section – i (course content · head and neck schedule1. posterior triangle of the neck. lecture:...

SECTION – I(Course Content

HEAD AND NECK

Schedule1.

POSTERIOR TRIANGLE OF THE NECK.Lecture: 02 hrs

Dissection/ Prosection: 10 hrsTutorials: 01 hr

LECTURES:

Triangles of the neck. Cervical fascia.

DISSECTION/ PROSECTION:

Identification of relevant skeletal features:temporal bone mastoid processmandible angle; lower border; symphysis menti.sternum jugular notch.clavicle medial end; shaft; lateral end.Subcutaneous structures: platysma, external jugular vein; lesser occipital nerve; great auricular nerve; transverse cutaneous nerve of the neck;supraclavicular nerves.Deep fascia:investing layer forming roof of the posterior triangle; prevertebral fascia; axillary sheath.Muscles: sternomastoid; trapezius; inferior belly of omohyoid; scalenus anterior; scaleenus medius; levator scapulae; splenius capitis;semispinalis capitis.Nerves: accessory nerve; brachial plexus: roots, trunks, dorsal scapular; nerve to subclavius; suprascapular; long thoracic; cervical plexus;cutaneous branches; phrenic nerve.Arteries: occipital; transverse cervical; suprascapular; subclavian;.Veins: suprascapular; transverse cervical; anterior jugular; subclavian.Lymph nodes: superficial cervical nodes along the external jugular vein.Surface anatomy: accessory nerve; external jugular vein.Applied anatomy: injury to roots and trunks of brachial plexus.

TUTORIAL TOPICS FOR THE WEEK Relevant osteology. Relevant radiological anatomy. Relevant living anatomy. Relevant crosssectional anatomy.

Schedule2.ANTERIOR TRIANGLE OF THE NECK.

Lecture: 04 hrsDissection/ Prosection: 10 hrs

Tutorials: 01 hr LECTURES:

Oesophagus Trachea Thyriod and parathyroid Carotid arteries

DISSECTION/ PROSECTION:Identification of relevant skeletal features:Occipital bone superior nuchal line; temporal bone mastoid process; mandible lower border, symphysis menti; hyoid bone body, lesser andgreater cornua; thyroid cartilage thyroid notch, oblique line; cricoid cartilage arch; trachea cartilaginous rings; manubrium sterni jugularnotch.Subcutaneous structures: platysma; anterior jugular vein; cervical branch of facial nerve; transverse cutaneous nerve of neck; submentallymph nodes.Deep fascia cervical fascia investing layer, pretracheal, prevertebral; carotid sheath.Ligaments: median thyroid; cricothyroid; cricotracheal.Glands: parotid; thyroid; parathyroid.Trachea: cervical part.Oesophagus: cervical part.Muscles: strenomastoid; digastric; mylohyoid; levator glandulae thyroidea; strnohyoid; superior belly of omohyoid; sternothyroid; thyrohyoid;

cricothyroid; inferior constrictor of pharynx.Nerves: external laryngeal; internal laryngeal; recurrent laryngeal; hypoglossal; ansa cervicalis; vagus; sympathetic trunk. Arteries: common carotid; internal carotid;external carotid; superior thyroid; lingual; facial; occipital; posterior auricular; inferior thyroid;thyroidea ima.Veins: internal jugular; superior thyroid; middle thyroid; inferior thyroid; brachiocephalic.Lymph nodes: anterior cervical; jugulodigastric; juguloomohyoid.Surface anatomy: thyroid gland; comon carotid artery.Applied anatomy: tracheostomy; laryngostomy.


Schedule3.FACE AND SCALP.


Tutorials: 01 hr

LECTURES:

Scalp and face blood supply, nerve supply & applied anatomy.


Face Identification of relevant skeletal features: nasal bone root of nose; maxilla body, processes, infraorbital foramen; zygomatic bone arch,zygomaticoorbital, zygomaticofacial and zygomaticotemporal foramina; mandible ramus, angle, body, symphysis, mental foramen.Subcutaneous structures: palpebral branch of the lacrimal; infratrochlear; external nasal; infraorbital; zygomaticofacial; buccal; mental andgreat auricular nerves.Muscles: orbicularis oculi; orbicularis oris; buccinator and other muscles of facial expression.Nerves: temporal; zygomatic; buccinator; mandibular and cervical branches of facial nerve.Arteries: facial; transverse facial; buccal; infraorbital branches of maxillary artery.Veins:facial and transverse facial veins.Surface anatomy: parotid duct; facial artery (pulse).Applied anatomy: scalp wounds; 'dangerous area' of scalp. Scalp Identification of relevant skeletal features:1.skull vault and base; 2.individual bones frontal, parietal, temporal, occipital;3.sutures sagittal, coronal, lambdoid; 4. meeting point of thesesutures bregma, lambda, pterion and asterion; 5.eminences frontal, parietal; 6.landmarks nasion, superior orbital margins, supraorbital notch;temporal lines; mastoid process; inion; external occipital protruberance; superior nuchal line; 7. Emissary veins parietal; mastoid; condylar etc.,Subcutaneous structures: supratrochlear nerve and vessels; supraorbital nerve and vessels; zygomaticotemporal nerve and superficialtemporal vessels; great auricular nerve; lesser occipital nerve; greater occipital nerve and vessels; third occipital nerve; posterior auricularvessels.Deep fascia:temporalis fascia.Muscles: occipitofrontalis muscle; epicranial aponeurosis.Nerves:posterior auricular artery and temporal branch of facial.Lymph nodes:occipital; mastoid.Applied anatomy:scalp wounds; 'dangerous area' of scalp.


Schedule4.

CRANIAL CAVITY.Lecture: 02 hrs


LECTURES:

Dural venous sinuses, cavernous sinus; internal jugular vein. Pituitary gland.


Identification of relevant skeletal features: skull vault; inner and outer tables; diploe. Anterior cranial fossa: ethmoid bone cribriform plate; crista galli; frontal bone frontal crest, orbital plates; sphenoid bone jugum

sphenoidale, lesser wing; anterior clinoid process; foramina olfactory, anterior and posterior ethmoidal; optic canal; foramen caecum. Middle cranial fossa: sphenoid bone body, sella turcica, dorsum sellae,

posterior clinoid process, basisphenoid, groove for cavernous sinus, greater wing; temporal bone superior surface of petrous part, squamous part,groove for posterior branch of middle meningeal artery and vein; foramina superior orbital fissure, foramen rotundum, canaliculus innominatus,foramen lacerum, foramen ovale, foramen spinosum, hiatuses for greater and lesser petrosal nerves.

Posterior cranial fossa: temporal bone posterior surface of petrous part,squamouspart, mastoid part; groove for sigmoid sinus; occipital bone groove for superior sagittal sinus, internal occipital crest, groove fortransverse sinus; parietl bone posteroinferior angle, groove for sigmoid sinus; foraminainternal acoustic meatus, jugular foramen; hypoglossalcanal, foramen magnum.

Dural folds: falx cerebri; falx cerebelli; tentorium cerebelli; diaphrgma sellae;cavum trigeminale.

Dural venous sinuses: superior sagital sinus, inferior sagittal sinus, straight sinus, occipital sinus, sphenoparietal sinus, cavernous sinus,superiior petrosal sinus, inferior petrosal sinus, transverse sinus, sigmoid sinus.Emissary foramina: foramen caecum; emissary sphenoidal foramen; parietal foramen; mastoid foaren; condylar canal.

Cranial nerves: olfactory; optic, oculomotor; trochlear; trigeminal; abducent; facial;vestibulocochlear; glossopharyngeal, vagus; accessory; hypoglossal.Arteries: middle meningeal (extradural); internal carotid and its branches.Surface anatomy: middle meningeal artery.Applied anatomy:subdural and extradural haemorrhage; fracture of base of skull.


Schedule5.ORBIT AND LACRIMAL APPARATUS.



Lacrimal apparatus. Extraocular muscles: innervation and action. Ciliary ganglion; superior orbital fissure.


