Head & Neck Muscle Table
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Selecting Different Approaches for Palate and Pharynx Surgery
SPECIAL ISSUE 4: INVITED ARTICLE Selecting Different Approaches for Palate and Pharynx Surgery: Palatopharyngeal Arch Staging System Rodolfo Lugo-Saldaña1 , Karina Saldívar-Ponce2 , Irina González-Sáez3 , Daniela Hernández-Sirit4 , Patricia Mireles-García5 ABSTRACT The examination of the anatomical structures involved in the upper airway collapse in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) is a key for integrated evaluation of patients. Our proposal is for a noninvasive classification system that guides us about the presence of anatomical differences between the palatopharyngeal muscle (PFM). The functions of the PFM are narrowing the isthmus, descending the palate, and raising the larynx during swallowing; these characteristics give the PFM a special role in the collapse of the lateral pharyngeal wall. Complete knowledge of the anatomy and classification of different variants can guide us to choose the appropriate surgical procedures for the lateral wall collapse. Until now there is not a consensus about description of the trajectory or anatomical variants of the PFM into oropharynx, the distance between both muscles, and the muscle tone. Here we also present the relationship between the lateral wall surgeries currently available (lateral pharyngoplasty by Cahali, expansion sphincteroplasty by Pang, relocation pharyngoplasty by Li, Roman blinds pharyngoplasty by Mantovani, and barbed sutures pharyngoplasty by Vicini) with the proposed classification of the palatopharyngeal arch staging system (PASS). Keywords: -
Larynx Anatomy
LARYNX ANATOMY Elena Rizzo Riera R1 ORL HUSE INTRODUCTION v Odd and median organ v Infrahyoid region v Phonation, swallowing and breathing v Triangular pyramid v Postero- superior base àpharynx and hyoid bone v Bottom point àupper orifice of the trachea INTRODUCTION C4-C6 Tongue – trachea In women it is somewhat higher than in men. Male Female Length 44mm 36mm Transverse diameter 43mm 41mm Anteroposterior diameter 36mm 26mm SKELETAL STRUCTURE Framework: 11 cartilages linked by joints and fibroelastic structures 3 odd-and median cartilages: the thyroid, cricoid and epiglottis cartilages. 4 pair cartilages: corniculate cartilages of Santorini, the cuneiform cartilages of Wrisberg, the posterior sesamoid cartilages and arytenoid cartilages. Intrinsic and extrinsic muscles THYROID CARTILAGE Shield shaped cartilage Right and left vertical laminaà laryngeal prominence (Adam’s apple) M:90º F: 120º Children: intrathyroid cartilage THYROID CARTILAGE Outer surface à oblique line Inner surface Superior border à superior thyroid notch Inferior border à inferior thyroid notch Superior horns à lateral thyrohyoid ligaments Inferior horns à cricothyroid articulation THYROID CARTILAGE The oblique line gives attachement to the following muscles: ¡ Thyrohyoid muscle ¡ Sternothyroid muscle ¡ Inferior constrictor muscle Ligaments attached to the thyroid cartilage ¡ Thyroepiglottic lig ¡ Vestibular lig ¡ Vocal lig CRICOID CARTILAGE Complete signet ring Anterior arch and posterior lamina Ridge and depressions Cricothyroid articulation -
The Muscular System Views
1 PRE-LAB EXERCISES Before coming to lab, get familiar with a few muscle groups we’ll be exploring during lab. Using Visible Body’s Human Anatomy Atlas, go to the Views section. Under Systems, scroll down to the Muscular System views. Select the view Expression and find the following muscles. When you select a muscle, note the book icon in the content box. Selecting this icon allows you to read the muscle’s definition. 1. Occipitofrontalis (epicranius) 2. Orbicularis oculi 3. Orbicularis oris 4. Nasalis 5. Zygomaticus major Return to Muscular System views, select the view Head Rotation and find the following muscles. 1. Sternocleidomastoid 2. Scalene group (anterior, middle, posterior) 2 IN-LAB EXERCISES Use the following modules to guide your exploration of the head and neck region of the muscular system. As you explore the modules, locate the muscles on any charts, models, or specimen available. Please note that these muscles act on the head and neck – those that are located in the neck but act on the back are in a separate section. When reviewing the action of a muscle, it will be helpful to think about where the muscle is located and where the insertion is. Muscle physiology requires that a muscle will “pull” instead of “push” during contraction, and the insertion is the part that will move. Imagine that the muscle is “pulling” on the bone or tissue it is attached to at the insertion. Access 3D views and animated muscle actions in Visible Body’s Human Anatomy Atlas, which will be especially helpful to visualize muscle actions. -
