This video provides a comprehensive review of Head and Neck Surgery (HNS) and radiology content for medical students, covering skull anatomy (neurocranium and viscerocranium with 8 cranial and 14 facial bones), skull foramina and their contents, skull fractures (basilar, Le Fort), scalp layers, facial muscles and innervation, nasal cavity anatomy and drainage, paranasal sinuses, pterygopalatine fossa communications, infratemporal fossa contents, ear anatomy (external, middle, inner), orbital anatomy and extraocular muscles, eye structure (cornea, lens, retina), and radiological interpretation of intracranial hemorrhages (epidural, subdural, subarachnoid) and brain abscess.
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HNS OSPE & RAD Review | Ismail Abdullah | HNS 242Ajouté :
Alam allayikum everyone my name is Abdullah I'm a fifth year medical student and inshallah today we will be uh having a quick review on the opi content for hs and radiology.
Uh so far my uh impression on HNS is that it's a very uh it's a very easy examshallah.
Uh it's very straightforward, not tricky. Uh basically you know if you know it, you know it, you know what I mean? Uh regarding the Ospy, it's going to be anatomy heavy very much. So this inshallah we're going to cover uh all the important and relevant aspects to to it. Uh and same goes for radiology.
So inshallah towards the end of this we will cover clinical anatomy uh common pathologies and neuroiology and uh if you see it you should know it.
If you don't know it then good luck having an educational guess towards it.
So let's start off with the skull.
So now what you really need to know about the skull is that skull is divided into two parts. The neuroranium and the visor cranium. So the neuroranium basically is the skull base and the calvarium. Right?
And then the visoranium visor cranium is the bones of the face. Uh we have eight cranial bones that you need to know. uh 14 facial bones as well. And of course there are certain holes in your skull that act as passage vessels uh for it acts as a passage for vessels and nerves. All right.
Now basically we're inshallah towards the end of this uh session you will be able to uh name all of these different bones. We're going to go through them systematically.
Uh however, I put this picture here today just so that you can appreciate the interior and the lateral view of the skull. So, as you can see, this is your frontal bone. And then you'll here have you know your spheroid bone. You're going to have your temporal bone. You're going to have your parietal bone as well. And see here an area where all these bones you know meet is called the uh the the petri. All right. So here this is the area where they all meet. A fracture to this area may lead to an epidural hematoma.
All right. Why? Because just beneath it runs the middle meninjial artery.
All right. And it's very important that you know this a very common MCQ, SECQ and OSBY uh question. All right. Usually a scenario of a patient who had a road traffic accident and they fractured you know you'll see that they fractured their you know pitrus bone or like their terri uh epidural hematoma middle artery. All right.
But second thing that you guys need to appreciate when it comes to the skull is the sutures. So we have the corodal suture that runs corotally. Then you'll have your sagittal suture right here.
And you need to know that the area where these two sutures meet is called the brema.
And then at the end here you have your lambdoid suture. And when it meets with the sagittal suture, it's known as the labda. All right. Uh you can be asked to label which of the following is you know the coronal suture, sagittal or the labid. Very important that you guys know this. Uh and yeah, now coming to the uh the forabida in your cranial uh the cranium. All right.
It's very important that you know them.
Very high yield and you are expected to be able to identify it and name what passes through it. Okay. So here we have our frontal bone. All right. So this is interior. This is posterior. And this is the frontal bone right here. This is the ethmoid bone. Ethmoid bone. You have the cristagali. You have the cryp the cripp plate. And then you have your spheroid bone. All right, spirit boy that looks like uh you know it has wings. You have the lesser wing, you have the greater wing and then we have here our forin rotundum. All right, for rotundum what passes through it? The maxillary nerve which is branch of the trigeminal. So it's the second branch of the trigeminal.
Then you have the for valley for valley.
What passes through it? You'll have the mandibular nerve and then you'll have forin spinosm for what passes through forin spinosm so that's gonna I think that's going to be your uh middleial artery okay then you'll have the cribfor plate through the cribform plate you're going to have the alfactory nerve passing through so uh something important if if it gets damaged you know you get to have something we call edosia which is basically the ability to lose your smell and then uh through the optic canal which is right here if you can appreciate it. All right, the optic canal what passes through it is the optic nerve. Okay, and then you have the internal acu acoustic mutus which is right here. All right. The facial nerve passes through and the vestibular cclear nerve. Yep. And then you have the jugular for jugular for you have cranial nerve 9, 10 and 11 passes through it.
And the hypoglossal canal right here.
You have the hypoglossal nerve passing through. It's very important that you know all of these very high yield. Okay.
And uh definitely expect an an ask me question from this slide.
Now let's talk about the uh front the front part of the skull for abramina. So the first form right here number one layup here you have uh here you have uh basically it's called the zy zy zygomatic zygomatico facial. All right and you have the zygomatico facial nerve passing through. Now something about forins uh especially you know in the skull whatever their name is sometimes that's exactly what the content is. All right so uh inshallah it's going to be very easy for you to remember. Then secondly right here just above the orbital rib right here you have the supraorbital notch and what passes through it the supraorbital nerve and the vessels and then you have the third one right here. So this is infraorbital. So if this is superorbital, this is going to be infraorbital. And you're going to have the orbital nerve and vessels passing through as well. And then this one right here. So this is the uh this is like the mental tubacle right here.
So this is going to be the mental forin.
And what what's going to pass through the mental nerve and the vessels.
Now something that's pretty clinically relevant here is that you know the supraorbital notch is could be a trigger point for trigeminal neuralgia uh which basically is an irritation to the first uh the first division of the uh trigeminal nerve. All right.
Okay. Skull fractures. Now uh I've honestly not seen much about uh all these different kinds of fractures uh in your past ops. However, we're going to go through them. The most high yield one in my personal opinion is going to be the baselor fracture. So let's start with the first one. The first one is called the diastatic fracture. So what does it mean? A diastatic fracture is a fracture that occurs along the line the the natural lines of your sutures. All right. What can happen to them? they could either widen or separate and this is very very common in infants and children. All right, so it's going to be along your sutures.
The second one is what we call a depressed fracture and as you can see it's a it's a it's a fracture where a segment of the skull bone is going to be broken and it's going to go inward all right towards the brain.
Third is a linear fracture. So it's a straight line fracture within the cranial bone but does not move unlike the depressed fracture where it just moves inside. This one does not move. It just stays where it is. All right. The last one is the basillar fracture. All right. So this is the basillar bone.
This is like the area where uh it's at the base of the skull. Okay. Given it's the basillar fracture. It involves the temporal occipital spheroid and ethmoid bones. And typically it presents with something we call the battle sign and raccoon eyes. So the battle sign is basically going to be uh like a blood accumulation right here behind the ear.
And raccoon's eyes is going to basically be perorbital echimosis around the eyes.
All right. Very high yield. Very very very high yield. The bizilla fracture is really high yield. All right. And then moving on we have what we call the layfort fractures or the bitface fractures. Now they're divided to three different uh categories. We have lefort one, we have le for two and we have leffort three. So le one is going to be a lowle lowle right here a low-level horizontal fracture. All right. Now what what's going to happen in this fracture is that it's going to detach the heart pallet and the upper teeth from the midface. So you're going to have what we call a floating pallet. All right. Now here of course is going to involve your lower mags, the anteriorateral uh margins of the nasal fossa, the magilary sinus as well and the tire goat plates.
All right. And everything else stays intact. Then moving on to the second one which is the leour 2 and this is what we call a pyramidal fracture. See here it's going to be midle almost triangular like fracture. It's and it separates what it separates the this pyramid kind of center fragment of the face from the surrounding zygomas and the cranial bones and you're going to have what we call a floating magilla. All right. Here the inferior uh the inferior rim of the orbit is going to be broken. However, the zygomatics the zygoma is going to be intact as you can see in the third one. This one is a complete dissociation.
So this is a high level fracture. All right, transverse fracture where your uh the facial skeleton completely dissociates from the neuroranium. So the visor cranium and the neuroranium completely dissociate from each other.
Here the zygomatic arch is definitely broken. All right. And since the skull base is involved, you're going to get symptoms like uh CSF renora.
You can also get uh dural tears. All right. So very very important, very high yield.
So let's have our first clinical scenario. So this is a 24 year old male brought to the emergency department following a high velocity motor vehicle collision. On on initial examination, his glasco scale was 14. He's hemodynamically stable but complains of a severe headache and a persistent salty tasting clear fluid dripping from his nose which increases when he leans forward. Physical examination reveals prominent bilateral perorbital echimosis without local soft tissue trauma. Upon formal neurological assessment of the cranial nerves, the patient is unable to identify the scent of coffee or so presented to either nostril.
What is your diagnosis?
So as you can see here, this is a patient, all right, who suffered uh you know uh a high impact uh road traffic accident and he's stable. However, he's having this severe headache and he's having this fluid dripping down his nose, right? And he's having basically bruises around his eyes and he cannot smell. So what could be your diagnosis?
So this I'm going to give you a minute.
So what do you think?
So this is going to be uh basillar skull fracture. All right. Involving the interior cranial fossa. And why would we say that? So because there's three uh three important symptoms that the patient you know presented with. He's has a he's having CSF uh radaria. All right. So basically there's CSF from the brain. All right. Dripping down the nose. That's one. He lost his sense of smell at aosia. And he also has raccoon eyes which is the perorbital echibosis.
And why does he have the perorbital echibosis? It's because the fracture that happened to the interior cranial fossa. All right. is going to cause blood uh you know bleeding right some arteries going to rupture and basically they're just going to follow gravity and they're going to accumulate around the orbit. All right.
So now skull very easy. So again the things that you really really need to know really well the uh forins the cranial uh the different cranial fossa. You also need to know the basillar fracture very well. The leord fractures these are very very important.
Then we move to the scalp. Scalp is really really easy. What you really need to know for a scalp, you need to know these layers exactly how they are. So we start off with the skin moving on to connective tissue. Then we have this aponurotic layer and then you'll have the loose connective tissue in the picranium. So scalp very easy you need to know this. This this is a potential uh uh question and could also be an MCQ. So it's very very important that you know this. Now you need to know the uh the basically the muscles that that are in your scalp. So first of all you'll have the fertalis and then you'll have the occipitalis and then they're joined by this aponurosis right here. So they're supplied by the temporal temporal uh temporal nerve and the post ericular nerve. All right. They function by elevating the eyebrows and wrinkles of the forehead. Okay. very very important that you know the occipital fertalis muscle.
So again it's two different bellies joined by this aponurosis.
So the frontalus part and the occipitalis all right you need to know the nerve very very potential uh ospby question.
So in OSby you know any muscle that you encounter you have to know its name the way it looks and the nerve very important. So yep now we're done with the scalp so far easy right now moving on to the face.
Face is a bit heavy so we'll make it easy. So now looking at the face the face mah very uh muscular all right and there are certain muscles that you h you you have to know you have to know uh their names they where they are and their function and their nerve supply. So first of all we start with the orvicularis orus. All right so this is the orbicularis orus right here. All right. The orbicularis orus is a is a muscle that helps in closing your eyelids and it is supplied by the temporal nerve. Then you have the zygomaticus major. All right, which is right here. All right, the zygomaticus major is a muscle that helps with the elevation of your upper lip. All right, and it's supplied by the zygomatic nerve. Then we have the buxinator. All right. The buxinator muscle is here in the cheeks and it it basically you know supplied by the buckle nerve and uh it presses the cheek against the molar teeth and it also works with the tongue to keep food out of your oral vestibule.
Okay.
Uh then we have the orbicularis orus right here. All right. So it's a muscle around your mouth supplied by the buckle nerve and it functions to close your mouth. Then we have the mentalis right here. All right. The mentalis which is basically uh a muscle that helps in elevating your jaw and it's supplied by the marginal mandibular nerve. And remember that we have a forin right here. It's called the mental for that helps pass the mental nerve through. All right. And then you have the platisma.
All right. Look at this muscle platisma right here. So this helps in depressing your mandible and it's supplied by the cervical nerve. So pretty straightforward. Nothing really much to explain here. Uh however it's very important that you be able to identify them on on the plastic models uh and also on you know uh on images like this and try to know their n their supply and their action. Okay.
Now this is from your uh lab uh slides and here it's very important that you be able to identify different arteries that uh you know supply the face. Okay. So first of all let's start with this artery right here at the back.
So this is the occipital bone. Hence occipital artery. Then this is where your temporal bone is. And here you're going to have your superficial temporal artery.
Then right here, so this is your berotin. Okay. And right here is the transverse facial artery.
And then this is the superior labial artery.
And this is the facial artery right here as well. Okay.
Very important that you know these. And then the the veins. Usually the veins and the arteries accompany each other.
Perfect example like you have the superficial uh temporal vein right here.
You have the transisacial nerve, superior labial vein, facial vein and the two ones that we haven't discussed the artery part. You have the posterior oricular vein. So this is the oracle right here and this is posterior to it.
So posterior orcular vein and this is your external jugular vein. external vein is a very important high yield uh opi uh structure that you'll be asked to pinpoint. Okay. So it's very important that you know this right here.
So now this is also from your uh slides.
So basically what you really want to know from this slide is that the fourth layer of the scalp is dangerous. Why? because if it if the infection happen to reach the fourth layer, all right, it can enter your cranium via the imissery veins. Okay, so that's something that you need to know.