Identification of relevant skeletal features:1. bony orbit axis; 2. Medial wall frontal process of the maxilla; lacrimal; orbital plate of ethmoid; body of the sphenoid; 3. Floor zygomatic;maxilla; orbital process of palatine; 4. Lateral wall zygomatic; greater wing of sphenoid; 5. roof orbital plate of the frontal; lesser wing of thesphenoid; 6. Openings optic canal; superior orbital fissure; inferior orbital fissure; infraorbital foramen; supraorbital notch or foramen;nasolacrimal canal; anterior ethmoidal foramen; zygomaticoorbital foramen.Fossa for lacrimal gland; Whitnall's tubercleFascia bulbi: check ligaments; suspensory ligament.Extraocular muscles: levator palpebrae superioris; superior rectus; inferior rectus; medial rectus; lateral rectus; superior oblique; inferioroblique.Nerves: optic; ophthalmic division of trigeminal; oculomotor; trochlear; abducent; zygomatic; infraorbital.Ciliary ganglion.Arteries: ophtahlmic artery and its branches.Veins: superior and inferior ophthalmic.Lacrimal apparatus:Lacrimal gland; lacrimal ducts; conjunctival sac; lacus lacrimalis; lacrimal punctum; lacrimal canaliculus; lacrimal sac; nasolacrimal duct;nasolacrimal fold.Surface anatomy: supraorbital foramen; infraorbital foramen.Applied anatomy: spread of infection to cavernous sinus; occlusion of central artery of retina; lesions of oculomotor, trochlear and abducentnerves.

TUTORIAL TOPICS FOR THE WEEK Relevant osteology.

Relevant radiological anatomy. Relevant living anatomy. Relevant crosssectional anatomy.

Schedule6.PAROTID AND INFRATEMPORAL FOSSA.



Parotid gland and seventh cranial nerve. Temporomandibular joint Maxillary artery.

DISSECTION/ PROSECTION: Parotid and infratemporal regions Identification of relevant skeletal features:1. mandible body; mylohyoid and groove; mental foramen; angle; ramus;

condylar process (head, neck); pterygoid fovea; coronoid process;mandibular notch; lingula; mandibular foramen.

2. temporal bone squamous; petromastoid; tympanic plate; styloid process;zygomatic process; external acoustic meatus; mastoid process;stylomastoid foramen; squamotympanic and petrotympanic fissures; mandibular fossa; articular tubercle; postglenoid tubercle.

3. sphenoid bone greater wing; infratemporal crest; lateral and medial pterygoid plates;scaphoid fossa; spine; formaen ovale; foramen spinosuum;emissary sphenoidal foramen.

4. Maxilla tuberosity; posterior surface. Pterygomaxillary fissure; pterygopalatine fossaDeep fascia: capsule of the parotid gland.Ligaments: stylomandibular; sphenomandibular.Parotid gland: surfaces and relations; duct; facial nerve and branches; retromandibular vein; external carotid artery; lymph nodes; nerve supplyto the gland.Muscles: masseter; temporalis; pterygoids.Nerves: mandibular and branches; chorda tympani; maxillary and branches.Arteries: maxillary artery and branches.Veins: pterygoid plexus.Surface anatomy: parotid duct.Applied anatomy: facial palsy; parotid infections; parotid tumours. Temporomandibular Joint:Muscles in relation to the capsule: lateral pterygoid.Capsule:attachments.Ligaments: lateral ligaments.Accessory ligaments: sphenomandibular; stylomandibular.Intraarticular structures: articular disc.Synovial membrane:reflection.Movements: protraction, retraction; elevation, depression; side to side movements.Nerve supply: auriculotemporal nerve.Blood supply: superficial temporal artery.Applied anatomy:dislocation; mandibular nerve palsy.


Schedule7.SUBMANDIBULAR REGION AND DEEP DISSECTION OF THE NECK.

Lecture: 02 hrs


LECTURE:

Submandibular gland, sublingual gland; innervation. Lymphatic drainage of the head and neck.


Submandibular region. Identification of relevant skeletal features:1. mandible lower border; digastric fossa; superior and inferior mental spine.2. hyoid bone body, lesser and greater cornua.3. temporal bone mastoid and styloid processes; mastoid notch.Ligaments: stylohyoid ligament.Submandibular gland:surfaces; relations; duct; nerve supply.Muscles: digastric; mylohyoid; hyoglossus; genioglossus; geniohyoid; styloglossus; middle and supoerior constrictors of the pharynx.Nerves: lingual; inferior alveolar; facial; glosspharyngeal; hypoglossal; submandibular ganglion.Arteries: facial, lingual.Veins: facial; common facial; retromandibular.Surface anatomy: facial artery.Applied anatomy: salivary calculi; veins and lymph nodes in relation to submandibular gland. Deep Dissection of the neck. Identification of relevant skeletal features:cervical vertebra transverse processes, foramen transversaria;first rib neck, shaft, scalene tubercle.Deep fascia: prevertebral.Muscles: sternomastoid; scalenus anterior; scalenus medius and posterior; rectus capitis anterior; rectus capitis lateralis; longus colli; longuscapitis.Nerves: glosspoharyngeal; vagus; accessory; hypoglossal; synpathetic trunk; cervical plexus.Arteries:common carotid; internal carotid; external carotid; subclavian; vertebral.Veins:internal jugular; subclavian; brachiocephalic; vertebral.Lymphatic ducts: thoracic; right lymphatic.Surface anatomy: apex of lung and pleura; carotid arteries; subclavian artery; accessory nerve.Applied anatomy: fascial spaces of the neck; jugular venous pulse; vertebrobasilar insufficiency; thoracic duct at the root of the neck.


Schedule8.DEEP STRUCTURES OF THE BACK OF THE NECK AND TRUNK.

Lecture: 02 hrs


LECTURE:

Joints of the vertebral column atlantooccipital, atlantoaxial. Joints of the vertebral coulmn joints between vertebral bodies.

DISSECTION/ PROSECTION: Deep dissection of the back. Identification of relevant skeletal features:Occipital bone superior and inferior nuchal lines; foramen magnum, temporal bone mastoid process;vertebral column atlas (posterior tubercle, posterior arch, transverse

processes); axis odentoid process, spine, vertebral arch;typical vertebrae spinous process, laminae, transverse processes; sacrum sacral canal; coccyx.

Subcutaneous structures: greater occipital nerve; occipital artery. Deep fascia: thoracolumbar. Ligaments:supraspinous; interspinous; ligamenta flava; posterior atlanto

occipital membrane.Muscles:splenius capitis; semispinalis capitis; rectus capitis posterior major andminor; obliquus capitis posterior major and minor; obliquus capitis superior andinferior; erector spinae.Nerves: suboccipital; dorsal rami of spinal nerves.Arteries: deep cervical; vertebral.Veins: suboccipital plexus.Surface anatomy: transverse process of atlas.Applied anatomy: cisternal puncture. Spinal cord and meninges Coverings: dura mater; arachnoid mater; pia mater and its processes.Spaces: epidural containing vertebral venous plexus; subdural containing lymph;subarachnoid containing cerebrospinal fluid.Spinal cord: anteromedian sulcus; posteromedian fissure; antero and posterolateral fissures; cervical and lumbar enlargements; conus medullaris.Spinal nerves: 31 pairs; rootlets; roots; ganglia; trunk; cauda equina.Arteries: anterior and posterior spinal; spinal branches of intersegmentalarteries.Veins:longitudenal venous channels.Surface anatomy: emergence of spinal nerves in relation to the vertebrae; conusmedullaris.Applied Anatomy: lumbar puncture.

Joints of the skull; Joints of the vertebral Column; Sacroiliac joint. Joints of the skull: sutural joints between the skull bones; primary cartilagenousjoint between basisphenoid and basiocciput; peg and socket joints betweenteeth and alveolar margins.Joints of the vertebral column: secondary cartilagenous joints betweenvertebral bodies; synovial joints between atlas and occiput; synovial jointsbetween odontoid process of axis and atlas; synovial joints between the articularprocesses of the adjacent vertebrae.Ligaments: atlantooccipital membranes; membrana tectoria; cruciate ligament;transverse ligament of the atlas; apical; alar.Sacroiliac joint: synovial type.Ligaments: ventral, dorsal and interosseous sacroiliac ligaments; iliolumbar;sacrotuberous; sacrospinous.


