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Embryology
Charts below list all the arches and pouches and important structures associated with them.
ARCH
First
(mandibular)
NERVE
Trigeminal (CN V)
MUSCLES
Muscles of mastication
Mylohyoid and anterior belly of
digastrics
Tensor tympani
Tensor veli palatine
Muscles of facial expression
Stapedius
Stylohyoid
Posterior belly of digastrics
Second (hyoid)
Third
Stylopharyngeus
Cricothyroid
Levator veli palatine
Constrictors of pharynx
Intrinsic muscles of larynx
Striated muscles of esophagus
SKELETAL STRUCTURES
Malleus
Incus
LIGAMENTS
Anterior ligament of
malleus
Sphenomandibular
ligament
Stapes
Styloid process
Lesser cornu of hyoid bone
Upper part of body of hyoid
bone
Greater cornu of hyoid bone
Lower part of body of hyoid
bone
Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Corniculate cartilage
Cuneiform cartilage
Stylohyoid ligament
PHARYNGEAL
POUCHES
First
DERIVATIVES
Second
Third
Fourth
Formation of tubotympanic recessthe expanded distal part of recess contacts the pharyngeal groove to later contribute to
form the tympanic membrane (eardrum)
The cavity of the tubotympanic recess becomes the tympanic cavity and mastoid antrum
The connection of the tubotympanic recess with the pharynx gradually elongates to from the pharyngotympanic tube (auditory
tube)
Obliterated as palatine tonsil develops
Part of cavity of pouch remains as tonsillar sinus/fossa
Endoderm proliferates and grows into the underlying mesenchyme..the central parts of these buds break down forming tonisllar
crypts
At ~20wks, mesenchyme around crypts differentiates into lymphoid tissue, which soon organizes into the lymphatic nodules of
the palatine tonsil
Expands and develops a solid, dorsal bulbar part and a hollow, elongate ventral part
It connection with the pharynx is reduced to a narrow duct that degenerates
By wk, the epithelium of each dorsal bulbar part of pouch begins to differentiate into inferior parathyroid glands
The epithelium of the elongate ventral parts of the pouch proliferates, obliterating their cavities
Both come together to form the thymus
The developing thymus and the parathyroid glands lose their connects with the pharynx
Later, the parathyroid glands separate from the thymus and lie on the dorsal surface of the thyroid gland
Expands into dorsal bulbar and elongate ventral parts
Its connection with pharynx is reduced to a narrow duct that degenerates
By wk, each dorsal part develops into a superior parathyroid gland, which lies on the dorsal surface of the thyroid gland
II.
III.
a. Development of laynx. Larynx cartilages (thyroid, cuniform, corniculate, arytenoids and cricoids cartilages ) derive from
mesenchyme of the IV pharyngeal arch
b. Epiglottis derives from cephalic part of the hypobranchial eminence or it may form by migration of mesenchyme into the
area of the IV arch
c. Muscles from arch IV: Pharyngeal constrictor, levator veli palatine and cricothyroid muscles. These are innervated by the
superior laryngeal branch of the Vagus nerve (CN X)
d. Intrinsic muscles of the larynx are derived from the paraxial mesoderm of the and occipital somites associated with arch
VI. These muscles are innervated by recurrent laryngeal branch of the Vagus nerve
2. Innervated by CN X: Vagus nerve. Has sensory and motor components. Arch IV innervated by superior laryngeal branch and
Arch VI innervated by recurrent (inferior) laryngeal branch.
Development of the face
a. Occurs between the and embryonic/fetal weeks.
b. The five processes must fuse in consort
i. Frontonasal process: prominence.
1. Nasal placodes (nasal discs, nasal plates)
2. Nasal pits develop during week
ii. Lateral nasal processes (2) fuses with maxillary swelling to produce nasolabial fold. Depression in the depth of the fold is called
nasolacrimal groove. Tears come out of here when someone cries hard. Further invagination of the cleft produces a tube like structure
called nasolacrimal duct (maxilla)
iii. Medial nasal processes (2). Fusion of the two forms the septum of nose and the bridge of the nose. When the tips of the medial nasal
process fuse, the intermaxillary process (premaxilla) develops and helps form the philtrum of the lip. The posterior extension of the
intermaxillary process forms the primary palate. When the septum fuses with the hard palate, the nasal cavity is portioned into two
chambers, which communicate posteriorly with the region of the oropharynx via passages called choanae.
iv. Maxillary processes (2) swellings. The secondary palate arises fom palatine shelves (processes of the maxilla). The medial part of the
maxillay continues to assist in the development of hard palates. After completion of the fusion of both secondary palates, and subsequent
endochondral ossification of the anterior part of the secondary palate, both the hard and soft palates form.
v. Mandibular processes (2) swellings: The lower lip develops by fusion of the distal extent of the mandibular swelling. The embryonic
stomatodeum (mouth) is formed by rupture of the bucco/oropharyngeal membrane.
c. Clefts-located between the pharyngeal brachial arches.
i. Cleft 1 develops the external acoustic meatus
ii. Clefts 2, 3 and 4 normally degenerate and are obliterated. Failure to do so can lead to development of brachial cysts or fistulas located
anterior to the sternocleidomastoid muscle.
d. Pouches- invagination of the endodermal lining forms these.
i. Pouch 1: Tubotympanic recess and tympanic cavity
ii. Pouch 2: palatine tonsils
iii. Pouch 3: thymus gland, inferior parathyroid glands
iv. Superior parathyroid glands
II.
Neurulation
a. NS development is initiated in the fourth week of gestation (22- day)
b. Nerve tissue is derived from surface ectoderms of the neuroepithelium (neuroectoderm)
c. Neuroectoderm on the dorsal surface of the embryo produces the neural plate.
d. The neuroectoderm of the neural plate forms a neural groove.
e. On the outside of the neural plate are the neural crest cells (stem cells of the NS). These migrate and form many things, like the ganglia,
ordontablasts in teeth, chromaffin cells in the adrenal medulla. Formation of the ganglia is the most important function. Ganglia are a population
of neurons that have the same cytoarchitechtonics and function.
i. From the neuroectoderm of the neural tube
ii. All the sensory ganglia of spinal and cranial nerves.
iii. All autonomic motor ganglia throughout the body, i.e.,postganglionic motor neurons.
iv. The chromaffin cells of the adrenal medulla
v. Some of the cartilage and skeletal muscle of the head region.
f. The neural groove becomes the neural tube on the day. Occurs via fusion.
g. Neural tube forms the spinal cord and the cephalic portion of the tube develops into 3 primary brain vesicles
i. Proencephalon: forebrain. Undergoes transformation into two secondary vesicular structures
1. Telencephalon (end brain) cerebrum, CN I, lateral brain ventricles and basal ganglia.
2. Diencephalon (interbrain. Connects the telencephalon with the rest of the brain) thalamus, hypothalamus, optic chiasm and CN
II.
ii. Mesencephalon: midbrain. Forms the tectum, CN III (oculomotor nuclear complex), CN IV (trochlear nucleus and nerve, red nucleus,
cerebral aqueduct, periaquiductal gray, substantia nigra and the locus ceruleus). Also has the cerebral peduncles that contain the
corticospinal tracts.
iii. Rhombencephalon: hindbrain.
1. Metencephalon pons, cerebellum, cerebellar peduncles, nuclei associated with CN V thru CN VIII and some of the fourth
ventricle.
2. Myelencephalon medulla oblongata which contains the nuclei associated with CN VII (in part) thru CN XII) and remainder of
the fourth ventricle.
The mesencephalon (midbrain), metencephalon (pons), and myelencephalon (medulla oblongata) form the brainstem.
Spinal cord development
a. Regions of the neural tube (embryonic cord)
III.
i. Marginal zone: the outermost region of the wall of the neural tube.
