HEAD & NECK

State the boundaries of the infratemporal fossa (40)

Roof greater wing of sphenoid(infratemporal surface)

(extra; squamous temporal bone )

Floor open
Lateral wall ramus of mandible
Medial wall lateral pterygoid plate / side wall of pharynx
o (extra; pyramidal process of palatine bone)
Posterior wall open
Anterior wall posterior surface of maxilla
o (extra; medial surface of zygomatic bone)
Anterior and medial wall are separated by pterygomaxillary
fissure
Communicate with the pterygopalatine fossa , temporal
fossa and orbit

Give a brief account on relations of the parotid gland (60)

Situated below the external acoustic meatus

Between the ramus of the mandible and
Sternocleidomastoid muscle
Anteriorly gland overlaps the masseter [below zygomatic
arch]
Deep cervical fascia split into 2 layers
Encloses the gland
Deep lamina of the fascia forms the stylomandibular
ligament,

And separates the parotid gland from submandibular gland

Apex of the gland overlaps the posterior belly of digastrics
muscle
Cervical branch of facial nerve,
2 divisions of the retromandibular vein,
Emerge from the apex
Superior surface of the gland related to the
temperomandibular joint,
Superficial temporal vessels,
Auriculotemporal nerve
Skin
Superficial fascia
And parotid fascia overlaps the superficial surface of the
gland
Anteromedial surface is grooved by the ramus of the
mandible
External carotid artery enters the gland through the
posteromedial surface of the gland
And divided into its terminal maxillary and
Superficial temporal branches
Within the substance of the gland
Behind the neck of mandible
Parotid duct emerges from the anterior surface of the gland
Run forwards over the masseter muscle
Then pierce the buccal fat pad and buccinator mauscle
And opened into vestibule of mouth opposite crown of
upper 2nd molar tooth
Facial nerve enter into the gland through the posteromedial
surface of the gland

And crosses the vessels superficially within the gland

And divided into its terminal 5 branches
Nerve is separated from the artery by the vein during its
course inside the gland
Temporal, zygomatic, buccal, marginal mandibular branches
Leave the gland through its anteromedial surface
Retromandibular vein is formed inside the gland
By the union of the maxillary and
Superficial temporal vein
Lymph nodes and lymphatics are closely related to the
gland

Describe the macroscopic anatomy of the thyroid gland. (60)

Butterfly shaped/shield like endocrine gland

Extent and location
In the lower part of the front and side of the neck
gland lies against C5,C6,C7 & T1 vertebrae/ each lobe
extend from middle of the side of the thyroid cartilage to
the 4th & 5th tracheal rings
gland has2 lobes joined by an isthmus/conical lobes are
connected with each other by an isthmus in its lower part
isthmus overlies 2nd to 4th tracheal rings
[an inconstant pyramidal lobe may project upward dfrom
the isthmus]
Have 2 capsules
Peripheral condensation of the connective tissue forms the
true capsule
False capsule is derived from the pretracheal fascia which
encloses it

Inner surface of the gland connected to the cricoids by

thicken pretracheal fascial layer called suspensory ligament
[of Berry]
Blood supply
By superior thyroid artery a branch from of external
carotid artery
By inferior thyroid artery a branch of thyrocervical trunk
Additional supply is by thyroidea ima artery and esophageal
and tracheal branches
Superior thyroid artery reach the upper pole of the gland
and [anastomose with the opposite artery along the upper
border of isthmus]
Inferior thyroid artery reach the lower pole
Superior thyroid vein emerges from the upper pole of the
gland drains into internal jugular vein
Middle thyroid vein also drain into internal jugular vein
Inferior thyroid veins emerge from the lower border of the
isthmus to be drained into brachiocephalic vein
Dense capillary plexus present deep to the true capsule
Lymph from the upper part of the gland drains into upper
deep cervical lymph nodes
Relations
Superficially gland is covered by strap muscle of
neck/sternothyroid, sternohyoid, superior belly of
omohyoid overlapped by sternoclastomastoid
Anterior jugular vein course over the isthmus
On the deep aspect lie the larynx and trachea, pharynx and
esophagus
Behind the carotid sheath on the either side

Recurrent laryngeal nerve coursing on the

tracheoesophageal groove
Closely related to the inferior thyroid artery
And external laryngeal nerve is closely related to the
superior thyroid artery
Sympathetic fibres are mainly derived from the middle
cervical ganglia/ cervical sympathetic trunk.

Briefly describe the embryological development of the thyroid

gland. (25)

Epithelium of endodermal origin

Begins proliferating in the floor of the ventral portion of the
pharynx
[the site is later known as foramen ceacum/ between the
tuberculum impar and copula]
Descend as blobbed diverticulum
In front of the pharyngeal gut/hyoid bone & forms a
recurrent loop
Laryngeal cartilage
In the midline
But remain connected to the tongue by thyroglossal duct
Later it disappears. (in the 7th week of development)
Acquired 2 lateral lobes and a small median lobe
Parafollicular cells are derived from the ultimo branchial
body of the 4th branchial pouch

Give the briedf account of microscopic appearance of the thyroid

follicle. (15)

Functional unit of the thyroid gland are thyroid follicles

Spherical structures
Composed of single layer of simple cuboidal epithelium
bounded by a basement membrane. (secrete thyroxin &
triiodothyronine)
The size of the follicle and their lining cells vary according to
state of activity (actively secreting small follicles, less
active large follicles)
Parafollicular cells are found within the basement
membrane (secrete calcitonin)
Contain large amount of pink stained stored colloid material
inside the follicle.