Very uh I'd say this is probably more common to be tested in your MCQs.
Uh something else that you want to know about the face, if you have an injury or an inflammation to your facial nerve, you could have something we call bellspy. All right. So, the patient will have drooping of the face. Uh will not be able to smile properly. All right. As you can see right here, uh they could also have tois as well. And this one right here is the danger triangle of the face. Okay? Why? Because this area right here is drained by your facial nerve and sorry, facial vein. Apologies. And it the facial vein communicates with the civerous sinus that is in the brain. So an infection all right could an infection right there could you know be carried all the way to the civerous sinus and cause some sort of trombosis.
So it's very very important that you know this.
So we're done with the face. Very straightforward. Uh muscles arteries straightforward. Moving on to the nose.
Nose is very important.
uh the things that we're going to discuss in the nose of course is going to be the structure uh the different parts of it and whatever we we study here we can apply heavily in radiology so I want you to focus with me so first of all we start with the external nose all right so the external no first of all we have the apex of the nose which is the tip right here you'll have the uh wings around the nostrils what we call the alla And then you have the nostril opening right here. So this is going to be your naries. All right. And this is going to be your nasal septum right here.
Okay. And then a part of the nasal septum is going to be cartilagages. And then the other part is going to be bony. So here you'll have the dorsome which is the going to be the bridge of your nose. And this is going to be the root where the nasal bones are. All right. The bony part. So superiorly right here you'll have the nasal bones. Okay. You'll also have frontal processes of the maxilla and inferiorly we have the septal cartilage as I mentioned the er cartilagages as well u and the naries. Okay very very straightforward and clear.
So now the nasal cavity is divided I'd like to divide it to three parts. You have the vestibial. So this is the naris right? This is the opening. So right after right after the opening of the nose, you'll have the vestibule and then you're going to have the respiratory region and then you're going to have the alactory region which where your cripppform plate is and where your alactory nerve runs. Okay. Now in your respiratory region you're going to have your different concave. So you're going to have the superior concave, the middle concave and the inferior concave. And then you're going to also have something we call the kowana.
The kowana here is basically uh where your nasal cavity communicates with the nasoperics.
Okay lamp. Now what are the certain openings that you have in nasal cavity and what does it communicate with? So first of all we have the right around the entrance uh in the skull. So you'll have the perform okay which is in the skull and then it communicates into the nasal cavity and then you will have the coin that I just mentioned earlier and it's going to lead to the nasoperings from the nasal cavity. So you have the perform forin which is just one forin all right that's going to lead basically from the skull into the nasal cavity all right and then you have two openings all right uh right here so this is going to be your kit all right which will lead into the nasoperics so the kada all right which is right Here you need to know the borders of it. So the superiorly you're going to have the sphenoid bone and inferiorly you're going to have the uh hard pallet or like just the uh palatine bone and then medially you're going to have the vulmer and laterally you're going to have the medial terrago plate of the spheroid.
Okay. Uh honestly I haven't seen a question on this in the opy part uh but it's it's good to know it. Yeah.
Then you'll have the walls of the nasal cavity. Now this is really high yield.
This is very important. So regarding the nasal cavity. All right.
Uh first of all we will start with the medial wall. So the medial wall right here you're going to have the nasal septum and then laterally you're going to have the the three the three concave that we've mentioned the miatuses as well and all the different bones that contribute to the nasal uh structure and then superiorly you're going to have the curbform plate and the body of the spheroid bone and then inferiorly you're going to have the heart pallet. Okay.
and the uh which is basically uh the palatine processes of the migilla and the horizontal plate of the palatine or just the heart pallet. Okay. So again medial wall nasal septum lateral wall the concaves and the meatsis that we've mentioned superiorly or the roof is going to be your curbform plate and the body of the spheroid bone and the floor of the nasal cavity is going to be your heart pallet. Okay, very very high yield.
Now the nasal septum itself, right, is divided to the cartilage, the cartilage part and the bony part, right? So this is your interior. This is your posterior and the interior part is majorly made of highlighting cartilage as you can see.
And then posteriorly, all right, uh you'll have the bony parts. Okay, so this part right here superiorly is the part that's made of the perpendicular plate of the ethmoid. And this one right here is the vulmer. Okay.
Uh in radiology, you we will discuss this further. You'll be able to see the vulmer. you'll be able to see the perpendicular plate of the ethmoid as well which we're going to discuss later inshallah.
Now we have the lateral wall all right which is made up of the concave and the miatus. Now when we say uh concave basically we it's Latin for shell and miatus is like a passage. Now it's very important that we know the openings and what drains and what like yep.
So first of all we have the superior cona middle cona inferior cona as well and right between the superior and the middle we have the superior miatus.
Right between the middle and the inferior we have the middle miatus and below the inferior cona you'll have the inferior miatus. And above the superior concentthmoidal reesus. Okay. So the spheroic excitus drades through the sphinoidal reesus and the posterior ethmoidal cells dra through the superior miatus and the frontal sinus maxillary sinus and the interior and middle ethmoidal cells drain through the middle miatus and the nasol lacrimal duct will drain through the inferior miatus. It's very important that you know this because you can get asked in it in your SAQs in your OSP and even in radiology questions and uh you know uh SAQs. All right.
Now the part where the superior and the middle cona are it's part of the ethmoid bone and the inferior cona is just a separate bone of the skull. Okay, it's very important to keep that in mind but it's not as high yield as what drains in what. Okay, so again spheroid sinus in the sppheninoithmoidal reesus posterior ethmoid in the superior miatus everything else genuinely in the middle miatus and the inferior miatus you're going to have the nasolacal duct. This is why when you cry you know you'll have your tears running down your nose. It's because of the it's coming from your eyes through the inferior venus. Okay.
Now, this is basically just me repeating myself again. Okay. Uh so we move forward.
Okay. The blood supply blood supply is very important to know uh especially for your opi. So this is the nose. So I've made this drawing. I divided the nose.
This is your nasal septum. All right.
This is the upper part. This is the lower part of the nose. And right here, this red dot is your quesal back plexus.
Okay. The lateral wall of your nose is supplied by the spopalatine artery. All right.
And the upper part is supplied by the interior and posterior ethmoidal arteries.
Okay. And then the anterior part of your nose is majorly supplied by the kiselbach plexus. Now what are the arteries that make the kilbach plexus?
So they're called the sags. So you have the spphenopalatine which is a branch of it's a branch of the maxillary artery.
Then you have the anterior ethmoidal which is branch of the ofthalmic artery.
Then you have the greater palatine which is a branch of the maxillary artery. And then you have the superior labial which is branch of the facial artery. Okay. So let's see if we can find all of them here. So you have this is the greater palati right here. You have this phenopalatine artery as well. This is the anterior thmoidal artery. All right.
And somewhere here you're going to have the labial artery as well. These four arteries all come together to form your kiselbach plexus. They basically uh supply the interior portion of the nose including the medial wall as well.
However, clinically speaking, when will this become relevant? When a patient presents with a lot of nose bleeds or what we call them epistaxis, they're usually due to the kissbach plexus. All right? Like for especially during the winter, you know, especially in kids during the winter, you know, they have very dry noses and this is going to cause the arteries there to break and when they break they're going to have a lot of uh, you know, epistaxis.
Okay. So just again the posterior part of your nose is going to be supplied by the interior and the posterior ethmoidal arteries. The lateral part is by the sphina palatine and the interior part is going to be by the kilbach plexus. Okay.
All right.
Now we've done the blood supply. There's definitely nerve supply. Okay. So the special sensation which is your smell is going to be meditated by the the alactory nerve which passes through the cribform plate to the alactory bulb.
Okay. And then the general sensation is going to be supplied by triinal.
So we have two different areas. The first area is going to be your vestibial and the interior nasal mucosa. All right. So that's going to be by the All right. Uh and then the second one which is basically the rest of your nasal cavity is going to be through the maxillary uh division of the trial nerve. Okay. Now these are the specific nerves that we're uh that you know you need to know. So for the vestibial and the interior nasal mucosa it's going to be the interior ethmoidal nerve but you need to know it's a branch of the or of the internal nasal branch of the in infraorbital nerve and branches of the targo palatine ganglia you need to know it all comes from the maxillary however if they just asked in general what's the general sensation what supplies the general sensation of the nose it's going to be trigeminal nerve and what supplies the smell is going to be your alactory nerve Okay, this is important. Uh it's very important actually. Uh this could be asked in your op. This could be also asked at your MCQs.
So the mucous secretion in your nose, what increases your mucous secretion?
What decreases your mucus secretion and how? So parasympathetic is going to increase your mucous secretion and sympathetic is going to decrease it. So let's see how.
So first of all we have uh the superior salvatory nucleus of the facial nerve which is located in your pods and then it's going to from there you're going to have the great petroal nerve joining the deep petroal nerve and they will become the nerve to tyrroid canal or the vidian nerve and then this vidian nerve is going to go all the way to your taropalatine ganglen which is located in the uh tycoaly fossa. All right, where you know they're going to synapse here and then they're going to they're going to go to the nasal mucosa and increase mucous secretion by vasoddilation.
So the great petroal nerve joining the deep petroal becoming the nerve to tyroid canal. It goes to the ty taro palatine for uh ganglen.
They synapse there and then basically provide parasympathetic intervation to the nose causing vasoddilation and increasing mucus production.
Sympathetically to provide the sympathetic intervation you'll have so you'll have uh you know the the nerves with from the uh intermedia intermediate lateral nucleus in the T1. So that's the lateral horn of the spinal cord. All right. There you're going to have the sympathetic trunk. And then the nerves are going to synapse in the superior cervical ganglia. All right. They're going to synapse there.
Then through the deep petroal nerve they will go pass through the taro tyopalatine ganglen. They do not synapse. They just pass through. All right. and then they go to the nasal mucosa cause vasa constriction.
All right. And decrease your mucus secretion. Okay. So something clinically relevant here in hoarder syndrome you know you lose sympathetic uh activity.
So you're going to have uh you know uh you're going to lose basically the sympathetic uh intervation to the nose.
So you could have you know runny nose part of your hoarder syndrome. All right. You're going to have like a lot of mucous secretion uh a lot of vasod dilation in the nose just because there's nothing that could oppose it.
Okay.
This is very important as well. So the lymphatic drainage of your nasal vestibule which is right after the opening of the nose is going to be through the submandibular lymph nodes and everything else is going to be through the deep cervical lymph nodes.
Okay, but this slide is really critically important because it shows how the nasal cavity is connected to all paradasal sinuses and and of course this is also uh very important which shows you the different pathways of infection and how it could reach for example the brain.
All right. Uh it's also radiologically very important. So right now we're going to learn the basics and then we're going to apply later on in radiology.
So first of all the frontal sinus. All right. The frontal sinus which is in your forehead right here. All right is it's in the frontal bone drains through the middle miatus if you remember. Okay.
It's connected to your nasal cavity. So if you've had for example an infection in your nose, it could go to the frontal sinus. It could have frontitis for example.
All right. Same goes with your ethmoidal sinuses which is found within your ethmoidal ethmoidal bone. And we have the interior in the middle part draining in the middle miatus and we have the posterior part draining in the superior miatus. Then we have the maxillary sinus which is by far the largest situs in in your in your body. All right. It drains through the middle miatus and it's present at birth. Two sinuses present at birth middle ifmoidal. Okay, it's very important that you know that uh because sometimes they would trick you and ask you you know uh what what is present and what is not present during birth. Okay.
And then you have the sphenoidal sinus which is found within the body of the sphenoid drains to the spinoithmoidal recess. All right. Now these sinuses what they do they reduce the weight of the skull they help within voice resonance and they warm and humidify inspired air. Okay.
So let's take a look. This is very beautiful this model which is present in the lab. So look at this. This is your superior cona. This is your middle cona.
This is your inferior cona. And these are just the miatus right below them.
Right? This is your sphenoidal sinus within the sphinoid bone. This is your ethmoidal bone. This is your forehead.
Right? This is your frontal sinus. All right? This is the palatine bone which floors your nasal cavity. All right?
This is the vulmer. This is the perpendicular plate of the ethmoid. And this is the septal cartilage part of your nasal septum. All right? It's very beautiful. You have to know these. And you know by knowing these structures you could easily answer uh all border kind of questions right.
Okay.
So this is uh another uh another slide.
So this is your superior cona. This is your middle cona inferior cona. This is the septum nasal septum right here.
These are your ethmoidal sinuses. This is the maxillary sinus right here. It's very large you can tell. And this is basically the roof of your nose which is formed by the nasal frontal spheroid and eithal bones. And this is the floor which is formed by the heart pallet.
Okay.
And this is another picture that you can also go through. But something that I'd like to highlight here is the opening of your sppheninoiththmoidal recess which is right above the superior cona. Okay.
So if you can see the cona right here all three conchkas and this above it is the sppheninoithmoidal recesses. Okay.
And if you can also notice the tubial opening into the nasop ferinx right here. All right. This is the opening into the nasop ferings. uh from the nose into the nasoperies the bone.
So what is this encircled area called and what are the arteries that contribute to it?
So this is the ethmoidal and source of flaw. This is the casebach area. Uh and the arteries that contribute to it we have the sphere palatide interior ethmoidal greater palatide and the superior labial as well. All right.