1. Contains axons of spinal neurons projecting to higher centers via tracts and pathways.
2. Also contain descending axons from higher centers that regulate the function of the spinal cord neurons
3. These neurons are first apolar and then form bipolar neurons (which are in the retina, cochlea). These neurons fuse with the DRG.
ii. Mantle zone: lies peripheral to the ependymal layer. It forms the grey matter.
1. Neuroblasts and glioblasts transform into mature cell population in the mantle layer.
2. These neurons transmit axons to higher and lower levels of the CNS.
iii. Ependymal zone: surrounds the central canal of the neural tube. Cells: neuroblasts, glioblasts and ependymal cells develop in this zone.
b. Development of the cells:
i. Neuroblasts transform into mature neurons.
ii. Glioblasts become CNS glial cells (astrocytes and oliogodendrocytes)
iii. Microglia are derived from mesoderm and migrate into the embryonic CNS tissue via the blood supply.
iv. Ependymal cells line the walls of the canal of the neural tube and the ventricles of the developing brain.
c. Neurons in the ventral gray matter occupy the basal plate, which becomes the ventral grey horns of the spinal cord.
i. Axons from the neurons in the basal plate exit the cord and from the alpha motor neurons of the peripheral nerves. These are the LMN.
d. Motor components of cranial nerves are also derived from basal plate neurons
i. The sulcus limitans is a depression in the lateral wall of neural canal and brain ventricles. It separates the alar plate neurons from basal
plate.
e. The alar plate of grey matter are located doroslaterally and form the dorsal grey horns.
i. Alar plate neurons are sensory. They receive input from the cord and the brainstem via the cranial nerves.
ii. Cranial nerves that possess sensory components synapse with neurons derived from the alar plate.
f. The motor and sensory neuron populations of the spinal cord and brainstem are organized in a longitudinal axial array. The neuron population
continues rostrally into the brain stem.
Brain development
IV.
Development disorders
a. Spinal
i. Spinal bifida occulata
ii. Spinal bifida cystic
1. Meningocele
2. Meningomyelocele
3. Myeloschisis
4. Anecephaly (meroanecephaly)
b. Brain disorders
i. Meroanencephalyfailure to have brain form porperly
ii. Microencephaly-small brain, small head
iii. Hydrocephalus-plug up cerebral aqueduct. Lateral ventral and ventral
1. Aqueductal stenosis
iv.
Meningoencephalocele
v.
Meningohydroencepalocele
vi. Arnold - Chiari Malformation
ANATOMY
Outline for anatomy of the superficial face, triangles of the neck and cervical fascia
I.
II.
Facial innervations
a. Trigeminal nerve (CN V): cutaneous innervations of the face and part of the scalp refer to sensory supply provided by one of the three divisions of
the trigeminal nerve: ophthalmic division (CN V1), maxillary division (CN V2) or mandibular division (CN V3). Dermatomes: area of skin
innervated by the sensory component of a cranial nerve or spinal nerve.
i. Ophthalmic division: supplies eyeball (afferent limp-blink reflex), supraorbital region (forehead, frontal sinus pain) and the scalp.
1. Supraorbital and supratrochlear branches of CN V1 supply the scalp up to the vertex of the skull
2. External nasal branch of the nasociliary nerve supplies the bridge of the nose.
3. Lacrimal nerve supplies the lateral and superior region of the orbit.
ii. Maxillary division: supplies infraorbital region, including the lower eyelid, lateral nasal area and the upper lip
1. Infraorbital nerve with its lateral nasal and superior labial branches is primarily involved
2. Zygomatic branch of CN V2 supplies the zygomatic facial and zygomaticotemporal regions of the head.
iii. Mandibular division: sensory component supplies the skin of lower lip, the chin via the mental nerve (which is a continuation of inferior
alveolar nerve) and temporal region of the scalp. The motor component supplies muscles of mastication.
b. Facial nerve:
i. banchiomotor components of facial nerve (SVE: special visceral efferent component. Innervates facial expression muscles that derived
from brachial arch.
1. Pathway
a. Origin: facial motor nucleus in the brainstem (pons).
b. Exits brainstem at inferior pontine sulcus. Joins CN VIII and enters the internal acoustic meatus of the petrous temporal
bone. Travels in the facial canal of temporal bone.
c. Exits the skull at the stylomastoid foramen. Divides within the parotid gland to supply the muscles of facial expression.
Nerve to the stapedius m. is given off while the nerve travels through the facial canal. Contraction of the stapedius m.
dampens the oscillations of the stapes.
d. Dysfunction of the branchiomotor (SVE) component of CN VII can result in Bells palsy and hyperacusia.
i. Bells palsy: ipsilateral hemifacial paralysis. Flattened nasolabial fold. Saliva dripping from the corner of the
mouth. Conjunctivitis (failure to close eyelid and reduced lacrimation). Structures affected: facial nucleus in the
pons or the infranuclear lower motor neuron distribution. Due to inflammation, viral etiology or facial trauma.
2. Branches
a. Temporal branch: Supplies the frontalis part of the occipitofrontalis m.
b. Zygomatic branch: Supplies the orbicularis oculi and frontalis mm.
c. Buccal branch: Supplies the orbicularis oris and other perioral mm.
d. Marginal mandibular branch: Supplies the platysma and perioral mm.
e. Cervical branch: Supplies the platysma m.
f. Posterior auricular branch: Supplies the auricular mm. and occipitalis part of the occipitofrontalis m.
III.
Muscles of facial expression: derived from brachial arch and is innervated by facial nerve (CN VII).
a. Occipitofrontalis muscle: Frontalis connected to occipital via aponeurotic sheath. Muscles get a dual nerve supply. Frontalis portion is indicator of
neuropathy, like Bells palsy.
b. Orbicularis oculi muscle: closes the eyelid. Weakness causes eyes to dry and can contribute to conjunctivitis.
c. Obicularis oris: surrounds the lips
d. Zygomatic major and minor: creates the nasolabial fold (crease) which flattens in facial paralytic states like Bells palsy and stroke.
e. Levator anguli oris muscle: elevates the angle of the oral cavity. if weak, will cause drooling of saliva from corner of mouth.
f. Buccinator muscle: assists with mastrication. Classificed as facial expression muscle because it originates from the brachial arch.
IV.
Arterial supply
a. External carotid: 8 major branches
i. Superior thyroid artery and superior laryngeal branch
ii. Ascending pharyngeal artery
iii. Lingual artery
iv. Facial artery
1. Ascending palatine br.--2. Tonsillar br.palatine tonsils.
3. Submental a. br.sublingual gland
4. Sup. and inf. labial aa. brs. Above and below lip
5. Angular br.comes up along lateral aspect of nose.
6. Anastomoses with the supratrochlear a. branch of the ophthalmic a. from internal carotid. If have issue w/internal carotid, can still
get flow from here. Anastomosis btwn external and internal carotid.
v. Posterior auricular artery
vi. Maxillary artery: major terminal branch of external carotid. Supplies blood to a wide area via the zygomaticofacial artery; this branch
supplies the superior and lateral orbital region and is derived from the orbital branch of the maxillary artery.
1. Inferior alveolar artery: sends a branch to the skin over the chin, known as the mental artery
2. Buccal branch: supplies the skin over the lateral cheek
3. Infraorbital artery: supplies the skin over the malar region of the face.
vii. Superior temporal artery: terminal branch of external carotid.
1. Transverse facial artery
b. Internal carotid artery
i. Ophthalmic artery: supplies all the structure in the orbit.
1. Supraorbital artery
2. Supratrochlear artery
V.
VI.
VII.