Briefly describe the relations of the cavernous sinus. (45)

Large venous sinus/space located in the middle cranial fossa

On either side of the body of the sphenoid
sinus is located within the dura mater
lateral medial walls and roof is formed by the meningeal
layer of the dura mater
and the floor is formed by the endosteal layer of dura
anteriorly sinus is extends up to medial end of the superior
orbital fissure
posteriorly to the apex of the petrous temporal bone
cavernous sinus is related superiorly to the optic tract
optic chiasma, internal carotid artery, internal carotid
artery, olfactory tract
inferiory to the sinus is foramen lacerum, junction between
body and the greater wing of the sphenoid
medially to the sphenoidal air sinus
and to pituitary gland/hypophysis cerebri

laterally, temporal lobe of the cerebrum

lateral wall related to the occulomotor
trochlear
ophthalmic
maxillary nerves above downwards
(extra- trigeminal ganglion also related to the lateral wall)
Internal carotid artery
Abducent nerve runs medially (nerve is inferolateral to the
artery)
Above nerves are separated from the sinus by a thin
endothelial cell layer

Name communications of the cavernous sinus

Into the transverse sinus through the superior petrosal sinus

Into the internal jugular vein through the inferior petrosal
Into the pterygoid plexus through the emissary veins
Into the facial vein through the superior ophthalmic vein
Intercavernous connection

Describe the layers of the scalp. (60)

The SCALP is made up of 5 layers. Superficial to deep they

are,
Skin
Superficial fascia
Epicranial aponeurosis/galea aponeurotica
Loose areolar tissue
Pericranium
Skin is thick
Hairy & rich in sebaceous glands

Superficial fascia is fibrous & has lobules of fat

Arranged in tight compartments divided by fibrous septa
Blood vessels running to the skin lies in this layer
Skin is firmly adherent to the underlying epicranial
aponeurosis via superficial fascia
Epicranial aponeurosis is fibrous over the dome of the skull
but
Receives insertion of frontalis anterioly & of occipitalis
posteriorly
Aponeurosis is attached posteriorly to the external occipital
protuberance, superior nuchel line &
Superior temporal line on either side. [sends down a thin
expansion passing over temporal fasia]
Loose areolar tissue extend anteriorly into eyelids. (because
frontalis does not have a bony attachment)
Posteriorly attached to superior/highest necheal lines,
& superior temporal lines on either sides
Due to its loose nature, aponeurosis & overlying layers are
freely movable
Pericranium is loosely adherent to bony surface
Except at sutures
Where it tightly attached to endocranium [via sutural
ligament]
(aponeurosis is tensed by the tone of occipitofrontalis)

Describe the relations of the submandibular gland

Is a mixed mucous and seroud in type

The mylohyoid divide gland into superficial and deep parts
Superficial part is triangular in shape

Its inferior/superficial surface is related to the

o skin,
o platysma,superficial fascia,
o investing layer of deep fascia,
o submandibular lymph nodes, (within the substance)
o the facial vein &
o the cervical branch of facial nerve (extra sometimes to marginal mandibular branch as well)
the lateral surface is related to the submandibular fossa &
medial pterygoid muscle(insertion)
the medial surface lies against the mylohyoid and behind it
on the hyoglossus, lingual nerve, hypoglossal nerve and its
accompanied veins
the facial artery is at first deep to the gland, and then
grooves posterosuperior part as it hooks over the top of the
gland on to its lateral surface
deep part of the gland extend forwards for variable distance
between mylohyoid and hyoglossus, below the lingual nerve
and above the hypoglossal nerve
the submandibular duct emerges from the medial surface of
the superficial part of the gland near the posterior part of
the mylohyoid
it runs with the deep part, forward, slightly upwards
first between mylohyoid and hyoglossus
then between sublingual gland & genioglossus
to open into the floor of the mouth beside the frenulum
as it lies on hyoglossus, the duct is crossed laterally by the
lingual nerve & turns under the duct to pass medially

A cricket player received a blow on the temple. He was diagnosed

to have a extradural hemorrhage.
What is the artery damage?
Anterior division of the middle meningeal artery
What is the commonest site it would be damage? How would you
surface mark it?

Pterion
2 finger breath posterior to the lateral orbital margin or
1 thumbs breath posterior to the lateral orbital margin

How would you differentiate between an extradural & subdural

hemorrhage?

Extradural hemorrhage is arterial in nature & subdural

hemorrhage is venous
In extradural hemorrhage paralysis first appear from face
and then spreads to the lower part of the body,
In subdural hemorrhage the progress of paralysis is
haphazard
In extradural hemorrhage there is no blood in CSF; while it
is a common feature in subdural hemorrhage
Symptoms of cerebral compression are late in extradural
hemorrhage

Describe the sign & symptoms observed in increased intracranial

pressure

Medial squint damage to abducent nerve as it winds over

superior border of the apex of the petrous temporal bone
Dilatation of pupil compression of the occulomotor nerve
over the edge of tentorium cerebelli
Papilloedema at the subarachnoid space extends around
the optic nerve up to the eye ball, increased pressure in this
space compress the retinal vaeins causing papilloedema
Contralateral hemiplegia due to compression of crus
cerebri of the midbrain (by the herniated uncus)