SPECIAL LECTURES/ PROSECTIONSDEMONSTRATIONS.

( Each topic of two hours duration )Total: 12 hrs

1. Nasal cavity and paranasal air sinuses 4. Larynx2. Oral cavity; tongue; tonsil. 5. Eye3. Soft palate and pharynx. 6. Ear external & middle.

SECTION – II(Course Content under Level – I, II, III)

LECTURESOUTLINE OF LECTURES

S.No TOPIC MUST KNOW SHOULD KNOW COULD KNOW

1. SCALP 1. Layers: Skin,Connecttive

tissue (superficial fascia& deep fascia),Apopneurotic layer,Loose connective tissueand Periosteum.

2. 2. Contents of connectivetissue layer: vessels,nerves

3. Lymphatic drainage4. a. Applied anatomy: Sebaceous cysts Closed woundspainful Open wounds bleedprofusely Emissary veins Blackeye Sfaety valvehaematoma

5. b. Applied

anatomy: Invertedflame shaped Haemorrhage Cephalohaematoma

2. CERVICAL FASCIA 1. Components Generalinvesting layer,pretracheal layer,prevertebral layer

2. General investing layer horizontal extent, verticalextent(cranial and caudalattachments), features

3. Pretracheal layer horizontal extent, verticalextent and features

4. Prevertebral layer horizontal extent, verticalextent, features

5. Axillary sheath

fascial spaces6. a. Ligament of

Berry

6. b.. Cold Abscess,other abscesses

3. POSTERIOR TRIANGLE 1. BoundariesAnterior,Posterior, Base Apex,Roof, Floor

2. Subdivisions occipital,omoclavicular

3. Contents4. Applied4a. Compression ofsubclavian artery to stop bleeding in upper limb4b. Wry neck

4c. Air embolism

4d. Phrenic crush4e. Acessoryphrenic nerve

4. ORBIT

1. Extrinsic muscles Recti/Obliques / LPS (Origin,insertion, nerve supply LR6SO4/3) Actions ofmuscles

2. Movement of eyeball in 3axis Vertical adduction/abductionHorizontalelevation/depressionApIntorsion/ExtorsionMuscles causing thesemovements

3. a. Applied Anatomy

3. b. Stability of

eyeVertical suspensory ligAPbonyattachment ofRecti, orbital fat,forward pull ofObliques

5. LACRIMAL APPARATUS 1. Components Lacrimalgland, ducts, conjunctivalsac, Lacrimal puncta,canaliculi and sac,nasolacrimal duct 4. Nerve supply of lacrimalgland

1. Parts of lacrimal

gland andrelation to LPS

2. Flow of lacrimalfluid

6. THYROID GLAND 1. Components lobes,isthmus

2. Isthmus Extent,surfaces & borders,Relations, Capsules(trueand false), Blood

4a. Pyramidal lobe

supply(superior thyroid,inferior thyroid artery,relation to the nerves)venous drainage(superior, middle andinferior thyroid veins),nerve supply, lymphdrainage

5a. Applied AnatomyPertaining to posteromedialborderThyroidectomy beforeremoval and during removal

4b. Levatorglandulae thyroidae 5b. Ligament ofberry Venous plexus Thyroidea ima Twigs fromOesophageal and trachealbranches Vein of Kocher

6. Synthesis ofthroxine and itsregulation

7. PAROTID

1. Situation2. Shape3. Extent sup, inf, ant, post4. Borders sup, ant, post,

med5. Surfaces sup,

superficial,medial(anteromedial,postermedial)

6. Relations structuresembedded in parotid lymph nodes,retromandibular vein,external carotid artery,fascial nerve

8. Capsules9. Parotid duct size, lumen,opening10. Blood supply11. Nerve supply(oticganglion)12. Applied anatomy Painful swelling(swellingaffects opening of mouth,parotidectomy incisionparallel to zygomaticbone(preserve VII nerve)Parotid abscess

7.Parotid space structures in depth ofparotid space 13. Development

8. TEMPORAL ANDINFRATEMPORALREGION

1. Muscles (Temporalis,Masseter)

Attachments &Actions2. Boundaries3. Contents

a. Superficial Pterygoidmuscles, pterygoidvenous plexus,Sphenomandibularligament, maxillaryartery

b. Deep mandibularnerve, cauda tympani,otic ganglion

c. Origin, insertion andactions of muscles

4. Mandibular nerve course, relations and branches

4. Branches of

maxillary artery5. Cauda tympani6. Otic ganglion connections and branches

5. # spine ofsphenoid

9. JUGULAR VEINS

1. Formation2. Course3. Relations4. Tributaries

5. Applied anatomy

Queckenstedt'stestJugular venouspressure

6. Anterior andOblique Jugularveins

10. TEMPEROMANDIBULARJOINT

1. Classification2. Articular surfaces3. Capsules and ligaments capsules Lateral ligament Sphenomandibularligament

Stylomandibularligament4. Articular disc5. Synovial membrane6. Blood supply7. Nerve supply8a. Movements9. Applied Anatomya. Dislocation

8b. Sequence ofmovements foropening of mouth 9b. Treatment ofdislocation

10. Stability of TMjoint

11. TONGUE 1. Functions2. Components root, body,

inferior surface, dorsalsurface(Anterior 2/3rd ,posterior 1/3rd )

3. Muscles: a. extrinsic4. Blood supply arterial /

venous5. Nerve supply motor,

general sensory supply,taste sensations,proprioception

6. Lymphatic drainage7. Applied anatomy Tongue pulled anteriorly toprevent choking Pulled anteriorly to preventbleeding Paralysis of XII nerve

3. b. Muscles:intrinsic

8. Carcinoma

tongue operation9. Alternate taste

pathway

12. SUBMANDIBULAR REGION

1. Boundaries2. Contents3a. Submaxillary salivaryglands Extent, components (superficial and deep)Relations of the threesurfacesWharton's ductBlood supply3b. Nerve supplySubmandibular ganglion

13. PHARYNX 1. Introduction2. Communicates with oral

cavity, nasal cavity andlaryngeal cavity

3. Relations4. MusculatureLongitudinal Stylopharyngeus Palatopharyngeus SalpingopharyngeusCircular musclesConstrictors( superior, middleand inferior )Blood supply arterial,venousNerve supply motor,sensory6. Interior (oropharynx,Nasopharynx, and Laryngopharynx) Piriform fossa

5. Origin, Insertion

and parts ofconstrictors

8. a. Appliedanatomy:

7. b. Appliedanatomy Space of Morgagni KillianJamison space Pharyngealdiverticula

14. PALATE

1. Introduction and function2. Features

Anterior or oral surfaceBorders

3. Muscles of soft palate Tensor palati Levator palati Palatoglossus Palatopharyngeus6. Blood supply arterial and

venous7. Nerve supply Motor,

Sensory(Generalsensations and taste

3. Origin, Insertionand actions ofmuscles of softpalate

sensations), Secretomotor supply

8. a. Applied anatomy :Cleft palate

9. b. Appliedanatomy:

Process ofdegluttition

Passvant’s ridge

15. PALATINE TONSIL 1. Waldeyers' ring2. Features 2 poles, 2

borders and 2 surfaces 3. Blood supply arterial and

venous4. Nerve supply5. Applied anatomy

Tonsillitis, tonsillectomy

2a. Surface relations

5b. Care duringtonsilectomy

16. LARYNX

3. Components Cartilages

LigamentsMusclesMembranesVocal cordsVestibular foldsRima glottides

3b. Joints formed by thecartilages 5. Muscles Extrinsic andintrinsic 7. Blood supply8. Lymphatic drainage9. Nerve supply10. Funcional considerations10. Applied anatomyDiphtheriaTracheostomyCadaveric positionDamage to recurrentlaryngeal nerve

