This summary is contain all of the following :

lecture # 20 ( the orbit & eye) . lecture # 21 ( the Ear ) .

lecture # 22 ( TMJ ) .

lecture # 25 ( trigeminal Nerve ) . lecture # 26 ( parasympathetic Ganglia in the head & neck ) but the lecture # 27 does not include in the material & of course the embryology lectures .

the doctor said that the final exam will be : 20 question are easy 10 question are hard (same as 2nd exam ) 30 question are between .

Lecture # 20 ( The orbit and the eye )

Page 1: Slide 2: ORBIT - Apex: optic foramen. - Base: the anterior surface of the orbit. - The angulation of the orbit: the medial wall is parallel to the saggital line while the lateral wall is angulated. - Medial?? : Continuous with the nasal bone. Page 2: Slide 1: ORBIT - The inferior orbital fissure is between the greater wing of sphenoid and maxilla. - It communicates with the pterygopalatine fossa. Slide 2: ORBIT - Between which bones??: the superior orbital fissure is between greater wing and lesser wing of sphenoid. - Communication?: middle cranial fossa. - Very important: because any infection can be transmitted ftom the superior ophthalmic vein to the cavernous sinus. Slide 3: ORBIT - the nasolacrimal canal transmits the nasolacrimal duct that communicates with the inferior meatus in the nasal cavity. Page 3: Slide 2: EXTRAOCULAR MUSCLES - lateral rectus is supplied by the abducens nerve (VI) - superior oblique is suppled by the trochlear nerve (IV) Page 5: Slide 2: EYEBALL - The optic disk when bulges posteriorly this represent intra ocular pressure, while anteriorly extra ocular pressure (papilloedema). Slide 3: EYEBALL - ciliary processes are in the vascular layer Slide 4: EYEBALL - the iris is in the vascular layer Final notes: - To move the eye upward centrally superior rectus + inferior oblique - To move the eye downward centrally inferior rectus + superior oblique
Done by :khawlah bashaireh

LEC # ( 21 ) The Statoacoustic Organ The Ear

Page 1 : Slide 2 : the ear divided into 3 part : the external ear middle ear :consist of tympanic cavity & ossicles which is small bone carries the sound waves from tympanic membrane to the inner ear . inner ear ( labyrinth ) :which contain the cochlea that responsible for hearing & have vestibule (circular canal ) which responsible for balance . slide 3 : the auricle made of the elastic cartilage & covered by skin .which collect the sound waves. Slide 4 : the EAM consist of cartilage in the outer 1/3 & tympanic bone of temporal in the inner 2/3 the EAM conduct the sound waves from auricle to T.M . page 2 : slide 1 :the tympanic membrane separate the EAM from middle ear ,and line in the outside by skin & inside by mucous membrane .and if we look on it we find that is concave outside &convex inside coz it tens by tensor tympanic muscle from inside . slide 2 : the tympanic membrane divided into 4 part : 1 pars flaccida :the superior part & avoid during surgery coz it is very rich of blood supply &the corda tympani pass deep to it . 2 Pars tensa : remaining part of tympanic membrane . 3 Umbo :central part . 4 cone of light :radiates anterior inferior from umbo . Slide 3 : the middle ear : air filled chamber within petrous part of temporal bone that line with squamous to cuboidal mucous membrane . divided into : tympanic cavity proper , epitympanic recess which is small space located superior to tympanic cavity proper , this epitympanic recess communicates anteriorly with nasopharynx & auditory tube , and posteriorly with mastoid antrum . slide 4 :the boundaries of tympanic membrane : anterior wall ( carotid) :which is separates tympanic cavity from carotid canal which pass to it internal carotid artery , ant. Wall contain superiorly 2 opening : the auditory tube to the nasopharynx &canal for tensor tympani muscle that tens the tympanic membrane medially .

posterior wall (mastoid) :which separate tympanic cavity from mastoid region ,and contains the aditus (entrance)to mastoid antrum (( all the mastoid air cells open in large cavity we call it antrum & then the antrum opening in tympanic cavity as aditus )) , and contain pyramidal eminence which a hollow bony cone enclosing by the stapedius muscle which attach to stapes to prevent excessive movment of the stapes .