Venous return
a. Supraorbital vein
b. Ophthalmic vein
c. Infraorbital vein
d. Deep facial vein
e. Transverse facial vein
Lymphatic drainage
a. Forehead and temporal scalp region: parotid nodes superficial cervical nodes deep cervical nodes
b. Nose and upper lip: submandibular nodes superficial cervical nodes deep cervical nodes
c. Lower lip (central part): submental nodes superficial cervical nodes deep cervical nodes
d. Lower lip (lateral part): submandibular nodes superficial cervical nodes deep cervical nodes
e. Cheek: buccal (facial) nodes submandibular nodes superficial cervical nodes deep cervical nodes
f. Posterior scalp: occipital nodes deep cervical nodes
g. Posterior scalp: retroauricular (mastoid) nodes deep cervical nodes
Anterior cervical triangles
a. Boundaries
i. Anterior: midline plane
ii. Superior: lower boarder of the mandible
iii. Posterior: anterior border of the sternocleidomastoid
b. Submandibular Triangle -lower border of the mandible and the anterior and posterior bellies of the digatric mm. makes anterior and posterior
bellies.
c. Carotid Triangle -Omohyoid m, (muscle from hyoid bone to scapula) sternocleidomastoid m., and the posterior belly of the digastric m. contains
carotid arteries
d. Submental Triangle -Anterior bellies of the two digastrics muscles and the hyoid bone. Lymph node that takes lymph from tip of tongue and bring
it to node (which one?)
VIII.
Muscles
Origin
Omohyoid
Sternohyoid
Insertion
Superior belly: lower border of
hyoid lateral to sternohyoid
insertion Inferior belly:
intermediate tendon
Innervation
Action
Ansa cervicalis
Ansa cervicalis
Sternothyroid
Ansa cervicalis
Depresses/stabilizes thyroid
cartilage
Thyrohyoid
Elevates larynx;
Depresses/stabilizes hyoid bone
Outline for boundaries of the temporal fossa, parotid region and TMJ
I.
Temporal fossa
a. Boundaries
i. Superior: superior temporal line of the skull
ii. Anterior: frontal process of the zygomatic bone and zygomatic process of frontal bone
iii. Inferior and lateral: zygomatic arch of the skull
iv. Floor: frontal, sphenoid, parietal and temporal bones
b. Contents of the temporal fossa
i. Temporal fascia:
1. Extent: from the superior temporal line of the skull continuing inferiorly to envelope the external surface of the temporalis muscle.
It terminates by attaching to the zygomatic arch.
2. Clinical relevance: the temporal fascia may help to contain the spread of infections by confinement to the region of the temporal
fossa.
ii. Temporalis muscle: muscle of mastication
1. Origin: from the floor of the temporal fossa and temporal fascia.
2. Insertion: the coronoid process and the anterior border of the ramus of the mandible.
3. Nerve supply: deep temporal nerves from the anterior division of CN V3.
4. Action: elevates and retracts the mandible.
iii. Nerves
1. Motor:
a. Temporal branches of CN VII (facial nerve) to frontalis portion of occipitofrontalis and auricular muscles.
b. Deep temporal nerve temporalis muscle
2. Sensory
a. Auriculotemporal nerve from the posterior division of CN
i. Causes severe headaches associated with temporal arteritis, a severe disease. The eyeball is supplied by the
ophthalmic artery, but inflammation in the superficial temporal artery can occur concurrently in the ophthalmic
artery because of common vascular origin. If temporal arteritis is left untreated, it can lead to blindness. Affects
patients over 60 and those who have elevated sedimentation rates. Treat with steroidsprednisone.
b. Zygomaticotemporal nerve from CN
c. Greater occipital n. (dorsal ramus, C 2)
d. Lesser occipital n. (ventral ramus, C 2 - C 3)
iv. Arteries
1. Superficial temporal artery: major terminal branch of external carotid. Main supply to scalp.
2. Deep temporal arteries from the maxillary artery. Supplies the temporalis muscle.
v. Anastomoses
1. Anterior: supraorbital artery (branch of ophthalmic) joins with superficial temporal artery.
II.
III.
2. Posterior: posterior auricular artery (branch of external carotid) joins the superficial temporal artery.
vi. Lymph drainage
1. Anterior Drainage : lymph drains to parotid nodes superficial cervical nodes deep cervical nodes
2. Posterior Drainage: lymph drains to mastoid (retroauricular nodes) superficial cervical nodes deep cervical nodes
Parotid region
a. Boundaries
i. Anterior: Ramus and angle of the mandible, masseter and medial pterygoid mm.
ii. Posterior: External acoustic meatus of the temporal bone and sternocleidomastoid m.
iii. Medial: Posterior belly of the digastric m., stylohyoid m., and the sphenomandibular ligament
b. Contents
i. Parotid facia
1. Great auricular nerve terminals
2. Stylomandibular ligament
ii. Parotid gland
1. Superficial portion
2. Retromandibular portion
iii. Anterior auricular/parotid nodes
iv. Parotid duct
1. Crosses masseter muscles
2. Accompanies transverse facial nerve
3. Pierces buccinators muscle
4. Enters mucosa of the vestibule of the mouth lateral and superior to the second molar of the maxilla.
v. External carotid artery
vi. Superficial temporal artery
vii. Transverse facial artery and vein
viii. Posterior auricular nervestylomastoid branch
ix. Maxillary artery
x. Retomandibular vein
xi. Great auricular n.
xii. Facial n.
xiii. Auriculotemporal n. (CN posterior div.)
xiv. Postganlionic parasympathetics of CN IX from the otic ganglion utilize the auriculotemporal n. to reach the parotid gland.
xv. Postganlionic sympathetics from the superior cervical ganglion course through the parotid gland with the carotid vessels.
Temporomandibular joint (TMJ)
a. Compound synovial joint. It possesses an intervening articular disc which divides the synovial cavity into superior and inferior compartments.
b. Classified as a condylar joint, but it is truly an ellipsoid joint capable of producing a pivotial hinge type sliding and gliding action
c. Establishes articulation between the condyle of the mandible, the mandibular fossa and the articular tubercle of the temporal bone.
d. Stabilized by
i. Articular (fibrous) capsule
ii. Articular disc
iii. Lateral ligament
iv. Sphenomandibular ligament
v. Stylomandibular ligament
e. Muscles acting on the TMJ: muscles of mastication
i. Temporalis muscle: elevates and retracts mandible (closes the jaw)
ii. Lateral pterygoid muscle: protrudes and depresses the mandible (opens the jaw)
iii. Medial pterygoid muscle: elevates and protrudes the manbile (closes the jaw)
iv. Masseter muscles: elevates, protrudes and retracts the mandible (closes the jaw)
f. Innervations:
i. Auriculotemporal nerveprimary supply
ii. Branches from the mesenteric nerve: derived from the anterior and posterior division of the mandibular division of the trigeminal nerve.
iii. Facial nerve branches cross the joint
g. Blood supply:
i. Superficial temporal artery
ii. Branches of the maxillary artery.
iii. Parotid lymph nodes
I.
II.
Scalp
a. Layers of the scalp
i. Skin: stratified squamous keratinized
ii. Connective tissue: collagen
iii. Aponeurosis (galea aponeuroticaconnects the muscles that make the occipitofrontalis (epicranius)
iv. Loose connective tissue layer
v. Periosteum of cranial bones
b. Arterial supply
i. External carotid branches
1. Superficial temporal artery
2. Posterior auricular artery
3. Occipital artery
ii. Internal carotid ophthalmic artery
1. Supratrochlear artery
2. Supraorbital artery
3. Zygomaticotemporal artery
c. Venous return
i. External jugular vein
ii. Emissary veins drain the diploe (marrow) of flat bones of the skull. Superficial drainage
iii. Dipole is also drained by diploic veins to the venous dural sinuses. Deep drainage.