But the perotid region pered is very very important. It's uh has a lot of structures a lot of borders that you need to know. So first of all something that you would I'd like to cover before I dig deep into this facial nerve pierces through the perot but does not supply it. All right.
However, if we get to have inflammation of the perotid or if we get to have tumors within the perotid, all right, whatever through the perotid, all right, the perotid is surrounded by this uh deep cervical fasia which is basically so strong that if anything that enlarges within it, all right, is going to stay within it. Cool. It's not going to go out. So, this is going to compress your facial nerve. All right, which can lead to you know facial nerve palsy. All right, so this is something that's very commonly asked within the peroted uh umbrella. Anyways, let's uh talk about the borders of the paroted very important. So this is your perot right here superiorly speaking. All right, this is going to be your zygomatic arch. Okay, this is the superior border of the zygomatic arch. And then inferiorly speaking, this is going to be the uh somewhere right here. Inferiorly, that's going to be basically the inferior border of the mandible.
And then posteriorly speaking, right here, it's going to be the external ear and the sternoccllyomistoid.
And anteriorly, it's going to be the basiatur muscle. Okay. Now, if you can notice right here, there's something like a duct. This is what we call the perot duct. And if stones get to develop in it, it's called seolithsis.
And you can actually feel it on the face. All right? Like if if there are stones in it, like you can press and feel, you know, like a stone-like structure. Okay? So very easy.
Superiorly, zygomatic arch. Inferiorly, you're going to have the mandible. then anteriorly massitor posteriorly sterocludytoid and the external ear now I know this slide is a bit uh wordy this uh it's very important that you know the parasympathetic and the sympathetic uh intervations that happen to the paroted so parasympathetic will decrease uh your salivation actually no it's the opposite I'm so This is going to be sympathetic. This is going to be parasympathetic.
Uh no actually sorry this is parasympathetic. This is sympathetic.
However, this will increase salivation.
This will decrease salivation. So here you're going to have the inferior salivatory nucleus which is going to be in your medola. All right. So this is going to be the pre gangleionic cell body. All right. It's going to go all the way to the otic ganglen which I'm going to show you in a bit. And then from there all right you know you get to have the uh oruricular temporal nerve that basically supplies the parasympathetic intervation.
All right you need to know that it all happens through the lesser petroal nerve as like in the pre gangleionic pathway.
Okay. uh for the sympathetic all right it's going to be through again the uh interior medial cell column in the spinal cord it's going to go through the superior cervical ganglion all right and basically it's going to reach uh it's going to reach through the external corroded arteries and its branches like the plexus will run along them okay so what's the really most important part of this slide is that you know this the the post gangleionic cell bodies. So this is going to be the auto ganglen. This is going to be the superior cervical ganglion. All right. And here the pre gangleionic pathway is going to be through the lesser petroal nerve. Okay.
It's very high yield. All right. So what supplies the sensation to the perotid is going to be two arteries. The greater oruricular nerve and the oricular temporal nerve. Okay. Again the facial nerve passes but does not supply the perot. And the lymphatic drainage is going to be through the pre-oricular lymph node that drain into the deep cervical nodes just like the nasal cavity. And the venus drainage is going to be through the retromandibular artery which basically connects the internal jigular and the external jugular. Uh and again this is a mistake. This is supposed to be increased salivation and this will be decreased salivation. Okay.
So when the corroted meets the corroted okay so you have the common corroted artery which bifurcates at the level C3C4 in the internal corroted artery and the external corroted artery the all the main reason that I'm covering this slide is that I want to show you all the branches of the external corroted artery and basically there are going to be two branches that terminate within the parroted okay so the interior branches of the external corroted artery are going to be the superior thyroid, the lingual and the facial. Tamal, those are going to be the interior ones. Then posterior branches are going to be your occipital and the posterricular ones.
Okay? And right here, this is the occipital. And somewhere here, it's going to be the postericular.
And then the medial ones are going to be your ascending fangial arteries. And two branches that terminate within the peroted is going to be the legillary artery and the superior the superficial temporal artery. Okay, very important that you know these. They might ask you what are the two branches that would terminate in the perot. So it's going to be the maxillary and the superficial temporal artery.
Okay. So for the facial nerve the facial nerve uh branches you know at the style of the stoid for and within the perot into five different branches. So we start off with the temporal branch zygomatic branches. You have also the buckle branches. Okay. So how how would you memorize this? This is a very nice pneumonic tanzibar by motor car. So you'll have temporal zygomatic buckle and then along the mandible you're going to have marginal mandibular branches and then you're going to have cervical branches along your platisma. Okay. So it's very important that you know these and you know what each supplies. Okay.
And this is basically just uh a flashback that you see all the vessels that supplies the face. Okay.
So which of the following AB or D relays parasympathetic fibers for the parroted gland?
And what's the nerve that carries the pre gangleionic paras pre gangleionic?
All right, focus on the word pre gangleionic parasympathetic fibers to this ganglia.
So which of the following A, B, C or D carries the parasympathetic fibers to the perot?
So it's going to be A. And what is it called? It's going to be called the otic ganglion.
And again the pre gangleionic one is going to be the lesser petroal nerve.
post ganglionotic one is going to be the oruricular temporal nerve. Okay. So it's very important.
So I we're done with the face. We're done with the face. Moving on now to the ear.
So for the ear uh basically we have the external ear, we have the middle ear and we have the inner ear. Both external and middle ear are filled with air. The only part that's filled with fluid is the inner ear. We're going to talk about the structures that are found within the external ear. Then we're going to talk about the tempanatic cavity. And then we're going to talk about the the the the structures that make your inner ear as well. Okay.
Like so this is the external ear right here. Uh I don't think you guys are expected to know uh any of these honestly. However, uh you need to know that this part is called the cona and you need to know that this is the external auditory matus. All right, I'm not sure that you need to know all these labelings. Uh particularly I haven't even came across a single ospy question that asks to know all these labelings.
However, the most important ones are the cona and the external auditory mus.
Okay. So this is the external ear as you can notice. All right. The outer one-third part of your ear is is you know made of cartilage. All right. And the inner two3 part of the inner ear is bony and it's within the temporal bone.
Yep. And this is your ear canal right here. Okay. So this is within the temporal bone right here. So this is the the inner two/3. This is the outer one/3 all the way from the cona to the tempanic membrane makes your external ear.
Then after the tempanic membrane, this part right here is the middle ear or what we call the tempanic cavity.
And then this part from the uh semic-ircular canal all the way from the oval window all right to the coccia.
This is your inner ear.
So let's look at the tempanic membrane.
The tempanatanic membrane I think you be you have to be able to identify it. This is a normal looking tempanatic membrane.
This is parse flaccida. This is parse tensa. Okay. Uh tumors are usually more likely located in the pars flaccida. This is going to be the short process of your malas.
Okay. This is the minibrium of the malus. It's very important that you know this. You'll see why in a minute. And this is the cone of light which is a triangular looking light uh light structure on the tempanic membrane. And in the middle this is called the umbbo.
Okay. Now if this light happens to not be there when you're looking at the tempanic membrane this can indicate that the patient could be having a middle ear eusion. Okay. So this is the only clinical relevance out of the cone of light. Okay.
But let's talk about the arterial supply of the external ear. So we have the posterior oricular artery which comes from the external corroted artery supplies the posterior oracle. You have the super superficial temporal artery which also comes from the external corroted artery supplies the interior oracle. Now where does the where does this branch uh of the external corroted artery terminate at?
It's pered. Okay. And then you have the deep oricular artery which comes from the maxillary artery supplies the external uh audiary miatus and the outer surface of the tempanatic membrane.
Okay.
Very important that you know these as well.
Now this is uh the nerve supply of the external ear. So here you'll have the uh you know the oricular temporal nerve supplying part of the uh interior it's basically it's going to supply the uh interior uh part of the external audiary miatus is also going to supply your outer ear. Okay. And uh this is going to be the this part uh is going to be supplied by the greater oruricular nerve. And here the cona is going to be supplied mainly by the facial and the vagus nerve. Okay. And the vagus nerve is going to supply the posterior part of the external auditory miatus. So the interior is going to be supplied the interior part of the uh external audit miatus is going to be supplied by the oricular temporal nerve and the posterior part is going to be supplied by the vagus nerve. Okay. And this is basically from behind as well. This is going to be the greater oricular nerve supplying it and this is going to be supplied by the lesser oipital nerve. Uh honestly I haven't seen much questions on the supplies of the nerve. uh the supplies of the uh external ear. Uh but it's good to know it like this is really important like uh if I want to leave everything about the ear and remember one thing it's probably going to be this slide which is the middle ear or the tempanatic cavity very commonly asked uh concept when it comes to the ear. So this is your tempanic cavity. Okay, just to refresh ourselves, what's where does it start and where does it end? So it starts after the tempanic membrane and it ends right at the oval window.
So that's going to be the lateral wall and this is going to be the medial wall.
Right? Makes complete sense.
And then we have the roof. So the roof of the tempanic cavity is going to be the segmental wall. Okay? And that's basically going to separate it from the middle cranial fosa which is going to lie right above it. And then the floor is what we call the jugular wall. All right? It's going to separate it from the internal jugular vein. Okay?
anteriorly to the tempanic cavity that's going to be the corroted wall and that's also uh going to be where the estian tube is going to also be and then posteriorly is going to be the mastoid wall. Okay. So interiorly corroted wall then mastoid tempanic membrane oval window and then you have the tigmental wall which separates it from the interior cranial fosa. Sorry, the middle cranial fossa and then the floor is going to be the jugular wall which separates it from the internal jugular vein. Very important. But what are the contents of the tempanic cavity? So if you look here, okay, you have the uh malus, incas and stapes. These are the three bone bod structures uh you know or what we refer to as ear oicles. Okay, the malus is attached to the tempanic membrane. Hence you know the short process of the malus and the minibrium of the malus seen on the tempanic membrane. Okay.
Yep. And then we have two muscles that are found within the tempanatic cavity.
We have the tensor tempen and we have the stipedius muscle. Okay. And then we have two nerves that run uh also in the tempanatic cavity. You have the cordy and you have the tempanatic plexus.
Okay. Now it's very important that you know the cordy will carry taste uh innervation will also carry parasympathetics to your submandibular and sublingual gland. Okay. And the stapes right here, the stapes, okay, is going to connect the lenticular process of the incus with the oval window. Okay.
So this is another uh diagram that will help you just look at the malus of the aus stapes all the way to the oval window. And this is going to be your tensor temp which is supplied by the third division of the cranial of the trigeminal nerve. And what it functions is that it pulls the be the malula the malus medially. All right. This is going to to make the temp tempanic membrane more tense yet it's going to dampen the vibration protecting the ear stedius which is supplied by the facial nerve. All right.
This is the muscle right here. As you can see, it will pull the stapes posteriorly, stiffening your oscular chain. All right? And it's basically what we call the acoustic reflex to protect our ears from loud sounds. So, it will basically decrease its uh you know the the vibrations and the passing of the of the vibrations uh to the inner ear. So this will basically protect your ear and this is what we call the acoustic reflex. Very important that you know it. Okay.
Now the middle ear has interior and posterior communication. The interior communication is going to be through the station tube that connects your ear to the nasoperings.
Why? so that it can equalize the pressure between the middle ear and your atmosphere. Okay. Now the thing about this is that usually when you have uh you know like uh certain cytoitis or if you have strep throat okay uh and if it's left untreated sometimes it could develop aitis media. Why? It's because the middle ear and the no nasop ferings are connected via the estian tube. Okay, it's very important that you know this.
And why children usually have uh you know higher incidence of having utitis media is because you know it's the estian tube is going to be shorter and wider in children. Hence they're going to be more prone to itis media. Okay.
And then these are the muscles around the estian tube. So you have your tensor tip. Look at it. It's a beautiful long muscle. This is going to be the tensor palatini muscle. And this is going to be the levator palatini muscle. And this is going to be the senjo ferigious muscle.
Now both tensors the tensor tempin and tensor palatini are supplied by the third division of the uh trigeminal nerve and then the other two are going to be supplied by the vagus nerve. Okay.
What else is supplied by the vagus nerve in the ear?
That's going to be the posterior external audit matus. Right.
Now the posterior communication in the middle ear is going to be the basically the the middle ear is going to be connected posteriorly to the mastoid air cells. Okay. Via this way passageway called the additus to mastoid and so all the way it connects it to the mastoid air cells. Okay. This is why if you get to develop atitis media, you can also develop massitis if the atitis media is left untreated.
Okay.
So the arterial supply of the middle ear comes from three arteries. You have the interior tempatic artery which comes from the maxillary. You have the styomtoid artery which comes from the posterior oricuricular artery which makes sense because the styomtoid is right there behind your ear and you have the betrosal branch which comes from the middle menial artery. Okay, just a quick uh flashback all the way to skull. If you hit the pit area in your skull, you get to develop epidural due to middle menial art.
rupture. Okay. Now, the inner ear, the inner ear is divided. So, why do we call it labyrinth? Labyrinth is uh I think it's Latin for maze. Okay. Because it's it's literally like a maze. And we have two structures. We have the bony maze and we have the membranous maze. The bony part contains the perilymph which is similar to CSF. The membranous part contains the endolymph.