3a. Cartilages Unpaired epiglottis, thyroid, cricoid Paired Arytenoid, Corniculate,cuneiforms 4. LigamentsExtrinsic Medianthyrohyoid Ligament Lateral thyrohyoid Thyroepiglottic Hyoepiglottic Cricotracheal lig.Intrinsic Mediancricothyroid Lateral cricothyroid Cricovocalmembrane 6. Origin, Insertion,Direction of musclefibres and action ofinstrinsic muscles

1. Size: Male,female

17a. EXTERNAL EAR 1. Components Pinna,External Acoustic meatus

3. External acoustic meatus Length Two parts Direction Lining Tympanic membrane4. Blood supply5. Nerve supply

2. Pinna: Parts ofpinna, structure andnerve supply

17b. MIDDLE EAR

1. Boundaries ant wall, postwall, medial wall, lateralwall, roof, floor 4. Ossicles Malleus, Incusand stapes

2. Features seen at theboundaries 5. Muscles TensorTympani andstapedius

3. Applied anatomy Otitis media Infection ofmiddle ear in children Meningitis

18. HYPOGLOSSAL NERVE 1. Nerve components2. Nucleus 3. Course

IntraneuralIntracranialExtracranial

4. Branches meningeal andmotor

2a. Location ofNucleus

Tympanic Branches Nerve toStylopharyngeus Carotid sinus branch Pharyngeal branch Tonsillar branch

5. AppliedThrombosis ofanterior spinalartery care of XIInerve duringoperation andlingual artery

19. GLOSSOPHARYNGEAL NERVE

1.Components2. Nuclei 3. Course

IntraneuralIntracranialExtracranial

4. Branches Tympanic Branches Nerve toStylopharyngeus Carotid sinus branch Pharyngeal branch Tonsillar branch

2a. Position of Nuclei

5. Applied anatomy Eagles' syndrome

20. FACIAL NERVE

1. Nerve components2. Nuclei 3. Course Intraneural Intracranial (Motor rootand sensory root greater superficial petrosaland chorda tympani) Extracranial 4. Branches


5. Applied AnatomySupranuclear leisonNuclear lesionInfranuclear lesion

21. OCULOMOTOR NERVE 1. Nerve Components2. Nuclei 3. Course Intraneural Intracranial Extracranial 4. Branches5b. Light reflex,Accomodation reflex, ArgyllRobertson's pupil

2a. Position ofNucleus2b. Components ofnucleus

5a. AppliedAnatomy weber'ssyndrome

22. ABDUCENT &TROCHLEAR

1. Nerve components2. Nuclei 3. Course intraneural ,

intracranial andextracranial

4. Muscles supplied by the

nerves


5. Applied anatomy Paralysis ofmuscles supplies squint / Diplopia

23. DURAL VENOUSSINUSES

1. Difference between veinsand sinuses

2. ClassificationUnpaired Superiorsagittal, Inferior sagittal,straight sinus, occipitalsinusPaired Sphenoparietal,cavernous, superiorpetrosal sinus, inferiorpetrosal sinus, transversesinus, sigmoid sinus

3. Flow of blood in sinuses4. Covernous sinuses

situationFormationExtentSize

5. b. Applied

RelationsTributaries

5. a. Applied anatomy : Dangerous area of face thrombosis ofcavernous sinus

Anatomy Queckenstedt'stest

24 ANTERIOR TRIANGLEOF THE NECK

1.Boundaries andsubdivisions2.Carotid triangle :Boundaries and contents Carotid arteries 3. Trachea: extent and

relations4. Oesophagus: extent and

relations

4b. Sites ofconstrictions 5. Parathyroids

25HYPOPHYSIS CEREBRI 1. Parts, Location,

Relations2. Blood supply3. Microscopic structure4. Development

5. Hormonessecreted

6. Tumours of thepituitary

Hypophysectomy

26 JOINTS OF THE HEADAND NECK

1. Atlanto occipital:Ligamanets, movementsand muscles causingthese movements

2. Atlanto axial:Ligamanets, movementsand muscles causingthese movements

3. Joints between thevertebral bodies

4. Applied anatomy:Spondylosis


DISSECTIONLearning Objectives of Dissection

S.No

TOPIC

DISSECTIONSTEPS

WHAT IS EXPECTED FROM THE STUDENTS

SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 1. SCALP Place a wooden

block under thehead end andraise the head

Make a medianincision in theskin of scalpfrom root ofnose to externaloccipitalprotuberance

Make a coronalincision frommiddle ofmedian incisionto the tragus onboth sides.Continue thisover the auricleto mastoidprocess andzygomatic arch.

Reflect the skinflaps, takingcare not todamage Ns &Vs. insucutaneoustissue

Expose upper

Main layers of

Scalp Skin Dense CT Galea Superficial

temporal Vs Frontal belly of

frontoocipitalis Lateral

attachement ofepicranialaponeurosis

Occipital belly of

frontooccipitalis

Deep layers of

scalp LCT Pericranium Auriculotemporal

N Great auricular N Lesser occipital N

Brs. of

supratrochlearandsupraorbitalNs. & Vs.

Temporal brs.of VII CN

1. Main layers ofscalp2. Musclesfrontalisoccipitalisepicranialaponeurosis3. Nervessupratrochlearauriculotemporal4. Vesselssupraorbitalsupratrochlearsuperficialtemporal

Open woundsof scalp bleedprofusely

Scalp swellingare painful

APPLIED ASPECTS

Sebaceous cysts Clinical importance of mobility of

superficial layers of scalp onpericardium and suturing of scalpwounds

part oforbicularisocculi. Trace &define

Clean andidentify nervesbehind theauricle

Expose ant. partof epicranialaponeurosis.Note itsattachment intotemple onsuperiortemporal line

Defineattachments ofoccipitalis andepicranialaponeurosis onhighest nuchallines.

Epicranialaponeurosis

3rd occipital

N

Incised margins of galeaaponeuotica medicolegalimportance

Dangerous area of scalp andemissary veins

Black eye Traumatic cephalhydrocoele Pedicles of scalp flaps with vessels

and nerves for grafts in plasticsurgery

Clinical testing of VII CN

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 2 SUPERFICIAL

DISSECTION OFFACE

Make amedianincisionfrom root ofnose to chinandhorizontalincisionfrom anglemouth topost. borderof ramus ofmandible

Reflect skinflaps.Exposemajor facialmusclestaking carenot to cutthroughthem

Pull eyeballlaterally &identify

Detachrisorius andreflect italong withplatysmatowardscorner ofmouth

Exposefacial ofmasseter andnote theirrelations andcourse

Orbicularis

occuli Platysma Depressor

anguli oris Depressor

labiiinferioris

Orbicularisoris

Buccinator Facial artery Facial vein

Zygomaticusmajor &minor

Levator labiisuperioris

Different

parts oforbicularisocculi

Risorius Levator

labii sup.Aleque nasi

Proserusnasalis

Mentalis Medial

palpebrallig. andorbital partoforbicularisocculi

Muscles offacialexpression

Facial artery Facial vein

Embryologicalbasis of cutaneousinnervation of face

Actions of facialmuscle

Bleeding from bothcut ends of artery

APPLIED ASPECTS

Palpation of facial artery Clinical testing of facial muscles &

VII CN Suturing of facial wounds Dangerous area of face

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 3 POSTERIOR

TRIANGLE Make an

incision from

1. Boundariesand

Deep cervicalfascia

mastoidprocess tosternal end ofclavicle alongthe middle ofSCM

Extend theincisionalong clavicleto itsacromial endand reflectthe skin flapupto anteriorborder oftrapezius.Clean anddefine vesselsand nerves

Clean thesuperficialfascia anddefineattachmentsof SCM onclavicle andsternum

Identify Ns.alongposteriorborder ofSCM

Clean &identify in theroof

Cut throughinvestingfascia aboveclavicle andalongposteriorborder ofSCM andexpose

Clean anddefinemusclesforming floorof posteriortriangle

Clean andidentify thecontents ofposteriortriangle

Accessory N Lymph nodes External

jugular vein Inferior belly

of omohyoid Occipital

triangle Omoclavicular

triangle Accessory N

(entering Tz) Cords of

brachialplexus

Subclavianvein artery

Subclavianvein and entryof EJV

Phrenic nerveover scalenusanterior

Great auricular

N Lesser occipital

N Suprascapular

Ns. Muscular floor

of posteriortriangle

Dorsal scapular

N Long thoracic N

Greater

OccipitalN (at theapex oftriangle)

Tr.

