Atlas of the Sensory Organs Functional and Clinical Anatomy
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ATLAS OF THE SENSORY ORGANS ATLAS OF THE SENSORY ORGANS FUNCTIONAL AND CLINICAL ANATOMY ANDRÁS CSILLAG, MD, PhD, DSc Department of Anatomy, Histology, and Embryology Semmelweis University, Budapest, Hungary HUMANA PRESS TOTOWA, NEW JERSEY © 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: [email protected]; or visit our Website: www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. 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Production Editor: Robin B. Weisberg Cover Illustration: Cover design by Patricia F. Cleary Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829-412-9/05 $25.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN 1-59259-849-8 Library of Congress Csillag, András (András Laszlo), 1949- Atlas of the sensory organs : functional and clinical anatomy / András Csillag. p. ; cm. Includes bibliographical references and index. ISBN 1-588-412-9 (alk. paper) 1. Sense organs--Atlases. [DNLM: 1. Ear--anatomy & histology--Atlases. 2. Eye--anatomy & histology--Atlases. 3. Nose--anatomy & histology--Atlases. 4. Sensation--physiology--Atlases. 5. Skin--anatomy & histology--Atlases. 6. Tongue--anatomy & histology--Atlases. WV 17 C958a 2005] I. Title. QM501.C75 2005 611'.8--dc22 20040442382 Preface Sensory organs constitute an elaborate and demanding and requirements of clinical research. However, both chapter of the anatomical curriculum. The structures are the surgery and diagnostics of ophthalmology and ENT confined to a small area, yet have to be discussed to a have undergone an impressive development in the re- degree of detail that has no match in human anatomy cent years. except for neuroanatomy. Partly owing to tradition and In the case of ophthalmic surgery, laser treatment of partly because of a real practical significance, there is an retinal detachment, lens implantation, corneal grafts, and unprecedented amount of nomenclature involved in the surgical treatment of ocular lesions or orbital tumors are field of sensory organs, a comprehensive knowledge of well known interventions. Modern diagnostic methods which presents a difficult task even for medically quali- have revealed more refined anatomical details in the liv- fied people. Given the great clinical importance of the ing patient (e.g., mapping of retinal blood vessels by topic, in particular the eye and the ear, the time allocated fluorescent dye markers, FLAG). Electrical signals of for the study of sensory organs is remarkably limited in the retina (ERG) are indicative of functional disorders. most anatomical curricula, with the organs usually being Fine details of the anatomy of the living eye can be discussed in the framework of (or as a supplement to) the observed by using modern diagnostic imaging methods nervous system. Diseases of the organs of vision and (e.g., keratometry, ultrasonography). Experimental hearing are an everyday occurrence in the work of the research and medical applications have brought an general practitioner. Furthermore, the latter are dealt with impressive development in the analysis of the retina, by separate medical specialties: ophthalmology and oto- visual pathway and cortical visual field. Retinal photo- rhinolaryngology (ENT). Novel diagnostic and surgical receptors of specific function and chemical nature can results as well as new questions raised by these may widen now be demonstrated by fluorescent immunohistochem- the knowledge of modern anatomy and may also prompt, istry. Precise projections of the human visual pathway and rightfully expect, new answers from macroscopic and have been described using postmortem pathway degen- microscopic anatomy. eration and tract tracing methods (such data used to be Specialized and comprehensive studies covering all available from animal experiments only). Further tech- sensory organs are rarely encountered in the medical niques of interest comprise the monitoring of a mito- literature. Sufficiently detailed descriptions can only be chondrial enzyme cytochrome oxidase histochemistry. found in large and expensive handbooks, consisting of The functionally active elements (and potential disor- several volumes, often as a chapter of neuroanatomy. ders) of the visual cortex of wakeful patients can now be Shorter, more concise editions confined to the topic are detected by the most up-to-date diagnostic methods, such either at the level of popular science, or deal with the as event-related potentials (ERP), visually evoked po- subject from a specific aspect such as comparative tentials (VEP), magnetoencephalography (MEG) and anatomy, evolution, etc. Moreover, the different sen- direct intraoperative microelectrode recordings, all char- sory organs are usually discussed in separate volumes. acterized by good time resolution. Further techniques of The current atlas is an attempt to demonstrate all major high spatial resolution (hence of particular anatomical sensory systems together with their neural pathways, relevance) comprise regional cerebral blood flow from primary sensation all the way to the brain. (rCBF) measurements using single photon emission The morphology of sensory organs is often described spectroscopy (SPECT) or positron emission spectros- separately from their function and also from the results copy (PET). Apart from measurement of local blood v VI PREFACE perfusion, oxygen and glucose uptake, the latter spectro- of the chapters contain a considerable amount of original scopic methods enable also the regional analysis of neu- light and electron microscopic specimens and, in some rotransmitters and receptors. cases, experimental studies, such as immunohistochem- Concerning the anatomy of the ear, important progress istry, have also been included. has been made by the use of modern surgical and endo- The majority of original specimens and recordings scopic techniques. This prompted a reappraisal and led are accompanied by schematic explanatory drawings. to a renaissance of previously existing refined prepara- Furthermore, overview figures and tables assisting the tory methods demonstrating the highly complicated understanding of the material are also included. microanatomical relations of the organs of hearing and Each chapter begins with a detailed anatomical over- equilibrium. The size of their structural elements verges view, covering also the development (ontogeny) of sensory on the border of visibility, therefore the visualization of organs, the functional aspect of sensory mechanisms. This details requires microphotography and glass fiber endo- introductory part is followed by original images from scopy of fresh cadaver tissue. Modern diagnostic meth- macroscopic, microscopic and