Axis Scientific Skull with Muscle Origins and Insertions A-108851
Axis Scientific Skull with Muscle Origins and Insertions A-108851 *Muscle Origins = RED Anterior View Occipital Bone Posterior View *Muscle Insertions = BLUE Posterior Cerebral Artery Frontal Bone Basilar Artery Pontine Arteries Parietal Bone Nasal Bone Temporal Bone Sphenoid Bone Temporalis Parietal Bone Occipitofrontalis Occipital Bone Lacrimal Bone Sternocleidomastoid Trapezius Temporalis Semispinalis Capitis Temporal Bone Corrugator Supercilii Splenius Capitis Longissimus Capitis Orbicularis Oculi Obliquus Capitis Superior Temporal Basilar Artery Bone Procerus Rectis Capitis C1 Posterior Major Vertebral Artery Levator Labii Superioris C2 Alaeque Nasi Rectis Capitis Posterior Minor Sphenoid Levator Labii Superioris Posterior Digastric Zygomatic Bone Bone C3 Nasalis (Transverse Part) Rectis Capitis C4 Masseter Lateralis Spinal Nerve Zygomaticus Major C5 Zygomatic Medial Pterygoid Bone Zygomaticus Minor C6 Temporalis Mylohyoid C7 Mandible Levator Anguli Oris Vomer Nasalis (Alar Part) Spinal Nerve Spinal Cord Maxilla Orbicularis Oris Depressor Septi Nasi Masseter Medial Superior Masseter Mandible Orbicularis Oris Constrictor Pterygoid Inferior View Styloglossus Platysma Mylohyoid Depressor Stylohyoid Anguli Oris Anterior Stylopharyngeus Spinal Nerve Depressor Digastric Labii Inferioris Posterior Geniohyoid Digastric Vertebral Artery Mentalis Rectis Capitis Genioglossus Lateralis Rectis Capitis Buccinator Mandible Posterior Major Rectis Capitis Posterior Minor Frontal Bone Corrugator Supercilii Orbicularis Oculi Lacrimal Bone Depressor -
Questions on Human Anatomy
Standard Medical Text-books. ROBERTS’ PRACTICE OF MEDICINE. The Theory and Practice of Medicine. By Frederick T. Roberts, m.d. Third edi- tion. Octavo. Price, cloth, $6.00; leather, $7.00 Recommended at University of Pennsylvania. Long Island College Hospital, Yale and Harvard Colleges, Bishop’s College, Montreal; Uni- versity of Michigan, and over twenty other medical schools. MEIGS & PEPPER ON CHILDREN. A Practical Treatise on Diseases of Children. By J. Forsyth Meigs, m.d., and William Pepper, m.d. 7th edition. 8vo. Price, cloth, $6.00; leather, $7.00 Recommended at thirty-five of the principal medical colleges in the United States, including Bellevue Hospital, New York, University of Pennsylvania, and Long Island College Hospital. BIDDLE’S MATERIA MEDICA. Materia Medica, for the Use of Students and Physicians. By the late Prof. John B Biddle, m.d., Professor of Materia Medica in Jefferson Medical College, Phila- delphia. The Eighth edition. Octavo. Price, cloth, $4.00 Recommended in colleges in all parts of the UnitedStates. BYFORD ON WOMEN. The Diseases and Accidents Incident to Women. By Wm. H. Byford, m.d., Professor of Obstetrics and Diseases of Women and Children in the Chicago Medical College. Third edition, revised. 164 illus. Price, cloth, $5.00; leather, $6.00 “ Being particularly of use where questions of etiology and general treatment are concerned.”—American Journal of Obstetrics. CAZEAUX’S GREAT WORK ON OBSTETRICS. A practical Text-book on Midwifery. The most complete book now before the profession. Sixth edition, illus. Price, cloth, $6.00 ; leather, $7.00 Recommended at nearly fifty medical schools in the United States. -
The Articulatory System Chapter 6 Speech Science/ COMD 6305 UTD/ Callier Center William F. Katz, Ph.D
