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The tragus of auricle is situated in: (c) the width of lips is roughly the identical as that between the 2 irises (d) the lower lip is separated from the chin by labial commissure 6 antifungal wipes for cats purchase 15gm butenafine overnight delivery. All of the next constructions may be palpated within the anterior median region of the neck besides: Frontal region of head Nasal region of head Temporal area of head Zygomatic area of head Hyoid bone Thyroid cartilage Transverse process of atlas vertebra Cricoid cartilage 7 fungus gnats vs. thrips purchase butenafine with paypal. The most distinguished a part of occipital regions of the top is called: Inion Opisthocranion Superior nuchal lines Basion Mucogingival junction Mucobuccal fold Vermillion border Labial frenulum 8 fungus edh deck order butenafine australia. Select incorrect statement regarding the auricle of the ear: (a) It helps to acquire the sound waves (b) the higher finish of helix lies on the degree of lateral Sublingual papillae Sublingual folds Parotid papillae Frenulum linguae canthus of eye (c) the lobule is roughly on the degree of the apex 9 fungus gnats inside house order 15 gm butenafine free shipping. A midline ridge of tissue on the oral side of the hard palate is called: of the nose (d) the tragus is located anterior to the opening of external auditory meatus 5. All of the following constructions traverse through the anterior compartment of the neck besides: by vermillion border (b) the philtrum is a triangular median despair in higher lip Digestive tract Respiratory tract Internal jugular veins Spinal wire 414 Textbook of Anatomy: Head, Neck, and Brain eleven. Regarding mastoid process, all of the following statements are correct besides: (a) It is absent at birth (b) It begins to develop on the finish of the 2nd yr after Medial and lateral Superior and inferior Anterior and posterior Proximal and distal birth (c) It contains tympanic cavity (d) It offers attachment to posterior stomach of digastric Answers 1. Bones of the skull which allow free movement are all besides: Neck of mandible Angle of mandible Canine area of the physique Symphysis menti Mandible Malleus Incus Vomer 8. All of the next foramina are current within the larger wing of sphenoid except: 2. Regarding pterion, all the following statements are true except: (a) It overlies the posterior division of center 10. Regarding backbone of sphenoid, the entire following statements are true besides: (a) It is situated on the bottom of skull posterolateral to the Uncinate strategy of ethmoid Descending process of lacrimal Horizontal palate of palatine Maxillary strategy of inferior nasal concha Answers 1. All of the next structures cross through foramen ovale besides: Subcutaneous layer Aponeurotic layer Layer of loose areolar tissue Pericranium It extends posteriorly up to superior nuchal line Epicranial aponeurosis varieties its second layer Its motor supply is derived from facial nerve Its vessels fail to retract if reduce 2. Select the wrong statement about the scalp: Mandibular nerve Anterior division of center meningeal artery Lesser superficial petrosal nerve Emissary vein connecting pterygoid venous plexus to cavernous sinus 3. All of the following nerves innervate the posterior quadrant of the scalp except: Multiple Choice Questions 415 Auriculotemporal Great auricular Greater occipital Lesser occipital (d) Openings of ciliary glands are situated alongside the anterior edge of the free margin of eyelids Answers 1. Regarding pores and skin of neck, the entire following statements are correct except: (a) Cleavage strains of pores and skin in the neck are disposed Supratrochlear Supraorbital Posterior auricular Superficial temporal 5. Superficial surface of temporal fascia is said to the entire following structures besides: transversely (b) It receives cutaneous innervation from C1 to C7 Auriculotemporal nerve Great auricular nerve Superficial temporal vessels Temporal branches of facial nerve spinal nerves (c) It receives cutaneous innervation from C2 to C4 spinal nerves (d) It is skinny and drains its lymph into superficial lymph nodes 2. Regarding platysma, all of the following statements are appropriate besides: (a) It is current deep to investing layer of deep cervical 6. Regarding muscles of facial features, which of the next statements is wrong: They are current in the superficial fascia They are developed from first pharyngeal arch Their motor provide is derived from facial nerve Morphologically they characterize panniculus carnosus fascia (b) Morphologically it represents panniculus carnosus (c) It is innervated by the facial nerve (d) Its contraction relieves the stress of skin on 7. Select the incorrect assertion concerning anterior jugular vein: (a) It is formed beneath the chin in submental region (b) It runs about 1 cm lateral to anterior midline of the half (b) It is a mucous gland (c) It receives its secretomotor supply by way of lacrimal nerve (d) the 2 parts of lacrimal glands are separated from each other by levator palpebrae superioris 9. All of the next are derivatives of deep cervical fascia except: whole extent (c) Openings of tarsal glands are present alongside the posterior fringe of free margins of eyelids Pretracheal fascia Prevertebral fascia Stylomandibular ligament Sphenomandibular ligament 416 Textbook of Anatomy: Head, Neck, and Brain 6. Superficial lymph nodes of neck include the entire following teams of lymph nodes besides: (c) Occipital artery (d) Third part of subclavian artery Submental Submandibular Retroauricular Retropharyngeal 3. Select the incorrect assertion concerning the spinal accessory nerve: (a) It emerges within the posterior triangle by piercing the posterior border of sternocleidomastoid (b) It is related to lymph nodes belonging to upper deep 7. All of the next nerves come up from cervical part of the brachial plexus besides: eight. All of the next are contents of carotid sheath besides: Internal carotid artery External carotid artery Internal jugular vein Vagus nerve It extends from base of cranium to the clavicle the ansa cervicalis is embedded in its anterior wall It is ill outlined over the inner jugular vein the cervical sympathetic chain is posterior to it Dorsal scapular nerve Nerve to serratus anterior Musculocutaneous nerve Suprascapular nerve concerning the 9. Select the inaccurate assertion relating to chilly abscess because of tubercular caries of cervical vertebrae: (a) Produces paramedian bulge in the posterior It tilts the pinnacle to the same side It overlaps the carotid sheath It is equipped by the cranial root of accent nerve It is crossed superficially by the exterior Jugular vein 6. The sternocleidomastoid is crossed superficially by all the following structures except: pharyngeal wall (b) Produces median bulge within the posterior pharyngeal wall (c) It might extend into posterior triangle of the neck (d) It might extend into axilla and arm Answers 1. All of the following muscular tissues varieties the ground of posterior triangle except: Left infraclavicular Left supraclavicular Right infraclavicular Right supraclavicular Splenius capitis Levator scapulae Scalenus medius Scalenus anterior eight. All of the next constructions lie deep to fascial carpet of posterior triangle except (a) Trunks of brachial plexus (b) Spinal accessory nerve Anterior jugular vein External jugular vein Supraclavicular nerves Great auricular nerve Answers 1. Select the wrong statement in regards to the psychological triangle: (a) It is positioned in the anterior median region of the eight. Which of the following strap muscle tissue of the neck can elevate the larynx if hyoid is mounted: neck (b) Its floor is fashioned by the oral diaphragm (c) It is bounded on both facet by the posterior stomach of Sternohyoid Omohyoid Sternothyroid Thyrohyoid 9.

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Pre- and Paravertebral Regions and Root of the Neck 177 On the left facet - the four trunks that converge are as follows: 1 antifungal agents list generic 15 gm butenafine. Left subclavian trunk drains the lymph from the left higher limb and left half of thoracoabdominal wall in the same means as that of right subclavian trunk antifungal mouth cream quality butenafine 15 gm. Left bronchomediastinal trunk is much like antifungal products discount butenafine american express that of the best trunk but drains more of the guts and esophagus fungus nutrition purchase butenafine 15gm. Thoracic duct begins in the stomach as an upward continuation of cisterna chyli at the lower border of the twelfth thoracic vertebra. In the neck, it arches laterally on the level of the transverse means of the seventh cervical vertebra. Its arch rises three or 4 cm above the clavicle and curves anteriorly in entrance of the vertebral system. It drains the lymph from entire of the body besides the proper upper quadrant (for details see pages 166 and 167 of General Anatomy by Vishram Singh). Tributaries in the neck Apart from the tributaries in the thorax and abdomen, the thoracic duct receives the next tributaries in the neck: 1. This a part of trachea is crossed by the isthmus of thyroid gland, inferior thyroid veins, the thyroidea ima artery (if present), and jugular venous arch. The thoracic duct lies on its left lateral border before arching over the triangle of the vertebral artery on the left facet (for details see chapter 10). Each vein is formed by the union of corresponding inside jugular and subclavian veins behind the medial finish of the clavicle. They finish by becoming a member of to type superior vena cava behind the lower border of the proper first costal cartilage on the margin of the sternum. The phrenic nerve and inside thoracic artery lie posterior to it whereas anterior to it lie sternohyoid and sternothyroid muscle tissue. The left brachiocephalic vein runs obliquely to cross behind the higher part of the manubrium sterni to be part of the right brachiocephalic vein and is therefore for a lot longer. The proper lymphatic duct, right jugular trunk, and right subclavian trunk enter the proper vein. Pre- and Paravertebral Regions and Root of the Neck 179 Golden Facts to Remember " Longest prevertebral muscle " Longest and largest scalene muscle " Scalenus medius arises from the transverse processes of all cervical vertebrae besides " Key muscle on the root of the neck " Largest cervical sympathetic ganglion " Cervical rib " Root of the neck " Stellate ganglion " Smallest prevertebral muscle " Accessory phrenic nerve Longus cervicis Scalenus medius Transverse process of 1st cervical vertebra Scalenus anterior Superior cervical sympathetic ganglion Enlarged costal component of transverse strategy of C7 vertebra Area of neck instantly above the thoracic inlet Cervicothoracic ganglion (p. She utterly recovered of her signs after the surgical removing of the cervical rib. It is an enlarged costal component of the transverse means of the seventh cervical vertebra. It is a slender