All right, which is similar to your intracellular fluid. And then within the membranous part, you're going to have your vestibule, which is basically your utricles and sacule. And you're going to have your semic-ircular canal and your coccia.
Now, you need to know that the utricle will help in detecting linear acceleration and the sacule is also going to help detecting linear acceleration.
And then in the semic-ircular canal we have anterior, posterior and lateral.
Okay. And they help detecting rotational acceleration. And within the cautia you'll have the organ of corti which basically detect sounds. Okay.
So this is the inner ear right here. So all the way from the oval window and then you have the vestibular system which basically helps with the balance with the vestibule the utricular and the saculle and here you have the the uh the semi the semicircular canals and then the clay. Okay so if you can appreciate this is uh this is your organ of corti right here. Okay this is the cclear duct as well. This is your your nerve all the way. All right. So very very easy, very straightforward. So this is so again this is the outer ear. This is your inner ear and this is this is the middle ear. Sorry. And this is your inner ear. Okay.
The inner ear is supplied by the vestibular cclear nerve. Okay. Now we have two divisions. We have the vestibular division and we have the cclear division. The vestibular division is going to supply your utricle, your saculle, your semic-ircular canal. This will help within the balance, right? The utricle and the sacul helps in linear acceleration. Semicircular ducts will help within the rotational acceleration.
And you have the codlear division which supplies the organ of corti. All right, which detects sounds and help with hearing. All right. And then both divisions are going to travel all the way to the brain stem.
Okay. So again, vestibular colear nerve is what supplies the inner ear. But very important that you know this.
Now what supplies the arterial uh vascule to the inner ear? That's going to be the labretine uh labide artery. Oh, also I forgot to mention something really important. This is uh this is going to be through the internal acoustic mus. Okay.
Yeah.
Okay. So here we have the labyrinine artery. Yep. And then uh the labretine artery is also known as the internal audiary artery which supplies the inner ear and it comes from a cup. So if you remember from you know uh neuro all right aa is a branch of the basillar artery okay and labyrinile artery is really a terminal artery doesn't have any collateral circulation uh which means that if a sudden occlusion that gets to happen to your labine artery you're going to get sensory neuro hearing loss Okay, but this was an Oski OSKY question that bothered me honestly. It says, "Which of the following images shows the right way to collect a swab for otitis media?"
Uh, what do you think?
That's going to be C. We call it the tpatosynthesis.
Okay.
Now, we go to the fossas. Uh if you guys want to maybe take a break for like uh 5 minutes then Zoom.
All right. And uh we're back.
Okay. So, moving on to the forces uh or what I call them, the scary forces. They're actually pretty easy.
They're not that scary. Uh it's just that they're a lot and sometimes, you know, it gets a bit overwhelming.
However, inshallah, we're going to cover them all today. Starting off with the targo palatine fosa. We've heard the taro palatine terminology before, right?
In the targo palatine ganglia, which is something that we're going to cover here as well.
But yeah, so this is uh part of your skull basically zoomed into and here right here you see this small cone shaped structure. This is your tyo palatine fossa. Okay, it's very deep in the face and it's like a it's like a crossroad of major nerves, arteries and gaglia. And this is where basically they meet and they pass signals all the way to the face and the skull.
You can see it's very highly vascularized area has a lot of very important structures, right? Uh so it's very important that you know the boundaries is one of the objectives in your opi. So this is your tyco palatar fosa. Interior to it is going to be your posterior surface of the migilla. All right. So just so it's just going to be just right below the bula and then the tarot fossa sits on the tyroid process of the sphenoid right and then you're going to have uh sorry this is going to be the posterior wall so it's going to have its back to it however it's going to be sitting on a palatine bone all right so which is going to be the inferior part and and and then the superior interior wall which or the roof of the entire the tarop palatine fossa is going to be the greater wing of the sphoid. So in front of it right here is going to be your magilla the posterior surface of the migilla and then posteriorly you're going to have the targoid process of the spheroid sitting so this this fosa is going to sit on your palatine bone loi. All right. The perinal process of the palati palatine bone and it's going to be roofed with the greater wing of the spinoid.
Okay. Medially you're going to have the perpendicular plate of the palatine bone and laterally you're going to have the target maxillary fissure which is just an opening. Okay.
But what are the contents of this uh cone shaped fosa? First of all, we have the terminal parts of the pixillary artery that help in supplying the nose, pallet, and orbit. You're going to have the maxillary nerve which will enter the uh tarop palatine fosa through the form and rotundum. And you're going to have the target palatine ganglia.
All right. uh which basically provides the parasympathetic uh parasympathetic nerve cell bodies the abil facial nerve and as we've mentioned it's you know it helps within the nasal gland lacrimal gland and the palatal glands which we already discussed and we're going to brush over as well. So this is a refresher. This slide is really just a refresher to what we discussed earlier regarding the parasympathetic intervations of the facial nerve through the targo palatine ganglen. So right here this is your target palatine ganglion right this is just within your uh you know within the target fosa.
How do we how does the parasympathetic intervation reach uh you know the lacrimal nasal and the palatal glands?
So remember we've mentioned we have the great petroal nerve that comes from the uh the cranial nerve the the facial nerve right joins the deep petroal nerve. So you have this is the deep petroal nerve right here. It joins the deep petroal nerve and then it becomes what we call nerve to thyroid canal or the vidian nerve. It will synapse with the gland and then it's going to basically pass through and provide uh you know uh the parasympathetic intervation sympathetic part. The sympathetic input comes from the deep petroal nerve. All right. from the internal corroted plexus. However, you need to remember that it passes through the ganglen, the thyro palat ganglion, but it does not synapse there. Okay? Does not synapse there at all. The synapse the superior cervical gangri okay and you'll also have sensory fibers uh from the second branch of the of the uh trigeminal nerve. Okay, will also pass through but they do not synapse. So it's very very important that you know these okay.
Uh however you need to know the branches the branches of the target palatine gang. So you have the nasop palatine nerve greater palatine nerve lesser palatine posterior superior and inferior lateral nasal nerves and the frenial nerves. Okay. So they're all low-key located in one certain area. Right?
They're all palatine. just you want to know which part is nasal, greater, lesser and then uh the fngial nerve.
Okay.
Uh this is also part of your opi uh objectives.
Now for the lacrimal gland, this is a bit interesting. So again, same thing.
We have the pre gangleionic uh nerves coming all the way from the facial nerve synapses of course it goes through through the greater petroal nerve. Then you'll have through the vidian nerve synapses in the turbo palatine ganglen and then something cool that it does that it hitchhikes the zygomatic nerve.
Okay, these postgalonic fibers are going to hitchhike the zygomatic nerve. they goes all the way to the lacrimmal nerve and then supply the parasympathetic uh the parasympathetic intervation to the lacrimal gland and then making you cry.
Okay, I hope the examin does not make you cry. So this is how the lacrimal gland gets innervated parasympathetically.
Okay, the only thing that's different here is that it hitchhikes the zygomatic nerve. Okay.
But the target palatyosa is a connection hub. All right. And why do I say it's a connection hub? It's it's because it connects all different parts of your skull and the face. All right. All through this fosa. Okay. And this is very very very important when it comes to the radiology aspect we're going to discuss earlier later on. So the target palati fosa. All right.
communicates with the middle cranial fossa through your forearm and retundum.
Okay, that that's where you have the bigillary nerve come up. It will also communicate with the orbit with the eye through the inferior orbital fish fissure and then it's also going to communicate with the nasal cavity via this feno palatine forbid and it will communicate with the infrmporal fossa via the tygo auxiliary fissure and this makes the lateral wall remember and it's going to communicate with the external skull base via the tyroid canal which is uh right here. Okay.
And it's also going to communicate with the heart pallet via the palatine canals. All right. And it's going to give off the branches their greater and lesser palatine nerves. It's very important that you know how it communicates with each uh different structure.
Okay. And what openings it communicates through. Very high yield. Extremely high yield. Okay.
Uh a nice way that I put it that you can remember I'm a pretty nice pallet person. So uh the I goes for the infront temporal fossa. Uh it's it's it's important that you know what it even communicates with. Okay. So it communicates with the inframporal fossa through the target fissure laterally.
The anterior superior part interior superior part of it is going to be the orbit. Okay. Through the inferior orbital fissure. And the P is for posterior superior which is going to be your middle period fossa, nasal cavity, target canal and the palite canals.
Okay.
The maxillary artery have uh has a lot of branches actually and it depends on the location. So we have three locations that we need to cover. We have the mandibular area. We have the targoid area within the infrmporal fossa. And we have the taropalatine area which is within the targo palatar fossa.
So this is a schematic of the uh of the bigillary artery and here you'll you'll see that these are the branches all right within the uh the first part okay which is the mandibular area. So here you're going to have accessory meningial middle menial interior tempic deep or uricular inferior alvular and then here you'll have second part deep temporal tyroid artery meic artery buckle artery and this is the third part as well okay fangial artery to tycoid canal sphero palatide and fororbital greater palatide and the posterior superior alvular artery you have to know the branches.
They might ask you uh what part. So for example, you have the D tree, right?
What parts uh what branches are located in the mandibular area? What branches are located in the tyroid? What branches are located in the targo pallet?
Sometimes they can also say infrontal fossa. So you need to know that you know uh the taro the targoid is within the infrontal fossa. Okay. Uh so it's very important that you know the branches and where they are. Okay.
And then we have the tyroid venus plexus. Okay. So basically uh this is just uh a meshwork of veins that happen to lie around the tyroid muscle in the infront temporal fosa. And basically what happens is that the uh all these veins will drain into your magilary vein right here. So see this is this is the mesh work right. They're going to drain into the maxillary vein right here and then they're going to join the superficial temporal vein. Okay. So maxillary vein will cross path with the superficial temporal vein making retromandibular vein which is going to connect the external jigular vein with the internal jigular vein. Okay.
Now why is it clinically important?
Because it connects the civerous situs via the imissary nerves. Oh my god again the imishery veins. So this is what we call the remember the dangerous triangle of the face right. So any facial or dental infection can spread intraraanially through the imissery veins from the tyro venus plexus. Okay.
It can als it also connects with the inferior of vein. So it connects the orbit to the plexus. So again any infection could ascend there and it also connects the facial vein uh connects with the facial vein through the deep facial vein. All right. So these are basically the uh clinical relevance like they can ask about pathways. All right.
That for example let's say how did this infection reach there? Okay. Or how uh they could just just purely ask about anatomical connections like for example how is it connected to the orbit? How is the plexus connected to the orbit?
Through the inferior ofthalic vein. How is it connected to the facial vein?
Through the deep facial vein. Okay.
So that's all about the target palatine.
So we just really need to know that the auxiliary arteries within it. We have the nerve within it. Uh we also have the targo pelatide uh ganglia. Okay. Then we move into the infrmporal fossa. Okay. So this is your infratemporal fossa. Uh it's really just irregular spacing uh that's below and medial to your zygomatic arch.
Okay. And deep to the ramis of the mandible. So it's right here. Uh it's very important that we cover the boundaries. So let me put myself here.
Okay. So this this is the superior this is the floor inferior interior posterior. All right superiorly all right we have the infront temporal surface of the greater wing of the sphenoid which is right here. This is the greater wing of the sphenoid.
This makes the the the the roof of the infrmporal fossil. Then you'll have anterior to it is going to be the posterior surface of the uh pigilla and then posteriorly you're going to have the tempanatic plate.
You're going to have the mastoid and the styloid processes of the temporal bone.
All right? And then the floor is just going to be open. Nothing is going to limit it uh inferiorly and it's medial.
It's going to be medial to the lateral thygoid plate and it's going to be lateral to the uh rabbis the rabus of the magnum. Okay. So again anteriorly you're going to have the magula.
Posteriorly you're going to have the tempanatic uh plate and you're going to have uh the styloid and the mastoid processes of the temporal bone. And superiorly you're going to have the greater ring of the spheroid. Inferiorly it's going to be open. Okay, it's going to be medial to the lateral thyroid plate and lateral to ramis of the mandible. Okay, so if you can appreciate it again right here. Okay, so this is the interior wall. This is going to be I'm stressing on it because this is really high yield. So this is going to be the interior wall right this is going to be the posterior surface of the magula all right this is going to be the ramis of the mandible laterally medially this is going to be the lateral uh thygoid plate okay and this is where it's going to be see inferiorly nothing holds it all right it's just going to be there and then uh posteriorly you're going to have the tempanatic plate styloid processes mastoid processes of the temporal bone and And uh superiorly it's going to be the greater weight of this phenoid. Okay, beautiful, very clear, very easy. I hope this p I hope this picture depicts exactly uh the borders of the infrmporal fossa. Okay.
Now, what are the contents of this infrmporal fossa? First of all, if we go back a bit, the otic gaglion is located in the infant temporal fossa.
Right? That's number one. Number two, we have the mandibular nerve, inferior alvular nerve, lingual nerve, buckle nerve, corded nerve, all are within the infront temporal fossa. In my opinion, two nerves that are very high yield that you need to know. The mandibular nerve and the corded tempmpony nerve.
Then you have the tyroid venus plexus that we just mentioned earlier. And we have the maxillary artery, the first and the second part, right? And then the medial thyroid muscle and the lateral thygoid muscle, which makes sense, right? So these are the contents. You have to know them. Okay?