page 3 : slide 1: medial wall ( labyrinthine ) : which separates middle ear from inner ear , it contain the promontory bony ,(convexity bone)it happen coz the basal part of the cochlea(part of inner ear) pressuring on the lateral wall of promontory ,so it gives it the convexity shape to tympanic cavity . and it contain tympanic plexus lies over the medial wall of the promontory formed by tympanic nerve this is small branches come from glossopharyngeal n. and enter from floor of tympanic cavity to the medial wall ,and divided iv several general sensory branches ,supply the mucous lining the tympanic cavity , however the remaining fibers from the upper part goes through the roof of the tympanic cavity to middle cranial fossa then we call it lesser petrosal verve ,carrying pre ganglionic parasympathetic secretomotor fiber to the parotid gland through otic ganglion . it also has 2 opening : the oval window ( lies where the stapes sitting and it transmit the waves to the inner ear ,, and it has round window (it allow the fluid within cochlea to move to produce the waves ). Slide 3 : lateral wall ( membranous): formed by lateral bony wall of epitympanic recess , and it separates the external ear from middle ear . Slide 4 : roof ( tegmental wall) : it separates middle ear from middle cranial fossa ,& formed by thin plate of temporal bone what we call it tegmen tympani .which also the roof of mastoid antrum . The floor (jugular wall) thin bony plate that separate middle ear from jugular pulp of jugular foramin . Page 4 : Slide 1+2+3+4 : the contents of middle ear Auditory ossicles :

1- malleus ( )or hummer : it has a head in epitympanic recess articulates with incus ,and has neck ,and hundle which attached to tympanic cavity laterally , & tensor tympani m. medially . 2Incus :it has body in the epitympanic recess articulates with head of malleus , and it has long limb articulates with head of stapes ,& short limb attached to posterior wall of tympanic cavity . 3Stapes : it has base (it like foot plate ) attached to oval window ,and has anterior & posterior limbs attached to the base , and has a neck attached to stapedius muscle ,and also has a head which articulates with Incus . Page 5 : Slide 1 +2 in following table Muscles Tensor typmani Origin Wall of auditory tube & its own canal Stapedius Pyramidle eminence Neck of stapes Facial n. (n. to stapedius) Insertion Handle of malleus Innervation n. to medial pterygoid from mandibular n. Action Prevent of excessive Vibration of tympanicMembra ne Prevent of e x c e s s i v e Movment of stapes Slide 3 : signs : the sign of diseases that is noticed by doctor himself . Symptoms : the sign of diseases that is noticed by patient himself . Mastoiditis :inflammation of mastoid air cells . Oseomyelitis : bone infection of tegmen tympani ,and it may spread superiorly to middle cranial fossa ,

Slide 4 : + slide 1 + slide 2 in page 6 :the doctor said that not important and he read just read it from slide But the missing part is that the semicircular canal communicates with vestibule. And the fxn. Of cochlea is the hearing . Done by :bilal alomari

Lec # (22) Temporomandibular joint & jaw bones

Page 1 : Slide 2: The TMJ is located between the head of the mandible and the mandibular fossa. Ginglymus: a Latin word for hinge, i.e. the hinge movement Arthrodial: the gliding movement The TMJ is involved in two main movements: The 1st movement: the rotating hinge movement. And this movement is between the head of the condyle and the manibular fossa. And its while opening the mouth. The 2nd movement: is the gliding movement i.e. slipping the bones (jaws) over each other . Slide 3: Articulations of the TMJ : 1. head of mandibular condyle 2. ant. Part of the mandibular fossa of? Squamous part of the temporal bone & The articular tubercle of The temporal bone

And this articular tubercle is important in the movement of the mandible. this joint is covered by fibrocartilage . unlike most of the other joints in the body which are Slide 4: Articular fibrous capsule : Surrounds the joint from all surfaces. Attached : sup.: margin of the mandibular fossa Inf.: the neck of the mandibular Lat. (TM) lig.: which is a thickening of the fibrous capsule runs downwards and backwards between? The articular tubercle and the lat. Aspect of the neck prevents? The Excessive movement of the mandible backwards i.e. prevents the post. Dislocation of the joint. And this post. Dislocation means that the condylar head moves more post. than required, away from the mandibular fossa protects? the tympanic plate of the EAM (external auditory meatus) page 2 : slide 1: the stylomandibular lig.: extends between? The tip of the styloid to the investing layer of the deep cervical fascia. Thickened part of? The parotid capsule. the sphenomandibular lig.: extends between : The greater wing of sphenoid to lingual of the mandible. Is there any other lig.? Yes there is. It limits the lat. Movement of the mandible along with the sphenomandibular lig. And this lig. Is called: the pterygomandibualr raphe lig. Which extends between the med. Pt. to the post. Surface of the raphe. Slide 2: The other joint in the body that contains an articular disc is the sternoclavicular joint. This disc is thin in the middle thats why its divided into ant. And post. Bands. Attachments: periphery: the fibrous capsule covered by hyaline cartilage.