triangular area bounded anteriorly by scalenus anterior, posteriorly by scalenus medius and inferiorly by the upper surface of the primary rib. This check is carried out to assess the functional standing of the arterial supply of the upper limb. The patient sitting on a stool is requested to take a deep breath and on the similar time turn his/her face in path of the affected facet. Oral Cavity 181 Blood Vessels Each lip is supplied by labial branches of facial artery. Each lip has an arterial arch shaped by the end-on anastomosis between labial branches of the facial arteries. Lymphatics the lymphatics from the central part of the lower lip drain into submental lymph nodes. The lymphatics from lateral elements of decrease lip and entire of upper lip drain into submandibular lymph nodes. The upper lip is equipped by labial branches of the infraorbital nerve (a department of maxillary division) and lower lip by the mental nerve (a department of mandibular division of the trigeminal nerve). The purple portions of lip are highly sensitive and represented by a big space within the sensory cortex of cerebral hemisphere. The lymphatics from cheek drain into the submandibular and preauricular lymph nodes. Mucus lining of the cheek the internal aspect of the cheek is lined by stratified squamous epithelium. It is pierced by parotid duct opposite the maxillary higher molar tooth at a small parotid papilla.

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The apex of philtrum is towards the nasal septum and the bottom downwards where it terminates in a thicker space called tubercle of the higher lip anti fungal house spray order butenafine 15gm amex. The corners of mouth where upper and decrease lips meet are referred to as labial commissure antifungal liquid soap 15gm butenafine with visa. The groove working upward between the labial commissure and the alae of nostril is identified as nasolabial sulcus fungus za mdomoni buy butenafine 15gm lowest price. The lips are a typical web site for carcinoma antifungal treatment for tinea versicolor 15gm butenafine amex, principally affecting people above 60 years of age. Carcinoma of the lip often occurs in lower lip (93%) as in comparison with the higher lip (5%). Uvula Palatopharyngeal arch Palatoglossal arch Palatine tonsil the bone underlying the upper lip is the alveolar process of the maxilla, whereas the bone underlying the decrease lip is the alveolar strategy of the mandible. The alveolar processes comprise enamel and are known as maxillary and mandibular tooth. The labial mucosa is steady with the equally pink and thick buccal mucosa that lines the inside cheek. On the inner facet of buccal mucosa reverse the upper second molar tooth is a small elevation known as parotid papilla on which opens the parotid duct. The gingiva is half of oral mucosa that covers the alveolar processes of the jaws. The roof of oral cavity which presents two portions: (a) a agency anterior portion is called onerous palate and a flexible posterior portion is called taste bud. A cone-shaped projection hanging down from the middle of the posterior free margin known as uvula of the palate, which is steady with palatopharyngeal arch on each side. A curved, leaf-like flap of cartilage is positioned behind the bottom of tongue and in entrance of oropharynx. The tonsil lies in triangular fossa called tonsillar fossa located between the palatoglossal and palatopharyngeal arches. Note that the tonsils lie reverse the angle of mandible between the back of tongue and soft palate. Topographically, the constructions of the neck are organized into anterior and posterior compartments. In the midline there are two tubes: the respiratory tract (larynx and trachea) in entrance and digestive tract (pharynx and esophagus) behind. The thyroid gland clasps the entrance and sides of the larynx and trachea and overlaps the carotid tree on either side. These constructions are bounded anteriorly by pretracheal fascia, which extends on either aspect to merge with the investing layer of deep cervical fascia deep to sternocleidomastoid. On either side of the midline tubes are several ascending and descending neurovascular structures, similar to carotid tree consisting of common carotid, inside carotid and exterior carotid arteries, internal jugular vein and last four cranial nerves. At the higher end these constructions enter or depart the cranium by way of varied foramina in the base of the cranium, viz. This musculoskeletal block is bounded by prevertebral fascia, which merges behind on either facet with the deep fascia enclosing the trapezius muscle. The vertebral canal throughout the cervical vertebral column provides passage to the spinal cord. The roots of cervical spinal nerves come out via intervertebral foramina on this area. The ventral rami of the first 4 cervical nerves kind the cervical plexus and ventral rami of the decrease four cervical nerves along with ventral ramus of T1 kind the brachial plexus. The spinal wire, digestive and respiratory tracts, and major blood vessels traverse this highly flexible area. The neural structures current in the area include: last 4 cranial nerves and cervical and brachial plexuses. A new child baby has no visible neck as a result of his or her lower jaw and chin touches the shoulders and thorax. The following structures can be simply palpated in the anterior area of the neck. Hyoid bone: It is situated in a depression behind and slightly under the chin and could be simply felt if the neck is barely extended.