The articulatory system Chapter 6 Speech Science/ COMD 6305 UTD/ Callier Center William F. Katz, Ph.D. STRUCTURE/FUNCTION VOCAL TRACT CLASSIFICATION OF CONSONANTS AND VOWELS MORE ON RESONANCE ACOUSTIC ANALYSIS/ SPECTROGRAMS SUPRSEGMENTALS, COARTICULATION 1 Midsagittal dissection From Kent, 1997 2 Oral Cavity 3 Oral Structures – continued • Moistened by saliva • Lined by mucosa • Saliva affected by meds 4 Tonsils • PALATINE* (laterally – seen in oral periph • LINGUAL (inf.- root of tongue) • ADENOIDS (sup.) [= pharyngeal] • Palatine, lingual tonsils are larger in children • *removed in tonsillectomy 5 Adenoid Facies • Enlargement from infection may cause problems (adenoid facies) • Can cause problems with nasal sounds or voicing • Adenoidectomy; also tonsillectomy (for palatine tonsils) 6 Adenoid faces (example) 7 Oral structures - frenulum Important component of oral periphery exam Lingual frenomy – for ankyloglossia “tongue-tie” Some doctors will snip for infants, but often will loosen by itself 8 Hard Palate Much variability in palate shape and height Very high vault 9 Teeth 10 Dentition - details Primary (deciduous, milk teeth) Secondary (permanent) n=20: n=32: ◦ 2 incisor ◦ 4 incisor ◦ 1 canine ◦ 2 canine ◦ 2 molar ◦ 4 premolar (bicuspid) Just for “fun” – baby ◦ 6 molar teeth pushing in! NOTE: x 2 for upper and lower 11 Types of malocclusion • Angle’s classification: • I, II, III • Also, individual teeth can be misaligned (e.g. labioversion) Also “Neutrocclusion/ distocclusion/mesiocclusion” 12 Dental Occlusion –continued Other terminology 13 Mandible Action • Primary movements are elevation and depression • Also…. protrusion/retraction • Lateral grinding motion 14 Muscles of Jaw Elevation Like alligators, we are much stronger at jaw elevation (closing to head) than depression 15 Jaw Muscles ELEVATORS DEPRESSORS •Temporalis ✓ •Mylohyoid ✓ •Masseter ✓ •Geniohyoid✓ •Internal (medial) Pterygoid ✓ •Anterior belly of the digastric (- Kent) •Masseter and IP part of “mandibular sling” •External (lateral) pterygoid(?)-- also protrudes and rocks side to side. -
Dr. Maue-Dickson Is Associate Professor of Pediat- Rics, University of Miami, Mailman Center for Child Development, University
Section II. Anatomy and Physiology WILMA MAUE-DICKSON, Ph.D. (CHAIRMAN) Introduction Middle Ear Musculature, The Auditory Tube, and The Velopharyngeal This Section has been prepared for the Mechanism purpose of updating the previous report, "Status of Research in Cleft Palate: Anat- 1. Tur Mippour® Ear omy and Physiology," published in two parts in the Cleft Palate Journal, Volume 11, The authors of the previous report 1974, and Volume 12, 1975. questioned the validity of the concept that As indicated in the previous two-part the tensor tympani and the stapedius mus- report, it is imperative to consider not only cles provide protection to the inner ear the palate but all of the oral-facial-pharyn- from loud sounds, except perhaps for geal system, both in normal and abnormal minimal protection (less than 10 dB) at low conditions, and both in the adult and in frequencies. They also cited research the developing child. Thus, this review in- which indicated that stapedius contraction cludes normal, abnormal, and develop- is more closely associated with voicing and mental studies on middle ear musculature, coughing than with acoustic stimuli, and the auditory tube, the velopharyngeal that the middle ear muscles might be in- mechanism, the tongue, the larynx, the volved in auditory tube opening. face and mandible, and blood supply and The literature reviewed for this report innervation relevant to cleft lip and palate. does not resolve all of these questions, but Though the relevance of embryology of it does add some focus for future research. the orofacial complex is obvious, it has Greisen and Neergaard (1975) used extra- been reviewed in a recently published re- tympanic phonometry to study middle ear port (Dickson, 1975) and will not be in- reflex activity and were able to demon- cluded as a separate topic in this review strate a tensor tympani reflex in response because of space limitations. -
The Myloglossus in a Human Cadaver Study: Common Or Uncommon Anatomical Structure? B