Ant.: lat. pt. muscle and the head of the mandible Post.: the neck of the mandible and the postglenoid Slide 3: Depressors: 3 goups ? .The suprahyoid :digastric and geniohyoid .the infrahyoid m. .the lat. Pt. m. Main mover ? The force of gravity. Elevators? 3 groups ? .masseter m. .the ant. Half of temporalis m. .med. pt. m. Slide 4: Protrusion? 3 m. ? the ant. Fibers of the masseter m. and the med. Pt. m.+ the lat pt. m. Main one? Lat. Pt. m. Retrosion by? The post. Half of temporalis m. Lat. Movement to the sides by?the med. And lat. Pt. muscles with the opposite side. Page 3 : Slide 1: 1.Rotation: here the condylar head rotate over the articular disc in the lower compartment of the joint . and this represents the hinge movement. it is done between the head of the condyle and the articular disc. which is the 1st movement. 2.translation: here both the head of the condyle and the articular disc translate anteriorly over the articular tubercle. and this represents the gliding movement. which is the 2nd movement. Further to know. This happens In the upper compartment of the joint and it keeps translating (gliding) until ?? The head of the condyle is inf. To the articular tubercle. Slide 2: Relations: tubercle.

Ant.: massetric a. (from ? The 2nd branch of the max. a.) and n.(from ? The ant. Division of the mandibular n.) Post.: glenoid process of? The parotid gland. & ? Superficial temporal vessels and the auriculotemporal n. Slide 3: we have 2 kinds of dislocations: ant.: which is the most common post.: which is very rare cause its limited by the action of the lat. Pt. lig. Slide 4: We have 2 kinds of abnormal sounds in the TMJ: Clicking and grinding. The ant. Displacement with reduction causes the clicking sound. With reduction means that the opening of the mouth is reduced and limited by the articular disc. Page 4 : Slide 1: In The ant. Displacement without reduction, the articular disc doesnt return so this disc grinds the post. Bands. Producing the grinding sound. Slide 2: The max. sinus is the largest air sinus. The body of the max. has 4 surfaces: The upper surface? The orbital surface of he max., contains the infraorbital groove Posteriorly. This groove deepens as we move forward to form a canal then keeps on moving forward and deepening until it forms the infraorbital foramen anteriorly. i.e. the contents of this surface from post. To ant.: the groove_the canal_ the foramen. The anterolateral surface? And it is called the external surface. Contains the infraorbital foramen. The posterolateral surface? also called the infratemporal surface, contains the infratemporal fossa.

The medial surface? Which is part of the lat. Wall of the nasal cavity. Slide 3: The incisive n. is from the nasopalatine n. which in turn is from the max. n. Slide 4: Just to remind you: We have 2 mental spines: Sup.: attached to the genioglossus m. Inf.: attached to the geniohyoid m. The mylohyoid line : marks the attachment of the mylohyoid m. The mandibular notch: the massetric a. and n. pass through this notch. Page 5 : Slide 1: we have 2 groups of muscles attached to the mandible: 1. the muscles of mastications: .temporalis attached to the coronoid process. .Lat. Pt. m. attached to the neck of the mandible. .med. pt. m. attached to the med. Surface of the angle of the mandible .masseter attached to the angle of the mandible 2. accessory muscles: . mylohyoid ( the floor of the mouth) . geniohyoid . genioglossus . the ant. Belly of digastric Done by rund alrusan

Lec # (23 ) muscles of mastication

the doctor just repeat we know about muscles of mastication ,and does not give any new knowledge of it .so we didnt writtin any thing about this lecture .

Lec # (24) neuro anatomy of cranial nerve

In This lecture the doctor ashraf said that the material which include in the exam just to page 10 on the slide (to facial nerve ) ,and the doctor said that we study the slide enough for exam . Thanx for you .