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Superficial temporal artery Nerve behind the ear is the posterior auricular department of the facial nerve antifungal shoe spray purchase butenafine once a day. Supratrochlear artery fungus eye purchase 15 gm butenafine with amex, enters the scalp round supraorbital margin one-finger breadth lateral to the midline fungus science definition order butenafine 15 gm fast delivery. Supraorbital artery anti fungal bacterial cream cheap butenafine 15 gm on-line, enters the scalp via supraorbital notch 2­3 cm lateral to the supratrochlear artery. Superficial temporal artery (the smaller terminal branch of the exterior carotid), enters the scalp in entrance of the foundation of zygoma and divides into anterior and posterior branches. Occipital artery, enters the scalp halfway between the ear and the exterior occipital protuberance. The first two arteries are the branches of ophthalmic artery from inside carotid artery while later three arteries are the branches of external carotid artery. Auriculotemporal, a department of Third occipital, derived from mandibular division of dorsal ramus of 3rd cervical trigeminal nerve nerve the arteries of 1 side freely anastomose with one another. There is also cross anastomosis between the 50 Textbook of Anatomy: Head, Neck, and Brain arteries of two sides. Thus the scalp is also the positioning of potential collateral circulation between the exterior and internal carotid arteries. Clinical correlation · the scalp wounds bleed profusely however heal quickly as a end result of excessive vascularity. To ensure the blood provide of the scalp, the skin incisions ought to be placed in such a method that the bottom of the flap incorporates the stem of one of the arteries supplying the scalp. Therefore life-threatening scalp-hemorrhage could be stopped as a first-aid measure, by encircling the top just above the ears and eyebrows with a string or strong-strap of cotton and tied tightly. Emissary Veins the veins connecting the veins outdoors the cranium with the intracranial dural venous sinuses by passing by way of foramina within the cranium are known as emissary veins. Emissary Veins within the Region of the Scalp On both sides of the midline within the region of the scalp two units of emissary veins are encountered, viz. Parietal emissary vein, which passes through parietal foramen and communicates with the superior sagittal sinus. Mastoid emissary vein, which passes through mastoid foramen and communicates with the sigmoid sinus. Supratrochlear and supraorbital veins: They be a part of each other on the medial angle of the attention to kind the angular vein, which continues downwards because the facial vein behind the facial artery. Superficial temporal vein: It descends in front of tragus to enter the parotid gland where it joins the maxillary vein to form the retromandibular vein, which terminates by dividing into anterior and posterior divisions. The anterior division unites with the facial vein to type frequent facial vein, which drains into the internal jugular vein. Posterior auricular vein: It descends behind the auricle and unites with the posterior division of the retromandibular vein to type the exterior jugular vein, which drains into the subclavian vein. The veins of the scalp talk with intracranial dural venous sinuses via emissary veins. The lymphatics from posterior part of the scalp drain into posterior auricular (mastoid) and occipital lymph nodes. Scalp, Temple, and Face 51 Clinical correlation Hair Skin (1) Connective tissue (2) Extension of epicranial aponeurosis (3) Temporal fascia (4) Temporalis muscle (5) Pericranium (6) Muscle of auricle Zygomatic arch the temporal fascia is silvery-white thick fibrous sheet, which is kind of aponeurotic in character. It extends superiorly up to the hair line, inferiorly as a lot as the chin and base of the mandible and on all sides as much as the auricle. For correct understanding of anatomy of the face, one ought to first research the features on the anterior facet of the cranium (norma frontalis) described in Chapter 2 and dwelling anatomy described in Chapter 1. The sweat glands assist to regulate the physique temperature whereas sebaceous glands keep the face oily by their secretion. Skin and connective tissue: these two layers are identical as within the area of the scalp. Extension of epicranial aponeurosis: It provides origin to the auricularis anterior and auricularis superior muscular tissues of the auricle. Inferiorly the temporal fascia splits into two layers, which are attached to the internal and outer lips of the zygomatic arch. A small gap between the two layers accommodates (a) fat, (b) a department from superficial temporal artery, and (c) zygomaticotemporal nerve. The superficial surface of temporal fascia is related to: (a) superficial temporal vessels, (b) auriculotemporal nerve, and (c) temporal branches of the facial nerve. The deep floor of temporal fascia provides origin to some fibres of temporalis muscle.