Now the mandibular nerve mandibular nerve which uh is connected to the infruboral fosa through the for oval all right has a lot of branches that we need to be aware of. So we have meninjial branches all right that can just re-enter the skull. We have the oricular temporal branches which are very important. We have the buckle nerve.
We have the inferior alvular nerve branches and we also have the lingual nerve and uh something about the mandibular nerve uh it's the probably the only part of the trigeminal that supplies both sensory and motor. All right because the lingual nerve is you know going to have the uh also taste and sensation to the interior twoird of the tongue. All right the motor branches all right are the muscle tastication. So it's going to provide nerve tassitor, deep temporal nerve, medial thygoid nerve and lateral thygoid nerve. Okay.
Uh yeah, that's pretty much it. Okay. Now you might say how does the mandibular nerve provide you know the lingual nerve and you know the function is taste and sensation. It's just that the cordy all right that comes from the facial nerve is going to join the lingual nerve in the infratemporal fossa. hands through the lingual nerve. All right, you get you'll get the taste and sensations of interior 2/3 of the tongue. Okay, so that's pretty much it for the infrmporal fossa. Very easy, very straightforward. You need to know the boundaries, the content. That's it pretty much. Temporal fossa, temporal fosa, you need just put it here for the sake of completion. It's like a ball, honestly. All right. uh you need to know of course what makes the the superior border. So the superior and the posterior border are made up of the temporal lines as you can see and then the inferior bordal is border is made up of the infrmporal crest. The interior border right here is made up of the frontal and the zygomatic bones. Right?
And the floor is made up of the made up of the tyrion which basically is a point where all these four bones meet up right the frontal uh the temporal uh and the greater wing of the sphenoid right so they all meet up right here the mom and of course this is clinically important because if gets fractured you're going to get epidural hematoma it's very high yield like extremely high yield you're definitely definitely going to get a question on it. Uh now what sits here in this bowl? Two things.
Temporales muscle and temporal facial.
So it's called temporal fosa and it has a muscle that's called the temporales muscle and it has fasia that's called the temporal fasia. All right? And major superior and posterior border are the temporal lines. Inferior border is the infront temporal crest. And interiorly what what basically uh borders it is the frontal and zygomatic bones. Very easy, very straightforward. I honestly don't think that you will get a question about the temporal fossa, but in case you do, here you go.
Okay. Next we have is the TMG which is uh the temporal mandibular joint. Okay.
This is a very uh a very important joint and a very uh unique joint. Okay.
because the only movement it allows is the gliding movement. Okay. So, uh these are just anatypical landmarks. Here you have the zygomatic process of the temporal uh board. Here you have the mandibular fossa and here you have the articular tubacle right here. Okay. So in the articular surfaces we have superiorly all right the mandibular fosa and the uh articular fosa. Okay right here. and inferiorly you're gonna have the head of the mandible play it. Now if you look here at this cadaavveric dissection all right this is going to be your TMJ.
Okay. And within your articular disc it gets divided to an upper sideial cavity and a lower sinovial cavity. Why? So the upper part is going to be responsible for gliding movement. is going to be responsible for protrusion, for retraction. The lower part is going to be responsible for rotation which basically mouth opening and mouth closing. Okay.
Now, you also need to know the ligaments that support this important joint. So, we have uh first of all, we have the lateral ligament which is right here.
So, this is a joint and this is the ligament that's lateral to it. So this is the lateral ligament and then you'll have the spphenino mandibular ligament as well. You have the stylo mandibular ligament as well. All right. So these are the three ligaments that support the TMJ. Now if the lateral ligament uh gets to be uh ruptured uh you could have posterior dislocation.
If the spherom mandibular ligament is not working properly then you could have you know uh just a lot of protrusion. Okay.
If the styendibular ligament is not working then you could have excessive protrusion. Okay. So you need to know the the functions and how it protects you know the TMJ. Okay. Muscles of tastication. Of course, we start off with the temporales muscle. Okay, temporales muscle, it helps with the elevation and retraction and lateral deviation as well. The mass muscle, it also helps with elevation and protrusion. Uh the medial terragoid helps with elevation and protrusion as well. And the lateral thyroid helps with the depression, all right, of uh of the mandible. All right, so it will basically open the mouth. Okay. So, depression of the mandible, protrusion and lateral deviation, very important.
All are supplied by the mandibular nerve. Okay. So, it's very important that you know the the the actions. Okay.
And the way that you locate them don't know why the figure is not showing up. Uh but it's supposed to be a plastic model.
I don't know. Yeah. Okay. We can have one here. to before that this is your master muscle which basically is anterior to your uh parroted gland. All right. This is going to be your temporalus muscle right here. Okay. This is your buxinator muscle right here as well.
So right here. Okay.
If you look here, this is going to be your mass muscle. Again, this is going to be your temporales, right? This is going to be the zygomatic arch.
All right? And right here, this is going to be the lateral thyroid.
Okay?
And this is going to be the buxillary muscle. Okay? And these are just processes. This is the canal processes.
Uh the process of the mandible. This is going to be the mandibular notch. And this is going to be the cordoid process of the mandible. Okay.
And this is the TMJ right here. Okay.
But now we're done with the fossas.
Moving on to the neck. Okay.
So in the neck uh really it's divided into interior and posterior part. And we have the interior triangle of the neck.
Okay. This is the interior triangle of the neck. And within the interior triangle of the neck, we have four different uh we have four different triangles that we need to cover. Okay. So the first one is the submental triangle. The submental triangle which is which is right here.
It sits exactly in the midline.
Okay. And it has this digastric muscle.
All right. both on each sides laterally.
Okay. And then it has the myo hyoid bone which basically is inferior to the to the to the triangle. So it's the floor of the triangle, the submental triangle.
And within this triangle, you'll have submental lymph nodes and anterior jugular veins. It's very important that you know that. Okay.
All right. So this is for the submental triangle. Moving on to the submandibular triangle. Okay. So this is the submandibular triangle right here. So if you if you look anterior inferiorly you have the anterior belly of the digastric muscle. And then if you look posteriorly all right posterior to the uh submitt triangle you're going to have the posterior belly of the digastric muscle.
And not just that you'll also have the stylohy muscle right there.
Okay. And then superiorly, you're going to have the inferior border of the mandible. And the floor of uh the submandibular triangle is going to be the myo hyoid and the hypoglossal muscles. Okay. Now, what are the structures that are found in the submandibular triangle? Of course, you're going to have your submandibular gland. You're going to have the facial artery, facial vein. You're going to have the hypoglossal nerve. uh myoh hyoid nerves and vessels uh styloid processes and its attached muscles as well but really really the things that are high yield that I want you to remember submandibular and gland facial artery and vein hypoglossal nerve submental artery very very important okay so again let's repeat the borders because I feel like it's very very important for you to know okay so this is the submandibular triangle superior Clearly you have the inferior board of the badible. The floor where it sits in is going to be the myo hyoid and the hypoglossal muscle. Hence it has the hypoglossal nerve. Right? And then anterior inferiorly you're going to have the anterior belly of the digastric muscle. And posteriorly you're going to have the posterior belly of the digastric muscle. Right? If you basically know the borders, you're going to be easily able to identify the contents right of the subpendicular triangle.
Then we have the corroed triangle. It's a very high yield. Actually, what out of all the four triangles, this is maybe the most commonly uh asked triangle and opies and uh and sec the corroted triangle. So right here, this is the corroted triangle. Okay. So posteriorly this is going to be the sternoclytoid anterior inferiorly is going to be the superior uh superior belly of the omo hyoid right here. So this is anterior inferiorly and superiorly it's going to be the posterior belly of the digastric at the stylo hyoid muscle. All right here. So it's very important that you know this okay but the content. So see this small triangle has all of this. So if you think about it the most things that it carries are genuinely things related to the corroted like you have the cocroted artery. So you have the internal and the external corroted arteries right there.
You're going to have the corroted situs the corroted body and of course you're going to have the internal jugular vein vagus nerve hypoglossal nerve spinal accessory nerve as well. All right. at the external corateed artery branches.
Okay. Usually the interior ones. The interior ones. Yeah. So, uh basically it's very important that you know this but also it's like uh common sense for you to make a guess of what the contents of the corroted triangle is. Maybe the only part that's going to be just a bit confusing is the kind of nerves that's going to pass through the corroted triangle. So it's going to be 10, 11, and 12. Okay.
Now the last triangle is going to be your muscular triangle. Okay. The muscular triangle uh the boundaries of the muscular triangle. First of all, if you see it right here, okay, this boundary medially, it's going to be the midline super the superior belly of the omihyoid. And then you'll have the uh anterior border of the sterlytoid inferiorly.
All right. Uh what really sits here is going to be your infraoid muscle, your thyroid gland, your parathyroid glands, the larynx, the trachea, and you know the esophagus. Okay. So yeah, I hope it makes sense.
Okay. So here just put this picture so that you could look at the hyoid bone.
All right. So this is the mandible. This is your hyoid board. This is the lyrics.
Okay. Now anything that's above the hyoid is called supra hyoid. Anything that's below the hyoid is called infraoid. Okay. So supra hyoid muscles which sit above the hyoid bone. All right. helps in elevating the hyoid at the floor of the mouth which will help in mouth opening and assist in swallowing. So there are four muscles digastric, milo hyoid, stylohyoid and giohyoid. All right, you need to know the intervations of course. So digastric the interior belly is by the myo hyoid nerve which comes from the mandibular division. You have the posterior belly which comes from the the facial nerve. Milo hyoid from milo hyoid nerve. Stylo hyoid from the facial nerve and go hyoid is from uh C1 via the hypoglossal nerve. Okay. It's very important that you know this. Oh yep.
Infraoid they help with depressing the hyoid and the larynx after swallowing.
Oh yep. So you have stero hyoid and then you have the uh thyro hyoid and then you have the omo omohyoid as well.
All right. So if you look here all right so you have see two sternoh hyoid muscles okay both on each side. So it's going to be from C1C3. The thyro hyoid is going to be from the hypoglossal nerve and omohyoid is going to be C1 C3 as well. Yep. Uh how would I remember this? I'll just think that below the hyoid I have the sternum and basically they're inserted into the sternum. If you look you know most of these muscles are inserted into the sternum. All right. And for the other muscle which is the thyro hyoid I'm just going to think of it because basically the thyroid g sits below the hyoid bone. Okay.
Now moving into onto the posterior triangle of the neck. Very easy. All right. Very straightforward. Uh the posterior triangle of the neck. Uh it's basically going to be behind the steroletoid.
That's number one.
So this is and then you'll have the uh floor of your posterior triangle of the neck is going to be the prevertebral fasia covering the scaline and other muscles right here and it's the roof superior part is going to be the investing layer of the deep cervical fasia and inferiorly is going to be the middle third of the clavicle just right here and interiorly it's going to be the sternoclytoid posteriorly ly is going to be your trapezius.
Okay. So just to repeat the boundaries of the posterior triangle of the neck superiorly you have the investig layer of the uh deep cervical fasia.
Inferiorly you have the middle third of the clavicle. The floor where it sits is basically going to be the prevertebral fasia that covers the skelly muscle and other muscles in there. Anteriorly you'll have the uh sternoclytoid and posteriorly you're going to have the trapezius.
Now what sits in my posterior triangle of the neck? First of all you'll have the obo hyoid splenous capus lev levator scapula and the scaline vessels. The vessels you're going to have external jugular vein subclavian vein and subclavian artery.
And the nerves that pass through, you're gonna have the accessory nerve. Okay, honestly supplies the trapezius. So I just think of it. This is how I remember it. You have the cervical plexus as well and trunks of the brachial plexus. Okay.
Now if you look at the ex if you look at the posterior triangle of the neck, all right, it's divided by the inferior belly of the ombo hyoid. It's divided into subclavia triangle and occipital triangle. All right. So if you look at the occipital triangle, it's the it takes up the major portion of the posterior triangle of the neck. So here is where you going to have your accessory nerve, lesser occipital nerve, uh great oruricular nerve, mainly the brachial plexus as well. All right. And it within the superclavicular triangle which sits right here by the way they interchange the names. It could be called subclavian or it could be called superclavicular. I like to call it subclavian. Why? Because it's going to make me easily remember the contents which is going to be the subclavian artery subclavian vein and the external jugular vein. So anything that's nerve related to the posterior triangle of the neck is going to be within the occipital triangle.
And anything that's uh related to vascule vessels is going to be within the subclavian or the superclavicular tri.
Okay. Just one minute please. I want to connect my back to the All right.
Now another thing that you need to know which is part of your objectives is the muscles of the floor from the back to the front. Yep. And this is the order of the muscles from the back all the way to the front. So we start off most uh inferiorly you have the spleenius scapus.
All right. Then the levator scapula, the posterior scaled, middle scaled, anterior scalid, and the semi-palis capus. Okay. Uh it's part of your objectives, but honestly never met a question that talks about this. So it's a bit low yield, I think, but I just put it here for the sake of completion.
Okay. Uh now let's take a look. This is the omohyoid. All right. Very clear.
very clear to see it. So this triangle right here is going to be the subclav and this right here is going to be the occipital.
So any nerve that I see here I can be able to pick up. Look at this nerve.