Lec # (25) Trigeminal Nerve

Question that I think it will help you in memorize the trigeminal nerve ( summary ) : * the anterior belly of digastric & mylohyoid are enervated by which of the following nerve : 1 - inferior alveolar of post. Division of mandibular n. . 2 - lingual n from post. Division of mandibular n . 3 main trunk of mandibular n. 4 buccal nerve . * one of the following is wrong about the ophthalmic n (V1) : 1 pass through the superior orbital fissure . 2 gives the lacrimal branch . 3 gives nasociliary branch . 4 supply buccinator muscle . * one of the following nerve goes back and joined the motor branches of trigeminal nerve : 1 ophthalmic n. 2 mandibular n. 3- maxillary n. 4 nasociliary n. * one of the following does not branches of the ophthalmic nerve : 1 lacrimal n. 2 frontal n. 3 nerve to masseter muscle . 4 nasociliary n. * which of the following nerve that supply the lateral part of the upper lid : 1- lacrimal n. . 2 supraorbital n. from frontal branches . 3- infratroclear n. from nasociliary branches . 4 supratroclear n. from frontal n. * which of the following nerve that supply the medial part of the upper lid & nose : 1- lacrimal n. . 2 supraorbital n. from frontal branches . 3- infratroclear n. from nasociliary branches . 4 supratroclear n. from frontal n. * which of the following nerve that supply lateral part of the lower lid : 1 - lacrimal n.

2- infratroclear n. from nasociliary branches . 3 infraorbital n. 4 zygomaticofacial n. * which of the following nerve that supply the lower lid & upper lip: 1 - lacrimal n. 2- infratroclear n. from nasociliary branches . 3 infraorbital n. 4 zygomaticofacial n. * one of the following nerves does not branch of pterygopalatine ganglion : 1 nasociliary n. 2 greater palatine n. 3 lesser palatine n. 4 nasopalatine n. * One of the following nerve does not pass through superior orbital fissure : 1 nasociliary n. 2 frontal n. 3 lacrimal n. 4 maxillary n . * one of the following nerve does not branch of the nasociliary n. : 1 long ciliary n. 2- post. Ethmoidal n. 3 ganglionic branches ( short ciliary n. ) 4 infratroclear n. 5 ant. Ethmoidal n. 6 lacrimal n. * the External nasal n. is branches of the : 1- nasociliary n. 2- frontal n. 3 lacrimal n. 4 maxillary n. * the maxillary n. pass through : 1 foramin oval . 2 foramin rotundum . 3 foramin spinosum . 4 superior orbital fissure . *one of these organ does not receive the innervation from auriclotemporal n. : 1 auricle . 2 External acoustic meatus . 3 tympanic membrane . 4 TMJ . 5 scalp .

* after extraction the lower 3rd molar ,if the patient sense there is paralysis in the same side of the tongue : So the nerve that is injury is lingual nerve . *one of the following nerve does not participate in suppling the upper posterior teeth (4 _ 8): 1 post. Sup. Alveolar n. 2 middle sup. Alveolar n. 3 greater palatine n. 4 sphenopalatine n. coz it supply the anterior teeth ( 1 _ 3 ) . The Notes about this lecture : The mandibular nerve after leave foramen ovale joined to motor root of trigeminal nerve The nerve that supply the forehead is supratrochlear &supraorbital The zygomaticotemporal n. does not supply the temporalalis muscle ,coz it is sensory , but the mandibular nerve supply its motor n. Story of anterior ethmoidal n. : nasociliary enter ant. Cranial fossa enter nasal cavity Appear on face as External Nasal n. The menengial branches of mandibular turn back to the skull through foramen spinosum. The nerve that we need to anesthetis it when we extract the lower 1st molar is the inf. Alveolar n. & lingual n. & buccal n. The buccal nerve supply the lower cheek & gum until the mental foramen . (between 2 premolar ) . The nerve that we need to anesthetis it when we extract the lower 1st premolar is the mental n. & lingual n. or ( inf. Alveolar & lingual n. ) The nerve that we need to anesthetis it when we extract upper 1st molar is post. Sup. Alveolar n. & middle sup. Alveolar n. &the greater palatine n. If the inf. Alveolar n. injury : so all lower teeth are paralysis & because it gives mental branches to supply the buccal gingival from (premolar to incisior ) it will paralysis . but the buccal gingiva of the molar does not paralysis coz it supply by buccal nerve ( from ant. Divi. Of trigeminal n. ) If we anesthetis the bccal n. & inf. Alveolar & lingual n but still the patient sense the pain, That is mean we have to anesthitis the great auricular n. from cervical plexsus , (it supply the angle of the mandible ) Done by :bilal alomari