Skull
a. Components
i. Cranium
1. Neurocranium: skeleton surrounding the brain
2. Viscerocanium: skeleton of the face
3. Calvaria: skull cap-the flat bones of the skull
4. Cranial base: inferior aspect of the skull
ii. Mandible (jaw bones)
b. Bones: 22 bones of the adult skull
i. Unpaired (6)
1. Mandible
a. Condyle
b. Coronoid process
c. Mental process (protuberance)
d. Mental foramen
e. Mandibular foramen
f. Lingula
2. Vomer: flat bone. Medial nasal septum
3. Frontal
a. Squamma (flat)
b. Supraorbital margin and foramen
c. Glabella --importance in strokes, reflex testing is hyperactive. It is between the supraorbital arches.
d. Fontal sinuses
4. Ethmoid
a. Crista galli
b. Cribriform plate: sieve like plate (olfactory bulbs)
c. Perpendicular plate: helps form nasal septum
d. Orbital plate: delicate
e. Superior and middle nasal concha
5. Sphenoid
a. Greater and lesser wings
b. Sella turcica: contains pituitary gland (hypoglosseal foss)
c. Pterygoid process: pterygoid muscles originate here
d. Optic foramen (canal): allows passage of optic nerve and ophthalmic artery
e. Superior orbital fissure: CN 3, 4, 6, 5, 1, superior ophthalmic vein
f. Foramen rotundum: maxillary nerve palatine fossa
g. Foramen ovale: mandibular division of trigeminal
h. Foramen spinosum: middle meningeal artery
6. Occipital
a. Foramen magnum
b. Hypoglossal canal: anterior potion of basal portion of occipital bone
c. Occipital condyles
d. External occipital protuberance
e. Superior nuchal line
f. Inferior nuchal line
ii. Paired (8)
1. Palatine
2. Inferior nasal concha
3. Maxilla
d. Cranial cavities
i. Fossae: depressions
1. Anterior cranial fossa
2. Middle cranial fossa
3. Posterior cranial fossa
ii. Orbits: contain the eyeball and extraocular eye muscle
iii. Middle and inner ear structures in the temporal bone contain the ear ossicles and neuroreceptor organs.
iv. Nasal cavity - contain the chonchae, and olfactory epithelium
v. Paranasal sinuses - frontal, sphenoid, ethmoid, maxillary sinuses
vi. Oral cavity - hard and soft palate, teeth and tongue
e. Foramina, canals and fissures
i. Supraorbital notch (foramen): supraorbital nerve
ii. Infraorbital foramen: distal extent of maxillary from trigeminal nerve (infraorbital nerve)
iii. Mental foramen: distal extent of inferior alveolar nerve (mental nerve)
iv. Superior orbital fissure: superior orbital nerve
v. Inferior orbital fissure: inferior orbital (maxillary division)
vi. Infraorbital canal: ophthalmic artery
vii. Optic foramen (canal): optic nerve
viii. Ostium of the maxillary sinus
f. Skull passage
i. Incisive foramen (fossa, canal): between palatine shelves of maxilla and pre-maxilla
ii. Greater and lesser palatine foramina: posterior laterally on hard palate, passage of nerves and arteries from pteryigalpalatine fossa.
iii. Foramen ovale
iv. Foramen spinosum
v. Carotid canal
vi. Stylomastoid foramen: major blood supply to brain (vertebral-posterior vertebral and back of brain and internal carotid-pareital). Canal is
in the temporal bone.
vii. Juglar foramen: branchiomotor component of facial nerve
viii. Hypoglossal foramen (canal)
ix. Foramen magnum
x. Cribriform plate of the ethmoid bone
xi. Optic canal
xii. Superior orbital fissure
xiii. Foramen rotundum
xiv. Foramen ovale
xv. Foramen spinosum
xvi. Internal acoustic meatus
xvii. Jugular foramen
I.
II.
III.
Boundaries
a. Anterior: infratemporal portion and tuberosity of the maxilla
b. Superior (roof): infratemporal parts of the greater wing of the sphenoid bone and the temporal bone
c. Posterior: mandible and styloid process of temporal bone
d. Medial posterior: styloid process of the temporal bone
e. Medial anterior: lateral pterygoid plate of the sphenoid bone
f. Floor: open
Muscles of mastication in the infratemporal fossa
a. Lateral pterygoid muscle
i. Origin: lateral pterygoid plate of the sphenoid
ii. Insertion: articular disk of TMJ (capsule of TMJ) and neck of mandibular condyle
iii. Action: protrudes and depresses the mandible (opens jaw)
b. Medial pterygoid muscle
i. Origin; scaphoid (pterygoid) fossa, and pyramidal process of palatine bone
ii. Insertion: inner aspect of the mandible at its angle
iii. Action: elevates and protrudes the mandible (closes jaw)
Arteries
a. Maxillary artery (mandibular, portion)
i. Deep auricular aa.
ii. Anterior tympanic aa. : supplies part of the tympanic membrane
iii. Middle meningeal a.
iv. Accessory meningeal a.
v. Inferior alveolar a.: mylohyoid a. (muscles on the floor of the mouth)
b. Maxillary artery (pterygoid, portion)
i. Deep temporal artery (anterior and posterior)
ii. Arterial branches to masseter and pterygoid
iii. Buccal artery
c. Maxillary artery (pterygopalatine, portion)
i. Posterior superior alveolar a.
ii. Middle superior alveolar a.
iii. Infraorbital a.
iv. Greater (descending) palatine a.
v. Pharyngeal br.
vi. A. of pterygoid canal
vii. Sphenopalatine a.: principal blood supply to nasal cavity
IV.
V.
Veins
a. Deep facial vein
b. Pterygoid plexus of vein
c. Maxillary vein
Nerves
a. Mandibular nerve (CN V3)
i. Anterior division
1. N. to medial and lateral pterygoid mm.
2. N. to tensor veli palatini m.
3. N. to tensor tympani m.
4. Deep temporal nn.
5. Buccal n. (sensory)
ii. Posterior divison
1. Inferior alveolar n.
2. Mylohyoid n. (motor)
3. Recurrent meningeal n. (nervus spinosum): hangover
4. Lingual nerve
a. Chorda tympani nerve of CN VII is carried to the tongue and submandibular ganglion by the lingual nerve
5. Auriculotemporal nerve: headaches
iii. Chorda tympani n. (CN VII)
iv. Postganglionic parasympathetics from otic ganglion (CN IX)
v. Postganglionic sympathetics from the superior cervical ganglion via the deep petrosal nerves.
I.
II.
1. Spinothalamic tract
i. Pathway for pain and temperature
ii. Enters spinal cord and crosses to the opposite half immediately (within one or two spinal cord vertebral segments)
iii. Ascends to thalamus on the opposite side and then moves on to the cerebral cortex.
iv. Lesion to tract: loss of pain and temperature sensation contralaterally below the level of lesion.
2. Fasciculus gracilis and fasiculus posterior column
i. Pathways for proprioception, stereognosis and perception of vibration (conscious)
ii. Remains on the same side of the spinal cord and crosses over at the junction between the spinal cord and the brain stem.
iii. The synaptic area prior to crossing over is called the nucleus cuneatus (conveys info from the upper part of the body fasiculus
cuneatus) and nucleus gracilis (conveys proprioceptive info from lower part of the body fasiculus gracillis)
iv. Lesion of the posterior column results in decrease in conscious proprioception and sterognosis ipsilaterally below the level of the
lesion.