Cervicalartery

N. tosubclavius

subdivisionsof posteriortriangle

2. Structures inthe roof

3. Contents

especiallyinvesting layer

Prevertebralfascia

Brachialplexus cordsentering intopost. triangle

Axillarysheath

APPLIED ASPECTS

Spasmodic torticollis. Injury to accessory nerve during

surgery in posterior triangle Air embolism CVP line Brachial plexus injuries involving Roots Trunks Branches Anatomical basis of cervical rib

syndrome injuries to subclavianartery

Compression of subclavian art.

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 4. DISSECTION

OF BACK Give a vertical

incisionextendingfrom inion tospine of C,and external itlaterally toacromion,reflect theskin flaps andstudy

Clean andidentifyvessels andnerves

Trapezius Lat. Dorsi Accessory

nerve

Post triangle

from behind Greater

occipital N Occipital

artery

Occipital

branch ofpost.auricularnerve

3rd occipitalN

Branches

from 3rd &

Muscles of back1.Superficiallayer

2.Intermediatelayer

3.Deep layer

Arrangement ofmuscles of back

Actions of thesemuscles

Nerve supply ofmuscles of back

Clean andidentify 1srlayer of backmuscles

Separatetrapezius fromsup. Nuchalline andreflect itlaterally anddivideertically about1cm awayfrom vertebralspines andidentify

Clean andidentify 2ndlayer of backmuscles

Trace Reflect

serratusposteriorsuperiorl

Removethoracic partofthracolumbarfascia toexpose erectorspinae andspleni curvingacross it

Defineattachment ofsplenius &separate itfrom vertebralspine & turn itsuperlaterally& expose.

Levator

scapulae Serratus

posteriorsuperior

Serratusposteriorinferior

Erectorspinae

Spleniuscapitis

Semispinalis Longissimus

muscle Sup.

Obliquecapitis

Dorsal

scapular N

4th cervicalNs.

Superficialbr. of Tr.Cervicalartery

Deep br. ofTr. Cervicalartery

N. supply of

splenius

APPLIED ASPECTS

Muscle spasm

S.No

TOPIC

DISSECTIONSTEPS

WHAT IS EXPECTED FROM THE

STUDENTS

SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 5 SUBOCCIPITAL

TRIANGLE Position of

cadaver Remove the

dense fibroustissue from theregion

Clean and tracegreateroccipital N.crossing thetriangle

Clean anddefine themusclesforming theboundaries

Find dorsal

ramus of C1 bytracing back br.to semispinaliscapitis to theramus(between post.

Rectus

capitisposteriormajor &minor

Inferiorobliquecapitis

Superiorobliquecapitis

Vertebral

artery (3rdpart)

Greater

occipital N Doral

ramus ofC1

Suboccipital

venousplexus

Boundaries ofsuboccipitaltriangle

Contents a. Dorsalramus of C1 b. vertebral artery(3rdpart)

Communicationsof suboccipitalvenous plexus

APPLIED ASPECTS

Clinical considerations of suboccipitalvenous plexus

Cisternal puncture

arch of atlas &vertebralartery)

Clean &identify

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 6 ORBIT Strip

periosteumfrom ant.cranial fossa

Break orbitalplate offrontal boneincludinglesser wingof sphenoid,leavingmargins ofoptic canalintact

Open the sup.Orbitalfissure &trace variousnerves to theorbit

Trace frontalN. on LPS &note itsdivisions

Cut frontal N.close to sup..orbitalfissure, LPS& SR andturn themaside

Post. toeyeball, noteloose tissue

Afterreflecting SR,clean, defineand expose

Posteriorlystructurescrossingoptic N.(3)

Defineattachmentsofextraocularmuscles bydiving opticN. close toeyeball &turn itforwardswith eyeball

Expose &note

Expose allrectusmuscles &trace

Extraoccularmuscles

LPS SR SO IO MR LR IR Nerves :

Optic Trochlear Abducent Frontal Optic N Ophthalmic

artery Attachments

ofextraocularmuscles oneyeball

Lacrimal

gland Nasocilliary

nerves Lacrimal

nerves Nasocilliary N Two heads of

LR

Ciliary ganglion Supratrochlear

N Supraorbital N Fascial sheath

of eyeball Extension of

sheath overmuscles at theirattachments oneyeball

Sup. Opthalmicvein

Nerves to IO,

IM & MR frominf. div. Of IIICN

1. Extraoccularmuscles2. Cranial Ns IICN IIICN IV CN VI CN Opthalmic

division ofV CN

3. Lacrimalgland4. Ciliaryganglia

Actions ofextraocularmuscles

Ciliary ganglion

APPLIED ASPECTS

Squint Convergent Divergent Ptosis Clinical importance of venous

drainage of orbit Horner's syndrome Accomodation reflex Pulsating eyeball

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 7 DEEP

DISSECTIONOF FACEINCLUDINGPAROTIDGLAND

Clean &define theparotid gland

Cut facialcovering ofparotid infront ofauricle fromzygomaticarch to angleof mandible

Dissectfasciaforwards tothe marginsof gland &identifyvariousnerves,vessels &ductemerging atthe borders

Trace buccalbranch offacial N. tobuuinator

Clean &identify atupper borderof gland

Clean &identify atlower borderof gland

Clean &identifyvariousbranchesfrom 3 div.Of V CN

After identifyingfacial artery atanteroinf.angleof masseter,trace it towardsmedial angle ofeye & identifyits variousbranches

Parotid gland Parotid duct( 1

finger breadthbelow zygomaticarch) at theant.border ofgland

Superficial

temporal Vs. Auriculotemporal

N Retromandibular

vein Facial artery

Above the duct Tr. Facial Vs Zygomatic

br.of VII CN Below duct,

brs. of VIICN

Buccal Mandibular Cervical Buccinator

muscle Buccal N.

from VII CN Temporal br.

of VII Cervical br.

of VII CN Inf. labial art Sup. Labial

art Angular art

Process of parotid Parotid lymphnodes

Ant. & post.

divisions ofretromandibularvein

V1 supraorbitalsupratrochlear

V2Zygomaticofacialinfraorbital

V3 Buccal N.Mental N.

Last. Nasal art

Parotidgland &duct

Branchesof facial N

SuperficialtemporalVs.

Facial art Facial vein

Secretomotorpathway forparotid gland

Factorsfacilitatingspread ofinfection tocavernoussinus

APPLIED ASPECTS

Parotid swelling Sialoliths Facial N. palsy Cavernous sinus thrombosis Herpes zoster

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 7Contd

DEEPDISSECTIONOF FACEINCLUDINGPAROTIDGLAND(Continued)

Remove

part ofglandpiecemeal& exposethestructureswithin thegland

Facial vein Common facial

vein Parotid duct Buccinator Trunk of VII CN Post. auricular br.

of VII CN

Post.

auricularart.

Terminal

Supratrochlear

vein Supraorbital

vein Angular vein Deep facial

vein

APPLIED ASPECTS

Facial N Ext. carotid art Retromandibular

vein

brs. ofECAMaxillaryart.Superficialtemporal

Br. of VII CNto post. belly ofdigastric &styloid

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 8. ANTERIOR

TRIANGLEOF NECK

Give amidlineincisionfrom chin tosternum andreflect skinflaps

Reflectplatysmaupwards andexpose thedeep fasciafrom ant.Bellies ofdigastrics &areabetweenthem

Removefascia belowhyoid &expose

infrahyoidmuscles Separate

thesemuscles inmidline andexpose

Clean fasciaininfrahyoidregion &note

At lowerborder ofmandibleidentify

Clean &define thedigastrictriangle &note

Remove fat& fasciabetweenpost. bellyof omohyoidto exposecarotidtriangle

Clean &define theboundariesof musulartriangle

Cut sternal& head ofSCM &expose

Raise sup.Belly ofomohyoid &trace its N.