This nerve is going all the way to the trapezius. So it's going to be the accessory nerve. All right? And then here this is part of the brachial plexus. This one right here is going to be my subclavian vein. This is going to be my subclav artery. Okay, it's very important that you know these.
Okay.
So, what's the name of this triangle and what are its contents?
First of all, is it interior or posterior?
And why it's going to be interior, right? Why? Because it's in front of the sternocus. Easy.
Then what is it called?
So it's just right above the omo hyoid right below the digastric uh the the the posterior belly of the digastric muscle.
So this is going to be the corroted triangle and the contents everything related to the corroted. What are the nerves that pass through the corroted triangle?
10 11 and 12. Okay.
So yeah, artery, internal jugular vein, vagus nerve, hypoglossal nerve and also the spinal accessory nerve. Okay. And now we reach our final part which is the eye.
So before we dig into the uh boundaries of the orbit of the eye, I would love that you guys appreciate these high yield fissures and openings within the orbit. We have the or optic canal where the optic nerve passes through. We have the superior orbital fissure and we have the inferior orbital fissure. Okay.
Like so the orbit it's very important that we know the boundaries of the orbit and we know what makes the medial wall.
The medial wall is so high yield because even in the radiology lectures they emphasize on the medial wall highly.
Okay. The lateral wall the roof and the floor. So let's take a look at it. So first of all the orbit. The orbit is a pyramid-shaped bony socket. Okay, you might not see that it's a pyramid like this, but if you look at it from the inside out, it's it is a pyramid-shaped uh bony socket. All right, the superior wall, what makes the superior wall of the orbit is the frontal bone, lesser wing of the spheroid and the supraorbital for. Okay.
uh you'll have the opening of the superorbital uh for right there. Okay, that's something very important to know.
Then the medial wall and this is highly highly important. You'll have the lacrimal bone, you'll have the lag patricia, you'll have the body of the spheroid and there you can also have the ethmoidal for forina opening the lateral wall. You're going to have the zygomatic bone and the greater wing of the spheroid. And you're going to have the zygomatic facial form and opening within the lateral wall. And in the floor inferiorly is going to be the orbital surface of the maxilla, the zygomatic bone and the palatine bone. So it's very easy. Okay, if you try to visualize it from everything that we've learned so far, the eye sits in an orbit that is right above.
Yes, sorry. It's so it's right below your frontal board, right? And the lesser wing of the spheroid.
All right. Medially to the lacrial uh board. All right. and to the laminate papriia. At the body of the spheroid laterally you have the zygomatic bone you have the greater wing of the spheroid. All right. And the floor where this orbit sits is going to be the orbital surface of the magula and the zygomatic bone and the palatide bone.
Okay.
Let's take a look. So this is going to be your lacrial gland laterally. This is going to be your canus, medial canus right here. And this is going to be the eyelids. All right. So, superior tarsus, inferior tarsus of the eyelids. All right. And this one right here is going to be your lacrial caniculus. And this is going to be your lacrial sack as well.
All right. Oh, yep. It's very important that you know uh these structures. All right. And this muscle right here is called the inferior oblique which we're going to talk about in a bit later.
Now we have so many openings that provide passage for nerves and these openings are within the orbit. So starting off with the superior orbital fissure. The superior orbital fissure.
All right. Holmes uh cranial nerve three four six and the first division of the uh you know the trigeminal nerve. Okay. And then the inferior orbital fissure is going to have basically hold auxiliary nerve the zygomatic nerve. The optic canal is going to provide passage for the optic nerve. Super superorbital forin is going to provide passage for the superorbital nerve. Infraorbital forin to the infraorbital nerve and the nasol lacrimal canal to the nasol lacrimal duct.
These are very important very easy and very high yield. All right. So I think maybe the ones that are just most difficult to learn are going to be the first two. All right. But if you think about it, the superior orbital fissure needs to needs to provide nerves that will supply the extra oruricular the extra ocular muscles. Right? So you have the superior oblique, you have the superior rectus, medial rectus, lateral rectus. These are all supplied by three, four and six. Okay. the inferior orbital fissure, you know, uh because the inferior wall, if you remember the floor, what makes the floor? You have the the the the palletide board, you have the big the bzilla and you have the zygomatic.
So the inferior orbital fissure is going to hold nerve and zygomatic nerve. See, it's very easy if you connect all the dots together. Okay? uh it's going to be really easy for you to apply uh and you try to remember uh the the anatomy.
Okay.
So what sits in the orbit? See all of this sits in the orbit but you do not need to know this. What you need to write in that Ospy question, the eyeball, the muscles of the eye, sensory and motor nerves and vascular supply to the eye which is mainly the orthalmic artery and its branches. All the branches sit within the orbit. What are the branches of the artery?
First of all, we have the central artery of the retina. This is very important because it's the only blood supply to the retina, the inner retina. If it gets oluded, which means blocked, you'll have sudden painless vision loss.
Okay? You'll have the lacrial artery, the posterior silary artery, the anterior silary artery, the supraorbital artery, and anterior posterior ethmoidal arteries.
Okay.
Bye.
Then we have the extraocular muscles.
The extraocular muscles are seven. Why are the seven? We included the levator the lev levator paltebrous superiosis uh which basically is a muscle that helps in elevating the upper eyelid.
It's not part of the eye movement but uh basically it just helps with elevating the upper eyelid. That's it. And it's supplied by cranial nerve three. So you need to know that the superior rectus helps with an elevation of the eye. Okay, helps with adduction and in torsion supplied by cranial nerve 3.
Inferior rectus helps with adduction as well. Medial rectus is the main muscle that provides adduction basically moves the eye towards the nose. Lateral rectus moves the eye towards the temporal board and it's done by cranial nerve six. Superior oblique helps in depressing and abducting the eye and it's provided by cranial nerve four which is the tcular nerve. Inferior oblique helps in elevating and abducting the eye and through cranial nerve three. Uh honestly I don't see that really much asking about the functions in most of them. Uh basically they're pretty straightforward.
Okay, you need to know the nerve supply.
It's very important. So this is a uh lateral rectus six, superior oblique four. The rest is three. Okay. Uh very high yield, extremely high yield. So yep. Uh there's a slide that I actually want to go to first. So this one, the nerve pals. So, if they get to tell you there's an eye that's down and out and blown or the pupil is dilated like this one, what nerve paly is this?
This is going to be the third cranial nerve. Okay, the ocular motor. Then you'll have the eye is displaced upwards. Okay. And they tell you in the scenario that the patient cannot walk down the stairs or cannot read. This is going to be the tlear nerve. And if the eye is turned inwards and the patient cannot abduct the eye laterally, that's going to be the abduc nerve because the lateral rectus is not working. Right?
And here the superior oblique is not working because the tract nerve is damaged. All right. So this is basically just something that you can clinically apply uh with whatever we just mentioned.
So here uh this is just a plastic model of all the muscles that we've mentioned.
This is your superior oblique right here. This is the levator palibra superiosis helps in elevating the upper eyelid here. This is your superior rectus.
And this is going to be your uh lateral rectus. This is going to be the laceral gland as well. All right. Very high yield.
Now this is from a posterior view. This is again your lateral rectus. This is your superior oblique. Okay. And uh sorry, this is your superior oblique.
And this is going to be your superior rectus.
All right.
Okay.
Now look at this eye. Now we're more invested within the eyeball itself.
Okay. Eyeball itself. We have the cordia which is the uh external part. And then we have the lens. We have the silary bodies and the muscles that help put the lens in in place. And then we have the vitrus body which is filled with vitrus humor. And then we have the retina. And then within the retina we have an blind spot which basically means that doesn't have any closal rods and it carries the optic disc. All right. Which is basically the optic nerve and retinal blood vessels. All right. And now the question is where is the acqueous humor produced and how does it and how does it flow and if that flow gets blocked how would the patient present.
So the aquasuber is produced within the silary body epithelium.
Okay. And it flows all the way from the posterior chamber to the anterior chamber. All right? And it helps drain the uh tribicular meshwork uh right here at the cordial egg. Now I don't want you to remember this but what I want you to remember is that the aquis humor is produced by the silary body and if the if there's a blockage from the posterior to the anterior chamber all right what's going to happen the patient's going to have an increased intraocular pressure and this could lead to gluccomba okay very important now look at the structure structure.
What can you see?
So this is the cordia and how do I remember the structure the the different parts of it. So we have every brave student deserves excellence. So epithelium bulbs the stroma the des and the endothelium right right here.
Okay.
Now you need to know that the epithelium is stratified squamus not keratinized all right and it regenerates rapidly. So if if the epithelium of the cordia gets damaged it can regenerate. However membrane is ascellular okay and it does not regenerate regenerate if it's damaged. So it's going to be permanently scarred.
The stroma is the thickest. It makes up about 90% of corial thickness and it's transparent and it contains the kuratosite. So if they ask you where are kuratosytes found they're found within straw.
The des membrane all right is basically the basement membrane of the epithelium.
So it's the basement membrane of the endthelium right here. And and basically it thickens with age and it's very resistant to disease.
And the endothelium is just a single layer of flat cells. They do not regenerate, but they help pump water out of this trauma. Okay? If you lose your endthelial cells, you will have cordial edema, right? So you will have blindness. Why cordial edema? Because it helps pump blood pump the water out of the stroma. So if it's not working, the water is going to build up within the uh cordia, right? And then you're going to have blindness. Okay?
Now this is the lens. Okay? So this is going to be the lens capsule. So this this is going to be your outermost layer. Okay? It's an elastic basement membrane secreted by the lens epithelium. And this is the lens epithelium right here. So you can see it's a single layer of uh cuboidal cells. They elongate and they lose their nuclei and then they become lens fibers.
So here are the lens fibers that they become later on. Okay. As you can see their nuclei is gone after they elongate. And basically here within the lens fibers you have this uh special protein called crystallin uh which builds up within the lens fibers to maintain lens transparency.
Okay.
So as you can see here this is the epithelium from the lens surface cuboidal in shape and then when they stretch out they lose their nuclei and you can see it's like onion it's like onion skin right this is the lens fiber and then we move on to the retina retina is the big guy it has 10 different layers and you must know every single layer and what each layer contains.
Okay. So here, so this is the vitrus body of the eyeball with it. And then you will have after the vitrus body, you'll have the optic nerve fibers, ganglia cell layer, you'll have the inner plexififor layer, inner nuclear layer, you'll have your outer plexififor all the way to the koid. Okay? So if you look here, this is from the coroid all the way to the vitrius. So from in out. Okay. In out. So yeah. So all the way from the inner part the very very very uh inner part of the retina you'll have the retinal pigment epithelium. So basically this helps in uh supporting your photo receptors. It will absorb any stray light. All right. And then you have your photo receptors. Photo receptors which is basically your rods and cones. All right. And then you'll have the uh outer limiting membrane. This is not a true membrane. Okay. This is just a junctional complex between the Miller cells and the photo receptor. Then you'll have the outer nuclear layer which is where the cell bodies of your photo receptor uh photo receptors uh lie in. And then you'll have the outer plexifform layer which basically synapses between the photo receptors and the bipolar and horizontal cells. Then you'll have the inner nuclear layer.
Then you'll have the inner plexififor layer and then you'll have the gagen cell layer. All right. Within the ganglion cell layer here you'll have the cell bodies of the retinal gangalot cells and they axis from the optic nerve and then you're going to have the nerve fiber layer and then lastly the one that's closest to the vitrus body is going to be the inner limiting membrane which is the basal membrane of the miller cells and the interurface with the vitrus body. Now how does the signal flow within the retina? So you'll have it from the photo receptors which is the second layer right here from the inside all the way to the bipolar cells within the inner nuclear layer. Okay? And then they're going to go to the ganglion cells which is in the eighth layer and then they will get carried all the way to the optic nerve. This is how you signal vision. photo receptors, the neurons and the cons, the bipolar cells to the gaglio cells all the way to the optic nerve. Okay, and this is a pneummonic that you can use to remember the layers.
Okay, sorry. that what structure is shown in this image and what will happen to the structure if you have increased intraocular pressure.
So this is the optic disc and basically if you have decreased uh intraocular pressure you're going to get what we call papaladeema.
All right papadeema is a is a hypertensive emergency. Okay. uh and you need to intervene immediately or the patient might lose vision and the optic nerve could die permanently.
Okay, now let's move to neuroraiology.
So within this part uh basically we're just going to skip through really quickly. We've done the anatomy of uh most of the structures. Uh just before we start, I just want you to to orient your mind. When you see uh a CT scan, an MRI or an X-ray, first of all, you always need to localize the lesion. Before diagnosing, before thinking of what the diagnosis is, localize. See, is there any midline shifts or not? Is it medial? Is it lateral? All right. Is it in the brain?
Is it outside the brain? All right. Uh and then afterwards after localizing the lesion, you interpret. Okay.
But uh this is just a slide just to to to to let you know how things appear on a CT scan. So any bony pro any bony structures are going to be bright white.
Any acute blood is going to be hyper dense. soft tissue is going to appear gray. Water or CSF is going to appear is dense. Uh the fats are going to appear black and the air is going to appear black as well. Okay. When do we use CT scans? We use it in brain hemorrhage. We use it in uh examining the sinuses. We use it in uh bone fractures. All right.