3. Pathway for light touch
i. Partly remains uncrossed until it reaches the level of the brain stem
ii. Partly crosses over at the lower level
iii. Light touch spared in unilateral spinal cord lesion because there is an alternative route.
b. Sensory tract: connects with the cerebellum (unconscious organ)
1. Spinocerebellar pathway
i. Unconscious pathway for walking and performing complex tasks subconsciously without having to think which joint to
flex/extend
ii. Remains ipsilateral because one side of the cerebellum connects with the same side of the body
iii. Lesion to the cerebellum produces ipsilateral malfunction.
iv. Cerebellum has three penduncles: superior (midbrain), middle (pons), and inferior (medulla).
v. Spinocerebellar enters the cerebellum via the superior and inferior peduncles
c. Motor tract: extends from the motor area of the cerebral cortex
1. Corticospinal tract: extends from the motor area of the cerebral cortex down through the brain stem, crossing over the same level as the
medial lemniscus (junction between brain stem and spinal cord).
i. Synapses in the anterior horn (motor gray matter) just prior to leaving the cord.
ii. Motor neurons above the synapse (which connect the cerebral cortex and anterior horn) are the UPPER MOTOR NEURONS
(UMN).
iii. Motor neuron beyond this level (peripheral nerve neurons) are the LOWER MOTOR NEURONS (LMN)
UMN
LMN
Spastic paralysis
Flaccid paralysis
No significant muscle atrophy
Significant atrophy
Fasciculations and fibrillations are not
Fasciculations and fibrillations present
present
Hyperreflexia
Hyporeflexia
Babinski reflex may be present
Babinski reflex not present
d. White matter contains: Ascending pathways: relay sensory information to the brain and Descending pathways: relay motor instructions down from
the brain
1. Dorsal columns (funiculus)
III.
IV.
V.
c. Nucleus dorsalis (clarks nucleus): origin of the dorsal spinocerebellar tract. Lamina VII (C8-L3).
Clinical considerations
a. Anacephaly: failure of neural tube to close at the cranial end. Maldevelopment of the brain. Incompatible with life
b. Spina bifida: failure of neural tube to close at the caudal end. Maldevelopment of the vertebrate.
1. Meningocele: protrusion of the membranes of the brain or spinal cord through a defect in the cranium or spinal cord.
2. Meningomyelocele: protrusion of the spinal cord and its membrane through a defect in the vertebral column.
Spinal cord: gray matter
a. Gray matter contains: Neuronal cell bodies and synapses
b. Anterior gray horn: Cell bodies of lower motor neurons
c. Dorsal gray horn: Axons of the sensory neurons
d. Dorsal root ganglion: Cell bodies of sensory neurons
II.
III.
I.
1. Blood supply
a. Middle meningeal artery (maxillary artery)
b. Accessory meningeal artery (maxillary artery)
c. Branches from lacrimal artery (ophthalmic artery)
2. Nerve supply
a. Trigeminal nerve
i. Branches of maxillary (CN V2)
ii. Branches of mandibular (CN V3)
iv. Posterior cranial fossa
1. Blood supply
a. Branches of the ascending pharyngeal arteries
b. Branches of the occipital arteries
c. Branches of the vertebral arteries
2. Nerve supply
a. Sensory from C1-C3 dorsal roots
v. Spinal cord: dura mater of the spinal cord forms the coccygeal ligament (filum terminale externum)
1. Blood supply
a. Meningeal branches of vertebral, intercostals and lumbosacral arteries
b. These enter the spinal canal via the intervertebral foramina
2. Nerve supply
a. Tentorium cerebella: tentorial nerve, branch of ophthalmic division of CN V (forms a tent between the occipital bone)
b. Autonomic nerves (sympathetic innervations of blood vessels) via superior cervical ganglion.
c. Spinal cord: recurrent meningeal nerves.
vi. Dural infoldings and sinuses: regions where the meningeal dura separates from the periosteal dura from infoldings including the falx
cerebri.
1. Venous sinuses: lined by endothelium. Large veins of brain drain into the sinuses and these veins may be torn by trauma to the
head causing subarachnoid or subdural hemorrhages.
a. Superior sagittal sinus: superior falx cerebri
b. Inferior sagittal sinus: inferior falx cerebri
c. Straight sinus: between superior and inferior sagittal sinuses at confluence of sinuses
d. Occipital sinus: inferior to confluence of sinuses
e. Transverse sinus: laterally from confluence of sinuses
f. Sigmoid sinus: continuation of transverse sinuses and extends as internal jugular vein as it passes exits the jugular
foramen.
g. Great cerebral vein of Galen extends to straight sinus to receive blood from the internal cerebral veins.
h. Cavernous sinus: can receive blood from ophthalmic veins and receives blood from olfractory vein.
i. Anterior and posterior intercavernous sinuses
II.
b.
c.
d.
e.
f.
g.
III.
IV.
ii. Symptoms
1. Fever headaches, and confusion.
2. More seriously, symptoms include seizures, rigidity and cranial nerve palsies.
3. After 1-2 weeks, the symptoms moderate, and the patient usually recovers without permanent problems.
I.
II.
III.
a.
b.
c.
d.
e.
f.
g.
IV.
V.
Frontal
Zygomatic
Maxilla
Lacrimal
Palatine
Sphenoid
Ethmoid
VI.
VII.
a. Arteries
i. Ophthalmic artery: most important. Gives off posterior cilliary arteries that cover the optic sheath of the eye (called the lamina proposa). If
this is infracted, one can go blind.
ii. Anastomosis: between the branches of the ophthalmic and the external carotid. Facial artery comes up as the angular artery. Establishes
anastomosis with the supratrochlear and supraorbital (from the ophthalmic artery)
b. Veins
i. Superior orbital vein drains into the venous sinus
ii. Inferior ophthalmic vein goes down to the canal and into the pterygoid plexus.
Motor units
a. Consists of an alpha motor neuron, its axons and all the muscle fibers it innervates.
i. Small motor units: recruited first
ii. Large motor units: recruited second
iii. Connecting a fast motor neuron to a slow muscle changes the muscle to a fast muscle (or vice versa) Cross innervation
b. Motor neurons determine if the muscle is a slow twitch or a fast twitch.
i. Slow twitch: red, high oxidative capacity and endurance fibers
ii. Fast twitch: white, glycolytic, explosive power, fatigable fibers
c. Destruction of alpha motor units
i. Weakness or paralysis flaccid (LMN)
ii. Muscle denervation syndrome
i. Atrophy of muscle decrease in the number of muscle fibers.
ii. Spontaneous contractions in muscles
1. Fasciculation: contraction of the entire bundle. Seen by the eye
2. Fibrillation: single muscle contraction that can be detected by an EMG
d. EMG
i.
Normal EMG: 2 alpha motor neurons controlling 5 individual fibers. Combined/integrated EMG from 5 action potentials.
II.
III.
IV.
V.
VI.
ii. Myopathic EMG: 3 of the 5 fibers die, so there is a less volume of individual fibers. Integrated EMG is less than A because there are less
spontaneous individual action potentials.
iii. Neuropathic EMG: only 1 neuron survived and it innervates the 7 muscle fibers. The EMG is larger because there are 7 individual action
potentials.
iv. In a resting condition, one can still see some noise on the EMG due to normal fasiculations and fibrillations, except in myopathic diseases
(no noise in EMG during resting conditions). Use an EMG to determine if its a neuropathic disease or a myopathic disease. If no EMG
noise during resting state, its a myopathic disease. Can also take a blood sample and test for levels of lactate dehydrogenase and creatine
kinase leaving the skeletal muscles; in myopathic disease, the levels of this enzyme is higher.
Spinal cord organization
a. Sensory input
i. Skin afferents: touch or vibration dorsal column via the fasiculus gracilis and cuneate thalamus somatosensory cortex.
ii. Proprioceptors (come form the muscles)
1. Spindle (Ia and II): I a senses changes in length and rate of the change in length. II senses a change in strength.
2. Golgi tendon organ (Ib): senses a change in tension and strength of the skeletal muscle during contraction.
e. Motor neurons
i. Alpha: controls regular skeletal muscle contraction
ii. Gamma: smaller and innervates the spindles. Has no direct effect on the skeletal muscle. Contracts the spindle to change the tension and the
length which causes an intrinsic stretch of type 1a and 2 fibers. External stretch occurs by stretching an actual skeletal muscle fiber.
f. Interneurons: more in number than alpha and gamma combined. Involved in inhibition of alpha motor neurons and sensory integration.
g. Summary of proprioceptors: outside there are extrafusal fibers (the regular skeletal muscle fibers which are innervated by alpha motor neurons) and
inside are the intrafusal fibers (which are innervated by gamma motor neurons). The muscle spindle is on the inside, which is where type Ia and type
II fibers are located. When muscle is stretched, these fibers are loaded. Type Ib fiber innervates the Golgi tendon organ.
