nerve for taste
(<=8) sensation. -he #osterior one third of the tongue is su##lied b the glosso#harngeal
nerve for both general and taste sensations.
8nnervation of the tongue
A<* motor innervation to muscles of the tongue from the h#oglossal nerve.
A<8 sensation from anterior two thirds of the tongue from the lingual nerve.
<=8 taste sensation from anterior two thirds of the tongue from the chorda tm#ani.
A=8 and <=8 sensation from #osterior one third of the tongue from the
glosso#harngeal nerve.
-he vallate #a#illae are located on the anterior two thirds of the tongue in front of the
sulcus terminalis" but the are innervated b the glosso#harngeal nerve.
Alands
-he submandibular gland has a larger su#erficial #ortion" which is se#arated b the
mlohoid muscle from the smaller dee# #ortion.
-he submandibular (ChartonBs) duct #asses medial to the lingual nerve and then
su#erior to the nerve and o#ens onto the sublingual caruncle.
-he sublingual gland has numerous small ducts that o#en on the sublingual fold or into
the submandibular duct.
Foth glands receive #ostganglionic #arasm#athetic fibers from the submandibular
ganglion" which receives #reganglionic #arasm#athetic fibers through the chorda
tm#ani (which also contains taste fibers).
-he lingual arter arises from the external carotid arter near the greater horn of the
hoid bone and #asses dee# to hoglossus muscle" but the lingual and h#oglossal
nerves #ass su#erficial to the muscle. -he arter has the dorsal lingual" dee# lingual"
and sublingual branches.
/asal Cavit$
-he nasal cavit is divided into a vestiule " which is a dilated area inside the nostril lined
b skin with hairs to filter incoming air0 an olfactor$ region " which is the u##er third of the
nasal cavit lined with olfactor mucosa0 and a respirator$ region " which is the lower two
thirds of the nasal cavit lined with vascular" glandular res#irator mucosa to warm and
humidif air.
,t has a roof formed b the bod of the s#henoid and s#henoid sinus0 a floor formed b the
hard #alate0 a me#ial *all formed b the nasal se#tum of the se#tal cartilage" #er#endicular
#late of ethmoid" and vomer0 and a lateral *all formed b the su#erior and middle concha of
the ethmoid and inferior concha.
,t receives A<8 innervation to its mucosa b branches of the o#hthalmic and maxillar
nerves and receives <=8 (olfaction) b the olfactor nerves. ,t receives loo# from the
s#heno#alatine branch of the maxillar arter" anterior ethmoidal branch of the o#hthalmic
arter" and se#tal branch of the facial arter.
(ter$gopalatine Fossa
Danglia
-he #tergo#alatine ganglion receives #arasm#athetic #reganglionic fibers from the
facial nerve through the greater #etrosal nerve and the nerve of the #tergoid canal.
&ostganglionic #arasm#athetic fibers su##l the lacrimal gland running through the
maxillar" :gomatic" :gomaticotem#oral" and lacrimal nerves.
-he ganglion receives branches from the maxillar nerve and then sends branches to
the #alate and nasal mucosae.
/erves
-he greater #etrosal nerve contains #reganglionic #arasm#athetic A=* fibers and A=8
and <=8 (taste) fibers to the #alate.
-he dee# #etrosal nerve contains #ostganglionic sm#athetic A=* fibers.
-he nerve of the #tergoid canal contains #reganglionic #arasm#athetic A=* fibers to
the lacrimal gland and nasal and #alatine mucosae and #ostganglionic sm#athetic A=*
fibers and A=8 and <=8 (taste) fibers to the #alate.
Lar$nx
-he larnx has a cartilaginous frame*or, " consisting of the throid cartilage (8damBs
a##le" a larngeal #rominence)" cricoid cartilage (signet ring sha#e)" artenoid cartilages
(have vocal #rocess and muscular #rocess and rotate on the cricoid cartilage)" e#iglottic
cartilage (leaf sha#ed)" and corniculate and cuneiform cartilages.
-he lar$ngeal muscles are innervated b the recurrent larngeal nerve exce#t the
cricothroid" which is innervated b the external larngeal branch of the su#erior larngeal
nerve. -he #osterior cricoartenoid muscle abducts the vocal cord" but all other muscles
adduct the vocal cord. -he chief adductor is the lateral cricoartenoid0 the sole abductor is
the #osterior cricoartenoid0 the chief tensor is the cricothroid0 the chief relaxer is the
throartenoid. -he lateral cricoartenoid rotates the vocal #rocess of the artenoid cartilage
mediall" closing the rima glottidis" whereas the #osterior cricoartenoid rotates the vocal
#rocess laterall" o#ening the rima glottidis.