Boundaries ofant. triangle &its varioussubdivisions

Platysma Digastric ms.

& triangle Mylohyoid Infrahyoid

muscles Laryngeal

prominence Isthmus of

thyroid gland Facial artery

& vein Digastric

triangle Superficial

part ofsubmandibular gland

Boundaries ofcarotidtriangle

CCA, ICA &ECA

IJV IX & XII

nerve Boundaries &

floor ofmusculartriangle

Ant. jugular vein Cerv.br. of VII

Cn Submental

triangle Pretracheal fascia Inf. thyroid veins Jugular arch Submandibular

LN Facial vein Mylohyoid N Branches from

ECA in carotidtriangle

Sup. & Inf. rootof ansa cervicalis

Intermediate

tendon ofomohyoid

Ansa cervicalis

Submental

LN Median

thyrohyoidlig

Levatorglandulaethyroidae

Submentalbr. of facialartery

Submentalartery

Nerves

supplyinginfrahyoidstrap

Intermediate

tendon ofomohyoid

Ansa

cervicalis

1. Boundaries &subdivisionsof ant. triangle

2. MusclessuprahyoidInfrahyoid

3. Vessels CCA,ICA, ECA &its brs. Facialveins IJV

4. Nerves VII,X, XII CNsAnsacervicalis

5. Other struct.Lymph nodesubmandibularsalivary gland

Deep cervicalfascia & itsvariouscomponents

Ansacervicalis

Midlinestructures inthe neck

APPLIED ASPECTS

Carotid pulse Jugular venous pressure

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 9 DEEP

DISSECTIONOF NECKANDTHYROIDGLAND

Displace SCm& sup. Bellyof OH laterally

Cutsternohyoidnear its lowerend & turn itupwards

Remove fat &fascia fromfront oftrachea

Remove fasciafrom lobes ofthyroid &expose itsblood Vs.

Lift lower partof gland &expose lat.Surface oftrachea &oesophagus

Clean &identify bld.Vs. of thyroid&accompanyingnerves

Lift thyroid &look forparathyroidglands on itsposterioraspect

Removecarotid sheathand exposevagus betweenCCA & IJV.Expose andidentify

Pull scalenusanteriorlaterally &expose

Separate IJV& CCA.Identify post.to them.

Displace CCAlat. & expose

Trace thesympathetictrunkssuperiorly &find

Trachea Thyroid in situ &

study it. Oesophagus Recurrent

laryngeal N.between them

Sup. Thyroid

artery Inf. thyroid

artery Sup. Laryngeal

N. External

laryngeal N. Rec. laryngeal N. Brachiocephalic

veins Branchiocephalic

trunk on rightside only

Subclavian artery Costocervical

trunk Sympathetic

trunk

Remains of

thymus Anastomosis

between sup.& inf.thyroidarteries

Thyroidea ina artery

Middle

cervicalganglion

1. Thyroid gland& its blood Vs.2. Nerves RLNSympathetictrunks3.Vessels brachiocephalicvs. subclavianarterycostocervicaltrunks4. Trachea5. Oesophagus

Pretrachealfascia

Lymphaticdrainage of head& neck

Thoracic duct inneck

APPLIED ASPECTS

Thyroid swellings Anatomical considerations during

thyroid surgery

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 10. INFRATEMPORAL

REGION Clean, define

& identify Divide

zygomaticarch ant. &post. toattachment of

Temporal fascia Masseter Temporalis

Neurovascular bundleentering masseter Buccal N & Vs

Muscles ofmastication1. Temporalis2. Masseter3. Lat. &

med.Pterygoid

Actions ofmuscles ofmastication

masseter &turn it downalong with themuscle

Strip masseterfrom surfaceof mandibleupto angle &exposeTemporalis

Separatecoronoidprocess frommandible byoblique cutfrommandibularnotch uptoant. margin oframusmeeting bodyof mandible

Turn coronoidprocess &attachedtemporalisupwards &separatemuscle fibresfrom temporalfossa toexpose

Exposestructures ininfratemporalfossa byremoval ofpart ofmandible asper figure andidentify

Give onehorizontal cutthrough neckof mandible &second abovemandibularforamen.

Remove pieceof bone &exposeunderlyingmuscles,nerves &vessels

Sphenomandibular

lig. Lat. Pterygoid Med.pterygoid Maxillary artery

Deep

temporalN & Vs

Structures

piercing thesphenomandibularlig.

Pterygoid venousplexus

APPLIED ASPECTS

Clinical consideration ofpterygoid venous plexus

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 11. INFRATEMPORAL

REGION(Continued)INCLUDING T.M.JOINT

Separate twoheads of lat.Pterygoid

Expose theunderlyingstructures atlower borderof lat.Pterygoid

Removeupper head oflat. Pterygoidby detachingit fromcapsule of

Capsule of

T.M. joint Middle

meningealart.

MandibularN. & itsbranches

Lingual N Inf. alveolar

N.

Lat. Ligament ofT.M. Joint

Two roots ofauriculotemporalN.

Acc. Meningealart

AuriculotemporalN (curvingaround med. &post. surface ofjoint capsule).

Articular disc

Buccal N.(betweentwo headsof lat.Pterygoid)

Otherbranches ofmandibularN.

1. Nerves. Mandibular N &its two majorbranches lingualN. inf. alveolarN. chordatympaniAuriculotemporal N.

2. Vesselsmaxillary arterymiddlemeningeal artacc. Meningealart. Inf. alveolarart.

Movements ofT.M. joint

Course &distribution ofmandibular N

Distribution ofchordatympani

Course anddistribution ofmaxillaryartery

T.M. joint &remove itpiecemealfrominfratemporalfossa

Separatelower headfrom lateralpterygoidplate &strip it

Disarticulatehead ofmandiblefrom articulardisc &remove itwithpterygoid &identify

LiftmandibularN. laterally &expose oticganglionmedial to it

Expose tensorpalati medialto MMA &mandibular N

Lift contentsof orbitupwards &medially andexpose

Removeperiosteumfrom orbitalfloor &identify

Exposemandibularcanal byremovingouter table ofbone withchisel &identifystructureswithin canal

Chorda

tympani

Otic gangilon Tensor palati Infraorbital

groove Infraorbital N &

Vs Inf. alveolar N &

Vs

Zygomatic

N. Brs. from

inf. alveolarN

Dental brs. Mental N

APPLIED ASPECTS

Dislocation of T.M. joint. Lingual N. block in tooth extraction Pterion & middle meningeal art Referred pain from diseased tooth Taking care of articular disc and facial

nerve

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 12

SUBMANDIBULARREGION &SUBMANDIBULARGLAND

Cut facial

vessels atlower borderof mandible

Detach ant.belly ofdigastric frommandible

Clean &expose post.belly ofdigastric &stylohyoid .

Turnsuperficial partof

Superficial partincludessubmentaltriangle digastrictriangle

Deep partincludes root oftongue floor ofmouth

Facial vessels Both bellies of

digastric Stylohyoid

muscle Submandibular

gland superficialpart

Mylohyoidmuscle

Continuation of

Stylomandibular

lig. Submental art.

Facial nerve Glandular brs.

of facial art N. to

1. Submandibulargland & its bothparts

2. Muscles Both bellies ofdigastricMyohyoidStylohyoidHyoglossusGeniohyoidGenioglossusStyloglossusStylopharyngeusMiddle constrictor

Submandibukarganglion

submandibulargland hookingaround post.free border ofmyohyoid

Dissect &clean facialartery fromdeep surfaceof gland &trace itsbranches

Trace &identify N. tomylohyoid onmylohyoid.