Folia Morphol. Vol. 76, No. 1, pp. 74–81 DOI: 10.5603/FM.a2016.0044 O R I G I N A L A R T I C L E Copyright © 2017 Via Medica ISSN 0015–5659 www.fm.viamedica.pl The myloglossus in a human cadaver study: common or uncommon anatomical structure? B. Buffoli*, M. Ferrari*, F. Belotti, D. Lancini, M.A. Cocchi, M. Labanca, M. Tschabitscher, R. Rezzani, L.F. Rodella Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy [Received: 1 June 2016; Accepted: 18 July 2016] Background: Additional extrinsic muscles of the tongue are reported in literature and one of them is the myloglossus muscle (MGM). Since MGM is nowadays considered as anatomical variant, the aim of this study is to clarify some open questions by evaluating and describing the myloglossal anatomy (including both MGM and its ligamentous counterpart) during human cadaver dissections. Materials and methods: Twenty-one regions (including masticator space, sublin- gual space and adjacent areas) were dissected and the presence and appearance of myloglossus were considered, together with its proximal and distal insertions, vascularisation and innervation. Results: The myloglossus was present in 61.9% of cases with muscular, ligamen- tous or mixed appearance and either bony or muscular insertion. Facial artery pro- vided myloglossal vascularisation in the 84.62% and lingual artery in the 15.38%; innervation was granted by the trigeminal system (buccal nerve and mylohyoid nerve), sometimes (46.15%) with hypoglossal component. Conclusions: These data suggest us to not consider myloglossus as a rare ana- tomical variant. -
The Ophthalmic Artery Ii
Brit. J. Ophthal. (1962) 46, 165. THE OPHTHALMIC ARTERY II. INTRA-ORBITAL COURSE* BY SOHAN SINGH HAYREHt AND RAMJI DASS Government Medical College, Patiala, India Material THIS study was carried out in 61 human orbits obtained from 38 dissection- room cadavers. In 23 cadavers both the orbits were examined, and in the remaining fifteen only one side was studied. With the exception of three cadavers of children aged 4, 11, and 12 years, the specimens were from old persons. Method Neoprene latex was injected in situ, either through the internal carotid artery or through the most proximal part of the ophthalmic artery, after opening the skull and removing the brain. The artery was first irrigated with water. After injection the part was covered with cotton wool soaked in 10 per cent. formalin for from 24 to 48 hours to coagulate the latex. The roof of the orbit was then opened and the ophthalmic artery was carefully studied within the orbit. Observations COURSE For descriptive purposes the intra-orbital course of the ophthalmic artery has been divided into three parts (Singh and Dass, 1960). (1) The first part extends from the point of entrance of the ophthalmic artery into the orbit to the point where the artery bends to become the second part. This part usually runs along the infero-lateral aspect of the optic nerve. (2) The second part crosses over or under the optic nerve running in a medial direction from the infero-lateral to the supero-medial aspect of the nerve. (3) The thirdpart extends from the point at which the second part bends at the supero-medial aspect of the optic nerve to its termination. -
Cranial Nerves 1, 5, 7-12
Cranial Nerve I Olfactory Nerve Nerve fiber modality: Special sensory afferent Cranial Nerves 1, 5, 7-12 Function: Olfaction Remarkable features: – Peripheral processes act as sensory receptors (the other special sensory nerves have separate Warren L Felton III, MD receptors) Professor and Associate Chair of Clinical – Primary afferent neurons undergo continuous Activities, Department of Neurology replacement throughout life Associate Professor of Ophthalmology – Primary afferent neurons synapse with secondary neurons in the olfactory bulb without synapsing Chair, Division of Neuro-Ophthalmology first in the thalamus (as do all other sensory VCU School of Medicine neurons) – Pathways to cortical areas are entirely ipsilateral 1 2 Crania Nerve I Cranial Nerve I Clinical Testing Pathology Anosmia, hyposmia: loss of or impaired Frequently overlooked in neurologic olfaction examination – 1% of population, 50% of population >60 years Aromatic stimulus placed under each – Note: patients with bilateral anosmia often report nostril with the other nostril occluded, eg impaired taste (ageusia, hypogeusia), though coffee, cloves, or soap taste is normal when tested Note that noxious stimuli such as Dysosmia: disordered olfaction ammonia are not used due to concomitant – Parosmia: distorted olfaction stimulation of CN V – Olfactory hallucination: presence of perceived odor in the absence of odor Quantitative clinical tests are available: • Aura preceding complex partial seizures of eg, University of Pennsylvania Smell temporal lobe origin -