Like for example the leffort fractures, basillar fracture and go for a CT scan.
An MRI is when I want to examine the soft tissue. All right? When I want to look at the brain para more further.
Okay? That's what I'll use. That's when I'll use an MRI. An X-ray again is for uh like situs opacification for example, any skull fractures, any forward bodies uh within for example the nasoperics, I'll definitely go for an X-ray. Okay.
Even when I will look at the airway, I'm going to look for I'm going to go for an X-ray.
Okay.
So, uh you need to know the here you need to know that within within you know uh a radiology image. Okay. Sutures happen to appear with a zigzag line fashion. Okay.
Fractures are sharp and they're straight and usually they will cross over the suture. Okay. And the vasculars vascular markings usually they're going to be branching. Okay. So if you can see here if you can look this is a branching uh branching marking Loki. Okay. This one is definitely vascular vascular uh vascular marking. Okay, like it's right here. Play it. So, it's not a fracture.
A fracture is just just going to be a straight line. Okay. And then right here, you're going to see this zigzag kind of uh kind of lighting. All right.
This is going to be a suture. Okay. Same goes here. You're going to have this zigzag kind of. This is your labid suture. It's going to be your corodal suture right here. Okay.
And yeah, it's very important that you uh not mistaken a suture for a fracture and a vascular barking. So a fracture is a straight line does not branch. All right. Vascular markings they do branch.
All right. Uh sutures are usually zigzag, bilateral.
uh and you know you know the locations if you know the anatomy but yeah an osteolytic lesion is basically when the bone eats itself up right osteolysis so this is in a patient who has multiple myoma and uh this is basically how an osteolytic lesion will appear okay a skull fracture right here you can see it's a it's very uh first of all we localize it okay so it's somewhere like uh around the temporal area and it's a fracture. You can see it's like a straight cut. Okay.
But uh right here I've just added this slide just so that you can uh understand something really important. What do we mean by when we say extraaxial and intraaxial? When I say extraaxial, I mean to say that it's outside the brain.
So when I have extraaxial hemorrhage, I have bleeding outside the brain. Okay, epidural hematoma, subdural hematoma, subaracttoid hemorrhage, they're all outside the brain. When I have intraxial, I it means that it's within the paricoma of the brain. Okay? And it's usually seen in uh you know like diffuse aal injury for example.
That's something that you'll see.
However, I don't think this is very important that for you to know. I just put it here for the sake of completion.
However, what you need to know is that when you see uh bleeding within the brain, it's called intrain. Okay? And of course, you need to know the menes, the duromatter, aricoid matter, pia matter.
Okay? Subdural space is the space between the dura and the aricenoid. And subaricoid is between the aricoid and the pia. Okay? And that's where your CSF runs.
Um, all right. So, let's take a look at this uh beautiful hematoma right here. It looks like an 11, right? This one is an epidural hematoma. Okay, an epidural hematoma which happens between the skull and the dura. All right, and this is due to the middle menial artery. By now, you should know it. I've repeated it like three times throughout the uh the the video and usually it happens from uh temporal bone fractures especially in children. Okay. And it does cross the midline. So you need to know that but it does not cross any sutures. Okay.
Subdural is between the dura and the aricoid and this is due to bridging veins. So we have these veins that we call bridging veins. Where is when is this common?
This crescentshaped bleeding. When is it common? When do I usually see it? I see it in elderly patients, patients who are really, really old like 70 plus. Uh we see it in alcoholics, right? Why? Because their brain shrinks. And imagine this brain is shrinking, shrinking, shrinking. What will happen to the bridging vein?
They're going to disrupt. Okay?
So that's something about the subdural hematoma. Now let's have a quick case.
So this is uh this is all right. This is a 52 year old woman with a history of hypertension and smoking presenting to the emergency department with uh sudden onset severe headache. She describes as the worst headache of my life. She states it began abruptly while she was training at the gym reaching maximum intensity within seconds. She had had previous episodes of vomiting and was found by staff sitting uh on the gym floor confused and holding her head. All right. She has high blood pressure. Everything else is normal. She had mild phototohobia and mix stiffness on flexion. No focal neurological deficit. Pupils are equal and reactive. No pepida.
What do you think is wrong with this patient?
Look at the scan.
So if you look at the scal you see like a star right I don't know if you can pick it up this is sub aricacoid hemorrhage all right usually it happens from uh ruptured adeurism so sometimes we have weak areas in uh you know within the uh for example the circular willie all right very commonly seen in the anterior communicating artery okay And sometime we will h sometimes you could have these aneurysms and sometimes they rupture suddenly out of nowhere. Okay.
When they rupture you will see uh this basically blood within the CSF. Okay.
So this is basically subaracttoid hemorrhage. Okay. It's very important that you know it. It's also could be caused during trauma or you could have something we call arterio venus malf formations. Okay. However, if you see this star shaped kind of scan, it's subartoloid hemorrhage. Okay.
Now, something else that I want you to pick up which is also very important.
uh the timing of uh subdural hematoba or hemorrhage okay can be deciphered from a scan. How if it was acute it's going to be hyperdense. Look it's hyperdense right compared to the uh soft tissue here.
However, after a month, it's going to become isodense, right?
And then two months later when it's become when it becomes chronotic, okay, it's going to become hypodense.
So if it's acute, it's going to be hyperdense. If it's subacute, it's going to be isoense. And if it's h if it's going to be chronic, it's going to be hypodense. Okay?
Like so this is the eye. uh regarding the eye probably you would want to identify the uh muscles. All right. Uh in a radiology scan. So these are your extrauricular muscles. Uh this is medial. This is lateral. So here you're going to have your superior rectus, lateral rectus, medial rectus.
Uh this log muscle is going to be your superior oblique. And this one that's just right below the eyeball is going to be your inferior rectus. So if you know the anatomy very well, you can apply it here perfectly.
Okay. Now the medial wall of the eye or the orbit is very high yield in the radiology lectures. Okay. So do expect a question from it. So look, this is the eye, right? This is the medial wall right here. Okay? And then you'll have the lateral wall right here. This is the optical orbit right here. All right. And then here you'll have the orbital floor.
And this is the orbital roof. All right.
So if we refresh, what makes orbital roof? The frontal bone lesser wing of the spheroid. What makes the floor?
Beexilary. Uh the bezilla the zygomatic right. the heart pallet as well. Okay.
And what makes my medial wall? So it's gonna be the maxilla, the lacrimal board, ethoid, which is the laminina papri and the body of the spheroid.
MLES.
Okay. Very very high yield. Okay. So you got expect a question they can ask you about it. Okay.
Now how do they divide the eye? Okay.
they divide the eye into intracodal and extracodal.
So this is an intracodal uh space okay which basically means that it's within the muscle cone and this one is extra conal which is basically out of the muscle cone okay and this is your globe right here.
So what's within the intraonal? The intraconal here you'll find your ocular motor nerve, your optic nerve, your nasocillary nerve, abducent nerve, uh of artery. Okay, basically all the contents of the orbit. So if you go back and review the contents of the orbit, most of them are going to be here.
Extra codonal, you're going to have your your lacrial gland, you're going to have the lacrial nerve, frontal nerve, and tlear nerve. Okay. All right. So, it's very important that you know uh the contents of intra and extracodal uh spaces.
Now, which view can I use to best see the medial and the lateral rectus?
That's going to be the axial. Okay.
Which view can show me all four rectus muscles?
That's going to be the corolla. And then which view is going to show me the superior and the inferior rectus?
That's going to be the sagittal. Okay.
Now, if you look here, all right, now we're back to the target pellet fosa.
Okay. I love the taro palati fosa. I really feel it's a very high yield concept and I think you guys are going to be questioned about it. So look at it. This is your tar taro palati fosa.
Okay. This is your spidito palatide forid. All right. This is the targo uh targoid canal. All right. This is the targo maxillary fissure. Okay. Uh now remember it's a connection hub right BPF is a connection hub and it connects me to so many parts within the brain and uh you need to know the openings. All right. So there are so many operings that it can connect to. So anteriorly you have the basilary situs. Uh posteriorly you could have the meticradial fosa through the fortundum uh where the bigillary nerve passes through. You'll have laterally uh the targo palatine. You'll have the targoary fissure which connects us to the infruporal fossa. All right. Superiorly it connects you all the way to the uh orbit.
And you need to know these very well.
It's something that's uh that I found within the slides uh a disease called juvenile nasoperigial agroa which is seen in adolescence. Uh it originates within the spho palati form. Okay. All right.
Can you name this board for me?
So this is part of the nasal uh septum. What's this board? This is the vulmer. comes from the skull and this is the perpendicular plate of the ethmoid and this is the septal cartilage. All right.
And this is your target of palatide fossa. Okay. Uh this is the fedoid right here as well. This is the perpendicular plate of the palatide board right here.
Like remember the connection hub slide?
I'm just translating that slide into radiology right here. So I know it's a bit overwhelming but I'm going to break it down. So here this is your targo palatide fossa right it's going to communicate with the infr temporal fosa via the targo palatide fissure and it's going to communicate with the nasal cavity via the sphino palatine for it can communicate with the middle cranial fosa via forin rotundum.
All right. Now this is the vidian canal right here. Vidia vidian canal or the targoid canal running to the forid lacerum.
And then here you'll have the uh tyroid the targo palati fosa in communication with the infraorbital uh infraorbital fissure.
All right. And here you have the uh sphalatile forid that will communicate with the orbit via the infraorbital fissure and here to the ITF via the targoary fissure. Okay. Uh again it will communicate with the orbit how to the infraorbital fissure. Okay. So it's very important that you take that slide of the content and the connection hub and how it connects with all that because uh you know they can ask how a disease could spread uh for example from the target pallet fosa to the middle cranial fosa and then you'll say form and rotundum. All right. And if they ask for example how uh a disease from the nasal cavity is going to reach the uh target paly fosa then you're going to say through the spopaly for. Okay.
Okay. So this is a question right here.
A 56 year old man presents to the emergency department uh with in info infalamus. All right. Infalamus. So the eye is like sunken in a bit. All right.
sunken left eye, diplopia on upward gaze, numbness of his left cheek. He was assaulted a day ago and punched in the face. So he was punched in the face. At examination, there's perorbital echibosis on the left. There's upward gaze restricted in the left eye. His vision is intact. There's reduced sensation distribution of the infraorbital nerve and a CT of the face is performed.
What is the diagnosis and which wall of the orbit is most commonly affected and what structure does it overly?
So first of all what's the diagnosis?
What do you think this is? So this is traumatic. It's a traumatic uh finding.
So what do you think it is? This is a left orbital blowout fracture and it's most commonly seen in the orbital wall which is the inferior wall which forms the roof of the maxillary sinus. Okay.
Now how did this injury lead to this fracture like the mechanism of the injury lead to this fracture? Okay. And what orbital contents are most likely to herniate through the fracture.
So in here if you see okay this is there's a direct direct blow it it decreases the uh the intraorbital pressure suddenly and then the weakest wall is going to get affected okay which is the uh orbital floor and then the orbital fat and the inferior rectus muscle are going to herniate through the defect which is right here okay so the inferior rectus muscle is going to herniate into the maxillary situs right here. Okay, it's very important that you know that herniation of this inferior rectus is going to cause the uh restriction of the upward gaze and the dipopia that you see in the patient. Now why does he now have numbness of the cheek? Uh this is due to basically uh the fracture of the orbital floor. it will injure uh you know the the the nerves of the you know the maxillary nerves right which is going to cause numbness. All right on CT scan what two abnormal findings would you expect to see again the fracture in the left orbital floor and the herniation of the contents into the maxillary sinus. Okay, it's very important that you know that.
And by the way, when you uh when you see a pathology on a scan, always try to compare it with the normal part. So this is normal, right? Try to compare and see like here for example, this is the maxillary situs is intact. Here it's you can't see the air anymore. Here you see the orbital floor intact. Here you don't see it anymore. See it's it's like it's fractured. Okay.
Right.
So this is basically just a summary of what I said, okay, that you can refer to.
All right.
Now, this is a second case. This is a 15 year old a 19year-old male university student presenting with a 10-day history of frontal headache, fever, and nasal congestion. He was prescribed amoxicylin uh by his GP one week ago, but has not improved. Today he develops a generalized tonic clonic seizure. On arrival he's fibral, confused and has mild neck stiffness. He has tenderness over his left and frontal region. Uh he has high neutrfils and basically a CT has been done. So the first question is what has developed intraraanially and what is the characteristic CT appearance that distinguish it from a simple area of cerebritis.
So I want you to look carefully and think.
Now this is a brain absis. Okay. And why do I say it's a brain absis and not just a cerebriis?
Because there's a rib enhancing lesion.
All right. Uh a ring enhancing lesion.
All right. With a well-defined uh hypodense center.
Okay.
Uh all right.
What else? What else would we would we would we see? We will see also vasogenic edema around the lesion. All right. So I'll see vasogenic edema right here. So they'll ask me can you trace the anatypical route by which the infection spread from the sinuses to the intracanial compartment in this case?
Uh of course it's it could either be frontal or magillary side. Mixillary sinusitis. All right. Direct spread to the posterior situs wall. All right. And then you know to the cverous uh plexus.
All right. Intracanial compartment all the way to the cerebral parallel. Okay.