Lec # (26) parasympathetic ganglia in the head & neck

Page 1 : Slide 1: Basic Tissues: 1. Nerves 2. Muscles 3. Epithelial 4. Connective tissue example : bld & adipose tissue Ganglia: aggregation of nerve cells within PNS (axons), the aggregation within CNS in the gray matter. Slide 2 : CNS: control part over PNS Somatic more expanded in sensory Autonomic more expanded in motor Slide 4 : Autonomic Nervous Sys: Chemoreceptor: carotid body (at the bifurcation of CCA into ICA & ECA) monitor the level of co2 & o2 in the body Mechanoreceptors: carotid sinus Motor: 1.cardiac muscle (excitation :tachycardia & inhibition : pradycardia ) 2. 3. smooth muscle(activation lead to vasoconstriction) glands like sweat & salivary(activation lead to increase sweating)

because the autonomic working in 2 waves ( excitation & inhibition ) it divided into 2 part :sympathetic & parasympathetic fibers . page 2 : slide 4 : preganglionic 1st order neuron duty of ganglion is the place where preganglionic & postganglionic neuron synapsis page 3 : slide 2 : Sympathetic Ganglia in Head & Neck 3 ganglia in the cervical region sup ,middle , inf

 Location: post. to carotid sheath within carotid triangle within sympathetic chain stellate ganglion : fusion between inf cervical ganglion & superior thoracic ganglion located between transverse process of C7 & the neck of the 1st rib . slide 3 : Parasympathetic Ganglia in Head & Neck 1 2 3 4 : Ciliary Ganglion : within the orbit to constriction of pupil . : Ptergopalatine Ganglion : in pterygopalatine fossa ,to secretion of lacrimal gland . : Otic ganglion : located inf. To foramen ovale to secret the parotid gland secretion. : submandibular ganglion :located just behind the mylohyoid muscle , & responsible for subman. & sublingual gland secretion . Slide 4 : Ciliary Ganglion : location: between optic n (med) and lat rectus muscle (lat) Suspended by : inf division of occulomotor N (CN III ) pregang para : with occulomotor N to ciliary postgang para : short ciliary N to sphincter pupillae M Sympathetic Ganglion: preganglionic in sympathetic chain we cant see it because they are very early in spinal cord. It exit from sup. Cervical ganglion through long ciliary n (from Nasociliary n from ophthalmic division of trigeminal n) .& this sympathetic post ganglionic dilate the pupillae muscle . Page 4 : Slide 2 : Horners syndrome * ptosis because levator palparea superioris has 2 muscles:1. skeletal by CN III 2. smooth Slide 3 : receive sympathetic * Flushing of the face : because of vasodilatation so more bld go to the face.

 Ptergopalatine Ganglion : location: Ptergopalatine fossa suspended by maxillary n. perganglionic parasympathetic comes from facial n ,and then this pregang comes together to form greater petrosal nerve ( goes away through petrous part of temporal bone) . postganglionic parasymp. :doesnt leave only ,it leave by joining with maxillary nerve through zygomaticotemporal branches ,then join to lacrimal nerve of the ophthalmic to reach the lacrimal gland ( inhance the secretion of lacrimal gland ) . post ganglionic sympathetic : once it leave ,it run on network plexus around the internal carotid artery ,then enter the brain ,then join together (sympathetic ) and it leave through petrous part of temporal as Deep Petrosal Nerve , and just before the Greater petrosal nerve enter the pterygopalatine it join the Deep petrosal nerve to form vidian nerve or n. of pterygoid canal .

so the vidian n. consist of sympathetic ( deep petrosal ) & parasymp. ( greater petrosal ) .
page 5 : slide 1: Otic ganglion : location beneath f. ovale & medial to mandibular nerve. suspende by n. to med pterygoid preganglionic parasymp. : comes from glossopharyngeal n. to tympanic n then form tympanic plexus and leave the tympanic cavity as a lesser petrosal nerve . post ganglionic parasymp. :distributed to parotid gland via auriculotemporal n slide 2 :postganglionic sympathetic : goes from sup. Cervical ganglion pass through parotid gland to slide 3 : Submandibular Ganglion located lat to hyoglossus m innervated by hypoglossul n suspended by lingual nerve . pregang parasymp. Gos from facial n. as chorda tympani & joins the lingual n . read the table on the last page of this lecture ok it is very important thanx supply its blood vessel .

done by : abeer hussein

forgive us for any mistake thanx for all & good luck