.ensation above the vocal cord is su##lied b the internal larngeal branch of the su#erior
larngeal nerve" whereas sensation below the vocal cord is su##lied b the recurrent
larngeal nerve. <=8 (taste) sensation on the e#iglottis is su##lied b the internal larngeal
nerve.
-he larnx receives loo# from the su#erior larngeal arter of the su#erior throid arter
and the inferior larngeal arter of the inferior throid arter.
Ear
-he external ear consists of the auricle" which is elastic cartilage covered b skin" and is
innervated b the great auricular" auriculotem#oral" and lesser occi#ital nerves. -he external
acoustic meatus consists of a cartilaginous outer third and bon inner two thirds. ,t is
innervated b the auriculotem#oral branch of the trigeminal nerve and the auricular branches
of the facial" vagus" and glosso#harngeal nerves.
-he t$mpanic memrane is covered b the skin externall and the mucosa internall. -he
external surface is innervated b the trigeminal" facial" glosso#harngeal" and vagus nerves"
and the internal surface is innervated b the glosso#harngeal nerve.
-he au#itor$ ossicles are the malleus (hammer)" incus (anvil)" and sta#es (stirru#). -he
handle of the malleus is attached to the tm#anic membrane and receives the tendon of the
tensor tm#ani (which is innervated b the trigeminal nerve). -he foot#late of the sta#es
occu#ies the oval window" and its neck receives insertion of the sta#edius (which is
innervated b the facial nerve).
-he chor#a t$mpani arises from the facial nerve in the facial canal" #asses between the
handle of the malleus and the long #rocess of the incus" exits through the #etrotm#anic
fissure" and +oins the lingual nerve in the infratem#oral fossa" carring #reganglionic
#arasm#athetic fibers to the submandibular ganglion and taste fibers to the anterior two
thirds of the tongue.
-he cochlea contains the s#iral organ of Corti for hearing" the membranous cochlear duct
filled with endolm#h" and the scala vestibule and scala tm#ani filled with #erilm#h. -he
vestibule contains the membranous utricle and saccule filled with endolm#h and rece#tors
(maculae) for linear acceleration. -he semicircular canals contain sensor rece#tors (cristae)
for angular movements in the am#ullae at one end of each canal.
Hea# an# /ec, )uscle 8nnervation
8ll of the infrah$oi# muscles are innervated b the ansa cervicalis exce#t the throhoid
muscle" which is innervated b C( through the h#oglossal nerve.
8ll of the muscles of facial expression are innervated b the facial nerve" and all of the
muscles of mastication are innervated b the trigeminal nerve.
8ll of the tongue muscles are innervated b the h#oglossal nerve exce#t the #alatoglossus
muscle" which is innervated b the vagus nerve.
8ll of the palate muscles are innervated b the vagus nerve exce#t the tensor veli #alatini
muscle" which is innervated b the trigeminal nerve.
8ll of the phar$ngeal muscles are innervated b the vagus nerve exce#t the
stlo#harngeus muscle" which is innervated b the glosso#harngeal nerve.
8ll of the lar$ngeal muscles are innervated b the recurrent larngeal nerve exce#t the
cricothroid muscle" which is innervated b the external larngeal nerve.
,n addition" for the suprah$oi# muscles " the stlohoid and digastric #osterior bell are
innervated b the facial nerve" whereas the mlohoid and digastric anterior bell are
innervated b the trigeminal nerve" and the geniohoid is innervated b C( through the
h#oglossal nerve.
,n the nec, " the sternocleidomastoid and tra#e:ius are innervated b the accessor nerve.
,n the mi##le ear " the tensor tm#ani and sta#edius are innervated b the trigeminal and
facial nerves" res#ectivel.
*es
9ilates #u#il
Constricts #u#il0 contracts ciliar muscle to thicken lens
.acrimal gland
<lightl reduces secretion
&romotes secretion
<alivar gland
!educes secretion and more viscid
,ncreases secretion and water
<weat gland
<timulates secretion
;o effect
Flood vessels
Constricts
;o effect
.$mpathetic /erve(aras$mpathetic /erve
Functions of Autonomic /erves