Or it could come from uh the cribform plate erosion of the cribform plate all the way to the subfrontal uh area. In this case, you know, you'll have uh spread again via the cavernous situs uh to the middle cranial fossa as you can see right here. Okay. Now, why did this patient develop a seizure? This patient developed a seizure uh because uh the absis happened in the temporal region. All right? And usually when it happens within the temporal region, okay, that's where you develop seizures.
Okay. Now, list three image findings you would expect on the CT scan and which modality CT or MRI is superior for evaluating the extent of the intercraanial spread and why.
So the three findings again it's a ringed lesion with a hypodensed center visogenic edema and sometimes there could there sometimes there could be a midline shift. Now remember the first slide I told you if I want to examine the brain parankma that's going to be MRI okay MRI is always superior to that because it could show me the miningial enhancement and if there's any citrusis to rule out okay so this is brain absis it was covered in the slides that's why I thought I should bring it up here uh now paradasal situses development at at functions so again the two situses present at birth are going to be maxillary and ethmoid. Frontal spheroid are not present. The frontal usually takes 1 to 12 years. Sphenoid starts to be there within two years. Okay.
Now this is the osteomal complex. The osteomal complex is made up of the similular hiatus, the magillary uh osteium sinus, infandibulum, ethmoid bula. All right. The idea is that the estroal complex is the final drainage of the frontal maxillary and interior ethmoidis.
This is basically the most important takeaway from this slide. It's present at birth and any obstruction to it uh you know would lead to impaired sinus drainage. Okay. So you would need to go in and like drain the sinuses so that you would not cause absesses and and like infections. Okay. So this is the most important part what it drains frontal maxillary and anterior ethoid situses.
Now uh honestly I've never seen these before in any questions bi. It's also nice to know them. Uh if you want to see your the bigillary situses the best thing is you do a water view and if you want to see frontal situses the best you do a calwell view and spheroid situses lateral view and to be able to see the zygomatic arches axillary situs walls you do a subbal vertex honestly uh I'm not bothered by these and I don't think you should too. Uh, however, these might pop up as an MCQ, but they're really low yield. I don't think they're going to be asked. I just put it here for the sake of completion. Okay. So, what sinus is this? And where does it drain into? And what's the blood supply?
So, this is the frontal sinus. Drains into the middle miatus. Remember to the middle miatus. And it's supplied by the superlear, superorbital, and interior ethmoidal arteries.
Okay.
Now what's this situs? Where does it drain into? And is it present at birth?
Steep axillary situs again middle matus and yes it's present at birth. Now what's the blue and the green sinuses?
So the blue one is ethmoidal right you should say that. So what's the blue one and what's the green one and where do they drain into? And are they present at birth?
Okay. So ethmoidal sinuses drain into the sphinoidal recess. All the ethmoid and are present at birth. Okay. So the spheroid situs borders you have to know this. So uh this is the spheroid situs right. Okay. Superior to it you'll have the celoturgical where the pituitary gland sits and right next to the pituitary gland you have the cveritis.
So inferior to the uh inferior to the spheroitis you'll have the nasal cavity interior to it you'll also have nasal cavities at the posterior ethmoidal cells and laterally you'll have the convertitis at the cranial cavity uh I don't think you're going to be asked these but you need to be able to pick it up on a on a lateral view uh of a radiology scan. Okay so it's right here. How would you know? I'd also just look at the celotica right here. Okay.
And I just pick it up. It's the closest closest thing to the uh cranial uh cavity.
Okay. So, this is going to be your maxillary situs. It's the largest sinus, right? So, it's going to be your maxillary situs. This is going to be your hard pallet. And this is going to be your orox.
Okay? This again situs. This is your nasoperics. Okay? And this is the turbinate. Now why is this not the oro ferex? Because you know this is the hard pallet, right? This is the hard pallet.
I've moved down the the nasal area. So I'm at the oro ferex. However, here I still can see the nasal structures. So this is going to be the nasoperics.
Okay, this is the globe. This is the eye right here. Uh then here you have the nasal septum. Okay, if you can actually see it's a bit deviated to the left. All right. Here this is your ethmoidal situs. This is your spheroid situs. And this is your clus right here. Okay.
Then this is the turbinet.
This is bilillary. You can see here it's opacified. This patient can have susitis actually. Okay. Then you have the uh lateral lamina of the tyroid process.
Here you have the nasoperics. This is your C1. And this is the targoary fissure that takes the taro palati fossa to infroral fossa.
Okay.
All right. This is your spheroid situs.
This is the uh middle turbinet. This is the inferior turbinet. Okay. This is uh your zygomatic arch. Okay. Uh this is the mandible. Okay.
This is your frontal lobe. All right.
This is the superior oblique muscle right here. And then you will have the optic nerve right in the middle. I don't know if you can see that there's a bit of uh hyper density here. This is going to be your optic nerve. Then you have lateral rectus, medial rectus, inferior rectus, and then you'll have the zygomatic arch. And then you have your heart pallet. And this is going to be your middle and inferior uh turbinets here. This is going to be your frontal sinus because it's you know within the uh cranium right? So frontal sinus nasal bone and this is going to be the nasal cavity and this is going to be the teeth.
Okay.
And again it's another picture. So this is the nasal bone. I think this could be part of the perpendicular plate of the ethmoid. Right. This is going to be the vulmer frontal sinus. All right. Uh could be ethmoidal sinuses. All right.
And then here you'll have the tongue.
Okay. So yeah.
Now this is your frontal sinus again.
This is your spheroid sinus. And this is your hypothesial fossa or like celotica.
This is your cleav. And this is your nasop. This is your uh this is your nasoperics actually. Sorry. This is supposed to be seven. Okay. I think this is the uh C1 structure.
Uh what structure does the star represent?
So the star actually represents the mastoid air cells. Okay. So if you can appreciate that this is the ear right here and this is the mastoid air cells.
Okay. Uh this is just another diagram showing the middle terminate, inferior terminate. All right. And the nasal septum right here. Okay. And the maxillary sinuses. All right. And this is the heart pallet right here. Just so that you can just appreciate uh the paradasal situses at the nasal cavity.
Okay. Now look here within the uh nasal structure. We have the opening of the station tube that connects it to the middle ear. And then we have something called Taurus tubarius. And then we have the fossa of frozen mer. Okay. Fossa of frozen muller basically is a posterior superior uh lateral recess of the uh you know uh nasal cavity. This is the most side most of nasoperial carcinoma.
Uh then you have the taurus tub tar taris. Okay. Here you have mucosal elevation antrolateral.
All right. So it's in front of the fossa of frozen mer. This is caused by the uh medial opening of the estacia tube. If this gets the get enlarged it will block the estacia tube and you can have something called conductive hearing loss. All right. And then we have something else called the adenoids.
Adenoids basically are lymphoid tissue that make up the posterior superior wall.
Okay.
Uh if you can see these are these are the adoids right here. Now if the addoids actually get enlarged, okay, it's going to uh compress uh and basically decrease the space of within the the the nasoperics. You're going to have uh snoring, apnea, recurrent infections and usually this is seen in patients who have lymphoma.
Okay, this is just uh different scans just that you can appreciate the uh the nasal cavity and you can also appreciate the larynx uh and the hyoid bone at different levels. So here you can see the mandibular condile the nasoperex and then we go then this is the hyoid bone.
All right, this is your jugular veins on the side. Okay. And then you move just below the hyoid, you'll find that your thy thyroid cartilage, your vocal cords, and this big chunk of muscle is called the sternoclytoid.
Okay.
So this is your hyoid bone. Okay.
Now areas could be superglottic, glottic or subglottic depending on where the vocal cords are. So at the hyoid bone level this is the superglottic area.
Here you can find the jugular veins. If you actually go back here you can find the jugular vein the valicula the perform sinus common corroded arteries.
Okay. So basically it the thyroid cartilage. So at the level of the thyroid right here you can find the true vocal cords sternoclytoid.
Okay. and and the cric cricoid criccoid cartilage which is the subclordic area.
All right here you'll find that tracheosphial groove ccoid ring and the ovalshaped airway lumen. Okay, ovalshaped airway lumen. All right, the thyroid cartilage. You can also see the sternoc clut sternoclytoic muscle. Okay, play the zygomatic magillary uh complex fractures. So when you have a fracture, okay, that involves the magilla, the zygomatic arch, okay, it's called the zygomatico complex fracture, okay, has to involve three components.
So if you look carefully about you will have a fracture to your zygomatic arch.
You will have uh a fracture to the inferior orbital rib and the posterior sinus wall. So right here okay and you'll also have a lateral orbital rib uh you know fracture. Okay. Mechism basically they will tell you in the question that there was a direct blow or trauma to the cheek. Okay. And basically here you would have to do a CT so that you can assess the the body landmarks of the orbit and see if there are any fractures or not. Okay.
Uh so these last couple slides are just uh like clinical radiology. So first we have croo happens from par influenza.
Okay. Uh and usually we see what we call the steeple side. So if you look here this is a steeple side and it also looks like an a wide bottle side or like an inverted V side. Okay. So this is something that you'll see on an AP radioraph.
Uh usually this is found within the subglottic area. So you'll have subglottic edema. you'll have hypoparagial deviation and distension as well. All right. So these are very important for you to to to pick up. So if if we're having subglottic edema, what will happen to the uh to the airway resistance? It's going to increase.
That's why these patients are going to present with inspiratory strider. Okay?
So that's very important to know. You don't really don't need to know the management, but I just put it here. Just for the sake of completion and corticosteroids we give bibilize adrenaline and supportive care. Okay.
Uh now what is this? Can you pick up what's that right here? Looks like a thumb, right?
Looks like a thumb. This is epiglatitis which is in the super glotus area. All right. It's very common in children who have etch influenza infection. All right. If it's more in adults, then it's going to be streptoco.
Okay. Thump sign very very high yield.
Okay. Uh and that's pretty much it for the epiglatitis.
Then Graves disease. Uh so I I don't think that you guys are actually going to be questioned about this. However, the takeaway from this slide is that you need to know that your thyroid is going to be enlarged, right? And with that you'll have something we call grace ofopathy. Okay. Where the extra uh ocular muscles are going to get enlarged. Okay. And because they get enlarged because of this hyperactivity in the body they get enlarged, right?
They're going to they're going to present with uh exothalamus where the eye is basically protruding. So it's called proptosis. Okay. And with time because of that proptosis you know at this extraocular muscle enlargement the patient could have optic nerve compression and could have visual loss.
Now something very important let's say we treated the Graves disease and the patient thyroid levels are back to normal everything is normal and all that will graves of thalopathy go away no because these muscles are going to be enlarged permanently okay uh basically that's really the takeaway from this slide uh juvenile nasoperial edify this is a bid nasoperial tumor okay within the nasoperics happens only in adolescent males. It's a very very highly vascular tumor. So you do not do a biopsy in it. Okay? Because uh you know it can lead to bleeding. How will the patient present? He's going to have multiple recurrent epistaxis, nasal obstruction and a nasal mass. Okay. And if you remember I mentioned that it's originates within the sphino palatide for okay now if you look here this is how uh you know a juvenile laserial adifro is going to look like. Okay literally you have this feno peli form is somewhere here originating from there and it you know penetrates all the way into the nasoperial cavity.
Okay, forward bodies. Uh again, for forward bodies, you'll do an X-ray.
Okay, and basically this slide is just to show you how they will look like on an X-ray. And where uh you know, where would they be commonly lodged? Okay, so in the tonsils, you know, needles are going to be lodged in there at the base of the thong probably needles, fishbone as well, perform fosa, bones, needles, and dentures. But within the esophagus, which is the most common, you'll have coins, uh, food, safety pins. All right.
However, the takeaway is that they're going to look like this. And you do an X-ray. Okay. Lastly, we have here the orbital cellulitis. So here you can you can appreciate, okay, the hyper density in this area. Okay. Usually orbital cellulitis is due to ethmoidal sinusitis. Okay. Most common uh and you can hear like see that there's proptosis as well because you know they're not like lining similarly.
Uh and then from orbital cilitis you can also develop orbital absis. Okay orbital abapsis if you can see it is within the intraodonal collection. So it's going to be a true intraconal collection rib enhancing on CT and MRI and because it's within the intraal you know the optic nerve is there so you can have visual loss all right so how does it spread we have from the sinositis to the labricia to the orbit optic nerve criopform plate and it could go intracradially if it goes incraially you can have brain absis as I mentioned Remember the clinical scenario, brain absis, rim enhancing mass with vasogenetic edema.
All right. And this thick shaggy wall of the uh of the mass. All right. And it can cause seizures because it's at the temporal lobe.
Then we have something called the subostial abapsis. The subostial absis is basically uh a crescentic. All right.
Microsentric hypodens collection along the medial wall of the orbit on the medial wall. Okay, so it's also right here if you can appreciate it.
Okay, it's uh it's a chetic hyperdense collection along the medial wall of the orbit between the lab preci and the perior orbital. And with that I conclude my session. Thank you so much. Uh I apologize for my voice. I I was pretty sick and uh I wish you all the best for your exam and uh you're one exam away from being third years and uh wish you all the best. If you have any questions, please feel uh feel free to reach out to me at any time and uh please scan the barcode and uh leave me a nice review.
Thank you so much and uh have a good day.
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