Turn S.M.glandanteriorly &identify

Displace S.M.

gland &submental Vs.posteriorly

Turn ant. bellyof digastricdownwards

deep &superficial partsof gland aroundpost. border ofmylohyoid

Facial art Deep part of

gland Hyoglossus XII CN over

hyoglossus Lingual N

(crossing theuscle at higherlevel)

Submandibularduct

Mylohyoid & itsattachments

mylohyoid Submandibular

ganglionsuspendedfrom lingual N

APPLIED ASPECTS

Submandibular salivary calculi Veins related to submandibular gland

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 13. SUBMANDI

BULARREGION &SUBMANDIBULARGLAND(Continued)

Take the sagittalsection of the head& neck onalternate table(one in 3 tables) ineach row

After identifyingcut edge ofmylohyoid onmedial surface,separate it fromoverlyinggeniohyoid

Identify plane ofseparationbetweengeniohyoid &genioglossus

Pull tongue awayfrom mandible cutm.m. between it &mandible

Strip m.m fromfloor of mouth &mandible and turnit down andexpose

Trace styloglossusback to styloidprocess andconfirmstylopharyngeuspassing deep tohyoglossus

Below IX CN,identify sup.Border of middleconstrictor & traceit to hyoid bone

Geniohyoid Genioglossus Submandibular

duct Lingual N Hypoglossal N Styloglossus Stylopharyngeus Glossopharyngeal

N Middle constrictor Lingual art Post. part of

Genioglossus Middle constrictor

Sublingual

gland Stylohyoid

ligament Lingual

veins

Deep

lingual vein Dorsal

branches oflingualartery

1. Submandibularduct

2. Nerves XII CNlingual N &SMD ganglionIX CN

3. Arteries facialsubmentallingual

4. Sublingualgland

APPLIED ASPECTS

Detach hyoglossusfrom hyoid & turnit upwards andexpose

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 14.

PHARYNX PROSECTION

Removebuccopharyngealfascia from ext.surface ofpharyngealmuscles

Clean & expose

IX CN windinground post.surface ofstylopharyngeus

Clean & definestructures atupper border ofsup. Constrictor

Clean & definestructuresbetween sup. &middleconstrictor

Clean & definestructuresbetween middle& inf.constrictors

Clean & definestructures atlower border ofinf. constrictor

Constrictors ofpharynx sup.Constrictormiddleconstrictor inf.constrictor

Stylopharyngeus IX Cranial

Nerve Levator palati Tensor palati Stylopharyngeus IX CN

Buccopharyngealfascia

Auditory tube Sup. Laryngeal N

& Vessels Recurrent

laryngeal Nerve

Pharyngealplexus of veins

Branch to

stylopharyngeus Ascending

palatine artery Inferior

laryngeal artey

1. MusclespharynxConstrictorsStylopharyngeuspalateLevator palti2. Nerves IX CN Sup.Laryngeal recurrentlaryngealrecurrentlaryngeal3. Vessels: Ascending palatine arteryInferiorlaryngeal artery.

Arrangementofconstrictorsof pharynx

Innervationof pharyngealmuslces &pharyngealplexus

APPLIED ASPECTS

Killian's dehiscence Pharyngeal abcess

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 15. PHARYNX

(Coninued) ANDSOFT PALATE PROSECTION

In the midsagittal cutspecimen ofhead andneck studythe interior ofpharynx.Strip off itsmucousmembrane toexpose thepharyngealmuscles frommedial slide.

Identify

differentparts ofpharynx, notetheir extent &features

Identify the

Pharyngeal muscles a. Nasopharynxopening of auditorytube b. Oropharynxpalatine tonsil intonsillar fossa c. LaryngopharynxAnt. wall showinglaryngeal inletlat. Wall presentingpiriform fossa Muscles of soft

palate levatorpalatipalatoglossuspalatopharygeusmusculus uvulae

Tubal elevation Salpingopharyngeal

fold Pharyngeal recess Pharyngeal tonsil Palatoglossal arch Palatopharyngeal

arch Aryepiglottic fold Thyrohyoid

membrane IX CN

(anterolateral tostypharyngeus)

Tubal tonsil Bed of tonsil Ascending

palatine art

1. Muscles ofpharynxconstrictors.LongitudinalpalatopharyngeusstylopharyngeusSaplingopharyngeus2. Muscles of softpalateLevator palatiTensor palatiPalatopharyngeus Musculus uvulae3. Palatine tonsil4. Opening ofauditory tube5. Epiglottis6. Laryngeal inlet7. Piriform fossa8. Nerves

Deglutition Blood supply of

palatine tonsil Passavant's

ridge

APPLIED ASPECTS

Dysphagia

soft palate Clean &

define themuscles afterstriping offthe mucousmembrane

Tonsillitis & anatomicalconsiderations in tonsillectomy

Quinsy Removal of foreign bodies from

piriform fossa Embryological basis of cleft palate

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 16. NASAL CAVITY

PROSECTION

In the mid

sagitally cutspecimen ofhead &neck,identify nasalseptum

Strip themucousmembranefrom theseptum &expose

Study &

identifyvariousfeatures of lat.Wall of nose

Identifyopenings &features ofmeatuses

Remove ant.part of inf.concha &exposeopening of

TracenasopalatineN. from nasalseptum acrossthe roof ofnasal cavity tosphenopalatineforamen

Breakperpendicularplate ofpalatine andexpose

Nasal septum Vomer Perpendicular

plate of ethmoid Sphenoethmoidal

recess Nasal conchae Meatuses a. Spheno

sph.recessb. Sup. Meatus

post. ethmoidalcells.

c. Middle meatusfrontal air sinusmaxillary & ant.ethmoidal

d. Inf. meatusnasolacrimalduct

Septal

cartilage Vestibule of

nose Atrium of

middle meatus Infundibulum Hiatus

semilunaris Bulla

ethmoidae

Parts ofMaxillaPalatineNasalSphenoid formingnasal septum Mucocutaneous

junction Nasopalatine

N. Greater palatine

1. Nasalseptum &itsformativeconstituents

2. Lat. Wall ofnose & itsfeatures

3. Conchae4. Meatuses

Nerve supply & bloodsupply of Nasal septum Lat. Wall of nose

Pterygopalatineganglion Functional aspects of

paranasal sinuses

APPLIED ASPECTS

Little's area & epistaxis Sinusitis Dacryocyctitis

S.No

TOPIC

DISSECTION

STEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND 17. LARYNX

PROSECTION

Study Cut through

sternothyroidupward &define itsattachment tothyroidcartilage

Identifyattachments ofinf. constrictoron thyroid andcricoidcartilages

Larynx in situ Thyroid cartilage &

laryngeal prominencesternothyroidmuscle

Thyrohyond muscle Cricoid cartilage Inf. constrictor Cricothyroid muscle Thyrohyoid muscle

Sup. Thyroid

notch

Cricothyroid

lig.

1. Cartilage2. Membranes

& ligaments3. Larynx and

its variouscomponents

Cricothyroid &cricoarytenoidjoints, theirmovements &muscles causingthem

N. & Bld.Supply of larynx

Lymphaticdrainage oflarynx

Expose inf.contrictor &divide ithorizontally

Trace inf. hornof the thyroidcartilage to itsarticulationswith cricoidcartilage

Expose Clean and

exposethyrohyoidmuscle

Cut throughthyrohyoidmuscle &expose

On sectionalsurface oflarynx identify

Study theinterior oflarynx

Thyrohyoid memb Sup. Laryngeal Vs. Int. laryngeal N Epiglottis Arytenoid cartilage Vestibule of larynx Vestibular folds Vocal folds Ventricle of larynx

Glossoepiglottic

folds Quadrate lig. Rima vestibuli Rima glottides

Thyrohyoid

lig. Hyoepiglottic

lig. Corniculate

cartilage Tubercle of

epiglottis Saccule of

larynx

APPLIED ASPECTS

Simons law Laryngeal oedema Laryngoscopy Vocal cord palsy

S.No

TOPIC

DISSECTIONSTEPS


SUMMARY

LEVEL 1 LEVEL 2 LEVEL 3 IDENTIFY UNDERSTAND

LARYNX(continued)

Cut vestibularfolds fromupper part ofarytenoidscartilage & stripit forwards fromthe wall oflarynx & notethe underlyingmuscle

Strip mucousmembrane frominf. surface ofvocal fold &expose

Strip mucousmembrane fromsup. Surface ofvocal fold &expose uppersurface of

In the specimenof larynx, clean& identifymuscles

Remove

cricothyroid onone side alonglower part oflamina & inf.horn of thyroidcartilage &expose

Thyroarytenoid Cricothyroid Post.

cricoarytenoid Tr. & oblique

arytenoid

Thyroepiglotticus Conus elasticus Thyroartenoid Thyroepiglotticus Cricothyroid joint

Vocal lig.