A Review of Central Retinal Artery Occlusion: Clinical Presentation And
Eye (2013) 27, 688–697 & 2013 Macmillan Publishers Limited All rights reserved 0950-222X/13 www.nature.com/eye 1 2 1 2 REVIEW A review of central DD Varma , S Cugati , AW Lee and CS Chen retinal artery occlusion: clinical presentation and management Abstract Central retinal artery occlusion (CRAO) is an that in turn place an individual at risk of future ophthalmic emergency and the ocular ana- cerebral stroke and ischaemic heart disease. logue of cerebral stroke. Best evidence reflects Although analogous to a cerebral stroke, there that over three-quarters of patients suffer is currently no guideline-endorsed evidence for profound acute visual loss with a visual acuity treatment. Current options for therapy include of 20/400 or worse. This results in a reduced the so-called ‘standard’ therapies, such as functional capacity and quality of life. There is sublingual isosorbide dinitrate, systemic also an increased risk of subsequent cerebral pentoxifylline or inhalation of a carbogen, stroke and ischaemic heart disease. There are hyperbaric oxygen, ocular massage, globe no current guideline-endorsed therapies, compression, intravenous acetazolamide and although the use of tissue plasminogen acti- mannitol, anterior chamber paracentesis, and vator (tPA) has been investigated in two methylprednisolone. None of these therapies randomized controlled trials. This review will has been shown to be better than placebo.5 describe the pathophysiology, epidemiology, There has been recent interest in the use of and clinical features of CRAO, and discuss tissue plasminogen activator (tPA) with two current and future treatments, including the recent randomized controlled trials on the 1Flinders Comprehensive use of tPA in further clinical trials. -
New Knowledge Resource for Anatomy Enables Comprehensive Searches of the Literature on the Feeding Muscles of Mammals
RESEARCH ARTICLE Muscle Logic: New Knowledge Resource for Anatomy Enables Comprehensive Searches of the Literature on the Feeding Muscles of Mammals Robert E. Druzinsky1*, James P. Balhoff2, Alfred W. Crompton3, James Done4, Rebecca Z. German5, Melissa A. Haendel6, Anthony Herrel7, Susan W. Herring8, Hilmar Lapp9,10, Paula M. Mabee11, Hans-Michael Muller4, Christopher J. Mungall12, Paul W. Sternberg4,13, a11111 Kimberly Van Auken4, Christopher J. Vinyard5, Susan H. Williams14, Christine E. Wall15 1 Department of Oral Biology, University of Illinois at Chicago, Chicago, Illinois, United States of America, 2 RTI International, Research Triangle Park, North Carolina, United States of America, 3 Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America, 4 Division of Biology and Biological Engineering, M/C 156–29, California Institute of Technology, Pasadena, California, United States of America, 5 Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America, 6 Oregon Health and Science University, Portland, Oregon, ’ OPEN ACCESS United States of America, 7 Département d Ecologie et de Gestion de la Biodiversité, Museum National d’Histoire Naturelle, Paris, France, 8 University of Washington, Department of Orthodontics, Seattle, Citation: Druzinsky RE, Balhoff JP, Crompton AW, Washington, United States of America, 9 National Evolutionary Synthesis Center, Durham, North Carolina, Done J, German RZ, Haendel MA, et al. (2016) United States of America, 10 Center for Genomic and Computational Biology, Duke University, Durham, Muscle Logic: New Knowledge Resource for North Carolina, United States of America, 11 Department of Biology, University of South Dakota, Vermillion, South Dakota, United States of America, 12 Genomics Division, Lawrence Berkeley National Laboratory, Anatomy Enables Comprehensive Searches of the Berkeley, California, United States of America, 13 Howard Hughes Medical Institute, M/C 156–29, California Literature on the Feeding Muscles of Mammals.