Stretch (myotatic) reflex
a. Pathway
i. Hit the tendon stretch muscle load stimulates the type Ia and II fibers sends signal to afferent traffic sensor neurons in the DRG
sends signal to stimulate alpha motor neurons leads to muscle contraction.
ii. Ia directly innervates the alpha motor neuron and causes contraction of the muscle. At the same time, through the interneuron, there is
inhibition of the alpha motor neuron for the flexor muscles. Recriporacal innervations: activation of agonist and inhibition of antagonist.
Inverse myotatic reflex
a. Occurs when there is too much muscle tension that has developed and sensed by type Ib.
b. The Golgi tension organ sends a signal via the Ib fibers through the inhibitory interneuron to inhibit alpha motor neurons of the agonist.
c. Inhibitory interneuron simultaneously excites the alpha motor neuron of the antagonist.
Flexion (withdrawal) reflex
a. Regulated by the nociceptors (pain and temperature). A painful stimulus causes withdrawal reflex.
b. Ipsilateral: The excitatory interneuron activates the alpha motor neurons that supply the flexor muscles, thus causing a flexor contraction. The
reciprocal inhibitory interneuron inhibits alpha motor neurons that supply the anagonist extensor muscles.
c. Contralateral: commissural interneuron cross over and synapse at the alpha motor neurons to activate the extensors and inhibit the flexors for
stabilization.
Superficial reflexes
a. Plantar flexion reflex: response to scratching the surface of the foot. Babinski sign dorsiflexion of the toe. This reflex is present in upper motor
neuron damage.
b. Abdominal reflex: stroking skin below umbilicus produces contraction of abdominal muscles. This reflex is absent in upper motor neuron damage.
HISTOLOGY
Outline for histology of the eye
I.
3. Colorless and clear. Transparent due to unique fiber arrangement and continual pumping out of interstitial fluid.
4. Five layers
a. Corneal epithelium: nonkeratinized stratified squamous 5-6 cells thick, contiguous with the bulbar conjunctival
epithelium. Responsible for maintaining the transparency of the cornea because it is capable of transporting sodium ions
to their apical surface. This keeps the stroma in a dehydrated state.
b. Bowmans membrane: contains collage fibrils, no cells
c. Stroma: layers of collage, rich in chondroitin sulfate and few cells
d. Descements membrane: homogenous structure of fine collagen fibrils
e. Corneal endothelium: simple squamous epithelium. Responsible for maintaining the transparency of the cornea because
it is capable of transporting sodium ions to their apical surface. This keeps the stroma in a dehydrated state.
ii. Limbus (corneolscleral junction)
1. Transition between the transparent cornea and white sclera
2. Highly vascularized
3. Contains stromal layer, irregular endothelium-lined channels, and trabecular meshwork, merge to form the canal of Schlemm
which drains aqueous humor from the anterior chamber of the eye.
iii. Sclera
1. Posterior 5/ of the external layer of the eye.
2. Maintains the size and shape of the eye.
3. External surface appears grayish/white
4. Optic nerve exits posteriorly at the lamina cribrosa, where the sclera is reduced to a fenestrated membrane
5. Anteriorly it is covered by the bulbar conjunctiva
6. Posterioly it is covered by bulbar sheath called Tenons capsule.
7. Site of attachment of the rectus and oblique muscles
8. Demarcated from the choroid by the sparchoroidal lamina (thin layer of loose connective tissue rich in melanocytes)
b. Middle layer or Vascular Tunic
i. Choroid
1. Highly vascularized coat
2. Loose connective tissue rich in fibroblasts, macrophages, lymphocytes, mast cells, plasma cells, melanocytes and elastic fibers
between blood vessels.
3. Inner layer is called the choriocapillary layer rich in small blood vessels and has an important function in the nutrition of the
retina. Composed of fenestrated capillaries
4. The choriocapillary layer of the choroid is separated from the retina by a thin amorphous hyaline membrane called Bruchs
membrane.
ii. Ciliary bodies
1. An anterior expansion of the choroid that lies at the inner surface of the anterior portion of the sclera.
2. Contains the ciliary muscle which controls the curvature of the lens by exerting tension via the zonules.
3. Ciliary processes are ridgelike extensions of the ciliary body from which the zonules emerge.
4. Cells from the ciliary process actively transport certain constituents of plasma into the posterior chamber as aqueous humor.
5. Aqueous humor flows from posterior chamber, over the lens to the anterior chamber and drains at the trabecular meshwork
iii. Iris
1. Extends from the angle of the anterior chamber partially covering the lens, leaving a round opening in the center called the pupil.
c.
2. Anterior surface: spongy stroma (facing the anterior chamber) containing fibroblasts, collagen fibers and varying amounts of
melanocytes.
3. Melanocytes function to keep stray light from interfering with image formation and in the stroma of the iris is responsible for the
color of the eye.
4. Posterior surface: basal surface of the posterior cells attach loosely to the lens, anterior layer of the cells comprise the muscular
elements and make up the dilator muscle, controlled by the sympathetic nervous system.
5. Smooth muscle bundles disposed in concentric with the papillary margin from the sphincter muscle which is parasympathetically
controlled.
iv. Lens
1. Lens capsule: basement membrane, 10 20 microns thick, consisting mainly of collagen type IV, glycoproteins and heparan
sulfate proteoglycan
2. Subcapsular epithelium
a. Single layer of cuboidal epithelium
b. Present on anterior surface
c. At the equator, begin to elongate into fiber cells
3. Lens fiber cells
a. Elongated, highly differentiated cells derived from epithelial cells
b. Lose their nuclei and organelles
c. At maturation, 7-10 microns in length and contains primarily crystallins as proteins
Internal layer or Photoreceptive Tunic
i.
II.
Retina
1. Retina comprises the inner layer and consists of a posterior portion which is photosensitive; the anterior portion, which is not
photosensitive, constitutes the ciliary body and the posterior part of the iris.
2. The ora serrata is the point of demarcation for the anterior and posterior portion of the retina.
3. The layers of the retina:
a. Pigment epithelium columnar cells with a basal nucleus that serves a variety of functions in the retina, including
transport of nutrients from the choroidal blood vessels to the outer layers of the retina, removal of waste products from
the sensory retina, phagocytosis of shed photoreceptor disks, synthesis of basal lamina of Bruchs membrane and is
essential for the synthesis of the photopigment, rhodopsin because it converts trans-retinol into retinal.
b. Photoreceptor layer layer of outer segments of rods and cones
c. Outer limiting membrane functional complexes between Muller cells and the receptor cells
d. Outer nuclear layer cell bodies and nuclei of photoreceptors
e. Outer plexiform layer synapses between photoreceptors and bipolar cells
f. Inner nuclear layer layer of various nuclei, including Muller cells, and bipolar cells, also horizontal and amicrine cells
g. Inner plexiform layer synaptic region between bipolar and ganglion cells
h. Ganglion cell layer ganglion cells whose fibers form the optic nerve fiber layer
i. Nerve fiber layer axons (nerve fibers) of the ganglion cells
j. Inner limiting membrane formed as the basal lamina of Muller cell processes
Refractile media of the eye
a. Cornea
b. Anterior and posterior chambers-contain aqueous humor
c. Lens
d. Vitreous space-contains vitreous humor
Parts
i. Brain (cerebrum, cerebellum, brain stem) No CT in the CNS.
ii. Spinal cord
II. Nervous tissue
i. Location: distributed throughout body as an integrated communications network
ii. Function: to detect, analyze, integrate and transmit info generated by sensory stimuli and chemical or mechanical changes. Also to organize and
coordinate functions of the body
III. General function of neurons
i. Respond to stimuli by altering electrical potential differences across membrane, which can spread along the membrane to generate an action
potential (nerve impulse).
ii. Can be excitable or irritable.