1. Muscle of larynx2. Cricothyroid3. Postcricoarytenoid

4. Tr. & obliqueartynoid

5. Lat.Cricoarytenoid

6. Extrinsic musclesacting on larynx

7. Thyrohyoid8. stylopharyngeus9. Palatopharyngeus10. Sternothyroid

APPLIED ASPECTS


TUTORIALS

LEARNING OBJECTIVES OF TUTORIALSOUTLINE OF TUTORIALS

S.No TOPIC MUST KNOW SHOULD KNOW COULD KNOW

1. ANT. CRANIALFOSSA

1. Boundaries Crista Galli ,Cribriform plate ofethmoid

2. Orbital plate of frontalbone

3. Lesser wing of sphenoid4. Ant clinoid process

1a. Foramen Caecum2a. Frontal crest

1b. Ant & Postethmoidal canal2b. JugumSphenoidal3a. Caroticoclinoidforamen

2. MIDDLE CRANIALFOSSA

1. Boundaries2. Sulcus chiamatis3. Optic canal4. Sella turcica5. Post clinoid process6. Groove for ICA7. Cavernous sinus8. Foramen ovale &

spinosum9. Superior orbital fissure &

contents

1a. Attachment oftentorium cerebelli2a. Foramen rotundum& F.lacerum3a. Meckel's cave4a. Arcuate eminence5a. Tegmen tympani6a. Squamotympanicfissure

1b. Dorello's canal2b. Foramen ofvesalius3b. Canaliculusinnomnatus4b. Hiatus forgreater & lesserpetrosal nerves

3. POSTERIORCRANIAL FOSSA

1. Boundaries2. Clivus basiocciput &

basisphenoid3. Foramen magnum4. Internal occipital crest &

protruberance5. Jugular foramen6. Hypoglossal canal7. Internal acoutic meatus8. Transverse & sigmoid

sulcus

2a. Structure attached toclivus

1a. Condylar canal2b.Petro occipitalfissure3a. Opening ofvestibular aqueduct

4. INTERIOR OFCRANIUM

1. Bones2. Sutures & types3. Frontal crest4. Sagittal sulcus

1a. Vascular impressions

1b. Parietalforamina2b. Impressions forcerebral gyri

5a. SKULL NORMAFRONTALIS

1. Anatomical positionReid's base lineFrankfurt's plane

2. Bones forming 4. Supercilliary arch5. Frontal eminence6. Glabella7. Nasion 9. Orbital margins10. Boundaries of Orbit Supraorbital foramen Infraorbital foramen Superior orbital fissure Inferior orbital fissure11. Ant. Nasal Aperture12. Parts of Maxilla

3. Sutures Metopicsuture 8. Lacrimal fossa 13. Incisive foramen14. Canine fossa15. Muscle attachments16. Applied Frontal sinuses

17. Ethmoidalforamen18. Whitnall'stubercle

5b. SKULL NORMAVERTICALIS

1. Bones taking part2. Sutures3. Bregma, lambda, vertex4. Fontanelle5. Parietal eminence

6. Parietal foramen 7. Temporal lines 9. Applied # of parietalbones

8. Sutural bones

5b. SKULL NORMAVERTICALIS

1. Bones taking part2. Sutures3. Bregma, lambda, vertex4. Fontanelle5. Parietal eminence

6. Parietal foramen 8. Temporal lines

7. Obelion

10. Applied # ofparietal bones

9. Sutural bones

6a. SKULL NORMAOCCIPITALIS

1. Bones taking part2. Lambdoid suture 4. External occipital protuberance5. Inion6. Nuchal lines

3. Mastoid foramen 7. Muscle attachments

8. Interparietalbones

6b. SKULL NORMALATERALIS

1. Bones taking part2. Sutures3. Pterion4. Asterion 6. Zygomatic arch 8. Ext. acoustic meatus9.Suprameatal triangle10.Infratemporal fossa boundaries & contents 12. Mastoid process13. Styloid process

5. Temporal lines 11. Pterygopalatine fossa 14. Muscles attachments Masseter Temporalis

7. SKULL NORMABASALIS

Boundaries1. Ant. part hard palate sutures & formation 4. Palatine crest5. Post. nasal spine 7. Middle part union of

basiocciput & basiphenoid 9. Pterygoid plate 10. Pterygoid hamulus Greater wing of sphenoid Identification Spine of sphenoid Foramen 13. Petrous temporal F. Lacerum Carotid canal Mandibular fossa15. Tympanic part of temporalbone 16. Post. Partf. Magnum17. Ext. Occipital crest18. Ext. Occipital protuberance19. Hypoglossal canal 20. Jugular foramen 21. Styloid process 22. Stylomastoid foramen23. Mastoid notch24. Occipital condyles

2. Palatine foramen3. Incisive fossa 6. Muscle attachments 11. Pterygoid fossa12. Muscle attachments 14. Squamotympanicfissure 25. Post. Condylar canal 26. Jugular fossa27. Mastoid canaliculus 28. Muscle attachment29. Applied facialnerve damage

8. Palatovaginalcanal

8. MANDIBLE

1. Parts2. Body symphysis menti3. Metal protuberance4. Mental tubercle5. Metal foramen 7. Oblique line8. Base9. Myloyoid line & groove 11. Ramusmandibularforamen12. Linula

6. Mental fossa 10. Genial tubercles

13. Myelohyoid groove14. Codyloid & coronoid

processes15. Atachments of muscles of

mastication16. Relation of vessels &

nerves17. Relation of salivary gland18. Age changes 19. Movements of mandible &muscle causing it.

20. Ossification21. Applied # Mandible Dislocation Lingual N. block

22. Growth of

mandible23. Sex differences

9. CERVICALVERTEBRAE

1. Total no. Typical Atypical

2. Identifying features 3. Articulations 4. C1 identifying features7. Anatomical position8. \Parts9. Course of vertebral art 10. Joints and movements 11. C2identifying features12. Anatomical position13. Odontoid process14. C7 identifying features15. Anatomical features16. Vertebra prominence

5. Costal & transverse

elements6. Carotid tubercle

17. Muscleattachment18. Sex differences

10. INDIVIDUAL BONESTEMPORALFRONTAL PARIETAL

1. Identification2. Parts3. Articulation : sutures 5. Fontanellae6. Relations on the internalsurface

7. Muscle attachments

4. Sutural bones

11a. SPHENOID

1. Identification2. Articulation, sutures3. Relations on the internal

surface4. Identify sup, orbital

fissure, Foramenrotundum. Foramen ovale& foramen spinosum

5. Muscle attachments6. Ossification

11b. MAXILLA 1. Identification, parts2. Articulation3. Maxillary air sinuses4. Infraorbital foramen

5. Muscle attachments6. Age changes7. Applied importance8. Ossification

11c. OCCIPITAL 1. Identification, parts2. Articulation3. Anatomical position4. Relations on the external &

internal surfaces

5. Muscle attachments6. Ossification

7. Interparietal bone

12a. FOETAL SKULL 1. Difference between skullat birth and skull

2. Fontanelle Time of closure Applied importance3. Closure of sutures4. Sex differences

5. Craniometry6. Cranial capacity

7. Mechanism of

growth8. Applied

Forensic reconstructionwith skeletalremainsestimation of age.

12b. SMALL BONESVOMER, LACRIMAL,INFERIOR NASAL,CONCHA NASAL,ETHMOID,PALATINE

1. Identification

2. Ossification

3. Obelion 4. Sutural bones

section – i (course content · head and neck schedule1. posterior triangle of the neck. lecture:...

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