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Clinical correlation Lesions of trochlear nerve: the damage of trochlear nerve will cause paralysis of the superior indirect muscle of the eyeball fungus gnats vegetable garden cheap 15gm butenafine visa. This will clinically current as: (a) extorsion of the eyeball and weak spot of downward gaze fungus gnats kill home remedy generic butenafine 15gm online. As a end result fungus link diet order butenafine in united states online, the patient faces problem whereas going downstairs or studying newspaper fungus feet purchase cheapest butenafine, and (b) diplopia (double vision), which occurs when the affected person seems laterally and in glances on looking downward. It is only motor and supplies just one muscle - the lateral rectus of the eyeball. Eyeball Superior indirect Levator palpebrae superioris Unique Feature It is most prone to harm of all the cranial nerves throughout elevated intracranial strain. They arise from the abducent nucleus within the pons and supply the lateral rectus muscle of the eyeball. They carry proprioceptive sensations from the lateral rectus and terminate within the mesencephalic nucleus of the trigeminal nerve. The nerve runs upward, ahead, and laterally dorsal to the anterior cerebellar artery and pierces the dura mater over the clivus inferolateral to the dorsum sellae. It consists of three giant nerves: ophthalmic, maxillary, and mandibular, therefore the name trigeminal nerve (L. It is a motor nerve to the muscular tissues of mastication and a number of other small muscular tissues and the principal sensory nerve of the pinnacle and face. Internal carotid artery Superior orbital fissure Cavernous sinus Upper border of petrous temporal bone Abducent nerve Anterior inferior cerebellar artery Facial nerve Motor nucleus of facial nerve Unique Features 1. Its sensory ganglion (largest in the body) is positioned inside the cranial cavity (cf. In the cavernous sinus, it runs ahead inferolateral to the interior carotid artery. The nerve enters the orbit by way of the superior orbital fissure within the tendinous ring lateral to two divisions of oculomotor and nasociliary nerves. In the orbit, it runs forward, towards the lateral facet to enter the orbital floor of the lateral rectus muscle which it supplies. They come up from motor the nucleus of the trigeminal nerve within the pons and provide the muscular tissues derived from the 1st pharyngeal arch, viz. The exteroceptive neurons are pseudounipolar and their cell our bodies are situated within the trigeminal ganglion. The proprioceptive neurons are unipolar and their cell our bodies are positioned in the mesencephalic nucleus of the trigeminal nerve. Clinical correlation Lesions of abducent nerve: the abducent nerve is mostly damaged during increased intracranial strain. During elevated intracranial pressure, the nerve is stretched due to the descent of brainstem. Consequently, the nerve is cut by the sharp bony fringe of the petrous temporal bone. The paralysis of lateral rectus muscle following the harm to the abducent nerve leads to: (a) convergent squint as a end result of the unopposed action of medial rectus, (b) lack of ability to abduct the attention, and (c) diplopia (double vision) with most separation of two images while wanting towards the paralyzed facet. The sensory root passes ahead and laterally over the apex of the petrous temporal bone to enter the middle cranial fossa. The mandibular nerve (the largest division) arises from the trigeminal ganglion and instantly enters the infratemporal fossa through the foramen ovale. The motor root of the trigeminal nerve after rising from the pons passes ahead and laterally deep to the sensory root and trigeminal ganglion and enters the infratemporal fossa via the foramen ovale. After rising from the foramen ovale, it immediately joins the mandibular nerve and thus the mandibular nerve accommodates each the motor and sensory fibres. The ophthalmic division of the maxillary nerve is described intimately in Chapter 19 and maxillary and mandibular divisions in Chapter 10. The sensory root may be reduce right here in order to relieve the ache of trigeminal neuralgia.

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