IV. Classification of neurons
i. Bipolar neurons: have an axon and dendrite. Found in the retina, olfactory epithelium and acuostic ganglia.
ii. Multipolar neurons: have an axon and two or more dendrites. Found throughout the NS and autonomic ganglia.
iii. Pseudounipolar neurons: have single process which divides into two branches creating a T shaped structure. Found in the cranial and spinal ganglia.
iv. Afferent neurons: transmit signals from the periphery t o the CNS.
v. Efferent neurons: transmit signals from the CNS to the periphery.
vi. Interneurons: transmit signals within the area of the perikaryon (cell body, soma). These link neurons via synapses.
vii. Projection neurons: transmit signals to distant targets.
V. General structure of neurons
i. Perikaryon (neuron cell body):
a. Trophic center of the cell. It can also receive stimuli.
b. Ranges from 5-150 micrometers in diameter.
c. Contains nucleus and cytpoplasm. No processes.
d. Receives nerve endings which transmit excitatory or inhibitory stimuli from other neurons.
e. Nucleus is usually large and contains euchromatin. Also has a prominent nucleolus (cats eye).
f. RER is highly developed and well organized. The RER and free ribosomes appear basophilic (stain dark purple), called Nissl bodies.
g. Chromatolysis: reduction in the number of Nissl bodies due to injury to the neuron. The Nissl bodies dissolve.
h. Golgi complex found only in perikaryon.
i. Mitochondria abundant in the axon terminals because energy is required for transport.
j.
Neurofilaments are intermediate filaments with a diameter of 10 nm. These are found in the neuronal perikaryon and processes. These form
neurofibrils when tissue is stained with heavy metals, visible by light microscopy.
k. Contain 24 nm diameter microtubules that can be associated with microfilaments. Primary function is transport and mitosis. These help
transport material from cytoplasm to into the axon or dendrites.
l. Lipofuscin: appears light brown; accumulates with age in the cell bodies (age pigment). Lysomes break down RER and leave behind
lipofucin (brown vesicles). These are found in phagocyte cells.
m. Melanin granules: appear dark brown or black. Fount in perikarya of some neurons, particularly in substantia nigra of the midbrain. These
protect nucleus from UV light.
ii. Dendrites:
a. Extend as processes from the perikarya.
b. Elongated processes that receive stimuli from the environment. Takes information from the external environment back to the cell body.
c. Increase receptive capacity of the neuron. The more dendrites, the more receptive the neuron is.
d. Nissl bodies (RER and free ribsomes) are found in the dendrites, but not the golgi.
e. Neurofilaments and microtubules are aligned along the long axis of the dendrites.
f. Dendritic microtubules aid in transport of macromolecules to the distal regions
g. Dendritic spines (small protusions) receive synaptic contacts. These are found all over the surface of the dendrites. In the Purkinje neuron,
there may be one million spines.
iii. Axons:
a. Single process which generates or conducts a nerve impulse to other cells.
b. May or may not be myelinated. Myelinated axons conduct AP faster because of salutatory conduction (jump from one node to another)
c. Plasma membrane of the axon is called axolemma and cytoplasm is called axoplasm. The PM and cytoplasm of the axon is different than
that of the neuron perikarya.
d. Axon hillock is a conical elevation from which the axon originates from the perikaryon. Has no RER or free ribosomes in the axon.
e. Microtubules and neurofilaments arrange in bundles.
f. Initial segment: part of the axon between the hillock and the point at which it becomes myelinated. The membrane of the initial segment
has the lowest threshold of excitability. It is a site of nerve impulse initiation. Have synapses here.
g. Synapse can occur between one axon and a dendrite (axodendritic), perikaryon (axosomatic) or other axon (axoaxonal). It can also be
between two dendrites (dendrodendritic)
VI. Glial cells: cytoplasm of the glial cells stains the same as surrounding tissue. Only the nuclei is seen in a stain. These cells are very small.
i. Astrocytes:
a. Largest and most abundant glial cell. Large nuclei which stains light.
b. Star shaped or satellite cells that has many processes which terminate at blood vessels, nodes of Ranvier and the neuron cell bodies.
Function in ion transport; have K channels. Play a role in maintaining the ion concentration at the nodes of Ranvier.
c. Protoplasmic astrocytes found in gray matter. These cover non-synaptic neuronal surfaces. Have a clearer cytoplasm than fibrous
astrocytes.
d. Fibrous astrocytes: found in white matter. Can also be found in gray matter. Have a higher level of intermediate filament proteins, glial
fibrillary acidic proteins (GFAP) than protoplasmic. These proteins are used in immunocytochemistry to detect astrocytes in the brain. Take
an antibody which binds t the epitopes of the molecule. Another antibody which has a fluorescent molecule binds to the primary antibody.
It fluoresces when hit with light.
e. If the brain is damaged, astrocytes hypertrophy to fill up the empty space and prevent regeneration. It forms a scar or a plaque. Cells also
play a role in fluid transport by their investment of blood vessels.
ii. Oligodendryocytes
a.
b.
c.
d.
e.
Nuclei are round and smaller. Stain more dense than astrocyte nuclei
Abundant in the corpus callosum because this region is highly myelinated.
Oligodendrocytes become enlarged during myelination. In white matter, these cells are reduced in diameter.
Satellite-support cells. Sends processes that wrap around the axon to myelinate it.
Detected in the brain by immunocytochemistry for the presence of myelin (myelin basic protein-MBP and myelin associated glycoprotein
proteinMAG)
iii. Ependymal cell
a.
Cubodial or squamous cells that line the ventricles of the brain and the central canal of the spinal cord. The ependymal cells and the
underlying capillaries form the choroid plexus which produces the CSF. CSF is located in the central canal. Cells are covered in CSF.
b. Have cilia in order to move the CSF down.
c. Have long processes which extend into neural tissue. Can also be flattened epithelial cell shaped. Tanycytes: long process bearing cells.
These are most prevalent at the floor of the third ventricle.
iv. Microglia
a. Small, dense and elongated. Nuclei contains highly condensed chromatin and are small, bean shaped
b. Found in white and gray matter
c. Primary phagocytic cells. Arise from bone marrow stem cells. Contribute to formation of brain microphages.
d. Have short extensions and are thorn like (spiny appearance)
e. Lipofusin accumulates in these cells because the cells cant recycle the breakdown product anymore.
II.
i. In the CNS, it is composed of complex multi-lamellar sheath wrapped around axons to facilitate in axonal conduction (salutatory
conduction).
ii. There are tight junctions in the PM layers of myelin which serve an adhesive function maintaining the compaction of myelin. These are
also important in proliferation and migration of progenitor cells which are destined to become oligodendrocytes.
iii. 30% is protein, 70% is lipid.
1. Protolipid protein (PLP): found in the IPL of compact myelin.
2. Myelin basic protein (MBP): found in the MDL.
3. Myelin associated glycoprotein (MAG): less than 1% of myelin protein. Role not understood, but it may be important in
remyelination during nerve regeneration and inhibit neurite outgrowth by neurons.
4. Enzyme 2, 3 cyclic neucleotide 3 phosphodiesterase (CNPase) makes up 2% of CNS myelin protein. Not restricted to nervous
tissue and function not determined.
c. Process
i. Axon becomes enclosed by the process of the oligodendrocyte. The process envelopes the axon and its lips come together to form the
mesaxon. Pocess wraps around the axon in a spiral fashion, one wrap inside the next.
ii. Compaction: as wraps increase, the cytoplasmic face of the PM of each side of the process becomes positioned close together to form the
major dense line (MDL). MDL formation is essential. If MDL doesnt form or lacks myelin basic protein (MBP), myeline will become
loosely wrapped around the axon. Find tight junctions here. MDL is the darker line.
iii. Areas of normal myelin (loops, incisures) which are not compacted allow for transport of newly synthezied myelin components from the
oligodendrocytes to the myelin proper.
iv. Outer face of the PM of the processes are in close apposition and form the intraperiod line (IPL)
d. Multiple sclerosis
i. Autoimmune disease that leads to nerve fibers becoming devoid of myelin. Myelin is stripped from the axons by the macrophages. MS
patients have antibodies to myelin proteins within their CSF.
ii. MS plaque: spaces created by the loss of myelin is taken up by astrocytic processes (astrocytic hyperplasia or hypertrophy). The plaque
stains immunocytochemicallly for glial fibrillary acidic protein (GFAP)
Synapses
a. Allow individual nerve cells to connect with one another. Occurs on neuronal cell processes or bodies.
b. Axon expanded and contains vesicles containing neurotransmitters.
c. NTs are released into the synaptic cleft, an extracellular space between the pre and post synaptic neurons. The synaptic cleft is occupied by
proteins and mucopolysaccharides.
d. Its function is to limit transmitter diffusion, transport NTs and formation of receptor sites.
e. Postsynaptic membrane may be a dendrite, perikaryon, axon or muscle/gland cells.
f. NTs released from the vesicle can bind to pre or post synaptic membrane. It can inhibit or enhance activity.
g. Vesicles that hold Ach are usually clear and lead to excitatory transmission. Vesicles that hold norepi are dense staining.
III.
Spinal cord
a. Gray matter
i. Composed of primarily perikarya, unmyelinated axons, protoplasmic astrocytes, satellite oligodendrocytes and microglia.
ii. Located in the center H.
iii. Gray matter of ventral bars forms the anterior horn which contains large motor neurons whose axons form the ventral roots of the spinal
nerves.
iv. Gray matter of the dorsal horns receives sensory fibers from neurons in the spinal ganglia dorsal roots.
v. Horns: continuous columns which extend up and down the spinal cord.
b. White matter
i. Composed of primarily myelinated axons, fibrous astrocytes, oligodendrocytes and microglia.
ii. Located in the periphery.
c. Central canal
i. Remnant of the lumen of embryonic neural tubes which are lined by ependymal cells that have cilia, and microvilla. These extend up and
down the spinal cord.
IV.
Cerebellum
V.
a. Outer layer is made of gray matter and the central core is made of white matter
b. 3 layers of the cerebellar cortex
i. Outer molecular layer: receives the dendrites of the Purkinje neurons
ii. Central Purkinje cells (molecular layer): Purkinje neurons
iii. Inner granule layer: receives axon of Purkinje neuron.
c. Purkinje neurons receive both excitatory and inhibitory impulses which arrive from the motor areas of the cerebral cortex. These neurons are flask
like cells and axons are myelinated.
d. Function: modulates and organizes the motor impulses to coordinate movement of muscle groups.
Cerebrum
a. Layers
i. Outer layer of gray matter: cell bodies of neurons
ii. Cortex: has glia and neurons which are pyramidal, stellate and spindle in shape. These cells are arranged in 6 layers.
1. Molecular layer: outer most layer. Has nerve fibers, processes and some neurons. Light staining because it has only few neurons
2. External granular layer: granule neurons (round neurons) and glial cells. Small layer.
3. External pyramidal layer: large pyramidal and granule neurons and glial cells.
4. Inner granular layer: granule neurons and some glial cells.
5. Internal pyramidal layer: medium sized pyramidal neurons and some glial cells.
6. Multiform layer (innermost) glial cells and neurons of various shape.
iii. Core of white matter: receives myelinated axons.
b. Function: sensory information is integrated, voluntary motor responses are initiated and coordinated. Cerebrum coordinates complex processes
such as language, learning and memorization.
II.
Components
a. Ganglia
b. Nerves
c. Nerve endings and organs of special sense
Nerve fibers
a. Axons surrounded by sheaths of cells of ectodermal origin (Schwann cells)
III.
b. Unmyelinated axons are enveloped by clefts of Schwann cells, but these axons have no Nodes of Ranvier.
c. Collagen is visible, unlike in CNS. CNS also has no basal lamina.
d. Arranged in bundles to form nerves.
Layers surrounding the nerve fibers
a. Epineurium: external fibrous coat that surrounds the peripheral nerve. Fills the space between nerve fiber bundles consisting of collagen,
fibroplasts and blood vessels. Surrounds neurofasicles. Provides structural suppor and elasticity to the nerve.
b. Perineurium: surrounds each nerve bundle (fascicle). Consists of flattened epithelial like cells. Cells are joined by tight junctions which protect the
nerve fiber from toxic macromolecules.
c. Schwann cells wrap each nerve fiber
d. Endoneurium: connective tissue layer consisting of reticular cells and collagen fibers. Surrounds the Schwann cells.
IV.
Myelination
a. Components
i. Schwann cells are the myelinating cells in the PNS. These have mitotic activity, unlike oligodendrocytes. These cells only myelinate 1
axon. These cells are immediately adjacent to axon.
ii. Neurilemma: each nerve fiber in the PNS is covered by thin cytoplasmic sheath of Schwann cells. Neurilemma is the outermost
cytoplasmic layer of a Schwann cell that surrounds an axon. Overlies the endoneurium.
iii. Group of unmyelinated fibers (small diameter axons) are surrounded by one Schwann cell at one point.
iv. Nodes of Ranvier seen between consecutive Schwann cells.
v. 30% protein, 70% lipid
1. Po glycoprotein is the major PNS myelin protein. This is a transmembrane protein that is found in MDL and IPL.
2. Myelin basic proteins (P1, P2, Pr) make up 20% of human PNS myelin. These are found in the MDL, as in the CNS. But these
are not essential in the formation of MDL in PNS myeline, unlike CNS, because of the presence of the Po glycoprotein.
V.
b. Process
i. Schwann process encloses many axons in a trough indenting its surface.
ii. After repeated mitotic events, the Schwann cell becomes segregated to 1 axon.
iii. Lips of the Schwann cell enveloping process extends around the axon in a spiral fashion forming the intraperiod line (IPL)
iv. Major dense line formed when the cytoplasm is lost in the spiraling process
v. Compaction: spiraling process increases and the lamellae of the sheath become more compact.
vi. Schmidth-lanterman cleft: areas of the myelin that do not compact. These areas allow transport and passage of newly synthesized myelin
components from the Schwann cell cytoplasm to the myelin proper.
Ganglia
a. A collection of nerve cell bodies outside the CNS
b. Surrounded by CT and each neuron cell body is surrounded by satellite cells, which are glial or supportive cells. Satellite cells are surrounded by
basal lamina.
c. Two types of nerve ganglia based on morphology and function
i. Sensory
1. Types:
a. Cranial: associated with the cranial nerves. Afferent nerves.
b. Spinal: associated with the DRG of spinal nerves. Afferent nerves.
2. Features:
a. The DRG has pseudounipolar neurons that send one thin process to the CNS and the other thick process passes to the
periphery.
b. Larger perikarya. Perikarya of neurons in the sensory ganglia do not receive nerve impulses so there are no synapses in
these ganglia.
c. Neurons have centrally located nucleus.
d. Nerve fibers are found in bundles and nerve cell bodies are grouped at the periphery of the ganglia.
ii. Autonomic
1. Distributed in both the sympathetic and parasympathetic divisions of the ANS.
2. Ganglia appear as bulbous dilations in the autonomic nerves.
3. Some found between the walls of muscles in the digestive tract (intramural ganglia). These are not surrounded by CT; instead they
are surrounded by the stroma of the organ. These ganglia in organs have few satellite cells.
4. Include submucosal plexus of Meissner and myenteric plexus of Auerbach
5. Multipolar neurons, that are star shaped. Small diameter.
6. Nucleus is round and eccentrically located. Cytoplasm has Nissl bodies.
7. Neuron cell bodies are surrounded by a layer of satellite cells. Cell bodies of neurons are not grouped, but are found between
scattered nerve fibers.